愚按伤寒为外感。杂病为内伤。今昔诸贤。论之详矣。谫劣如余。不必复赞一词也。虽
然外
感由于六气外侵。内伤由于五脏自病。愚以为六气之入。未有不先于元气虚弱。以致卫气不
能卫外。而任邪气侵卫。营气不能营内。而任邪气攻内也劳倦不能耐。则肺之元气虚。思虑
不能周则心之元气虚。饮食不能运。则脾之元气虚。智谋不能决。则肝之元气虚。精血不能
充则肾之元气虚此五脏之内伤也夫人一身阴阳表里经络脏腑总由一气贯通。故气实则五脏亦
实。皮毛便固。六气难侵。气虚则皮毛并虚。六气虽不入。而五脏自生招感。古人谓肝虚风
自生。肾虚寒自生。义可见矣。顾安得以阴阳表里。经络脏腑。而岐视之乎。奈何学人不察
。乃以外感内伤。分为两科。是将分一人而为两身。则天地可不必交泰。水火可不必既济。
人身气血便不必相根据附矣。于是专伤寒者昧于杂病。专杂病者昧于伤寒。一遇伤寒似杂病者
治以杂病之药。杂病似伤寒者治以伤寒之药。不几谬妄颠倒。杀人反掌乎。此古今所通病。
而缓扁所莫疗。余曰治固可分而术则当兼习者也留心斯道者识之。勿以为业不专门者不精。
甲申季春侍御曾儆炫次子奕昭。年四旬。素恋帏幕。复因丧子悲郁。病两载。治疗增剧
。至
念七日。延余见其面黯无光。头颅俯垂。或语微喜睡。饮食少思。或两足痿软。大便滑泄。
小水清利。外症则头疮未愈。脉六部沉迟不鼓。左关沉涩。左尺兼缓。脾脉亦弦此为阳虚已
极法应益火之源以消阴翳及阅所服方案。大都皆归芍枣仁苡薏威灵仙黄柏知母诸品。余曰病
本起于肝肾两虚。即勤加峻补。犹虑不济。奈何反以苦寒败胃滑肠耗气之物。大泄真阳乎。
夫面黯无光。头颅俯垂。乃阳气不能上温而复下陷也。语微喜睡。乃阳气不能升发也。饮食
少思。乃脾败于寒剂。而胃气虚寒。不能健啖也。两足痿软。乃筋脉缓弛。肝气不收也。二
便滑利。乃命门火衰不能温土。肾气虚寒不能约液也。疮口不合。乃脾气败也。脉沉迟不鼓
。则为元气衰左关沉涩受克于金右关弦受克于木左尺虚缓则为土克断以季夏初秋当不起与其
弟奕远言曰脉见三克。若不急治。何以回生。备开一案。与之为券。余用补中益气汤。去升
麻陈皮倍人参。加桂附炮姜骨脂五味与服。四剂泄数渐少脉亦稍健。仍授方以八味丸去泽泻
加人参炙草阿胶五味诸品。彼已市药待制。其乃内以余所开医案。往询前医。医谓余妄用燥
药。仍根据前治至六月十二日而殁。乙酉季夏姻家陈泰宇年逾六旬。病虚喘吐痰。自汗倦卧。
不进饮食。多食便呕。小便清长。大便滑泄。面青黯。形肉日脱脉左三部虚浮无力。右关尺
弦小余以为命门火衰阳气脱陷真藏脉见逢土堪忧勉进六君加姜桂。丸八味。初剂症亦减。数
剂如旧。遂辍服。至月终渐笃。仍投前药一二剂。越次月初四日复再延余脉益少胃气。用大
剂参 术归桂附毫不应断以越三旬当殁。令二子备后事。彼别延一医。病余用桂附误认为痰
火实症。投清气化痰麦冬栝蒌之类。初服顿觉胸次豁然。连三服竟完谷吐出。益增昏 。且
勒金酬券。再请陈雪潭用益土药。犹庶几近之。即知补母。亦迟不及事。果以是月念八日而
终。先是五月内过余求诊。令急服补药。乃因循增剧。始延治。晚矣。愚按前症乃命门火衰
不能生脾土以致脾土不能生肺金夫多食便呕。形肉日脱。自汗吐痰。大便滑利皆土败金亏真
藏为患此时即恪服虚则补母之剂。犹虑不济。奈何误认为实则泻子。而用清金安得不速人于
毙乎。又每见世医一遇痰症。不分虚实。执以为火。动手便攻。而病家亦甘心自误。然痰有
热痰寒痰风痰湿痰酒痰血痰气痰惊痰食痰老痰新痰。有属肾津上溢。脾液上涌泛而似痰者。
郁火
上升者。属饮属涎。若咯若唾若咳若吐。病源非一皆不可不详为辨仍察其所兼何症此为第一
吃紧庶几施治非谬即吐痰一症未有不由于元气虚寒。命火衰微所致。投以四神八味之属
。急
资化源。或克有济者。敬附录先哲经验数案于后。取其大法。以告世之医病两家。治病当求
其本。勿徒徇现下之症。而漫投不切之剂。抑亦以破时师拘挛之见。按薛立斋先生曰一儒者
虽盛暑喜燃火。四肢尝欲沸汤渍之。而面赤吐痰。又似实火吐甚宿食亦出。惟食椒姜之物方
快。余谓食之反出。乃脾胃虚寒。用八味丸及十全大补。加炮姜渐愈。不月而康。又曰工部
陈禅林。发热有痰。服二陈黄连枳壳之类。病益甚。甲辰季冬请治其脉右尺微细。右关浮大
。重按微弱。余曰此命门火衰。不能生土而脾病当补火以生土。或可愈也。不悟。仍服前药
。脾土愈弱。至乙巳闰正月病已革。复邀治。右寸脉平脱。此土不能生金。生气绝于内矣。
辞不治。经云虚则补其母实则泻其子凡病在子当补其母况病在母而属不足反泻其子不死何待
又云光禄邝子泾面白。神劳。食少难化。所服皆二陈枇栀枳实之类。形体日瘦。饮食日减。
余谓此脾胃虚寒之症。法当补土之母。彼不信。乃径补土。以致不起。又云表弟妇咳嗽发热
。呕吐痰涎。日夜约五六碗。喘咳不止。胸满燥渴。饮食不进。崩血如涌。此命门火衰。脾
土
虚寒。用八味丸及附子理中汤加减治之而愈。又云罗工部仲夏腹恶寒而外恶热。鼻吸气而腹
觉冷体畏风而恶寒。脉大而虚微。每次进热粥瓯许。必兼食生姜瓯许。若粥离火食。腹内即
冷。余曰热之不热。是无火也。当用八味丸益火之源。以消阴翳。彼反服四物玄参之类而殁
。又云一儒者体肥善饮。仲秋痰喘。用二陈芩连益甚。加桑皮杏仁盗汗气促。加贝母枳壳。
不时发热。余以为脾肺虚寒用八味丸以补土母。补中益气汤以接中气而愈又云都宪孟
有涯气短痰晕服辛香之剂痰盛遗尿。两尺浮大。按之如无。余以为肾家不能纳气归源。香燥
致甚耳。用八味丸料三剂而愈。又云一男子素浓味胸满痰盛。余曰膏粱之人。内多积热。与
法制清气化痰丸而愈。彼为有验。修合馈送。脾胃虚者无不受害。又云先兄体貌丰伟。唾痰
