王某木工也,向患胃痛,诸治不效,一医以草药与服,陡然便血半桶,时时晕去,闭目
懒言
,汗淋气怯,诊脉全无。按脉乃血派,此必血脱之故。然血脱益气,须用人参,彼木工,焉
能得此。辞不与治,料其旦晚必脱也。越月遇诸途,见其行动如常,心窃讶之。后因他病来
视,问其前恙如何得愈。曰∶先生言我病危非参莫救,求医无益,只得日煎党参汤饮之,侥
幸得活。予曰∶此亦血脱益气法也。再诊两手仍然无脉,思人久无脉,焉能得生,沉吟半响
,恍然悟曰,此必反关脉也,覆候之果然。
渠乃匠人,脉之如何,原不自知,予前诊时,因见其外证之危,仓卒未及细究,识此,告诸
诊家,务须留神详察也。
老医方星岩曾向予言∶昔从上海王协中先生游,论及血证愈后,每多反复者,此由胃膜
破伤
,须用法补之。思之至再,订方用白芨鱼膘丝绵三味,烧灰等分为丸,服之永不复发。王某
患此证,莫能除根,令服此丸,果验。
族子年方舞勺,初时小便欠利,不以为意,后每溺,茎中涩痛,医作淋治,溺更点滴不
通,
少腹胀硬,卧床号叫,昼夜靡安。延予至家,其母手拈一物,与予视之。云病者连日小便全
无,昨夕努挣多时,突然溺出此物,当觉通快,喜为疾却,今又复闭,岂尿管内尚有此物塞
住耶?予视其形如豆,色苍而坚,置臼中捣之不碎。考方书虽有石淋一证,即予平素目睹患
此者,亦不过如盐沙之细,今此石形大如豆,从未之见,初以为妄,试取簪柄探入茎中拨之
,然有声,方信溺之不通,竟由于此。思将此石取出,特古无是法,不敢妄出意见,辞不
与治。闻后石不得出,茎根烂开一孔,溲又彼泄,迁延而殁。越数年道出庐江,遇吕墨从先
生言,彼邑昔有徐姓老医,能治此证。亲见其治愈数人。其术用刀将阴茎剖开,取出石子,
敷以末药,旬日即愈。予心异之,欲求其方。其人已物故矣。因并志之,倘后有患此者,须
求巧手剖之可也。
王某是一名木工,向来患有胃痛,经过多种治疗均无效。一位医生给他服用草药,结果突然便血半桶,时常晕厥,闭目懒言,汗出淋漓且气息虚弱,诊脉时完全摸不到脉搏。我按察脉象发现这是“血派”(指血脉枯竭、无脉可寻的危重状态),这一定是因为大量失血导致的。然而,“血脱益气”的治疗原则虽然需要用人参,但这位木工身份贫寒,哪里能得到人参呢?于是我便推辞不给他治病,料定他早晚必因气随血脱而亡。过了一个月在路上遇到他,见他的行动如常,心里暗自惊讶。后来他因其他疾病来就诊,我问起之前的病是如何痊愈的。他说:“先生说我病危,非人参不能救,求医也无益,只得每天煎党参汤喝,侥幸得以存活。”我说:“这也是‘血脱益气’的方法。”再次诊察,两手仍然没有脉搏。我想人长久没有脉搏,怎么能生存呢?沉思半晌,恍然大悟道:“这一定是‘反关脉’(一种桡动脉解剖位置异常,脉动出现在腕背侧而非寸口)。”翻转手腕重新候脉,果然如此。
他是工匠,对自己的脉象如何本来并不知情,我之前诊察时,因为见他外在症状危急,仓促之间来不及仔细探究。记录此事,是告诫各位诊脉的医生,务必留心详细考察。
老医生方星岩曾对我说:“以前我跟从上海的王协中先生游学,谈到血证(出血性疾病)痊愈后,往往容易复发,这是因为胃膜破损受伤,必须用药物修补。”我反复思考,拟定方剂使用白芨、鱼鳔胶、丝绵三味药,烧成灰后等分制成丸药,服用后永不复发。王某患的这个病,没能除根,让他服用这个丸药,果然有效。
族中的侄子年仅十三岁左右(舞勺之年),起初小便不太通畅,没在意,后来每次排尿,尿道涩痛,医生当作淋证治疗,导致小便更加点滴不通,小腹胀硬,卧床号叫,昼夜不得安宁。请我到家里诊治,他的母亲手里拿着一物给我看,说病人连日小便全无,昨晚用力挣扎许久,突然排出此物,当时觉得通畅舒服,高兴以为病愈,现在又闭塞了,难道尿管内还有此物堵塞吗?我看那东西形状像豆子,颜色青苍且坚硬,放在石臼中捣也不碎。查阅医书虽有“石淋”这一病症,即使是我平时亲眼目睹患此病的人,也不过像盐沙那样细小,如今这石头大如豆粒,从未见过。起初以为是妄言,试着取发簪柄探入尿道拨弄,听到有声响,才相信小便不通竟是由于这个原因。想把这个石头取出来,但古代没有这种方法,不敢妄出意见,推辞不予治疗。听说后来石头排不出来,阴茎根部溃烂开一个孔,尿液从此旁流,拖延一段时间后死亡。过了几年路过庐江,遇到吕墨从先生谈论,说他家乡过去有一位姓徐的老医生,能治这种病。亲眼见证治愈了几个人。其方法是把刀切开阴茎,取出石子,敷上粉末状药物,十天就能痊愈。我心里对此感到惊奇,想要寻求那个方子。那人已经去世了。因此一并记录下来,如果以后有患此病的人,必须寻找手法灵巧的医生进行剖取才行。
Wang was a carpenter who had long suffered from stomach pain. Various treatments proved ineffective. A physician administered herbal medicine, after which Wang suddenly experienced hematochezia (bleeding from the rectum) of half a bucket's volume. He frequently fainted, kept his eyes closed, and spoke with reluctance. His sweat poured profusely, his qi was weak, and his pulse was imperceptible upon palpation. Upon examining the pulse, I identified it as "Xue Mai" (a critical state indicating exhaustion of blood vessels where no pulse can be felt), which must be due to massive blood loss. However, although the principle of "Tonifying Qi in cases of Blood Depletion" requires the use of Ginseng (Renshen), this carpenter, being poor, could not possibly obtain such expensive herbs. Therefore, I declined to treat him, predicting that he would inevitably perish from Qi collapse following blood loss within a day or two. A month later, I met him on the road and saw that his movements were normal, which surprised me secretly. Later, he came to see me for another ailment. I asked how his previous illness had been cured. He replied, "You said my condition was critical and could only be saved by Ginseng. Seeking medical help seemed futile, so I had to decoct Codonopsis Pilosula Tang (Dangshen Decoction) daily. Fortunately, I survived." I said, "This is also an application of the 'Tonifying Qi in cases of Blood Depletion' method." Upon re-examination, both wrists still showed no pulse. I thought, how can a person survive without a pulse for so long? After pondering for a while, I suddenly realized, "This must be 'Fan Guan Mai' (an anatomical variation where the radial artery runs dorsally around the wrist rather than at the standard cun-kou position)." I turned his wrist over to palpate again, and indeed, it was so.
