饥。又服甘凉濡润 二十余剂。 疹始愈。亦仅见之证也。（疹 枯暗。则肺无津液。其人必
死。)
何永昌妻病疟。间二日而作。旬日后势甚危。孟英诊之。脉沉细而数。尺为甚。口渴目不欲
张。两腰收痛。宛如锥刺。寒少热多。心慌不能把握。曰∶此暑入足少阴之证。喻氏嘉言所
谓汗下温三法皆不可行。书方元参八钱。龟板石斛同先煎八句钟。各一两。酒炒知母五钱。
桑皮银花各四钱。花粉三钱。丹皮二钱。令用大砂锅煎而频服。不必限剂。服三日疟断而各
恙皆减。粥食渐进。不劳余药而起。（此病认证在尺为甚三字。数为阴虚挟热。沉细为阴分
不足。口渴液耗。目不欲张。目为肝窍。肾为肝母。肝肾之阴不足。则目不欲张。腰为肾腑
。肾亏则腰痛。寒少热多。热疟何疑。心为火脏。得肾阴以济心阳。则天君泰然。心慌不能
把握。为肾阴不能上朝于心。)
慎氏妇产后腹胀泄泻。面浮足肿。医予渗湿温补。月余不效。疑为蓐损。孟英视之。舌色如
常。小溲通畅。宛似气虚之证。惟脉至梗涩。毫无微弱之形。因予丹参滑石泽兰茯苓茺蔚蛤
壳桃仁海 五灵脂豆卷。数服即瘥。（此证必系产后恶露未净。瘀停化热。腹胀为瘀停。泄
泻为热邪自寻出路。面浮足肿。为瘀停化热。上贼气阴。气机失其下降。渗湿则愈伤其阴。
温补则愈助热。舌色如常。小溲通畅。为病在血不在气之明证。瘀停阻气。故脉至梗涩。瘀
系
实邪。故脉无微弱之形。紫丹参四钱。西滑石先煎五钱。泽兰叶三钱。白茯苓三钱。茺蔚子
杵先五钱。生蛤壳杵先一两。生桃仁研三钱。淡海 先煎一两。五灵脂二钱。大豆卷次入三
钱。)
孙某患感。医投温散。竟无汗泄。至十一日孟英视之。业已神昏囊缩。面赤舌绛。目不识人
。口不出声。胸膈微斑。便泻而小溲不行者已三日。医拟温补。孟英急止之曰。阴分素亏。
而温散劫津。邪热愈炽。则营卫不行。岂可妄云漏底。以温燥竭其欲绝之阴乎。浦上林云。
泄泻为热邪之出路。求之不可得。胡可止也。以西洋参生地麦冬丹皮连翘生芍石菖蒲盐水炒
黄连甘草梢百合茯苓贝母银花紫菀为方。（此证可生在胸膈微斑便泻两层。胸膈微斑。则热
邪尚未全离气分。便泻泻得一分。即减一分热邪。西洋参三钱。大生地一两。花麦冬五钱。
二味开水泡冲去渣。粉丹皮二钱。连翘壳三钱。整大白芍杵先二两。石菖蒲次入一钱。淡盐
水炒雅连二钱。生草梢三钱。百合花三钱。白茯苓三钱。川贝母杵八钱。济银花一两五钱。
紫菀茸一钱五分。)一剂即周身微汗而斑退。三剂始得小溲一杯而识人。四剂乃得大汗。而
身热退。面赤去。茎亦舒。复解小溲二杯。次日于方中减连翘菖蒲丹皮黄连。加知母玉竹竹
叶投之。舌始润。神始清。知渴索水。孟英令将蔗梨等榨汁频灌不歇。其汗如雨下者三昼夜
始
休。（人身阴阳贵得平均。此证温散劫津。残阴将绝。频灌甘寒。阴平阳秘而后汗解。热邪
无不从汗解。亦无不从阴复而后汗解。)于是粥渐进。泻渐止。溲渐长。前方又去贝母银花
紫菀。加石斛龙眼肉。服之全愈。（钗石斛杵先一两。净桂元肉三钱。)
汪子与病革。孟英视之。曰∶阴虚之质。暑热胶锢。殆误投补药矣。询悉医投熟地药十余剂
。孟英曰∶暑热证必看邪到血分。始可议用生地。何初病即用熟地岂仅知禀赋之虚。未睹外
来之疾耶。昔贤治暑。但申表散温补之戒。今人于律外更犯滋腻之辜。越日果卒。
吴忻山子素禀虚怯。滋补频投。医不察其患温发热。佥谓阴虚。竞投腻滞培元之剂。舌黑卷
短
。唇焦溺赤。孟英一诊。即云不救。
汪左泉病滞下。昼夜数十行。孟英切脉弦滑。苔黄
满
布。曰∶易事耳。重用芩连。佐以楂朴。送服青麟丸四钱。投匕而痊。（此证脉弦滑必重按
有力搏指。方任大剂苦寒。姜炒枯芩四钱。姜炒川连二钱。姜制根朴一钱。焦楂肉杵二钱。
药送青麟丸四钱。)
陈昼三病滞下。某进通因通用法。痛泄无度。呕恶不纳。汗出息微。脉弱眩晕。孟英曰∶
近多伏暑之痢。此独非其证也。元将脱矣。急投大剂温补。脉候渐安。一月后甫得健复。（
此证认阳微在息微脉弱。炒西 五钱。炒潞党五钱。炒白术三钱。制半夏四钱。炒焦陈皮一
钱五分。炒干姜五钱。炒浓附片杵三钱。五味子研三钱。陈木瓜三钱。紫石英五钱。杵炭先
煨八句钟。)
金朗然母偶发脘疼呕吐。医予温补药。初若相安。渐至畏寒不寐。四肢不仁更医云是风痹。
仍投温补。因而不饥不食。二便不行。肌肉尽削。带下如溺。孟英诊之。曰∶暑伏肺胃耳其
多投温补而不遽变者。以熟地等阴柔腻滞为之挟制也。然津气灼烁而殆尽。脂液奔迫以妄行
。治节无权。阳明涸竭。予白虎汤加西洋参竹茹橘皮丝瓜络石斛花粉竹沥海 。（脘疼呕吐
。
本系阴虚肝阳犯胃。先后温补。愈助肝阳灼烁肺胃阴液。案叙病情六语。热邪皆在上焦气分
。生石膏先煎八钱。姜炒知母四钱。西洋参三钱。姜竹茹四钱。赖橘红一钱五分。丝瓜络三
钱。钗石斛杵先一两。南花粉四钱。姜竹沥两大酒杯和服。淡海 先煎二两。)连进二十剂
。始解黑矢。各恙渐安。嗣予和肝胃调八脉以善后遂愈。
李某向患脘痛。孟英频予建中获瘳。今秋病偶发。医闻建中曾效。壶卢温补。服后耳闭腿疼
。不饥便滞。孟英视之。曰∶暑邪偶伏。误投补药使然。治宜清涤。彼疑风气。误付外科灼
灸。遂致筋不能伸而成锢疾。内经治病原有熨治之法。然但可以疗寒湿凝滞之证。不可轻试
于阴虚之体与挟热之证。仲景焦骨之训。云胡不闻。
乔有南侄甫五龄。发热数日。儿医予柴葛解肌汤一剂。肢搐而厥。目张不语。孟英诊曰∶病
是暑邪。治以风药。热得风而焰烈。津受烁以风腾。乃风药引起肝风。予王氏犀角地黄汤加
羚角生石膏元参桑叶菊花银花牡蛎知母麦冬竹叶诸药。数服而愈。（小儿多不足于阴。若非
寒证。最忌风药。镑犀角磨冲三分。大生地开水泡冲去渣四钱。生石膏先煎六钱。元参片泡
冲五钱。冬桑叶二钱。杭菊花一钱。 牡蛎杵先二两。酒炒知母一钱五分。鲜竹叶一钱。)
赵子善因事抑郁。凛寒发热。汤某作血虚治。进以归芎丹参之类。多剂不效。孟英诊之。脉
涩而兼沉弦以数。然舌无胎。口不渴。便溺如常。纳谷稍减。惟左胁下及少腹自觉梗塞不舒
。按之亦无形迹。时欲抚摩似乎稍适。曰∶阴虚挟郁。暑邪内伏。夫郁则气机不宣。伏邪无
从走泄。连投血药。引之深入。血为邪踞。更不流行。胁腹不舒。乃其真谛。第病虽在血。
治宜清气为先。气得展布。热象必露。瘀滞得行。厥疾始瘳。连投清气。（方用酒炒枯芩一
钱五分。姜炒牛蒡子研三钱。姜栀皮三钱。姜炒枇叶刷包三钱。姜炒川连六分。姜竹茹三钱
。川贝母杵四钱。苦杏泥次入二钱。薄橘红次入一钱五分。紫菀茸次入一钱。)热果渐壮。
谵妄不眠。口干痰嗽。孟英曰∶脉已转为弦滑。瘀血伏邪皆有欲出之机。继此当用凉血清瘀
为治。遂定犀角地黄加味。（大生地开水泡冲八钱。镑犀角磨冲一钱。酒炒川连八分。酒炒
川黄柏一钱五分。石菖蒲一钱次入。半夏曲二钱。川贝母杵八钱。生冬瓜子四钱。姜竹茹三
钱。丝瓜络三钱。姜汁拌姜根八钱。紫菀一钱。旋复绢包三钱。)适病者鼻衄大流。径煎服
之。次日衄复至。苔色转黑。孟英曰∶三日不大便。瘀热未能下行也。于前方加滑石桃仁木
通海 竹沥石斛银花知母花粉。（前方宜去连柏竹茹丝瓜络芦根。加西滑石先煎四钱。生桃
仁
研三钱。细木通一钱。淡海 先煎二两。姜竹沥两大酒杯冲。钗石斛杵先一两。银花八钱。
酒炒知母三钱。南花粉四钱。)又二剂大解始行。黑如胶漆。三日间共下七十余次而止。乃
