中医用药，惟凭气味以扶偏制胜，乃今药肆所售，竟有形似而实非者，倘非常品，必亲
尝而
后用之。盖投药如遣将，若未知其人之性情贤否而任之，鲜不偾事。忆昔在乡近镇有王某，
病火腑秘结，便阻五十余日，余用更衣丸，以未效而疑之。幸病家细心，服时留取数枚以示
，余尝之，味甚甘。骇曰∶是丸仅用芦荟、朱砂二味，取其苦滑重镇；今味反甘，乃伪耳。
因书方令自合，一服即通。知乡间药肆，其不可靠有如此者。昔人言用药有三忌，谓从未经
验，臭秽猛毒，气味异常也。知此三者，庶可驱使草木耳。
无为程生，夏月露坐，夜既深，觉小腹重滞而微痛，久则如有物攻，群医莫名其症。近
村有
老儒能医而不名，程延以诊视。乃令市诸药料，以次熏腹，至雄黄而腹鸣如雷。曰∶此蛇膨
也。是必坐处有蛇窟，夜深将出，触其所吐之气，致成此疾，经岁腹膨如鼓，至脐中出水，
则
不可救矣。遂以雄黄和酒令饮，阅三日顿泻绿水斗余而愈。按∶本草载雷丸之治应声虫，与
此相类。盖物必有制，因其畏而投之，故能取效。法虽异，理自一也。
世俗有云∶若要小儿安，须带三分饥与寒。盖言衣絮弗使过暖，饮食弗令过饱，庶无蕴
热停滞
之患，是亦保婴之一法也。凡襁褓之儿，内证多痰火，外感多风热，每患口舌肿毒，投以辛
凉
化毒自安。近有推惊婆子，指为螳螂子，言过一周即不救，每用利刀剔儿两颐，以出血块。
是惟江浙有之，而吴中为甚，他处未闻有此患也。然孩提之子，肌肤娇薄，即欲稍泄风热
，以针略刺犹可，切勿用刀割裂，以伤血络，致不能乳食，可不慎欤？
世言以醋泥涂火烧疮，取验最速。其言恰非无本，盖《北梦琐言》中载∶孙光宪家人，
方作
煎饼，一婢抱儿傍玩，失手落儿火上，遽以醋泥涂之，至晚即愈，并无瘢痕。可见当时已有
此说，故能应手取效，然则世俗相传，固不厌多闻也。
桐城俞澹香言，其族子昔患水胀，腹膨如鼓，渐至手足面目皆肿，危殆已甚，自问无生
理。
一日，闻邻家葱煎豆腐甚香，思食之，因自煮一盘，食颇快口，而小便觉爽，遂连食数日，
溺更大通，肿渐消，腹亦渐小，不半月而愈。俞谓∶水蛊重症，而以葱腐获痊，殊不可解。
余曰∶凡人感疾，皆由气味相触，内阻流行之机，感时虽微，久能致病，惟遇气味相投之物
，一动其机，虽痼疾亦或可瘳。如《内经》言∶临病患问所便。即是此理，非臆说也！
感丰初，黄严叶某，贾于沪。一夕偕友小饮，归时已三鼓，倏有旋风刮地起，风过，叶
仆地
不起，同伴扶掖回寓，超时气绝。其友徐姓者，尝谓余曰∶叶年壮盛，气体素强，何病之骤
，而死之速也？余曰∶此殆非病，或因惊散生魂耳。问∶是时尚可救否？曰∶按本草以腰刀鞘
二三寸烧末服，谓可救。明年，徐赴苏郡，泊舟黄渡，晚餐方毕，闻岸上喧呶声，往观见一
人倒地，因询其何病，其家人曰∶本无疾苦，黄昏出门，欲往友家，半行未里，遽踣于此。
徐忆余言，令以刀鞘试之，移时渐苏，顷即起坐，自言初至此，闻树头鸟声乱噪，阴风起林
间，使人毫发皆竖。忽来一巨人，挥拳猛击，骇极狂窜，正不识路，继闻前面锋刃声甚厉，
意巨人持械复来，遂回身而走，不知何以仍在此也。观此，可见古书所载奇方异疾，若治之
得中，固无不验者。然此理甚微，颇不易解。
尝观《拮奇集》载∶黑犬遍体无杂毛，目如丹朱者，名风夷，能治飞头之疾。初不知飞
头何
疾，阅《搜神记》吴时将军朱桓一婢，每夜卧，头辄飞去，将晓复还；又《酉阳杂俎》言，
岭
南溪洞中，往往有飞头者，故有飞头獠子之名。头飞一日，前颈有痕，匝项如红缕，妻子咸
守之，其人及夜，状如病，头忽离身而去，将晓还复，如梦觉云。噫！此固疾耶！奇甚矣！未
识何由而得。遍阅诸书，无从考证耳。
宋·徐文伯入山采药，遇二老人，凿石取水自饮。文伯渴甚，欲乞一盂，老人曰∶此玉
液也
，非汝可饮。过恳之，授半盏，方入口，齿即相击，下咽觉冷不可耐。一老曰∶何自苦乃尔
，遂摘树叶三片使食，食之即觉温暖异常，老人复授书一册，曰∶归习之，能疗世人疾。文
伯暮年遂神其技。尝于路旁见一人倒地死，腹大如瓮，文伯曰∶此人为爆蛇击死，气虽绝，
神未离，尚可活也。乃取药丸，纳其鼻孔，顷之腹鸣便泄而苏。众问所施何药，曰∶骨笃
犀也。按∶骨笃犀乃巨蛇角，能解诸毒。又，明帝时有内侍，患头痛如破，发即厥绝，群医
以为风，文伯曰∶此脑蛆也。以药点两眼角，顷则鼻中出蛆无数，乃取以捣汁，入药少许，
令服，曰∶此脑髓所化，非此不能补耳。自后病遂不发。
吐衄诸血症，今人每宗仲景泻心法，不知其所谓泻心者，实泻手厥阴、足厥阴、太阴、
阳明
四经之邪火有余也。大黄峻利之品，用得宜，取效固捷；若施之体弱之人，祸可立待。梁武
帝时姚僧坦以医擅名，值帝病热，欲服大黄，姚言至尊年高，不可轻用快药，帝不从，几殆
。其后元帝得心疾，群医拟进补心之品，姚言脉洪而实，盖有宿妨，非大黄不瘥，剂进立愈
。观此，知大黄之用，必有把握，未可混施。
华亭费秋谷母，骤腹痛频危者再，闻天马山有道人能医，乃亲往延治。途遇一老翁，同
憩于
亭，问何适，费以延医对，翁于囊中出一方，曰∶此孙思邈所得龙宫方也，服之当有效。
费于忽迫间，不辨何药，即市归进母，一服而愈。后以方示人，盖即《千金方》温脾汤也。
是方寒热并用，补泻兼施，信非凡子所能定。按∶唐段成式《酉阳杂俎》∶思邈尝隐居终南
，时逢大旱，有西域僧奏请于昆明池结坛祈雨，凡七日，池水骤缩。忽有老人夜诣思邈室，
曰∶弟子昆明池龙也，今胡僧利弟子脑，诡言祈雨，实欲杀我，望先生怜而救之。孙曰∶余
知昆明龙宫有仙方三十首，尔授我将救汝。老人曰∶此方上帝不许妄传，今事急，何敢吝？
孙得方，遂别撰三十卷，每卷入一方，致后世莫辨。老翁所授，盖即真方也。
医学十三科，惟针科效最速。然非精其技者，不可轻试。经云∶形气不足，阴阳俱虚，
刺则
重伤其阴阳，老者绝灭，壮者不复矣。东垣曰∶脉浮数而发热，咽干舌赤，时作渴者，热在
外也，灸则灾害立至。据此，知虚寒忌针，实热忌灸。未明虚实者，针与灸岂可妄使哉！唐
