上卷葛根芩连汤证，师用退一步法，余用进一步法者，遥遥对映，正可相得益彭。学者当知一病之来，每非一方可奏全功，见其实则进，虑其虚则退；惟其急则顾标，因其缓则保本。必也进退合度，标本无误，病乃速已。抑进退之外，尚有旁敲侧击之法，标本之间，更有中气逆从之调。一隅三反，又岂待焦唇之喋喋乎？曹颖甫曰：治病不经实地考验，往往失之悬断。孟子有言：为高必自邱陵，为下必因川泽。今佐景乃因仲师所言之病情，进而求其所以然，则见证用药，随在有得心应手之妙，要不惟奔豚为然也。又按奔豚向称肾积，而方治实为肝病。
陈修园谓奔豚汤畅肝气而逐客邪，黄坤载发明桂枝解达肝郁，按中所述某同学所言肝气亦自有理。但以奔豚证属肝病则可，泛称肝病，并不知为奔豚证则不可耳。
耿右初诊八月二十七日一身肢节疼痛，脚痛，足胫冷，日晡所发热，脉沈而滑，此为历节，宜桂枝芍药知母汤。瘰疬，从缓治。
川桂技五钱赤白芍各三钱生甘草三钱生麻黄三钱熟附块五钱生白术五钱肥知母五钱青防风五钱生姜一块打二诊九月一日服桂枝芍药知母汤，腰痛略减，日晡所热度较低，惟手足痠痛如故，仍宜前法。
川桂技五钱赤白芍各五钱生甘草三钱净麻黄四钱苍白术各五钱肥知母五钱青防风四钱生姜一块打咸附子三钱生用勿泡
【按】吾师又曾治一戴姓妇人妊娠八月，为其夫病求医，抱夫乘车，胎儿竟为夫身压毙，遂作腹痛。一医药而堕之，腐矣，妇本属血虚体质，死胎既下，因贫不能善后，即病历节。手足拘挛，节骱剧痛，旦日较缓。拖延二年，方求师诊。
师用一方，二剂不应。二诊改用某药，汗乃大出。两剂，肢节便可屈伸，足肿亦小，独手发出大泡，有浓有水，将成溃烂。乃采丁甘仁先贤法，用大小蓟各五钱，丹皮一两，地骨皮四钱，清其血热，二剂而痂成，四剂而痂脱。遂与未病时无异。
以为可无恙矣，妇忽阴痒难忍，盖湿毒未尽，而下注也。师因令其用蛇床子煎汤薰洗，良瘥。未几，入市购物，卒然晕倒，诸恙退而血虚之真象见。师乃用大熟地一两，潞党参五钱，川芎、当归各四钱，龙骨、牡蛎各一两，凡二十余剂全愈，后竟抱子云云。
曹颖甫曰：肢节疼痛，病名历节。此证起于风邪外感，汗出不畅，久久湿流关节，脉迟而滑，属寒湿。其微者用桂枝芍药知母汤。其剧者宜乌头扬。尝治一吴姓少病，予用净麻黄三钱，生白芍三钱，生绵耆三钱，炙甘草三钱，乌头二枚切片，用蜜糖一碗另煎，煎至半碗，盖悉本《金匮》法也。
人体外证之属寒者，除流注外，发背脑疽最为重大。惟世传阳和汤一方与仲师当发其痈之旨最合，若误投寒凉败毒之品，十不活一。所以然者，为血络凝于寒湿，非疔毒流火之属于阳证者比也。附阳和汤方如下：麻黄三钱去根节炮姜三钱熟地黄一两鹿角胶三钱肉桂一钱（寒重加附子）
【按】友人周慕莲君患脑疽，初起，察其属阴性，法当与阳和汤，顾大便五日未行，疑其有热结，为之踌躇者再。谁知服汤后，次早项背转动便易，大便畅下，乃悟其大便之闭，亦属寒性故也。其外用膏药，为阳和膏。
又有友人周焕根君患脑疽，发于项后偏右，皮色不变而结块，脉微细，大便亦不行。采邻居之言，购番泻叶值铜元十枚服之，大下，而自止，疽反日剧。予仍以阳和汤投之，二日不应。易医，又投阳和汤加减，二日，又不应。易名医，投和荣通络轻剂，不更衣，则无暇问也。如是二日，疽依然，而大便之不行也如故。无已，予乃嘱用甘油锭以润之，因用之不得法，无效。次日详告以术，乃下燥矢四五颗，随以溏薄矢液，自是得安寐竟日。醒来知饥索粥，精神大振。便下皆溏者，湿既有去处，疽乃以渐告愈。事后，余乃悟此为先鞕后溏证，原不可攻，其所以有燥矢结于肠中者，必是番泻叶之流弊，盖大下亡阴，液去而矢在，故结而致燥也。病家之药误，医者可不留意哉？曹颖甫曰：阳和汤一方不惟脑疽发背为宜，即膝盖忽然酸疼，为鹤膝风初步，用之亦多效。若华母于去冬今春两次患此，临睡时服药，醒即不痛。施之骨槽风病，亦能一服定痛，真神方也。
汗后致虚
若华母案缺。
生半夏三钱炙草五钱当归三钱陈皮三钱白术三钱生黄耆三钱熟附块五钱党参四钱熟地二两干姜三钱川芎三钱炙乳没各三钱生米仁一两
【按】师母体素瘦削，而微有痰饮之疾。数日前，偶感风寒，恶寒，头痛，发热，师硫表剂予之，稍瘥而未了了。再予之，如是者屡。余曾检得其一方，为桂枝三钱，白芍三钱，生草二钱，浮萍三钱，姜三片，盖桂枝汤去大枣加浮萍也。
服后，汗出甚多，微恶寒，神疲心痛，叉手自冒，徐按稍瘥，筋肉不舒，有如针刺，皮肤干燥，血脉色转褐，心时悸，头时眩，坐立不稳，自觉摇摇然，脉细小而弱。师母固知医者，因谓师曰：我今虚，法当补。互商之下，乃得上方。师母且曰：倘熟附而不效者，我明日当易生附也。其时方暮，心痛甚剧，筋肉牵掣亦良苦。进初煎，旋得安睡。夜半醒来，痛随大减。次早进次煎，精神大振。皮色较润，而行动渐渐如常矣。
事后，余推测本案之病理药效，其有可得而言者，师母似系血液衰少，痰浊凝据之体，虽有表证，本不宜发汗过多。论曰：脉浮紧者，法当身疼痛，宜以汗解之。假令尺中迟者，不可发汗。何以知然，以荣气不足，血少故也。可以见之。况桂枝汤去大枣加浮萍，其发汗之力较桂枝原汤为尤猛。因大枣本为保存津液者，今反易以伤津液之浮萍故也。以不宜发汗之人，令大发其汗，自有变证。
大论曰：发汗过多，其人叉手自冒心，心下悸，欲得按者，桂枝甘草汤主之。
