上洋秦斋之，劳欲过度，每阴雨左足麻木，有无可形容之苦。历访名医，非养血即补气，时作时止，终未奏效。戊戌春病势大作，足不转舒，背心一片，麻木不已。延予治之。左脉沉紧，右脉沉涩，此风湿寒三气杂至，合而为痹。其风气胜者为行痹，寒气胜者为痛痹，湿气胜者为着痹。着痹者即麻木之谓也。明系湿者邪，内着痰气凝结，郁而不畅，发为着痹。须宣发燥湿之剂，加以报使之药，直至足膝，庶湿痰消而大气周流也。方以黄耆苍术桂枝半夏羌活独活防己威灵仙数帖而痊。若以斋之多劳多欲而日服参耆，壅瘀隧道，外邪焉能发，而病安能去乎。
海宁相国陈素庵，病足肿痛，用补血药则肿愈甚，用补气药则痛益增。延家君往治。诊其脉软而气滑，属湿痰流注下焦，为有余之症，定非不足也。若滋阴则壅沉滞阳气，若补阳则胶固经络，此病之所以增进也。用陈皮茯苓半夏独活苍术厚朴桔梗灵仙两服痛减肿消。故虚虚之祸世所共戒，实实之殃人每蹈之。若徒执补养之法是未明标本缓急邪正虚实之机也，乌足以与议道哉。所以戴人立法专主驱邪，诚虑夫补实之祸，以救末流时弊耳。
皖城玉山王学师子舍，产后早服参耆致恶露不尽，兼因过于恚怒变为臌胀，青筋环腹，神阙穴出。延予商治。左手脉皆弦劲，重按则涩，右手洪滑。此下焦积瘀，怒气伤肝以致是症。夫畜血之候，小腹必硬而手按畏痛，且水道清长，脾虚之症，大腹柔软而重按之不痛，必水道涩滞，以此辨之则属虚属实判然明矣。王翁曰：是症为积瘀不行无疑矣。前治皆模糊脉理，溷投药石，所以益增胀痛。今聆详辨，洞如观火，请疏方为感。遂用归梢赤芍香附青皮泽兰厚朴枳实肉桂元胡等加生姜，间投花椒仁丸三服，数日后胀痛悉愈。
张侍川，脾泄经年，汤药遍尝，大肉尽削，小便枯竭，势已危殆，余往诊之。左脉弦细，右脉虚微，此系乾阳不运，坤阴无权，所以脾伤而破胭肉脱。肺虚而气化失调，俾浊阴不降，内滞肠胃，清阳不发，下乘肾肝，由是三阴受伤而成久泄之症。况当四十年之升阳之气与浊阴之令自此相半，今侍川已逾五旬，不思举其下陷之阳，反以渗利为用，则失治本之旨矣。且下久亡阴，未有久泄而肾不虚者。若单补其脾则力缓不能建功，须得温暖下焦之晶辅佐其脾间，丹田火旺则脾土自温暖，中州健运则冲和自布，精微之气上奉乾金，下输膀胱，分别清浊，则二便自和，可以指日收功矣。方用人参白术黄耆炙草广皮木香升麻柴胡肉果补骨脂数剂，而小便亦实，后以四神丸加煨木香调理乃安。
家君治江右太师傅继庵夫人，久泄不已，脉象迟微，微为阳衰，迟为阴胜，此脾土虚而真阳衰也。盖脾虚必补中而后土旺，阳衰必温中然后寒释。乃以四君子加姜桂，眼二剂而畏寒如故，泄亦不减。知非土中之阳不旺，乃水中火不升也。须助少火之气上蒸于脾，方能障土之湿。遂用人参三钱白术五钱肉桂一钱附子一钱，数帖渐瘥，后八味丸调理乃安。
春元唐次仲，小腹脐傍刺痛，连胁及胸，坐卧不安。余诊六脉弦滑，重取则涩。此食后感怒，填寒太阴，致肝气郁而不舒，胸困作痛。经曰：木郁达之，解其郁而痛自止。用二陈汤合平胃散加枳壳木香，一服而愈。
???????????????????秣陵罗明求，奉藩摧饷，适感风寒，发热恶寒，头疼而体痛，至七日后变成温疟，发时惊骇异常，日哺见鬼，如二岁童子大者数十缠绕腰问，悚惧不堪，至晚方散，已五六发矣。治者皆为鬼疟，议用截法，然犹未决，邀余诊视。六脉洪滑，余曰：此系痰涎内积，非真邪祟外干也。古语有云：无谈不成疟，又曰：怪病多属痰。盖痰乃液所化，液乃肾所主。必平日肾水素弱，虚火独旺，煎熬精液成痰，攻冲经络而为疟之根本。况腰原属肾，其液化痰更无疑矣。惟先驱其痰，俟痰去而疟鬼自除，然后培补本原至为切当。遂用小柴胡汤加茯苓枳壳槟榔，临服调元明粉三钱，顷刻便润下积痰甚快，至明日而疟鬼俱绝。
句容孔太师，随朝使者。每至午余，无端见鬼，恐惧昏沉，夜半发热，黎明始苏。诸医用安神养血之药，继投导痰顺风之剂，均无效验。邀家君诊视，两手脉现滑数此因沉湎于酒，酒能生湿，湿能助火，火湿相合而成痰，痰迷心窍则见鬼。即以橘红贝母天花粉干菖蒲黄芩麦冬山栀竹茹苦丁茶，二服而神清鬼没，四剂而平复如初。
胡文宰子舍，向患怯弱。乙巳季夏方饮食后，忽腹中绞痛，自谓着暑，调天水散一服不愈，又疑停食，进山查麦芽汤，其痛更增，发厥昏晕，无有停歇，中脘硬痛，手不可近，两眼露白，舌缩谵语，状若神灵。延医调治，或曰大便实而用枳朴，或云积暑而用芩连，诸药杂投病势益增，当事者咸疑惧无措，余独谓虚症，力主大补之剂。盖平昔脉弦洪兼数，且右手更旺，今也转数成迟，左手更觉无本根，此至虚有盛候，凭脉合症之良法。急煎理中汤加陈皮半夏与服。庶胃气充肺，元阳流动，总有蓄积盘踞方隅，定然向风自化。果一剂而稍安，数剂而全愈。
慈溪天生杨先生，馆江湾镇，时值盛暑，壮热头痛，神昏发斑，狂乱不畏水火，数人守望，犹难禁止，甚至舌黑刺高，环口青暗，气促眼红，谵语直视，迎余往治。余见众人环绕，蒸汗如雨，病狂躁无有休息，寻衣摸床，正在危候。强按诊脉，幸尚未散，急取箸头缠绵，用新汲水抉开口，凿去芒刺，即以西瓜与之犹能下咽。乃用大桶置凉水，并洒湿中间空地，设席于地，扶患者卧上，再用青布丈许，摺作数层，浸湿搭在心间，便能云顿入清凉世界六字，语虽模糊，亦为吉兆。遂用大剂白虎汤与服，加黄芩山栀元参。半日之间狂奔乱走，目无交睫，此药入口，熟睡如泥。乡人尽曰休矣。余曰此胃和而睡着也，不可惊觉。自日中至半夜方苏，其病遂愈。
吴明初，平素体弱，因年来忧郁，忽然呕血，自早至暮百余碗，两目紧闭，四肢畏寒，冷汗如注，汤药入口，随即吐出，举族惊狂，迎余视之。幸病虽为急，脉尚未散，喘促犹缓，一线生机，尚可挽回，若以血药投治则不及矣。盖初则血随气上，今则气随血脱。语云：有形之血不能速生，几微之气在所急固。此阳生阴长之道，寓诸《灵素》扶阳抑阴之权，具于羲易。诚以阳者生之本，阴者死之基，故充塞四大，温润肌肉，皆赖此阳气耳。今脉气虚微，天真衰败也；汗雨不收，卫气散失也；四肢畏冷，虚阳不能旁达也；两目紧闭，元神不能上注也；药入即吐，继之以血者，乃呕伤胃脘，守荣之血不藏也。为再用汤药，恐激动其吐，宜设计以取之。遂用人参一两，白芨四钱，均为细末，米饮调丸如樱桃大，含化。自黄昏至一更，约用一半，汤饮方通，血亦不吐。至明日神思稍清，脉气未静，似芤似革，参互不调，全无胃气，尽属阴亡于中，阳散于外之象。乃速煎参附进之，以追散失之元阳。八日内记服人参二斤，附子五枚，而元气顿充，脉始收敛，至今强健倍常。倘此时稍有疑虑，徒任浅剂，焉能挽回其真气耶。
上海邑尊陈虞门慕宾，吐血不已，或用犀角地黄汤降火，或以加味四物汤滋阴，绝谷数日，气喘随毙，延家君诊治。六脉虚弱，精神怠倦，明属思虑过度，脾元亏损。所以气衰则火旺，火旺则血沸而上溢也；血脱则气孤，气孤则胃闭而绝谷也。法当甘以悦脾，温以启胃，甘温相济，脾胃调和。庶元阳得以扶持，气血有所生长耳。遂用四物汤加米仁石斛麦冬五味广皮桔梗，数剂而愈。
