雄按:服温补药而强旺加餐，病家必以为对证矣，而孰知隐受其害哉。更有至死而犹不悟者，目击甚多，可为叹息。
娄门范昭，素患翻胃，粒米不能入咽者月余，胸中如有物蠢动。余曰:此虫膈也，积血所成。举家未信，余处以开膈末药，佐以硫黄，三剂后，吐出痰血半瓯，随吐虫二十余枚，长者径尺，短者二寸，色微紫。其肠俱空，乃药入而虫积食之，皆洞肠而死者，举家惊喜，以为病愈。余曰:未也。姑以粥与之，连进二碗，全然不呕，更觉宽适，顷之粥停不下，不能再食。余曰:胃腑已为虫蚀，无藏食之地，无救也。辞不复用药，不旬日而卒。
呃
郡中陆某，患呃逆，不过偶尔胃中不和，挟痰挟气，世俗所谓冷呃也，不治自愈。非若病后呃逆，有虚实寒热之殊，关于生死也。陆乃青粱之人，从未患此，遂大惧，延医调治。医者亦大骇云:此必大虚之体，所以无病见此。即用人参、白术等药，痰火凝结而胃络塞，呃遂不止，病者自问必死，举家惊惶。余诊视之，不觉狂笑，其昆仲在旁，怪而问故。余曰:不意近日诸名医冒昧至此，此非病也，一剂即愈矣。以泻心汤加旋覆花、枇杷叶，果一剂而呃止。越一月，呃又发，仍用前日诸医治之，数日而死。其老仆素相熟，偶遇于他所，问其主人安否?因述其故。岂非命耶!
雄按:吴雨峰大令，年七十一岁，今秋患感发热，而兼左胁偏痛，舌色干紫无苔，稍呷汤饮，小溲即行，不食不便，脉洪且数。余知其平素津虚脾约，气滞痰凝，连予轻肃宣濡之剂，热渐缓，胁渐舒，而舌色不润，仍不喜饮，溲赤便闭，呃忒频来，举家皇皇。余曰：无恐也，便行即止矣。逾二日，连得畅解，脉静身凉，舌色有津，呃仍不减，人皆谓高年病后之虚呃，议用镇补。余曰:此气为痰阻，升降失调，得食不舒，平时无嚏，是其征也。授以枳桔汤加蒌、薤、菖、茹、橘、半、柴胡，果一剂知，二剂已。
癃
学宫后金汝玉，忽患小便不通，医以通利导之，水愈聚而溺管益塞，腹胀欲裂，水气冲心即死，再饮汤药，必不能下，而反增其水。余曰：此因溺管闭极，不能稍通也。以发肿药涂之，使溺器大肿，随以消肿之药解之，一肿一消，溺管稍宽，再以药汤洗少腹而挤之，蓄溺涌出而全通矣。此无法中之法也。
木渎某，小便闭七日，腹胀如鼓，伛偻不能立，冲心在顷刻矣。就余山中求治，余以鲜车前根捣烂敷其腹，用诸利水药内服，又煎利水通气药，使坐汤中，令人揉挤之，未几溺迸出，洒及揉者之面，溺出斗余，其所坐木桶几满，腹宽身直。雄按:两外治法皆妙。
洞庭席君际飞，形体壮实，喜饮善啖，患水肿病，先从足起，遂及遍身，腰满腹胀，服利水之药，稍快，旋即复肿，用针针之，水从针孔出，则稍宽，针眼闭则复肿。《内经》有刺水病之法，其穴有五十七，又须调养百日，且服闭药，而此法失传，所以十难疗一。余所治皆愈而复发，遂至不救。虽因病者不能守法，亦由医治法不全耳。惟皮水风水，则一时之骤病，驱风利水，无不立愈，病固各不同也。
消
常熟汪东山夫人，患消证，夜尤甚，每夜必以米二升，煮薄粥二十碗，而溲便不异常人，此乃为火所烁也。先延郡中叶天士，治以乌梅、木瓜等药，敛其胃气，消证少痊。而烦闷羸瘦，饮食无味，余谓此热痰凝结，未有出路耳。以清火消痰，兼和中开胃调之，病情屡易，随证易方，半年而愈。
苏州黄四房女，年十二，患腹痛，愈医愈甚。余偶至其家，昏厥一夕方苏，舌俱咬破，流血盈口，唇白而目犹直视，脉参错无常。余曰:此虫痛也。贯心则死，非煎药所能愈，合化虫丸与之，痛稍缓，忽复更痛，吐出虫二十余条，长者径尺，紫色，余长短不齐，淡红色，亦有白者，自此而大痛不复作，小痛未除，盖其窠未去也。复以杀虫之药，兼安胃补脾之方调之，而虫根遂绝。盖此证甚多，医者既不能知，惟认为寒与食，即以为虫，又无杀虫之方，在精力强旺者，久能自化;其不足者，变为丁奚、劳怯、痞臌等证，至死而人不能知，亦可哀也。余治此证不一，姑举其最剧者以明治法。
常州蒋公讳斌之孙，患心腹痛，上及于头，时作时止，医药罔效，向余求治。余曰此虫病也。以杀虫之药，虫即远避，或在周身皮肤之中，或在头中，按之如有蠕动往来之象。余用杀虫之药为末，调如糊，到处敷上，而以热物熨之，虫又逃之他处，随逃随敷，渐次平安，而根终不除，遂授方令归。越二年书来，云虫根终未尽，但不甚为害耳，此真奇疾也。
淮安巨商程某，母患怔忡，日服参术峻补，病益甚，闻声即晕，持厚聘邀余。余以老母有恙，坚持不往，不得已，来就医，诊视见二女仆从背后抱持，二女仆遍体敲摩，呼太太无恐，吾侪俱在也，犹惊惕不已。余以消痰之药去其涎，以安神之药养其血，以重坠补精之药纳其气，稍得寝。半月余，惊恐全失，开船放炮，亦不为动，船挤喧嚷，欢然不厌。盖心为火脏，肾为水脏，肾气挟痰以冲心，水能克火，则心振荡不能自主，使各安其位，则不但不相克，而且相济，自然之理也。
长兴赵某，以经营过劳其心，患怔忡证，医者议论不一，远来就余。余以消痰补心之品治其上，滋肾纳气之药治其下，数日而安。此与程母病同，而法稍异。一则气体多痰，误服补剂，水溢而火受克之证;一则心血虚耗，相火不宁，侵犯天君之证，不得混淆也。
姻戚殷之晋，年近八旬，素有肠红证，病大发，饮食不进，小腹高起，阴囊肿亮，昏不知人。余因新年贺岁候之，正办后事。余诊其脉，洪大有力，先以灶灰、石灰作布袋，置阴囊于上，袋湿而囊肿消;饮以知母、黄柏泻肾之品。越三日，余饮于周氏，周与至戚相近半里，忽有叩门声，启视之，则其子扶病者至，在座无不惊喜，同问余曰：何以用伐肾之药而愈?余曰:此所谓欲女子而不得也。众以为戏言。翁曰:君真神人也。我向者馆谷京师，患亦相似，主人以为无生理也，遂送我归，归旬日即痊。今妻妾尽亡，独处十余年，贫不能蓄妾，又耻为苟且之事，故病至此，既不可以告人，亦无人能知之者。言毕凄然泪下，又阅五年而卒。盖人之气禀各殊，亢阳之害，与纵欲同，非通于六经之理，与岐黄之奥者，不足与言也。雄按:纵欲固伤阴，而亢阳亦烁阴，知柏泻肾者，泻肾火之有余，而保其不足之水也
。 平望镇张瑞五，素有血证，岁辛丑，余营葬先君，托其买砖灰等物，乡城往返，因劳悴而大病发，握手泣别，谓难再会矣。余是时始合琼玉膏未试也，赠以数两而去，自此不通音问者三四载。一日镇有延余者，出其前所服方，问:何人所写?则曰:张瑞五。曰:今何在?曰:即在馆桥之右。即往候之，精神强健，与昔迥异，因述服琼玉膏后，血不复吐，嗽亦渐止，因涉猎方书，试之颇有效，以此助馆谷所不足耳。余遂导以行医之要，惟存心救人，小心敬慎，择清淡切病之品，稗其病势稍减，即无大功，亦不贻害。若欺世徇人，止知求利，乱投重剂，一或有误，无从挽回，病者纵不知，我心何忍。瑞五深以为然，后其道大行，遂成一镇名家，年至七十余而卒。琼玉膏为治血证第一效方，然合法颇难，其时不用人参，只用参须，生地则以浙中所出鲜生地，打自然汁熬之，不用干地黄，治血证舍此无有无弊者。
