乡人李生。病伤寒。身热。大便不通。烦渴郁冒。一医以巴豆丸下之。虽得溏利。而病宛然
如旧。予视之曰。阳明热结在里。非大柴胡承气不可。巴豆止去寒积。岂能荡涤邪热温毒耶。亟
进大柴胡。三服而溏利止。中夜汗解。
论曰。仲景一百十三方。丸者有五。理中。陷胸。抵当。麻仁。乌梅也。理中。陷胸。抵当。
皆大弹丸。煮化而服之。与汤散无异。至于麻仁治脾约。乌梅治湿 。故须小丸达下部。其他皆入经络。逐邪毒。破坚
癖。导血润燥屎之类。必凭汤剂也。未闻巴豆小丸以下邪毒。且如巴豆性热大毒。而病热人服之。非
徒无益。而为害不小矣。李生误服不死。其大幸欤。
庚戌。建康徐南强。得伤寒。背强。汗出。恶风。予曰。桂枝加葛根汤证。病家曰。他医用
此方。尽二剂而病如旧。汗出愈加。予曰。得非仲景三方乎。曰然。予曰。误矣。是方有麻黄。
服则愈见汗多。林亿谓止于桂枝加葛根汤也。予令生而服之。微汗而解。
市人杨姓者。病伤寒。无汗。恶风。项虽屈而强。医者以桂枝麻黄各半汤与之。予曰。非其
治也。是谓项强KT KT 。葛根证也。三投。 然微汗解。翌日项不强。脉已和矣。
论曰。何谓KT KT 。如短羽鸟之状。虽屈而强也。谢复古谓病患羸弱。须凭几而起。非是。此
与成氏解不同。
A fellow townsman, Li Sheng, suffered from Shanghan (Cold Damage). His body was hot, his stool was blocked, he felt restless and thirsty, and experienced dizziness. A physician administered Baidu Wan (Croton Seed Pills) to purge him. Although loose stools were passed, the illness remained unchanged. Upon examination, I said, "This is Yangming heat accumulation in the interior; it requires Dahuang Chaihu Tang (Rhubarb and Bupleurum Decoction) or Chengqi Tang (Purgative Decoction). Baidu Croton Seed only removes cold accumulation; how can it cleanse pathogenic heat and warm toxins?" We urgently advanced Dahuang Chaihu Tang. After three doses, the loose stools stopped, and at midnight, he recovered through sweating.
The commentary states: Among Zhang Zhongjing's 113 formulas, there are five pill formulations: Lizhong Wan (Regulate the Middle Pill), Xiongxiong Wan (Chest-Sinking Pill), Didang Wan (Resist the Stasis Pill), Maziren Wan (Hemp Seed Pill), and Wumei Wan (Mume Fruit Pill). Lizhong, Xiongxiong, and Didang are all large pellets, taken after being boiled and dissolved, which is no different from decoctions or powders. As for Maziren Wan treating Pi Yue (Spleen Constraint) and Wumei Wan treating Shi (Dampness/Worms - *Note: Text says 'Shi', likely a typo for 'Hui' (Worms)*), small pills are needed to reach the lower part. The others act on the meridians, expel pathogenic toxins, break up firm masses, guide blood, and moisten dry feces, etc., all of which must rely on decoctions. It has not been heard that small pills of Baidu Croton are used to expel pathogenic toxins. Moreover, Baidu Croton is hot in nature and highly toxic; administering it to a patient with heat illness is not only useless but also causes significant harm. That Li Sheng survived the mistaken administration is truly fortunate.
In the year Gengxu, Xu Nanqiang from Jiankang contracted Shanghan. He had stiffness in the back, sweating, and aversion to wind. I said, "This is a Guizhi Jia Gegen Tang (Cinnamon Twig plus Kudzu Root Decoction) pattern." The patient's family said, "Other physicians used this formula. After two doses, the illness remained as before, and the sweating increased." I said, "Could it be one of Zhang Zhongjing's three formulas?" They replied, "Yes." I said, "It was a mistake. That formula contains Mahuang (Ephedra). Taking it would cause even more sweating. Lin Yi stated that it should be only Guizhi Jia Gegen Tang." I instructed Xu Nanqiang to take it accordingly. He recovered with slight sweating.
A merchant surnamed Yang suffered from Shanghan. He had no sweating, aversion to wind, and although his neck could bend, it felt stiff. The physician gave him Guizhi Mahuang Ge Ban Tang (Half Guizhi Half Mahuang Decoction). I said, "This is not the correct treatment. This is referred to as Xiang Qiang [KTKT]. This is a Gegen Tang (Kudzu Root Decoction) pattern." After three doses, he recovered with slight sweating. The next day, his neck was no longer stiff, and his pulse had harmonized.
The commentary asks: What is KTKT? It resembles the posture of a short-winged bird; although it can bend, it feels stiff. Xie Fugu claimed it refers to patients who are emaciated and weak, requiring a table to rise up, which is incorrect. This differs from Cheng Wuji's explanation.