何保义从王太尉军中。得伤寒。脉浮涩而紧。予曰若头疼。发热。恶风。无汗。则麻黄证也。
烦躁。则青龙汤证也。何曰。今烦躁甚。予投以大青龙汤。三投。汗解。
论曰。桂枝。麻黄。青龙。皆表证发汗药。而桂枝治汗出。恶风。麻黄治无汗。恶寒。青龙
治无汗。而烦。三者皆欲微汗解。若汗多。亡阳。为虚。则烦躁不眠也。
一武弁李姓。在宣化作警。伤寒五六日矣。镇无医。抵郡召予。予诊视之曰。脉洪大而长。
大便不通。身热无汗。此阳明证也。须下。病家曰。病者年逾七十。恐不可下。予曰。热邪毒瓦斯并蓄于阳明。况阳
明经络多血少气。不问老壮。当下。不尔别请医占。主病者曰。审可下。一听所治。予以大承气
汤。半日。殊未知。诊其病。察其证宛然在。予曰。药曾尽否。主者曰。恐气弱不禁。但服其半
耳。予曰。再作一服。亲视饮之。不半时间。索溺器。先下燥粪十数枚。次溏泄一行。秽不可近。
未离已中汗矣。 然周身。一时顷。汗止身凉。诸苦遂除。次日予自镇归。病患索补剂。予曰。
服大承气汤得瘥。不宜服补剂。补则热仍复。自此但食粥。旬日可也。故予治此疾。终身止大承
气。一服而愈。未有若此之捷。
论曰。老壮者形气也。寒热者病邪也。脏有热毒。虽衰年亦可下。脏有寒邪。虽壮年亦可温。
要之与病相当耳。失此。是致速毙也。谨之。
He Bao Yi, serving in the army of Grand Marshal Wang, contracted Shanghan (Cold Damage). The pulse was floating, choppy, and tight. I said, "If there is headache, fever, aversion to wind, and anhidrosis (absence of sweating), it is a Mahuang Tang (Ephedra Decoction) pattern."
"If there is irritability, it is a Da Qing Long Tang (Major Blue Dragon Decoction) pattern." He Bao Yi replied, "The irritability is now severe." I administered Da Qing Long Tang. After three doses, he sweated and recovered.
Commentary: Guizhi Tang (Cinnamon Twig Decoction), Mahuang Tang (Ephedra Decoction), and Da Qing Long Tang are all diaphoretic agents for treating exterior patterns. However, Guizhi Tang treats patterns with sweating and aversion to wind; Mahuang Tang treats patterns without sweating and aversion to cold; Da Qing Long Tang treats patterns without sweating accompanied by irritability. All three aim to resolve the pathogen through mild sweating. If sweating is excessive, leading to Yang collapse and deficiency, irritability and insomnia will occur.
A military officer surnamed Li, stationed on guard duty in Xuanhua, had suffered from Shanghan for five or six days. There were no physicians in the garrison, so he went to the prefecture to summon me. Upon examination, I stated, "The pulse is surging, large, and long. There is constipation, body heat, and anhidrosis. This is a Yangming pattern. Purgation is required." The patient's family said, "The patient is over seventy years old; we fear purgation is not suitable." I said, "Heat pathogens and toxic vapors are accumulated in the Yangming channel. Moreover, the Yangming channels have abundant blood but scarce Qi. Purgation is indicated regardless of age or robustness. Otherwise, please consult another physician." The guardian said, "If purgation is indeed appropriate, we submit to your treatment." I prescribed Dachengqi Tang (Major Orderly Descending Decoction). Half a day passed with no significant change. I re-examined the patient and observed that the symptoms persisted. I asked, "Has the medicine been fully consumed?" The guardian replied, "We feared his weak Qi could not tolerate it, so only half was taken." I said, "Prepare another dose, and I will watch him drink it personally." Within less than half an hour, he requested a urinal. First, several hard fecal pellets were expelled, followed by a discharge of loose stool, which was foul-smelling and repulsive. Before leaving the room, sweat began to appear on his body. However, the sweating occurred simultaneously over the entire body. In a short while, the sweating ceased, the body cooled, and all distressing symptoms were eliminated. The next day, upon my return from the garrison, the patient requested tonic medicines. I said, "Having recovered after taking Dachengqi Tang, tonics should not be taken. Tonification would cause the heat to recur. From now on, consume only congee; recovery can be expected within ten days." Thus, in treating this illness, I used only Dachengqi Tang throughout his life, achieving a cure with a single dose. No case has been as swift as this.
Commentary: Old and young refer to physical constitution and Yuan Qi (Original Qi). Cold and heat refer to the nature of the pathogenic factors. If there is heat toxicity in the Zang organs, purgation may be used even in advanced age; if there is cold pathogens in the Zang organs, warming therapy may be used even in youth. The key lies in matching the treatment to the disease. Deviating from this principle leads to rapid death. One must exercise caution.