己未岁。一时官病伤寒。发热狂言烦躁。无他恶证。四日死。或者以为两感。然其证初无两
感证候。是岁得此疾。三日四日死者甚多。人窃怪。予叹之。曰是运使然也。己为土运。土运之
岁。上见太阴。盖太乙天符为贵人。中执法者。其病速而危。中行令者。其病徐而持。中贵人者。
其病暴而死。谓之异也。又曰臣为君则逆。逆则其病危。其害速。是年少宫土运。木气大旺。邪
中贵人。故多暴死。气运当然。何足怪也。
陈姓士人。初得病。身热。脉浮。自汗。医者麻黄汤汗之。发热愈甚。夜间不得眠。头重。
烦闷。悸悸然。中风证强责汗之过也。仲景云太阳病。发汗后。大汗出。胃中干燥。不得眠。其人欲得饮水者。少少与
之。令胃气和则愈。予先与猪苓汤。次投之以当归。地黄。麦门冬。芍药。乌梅之类为汤。饮之。不汗而愈。
论曰。黄帝针经曰。卫气者昼行阳。夜行阴。卫气不得入于阴。常行于外。行于外则阳满。
满则阳跷盛而不得入于阴。阴虚则夜不得眠也。今津液内竭。胃中干燥。独恶于阳。阴无所归。
其候如此。故以当归。地黄补血。用乌梅以收之。故不汗自愈。
羽流蒋尊病。其初心烦喜呕。往来寒热。医初以小柴胡汤与之。不除。予诊之曰。脉洪大而
实。热结在里。小柴胡安能除也。仲景云伤寒十余日。热结在里。复往来寒热者。与大柴胡。二
服而病除。
论曰。大黄为将军。故荡涤湿热。在伤寒为要药。今大柴胡汤不用。诚误也。王叔和曰。若
不加大黄。恐不名大柴胡。须是酒洗生用。乃有力。昔后周姚僧坦名善医。上因发热。欲服大黄。
僧坦曰。大黄乃是快药。至尊年高。不宜轻用。上弗从。服之。遂不起。及至元帝有疾。诸医者
为至尊至贵不可轻服。宜用平药。僧坦曰。脉洪而实。必有宿食。不用大黄。病不能除。上从之。
果下宿食而愈。此明合用与不合用之异也。
In the Jiwei year, an official contracted Shanghan (Cold Damage). He exhibited fever, delirious speech, and irritability, without other severe exterior symptoms. He died four days later. Some considered it Lianggan disease (simultaneous contraction of pathogenic factors in both Taiyang and Shaoyin meridians). However, his initial symptoms did not present with Lianggan characteristics. Many people who contracted this illness that year died on the third or fourth day. People were secretly puzzled. I sighed and said: This is due to the influence of Qi Yun (Five Movements and Six Qi theory). The Ji year corresponds to Earth Yun (Earth Movement). In years of Earth Yun, the upper aspect manifests as Taiyin (Great Yin) dampness. When Taiyi Tianfu (a rare convergence where the Yearly Movement, Supreme Ruler, and Lower Ruler coincide) acts as a "Noble Person," diseases affecting the "Central Enforcer" (convergence of Yearly Movement and Supreme Ruler) are rapid and critical; those affecting the "Central Messenger" (convergence of Yearly Movement and Lower Ruler) are slow and lingering; those affecting the "Central Noble" (triple coincidence) are violent and fatal. This is termed "Yi" (special anomaly). Furthermore, when the Minister (Yearly Movement) opposes the Sovereign (Supreme Ruler), it creates opposition, leading to critical illness and rapid deterioration. That year was Shaogong (deficient Earth Yun), with Wood Qi flourishing excessively. Pathogens attacked the "Noble" constitution, resulting in many sudden deaths. This is the natural course of Qi Yun; why be surprised?
A scholar surnamed Chen initially presented with body heat, floating pulse, and spontaneous sweating. A physician administered Mahuang Tang (Ephedra Decoction) to induce sweating. Consequently, the fever worsened. He suffered from insomnia at night, heavy head, vexation, and palpitations. This resulted from forcibly inducing sweat in a Fengzheng (Wind Strike/Solar Wind pattern) case. Zhang Zhongjing stated: In Taiyang disease, after sweating, if excessive sweating occurs, causing dryness in the Stomach, insomnia results. If the patient desires water, provide it in small amounts frequently; harmony of Stomach Qi leads to recovery. I first administered Zhuling Tang (Polyporus Decoction), followed by a decoction containing Danggui (Angelicae Sinensis Radix), Dihuang (Rehmanniae Radix), Maimendong (Ophiopogonis Radix), Shaoyao (Paeoniae Radix), and Wumei (Mume Fructus). He recovered without further sweating.
The commentary states: The Huangdi Zhenjing (Yellow Emperor's Classic of Acupuncture) says: Wei Qi (Defensive Qi) travels through Yang during the day and Yin at night. If Wei Qi cannot enter Yin and remains in Yang, Yang becomes full. Fullness causes the Yang Qiao vessel to flourish, preventing entry into Yin. Yin deficiency leads to nighttime insomnia. Here, internal fluids are exhausted, Stomach dryness prevails, and there is aversion to Yang. Yin has no place to return. Given these signs, Danggui and Dihuang were used to nourish Blood, and Wumei to astringe. Thus, recovery occurred without sweating.
The Daoist priest Jiang Zun fell ill. Initially, he experienced mental restlessness, frequent vomiting, and alternating chills and fever. The physician initially prescribed Xiaochaihu Tang (Minor Bupleurum Decoction), but the condition persisted. Upon examination, I noted a surging and excess pulse, indicating heat accumulation in the interior. How could Xiaochaihu Tang resolve this? Zhang Zhongjing stated: In Shanghan lasting over ten days, with heat accumulated internally and accompanied by alternating chills and fever, Da Chaihu Tang (Major Bupleurum Decoction) should be given. After two doses, the illness resolved.
The commentary states: Dahuang (Rhei Radix et Rhizoma) is known as the General; it purges damp-heat and is a crucial herb for Shanghan. Omitting Dahuang in Da Chaihu Tang is indeed an error. Wang Shuhe stated: Without Dahuang, it cannot rightly be called Da Chaihu Tang. It must be raw and wine-washed to be effective. Previously, Yao Sengt'an of the Later Zhou dynasty was renowned for his medical skill. When the Emperor had a fever and wished to take Dahuang, Yao advised: Dahuang is a drastic medicine. Given Your Majesty's advanced age, it should not be used lightly. The Emperor did not listen and took it, leading to his demise. Later, when Emperor Yuan fell ill, physicians argued that such a noble figure should not take harsh medicines like Dahuang but rather mild ones. Yao Sengt'an replied: A surging and excess pulse indicates retained food stagnation. Without Dahuang, the illness cannot be cured. The Emperor agreed. Indeed, retained food was expelled, and he recovered. This illustrates the difference between appropriate and inappropriate usage.