又见其治周姓予，面赤大汗，神昏谵语，或以为邪入心包，君谓呼之神清，左才不数，右关浮滑数，此白虎证也，误用清心丸、至宝丹则反领邪入内矣。嘉年之侄孙女，午九岁，幼居北地，曹种牛痘，今患似疹者累累，君谓此天花也，乃从前余毒未净，北地高寒．蓄而不泄，今南来，感时气而发，虽云痘出五脏，古法用温，然今乃热毒伤阴，断难泥古，用解毒养阴药而痊。
静章两子相戏，伤长者，胸痛甚，静章以为伤也．君视之曰"非是。"适感时气，气阻胸膈耳，用疏表气分而愈。设投行血消瘀之剂，误矣。他如溥孙之患类中风，人龙内予之患大头风，盛年之子女，子妇孙辈患各症，无不药到病除。此外目击其治验，更指不胜屈，姑就嘉年等熟人赖其治愈者，略述一二，为之表彰，以鸣谢忱。邹嘉年、潘盛年、冯廷韶。孙文诒，金国桢、顾元基、彭溥孙、潘静幸、彭诚保，钱人龙、刘家怡．汪承豫同启。
肝气为湿热所遏 痘不化浆
虞师涅邃于医而不行道，见沪上二医之谬，著XXX、XXX是名医而非庸医辨，余因其于医道有所裨益，故录之。其辨云：友人告余曰："XXX治许妪，肝气为湿热所遏，理宜辛温以舒肝郁，苦寒以清湿热。"某医案云"木火内寄，脾胃受侮，升降矢司，以致胁痛、痰多、神疲．嗜卧、苔黄，脉细弦滑数。"而药则用旋复花、海浮石、杏仁、象贝、杷叶等肺家药为多，方案不符，未识何故?
陈君有女患痘，点已齐备而未化浆，考浆之不化，其因有二：一则毒气炽盛，血燥而凝，不能运化成浆，法宜清血化毒；一则元气虚弱，血寒而滞，亦不能运化成浆，法宜温补内托。延XXX诊治，其案明云。痘点齐而浆未化"，乃药则用[皂]角针、笋尖、大力子等攻透之品，亦方案不符，未识何故?余曰："此其所以为名医也。"夫所谓名医者，联络同道，互相标榜，延必厚值，出必高车，一病幸中，便侈然自誉，罔顾匿笑于旁观，是不务其实而务其名也，吾故曰名医也。至于庸者，平庸之谓，虽不能杰出寻常，而犹不至谬妄陋劣。其头痛医头，脚痛医脚，而莫明其所以然，故或愈或否，重为世诟，然何至自相矛盾，方案不符耶，是则若辈并不获在干庸之列，吾故曰非庸医也。夫夏桀殷纣，茶毒生灵，二医殆其苗裔．故草管人命，以致于此。仆将辑其谬方谬案，指摘驳辩，刊以问世，名之曰哎伐罪编]，庶几人知其谬，而枉死者鲜，当亦慈善之一端，虽然世俗骄奢，人心浇薄，天道福善而祸淫，水劫，火劫、兵劫、疫劫之未已，而更加以"医劫"，是天意也，于二医乎何尤?
神昏谵语
前论神昏谵语，义有未尽，因再言之。此证并非无属心包络者，但不专厉渚心包络耳。其属诸心包络者，病在上焦，叶天士云："舌色纯绛鲜泽者，胞络受邪。"吴鞠通云："夜寐不安，烦渴舌赤，暑入手厥阴也。"又云"舌白滑者，不可与也，心为君主，义不受邪，邪入即死，包络与心相附，居隔上，代君行事，臣使之官，其能受邪者，胞络也。"凡古今方书所言心病者，皆包络病也，故真心痛者不冶。包络受病，与心相邻，症已危险。色绛厉心，故叶天士以舌色纯绛鲜泽为候，吴鞠通以舌赤为候，复申其诫曰舌白滑者，不可与。又云"色绛而舌中心或黄或白者，此非血分，乃上焦气热烁津也。"其辨明绛而中心黄、白者，非血分病，正恐人误作心包络病治之耳。可见叶，吴辈于神昏谵语症，苟遇舌苔黄、白者，亦并不以牛黄丸，至宝丹等治之，既不以牛黄丸，至宝丹为治，岂遂别无治法，我于此知叶先生时，必然世多以治胃治肝者疗神昏谵语，绝不知温邪有袭入心包络症。爰著《温热论》以救其失，乃近今医家，不复博览群书，细辨病症，手一卷《温热论》、《温病条辨》、《温热经纬》，遂以为道尽于是，而其于"不可与"之诫，全未细察，叶、吴辈岂任咎哉！
肿胀后昏厥 热病经来
肝藏血而主疏泄，故阴虚火旺之体，每有水不涵木，木火内炽，血不能藏，失其疏泄之常，而月经先期而至，或因热病而未期骤至者，此须凉肝凉血为要。经初至一日，或有瘀积，可用凉血而动血者，如丹皮之辛以流动之，丹参之下行以畅达之，二药性虽寒凉，决不至凝涩不行。医家辄用桃仁、红花、泽兰等温剂，谓寒凉则血凝滞，不知此盖指苦寒而味不辛、性不下行者而言；设热病而用温剂以助热，害不胜言；经将净时，则并此二药亦不可用，须白薇、紫草，生地等凉血而不动血者治之矣。昔治张绍庭景羲女，骤然昏厥，至三时之久，绍庭见昏厥，即来延余，余适出诊松江，又延叶晋叔君，叶亦适他出，绍庭惶急万状，知余三钟返，在寓守候。余归，即同往，犹未醒也，面青，脉伏，四肢逆冷，但知其体肥有痰，月经先期而至，先患肿胀，是肝厥耳，为寒为热不得而知之。余甚踌躇，其时牙犹紧闭，姑用箸强汗之，略露一缝，窥见舌边尖碎烂，乃知为心肝两经血分之热．病亟不及详列脉案，因嘱先以紫雪(丹)开之，俟其稍醒，以犀角、羚羊角磨竹沥等频灌之，半时即醒．乃继之以方药，而列脉案如右：初病肿胀，胀属肝，肿属脾，木强土弱，木强则生火，土弱则聚湿，湿为火烁，则凝而为痰，火热盛而动风，则手足抽搦，肝阳为痰湿所遏，郁而暴发，挟痰以上升，则发厥，上蒙清窍，则神昏，今窍已开，神识已清，但两手脉皆沉伏不见．名曰伏匿脉，乃热深蹶深之候，慎防再厥再昏。此际痰火未平，亟宜清降，舌尖碎，心热也，舌边碎，肝热也，由肝及心，心肝皆属血，宜清血分之热，肝主疏泄，故经期反先时而至，但用辛凉以清血，勿嫌其性寒阻经也，药为青黛拌石决明二两，竹卷心三钱，大丹参三钱，西赤芍五钱，粉丹皮二钱，水炒竹茹三钱后下，嫩钩藤一钱五分，冲入鲜竹沥二两，白莱菔汁一杯，枳实汁一匙，连三剂而大愈，厥未再发。又调理肝脾，并肿胀亦尽消。当时颇有以两脉伏经来，訾余用凉者，乃绍庭信余深，不之疑，因录出以告时医之温病经至．而扭于用温通者；热深厥深致脉伏，而误认为虚寒欲脱者。