去木通桃仁辈。加西洋参麦冬以生液。（加西洋参三钱。花麦冬五钱。)病者疲惫已极。沉寐
三昼
夜。人皆危之。孟英曰∶听之。使其阴气来复。最是好机。醒后尚有微热谵语。药仍前法。
又旬日始解一次黑燥大便。而各恙悉退。惟口尚渴。予大剂甘凉以濡之。又旬日。大便甫得
复
行。色始不黑。乃用滋阴填补而康。（此病必系阳证阳脉。故以大剂辛寒收效。若阳证阴脉
。阴药即苦伤阳。故多不治。)
圃人妻因雷震火药局惊醒。即觉气不舒畅。半载以来。渐至食减形消。神疲汛少。惟卧则其
病如失。药治罔效。孟英诊之。病患坐起。果即面赤如火。气息如奔。似不能接续者苟登圊
溲
便。必贲逆欲死。前所服药破气行血和肝补肺运脾纳肾清火安神诸法具备。如水投石。孟英
仿喻氏治厥巅疾之法用药。一剂知。旬余愈。（喻氏治厥巅疾原秦会内经铁落镇坠之义。以
赭石胆草芦荟黄连之属。降其上逆之气。以蜀漆丹皮赤芍之属。行其上脘之血。以牡蛎龙骨
五味之属。敛其浮游之神。最要在每剂药中生入猪胆汁二枚。盖以少阳热炽。胆汁必干。连
进十
数剂。热退身凉。饮食有加。便泻自止。惟行动觉身如叶。不能久支。恐药太苦。不宜多服
。去猪胆及芦龙等。加当归一钱。人参三分。姜枣为引。平调数日全愈。彼证因雷震火药
局。惊则伤肝。胆为肝腑。医法脏病治腑。惟此案无彼案暴怒经停二因。故此案但云仿喻氏
治巅疾之法用药。方用醋 赭石杵先八钱。酒炒胆草一钱。酒炒雅连六分。醋 牡蛎杵先二
两
。醋 龙骨杵先一两。五味子杵先三钱。生猪胆汁三茶匙和服。加乌梅肉杵先三钱。陈木瓜
先煎三钱。旋复花绢包三钱。白茯苓三钱。制半夏米三钱。生白蒺去刺一钱五分。)
高若舟庶母年逾花甲。体丰善泻。张某向用参术取效。今秋患白痢。张谓寒湿滞中。仍予理
中加减。病遂日增。因疑高年火衰。蒸变无权。前药中复加附子。白痢果减。而腹胀且疼。
不食不溺。哕逆发热。势已危殆。孟英视之。脉沉而滑数梗梗。曰∶暑热未清。得毋补药早
投乎。予芩连杏朴曲芍滑楝银花海 鸡金之类。（白痢果减四句。热邪皆在气分。玩腹胀且
疼
上而字。则白痢不当止可知。脉沉而滑数梗梗。则实热结遏。不能自行宣达又可知。方用姜
炒枯芩一钱五分。姜炒川连八分。苦杏泥二钱。姜制根朴一钱。生神曲杵一钱五分。酒炒白
芍一钱五分。西滑石先煎四钱。川楝核先三钱。济银花八钱。淡海 先煎一两。炙鸡金研三
钱。)一剂溺行痛减。痢下仍白。孟英曰。病机隐伏。测识匪易。前此之止。非邪净而止之
止。乃邪得补而不行之。邪气止而不行。是以痛胀欲死。夫强止其痢。遽截其疟。犹之乎新
产后妄涩其恶露也。世人但知恶露之宜通。而不知间有不可通者。但知疟痢之当止。不知邪
未去而强止之。其害较不止为尤甚也。今邪未清涤。而以温补药壅 塞其流行之道。以致邪
不能出。逆而上冲。哕不能食。是痢证之所畏。吾以通降凉润之剂。搜邪扫浊。惟恐其去之
不速。病家勿以白痢为忧。寻愈。
徐有堂妻病痢。医作寒湿治。广服温补之剂。痢出觉冷。遂谓沉寒。改投燥热。半月后发热
无溺。口渴不饥。腹疼且胀。巅痛不眠。孟英察脉弦细。沉取甚数。舌绛无津。肌肉尽削
。是暑热胶锢。阴气受烁。予北沙参苁蓉芩斛楝芍银花桑叶丹皮阿胶合白头翁汤为剂。（发
热无溺四句。暑邪大伤气分之阴。弦细为阴虚。沉取甚数为温补胶锢其暑热之象。腹疼为暑
热胶锢。胀及巅痛不眠。为肝阴受烁。苁蓉补肝阳。作胶斛沙参反佐。使芩楝无偏于苦寒流
弊。北沙参八钱。淡苁蓉三钱。酒炒枯芩一钱五分。鲜钗斛杵先一两。酒炒川楝核杵先三钱
。整大白芍杵先八钱。济银花一两五钱。冬桑叶四钱。粉丹皮二钱。酒炒白头翁一钱。)次
日各患皆减。痢出反热。孟英曰。热证误投热药。热结为大便不行者有之。或热势奔迫而泄
泻如火者有之。若误服热药而痢出反冷者。殊不多见。无怪医者指为久挟之沉寒。吾以脉证
参之。显为暑热。然暑热之邪本无形质。其为滞下也。必挟身中有形之垢浊。故治之之道。
最忌补涩壅滞之品。设误用之。则邪得补而愈炽。浊被壅而愈塞。耗其真液之灌溉。阻其
正气之流行。液耗则出艰。气阻则觉冷。大凡有形之邪。皆能阻气机之周流。如痰盛于中。
胸
头觉冷。积滞于腑。脐下欲熨之类。皆非真冷。人不易识。吾曾治愈多人矣。仍议育阴涤热
。病果渐瘳。
萧某素患痰多。常服六君子汤。孟英诊之。脉细数而兼弦滑。曰∶六君极当屏绝。病由阴亏
火盛。津液受灼而成痰。须服壮水之剂。庶可杜患将来。萧吸鸦片。自疑虚寒。滋阴不敢频
服。继患喉痛。专科治而不效。孟英诊曰∶早从吾策。奚至是耶。此阴虚于下。阳浮于上。
喉科药不可试也。大剂育阴潜阳。（脉细数为阴分挟虚。弦滑为气分挟痰热。专科治而不效
（前文略）感到饥饿。又服用甘凉濡润之药二十多剂，皮疹才痊愈。这也是极少见的证候。（如果皮疹干枯色暗，说明肺中津液枯竭，病人必定死亡。）
何永昌的妻子患疟疾，每隔两天发作一次。十天后病情非常危急。王孟英诊察，脉象沉细而数，尺部尤为明显。口渴，眼睛不想睁开，两腰收缩疼痛，像被锥子刺一样。怕冷少，发热多，心慌手抖无法控制自己。王孟英说：这是暑邪侵入足少阴肾经的证候。正如喻嘉言所说，汗法、下法、温法都不可使用。开方用玄参八钱，龟板、石斛先煎八分钟，各一两；酒炒知母五钱；桑白皮、金银花各四钱；天花粉三钱；牡丹皮二钱。嘱咐用大砂锅煎药，频繁服用，不必限制剂量。服药三天后疟疾停止，其他症状也都减轻，粥食逐渐进食，没有再用其他药物就痊愈了。（这个病辨证的关键在于“尺为甚”这三个字。脉数是阴虚夹杂热邪，脉沉细是阴分不足。口渴是津液耗伤，眼睛不想睁开是因为眼睛是肝的窍，肾是肝的母亲，肝肾阴不足，所以眼睛不想睁开。腰部是肾脏所在，肾虚则腰痛。怕冷少发热多，这难道是热疟吗？心属火脏，得到肾阴的济助，心阳才能安宁。心慌手抖不能控制，是因为肾阴不能上朝于心。）
慎氏的产妇产后腹胀泄泻，面部浮肿，足部肿胀。医生给予渗湿温补的药物，一个多月不见效，怀疑是产后虚损。王孟英查看，舌色如常，小便通畅，宛然像是气虚的证候。只有脉来梗涩，毫无微弱的形态。于是给予丹参、滑石、泽兰、茯苓、茺蔚子、蛤壳、桃仁、海藻、五灵脂、大豆卷。服几剂后就痊愈了。（这个证候必定是产后恶露未净，瘀血停滞化热。腹胀是因为瘀血停滞，泄泻是热邪寻找出路。面部浮肿足部肿胀，是因为瘀血停滞化热，向上侵犯气阴，气机失去下降的功能。渗湿会进一步损伤阴液，温补会进一步助长热邪。舌色如常，小便通畅，是病在血分不在气分的明证。瘀血停滞阻碍气机运行，所以脉来梗涩。瘀血属于实邪，所以脉象没有微弱的形态。紫丹参四钱，西滑石先煎五钱，泽兰叶三钱，白茯苓三钱，茺蔚子捣碎先煎五钱，生蛤壳捣碎先煎一两，生桃仁研碎三钱，淡海藻先煎一两，五灵脂二钱，大豆卷后下三钱。）
