谬说，故无人阻挠，而得偶然幸愈也。
枫泾程笙伯令正，半产之后，汛事先期，淋漓不断，时且痛胀，龈衄减餐，苦渴苔黄，脉弦而数。频服补剂，
久不能瘳。余投沙参、龟版、制香附、丝瓜络、茹、楝、菖、蒿、桅、薇、柏、藕十余剂，次月经即调，复来求
诊，与柔养善其后。
细君上年病后，以清养药熬膏，服至岁杪，已康复胜常。孟春十八日，分娩亦快健。七日后，余即游武林，
继返硖川，由梅溪而游嘉秀，至清明归，为展墓也。知其左乳裂疼，乳房亦痒，搔即水出，起已月余，初谓外恙
不足虑，令取疡科善药敷之。余复鼓棹游梅泾而至 李，又浮海游崇沙，迨归已届端阳矣。见其右目胞坍而甚赤，
询厥乳患，左加甚而更及于右，诸药久敷，皆无偶效，且兼气冲痰嗽，口渴肤糙，盖津液悉从外患而耗也。察其
脉滑而数，良由肺胃热炽使然。遂授元参、石膏、知、翘、甘、苡、蒌、栀、菖、菊、蛤壳、银花等，二十余剂
而各恙并蠲。既而余游吴越间者月余，归见其遍身暑疖，形瘦少餐，食后神疲，二便不畅，脉则弦涩不调。与元
参、丝瓜络、栀、连、菖、橘、蒌、苑、薇、苏，四帖而经月之病若失，亦因气郁热壅也。可见治病必探其源，
勿徒遏其流，而故人管君荣棠尝谓外证不宜服药，盖为服不得其当，及信书太过、
泥用成方者言耳。若宣气清血之法，原不禁也。
沈雪江光禄年五十岁，于客腊偶患头晕，既而右手足麻木，医进再造丸十余颗，渐至挛曲不伸，针药无效。
仲春余游 李，吴门李君雨村招往视之。手足亦肿而疼，便坚溲赤，口干舌绛，准头一瘰磊然，脉象弦滑而数，
平时屡有鼻衄。肝阳易动，曲运神机，体质性情，阴虚火盛，风自火出，烁液成痰，窜入络中，则为是证。初起
若以竹沥一味灌之，可以渐愈。乃温补率投，遂成锢疾，幸而病在经络，停补尚可延年，苟欲望有转机，必与清
通宣泄。拟方三剂，肿痛稍瘥。议者谓药太清凉，多服恐妨脾胃，更医复事温补，并雨村亦不延诊矣。迨四月中
旬，大便忽秘，饮食不思，半月余，更衣极艰滞，而解后胸次愈形窒塞，遂不食，然参药不辍也。至五月十八日，
复解燥矢，仍不思食，勉强啜粥辄呕吐，次日转为滞下，色如鱼脑，日数十行。医谓有出无入，脾肾两败矣，温
补方再加固涩之品，遂鼻血如注，且有成块成条之坚韧紫血，自喉间涌出，虽米饮不能下咽，小溲涩滞不行，时
欲呷茶以润口。或云已传关格，无药可图，而引火归元之法，愈用愈剧。诸医无策，眷属皇皇，业办后事矣。乃
弟云峰待诏，余春时所嘱，挽人聘余往援。二十四日余抵禾，见其面色枯黧，牙关紧而舌不出齿，脉至右滑左弦
细数，皆上溢而尺不应指。胸闷溺涩，阳宜通而不通，是滋腻阻塞气道也；血溢下利，阴宜守而不守，是温燥灼
烁营液也。吾先慈所谓人身如欹器，满则必覆。半年蛮补，填满胃中，设不倾筐倒箧而出，亦必塞死，岂可不加
揣测，而误认为神机化灭之出入废、关闸不禁之下利、阴盛格阳之吐衄，而再施镇纳堵截之药哉！古云∶上部有
脉，下部无脉，其人当吐，
不吐者死。今火炽上炎，鼻血大流，汤水不能略咽，有升无降，与吐何殊？况见证虽危，而呼吸不促，稍能安寐，
皆是未绝之生机。考古下利而渴者属厥阴，白头翁汤主之；滞下不食者为噤口，参连汤主之。余合而用之，加石
菖蒲宣气通阳，石斛、茅根生津凉血，一服而利减其半；次日去连、柏，加元参、犀角、童便，专治其衄，一服
血渐少，利渐止；然离络之血，不可不使之出，未动之血，亟当使其各安于位，故以西洋参、丹参、麦冬、茯苓、
菖蒲、石斛、小麦、竹叶、栀子、甘草梢、燕窝等出入，三剂血既止，牙关渐开，苔色黄腻，啜饮必拍膈始得下
行；因参以小陷胸法，数剂自觉身体略轻，手腕稍舒；改清肃肺胃，展气化以充津，苔渐退，渴亦减，脉较平；
守至闰月二十二日，尺脉滑动，于方中加肉苁蓉、麻仁二味，夜间即解坚黑燥矢，而渐能进粥；随去麻、苁，加
生地，服至六月初七日，口始不渴而吃饭。继因过饮西瓜汁，大便溏泻，复延余往。以六君去术、草，加苡、藿，
数帖而安；随去藿，加首乌、络石、石斛、十大功劳，服二十剂渐能起坐，右腿可以屈伸，但软而无力耳。中秋
后又邀余往，则胃气已复，右指已伸，皮肤色泽，而右臂未能动，右颊犹觉木硬，是络中之痰未净，肝脏之风易
生，气血之灌溉流行，因有所阻碍，而不能贯注也。以养血息风、蠲痰宣气之方，加竹沥为向导，服后足渐能立。
十月间食蟹过多，大解泄泻。余以六君加藕、木香、苏叶调愈。嗣余游盛湖转禾，适交至节，而天暖不藏，又因
劳怒，陡发头晕，呕吐痰涎，目闭不言，不食不便，举家无措。医者率主首乌、牡蛎等滋摄之治。余脉之弦而缓，
是中虚不能御木，故内风上僭，阴柔之品徒滞中枢，不可服也。仍用六君去
甘草，加菖蒲、黄连、旋复花、姜皮、钩藤，三剂霍然。小寒后余游姑苏转禾，又因天暖而发鼻衄，改换养阴潜
阳法而瘳。次年春季出门，因不节劳，至端阳复中而逝。
季夏余游 李，陆君又溪邀视其友王姓之病。寒热时作，汗多不解，便溏不畅，溲赤妄言，面黑如煤，苔黄
大渴，烦燥气逆，脉滑而洪，按其心胸，坚硬而痛，乃暑湿挟痰食也。群医但知时感，辄进寒凉，闻说胸次不舒，
遂疑为疹，羚、犀、膏、地，力竭计穷，已嘱病家备后事。余曰∶此非重证，何必张皇！撤被启窗，胜于服药，
病家唯唯，而不甚信。余即手为揭被开窗。病患 曰∶舒畅多矣。药以小陷胸加芩、枳、翘、茹、薤、菖、海 ，
数服而愈。继有里中张姓者，证相类，面不黑而红，舌无苔而干。诸医亦不察其气分之尚结，痰食之未行，屡进
生地，唇齿渐焦，遂束手。余以小陷胸加元参、海 、菖、枳、芩、翘，一饮而脘舒得卧，齿舌皆津。盖结散邪
行，则气通液布也。
乙卯六月，余三媳患感。身热头重，脘闷，频呕不食，耳聋。余投清解药一剂，病不少减，而汛事非期而至，
邪虽尚在气分，但营阴素亏，恐易陷血室。亟迓半痴至，投小柴胡加减一帖，病少瘥而虚象毕呈，少腹右角甚形
掣痛；半痴于清解中即佐养营通络柔肝之品，服四剂，证交七日，得大战汗而愈。原方为三儿遗失，惟记后四剂
重用干地黄为君，是血虚者必养血则得汗，而儿妇气分甚郁，苟不先行清展气机，则养血之药不能遽入，此因事
制宜之所以不易也，要在先辨其体气与病情耳。更奇者，同时余内侄许贯之茂才室，体极清 ，似较余媳更弱，
且娩已五
次，而产后即发壮热。半痴视为暑证，投大剂凉解数帖，即战汗而瘥。无何胃气渐复，忽又壮热，便闭渴闷，不
饥不食，或疑新产误饵凉药使然，幸病家素信，仍延半痴诊之。右甚滑实，曰食复也。诘之，果啖豆腐稍多。遂
投枳实栀豉汤加蒌、翘、桔、薄、芦菔汁，三啜而痊。斯人斯证，使他医视之，必以为营阴大亏矣，而半痴独不
顾及，证书用药，应手而痊，且愈后不劳培补，寻健如常。可见产后不必皆虚，而体气之坚脆，亦不能但凭于形
色之间也。嘻，难矣。丁巳冬，余假馆潜斋，适半痴草《归砚录》，余读至“结散邪行，气通液布”二语，因追
忆两案，笔之于此。又可见佳案之遗漏尚多。惟冀同志者抄存以期续采仁和徐然石附识。
七月初旬，余游鸳湖归，三侄寿和陡患凛寒，身热筋 ，面红，谵妄汗频，四肢厥冷。年甫六岁，其母危之。
余察其苔色黄腻，口渴唇红，乃停食感冒耳。以枳实栀豉汤加菖蒲及冬干之芦菔叶，煎成调入玉枢丹五分灌之，
