此症只须通阳，不必顾阴。
李 积劳伤阳，腹膨仍软，脉弦(杂症细)无胃气，形衰废食，理中宫阳气之转旋，望其
进食。延久无能却病矣。
人参 淡附子 谷芽 茯苓 益智 广皮
腹膨而不软，不但伤中宫之阳，中下浊阴凝结矣。惟膨而仍软，知阳虽伤而尚未阴凝，
但理中宫之阳，俾得转旋斯愈矣。
阳气在胸腹升降转旋，无一息之停，斯清浊分而上下治。
沈(北城下，三十六岁) 温疹皆病气鼻口吸受其秽邪，是天地乖戾不正之气，无形之物
，上窍阻塞，呛物不下，医不知无形有形，但曰清火寒降，至药直入肠胃，与咽中不相干涉
(无形秽浊之邪，有气无质，气虽浊而性仍上浮，故以清轻气分药治之)。
连翘心(一钱) 射干(三分) 鲜芦(一两) 马屁勃(七分) 牛蒡子(钱半) 银花(一钱)
以无形治无形，针锋的对，此法前人所未发泄。天翁具此清轻一路，使无形之感化于无
有，抑何巧思至此。
徐(宿迁，四十七岁) 冬月涉水之寒，深入筋骨，积数年发，胫膝骨冷筋纵，病在下为
阴，久必气血与邪交混，草木不能驱逐。古人取虫蚁佐芳香，直攻筋骨，用许学士法。
炒乌头 山东地龙 全蝎 麝香
着筋着骨病邪，须服着筋着骨药品。
钱(同里，五十六岁) 酒热入血，瘀呕盈盆，越六七年变成反胃妨食，呕吐涎沫。问大
便仍通，结闭在脘中。姑以通瘀开闭(酒性本走血分，火酒更易煎熬，血被热气劫住，故瘀
滞耳。)
韭白汁 桃仁 延胡 京墨汁 生蒲黄 片子姜黄
得诀在问大便仍通，故知结闭乃在脘中。通瘀开闭，足愈斯病。不入治反胃门药矣，此
为善审病机。
韩(新开湖，四十五岁) 臭气入喉(吸字解勿作香臭，斯乃肾不纳气之病)，呛咳失血，
缘肾脉上循咽喉舌下，是肾虚气逆也。风药治表，清寒降气，无识者，皆然。病患说病来必
先寒冷，阴中阳虚不收摄(孟于谓鼻之于臭也。)
人参 枸杞 茯苓 沉香汁 坎气 建莲肉 人乳粉
李(无锡，三十三岁) 呛呕下焦寒冷(先治下，继治中。)
此症只需通阳，不必顾护阴液。
李姓患者因长期劳累损伤阳气，腹部胀满但按之仍软，脉象弦细（杂病脉象细微）且无胃气，形体衰败、无法进食，需调理中焦脾胃的阳气以恢复其运化功能，期望能重新进食。若拖延日久，则难以祛除疾病了。
人参 淡附子 谷芽 茯苓 益智仁 广陈皮
腹部胀满且按之不软，说明不仅损伤了中焦脾胃的阳气，中下焦的浊阴之气也已凝结。只有当腹部胀满但按之仍软时，才知阳气虽伤但尚未发生阴凝，只需调理中焦脾胃的阳气，使其恢复运转，疾病即可痊愈。
阳气在胸腹间升降运转，没有一刻停歇，这样清浊之气才能分离，上下焦才能治理得当。
沈姓患者（北城下，三十六岁）患温疹，皆因鼻口吸入天地乖戾不正的秽浊邪气所致，这是无形之物，导致上窍阻塞，呛逆食物不下。医生不知区分无形与有形之邪，只知用清热泻火寒降之法，致使药力直入肠胃，与咽喉部位不相干涉。（无形秽浊之邪，有气无质，气虽浊而性质仍上浮，故用清轻的气分药物治疗。）
连翘心（一钱） 射干（三分） 鲜芦根（一两） 马屁勃（七分） 牛蒡子（钱半） 金银花（一钱）
以治疗无形之邪的方法应对无形之邪，针锋相对，此法是前人未曾阐发的。天翁（指叶天士自谦或指自然造化）具备这种清轻的治疗思路，使无形的感受转化为乌有，构思何其巧妙至此。
徐姓患者（宿迁，四十七岁）冬季涉水受寒，寒气深入筋骨，积累数年发作，小腿膝盖骨冷筋脉松弛，病位在下属阴，日久必然气血与邪气交混，草木类药物不能驱逐。古人取虫蚁类药材佐以芳香药，直攻筋骨，采用许学士的方法。
炒乌头 山东地龙 全蝎 麝香
钱姓患者（同里，五十六岁）酒热进入血分，瘀血呕吐盈盆，经过六七年变成反胃妨食，呕吐涎沫。询问大便仍然通畅，结闭在于脘部。暂且以通瘀开闭之法治疗。（酒性本走血分，烈酒更易煎熬，血液被热气劫持停留，故而瘀滞。）
韭白汁 桃仁 延胡索 京墨汁 生蒲黄 片子姜黄
关键在于问到大便仍然通畅，所以知道结闭乃在脘中。通瘀开闭，足以治愈此病。不纳入治疗反胃门的药物范畴，这是善于审察病机。
韩姓患者（新开湖，四十五岁）臭气入喉（“吸”字解释不要作香臭解，这乃是肾不纳气的病证），呛咳失血，因为肾脉上行循行于咽喉舌下，这是肾虚气逆所致。风药治表，清寒降气，无识见的医生都这样做。病患说发病前必定先感到寒冷，阴中阳虚不能收摄（孟子谓鼻子对于嗅觉而言）。
人参 枸杞子 茯苓 沉香汁 坎炁 建莲肉 人乳粉
This syndrome requires only the unblocking of Yang, without the need to protect Yin.