此盖为无痰饮者言之耳。又曰：太阳病，发汗，汗出不解，其人仍发热，心下悸，头眩，身瞤动，振振欲擗地者，真武汤主之。此盖为有痰饮者言之。又曰：发汗，病不解，反恶寒者，虚故也。芍药甘草附子汤主之。此盖为虚者言之。
今师母所服之方，虽非桂枝甘草汤，亦非真武汤，又非芍药甘草附子汤，然相去匪远，而周详或且过之，故能效也。由是观之，仲圣教人用麻桂以表邪，固又教人有不宜用麻桂之证，而又教人误用后补救之法。其意也苦，其法也备，观本案而益信。读《伤寒论》者，又安可执其一而舍其二哉？曹颖甫曰：虚人发汗，是谓重虚。重虚之人，必生里寒。血不养筋，故筋脉牵掣。血不充于脉道，故微细。不补气血则筋脉不调，不调水藏则表阳不达。又因其有水气也，加干姜半夏。因其体痛也，加乳香没药。因其心悸也，重用炙甘草。因其夹湿也，而加生苡仁。大要随证酌加，初无成方之可据。而初意却在并用术附，使水气得行于皮中。盖救逆之方治，原必视病体为进退也。
太阳转阳明其一
姚左发热，头痛，有汗，恶风，脉浮缓，名曰中风，桂枝汤加浮萍主之。
川桂枝三钱生白芍三钱生草钱半浮萍三钱生姜三片大枣三枚服药后进热粥一碗，汗出后，诸恙可愈。汗出热不除，服后方，热除不必服。
【按】上列二方乃师初诊时一次疏予者也。他医似无此例，然师则常为之。
师曰：我今日疏二方，病者明日可以省往返之劳，节诊金之费，不亦善哉？虽然，苟我师无先见之明，能预知明日之变证者，其亦安肯若是耶？浮萍为我师暑天常用之药，多加于桂枝汤中。师每赞其功。病者姚君持方去后，竟不敢服。质疑于恽铁樵先生之门人某君。某君曰：先解其表，后攻其里，是乃仲圣之大法也，安用疑为？卒从其言。服后汗出，果如方案所记，诸恙悉愈。不意半日许，复热，病者固不知此热却非彼热，姑壮胆服后方，竟便行而热除。三日，悉如常人。
余问曰：桂枝汤之后，有宜继以承气者，有无须继以承气者，其间岂无辨认之点耶？师曰：病者初诊，吾见其有作黄色而且厚，吾以是用承气也。余曰：诺，举一反三，又岂惟苔黄厚而已？则凡便之不畅或不行者，口渴者，阙上痛者，或素体热盛者，莫非皆承气之预见证乎？予自是亦能效吾师之法，一诊而疏二方矣。
以余临床实验所得，凡服桂枝汤后，桂枝证除而转为阳明轻证，又服承气而病愈不传者，甚多。状此事实，则一日太阳，二日阳明八字恰甚贴切。虽然，此仅就太阳病服药者言，若不服药，恐又非如是矣。余固不谓内经之一日至六日相传一说，尽合于事实者也。
曹颖甫曰：予治伤寒学，早于仲师大论中证明七日为一候，一候为一经，二候为再经，六经传遍当在四十二日。然亦有不作再经者，由其肠胃中本不燥实也。
若太阳之病初起，阳明先见燥实，则先解其表，后攻其里，即为正治。予昔治赵庭槐之妻常以一方笺书二方，治愈者不止一二次。又尝治缪桂堂亦用二方并书一笺，缪不识字，误以二方之药并煎，亦汗出便通而愈。
太阳转阳明其二
徐柏生初诊微觉恶寒，头痛，腰脚痠，左脉甚平，右脉独见浮缓，饮暖水，微有汗，而表热不去，此风邪留于肌腠也。宜桂枝汤加浮萍。
川桂枝三钱生白芍三钱生草一钱浮萍三钱生姜三片枣七枚二诊汗出身凉，大便不行，宜麻仁丸。
拙巢注：药后大便行，愈矣。
太阳转阳明其三
净麻黄三钱桂枝三钱生草一钱光杏仁三钱二诊汗出，热除，头痛恶寒止，惟大便三日不行，胸闷恶热，脉浮大，宜承气汤，所谓先解其表后攻其里也。
生川军三钱后入枳实四钱川朴二钱芒硝二钱冲拙巢注：服药后，下四次，病全愈。
太阳转阳明其四
王左初诊二十四年三月五日起病于浴后当风，恶寒而咳，一身尽痛，当背尤甚，脉弦，法当先解其表。得汗后，再行攻里。大便七日不行，从缓治。
生麻黄三钱川桂枝三钱光杏仁三钱北细辛二钱干姜三钱五味子二钱生甘草一钱制半夏三钱白前四钱
【按】本案病者王君平素有疾必就师诊，每诊一二次，疾必良已。者番又来，自谓病重甚，不知能如前速愈否？师笑谓无妨，汗出续诊一次可矣。君欣然告辞。
二诊三月六日发汗已，而大便未行，食入口甜，咽肿脘胀，右脉滑大，下之可愈。
【按】诊后病者问明日尚须覆诊否，察其神清，盖已非昨日病象矣。师笑曰，无须再劳驾矣，后如师言。
学者当知疾病之传变，绝无一定之成规。若我前所谓桂枝汤证一变而为白虎汤证，麻黄汤证一变而为麻杏甘石汤证，葛根汤证一变而为葛根芩连汤证，此皆言其至常者也。若以上太阳转阳明诸案，或由桂枝证传为承气证或麻子仁丸证，或由麻黄汤证或由小青龙汤证传为承气证，又皆不失其常者也。若其他种种传变，或由葛根汤证传为承气证，或由大青龙汤证传为承气证，又悉在可能之中，何必一一赘列？是故医者但求能辨证用方，初不必虑其病变多端，但求能大胆细心，初不必泥于温热伤寒也。
邪之着人，如饮酒然。凡人醉酒，脉必洪而数，气高身热，面目俱赤，乃其常也。及言其变，各有不同。有醉后妄言妄动，醒后全然不知者，有虽沈醉，而神思终不乱者，醉后应面赤而反刮白者，应委顿而反刚强者，应壮热而反恶寒战栗者，有易醉而易醒者，有难醉而难醒者，有发呼欠及喷嚏者，有头眩眼花及头痛者。因其气血虚实之不同，脏腑禀斌之各异，更兼过饮少饮之别。考其情状，各自不同。至论醉酒一也，及醒，一时诸态如失。此吴氏又可借饮酒以喻邪之传变无定者也。因其言通俗易晓，故借录之。
暑天阳明