雄按:行医要诀，尽此数语，所谓以约失之者鲜，学者勿以为浅论也。
洞庭吴伦宗夫人，席翁士俊女也，向患血证，每发，余以清和之药调之，相安者数年。郡中名医有与席翁相好者，因他姓延请至山，适遇病发，邀之诊视，见余前方，谓翁曰:此阳虚失血，此公自命通博，乃阴阳不辨耶!立温补方加鹿茸二钱，连服六剂，血上冒，连吐十余碗，一身之血尽脱，脉微目闭，面青唇白，奄奄待毙，急延余治。余曰：今脏腑经络俱空，非可以轻剂治。觅以鲜生地十斤，绞汁煎浓，略加人参末，徐徐进之，历一昼夜尽生地汁，稍知人事，手足得展动，唇与面红白稍分，更进阿胶、三七诸养阴之品，调摄月余，血气渐复。夫血脱补阳，乃指大脱之后，阴尽而阳无所附，肢冷汗出，则先用参附以回其阳，而后补其阴。或现种种虚寒之证，亦当气血兼补。岂有素体阴虚之人，又遇气升火旺之时，偶尔见红，反用大热升发之剂，以扰其阳而烁其阴乎!此乃道听途说之人，闻有此法，而不能深思其理，误人不浅也。
嘉兴王蔚南，久患血证，左胁中有气，逆冲喉旁，血来有声如沸。戊子冬，忽大吐数升，面色白而带青，脉微声哑，气喘不得卧，危在旦夕。余以阿胶、三七等药，保其阴而止其血，然后以降火纳气之品，止其冲逆。复以补血消痰，健脾安胃之方，上下分治，始令能卧，继令能食，数日之后，方能安卧。大凡脱血之后，断不可重用人参升气助火，亦不可多用滋腻以助痰滞胃。要知补血之道，不过令其阴阳相和，饮食渐进，则元气自复，非补剂入腹，即变为气血也。若以重剂塞其胃口，则永无生路矣。况更用温热重剂，助阳烁阴而速之死乎。
洞庭张姓，素有血证，是年为女办装，过费心力，其女方登轿，张忽血冒升余，昏不知人。医者浓煎参汤服之，命悬一息，邀余诊视。六脉似有如无，血已脱尽，急加阿胶、三七，少和人参以进，脉乃渐复，目开能言，手足展动，然后纯用补血之剂以填之，月余而起。盖人生不外气血两端，血脱则气亦脱，用人参以接其气，气稍接，即当用血药，否则孤阳独旺而阴愈亏，先后主客之分不可不辨也。
乌镇莫秀东，患奇病，痛始于背，达于胸胁，昼则饮食如常，暮乃痛发，呼号彻夜，邻里惨闻。医治五年，家资荡尽，秀东欲自缢。其母曰：汝有子女之累，尚须冀念，不如我死，免闻哀号之声。欲赴水，其戚怜之，引来就医。余曰：此瘀血留经络也。因谓余子曦曰:此怪病也。广求治法以疗之，非但济人，正可造就己之学问。因留于家，用针灸熨拓煎丸之法，无所不备，其痛渐轻亦渐短，一月而愈，其人感谢不置。余曰:我方欲谢子耳。凡病深者，须尽我之技而后奏功。今人必欲一剂见效，三剂不验，则易他医。子独始终相信，我之知己也，能无感乎。
淮安程春谷，素有肠红证，一日更衣，忽下血斗余，晕倒不知人，急灌以人参一两，附子五钱而苏。遂日服人参五钱，附子三钱，而杂以他药，参附偶间断，则手足如冰，语言无力，医者亦守而不变，仅能支持，急棹来招，至则自述其全赖参附以得生之故。诊其六脉，极洪大而时伏，面赤有油光，舌红而不润，目不交睫者旬余矣。余曰：病可立愈，但我方君不可视也。春谷曰:我以命托君，止求效耳，方何必视。余用茅草根四两作汤，兼清凉平淡之药数品，与参附正相反。诸戚友俱骇，春谷弟风衣，明理见道之士也，谓其诸郎曰:尔父千里招徐君，信之至，徐君慨然力保无虞，任之至，安得有误耶。服一剂，是夕稍得寝，二剂手足温，三剂起坐不眩，然后示之以方，春谷骇叹，诸人请申其说。余曰：血脱扶阳，乃一时急救之法，脱血乃亡阴也。阳气既复，即当补阴。而更益其阳，则阴血愈亏，更有阳亢之病。其四肢冷者，《内经》所谓热深厥亦深也。不得卧者，《内经》所谓阳胜则不得人于阴，阴虚故目不眠也。白茅根交春透发，能引阳气达于四肢，又能养血清火，用之，使平日所服参附之力，皆达于外，自能手足温而卧矣。于是始相折服。凡治血脱证俱同此。 雄按:论治既明，而茅根功用，尤为发人所未发。
血 痢
洞庭葛允诚，患血痢五年，日夜百余次，约去血数石，骨瘦如柴，饮食不进，举家以为必无生理。余友姜君锡常次子曹芳，从余学医于山中，病者即萼芳妻弟也。锡常怜之，令同萼芳寄膳余家，朝夕诊视。余先用滋补之剂以养其血脉，复用开胃之药以滋其化源，稍健而能食。久痢至五载，大肠之内必生漏管，遂以填补之品塞其空窍，痢日减，饭日增，不半年而每食饭必六七碗，至冬病全愈。丰肥强壮，归至家，亲戚俱不相识认，无不叹以为奇。
崩
徽州盐商汪姓，始富终贫，其夫人年四十六，以忧劳患崩证，服参附诸药而病益剧，延余治之。处以养血清火之剂，而病稍衰，盖此病本难除根也。越三年夫卒，欲往武林依其亲戚，过吴江求方，且泣曰：我遇先生而得生，今远去，病发必死耳。余为立长服方，且赠以应用丸散而去。阅十数年，郡中有洋客请治其室人，一白头老妪出拜，余惊问，曰：我即汪某妻也。服先生所赠方药，至五十二而崩证绝，今已六十余，强健逾昔，我婿迎我于此，病者即我女也。不但求治我女，必欲面谢，故相屈耳。盖崩证往往在五十岁以前天癸将绝之时，而冲任有火，不能摄纳，横决为害。至五十以后，天癸自绝，有不药而愈者，亦有气旺血热，过时而仍有此证者，当因时消息，总不外填阴补血之法。不知者以温热峻补，气愈旺而阴愈耗，祸不旋踵矣。此极易治之病，而往往不治，盖未能深考其理，而误杀之耳。
瘀血冲厥
徐大椿按语：服用温补药物后，患者食欲旺盛、进食增多，家属必定认为药证相符，但谁又知道这暗中却受到其害呢？更有至死都不醒悟的，我亲眼目睹的很多，令人叹息。
娄门范昭，平素患有翻胃（膈食），一粒米不能咽下已有一个多月，胸中好像有东西在蠕动。我说：这是虫膈，由积血形成的。全家都不相信，我给他开膈末药，配合硫黄，服药三剂后，吐出痰血半碗，随后吐出虫子二十多条，长的有一尺长，短的有二寸长，颜色微紫。他的肠道都空了，是因为药力进入后，虫子吃了药，都钻破肠道而死，全家惊喜，以为病好了。我说：还没好。暂且给他喝粥，连续喝了两大碗，完全不呕吐，更觉得舒适宽快，过了一会儿，粥停住不往下走，不能再吃了。我说：胃腑已经被虫子侵蚀，没有容纳食物的地方，无法救治了。辞别不再用药，不到十天就去世了。
