凡虚泻之症，大率身体瘦弱，皮肤苍白，腹部凹陷，不腹痛或有隐微之痛，脉多细弱无力或小数，舌多无苔，小便清利，普通多无高热（与后有热者参看），斯泻之粪多稀溏，或稍有白油样之物（不可误认为痢疾），或完谷不化，一日三五次至七八次者居多，尤以下半夜或晨间，必泻一二次（有五更泻、鸡鸣泻等俗名信）。愈泻愈弱，则虚证毕现，例如盗汗、喘息、身肿以致于死。此种泄泻，中医多责之睥虚，相火衰弱，故多以健脾（白术、山药、茯苓等）、补气（参、芪等）、补相火（补骨脂，肉苁蓉等）、补阳（南子、肉桂等）、收涩（桑螵蛸。粟壳等，以上等药皆历经试验有效者，等药治疗之，强半有效，药力持续甚久，因而根本治愈者颇多。西药中之硝酸苍铅、单那尔并、阿片末等，对此症更易见效，但比较效力持续之时间略短，且长时间服用西药之阿片等，又恐慢性中毒成瘾，故余每遇此症，必连用数日西药后，即惭渐改用中药，收效之佳，不可思议（西药则渐减，中药必用大量方可。）然此皆指普通之虚泻者而言，若系肺结核末期之泻（肠结核），中药内之桂；附、参、芪，万不可用，西药收敛剂用之，亦只生效一时（此时只有用西药之一法）无济于事也。更有阳虚发热之虚泻，及小儿慢惊风（此症多由疹后、痢疾或吐泻症转来）之虚泻，皆有发热，则中药补剂有唯一之特效，西药不能望其项背也（阿片不可用于小儿，注意切记）。以上阳虚之泻，参看前论阳虚发热，兹不复述。又有胎前患泻症者，治最棘手，应参看后列王姓医验。
肿胀‘（七）肿胀此二症不必相兼，更有虚实之分，不可混同，且肿之原因极多（例如充血性水肿、瘀血牲水肿之类），西医病理学言之甚详，必须参考。兹所欲言者，仅为习见之虚肿（俗有水臌、气臌之名或称浮肿，及腹胀之二者，以本编叙述，皆历经实验之症，故不欲多所铺张，故示渊博。然仅此二者之实验，学者苟能深信不疑，则于此极难诊治之臌症已不啻得一指南针矣。
大凡肿胀二症，在中医大约以肿属水病，胀属气病，水病之中，又分阳水和阴水。推其意义，凡实证（皆因风、因热、因湿、因气以成，邪自外来皆有余之象。初得之病，偶尔浮肿皆属此类。），偶尔之浮肿，率多暴得之症，小便短赤，大便不爽，或热泻，或有寒热呕吐，骨节疼痛，舌苔黄绛或白厚，或皮肤起有红点，（虚肿二便亦有不利，不可相混）脉象实而有力。此种症象，率宜发散，宣通、利水、顺气、清热、甚则宜于攻下（注意以上之肿系属暴得，例如温病多有之）。中药内之麻黄、防风、生姜、桂枝、防己、柴胡。半夏、杏仁、陈皮、厚朴、茯苓、猪苓、泽泻、黄芩、栀子、大黄、芒硝、瓜蒌仁等，均为有效之品，西药内之硫苦、醋剥亦极有效，但若系久病之虚肿，则万不可用也。以上系治暴得之水肿，皆有效。余曾见一医为人治一久病之水肿，始用麻黄等发汗，继用硫苦等泻之，一误再误，因而病死，（以此药西医书中有治脚气水肿特效之语，故误用之）可不慎欤！虚证之肿，率多久病，其症象皆系渐渐而来（与实证暴然而肿者正相反），其原因，中医书谓为脾、肺、肾三经虚弱，不能气化。其症候率溺少、食少、无汗、无津液，渐渐四肢浮肿，日久延及全身尽肿（此症大便或溏或燥，绝不可误用行气泻下之药，若系男子，则肾囊亦肿。）症自内发（皆不足之象，中医谓之阴水），脉象多细弱，然亦有反见洪大无力之脉者（吐者、泻者亦有之），皮肤肿处，以手按之，多不能复起（如按湿面），皮肤苍白（发热者甚少）。中医有效治法，以补睥补气（白术，茯苓、山药、人参、黄芪之类）、补阳（附子、肉桂、干姜等）、补肾（补骨脂等）等法为最确实，西药中之巴拉奴妥林亦有效（单用西药则不效。）对于虚肿之症，尤宜于相当方剂之中，加以淡渗利尿之品（茯苓皮必重用，或酌加其他利水之药），且宜兼顾胃气，稍加砂仁。实证浮肿，原因一去，其肿立消（例如温病关节肿不必治肿，温毒既散肿必自愈。），不必深谈。兹所欲述者，为治久病虚证之肿之要诀，此症认定后，即以大剂之补品，放胆与服，不可因有千呕，或自觉有热气冲咽胸满等现象，而不敢用补晶。药味愈简愈好，药量愈大愈好，补剂之中，加以渗利，加以和胃之品，重者数十剂，轻者十余荆，无不收功（参看医验，。余往往接治他医不治之虚肿，仍就原方，只减去其杂滥不关重要之品（例如补心、补肺、补血等药），而加重其适合本症之药（例如参，芪、桂、附，往往加至八钱至一两），简单数味，药力专而效反大，数剂后无不见效者，药虽平常，效已实验。此即余治本症最得意之处，愿以告同好也（虚肿单用西药多无效，外科手术亦不能适用，于全身皆肿之后即放水法，亦非根本治法，愿医者唯一适用中药也（参看医验>）。
胀之一症，较肿为轻，西医谓胀是肠腹内有蓄积之瓦斯（气体），中医则分虚胀与实胀二种。经云诸胀腹大，皆属于热，此语颇有精义，故历来治虚肿者，可以纯用补药，治虚胀者（虚肿至胸腹，此时内脏亦肿，往往病人自诉苦闷填胀，医者若误认此是真胀，加入顺气消导之药，则大谬矣。须知浊阴上千，必元阳大虚，乃如此也。）则纯用补药之时甚少，即或确系虚证，亦宜于补药中稍加疏利之品为妥（例如蔻仁等），万勿一味蛮补也。至于实证之胀，率多以顺气缓下之剂为宜，原因一去（例如停水、停食作胀）胀满即除，不难疗治，勿庸赘述。
汗（八）汗已详前发热论，可参照。
！头痛（九）头痛、眩晕、神昏、谵语此种病象，更须分别虚证、实证论治，不可含混。大凡实证多新得，轻则眩晕（温病多有），重则头痛（温病、伤寒，凡热性病初作，多有此症。所谓表证，宜用发散药，然温病逆传已危，绝无表邪，而头奇痛者更多，此时万不可误认仍有表证在也。）再重（邪已入内）则神昏、谵语、发狂，此盖由于脑神经受侵袭（瞄膜炎、脑充血均有头痛。），在中医则责之心包络受邪（不属于表证矣），热邪胶滞膻中（邪入心包血分，亦有似表证之极重头痛、头昏，但不恶寒，而呕吐极甚，医者应参看其他症象认定之。）。此症在温热病中，最易误治，率因医者仅知内热二宇（虽此不能谓之误认，然一味清解或攻下。大便愈下，上热愈结，津液因热耗与攻下而益伤，陡变惊厥角弓反张、鼻干目吊、上窜无泪，或四肢厥逆、狂躁烦闷、胸高气促、呕逆、精神昏迷，粗工见此症状，认为结胸，与以小陷胸汤，是谓无的放矢。更或大加攻下，与以承气汤，是谓攻伐无过，盖邪不在肠胃，愈泻愈危，下愈虚，上愈实，医药杀人，即在于此。余对此症，不厌反复叮咛，必使学者深识此症为（内闭）邪热在上，邪入膻中，邪在血分，如非大便燥或热结旁流，此症不但不可仅仅调胃，更不可鲁莽攻下，致误人命，戒之戒之。）而不能分清热在何处。用药初则清凉，继则甘寒，继则苦降（此三法非无效者，但至内闭之候，无济于事矣。），三法既施，束手无策矣。（西药对于内闭险症，绝对无效，不必试用。）兹将余治温病试验所得，有效方法，详列于下，以备参考。（此由论头痛、．眩晕、神昏、谵语等病理，连类而及，阅者勿以为不伦也。）①初得温病，咳嗽、头痛、呕吐、身酸或痛，舌白苔或无苔，脉或浮洪，身热或微恶寒，治宜注重上焦（肺经）类以轻清之品，开发肺气。例如连翘、双花、菊花、桑叶、绿豆皮、竹叶、贝母、荆芥、防风、薄荷、苏叶等（此后四味，初得有外寒束缚，头痛、身痛或恶寒者，方可加入。温病忌汗四字，须活看，不必拘泥。）治之为宜。
