痿证也。古人治痿独取阳明，脾主四肢，表里相应，投以桂枝白虎汤，神识顿清，手指无恙。
潘氏子肋下肿溃，窜孔甚巨，孔中作声，如婴儿啜泣。余曰∶是名渊疽，法不得治。其母哀请曰∶是子少孤，
婚又未久，一脉之传，惟此而已。余闻之恻然，乃曰∶但善调摄，更量力以行阴德，万分一得不死，专事医药，
不足恃也。母子唯唯受教。余乃日夜属思，以谓证属大虚，固当补益，但疽孔作声，则内膜已破，气从旁出矣。
非护其膜，补亦徒施！以人参、白术、乌梅炭、白芨、白蜡、象牙屑、猪脊髓和为丸，令日三服，以固气；仍捣
诸药，益以生肌之品，制若粘饼，塞疽口，丝绵裹青铅罨其外，大膏药盖之，阔布缠缚其体，三日一易；复用参
麦六味加龙、蛎等品，煎汁饮之。如是二十余日，其声渐除，三月余而口敛。余初经治，不望其果奏效也。
镇洋郑秀才颈下出水，涓涓不绝，已数年矣。医谓串 。余视之，溃口三、四，皆甚深奥，曰∶此古所谓蚁
也。用穿山甲炙存性研敷，果瘳。
有食阿芙蓉者，遍体发 ，痛痒交作，抑搔肤脱，终日昏聩，言语诞妄。余曰∶此中毒之最盛者，寻常解法，
恐不及济。用朱砂一两，与琥珀同研末，犀角磨汁，和三豆汤进之。神志顿清，而遍身无皮，痛不可忍，复磨石
菖蒲、绿豆粉如尘粘席，
乃得安卧，不半月愈。
一妇患三疟年余，忽转身发疮，大皆如钱，疡医治久转剧，饮食不进。余曰∶此伏邪走泄为疮，三阴无恙矣，
不可作疮治，而以寒凉伤胃也。以四君子加 、归、白芷，数服即愈。
昔在海门，有同事樊姓者，肩上患痈，医进荆防败毒散而寒热大作；又进仙方活命饮、外敷三黄散四五日，
侠脊 肿作痛，红晕满背，脊间高如覆碗；又饮内疏黄连汤、外涂铁箍等散，更日服蜡矾丸，至十朝黑陷，声嘶
呕恶，汤水亦不能沾，十一朝昏晕不苏。前医皆云毒盛无可挽回，招之不至矣。有故游击杨公朝栋之孙忘其名，
善治痈疽，因不识字，人皆轻之。樊证濒危，不得已邀彼来视。笑曰∶此非阴证，被寒凉遏抑所致。用吾药而患
处能高起者，尚可救。乃出药敷疮上，越日果高起。杨复视曰∶能从吾言，此疾可生。第一不许服药，第二不许
忌口。缘现下粒米不进，必停药三日，使胃中宿药渐消，自能进食。既能食，正宜投其所喜，岂可强禁其口，而
再绝其胃气哉？如此则百二十日可以收功。后竟如其言而愈。至所用之药，留心揣测，终莫能识。然此证若于初
起时，内以点舌丹汗之，顶上以蟾酥丸或白降丹泄其毒，使有出路，必无横溃决裂之祸。寒凉日进而胃闭不纳，
蜡矾频服而声嘶作呕，酿成败证。设无杨公，人亦但知其死于病，恶知其死于药乎？举世梦梦，良可深悼。
壬寅，余在海门之东昌镇。有徐姓者，患胸铄，腐肉上至顶，下至颈，左右至两耳，医不能治。余悯其贫，
为设法痊之。并不服药，凡百四十余日而收攻。此开手第一证也，由是求治
者踵门不绝。余初亦未知不服药可愈病，因目击杨公之法，而私淑其意，治之果应。始悟世之外科，朝凉暮热，
欺世盗名，杀人不可胜计，而无形迹可寻也。其始临证，则曰死证也，或他人治过之证，则曰前医误治，不可救
矣。皆为日后邀功避谤之计耳，可叹也已。
余在海门，见沈氏司炊者患唇疔，自辰至午，口不能开，医投葱矾不能吞，用活命饮亦无济。易医屡进寒凉，
遂硬肿至项，色白不变。最后一医砭肿处，出血筋一条，流血不止，知饥不能食，至三十一日而死。夫唇疔急证
也，色白无红阴证也，发于手足阳明交会之所，误投寒凉克伐之药，内热为外寒所束可知。若初起时刺委中及阳
明诸穴出黑血，进点舌丹汗之，外涂蟾酥，或有可效。惜诸医皆不知之。不然急证安能延至一月余之久？人不知
死于药也，哀哉！
癸丑四月，桐乡屠甸镇张德祥令正，年八十一岁，患脑铄，医者皆云必死。余视之，疮已溃烂不堪，不卧者
二十三日，不饮食者五日，平素体肥，肌已削尽，两耳绝不闻声，脉象弦数。性不喜药，一病至此，亦未尝一药
也。诸医皆谓不服药以至于是，余谓溃败至此，尚可挽回者，幸未服药耳。但须从我言，行我法，则五、六十日
可以收功。盖疮口已深，须开一孔泄其脓血，若不从我言，则下延及喉，虽有神丹，不可救矣。病家唯唯。遂开
一孔，去黑血盏许，脓亦相等。明日头重如失，两耳能听，且进粥碗许。越五日复视，腐肉下半脱尽，新肉已生，
细视上半黑处，尚未全死，用物挑起其皮，入药于内，令其每日抽换，果得粘连。凡九十日全愈。其满头之发皆
白，而烂处复生之肉，新发皆黑。此人至今尚健，益信享高年者不服丸散。嗣有于某等十余人，余悉治愈。是此
证并无死法。曩上海望族
王辑庭之嗣君，年六十一岁，患此证。素识医者谓曰∶少忍痛，当为去之。不听，逾旬渐大，适道署延苏州陈某
治疾，乃赫赫一时者，遂请视之。进以人参、鹿茸等药，疮已势甚，犹曰未也，乃杀鸡煎汤，煮药以进，一服而
口眼皆合，头重如山，证随以败。凡富贵之家，死于此者甚多。始则畏少痛而逆忠言，继则慕虚名而被惨杀。非
死于病，实死于医。愿天下人少察狂瞽之言，毋蹈前车之覆。
发背之极大者，所谓竟体发也。平湖郭湘屏患此证，始医者进犀角、黄连，致成黑陷，后医者投桂、附而作
淋渴，饮食不进。或断三日，或断一旬，更医数辈，技穷莫措。令郎肖屏茂才求余往视。被问曰∶曾见此大证乎？
余实未尝见如许大证，欲安其心，慰之曰∶吾所见有大于此者，不足畏也。为取去腐肉碗许，病者即觉如释重负。
其子请用十全大补，余晓之曰∶尊翁之所以绝粒者，正坐补托之故，胸次宿药未消，今再峻补，生机绝也。俟三
