东山叶宝伦患五色痢，每日百余次，余悉治痢之法治之，五六日疾如故，私窃怪之，为抚其腹，腹内有块，大小各一，俨若葫芦形，余重揉之，大者裂破有声，暴下五色浓垢斗许，置烈日中，光彩眩目，以后痢顿减，饮食渐进。再揉其小者，不可执持，亦不能消，痢亦不全止。令其不必专力治之，惟以开胃消积之品，稍稍调之，三四月而后块消，痢止。大抵积滞之物，久则成囊成癖，凡病皆然。古人原有此说，但元气已虚，不可骤消，惟养其胃气，使正足自能驱邪，但各有法度，不可并邪亦补之耳。
疟 痢
东山姜锡常，气体素弱，又患疟痢，每日一次，寒如冰而热如炭，随下血痢百余次，委顿无生理。因平日相契，不忍委之，朝夕诊视，为分途而治之，寒御其寒，热清其热，痢止其痢，俱用清和切病之品，以时消息，而最重者在保其胃气，无使生机又绝。经云:食养尽之，无使过之，伤其正也。诸证以次渐减而愈。或谓如此大虚，何以不用峻补?余曰:寒热未止，必有外邪，血痢未清，必有内邪，峻补则邪留不去，如此虚人，可使邪气日增乎?去邪毋伤正，使生机渐达，乃为良策。锡常亦深会此意，而医理渐明，嗣后小病皆自治之，所谓三折肱者也。
畏 寒
洞庭卜夫人，患寒疾，有名医进以参附，日以为常，十年以来，服附子数十斤，而寒愈剧，初冬即四面环火，绵衣几重，寒栗如故。余曰:此热邪并于内，逼阴于外。《内经》云:热深厥亦深。又云:热极生寒。当散其热，使达于外。用芦根数两，煎清凉疏散之药饮之，三剂而去火，十剂而减衣，常服养阴之品而身温。逾年，附毒积中者尽发，周身如火烧，服寒凉得少减，既又遍体及头、面、口、鼻俱生热疮，下体俱腐烂，脓血淋漓。余以外科治热毒之法治之，一年乃复。以后年弥高而反恶热，与前相反。如不知其理，而更进以热药，则热并于内，寒并于外，阴阳离绝而死，死之后，人亦终以为阳虚而死也。
畏 风
嘉善许阁学竹君夫人抱疾，医过用散剂以虚其表，继用补剂以固其邪，风入营中，畏风如矢，闭户深藏者数月，与天光不相接，见微风则发寒热而晕，延余视。余至卧室，见窗櫊皆重布遮蔽，又张帷于床前，暖帐之外，周以擅单。诊其脉微软无阳。余曰:先为药误而避风太过，阳气不接，卫气不闭，非照以阳光不可，且晒日中，药乃效。阁学谓见日必有风，奈何?曰:姑去其瓦，令日光下射晒之何如?如法行之，三日而能启窗户，十日可见风，诸病渐愈。明年阁学掣眷赴都，舟停河下，邀余定常服方。是日大风，临水窗候脉，余甚畏风，而夫人不觉也。盖卫气固，则反乐于见风，此自然而然，不可勉强也。雄按:论证论治，可与戴人颉颃。
痰
嘉兴朱宗周，以阳盛阴亏之体，又兼痰凝气逆，医者以温补治之，胸膈痞塞，而阳道疾。群医谓脾肾两亏，将恐无治，就余于山中。余视其体丰而气旺，阳升而不降，诸窍皆闭，笑谓之曰:此为肝肾双实证。先用清润之品，加石膏以降其逆气；后以消痰开胃之药，涤其中宫；更以滋肾强阴之味，镇其元气。阳事即通。五月以后，妾即怀孕，得一女。又一年，复得一子。惟觉周身火太旺，更以养阴清火膏丸为常馔，一或间断，则火旺随发，委顿如往日之情形矣。而世人乃以热药治阳疾，岂不谬哉。
雄按:今秋落库吏孙位申，积劳善怒，陡然自汗凛寒，腕疼咳逆，呕吐苦水，延余诊之，脉弦软而滑，形瘦面黎，苔黄不渴，溲赤便难，以二陈去甘草，加沙参、竹茹、枇杷叶、竹叶、黄连、萎仁为剂。渠云阳痿已匝月类，恐不可服此凉药。余曰:此阳气上升，为痰所阻，而不能下降耳。一服逆平痛定，呕罢汗止，即能安谷。原方加人参，旬日阳事即通，诸恙若失。
苏州府治东首杨姓，年三十余，以狎游私用父千金，父庭责之，体虚而兼郁怒，先似伤寒，后渐神昏身重。医者以为纯虚之证，惟事峻补，每日用人参三钱，痰火愈结，身强如尸，举家以为万无生理。余入视时，俱环而泣。余诊毕，又按其体，遍身皆生痰核，大小以千计，余不觉大笑，泣者尽骇。余曰:诸人之泣，以其将死耶?试往府中借大板重打四十，亦不死也。其父闻之颇不信，曰:如果能起，现今吃人参费千金矣，当更以千金为寿。余曰:此可动他人，余无此例也，各尽其道而已。立清火安神极平淡之方，佐以末药一服，三日而能言，五日而能坐，一月而行动如常。其时牡丹方开，其戚友为设饮花前以贺，余适至，戏之曰:君服人参千金而几死，服余末药而愈，药本可不偿乎?其母舅在旁曰:必当偿，先生明示几何?余曰:增病之药值千金，去病之药自宜倍之。病者有惊惶色，余曰:无恐，不过八文钱，萝卜子为末耳。尚有服剩者，群取视之，果卜子也，相与大笑。其周身结核，皆补住痰邪所凝成者，半载方消。邪之不可留如此，幸而结在肤膜，若入脏则死已久矣。
雄按:今夏刘午亭，年六十三岁，久患痰喘自汗，群医皆以为虚，补剂备施，竟无效。徐月岩嘱其浼余视之，汗如雨下，扇不停挥，睛凸自高，面浮颈大，胸前痞塞，脉滑而长，妻女哀求，虑其暴脱。余曰:将塞死矣，何脱之云?与导痰汤加旋覆、海石、泽泻、白前，一饮而减，七日后囟门始平，匝月而愈。继有顾某年五十六岁，肥白多痰，因啖莲子匝月，渐觉不饥，喘逆自汗无眠，以为虚也。屡补之后，气逆欲死，速余视之，苔黄溲赤，脉滑不调，以清肺涤痰治之而愈，旋以茯苓饮善其后。
痰 喘
松江王孝贤夫人，素有血证，时发时止，发则微嗽，又因感冒变成痰喘，不能著枕，日夜俯几而坐，竟不能支持矣。是时有常州名医法丹书，调治无效，延余至。余曰：此小青龙证也。法曰:我固知之，但弱体而素有血证，麻桂等药可用乎?余曰:急则治标，若更喘数日，则立毙矣。且治其新病，愈后再治其本病可也。法曰:诚然。然病家焉能知之，治本病而死，死而无怨;如用麻桂而死，则不咎病本无治，而恨麻桂杀之矣。我乃行道之人，不能任其咎。君不以医名，我不与闻，君独任之可也。余曰:然。服之有害，我自当之，但求先生不阻之耳。遂与服。饮毕而气平就枕，终夕得安。然后以消痰润肺养阴开胃之方以次调之，体乃复旧。法翁颇有学识，并非时俗之医，然能知而不能行者。盖欲涉世行道，万一不中，则谤声随之。余则不欲以此求名，故毅然用之也。凡举世一有利害关心，即不能大行我志，天下事尽然，岂独医也哉。
雄按:风寒外束，饮邪内伏，动而为喘嗽者，不能舍小青龙为治。案中云感冒是感冒风寒，设非风寒之邪，麻桂不可擅用。读者宜有会心也。
痰喘亡阴
苏州沈母，患寒热痰喘，浼其婿毛君延余诊视。先有一名医在座，执笔沉吟曰：大汗不止，阳将亡矣。奈何?非参、附、熟地、干姜不可。书方而去。余至不与通姓名，俟其去乃入，诊脉洪大，手足不冷，喘汗淋漓。余顾毛君曰：急买浮麦半合，大枣七枚，煮汤饮之可也。如法服而汗顿止，乃为立消痰降火之方二剂而安。盖亡阳亡阴，相似而实不同，一则脉微，汗冷如膏，手足厥逆而舌润。一则脉洪，汗热不粘，手足温和而舌干。但亡阴不止，阳从汗出，元气散脱，即为亡阳。然当亡阴之时，阳气方炽，不可即用阳药，宜收敛其阳气，不可不知也。亡阴之药宜凉，亡阳之药宜热，一或相反，无不立毙。标本先后之间，辨在毫发，乃举世更无知者，故动辄相反也。
