窦材治一人，年十五，因大忧大恼，却转脾虚。庸医用五苓散及青皮、枳壳等药，遂致饮食不进，胸中作
闷。乃命灸命关二百壮，灸关元五百壮，服姜附汤一二剂，金液丹二斤，方愈。方书混于劳损，用温平小药，
误人不少，悲矣。
一人功名不遂，神思不乐，饮食渐少，日夜昏默，已半年矣，诸治不效。此药不能治，令灸巨阙百壮，关
元二百壮，病减半。令服醇酒，一旦三度，一月全安。（原注∶失志不遂之病，非排遣性情不可，以灸法操
其要，醉酒陶其情，此法妙极。）
张子和治项关令之妻，病饥不欲食，常好叫呼怒骂，欲杀左右，恶言不辍，众医半载无效。张视之曰∶此
难以药治，乃使二媪，各涂丹粉，作伶人状，其妇大笑。次日又令作角 ，又大笑，其旁令两个能食之妇，常
夸其食美，其妇亦索其食，而为一尝之。不数日，怒减食增，不药而瘥，后得一子。夫医贵有才，无才何得应
变无穷？
罗太监治一病僧，黄瘦倦怠。询其病，曰∶乃蜀人，出家时其母在堂，及游浙右，经七年。忽一日，念母
之心不可遏，欲归无腰缠，徒尔朝夕西望而泣，以是得病。时僧二十五岁，罗令其隔壁泊宿，每以牛肉猪肚甘
肥等煮糜烂与之，（太监替和尚开荤。）凡经半月余，且慰谕之。且又曰∶我与钞十锭作路费，我不望报，但欲救
汝之死命耳。察其形稍苏，与桃仁承气汤，一日三帖，下之皆是血块痰积。次日与熟干菜稀粥，将息又半月，其人
遂愈。又半月，与钞十锭遂行。（《格致余论》。）
孙文垣治丁耀川母，年四十四，常患胃脘痛，（肝木侮胃。）孀居十五年，日茹疏素。七月，因怒，吐血碗许，不
数日平矣。九月又怒，吐血如前，加腹痛。（肝木乘脾。）次年二月，（木旺之时。）忽里急后重，肛门大疼，（肝
火后迫。）小便短涩，惟点滴痛不可言，（肝火前迫。）腰与小腹热如汤泡，（三阴火炽。）日惟仰卧，不能侧，
侧则左胯并腿作痛。两胯原有痛，二阴之痛，前甚则后减，后甚则前减，（诸痛属火。）至不能坐，遇惊恐则下
愈坠疼，（惊则火动，火动则水伤。）经不行者两月。往行经时，腰腹必痛，下紫黑血块甚多。今又白带如注，
口渴不寐，不思饮食，多怒，面与手足虚浮，喉中梗梗有痰，肌肉半消。诊之，脉仅四至，两寸软弱，右关滑，
左关弦，两尺涩。据脉，上焦气血不足，中焦有痰，下焦气凝血滞，郁而为火，盖下焦肝肾所摄，腰胯肝之所经，
二便肾之所主也。据症，面与手足虚浮，则脾气甚弱；饮食不思，则胃气不充；不寐由过于忧愁思虑，而心血不
足，总为七情所伤故尔。经曰∶二阳之病发心脾，女子得之则不月。此病近之，所幸脉不数，声音清亮，当先为
开郁清热，调达肝气，保过夏令。（欠通。）后再峻补阴血，必戒恼怒，使血得循经乃可愈。初投当归龙荟丸，
以彻下焦之热。继以四物汤、龙胆草、知、柏、柴胡、泽兰，煎吞滋肾丸，连服两日，腰与少腹之热渐退。后以香
薷、石苇、龙胆、桃仁、滑石、杜牛膝、甘草稍、软柴胡，煎吞滋肾丸，二阴全减。
韩约斋子妇，每怒动则夜卧不安，如见鬼魅，小水淋沥。今又大便秘结，腹中疼痛，腰胯胀坠，如生产状，
坐卧不安。因痛而脉多不应指，孙曰∶此肝经郁火所致，法当通利。以杏仁、桃仁各三钱， 树根皮、山栀仁、
青皮各一钱，槟榔五分，枳壳八分，水煎服之。少顷，大便通，痛胀遂减。
按∶此亦治标耳。非滋水生肝，病何能已？
一妇人因夫荒于酒色，不事生产，多忧多郁，左胯及环跳穴疼痛过膝，（肝火下郁于经隧。）大小便频数，（肝火
下迫于二阴。）脐腹胀痛，口干。脉之，右手弱，左手数。近又发热恶寒，汗因痛出，时刻不宁。此食积、痰饮、
瘀血流于下部足厥阴经，挟郁火而痛。恐成肠痈，与神效栝蒌散，一帖痛减半，汗止，数脉稍退。小腹坚如石，按之
且痛，再与前药，小腹稍软。余无进退，再进之，每帖大栝蒌二枚，加丹皮、莪术、五灵脂、金银花，诸症悉平。
亮卿内人，头痛，遍身痛，（挟暑。）前后心乳皆胀，玉户撮急，肛门逼迫，（皆肝火为患。）大便三日
未行，口干。因大拂意事而起，下午发热似疟，恶心烦躁不宁，而时当盛暑，乃怒气伤肝，挟暑热而然。以石膏
三钱，青皮、柴胡、枳壳各一钱，半夏曲、黄芩各八分，甘草、桔梗各五分，夜与当归龙荟丸下之，大小便
皆利，热退，诸症悉减。惟略见恶心，与青皮饮两帖全安。
程湘内人，鼻衄后眩晕噪杂，呕吐清水，夜卧不安，腹中饥而食不下膈。孙谓由脾虚，肝胆有郁火也。以
人参、黄连、白术、扁豆、甘草、陈皮、半夏、竹茹、茯苓、石膏，水煎，调理而平。
黄履素曰∶予少年患郁火之症，面时赤而热，手足不温，复觉咽干口燥，体中微黄，夜更甚。就医吴门，
粗工投以黄连、黄芩、黄柏等药。服方二剂，忽觉手足甚冷，渐渐过腕过膝，鼻间突出冷气，神魂如从高桥坠
下深溪，阴阴不能自止，几登鬼 。延名医张涟水治之，张云∶症虽误服寒药，又不可骤以热药激之，但服八
珍汤加姜及天麻，久当自愈。如法调之，虽渐安而元气则大减矣。后简方书有云∶郁不可折以寒剂，误治必致
死，然则予之不死者幸也。夫记之以为戒鉴。
潘埙曰∶予禀气素偏于火，晚年多难，怀抱郁郁，因而肝气不平，上冲心肺，水火不能既济，殊无应病之
药，乃自制一方，名曰兼制丸。以柴胡、龙胆、青皮各五钱平肝，归身一两养肝，生地一两，生甘草五钱，黄
柏一两，知母五钱补北方，苍术八钱燥湿，芩、连各六钱清心肺，桂心二钱引经，加白术、防己、陈皮、茯苓
蜜丸。每服八十丸，常服有效。（楮记室。）
按∶合黄、潘二说观，皆郁火之症也。一则服苦寒几毙，一则服苦寒有效。要之，人之禀赋各殊，阴
阳亦异，临症者不宜执着也。
龚子才治何进士夫人，患经行胃口作痛，憎寒发热。一医以四物汤加官桂、香附，服之即吐血而痛愈甚。
诊之，六脉洪数，乃郁火也，以山栀二两，姜汁炒黑色，服之立愈。
冯楚瞻治一壮年，作宦失意退居，抑郁成疾，即经所谓常贵后贱，名曰脱营，常富后贫，名曰失精。其后
气血日消，神不外扬，六脉弦细而涩，饮食入胃尽化为痰，必咳吐尽出乃能卧，津液内耗，肌表外疏，所以恶寒
而瘦削。以人参保元固中为君；黄 助表达卫为臣；当归和养气血，白术助脾胜湿，麦冬保护肺中之气，五味
收敛耗散之金，炙甘草和药性而补脾，并以为佐；桂枝辛甘之性，能调荣卫而温肌达表，麻黄轻扬力猛，率领
群药，遍彻皮毛，驱逐阴凝之伏痰，化作阳和之津液，并以为使。但恐麻、桂辛烈，有耗荣阴，入白芍和肝，
以抑二药之性，更加白术以固中，姜、枣以助脾生津。二三剂，脉气渐充有神，痰涎咳吐俱愈。继以十补丸及
归脾养荣加减全愈。
吕东庄治弁玉偶患寒热，旋至热不退，胸中作恶。诊之曰∶此肝郁而致感也。用加减小柴胡汤，一剂热减
半，次进柴胡饮、地黄饮子。吕适他往，后日用六君子汤加黄芩，且戒之曰∶明日若尚有微热在内，则后日须
再用地黄饮子一帖，而后用六君子，此后皆有次第，不可乱也。因服地黄饮子，觉热已尽退，遂竟用补中益气
一帖。是夜即烦热不安，乃知次第果不可紊，仍用地黄饮子即安。然后根据次服至第三日，再用补中益气汤，泰
然得力矣。第觉病后烦怒易动，时体虚劣，自改用归脾汤。吕归诊之，曰∶今脉已无病，但夜不寐着耳。曰∶
