二日。不敢与饮。故发狂乱。因令速与。连进二盏。稍宁。少顷复索。又与一大盏。放盏。通身
大汗。安睡热除。不烦汤药而愈。同时有西客二人寓毛家。亦患此证。皆与水而安。
文学范铉甫孙振麟。于大暑中患厥冷自利。六脉弦细芤迟。而按之欲绝。舌色淡白。中心黑润无
苔。口鼻气息微冷。阳缩入腹。而精滑如冰。问其所起之由。因卧地昼寝受寒。是夜连走精二度。
忽觉颅胀如山。坐起晕倒。便四肢厥逆。腹痛自利。胸中兀兀欲吐。口中喃喃妄言。与湿温之证
不殊。医者误为停食感冒。而与发散消导药一剂。服后胸前头项汗出如漉。背上愈加畏寒。而下
体如冰。一日昏愦数次。此阴寒挟暑。入中手足少阴之候。缘肾中真阳虚极。所以不能发热。遂
拟四逆加人参汤。方用人参一两。熟附三钱。炮姜二钱。炙甘草二钱。昼夜兼进。三日中进六剂。
厥定。第四日寅刻阳回。是日悉屏姜附。改用保元。方用人参五钱。黄 三钱。炙甘草二钱。加
麦门冬二钱。五味子一钱。清肃膈上之虚阳。四剂食进。改用生料六味加麦冬、五味。每服用熟
地八钱。以救下焦将竭之水。使阴平阳秘。精神乃治。
徐君育素禀阴虚多火。且有脾约便血证。十月间患冬温发热咽痛。里医用麻黄、杏仁、半夏、
枳、橘之属。遂喘逆倚息不得卧。声飒如哑。头面赤热。手足逆冷。右手寸关虚大微数。此热伤
手太阴气分也。与葳蕤、甘草等药不应。为制猪肤汤一瓯。令隔汤炖热。不时挑服。三日声清。
终剂而痛如失。
国学郑墨林夫人。素有便红。怀妊七月。正肺气养胎时。而患冬温咳嗽。咽痛如刺。下血如
崩。脉较平时反觉小弱而数。此热伤手太阴血分也。与黄连阿胶汤二剂。血止。后去黄连加葳蕤、
桔梗、人中黄。四剂而安。
太仓州尊陈鹿屏夫人。素患虚羸骨蒸。经闭少食。偶感风热咳嗽。向来调治之医。误进滋阴
清肺药二剂。遂昏热痞闷异常。邀石顽诊之。脉见人迎虚数而气口濡细。寸口瞥瞥而两尺搏指。
此肝血与胃气皆虚。复感风热之象。
与加减葱白香豉汤。一服热除痞止。但咳则头面微汗。更与小剂保元汤调之而安。
同道王公峻子。于四月间患感冒。昏热喘胀。便秘。腹中雷鸣。服硝、黄不应。始图治于石
顽。其脉气口弦滑而按之则芤。其腹胀满而按之则濡。此痰湿挟瘀。浊阴固闭之候。与黄龙汤去
芒硝易桂、苓、半夏、木香。下瘀垢甚多。因宿有五更咳嗽。更以小剂异功加细辛调之。大抵腹中
奔响之证。虽有内实当下。必无燥结。所以不用芒硝。而用木香、苓、半也。用人参者。借以资
助胃气。行其药力。则大黄辈得以振破敌之功。非谓虚而兼补也。当知黄龙汤中用参。则硝、黄
之力愈锐。用者不可不慎。
贰尹闵介眉甥媳。素禀气虚多痰。怀妊三月。因腊月举丧受寒。遂恶寒不食。呕逆清血。腹
痛下坠。脉得弦细如丝。按之欲绝。与生料干姜人参半夏丸二服。不应。更与附子理中。加苓、
半、肉桂调理而康。门人问曰。尝闻桂、附、半夏。孕妇禁服。而此并行无碍。何也。曰。举世
皆以黄芩、白术为安胎圣药。桂、附为陨胎峻剂。孰知反有安胎妙用哉。盖子气之安危。系乎母
气之偏胜。若母气多火。得芩、连则安。得桂、附则危。母气多痰。得苓、半则安。得归、地则
危。母气多寒。得桂、附则安。得芩、连则危。务在调其偏胜。适其寒温。世未有母气逆而胎得
安者。亦未有母气安而胎反堕者。所以金匮有怀妊六七月。胎胀腹痛恶寒。少腹如扇。用附子汤
温其脏者。然认证不果。不得妄行是法。一有差误。祸不旋踵。非比芩、术之误。犹可延引时日也。
馆师吴百川子。年二十余。素有梦交之疾。十月间患伤寒。头疼足冷。医用发散消导。屡汗
而昏热不除。反加喘逆。更一医。用麻黄重剂。头面大汗。喘促愈甚。或者以为邪热入里。主用
芩、连。或者以为元气大虚。议用冬、地。争持未
决。始求治于石顽。诊之六脉瞥瞥。按之欲绝。正阳欲脱亡之兆。急须参、附。庶可望其回阳。
遂疏回阳返本汤。加童便以敛阳。一剂稍宁。三啜安卧。改用大剂独参汤加童便。调理数日。频
与稀糜而安。
洪德敷女。于壬子初冬。发热头痛。胸满不食。已服过发散消导药四剂。至第六日。
周身痛楚。腹中疼痛。不时奔响。屡欲圊而不可得。口鼻上唇。忽起黑色成片。光亮如漆。与玳
瑁无异。医者大骇辞去。邀石顽诊之。喘汗脉促。而神气昏愦。虽证脉俱危。喜其黑色四围有红
晕鲜泽。若痘疮之根脚。紧附如线。他处肉色不变。许以可治。先与葛根黄芩黄连汤。加犀角、连
翘、荆、防、紫荆、人中黄。解其肌表毒邪。俟其黑色发透。乃以凉膈散加人中黄、紫荆、乌犀。
微下二次。又与犀角地黄汤加人中黄之类。调理半月而安。此证书所不载。惟庞安常有玳瑁瘟之
