玉台新案
清·徐镛《医学举要》
转自民间中医网
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寒证医案
发热恶寒，头疼身痛之暴证，人易辨之。惟久郁肺经而成喘嗽，有似阴虚劳嗽者，不可不辨。郡城西门外奚藕庄客幕于外，上年道途受热，曾患喘嗽，服自便而愈，今复患喘嗽，投自便而加剧，医亦概用清肺补肺，终不见效。自疑为阴虚重证，彷徨无措，遂延予诊。余为脉象见紧，似数非数，前患暑热，故自便可愈。今患寒邪，故反增剧，用小青龙汤而愈。
郡庙道士徐兆奎久患三疟，坚不服药，二年方愈。愈后冬月又病伤寒，壮热头痛，医疑冬温，误投辛凉之剂，即昏嘿不省人事。医者以其昏嘿不省，以为热邪内陷，束身告辞。其师杨承宗求治于予，予诊其脉，虚软无神，似数非数，亦为惊徨，但知其疟后中气素亏，复伤于寒，非冬温也。即投温中之剂，一剂稍苏，二剂方醒，三剂乃安。粥饮日渐增加，但膈中似有冷块，即于温中剂内加附子三分，始得平复，调理一月而安。
发斑医案
发斑初用辛凉，继用咸寒，人人知之。而阴斑之证，最不可误。南汇承役许龙之子，身热发斑，有似火证，医用犀角等化斑套剂，病势转危，不省人事，口中歌唱不休，有时谵语。余诊其脉，浮越无伦，按之不实，舌绛而润，并不燥渴，疑是阴证。细询病因，其妻言未病时，大叫脚冷，其为阴证无疑。遂用姜附等药冷服一剂，夜即安睡。但元阳丧败之余，神疲倦怠者半月，服归脾汤二十余剂而愈。
火证医案
火证清之，此其常也。而有不得不急下者，最当坚决。得胜渡范某，初病即昏沉，医用辛散，汗后不解，即惊徨推委。余曰：汗之不解，治须下之。前医曰：下之利不止奈何？余曰：右关沉实，攻下无虞。用大承气合凉膈而愈。
南汇本城杨熙宗令郎，病疟寒热俱轻，饮食如故，守不服药之戒。一日自神庙烧香而归，忽发狂言，似有神灵所作。邀余诊视。脉象沉郁，魄汗淋漓，未能审其果为热厥，不敢骤用寒凉，姑用胆星、竹沥与服，服下人事顿清。询其近日所服何物，曰姜枣汤日服两次。视其舌色，面白底绛，唇若涂朱，知为热邪无疑，时已三更，余见其病势稍持，约其明日转方。天明复来邀诊，据述醒时未及三刻，旋又发厥，遂用犀角地黄汤合大承气，许其大便一行即愈。奈他医谓下则必死，病家转多疑虑，时有张二川系杨内戚，力动本家定服余方，煎药已近下午时候，病者牙关紧闭，强将羊角灌入，服至半剂，大便即解，前恙顿除。
南汇姚裕丰，医士也。秋月寒热，杂投藿香正气、香薷饮之类，医中来问病者，必定一方，其自己亦不能主持矣。其父沛寰因其病势危剧，始来邀余。余用急下之剂，前医交沮，谓此属不治之证，何用下为。余坐等其家煎服，大下宿垢，继服滋补半月而愈。
治脉伏医案
前营游击舒公，初夏病感，寒热颇轻，但右胁以下掣痛不安，头痛亦在右边，大便不实。医以为类伤寒证，用辛温表散不效。余按其脉隐伏不彰，舌上灰色，苔厚而湿润欲滴，初疑湿胜于热，用吴氏达原饮，继疑寒热互结，用进退黄连汤，但有二三分效验。舒公深信不疑，然必终奏全效，余心始安。沉思良久，头痛胁痛俱在右边，此热气郁遏阳明，故脉象不彰，遂拣去温药，专用三黄石膏，坚服二十余剂而愈。时前营守备邢公亦患热病，初起即舌绛神昏，医皆用葱豉汤透表，余用凉膈散清中，授方不服，听其津干液涸五日而亡，官在同营，病在一时，或信或不信，判若恩仇，舒公曰：总难逃一命字。
附录与姚敬修书令爱之证，肝藏积热，肺受暴寒，故冲气上逆，咳嗽发喘。余用仲景麻杏甘膏汤，发散外邪，扫除内热，失此不治，必延劳怯。因受足下重托，故再四沉思而用此方也。得汗后，用钱仲阳补肺阿胶散，大下宿垢瘀滞后，用喻氏清燥救肺汤。石膏搜剔余邪，人参补气，阿胶补血，乃虚实兼到之方。写方时，贤乔梓细问毕竟吉凶何如？予一口担承，何尝有片言惊骇。其方其案，尚在尊斋，可覆视也。足下受方不用，先自彷徨，更请某师诊治，误认虚脱之证，扬言左脉已无，遂令合家大小，涕泪交零，并通知媒氏，通知许字之家，谓此证已被石膏吃坏，今已不治矣。噫！某师久负盛名，何徒恃妄才而不达古训也。夫脉之郁也，被火逼勒耳，非无也。精究古大家书，则悟此奥义矣。某师言此是怯证。非时邪也，殊不知怯证初起，亦须下去恶物。古方百劳丸，许州陈大夫托名仲景而传者也，某师亦尝精究其义乎。人言某师所定之方，与予方相似，不知实判天渊。余以人参、石膏同用，意仍在于清火，某师以人参、五味、陈皮同用，意专在于补虚，不知此证大积虽去，余火尚多，稍带温补，尚虑复焰之势，人参只宜些少，足下过费人参，反致增病。尊居之北，有俞姓女病伏热，绵延四十余日，人用轻清不效，余用石膏而效。今岁少阴司天，阳明在泉，运气使然也。某师读景岳书，不达玉女煎用石膏之旨，其能升其堂而入其室乎。前俞姓女服石膏后，发出暑毒满身，其母不以为药之过，而以为药之功。奇哉妇人有识，乃远胜于丈夫也。敬修得书之后，其胆始壮，余仍大进寒凉，下利五日而全愈。
治老人医案
老人元虚，病宜扶元，人人知之。竟有阳气充实，常服大寒之药，常得带病延年者。南汇本城谢凰鸣年七十有四，因上年秋间涉讼到郡，舟中冒暑，即发温疟。微寒恶热，胸膈痞闷，余适寓郡城，用清心凉膈散而寒热止，继用半夏泻心汤而痞闷除，旋即结讼回南，不再服药。延至初冬，喘嗽大作，医用疏散，愈治愈剧。至新正初十外，日夜不能交睫，痰涎盈盆盈碗，嘱其子恩荣等速办后事，无余望矣。适有徽友汪郁廷在座，谓此证仍请予诊治，必有出奇制胜之处。郡城仅一浦之隔，何不专舟邀归以一诊。凰鸣平日持家甚俭，因欲死里求生，不得不从汪议，余亦以世好难辞，即束装东归。时已正月十六夜，诊毕，即知其误用辛温，许以尚可挽救，方用大剂白虎，参入大剂犀角地黄，坚服四十余日而全愈。若不细察其脉，而但拘年齿以施治，必至抱怨九泉。至嘉庆二十五年，重游泮水，至道光五年，已八十有四。一日不饮蔗汁梨浆等味，即大便艰涩，辛温误人有如此。
疟疾医案
寒热往来之疟，治宜小柴胡汤。不知阴虚之体，用之转增大患者，郡城姚敬修夏日病疟，医投小柴胡十余剂，竟无增减，停药二日，忽然发厥，舌短眩晕，危在顷刻。居与余寓相近，急来延诊，余用大剂清肝之药，一服而安。知其多服柴胡，肝阴亏乏，厥阳亢逆也。愈后四肢酸麻，用养阴药调理半年，始得平复。
劳倦内伤医案
南汇南门张宝华，劳倦之余，又兼食滞，及内伤中之有余者。脉象狂大，热渴异常，子系旧戚，平日相信不疑，即用下夺清中之法，但前因葬事太劳，未即痊愈，亲友中有疑为失表之证，嘱其更请他医调治。医谓从未得汗，热邪内陷之象，用葱豉等发汗，汗竟不出，反发昏沉。仍恳予治。予惟以清降为事，渐渐神清食进，始终无汗而愈，愈后大便艰涩，惟服大黄。补药一剂不服，于以知外邪宜汗，内伤禁汗，内伤之虚者，为劳倦伤，宜补中益气。饮食伤虚中挟实者，宜枳术丸。内伤之纯实者，则宜攻下也，王安道辨之甚详。
痢疾医案
府廪生高菊裳（名崇瑚弟药房名崇瑞选拔又中式）令堂，病阳虚久痢，医频服温补延至半载，病反增剧，昼夜三五十次。余诊时，但述腰脊空痛异常，遂用斑龙丸峻补奇脉。初服一剂，病势大减，自后连服数剂，竟无增减，服参些少，略安片刻，而菊裳药房昆仲，以尊人病怔忡经年，参药大费，人参岂能常服。余为沉思良久，改用黄芪建中加鹿角。时有医士李蘅堂（秀）在座，谓峻补之法，继以宣通阳气，亦是一法。力赞此方为中病，坚服二十余剂而愈。
南汇东门李连城病肝气胀痛，因多服左金，遂至下痢不止，食饮不思，人亦不与之食。更医则倏张倏李，用药则惟术惟苓，佥云不治，已措办后事矣。不得已而索治于余，予令其早上服大剂归脾，晚间服大剂六味，并令家人诱其食肉，即有效验，一月全痊。
劳倦内伤医案
南汇南门张宝华，劳倦之余，又兼食滞，及内伤中之有余者。脉象狂大，热渴异常，子系旧戚，平日相信不疑，即用下夺清中之法，但前因葬事太劳，未即痊愈，亲友中有疑为失表之证，嘱其更请他医调治。医谓从未得汗，热邪内陷之象，用葱豉等发汗，汗竟不出，反发昏沉。仍恳予治。予惟以清降为事，渐渐神清食进，始终无汗而愈，愈后大便艰涩，惟服大黄。补药一剂不服，于以知外邪宜汗，内伤禁汗，内伤之虚者，为劳倦伤，宜补中益气。饮食伤虚中挟实者，宜枳术丸。内伤之纯实者，则宜攻下也，王安道辨之甚详。
