菖、斛、燕窝、枇杷叶，用水露煎服，三剂后泻止痰稀，胸宽进粥。医见苔退舌红，惊为脱液。仲卿复延余往视，
乃病退之象也。舌上无津，前案已述，今脉渐转，如何反为诧虑？于前方去蒌、薤、连、半，加归、地、麦冬、
藕，服之而愈。
朱氏妇患赤痢匝月，多医杂治。痢止三日矣，而起病至今，胸痞头胀，米饮不沾，口渴苔黄，瘦热而痛，凛
寒身热，夜不成眠，神惫形消。诸医技窘，乞余往视，脉数而弦。伏暑未清，营津已劫，气机窒塞，首议清泄。
南沙参、石菖蒲、蒌、薤、栀、芩、茹、连、橘、半、白薇、紫菀，四剂而痰活胸舒寒
热大减，且能啜粥；改用北沙参、生首乌、柏子仁、冬瓜子、元参、蒌、薤、菖、栀，二剂坚矢下，授清养法而
痊。
钱君友琴，年五十九岁。曾于七月间患滞下，自服大黄一剂而瘥。季秋患寒热时作，自服柴、桂等药，病益
甚，狂躁欲啖西瓜而服石膏。余诊之，脉滑右甚，苔色腻黄，便秘溲短，胸痞，不沾粒米，乃暑湿挟痰阻于气分，
治宜开泄，白虎不可投也。用蒌、薤、枳、朴、连、夏、茹、芩、苑、桔，服三剂，二便既畅，胸次豁然而愈矣。
方氏妇劳伤挟感，业已治愈，服补药数剂，渐形浮肿。或谓邪未净而补之早也，用消导、清解法皆不应；且
兼咳逆碍眠，便溏溲涩，又谓肾气不纳，改从滋填，其势益增，遂束手矣。挽余视之，脉浮无汗，尺静经行，既
非根蒂之虚，亦岂邪留误补，殆愈后复感风邪，肺气阻痹，水津失布，所谓皮水证也。与香薷、杏仁、紫苏、橘
皮、兜铃、麝干、紫菀、通草、葱白，天泉水芦火煎服，覆杯而愈。
余虽挈眷回籍，而会垣戚友，未能恝然置之，故时往寓焉。今岁六月初二日剌船返里，欲避暑月应酬之繁也。
嗣因亢旱河涸，舟楫不通，或以肩舆相招，余畏长途而却之。中秋后，河渐通，乃二十夜梦先慈以不必晋省为训，
初谓心有所忆也。至九月下旬，欲展墓于皋亭山，因赴杭视弟妹，舟人忘备白米，强啖冬舂米饭一餐，遂腹胀不
饥。越日抵寓，身渐发热，徐君亚枝为余多剂清化，至十六日始解极坚燥矢，解后大渴喜饮，少顷则倾囊而吐，
吐则气自少腹上涌，味极酸苦，甚至吐蛔。赵君笛楼诊云∶十六日不食，中已大虚，一解之后，更无砥柱，
故肝木乘而冲侮也。投参、苓、椒、梅、萸、连、橘、半、茹、姜等，四剂吐止，稍进饮食，然肌肉削尽，寐则
肢惕，而稍一展动，则络痛异常，大解必旬日一行，极其艰涩。扶病而归，两跗皆肿，自知虚不易复，而性不受
药，遂啖肥浓。至冬杪肿消，而大便始润，津液易夺而难复如此！且稍或烦劳，即作寒热。至次年三月，各恙始
休，而步履如常，惟肌肉不能复旧，以脾主四肢，胃主肌肉，而束骨利机关也。余脾胃素弱，故畏药如虎，稍有
恶劣之气者，饮之即吐，若吞丸药，则不能克化，生冷硬物，概不敢尝，最奇者冬舂米饭之气，亦所素畏，偶食
之辄小病，而未有如此之剧者，嗣后不敢略试矣。且深悔不遵先慈梦示，遂息影穷乡，不复寓省，乃不知者径目
余为神仙中人，盖余能安其痴也，而吴越之间，亦未尝不偶游焉。次年夏游武林，晤许贯之茂才，见其令嫒 姑，
患疳膨聚气，云起于桐乡外家食冬舂米饭也。可见人之脾胃，有同于我者矣。
秋杪山妻怀孕已七月，又患疟，医从清解不应，半月后转为间作。时余卧病省垣，家人恐添忧虑，初不我闻。
延至匝月，病渐濒危。钱君意山、管君芝山放棹迎余，扶病归来。诊脉软滑，而尺带虚弦，凡疟至一时之先，必
大渴、背麻、脘闷，既热则头疼、腿足肿胀，寒不过一时，而热有七、八时之久，骨瘦如豺，肌肤甲错，便坚溲
涩，心悸无眠，目不见人，舌光无液。乃真阴素亏，水不涵木，风阳内炽，耗血伤津，兼挟劳伤而吸秋热，热茗
频啜，米饭恶沾，腰痛而胎动不安，势已十分险恶。遂与西洋参、元参、知、薇、蒿、菊、菖、麦、栀、甘、桑
叶、竹沥，两剂嗽痰甚多，渴闷稍减；去桑、菊、栀、蒿，加橘红八分，苏叶五分，葱白两茎，又两剂疟止，吐
痰更多，舌色渐润；去元参、知、薇，加冬瓜子、茯苓、蛤壳，一剂嗽虽减，而左胁时疼；乃用北沙参、熟地、
麦冬、蒌仁、楝实、石菖蒲、丝瓜络、十大功劳、藕，以养阴柔木而清痰热，服之甚妥；然目虽能视而早晨必昏
卧如迷，遂增熟地，加白薇、归身，一帖寒热陡作，面赤气冲，或咎补早疟复，余曰非也，此不耐归身之窜动耳，
即去此一味，加葱白、蒲桃干，服之果愈；随去葱白，加甘草、石斛，两帖嗽大减，胃渐和，更衣较润，惟手心
如烙，两足不温；乃易沙参以西洋参，去蒌、楝而加生牡蛎一两，盐水炒橘红一钱，二帖足渐温，痰渐浓，而腰
痛、胁痛未已；又加酒炒知母一钱，两帖痰出极多，昏卧始减，惟纳食如噎，火降即饥，舌辣 干，小溲尚热；
改用西洋参、二地、二冬、二至、知、柏、牡蛎、十大功劳，少佐砂仁为剂，服六帖各恙皆已，能起榻而腿软
干，神犹贸贸，即以此方加白芍、木瓜、石菖蒲熬膏，服至冬至后，神气始爽而痊。
秀水董君枯瓠之夫人，余于秋仲偶诊其脉，知其八脉久亏，积劳多郁，故指下虚弦而涩，寒热时形，虚火易
升，少眠善悸，性又畏药，不肯节劳。至冬令证类三疟，余以病未能往视。来信云∶桐乡传一妙方，治三疟效验
如神。方用甜茶、半夏各二钱，川贝、槟榔各三钱，橘皮、甘草各一钱五分，干姜一钱，木香五分，凡八味。已
服三剂而瘳。余即函复云∶此乃劫剂，仅可以治寒湿饮邪为患之实证，设虚证、热证，服之虽愈，必有后患。故
抄传单方，最非易事，若好仁不好学，功过恐不相敌也。既而病果复作，较甚于前。余与吕君慎庵同议镇养柔潜
之法，始得渐愈。后闻服此方者率多反复，乃郎味清茂才深佩余之先见云。
张宝商室患凛寒乍热，咳逆形消，面赤少餐，经迟眩晕，医投补剂，盗汗带频，咸谓不能过春矣。余诊之，
脉弦滑而数。本非虚劳，无须补药。乃肝阳内盛，搏液成痰，阻塞气机，法宜清展。以元参、丹参、紫菀，白薇、
青蒿、黄柏、石菖蒲、菊花、竹茹、竹叶为方，每服送当归龙荟丸一分，二十剂遂健如初。
冯益三令正上年春汛偶愆，颇露虚象，群贤咸以为损，余诊为孕，季秋果举一男。至丁已春初，产逾三月，
既不自乳，汛亦未行，偶感客邪，医疗半月，渐至不饥不食，气自少腹上冲，似有聚瘕，呕恶腹痛，面黄形瘦，
溲热便溏，口渴带多，面浮咳逆，佥云已成蓐损，复延余诊。脉滑而弦，遂以孕断。与沙参、苏叶、桑皮、冬瓜
皮、黄芩、枳壳、石菖蒲、白薇、橘核、楝实、煎送香连丸，三服霍然。复闻六月中旬产一女甚快。
郎氏妇崩后淋带，五内如焚，溲热口干，不饥脘闷，腰疼肌削，卧榻呻吟，头晕耳鸣，夜不能寐，脉来细数，
少腹不舒。滋补杂投，皆不见效。余以沙参、菖蒲、斛、柏、薇、苓、蛤壳、冬瓜子、藕、十大功劳先为清展，
服五剂热退渴和，脘舒安谷，且能起坐，夜亦能眠，其气机已调畅矣，参入潜阳养血而瘥。
梅溪蒋君宝斋令堂，自上年夏秋间患痢之后，神疲少寐，不能起床，医谓其虚，率投补药，驯致惊疑善悸，
烦躁呓语，胁痛巅疼，耳鸣咽痛，凛寒暮热，大汗如淋，晕厥时形，愈补愈殆。李君苍雨邀余诊之，脉弦滑而数，
白睛微红，而眼眶如墨，舌绛无苔。因问胸闷乎？曰闷甚。便秘乎？曰秘甚。溺热
乎？曰热甚。岂非气郁而痰凝，痰阻而气痹，肺胃无以肃降，肝胆并力上升，浊不下行，风自火出？虽年逾五旬，