吴淞一女，在闺时患左眼上胞内生疙瘩，日渐长大，下垂遮目，红肿重坠，痛楚异常。专科者始以驱风治标，继以养血治本，迁延岁月未获稍减。余诊其脉，左关弦强搏指，右关艰涩。予曰：目廓应肝，内轮应脾，肝脾二脏性喜疏利，故忧思伤脾则气结而血瘀，恚怒伤肝则气郁而热生。由是火炎血沸，上腾空窍，目廓积闭，火旺赤肿也，治宜疏中宫之滞，泻东方之实，则郁开火降，瘀化肿消耳，用龙胆泻肝汤数帖，疙瘩渐消，复以六味丸料加龙胆草白蒺藜决明子牡蛎，与滋阴之中兼以清火之品，逾日而平复。
周文伯，乡居课农，偶发寒热，解表一剂，转觉神思恍惚，日增倦怠，目呆如愚，语言错乱，昼夜呻吟，六脉微弱，不堪重按。余曰：是症之因，必有大惊，损伤神气，故现神鬼飞越之象。盖神藏于心，心主镇静；魂藏于肝，肝主惊骇。故惊则气乱，心失镇静之常，神气孤浮，邪入神明之窟。由是魂无安宅，飘荡于外。若能安神益气固守飞扬之真，自然魂随神摄可复清明之职。丹书所谓神是性兮气是命，神不外驰气自定者也。遂服归脾汤数帖灵动如初。自述病概缘溪头失足，从高坠下，遂觉神气越出，精采不定，作见游魂，须眉状貌，酷肖已身，约长尺许，或从空行走，或相依同寝，所谓魂离吾体断不诬矣。自后稍有震怒惊呆复作，屡用前方获效。后迁于城，道逢形人，因而受惊，至晚忽大呼杀人，举家骇异，议用前药。值余适至，复诊其脉弦强搏指较前大异，此正虚祟乘之病，非从前神脱魂离者比也。治当清痰降火，祟是不作。若用参耆胶固邪气，将成痼疾矣。乃以温胆汤加苏子黄芩山栀瓜蒌，服即熟睡，醒来诸病如失，但觉倦怠。乃淡粥调养数日后，仍服归脾汤而全愈，则知鬼岂真鬼耶。
萎江金公采谋，秋患痢昼夜百余次，赤脓腥秽，呕恶不食，口渴发热，向用滞下法竟难奏效。忽冷汗不止，四肢如冰，气促神昏，延余往治。外证虽逆，六脉尚存，乃煎附子理中汤。服二剂，四肢渐温，自汗渐收。又服数帖，精神充旺，痢下顿除。若抱痢之赤白，口渴身热，再投凉药，气将脱矣。故曰泻虚朴实，神失其室，此之谓也。
淮右章公克，壬寅春客游海邑，患温病发热，邪气再传，壮热神昏,濈濈自汗，眼红面赤，口渴舌黑，胸膈满闷，势甚危殆。医者泛用清热轻剂以冀幸免，余曰：春温之温邪，伏藏于冬，触发于春，随天气化，寒郁为热，此时令之热也。脉来洪大，舌黑口于，灼热汗流，神思昏喷，此脉症之热也。当速煎甘寒大剂清彻里邪，庶不使胃热腐化。若徒任芩连诸药，恐一杯之水难救车薪之火，热必自焚矣。立方用石膏五钱，麦冬二钱，知母花粉各一钱五分，山栀一钱，甘草五分，加竹叶粳米灯心为引，二剂而神爽热除。
大名司理陈玉山，素患胸膈胀闷，四肢顽麻，六脉坚劲，似芤类革，咸属冲和虚损清阳散耗之症，用六君子汤加益智肉桂以培脾，并进金匮肾气丸一料，已获稍安。至丙午春偶遭奇讼，恚怒不舒，胸膈否塞，右胁胀痛，下便瘀血，上增呕恶，粒米不进者二十余日，六脉顿退，重按豁然。予曰：脉为神机，神为气立，全赖胃气充沛者也。今脉息无神则知郁结伤脾，脾病传胃，俾磅礴浩大之气停留郁滞于中，所以胃脘否满者，脾土中州也。右胁胀痛者坤出西南也。况木虽条达依土为生，土既硗薄木无生长，此物理中之常耳。故郁怒太过，不但重损脾阴，而肝亦自病，所以不能藏血而血瘀，血去而阴伤，阴伤则阳无以自主，将有飞越之虞也。速宜培养元神，不使涣散，乃可万全。遂用附子理中汤数帖，食能渐进，后用六君子汤兼八味丸而安。
文学包曰：余因食蟹腹痛，发则厥逆；逾月不已，延余商洽。述前服平胃二陈，继服姜桂理中，不但无效反增胀痛。余曰：痛非一端，治亦各异。感寒者绵绵无间，因热者作止不常，二者判若霄壤。尊恙痛势有时，脉带沉数，其为火郁无疑。虽因食蟹，然寒久成热，火郁于中，热郁似寒，厥冷于外。此始末传变之道，明训可考。奈何执泥虚寒，漫投刚剂，是以火济火，求愈岂不难哉。以四逆散加酒炒黄连一剂而愈。
《旧德堂医案》终
上海洋行的秦斋之，因劳累和房事过度，每逢阴雨天左足便出现麻木，那种痛苦难以用言语形容。他遍访名医，医生们不是给他养血就是补气，病情时好时坏，始终没有见效。戊戌年春天病情加重，双腿无法舒展，背部一片区域也持续麻木。于是请我诊治。他的左脉沉紧，右脉沉涩，这是风、湿、寒三种邪气混杂侵袭，合而为痹证。其中风气偏胜的叫行痹，寒气偏胜的叫痛痹，湿气偏胜的叫着痹。所谓着痹，就是指麻木不仁的症状。这明显是湿邪作祟，体内痰气凝结，郁滞不畅，从而发为着痹。必须使用宣发燥湿的药剂，并加入引导药力直达病所的引经药，使湿痰消除，人体大气得以周流运行。方剂选用黄芪、苍术、桂枝、半夏、羌活、独活、防己、威灵仙等，服用数帖后痊愈。如果因为斋之平时劳欲过度就每天服用人参、黄芪，会导致经络壅塞瘀阻，外邪怎么能发散出去，病又怎么能好呢？
海宁宰相陈素庵，患有足部肿痛，服用补血药则肿胀更严重，服用补气药则疼痛更剧烈。于是请家父前往诊治。诊察其脉象软而气滑，属于湿痰流注于下焦，是有余的实证，绝非不足之症。如果滋阴则会壅滞沉困阳气，如果补阳则会使经络胶固不通，这正是病情加重的原因。使用陈皮、茯苓、半夏、独活、苍术、厚朴、桔梗、灵仙，服用两剂后疼痛减轻，肿胀消退。所以“虚虚”（使虚者更虚）的祸患世人共知警惕，但“实实”（使实者更实）的灾殃人们却往往重蹈覆辙。如果只执着于补养的方法，就是不明白标本缓急、邪正虚实的关键，怎么足以与之讨论医道呢？因此戴人（张从正）立法专门主张驱除邪气，确实是担心补益导致实证的危害，以此来纠正末流时代的弊病罢了。
皖城玉山的王学师之子，产后过早服用人参、黄芪，导致恶露不尽，又因过于愤怒变成臌胀病，腹部青筋环绕，神阙穴突出。请我商量治疗。左手脉皆弦劲，重按时涩，右手脉洪滑。这是下焦积瘀，怒气伤肝导致的病症。凡是蓄血的症状，小腹必定硬且手按怕痛，且小便清长；脾虚的症状，大腹柔软且重按不痛，必定小便涩滞，以此辨别，属虚属实判然分明。王翁说：这个病症确实是积瘀不行无疑了。之前的治疗都模糊脉理，胡乱投药，所以更加增加了胀痛。现在听了详细的辨析，清楚得像看火一样，请开方感激不尽。于是用归梢、赤芍、香附、青皮、泽兰、厚朴、枳实、肉桂、元胡等，加上生姜，中间穿插服用花椒仁丸，三服之后，几天后胀痛全部痊愈。
张侍川，脾泄多年，汤药尝遍，肌肉消瘦殆尽，小便枯竭，形势已经危急，我去诊治。左脉弦细，右脉虚微，这是乾阳不运，坤阴无权，所以脾受伤而肌肉脱失。肺虚而气化失调，导致浊阴不降，内滞肠胃，清阳不发，下乘肾肝，因此三阴受伤而成久泄之症。况且正值四十年升阳之气与浊阴之令相半之时，现在侍川已五十多岁，不思提升下陷之阳气，反而以渗利为用，这就失去了治本的宗旨。而且久泄亡阴，没有久泄而肾不虚的。如果单补脾则力量缓慢不能建功，必须得到温暖下焦的药物辅助脾土，丹田火旺则脾土自然温暖，中州健运则冲和之气自然布散，精微之气上奉肺金，下输膀胱，分别清浊，则二便自然调和，可以指日成功矣。方用人参、白术、黄芪、炙甘草、广陈皮、木香、升麻、柴胡、肉果、补骨脂等，数剂后小便也充实，后来用四神丸加煨木香调理才安定。
家父治疗江右太师傅继庵夫人，久泄不止，脉象迟微，微为阳衰，迟为阴胜，这是脾土虚而真阳衰也。大概脾虚必须补中气而后土旺，阳衰必须温中然后寒解。于是用四君子汤加干姜、肉桂，服用两剂后畏寒依旧，泄泻也不减。知道不是土中之阳不旺，而是水中火不升。必须助少火之气上蒸于脾，才能障护脾土之湿。于是用人参三钱、白术五钱、肉桂一钱、附子一钱，数帖后逐渐好转，后来用八味丸调理才安定。
