书论
医书始内经，赅括群言，为医家之祖．后仲景之伤寒论，河间之瘟疫，东垣十书，丹溪心法四大家如日月行天，江河在地，前辈论之详矣。然其卷帙浩繁，学者不免望洋而叹。近则钦定医宗金鉴一书，兼集诸家之长而条贯之，又分门别类，编为歌诀，使学者便于记诵，诚此道之津梁也。学者诚能熟读精思，本之仲景以正其源，参之河间以穷其变，内伤则法乎东垣，滋补则遵之丹溪，其于斯道，思过半矣。再能博极群书，自有左右逢源之妙。于是得兔忘筌，得意忘言，未有不精妙入神者，每见吾乡业斯道者，叩其书，小则寿世保元，医宗必读，大则景岳全书，张氏类经，是书岂为不善，无奈学者执一以求，胸中头绪不清，手下必歧误杂出，虽背诵内经无益也。噫！难言矣。
医书中方药之多，无过许景亮之东医宝鉴，有一病而录数十方者，学者苟无根底，按而用之，反多遗误。惟其每论一症，必集诸家之说列于前，实为简便。甚至矛盾抵牾者，非胸有成竹，乌有别其是非哉！
孙真人海上方，药味不多，施之辄有神效。至千金衍义则说多神奇，用圆（丸），用散，多至数十味，且有用玉屑，珊瑚，空青，石胆者，穷乡僻壤，何能有是，学者求其说焉可也。
郭鹤轩名昌年，医士也，货药于乡。甲辰夏，忽患目痛，因自知医，用黄连、山栀、菊花、薄荷之类清之，转益增剧。不得已，延余视之。观其不红至少肿，又无翳障，惟黑珠起红一点。诊其脉搏，沉数细弱，知为阴虚血热，郁于肝脏，无怪寒凉之不应也。因以杞菊地黄汤易生地而投之。一服而疼减，三服而红点除，疼全止矣。遂设席请教，乃告之曰：凡眼疾有内外之分，前人虽谓眼无火不病，然火有虚实，病有内外。如暑天酷热，天行暴肿，羞涩难开，此外症也，但用黄连、蝉蜕等洗之即可。如湿热内淫，脾胃郁火，因而攻目，必兼头晕口渴、上下眶暴肿，此内实热也。可下之。若夫不红不肿，又无翳障，断为阴热无疑。君用寒凉，截其发生之源，能无增剧乎。经云："阴虚生内热"。又云："乙癸同源"。又云："壮水之主，以制阳光"。合此数者观之，其用丹溪之法必矣。若夫阴虚而寒必生翳障，转成大症，又不可同日而语矣。鹤翁乃谢不敏。
刑部主政杨星臣，宁乡人，与余为前后同年，喘咳廿余年。每咳甚，或至晕绝不醒。医药不啻百数，而终罔获效。在星槎侍御处谈及其病，喟然长叹，忧形于色。余问君服何药？星翁云："医家皆谓余好内阴亏，所服药皆滋补剂。年近五旬，不敢强辩，然心窃非之。"余问："君发嗽时，面赤气急否？曰：实有之，不自知也。次早星翁即来求予诊视，因诊其右寸关脉坚凝而滑，几乎搏指，余则平平。乃曰：滑者痰象也，坚凝者，痰结也，见於部寸关之间，盖顽痰结于肺胃之管。肺为清道，胃为浊道，两道为痰所壅，故甚则晕绝也。此病非汤剂可疗，非礞石滚痰丸下之不可。星翁曰：歧黄家畏礞石如砒毒，何可入口？余曰：然则先贤留此方，为毒人耶？君试服之，如误，当甘庸医杀人之罪。星翁见余言确有定见，乃市三钱服之，卧后觉胸膈烦扰，欲吐不吐，不移时，中脘漉漉，解下黑秽数碗，倦而归寝，爽适异常，至晓而若失矣。急驱车揖余，谢曰："奇哉！奇哉！君有胆有识，三钱药去数十年之病，孙思邈之神奇，不是过也。诸医谓余阴亏，抱此不白之冤久矣，得君并雪是耻，感铭何既？"至今函札往来，犹时时道谢也。
星槎侍御之女，年十三，能读葩经、四子书，唐诗古文，略皆上口。写画亦颇有法度。星槎爱如拱璧。乙卯夏，偶患发热，身面皆赤。延医视之，或曰瘟疫也，用藿香正气散；或曰过食生冷，阳郁於脾也，用散火汤；或曰中暑，用香薷饮；或曰实火，用承气汤、天水散，而皆不效。急遣纪纲迎余。问曰：头痛乎？曰否，然则非瘟疫也。问腹痛吐泻乎？曰否，然则非中暑也。问扪之炙手乎？曰否。然则非脾郁也；问烦渴出汗乎？曰否，然则非实火也。余曰：既无此数者，必午后转甚也。曰然。且眼黑耳鸣也。曰然。且口干咽痛也。曰然。星槎惊曰：尚未诊脉，何了如指掌如是。余曰：此为阴虚内热，既非彼，则在此。症如是，脉必沉数，不必诊也。投以大剂归芍地黄汤，加生地、蝉蜕。二服而愈。星槎谢曰：他人诊脉，移时不放，立方之际，不胜迟疑，君寥寥数语，所见如是其捷，奏效如是其速，非绝顼聪明曷有此哉！余谢过奖。
寅春，同乡寻管香太史，在文昌馆作团拜，申未之交忽患身疼，众以为坐久而倦也。嘱之少息，晚餐初上，竟命驾归矣，次早张太常炳堂，专车迎余，问何为？曰：管香病笃危在倾刻。其纪纲乃多年旧人，涕泣长跪，求余救主人之命，余曰：昨在会中尚同席，何至如是？因系心腹交，不暇栉沐，而往视之。四肢椎床，昏不知人，提腕诊脉，无一丝可见；按太奚，则沸如涌泉，心头突突乱动。余曰：此红痧也，症虽危，却无碍。乃刺其委中、尺泽，出黑血半盏，神气稍定。急进柴葛解肌汤灌之，因嘱众人勿动，后半日当有红紫点发於肢体，晚再进一剂，明早当再来也。越日往视，炳堂太常迎门云，君言果验，此时紫斑夹痧而发，遍身如涂，而心地清明，约无害也，已进粥矣。余惊曰，谁使食粥！痧最恶粥，恐增剧也。炳堂又惶恐自怨。逮余入，又手足乱动，烦闷颠倒矣。急取麦芽汤灌之，始少安。晚以犀角地黄汤解其热，又以小陷胸汤解其烦，越五日而病安。惟余热未清，身如束缚。余曰：血热伤阴，固应尔尔。命服滋补之剂，半月而后，安然如常矣。
管香病愈未一月，其兄伟卿大令，在都候选，忽有友人招饮，醉饱之余，又苦炎热，自恃气半咆西瓜一颗。臣后觉腹中绞痛，吐泻并作，夜已四更，遣人招余。余询其由知为霍乱，命服藿香正气丸，不必往视也。其家人逼之不已，疑予深夜懒行，因随之去。见伟卿呻吟不已，腹膨膨如鼓。余笑曰：西瓜作怪也。问小便利否？曰否。乃命其家人循腹极力推下之，不十度，腹中漉漉有声，溺下数碗，而痛少止矣。因仍使服藿香正气丸。次午衣冠来谢曰：西瓜如此可恶，余当与绝交也。为之一笑。
薛鹤亭侍御名呜皋，陵川人，古道照人。在吏部时掌选事，胥吏不敢欺以隐。后作御使，数条奏忤上旨，而公正无阿识者服焉。甲寅夏，其夫人患大便不通，医士或以为实热，投承气汤不效；或以为肠燥，投火麻仁亦不效；或以为食滞，投平胃散，通而旋塞。延余治之。诊其六脉微弱，右关尤甚，右尺脉细如丝。乃曰：此脾虚不能转运故也。遂立四君平胃汤，重用潞参至一两。鹤翁曰：病苦不通，塞之不转剧乎？余曰：君不识此。内经云："塞因寒用"。盖人大小二便，全凭中气转运中气不摄，则泄泻；中气太虚，则不能下送。夫人之病，非不欲不便，盖欲便而不下也。今以四君提其中气，平胃散调其胃气，再不通者事不复为此矣。晚即照方服之，次早即便数下，肚腹空虚，精神爽健，早餐已进三碗矣。午后来信云：同内之病，已十去八九，何神若是，昨日之言，思之不得其解，愿暇时一请教也。次日即来拜谢。余曰：君未读医书，诚难下也。人之脾胃，何独不然。鹤翁曰：闻所未闻，今乃知大便不通之不无虚证也。遂与余为至交焉。
邪风中府卒然昏噤