名。而治法未备。人罕能识。先是牙行徐顺溪患此。误用发散消克药过多。胃气告匮。辞以不治。
又绸铺王允吉侄。患此濒危。始邀予往。其口目鼻孔皆流鲜血。亦不能救。一月间。亲历此证十
余人。大抵黑色枯焦不泽。四围无红晕。而灰白色黯者。皆不可救。其黑必先从口鼻至颧颊目胞
两耳及手臂足胫。甚则胸腹俱黑。从未见于额上肩背阳位也。有武员随任家丁黄姓者。患伤寒半
月。道经吴门。泊舟求治。询其同伴云。自渡淮露卧受寒。恣饮烧酒发热。在京口服药。行过两
次。热势略减。而神昏不语。不时烦扰。见其唇舌赤肿燥裂。以开水与之则咽。不与则不思。察
其两寸瞥瞥虚大。关寸小弱。按久六脉皆虚。曰。此热传手少阴心经也。与导赤泻心汤。一啜神
识稍宁。泊舟一日夜。又进二帖。便溺自知。次早解维。复延往诊。而脉静神安。但与小剂五苓
去桂易门冬二帖。嘱其频与稀糜。可许收功也。钱顺所素有内伤。因劳力感寒。发热头痛。医用
表散药数服。胸膈痞闷不安。以大黄下之。痞闷益甚。更一医。用消
克破气药过伤胃气。遂厥逆昏愦。势渐濒危。邀石顽诊之。六脉萦萦如蜘蛛丝。视其舌上。焦黑
燥涸异常。此热伤阴血。不急下之。真阴立槁。救无及矣。因以生地黄黄连汤。去黄芩、防风。
加人中黄、麦门冬、酒大黄。另以生地黄一两酒浸捣汁和服。夜半下燥矢六七枚。天明复下一次。
乃与生脉散二帖。以后竟不服药。日进糜粥调养。而大便数日不行。魄门迸迫如火。令用导法通
之。更与异功散调理而安。
陈瑞之七月间患时疫似疟。初发独热无寒。或连热二三日。或暂可一日半日。发热时烦渴无
汗。热止后则汗出如漉。自言房劳后乘凉所致。服过十味香薷、九味羌活、柴胡枳桔等十余剂。
烦渴壮热愈甚。因邀石顽诊之。六脉皆洪盛搏指。舌胎焦枯。唇口剥裂。大便五六日不通。病家
虽言病起于阴。而实热邪亢极。胃府剥腐之象。急与凉膈加黄连、石膏、人中黄。得下三次。热
势顿减。明晚复发热烦渴。与白虎加人中黄、黄连。热渴俱止。两日后左颊发颐。一 时即平。
而气急神昏。此元气下陷之故。仍与白虎加人参、犀角、连翘。颐复 发。与犀角、连翘、升柴、
甘、桔、鼠粘、马勃二服。右颐又发一毒。高肿赤亮。另延疡医治其外。调理四十日而痊。同时
患此者颇多。良由时师不明此为湿土之邪。初起失于攻下。概用发散和解。引邪泛滥而发颐毒。
多有肿发绵延。以及膺胁肘臂数处如流注溃腐者。纵用攻下解毒。皆不可救。不可以为发颐小证
而忽诸。
山阴令景昭侯弟介侯。辽东人。患时疫寒热不止。舌苔黄润。用大柴胡下之。烦闷神昏。杂进
人参白虎、补中益气。热势转剧。频与芩、连、知母不应。因遣使兼程过吴。相邀石顽到署。诊之
左脉弦数而劲。右脉再倍于左。而周身俱发红斑。惟中脘斑色皎白。时湖绍诸医群集。莫审胸前
斑子独白之由。因论之曰。良由过服苦寒之剂。中焦阳气
失职。所以色白。法当透达其斑。兼通气化。无虑斑色不转也。遂用犀角、连翘、山栀、人中黄。
昼夜兼进二服。二便齐行。而斑化热退。神清食进。起坐徐行矣。昭侯曦侯。同时俱染其气。并
进葱白、香豉、人中黄、连翘、薄荷之类。皆随手而安。
吴介臣伤寒。余热未尽。曲池雍肿。不溃不消。日发寒热。疡医禁止饮食。两月余。日服清
火消毒药。上气形脱。倚息不得卧。渴饮开水一二口。则腹胀满急。大便燥结不通。两月中用蜜
导四五次。所去甚难。势大濒危。邀石顽诊之。其脉初按绷急。按之绝无。此中气逮尽之兆。岂
能复胜药力耶。乃令续进稀糜。榻前以鸭煮之。香气透达。徐以汁啜之。是夕大便。去结粪甚多。
喘胀顿止。饮食渐进。数日后肿亦渐消。此际虽可进保元、独参之类。然力不能支。仅惟谷肉调
理而安。近松陵一人过饵消导。胃气告匮。闻谷气则欲呕。亦用上法。不药而痊。徽商黄以宽。
风温十余日。壮热神昏。语言难出。自利溏黑。舌苔黑燥。唇焦鼻煤。先前误用发散消导药数剂。
烦渴弥甚。恣饮不彻。乃求治于石顽。因谕之曰。此本伏气郁发。更遇于风。遂成风温。风温脉
气本浮。以热邪久伏少阴。从火化发出太阳。即是两感。变患最速。今幸年壮质强。已逾三日六
日之期。证虽危殆。良由风药性升。鼓激周身元气。皆化为火。伤耗真阴。少阴之脉不能内藏。
所以反浮。考诸南阳先师。原无治法。而少阴例中则有救热存阴承气下之一证。可借此以迅埽久
伏之邪。审其鼻息不鼾。知肾水之上源未绝。无虑其直视失溲也。时歙医胡晨敷在坐。相与酌用
凉膈散加人中黄、生地黄。急救垂绝之阴。服后下溏黑三次。舌苔未润。烦渴不减。此杯水不能