春元唐次仲，小腹脐旁刺痛，牵连胁肋及胸部，坐卧不安。我诊六脉弦滑，重取则涩。这是进食后感怒，寒气填塞太阴，导致肝气郁结而不舒，胸困作痛。经书说：木郁达之，解除郁结而痛自止。用二陈汤合平胃散加枳壳、木香，一服而愈。
秣陵罗明求，奉藩司催促饷银，恰好感受风寒，发热恶寒，头疼身体痛，到了第七天变成温疟，发作时惊骇异常，傍晚见鬼，像两岁童子大小的几十个人缠绕腰间，恐惧不堪，直到晚上才散去，已经发作五六次了。治疗的人都认为是鬼疟，议论用截疟法，但还没有决定，邀请我诊治。六脉洪滑，我说：这是痰涎内积，不是真正的邪祟外侵。古语有云：无痰不成疟，又说：怪病多属痰。大概痰是由津液所化，津液由肾所主。必定平日肾水素弱，虚火独旺，煎熬精液成痰，攻冲经络成为疟疾的根本。况且腰部原属肾，其液化痰更无疑义了。只有先驱除其痰，等痰去而疟鬼自除，然后培补本原最为恰当。于是用小柴胡汤加茯苓、枳壳、槟榔，临服时调元明粉三钱，顷刻间大便润下，积痰排出很快，到第二天疟鬼俱绝。
句容孔太师，随朝使者。每到中午以后，无故见鬼，恐惧昏沉，半夜发热，黎明才苏醒。众医用安神养血的药，接着投导痰顺风的剂，都没有效果。邀请家父诊治，两手脉现滑数，这是因为沉湎于酒，酒能生湿，湿能助火，火湿相合而成痰，痰迷心窍则见鬼。即以橘红、贝母、天花粉、干菖蒲、黄芩、麦冬、山栀、竹茹、苦丁茶，两服后神清鬼没，四剂后平复如初。
胡文宰之子，向来患怯弱。乙巳年季夏，刚吃完饭，忽然腹中绞痛，自认为着暑，调天水散一服不愈，又疑停食，进山楂麦芽汤，其痛更增，发厥昏晕，没有停歇，中脘硬痛，手不可近，两眼露白，舌缩谵语，状若神灵。延医调治，有人说大便实而用枳实、厚朴，有人说积暑而用黄芩、黄连，诸药杂投病势益增，当事者都怀疑恐惧无措，我却认为是虚症，力主大补之剂。大概平时脉弦洪兼数，且右手更旺，现在转数成迟，左手更觉无根，这是至虚有盛候，凭脉合症的良法。急煎理中汤加陈皮、半夏与服。这样胃气充肺，元阳流动，总有蓄积盘踞一方，定然向风自化。果然一剂后稍安，数剂后全愈。
慈溪天生杨先生，在江湾镇教书，时值盛暑，壮热头痛，神昏发斑，狂乱不畏水火，数人看守，犹难禁止，甚至舌黑刺高，环口青暗，气促眼红，谵语直视，迎我前往诊治。我看见众人环绕，蒸汗如雨，病狂躁无有休息，寻衣摸床，正在危候。强按诊脉，幸尚未散，急取筷子头缠绵，用新汲水撬开口，凿去芒刺，即以西瓜与之，犹能下咽。于是用大桶置凉水，并洒湿中间空地，设席于地，扶患者卧上，再用青布丈许，折作数层，浸湿搭在心间，便能云顿入清凉世界六字，语虽模糊，亦为吉兆。遂用大剂白虎汤与服，加黄芩、山栀、元参。半日之间狂奔乱走，目无交睫，此药入口，熟睡如泥。乡人尽曰休矣。我说这是胃和而睡着也，不可惊觉。自日中至半夜方苏，其病遂愈。
吴明初，平素体弱，因年来忧郁，忽然呕血，自早至暮百余碗，两目紧闭，四肢畏寒，冷汗如注，汤药入口，随即吐出，举族惊狂，迎我视之。幸病虽为急，脉尚未散，喘促犹缓，一线生机，尚可挽回，若以血药投治则不及矣。盖初则血随气上，今则气随血脱。语云：有形之血不能速生，几微之气在所急固。此阳生阴长之道，寓诸《灵素》扶阳抑阴之权，具于羲易。诚以阳者生之本，阴者死之基，故充塞四大，温润肌肉，皆赖此阳气耳。今脉气虚微，天真衰败也；汗雨不收，卫气散失也；四肢畏冷，虚阳不能旁达也；两目紧闭，元神不能上注也；药入即吐，继之以血者，乃呕伤胃脘，守荣之血不藏也。为再用汤药，恐激动其吐，宜设计以取之。遂用人参一两，白芨四钱，均为细末，米饮调丸如樱桃大，含化。自黄昏至一更，约用一半，汤饮方通，血亦不吐。至明日神思稍清，脉气未静，似芤似革，参互不调，全无胃气，尽属阴亡于中，阳散于外之象。乃速煎参附进之，以追散失之元阳。八日内记服人参二斤，附子五枚，而元气顿充，脉始收敛，至今强健倍常。倘此时稍有疑虑，徒任浅剂，焉能挽回其真气耶。
上海邑尊陈虞门的幕宾，吐血不已，或用犀角地黄汤降火，或以加味四物汤滋阴，绝谷数日，气喘随毙，延家君诊治。六脉虚弱，精神怠倦，明属思虑过度，脾元亏损。所以气衰则火旺，火旺则血沸而上溢也；血脱则气孤，气孤则胃闭而绝谷也。法当甘以悦脾，温以启胃，甘温相济，脾胃调和。庶元阳得以扶持，气血有所生长耳。遂用四物汤加米仁、石斛、麦冬、五味子、广陈皮、桔梗，数剂而愈。
吴淞一女，在闺时患左眼上胞内生疙瘩，日渐长大，下垂遮目，红肿重坠，痛楚异常。专科者始以驱风治标，继以养血治本，迁延岁月未获稍减。我诊其脉，左关弦强搏指，右关艰涩。我说：目廓应肝，内轮应脾，肝脾二脏性喜疏利，故忧思伤脾则气结而血瘀，恚怒伤肝则气郁而热生。由是火炎血沸，上腾空窍，目廓积闭，火旺赤肿也，治宜疏中宫之滞，泻东方之实，则郁开火降，瘀化肿消耳，用龙胆泻肝汤数帖，疙瘩渐消，复以六味丸料加龙胆草、白蒺藜、决明子、牡蛎，与滋阴之中兼以清火之品，逾日而平复。
周文伯，乡居课农，偶发寒热，解表一剂，转觉神思恍惚，日增倦怠，目呆如愚，语言错乱，昼夜呻吟，六脉微弱，不堪重按。我说：这个病症的原因，必有大惊，损伤神气，故现神鬼飞越之象。大概神藏于心，心主镇静；魂藏于肝，肝主惊骇。故惊则气乱，心失镇静之常，神气孤浮，邪入神明之窟。由是魂无安宅，飘荡于外。若能安神益气固守飞扬之真，自然魂随神摄可复清明之职。丹书所谓神是性兮气是命，神不外驰气自定者也。遂服归脾汤数帖灵动如初。自述病概缘溪头失足，从高坠下，遂觉神气越出，精采不定，作见游魂，须眉状貌，酷肖已身，约长尺许，或从空行走，或相依同寝，所谓魂离吾体断不诬矣。自后稍有震怒惊呆复作，屡用前方获效。后迁于城，道逢形人，因而受惊，至晚忽大呼杀人，举家骇异，议用前药。值余适至，复诊其脉弦强搏指较前大异，此正虚祟乘之病，非从前神脱魂离者比也。治当清痰降火，祟是不作。若用参耆胶固邪气，将成痼疾矣。乃以温胆汤加苏子、黄芩、山栀、瓜蒌，服即熟睡，醒来诸病如失，但觉倦怠。乃淡粥调养数日后，仍服归脾汤而全愈，则知鬼岂真鬼耶。
萎江金公采谋，秋患痢昼夜百余次，赤脓腥秽，呕恶不食，口渴发热，向用滞下法竟难奏效。忽冷汗不止，四肢如冰，气促神昏，延我往治。外证虽逆，六脉尚存，乃煎附子理中汤。服二剂，四肢渐温，自汗渐收。又服数帖，精神充旺，痢下顿除。若抱痢之赤白，口渴身热，再投凉药，气将脱矣。故曰泻虚朴实，神失其室，此之谓也。
淮右章公克，壬寅春客游海邑，患温病发热，邪气再传，壮热神昏,濈濈自汗，眼红面赤，口渴舌黑，胸膈满闷，势甚危殆。医者泛用清热轻剂以冀幸免，我说：春温之温邪，伏藏于冬，触发于春，随天气化，寒郁为热，此时令之热也。脉来洪大，舌黑口于，灼热汗流，神思昏喷，此脉症之热也。当速煎甘寒大剂清彻里邪，庶不使胃热腐化。若徒任芩连诸药，恐一杯之水难救车薪之火，热必自焚矣。立方用石膏五钱，麦冬二钱，知母花粉各一钱五分，山栀一钱，甘草五分，加竹叶粳米灯心为引，二剂而神爽热除。