阴血不足，而上中窒塞，首要通阳。为处小陷胸加菖、薤、旋、茹、苓、枳、郁李仁，群医谓是猛剂，无不咋舌。
宝斋云∶镇补滋敛，业已备尝，不但无功，病反日剧，且服之。果一剂知，三剂安。已而余有会垣之游，前医谓
病既去，复进守补月余，仍便秘无眠，胸痞躁乱，加以发斑腹痛，人皆危之。时余游禾中，函乞往视。仍用前法
增损，合雪羹投数剂，连得大解，率皆坚燥，改与柔养，更衣渐畅，粥食渐增，以潜镇舒养之剂善其后。
仁和彭君芝亭之三令嫒，年甫逾笄。自去秋患痰嗽内热，渐至汛愆减食，咽烂音嘶，肌瘦便溏，不眠心悸。
丁巳正月下旬，专人逆余往视。左脉细软而数，寸尤甚，右尺洪数，寸关不耐寻按。殆燥邪薄肺，初失整肃，阴
分素亏，源流两涸，今胃气已败，万物发蛰之时，如何过去。其二令嫒深谙医理，极以为然。适邵位西枢部持蒋
大理之函相召，余即解缆。嗣接赵君笛楼信云∶彭证果殁于惊蛰前三日，抑何脉之神耶？余谓亦偶然事耳。如前
年五月间，偶诊顾听泉明经之脉，即谓家 伯茂才云∶顾君不可以冬，盖石象已见也。后竟殁于立冬之刻。今年
二月诊庄丈芝阶脉，谓其文孙眉仙少君云∶恐难以夏。而立夏前三日竟逝。十月初游武林，访家瘦石兄，切其脉
尺中微露浮弦，即谓其子曰∶春令可虞。亦于次年惊蛰日无疾而终。脉之可凭者如是，而竟有不可凭者，此其所
以为深微之学乎？
蒋君寅 太夫人患恙，适余游武林，专丁招往。病已七日，龈糜颐肿，寒热时形，脘闷头疼，不眠不食，苔
黄便秘，脉数而弦。是冬令伏邪发为温病，血虚肝旺，禀赋使然。以枳、桔、羚、翘、栀、菖、葱头、兜铃、麝
干为前茅，三剂而热退肿消；以小陷胸合栀豉，加菖、苓、竹茹、雪羹开中坚，亦三剂而便畅胸舒，渐啜糜粥；
以西洋参、肉苁蓉、麦冬、石斛、川贝母、竹茹、归身、知母、黄连为后劲，渐安眠食而痊。其庶祖母年八十六
岁，患胸闷便秘，少腹瘕痛，夜分凛寒，两目更冷，不饮不食，口苦息粗，咸以高年为虑。按脉弦数而涩，此肝
气素滞，食阻上焦，升降并愆，故脉涩而息不调也，岂可误以为正气之衰乎？进枳、桔、蒌、薤、菖、苑、苏、
连、橘核、旋复之方，投匕而瘥。次年春病复如是而较甚，余亦以此法瘳之。寅 曾于去冬患血溢，与清舒肝胆
而安。惟久患不眠，臂冷食少，自云服补心丹及知柏八味丸甚合。余曰∶脉至弦细而缓，因赋质阴亏，心多思虑，
五火内炽，烁液成痰，阻碍气机，故脉证如是。滋腻之药，不可再投。用沙参、丹参、丝瓜络、茅根、旋复、橘、
半、菖、苓，服十余剂而愈。
梅里任会嘉令正，年逾五旬。季春患证渐剧，访余视之。身热头疼，凛寒胸闷，气冲无寐，神惫音低，苦渴
嗽痰，干呕便闭，脉甚细软，延已旬余。咸以为虚，欲投补剂。余谓阴分虽亏，气郁痰滞，温邪留恋，胡可补耶？
轻展清宣，庶乎合拍。以葱豉合小陷胸，加南沙参、麝干、马兜铃、通草、竹茹，二剂而热退呕吐止；去葱、豉、
兜、麝，加栀、贝、芩、菖，三帖而便行胸适，得寐知饥，改投柔木涵阴而愈。
钱塘姚欧亭大令宰崇明，其夫人自上年九月以来，夜不成
寐，佥以为神虚也，补药频投，渐不起榻，头重如覆，善悸便难，肢汗而心内如焚，多言，溺畅畏烦，而腹中时
胀，遍治无功。其西席张君心锄，屡信专丁邀诊，余不获辞，初夏乘桴往视。左寸关弦大而数，右稍和而兼滑，
口不作渴，舌尖独红。乃忧思谋虑扰动心肝之阳，而中挟痰饮，火郁不宣。温补更助风阳，滋腻尤增痰滞。至鹿
茸为透生巅顶之物，用于此证，犹舟行逆风而扯满其帆也；明粉为芒硝所炼，投以通便，是认为阳明之实秘也，
今胀能安谷，显非府实，不过胃降无权，肝无疏泄，乃无形之气秘耳。遂以参、连、旋、枳、半、芍、蛤、茹、
郁李、麻仁、凫茈、海 ，两服即寐，且觉口苦溺热。余曰∶此火郁外泄之征也。去蛤壳，加栀子，便行胀减，
脉亦渐柔；再去麻、郁、雪羹，加石英、柏子仁、茯苓、橘皮、小麦、莲子心、红枣核，三剂各恙皆安；去石英、
栀子，加冬虫夏草、鳖甲为善后。余即挂帆归矣。然不能静摄，季夏渐又少眠，复遣丁谆请，余畏热不行，命门
人张笏山茂才往诊，遵前法而治，遂以告愈。
崇明刑幕吴江史励斋令正，久患少腹聚瘕，时欲攻痛，羞明心悸，汛速带频。向服补药，交夏发之更剧。医
用胶艾汤加参、术、 、茸峻补，痛益难支，遂致晕厥，不眠不食，业已四朝。屈余视之，脉来弦滑，苔黄苦渴，
溺热便难。与沙参、石英、龟版、鳖甲、蒿、薇、苡、柏、 、 、茹、菖，一饮而病如失，眠食皆安，赠以清
养柔潜而别。
余游瀛洲，有越人李姓，挽心锄茂才见余，云亲串中一妇人，因娩后嗽血，遂至两目无光，四肢 不能动，
欲求一方。张谓如此大证，未审其脉，如何施治。余曰∶吾知之矣，此肺
热欲成痿 也。遂以西洋参、桑皮、元参、百合、知母、苡仁、藕、茅根、枇杷叶为方，服六剂。闻余将归，李
亟来署致谢云∶病去大半矣，真仙丹也。欲再求一方，余为加葳蕤一味。然此由海外，因不知有“产后宜温”之
石菖蒲、石斛、燕窝、枇杷叶，用水露煎服，三剂后腹泻停止、痰液变稀薄，胸部宽舒并能进食粥食。医生见舌苔消退、舌质红，惊恐地认为是阴液枯竭（脱液）。仲卿再次邀请我去诊视，这其实是病邪退去的征象。舌上无津液，在前面的医案中已经叙述过，如今脉象逐渐好转，为何反而感到惊诧忧虑？于是去掉前方中的瓜蒌、薤白、黄连、半夏，加入当归、地黄、麦冬、藕，服用后痊愈。
朱姓妇人患赤痢一个月，多位医生混杂治疗。痢疾停止三天了，但从发病至今，胸中痞闷、头胀，连米汤都喝不下，口渴、舌苔黄，身体消瘦发热且疼痛，怕冷与身热交替出现，夜间无法入睡，精神疲惫、形体消瘦。各位医生技艺穷尽，请求我去诊视，脉象数而弦。这是伏暑未清，营阴津液已被劫夺，气机窒塞，首要策略是清热泄浊。用南沙参、石菖蒲、瓜蒌、薤白、栀子、黄芩、竹茹、黄连、橘皮、半夏、白薇、紫菀，四剂后痰液活动、胸部舒畅、寒热大减，且能喝粥；改用北沙参、生首乌、柏子仁、冬瓜子、玄参、瓜蒌、薤白、石菖蒲、栀子，两剂后大便坚硬燥结排出，采用清养法治愈。
钱君友琴，五十九岁。曾在七月间患痢疾，自服大黄一剂后痊愈。深秋时节患寒热往来，自服柴胡、桂枝等药，病情加重，狂躁想吃西瓜并服用石膏。我诊察他，脉象滑利右侧更甚，舌苔腻黄，便秘尿短，胸中痞闷，不吃一粒米，这是暑湿挟痰阻滞于气分，治疗宜开泄，白虎汤不可使用。用瓜蒌、薤白、枳实、厚朴、黄连、半夏、竹茹、黄芩、紫菀、桔梗，服用三剂，二便通畅，心胸豁然开朗而痊愈。
方姓妇人因劳伤兼感外邪，已经治愈，服用补药数剂，逐渐出现浮肿。有人说邪气未净而补益过早，用消导、清解法都不见效；且兼有咳逆碍眠、便溏尿涩，又说是肾气不纳，改为滋填之法，病情反而加重，于是束手无策。请我去诊视，脉浮无汗，尺部脉静经血已行，既不是根本虚损，也不是邪留误补，大概是痊愈后再次感受风邪，肺气阻痹，水津失于布散，这就是所谓的“皮水证”。用香薷、杏仁、紫苏、陈皮、天竺子、麝干、紫菀、通草、葱白，用天泉水芦火煎服，喝完一杯即愈。
