甲辰闰九月间，天气寒热不时，痢者甚众。予四弟永穆，年二十七岁。忽患痢下红，腹
痛后重，已三日矣。来取药，付以芍药汤一帖，香连丸二服。不止，反增心口如刀 ，当脐腹
痛，肛门痛亦剧，声撼四邻，自分必死，告母决别，因整囊往乡视之，昼夜不得卧，次数难定
，日下红血一桶，痛不可忍，发热流汗不食。脉之，六部皆豁大，浮中沉无力，四至。予曰
∶虽痛，虽发热，脉无力，已虚寒矣。古人云∶脱血益气，此证正宜。遂用异功散加升麻三
分、木香五分、炒干姜五分。一剂，去后觉疏，痛亦可忍，至五更，腹痛如前。予曰∶此药
力尽也。急煎一剂与之，比前愈疏，痛亦减七八，即酣睡至日中方醒，云不甚好过。予又曰
∶此药只能支持一觉，再煎与之，遂安寝至晚，痛止，后重亦可，还服前剂而愈。一、二日
后，因吃鸡肉，仍前腹痛、肛肿，秽下不止。第三日，病势笃极，复报予诊之。脉三至余，
浮无沉，按之则大，脾命脉微，与补中益气汤不应。此虚脱之甚，加御米壳一钱，亦不应，下
如洞泄，流汗发躁，尺脉渐欲收敛，予亦慌急，令人二更后往城取参，至早归，补中益气加
人参二钱服之，下咽常愦（参能令人愦，湿热内盛者尤甚，历试验之。）此正气欲复，邪气欲
退也，顷之，精神顿增，痢稍缓，恐再作，又一剂。下注、昏愦、发热、躁诸症渐缓，脉亦
有神，短脉退。寻思久之，古人云∶久泄久痢，汤剂不如丸、散。即合参苓白术散与服，觉
疏下，至下午复躁热。予再脉之，左尺洪如火射状，此阴虚火动之象。与加减八味丸至六十丸
，精神觉爽。顷之，又下八、九十丸，睡至天明，病去十七。方信立斋师加减八味丸治水涸
之症。即令朝暮服此丸，复合参苓白术散，渐愈，觉小便痛，想动色事故耳，服以逍遥散、
门冬、五味子而平。（此病动色而不死，必体实而邪气仍非深重者，前叙证似未协。细审尺
脉收缩，当是血去痰生，痰伏下焦；尺脉洪射，当是下阳乍复与痰相激也。）
王春元二令郎，年甫七岁。久患赤痢，消导削积之剂已服过多，后转下白如涕，浑无粪
。诊
之症。宜温补脾胃以生肺金，用补中益气加炮姜、官桂各二分，其间人参止用三分，且陈腐
不堪。服四剂，手足略软，言语亦健，第未温耳，其下白仍不减，亦虚寒滑脱危症，宜补、
宜涩、宜温，复用前药加好参五分、大附二分半、御米壳一分。服一剂，则足已温，大便即
有粪，白退十八，自兹手足俱温软，泄自全止，还服前方，去御米壳、附子二味。予归，嘱
以如身中已温暖，姜、桂亦去，后服参苓白术散以培中气。使来岁乙巳厥阴风木之气不能制
，饮食尤宜慎之。
予友薛理还仆，远行忍饥，又相殴脱力，时五月初，遂发热谵语，以补中益气及五苓数
剂不效。延予诊之，六脉俱无，乍有则甚细，其外症则面赤、谵语、口碎。一友曰∶阳症见阴脉
，证在死例。予曰∶当以阳虚从脉舍症治之，遂下附子理中汤冷服。二帖，脉稍见；四帖则
脉有神，而口碎愈矣；六帖则脉如常，但谵语未已。予曰∶脉气已完复，而谵语不休者，胃
