沈若兹乃郎。因痘后食物不节。病泻。泻久脾虚。病疟。遂尔腹痛胀大。三年来服消导药无算。腹胀及
泻利总不愈。去岁迎医。服参苓白术稍效。医去仍复如故。病本腹胀。更兼肠 。肠 者。大肠之气。空洞易
走。胃中传下之物。总不停留。 出无度。腥水不臭。十中五死五生之症也。今则病势转深。又加四逆矣。暮
热朝凉。一逆也。大渴引汤救急。二逆也。气喘不能仰睡。三逆也。多汗烦躁不宁。四逆也。无病患腹中之
气。运转收摄。是以身体轻快。大便省约。今为久泻。遂至气散不收。腹之胀。肠之鸣。便出之不自知。皆此
故也。气既散而不收。又服行气利水之药。不愈增其散乎。无病患身中营卫。两无偏胜。故阳胜则发热。阴胜
则恶寒。病疟之时。寒热交作。犹是阴阳互战。迨泻久亡阴。整夜发热。一线之阴。为阳所乘。求其相战。不
可得矣。内水亏竭。燎原之火自焚。不得不引外水以济急。然有形
之水。不足以制无形之火。徒增胀泻。而重伤其阴气耳。医不清其源。以香燥之药。助火劫阴。如官桂肉豆蔻
等类。用之误矣。夫男子气海在于脐下。乃元气之舍。性命之根也。久泻则真气亦散。势必上乾清道。而不下
行。鼻中鼾鼾有声。不能仰卧。是其征也。夫此已散之气。必不能复归其处。但冀未散之气。不致
尽散则可耳。屡服木香槟榔苏子腹皮浓朴等降气之药。尤误之误矣。至于汗出烦躁。则阴气虚尽。孤阳亦不能
久留之兆也。总如岁运。有温热无寒凉。有生长无收藏。人物能免夭札疵疠乎。于此而图旋转之功。亦难之难
矣。若兹见案。转托戚友。强恳用药。因以清燥润肺为主。阿胶地黄门冬等类同蜜熬膏三斤。渠
男三年为药所苦。得此甘味。称为糖也。日争十余次服之。半月药尽。遂至大效。身凉气平。不渴不
烦不泻。诸症俱退。另制补脾药末善后。全愈。
胡卣臣先生曰。久泻而用润药。与症相反。而究竟相宜。议病时先辟三种治法之误。
已隐隐见大意矣。与吴吉长乃室治验。参看自明。
沈若兹的公子，因为出痘之后饮食不节制，患上了腹泻。腹泻日久导致脾虚，进而又患上了疟疾。于是出现腹痛、腹部胀大等症状。三年来服用了无数消食导滞的药物，但腹胀和腹泻始终没有痊愈。去年请医生诊治，服用参苓白术散后稍微见效，但医生离开后病情又恢复原状。
他的病本原是腹胀，更兼有“肠泄”的症状。“肠泄”是指大肠之气空洞易散，胃中传导下来的食物残渣无法停留，泻出毫无节制，排泄物为腥臭的水样便。这是十个人中有五个死亡、五个存活的危重病症。如今病情进一步加深，又出现了四种“逆证”（预后不良的表现）：傍晚发热、早晨转凉，这是一逆；极度口渴，大量饮水以救急，这是二逆；气喘吁吁，不能仰卧睡眠，这是三逆；出汗多且烦躁不安，这是四逆。
健康人的腹中气机运转自如、收摄有度，所以身体轻快，大便次数正常。现在因为长期腹泻，导致气机涣散而不能收敛。腹部的胀满、肠鸣音亢进、大便失禁不知控制，都是因为这个原因。气机既然已经涣散不收，如果再服用行气利水的药物，岂不是更加助长其涣散吗？
健康人身体的营卫之气平衡，没有偏胜。所以阳气胜则发热，阴气胜则恶寒。患疟疾时，寒热交替发作，还是阴阳相互抗争的状态。等到腹泻日久耗伤了阴液，整夜发热，仅存的一线阴气被阳气乘虚而入，想要再与阳气相抗争，也不可能了。体内的津液枯竭，就像燎原之火自焚一样，不得不引外水来紧急救助。然而，有形之水不足以制约无形的火热，只会增加腹胀和腹泻，从而更严重地损伤阴气。
医生不清除病源，反而用香燥的药物，助长火势、劫夺阴液，如官桂、肉豆蔻等类药物，使用这些是错误的。男子的气海位于脐下，是元气藏舍之处，也是性命的根本。长期腹泻会导致真气涣散，势必向上干犯清窍，而不能下行。鼻中发出鼾声，不能仰卧，就是这种征象。那已经涣散的气，必然不能重新回归原位，只能希望尚未涣散的气不至于全部散失即可。多次服用木香、槟榔、苏子、腹皮、厚朴等降气药物，更是错上加错。至于出汗、烦躁，则是阴气虚竭殆尽，孤阳也不能长久留存的征兆。这就像一年的气候运行，只有温热而没有寒凉，只有生长而没有收藏，人和物怎么能避免早夭、瘟疫和疾病呢？在这种情况下想要扭转乾坤，也是难上加难。
沈若兹看到医案后，通过亲戚朋友极力恳求用药。因此以清燥润肺为主方，将阿胶、地黄、麦冬等药材同蜂蜜一起熬制成膏剂三斤。他的儿子三年以来受药物之苦，得到这种甘甜的味道，称之为糖。每天争着服用十余次。半个月药吃完，取得了显著疗效。身体凉爽，气息平稳，不渴、不烦、不泻，各种症状都退去了。另外配制补脾的药末进行善后调理，最终完全康复。
胡卣臣先生说：长期腹泻却使用润燥药物，看似与病症相反，但最终却很适宜。在分析病情时，先驳斥了三种治疗方法的错误，已经隐约显露出大意了。这与吴吉长妻子的治疗验案对照来看，自然明白其中的道理。
Shen Ruoci's son, due to irregular diet after recovering from smallpox, developed diarrhea. Prolonged diarrhea led to Spleen deficiency (Spleen Qi deficiency), which subsequently caused malaria. This resulted in abdominal pain and distension. For three years, he took countless digestive-promoting and stagnation-resolving medicines, yet the abdominal distension and diarrhea never healed. Last year, a physician was invited; taking Shenling Baizhu San (Ginseng, Atractylodes Macrocephala, and Poria Decoction) showed slight effect, but once the physician left, the condition reverted.