虚喘
治病用药，可因此悟破，唐立三治其妹，夙苦难产，谓瘦胎饮为阳湖公主作，以奉养之人气必实，耗其气使和平，故易产。今妹形肥，知其气虚，勤针黹久坐，知其下运，于孕五六月。以紫苏饮加补气药与十数帖，得男甚快。同一难产，而有虚实之别，补气之方反从瘦胎方悟出。
又张仲华案云，表热四候，额汗如淋，汗时肤冷，汗收热灼，诊脉虚细。惟尺独滑，舌苔已净，细绎咏证，不在三阳而在三阴，考仲圣有反发热一条，是寒邪深伏少阴阳分，今乃湿温余邪流入少阴阴分，宗其旨，变其法．拟补肾阴泄肾邪．以熟地、枸杞等补之，细辛，丹皮等泄之，一剂而愈．是从寒邪入肾悟出湿温之邪入肾治法。前余诊治王立群嗣母。病喘，询其状，确系肾家之虚喘。而非肺家之实喘，阅前方，系专科女医蔡小香君所开，用咸温重镇，甚合肾气不纳治法，惟恩服药何以反甚，既以形瘦尺脉带数也，乃悟其故．因即原方于其蛤蚧，杜仲等之咸温者，易以阿胶、元参之咸寒，于其苏子之温降者，易以白前之寒降，惟旋复、赭石二味未之易，亦即其理以对勘之．即其法以变用之。
剂[剂]字解
读书必先识字，为医亦何独不然。古者造宇之初，义寓于声，剂[剂]从齐[齐]声，即有齐[齐]义，齐者平也，药称剂[剂]者，即虚者补之，实者泻之，热者寒之，寒者温之之旨．故六淫之外因，饮食伤之不内外因，于我身所本无者，则必散之、泻之、消之、下之而后安；七情之内因伤及我身所本有者，则必血亏益以血、气亏益以气而后可。凡所以剂其平也，俗称一剂，日一帖意亦犹是。
淫字解
人身生气通于天，凡风寒暑湿燥火六气，皆与我身脏腑相感应，天地一阴阳五行也，人身亦一阴阳五行也。然则六气皆为生入之具，而非杀人之物，何称之曰六淫?曰。此惟过则为害耳。"淫者，过也。大水曰淫，大雨曰霪，佚荡曰侄，并义寓于声。六气苟不过极，即不得名之曰淫。
取字解
治痿必取阳明，《内经》下一"取"字，大有斟酌。近人多以痿为虚症而用补．或知其多湿热症而用泻。实则痿症虚实皆有，而治法总在乎阳明，故不曰治痿必补阳明，亦不曰治痿必泻阳明，而独曰"取"也，治病不知分经论治，其犹瞽者之挺埴乎。
变字解
《内经》于"肺气虚曰溺色变；少阴司天热淫胜曰溺色变。"释者多以色黄赤言之，实则变者，反乎常也，与寻常溺色有异，即谓之变，如米泔色、败酱色、黑色皆包括在内，不专指黄赤色言。经又云："冬脉不及小便变。阳明司天燥气下陷小便变。"释者亦多以色黄赤言之，此更连癃闭、不禁皆包括在内，不专指黄赤色言，并不专指溺色言，故不曰色变，而仅曰变也。经又曰"中气不足，溲便为之变。"溲为小便，便为大便，此更兼大小便而言，凡二便之异乎常者，一应包括在内。而释者亦多以溺色黄赤言之，得毋挂一漏万耶，实则读书不细耳。至于经云"肝热病者小便先黄；胃气盛溺色黄；厥阴之胜小便黄赤；少阳之胜溺赤。"然则果系色之为黄为赤为兼黄赤者，经固未尝不明言之。
又王孟英《随息居，霍乱论》云："干矢自遗而不觉者，经谓中气不足，溲便为之变，是亦变也。"所谓不足者，非言中气虚也，以中气为病所阻，则不足于降浊升清之职，故溲便为之改常也。赵菊斋谓霍乱之吐泻无度，干霍乱之便秘不行，皆变也、皆中气为病所阻，而不足于降浊升清之职也。设泥不足为虚，则诸霍乱皆当补中气为治矣。余谓王赵以二便释溲便，以二便失常释"变"字，俱得经旨。但以不足于降浊升清释"不足"两字，恐未必确。窃以邪之所凑，其气必虚，是皆因中气本虚，故邪得而干之，有邪即是实，当其邪方盛时，自断无补中之理；及邪之既去，仍宜以补善其后，断未有中气本足，而邪能干之者。然则其标为邪实，其本为正虚，故不足者，不必曲为之解，仍以虚释之，自觉直截了当。
圣人不治已病治未病解
《金匮》云："上工治未病何也?师曰治未病者，见肝之病，知肝传睥，当先实睥，余脏准此。"《不谢方·序》>云："疾甚曰病。"谓人于已疾之后未病之先，即当早为之药。引《说文》"疾病也，病疾加也"为证。两说不同。愚按《内经》云"善治者治皮毛，其次治五脏。治五脏者，半死半生也。以及风寒客于人，使人毫毛毕直，皮肤闭而为热，当是之时，可汗而发也"云云一节，俱可为治未病之根据，以经证经，毫无疑义，故扁鹊治齐桓侯，在腠理、在血脉、在肠胃谓为可治，在骨髓则望而却走，是未病始治，已病则不治也。
内伤解
王孟英述其慈训曰；"内伤证必求其所伤何病，而先治其伤，则病去而元自复。"古人不曰内虚而曰内伤，顾名思义，则纯虚之证殊少也。徐洄溪亦云"大凡人非老死即病死，其无病而虚死者，干不得一。况病去则虚者亦生，病留则实者亦死。"孟英又云尸虽在极虚之人，既病即为虚中有实，然则近今医家，一遇内伤，而专事蛮补者，其亦来明"伤"字之真谛乎。经曰'"不能治其虚，焉问其余。"既云虚矣，犹曰治而不曰补，读书细心者盍昧之?
