因知甘草安肠一说，不为无见。盖疾病由上传下，由表入里，由寒化热，既为必然之趋势，今安和其肠，即所以保其在里在下之津者，自为着要之法矣。至于大小二承气汤证因病已传肠，邪已内实，故不必用甘草。及其邪去肠虚，又当重用甘草以益之，不待再计者也。学者当知此九方者处同等重要之地位，各有专功，不容漠视。集此九方，即成《防寒论》中太阳阳明二经之骨干。识此九方，即能治伤寒，亦能治温病。学者将疑吾言之夸乎？吾敢实陈读者。
尤氏在泾曰：无汗必发其汗，麻黄汤所以去表实，而发邪气。有汗不可更发汗。桂枝汤所以助表气，而逐邪气。学者但当分病证之有汗无汗，以严麻黄桂枝之辨，不必执营卫之孰虚孰实，以证中风伤寒之殊。是无汗为表实，反云卫虚，麻黄之去实，宁独遗卫？能不胶于俗说者，斯为豪杰之士！柯氏韵伯曰：桂枝汤证唯以脉弱自汗为主耳。粗工妄谓桂枝汤专治中风，印定后人耳目，而所称中风者又与此方不合，故置之不用。愚常以此汤治自汗盗汗虚疟虚痢，随手而愈。
又曰：予治冷风吹与风寒湿三气合成痹等证，用麻黄汤辄效，非伤寒证可拘也。
其言何等精辟，然则尤氏柯氏皆能识麻桂二汤者也。陆氏九芝曰：葛根芩连一方独见遗于阳明者，以人必见下利始用之，不下利即不用，而不以为是阳明主方也。孰知此方之所用者宏，而所包者广也。然则陆氏能识葛根芩连汤者也。又曰：无人知温热之病，本隶于伤寒论中，而温热之方，并不在伤寒论外。然则陆氏又能看破伤寒温病之画地为牢者也。
吴氏又可曰：应下之证，见下无结粪，以为下之早，或以为不应下之证，误投下药。殊不知承气本为逐邪而设，非专为结粪而设也。必侯其粪结，血液为热所搏，变证迭起，是犹养虎遗患，医之咎也。况多有溏粪失下，但蒸作极臭，如败酱，或如藕泥，临死不结者。但得秽恶一去，邪毒从此而消，脉证从此而退，岂徒孜孜粪结而后行哉？此言超拔非凡，然则吴氏能识诸承气汤者也。叶氏天士曰：温邪上受，首先犯肺。吴氏鞠通曰：凡病温者，始于上焦，在手太阴。
法曰辛凉轻平，方号桑菊银翘。虽无麻杏甘石之名，而有泛治肺热之实。苟吾人不求酷论，谓叶氏吴氏能识麻杏甘石汤可也。而吴氏之用白虎，或以化斑，或以解暑，颇具变化之观。苟吾人不吝誉语，可称之曰微有仲圣用桂枝之风，然则吴氏亦能识白虎汤者也。由是言之，诸氏皆仲圣之功臣也。
中卷
桂枝二麻黄一汤证其一
王右六月二十二日寒热往来，一日两度发，仲景所谓宜桂枝二麻黄一汤之证也。前医用小柴胡，原自不谬，但差一间耳！川桂技五钱白芍四钱生草三钱生麻黄二钱光杏仁五钱生姜三片红枣五枚
【按】病者服此，盖被自卧，须臾发热，遍身漐漐汗出，其病愈矣。又服药时，最好在寒热发作前约一二小时许，其效为著。依仲圣法，凡发热恶寒自一日再发（指发热二次，非谓合发热恶寒为二次）以至十数度发，皆为太阳病。若一日一发，以至三数日一发，皆为少阳病。少阳病多先寒而后热，太阳如疟证却有先热而后寒者，观大论称少阳曰寒热往来，称太阳如疟曰发热恶寒，热多寒少，不无微意于其间欤。以言治法，少阳病宜柴胡剂，太阳病宜麻桂剂，证之实验，历历不爽。若反其道以行之，以柴胡剂治寒热日数度发之太阳如疟，每每不效，以麻桂剂治寒热一作之少阳病，虽偶或得效，究未能恰中规矩。
《方极》云：桂枝二麻黄一汤治桂枝汤证多，麻黄汤证少。桂枝麻黄各半汤治桂枝汤麻黄汤二方证相半者。此言似是而非，将令人有无从衡量之苦。余则凭证用方，凡发热恶寒同时皆作，有汗者用桂枝汤，无汗者用麻黄汤，发热恶寒次第间作，自再发以至十数度发者，择用桂二麻一等三方，层次厘然，绝无混淆。
曹颖甫曰：少阳病之所以异于太阳者，以其有间也。若日再发或二三度发，则为无间矣。太阳所以异于阳明者，以其有寒也，若但热不寒，直谓之阳明可矣，恶得谓之太阳病乎？固知有寒有热，一日之中循环不已者为太阳病，寒热日发，有间隙如无病之人者为少阳病，此麻桂二汤合用与柴胡汤独用之别也。病理既明，随证用药可矣。
桂枝二麻黄一汤证其二（附列门人治验）
施右住唐家湾肇周路仁德里二号
【按】本年七月十五日，予施诊于广益中医院，有施姓妇者蹙頞告诉曰：先生，我昨服院外他医之方，病转剧，苦不堪言。余为之愕然，令陈其方，照录如下：经事淋漓，入夜寒热，胸闷泛恶，苔灰腻，治宜荆芩四物汤加味。
炒荆芥钱半炒条芩钱半全当归二钱大川芎八分炒丹皮钱半赤白芍各钱半金铃子二钱制香附钱半元胡索钱半贯仲炭三钱荷叶一角余曰：方未误，安得转剧？妇曰：否，初我夜寐粗安，大便如常，自进昨药，夜中心痛甚剧，辗转不能成寐，且大便转为泄泻，乞先生一治之。予按例首问其病历，妇曰：半月矣。次问其寒热，妇曰：倏冷倏热，不计其次。余闻其言，若有所得焉。妇自陈其异状，汗出自首至胸而止，既不达于胸下，亦不及于两臂。予思论有剂颈而还之语，此殆剂胸而还乎？察其舌，黑近墨而不焦，口奇干。
