Library

Not aversion to cold, and there is no severe fever from the transmission of meridians. Occasionally, tidal fever appears slightly, resembling internal injury fever. If mistakenly treated with tonics such as Ginseng Radix (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu), the pathogenic factor has no outlet. Over time, it mixes with the original qi, resulting in mental confusion and silence. Furthermore, the Yangming meridian is the leader of the twelve meridians, capable of binding sinews and bones and facilitating joint movement. If Yangming is not properly treated, the sinews and vessels lose nourishment, leading to restlessness and tremors. When external pathogens are entrenched in Yangming, the Earth element (Spleen/Stomach) becomes scorched earth or dry soil like ash and sand. Without the aid of Water from the North (Kidney Water), how can the withered state be moistened? Therefore, bitter-cold herbs are used initially, followed by sweet-cold herbs, much like timely rain falling, allowing crops to return to their normal state.

Yu Zhen commented: In this case, the examination of the disease mechanism was like Zhuge Liang using troops, wearing a silk scarf and waving a feather fan with composure; his elucidation of principles was like Master Dao Shen preaching, causing even stubborn stones to nod. Truly an excellent medical case by a renowned physician. The original text is long, so I have presumptuously excerpted parts of it.

[Appendix: Complications of Excessive Sweating and Fasting in External Contraction] Yu Jiayan told his disciples: "I once treated a pregnant woman with Shanghan (Cold Damage). After sweating to release the exterior, she suddenly called for her maid, making sounds of seeking justice. I realized this indicated disturbance of Yang qi, urgent and helpless. I ordered Ginseng Decoction to be administered, but it could not be obtained quickly. So, I used three taels of Atractylodis Macrocephalae Rhizoma (Baizhu), boiled into a thick decoction of one bowl, and gave it to her. She settled immediately. Moreover, the power of Ginseng Radix (Renshen) is a hundred times that of Baizhu."

Jiang Zhongzun from Chongming suffered from Shanghan. On his deathbed, he requested half a bowl of rice rinsed with meat broth. After eating, he let out a loud cry and died. Someone asked Xichang about this, who replied: "Previously, I saw his face covered with oily shine, knowing his spirit was projecting outward, indicating he was not destined for longevity. Furthermore, his body was weak like stubborn stone, and he exerted himself excessively like a nocturnal traveler on the sea. His illness was purely internal injury, while the external contraction was merely exposure to fog and dew. Fog and dew pathogens, upon entering the human body, only enter the Qi passages and clear pathways; originally, they do not transmit through meridians. Thus, they cannot be expelled by releasing the exterior or purging the interior. Only by doubling the Original Qi and thickening the Grain Qi can the pathogens exit without being driven. If one mistakes his dizziness and fever for a Taiyang syndrome and erroneously induces sweating, the internal injury will worsen, leading to danger. Moreover, those with internal injury already suffer from irregular eating habits. Misdiagnosing it as Shanghan and cutting off food further depletes the already deficient body, causing hunger and fatigue in the abdomen, leading to a desperate craving for food. Dying with a loud cry after eating is due to the severing of the intestines. It is like a starving person collapsing and dying instantly, where Qi is cut off mid-stream and does not continue. If the pathogen were truly heavy, with external pathogens fighting righteous Qi, he would have first become confused and unconscious. Therefore, when he craved rice at his deathbed, if one had given him Single Ginseng Decoction instead of rice, he might have been saved."

Yu Zhen commented: Nowadays, people suffering from chills and fever immediately drink Hawthorn Fruit (Shanzha) and Malty Hordeum (Maiya) soup, or even take Neixiao Wan (Beiji Wan). This attacks and injures the Stomach Qi, allowing external pathogens to enter internally due to deficiency, causing drastic changes in the disease. They fail to realize that food itself is not harmful; the pathogen is the harm. Not resolving the pathogen but solely eliminating food stagnation is erroneous. Blind physicians treating fever, regardless of whether it is external contraction or internal injury, universally forbid all diet, which is a greater error. If external contraction has not transmitted to Yangming, eating is still appropriate, such as drinking hot thin porridge after Guizhi Tang to assist sweating. If it has transmitted to Yangming, appetite may naturally decrease, but consuming a small amount of hot thin porridge causes no harm. For internal injury cases, diet should never be forbidden throughout. Forbidden diet combined with attacking drugs leads inevitably to peril. Jiang Zhongzun serves as a warning from the past.