郡中的陆某，患呃逆，不过是偶尔胃气不和，挟带痰湿和滞气，世俗所说的冷呃，不治也能自愈。不像病后的呃逆，有虚、实、寒、热的区别，关系到生死。陆某是富贵人家的人，从未患过此病，于是非常恐惧，请医生调治。医生也大为惊讶说：这一定是极度虚弱的体质，所以无病时出现这种情况。立即用人参、白术等药，导致痰火凝结而胃络堵塞，呃逆于是停止不了，病人自己问必死无疑，全家惊慌失措。我诊视后，忍不住大笑，他的兄弟在旁边，奇怪地问我原因。我说：没想到近日各位名医冒昧到这种地步，这不是病，一剂药就能治好。用泻心汤加旋覆花、枇杷叶，果然一剂后呃逆停止。过了一个月，呃逆又发作，仍然用前几天那些医生治疗，几天后就死了。他家的老仆和我很熟，偶然在别处遇到，问他主人安好否？于是讲述此事。这难道不是命运吗！
徐大椿按语：吴雨峰县令，七十一岁，今年秋天患感冒发热，兼左胁偏痛，舌色干紫无苔，稍微喝点汤水，小便即通，不吃东西也不大便，脉象洪大而数。我知道他平素津液亏虚、脾约（脾阴不足致便秘），气滞痰凝，连续给予轻清肃肺宣润的药物，热势渐缓，胁痛渐舒，但舌色仍不滋润，依然不喜欢喝水，小便赤涩大便闭结，呃逆频繁发作，全家惶恐不安。我说：不要怕，大便通了就会停止。过了两天，连得畅利排便，脉静身凉，舌色有津液，呃逆仍不减，人们都说这是高龄病后的虚性呃逆，议论用镇摄补益的方法。我说：这是气被痰阻，升降失调，进食后不舒服，平时不打喷嚏，这是征象。给予枳桔汤加瓜蒌、薤白、石菖蒲、竹茹、橘皮、半夏、柴胡，果然一剂见效，两剂痊愈。
学宫后面的金汝玉，忽然患小便不通，医生用通利导尿的方法，水液越积聚，溺管越堵塞，腹胀欲裂，水气冲心就会死，再喝汤药，必然不能下咽，反而增加体内水液。我说：这是因为溺管闭塞到了极点，不能稍通。用发肿的药涂抹，使溺器部位大肿，随即用消肿的药解除它，一肿一消，溺管稍宽，再用药汤洗少腹并挤压，蓄积的小便涌出而完全通畅了。这是无法之中的办法。
木渎某人，小便闭七天，腹胀如鼓，弯腰不能站立，冲心就在顷刻之间。到我家山中求治，我用鲜车前根捣烂敷在他的腹部，用各种利水药内服，又煎利水通气的药，让他坐在药汤中，让人揉挤，不久小便迸出，溅到揉者脸上，小便出一斗多，他所坐的木桶几乎满了，腹部变宽身体挺直。徐大椿按语：两种外治法都很奇妙。
洞庭席君际飞，形体壮实，喜欢饮酒善于进食，患水肿病，先从足部开始，遂及遍身，腰部胀满腹部膨隆，服用利水药，稍感轻松，随即又肿，用针刺之，水从针孔流出，则稍感宽松，针眼闭合则又肿。《内经》有刺水病的方法，穴位有五十七个，又须调养百日，并且服用固涩药，而此法失传，所以十难疗一。我所治疗的都痊愈但复发，遂至无法救治。虽然因为病人不能遵守医嘱，也是由于医治方法不全备罢了。只有皮水风水，是一时的骤发病，驱风利水，无不立刻痊愈，病情本来各不相同。
常熟汪东山夫人，患消渴证，夜间尤其严重，每晚必须用米二升，煮薄粥二十碗，而大小便不异常人，这是因为被火热所灼伤。先请郡中叶天士，用乌梅、木瓜等药，收敛胃气，消渴证稍有好转。但烦闷羸瘦，饮食无味，我说这是热痰凝结，没有出路。用清火消痰，兼和中开胃调理，病情屡有变化，随证更换方剂，半年而愈。
苏州黄四房女，十二岁，患腹痛，越治越重。我偶然到她家，昏厥一晚才苏醒，舌头都被咬破，流血满口，嘴唇白而眼睛还直视，脉象参差错乱无常。我说：这是虫痛。虫子贯穿心脏就会死，不是煎药所能治愈的，合化虫丸给她吃，疼痛稍缓，忽然又剧痛，吐出虫子二十多条，长的有一尺长，紫色，余下的长短不齐，淡红色，也有白色的，从此以后大痛不再发作，小痛未除，大概虫巢未去除。再用杀虫的药，兼安胃补脾的方子调理，而虫根遂绝。大概这种证候很多，医生既不知道，只认为是寒与食，即使认为是虫，也没有杀虫的方子，在精力强旺的人，久能自行化解；体弱不足的，变为丁奚、劳怯、痞臌等证，至死别人都不知道，也可悲哀。我治疗这种证候不止一次，姑且举其中最严重的来阐明治疗方法。
常州蒋公讳斌的孙子，患心腹痛，上及于头，时作时止，医药无效，向我求治。我说这是虫病。用杀虫的药，虫子就远避，或在周身皮肤之中，或在头中，按之如有蠕动往来之象。我用杀虫的药研为末，调成糊状，到处敷上，并用热物熨烫，虫子又逃到别处，随逃随敷，渐渐平安，而虫根终究没除，于是授方让他回去。过了两年来信说，虫根终究没尽，但不怎么危害了，这真是奇疾啊。
淮安巨商程某，母亲患怔忡，每天服用参术峻补，病更加严重，听到声音就晕倒，拿着厚礼邀请我。我以老母有病为由，坚持不去，不得已，来就医，诊视见两个女仆从背后抱持，两个女仆遍体敲摩，喊太太不要怕，我们都在，仍然惊惕不已。我用消痰的药去掉她的涎沫，用安神的药滋养她的血，用重坠补精的药收纳她的气，稍微能睡觉。半月多，惊恐全失，开船放炮，也不为动，船挤喧嚷，欢然不厌。盖心为火脏，肾为水脏，肾气挟痰以冲心，水能克火，则心振荡不能自主，使各安其位，则不但不相克，而且相济，是自然之理。
长兴赵某，因经营过劳其心，患怔忡证，医生议论不一，远道而来找我。我用消痰补心的药治其上，滋肾纳气的药治其下，几天就安稳了。这与程母的病相同，但方法稍有不同。一个是气体多痰，误服补剂，水溢而火受克之证；一个是心血虚耗，相火不宁，侵犯天君之证，不得混淆。
姻戚殷之晋，年近八十，素有肠红证，病大发，饮食不进，小腹高起，阴囊肿亮，昏不知人。我因新年贺岁去问候他，正办后事。我诊他的脉，洪大有力，先用灶灰、石灰做布袋，把阴囊放在上面，袋湿了而囊肿消；饮以知母、黄柏泻肾的药。过了三天，我在周氏喝酒，周与至戚相近半里，忽然有叩门声，打开看，是他的儿子扶着病人来，在座的人无不惊喜，一起问我：为什么用伐肾的药而痊愈？我说：这就是所谓的想女人而得不到。众人以为是戏言。老人说：您真是神人。我以前在京师馆谷（教书），病也相似，主人认为没救了，就送我回家，回家十天就好了。现在妻妾都亡，独处十多年，贫穷不能蓄妾，又耻于做苟且之事，所以病到这种地步，既不可以告诉别人，也没人能知道。说完凄然泪下，又过了五年去世。大概人的气禀各不相同，亢阳的危害，与纵欲相同，不通晓六经之理，与岐黄之奥妙的人，不足以与他谈论。徐大椿按语：纵欲固然伤阴，而亢阳也烁阴，知母、黄柏泻肾，是泻肾火之有余，而保其不足之水。
平望镇张瑞五，素有血证，辛丑年，我营葬先父，托他买砖灰等物，乡城往返，因劳累憔悴而大病发作，握手泣别，说难以再会了。我当时刚合制琼玉膏还未试用，赠给他几两而去，从此不通音问三四载。一天镇上有人请我去，拿出以前服的方子，问：谁写的？回答说：张瑞五。问：现在在哪里？回答说：就在馆桥右边。我就去探望他，精神强健，与过去迥异，于是讲述服琼玉膏后，血不再吐，咳嗽也逐渐停止，于是涉猎方书，试之颇有效，以此补助馆谷收入的不足。我于是引导他以行医的要诀，只要存心救人，小心敬慎，选择清淡切病的药，稗其病势稍减，即无大功，也不贻害。若欺世徇人，只知道求利，乱投重剂，一或有误，无从挽回，病人纵然不知道，我心何忍。瑞五深以为然，后来其道大行，遂成一镇名家，年至七十多岁去世。琼玉膏为治血证第一效方，然而合法颇难，当时不用人参，只用参须，生地则以浙江出产的鲜生地，打自然汁熬之，不用干地黄，治血证舍此无有无弊者。