正若此，奈何？曰∶当加味归脾汤。曰∶今已服此方而未效。曰∶君试我归脾自愈矣。一剂而鼾睡达旦。（必
去远志、木香，而入地黄、麦冬、白芍。）
按∶此等病，予惟以地黄饮子，令服五七剂，永无他患。今必用六君、补中、归牌，以至纷纷，此何
故耶？未免呆守立斋成法之过。
沈氏妇夏月发寒热，医以为疟也。时月事适下，遂淋漓不断，又以为热入血室。用药数帖，寒热益厉，月
事益下，色紫黑，或如败酱，医且云∶服此药，势当更甚，乃得微愈矣。乃疑其说，请吕诊之。委顿不能起坐，
脉细数甚，按之欲绝。问其寒热，则必起未申而终于子亥。曰∶郁火虚症耳。检前药则小柴胡汤，彼意以治寒
热往来，兼治热入血室也。又加香薷一大握，则又疑暑毒作疟也。乃笑曰∶所谓热入血室者，乃经水方至，遇
热而不行，故用清凉而解之。今下且不止，少腹疼痛，与此症何与，而进黄芩等药乎？即灼知热入血室矣，当
加逐瘀通经之味。香薷一握，又何为者？乃用肉桂二钱，白术四钱，炮姜二钱，当归、白芍各三钱，人参三钱，
陈皮、甘草各四分，一服而痛止经断，寒热不至，五服而能起。惟足心时作痛，此去血过多，肝肾伤也，投都
气饮子加肉桂、牛膝各一钱而全愈。使卒进寒凉，重阴下逼，天僵地折，生气不内，水泉冰溃，不七日死矣。
乃云更甚方愈，夫谁欺哉！庸妄之巧于卸脱，而悍于诛伐如是夫。
朱绮 ，多愤郁，又以内病忧劳，百感致疾。初发寒热，（少阳之症也。）渐进不解，时方隆冬，医进九味羌活汤，
不效。易医，大进发表消中之药，凡狠悍之味悉备，杂乱不成方，三剂势剧。又进大黄利下等物，下黑水数升，
遂大热发狂，昏愦晕绝，汤水入口即吐。其家无措，试以参汤与之，遂受，垂绝更苏。次日吕至，尚愦乱不省
人事，承灵、（在颠顶通天穴两旁。）正营（在承灵穴两旁。）及长强（在尻骨上腰 穴下。）俱发肿毒，时时躁乱。
诊其脉，数而大，曰∶幸不内陷，可生也。遂重用参、 、归、术，加熟地一两许。时村医在座，欲进连翘、
角刺等败毒散，且力言熟地不可用。其家从吕言进药，是夜得卧，次早神情顿清。谓曰∶吾前竟不解何故卧此，
今乃知病，如梦始觉也。又次日，脉数渐退，烦躁亦平。但胃口未开，肿毒碍事，旬日间，但令守服此，诸症
悉治。因晋方及加减法，且嘱之曰∶毋用破气药以开胃，苦寒药以降火，通利药以启后，败毒药以消肿，有一于
此，不可为也。出邑，遇友人，问其病状。曰∶七情内伤，而外感乘之，伤厥阴而感少阳，从其类也。乃不问
经络而混表之，三阳俱敝矣。然邪犹未入府也，转用枳实、浓朴、山楂、栝蒌之属，而邪入二阳矣。然阴犹未
受病也，用大黄、元明粉而伤及三阴矣。究竟原感分野之邪，不得外泄，展转内逼，中寒拒逆，幸得参扶胃气，
鼓邪出外。其发于承灵、正营者，乃本经未达郁怫之火也；其发于腰 、长强者，乃下伤至阴，凝 而成也。
盖毒得发者，参之功也。今毒之麻木平塌，将来正费调理者，前药之害也。其家如言守防，服之而愈。
张路玉治江礼科次媳，春初患发热头疼腹痛，咳逆无痰，十指皆紫黑而痛，或用发表顺气不效。诊之，脉
来弦数而细，左大于右。曰∶此怀抱不舒，肝火郁干脾土而发热，热蒸于肺故咳；因肺本燥，故无痰；脾受木
克，故腹痛；阳气不得发越，故头疼；四肢为诸阳之本，阳气不行，气凝血滞，故十指疼紫。其脉弦者，肝也；
数者，火也；细者，火郁于血分也。遂以加味逍遥散，加桂枝于土中达木，三剂而诸症霍然，十指亦不疼紫矣。
徐孝廉室不得寐，不能食，心神恍惚，四肢微寒，手心热汗，至晚则喉间热结有痰，两耳时塞，用安神清
火药不效。诊之，六脉萦萦如蛛丝而兼弦数，此中气久郁不舒，虚火上炎之候也。本当用归脾汤以补心脾之虚，
奈素有虚痰阴火，不胜 、圆之滞，木香之燥，（用归脾之法。）遂以五味异功散，略加归、芍、肉桂以和其
阴，导其火，不数剂而食进寝宁，诸症释然矣。
张飞畴治一妇，平昔虚火易于上升，因有怒气不得越，致中满食减，作酸嗳气，头面手足时冷时热，少腹
不时酸痛，经不行者半载余。其脉模糊，驶而无力。服诸破气降气行血药不愈。此蕴怒伤肝，肝火乘虚而克脾
土，脾受克则胸中之大气不布，随肝火散漫肢体。当知气从湿腾，湿由火燥。惟太阳当空，则阴霾自散；真火
行令，则郁蒸之气自伏。又釜底得火，则能腐熟水谷，水谷运则脾胃有权，大气得归，而诸症可愈矣。用生料
八味倍桂、附，十日而头面手足之冷热除。间用异功而中宽食进，调理两月，经行而愈。
柴屿青治潼川守母，八十三。在沈阳礼部时，闻伊芳母在京病甚，忽身热吐痰，妄言昏愦。众医俱主发表
病势日增，始求治。悲泪哀号，自分必死。诊其右关沉涩微滑，曰∶此思虑伤脾，更兼郁结，痰涎壅盛，脾不
能运也；身热昏愦，清阳不升，脾气伤也。先用二陈、栝蒌治其标，继用归脾加神曲、半夏、柴胡，调治数口
而痊。向使误服表剂，岂不蹈昔人虚虚之戒耶？
山阴林素臣，偶患时气，为医所误，身热，呕吐绿水，转侧不宁。柴以为肝郁所致，用逍遥散加吴茱萸、
窦材治疗一名十五岁的患者，因极度忧愁和恼怒，导致脾气虚弱。庸医使用五苓散以及青皮、枳壳等药物，致使患者饮食不进，胸中感到闷塞。于是命令灸命关穴二百壮，灸关元穴五百壮，服用姜附汤一两剂，金液丹二斤，病才痊愈。医书将此类病症混同于劳损，使用温和平淡的小药，误人不少，可悲啊。
另一人功名未遂，精神思虑不乐，饮食逐渐减少，日夜昏沉沉默，已经半年了，各种治疗均无效。此病用药不能治愈，令其灸巨阙穴一百壮，关元穴二百壮，病情减轻一半。令其饮用纯酒，一天三次，一个月后完全康复。（原注：失志不遂的病症，必须排遣性情不可，以灸法掌握关键，醉酒陶冶性情，此法极妙。）
张子和治疗项关令的妻子，病症表现为饥饿但不想进食，经常大声呼叫、怒骂，想要杀死身边的人，恶言不绝，众医治疗半年无效。张子和看她后说：“这难以用药物治疗。”于是让两名老妇人，各自涂上丹粉，装作伶人的样子，这位妇人便大笑。第二天又令其表演角抵戏（摔跤），再次大笑，旁边让两个能吃的妇人，常常夸赞食物美味，这位妇人也就索要食物，并尝了一口。没过几天，怒气减轻，食欲增加，不用药而痊愈，后来生了一个儿子。医生贵在才有，没有才能怎能应对无穷的变化？
罗太监治疗一名患病僧人，面色黄瘦，倦怠无力。询问病情，僧人说：“我是蜀地人，出家时母亲健在，等到游历浙右，经过七年。忽然有一天，思念母亲的心情无法遏制，想回家却没有路费，只能早晚向西望着哭泣，因此得病。”当时僧人二十五岁，罗令他在隔壁住宿，每天用牛肉、猪肚等甘肥之物煮烂给他吃，（太监替和尚开荤。）总共经过半月多，一边安慰开导他。又说：“我给您十锭钱作路费，我不指望报答，只想救您的死命罢了。”观察他的形体稍微苏醒，给予桃仁承气汤，一天三帖，泻下全是血块痰积。第二天给予熟干菜稀粥，调养又半个月，那人便痊愈了。又过半个月，给十锭钱让他上路。（《格致余论》。）