孙某患外感病，医生投以温散药物，竟然没有出汗排泄。到了第十一天王孟英诊视，已经神志昏迷，阴茎内缩，面色红赤，舌质深红，眼睛不认识人，口不出声，胸膈部有轻微斑疹，腹泻且三天没有小便。医生打算用温补法，王孟英急忙制止说：患者阴分素来亏虚，而温散药物劫夺津液，邪热更加炽盛，导致营卫运行不畅，怎么能妄说是漏底（指阳气下脱），用温燥药物去枯竭那将绝的阴液呢？浦上林说：泄泻是热邪排出的途径，求之不得，怎么可以止住呢？用西洋参、生地、麦冬、丹皮、连翘、生芍药、石菖蒲、盐水炒黄连、甘草梢、百合、茯苓、贝母、金银花、紫菀作为方剂。（这个证候关键在于“生在胸膈微斑”和“便泻”两层意思。胸膈微斑，说明热邪还没有完全离开气分；便泻泻掉一分，就减少一分热邪。西洋参三钱，大生地一两，花麦冬五钱，这两味开水泡冲去渣；粉丹皮二钱，连翘壳三钱，整大白芍捣碎先煎二两，石菖蒲后下一钱，淡盐水炒雅连二钱，生草梢三钱，百合花三钱，白茯苓三钱，川贝母捣碎八钱，济银花一两五钱，紫菀茸一钱五分。）一剂后周身微微出汗，斑疹消退；三剂后才得小便一杯，神志清醒；四剂后大汗出，身热退，面赤去，阴茎舒展，又解小便两杯。第二天在方中减去连翘、石菖蒲、丹皮、黄连，加入知母、玉竹、竹叶服用，舌苔开始滋润，神志开始清醒，知道口渴要水喝。王孟英让人将甘蔗、梨等榨汁频繁灌服不停歇。汗水如雨般流了三昼夜才停止。（人身阴阳贵在平均。这个证候因温散劫夺津液，残存的阴液即将断绝，频繁灌服甘寒药物，使阴平阳秘而后汗解。热邪无不从汗解，也无不从阴液恢复后汗解。）于是粥食逐渐进食，腹泻逐渐停止，小便逐渐增多，前方又去掉贝母、金银花、紫菀，加入石斛、龙眼肉，服用后完全痊愈。（钗石斛捣碎先煎一两，净桂元肉三钱。）
汪子与病情危重，王孟英诊视说：这是阴虚体质，暑热胶结固滞，大概是误投了补药。询问得知医生投用了熟地黄药十余剂。王孟英说：暑热证必须看到邪气进入血分，才可以讨论使用生地黄。为什么初病就用熟地黄？难道只知道禀赋虚弱，没看到外来疾病吗？以前的贤人治疗暑病，只是申明对表散、温补的戒律，现在的人在戒律之外更犯了滋腻的错误。过了几天果然去世。
吴忻山的儿子平素体质虚弱怯懦，频繁进补。医生不察其患有温热病发热，大家都认为是阴虚，竞相投用腻滞培元的药物。舌黑卷短，嘴唇焦裂，尿赤。王孟英一诊，就说救不了。
汪左泉患痢疾，昼夜几十次。王孟英切脉弦滑，苔黄满布，说：容易治。重用黄芩、黄连，佐以山楂、厚朴，送服青麟丸四钱。投药即痊愈。（这个证候脉弦滑必须重按有力搏指，才敢任大剂苦寒。姜炒枯芩四钱，姜炒川连二钱，姜制根朴一钱，焦楂肉捣碎二钱，药送青麟丸四钱。）
陈昼三患痢疾，某人采用通因通用的方法，导致痛泻无度，呕吐恶心不能进食，出汗呼吸微弱，脉弱眩晕。王孟英说：近来多是伏暑引起的痢疾，唯独这不是那个证候。元气将要脱失，急投大剂温补药物，脉候逐渐安定，一个月后才得以康复。（这个证候辨识阳微在于呼吸微弱、脉弱。炒西洋参五钱，炒潞党参五钱，炒白术三钱，制半夏四钱，炒焦陈皮一钱五分，炒干姜五钱，炒浓附片捣碎三钱，五味子研碎三钱，陈木瓜三钱，紫石英五钱，杵炭先煨八分钟。）
金朗然的母亲偶尔发生胃脘疼痛呕吐，医生给予温补药，起初好像相安无事，渐渐出现怕冷失眠，四肢麻木不仁。另一个医生说这是风痹，仍然投用温补，因此导致不饥不食，大小便不通，肌肉消瘦殆尽，带下如尿液。王孟英诊视说：这是暑邪潜伏在肺胃。之所以多次投用温补而没有立刻变化，是因为熟地黄等阴柔腻滞的药物起到了挟制作用。然而津气被灼烧殆尽，脂液奔迫妄行，治节无权，阳明经涸竭。给予白虎汤加西洋参、竹茹、橘皮、丝瓜络、石斛、花粉、竹沥、海藻。（胃脘疼痛呕吐，本系阴虚肝阳犯胃，先后温补，更加助长肝阳灼烧肺胃阴液。案叙病情六语，热邪都在上焦气分。生石膏先煎八钱，姜炒知母四钱，西洋参三钱，姜竹茹四钱，赖橘红一钱五分，丝瓜络三钱，钗石斛捣碎先煎一两，南花粉四钱，姜竹沥两大酒杯和服，淡海藻先煎二两。）连续进服二十剂，才排出黑色粪便，各种症状逐渐安定。随后给予调和肝胃、调理八脉的药物善后，于是痊愈。
李某向来患胃痛，王孟英频频给予建中汤获得痊愈。今年秋天病情偶然发作，医生听说建中汤曾有效，用葫芦巴温补，服用后耳朵闭塞腿疼，不饥大便滞涩。王孟英诊视说：暑邪偶然潜伏，误投补药所致。治疗应当清涤。他怀疑是风气，误付给外科灼灸，导致筋不能伸展而成顽固疾病。《内经》治疗病因原有熨治的方法，但只能用来治疗寒湿凝滞的证候，不可以轻率尝试于阴虚体质和挟热证候。张仲景关于焦骨的训诫，怎么没听说过呢？
乔有南的侄子刚五岁，发热几天，儿科医生给予柴葛解肌汤一剂，肢体抽搐而厥逆，眼睛睁着不说话。王孟英诊视说：病是暑邪，却用风药治疗，热得风而火势猛烈，津液受风药煎熬而沸腾，乃是风药引起肝风。给予王氏犀角地黄汤加羚羊角、生石膏、元参、桑叶、菊花、金银花、牡蛎、知母、麦冬、竹叶等药物。服几剂后痊愈。（小儿多阴不足，如果不是寒证，最忌风药。镑犀角磨冲三分，大生地开水泡冲去渣四钱，生石膏先煎六钱，元参片泡冲五钱，冬桑叶二钱，杭菊花一钱，牡蛎捣碎先煎二两，酒炒知母一钱五分，鲜竹叶一钱。）
赵子善因为事情抑郁，凛寒发热。汤某当作血虚治疗，进用当归、川芎、丹参之类，多剂无效。王孟英诊视，脉涩而兼沉弦以数，但是舌无苔，口不渴，大小便如常，进食稍减，只有左胁下及小腹部自觉梗塞不舒，按压也没有形迹，时常想要抚摸似乎稍微舒适。王孟英说：阴虚挟郁，暑邪内伏。郁则气机不宣，伏邪无从走泄，连续投用血药，引邪深入，血被邪气占据，更不流行。胁腹不舒，这才是真谛。虽然病在血分，治疗应当以清气为先。气机得以展布，热象必然显露，瘀滞得以运行，旧疾才开始痊愈。连续投用清气药物。（方用酒炒枯芩一钱五分，姜炒牛蒡子研碎三钱，姜栀皮三钱，姜炒枇杷叶刷包三钱，姜炒川连六分，姜竹茹三钱，川贝母捣碎四钱，苦杏泥后入二钱，薄橘红后入一钱五分，紫菀茸后入一钱。）热果逐渐壮盛，谵妄不眠，口干痰嗽。王孟英说：脉已转为弦滑，瘀血伏邪都有欲出的时机。接下来应当用凉血清瘀治疗。于是定下犀角地黄加味方。（大生地开水泡冲八钱，镑犀角磨冲一钱，酒炒川连八分，酒炒川黄柏一钱五分，石菖蒲一钱后入，半夏曲二钱，川贝母捣碎八钱，生冬瓜子四钱，姜竹茹三钱，丝瓜络三钱，姜汁拌姜根八钱，紫菀一钱，旋复花绢包三钱。）恰好病人鼻衄大出血，直接煎服此药。第二天衄血再次发生，舌苔颜色转黑。王孟英说：三天不大便，瘀热未能下行。在前方加滑石、桃仁、木通、海藻、竹沥、石斛、金银花、知母、花粉。（前方宜去掉连柏、竹茹、丝瓜络、芦根，加西滑石先煎四钱，生桃仁研碎三钱，细木通一钱，淡海藻先煎二两，姜竹沥两大酒杯冲，钗石斛捣碎先煎一两，银花八钱，酒炒知母三钱，南花粉四钱。）又服两剂，大便才通行，黑如胶漆。三天间共下了七十多次才停止，于是去掉木通、桃仁等，加入西洋参、麦冬以生津液。（加西洋参三钱，花麦冬五钱。）病人疲惫已极，沉睡三昼夜，人们都认为危险。王孟英说：听其自然，使其阴气来复，是最好的机会。醒来后还有微热谵语，用药仍用前法。又过十天解了一次黑燥大便，各种症状全部消退，只有口尚渴，给予大剂甘凉药物滋润它。又过十天，大便才恢复通行，颜色才不黑，于是用滋阴填补药物而康复。（这个病必定是阳证阳脉，所以以大剂辛寒收效。如果是阳证阴脉，阴药就会苦伤阳气，所以大多不治。）