徐大椿按语：行医要诀，尽在这几句话，所谓简约而失误的很少，学者不要以为这是浅论。
洞庭吴伦宗夫人，是席翁士俊的女儿，向来患血证，每次发作，我用清和的药调理，相安数年。郡中名医有与席翁相好的，因其他姓氏请至山中，恰好遇病发，邀他诊视，看到我的前方，对席翁说：这是阳虚失血，这位先生自命通博，竟然阴阳不辨耶！立温补方加鹿茸二钱，连服六剂，血上冒，连吐十余碗，一身之血尽脱，脉微目闭，面青唇白，奄奄待毙，急延我治。我说：现在脏腑经络俱空，不可以轻剂治。觅以鲜生地十斤，绞汁煎浓，略加人参末，徐徐进之，历一昼夜尽生地汁，稍知人事，手足得展动，唇与面红白稍分，更进阿胶、三七诸养阴之品，调摄月余，血气渐复。夫血脱补阳，乃指大脱之后，阴尽而阳无所附，肢冷汗出，则先用参附以回其阳，而后补其阴。或现种种虚寒之证，亦当气血兼补。岂有素体阴虚之人，又遇气升火旺之时，偶尔见红，反用大热升发之剂，以扰其阳而烁其阴乎！这是道听途说之人，闻有此法，而不能深思其理，误人不浅。
嘉兴王蔚南，久患血证，左胁中有气，逆冲喉旁，血来有声如沸。戊子冬，忽大吐数升，面色白而带青，脉微声哑，气喘不得卧，危在旦夕。我用阿胶、三七等药，保其阴而止其血，然后用降火纳气的药，止其冲逆。再用补血消痰，健脾安胃的方子，上下分治，始令能卧，继令能食，数日之后，方能安卧。大凡脱血之后，断不可重用人参升气助火，也不可多用滋腻以助痰滞胃。要知道补血之道，不过令其阴阳相和，饮食渐进，则元气自复，非补剂入腹，即变为气血也。若以重剂塞其胃口，则永无生路矣。何况更用温热重剂，助阳烁阴而速之死乎。
洞庭张姓，素有血证，是年为女儿办嫁妆，过费心力，其女方登轿，张忽然血冒升余，昏不知人。医生浓煎参汤服之，命悬一息，邀请我诊视。六脉似有如无，血已脱尽，急加阿胶、三七，少和人参以进，脉乃渐复，目开能言，手足展动，然后纯用补血之剂以填之，月余而起。盖人生不外气血两端，血脱则气亦脱，用人参以接其气，气稍接，即当用血药，否则孤阳独旺而阴愈亏，先后主客之分不可不辨也。
乌镇莫秀东，患奇病，痛始于背，达于胸胁，昼则饮食如常，暮乃痛发，呼号彻夜，邻里惨闻。医治五年，家资荡尽，秀东欲自缢。他母亲说：你有子女拖累，还需希望念头，不如我死，免闻哀号之声。欲赴水，亲戚怜悯他，引来就医。我说：这是瘀血留经络。于是对我儿子徐曦说：这是怪病。广求治法以疗之，不仅济人，正可造就自己的学问。于是留在他家，用针灸熨拓煎丸之法，无所不备，其痛渐轻亦渐短，一月而愈，其人感谢不置。我说：我正想谢你。凡是病深的，须尽我的技而后奏功。今人必欲一剂见效，三剂不验，则易他医。你唯独始终相信，是我的知己，能不感激吗。
淮安程春谷，素有肠红证，一日更衣，忽然下血斗余，晕倒不知人，急灌以人参一两，附子五钱而苏。于是日服人参五钱，附子三钱，而杂以他药，参附偶间断，则手足如冰，语言无力，医生也守而不变，仅能支持，急棹来招，至则自述其全赖参附以得生之故。诊其六脉，极洪大而时伏，面赤有油光，舌红而不润，目不交睫者旬余矣。我说：病可立愈，但我方君不可视也。春谷说：我以命托君，只求效耳，方何必视。我用茅草根四两作汤，兼清凉平淡之药数品，与参附正相反。亲戚朋友都骇然，春谷弟风衣，明理见道之士，对他的兄弟们说：你们父亲千里招徐君，信之至，徐君慨然力保无虞，任之至，安得有误耶。服一剂，当晚稍得寝，二剂手足温，三剂起坐不眩，然后示之以方，春谷骇叹，众人请申其说。我说：血脱扶阳，乃一时急救之法，脱血乃亡阴也。阳气既复，即当补阴。而更益其阳，则阴血愈亏，更有阳亢之病。其四肢冷者，《内经》所谓热深厥亦深也。不得卧者，《内经》所谓阳胜则不得人于阴，阴虚故目不眠也。白茅根交春透发，能引阳气达于四肢，又能养血清火，用之，使平日所服参附之力，皆达于外，自能手足温而卧矣。于是始相折服。凡治血脱证俱同此。 徐大椿按语：论治既明，而茅根功用，尤为发人所未发。
洞庭葛允诚，患血痢五年，日夜百余次，约去血数石，骨瘦如柴，饮食不进，全家以为必无生理。我朋友姜君锡常次子曹芳，随我学医于山中，病者是曹芳妻弟。锡常怜悯他，让他同曹芳寄膳我家，朝夕诊视。我先用滋补之剂以养其血脉，复用开胃之药以滋其化源，稍健而能食。久痢至五载，大肠之内必生漏管，遂以填补之品塞其空窍，痢日减，饭日增，不半年而每食饭必六七碗，至冬病全愈。丰肥强壮，归至家，亲戚俱不相识认，无不叹以为奇。
徽州盐商汪姓，始富终贫，其夫人年四十六，以忧劳患崩证，服参附诸药而病益剧，延我治之。处以养血清火之剂，而病稍衰，盖此病本难除根也。过了三年丈夫去世，想去武林依靠亲戚，过吴江求方，且哭泣说：我遇先生而得生，今远去，病发必死耳。我为立长服方，且赠以应用丸散而去。过了十几年，郡中有洋客请治其室人，一白头老妪出拜，我惊问，说：我就是汪某妻也。服先生所赠方药，至五十二而崩证绝，今已六十余，强健逾昔，我婿迎我于此，病者即我女也。不但求治我女，必欲面谢，故相屈耳。盖崩证往往在五十岁以前天癸将绝之时，而冲任有火，不能摄纳，横决为害。至五十以后，天癸自绝，有不药而愈者，亦有气旺血热，过时而仍有此证者，当因时消息，总不外填阴补血之法。不知者以温热峻补，气愈旺而阴愈耗，祸不旋踵矣。此极易治之病，而往往不治，盖未能深考其理，而误杀之耳。
瘀血冲厥
Xu Dachun's commentary: After taking warming and tonifying medicines, if the patient's appetite increases and they eat more, the family will certainly believe that the medicine matches the syndrome. However, who knows that this secretly causes harm? There are even those who remain unaware until death; I have witnessed many such cases, which is sigh-worthy.