孙文垣治疗丁耀川的母亲，四十四岁，常患胃脘痛，（肝木侮犯胃土。）守寡十五年，每日吃素食。七月，因发怒，吐血约一碗，没过几天平复。九月又发怒，吐血如前，加上腹痛。（肝木乘脾。）次年二月，（木旺之时。）忽然出现里急后重，肛门剧痛，（肝火向后逼迫。）小便短少涩痛，仅点滴而出，疼痛难忍，（肝火向前逼迫。）腰部和下腹部热得像热水泡一样，（三阴经火炽盛。）每天只能仰卧，不能侧卧，侧卧则左侧胯部及腿部疼痛。两胯原有疼痛，前后二阴的疼痛，前甚则后减，后甚则前减，（诸痛属火。）直到不能坐立，遇到惊恐则下部坠痛更甚，（惊则火动，火动则水伤。）月经两个月没来。以往行经时，腰腹必痛，排出大量紫黑色血块。现在白带如注，口渴失眠，不思饮食，易怒，面部和手足虚浮，喉中有梗塞感且有痰，肌肉消瘦一半。诊脉，脉仅四至，两寸软弱，右关滑，左关弦，两尺涩。根据脉象，上焦气血不足，中焦有痰，下焦气凝血滞，郁结化为火，盖下焦由肝肾所主摄，腰胯是肝经所经过的地方，二便是肾所主管的。根据症状，面部和手足虚浮，说明脾气很弱；不思饮食，说明胃气不充；失眠由于过于忧愁思虑，导致心血不足，总归是七情所伤所致。《内经》说：“二阳之病发心脾，女子得之则闭经。”此病接近这种情况，所幸脉不数，声音清亮，应当先为开通郁结、清热，调达肝气，保过夏季。（欠通顺。）然后再峻补阴血，必须戒除恼怒，使血液循经而行才可痊愈。初投当归龙荟丸，以清除下焦之热。继以四物汤、龙胆草、知母、黄柏、柴胡、泽兰，煎服吞服滋肾丸，连服两日，腰部与少腹之热渐退。后用香薷、石苇、龙胆、桃仁、滑石、杜牛膝、甘草稍、软柴胡，煎服吞服滋肾丸，前后二阴症状全减。
韩约斋的儿子媳妇，每次发怒则夜间睡眠不安，如见鬼魅，小便淋沥不尽。如今又大便秘结，腹中疼痛，腰胯胀坠，如临产状，坐卧不安。因为疼痛所以脉多不应指，孙文垣说：“这是肝经郁火所致，治法应当通利。”用杏仁、桃仁各三钱，樗树根皮、山栀仁、青皮各一钱，槟榔五分，枳壳八分，水煎服。不久，大便通畅，痛胀随即减轻。
按语：这也是治标罢了。如果不滋水生肝，病怎么能停止？
一妇人因丈夫荒淫酒色，不事生产，多忧多郁，左侧胯部及环跳穴疼痛过膝，（肝火下郁于经络隧道。）大小便频数，（肝火下迫于前后二阴。）脐腹胀痛，口干。诊脉，右手弱，左手数。近来又发热恶寒，汗因痛而出，时刻不宁。这是食积、痰饮、瘀血流注于下部足厥阴肝经，挟带郁火而痛。恐怕形成肠痈，给予神效栝蒌散，一帖疼痛减半，汗止，数脉稍退。小腹坚硬如石，按压且痛，再与前药，小腹稍软。其余无进退，再进前方，每帖加大栝蒌二枚，加丹皮、莪术、五灵脂、金银花，诸症悉平。
亮卿的内人，头痛，遍身痛，（挟暑邪。）前后心及乳房皆胀，外阴收缩紧急，肛门逼迫感，（皆因肝火为患。）大便三日未行，口干。因大不如意之事而起，下午发热似疟疾，恶心烦躁不宁，而此时正值盛暑，乃是怒气伤肝，挟暑热所致。用石膏三钱，青皮、柴胡、枳壳各一钱，半夏曲、黄芩各八分，甘草、桔梗各五分，夜间给予当归龙荟丸泻下，大小便皆通利，热退，诸症悉减。只是略见恶心，给予青皮饮两帖全安。
程湘的内人，鼻衄后眩晕嘈杂，呕吐清水，夜间睡眠不安，腹中饥但食物不下膈。孙文垣认为由脾虚，肝胆有郁火所致。用人参、黄连、白术、扁豆、甘草、陈皮、半夏、竹茹、茯苓、石膏，水煎，调理而平。
黄履素说：“我年轻时患郁火之症，面部时常发红发热，手足不温，又觉得咽干口燥，身体微黄，夜间更甚。就医于吴门，粗工投以黄连、黄芩、黄柏等药。服药方二剂，忽觉手足非常冷，渐渐超过手腕膝盖，鼻间突出冷气，神魂如同从高桥坠入深溪，阴冷不能自止，几乎登鬼录。延请名医张涟水治疗，张说：‘症虽误服寒药，又不可骤以热药激之，只服八珍汤加生姜及天麻，久当自愈。’照此法调理，虽然渐安但元气则大减矣。后来翻阅简方书有云：‘郁不可折以寒剂，误治必致死’，那么我不死是侥幸啊。记录此事作为警戒。”
潘埙说：“我禀赋之气素偏于火，晚年多难，怀抱郁郁，因而肝气不平，上冲心肺，水火不能既济，殊无应病之药，于是自制一方，名叫兼制丸。用柴胡、龙胆、青皮各五钱平肝，当归身一两养肝，生地一两，生甘草五钱，黄柏一两，知母五钱补北方（肾），苍术八钱燥湿，黄芩、黄连各六钱清心肺，桂心二钱引经，加白术、防己、陈皮、茯苓蜜丸。每服八十丸，常服有效。（楮记室。）”
按语：结合黄、潘两人的说法观看，都是郁火之症。一则服苦寒药几乎毙命，一则服苦寒药有效。总之，人的禀赋各不相同，阴阳亦异，临症者不宜执着。
龚子才治疗何进士夫人，患经期胃口作痛，憎寒发热。一医以四物汤加官桂、香附，服之即吐血而痛更甚。诊之，六脉洪数，乃郁火也，用山栀二两，姜汁炒黑色，服之立即痊愈。
冯楚瞻治疗一名壮年男子，做官失意退居，抑郁成疾，即经所谓“常贵后贱”，名叫脱营，“常富后贫”，名叫失精。其后气血日渐消耗，神不外扬，六脉弦细而涩，饮食入胃尽化为痰，必须咳吐尽出才能躺卧，津液内耗，肌表外疏，所以恶寒而瘦削。以人参为君药，保元固中；黄芪为臣药，助表达卫；当归和养气血，白术助脾胜湿，麦冬保护肺中之气，五味子收敛耗散之金，炙甘草调和药性而补脾，并以为佐；桂枝辛甘之性，能调荣卫而温肌达表，麻黄轻扬力猛，率领群药，遍彻皮毛，驱逐阴凝之伏痰，化作阳和之津液，并以为使。但恐麻黄、桂枝辛烈，有耗伤营阴之弊，加入白芍以和肝，以抑制这两味药的药性，更加白术以固中，生姜、大枣以助脾生津。二三剂后，脉气渐充有神，痰涎咳吐俱愈。继以十补丸及归脾养荣加减全愈。
吕东庄治疗弁玉偶然患寒热，旋即热不退，胸中作恶。诊之曰：“这是肝郁而导致的外感。”用加减小柴胡汤，一剂热减一半，次进柴胡饮、地黄饮子。吕适逢他往，后日用六君子汤加黄芩，并且告诫他说：“明日若尚有微热在内，则后日须再用地黄饮子一帖，而后用六君子，此后皆有次第，不可乱也。”因服地黄饮子，觉热已尽退，遂竟用补中益气一帖。是夜即烦热不安，乃知次第果不可紊，仍用地黄饮子即安。然后根据次序服至第三日，再用补中益气汤，泰然得力矣。只觉病后烦怒易动，时时体虚劣，自改用归脾汤。吕归来诊之，曰：“今脉已无病，但夜不寐着耳。”曰：“正若此，奈何？”曰：“当加味归脾汤。”曰：“今已服此方而未效。”曰：“君试我归脾自愈矣。”一剂而鼾睡达旦。（必去远志、木香，而入地黄、麦冬、白芍。）
按语：这种病，我只用地黄饮子，令服五七剂，永无他患。如今必用六君、补中、归脾，以至纷纷，这是什么缘故呢？未免呆守立斋成法之过。
沈氏妇夏月发寒热，医以为是疟疾。此时月经刚来，遂淋漓不断，又以为是热入血室。用药数帖，寒热益厉，月事益下，色紫黑，或如败酱，医且云：“服此药，势当更甚，乃得微愈矣。”乃疑其说，请吕东庄诊之。委顿不能起坐，脉细数甚，按之欲绝。问其寒热，则必起于未申时而终于子亥时。曰：“郁火虚症耳。”检前药则小柴胡汤，彼意以治寒热往来，兼治热入血室也。又加香薷一大握，则又疑暑毒作疟也。乃笑曰：“所谓热入血室者，乃经水方至，遇热而不行，故用清凉而解之。今下且不止，少腹疼痛，与此症何与，而进黄芩等药乎？即灼知热入血室矣，当加逐瘀通经之味。香薷一握，又何为者？”乃用肉桂二钱，白术四钱，炮姜二钱，当归、白芍各三钱，人参三钱，陈皮、甘草各四分，一服而痛止经断，寒热不至，五服而能起。惟足心时作痛，此去血过多，肝肾伤也，投都气饮子加肉桂、牛膝各一钱而全愈。使卒进寒凉，重阴下逼，天僵地折，生气不内，水泉冰溃，不七日死矣。乃云更甚方愈，夫谁欺哉！庸妄之巧于卸脱，而悍于诛伐如是夫。