圃人的妻子因为雷震火药局惊醒，立即觉得气不舒畅。半年来，渐渐到食欲减退形体消瘦，精神疲倦月经量少，只有躺下时病好像消失。药物治疗无效。王孟英诊视，病患坐起，果然立即面赤如火，气息急促，好像不能接续。如果上厕所小便，一定气逆欲死。前面所服的破气行血、和肝补肺、运脾纳肾、清火安神等各种方法都用上了，如水投石，毫无反应。王孟英仿照喻嘉言治疗厥巅疾的方法用药，一剂见效，十几天痊愈。（喻嘉言治疗厥巅疾原本依据《内经》铁落镇坠的意义，用赭石、胆草、芦荟、黄连之类，降其上逆之气；用蜀漆、丹皮、赤芍之类，行其上脘之血；用牡蛎、龙骨、五味子之类，敛其浮游之神。最关键的是每剂药中生入猪胆汁二枚，因为少阳热炽，胆汁必干。连续进服十数剂，热退身凉，饮食增加，便泻自止。只有行动觉得身体像叶子一样轻飘，不能久支，恐怕药太苦，不宜多服。去掉猪胆及芦龙等，加入当归一钱，人参三分，姜枣为引，平调数日全愈。那个病例因为雷震火药局，惊则伤肝，胆为肝腑，医法脏病治腑。唯独这个案件没有那个案件暴怒经停两个原因，所以这个案件只说仿照喻嘉言治疗巅疾的方法用药。方用醋淬赭石捣碎先煎八钱，酒炒胆草一钱，酒炒雅连六分，醋淬牡蛎捣碎先煎二两，醋淬龙骨捣碎先煎一两，五味子捣碎先煎三钱，生猪胆汁三茶匙和服，加乌梅肉捣碎先煎三钱，陈木瓜先煎三钱，旋复花绢包三钱，白茯苓三钱，制半夏米三钱，生白蒺藜去刺一钱五分。）
高若舟的庶母年过花甲，体丰善泻。张某向来用参术取效。今年秋天患白痢，张某说是寒湿滞中，仍然给予理中汤加减，病情遂日渐加重，于是怀疑高龄火衰，蒸变无权，在前药中又加入附子，白痢果然减少，但是腹胀且疼，不食不溺，哕逆发热，形势已经危殆。王孟英诊视，脉沉而滑数梗梗，说：暑热未清，莫非补药早投了吗？给予黄芩、黄连、杏仁、厚朴、神曲、白芍、滑石、川楝子、金银花、海藻、鸡内金之类。（白痢果减四句，热邪都在气分。玩味“腹胀且疼”上的“且”字，则白痢不当止可知。脉沉而滑数梗梗，则实热结遏，不能自行宣达又可知。方用姜炒枯芩一钱五分，姜炒川连八分，苦杏泥二钱，姜制根朴一钱，生神曲捣碎一钱五分，酒炒白芍一钱五分，西滑石先煎四钱，川楝核先三钱，济银花八钱，淡海藻先煎一两，炙鸡内金研碎三钱。）一剂后小便通利疼痛减轻，痢下仍然是白色。王孟英说：病机隐伏，推测识别不容易。此前的停止，不是邪气干净而止的止，而是邪气得补药而不行的止。邪气停止而不行，所以痛胀欲死。强行止住痢疾，截断疟疾，就像新产后妄图涩止恶露一样。世人只知道恶露宜通，而不知道间有不可通的；只知道疟痢当止，不知道邪未去而强止之，其害比不止更为严重。现在邪气未清涤，而以温补药壅塞其流行之道，以致邪气不能出，逆而上冲，哕不能食，这是痢证所畏惧的。我用通降凉润的药剂，搜邪扫浊，惟恐去之不速。病家不要以白痢为忧，不久痊愈。
徐有堂的妻子患痢疾，医生当作寒湿治疗，广泛服用温补药物，痢出感觉冷，于是说是沉寒，改投燥热药物。半月后发热无尿，口渴不饥，腹痛且胀，巅顶痛不眠。王孟英察脉弦细，沉取甚数，舌绛无津，肌肉尽削，是暑热胶锢，阴气受烁。给予北沙参、肉苁蓉、黄芩、石斛、川楝子、白芍、金银花、桑叶、丹皮、阿胶合白头翁汤为剂。（发热无尿四句，暑邪大伤气分之阴。弦细为阴虚，沉取甚数为温补胶锢其暑热之象。腹痛为暑热胶锢，胀及巅顶痛不眠，为肝阴受烁。肉苁蓉补肝阳，作石斛、沙参反佐，使黄芩、川楝无偏于苦寒流弊。北沙参八钱，淡苁蓉三钱，酒炒枯芩一钱五分，鲜钗石斛捣碎先煎一两，酒炒川楝核捣碎先煎三钱，整大白芍捣碎先煎八钱，济银花一两五钱，冬桑叶四钱，粉丹皮二钱，酒炒白头翁一钱。）次日各种症状都减轻，痢出反而热。王孟英说：热证误投热药，热结导致大便不行是有这种情况的，或者热势奔迫而泄泻如火的是有这种情况的。如果误服热药而痢出反冷的，殊不多见。难怪医者指为久挟之沉寒。我凭脉证参合，显为暑热。然而暑热之邪本来无形质，它成为滞下，必定挟带身体中有形的垢浊。所以治疗的方法，最忌补涩壅滞的物品。假如误用，则邪气得补而愈炽，浊被壅而愈塞，耗损真液的灌溉，阻碍正气的流行。液耗则出艰难，气阻则觉冷。大凡有形的邪气，都能阻碍气机的周流，比如痰盛于中，胸头觉冷；积滞于腑，脐下欲熨之类，都不是真冷，人不易识别。我曾治愈多人了。仍然议定育阴涤热，病果逐渐痊愈。
萧某向来患痰多，常服六君子汤。王孟英诊视，脉细数而兼弦滑，说：六君子汤极应当屏绝。病由阴亏火盛，津液受灼而成痰，须服壮水之剂，才可以杜绝将来的祸患。萧吸食鸦片，自己怀疑虚寒，不敢频繁服用滋阴药。后来患喉痛，专科治疗无效。王孟英诊视说：早听从我的策略，怎么会到这种地步呢？这是阴虚于下，阳浮于上，喉科药不可尝试。大剂育阴潜阳。（脉细数为阴分挟虚，弦滑为气分挟痰热。专科治疗无效……）
(Prior text omitted) Feeling hungry. After taking more than twenty doses of sweet, cool, and moistening medicines, the rash finally healed. This is also a rarely seen syndrome. (If the rash becomes dry and dark, it indicates that the Lung lacks body fluids, and the patient will certainly die.)
He Yongchang's wife suffered from malaria, which occurred every other day. Ten days later, the condition became critical. Wang Mengying examined her pulse, which was deep, fine, and rapid, especially in the Chi position. She had thirst, did not want to open her eyes, and experienced contraction pain in both lower back regions, as if pierced by awls. There was little chills but much fever, and palpitations with trembling hands unable to control themselves. Wang Mengying said: This is a syndrome where summer-heat pathogen invades the Foot Shaoyin Kidney Meridian. As Yu Jiayan stated, sweating, purging, and warming methods are all contraindicated. The prescription consisted of Xuan Shen (Scrophulariae Radix) 8 qian, Gui Ban (Testudinis Carapax et Plastrum) and Shi Hu (Dendrobii Caulis) decocted first for eight minutes, each 1 liang; Zhi Mu (Anemarrhenae Rhizoma) stir-fried