易思兰治一妇人，患浑身倦怠，呵欠，口干饮冷，一月不食，强之食，数粒而已。有以血虚治之者，有以
气弱治之者，有知为火而不知火之原者，用药杂乱，愈治愈病。自夏至冬觉微瘥，次年夏，诸病复作甚于前，
肌消骨露。诊得三焦脉洪大侵上，脾肺二脉微沉，余皆和平，曰∶此肺火病也，以栀子汤饮之。栀子汤用山栀
仁，姜汁浸一宿，晒干炒黑，研极细末，用人参二分，麦冬一钱，乌梅二个，冲汤调栀仁末二茶匙服。进二服，
即知饥而喜食，旬月，气体充实如常。后因久病不孕，众皆以为血虚，而用参、 为君大补之剂，胸膈饱胀，
饮食顿减。至三月余，经始通，下黑秽不堪，或行或止，不得通利，治以顺气养荣汤十剂。顺气养荣汤，当归
八分，南芎六分，生地一钱二分，酒炒白芍一钱，陈皮六分，甘草五分，醋炒香附一钱，乌药五分，姜汁炒山
栀五分，苏梗五分，酒炒黄芩八分，枳壳五分，青皮五分。因大便燥结，加黄芩、枳壳煎服，一月内即有孕。
夫火与气不两立，怠倦者，火耗其精神也；呵欠者，火郁而不伸也。其夫曰∶荆人之恙，自处子时至今，二十
载矣，百治不效，君独以火治而效，何也？曰∶尊壶之脉，左三部和平无恙，惟右寸微沉，右尺洪大侵上，此
三焦之火升上而侮金也。口干饮冷者，火炽于上也；饮食不进者，火格于中也；肌消骨露者，火气消烁也。不
治其火，血气何由而平？故用黑栀去三焦屈曲之火，人参、麦冬收肺中不足之金，乌梅酸以收之，火势既降，
金体自坚矣。至经水过期而多，其色红紫，肝脉有力，乃气滞血实也。用参、 补之，则气愈滞，血愈实，安
能得孕？故以调气为主，佐以养血，气顺血行，经事根据期，而妊娠有准矣。前以降火为先，今以调气为主，治
法不同，病源则一。盖气有余即是火，其病归于气郁而已。郁气一舒，火邪自退，得其病本，斯随手取效也。
孙文垣治孙君锡，头痛胸背胀，饮食下膈即吐，（诸逆冲上，皆属于火。）咳嗽不住口，痰浊如脓，大便
燥结。脉之，右寸独洪大。（皆金受火克之候。）以二陈汤加竹茹、滑石、石膏、黄连、麦冬，连进四剂，夜
与益元散兼服，（益元能清六腑之火，然不宜于大便燥结之人。）嗽吐俱止。惟痰浊如脓色，且腥气触人，
此将作肺痈，改用丹皮、麦冬、山栀、甘草、贝母、枳壳、桑白皮、紫菀、知母、当归、生地、桔梗，四剂全愈。
易思兰治一士人，素眈诗文，夜分忘寝，劳神过度，忽身热烦渴，自汗恶寒，四肢微冷，饮食少减。初以
为外感，先发散，后和解，不应。又用补中益气汤加参二钱，逾月诸症仍前。一日午后，忽发热耳聋，不知人
事，恍惚谵语，或谓少阳症也，宜小柴胡和之。易诊之，六脉皆洪大而无力，曰∶非少阳症，乃劳神过度，虚
火症也。不信，遂以小柴胡去半夏加花粉、知母。易谓∶服此必热愈甚，当有如狂症作。已而胸如火炙刀刺，
发狂欲走，饮冷水一盏始定。复求治，以人乳并人参汤与之，当日进四服，浓睡四五时，病减半。次日又进四
服，六脉归经，沉细有力，终夜安寐，诸症悉退。或曰∶是症人谓伤寒，公作虚火，何也？曰∶伤寒自表达里，
六日传遍经络，复传至二十一日外，虽有余症，亦从杂病论，今病已二月，岂可以伤寒论乎？况少阳之脉，弦
长有力，今浮洪满指而无力，岂少阳脉乎？盖平日劳神过分，心血久亏，脾肝亦损，阳气独盛，气即火也。经
云∶壮火食气。火与元气不两立。于是水涸火胜之病作矣，伤寒云乎哉。夫小柴胡乃治少阳实症，今阴虚病而
以此泻之，则元气愈亏，阴火愈炽，故知其当发狂也。又补中益气汤，补阳者也。阴虚而补阳，阳愈盛而阴愈
虚，所以不效。今用人乳者，以真血补真水，又以人参导引，散于诸经，以济其火，与他药不同，故见效尤速也。
龚子才治管藩相夫人，每至半夜不睡，口干烦渴，吐粘痰，必欲茶水漱口，舌上赤黑皮浓，胸痞嘈杂，饮
食少思。脉之，两寸洪数，两尺空虚，右气口盛，此上盛下虚，血虚气郁而有火也。以四物汤加生地、黄连、
麦冬、知母、贝母、花粉、元参、栀子、桔梗、枳实、青皮、甘草，数剂奏功。又以六味丸加生地、麦冬、知
母、元参、花粉、贝母、五味、黄连，一料全安。
陈三农治一士人，素好滋补之剂，久之，致口舌干燥，脑后作痛，神思不爽，饮食减少，食肉则泻，六脉
实大。作实火治，以知、柏、连、栀、赤芍、甘草，一剂而胸次爽豁，痛泻俱止。再剂饮食倍加，精神顿长，
诸症悉愈。书此以为无病好补之戒。
陆养愚治董龙山外家，每小腹气上冲则热壅头面，卧不能寐，身战栗，日中发热无常，至四鼓五鼓，其热更
甚，热时腹中有块升起，经期参前，而淋漓数日，饮食过于平时，而肌肉消瘦。或作阴虚发热治之，数月不效。
脉之，数而弦，左尺为甚，曰∶此肝胆病也，胆主决断，谋虑不决，则木气郁而成火，故于少阳初动之时，其
热更甚也。因胆之气既郁而成火，则肝之血亦滞而成瘕。瘕非血不聚，非火不升，今块之上升，热之上壅，即
经所谓诸逆冲上，皆属于火也。第初病止在无形之气，但调其气而火自息。今兼在有形之血，必先去瘀，令有
形消而无形可调也。适在经行之际，乃以女金丹连服，去瘀块甚多。后以达气养荣汤，尽其旧以生其新，数剂
诸症渐愈。再用槟榔加人参，数剂而肌肉渐长矣。
张路玉治张太史虚火症，精气下脱，虚火上逆，怔忡失血。脉之，右关气口独显弦象，左尺微数，余皆微
细搏指，盖阴火内伏也。缘劳心太过，精气滑脱，加以怵惕恐惧，怔忡惊悸。医峻用人参、桂、附，初稍可，
交春复剧如前。仍用参、附导火归元，固敛精气之药转剧，（凡阴虚病，初服桂、附有小效，久服则阴竭而脱，
余目击者十人矣。）稍用心则心系牵引掣痛，痛连脊骨对心处，或时病引膺胁，或时颠顶如掀，或时臂股爪甲，
皆隐隐作痛，怔忡之状，如碓杵，如绳牵，如簸物，如绷绢，如以竹击空，控引头中，如失脑髓，梦寐不宁，
达旦倦怠，睡去便欲失精，精去则神魂飞越。观其气色鲜泽，言谈 ，总属真元下脱，虚阳上扰之候。（其人
本病三阴虚损，误以参、附热补，遂致变症峰起。）细推脉症，其初虽属阳气虚脱，（着此一语，便于此道未彻。）