·狄梁公性娴医药，尤精针术。显庆中应制入关，路出华州， 之北，稠人广众，聚观如
堵。梁公引辔遥望，有巨牌大书，能疗此疾，酬绢千匹。就观之，有儿年可十四五，卧牌下
，鼻端生赘，大如拳石，根蒂缀鼻，才如食筋。或触之，酸痛刻骨，双目为赘所绳，目睛翻
白，痛极欲绝。公恻然久之，乃曰∶吾能为也。其父母暨亲属叩颡祈请。公令扶病者起，即
于脑后下针寸许，乃询针气已达痛所乎？病患颔之，公遽出针，疣赘应手而落，病顿失。其
家人且泣且拜，遂奉缣物。公笑曰∶吾哀尔命之危，非鬻技也。罔顾而去。然行针之法，必
达乎阴阳，分别穴道，倘失毫厘，则差以千里。如公者，始可行其伎矣。
咸丰初，邓作夫都阃，奉檄征皖南，左额受枪伤，时贼势方炽，郑枕戈露宿，以至肿势
日甚
。医者谓是破伤风，邪已内闭不能治。有一老兵，取桑条数十茎，以火烧其中，取汁和酒，
令服遂愈。此法曾见之方书，不意其奇验果如此。然则应验诸方，医家亦不可不谙也。《齐
谐
记》载∶江夏郭坦有儿，于病后忽能食，日必需米斛余，阅五年，家至罄。坦乃驱使自觅食
，儿因饥不可忍，乃取圃中韭啖之，竟尽二畦，旋觉闷极，因大呕，陡出一物，状如龙，撮
饭着物，即化为水，而其病顿愈。物则恰莫能试云。及观闾阎僧《睡余偶笔》言∶秦有化谷
虫，长仅数寸，于谷笔中投其一，不二三日，谷尽化水。始悟郭儿所呕，或即此虫。是必采
药时，未经洗净，误吞其子，致有此患，韭能解蛇虫诸毒，故得疗此异疾。
谚云∶走马看伤寒。盖言转眼更改，治之不容稍缓也。若令晨服药一剂，明晚再服，中
间已
隔两昼一夜，经络已传，药力有所不及，则难取效矣。故古方有日三服，甚则昼夜服六次，
使药不间断，始能制病。若危急之症，死生于旦暮之间，用药尤当不失其时。近日有一等医
人，日则高卧，晚始出诊，以为延者众，而深夜犹不得安息。一至病家，故作匆忙之态，聊
且疏方，告其病情，则闭目不答，似厌其言之多也。嗟乎！病者求医，望之甚切，早延夕至
，一日虚过，以致鞭长莫及。此谁之过欤？其心安乎哉？
有友病疝，尝问方于余，余按前人治疝，各有所偏，立方不无错杂。仲景以寒为名，故
主温
散，调营补虚，不入气分之药；而子和又以辛香流气为主，谓肝得疏泄，病将自愈也；巢氏
言∶阴气内积，复加寒气，盖由营卫失调而致；陈无择亦言∶女血因寒湿而为瘕，男气因寒
聚而成疝，是以疝属寒者固多。然此病亦有起于湿热者。盖湿热在经，郁遏即久，外复感冒
，
寒气收束，络脉不行，所以作痛。若专作寒论，恐未尽然。近惟叶氏有暴疝多寒，久疝多热
之议，发前人所未发，后学似当深味。今友患此有年，且多目疾，维友疝病，治肝十居八九
，因以辛甘化风为治，而附其说于此。
经云∶湿多成五泄。水湿侵脾固多注下，然因风病泄者，亦习见焉。盖肠有风则飧泄，
胃有风
则濡泄，肝为风脏，故厥阴症每多作泻。今之俗工不察病情，以为健脾导湿，治泻之要，用
药大都香燥。不知肝为刚脏，必甘柔酸敛以和之，燥则劫津，香能耗散，不反增其病乎？《
竹楼间笔》载∶宋时有朝贵，患痢经年，群医每进升阳理脾之剂，而病转剧。蜀医唐慎微诊
之曰∶此肠风也。投以育阴之品，不旬而瘥。余每治肠风泄泻，亦以柔肝获效，故特笔之。
痢疾古称滞下，盖湿热内阻，气失流行，久成积滞。昔人每以导气分消为主，此诚治夏
秋时
痢之常法。然风淫火迫，寒侵积痰，亦能致痢，治之又当分别。更有脾肾交亏，饮食入胃，
输化不清，积留于肠回曲折之间，入秋气，收藏不固而下泄者。道光丁酉先君年七十有三，
仲秋患痢，昼夜百余次，初延医诊视，进苦辛调气之剂，因循十余日，病益甚。闻谷即呕，
虽汤饮亦不能下咽，满口白縻而作呃忒，举家惶惶，余方寸已乱，漫无意见，惟日夜祈祷，
因思得一人与之共商，庶可放胆立方。越日，适毗陵庄生至，庄号春冶，曾从余学医，颇有
机变，因令诊。春冶蹙额曰∶尊年营卫既亏，痢疾大下，阴液已涸，今口縻呃逆，胃气将绝
，实难措手，惟有扶持元气，兼养胃阴，冀得胃气稍醒，以图转机，未识是否？余曰∶子言
颇合。遂与定生脉佐芍药、银花、陈皮、炙草等味，以糯稻根煎汤代水，春冶用党参。余曰
∶是方所重在参，党参气味平淡，仅可调补常病，岂能恃以为治。乃用吉林上好山参，每服
五分，日进药一次，参则昼夜四次，如是者五日，旁症悉除，渐能进粥，旬余而痢亦止。然
仍不撤参药，至冬初，大啖肉食，盘餐罗列，无不称美。春初，始起床步履，然能食不充肌
肉，余窃虑之。气候渐暖，饮食渐减，夏日惟食粥数次，至秋而痢复作，悉根据前法治之遂愈
。次年秋病又作，仍进参药，先君谓麟曰∶汝素知医，岂不知攻补有时？前者初病，曾服利
导之剂，继用参药，是以有效。去年病即服参，积滞未清，故今秋复发，参药断不可再用。
余心知非参不可，而又不敢违命，日夜苦思，忽忆先君昔患肝疾，得苏郡医生阮仁昌治愈，
先君每称其能。乃禀知延请，星夜着人赴苏，阅五日而阮至。诊之曰∶湿热内蕴，参药姑缓
。乃用芩、苓、楂、朴等治痢之药，先君索方观之，深以为然，命速煎。余不能措一词，时
已申分，服后未及半时，即觉气促神乱，延至亥刻，遽尔见背。呜呼痛哉！可见二载之一息
绵存，皆人参之力，一旦受此耗散，气泄不能再续，今日思之，未尝不饮泣而痛恨焉。
余作医话，不过借此遣兴，非沾沾于五运六气而言也。适阅杨 《山居新话》载一事死
不以
病，而疑为病死。余故话不涉医，而亦登医话，其略言钱塘韩介石巨室也，延 某年夏，雷
雨骤至，令庖僮登楼闭窗，雨过觅僮，则已僵毙。因疑中风猝死，而观身佩之刀，绦鞘如故
，刃则销铄过半矣，杨言其故，殊不可解。余谓此必雷死，非病死也。尝见西人于高楼及藏
火药处，每坎地竖铁杆，上出屋宇，以引雷火流入地中，而其旁必尽去五金之属，言能引雷
。由此证之，是僮之死，亦以刀铁引雷入室而然也。猝中云乎哉！
苏郡叶天士，良医也。有孙六龄发痘，叶视之曰∶绝症无生理，不必服药，其子妇只生
一子