病血热壮盛之人，遇天时酷蒸，往往以多汗而胃中化燥。始则大便不行，继则口燥饮冷。夏令伏阴之体，饮冷太暴，或且转为下利。究之利者自利，胃中燥实依然不去，故仍宜用大承气汤以下之。予子湘人辛未六月在红卍字会治一山东人，亲见之。一剂后，不再来诊，盖已瘥矣。壬申六月，复见此人来诊。诊其脉，洪大而滑疾，已疏大承气汤方治矣。其人曰，去岁之病承先生用大黄而愈，湘人告以亦用大黄，其人欣然持方去，不复来，盖又瘥矣。又江阴街烟纸店主严姓男子，每年七月上旬，大便闭而腹痛，予每用调胃承气汤，无不应手奏效。
【按】此又天时之关系于疾病者也，吾人但知其理足矣。至疏方用药，仍当一以脉证为依归，设在盛夏遇真寒之霍乱证，脉伏肢冷，吾知四逆又为必用之方矣。
曹颖甫曰：以上所列二证不过欲证明至其年月日时复发之理由，而病之变化，要必视其人之本体为断。其人血热过重，则易于化燥，水分过多，则易于化湿，燥热当泻，寒湿当温，诚当如佐景所云矣。
产后阳明病
In Volume 1, regarding the syndrome of Gegen Qinlian Decoction (Kudzu and Coptis Decoction), the Master adopted a "step back" strategy, while I adopted a "step forward" method. The two correspond remotely and complement each other perfectly. Students should know that the onset of a disease is often not fully curable by a single formula; when excess patterns are observed, advance treatment; when deficiency patterns are considered, retreat. When the condition is urgent, address the branch symptoms; when it is mild, preserve the root. Only when advancement and retreat are measured correctly, and root and branch are addressed without error, can the disease be rapidly resolved. Furthermore, beyond advancement and retreat, there are methods of indirect approach; between root and branch, there is the regulation of the reversal and compliance of Middle Qi. One corner reflects three; why wait for verbose explanations? Cao Yingfu said: Treating diseases without practical verification often leads to subjective speculation. Mencius said: To build high, one must start from hills; to dig deep, one must follow rivers and marshes. Now, Zuojing follows the disease conditions described by Master Zhongjing to seek their underlying causes. Thus, in prescribing based on manifestations, one can achieve ease and effectiveness at any time, not just for Ben Tun (a disease characterized by the sensation of Qi rushing upward from the lower abdomen). Additionally, note: Ben Tun was traditionally called Kidney Accumulation, but its actual treatment targets Liver pathology.
Chen Xiuyuan believed that Bentun Tang (Pulsatilla Decoction) soothes Liver Qi and expels pathogenic factors, while Huang Kunzai elucidated that Guizhi Tang (Cinnamon Twig Decoction) resolves Liver depression. According to the student's statement mentioned in the text, the theory of Liver Qi has its own merit. However, attributing Ben Tun syndrome to Liver pathology is acceptable; if one generally refers to Liver pathology without recognizing it as Ben Tun syndrome, that is incorrect.