记诸兄姊妹病故情形
又看到他治疗周姓患者，面色红赤、大汗淋漓、神志昏迷且胡言乱语。有人认为是邪气侵入心包，他认为只要呼唤患者能清醒过来，说明神志未完全丧失；诊脉发现左手寸关尺三部脉象不数（快速），而右关部脉象浮滑且数，这是白虎汤证（阳明经热盛证）。如果误用清心丸、至宝丹等开窍药，反而会引邪深入体内。
嘉年先生的侄孙女，当时九岁，幼时居住在北地，曾经接种牛痘。如今身上长出类似疹子的疮疡很多。先生认为这是天花（痘症），是由于从前余毒未净，北地气候高寒，毒素蓄积而不能发泄，如今来到南方，感受时令之气而发作。虽然古法说痘症出自五脏，古代治疗方法多用温补，但如今这是热毒损伤阴液，绝不能拘泥于古法。于是使用解毒养阴的药物，患者痊愈。
静章的两个儿子互相嬉戏，其中一人伤了年长者，导致胸部剧烈疼痛。静章以为是外伤所致，先生查看后说：“不是外伤。”是因为适逢感受时令之气，气机阻滞在胸膈部位罢了。使用疏解表气分的药物而痊愈。如果投用行血消瘀的药剂，就错了。其他如溥孙患类似中风的病，人龙的内子患大头风（头面红肿热痛的疾病），盛年的子女、儿媳孙辈患各种病症，没有不是药到病除的。此外亲眼目睹其治疗验证的案例，多得指不过来，姑且列举嘉年等熟人赖其治愈的例子，略述一二，以此表彰，表达感谢之情。邹嘉年、潘盛年、冯廷韶、孙文诒、金国桢、顾元基、彭溥孙、潘静章、彭诚保、钱人龙、刘家怡、汪承豫 同启。
肝气被湿热所遏制，痘症不能化浆
虞师涅医术精深但不行医，看到上海两位医生的谬误，撰写了《是名医而非庸医辨》一文，我因为觉得它对医学之道有所裨益，所以记录下来。文中辨析道：朋友告诉我：“XXX治疗许姓老妇，肝气被湿热所遏制，按理应该用辛温药物来舒展肝郁，用苦寒药物来清除湿热。”某医生的医案记载：“木火内寄，脾胃受侮，升降失司，以致胁痛、痰多、神疲、嗜卧、苔黄、脉细弦滑数。”然而用药却多用旋复花、海浮石、杏仁、象贝母、枇杷叶等肺家药物，方案与病情不符，不知是何缘故？
陈君的女儿患痘症，痘点已经齐备但不能化脓成浆。考察痘浆不化的原因，有两个方面：一是毒气炽盛，血液干燥而凝结，不能运化成浆，治法宜清血解毒；二是元气虚弱，血液寒冷而凝滞，也不能运化成浆，治法宜温补内托。延请XXX诊治，他的医案明明写着“痘点齐而浆未化”，然而用药却用皂角针、笋尖、牛大力等攻透的药物，也是方案与病情不符，不知是何缘故？我说：“这就是他们被称为‘名医’的原因。”所谓名医，就是联络同道，互相标榜，求诊必给厚礼，出门必乘高车，一旦碰巧治中一病，便狂妄自夸，不顾旁观者的讥笑，这是不务实际而务虚名，所以我称他们为名医。至于庸医，是指平庸之辈，虽然不能杰出寻常，但还不至于谬妄陋劣。他们头痛医头，脚痛医脚，不明白其中的道理，所以有时治好有时没治好，再次遭到世人诟病，但这又何至于自相矛盾、方案不符呢？这些人甚至够不上庸医的行列，所以我称他们为非庸医。夏桀、殷纣王荼毒生灵，这两位医生大概是他们的后裔，所以草菅人命，以至于此。我将编辑他们的谬误方剂和医案，加以指摘驳辩，刊印问世，命名为《哎伐罪编》，或许能让人知道他们的谬误，使枉死者减少，这也算是慈善的一方面。虽然世俗骄奢，人心浇薄，天道福善祸淫，水劫、火劫、兵劫、疫劫尚未结束，再加上“医劫”，这是天意，对这两位医生又有什么可责怪的呢？
神昏谵语
前面对神昏谵语的论述，义理尚有未尽之处，因此再谈谈这个问题。这个症状并非没有属于心包络的，但不专属于心包络而已。属于心包络的，病位在上焦。叶天士说：“舌色纯绛鲜泽的，是胞络受邪。”吴鞠通说：“夜间睡眠不安，烦躁口渴，舌质红，是暑邪入手厥阴经。”又说：“舌苔白滑的，不可给予清热药。心为君主之官，本不受邪，邪入即死。包络与心相邻，居隔上，代君主行事，是臣使之官，能够受邪的是胞络。”凡是古今方书所说的心病，都是包络的病，所以真心痛是不治之症。包络受病，与心脏相邻，症状已经危险。舌色绛红表明热入心包，所以叶天士以舌色纯绛鲜泽为征候，吴鞠通以舌红为征候，再次告诫说舌苔白滑的，不可给予清热药。又说：“舌色绛而舌中心或黄或白的，这不是血分病，而是上焦气热灼伤津液。”他辨别出舌绛而中心黄、白的，不是血分病，正是担心人们误作心包络病来治疗。可见叶天士、吴鞠通等人对于神昏谵语的症状，如果遇到舌苔黄、白的，也并不用牛黄丸、至宝丹等药物治疗。既然不用牛黄丸、至宝丹治疗，难道就没有其他治法了吗？我在此了解到，叶天士先生那个时代，世人大多用治胃、治肝的方法治疗神昏谵语，绝不知道温邪有袭入心包络的症状。于是撰写《温热论》来补救这一缺失。然而近来的医家，不再博览群书，仔细辨别病症，手里拿着一卷《温热论》、《温病条辨》、《温热经纬》，就以为道理全在这里了，而对于“不可给予”的告诫，完全没有仔细观察。叶天士、吴鞠通等人岂能承担过错呢！