偏枯医案
新场镇闵钦斋年五十外，形体清瘦，多火少痰，冬月忽患偏枯在左，遂从吴门解馆而归，医惟以补气消痰为事，反增咽燥喉痹等证。病家谓本原既竭，故用补剂不效。延予聊问消息，余谓其脉其证，纯是一团火气，须用河间治火之法，方用二地二冬知柏等，甘寒苦寒相间。投二剂，顿觉神情清爽，病者方意未病前数日，左肩胛犹如火烧，始信治火之说为不谬也，继服虎潜丸而全愈。
痹证医案
风、寒、湿三气合而为痹，祛风、祛寒、祛湿，人人知之。不知有当变通者，泗经戴星杓年近四十，因烟业赴上洋，一夕忽患腿痛，不便行走，寓中适有素明医理者，谓肾气素虚，乃欲中之渐，必服大造丸可。戴以客寓起居不便，遂乘肩舆而归。本镇及郡中之医，皆用温药，并服大造丸，服下掣痛增至十分，两手亦痛，阳事痿缩，遂延余诊。余谓此属热痹，俗名流火是也，舌苔虽白，其实绛底，阳事痿缩，王节斋所云郁火也。遂用三黄、石膏、犀角地黄等大剂，半月而起于床，更用虎潜大补阴丸等，一月后步履如常矣。
南庠生谢恩荣令堂患热痹，医以为血衰气弱，投以补剂转剧。余用羚羊角、二冬、玉竹、竹沥等通络之剂，投数剂而全愈。
痿证医案
前营千总龚振邦，多欲阴亏，夏月病足膝痿弱。余谓当作暑痿治，清暑益气加活血之品。授方不服，转服伤科之药。一旦昏厥，心痛欲死。仍延余诊。脉来虚散，生脉散加和中之品，服一剂果觉少安，渠家信之不笃，遍请他医通同酌治，改用参地桂附，服之转增胀满。又请一医以和中降气为治，胀满虽稍除而元气愈弱，病者益难支撑，改用参术一剂，而从前心痛欲死之证复作。不得已，遂听命于予焉。余谓此属少阴肾水亏乏，转服伤科之药，则气亦虚矣。参术桂附，适以耗阴，橘半枳砂，适以耗气，俱未中病，故愈治愈剧。壮水之主以制阳光，乃正治也，用六味合生脉等，坚服五十余剂而愈。
南汇营兵朱七官，湿热成痿，求治于他县时医，以峻补刚剂嘱其频服，半月后厥阳上逆，头眩耳鸣，胸中扰攘不安，格寒于下，两脚如冰，自分已无生理。友人武生顾鸣鹤与朱邻近，延予判决死生，余按脉象狂大，谓此证因温补误投，非绝证也。遂用芩连知柏猪胆汁等大寒之品，一剂即减，投二十余剂而全愈。
郡城徐华封女病痿，两足不能相去以寸，脊间皮宽肉软，有如斗大，医用杂补气血之剂不效。予谓饮食如故，病属下焦，芪术守中，不能达下，四物诚为女科要药，若欲填实精髓，则又不胜任矣。考《内经》筋痿骨痿，皆属奇经络病，乃用生鹿角、龟板、海参、鱼胶、羊肉等血肉之味，配入熟地、枸杞、牛膝、归芍，坚服三十余剂而全痊。
虚劳医案
亭林镇北陆某，素患劳嗽，时作时止，至是益加气喘，偏卧不能转侧，脉象细弱，有似气虚痰饮，医用补脾理气，久而不效，遂以本证为辞。予适在镇中顾宅，延予一判安危。余谓此属肺肾阴亏，非气虚也，初用钱氏阿胶散，继用六味地黄汤而愈。
肿胀医案
府庠生王迪贤令堂，患喘肿，脉浮无汗，渴饮异常，宗仲景风水治例，兼参王节斋先喘后肿之旨，用麻杏甘膏汤而愈。
南汇本城李孝思，单胀数月，诸药不效，余按脉象沉微，此属阳微，用塞因塞用法，专服理中加附子而愈。
郡城卜姓女十有三岁，先患痧疹，继患疟疾，医用开泄太过，遂至胀满，肚腹以下坚硬如石，本家疑为虚证，请一老医中专用补药者诊治，岂知竟云痧毒内攻，法在不治。余时初到郡中，遂延余诊。余按其脉沉细而微，脾虚景象，显然如绘，初用钱氏白术散而坚硬消，继用陈氏六神汤而胀满愈。
得胜渡张永椿室，系气虚之体，秋月患腹胀，服消耗药太过，数日间腹大如臌。余即用《济生》肾气，见奇效，后稍有胀意，即投前方而愈。
脚气医案
郡廪生方铁华（刚）令尊患脚气上攻；医投燥湿理气通阳之剂，喘肿益加，余谓诸热之而寒者取诸阳，因立加味肾气汤，初服不觉其功，而亦不见其燥热，坚服三十余剂而愈。
发黄医案
玉台新案
清·徐镛《医学举要》
转自民间中医网
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寒证医案
发热、恶寒（怕冷）、头痛、身体疼痛的急性病症，人们容易辨别。只有久郁于肺经而形成的喘咳，有类似阴虚劳嗽（因阴虚导致的慢性咳嗽）的情况，不可不加以辨别。郡城西门外的奚藕庄在外做幕僚，去年在旅途中受热，曾患喘咳，服用自便汤后痊愈。如今再次患喘咳，服用自便汤反而加重，医生也都一概使用清肺、补肺的药物，始终不见效。他自己怀疑是严重的阴虚证，彷徨无措，于是请我来诊治。我诊察他的脉象，见脉紧，似数非数。前次患病是因为暑热，所以服用自便汤可以痊愈。这次患病是因为寒邪，所以反而加剧。我使用小青龙汤治疗，他痊愈了。
郡庙道士徐兆奎长期患有三疟（一种疟疾），坚决不服药，两年后才痊愈。痊愈后冬天又患伤寒，高热、头痛，医生怀疑是冬温（冬季发生的温病），误投辛凉解表的药物，患者立即昏迷不省人事。医生因为他昏迷不省，认为这是热邪内陷，便束身告辞。他的师父杨承宗求治于我，我诊察他的脉象，虚软无神，似数非数，也感到惊慌，但知道他在疟疾之后中气素来亏虚，又受到寒邪伤害，不是冬温。立即投用温中的药物，一剂后稍苏醒，二剂后清醒，三剂后安宁。粥饮日渐增加，但胸膈中似乎有冷块，就在温中剂中加入三分附子，才平复，调理一个月后安定。
发斑医案
发斑初起用辛凉，继用咸寒，这是人人皆知的道理。然而阴斑这一证候，最不可误治。南汇承役许龙之子，身热发斑，看起来像火证，医生使用犀角等化斑的套方，病情转危，不省人事，口中歌唱不停，有时说胡话。我诊察他的脉象，浮越无序，按之不实，舌质绛红而湿润，并不燥渴，怀疑是阴证。仔细询问病因，他的妻子说发病前大叫脚冷，这无疑是阴证。于是用姜、附等药物冷服一剂，当晚即安睡。但因元阳丧败之余，精神疲倦懈怠了半个月，服用归脾汤二十多剂后痊愈。
火证医案
火证用清热法，这是常规。但有不得不急下（峻下热结）的情况，最应当坚决果断。得胜渡范某，初病即昏沉，医生用辛散药物，汗出后病不解，就惊慌推委责任。我说：汗之不解，治疗须用下法。前医说：用下法导致腹泻不止怎么办？我说：右关脉沉实，攻下没有忧虑。使用大承气汤合凉膈散而痊愈。
南汇本城杨熙宗的儿子，患疟疾寒热都很轻，饮食如常，遵守不服药的戒律。一天从神庙烧香回来，忽然发狂言，好像有神灵作祟。邀请我去诊视。脉象沉郁，魄汗（大汗）淋漓，未能审察清楚果真是热厥，不敢骤用寒凉药物，暂用胆星、竹沥给他服用，服下后人事顿时清醒。询问他近日服用了什么，他说每天两次服用姜枣汤。看他的舌色，面白底绛，嘴唇像涂了朱砂，知道是热邪无疑。当时已是三更天，我看他病情稍稳，约定第二天再调整方药。天亮后来邀我诊脉，据述醒来不到一刻钟，随即又发厥，于是用犀角地黄汤合大承气汤，许诺他大便一通即愈。无奈其他医生说下则必死，病人家属转而多有疑虑。时有张二川是杨家的亲戚，极力劝动本家决定服用我的方药，煎药已近下午时候，病人牙关紧闭，强行将羊角（代指灌药工具或药物形态，此处指强行灌药）灌入，服到半剂，大便即解，前面的病恙顿时消除。
南汇姚裕丰，是位医生。秋月间寒热，杂投藿香正气散、香薷饮之类的药物，医生中间问病的，必定定下一个方子，他自己也不能主持主见。他的父亲沛寰因为病情危重剧烈，才来邀请我。我用急下的药剂，前医交相阻挠，说这是不治之证，为什么要用下法。我坐着等他们家煎服，大下宿垢，继服滋补半月而痊愈。
治脉伏医案
前营游击舒公，初夏患病，寒热颇轻，只是右胁以下掣痛不安，头痛也在右边，大便不成形。医生认为是类伤寒证，用辛温解表发散无效。我按压他的脉象隐伏不显，舌上有灰色苔，苔厚而湿润欲滴，起初怀疑湿胜于热，用吴氏达原饮，继而怀疑寒热互结，用进退黄连汤，但只有二三分的疗效。舒公深信不疑，但我必须最终奏全效，心里才安心。沉思良久，头痛胁痛都在右边，这是热气郁遏阳明经，所以脉象不显，于是拣去温药，专用三黄石膏汤，坚持服用二十多剂而痊愈。当时前营守备邢公也患热病，初起即舌绛神昏，医生都用葱豉汤透表，我用凉膈散清中，授方不服，听任其津干液涸五日而亡。官在同营，病在一时，有的信有的不信，判若恩仇，舒公说：总难逃一个命字。