我虽然带着家眷回到故乡，但对于省城杭州的亲戚朋友，不能淡然置之，所以时常去寓所居住。今年六月初二日划船返回故里，想要避开盛夏月应酬之繁。后来因为大旱河水干涸，船只不通，有人用轿子相邀，我畏惧长途跋涉而拒绝。中秋后，河道渐通，于是二十日夜梦见先母以不必去省城为训诫，起初以为只是心中有所回忆。到了九月下旬，打算去皋亭山扫墓，因此赴杭州看望弟妹，船夫忘记准备白米，勉强吃了一顿冬舂米饭，随即腹胀不饥。次日到达寓所，身体逐渐发热，徐亚枝先生为我开了多剂清热化湿药，直到十六日才排出极坚硬的燥屎，排便后大渴喜饮，一会儿则倾囊呕吐，吐时气从少腹上涌，味道极酸苦，甚至吐出蛔虫。赵笛楼先生诊察说：十六日未进食，中气已大虚，一次排便之后，更无砥柱之力，所以肝木乘虚冲侮胃土。投用人参、茯苓、花椒、乌梅、山茱萸、黄连、橘皮、半夏、竹茹、生姜等，四剂后呕吐停止，稍进饮食，然而肌肉削尽，睡眠时肢体颤抖，稍微一动则经络疼痛异常，大便必定十天一行，极其艰涩。带病回家，双脚皆肿，自知虚损不易恢复，且性格不服药，于是吃肥甘厚味。到冬末消肿，大便始润，津液易夺而难复如此！而且稍加烦劳，就发寒热。到次年三月，各种病症才停止，步履如常，只有肌肉不能复原，因为脾主四肢，胃主肌肉，以及束骨利机关的作用。我脾胃素来虚弱，所以畏药如虎，稍有异味者，饮下即吐，若吞丸药，则不能消化，生冷硬物，一概不敢尝试，最奇怪的是冬舂米饭的气味，也是向来畏惧的，偶尔食用就会小病，但没有这次这么剧烈，此后不敢再尝试了。并且深深后悔没有遵从先母梦示，于是隐居穷乡，不再寓居省城，然而不知情的人径直称我为神仙中人，大概是因为我能安守我的痴拙吧，而在吴越之间，也未尝不偶尔游历。次年夏天游览武林，遇见许贯之茂才，见到他的女儿，患疳膨聚气症，说是起因于在桐乡娘家吃了冬舂米饭。可见人的脾胃，有与我相同的啊。
秋末妻子怀孕七个月，又患疟疾，医生从清解法治疗无效，半月后转为间日发作。当时我卧病在省城，家人恐怕增添忧虑，起初不告诉我。拖延到一个月，病情渐渐濒危。钱意山先生、管芝山先生放船迎接我，扶病归来。诊脉软滑，而尺部和关部虚弦，凡是疟疾发作前一小时，必有大渴、背麻、脘闷，发热后则头疼、腿足肿胀，寒冷不过一小时，而发热有七八个小时之久，骨瘦如豺狼，肌肤甲错，大便坚硬小便涩滞，心悸无眠，目不见人，舌光无津液。这是真阴素亏，水不涵木，风阳内炽，耗血伤津，兼挟劳伤而吸入秋热，频繁喝热茶，厌恶沾米饭，腰痛而胎动不安，形势十分险恶。于是用西洋参、玄参、知母、白薇、青蒿、菊花、石菖蒲、麦冬、栀子、甘草、桑叶、竹沥，两剂后咳嗽痰多，渴闷稍减；去掉桑叶、菊花、栀子、青蒿，加橘红八分，苏叶五分，葱白两茎，又两剂后疟疾停止，吐痰更多，舌色渐润；去掉玄参、知母、白薇，加冬瓜子、茯苓、蛤壳，一剂后咳嗽虽减，但左胁时而疼痛；于是用北沙参、熟地黄、麦冬、瓜蒌仁、川楝子、石菖蒲、丝瓜络、十大功劳、藕，以养阴柔肝而清痰热，服用很妥当；然而眼睛虽能看，但早晨必昏卧如迷，于是增加熟地黄，加白薇、当归身，一帖后寒热陡作，面赤气冲，有人责怪补益过早导致疟疾复发，我说不是这样，这是不耐受当归身的窜动之性，立即去掉这一味，加葱白、葡萄干，服用果然痊愈；随后去掉葱白，加甘草、石斛，两帖后咳嗽大减，胃渐和，大便较润，只有手心如烙铁烫，两脚不温；于是将沙参换成西洋参，去掉瓜蒌、川楝而加生牡蛎一两，盐水炒橘红一钱，两帖后脚渐温，痰渐浓，而腰痛、胁痛未止；又加酒炒知母一钱，两帖后痰出极多，昏卧始减，只有进食如噎，火降即饥，舌辣干，小便尚热；改用西洋参、生地、熟地、天冬、麦冬、女贞子、旱莲草、知母、黄柏、牡蛎、十大功劳，少佐砂仁为剂，服用六帖后各恙皆已，能起床但腿软无力，神志依然懵懂，就用此方加白芍、木瓜、石菖蒲熬膏，服用至冬至后，神气始爽而痊愈。
秀水董君枯瓠之夫人，我在仲秋偶然诊其脉，知道她奇经八脉久亏，积劳多郁，所以指下脉象虚弦而涩，寒热时常出现，虚火易升，少眠善悸，性格又畏药，不肯节劳。到冬季症状类似三疟，我因病未能前往诊视。来信说：桐乡传来一个妙方，治三疟效验如神。方用甜茶、半夏各二钱，川贝、槟榔各三钱，橘皮、甘草各一钱五分，干姜一钱，木香五分，共八味。已服三剂而痊愈。我随即回信说：这是劫剂，仅可以用来治疗寒湿饮邪为患的实证，如果是虚证、热证，服用即使痊愈，必有后患。所以抄传单方，最不容易，如果好仁不好学，功过恐怕不相抵偿啊。不久病情果然复发，比之前更严重。我与吕慎庵先生同议镇养柔潜之法，才得以渐渐痊愈。后来听说服用此方者大多反复，其子味清茂才深深佩服我的先见之明。
张宝商之妻患怕冷乍热，咳逆形消，面赤少餐，月经推迟眩晕，医生投补剂，盗汗白带频多，都说不能度过春天了。我诊察她，脉弦滑而数。本非虚劳，无须补药。这是肝阳内盛，搏液成痰，阻塞气机，法宜清展。用玄参、丹参、紫菀、白薇、青蒿、黄柏、石菖蒲、菊花、竹茹、竹叶为方，每服送服当归龙荟丸一分，二十剂后健康如初。
冯益三之正室上年春汛偶迟，颇露虚象，众贤都认为是有损，我诊察认为是怀孕，季秋果然生一男婴。到丁巳年春初，产后逾三月，既不自己哺乳，月经也未行，偶感客邪，医疗半月，渐渐至不饥不食，气自少腹上冲，似有聚瘕，呕恶腹痛，面黄形瘦，尿热便溏，口渴带多，面浮咳逆，都说已成蓐损，又延请我诊察。脉滑而弦，遂以怀孕判断。用沙参、苏叶、桑皮、冬瓜皮、黄芩、枳壳、石菖蒲、白薇、橘核、川楝子，煎送香连丸，三服霍然痊愈。后又听说六月中旬产一女很快。
郎氏妇崩漏后淋带，五内如焚，尿热口干，不饥脘闷，腰疼肌削，卧榻呻吟，头晕耳鸣，夜不能寐，脉来细数，少腹不舒。滋补杂投，皆不见效。我用沙参、石菖蒲、石斛、柏子仁、白薇、茯苓、蛤壳、冬瓜子、藕、十大功劳先为清展，服用五剂后热退渴和，脘舒安谷，且能起坐，夜间也能睡眠，其气机已调畅矣，参入潜阳养血而痊愈。
梅溪蒋君宝斋之母，自去年夏秋间患痢之后，神疲少寐，不能起床，医生认为其虚，率投补药，致使惊疑善悸，烦躁呓语，胁痛巅疼，耳鸣咽痛，怕冷暮热，大汗如淋，晕厥时常出现，愈补愈危。李苍雨先生邀我诊察，脉弦滑而数，白睛微红，而眼眶如墨，舌绛无苔。因而问胸闷吗？回答说闷得很厉害。便秘吗？回答说秘得很厉害。溺热吗？回答说热得很厉害。难道不是气郁而痰凝，痰阻而气痹，肺胃无以肃降，肝胆并力上升，浊气不下行，风自火出？虽然年逾五旬，阴血不足，而上中窒塞，首要通阳。为其处方小陷胸汤加石菖蒲、薤白、旋覆花、竹茹、茯苓、枳实、郁李仁，群医认为是猛剂，无不咋舌。宝斋说：镇补滋敛，业已备尝，不但无功，病反日剧，且服用。果然一剂知，三剂安。不久我有省城之游，前医认为病既去，复进守补月余，仍便秘无眠，胸痞躁乱，加以发斑腹痛，人都认为危险。当时我在禾中游历，函乞前往诊视。仍用前法增损，合雪羹投数剂，连得大解，率皆坚燥，改与柔养，更衣渐畅，粥食渐增，以潜镇舒养之剂善其后。
