洄溪医案
清·徐灵胎著
序
袁简斋太史作《灵胎先生传》云：欲采其奇方异术，以垂医鉴，而活苍生。因仓卒不可得，仅载迮耕石汪令闻数条，而语焉未详，余甚惜之。今夏吕君慎■以《洄溪医案》钞本一卷寄赠，云得之徐氏及门金君复村者。余读之如获鸿宝，虽秘本而方药不甚详，然其穿穴膏肓，神施鬼设之伎，足以垂予鉴而活苍生。爰为编次，窃附高窥，用俟高明，梓以传世，余殷望焉。
咸丰五年岁次乙卯十月海昌后学王士雄
封门金姓，早立门首，卒遇恶风，口眼歪邪，噤不能言。医用人参、桂、附诸品，此近日时医治风证不祧之方也。趣余视之，其形如尸，面赤气粗，目瞪脉大，处以祛风消痰清火之剂。其家许以重赀，留数日。余曰:我非行道之人，可货取也。固请，余曰:与其误药以死，莫若服此三剂，醒而能食，不服药可也。后月余，至余家拜谢。问之，果服三剂而起，竟不敢服他药。惟腿膝未健，手臂犹麻，为立膏方而全愈。此正《内经》所谓虚邪贼风也，以辛热刚燥治之固非，以补阴滋腻治之亦谬，治以辛凉，佐以甘温，《内经》有明训也。
运使王公叙揆，自长芦罢官归里，每向余言，手足麻木而痰多。余谓公体本丰腴，又善饮啖，痰流经脉，宜撙节为妙。一日忽昏厥遗尿，口噤手拳，痰声如锯，皆属危证。医者进参、附、熟地等药，煎成未服。余诊其脉，洪大有力，面赤气粗，此乃痰火充实，诸窍皆闭，服参附立毙矣。以小续命汤去桂附，加生军一钱，为末，假称他药纳之，恐旁人之疑骇也。戚党莫不哗然，太夫人素信余，力主服余药。三剂而有声，五剂而能言，然后以消痰养血之药调之，一月后步履如初。
张由巷刘松岑，素好饮，后结酒友数人，终年聚饮，余戒之不止。时年才四十，除夕向店沽酒，秤银手振，秤坠而身亦仆地，口噤不知人，急扶归。岁朝，遣人邀余，与以至宝丹数粒，嘱其勿服他药，恐医者知其酒客，又新纳宠，必用温补也。初五至其家，竟未服药，诊其脉弦滑洪大，半身不遂，口强流涎，乃湿痰注经传腑之证。余用豁痰驱湿之品调之，月余而起。一手一足，不能如旧，言语始终艰涩。初无子，病愈后，连举子女皆成立，至七十三岁而卒。谁谓中风之人不能永年耶?凡病在经络筋骨，此为形体之病，能延岁月，不能除根。若求全愈，过用重剂，必至伤生。富贵之人闻此等说，不但不信，且触其怒，于是谄谀之人，群进温补，无不死者，终无一人悔悟也。
西门外汪姓，新正出门，遇友于途，一揖而仆，口噤目闭，四肢瘫痪，舁归不省人事，医亦用人参、熟地等药。其母前年曾抱危疾，余为之治愈，故信余求救。余曰:此所谓虚邪贼风也，以小续命汤加减。医者骇，谓壮年得此，必大虚之证，岂可用猛剂?其母排众议而服之。隔日再往，手揽余衣，两足踏地，欲作叩头势。余日:欲谢余乎?亟点首，余止之。复作垂涕感恩状，余慰之，且谓其母日:风毒深人，舌本坚硬，病虽愈，言语不能骤出，毋惊恐而误投温补也。果月余而后能言，百日乃痊。
东山席以万，年六十余，患风痹，时医总投温补，幸不至如近日之重用参、附，病尚未剧。余诊之，脉洪而气旺，此元气强实之体，而痰火充盛耳。清火消痰以治标，养血顺气以治本。然经络之痰，无全愈之理，于寿命无伤，十年可延也。以平淡之方，随时增损，调养数载，年七十余始卒。此所谓人实证实，养正驱邪，以调和之，自可永年。重药伤正，速之死耳。
叔子静，素无疾，一日，余集亲友小酌，叔亦在座，吃饭至第二碗仅半，头忽垂，著亦落。同座问曰:醉耶?不应。又问:骨哽耶?亦不应。细视之，目闭而口流涎，群起扶之别座，则颈已歪，脉已绝，痰声起，不知人矣。亟取至宝丹灌之，始不受，再灌而咽下。少顷开目，问扶者曰:此何地也?因告之故。曰:我欲归。扶之坐舆内以归，处以驱风消痰安神之品，明日已能起，惟软弱无力耳。以后亦不复发。此总名卒中，亦有食厥，亦有痰厥，亦有气厥。病因不同，如药不预备，则一时气不能纳，经络闭塞，周时而死。如更以参、附等药助火助痰，则无一生者。及其死也，则以为病本不治，非温补之误，举世皆然也。
雄按:《资生经》云:有人忽觉心腹中热甚，或曰:此中风之候，与治风药而风不作。夷陵某太守夏间忽患热甚，乃以水洒地，设簟卧其上，令人扇之，次日忽患中风而卒。人但咎其卧水簟而用扇也。暨见一澧阳老妇，见证与太守同，因服小续命汤而愈。合而观之，乃知中风由心腹中多大热而作也。徐氏之论，正与此合。《易》曰:风自火出。谚云:热极生风。何世人之不悟耶?若可用参、附等药者，乃脱证治法，不可误施于闭证也。
恶 风
湖州副总戎穆公延弼，气体极壮，忽患牙紧不开，不能饮食，绝粒者五日矣。延余治之，晋接如常，惟呼饥耳。余启视其齿，上下止开一细缝，抚其两颊，皮坚如革，细审病情，莫解其故。因问曰：此为恶风所吹，公曾受恶风否?曰:无之。既而恍然曰:诚哉!二十年前曾随围口外卧帐房中，夜半怪风大作，帐房拔去，卒死者三人，我其一也。灌以热水，二人生而一人死。我初醒，口不能言者二日，岂至今复发乎?余曰:然。乃戏曰：凡治皮之工，皮坚则消之。我今欲用药消公之颊皮也。乃以蜈蚣头、蝎子尾及朴硝、硼砂、冰、麝等药擦其内，又以大黄、牙皂、川乌、桂心等药涂其外，如有痰涎，则吐出。明晨余卧未起，公启户曰:真神仙也，早已食粥数碗矣。遂进以驱风养血膏而愈。盖邪之中人深，则伏于脏腑骨脉之中，精气旺，则不发。至血气既衰，或有所感触.虽数十年之久亦有复发者。不论内外之证尽然，亦所当知也。
雄按:皮肤顽痹，非外治不为功。此因其坚如革，故多用毒烈之品。
周 痹
乌程王姓患周痹证，遍身疼痛四肢瘫痪，日夕叫号，饮食大减，自问必死，欲就余一决。家人垂泪送至舟中，余视之曰:此历节也。病在筋节，非煎丸所能愈，须用外治。乃遵古法，敷之、拓之、蒸之、薰之，旬日而疼痛稍减，手足可动，乃遣归，月余而病愈。大凡营卫脏腑之病，服药可至病所，经络筋节，俱属有形。煎丸之力，如太轻则不能攻邪，太重则恐伤其正，必用气厚力重之药，敷、拓、薰、蒸之法，深入病所，提邪外出。古之所议独重针灸之法，医者不知，先服风药不验，即用温补，使邪气久留，即不死亦为废人，在在皆然，岂不冤哉。
雄按:风药耗营液，温补实隧络，皆能助邪益痛。若轻淡清通之剂，正宜频服，不可徒恃外治也。
新郭沈又高，续娶少艾，未免不节，忽患气喘厥逆，语涩神昏，手足不举。医者以中风法治之，病益甚。余诊之曰:此《内经》所谓痱证也。少阴虚而精气不续，与大概偏中风、中风、痰厥、风厥之病绝不相类。刘河间所立地黄饮子，正为此而设，何医者反忌之耶?一剂而喘逆定，神气清，声音出，四肢展动。三剂而病除八九，调以养精益气之品而愈。余所见类中而宜温补者，止此一人。识之以见余并非禁用补药，但必对证，乃可施治耳。