次日谵 皆减，而腹痛微有吐泻，寐醒则神犹瞀乱，知其邪有外泄之机，治当迎刃而导，于前方加苏叶一分、黄
连二分同炒煎服，连吐三，五次，泻六、七次，痛即减；第三日神情爽慧，余谓去疾莫如尽，再服原方一剂，遂
愈。盖小儿之病，因于食滞者多，胃不和则卧不安，阳明实则谵妄，而世人辄作惊风治之，每致偾事。昧者更惑
于巫瞽，而祭非其鬼，则尤可笑也。八月初，余游虎林归，二女定宜患感旬余，热虽退而干咳无痰，不眠，不食，
不便，胸腹无所苦，汤饮亦不思，五热形瘦，佥虑成劳。余按脉弦细，是痰阻而气不通也。以紫菀、白前、蒌仁、
薤白、橘红、
半夏、菖蒲、竹茹、枳壳、桔梗，服数帖渐愈。三女杏宜年十四，因侍姊病过劳，且浃旬风雨，寒气外侵，而自
恐不支，勉强纳食，起病则凛寒微热，腿肿而 ，泛泛欲呕，兼以微嗽。适余归之次日也。视其苔微黄而腻，尖
微绛，脉缓滑。以枳实栀豉汤加前、苏、杏、桔、芩、菔饮之。日晡余游南乡归，内子述服药后神情昏瞀，呕出
药食，恐夹痧邪，曾为刮背。余谓此食滞上焦，浊未下行耳。迨夜颇静，诘朝察之，胸仍拒按，原方加菖蒲、紫
菀投之，余即游硖川，黄昏而归。内子云午后神复瞀乱，恐有变证，明日君毋他往也。余颔之。夜间亦静，次早
问答如常，胸犹拒按，因其吐既未畅，大便未行，以前方合小陷胸为剂，外用朴硝罨其胸次。至已刻即神昏如寐，
引衣自覆，呼之不应，时或妄言，面色晦滞，四肢时冷。内子对之下泪。余按脉如故，确系浊气上熏，清阳失布，
既非寒邪深入，亦非温热逆传，原方再服一剂，病如故。余再四思维，径以薤白、石菖蒲各一钱，蒌仁三钱，煎
成和入醇酒一杯灌之；外用葱白杵罨胸次，牙皂末吹鼻取嚏。时将薄暮，至初更始得微汗而肢和，寻即溏解一次
而识人，夜分安眠。第四、五日胸次已舒，略无谵语，乃目有妄见，寐即恶梦，时有潮热。余以蒌、薤、菖，茹、
翘、薇、苑、半、栀、豉、省头草等药通府涤浊，连解三次，各恙皆安；改用清肝肃肺法，至七朝身凉全愈。继
治蒋君寅 五令郎全官，身热筋螈，不啼不乳，神呆嗜卧，或疑惊风，夤夜逆余往视，乃风热夹食也。与开泄清
解法数帖，便行而痰渐嗽出，病即渐瘥。此等虽非大证。设稍误治，告危极速，故连类录之，以备大匠木屑竹头
之需。
管君芝山拉余治其表嫂吴媪，年五十五岁。上年仲夏患癃
二十余日，愈后小溲迄未通畅，已成锢疾。今秋分后，溺秘不行，医疗旬余，温如姜、桂、乌药，凉如栀、芩、
黄柏，利如木通、滑石，皆不效，甚有用益智等以涩之者，渐至腰腹皆胀而拒按，胸高腿肿，不饥不食，大便不
通，小溲略滴几点，热痛异常，舌绛无津，渴喜沸饮，而不敢多啜以增胀满，呻吟待毙。脉软而微，乃阴虚气化
无权也。以沙参、熟地、连、蒌、苓、泽、麦冬、紫菀、牛膝、车前，加附子一钱，桂心五分，煎成冷服，一周
时溺出桶许，而大便随行，进粥得眠，口苦而喜凉饮，即去附、桂、连、蒌、苑、膝，加知、柏、芍药、砂仁，
数服而起。缘境窘不复调理，锢疾闻犹存也。
盛泽王西泉丈仲郎巽斋刑部夫人，年未四旬，而十八年前诞子之后，汛即不行，医以为虚，频年温补，略无
小效。董味青茂才嘱就余诊。脉弦滑而体甚丰，乃气郁生热，热烁津液以成痰，痰复阻其气道，不能化血以流行，
以致行度愆期，腹形胀痛，肢背不舒，骨疼寐惕，渴不欲饮，间或吐酸，二便不宣，苔黄口苦，皆风阳浮动，治
节横斜之故也。与沙参、蛤粉各四钱，丝瓜络、石菖蒲各一钱，紫菀、仙夏、旋复、蒺藜各一钱五分，茯苓三钱，
丹参二钱，黄连四分，海 二两，凫茈一两，服十余剂，来转方云∶胀痛蠲而腹背皆舒，夜寐安而二便亦畅，酸
水不吐，痰出已松，是肝已渐柔，惟食少无味，骨节 疼右甚，乃阳明虚无以束骨利机关也。拟通养法∶参须、
石菖蒲各一钱，茯神、络石各三钱，薏苡四钱，仙夏、竹茹各一钱五分，木瓜八分，姜汁炒黄连三分，十大功劳
一两。仲冬招余往游复视，则诸恙皆安，惟右腿尚疼耳。即于通养方内加黄柏、仙灵脾，服之遂愈。
王西翁令孙芝生茂才室，久患汛行太速，头痛神疲，形瘦内烦，渴喜热饮，纳食滞膈，络胀少眠，脉至软滑
虚弦，腿 而有赤块甚痛，乃阴亏水不涵木，风阳内炽，气郁痰凝。议宣养清潜互用法∶沙参六钱，鳖甲八钱，
首乌三钱，茯神、菊花各二钱，栀炭、竹茹、桑叶各一钱五分，白薇、黄柏、丝瓜络各一钱，以藕二两，十大功
劳一两，煮汤煎药；外用葱白杵烂，蜜调，涂腿上赤块。仲冬复视，烦减能眠，汛行较缓，头疼腿块均已渐瘥，
乃与通补柔潜之剂。后信来知其服甚效。
鸳湖吴君小渔令宠，数年前因娩后啖生菜而患便泻，久治不愈。仲秋余视之，脉弦数。曰∶此非菜之罪也，
乃土受木乘，而频年温补，益广病机，头痛带多，脘疼食少，吐酸痰嗽，五热无眠，无非八脉无权，风阳偏盛，
授宣养清潜之法而愈。继其令妹适岳氏者，久患带下，去冬崩血，赤白并行，延今不已，卧榻数月，佥云无生理
这是错误的说法，所以没有人阻挠，从而侥幸痊愈。
枫泾人程笙伯的夫人，在半产（流产）之后，月经提前来潮，淋漓不断，时常伴有疼痛和胀感，牙龈出血，食欲减退，极度口渴且舌苔黄，脉象弦而数。频繁服用补药，长久不能治愈。我给她开沙参、龟版、制香附、丝瓜络、竹茹、川楝子、石菖蒲、茵陈、山栀、白薇、侧柏叶、藕节等十余剂药，次月月经即调顺。她再次来求诊，我用柔润滋养的方法善后。
我的妻子去年病后，用清养药物熬成膏滋，服用到年底，已经康复胜过平常。孟春十八日，分娩也顺利健康。七日后，我便去杭州游玩，随后返回硖川，经由梅溪游览嘉秀，直到清明才回来，是为了扫墓。我知道她左乳裂开疼痛，乳房也发痒，一抓就有水流出，起病已有一个多月，起初认为外症不足为虑，让她取外科良药敷贴。我又划船游览梅泾并到达李氏家族所在地，又渡海游览崇沙，等到回来已经到了端午节。见她右眼睑塌陷且非常红，询问她的乳房病情，左侧加重且波及右侧，各种药物久敷，都没有偶然见效，并且兼有气逆冲上、咳嗽痰多、口渴、皮肤粗糙，这是因为津液都从外部患处耗散了。观察她的脉象滑而数，这确实是由于肺胃热盛导致的。于是授予玄参、石膏、知母、连翘、甘草、薏苡仁、瓜蒌、山栀、石菖蒲、菊花、蛤壳、金银花等药，二十余剂后各种病症都消除了。不久后我在吴越之间游历了一个多月，回来见到她全身都是暑疖，形体消瘦，进食减少，饭后精神疲倦，大小便不畅，脉象弦涩不调。给予玄参、丝瓜络、山栀、黄连、石菖蒲、陈皮、瓜蒌、远志、白薇、苏梗，四帖药后，一个月的病好像消失了，这也是因为气郁热壅所致。可见治病必须探究其根源，不要只是遏制其表象，所以故人管君荣棠曾说外证不宜服药，那是针对服药不得当，以及迷信书本、拘泥于成方的人说的罢了。如果是宣通气机、清凉血分的治法，原本是不禁止的。