商人穆栖桐，吾介东乡人也。在京为号中司事。体素肥胖，又兼不节饮食。夏有友人招饮，洒后出饭肆，卒然错噤，口不能言，四肢不能运动，胸腹满闭，命在旦夕，车载而归。其契友南方人，颇知医，以为瘫也，用续命汤治之，数日无效。乃转托其同事延余视之，余诊其六脉缓大，惟右关坚欲搏指，问其症，则不食、不便、不言数日矣。时指其腹，作反侧之状。余曰：瘫则瘫矣，然邪风中府，非续命汤所能疗，必先用三化汤下之，然后可疗，盖有余症也。南医意不谓然，曰：下之亦恐不动。余曰：下之不动，当不业此。因立进三化汤，留南医共守之。一饭之际，病者欲起，肠中漉漉，大解秽物数次，腹小而气定，声亦出矣。惟舌根蹇涩，语不甚可辨，伏枕视余，叩头求命。因问南医曰：何如？南医面赤如丹，转瞬间鼠窜而去。因命再服二剂，神气益清。用龟尿点其舌，言亦渐出。不十日铺东逼之归家。余在京供职，今不知其如何也。
又有银商，忘其名，夏得痢疾，医家以为火，用承气汤下之，逐日下数十次，又一医以为虚，补之，痢下止而胸满腹胀，委顿不起。司事者惧其死，邀伊表兄某引之出铺，在寺中凭一屋居之，又十余日医药罔效。其表兄已为市殓具矣。一日午饭后其表兄来请曰：舍亲病重，恐吓不能起，闻阁下脉理清真，欲往驾，以决生死，如可敬延半月。拟即遣之还家，较胜殁於旅舍也。余随而往视，屋中臭不可近，急命舁置他处，见其合眼朦胧，转侧之，并不知矣。提腕而诊之，俱微弱沉细，然至数匀称，惟右关独大，按之搏指。乃曰：此病因食积致痢，初医下其火，未去其食也。此时必肚腹膨胀，醒时见食作呕，病虽危，不惟不即死，并可生也。其表兄曰：果尔，请治之。乃以平胃散加神曲、麦芽等类进之，至夜解下秽物极多，腹平而知人矣。越日视之，脉小而气虚。因以真人养脏汤固其痢，三剂而痢止，略进食矣。因继以人参养荣丸半月而健。余当其病时曾见二次，不识其人，越两月，有以靴帽等踵门而谢者，不知何人，入门自称乃前病痢者也。叩头不起谢曰：蒙先生再生之恩，不惟病愈，且健壮胜于往日，衔环结草所不惜也。余却其物而善遣之。
祁寿阳相国，予告京居，素有头晕疾，每发则呕逆旋转欲跌。延医数辈，皆以为虚，参芪之类，久不离口，而病终不去。风天阴则转甚。一日雨后无事，邀余闲谈，并求一诊，见其左寸独虚，右三部俱滑而缓，并见弦象。乃曰：老师劳心过度，脾湿停痰，且时泻时止，身体重困，非燥湿祛痰不可，而古人云治痰不理脾胃，非其治也，非健脾不可。脾健则痰消，痰消则晕止，相因之势也。乃进以香砂六君子加益智、泽泻之类。五服而晕全除矣。继相国邀晚餐，席间告同乡云，头晕属痰，此语未经人道。润园为此语，吾始不信，服其药，竟去宿恙，非深明脉理，何能见及于此。余谢不敏。
仲秋又苦臂痛，使部曹某治之，乃为部曹述前病，并道余治之之法。部曹乃因而附会曰：王某之言诚然，今之臂痛，仍系痰之为害，不早除之成瘫痪。乃以大秦艽汤进。药甫入口，痛益增，不可屈伸，次早而寝食俱废。仍使其子子禾部郎延余，急往视之，脉浮而弱，而津津有汗出，而神气清明，语言便利。乃告相国曰：此肩臂中风而痛，病极微末，部曹小题大做，用秦艽汤，岂知秦艽汤以十全大补为主，风在皮肤，以疏发腠理为要，兹用参芪固之，岂非益之痛乎。老师勿为所惑，药三进必无苦矣。因进东垣羌活胜湿汤，加威灵仙、苍术、各二钱，一进而痛减，三进而若失。越日谈及，曰：中风之言不谬，余以书名，持纸素索书者颇多，因循堆积未暇搦管，尔日无事，开窗作字，窗外多竹，适风起觉冷，晚而痛作。子言之，余忆之矣。然何以所用皆汗药？余曰：老师营心经济，医道小技，究未深考，羌活、藁本，乃太阳皮肤疏散之药，非发汗也。汗症用之者，以其能开腠理，非能动汗也。相国惊曰：此言更觉入微，医家多不识此，可谓才大於身，心细如发矣。君少年乃造诣如此，将来必歧黄中自树一帜，勉之哉！具此才思，早缀高科，老夫当避三舍。余惶愧而退。在陕需次时，相国来书，尚称之不已。
相国之长媳,子禾之夫人也。性颇暴，而相国家法綦严，郁而腹胀，月事不至者两度，人世间以为孕，置而不问，且子禾未获嗣，转为服保胎药，则胀而增痛．一日子禾公退，偕与往视，诊其左关弦急，乃肝热郁血．以逍遥散合左金丸处之，子禾恐其是胎，疑不欲服，余曰：必非胎，若胎则两月何至如是，请放心服之．勿为成见所误。乃服二帖，腹减气顺，惟月事不至．继以加味乌药汤，两日而潮来．身爽然矣，至是每病必延余，虽婢仆乳媪染微恙，皆施治矣。
脾劳过食误下致危
【医论】
医学书籍始于《黄帝内经》，它概括了各种言论，是医家的始祖。后来张仲景的《伤寒论》、刘河间的《瘟疫论》、李东垣的《十书》、朱丹溪的《格致余论》（注：原文“丹溪心法”通常指其学术体系或后世整理本，此处依原文翻译为丹溪的著作/心法），这四位大家的学说如同日月运行于天空，江河流淌在大地上，前辈们论述得非常详细了。然而他们的著作卷帙浩繁，学者们不免望而生叹。近来钦定的《医宗金鉴》一书，兼收各家之长并加以条理贯通，又分门别类，编成歌诀，使学者便于记诵，确实是学习中医的门径。学者如果能熟读深思，以张仲景的学说为正源，参考刘河间的理论以探究变化，内伤杂病则效法李东垣，滋补调理则遵循朱丹溪，那么对于这门学问，就已经掌握了一半以上了。如果再能博览群书，自然会有左右逢源的妙处。于是就能得鱼忘筌，得意忘言，没有不精妙入神的。我常看见我们乡里从事这一行的人，询问他们读的书籍，小的如《寿世保元》、《医宗必读》，大的如《景岳全书》、《张氏类经》，这些书难道不好吗？无奈学者们执着于一端去探求，胸中头绪不清，手下必然歧误百出，虽然背诵《内经》也是无益的。唉！难以言说啊。
医书中的方药之多，没有超过许浚的《东医宝鉴》的，有一种病记录几十首方的情况，学者如果没有根基，照着使用，反而多有遗漏和错误。只有他每论述一个症状，必定汇集各家的说法列在前面，确实简便。甚至遇到矛盾抵触的说法，如果不是胸有成竹，怎么能辨别是非呢！
孙思邈的《海上方》，药味不多，施用往往有神奇效果。至于《千金衍义》则说得很多很神奇，用丸药，用散剂，多至几十味，而且有用玉屑、珊瑚、空青、石胆的，穷乡僻壤，哪里能有这些东西，学者只要探求其中的道理就可以了。
郭鹤轩名昌年，是一名医生，在乡下卖药。甲辰年夏天，忽然患眼痛，因为他自己懂医，用了黄连、山栀、菊花、薄荷之类来清热，病情反而加重。不得已，请我去诊治。观察他的眼睛不红且很少肿胀，又没有翳障，只有黑眼球上起红点。诊脉象沉数细弱，知道这是阴虚血热，郁结在肝脏，难怪寒凉药无效。于是用杞菊地黄汤，将生地换掉后投药服用。服一次疼痛减轻，服三次红点消除，疼痛完全停止。于是设宴请教，我便告诉他：凡是眼疾有内因外因之分，前人虽然说“眼无火不病”，但火有虚实，病有内外。比如暑天酷热，天行暴肿，羞明难开，这是外症，只用黄连、蝉蜕等清洗即可。如果是湿热内侵，脾胃郁火，因而攻目，必定兼有头晕口渴、上下眼睑突然肿胀，这是内实热证。可以用泻下法。如果是不红不肿，又没有翳障，断定为阴热无疑。你使用寒凉药，截断了发生之源，能不加重吗？《内经》说：“阴虚生内热”。又说：“乙癸同源”（肝肾同源）。又说：“壮水之主，以制阳光”。综合这几方面来看，必须使用丹溪的方法。如果是阴虚而寒，必定产生翳障，转变成大症，那就不可同日而语了。鹤翁于是感谢我的不吝指教。
【痰结肺胃咳喘晕绝】