甚多。脉洪有力。殊不耐劳。遇风头晕欲仆。口舌欲裂。或至赤烂。误食姜蒜少许。口疮益
甚。服八味丸及补中益气加附子钱许。即愈停药月余。诸症仍作。此命门虚火不归原也。以
上十条。盖立斋先生治命门火衰吐痰虚症也。其治阴虚诸痰。亦晰治甚良。夫先生一代医圣
。千载宗工。叨侥武世两庙宸眷最渥。时工部陈禅林光禄邝子泾罗工部诸君。尚违先生之治
。甘心任时师攻伐丧生。余可知矣自王节斋老痰丸。王隐君滚痰丸之论一出。举世争相艳习
，罔顾败胃泻阳。无辜生灵。殒命于二王作俑。可胜哀悼。然二王之法。只可投于元气壮实
。积热为患者。暂用亦得见效也。故汴督学西衢叶敬君先生序类经文云。余初与景岳交。自
癸卯岁始。余以苦心诵着。耗脾家之思虑。兼耗肾家之伎巧。于是病泄泻者二十年。医家
咸
以为火盛。而景岳独以为火衰。遂用参术桂附之剂。培命门之火。而吠者竞起。余独坚信不
回。服之五年不辍。竟使前病全瘥。而脾肾还元。余之敢于多服者胆力之决断也。景岳之敢
于多用者识力之明透也。非景岳不能有此识。非余不能有此胆。余两人之相与亦奇矣。嗟乎
欲治命门而舍桂附。非其治也而先生所云吠者竞起。则时名诸医竟不知命门为何物乃谓久泻
属火盛谬滋大矣而余之治曾奕昭陈泰宇。以补母之药。反贻同道之诮。不亦宜乎夫先生以吠
喻时名之医。虽其言固太峻。而揆之情理。殊为恰当。但愚以为应用桂附而不用桂附与不应
用桂附而妄用桂附皆吠之属也应用而不用则为胆小无识而误人不应用而妄用则为胆大逞臆而
害人误人而因循致死。与害人而逼迫随亡。均有罪耳。今之医者不明阴阳水火虚实真
假之义。而只见病治病纵巧可猎虚声。术足弋实利。口给求售。喜动王公。架列百氏之书。
日应千人之请。吾恐开口便错。庸妄取罪不能免已。陶节庵有云杀人不用刃者。政此谓欤。
大要病之轻而缓者。固可投以和平之剂优游取效而症之重而速者生死呼吸亦犹迂缓漫视坐失
机宜可乎临病之工不可无此一 胆识庶无负司命之责云尔。
甲申孟春万兵周开夫年逾六旬。初因 捧之役。修途中湿。归病疮疡。延外科投清火寒
剂。
竟至败胃便脱方悟。服益火药渐愈。嗣因奉委夜巡。复感风寒。呕痰少食。请余诊视。六脉
弦实。右关尺弦细。余曰此非痰乃脾气败而津液上脱也断以难越三月。至二月中旬果殁。愚
意疮疡诸疾。悉属脏腑有伤。显症于外。故薛立斋先生谓十三科皆是一理。因见外科之医。
固执局方。不循表里虚实经络脏腑之宜而误人者众。遂大发所蕴。皆内外合一之道。对症处
方
。随手而愈。世人奈何视疮疡为纤 罔顾虚实。轻服凉剂。甘以性命陷于粗工之手。可不戒
乎。
壬午冬犹子望久患疥疮频年治疗不瘥。一疡医令吞水火丹。正在升炼。余见之曰用此将
求死
乎。夫水银性至沉寒。假以烈火 炼。转为燥毒之物。柔弱肠胃。能堪此销烁耶。若辈谬妄
伤人。即寸磔不足以尽其辜矣。余教服六味丸。不终剂而愈。此盖立斋先生治法也。诸家
方书。皆指疥癣为阳明经湿热之病独先生则归本于足少阴谓系肾经虚热所致如此卓识洵越千
载而上之矣。
癸未夏连参天从母一婢足面生疮。经年恪服解毒寒剂。且令足心频践砖石。竟不敛口。
余见
其头倾面黯。谓连曰。死期近矣。察其脉症胃败便脱。断以入秋当殁。已而果然。大都一
切疮疡皆属足三阴血虚所致至疮口不合乃脾气败也纵初起毒盛热炽。察果体实气旺。消解凉
药。只宜暂投。少俟热势稍退。即当以益气补血健脾为主。脾气充则肌肉自生。阴血旺则旧
瘀自消。无有不瘥。何至丧生。
癸未春庆城郑姻亲之内。年逾四旬。怀抱郁结。呕痰少食。胸腹疼胀。虽盛暑犹裹首着
绵。
六脉浮结。或时烦渴不寐。余曰。此命门火衰。元气虚寒症也。投以六君加姜桂及八味丸与
服。彼能恪遵余法。不惑于众论。周两月而诸症全瘥。
我考察认为，伤寒属于外感病。杂病属于内伤病。古今各位贤达对此论述得非常详细了。像我这样浅薄低劣的人，不必再赘述一言了。虽然如此，外感是由于六气（风、寒、暑、湿、燥、火）从外部侵袭所致，内伤是由于五脏自身病变引起。我认为六气入侵，没有不是先因为元气虚弱，导致卫气不能护卫体表，从而任由邪气侵犯卫分；营气不能滋养体内，从而任由邪气攻伐内脏的。劳倦过度无法承受，则肺的元气虚弱；思虑过度无法周全，则心的元气虚弱；饮食无法正常运化，则脾的元气虚弱；智谋决断无法果断，则肝的元气虚弱；精血无法充盈，则肾的元气虚弱。这五种脏器的内部损伤就是内伤。人的一身，阴阳、表里、经络、脏腑，总由一气贯通。所以气实则五脏也实，皮毛就坚固，六气难以侵袭；气虚则皮毛也虚，六气即使不进入，五脏也会自己产生招感。古人说肝虚风自生，肾虚寒自生，道理由此可见一斑。怎么可以将阴阳表里、经络脏腑区别看待呢？无奈学习医学的人不加考察，竟然将外感和内伤分为两个科目，这是将一个人分成两副身躯，那么天地就不必交泰，水火就不必既济，人身的气血就不必相互依附了。于是专攻伤寒的人不懂杂病，专攻杂病的人不懂伤寒。一遇到像杂病的伤寒，就用治杂病的药治疗；像伤寒的杂病，就用治伤寒的药治疗，这不简直是谬妄颠倒，在手掌翻转之间杀人吗？这是古今通病，即使是扁鹊也无法医治。我说：治疗固然可以区分，但医术应当兼修精通。留心此道的人要认清这一点，不要以为专业不专门就不精通。