Li: Accumulated fatigue has damaged Yang Qi. The abdomen is distended but remains soft upon palpation. The pulse is wiry (fine in miscellaneous diseases) and lacks Stomach Qi. The physique is emaciated, and food intake is impossible. It is necessary to regulate the rotational movement of Yang Qi in the Middle Jiao (Spleen and Stomach), hoping for the resumption of eating. If prolonged, it will be unable to expel the disease.
*Ren Shen* (Ginseng Radix et Rhizoma), *Dan Fu Zi* (Prepared Aconiti Lateralis Radix), *Gu Ya* (Hordei Fructus Germinatus), *Fu Ling* (Poria), *Yi Zhi Ren* (Alpiniae Oxyphyllae Fructus), *Guang Pi* (Citri Reticulatae Pericarpium).
If the abdomen is distended and hard upon palpation, it indicates not only damage to the Yang Qi of the Middle Jiao, but also the coagulation of turbid Yin in the Middle and Lower Jiao. Only when the distension remains soft can we know that although Yang is damaged, Yin has not yet coagulated. By regulating the Yang Qi of the Middle Jiao and allowing it to rotate freely, the condition will improve.
Yang Qi ascends and descends, rotating in the chest and abdomen without a moment's pause. Only then can Clear and Turbid Qi separate, and the Upper and Lower Jiao be governed properly.
Shen (North City Lower, 36 years old): Warm pathogenic factors (Wen Bing) arise from inhaling foul pathogens through the nose and mouth. These are chaotic and abnormal energies of Heaven and Earth, formless entities. They obstruct the upper orifices, causing choking and inability to swallow food. Physicians, unaware of the distinction between formless and formed pathogens, merely employ clearing heat and cold-descending methods. Consequently, the medicine enters directly into the intestines and stomach, having no effect on the throat. (Formless foul pathogens possess Qi but lack substance; although the Qi is turbid, its nature tends to float upward. Therefore, light and clear Qi-level herbs are used.)
