或又曰、若卿都督之病，予略闻之矣。而其夫人就医远地，常从事于药饵，询其状则曰胸胁痛也，气升
也，寒热也，精神疲备，气力衰微。丹溪云、上升之气，多从肝出。且两胁隶于肝，胆附于肝叶之中，而为开
合之枢纽。吾意木郁则痛，亢极则气升，肝病胆亦病，枢纽不灵，开合失常，则为寒为热，此即俗所称之
肝气是也。及至病退而精神气力衰微，元气已为病魔所伤。此时顾虑元气，窃恐气得补而愈滞，转触
动其肝邪。疏泄肝邪。窃恐气以破而愈虚，更戕贼其根本。而子漫以橘半星枳杏郁藿朴投之，所效亦
幸耳。答曰、子所言是也，而实非也。子所论者，木郁气滞也。余所诊者，饮蓄肺胃也。初诊之时，见其脉弦，
亦以为木郁致之，而投药罔效。嗣察弦脉，沉候愈搏，因思沉弦为饮，则知此症实因饮阻肺胃之分，气
不得通，故胸胁作痛。肺右旋而下降，饮阻其下降之令，故发为气升。饮阻则营卫循环失度，故为寒为
热。精神气力衰微，由病而致，能却其病，则精神气力，不补而自复矣。所以导痰、温胆、四七、二陈、越曲、大
和中饮、正气散等汤专主疏利痰气，痰气化而胸阳以通，故痛止。痰去则肺气得降，故喘宁。营卫无所
窒碍，故寒热愈也。精力不补自复者，譬如人身负物，则手足沉重，一旦释其重负，岂不手足轻便，快然
自如哉。所以昔常偃卧，而今俨如平人。虽经一月或数十日，必倦怠嗜卧，而肌肤凛凛然，似寒非寒，吾
知其饮食又酿湿痰于内，脾阳受困，阳气不通，不能敷布，所以仍如前治，辄应手效验也。或又曰、然则
通阳而独不投附桂，何也。曰、阳虚不布者，当用附桂人参之属以助其阳，此则阳气无损，不过为湿痰
所遏，不能敷布，非真正阳虚之比，所以化其痰、和其中、理其气，阳气一通，便爽适矣。或曰、谚有云千方
易得，一效难求。子治此疾，吾窃非之，而历数年来投药辄效者，究非无故也。医可忽乎哉。
有人又说：“关于那位都督夫人的病，我略有所闻。她的夫人去远方就医，长期服药，询问病情时说是胸胁疼痛、气机上逆、寒热往来、精神疲惫、气力衰微。朱丹溪说：‘上升的气机，多从肝发出。’况且两胁隶属于肝，胆附在肝脏之中，是开合的枢纽。我的意思是，木气郁结则疼痛，亢盛至极则气机上逆，肝病则胆亦病，枢纽不灵，开合失常，从而表现为寒或热，这就是俗称的‘肝气’病。等到病症消退后，精神和气力依然衰微，是因为元气已经被病魔所伤。此时顾虑元气，我担心补气会导致气机更加滞涩，反而触动肝邪。想要疏泄肝邪，又担心破气药会使正气更加虚弱，进一步损伤根本。而你随意使用橘红、半夏、天南星、枳实、杏仁、郁金、藿香、厚朴等药物投治，能取得疗效也是侥幸罢了。”
回答说：“你所说的有道理，但实际上不对。你所论述的是木郁气滞证。我所诊断的，是痰饮蓄积于肺胃。初诊时，看到脉象弦，也以为是木郁所致，但用药无效。后来观察弦脉，沉取时搏指有力，想到沉弦脉主饮邪，便知道此症实际上是因为饮邪阻滞于肺胃之间，气机不得通畅，所以胸胁作痛。肺气右旋而下降，饮邪阻遏了肺气下降的功能，所以发为气机上逆。饮邪阻滞导致营卫循环失度，所以出现寒热往来。精神和气力的衰微，是由疾病导致的，如果能祛除疾病，精神和气力不用补益也能自然恢复。因此，使用导痰汤、温胆汤、四七汤、二陈汤、越鞠丸、大和中饮、正气散等方剂，专门主治疏利痰气。痰气化散则胸阳得以通畅，所以疼痛停止。痰饮去除则肺气得以下降，所以气喘平息。营卫没有阻碍，所以寒热痊愈。精力不用补益就能恢复，就像人身背负重物，手足沉重，一旦卸下重担，难道不是手足轻便，轻松自如吗？所以以前常常卧床不起，现在却像正常人一样。虽然经过一个月或几十天，必定倦怠嗜卧，肌肤凛凛然，似冷非冷，我知道这是因为饮食又酿生湿痰于体内，脾阳受困，阳气不通，不能敷布全身，所以仍然按照之前的方法治疗，往往应手见效。”
回答说：“如果是阳虚不能敷布的，应当用附子、肉桂、人参之类来助阳。此症则是阳气并未受损，只不过被湿痰所遏制，不能敷布，并非真正的阳虚，所以化解痰饮、调和脾胃、调理气机，阳气一通，身体就清爽舒适了。”
有人说：“谚语说：‘千方易得，一效难求。’你治疗这个疾病，我私下里并不认同，但你多年来用药辄有效验，终究不是没有原因的。医生怎么能轻视呢？”
Another person said, "Regarding the illness of that Governor's wife, I have heard a little about it. Her ladyship sought medical treatment in a distant place and has been engaged in medication for a long time. Inquiring about her condition, she described chest and hypochondriac pain, rising Qi, alternating chills and fever, mental fatigue, and weak physical strength. Zhu Danxi stated: 'The ascending Qi mostly originates from the Liver.' Moreover, the two hypochondria belong to the Liver, and the Gallbladder is attached within the liver lobes, serving as the pivot of opening and closing. My understanding is that when Wood Qi is depressed, pain occurs; when hyperactive to the extreme, Qi ascends. When the Liver is diseased, the Gallbladder is also diseased; if the pivot becomes unresponsive and opening and closing become abnormal, it manifests as cold or heat. This is what is commonly referred to as 'Liver Qi' disorder. After the disease recedes but mental and physical strength remain weak, it is because the Yuan Qi (Original Qi) has been damaged by the pathogen. At this time, worrying about the Yuan Qi, I fear that tonifying Qi will cause further stagnation, thereby triggering Liver pathogens. Attempting to drain Liver pathogens, I fear that Qi-breaking herbs will further weaken the righteous Qi, damaging the root even more. You casually prescribed Ju Hong (Citrus reticulata Pericarpium), Ban Xia (Pinelliae Rhizoma), Tian Nan Xing (Arisaematis Rhizoma), Zhi Shi (Aurantii Fructus Immaturus), Xing Ren (Armeniacae Semen Amarum), Yu Jin (Curcumae Radix), Huo Xiang (Agastaches Herba), and Hou Po (Magnoliae Officinalis Cortex). That any efficacy was achieved is merely fortunate."