甲申年季春，侍御曾儆炫的次子奕昭，四十岁。平素留恋帷帐（指生活安逸、缺乏运动），又因丧子悲伤抑郁，患病两年，治疗反而加重。到第七天，请我去诊视。见他面色黯淡无光，头颅低垂，说话声音微弱且喜欢睡觉，饮食很少想吃，有时两足痿软无力，大便滑泄不禁，小便清长通畅。外在症状则是头疮未愈。脉象六部沉迟且不鼓动，左关脉沉涩，左尺脉兼缓，脾脉也弦。这是阳虚到了极点，法度上应当益火之源以消除阴翳（温补肾阳以驱散阴寒）。及至查阅他所服用的方案，大都是当归、白芍、枣仁、薏苡仁、威灵仙、黄柏、知母等药物。我说：病本起于肝肾两虚，即使勤加峻补，还担心不够，怎么能反而用苦寒败胃、滑肠耗气的药物，大大泄掉真阳呢？面黯无光是阳气不能上温而向下陷落的表现；说话微弱喜欢睡觉，是阳气不能升发的表现；饮食少想，是因为脾胃被寒凉药剂败坏，胃气虚寒，不能健旺进食；两足痿软，是因为筋脉缓弛，肝气不收摄；二便滑利，是因为命门火衰不能温煦脾土，肾气虚寒不能固摄津液；疮口不合，是因为脾气败坏。脉沉迟不鼓动，说明元气衰微；左关沉涩，受金克；右关弦，受木克；左尺虚缓，则为土克。断定他在季夏初秋时节当不起病。我对他的弟弟奕远说：脉象出现三克，如果不紧急治疗，如何能回生？于是备开一个医案，作为凭证给他。我使用补中益气汤，去掉升麻、陈皮，加倍人参，加入肉桂、附子、炮姜、骨脂、五味子服用。四剂后腹泻次数逐渐减少，脉象也稍微强健。仍然授方用八味丸，去掉泽泻，加入人参、炙甘草、阿胶、五味子等品。他已经买好药物等待煎制，却拿出我所开的医案，去询问以前的医生。医生说我是妄用燥药，仍然按照之前的方法治疗。到六月十二日去世。
乙酉年季夏，姻亲陈泰宇，六十多岁。患虚喘吐痰，自汗倦怠卧睡，不进饮食，多吃就呕吐，小便清长，大便滑泄，面色青黯，形体肌肉日渐消瘦。脉象左三部虚浮无力，右关尺弦小。我认为这是命门火衰，阳气脱陷，真脏脉出现，逢土气旺盛令人担忧。勉强进服六君子汤加干姜、肉桂，以及八味丸。初服药症候也减轻，几服药后恢复原状，于是停止服用。到月底病情逐渐加重，仍投前药一二剂。过了次月初四日，再次请我诊视。脉象更加缺少胃气，我用大剂量人参、白术、当归、肉桂、附子，完全无效。断定他超过三十天将会死亡，让两个儿子准备后事。他另外延请一位医生，医生认为我误用桂附，将其认定为痰火实证，投用清气化痰丸、麦冬、瓜蒌之类。初服顿时觉得胸膈豁然开朗，连服三剂竟将完谷吐出，更加增加昏愦。并且勒索金钱酬谢契约，再次请陈雪潭用补益脾土的药物，还差不多接近正确。即使知道补母（补脾土之母即补肾水，或此处指补火生土），也来不及了。果然在该月二十八日去世。在此之前五月内，经过我这里求诊，让我急服补药，他却因循拖延导致病情加重，才开始延请治疗，太晚了。我考察前面的病症，乃是命门火衰不能生脾土，以致脾土不能生肺金。那多食便呕、形体肌肉日渐消瘦、自汗吐痰、大便滑利，都是土败金亏、真脏为患。此时即使严格服用“虚则补其母”的药剂，还担心不够，怎么能误认为是实证而“泻其子”，并用清金之法，不加速使人死亡吗？我又常见世间医生一遇到痰症，不分虚实，固执地认为是火，动手就攻伐，而病人也甘心自我误导。然而痰有热痰、寒痰、风痰、湿痰、酒痰、血痰、气痰、惊痰、食痰、老痰、新痰。有属于肾津上溢、脾液上涌泛而似痰的，有郁火上升的，属于饮、属于涎。若咯、若唾、若咳、若吐，病源不一，都不可不详加辨别，还要察看他兼有什么症状，这是第一紧要的。庶几施治不会谬误。至于吐痰这一症状，无不由于元气虚寒、命火衰微所致。投用四神丹、八味丸之类的药物，急切资助化源，或许能有希望。恭敬附录先哲经验数案在后面，取其大法，告知世上的医患两家。治病应当探求根本，不要只顺从眼前的症状，而漫不经心地投用不切实际的药剂。这也是为了破除当时医生拘挛的见解。
按薛立斋先生说：有一位读书人，即使在盛夏也喜欢燃火，四肢常常想用沸水浸泡，而面赤吐痰，又像是实火，吐得很厉害，宿食也出来，只有吃胡椒、生姜的东西才痛快。我说吃了反而吐出，是脾胃虚寒，用八味丸及十全大补汤，加炮姜，渐渐痊愈，不到一个月就好了。又说工部陈禅林，发热有痰，服用二陈汤、黄连、枳壳之类，病更重。甲辰年季冬请我诊治，脉象右尺微细，右关浮大，重按微弱。我说这是命门火衰，不能生土而脾病，应当补火以生土，或许能痊愈。他不醒悟，仍服前药，脾土更弱。到乙巳年闰正月，病已革除，再次邀请诊治，右寸脉平脱，这是土不能生金，生气绝于内了。推辞不治。经云：虚则补其母，实则泻其子。凡病在子当补其母，何况病在母而属不足，反泻其子，不死等什么？又说光禄邝子泾，面白，神劳，食少难化，所服皆二陈汤、枇杷叶、栀子、枳实之类。形体日渐消瘦，饮食日渐减少。我说这是脾胃虚寒之症，法度应当补土之母，他不相信，乃直接补土，以致不起。又说表弟妇咳嗽发热，呕吐痰涎，日夜约五六碗，喘咳不止，胸满燥渴，饮食不进，崩血如涌。这是命门火衰，脾土虚寒，用八味丸及附子理中汤加减治疗而痊愈。又说罗工部，仲夏腹恶寒而外恶热，鼻吸气而腹觉冷，体畏风而恶寒，脉大而虚微。每次进热粥一碗许，必须兼食生姜一碗许，如果粥离火吃，腹内即冷。我说热之不热，是无火也，应当用八味丸益火之源，以消阴翳。他反而服四物汤、玄参之类而死亡。又说一位读书人体肥善饮，仲秋痰喘，用二陈汤、黄芩、黄连益甚，加桑皮、杏仁盗汗气促，加贝母、枳壳，不时发热。我认为脾肺虚寒，用八味丸以补土母，补中益气汤以接中气而痊愈。又说都宪孟有涯，气短痰晕，服辛香之剂痰盛遗尿，两尺浮大，按之如无。我认为肾家不能纳气归源，香燥致甚耳，用八味丸料三剂而痊愈。又说一男子素喜浓味，胸满痰盛。我说膏粱之人，内多积热，给予法制清气化痰丸而痊愈。他认为有效，修合馈赠送人，脾胃虚者无不受害。又说先兄体貌丰伟，唾痰甚多，脉洪有力，殊不耐劳，遇风头晕欲仆，口舌欲裂，或至赤烂。误食姜蒜少许，口疮益甚。服八味丸及补中益气汤加附子钱许，即愈。停药月余，诸症仍作。这是命门虚火不归原也。