孝廉王于 父，年六十余。六脉俱弦牢，右三关浮中沉甚豁大，左三略差；外症晚则作
饱，且大便不利。此土受木制，脾胃不输津液，中气亏损之候也。宜补脾胃生肺金，乃用补中益
气
味骤收肺金以生新水。服二剂，觉胸中稍宽，身中反有眩意，此正气欲复，而邪渐退，故瞑眩
耳。又服数剂，复诊之，则牢坚已去，第二尺俱洪。此真阴真阳并虚，当平补之，用八珍，
晚服六味丸，大肠渐润，再数剂全愈。
邱生，年十八岁。正月间，过食曲饼汤面，遂不快，发热，头痛。邀予诊之，脉略紧，
中沉
彼延别医，用柴平汤一帖，病不减。晚归诊之，脉洪汗出，而腹痛甚，不可按。以元明粉泡
汤下导滞丸二钱，其痛减半，尚有胀，再用前丸一剂，而饱胀如脱，但腹痛耳，复增疟状。
（诸症皆胃中有死血也，何不重加桃仁于剂中。）予又诊之，六脉俱细弦，此脾土受木乘，又
被伐之过，宜用温补，以理中汤二剂，肚痛除。又以过食复饱，诊之，弦细如前，仍以前汤
，但温脾胃，而食自消，诸症去。
汤如玉母，怀七月而生，后每大便甚艰，须二、三时方安，百治不效。予谓∶肺肠气血
不能
之气自如，调理数月而愈。（每见鸡雏初生，当肛门内，犹一片色如卵黄，是人物之生，以
肠胃为最后。七月而生，肠力未全，必有补血坚筋强力固肠之法，随时进退，与之终身。）
一妇，年五旬。二寸浮洪，二尺小，右关弦，不思食，头眩。余曰∶二寸浮洪，病主头
眩，亦主上膈不清，此阳气虚而越上，不能归根复元，以致丹田气虚寒，不能养温脾胃，是以右
关脉弦，饮食不消而少飧也。理宜敛阳气归于下焦丹田之内，下焦温暖，脾胃自健，水谷自
化矣。用桂枝、白芍六分，五味子二分，白茯一钱，黑姜三分，人参五分，杜仲一钱，破故
纸五分，炙草四分，汤泡半夏一钱，加煨姜，十余剂而愈。
蒋怀劬，年六十。素吐白沫，已数十年矣。忽喉中有噎意，以白予。曰∶此脾胃虚寒也
，宜用人参调补中气，彼辞以贫窭，自将白糖齑汁熬化含吐，及六七日，则溏泄，日五六次，神
亦劳倦，食亦不贪。延视之，六脉皆二至，来三五至则止，如雀啄之状。此元气大虚，不能
嘘
，反加浮洪粗大，数七八至，发热、口碎，舌碎，乃虚阳上越之证，予思之，脉已犯难治之
例，且吐沫不止，肾水泛，脾虚失统也。用（缺）。病亦稍退。稍劳即复，服数剂复减，再劳
又如故。至两三月后，药亦不受，亦不效，五六日而殁。先贤云∶粗大之脉难治。书此以证
孝廉王于的父亲，年龄六十多岁。六脉都呈现弦而牢硬的脉象，右手寸、关、尺三部浮、中、沉取都非常豁大，左手三部稍好一些；外在症状是傍晚时感到饱胀，并且大便不通畅。这是土（脾胃）受到木（肝气）的克制，脾胃不能输布津液，属于中气亏损的证候。应当补益脾胃以生肺金，于是使用补中益气汤，并加入少量收敛肺气、促进新水生成的药物。服用两剂后，感觉胸部稍微宽松，身体反而出现眩晕感，这是正气想要恢复，邪气逐渐消退，所以出现瞑眩反应。又服用几剂后，再次诊察，原来牢坚的脉象已经消失，第二尺部（肾脉）变得洪大。这是真阴和真阳都虚弱，应当平和地补益，使用八珍汤，晚上服用六味地黄丸，大肠逐渐滋润，再服用几剂后完全痊愈。
邱生，年龄十八岁。正月期间，因为过量食用曲饼、汤面等食物，随即感到不适，发热，头痛。邀请我诊治，脉象略微紧束，中取和沉取……（原文此处有缺漏，根据上下文推测为脉象变化或具体描述缺失）。他请其他医生诊治，使用柴平汤一帖，病情没有减轻。晚上回去诊察，脉象洪大且有汗出，但腹痛剧烈，不可按压。用元明粉泡汤送服导滞丸二钱，疼痛减少了一半，仍有胀感，再用前一方的药丸一剂，饱胀感如解脱般消失，只剩下腹痛，又增加了类似疟疾的症状。（这些症状都是胃中有死血所致，为什么不加重桃仁在方剂中呢？）我又诊察，六脉都细而弦，这是脾土受到肝木的乘克，又被误治攻伐过度，应当使用温补法，用理中汤两剂，肚痛消除。又因过食导致再次饱胀，诊察时，脉象仍像之前一样弦细，仍然使用前面的方剂，只要温补脾胃，食物自然消化，各种症状去除。
汤如玉的母亲，怀孕七个月时早产，之后每次大便非常困难，需要两三个时辰才能缓解，多种治疗都不见效。我说：肺与大肠的气血……（原文此处有缺漏，结合下文推测为气血不足或运行不畅），调理几个月后痊愈。（经常看到小鸡刚出生时，肛门内还有一片颜色像蛋黄的东西，这说明人和动物的生长，是以肠胃最后形成的。七个月早产，肠力尚未完全，必须有补血、强筋、强力固肠的方法，随时调整进退，伴随终身。）