沈雪江光禄年五十岁，在去年的腊月偶然患头晕，接着右手足麻木，医生进服再造丸十余颗，逐渐发展到肢体挛曲不能伸直，针灸药物都无效。仲春时节，我去李氏家族所在地，吴门的李雨村先生邀请我去诊治。手足也肿胀疼痛，大便干结，小便赤涩，口干舌绛，鼻准头有一个明显的肿块，脉象弦滑而数，平时屡次有鼻出血。肝阳容易妄动，心思劳碌，体质性情方面，属于阴虚火盛，风从火出，灼烧津液形成痰浊，窜入经络中，就形成了这个病症。初起如果只用竹沥一味灌服，可以逐渐痊愈。然而盲目投用温补药，遂成了顽固疾病，幸好病在经络，停止温补还可以延年，如果想要看到转机，必须用清通宣泄的方法。拟定方剂三剂，肿痛稍微减轻。议论的人说药太清凉，多服恐怕妨害脾胃，换了医生继续从事温补，连李雨村也不再延请我诊治了。到了四月中旬，大便突然秘结，不想饮食，半个多月，排便极其艰难滞涩，而且解完后胸中更加窒塞，于是就不吃东西了，然而人参药却不停止服用。到了五月十八日，再次排出燥屎，仍然不想吃食，勉强喝粥就呕吐，第二天转为痢疾，颜色像鱼脑一样，一天几十次。医生说有出无入，脾肾两败了，温补方中再加固涩的药物，于是鼻血如注，且有结成块状条状的坚韧紫血，从喉间涌出，虽然米汤也不能咽下，小便涩滞不行，时常想喝茶以润口。有人说已经传到关格病，无药可治，而引火归元的方法，越用越严重。各位医生没有办法，家属惊慌失措，已经办理后事了。他的弟弟云峰待诏，是我春天时嘱托的人，派人聘请我去救援。二十四日我到达嘉兴，见其面色枯黑，牙关紧闭舌头伸不出牙齿，脉至右滑左弦细数，都是上部脉象溢满而尺部不应指。胸闷尿涩，阳气应当通利而不通利，这是滋腻药物阻塞气道；血溢下利，阴血应当固守而不能固守，这是温燥药物灼烧营阴津液。我先母曾说人身就像倾斜的器皿，满了就会翻倒。半年来的蛮横进补，填满了胃中，如果不倾筐倒箧地吐出来，也一定会堵塞致死，怎么能不加以揣测，而误认为是神机化灭的出入废绝、关闸不禁的下利、阴盛格阳的吐衄，而再施用镇纳堵截的药物呢！古话说：上部有脉，下部无脉，其人应当呕吐，不呕吐的会死。现在火炽上炎，鼻血大流，汤水不能略咽，有升无降，与呕吐有什么不同？况且见证虽然危险，但呼吸不急促，稍能安睡，这些都是未绝的生机。考证古代下利而渴的属于厥阴病，白头翁汤主治；痢疾不食的称为噤口痢，参连汤主治。我将两方合用，加石菖蒲宣气通阳，石斛、茅根生津凉血，一服后痢疾减半；第二天去掉黄连、黄柏，加玄参、犀角、童便，专门治疗鼻衄，一服后血渐少，痢渐止；然而离经之血，不可不让它排出，未动之血，亟当使其各安于位，所以用西洋参、丹参、麦冬、茯苓、菖蒲、石斛、小麦、竹叶、栀子、甘草梢、燕窝等加减，三剂后血既止，牙关渐开，苔色黄腻，喝东西必须拍膈才能下行；因此参用小陷胸汤法，数剂后自觉身体略轻，手腕稍舒；改为清肃肺胃，展气化以充津液，苔渐退，渴亦减，脉较平；坚守到闰月二十二日，尺脉滑动，在方中加入肉苁蓉、麻仁两味药，夜间即排出坚黑燥屎，而渐渐能进粥；随即去掉麻仁、肉苁蓉，加生地，服用到六月初七日，口才开始不渴而吃饭。后来因为过量饮用西瓜汁，大便溏泻，又延请我去。用六君子汤去掉白术、甘草，加薏苡仁、藿香，数帖后安定；随即去掉藿香，加首乌、络石藤、石斛、十大功劳，服用二十剂后渐渐能起坐，右腿可以屈伸，只是软而无力的罢了。中秋后又邀我去，则胃气已恢复，右手指已伸展，皮肤色泽正常，而右臂还不能动，右颊还觉得木硬，这是络中的痰未净，肝脏的风易生，气血的灌溉流行，因有所阻碍，而不能贯注。用养血息风、蠲痰宣气的方子，加竹沥作为向导，服用后脚渐渐能站立。十月间吃蟹过多，大便泄泻。我用六君子汤加藕、木香、苏叶调理治愈。后来我去盛湖转往嘉兴，恰逢冬至节气，而天气暖和没有收藏，又因为劳累愤怒，突然发作头晕，呕吐痰涎，闭目不说话，不吃不便，全家不知所措。医生们都主张用首乌、牡蛎等滋阴摄纳的治疗。我诊脉弦而缓，这是中虚不能御木，所以内风上僭，阴柔之品只会阻滞中枢，不可服用。仍用六君子汤去掉甘草，加菖蒲、黄连、旋复花、姜皮、钩藤，三剂后霍然痊愈。小寒后我去姑苏转往嘉兴，又因为天暖而发作鼻衄，改用养阴潜阳法而痊愈。次年春季出门，因为不节制劳累，到端阳节又中暑而去世。
季夏时节，我去李氏家族所在地，陆又溪先生邀请我诊治他朋友王某的病。寒热交替发作，汗多不解，大便溏泄不畅，小便赤涩胡言乱语，面色黑如煤，舌苔黄大渴，烦躁气逆，脉滑而洪，按压心胸部位，坚硬而痛，这是暑湿挟带痰食。众医生只知道是时令感冒，辄进寒凉药，听说胸中不适，就怀疑是疹子，羚羊角、犀角、阿胶、地黄，力量耗尽计策穷尽，已经嘱咐病人家属准备后事。我说：这不是重症，何必慌张！掀开被子打开窗户，胜过服药，病人家属唯唯诺诺，但不太相信。我立即亲手揭开被子打开窗户。病人说：舒畅多了。用药用小陷胸汤加黄芩、枳实、连翘、竹茹、薤白、石菖蒲、海浮石，数服而愈。接着有同里的张某，症状相似，面色不黑而红，舌无苔而干。众医生也没有察觉气分之邪尚结聚，痰食未行，屡次进生地，唇齿渐渐焦黑，于是束手无策。我用小陷胸汤加玄参、海浮石、石菖蒲、枳实、黄芩、连翘，一饮而脘腹舒展得以卧倒，齿舌都有津液。这是因为结散邪行，则气通液布。
乙卯年六月，我的第三个儿媳患感冒。身热头重，脘闷，频繁呕吐不食，耳聋。我投清解药一剂，病不少减，而月经非期而至，邪气虽尚在气分，但营阴素亏，恐怕容易陷入血室。急忙迎接半痴到来，投小柴胡汤加减一帖，病稍好转而虚象毕呈，少腹右角非常掣痛；半痴在清解中即佐以养营通络柔肝之品，服用四剂，病程交过七天，得大战汗而愈。原方被三个孩子遗失了，只记得后四剂重用干地黄为君药，这是血虚者必须养血才能得汗，而儿媳妇气分甚郁，如果不先行清展气机，则养血的药不能遽然进入，这是因事制宜之所以不易，关键在于先辨别其体气与病情罢了。更奇怪的是，同时我的内侄许贯之茂才的妻子，体质极清瘦，似乎比我的儿媳更弱，而且已经生育五次，而产后即发壮热。半痴视为暑证，投大剂凉解数帖，即战汗而瘥。不久胃气渐复，忽然又壮热，便秘渴闷，不饥不食，有人怀疑是新产误服凉药所致，幸好病人家属素来信任，仍延请半痴诊治。右脉甚滑实，说是食复。追问之下，果然吃了稍多的豆腐。于是投枳实栀子豉汤加瓜蒌、连翘、桔梗、薄荷、芦菔汁，三次服用而痊愈。这个人这个病，让其他医生看，一定认为是营阴大亏，而半痴独不顾及，确诊用药，应手而痊，而且愈后不需培补，很快健如常。可见产后不必皆虚，而体气的坚脆，也不能仅凭形色来判断。唉，难啊。丁巳年冬天，我在潜斋馆舍教书，恰好半痴起草《归砚录》，我读到“结散邪行，气通液布”这两句话，因而追忆这两个医案，写在这里。又可见佳案的遗漏还很多。只希望同志者抄存以期继续采集，仁和徐然石附识。