以上十条，大概是立斋先生治疗命门火衰吐痰虚症的方法。他治疗阴虚诸痰，也辨析治疗得很好。先生是一代医圣，千载宗工，叨扰侥幸武世两庙宸眷最厚。当时工部陈禅林、光禄邝子泾、罗工部诸位君侯，尚违抗先生的治疗，甘心任从时师攻伐丧生，我就可以知道了。自从王节斋老痰丸、王隐君滚痰丸的论调一出，举世争相艳羡习用，不顾败胃泻阳，无辜生灵，殒命于二王作俑，可胜哀悼。然而二王的方法，只可投于元气壮实、积热为患者，暂用也得见效。所以汴督学西衢叶敬君先生序类经文云：我起初与景岳交往，从癸卯年开始。我以苦心诵读著作，耗损脾家之思虑，兼耗肾家之伎巧，于是病泄泻者二十年，医家都以为是火盛，而景岳独以为是火衰，遂用参术桂附之剂，培命门之火，而吠者竞起。我独坚信不回，服之五年不辍，竟使前病全瘥，而脾肾还元。我敢于多服，是胆力之决断；景岳敢于多用，是识力之明透。非景岳不能有此识，非我不能有此胆，我们两人相与亦奇矣。嗟乎！欲治命门而舍桂附，非其治也。而先生所云吠者竞起，则时名诸医竟不知命门为何物，乃谓久泻属火盛，谬滋大矣。而我治疗曾奕昭、陈泰宇，用补母之药，反贻同道之诮，不也是应该的吗？先生以吠比喻时名之医，虽然言辞固太峻，而揆之情理，殊为恰当。但我认为应用桂附而不用桂附，与不应应用桂附而妄用桂附，都是吠之属也。应用而不用，则为胆小无识而误人；不应用而妄用，则为胆大逞臆而害人。误人而因循致死，与害人而逼迫随亡，均有罪耳。现在的医者不明阴阳水火虚实真假之义，而只见病治病，纵巧可猎虚声，术足弋实利，口给求售，喜动王公，架列百氏之书，日应千人之请，吾恐开口便错，庸妄取罪不能免已。陶节庵有云：杀人不用刃者，政此谓欤。大要病之轻而缓者，固可投以和平之剂优游取效；而症之重而速者，生死呼吸，亦犹迂缓漫视，坐失机宜，可乎？临病之工，不可无此一胆识，庶无负司命之责云尔。
甲申年孟春，万兵周开夫，六十多岁。起初因捧之役，修途中湿，归病疮疡，延请外科投清火寒剂，竟至败胃便脱。方悟，服益火药渐愈。嗣因奉委夜巡，复感风寒，呕痰少食，请我诊视。六脉弦实，右关尺弦细。我说这不是痰，乃是脾气败而津液上脱也。断定他难越三月，到二月中旬果然去世。我的意思是疮疡诸疾，悉属脏腑有伤，显症于外。故薛立斋先生说十三科皆是一理。因见外科之医，固执局方，不循表里虚实经络脏腑之宜而误人者众，遂大发所蕴，皆内外合一之道，对症处方，随手而愈。世人奈何视疮疡为纤微，罔顾虚实，轻服凉剂，甘以性命陷于粗工之手，可不戒乎。
壬午冬，犹子望久患疥疮，频年治疗不瘥。一疡医令吞水火丹，正在升炼。我见之曰：用此将求死乎？夫水银性至沉寒，假以烈火锻炼，转为燥毒之物，柔弱肠胃，能堪此销烁耶？若辈谬妄伤人，即寸磔不足以尽其辜矣。我教服六味丸，不终剂而愈。这是盖立斋先生治法也。诸家方书，皆指疥癣为阳明经湿热之病，独先生则归本于足少阴，谓系肾经虚热所致。如此卓识，洵越千载而上之矣。
癸未夏，连参天从母一婢足面生疮，经年恪服解毒寒剂，且令足心频践砖石，竟不敛口。我见其头倾面黯，谓连曰：死期近矣。察其脉症胃败便脱，断定入秋当殁。已而果然。大都一切疮疡皆属足三阴血虚所致，至疮口不合乃脾气败也。纵初起毒盛热炽，察果体实气旺，消解凉药，只宜暂投，少俟热势稍退，即当以益气补血健脾为主。脾气充则肌肉自生，阴血旺则旧瘀自消，无有不瘥，何至丧生。
癸未春，庆城郑姻亲之内，年逾四旬，怀抱郁结，呕痰少食，胸腹疼胀，虽盛暑犹裹首着绵。六脉浮结，或时烦渴不寐。我说：此命门火衰，元气虚寒症也。投以六君子汤加姜桂及八味丸与服。彼能恪遵余法，不惑于众论，周两月而诸症全瘥。
I have observed that Shanghan (Cold Damage) belongs to external contraction diseases, while Zabing (Miscellaneous Diseases) belongs to internal injury diseases. Sages of past and present have discussed this in detail. As a person of shallow ability like myself, there is no need for me to add another word. Nevertheless, external contractions arise from the invasion of the Six Qi (Wind, Cold, Summerheat, Dampness, Dryness, Fire) from outside, while internal injuries stem from pathological changes within the Five Zang organs. I believe that when the Six Qi invade, it is invariably because Yuanqi (Original Qi) is deficient first, causing Wei Qi (Defensive Qi) to fail in protecting the exterior, thereby allowing pathogenic factors to invade the Wei level; and Ying Qi (Nutritive Qi) to fail in nourishing the