余疑其方进陈皮梅、松花蛋之属。妇曰：非是，日来苔黑，常作此状。按其脉，幸尚不微细。两肩至臂颇麻木。加以经事淋漓不止，妇几不能悉陈其状。予对此错杂之证，亦几有无从下笔之苦。使从所谓对症治法，琐琐而治之，则用药得毋近数十味？然而此非我所能也，因书方曰：初诊七月十五日寒热往来，每日七八度发，已两候矣。汗出，剂胸而还，经事淋漓，法当解表为先，以其心痛，加生地，倍甘草。
净麻黄一钱川桂枝二钱生甘草三钱生苡仁一两杏仁三钱生白芍钱半生地五钱制川朴一钱生姜二片红枣六枚二诊七月十六日昨进药后，汗出，遍身漐漐，心痛止，经事停，大便溏薄瘥，麻木减，仅自臂及指矣。黑苔渐退，口干渐和，夜中咳嗽得痰，并得矢气，是佳象。前方有效，不必更张。
净麻黄一钱川桂枝钱半生甘草二钱生白芍钱半大生地五钱制小朴一钱杏仁三钱生姜二片红枣六枚
【按】子遵仲圣脉证治法，而疏昨方，心未尝不惴惴也！以为次日彼诊，能得寒热略除，即是大功，乃喜出望外，非但热退神振，抑且诸恙并差，有如方案所云，斯亦奇矣！试求其所以能愈病之理，以证状学之立场言之，必曰能治其主证，斯一切客证或副证不治自愈也。此言不误，然而无补于病理之了解。幸有博雅君子，阅吾此案，赐予说明其中一切病理。如苔黑口干，何以反立麻桂？发汗伤津，何以反除心痛？经水淋漓，大便溏泄，犹风马牛之不相及，何以戛然并止？所深愿也。
曹颖甫曰：太阳水气留于心下，则津不上承而渴，此意丁甘仁先生常言之。舌黑不焦，大便又溏，知非阳明热证，而黑色亦为水气，水气凌心，心阳不振，故痛。大便溏，则为条芩之误，不用条芩，溏薄自止，非本方之功也。水气不能化汗外泄，故脾阳不振，而指臂麻。经水淋漓，亦水分多于血分，为水气所压故也。知病之所从来，即知病之所由去，不待烦言矣。
三诊七月十七日寒热如疟渐除，大便已行，舌苔黑色亦淡，麻木仅在手指间。惟余咳嗽未楚，胸胁牵痛，有喘意，参桂枝加厚朴杏子法。
杏仁四钱厚朴钱半川桂枝二钱生草三钱白芍二钱大生地六钱丝瓜络四钱生姜一片红枣六枚
【按】服此大佳，轻剂调理而安。
顾左住方斜路十月二十一寒热交作，一日十数度发，此非疟疾，乃太阳病，宜桂枝麻黄各半汤。
【按】桂枝麻黄各半汤方，原法分为三服，桂枝二麻黄一汤方，原法分为再服。取前方原量三之一，后方原量二之一而较之，得麻杏同量，而后方之桂芍姜草枣悉比前方约多一倍，故前方名各半，而后方名桂二麻一也。然而近代煎服法，率分二次煎服，与古者不同，况其分量上下，又甚微细，故吾人但知此二方之应用足矣，初不必过分斤斤于铢两之间也。
曹颖甫曰：此证甚轻，故轻剂而病易愈，不徒与铢两不合已也。
庆孙七月二十七日起病由于暴感风寒，大便不行，头顶痛，此为太阳阳明同病。自服救命丹，大便行，而头痛稍愈。今表证未尽，里证亦未尽，脉浮缓，身常有汗，宜桂枝加大黄汤。
【按】治病当先解其表，后攻其里，此常法也，前固言之稔矣。余依临床所得，常有表解之后，其里自通，初不须假药力之助者。缘先表束之时，病者元气只顾应付表证，不暇及里，及表解之后，则元气自能反旌对里。夫元气之进退往返，谁能目之者，然而事实如此，勿可诬也。故余逢表束里张之证，若便闭未越三日者，恒置通里于不问，非不问也，将待其自得耳。
若本汤之合解表通里药为一方者，又是一法。然其间解表者占七分，通里者占三分，不无宾主之分。以其已用里药，故通里为宾，以其未用表药，故解表为主，双管齐下，病去而元气乃无忧。
余二十五岁时，能读医书，而尚不善于治病。随表兄陈尚白买舟赴南京，应秋试。陈夫妇同宿中舱，余宿前舱。天方褥暑，骄阳如炽。
舟泊无锡，陈夫妇相偕登陆，赴浴惠泉，嘱余守舱中。余汗出侠背，又不便易衣，令其自干。饮食起居又不适，因是心恒悒悒然。舟泊五日，方启锭。又五日，乃抵镇江。下榻后，部署初定，即卧病矣。延医疏方，不外鲜藿香、鲜佩兰之属。服之数日，病反加剧。汗出，热不清，而恶寒无已。当夜乘轮赴京。时觉天昏地黑，不知人事。比抵石城，诸友扶住堂子巷寓所。每小便，辄血出，作殷红色，且觉头痛。
时为八月初五日，距进场之期仅三天矣。是时，姻丈陈葆厚先生已先余到南京。丈精于医，诊脉一过，即亲出市药，及荷叶露三大瓶，生梨十余枚以归。并属先饮露，饮已，口即不干。顷之又渴，复啖生梨，梨皮不遑削，仅弃其心，顷刻尽十枚。迨药煎成，即进一大碗，心中顿觉清朗，倦极而睡。醒后，头已不痛，惟汗未出。更进二煎，浓倍于前。服后，又睡。醒时，不觉周身汗出，先小汗，后大汗，竟至内衣夹袄被褥上下皆湿，急起更易，反被以盖。于是方觉诸恙悉除，腹中知饥，索热粥。侍者曰：粥已备，盖陈丈所预嘱者也。初吸一小碗，觉香甜逾恒。稍停，又续进，竟其夜，竟尽二大碗。初七日，即能进场。试期达九日夜，毫无倦容。余乃惊陈丈医术之神。叩其药，则桂枝石膏二味同捣也。问其价，曰：适逢新开药铺，共费钱六文而已。遂相与大笑。