雄按:古云真中属实，类中多虚，其实不然。若其人素禀阳盛，过啖肥甘，积热酿痰，壅塞隧络，多患类中。治宜化痰清热，流利机关，自始至终，忌投补滞。徐氏谓宜于温补者不多见，洵阅历之言也。
伤 寒
苏州柴行倪姓，伤寒失下，昏不知人，气喘舌焦，已办后事矣。余时欲往扬州，泊舟桐涇桥河内，适当其门，晚欲登舟，其子哀泣求治。余曰:此乃大承气汤证也。不必加减，书方与之。戒之曰:一剂不下则更服，下即止。遂至扬。月余而返，其人已强健如故矣。古方之神效如此。凡古方与病及证俱对者，不必加减；若病同而证稍有异，则随证加减，其理甚明，而人不能用。若不当下者反下之，遂成结胸，以致闻者遂以下为戒。颠倒若此，总由不肯以仲景《伤寒论》潜心体认耳。
嘉善黄姓，外感而兼郁热。乱投药石，继用补剂，邪留经络，无从而出，下注于足，两胫红肿大痛，气逆冲心，呼号不寐。余曰:此所谓刖足伤寒也，足将落矣。急用外治之法薰之、蒸之，以提毒散瘀，又用丸散内消其痰火，并化其毒涎，从大便出，而以辛凉之煎剂，托其未透之邪，三日而安。大凡风寒留于经络，无从发泄，往往变为痈肿，上为发颐，中为肺痈、肝痈、脾积，下为肠痈、便毒，外则散为斑疹疮疡，留于关节则为痿痹拘挛，注于足胫则为足矣。此等证具载于《内经》诸书，自内外科各分一门，此等证遂无人知之矣。
淮安大商杨秀伦，年七十四，外感停食。医者以年高素封，非补不纳。遂致闻饭气则呕，见人饭食辄叱曰:此等臭物，亏汝等如何吃下?不食不寝者匝月，惟以参汤续命而已。慕名来聘，余诊之曰:此病可治，但我所立方必不服，不服则必死。若徇君等意以立方亦死，不如竟不立也。群问:当用何药?余曰:非生大黄不可。众果大骇，有一人曰:姑俟先生定方再商。其意盖谓千里而至，不可不周全情面，俟药成而私弃之可也。余觉其意，煎成，亲至病人所强服，旁人皆惶恐无措，止服其半，是夜即气平得寝，并不泻。明日全服一剂，下宿垢少许，身益和。第三日侵晨，余卧书室中未起，闻外哗传云:老太爷在堂中扫地。余披衣起询，告者曰:老太爷久卧思起，欲亲来谢先生。出堂中，因果壳盈积，乃自用帚掠开，以便步履。旋入余卧所，久谈。早膳至，病者观食，自向碗内撮数粒嚼之，且曰:何以不臭?从此饮食渐进，精神如旧，群以为奇。余曰:伤食恶食，人所共知，去宿食则食自进，老少同法。今之医者，以老人停食不可消，止宜补中气，以待其自消，此等乱道，世反奉为金针，误人不知其几也。余之得有声淮扬者，以此。
时 证
西塘倪福征，患时证，神昏脉数，不食不寝，医者谓其虚，投以六味等药。此方乃浙中医家，不论何病，必用之方也。遂粒米不得下咽，而烦热益甚，诸人束手。余诊之曰:热邪留于胃也。凡外感之邪，久必归阳明，邪重而有食，则结成燥矢，三承气主之；邪轻而无食，则凝为热痰，三泻心汤主之。乃以泻心汤加减，及消痰开胃之药，两剂而安。诸人以为神奇，不知此乃浅近之理，《伤寒论》具在，细读自明也。若更误治，则无生理矣。
雄按:韩尧年年甫逾冠，体素丰而善饮，春间偶患血溢，广服六味等药。初夏患身热痞胀，医投泻心、陷胸等药，遂胀及少腹，且拒按，大便旁流，小溲不行，烦热益甚，汤饮不能下咽，澹语唇焦。改用承气、紫雪，亦如水投石。延余视之，黄苔满厚而不甚燥，脉滑数而按之虚软，不过湿热阻气，升降不调耳。以枳桔汤加白前、紫菀、射干、马兜铃、杏仁、厚朴、黄芩，用芦根汤煎。一剂谵语止，小溲行。二剂旁流止，胸渐舒。三剂可进稀糜。六剂胸腹皆舒，粥食渐加。改投清养法，又旬日得解燥矢而愈。诸人亦以为神奇，其实不过按证设法耳。
又按:今夏衣贾戴七，患暑湿，余以清解法治之，热退知饥，家人谓其积劳多虚，遽以补食啖之。三日后二便皆闭，四肢肿痛，气逆冲心，呼号不寐。又乞余往视，乃余邪得食而炽，壅塞胃腑，腑气实，则经气亦不通，而机关不利也。以苇茎汤去薏苡，加萎仁、积实、桅子、菔子、黄芩、桔梗，煎调元明粉，外用葱白杵烂，和蜜涂之。小溲先通，大便随行，三日而愈。
游 魂
郡中蒋氏子，患时证，身热不凉，神昏澹语，脉无伦次。余诊之曰:此游魂证也。虽服药必招其魂，因访招魂之法。有邻翁谓曰:我闻虔祷灶神，则能自言。父如其言，病者果言曰:我因看戏小台倒，几被压受惊，复往城隍庙中散步，魂落庙中，当以肩舆抬我归。如言往招。明日延余再诊，病者又言:我魂方至房门，为父亲冲散，今日魂卧被上，又为母亲叠被掉落，今不知所向矣。咆哮不已。余慰之曰:无忧也，我今还汝。因用安神镇魄之药，加猪心尖、辰砂，绛帛包裹，悬药罐中煎服。戒曰:服药得寝，勿惊醒之，熟寐即神合。果一剂而安，调理而愈，问之俱不知也。
失 魂
洄溪医案
清代·徐灵胎著
序言
袁枚（字子才，号简斋）太史在《灵胎先生传》中写道：想要采集他的奇特方剂和医术，以作为医学界的借鉴，从而拯救百姓。因为仓促之间无法得到，只记载了迮耕石、汪令闻等人的几条医案，但叙述得不够详细，我感到非常惋惜。今年夏天，吕慎■将一卷《洄溪医案》的抄本寄赠给我，说是从徐氏的学生金复村那里得到的。我读后如同获得了稀世珍宝，虽然秘本中方药细节不甚详尽，但其洞察病机、神妙莫测的技艺，足以作为借鉴并拯救苍生。于是我为其编排次序，谦卑地附上我的见解，以此等待高明之士，刻印传世，这是我殷切的期望。
咸丰五年（乙卯年）十月 海昌后学 王士雄
封门有一位姓金的病人，早起站在门口，突然遭遇恶风侵袭，导致口眼歪斜，牙关紧闭不能说话。医生使用人参、桂枝、附子等药物，这是当时治疗风证不违背常规的方法。急忙请我去诊治，患者形体僵硬如尸体，面色红赤，气息粗重，双眼直视，脉象宏大。我处以祛风、消痰、清火的方剂。家属许诺重金，挽留我数日。我说：“我不是靠行医谋生的人，可以拿钱走人。”他们坚决请求留下，我说：“与其误用药物致死，不如服用这三剂药，如果醒来能进食，不服药也可以。”后来过了一个多月，他到我家拜谢。询问病情，果然服了三剂药后痊愈，竟不敢再服其他药物。只有腿膝尚未恢复健康，手臂仍然麻木，我为他制定了膏方，最终完全治愈。这正是《黄帝内经》所说的“虚邪贼风”。用辛热刚燥的药物来治疗固然不对，用滋阴滋腻的药物来治疗也是错误的，应当用辛凉药物为主，佐以甘温药物，《黄帝内经》有明确的教导。