雄按:吴馥斋令姐体属阴亏，归沈氏后，余久不诊，上年闻其久嗽，服大剂滋补而能食肌充，以为愈矣。今夏延诊云:嗽犹不愈。及往视，面浮色赤，脉滑不调，舌绛而干，非肉不饱。曰：此痰火为患也。不可以音嘶胁痛，遂疑为损怯之未传。予清肺化痰药为丸喻化，使其廓清上膈，果胶痰渐吐，各恙乃安。其形复瘦，始予养阴善后。病者云:前进补时，体颇渐丰，而腰间疼胀，略一抚摩，嗽即不已，自疑为痰。而医者谓为极虚所致，补益加峻，酿为遍体之痰也。
观察毛公裕，年届八旬，素有痰喘病，因劳大发，俯几不能卧者七日，举家惊惶，延余视之。余曰此上实下虚之证。用清肺消痰饮，送下人参小块一钱。二剂而愈。毛翁曰：徐君学问之深，固不必言，但人参切块之法，此则聪明人以此玄奇耳。后岁余，病复作，照前方加人参煎入，而喘逆愈甚。后延余视，述用去年方 曰:前几死，我以一剂救之，何以蹈搜辙。日:众论纷纷，谓补药一定不错，直至临死时欲来敦请，已无及矣。呜呼!岂 而病有加。余曰：莫非以参和入药中耶?曰然。余曰:宜其增病也。仍以参作块服之，亦二剂而愈。盖下虚固当补，但痰火在上，补必增盛，惟作块则参性未发，而清肺之药已得力，迨过腹中，而人参性始发，病自获痊。此等法古人亦有用者，人自不知耳，于是群相叹服。
雄按:痰喘碍眠，亦有不兼虚者。黄者华年逾五旬，自去冬因劳患喘，迄今春两旬不能卧，顾某作下喘治，病益甚。又旬日，迓余视之，脉弦滑，苔满布，舌边绛，乃冬温薄肺，失于清解耳。予轻清肃化药治之而痊。至参不入煎，欲其下达，与丸药喻化，欲其上恋，皆有妙义，用药者勿以一煎方为了事也。又有虚不在阴分者，余治方啸山今秋患痰喘汗多，医进清降药数剂，遂便溏肢冷，不食碍眠，气逆脘疼，面红汗冷。余诊之，脉弦软无神，苔白不渴，乃寒痰上实，肾阳下虚也。以真武汤去生姜，加干姜、五味、人参、厚朴、杏仁，一剂知，二剂已。又治顾某体肥白，脉沉弱，痰喘易汗，不渴痰多，啜粥即呕，以六君去甘草，加厚朴、杏仁、姜汁、川连，盖中虚痰滞也，投七日果痊。
饮 癖
洞庭席载岳，素胁下留饮，发则大痛，呕吐，先清水，后黄水，再后吐黑水而兼以血，哀苦万状，不能支矣。愈则复发。余按其腹有块在左胁下，所谓饮囊也。非消此则病根不除，法当外治，因合蒸药一料，用面作围，放药在内，上盖铜皮，以艾火蒸之，日十余次，蒸至三百六十火而止，依法治三月而毕，块尽消，其病永除，年至七十七而卒。此病极多，而医者俱不知，虽轻重不一，而蒸法为要。 雄按:今夏江阴沙沛生■尹，患胸下痞闷，腹中聚块，卧则脾间有气下行至指，而惕然惊寤。余谓气郁饮停，治以通降。适渠将赴都，自虑体弱，有医者迎合其意，投以大剂温补，初若相安，旬日后神呆不语，目眩不饥，便闭不眠，寒热时作，复延余诊。按其心下，则漉漉有声，环脐左右，块已累累，溺赤苔黄，脉弦而急，幸其家深信有年，旁无掣肘。凡通气涤饮清络舒肝之剂，调理三月，各恙皆瘳。
郡中朱姓，素有饮癖，在左胁下，发则胀痛呕吐，始发甚轻，医者每以补剂疗之，发益勤而甚，余戒之曰：“此饮癖也，患者甚多，惟以消饮通气为主，断不可用温补，补则成坚癖，不可治矣。”不信也。后因有郁结之事，其病大发，痛极呕逆，神疲力倦，医者乃大进参、附，热气上冲，痰饮闭塞，其痛加剧，肢冷脉微，医者益加参、附，助其闭塞，饮药一口，如刀箭钻心，哀求免服，妻子环跪泣求曰：“名医四人合议立方，岂有谬误？人参如此贵重，岂有不效？”朱曰：“我岂不欲生？此药实不能受!使我少缓痛苦，死亦甘心耳，必欲使我痛极而死，亦命也。”勉饮其半，火沸痰壅，呼号宛转而绝。大凡富贵人之死，大半皆然，但不若是之甚耳。要知中病之药，不必入口而知，闻其气即喜乐而欲饮；若不中病之药，闻其气则厌恶之。故服药而勉强若难者，皆与病相违者也。《内经》云临病人问所便，此真治病之妙诀也。若《孟子》云药不暝眩，厥疾不瘳，此乃指攻邪破积而言，非一例也。
雄按：余编《洄溪医案》，吾乡蒋寅昉大理欲以付梓，嘱友人缮清本，漏此一条，迨刻竣始知之，不便补镌，故录于此（指《归砚录》）。又按此人饮癖，亦素因肝热内炽而成，与中气虚寒饮停，宜温药和之者，证候迥别也。所云中病与否，闻气即知，最为有理。曩省中顾肇和大令之室患暑，医者以其产后而泥用肉桂，病者闻之甚畏，坚不肯服，家人再四劝饮，遂至不救。不但药也，食物亦然。余性畏闻冬舂饭气，故食之辄病。
翻 胃
嘉兴朱亭立，曾任广信太守，向病呕吐，时发时愈，是时吐不止，粒米不下者三日，医以膈证回绝，其友人来邀诊。余曰：此翻胃证，非膈证也。膈乃胃腑干枯，翻胃乃痰火上逆，轻重悬殊，以半夏泻心汤加减治之，渐能进食，寻复旧，从此遂成知己。每因饮食无节，时时小发，且不善饭，如是数年，非余方不服，甚相安也。后余便道过其家，谓余曰:我遇武林名医，谓我体虚，非参附不可。今服其方，觉强旺加餐。余谓此乃助火以腐食，元气必耗，将有热毒之害。亭立笑而腹非之，似有恨不早遇此医之意。不两月遣人连夜来迎，即登舟，抵暮人其寝室。见床前血汗满地，骇问故，亭立已不能言，惟垂泪引过，作泣别之态而已。盖血涌斗余，无药可施矣，天明而逝。十年幸活，殒于一朝，天下之服热剂而隐受其害者，何可胜数也。
【痢疾】
东山的叶宝伦患五色痢，每天发作一百多次。我按照治疗痢疾的常规方法用药，经过五六天，病情依然如故。我心里暗自感到奇怪，便抚摸他的腹部，发现腹内有肿块，大小各一个，形状像葫芦一样。我用力揉按，较大的那个肿块破裂时发出声响，随即大量排出约一斗多的五色浓稠污物，放在烈日下照射，光彩夺目。此后痢疾症状立刻减轻，饮食也逐渐恢复。再揉按那个较小的肿块，却无法控制它，也不能消除，痢疾也没有完全停止。我让他不必专门针对这个肿块进行治疗，只需使用开胃消积的药物稍微调理，经过三四个月，肿块才消退，痢疾也停止了。大抵积滞之物，时间久了就会形成囊状或癖块，各种疾病都是如此。古人原本就有这种说法，但如果元气已经虚弱，就不能急于攻消，只能养护胃气，使正气充足后自然能驱除邪气，但其中各有法度，不能一边补益正气一边留滞邪气。
疟疾与痢疾
东山的姜锡常，体质向来虚弱，又患有疟疾和痢疾，每天发作一次，发冷时身体像冰一样，发热时像炭火一样，随后拉血痢一百多次，极度疲惫，毫无生机。因为平日关系融洽，我不忍心看着他这样，于是早晚诊视，分别对治：寒证用御寒药，热证用清热药，痢疾用止痢药，都选用清和平缓、切合病情的药物，根据病情变化随时调整。而最重要的是保护胃气，不让生机断绝。《内经》说：“用饮食调养来治愈疾病，不要过度，以免损伤正气。”各种症状依次逐渐减轻并痊愈。有人问：“如此大的虚证，为什么不用峻猛的补药？”我说：“寒热症状没有停止，必然有外邪；血痢没有清除，必然有内邪。如果峻补，邪气就会滞留不去，对于这样虚弱的人，难道能让邪气日益增加吗？去除邪气而不伤正气，让生机逐渐恢复，这才是良策。”姜锡常也深刻领会了这个意思，医理逐渐明白，此后小病都能自己治疗，这就是所谓的“三折肱”（指经验丰富）。