中医用药，全凭药物的气味来扶持正气、纠正偏颇以战胜病邪。然而如今药铺所售的药物，竟有外形相似而实质不同的情况。如果不是常见的普通药材，必须亲自品尝之后才敢使用。因为投药如同派遣将领，如果不了解那个人的性情贤良与否就任用他，很少有不把事情搞砸的。
回忆过去在家乡靠近城镇的地方有个姓王的人，患火腑（指小肠或膀胱等属火的脏腑）秘结不通，大便阻塞五十多天。我用更衣丸治疗，因为没有见效而让我产生怀疑。幸好病人家属细心，服药时留下几颗药丸给我看，我尝了一下，味道很甜。我惊骇地说：“这药丸只用了芦荟和朱砂两味药，是取其苦寒滑利、重镇清热的功效；现在味道反而甘甜，这是假药。”于是写方子让他们自己配制，吃一次就通了。由此可知乡间药铺不可靠到了这种地步。
古人说用药有三忌，指的是：从未经过验证的药、气味臭秽猛毒的药、以及气味异常的药。懂得这三点，才可以驾驭草木药物。
无为地方的程生，夏天在露天坐着，夜深时觉得小腹沉重滞涩且微痛，时间久了就像有东西冲击一样，众医生都不知道这是什么病。邻近村庄有个老儒生会医术但不以此闻名，程生请他去诊治。他便让去买各种药料，依次熏蒸腹部，直到用雄黄时，腹中雷鸣般作响。他说：“这是蛇膨病。”这一定是坐的地方有蛇洞，夜深时蛇要出来，触碰到它吐出的气，导致得了这个病，如果一年肚子胀得像鼓一样，直到肚脐流水，那就不可救了。于是用雄黄配酒让他喝下，过了三天突然拉出绿色的水一斗多就好了。按：本草记载雷丸能治应声虫，与此类似。大概万物都有制约，顺着它的畏惧之处投药，所以能取效。方法虽然不同，道理是一样的。
世俗有句话叫：“若要小儿安，须带三分饥与寒。”意思是衣服不要穿得太暖，饮食不要让太饱，这样就没有蕴热停滞的祸患，这也是保婴的一种方法。凡是婴儿，内证多有痰火，外感多为风热，常患口舌肿毒，投以辛凉化毒的药物自然平安。近来有个推鬼婆子，指着说是螳螂子（一种迷信说法），说超过一周就不救，每用利刀剔割孩子的两腮，以出血块为法。这在江浙一带有，而在吴中地区特别严重，其他地方没听说有此病患。然而小孩子肌肤娇嫩薄弱，即使想要稍微宣泄风热，用针略刺还可以，千万不要用刀割裂，以免损伤血络，导致不能乳食，能不谨慎吗？
世人说用醋泥涂抹烧烫伤处，取得效果最快。这话恰好不是没有根据的，盖《北梦琐言》中记载：孙光宪的家人，正在做煎饼，一个婢女抱着孩子在旁边玩，失手把孩子掉在火上，急忙用醋泥涂在上面，到晚上就好了，并没有留下瘢痕。可见当时已有这种说法，所以能应手取效。那么世俗相传的说法，确实是不嫌听得多的。
桐城俞澹香说，他的族侄以前患水胀病，肚子胀得像鼓一样，渐渐发展到手足面目都肿，危险极了，自问没有活路了。一天，听到邻家葱煎豆腐很香，想吃，于是自己煮了一盘，吃得很快意，而且小便觉得通畅，于是连续吃了好几天，尿更加大通，肿渐渐消退，肚子也渐渐变小，不到半个月就好了。俞说：水蛊重症，却靠葱腐痊愈，实在无法理解。我说：人得病，都是因为气味相触，阻碍了内部运行的机制，感受时虽然轻微，久了能致病，只有遇到气味相投的东西，一动其机，即使是顽固疾病也可能治愈。如《内经》所说：“临病患问所便。”就是这个道理，不是臆说！
感丰初年，黄严叶某，在沪上经商。一天晚上和朋友小饮，回家时已经三更天，突然有旋风刮地而起，风过后，叶某倒地不起，同伴扶着他回寓所，过了一会儿就气绝身亡。他的朋友徐某曾经对我说：“叶某年壮盛，体质素来强壮，为什么病来得这么急，死得这么快？”我说：“这大概不是病，可能是因惊吓散失了生魂。”问：“那时候还可以救吗？”说：“按本草记载，将腰刀鞘二三寸烧成末服用，据说可以救。”第二年，徐某去苏州郡，停船在黄渡，晚餐刚吃完，听到岸上传来喧闹声，前去观看见一人倒地，于是询问是什么病，那家人说：“本来没有疾苦，黄昏出门，想去朋友家，走了不到一里路，突然跌倒在这里。”徐某想起我的话，让人用刀鞘试一下，过了一会儿渐渐苏醒，随即起坐，自己说刚开始到这里，听到树头鸟声乱噪，阴风起于林间，使人汗毛都竖起来。忽然来个巨人，挥拳猛击，吓坏了狂奔，正不知道路，接着听到前面锋刃声很厉害，心想巨人拿着器械又来，于是转身跑，不知道怎么会还在这里。看这个，可见古书所载奇方异疾，如果治疗得当，果然没有不灵的。然而这个道理很微妙，颇不容易解释。
曾看《拮奇集》记载：黑狗遍体无杂毛，眼睛像丹朱色的，名叫风夷，能治飞头之疾。起初不知道飞头是什么病，看《搜神记》吴国将军朱桓的一个婢女，每晚睡觉，头就飞去，天亮又回来；又《酉阳杂俎》说，岭南溪洞中，往往有飞头的，所以有飞头獠子的名字。头飞一天，前颈有痕，环绕脖子像红线，妻子都守着它，那人到了夜里，样子像生病，头忽然离身而去，天亮回来，像做梦醒来一样。唉！这固然是怪病啊！太奇怪了！不知道是怎么得的。遍阅诸书，无从考证罢了。
宋代徐文伯进山采药，遇到两个老人，凿石取水自己喝。徐文伯很渴，想讨一碗，老人说：“这是玉液，不是你可喝的。”再三恳求，给了半盏，刚入口，牙齿就互相撞击，咽下去觉得冷得受不了。一个老人说：“何必自找苦吃成这样呢？”于是摘树叶三片让他吃，吃了就觉得温暖异常，老人又给了一本书，说：“回去学习它，能治疗世人的疾病。”徐文伯晚年因此神乎其技。曾经在路边见一人倒地死，肚子大如瓮，徐文伯说：“这个人被爆蛇击死，气虽绝，神未离，还可以活。”于是取药丸，塞入鼻孔，一会儿腹鸣便泄而苏醒。众人问施了什么药，说：“骨笃犀。”按：骨笃犀乃巨蛇角，能解诸毒。另外，明帝时有个内侍，患头痛如破，发作就昏厥，群医认为是风，徐文伯说：“这是脑蛆。”用药点两眼角，一会儿鼻中出蛆无数，于是取来捣汁，入少许药，让他服，说：“这是脑髓所化，不用这个不能补。”从此病不再发。