朱绮，多愤郁，又以内病忧劳，百感致疾。初发寒热，（少阳之症也。）渐进不解，时方隆冬，医进九味羌活汤，不效。易医，大进发表消中之药，凡狠悍之味悉备，杂乱不成方，三剂势剧。又进大黄利下等物，下黑水数升，遂大热发狂，昏愦晕绝，汤水入口即吐。其家无措，试以参汤与之，遂受，垂绝更苏。次日吕东庄至，尚愦乱不省人事，承灵、（在颠顶通天穴两旁。）正营（在承灵穴两旁。）及长强（在尻骨上腰俞穴下。）俱发肿毒，时时躁乱。诊其脉，数而大，曰：“幸不内陷，可生也。”遂重用参、芪、归、术，加熟地一两许。时村医在座，欲进连翘、角刺等败毒散，且力言熟地不可用。其家从吕言进药，是夜得卧，次早神情顿清。谓曰：“吾前竟不解何故卧此，今乃知病，如梦始觉也。”又次日，脉数渐退，烦躁亦平。但胃口未开，肿毒碍事，旬日间，但令守服此，诸症悉治。因晋方及加减法，且嘱之曰：“毋用破气药以开胃，苦寒药以降火，通利药以启后，败毒药以消肿，有一于此，不可为也。”出邑，遇友人，问其病状。曰：“七情内伤，而外感乘之，伤厥阴而感少阳，从其类也。乃不问经络而混表之，三阳俱敝矣。然邪犹未入府也，转用枳实、浓朴、山楂、栝蒌之属，而邪入二阳矣。然阴犹未受病也，用大黄、元明粉而伤及三阴矣。究竟原感分野之邪，不得外泄，展转内逼，中寒拒逆，幸得参扶胃气，鼓邪出外。其发于承灵、正营者，乃本经未达郁怫之火也；其发于腰俞、长强者，乃下伤至阴，凝泣而成也。盖毒得发者，参之功也。今毒之麻木平塌，将来正费调理者，前药之害也。”其家如言守防，服之而愈。
张路玉治疗江礼科次媳，春初患发热头疼腹痛，咳逆无痰，十指皆紫黑而痛，或用发表顺气不效。诊之，脉来弦数而细，左大于右。曰：“此怀抱不舒，肝火郁干脾土而发热，热蒸于肺故咳；因肺本燥，故无痰；脾受木克，故腹痛；阳气不得发越，故头疼；四肢为诸阳之本，阳气不行，气凝血滞，故十指疼紫。其脉弦者，肝也；数者，火也；细者，火郁于血分也。”遂以加味逍遥散，加桂枝于土中达木，三剂而诸症霍然，十指亦不疼紫矣。
徐孝廉之妻不得寐，不能食，心神恍惚，四肢微寒，手心热汗，至晚则喉间热结有痰，两耳时塞，用安神清火药不效。诊之，六脉萦萦如蛛丝而兼弦数，此中气久郁不舒，虚火上炎之候也。本当用归脾汤以补心脾之虚，奈素有虚痰阴火，不胜参、芪、圆之滞，木香之燥，（用归脾之法。）遂以五味异功散，略加归、芍、肉桂以和其阴，导其火，不数剂而食进寝宁，诸症释然矣。
张飞畴治疗一妇人，平昔虚火易于上升，因有怒气不得越，致中满食减，作酸嗳气，头面手足时冷时热，少腹不时酸痛，经不行者半载余。其脉模糊，驶而无力。服诸破气降气行血药不愈。此蕴怒伤肝，肝火乘虚而克脾土，脾受克则胸中之大气不布，随肝火散漫肢体。当知气从湿腾，湿由火燥。惟太阳当空，则阴霾自散；真火行令，则郁蒸之气自伏。又釜底得火，则能腐熟水谷，水谷运则脾胃有权，大气得归，而诸症可愈矣。用生料八味倍桂、附，十日而头面手足之冷热除。间用异功而中宽食进，调理两月，经行而愈。
柴屿青治疗潼川太守之母，八十三岁。在沈阳礼部时，闻其母在京病甚，忽身热吐痰，妄言昏愦。众医俱主发表，病势日增，始求治。悲泪哀号，自分必死。诊其右关沉涩微滑，曰：“此思虑伤脾，更兼郁结，痰涎壅盛，脾不能运也；身热昏愦，清阳不升，脾气伤也。”先用二陈、栝蒌治其标，继用归脾加神曲、半夏、柴胡，调治数日而痊。向使误服表剂，岂不蹈昔人虚虚之戒耶？
山阴林素臣，偶患时气，为医所误，身热，呕吐绿水，转侧不宁。柴屿青认为是肝郁所致，用逍遥散加吴茱萸、
Dou Cai treated a fifteen-year-old patient who, due to extreme worry and anger, developed Spleen Qi deficiency (Spleen Qi deficiency). A mediocre physician administered Wu Ling San (Five-Ingredient Powder with Poria) along with Qing Pi (Tangerine Peel) and Zhi Ke (Aurantium Fruit), which resulted in the patient's inability to eat and a sensation of chest stuffiness. Dou then ordered moxibustion on Ming Guan (Ming Gate, likely referring to a specific point or area outside standard meridian points, often associated with the Stomach meridian in some contexts, but here treated as a specific therapeutic site) for two hundred burns, and on Guan Yuan (Gate of Origin, CV4) for five hundred burns. The patient was given Jiang Fu Tang (Ginger and Aconite Decoction) for one or two doses and Jin Ye Dan (Golden Elixir Pill) for two jin, after which the illness was cured. Medical texts confuse such conditions with consumption (Lao Sun), using mild and neutral small prescriptions, misleading many people; this is truly sad.