②温病稍久，邪不得解，口渴烦闷呕吐，舌苔黄绛，小便赤短，大便或燥或泻极臭之稀粪，身热，头晕头痛（此时头痛，万不可认为表证）脉沉数洪实甚则或反沉小（四肢厥逆咏多沉小儿拍宜注重胃中实热，酌加苦寒方可，若仍尽用轻清之品，病重药轻，无济于事，必兼用川连、石菖蒲、桑皮、瓜蒌或石膏、黄芩、栀子、郁金等（西医谓石膏毫无效用，盲从者即置之弗用，可再细心试验，即知余列此味，非率而操觚者），橘红、陈皮、大黄（余于此症，喜熟军，以温病病在上焦，不宜大下，故稍用熟军亦有大效，过下之弊，往往演成内闭外脱之险症，又不可不慎也）等药。此外再以病之情状加入清轻芳香、清热解毒之品，率多奇效。（参看医验-）⑧温病七、八日后，失治，热邪逆传入膻中，实为危候。（温病初起不难治愈，入此阶段杀人极速，中医奥妙即在此处，起死回生其效如神。惜学者临症茫然，不易臻此境也。）此时病者，并不能指定何处痛苦，所最著者，精神昏迷，呕逆更甚，头痛、头晕、无汗（绝非表证），或自汗，四肢厥逆，（若系多日不大便，小便赤短，潮热，亦可稍用泻药，大便不结不腹痛者勿用。）目瞑。鼻干无涕泪，身体发痉，狂躁，胸高气促，（小儿误服泻药，尤多此现象，非陷胸症也。）甚则角弓反张。若用泻药太过，下愈通，上愈实（渚窍将闭），医者须认定此症，即系邪闭膻中。无形、无质，胶滞郁结既不在胃腑，亦不在肠，屡用攻下，是速其死也，此时惟一治法，即在以芳香上宣诸窍（石菖蒲、郁金、金银花、连翘、石斛等类，再佐以其他清热解毒之药），此时犀角一味，为必不可少之品（此药最昂贵，必要时匆惜也），至宝丹、紫雪丹，更为有效（此药开窍最速），神昏发痉之候，速以此类药救之，再参以滋阴药，例如生地、元参、麦冬，及以上芳香诸品，大剂（若呕逆太甚，可分数次服）缓缓与服（能一次服更佳，可一日两剂。），强半有生望也（此症稍延时日，多致不救。）。
久病亦有实证，例如胃溃疡症，率多经年累月，吾人读书要灵活，不可拘泥，胃脘痛一症，最要与心痛详辨，凡心口痛，而无吞酸、便秘、食后胀闷、呕吐嘈杂等等胃病现症者，多系心痛（绞心症、心炎等），宜以西药（中药无效）治疗，凡心口绞痛、气短，一经劳动凉风，立时痛起，喘促不能起立，痛时上连胸背（间有吐白沫一二次者）者，皆心痛危症，死期近矣，不可认为胃痛也（心痛一症，中医往往不易认识，故附识于此）。
以上因论神昏谵语，连类及于温病，又特举出温病内闭之危症，以告学者。此段文字应与前论大热似寒一节对照，自不致有误认。盖大热似寒之危症，是上关下格。（即肠胃热滞，上下不通气，因而内外不通气，是有形之热滞，所以非急开下窍不可，用重泻药）温病热入膻中之危象，是内闭外脱。（系热痰胶滞膻中，因而肺胀血滞心包，内外不通气，并非肠胃不通气，与肠尤无涉，是无形之热滞，所以越用泻药，病越加重，非急开诸窍不可。）此数语最为紧要，临症时要认清也。
至若虚证之头痛、眩晕，率多久病，不难辨认。大凡头痛时发时愈，或偏头痛，或眩晕，最为常见。中医论此症（此症亦有因实证头痛日久失治，转变为虚证头痛者，不可不知），率谓清阳不升，风火乘虚上攻（肝风）巅顶，及浊阴阻滞，气血瘀痹而然。；此说骤观之似近玄虚，然细参此理，实与西医神经性头痛、眩晕之说吻合。盖中医无神经二字，凡所谓络及孙络等名词，多指神经系而言，故有久病入络之说。其法之最有效者，例如熄内风（平肝滋阴之药，滋肾液，及镇摄潜阴，宣和清阳等药，屡试屡验，绝非玄虚（参看医验）。西药中治头痛、眩晕等药，亦非常灵验，然药力持续时间甚短，且不宜于虚证，屡试皆然，故附录于此（久服西药止头痛、眩晕，恐有侵害心脏之弊，且易呕吐，不可不慎。）。于必不得已时，偶一用之，略以缓和病势则可，慎勿常久服用也。（近人对于西药．一知半解，辄好滥用，最为危验，治此症之药，例如安基比林、咖啡涅等，均属剧药，如无真正西医学识，万不可任意用之，而咖啡涅一药，尤属剧烈，用不得当，危险立至，不可不知。）此症脉弦细者易治，洪大有力或无力（老年入及阳虚者多有此咏，此即西医说血压高之现脉），神昏谵语，亦有虚证（无热）至久病将死，多有此现象，不易挽救矣。
凡属虚性泄泻的病证，大体表现为身体瘦弱，皮肤苍白，腹部凹陷，没有腹痛或仅有轻微的隐痛，脉象多细弱无力或稍快，舌面大多无苔，小便清长通畅，通常没有高热（可与后文提到的有发热的情况参照比较），这种泄泻的大便多稀薄，或者稍微带有一点像白油样的物质（不能误认为是痢疾），或者是完谷不化（食物未经消化排出），一天排便三到五次甚至七八次居多，尤其在后半夜或清晨，必定要腹泻一两次（俗称五更泻、鸡鸣泻等）。越泻身体越虚弱，那么虚证的征象就全部显露出来，例如盗汗、喘息、全身浮肿以至于死亡。这种泄泻，中医多归责于脾脏虚弱，相火衰弱，所以多用健脾药（如白术、山药、茯苓等）、补气药（如人参、黄芪等）、补相火药（如补骨脂、肉苁蓉等）、补阳药（如附子、肉桂等）、收涩药（如桑螵蛸、罂粟壳等，以上药物都是经过试验有效的）来治疗，大半都能见效，药效持续很久，因此从根本上治愈的很多。西药中的硝酸银、单那尔宾、阿片粉等，对此症更容易见效，但相比之下效力持续的时间略短，而且长时间服用西药中的阿片等，又担心慢性中毒成瘾，所以我每次遇到此症，必定连续使用几天西药后，就逐渐改用中药，疗效之好，不可思议（西药则逐渐减量，中药必须用大量才能见效）。然而这都是指普通的虚性泄泻而言，如果是肺结核末期的泄泻（肠结核），中药里的桂枝、附子、人参、黄芪，万万不可用，西药收敛剂用了，也只生效一时（此时只有用西药这一种办法），无济于事。更有阳虚发热的虚性泄泻，以及小儿慢惊风（此症多由出疹后、痢疾或吐泻症转变而来）的虚性泄泻，都有发热，那么中药补剂有唯一的特效，西药不能望其项背（阿片不可用于小儿，注意切记）。以上阳虚的泄泻，参看前文关于阳虚发热的论述，这里不再重复叙述。又有怀孕前患泄泻病的，治疗最棘手，应参看后面列出的王姓医案。
肿胀（七）肿胀这两个病症不必同时出现，更有虚实之分，不可混淆，而且肿的原因极多（例如充血性水肿、瘀血性水肿之类），西医病理学解释得很详细，必须参考。这里想要说的，仅仅是常见的虚性水肿（俗有水臌、气臌之名或称浮肿，及腹胀的两种情况，以本编叙述，都是经过实验验证的病症，所以不想过多铺陈以显示渊博。然而仅凭这二者的实验，学者如果能深信不疑，那么对于极难诊治的鼓胀症就已经如同得到了指南针一样。）
大凡肿胀两个病症，在中医里大概认为肿属于水病，胀属于气病，水病之中，又分阳水和阴水。推究其意义，凡是实证（都是因为风、热、湿、气而成，邪气从外来，都是有余的现象。初得的病，偶尔出现的浮肿都属于此类。），偶尔的浮肿，大多是突然得的病，小便短赤，大便不爽，或者有热泻，或者有寒热呕吐，骨节疼痛，舌苔黄绛或白厚，或者皮肤起有红点，（虚性水肿大小便也有不利，不可混淆）脉象实而有力。这种症象，大多适宜发散、宣通、利水、顺气、清热，甚至适宜攻下（注意以上的肿属于突然得病，例如温病多有这种情况）。中药里的麻黄、防风、生姜、桂枝、防己、柴胡、半夏、杏仁、陈皮、厚朴、茯苓、猪苓、泽泻、黄芩、栀子、大黄、芒硝、瓜蒌仁等，都是有效的药物，西药里的硫酸镁、醋酸钠也极有效，但如果属于久病的虚性水肿，则万万不可用。以上是治疗突然得病的水肿，都有效。我曾见一位医生给人治疗久病的水肿，开始用麻黄等发汗，接着用硫酸镁等泻下，一误再误，因而病死，（因为西医书中有治脚气水肿特效的说法，所以误用了）能不谨慎吗！虚证引起的肿，大多是久病，其症象都是渐渐而来的（与实证突然浮肿正好相反），其原因，中医书说是脾、肺、肾三经虚弱，不能气化。其症候大多尿少、食少、无汗、无津液，渐渐四肢浮肿，日久延及全身尽肿（此症大便或者溏薄或者干燥，绝不可误用行气泻下的药，如果是男子，则阴囊也会肿。）症自内发（都是不足的现象，中医称之为阴水），脉象多细弱，但也有反而出现洪大无力的脉象的（呕吐者、腹泻者也有这种情况），皮肤肿处，用手按压，多不能立即复原（如按湿面），皮肤苍白（发热的很少）。中医有效的治疗方法，以补脾补气（白术、茯苓、山药、人参、黄芪之类）、补阳（附子、肉桂、干姜等）、补肾（补骨脂等）等方法为最确实，西药中的巴拉奴妥林也有效（单用西药则无效）。对于虚性水肿的病症，尤其适宜在相应的方剂中，加入淡渗利尿的药物（茯苓皮必重用，或者酌情加入其他利水的药），并且适宜兼顾胃气，稍加砂仁。实证浮肿，原因一去，其肿立刻消退（例如温病关节肿不必治肿，温毒既散肿必自愈），不必深谈。这里所要叙述的，是治疗久病虚证之肿的要诀，此症认定后，就用大剂的补品，放胆给病人服用，不要因为病人有干呕，或者自觉有热气冲咽胸满等现象，而不敢用补药。药味愈简单愈好，药量愈大愈好，补剂之中，加入渗利药物，加入和胃的药物，重者数十剂，轻者十余剂，没有不收效的（参看医案）。我往往接治其他医生治不好的虚性水肿，仍然沿用原方，只减去其中杂乱滥竽不关重要的药物（例如补心、补肺、补血等药），而加重适合本症的药物（例如人参、黄芪、桂枝、附子，往往加至八钱至一两），简单几味药，药力专一而效果反而更大，几剂后没有不见效的，药虽然平常，疗效已经过实验。这就是我治疗本症最得意的地方，愿意以此告诉同行（虚性水肿单用西药多无效，外科手术也不适用，在全身皆肿之后放水法，也不是根本治法，希望医者唯一适用中药也（参看医案）。