interior, thereby allowing pathogenic factors to attack the interior. Excessive labor and fatigue that cannot be endured lead to deficiency of Lung Yuanqi; excessive thinking that cannot be managed leads to deficiency of Heart Yuanqi; inability of diet to be transported and transformed leads to deficiency of Spleen Yuanqi; inability to make decisive plans leads to deficiency of Liver Yuanqi; and insufficiency of Essence and Blood leads to deficiency of Kidney Yuanqi. These constitute internal injuries of the five zang organs. The entire body, encompassing Yin and Yang, interior and exterior, meridians and collaterals, and zang-fu organs, is connected by a single Qi. Therefore, if Qi is substantial, the five zang organs are also substantial, the skin and hair become firm, and the Six Qi find it difficult to invade. If Qi is deficient, the skin and hair also become weak; even if the Six Qi do not enter, the five zang organs will generate susceptibility internally. The ancients said that when the Liver is deficient, wind arises spontaneously; when the Kidney is deficient, cold arises spontaneously. This illustrates the principle clearly. How can one treat Yin and Yang, interior and exterior, meridians and collaterals, and zang-fu organs as separate entities? Regrettably, medical practitioners fail to investigate this and divide external contractions and internal injuries into two distinct specialties. This is akin to dividing one person into two bodies, implying that Heaven and Earth need not interact, Water and Fire need not balance, and the Qi and Blood of the human body need not support each other. Consequently, those who specialize in Shanghan lack knowledge of Zabing, and those who specialize in Zabing lack knowledge of Shanghan. When encountering Shanghan that resembles Zabing, they use medicines for Zabing; when encountering Zabing that resembles Shanghan, they use medicines for Shanghan. Is this not a ridiculous inversion, capable of killing someone with a mere flip of the hand? This is a common malady throughout history, incurable even by Bian Que. I say: although treatment can be categorized, medical skills must be comprehensively mastered. Those attentive to this path should recognize this and not assume that specialization guarantees proficiency.