大名司理陈玉山，素患胸膈胀闷，四肢顽麻，六脉坚劲，似芤类革，咸属冲和虚损清阳散耗之症，用六君子汤加益智、肉桂以培脾，并进金匮肾气丸一料，已获稍安。至丙午春偶遭奇讼，恚怒不舒，胸膈否塞，右胁胀痛，下便瘀血，上增呕恶，粒米不进者二十余日，六脉顿退，重按豁然。我说：脉为神机，神为气立，全赖胃气充沛者也。今脉息无神则知郁结伤脾，脾病传胃，俾磅礴浩大之气停留郁滞于中，所以胃脘否满者，脾土中州也。右胁胀痛者坤出西南也。况木虽条达依土为生，土既硗薄木无生长，此物理中之常耳。故郁怒太过，不但重损脾阴，而肝亦自病，所以不能藏血而血瘀，血去而阴伤，阴伤则阳无以自主，将有飞越之虞也。速宜培养元神，不使涣散，乃可万全。遂用附子理中汤数帖，食能渐进，后用六君子汤兼八味丸而安。
文学包说：我因吃螃蟹腹痛，发作时厥逆；过了一个月不好，请我商量。叙述之前服平胃二陈，继服姜桂理中，不但无效反增胀痛。我说：痛非一端，治亦各异。感寒者绵绵无间，因热者作止不常，二者判若霄壤。您的病痛势有时，脉带沉数，其为火郁无疑。虽因吃螃蟹，然而寒久成热，火郁于中，热郁似寒，厥冷于外。这是始末传变之道，明训可考。奈何执泥虚寒，漫投刚剂，是以火济火，求愈岂不难哉。以四逆散加酒炒黄连一剂而愈。
《旧德堂医案》终
Qin Zhizhi of Shanghai Yanghang (foreign concession), due to excessive labor and sexual indulgence, experienced numbness in his left foot every time it rained or was cloudy. The pain was indescribable. He visited many famous doctors, who either prescribed blood-nourishing or qi-tonifying remedies. His condition fluctuated but never fully resolved. In the spring of the Wuxu year, the disease worsened significantly; his legs became stiff and unable to move freely, and a patch on his back remained numb. He then sought my treatment. His left pulse was deep and tight, and his right pulse was deep and choppy. This indicated that wind, dampness, and cold pathogens had mixed and invaded, resulting in Bi syndrome (obstruction syndrome). When wind is predominant, it is called Moving Bi; when cold is predominant, it is called Painful Bi; when dampness is predominant, it is called Fixed Bi. Fixed Bi refers specifically to numbness. Clearly, this was caused by dampness pathogen, with internal phlegm and qi stagnation condensing and obstructing flow, leading to Fixed Bi. It was necessary to use formulas that ventilate and dry dampness, combined with guiding herbs to direct the medicinal action to the feet and knees, so that dampness and phlegm would dissipate and the great Qi could circulate freely. The prescription consisted of Huangqi (Astragali Radix), Cangzhu (Atractylodis Rhizoma), Guizhi (Cinnamomi Ramulus), Banxia (Pinelliae Rhizoma), Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Fangji (Stephaniae Tetrandrae Radix), and Weilingshen (Clematidis Radix et Rhizoma). After several doses, he recovered. If one were to administer Renshen (Ginseng Radix) and Huangqi daily simply because of his history of overwork and indulgence, it would cause obstruction in the collaterals, preventing the expulsion of external pathogens and thus failing to cure the disease.
Chen Su'an, Grand Secretary of Haining, suffered from swelling and pain in his feet. Blood-nourishing medicines exacerbated the swelling, while qi-tonifying medicines intensified the pain. My father was invited to treat him. Upon palpation, the pulse was soft with slippery Qi characteristics, indicating that damp-phlegm was flowing into the lower Jiao. This was an excess syndrome, definitely not deficiency. Nourishing Yin would further