吐血衄血等各种血症，今人往往遵循张仲景的泻心法，不知道所谓泻心，实际上是泻手厥阴、足厥阴、太阴、阳明四经的邪火有余。大黄是峻烈通利的药物，用得恰当，取效固然快；如果用在身体虚弱的人身上，灾祸立刻就会到来。梁武帝时姚僧坦以医术著名，正值皇帝患热病，想服大黄，姚僧坦说至尊年高，不可轻用快药，皇帝不听，几乎丧命。后来元帝得心疾，群医打算进补心的药，姚僧坦说脉洪大而实，大概有宿积阻碍，非大黄不能愈，药剂进服立刻痊愈。看这个，知道大黄的使用，必须有把握，不可胡乱施用。
华亭费秋谷的母亲，突然腹痛多次濒危，听说天马山有道人能医，于是亲自前往延请治疗。途中遇到一个老翁，一起在亭子里休息，问去哪里，费说去延医，老翁从囊中拿出一方，说：“这是孙思邈所得龙宫方，服用应当有效。”费在匆忙之间，不分什么药，就买回来给母亲进服，一次就痊愈了。后来把方子给人看，原来是《千金方》温脾汤。这个方子寒热并用，补泻兼施，确实不是庸俗之人所能定夺的。按：唐代段成式《酉阳杂俎》记载：孙思邈曾经隐居终南山，当时逢大旱，有西域僧人奏请在昆明池建坛祈雨，凡七天，池水骤缩。忽然有个老人夜里到孙思邈室，说：“弟子昆明池龙也，现在胡僧贪图弟子的脑子，诡称祈雨，实际想杀我，希望先生怜悯救我。”孙说：“我知道昆明龙宫有仙方三十首，你传授我将救你。”老人说：“此方上帝不许妄传，现在事急，怎敢吝啬？”孙得到方，于是别撰三十卷，每卷入一方，致使后世无法辨别。老翁所授，大概就是真方。
医学十三科，只有针灸科效果最快。然而不是精通技艺的人，不可轻易尝试。经云：形气不足，阴阳俱虚，针刺则重伤其阴阳，老者绝灭，壮者不复了。东垣说：脉浮数而发热，咽干舌赤，时常口渴的，热在外表，灸则灾害立至。据此，知道虚寒忌针，实热忌灸。不明白虚实的人，针与灸怎么可以妄用呢！唐代狄梁公性格通晓医药，尤其精通针术。显庆年间应制入关，路过华州，城北，人群密集，围观如墙。梁公拉着马缰绳遥望，有巨牌大字写着，能疗此疾，酬绢千匹。走近观看，有个孩子大约十四五岁，躺在牌下，鼻端生赘生物，大如拳石，根蒂连在鼻子上，才如食筋。或者触碰它，酸痛刻骨，双目被赘生物束缚，眼珠翻白，痛极欲绝。梁公怜悯很久，就说：“我能治。”他的父母及亲属磕头祈求。梁公让人扶起病人，就在脑后下针一寸许，就问针气已达痛处了吗？病人点头，梁公迅速出针，疣赘应手而落，病顿失。他的家人边哭边拜，于是奉上丝织品。梁公笑着说：“我哀怜你的生命危急，不是卖弄技艺。”不顾而去。然而行针之法，必须通达阴阳，分别穴道，倘若失之毫厘，则差以千里。像梁公这样的人，才可以施展他的伎俩。
咸丰初年，邓作夫都阃，奉檄征皖南，左额受枪伤，当时贼势正盛，郑枕戈露宿，以至于肿势日益严重。医生说这是破伤风，邪已内闭不能治。有一个老兵，取桑条几十茎，火烧其中，取汁和酒，让他喝下就痊愈了。这个方法曾在方书中见过，没想到其奇验果如此。那么应验的诸方，医家也不可不明晓。《齐谐记》记载：江夏郭坦有个儿子，病后忽然能食，每天必需米一斛多，过了五年，家产耗尽。郭坦于是驱使他自己觅食，儿子因为饥饿难忍，就拿园中的韭菜吃，竟然吃尽两畦，随即觉得闷极，于是大呕，陡出一物，状如龙，撮饭着物，即化为水，而其病顿愈。物则恰莫能试云。等到看闾阎僧《睡余偶笔》说：秦朝有化谷虫，长仅数寸，于谷器中投其一，不二三日，谷尽化水。才明白郭儿所呕，或许就是此虫。这必定是采药时，未经洗净，误吞其子，致有此患，韭能解蛇虫诸毒，故得疗此异疾。
谚语说：“走马看伤寒。”意思是转眼更改，治疗不容稍缓。如果早晨服药一剂，明晚再服，中间已隔两昼一夜，经络已传变，药力有所不及，就难取效了。所以古方有日三服，甚至昼夜服六次，使药不间断，才能制病。若是危急之症，死生于旦暮之间，用药尤当不失其时。近日有一等医人，白天高卧，晚上才出诊，以为患者众多，深夜还不得安息。一到病家，故作匆忙之态，随便开方，告知病情，则闭目不答，似厌其言之多也。唉！病患者求医，盼望很切，早延夕至，一日虚过，以致鞭长莫及。这是谁的过错呢？其心安乎哉？
有个朋友患疝气，曾经问我方子，我按前人治疝，各有所偏，立方不无错杂。张仲景以寒为名，所以主温散，调营补虚，不入气分之药；而子和又以辛香流气为主，谓肝得疏泄，病将自愈也；巢氏说：阴气内积，复加寒气，盖由营卫失调而致；陈无择也说：女血因寒湿而为瘕，男气因寒聚而成疝，是以疝属寒者固多。然而此病也有起于湿热者。盖湿热在经，郁遏既久，外复感冒，寒气收束，络脉不行，所以作痛。若专作寒论，恐未尽然。近来只有叶氏有暴疝多寒，久疝多热之议，发前人所未发，后学似当深味。现在朋友患此有年，且多目疾，维友疝病，治肝十居八九，因以辛甘化风为治，而附其说于此。
经云：湿多成五泄。水湿侵脾固多注下，然而因风病泄者，亦习见焉。盖肠有风则飧泄，胃有风则濡泄，肝为风脏，故厥阴症每多作泻。今之俗工不察病情，以为健脾导湿，治泻之要，用药大都香燥。不知肝为刚脏，必甘柔酸敛以和之，燥则劫津，香能耗散，不反增其病乎？《竹楼间笔》记载：宋时有朝贵，患痢经年，群医每进升阳理脾之剂，而病转剧。蜀医唐慎微诊之曰：此肠风也。投以育阴之品，不旬而瘥。我每次治肠风泄泻，也以柔肝获效，故特笔之。
痢疾古称滞下，盖湿热内阻，气失流行，久成积滞。昔人每以导气分消为主，此诚治夏秋时痢之常法。然而风淫火迫，寒侵积痰，亦能致痢，治之又当分别。更有脾肾交亏，饮食入胃，输化不清，积留于肠回曲折之间，入秋气，收藏不固而下泄者。道光丁酉年先君年七十有三，仲秋患痢，昼夜百余次，初延医诊视，进苦辛调气之剂，因循十余日，病益甚。闻谷即呕，虽汤饮亦不能下咽，满口白糜而作呃忒，举家惶惶，余方寸已乱，漫无意见，惟日夜祈祷，因思得一人与之共商，庶可放胆立方。越日，适毗陵庄生至，庄号春冶，曾从我学医，颇有机变，因令诊。春冶蹙额曰：尊年营卫既亏，痢疾大下，阴液已涸，今口縻呃逆，胃气将绝，实难措手，惟有扶持元气，兼养胃阴，冀得胃气稍醒，以图转机，未识是否？我说：你的话很合宜。于是与他定生脉佐芍药、银花、陈皮、炙草等味，以糯稻根煎汤代水，春冶用党参。我说：这个方子重在人参，党参气味平淡，仅可调补常病，岂能恃以为治。