日后，宿药消尽，胃气自苏。此证本由湿热郁蒸而成，寒凉以遏之，温补以锢之，宜其滋蔓日甚也。今惟导赤散
驱其湿热下行，至溺清则止。越五日复视，已能自起，在床沿叩谢救命。凡百八十余日而全愈。在百日之间，曾
患牙疳，与竹叶石膏汤而安。其人至今尚在。设根据立斋上渴下淋而用十全、八味，安有生理？陈良甫云∶既溃一
毫冷药不可进，其可泥乎？
斜桥苏氏妇，年二十四岁，患乳肿如悬瓠，溃处日流水，医治二百余日，略不见效。冬初求治于余，视其面
色青瘦，微
嗽唇红，音朗不嘶，寒热暮甚，日进粥两盏、饭半盏。所服之药，洋参、鳖甲、丹皮之类，皆谓疮劳已成，不过
苟延时日也。余知其因循误药致此，以纸捻入药于疮孔，嘱到家自为抽换。妇云∶胃气不佳，求赐一方。余曰∶
汝误药至此，尚不悟耶？停药五日，胃自苏矣。又问究成劳否？余给之曰∶后五日来，当赠汝妙药，决不成劳也。
忻然而去。越五日来日∶奇哉，到家方暮，觉乳胀，抽去药线，出清脓碗许，是夜寒热顿减；近来抽换，日得清
脓杯许，今不复如前肿硬矣。饭已可进两盏，固求赐方。余曰∶煎剂费事，余有合就丸药，日服数钱可也。持去
后，越旬复来曰∶自服妙药，胃气胜于平时，惟脓水未净，月事未行，求一通经方。余见其肌肉丰润，两颊红晕，
经已将至。若不与药，而另求内科通经，反恐误事，仍以前丸与之。后即全愈受孕。其实两次所用之药，皆饭焦
磨末，少如橘皮而丸也。余治六、七年不愈之乳证，无不用药线刀针愈者，不胜仆数。即如此妇，若不插药，脓
何由出？寒热何由止？胃气何由复？岂但疮劳而已，殆无生理矣！设不停药，肠胃津液被伐，必致绝粒。尝谓汉、
唐方士以金石杀人，赖高贤救止，而草木延年补益诸说，牢不可破，真医道设而枉死者多矣。窃怪今之医生劝人
服药，吾不知其居心何为？或问∶断为死证而得不死，何也？曰∶医之所谓死证，彼自有死之之法耳。断为死证
而竟死，昧者必诧其术之神，而医者亦诩其断之准，而自鸣得意。悲夫，业医者知此有几人哉？
张德祥令孙患行程蹇，多医不效。上至小腿，肿如瓠，气喘声嘶，不食者九日，烦躁恶近人，近则热不可当。
多医聚讼，或决之立毙，或决之成废。邀余往，已暮，执烛视之，近烛则痛如锥刺。乃父恐余用刀，屡述群医之
说。余晓之曰∶汝
不欲此子之生，余不敢言。既邀余来，是欲其生也，岂可随声附和、袖手旁观耶？今之外科皆乡愿也，抄写成方，
虚应故事，并无真知灼见；更可恶者，造作疑似之言，簧惑病家，有如奸胥猾吏造案，虽咎陶听之，犹以为杀无
可宥。要知脚跟之皮，浓于牛领，不能下溃，必至上穿足面，则不可救矣。言未已，病者曰∶怪道数日来骨缝锥
痛难忍。其妻跪求请救，而一家数十口犹执不可。余曰∶吾岂挟仇而欲害彼，若决之而毙，吾偿其命可也。众皆
咋舌不敢言，遂决之，出脓半盏，敷贴已，余至外厅晚膳，未毕，内报熟睡矣，如之何？余曰∶觉来要啜粥矣。
既而果然。三日后吃饭，四十日收功。然人情畏痛苟安者多，故庸医之言易于入耳。病无去路，上溃足面，腐及
内外踝，而迁延以死者，比比也。
屠甸镇王某，先患疔毒，旋生背疽，高肿不红，医巫术尽，家破而病日剧。延余往视，肌肉全消，面无人色，
脉至断续如丝，按其疮，虚软漫肿无红，证已七十六日矣。流泪被面，声言救命，音细如蜂，深堪悯恻，殊难措
手。合家痛哭，而求设法。余索其方视之，先则犀角、牛黄，继则参、 、归、术之类，皆谓内有瘀血，虚不化
脓也。余静坐筹思，七十余日之瘀血，既不化脓，亦不消散，乃脾胃被伐，气弱难溃，内肌尽腐，皮浓难穿，日
久力穷，势濒于殆。若不决则必死，设决之而斯须毙命，又当如何？乃谓其父曰∶此证内肉尽腐，外皮甚浓，脓
无出路，以致背重如山，肌肉日消，而脓日多，势必消尽而后已。吾今筹一死里求生之法，汝可导我复视，其父
从之。因细按其皮，略无薄隙可乘，不得已久按以乱之，卒然一刺，得大脓四大碗，幸不毙命，随以粥食调之。
越五日复视，已能披衣起坐矣。以上数证，皆所谓养痈为患也。古人原
有刀针不可轻用之戒，盖为手法不精，或轻浅之证，及脓未成时而言也。以决之之法，诚不易易，即辨脓亦甚难，
脉诀洪滑为脓成，而此证脉至如丝，刺脓至四大碗，脉岂可凭乎？然此证若诊于三十日内外，未始非洪滑也。惟
医家误信补托可使自溃，孰知欲托其脓者，反能化肌肉以为脓，脓日多则气血日少，尚欲寻其洪滑之脉，安可得
乎？昧者犹訾刀针为蛮法。呜呼，此与谈性命而废武备，寇至不战，委而去之者，何以异耶？须知此脓不刺，必
与此身同就木而已。余见如此毙命者，指不胜屈，故愤而为之，岂好为疡医哉！至腿上附骨疽，迁延补托，而脓
随身敛者，则尤多也。
一妇渊疽，脓蓄不溃，下至腰，前至胸，形容骨立，声细如蜂，头晕身热，不食。延逾半载，求治于余。余
亦不能措手，实深惭愧。然此二证，皆误于补托求溃，孰知终不可溃。元气未漓者，尚可决之求活；元气已漓者，
脓必随身而殉。
一膀胱痈，胀痛求死，脓自小便而出，与八正散加琥珀、乳香、麝香而愈。
一男子小腿数日间全腐，疼痛难忍。与珠黄十宝而痛止腐脱。
一男子臂肿如腿， 木而硬，医投消散如故。余与 峒丸二服，外敷解散之药于骱间，四面作脓而溃。此亦
臂上附骨疽也。治不得法，即难收功。
一男子唇疔，既拔其一，复生其七。先用蟾酥丸，头面肿退，后用犀地加牛黄而愈。
壬子夏，余次子患干霍乱，身热不渴，舌燥无苔，六脉俱