肿胀后昏厥，热病期间月经来潮
肝藏血而主疏泄，所以阴虚火旺体质的人，常有水不涵木，木火内炽，血不能藏，失去疏泄的正常规律，而导致月经先期而至；或者因热病而在非经期突然来潮的，这必须以凉肝凉血为关键。月经刚来时，或有瘀积，可用凉血而动血的药物，如丹皮的辛味以流动气血，丹参的下行之性以畅达气血，这两味药性虽寒凉，绝不会导致凝涩不通。医家往往用桃仁、红花、泽兰等温性药剂，说寒凉会导致血凝滞，却不知道这指的是苦寒而味不辛、性不下行的药物而言；如果在热病期间用温性药剂以助热，害处说不尽；月经将干净时，那么连这两味药也不可再用，须用白薇、紫草、生地等凉血而不动血的药物治疗。
过去治疗张绍庭景羲的女儿，突然昏厥，长达三个时辰。绍庭见女儿昏厥，就来请我，我恰好去松江出诊，又请叶晋叔先生，叶先生也恰好外出。绍庭惶恐焦急万分，知道我在三钟（约下午1-3点）返回，便在寓所守候。我回来后，立即前往，病人仍未醒。面色青，脉伏，四肢逆冷，只知道她体胖有痰，月经先期而至，先前患有肿胀，这是肝厥。至于属寒还是属热不得而知。我很犹豫，当时牙关紧闭，暂且用筷子强行撬开，略微露出一条缝，窥见舌边和舌尖碎烂，才知道是心肝两经血分之热。病情紧急来不及详细列出脉案，于是嘱咐先用紫雪丹开窍，等她稍醒，用犀角、羚羊角磨竹沥等频频灌服，半小时后即苏醒，然后继之以方药，并列出脉案如下：初病肿胀，胀属肝，肿属脾，木强土弱，木强则生火，土弱则聚湿，湿被火灼，则凝结为痰，火热盛而动风，则手足抽搐，肝阳被痰湿所遏，郁而暴发，挟痰以上升，则发厥，上蒙清窍，则神昏。现在窍已开，神识已清，但两手脉皆沉伏不见，名叫伏匿脉，是热深厥深的征候，谨防再次发厥昏厥。此时痰火未平，亟宜清降，舌尖碎烂，是心热，舌边碎烂，是肝热，由肝及心，心肝皆属血，宜清血分之热。肝主疏泄，所以经期反而先时而至，只用辛凉以清血，不要嫌弃其性寒阻碍月经。药物为青黛拌石决明二两，竹卷心三钱，大丹参三钱，西赤芍五钱，粉丹皮二钱，水炒竹茹三钱后下，嫩钩藤一钱五分，冲入鲜竹沥二两，白菜菔汁一杯，枳实汁一匙。连服三剂而大愈，厥未再发。又调理肝脾，肿胀也全部消除。当时颇有以两脉伏、月经来为由，指责我用凉药的，但绍庭信任我很深，没有怀疑，因此录出此案，告知那些在温病期间月经来潮而固执于用温通方法的医生；以及那些因热深厥深导致脉伏，而误认为虚寒欲脱的医生。
虚喘
治病用药，可以由此领悟破绽。唐立三治疗他的妹妹，素来苦难产，说是瘦胎饮是为阳湖公主所作，用来奉养的人必然气实，耗损其气使其平和，所以容易生产。如今妹妹形体肥胖，知其气虚，勤于针线活久坐，知其下运不足，在怀孕五六月时，用紫苏饮加补气药服用十余帖，生下男孩非常顺利。同样是难产，却有虚实之别，补气之方反而从瘦胎方悟出。
另外张仲华医案记载，表热四候，额头汗如雨下，出汗时皮肤冰冷，汗止后热势灼人，诊脉虚细，唯独尺脉滑，舌苔已净。细细推究症状，不在三阳而在三阴。考证张仲景有“反发热”一条，是寒邪深伏少阴阳分，如今是湿温余邪流入少阴阴分，遵循其旨意，改变其方法，拟补肾阴泄肾邪，以熟地、枸杞等补之，细辛、丹皮等泄之，一剂而愈。这是从寒邪入肾悟出湿温之邪入肾的治法。
以前我诊治王立群的嗣母，病喘，询问其状况，确系肾家的虚喘，而非肺家的实喘。阅看前方，是专科女医蔡小香先生所开，用咸温重镇之品，很符合肾气不纳的治法，只是为何服药后反而加重？既以形体瘦、尺脉带数来看，才悟出其中的缘故。于是就在原方中将蛤蚧、杜仲等咸温的药物，改为阿胶、元参等咸寒的药物；将苏子的温降，改为白前的寒降；只有旋复花、赭石两味没有改，也是依据同样的道理进行对照检验，即按照其法变通使用。
“剂”字解释
读书必须先识字，学医又何尝不是如此。古人造字之初，意义蕴含在声音中。“剂”从“齐”声，就有“齐”的意义，“齐”就是平的意思。药物称为“剂”，就是虚者补之，实者泻之，热者寒之，寒者温之的宗旨。所以六淫之外因，饮食伤之不内外因，对于我身所本无的邪气，则必须散之、泻之、消之、下之而后安；七情之内因伤及我身所本有的正气，则必须血亏益以血、气亏益以气才可以。凡所以使其平正的方法，俗称一剂，也叫一帖，意思也是如此。
“淫”字解释
人身生气通于天，凡风寒暑湿燥火六气，都与我身脏腑相感应，天地是一阴阳五行，人身也是一阴阳五行。既然这样，六气都是生成人的工具，而不是杀人的东西，为什么称之为六淫？回答说：这只是过度就会有害罢了。“淫”的意思是过。大水叫淫，大雨叫霪，放纵叫佚，意义都蕴含在声音中。六气如果不极端过度，就不能称之为淫。
“取”字解释
治疗痿症必取阳明，《内经》用一个“取”字，大有斟酌。近来人多以痿症为虚症而用补法，或者知道多有湿热症而用泻法。实际上痿症虚实皆有，而治法总在乎阳明，所以不说治痿必补阳明，也不说治痿必泻阳明，而独独说“取”。治病不知道分经论治，就像盲人捏陶器一样盲目。