刑部主政杨星臣，是宁乡人，与我是一前一后的同年进士，喘咳二十多年。每次咳嗽厉害时，甚至会晕厥不醒。医药吃了不止上百种，但最终都没有效果。在星槎侍御处谈到他的病，他长叹一声，忧虑表现在脸色上。我问您服什么药？星翁说：“医生都说我喜好房事导致阴亏，所服的药都是滋补剂。我年近五十，不敢强辩，但心里私下认为不对。”我问：“您发作咳嗽时，面赤气急吗？”他说：“确实有，自己不知道。”第二天早上星翁就来找我诊治，于是我诊察他右寸关脉坚硬凝聚而滑，几乎搏指，左脉则平平。于是我说：“滑是痰的征象，坚硬凝聚是痰结，出现在寸关之间，大概是顽痰结在肺胃的管道。肺是清道，胃是浊道，两道被痰壅塞，所以严重时就会晕厥。这个病不是汤剂可以治疗的，非要用礞石滚痰丸泻下不可。”星翁说：“岐黄家害怕礞石像砒毒一样，怎么可以吃入口？”我说：“既然如此，先贤留下这个方子，是为了毒害人吗？您试着服用它，如果误事，我愿意承担庸医杀人的罪名。”星翁见我的话确有定见，于是买三钱服用，躺下后觉得胸膈烦扰，想吐吐不出来，不一会儿，中脘部漉漉有声，解下黑秽物几碗，疲倦地回去睡觉，异常爽快舒适，到天亮时感觉病若失矣。急忙驾车来拜谢我说：“奇怪啊！奇怪啊！您有胆识，三钱药去除了几十年的病，孙思邈的神奇，也不过如此。众医生说我是阴亏，抱这种不白之冤很久了，得到您一并洗雪耻辱，感激之情无法言尽？”至今书信往来，还时常道谢。
星槎侍御的女儿，十三岁，能读《诗经》、四书、唐诗古文，大致都能背诵。写字画画也很有法度。星槎视如珍宝。乙卯年夏天，偶然患发热，身面都发红。请医生诊治，有的说是瘟疫，用藿香正气散；有的说是过食生冷，阳气郁结在脾，用散火汤；有的说是中暑，用香薷饮；有的说是实火，用承气汤、天水散，但都不见效。急忙派管家迎接我。我问：“头痛吗？”回答说：“不痛。”既然不痛，那就不是瘟疫。问腹痛吐泻吗？回答说：“没有。”既然没有，那就不是中暑。问摸上去烫手吗？回答说：“不烫。”既然不烫，那就不是脾郁；问烦躁口渴出汗吗？回答说：“没有。”既然没有，那就不是实火。我说：“既然没有上述几种情况，必定是午后加重吧。”回答说：“是的。”并且伴有眼黑耳鸣。回答说：“是的。”并且口干咽痛。回答说：“是的。”星槎惊讶地说：“还没有诊脉，为什么了解得如此清楚？”我说：“这是阴虚内热，既然不是那些，那就是这个。症状如此，脉象必定沉数，不必诊察了。”投以大剂量的归芍地黄汤，加生地、蝉蜕。服两次就好了。星槎谢我说：“别人诊脉，移时不放，开方时，不胜迟疑，您寥寥数语，所见如此敏捷，奏效如此迅速，如果不是绝顶聪明，怎么能这样呢！”我谦虚地接受了夸奖。
寅春，同乡寻管香太史，在文昌馆作团拜，申未之交忽然患身体疼痛，众人以为是坐久了疲倦。嘱咐他稍作休息，晚餐刚上，竟然就乘车回去了。第二天早上张太常炳堂，专车迎我，问为什么？他说：管香病重，危在旦夕。他的管家是多年的旧人，涕泣长跪，请求我救主人的命，我说：“昨天在会中还同席，怎么会这样？”因为他是心腹之交，来不及梳洗，就去诊治。四肢瘫软在床上，昏迷不省人事，提腕诊脉，无一丝脉象可见；按太溪穴，则脉搏沸腾如涌泉，心头突突乱动。我说：“这是红痧（猩红热或类似急性发疹性疾病），症虽危，却无碍。”于是刺他的委中、尺泽穴，放出黑血半盏，神气稍微安定。急忙灌服柴葛解肌汤，并嘱咐众人不要移动病人，后半日当有红紫点发于肢体，晚上再进一剂，明天早上再来。过一天去探望，炳堂太常在门口迎接说，您的话果然灵验，此时紫斑夹痧而发，遍身如涂，而心地清明，大约无害了，已经喝粥了。我惊讶地说，谁让他吃粥！痧症最忌讳粥，恐怕会加重。炳堂又惶恐自责。等我进去，他又手足乱动，烦闷颠倒。急忙取麦芽汤灌服，才稍微安静。晚上用犀角地黄汤解除其热，又用小陷胸汤解除其烦闷，过了五天病才安。只是余热未清，身体像被束缚一样。我说：“血热伤阴，本来就应该这样。”命令服用滋补的药剂，半个月后，安然如常。
管香病愈不到一个月，他的哥哥伟卿大令，在京城候补，忽然有朋友招饮，醉饱之余，又苦于炎热，自恃气盛，吃了一颗西瓜。之后觉得腹中绞痛，吐泻并作，夜里已四更，派人叫我。我询问缘由，知道是霍乱，命令服用藿香正气丸，不必亲自去诊治。他的家人逼迫不已，怀疑我深夜懒于行路，于是跟着我去。看见伟卿呻吟不停，腹部膨隆如鼓。我笑着说：“是西瓜作怪。”问小便通利吗？回答说：“不通。”于是命令他的家人顺着腹部极力向下推按，不到十次，腹中漉漉有声，溺下几碗，而疼痛稍微停止。于是仍让服用藿香正气丸。第二天中午穿戴整齐来谢我说：“西瓜如此可恶，我应当与它绝交。”为此一笑。
薛鹤亭侍御名呜皋，是陵川人，古道照人。在吏部时掌管选事，胥吏不敢欺骗隐瞒。后来做御史，多次条奏违背圣旨，而公正不阿的人佩服他。甲寅年夏天，他的夫人患大便不通，医生有的认为是实热，投承气汤无效；有的认为是肠燥，投火麻仁也无效；有的认为是食滞，投平胃散，通了一下随即又堵塞。请我去治疗。诊察六脉微弱，右关尤其严重，右尺脉细如丝。于是说：“这是脾虚不能转运的缘故。”于是立四君平胃汤，重用潞参至一两。鹤翁说：“病苦不通，塞而不转剧乎？”我说：“您不了解这个。《内经》说：‘塞因塞用’（注：原文‘塞因寒用’疑为笔误或特定版本，标准术语为塞因塞用，意为用补益法治疗闭塞不通的虚证）。人大小便，全凭中气转运，中气不摄，则泄泻；中气太虚，则不能下送。夫人的病，不是不想不便，是想便而下不来。现在用四君子汤提升其中气，平胃散调和其胃气，再不通者，事情不再如此了。”当晚即照方服用，第二天早上就大便数次，肚腹空虚，精神爽健，早餐已进三碗。下午来信说：家里的病，已十去八九，为何神效如此，昨天的话，思考不得其解，希望闲暇时请教。第二天就来拜谢。我说：“您没读过医书，确实难懂。人的脾胃，何独不然。”鹤翁说：“闻所未闻，现在才知道大便不通的不无虚证。”于是与我成为至交。
【邪风中府卒然昏噤】
商人穆栖桐，是我介东乡人。在京为商号司事。体质素来肥胖，又兼饮食不节制。夏天有朋友招饮，酒后出饭肆，突然错噤，口不能言，四肢不能运动，胸腹满闭，命在旦夕，车载而归。他的契友南方人，颇懂医，认为是瘫痪，用续命汤治疗，数日无效。于是转托其同事请我去诊治，我诊察六脉缓大，只有右关坚硬欲搏指，问症状，则不食、不便、不言数日了。这时指着他的腹部，呈反侧之状。我说：“虽然是瘫，但这是邪风中府，不是续命汤所能治疗的，必须先用三化汤泻下，然后可疗，这是有余症。”南医意不以为然，说：“泻下恐怕也不动。”我说：“如果泻下不动，我就不干这行了。”于是立即进三化汤，留南医共同守护。一顿饭的功夫，病人想起身，肠中漉漉，大便秽物数次，腹部变小而气定，声音也出来了。只是舌根蹇涩，言语不甚可辨，伏枕看着我，叩头求命。于是问南医说：“怎么样？”南医面赤如丹，转眼间鼠窜而去。于是命令再服二剂，神气更加清醒。用龟尿点其舌，言语也逐渐出来。不到十天铺东逼之回家。我在京供职，现在不知道他怎么样了。
【食积致痢】