【按】头痛而恶寒，此太阳病未罢也，法当令其汗出而解。然小便已见血出，安复有余液可以作汗？故先饮荷叶露及生梨者，增其液以为作汗之张本也。于是与石膏以清其内蕴之热，与桂枝以祛其外束之寒。寒因汗解，热因凉除。醒来索粥，是即白虎汤之粳米，向之饮露，亦犹加参汤之人参。看其啖梨啜露之顷，孰知已含圣法。呜呼，化冲圣方活而用之，其功效必无穷也。
【又按】白虎加挂枝汤证多见于夏日，诚以炎暑蒸人，胃肠本已热化，入夜凉风习习，未免贪享，故致表里交病。表为寒束，则热无外泄之机，势必愈炽。
热既内炽，则更易伤津，使无从作汗以解表。惟有投白虎汤以治其本（肠胃之热），同时加桂枝以治其标（表证之寒），标本并治，方可热除津复，汗出表解。依余经验，桂枝轻至一钱，生石膏轻至三钱，亦可有效。设不尔者，但用白虎以清热，则表证将愈甚，但用桂枝以解表，则内热将愈炽，终不免坏病之变，此乃桂枝石膏二药必须合作而不可分离之理也。或曰：君前谓石膏凉胃，桂枝温胃，何能温凉并进，反获奇功耶？曰：仲圣方温凉并用者，诸泻心汤即在其例，若桂枝与石膏犹其始焉者尔。盖人体之机构复杂繁沓，灵敏万分，及其病时，作用尤显。各部机构每自能吸取其所需，而放任其所不需者。若论本汤证，则胃取石膏之凉而消热，动脉取桂枝之散而致汗，故二者非但不相左，抑且相成。
前桂枝加大黄汤为七分太阳，三分阳明。今白虎加桂枝汤为七分阳明，三分太阳。二汤之对仗，堪称工整。医者能合用仲圣诸方，即可曲应万变之病，兹二汤特发其凡耳。
麻黄附子甘草汤证（附列门人治验）
余尝治上海电报局高君之公子，年五龄，身无热，亦不恶寒，二便如常，但欲寐，强呼之醒，与之食，食已，又呼呼睡去。按其脉，微细无力。余曰：此仲景先圣所谓少阴之为病，脉微细，但欲寐也。
顾余知治之之方，尚不敢必治之之验，请另乞诊于高明。高君自明西医理，能注射强心针，顾又知强心针仅能取效于一时，非根本之图，强请立方。余不获已，书：熟附片八分净麻黄一钱炙甘草一钱与之，又恐其食而不化，略加六神曲、炒麦芽等消食健脾之品。
Therefore, it can be known that the theory of Licorice Root (Gancao) soothing the intestines is not without merit. Since diseases often transmit from the upper jiao to the lower jiao, from the exterior to the interior, and transform from cold syndromes to heat syndromes—this being an inevitable trend—soothing the intestines now is precisely a way to protect the body fluids in the interior and lower parts; thus, it is naturally an important treatment method. Regarding the indications for Da Chengqi Tang (Major Order the Qi Decoction) and Xiao Chengqi Tang (Minor Order the Qi Decoction), because the pathogenic factor has already transmitted to the intestines and become internally solidified, there is no need to use Licorice Root. Once the pathogen is eliminated and the intestines are deficient, one should heavily reuse Licorice Root to tonify them, which goes without saying. Scholars should know that these nine formulas hold equally important positions, each with specific functions, and cannot be ignored. Collecting these nine formulas constitutes the