甲申仲春连翔梧次郎参天头痛发热。小腹微痛。大便不实。脉寸关浮数。两尺沉迟。此
肾虚
应温。即伤寒论。亦谓尺迟暂补何妨之说。遂以温中诸品。少佐桂附炮姜与服。至晡加热增
喘。家人疑为前剂太补。延余复视。脉转和缓。肾部亦健。余曰前剂乃固正以逐邪。温肾而
驱寒。今寒邪已和盘托出。正气拒邪。势必瞑眩非补邪而致加热增喘也越三更当平复。
次早果
大安。设使误用辛凉。淹延生变。必无幸矣。自后每患前症。辄饮前药。皆得痊可。彼以为
奇。愚按三阳显症。虽为可汗而想其尺迟暂补何妨之说则明为虚寒入内当先救里无疑若里症
得救即表邪不汗亦当自愈若罔顾脉而用表剂。杀人必矣。
癸未冬西城边有陈姓老军一女适因行经浣衣受寒。发热喘渴。小腹胀痛。初治或用辛凉
解表
。或用降气清热。或以冒寒而投温剂。展转增剧。脉寸关浮数。两尺沉结。余曰此蓄血症也
。治本非难。特诸医未识病源耳。以桃仁承气汤两剂下黑血数碗而愈。
癸未季秋太学林琳环次女。年近四十寡居劳郁。亦因行经冒寒血停冲任。烦躁绝食。小
腹绞
痛拒按。二便不通。经旬遍治不瘥。初二日延余诊视。察其六脉浮数无力。左关沉涩。余曰
此本桃仁承气症也。今脉与症反。肝经已败。胃气将绝。药岂能生。一医以四物加香附玄胡
牛膝桃仁一剂。仅下黑血碗许。加减再服。前症如故。至十七日果殁。夫前症均属伤寒蓄血
。何以一用峻剂而得生。一用平剂而反死。余以为室女真气未雕。与 妇悲郁伤肝。一殊也
。一受病未久。一病势已过。二殊也。一脉与症合。一症与脉反。三殊也。一胃气未败。一
经旬绝粒。四殊也。一以峻剂而得告瘳。一以平剂仅延旬日。虚实顿悬。五殊也顾安得以症
而混同治之乎。
甲申年仲春，连翔梧的次子参天主诉头痛、发热。小腹轻微疼痛，大便不成形。脉象寸关部浮数，两尺部沉迟。这是肾虚的表现，应当采用温补法。即使是《伤寒论》中，也有“尺脉迟暂且补益无妨”的说法。于是使用温中药品，稍加桂枝、附子、炮姜服用。到了傍晚，患者发热加重并出现气喘。家人怀疑是之前的药方过于温补，请我再次诊治。此时脉象转为和缓，肾脉也显得有力。我说：之前的药方是为了固护正气以驱逐邪气，温补肾阳以驱散寒邪。现在寒邪已经全部排出，正气抗拒邪气，必然会出现瞑眩反应（服药后病情暂时加重的现象），这并不是因为进补导致邪气入内而引发发热气喘。过了三更天应该会平复。第二天早上果然大安。假如误用辛凉解表药，拖延时间产生变证，必定无法幸免。此后每当患前症，只要饮用之前的药方，都能痊愈。他认为很神奇。我认为三阳经显现的症状，虽然属于可发汗的范围，但想到“尺脉迟暂且补益无妨”的说法，就明确知道这是虚寒入里，应当先救里，毫无疑问。如果里证得到救治，即使不发汗，表邪也会自愈。如果不顾脉象而使用解表剂，必致人死亡。
癸未年冬天，西城边有一位姓陈的老兵的女儿，恰逢经期洗衣受寒。出现发热、气喘、口渴。小腹胀痛。起初治疗有的用辛凉解表，有的用降气清热，有的认为因冒寒而投用温剂。病情辗转加重。脉象寸关部浮数，两尺部沉结。我说：这是蓄血症。治疗本来不难，只是各位医生没有识别病源罢了。用桃仁承气汤两剂，排出黑色血液数碗而痊愈。
癸未年季秋，太学生林琳环的次女，年纪近四十岁，寡居且劳累忧郁。也因经期冒寒，血停于冲任二脉。烦躁不安，拒绝进食。小腹绞痛且拒按。大小便不通。经过十天遍治无效。初二日请我诊视。观察其六脉浮数无力，左关脉沉涩。我说：这本来是桃仁承气汤证。现在脉象与症状相反，肝经之气已败，胃气将绝，药物怎能起效？一位医生用四物汤加香附、玄胡索、牛膝、桃仁，一剂仅排出黑色血液约一碗。加减再服，前症依旧。到十七日果然去世。前面的病症都属于伤寒蓄血，为什么一个用峻猛药剂而得生，一个用平和药剂反而致死？我认为处女真气未衰，与寡妇悲伤忧郁伤肝，这是第一点不同。一个患病不久，一个病势已过，这是第二点不同。一个脉症相符，一个脉症相反，这是第三点不同。一个胃气未败，一个十天粒米不进，这是第四点不同。一个用峻猛药剂而告痊愈，一个用平和药剂仅延续十天，虚实悬殊巨大，这是第五点不同。怎么能因为症状相同就混同治疗呢？
In the mid-spring of Jiashen year, Canzhu, the second son of Lian Xiangwu, complained of headache and fever. There was slight pain in the lower abdomen, and loose stools. The pulse at the Cun and Guan positions was floating and rapid, while the pulses at both Chi positions were deep and slow. This indicates Kidney deficiency (Kidney deficiency), requiring warming and tonification methods. Even in the *Shanghan Lun* (Treatise on Cold Damage Diseases), there is the saying: "If the Chi pulse is slow, temporary tonification is permissible." Therefore, warming middle-jiao herbs were used, with a small addition of Guizhi (Cinnamon Twig), Fuzi (Prepared Aconite Root), and Paojiang (Baked Ginger). By dusk, the fever intensified, accompanied by panting. The family suspected that the previous prescription was too tonifying and invited me to re-examine. The pulse had become harmonious and moderate, and the Kidney pulse appeared robust. I said: "The previous prescription was intended to consolidate the righteous qi to expel pathogenic factors, warming the Kidney to drive out cold. Now that the cold pathogen has been completely expelled, the righteous qi is resisting the pathogen, which inevitably leads to 'mingxuan' (a reaction where symptoms temporarily worsen after taking medicine). This is not caused by tonifying leading to pathogenic invasion resulting in fever and panting. After three watches of the night, he should recover." The next morning, he was indeed greatly relieved. Had mistaken use of acrid-cool exterior-resolving agents occurred, delaying treatment would have led to complications, and survival would have been impossible. Since then, whenever he suffered from these symptoms, drinking the previous prescription always resulted in recovery. He considered it miraculous. In my opinion, although symptoms manifesting in the Three Yang meridians are generally suitable for sweating therapy, considering the principle that "temporary tonification is permissible if the Chi pulse is slow," it is clear that this is deficiency-cold entering the interior, requiring immediate rescue of the interior. If the interior syndrome is rescued, even without inducing sweating, the exterior pathogen should heal itself. Ignoring the pulse and using exterior-resolving agents would certainly be fatal.