而过饵辛温之剂，致阳亢而反耗真阴，当此急而转关，以救垂绝之阴，庶可挽回前过。为疏二方，煎用保元合四君，
丸用六味合生脉，（此时却用二地、二冬、沙参、杞子，少加川连、蒌仁，养阴兼解郁之法，俟元气大复，然后
议补，乃为合法。六味、生脉，留为后劲。若保元、四君，则仍鲁卫之政耳。）服及两月，诸症稍平。但倦怠力微，
因自检方书，得补中益气汤，为夏月当用之剂，于中加入桂、附二味，一啜即喉痛声喑。（用补中益气者宜着眼。）
复邀诊，见其面颜精彩，声音忽喑，莫解其故。询之，知为升、柴、桂、附，扰动虚阳所致，即以前方倍生脉服
之，半月后声音渐复，日渐向安。但衣被过暖，便咽干痰结，稍凉则背微恶寒，或热饮则大汗，时怔忡走精，此
皆宿昔过用桂、附，内伏之热所致也。适石门董某，谓其伏火未清，非芩、连不能解散。自仲春至初夏，纯服苦
寒，（亦大庸手。）初甚觉爽朗，至初夏反觉精神散乱，气不收摄。后仍用六味合生脉，经岁服之，以化桂、附
余毒云。（雄按∶此真阅历之言。三十年来，余见不知若干人矣。其奈世人之不悔悟何。）
内翰孟端士之母，虚火不时上升，自汗不止，心神恍惚，欲食不能食，欲卧不能卧，口苦，小便难，溺则
洒淅头晕。凡医每用一药，辄增一病。用白术则窒塞胀满，用橘皮则喘息怔忡，用远志则烦扰哄热，用木香则
腹热咽干，用黄 则迷闷不食，用枳壳则喘咳气乏，用门冬则小便不禁，用肉桂则颅胀咳逆，用补骨脂则后重
燥结，用知、柏则小腹枯KT ，用芩、栀则脐下引急，用香薷则耳鸣目眩，时时欲人扶掖而走，用大黄则脐下筑
筑，少腹愈觉收引，遂畏药如蝎。惟日用人参钱许，入粥饮和服，聊藉支撑。交春虚火倍剧，火气一升，则周
身大汗，神气 欲脱，惟倦极少寐，则汗不出，而神气稍宁。觉后少顷，火气复升，汗亦随至，较之盗汗迥
殊。诊之，其脉微数，而左尺与左寸倍于他部，气口按之，似有似无。此本平时思虑伤脾，脾阴受困，而厥阳
之火，尽归于心，扰其百脉致病，病名百合。此症惟仲景《金匮》言之甚详，原云诸药不能治，所以每服一药，
辄增一病，惟百合地黄汤为之专药。奈病久中气亏乏，复经药误，而成坏病，姑用生脉散加百合、茯苓、龙齿，
以安其神，稍兼茱、连以折其势，数剂少安。即令勿药，以养胃气，但令日用鲜百合煮汤服之，交秋天气下降。
火气渐伏，可保无虞。迨至仲秋，果勿药而愈。
喻嘉言治吴添官，因母久病初愈，自患腹痛，彻夜叫喊不绝，小水全无，（知为火郁之病。）以茱、连加元胡
索投之始安。又因伤食，反复病至二十余日，肌肉瘦削，眼胞下陷，适遭家难，症变壮热，目红腮肿，全似外感有
余之候。知其为激动真火上焚，令服六味加知、柏，二十余剂其火始退。后遍身疮痍黄肿，（燥火反类热。）腹中
急欲得食，不能少耐片时，镇日哭烦。（脏燥者多哭泣。）慰之曰∶旬日后腹稍充，气稍固，即不哭烦矣。服
二冬膏而全瘳。
朱丹溪治一人，小腹下常唧唧如蟹声，作阴火处治，用败龟板、（用酥炙，盐、酒炙亦得。）侧柏、（用酒九蒸
九焙。）黄柏、知母、（俱酒炒。）川芎、（酒制。）当归，（酒浸。）上各等分，酒糊丸，每服八十丸，淡盐汤送下。
陆祖愚治陈符卿夫人，素有痰火症，每遇经行，一日觉涩滞，二日即汹涌，三日大下如崩，昏晕几绝。尝
善怒，发即咽喉干燥，气出如火，痰涌胸塞，不能转舒。其平日，辛燥之品如陈、枳、前、术及芎、归之类，
稍用即晕眩气绝，不足以息，及寒凉稍过，即大便作泄。病作时，日进粥数十碗不觉饱。脉之，左三部弦细而
驶，右脉数而稍充，曰∶此血虚甚，故狂火偏旺如此，而气原非有余也。此时养血，则血一时不能充；补气，
则浮火无由熄，莫若分上下为治。入人参于滋阴药中为丸，引阳入阴，以扶生气之原，所以治其本也。再用清
凉以为煎剂，助阴抑阳，以制浮游之火，所以治其标也。煎丸间服而愈。丸方∶人参、二地、二冬、知、柏、
阿胶、杜仲。煎方∶花粉、元参、二母、芩、苓、地、芍、麦冬、甘草、灯心。随症加减，如精神困倦，略加
人参。如咽喉火盛，加黄连，或炒山栀、连翘。如有痰，或胸膈痞满，加山楂、蒌仁，去地黄、麦冬、甘草。
如清凉太过，脾气受伤，则去苦寒，加山药、木通、泽泻、炙草、人参。如遇经水将行，亦忌苦寒，惟活血补
血为主。如气滞，小腹或胀或痛，加丹皮、山楂、丹参，甚则加元胡少许。如月水去多，腰胁骨节酸痛，用生
熟地、杜仲、续断、山萸、白芍、丹参、黑荆芥、阿胶、童便。或经行不止，倍阿胶，并炒黑蒲黄。经毕仍大
补血分。此调理之梗概也。夫天地之间，阳常有余，阴常不足。人身之中，气常有余，血常不足。气有余便是
火，血不足则阴虚。三十以前，精神气血日渐旺盛，三十以后，日渐衰微。语曰∶阴阳水火，犹权衡也，一高
则一下，一盛则一衰。又曰∶火与元气不两立。故凡火盛之症，必先阴虚，而后元气亦弱也。
朱丹溪治一人，夜间发热，早晨退，五心烦热无休，六脉沉数，此郁火也。用升阳散火汤，热退。以四物
加知、柏，佐以干姜，调理而安。
东垣治一人，恶热目赤，烦渴引饮，脉七八至，按之则散，此无根之火也。用姜、附加人参，服之愈。
刘彦纯治一人，不能食而热，自汗气短。不食而热，脾阴弱也；自汗气短，肺气虚也。以甘寒之剂，补气
泻火而安。
按∶治法只从壮火食气四字得之。
薛立斋治一妇人，口苦胁胀，此肝火之症也。用小柴胡加山栀、黄连少愈。更以四君子加白芍、当归、柴
胡补脾胃而痊。
一妇人每怒，口苦发热，晡热，此肝火盛而血伤也。以小柴胡合四物汤二剂，以清火而生血，更以四物加
柴胡、白术、茯苓、丹皮，生血健脾而愈。
薛立斋治一妇人，每怒则口苦兼辣，胸痛胁胀，乳内或时如刺，此肝肺之火也。用小柴胡加山栀、青皮、
芎、归、桑皮而安。后又劳怒，口复苦，经水顿至，此血得热而妄行。用四物加炒芩、炒栀、胆草，一剂而血
止，更以加味逍遥散而愈。
张路玉治徐君玉，素禀阴虚多火，且有脾约便血症，十月间患冬温，发热咽痛。里医用麻、杏、橘、半、