七月初旬，我去鸳湖游玩回来，三侄寿和突然患凛寒，身热筋脉抽搐，面红，谵妄汗频，四肢厥冷。年仅六岁，其母亲很担心。我察其苔色黄腻，口渴唇红，这是停食感冒。用枳实栀子豉汤加石菖蒲及冬季干的芦菔叶，煎成调入玉枢丹五分灌服，次日谵妄皆减，而腹痛微有吐泻，睡醒则神志仍昏乱，知道邪气有外泄之机，治疗应当迎刃而导，于前方加苏叶一分、黄连二分同炒煎服，连吐三四次，泻六七次，痛即减；第三日神情爽慧，我说去疾莫如尽，再服原方一剂，遂愈。大概小儿的病，因于食滞的多，胃不和则卧不安，阳明实则谵妄，而世人辄作惊风治之，每致失败。愚昧者更惑于巫瞽，而祭非其鬼，则尤可笑也。八月初，我去虎林游玩回来，二女定宜患感冒十几天，热虽退而干咳无痰，不眠，不食，不便，胸腹无所苦，汤饮亦不思，五心烦热形瘦，大家都担心成为痨病。我按脉弦细，这是痰阻而气不通。用紫菀、白前、瓜蒌仁、薤白、橘红、半夏、石菖蒲、竹茹、枳壳、桔梗，服用数帖渐愈。三女杏宜年十四岁，因为侍奉姐姐生病过度劳累，且连续十天风雨，寒气外侵，而自己恐不支，勉强进食，起病则凛寒微热，腿肿而痛，泛泛欲呕，兼以微嗽。恰好是我回来的第二天。视其苔微黄而腻，舌尖微绛，脉缓滑。用枳实栀子豉汤加前胡、苏叶、杏仁、桔梗、黄芩、芦菔汁服用。傍晚我从南乡游玩回来，内子述说服药后神情昏乱，呕出药食，恐怕夹痧邪，曾为她刮背。我说这是食滞上焦，浊气未下行。等到夜里颇静，第二天早晨察之，胸仍拒按，原方加石菖蒲、紫菀投之，我随即去硖川，黄昏而归。内子说午后神复昏乱，恐有变证，明天您不要往别处去。我点头答应。夜间也静，第二天早上问答如常，胸犹拒按，因其吐既未畅，大便未行，以前方合小陷胸汤为剂，外用朴硝罨其胸次。到巳时即神昏如寐，拉衣自覆，呼之不应，时而妄言，面色晦滞，四肢时冷。内子对着她流泪。我按脉如故，确系浊气上熏，清阳失布，既非寒邪深入，亦非温热逆传，原方再服一剂，病如故。我再四思维，径以薤白、石菖蒲各一钱，瓜蒌仁三钱，煎成和入醇酒一杯灌服；外用葱白杵烂，罨胸次，牙皂末吹鼻取嚏。将近薄暮，到初更始得微汗而肢和，随即溏解一次而识人，夜分安眠。第四、五日胸次已舒，略无谵语，乃目有妄见，寐即恶梦，时有潮热。我用瓜蒌、薤白、石菖蒲、竹茹、连翘、白薇、紫菀、半夏、栀子、豆豉、省头草等药通腑涤浊，连解三次，各恙皆安；改用清肝肃肺法，至七朝身凉全愈。继治蒋寅五先生的令郎全官，身热筋脉抽搐，不啼不乳，神呆嗜卧，有人怀疑惊风，深夜逆请我去诊治，乃是风热夹食。给予开泄清解法数帖，便行而痰渐嗽出，病即渐瘥。这种病虽然不是大证，设稍误治，告危极速，故连类录之，以备大匠木屑竹头之需。
管芝山先生拉我诊治他的表嫂吴媪，年五十五岁。上年仲夏患癃闭二十余日，愈后小便迄未通畅，已成锢疾。今秋分后，溺秘不行，医疗旬余，温如姜、桂、乌药，凉如栀、芩、黄柏，利如木通、滑石，皆不效，甚至有用益智仁等以涩之者，渐至腰腹皆胀而拒按，胸高腿肿，不饥不食，大便不通，小便略滴几点，热痛异常，舌绛无津，渴喜沸饮，而不敢多啜以增胀满，呻吟待毙。脉软而微，乃阴虚气化无权也。用沙参、熟地、黄连、瓜蒌、茯苓、泽泻、麦冬、紫菀、牛膝、车前，加附子一钱，桂心五分，煎成冷服，一周时溺出桶许，而大便随行，进粥得眠，口苦而喜凉饮，即去附子、桂心、黄连、瓜蒌、远志、牛膝，加知母、黄柏、芍药、砂仁，数服而起。因为家境窘迫不复调理，锢疾闻犹存也。
盛泽王西泉丈人的仲郎巽斋刑部夫人，年未四旬，而十八年前诞子之后，月经即不行，医生以为虚，频年温补，略无小效。董味青茂才嘱就我诊。脉弦滑而体甚丰，乃气郁生热，热烁津液以成痰，痰复阻其气道，不能化血以流行，以致行度愆期，腹形胀痛，肢背不舒，骨疼寐惕，渴不欲饮，间或吐酸，二便不宣，苔黄口苦，皆风阳浮动，治节横斜之故也。用沙参、蛤粉各四钱，丝瓜络、石菖蒲各一钱，紫菀、仙半夏、旋复花、蒺藜各一钱五分，茯苓三钱，丹参二钱，黄连四分，海浮石二两，凫茈一两，服用十余剂，来信说：胀痛消除而腹背皆舒，夜寐安而二便亦畅，酸水不吐，痰出已松，是肝已渐柔，惟食少无味，骨节疼痛右甚，乃阳明虚无以束骨利机关也。拟通养法：参须、石菖蒲各一钱，茯神、络石藤各三钱，薏苡四钱，仙半夏、竹茹各一钱五分，木瓜八分，姜汁炒黄连三分，十大功劳一两。仲冬招我去复视，则诸恙皆安，惟右腿尚疼耳。即在通养方内加黄柏、仙灵脾，服用遂愈。
王西翁的令孙芝生茂才的妻子，久患月经行太速，头痛神疲，形瘦内烦，渴喜热饮，纳食滞膈，络胀少眠，脉至软滑虚弦，腿痛而有赤块甚痛，乃阴亏水不涵木，风阳内炽，气郁痰凝。议宣养清潜互用法：沙参六钱，鳖甲八钱，首乌三钱，茯神、菊花各二钱，栀炭、竹茹、桑叶各一钱五分，白薇、黄柏、丝瓜络各一钱，以藕二两，十大功劳一两，煮汤煎药；外用葱白杵烂，蜜调，涂腿上赤块。仲冬复视，烦减能眠，月经行较缓，头疼腿块均已渐瘥，乃与通补柔潜之剂。后信来知其服甚效。
鸳湖吴小渔先生的令宠，数年前因娩后啖生菜而患便泻，久治不愈。仲秋我看诊，脉弦数。说：这不是菜的罪过，乃土受木乘，而频年温补，益广病机，头痛带多，脘疼食少，吐酸痰嗽，五热无眠，无非八脉无权，风阳偏盛，授宣养清潜之法而愈。继其令妹适岳氏者，久患带下，去冬崩血，赤白并行，延今不已，卧榻数月，佥云无生理
This absurd theory, therefore, no one obstructed it, and she happened to recover by luck.
The wife of Cheng Shengbo from Fengjing, after a spontaneous abortion (half-birth), had her menstruation arrive early, dripping continuously, often accompanied by pain and distension, gum bleeding, reduced appetite, bitter thirst, yellow tongue coating, and a wiry and rapid pulse. Frequently taking tonics, she could not be cured for a long time. I prescribed Glehniae Radix (Shashen), Testudinis et Chelonae Carapax et Plastrum (Guiban), Cyperi Rhizoma prepared (Zhixiangfu), Luffae Fructus Retinervus (Sigualuo), Bambusae Medulla (Ruzhu), Meliae Cortex (Lianpi), Acori Tatarinowii Rhizoma (Changpu), Artemisiae Capillaris Herba (Yinchen), Gardeniae Fructus (Zhizi), Anemarrhenae Rhizoma (Weimu), Platycladi Cacumen (Baiye), and Lotus Rhizome (Ou) for more than ten doses. The following month, her menstruation became regular. She came again for consultation, and I used soft nourishing methods to conclude the treatment.