backbone of the Taiyang (Greater Yang) and Yangming (Yang Brightness) meridians in "Fanghan Lun" (Treatise on Preventing Cold). Mastering these nine formulas enables one to treat both Shanghan (Cold Damage) and Wenbing (Warm Diseases). Scholars may suspect my words are exaggerated? I dare to state this truthfully to the readers.
You Zaijing said: For cases without sweating, diaphoresis must be induced; Mahuang Tang (Ephedra Decoction) is used to resolve exterior excess and disperse pathogenic factors. For cases with sweating, further diaphoresis is contraindicated. Guizhi Tang (Cinnamon Twig Decoction) is used to assist exterior qi and expel pathogenic factors. Scholars should only distinguish between the use of Mahuang Tang and Guizhi Tang based on whether the syndrome presents with sweating or not, and need not adhere to the debate on whether Ying (Nutritive) and Wei (Defensive) qi are deficient or excess to differentiate between Zhongfeng (Wind Strike) and Shanghan. If one argues that lack of sweating indicates exterior excess but claims Wei qi deficiency, then when Mahuang Tang removes excess, does it uniquely neglect Wei qi? Those who do not stick to vulgar theories are truly heroic scholars! Ke Yunbo said: The main indications for Guizhi Tang are weak pulse and spontaneous sweating. Crude practitioners wrongly claim that Guizhi Tang specifically treats Zhongfeng, misleading later generations' perceptions, and the so-called Zhongfeng they describe does not match this formula's indications, so they discard its use. I often use this formula to treat spontaneous sweating, night sweats, deficiency-type malaria, and deficiency-type dysentery, achieving immediate cures.
He also said: When I treat conditions caused by cold wind blowing or the combination of cold, wind, and dampness pathogens forming Bi (Obstruction) syndromes, using Mahuang Tang often yields effective results; this is not restricted to Shanghan syndromes.