“变”字解释
《内经》说：“肺气虚曰溺色变；少阴司天热淫胜曰溺色变。”解释的人多以颜色黄赤来说明，实际上“变”是反乎常也，与寻常小便颜色不同，就称之为变，如米泔色、败酱色、黑色都包括在内，不专指黄赤色而言。经文又说：“冬脉不及小便变。阳明司天燥气下陷小便变。”解释的人也多以颜色黄赤来说明，这更连癃闭、不禁都包括在内，不专指黄赤色而言，并不专指小便颜色而言，所以不说“色变”，而仅说“变”。经文又说：“中气不足，溲便为之变。”溲是小便，便是大便，这更兼大小便而言，凡二便异乎常者，一应包括在内。而解释的人也多以小便颜色黄赤来说明，岂不是挂一漏万吗？实际上是读书不细致罢了。至于经文说：“肝热病者小便先黄；胃气盛溺色黄；厥阴之胜小便黄赤；少阳之胜溺赤。”既然这样，如果确实是颜色为黄、为赤、或兼黄赤的，经文固然未曾不明言。
另外王孟英《随息居霍乱论》说：“干矢自遗而不觉的，经文说中气不足，溲便为之变，这也是变。”所谓不足，不是说中气虚，而是因为中气被病邪阻遏，则不足于降浊升清的职能，所以溲便为之改变常态。赵菊斋说霍乱的吐泻无度，干霍乱的便秘不行，都是变，都是中气被病邪阻遏，而不足于降浊升清的职能。如果拘泥于“不足”为虚，那么诸霍乱都应当补中气来治疗了。我认为王、赵二人以二便解释溲便，以二便失常解释“变”字，都符合经旨。但以“不足于降浊升清”解释“不足”两字，恐怕未必确切。窃以为邪之所凑，其气必虚，这都是因为中气本虚，所以邪气得而侵犯之，有邪即是实，当其邪方盛时，自然断无补中之理；等到邪气既去，仍宜以补法善后，断未有中气本足，而邪气得而侵犯的。既然如此，其标为邪实，其本为正虚，所以“不足”者，不必曲为之解，仍以虚解释它，自觉直截了当。
“圣人不治已病治未病”解释
《金匮要略》说：“上工治未病，何也？”老师说：“治未病的含义，见到肝病，知道肝病会传脾，应当先实脾，其余脏腑依此类推。”《不谢方·序》说：“疾甚曰病。”谓人在已有疾病之后、未发病之前，就应当早为之药。引用《说文》“疾病也，病疾加也”为证。两种说法不同。我按《内经》说：“善治者治皮毛，其次治五脏。治五脏者，半死半生也。”以及“风寒客于人，使人毫毛毕直，皮肤闭而为热，当是之时，可汗而发也”等一节，都可以作为治未病的根据，以经证经，毫无疑义。所以扁鹊治疗齐桓侯，在腠理、在血脉、在肠胃谓为可治，在骨髓则望而却走，这是未病始治，已病则不治。
“内伤”解释
王孟英记述他母亲的教诲说：“内伤证必求其所伤何病，而先治其伤，则病去而元气自复。”古人不叫内虚而叫内伤，顾名思义，则纯虚之证很少。徐洄溪也说：“大凡人非老死即病死，其无病而虚死的，十不得一。何况病去则虚者亦生，病留则实者亦死。”孟英又说：尸虽在极虚之人，既病即为虚中有实。然而近来的医家，一遇内伤，而专事蛮补的，他们也不明白“伤”字的真谛吗？经文说：“不能治其虚，焉问其余。”既然说虚了，还说治而不说补，读书细心的人何不思考呢？
记录各位兄长姊妹病故的情形
I also observed him treating a patient surnamed Zhou, who presented with a red face, profuse sweating, coma, and delirious speech. Some believed it was pathogenic factors invading the Pericardium (Pericardium). He stated that if calling the patient could restore clarity of consciousness, it indicated that the spirit was not completely lost; upon pulse diagnosis, the left Cun, Guan, and Chi positions were not rapid, while the right Guan position was floating, slippery, and rapid. This is a Baihu Tang syndrome (Yangming Channel Excess Heat Syndrome). If Qingxin Wan (Clear Heart Pill) or Zhibao Dan (Precious Treasure Pill) are mistakenly used, they will instead lead pathogens deeper into the interior.