枳实之属，遂喘逆倚息不得卧，声飒如哑，头面赤热，手足逆冷，右手寸关虚大微数。此热伤手太阴气分也，
易思兰治疗一位妇人，患全身倦怠，频繁打哈欠，口干想喝冷水，一个月吃不下饭，强迫进食也只能吃几粒。有人用血虚来治疗，有人用气弱来治疗，有人知道是火邪但不知道火的根源，用药杂乱无章，越治病情越重。从夏至冬感觉稍微好转，次年夏天，各种病症复发且比之前更严重，肌肉消瘦，骨骼显露。诊脉发现三焦脉洪大且向上冲逆，脾肺二脉微沉，其余脉象平和，说：这是肺火病，用栀子汤服用。栀子汤使用山栀仁，用姜汁浸泡一夜，晒干后炒黑，研成极细粉末，取人参二分，麦冬一钱，乌梅二个，冲入汤剂调服两茶匙栀仁末。服用两次后，即感到饥饿并喜欢进食，一个月左右，身体气息充实如常人。后来因久病不孕，众人都认为是血虚，而用人参、（当归等）作为君药的大补方剂，导致胸膈饱胀，饮食突然减少。到了三个多月，月经才来潮，排出黑色污秽之物，或行或止，不通畅，用顺气养荣汤治疗十剂。顺气养荣汤，包含当归八分，南芎六分，生地一钱二分，酒炒白芍一钱，陈皮六分，甘草五分，醋炒香附一钱，乌药五分，姜汁炒山栀五分，苏梗五分，酒炒黄芩八分，枳壳五分，青皮五分。因为大便燥结，加黄芩、枳壳煎服，一个月内即怀孕。
火与气不能共存，倦怠是因为火消耗了精神；打哈欠是因为火郁结而不能舒展。她的丈夫说：妻子的病，从少女到现在，已经二十年了，百治不效，唯独你用治火的方法有效，为什么呢？我说：尊夫人的脉象，左三部平和无恙，只有右寸微沉，右尺洪大且向上冲逆，这是三焦之火上升而克制肺金。口干想喝冷水，是因为火炽盛于上；饮食不进，是因为火阻隔于中；肌肉消瘦骨骼显露，是因为火热之气消烁形体。不治疗火，气血怎么能平复？所以用黑栀去除三焦屈曲之火，人参、麦冬收敛肺中不足的金气，乌梅酸味以收敛它，火势既然下降，肺金本体自然坚固了。至于月经过期且量多，颜色红紫，肝脉有力，这是气滞血实。用人参、（当归等）补益，则气更加滞涩，血更加实滞，怎么能怀孕？所以以调气为主，辅以养血，气顺血行，月经按期而至，妊娠也就有把握了。前面以降火为先，现在以调气为主，治疗方法不同，病源却是一样的。大概气有余就是火，病症归结于气郁罢了。郁结的气一旦舒展，火邪自然消退，抓住了病的根本，就能随手取得疗效。
孙文垣治疗孙君锡，头痛胸背胀满，饮食下咽即呕吐，（各种逆气冲上，都属于火。）咳嗽不止，痰浊如脓，大便燥结。诊脉，右寸独显洪大。（这都是肺金受火克制的征候。）用二陈汤加竹茹、滑石、石膏、黄连、麦冬，连续服用四剂，晚上兼服益元散，（益元散能清六腑之火，但不适合大便燥结的人。）咳嗽呕吐都停止了。只有痰浊如脓色，且有腥气触人，这即将形成肺痈，改用丹皮、麦冬、山栀、甘草、贝母、枳壳、桑白皮、紫菀、知母、当归、生地、桔梗，四剂后全愈。
易思兰治疗一位士人，素来沉迷诗文，深夜忘记睡觉，劳神过度，忽然身热烦渴，自汗恶寒，四肢微冷，饮食减少。起初以为是外感，先发散，后和解，无效。又用补中益气汤加人参二钱，过了一个月各种症状依旧。一天午后，忽然发热耳聋，不知人事，恍惚谵语，有人说这是少阳症，宜用小柴胡汤调和。易思兰诊察，六脉皆洪大而无力，说：这不是少阳症，而是劳神过度导致的虚火症。不信，于是用小柴胡去半夏加花粉、知母。易思兰说：服用这个必然热势更甚，应当出现如狂的症状。不久果然胸部如火炙刀刺，发狂欲跑，饮下一盏冷水才安定。再次求治，用人乳并人参汤给他，当天进服四次，浓睡四五个小时，病减半。第二天又进服四次，六脉归经，沉细有力，整夜安睡，各种症状全部消退。有人说：这个病症别人说是伤寒，您说是虚火，为什么呢？我说：伤寒由表传里，六天传遍经络，再传到二十一天以外，虽然有余症，也从杂病论治，现在病已两个月，怎么可以用伤寒论治呢？况且少阳之脉，弦长有力，现在浮洪满指而无力，难道是少阳脉吗？大概平日劳神过分，心血久亏，脾肝也受损，阳气独盛，气即是火。经云：壮火食气。火与元气不两立。于是水涸火胜的病就发作了，这哪里是伤寒呢。小柴胡汤是治疗少阳实症的，现在阴虚病却用它来泻，则元气更亏，阴火更炽，所以知道他会发狂。还有补中益气汤，是补阳的。阴虚而补阳，阳更盛而阴更虚，所以无效。现在用人乳，是用真血补真水，又以人参引导，散布于各经，以济助其火，与其他药不同，所以见效特别快。
龚子才治疗管藩相夫人，每到半夜不睡，口干烦渴，吐粘痰，一定要用茶水漱口，舌上有浓重的赤黑苔，胸痞嘈杂，饮食少思。诊脉，两寸洪数，两尺空虚，右气口盛，这是上盛下虚，血虚气郁而有火。用四物汤加生地、黄连、麦冬、知母、贝母、花粉、元参、栀子、桔梗、枳实、青皮、甘草，数剂奏效。又用六味丸加生地、麦冬、知母、元参、花粉、贝母、五味子、黄连，一料全安。
陈三农治疗一位士人，素来喜好滋补之剂，久而久之，导致口舌干燥，脑后作痛，神思不爽，饮食减少，吃肉则腹泻，六脉实大。按实火治疗，用知母、黄柏、黄连、山栀、赤芍、甘草，一剂后胸次爽豁，痛泻俱止。再剂饮食加倍增加，精神顿长，各种症状全部痊愈。写下此案例作为无病好补的警戒。
陆养愚治疗董龙山岳母，每当小腹气上冲则热壅头面，卧不能寐，身体战栗，日中发热无常，到四鼓五鼓，热势更甚，热时腹中有块升起，经期提前，淋漓数日，饮食过于平时，而肌肉消瘦。有人按阴虚发热治疗，数月无效。诊脉，数而弦，左尺为甚，说：这是肝胆病，胆主决断，谋虑不决，则木气郁而成火，所以在少阳初动之时，热势更甚。因为胆之气既郁而成火，则肝之血亦滞而成瘕。瘕非血不聚，非火不升，现在块的上升，热的上壅，就是经书所说的诸逆冲上，皆属于火。只是初病只在无形之气，只要调其气而火自息。现在兼在有形之血，必须先去瘀，令有形消而无形可调。适在经行之际，就用女金丹连服，去瘀块很多。后用达气养荣汤，尽去旧血以生新血，数剂各种症状逐渐痊愈。再用槟榔加人参，数剂后肌肉逐渐长起。