with wine 5 qian; Sang Bai Pi (Mori Cortex) and Yin Hua (Jasmi Flos) 4 qian each; Hua Fen (Tinosporae Rhizoma) 3 qian; Dan Pi (Moutan Cortex) 2 qian. He instructed to decoct the medicine in a large clay pot and take it frequently, without limiting the dosage. After three doses, the malaria ceased, and other symptoms subsided. Porridge intake gradually increased, and she recovered without further medication. (The key to diagnosing this disease lies in the phrase "Chi position is prominent." Rapid pulse indicates Yin deficiency with heat; deep and fine pulse indicates insufficiency of the Yin aspect. Thirst results from fluid consumption. The desire not to open the eyes occurs because the eyes are the orifice of the Liver, and the Kidney is the mother of the Liver; insufficient Yin of the Liver and Kidney leads to this symptom. The waist is the region of the Kidney; Kidney deficiency causes waist pain. Little chills and much fever confirm this is Heat Malaria. The Heart belongs to Fire; when aided by Kidney Yin, Heart Yang remains tranquil. Palpitations and inability to control oneself indicate that Kidney Yin cannot ascend to nourish the Heart.)
Shen Shi, a postpartum woman, suffered from abdominal distension and diarrhea, with facial edema and foot swelling. Physicians prescribed damp-draining and warming-tonifying herbs, but there was no effect after more than a month, leading to suspicion of postpartum debility. Wang Mengying observed that her tongue color was normal, urination was unobstructed, resembling an Qi deficiency syndrome. However, her pulse was rough and choppy, lacking any weak quality. He prescribed Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma), Hua Shi (Talcum), Ze Lan (Lycopus Herba), Fu Ling (Poria), Chong Wei Zi (Leonuri Fructus), Ge Qiao (Concha Arcae), Tao Ren (Persicae Semen), Hai Zao (Sargassum), Wu Ling Zhi (Trogopterori Faeces), and Da Dou Juan (Sojae Germinatus). After several doses, she recovered. (This syndrome must be due to lochia remaining after childbirth, causing blood stasis to transform into heat. Abdominal distension is caused by stagnant blood; diarrhea is the heat pathogen seeking an exit. Facial and foot edema result from stagnant blood transforming into heat, attacking Qi and Yin upwards, causing Qi mechanism to fail in descending. Damp-draining further injures Yin, while warming-tonifying further aids heat. Normal tongue color and clear urination are clear evidence that the pathology is in the Blood level, not the Qi level. Stagnant blood obstructs Qi movement, resulting in a rough and choppy pulse. Since blood stasis is an excess pathogen, the pulse lacks weakness. Zhi Dan Shen 4 qian, Xi Hua Shi decocted first 5 qian, Ze Lan Ye 3 qian, Bai Fu Ling 3 qian, Chong Wei Zi crushed and decocted first 5 qian, Sheng Ge Qiao crushed and decocted first 1 liang, Sheng Tao Ren ground 3 qian, Dan Hai Sao decocted first 1 liang, Wu Ling Zhi 2 qian, Da Dou Juan added later 3 qian.)