运使王公叙揆，从长芦罢官回到家乡，经常向我诉说手足麻木且痰多。我对他说，您身体本来丰满，又喜欢饮酒饮食，痰湿流注经脉，节制饮食是妙策。一天突然昏厥遗尿，牙关紧闭手握拳，痰声如锯，都属于危重证候。医生进献人参、附子、熟地黄等药物，煎好还未服用。我诊察他的脉象，洪大有力，面赤气粗，这是痰火充实，诸窍闭塞，如果服用参附类药物立刻就会死亡。用小续命汤去掉桂枝、附子，加入生大黄一钱，研成粉末，假装是其他药物混入其中，以免旁人怀疑惊骇。亲戚们无不哗然议论，太夫人一向信任我，极力主张服用我的药。三剂药后有了声音，五剂药后能说话，然后用消痰养血的药物调理，一个月后步履如初。
张由巷的刘松岑，平时喜好饮酒，后来结交了几位酒友，整年聚会饮酒，我劝诫他也不听。当时他才四十岁，除夕那天去店里买酒，称银子时手颤抖，秤砣坠落他也随之仆倒在地，牙关紧闭不知人事，急忙扶回家。正月初一，派人邀请我，我给了他几粒至宝丹，嘱咐他不要服用其他药物，恐怕医生知道他是酒客，又新纳宠妾，一定会用温补药物。初五到他家，竟然没有服药，诊察脉象弦滑洪大，半身不遂，口角强直流涎，这是湿痰注于经络传入腑脏的证候。我用豁痰驱湿的药物调理他，一个多月后起身。一只手和一只脚不能像以前那样灵活，言语始终艰涩。起初没有子女，病愈后，接连生下子女都健康成长，直到七十三岁去世。谁说中风的人不能长寿呢？凡是病在经络筋骨，这属于形体之病，能延长寿命，但不能除根。如果追求完全治愈，过度使用重剂，必然导致伤身丧命。富贵之人听到这种说法，不仅不信，反而触怒，于是谄媚阿谀之人，群起进献温补药物，没有不死人的，最终也没有一人悔悟。
西门外有一位姓汪的病人，新年出门，在路上遇到朋友，作揖时突然跌倒，牙关紧闭眼睛闭合，四肢瘫痪，抬回家不省人事，医生也用人参、熟地黄等药物。他的母亲前年曾患重病，我治愈了她，所以信任我并求救。我说：“这就是所谓的虚邪贼风”，用小续命汤加减。医生感到惊骇，说壮年人得此病，必定是大虚的证候，怎么能用猛药？他的母亲排除众人异议而服用。隔天再去，他拉着我的衣服，双脚踩在地上，想做叩头礼的姿势。我说：“想感谢我吗？”他拼命点头，我制止了他。他又做出流泪感恩的样子，我安慰他，并且对他的母亲说：“风毒深入，舌根僵硬，病虽然好了，言语不能立即恢复，不要惊恐而误投温补药物。”果然一个多月后才能说话，一百天才痊愈。
东山席以万，六十多岁，患风痹，当时的医生总是投用温补药物，幸好不至于像近日那样重用参、附，病情还不严重。我诊察他，脉象洪大而气旺，这是元气强实的体质，只是痰火充盛罢了。清火消痰以治标，养血顺气以治本。然而经络中的痰，没有完全治愈的道理，对寿命没有伤害，可以延续十年。用平淡的方剂，随时增减，调养数年，七十多岁才去世。这就是所谓的人体实、病证实，养护正气驱除邪气，通过调和，自然可以长寿。重用药物损伤正气，只会加速死亡。
叔子静，平时没有疾病，一天，我召集亲友小酌，叔也在座，吃饭吃到第二碗只剩半碗时，头突然垂下，下巴也掉落。同座的人问：“醉了吗？”他不回答。又问：“被骨头卡住了吗？”也不回答。仔细一看，眼睛闭合且口流涎水，大家起来扶他到别座，脖子已经歪斜，脉搏已绝，痰声响起，不知人事了。急忙取至宝丹灌服，开始不接受，再次灌服才咽下。过了一会儿睁开眼睛，问扶他的人：“这是什么地方？”于是告诉他原因。他说：“我想回家。”扶着他坐在轿子里回家，处以驱风、消痰、安神的药物，第二天就能起床，只是软弱无力而已。以后也没有再复发。这总称为卒中，也有食厥，也有痰厥，也有气厥。病因不同，如果不预备药物，那么一时气机不能纳入，经络闭塞，一个时辰就会死亡。如果再用人参、附子等药物助火助痰，就没有能活下来的。等到死后，就认为是病本身无法治愈，不是温补的错误，举世皆如此啊。
王士雄按：《资生经》说：有人忽然觉得心腹中非常热，有人说：这是中风的征兆，给予治风药而风症未发作。夷陵某太守夏天忽然患热症，就用洒水在地，铺上竹席躺在上面，让人扇风，第二天忽然患中风而死。人们只责怪他睡在水席上用扇子扇。等到见到一位澧阳老妇人，症状与太守相同，因服用小续命汤而痊愈。综合来看，才知道中风是由心腹中多大热而引起的。徐氏的论述，正与此相合。《易经》说：“风自火出。”谚语说：“热极生风。”为什么世人都不醒悟呢？如果可以用参、附等药物的，那是脱证的治法，不可误施用于闭证。
湖州副总戎穆公延弼，身体极其强壮，忽然患牙关紧闭不能张开，不能饮食，断食五天了。请我去治疗，接待如常，只是喊饿。我打开查看他的牙齿，上下只能开一条细缝，抚摸他的两颊，皮肤坚硬如皮革，仔细审察病情，不明白原因。于是问道：“这是被恶风吹袭，您曾经受恶风吗？”他说：“没有。”过了一会儿恍然大悟说：“确实！二十年前曾随军在外围宿营帐房中，半夜怪风大作，帐房被拔起，死了三个人，我是其中之一。灌以热水，两人活了一人死亡。我刚醒来，两天不能说话，难道至今复发吗？”我说：“是的。”于是开玩笑说：“凡是治皮工匠，皮坚则消除它。我现在想用药物消除您的脸颊皮肤。”于是用蜈蚣头、蝎子尾及朴硝、硼砂、冰片、麝香等药物擦拭其口腔内部，又用大黄、牙皂、川乌、桂心等药物涂抹其外部，如果有痰涎，则吐出。第二天早晨我还没起床，公开门说：“真是神仙啊，早就喝了几碗粥了。”于是进服驱风养血膏而痊愈。大概邪气侵入人体深，则潜伏于脏腑骨脉之中，精气旺盛，则不发病。到了血气衰退，或者有所感触，即使几十年之久也有复发者。不论内外证候都是这样，也是应当知道的。
王士雄按：皮肤顽痹，不用外治法不能见效。这是因为其坚硬如皮革，所以多用毒烈之品。
乌程县一位姓王的病人患周痹证，遍身疼痛四肢瘫痪，日夜叫喊号哭，饮食大减，自己认为必死无疑，想要找我决断。家人含泪将他送到船上，我看后说：“这是历节病。”病在筋节，不是煎药丸所能治愈，必须用外治法。于是遵循古法，敷贴、拓敷、蒸熏，十天疼痛稍减，手足可动，于是让他回家，一个多月后病愈。大凡营卫脏腑的病，服药可达病所，经络筋节，都属于有形之物。煎丸的力量，太轻则不能攻邪，太重则恐伤正气，必须用气味厚重力量大的药物，采用敷、拓、薰、蒸的方法，深入病所，提邪外出。古人唯独重视针灸之法，医者不知道，先服风药无效，就用温补，使邪气久留，即使不死也成为废人，处处皆然，岂不冤枉。