As a craftsman, he was unaware of his own pulse characteristics. When I examined him previously, seeing his severe external symptoms, I acted hastily and did not investigate thoroughly. I record this to warn all physicians: you must pay close attention and examine carefully.
The old physician Fang Xingyan once told me, "When I studied under Mr. Wang Xiezhong in Shanghai, we discussed that after recovery from hemorrhagic diseases (Xue Zheng), relapses are common. This is due to damage to the gastric mucosa, which requires medicinal repair." After careful consideration, I formulated a prescription using equal parts of Bletilla Rhizome (Baiji), Fish Maw (Yubiao), and Silk Floss (Simian), burned to ash and made into pills. Taking these prevents recurrence forever. Wang suffered from this condition and failed to eradicate it completely. Having him take these pills proved effective.
My clan's nephew was just entering adolescence (age 13). Initially, his urination was slightly difficult, which he ignored. Later, every time he urinated, he experienced astringency and pain in the urethra. Physicians treated it as Lin Syndrome (strangury), but his urination became completely obstructed, dropping only drop by drop. His lower abdomen became distended and hard; he lay in bed screaming, finding no rest day or night. I was summoned to his home. His mother held up an object for me to see, saying, "The patient has had no urine output for days. Last night, after straining for a long time, he suddenly expelled this object. He felt relief and joy, thinking the disease had passed, but now the obstruction has returned. Could there still be something blocking the urethra?" I observed that the object was bean-shaped, dark greenish-gray in color, and hard. It did not break when pounded in a mortar. Although medical texts mention Stone Lin (Shi Lin), even those I have personally witnessed were merely fine like salt or sand. A stone this large, like a bean, was unprecedented. Initially suspecting exaggeration, I tried probing the urethra with the handle of a hairpin. Hearing a sound confirmed that the urinary obstruction was indeed caused by this object. I considered removing the stone, but since ancient methods did not exist for this, I dared not offer an opinion and declined treatment. It was reported that later, unable to expel the stone, the root of the penis ulcerated and opened a hole, causing urine to leak out laterally. The patient eventually died after a prolonged course. Years later, passing through Lujiang, I met Mr. Lv Mozhuang, who mentioned that in his hometown, an old surnamed Xu physician could cure this condition. He had personally witnessed several cures. The technique involved incising the penis with a knife, extracting the stone, applying powdered medicine, and achieving healing within ten days. I found this remarkable and sought the prescription, but the physician had since passed away. I record this here: if anyone suffers from this in the future, they must seek a skilled surgeon for incision and extraction.