有燥粪，宜以胆导导之，果下燥结，谵语遂平。（此证若大便滑易者，有瘀血也。以桃仁下
马见源精神素弱，且劳甚，饿时吃冷肉一块，遂不快，发热谵语作狂，乃饮食劳倦之症
。乡
吐痰者，肺胃筋膜内伤也，多由饮食劳倦，宜坚筋以复其力。痰发于筋膜者也，筋膜伤而湿
困之，则痰常多，筋膜伤而火激之，则痰暴涌。凡治痰欲除根本者，在补血养筋而坚之，筋
力坚强，自液不外泄。）下多亡阴，中气大虚之故。迎予诊，六脉俱有四至，洪缓无力。（缺
）至半夜，反加吐痰不已。起复诊之，六脉俱细，此邪气已去，真阴欲还，阳虚反发躁之象
。急用六君加姜、桂各三分，服即成寝，至明午方唤醒之。又一剂，欲睡不醒，精神反觉懒
怠，邪气尽退，而正气将复矣。至下午，吃米汤一盅，口知谷味，再用补中加干姜、桂、门
甲辰年闰九月期间，天气寒热交替无常，患痢疾的人很多。我的四弟永穆，二十七岁。突然患上痢疾，下红白脓血，腹痛且里急后重，已经三天了。来找我取药，我给他开了芍药汤一帖，香连丸两服。服药后痢疾不止，反而增加了心口像刀割一样的疼痛，肚脐周围腹痛剧烈，肛门疼痛也很厉害，叫声震动四邻，他自己认为必死无疑，向母亲告别，整理行囊准备去乡下（或指临终安排），于是我去乡下探望他。他昼夜无法入睡，排便次数难以确定，每天排出红血一桶，疼痛难以忍受，发热、流汗、不进食。诊脉时，六部脉象都豁大，浮、中、沉三候均无力，每呼吸一次脉动四次（迟脉）。我说：虽然疼痛，虽然发热，但脉象无力，这已经是虚寒证了。古人说：脱血者益气，这个病症正适合用这个方法。于是使用异功散加升麻三分、木香五分、炒干姜五分。服用一剂后，大便感觉通畅一些，疼痛也可以忍受，到了五更天，腹痛又和之前一样。我说：这是药效过了。急忙煎煮一剂给他喝，比前一次更加通畅，疼痛也减少了七八成，随即熟睡到中午才醒来，说感觉不太舒服。我又说：这药只能支撑睡一觉，再煎煮给他喝，于是安稳睡觉直到晚上，疼痛停止，里急后重也缓解了，继续服用前面的方剂而痊愈。
过了一两天后，因为吃了鸡肉，再次出现腹痛、肛门肿胀，排泄污秽之物不止。第三天，病情极其严重，再次报告给我诊治。脉象每呼吸三次多一点，浮取可见沉取不可见，按压则脉大，脾脉和命门脉微弱，服用补中益气汤没有反应。这是虚脱非常严重，加入御米壳一钱，也没有反应，排泄像洞泄一样，流汗发躁，尺脉逐渐想要收敛，我也惊慌着急，让人在二更后去城里取人参，到早上回来，在补中益气汤中加入人参二钱服用，咽下后常常感到昏愦（人参能令人昏愦，湿热内盛者尤其明显，经过多次试验验证）。这是正气将要恢复，邪气将要退去的迹象，过了一会儿，精神顿时增加，痢疾稍微缓解，担心复发，又给了一剂。下注、昏愦、发热、烦躁等症状逐渐缓解，脉象也有神气，短脉消退。仔细思考很久，古人说：久泻久痢，汤剂不如丸剂、散剂。于是配制参苓白术散让他服用，感觉大便通畅，到了下午又出现烦躁发热。