一位妇女，年龄五十岁。两手寸脉浮洪，两手尺脉小，右关脉弦，不想吃东西，头晕目眩。我说：两手寸脉浮洪，病主头晕目眩，也主上焦膈膜不清，这是因为阳气虚弱而上越，不能归根复元，导致丹田气虚寒，不能温养脾胃，所以右关脉弦，饮食不消化而进食少。理应收敛阳气归于下焦丹田之内，下焦温暖，脾胃自然强健，水谷自然运化。使用桂枝、白芍各六分，五味子二分，茯苓一钱，干姜三分，人参五分，杜仲一钱，破故纸五分，炙甘草四分，汤泡半夏一钱，加煨姜，十余剂后痊愈。
蒋怀劬，年龄六十岁。平时吐白沫，已经有几十年了。忽然喉咙中有噎塞感，告诉我。我说：这是脾胃虚寒，应当用人参调补中气，他推辞说贫穷，自己将白糖腌菜汁熬化含服吐出，过了六七天，就出现溏泄，每天五六次，精神疲倦，食欲也不佳。延请我去看，六脉都只有两次跳动，来三五次就停止，像雀啄脉的样子。这是元气大虚，不能……（原文此处有缺漏，推测为嘘吸或维持生命活动），反而出现浮洪粗大，数七八至，发热、口舌生疮，舌头溃烂，这是虚阳上越的证候，我想，脉象已经犯了难治的例子，而且吐沫不止，肾水泛溢，脾虚失于统摄。使用（原文缺药方）。病情也稍微减退。稍微劳累就复发，服用几剂后又减轻，再劳累又像以前一样。到了两三个月后，药也吃不下了，也没有效果，五六天后去世。先贤说：脉象粗大难治。写下此案例以证明。
Xiaolian Wang Yu's father, aged over sixty. The six pulses were all wiry and firm (Xian Lao). The three positions on the right hand (Cun, Guan, Chi) were extremely expansive in floating, middle, and deep palpation, while the left hand was slightly better; externally, he felt fullness in the evening and had difficulty with bowel movements. This is Earth (Spleen/Stomach) being controlled by Wood (Liver Qi), where the Spleen and Stomach fail to transport fluids, indicating a deficiency of Middle Qi. It is appropriate to tonify the Spleen and Stomach to generate Lung Metal, so Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) was used, with added herbs to astringe Lung Metal and generate new fluids. After two doses, he felt slightly relieved in the chest, but experienced dizziness in the body; this is Zheng Qi (Upright Qi) attempting to recover and Xie Qi (Pathogenic Qi) gradually retreating, hence the Ming Xuan (dazzling/dizzy reaction). After taking several more doses, upon re-examination, the firm pulse had disappeared, and the second Chi position (Kidney pulse) became surging. This indicates both True Yin and True Yang are deficient, requiring mild tonification. Ba Zhen Tang (Eight Treasures Decoction) was used, and Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) was taken at night. The large intestine gradually moistened, and after a few more doses, he fully recovered.