畏寒
洞庭的卜夫人，患有寒性疾病，有名医给她服用参附汤，每天都作为常规药物，十年来，服用了数十斤附子，但寒冷症状反而加剧，初冬时节就要四面生火，穿好几层棉衣，仍然寒战不止。我说：“这是热邪郁结在体内，逼迫阴气浮越于外。”《内经》说：“热邪越深，四肢厥冷就越严重。”又说：“热极生寒。”应当疏散热邪，使其发散到体表。我用数两芦根，煎煮清凉疏散的药物让她饮用，三剂后撤去火炉，十剂后减少衣物，长期服用养阴的药物，身体就温暖了。过了一年，积聚在体内的附子毒性全部爆发，全身像火烧一样，服用寒凉药物才稍见减轻，接着全身及头、面、口、鼻都生出热疮，下半身全部腐烂，脓血淋漓。我用治疗外科热毒的方法治疗她，一年后康复。此后年纪越大反而越怕热，与之前的症状相反。如果不了解其中的道理，反而继续进服热药，就会导致热邪郁结在内，寒邪浮越在外，阴阳离绝而死，死后人们也最终认为是阳虚而死。
畏风
嘉善的许阁学竹君夫人患病，医生过度使用发散药物导致表虚，继而又用补剂固守邪气，风邪侵入营分，极度怕风，闭门深藏数月，不与外界光线接触，见到微风就引发寒热并头晕，邀请我去诊治。我来到卧室，看到窗户都用多层布遮蔽，床前又挂起帷幔，暖帐之外，周围还围着单纱。诊察她的脉象，微弱且无阳气表现。我说：“先前被药物误治，加之避风太过，导致阳气不接，卫气不固，非要用阳光照射不可，并且要在日中晒太阳，药物才能见效。”许阁学说：“见太阳必定有风，怎么办？”我说：“暂且去掉瓦片，让日光直射下来晒晒怎么样？”照此法施行，三天后能打开窗户，十天后可见风，各种病症逐渐痊愈。第二年许阁学携带家眷赴京，船停在河下，邀请我制定常服方。那天大风，我在临水窗前诊脉，我很怕风，而夫人却不觉害怕。这是因为卫气坚固，反而乐于见风，这是自然而然的现象，不可勉强。按语：论证论治，可与戴人相抗衡。
痰证
嘉兴的朱宗周，属于阳盛阴亏的体质，又兼有痰凝气逆，医生用温补法治疗，导致胸膈痞塞，并且出现阳事易举（阳强）的症状。众医认为脾肾两亏，恐怕无法医治，便到山中找我。我看他形体丰满而气旺，阳气上升而不下降，各种窍道闭塞，笑着对他说：“这是肝肾双实证。”先用清润的药物，加入石膏以降逆气；后用消痰开胃的药物，涤荡中焦脾胃；再用滋肾强阴的药物，镇摄元气。阳事即恢复正常。五月以后，妾室怀孕，生下一个女儿。又一年，再生下一个儿子。只是觉得周身火气太旺，便以养阴清火的膏丸作为常食，一旦间断，火旺症状随即发作，疲惫得像往日的情形一样。然而世人却用热药治疗阳强之疾，这难道不是谬误吗？
按语：今年秋天落库吏孙位申，因积劳且善于发怒，突然自汗恶寒，手腕疼痛咳嗽气逆，呕吐苦水，请我诊治。脉象弦软而滑，形体消瘦面色黑黄，苔黄但不口渴，小便赤涩大便困难。我用二陈汤去掉甘草，加入沙参、竹茹、枇杷叶、竹叶、黄连、萎仁组成药剂。他说阳痿已经一个月了，恐怕不能服用这种凉药。我说：“这是阳气上升，被痰邪阻滞，而不能下降罢了。”服用一剂后气逆平息疼痛停止，呕吐罢止出汗停止，就能安吃食物。原方加入人参，十天后阳事即通，各种病症消失。
苏州府治东首杨姓人家，三十多岁，因狎妓私用父亲千金，被父亲在庭上责打，体质虚弱又兼郁怒，起初像伤寒，后来逐渐神昏身重。医生认为是纯虚证，只从事峻补，每天用人参三钱，导致痰火更加凝结，身体僵硬如尸体，全家以为万无生理。我进去诊视时，大家都围着我哭泣。我诊完脉，又按压他的身体，遍身都生出痰核，数以千计，我不禁大笑，哭泣的人都惊呆了。我说：“你们哭，是因为他将要死了吗？试着去府里借大板重打四十，也不会死。”他的父亲听说后很怀疑，说：“如果能治好，现在吃人参费千金了，应当再送千金作为酬谢。”我说：“这可以打动别人，我没有这个先例，各自尽自己的道义罢了。”立即开具清火安神极其平淡的方子，佐以萝卜子末药一服，三天后能说话，五天后能坐，一个月后行动如常。当时牡丹花刚开，亲戚朋友在花前设宴庆贺，我恰好到了，开玩笑说：“你服人参千金差点死了，服我的末药就好了，药费可以不偿还吗？”他的母舅在旁边说：“必须偿还，先生明示多少？”我说：“增病的药值千金，去病的药自然应该加倍。”病人露出惊惶神色，我说：“别怕，不过是八文钱，萝卜子研成的末罢了。”还有剩下的，大家拿来查看，果然是萝卜子，一起大笑。他全身的结核，都是被补药留住痰邪所凝结而成的，半年后才消退。邪气不可留存如此之久，幸好结在肤膜之间，如果进入脏腑则早已死亡。
按语：今年夏天刘午亭，六十三岁，久患痰喘自汗，众医都认为虚证，备施补剂，竟然无效。徐月岩嘱咐我请我去诊治，汗水如雨下，扇子不停挥动，眼球突出，面部浮肿颈部粗大，胸前痞塞，脉滑而长，妻女哀求，担心他暴脱。我说：“快要塞死了，说什么脱呢？”给予导痰汤加旋覆花、海浮石、泽泻、白前，一饮而减症，七日后囟门才平复，一个月痊愈。继而有顾某五十六岁，肥白多痰，因吃莲子一个月，渐渐觉得不饥，喘逆自汗失眠，以为是虚证。屡次进补之后，气逆欲死，急忙请我去看，苔黄溲赤，脉滑不调，用清肺涤痰法治疗而愈，随后用茯苓饮善后。
痰喘
松江王孝贤夫人，素有血证，时发时止，发作时轻微咳嗽，又因感冒变成痰喘，不能着枕，日夜俯在几案上坐着，竟不能支持了。当时有常州名医法丹书，调治无效，邀请我去。我说：“这是小青龙汤证。”法医生说：“我当然知道，但她体弱且素有血证，麻黄、桂枝等药可用吗？”我说：“急则治其标，如果再喘几天，就会立即死亡。况且治疗新病，好了之后再治本病也可以。”法说：“诚然。但是病家怎么能知道呢？治本病而死，死了无怨恨；如果用麻桂而死，就不会责怪病根本无治，而怨恨是麻桂杀了她。我是行道之人，不能承担这个罪责。您不以医名闻名，我不参与此事，您独自承担即可。”我说：“是的。服药有害，我自己承担，只求先生不要阻拦。”于是给她服用。喝完气平能躺下枕头，整夜安宁。然后用消痰润肺养阴开胃的方子依次调理，身体才恢复旧观。法老先生颇有学识，并非世俗庸医，然而能知而不能行。大概想要涉世行道，万一不中，诽谤声随之而来。我不想以此求名，所以毅然使用。凡举世一有利害关心，就不能大胆实行我的志向，天下事都是如此，岂止是医学呢？
按语：风寒外束，饮邪内伏，动而为喘嗽者，不能舍弃小青龙汤为治。案中云感冒是感冒风寒，如果不是风寒之邪，麻黄、桂枝不可擅自使用。读者宜有会心之处。
痰喘亡阴