又有银商，忘了名字，夏天得痢疾，医生认为是火，用承气汤泻下，逐日下数十次，又一医生认为是虚，补之，痢下止而胸满腹胀，委顿不起。司事者怕他死，邀他表兄某引他出铺，在寺中凭一屋居之，又十余日医药无效。他表兄已经买了殓具。一天午饭后他表兄来请说：“舍亲病重，恐吓不能起，听说阁下脉理清真，想去请您决生死，如果可以敬延半月。打算让他回家，比死在旅舍好。”我随即前往诊治，屋中臭不可近，急忙命令抬到别处，见他合眼朦胧，转侧，并不知觉。提腕而诊之，俱微弱沉细，但至数匀称，只有右关独大，按之搏指。于是说：“这个病因食积致痢，初医下其火，未去其食也。此时必肚腹膨胀，醒时见食作呕，病虽危，不惟不即死，并可生也。”他表兄说：“果真如此，请治之。”于是以平胃散加神曲、麦芽等类进之，至夜解下秽物极多，腹平而知人矣。过一天看，脉小而气虚。于是以真人养脏汤固其痢，三剂而痢止，略进食矣。接着以人参养荣丸半月而健。我在他生病时曾见过两次，不认识其人，过了两个月，有以靴帽等物登门致谢的，不知是何人，进门自称是前病痢者。叩头不起谢说：“蒙先生再生之恩，不惟病愈，且健壮胜于往日，衔环结草所不惜也。”我拒绝了礼物并善意地送走了他。
【脾湿痰晕】
祁寿阳相国，予告京居，素有头晕疾，每发则呕逆旋转欲跌。延医数辈，皆以为虚，参芪之类，久不离口，而病终不去。风天阴则转甚。一日雨后无事，邀余闲谈，并求一诊，见其左寸独虚，右三部俱滑而缓，并见弦象。乃曰：老师劳心过度，脾湿停痰，且时泻时止，身体重困，非燥湿祛痰不可，而古人云治痰不理脾胃，非其治也，非健脾不可。脾健则痰消，痰消则晕止，相因之势也。乃进以香砂六君子加益智、泽泻之类。五服而晕全除矣。继相国邀晚餐，席间告同乡云，头晕属痰，此语未经人道。润园为此语，吾始不信，服其药，竟去宿恙，非深明脉理，何能见及于此。余谢不敏。
仲秋又苦臂痛，使部曹某治之，乃为部曹述前病，并道余治之之法。部曹乃因而附会曰：王某之言诚然，今之臂痛，仍系痰之为害，不早除之成瘫痪。乃以大秦艽汤进。药甫入口，痛益增，不可屈伸，次早而寝食俱废。仍使其子子禾部郎延余，急往视之，脉浮而弱，而津津有汗出，而神气清明，语言便利。乃告相国曰：此肩臂中风而痛，病极微末，部曹小题大做，用秦艽汤，岂知秦艽汤以十全大补为主，风在皮肤，以疏发腠理为要，兹用参芪固之，岂非益之痛乎。老师勿为所惑，药三进必无苦矣。因进东垣羌活胜湿汤，加威灵仙、苍术、各二钱，一进而痛减，三进而若失。越日谈及，曰：中风之言不谬，余以书名，持纸素索书者颇多，因循堆积未暇搦管，尔日无事，开窗作字，窗外多竹，适风起觉冷，晚而痛作。子言之，余忆之矣。然何以所用皆汗药？余曰：老师营心经济，医道小技，究未深考，羌活、藁本，乃太阳皮肤疏散之药，非发汗也。汗症用之者，以其能开腠理，非能动汗也。相国惊曰：此言更觉入微，医家多不识此，可谓才大於身，心细如发矣。君少年乃造诣如此，将来必歧黄中自树一帜，勉之哉！具此才思，早缀高科，老夫当避三舍。余惶愧而退。在陕需次时，相国来书，尚称之不已。
【肝热郁血】
相国之长媳,子禾之夫人也。性颇暴，而相国家法綦严，郁而腹胀，月事不至者两度，人世间以为孕，置而不问，且子禾未获嗣，转为服保胎药，则胀而增痛．一日子禾公退，偕与往视，诊其左关弦急，乃肝热郁血．以逍遥散合左金丸处之，子禾恐其是胎，疑不欲服，余曰：必非胎，若胎则两月何至如是，请放心服之．勿为成见所误。乃服二帖，腹减气顺，惟月事不至．继以加味乌药汤，两日而潮来．身爽然矣，至是每病必延余，虽婢仆乳媪染微恙，皆施治矣。
【脾劳过食误下致危】
[Medical Discourse]
Medical literature began with the *Huangdi Neijing* (Yellow Emperor's Inner Canon), which summarized various theories and served as the ancestor of medical schools. Later, Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Damage), Liu Hejian's works on epidemic febrile diseases, Li Dongyuan's *Ten Books*, and Zhu Danxi's *Xinfa* (Core Methods) became like the sun and moon in the sky or rivers on the earth; predecessors had discussed them in detail. However, their volumes are vast and numerous, causing scholars to sigh at the daunting task. Recently, the imperial compilation *Yizong Jinjian* (Golden Mirror of Medical Tradition) has integrated the strengths of various schools, organized them systematically, categorized them, and compiled them into rhymed verses for easier memorization, truly serving as a gateway to this path. If scholars can study these thoroughly and think deeply, taking Zhang Zhongjing's teachings as the orthodox source, consulting Liu Hejian's theories to explore variations, following Li Dongyuan's methods for internal injuries, and adhering to Zhu Danxi's principles for nourishing and tonifying, they will have mastered more than half of this discipline. By further reading extensively, one will naturally experience the ease of finding resources from all directions. Thus, one can grasp the essence while forgetting the means, understand the meaning while forgetting the words, and inevitably achieve profound and divine mastery. I often see local practitioners who, when asked about their