王士雄按：风药耗伤营液，温补填塞隧络，都能助邪增加疼痛。如果是轻淡清通的药剂，正宜频繁服用，不可单纯依赖外治。
新郭沈又高，续娶年轻妻子，未免不节制，忽然患气喘厥逆，语涩神昏，手足不能抬起。医生用治疗中风的方法，病情更加严重。我诊察说：“这是《黄帝内经》所说的痱证。”少阴虚损而精气不续，与一般的偏中风、中风、痰厥、风厥的病完全不同。刘河间设立的地黄饮子，正是为此而设，为什么医生反而忌讳它呢？一剂药后喘逆平息，神气清醒，声音发出，四肢舒展活动。三剂药后病除八九，用养精益气的药物调理而痊愈。我所见到的类似中风而适宜温补的，只有这一人。记录下来是为了说明我并非禁用补药，但必须对症，才可以施治。
王士雄按：古话说真中风属实证，类中风多虚证，其实不然。如果那人平素禀赋阳盛，过食肥甘，积热酿痰，壅塞隧络，多患类中风。治疗宜化痰清热，流利机关，自始至终，忌投补滞。徐氏谓适宜温补的不多见，确实是阅历之言。
苏州柴行一位姓倪的病人，伤寒失于攻下，昏迷不知人事，气喘舌焦，已经办理后事了。我当时想去扬州，船停泊在桐涇桥河内，正好经过他家门前，晚上要登船，他的儿子哀求治疗。我说：“这是大承气汤证。”不必加减，写方给他。告诫他说：“一剂不下则再服，下了就停止。”于是前往扬州。一个多月后返回，那人已经强健如故。古方的神效如此。凡是古方与病及证都对应的，不必加减；如果病同而证稍有差异，则随证加减，道理很明白，而人不能用。如果不当下者反而下之，遂成结胸，以至于听到的人就把攻下作为戒律。颠倒若此，总由不肯潜心体认仲景《伤寒论》耳。
嘉善县一位姓黄的病人，外感兼郁热。乱投药石，继用补剂，邪留经络，无从而出，下注于足，两小腿红肿大痛，气逆冲心，呼号不寐。我说：“这就是所谓的刖足伤寒”，脚将要脱落了。急忙用外治法薰之、蒸之，以提毒散瘀，又用丸散内消其痰火，并化其毒涎，从大便排出，并用辛凉的煎剂，托举未透之邪，三天而安。大凡风寒留于经络，无从发泄，往往变为痈肿，上为发颐，中为肺痈、肝痈、脾积，下为肠痈、便毒，外则散为斑疹疮疡，留于关节则为痿痹拘挛，注于足胫则为足矣。这些证候都记载于《内经》诸书，自从内外科各分一门，这些证候就无人知道了。
淮安大商杨秀伦，七十四岁，外感停食。医生因为他年高富有，非补不可。遂致闻到饭味就呕吐，见人吃饭就斥责说：“这等臭东西，亏你们怎么吃得下去？”不吃不睡了一个月，只靠参汤续命而已。慕名来聘请，我诊察说：“这病可治，但我所立的方子一定不服，不服则必死。如果顺从你们的意愿立方也会死，不如干脆不立。”众人问：“当用什么药？”我说：“非生大黄不可。”众人果然大惊，有一人说：“暂且等先生定方再商量。”他的意思大概是说千里而来，不可不周全情面，等药成后私下扔掉即可。我觉察到他的心意，煎好后，亲自到病人处强行喂服，旁人都惶恐无措，只服了一半，当晚即气平得寝，并不泻。第二天全服一剂，下宿垢少许，身体更和缓。第三天清晨，我在书房没起床，听到外面喧哗传说：“老太爷在堂中扫地。”我披衣起来询问，告知者说：“老太爷久卧思起，想亲自来谢先生。”出堂中，见果壳堆积，乃自己用扫帚扫开，以便行走。随即进入我卧室，久谈。早膳至，病者看食物，自己向碗里撮几粒嚼之，且说：“为什么不臭？”从此饮食渐进，精神如旧，众人都以为神奇。我说：“伤食恶食，人所共知，去宿食则食自进，老少同法。现在的医生，认为老人停食不可消，只宜补中气，以待其自消，这等乱道，世人反而奉为金针，误人不知其几也。我之所以在淮扬有声名，以此。”
西塘倪福征，患时证，神昏脉数，不食不寝，医生认为他虚，投以六味地黄丸等药。此方乃是浙江中医家，不论何病，必用的方剂。遂粒米不得下咽，而烦热益甚，众人束手。我诊察说：“热邪留于胃也。”凡是外感之邪，久必归阳明，邪重而有食，则结成燥屎，三承气汤主之；邪轻而无食，则凝为热痰，三泻心汤主之。于是以泻心汤加减，及消痰开胃之药，两剂而安。众人以为神奇，不知这是浅近之理，《伤寒论》具在，细读自明也。如果更误治，则无生理矣。
王士雄按：韩尧年年甫逾冠，体素丰而善饮，春间偶患血溢，广服六味等药。初夏患身热痞胀，医投泻心、陷胸等药，遂胀及少腹，且拒按，大便旁流，小溲不行，烦热益甚，汤饮不能下咽，谵语唇焦。改用承气、紫雪，亦如水投石。延余视之，黄苔满厚而不甚燥，脉滑数而按之虚软，不过湿热阻气，升降不调耳。以枳桔汤加白前、紫菀、射干、马兜铃、杏仁、厚朴、黄芩，用芦根汤煎。一剂谵语止，小溲行。二剂旁流止，胸渐舒。三剂可进稀糜。六剂胸腹皆舒，粥食渐加。改投清养法，又旬日得解燥矢而愈。众人亦以为神奇，其实不过按证设法耳。
又按：今夏衣贾戴七，患暑湿，我以清解法治之，热退知饥，家人谓其积劳多虚，遽以补食啖之。三日后二便皆闭，四肢肿痛，气逆冲心，呼号不寐。又乞余往视，乃余邪得食而炽，壅塞胃腑，腑气实，则经气亦不通，而机关不利也。以苇茎汤去薏苡，加萎仁、枳实、栀子、萝卜子、黄芩、桔梗，煎调元明粉，外用葱白杵烂，和蜜涂之。小溲先通，大便随行，三日而愈。
郡中蒋氏子，患时证，身热不凉，神昏谵语，脉无伦次。我诊察说：“这是游魂证。”虽服药必招其魂，于是访寻招魂之法。有邻居老翁说：“我听说虔诚祈祷灶神，则能自言。”父亲照他的话做，病人果然说：“我因看戏小台倒塌，几乎被压受惊，又往城隍庙中散步，魂落庙中，应当用肩舆抬我回去。”按照话去招魂。第二天请我再诊，病人又说：“我的魂刚到房门，被父亲冲散，今天魂卧在被上，又被母亲叠被掉落，现在不知去向。”咆哮不已。我安慰他说：“不用担心，我现在还给你。”于是用安神镇魄之药，加猪心尖、辰砂，绛帛包裹，悬药罐中煎服。告诫说：“服药得寝，勿惊醒之，熟寐即神合。”果然一剂而安，调理而愈，问之俱不知也。
失魂
Hui Xi Medical Cases
Written by Xu Lingtai in the Qing Dynasty
Preface