乃用吉林上好山参，每服五分，日进药一次，参则昼夜四次，如是者五日，旁症悉除，渐能进粥，旬余而痢亦止。然而仍不撤参药，至冬初，大啖肉食，盘餐罗列，无不称美。春初，始起床步履，然能食不充肌肉，我窃虑之。气候渐暖，饮食渐减，夏日惟食粥数次，至秋而痢复作，悉根据前法治之遂愈。次年秋病又作，仍进参药，先君谓麟曰：你素知医，岂不知攻补有时？前者初病，曾服利导之剂，继用参药，是以有效。去年病即服参，积滞未清，故今秋复发，参药断不可再用。我心里知道非参不可，而又不敢违命，日夜苦思，忽忆先君昔患肝疾，得苏郡医生阮仁昌治愈，先君每称其能。于是禀知延请，星夜着人赴苏，阅五日而阮至。诊之曰：湿热内蕴，参药姑缓。乃用芩、苓、楂、朴等治痢之药，先君索方观之，深以为然，命速煎。我不能措一词，时已申分，服后未及半时，即觉气促神乱，延至亥刻，遽尔见背。呜呼痛哉！可见二载之一息绵存，皆人参之力，一旦受此耗散，气泄不能再续，今日思之，未尝不饮泣而痛恨焉。
我作医话，不过借此遣兴，并非沾沾于五运六气而言也。适阅杨 《山居新话》载一事死不以病，而疑为病死。我故话不涉医，而亦登医话，其略言钱塘韩介石巨室也，延 某年夏，雷雨骤至，令庖僮登楼闭窗，雨过觅僮，则已僵毙。因疑中风猝死，而观身佩之刀，绦鞘如故，刃则销铄过半矣，杨言其故，殊不可解。我认为这必是雷死，非病死也。曾见西人在高楼及藏火药处，每坎地竖铁杆，上出屋宇，以引雷火流入地中，而其旁必尽去五金之属，言能引雷。由此证之，是僮之死，亦以刀铁引雷入室而然也。猝中云乎哉！
苏州叶天士，是良医。有个孙子六岁发痘，叶看后说：绝症无生理，不必服药，其子妇只生一子
In the use of Chinese medicine, drugs are relied upon solely for their flavors and odors to support healthy qi, correct imbalances, and overcome pathogenic factors. However, the drugs sold in modern pharmacies often have similar appearances but different natures. If they are not common varieties, one must taste them personally before using them. This is because administering medicine is like dispatching a general; if one does not know the person's character and virtue before appointing them, it is rare that things will not go wrong.
I recall that in my hometown near a town, there was a man surnamed Wang who suffered from constipation due to the obstruction of the "Fire Fu" (organs associated with fire, such as the small intestine or bladder), with blocked bowel movements for over fifty days. I prescribed *Gengyi Wan* (Clothing Change Pill), but when it failed to work, I became suspicious. Fortunately, the patient's family was careful and kept a few pills for me to inspect. After tasting them, I found the flavor very sweet. I was shocked and said, "This pill uses only two ingredients: Aloe (*Aloe*) and Cinnabar (*Zhusha*), chosen for their bitter, slippery, and heavy-settling properties. Now the flavor is sweet, indicating it is fake." Therefore, I wrote out the prescription for them to prepare it themselves. One dose resulted in immediate relief. This shows how unreliable local pharmacies can be.
Ancients stated three taboos in medication: drugs never tested, those with foul smells and fierce toxicity, and those with abnormal flavors. Understanding these three allows one to properly utilize herbal medicines.