苏州沈母，患寒热痰喘，委托女婿毛君邀请我诊治。先有一位名医在座，执笔沉吟说：“大汗不止，阳气将亡了。怎么办？非人参、附子、熟地、干姜不可。”写完方子离去。我到后不与通报姓名，等他走了才进去，诊脉洪大，手足不冷，喘汗淋漓。我看着毛君说：“赶快买浮麦半合，大枣七枚，煮汤饮用即可。”照此法服用而汗立刻停止，于是为她立消痰降火之方两剂而安。盖亡阳亡阴，相似而实不同，一则脉微，汗冷如膏，手足厥逆而舌润。一则脉洪，汗热不粘，手足温和而舌干。但亡阴不止，阳从汗出，元气散脱，即为亡阳。然而在亡阴之时，阳气方炽，不可即用阳药，宜收敛其阳气，不可不知也。亡阴之药宜凉，亡阳之药宜热，一或相反，无不立毙。标本先后之间，辨在毫发，乃举世更无知者，故动辄相反也。
按语：吴馥斋令姐体属阴亏，归沈氏后，余久不诊，上年闻其久嗽，服大剂滋补而能食肌充，以为愈矣。今夏延诊云:嗽犹不愈。及往视，面浮色赤，脉滑不调，舌绛而干，非肉不饱。曰：此痰火为患也。不可以音嘶胁痛，遂疑为损怯之未传。予清肺化痰药为丸喻化，使其廓清上膈，果胶痰渐吐，各恙乃安。其形复瘦，始予养阴善后。病者云:前进补时，体颇渐丰，而腰间疼胀，略一抚摩，嗽即不已，自疑为痰。而医者谓为极虚所致，补益加峻，酿为遍体之痰也。
观察毛公裕，年届八旬，素有痰喘病，因劳大发，俯几不能卧者七日，举家惊惶，延余视之。余曰此上实下虚之证。用清肺消痰饮，送下人参小块一钱。二剂而愈。毛翁曰：徐君学问之深，固不必言，但人参切块之法，此则聪明人以此玄奇耳。后岁余，病复作，照前方加人参煎入，而喘逆愈甚。后延余视，述用去年方 曰:前几死，我以一剂救之，何以蹈搜辙。日:众论纷纷，谓补药一定不错，直至临死时欲来敦请，已无及矣。呜呼!岂 而病有加。余曰：莫非以参和入药中耶?曰然。余曰:宜其增病也。仍以参作块服之，亦二剂而愈。盖下虚固当补，但痰火在上，补必增盛，惟作块则参性未发，而清肺之药已得力，迨过腹中，而人参性始发，病自获痊。此等法古人亦有用者，人自不知耳，于是群相叹服。
雄按:痰喘碍眠，亦有不兼虚者。黄者华年逾五旬，自去冬因劳患喘，迄今春两旬不能卧，顾某作下喘治，病益甚。又旬日，迓余视之，脉弦滑，苔满布，舌边绛，乃冬温薄肺，失于清解耳。予轻清肃化药治之而痊。至参不入煎，欲其下达，与丸药喻化，欲其上恋，皆有妙义，用药者勿以一煎方为了事也。又有虚不在阴分者，余治方啸山今秋患痰喘汗多，医进清降药数剂，遂便溏肢冷，不食碍眠，气逆脘疼，面红汗冷。余诊之，脉弦软无神，苔白不渴，乃寒痰上实，肾阳下虚也。以真武汤去生姜，加干姜、五味、人参、厚朴、杏仁，一剂知，二剂已。又治顾某体肥白，脉沉弱，痰喘易汗，不渴痰多，啜粥即呕，以六君去甘草，加厚朴、杏仁、姜汁、川连，盖中虚痰滞也，投七日果痊。
饮癖
洞庭席载岳，素胁下留饮，发则大痛，呕吐，先清水，后黄水，再后吐黑水而兼以血，哀苦万状，不能支矣。愈则复发。余按其腹有块在左胁下，所谓饮囊也。非消此则病根不除，法当外治，因合蒸药一料，用面作围，放药在内，上盖铜皮，以艾火蒸之，日十余次，蒸至三百六十火而止，依法治三月而毕，块尽消，其病永除，年至七十七而卒。此病极多，而医者俱不知，虽轻重不一，而蒸法为要。 雄按:今夏江阴沙沛生■尹，患胸下痞闷，腹中聚块，卧则脾间有气下行至指，而惕然惊寤。余谓气郁饮停，治以通降。适渠将赴都，自虑体弱，有医者迎合其意，投以大剂温补，初若相安，旬日后神呆不语，目眩不饥，便闭不眠，寒热时作，复延余诊。按其心下，则漉漉有声，环脐左右，块已累累，溺赤苔黄，脉弦而急，幸其家深信有年，旁无掣肘。凡通气涤饮清络舒肝之剂，调理三月，各恙皆瘳。
郡中朱姓，素有饮癖，在左胁下，发则胀痛呕吐，始发甚轻，医者每以补剂疗之，发益勤而甚，余戒之曰：“此饮癖也，患者甚多，惟以消饮通气为主，断不可用温补，补则成坚癖，不可治矣。”不信也。后因有郁结之事，其病大发，痛极呕逆，神疲力倦，医者乃大进参、附，热气上冲，痰饮闭塞，其痛加剧，肢冷脉微，医者益加参、附，助其闭塞，饮药一口，如刀箭钻心，哀求免服，妻子环跪泣求曰：“名医四人合议立方，岂有谬误？人参如此贵重，岂有不效？”朱曰：“我岂不欲生？此药实不能受!使我少缓痛苦，死亦甘心耳，必欲使我痛极而死，亦命也。”勉饮其半，火沸痰壅，呼号宛转而绝。大凡富贵人之死，大半皆然，但不若是之甚耳。要知中病之药，不必入口而知，闻其气即喜乐而欲饮；若不中病之药，闻其气则厌恶之。故服药而勉强若难者，皆与病相违者也。《内经》云临病人问所便，此真治病之妙诀也。若《孟子》云药不暝眩，厥疾不瘳，此乃指攻邪破积而言，非一例也。
雄按：余编《洄溪医案》，吾乡蒋寅昉大理欲以付梓，嘱友人缮清本，漏此一条，迨刻竣始知之，不便补镌，故录于此（指《归砚录》）。又按此人饮癖，亦素因肝热内炽而成，与中气虚寒饮停，宜温药和之者，证候迥别也。所云中病与否，闻气即知，最为有理。曩省中顾肇和大令之室患暑，医者以其产后而泥用肉桂，病者闻之甚畏，坚不肯服，家人再四劝饮，遂至不救。不但药也，食物亦然。余性畏闻冬舂饭气，故食之辄病。
翻胃
嘉兴朱亭立，曾任广信太守，向病呕吐，时发时愈，是时吐不止，粒米不下者三日，医以膈证回绝，其友人来邀诊。余曰：此翻胃证，非膈证也。膈乃胃腑干枯，翻胃乃痰火上逆，轻重悬殊，以半夏泻心汤加减治之，渐能进食，寻复旧，从此遂成知己。每因饮食无节，时时小发，且不善饭，如是数年，非余方不服，甚相安也。后余便道过其家，谓余曰:我遇武林名医，谓我体虚，非参附不可。今服其方，觉强旺加餐。余谓此乃助火以腐食，元气必耗，将有热毒之害。亭立笑而腹非之，似有恨不早遇此医之意。不两月遣人连夜来迎，即登舟，抵暮人其寝室。见床前血汗满地，骇问故，亭立已不能言，惟垂泪引过，作泣别之态而已。盖血涌斗余，无药可施矣，天明而逝。十年幸活，殒于一朝，天下之服热剂而隐受其害者，何可胜数也。
[Li Disease]