readings, cite small texts like *Shoushi Baoyuan* (Preserving Vitality and Protecting Original Qi) and *Yizong Bidu* (Essential Readings for Medical Practitioners), or large ones like *Jingyue Quanshu* (Complete Works of Jingyue) and *Zhangshi Leijing* (Classified Inner Canon by Zhang), asking if these books are not good. The problem lies in scholars clinging to single aspects without clarity in their minds, leading to confusion and errors in practice; even reciting the *Neijing* becomes useless. Alas, it is hard to explain.
Among medical books, none contains more prescriptions and herbs than Xu Jun's *Dongyi Baojian* (Treasure Mirror of Eastern Medicine), where dozens of formulas are recorded for a single disease. Without a solid foundation, scholars using them blindly may cause omissions and errors. Only his method of listing various schools' opinions before discussing each symptom is truly convenient. Even when contradictions arise, only those with clear insights can distinguish right from wrong.
Sun Simiao's *Haishang Fang* (Sea Above Prescriptions) uses few herbs but yields miraculous effects. In contrast, *Qianjin Yanyi* (Extension of Thousand Gold Formulas) describes many magical remedies, using pills and powders with up to dozens of ingredients, including jade dust, coral, azurite, and copper sulfate. Such rare materials are unavailable in remote areas; scholars should only seek the underlying principles.
[Yin Deficiency Eye Pain]
Guo Hexuan, courtesy name Changnian, was a physician selling herbs in the countryside. In the summer of Jiachen year, he suddenly suffered eye pain. Knowing medicine himself, he used cooling herbs like Huanglian (Coptis Rhizome), Shanzhi (Gardenia Fruit), Juhua (Chrysanthemum Flower), and Bohe (Mint Herb), but the condition worsened. Reluctantly, he invited me to examine him. His eyes were neither red nor swollen, with no nebulae, except for a red spot on the black pupil. His pulse was deep, rapid, fine, and weak, indicating Yin deficiency with blood heat stagnating in the Liver. No wonder cooling herbs failed. I prescribed Qiju Dihuang Tang (Lycium, Chrysanthemum, and Rehmannia Decoction), replacing Shengdi (Rehmannia Root) with another ingredient. After one dose, pain decreased; after three doses, the red spot disappeared, and pain ceased completely. At a banquet seeking advice, I explained: Eye diseases have external and internal causes. Although ancients said "eyes do not suffer without fire," fire can be excess or deficient, and diseases can be external or internal. For example, severe heat in summer causing sudden swelling and photophobia is an external syndrome, treatable with washing using Huanglian and Chantui (Cicada Slough). If damp-heat invades internally, causing spleen-stomach stagnant fire attacking the eyes, accompanied by dizziness, thirst, and sudden swelling of eyelids, it is an internal excess heat