友人杨达奎君，其夫人秦碧筠，年41岁。于1942年6月下旬，忽患伤寒。余诊之，症状如上。心窃异之，因其非劳动阶级，何由致此。既询其致病之由。秦即详告云：“沪上风行一时之观世音影片，在沪光大戏院开映。闻其情节至佳，因于昨日晚场往观。时天气颇热，乃着云纱短衣而往。
入场则冷气开放，凉爽如秋，意至适也。
迨一小时后，身觉微凉，继则较甚。但以情节苦楚，为之心酸堕泪，欲罢观而不能也。直至终场以后，更觉寒矣。
归时路远，又未步行，乘车而返。夜深途中人少，车快如飞，于是恶寒更甚矣。抵家即覆被而卧，始则恶寒不热，至四小时后，则寒热并作矣。再进则头痛项强，身痛骨痛，周身无汗，而亢热矣。若初微觉凉时，早出影场，必不至有此病也。
余既得其病情，且确为伤寒的证。不能因在夏令，而概不用麻黄也。昔贤谓有此证即用此药，亦何惧哉。乃处以麻黄汤加葛根、藿香，令其照法煎服，不必顾虑。时其夫杨君已回原籍，无人掌握服药事。其邻人有稍知药性者，谓”六月不可服麻黄，即便服之，亦只能三分之一，不可孟浪也，”秦从其商。服后微汗，但旋又复热而无汗，次日再延余诊。
余颇讶之，再三质询，乃以实告。余当谢以不敏，令其再延他医。他医治之，仍然无效。
至第三日，挽张士瀛复来延余，并为深致歉意。且云：“先做与杨君为好友，请勿计其妻不信任也。”余从之往。见其症状虽末变。而较有烦躁意。因将原方去霍香，加生石膏五钱。秦服之，一剂而汗出、热退、神安。后为之清理余邪，微和其大便，即告痊可。中秋将至，杨君由原籍回沪。
备悉其事，特向余致谢意曰：“若不再服麻黄，辗转更换多医，设有不测，咎将谁归耶?无怪先生之不肯复诊也。”余笑颔之。
麻黄汤加葛根藿香方生麻黄三钱川桂枝三钱杏仁四钱炙甘草二钱粉葛根四钱广藿香三钱(按第二方，去藿香，加生石膏五钱。)夏令伤寒证(二)夏令酷热，晚间当门而卧，迎风纳凉。午夜梦酣，渐转凉爽。至二时左右，觉寒而醒，人室就睡。俄而寒热大作，头痛骨疼，壮热无汗。渐至烦躁不安，目赤口干，气急而喘。此夏令急性伤寒也，大青龙汤主之。
友人邓汉城之侄，名一东，身体素壮，不易患病，于七月间忽病伤寒。时天气白昼颇热，至半夜后则转清凉。一东于晚间十时后，当门而卧，赤膊赤胫，只着一短裤，凉风拂拂，一梦如登仙矣。迨至二时左右，迎门风势更大，凉气逼人，身发寒战而醒。立即闭户入房，裹毯而卧，犹觉寒战不已。再加厚被，并饮开水一杯，约一小时，寒战始止。
孰知再后不半小时顷，而体温上升，愈升愈高。头痛体痛，周身无汗，扪之炙手。时渐天明，遂延医疗治。时医以荆芥、薄荷、豆豉、藿香等治之，丝毫无效。延至下午三时，汉城延余往诊，途中即告余以得病之由。既至入室，见其时寒时热，热多寒少，周身无汗，心烦不安，手足躁扰，气急微喘?自诉头痛如刀劈，百节如被校。再测其体温，已至41℃。脉亦洪大而浮紧。其病之重，可想而知矣。
立为书大青龙汤一方。主药生麻黄用四钱，川桂枝用四钱，生石膏用四两，他药准此比例。不用大枣，而易以鲜竹叶五钱。嘱配方回家自煎，并告以煎法。先煎石膏，次下诸药。煎成滤去汤上浮沫，满碗服之。必得大汗一身，乃可速愈也。余乃辞去。不意方笺送至药店，店员不敢配方，惊讶之极曰：“此方剂量之大，从未见闻。现虽暑热炎天，石膏竟用至四两，已属骇人。而麻黄、桂枝，均用至四钱。当此时令，而服此方，岂不火上加油耶。此位大医师，必是昨晚醉酒，至今日尚未醒者也。”以方笺授来人，挥之使去。
汉城得知，复亲来余所，问分量有无错误，并告知药店人员之言。余曰：“丝毫无误，此时医所不敢用，故彼未之见耳。”乃于方笺眉上写明：“此方由本医师完全负责，与药店无涉。”并加盖一章，以昭责任。使人再去配方，店员只得照配，并谓来人云：“但愿第二方明日再来。”尽半讥半惧之辞也．。
药既配回煎服，无何，烦躁更甚，一家惶恐，强自镇静。不半小时，而汗渐出，愈出愈畅。内衣尽湿，浸及被里亦湿。大汗约半小时，渐渐汗少。计汗出汗止，为一小时又四十分。而高热一退，诸病爽然若失矣。次日一东亲自乘车，来就余诊。告我服药后之情形，余心大快。又为处一清理余邪之方，兼通大便，使之照服一剂，毋须三诊也。一东即乘车至药店，告店员曰：“我即昨日服四两石膏、四钱麻黄之人也。”于是相与惊讶，均大赞服。
然吾犹有言者。依余经验，麻黄汤证多，小青龙汤证次之，而大青龙汤证则较少。盖正伤寒之发于冬令，而化为大青龙汤证者颇少。问或有之，亦须至五六日不解，天寒忽然转温，化烦躁乃速，否则不易见。今一东化烦躁如此之速．盖是时令炎热之故。昔人谓，有是证即用是药，岂可不三致意哉。