胀这一个病症，比肿轻，西医认为胀是肠腹内有蓄积的气体，中医则分虚胀与实胀两种。《内经》说诸胀腹大，皆属于热，这句话颇有精义，所以历来治疗虚性水肿者，可以纯用补药，治疗虚性胀满者（虚性水肿发展到胸腹，此时内脏也肿，往往病人自诉苦闷填胀，医者如果误认为这是真胀，加入顺气消导的药，那就大错特错了。须知浊阴上干，必是元阳大虚，才会这样。）则纯用补药的时候很少，即使确实属于虚证，也适宜在补药中稍加疏利的药物为妥（例如蔻仁等），千万不要一味蛮补。至于实证引起的胀，大多以顺气缓下的药剂为宜，原因一去（例如停水、停食作胀）胀满即除，不难治疗，无需赘述。
汗（八）汗已在前面的发热论中详述，可参照。
头痛（九）头痛、眩晕、神昏、谵语这些病象，更须分别虚证、实证论治，不可含糊。大凡实证多是新得的病，轻则眩晕（温病多有），重则头痛（温病、伤寒，凡是热性病初起，多有此症。所谓表证，宜用发散药，然而温病逆传已危，绝无表邪，而头奇痛者更多，此时万万不可误认仍有表证在也。）再重（邪气已入内）则神昏、谵语、发狂，这大概是由于脑神经受侵袭（脑膜炎、脑充血均有头痛。）在中医则归责于心包络受邪（不属于表证了），热邪胶滞膻中（邪入心包血分，也有似表证之极重头痛、头昏，但不恶寒，而呕吐极甚，医者应参看其他症象认定之。）此症在温热病中，最容易误治，大多因为医者只知道“内热”二字（虽然这不算是误认，然而一味清解或攻下。大便愈下，上热愈结，津液因热耗损与攻下而更加受伤，突然变成惊厥角弓反张、鼻干目吊、上窜无泪，或者四肢厥逆、狂躁烦闷、胸高气促、呕逆、精神昏迷，粗工见此症状，认为结胸，给予小陷胸汤，这叫无的放矢。更或大加攻下，给予承气汤，这叫攻伐无罪，盖邪气不在肠胃，愈泻愈危，下愈虚，上愈实，医药杀人，就在于此。我对此症，不厌反复叮咛，必使学者深刻认识此症为（内闭）邪热在上，邪入膻中，邪在血分，如果不是大便燥结或热结旁流，此症不但不可仅仅调胃，更不可鲁莽攻下，以致误人性命，戒之戒之。）而不能分清热在何处。用药起初清凉，继而甘寒，继而苦降（这三种方法并非无效，但到了内闭的候象，无济于事了。）三种方法既施，束手无策了。（西药对于内闭险症，绝对无效，不必试用。）现将我治疗温病试验所得的有效方法，详细列于下，以备参考。（此由论头痛、眩晕、神昏、谵语等病理，连类而及，阅者勿以为不伦也。）①初得温病，咳嗽、头痛、呕吐、身酸或痛，舌白苔或无苔，脉或浮洪，身热或微恶寒，治疗宜注重上焦（肺经），选用轻清的药物，开发肺气。例如连翘、双花、菊花、桑叶、绿豆皮、竹叶、贝母、荆芥、防风、薄荷、苏叶等（此后四味，初得有外寒束缚，头痛、身痛或恶寒者，方可加入。温病忌汗四字，须活看，不必拘泥。）治疗为宜。
②温病稍久，邪气不得解，口渴烦闷呕吐，舌苔黄绛，小便赤短，大便或者干燥或者泻极臭的稀粪，身热，头晕头痛（此时头痛，万万不可认为表证）脉沉数洪实甚至或反沉小（四肢厥逆脉多沉，小儿拍宜注重胃中实热，酌加苦寒方可，若仍尽用轻清的药物，病重药轻，无济于事，必兼用川连、石菖蒲、桑皮、瓜蒌或石膏、黄芩、栀子、郁金等（西医谓石膏毫无效用，盲从者即置之弗用，可再细心试验，即知我列此味，非率而操觚者），橘红、陈皮、大黄（我于此症，喜用熟军，因为温病病在上焦，不宜大下，故稍用熟军亦有大效，过下之弊，往往演成内闭外脱的险症，又不可不慎也）等药。此外再以病情状况加入清轻芳香、清热解毒的药物，大多有奇效。（参看医案-）③温病七、八日后，失治，热邪逆传入膻中，实为危候。（温病初起不难治愈，入此阶段杀人极速，中医奥妙即在此处，起死回生其效如神。可惜学者临症茫然，不易臻此境也。）此时病人，并不能指定何处痛苦，所最显著的是精神昏迷，呕逆更甚，头痛、头晕、无汗（绝非表证），或者自汗，四肢厥逆，（如果是多日不大便，小便赤短，潮热，也可稍用泻药，大便不结不腹痛者勿用。）目瞑。鼻干无涕泪，身体发痉，狂躁，胸高气促，（小儿误服泻药，尤多此现象，非陷胸症也。）甚至角弓反张。如果用泻药太过，下愈通，上愈实（诸窍将闭），医者须认定此症，即是邪闭膻中。无形、无质，胶滞郁结既不在胃腑，亦不在肠，屡用攻下，是速其死也，此时唯一治法，即在以芳香上宣诸窍（石菖蒲、郁金、金银花、连翘、石斛等类，再佐以其他清热解毒的药物），此时犀角一味，为必不可少之品（此药最昂贵，必要时不惜也），至宝丹、紫雪丹，更为有效（此药开窍最速），神昏发痉的候象，速以此类药物救之，再参以滋阴药，例如生地、元参、麦冬，以及上述芳香诸品，大剂（如果呕逆太甚，可分数次服）缓缓给予服用（能一次服更佳，可一日两剂。），大半有生机（此症稍延时日，多致不救。）
久病也有实证，例如胃溃疡症，大多经年累月，我们读书要灵活，不可拘泥，胃脘痛一症，最要与心痛详辨，凡心口痛，而没有吞酸、便秘、食后胀闷、呕吐嘈杂等等胃病现症者，多系心痛（绞心症、心炎等），宜以西药（中药无效）治疗，凡心口绞痛、气短，一经劳动凉风，立时痛起，喘促不能起立，痛时上连胸背（间有吐白沫一二次者）者，皆心痛危症，死期近矣，不可认为胃痛也（心痛一症，中医往往不易认识，故附识于此）。
以上因论神昏谵语，连类及于温病，又特举出温病内闭的危症，以告学者。这段文字应与前论大热似寒一节对照，自不会有误认。盖大热似寒的危症，是上关下格。（即肠胃热滞，上下不通气，因而内外不通气，是有形之热滞，所以非急开下窍不可，用重泻药）温病热入膻中的危象，是内闭外脱。（系热痰胶滞膻中，因而肺胀血滞心包，内外不通气，并非肠胃不通气，与肠尤无涉，是无形之热滞，所以越用泻药，病越加重，非急开诸窍不可。）这几句话最为紧要，临症时要认清也。
至于虚证引起的头痛、眩晕，大多是久病，不难辨认。大凡头痛时发时愈，或者偏头痛，或者眩晕，最为常见。中医论此症（此症也有因实证头痛日久失治，转变为虚证头痛者，不可不知），大多说清阳不升，风火乘虚上攻（肝风）巅顶，以及浊阴阻滞，气血瘀痹而然。；此说乍看似乎接近玄虚，然而细参此理，实在与西医神经性头痛、眩晕之说吻合。盖中医无神经二字，凡所谓络及孙络等名词，多指神经系统而言，故有久病入络之说。其法中最有效的，例如熄内风（平肝滋阴的药物，滋肾液，及镇摄潜阴，宣和清阳等药物，屡试屡验，绝非玄虚（参看医案）。西药中治头痛、眩晕等药，也非常灵验，然而药力持续时间很短，且不适用于虚证，屡试皆然，故附录于此（久服西药止头痛、眩晕，恐有侵害心脏之弊，且易呕吐，不可不慎。）在万不得已时，偶尔用之，略以缓和病势则可，慎勿长久服用也。（近人对于西药一知半解，辄好滥用，最为危险，治此症的药物，例如安基比林、咖啡涅等，均属剧药，如无真正西医学识，万万不可任意用之，而咖啡涅一药，尤属剧烈，用不得当，危险立至，不可不知。）此症脉弦细者易治，洪大有力或无力（老年人及阳虚者多有此脉，此即西医说血压高之现脉），神昏谵语，也有虚证（无热）直到久病将死，多有此现象，不易挽救矣。