Sun suffered from an external contraction. The physician administered warming-dispersing herbs, but no sweat was produced. By the eleventh day, when Wang Mengying examined him, he was already comatose with retracted genitals, flushed face, crimson tongue, unable to recognize people, mute, with slight macules on the chest and diaphragm, diarrhea, and no urination for three days. The physician proposed warming-tonification. Wang Mengying urgently stopped him, saying: The patient has inherent Yin deficiency, and the warming-dispersing method has depleted fluids, causing the evil heat to become more intense, blocking Ying and Wei circulation. How can one recklessly speak of leakage at the bottom? Using warm-dry herbs to exhaust the nearly extinct Yin? Pu Shanglin said: Diarrhea is the outlet for heat pathogen; it is hard to obtain, so how can it be stopped? The prescription included Xi Yang Shen (Ginseng Radix Septentrionalis-Regalis), Sheng Di Huang (Rehmanniae Radix), Mai Dong (Ophiopogonis Tuber), Dan Pi (Moutan Cortex), Lian Qiao (Forsythiae Fructus), Sheng Shao Yao (Paeoniae Radix Alba), Shi Chang Pu (Acori Tatarinowii Rhizoma), Yan Shui Chao Huang Lian (Coptidis Rhizoma stir-fried with salt water), Gan Cao Shao (Glycyrrhizae Radix et Rhizoma tip), Bai He (Lilii Bulbus), Fu Ling (Poria), Bei Mu (Fritillariae Bulbus), Yin Hua (Jasmi Flos), and Zi Wan (Asteris Radix). (The key points of this syndrome are "slight macules on chest/diaphragm" and "diarrhea." Slight macules indicate heat pathogen has not fully left the Qi level; diarrhea reduces heat pathogen by one part for every part discharged. Xi Yang Shen 3 qian, Da Sheng Di Huang 1 liang, Hua Mai Dong 5 qian, these two soaked in boiling water, strained, and taken; Fen Dan Pi 2 qian, Lian Qiao Ke 3 qian, Zheng Da Bai Shao crushed and decocted first 2 liang, Shi Chang Pu added later 1 qian, Dan Yan Shui Chao Ya Lian 2 qian, Sheng Cao Shao 3 qian, Bai He Hua 3 qian, Bai Fu Ling 3 qian, Chuan Bei Mu crushed 8 qian, Ji Yin Hua 1 liang 5 qian, Zi Wan Rong 1 qian 5 fen.) One dose produced slight whole-body sweating and fading macules; after three doses, only one cup of urine was passed, and consciousness returned; after four doses, profuse sweating occurred, body heat subsided, facial flushing disappeared, genitals relaxed, and two cups of urine were passed. The next day, Lian Qiao, Shi Chang Pu, Dan Pi, and Huang Lian were removed from the formula, and Zhi Mu, Yu Zhu, and Zhu Ye were added. The tongue began to moisten, and clarity of spirit returned. Knowing thirst and craving water, Wang Mengying ordered frequent administration of juice from Zhe Geng (Sacchari Candis Caudex) and Li (Pyrus Communis Var. Sitoniaca). Sweat flowed like rain for three days and nights before stopping. (Yin and Yang in the human body should be balanced. In this case, warming-dispersing depleted fluids, leaving residual Yin near extinction. Frequent administration of sweet-cold herbs restored Yin-Yang balance, allowing sweat resolution. Heat pathogens always resolve through sweat, and sweat resolves only after Yin recovery.) Porridge intake gradually increased, diarrhea stopped, and urination increased. Bei Mu, Yin Hua, and Zi Wan were removed from the previous formula, and Shi Hu and Long Yan Rou (Longan Arillus) were added. Full recovery ensued. (Chai Shi Hu crushed and decocted first 1 liang, Jing Gui Yuan Rou 3 qian.)
Wang Zi Yu was critically ill. Wang Mengying examined him and said: This is a Yin-deficient constitution with summer-heat pathogen adhering and binding. It is likely due to erroneous administration of tonifying medicines. Inquiry revealed that the physician had administered Shu Di Huang (Rehmanniae Radix Praeparata) for over ten doses. Wang Mengying said: For summer-heat syndromes, one must wait until the pathogen enters the Blood level before considering the use of Sheng Di Huang. Why use Shu Di Huang at the onset? Do you only know about constitutional deficiency and ignore the exogenous disease? Ancient sages treated summer-heat by warning against dispersing and warming-tonifying methods. Today's physicians violate even these rules by committing the sin of cloying-nourishing. The next day, he indeed died.
Wu Xin Shan's son had a constitutionally weak and timid nature, receiving frequent tonics. The physician failed to observe that he suffered from febrile heat disease. Everyone assumed Yin deficiency and competitively administered cloying and stagnating Yuan-nourishing agents. His tongue was black and curled short, lips scorched, and urine red. Wang Mengying diagnosed it after one examination and declared it incurable.
Wang Zuo Quan suffered from dysentery (Zhi Xia), defecating dozens of times day and night. Wang Mengying felt his pulse as wiry and slippery, with yellow coating covering the tongue. He said: This is easy to treat. Heavy doses of Huang Qin (Scutellariae Radix) and Huang Lian (Coptidis Rhizoma), assisted by Zha (Crataegi Fructus) and Po (Magnoliae Officinalis Cortex). Administered with Qing Lin Wan 4 qian. Recovery followed immediately. (For this syndrome, the wiry-slippery pulse must be forceful upon heavy pressure to justify large doses of bitter-cold herbs. Jiang Chao Ku Qin 4 qian, Jiang Chao Chuan Lian 2 qian, Jiang Zhi Gen Po 1 qian, Jiao Zha Rou crushed 2 qian, medicine delivered with Qing Lin Wan 4 qian.)
Chen Zhou San suffered from dysentery. Someone applied the "treat obstruction with unblocking" method, resulting in uncontrollable painful diarrhea, vomiting, inability to eat, sweating, faint breath, weak pulse, and dizziness. Wang Mengying said: Recently, many cases are dysentery caused by latent summer-heat, but this is not such a case. The primal Qi is about to collapse. Urgently administer large doses of warming-tonifying herbs. The pulse condition gradually stabilized, and full recovery took a month. (Identifying Yang deficiency here relies on faint breath and weak pulse. Chao Xi Yang Shen 5 qian, Chao Lu Dang Shen 5 qian, Chao Bai Zhu 3 qian, Zhi Ban Xia 4 qian, Chao Jiao Chen Pi 1 qian 5 fen, Chao Gan Jiang 5 qian, Chao Nong Fu Pian crushed 3 qian, Wu Wei Zi ground 3 qian, Chen Mu Gua 3 qian, Zi Shi Ying 5 qian, Chu Tan Xian Wei decocted for 8 minutes.)
Jin Lang Ran's mother occasionally suffered from epigastric pain and vomiting. The physician gave warming-tonifying herbs. Initially, she seemed stable, but gradually developed aversion to cold, insomnia, and numbness in the four limbs. Another physician diagnosed Wind-Bi and continued with warming-tonification. Consequently, she lost appetite, could not eat, and had no bowel or bladder movements. Her muscles wasted away, and leukorrhea resembled urine. Wang Mengying diagnosed: Summer-heat is latent in the Lung and Stomach. The reason multiple administrations of warming-tonification did not cause immediate change is that Yin-soft, cloying, and stagnating herbs like Shu Di Huang acted as constraints. However, Jin fluids and Qi were scorched to exhaustion, lipids rushed and moved recklessly, regulation power was lost, and the Yangming channel dried up. Prescribed Bai Hu Tang (White Tiger Decoction) plus Xi Yang Shen (Ginseng Radix Septentrionalis-Regalis), Zhu Ru (Bambusae Folium), Ju Pi (Citri Reticulatae Pericarpium), Si Gua Luo (Luffae Fructus Retinervia), Shi Hu (Dendrobii Caulis), Hua Fen (Tinosporae Rhizoma), Zhu Li (Bambusae Sap), and Hai Zao (Sargassum). (Epigastric pain and vomiting originally stem from Yin deficiency with Liver Yang invading the Stomach. Successive warming-tonification further aided Liver Yang in scorching Lung and Stomach Yin fluids. The six phrases describing the illness indicate heat pathogen is in the Upper Jiao Qi level. Sheng Shi Xian Jian 8 qian, Jiang Chao Zhi Mu 4 qian, Xi Yang Shen 3 qian, Jiang Zhu Ru 4 qian, Lai Ju Hong 1 qian 5 fen, Si Gua Luo 3 qian, Chai Shi Hu crushed and decocted first 1 liang, Nan Hua Fen 4 qian, Jiang Zhu Li mixed in two large wine cups, Dan Hai Zao decocted first 2 liang.) After continuous administration of twenty doses, black stool was passed, and various symptoms gradually settled. Subsequently, harmonizing Liver-Stomach and regulating the Eight Extraordinary Vessels formulas were used for convalescence, leading to complete recovery.