Yuan Mei (courtesy name Zicai, pseudonym Jianzhai), a Grand Historian, wrote in "Biography of Mr. Lingtai": "I wished to collect his extraordinary prescriptions and techniques to serve as a medical reference, thereby saving the common people. However, due to the haste, I could not obtain them, and only recorded a few cases from Ze Gengshi and Wang Lingwen, but the descriptions were not detailed. I deeply regretted this." This summer, Mr. Lv Shen [character missing] sent me a handwritten copy of one volume of *Hui Xi Medical Cases*, stating that he obtained it from Jin Fucun, a student of the Xu family. Reading it was like obtaining a rare treasure. Although the secret text did not detail the prescriptions and herbs sufficiently, its profound insight into pathogenesis and miraculous skills were sufficient to serve as a reference and save lives. Therefore, I arranged and edited it, humbly adding my insights, awaiting the judgment of experts, to have it printed and passed down to future generations. This is my earnest hope.
Wang Shixiong, Junior Scholar from Haichang, October of the Yimao Year (1855)
Wind Stroke
A patient surnamed Jin at Fengmen stood at his gate early in the morning and suddenly encountered fierce wind, resulting in deviation of the mouth and eye, and inability to speak due to locked jaws. The physician used Ren Shen (Ginseng), Gui Zhi (Cinnamon Twig), Fu Zi (Aconite Root), and other substances. This was the standard prescription for treating wind syndromes at that time. I was urgently summoned to examine him. His body was stiff like a corpse, face red, breath coarse, eyes staring fixedly, and pulse large. I prescribed a formula to dispel wind, resolve phlegm, and clear heat. The family promised a heavy reward and urged me to stay for several days. I said, "I am not a professional practitioner seeking livelihood; you may take the money and let me go." They insisted. I said, "Rather than being killed by erroneous medication, it is better to take these three doses. If he wakes up and can eat, no further medication is needed." Over a month later, he came to my home to express gratitude. Upon inquiry, he indeed recovered after taking three doses and dared not take any other medications. Only his legs and knees remained weak, and his arms were still numb. I prescribed a medicinal paste, and he fully recovered. This corresponds exactly to what the *Nei Jing* (Inner Canon) calls "empty evil and thieving wind" (Xu Xie Zei Feng). Treating it with acrid-hot and drying drugs was certainly wrong, and treating it with yin-nourishing and cloying drugs was also erroneous. The correct approach is to use acrid-cool drugs assisted by sweet-warm drugs, as clearly instructed in the *Nei Jing*.