伏，痛在胃脘，连及胸胁，势甚汹涌。余与地浆一碗，势少定，少顷复作，因径投大承气汤一帖，其痛即下行之
脐间，又一帖，痛又下行，伏于少腹右角，按之始痛，不按则与平人无异，起病至此，已历周时，思食甚急，乃
与绿豆煮粥与之。食后一切如常，惟少腹右角按之仍有小块，隐隐作痛，遂重用当归、杞子、蒌仁，佐以桃仁、
红花，少加牛膝以导之。服一时许，腹中 有声，下紫黑血一块，约五寸许，而少腹之痛块若失。此病治法，
原出一时臆见，然竟已获痊，特录出质之潜斋，不知以为何如？愚谓霍乱证因于暑热者多，故感受稍重，极易入
营，古人刺以泄血，及内饮茺蔚汤、藕汁、童便，此所以治营分之邪也。杨公子舌燥无苔而不渴，痛又及胁，必
平日偶有络伤未觉，乃邪遂乘隙而入也。承气之硝、黄，并是血药，气行则瘀降，故痛得渐下，迨块在痛未蠲，
而知饥能食，益见气分之邪已廓，而血分之邪尚匿，无庸承气之直攻，改从濡化而曲导。操纵有法，余服其手眼
之超。
这是痿证。古人治疗痿证，主张独取阳明经，因为脾主四肢，表里相应，投用桂枝白虎汤后，患者的神志立刻清醒，手指功能恢复正常。
潘氏的儿子肋下肿胀溃烂，破开的孔洞非常大，孔中发出声音，像婴儿哭泣一样。我说：这名叫渊疽，按照常规治法无法治愈。他的母亲哀求道：这孩子年少丧父，结婚又不久，家族血脉的传承只有他了。我听了感到悲伤，于是说：只要好好调养护理，再量力而行地做阴德善事，万分之一或许能不死；如果专门依赖医药，是不足以依靠的。母子二人恭敬地接受教导。我日夜思考，认为此证属于大虚之证，固然应当补益，但既然疽孔发声，说明内膜已经破裂，气从旁边漏出了。如果不保护内膜，补药也是白施！于是用人参、白术、乌梅炭、白芨、白蜡、象牙屑、猪脊髓混合制成丸药，让患者每天服用三次，以固护元气；仍将各种药物捣碎，加入生肌的药物，制成像粘饼一样的形状，塞入疽口，用丝绵包裹青铅敷在外面，再用大膏药覆盖，用宽布缠绕束缚身体，每三天更换一次；又用参麦六味地黄汤加龙骨、牡蛎等药材，煎汁给患者饮用。像这样过了二十多天，声音逐渐消失，三个月左右伤口收敛。我刚开始治疗时，并没有指望它能立即见效。
镇洋的郑秀才脖子下面流水，涓涓不断，已经好几年了。医生说是串瘘。我看他，有三四处溃口，都很深奥，说：这就是古书上所说的蚁瘘。用穿山甲炙烤存性研成粉末外敷，果然痊愈。
有一个吸食鸦片的人，全身发出疮疡，疼痛和瘙痒交替发作，抓挠导致皮肤脱落，整天昏沉糊涂，言语荒诞妄乱。我说：这是中毒最严重的情况，普通的解毒方法，恐怕来不及救治。用朱砂一两，与琥珀一起研成末，犀角磨成汁，配合三豆汤送服。神志立刻清醒，但全身没有皮肤，疼痛难以忍受，又磨石菖蒲、绿豆粉像灰尘一样撒在席子上，才能安稳躺卧，不到半个月就好了。
有一位妇女患疟疾三年多，忽然转身发疮，疮疡大小都像铜钱，外科医生治疗很久反而加重，饮食不进。我说：这是伏邪走泄形成的疮疡，三阴经无恙了，不能当作普通疮疡治疗，而是被寒凉药物伤了胃气。用四君子汤加黄芪、当归、白芷，服用几剂就痊愈了。
以前在海门，有一位同事姓樊，肩上患痈，医生进荆防败毒散后寒热大作；又进仙方活命饮，外敷三黄散四五日，胁脊处红肿作痛，红晕布满背部，脊间隆起高如倒扣的碗；又喝内疏黄连汤，外涂铁箍散等药，更每日服用蜡矾丸，到了第十天疮面黑陷，声音嘶哑恶心呕吐，连汤水都不能沾唇，第十一天的时候昏迷不醒。之前的医生都说毒气盛极无法挽回，招魂都叫不回来了。有一位故游击杨公朝栋的孙子（名字忘了），擅长治疗痈疽，因为不识字，人们都轻视他。樊某病情危急，不得已邀请他来诊治。他笑着说：这不是阴证，是被寒凉药物遏制压抑所致。如果用我的药，患处能高起来，还可以救。于是拿出药敷在疮上，第二天果然高起来。杨某再次查看说：如果能听从我的话，这个病可以治好。第一不许服药，第二不许忌口。因为现在粒米不进，必须停药三天，使胃中的宿药逐渐消除，自然就能进食。既然能吃饭，正应该投其所好，怎么能强行禁止饮食，从而断绝胃气呢？像这样一百二十天可以收功。后来竟然真的像他说的那样痊愈了。至于所用的药，留心揣摩猜测，始终没能认出来。然而这个病如果在初起时，内服点舌丹发汗，头顶上用蟾酥丸或白降丹泄其毒，使毒有出路，必定不会有横决溃裂的祸患。寒凉药日益进入而胃闭不纳，蜡矾丸频繁服用而导致声嘶呕吐，酿成坏证。如果没有杨公，人们也只知他死于疾病，哪里知道他其实是死于药物呢？举世昏昏沉沉，实在令人深深悲痛。
壬寅年，我在海门的东昌镇。有一个姓徐的人，患胸痈，腐肉向上到头顶，向下到颈部，向左右到两耳，医生无法治疗。我怜悯他家贫，为他设法治愈。并不让他服药，经过一百四十多天而收功。这是我开手的第一例病例，从此求治的人络绎不绝。我起初也不知道不服药可以治病，因为是亲眼目睹杨公的方法，私下仰慕他的意旨，治疗果然应验。这才领悟到世上的外科医生，早上用凉药晚上用热药，欺世盗名，杀人数不胜数，而且没有痕迹可寻。他们刚临证时，就说这是死证，或者是别人治过的病，就说前医误治，不可救了。这都是为了日后邀功避谤的打算罢了，可悲啊！