Lijie (Joint Bi Syndrome)
Geng You, First Visit, August 27: Pain in all limbs and joints, foot pain, coldness in calves, fever in the afternoon (Shen-You hours), pulse deep and slippery. This is Lijie, suitable for Guizhi Shaoyao Zhimu Tang (Cinnamon Twig, Peony, and Anemarrhena Decoction). Luoli (Scrofula) should be treated gradually.
Chuan Guizhi (Cinnamomi Ramulus) 5 qian, Chi Shao (Red Peony Root) and Bai Shao (White Peony Root) 3 qian each, Sheng Gancao (Raw Licorice Root) 3 qian, Sheng Mahuang (Raw Ephedrae Herba) 3 qian, Shu Fukuai (Prepared Aconiti Lateralis Radix) 5 qian, Sheng Baizhu (Raw Atractylodis Macrocephalae Rhizoma) 5 qian, Fei Zhimu (Anemarrhenae Rhizoma) 5 qian, Qing Fangfeng (Saposhnikoviae Radix) 5 qian, Shengjiang (Fresh Ginger) 1 piece (beaten).
Second Visit, September 1: After taking Guizhi Shaoyao Zhimu Tang, lower back pain slightly decreased, afternoon fever was lower, but soreness and pain in hands and feet remained. Continue with the previous method.
Chuan Guizhi 5 qian, Chi Shao and Bai Shao 5 qian each, Sheng Gancao 3 qian, Jing Mahuang (Cleaned Ephedrae Herba) 4 qian, Cang Zhu (Atractylodis Rhizoma) and Bai Zhu 5 qian each, Fei Zhimu 5 qian, Qing Fangfeng 4 qian, Shengjiang 1 piece (beaten), Xian Fuzi (Salted Prepared Aconiti Lateralis Radix) 3 qian (raw, do not soak).
[Note] My Master once treated a woman surnamed Dai, who was eight months pregnant. She carried her sick husband in a cart, and the fetus was crushed by her husband's body, causing abdominal pain. A doctor administered medicine to induce abortion, resulting in the expulsion of putrefied dead fetus. The woman had a constitution of Blood deficiency. Since the dead fetus was expelled and she could not afford proper aftercare due to poverty, she developed Lijie. She suffered from spasms of hands and feet, severe joint pain, which was milder in the morning. After dragging on for two years, she sought the Master's diagnosis.
