里间张太医家一妇。病伤寒。发热。恶风。自汗。脉浮而弱。予曰。当服桂枝。彼云家有自
合者。予令三啜之。而病不除。予询其药中用肉桂耳。予曰。肉桂与桂枝不同。予自治以桂枝汤。
一啜而解。
论曰。仲景论用桂枝者。盖取桂枝轻薄者耳。非肉桂之肉浓也。盖肉桂浓实。治五脏用之。
取其镇重。桂枝清轻。治伤寒用之。取其发散。今人一例。是以无功。
有人病伤寒数日。自汗。咽喉肿痛。上吐下利。医作伏气。予诊之曰。此证可疑。似是之非。乃
少阴也。其脉三部俱紧。安得谓之伏气。伏气脉必浮弱。谓非时寒冷。着人肌肤。咽喉先痛。次
下利者是也。近虽有寒冷不时。然当以脉证为主。若误用药。其毙可待。予先以吴茱萸汤救之。
次调之以诸药而愈。
论曰。仲景论伏气之病。其脉微弱。喉中痛。似伤寒非喉痹也。实咽中痛。今复下利。仲景
少阴云。病患手足俱紧。反汗出者亡阳也。此属少阴证。法当咽痛而复吐利。此证见少阴篇。今
人三部脉俱紧。而又自汗。咽痛下利。与伏气异。然毫厘之差。千里之谬。须讲熟此书。精详分
别。庶免疑惑矣。
市人周姓者。同里俱病头痛发热。耳聋目赤。胸中满闷。医中见外证胸满。遂吐之。既吐后
病宛然在。又见其目赤发热。复利之。病不除。惴惴然恂栗。予诊视之。曰少阳误吐下之过也。
仲景少阳中风。两耳无闻。目赤。胸满而烦者。不可吐下。吐下则惊而悸。此当用小柴胡汤。今
误吐下。遂成坏证矣。乃以牡蛎四逆汤调于前。继之以桂枝柴胡各半汤。旬日瘥。
论曰。仲景虽云三阳受病。未入于脏者。可汗。然少阳脉弦细。则不可汗。将入少阴经也。
若误吐下之。是逆之。且当以救逆。先待惊悸定。后治余证。此所谓急其所当先也。
A woman in the household of Zhang, a Grand Physician in the neighborhood, contracted Shanghan (Cold Damage). She presented with fever, aversion to wind, spontaneous sweating, and a floating and weak pulse. I stated, "She should take Guizhi Tang (Cinnamon Twig Decoction)." She replied that she had self-prepared medicine at home. I instructed her to take three doses, but the illness did not resolve. I inquired whether the medicine contained Rougui (Cortex Cinnamomi). I said, "Rougui (Cortex Cinnamomi) is different from Guizhi (Ramulus Cinnamomi)." I prepared Guizhi Tang for her myself; after one dose, she was cured.
In commentary: When Zhang Zhongjing discusses the use of Guizhi (Ramulus Cinnamomi), he refers to taking the lighter, thinner twigs, not the thick flesh of Rougui (Cortex Cinnamomi). Rougui (Cortex Cinnamomi) is dense and solid, used for treating the Five Zang Organs for its heavy, sedating nature. Guizhi (Ramulus Cinnamomi) is clear and light, used for treating Shanghan (Cold Damage) for its dispersing properties. Today, people treat them as identical, hence achieving no efficacy.
A person suffered from Shanghan (Cold Damage) for several days, presenting with spontaneous sweating, sore throat and swelling, vomiting above, and diarrhea below. The physician diagnosed it as Fuqi (Latent Qi disease). Upon examination, I said, "This syndrome is questionable; it appears correct but is actually Shaoyin Syndrome (Syndrome of the Lesser Yin)." His pulses in all three positions were tight; how can this be called Fuqi (Latent Qi disease)? The pulse of Fuqi (Latent Qi disease) must be floating and weak, referring to cold striking the body's skin and muscles out of season, first causing sore throat, followed by diarrhea. Although there is occasional cold recently, one must prioritize the pulse and symptoms. If medication is misapplied, death is imminent. I first treated him with Wuzhuyu Tang (Evodia Decoction) to rescue the condition, then regulated him with various other medicines until he recovered.
In commentary: Zhang Zhongjing discusses Bing Fuqi (Disease of Latent Qi), where the pulse is faint and weak, with pain in the throat. It resembles Shanghan (Cold Damage) but is not Hou Bi (Throat Bi obstruction). It is truly pain in the pharynx, now accompanied by diarrhea. In the Shaoyin chapter, Zhang Zhongjing states: "If the patient's hands and feet are both tight, yet there is spontaneous sweating, this indicates loss of Yang." This belongs to Shaoyin Syndrome (Syndrome of the Lesser Yin); according to the method, it should present with sore throat accompanied by vomiting and diarrhea. This syndrome is found in the Shaoyin chapter. Today, people have tight pulses in all three positions, yet also have spontaneous sweating, sore throat, and diarrhea, which differs from Fuqi (Latent Qi disease). However, a difference of a hair's breadth leads to an error of a thousand miles. One must study this book thoroughly and distinguish precisely to avoid confusion.
A man surnamed Zhou in the marketplace, along with fellow townspeople, suffered from headache, fever, deafness, red eyes, and fullness/stuffiness in the chest. The physician saw the external symptom of chest fullness and thus induced vomiting. After vomiting, the illness remained unchanged. Seeing his red eyes and fever again, the physician then induced purgation (diarrhea). The illness did not resolve. The patients were terrified and trembling. I examined them and said, "This is the fault of mistakenly using vomiting and purgation on Shaoyang Syndrome (Syndrome of the Lesser Yang)." Zhang Zhongjing discusses Shaoyang Wind Strike: if there is inability to hear in both ears, red eyes, chest fullness, and irritability, vomiting and purgation must not be used. Vomiting and purgation will lead to fright and palpitations. This should be treated with Xiaochaihu Tang (Minor Bupleurum Decoction). Now, due to mistaken vomiting and purgation, it has become a Huazheng (Ruined Syndrome/Complicated Disease). Therefore, I first regulated him with Musi Sini Tang (Oyster Shell Four Reversal Decoction), followed by Guizhi Chaihu Banxia Tang (Cinnamon Twig and Bupleurum Half-Decoction). After ten days, he recovered.
In commentary: Although Zhang Zhongjing states that when the Three Yang channels are affected and the pathogen has not entered the Zang Organs, sweating therapy may be used, Shaoyang Syndrome (Syndrome of the Lesser Yang) presents with a wiry and fine pulse, so sweating is contraindicated, as it is about to enter the Shaoyin channel. If mistakenly treated with vomiting or purgation, this is contrary to the proper treatment. One must prioritize rescuing from the adverse reaction. First, wait for the fright and palpitations to settle, then treat the remaining syndromes. This is what is meant by "addressing the urgent priority first."