张路玉治疗张太史虚火症，精气下脱，虚火上逆，怔忡失血。诊脉，右关气口独显弦象，左尺微数，其余皆微细搏指，盖阴火内伏也。因为劳心太过，精气滑脱，加上怵惕恐惧，怔忡惊悸。医生峻用人参、桂枝、附子，初稍可，交春复剧如前。仍用参、附导火归元，固敛精气之药转剧，（凡阴虚病，初服桂、附有小效，久服则阴竭而脱，我亲眼目睹者十人了。）稍用心则心系牵引掣痛，痛连脊骨对心处，有时病引膺胁，有时颠顶如掀，有时臂股爪甲，皆隐隐作痛，怔忡之状，如碓杵，如绳牵，如簸物，如绷绢，如以竹击空，控引头中，如失脑髓，梦寐不宁，达旦倦怠，睡去便欲失精，精去则神魂飞越。观其气色鲜泽，言谈（清晰），总属真元下脱，虚阳上扰之候。（其人本病三阴虚损，误以参、附热补，遂致变症峰起。）细推脉症，其初虽属阳气虚脱，（着此一语，便于此道未彻。）而过饵辛温之剂，致阳亢而反耗真阴，当此急而转关，以救垂绝之阴，庶可挽回前过。为他开两个方，煎用保元合四君，丸用六味合生脉，（此时却用二地、二冬、沙参、杞子，少加川连、蒌仁，养阴兼解郁之法，俟元气大复，然后议补，乃为合法。六味、生脉，留为后劲。若保元、四君，则仍鲁卫之政耳。）服用两个月，各种症状稍平。但倦怠力微，因自检方书，得补中益气汤，为夏月当用之剂，于中加入桂、附二味，一啜即喉痛声喑。（用补中益气者宜着眼。）再次邀请诊治，见其面颜精彩，声音忽喑，莫解其故。询问得知，为升麻、柴胡、桂、附，扰动虚阳所致，即用前方倍生脉服之，半月后声音渐复，日渐向安。但衣被过暖，便咽干痰结，稍凉则背微恶寒，或热饮则大汗，时怔忡走精，此皆宿昔过用桂、附，内伏之热所致也。适石门董某，谓其伏火未清，非芩、连不能解散。自仲春至初夏，纯服苦寒，（亦大庸手。）初甚觉爽朗，至初夏反觉精神散乱，气不收摄。后仍用六味合生脉，经岁服之，以化桂、附余毒云。（雄按∶此真阅历之言。三十年来，余见不知若干人矣。其奈世人之不悔悟何。）
内翰孟端士之母，虚火不时上升，自汗不止，心神恍惚，欲食不能食，欲卧不能卧，口苦，小便难，溺则洒淅头晕。凡医每用一药，辄增一病。用白术则窒塞胀满，用橘皮则喘息怔忡，用远志则烦扰哄热，用木香则腹热咽干，用黄芪则迷闷不食，用枳壳则喘咳气乏，用门冬则小便不禁，用肉桂则颅胀咳逆，用补骨脂则后重燥结，用知母、黄柏则小腹枯KT ，用黄芩、山栀则脐下引急，用香薷则耳鸣目眩，时时欲人扶掖而走，用大黄则脐下筑筑，少腹愈觉收引，遂畏药如蝎。惟日用人参钱许，入粥饮和服，聊藉支撑。交春虚火倍剧，火气一升，则周身大汗，神气（涣散）欲脱，惟倦极少寐，则汗不出，而神气稍宁。觉后少顷，火气复升，汗亦随至，较之盗汗迥殊。诊之，其脉微数，而左尺与左寸倍于他部，气口按之，似有似无。此本平时思虑伤脾，脾阴受困，而厥阳之火，尽归于心，扰其百脉致病，病名百合。此症惟仲景《金匮》言之甚详，原云诸药不能治，所以每服一药，辄增一病，惟百合地黄汤为之专药。奈病久中气亏乏，复经药误，而成坏病，姑用生脉散加百合、茯苓、龙齿，以安其神，稍兼茱、连以折其势，数剂少安。即令勿药，以养胃气，但令日用鲜百合煮汤服之，交秋天气下降。火气渐伏，可保无虞。迨至仲秋，果勿药而愈。
喻嘉言治疗吴添官，因母亲久病初愈，自己患腹痛，彻夜叫喊不绝，小水全无，（知为火郁之病。）用茱萸、黄连加元胡索投之始安。又因伤食，反复病至二十余日，肌肉瘦削，眼胞下陷，适遭家难，症变壮热，目红腮肿，全似外感有余之候。知其为激动真火上焚，令服六味加知、柏，二十余剂其火始退。后遍身疮痍黄肿，（燥火反类热。）腹中急欲得食，不能少耐片时，镇日哭烦。（脏燥者多哭泣。）慰之曰：旬日后腹稍充，气稍固，即不哭烦矣。服二冬膏而全瘳。
朱丹溪治疗一人，小腹下常唧唧如蟹声，作阴火处治，用败龟板、（用酥炙，盐、酒炙亦得。）侧柏、（用酒九蒸九焙。）黄柏、知母、（俱酒炒。）川芎、（酒制。）当归、（酒浸。）上各等分，酒糊丸，每服八十丸，淡盐汤送下。
陆祖愚治疗陈符卿夫人，素有痰火症，每遇经行，一日觉涩滞，二日即汹涌，三日大下如崩，昏晕几绝。尝善怒，发即咽喉干燥，气出如火，痰涌胸塞，不能转舒。其平日，辛燥之品如陈、枳、前、术及芎、归之类，稍用即晕眩气绝，不足以息，及寒凉稍过，即大便作泄。病作时，日进粥数十碗不觉饱。诊脉，左三部弦细而驶，右脉数而稍充，说：这是血虚甚，故狂火偏旺如此，而气原非有余也。此时养血，则血一时不能充；补气，则浮火无由熄，莫若分上下为治。入人参于滋阴药中为丸，引阳入阴，以扶生气之原，所以治其本也。再用清凉以为煎剂，助阴抑阳，以制浮游之火，所以治其标也。煎丸间服而愈。丸方：人参、二地、二冬、知、柏、阿胶、杜仲。煎方：花粉、元参、二母、芩、苓、地、芍、麦冬、甘草、灯心。随症加减，如精神困倦，略加人参。如咽喉火盛，加黄连，或炒山栀、连翘。如有痰，或胸膈痞满，加山楂、蒌仁，去地黄、麦冬、甘草。如清凉太过，脾气受伤，则去苦寒，加山药、木通、泽泻、炙草、人参。如遇经水将行，亦忌苦寒，惟活血补血为主。如气滞，小腹或胀或痛，加丹皮、山楂、丹参，甚则加元胡少许。如月水去多，腰胁骨节酸痛，用生熟地、杜仲、续断、山萸、白芍、丹参、黑荆芥、阿胶、童便。或经行不止，倍阿胶，并炒黑蒲黄。经毕仍大补血分。此调理之梗概也。夫天地之间，阳常有余，阴常不足。人身之中，气常有余，血常不足。气有余便是火，血不足则阴虚。三十以前，精神气血日渐旺盛，三十以后，日渐衰微。语曰：阴阳水火，犹权衡也，一高则一下，一盛则一衰。又曰：火与元气不两立。故凡火盛之症，必先阴虚，而后元气亦弱也。
朱丹溪治疗一人，夜间发热，早晨退，五心烦热无休，六脉沉数，此郁火也。用升阳散火汤，热退。以四物加知、柏，佐以干姜，调理而安。
东垣治疗一人，恶热目赤，烦渴引饮，脉七八至，按之则散，此无根之火也。用姜、附加人参，服之愈。
刘彦纯治疗一人，不能食而热，自汗气短。不食而热，脾阴弱也；自汗气短，肺气虚也。以甘寒之剂，补气泻火而安。