stagnate and sink the Yang Qi, while tonifying Yang would cause the collaterals to become glued and obstructed, which explained why the condition worsened. A prescription of Chenpi (Citri Reticulatae Pericarpium), Fuling (Poria), Banxia (Pinelliae Rhizoma), Duhuo (Angelicae Pubescentis Radix), Cangzhu (Atractylodis Rhizoma), Houpo (Magnoliae Officinalis Cortex), Jiegeng (Platycodonis Radix), and Lingxian (Spatholobi Caulis) was used. After two doses, the pain subsided and the swelling disappeared. Thus, the disaster of "making the deficient more deficient" is widely cautioned against by the world, yet people often fall into the trap of "making the excess more excess." If one merely adheres to nourishing and tonifying methods, they fail to understand the principles of root versus branch, urgency versus delay, and pathogenic factor versus healthy Qi, and their deficiency versus excess. How can such individuals discuss medical Dao? Therefore, Zhang Congzheng (Zihe) established laws focusing primarily on expelling pathogens, truly fearing the disasters of tonifying excess, aiming to correct the abuses of later generations.
The son of Scholar Wang Yushan from Wan Cheng suffered from incomplete lochia discharge after taking Renshen (Ginseng Radix) and Huangqi (Astragali Radix) too early postpartum. Additionally, due to extreme anger, he developed abdominal distension (Gu Zhang), with green veins encircling the abdomen and the Shenque acupoint protruding. I was invited to consult on the treatment. The pulses on the left hand were all wiry and forceful, becoming choppy upon heavy pressure, while the right hand pulse was surging and slippery. This indicated blood stasis accumulating in the lower Jiao, caused by anger injuring the Liver. Generally, symptoms of blood accumulation involve hardness in the lower abdomen with tenderness upon pressure, and clear, long urination. Symptoms of Spleen deficiency involve softness of the large abdomen with no pain upon heavy pressure, and obstructed, difficult urination. By distinguishing these, deficiency and excess are clearly differentiated. Mr. Wang said: "This condition is undoubtedly due to stagnant blood. Previous treatments blurred the pulse patterns and indiscriminately administered medicines, thereby increasing pain and distension. Now, listening to your detailed analysis, it is as clear as fire. I am grateful for your prescription." I prescribed Guishao (Rosae Rugosae Radix), Chishao (Paeoniae Radix Rubra), Xiangfu (Cyperi Rhizoma), Qingpi (Citri Reticulatae Pericarpium Viride), Zelan (Leonuri Herba), Houpo (Magnoliae Officinalis Cortex), Zhishi (Aurantii Fructus Immaturus), Rougui (Cinnamomi Cortex), and Yuanhu (Corydalis Rhizoma), added with fresh ginger. Intermittently, Huajiaoren Wan (Sparganii Granules) was administered. After three doses, within a few days, the pain and distension completely resolved.