The niece-granddaughter of Mr. Jianian, aged nine at the time, had lived in the northern region during her childhood and received cowpox vaccination. She now presents with numerous lesions resembling rashes. He diagnosed this as smallpox (Dou Zheng), caused by residual toxins from previous infections that were not fully cleared. The cold climate of the north caused the toxins to accumulate without being expelled. Upon moving south, she contracted seasonal qi, triggering the eruption. Although ancient texts state that pox originates from the five Zang organs and ancient methods often employed warming tonification, current pathology involves heat-toxin damaging Yin fluids. One must not rigidly adhere to ancient methods. He prescribed detoxifying and Yin-nourishing herbs, resulting in recovery.
The two sons of Jingzhang were playing, and one injured the elder brother, causing severe chest pain. Jingzhang attributed it to trauma. Upon examination, he said, "It is not trauma." It was due to contracting seasonal qi, causing Qi stagnation in the chest and diaphragm. Treatment with herbs to disperse exterior Qi led to recovery. Had blood-invigorating and stasis-resolving formulas been administered, it would have been an error. Similarly, Pusun suffered from symptoms resembling stroke, Renlong's wife suffered from Datou Feng (a disease characterized by swelling and redness of the head and face), and the children, daughters-in-law, and grandchildren of Shengnian suffered from various ailments; all were cured effectively. Furthermore, the number of verified treatments witnessed by me is too numerous to recount. I briefly list a few cases involving acquaintances like Jianian who were cured by him, to commend his skill and express my gratitude. Signed jointly by: Zou Jianian, Pan Shengnian, Feng Tingshao, Sun Wenyi, Jin Guozhen, Gu Yuanji, Peng Pusun, Pan Jingzhang, Peng Chengbao, Qian Renlong, Liu Jiayi, Wang Chengyu.
Liver Qi Obstructed by Damp-Heat, Pox Fails to Suppurate
Master Yu Nie was profound in medicine but did not practice clinically. Witnessing the errors of two physicians in Shanghai, he wrote "On Distinction Between Famous Physicians and Quacks." I recorded it because I found it beneficial to medical understanding. He wrote: A friend told me, "XXX treated an old woman surnamed Xu. Her Liver Qi was obstructed by damp-heat. Ideally, acrid-warm herbs should be used to soothe Liver depression, and bitter-cold herbs to clear damp-heat." However, a certain physician's case record stated: "Wood and Fire reside internally, insulting the Spleen and Stomach, leading to loss of ascending and descending functions, resulting in hypochondriac pain, excessive phlegm, mental fatigue, lethargy, yellow tongue coating, and fine, wiry, slippery, rapid pulse." Yet the prescription consisted mainly of lung-related herbs such as Inulae Flos (Xuanfuhua), Pyrope (Haifushi), Armeniacae Semen (Xingren), Fritillariae Thunbergii Bulbus (Xiangbei), and Loquat Leaf (Paye). The prescription did not match the pattern analysis; the reason is unknown.
Chen Jun's daughter suffered from smallpox. The pustules were formed but failed to suppurate. The failure to suppurate has two causes: First, intense toxin heat dries and coagulates the blood, preventing transformation into pus; the method should be to clear blood and resolve toxins. Second, Yuan Qi (Primal Qi) deficiency leads to cold blood stagnation, also preventing pus formation; the method should be warming and tonifying to support the interior. XXX was consulted. His case record clearly stated "Pustules formed but no pus," yet he prescribed penetrating and attacking herbs like Gleditsiae Spina (Zaocis Spina), Bamboo Shoot Tip, and Arctii Fructus (Niu Bang Zi). Again, the prescription did not match the analysis. I said, "This is why they are called 'Famous Physicians.'"所谓名医 (So-called famous physicians) connect with peers, promote each other, demand high fees, travel in luxury carriages, and boast after accidental successes, ignoring the ridicule of bystanders. They pursue fame over substance. Thus, I call them famous physicians. As for quacks, they are mediocre. Though not outstanding, they are not necessarily absurd or inferior. They treat the head when the head hurts and the foot when the foot hurts, lacking understanding of the underlying principles, so outcomes vary, leading to criticism. However, they do not exhibit self-contradiction between prescription and analysis. They do not even qualify as quacks; thus, I call them non-quacks. Xia Jie and Yin Zhou Di abused the people; these two doctors are likely their descendants, treating human lives lightly, leading to this state. I will compile their erroneous prescriptions and case records, critique them, publish them, and name the work "Ai Fa Zui Bian" (Chronicle of Condemning Crimes), hoping people will recognize their errors and reduce unjust deaths. This is a form of charity. Although the world is arrogant and thin-hearted, and heavenly disasters (water, fire, war, plague) continue, adding a "medical disaster" is heaven's will. What blame can be placed on these two doctors?
Coma and Delirious Speech
My previous discussion on coma and delirious speech was incomplete, so I elaborate further. This symptom is not exclusively related to the Pericardium (Pericardium), though it can involve it. When related to the Pericardium, the pathology is in the Upper Jiao. Ye Tianshi stated: "A pure crimson, bright, and moist tongue indicates Pathogen affecting the Pericardium." Wu Juzhong stated: "Restless sleep at night, irritability, thirst, and red tongue indicate Summerheat entering the Hand Jueyin Channel." He also said: "If the tongue coating is white and slippery, do not administer cooling herbs. The Heart is the Sovereign and does not accept Pathogens; if Pathogens enter, death ensues. The Pericardium attaches to the Heart, resides above the diaphragm, acts on behalf of the Sovereign, serves as the Official of Envoy, and is capable of accepting Pathogens." Therefore, all heart diseases mentioned in ancient and modern formularies refer to Pericardium diseases. Hence, True Heart Pain is incurable. Pericardium disease is adjacent to the Heart, indicating a dangerous condition. Crimson tongue color indicates heat entering the Pericardium. Thus, Ye Tianshi used pure crimson, bright, moist tongue as a sign, and Wu Juzhong used red tongue as a sign, reiterating the warning against using cooling herbs for white-slippery tongues. He also stated: "If the tongue is crimson with yellow or white coating in the center, this is not a Blood-level disease, but Upper Jiao Qi-heat scorching body fluids." His distinction clarifies that crimson tongue with central yellow/white coating is not a Blood-level disease, fearing misdiagnosis as Pericardium disease. Thus, Ye and Wu would not use Niuhuang Wan (Calculus Bovis Pill) or Zhibao Dan for coma/delirium with yellow/white coatings. Since they did not rely solely on these pills, other methods existed. I understand that in Ye Tianshi's era, physicians mostly treated coma/delirium via Stomach or Liver methods, unaware of Warm Pathogens invading the Pericardium. Ye wrote "Wen Re Lun" (Treatise on Warm-Heat) to correct this. However, recent physicians, failing to study broadly and differentiate carefully, cling to "Wen Re Lun," "Wen Bing Tiao Bian," and "Wen Re Jing Wei," believing they contain all wisdom, while ignoring the warning about "not administering" certain herbs. Can Ye and Wu be blamed?
