典藏书目

The recording of medical cases in medicine originated with Cang Gong (Chunyu Yi) of the Han Dynasty. Those who followed Cang Gong in writing medical cases have appeared in every generation. Among them, Xue Ji (styled Lizhai) and Yu Chang (styled Jiayan) of the Ming Dynasty are particularly renowned. I feel ashamed of my limited knowledge; how dare I follow in the footsteps of these sages? Nevertheless, as Zhuangzi said, the wheelwright Bian’s carving of wheels illustrates that skill lies in mental comprehension and manual response. I merely record those treatments where my mind and hand were in harmony. Moreover, medicine as an art: disregarding the ancients leads to laxity, while being bound by them leads to rigidity. Since I began practicing medicine, I have taken the ancients as my teachers, yet occasionally introduced new ideas to supplement what ancient methods failed to cover. Although I cannot claim perfect accuracy every time, my cautious and rigorous attitude is something I can confidently assert. Therefore, whenever a treatment proves effective, I often record it for preservation, to verify the depth of my learning. Mr. Bao Juesheng, a Grand Historian, praised these records and advised me to have them printed. I hesitated for a long time; until now, the number of recorded cases has increased daily. My friend Mr. Jiang Jinthree urged publication again. Presuming upon my own inadequacy, I finally yielded to his request. Thus, I briefly record a few cases where my conviction matched clinical success, and earnestly request guidance from learned gentlemen everywhere.

Preface by Cheng Wenyu on the 16th day of the 12th lunar month in the year of Gefeng Kundun (Qianlong 50, 1785).

Zhu Danxi stated: "Postpartum conditions should primarily be treated with substantial tonification of Qi and Blood, while other syndromes are addressed secondarily." This statement is indeed sound, yet circumstances sometimes defy rigid adherence. In mid-summer of the Yisi year of Qianlong (Qianlong 60, 1795), the wife of Old Man Xu Jingting from Yanzhen fell ill, and I was summoned to diagnose her. According to the account: Twelve days postpartum, she initially presented with alternating chills and fever. The physician administered warm-releasing herbs without effect, then switched to warm-tonifying herbs. The condition worsened, with persistent fever, thirst, irritability, chest stuffiness, and constipation. It was the humid heat of summer, and the patient resided upstairs with doors and windows closed. Her pulse was wiry and rapid; her tongue coating was yellow. I told Mr. Xu: "Madam’s condition results from pathogenic invasion postpartum. The physicians’ indulgent approach prevented the pathogen from exiting, leading to stagnation and heat transformation. Today, I intended to use heavy-dose clearing and resolving formulas, but fearing your doubt or fear, I will first try one dose of Chaihu Yin (Bupleurum Decoction). Given the severity of the illness and lightness of the medication, efficacy is unlikely. We will reassess tomorrow morning." I also instructed moving her bed downstairs to avoid the stifling heat. The next morning, her pulse and symptoms remained unchanged, but her tongue coating had turned black. The crowd suspected a Cold syndrome. I said: "Incorrect. Both Yin and Yang syndromes can present with a black tongue coating. In Yang syndromes, the black coating is moist and slippery, appearing early, indicating Kidney Water overwhelming the Heart. In Yin syndromes, the black coating is dry and scorched, appearing only after prolonged heat, akin to wood turning into charcoal. The previous prescriptions were too weak to handle this case. I propose using Baihu Tang (White Tiger Decoction) added with Huangqin (Scutellariae Radix) and Lianhua (Coptidis Rhizoma)." After one hour of drinking the medicine, family members reported: "Her fever subsided, and her hands and feet became slightly cold." Shortly after: "Her entire body feels very cold." Mr. Xu was alarmed, suspecting a Yin syndrome and fearing that taking such cold medicines would be fatal. I said: "Do not worry. If it were truly a Yin syndrome, the previously administered warm tonics should have worked. Otherwise, she would have died when taking Chaihu Yin yesterday. How could she survive until now? This is what Zhang Zhongjing referred to as 'the deeper the heat, the deeper the cold extremities' (Re Shen Jue Ye Shen). Let us wait and see." By dusk, her cold extremities returned to normal, and her fever recurred. She felt irritable, thirsty, and desired cold water. I ordered a bowl of well water, which she drank with relief. I said: "Stirring the soup to stop boiling is inferior to removing firewood from under the pot. Let us use Yuzhu San (Jade Candle Powder) to purge and unblock bowels." The first dose produced no bowel movement. After the second dose, five or six pieces of black stool were passed, and the feverish sensation slightly alleviated. I then prescribed Yuni Jian (Jade Woman Decoction) for several doses. All symptoms resolved, and she recovered after one month of recuperation. The crowd worried that excessive consumption of cold-natured medicines postpartum might impair her fertility. I said: "No harm will come. The Classic states 'If there is a cause/pathogen, there is no destruction' (You Gu Wu Yun). Twenty years later, she has borne several children. In the Renxu year, our families arranged a marriage alliance between our children." My practice of discussing medicine in Yanzhen began with Mr. Xu Jingting.