钱小鲁奕秋之徒也。兼善饮。每奕必饮。饮必醉。岁无虚
日。辛巳秋。浩饮晚归。呕吐寒热兼作。骨节烦疼。医以时行感冒表散药治之。不愈。更医知为酒毒。于寒
凉药中用热药为乡导。治之亦不愈。卧床二十余日。始请余诊。其脉洪大促急。身 着席不能动展。左腿痛如
刀刺。鼻煤。从病起至是。总不大便。此痈疽之候也。归语两门人。王生欣然有得。曰。迄今燥金司令。酒客
素伤湿热。至此而发。金盛则木衰。是以筋骨疼痛。而不能起于床。脏燥而腑亦燥。是以津液干枯。而大肠失
其润。以清金润燥治之可矣。吴生曰。不然。酒毒大发。肠胃如焚。能俟掘井取水乎。是必以大下为急也。
余曰。下法果胜。但酒客胃气。素为多呕所伤。药入胃中。必致上壅。不能下达。即敷脐导肠等法。无所
用之。掘井固难。开渠亦不易。奈何奈何。吾为子辈更开一窦。夫酒者清冽之物。不随浊秽下行。惟喜渗入
者也。渗入之区。先从胃入胆。胆为清净之府。同气相交故也。然胆之收摄无几。其次从胃入肠。膀胱渗之。
化溺为独多焉。迨至化溺。则所存者酒之余质。其烈性实惟胆独当之。每见善饮者。必慢斟缓酌。以俟腹中之
渗。若连飞数觥。有倾囊而出耳。是以酒至半酣。虽懦夫有挥拳骂座之胆。虽窭人有千金一掷之胆。虽
狷士有钻穴逾垣之胆。甚至凶徒有抚剑杀人之胆。以及放浪形骸之流。且有一饮数斛。罔顾余生之胆。以小
鲁之赤贫。而胆不丧落者。夫非藉赀于酒乎。其受病实有较他人不同者。盖胆之腑。原无输泻。胆之热。他人
可移于脑。浊涕从鼻窍源源而出。亦少杀其势。若小鲁则阳分之阳过旺。阳分之阴甚衰。发鬓全无。直似南方
不毛之地。热也极矣。肯受胆之移热乎。幸其头间多汗。脑热暗泄。不为大患。乃胆热既无可宣。又继以酒
之热时之燥。热淫内炽。脉见促急。几何不致极惫耶。故胆之热汁满而溢出于外。以渐渗于经络。则身目俱
黄。为酒瘅之病。以其渗而出也。可转驱而纳诸膀胱。从溺道而消也。今独攻环跳之穴。则
在胆之本属。可无驱矣。且其步履素为此穴所苦也。受伤已久。
气离血散。热邪弥满留连。服药纵多。有拒而不纳耳。何能取效。即欲针之。此久伤之穴。有难于抉泻者。
设遇良工如古人辈。将何法以处此乎。吾更有虑焉。有身以后。全赖谷气充养。谷气即元气也。谷入素少之
人。又即藉酒为元气。今以病而废饮。何所恃为久世之资耶。吾谛思一法。先搐脑中黄水出鼻。次针胆穴
之络脑间者数处。务期胆中之热。移从脑鼻而出。庶乎环跳穴中。结邪渐运。而肠胃之枯槁渐回。然后以泻
胆热之药入酒中。每日仍痛饮一醉。饮法同而酒性异。始得阴行而妙其用。盖其以生平之偏。造为坚垒。必藉
酒为乡导。乃克有济也。岂清金润燥与下夺之法。能了其局乎。两生踊跃曰。蒙诲治法。令人心地开朗。请
笔之以志一堂授受之快。录此付渠子。令送商顾幼疏孝廉求救。小鲁竟阻之。或以余言为不然耶。
胡卣臣先生曰。先写全神。后论治法。大是奇观。
钱小鲁是奕秋的学生。他同时擅长饮酒，每次下棋必定喝酒，喝酒必定喝醉，一年中没有一天不如此。辛巳年秋天，他深夜豪饮后回家，出现呕吐、寒热交替发作、骨节烦扰疼痛的症状。医生用治疗时行感冒的解表药治疗，没有痊愈。换了一位医生知道这是酒毒所致，在寒凉药中加入热性药作为引导来治疗，也没有痊愈。卧床二十多天后，才请我诊治。他的脉象洪大且急促，身体贴着床席无法动弹舒展，左腿痛如刀刺，鼻头色黑。从发病到现在，始终没有大便，这是痈疽的征兆。回去我对两位门人说，王生欣然有所领悟，说：“如今燥金当令，酒客素来损伤湿热，至此而发作。金气盛则木气衰，所以筋骨疼痛而不能起床。脏燥而腑也燥，所以津液干枯，大肠失去滋润，用清金润燥的方法治疗就可以了。”吴生说：“不对。酒毒大发，肠胃像被焚烧一样，能等到掘井取水吗？这必须用峻下法为急务。”我说：“下法果然有效，但酒客的胃气，素来因频繁呕吐而受损，药物进入胃中，必然导致上壅，不能下达。即使使用敷脐导肠等方法，也无济于事。掘井固然困难，开渠也不容易，怎么办呢？我为你们再开辟一条路径。酒是清冽之物，不随浊秽下行，只喜欢渗入体内。渗入的途径，先从胃进入胆，因为胆是清净之府，同气相求的缘故。然而胆的收纳能力有限，其次从胃进入肠，膀胱渗透它，化溺的作用最多。等到化为尿液时，剩下的就是酒的余质，其烈性实际上只有胆独自承担。常见善于饮酒的人，一定慢慢斟酒缓缓饮用，以等待腹中的渗透。如果连续猛喝几杯，就像倾囊而出一样。因此酒喝到半醉时，即使是懦夫也有挥拳骂座的胆量，即使是贫穷的人也有千金一掷的胆量，即使是狷介之士也有钻洞翻墙的胆量，甚至有凶徒有拔剑杀人的胆量，以及放浪形骸的一类人，甚至有一饮数斛、不顾性命的胆量。凭钱小鲁的极度贫困，而胆气不丧失坠落，难道不是借助于酒的力量吗？他患病确实与他人不同。盖胆腑原本没有输泻通道，胆的热邪，他人可以转移到大脑，浊涕从鼻窍源源流出，也能稍微减弱其势头。若像钱小鲁这样，阳分的阳气过旺，阳分的阴气甚衰，头发胡须全无，简直像南方不毛之地，热极到了极点，肯接受胆热转移吗？幸好他头部多汗，脑热暗中宣泄，不成为大患。既然胆热既无法宣散，又加上酒的火热和时令的燥气，热邪在内炽盛，脉象出现促急，怎能不导致极度疲惫呢？所以胆中的热汁满溢而出，逐渐渗入经络，则身体和眼睛都发黄，成为酒瘅病。因为它通过渗透而出，可以转而驱除并纳入膀胱，从尿道消除。现在单独攻击环跳穴，这在胆的本属部位，可以不驱除（指不需要额外驱邪）。而且他走路素来受此穴之苦，受伤已久，气离血散，热邪弥满留连，服药再多，也是拒而不纳，怎么能见效呢？即使想针刺，这个久伤之穴，难以抉泻。假如遇到像古人那样的良医，将用什么方法来处理呢？我还有更深远的忧虑。有了身体之后，全赖谷气充养，谷气就是元气。平时摄入谷物很少的人，又借酒作为元气。现在因病戒酒，依靠什么作为长久生存的资本呢？我仔细思考了一个方法，先搐出脑中黄水从鼻流出，其次针刺胆穴与脑相连的络脉数处，务必使胆中之热，从脑鼻排出，这样环跳穴中的结聚邪气逐渐运化，而肠胃的枯槁逐渐恢复，然后用泻胆热的药混入酒中，每天仍然痛饮至醉。饮法相同而酒性不同，才能暗中发挥作用。因为他平生的偏嗜，造就了坚固的壁垒，必须借酒作为向导，才能成功。难道清金润燥和下夺之法，能解决这个局面吗？”两位学生踊跃地说：“承蒙教诲治法，令人心地开朗，请记录下来以纪念一堂授受的愉快。”将此记录交给他的儿子，让他送去请教顾幼疏孝廉求救。钱小鲁最终阻止了这件事。或许有人认为我的话不对吧。胡卣臣先生说：“先写全神，后论治法，真是奇观。”