大青龙汤方生麻黄四钱川桂枝四钱生石膏四两杏仁泥四钱炙甘草三钱生姜三钱鲜竹叶五钱(原方有大枣，去之，易以竹叶。)冬令伤寒证冬令伤寒，发热无汗。重衾叠被，仍觉恶寒。头痛肢疼，背腰尤甚。以麻黄汤加羌、芷与服，再剂不效。询知煎法不善，几误病机，仍以原方如法与之，一剂而汗出即解。
友人邓汉城君，住北京西路宏文书店之楼上。于1940年冬月中旬，重感寒邪。初时恶寒发热即重，当延附近之中医，治之无效，改延余诊。余察其恶寒高热，虽重衾叠被，而犹啬啬不已。头痛项强，腰脊酸痛，四肢骨节亦然。扪之则皮肤干热无汗，切之则脉浮而紧。此冬月之正伤寒也，当处以麻黄汤加味方。所以内加羌、芷二味者，以其体肥多湿也。意其必可以一汗而解。讵一剂不效，次日复诊，再荆亦不效。余觉药颇对证，然何以不效，世果有剪草席而冒为麻黄者乎?因令转延他医。邓因喉间微有疼痛，改延喉科朱子云诊之，服药依然无效。
翌日午后，请杨星候君，复延余诊。察其病状如前，恶寒等表证仍在。因细询前日两次煎药之情况。讵其夫人龚志芳女士。嗫嚼欲言而又止。余告以但说无妨，可设法补救也。龚因详告余曰：“第一日之方，系未遵先生之嘱，由药店代客煎药者，觉其药淡而不浓。次日因两孩吵闹，病人怕烦，我携孩外出，令娘姨朱妈煎药。不料朱妈又去洗衣，将药汤烧干，再急加水重煎。而又加得太多，故头煎服下一碗，还余下半碗之多。后再加入二煎服之，始终无汗，故不敢令汉城知。”今始密告我也。
余闻之大笑，知其煎服未能如法之由。乃令速配原方，由余指导煎药。先将药置罐中，水泡半小时后(仍须多泡些时，因余不能久留也)，即将炉火改小，慢火煎熬，渐至煎沸。约又二十分钟，药汤已浓。其色深黄而带棕色，余曰可矣。乃离火置地上，约两分钟，沥清乘热与服。余即辞去。
服药不半小时，果周身觉热，而汗渐外出，终之淋漓不已。
又半小时后，汗虽渐少，而约持续二小时之久，其汗乃止。
一身寒热尽退。六小时后，再服二煎。又得微汗片时，病即霍然。后又服调理之剂两帖，恢复健康矣。
麻黄汤加羌活白芷方生麻黄三钱川桂枝三钱杏仁泥四钱炙甘草二钱川羌活二钱五分香白芷三钱生姜三片冬令伤寒液少证病者胃素不健，体质不强，表里津液不足，非盛夏则皮肤无汗，至严冬则小便颇多，故平素即大便干燥。忽患伤寒，余诊其发热恶寒，头痛肢痛，项背腰臀，均觉痛楚，两目带红，而唇齿干燥。予以桂枝麻黄各半汤，服如桂枝汤法。一剂而缓汗解，再以小量之小承气汤，微和其里，便通即愈。
友人杨达奎教授，胃纳不甚强健，故体质不强。周身皮肤，干燥不泽。平素颇喜品茗，虽每日饮多，而小便亦多，故其津液显然呈不足之象。非至盛夏之时，则皮肤无汗。一至严冬之际，则小便更多。此所以肌肤索泽，而为大便干燥之因也。在1949年冬月下旬，忽患伤寒。始则啬啬恶寒，及四肢手足关节，均觉酸楚。而独皮处无汗，气息微喘，而微有恶心。经余诊之，断为正伤寒之候。
杨君闻之，以为必用麻黄汤方，盖向知余治伤寒而喜用经方也。余曰：“以君之证，麻黄汤在所必用。以君之体质，素来津液不足，麻黄总嫌太峻，盖不能大发其汗也。余有一法，改用桂枝麻黄各半汤，服如桂枝汤法。即服药后，俟微有汗意之时，再饮热粥一小碗，使微汗缓缓外透。不可令如水淋漓，如此则病必除矣。”杨君然之，其夫人秦碧筠亲为煎药。如法服后，约半小时，果然微汗出矣，头面胸腹及四肢，均感微湿，而周身疼痛已较松。乃将预先煮好之热稀粥，以汤瓢与之。服粥后，微汗时间更为延长，先后约三小时，而寒热渐退，身疼立瘳。晚间续服第二煎，其病爽然若失。
次日复诊，见其体温复常，毫无所苦，惟舌苔微腻。询其大便，因素来大肠津液不足，必隔二三日一解。今前后计之，已五日未解。按其腹部，脘口尚和，惟按其脐下少腹，微有硬痛耳。再为之处以小承气汤，量亦较少。令其煎服之后，只求大便一通，即停后服，目的在微和其胃肠，而不在大攻也。迨一服之后，大便果下燥黑之粪球数枚，夹以溏粘之半流动物，而表里均和而痊矣。
桂枝麻黄各半汤方川桂枝二钱五分京赤芍一钱五分生麻黄一钱五分炙甘草一钱五分杏仁泥三钱生姜三片红枣五枚小承气汤方锦纹军二钱川厚朴二钱炒枳实二钱五分湿温湿温化燥证夏令酷热，患生湿温，经医久治不愈，渐至谵语神糊。
余诊其热度颇高，自汗不已，胸闷心烦，舌苔腻而灰黄，小便黄赤，大便转燥。疹痦隐于皮下，而不能外达。余以大黄黄连泻心汤合三仁汤与之。一剂而便通热减，疹痦外透。再剂则痦密如珠，疹则疏少。终以竹叶石膏汤合黄连解毒汤法加减，以竞全功。