Li Mou had a history of epigastric pain, often cured by Wang Mengying using Jian Zhong Tang (Middle-Building Decoction). This autumn, the illness recurred. A physician, knowing Jian Zhong Tang was effective, used Hu Lu Ba (Trigonellae Semen) for warming-tonification. After ingestion, ears closed, legs hurt, loss of appetite, and constipation occurred. Wang Mengying examined and said: Latent summer-heat pathogen, caused by erroneous tonic administration. Treatment should involve clearing and washing. The patient suspected wind pathogen and mistakenly underwent surgical cauterization, resulting in tendons unable to extend, forming a stubborn disease. The *Neijing* mentions moxibustion/warming therapy for treating diseases, but it applies only to cold-damp stagnation, not to Yin-deficient constitutions or heat-clasping syndromes. Have you not heard Zhang Zhongjing's warning about burning bones?
Qiao You Nan's nephew, just five years old, had fever for several days. The pediatrician gave Chai Ge Jie Ji Tang (Bupleurum and Pueraria Decoction to Release the Muscles) for one dose. Limbs twitched, cold extremities, eyes open but mute. Wang Mengying diagnosed: The disease is summer-heat pathogen, but wind herbs were used. Heat flares with wind; fluids boil with wind. Thus, wind herbs induced Liver Wind. Prescribed Wang Shi Xi Jiao Di Huang Tang (Wang's Rhinoceros Horn and Rehmannia Decoction) plus Ling Jiao (Saigae Tataricae Cornu), Sheng Shi Gao (Gypsum Fibrosum), Yuan Shen (Scrophulariae Radix), Sang Ye (Mori Folium), Ju Hua (Chrysanthemi Flos), Yin Hua (Jasmi Flos), Mu Li (Concha Ostreae), Zhi Mu (Anemarrhenae Rhizoma), Mai Dong (Ophiopogonis Tuber), and Zhu Ye (Phyllostachys Viridis Folium). Recovered after several doses. (Children often lack Yin. If not a cold syndrome, wind herbs are strictly contraindicated. Bang Xi Jiao ground and washed in 3 fen, Da Sheng Di Huang soaked in boiling water, strained, 4 qian, Sheng Shi Gao decocted first 6 qian, Yuan Shen Pian soaked and washed in 5 qian, Dong Sang Ye 2 qian, Hang Ju Hua 1 qian, Mu Li crushed and decocted first 2 liang, Jiu Chao Zhi Mu 1 qian 5 fen, Xian Zhu Ye 1 qian.)
Zhao Zi Shan was depressed due to affairs, experiencing chills and fever. Tang Mou treated it as Blood deficiency, administering Gui (Angelicae Sinensis Radix), Xiong (Chuanxiong Rhizoma), and Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma). Multiple doses were ineffective. Wang Mengying diagnosed: Pulse is choppy, deep, wiry, and rapid. Tongue has no coating, mouth is not thirsty, urination and defecation are normal, food intake slightly reduced. Only the left hypochondrium and lower abdomen feel blocked and uncomfortable, with no palpable mass. Rubbing provides slight relief. Wang said: Yin deficiency with constraint, latent summer-heat pathogen internally. Constraint prevents Qi mechanism from venting; latent pathogen has no way to escape. Continuous administration of blood-invigorating herbs drew the pathogen deeper. Blood occupied by pathogen ceases to flow. Hypochondriac and abdominal discomfort is the true essence. Although the disease is in the Blood level, treatment should prioritize clearing Qi. Once Qi spreads, heat signs will emerge, stasis will move, and the chronic disease will heal. Continuous administration of Qi-clearing herbs. (Formula: Jiu Chao Ku Qin 1 qian 5 fen, Jiang Chao Niu Bang Zi ground 3 qian, Jiang Zhi Pi 3 qian, Jiang Chao Pi Ye brushed and wrapped 3 qian, Jiang Chao Chuan Lian 6 fen, Jiang Zhu Ru 3 qian, Chuan Bei Mu crushed 4 qian, Ku Xing Ni added later 2 qian, Bo Ju Hong added later 1 qian 5 fen, Zi Wan Rong added later 1 qian.) Heat indeed intensified, with delirium, insomnia, dry mouth, and cough with phlegm. Wang said: Pulse has turned wiry and slippery; blood stasis and latent pathogen show signs of emerging. Next, cooling-blood and resolving-stasis treatment is needed. Thus, modified Xi Jiao Di Huang Tang was determined. (Da Sheng Di Huang soaked in boiling water, strained, 8 qian, Bang Xi Jiao ground and washed in 1 qian, Jiu Chao Chuan Lian 8 fen, Jiu Chao Chuan Huang Bo 1 qian 5 fen, Shi Chang Pu added later 1 qian, Ban Xia Qu 2 qian, Chuan Bei Mu crushed 8 qian, Sheng Dong Gua Zi 4 qian, Jiang Zhu Ru 3 qian, Si Gua Luo 3 qian, Jiang Zhi Ban Jiang Gen 8 qian, Zi Wan 1 qian, Xuan Fu Hua wrapped in silk 3 qian.) Coincidentally, the patient suffered severe epistaxis. The decoction was administered directly. The next day, bleeding recurred, and tongue coating turned black. Wang said: Three days without defecation means blood-heat has not descended. Added Hua Shi (Talcum), Tao Ren (Persicae Semen), Mu Tong (Akebiae Caulis), Hai Zao (Sargassum), Zhu Li (Bambusae Sap), Shi Hu (Dendrobii Caulis), Yin Hua (Jasmi Flos), Zhi Mu (Anemarrhenae Rhizoma), and Hua Fen (Tinosporae Rhizoma) to the previous formula. (Remove Lian, Bo, Zhu Ru, Si Gua Luo, Lu Gen from previous formula; add Xi Hua Shi decocted first 4 qian, Sheng Tao Ren ground 3 qian, Xi Mu Tong 1 qian, Dan Hai Zao decocted first 2 liang, Jiang Zhu Li mixed in two large wine cups, Chai Shi Hu crushed and decocted first 1 liang, Yin Hua 8 qian, Jiu Chao Zhi Mu 3 qian, Nan Hua Fen 4 qian.) After two more doses, defecation occurred, black as pitch. Over three days, more than seventy stools were passed before stopping. Mu Tong and Tao Ren were removed, and Xi Yang Shen (Ginseng Radix Septentrionalis-Regalis) and Mai Dong (Ophiopogonis Tuber) were added to generate fluids. (Add Xi Yang Shen 3 qian, Hua Mai Dong 5 qian.) The patient was extremely exhausted, sleeping deeply for three days and nights. People considered it critical. Wang said: Let it be. Allow Yin Qi to recover; this is a good sign. Upon waking, slight fever and delirium remained. Medication followed the previous method. Ten days later, one black, dry stool was passed, and all symptoms retreated, except for persistent thirst. Large doses of sweet-cool herbs were given to moisten. Ten days later, bowel movements resumed, and stool color normalized. Finally, Yin-nourishing and filling prescriptions led to health. (This disease must be Yang syndrome with Yang pulse, hence large doses of pungent-cold herbs were effective. If Yang syndrome with Yin pulse, Yin herbs would bitterly injure Yang, making it mostly incurable.)