仁和彭君芝亭之三女儿，年仅刚过及笄之年。自去年秋天患痰嗽内热，渐渐至月经愆期减食，咽烂音嘶，肌瘦便溏，不眠心悸。丁巳年正月下旬，专人迎我前往诊视。左脉细软而数，寸部尤其甚，右尺洪数，寸关不耐寻按。大概是燥邪薄肺，初失整肃，阴分素亏，源流两涸，今胃气已败，万物发蛰之时，如何过去。其二女儿深谙医理，极以为然。适逢邵位西枢部持蒋大理之函相召，我即解缆离去。嗣后接到赵笛楼先生信说：彭证果殁于惊蛰前三日，何脉之神耶？我说这也是偶然事耳。如前年五月间，偶然诊顾听泉明经之脉，就对家伯茂才说：顾君不可以过冬，盖石象已见也。后竟殁于立冬之刻。今年二月诊庄丈芝阶脉，对其文孙眉仙少君说：恐难以度夏。而立夏前三日竟逝。十月初游武林，访家瘦石兄，切其脉尺中微露浮弦，即对其子说：春令可虞。亦于次年惊蛰日无疾而终。脉之可凭者如是，而竟有不可凭者，此其所之所以为深微之学乎？
蒋君寅太夫人患病，恰逢我游武林，专丁招往。病已七日，龈糜颐肿，寒热时形，脘闷头疼，不眠不食，苔黄便秘，脉数而弦。这是冬令伏邪发为温病，血虚肝旺，禀赋使然。用枳实、桔梗、羚羊角、连翘、栀子、石菖蒲、葱头、天竺子、麝干为前茅，三剂后热退肿消；用小陷胸汤合栀豉汤，加石菖蒲、茯苓、竹茹、雪羹开中坚，亦三剂而便畅胸舒，渐啜糜粥；用西洋参、肉苁蓉、麦冬、石斛、川贝母、竹茹、当归身、知母、黄连为后劲，渐安眠食而痊愈。其庶祖母年八十六岁，患胸闷便秘，少腹瘕痛，夜分凛寒，两目更冷，不饮不食，口苦息粗，都以高年为虑。按脉弦数而涩，这是肝气素滞，食阻上焦，升降并愆，故脉涩而息不调也，岂可误以为正气之衰乎？进枳实、桔梗、瓜蒌、薤白、石菖蒲、紫菀、苏叶、黄连、橘核、旋覆花之方，投匕而痊愈。次年春病复如是而较甚，我也以此法治愈之。寅曾于去年冬天患血溢，与清舒肝胆而安。惟久患不眠，臂冷食少，自云服补心丹及知柏八味丸甚合。我说：脉至弦细而缓，因赋质阴亏，心多思虑，五火内炽，烁液成痰，阻碍气机，故脉证如是。滋腻之药，不可再投。用沙参、丹参、丝瓜络、茅根、旋覆花、橘皮、半夏、石菖蒲、茯苓，服用十余剂而痊愈。
梅里任会嘉之正室，年逾五旬。季春患证渐剧，访我诊视。身热头疼，怕冷胸闷，气冲无寐，神惫音低，苦渴嗽痰，干呕便闭，脉甚细软，延已旬余。都认为虚，欲投补剂。我说阴分虽亏，气郁痰滞，温邪留恋，怎可补耶？轻展清宣，庶乎合拍。用葱豉汤合小陷胸汤，加南沙参、麝干、马兜铃、通草、竹茹，二剂后热退呕吐止；去葱、豉、兜、麝，加栀子、贝母、黄芩、石菖蒲，三帖后便行胸适，得寐知饥，改投柔木涵阴而痊愈。
钱塘姚欧亭大令宰崇明，其夫人自去年九月以来，夜不成寐，都认为神虚，补药频投，渐渐不起榻，头重如覆，善悸便难，肢汗而心内如焚，多言，溺畅畏烦，而腹中时胀，遍治无功。其西席张君心锄，屡信专丁邀诊，我不获辞，初夏乘桴往视。左寸关弦大而数，右稍和而兼滑，口不作渴，舌尖独红。这是忧思谋虑扰动心肝之阳，而中挟痰饮，火郁不宣。温补更助风阳，滋腻尤增痰滞。至鹿茸为透生巅顶之物，用于此证，犹舟行逆风而扯满其帆也；明粉为芒硝所炼，投以通便，是认为阳明之实秘也，今胀能安谷，显非府实，不过胃降无权，肝无疏泄，乃无形之气秘耳。遂用人参、黄连、旋覆花、枳实、半夏、白芍、蛤壳、竹茹、郁李仁、麻仁、凫茈、海螵蛸，两服即寐，且觉口苦溺热。我说：此火郁外泄之征也。去蛤壳，加栀子，便行胀减，脉亦渐柔；再去麻、郁、雪羹，加石英、柏子仁、茯苓、橘皮、小麦、莲子心、红枣核，三剂各恙皆安；去石英、栀子，加冬虫夏草、鳖甲为善后。我即挂帆归矣。然不能静摄，季夏渐又少眠，复遣丁谆请，我畏热不行，命门人张笏山茂才往诊，遵前法而治，遂以告愈。
崇明刑幕吴江史励斋之正室，久患少腹聚瘕，时欲攻痛，羞明心悸，汛速带频。向服补药，交夏发之更剧。医生用胶艾汤加人参、白术、阿胶、鹿茸峻补，痛益难支，遂致晕厥，不眠不食，业已四朝。屈我诊视，脉来弦滑，苔黄苦渴，溺热便难。用沙参、石英、龟版、鳖甲、青蒿、白薇、薏苡仁、黄柏、阿胶、鹿茸、竹茹、石菖蒲，一饮而病如失，眠食皆安，赠以清养柔潜而别。
我游瀛洲，有越人李姓，挽心锄茂才见我，说亲串中一妇人，因娩后嗽血，遂至两目无光，四肢痿弱不能动，欲求一方。张说如此大证，未审其脉，如何施治。我说：吾知之矣，此肺热欲成痿躄也。遂用西洋参、桑皮、玄参、百合、知母、苡仁、藕、茅根、枇杷叶为方，服用六剂。闻我将归，李亟来署致谢说：病去大半矣，真仙丹也。欲再求一方，我为加葳蕤一味。然此由海外，因不知有“产后宜温”之...
Shichangpu (Rhizoma Acori Tatarinowii), Shihu (Dendrobii Caulis), Yanwo (Swallow's Nest), and Pipayie (Loquat Leaf), decocted with water dew, taken orally. After three doses, diarrhea ceased, phlegm became thin, the chest felt loose, and porridge could be consumed. The physician saw that the tongue coating had receded and the tongue body was red, and was alarmed, considering it to be Yin fluid depletion (loss of body fluids). Zhongqing invited me again to examine the patient. This is actually a sign of pathogenic retreat. The absence of saliva on the tongue was already described in the previous case record; now that the pulse is gradually improving, why the surprise and worry? Therefore, from the previous prescription, remove Gualou (Trichosanthis Fructus), Xiebai (Allii Macrostemonis Bulbus), Lianlian (Coptidis Rhizoma), and Banxia (Pinelliae Rhizoma), and add Danggui (Angelicae Sinensis Radix), Dihuang (Rehmanniae Radix), Maidong (Ophiopogonis Radix), and Ou (Nelumbinis Rhizoma). After taking this, the patient recovered.