患者刘庆生，住曹家渡忻康里，年52岁，于1942年夏末，患生湿温伤寒。初经他医治之无效，延及旬日，渐至谵语神糊，合家惊惧，谋之于窑货店主刘裕昌。盖裕昌店主，与刘为兄弟行也。因荐余往诊，时在抗战胜利之前三年。余至该里，见赌台林立，烟馆亦有数家。盖余过比户之门，非呼卢呼雉之声，即吞云吐雾之气。余自忖，今来鬼国矣。及入病家之门，登楼入室，则病者卧床上，亦置一付烟具，始知病者亦芙蓉城主也。
余乃为之诊察，热度颇高，自汗不已。盖病候与天时之热，及房间之小，有相因而至者，故使其自汗多也。据自诉胸闷异常，心烦特甚，口渴而不欲多饮。察其舌苔，则湿腻而灰黄，扪之粘指。此即湿温固有之苔也，而不易化燥，即湿为之耳。询其小便黄赤，大便在前一星期，则软而不畅，此三四日中，则大便未解。此湿与热并之邪，渐将化燥也。
细察其胸背皮肤，似有白痦隐于皮下，但不明显。红疹虽有，但亦不多。诊其六脉迟缓，与体温之高不相应，此湿温固有之脉象，乃诊断上之一大助也。
余因忖度其情，湿温当通大便之时，不能不通，不过不能大下耳。此时虽未全化燥，但大便已三四日不解，若不通利，则反有造成肠出血之危险。设大肠之湿，全从热化，而致大便燥结者，则又当大下矣。乃为之处方，以大黄黄连泻心汤合三仁汤法，加减与之。令服一剂，告以用药之意。迨服后果大便得解，粘腻而酱黄，小便亦较多。二煎服后，大便又解一次，粘腻如前。次晨视之，皮肤之白痦，已渐透出，而扪之格手矣。原有红疹，颜色亦较鲜艳。
至下午复延余诊，询其胸闷已较减，心烦亦较安。乃将原方锦军减为一钱，加炒僵蚕二钱五分，再服一剂，大便又解一次，小便转为淡黄，而量亦较多，心烦已除，惟胸闷未。
清。至三诊之时，为之去锦军，减川连，令再服二帖。于是诸症大减，而胸闷亦解矣。至第五日复诊，见其险象已除，余邪未清。改以竹叶石膏汤合黄连解毒汤法加减，连服二帖，热即退清，表里均和。再处以调理本元之方，以扶其病后之虚赢焉。
大黄黄连泻心汤合三仁法方锦纹军二钱川黄连一钱生黄芩三钱飞滑石四钱杏仁泥三钱生姜仁五钱白蔻仁二钱制半夏三钱粉葛根三钱鲜竹叶三钱再诊方即前方锦军减为一钱。加炒僵蚕二钱五分。
三诊方即前方去锦军，减川连为七分。
竹叶石膏汤合黄连解毒法加减方鲜竹叶三钱生石膏二两制半夏三钱炙甘草一钱五分上川连七分生黄芩二钱五分生山栀二钱生薏仁三钱炒粳米一酒杯。
产后湿温化燥证妇人产后，患生湿温，胸闷热高，头痛肢疼，中西医治之，均无效果。渐至化燥，神昏谵语，时或笑妄，胸部有疹，大便四日未解，舌上断津，撮空已见。姑以泻心汤合承气增液法，加生石膏、葛根、山栀与之，一剂而谵语、笑妄及撮空均止，舌上津回，再剂即神识清明而转安。
1953年夏季，上海城内果育堂街育德里18号，有张姓妇陈瑞娣者，年24岁。于产后十八天，患湿温伤寒，初延中医，以豆豉、豆卷等治之无效。复延西医注射青霉素，前后八针，依然无功。渐至化燥，神昏谵语，此时延余往诊。
余见如此重症，且有撮空之象，问知大便四日未解，扪其舌上，业已断津。
My friend Mr. Yang Dakui's wife, Ms. Qin Bijun, was 41 years old. In late June 1942, she suddenly contracted Shanghan (an acute febrile disease caused by external contraction of cold pathogen). When I examined her, the symptoms were as described above. I secretly wondered why she, who did not belong to the working class engaged in manual labor, would suffer from this illness. After inquiring about the cause of her illness, Ms. Qin detailed that: "A film titled 'Guanyin' was very popular in Shanghai at the time, screening at the Guangda Grand Theater. Hearing that the plot was excellent, I went to watch the evening show yesterday. The weather was quite hot, so I wore thin gauze short clothes when I went.