Qian Xiaolu was a disciple of Yiqiu. He was also proficient in drinking alcohol, and would always drink when playing chess, always getting drunk, without exception for any day of the year. In the autumn of the Xinsi year, he returned home late after heavy drinking, suffering from vomiting, alternating chills and fever, and vexing pain in the bone joints. Physicians treated him with exterior-releasing medicines for epidemic colds, but to no avail. Another physician, recognizing it as alcohol toxicity, used hot-natured herbs as guides within cold-natured prescriptions, yet this also failed. After lying in bed for more than twenty days, I was finally invited to examine him. His pulse was surging (Hong) and rapid/irregular (Cu), his body pressed against the mat unable to move or stretch, his left leg painful as if pierced by a knife, and his nose black. From the onset of the illness until then, he had not had a bowel movement; this is a sign of carbuncle and ulcer (Yong Ju). Upon returning, I spoke to my two disciples. Wang Sheng happily expressed his understanding, saying, "Currently, Dryness Metal governs the season. Alcoholics are inherently damaged by damp-heat, which manifests now. When Metal is excessive, Wood declines, hence the pain in sinews and bones preventing him from rising. The Zang organs are dry and the Fu organs are also dry, leading to dried-up fluids and loss of lubrication in the Large Intestine. Treating with clearing Metal and moistening dryness should suffice." Wu Sheng said, "Incorrect. With severe alcohol toxicity, the intestines and stomach are like burning furnaces; can we wait to dig a well for water? Urgent treatment requires drastic purgation (Da Xia)." I replied, "Purgation might indeed be effective, but an alcoholic's Stomach Qi has been damaged by frequent vomiting. Medications entering the Stomach will likely cause upper congestion, failing to descend. Even methods like umbilical application or intestinal guidance would be useless. Digging a well is difficult, and opening a canal is not easy either. What shall we do? I will open another path for you. Alcohol is a clear and pure substance; it does not descend with turbid waste but prefers to infiltrate. The infiltration pathway starts from the Stomach into the Gallbladder, because the Gallbladder is the organ of purity, and similar energies interact. However, the Gallbladder's capacity for retention is limited; next, it moves from the Stomach to the Intestines, where the Bladder permeates it, resulting in the most significant transformation into urine. By the time it becomes urine, only the residual quality of alcohol remains, and its intense nature is borne solely by the Gallbladder. I often observe that good drinkers sip slowly to allow for abdominal infiltration. If they gulp down several cups at once, it is like emptying a purse. Thus, when half-drunk, even a coward gains the courage to throw punches and curse at others; even a poor person gains the courage to spend a thousand gold pieces; even a reserved scholar gains the courage to climb walls; even a villain gains the courage to kill with a sword; and those who indulge in wild behavior may drink several hu without regard for their lives. Given Qian Xiaolu's extreme poverty, how could his Gallbladder spirit remain unbroken unless sustained by alcohol? His pathology differs from others. The Gallbladder Fu organ originally lacks drainage pathways. In others, Gallbladder heat can transfer to the brain, with