我再诊脉，左尺脉洪大如火射状，这是阴虚火动的征象。给予加减八味丸六十丸，精神觉得清爽。过了一会儿，又服用八十到九十丸，睡到天亮，病去十分之七。这才相信立斋老师用加减八味丸治疗水涸之症的功效。于是命令早晚服用此丸，同时配合参苓白术散，逐渐痊愈，感觉小便疼痛，想是动了色欲的缘故，服用逍遥散、麦冬、五味子而平复。（这个病动了色欲却没有死，一定是体质实而邪气并不深重，前面叙述的证候似乎不完全吻合。仔细审视尺脉收缩，应当是失血后生痰，痰伏在下焦；尺脉洪大喷射，应当是下焦阳气乍复与痰相激荡。）
王春元的两个儿子，年仅七岁。长期患赤痢，消食导滞、削积的药物已经服用过多，后来转为排泄白色如鼻涕样的物质，完全没有粪便。诊察其症状，适宜温补脾胃以生肺金，使用补中益气汤加炮姜、官桂各二分，其中人参只用了三分，而且陈腐不堪。服用四剂后，手脚略微柔软，言语也健壮，只是身体还不温暖，下面的白色排泄物仍然不减，也是虚寒滑脱的危重症，适宜补益、适宜固涩、适宜温补，再次用前面的药方加好人参五分、大附子二分半、御米壳一分。服用一剂后，脚已经温暖，大便立即有粪便，白色排泄物退了十分之八，从此手脚都温暖柔软，泄泻完全停止，继续服用前方，去掉御米壳、附子两味药。我回去后，嘱咐如果身体已经温暖，姜、桂也要去掉，后面服用参苓白术散以培补中气。使得来年乙巳年厥阴风木之气不能克制（脾胃），饮食尤其应该谨慎。
我的朋友薛理还的仆人，远行忍饥，又互相殴打导致脱力，当时是五月初，于是发热谵语，用补中益气汤及五苓散几剂没有效果。请我诊治，六脉俱无，偶尔出现则非常细，外在症状则是面赤、谵语、口腔溃烂。一位朋友说：阳证见到阴脉，属于死证。我说：应当根据阳虚从脉舍症治之，于是给予附子理中汤冷服。两帖后，脉稍现；四帖后脉有神，口腔溃烂痊愈；六帖后脉象如常，但谵语未停。我说：脉气已经完整恢复，而谵语不休的，是胃中有燥屎，适宜用胆导法导之，果然排出燥结，谵语于是平静。（这个证如果大便滑利容易的，是有瘀血。以桃仁... 马见源精神素弱，且劳累甚，饥饿时吃了一块冷肉，于是身体不适，发热谵语发狂，乃是饮食劳倦之症。乡间吐痰者，是肺胃筋膜内伤，多由饮食劳倦引起，宜坚固筋膜以恢复其力量。痰发于筋膜，筋膜受伤而湿气困阻它，则痰常多；筋膜受伤而火激扰它，则痰暴涌。凡是治疗痰想除根本的，在于补血养筋而坚固它，筋力坚强，津液自然不外泄。）下利多亡阴，是中气大虚的缘故。迎接我诊治，六脉俱有四至，洪缓无力。（缺）到半夜，反而加重吐痰不止。起来复诊，六脉俱细，这是邪气已去，真阴欲还，阳虚反而发躁的征象。急忙用六君子汤加姜、桂各三分，服用后即入睡，到第二天中午才唤醒。又一剂，想睡不醒，精神反而觉得懒惰，邪气尽退，而正气将要恢复了。到了下午，吃了一盅米汤，口中知道谷物的味道，再用补中益气汤加干姜、桂、麦冬...