Another person, frustrated in his official career, suffered from mental distress and unhappiness, leading to gradually decreasing food intake. He remained lethargic and silent day and night for half a year, with all treatments ineffective. This condition could not be cured by medicine alone. He was instructed to undergo moxibustion on Ju Que (Great Court, CV14) for one hundred burns and on Guan Yuan (CV4) for two hundred burns, which reduced the illness by half. He was then instructed to drink pure wine three times a day, resulting in complete recovery within one month. (Original note: For illnesses caused by unfulfilled ambitions, it is essential to relieve emotional constraints. Moxibustion grasps the key aspect, while intoxication helps cultivate emotions; this method is extremely effective.)
Zi He treated the wife of Xiang Guanling, who presented with hunger but no desire to eat, frequent loud shouting, cursing, and an urge to kill those around her, with abusive words continuing incessantly. After six months of ineffective treatment by various physicians, Zi He observed her and said, "This is difficult to treat with medicine." He then had two old women apply rouge and powder and act like actors, causing the woman to laugh heartily. The next day, he had them perform wrestling acts, causing her to laugh again. Two other women who ate well were placed nearby to constantly praise the deliciousness of the food, prompting the patient to ask for food and taste it. Within a few days, her anger subsided, her appetite increased, and she recovered without medication. She later gave birth to a son. Physicians must possess talent; without it, how can they respond to infinite changes?
Luo Taijian (Eunuch Luo) treated a sick monk who was yellow, thin, and fatigued. Upon inquiry, the monk stated, "I am from Shu. When I became a monk, my mother was alive. By the time I traveled to the right side of Zhejiang, seven years had passed. Suddenly, one day, my longing for my mother became unbearable. I wanted to return home but had no travel funds, so I could only weep facing west morning and evening, which led to my illness." The monk was twenty-five years old at the time. Luo had him stay in the adjacent room and cooked tender beef and pork stomach daily for him to eat. (The eunuch broke the monk's vegetarian fast.) This continued for over half a month, accompanied by comfort and advice. Luo also said, "I will give you ten ingots of silver for your travel expenses. I do not expect repayment; I simply wish to save your life." Observing that the monk's physical condition had slightly improved, Luo administered Tao Ren Cheng Qi Tang (Peach Kernel and Rhubarb Decoction to Drain the Lower Jiao), three doses per day, resulting in the passage of blood clots and phlegm accumulation. The next day, he provided a thin porridge made with dried vegetables, and after another half month of recuperation, the monk recovered. Half a month later, Luo gave him ten ingots of silver for his journey. (From *Gezhi Yulun*.)