The Master prescribed a formula, but two doses were ineffective. In the second visit, another medicine was used, resulting in profuse sweating. After two doses, limbs and joints could flex and extend, and foot swelling subsided slightly. However, large blisters appeared on the hands, containing pus and fluid, threatening to ulcerate. Adopting the method of the late Ding Garen, the Master used Da Ji (Cirsii Japonici Herba) and Xiao Ji (Cirsii Herba) 5 qian each, Mudan Pi (Moutan Cortex) 1 liang, Digupi (Lycii Cortex) 4 qian to clear blood heat. After two doses, scabs formed; after four doses, scabs fell off. She returned to normal.
Thinking she was safe, she suddenly experienced unbearable vaginal itching, caused by residual damp-toxin flowing downward. The Master instructed her to fumigate and wash with decoction of Shechuangzi (Cnidii Fructus), which led to significant improvement. Soon after, while shopping in the market, she fainted. All other symptoms receded, revealing the true picture of Blood deficiency. The Master then used Shu Dihuang (Prepared Rehmanniae Radix) 1 liang, Lu Dangshen (Codonopsis Radix) 5 qian, Chuan Xiong (Ligustici Chuanxiong Rhizoma) and Danggui (Angelicae Sinensis Radix) 4 qian each, Longgu (Fossilia Ossis Mastodi) and Muli (Concha Ostreae) 1 liang each. After more than twenty doses, she was completely cured, and later gave birth to a child.
Cao Yingfu said: Joint pain is named Lijie. This syndrome originates from external wind-pathogen invasion, with incomplete sweating, leading to dampness accumulating in joints over time. Pulse slow and slippery indicates Cold-Damp. Mild cases use Guizhi Shaoyao Zhimu Tang; severe cases require Wutou Tang (Aconite Decoction). He once treated a young man surnamed Wu, using Jing Mahuang 3 qian, Sheng Baishao 3 qian, Sheng Huangqi (Raw Astragali Radix) 3 qian, Zhi Gancao (Honey-fried Licorice Root) 3 qian, Wutou (Aconiti Radix) 2 pieces sliced, boiled separately with honey until half remains. This largely follows the method in *Jin Gui Yao Lue*.
Faback and Brain Abscess
External cold-type lesions in the human body, aside from Liuzhu (flowing abscesses), include Faback (back carbuncle) and Naoju (brain/neck abscess), which are most serious. The world-transmitted Yanghe Tang (Yang-Nourishing Decoction) aligns best with Master Zhongjing's principle of "venting the carbuncle." If cold-cooling detoxifying drugs are mistakenly used, less than one in ten survives. This is because blood collaterals are congealed by Cold-Damp, unlike Dingdu (carbuncles) or Liuhuo (flowing fire) which belong to Yang syndromes. Yanghe Tang formula is attached below: Mahuang 3 qian (remove roots and nodes), Pao Jiang (Baked Ginger) 3 qian, Shu Dihuang 1 liang, Lujiao Jiao (Deer Antler Glue) 3 qian, Rougui (Cinnamon Bark) 1 qian (add Fuzi if Cold is severe).
[Note] Friend Mr. Zhou Mulin suffered from a brain abscess. Initially, observing it as Yin-type, the method dictated Yanghe Tang. However, his stool had not passed for five days, raising suspicion of Heat accumulation, causing hesitation. Who would have thought that after taking the decoction, his neck and back became easier to move the next morning, and stool passed freely? He realized the constipation was also due to Cold. The external plaster used was Yanghe Gao (Yanghe Plaster).
Another friend, Mr. Zhou Huangen, suffered from a brain abscess on the right posterior neck. Skin color unchanged, but a lump formed. Pulse was faint and thin, and stool did not pass. Following a neighbor's advice, he bought Fanxieye (Sennae Folium) for ten copper coins and took it. It caused severe diarrhea, then stopped, but the abscess worsened daily. I still administered Yanghe Tang, but no effect after two days. Another doctor tried modified Yanghe Tang, no effect after two days. A famous doctor prescribed a mild formula to harmonize nutrients and unblock collaterals. Since the patient did not defecate, I had no time to inquire further. Two days passed, the abscess remained, and constipation persisted. Finally, I advised using glycerin suppositories to moisten the intestines. Due to improper use, it was ineffective. The next day, I explained the correct method, and he passed four or five hard stools, followed by loose stools. He then slept peacefully all day. Waking up, he felt hungry and asked for porridge, with great revitalization of spirit. Since the stool was loose, dampness had an outlet, and the abscess gradually healed. Afterwards, I realized this was a case of initial hardness followed by looseness, originally unsuitable for purgation. The hard stool stuck in the intestines was likely due to the side effects of Fanxieye; severe purgation depleted Yin, leaving fluids gone but feces remaining, thus becoming dry and stuck. How can physicians neglect such medical errors by patients? Cao Yingfu said: Yanghe Tang is suitable not only for brain abscesses and back carbuncles but also for sudden knee soreness, which is the early stage of Hexikeng Feng (Crane-Knee Wind/Bilateral Knee Swelling). It is often effective. For example, Mother Hua suffered from this twice last winter and early spring. Taking medicine before sleep relieved pain upon waking. Applied to Gucaofeng (Bone Channel Wind/Mandibular Osteomyelitis), it also relieves pain with one dose. Truly a miraculous formula.
