陆祖愚治张登之男，年十四，患疟截早，变成痢疾，痞满晡热，眼胞红肿而痛，所下红白相间，日夜三四
十次。或与消积温补敛涩，俱不效，而转剧。脉之，左手弦数，右关沉实，右寸浮滑。此疟疾失表，又内伤饮
食，风热泊于肠胃而为病也。先用山楂、枳实、芩、连、木通、泽泻、小柴胡、甘草，并下香连丸。服丸药两
许，煎药四剂，遂积减胃开。调理旬日，但下淡白积一二次。又数日，大便实矣。忽一日，仍不思饮食，日行
二三次，十余次，粒米不进，计大便数十行。盖连日粥食过多，而复伤也。今积滞已行，肠中润滑，无所虑矣。
仍用小柴胡、归、芍、知、苓、楂、橘之类，宿垢尽行，胃气仍复。乃加减前方，人参、术调理而安。
万密斋治李氏女，初病疟，又病痢，发热少食，日啖莲肉五六枚，乃与集圣丸而愈。
张子和曰∶鹿子春一小儿八岁，夏月病嗽，羸甚，余欲涌之，子春以为儿幼弱，惧其不胜，少难之。一日
饮酒，家人与之酒，过多大吐，吐定而嗽止。盖酒味苦，苦属通剂，乃大悟余之言也。
万密斋治胡元溪子，五岁，春病嗽。医用葶苈丸，乍止乍作，至夏转作。又一医用五物汤不效。或以葶苈，
或以三拗，发表攻里，其嗽益加，至百十声不止，面青气促，口鼻出血，势急矣。曰∶自春至秋，病已半年，
治之不易。乃用二冬、二母、栀、芩、甘、桔、苏子、茯苓、陈皮去白，连进三剂，咳只二三十声。一医以二
陈加防风、百部、杏仁、紫菀、桑皮。万曰∶肝气已逆，吾方降之，其咳稍罢，防风、百部升发之品，似不可
用。彼云∶防风、百部，乃咳嗽圣药也。服之，气上逆而咳，百十声不止，口鼻血复来。再求治，仍用前方，
取生茅根捣自然汁，和药与之，五日而血止。去茅根，或加款冬、杏仁以止其咳。或去黄芩、栀子，加人参、
白术以补其脾。或加阿胶以补其肺。调理二旬而安。盖方春时，多上升之气，肺感风寒，当与发散；葶苈丸乃
攻里之剂，肺金本虚，而反泻之，此一逆也。夏天火旺，肺金受克，当用清金泻火之剂；三拗汤乃发散药也，
用热犯热，此二逆也。一汗一下，肺金大虚矣；方秋时，气应降而不降，反用升发之剂，此三逆也。今用收敛
清降之药，以平其浮游之火，火衰于戌，时值九月，故病易已。
许氏子病嗽，痰中带血，或用茅根汤治之不效，延万治。因问先生治胡元溪子用茅根，此亦用茅根，然不
愈何也？曰∶彼病于秋，肺旺肝燥，此病于冬，血衰时也。且彼乃口鼻出血，属阳明胃；此是痰中有血，属太
阴肺。病既不同，治亦有别，乃用阿胶为君，杏仁霜、栝蒌霜、贝母为臣，苏叶、桔梗、甘草为佐，炼蜜为丸，
薄荷煎汤化服而愈。
万石泉女，病久嗽不止，胸高气急，曰∶此龟胸病也。胸者，肺之府也，肺胀则胸骨高起，而状如龟壳。
吾闻其病，未曾治之，故无方也。或者不可治乎？石泉曰∶气胀者，肺实也，当服葶苈丸。曰∶病有新久，症
有虚实，（知为虚，何不投补？）再服葶苈泻肺之剂，恐有虚脱之祸。不听，竟以是卒。
吴孚先治一小儿咳嗽，动便作痰声，喉如曳锯，脉数洪滑，纹如鱼刺，用加减二陈汤，兼服神仙玉露散而痊。
万密斋治举人蔡沙江子，病咳久不止，其咳连声不绝，咳时面青，右手常自摆动。曰∶不可治也。问何故？
曰∶咳者，肺病也，肺属金。面青者，肝之色也，肝属木。手摆者，肝风欲发之状。木来侮金，寡乎畏也。今
十月，金病木生之时，四时之序，将来者进，成功者退。木生而进，金病而退，必发搐，甲乙日剧。果乙日搐
而死。（此段谈理入微，然何不大用养肝清肺之剂以冀万一？设玉横遇此症，必有以处之矣。）
曾芸塘子九岁，病咳，半夜甚，乃胎禀不足，肾虚嗽也。用人参固本丸加阿胶、桑皮，尽剂而安。又汪元
津子，病肾虚嗽，与上症同，亦用人参固本丸加茯苓、知母、贝母、山药各等分，为丸服之而安。
蒋仲芳治盛氏女，十余岁，患内热，干咳特甚。医与清火滋阴麦冬、黄芩之品，服之不效。脉得弦数，脉
症汤药甚相合也，因何不愈？沉思间，忽闻女衣有烟火气，询其曾卧火箱中乎？曰∶然。即以前方与之，令其
迁卧床上，遂不终剂而愈。问故，曰∶咳嗽，火热烁金，以清火润肺之品治之甚当，其如外火复逼，一杯水，
其能救车薪之火乎？今离却外火，其病自愈耳。（可见药即对症，而饮食起居调摄失宜，亦致不效，非如此
细心体察，鲜不误矣。）
陆祖愚诊治张登之子的病案：患者十四岁，患疟疾被过早截断，进而演变为痢疾。症状表现为心下痞塞胀满、傍晚发热（晡热），眼睑红肿疼痛，排泄物中红白脓血相间，每日排便达三四十次。医生曾给予消食导滞、温补及收敛固涩的药物，但均无效，病情反而加重。诊脉发现：左手脉弦数，右关脉沉实，右寸脉浮滑。此证因疟疾失于解表，加之饮食内伤，风热邪气滞留肠胃所致。治疗先用山楂、枳实、黄芩、黄连、木通、泽泻、小柴胡汤、甘草，并配合服用香连丸。服用丸药约二两，煎药四剂后，积滞减少，胃气开通。经过十日调理，仅排出淡白色积滞一两次。又过数日，大便恢复正常。忽然有一天，患者再次不思饮食，每日排便由两三次增至十余次，甚至粒米不进，大便次数多达数十行。这是因为连日喝粥过多，导致再次伤食。此时积滞已去，肠道润滑，无需担忧。仍用小柴胡汤加当归、白芍、知母、茯苓、山楂、陈皮等药物，待宿垢排尽，胃气恢复。最后加减前方，用人参、白术调理而痊愈。