My wife, after recovering from illness last year, took a paste made of clearing and nourishing herbs until the end of the year, and had already recovered better than usual. On the 18th day of the first lunar month, she gave birth quickly and healthily. Seven days later, I traveled to Wulin, then returned to Xiachuan, touring Jiuxiu via Meixi, and returned around Qingming Festival to sweep the tombs. I learned that her left breast was cracked and painful, and her breasts were also itchy; scratching caused fluid to ooze out. This had been going on for over a month. Initially thinking it was a minor external condition, I advised her to apply good surgical medicines externally. I then rowed to Meijing and Li, and crossed the sea to Chongsha. By the time I returned, it was already the Duanwu Festival. I saw that her right eyelid was sunken and very red. Inquiring about her breast condition, I found the left side worsened and spread to the right. Various medications applied externally for a long time yielded no occasional effect. Additionally, she suffered from rebellious Qi, phlegm cough, thirst, and rough skin, indicating that body fluids were entirely consumed by the external lesion. Observing her slippery and rapid pulse, this was undoubtedly due to blazing heat in the Lung and Stomach. I prescribed Scrophulariae Radix (Yuanshen), Gypsum Fibrosum (Shigao), Anemarrhenae Rhizoma (Zhimu), Forsythiae Fructus (Lianqiao), Glycyrrhizae Radix et Rhizoma (Gancao), Coicis Semen (Yiyiren), Trichosanthis Fructus (Gualou), Gardeniae Fructus (Zhizi), Acori Tatarinowii Rhizoma (Changpu), Chrysanthemi Flos (Juhua), Arcae Concha (Geqiao), and Lonicerae Japonicae Flos (Jinyinhua). After more than twenty doses, all ailments were eliminated. Later, after traveling in Wu and Yue for over a month, I returned to find her covered with summer heat boils, emaciated, with poor appetite, fatigue after eating, and unsmooth bowel and bladder movements. Her pulse was wiry, choppy, and irregular. I prescribed Scrophulariae Radix (Yuanshen), Luffae Fructus Retinervus (Sigualuo), Gardeniae Fructus (Zhizi), Coptidis Rhizoma (Huanglian), Acori Tatarinowii Rhizoma (Changpu), Citri Reticulatae Pericarpium (Chenpi), Trichosanthis Fructus (Gualou), Polygalae Radix (Yuanzhi), Anemarrhenae Rhizoma (Weimu), and Perillae Caulis (Sugen). After four doses, the month-long illness seemed to vanish. This was also due to Qi stagnation and heat obstruction. Thus, treating disease requires exploring its source, not merely suppressing its flow. Hence, my friend Guan Rongtang once said that external conditions should not be treated with internal medicine; this was likely said for those who take medication improperly or rely too heavily on books and rigidly apply established formulas. However, methods that promote Qi circulation and clear blood are originally not prohibited.