Upon entering the theater, the air conditioning was on, cool as autumn, feeling very comfortable.
After about an hour, my body felt slightly chilly, which then became more severe. However, due to the tragic plot, my heart ached and tears fell; I wanted to stop watching but could not. Only after the movie ended did I feel even colder.
The journey home was long, and since I did not walk, I took a car back. Late at night, there were few people on the road, and the car moved fast like flying, so the aversion to cold (Ehan) became even more severe. Upon arriving home, I immediately covered myself with blankets and lay down. Initially, I only had aversion to cold without fever, but four hours later, chills and fever occurred alternately. Then headache, stiffness of the neck and back, body pain, bone ache, general absence of sweating, and high fever ensued. If I had left the theater early when I first felt slightly chilly, I certainly would not have gotten this illness.
Having understood her condition, I determined it was a typical Shanghan syndrome. Just because it was summer, one should not categorically avoid using Ephedrae Herba (Mahuang, 麻黄). Ancient sages said that if there is this syndrome, use this medicine; what is there to fear? Therefore, I prescribed Mahuang Tang (Cinnamon Twig Decoction) plus Puerariae Radix (Gegen, 葛根) and Pogostemonis Herba (Huoxiang, 藿香), instructing her to decoct and take it according to the method, without worries. At that time, her husband Mr. Yang had already returned to his hometown, so no one was supervising the medication. A neighbor who knew a little about medicinal properties said, 'In June, one should not take Mahuang. Even if taken, the dose should only be one-third; do not act rashly.' Ms. Qin followed his advice. After taking the medicine, she sweated slightly, but soon fever returned without sweating. She invited me again the next day.
I was quite surprised and questioned her repeatedly until she told the truth. I apologized for my lack of insight and advised her to consult another doctor. The other doctors treated her, but to no avail.
On the third day, Mr. Zhang Shiying came to invite me again on behalf of the family, expressing deep apologies. He said, 'Previously, I was good friends with Mr. Yang; please do not hold against him that his wife did not trust you.' I agreed and went. I saw that although her symptoms had not changed, she had developed irritability. Therefore, I removed Pogostemonis Herba (Huoxiang, 藿香) from the original formula and added Raw Gypsum (Sheng Shigao, 生石膏) five qian. After Ms. Qin took it, one dose resulted in sweating, reduction of fever, and calmness of spirit. Later, I cleared the residual pathogens and mildly promoted bowel movement, and she recovered. Approaching Mid-Autumn Festival, Mr. Yang returned to Shanghai from his hometown.
Having learned all the details, he specifically expressed his gratitude to me, saying, 'If we had not taken Mahuang again, and instead switched doctors repeatedly, what if something unexpected happened? Who would be responsible? No wonder the doctor refused to follow up.' I smiled and nodded.
[Formula: Mahuang Tang Plus Puerariae Radix and Pogostemonis Herba] Raw Ephedrae Herba (Mahuang, 麻黄) 3 qian, Cinnamomi Ramulus (Guizhi, 桂枝) 3 qian, Armeniacae Semen Amarum (Xingren, 杏仁) 4 qian, Prepared Glycyrrhizae Radix et Rhizoma (Zhigancao, 炙甘草) 2 qian, Puerariae Radix (Gegen, 葛根) 4 qian, Pogostemonis Herba (Huoxiang, 藿香) 3 qian. (For the second prescription, remove Pogostemonis Herba and add Raw Gypsum 5 qian.)
Summer Shanghan Syndrome (II): During the hot summer, sleeping facing the door at night, cooling off in the wind. Around midnight, while dreaming deeply, it gradually turned cool. Around 2 AM, feeling cold, woke up and went into the room to sleep. Soon, severe chills and fever erupted, headache, bone pain, high fever without sweating. Gradually developing irritability, red eyes, dry mouth, rapid breathing, and panting. This is acute summer Shanghan, primarily treated with Da Qing Long Tang (Major Blue Dragon Decoction).