万密斋诊治李氏之女：初患疟疾，后又患痢疾，发热且食欲减退。每日只吃莲子五六枚，万密斋给予集圣丸治疗而愈。
张子和论述：鹿子春的一个八岁小儿，夏季患咳嗽，身体极度消瘦。张子和打算用涌吐法治疗，鹿子春认为孩子幼小体弱，担心不能耐受，对此表示犹豫。一天，家人给鹿子春饮酒，他喝多后剧烈呕吐，吐完后咳嗽停止。鹿子春恍然大悟，明白张子和所说的道理。因为酒味苦，苦味属于通泄之剂，能引邪外出。
万密斋诊治胡元溪之子：五岁，春季患咳嗽。医生使用葶苈丸，咳嗽时止时发，到了夏天复发。另一位医生使用五物汤无效。有人用葶苈丸，有人用三拗汤，发表攻里，结果咳嗽加剧，连续咳嗽上百声不止，面色青紫，气息急促，口鼻出血，形势危急。万密斋说：从春到秋，病程已达半年，治疗不易。于是用天冬、麦冬、知母、贝母、栀子、黄芩、甘草、桔梗、苏子、茯苓、陈皮（去白），连续服用三剂，咳嗽减至每天二三十声。另一位医生用二陈汤加防风、百部、杏仁、紫菀、桑白皮。万密斋说：肝气已经上逆，我的方子是降气的，咳嗽稍停，防风、百部是升发之品，似乎不可用。那位医生说：防风、百部是治咳嗽的圣药。服药后，气机上逆，咳嗽百十声不止，口鼻再次出血。再次求治，仍用前方，加入生茅根捣取自然汁，和药一起服用，五日血止。去掉茅根，可加款冬花、杏仁以止咳；或去掉黄芩、栀子，加人参、白术以补脾；或加阿胶以补肺。调理二十天而痊愈。万密斋分析道：正值春季，阳气上升，肺感风寒，应当发散；葶苈丸是攻里的药剂，肺金本虚，反而泻之，这是第一逆。夏季火旺，肺金受克，应当用清金泻火的药剂；三拗汤是发散药，用热药犯热邪，这是第二逆。一汗一下，肺金大虚。正值秋季，气应下降而不降，反用升发之剂，这是第三逆。现在用收敛清降的药物，以平息浮游之火。火衰于戌时，时令值九月，所以病易愈。
许氏之子患咳嗽，痰中带血，用茅根汤治疗无效，延请万密斋诊治。万密斋问：先生治胡元溪之子用了茅根，这里也用茅根，为何不愈？回答说：那孩子是秋天生病，肺旺肝燥；这孩子是冬天生病，血衰之时。而且那是口鼻出血，属阳明胃经；这是痰中有血，属太阴肺经。病既不同，治法也有区别。于是用阿胶为君药，杏仁霜、瓜蒌霜、贝母为臣药，苏叶、桔梗、甘草为佐药，炼蜜为丸，薄荷煎汤化服而愈。
万石泉之女：久咳不止，胸部高耸，气息急促。万密斋说：这是龟胸病。胸是肺的府邸，肺胀则胸骨高起，状如龟壳。我听说这病，未曾治疗过，所以没有方子。有人问：难道不可治吗？万石泉说：气胀者，是肺实证，应当服用葶苈丸。有人说：病有新久，症有虚实（既然知道是虚证，为何不投补益药？）。再服用葶苈泻肺之剂，恐怕有虚脱之祸。家属不听，最终因此去世。
吴孚先诊治一小儿咳嗽，一动就有痰声，喉间声音如拉锯，脉象数而洪滑，指纹如鱼刺状。用加减二陈汤，兼服神仙玉露散而痊愈。
万密斋诊治举人蔡沙江之子：病咳久不止，咳嗽连声不绝，咳时面色青紫，右手常自行摆动。万密斋说：不可治。问何故？回答说：咳嗽是肺病，肺属金。面色青是肝之色，肝属木。手摆动是肝风欲发的征象。木来侮金，寡畏也（指孤阳无依，畏惧克制）。现在是十月，金病木生之时，四时之序，将来者进，成功者退。木气生长而进，金气病退，必然发生抽搐，在甲乙日加重。果然在乙日抽搐而死。（此段谈理入微，然而为何不大用养肝清肺之剂以冀万一？如果王孟英遇到此症，必有办法处置。）
曾芸塘之子九岁，病咳，半夜加重，这是胎禀不足，肾虚咳嗽。用人参固本丸加阿胶、桑白皮，服完一剂而安。又有汪元津之子，病肾虚咳嗽，与上述症状相同，也用人参固本丸加茯苓、知母、贝母、山药各等分，制成丸药服用而安。
蒋仲芳诊治盛氏女：十余岁，患内热，干咳特别严重。医生给予清火滋阴的麦冬、黄芩等药物，服用无效。脉象弦数，脉症汤药甚相合，为何不愈？沉思间，忽然闻到女孩衣服上有烟火气，询问是否曾睡在火箱中？回答说：是的。即以前方与之，令其搬离火箱睡在床上，药未服完而愈。问其原因，回答说：咳嗽，火热灼伤肺金，用清火润肺之品治疗很恰当，无奈外火逼迫，一杯水怎能救车薪之火？如今离开外火，病自愈耳。（可见药虽对症，而饮食起居调摄失宜，也会导致无效，非如此细心体察，很少不误诊。）