附录与姚敬修书令爱之证，肝藏积热，肺受暴寒，故冲气上逆，咳嗽发喘。我用仲景麻杏甘膏汤，发散外邪，扫除内热，错过这个时机不治疗，必延成劳怯。因为受足下重托，所以再四沉思而用此方。得汗后，用钱仲阳补肺阿胶散，大下宿垢瘀滞后，用喻氏清燥救肺汤。石膏搜剔余邪，人参补气，阿胶补血，乃虚实兼到的方子。写方时，贤乔梓（父子）细问毕竟吉凶如何？我一口担承，何尝有片言惊骇。其方其案，尚在尊斋，可覆视也。足下受方不用，先自彷徨，更请某师诊治，误认虚脱之证，扬言左脉已无，遂令合家大小，涕泪交零，并通知媒氏，通知许字之家，谓此证已被石膏吃坏，今已不治矣。噫！某师久负盛名，何徒恃妄才而不达古训也。夫脉之郁也，被火逼勒耳，非无也。精究古大家书，则悟此奥义矣。某师言此是怯证。非时邪也，殊不知怯证初起，亦须下去恶物。古方百劳丸，许州陈大夫托名仲景而传者也，某师亦尝精究其义乎。人言某师所定之方，与予方相似，不知实判天渊。余以人参、石膏同用，意仍在于清火，某师以人参、五味、陈皮同用，意专在于补虚，不知此证大积虽去，余火尚多，稍带温补，尚虑复焰之势，人参只宜些少，足下过费人参，反致增病。尊居之北，有俞姓女病伏热，绵延四十余日，人用轻清不效，余用石膏而效。今岁少阴司天，阳明在泉，运气使然也。某师读景岳书，不达玉女煎用石膏之旨，其能升其堂而入其室乎。前俞姓女服石膏后，发出暑毒满身，其母不以为药之过，而以为药之功。奇哉妇人有识，乃远胜于丈夫也。敬修得书之后，其胆始壮，余仍大进寒凉，下利五日而全愈。
治老人医案
老人元气虚弱，病宜扶元，这是人人皆知的道理。竟有阳气充实，常服大寒之药，常得带病延年者。南汇本城谢凰鸣年七十有四，因上年秋间涉讼到郡，舟中冒暑，即发温疟。微寒恶热，胸膈痞闷，我适寓郡城，用清心凉膈散而寒热止，继用半夏泻心汤而痞闷除，旋即结讼回南，不再服药。延至初冬，喘嗽大作，医生用疏散药，愈治愈剧。至新正初十外，日夜不能交睫，痰涎盈盆盈碗，嘱其子恩荣等速办后事，无余望矣。适有徽友汪郁廷在座，谓此证仍请予诊治，必有出奇制胜之处。郡城仅一浦之隔，何不专舟邀归以一诊。凰鸣平日持家甚俭，因欲死里求生，不得不从汪议，余亦以世好难辞，即束装东归。时已正月十六夜，诊毕，即知其误用辛温，许以尚可挽救，方用大剂白虎汤，参入大剂犀角地黄汤，坚服四十余日而全愈。若不细察其脉，而但拘年齿以施治，必至抱怨九泉。至嘉庆二十五年，重游泮水，至道光五年，已八十有四。一日不饮蔗汁梨浆等味，即大便艰涩，辛温误人有如此。
疟疾医案
寒热往来之疟，治宜小柴胡汤。不知阴虚之体，用之转增大患者，郡城姚敬修夏日病疟，医投小柴胡十余剂，竟无增减，停药二日，忽然发厥，舌短眩晕，危在顷刻。居与余寓相近，急来延诊，余用大剂清肝之药，一服而安。知其多服柴胡，肝阴亏乏，厥阳亢逆也。愈后四肢酸麻，用养阴药调理半年，始得平复。
劳倦内伤医案
南汇南门张宝华，劳倦之余，又兼食滞，及内伤中之有余者。脉象狂大，热渴异常，子系旧戚，平日相信不疑，即用下夺清中之法，但前因葬事太劳，未即痊愈，亲友中有疑为失表之证，嘱其更请他医调治。医谓从未得汗，热邪内陷之象，用葱豉等发汗，汗竟不出，反发昏沉。仍恳予治。予惟以清降为事，渐渐神清食进，始终无汗而愈，愈后大便艰涩，惟服大黄。补药一剂不服，于以知外邪宜汗，内伤禁汗，内伤之虚者，为劳倦伤，宜补中益气。饮食伤虚中挟实者，宜枳术丸。内伤之纯实者，则宜攻下也，王安道辨之甚详。
痢疾医案
府廪生高菊裳（名崇瑚弟药房名崇瑞选拔又中式）令堂，病阳虚久痢，医频服温补延至半载，病反增剧，昼夜三五十次。余诊时，但述腰脊空痛异常，遂用斑龙丸峻补奇脉。初服一剂，病势大减，自后连服数剂，竟无增减，服参些少，略安片刻，而菊裳药房昆仲，以尊人病怔忡经年，参药大费，人参岂能常服。余为沉思良久，改用黄芪建中加鹿角。时有医士李蘅堂（秀）在座，谓峻补之法，继以宣通阳气，亦是一法。力赞此方为中病，坚服二十余剂而愈。
南汇东门李连城病肝气胀痛，因多服左金丸，遂至下痢不止，食饮不思，人亦不与之食。更医则倏张倏李，用药则惟术惟苓，佥云不治，已措办后事矣。不得已而索治于余，予令其早上服大剂归脾汤，晚间服大剂六味地黄丸，并令家人诱其食肉，即有效验，一月全痊。
劳倦内伤医案
南汇南门张宝华，劳倦之余，又兼食滞，及内伤中之有余者。脉象狂大，热渴异常，子系旧戚，平日相信不疑，即用下夺清中之法，但前因葬事太劳，未即痊愈，亲友中有疑为失表之证，嘱其更请他医调治。医谓从未得汗，热邪内陷之象，用葱豉等发汗，汗竟不出，反发昏沉。仍恳予治。予惟以清降为事，渐渐神清食进，始终无汗而愈，愈后大便艰涩，惟服大黄。补药一剂不服，于以知外邪宜汗，内伤禁汗，内伤之虚者，为劳倦伤，宜补中益气。饮食伤虚中挟实者，宜枳术丸。内伤之纯实者，则宜攻下也，王安道辨之甚详。
偏枯医案
新场镇闵钦斋年五十外，形体清瘦，多火少痰，冬月忽患偏枯在左，遂从吴门解馆而归，医惟以补气消痰为事，反增咽燥喉痹等证。病家谓本原既竭，故用补剂不效。延予聊问消息，余谓其脉其证，纯是一团火气，须用河间治火之法，方用二地二冬知柏等，甘寒苦寒相间。投二剂，顿觉神情清爽，病者方意未病前数日，左肩胛犹如火烧，始信治火之说为不谬也，继服虎潜丸而全愈。
痹证医案
风、寒、湿三气合而为痹，祛风、祛寒、祛湿，人人皆知。不知有当变通者，泗经戴星杓年近四十，因烟业赴上洋，一夕忽患腿痛，不便行走，寓中适有素明医理者，谓肾气素虚，乃欲中之渐，必服大造丸可。戴以客寓起居不便，遂乘肩舆而归。本镇及郡中之医，皆用温药，并服大造丸，服下掣痛增至十分，两手亦痛，阳事痿缩，遂延余诊。余谓此属热痹，俗名流火是也，舌苔虽白，其实绛底，阳事痿缩，王节斋所云郁火也。遂用三黄、石膏、犀角地黄等大剂，半月而起于床，更用虎潜大补阴丸等，一月后步履如常矣。
南庠生谢恩荣令堂患热痹，医以为血衰气弱，投以补剂转剧。余用羚羊角、二冬、玉竹、竹沥等通络之剂，投数剂而全愈。
痿证医案
前营千总龚振邦，多欲阴亏，夏月病足膝痿弱。余谓当作暑痿治，清暑益气加活血之品。授方不服，转服伤科之药。一旦昏厥，心痛欲死。仍延余诊。脉来虚散，生脉散加和中之品，服一剂果觉少安，渠家信之不笃，遍请他医通同酌治，改用参地桂附，服之转增胀满。又请一医以和中降气为治，胀满虽稍除而元气愈弱，病者益难支撑，改用参术一剂，而从前心痛欲死之证复作。不得已，遂听命于予焉。余谓此属少阴肾水亏乏，转服伤科之药，则气亦虚矣。参术桂附，适以耗阴，橘半枳砂，适以耗气，俱未中病，故愈治愈剧。壮水之主以制阳光，乃正治也，用六味合生脉等，坚服五十余剂而愈。
南汇营兵朱七官，湿热成痿，求治于他县时医，以峻补刚剂嘱其频服，半月后厥阳上逆，头眩耳鸣，胸中扰攘不安，格寒于下，两脚如冰，自分已无生理。友人武生顾鸣鹤与朱邻近，延予判决死生，余按脉象狂大，谓此证因温补误投，非绝证也。遂用芩连知柏猪胆汁等大寒之品，一剂即减，投二十余剂而全愈。
郡城徐华封女病痿，两足不能相去以寸，脊间皮宽肉软，有如斗大，医用杂补气血之剂不效。予谓饮食如故，病属下焦，芪术守中，不能达下，四物诚为女科要药，若欲填实精髓，则又不胜任矣。考《内经》筋痿骨痿，皆属奇经络病，乃用生鹿角、龟板、海参、鱼胶、羊肉等血肉之味，配入熟地、枸杞、牛膝、归芍，坚服三十余剂而全痊。
虚劳医案
亭林镇北陆某，素患劳嗽，时作时止，至是益加气喘，偏卧不能转侧，脉象细弱，有似气虚痰饮，医用补脾理气，久而不效，遂以本证为辞。予适在镇中顾宅，延予一判安危。余谓此属肺肾阴亏，非气虚也，初用钱氏阿胶散，继用六味地黄汤而愈。
肿胀医案
府庠生王迪贤令堂，患喘肿，脉浮无汗，渴饮异常，宗仲景风水治例，兼参王节斋先喘后肿之旨，用麻杏甘膏汤而愈。