The root of his illness was abdominal distension, complicated by "Chang Xie" (Intestinal Leakage). "Chang Xie" refers to the condition where the Qi of the Large Intestine is hollow and prone to dispersion, causing food residues transmitted from the Stomach to fail to stay, resulting in uncontrolled discharge of foul-smelling watery stool. This is a critical syndrome with a mortality rate of 50%. Now, the disease has deepened, accompanied by four "Ni" signs (adverse prognostic indicators): evening fever and morning chills, which is the first adverse sign; extreme thirst requiring large amounts of water for relief, the second adverse sign; wheezing and inability to lie flat to sleep, the third adverse sign; profuse sweating and restlessness, the fourth adverse sign.
In a healthy person, the Qi in the abdomen moves and retains properly, resulting in a light body and normal bowel movements. Due to prolonged diarrhea, the Qi has become scattered and unable to consolidate. The abdominal distension, borborygmus (intestinal rumbling), and involuntary defecation are all due to this reason. Since the Qi is already scattered and unconsolidated, administering Qi-moving and diuretic drugs would only further increase its dispersion.
In a healthy person, Ying (Nutritive) and Wei (Defensive) Qi are balanced. Thus, Yang excess causes fever, and Yin excess causes aversion to cold. During malaria, alternating chills and fever indicate that Yin and Yang are still battling. However, after prolonged diarrhea depletes Yin, the remaining trace of Yin is overwhelmed by Yang, leading to night-long fever, making any further battle between Yin and Yang impossible. With internal fluids exhausted, it is like a prairie fire burning itself out; external water must be drawn to save the emergency. However, tangible water cannot control intangible fire, merely increasing distension and diarrhea while severely injuring Yin Qi.
The physician failed to clear the source of the disease, instead using aromatic and drying herbs to assist fire and rob Yin, such as Guirou (Cinnamon Bark) and Roudoukou (Nutmeg), which was a mistake. In men, the Qi Sea is located below the navel, being the residence of Yuan Qi (Original Qi) and the root of life. Prolonged diarrhea scatters True Qi, causing it to ascend and harass the clear orifices rather than descend. Snoring sounds from the nose and inability to lie supine are signs of this. The already scattered Qi cannot return to its place; one can only hope that the not-yet-scattered Qi does not fully dissipate. Repeatedly administering descending-Qi herbs like Muxiang (Aucklandia Root), Binglang (Areca Seed), Suzi (Perilla Fruit), Fupi (Tangerine Peel), and Houpo (Magnolia Bark) was an error compounded by another error. As for sweating and restlessness, these are omens that Yin Qi is completely exhausted and Lone Yang cannot remain long. This is akin to a yearly climate cycle having warmth and growth but no coldness and storage; how can people and things avoid premature death, plagues, and diseases? Under such circumstances, attempting to reverse the situation is extremely difficult.
Upon seeing the case analysis, Shen Ruoci, through relatives and friends, strongly requested medication. Therefore, the treatment focused on clearing dryness and moistening the Lungs. Ejiao (Donkey-hide Gelatin), Dihuang (Rehmannia Root), and Donggen (Ophiopogon Tuber) were boiled with honey to make three jin (approx. 1.5 kg) of paste. His son, who had suffered from medication for three years, called this sweet taste "candy." He eagerly took it more than ten times a day. After half a month, when the medicine was finished, significant efficacy was achieved: the body became cool, breathing normalized, and there was no thirst, restlessness, or diarrhea. All symptoms receded. Subsequently, Spleen-tonifying powder was prepared for convalescence, leading to complete recovery.
Mr. Hu Youchen stated: Using moistening herbs for prolonged diarrhea seems contrary to the syndrome but ultimately proves suitable. By refuting three erroneous treatment methods during the diagnosis, the main idea was implicitly revealed. Comparing this with the treatment verification of Wu Jichang's wife will make the principles clear.