Friend Deng Hancheng's nephew, named Yidong, was generally strong and rarely got sick. In July, he suddenly contracted Shanghan. The weather was hot during the day and turned cool after midnight. Yidong slept facing the door after 10 PM, bare-chested and bare-legged, wearing only shorts. The cool breeze was refreshing, making him feel like ascending to immortality in his dream. Around 2 AM, the wind blowing through the door became stronger, the chill piercing. He woke up shivering. Immediately closing the door and entering the room, wrapping himself in a blanket, he still felt uncontrollable shivering. Adding thicker quilts and drinking a cup of boiling water, it took about an hour for the shivering to stop.
Who knew that half an hour later, his body temperature rose, higher and higher. Headache, body pain, no sweating on the whole body, skin burning to the touch. As dawn approached, he sought medical treatment. The contemporary doctors used Schizonepetae Herba (Jingjie, 荆芥), Menthae Haplocalycis Herba (Bohe, 薄荷), Fermented Soybean (Douchi, 豆豉), Pogostemonis Herba (Huoxiang, 藿香), etc., with no effect. By 3 PM, Hancheng invited me to examine him. On the way, he told me the cause of the illness. Upon entering the room, I saw him alternating chills and fever, with more heat than cold, no sweating, irritability, restlessness of hands and feet, rapid breathing, and slight panting. He complained of headache like being split by a knife, and bones feeling like being tortured. Measuring his temperature again, it reached 41°C. The pulse was surging, large, floating, and tight. The severity of the illness can be imagined.
I immediately wrote a prescription for Da Qing Long Tang (Major Blue Dragon Decoction). The main drug, Raw Ephedrae Herba (Mahuang, 麻黄), was 4 qian; Cinnamomi Ramulus (Guizhi, 桂枝) was 4 qian; Raw Gypsum (Sheng Shigao, 生石膏) was 4 liang; other drugs were proportioned accordingly. Jujubae Fructus (Dazao, 大枣) was omitted and replaced with Fresh Ardisiae Cauliflos (Xian Zhuye, 鲜竹叶) 5 qian. I instructed him to prepare the herbs at home and decoct them, explaining the method. First decoct the gypsum, then add the other herbs. After decoction, filter off the foam on the surface, and drink a full bowl. Profuse sweating over the entire body is required for rapid recovery. I then left. Unexpectedly, when the prescription was brought to the pharmacy, the staff dared not dispense it, extremely surprised, saying, 'Such large dosages have never been seen before. Although it is the hot summer, using 4 liang of gypsum is already shocking. And Ephedrae Herba and Cinnamomi Ramulus are both used in 4 qian doses. Taking such a prescription in this season is like adding oil to fire. This great physician must have been drunk last night and hasn't sobered up yet.' They handed the prescription back to the messenger and waved him away.
Hancheng learned of this and personally came to my residence to ask if there were any errors in the dosage and informed me of the pharmacy staff's words. I said, 'Not a bit wrong. It is simply that current doctors dare not use it, which is why they haven't seen it.' I wrote on the header of the prescription: 'This prescription is fully responsible by this physician, unrelated to the pharmacy,' and stamped it to clarify responsibility. Sending someone again to dispense the medicine, the staff had no choice but to comply, telling the messenger, 'I hope you don't come back tomorrow.' These were words half mocking and half fearful.
Once the medicine was prepared and decocted, shortly after taking it, irritability worsened, causing panic in the family, though they tried to remain calm. Within half an hour, sweat began to appear, becoming more profuse. Inner clothes were completely wet, soaking into the quilt. Profuse sweating lasted about half an hour, then gradually decreased. From start to stop of sweating, it took one hour and forty minutes. The high fever subsided, and all symptoms vanished. The next day, Yidong came to see me by car, reporting the effects of the medication. I was greatly pleased. I prescribed another formula to clear residual pathogens and promote bowel movement, instructing him to take one dose, requiring no third visit. Yidong went to the pharmacy and told the staff, 'I am the person who took 4 liang of gypsum and 4 qian of Mahuang yesterday.' Everyone was astonished and praised us highly.
However, I have more to say. Based on my experience, Mahuang Tang syndromes are common, Xiao Qing Long Tang (Minor Blue Dragon Decoction) syndromes are next, and Da Qing Long Tang syndromes are rare. Because Zheng Shanghan (typical Shanghan) occurring in winter rarely transforms into a Da Qing Long Tang syndrome. Even if it does, it usually requires unresolved symptoms for five or six days, sudden warming in cold weather, and transformation into irritability to appear quickly; otherwise, it is hard to see. Now, Yidong transformed into irritability so quickly because of the hot season. The ancients said, 'If there is this syndrome, use this medicine.' How can we not pay close attention to this?
[Da Qing Long Tang Formula] Raw Ephedrae Herba (Mahuang, 麻黄) 4 qian, Cinnamomi Ramulus (Guizhi, 桂枝) 4 qian, Raw Gypsum (Sheng Shigao, 生石膏) 4 liang, Armeniacae Semen Amarum Paste (Xingren Ni, 杏仁泥) 4 qian, Prepared Glycyrrhizae Radix et Rhizoma (Zhigancao, 炙甘草) 3 qian, Zingiberis Rhizoma Recens (Shengjiang, 生姜) 3 qian, Fresh Ardisiae Cauliflos (Xian Zhuye, 鲜竹叶) 5 qian. (Original formula has Jujubae Fructus, remove it and replace with Bamboo Leaf.)