Zhang Shichuan suffered from Spleen diarrhea for years. Having tried various decoctions, his muscles wasted away, and his urine dried up, putting him in critical condition. I went to examine him. The left pulse was wiry and thin, and the right pulse was deficient and faint. This indicated that Upper Yang (Qi of Heaven/Lungs) failed to circulate, and Lower Yin (Earth/Spleen) lacked authority, causing Spleen injury and muscle wasting. Lung deficiency led to disordered Qi transformation, preventing turbid Yin from descending and causing stagnation in the intestines and stomach. Clear Yang failed to ascend and instead descended to invade the Kidney and Liver, damaging the Three Yin meridians and resulting in chronic diarrhea. Furthermore, during the forty-year cycle where ascending Yang Qi and turbid Yin commands are balanced, Mr. Shichuan, now over fifty, should have had his sunken Yang lifted. Instead, using diuretic and draining methods missed the essence of treating the root. Moreover, prolonged diarrhea consumes Yin, and there is no case of chronic diarrhea without Kidney deficiency. Simply tonifying the Spleen would be too slow to achieve results. It was necessary to use warming agents for the Lower Jiao to assist the Spleen. When the Fire of the Dantian flares, the Spleen Earth warms naturally. When the Central Pivot moves vigorously, harmonious Qi distributes. Essence and Qi are sent upward to support the Metal (Lungs) and downward to the Bladder, separating clear from turbid, thus harmonizing urination and defecation, allowing for quick recovery. The formula included Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Huangqi (Astragali Radix), Zhigancao (Glycyrrhizae Radix et Rhizoma Preparatum), Guangpi (Citri Reticulatae Pericarpium), Muxiang (Aucklandiae Radix), Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Rouguo (Myristicae Semen), and Buguzhi (Psoraleae Fructus). After several doses, his urination became solid. Later, Six God Pill (Sishen Wan) with roasted Muxiang was used for regulation, ensuring stability.
My father treated Madam Fu, wife of Grand Tutor Ji An of Jiangyou, who suffered from chronic diarrhea. Her pulse was slow and faint; faint indicates Yang decline, and slow indicates Yin excess. This was Spleen Earth deficiency with true Yang decline. Generally, Spleen deficiency requires tonifying the Middle to strengthen Earth, and Yang decline requires warming the Middle to dispel cold. He prescribed Si Jun Zi Tang (Four Gentlemen Decoction) with Ganjiang (Zingiberis Rhizoma) and Rougui (Cinnamomi Cortex). After two doses, chills persisted, and diarrhea did not decrease. It was realized that the issue was not just weak Yang within the Earth, but the Fire within Water failing to ascend. It was necessary to assist the mild Fire Qi to steam upward to the Spleen to control Spleen dampness. Thus, Renshen (Ginseng Radix) 3 qian, Baizhu (Atractylodis Macrocephalae Rhizoma) 5 qian, Rougui (Cinnamomi Cortex) 1 qian, and Fuzi (Aconiti Lateralis Radix Preparata) 1 qian were used. After several doses, she gradually improved, and later Eight Flavor Pill (Bawei Wan) was used for maintenance.
Tang Cizhong from Chunyuan suffered from stabbing pain around the lower abdomen and umbilicus, radiating to the hypochondrium and chest, causing restlessness. I palpated six wiry and slippery pulses, becoming choppy upon heavy pressure. This was caused by anger after eating, filling the Taiyin with cold, leading to Liver Qi stagnation and discomfort, causing chest distress and pain. The Classic states: "When Wood is stagnant, ventilate it." Resolving the stagnation stops the pain. Er Chen Tang (Two-Cured Decoction) combined with Ping Wei San (Peace the Stomach Powder) plus Zhike (Aurantii Fructus) and Muxiang (Aucklandiae Radix) cured him in one dose.
Luo Mingqiu from Moling, while urging tax collection, contracted wind-cold. He had fever, aversion to cold, headache, and body ache. After seven days, it transformed into Warm Malaria. During attacks, he was extremely terrified, saw ghosts at dusk, and felt dozens of figures like two-year-old children wrapping around his waist, causing unbearable fear until evening when they dispersed. He had already had five or six attacks. Other physicians diagnosed it as Ghost Malaria and discussed using malaria-intercepting methods but hesitated. I was invited to examine him. The six pulses were surging and slippery. I said: "This is internal accumulation of phlegm-saliva, not genuine evil spirits invading externally." As the old saying goes: "No phlegm, no malaria," and "Strange diseases often belong to phlegm." Phlegm is transformed from fluids, and fluids are governed by the Kidneys. Normally, if Kidney Water is weak, deficient Fire flares alone, boiling essence and fluids into phlegm, attacking collaterals and forming the root of malaria. Since the waist belongs to the Kidneys, fluid transforming into phlegm is undeniable. Only by first driving out the phlegm, waiting for the phlegm to leave so the ghost malaria disappears, and then tonifying the root, is it appropriate. Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Fuling (Poria), Zhike (Aurantii Fructus), and Binglang (Arecae Semen) was used. Before taking it, 3 qian of Yuán Míng Fěn (Sal Nitri) was mixed in. Within moments, bowel movements became loose, and phlegm accumulated rapidly expelled. By the next day, the ghost malaria was gone.
Kong Taishi from Jurong, an envoy accompanying the court, would inexplicably see ghosts after noon, feeling fearful and lethargic, with fever at midnight and waking only at dawn. Physicians used calming spirit and nourishing blood medicines, followed by phlegm-resolving and wind-dispersing agents, all ineffective. My father was invited to examine him. Both hands showed slippery and rapid pulses. This was due to alcohol indulgence; alcohol generates dampness, dampness aids fire, and fire-dampness combine to form phlegm. Phlegm confusing the Heart orifice causes ghost visions. Ju Hong (Citri Reticulatae Pericarpium), Beimu (Fritillariae Bulbus), Tianhuafen (Trichosanthis Radix), Shichangpu (Acori Tatarinowii Rhizoma), Huangqin (Scutellariae Radix), Maidong (Ophiopogonis Radix), Shanzhi (Gardeniae Fructus), Zhuru (Bambusae Caulis in Taenia), and Kudingcha (Ilicis Kudingcha Folium) were used. After two doses, clarity returned and ghosts vanished; after four doses, he recovered completely.