For all cases of deficiency-type diarrhea, the general presentation involves a thin and weak body, pale skin, sunken abdomen, absence of abdominal pain or only slight dull pain, a pulse that is mostly fine, weak, and forceless or slightly rapid, a tongue surface mostly without coating, clear and free urination, and typically no high fever (compare with later sections mentioning fever). The stool in such diarrhea is mostly loose, or may contain a small amount of white oily substance (do not mistake for dysentery), or undigested food particles. Bowel movements occur three to seven or eight times a day, especially one or two times in the late night or early morning (commonly known as "fifth-watch diarrhea" or "rooster-crow diarrhea"). The more one defecates, the weaker the body becomes, revealing all signs of deficiency syndrome, such as night sweats, panting, generalized edema leading to death. In Traditional Chinese Medicine (TCM), this type of diarrhea is largely attributed to Spleen Qi deficiency (deficiency of the Spleen organ system) and decline of Ministerial Fire (a concept related to metabolic heat and vitality). Therefore, treatment often employs herbs to strengthen the Spleen (such as Atractylodis Rhizoma [Baizhu], Dioscoreae Rhizoma [Shanyao], Poria [Fuling]), tonify Qi (such as Ginseng Radix et Rhizoma [Renshen], Astragali Radix [Huangqi]), supplement Ministerial Fire (such as Psoraleae Fructus [Buguzhi], Cistanches Herba [Roucongrong]), tonify Yang (such as Aconiti Lateralis Radix Praeparata [Fuzi], Cinnamomi Cortex [Rougui]), and astringe (such as Sangiaospermum [Sangpiaoxiao], Papaveris Pericarpium [Yingsuke]). These medicines have been tested and proven effective. More than half of the cases respond well, with long-lasting efficacy, resulting in many fundamental cures. Western medicines such as Silver Nitrate, Tannalbin, and Opium Powder are also highly effective for this condition but their effects last for a shorter duration. Moreover, prolonged use of Western opium products risks chronic toxicity and addiction. Thus, whenever I encounter such cases, I initially administer Western medicine for several days, then gradually switch to TCM, achieving miraculous results (Western medicine dosage should be tapered; TCM requires large doses for effectiveness). However, this refers only to ordinary deficiency diarrhea. If it is diarrhea in the terminal stage of Pulmonary Tuberculosis (Intestinal Tuberculosis), TCM herbs like Cinnamomum Ramulus (Guizhi), Aconitum (Fuzi), Ginseng (Renshen), and Astragalus (Huangqi) must absolutely not be used. Western astringents provide only temporary relief at this stage (only Western medicine is viable), offering no substantial help. Furthermore, there is deficiency diarrhea accompanied by fever due to Yang deficiency, and deficiency diarrhea in pediatric slow convulsion syndrome (often arising after exanthematous diseases, dysentery, or vomiting/diarrhea syndromes), which also present with fever. For these, TCM tonic formulas offer unique specific efficacy, far surpassing Western medicine (Note: Opium must not be used in children). Regarding Yang-deficiency diarrhea, refer to the previous discussion on Yang-deficiency fever; it will not be repeated here. Additionally, diarrhea occurring during pregnancy is most difficult to treat; refer to the Wang family medical case listed later.