Wang Shukui, an Envoy who had resigned from his post in Changlu and returned home, often told me of his numbness in hands and feet and excessive phlegm. I told him, "Your constitution is naturally robust and plump, and you enjoy drinking and eating rich foods. Phlegm flows into the meridians; moderation is advisable." One day, he suddenly fainted, lost urine control, had locked jaws, clenched fists, and rattling phlegm sounds, all indicating critical conditions. Physicians prepared decoctions of Ren Shen (Ginseng), Fu Zi (Aconite Root), and Shu Di Huang (Prepared Rehmannia Root), but they had not yet been administered. I palpated his pulse: surging, large, and forceful; his face was red, and breath coarse. This indicated fullness of phlegm-fire and closure of all orifices. Administering Ren Shen and Fu Zi would have caused immediate death. I used Xiao Xu Ming Tang (Minor Decoction to Extend Life), removing Gui Zhi (Cinnamon Twig) and Fu Zi (Aconite Root), and added 1 qian of raw Da Huang (Rhubarb Root), ground into powder. To avoid suspicion from bystanders, I pretended it was another medicine mixed in. Relatives were uproarious. However, the Grand Madam trusted me and strongly advocated taking my prescription. After three doses, he regained his voice; after five doses, he could speak. Subsequently, I regulated him with phlegm-resolving and blood-nourishing medicines. After one month, his gait returned to normal.
Liu Songcen from Zhangyou Alley loved drinking and formed a group of drinking companions, gathering year-round. I advised against it without success. He was only forty years old. On New Year's Eve, he went to a shop to buy wine. While weighing silver, his hand trembled, the weight fell, and he collapsed. His jaws locked, and he was unconscious. He was rushed home. On New Year's Day, he sent for me. I gave him several pills of Zhi Bao Dan (Precious Treasure Pill) and instructed him not to take other medicines, fearing that if doctors knew he was a drinker and had recently taken a concubine, they would prescribe warming and tonifying agents. On the fifth day, I visited him. He had not taken the medicine. His pulse was wiry, slippery, and surging. He suffered hemiplegia, rigid jaw, and drooling. This was a syndrome of damp-phlegm lodging in meridians and transmitting to fu organs. I treated him with phlegm-expelling and damp-draining substances. After over a month, he recovered. One hand and one foot remained less flexible, and speech remained difficult. Initially childless, after recovery, he had children who grew up healthy. He died at seventy-three. Who says stroke patients cannot live long? Diseases affecting meridians, sinews, bones, and joints are diseases of the physical form. They can prolong life but cannot be completely eradicated. Seeking complete cure through heavy dosages will inevitably harm life. Wealthy people hearing such views not only disbelieve but become angry. Flatterers then collectively prescribe warming and tonifying drugs, leading to death, with no one repenting.
A patient surnamed Wang outside the West Gate met a friend on the road during the New Year. After bowing, he collapsed, jaws locked, eyes closed, limbs paralyzed, and became unconscious upon return. Doctors also used Ren Shen (Ginseng) and Shu Di Huang (Prepared Rehmannia Root). His mother had previously been critically ill and cured by me, so she trusted me and sought help. I said, "This is 'empty evil and thieving wind'." I prescribed modified Xiao Xu Ming Tang (Minor Decoction to Extend Life). Doctors were shocked, arguing that a young man suffering this must have severe deficiency and could not tolerate strong drugs. His mother dismissed their objections and administered the medicine. The next day, he pulled my robe, stood on the ground, and attempted to kowtow. I asked, "Do you wish to thank me?" He nodded vigorously. I stopped him. He appeared tearful and grateful. I comforted him and told his mother, "The wind-toxin has penetrated deeply, causing stiffness of the tongue root. Although the illness has resolved, speech cannot return immediately. Do not panic and mistakenly administer warming and tonifying drugs." Indeed, he could speak after over a month and fully recovered after one hundred days.
Xi Yiwan from Dongshan, over sixty years old, suffered from wind-bi (painful obstruction). Contemporary physicians always prescribed warming and tonifying drugs. Fortunately, they did not heavily use Ren Shen (Ginseng) and Fu Zi (Aconite Root) as was common recently, so the condition was not severe. I palpated his pulse: surging and vigorous. This indicated a constitution with strong primordial qi, merely filled with phlegm-fire. I cleared fire and resolved phlegm to treat the branch (symptoms), and nourished blood and smoothed qi to treat the root. However, phlegm in the meridians cannot be completely cured; it does not affect lifespan and can allow survival for ten years. Using mild formulas adjusted as needed, he was nursed back to health over several years and died in his seventies. This illustrates that when the person is solid and the syndrome is excess, nurturing righteousness and driving out evil through harmonization allows for longevity. Heavy drugs damage righteousness and hasten death.
Shu Zijing, usually healthy, was dining with relatives and friends one day. When eating the second bowl, halfway through, his head suddenly dropped, and his chin fell. Companions asked, "Are you drunk?" No response. "Is your throat blocked?" No response. Observing closely, his eyes were closed, saliva flowed from his mouth, and he was moved to another seat where his neck was tilted, pulse absent, phlegm rattling, and consciousness lost. I urgently administered Zhi Bao Dan (Precious Treasure Pill). He initially refused but swallowed it upon second attempt. Soon, he opened his eyes and asked, "Where is this?" I explained. He said, "I want to go home." He was placed in a sedan chair and brought home. I prescribed wind-dispelling, phlegm-resolving, and spirit-calming substances. He could rise the next day, though weak. It never recurred. This is generally termed sudden collapse (Zhong Chu). There are food syncope, phlegm syncope, and qi syncope. Etiologies differ. Without prepared medicine, qi fails to enter, meridians close, and death occurs within half a day. If Ren Shen (Ginseng) and Fu Zi (Aconite Root) are used to assist fire and phlegm, no one survives. Upon death, it is assumed the disease was incurable and not due to error in warming/tonifying. This is the norm worldwide.
Wang Shixiong notes: *Zi Sheng Jing* states: Someone suddenly felt intense heat in the heart and abdomen. Others said this was a sign of wind stroke, but wind-dispelling drugs did not induce wind. A magistrate in Yiling suddenly suffered intense heat in summer, sprinkled water on the ground, lay on a bamboo mat, and had someone fan him. The next day, he died of wind stroke. People blamed him for lying on the wet mat and using a fan. Later, an old woman from Liyang presented identical symptoms and recovered after taking Xiao Xu Ming Tang (Minor Decoction to Extend Life). Comparing these cases reveals that wind stroke arises from excessive internal heat. Xu’s discussion aligns with this. The *I Ching* says: "Wind comes from fire." Proverb: "Extreme heat generates wind." Why do people fail to realize this? If Ren Shen (Ginseng) and Fu Zi (Aconite Root) are applicable, it is the treatment for collapse syndrome (Tuo Zheng), which must not be mistaken for application in closure syndrome (Bi Zheng).