I replied, "What you say has merit, but is essentially incorrect. What you discussed is Wood depression and Qi stagnation. What I diagnosed is Phlegm-fluid retention accumulating in the Lungs and Stomach. Upon initial diagnosis, seeing the Wiry pulse (Xian Mai), I also suspected it was caused by Wood depression, but the medication was ineffective. Subsequently, observing the Wiry pulse, which became more distinct upon deep pressure (Chen Hou), I recalled that a Deep-Wiry pulse indicates fluid retention. Thus, I realized this case was actually due to fluid retention obstructing the boundary between the Lungs and Stomach, preventing Qi from flowing freely, hence the chest and hypochondriac pain. Lung Qi rotates rightward and descends; fluid retention obstructs this descending function, causing Qi to ascend. Fluid retention disrupts the circulation of Ying (Nutritive) and Wei (Defensive) Qi, leading to alternating chills and fever. The weakness of mental and physical strength is caused by the disease itself; once the disease is eliminated, mental and physical strength will recover spontaneously without tonification. Therefore, using formulas such as Dao Tan Tang (Phlegm-Draining Decoction), Wen Dan Tang (Warming the Gallbladder Decoction), Si Qi Tang (Four-Seven Decoction), Er Chen Tang (Two-Aged Decoction), Yue Ju Wan (Relieving Depression Pill), Da He Zhong Yin (Great Middle-Harmonizing Drink), and Zheng Qi San (Righteous Qi Powder), specifically to ventilate and regulate Phlegm-Qi. Once Phlegm-Qi is resolved, Chest Yang becomes unobstructed, so pain ceases. Once Phlegm is removed, Lung Qi descends, so panting calms. With no obstruction to Ying and Wei Qi, chills and fever resolve. Energy recovering without tonification is like a person carrying a heavy load, whose limbs feel heavy; once the burden is lifted, are the limbs not light and comfortable? Hence, previously lying prostrate, now appearing like a healthy person. Although after a month or dozens of days, there must be fatigue and a desire to lie down, with skin feeling chilly yet not truly cold, I know this is because diet has again generated damp-phlegm internally, confining Spleen Yang, blocking Yang Qi flow and distribution. Thus, treating according to the previous method yields immediate results.
Another asked, "Then why did you not use Fu Zi (Aconiti Lateralis Radix Preparata) and Rou Gui (Cinnamomi Cortex) alone to unblock Yang?"
I answered, "If it were Yang deficiency failing to distribute, one should use Fu Zi, Rou Gui, and Ren Shen (Ginseng Radix et Rhizoma) to assist Yang. In this case, however, Yang Qi is not damaged but merely inhibited by damp-phlegm, unable to distribute. It is not comparable to true Yang deficiency. Therefore, resolving phlegm, harmonizing the middle, and regulating Qi allows Yang Qi to flow freely, resulting in comfort."
Someone said, "As the proverb goes: 'Easy to find a thousand prescriptions, hard to find one effective cure.' Regarding your treatment of this illness, I privately disagree, yet over the years, your prescriptions have consistently proven effective, which is certainly not without reason. How can physicians be slighted?"