Swelling and Distension (7): Swelling and distension do not necessarily occur together and have distinct deficiency and excess patterns that must not be confused. The causes of swelling are numerous (e.g., congestive edema, stasis-induced edema), which Western pathology explains in detail and must be referenced. What I wish to discuss here are merely common cases of deficiency-type edema (colloquially known as water drum, qi drum, or generalized edema, and abdominal distension). Since these descriptions in this volume are based on verified clinical experiments, I do not intend to elaborate excessively to display erudition. However, if scholars can firmly believe in these two experimental approaches, they will possess a compass for diagnosing and treating the extremely difficult condition of abdominal distension (鼓胀).
Generally, in TCM, swelling is attributed to Water Disease, while distension is attributed to Qi Disease. Water Disease is further divided into Yang Water and Yin Water. Analyzing the meaning, Excess Syndromes (caused by Wind, Heat, Dampness, or Qi stagnation, with pathogenic factors entering from outside, presenting as surplus) typically manifest as occasional acute edema. Acute edema usually arises suddenly, accompanied by scanty dark urine, uncomfortable bowel movements, hot diarrhea, alternating chills and fever with vomiting, bone and joint pain, yellow-red or thick white tongue coating, or red spots on the skin. (Note: Deficiency edema can also involve difficult urination and defecation; do not confuse them.) The pulse is solid and forceful. Such presentations generally require dispersing, unblocking, promoting diuresis, regulating Qi, clearing Heat, or even purging (Note: The above swelling refers to acute onset, common in Warm Diseases). Effective TCM herbs include Ephedrae Herba (Mahuang), Saposhnikoviae Radix (Fangfeng), Zingiberis Rhizoma Recens (Shengjiang), Cinnamomi Ramulus (Guizhi), Stephaniae Tetrandrae Radix (Fangji), Bupleuri Radix (Chaihu), Pinelliae Rhizoma (Banxia), Armeniacae Semen (Xingren), Citri Reticulatae Pericarpium (Chenpi), Magnoliae Officinalis Cortex (Houpo), Poria (Fuling), Polyporus (Zuling), Alismatis Rhizoma (Zexie), Scutellariae Radix (Huangqin), Gardeniae Fructus (Zhizi), Rhei Radix et Rhizoma (Dahuang), Natrii Sulfas (Mangxiao), Trichosanthis Semen (Gualouren), etc. Western medicines like Magnesium Sulfate and Sodium Acetate are also very effective. However, they must absolutely not be used for chronic deficiency edema. The above methods are effective for acute edema. I once witnessed a physician treating chronic edema by first inducing sweating with Mahuang, followed by purging with Magnesium Sulfate. One error after another led to the patient's death (misguided by Western texts claiming these drugs are specific for beriberi edema). How can one not be cautious! Edema due to deficiency syndromes is usually chronic, developing gradually (opposite to acute excess edema). TCM attributes this to weakness of the Spleen, Lung, and Kidney meridians, failing to transform Qi. Symptoms include oliguria, anorexia, anhidrosis, lack of body fluids, gradual swelling of limbs progressing to whole-body edema (stool may be loose or dry; never use Qi-moving or purgative herbs; in males, the scrotum may also swell). This originates internally (signs of insufficiency, termed Yin Water in TCM), with a fine and weak pulse, though occasionally a surging yet