Sun Wen Yuan treated the mother of Ding Yaochuan, aged forty-four, who frequently suffered from epigastric pain (Liver Wood insulting Stomach Earth). Having been a widow for fifteen years, she consumed only vegetarian food. In July, due to anger, she vomited approximately one bowl of blood, which resolved after a few days. In September, angered again, she vomited blood as before, accompanied by abdominal pain (Liver Wood invading Spleen Earth). In February of the following year, during the season when Wood energy is prosperous, she suddenly experienced tenesmus and severe anal pain (Liver Fire pressing downward posteriorly). Her urine was scanty and dysuric, painful and difficult to pass drop by drop (Liver Fire pressing downward anteriorly). Her lower back and lower abdomen felt hot as if soaked in boiling water (Blazing Fire of the Three Yin meridians). She could only lie supine and could not turn to her side, as doing so caused pain in her left hip and leg. She already had pain in both hips; pain in the anterior and posterior orifices would decrease in one area when severe in the other (All pains belong to Fire). Eventually, she could not sit. Fearfulness exacerbated the dragging pain in the lower body (Fear agitates Fire; agitated Fire damages Water). Her menstruation had ceased for two months. Previously, during menstruation, she always experienced waist and abdominal pain and passed large amounts of dark purple blood clots. Now, she had profuse leukorrhea, thirst, insomnia, loss of appetite, irritability, puffy face and extremities, a sensation of obstruction in the throat with phlegm, and significant muscle wasting. Pulse diagnosis revealed a rate of four beats per breath, weak and soft Cun positions on both sides, slippery Chi position on the right, wiry Chi position on the left, and choppy Chi positions on both sides. Based on the pulse, there was a deficiency of Qi and Blood in the Upper Jiao, Phlegm in the Middle Jiao, and stagnation of Qi and Blood transforming into Fire in the Lower Jiao. The Lower Jiao is governed by the Liver and Kidney; the waist and hips are traversed by the Liver meridian; and urination and defecation are controlled by the Kidneys. Based on symptoms, facial and extremity puffiness indicates very weak Spleen Qi; lack of appetite indicates insufficient Stomach Qi; insomnia results from excessive worry and thought depleting Heart Blood. All stem from injury by the Seven Emotions. The Classic states: "Diseases of the Two Yangs originate from the Heart and Spleen; in women, this leads to amenorrhea." This case is similar. Fortunately, the pulse is not rapid, and the voice is clear. Treatment should first focus on resolving stagnation, clearing heat, and smoothing Liver Qi, ensuring safety through the summer season. (Note: This reasoning is somewhat flawed.) Subsequently, vigorous tonification of Yin and Blood should be employed, along with strict avoidance of anger, allowing Blood to follow its normal pathways for recovery. Initially, Dang Gui Long Hui Wan (Angelica Sinensis and Gelsemium Pill) was administered to clear Lower Jiao heat. This was followed by Si Wu Tang (Four Substance Decoction) combined with Long Dan Cao (Gentian Root), Zhi Mu (Anemarrhena Rhizome), Huang Bo (Phellodendron Bark), Chai Hu (Bupleurum Root), and Ze Lan (Lygodium Spore), taken with Zi Shen Wan (Nourish Kidney Pill) for two days, gradually reducing heat in the waist and lower abdomen. Later, Xiang Ru (Mosla Herb), Shi Wei (Pyrrosia Leaf), Long Dan Cao, Tao Ren (Peach Seed), Hua Shi (Talcum), Du Niu Xi (Achyranthes Root), Gan Cao Gao (Licorice Tip), and Ruan Chai Hu (Soft Bupleurum) were decocted and taken with Zi Shen Wan, completely relieving symptoms in both orifices.
Han Yuezhai's daughter-in-law experienced sleeplessness upon anger, hallucinations of ghosts, and dribbling urine. Currently, she suffered from constipation, abdominal pain, distending and dragging pain in the waist and hips resembling labor, and restlessness. Due to pain, her pulse was often imperceptible. Sun Wen Yuan stated, "This is caused by stagnant Fire in the Liver Meridian. The treatment should promote free flow." He prescribed Xing Ren (Apricot Seed) and Tao Ren (Peach Seed), each 3 qian; Chu Pi (Tree Root Bark), Shan Zhi Ren (Gardenia Seed), and Qing Pi (Green Tangerine Peel), each 1 qian; Bing Lang (Areca Nut) 5 fen; and Zhi Ke (Aurantium Fruit) 8 fen, decocted in water. Soon after, bowel movements were relieved, and pain and distension decreased.
Commentary: This treats only the branch symptoms. Without nourishing Water to support the Liver, how can the disease cease?
A woman, whose husband indulged in alcohol and lust and neglected family duties, suffered from excessive worry and depression. Pain radiated from her left hip through the Huan Tiao (GB30) acupoint down past the knee (Stagnant Liver Fire descending into the meridians). She experienced frequent urination and defecation (Liver Fire pressing downward on the two orifices), umbilical and abdominal distending pain, and dry mouth. Pulse diagnosis showed a weak Right hand and a rapid Left hand. Recently, she developed fever and aversion to cold, sweating triggered by pain, and constant agitation. This was caused by Food Stagnation, Phlegm-Fluid retention, and Blood Stasis flowing into the lower Foot Jueyin (Liver) meridian, complicated by stagnant Fire causing pain. There was fear of developing Intestinal Abscess (Chang Yong). Shen Xiao Gua Lou San (Miraculous Trichosanthes Powder) was administered; after one dose, pain halved, sweating stopped, and the rapid pulse slightly receded. Her lower abdomen was hard as stone and painful to pressure. The same prescription was repeated, softening the lower abdomen slightly. With no further progression, the formula was advanced by adding two large Gua Lou (Trichosanthes Fruit) per dose, plus Dan Pi (Moutan Cortex), E Zhu (Curcuma Rhizome), Wu Ling Zhi (Trogopterus Feces), and Jin Yin Hua (Honeysuckle Flower). All symptoms resolved.
Liangqing's wife suffered from headache and generalized body pain (complicated by Summerheat). Distension affected the chest, back, and breasts; vaginal contraction urgency, and anal pressure (all caused by Liver Fire). Constipation for three days and dry mouth. The onset followed a major frustrating event. Fever resembling malaria appeared in the afternoon, accompanied by nausea, irritability, and restlessness. Given the peak of summer, this was attributed to Anger injuring the Liver, complicated by Summerheat-Fire. Shi Gao (Gypsum) 3 qian, Qing Pi, Chai Hu, and Zhi Ke, each 1 qian, Ban Xia Qu (Pinellia Fermented Paste), and Huang Qin (Scutellaria Root), each 8 fen, Gan Cao (Licorice Root) and Jie Geng (Platycodon Root), each 5 fen, were decocted. At night, Dang Gui Long Hui Wan was administered to purge. Bowel and urinary functions cleared, fever subsided, and symptoms largely resolved. Only slight nausea remained, which was cured with two doses of Qing Pi Yin (Green Tangerine Peel Decoction).
Cheng Xiang's wife experienced dizziness and tinnitus after epistaxis, vomiting of clear fluid, sleeplessness, and hunger without ability to swallow. Sun Wen Yuan attributed this to Spleen deficiency with stagnant Fire in the Liver and Gallbladder. Ren Shen (Ginseng Root), Huang Lian (Coptis Rhizome), Bai Zhu (Atractylodes Rhizome), Bian Dou (Lablab Bean), Gan Cao, Chen Pi (Tangerine Peel), Ban Xia (Pinellia Tuber), Zhu Ru (Bamboo Shavings), Fu Ling (Poria), and Shi Gao were decocted, leading to recovery.
Huang Lv Su stated: "In my youth, I suffered from Stagnant Fire syndrome, characterized by occasional facial redness and heat, cool hands and feet, dry throat and mouth, slight yellowing of the body, worsening at night. Seeking treatment in Wu men, a crude physician prescribed Huang Lian, Huang Qin, and Huang Bo. After two doses, my hands and feet became extremely cold, spreading past wrists and knees. Cold air seemed to emanate from my nose, and my spirit felt as if falling from a high bridge into a deep abyss, shivering uncontrollably, nearly dying. I sought the famous physician Zhang Lianshui. Zhang said, 'Although the condition resulted from mistaken cold herbs, sudden use of hot herbs is also dangerous. Take Ba Zhen Tang (Eight-Treasure Decoction) with Ginger and Tian Ma (Gastrodia Rhizome); it will heal over time.' Following this regimen, although I gradually stabilized, my Yuan Qi was significantly depleted. Later, consulting medical texts, I found the statement: 'Stagnation should not be broken with cold agents; mistreatment leads to death.' Thus, my survival was fortunate. I record this as a warning."