Monk Shenrou treated the servant of Xue Lihuan, who had traveled far, endured hunger, and was beaten until exhausted. It was early May, and he developed fever and delirious speech. He had taken several doses of Buzhong Yiqi Tang and Wuling San without effect. Shenrou diagnosed no pulse in any of the six positions, occasionally appearing very fine. External symptoms included red face, delirious speech, and mouth ulcers. One doctor said: "Yang disease presenting Yin pulse indicates a fatal case." Shenrou said: "One should treat based on Yang deficiency, disregarding the symptoms." He prescribed Fuzi Lizhong Tang, administered cold, two doses. The pulse appeared slightly. After four doses, the pulse became spirited and mouth ulcers healed. After six doses, the pulse was normal, but delirious speech persisted. Shenrou said: "Since the pulse qi has fully recovered but delirium continues, there must be dry feces in the Stomach/Intestines." He used Pig Bile to guide them out. Indeed, dry accumulation was passed, and delirium ceased.

Zhang Luyu treated Fan Qiuxian, who suffered from Shanghan with aversion to cold for three days continuously. He had taken two doses of dispersing medicines. By the seventh day, he was restless and agitated, with no pulse in the six positions and cold extremities. Zhang diagnosed that only the left Cun position showed a trembling pulse, identifying it as a sign of impending Zhanhan (battle sweat). He instructed not to take medicine, but only to give hot ginger soup to assist sweating. If medicine were mistakenly taken, the heat would not cease. Indeed, he recovered as predicted.

Yu Zhen commented: The case of Shenrou is similar to Haicang's treatment of Hou Fuzhi, but opposite to Jintan's treatment of Yu Yunqu. One must carefully ponder and understand. This recalls the record in *Zhunsheng* regarding Danxi's cases: Lu Xiong had recurrent fever and delirium after sweating; Lv Zhongxiu had persistent fever and delirium after sweating; Tao Mingjie lost recognition of people after fever subsided and spoke absurdly. All were cured using tonics such as Ginseng Radix (Renshen), Astragali Radix (Huangqi), Atractylodis Macrocephalae Rhizoma (Baizhu), Angelicae Sinensis Radix (Danggui), and Aconiti Lateralis Radix Praeparata (Fuzi). Truly so. Delirium due to deficiency accounts for eight or nine out of ten cases. In this case, warming and tonifying cured the mouth ulcers; although the pulse returned to normal, delirium persisted, attributed to dry feces in the Stomach/Intestines. This aligns with the principle stated at the end of the *Zhengxiang Yangdan* chapter in *Shanghan Lun*: "Using Chengqi Tang to produce slight loose stools stops the delirium." Differentiating between delirium caused by deficiency-cold and delirium not caused by deficiency-cold is indeed difficult. Summarizing, there are roughly three paths: 1. Pathogen transmits to Yangming, heat pathogen binds with dry feces causing delirium (Three Chengqi Decoctions, Chengqi combined with Baihu Decoction); 2. Internal deficiency-cold with external false heat causing delirium (Danxi's treated cases, Jintan's described cases); 3. Root deficiency-cold complicated by retained food, turning into dry feces due to body heat causing delirium (This case and Yangdan syndrome). Which physician possesses the insight of burning a rhino horn to see through illusions? A slight error in medication can reverse life and death in the flip of a hand. Thus, Shanghan and warm-heat diseases are major illnesses. Some are promised harmless today but die suddenly tomorrow; some are judged fatal but survive after lingering. Unlike wind, phthisis,鼓胀 (Gu distension), and diaphragm obstruction, which, though critical, allow for calm deliberation on urgency. Hence, Zhang Zhongjing wrote in his preface: "If one can seek my collected works, one will understand more than half." He explicitly shows future generations that Shanghan is hard to treat and *Shanghan Lun* is hard to read. If it were not hard to read, why seek it? Zhang's case also presents absent pulses, yet the condition differs. Is it difficult? Yes. Must one not seek understanding?