南汇本城李孝思，单胀数月，诸药不效，余按脉象沉微，此属阳微，用塞因塞用法，专服理中汤加附子而愈。
郡城卜姓女十有三岁，先患痧疹，继患疟疾，医用开泄太过，遂至胀满，肚腹以下坚硬如石，本家疑为虚证，请一老医中专用补药者诊治，岂知竟云痧毒内攻，法在不治。余时初到郡中，遂延余诊。余按其脉沉细而微，脾虚景象，显然如绘，初用钱氏白术散而坚硬消，继用陈氏六神汤而胀满愈。
得胜渡张永椿室，系气虚之体，秋月患腹胀，服消耗药太过，数日间腹大如臌。余即用《济生》肾气汤，见奇效，后稍有胀意，即投前方而愈。
脚气医案
郡廪生方铁华（刚）令尊患脚气上攻；医投燥湿理气通阳之剂，喘肿益加，余谓诸热之而寒者取诸阳，因立加味肾气汤，初服不觉其功，而亦不见其燥热，坚服三十余剂而愈。
发黄医案
Yu Tai Xin An (New Cases from the Jade Terrace)
Qing Dynasty · Xu Yong, *Yi Xue Ju Yao* (Essentials of Medicine)
Transferred from Folk TCM Network
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Medical Cases of Cold Syndromes
Acute conditions presenting with fever, aversion to cold (Aversion to Cold), headache, and body pain are easily identified by people. However, wheezing and coughing resulting from long-standing stagnation in the Lung Meridian can resemble Yin Deficiency Labor Cough (Chronic cough due to Yin deficiency), which must not be confused. Xi Ouzhuang, a guest tutor living outside the West Gate of the Prefecture City, suffered from heat exposure while traveling last year and previously had wheezing and coughing, which healed after taking Zibian Tang (Self-Convenient Decoction). This year, he again suffered from wheezing and coughing; taking Zibian Tang aggravated his condition. Physicians generally used Lung-Clearing and Lung-Nourishing drugs without effect. He suspected himself to have a severe Yin Deficiency syndrome, wandering in confusion and at a loss. He then invited me to diagnose him. I examined his pulse and found it tight, appearing rapid but not truly so. The previous illness was due to Summer-Heat, so Zibian Tang could cure it. This time, the illness is due to Cold Pathogen, so it worsened instead. I prescribed Xiao Qing Long Tang (Minor Blue Dragon Decoction), and he recovered.
Daoist Xu Zhaokui from the Prefecture Temple suffered from San Nüe (a type of Malaria) for a long time and firmly refused medication, recovering only after two years. After recovery, in winter, he contracted Shang Han (Cold Damage). He had high fever and headache. Physicians suspected Dong Wen (Warm Disease occurring in Winter) and mistakenly administered Acrid-Cool agents. He immediately fell into a coma and lost consciousness. Because he was comatose, physicians believed this was Heat Pathogen sinking inward, and they resigned from treatment. His master, Yang Chengzong, sought treatment from me. I diagnosed his pulse as deficient, soft, and lacking spirit, appearing rapid but not truly so. I was also alarmed, but knowing that his Middle Qi had been chronically deficient after the malaria and that he had been injured by Cold, I determined it was not Dong Wen. I immediately administered Warm-Middle agents. After one dose, he slightly revived; after two doses, he woke up; after three doses, he was stable. His intake of porridge and drinks increased day by day, but he felt a cold lump in his chest and diaphragm. I added 3 fen of Fuzi (Prepared Aconite Root) to the Warm-Middle agent, and he finally stabilized. After one month of regulation, he was secure.
Medical Cases of Macules (Fa Ban)