Winter Shanghan Syndrome: Winter Shanghan, fever without sweating. Despite heavy quilts, still feeling aversion to cold. Headache and limb pain, especially severe in the back and waist. Using Mahuang Tang plus Notopterygii Rhizoma et Radix (Qianghuo, 羌活) and Angelicae Dahuricae Radix (Baizhi, 白芷) orally, two doses ineffective. Inquiry revealed improper decoction method, nearly missing the pathology. Still using the original formula correctly decocted, one dose resulted in sweating and resolution.
Friend Mr. Deng Hancheng lived upstairs at Hongwen Bookstore on Beijing West Road. In mid-December 1940, he contracted cold pathogen again. Initially, aversion to cold and fever were severe. Local TCM doctors were consulted but ineffective. I was then consulted. Observing his severe aversion to cold and high fever, despite heavy quilts, he remained shivering. Headache, stiff neck, sore lower back and spine, and painful limbs and joints. Skin was dry, hot, and non-sweating to touch; pulse was floating and tight. This was typical winter Shanghan. I prescribed a modified Mahuang Tang. The reason for adding Notopterygii Rhizoma et Radix (Qianghuo, 羌活) and Angelicae Dahuricae Radix (Baizhi, 白芷) was his obesity and dampness. I thought one dose would resolve it with sweating. Alas, one dose failed. Next day follow-up, another dose also failed. I felt the medicine matched the syndrome, but why no effect? Could there really be cut straw mats passed off as Mahuang? So I advised him to consult another doctor. Due to slight throat pain, Mr. Deng consulted throat specialist Dr. Zhu Ziyun, but medication was still ineffective.
The next afternoon, Mr. Yang Xinghou invited me again. Observing his condition as before, aversion to cold and other exterior signs persisted. I carefully inquired about the decoction process of the previous two days. His wife, Ms. Gong Zhifang, hesitated to speak. I assured her it was fine and that remedies could be found. Ms. Gong detailed: 'The first day's prescription was decocted by the pharmacy as requested, but the medicine tasted weak. The next day, due to children's noise and patient's annoyance, I took the kids out and asked the maid, Auntie Zhu, to decoct the medicine. Unfortunately, Auntie Zhu went to wash clothes, boiled the medicine dry, and hastily added water to re-decoct. Too much water was added. So, after drinking one bowl of the first decoction, half a bowl remained. Then the second decoction was added. There was still no sweating, so I didn't dare tell Hancheng.' She finally confided in me privately.
I laughed loudly, realizing the reason for improper decoction. I ordered immediate preparation of the original formula and supervised the decoction. First, soak the herbs in water for half an hour (need longer soak as I couldn't stay long), then reduce the fire to slow simmer until boiling. About twenty minutes later, the decoction was thick, dark yellow with brownish hue. I said it was ready. Removed from fire, placed on ground for two minutes, strained, and served hot. I then left.
Within half an hour of taking the medicine, the whole body felt hot, and sweat gradually emerged, eventually pouring profusely.
Half an hour later, although sweat decreased, it continued for about two hours before stopping.
All chills and fever subsided. Six hours later, the second decoction was taken. Another brief period of slight sweating occurred, and the illness vanished. Two more doses of conditioning agents were taken, and health was restored.
[Mahuang Tang Plus Notopterygii Rhizoma et Radix and Angelicae Dahuricae Radix Formula] Raw Ephedrae Herba (Mahuang, 麻黄) 3 qian, Cinnamomi Ramulus (Guizhi, 桂枝) 3 qian, Armeniacae Semen Amarum Paste (Xingren Ni, 杏仁泥) 4 qian, Prepared Glycyrrhizae Radix et Rhizoma (Zhigancao, 炙甘草) 2 qian, Notopterygii Rhizoma et Radix (Qianghuo, 羌活) 2.5 qian, Angelicae Dahuricae Radix (Baizhi, 白芷) 3 qian, Zingiberis Rhizoma Recens (Shengjiang, 生姜) 3 slices.
Winter Shanghan with Deficient Body Fluids Syndrome: The patient's stomach has always been weak, constitution not strong, insufficient body fluids in interior and exterior. Without midsummer, skin does not sweat; in severe winter, urination is frequent, hence chronic constipation. Suddenly contracting Shanghan, I diagnosed fever, aversion to cold, headache, limb pain, pain in neck, back, waist, and buttocks, red eyes, dry lips and teeth. Prescribed Guizhi Mahuang Ban Ge Tang (Half-and-Half Decoction of Cinnamon Twig and Ephedra), administered like Guizhi Tang. One dose resolved it with mild sweating. Then, a small amount of Xiaochengqi Tang (Minor Order the Qi Decoction) was used to mildly harmonize the interior; once bowels moved, cure was achieved.