我在海门，看见沈家做饭的仆人患唇疔，从辰时到午时，嘴张不开，医生投葱矾不能吞服，用活命饮也没有帮助。换医生多次使用寒凉药，于是硬肿直到颈部，颜色发白不变。最后一个医生用砭石刺肿处，流出一条筋状的血液，流血不止，知道饿了但不能吃，到了第三十一日而死。唇疔是急症，颜色发白无红是阴证，发于手足阳明经交会的地方，误投寒凉克伐的药物，可知内热被外寒所束缚。如果在初起时刺委中及阳明各穴放出黑血，进服点舌丹发汗，外涂蟾酥，或许有疗效。可惜各位医生都不知道。不然急症怎么能拖延到一个多月之久？人们不知道他是死于药物，悲哀啊！
癸丑年四月，桐乡屠甸镇张德祥的妻子，八十一岁，患脑痈，医生都说必死无疑。我看他，疮已溃烂不堪，不卧床二十三天，不饮食五天，平素身体肥胖，肌肉已削尽，两耳完全听不见声音，脉象弦数。性格不喜欢吃药，生病到这个地步，也未曾吃过一剂药。众医生都说是不吃药才导致这样的，我说溃败到这种程度，还可以挽回的，幸亏没吃药。只要听从我的话，实行我的方法，那么五六十天可以收功。因为疮口已经很深，需要开一个孔泄出脓血，如果不听我的话，则向下延及喉咙，虽然有神丹妙药，也不可救了。病家恭敬答应。于是开一个孔，去黑血约一碗，脓也相等。第二天头重感消失，两耳能听见声音，且能吃下一碗粥。过了五天复诊，腐肉下半部分脱尽，新肉已生，仔细看上半部分黑色处，尚未全死，用工具挑起其皮，将药放入其中，让它每天抽取更换，果然得以粘连。共九十天完全痊愈。他满头头发都是白的，而腐烂处长出的新肉，新长出的头发都是黑的。这个人至今还健康，更加相信享高寿的人不服用丸散。随后有于某等十多人，我都治愈了。这个病并没有死法。从前上海望族王辑庭的继子，六十一岁，患这个病。平时认识的医生说：稍微忍耐疼痛，我会为你去除它。他不听，过了一旬逐渐变大，恰逢道署请苏州陈某来治病，陈某当时赫赫有名，于是请他诊治。陈某进用人参、鹿茸等药，疮势已经很严重，还说没事，于是杀鸡煎汤，煮药给他喝，一服下去口眼都闭合，头重如山，病症随即败坏。凡是富贵人家，死于此病的很多。开始时害怕轻微疼痛而违背忠言，后来羡慕虚名而被惨杀。不是死于疾病，实在是死于医生。愿天下人少听信狂妄浅薄的话，不要重蹈覆辙。
发背中极大的，所谓竟体发。平湖郭湘屏患这个病，开始医生进犀角、黄连，导致变成黑陷，后来的医生投桂枝、附子而导致小便淋涩口渴，饮食不进。有时断药三天，有时断药十天，换了几个医生，技术穷尽没办法。他的儿子肖屏茂才请求我去诊治。我问：曾见过这么大的病吗？我确实没见过这么大的病，想安抚他的心，安慰他说：我见过的比这更大的，不必害怕。为他取去腐肉约一碗，病人立刻觉得如释重负。他的儿子想用十全大补汤，我开导他说：令尊之所以绝食，正是由于补托的缘故，胸中宿药未消，现在再峻补，生机就断绝了。等到三天后，宿药消尽，胃气自然苏醒。这个病本来由湿热郁蒸而成，寒凉药遏制它，温补药禁锢它，难怪蔓延日益严重。现在只用导赤散驱除湿热下行，直到尿液清亮为止。过了五天复诊，已经能自己起身，在床沿叩谢救命之恩。共一百八十多天完全痊愈。在一百天之间，曾患牙疳，用竹叶石膏汤而安定。这个人至今还在世。如果根据立斋的理论，上渴下淋而用十全大补、八味丸，哪里有生机？陈良甫说：既已溃烂，一毫冷药不可进，这话可以拘泥吗？
斜桥苏氏妇，二十四岁，患乳肿如悬壶，溃处每天流水，医治二百多天，略不见效。冬初求治于我，看她的面色青瘦，微咳唇红，声音洪亮不嘶哑，傍晚寒热甚重，每天进粥两盏、饭半盏。所服用的药，西洋参、鳖甲、丹皮之类，都说已成疮劳，不过是苟延残喘罢了。我知道她是因循延误用药导致这样，用纸捻蘸药插入疮孔，嘱咐回家后自行抽取更换。妇人说：胃气不好，请求赐一方药。我说：你误药到这种地步，还不醒悟吗？停药五天，胃气自然苏醒。又问终究会成劳吗？我骗她说：五天后来，当赠你妙药，绝不会成劳。她高兴地离开。过了五天来说：奇怪啊，到家刚傍晚，觉得乳房胀，抽去药线，流出清脓约一碗，那天晚上寒热顿减；近来抽取更换，每天得清脓一杯左右，现在不再像之前那样肿硬了。饭已经可以吃两盏，坚决请求赐方。我说：煎剂费事，我有现成的丸药，每天服用几钱即可。拿回去后，过了十天又来：自服妙药，胃气胜于平时，只是脓水未净，月经未行，请求一通经方。我看她肌肉丰润，两颊红晕，月经将至。如果不给她药，而另求内科通经，反倒恐误事，仍给以前的丸药。之后完全痊愈并受孕。其实两次所用的药，都是饭焦磨末，少许橘皮为引制成的丸药。我治疗六七年不愈的乳证，无不用药线刀针治愈的，数不胜数。就像这位妇人，如果不插药，脓从哪里出？寒热从哪里止？胃气从哪里恢复？岂止是疮劳而已，几乎没有生机了！如果不停药，肠胃津液被攻伐，必定导致绝食。我曾说汉唐方士用金石杀人，赖高贤救止，而草木延年补益诸说牢不可破，真是医学设立后枉死者多了。窃怪现在的医生劝人服药，我不知道他们居心何为？有人问：断为死证而得不死，为什么呢？我说：医生所谓的死证，他们自有使其死的方法罢了。断为死证而竟死，愚昧的人一定惊讶他的医术神奇，而医生也夸耀诊断准确，自我得意。可悲啊，从事医学的人知道这些有几个人呢？