Ye Baolun from Dongshan suffered from five-color dysentery, occurring more than a hundred times daily. I treated him according to the standard methods for dysentery. After five or six days, the condition remained unchanged. I privately felt puzzled and palpated his abdomen, finding masses inside, one large and one small, resembling gourd shapes. Upon firm kneading, the larger mass ruptured with a sound, expelling approximately one dou of thick, five-colored foul matter. Placed in the scorching sun, it shone dazzlingly. Thereafter, the dysentery symptoms decreased abruptly, and dietary intake gradually improved. When I attempted to knead the smaller mass, it could not be controlled nor eliminated, and the dysentery did not completely cease. I advised him not to focus solely on treating the mass, but rather to use mild stomach-opening and accumulation-resolving herbs for slight regulation. After three to four months, the mass dissipated, and the dysentery stopped. Generally speaking, stagnant accumulations, if left for a long time, form cysts or fixed masses; this applies to all diseases. The ancients indeed held this view. However, when the primordial qi is already deficient, sudden elimination should not be employed. Instead, one must nourish the stomach qi so that sufficient righteous qi can naturally expel the pathogen. Yet, each case has its own rules; one cannot simultaneously tonify righteousness and retain pathogens.
Jiang Xichang from Dongshan had always possessed a weak constitution and subsequently contracted malaria and dysentery. He experienced one episode daily: chills as cold as ice followed by fever as hot as charcoal, then passing over a hundred stools of bloody dysentery. He was exhausted and devoid of vital signs. Due to our close relationship, I could not bear to see him in such a state, so I visited him morning and night. I treated the conditions separately: using cold-natured herbs for chills, heat-clearing herbs for fever, and dysentery-stopping herbs for the dysentery, selecting clear, harmonious, and precise medications, adjusting them according to the timing and changes of the disease. Most importantly, I preserved his stomach qi to prevent the extinction of his life force. The *Neijing* states: "Use dietary therapy to complete the cure; do not overdo it, lest you damage the righteous qi." The various symptoms gradually subsided one by one until he recovered. Someone asked, "For such severe deficiency, why not use potent tonics?" I replied, "Since the chills and fever have not ceased, there must be external pathogens; since the bloody dysentery has not cleared, there must be internal pathogens. Potent tonification will cause pathogens to linger. For such a deficient person, can we allow pathogens to increase daily? Removing pathogens without damaging righteousness, allowing the life force to gradually return, is the best strategy." Jiang Xichang deeply understood this meaning, and his medical knowledge gradually clarified. Subsequently, he could treat minor illnesses himself, which is what is meant by 'three fractures of the arm' (referring to extensive experience).