forceless pulse may appear (also seen in vomiting or diarrhea patients). Pressing swollen skin leaves an indentation that does not immediately rebound (like pressing wet dough), and the skin is pale (fever is rare). Effective TCM treatments focus on strengthening the Spleen and tonifying Qi (Atractylodis Rhizoma, Poria, Dioscoreae Rhizoma, Ginseng, Astragalus), tonifying Yang (Aconite, Cinnamon, Dried Ginger), and tonifying the Kidney (Psoralea). Western medicine Barbiturates are also effective (but ineffective if used alone). For deficiency edema, it is particularly suitable to add mild diuretics to appropriate formulas (use heavy doses of Poria Peel, or add other diuretics as needed), while protecting Stomach Qi by adding Amomi Fructus (Sharen). Once the cause of excess edema is removed, the swelling subsides immediately (e.g., in Warm Diseases, joint swelling resolves spontaneously as the toxin dissipates); thus, deep discussion is unnecessary. Here, I describe the key to treating chronic deficiency edema: once diagnosed, boldly administer large doses of tonics. Do not hesitate due to symptoms like dry heaving or sensations of heat rushing to the throat/chest/fullness. Simpler formulas and larger doses are better. Add damp-draining and stomach-harmonizing herbs to tonics. Severe cases may take dozens of prescriptions; mild cases, ten-plus. All achieve success (see medical cases). I often treat chronic deficiency edema neglected by other physicians by retaining the original formula, removing irrelevant herbs (e.g., Heart/Lung/Blood tonics), and increasing dosages of targeted herbs (e.g., Ginseng, Astragalus, Cinnamon, Aconite up to 8 qian to 1 liang). Simple formulas with focused efficacy yield greater results, showing effect within a few doses. Though the herbs are common, the efficacy is verified. This is my proudest achievement in treating this condition, shared with colleagues (Deficiency edema rarely responds to Western medicine alone; surgery is unsuitable; draining fluid after whole-body edema is not a root cure. Physicians should rely solely on TCM; see cases).
Distension is milder than swelling. Western medicine defines it as gas accumulation in the intestines/abdomen. TCM distinguishes between deficiency and excess distension. The *Classic* states: "All distensions with abdominal enlargement belong to Heat." This has profound significance. While pure tonics suffice for deficiency edema, they are rarely sufficient for deficiency distension (when edema reaches the chest/abdomen, internal organs swell, causing patient distress/fullness; mistaking this for true distension and adding Qi-regulating/digestive herbs is a major error. Turbid Yin ascending indicates severe Yuan Yang deficiency). Even in confirmed deficiency, adding mild resolving/draining herbs (e.g., Cardamomum Fructus [Kaoren]) to tonics is prudent; avoid blind tonification. Excess distension is best treated with Qi-regulating and mild purgatives; once the cause (e.g., water retention, food stagnation) is removed, distension resolves easily. No need for elaboration.
Sweating (8): Detailed in the previous Fever section; refer thereto.