救车薪之火也。更与大剂凉膈。大黄加至二两。兼黄连、犀角。三下方得热除。于是专用生津止
渴。大剂投之。舌苔
方去。而津回渴止。此证之得愈者。全在同人契合。无分彼此。得以挽回。设异论纷纭。徒滋眩
惑。安保其有今日哉。上仁渊祖道台时疫大义。谨按时疫之邪。皆从湿土郁蒸而发。土为受盛之
区。平时污秽之物。无所不受。适当岁气并临。则从分野疏豁之隅。蒸腾郁发。不异瘴雾之毒。
或发于山川原陆。或发于河井沟渠。人触之者。皆从口鼻流入募原。而至阳明之经。脉必右盛于
左。盖湿土之邪。以类相从。而犯于胃。所以右手脉盛也。阳明居太阳之里。少阳之外。为三阳
经之中道。故初感一二日间。邪犯募原。但觉背微畏寒。头额晕胀。胸膈痞满。手指酸麻。此为
时疫之报使。与伤寒一感便发热头痛不同。至三日以后。邪乘表虚而外发。则有昏热头汗。或咽
肿发斑之患。邪乘里虚而内陷。或挟饮食。则有呕逆痞满。嘈杂失血。自利吐蛔之患。若其人平
素津枯。兼有停滞。则有谵语发狂。舌苔黄黑。大便不通之患。平素阴虚。则有头面赤热。足膝
逆冷。至夜发热之患。至于发呃发哕。冷汗喘乏。烦扰螈 等证。皆因误治所致也。大抵伤寒之
邪。自表传里。温热之邪。自里达表。疫疠之邪。自阳明中道。随表里虚实而发。不循经络传次
也。以邪既伏于中道。不能一发便尽。故有得汗热除。二三日复热如前者。有得下里和。二三日
得见表热者。有表和复见里证者。总由邪气内伏。故屡夺屡发。不可归咎于调理失宜。复伤风寒
饮食也。外解无如香豉、葱白、连翘、薄荷之属。内清无如滑石、芩、连、山栀、人中黄之属。
下夺无如硝、黄之属。如见发热自利。则宜葛根、芩、连。胸膈痞满。则宜枳、桔、香附。呕吐
呃逆。则宜藿香、芩、连。衄血下血。则宜犀角、丹皮。发斑咽痛。则宜犀角、牛蒡。烦渴多汗。
则宜知母、石膏。愈后食复劳复。则宜枳实栀豉。随证加葳蕤、茯苓、丹皮、芍药之类。皆为合
剂。而香豉、人中黄又为时疫之专药。豉乃黑豆所 。得湿热之气。酿成败秽之质。故能引领内
邪。从巨阳蒸汗而解。人中黄本
甘草所制。渍以滓秽。专解脏腑恶毒。从下而泄。同气相求之妙。莫过于此。以其总解温热时行。
外内热毒也。当知其证虽有内外之殊。一皆火毒为患。绝无辛温发散之例。每见穷乡无医无药之
处。热极恣饮凉水。多有浃然汗出而解者。此非宜寒凉不宜辛热之明验乎。况当庚申金运。北政
少阳相火司天之岁。目今又在三气之中。主令客气。俱属相火。一切风燥辛热。皆不可犯。每见
时师用羌、独、柴、前、苍、芷、芎、防之类引邪上逆亢热弥甚者。以风燥之药。性皆上升横散。
如炉冶得鼓铸之力也。用朴、半、槟榔、青皮、木香等耗气之药胸膈愈加痞满者。揠苗助长之道
也。有下证已具。而迟疑不敢攻下。屡用芩、连不应者。此与扬汤止沸不殊也。至于发狂谵语。
舌苔焦黑。而大便自利。证实脉虚。不可攻者。及烦热痞闷。冷汗喘乏。四肢逆冷。六脉虚微不
On the second day. [The patient] dared not be given water to drink. Hence, madness and confusion ensued. [The physician] ordered that water be given immediately. Two cups were consumed consecutively, and the condition slightly stabilized. After a short while, the patient demanded more. Another large cup was given. Upon setting down the cup, profuse sweating covered the entire body. The patient slept peacefully, the fever subsided, and recovery occurred without the need for herbal decoctions. At the same time, two Western merchants staying at the Mao family suffered from this same syndrome; both recovered after being given water.