syndrome, requiring purgation. If there is no redness, swelling, or nebulae, it is undoubtedly Yin heat. Using cold-natured herbs cuts off the source of generation, worsening the condition. The *Neijing* states: "Yin deficiency generates internal heat." It also says: "Yi and Gui share the same source" (Liver and Kidney share the same origin). And: "Strengthen the master of Water to control the sunlight" (Nourish Kidney Yin to subdue empty Heat). Considering these, Danxi's methods must be used. If Yin deficiency leads to cold, nebulae will form, turning into a major disease, which is incomparable to this case. Mr. Guo thanked me for my guidance.
[Phlegm Knotting Lung and Stomach Causing Cough, Asthma, and Syncope]
Yang Xingchen, Director of the Ministry of Justice, was from Ningxiang and my senior colleague in the civil service examinations. He suffered from cough and asthma for over twenty years. Severe coughing spells sometimes led to syncope and unconsciousness. He tried hundreds of medicines without effect. Discussing his illness at the residence of Censor Xingcha, he sighed deeply, showing worry. I asked what medicines he took. He replied: "Doctors say I have kidney Yin deficiency due to excessive sexual activity, so they gave me tonic medicines. Near fifty, I dare not argue, but privately disagree." I asked: "When coughing fits occur, do you have facial flushing and rapid breathing?" He said: "Indeed, though I didn't realize it." The next morning, he sought my diagnosis. His Right Cun and Guan pulses were firm, condensed, and slippery, almost beating against the finger, while the Left pulses were normal. I said: "Slippery indicates phlegm; firm and condensed indicates phlegm knotting. Located at Cun and Guan, this suggests stubborn phlegm knotting in the Lung and Stomach channels. The Lung is the clear pathway, the Stomach the turbid pathway. When both are blocked by phlegm, severe cases lead to syncope. This disease cannot be treated with decoctions alone; it requires Mengshi Gun Tan Wan (Magnesium Silicate Pill for Rolling Out Phlegm) to purge." Mr. Yang said: "Practitioners fear Mengshi like arsenic; how can it be ingested?" I replied: "If so, why did ancient sages leave this formula? To poison people? Try it. If it fails, accept the blame for a quack killing someone." Seeing my resolve, he bought three qian of the pill. After lying down, he felt chest discomfort, wanting to vomit but unable to. Soon, gurgling sounds arose in the epigastrium, and several bowls of black, foul stool were passed. He returned to bed exhausted but felt unusually refreshed. By dawn, the illness seemed gone. He rushed to thank me: "Miraculous! You have courage and insight. Three qian of medicine cured decades of illness. Sun Simiao's magic is surpassed. Doctors blamed my Yin deficiency; you cleared this injustice. My gratitude is boundless." We corresponded frequently, always thanking me.