Headache (9): Headache, dizziness, coma, and delirium require differentiation between deficiency and excess syndromes; do not be vague. Excess syndromes are usually new-onset. Mild cases present with dizziness (common in Warm Diseases); severe cases with headache (Warm Diseases, Cold Damage; common in early stages of febrile diseases. Known as Exterior Syndrome, treated with dispersing herbs. However, in Warm Diseases with reverse transmission, danger is imminent; there is no exterior pathogen, yet severe headache occurs. Do not mistake this for remaining exterior syndrome.) Further progression (pathogen enters interior) leads to coma, delirium, and mania, likely due to cranial nerve invasion (meningitis, cerebral congestion both cause headache). In TCM, this is attributed to the Pericardium Meridian being invaded (no longer an Exterior Syndrome), with Heat pathogens stagnating in the Danzhong (Chest Center). (Pathogen entering Pericardium Blood level can cause severe headache/dizziness resembling exterior syndrome, but without aversion to cold and with severe vomiting; physicians must assess other signs.) This condition is easily misdiagnosed in Warm Diseases because physicians only recognize "Internal Heat." While not entirely wrong, using only clearing/purging methods worsens the condition: purging damages fluids and aggravates upper Heat, leading to sudden convulsions, opisthotonos, dry nose, staring eyes, upward gaze without tears, cold limbs, restlessness, shortness of breath, vomiting, and coma. Unskilled physicians may diagnose "Jueyin Chest Binding" and prescribe Xiaoxianxiong Tang (aimless shooting). Others may heavily purge with Chengqi Tang (attacking non-existent pathogens). Since the pathogen is not in the intestines/stomach, purging increases danger: lower deficiency, upper excess. Medical errors kill. I repeatedly emphasize: scholars must recognize this as Internal Closure with Heat in the Upper Jiao/Danzhong/Blood Level. Unless there is dry stool or hot binding with leakage, do not merely harmonize the Stomach, let alone recklessly purge, risking life. Beware! Physicians fail to locate the Heat precisely. Initial treatment uses cooling, then sweet-cool, then bitter-draining methods. These work initially but fail in Internal Closure. At this point, physicians are helpless. (Western medicine is absolutely ineffective for internal closure critical conditions; do not test.) Below are my tested effective methods for Warm Diseases, for reference. (This follows logically from discussions on headache/dizziness/coma/delirium pathology; readers should not find it disjointed.)
1. Early Warm Disease: Cough, headache, vomiting, body ache/soreness, white or no tongue coating, floating or surging pulse, fever or slight aversion to cold. Treatment focuses on the Upper Jiao (Lung Meridian) using light/clearing herbs to diffuse Lung Qi. Examples: Forsythiae Fructum (Lianqiao), Lonicerae Flos (Jinyinhua/Shuanghua), Chrysanthemi Flos (Juhua), Mori Folium (Sangye), Vigna Radiata Pericarpium (Lvdoupi), Bambusae Folium (Zhuye), Fritillariae Bulbus (Beimu), Schizonepetae Spica (Jingjie), Saposhnikoviae Radix (Fangfeng), Menthae Haplocalycis Herba (Bohe), Perillae Folium (Ziyeh). (The latter four may be added only if external cold constriction exists with headache/body ache/aversion to cold. The rule "Warm Diseases forbid sweating" must be applied flexibly, not rigidly.)