Fan Zhenlin, grandson of the scholar Fan Xianfu, suffered from cold extremities (Jue) and spontaneous diarrhea during the height of summer. The six pulses were wiry, thin, hollow, and slow, feeling nearly imperceptible upon deep pressure. The tongue was pale white with a black, moist center and no coating. Breath from the mouth and nose was slightly cold. The penis retracted into the abdomen, and seminal emission occurred as if icy. Inquiring about the cause, it was learned that he had slept on the ground during the day and caught cold. That night, he experienced nocturnal emissions twice. Suddenly, he felt his head swelling as if under a mountain weight, fainted upon sitting up, followed by cold extremities, abdominal pain, spontaneous diarrhea, nausea in the chest, and muttering delirium. This presentation was indistinguishable from Damp-Warmth syndrome. The physician mistakenly diagnosed food stagnation and common cold, administering one dose of dispersing and digesting herbs. After ingestion, sweat poured from the chest, head, and neck; the back became increasingly sensitive to cold, while the lower body felt like ice. The patient fell into stupor several times a day. This indicated Yin-cold combined with Summerheat invading the Hand and Foot Shaoyin meridians. Because the True Yang in the Kidney was extremely deficient, heat generation was impossible. Thus, Sini Tang plus Ginseng Decoction was prescribed: Ren Shen (Ginseng Root) 1 liang, Shu Fu Zi (Prepared Aconite Root) 3 qian, Pao Jiang (Roasted Ginger) 2 qian, Zhi Gan Cao (Honey-fried Licorice Root) 2 qian. Administered day and night, six doses were taken over three days. Cold extremities resolved. On the fourth day, at Yin hour, Yang returned. All ginger and aconite were discontinued that day, and Baoyuan Tang was substituted: Ren Shen (Ginseng Root) 5 qian, Huang Qi (Astragalus Root) 3 qian, Zhi Gan Cao (Honey-fried Licorice Root) 2 qian, Mai Men Dong (Ophiopogon Tuber) 2 qian, Wu Wei Zi (Schisandra Berry) 1 qian. This cleared deficient Yang above the diaphragm. After four doses, appetite improved. Then, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) with added Mai Men Dong (Ophiopogon Tuber) and Wu Wei Zi (Schisandra Berry) was used. Each dose contained 8 qian of Shu Di Huang (Prepared Rehmannia Root) to rescue the nearly exhausted Yin fluids of the Lower Jiao, achieving balance between Yin and Yang, thereby restoring mental clarity.
Mr. Xu Yu had a constitution characterized by Yin deficiency and excessive fire, along with Pi Yue (Spleen Confinement) causing bloody stools. In October, he contracted Winter-Warmth, presenting with fever and sore throat. The local physician administered herbs such as Ma Huang (Ephedra Stem), Xing Ren (Apricot Seed), Ban Xia (Pinellia Tuber), Zhi Ke (Bitter Orange Fruit), and Ju Pi (Tangerine Peel). Consequently, he developed wheezing, orthopnea, hoarseness resembling aphonia, redness and heat on the head and face, and cold extremities. The pulse at the Cun and Guan positions on the right hand was deficient, large, and slightly rapid. This indicated Heat injuring the Qi aspect of the Hand Taiyin Lung Meridian. Treatment with Yu Zhu (Polygonatum Rhizome) and Gan Cao (Licorice Root) failed. A bowl of Zhufu Tang (Pig Skin Decoction) was prepared, heated by steaming, and administered intermittently. After three days, his voice cleared, and upon finishing the course, the pain vanished.
Madam Zheng Molin, wife of the Guoxue scholar, had a history of rectal bleeding. At seven months pregnant, during the period when Lung Qi nourishes the fetus, she contracted Winter-Warmth cough with piercing sore throat and severe vaginal bleeding. Her pulse was smaller, weaker, and more rapid than usual. This indicated Heat injuring the Blood aspect of the Hand Taiyin Lung Meridian. Two doses of Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) stopped the bleeding. Later, Huang Lian (Coptis Rhizome) was removed, and Yu Zhu (Polygonatum Rhizome), Jie Geng (Platycodon Root), and Ren Zhong Huang (Human Waste Charcoal) were added. Four doses brought stability.