Hu Wenze's son, previously frail, suddenly suffered severe abdominal colic after eating in late summer. He thought it was heatstroke and took Tianshui San (Heavenly Water Powder) without relief. Suspecting food stagnation, he drank Hawthorn and Malt soup, which increased the pain. He fainted, lost consciousness, with no respite. The Zhongwan point was hard and painful, intolerable to touch. His eyes rolled back, tongue retracted, and he spoke deliriously, appearing possessed. Physicians were consulted. Some suggested Zhishi (Aurantii Fructus Immaturus) and Houpo (Magnoliae Officinalis Cortex) for constipation; others suggested Huangqin (Scutellariae Radix) and Lianhua (Coptidis Rhizoma) for heat-stagnation. Various medicines were mixed, worsening the condition. The family was terrified, but I identified it as a deficiency syndrome and strongly advocated for major tonification. His usual pulse was wiry, surging, and rapid, stronger on the right. Now it turned slow and weak, especially on the left, lacking root. This is "extreme deficiency presenting with excess signs," a good method of combining pulse and symptom analysis. I urgently decocted Lizhong Tang (Regulate the Middle Decoction) with Chenpi (Citri Reticulatae Pericarpium) and Banxia (Pinelliae Rhizoma). This would fill Stomach Qi, activate Primordial Yang, and allow any accumulated pathogens to dissolve naturally. Indeed, after one dose he stabilized, and after several doses he fully recovered.
Mr. Tiansheng from Cixi, teaching in Jiangwan Town, suffered from high fever, headache, confusion, macules, mania, indifference to fire and water, requiring several people to restrain him. His tongue was black with prickles, perioral area dark blue, breathing rapid, eyes red, delirious with fixed gaze. I was summoned. Seeing the crowd surrounding him, sweating profusely, restless, picking at clothes and bedrails, he was in critical condition. I forced a pulse check; fortunately, it had not scattered. I quickly used a chopstick wrapped in cloth, pried open his mouth with new well water, scraped off the tongue prickles, and gave him watermelon, which he swallowed. I placed a large tub of cold water, wetted the ground, laid a mat, and had him lie on it. I folded a long piece of green cloth, soaked it, and placed it on his heart region. He murmured, "Suddenly entering a cool world," a auspicious sign though vague. I prescribed a large dose of Baihu Tang (White Tiger Decoction) plus Huangqin (Scutellariae Radix), Shanzhi (Gardeniae Fructus), and Xuanshen (Scrophulariae Radix). Within half a day, he ran wildly with sleepless eyes. After the medicine entered, he slept soundly. Villagers said he was finished. I said, "This is Stomach harmony leading to sleep; do not wake him." He woke from noon to midnight, and the illness was cured.
Wu Mingchu, usually weak, suffered sudden hematemesis due to years of depression. From morning to evening, he vomited over a hundred bowls. His eyes were tightly shut, limbs cold, cold sweat pouring like rain. Any medicine taken was immediately vomited. The whole clan was panicked. I examined him. Fortunately, although acute, the pulse had not scattered, and panting was still slow. There was a thread of life to save. Using blood-stopping medicines would be too late. Initially, blood followed Qi upward; now, Qi follows Blood loss. As the saying goes: "Formative blood cannot be generated quickly; subtle Qi must be urgently secured." This is the way of Yang generating Yin, contained in the *Lingshu* and *Suwen* regarding supporting Yang and suppressing Yin. Yang is the root of life; Yin is the foundation of death. All four limbs and moistening of muscles rely on this Yang Qi. Now, pulse Qi is deficient and faint, indicating decline of innate truth; uncontrolled sweat indicates dispersion of Defensive Qi; cold limbs indicate deficient Yang cannot reach extremities; closed eyes indicate Primordial Spirit cannot ascend; vomiting medicine followed by blood indicates Stomach injury and failure of Nutritive Blood to store. To avoid agitating vomiting with decoctions, I designed pills. One liang of Renshen (Ginseng Radix) and 4 qian of Baiji (Bletillae Rhizoma) were powdered, formed into cherry-sized pills with rice water, and dissolved in the mouth. By the first watch, half was consumed, digestion resumed, and bleeding stopped. The next day, mind cleared slightly, but pulse was empty and tense, irregular, lacking Stomach Qi, showing Yin collapse internally and Yang dispersion externally. I quickly decocted Shenfu Tang (Ginseng and Aconite Decoction) to retrieve dispersed Primordial Yang. Within eight days, he consumed two jin of Renshen and five Fuzi (Aconiti Lateralis Radix Preparata). Vitality instantly filled, pulse converged, and he remains twice as strong as usual. Had there been doubt then, using mild doses, how could true Qi be saved?
Chen Yumen's guest scholar in Shanghai suffered from persistent hematemesis. Others used Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) to descend fire, or Jiawei Siwu Tang (Modified Four Substances Decoction) to nourish Yin. After fasting for days, he gasped and died. My father was invited to treat. The six pulses were weak, spirit listless, clearly due to excessive worry and Spleen Yuan damage. Thus, Qi decline leads to Fire flaring, Fire flaring boils Blood causing upward overflow; Blood loss leaves Qi isolated, Qi isolation closes Stomach causing fasting. The method should be sweet to please the Spleen, warm to open the Stomach, sweet and warm complementing each other to harmonize Spleen and Stomach. Thus, Primordial Yang is supported, and Qi and Blood grow. Siwu Tang (Four Substances Decoction) plus Yiyiren (Coicis Semen), Shihu (Dendrobii Caulis), Maidong (Ophiopogonis Radix), Wuweizi (Schisandrae Fructus), Guangpi (Citri Reticulatae Pericarpium), and Jiegeng (Platycodonis Radix) cured him in several doses.
A young woman from Wusong suffered from a lump inside the upper eyelid of her left eye since girlhood. It grew daily, drooping to cover the eye, red, swollen, heavy, and extremely painful. Specialists first treated the branch with wind-dispelling, then the root with blood-nourishing, delaying for years without improvement. I palpated the left Guan pulse as wiry, strong, and beating against the finger; the right Guan pulse was difficult and choppy. I said: "The outer eye corresponds to the Liver, the inner wheel to the Spleen. Liver and Spleen prefer free flow. Worry injures Spleen, knotting Qi and stasis Blood; anger injures Liver, stagnating Qi and generating Heat. Thus, Fire flares, Blood boils, rising to empty orifices, closing the eye shell, causing redness and swelling from Fire excess. Treatment should clear Middle Palace stagnation and drain Eastern Excess. Then stagnation opens, Fire descends, stasis resolves, and swelling disappears." Longdan Xiegan Tang (Gentian Liver-Draining Decoction) for several doses reduced the lump. Then Liuwei Wan (Six-Ingredient Pill) material plus Longdancao (Gentianae Radix), Bjlili (Tribuli Fructus), Juemingzi (Cassiae Semen), and Muli (Concha Ostreae) was used, combining Yin-nourishing with Fire-clearing. She recovered the next day.