张德祥的孙子患行程蹇（一种严重的下肢肿痛病），多位医生无效。肿至上至小腿，肿如葫芦，气喘声嘶，不食九天，烦躁厌恶靠近人，靠近则热不可当。多位医生争论不休，有的断定立即死亡，有的断定成为废人。邀请我去，已是傍晚，拿着蜡烛看，靠近蜡烛则痛如锥刺。父亲怕我用刀，屡次叙述众医生的话。我开导他说：你不想让这个孩子活，我不敢说。既然邀请我来，是想让他活，怎么能随声附和、袖手旁观呢？现在的外科医生都是老好人，抄写现成方子，虚应故事，并无真知灼见；更可恶的是，制造似是而非的话，迷惑病家，有如奸猾官吏造案，即使是皋陶听之，也认为杀无可赦。要知道脚跟的皮，厚于牛颈，不能向下溃烂，必然向上穿破足面，则不可救了。话没说完，病人说：难怪这几天骨缝锥痛难忍。妻子跪求求救，而一家几十口人还坚持不行。我说：我难道挟仇想要害他吗？如果切开而死，我赔他性命也可以。众人都咋舌不敢说话，于是切开，流出脓半盏，敷贴完毕，我到外厅晚膳，还没吃完，里面报告熟睡了，怎么办？我说：醒来要喝粥了。后来果然如此。三天后吃饭，四十天收功。然而人情畏惧疼痛苟安者多，所以庸医的话易于入耳。病无去路，向上溃烂足面，腐及内外踝，而迁延致死的，比比皆是。
屠甸镇王某，先患疔毒，随即生背疽，高肿不红，医巫术都用尽了，家破而病日益严重。请我去诊治，肌肉全消，面无人色，脉至断续如丝，按他的疮，虚软漫肿无红，病程已七十六天了。流泪满面，声言救命，声音细如蜂鸣，深堪怜悯，很难下手。全家痛哭，请求设法。我索取他们的方子看，先是犀角、牛黄，接着是参、芪、归、术之类，都说内有瘀血，虚不能化脓。我静坐筹思，七十多日的瘀血，既不化脓，也不消散，乃是脾胃被攻伐，气弱难溃，内肌尽腐，皮厚难穿，日久力穷，形势濒临危险。如果不切开则必死，如果切开而片刻毙命，又该怎么办？于是对他的父亲说：这个病内肉尽腐，外皮很厚，脓无出路，以致背重如山，肌肉日渐消瘦，而脓日渐增多，势必消尽而后已。我现在筹划一个死里求生的方法，你可以引导我再次查看，父亲听从了。于是仔细按压皮肤，完全没有薄弱缝隙可乘，不得不长时间按压以扰乱判断，突然一刺，得到大脓四大碗，幸好没有毙命，随即用粥食调理。过了五天复诊，已经能披衣起坐了。以上几个病例，都所谓养痈为患。古人原本有刀针不可轻用的戒律，那是针对手法不精，或轻浅之证，以及脓未成时而言的。以切开的方法，确实不容易，即使辨脓也很难，脉诀说洪滑为脓成，而这个病脉至如丝，刺脓至四大碗，脉岂可凭靠呢？然而这个病如果在三十日内外诊断，未始不是洪滑脉。只是医生误信补托可使自溃，谁知道想要托出脓来，反而能化肌肉以为脓，脓越多则气血越少，还想寻找洪滑之脉，怎么可能得到呢？愚昧的人还诟病刀针为蛮法。唉，这与谈论性命而废弃武备，寇至不战，丢下城池逃跑的人，有什么不同呢？须知这个脓不刺破，必定与此身一同入棺木罢了。我看见这样毙命的，指不胜屈，所以愤而为之，难道是喜欢做疡医吗！至于腿上附骨疽，迁延补托，而脓随身敛的，则更多了。
一位妇女渊疽，脓蓄积不溃，下至腰，前至胸，形容骨立，声音细如蜂鸣，头晕身热，不食。拖延半年多，求治于我。我也不能下手，实在深感惭愧。然而这两个病，都误于补托求溃，谁知道最终不可溃。元气未漓的，还可以切开求活；元气已漓的，脓必定随身殉葬。
一个膀胱痈，胀痛求死，脓从小便而出，用八正散加琥珀、乳香、麝香而愈。
一个男子小腿几天间全腐，疼痛难忍。用珠黄十宝而痛止腐脱。
一个男子臂肿如腿，麻木而硬，医生投消散药如故。我用峒丸二服，外敷解散的药在关节间，四面作脓而溃。这也是臂上附骨疽。治不得法，即难收功。
一个男子唇疔，拔掉一个，又生出七个。先用蟾酥丸，头面肿退，后用犀地加牛黄而愈。
壬子夏，我的次子患干霍乱，身热不渴，舌燥无苔，六脉俱伏，痛在胃脘，连及胸胁，势头汹涌。我给一碗地浆，势头稍定，一会儿又发作，于是直接投大承气汤一帖，其痛即下行至脐间，又一帖，痛又下行，伏于少腹右角，按之始痛，不按则与常人无异，起病至此，已历一周时，思食很急，于是给绿豆煮粥给他吃。食后一切如常，只是少腹右角按之仍有小块，隐隐作痛，于是重用当归、杞子、蒌仁，佐以桃仁、红花，少加牛膝以导之。服一时许，腹中有声响，下紫黑血一块，约五寸许，而少腹之痛块若失。这个病治法，原出一时臆见，然而竟然痊愈，特意记录出质疑于潜斋，不知他认为如何？我认为霍乱证因于暑热的多，所以感受稍重，极易入营分，古人刺以泄血，及内饮茺蔚汤、藕汁、童便，这是治疗营分之邪的方法。杨公子舌燥无苔而不渴，痛又及胁，必定平日偶有络伤未觉，乃邪遂乘隙而入也。承气汤中的硝、黄，都是血药，气行则瘀降，故痛得渐下，等到块在痛未蠲，而知饥能食，更见气分之邪已廓清，而血分之邪尚隐匿，无需承气汤直攻，改从濡化而曲导。操纵有法，我佩服他的手眼高超。
This is Wei syndrome (Wasting and Thirsting Syndrome). Ancients treated Wei syndrome by focusing solely on the Yangming channel, because the Spleen governs the four limbs, and interior and exterior correspond. After administering Guizhi Baihu Tang (Cinnamon Twig and White Tiger Decoction), the patient's consciousness cleared instantly, and finger function recovered.