Madam Chen Luping, wife of the Prefect of Taicang, suffered from emaciation and bone-steaming fever, amenorrhea, and poor appetite. She accidentally contracted Wind-Heat cough. Previous physicians mistakenly administered Yin-nourishing and Lung-clearing herbs for two doses, resulting in severe stupor, heat, and chest fullness. Physician Shiwen was invited to diagnose. The pulse showed Renying (Carotid artery pulse) as deficient and rapid, while Qikou (Radial artery pulse) was soggy and fine. The Cun position was flickering, while the two Chi positions were forceful against the finger. This indicated deficiency of Liver Blood and Stomach Qi, compounded by Wind-Heat invasion. Jiawei Congbai Xiangchi Tang (Modified Scallion White and Fermented Soybean Decoction) was administered. One dose eliminated heat and fullness. However, coughing induced slight sweating on the head and face. A small dose of Baoyuan Tang was then used for regulation, leading to recovery.
Wang Gongjun, a colleague, contracted a common cold in April. He presented with stuporous heat, wheezing, distension, constipation, and borborygmus. Sodium nitrate and Da Huang (Rhubarb Root) were ineffective. Shiwen was consulted. The Qikou pulse was wiry and slippery but hollow upon deep pressure. Abdominal distension was firm yet soft upon deep palpation. This indicated Phlegm-Dampness combined with Blood stasis, with turbid Yin obstructing closure. Longdan Xiegan Tang was modified by removing Mang Xiao (Mirabilite) and adding Gui Zhi (Cinnamon Twig), Fu Ling (Poria), Ban Xia (Pinellia Tuber), and Mu Xiang (Aucklandia Root). Profuse dark stool was expelled. Due to chronic morning cough, Yicheng San (Yi Cheng Powder) with Xi Xin (Asarum Root) was used in small doses for regulation. Generally, borborygmus indicates internal excess requiring purgation, but dryness is absent. Therefore, Mang Xiao is omitted in favor of Mu Xiang, Fu Ling, and Ban Xia. Ren Shen (Ginseng Root) is used to support Stomach Qi and propel the medicinal action, allowing Da Huang (Rhubarb Root) and similar herbs to exert their breaking power. It is not merely for tonifying deficiency. Note that in Longdan Xiegan Tang, the addition of Ren Shen sharpens the effect of Mang Xiao and Da Huang; thus, caution is required.
The niece-in-law of Min Jiemei, an Assistant Magistrate, had a constitution of Qi deficiency and excessive phlegm. At three months pregnant, she caught cold while attending a funeral in the twelfth lunar month. Symptoms included aversion to cold, anorexia, vomiting of clear blood, abdominal pain, and bearing-down sensation. The pulse was wiry and thin as a thread, nearly imperceptible upon pressure. Two doses of Shengliao Ganjiang Renshen Banxia Wan (Raw Ingredient Dry Ginger, Ginseng, and Pinellia Pills) failed. Fuzi Lizhong Tang (Aconite Formula for Regulating the Middle) with added Fu Ling (Poria), Ban Xia (Pinellia Tuber), and Rou Gui (Cinnamon Bark) restored health. A student asked: "It is commonly said that Gui Zhi (Cinnamon Twig), Fu Zi (Aconite Root), and Ban Xia (Pinellia Tuber) are contraindicated in pregnancy, yet here they are used safely together. Why?" I replied: "The world regards Huang Qin (Scutellaria Root) and Bai Zhu (Atractylodes Rhizome) as sacred herbs for calming the fetus, while viewing Gui Zhi and Fu Zi as harsh abortifacients. Who knows they can have miraculous effects in calming the fetus? The safety of the fetus depends on the predominance of the mother's Qi. If the mother has excessive Fire, Huang Qin and Huang Lian bring peace, while Gui Zhi and Fu Zi bring danger. If the mother has excessive Phlegm, Fu Ling and Ban Xia bring peace, while Dang Gui (Angelica Sinensis Root) and Di Huang (Rehmannia Root) bring danger. If the mother has excessive Cold, Gui Zhi and Fu Zi bring peace, while Huang Qin and Huang Lian bring danger. One must adjust the predominance and adapt to cold or warmth. There is no case where maternal Qi is chaotic yet the fetus remains safe, nor where maternal Qi is peaceful yet the fetus miscarries. Thus, *Jinkui Yaolue* records using Fuzi Tang to warm the viscera for fetal distension, abdominal pain, and aversion to cold in the sixth or seventh month of pregnancy. However, if diagnosis is uncertain, this method should not be applied recklessly. An error leads to immediate disaster, unlike mistakes with Huang Qin and Bai Zhu, which allow time for correction."