Shen Xuejiang, Guanglu, at age fifty, suddenly suffered from dizziness in the twelfth lunar month of last year. Soon after, his right hand and foot became numb. Physicians administered Dozen Zzaizao Wan (Rebirth Pill) for more than ten pills, leading gradually to limb contracture and inability to extend. Acupuncture and medication were ineffective. In the second lunar month, while I was traveling in Li, Mr. Li Yucun from Wumen invited me to examine him. His hands and feet were swollen and painful, stool was hard, urine was red, mouth was dry, tongue was crimson, and there was a prominent lump on the tip of his nose. The pulse was wiry, slippery, and rapid. He frequently suffered from epistaxis in the past. His Liver Yang tends to move easily; he exerts his mind excessively. His constitution and temperament indicate Yin deficiency with abundant Fire. Wind arises from Fire, scorching fluids into Phlegm, which invades the collaterals, causing this syndrome. If initially treated by administering only Zhuli (Bamboo Sap), he could have gradually recovered. Instead, warming tonics were indiscriminately given, turning it into an entrenched disease. Fortunately, the disease was in the collaterals; stopping tonics could still prolong life. To hope for a turnaround, one must use clearing, unblocking, and draining methods. I prescribed three doses, and swelling and pain slightly improved. Critics said the medicine was too cooling and feared it would harm the Spleen and Stomach if taken in excess. Another physician continued with warming tonics, and even Li Yucun stopped consulting me. By mid-April, his stool suddenly became constipated, and he lost his appetite. For over half a month, defecation was extremely difficult and sluggish. After defecating, his chest felt even more blocked, so he ate nothing, although Ginseng preparations were not discontinued. On May 18th, he passed dry feces but still had no appetite. Forcing himself to drink porridge led to vomiting. The next day, it turned into dysentery with stool resembling fish brains, occurring dozens of times a day. Physicians said there was exit without entry, indicating failure of both Spleen and Kidney. They strengthened the warming tonic formula with astringents. Consequently, epistaxis poured forth, with tough, purple blood clots and strips gushing from the throat. Even rice water could not be swallowed. Urination was scanty and obstructed. He occasionally wanted to sip tea to moisten his mouth. Some said it had progressed to Guange (Obstruction and Rejection) syndrome, incurable. Methods like guiding fire back to its origin made it worse. Physicians had no strategy; family members were panicked and had already prepared funeral arrangements. His younger brother, Yunfeng Daizhao, whom I had entrusted in spring, sent someone to invite me for rescue. On the 24th, I arrived in Hecheng. His complexion was withered and dark. His jaw was tight, and his tongue could not protrude from his teeth. The pulse was slippery on the right and wiry, fine, and rapid on the left, all surging upward with no response at the Chi position. Chest fullness and urinary obstruction indicated Yang should be unblocked but was not, due to cloying substances blocking the Qi pathway. Blood loss and diarrhea indicated Yin should be conserved but was not, due to warming and drying substances scorching Ying fluids. As my late mother said, the human body is like a tilted vessel; when full, it must overturn. Six months of reckless tonification filled the stomach. If it did not pour out completely, it would surely cause blockage. How could one fail to consider this and mistakenly diagnose it as the cessation of Shenji (Spirit Mechanism) leading to waste of entry/exit, uncontrollable diarrhea due to failed gates, or吐衄 (vomiting blood and epistaxis) due to Yin excess repelling Yang, and then administer sedative, consolidating, and blocking drugs? Ancient texts say: "If there is a pulse above but none below, the person should vomit; if they do not vomit, they will die." Now, with blazing Fire flaming upward, massive epistaxis, inability to swallow even soup or water, rising without descending, what is the difference from vomiting? Although the symptoms are critical, breathing is not rapid, and he can sleep slightly, indicating surviving vitality. According to ancient classics, diarrhea with thirst belongs to Jueyin, treated with Baitouweng Tang; dysentery with inability to eat is called Jinkou Dysentery, treated with Shenlian Tang. I combined these, adding Acori Tatarinowii Rhizoma (Changpu) to promote Qi and unblock Yang, Dendrobii Caulis (Shihu), and Imperatae Rhizoma (Magen) to generate fluids and cool blood. After one dose, diarrhea halved. The next day, I removed Coptidis Rhizoma (Huanglian) and Phellodendri Cortex (Huangbai), added Scrophulariae Radix (Yuanshen), Rhinocerotis Cornu (Xijiao - *Note: Substitute with Water Buffalo Horn/Shuiniujiao in modern practice*), and Child's Urine (Tongbian) to specifically treat epistaxis. After one dose, bleeding decreased, and diarrhea stopped. However, blood that has left its vessels must be allowed to exit, and blood that has not moved must be kept in place. Therefore, I used American Ginseng (Xiyangshen), Salviae Miltiorrhizae Radix (Danshen), Ophiopogonis Radix (Maidong), Poria (Fuling), Acori Tatarinowii Rhizoma (Changpu), Dendrobii Caulis (Shihu), Triticum Semen (Xiaomai), Lophatheri Herba (Zhuye), Gardeniae Fructus (Zhizi), Glycyrrhizae Radix et Rhizoma tip (Gancaoshao), and Bird's Nest (Yanwo) in varying combinations. After three doses, bleeding stopped, jaw opened gradually, tongue coating became yellow and greasy, and drinking required patting the diaphragm to go down. I incorporated Xiaoxianxiong Tang method. After several doses, he felt lighter, and wrist movement improved. I switched to clearing and purifying Lung and Stomach, promoting Qi transformation to replenish fluids. Tongue coating receded, thirst decreased, and pulse flattened. Keeping this regimen until the 22nd day of the leap month, the Chi pulse became slippery and moving. I added Cistanche Stem (Roucongrong) and Cannabis Seed (Maren). That night, he passed hard, black, dry feces and could gradually eat porridge. I then removed Maren and Roucongrong, added Rehmanniae Radix (Shengdi). By July 7th, his mouth was no longer thirsty, and he could eat rice. Later, due to excessive watermelon juice consumption, he had loose stools. I consulted him again. Using Liu Jun Zi Tang removing Atractylodis Macrocephalae Rhizoma (Baizhu) and Glycyrrhizae Radix et Rhizoma (Gancao), adding Coicis Semen (Yiyiren) and Agastache Herba (Huoxiang), he stabilized after several doses. Then I removed Huoxiang, added Polygoni Multiflori Preparatum (Shouwu), Cryptostegiae Grandiflorae Caulis (Luoshi), Dendrobii Caulis (Shihu), and Mahoniae Caulis (Shida Gonglao). After twenty doses, he could sit up, and his right leg could flex and extend, though weak. After Mid-Autumn Festival, he invited me again. His Stomach Qi had recovered, right fingers extended, skin color improved, but right arm could not move, and right cheek felt stiff. This indicated residual Phlegm in collaterals and easy generation of Liver Wind. Irrigation and circulation of Qi and Blood were hindered. I used a formula to nourish Blood, extinguish Wind, dispel Phlegm, and promote Qi, using Bamboo Sap (Zhuli) as a guide. After taking it, his legs could stand gradually. In October, after eating too many crabs, he had diarrhea. I treated him with Liu Jun Zi Tang plus Lotus Rhizome (Ou), Aucklandiae Radix (Muxiang), and Perillae Folium (Suye) to cure him. Later, I traveled from Shenghu to Hecheng. It was near Winter Solstice, but the weather was warm, failing to store energy. Due to labor and anger, he suddenly developed dizziness, vomiting phlegm-saliva, closed eyes, silence, no eating, and no bowel movement. The family was at a loss. Physicians generally advocated Zizhong Qianyang (Nourishing Yin and Subduing Yang) with He Shou Wu (Shouwu) and Ostreae Concha (Muli). My pulse diagnosis showed wiry and slow, indicating Middle Deficiency unable to control Wood, causing internal Wind to rebel. Yin-nourishing substances only stagnate the center; they cannot be taken. I used Liu Jun Zi Tang removing Gancao, adding Changpu, Huanglian, Inulae Flos (Xuanjufhua), Zingiberis Rhizoma Recens (Jiangpi), and Uncariae Ramulus cum Uncis (Gouteng). After three doses, he recovered suddenly. After Minor Cold, I traveled from Gusu to Hecheng. Again due to warm weather, he had epistaxis. Changing to Nourishing Yin and Subduing Yang methods, he recovered. The following spring, upon leaving home, due to lack of rest, he died of Summerheat at Duanwu.