Using Acrid-Cool agents initially for Fa Ban (Macules/Eruptions) and Saline-Cold agents subsequently is known to everyone. However, the syndrome of Yin Macules is most prone to misdiagnosis. The son of Xu Long, a corvée laborer from Nan Hui, had body heat and macules, resembling a Fire syndrome. Physicians used standard macule-resolving formulas containing Xi Jiao (Rhinoceros Horn) etc., and the condition became critical. He lost consciousness, sang continuously, and sometimes spoke deliriously. I diagnosed his pulse as floating and disordered, empty upon pressure. His tongue was crimson and moist, without dryness or thirst. I suspected a Yin syndrome. Upon detailed inquiry into the cause, his wife said that before falling ill, he shouted that his feet were cold. This was undoubtedly a Yin syndrome. I used Jiang (Ginger) and Fu (Aconite) etc., administered cold, one dose. He slept peacefully that night. However, due to the aftermath of Yuan Yang (Primordial Yang) depletion, he was spiritually fatigued and lethargic for half a month. He took Gui Pi Tang (Restore the Spleen Decoction) for more than twenty doses and recovered.
Medical Cases of Fire Syndromes
Clearing Fire is the routine method for Fire syndromes. But there are cases requiring urgent Purging (Ji Xia - Rapid Purgation), where one must be resolute. Fan Mou from Desheng Du was comatose from the onset. Physicians used Acrid-Dispersing agents; after sweating, the disease did not resolve, leading to panic and buck-passing. I said: "If sweating does not resolve it, treatment requires purging." The previous physician asked: "What if purging causes incessant diarrhea?" I said: "The Right Guan pulse is deep and solid; there is no worry in attacking with purgatives." I used Da Cheng Qi Tang (Major Order the Qi Decoction) combined with Liang Ge San (Cool the Diaphragm Powder), and he recovered.
The young master of Yang Xizong in Nan Hui city suffered from Malaria with mild chills and fever, and normal appetite. He adhered to the rule of not taking medicine. One day, returning from burning incense at the temple, he suddenly spoke madly, as if possessed by spirits. I was invited to diagnose him. The pulse was deep and depressed, with profuse sweating (Po Han). Unable to confirm whether it was truly Re Jue (Heat Jue), I dared not abruptly use Cold-Cooling agents. I tentatively used Dan Xing (Arisaema Cum Bile) and Zhu Li (Bamboo Sap). After administration, he regained consciousness. I asked what he had taken recently; he said he drank Ginger and Jujube Decoction twice daily. Observing his tongue color—white surface with a crimson base, and lips like vermilion—I knew it was undoubtedly Heat Pathogen. It was already the third watch (late night). Seeing his condition stabilize slightly, I agreed to adjust the prescription the next day. At dawn, he invited me again, stating he was awake for less than fifteen minutes before relapsing into Jue. I used Xi Jiao Di Huang Tang (Rhino Horn and Rehmannia Decoction) combined with Da Cheng Qi Tang, promising that once stool passed, he would recover. Unfortunately, other doctors claimed death was certain if purged, causing the family much doubt. Zhang Er Chuan, a relative of the Yang family, strongly urged them to take my prescription. By the time the decoction was nearly ready in the afternoon, the patient's jaw was clenched. They forcibly poured the medicine in. After half a dose, stool passed, and the previous symptoms vanished instantly.