The son of the Pan family had swelling and ulceration under his ribs, with a large opening in the wound emitting sounds like a crying infant. I said: This is named Yuan Ju (Abyssal Carbuncle), and according to standard methods, it is incurable. His mother pleaded: This child lost his father young, married only recently, and he is the sole heir to our lineage. Hearing this, I felt compassion and said: As long as you care for him well and perform charitable deeds within your means, there is a one-in-ten-thousand chance he might survive; relying solely on medicine is insufficient. The mother and son accepted my advice respectfully. I pondered day and night, believing that although this condition belongs to severe deficiency and requires tonification, the sound from the carbuncle indicates the inner membrane has ruptured, and Qi is leaking out. Without protecting the membrane, tonification is futile! Thus, I mixed Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Rhizome), Wu Mei Tan (Charred Mume Fruit), Bai Ji (Bletilla Tuber), Bai La (White Beeswax), Xiang Ya Xie (Ivory Shavings), and Zhu Ji Sui (Pig Spinal Cord) into pills, instructing them to be taken three times daily to consolidate Qi. I also crushed these herbs, added tissue-generating ingredients, formed them into paste-like cakes, stuffed them into the carbuncle opening, wrapped green lead in silk cotton to apply externally, covered with large plasters, bound the body with wide cloth, and changed dressings every three days. Additionally, I decocted Shen Mai Liu Wei Di Huang Wan (Rehmannia Pill with Ginseng and Ophiopogon) plus Long Gu (Dragon Bone) and Li Shi (Oyster Shell) for oral administration. After more than twenty days, the sound gradually ceased, and the wound closed after about three months. Initially, I did not expect immediate results.
Scholar Zheng Zhenyang had continuous dripping fluid from below his neck for several years. Physicians diagnosed it as Chuan Lou (Fistula). Upon examination, I found three or four deep ulcers and said: This is what ancients called Yi Lou (Ant Fistula). I applied powdered Chuan Shan Jia (Pangolin Scale) roasted to retain its properties, and he was cured.
A person who consumed Opium developed widespread sores, alternating pain and itching, with skin shedding from scratching, constant drowsiness, and delirious speech. I said: This is the most severe poisoning; ordinary detoxification methods may fail. I used Zhu Sha (Cinnabar) combined with Hu Po (Amber) ground into powder, mixed with Xi Jiao (Rhinoceros Horn) juice, administered with San Dou Tang (Three Bean Decoction). Consciousness cleared instantly, but the body lacked skin, causing unbearable pain. I then ground Shi Chang Pu (Acorus Rhizome) and Lu Dou Fen (Mung Bean Powder) into dust to sprinkle on the mat, allowing him to sleep peacefully. He recovered in half a month.
A woman suffered from San Nue (Tri-periodic Malaria) for over a year when suddenly sores appeared on her back, each the size of a coin. Surgical treatment worsened the condition, leading to anorexia. I said: These are sores caused by latent pathogens venting out; the Three Yin channels are intact. Do not treat them as ordinary sores, but recognize they were injured by cold-natured drugs damaging the Stomach Qi. I prescribed Si Jun Zi Tang (Four Gentlemen Decoction) plus Huang Qi (Astragalus Root), Dang Gui (Angelica Sinensis Root), and Bai Zhi (Angelica Dahurica Root). She recovered after a few doses.
Previously in Haimen, a colleague surnamed Fan developed a carbuncle on his shoulder. After taking Jing Fang Bai Du San (Schizonepeta and Saposhnikovia Powder to Overcome Toxins), chills and fever intensified. Subsequent use of Xian Fang Huo Ming Yin (Immortal Formula to Activate Life and Kill Toxins) and external application of San Huang San (Three Yellow Powder) for four to five days resulted in swelling and pain along the spine, with redness covering the back and a hump like an inverted bowl on the spine. Further treatments included Nei Shu Huang Lian Tang (Internal Draining Coptis Decoction), external Tie Gu San (Iron Hoof Powder), and daily La Fan Wan (Beeswax and Alum Pills). By the tenth day, the sore turned black and sunken, accompanied by hoarseness, nausea, and inability to swallow liquids. On the eleventh day, he fell into coma. Previous physicians declared the toxicity too intense to reverse. A grandson of former Military Commander Yang Chaodong, whose name I forgot, was skilled in treating carbuncles but illiterate and despised. Desperate, Fan invited him. He laughed and said: This is not a Yin pattern but caused by suppression via cold-natured drugs. If my medication raises the lesion, it can still be saved. He applied his medicine, and the next day the lesion rose. Yang returned and said: If you follow my instructions, you will live. First, no internal medicine; second, no dietary restrictions. Since he eats nothing, stop all medicines for three days to let residual drugs clear from the stomach, enabling appetite. Once eating resumes, provide foods he likes; do not restrict diet and cut off Stomach Qi. Recovery would take 120 days. He indeed recovered as predicted. I could never identify the ingredients of his prescription despite speculation. Had this case been treated early with Dian She Dan (Tongue Pointing Pill) to induce sweating, and Chan Su Wan (Toad Venom Pills) or Bai Jiang Dan (White Reduction Pill) on the crown to drain toxicity, such catastrophic rupture would have been avoided. Daily cold-natured drugs closed the stomach; frequent La Fan Wan caused vomiting and hoarseness, creating a critical state. Without Mr. Yang, people would only know he died of disease, unaware he died of medicine. The world’s ignorance is deeply lamentable.