Qiu Sheng, aged eighteen. In January, due to excessive consumption of fermented dough cakes, soups, and noodles, he subsequently felt unwell, with fever and headache. I was invited to examine him; the pulse was slightly tight, [text missing]... He consulted another doctor who prescribed Chai Ping Tang (Bupleurum and Pinellia Decoction) for one dose, but the illness did not subside. Returning in the evening to examine him, the pulse was surging with sweating, yet severe abdominal pain that could not be pressed. Yuan Ming Fen (Mirabilite) dissolved in water was used to administer Dao Zhi Wan (Guide Out Stagnation Pills), 2 qian; the pain reduced by half, but distension remained. Another dose of the previous pill was given, resolving the fullness and distension as if released, leaving only abdominal pain, and adding symptoms resembling malaria. (All these symptoms are due to dead blood in the stomach; why not add heavier amounts of Tao Ren [Peach Kernel]?) I examined him again; the six pulses were all fine and wiry. This is Spleen Earth being overcome by Liver Wood, further damaged by excessive purging. Warm tonification is indicated. Li Zhong Tang (Regulate the Middle Decoction) for two doses eliminated the abdominal pain. Due to recurrence of fullness from overeating, examination showed the pulse remained wiry and fine as before. The same formula was still used; by warming the Spleen and Stomach, food digested naturally, and all symptoms resolved.
Tang Ruyu's mother, born prematurely at seven months of gestation. Afterwards, every bowel movement was very difficult, requiring two or three hours to feel relief; various treatments were ineffective. I said: The Qi and Blood of the Lung and Large Intestine [text missing]... After several months of regulation, she recovered. (I often observe that when chicks first hatch, inside the anus there is still a piece of tissue colored like egg yolk. This shows that human and animal development forms the intestines and stomach last. Born at seven months, intestinal strength is incomplete; methods to nourish blood, strengthen sinews, and firmly consolidate the intestines must be employed, adjusting dynamically throughout life.)
A woman, aged fifty. The Cun pulses on both hands were floating and surging; the Chi pulses on both hands were small; the right Guan pulse was wiry. She had no appetite and suffered from dizziness. I said: Floating and surging Cun pulses indicate disease primarily causing dizziness, and also indicate turbidity in the upper Jiao (Diaphragm). This is because Yang Qi is deficient and floats upward, unable to return to its root and restore origin, leading to deficiency-cold in the Dantian. Unable to warm and nourish the Spleen and Stomach, the right Guan pulse becomes wiry, resulting in indigestion and poor intake. Ideally, Yang Qi should be gathered and returned to the lower Jiao Dantian. Once the lower Jiao is warm, the Spleen and Stomach will naturally strengthen, and food and water will transform naturally. Gui Zhi (Cinnamon Twig) and Bai Shao (White Peony Root) each 6 fen, Wu Wei Zi (Schisandra Berry) 2 fen, Fu Ling (Poria) 1 qian, Hei Jiang (Black Ginger/Roasted Ginger) 3 fen, Ren Shen (Ginseng) 5 fen, Du Zhong (Eucommia Bark) 1 qian, Po Gu Zhi (Cibotium Rhizome) 5 fen, Zhi Cao (Honey-fried Licorice) 4 fen, Ban Xia (Pinellia Tuber) soaked in decoction 1 qian, plus Wei Jiang (Roasted Ginger). After more than ten doses, she recovered.
Jiang Huaiqu, aged sixty. He habitually vomited white foam for decades. Suddenly, he felt a sensation of obstruction in his throat and told me. I said: This is deficiency-cold of the Spleen and Stomach. Ren Shen (Ginseng) should be used to regulate and tonify Middle Qi. He declined due to poverty, instead boiling pickled vegetables in white sugar juice, holding it in his mouth, and spitting it out. After six or seven days, he developed loose stools, five to six times daily, with mental fatigue and lack of appetite. Upon examination, the six pulses beat only twice, stopping after three to five beats, resembling Que Zhuo Mai (Bird Pecking Pulse). This is severe deficiency of Yuan Qi (Original Qi), unable to [text missing], suddenly becoming floating, surging, coarse, and large, beating seven to eight times per breath, with fever, mouth ulcers, and tongue lesions. This is a syndrome of floating Deficient Yang. I considered that the pulse already fell into a difficult-to-treat category. Moreover, continuous vomiting of foam indicates Kidney Water flooding and Spleen deficiency failing to control. [Prescription missing]. The illness subsided slightly. Relapse occurred with slight exertion; several doses reduced it again, but relapse followed further exertion. Two or three months later, he could not tolerate medicine, nor was it effective. He died after five or six days. The sages said: Coarse pulses are difficult to treat. I record this case as proof.