[Yin Deficiency Internal Heat with Red Face and Body]
The daughter of Censor Xingcha, aged thirteen, could recite the *Shijing* (Classic of Poetry), Four Books, Tang poetry, and classical prose. She wrote and painted well. Xingcha cherished her like a gem. In the summer of Yimao year, she suddenly developed fever, with her body and face turning red. Physicians diagnosed plague (using Huoxiang Zhengqi San), spleen Qi stagnation from cold food (using Sanhuo Tang), summerheat (using Xiangru Yin), or excess fire (using Chengqi Tang or Tianshui San), all ineffective. Urgently, they sent for me. I asked: "Headache?" "No." Then not plague. "Abdominal pain, vomiting, diarrhea?" "No." Then not summerheat. "Hot to touch?" "No." Then not spleen stagnation. "Irritability, thirst, sweating?" "No." Then not excess fire. I said: "Without these, it must worsen in the afternoon." "Yes." "Dark vision, tinnitus?" "Yes." "Dry mouth, sore throat?" "Yes." Xingcha exclaimed: "You haven't palpated the pulse, yet you know so clearly!" I replied: "This is Yin deficiency internal heat. Since it's not the others, it must be this. With such symptoms, the pulse must be deep and rapid; palpation is unnecessary." I prescribed a large dose of Guishao Dihuang Tang (Rehmannia, Angelica, and Paeonia Decoction) with added Shengdi and Chantui. Two doses cured her. Xingcha thanked me: "Others take long to diagnose and hesitate to prescribe. Your few words brought swift results. Only supreme intelligence achieves this." I modestly accepted the praise.
[Red Sha Critical Condition with Unconsciousness]
In spring of Yin year, fellow scholar Xun Guanxiang attended a New Year gathering at Wenchang Hall. Around Shen-Wei hours, he suddenly suffered body aches. Others assumed fatigue from sitting. Advising rest, he left after dinner. Next morning, Zhang Bingtang urgently summoned me, saying Guanxiang was critically ill. The servant knelt weeping, begging for help. As Guanxiang was a close friend, I went immediately without grooming. He lay paralyzed, unconscious. Radial pulse was imperceptible; Taixi pulse was surging like a spring, with heart palpitations. I diagnosed Red Sha (a toxic rash disease). Though critical, it was manageable. I punctured Weizhong and Chize acupoints, draining half a cup of dark blood. Spirit stabilized slightly. I urgently administered Chaige Jieji Tang (Bupleurum and Kudzu Decoction for Resolving Muscle Layer) and instructed family not to move him, predicting red-purple spots would appear later that day. I would return the next morning. The next day, Bingtang greeted me saying my prediction came true: purple spots mixed with rash appeared all over, but his mind was clear, and he ate porridge. I shocked: "Who let him eat porridge! Sha hates porridge; it worsens the condition." Bingtang apologized. Upon entering, the patient thrashed in distress. I gave Maiya Tang (Barley Sprout Decoction), calming him. That evening, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) cleared heat, and Xiaoxianxiong Tang (Minor Chest Trap Decoction) relieved irritability. Five days later, he recovered. Residual heat caused tightness. I attributed this to blood heat injuring Yin and prescribed tonics. Half a month later, he was normal.
[Colic with Vomiting and Diarrhea]
Less than a month after Guanxiang recovered, his brother Weiqing, awaiting appointment in the capital, drank heavily and ate watermelon due to heat. Soon, severe abdominal colic, vomiting, and diarrhea occurred. At midnight, he sent for me. Diagnosing Colic (acute gastrointestinal disorder), I ordered Huoxiang Zhengqi Wan (Agastache and Perilla Pill) without visiting. Family insisted, suspecting laziness. Finding Weiqing groaning, abdomen distended like a drum, I joked: "Watermelon caused this." Asked about urination: "Blocked." I instructed family to press firmly down the abdomen ten times. Gurgling ensued, followed by several bowls of urine, relieving pain. He continued the pills. Next noon, he thanked me, vowing never to eat watermelon again.
[Spleen Deficiency Failure to Transport Causing Constipation]
Censor Xue Heting, Ming Wu'gao, from Lingchuan, was upright. While in the Ministry of Personnel, clerks dared not deceive him. Later as Censor, his honest remonstrations offended the emperor, earning respect from the righteous. In summer of Jiayin year, his wife suffered constipation. Some doctors treated excess heat with Chengqi Tang (ineffective); others treated dry intestines with Huomaren (Sesame Seed, ineffective); others treated food stagnation with Pingwei San (incomplete relief). I diagnosed weak pulses everywhere, especially Right Guan, and thread-like Right Chix. I said: "Spleen deficiency fails to transport." I prescribed Sijun Pingwei Tang (Four Gentlemen and Stomach-Pacifying Decoction) with heavy Lu Shen (Codonopsis Root) up to one liang. Heting worried: "Constipation worsens with clogging?" I explained: "*Neijing* teaches 'treat obstruction with tonification.' Bowel movement relies on Middle Qi. If Qi fails to secure, diarrhea occurs; if Qi is too deficient, downward movement fails. Your wife wants to defecate but cannot descend. Sijun Ti raises Middle Qi; Pingwei San harmonizes Stomach Qi. It will work." She took it that night. Next morning, multiple bowel movements occurred, abdomen felt empty, spirit bright, appetite restored. He wrote thanking me, puzzled by the theory. Next day, he visited. I said: "Without studying classics, it's hard to understand. Spleen and Stomach function similarly." He realized constipation can be deficiency-based and became a close friend.