Aversion to Cold
Madam Bu from Dongting suffered from a cold disease. A famous physician prescribed Shenfu Tang (Ginseng and Aconite Decoction) for her, taken daily as a routine medication. Over ten years, she consumed dozens of jin of Fuzi (Prepared Aconite Root), yet her cold symptoms worsened. In early winter, she needed fire on all four sides and wore several layers of cotton clothes, yet still shivered violently. I said, "This is heat pathogens constrained internally, forcing yin to float externally." The *Neijing* says: "The deeper the heat, the deeper the厥 (cold extremities)." It also says: "Extreme heat generates cold." One should dissipate the heat and allow it to reach the exterior. I used several liang of Lugen (Reed Rhizome), decocted into a cooling and dispersing drink for her. After three doses, she removed the fires; after ten doses, she reduced her clothing. By regularly taking yin-nourishing herbs, her body became warm. A year later, the accumulated toxicity of Fuzi within her body fully erupted. Her whole body felt like burning. Taking cold-natured herbs provided slight relief. Subsequently, hot sores appeared all over her body, head, face, mouth, and nose, while her lower body rotted completely with dripping pus and blood. I treated her with surgical methods for heat toxins. It took one year for her to recover. Later, the older she got, the more she disliked heat, opposite to her previous condition. If one does not understand the principle and continues to administer hot herbs, heat will constrain internally and cold will float externally, leading to the separation of yin and yang and death. Even after death, people will ultimately believe she died of yang deficiency.
Aversion to Wind
Madam Xu, wife of Scholar Zhu Jun from Jiashan, was ill. Physicians overused dispersing agents, causing surface deficiency, and subsequently used tonifying agents to secure the pathogens. Wind entered the Ying (Nutritive) level. She feared wind intensely, hiding indoors for months, avoiding natural light. Seeing even a slight breeze triggered chills, fever, and dizziness. She invited me to examine her. Upon entering the bedroom, I saw the window lattices covered with multiple layers of cloth, curtains hung before the bed, and gauze screens surrounding the warm canopy. Her pulse was soft and weak, lacking yang signs. I said, "Previous medicinal errors combined with excessive wind avoidance led to disconnected yang qi and unsecured Wei (Defensive) qi. Sunlight exposure is necessary, specifically basking in the midday sun, for the medicine to take effect." Scholar Xu asked, "Seeing the sun inevitably involves wind. What should we do?" I said, "Temporarily remove the roof tiles to let sunlight shine directly down. How about that?" Following this method, after three days she could open the windows; after ten days, she could tolerate wind, and all ailments gradually healed. The following year, Scholar Xu took his family to the capital. His boat docked by the river, and he invited me to prescribe a maintenance formula. That day was windy. While diagnosing at the waterside window, I feared the wind greatly, whereas Madam Xu felt no discomfort. This is because when Wei qi is solid, one naturally enjoys seeing the wind. This is spontaneous and cannot be forced. Note: The argumentation and treatment principles rival those of Dai Ren.
Zhu Zongzhou from Jiaxing had a constitution of excess yang and deficient yin, complicated by phlegm stagnation and rebellious qi. Physicians treated him with warming and tonifying methods, resulting in chest and diaphragm fullness and obstruction, along with priapism (excessive sexual arousal). Other physicians believed both spleen and kidney were deficient and feared it was incurable. They sought my help in the mountains. Observing his robust physique and vigorous qi, with ascending yang that failed to descend and closed orifices, I smiled and said, "This is a double excess syndrome of the liver and kidneys." First, I used clearing and moistening herbs, adding Shigao (Gypsum Fibrosum) to direct rebellious qi downward. Then, I used phlegm-resolving and stomach-opening herbs to cleanse the middle jiao. Finally, I used kidney-nourishing and yin-strengthening herbs to anchor the primordial qi. His sexual function normalized. After May, his concubine became pregnant and gave birth to a daughter. A year later, she bore a son. He only felt excessive internal heat, so he regularly took Yangyin Qinghuo Wan (Nourish Yin and Clear Fire Pills). If he interrupted them, the fire would flare up, leaving him exhausted as before. Yet, the world uses hot herbs to treat priapism. Is this not absurd?
Note: In autumn this year, Sun Weishen, a clerk who had fallen out of favor, suffered from chronic fatigue and anger. Suddenly, he had spontaneous sweating and aversion to cold, wrist pain, coughing with rebellious qi, and vomiting bitter fluid. I diagnosed his pulse as wiry, soft, and slippery. His form was thin, complexion dark-yellow, coating yellow, no thirst, red urine, and difficult defecation. I prescribed Erchen Tang (Two-Cured Decoction) minus Gancao (Licorice Root), plus Shashen (Glehniae Radix), Zhuru (Bambusae Caulis in Taeniam), Pipaye (Loquat Leaf), Zhuye (Bambusae Folium), Huanglian (Coptidis Rhizoma), and Luoren (Trichosanthis Semen). He said, "I have had impotence for a month; I fear I cannot take these cooling herbs." I said, "This is yang qi ascending, blocked by phlegm, preventing descent." After one dose, the rebellious qi calmed, pain stopped, vomiting ceased, sweating stopped, and he could eat normally. Adding Renshen (Ginseng Radix et Rhizoma) to the original prescription, his sexual function returned within ten days, and all ailments vanished.
Yang surnamed, living east of Suzhou Prefecture, was in his thirties. He squandered his father's thousand taels of silver on prostitutes. His father reprimanded him publicly. His constitution was weak, compounded by depression and anger. Initially, it resembled Taiyang disease, but gradually he became comatose and heavy-bodied. Physicians considered it a pure deficiency syndrome and only performed potent tonification, administering three qian of Renshen daily. This caused phlegm-fire to knot further, making his body stiff as a corpse. The family thought there was no hope. When I entered to examine him, everyone was weeping around him. After finishing the pulse diagnosis, I palpated his body and found thousands of phlegm nodules all over. I could not help but laugh loudly, startling the weeping family. I said, "You cry because you think he is dying? Try borrowing a large plank from the prefecture and beating him forty times; he won't die." His father doubted this, saying, "If he can be cured, having spent a thousand taels on Renshen, I should give another thousand taels as gratitude." I said, "That may work on others, but I have no such precedent. Let us just follow the proper way." I immediately prescribed a very plain formula for clearing fire and calming the spirit, assisted by a powder of Luobozhong (Radish Seed). After one dose, he could speak in three days; sit in five days; walk normally in one month. At that time, peonies were blooming. Relatives and friends held a flower-viewing banquet to celebrate. I happened to arrive and joked, "You took a thousand taels worth of Renshen and nearly died; you took my powder and recovered. Shouldn't you repay the medicine fee?" His maternal uncle present said, "Must repay. Please specify the amount." I said, "Medicine that increased the illness was worth a thousand taels; medicine that removed the illness should naturally be double." The patient looked alarmed. I said, "Don't fear. It's merely eight cash for Luobozhong powder." We took the remaining powder to look at; it was indeed radish seed. Everyone laughed heartily. The nodules all over his body were formed by tonics trapping phlegm pathogens. It took half a year for them to dissolve. Pathogens are hard to keep for so long. Fortunately, they were stuck in the skin and fascia; had they entered the zang-fu organs, he would have died long ago.