Deficiency Caused by Sweating
Case of Ruo Huamu missing.
Sheng Banxia (Raw Pinelliae Tuber) 3 qian, Zhi Cao 5 qian, Danggui 3 qian, Chenpi (Tangerine Peel) 3 qian, Baizhu 3 qian, Sheng Huangqi 3 qian, Shu Fukuai 5 qian, Dangshen 4 qian, Shu Dihuang 2 liang, Ganjiang (Dried Ginger) 3 qian, Chuan Xiong 3 qian, Zhi Ruxiang (Frankincense) and Moyao (Myrrh) 3 qian each, Sheng Yiren (Coix Seed) 1 liang.
[Note] The Master's wife was naturally slender and had slight Phlegm-Fluid retention. A few days ago, she accidentally contracted Wind-Cold, with aversion to cold, headache, and fever. The Master gave her exterior-releasing agents. She improved slightly but not completely. Repeated administration occurred several times. I found one formula: Guizhi 3 qian, Baishao 3 qian, Sheng Cao 2 qian, Fuping (Azolla Herba) 3 qian, Ginger 3 slices. This was essentially Guizhi Tang minus Dazao (Jujube) plus Fuping.
After taking it, she sweated profusely, with slight aversion to cold, mental fatigue, heart pain, crossing arms over the chest, pressing slowly brought slight relief, muscles uncomfortable with needle-like sensations, dry skin, brownish blood vessels, palpitations, dizziness, instability sitting or standing, feeling dizzy. Pulse was fine, small, and weak. Knowing medicine, she told the Master: "I am now deficient; the method requires tonification." After discussion, the above formula was obtained. She added: "If Shu Fuzi (Prepared Aconite) doesn't work, I will switch to Sheng Fuzi (Raw Aconite) tomorrow." It was evening, heart pain was severe, and muscle spasms were painful. After the first decoction, she slept peacefully. Waking at midnight, pain greatly reduced. Next morning, after the second decoction, spirit revived. Skin became moist, and movement gradually normalized.
Later, analyzing the pathology and efficacy: The Master's wife seemed to have low blood volume and phlegm-turbidity stagnation. Although having exterior symptoms, excessive sweating was inappropriate. The treatise states: With floating-tight pulse, body pain is expected, suitable for sweating. But if Chi pulse is slow, do not sweat. Why? Because Ying Qi is insufficient and Blood is scant. See? Moreover, Guizhi Tang minus Dazao plus Fuping has stronger diaphoretic power than original Guizhi Tang. Dazao preserves fluids; Fuping damages them. Giving excessive sweat to someone unsuited for it inevitably causes transformation of syndrome.
The Great Treatise says: Excessive sweating leads to crossing arms over the heart, palpitations, desire to press—treat with Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction). This applies to those without Phlegm-Fluid. It also says: Taiyang disease, sweating fails to resolve, fever persists, palpitations, dizziness, muscle twitching, trembling desire to fall—treat with Zhenwu Tang (True Warrior Decoction). This applies to those with Phlegm-Fluid. It also says: Sweating fails to resolve disease, aversion to cold returns—this is deficiency. Treat with Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction). This applies to deficiency.
The formula taken by the Master's wife was neither Guizhi Gancao Tang nor Zhenwu Tang nor Shaoyao Gancao Fuzi Tang, yet close, perhaps even more comprehensive, hence effective. Thus, Master Zhongjing teaches using Mahuang and Guizhi for exterior pathogens, but also teaches contraindications for these herbs, and rescue methods for misuse. His intent is earnest, methods complete. This case confirms it. Readers of *Shanghan Lun* cannot cling to one aspect while ignoring others. Cao Yingfu said: Sweating a deficient person is called "double deficiency." Double deficiency leads to interior Cold. Blood failing to nourish tendons causes spasms. Blood failing to fill vessels causes faint/small pulse. Without tonifying Qi and Blood, tendons/vessels remain disordered; without regulating Water organs, Exterior Yang cannot reach surface. Due to Water Qi, add Ganjiang and Banxia. Due to body pain, add Ruxiang and Moyao. Due to palpitations, heavily use Zhi Gancao. Due to dampness, add Sheng Yiren. Generally, add according to syndrome; initially no fixed formula exists. The original intent was using Baizhu and Fuzi together to move Water Qi in the skin. Rescue formulas must adjust based on the patient's condition.