Yu Zhen commented: Shanghan is a major illness, and its treatment methods are extremely complex, beyond full description. One must thoroughly study Zhongjing's book, then widely read later experts' works, to gain confidence in clinical practice. Zhongjing's book was compiled by Shuhe, possibly containing errors, while the commentary in *Liaoshe* seems particularly stable. Later commentators include Zhang Qingzi, Wang Sanyang, Tang Buyan, Shen Liangchen, Zhang Jianshan, Zhang Yinan, Lin Beihai, etc., none exceeding the scope. Since Cheng, Fang, and Yu families arranged matters according to their own ideas, Zhongjing's original text has since lacked a fixed status. The three commentaries have pros and cons; generally, Cheng is inferior to Fang, and Fang to Yu. However, Yu's commentary divides the Taiyang meridian into three main outlines, categorizing syndromes like chest bind, blood stasis, and jaundice from mistaken sweating/purging into two sections, seemingly clear in boundaries. Who knew that in treating diseases, these are completely useless? At the onset of disease, Ying and Wei must be distinguished; after half a month, it is hard to trace origins—how to point out if it transmitted from Windstroke, Shanghan, or dual injury of Wind-Cold? Transmission syndromes involve deficiency/excess and cold/heat, which are already confusing; insisting on fitting the Three Outlines is speaking without ability to act. Wei Baixiang, Zhou Yuza, Shen Zinan, etc., all follow this, merely admiring empty words without testing them. Lu Ziyou's annotated *Jingui*, rejecting the Three Outlines, added concepts of Qi transformation, form layers, root/branch, and Four Bigs, becoming increasingly fragmented and entrapping. Cases of Zangjie resemble monsters and demons. Ke Yunbo mocked both families, rightly so. *Shanghan Lun Yi* by Yunbo is indeed a high theory, showing unique insight and avoiding predecessors' ruts, but criticizing the Six Meridians by overturning previous cases to shock people is ultimately theoretical talk. Commentators on *Shanghan Lun* usually follow the text; where incomprehensible, they gloss over or force interpretations, failing to clarify principles for clinical application. Only Cheng Fusheng's *Jingzhu* is clear and easy to understand, yet he dared not directly point out errors in the original text. Ke's *Laishuji* boldly deleted and modified, which, though presumptuous, benefits later learners. Organizing by formula name is another approach. Xu Lingtai's *Shanghan Leifang* follows this style, concise and clean, achieving more with less compared to Cheng Jiaoqian's verbose style. Shen Yaofeng's *Shanghan Lun* also achieves more with less, using Six Qi as headings and incorporating pulse diagnosis, opening new avenues. His discussion on Daqinglong Tang reveals what predecessors missed, washing away the crude theory of dual injury of Ying and Wei by Wind-Cold. As the *Zuo Zhuan* says, "Drawing one's own weapon to form a separate team," this book resembles that, though deleting original text was not his intent. Carefully examining Ke's deletions, they fall far short of the precision of the Imperial *Yizong Jinjian·Shanghan Lun*. Publishing Zhongjing's original text first, establishing separate chapters for corrections and doubts, annotating minor characters for revisions, and extracting deletable items afterwards makes right and wrong clear to all, truly a compassionate boat in the sea of bitterness and a giant candle in dark streets. Shu Zhao's *Shanghan Jizhu* from Jiangxi largely dismisses texts as forgeries, viciously attacks several formulas, and proposes replacements. This is also a compassionate heart for saving the world, albeit somewhat arrogant. Comparing to Wang Hu dividing Yin and Yang pulses into two volumes and adding later formulas, both intend to prevent beginners from blindly following ancient formulas to harm people; Wang is cautious, while Shu is unrestrained. There are many other commentators, such as Qian's *Suyuanji* and Chen Mingbo's *Jizhu*, which have innovations. Others are mediocre and unworthy of mention. Here, I list those who established their own structures and arguments for colleagues to study. In summary, reading and treating disease intersect and diverge; ancient methods and modern formulas have inheritance and reform. Good readers are good practitioners, not dead readers. Using ancient methods requires adapting to modern contexts, not rigid adherence. Specializing only in Zhongjing's book without reading later experts is like trying to govern Han and Tang dynasties with Well-field system or *Rites of Zhou*. Reading only later experts without Zhongjing is like expecting five-character or seven-character regulated verse or Kun-style palace lyrics to replace the *Odes* of the *Classic of Poetry*. Thus, Wu Shou's *Yunyao*, Jian'an's *Liushu*, Wang Yutai's *Shanghan Zhunsheng*, and Zhang Luyu's *Shanghan Xulun* all benefit later generations and merit Zhongjing. If students extensively explore these cited books, the selected cases will be worthy of friendship with sages.