夏有高师病黄证。鼻内 疼。身与目如金色。小便赤涩。大便如常。则知病不在脏腑。今眼
睛疼。鼻额痛。则知病在清道中矣。清道者华盖。肺之经也。若服大黄。则必腹胀为逆。当用瓜蒂散。先含水。次
搐之。令鼻中黄水尽则愈。如其言。数日而病除。
己酉夏。一时官病伤寒。身热头疼无汗。大便不通。已五日矣。予适自外邑归城。访之。见
医者治大黄芒硝辈。将下之矣。予曰子姑少待。予适为诊视。视之脉缓而浮。卧密室中。自称恶
风。予曰。病患表证如此。虽大便闭。腹且不满。别无所苦。何遽便下。于仲景法。须表证罢。
方可下。不尔。邪毒乘虚而入内。不为结胸。必为协热利也。予作桂枝麻黄各半汤。继之以小柴
胡汤。 然汗出。大便通。数日愈。
论曰。仲景云。伤寒病多从风寒得之。始表中风。寒入里。则不消矣。拟欲攻之。当先解表。
方可下之。若表已解。而内不消。大满大坚。实有燥屎。方可议下。若不宜下而遽攻之。诸变不
可胜数。轻者必笃。重者必死。
仇景莫子仪病伤寒七八日。脉微而沉。身黄发狂。小腹胀满。脐下如冰。小便反利。医见发
狂。以为热毒蓄伏心经。以铁粉牛黄等药。欲止其狂躁。予诊之曰非其治也。此瘀血证尔。仲景
云阳病身黄。脉沉结。小腹硬。小便不利。为无血。小便自利。其人如狂者。血证也。可用抵当汤。
再投。而下血几数升。狂止。得汗而解。经云血在下则狂。在上则忘。太阳膀胱经也。随经而蓄
于膀胱。故脐下胀。自阑门会渗入大肠。若大便黑者。此其验也。
In summer, a teacher surnamed Gao suffered from jaundice. There was pain inside the nose. The body and eyes appeared golden. Urine was dark red and difficult to pass with a涩 (astringent/rough) sensation. Stool was normal. From this, it is known that the disease is not in the Zang-Fu organs. Now, with eye pain and pain in the nose and forehead, it is known that the disease is in the Qing Dao (Clear Path). The Qing Dao refers to Huagai (Canopy), which is the meridian of the Lung. If Da Huang (Rhubarb Rhizome) were taken, abdominal distension would inevitably occur, constituting a contrary syndrome. One should use Gou Ti San (Melon Spicule Powder). First, let the patient hold water (or medicated liquid) in the mouth, then perform nasal irrigation (snuffing). When yellow fluid flows out completely from the nose, the illness will be cured. Following these instructions, the disease was eliminated after several days.
In the summer of the Jiyi year, an official contracted Shanghan (Cold Damage). He had fever, headache, no sweat, and constipation for five days. I happened to return to the city from a neighboring county and visited him. I saw the attending physician preparing to administer purgatives such as Da Huang (Rhubarb Rhizome) and Mang Xiao (Mirabilite). I said, "Please wait a moment; let me examine the patient." Upon examination, his pulse was slow and floating. Lying in a closed room, he complained of aversion to wind. I said, "The patient presents with such obvious exterior symptoms. Although there is constipation, the abdomen is not full or distended, and there are no other complaints. Why rush to purge? According to Zhang Zhongjing's method, one must wait until the exterior syndrome resolves before purging. Otherwise, pathogenic toxins will enter the interior by taking advantage of the deficiency, leading either to Jie Xiong (Chest Binding) or Xie Re Li (Heat-Collapsing Diarrhea)." I prescribed Guizhi Mahuang Ge Ban Tang (Half-Guizhi Half-Mahuang Decoction), followed by Xiaochaihu Tang (Minor Bupleurum Decoction). Subsequently, the patient sweated, stool became unobstructed, and he recovered after several days.
It is stated: Zhang Zhongjing said, "Shanghan diseases mostly arise from wind-cold. Initially, wind attacks the exterior; once cold enters the interior, it cannot dissipate on its own." If intending to attack the pathogen, one must first resolve the exterior, and only then can one purge. If the exterior is resolved but internal stagnation remains, presenting with severe fullness and hardness, and there are indeed dry feces, then one may discuss purging. If purging is inappropriate yet rushed, various complications will be countless. Mild cases will become severe, and severe cases will result in death.
Qiu Jing Mo Zi Yi suffered from Shanghan for seven or eight days. His pulse was faint and deep. His body was yellow, and he exhibited mania. His lower abdomen was full and distended, feeling cold like ice below the umbilicus. His urine flowed freely. Seeing the mania, the physician believed it was heat-toxin accumulating in the Heart meridian and used drugs such as Tie Fen (Iron Powder) and Niu Huang (Calculus Bovis) to stop the restlessness. I examined him and said, "This is not the correct treatment. This is a Yu Xue (Blood Stasis) syndrome. Zhang Zhongjing said: In Yang diseases, if the body is yellow, pulse is deep and knotted, lower abdomen is hard, and urine is obstructed, it indicates no blood stasis; if urine flows freely and the person is like mad, it is a blood syndrome. Dang Ke Tang (Ephedra and Dogwood Decoction - *Note: Contextually refers to Didang Tang*) can be used." After administering the decoction twice, several sheng (units of volume) of bloody material were discharged. The mania ceased, and he recovered through sweating. The Classics state: Blood in the lower part causes mania; blood in the upper part causes forgetfulness. This involves the Taiyang Bladder meridian. Pathogens follow the meridian and accumulate in the Bladder, causing distension below the umbilicus. Blood seeps into the Large Intestine via the Lanmen (Appendix gate); if the stool is black, this is the verification.