In the intercalary ninth month of the Jia Chen year, the weather was alternately cold and hot without regularity, and many people suffered from dysentery. My fourth brother, Yongmu, aged twenty-seven, suddenly developed dysentery with red discharge, abdominal pain, and tenesmus, which had persisted for three days. He came to seek medicine, and I prescribed one dose of Shaoyao Tang (Peony Decoction) and two doses of Xianglian Wan (Aromatic Coptis Pill). The dysentery did not cease; instead, he developed a sensation of knife-like pain in the epigastrium, severe pain around the umbilicus, and intense anal pain, his cries shaking the neighbors. Believing he would surely die, he bid farewell to his mother and prepared to leave for the countryside. I went to visit him there. He could not sleep day or night, the frequency of defecation was irregular, and he passed a bucketful of red blood daily. The pain was unbearable, accompanied by fever, sweating, and anorexia. Palpation revealed that all six pulse positions were large and empty (Huo), lacking strength in floating, middle, and deep pressures, with four beats per respiration (slow pulse). I said: "Although there is pain and fever, the pulse lacks strength, indicating deficiency-cold. As the ancients stated: 'For hemorrhage, tonify Qi.' This condition is precisely suitable for this approach." Thus, I used Yigong San (Extraordinary Power Powder) augmented with Shengma (Cimicifugae Rhizoma) 3 fen, Muxiang (Aucklandiae Radix) 5 fen, and Chao Ganjiang (Stir-fried Zingiberis Rhizoma) 5 fen. After one dose, bowel movements became slightly looser, and the pain became bearable. By the fifth watch (early morning), the abdominal pain returned as before. I said: "The efficacy of this medicine has worn off." I urgently decocted another dose for him. Compared to the previous one, it worked even better, reducing the pain by seven or eight parts. He then fell into a sound sleep until noon, waking up to say he felt somewhat uncomfortable. I said again: "This medicine can only sustain one sleep. Decoct another dose." He slept peacefully until evening, the pain ceased, and tenesmus improved. He continued taking the previous prescription and recovered.
A day or two later, due to eating chicken meat, the abdominal pain and anal swelling recurred, with continuous discharge of foul matter. On the third day, the condition became extremely critical, and I was summoned again. The pulse beat slightly more than three times per respiration, palpable on the surface but not at depth, becoming large when pressed. The Spleen and Mingmen pulses were faint. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) was ineffective. This indicated severe collapse of deficiency. Yu Mi Ke (Papaveris Pericarpium) 1 qian was added, but still no effect. The discharge resembled hole-leak diarrhea, accompanied by sweating and restlessness. The Chi (cunimal) pulse gradually tended to contract. I was also panicked and anxious, sending someone to fetch Ginseng from the city after the second watch. Returning early in the morning, I added Ren Shen (Ginseng Radix et Rhizoma) 2 qian to Bu Zhong Yi Qi Tang. Upon swallowing, he often experienced mental confusion (Ren Shen can cause confusion, especially in cases of internal damp-heat accumulation, as verified through repeated trials). This signified that righteous Qi was about to recover and pathogenic factors were retreating. Shortly after, his spirit markedly improved, and the dysentery slowed slightly. Fearing recurrence, another dose was given. The symptoms of profuse discharge, confusion, fever, and restlessness gradually subsided, the pulse gained spirit, and the short pulse disappeared. Reflecting deeply, I recalled the ancients' saying: "For chronic diarrhea and dysentery, pills and powders are superior to decoctions." Therefore, I compounded Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) for him to take. He felt loose stools, but by afternoon, restlessness and heat returned. I palpated the pulse again; the left Chi position was surging like fire shooting, indicating Yin deficiency with hyperactive fire. I administered Jia Jian Ba Wei Wan (Modified Eight-Ingredient Pill) 60 pills, after which he felt refreshed. Subsequently, he took 80-90 more pills, slept until dawn, and the illness resolved by seventy percent. Only then did I believe in Master Lizhai's use of Jia Jian Ba Wei Wan to treat conditions of dried-up water (Yin fluid exhaustion). I instructed him to take these pills morning and evening, combined with Shen Ling Bai Zhu San, leading to gradual recovery. He complained of painful urination, likely due to sexual activity. Xiao Yao San (Free and Easy Wanderer Powder), Mai Dong (Ophiopogonis Radix), and Wu Wei Zi (Schisandrae Fructus) were administered to calm the condition. (Note: This patient engaged in sexual activity yet survived, implying his constitution was solid and the pathogen was not deep-seated. The previously described symptoms seemed inconsistent. Careful examination of the contracting Chi pulse suggests phlegm generated after blood loss, lurking in the lower jiao; the surging Chi pulse suggests sudden restoration of lower Yang clashing with phlegm.)