Cheng Sheng from Wuwei sat outdoors in summer. Late at night, he felt heaviness and slight pain in his lower abdomen, which later felt like something attacking him. Many doctors could not identify the disease. An old scholar from a nearby village, skilled in medicine but unknown, was invited by Cheng. He instructed the purchase of various medicinal materials to fumigate the abdomen sequentially. When realgar (*Xionghuang*) was used, thunderous sounds were heard in the abdomen. The doctor said, "This is 'Snake Bloat'. There must be a snake hole where you sat. At night, snakes emerge and release vapors that cause this illness. If your abdomen swells like a drum for a year and fluid leaks from the navel, it is incurable." He then mixed realgar with wine for Cheng to drink. After three days, Cheng suddenly passed over a dou (approx. 10 liters) of green water and recovered. Note: Materia Medica records that *Leiwan* (Omphalia lapidescens) treats the "Echoing Worm," which is similar here. All things have their counteragents; by targeting what they fear, efficacy is achieved. Although the methods differ, the principles are the same.
There is a saying: "To keep a child safe, allow them a touch of hunger and cold." This means clothing should not be too warm, and diet should not be too full, preventing heat accumulation and stagnation. This is also a method for infant care. Infants often suffer from internal phlegm-fire and external wind-heat, frequently experiencing swelling and sores in the mouth and tongue. Administering acrid-cool detoxifying herbs ensures safety. Recently, some superstitious women claimed infants had "Mantis Eggs" (a superstition), stating that if not treated within a week, it would be fatal. They used sharp knives to cut the infants' cheeks to extract blood clots. This practice exists in Jiangsu and Zhejiang, especially in the Wu region, but is unheard of elsewhere. However, infants have delicate skin. Even to vent wind-heat slightly, needle pricking is acceptable, but cutting with knives damages blood collaterals, leading to inability to nurse or eat. How can one not be cautious?
It is said that applying vinegar mud to burns yields the fastest results. This is not without basis. *Bei Meng Suo Yan* records that Sun Guangxian's servant dropped a baby onto a hot griddle while making pancakes. Vinegar mud was applied immediately, and by evening, the baby healed without scars. This shows the practice existed then and worked effectively. Thus, popular traditions deserve attention.