Yao Yufeng from Nan Hui was a physician. In autumn, suffering from alternating chills and fever, he indiscriminately used Huo Xiang Zheng Qi San (Agaricus Rectus and Magnolia Bark Powder) and Xiang Ru Yin (Elsholtzia Decoction) etc. When other doctors visited to ask about the patient, they would settle on one formula, unable to maintain their own judgment. His father, Pei Huan, seeing the critical severity, invited me. I used an urgent purgative. Previous doctors opposed it, saying this is an incurable case, why use purgatives? I waited for them to brew and administer it. He passed large amounts of accumulated filth. Subsequently, he took tonics for half a month and recovered.
Medical Cases of Treating Hidden Pulses (Mai Fu)
Youji Shu Gong of the Former Camp contracted a pathogen in early summer. Chills and fever were mild, but he had pulling pain below the right hypochondrium, restlessness, and headache on the right side, with loose stools. Physicians considered it similar to Shang Han and used Acrid-Warm exterior-releasing methods without effect. I palpated his pulse as hidden and indistinct. His tongue had gray coating, thick and wet enough to drip. Initially suspecting Dampness exceeding Heat, I used Wu Shi Da Yuan Yin (Wu's Origin-Reaching Decoction). Suspecting subsequent Cold-Heat knotting, I used Jin Tui Huang Lian Tang (Advance-Retreat Coptis Decoction), but only achieved 20-30% efficacy. Shu Gong trusted me completely, but I would not feel at ease until full efficacy was achieved. After deep contemplation, since both headache and hypochondriac pain were on the right, this indicated Heat Qi stagnating in the Yangming channel, hence the indistinct pulse. I discarded warm herbs and used exclusively San Huang Shi Gao Tang (Three Yellows and Gypsum Decoction), insisting on taking it for over twenty doses, and he recovered. At that time, Xing Gong, Garrison Commander of the Former Camp, also suffered from a Heat disease. From the onset, his tongue was crimson and he was comatose. Physicians all used Cong Chi Tang (Scallion and Fermented Soybean Decoction) to release the exterior. I used Liang Ge San to clear the middle. My prescription was rejected; he allowed his fluids to dry up for five days and died. Officials in the same camp, facing illness at different times, either believed or disbelieved, creating enmity or gratitude. Shu Gong said: "Ultimately, one cannot escape the word 'Fate'."
Appendix: Letter to Yao Jingxiu regarding your daughter's syndrome. Liver stores accumulated Heat; Lungs received sudden Cold. Thus, Chong Qi rebels upward, causing coughing and wheezing. I used Zhong Jing's Ma Xing Gan Shi Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) to disperse external pathogens and sweep away internal Heat. Missing this opportunity to treat would inevitably lead to Lao Qie (Consumption). Due to your heavy trust, I pondered repeatedly before using this formula. After sweating, I used Qian Zhong Yang's Bu Fei E Jiao San (Tonify Lung and Donkey-Hide Gelatin Powder). After vigorously purging accumulated filth and stasis, I used Yu Shi's Qing Zao Jiu Fei Tang (Clear Dryness and Save the Lung Decoction). Shi Gao (Gypsum) eliminates residual pathogens; Ren Shen (Ginseng) tonifies Qi; E Jiao (Donkey-Hide Gelatin) nourishes Blood. This is a formula addressing both deficiency and excess. When writing the prescription, you and your son asked carefully about the prognosis. I took full responsibility, never uttering a word of alarm. The prescription and case record remain in your study for review. You received the prescription but did not use it, hesitating first, and consulted another physician who mistook the syndrome for Collapse. He proclaimed the Left pulse was absent, causing the entire family to weep bitterly. He notified matchmakers and betrothed families, claiming this syndrome was ruined by Shi Gao and is now incurable. Alas! That physician has long enjoyed fame; how can he rely on arrogant talent while ignoring ancient teachings? The pulse is merely constrained/stagnant, forced by Fire, not absent. Carefully studying ancient masters' works would reveal this profound truth. That physician called this Que Zheng (Timidity Syndrome/Deficiency Syndrome), not a seasonal pathogen. Little does he know that even at the onset of Que Zheng, one must remove evil substances. The ancient formula Bai Lao Wan (Hundred Fatigue Pills) was transmitted by Physician Chen from Xu Zhou under Zhong Jing's name. Did that physician ever study its meaning deeply? People say that physician's formula resembles mine, unaware they are worlds apart. I used Ren Shen and Shi Gao together, intending to clear Fire. That physician used Ren Shen, Wu Wei Zi (Schisandra), and Chen Pi (Tangerine Peel) together, intending specifically to tonify Deficiency. He does not know that although the major accumulation is gone, residual Fire remains. Adding even slight warming tonification fears reigniting the flames. Ren Shen should only be used in small amounts. Your excessive use of Ren Shen反而 caused the disease to worsen. North of your residence, a woman surnamed Yu suffered from latent Heat for over forty days. Others used light-clearing methods without effect; I used Shi Gao with effect. This year, Shao Yin governs the Heaven, and Yang Ming governs the Earth. This is due to Luck and Qi. That physician read Jing Yue's books but did not understand the purpose of using Shi Gao in Yu Nu Jian (Jade Maiden Decoction). How can he enter the hall, let alone the inner chamber? After the woman surnamed Yu took Shi Gao, she erupted with Summer-Toxin all over her body. Her mother did not blame the medicine but credited it. Remarkable insight in women, far surpassing men! After receiving this letter, Jingxiu's courage strengthened. I continued to aggressively use Cold-Cooling agents. He had diarrhea for five days and fully recovered.
Medical Cases of Treating the Elderly
It is known to all that the elderly have deficient Primordial Qi and diseases require supporting Primordial Qi. Yet there are cases where Yang Qi is substantial; they often take large-dose Cold drugs and manage to extend life with illness. Xie Huangming of Nan Hui city was seventy-four. Last autumn, involved in litigation in the prefecture, he was exposed to Summer-Heat on a boat and developed Wen Nüe (Warm Malaria). Mild chills, aversion to heat, chest and diaphragm stuffiness. I happened to reside in the prefecture city and used Qing Xin Liang Ge San (Clear Heart and Cool Diaphragm Powder) to stop chills and fever, followed by Ban Xia Xie Xin Tang (Pinellia Decocting the Epigastric Region Decoction) to remove stuffiness. Soon after, litigation concluded, and he returned South, taking no more medicine. By early winter, wheezing and coughing became severe. Physicians used dispersing methods, worsening the condition. Around the tenth day of the New Year, he could not sleep day or night, with basins and bowls full of phlegm and saliva. He instructed his son En Rong etc. to prepare funeral affairs, having no hope left. Fortunately, Huì friend Wang Yuting was present, suggesting still inviting me to diagnose, promising a surprising victory. The prefecture city is only separated by a river; why not send a dedicated boat to invite him back for a diagnosis? Huangming was usually frugal, but wanting to seek life from death, he had to follow Wang's advice. I also could not refuse out of friendship, so I packed and returned East. It was the night of the sixteenth of the first lunar month. After diagnosis, I knew the previous use of Acrid-Warm was mistaken but promised salvageability. The prescription used a large dose of Bai Hu Tang (White Tiger Decoction) combined with a large dose of Xi Jiao Di Huang Tang. Insisting on taking it for over forty days, he fully recovered. If one does not examine the pulse carefully but restricts treatment by age, one will surely face complaints from the grave. By the twenty-fifth year of Jiaqing, he re-entered the academy. By the fifth year of Daoguang, he was eighty-four. If he did not drink sugarcane juice or pear syrup for one day, his bowel movements became difficult. Such is the harm of mistakenly using Acrid-Warm.