按：治法只从壮火食气四字得之。
薛立斋治疗一妇人，口苦胁胀，此肝火之症也。用小柴胡加山栀、黄连少愈。更以四君子加白芍、当归、柴胡补脾胃而痊。
一妇人每怒，口苦发热，晡热，此肝火盛而血伤也。以小柴胡合四物汤二剂，以清火而生血，更以四物加柴胡、白术、茯苓、丹皮，生血健脾而愈。
薛立斋治疗一妇人，每怒则口苦兼辣，胸痛胁胀，乳内或时如刺，此肝肺之火也。用小柴胡加山栀、青皮、芎、归、桑皮而安。后又劳怒，口复苦，经水顿至，此血得热而妄行。用四物加炒芩、炒栀、胆草，一剂而血止，更以加味逍遥散而愈。
张路玉治疗徐君玉，素禀阴虚多火，且有脾约便血症，十月间患冬温，发热咽痛。里医用麻、杏、橘、半、枳实之属，遂喘逆倚息不得卧，声飒如哑，头面赤热，手足逆冷，右手寸关虚大微数。此热伤手太阴气分也，
Yi Silan treated a woman suffering from general fatigue, frequent yawning, dry mouth with a desire for cold drinks, anorexia for one month (where forced feeding yielded only a few bites), and worsening symptoms despite various treatments for blood deficiency or qi weakness. Her condition deteriorated to emaciation by the following summer. Pulse diagnosis revealed surging, upward-moving pulses in the Sanjiao (Triple Burner) channels, while the Spleen and Lung pulses were slightly deep; other pulses were peaceful. Yi diagnosed this as Lung Fire Disease and prescribed Zhizi Tang (Gardenia Decoction). The formula used Gardeniae Fructus (Shanzhiren) soaked in ginger juice overnight, dried, charred, and powdered, combined with Ginseng Radix et Rhizoma (Renshen) 2 fen, Ophiopogonis Radix (Maidong) 1 qian, and two Mume Fructus (Wumei). After two doses, appetite returned, and within a month, her vitality was restored. Later, due to infertility attributed to blood deficiency by others, she was given strong tonics containing Ginseng Radix et Rhizoma (Renshen), which caused chest fullness and reduced intake. Menstruation resumed after three months with dark, obstructed discharge. She was treated with Shunqi Yangrong Tang (Regulate Qi and Nourish Blood Decoction) for ten doses, followed by modifications for constipation, resulting in pregnancy within a month. Yi explained that fire and qi are mutually exclusive; fatigue results from fire consuming spirit, and yawning from fire stagnation. The husband’s pulse showed right Cun slightly deep and right Chi surging upward, indicating Sanjiao Fire insulting Metal (Lung). Dry mouth and anorexia were due to fire in the upper and middle jiao respectively. Emaciation resulted from fire consuming essence. Black Gardeniae Fructus (Hei Zhizi) clears twisted fire in the Sanjiao; Ginseng Radix et Rhizoma (Renshen) and Ophiopogonis Radix (Maidong) nourish Lung Yin; Mume Fructus (Wumei) astringes. For the subsequent menstrual irregularity and infertility, characterized by Qi stagnation and Blood excess, treatment focused on regulating Qi and nourishing Blood using Tiaojie methods, allowing conception.