Pan Xun stated: "My constitution is naturally prone to Fire. In my later years, facing difficulties, I harbored depression, causing Liver Qi imbalance, rushing upward to the Heart and Lungs, preventing the interaction of Water and Fire. Lacking appropriate medicine, I formulated a prescription named Jian Zhi Wan (Simultaneous Restraint Pill). It contains Chai Hu, Long Dan Cao, and Qing Pi (each 5 qian) to calm the Liver; Dang Gui Shen (Angelica Body) 1 liang to nourish the Liver; Sheng Di Huang (Rehmannia Root) 1 liang, Sheng Gan Cao (Raw Licorice) 5 qian, Huang Bo, and Zhi Mu (each 5 qian/1 liang respectively) to tonify the North (Kidney); Cang Zhu (Atractylodes Lancea Rhizome) 8 qian to dry Dampness; Huang Qin and Huang Lian (each 6 qian) to clear Heart and Lung heat; Gui Xin (Cinnamon Heart) 2 qian to guide the herbs; plus Bai Zhu, Fang Ji (Stephania Root), Chen Pi, and Fu Ling, prepared as honey pills. Each dose consists of eighty pills. Regular use proved effective. (From *Chu Ji Shi*.)"
Commentary: Comparing the cases of Huang and Pan, both involve Stagnant Fire. One nearly died from bitter-cold herbs; the other recovered with them. Ultimately, individual constitutions differ, and Yin-Yang balances vary. Clinicians should not adhere rigidly to fixed methods.
Gong Zicai treated the wife of Scholar He, who suffered from epigastric pain during menstruation, aversion to cold, and fever. A physician prescribed Si Wu Tang (Four Substance Decoction) with Guan Gui (Cassia Twig) and Xiang Fu (Cyperus Rhizome). After ingestion, she vomited blood, and pain worsened. Pulse diagnosis revealed six rapid and surging pulses, indicating Stagnant Fire. Shan Zhi (Gardenia Fruit) 2 liang, stir-fried with Ginger Juice until black, was administered, resulting in immediate cure.
Feng Chuzhan treated a young man who, frustrated in his official career, retired and fell ill due to depression. This corresponds to the Classic's description of "De Ying" (Loss of Vitality) for those who were once noble but became humble, and "Shi Jing" (Loss of Essence) for those who were once wealthy but became poor. His Qi and Blood diminished daily, his Spirit did not manifest outwardly, and his six pulses were wiry, fine, and choppy. Food entering the stomach transformed entirely into Phlegm, requiring expectoration before he could lie down. Internal depletion of fluids and external疏 (looseness) of the skin surface caused aversion to cold and emaciation. Ren Shen (Ginseng) was used as the Sovereign herb to preserve Yuan Qi and consolidate the Middle; Huang Qi (Astragalus Root) as the Minister to assist the Exterior and protect Wei Qi; Dang Gui (Angelica Root) to harmonize and nourish Qi and Blood; Bai Zhu to assist the Spleen in overcoming Dampness; Mai Dong (Ophiopogon Tuber) to protect Lung Qi; Wu Wei Zi (Schisandra Berry) to收敛 (astringe) dissipating Metal; and Zhi Gan Cao (Honey-fried Licorice) to harmonize properties and tonify the Spleen, serving as Assistants. Gui Zhi (Cinnamon Twig), with its pungent-sweet nature, harmonizes Ying and Wei, warms muscles, and reaches the exterior; Ma Huang (Ephedra Stem), light and potent, leads the group of herbs through the skin and hair, driving out latent Yin-congealing Phlegm and transforming it into Yang-harmonizing fluids, serving as Envoys. However, fearing the pungent and acrid nature of Ma Huang and Gui Zhi might consume Ying-Yin, Bai Shao (White Peony Root) was added to soothe the Liver and inhibit their harshness. Additional Bai Zhu consolidates the Middle, while Ginger and Jujube assist the Spleen in generating fluids. After two or three doses, the pulse became full and spirited, and phlegm coughing ceased. Subsequently, Shi Bu Wan (Ten Tonics Pill) and modified Gui Pi Yang Rong (Restore Spleen and Nourish Ying) formulas led to complete recovery.
Lu Dongzhuang treated Bian Yu, who initially had alternating chills and fever, which progressed to persistent fever and chest nausea. Diagnosis indicated Liver Stagnation leading to External Contraction. Modified Xiao Chai Hu Tang (Minor Bupleurum Decoction) was prescribed, reducing fever by half after one dose. Next, Chai Hu Yin (Bupleurum Drink) and Di Huang Yin Zi (Rehmannia Decoction) were administered. Lu was away, and the subsequent day, Liu Jun Zi Tang (Six-Gentleman Decoction) with Huang Qin was used. Lu advised, "If slight internal heat remains tomorrow, use Di Huang Yin Zi the day after, followed by Liu Jun Zi. The sequence must not be disrupted." Due to taking Di Huang Yin Zi, the heat fully subsided, leading to the use of Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). That night, he experienced irritability and restlessness, confirming the sequence was crucial. Resuming Di Huang Yin Zi brought peace. Following the sequence until the third day, Bu Zhong Yi Qi Tang was used successfully. However, post-illness irritability and weakness led him to self-prescribe Gui Pi Tang (Restore Spleen Decoction). Upon Lu's return, he noted the pulse was normal but insomnia persisted. Lu prescribed Modified Gui Pi Tang. The patient claimed prior ineffectiveness. Lu insisted, "Try my modification." One dose resulted in sound sleep until dawn. (Must remove Yuan Zhi and Mu Xiang, add Di Huang, Mai Dong, and Bai Shao.)
Commentary: For such illnesses, I typically prescribe Di Huang Yin Zi for five to seven doses, ensuring no further complications. Why insist on Liu Jun Zi, Bu Zhong Yi Qi, and Gui Pi Tang, causing confusion? This reflects a rigid adherence to Li Zhai's established methods.
Madam Shen developed chills and fever in summer. Physicians diagnosed Malaria. Her menstruation had just begun, resulting in continuous dripping, leading to a diagnosis of Heat Entering the Blood Chamber. Several doses of medication intensified chills and fever, increased menstrual flow (dark purple or like spoiled sauce). Physicians claimed symptoms would worsen before improving. Suspecting this, she consulted Lu. She was too weak to sit up, with a fine, rapid pulse barely perceptible. Chills and fever occurred from Wei/Shen hours (1-5 PM) to Zi/Hai hours (9 PM-1 AM). Lu diagnosed it as Deficiency Syndrome with Stagnant Fire. Reviewing previous prescriptions, Xiao Chai Hu Tang was used for alternating chills/fever and Heat Entering the Blood Chamber. Adding a large handful of Xiang Ru (Mosla Herb) suggested suspicion of Summerheat-toxin Malaria. Lu laughed, stating, "Heat Entering the Blood Chamber occurs when menstruation begins and heat prevents flow, requiring cooling resolution. Here, bleeding continues, and lower abdominal pain exists, unrelated to this syndrome. Why administer Huang Qin? Even if confirmed as Heat Entering the Blood Chamber, blood-invigorating and meridian-unblocking herbs should be added. What purpose does a handful of Xiang Ru serve?" Lu prescribed Rou Gui (Cinnamon Bark) 2 qian, Bai Zhu 4 qian, Pao Jiang (Prepared Ginger) 2 qian, Dang Gui and Bai Shao, each 3 qian, Ren Shen 3 qian, Chen Pi and Gan Cao, each 4 fen. One dose stopped pain and bleeding, eliminated chills/fever, and five doses enabled sitting up. Occasional sole pain indicated excessive blood loss injuring Liver and Kidney. Du Qi Yin Zi (Du Qi Drink) with Rou Gui and Niu Xi (Achyranthes Root), each 1 qian, achieved full recovery. Had cold-cooling herbs been administered abruptly, heavy Yin would have pressed downward, freezing life force and causing death within seven days. Claiming worsening before improvement is deception! How mediocre and reckless physicians evade responsibility and attack aggressively!