Professor Yang Dakui, whose stomach function was not robust, had a weak constitution. His skin was dry and lusterless. He liked tea, drinking much daily, resulting in frequent urination, indicating obvious deficiency of body fluids. Without midsummer, skin does not sweat; in severe winter, urination increases further. This causes dry skin and constipation. In late December 1949, he suddenly contracted Shanghan. Initially, slight aversion to cold, soreness in limbs and joints. Skin lacked sweat, slight panting, mild nausea. I diagnosed typical Shanghan syndrome.
Mr. Yang believed Mahuang Tang was necessary, knowing I prefer classical formulas for Shanghan. I said, 'Based on your syndrome, Mahuang Tang is essential. But given your constitution and chronic fluid deficiency, Mahuang is too harsh and may induce excessive sweating. I have a method: switch to Guizhi Mahuang Ban Ge Tang (Half-and-Half Decoction of Cinnamon Twig and Ephedra), administered like Guizhi Tang. After taking the medicine, when slight sweating intention arises, drink a small bowl of hot porridge to allow mild sweat to slowly emerge. Do not let it pour like rain. Thus, the illness will surely be cured.' Mr. Yang agreed. His wife, Ms. Qin Bijun, decocted the medicine. Following the method, after about half an hour, mild sweat appeared. Head, face, chest, abdomen, and limbs felt slightly moist, and body pain relaxed. Pre-cooked hot thin porridge was fed to him. After eating porridge, mild sweating lasted longer, about three hours in total. Chills and fever gradually receded, body pain healed. Evening second decoction completed the cure.
Next day follow-up: temperature normal, no discomfort, tongue coating slightly greasy. Bowel movement inquiry: due to chronic large intestine fluid deficiency, normally defecates every two to three days. Currently, five days without stool. Abdominal palpation: epigastrium soft, but slight hardness and tenderness below navel in lower abdomen. Prescribed Xiaochengqi Tang (Minor Order the Qi Decoction) in smaller dose. Instruction: stop after one successful bowel movement. Goal is mild harmonization of stomach and intestines, not strong purgation. After one dose, several dry black fecal pellets mixed with semi-fluid sticky matter were passed. Interior and exterior harmonized, and he recovered.
[Guizhi Mahuang Ban Ge Tang Formula] Cinnamomi Ramulus (Guizhi, 桂枝) 2.5 qian, Paeoniae Radix Rubra (Chishao, 赤芍) 1.5 qian, Raw Ephedrae Herba (Mahuang, 麻黄) 1.5 qian, Prepared Glycyrrhizae Radix et Rhizoma (Zhigancao, 炙甘草) 1.5 qian, Armeniacae Semen Amarum Paste (Xingren Ni, 杏仁泥) 3 qian, Zingiberis Rhizoma Recens (Shengjiang, 生姜) 3 slices, Jujubae Fructus (Hongzao, 红枣) 5 pieces.
[Xiaochengqi Tang Formula] Rheae Radix et Rhizoma (Jinwen Jun, 锦纹军) 2 qian, Magnoliae Officinalis Cortex (Houpo, 厚朴) 2 qian, Aurantii Fructus Immaturus (Zhizhi, 枳实) 2.5 qian.
Damp-Warmth Transforming into Dryness Syndrome: Hot summer, contracting Damp-Warmth. Long-term treatment by other doctors failed. Gradually developed delirium and clouded consciousness.
I diagnosed high fever, continuous spontaneous sweating, chest oppression, irritability, greasy grey-yellow tongue coating, yellow-red urine, dry stool. Rash and macules hidden under skin, unable to erupt. I prescribed Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Heart-Draining Decoction) combined with Sanren Tang (Three Seeds Decoction). One dose resulted in bowel movement, reduced fever, and eruption of rash/macules. Second dose: macules dense like pearls, rash sparse. Finally, modified Zhuyegao Tang (Bamboo Leaf and Gypsum Decoction) combined with Huanglian Jiedu Tang (Coptis Detoxification Decoction) to complete treatment.
Patient Liu Qingsheng, living in Xinkang Lane, Caojiadu, 52 years old. In late summer 1942, contracted Damp-Warmth Shanghan. Initial treatment by other doctors failed. Ten days later, developed delirium and clouded consciousness. Family frightened, consulted kiln owner Liu Yuchang (brotherly friend). Recommended me to treat. This was three years before Victory of Anti-Japanese War. Arriving at the lane, gambling tables stood everywhere, opium dens present. Passing neighbors' doors, sounds of dice or smell of smoke prevailed. I thought, 'I've entered the ghost kingdom.' Entering the patient's home, upstairs, the patient lay in bed with opium paraphernalia. Realized the patient was also an opium addict.
I examined him: high fever, continuous spontaneous sweating. Caused by illness interacting with hot weather and small room, leading to profuse sweating. Patient reported extreme chest oppression, severe irritability, thirst but desire to drink little. Tongue coating greasy, grey-yellow, sticky to touch. Typical Damp-Warmth coating, resistant to drying due to dampness. Urine yellow-red. Stool loose and difficult one week ago, none for past three to four days. Damp-heat pathogen transforming into dryness.