Wang Chuanyuan's two sons, only seven years old, had suffered from bloody dysentery for a long time. They had taken excessive amounts of digestive and accumulative-resolving agents, which later transformed into white discharge resembling mucus, with no feces. Diagnosing the symptoms, warming and tonifying the Spleen and Stomach to generate Lung Metal was appropriate. Bu Zhong Yi Qi Tang was used with Pao Jiang (Prepared Zingiberis Rhizoma) and Guan Gui (Cinnamomi Cortex) each 2 fen. Ren Shen (Ginseng Radix et Rhizoma) was limited to 3 fen, and the material was stale and inferior. After four doses, his hands and feet became slightly soft, and his speech strengthened, though his body remained cold. The white discharge did not decrease. This was also a critical condition of deficiency-cold with slipping and unconsolidation, requiring tonification, astringency, and warming. The previous prescription was reused with high-quality Ren Shen 5 fen, Da Fu Zi (Aconiti Lateralis Radix Praeparata) 2.5 fen, and Yu Mi Ke 1 fen. After one dose, his feet warmed, feces appeared in the stool, and the white discharge reduced by eighty percent. From then on, his hands and feet were warm and soft, and diarrhea stopped completely. He continued the previous formula, removing Yu Mi Ke and Fu Zi. Upon my return, I instructed that if the body temperature normalized, Jiang (Zingiberis Rhizoma) and Gui (Cinnamomi Cortex) should also be removed, followed by Shen Ling Bai Zhu San to cultivate central Qi, preventing the Wood Qi of Jueyin in the coming Yisi year from overacting, and advising strict dietary caution.
My friend Xue Lihuan's servant, having traveled far while enduring hunger, and subsequently beaten to the point of exhaustion, developed fever and delirious speech in early May. Bu Zhong Yi Qi Tang and Wu Ling San (Five-Ingredient Poria Decoction) failed after several doses. I was called to diagnose him. All six pulses were absent; occasionally appearing, they were very fine. External symptoms included a red face, delirious speech, and oral ulcers. A friend remarked: "Yang syndrome presenting with Yin pulse indicates a fatal case." I said: "We must treat based on the pulse, disregarding the symptoms, considering Yang deficiency." Thus, I prescribed Fuzi Lizhong Tang (Aconite and Ginger Decoction to Warm the Middle) to be taken cold. After two doses, the pulse slightly appeared; after four doses, the pulse gained spirit, and oral ulcers healed; after six doses, the pulse was normal, but delirious speech persisted. I said: "The pulse energy has fully recovered, but persistent delirium indicates dry feces in the Stomach. It is appropriate to use a gallbladder suppository method." Indeed, dry feces were discharged, and the delirium subsided. (Note: If the stool were slippery and easy to pass, it would indicate blood stasis. Ma Jianyuan had weak spirit inherently, suffered severe fatigue, and ate a piece of cold meat while hungry, leading to discomfort, fever, delirium, and madness. This is a case of injury from diet and overexertion. Phlegm expectorated in rural areas stems from internal injury to the lung and stomach fascia, mostly caused by diet and overexertion. One should strengthen the fascia to restore its power. Phlegm originates from the fascia; if injured and trapped by dampness, phlegm is abundant; if injured and agitated by fire, phlegm gushes violently. To eliminate the root of phlegm, one must nourish blood and strengthen the fascia. When the fascia is strong, fluids will not leak externally.) Profuse downward discharge leads to Yin depletion, due to severe deficiency of Central Qi. Upon my diagnosis, all six pulses had four beats per respiration, surging and slow but lacking strength. [Missing text] By midnight, vomiting of phlegm worsened. Rising for a re-diagnosis, all six pulses were fine. This indicated that pathogenic factors had departed, true Yin was returning, and Yang deficiency manifested as restlessness. Urgently, Liu Jun Tang (Six-Gentleman Decoction) with Jiang and Gui each 3 fen was administered. He fell asleep immediately and woke up at noon the next day. Another dose made him sleepy and unwilling to wake, with apparent lethargy, indicating complete departure of pathogens and recovery of righteous Qi. In the afternoon, he drank a bowl of rice soup, recognized the taste of grain, and Bu Zhong Yi Qi Tang was used again with Gan Jiang (Zingiberis Rhizoma), Gui (Cinnamomi Cortex), and Men Dong (Asparagi Radix)...