Madam Zhu suffered from bloody dysentery for a month, treated by multiple physicians with mixed methods. The dysentery had stopped for three days, but since the onset of the illness, she experienced chest fullness and head distension, could not even take rice water, felt thirsty with a yellow tongue coating, suffered from emaciation, fever, and pain, alternated between chills and fever, and could not sleep at night. Her spirit was exhausted and her form wasted. Various physicians found their skills inadequate and begged me to examine her. Her pulse was rapid and wiry. This indicates lingering summerheat not cleared, with Ying (nutritive) fluids and Jin (fluids) having been depleted, and Qi mechanism obstructed. The primary strategy is to clear and drain. Use Nanshashen (Glehniae Radix), Shichangpu (Rhizoma Acori Tatarinowii), Gualou (Trichosanthis Fructus), Xiebai (Allii Macrostemonis Bulbus), Zhizi (Gardeniae Fructus), Huangqin (Scutellariae Radix), Zhuru (Bambusae Caulis in Taeniam), Lianlian (Coptidis Rhizoma), Juapi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma), Baiwei (Cynanchi Atrati Radix), and Ziwan (Asteris Radix). After four doses, phlegm moved, the chest felt comfortable, and chills/fever greatly reduced, and she could sip porridge. Switch to Beishashen (Glehniae Radix), Sheng Shouwu (Polygoni Multiflori Preparatus Radix), Baiziren (Biota Semen), Dongguazi (Benincasae Semen), Xuanshen (Scrophulariae Radix), Gualou (Trichosanthis Fructus), Xiebai (Allii Macrostemonis Bulbus), Shichangpu (Rhizoma Acori Tatarinowii), and Zhizi (Gardeniae Fructus). After two doses, hard stool was passed. Adopting a clearing and nourishing method, she recovered.
Mr. Qian Youqin, aged fifty-nine. In July, he suffered from damp-turbidity dysentery (Zhixia) and cured himself by taking one dose of Dahuang (Rhei Radix et Rhizoma). In late autumn, he suffered from alternating chills and fever, took Chaihu (Bupleuri Radix), Guizhi (Cinnamomi Ramulus), etc., on his own, and the condition worsened. He became manic and agitated, wanting to eat watermelon and taking Shigao (Gypsum Fibrosum). I examined him: the pulse was slippery, more so on the right side; the tongue coating was greasy and yellow; there was constipation and short urine; chest fullness; and he ate no grain. This is summerheat-dampness combined with phlegm obstructing the Qi level. Treatment should involve opening and draining; Baihu Tang (White Tiger Decoction) must not be used. Use Gualou (Trichosanthis Fructus), Xiebai (Allii Macrostemonis Bulbus), Zhishi (Aurantii Fructus Immaturus), Houpo (Magnoliae Officinalis Cortex), Lianlian (Coptidis Rhizoma), Xia (Banxia), Zhuru (Bambusae Caulis in Taeniam), Huangqin (Scutellariae Radix), Yuan (Ziwan), Jiegeng (Platycodonis Radix). After three doses, both bowels and urination became smooth, the chest felt open, and he recovered.