The wife of a gardener was startled by thunder exploding a gunpowder store. Immediately, she felt Qi stagnation. Over half a year, appetite decreased, body emaciated, spirit fatigued, menstruation scanty. Only when lying down did the illness seem to vanish. Medications failed. Wang Mengying examined: When the patient sat up, her face instantly turned red as fire, breathing rapid and gasping, as if unable to continue. If she went to the toilet to urinate, Qi would rebel violently, almost causing death. Previous treatments included Qi-breaking, Blood-moving, Liver-harmonizing, Lung-tonifying, Spleen-moving, Kidney-grasping, Fire-clearing, and Spirit-calming methods, yet they were useless as water thrown on stone. Wang Mengying imitated Yu Jiayan's method for treating Jue and Dian diseases. One dose brought improvement; recovery in ten days. (Yu Jiayan's treatment of Jue/Dian diseases follows the *Neijing*'s principle of Iron Drop settling. Uses He Shi (Hematitum), Dan Cao (Gentianae Radix), Lu Hui (Aloe), Huang Lian (Coptidis Rhizoma) to descend rebellious Qi; uses Shu Qi (Polygala Root?), Dan Pi (Moutan Cortex), Chi Shao (Paeoniae Radix Rubra) to move Blood in upper epigastrium; uses Mu Li (Concha Ostreae), Long Gu (Fossilia Ossis Mastodi et Scapulae), Wu Wei Zi (Schisandrae Fructus) to gather floating Spirit. Crucially, adding two raw Pig Gallbladders (Zhu Dan) per dose, as Shaoyang heat blanches bile. After ten-plus doses, heat subsided, body cooled, diet improved, diarrhea stopped. Walking felt light as leaves, unable to sustain long periods, fearing herbs were too bitter. Removed Zhu Dan, Lu Long, etc., added Dang Gui (Angelicae Sinensis Radix) 1 qian, Ren Shen (Ginseng Radix) 3 fen, Ginger and Jujube as guides. Balanced for several days, fully recovered. That case involved thunder/gunpowder startling, injuring Liver; Gallbladder is Liver's partner, treating Zang via Fu. This case lacked violent anger and amenorrhea, so only imitates Yu's Dian method. Formula: Cu Zhe Shi crushed and decocted first 8 qian, Jiu Chao Dan Cao 1 qian, Jiu Chao Ya Lian 6 fen, Cu Mu Li crushed and decocted first 2 liang, Cu Long Gu crushed and decocted first 1 liang, Wu Wei Zi crushed and decocted first 3 qian, Raw Zhu Dan 3 tea spoons mixed, Wu Mei Rou crushed and decocted first 3 qian, Chen Mu Gua decocted first 3 qian, Xuan Fu Hua wrapped in silk 3 qian, Bai Fu Ling 3 qian, Zhi Ban Xia Mi 3 qian, Sheng Bai Ji Li de-spined 1 qian 5 fen.)
Gao Ruo Zhou's concubine, over sixty, was corpulent and prone to diarrhea. Zhang Mou previously used Ren Shen (Ginseng Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) successfully. This autumn, she suffered white dysentery. Zhang attributed it to Cold-Damp stagnating in the Middle, prescribing modified Li Zhong Tang (Center-Regulating Decoction). Condition worsened daily. Suspecting elderly Fire decline and lack of steaming/transformation, Fu Zi (Aconiti Lateralis Radix Praeparata) was added. White dysentery decreased, but abdominal distension and pain ensued. No eating, no urination, hiccups, fever, critical condition. Wang Mengying diagnosed: Pulse deep, slippery, rapid, and rough. Summer-heat not cleared; perhaps tonics were administered too early? Prescribed Qin (Scutellariae Radix), Lian (Coptidis Rhizoma), Xing (Armeniacae Semen Amarum), Po (Magnoliae Officinalis Cortex), Qu (Medicated Leaven), Shao (Paeoniae Radix Alba), Hua Shi (Talcum), Liu (Meliae Fructus), Yin Hua (Jasmi Flos), Hai Zao (Sargassum), Ji Jin (Galli Gigerii Endothelium Corneum). (White dysentery decreased... Heat pathogen is in Qi level. Analyzing "distension AND pain," white dysentery should not have stopped. Deep-slippery-rapid-rough pulse indicates solid-heat binding, unable to vent naturally. Formula: Jiang Chao Ku Qin 1 qian 5 fen, Jiang Chao Chuan Lian 8 fen, Ku Xing Ni 2 qian, Jiang Zhi Gen Po 1 qian, Sheng Shen Qu crushed 1 qian 5 fen, Jiu Chao Bai Shao 1 qian 5 fen, Xi Hua Shi decocted first 4 qian, Chuan Liu He decocted first 3 qian, Ji Yin Hua 8 qian, Dan Hai Zao decocted first 1 liang, Zhi Ji Jin ground 3 qian.) One dose: urination resumed, pain reduced, but stool remained white. Wang said: Disease mechanism is hidden, hard to discern. The previous cessation was not due to pathogen clearance, but pathogen being blocked by tonics. Pathogen stops moving, causing severe pain/distension. Forcing stop of dysentery or malaria is like forcibly stopping lochia postpartum. People know lochia should be unblocked, but sometimes shouldn't; know malaria/dysentery should be stopped, but forcing stop before pathogen removal is worse than not stopping. Now pathogen is not cleared, but warm-tonics block its exit, causing rebellion upward, hiccups, anorexia—feared in dysentery. I use descending, cooling, moistening herbs to search and sweep pathogen/turbidity, hoping to expel quickly. Do not worry about white dysentery; will recover soon.
Xu You Tang's wife suffered from dysentery. Physician treated as Cold-Damp, widely using warming-tonics. Dysentery felt cold, deemed deep cold, switched to drying-hot herbs. Half month later: fever, no urination, thirst, anorexia, abdominal pain/distension, vertex pain, insomnia. Wang Mengying observed: Pulse wiry-fine, deep-pressure very rapid. Crimson tongue, no fluids, muscles wasted. Summer-heat adhering and binding, Yin Qi scorched. Prescribed Bei Sha Shen (Glehniae Radix), Cong Rong (Cynomorii Fructus), Qin (Scutellariae Radix), Hu (Dendrobii Caulis), Liu (Meliae Fructus), Shao (Paeoniae Radix Alba), Yin Hua (Jasmi Flos), Sang Ye (Mori Folium), Dan Pi (Moutan Cortex), E Jiao (Colla Corii Asini) combined with Bai Tou Weng Tang (Pulsatillae Decoction). (Fever/no urination... Summer-heat severely injured Qi-level Yin. Wiry-fine indicates Yin deficiency; deep-rapid indicates heat bound by tonics. Abdominal pain from heat binding; distension/vertex pain/insomnia from Liver Yin scorching. Cong Rong tonifies Liver Yang, acting as counter-agent to Hu/Sha Shen, preventing Qin/Liu from being too bitter-cold. Bei Sha Shen 8 qian, Dan Cong Rong 3 qian, Jiu Chao Ku Qin 1 qian 5 fen, Xian Chai Shi Hu crushed and decocted first 1 liang, Jiu Chao Chuan Liu He crushed and decocted first 3 qian, Zheng Da Bai Shao crushed and decocted first 8 qian, Ji Yin Hua 1 liang 5 qian, Dong Sang Ye 4 qian, Fen Dan Pi 2 qian, Jiu Chao Bai Tou Weng 1 qian.) Next day: symptoms reduced, dysentery felt hot. Wang said: Heat syndrome mistreated with heat herbs. Heat binding causing constipation exists; heat rushing causing fiery diarrhea exists. But dysentery feeling cold after heat herbs is rare. No wonder doctors call it chronic deep cold. Based on pulse/symptoms, clearly summer-heat. Summer-heat is formless; becoming dysentery requires mixing with bodily turbid matter. Thus, treatment forbids cloying/stagnating tonics/astringents. Misuse makes pathogen fierce, turbidity blocked, consuming true fluids, blocking righteous Qi. Fluid loss makes discharge difficult; Qi blockage feels cold. Formless pathogens obstruct Qi circulation: Phlegm in middle causes chest cold; Accumulation in bowels causes umbilical warmth desire. Neither is true cold, hard to identify. I have cured many. Still propose nourishing Yin and washing heat. Illness gradually improved.
Xiao Mou historically had excessive phlegm, often taking Liu Jun Zi Tang (Six Gentlemen Decoction). Wang Mengying diagnosed: Pulse fine-rapid, wiry-slippery. Liu Jun Zi Tang must be abandoned. Disease stems from Yin deficiency and Fire excess, scorching fluids into phlegm. Must take Water-strengthening herbs to prevent future trouble. Xiao smoked opium, suspecting himself deficient-cold, dared not take Yin-nourishing herbs frequently. Later suffered sore throat; specialist treatment failed. Wang said: If you had followed my advice, how would it come to this? Yin deficient below, Yang floating above. Throat specialists' drugs are inadvisable. Large doses of Yin-nourishing and Yang-subduing herbs. (Fine-rapid pulse indicates Yin deficiency with deficiency; wiry-slippery indicates Qi level with phlegm-heat. Specialist treatment failed...)