In mid-summer, while traveling in Li, Lu Youxi invited me to see his friend surnamed Wang. Alternating chills and fever, profuse sweating without relief, loose and unsmooth stool, red urine, delirious speech, face black as coal, yellow tongue coating, great thirst, irritability, rebellious Qi, slippery and flooding pulse. Palpation of chest and heart revealed hardness and pain. This was Summerheat-Dampness complicated by Phlegm and Food retention. Physicians only knew it as seasonal infection and administered cooling herbs. Hearing of chest discomfort, they suspected rash and used Antelopis Cornu (Lingyangjiao), Rhinocerotis Cornu (Xijiao), Gelatin (Gao), and Rehmanniae Radix (Dihuang). Exhausted of resources, they had already told the family to prepare for death. I said: "This is not a severe case, why panic?" Removing blankets and opening windows is better than medication. The family agreed verbally but didn't believe much. I personally lifted the blanket and opened the window. The patient said: "Much more comfortable." I prescribed Xiaoxianxiong Tang plus Scutellariae Radix (Qin), Aurantii Fructus (Zhi), Forsythiae Fructus (Qiao), Bambusae Medulla (Ru), Allii Macrostemonis Bulbus (Xie), Acori Tatarinowii Rhizoma (Changpu), and Saccharinae Thallus (Haizao). After several doses, he recovered. Next, a Zhang from the same village had similar symptoms, but his face was red, not black, and tongue had no coating but was dry. Physicians failed to notice the lingering Qi-level constraint and unpassed Phlegm-Food. They repeatedly administered Rehmanniae Radix (Dihuang), causing lips and teeth to char. They were helpless. I used Xiaoxianxiong Tang plus Scrophulariae Radix (Yuanshen), Haizao, Changpu, Zhishi, Qin, and Qiao. One dose relieved epigastric fullness, allowing sleep, and restored moisture to teeth and tongue. Because constraints dispersed and pathogens exited, Qi flowed and fluids distributed.
In the sixth month of Yi Mao year, my third daughter-in-law contracted a pathogen. Fever, heavy head, epigastric stuffiness, frequent vomiting, anorexia, deafness. I gave one dose of clearing-resolving medicine, but the condition did not improve. Menstruation arrived unexpectedly. Although the pathogen was still in the Qi level, her Ying-Yin was chronically deficient, fearing invasion of the Blood Chamber. I urgently summoned Banshi. I prescribed modified Xiao Chai Hu Tang for one dose. Condition improved slightly, but deficiency signs appeared fully. Severe pulling pain in the lower right abdomen. Banshi added nourishing Ying, unblocking collaterals, and softening Liver herbs to the clearing-resolving base. After four doses, on the seventh day of the illness, she recovered after a severe battle sweat. The original prescription was lost by the children; I only remember that the last four doses heavily used Rehmanniae Radix Preparata (Di Huang) as the sovereign herb. For blood deficiency, one must nourish blood to induce sweat. Since the daughter-in-law had significant Qi depression, if Qi mechanism is not first cleared and expanded, blood-nourishing herbs cannot enter quickly. This illustrates the difficulty of adapting to circumstances, relying on first distinguishing constitution and disease condition. More strangely, at the same time, my nephew Xu Guanzhi's wife, extremely thin, seemingly weaker than my daughter-in-law, and having given birth five times, developed high fever immediately postpartum. Banshi diagnosed it as Summerheat and gave large doses of cooling-resolving herbs for several doses. She recovered after battle sweat. Soon Stomach Qi recovered, but suddenly high fever returned, constipation, thirst, stuffiness, anorexia. Some suspected new birth mistook cooling medicine. Fortunately, the family trusted Banshi. Right pulse was slippery and solid. He said it was food recurrence. Inquiry confirmed she ate slightly too much tofu. I prescribed Zhishi Zhizi Chi Tang plus Gualou, Qiao, Jiegeng, Bohe, and Radish Juice. After three doses, she recovered. Other doctors would have seen this case and assumed severe Ying-Yin deficiency, but Banshi ignored this, diagnosed correctly, and cured promptly. Post-recovery, no tonification was needed, and she soon returned to normal. This shows postpartum is not always deficiency, and constitutional strength cannot be judged solely by appearance. Alas, it is difficult. In winter of Ding Si year, I was teaching at Qianzhai. Banshi was drafting "Gui Yan Lu". Reading "Constraints disperse, pathogens exit, Qi flows, fluids distribute," I recalled these two cases and wrote them here. It shows many good cases are omitted. I hope colleagues copy and preserve them for future collection. Renhe Xu Ran Shi adds notes.
In early July, returning from Yuan Lake, my third nephew Shouhe suddenly had chills, fever, muscle stiffness, red face, delirium, frequent sweating, and cold limbs. Only six years old, his mother was alarmed. I observed yellow-greasy tongue coating, thirst, and red lips. It was food stagnation with cold damage. I used Zhishi Zhizi Chi Tang plus Changpu and dried winter Radish Leaves. Decoction mixed with 5 fen of Yushu Dan and administered. Next day, delirium decreased, but mild abdominal pain with slight vomiting/diarrhea occurred. Upon waking, spirit was still confused. Knowing pathogens had an outlet, treatment should guide them. I added Perillae Folium (Suye) 1 fen and Coptidis Rhizoma (Huanglian) 2 fen, stir-fried together, decocted, and administered. Vomited 3-5 times, diarrhea 6-7 times, pain decreased. Third day, spirit clear. I said remove disease completely. One more dose of original formula, and he recovered. Children's diseases are often due to food stagnation. Disharmony of Stomach leads to restless sleep. Yangming excess causes delirium. People usually treat it as Convulsion, often causing failure. Ignorant people are further confused by shamans, worshipping wrong ghosts, which is laughable. In August, returning from Hulin, my second daughter Dingyi had a cold for over ten days. Fever subsided but dry cough without phlegm, insomnia, anorexia, constipation. No chest/abdominal distress, no desire for liquids. Five-center heat, emaciation. Everyone worried it would become Consumption. Pulse wiry and fine indicates Phlegm obstruction blocking Qi. I used Ziwan, Baiqian, Gualouren, Xiebai, Juhong, Banxia, Changpu, Zhuru, Zhike, and Jiegeng. Several doses brought gradual improvement. My third daughter Xingyi, fourteen years old, exhausted caring for her sister, exposed to wind/rain for ten days, feared collapse, forced herself to eat. Illness started with chills, slight fever, leg swelling/pain, nausea, slight cough. I returned the next day. Tongue slightly yellow-greasy, tip slightly crimson, pulse slow-slippery. Zhishi Zhizi Chi Tang plus Qianhu, Suye, Xingren, Jiegeng, Huangqin, and Radish Juice. At dusk, returning from South Country, my wife said after medication, spirit was confused, vomited medicine/food, fearing Sha pathogen, had back scraping. I said this is upper Jiao food stagnation, turbidity not descending. Night was quiet. Next morning, chest still rejected pressure. Original formula plus Changpu and Ziwan. I traveled to Xiachuan, returned at dusk. Wife said afternoon spirit confused again, fearing change. Asked me not to go elsewhere. I agreed. Night quiet. Next morning, conversation normal, chest still rejected pressure. Since vomiting not smooth, stool not passed, I combined original formula with Xiaoxianxiong Tang. Externally applied Mirabilite (Piaoxiao) to chest. At Si hour, coma-like sleep, covering self, unresponsive, occasional delirium, dull complexion, intermittent cold limbs. Wife wept. Pulse unchanged. Confirmed Turbid Qi steaming upward, Clear Yang failing to distribute. Not deep Cold, nor reverse transmission of Warmth. One more dose of original formula, condition unchanged. Thinking deeply, I prescribed Xiebai and Changpu 1 qian each, Gualouren 3 qian, decocted and mixed with one cup of pure wine, administered. Externally, mashed Green Onion White (Congbai) applied to chest, Toothpod powder (Yaokao) blown into nose to induce sneezing. Near dusk, until first watch, slight sweat, limbs harmonized. Soon loose stool once, recognized people, slept peacefully at night. Fourth/fifth day, chest comfortable, no delirium, but visual hallucinations, bad dreams, tidal fever. I used Gualou, Xiebai, Changpu, Zhuru, Qiao, Weimu, Ziwan, Banxia, Zhizi, Zhichi, and Shentoucao to purge Fu organs and cleanse turbidity. Three stools passed, all ailments settled. Switched to clearing Liver and purifying Lung. By seventh day, fever gone, fully recovered. Then treated Jiang Yinwu's son Quanguan. Fever, convulsions, no crying/suckling, dull spirit,嗜睡. Suspected Convulsion. Summoned in middle of night. Wind-Heat complicated by Food. Opened and resolved clearing methods for several doses. Bowel movement occurred, phlegm coughed out, condition improved. Though not major cases, slight mismanagement leads to rapid danger. Recorded here for reference.