Zhu Qi, prone to anger and depression, compounded by internal illness and worry, fell ill. Initial chills and fever (Shaoyang syndrome) progressed unresolved. In mid-winter, doctors prescribed Jiu Wei Qiang Huo Tang (Nine-Ingredient Notopterygium Decoction) without effect. Changing physicians, aggressive exterior-releasing and middle-clearing herbs were used, including harsh ingredients, forming a chaotic prescription. Three doses worsened the condition. Further administration of Da Huang (Rhubarb) and purgatives resulted in passing several sheng of black water, leading to high fever, mania, coma, and vomiting upon drinking. Family tried Ren Shen Tang (Ginseng Decoction), which he accepted, reviving him from near-death. The next day, Lu arrived; he was still confused and unconscious. Swelling and sores appeared at Cheng Ling (beside Tong Tian acupoint on vertex), Zheng Ying (beside Cheng Ling), and Chang Qiang (below Yao Shu acupoint on sacrum), with constant agitation. Pulse was rapid and large. Lu said, "Fortunately, the pathogen has not collapsed inward; there is hope." Heavy doses of Ren Shen, Huang Qi, Dang Gui, and Bai Zhu, plus 1 liang of Shu Di Huang (Prepared Rehmannia Root), were used. A village doctor present wanted to administer Lian Qiao (Forsythia) and Ci Ji (Thorns) for detoxification, strongly opposing Shu Di Huang. The family followed Lu's advice. That night, he slept; by morning, his mind cleared. He said, "I didn't understand why I lay here before; now I know the illness, feeling like waking from a dream." The next day, rapid pulse subsided, and irritability calmed. Appetite remained poor, and sores interfered. For ten days, maintaining this prescription cured all symptoms. Lu explained the modifications, warning, "Do not use Qi-breaking herbs to open appetite, bitter-cold herbs to descend fire, purgatives to open the rear, or detoxifying herbs to reduce swelling. Any of these would be fatal." Leaving the county, he met a friend asking about the illness. Lu explained, "Seven emotions injured internally, external pathogens exploited this, injuring Jueyin and contracting Shaoyang, following their kind. Ignoring meridians and indiscriminately releasing the exterior exhausted the Three Yang. However, the pathogen had not entered the Fu organs. Switching to Zhi Shi (Immature Bitter Orange), Hou Po (Magnolia Bark), Shan Zha (Hawthorn), and Gua Lou (Trichosanthes Fruit) allowed the pathogen to enter the Two Yang. Yin was still unaffected, but Da Huang and Yuan Ming Fen (Mirabilite) injured the Three Yin. Ultimately, the original pathogen could not exit externally, turning inward, meeting Cold rejection in the Middle. Fortunately, Ginseng supported Stomach Qi, driving the pathogen out. Sores at Cheng Ling and Zheng Ying represented undischarged stagnant Fire of the local meridian; sores at Yao Shu and Chang Qiang resulted from lower injury to Extreme Yin, congealing into toxicity. The release of toxicity was due to Ginseng's merit. Current numbness and flatness of sores, requiring future regulation, is the harm of previous medications." The family followed precautions, and he recovered.
Zhang Luyu treated the second daughter-in-law of Jiang Like, who in early spring suffered from fever, headache, abdominal pain, retching without phlegm, and purple-black painful fingers. Exterior-releasing and Qi-smoothing herbs failed. Pulse was wiry, rapid, fine, stronger on the Left than Right. Zhang stated, "Uncomfortable emotions caused Liver Fire to stagnate and invade Spleen Earth, causing fever; heat steaming the Lungs causes cough; since Lungs are inherently dry, there is no phlegm; Spleen suffers Wood oppression, causing abdominal pain; Yang Qi cannot diffuse, causing headache; limbs are the root of all Yang; Yang Qi failure leads to Qi stagnation and Blood stasis, causing finger pain and discoloration. Wiry pulse indicates Liver; rapid indicates Fire; fine indicates Fire stagnating in Blood level." Modified Xiao Yao San (Free and Easy Wanderer Plus Decoction) with Gui Zhi (Cinnamon Twig) to reach Wood from Earth was prescribed. After three doses, symptoms vanished, and fingers returned to normal color.
Consort Xu's wife suffered from insomnia, anorexia, mental vagueness, slight cold limbs, hot sweaty palms, evening throat heat with phlegm, and intermittent ear blockage. Calming and heat-clearing herbs failed. Pulse was thread-like, wiry, and rapid, indicating long-term Middle Qi stagnation and deficient Fire flaming upward. Although Gui Pi Tang should tonify Heart and Spleen deficiency, chronic deficient Phlegm and Yin Fire could not tolerate the cloying nature of Ren Shen/Huang Qi or the dryness of Mu Xiang. Thus, Wu Wei Yi Gong San (Five-Ingredient Extra-Efficacy Powder) was used, slightly modified with Dang Gui, Bai Shao, and Rou Gui to harmonize Yin and guide Fire. After a few doses, appetite improved, sleep normalized, and symptoms resolved.
Zhang Feichou treated a woman with easily ascending deficient Fire. Unexpressed anger caused abdominal fullness, reduced appetite, acid regurgitation, alternating cold/heat in head/face/extremities, periodic lower abdominal soreness, and amenorrhea for over half a year. Pulse was vague, rapid, and powerless. Qi-breaking, Qi-descending, and Blood-moving herbs failed. This was suppressed anger injuring the Liver, with Liver Fire exploiting deficiency to oppress Spleen Earth. Spleen oppression prevented distribution of Great Qi in the chest, which scattered with Liver Fire throughout the body. Qi rises with Dampness; Dampness dries from Fire. Only when the Sun shines do shadows disperse; only when True Fire governs does stagnant vapor subside. With fire under the pot, food digests; digestion empowers Spleen/Stomach, restoring Great Qi and curing symptoms. Raw Ba Wei Wan (Eight-Ingredient Pill) with doubled Rou Gui and Fu Zi was used. After ten days, temperature fluctuations ceased. Intermittent Yi Gong San widened the middle and improved appetite. Two months of regulation restored menstruation and health.
Chai Yuqing treated the mother of the Prefect of Tongchuan, aged eighty-three. While in the Ministry of Rites in Shenyang, she heard her mother in Beijing was critically ill. Suddenly, she developed fever, phlegm, delirium, and confusion. Physicians advocated exterior release, worsening the condition. She sought treatment, weeping and despairing of death. Right Guan pulse was deep, choppy, and slightly slippery. Chai diagnosed: "Worry injures Spleen, compounded by stagnation, leading to abundant Phlegm-Saliva and Spleen failure to transport. Fever and confusion indicate failing Clear Yang and damaged Spleen Qi." Er Chen Tang (Two-Aged Decoction) and Gua Lou were used first to treat the branch. Then, Gui Pi Tang with Shen Qu, Ban Xia, and Chai Hu was used for several days, resulting in recovery. Had exterior-releasing herbs been mistakenly used, it would have violated the ancient warning against treating deficiency with draining methods.
Lin Suchen of Shanyin contracted a seasonal pathogen, mistreated by physicians, resulting in fever, vomiting of green water, and restlessness. Chai attributed this to Liver Stagnation, prescribing Xiao Yao San with Wu Zhu Yu (Evodia Fruit)...