Sun Wen Yuan treated Sun Junxi with headache, chest/back distension, vomiting upon swallowing, incessant cough with purulent sputum, and constipation. The Right Cun pulse was surging, indicating Metal受Fire oppression. He prescribed Erchen Tang (Two-Aged Decoction) modified with Bambusae Folium (Zhuru), Talcum (Huashi), Gypsum Fibrosum (Shigao), Coptidis Rhizoma (Huanglian), and Ophiopogonis Radix (Maidong) for four doses, plus Yiyuan San (Benefit Prime Powder) at night. Cough and vomiting ceased, but purulent, foul sputum persisted, suggesting Lung Abscess (Fei Yong). He switched to a formula containing Moutan Cortex (Danpi), Ophiopogonis Radix (Maidong), Gardeniae Fructus (Zhizi), Glycyrrhizae Radix et Rhizoma (Gancao), Fritillariae Bulbus (Beimu), Aurantii Fructus (Zhiqiao), Morus Albae Cortex (Sangbaipi), Asteris Radix et Rhizoma (Ziwan), Anemarrhenae Rhizoma (Zhimu), Angelicae Sinensis Radix (Danggui), Rehmanniae Radix (Shengdi), and Platycodonis Radix (Jiegeng), curing him in four doses.
Yi Silan also treated a scholar who, due to excessive mental labor, developed fever, thirst, spontaneous sweating, aversion to cold, and cold limbs. Initial treatments for exterior contraction and harmonizing Shaoyang failed. A tonic formula (Buzhong Yiqi Tang) with Ginseng Radix et Rhizoma (Renshen) also failed. He then developed sudden fever, deafness, confusion, and delirium. Although some suspected Shaoyang Syndrome, Yi noted surging yet powerless pulses throughout, diagnosing Deficient Fire from mental exhaustion. Disregarding this, a modified Xiaochaihu Tang (Minor Bupleurum Decoction) was given, leading to severe chest pain and mania. Yi then administered Human Milk (Renru) with Ginseng Radix et Rhizoma (Renshen) decoction. After eight doses over two days, pulses normalized, sleep improved, and symptoms resolved. Yi explained that Shaoyang pulse should be wiry and forceful; here it was floating and surging but weak. The disease stemmed from Heart Blood deficiency and Spleen/Liver damage due to overwork, leading to isolated Yang/Fire. "Strong fire consumes Qi." Xiaochaihu Tang is for Shaoyang Excess, not Yin Deficiency; Buzhong Yiqi Tonifies Yang, worsening Yin deficiency. Human Milk nourishes true Blood/Water, guided by Ginseng Radix et Rhizoma (Renshen) to distribute heat, hence its efficacy.
