乡里豪子得伤寒。身热。目痛。鼻干。不眠。大便不通。尺寸俱大。已数日矣。自昨夕汗大
出。予曰。速以大柴胡下之。众医骇然。曰。阳明自汗。津液已竭。当用蜜兑。何故用大柴胡药。
予曰。此仲景不传妙处。诸公安知之。予力争。竟用大柴胡。两服而愈。
论曰。仲景论阳明云。阳明病。多汗者。急下之。人多谓己自汗。若更下之。岂不表里俱处
也。论少阴云。少阴病一二日。口干燥者。急下之。人多谓病发于阴。得之日浅。但见干燥。若
更下之。岂不阴气愈盛也。世人罕读。予以为不然。仲景称急下之者。亦犹急当救表。急当救里。
凡称急者。急下之。有三处。才觉汗出。多。未至津液干燥。速下之。则为径捷。免致用蜜兑也。
盖用蜜兑。已是失下。出于不得已耳。若胸中识得了了。何疑殆之有哉。
闽人李宗古得疾。口中气热。唇干。屈体卧。足冷。舌上有苔。予诊之。尺寸俱紧。或者谓
气热口干。疑其阳胜。蜷足卧。足冷。疑其阴胜。而又阴阳俱紧。是诚可疑也。若不熟读仲景方
法。何能治。予曰尺寸俱紧。是寒邪胜也。仲景云阴阳俱紧。法当清。邪中于下焦。又云阴阳俱
紧。口中气出。唇干舌燥。蜷卧。足冷。鼻中涕出。舌上苔滑。勿妄治也。到七日以来。其人发
热。手足温者。此为欲解。盖以上证候。皆是阴盛阳弱。故仲景云勿妄治者。诚恐后人之疑也。
故予以抑阴助阳温剂与之。紧脉渐退。四体和。不汗而自解矣。
A local wealthy youth contracted *Shanghan* (Cold Damage). He presented with fever, eye pain, nasal dryness, insomnia, and constipation. Both the Cun (Inch) and Chi (Cubit) pulses were large. This condition had persisted for several days. Since the previous evening, he had sweated profusely. I stated, "One must immediately administer Da Chai Hu Tang (Major Bupleurum Decoction) to purge." The other physicians were shocked, saying, "Yangming disease with spontaneous sweating indicates that body fluids are already exhausted; one should use honey suppositories (Mi Dui). Why use Da Chai Hu Tang?" I replied, "This is a subtle point not readily transmitted by Zhang Zhongjing. How could you know it?" I argued strongly and ultimately used Da Chai Hu Tang. After two doses, he recovered.
The commentary states: In discussing Yangming disease, Zhang Zhongjing wrote, "In Yangming disease, if there is excessive sweating, one must urgently purge." People often argue that since there is already spontaneous sweating, purging again would damage both the exterior and interior. In discussing Shaoyin disease, he wrote, "In Shaoyin disease, on the first or second day, if the mouth and throat are dry, one must urgently purge." People often argue that the disease originates in the Yin aspect, has been present for only a short time, and merely shows dryness; purging again would make the Yin qi even more abundant. Few people read these passages carefully. I believe this is incorrect. When Zhang Zhongjing says "urgently purge," it is similar to "urgently rescue the exterior" or "urgently rescue the interior." Whenever "urgent" is mentioned, there are three situations requiring "urgent purging": when one just notices excessive sweating but before body fluids become dried up, one must purge quickly. This is the direct and expedient method, avoiding the need for honey suppositories. Using honey suppositories means one has missed the opportunity for purging and is doing so out of necessity. If one's understanding is clear, what doubts remain?
Li Zonggu, a man from Fujian, fell ill. His breath was hot, his lips were dry, he lay curled up, his feet were cold, and there was coating on his tongue. Upon diagnosis, both the Cun and Chi pulses were tight. Some suspected that hot breath and dry mouth indicated Yang excess, while curling up and cold feet indicated Yin excess. With both Yin and Yang pulses being tight, this was indeed suspicious. Without familiarity with Zhang Zhongjing's methods, how could one treat this? I said, "Tight pulses at both Cun and Chi indicate an excess of Cold Evil." Zhang Zhongjing stated, "When Yin and Yang pulses are both tight, the method suggests clarity/purification [Note: Contextual interpretation varies, often linked to specific cold patterns]; if evil invades the Lower Jiao..." He also said, "If Yin and Yang pulses are both tight, accompanied by hot breath, dry lips and tongue, curled posture, cold feet, runny nose, and a slippery coating on the tongue, do not treat rashly." By the seventh day, if the patient develops fever and warm hands and feet, this indicates impending resolution. Because the aforementioned symptoms all reflect Yin excess and Yang weakness, Zhang Zhongjing said "do not treat rashly" precisely to prevent confusion among later generations. Therefore, I administered warming tonics to suppress Yin and assist Yang. The tight pulse gradually receded, the four limbs became harmonious, and the disease resolved spontaneously without sweating.