In the Renyin year, in Dongchang Town, Haimen, a man surnamed Xu suffered from a chest carbuncle extending from head to neck and ears. Physicians failed to treat him. Pitying his poverty, I devised a cure without internal medicine, achieving recovery in 140+ days. This was my first case, attracting many patients thereafter. Initially, I did not know diseases could be cured without medicine; witnessing Mr. Yang’s method, I privately adopted his intent and succeeded. I realized many surgeons use alternating cold and hot remedies, deceiving the public and killing countless people invisibly. They label cases as terminal or blame previous doctors to avoid criticism later. How pitiable!
In Haimen, I saw a cook for the Shen family suffer from a lip Ding (Hard Carbuncle). From Chen hour to Wu hour, his mouth could not open. Cong Fan (Scallion and Alum) failed to be swallowed; Huo Ming Yin (Activate Life Decoction) was ineffective. Successive doctors used cold-natured drugs, causing hard swelling up to the neck with white discoloration. The last physician bled the area, releasing a tendon-like blood flow that wouldn't stop. Knowing hunger but unable to eat, he died on the 31st day. Lip Ding is an emergency; white color indicates Yin pattern at the intersection of Hand and Foot Yangming channels. Misuse of cold-draining drugs trapped internal heat. Early puncture of Weizhong (BL60) and Yangming acupoints to release dark blood, followed by Dian She Dan and external Chan Su (Toad Venom) might have worked. Regrettably, physicians ignored this. Otherwise, how could an emergency last over a month? People don’t realize he died from medicine. Alas!
In April of the Guichou year, Mrs. Zhang Dexiang of Tudian Town, Tongxiang, aged 81, suffered from a brain carbuncle. Doctors deemed it fatal. Examination showed severe ulceration, bedridden for 23 days, fasting for 5 days. Previously obese, now emaciated, deaf, with wiry-rapid pulse. Disliking medicine, she took none. Physicians blamed lack of treatment; I argued that since she hadn't taken medicine, recovery was possible if she followed my method for 50-60 days. Deep wounds required drainage. Failure meant spread to the throat, making rescue impossible. Family agreed. I opened a hole, draining a cup of dark blood and equal pus. Next day, heavy head sensation vanished, hearing returned, and she ate porridge. Five days later, half the necrotic tissue detached, new flesh grew. Upper black areas remained alive; I lifted skin, inserted medicine, changing daily until adhesion occurred. Full recovery in 90 days. Her white hair regrew black where lesions healed. She remains healthy today, confirming that longevity often correlates with avoiding pills/powders. I subsequently cured over ten similar cases. There is no fatal outcome for this condition. Formerly, Wang Jiting’s stepson, aged 61, suffered similarly. An acquaintance doctor advised enduring pain for removal. He refused, worsening over ten days. A famous Suzhou doctor was summoned, prescribing Ren Shen (Ginseng) and Lu Rong (Deer Antler). Despite severe condition, the doctor insisted. Chicken soup was used to decoct medicine. One dose caused eye/mouth closure, heavy head, and collapse. Many wealthy families die thus—fearing minor pain, ignoring advice, chasing fame, suffering cruel deaths. Not from disease, but from doctors. May people heed humble words and avoid past mistakes.
Extremely large back carbuncles, termed Jing Ti Fa (Whole Body Hair/Carbuncle), affected Guo Xiangping of Pinghu. Initial treatment with Xi Jiao (Rhinoceros Horn) and Huang Lian (Coptis) led to black sunken sores. Later, Gui Zhi (Cinnamon Twig) and Fu Zi (Aconite) caused dysuria and thirst, anorexia. Medications were stopped intermittently; multiple doctors exhausted their skills. His son, Xiao Ping, requested my help. I asked if he had seen such large cases. Though I hadn't, I reassured him I had seen worse. I removed a bowl of necrotic tissue; the patient felt immense relief. Son requested Shi Quan Da Bu Tang (Ten Significant Tonifying Decoction). I explained: Anorexia resulted from premature tonification blocking residual drugs. Severe tonification now would kill vitality. Wait three days for residual drugs to clear and Stomach Qi to recover. This condition stems from damp-heat stagnation; cold drugs suppressed it, warm drugs confined it, allowing progression. Now, use Dao Chi San (Guide Out Red Powder) to drain damp-heat downward until urine clears. Five days later, he rose independently and thanked me. Full recovery in 180+ days. During this period, he had gum disease, resolved with Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction). He lives today. Had we used Shi Quan Da Bu Tang or Ba Wei Wan (Eight Flavor Pill) based on Li Zhai’s theory for thirst/dysuria, survival would be impossible. Chen Liangfu stated: Once ulcerated, absolutely no cold drugs should enter. Can this be rigidly applied?
Mrs. Su from Xieqiao, aged 24, had breast swelling like a hanging gourd, oozing daily for 200+ days with no improvement. Seeking treatment in early winter, her face was pale/thin, slight cough, red lips, clear voice, evening chills/fever, consuming small amounts of food. Previous meds (Yang Shen/American Ginseng, Bie Jia/Turtle Shell, Dan Pi/Moutan Bark) suggested chronic wasting. I knew delay and wrong meds caused this. I inserted medicated paper wicks into the wound, instructing self-replacement. She complained of poor Stomach Qi, asking for a prescription. I said: You’ve been harmed by wrong meds; stop for five days, and Stomach Qi will recover. Asked if it would become wasting disease, I promised a miracle drug in five days. She left happily. Five days later, upon removing the wick, a bowl of clear pus drained, reducing chills/fever. Continued drainage yielded cups of clear pus daily, reducing hardness/swelling. Appetite improved. She begged for a formula. I offered pre-made pills instead of decoctions. Ten days later, she reported better Stomach Qi but persistent pus and amenorrhea, requesting menstruation-inducing herbs. Seeing her rosy cheeks and full muscles, menses were imminent. Giving internal medicine might cause error; I gave the same pills. She fully recovered and conceived. Actually, both prescriptions were merely scorched rice powder with orange peel pills. I successfully treated numerous chronic breast cases using wicks/needles. For this woman, without drainage, how would pus exit, fevers cease, or Stomach Qi return? Without stopping meds, intestinal fluids would be depleted, leading to starvation. Han/Tang alchemists killed with minerals; wise ones stopped them. Yet beliefs in herbal longevity persist, causing many wrongful deaths. I wonder at modern doctors urging medication. Why? Someone asked: How did you save a "terminal" case? I replied: Doctors’ "terminal" diagnoses often contain methods to ensure death. If a patient dies after being labeled terminal, fools praise the diagnosis, and doctors boast accuracy. Sad! How many practitioners understand this?
