吴叔宝先生。因治长公圣符之暇日。无病索为立案。岂求隔垣早见。而撤土先防乎。仆未悉翁平素
之脉。因尝药而吐泻交作。始为诊之。见脉躁而不静。劲而不柔。疑所伤甚大。乃翁漫不介意。无非恃体之
坚固耳。及具道平昔。始知禀受元阳甚旺。从前所患。皆为热中之病。盖膏粱浓味之热。阳气载以俱
升。势必发为痈疽疔毒。及脓溃斗许。毒尽而阳不乏。夫非得于天者浓耶。然屡费不赀。久从暗耗。况人身
候转不常。始传热中。今传寒中矣。热中则一身之痰。俱变为热。痰热则走。故发为疮疡。寒中则一身之痰。
俱变为寒。痰寒则凝。故结塞于胸膈。不易开散。一繇阳气高亢。一繇阳气卑微耳。今见脉中或三
至一转。或五至一转。不与指相值。自为区别。虽名三五不调。其实阳气孤危已甚。翁弗病则已。万一病出。
必非纾徐迂缓。试即以冬时为譬。寒威凛冽。阴霾昼见。天日无光。或有之矣。能无虑乎。据所禀之浓。宜
百年有常。乃今亦觉少衰。扶身药饵。有断不可缺者。服药而脉返其驯。缉续罔间。尚可臻古稀之列。
盖所禀之丰。如有国者祖功宗德之隆。即当衰季。复有中兴一段光彩耳。
翁见案不怿。至冬月果患胸腹紧痛。胀闷不堪。以滚酒热盐。内浇外熨不止。服附子理中十数剂始安。
次年四月。临丧过哀。呕血升余。服润滞药过多。饮食入胃。先痛后呕。大便粘滞而不坚燥。欲成痰膈。
在郡更医十余手。杂投罔效。归用土医服观音对坐草。而胃气搜削殆尽。最后饮水恶热。乃胃中久失谷
养。津液尽枯。一团真火内炽。凡病此症者。无不皆然。医者不审痰膈与热膈异治。尚以牛黄狗宝。漫图侥
幸。仆以未病先识。不敢染指投剂。亦繇时辈媚嫉。欲借翁病为刀俎地。先以去年所用之药为谤端。
是以即有旋复代赭成法可施。承当不下耳。可胜悼哉。
胡卣臣先生曰。舆谤易兴易息。出于公耳。独熏 中之鬼域。造端微而贻祸远。可慨可慨。
附极闸人论饮滚酒过多成膈症之故 过饮滚酒。多成膈症。人皆知之。而所以然之理不达也。盖膈
有二种。一者上脘之艰于纳。一者下脘之艰于出耳。然入之胃中。全是一团冲和之气。所以上脘清阳居多。
不觉其热。下脘浊阴居多。不觉其寒。实时令大热。而胃中之气。不变为热。时令大寒。而胃中之气。
不变为寒。气惟冲和。故但能容食。不能化食。必藉脾中之阳气入胃。而运化之机始显。此身中自然之造化
也。曲 之性。极能升腾。日饮沸酒不辍。势必将下脘之气。转升于中上二脘。而幽
门之口。闭而不通者有之。且滚酒从喉而入。日将上脘炮灼。渐有腐熟之象。而生气不存。窄隘有加。止能咽
水。不能纳谷者有之。此其所以多成膈证也。若夫热药之性。其伤人也必僭。以火
曰炎上也。寒药之性。其伤人也必滥。以水曰润下也。不僭不滥。而独伤中焦冲和之气者。必无之理。设果服附
子能成膈患。去年劝勿饮热酒时。何不蚤言。而治钱州尊失血。大剂倍用。又何自戾耶。赤土不容朱砂。
巧于用谮。此方之不我谷者。岂偶哉。
吴叔宝先生。在忙于为尊长圣符公治病之余，抽空让我为他建立病历档案。这难道是希望我未卜先知，在他生病前就提前防范吗？我不了解他平时的脉象，因为他曾服药后出现呕吐和腹泻交替发作的症状，我才开始为他诊脉。发现他的脉搏躁动而不宁静，强劲而缺乏柔和之象，怀疑他受到的损伤很大。然而老先生并不在意，无非是仗着身体坚固罢了。等到详细询问他平素的情况，才知道他先天禀受的元阳非常旺盛，从前所患的疾病，都是属于“热中”的病证。这是因为饮食肥甘厚味产生的内热，随着阳气一起上升，势必会引发痈疽、疔毒等疮疡。等到脓液排出数升，毒素排尽而阳气依然充足。这难道不是得益于天赋的浓厚元气吗？然而多次治疗耗费巨大，长期暗中消耗。况且人体的状态变化无常，起初是热中，现在转为寒中了。热中时，全身的痰都变为热痰，热痰具有走窜的特性，所以发为疮疡；寒中时，全身的痰都变为寒痰，寒痰具有凝滞的特性，所以结塞在胸膈部位，不易消散。一个是由于阳气高亢，一个是由于阳气卑微。现在看到他的脉象，有时三至才转一次，有时五至才转一次，脉搏跳动与手指的感觉不相应，自然呈现出区别。虽然名为“三五不调”，其实阳气已经孤危到了极点。老先生如果不生病则罢，万一发病，必定不是缓慢渐进的过程。试以冬天为例，寒气凛冽，阴霾白天出现，天日无光，这种情况是可能存在的。能不令人担忧吗？依据他原本丰厚的禀赋，本该活到百岁正常寿命，如今也感觉衰退了。维持身体的药物，有绝对不可缺少的。如果服药后脉象恢复驯顺，连续不断没有间断，还可以达到古稀之年（七十岁）。大概禀赋丰厚的人，就像国家祖先功德隆盛一样，即使到了衰败时期，也有中兴的一段光彩。
老先生看了病历很不高兴。到了冬天果然患上胸腹紧痛，胀闷不堪忍受。用滚烫的酒和热盐，内服外敷不停止。服用附子理中汤十几剂后才安定下来。次年四月，因为参加丧礼过度悲伤，呕血一升多。服用润燥滑肠药过多，饮食进入胃中，先疼痛后呕吐，大便粘滞而不干硬，想要形成痰膈症。在郡里换了十几个医生，乱投药物无效。回家后使用土医，服用观音对坐草，导致胃气被搜刮削夺殆尽。最后喝水怕热，这是胃中长期失去谷物的滋养，津液完全枯竭，一团真火在内炽盛。凡是患有这种病症的人，没有不是这样的。医生不审察痰膈与热膈的治疗差异，还用牛黄、狗宝等药，盲目图侥幸。我因为未病先识的道理，不敢插手开方，也是因为当时同僚嫉妒，想借老先生的病作为攻击我的把柄，先拿去年所用的药物作为诽谤的开端。因此即使有旋覆代赭汤成法可以施用，我也承担不下来。真是令人悲痛啊。
胡卣臣先生说：外界的诽谤容易兴起也容易平息，出于公众舆论。唯独那些像熏鼠洞中的鬼域小人，事情开头微小却遗留祸患深远，可叹可叹。
附：极闸人论述因饮用过多滚酒而成膈症的原因 过量饮用滚烫的酒，大多会形成膈症，人们都知道这一点，但不明白其中的道理。大概膈症有两种，一种是上脘难以纳食，一种是下脘难以出食。然而食物进入胃中，全是一团冲和之气，所以上脘清阳居多，不觉其热；下脘浊阴居多，不觉其寒。即使是时令大热，胃中之气也不会变为热；时令大寒，胃中之气也不会变为寒。气只有冲和，所以只能容纳食物，不能消化食物，必须借助脾中的阳气进入胃中，运化的机制才能显现。这是人体自然的造化。酒的性质，极能升腾，每天饮用沸酒不停，势必会将下脘的气，转升到中、上二脘，而幽门的口，闭而不通的情况就会出现。而且滚酒从喉咙进入，每天将上脘炮灼，渐渐有腐熟的现象，而生气不存在，狭窄更加严重，只能咽水，不能进食的情况就会出现。这就是为什么多形成膈证的原因。至于热药的性质，它伤害人必然僭越，因为火性炎上；寒药的性质，它伤害人必然泛滥，因为水性润下。不僭越不泛滥，而单独伤害中焦冲和之气的，一定没有这个道理。如果真的服用附子能造成膈患，去年劝不要喝热酒时，为什么不早说？而治疗钱州尊失血时，大剂量加倍使用，又怎么自相矛盾呢？赤土不容纳朱砂，善于进谗言。这个方子不被我采纳，难道是偶然的吗？