Gong Zicai treated Lady Guan with insomnia, dry mouth, sticky phlegm, red-black tongue coating, chest stuffiness, and poor appetite. Pulses were surging/fast at both Cun and empty at both Chi, with a strong Right Qikou, indicating Upper Excess/Lower Deficiency, Blood deficiency, Qi stagnation, and Fire. He prescribed Siwu Tang (Four Substances Decoction) modified with Rehmanniae Radix (Shengdi), Coptidis Rhizoma (Huanglian), Ophiopogonis Radix (Maidong), Anemarrhenae Rhizoma (Zhimu), Fritillariae Bulbus (Beimu), Trichosanthis Radix (Gualougen), Scrophulariae Radix (Xuanshen), Gardeniae Fructus (Zhizi), Platycodonis Radix (Jiegeng), Zingiberis Rhizoma Recens (Shengjiang - implied contextually or omitted if not listed, text says Zhi Shi/Qingpi/Gancao), Aurantii Fructus (Zhi Shi), Citri Reticulatae Pericarpium (Qingpi), and Glycyrrhizae Radix et Rhizoma (Gancao). Later, Liuwei Wan (Six-Ingredient Pill) modified cured her completely.
Chen Sansan treated a scholar prone to tonics who developed dry mouth/tongue, occipital pain, mental fogginess, reduced appetite, diarrhea after meat, and surging/large pulses. Diagnosed as Excess Fire, he prescribed Zhi Mu (Anemarrhenae Rhizoma), Huang Bai (Phellodendri Cortex), Huang Lian (Coptidis Rhizoma), Zhi Zi (Gardeniae Fructus), Chishao (Paeoniae Radix Rubra), and Gancao (Glycyrrhizae Radix et Rhizoma). One dose relieved chest stuffiness and pain/diarrhea; two doses restored appetite and energy. This serves as a warning against unnecessary tonification.
Lu Yangyu treated Dong Longshan’s mother-in-law with abdominal Qi rushing upward causing head/face heat, insomnia, trembling, irregular fever peaking at night, abdominal masses during menstruation, polyphagia with emaciation. Previous Yin-deficiency treatments failed. Pulses were rapid/wiry, especially Left Chi. Lu diagnosed Liver/Gallbladder disease: indecision leads to Wood stagnation transforming into Fire (Shaoyang). Stagnant Qi becomes Fire; stagnant Blood becomes Masses (Jia). Since masses (solid) and heat (empty) coexisted, he first removed stasis using Nvjindan (Lady’s Golden Pill) during menstruation, then used Daqi Yangrong Tang (Move Qi and Nourish Blood Decoction) to regenerate new blood, followed by Arecae Semen (Binglang) with Ginseng Radix et Rhizoma (Renshen) to restore flesh.
Zhang Luyu treated Grand Secretary Zhang with Deficient Fire, Kidney Essence depletion, rebellious Deficient Fire, palpitations, and bleeding. Right Guan pulse was wiry, Left Chi slightly rapid, others fine. This indicated hidden Yin Fire from mental overwork and fear. Previous doctors used strong Ginseng Radix et Rhizoma (Renshen), Cinnamomi Ramulus (Guizhi), and Aconiti Lateralis Radix Praeparata (Fuzi). While initially effective, symptoms worsened in spring. Continued use of these warming herbs exacerbated the condition, causing severe pain, palpitations, and insomnia. Zhang diagnosed True Yuan depletion with Floating Yang disturbing upwards. He prescribed Baoyuan Tang (Preserve Origin Decoction) combined with Sijunzi Tang (Four Gentlemen Decoction) for decoction, and Liuwei Wan (Six-Ingredient Pill) combined with Shengmai San (Generate Pulse Powder) for pills, focusing on nourishing Yin. Later, when fatigue persisted, the patient self-prescribed Buzhong Yiqi Tang (Tonify Middle and Augment Qi Decoction) with Guizhi and Fuzi, causing hoarseness. Zhang identified this as disturbance of Floating Yang by Ascending herbs (Shengma, Chaihu) and warming agents. He reverted to Shengmai San with increased dosage, restoring voice. Persistent internal heat from previous overheating required clearing with Huang Qin (Scutellariae Radix) and Huang Lian (Coptidis Rhizoma) in late spring/early summer, though this scattered spirit. Finally, long-term use of Liuwei Wan and Shengmai San cleared residual toxicity.
The mother of Hanlin Scholar Meng Duanshi suffered from rising Deficient Fire, spontaneous sweating, mental confusion, inability to eat/sleep, bitter taste, difficult urination with dizziness. Every herb prescribed aggravated specific symptoms (e.g., Atractylodis Macrocephalae Rhizoma caused bloating, Citri Reticulatae Pericarpium caused panting/palpitations). She relied on small daily doses of Ginseng Radix et Rhizoma (Renshen) in porridge. In spring, fire surged causing profuse sweating and near-collapse. Pulse was slightly rapid, with Left Chi and Left Cun significantly stronger than others; Right Qikou was faint. This was Baihe Bing (Lily Disease) due to Spleen Yin injury from worry, leading to Jue Yang Fire harassing the Heart and vessels. Zhang Zhongjing’s Baihe Dihuang Tang (Lily and Rehmannia Decoction) is the specific remedy. Due to chronic Spleen Qi deficiency and prior medication errors, she was treated with Shengmai San (Generate Pulse Powder) plus Baihe (Lilii Bulbus), Fuling (Poria), and Longgu (Fossilized Bones) to calm the spirit, with minor adjustments. Eventually, stopping all medicine and consuming fresh Lily Bulb soup allowed autumn Qi descent to subside the fire, leading to recovery by mid-autumn.
