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A student asked, "Mr. Jiang Zhongzun from Chongming contracted Shanghan (Cold Damage). When his condition became critical, he requested half a bowl of rice washed with meat broth. After eating it, he let out a loud cry and passed away. What is the reason for this?"

I replied, "Currently, many patients suffering from external contraction diseases also have internal injury. Medication must be carefully differentiated. If the condition is seventy percent external contraction and thirty percent internal injury, the medication for the external contraction should use mild agents in small doses, accompanied by Ginger and Jujube as guides to harmonize the middle jiao. This way, there will be no excessive disturbance of the righteous qi, leading to complications such as profuse sweating or loss of blood. If the condition is seventy percent internal injury and thirty percent external contraction, the medication should focus entirely on treating the internal injury, adding only one herb that releases the exterior. It should be taken hot to assist the medicinal power, so that the external contraction will naturally dissipate. This is because people with internal injury will fall ill immediately upon encountering even slight external pathogens, unlike robust individuals who require deep and heavy pathogenic invasion before illness manifests.

Regarding Mr. Jiang, I once observed his face was shiny with oil, knowing he was someone whose spirit was externally dissipated, not one destined for longevity. Only when a person's essence is inwardly contained (lacking outward display) is there room to navigate the world and withstand disease. If one's spiritual brilliance is displayed externally, how much true essence remains within? Recently, I heard that his ambition for officialdom and indulgence in sensual pleasures were intense. He traveled at night on the sea surface, exposing himself to the miasma of mirages and dragon fogs, and still violated taboos against reckless behavior. Thus, his illness was purely internal injury, and the so-called external contraction was merely exposure to mist and dew. The pathogen of mist and dew, upon entering the human body, enters only the clear pathways of the qi mechanism and does not transmit through the meridians. Therefore, it cannot be expelled by diaphoresis (sweating methods) or purgation. Only by tonifying the primordial qi and enriching the grain qi can the pathogen exit spontaneously without being forcibly driven. If one mistakes dizziness and fever for Taiyang disease (a syndrome caused by pathogenic invasion of the Taiyang channel) and erroneously induces sweating, the internal injury will inevitably worsen, leading to a critical and dangerous situation. Moreover, people with internal injury already suffer from fluctuations between fullness and hunger. Misdiagnosing this as Shanghan and denying them food makes their existing deficiency even more severe, causing emptiness and fatigue in the abdomen, leading them to seek relief through food. The loud cry upon eating indicates rupture of the intestines and death. This principle is clear: just as starving people collapse and die instantly because their qi is interrupted and cannot continue, so too do patients with Ge Disease (dysphagia/esophageal obstruction) often cry out loudly before dying as they struggle unable to eat. This occurs because there is no external pathogen disturbing their shen (spirit), allowing them to clearly perceive their impending demise. If there were truly an external pathogen contending with the righteous qi, the person would have become confused and unconscious long before death. How could they remain so lucid? You should have discerned this truth clearly before employing observation, listening/smelling, inquiry, and palpation."

The student asked again, "I often see people with externally displayed spirit who, when ill, sweat excessively and become irritable. I do not know what medicine can treat this."

I replied, "The highest method is to treat the shen with the shen. Since the spirit has flown outward, it must be retained inward to reverse the decline. As Laozi said, 'Know the masculine, keep to the feminine; know the white, keep to the black.' This is the true antidote for this condition. Regarding the nature of herbal medicines, select those with descending qi and heavy, profound flavors. Use them continuously without interruption. This imitates the example of irrigating a garden: frequently watering in advance to prevent drought."

The student asked again, "At the time of requesting rice near death, was there any medicine that could have saved him?"

I said, "Dushen Tang (Decoction of Single Ginseng) could have saved him. I once treated a pregnant woman with Shanghan. After inducing sweating to release the exterior, she suddenly called her maid to cry out her injustice. I realized this indicated disturbance of the yang qi due to urgency and helplessness. I ordered the administration of Ginseng Decoction. Since Ginseng was not readily available, I used three liang of Atractylodis Macrocephalae Rhizoma (Baizhu, 白术), boiled into a concentrated decoction of one bowl, which she took. She stabilized immediately. Besides, the efficacy of Panax Ginseng Radix et Rhizoma (Renshen, 人参) is a hundred times that of Atractylodis Macrocephalae Rhizoma."