Fan Zhao from Loumen suffered from Fanwei (regurgitation/dysphagia) for over a month, unable to swallow even a grain of rice, with a sensation of something moving in his chest. I said: This is Chongge (worm-related dysphagia), formed by accumulated blood. The whole family did not believe it. I prescribed Kaidi powder (a formula to open the diaphragm) assisted by Sulfur (Liu Huang). After three doses, he vomited half a bowl of phlegm and blood, followed by vomiting more than twenty worms. The long ones were one chi long, the short ones two cun long, with a slightly purple color. His intestines were empty because the medicine entered, the worms ate it, and all died by piercing through their intestines. The family was surprised and joyful, thinking the disease was cured. I said: Not yet. Temporarily give him porridge. He drank two bowls continuously without vomiting, feeling more comfortable. However, after a while, the porridge stopped going down, and he could not eat anymore. I said: The stomach has been eroded by worms; there is no place to hold food. It cannot be saved. I declined to prescribe further medicine. Less than ten days later, he passed away.
Epigastric Distress (E Ni)
Lu from the commandery suffered from E Ni (hiccups). It was merely occasional disharmony of the Stomach Qi, carrying Phlegm and Qi stagnation, known in common parlance as Cold E Ni, which heals itself without treatment. This is unlike post-illness E Ni, which differs in deficiency, excess, cold, and heat, and relates to life and death. Lu was a person of wealth and luxury, never having suffered from this before, so he was greatly afraid and invited a doctor for treatment. The doctor was also greatly alarmed, saying: This must be an extremely deficient constitution, hence appearing without illness. He immediately used medicines like Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu). This caused Phlegm-Fire to coagulate and block the Stomach collaterals, so the hiccups continued unabated. The patient asked himself if he would surely die, causing panic in the family. Upon examination, I could not help but laugh wildly. His brothers, standing nearby, asked curiously why. I said: I did not expect recent famous doctors to be so rash. This is not a disease; one dose will cure it. I used Xie Xin Tang (Drain the Epigastrium Decoction) added with Inulae Flos (Xuanfu Hua) and Loquat Leaf (Pipaye). Indeed, after one dose, the hiccups stopped. A month later, the hiccups recurred. They still used the previous doctors' treatments, and he died after a few days. An old servant, familiar with me, met me elsewhere and asked about his master's health, then recounted the incident. Is this not fate!
