曹生初病伤寒。六七日。腹满而吐。食不下。身温。手足热。自利。腹中痛。呕。恶心。医
者谓之阳多。尚疑其手足热。恐热蓄于胃中而吐呕。或见吐利而为霍乱。请予诊。其脉细而沉。
质之。曰太阴证也。太阴之为病。腹满而吐。食不下。自利益甚。时腹自痛。予止以理中丸。用
仲景云如鸡子黄大。昼夜投五六枚。继以五积散。数日愈。
论曰。予见世医论伤寒。但称阴证阳证。盖仲景有三阴三阳。就一证中又有偏胜多寡。须是
分明辩质。在何经络。方与证候相应。用药有准。且如太阴少阴。就阴证中。自有补泻。岂可止
谓之阴证也哉。
毗陵一时官得病。身疼痛。发热。体重。其脉虚弱。人多作风湿。或作热病。则又疑其脉虚
弱不敢汗也。已数日矣。予诊视之。曰中 证也。仲景云太阳中 者。身热体疼。而脉微弱。此
以夏月伤冷水。水行皮中所致也。予以瓜蒂散。治之。一呷而愈。
论曰。仲景论 有三证。一则汗出。恶寒。身热而渴。此太阳经中 也。一则发热恶寒。身
疼痛。其脉弦细芤迟。一则夏月伤冷水。水行皮中。身热。疼痛重而脉微弱。不可下。不可行温
针。上二证皆宜用白虎加人参汤。后一证宜用瓜蒂散方治。不见于本论。而见于金匮要略。其脉
证云。治太阳中 。身热。疼痛。而脉微弱者。夏月伤冷水。水行皮中所致。宜瓜蒂散。盖谓此也。
Cao Sheng initially contracted Shanghan (Cold Damage). By the sixth or seventh day, he presented with abdominal fullness and vomiting, inability to eat, warm body temperature, heat in the hands and feet, spontaneous diarrhea, abdominal pain, retching, and nausea. The attending physician attributed this to an excess of Yang, still doubting whether the heat in his extremities was due to heat accumulation in the stomach causing vomiting. Others, observing both vomiting and diarrhea, suspected Huoluan (Cholera-like disease). I was invited to diagnose him; his pulse was fine and deep. Upon inquiry, I determined it was Taiyin Syndrome (Disease of the Taiyin Meridian). The manifestations of Taiyin disease include abdominal fullness, vomiting, inability to eat, worsening diarrhea, and occasional spontaneous abdominal pain. I prescribed only Lizhong Wan (Regulate the Middle Pill), administered according to Zhang Zhongjing’s instruction: a size equivalent to a chicken egg yolk, given five to six pills throughout the day and night. Subsequently, Wujie San (Five Accumulations Powder) was administered, and he recovered after several days.
Commentary: I observe that contemporary physicians discussing Shanghan merely categorize them broadly as Yin syndromes or Yang syndromes. However, Zhang Zhongjing delineates three Yin and three Yang stages. Within a single syndrome, there are variations in dominance and severity. One must clearly differentiate the constitution and identify the specific meridian involved to match the treatment to the symptoms accurately. For instance, within Yin syndromes such as Taiyin and Shaoyin, there are distinct tonifying and purging methods; how can one simply label them as Yin syndromes?
An official in Biling fell ill with body pain, fever, heaviness of the body, and a weak pulse. Many diagnosed it as Fengshi (Wind-Dampness) or Rebing (Heat Disease), but hesitated to use sweating methods due to the weak pulse. After several days, I examined him and diagnosed it as Taiyang Zhongshu (Summerheat Stroke of the Taiyang Meridian). Zhang Zhongjing stated: In Taiyang Zhongshu, the body is hot and painful, yet the pulse is faint and weak. This results from exposure to cold water in summer, causing water qi to circulate within the skin. I treated him with Goudi San (Melon Peduncle Powder); after a single sip, he recovered.
Commentary: Zhang Zhongjing describes three types of Zhongshu (Summerheat). The first involves sweating, aversion to cold, fever, and thirst, representing Zhongshu affecting the Taiyang Meridian. The second involves fever, aversion to cold, body pain, with a pulse that is string-taut, fine, hollow, and slow. The third involves summer exposure to cold water, with water qi circulating in the skin, presenting with fever, heavy pain, and a weak pulse; this type should not be treated with purgation or warm needle therapy. The first two types are suitable for Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng), while the third type is suitable for Goudi San. This latter indication is not found in the main text of Shanghan Lun but appears in Jin Gui Yao Lue (Essential Prescriptions from the Golden Cabinet). Its pulse and symptom description states: To treat Taiyang Zhongshu characterized by fever, pain, and a weak pulse caused by summer exposure to cold water circulating in the skin, Goudi San is indicated. This refers to the case described above.