turbid mucus flowing continuously from the nasal orifices, slightly reducing the intensity. But Qian Xiaolu suffers from excessive Yang Qi in the Yang aspect and severely deficient Yin Qi in the Yang aspect. His hair and beard are completely absent, resembling the barren lands of the South, indicating extreme heat. Would he accept the transfer of Gallbladder heat? Fortunately, he sweats profusely on his head, allowing brain heat to dissipate secretly, avoiding major disaster. Since Gallbladder heat cannot be dispersed, compounded by the heat of alcohol and the dryness of the season, internal heat blazes fiercely, causing a rapid/irregular pulse. How could this not lead to extreme exhaustion? Therefore, the hot juice of the Gallbladder overflows and gradually infiltrates the collaterals, turning the body and eyes yellow, resulting in Jaundice due to Alcohol (Jiu Dan). Because it exits via infiltration, it can be driven into the Bladder and eliminated through urination. Now, targeting only the Huantiao acupoint, which belongs to the Gallbladder channel, requires no additional driving force. Moreover, he has long suffered from this point during walking; the injury is old, Qi and Blood are scattered, and heat pathogens linger densely. Even taking many medicines would result in rejection. How could it work? Even if acupuncture were attempted, this chronically injured point is difficult to drain. If one encountered a master craftsman like the ancients, what method would they use? I have further concerns. After birth, the body relies entirely on Grain Qi for nourishment; Grain Qi is Yuan Qi (Original Qi). For those who consume little grain, alcohol serves as Yuan Qi. Now, due to illness, he must stop drinking; what will sustain him for the long term? I have carefully considered a method: first, extract the yellow fluid from the brain through the nose; second, puncture several collaterals connecting the Gallbladder points to the brain, ensuring Gallbladder heat transfers out through the brain and nose. This way, the accumulated evil in the Huantiao point will gradually circulate, and the dryness of the intestines and stomach will recover. Then, administer herbs that purge Gallbladder heat mixed into alcohol, allowing him to still get drunk daily. Although the method of drinking is the same, the nature of the alcohol changes, allowing it to function subtly through Yin channels. His lifelong bias has built a strong fortress; only by using alcohol as a guide can success be achieved. Could methods of clearing Metal/moistening dryness or drastic purgation resolve this situation?" The two students eagerly said, "Your teaching of the treatment method opens our minds. Please record this to commemorate the joy of transmission in this hall." I gave this record to his son, instructing him to seek help from Gu Youshu, a Xiaoqiu (scholar-official). Qian Xiaolu ultimately prevented this. Perhaps some think my words are incorrect. Mr. Hu Youchen stated, "Describing the full spiritual state before discussing treatment methods is truly a marvel."