Madam Fang suffered from labor injury complicated by external contraction, which had already been cured. After taking several doses of tonifying medicines, edema gradually appeared. Someone said the pathogen was not cleared and tonification was too early. Using resolving and clearing methods yielded no result. Additionally, she had coughing and air rushing up disturbing sleep, loose stools, and difficult urination. It was said that Kidney Qi fails to grasp, so treatment shifted to filling and nourishing, but the condition worsened, leaving them helpless. They asked me to examine her. The pulse was floating without sweat; the Chi (cun-guan-chi) position was quiet, and menstruation had occurred. It was neither a deficiency of the root nor an error of tonifying while pathogens remained. It was likely that after recovery, she contracted wind pathogen again, causing Lung Qi obstruction and failure to distribute water fluids, known as Pi Shui Syndrome (Edema of the Skin). Use Xiangru (Moslae Herba), Xingren (Armeniacae Semen Amarum), Zisu (Perillae Folium), Chenpi (Citri Reticulatae Pericarpium), Douling (Fritillariae Thunbergii Bulbus), Shegan (Musk), Ziwan (Asteris Radix), Tongcao (Tetrapanacis Medulla), and Congbai (Allii Fistulosi Bulbus). Decoct with Tianquan Shui (Heavenly Spring Water) and reed fire. She recovered after drinking one cup.
Although I brought my family back to my hometown, I could not ignore relatives and friends in the provincial capital, so I occasionally stayed there. On the second day of the sixth lunar month this year, I rowed a boat back to my village to avoid the busy social engagements of the hot months. Later, due to severe drought and dried-up rivers, boats could not pass. Some invited me via sedan chair, but I feared the long journey and declined. After the Mid-Autumn Festival, the river gradually opened. On the night of the 20th, I dreamed of my deceased mother instructing me not to go to the province. At first, I thought it was just memory. By late September, intending to sweep graves at Gaoting Mountain, I went to Hangzhou to visit my younger siblings. The boatman forgot to prepare white rice, and I forced myself to eat a meal of winter-pounded rice. Immediately, my abdomen bloated and I lost appetite. The next day, upon arriving at my residence, I gradually developed a fever. Mr. Yuzhi prescribed several doses of clearing and transforming herbs. On the 16th, I finally passed extremely hard, dry stool. Afterward, I felt intense thirst and desired to drink. Shortly after, I vomited profusely. The vomiting involved Qi surging up from the lower abdomen, tasting extremely sour and bitter, even bringing up roundworms. Mr. Dilou diagnosed: "On the 16th you didn't eat, so the Middle Jiao was greatly deficient. After one bowel movement, there was no pillar left to support, so Liver Wood overacted and insulted." Prescribed Renshen (Ginseng Radix et Rhizoma), Fuling (Poria), Jiaojiao (Zanthoxyli Pericarpium), Wumei (Mume Fructus), Yuzhu (Polygonati Odorati Rhizoma - *Note: Text says Yu, likely Yuzhu or similar, context suggests sour/astringent*, actually text says 'Yu' likely referring to Shan Zhu Yu or similar, but standard is often Wu Mei/Yu here implies sour/astringent herbs, let's stick to text 'Yu' -> likely Shan Zhu Yu Corni Fructus based on context of sour/astringent), Lianlian (Coptidis Rhizoma), Juapi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma), Zhuru (Bambusae Caulis in Taeniam), Jiang (Zingiberis Rhizoma). After four doses, vomiting stopped, and diet slightly resumed. However, muscles wasted away, limbs trembled during sleep, and any slight movement caused abnormal meridian pain. Bowel movements occurred only once every ten days, extremely difficult. Returning home ill, both feet swelled. Knowing deficiency was hard to restore, and my nature resisting medicine, I ate rich, fatty foods. By late winter, swelling subsided, and bowels moistened. Fluids are easily lost and hard to restore! And with slight mental labor, chills and fever would arise. By the third month of the following year, all ailments ceased, and walking was normal, except muscles did not recover, because Spleen governs the four limbs, Stomach governs muscles, and [tendons] bind bones and facilitate joints. My Spleen and Stomach have always been weak, so I fear medicine like a tiger. Any substance with a strong odor causes immediate vomiting if drunk. If swallowing pills, they cannot be digested. Raw, cold, and hard foods are strictly avoided. Most strangely, the smell of winter-pounded rice is also something I have always feared; occasional consumption causes minor illness, but never this severe. I dare not try it again. I deeply regret not following my mother's dream instruction, so I retired to a remote village and no longer stayed in the province. Ignorant people called me a celestial being, probably because I can remain content with my simplicity. In the Wu-Yue region, I did occasionally travel. The following summer, visiting Wulin, I met Scholar Xu Guanzhi and saw his daughter suffering from Gan Peng Ju Qi Syndrome (Infantile Malnutrition with Distension and Qi Accumulation), said to originate from eating winter-pounded rice at her maternal home in Tongxiang. Thus, human Spleen and Stomach can be similar to mine.
At the end of autumn, my wife was seven months pregnant and contracted malaria. Physicians tried clearing and resolving without success. Half a month later, it became intermittent. I was bedridden in the provincial capital. Family feared adding to my worry and hid it from me initially. Dragged on for a month, the condition became critical. Scholars Qian Yishan and Guan Zhishan boated to fetch me, bringing me back while ill. Pulse was soft and slippery, with Chi and Guan positions deficient and wiry. Before each malaria attack, there was extreme thirst, back numbness, and epigastric oppression. After heat came, headache, leg and foot swelling. Chills lasted less than an hour, but heat lasted seven or eight hours. Emaciated like a jackal, skin rough like fish scales, hard stool, difficult urination, palpitations, insomnia, unable to see, tongue bare without fluid. This is fundamental Yin deficiency, Water failing to nourish Wood, internal blazing Wind-Yang, consuming Blood and injuring Fluids, combined with labor injury absorbing Autumn Heat, frequent drinking of hot tea, aversion to rice, lower back pain, and restless fetus. The situation was very dangerous. Prescribed Xiyangshen (American Ginseng), Xuanshen (Scrophulariae Radix), Zhimu (Anemarrhenae Rhizoma), Baiwei (Cynanchi Atrati Radix), Qinghao (Artemisiae Annuae Herba), Juhua (Chrysanthemi Flos), Shichangpu (Rhizoma Acori Tatarinowii), Maidong (Ophiopogonis Radix), Zhizi (Gardeniae Fructus), Gancao (Glycyrrhizae Radix et Rhizoma), Sangye (Mori Folium), Zhuli (Bambusae Caulis in Taeniam). After two doses, much phlegm was coughed up, thirst and oppression slightly reduced. Remove Sangye, Juhua, Zhizi, Qinghao. Add Juhong (Citri Reticulatae Pericarpium Rubrum) 8 fen, Zhusu (Perillae Folium) 5 fen, Congbai (Allii Fistulosi Bulbus) 2 stalks. After another two doses, malaria stopped, more phlegm expectorated, tongue color gradually moist. Remove Xuanshen, Zhimu, Baiwei. Add Dongguazi (Benincasae Semen), Fuling (Poria), Geke (Tridacnis Concha). After one dose, cough reduced, but left hypochondrium hurt occasionally. Then use Beishashen (Glehniae Radix), Shudi (Rehmanniae Radix Preparata), Maidong (Ophiopogonis Radix), Gualou Ren (Trichosanthis Semen), Lianshi (Meliae Fructus), Shichangpu (Rhizoma Acori Tatarinowii), Sigualuo (Luffae Fructus Retinervia), Shida Gonglao (Mahoniae Caulis), Ou (Nelumbinis Rhizoma) to nourish Yin and soften Liver, clearing Phlegm-Heat. Taken well. However, although eyes could see, morning drowsiness persisted. Increase Shudi, add Baiwei (Cynanchi Atrati Radix), Guishen (Angelicae Sinensis Radix). After one dose, sudden chills and fever, red face, Qi rushing up. Some blamed early tonification causing malaria recurrence. I said no, this is intolerance to the moving property of Guishen. Immediately remove it, add Congbai (Allii Fistulosi Bulbus), Putaogan (Vitis Vinifera Fruit Dried). Took it, indeed recovered. Then remove Congbai, add Gancao (Glycyrrhizae Radix et Rhizoma), Shihu (Dendrobii Caulis). Two doses, cough greatly reduced, Stomach harmonized, bowel movements moister. Only palms hot like iron, feet cold. Change Shashen to Xiyangshen (American Ginseng). Remove Gualou, Lianshi, add Sheng Muli (Ostreae Concha) 1 liang, Shuiyan Chao Juhong (Salt-fried Citri Reticulatae Pericarpium Rubrum) 1 qian. Two doses, feet warmed, phlegm thickened, but lower back and hypochondriac pain continued. Add Jiuchao Zhimu (Wine-fried Anemarrhenae Rhizoma) 1 qian. Two doses, much phlegm discharged, drowsiness reduced. Only swallowing food felt like choking, hunger returned when Fire descended, tongue spicy and dry, urine still hot. Change to Xiyangshen (American Ginseng), Erdi (Shengdi & Shudi), Erdong (Tian Dong & Mai Dong), Erzhi (Nvzhenzi & Hanliancao), Zhimu (Anemarrhenae Rhizoma), Baipiao (Phellodendri Cortex), Muli (Ostreae Concha), Shida Gonglao (Mahoniae Caulis), with Shaoren (Amomi Fructus) as assistant. Six doses, all ailments resolved, able to rise but legs soft, spirit still confused. Use this formula plus Baishao (Paeoniae Radix Alba), Mugua (Chaenomelis Fructus), Shichangpu (Rhizoma Acori Tatarinowii) to make paste. Take until after Winter Solstice, spirit refreshed, recovered.
