真定府赵吉夫。约年三旬有余。至元丙寅五月间。因劳役饮食失节。伤损脾胃。时发烦躁而渴
。又食冷物过度。遂病身体困倦头痛。四肢逆冷呕吐。而心下痞。医者不审。见其四肢逆冷。呕吐
心下痞。乃用桂末三钱。以热酒调服。仍以绵衣覆之。作阴毒伤寒治之。须臾汗大出。汗后即添口
干。舌涩。眼白睛红。项强硬。肢体不柔和。小便淋赤。大便秘涩。循衣摸床。如发狂状。问之则
言。语错乱。视其舌则赤而欲裂。朝轻暮剧。凡七八日。家人皆自谓危殆不望生全。邻人吉仲元举
予治之。诊其脉六七至。知其热证明矣。遂用大承气汤苦辛大寒之剂一两。作一服服之。利下三行
。折其胜势。翌日。以黄连解毒汤大苦寒之剂二两。使徐徐服之以去余热。三日后。病十分中减之
五六。更与白虎加人参汤约半斤。服之。泻热补气。前证皆退。戒以慎起居。节饮食。月余渐得平
复。内经曰。凡用药者。无失天时。无逆气宜。无翼其胜。无赞其复。是谓至治。又云。必先岁气
。无伐天和。当暑气方盛之时。圣人以寒凉药。急救肾水之原。补肺金之不足。虽有客寒伤人。仲
景用麻黄汤内加黄芩知母、石膏之类。发黄发狂。又有桂枝汤之戒。况医者用桂末热酒调服。此所
谓差之毫厘。谬之千里。此逆仲景之治法。经云。不伐天和。不赞其复。不翼其胜。不失气宜。不
然。则故病未已。
新病复起矣。
Zhao Jifu from Zhengding Prefecture was a man in his early thirties. In the fifth month of the Bingyin year of Zhiyuan, due to overwork and irregular diet, he injured his Spleen and Stomach. He frequently experienced irritability and thirst. Subsequently, excessive consumption of cold foods led to symptoms of physical fatigue, headache, cold limbs, vomiting, and fullness/oppression in the epigastrium (Xin Xia). The physician failed to examine the condition carefully; seeing the cold limbs, vomiting, and epigastric fullness, he administered three qian of Cinnamon Bark powder (Guixin), mixed with hot wine, and covered the patient with cotton clothes, treating it as Yin Toxin Cold Damage (Yin Du Shang Han). Shortly after, profuse sweating occurred. Following the sweat, new symptoms emerged: dry mouth, rough tongue, redness of the whites of the eyes, neck stiffness, lack of flexibility in the limbs, scanty dark urine, and constipation. The patient exhibited behaviors such as picking at clothes and touching the bed, resembling madness. When questioned, his speech was disordered. His tongue appeared bright red and cracked. The condition was mild in the morning and severe in the evening. This persisted for seven or eight days. His family believed he was critically ill and did not expect him to survive. A neighbor, Ji Zhongyuan, recommended me to treat him. I palpated his pulse, which beat six or seven times per respiration cycle, confirming that this was clearly a Heat syndrome. Therefore, I used Da Cheng Qi Tang (Major Order the Qi Decoction), a bitter, acrid, and greatly cold formula, one liang in dose, taken in one serving. The patient had three bowel movements, which checked the excess pathogenic factor. The next day, I prescribed Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity), a greatly bitter and cold formula, two liang in dose, to be taken slowly to eliminate residual heat. After three days, the illness had reduced by five or six parts out of ten. I then administered approximately half a jin of Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) to clear heat and tonify Qi. All previous symptoms receded. I advised him to be cautious with daily activities and regulate his diet. Over more than a month, he gradually recovered. The Nei Jing states: "When using medicine, do not lose sight of the timing of heaven, do not go against the suitability of qi, do not assist the victory [of pathogens], and do not praise the recurrence [of pathogens]. This is called perfect treatment." It also says: "First determine the annual qi, and do not harm the harmony of heaven [natural bodily functions]." When summer heat qi is flourishing, the sages use cold and cool medicines to urgently rescue the source of Kidney Water and supplement the insufficiency of Lung Metal. Even if there is an invasion of exogenous cold damaging the body, Zhang Zhongjing would add herbs like Huang Qin (Scutellariae Radix), Zhi Mu (Anemarrhenae Rhizoma), and Shi Gao (Gypsum Fibrosum) within Ma Huang Tang (Ephedra Decoction). If jaundice or madness occurs, there are warnings against using Gui Zhi Tang (Cinnamon Twig Decoction). Moreover, the physician used Cinnamon Bark powder mixed with hot wine. This is what is meant by "a miss is as good as a mile" (a slight error leads to a huge mistake). This violates Zhang Zhongjing's therapeutic principles. The classics state: Do not harm Tian He (Heavenly Harmony), do not praise Fu Xie (Recurrent Pathogens), do not assist Sheng Xie (Victorious Pathogens), and do not lose Qi Yi (Suitability of Qi). Otherwise, the old disease will not cease, and new diseases will arise.