Taiyang Transforming to Yangming I
Yao Zuo: Fever, headache, sweating, aversion to wind, floating-slow pulse. Named Fengzhong (Wind Strike). Treat with Guizhi Tang plus Fuping.
Chuan Guizhi 3 qian, Sheng Baishao 3 qian, Sheng Cao 1.5 qian, Fuping 3 qian, Shengjiang 3 slices, Dazao 3 pieces. Drink hot porridge after medication. After sweating, symptoms resolve. If heat persists after sweating, take the subsequent formula (Chengqi Tang); if heat clears, do not take it.
Sheng Chuanjun (Raw Rhubarb) 3 qian, Zhishi (Immature Bitter Orange) 3 qian, Houpo (Magnolia Bark) 1.5 qian, Mangxiao (Mirabilite) 2 qian (dissolve), Sheng Gancao 1.5 qian.
[Note] These two formulas were prescribed together during the first visit. Other doctors rarely do this, but the Master often does.
Master said: Prescribing two formulas today saves the patient往返 (round trips) tomorrow and reduces consultation fees, is it not good? Although, if I lacked foresight to predict tomorrow's changes, would I dare do this? Fuping is commonly used by my Master in summer, often added to Guizhi Tang. He praised its efficacy. Patient Mr. Yao left with the prescription but dared not take it. He questioned a disciple of Mr. Yun Tieqiao. The disciple said: Release the exterior first, then attack the interior; this is Master Zhongjing's major principle. Why doubt? He finally followed the advice. Sweating occurred, and as recorded, all symptoms resolved. Unexpectedly, half a day later, fever returned. The patient didn't realize this fever was different from the previous one. Bravely taking the second formula, stool passed, and heat cleared. Three days later, he was normal.
I asked: After Guizhi Tang, some need Chengqi Tang, others don't. Is there a distinguishing point? Master said: At first visit, I saw yellow and thick tongue coating, so I used Chengqi Tang. I said: Understand. Does "infer three from one" mean only yellow-thick coating? What about difficult/unformed stool, thirst, pain above the glabella, or constitutions prone to Heat? Are these not precursors for Chengqi Tang? From then on, I could emulate the Master, prescribing two formulas in one visit.
From my clinical experience, many cases where Guizhi syndrome clears after Guizhi Tang, transforming into mild Yangming syndrome, and resolving with Chengqi Tang without transmission, are common. Describing this fact, "Day 1 Taiyang, Day 2 Yangming" fits well. However, this is only for Taiyang patients taking medicine. Without medicine, it might differ. I do not believe the *Neijing* theory of transmission from Day 1 to Day 6 fully matches reality.
Cao Yingfu said: In studying Shanghan, I proved in Master Zhongjing's treatise that seven days is one period (Hou), one period equals one channel, two periods equal re-transmission. Six channels complete in forty-two days. However, some do not re-transmit because their intestines/stomach are not dry/excess.
If Taiyang disease begins with Yangming dry/excess appearing first, releasing exterior then attacking interior is correct treatment. I once treated Mrs. Zhao Tinghuai, often writing two formulas on one paper, curing her more than once or twice. I also treated Miao Guantang, writing two formulas on one paper. Miao was illiterate and mistakenly boiled both formulas together. He sweated, stool passed, and recovered.
Taiyang Transforming to Yangming II
Xu Baisheng, First Visit: Slight aversion to cold, headache, sore waist/legs. Left pulse very level; right pulse uniquely floating-slow. Drinking warm water, slight sweating, but exterior heat persists. Wind-pathogen lingering in muscle interstices. Suitable for Guizhi Tang plus Fuping.
Chuan Guizhi 3 qian, Sheng Baishao 3 qian, Sheng Gancao 1 qian, Fuping 3 qian, Shengjiang 3 slices, Zao (Jujube) 7 pieces.
Second Visit: Sweating occurred, body cooled, but stool did not pass. Suitable for Mahuang Ren Wan (Ephedra and Hemp Seed Pill).
Pi Yue Mahuang Ren Wan 3 qian, Mangxiao (Mirabilite) dissolved in water to swallow.
Zhuochao Note: Stool passed after medication, cured.
Taiyang Transforming to Yangming III
Yu Zhesheng, First Visit: Slight aversion to cold, headache, fever, floating-small-tight pulse. Suitable for Mahuang Tang (Ephedra Decoction).
Jing Mahuang 3 qian, Guizhi 3 qian, Sheng Gancao 1 qian, Guang Xingren (Apricot Seed) 3 qian.
Second Visit: Sweating occurred, heat cleared, headache and aversion to cold stopped. Only stool has not passed for three days, chest tightness, aversion to heat, floating-large pulse. Suitable for Chengqi Tang, meaning "release exterior first, then attack interior."
Sheng Chuanjun 3 qian (add later), Zhishi 4 qian, Chuan Pu 2 qian, Mangxiao 2 qian (dissolve).