Medical Cases of Malaria
Malaria with alternating chills and fever should be treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction). Not knowing that for those with Yin Deficiency constitutions, using it increases the patient's suffering. Yao Jingxiu of the Prefecture City suffered from Malaria in summer. Physicians administered Xiao Chai Hu Tang for over ten doses with no change. Stopping medication for two days, he suddenly experienced Jue (collapse/reversal), short tongue, vertigo, critically endangered. Living near my residence, he urgently sought diagnosis. I used a large dose of Liver-Clearing medicine. One dose brought peace. Knowing he had taken too much Chai Hu (Bupleurum), causing Liver Yin deficiency and Hyperactive Jue Yang. After recovery, his limbs were sore and numb. He used Yin-Nourishing medicine to regulate for half a year before stabilizing.
Medical Cases of Labor and Exhaustion Internal Injury
Zhang Baohua of South Gate, Nan Hui, suffered from labor and exhaustion, compounded by food stagnation, representing the Excess type of Internal Injury. The pulse was wild and large; heat and thirst were extreme. As his son was an old relative, trusted implicitly, I used Purging and Clearing Middle methods. However, due to excessive fatigue from funeral arrangements, he did not recover immediately. Relatives suspected failure to release the exterior and advised consulting another physician. The new physician said he had never sweated, indicating Heat Pathogen sinking inward, and used Cong Chi (Scallion and Fermented Soybean) etc. to induce sweating. Sweat did not come out; instead, he became comatose. He begged me to treat him again. I focused solely on clearing and descending. Gradually, his spirit cleared, and appetite improved. He recovered without ever sweating. Post-recovery, bowel movements were difficult, requiring only Da Huang (Rhubarb). He refused any tonic. Thus, we know: External pathogens should be released via sweating; Internal injuries prohibit sweating. For Internal Injury due to Deficiency (Labor/Exhaustion), Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is appropriate. For Food Injury with Deficiency mixed with Excess, Zhi Zhu Wan (Immature Bitter Orange and Atractylodes Pill) is suitable. For pure Excess Internal Injury, Purging is appropriate. Wang Andao distinguished these very clearly.
Medical Cases of Dysentery
The mother of Gao Jushang (Prefectural Student, name Chonghu; younger brother Yaofang name Chongrui, selected and passed examination) suffered from Yang Deficiency chronic dysentery. Physicians frequently administered Warming Tonics for half a year, yet the condition worsened, occurring thirty to fifty times day and night. During my diagnosis, he only described abnormal emptiness and pain in the lower back and spine. I used Ban Long Wan (Spotted Dragon Pill) to severely tonify the Extraordinary Vessels. After one dose, the condition decreased significantly. Subsequent doses showed no further change. Taking a little Ren Shen provided brief relief. However, Jushang and Yaofang brothers argued that since their father had suffered from Zheng Chong (Palpitations) for years, the cost of Ren Shen was huge, and Ginseng cannot be taken constantly. After deep thought, I changed to Huang Qi Jian Zhong Tang (Astragalus Decocting the Middle Plus) adding Lu Jiao (Deer Antler). Physician Li Hengtang (Xiu) present praised this method: following severe tonification with promoting and unblocking Yang Qi is also a valid approach. He strongly endorsed this formula as hitting the target. Insisting on taking it for over twenty doses, he recovered.
Li Liancheng of East Gate, Nan Hui, suffered from Liver Qi distending pain. Due to excessive use of Zuo Jin Wan (Left Metal Pill), he developed incessant dysentery, loss of appetite, and others refused to feed him. Doctors changed frequently, using only Zhu (Atractylodes) and Ling (Poria). All declared it incurable, and funeral preparations were made. Forced to seek my treatment, I ordered him to take a large dose of Gui Pi Tang (Restore the Spleen Decoction) in the morning and Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) in the evening, and instructed family members to tempt him to eat meat. There was immediate effect, and he fully recovered in one month.
Medical Cases of Labor and Exhaustion Internal Injury (Duplicate Entry)
Zhang Baohua of South Gate, Nan Hui, suffered from labor and exhaustion, compounded by food stagnation, representing the Excess type of Internal Injury. The pulse was wild and large; heat and thirst were extreme. As his son was an old relative, trusted implicitly, I used Purging and Clearing Middle methods. However, due to excessive fatigue from funeral arrangements, he did not recover immediately. Relatives suspected failure to release the exterior and advised consulting another physician. The new physician said he had never sweated, indicating Heat Pathogen sinking inward, and used Cong Chi (Scallion and Fermented Soybean) etc. to induce sweating. Sweat did not come out; instead, he became comatose. He begged me to treat him again. I focused solely on clearing and descending. Gradually, his spirit cleared, and appetite improved. He recovered without ever sweating. Post-recovery, bowel movements were difficult, requiring only Da Huang (Rhubarb). He refused any tonic. Thus, we know: External pathogens should be released via sweating; Internal injuries prohibit sweating. For Internal Injury due to Deficiency (Labor/Exhaustion), Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is appropriate. For Food Injury with Deficiency mixed with Excess, Zhi Zhu Wan (Immature Bitter Orange and Atractylodes Pill) is suitable. For pure Excess Internal Injury, Purging is appropriate. Wang Andao distinguished these very clearly.
Medical Cases of Hemiplegia (Pian Ku)
Min Qinzhai from Xinchang Town was over fifty, thin, with much Fire and little Phlegm. In winter, he suddenly suffered from Hemiplegia on the left, so he resigned from his teaching post in Wu Men and returned. Physicians focused only on tonifying Qi and eliminating Phlegm, aggravating symptoms like dry throat and Bi (obstruction). The family said the root was exhausted, hence tonics failed. Inviting me to inquire, I said his pulse and symptoms were purely a mass of Fire Qi. Must use He Jian's methods for treating Fire. The formula used Er Di (Two Rehmannias), Er Dong (Two Asparas), Zhi Mu (Anemarrhena), Bai Xian Pi (Dictamnus) etc., alternating Sweet-Cold and Bitter-Cold. After two doses, he felt mentally refreshed. The patient recalled that days before falling ill, his left scapula felt like burning. Only then did he believe the theory of treating Fire was correct. Subsequently taking Hu Qian Wan (Tiger Crouching Pill), he fully recovered.
Medical Cases of Bi Syndrome (Arthralgia)
Wind, Cold, and Dampness combining to form Bi syndrome, and dispelling Wind, Cold, and Dampness, is known to all. Not knowing there are cases requiring flexibility. Dai Xingbiao of Si Jing, nearing forty, traveled to Shang Yang for tobacco business. One night, he suddenly suffered leg pain, unable to walk. Someone in his lodging familiar with medicine said Kidney Qi was chronically deficient, indicating the onset of Zhong (Stroke/Collapse), and suggested Da Zao Wan (Great Creation Pill). Dai, finding lodging inconvenient, returned by sedan chair. Physicians in the town and prefecture all used Warm drugs and Da Zao Wan. After taking it, pulling pain increased to ten degrees, both hands hurt, and sexual function atrophied. He invited me to diagnose. I said this belongs to Re Bi (Hot Bi), commonly called Liu Huo (Flowing Fire). Although the tongue coating is white, the base is actually crimson. Sexual atrophy is what Wang Jiezhai called Yu Huo (Stagnant Fire). I used San Huang (Three Yellows), Shi Gao (Gypsum), Xi Jiao Di Huang Tang etc. in large doses. Within half a month, he rose from bed. Using Hu Qian Da Bu Yin Wan (Tiger Crouching Great Tonify Yin Pill) etc., after one month, his gait was normal.