Note: This summer, Liu Wuting, aged sixty-three, suffered from chronic phlegm-wheezing and spontaneous sweating. All physicians considered it deficiency and applied tonics extensively, to no avail. Xu Yueyan instructed me to visit him. Sweat poured like rain; he waved his fan incessantly. His eyes protruded, face swollen, neck enlarged, chest obstructed. Pulse was slippery and long. Wife and daughters begged anxiously, fearing sudden collapse. I said, "He is about to be blocked to death; how can you talk of collapse?" I prescribed Daotan Tang (Guide Out Phlegm Decoction) plus Xuanfuhua (Inulae Flos), Haishi (Aragoniae Concha), Zexie (Alismatis Rhizoma), and Baiqian (Cynanchi Stauntonii Radix). After one drink, symptoms reduced. After seven days, his fontanelle flattened; after a month, he recovered. Next, Gu surnamed, aged fifty-six, fat and white with much phlegm, ate lotus seeds for a month. Gradually lost appetite, developed wheezing, rebellious qi, spontaneous sweating, and insomnia. Thinking it was deficiency, he underwent repeated tonification. Qi rebelled dangerously. I was summoned urgently. Coating was yellow, urine red, pulse slippery and irregular. Treated with lung-clearing and phlegm-eliminating methods until recovery, then followed up with Fuling Yin (Poria Drink).
Madam Wang Xiaoxian from Songjiang had a history of blood disorders, intermittent. During attacks, she had mild coughing. Due to catching a cold, it transformed into phlegm-wheezing. She could not lie on a pillow, sitting bent over a table day and night, unable to sustain herself. At that time, Fa Danshu, a famous physician from Changzhou, had treated her unsuccessfully and invited me. I said, "This is Xiaoqinglong Tang (Minor Green Dragon Decoction) syndrome." Fa said, "I certainly know this, but she has a weak constitution and chronic blood disorder. Can Mahuang (Ephedrae Herba) and Guizhi (Cinnamomi Ramulus) be used?" I said, "In emergencies, treat the branch first. If she wheezes for a few more days, she will die immediately. Treat the new illness first; after recovery, treat the root illness." Fa said, "True. But how can the family know? If treated for the root and she dies, she bears no resentment; if treated with Mahuang/Guizhi and she dies, they will blame the herbs for killing her, not the lack of treatment for the root. I am a practitioner and cannot bear this blame. You do not seek fame in medicine; I will not interfere. You take sole responsibility." I said, "Agreed. If the medicine causes harm, I will accept it. I only ask you not to obstruct." So she took it. After drinking, her breathing calmed, she lay on the pillow, and slept peacefully through the night. Then, I used phlegm-resolving, lung-moistening, yin-nourishing, and stomach-opening formulas sequentially to regulate her, and her body returned to normal. Old Man Fa had considerable learning and was not a vulgar physician, yet he knew but could not act. Perhaps wanting to navigate society and practice medicine, if one misses, slander follows. I do not seek fame this way, so I acted decisively. Whenever there is concern for personal gain or loss in the world, one cannot fully execute one's will. This applies to all matters under heaven, not just medicine.
Note: When external wind-cold constrains and internal fluid retention moves to cause wheezing and coughing, one cannot abandon Xiaoqinglong Tang. The case mentions 'catching a cold' refers to wind-cold. If not wind-cold pathogens, Mahuang and Guizhi should not be used arbitrarily. Readers should grasp this insight.
Phlegm-Wheezing with Yin Collapse
Mother Shen from Suzhou suffered from alternating chills/fever, phlegm, and wheezing. Her son-in-law, Mr. Mao, invited me. A famous physician was present, pen in hand, hesitating: "Profuse sweating without stopping; yang is collapsing. What to do? Only Renshen, Fuzi, Shudihuang (Rehmanniae Radix Preparata), and Ganjiang (Zingiberis Rhizoma) will suffice." He wrote the prescription and left. I arrived without announcing my name, waiting for him to leave before entering. Her pulse was surging and large; hands and feet were not cold; she wheezed and sweated profusely. I looked at Mr. Mao and said, "Quickly buy Banxia Mai (Floating Wheat) half a he and seven Dazao (Jujubae Fructus). Boil them into a soup for her to drink." Following this, sweating stopped abruptly. Then I prescribed two doses of phlegm-resolving and fire-clearing herbs, and she stabilized. Collapse of yang and collapse of yin appear similar but are fundamentally different. One presents with a faint pulse, cold sweat like grease, cold extremities, and a moist tongue. The other presents with a surging pulse, hot non-sticky sweat, warm extremities, and a dry tongue. However, if yin collapse persists, yang escapes with the sweat, primordial qi scatters and collapses, becoming yang collapse. But during yin collapse, yang qi is still vigorous; one must not immediately use yang-tonifying herbs. One should consolidate the yang qi. This must be known. Herbs for yin collapse should be cool; herbs for yang collapse should be hot. Reversing them leads to immediate death. Between root and branch, priority and sequence, the distinction lies in hair's breadth. Yet, the world knows nothing of this, hence acting oppositely.
Note: Sister of Wu Fuzhai had a yin-deficient constitution. After marrying into the Shen family, I hadn't seen her for a long time. Last year, I heard of her chronic cough. She took large doses of tonics, gained appetite and flesh, and I thought she had recovered. This summer, I was called again; she said the cough persisted. Upon examination, her face was swollen and red, pulse slippery and irregular, tongue crimson and dry. She craved meat. I said, "This is caused by phlegm-fire. Do not mistake hoarseness and hypochondriac pain for consumption (tuberculosis). I gave pills of lung-clearing and phlegm-resolving herbs to transform, clearing the upper jiao. Indeed, sticky phlegm was gradually expectorated, and all ailments settled. Her body became thin again, so I began yin-nourishing aftercare. The patient said: 'When taking tonics earlier, my body grew plump, but my waist ached and distended. Slight touching triggered endless coughing. I suspected phlegm. But physicians attributed it to extreme deficiency, increasing tonification, which brewed phlegm throughout the body.'"
Inspector Mao Gongyu, nearing eighty, had chronic phlegm-wheezing. Due to overwork, it flared severely. He sat bent over a table for seven days, unable to lie down. The family panicked and summoned me. I said, "This is excess above and deficiency below." I prescribed Qingfei Xiaotan Yin (Clear Lung and Eliminate Phlegm Drink), administered with a small piece of Renshen (one qian). Two doses cured him. Old Man Mao said, "Mr. Xu's scholarship is profound, needless to say. But cutting Renshen into pieces—this is clever trickery by smart people." More than a year later, the illness recurred. He followed the previous prescription but added Renshen to the decoction. Wheezing worsened. I was summoned again. He recounted using last year's formula: "I nearly died last time; you saved me with one dose. Why repeat the same path?" I asked, "Did you add the Renshen to the decoction?" He said, "Yes." I said, "No wonder it increased the illness." I prescribed taking the Renshen as a piece again. Two doses cured him. Deficiency below should indeed be tonified, but with phlegm-fire above, tonification increases it. Only by taking it as a piece does the Renshen property not release immediately, allowing the lung-clearing herbs to take effect first. Once it passes through the stomach, the Renshen property releases, and the illness heals. Ancient doctors also used such methods; people simply do not know. Everyone admired this.