Zhou Wenbo, a farmer living in the countryside, occasionally had chills and fever. After one dose of exterior-releasing medicine, he became confused, increasingly fatigued, eyes dull, speech disordered, groaning day and night. Six pulses were weak and unfelt under heavy pressure. I said: "The cause must be great fright, damaging Spirit Qi, hence the image of flying spirits and ghosts. Spirit resides in the Heart, which governs calmness; Soul resides in the Liver, which governs fright. Fright disorders Qi, Heart loses calmness, Spirit Qi floats alone, evil enters the mansion of Spirit. Thus, Soul has no home, wandering outside. If one calms Spirit, benefits Qi, and guards the floating True Qi, naturally the Soul returns with Spirit, restoring clarity." Dan Shu says: "Spirit is Nature, Qi is Life; if Spirit does not wander, Qi settles." He took Guipi Tang (Restore the Spleen Decoction) for several doses and regained agility. He recounted falling from a stream bank, feeling Spirit escape, seeing a wandering soul resembling himself, about a chi tall, walking in air or sleeping together. This confirms Soul leaving the body. Later, slight anger or fright caused recurrence, responding to previous prescriptions. After moving to the city, he was startled by a figure on the road, shouting "Murderer!" at night. Family feared, planned to use previous meds. I arrived, palpated wiry-strong pulse, very different from before. This was Right Deficiency with Evil趁 (taking advantage), not the previous Spirit departure/Soul separation. Treatment should clear phlegm and descend Fire; Evil will cease. Using Renshen/Huangqi would glue pathogens, becoming chronic. Wendan Tang (Warm Gallbladder Decoction) plus Suzi (Perillae Fructus), Huangqin (Scutellariae Radix), Shanzhi (Gardeniae Fructus), and Gualou (Trichosanthis Fructus) made him sleep deeply. Waking, all symptoms vanished, only fatigue remained. Light porridge for days, then Guipi Tang again for full recovery. Thus, are ghosts really ghosts?
Jin Gongcai from Weijiang suffered from dysentery in autumn, over a hundred times day and night, with red pus, foul odor, nausea, anorexia, thirst, and fever. Previous dysentery methods failed. Suddenly, cold sweat poured, limbs ice-cold, shortness of breath, coma. I was summoned. Although external signs were adverse, six pulses remained. I decocted Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction). After two doses, limbs warmed, spontaneous sweating stopped. After several more doses, spirit revived, dysentery ceased. If one continues cooling medicines for red/white dysentery with thirst and fever, Qi will collapse. Hence, "Emptying deficiency and solidifying reality causes Spirit to lose its chamber," this is what it means.
Zhang Ke from Huaiyou, traveling in Haiyi in spring Renyin year, suffered from Warm Disease fever. Pathogen transmitted twice, high fever, coma, continuous sweating, red eyes and face, thirst, black tongue, chest oppression, critical condition. Physicians used light clearing-heat agents hoping for luck. I said: "Spring Warmth pathogen hides in Winter, triggered in Spring, transforms with weather. Cold stagnates into Heat, this is seasonal Heat. Pulse surging-large, tongue black, mouth dry, burning sweat, confused spirit—this is pulse/symptom Heat. Must quickly decoct large sweet-cold dose to clear interior pathogens, lest Stomach Heat rot. Merely using Huangqin/Lianhua might be like a cup of water saving a cartload of burning wood; Heat will self-combust." Formula: Shigao (Gypsum Fibrosum) 5 qian, Maidong (Ophiopogonis Radix) 2 qian, Zhimu (Anemarrhenae Rhizoma) and Huafen (Trichosanthis Radix) 1.5 qian each, Shanzhi (Gardeniae Fructus) 1 qian, Gancao (Glycyrrhizae Radix) 0.5 qian, plus Zhuye (Phyllostachys Folium), Jingmi (Oryzae Semen), and Dengxincao (Junci Medulla) as guides. Two doses cleared spirit and heat.
Chen Yushan, Judicial Administrator of Daming, always suffered from chest/diaphragm fullness and limb numbness. Six pulses firm and strong, resembling Kou or Ge pulses, all indicating depletion of Harmonious Qi and scattering of Clear Yang. Liujunzi Tang (Six Gentlemen Decoction) plus Yizhi (Alpiniae Oxyphyllae Fructus) and Rougui (Cinnamomi Cortex) cultivated Spleen; Jin Gui Shenqi Wan (Golden Cabinet Kidney Qi Pill) was taken, gaining slight relief. In spring Bingwu year, involved in a strange lawsuit, angry and frustrated, chest blocked, right hypochondrium painful/swollen, bloody stool, vomiting bile, unable to eat for 20+ days. Six pulses suddenly retreated, hollow upon heavy pressure. I said: "Pulse is Spirit mechanism, Spirit stands on Qi, relying entirely on abundant Stomach Qi. Now pulse lacks Spirit, knowing stagnation injured Spleen, Spleen disease transmitted to Stomach, causing vast Qi to stagnate in middle, hence gastric fullness (Spleen Earth central pivot). Right hypochondrium pain relates to Kun (Southwest). Although Wood spreads relying on Earth for growth, if Earth is barren, Wood cannot grow, this is natural law. Thus, excessive anger not only severely damages Spleen Yin but also injures Liver, failing to store Blood, causing stasis. Blood loss injures Yin, Yin injury leaves Yang without master, risking flight. Quickly cultivate Primordial Spirit, prevent dispersion, then safe." Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction) for several doses allowed gradual eating. Later, Liujunzi Tang combined with Bawei Wan ensured peace.
Literati Bao said: I suffered abdominal pain after eating crabs, with厥逆 (reversal cold) during attacks. Unresolved for a month, I consulted you. I described taking Pingwei San (Peace the Stomach Powder) and Er Chen Tang (Two-Cured Decoction), then Jianggui Lizhong (Ginger-Cinnamon Regulate the Middle), but instead of relief, pain increased. I said: "Pain has many causes, treatments vary. Cold-induced pain is continuous; Heat-induced pain comes and goes. They are worlds apart. Your pain is intermittent, pulse deep-rapid, undoubtedly Fire Stagnation. Though caused by crab, cold long becomes heat, Fire stagnates inside, Heat stagnation mimics cold, causing external reversal cold. This is transmission logic, verifiable by clear teachings. Why cling to deficiency-cold and blindly administer hot agents? Using Fire to aid Fire, how can healing be easy?" Sini San (Four Counterflow Powder) plus wine-fried Huanglian (Coptidis Rhizoma) cured him in one dose.
End of *Jiude Tang Medical Cases*