2. Later Warm Disease: Pathogen unresolved, thirst, irritability, vomiting, yellow-red tongue coating, scanty dark urine, dry stool or foul-smelling loose stool, fever, dizziness/headache (Do NOT consider this exterior syndrome). Pulse is deep, rapid, surging, solid, or occasionally deep/small (cold limbs often show deep pulse). Focus on Stomach Excess Heat; add bitter-cold herbs if necessary. Using only light/clearing herbs is insufficient for severe disease. Combine with Coptidis Rhizoma (Chuanlian), Acori Tatarinowii Rhizoma (Shichangpu), Morus Cortex (Sangbai), Trichosanthis Fructus (Gualou), Gypsum Fibrosum (Shigao), Scutellariae Radix (Huangqin), Gardeniae Fructus (Zhizi), Curcumae Radix (Yujin), Citri Reticulatae Pericarpium (Juhong), Citri Reticulatae Pericarpium (Chenpi), Rhei Radix et Rhizoma (Dahuang). (I prefer prepared Rhubarb for this condition because Warm Disease affects the Upper Jiao and heavy purging is contraindicated; mild prepared Rhubarb is effective. Over-purging risks Internal Closure with External Collapse; be cautious.) Add light/aromatic/heat-clearing/toxin-resolving herbs based on symptoms for miraculous effects (see cases).
3. Warm Disease Day 7-8: Untreated, Heat reverses into Danzhong, a critical state. (Early Warm Disease is easy to cure; this stage kills rapidly. TCM's subtlety lies here, bringing the dead back to life. Scholars often lack clarity in practice.) Patients cannot localize pain. Key signs: mental coma, severe vomiting, headache/dizziness, anhidrosis (NOT exterior syndrome) or spontaneous sweating, cold limbs (if no stool for days, dark urine, tidal fever, mild purgatives may be used; if stool is not dry and no abdominal pain, do not use), closed eyes, dry nose without tears/mucus, muscle spasms, mania, chest fullness with rapid breathing (common in children mistakenly given purgatives; not Xianxiong syndrome), eventually opisthotonos. Excessive purging makes the lower pass and upper block tighter (orifices closing). Physicians must recognize this as Pathogen Closing Danzhong. It is formless, sticky, and stagnant, neither in Stomach nor Intestines. Repeated purging hastens death. The only treatment is aromatic herbs to open orifices (Acori Tatarinowii Rhizoma, Curcumae Radix, Lonicerae Flos, Forsythiae Fructum, Dendrobii Caulis, etc.), combined with heat-clearing/toxin-resolving herbs. Rhinoceros Horn (Xijiao) is essential (expensive; use when necessary). Zhibao Dan and Zixue Dan are more effective (fastest orifice-opening). For coma/spasms, use these urgently, supplemented by Yin-nourishing herbs (Rehmanniae Radix, Scrophulariae Radix, Ophiopogonis Radix) and aromatics. Administer large doses slowly (divide if vomiting is severe; twice daily is ideal). More than half survive (delay leads to death).
Chronic illness can also present with Excess Syndromes, e.g., Gastric Ulcer (chronic). Study must be flexible. Epigastric pain must be distinguished from Heart Pain. Heart pain without acid regurgitation, constipation, postprandial fullness, or belching is likely Heart Pain (cardiac spasm, myocarditis), treatable only by Western medicine (TCM ineffective). Severe heart pain with shortness of breath, triggered by exertion/cold wind, radiating to chest/back, possibly with white foam, is a critical Heart Pain condition nearing death; do not mistake for Stomach pain (TCM often struggles to identify Heart Pain; noted here).
Above, discussing coma/delirium led to Warm Disease, specifically highlighting the critical Internal Closure of Warm Disease for students' benefit. Compare this with the earlier "Great Heat Resembling Cold" section to avoid confusion. Great Heat Resembling Cold is "Upper Obstruction and Lower Gridlock" (有形热滞 - tangible heat stagnation in intestines/stomach blocking Qi flow internally/externally; requires urgent opening of lower orifices with heavy purgatives). Warm Disease Heat entering Danzhong is "Internal Closure and External Collapse" (无形热滞 - formless heat-phlegm stagnating in Danzhong, causing Lung distension and Pericardium blood stasis, blocking internal/external Qi but NOT intestinal Qi; unrelated to intestines; requires urgent opening of all orifices, NOT purgatives). These distinctions are crucial for clinical practice.
Deficiency-type headache/dizziness is usually chronic and easy to identify. Headache comes and goes, migraines, or dizziness are common. TCM attributes this to Clear Yang failing to ascend, Wind-Fire attacking the vertex due to deficiency (Liver Wind), and Turbid Yin obstructing, causing Qi/Blood stasis. (Note: Chronic excess headache untreated can transform into deficiency headache.) This theory seems abstract but aligns with Western neurogenic headache/dizziness concepts. TCM lacks the term "nerve"; terms like Luo vessels and Sun-Luo vessels often refer to the nervous system ("chronic disease enters the Luo vessels"). Most effective methods include extinguishing internal Wind (Liver-calming/Yin-nourishing, Kidney-fluid-nourishing, anchoring/subduing, diffusing/harmonizing Clear Yang). These are proven effective, not abstract (see cases). Western medicines for headache/dizziness are also effective but short-acting and unsuitable for deficiency. (Long-term use risks cardiac damage and vomiting; be cautious.) Use only reluctantly to temporarily relieve symptoms; do not use long-term. (Modern misuse of Western medicine due to partial knowledge is dangerous. Drugs like Antipyrine and Coffeine are potent; without proper Western medical knowledge, do not use arbitrarily. Caffeine is particularly dangerous if misused.) Pulse wiry and fine indicates easier treatment. Surging/forceful or forceless pulses (common in elderly/Yang-deficient; corresponds to Western high blood pressure) with coma/delirium (without fever) in chronic dying patients are difficult to rescue.