In the late spring of Jiashen year, Zeng Yizhao, the second son of Censor Zeng Jingxuan, was forty years old. He had a lifestyle of indulgence and lacked physical exertion, and following the grief and depression of losing his son, he had been ill for two years, with treatment exacerbating his condition. On the seventh day, I was summoned to examine him. His face was dark and lusterless, his head hung low, his speech was faint and he preferred sleep, he had little appetite, sometimes his legs were flaccid and weak, his stool was slippery and incontinent, and his urine was clear and profuse. Externally, his scalp sores had not healed. The pulse was deep, slow, and non-pulsatile in all six positions; the left Guan position was deep and choppy; the left Chi position was deep, slow, and moderate; and the Spleen pulse was wiry. This indicates extreme Yang deficiency. The therapeutic principle should be to benefit the source of Fire to eliminate Yin shadows (warm and tonify Kidney Yang to dispel Yin cold). Reviewing his previous prescriptions, they mostly consisted of Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Suan Zao Ren (Ziziphi Spinosae Semen), Yi Yi Ren (Coicis Semen), Wei Ling Xian (Clematidis Radix), Huang Bo (Phellodendri Cortex), and Zhi Mu (Anemarrhenae Rhizoma). I said: The root of the disease lies in the deficiency of both Liver and Kidney. Even with vigorous tonification, we might fear insufficiency. How could one instead use bitter-cold herbs that damage the Stomach, cause loose stools, and deplete Qi, thereby severely draining True Yang? A dark and lusterless face indicates that Yang Qi cannot warm the upper body and sinks downward. Faint speech and preference for sleep indicate that Yang Qi fails to ascend and emerge. Lack of appetite indicates that the Spleen and Stomach have been damaged by cold herbs, leaving Stomach Qi deficient and cold, unable to digest food well. Flaccid legs indicate laxity of sinews and vessels due to unrestrained Liver Qi. Slippery bowel movements and urination indicate that Mingmen Fire (Gate of Life Fire) is too weak to warm the Earth (Spleen/Stomach), and Kidney Qi is deficient and cold, failing to consolidate fluids. Non-healing sores indicate failure of Spleen Qi. A deep, slow, non-pulsatile pulse signifies decline of Yuanqi. A deep, choppy left Guan pulse suggests being overcome by Metal; a wiry right Guan pulse suggests being overcome by Wood; a deficient and slow left Chi pulse suggests being overcome by Earth. I predicted he would not survive until early summer. I told his brother, Yi Yuan: With three types of pulse overcoming indicated, if urgent treatment is not administered, how can life be restored? I prepared a prescription as a guarantee. I used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), removing Sheng Ma (Cimicifugae Rhizoma) and Chen Pi (Citri Reticulatae Pericarpium), doubling the dose of Ren Shen (Ginseng Radix et Rhizoma), and adding Rou Gui (Cinnamomi Cortex), Fu Zi (Aconiti Lateralis Radix Praeparata), Pao Jiang (Zingiberis Rhizoma Praeparatum), Gu Zhi (Dictamni Cortex), and Wu Wei Zi (Schisandrae Chinensis Fructus). After four doses, diarrhea decreased gradually, and the pulse became slightly stronger. I continued with Bawei Wan (Eight-Ingredient Pill), removing Ze Xie (Alismatis Rhizoma), and adding Ren Shen, Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle), E Jiao (Asini Corii Colla), and Wu Wei Zi. He had already purchased the medicine but showed my prescription to his previous doctor, who claimed I recklessly used drying/hot herbs and insisted on continuing the previous treatment. He died on June 12th.