Mr. Guan Zhishan asked me to treat his cousin Wu Ao, 55 years old. Last mid-summer, she suffered from strangury for over 20 days. After recovery, urination remained unsmooth, becoming an entrenched disease. After Autumn Equinox this year, urine retention occurred. Medical treatment for ten days included warming herbs like Ginger, Cinnamon, Lindera; cooling herbs like Gardenia, Scutellaria, Phellodendron; and draining herbs like Akebia, Talcum. None worked. Some used益智仁 (Yizhiren) to astringe. Gradually, waist and abdomen distended and rejected pressure. High chest, swollen legs, anorexia, constipation, scanty drops of urine, extreme heat/pain, crimson tongue without fluid, thirst preferring boiling water but afraid to drink much due to distension. Moaning, awaiting death. Pulse soft and faint, indicating Yin deficiency with powerless Qi transformation. I prescribed Glehniae Radix (Shashen), Prepared Rehmanniae Radix (Shudi), Coptidis Rhizoma (Huanglian), Trichosanthis Fructus (Gualou), Poria (Fuling), Alisma Rhizoma (Zexie), Ophiopogonis Radix (Maidong), Asteris Radix (Ziwan), Achyranthis Bidentatae Radix (Niuxi), Plantaginis Semen (Cheqian), plus Aconiti Lateralis Radix Preparata (Fuzi) 1 qian and Cinnamomi Cortex (Guixin) 5 fen. Decocted and taken cold. Within a week, a bucket of urine passed, followed by stool. Porridge eaten, sleep obtained. Bitter mouth, preference for cool drinks. Removed Fuzi, Guixin, Huanglian, Gualou, Yuanzhi, Niuxi. Added Anemarrhenae Rhizoma (Zhimu), Phellodendri Cortex (Huangbai), Paeoniae Radix Alba (Shaoyao), Amomi Fructus (Sharen). Several doses brought recovery. Due to poverty, no further conditioning, the entrenched disease reportedly remains.
Madam of Minister Xunzhai, son-in-law of Wang Xiquan from Shengze, under forty. Eighteen years ago after childbirth, menstruation ceased. Physicians thought it deficiency, gave warming tonics yearly with no effect. Dong Weiqing Mao Cai asked me to diagnose. Pulse wiry-slippery, body very plump. Qi stagnation generating Heat, Heat scorching fluids into Phlegm, Phlegm blocking Qi pathway, unable to transform into Blood for circulation. Resulting in delayed menstruation, abdominal distension/pain, limb/back discomfort, bone pain, startle during sleep, thirst without desire to drink, occasional sour regurgitation, unsmooth bowels/bladder, yellow coating, bitter mouth. All due to floating Wind-Yang and disorderly regulation. Prescribed Glehniae Radix (Shashen) and Concha Arcae (Ge Fen) 4 qian each, Luffae Fructus Retinervus (Sigualuo) and Acori Tatarinowii Rhizoma (Changpu) 1 qian each, Asteris Radix (Ziwan), Pinelliae Preparata (Xianxia), Inulae Flos (Xuanjufhua), Tribuli Fructus (Jili) 1.5 qian each, Poria (Fuling) 3 qian, Salviae Miltiorrhizae Radix (Danshen) 2 qian, Coptidis Rhizoma (Huanglian) 4 fen, Saccharinae Thallus (Haizao) 2 liang, Eleocharis Tubers (Fuchi) 1 liang. Over ten doses, letter received: Pain/distension eliminated, back/abdomen comfortable, sleep peaceful, bowels/bladder smooth, no sour regurgitation, phlegm loose. Liver softening. Only poor appetite, bone/joint pain worse on right. Yangming deficiency fails to bind bones and benefit joints. Proposed Tonifying-Nourishing method: Ginseng Tendril (Renshenxu) and Changpu 1 qian each, Poria Spirit (Fushen) and Cryptostegiae Grandiflorae Caulis (Luoshi) 3 qian each, Coicis Semen (Yiyiren) 4 qian, Xianxia and Zhuru 1.5 qian each, Papaveris Fructus (Mugua) 8 fen, Huanglian stir-fried with Ginger Juice 3 fen, Mahoniae Caulis (Shida Gonglao) 1 liang. Mid-winter visit: All ailments safe, only right leg pain. Added Phellodendri Cortex (Huangbai) and Epimedii Folium (Xianlingpi) to Tonifying-Nourishing formula. Recovered.
Grandson Zhisheng Mao Cai's wife of Wang Xi Weng. Long-term rapid menstruation, headache, fatigue, emaciation, internal vexation, thirst preferring hot drinks, food stagnation in chest, collateral distension, little sleep. Pulse soft-slippery-deficient-wiry. Leg pain with red painful lumps. Yin deficiency, Water fails to nourish Wood, internal blazing Wind-Yang, Qi stagnation, Phlegm condensation. Discussed alternating Promoting-Nourishing and Clearing-Sinking methods: Glehniae Radix (Shashen) 6 qian, Testudinis Carapax (Biejia) 8 qian, Polygoni Multiflori Radix (Shouwu) 3 qian, Fushen and Chrysanthemi Flos (Juhua) 2 qian each, Gardeniae Fructus Charred (Zhitan), Zhuru, Mori Folium (Sangye) 1.5 qian each, Anemarrhenae Rhizoma (Weimu), Phellodendri Cortex (Huangbai), Sigualuo 1 qian each. Decoct with Lotus Rhizome (Ou) 2 liang and Mahoniae Caulis (Shida Gonglao) 1 liang. Externally: Mashed Congbai mixed with honey, applied to red lumps on legs. Mid-winter revisit: Vexation reduced, sleep improved, menstruation slower, headache/leg lumps improving. Given Tonifying-Supplementing Softening-Sinking agents. Letter later said effective.
Wu Xiaoyu from Yuan Lake's favored son. Years ago, after childbirth, ate raw vegetables, developed diarrhea. Long-term treatment failed. Mid-autumn visit: Wiry-rapid pulse. Said: Not the vegetable's fault. Earth conquered by Wood. Yearly warming tonics widened the pathology. Headache, leukorrhea, epigastric pain, anorexia, sour regurgitation, phlegm cough, five-center heat, insomnia. All due to powerless Eight Extraordinary Vessels, dominant Wind-Yang. Taught Promoting-Nourishing Clearing-Sinking method, cured. His sister married to Yue family. Long-term leukorrhea. Last winter metrorrhagia, red and white discharge. Continued until now, bedridden for months. All said hopeless.