Note: Phlegm-wheezing interfering with sleep can occur without deficiency. Huang Zhehua, over fifty, caught wheezing from overwork last winter. Until spring, he couldn't sleep for twenty days. Mr. Gu treated it as lower-jiao wheezing, worsening the condition. Ten days later, I examined him. Pulse wiry-slippery, coating widespread, tongue edges crimson. This was winter-warmth attacking the lung, missed by clearing and resolving. I gave light, clear, and transforming herbs until recovery. Regarding Renshen not being decocted: to make it descend, use pills to transform slowly; to make it linger above, use pills. Both have subtle meanings. Prescribers should not consider a single decoction as the end of treatment. Also, deficiency not in the yin aspect: I treated Fang Xiaoshan this autumn with phlegm-wheezing and profuse sweating. Physicians gave clearing and descending herbs for several doses. Result: loose stools, cold limbs, anorexia, sleep disturbance, rebellious qi, epigastric pain, red face, cold sweat. My diagnosis: pulse wiry-soft without spirit, white coating, no thirst. This is cold-phlegm excess above and kidney-yang deficiency below. I prescribed Zhenwu Tang (True Warrior Decoction) minus Shengjiang (Fresh Ginger), plus Ganjiang, Wuweizi (Schisandrae Fructus), Renshen, Houpo (Magnoliae Officinalis Cortex), and Xingren (Armeniacae Semen Amarum). One dose showed improvement; two doses resolved it. I also treated Gu surnamed, fat and white, pulse deep-weak, prone to phlegm-wheezing and sweating, no thirst, much phlegm, vomiting after sipping porridge. This was middle-jiao deficiency with phlegm stagnation. I prescribed Liujun Zi Tang (Six-Gentlemen Decoction) minus Gancao, plus Houpo, Xingren, Jiangzhi (Ginger Juice), and Chuanlian (Coptidis Rhizoma). Seven doses resulted in full recovery.
Fluid Retention and Masses
Xi Zaiyue from Dongting had chronic fluid retention under the hypochondrium. Attacks caused severe pain, vomiting: first clear water, then yellow water, then black water mixed with blood. He suffered immensely, unable to endure. Remissions were followed by recurrences. Palpating his abdomen, I found a mass under the left hypochondrium, called a 'fluid cyst.' Unless this is eliminated, the root cause remains. External treatment was indicated. I prepared a steaming herb mixture, made a dough ring, placed the herbs inside, covered with copper sheet, and steamed with moxa fire. Over ten times daily, stopping after 360 applications. Following this regimen for three months, the mass completely dissolved, and the disease was permanently eradicated. He lived to seventy-seven. This disease is common, yet physicians ignore it. Although severity varies, steaming is key. Note: This summer, Sha Peisheng from Jiangyin suffered from substernal fullness and abdominal masses. Lying down, qi descended from the spleen area to the fingers, waking him with fright. I diagnosed qi stagnation and fluid retention, treating with descending methods. As he was preparing to go to the capital, fearing weakness, a physician catered to him with large-dose warming tonics. Initially seemed fine, but ten days later: dull mind, mutism, vertigo, anorexia, constipation, insomnia, alternating chills/fever. I was summoned again. Palpating the epigastrium, gurgling sounds were heard. Masses piled up around the navel. Urine red, coating yellow, pulse wiry-rapid. Fortunately, his family trusted me for years, without interference. Using qi-moving, fluid-draining, collateral-clearing, and liver-soothing agents, regulated for three months, all ailments healed.
Gu surnamed in the prefecture had chronic fluid retention/masses under the left hypochondrium. Attacks caused distending pain and vomiting. Initially mild, physicians treated with tonics. Recurrences became frequent and severe. I warned him, "This is fluid retention. Many patients suffer this. Focus on resolving fluid and moving qi. Absolutely avoid warming tonics. Tonification creates hard masses, which are incurable." He did not believe me. Later, due to emotional depression, the disease flared severely. Extreme pain, vomiting, exhaustion. Physicians administered massive doses of Renshen and Fuzi. Heat rushed upward, phlegm-fluid blocked. Pain intensified. Extremities cold, pulse minute. Physicians added more Renshen and Fuzi, aiding blockage. One sip of medicine felt like knives piercing the heart. He begged to stop. Wife and children knelt weeping, "Four famous physicians agreed on this formula. How could it be wrong? Renshen is so precious; how could it fail?" Zhu said, "Do I not want to live? I truly cannot bear this medicine! If it relieves my pain slightly, I would accept death. But if you force me to die in agony, it is fate." He reluctantly drank half. Fire boiled, phlegm choked. He cried out and died. Deaths of the wealthy and noble are mostly like this, though not always this severe. Know that medicine hitting the target need not be tasted; smelling the aroma brings joy and desire to drink. Medicine missing the target smells repulsive. Thus, medicines taken with reluctance contradict the disease. The *Neijing* says: "When attending patients, ask what they prefer." This is the true secret of healing. Mencius said, "If medicine does not cause dizziness/discomfort, the serious disease will not heal." This refers to attacking pathogens and breaking accumulations, not a universal rule.
Note: When compiling *Huixi Medical Cases*, my fellow townsman Jiang Yinfang wanted to publish it. He asked a friend to copy the clean version. This case was omitted. I realized it only after printing was finished. It was inconvenient to insert it, so I record it here (from *Guiyan Lu*). Also, this patient's fluid retention was caused by internal blazing liver heat, distinct from middle-jiao deficiency-cold with fluid retention requiring warming harmony. The idea that knowing if medicine hits the target relies on smell is most reasonable. Previously, Mrs. Gu Zhaoda, magistrate of our province, suffered from summerheat. Physicians, noting her postpartum state, stubbornly used Rougui (Cinnamomi Cortex). The patient feared the smell and refused firmly. Family urged her repeatedly to drink. She died. Not only medicine, but food too. I dislike the smell of winter-pounded rice; eating it makes me sick.
Regurgitation (Fanwei)
Zhu Tingli from Jiaxing, former Prefect of Guangxin, suffered from vomiting, intermittent remission. At that time, vomiting continued, unable to swallow a grain of rice for three days. Physicians declared it Gezheng (Obstruction Syndrome) hopeless. His friend invited me. I said, "This is Fanwei (Regurgitation) syndrome, not Gezheng. Gezheng is dryness of the stomach fu organ; Fanwei is rebellious phlegm-fire. The severity differs greatly." I treated him with modified Banxia Xiexin Tang (Pinellia Heart-Draining Decoction). Gradually, he could eat and recovered. From then on, we became close friends. Due to irregular diet, minor episodes occurred frequently. He was not good at eating regular meals. For years, he only accepted my prescriptions, living peacefully. Later, passing by his home, he told me, "I met a famous physician in Wulin. He said my constitution is deficient and requires Renshen and Fuzi. Since taking his prescription, I feel stronger and eat more." I said, "This aids fire to rot food, consuming primordial qi. There will be harmful heat toxins." Tingli laughed and disagreed, seeming to regret not meeting this physician sooner. Within two months, he sent someone overnight to invite me. I boarded the boat and arrived at dusk at his bedroom. Blood and sweat covered the floor. Shocked, I asked the cause. Tingli could no longer speak, only shedding tears, apologizing, acting as if bidding farewell. He had vomited over a dou of blood; no medicine could help. He passed away at dawn. Surviving luckily for ten years, perished in a moment. How many in the world suffer hidden harm from taking hot agents?