In the late summer of Yiyi year, my relative-in-law Chen Taiyu, over sixty years old, suffered from deficiency wheezing and expectoration, spontaneous sweating, fatigue and desire to lie down, anorexia, vomiting after eating, clear and profuse urination, loose stools, cyanotic and dark complexion, and emaciation. The pulse was deficient, floating, and powerless in the left three positions, and wiry and small in the right Guan and Chi positions. I diagnosed this as Mingmen Fire deficiency with Yang Qi escaping and sinking, manifesting as Zang Pulse (True Pulse indicating organ failure), which is ominous when Earth Qi is strong. I reluctantly prescribed Liujunzi Tang (Six-Gentleman Decoction) plus Gan Jiang (Zingiberis Rhizoma) and Rou Gui, along with Bawei Wan. Symptoms improved initially but returned after several doses, leading to cessation of medication. By month-end, the condition worsened. A few more doses of the previous prescription were given. On the fourth day of the next month, upon re-examination, the pulse showed even less Stomach Qi. I prescribed a large dose of Ren Shen, Bai Zhu (Atractylodis Macrocephalae Rhizoma), Dang Gui (Angelicae Sinensis Radix), Rou Gui, and Fu Zi, but to no avail. I predicted death within thirty days and advised his sons to prepare funeral arrangements. Another doctor, believing my use of Gui and Fu was erroneous, diagnosed Phlegm-Fire excess and prescribed Qingqi Huatan Wan (Clear the Qi and Resolve Phlegm Pill), Mai Dong (Ophiopogonis Radix), and Gua Lou (Trichosanthis Fructus). Initially, the patient felt relief in the chest, but after three doses, undigested food was vomited, and confusion increased. He demanded payment and invited Chen Xuetan to prescribe Spleen-tonifying herbs, which might have been closer to the correct approach. However, even knowing to tonify the Mother (Kidney/Spleen relationship contextually implies warming Fire to generate Earth or tonifying Spleen to generate Lung), it was too late. He died on the 28th of that month. Earlier in May, he had visited me seeking consultation, and I advised immediate tonic treatment, but he delayed, worsening his condition. My analysis of these cases is that Mingmen Fire deficiency fails to generate Spleen Earth, which in turn fails to generate Lung Metal. Symptoms like vomiting after eating, emaciation, spontaneous sweating, expectoration, and loose stools indicate failure of Earth and deficiency of Metal, manifesting as Zang Pulses. Even strict adherence to "tonify the mother when deficient" might not suffice. How could one mistakenly diagnose excess and "drain the child," using Lung-clearing methods, thus hastening death? I often see physicians treating phlegm without distinguishing deficiency or excess, stubbornly attributing it to Fire and attacking it, while patients accept this self-mistreatment. Phlegm can be Heat-Phlegm, Cold-Phlegm, Wind-Phlegm, Damp-Phlegm, Wine-Phlegm, Blood-Phlegm, Qi-Phlegm, Shock-Phlegm, Food-Phlegm, Old-Phlegm, or New-Phlegm. It may arise from Kidney fluids overflowing, Spleen fluids surging, or stagnant Fire rising, resembling fluid or saliva. Whether coughed, spat, or vomited, the origins vary and must be distinguished carefully, along with accompanying symptoms. This is crucial. Expectoration is invariably caused by Yuanqi deficiency-cold and Mingming Fire decline. Prescriptions such as Sishen Dan (Four-Spirit Pellet) or Bawei Wan should be used urgently to aid the source of transformation, offering hope. I append several case records of sages below to illustrate general principles for physicians and patients alike. Treatment must address the root, not just current symptoms, avoiding inappropriate prescriptions. This aims to break the rigid views of contemporary doctors.
According to Mr. Xue Lizhai: A scholar, despite midsummer heat, preferred fire and wished to soak his limbs in boiling water, yet had a red face and expectorated phlegm, seemingly Fire-excess. Vomiting was severe, expelling undigested food. Only eating pepper and ginger brought relief. I stated that vomiting after eating indicates Spleen-Stomach deficiency-cold. Using Bawei Wan and Shiquan Dabu Tang (Ten-Agent Great Tonifying Decoction) plus Pao Jiang, he gradually recovered and was healthy within a month. Also, Chen Chanlin of the Ministry of Works had fever and phlegm. After taking Erchen Tang (Two-Aged Decoction), Huang Lian (Coptidis Rhizoma), and Zhi Ke (Aurantii Fructus), his condition worsened. In late winter of Jiachen year, his pulse was micro-fine at the right Chi, floating-large at the right Guan, and weak upon heavy pressure. I diagnosed Mingmen Fire deficiency failing to generate Earth, causing Spleen disease. Tonifying Fire to generate Earth might cure him. He did not heed this, continued previous meds, and his Spleen Earth weakened further. By leap January of Yisi year, his condition deteriorated. The right Cun pulse was flat and detached, indicating Earth failing to generate Metal and vital Qi perishing internally. I declined treatment. The Classic states: "When deficient, tonify the mother; when excess, drain the child." If disease is in the Child, tonify the Mother. How much more so if the Mother is deficient and one drains the Child? Death is inevitable. Also, Kuang Zijing of the Court of Imperial Entertainments had a pale face, mental fatigue, poor appetite, and difficulty digesting. He took Erchen Tang, Pi Pa Ye (Loquat Leaf), Zhi Zi (Gardeniae Fructus), and Zhi Shi (Aurantii Fructus Immaturus). He wasted away. I diagnosed Spleen-Stomach deficiency-cold and advised tonifying the Mother of Earth (Fire/Kidney). He refused, directly tonified Earth, and died. Also, my cousin's wife had cough, fever, vomiting of phlegm/saliva (5-6 bowls/day), continuous wheezing, chest fullness, dry mouth/thirst, anorexia, and uterine bleeding. This was Mingmen Fire deficiency and Spleen Earth deficiency-cold. Treated with Bawei Wan and Fuzi Lizhong Tang (Aconite and Ginger Decoction to Warm the Middle) modified, she recovered. Also, Luo Gongbu had abdominal coldness in midsummer while feeling hot externally, cold abdomen when inhaling through nose, wind aversion, and large-deficient-micro pulse. He needed hot porridge and ginger to prevent abdominal coldness. I said "Heat does not produce heat; there is no Fire." Use Bawei Wan to benefit the source of Fire. He took Siwu Tang (Four-Substance Decoction) and Xuan Shen (Scrophulariae