Xu Dachun's commentary: Wu Yufeng, the county magistrate, aged seventy-one, contracted a febrile disease this autumn with left hypochondriac pain. His tongue was dry and purple without coating. After sipping soup, urination occurred immediately. He ate nothing and had no bowel movement. The pulse was surging and rapid. Knowing his usual Yin fluid deficiency and Spleen constraint (Qi stagnation and Phlegm coagulation), I repeatedly administered light, purgative, and moistening agents. The fever gradually eased, and the hypochondriac pain relaxed, but the tongue remained unmoistened, he still disliked drinking, urine was red, bowels were closed, and hiccups came frequently. The family was terrified. I said: Do not fear. Once the bowels move, it will stop. Over two days, he had smooth bowel movements. The pulse became calm, body temperature normalized, and the tongue regained moisture. However, the hiccups persisted. People said this was deficiency-type hiccups due to advanced age and post-illness state, proposing sedating and tonifying methods. I said: This is Qi obstructed by Phlegm, with disordered ascending and descending functions. Discomfort after eating and lack of sneezing are signs. I prescribed Zhijie Tang (Bitter Orange and Magnolia Bark Decoction) added with Trichosanthis Fructus (Gualou), Allii Macrostemonis Bulbus (Xiebai), Acori Tatarinowii Rhizoma (Shichangpu), Pinelliae Ternatae Rhizoma processed with Ginger (Banxia), Citri Reticulatae Pericarpium (Chenpi), and Bupleuri Radix (Chaihu). Indeed, improvement after one dose, cure after two.
Enuresis/Retention of Urine (Long Bi)
Jin Ruyu, located behind the Confucian Temple, suddenly suffered from urinary retention. Doctors used promoting diuresis and guiding methods, but water accumulated more, and the urethra became more blocked. Abdominal distension felt like bursting; Water Qi rushing to the Heart would cause death. Drinking decoctions would be impossible and only increase internal water. I said: This is because the urethra is extremely closed and cannot allow slight passage. I applied a vesicant medicine externally to cause significant swelling of the urinary organs, then resolved it with anti-swelling medicine. One cycle of swelling and subsiding widened the urethra slightly. Then, I washed the lower abdomen with medicinal decoction and squeezed it. Accumulated urine gushed out, and patency was fully restored. This is a method within non-methods.
Someone from Mudu suffered from urinary closure for seven days. Abdominal distension was drum-like; he was stooped and unable to stand. Rushing to the Heart was imminent. He sought treatment at my mountain residence. I mashed fresh Plantago asiatica Root (Cheqian Gen) and applied it to his abdomen. Internally, I administered various diuretic herbs. I also decocted diuretic and Qi-moving medicine for him to sit in, while someone massaged and squeezed him. Soon, urine burst forth, splashing on the masseur's face. More than a dou of urine was excreted, nearly filling the wooden bucket he sat in. His abdomen relaxed, and his body straightened. Xu Dachun's commentary: Both external treatment methods are excellent.
Edema (Shui Zhong)
Xi Jifei from Dongting was robust, fond of drinking and eating. He suffered from edema starting from the feet and spreading to the entire body. Waist fullness and abdominal distension occurred. Taking diuretics provided slight relief, but swelling returned quickly. Needling released water from the needle holes, providing slight relaxation, but swelling returned upon closing the needle eyes. The *Neijing* mentions needling methods for water diseases involving fifty-seven acupoints, requiring hundred-day recuperation and astringent medicines. Since this method is lost, ten cases rarely yield one cure. My treatments resulted in recovery but recurrence, leading to untreatable states. Although partly due to patients not following instructions, it is also due to incomplete treatment methods. Only Pi Shui (Skin Edema) and Feng Shui (Wind Edema), being sudden acute conditions, respond immediately to wind-dispelling and diuretic methods. Diseases naturally differ.
Wasting-Thirst (Xiao Ke)
Madam Wang Dongshan of Changshu suffered from Xiao Ke (wasting-thirst), worse at night. She needed two sheng of rice to cook twenty bowls of thin porridge nightly, while urination and defecation were normal. This was due to scorching by Fire. Ye Tianshi of the commandery was first consulted, treating with Mume Fructus (Wumei) and Chaenomelis Fructus (Mugua) to astringe Stomach Qi. Wasting-thirst improved slightly. However, irritability, emaciation, and loss of taste persisted. I stated this was Heat-Phlegm coagulation without an outlet. Using Fire-clearing and Phlegm-resolving methods, combined with harmonizing the Middle and opening the Stomach, the condition changed frequently. Prescriptions were adjusted according to symptoms, and she recovered after half a year.
Abdominal Pain due to Parasites (Chong Tong)
The daughter of Huang Sifang in Suzhou, aged twelve, suffered from abdominal pain that worsened with each doctor. I happened to visit her home. She had fainted for a night before waking up. Her tongue was bitten and bleeding filled her mouth. Her lips were white, and her eyes stared straight ahead. The pulse was irregular and unpredictable. I said: This is Chong Tong (parasitic pain). If parasites penetrate the Heart, death ensues. Decoctions alone cannot cure it. I gave Huachong Wan (Parasite-Destroying Pill). Pain eased slightly, then suddenly returned. She vomited more than twenty worms. Long ones were one chi long and purple; others varied in length, pale red or white. Major pain ceased thereafter, but minor pain remained, likely because the nest was not removed. I subsequently used vermifuge medicines combined with Stomach-calming and Spleen-tonifying formulas, eliminating the root of the parasites. Such cases are numerous. Doctors often fail to recognize them, attributing them to Cold or Food Retention. Even if suspected as parasitic, lacking vermifuge prescriptions leads to outcomes where vigorous individuals may self-resolve over time, while weak individuals develop Ding Xi (emaciation), Lao Qie (consumption), or Pi Gu (masses/distension), dying unknowingly, which is lamentable. I have treated such cases multiple times; here I cite the most severe to illustrate treatment principles.
The grandson of Jiang Binzhi from Changzhou suffered from heart and abdominal pain radiating to the head, intermittent, unresponsive to medicine. He sought my treatment. I said: This is a parasite disease. Using vermifuges, the parasites retreated, either into the skin or the head, feeling like wriggling upon palpation. I powdered vermifuges, mixed them into a paste, applied them everywhere, and warmed them with hot compresses. As parasites fled, I reapplied. Gradually, peace was restored, though roots remained. I gave him a prescription to take home. Two years later, a letter arrived stating roots were not fully eliminated but harmless. Truly a rare disease.
Palpitations (Zhong Kong)
The mother of Cheng, a wealthy merchant from Huai'an, suffered from Zhong Kong (palpitations/fear). Daily heavy tonification with Ginseng and Atractylodes worsened the condition. She fainted at the sound of noise. Offering high fees, I was invited. Refusing due to my own mother's illness, she eventually came to me. Examination showed two maids holding her from behind, patting her body, shouting "Madam, do not fear, we are here," yet she remained terrified. I used Phlegm-resolving medicines to remove saliva, Spirit-calming medicines to nourish Blood, and heavy, sinking, essence-tonifying medicines to anchor Qi. She slept slightly. Over half a month, fear vanished. Boat noises and cannon fire did not disturb her; crowded noisy boats did not annoy her. The Heart is a Fire organ; the Kidney is a Water organ. Kidney Qi carrying Phlegm rushes to the Heart. Water controls Fire; thus, the Heart oscillates uncontrollably. If each stays in its position, they do not control but support each other, which is natural law.