Zhang Dexiang’s grandson suffered from Cheng Jing Jian (a severe leg swelling disorder). Multiple doctors failed. Swelling extended to calves, gasping, hoarse, fasting nine days, irritable, intolerant of touch. Doctors debated: immediate death vs. disability. Invited me at dusk. Candlelight exacerbated stabbing pain. Father feared surgery, citing other doctors. I said: If you don’t want him to live, I won’t speak. But inviting me implies desire for life. Don’t just agree passively. Modern surgeons are conformists, copying formulas, lacking insight, confusing families like corrupt officials. Heel skin is thick like ox neck; cannot drain downward, must burst upward through foot sole, becoming incurable. Patient admitted bone pain. Wife knelt begging; family resisted. I offered to pay with my life if cutting killed him. Silence ensued. I incised, draining half a cup of pus. Dressing applied. Dinner unfinished, news came: patient slept soundly. I predicted he’d want porridge. Indeed, he ate in three days, recovered in forty. Fear of pain favors quacks. Cases where pus drains upward through ankles, delaying death, are common.
Wang from Tudian Town first had Ding poison, then back carbuncle, high swelling without redness. Medicine and magic failed; family ruined, illness worsened. I examined: muscle loss, pallor, threadlike pulse, soft/swollen non-red wound, 76 days duration. Tears flowing, voice like a bee, pitiful. Family wept, begged for help. Prescriptions showed Xi Jiao (Rhinoceros Horn), Niu Huang (Calculus Bovis), then Ren Shen, Huang Qi, Dang Gui, Bai Zhu, claiming blood stasis preventing suppuration. I pondered: 70-day stasis neither suppurates nor dissipates; Spleen/Stomach damaged, Qi weak, unable to erupt, internal rotting, thick skin preventing penetration. Critical state. Incision necessary or death; risk of instant death if done poorly. I told father: Internal rot, thick skin, no pus outlet, heavy back, wasting muscles, increasing pus. Must drain completely. I devised a life-from-death plan. Guided me to re-examine. Pressed skin thoroughly, finding no thin spot. Pressed long to confuse judgment, then stabbed suddenly. Four bowls of large pus drained; survived. Fed with porridge. Five days later, sat up. These cases illustrate "nurturing carbuncles." Ancients warned against light use of knives/needles for unskilled hands, mild cases, or unsuppurated stages. Incision is difficult; diagnosing pus is hard. Pulse texts say surging/slippery indicates pus, yet this case had threadlike pulse despite four bowls of pus. Could pulse be relied upon? Within 30 days, pulse might have been surging/slippery. Doctors mistakenly believe tonification induces spontaneous rupture, not knowing it converts muscle to pus, depleting Qi/Blood, making surging pulse impossible. Fools call knife/needle methods barbaric. Alas! This is like discussing life/death while disarming defense, fleeing invaders. Un-drained pus leads to burial with the body. Countless such deaths inspire my indignation. Is it love for surgery? More common are leg osteomyelitis cases where delayed tonification causes pus to retreat with healing skin.
A woman with Yuan Ju had retained pus, extending to waist/chest, emaciated, bee-like voice, dizziness, fever, anorexia. Six months passed before seeking me. I hesitated, ashamed. Both cases erred in seeking spontaneous rupture via tonification. If Yuan Qi intact, incision saves; if depleted, pus follows death.
A bladder abscess caused painful urgency, pus exiting via urine. Cured with Ba Zheng San (Seven Herb Powder for Urinary Obstruction) plus Hu Po (Amber), Ru Xiang (Frankincense), She Xiang (Musk).
A man’s lower leg necrosed in days, unbearable pain. Cured with Zhu Huang Shi Bao (Pearl-Yellow Ten Treasures).
A man’s arm swelled like a leg, numb/hard, resisting dispersal meds. Two doses of Tong Wan (Village Pill) plus external dispersal paste at joints caused suppuration around four sides. Also arm osteomyelitis. Improper treatment fails.
A man’s lip Ding: one拔 (extracted), seven regenerated. Chan Su Wan reduced facial swelling; Xi Di Jia Niu Huang (Rhino-Earth Plus Calves Bovis) cured.
Summer of Renzi year, my second son had Gan Huo Luan (Dry Cholera): fever, no thirst, dry tongue/no coating, hidden pulses, epigastric/chest pain, violent onset. Gave Earth Slurry (Di Jiang); symptoms stabilized then returned. Administered Da Cheng Qi Tang (Major Order the Qi Decoction). Pain moved to umbilicus, then to right lower quadrant, tender only on pressure. After one week, urgent hunger. Fed mung bean porridge. Post-meal normalcy except lingering tender mass in right lower quadrant. Used heavy Dang Gui (Angelica), Gou Qi Zi (Goji Berry), Gua Lou Ren (Trichosanthes Seed), Tao Ren (Peach Kernel), Hong Hua (Safflower),少量 Niu Xi (Achyranthes Root). After one hour, bowel sounds, passage of 5-inch purple-black blood clot, pain vanished. Treatment was intuitive but successful. Recorded for Qianzhai’s critique. Cholera from summer-heat easily enters Ying (Nutritive) level. Ancients pricked for blood, drank Chong Wei Tang, lotus root juice, child’s urine to clear Ying pathogens. My son’s dry tongue/no thirst, rib pain suggested prior collateral injury allowing pathogen entry. Mang Xiao (Mirabilite) and Da Huang (Rhubarb) in Cheng Qi Tang act on Blood. Qi movement reduces stasis, easing pain. When mass persists but hunger returns, Qi-level pathogen cleared, Blood-level pathogen remains. Direct attack unnecessary; gentle guidance preferred. Skillful manipulation deserves praise.