Swelling followed by Syncope, Menstruation during Febrile Disease
The Liver stores Blood and governs free flow. In individuals with Yin deficiency and hyperactive Fire, Water fails to nourish Wood, leading to internal blazing of Wood-Fire. Blood cannot be stored, and free flow becomes abnormal, causing early menstruation or sudden onset during febrile illness. Cooling the Liver and Blood is essential. At the start of menstruation, if stasis exists, herbs that cool blood and move blood, such as Moutan Cortex (Mudanpi) for its acridity to move Qi/Blood, and Salvia Miltiorrhiza Radix et Rhizoma (Danshen) for its descending nature to unblock channels, can be used. Though cold, they do not cause stagnation. Physicians often use warm herbs like Peach Kernel (Taoren), Safflower (Honghua), and Lygodii Spora (Zelan), claiming cold causes blood stagnation. This applies only to bitter-cold, non-acrid, non-descending herbs. Using warm herbs during febrile disease exacerbates heat dangerously. Near the end of menstruation, even Mudanpi and Danshen should be avoided; use Baoweia Radix (Baiwei), Leonurus Herba (Zicao), and Rehmanniae Radix Preparata (Shengdi) to cool blood without disturbing it.
Previously, I treated the daughter of Zhang Shaoting Jingxi, who suddenly fainted for three hours (Shichen). Shaoting sought my help, but I was away in Songjiang. He then invited Master Ye Jinchu, who was also out. Desperate, he waited for my return at 3 o'clock. Upon returning, we went together; she was still unconscious. Face was cyanotic, pulse was hidden (Fu), limbs were cold. She was obese with Phlegm, had early menstruation, and prior swelling. This is Liver Jue (Syncope). Etiology (cold vs. heat) was unclear. I hesitated. Her teeth were clenched. I pried them open slightly, revealing ulcerated tongue edges and tip. This indicated Heat in the Blood levels of the Heart and Liver Channels. Urgent treatment precluded detailed recording. I instructed opening the orifices with Zixue Dan (Purple Snow Pill). Once slightly awake, administer Rhinoceros Horn (Xijiao - note: protected species, historically used), Antelope Horn (Lingyangjiao), and Bamboo Juice (Zhuli) frequently. She woke in half an hour. Then continued with herbal formula. Case record follows: Initial swelling: Distension belongs to Liver, Edema belongs to Spleen. Wood excess weakens Earth. Wood excess generates Fire; Earth weakness gathers Dampness. Dampness scorched by Fire condenses into Phlegm. Intense Fire agitates Wind, causing convulsions. Liver Yang obstructed by Phlegm-Dampness erupts violently, carrying Phlegm upward, causing syncope and clouding the clear orifices (coma). Now orifices are open, consciousness restored, but pulses are deep-hidden (Fu Nuo Mai), indicating Deep Heat and Deep Jue. Guard against recurrence. Phlegm-Fire is uncalmed; urgently clear and descend. Ulcerated tip = Heart Heat; ulcerated edge = Liver Heat. Path moves from Liver to Heart; both relate to Blood. Clear Blood-level Heat. Liver governs free flow, hence early menstruation. Use Acrid-Cool to clear Blood; do not fear cold properties delaying menses. Prescription: Qingdai mixed with Abalone Shell (Shijueming) 2 liang, Bamboo Core (Zhujuanxin) 3 qian, Large Salvia Root (Danshen) 3 qian, Red Peony Root (Chishao) 5 qian, Powdered Moutan Bark (Danpi) 2 qian, Stir-fried Bamboo Shavings (Zhuru) 3 qian added later, Tender Hookvine (Gouteng) 1.5 qian, mixed with Fresh Bamboo Juice 2 liang, Chinese Cabbage Radish Juice 1 cup, Immature Bitter Orange Juice (Zhishi) 1 spoon. Three doses led to major improvement, no recurrence of syncope. Subsequent regulation of Liver and Spleen resolved swelling. Some criticized my use of cooling herbs due to hidden pulse and menstruation, but Shaoting trusted me deeply. I record this to warn physicians who stubbornly use warming/unblocking methods for menstruation during warm diseases, or those who mistake deep heat/syncope-induced hidden pulse for deficiency-cold collapse.
Deficiency Asthma
Treatment principles can be understood through this case. Tang Lisan treated his sister, who had a history of difficult labor. He cited "Shoutai Yin" (Thin Fetus Decoction), created for Princess Yanghu, which reduces Qi to facilitate birth for robust individuals. His sister was obese, indicating Qi deficiency, and sedentary needlework suggested lower Jiao weakness. At 5-6 months pregnancy, he gave Zisu Yin plus Qi-tonifying herbs for over ten doses, resulting in smooth delivery of a son. Difficult labor varies by deficiency/excess; the Qi-tonifying formula was derived from the Thin Fetus concept.