*Lian Qiao Xin* (Juglandis Semen Cordis, 1 qian), *She Gan* (Belamcandae Rhizoma, 3 fen), *Xian Lu Gen* (Phragmitis Rhizoma, 1 liang), *Ma Pi Bo* (Euphorbiae Humifusae Herba, 7 fen), *Niu Bang Zi* (Arctii Fructus, 1.5 qian), *Yin Hua* (Lonicerae Japonicae Flos, 1 qian).
Treating the formless with the formless, hitting the mark precisely. This method was not fully elucidated by predecessors. Tian Weng (referring to natural efficacy or self-deprecation) possesses this clear and light approach, transforming formless influences into nothingness. How ingenious such thought is!
Xu (Suqian, 47 years old): Cold contracted from wading in water during winter penetrated deeply into the sinews and bones. After accumulating for several years, it manifested as cold bones in the shins and knees, with flaccid sinews. The disease is located below, belonging to Yin. Over time, Qi and Blood inevitably mix with pathogens, making herbal medicines ineffective for expulsion. Ancients utilized insect and ant drugs assisted by aromatic substances to attack the sinews and bones directly, adopting the method of Scholar Xu.
*Chao Wu Tou* (Processed Aconiti Kusnezoffii Radix), *Shan Dong Di Long* (Pheretima, Shandong origin), *Quan Xie* (Scorpio), *She Xiang* (Moschus).
Pathogens adhering to sinews and bones require medications that adhere to sinews and bones.
Qian (Tongli, 56 years old): Wine-heat entered the Blood level, causing profuse vomiting of blood clots. After six or seven years, this transformed into regurgitation (Fan Wei) and food intolerance, with vomiting of saliva and foam. Inquiry revealed that bowel movements remain unobstructed; the blockage lies within the epigastrium (Wan). Temporarily employ methods to unblock stasis and open obstruction. (Wine nature naturally moves in the Blood level; strong wine is more likely to cause boiling/concoction. Blood is detained by heat qi, leading to stasis.)
*Jiu Bai Zhi* (Allii Tuberosi Bulbus Juice), *Tao Ren* (Persicae Semen), *Yan Hu Suo* (Corydalis Rhizoma), *Jing Mo Zhi* (Ink Stick Juice), *Sheng Pu Huang* (Typhae Pollen), *Pian Zi Jiang Huang* (Curcumae Longae Rhizoma Slice).
The key lies in asking whether bowel movements are still patent; thus, knowing the blockage is in the epigastrium. Unblocking stasis and opening obstruction is sufficient to cure this disease. It does not fall under the category of treating Fan Wei, demonstrating skillful assessment of the pathological mechanism.
Han (Xinkai Lake, 45 years old): Foul odor entering the throat ("inhale" should not be interpreted as smelling fragrant or foul; this is a disease of Kidney failing to grasp Qi). Choking cough and hemoptysis occur because the Kidney meridian ascends along the throat and under the tongue. This is Kidney deficiency with rebellious Qi. Physicians lacking insight use wind herbs to treat the exterior, and cold-clearing herbs to descend Qi. The patient states that before the illness onset, there was always a sensation of cold. This indicates Yang deficiency within Yin, failing to receive and retain. (As Mencius said regarding the nose and smell.)
*Ren Shen* (Ginseng Radix et Rhizoma), *Gou Qi Zi* (Lycii Fructus), *Fu Ling* (Poria), *Chen Xiang Zhi* (Aquilaria Resin Juice), *Kan Qi* (Umbilical Cord), *Jian Lian Rou* (Nelumbinis Semen), *Ren Ru Fen* (Human Milk Powder).
Li (Wuxi, 33 years old): Choking and vomiting accompanied by coldness in the Lower Jiao (Treat the Lower Jiao first, then the Middle Jiao.)