Zhao from Changxing suffered from Zhong Kong due to mental exhaustion from business operations. Doctors disagreed. He traveled far to seek my treatment. I used Phlegm-resolving and Heart-nourishing medicines for the upper jiao, and Kidney-nourishing and Qi-anchoring medicines for the lower jiao. He stabilized in a few days. This is similar to Cheng's mother's case but treated differently. One case involved excessive Phlegm-Qi and mistaken tonification, leading to Water overflowing and suppressing Fire. The other involved Heart Blood deficiency and unsettled Ministerial Fire invading the Heavenly Ruler (Heart). These must not be confused.
Hyperactive Yang (Kang Yang)
Yin Zhijin, a relative by marriage, near eighty years old, had chronic intestinal bleeding (Chang Hong). The disease flared severely; he could not eat, lower abdomen protruded, scrotum was swollen and shiny, and he was unconscious. I visited during New Year greetings to find funeral preparations underway. His pulse was surging, large, and forceful. I first made bags of stove ash and quicklime, placing his scrotum above them. When the bags became wet, the swelling subsided. He drank Zhi Mu (Anemarrhenae Rhizoma) and Huang Bai (Phellodendri Cortex) to drain the Kidney. Three days later, at a gathering at Zhou's house, a knocking sound was heard. Opening the door, his son brought the patient. Everyone was surprised and asked how draining Kidney medicine cured him. I said: This is what is called desiring women but being unable to obtain them. Others thought it a joke. The old man said: You are truly divine. I once taught in Beijing with similar illness. The host thought I would die and sent me home. I recovered in ten days. Now, wife and concubines are dead. Living alone for over ten years, too poor to keep concubines, and ashamed of illicit affairs, the illness reached this state. I could not tell anyone, nor did anyone know. He shed tears sadly and died five years later. Human constitutions vary. The harm of Hyperactive Yang is same as excessive lust. Those unfamiliar with the Six Channels' principles and the mysteries of Qi Bo and Huang Di cannot discuss this. Xu Dachun's commentary: Excessive lust injures Yin, but Hyperactive Yang also scorches Yin. Zhi Mu and Huang Bai drain Kidney Fire excess to preserve insufficient Water.
Hematemesis (Tu Xue)
Zhang Ruiwu from Pingwang Town had a history of blood disorders. In the Xin Chou year, while I managed my father's burial, I entrusted him to buy brick ash etc. Traveling between village and city, he fell seriously ill due to fatigue. We parted with tears, saying we might not meet again. At that time, I had just prepared Qiongyu Gao (Jade Dew Paste) but hadn't tested it. I gave him several taels and departed. We lost contact for three or four years. One day, someone in town invited me and showed me a previous prescription, asking who wrote it. He replied: Zhang Ruiwu. Asked where he was now, he said: Just right of Guan Bridge. I went to visit. He looked vigorous, completely different from before. He recounted that after taking Qiongyu Gao, hematemesis stopped, and cough gradually ceased. He studied medical books, tried them with good effect, using the savings to supplement his income. I guided him on the essentials of practicing medicine: focus on saving lives, be cautious and respectful, choose light and appropriate herbs. If the disease eases slightly, great merit is not required, but harm is avoided. Deceiving the world for profit and recklessly using heavy doses leads to irrecoverable errors. Though patients may not know, how can my conscience bear it? Ruiwu agreed deeply. Later, his reputation grew, becoming a renowned doctor in the town until his death in his seventies. Qiongyu Gao is the most effective formula for blood disorders, but preparation is difficult. At that time, Ginseng Radix et Rhizoma (Renshen) was not used, only Ginseng Radix et Rhizoma Fibers (Renshen Xu). Fresh Rehmanniae Radix (Shengdi) from Zhejiang was juiced and boiled, not dried Rehmanniae Radix Preparata (Shudi). For blood disorders, excluding this leaves no room for flaws.
Xu Dachun's commentary: The essence of medical practice lies in these few words. Few mistakes are made by keeping it simple. Scholars should not dismiss this as shallow theory.
Madam Wu Lenzong of Dongting, daughter of Xi Shijun, had a history of blood disorders. Each flare-up was managed by me with harmonizing medicines, remaining stable for years. A famous doctor in the commandery, friendly with Xi, was invited to treat her during a flare-up. Seeing my previous prescription, he told Xi: This is Yang deficiency causing blood loss. Does this gentleman claim broad knowledge yet fail to distinguish Yin and Yang? He prescribed a warming and tonifying formula adding Deer Antler Glue (Lurong) two qian. After six doses, blood rushed upward, vomiting more than ten bowls. Total blood loss ensued. Pulse was faint, eyes closed, face blue, lips white, nearing death. Urgently summoned me. I said: Viscera and collaterals are empty. Light medicines cannot work. I sourced ten jin of fresh Rehmanniae Radix (Shengdi), juiced and concentrated, adding a little Ginseng powder, administered slowly. Over a day and night, the juice was consumed. Consciousness returned slightly, limbs moved, lips and face color differentiated. Further administration of Donkey-Hide Gelatin (Ejiao) and Notoginseng Radix (Sanqi) and other Yin-nourishing items, regulated for over a month, Qi and Blood gradually recovered. Tonifying Yang after blood loss applies only after massive loss where Yin is exhausted and Yang has no attachment, presenting with cold limbs and sweating. In such cases, Ginseng and Aconite are used first to restore Yang, then Yin is tonified. Or if various deficiency-cold signs appear, Qi and Blood should be tonified together. How can a person with inherent Yin deficiency, experiencing rising Qi and blazing Fire, occasionally seeing red blood, be given large heating and ascending agents to disturb Yang and scorch Yin? This is hearsay from those who do not ponder the principles, causing deep error.
Wang Weinan from Jiaxing suffered from blood disorders for a long time. Qi in the left hypochondrium rushed to the throat, blood coming with boiling sounds. In winter of Wu Zi year, he suddenly vomited several sheng. Face was white with a bluish tint, pulse faint, voice hoarse, panting unable to lie flat, critical. I used Ejiao and Sanqi to preserve Yin and stop bleeding, then used Fire-descending and Qi-anchoring medicines to stop the rushing. Subsequently, Blood-tonifying, Phlegm-resolving, Spleen-strengthening, and Stomach-calming formulas were used to treat upper and lower separately. First enabling lying down, then eating, finally resting peacefully after several days. Generally, after massive blood loss, heavy Ginseng to raise Qi and assist Fire must be avoided. Heavy cloying medicines aiding Phlegm and Stomach stagnation must also be avoided. Know that the way to tonify Blood is to harmonize Yin and Yang, advance diet gradually, then Yuan Qi restores itself. It is not that tonics entering the stomach instantly become Qi and Blood. If heavy doses block the Stomach gate, there is no path to life. Especially using heavy heating and tonifying medicines to assist Yang and scorch Yin accelerates death.