Madam of Dr. Dong Kuhupu from Xiushui. I accidentally checked her pulse in mid-autumn, knowing her Eight Extraordinary Vessels were long deficient, accumulated labor and depression. Pulse under fingers was deficient, wiry, and choppy. Chills and fever frequently appeared, defying fire rose easily, little sleep, prone to palpitations. Nature feared medicine, unwilling to rest. In winter, symptoms resembled San Nue (Tri-periodic Malaria). I couldn't visit due to illness. Letter said: Tongxiang passed a miraculous formula for San Nue, effective as a god. Formula: Tianta (Sweet Tea), Banxia (Pinelliae Rhizoma) each 2 qian; Chuanbei (Fritillariae Cirrhosae Bulbus), Binglang (Arecae Semen) each 3 qian; Juapi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma) each 1.5 qian; Ganjiang (Zingiberis Rhizoma) 1 qian; Muxiang (Aucklandiae Radix) 0.5 qian. Total eight ingredients. Taken three doses, cured. I replied: This is a coercive formula, only suitable for excess patterns of Cold-Dampness and Drink Pathogens. If deficiency or heat patterns, even if cured, will have aftermath. Thus, copying and transmitting single formulas is difficult. If one loves benevolence but not learning, merit and fault may not balance. Soon, illness relapsed, worse than before. I discussed with Lv Shen'an using calming, nourishing, softening, and subduing methods, gradually recovering. Later heard most who took this formula relapsed. His son, Scholar Weiqing, deeply admired my foresight.
Madam of Zhang Baoshang suffered chills and sudden fever, coughing and air rushing up, wasting form, red face, poor appetite, delayed menstruation, dizziness. Doctors gave tonics, night sweats and leukorrhea frequent. All said she wouldn't survive spring. I examined: pulse wiry, slippery, rapid. Not consumptive disease, no need for tonics. Liver Yang internally abundant, condensing fluids into phlegm, blocking Qi mechanism. Method: Clear and expand. Xuanshen (Scrophulariae Radix), Danshen (Salviae Miltiorrhizae Radix), Ziwan (Asteris Radix), Baiwei (Cynanchi Atrati Radix), Qinghao (Artemisiae Annuae Herba), Huangbai (Phellodendri Cortex), Shichangpu (Rhizoma Acori Tatarinowii), Juhua (Chrysanthemi Flos), Zhuru (Bambusae Caulis in Taeniam), Zhuye (Bambusae Folium). Each dose accompanied by Danggui Longhui Wan (Angelica and Gardenia Pill) 1 fen. Twenty doses, healthy as before.
Madam of Feng Yisan. Last year spring flood missed, showing deficiency signs. Everyone thought damage, I diagnosed pregnancy. Late autumn, gave birth to a boy. Early spring of Ding Si year, postpartum over three months, not breastfeeding, menses not returned. Accidentally caught external pathogen. Medical treatment half a month, gradually no hunger, no eating, Qi surging from lower abdomen, feeling like mass, vomiting, abdominal pain, yellow face, wasted form, hot urine, loose stool, thirst, leukorrhea, facial edema, coughing. All said postpartum damage. Re-invited me. Pulse slippery and wiry. Diagnosed pregnancy again. Shashen (Glehniae Radix), Zhusu (Perillae Folium), Sangpi (Mori Cortex), Dongguapi (Benincasae Exocarpium), Huangqin (Scutellariae Radix), Zhike (Aurantii Fructus), Shichangpu (Rhizoma Acori Tatarinowii), Baiwei (Cynanchi Atrati Radix), Juhe (Citri Reticulatae Pericarpium), Lianshi (Meliae Fructus). Decocted, sending Xianglian Wan (Coptis and Cinnamon Pill). Three servings, instantly recovered. Heard mid-June gave birth to a girl quickly.
Madam Lang. After metrorrhagia, leukorrhea, five internal organs burning, hot urine, dry mouth, no hunger, epigastric oppression, back pain, muscle wasting, groaning in bed, dizziness, tinnitus, insomnia, fine rapid pulse, lower abdomen discomfort. Tonics miscast, no effect. Use Shashen (Glehniae Radix), Shichangpu (Rhizoma Acori Tatarinowii), Shihu (Dendrobii Caulis), Baizi (Biota Semen), Baiwei (Cynanchi Atrati Radix), Fuling (Poria), Geke (Tridacnis Concha), Dongguazi (Benincasae Semen), Ou (Nelumbinis Rhizoma), Shida Gonglao (Mahoniae Caulis) to clear and expand first. Five doses, heat retreated, thirst harmonized, epigastrium comfortable, eating well, sit up, sleep at night. Qi mechanism smoothed. Add calming Yang and nourishing Blood, recovered.
Mother of Jiang Baozhai from Meixi. Since dysentery last summer/autumn, tired spirit, little sleep, unable to get out of bed. Doctor said deficiency, gave tonics. Gradually panic, palpitations, irritability, talking in sleep, hypochondriac pain, vertex pain, tinnitus, sore throat, chills evening fever, heavy sweating like rain, fainting occasionally. More tonics, more danger. Li Cangyu invited me. Pulse wiry, slippery, rapid. Whites of eyes slightly red, eye sockets dark like ink, crimson tongue without coating. Asked: Chest stuffy? Answer: Very stuffy. Constipated? Answer: Very constipated. Hot urine? Answer: Very hot. Is it not Qi stagnation condensing phlegm, phlegm blocking Qi obstruction, Lung/Stomach failing to descend, Liver/Gallbladder rising together, turbid not descending, wind from fire? Although over fifty, Yin/Blood insufficient, upper/middle blocked,首要 (primary) is to unblock Yang. Prescribed Xiao Xianxiong Tang (Minor Trap in the Chest Decoction) plus Shichangpu (Rhizoma Acori Tatarinowii), Xiebai (Allii Macrostemonis Bulbus), Xuanfu (Inulae Flos), Zhuru (Bambusae Caulis in Taeniam), Fuling (Poria), Zhishi (Aurantii Fructus Immaturus), Yuliren (Pruni Semen). Doctors called it fierce, shocked. Baozhai said: Calming/tonic/astringent tried, useless, disease worsened. Take it. Indeed, one dose better, three doses safe. Then I traveled to provincial capital. Previous doctor said pathogen gone, continued tonifying for a month. Still constipated, insomnia, chest fullness, irritability, added macules and abdominal pain. People considered critical. I was in Hezhong, letter requested visit. Still use previous method modified, combine Xue Geng (Snow Soup). Several doses, large bowel movements, all hard/dry. Change to soft/nourishing. Bowels smoother, porridge increased. Finish with calming/subduing/soothing/nourishing agents.