Mr. Wu Shubao, while having time off from treating his elder, Mr. Shengfu, asked me to establish a medical record for him when he was not ill. Was this seeking my clairvoyance to prevent illness before it occurred? I was unfamiliar with his usual pulse. After he took medicine and suffered from alternating vomiting and diarrhea, I began to examine him. I observed a pulse that was restless and unquiet, vigorous but lacking softness, suspecting significant damage had occurred. However, the old gentleman paid no attention, relying merely on his robust constitution. Upon detailing his past history, I learned that his innate primordial Yang (Yuan Yang, 元阳) was very vigorous. Previous illnesses were all "Heat in the Middle" (Re Zhong, 热中) conditions. The heat from rich and greasy food ascended together with Yang Qi, inevitably leading to carbuncles, sores, and toxic boils. When pus discharged in large quantities and toxins were exhausted, Yang Qi remained abundant. This must be due to thick endowment from Heaven. However, frequent treatments cost dearly, causing long-term hidden depletion. Moreover, human physiological states change constantly; initially it was Heat in the Middle, now it has transmitted to Cold in the Middle (Han Zhong, 寒中). In Heat in the Middle, phlegm throughout the body transforms into Heat Phlegm (Tan Re, 痰热), which moves freely, thus manifesting as sores and ulcers. In Cold in the Middle, phlegm transforms into Cold Phlegm (Tan Han, 痰寒), which coagulates, thus knotting in the chest and diaphragm, difficult to disperse. One is due to high and hyperactive Yang Qi, the other to deficient and lowly Yang Qi. Now, seeing the pulse, sometimes three beats per turn, sometimes five beats per turn, not aligning with the finger's sensation, naturally showing distinction. Although named "Three-Five Irregularity" (San Wu Bu Tiao, 三五不调), actually Yang Qi is extremely isolated and precarious. If the old gentleman does not get sick, fine; if he does, it will certainly not be a gradual process. Take winter as an analogy: biting cold, dark clouds appearing during the day, sunlight obscured—this can happen. Can one not worry? Based on his originally rich endowment, he should have lived a normal lifespan of a hundred years, yet now feels declining. Medicines to support the body are absolutely indispensable. If after taking medicine the pulse returns to being tame and continuous without interruption, one might still reach the age of seventy (Gu Xi, 古稀). Generally, those with rich endowment are like states with illustrious ancestral merit; even in decline, there is a period of revival and brilliance.