Yu Danxiang from Tongcheng said his clan's nephew suffered from severe edema ("Water Gu"), with a swollen abdomen like a drum, spreading to limbs and face, nearing death. One day, smelling scallion-tofu stew from a neighbor, he craved it, cooked a plate, and ate heartily. His urination became smooth, and after several days, urine flow increased significantly, swelling subsided, and the abdomen shrank. He recovered in half a month. Yu found this puzzling. I said: Illness arises from interactions of flavors and odors obstructing internal circulation. Minor exposures can cause disease over time. Encountering compatible flavors can activate mechanisms, curing even stubborn diseases. As *Neijing* states: "Ask patients what they prefer." This is the principle, not speculation.
In early Gengfeng era, Ye from Huangyan, a merchant in Shanghai, drank with friends and returned past midnight. A whirlwind arose, and Ye collapsed. Companions carried him home, but he died shortly after. His friend Xu asked why a strong young man died so suddenly. I replied: "Perhaps not a disease, but shock scattering the soul." Xu asked if rescue was possible. I cited Materia Medica: burning 2-3 cun of a sword sheath into powder and ingesting it may help. The next year, Xu stopped at Huangdu. Hearing noise, he saw a man collapse. The family said he was fine until dusk, walked less than a li, and fell. Remembering my words, Xu tried the sword sheath remedy. The man revived, sat up, and recounted hearing chaotic birds, cold winds raising his hair, being attacked by a giant, fleeing, hearing blades, and running back, ending up where he fell. This proves ancient strange prescriptions work if applied correctly, though the principles are subtle and hard to explain.
*Jie Qi Ji* records a black dog with no mixed fur and red eyes named "Feng Yi," capable of treating "Flying Head" disease. Initially unknown, *Soushen Ji* mentions a maid of General Zhu Huan in Wu dynasty whose head flew off at night and returned at dawn. *Youyang Zazu* mentions "Flying Head Liao" in Lingnan caves. Those with flying heads have red marks around the neck. Wives guard them. At night, the head detaches and returns at dawn, like waking from a dream. Alas! What a strange disease! How it occurs remains unverified in books.
Xu Wenbo of Song dynasty collected herbs and met two elders drinking stone water. Thirsty, he begged for a cup. They called it "Jade Liquid," unfit for him. After insistence, they gave half a cup. Upon tasting, his teeth chattered, and swallowing felt unbearably cold. An elder said, "Why suffer?" and gave three leaves to eat, causing warmth. He also gave a book, saying study it to cure others. Xu became skilled in old age. Once seeing a dead man with a large belly, Xu said, "Struck by an exploding snake. Qi is gone, but spirit remains. Can be saved." He inserted a pill into the nostrils. Soon, abdominal sounds and bowel movement occurred, and the man revived. Asked about the drug, Xu said: "Gudu Xi" (Horn of a giant snake), which resolves all toxins. Also, an eunuch under Emperor Ming suffered splitting headaches and fainting. Doctors blamed wind. Xu diagnosed "Brain Maggots." Applying medicine to eye corners caused maggots to pour from the nose. These were crushed into juice, mixed with medicine, and ingested. Xu said, "Derived from brain marrow, necessary for tonification." The disease never recurred.
For bleeding disorders, modern practitioners follow Zhang Zhongjing's Xixin Method, unaware that "draining Heart" actually drains excess fire from the Hand Jueyin, Foot Jueyin, Foot Taiyin, and Foot Yangming meridians. Rhubarb (*Dahuang*) is harsh and purgative. Used appropriately, it works fast; on weak constitutions, it brings disaster. Yaoengt'an, famous during Liang Wudi's reign, advised against using Rhubarb on the elderly emperor, but the emperor refused and nearly died. Later, Yuan Di had heart disease. Doctors proposed tonics. Yao said the pulse was surging and solid, indicating stagnation, requiring Rhubarb. It cured him instantly. This shows Rhubarb requires precise judgment and cannot be used indiscriminately.
Fei Qiugu's mother from Huating suffered severe abdominal pain twice. Hearing of a Daoist on Tianma Mountain who could cure, Fei went to invite him. On the way, resting in a pavilion with an old man, Fei explained his purpose. The old man gave a prescription, claiming it was from Sun Simiao's Dragon Palace formula. Fei bought it blindly and administered it, curing his mother. Later revealed to be *Wenpi Tang* (Warm the Spleen Decoction) from *Qianjin Fang*. This formula combines cold/heat and tonification/purging, beyond ordinary capability. *Youyang Zazu* records Sun Simiao隐居 Zhongnan Mountain during drought. A Western monk prayed for rain at Kunming Pool for seven days, draining the water. A dragon appeared to Sun, begging for help against the monk who sought his brain. Sun offered thirty immortal formulas from the Dragon Palace in exchange for saving the dragon. The dragon agreed. Sun compiled them into thirty volumes, obscuring their origin. The old man's formula was likely genuine.
Among thirteen medical departments, acupuncture acts fastest. But only experts should attempt it. Classics state: If form and qi are deficient, and yin/yang are both weak, acupuncture severely injures them; the elderly may die, the strong may not recover. Dongyuan said: Floating, rapid pulse with fever, dry throat, red tongue, and thirst indicate external heat. Moxibustion brings disaster. Thus, deficiency-cold avoids needles, excess-heat avoids moxa. Without understanding deficiency/excess, neither should be used recklessly. Di Lianggong of Tang dynasty excelled in medicine and acupuncture. During Xianqing era, passing Huazhou, he saw a sign offering silk for curing a specific ailment. A boy of 14-15 lay beneath, with a nose tumor like a fist, rooted deeply, causing agony and blind eyes. Di pitied him, said he could cure it. Parents begged. Di inserted a needle an inch below the back of the head, asked if sensation reached the pain, and upon nodding, withdrew it. The tumor fell off, and the boy recovered. Family wept and bowed, offering gifts. Di smiled, said he acted out of pity, not for profit, and left. Acupuncture requires mastery of yin/yang and acupoints; a millimeter error leads to miles of deviation. Only masters like Di can truly practice it.