The son of Tutor Wu Baichuan, in his twenties, suffered from nocturnal emissions. In October, he contracted Cold Damage with headache and cold feet. Physicians used dispersing and digesting herbs; repeated sweating failed to remove stuporous heat, worsening wheezing. Another physician used a heavy dose of Ma Huang (Ephedra Stem), causing profuse sweating on the head and face, further aggravating dyspnea. Some attributed it to Evil Heat entering the interior, prescribing Huang Qin (Scutellaria Root) and Huang Lian (Coptis Rhizome). Others attributed it to severe Yuan Qi deficiency, proposing Dong Chong Xia Cao (Cordyceps) and Di Huang (Rehmannia Root). Debate remained unresolved until Shiwen was consulted. The six pulses were flickering and nearly imperceptible upon pressure, indicating impending collapse of Yang Qi. Urgent treatment with Ren Shen (Ginseng Root) and Fu Zi (Aconite Root) was needed to restore Yang. Huiyang Fanben Tang (Decoction to Return Yang and Restore the Foundation) with Tong Bian (Child's Urine) to consolidate Yang was prescribed. One dose brought slight relief; three doses allowed peaceful sleep. A large dose of Dushen Tang (Single Ginseng Decoction) with Tong Bian was then used for regulation. Frequent administration of thin gruel led to recovery.
Hong Defu’s daughter, in early winter of the Renzi year, presented with fever, headache, chest fullness, and anorexia. After four doses of dispersing and digesting herbs, on the sixth day, she suffered generalized pain, abdominal pain, borborygmus, and tenesmus (urge to defecate without success). Black patches appeared on the upper lip and around the mouth/nose, shiny like lacquer, resembling tortoise shell. Physicians fled in alarm. Shiwen diagnosed panting, sweating, rapid pulse, and stupor. Although critical, the black areas had fresh red halos, attached tightly like pockmark roots, with normal skin elsewhere. Recovery was promised. Gegen Huangqin Huanglian Tang (Kudzu, Scutellaria, and Coptis Decoction) with Xijiao (Rhinoceros Horn - substitute now Buffalo Horn), Lianqiao (Forsythia Fruit), Jingjie (Schizonepeta Spike), Fangfeng (Saposhnikovia Root), Zijing (Buddleja Branch), and Renzhong Huang (Human Waste Charcoal) was given to resolve exterior toxin. Once the blackness fully emerged, Liangge San (Cool the Upper Jiao Powder) with Renzhong Huang, Zijing, and Wuxi (Black Rhinoceros Horn - substitute) was used to mildly purge twice. Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) with Renzhong Huang regulated her for half a month. This syndrome is unrecorded in classics; only Pang Anchang mentioned "Daimao Wen" (Tortoise Shell Plague) but lacked treatment methods. Previously, Xu Shunxi, a broker, suffered this due to excessive dispersing and draining herbs depleting Stomach Qi, deemed incurable. Wang Yongji’s nephew also suffered critically with bleeding from mouth, eyes, and nostrils, and could not be saved. Within a month, over ten cases were witnessed. Those with dry, dull blackness without red halos, or gray-white dark colors, were incurable. The blackness typically spread from mouth/nose to cheeks, eyelids, ears, arms, legs, and even chest/abdomen, never appearing on forehead, shoulders, or back (Yang regions). A servant named Huang, accompanying a military officer, contracted Cold Damage for half a month. Traveling through Wu, he sought treatment. Companions reported exposure to cold after sleeping outdoors crossing the Huai River, followed by binge drinking liquor. Medication in Beijing reduced fever slightly but caused stupor, mutism, and restlessness. Lips and tongue were red, swollen, dry, and cracked. He swallowed water when offered but refused otherwise. Cun pulses were flickering and large; Guan pulses were weak; all six pulses were deficient upon prolonged pressure. This indicated Heat transmitting to the Hand Shaoyin Heart Meridian. Daochi Xixin Tang (Draining Heart Decoction) was given. One dose calmed consciousness. After two more doses while moored, urination and defecation normalized. The next morning, upon resuming diagnosis, pulse was calm and spirit stable. Small doses of Wuling San (Five-Ingredient Powder) with Gui Zhi (Cinnamon Twig) replaced by Maidong (Ophiopogon Tuber) were prescribed with frequent thin gruel. Recovery was expected.
Qian Shunsuo had chronic internal injury. Labor-induced cold contraction caused fever and headache. Several doses of exterior-releasing herbs caused chest oppression. Da Huang (Rhubarb Root) purgation worsened oppression. Another physician used excessive draining and Qi-breaking herbs, damaging Stomach Qi, leading to cold extremities, stupor, and critical condition. Shiwen diagnosed spider-web-like pulses. Tongue was scorched black and excessively dry. This indicated Heat injuring Yin Blood. Without urgent purgation, True Yin would wither instantly. Shengdi Huang Huanglian Tang (Fresh Rehmannia and Coptis Decoction) was modified by removing Huang Qin (Scutellaria Root) and Fengfang (Ledebouriella Root), adding Renzhong Huang (Human Waste Charcoal), Maidong (Ophiopogon Tuber), and Jiuhuang (Wine-processed Rhubarb). Fresh Sheng Di Huang (Fresh Rehmannia Root) soaked in wine and juiced was mixed and taken. At midnight, six or seven hard stools passed. Another passage occurred at dawn. Shengmai San (Generate Pulse Powder) was given for two doses. No further medication was taken; diet consisted of thin gruel. Constipation persisted for days with burning anal urgency. Enema was used. Yicheng San (Yi Cheng Powder) regulated him to recovery.