Another case by Zhang Zhonghua: Exterior heat for four days, forehead sweating profusely, cold skin during sweating, burning heat after sweating. Pulse: deficient and fine, except Chi position which is slippery. Tongue coating clean. Analysis places pathology in Three Yin, not Three Yang. Zhang Zhongjing described "counter fever" due to Cold Pathogen hiding in Shaoyin Yang division. Here, residual Damp-Warmth enters Shaoyin Yin division. Following his principle but changing method: Tonify Kidney Yin, drain Kidney Pathogen. Rehmannia (Shudi) and Goji (Gouqi) to tonify; Asarum (Xixin) and Moutan (Danpi) to drain. One dose cured. This derives Damp-Warmth Kidney treatment from Cold Pathogen Kidney treatment.
Previously, I treated Mrs. Wang Liqun's adopted mother with asthma. It was Kidney Deficiency Asthma, not Lung Excess Asthma. Previous prescription by female specialist Cai Xiaoxiang used salty-warm heavy sedatives, fitting Kidney Qi failing to grasp. Why worsening? Given emaciation and rapid Chi pulse, I realized the issue. Modified original formula: replaced salty-warm Gecko (Hejie) and Eucommia (Duzhong) with salty-cold Donkey-hide Gelatin (Ejiao) and Scrophularia (Yuanshen); replaced warm-descending Perilla Seed (Suzi) with cold-descending Cynanchum (Baiqian). Kept Inula (Xuanfu) and Hematite (Zhe Shi) based on similar logic.
Explanation of "Ji" (Dosage/Formulation)
Reading requires knowing characters; medicine is no different. Ancient characters embed meaning in sound. "Ji" (Dosage) sounds like "Qi" (Equal/Uniform), implying balance. Medicinal dosage aims to balance: tonify deficiency, drain excess, cool heat, warm cold. For external Six Evils or dietary injury (pathogens not originally present), scatter, drain, dissolve, or purge. For Seven Emotions injuring intrinsic Qi/Blood, replenish deficiency. "Ji" means making equal/balanced. Commonly, one "Ji" equals one "Tie" (pack).
Explanation of "Yin" (Excess/Perversion)
Human vital Qi connects with Heaven. Six Qi (Wind, Cold, Summerheat, Dampness, Dryness, Fire) interact with Zang-Fu. Heaven and Earth are Yin-Yang and Five Elements; humans are too. Six Qi generate life, not kill. Why "Six Yin" (Perverse Qi)? "Yin" means excess. Floods are "Yin," continuous rain is "Yin," licentiousness is "Yin." Meaning lies in sound. Six Qi are only "Yin" if extreme.
Explanation of "Qu" (Select/Take)
"Treat Wei Syndrome by selecting Yangming." The term "Qu" (Select) in Neijing is deliberate. Recent physicians treat Wei as deficiency (tonify) or damp-heat (drain). Wei syndrome has both deficiency and excess, but treatment focuses on Yangming. Hence, not "Tonify Yangming" nor "Drain Yangming," but "Select Yangming." Treating without channel differentiation is like a blind person molding clay.
Explanation of "Bian" (Change)
Neijing states: "Lung Qi deficiency causes urine color change; Shaoyin governing year with Heat excess causes urine color change." Interpreters focus on yellow/red. Actually, "Bian" means deviation from normal. Includes rice-water color, bean-jelly color, black, not just yellow/red. Also: "Winter pulse insufficient causes urine change; Yangming governing year with Dryness sinking causes urine change." Includes retention and incontinence, not just color. Also: "Middle Qi insufficiency causes urinary/fecal changes." Covers both urine and stool. Interpreters focusing only on yellow/red miss the point due to careless reading. Neijing explicitly mentions yellow/red for Liver Heat, Stomach Qi excess, Jueyin/Yangming excess.
Wang Mengying in "Huoluan Lun" states: "Involuntary passage of dry stool indicates Middle Qi insufficiency causing change." "Insufficiency" here means obstruction of descent/ascent, not mere deficiency. Zhao Juzhai says cholera vomiting/diarrhea or dry cholera constipation are "changes" due to obstruction. If "insufficiency" meant pure deficiency, all cholera would require tonifying Middle Qi. Wang and Zhao correctly interpret "urinary/fecal change" but may be imprecise on "insufficiency." I argue: Where Pathogen gathers, Qi is deficient. Middle Qi deficiency allows Pathogen invasion. Presence of Pathogen implies Excess. During peak Pathogen, tonifying Middle Qi is wrong. After Pathogen clears, tonification aids recovery. No one with sufficient Middle Qi is invaded. Thus, branch is Pathogen Excess, root is Righteous Qi Deficiency. "Insufficiency" need not be over-interpreted; interpreting it as deficiency is direct.
Explanation of "Sages Treat Disease Before It Occurs"
Jingui says: "Superior physicians treat disease before it occurs." Teacher explains: Knowing Liver disease transmits to Spleen, first strengthen Spleen. "Bushie Fang Preface" defines "Bing" as severe disease, suggesting treatment before onset. Cites Shuowen. These views differ. Neijing states: "Good physicians treat skin/hair; next, Zang organs. Treating Zang organs results in half death, half survival." And: "Wind-Cold invades, hair stands erect, skin closes causing heat; sweat to release." This supports preventive treatment. Bian Que treated Duke Huan of Qi at stages of skin, vessels, stomach/intestines (curable), but fled when in bone marrow (uncurable). This illustrates treating before disease manifests.
Explanation of "Neishang" (Internal Injury)
Wang Mengying quoted his mother: "For Internal Injury, identify the injury, treat it first; then disease resolves and Yuan Qi recovers." Ancients said "Neishang" (Internal Injury), not "Neixu" (Internal Deficiency). Implies pure deficiency is rare. Xu Huixi said: "People die of old age or disease. Few die of deficiency without disease. If disease leaves, deficiency recovers; if disease remains, even excess dies." Mengying added: Even in extreme deficiency, disease creates deficiency-with-excess. Recent physicians blindly tonify Internal Injury, missing the true meaning of "Injury." Neijing says: "Cannot treat deficiency, how ask about the rest?" If deficient, why say "treat" not "tonify"? Careful readers should ponder.
Record of Deaths of Brothers and Sisters