Lu Zuyu treated the son of Zhang Deng, aged fourteen. He suffered from malaria that was prematurely arrested, which transformed into dysentery. Symptoms included epigastric fullness and obstruction (pi man), afternoon fever (bu re), redness and swelling with pain in the eyelids, and passage of mixed red and white pus and blood in the stool, occurring thirty to forty times a day. Treatments with herbs for resolving accumulation, warming tonification, and astringency were ineffective, and the condition worsened. Pulse diagnosis revealed: left hand pulse was wiry and rapid (xian shu); right guan pulse was deep and solid (chen shi); right cun pulse was floating and slippery (fu hua). This case resulted from malaria failing to be resolved via sweating (biao), compounded by dietary injury, leading to wind-heat stagnating in the intestines and stomach. Initially, Hawthorn Fruit (Shanzha), Immature Bitter Orange (Zhishi), Scutellaria Root (Qin), Coptis Rhizome (Lian), Akebia Caulis (Mutong), Alisma Rhizome (Zexie), Xiao Chai Hu Tang (Minor Bupleurum Decoction), and Licorice Root (Gancao) were used, along with Xiang Lian Wan (Fragrant Coptis Pill). After taking approximately two liang of the pill and four doses of the decoction, the accumulation decreased and stomach qi opened. After ten days of regulation, only one or two passages of pale white residue occurred. Several days later, bowel movements normalized. Suddenly, one day, the patient lost appetite again, progressing from two or three daily bowel movements to over ten, even refusing all food, with dozens of stools per day. This was due to excessive congee consumption over consecutive days, causing a secondary food injury. Since the accumulation had passed and the intestines were lubricated, there was no cause for concern. Treatment continued with Xiao Chai Hu Tang plus Angelica Sinensis Root (Gui), White Peony Root (Shaohao), Anemarrhena Rhizome (Zhimu), Poria (Fuling), Hawthorn Fruit (Zhazha), and Tangerine Peel (Chenpi). Once residual filth was cleared and stomach qi recovered, the previous formula was modified with Ginseng Radix (Renshen) and Atractylodes Macrocephala Rhizome (Baizhu) for regulation, leading to recovery.