Chen Ruizhi contracted epidemic malaria-like illness in July. Initial onset featured isolated fever without chills. Fever lasted two to three days continuously or briefly for half a day. During fever, irritability, thirst, and anhidrosis occurred; after fever ceased, profuse sweating ensued. He attributed it to sexual exhaustion followed by cooling exposure. Over ten doses of Shiwei Xiangru (Ten-Ingredient Elsholtzia), Jiuwei Qianghuo (Nine-Ingredient Notopterygium), and Chaihu Zhijie (Bupleurum and Aurantium Decoction) worsened irritability and high fever. Shiwen diagnosed surging, forceful pulses at all six positions, scorched tongue coating, cracked lips/mouth, and constipation for five to six days. Although the family claimed Yin origin, actual Heat Evil was extreme, showing stomach tissue decay. Liangge San (Cool the Upper Jiao Powder) with Huang Lian (Coptis Rhizome), Shigao (Gypsum), and Renzhong Huang (Human Waste Charcoal) was urgently given. Three purgations rapidly reduced fever. Next evening, fever and thirst recurred. Baihu Tang (White Tiger Decoction) with Renzhong Huang and Huang Lian stopped heat and thirst. Two days later, parotitis (swelling of cheek/jaw) appeared on the left side, resolving quickly. However, rapid breathing and stupor indicated sinking of Yuan Qi. Baihu Tang plus Ren Shen (Ginseng Root), Xijiao (Rhinoceros Horn), and Lianqiao (Forsythia Fruit) was used. Parotitis recurred. Xijiao, Lianqiao, Shengma (Cimicifuga Rhizome), Chaihu (Bupleurum Root), Gancao (Licorice Root), Jiegeng (Platycodon Root), Niubangzi (Arctium Seed), and Mabo (Malacodendron Flower) were given for two doses. Right-sided parotitis developed, high, swollen, red, and bright. External surgeon treated locally. Forty days of regulation led to cure. Many others suffered similarly. This was due to physicians failing to recognize Wet-Earth Evil, neglecting initial purgation, and indiscriminately using dispersing/harmonizing methods, driving evil outward causing parotitis. Swelling often spread to chest, ribs, elbows, arms, ulcerating like abscesses. Even with purgation and detoxification, recovery was impossible. Do not dismiss parotitis as minor.
Jiehou, brother of Jing Zhaohou, Magistrate of Shanyin (from Liaodong), suffered persistent alternating chills and fever from epidemic illness. Yellow, moist tongue coating. Da Chaihu Tang (Major Bupleurum Decoction) purged him, causing irritability and stupor. Mixed use of Renshen Baihu Tang (Ginseng White Tiger Decoction) and Buzhong Yiqi Tang (Tonify Middle and Augment Qi Decoction) worsened heat. Repeated Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome), and Zhimu (Anemarrhena Rhizome) failed. Envoy summoned Shiwen. Left pulse was wiry, rapid, and tense; right pulse was double the left. Generalized erythematous macules appeared, except for white macules at Zhongwan. Physicians gathered, puzzled by white macules on chest. Shiwen explained: "Overuse of bitter-cold herbs impaired Middle Jiao Yang Qi, causing whiteness. Method requires venting macules and promoting Qi transformation. Color will change." Xijiao (Rhinoceros Horn), Lianqiao (Forsythia Fruit), Shanzhi (Gardenia Fruit), and Renzhong Huang (Human Waste Charcoal) were given day and night. Two doses resulted in simultaneous bowel/bladder movement, macule resolution, fever reduction, clear spirit, appetite return, and mobility. Zhao Hou and Xi Hou contracted same qi. Congbai (Scallion White), Xiangchi (Fermented Soybean), Renzhong Huang, Lianqiao, and Bohe (Mint Leaf) brought quick recovery.
Wu Jiechen suffered Cold Damage with lingering residual heat. Ququ (Elbow joint) swelling did not suppurate or resolve. Daily chills and fever. Surgeon prohibited diet. For over two months, daily clearing-fire and detoxifying herbs caused Qi rebellion, emaciation, orthopnea, thirst for small sips of boiling water causing abdominal distension, and dry constipation. Honey enemas used four to five times with little effect. Critical condition. Shiwen diagnosed initially tense pulse vanishing upon pressure, indicating depletion of Middle Qi. Medicine would fail. Advised continued thin gruel, cooked duck broth near bed for aroma, sipped slowly. That night, large amount of hardened stool passed, stopping wheezing/distension. Diet gradually resumed. Swelling subsided in days. Though Baoyuan Tang or Dushen Tang might be considered, strength was insufficient. Only grain/meat regulation ensured recovery. A person from Songling overused digesting herbs, depleting Stomach Qi, vomiting at smell of food. Same method cured without medicine.