Fine observation of chest and back skin: white miliary rash (Bai Ping) hidden under skin, not obvious. Red rash present but scarce. Pulse slow and sluggish, inconsistent with high fever. Typical Damp-Warmth pulse, aiding diagnosis.
I reasoned: Damp-Warmth requires promoting bowel movement, but not strong purgation. Although not fully dry, three to four days without stool risks intestinal hemorrhage if not relieved. If dampness fully transforms to heat causing dry stool, strong purgation would be needed. Prescribed Dahuang Huanglian Xiexin Tang combined with Sanren Tang, modified. One dose instructed. Result: stool passed, sticky and sauce-yellow, increased urine. Second decoction: another stool passage, similar consistency. Next morning: white miliary rash emerging, rough to touch. Original red rash brighter.
Afternoon follow-up: chest oppression reduced, irritability calmed. Reduced Rheae Radix et Rhizoma (Jinwen Jun, 锦纹军) to 1 qian, added Stir-fried Bombyx Batryticatus (Jiangcan, 僵蚕) 2.5 qian. One dose: another stool passage, urine pale yellow and increased, irritability gone, chest oppression lingering.
Third visit: Removed Rheae Radix et Rhizoma, reduced Coptidis Rhizoma (Chuanlian, 川连) to 0.7 qian. Two doses: major symptom reduction, chest oppression resolved. Fifth day follow-up: danger passed, residual pathogens unclear. Modified Zhuyegao Tang combined with Huanglian Jiedu Tang. Two doses: fever cleared, interior/exterior harmonized. Final formula to tonify root and recover post-illness weakness.
[Dahuang Huanglian Xiexin Tang Combined with Sanren Method Formula] Rheae Radix et Rhizoma (Jinwen Jun, 锦纹军) 2 qian, Coptidis Rhizoma (Chuanlian, 川连) 1 qian, Scutellariae Radix (Huangqin, 黄芩) 3 qian, Talcum (Huashi, 滑石) 4 qian, Armeniacae Semen Amarum Paste (Xingren Ni, 杏仁泥) 3 qian, Coix Seed (Yiyiren, 薏苡仁) 5 qian (Note: Text says Shengjiang Ren, likely typo for Yiyiren in Sanren Tang context), Amomi Fructus Rotundus (Baokouren, 白蔻仁) 2 qian, Pinelliae Rhizoma Preparatum (Banxia, 半夏) 3 qian, Puerariae Radix (Gegen, 葛根) 3 qian, Fresh Ardisiae Cauliflos (Zhuyeye, 竹叶) 3 qian.
Second Visit Formula: Previous formula, Rheae Radix et Rhizoma reduced to 1 qian. Added Stir-fried Bombyx Batryticatus (Jiangcan, 僵蚕) 2.5 qian.
Third Visit Formula: Previous formula, removed Rheae Radix et Rhizoma, reduced Coptidis Rhizoma to 0.7 qian.
[Modified Zhuyegao Tang Combined with Huanglian Jiedu Method Formula] Fresh Ardisiae Cauliflos (Zhuyeye, 竹叶) 3 qian, Raw Gypsum (Sheng Shigao, 生石膏) 2 liang, Pinelliae Rhizoma Preparatum (Banxia, 半夏) 3 qian, Prepared Glycyrrhizae Radix et Rhizoma (Zhigancao, 炙甘草) 1.5 qian, Coptidis Rhizoma (Chuanlian, 川连) 0.7 qian, Scutellariae Radix (Huangqin, 黄芩) 2.5 qian, Gardeniae Fructus (Shanzhi, 山栀) 2 qian, Coix Seed (Shengyiren, 生薏仁) 3 qian, Stir-fried Oryza Sativa (Chao Jingmi, 炒粳米) 1 wine cup.
Postpartum Damp-Warmth Transforming into Dryness Syndrome: Woman postpartum, contracted Damp-Warmth. Chest oppression, high fever, headache, limb pain. Western and Chinese medicine ineffective. Gradually transformed into dryness: coma, delirium, occasional manic laughter, chest rash, four days without stool, dry tongue, grasping at empty air (Cuokong, 撮空). Temporarily prescribed Xiexin Tang combined with Chengqi Zengye Method, plus Raw Gypsum, Puerariae Radix, Gardeniae Fructus. One dose: delirium, manic laughter, and grasping stopped, tongue moisture returned. Second dose: consciousness clear, stabilized.
Summer 1953, No. 18 Yude Li, Guoyutang Street, Shanghai. Mrs. Chen Ruidi, surnamed Zhang, 24 years old. Eighteen days postpartum, contracted Damp-Warmth Shanghan. Initial TCM treatment with Fermented Soybean (Douchi, 豆豉) and Soybean Sprout (Doujuan, 豆卷) failed. Western medicine Penicillin injections (8 doses) also failed. Gradually transformed into dryness: coma, delirium. Invited me to treat.
Seeing such severe illness with grasping at empty air, inquired: four days without stool. Tongue dry and cracked.