Early Xianfeng era, Marshal Deng Zuofu fought in Southern Anhui, suffering a gunshot wound to the left forehead. With rebel forces strong, he slept exposed, worsening swelling. Doctors diagnosed lockjaw (tetanus), saying internal closure made it incurable. A veteran soldier took mulberry branches, burned them, extracted juice, mixed with wine, and fed it to Deng, curing him. I had seen this method in texts but marveled at its efficacy. Physicians must know such verified formulas. *Qi Xie Ji* records Guo Tan's son from Jiangxia, who after illness ate voraciously, consuming over a hu of rice daily for five years, bankrupting the family. Forced to find food, he ate two plots of leeks, felt suffocated, vomited a dragon-like creature that turned food to water, and recovered. The creature couldn't be tested. Reading *Shuiyu Oubi*, I learned of Qin Dynasty "Grain-Dissolving Worms," inches long, turning grain to water in days. Guo's vomit might have been this worm, swallowed via unwashed herbs. Leeks resolve snake/insect toxins, hence curing this anomaly.
Proverb: "Watch typhoid like a galloping horse." Meaning changes rapidly, treatment cannot delay. If dosed morning and night, gaps allow pathogen transmission, reducing efficacy. Ancient formulas prescribed three times daily, even six times day and night, to maintain uninterrupted drug action. In critical cases, life hangs in balance; timing is crucial. Recently, some doctors sleep all day, visit patients late, claiming many appointments. Arriving hurriedly, they prescribe casually, ignoring detailed inquiries. Alas! Patients seek help urgently. Delay causes missed opportunities. Whose fault is this? Is their conscience clear?
A friend with hernia asked for a formula. Precedents vary. Zhang Zhongjing focused on cold, using warming/dispersing and nourishing Ying/Blood, avoiding Qi-moving herbs. Hezi emphasized acrid-aromatic Qi-moving herbs, believing liver soothing heals hernia. Chao Shi attributed it to internal Yin accumulation plus cold, due to Ying/Wei disharmony. Chen Wuyue linked female masses and male hernia to cold-damp/cold-aggregation. Thus, cold is common. However, damp-heat can also cause it. Damp-heat stagnates in collaterals; external cold constricts, blocking flow and causing pain. Assuming only cold is incomplete. Ye Tianshi recently proposed acute hernia is mostly cold, chronic mostly heat, revealing new insights. My friend has had hernia for years with eye issues. Since liver treatment covers 80-90% of cases, I used acrid-sweet wind-resolving methods and appended this note.
Classics: Dampness causes five types of diarrhea. Water-damp invading spleen causes loose stools, but wind-induced diarrhea is also common. Wind in intestines causes undigested stool diarrhea; wind in stomach causes watery diarrhea. Liver is the wind organ, so Jueyin syndromes often involve diarrhea. Modern mediocre doctors assume spleen-tonifying and damp-draining with aromatic-dry herbs. Ignoring that liver is a rigid organ needing sweet-soft-astringent harmonization. Dryness consumes fluids, aromatics scatter qi, worsening the condition. *Zhulou Jianbi* records a Song official with chronic dysentery worsened by yang-raising/spleen-regulating herbs. Tang Shenwei diagnosed "Intestinal Wind" and cured with yin-nourishing herbs in ten days. I also treat intestinal wind diarrhea with liver-softening herbs successfully.
Dysentery, anciently "Stagnant Down," involves damp-heat obstruction and qi stagnation, forming accumulation. Ancients used qi-guiding and dispersion, standard for summer-autumn dysentery. However, wind-fire, cold-phlegm can also cause it, requiring differentiation. Spleen/kidney deficiency with unclear digestion leads to accumulation in intestinal folds, exacerbated by autumn qi failing to secure, causing leakage. In Dingyou year of Daoguang era, my father, aged 73, suffered dysentery in mid-autumn, over 100 times day/night. Initial bitter-acrid qi-regulating herbs failed for ten days, worsening condition. Vomiting every intake, white coating, hiccups. Family panicked. I consulted Zhuang Chunye, a former student. Zhuang noted depleted yin/fluids, impending stomach qi failure. Proposed supporting primordial qi and nourishing stomach yin. We formulated *Shengmai San* with Peony, Honeysuckle, Tangerine Peel, Licorice, using Glutinous Rice Root decoction. Zhuang used Codonopsis (*Dangshen*). I argued Codonopsis is too mild; used high-grade Jilin Ginseng (*Renshen*), 5 fen per dose, four times day/night. After five days, symptoms cleared, porridge tolerated, dysentery stopped. Continued Ginseng through winter. Spring recovery allowed walking, though emaciated. Summer light diet. Autumn relapse. Recurred again next autumn. Father insisted stopping Ginseng, citing prior success with purgatives followed by tonics, arguing current retention required clearing first. I knew Ginseng was essential but feared disobeying. Recalled Dr. Ruan Renchang cured father's liver disease. Invited Ruan, who arrived in five days. Ruan diagnosed internal damp-heat, advised pausing Ginseng, prescribing Scutellaria, Poria, Hawthorn, Magnolia Bark. Father approved. I remained silent. Half hour post-ingestion, shortness of breath and confusion ensued. Died by Hai hour. Alas! Two years of survival depended on Ginseng. Sudden dispersal led to qi collapse. I weep and regret deeply.
My medical notes aim to relieve boredom, not obsess over Five Movements and Six Qi. Reading Yang's *Mountain Dwelling New Tales*, a case of death by lightning suspected as stroke. A servant died closing windows during a storm. His sword blade melted halfway. Yang couldn't explain. I believe it was lightning strike. Westerners install lightning rods to ground electricity, removing metal nearby. The servant likely attracted lightning via his sword. Not sudden stroke!
Ye Tianshi of Suzhou was a great physician. His grandson, aged six, developed smallpox. Ye examined and said, "Terminal case, no hope. No need for medicine." The daughter-in-law bore only this son...