Wan Mizhai treated the daughter of the Li family. She initially contracted malaria, followed by dysentery, presenting with fever and poor appetite. She consumed only five or six lotus seeds daily. Wan Mizhai prescribed Ji Sheng Wan (Accumulation-Resolving Sage Pill), resulting in recovery.
Zhang Zihe stated: Lu Zichun’s eight-year-old son suffered from cough in summer, becoming extremely emaciated. I intended to use emesis (yong) therapy. Lu Zichun hesitated, fearing the child was too young and weak to tolerate it. One day, while drinking wine, he drank excessively and vomited profusely. After vomiting ceased, the cough stopped. Lu Zichun realized my words were correct. Wine is bitter; bitterness belongs to purgative/descending agents, effectively expelling pathogenic factors.
Wan Mizhai treated the son of Hu Yuanxi, aged five, who developed cough in spring. A physician used Ting Li Wan (Descurainia Seed Pill), but the cough intermittently stopped and recurred, worsening in summer. Another physician used Wu Wu Tang (Five Substance Decoction) without effect. Some used Ting Li Wan, others San Ao Tang (Three Unblocking Decoction), employing both exterior-releasing and interior-purgative methods, which exacerbated the cough. The child coughed continuously over a hundred times, with cyanotic face, shortness of breath, and bleeding from mouth and nose, indicating critical severity. Wan Mizhai said: From spring to autumn, the disease has lasted half a year, making treatment difficult. He prescribed Dong Gu (Asparagus Tuber), Mai Men Dong (Ophiopogon Tuber), Zhi Mu (Anemarrhena Rhizome), Bei Mu (Fritillaria Bulb), Zhi Zi (Gardenia Fruit), Huang Qin (Scutellaria Root), Gan Cao (Licorice Root), Jie Geng (Platycodon Root), Su Zi (Perilla Seed), Fu Ling (Poria), and Chen Pi (Tangerine Peel, pith removed). After three doses, cough reduced to twenty or thirty times daily. Another physician prescribed Er Chen Tang (Two-Cured Decoction) plus Fang Feng (Saposhnikovia Root), Bai Bu (Stemona Root), Xing Ren (Apricot Seed), Zi Wan (Aster Root), and Sang Bai Pi (Mulberry Root Bark). Wan Mizhai said: Liver qi has rebelled upward. My formula descends qi. With cough slightly suppressed, Fang Feng and Bai Bu, being ascending and dispersing agents, should not be used. The other physician replied: Fang Feng and Bai Bu are sacred medicines for cough. Upon administration, qi rebelled upward, coughing continued violently, and bleeding recurred. Seeking further treatment, Wan Mizhai reused his original formula, adding fresh Mugwort Root (Mao Gen) juice pressed naturally, mixed with the medicine. Bleeding stopped after five days. Mao Gen was removed; Kuan Dong Hua (Coltsfoot Flower) and Xing Ren could be added to stop cough. Alternatively, Huang Qin and Zhi Zi could be removed, and Renshen and Baizhu added to tonify spleen. Or Ejiao (Donkey-hide Gelatin) added to tonify lung. After twenty days of regulation, the patient recovered. Wan Mizhai analyzed: In spring, qi ascends; lung affected by wind-cold requires dispersing. Ting Li Wan is an interior-purgative agent. Lung metal is originally deficient; purging it constitutes the first contraindication (ni). In summer, fire is prosperous, overcoming lung metal; clearing metal and draining fire is required. San Ao Tang is a dispersing agent; using hot agents against heat constitutes the second contraindication. Sweating and purging have severely depleted lung metal. In autumn, qi should descend; using ascending agents constitutes the third contraindication. Now, using astringent and descending agents to calm floating fire allows recovery, as fire declines in Xu hour, corresponding to the ninth month.