Yu Jiayan treated Wu Tian Guan with abdominal pain, screaming, and anuria after his mother’s illness, diagnosed as Fire Stagnation. Zhu Yu and Huang Lian with Yanhusuo brought relief. Later, food stagnation led to wasting and eye bags sinking. Family tragedy triggered high fever, red eyes, and swollen cheeks, resembling exterior excess. Yu recognized this as agitation of True Fire burning internally. He prescribed Liuwei Wan (Six-Ingredient Pill) with Zhimu and Houbai for over twenty doses to clear the fire. Subsequent yellow swelling and restlessness were attributed to Dry Fire mimicking Heat and Zang Dryness. Two Winter Melon Pastes (Er Dong Gao) cured him.
Zhu Danxi treated a man with bubbling sounds in the lower abdomen, diagnosed as Yin Fire. He prescribed Tortoise Plastron (Baiguiban), Biota Tops (Cebaiye), Phellodendri Cortex (Huangbai), Anemarrhenae Rhizoma (Zhimu), Ligustici Chuanxiong Rhizoma (Chuanxiong), and Angelicae Sinensis Radix (Danggui), processed with wine, formed into pills with wine paste, taken with light salt water.
Lu Zuyu treated Lady Chen with Phlegm-Fire syndrome, experiencing heavy bleeding during menstruation, fainting, anger, dry throat, fiery breath, and chest congestion. Spicy/dry herbs caused fainting; cold herbs caused diarrhea. During attacks, she ate large amounts of porridge without satiety. Pulses were wiry/fine/rapid on the Left, and rapid/full on the Right. Lu diagnosed severe Blood deficiency with hyperactive Wild Fire, but Qi was not truly excessive. Treatment involved tonifying Blood and suppressing Fire separately. Pills contained Ginseng Radix et Rhizoma (Renshen) in Yin-nourishing herbs to guide Yang into Yin (treating root); decoctions were cooling to assist Yin and suppress Yang (treating branch). The pill formula included Ginseng Radix et Rhizoma (Renshen), Shengdi, Shudi, Maidong, Zhimu, Huangbai, Ejiao, and Duzhong. The decoction included Gualougen, Xuanshen, Zhimu, Huangbai, Huangqin, Fuling, Shengdi, Baishao, Maidong, Gancao, and Dengxincao. Modifications were made based on symptoms: adding Ginseng for fatigue, Huanglian/Zhizi for throat fire, Hawthorn/Trichosanthis Semen for phlegm, removing cold herbs if Spleen was damaged, etc. Zhu Danxi’s principle: Yang is often in excess, Yin is often deficient; Qi is often in excess, Blood is often deficient. Excess Qi becomes Fire; deficient Blood is Yin Deficiency. Before thirty, vitality rises; after thirty, it declines. Fire and Original Qi are mutually exclusive. Thus, Fire excess implies prior Yin deficiency and subsequent Original Qi weakness.
Zhu Danxi treated another man with night fever, morning resolution, five-palm heat, and deep/rapid pulses, diagnosing Depressed Fire. Shengyang Sanhuo Tang (Raise Yang and Scatter Fire Decoction) resolved the fever. Siwu Tang (Four Substances Decoction) with Zhimu, Huangbai, and Ganjiang (Dried Ginger) regulated the condition.
Dong Yuan treated a man with heat intolerance, red eyes, thirst, and a pulse of 7-8 beats per breath that dispersed on pressure, diagnosing Rootless Fire. Ginger and Aconite with Ginseng Radix et Rhizoma (Renshen) cured him.
Liu Yanchun treated a man unable to eat, with fever, spontaneous sweating, and shortness of breath. Non-eating fever indicated weak Spleen Yin; sweating/shortness of breath indicated Lung Qi deficiency. Sweet-Cold herbs tonified Qi and drained Fire, resolving the issue. Note: Treatment principles derive from "Strong Fire Consumes Qi."
Xue Lizhai treated a woman with bitter taste and hypochondriac distension, diagnosing Liver Fire. Xiaochaihu Tang (Minor Bupleurum Decoction) with Zhizi and Huanglian provided slight relief, followed by Sijunzi Tang (Four Gentlemen Decoction) with Baishao, Danggui, and Chaihu to tonify Spleen/Stomach for cure. Another woman with anger-induced bitter taste, fever, and afternoon fever had Liver Fire damaging Blood. Xiaochaihu Tang combined with Siwu Tang (Four Substances Decoction) cleared fire and generated blood, followed by Siwu Tang with Chaihu, Baizhu, Fuling, and Mudan Pi to generate blood and strengthen Spleen. Xue also treated a woman with bitter/spicy taste, chest/hypochondriac pain, and breast stabbing pain upon anger, diagnosing Liver/Lung Fire. Xiaochaihu Tang with Zhizi, Qingpi, Chuanxiong, Danggui, and Sangbaipi brought peace. Later, anger caused sudden menstruation due to Heat forcing Blood. Siwu Tang with fried Huangqin, Zhizi, and Longdancao stopped bleeding, followed by Jia Wei Xiaoyao San (Modified Free Wanderer Powder) for cure.
Zhang Luyu treated Xu Junyu with Yin deficiency and Fire, prone to constipation and bloody stool, who contracted Winter Warmth in October with fever and sore throat. Local physicians used Ephedrae Herba (Mahuang), Armeniacae Seminum Amarum (Xingren), Citri Reticulatae Pericarpium (Chenpi), Pinelliae Rhizoma (Banxia), and Zhi Shi, leading to wheezing, inability to lie flat, hoarseness, red face/head, and cold extremities. Right Cun/Guan pulses were deficient/large/slightly rapid. This indicated Heat injuring Hand Taiyin Qi (Lung),