The mother of Xie Enrong, a Southern Academy Student, suffered from Hot Bi. Physicians thought it was Blood deficiency and Qi weakness, administering tonics which worsened it. I used Ling Yang Jiao (Antelope Horn), Er Dong, Yu Zhu (Polygonatum Odoratum), Zhu Li etc., meridian-unblocking agents. After several doses, he fully recovered.
Medical Cases of Wei Syndrome (Flaccidity)
Gong Zhenbang, Chief of Camp, had excessive desires and Yin deficiency. In summer, he suffered from flaccidity and weakness of feet and knees. I said it should be treated as Shu Wei (Summer-Heat Flaccidity), using Qing Shu Yi Qi Tang (Clear Summer-Heat and Augment Qi Decoction) plus Blood-Activating products. He rejected the prescription and took orthopedic medicines instead. Suddenly he fainted, heartache as if dying. He invited me again. Pulse was deficient and scattered. Sheng Mai San (Generate the Pulse Powder) plus harmonizing agents. One dose brought slight relief. His family lacked firm faith, consulting other doctors jointly. They changed to Ren Shen, Di Huang, Gui (Cinnamon), Fu Zi (Aconite). Taking it increased bloating. Another doctor treated with harmonizing and descending Qi. Bloating decreased slightly, but Yuan Qi weakened further, making support harder. Changing to Ren Shen and Bai Zhu (Atractylodes) one dose, the previous heartache returned. Forced to obey me. I said this belongs to Shaoyin Kidney Water deficiency. Switching to orthopedic medicines also depleted Qi. Ren Shen, Bai Zhu, Gui, Fu Zi consume Yin; Ju (Tangerine), Ban (Pinellia), Zhi (Magnolia), Sha (Amomum) consume Qi. None hit the target, hence worsening. Strengthening the Master of Water to control Solar Flare is the correct treatment. Using Liu Wei Di Huang Wan combined with Sheng Mai San etc., insisting on taking it for over fifty doses, he recovered.
Zhu Qiguan, soldier in Nan Hui Camp, suffered from Wei syndrome due to Damp-Heat. Seeking treatment from a fashionable physician in another county, he was told to frequently take strong-tonic rigid agents. Half a month later, Jue Yang rebelled upward, causing dizziness, tinnitus, chest agitation, Cold blocked below, feet like ice. He felt there was no hope. Friend Gu Minghe, a Military Student nearby, invited me to judge life or death. I palpated the wild and large pulse, saying this syndrome was caused by mistaken warm tonification, not a terminal case. I used Qin (Scutellaria), Lian (Coptis), Zhi Mu, Bai Xian Pi, Pig Gallbladder Juice etc., large Cold agents. One dose reduced it; twenty doses cured it.
The daughter of Xu Huafeng in the Prefecture City suffered from Wei syndrome. Feet could not separate by an inch. Skin between spine was loose and soft, like a bean bag. Physicians used miscellaneous Qi-Blood tonics without effect. I said diet was normal, disease located in Lower Jiao. Qi and Zhu stay in the Middle, cannot reach below. Si Wu Tang is indeed a key female medicine, but if aiming to fill essence and marrow, it is incompetent. Examining *Nei Jing*, Jin Wei (Sinew Flaccidity) and Gu Wei (Bone Flaccidity) all belong to Extraordinary Meridian diseases. I used raw Lu Jiao (Deer Antler), Gui Ban (Turtle Shell), Hai Shen (Sea Cucumber), Yu Jiao (Fish Maw), Lamb meat etc., animal-derived flavors, combined with Shu Di (Prepared Rehmannia), Gou Qi (Goji), Niu Xi (Achyranthes), Gui (Angelica), Shao (Peony). Insisting on taking it for over thirty doses, he fully recovered.
Medical Cases of Consumption (Xu Lao)
Lu Mou north of Tinglin Town, chronically suffered from Labor Cough, intermittent. Now asthma worsened, unable to turn sides when lying obliquely. Pulse fine and weak, resembling Qi Deficiency with Phlegm-Fluid. Physicians used Spleen-Tonifying and Qi-Regulating methods for a long time without effect, giving up on the original syndrome. I happened to be at Gu Residence in the town, invited to judge safety. I said this belongs to Lung and Kidney Yin deficiency, not Qi deficiency. Initially using Qian Shi's E Jiao San (Donkey-Hide Gelatin Powder), subsequently Liu Wei Di Huang Tang (Six-Ingredient Rehmannia Decoction), and he recovered.
Medical Cases of Swelling (Zhong Zhang)
Wang Dixian's mother, a Prefectural Academy Student, suffered from Wheezing and Swelling. Pulse floating, no sweat, extreme thirst. Following Zhong Jing's Feng Shui (Wind Water) treatment example, and referencing Wang Jiezhai's principle of "Wheezing precedes Swelling," I used Ma Xing Gan Shi Tang, and he recovered.
Li Xiaosi of Nan Hui city suffered from isolated abdominal distension for months, various drugs ineffective. I palpated the pulse deep and minute, belonging to Yang deficiency. Using Sai Yin Sai Fa (Treating Obstruction with Obstruction method), specifically taking Li Zhong Tang (Regulate the Middle Decoction) plus Fu Zi, and he recovered.
A thirteen-year-old girl surnamed Bu in the Prefecture City first suffered from Sha Zhen (Scarlet Fever/Rash), then Malaria. Physicians used opening and draining methods excessively, leading to distension. Abdomen below hard as stone. Family suspected Deficiency, invited an old physician specializing in tonics. Unexpectedly, he said Sha Toxin attacked inward, incurable. I had just arrived in the prefecture and was invited to diagnose. I palpated the pulse deep, fine, and minute, clearly showing Spleen Deficiency. Initially using Qian Shi's Bai Zhu San (Atractylodes Powder), hardness disappeared. Subsequently using Chen Shi's Liu Shen Tang (Six Spirits Decoction), distension resolved.
Mrs. Zhang Yongchun of Desheng Du, Qi Deficient constitution, suffered from abdominal distension in autumn. Took consuming drugs excessively, abdomen swelled like drum within days. I immediately used Ji Sheng Shen Qi Wan (Kidney Qi Pill from *Prescriptions Generated from Empathy*), seeing miraculous effect. Later slight distension, repeated the former prescription, and he recovered.
Medical Cases of Jiao Qi (Beriberi/Leg Swelling)
Fang Tiehua's father, a Prefectural Student, suffered from Jiao Qi attacking upward. Physicians administered Drying-Dampness, Regulating-Qi, Unblocking-Yang agents, worsening wheezing and swelling. I said "For those heated yet feeling cold, seek Yang." Thus establishing Jia Wei Shen Qi Tang (Modified Kidney Qi Decoction). Initially no perceived benefit, nor dryness/heat. Insisting on taking it for thirty doses, he recovered.
Medical Cases of Jaundice (Fa Huang)