Huang Yikuan, Hui merchant, suffered Wind-Warmth for ten+ days. High fever, stupor, difficulty speaking, loose black stool, black dry tongue coating, scorched lips, sooty nose. Previous dispersing/digesting herbs worsened thirst. Excessive drinking failed to quench. Shiwen advised: "This is latent Qi郁发 (stagnant Qi erupting) triggered by Wind, becoming Wind-Warmth. Wind-Warmth pulse is naturally floating. Heat Evil long hidden in Shaoyin transforms via Fire, emerging to Taiyang, constituting 'Liang Gan' (Dual Contraction), changing rapidly. Fortunately, young and strong, past critical days. Though critical, wind herbs ascend, stirring Yuan Qi into Fire, consuming True Yin. Shaoyin pulse cannot store internally, hence floating. Master Zhang Zhongjing had no specific method, but Shaoyin examples include Chengqi Decoction to save Heat and preserve Yin. Check nasal breathing: if not snoring, Kidney Water source intact, no fear of fixed gaze/incontinence." Hu Chenfu present. Liangge San (Cool the Upper Jiao Powder) with Renzhong Huang and Sheng Di Huang (Fresh Rehmannia Root) used to rescue dying Yin. Three passages of loose black stool. Tongue still dry, thirst unchanged. "A cup of water cannot extinguish a burning cartload of fire." Larger Liangge San with 2 liang Da Huang (Rhubarb Root), Huang Lian (Coptis Rhizome), and Xijiao (Rhinoceros Horn) cleared heat after three doses. Then, large doses of fluids-generating and thirst-quenching herbs removed tongue coating and restored moisture/thirst. Recovery depended on unity among physicians. Disagreement would have caused confusion. How could we have reached today?
Regarding Epidemic Illness principles for Shangrenyuan: Epidemic Evil arises from damp-earth stagnation. Earth receives filth. When annual Qi converges, it evaporates from open areas like miasma. Enters via mouth/nose to Moyuan (Upright Original), reaching Yangming Meridian. Right pulse stronger than left. Damp-Earth Evil follows its kind, attacking Stomach, hence right pulse dominance. Yangming lies inside Taiyang, outside Shaoyang, middle path of Three Yang. Initial 1-2 days: Evil at Moyuan causes slight back chill, dizziness, chest fullness, limb numbness. This is epidemic herald, different from Cold Damage fever/headache. After 3 days: Evil exploits exterior deficiency, causing stuporous heat, head sweat, throat swelling, macules. Exploits interior deficiency, causing vomiting, fullness, bleeding, diarrhea, roundworm expulsion. If Yin fluid depleted with stagnation: delirium, madness, yellow/black tongue, constipation. If Yin deficient: red hot head/face, cold knees/feet, night fever. Hiccups, cold sweat, panting, convulsions result from mismanagement. Cold Damage moves exterior to interior; Warmth moves interior to exterior; Epidemic Evil moves from Yangming middle path based on exterior/interior deficiency/excess, not following meridian sequence. Evil hidden in middle path cannot exit fully. Hence, sweating may clear heat but recur; purgation may harmonize interior but exterior heat appears; exterior harmony may reveal interior signs. Total cause: internal evil hiding, recurring despite attacks. Do not blame poor care or dietary relapse. Exterior resolution: Xiangchi, Congbai, Lianqiao, Bohe. Interior clearing: Shishi (Talcum), Qin, Lian, Zhizi, Renzhong Huang. Purging: Xiao, Huang. Fever with diarrhea: Gegen, Qin, Lian. Chest fullness: Zhi, Jie, Xiangfu. Vomiting/hiccups: Huoxiang, Qin, Lian. Epistaxis/bleeding: Xijiao, Danpi. Macules/sore throat: Xijiao, Niubang. Thirst/sweating: Zhimu, Shigao. Post-recovery relapse: Zhishi Zhichi. Add Yu Zhu, Fuling, Danpi, Shaoyao as needed. Xiangchi and Renzhong Huang are specific for epidemics. Xiangchi (fermented black bean) absorbs damp-heat, transforming into foul quality, guiding internal evil out via Juyang (Taiyang) sweating. Renzhong Huang (licorice soaked in waste) clears visceral toxins downward. Sympathetic resonance is supreme here. Both resolve external/internal heat toxins of Warmth/Epidemics. Regardless of location, all are Fire-Toxin. No place for acrid-warm dispersants. In remote areas, extreme heat quenched by cold water often resolves via sweating. Clear proof of preferring cold over acrid-warm. Given Gengshen Metal Transport, North Government Shaoyang Ministerial Fire ruling Heaven, currently in Third Qi. Host/Guest Qi belong to Ministerial Fire. Acrid-warm drying herbs forbidden. Physicians using Qianghuo, Duhuo, Chaihu, Qianhu, Cangzhu, Baizhi, Xiong, Fangfeng guide evil upward, increasing heat like bellows to furnace. Using Po Xiao, Banxia, Binglang, Qingpi, Muxiang deplete Qi, worsening fullness like pulling seedlings to help them grow. With purgation indications present, hesitation and repeated Qin/Lian failure is like stirring boiling water to stop boiling. Regarding mania, delirium, scorched black tongue, spontaneous diarrhea, excess syndrome with deficient pulse (non-purgable), and irritability, fullness, cold sweat, panting, cold extremities, minute/dead pulses...