Third daughter of Peng Zhiting from Renhe, just past puberty. Since last autumn, phlegm-cough internal heat, gradually missed periods, reduced eating, rotten throat, hoarse voice, emaciation, loose stool, insomnia, palpitations. Late Jan Ding Si, special envoy fetched me. Left pulse fine, soft, rapid, Cun especially so. Right Chi洪 (flooding) rapid, Cun/Guan intolerant to pressure. Dry pathogen attacking Lung, initial loss of regulation, Yin level deficient, source and flow dried, Stomach Qi defeated. When hibernating insects wake, how to pass? Second daughter knows medicine, agrees. Shao Weixi summoned by Jiang Dalì. I left. Zhao Dilou wrote: Peng died three days before Jingzhe. How divine the pulse? I say accidental. Like May last year, checking Gu Tingquan's pulse, told uncle: Cannot survive winter, Stone Image seen. Died at Lidong. Feb this year, checked Zhuang Zhijie's pulse, told grandson: Hard to survive summer. Died three days before Lixia. Oct visited Jia Shoushi, Chi pulse slightly floating/wiry, told son: Spring dangerous. Died Jingzhe next year without illness. Pulse reliable thus, yet unreliable sometimes, this is why it's profound learning.
Grandmother of Jiang Yin. Illness, I visited Wulin. Seven days sick, gum erosion, cheek swelling, chills/fever, chest stuffiness, headache, insomnia, no eating, yellow coating, constipation, rapid wiry pulse. Winter latent pathogen becoming Warm Disease, Blood deficiency Liver hyperactivity, constitution. Zhi (Zhishi), Jie (Jiegeng), Ling (Lingyangjiao), Qiao (Lianqiao), Zhi (Zhizi), Changpu (Shichangpu), Congtou (Congbai head), Douling (Doulingzi), Shegan (Shegan) as vanguard. Three doses, heat down, swelling gone. Xiao Xianxiong Tang + Zhichi Tang, plus Changpu, Fuling, Zhuru, Xue Geng to strengthen middle. Three doses, bowel smooth, chest comfortable, sip porridge. Xiyangshen (American Ginseng), Roucongrong (Cynomorii Fructus), Maidong (Ophiopogonis Radix), Shihu (Dendrobii Caulis), Chuanbeimu (Fritillariae Cirrhosae Bulbus), Zhuru (Bambusae Caulis in Taeniam), Guishen (Angelicae Sinensis Radix), Zhimu (Anemarrhenae Rhizoma), Huanglian (Coptidis Rhizoma) as rear guard. Sleep/eating improved, recovered. Great-grandmother, 86 years old. Chest stuffiness, constipation, lower abdomen mass pain, chills at night, cold eyes, no drink/eat, bitter taste, coarse breath. Worried about age. Pulse wiry, rapid, choppy. Liver Qi stagnant, food blocking Upper Jiao, ascending/descending disrupted, hence choppy pulse and irregular breath. Mistaken for Zheng Qi decline? Give Zhi, Jie, Gualou, Xiebai, Changpu, Yuan, Su, Lian, Juhe, Xuanfu. One dose cured. Next spring relapse worse, cured same way. Yin had blood overflow last winter, cleared Liver/Gallbladder, calmed. Insomnia, cold arms, poor eating, said Buxin Dan and Zhibo Bawei Wan suited. I said: Pulse wiry, fine, slow. Constitution Yin deficient, mind overthinking, Five Fires internal blazing, melting fluids into phlegm, blocking Qi, hence pulse/symptoms. Greasy tonics forbidden. Shashen, Danshen, Sigualuo, Maogen, Xuanfu, Juapi, Banxia, Shichangpu, Fuling. Ten doses, recovered.
Ren Huijia's wife from Meili, over fifty. Late spring illness worsening. Fever, headache, chills, chest stuffiness, Qi rushing, insomnia, tired spirit, low voice, thirsty coughing phlegm, dry retching, constipation, fine soft pulse, ten days. Thought deficiency, wanted tonics. I said: Yin deficient, Qi stagnation phlegm obstruction, Warm pathogen lingering, how to tonify? Lightly clear/expand. Congchi Tang + Xiao Xianxiong Tang, plus Nanshashen, Shegan, Madouling, Tongcao, Zhuru. Two doses, heat down, vomiting stops. Remove Cong, Chi, Dou, She. Add Zhi, Bei, Qin, Changpu. Three doses, bowel moves, chest comfortable, sleep/hunger return. Change to softening Liver nourishing Yin, recovered.
Yao Outing, magistrate of Chongming, wife. Since last Sept, insomnia. Thought Spirit deficiency, frequent tonics, bedridden, heavy head, palpitations, difficult stool, limb sweat, heart burning, talkative, free urination, aversion to annoyance, abdominal bloating. Treatments failed. Tutor Zhang Xinchu invited me. Early summer visited. Left Cun/Guan wiry, large, rapid. Right harmonious, slippery. No thirst, tip of tongue red. Worry/thought disturbed Heart/Liver Yang, middle carries Phlegm-Drink, Fire郁 (stagnant) not expressed. Warm tonics help Wind-Yang, greasy tonics increase Phlegm obstruction. Deer Antler penetrates vertex, like sailing against wind with full sails; Mingfen (refined Glauber's salt) clears bowels, treating Yangming excess constipation. Now bloating but eats well, clearly not Fu excess, just Stomach failing to descend, Liver failing to diffuse, invisible Qi constipation. Use Renshen, Lianlian, Xuanfu, Zhishi, Banxia, Shaohao, Geke, Zhuru, Yuliren, Mahren, Fuci, Hai Piao Xiao. Two doses, sleep, bitter taste, hot urine. I said: Fire escaping. Remove Geke, add Zhizi. Bowel moves, bloating reduces, pulse soft. Remove Mah, Yu, Xue Geng. Add Shiyin, Baiziren, Fuling, Juapi, Xiaomai, Lianzixin, Hongzaohé. Three doses, all calm. Remove Shiyin, Zhizi. Add Dongchongxiacao, Biejia for follow-up. I sailed home. Could not rest quietly. Mid-summer less sleep. Sent messenger urgently. Feared heat, sent disciple Zhang Hushan. Followed method, recovered.
Shi Lizhai's wife, legal clerk in Chongming. Long-term lower abdomen mass, attacking pain, photophobia, palpitations, fast periods, frequent leukorrhea. Previously took tonics, summer flare worse. Doctor used Jiao Ai Tang + Renshen, Baizhu, Ejiao, Lurong (Deer Antler) strong tonification. Pain unbearable, fainting, insomnia, no eating, four days. Asked me. Pulse wiry, slippery, yellow coating, bitter thirst, hot urine, difficult stool. Shashen, Shiyin, Guiban, Biejia, Qinghao, Baiwei, Yiyiren, Huangbai, Ejiao, Lurong, Zhuru, Shichangpu. One drink, illness lost, sleep/eat peaceful. Gifted clearing/nourishing/softening/subduing, parted.
Traveling Yingzhou, Yue person surnamed Li, asked Zhang Xinchu to see me. Relative woman, postpartum coughing blood, blind, limbs flaccid unable to move, sought formula. Zhang said major illness, no pulse, how treat? I said: I know, Lung Heat becoming Wei Bi (Flaccidity Syndrome). Xiyangshen (American Ginseng), Sangpi (Mori Cortex), Xuanshen (Scrophulariae Radix), Baihe (Lilii Bulbus), Zhimu (Anemarrhenae Rhizoma), Yiren (Coicis Semen), Ou (Nelumbinis Rhizoma), Maogen (Imperatae Rhizoma), Pipayie (Loquat Leaf). Six doses. Hearing I leave, Li thanked: Illness mostly gone, true immortal pill. Wanted another formula. Added Weirui (Polygonati Rhizoma). But from overseas, unaware of "Postpartum should be warm"...