The son of Mr. Xu suffered from cough with blood in sputum. Maogen Tang (Imperata Rhizome Decoction) was ineffective. Wan Mizhai was consulted. Wan asked: You used Maogen for Hu Yuanxi’s son, and now use it here, yet why no cure? Reply: That case occurred in autumn, when lung qi is robust and liver dryness prevails. This case occurs in winter, a time of blood deficiency. Furthermore, that case involved oral/nasal bleeding, belonging to Yangming Stomach meridian; this case involves blood in sputum, belonging to Taiyin Lung meridian. Since diseases differ, treatments must differ. Wan prescribed Ejiao as sovereign herb, Xing Ren Shuang (Apricot Frost), Gua Lou Shuang (Trichosanthes Frost), and Bei Mu as minister herbs, Su Ye (Perilla Leaf), Jie Geng, and Gancao as assistant herbs. Formulated into pills with refined honey, taken dissolved in Mint Decoction (Bohe Jian Tang), resulting in recovery.
Wan Shiquan’s daughter suffered from chronic cough, elevated chest, and shortness of breath. Wan Mizhai diagnosed this as Turtle Chest Disease (Gui Xiong Bing). The chest is the mansion of the lung; lung distension causes sternal elevation resembling a turtle shell. Having heard of the disease but never treated it, Wan had no prescription. Someone asked if it was incurable. Wan Shiquan stated: Qi distension indicates lung excess; Ting Li Wan should be administered. Another remarked: Diseases vary in duration; symptoms vary in deficiency/excess. (If known as deficiency, why not tonify?) Insisting on Ting Li Wan to purge lung qi risks collapse. The family did not listen, and the child died.
Wu Fuxian treated a child with cough producing phlegm sounds upon movement, rattling throat sound like sawing wood, rapid, surging, and slippery pulse, and finger vein pattern resembling fish spines. Jia Jian Er Chen Tang (Modified Two-Cured Decoction) was used, combined with Shen Xian Yu Lu San (Immortal Jade Dew Powder), resulting in recovery.
Wan Mizhai treated the son of Scholar Cai Shajiang, suffering from persistent continuous cough. During coughing fits, the face turned cyanotic, and the right hand trembled spontaneously. Wan declared it incurable. When asked why, he explained: Cough is a lung disease; lung belongs to Metal. Cyanotic face indicates liver color; liver belongs to Wood. Hand trembling indicates impending liver wind. Wood insulting Metal signifies isolation and fear of suppression. It is October, a time when metal is diseased and wood generates. According to seasonal order, what advances enters, what succeeds retreats. Wood advancing and generating, while metal retreating due to disease, will lead to convulsions, worsening on Jia/Yi days. Indeed, the child died of convulsions on Yi day. (This reasoning is profound; however, why not attempt nourishing liver and clearing lung measures? If Wang Mengying encountered this, he would have managed it.)
Zeng Yuntang’s nine-year-old son suffered from cough, worsening at midnight. This indicated congenital insufficiency and kidney-deficiency cough. Ren Shen Gu Ben Wan (Ginseng Root Solidifying Foundation Pill) plus Ejiao and Sang Bai Pi was administered, leading to stability. Similarly, Wang Yuanjin’s son suffered from kidney-deficiency cough with identical symptoms. He was treated with Ren Shen Gu Ben Wan plus equal parts Fu Ling, Zhi Mu, Bei Mu, and Shan Yao, formulated into pills, resulting in stability.
Jiang Zhongfang treated the daughter of the Sheng family, aged over ten, suffering from internal heat and severe dry cough. Physicians prescribed cooling-fire and yin-nourishing herbs like Mai Dong and Huang Qin, without effect. Pulse was wiry and rapid; pulse and symptoms matched the decoction, yet why no cure? While pondering, Jiang smelled smoke on the girl’s clothes and asked if she slept near a heating box. She confirmed. Jiang prescribed the same formula but instructed moving her bed away from the heat source. The patient recovered before finishing the dose. Explaining the rationale: Cough caused by fire scorching metal is correctly treated with cooling and moistening agents. However, external fire pressure renders a cup of water insufficient to save a burning cartload of firewood. Removing the external heat source allows self-healing. (This demonstrates that even if medication matches symptoms, improper lifestyle and dietary management can cause failure. Without such careful observation, misdiagnosis is common.)