Zhuochao Note: Four bowel movements after medication, completely cured.
Taiyang Transforming to Yangming IV
Wang Zuo, First Visit: Illness started March 5, Year 24, after bathing and exposure to wind. Aversion to cold with cough, whole body pain, especially back. Pulse wiry. Method: Release exterior first. After sweating, then attack interior. Stool not passed for seven days, treat gradually.
Sheng Mahuang 3 qian, Chuan Guizhi 3 qian, Guang Xingren 3 qian, Bei Xixin (Asari Radix et Rhizoma) 2 qian, Ganjiang 3 qian, Wuweizi (Schisandra Fruit) 2 qian, Sheng Gancao 1 qian, Zhi Banxia 3 qian, Baiqian (Polygalae Radix) 4 qian.
[Note] Patient Mr. Wang usually seeks the Master's diagnosis for illnesses, typically recovering after one or two visits. This time he claimed severe illness, wondering if recovery would be as fast. Master smiled, saying no harm, just one more visit after sweating. Mr. Wang left happily.
Second Visit, March 6: Sweating completed, but stool not passed. Sweet taste in mouth upon eating, swollen throat, distended epigastrium. Right pulse slippery-large. Purging will cure.
Sheng Chuanjun 3 qian, Zhishi 4 qian, Houpo 1 qian, Mangxiao 3 qian (dissolve).
[Note] After diagnosis, patient asked if a follow-up was needed tomorrow. Observing his clear spirit, he was no longer exhibiting yesterday's symptoms. Master smiled, saying no need for further trouble, as later confirmed.
Students should know disease transmission has no fixed rules. As mentioned, Guizhi syndrome transforming into Baihu Tang syndrome, Mahuang Tang transforming into MaXing Gan Shi Tang syndrome, Gegen Tang transforming into Gegen Qinlian Tang syndrome—these are common examples. Regarding the Taiyang-to-Yangming cases above, whether Guizhi syndrome transmits to Chengqi or Mazirenwan syndrome, or Mahuang/Xiao Qinglong Tang syndrome transmits to Chengqi syndrome, these are also standard. Other transmissions, such as Gegen Tang or Da Qing Long Tang transmitting to Chengqi, are also possible. Why list them all? Physicians should focus on pattern differentiation and formula selection, not worry about varied changes, and be bold yet careful, not rigidly adhering to Warm Disease or Cold Damage categories.
Pathogens attaching to humans are like drinking alcohol. Drunk people have surging-rapid pulses, high breath, body heat, red face and eyes—this is normal. Variations differ. Some talk/move wildly while drunk, forgetting entirely upon waking; some remain mentally clear despite deep intoxication; some should have red faces but turn pale; some should be lethargic but become stiff; some should have high fever but shiver with aversion to cold; some get drunk easily and wake easily; some get drunk hard and wake hard; some yawn/sneeze; some have dizziness/blurred vision/headache. Due to differences in Qi/Blood deficiency/excess and organ constitution, plus varying amounts of alcohol, situations differ. Yet, regarding drunkenness itself, upon waking, all states vanish. Wu又可 (Wu Jutong) used drinking to metaphorize unpredictable pathogen transmission. His words are easy to understand, so quoted here.
Summer Yangming
People with vigorous Blood Heat, encountering hot weather, often develop stomach dryness due to excessive sweating. Initially, constipation; subsequently, dry mouth craving cold drinks. Those with latent Yin constitution in summer, drinking cold water too aggressively, may transform into diarrhea. Ultimately, diarrhea occurs, but stomach dryness/excess remains, so Dachengqi Tang (Major Order the Qi Decoction) is still suitable for purging. My son Xiangren witnessed this in June of Xinwei year at the Red Cross Society treating a Shandong man. One dose, no return visit, cured. In June of Ren Shen year, the same man visited. Pulse surging-large-slippery-rapid. Prescribed Dachengqi Tang. He said last year cured by Master's Rhubarb. Xiangren told him Rhubarb would be used again. Man happily left, cured again. Also, Mr. Yan, owner of a tobacco/paper shop in Jiangyin Street, suffers annual constipation and abdominal pain in early July. Using Weichengqi Tang (Minor Order the Qi Decoction) always works instantly.
[Note] This shows the relationship between climate and disease. We need only understand the principle. Prescribing must still rely on pulse and symptoms. If encountering true Cold Huoluan (Cholera) in midsummer with hidden pulse and cold limbs, Sini Tang (Reverse-Return Decoction) is mandatory.
Cao Yingfu said: The two cases listed above aim to prove the reason for recurrence at specific dates/times. Disease changes depend on the individual's constitution. Excessive Blood Heat leads to dryness; excessive moisture leads to dampness. Dry-Heat requires purging; Cold-Damp requires warming. Indeed, as Zuojing stated.
Postpartum Yangming Disease