Fear of Wind
Mu Yanbi, Vice Commander-in-Chief of Huzhou, had a very robust constitution. Suddenly, his jaws locked, preventing eating and drinking. He fasted for five days. I was invited to treat him. He received visitors normally, only complaining of hunger. I examined his teeth; the opening was a narrow slit. Palpating his cheeks, the skin was hard as leather. Studying the condition carefully, I could not understand the cause. I asked, "This is caused by fierce wind. Have you been exposed to fierce wind?" He said, "No." Then he realized, "Indeed! Twenty years ago, while camping outside the border, a strange wind arose at midnight, blowing away the tent. Three people died instantly; I was one of them. Hot water was poured on us; two survived, one died. I woke up unable to speak for two days. Could it be recurring now?" I said, "Yes." Jokingly, I said, "Leather workers soften hard leather. I intend to use medicine to soften your cheek skin." I applied centipede heads, scorpion tails, Po Xiao (Mirabilite), Peng Sha (Borax), Bing Pian (Borneol), and She Xiang (Musk) inside his mouth. Outside, I applied Da Huang (Rhubarb Root), Ya Zao (Gleditsia Sinensis Fruit), Chuan Wu (Aconitum Carmichaelii), and Gui Xin (Cinnamon Heart). Saliva and phlegm were expectorated. The next morning, before I rose, Mu opened the door and said, "Truly a immortal! I have already eaten several bowls of porridge." I then prescribed a wind-dispelling and blood-nourishing paste, and he recovered. Generally, when pathogens penetrate deeply, they lie dormant in zang-fu organs, bones, and vessels. When essence and qi are vigorous, they do not manifest. When blood and qi decline, or upon contact with triggers, recurrence can happen even after decades. This applies to both internal and external conditions and should be known.
Wang Shixiong notes: Skin頑痹 (stubborn numbness/obstruction) requires external treatment. Because it was hard as leather, toxic and potent substances were used.
Generalized Bi
A patient surnamed Wang from Wucheng suffered from generalized bi syndrome, with pain throughout the body and paralysis of limbs. He cried day and night, ate very little, and believed he would die. He wanted me to decide his fate. His family tears accompanied him to the boat. I examined him and said, "This is Li Jie (joint-penetrating) syndrome." The disease is in the sinews and joints; decoctions and pills cannot cure it. External treatment is required. Following ancient methods, I applied compresses, poultices, steaming, and fumigation. After ten days, pain decreased slightly, and limbs moved. He was sent home and recovered after a month. Generally, diseases of Ying (Nutritive) Qi, Wei (Defensive) Qi, and zang-fu organs can be treated with oral medicine reaching the site. Meridians and sinews/joints are tangible structures. The power of decoctions/pills: if too light, it cannot attack evil; if too heavy, it harms righteousness. Medicines with thick aroma and heavy power, applied via compresses, poultices, fumigation, and steaming, penetrate deeply to draw evil out. Ancients emphasized acupuncture and moxibustion. Physicians ignore this, first trying wind-dispelling drugs, then warming tonics when ineffective, allowing evil to linger. Even if not fatal, the patient becomes disabled. This happens everywhere; how unjust!
Wang Shixiong notes: Wind-dispelling drugs consume Ying fluids; warming tonics fill the collaterals. Both assist evil and increase pain. Light, bland, clearing, and unblocking agents are suitable for frequent administration; relying solely on external treatment is insufficient.
Fei (Paralytic Syndrome)
Shen Yougao from Xinguo remarried a young wife and failed to exercise restraint. Suddenly, he suffered panting, syncope, slurred speech, confusion, and inability to lift limbs. Doctors treated him for wind stroke, worsening the condition. I diagnosed, "This is Fei syndrome described in the *Nei Jing*." Shaoyin (Lesser Yin) deficiency leads to discontinuity of essence and qi. It is completely different from typical hemiplegia, wind stroke, phlegm syncope, or wind syncope. Liu Hejian’s Di Huang Yin Zi (Rehmannia Decoction) was established precisely for this. Why do doctors fear it? After one dose, panting ceased, spirit cleared, voice returned, and limbs moved. After three doses, eight or nine parts of the illness disappeared. Regulated with essence-nourishing and qi-boosting substances, he recovered. Among similar stroke cases I have seen requiring warming tonics, this was the only one. I record this to show I do not forbid tonics but insist on accurate syndrome differentiation.
Wang Shixiong notes: Ancient texts say true wind stroke is excess, while simulated wind stroke (Lei Zhong) is mostly deficiency. This is not entirely true. If a person has innate yang excess, overconsumes rich/greasy foods, accumulates heat transforming into phlegm, and blocks collaterals, they often suffer simulated wind stroke. Treatment should focus on resolving phlegm and clearing heat to free joint mechanisms. Throughout, tonics and stagnation-inducing agents are contraindicated. Xu’s statement that warming tonics are rarely suitable is indeed based on experience.
Cold Damage
A patient surnamed Ni from the firewood market in Suzhou suffered from Cold Damage (Shang Han) due to failure to purge. He was comatose, panted, and had a scorched tongue. His family had prepared funeral arrangements. I was about to leave for Yangzhou, docking at Tongjing Bridge, right past his house. In the evening, as I boarded, his son wept and begged for treatment. I said, "This is a Da Cheng Qi Tang (Major Order the Qi Decoction) syndrome." No modifications needed. I wrote the prescription. I warned, "If one dose does not produce stool, take another. Stop once stool passes." I then left for Yangzhou. Returning a month later, he was as strong as before. Such is the efficacy of ancient formulas. Whenever ancient formulas match the disease and syndrome exactly, no modification is needed. If the disease is the same but the syndrome differs slightly, modify according to the syndrome. The principle is clear, yet people fail to apply it. Purging when not indicated leads to Jie Xiong (Knotted Chest), causing people to fear purgatives. Such inversion stems from failing to study Zhang Zhongjing’s *Shang Han Lun* (Treatise on Cold Damage) deeply.
Amputated Foot Cold Damage
A patient surnamed Huang from Jiashan had external contraction combined with stagnant heat. Random medications were given, followed by tonics. Evil remained in meridians with no exit, sinking into the feet. Both calves were red, swollen, and extremely painful. Qi rebelled upward to the heart, causing crying and insomnia. I said, "This is Amputated Foot Cold Damage. The foot will fall off." Urgently, I used external fumigation and steaming to raise toxicity and dissipate stasis. Internally, I used pills and powders to resolve phlegm-fire and transform toxic saliva, expelling them via stool. Externally, I used acrid-cool decoctions to support unexposed evil. He stabilized in three days. Generally, wind-cold lingering in meridians without release often transforms into abscesses: upper face (Fa Yi), middle lung/liver/spleen abscesses, lower intestinal abscesses or groin sores. Externally, it disperses as macules, rashes, or ulcers. In joints, it causes wasting, bi, or spasms. In calves, it causes foot issues. These conditions are recorded in the *Nei Jing*. Since internal and external medicine separated, these conditions are largely unknown.