In the winter of Guiwei year, a daughter of an old soldier surnamed Chen in the western suburbs contracted cold while washing clothes during her menstrual period. She presented with fever, panting, thirst, and distending pain in the lower abdomen. Initial treatments included acrid-cool exterior-resolving agents, descending qi and clearing heat formulas, or warming agents due to cold exposure. Her condition deteriorated progressively. The pulse at the Cun and Guan positions was floating and rapid, while the pulses at both Chi positions were deep and knotted. I said: "This is Blood Stasis Syndrome (Blood stasis accumulation)." Treatment is not difficult; it is merely that other physicians failed to identify the source of the disease. Two doses of Taoren Chengqi Tang (Peach Kernel Decoction to Order the Qi) were administered, resulting in the discharge of several bowls of black blood, and she recovered.
In the late autumn of Guiwei year, the second daughter of Lin Linhuan, a student of the Imperial Academy, nearly forty years old, living as a widow and suffering from labor and depression, also contracted cold during her menstrual period. Blood stagnated in the Chong and Ren vessels. She experienced irritability, refusal to eat, severe cramping pain in the lower abdomen that resisted pressure, and obstruction of both urination and defecation. Despite various treatments over ten days, she did not improve. On the second day, I examined her. All six pulses were floating, rapid, and forceless; the Left Guan pulse was deep and choppy. I said: "This is originally a Taoren Chengqi Tang syndrome. However, the pulse contradicts the symptoms. The Liver meridian qi is exhausted, and the Stomach qi is about to perish. How can medicine work?" One physician prescribed Siwu Tang (Four Substance Decoction) plus Xiangfu (Cyperus Rhizome), Yuanhusuo (Corydalis Rhizome), Niuxi (Achyranthes Root), and Taoren (Peach Seed). Only about one bowl of black blood was discharged after one dose. After adjusting and administering again, the previous symptoms remained unchanged. She died on the seventeenth day. Both cases belonged to Cold Damage Blood Stasis Syndrome. Why did one survive with a potent formula while the other died with a mild formula? I believe: First, the virgin's true qi was uncorrupted, whereas the widow's liver was injured by sorrow and depression—this is the first difference. Second, one had been ill for a short time, while the other's disease process had advanced—this is the second difference. Third, one case had matching pulse and symptoms, while the other had contradictory pulse and symptoms—this is the third difference. Fourth, one's Stomach qi was not exhausted, while the other had eaten nothing for ten days—this is the fourth difference. Fifth, one recovered with a potent formula, while the other survived only ten days with a mild formula—the distinction between deficiency and excess was stark—this is the fifth difference. How can one treat them identically simply because the symptoms appear similar?