Radix) and died. Also, a fat, drinking scholar had phlegm-wheezing in mid-autumn. Erchen Tang, Huang Qin (Scutellariae Radix), and Huang Lian worsened it. Adding Sang Bai Pi (Mori Cortex) and Xing Ren (Armeniace Semens) caused night sweats and shortness of breath. Adding Bei Mu (Fritillariae Bulbus) and Zhi Ke increased intermittent fever. I diagnosed Spleen-Lung deficiency-cold, used Bawei Wan to tonify the Mother of Earth, and Buzhong Yiqi Tang to support Middle Qi, resulting in recovery. Also, Chancellor Meng Youya had shortness of breath, phlegm-dizziness, and urinary incontinence after taking acrid-aromatic herbs. Pulses at both Chi positions were floating-large but empty upon pressure. I diagnosed Kidney's failure to grasp Qi, exacerbated by aromatic-drying herbs. Three doses of Bawei Wan material cured him. Also, a man fond of rich foods had chest fullness and phlegm. I diagnosed internal accumulated heat due to rich diet, treated with processed Qingqi Huatan Wan, and he recovered. He shared this remedy, harming those with Spleen-Stomach deficiency. Also, my elder brother had abundant phlegm, forceful pulse, intolerance to effort, dizziness upon wind exposure, cracking/redness of mouth/tongue. Mistakenly eating ginger/garlic worsened mouth ulcers. One qian of Bawei Wan plus Buzhong Yiqi Tang with Fu Zi cured him immediately. Symptoms returned after stopping meds for a month. This is Mingmen Deficient Fire failing to return to its origin. These ten cases illustrate Mr. Lizhai's treatment of Mingmen Fire deficiency with phlegm/deficiency. His treatment of Yin-deficiency phlegm was also excellent. Mr. Lizhai is a medical sage. Yet contemporaries like Chen Chanlin, Kuang Zijing, and Luo Gongbu ignored his advice, succumbing to aggressive treatments by contemporary doctors. Since Wang Jiezai's Laotan Wan and Wang Yinjun's Guntan Wan were published, everyone imitated them, damaging Stomach Qi and draining Yang, causing countless deaths. Their methods are only suitable for robust individuals with accumulated heat, for temporary use. Mr. Ye Jingjun of Bian Prefecture wrote in his preface: I met Jingyue in Gui Mao year. I exhausted Spleen and Kidney Qi through study, suffering chronic diarrhea for twenty years. Doctors attributed it to Fire-excess; Jingyue attributed it to Fire-deficiency, prescribing Ren Shen, Bai Zhu, Rou Gui, and Fu Zi to tonify Mingmen Fire. Critics arose, but I trusted him, taking it for five years until cured and Spleen-Kidney restored. My courage lay in boldness; Jingyue's in insight. Neither could exist without the other. Alas! Treating Mingmen without Gui and Fu is incorrect. The critics' barking shows ignorance of Mingmen, wrongly attributing chronic diarrhea to Fire-excess. My use of Mother-tonifying herbs for Zeng Yizhao and Chen Taiyu drew criticism from peers, which is fitting. While Ye's metaphor was harsh, it was appropriate. However, I believe both failing to use Gui/Fu when needed (cowardice/ignorance) and using them when not needed (recklessness/harm) are errors. Both harm patients. Current doctors ignore Yin-Yang, Water-Fire, deficiency-excess, and true/false distinctions, treating only symptoms for fame and profit, quoting classics to impress nobles. I fear they will err constantly and incur blame. Tao Jian'an said: "Killing without a blade"—this applies here. Generally, mild/slow diseases allow gentle remedies. Severe/rapid diseases require swift action; delaying misses the opportunity. Physicians must have courage and insight to fulfill their responsibility.
In early spring of Jiashen year, Zhou Kaifu, a military officer over sixty, contracted sores after getting wet during travel. External surgeons prescribed cooling/cold herbs, damaging the Stomach and causing stool incontinence. Only after realizing this and taking Fire-benefiting herbs did he improve. Later, night patrol exposed him to Wind-Cold, causing phlegm-vomiting and anorexia. Pulse was wiry-solid generally, wiry-thin at right Guan/Chi. I diagnosed this not as phlegm, but Spleen Qi failure with fluid loss upward. Predicted death within three months; he died in mid-spring. Sores and ulcers reflect internal organ damage manifesting externally. Mr. Lizhai stated all thirteen departments follow one principle. External surgeons often stick to fixed formulas, ignoring interior/exterior, deficiency/excess, and meridian/organ patterns, causing errors. I advocate integrating internal and external medicine, treating according to syndrome. Why do people view sores as trivial, ignore deficiency/excess, take cold herbs lightly, and entrust lives to incompetent surgeons? One must beware.
In winter of Renwu year, my nephew Wang Jiu suffered from scabies for years without improvement. A surgeon prescribed Shuihuo Dan (Water-Fire Pill) containing mercury. I warned against it: Mercury is extremely cold/heavy; refined with fire, it becomes a toxic, drying agent that damages soft intestines/stomach. Such reckless harm deserves death. I taught him to take Liuwei Wan (Six-Ingredient Pill), curing him before finishing the dose. This follows Mr. Lizhai's method. Most texts attribute scabies to Damp-Heat in Yangming Meridian. Mr. Lizhai traced it to Deficient-Heat in Foot-Shaoyin (Kidney) Meridian. This insight transcends millennia.
In summer of Guiwei year, a maid of Lian Cantian's mother had a foot ulcer for a year, taking cooling/cold detox herbs and walking on bricks, yet it didn't heal. Her head tilted, face dark. I told Lian: Death is near. Pulse/symptoms showed Stomach failure and stool incontinence. Predicted death in autumn; it happened. Most sores/ulcers result from Blood deficiency in Foot-Taiyin/Yinming/Jueyin. Non-healing sores indicate Spleen Qi failure. Even if initial toxicity is high, if constitution is strong, cooling herbs are only temporary. Once heat subsides, prioritize tonifying Qi, Blood, and strengthening Spleen. Full Spleen Qi generates flesh; robust Yin/Blood resolves stasis. Recovery is certain. Why die?
In spring of Guiwei year, a relative's wife, over forty, had emotional stagnation, phlegm-vomiting, anorexia, chest/abdominal pain/distension, wore wool in summer, had floating-knotted pulses, occasional thirst/insomnia. I diagnosed Mingmen Fire deficiency and Yuanqi deficiency-cold. Prescribed Liujunzi Tang plus Gan Jiang/Rou Gui and Bawei Wan. She followed treatment strictly, ignoring others, and recovered completely in two months.