External Contraction with Food Stagnation
Yang Xiulun, a wealthy merchant from Huai'an, aged 74, had external contraction with food stagnation. Doctors argued that due to his age and wealth, he required tonification. Consequently, he vomited at the smell of rice, scolded others for eating ("How can you eat such smelly stuff?"), and abstained from food and sleep for a month, surviving only on Ginseng soup. He hired me. I diagnosed, "This is curable, but you will not accept my prescription. If you don't take it, you will die. If I comply with your wishes, you will also die. Better not to prescribe at all." They asked, "What medicine?" I said, "Raw Da Huang (Rhubarb Root) is essential." Everyone was shocked. One said, "Let us wait for your prescription before discussing." His intent was likely to delay until the medicine was ready, then secretly discard it. Sensing this, I boiled the medicine, went to the patient, and forced him to take it. Bystanders were terrified. He took only half. That night, his breathing calmed, he slept, and had no diarrhea. The next day, he took the full dose, passed some accumulated feces, and felt more comfortable. Early morning on the third day, I was in my study when noise erupted outside: "The Old Master is sweeping the hall!" I dressed and asked. The messenger said, "The Old Master wanted to get up after lying down for long and wished to thank you personally." In the hall, fruit shells were piled up; he had swept them himself to walk. He entered my room and talked for a long time. At breakfast, seeing food, he picked a few grains, chewed them, and asked, "Why isn't it smelly?" From then on, diet gradually increased, and spirits returned to normal. Everyone thought it miraculous. I said, "Food stagnation causes aversion to food, known to all. Removing accumulated food restores appetite; this applies to young and old alike. Current doctors believe elderly food stagnation cannot be digested and only mid-Qi tonification is suitable, waiting for self-resolution. This nonsense is revered as gold standard, harming many unknowingly. My reputation in Huai'an and Yangzhou stems from this."
Seasonal Pathogen (Shi Zheng)
Ni Fuzheng from Xitang suffered from seasonal pathogen syndrome: confusion, rapid pulse, no eating or sleeping. Doctors deemed it deficiency and prescribed Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia). This formula is universally used by Zhejiang physicians regardless of the disease. He could not swallow even a grain of rice, and irritability/heat worsened. Physicians were helpless. I diagnosed, "Heat evil remains in the stomach." External pathogens eventually return to Yangming. If evil is heavy with food, dry feces form, treated by San Cheng Qi Tang (Three Major Order the Qi Decoctions). If evil is light without food, hot phlegm forms, treated by San Xie Xin Tang (Three Drain the Epigastrium Decoctions). I used modified Xie Xin Tang and phlegm-resolving/appetite-stimulating medicines. He stabilized in two doses. Others thought it magical, not realizing this is simple logic found in the *Shang Han Lun*. Read carefully, and it is clear. Further misdiagnosis would mean no chance of survival.
Wang Shixiong notes: Han Yao, just over twenty, robust and a drinker, suffered occasional bleeding in spring. He widely took Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia). In early summer, he developed fever and chest/abdominal distension. Doctors prescribed Xie Xin Tang (Drain the Epigastrium Decoction) and Xian Xiong Tang (Pierce the Chest Decoction). Distension spread to the lower abdomen, was tender to pressure, with paralogical diarrhea, urinary retention, worsening irritability, inability to swallow liquids, delirium, and scorched lips. Switching to Cheng Qi Tang (Order the Qi Decoction) and Zi Xue (Purple Snow) was like throwing water on stone. I examined him: thick yellow coating, not very dry; pulse slippery and rapid but empty/soft on pressure. Merely damp-heat blocking qi, disrupting ascending/descending functions. I used Zhi Ju Tang (Citrus and Magnolia Decoction) plus Bai Qian, Zi Wan, She Gan, Ma Dou Ling, Xing Ren, Hou Po, Huang Qin, decocted in Lu Gen (Reed Rhizome) soup. One dose: delirium stopped, urination resumed. Two doses: paralogical diarrhea stopped, chest relaxed. Three doses: thin gruel accepted. Six doses: chest/abdomen relaxed, porridge intake increased. Switched to clearing/nourishing method. Ten days later, dry feces passed, and he recovered. Others thought it magical, but it was simply appropriate treatment for the syndrome.
Another note: Dai Qi, a cloth merchant, suffered from summerheat-dampness this summer. I treated with clearing/resolving methods. Heat subsided, hunger returned. Family thought chronic fatigue meant deficiency and fed him tonifying foods. Three days later, bowel/bladder obstruction, limb swelling/pain, rebellious qi to heart, crying, insomnia. I was called again. Residual evil flared with food, blocking the stomach fu. Fu qi excess led to meridian qi blockage and joint dysfunction. I used Wei Jing Tang (Eupatorium Decoction) without Yi Yi Ren, adding Gua Lou Ren, Zhi Shi, Zhi Zi, Luo Bo Zi, Huang Qin, Jie Geng, decocted with Yuan Ming Fen (Niter). Externally, scallion white mashed with honey applied. Urination opened first, bowel movement followed. Recovered in three days.
Wandering Soul
Son of the Jiang family in the prefecture suffered from seasonal pathogen syndrome: persistent fever, confusion, delirium, chaotic pulse. I diagnosed, "This is Wandering Soul syndrome." Medication alone won't retrieve the soul. I sought methods to summon the soul. A neighbor elder said, "I heard devout prayer to the Kitchen God allows the patient to speak." The father followed this. The patient spoke: "I watched a play, the small stage collapsed, nearly crushed, frightened. Then I walked in the City God Temple. My soul fell there. Carry me back in a sedan chair." They went to summon. Next day, I re-examined. Patient said, "My soul reached the door, scattered by my father. Today, my soul lay on the quilt, knocked off by my mother folding it. Now I don't know where it is." Roaring incessantly. I comforted him, "Do not worry. I will return it to you." I prescribed spirit-calming and soul-anchoring drugs, added Zhu Xin Jian (Pig Heart Tip) and Chen Sha (Cinnabar), wrapped in crimson silk, suspended in the decoction pot. Warning: "After taking medicine and sleeping, do not startle him. Deep sleep means spirit reunites." Indeed, one dose brought peace. Regulated and recovered. Asked later, he knew nothing.
Lost Soul