A Zhang from Dongting had chronic blood disorders. That year, spending excessive mental energy preparing dowry for his daughter, just as she boarded the sedan chair, he suddenly vomited more than a sheng of blood and fainted. Doctors decocted heavy Ginseng soup, leaving his life hanging by a thread. I examined him. Six pulses were faintly present or absent. Blood was exhausted. Urgently added Ejiao and Sanqi, mixed with a little Ginseng. Pulse gradually recovered, eyes opened, able to speak, limbs moved. Then purely Blood-tonifying medicines were used to fill the void. Recovered after a month. Human life revolves around Qi and Blood. Blood loss entails Qi loss. Ginseng is used to connect Qi. Once Qi connects slightly, Blood medicines should follow. Otherwise, solitary Yang flares while Yin declines. The distinction of primary and secondary, host and guest must be clear.
Blood Stasis in Collaterals
Mo Xiudong from Wuzhen suffered from a strange disease. Pain started in the back, reaching the chest and hypochondrium. Daytime eating was normal; pain erupted at night, wailing all night, heard tragically by neighbors. Medical treatment lasted five years, exhausting family wealth. Xiudong attempted suicide by hanging. His mother said: You have children to care for. Let me die to avoid hearing your wails. Attempting suicide by drowning, relatives pitied him and brought him to me. I said: This is Blood Stasis retained in collaterals. I told my son Xu Xi: This is a strange disease. Seek broadly for treatments. Not only to help others, but to cultivate your own learning. He stayed at my home. Acupuncture, moxibustion, hot compresses, scraping, decoctions, and pills were all employed. Pain gradually lessened and shortened. Cured in one month. He expressed endless gratitude. I said: I am the one who should thank you. For deep diseases, one must exhaust techniques to achieve results. Modern people demand effect in one dose, change doctors if ineffective in three. You trusted me throughout; you are my confidant. Can I not feel grateful?
Intestinal Bleeding (Chang Hong)
Cheng Chungu from Huai'an had chronic intestinal bleeding. One day during defecation, he suddenly passed more than a dou of blood, fainted, and lost consciousness. Urgently灌ed with one liang of Ginseng and five qian of Prepared Aconite Root (Fuzi), he revived. He then took daily five qian of Ginseng and three qian of Fuzi, mixed with other medicines. Intermittent cessation of Ginseng and Fuzi led to ice-cold limbs and weak speech. Doctors maintained this regimen, barely sustaining him. Urgently rowed to summon me. Upon arrival, he recounted relying entirely on Ginseng and Fuzi for survival. Examining his six pulses: extremely surging and large, sometimes hidden. Face red with oily shine, tongue red but unmoistened. Had not slept for over ten days. I said: The disease can be cured immediately, but my prescription must not be seen. Chungu said: I entrust my life to you, seeking only effect. Why see the prescription? I used four liang of Imperata Rhizome (Maogen) as decoction, combined with several cooling and bland medicines, directly opposite to Ginseng and Fuzi. Relatives and friends were shocked. Chungu's brother Feng Yi, a man of reason and principle, told his brothers: Our father traveled thousands of miles to invite Dr. Xu, trusting him completely. Dr. Xu generously guaranteed safety, bearing full responsibility. How could there be error? After one dose, he slept slightly that night. After two doses, limbs warmed. After three doses, sitting up without dizziness. Then I showed the prescription. Chungu was startled and sighed. Others asked for explanation. I said: Supporting Yang after blood loss is a temporary emergency method. Blood loss is Yin depletion. Once Yang recovers, Yin must be tonified. Further increasing Yang makes Yin-Blood more deficient and causes Hyperactive Yang disease. Cold limbs are described in *Neijing* as "deep heat leads to deep cold." Insomnia is described as "Yang excess prevents entry into Yin; Yin deficiency causes wakefulness." Imperata Rhizome emerges in spring, guiding Yang Qi to limbs, nourishing Blood and clearing Fire. Using it allows the power of previously taken Ginseng and Fuzi to reach the exterior, naturally warming limbs and enabling sleep. Thus, they were convinced. All blood loss cases follow this principle. Xu Dachun's commentary: Treatment logic is clear, and the function of Maogen is particularly enlightening.
Bloody Dysentery (Xue Li)
Ge Yuncheng from Dongting suffered from bloody dysentery for five years, over a hundred times daily, losing several shi of blood. Emaciated like firewood, unable to eat. Family believed no hope. My friend Jiang Xichang's second son, Cao Fang, studied medicine with me in the mountains. The patient was Cao Fang's brother-in-law. Xichang pitied him, allowing him to stay and eat at my home for daily examination. I first used tonifying agents to nourish blood vessels, then digestive-opening medicines to nourish the source of transformation. Strength improved, appetite returned. Chronic dysentery for five years implies fistulas in the Large Intestine. I used filling materials to seal cavities. Dysentery decreased daily, food intake increased. Within half a year, he ate six or seven bowls per meal. By winter, the disease was fully cured. Robust and strong, returning home, relatives did not recognize him, marveling at the miracle.
Metrorrhagia (Beng Lou)
Madam of a salt merchant from Huizhou, initially rich then poor, aged forty-six, suffered from Beng Lou due to worry and labor. Taking Ginseng, Fuzi, and other medicines worsened the condition. I treated her. Prescribed Blood-nourishing and Fire-clearing agents. Condition slightly improved, as this disease is hard to eradicate completely. Three years later, husband died. She wanted to go to Wulin to rely on relatives, stopping at Wujiang for a prescription. Crying, she said: I survived meeting you. Going far away, relapse means death. I established a long-term prescription and gifted pills/powders. Over ten years later, foreign guests in the commandery requested treatment for their wife. A white-haired old woman bowed. I asked in surprise. She said: I am Madam Wang. Taking your prescription, Beng Lou ceased at fifty-two. Now over sixty, stronger than before. My son-in-law brought me here. The patient is my daughter. Seeking treatment for her, I wished to thank you personally, hence the request. Beng Lou often occurs before age fifty when Tian Gui (menstruation) is ending, with Fire in Chong and Ren vessels failing to contain, causing violent discharge. After fifty, Tian Gui naturally ceases. Some heal without medicine; some have Qi excess and Blood Heat, persisting beyond time. Treatment should adapt to timing, always focusing on filling Yin and tonifying Blood. Ignorant people use heavy heating tonics, increasing Qi while consuming Yin, bringing disaster swiftly. This is an easy-to-treat disease, yet often untreated, due to lack of deep understanding, causing misdeaths.
Stasis-Blood Rushing to Cause Syncope (Yu Xue Chong Jue)