[Wind Evil Attacking Fu Organs Causing Sudden Aphasia]
Merchant Mu Qitong, from my hometown, worked in a Beijing trading house. Obese and indulgent in diet, he suddenly fell aphasic and paralyzed after drinking outdoors in summer. Chest and abdomen full and closed, life threatened. A southern friend, knowing medicine, treated him as paralysis with Xuming Tang (Continuing Life Decoction) without success. Colleagues invited me. Pulses were slow and large, except Right Guan which was firm and beating. Symptoms: no eating, defecating, or speaking for days. Abdomen showed restless movement. I said: "It resembles paralysis, but Wind evil attacking Fu organs requires different treatment. Use Sanhua Tang (Three Transformations Decoction) to purge first, then treat. This is an excess syndrome." Southern doctor doubted purging would work. I insisted. One meal later, the patient wanted to rise, bowels moved foul matter, abdomen shrank, breath steadied, voice returned. Tongue stiff, speech unclear. Kneeling for life, he asked the southern doctor's opinion. The southern doctor blushed and fled. I prescribed two more doses, improving spirit. Turtle urine applied to tongue aided speech. Ten days later, employer forced him home. I remained in Beijing; his fate unknown.
[Food Stagnation Leading to Dysentery]
A silver merchant, unnamed, contracted dysentery in summer. Doctors treated fire with Chengqi Tang, causing frequent stools. Another treated deficiency with tonics, stopping stools but causing chest/abdominal fullness and prostration. Fearing death, colleagues moved him to a temple. After ten days, no improvement, funeral clothes bought. Relative invited me to decide life or death. Entering, foul odor overwhelmed me. Patient unconscious, eyes closed. Pulses weak, deep, fine, regular, except Right Guan large and beating. I diagnosed dysentery from food stagnation. Initial purging cleared fire but not food. Abdomen distended, nausea at sight of food. Dangerous but survivable. Relative agreed to treatment. I prescribed Pingwei San with Shenqu and Maiya. Night brought massive foul discharge, abdomen flattened, consciousness returned. Next day, pulse small, Qi deficient. Zhenren Yangzang Tang (True Person Nourishing Viscera Decoction) stopped dysentery in three doses. Ren Shen Yangrong Wan (Ginseng and Blood-Nourishing Pill) restored health over half a month. Two months later, a man thanked me with boots and hats, claiming to be the cured patient. I declined gifts kindly.
[Spleen Dampness and Phlegm Causing Dizziness]
Grand Secretary Qi Shouyang, retired in Beijing, suffered chronic dizziness with vertigo and vomiting. Doctors treated deficiency with Renshen and Huangqi continuously without cure. Worse on cloudy windy days. After rain, he invited me for tea and diagnosis. Left Cun pulse deficient; Right three positions slippery, slow, and wiry. I said: "Excessive mental labor causes Spleen dampness and phlegm retention. Intermittent diarrhea, heavy body require drying dampness and resolving phlegm. Ancients say treating phlegm without regulating Spleen/Stomach is incorrect. Strengthening Spleen eliminates phlegm, stopping dizziness." I prescribed Xiangsha Liujunzi Tang (Costus, Amomum, and Six Gentlemen Decoction) with Yizhi and Zexie. Five doses eliminated dizziness. At dinner, he told colleagues: "Dizziness belongs to phlegm; unheard before. I didn't believe Runyuan [my pseudonym], but medicine cured old ailment. Only deep pulse knowledge sees this." I modestly declined praise.
[Wind Stroke Arm Pain]
Mid-autumn, I suffered arm pain. Minister Cao treated me, recounting previous cases and my methods. He附和 (agreed): "Wang's words are correct. Current arm pain is phlegm harm.若不早除 (if not removed early), it becomes paralysis." He prescribed Da Qinjiao Tang (Large Gentian Decoction). Pain increased upon ingestion, immobility ensued, sleep and appetite lost. Son Ziyu invited me. Pulse floating and weak, sweating, spirit clear, speech fluent. I told Grand Secretary: "Shoulder/arm wind stroke pain is minor. Minister exaggerates. Qinjiao Tang focuses on tonification. Wind in skin requires dispersing pores. Using Ginseng/Astragalus consolidates, increasing pain. Do not be confused. Three doses will relieve pain." I prescribed Dongyuan Qianghuo Shengshi Tang (Dongyuan Notopterygium and Drynaria Decoction for Overcoming Dampness) with Weilingxian and Cangzhu. One dose reduced pain; three doses eliminated it. Next day, he recalled opening window, feeling cold from bamboo wind, triggering pain. Asked why diaphoretics were used. I explained: Qianghuo and Gaoben disperse Taiyang skin layer, not induce sweat. They open pores, don't force sweat. Secretary amazed: "Insightful. Many doctors miss this. Great talent, fine mind. Young achievement promises distinction in medicine. Strive! Early success expected; I will yield precedence." I retreated humbled. Later in Shaanxi, he praised me in letters.
[Liver Heat and Stagnant Blood]
Grand Secretary's eldest daughter-in-law, wife of Ziyu, had a violent temper under strict family rules. Depressed, she developed abdominal distension and missed menstruation twice. Others thought pregnant, ignored. Ziyu, lacking heirs, gave fetal protection pills, worsening distension and pain. After official duties, Ziyu and I examined her. Left Guan pulse wiry and urgent: Liver heat with stagnant blood. Prescribed Xiaoyao San (Free and Easy Wanderer Powder) combined with Zuojin Wan (Left Metal Pill). Ziyu feared pregnancy, hesitated. I assured: "Definitely not pregnancy. Two months would not present thus. Take it confidently. Don't let prejudice mislead." Two doses reduced distension, smoothed Qi, but menses still absent. Continued with Jiawei Wuyao Tang (Modified Ligusticum Decoction). Menses arrived in two days, body refreshed. From then, she always consulted me for illnesses, even servants' minor ailments.
[Spleen Labor and Overeating Mistakenly Purged to Critical State]