The old gentleman was displeased with the record. In winter, he indeed suffered from tight pain in the chest and abdomen, unbearable distension and stuffiness. He used boiling wine and hot salt, applying internally and externally without stopping. Only after taking several doses of Fuzi Lizhong Wan (Aconite Decoction for Warming the Middle) did he stabilize. In April of the following year, grieving excessively at a funeral, he vomited more than one sheng of blood. Having taken too many moistening and purgative medicines, food entering the stomach caused pain followed by vomiting. Stool was sticky but not dry and hard, suggesting the formation of Phlegm Obstruction (Tan Ge, 痰膈). Over ten doctors in the prefecture treated him, administering miscellaneous drugs with no effect. Returning home, he used a local practitioner who administered Guanyin Duizuo Cao (Herba Siegesbeckiae Orientalis), which completely depleted his Stomach Qi (Wei Qi, 胃气). Finally, he feared heat when drinking water. This is because the Stomach had long lost nourishment from grain, fluids were entirely dried up, and a mass of True Fire (Zhen Huo, 真火) blazed internally. All patients with this condition are invariably like this. Physicians failing to distinguish the different treatments for Phlegm Obstruction and Heat Obstruction (Re Ge, 热膈) still used Niuhuang Gou Bao (Calculus Bovis and Calculus Moschus), blindly hoping for luck. Because I recognized the pathology before disease onset, I dared not intervene or prescribe. Also, due to jealousy from contemporaries who wanted to use the old gentleman's illness as a weapon against me, using last year's medications as grounds for slander, even though the proven method of Xuanfu Daizhe Tang (Inula and Hematite Decoction) could be applied, I could not take responsibility. How sorrowful!
Mr. Hu Youchen said: External slander rises and falls easily, stemming from public opinion. But the machinations of those like ghosts in a smoky burrow, starting small but causing distant disasters, are truly lamentable.
Appendix: Discussion by a person from Jizha on the cause of Obstruction Syndrome (Ge Zheng, 膈症) from excessive drinking of boiling wine. Excessive drinking of boiling wine often leads to Obstruction Syndrome, which everyone knows, but the underlying reason is not understood. There are two types of Obstruction: difficulty in receiving food in the Upper Jiao/Stomach (Shang Wan, 上脘) and difficulty in expelling food from the Lower Jiao/Stomach (Xia Wan, 下脘). However, once food enters the Stomach, it becomes a mass of Harmonious Qi (Chong He Zhi Qi, 冲和之气). Thus, the Upper Jiao has mostly Clear Yang (Qing Yang, 清阳) and does not feel hot; the Lower Jiao has mostly Turbid Yin (Zhuo Yin, 浊阴) and does not feel cold. Even in extreme summer heat, Stomach Qi does not become hot; in extreme winter cold, Stomach Qi does not become cold. Qi is only harmonious, so it can contain food but cannot digest it. It must rely on Spleen Yang Qi entering the Stomach for the mechanism of transformation to appear. This is the natural creation within the body. Wine nature is extremely ascending. Daily consumption of boiling wine will inevitably shift Qi from the Lower Jiao to the Middle and Upper Jiao, causing the Gate of Youmen (Youmen, 幽门) to close and block. Furthermore, boiling wine enters from the throat, roasting the Upper Jiao daily, gradually creating a state of putrefaction where vital Qi disappears, narrowing further, allowing only water to pass but not grain. This is why it often forms Obstruction Syndrome. As for hot medicines, their damaging nature is necessarily transgressive, as Fire flares upward; cold medicines' damaging nature is necessarily overflowing, as Water moistens downward. It is impossible for something to be neither transgressive nor overflowing yet specifically damage the Harmonious Qi of the Middle Jiao. If Aconite (Fuzi, 附子) truly caused Obstruction, why didn't you speak early when advising against hot wine last year? And when treating Physician Qian's hemorrhage, why use large doses doubled? Red earth cannot accept Cinnabar; skillful in slander. That this prescription was not accepted by me, is it accidental?