刘少君年近三旬,春间由都来徽,抱疾数月,食减形倦,心悸少寐,浮火上升,间或见
血。
医云∶肝肺火盛。药投清降,屡治不效。金文舫中翰荐延予诊,谓曰∶病由先天不足,心脾
内亏所致。丹溪云∶虚火可补,实火可泻。虚以实治,宜乎无功。拟黑归脾汤合生脉散,数
服稍应。复诊令照原方再进,诸恙渐平,接服丸药。次春北上,秋归晤之,状貌丰腴,前病
如失。
鲍宫詹未第时,游昆陵幕,抱 半载,百治不痊,因买舟回里,延予治之。望色,颊赤
面青
,诊脉虚弦细急。自述数月来通宵不寐,闻声即惊,畏见亲朋,胸膈嘈痛,食粥一盂,且呕
其半,粪如羊矢,色绿而坚,平时作文颇敏,今则只字难书,得无已成隔证耶。予曰∶君质
本弱,兼多抑郁,心脾受伤,脾不能为胃行其津液,故食阻。二肠无所禀受,故便干。若在
高年,即虑成隔,今方少壮,犹可无虞。方仿逍遥、归脾出入,服至数十剂,病尚未减,众
忧之。予曰∶内伤日久,原无速效,况病关情志,当内观静养,未可徒恃药力,续得弄璋之
喜,予曰∶喜能胜忧,病可却矣。半月后果渐瘥,仍劝往僧斋静养,共服煎药百剂,丸药数
斤乃瘳。因更号觉生,盖幸其殆而复生也。
洪楚峰孝廉病,遣使延诊。问其使曰∶何候?曰∶中风。问年几何。曰∶耋矣。予曰∶
殆证
也。辞不往,使者强之。将及门,闻邻人语云∶病将就木,医来何为。若能起之,其卢扁乎
。入视,身僵若尸,神昏不语,目阖口张,声鼾痰鸣,遗尿手撒,切脉虚大,歇至。予曰∶
此中脏也。高年脏真已亏,况见五绝之候,不可为矣。其弟曰∶固知病不可为,然尚有一息
之存,安忍坐视,求惠一七,姑冀万一。勉处地黄饮子合大补元煎,以为聊尽人事而已,讵
意服药后,痰平鼾定,目开能言,再剂神清食进,复诊更加河车鹿茸,脉证大转。续订丸方
付之,半载后因视他病,过其家,见翁矍铄如常矣。
刘少君年纪接近三十岁,春季从京城来到徽州,患病数月,食欲减退,身体疲倦,心悸且睡眠少,虚火上炎,偶尔出现咳血。
医生说是肝肺火盛,用药以清降为主,多次治疗无效。金文舫中翰推荐我诊治,我说:这病是由于先天不足,心脾内部亏损所致。朱丹溪说:虚火可以用补法,实火可以用泻法。用治实证的方法去治虚证,当然不会见效。我拟定黑归脾汤合生脉散,服用几剂后稍有好转。复诊时让他照原方继续服用,各种症状逐渐平息,接着服用丸药调理。次年春天北上,秋天回来见面时,他体态丰满,之前的病好像完全消失了。
鲍宫詹在未考中功名之前,在昆陵做幕僚,患噎隔病半年,多种治疗都不痊愈,于是买船回乡,请我诊治。望面色,两颊红而面部青,诊脉象虚弦细急。他自述几个月来整夜不睡觉,听到声音就惊恐,害怕见亲朋好友,胸膈部嘈杂疼痛,喝一碗粥,还要呕吐出一半,大便像羊屎一样,颜色绿而且坚硬,平时写文章很敏捷,现在却连一个字都写不出,难道已经成了噎隔重症了吗?我说:你体质本来虚弱,加上多抑郁,心脾受伤,脾不能为胃输送津液,所以食物阻滞。大小肠得不到滋养,所以大便干燥。如果在高龄老人身上,就会担心成为噎隔重症,现在你还年轻力壮,还可以不用担心。处方仿照逍遥散、归脾汤加减,服了几十剂,病情还没有减轻,众人担忧。我说:内伤日久,本来就没有速效,何况病情与情志有关,应当内观静养,不能单纯依赖药力,后来(他)又得了生子的喜事,我说:喜悦可以战胜忧愁,病就可以好了。半个月后果然逐渐好转,仍劝他去僧舍静养,共服煎药一百剂,丸药几斤才痊愈。因此改名叫觉生,庆幸自己差点死掉又活过来。
洪楚峰孝廉生病,派人来请我诊治。我问他的使者:什么症状?回答说:中风。问年龄多少。回答说:八十多岁了。我说:这是危重证候。推辞不去,使者强迫我去。快到门口时,听到邻居议论说:病人快要死了,医生来干什么。如果能治好他,难道是卢医扁鹊再世吗?进去诊视,身体僵硬像尸体,神志昏迷不说话,眼睛闭着嘴巴张开,打鼾痰鸣,遗尿手撒开,切脉虚大,时有间歇。我说:这是中脏证。高龄者脏腑真气已经亏损,况且见到五绝的征候,无法救治了。他的弟弟说:确实知道病无法治愈,然而还有一口气存在,怎么忍心坐视不管,请求给开一星期的药,姑且希望有万分之一的可能。勉强开了地黄饮子合大补元煎,认为只是尽力而为罢了,没想到服药后,痰平鼾声停止,眼睛睁开能说话,再服两剂神志清醒饮食增加,复诊时更加入紫河车鹿茸,脉象和症状大大好转。随后订制药丸方给他,半年后因看其他病,经过他家,看见老人精神矍铄如常。
Liu Shaojun was nearly thirty years old. In spring, he came from the capital to Huizhou, suffering from an illness for several months. He had reduced appetite and physical fatigue, palpitations with insomnia, rising deficiency fire, and occasional hemoptysis (coughing up blood).
The physician diagnosed it as excessive fire in the liver and lungs, prescribing clearing and descending remedies, but repeated treatments were ineffective. Jin Wenfang Zhonghan recommended me for consultation. I stated: This disease is caused by congenital insufficiency and internal deficiency of the heart and spleen. Zhu Danxi said: Deficiency fire can be treated by tonification, while excess fire can be treated by purgation. Treating a deficiency pattern with methods for excess patterns explains why there was no effect. I prescribed Hei Guipi Tang (Black Spleen-Empowering Decoction) combined with Shengmai San (Generate the Pulse Powder). After a few doses, there was slight improvement. At the follow-up visit, I instructed him to continue with the original prescription. All symptoms gradually subsided, and he subsequently took pill medicines for maintenance. The following spring, when he went north, and we met again in autumn, his appearance was robust and plump, and the previous illness seemed completely gone.
Gongzhan Bao, before passing the imperial examinations, worked as a幕僚 (staff member) in Kunling. He suffered from Yige (dysphagia/obstruction) for half a year, and various treatments failed to cure him. Consequently, he bought a boat to return to his hometown and invited me to treat him. Upon inspection, his cheeks were red and his face blue; his pulse was deficient, wiry, fine, and rapid. He reported that for several months he had been unable to sleep all night, startedle easily at sounds, feared seeing relatives and friends, experienced burning pain in the chest and diaphragm, vomited half of a bowl of porridge after eating, and passed stool resembling sheep dung—green, hard, and dry. Previously, he was quite agile in writing essays, but now he could hardly write a single word. He asked if this had already become severe obstruction (Gezheng). I said: Your constitution is inherently weak, compounded by frequent depression, injuring the heart and spleen. The spleen fails to transport fluids for the stomach, causing food obstruction. The intestines lack nourishment, resulting in dry stool. If this occurred in an elderly person, one would fear it becoming severe Gezheng, but since you are young and vigorous, there is little cause for alarm. The formula was modeled on Xiaoyao San (Free and Easy Wanderer Powder) and Guipi Tang (Spleen-Empowering Decoction), with modifications. After dozens of doses, the condition had not diminished, causing concern among others. I said: Chronic internal injury naturally lacks rapid effects. Moreover, since the disease involves emotional factors, internal observation and quiet rest are necessary; one cannot rely solely on medicinal power. Later, he experienced the joy of having a son. I said: Joy can overcome sorrow, and the illness will recede. Half a month later, he indeed gradually improved. I advised him to stay quietly in a monastery for recuperation. He took 100 doses of decoctions and several jin of pills before recovering. Thereafter, he changed his name to Juesheng, expressing gratitude for having survived near-death.
Xiaolian Hong Chufeng fell ill and sent an envoy to invite me. I asked the envoy: What are the symptoms? He replied: Stroke. I asked: How old is he? He answered: Over eighty years old. I said: This is a critical syndrome. I declined to go, but the envoy insisted. As I approached the gate, I heard neighbors saying: The patient is about to die; what is the doctor coming for? If he can revive him, he must be Lu Yuan (Lu Qian and Bian Que). Upon entering, I examined the patient: his body was stiff like a corpse, consciousness was clouded and he did not speak, eyes were closed and mouth open, snoring with phlegm rales, urinary incontinence, and hand relaxation. His pulse was deficient and large, with intermittent pauses. I said: This is Zhongzang (Stroke affecting the zang organs). In an elderly person, the true qi of the zang organs is already depleted. Furthermore, the signs of the Five Extinctions are present; it is untreatable. His younger brother said: We know the illness is incurable, yet there is still a breath remaining. How can we bear to sit idly by? Please prescribe medicine for one week, hoping for even a one-in-ten-thousand chance. Reluctantly, I prescribed Dihuang Yinzi (Rehmannia Decoction) combined with Dabu Yuanyuan Jian (Great Tonification of the Primal Source Decoction), merely to do my duty. Unexpectedly, after taking the medicine, the phlegm settled, snoring stopped, eyes opened, and he could speak. After two more doses, his spirit cleared, and appetite returned. At the follow-up, I added Heche (Placenta Hominis) and Lurong (Deer Antler Velvet). The pulse and symptoms improved significantly. Subsequently, I prepared a pill formula for him. Half a year later, while attending to another case nearby, I visited his home and saw the old man vigorous and healthy as usual.