His words are profoundly insightful. Thus, both You and Ke could recognize Mahuang Tang and Guizhi Tang. Lu Jiuzhi said: Gegen Qinlian Tang (Kudzu, Scutellaria, and Coptis Decoction) is uniquely omitted from the discussion of Yangming syndromes because people only use it when diarrhea is present; if there is no diarrhea, they do not use it, and do not consider it the principal formula for Yangming. Who knows that the scope of application for this formula is broad and comprehensive? Thus, Lu could recognize Gegen Qinlian Tang. He also said: No one realizes that warm-heat diseases originally belong within the context of Shanghan Lun, and the formulas for warm-heat diseases are not outside Shanghan Lun. Thus, Lu could also see through the artificial boundaries drawn between Shanghan and Wenbing.
Wu Keyi said: For syndromes requiring purgation, if purgation is administered but no dry feces are expelled, it is considered that purgation was done too early, or it is deemed that the syndrome did not require purgation and the medicine was mistakenly administered. Little do they know that Chengqi formulas were established to expel pathogens, not specifically for dry feces. One must wait until the feces are hardened, blood is constrained by heat, and various complicated syndromes arise; this is like raising a tiger and leaving trouble behind—it is the physician's fault. Moreover, there are many cases where loose stools persist due to failure to purge in time; the stool steams with an extremely foul odor, resembling fermented bean curd dregs or lotus root paste, and will not harden even at death. As long as the foul matter is expelled, the pathogenic toxin dissipates, and the pulse and symptoms recede. Why merely strive for hardened feces before acting? This statement is extraordinary and profound. Thus, Wu could recognize the various Chengqi formulas. Ye Tianshi said: Warm pathogens enter from above and first attack the Lung. Wu Jutong said: All warm diseases begin in the upper jiao, affecting the Hand-Taiyin Lung meridian.
The treatment method advocates pungent-cool and light-neutral approaches, with formulas named Sangju Yin (Mulberry Leaf and Chrysanthemum Drink) and Yinqiao San (Honeysuckle and Forsythia Powder). Although they lack the name of Maxing Gan Shi Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction), they possess the practical effect of broadly treating Lung heat. If we do not demand harsh criticism, we can say that Ye and Wu could recognize Maxing Gan Shi Tang. Wu's use of Baihu Tang (White Tiger Decoction), sometimes for resolving macules and sometimes for clearing summerheat, shows considerable flexibility. If we do not spare praise, we can say he slightly resembles Zhongjing's style in using Guizhi Tang. Thus, Wu could also recognize Baihu Tang. From this perspective, all these physicians are meritorious contributors to Zhongjing.
Volume 2
Indication for Guizhi Er Mahuang Yi Tang (Two Parts Cinnamon Twig and One Part Ephedra Decoction) - Case 1
Patient Wang, June 22nd: Alternating chills and fever, occurring twice a day. This is the indication described by Zhang Zhongjing for Guizhi Er Mahuang Yi Tang. The previous physician used Xiaochaihu Tang (Minor Bupleurum Decoction), which was originally not wrong, but missed by a small margin! Sichuan Guizhi (Cinnamon Twig) 5 qian, Baishao (White Peony Root) 4 qian, Sheng Gancao (Raw Licorice Root) 3 qian, Sheng Mahuang (Raw Ephedra) 2 qian, Guang Xingren (Apricot Kernel) 5 qian, Shengjiang (Fresh Ginger) 3 slices, Hongzao (Red Date) 5 pieces.
[Commentary] After taking this prescription, the patient likely lay covered with a blanket. Soon after, fever arose, followed by slight sweating over the entire body, and the illness resolved. Additionally, the best time to take the medicine is approximately one to two hours before the onset of chills and fever, yielding better efficacy. According to Zhongsheng's method, whenever fever and aversion to cold occur twice a day (referring to two episodes of fever, not counting fever and aversion to cold together as two) up to ten or more times a day, it belongs to Taiyang disease. If it occurs once a day, or every few days, it belongs to Shaoyang disease. Shaoyang disease usually presents with chills first and then fever; Taiyang disease resembling malaria often presents with fever first and then chills. Observing that Shanghan Lun refers to Shaoyang as "alternating chills and fever" and Taiyang resembling malaria as "fever and aversion to cold, with more heat than cold," there seems to be subtle intent here. In terms of treatment methods, Shaoyang disease is suitable for Chaihu agents, while Taiyang disease is suitable for Mahuang-Guizhi agents. Clinical verification confirms this without fail. Conversely, using Chaihu agents to treat Taiyang-like malaria with multiple daily episodes of chills and fever is often ineffective; using Mahuang-Guizhi agents to treat Shaoyang disease with single episodes of chills and fever may occasionally work but ultimately fails to strictly conform to principles.
"Fangji" states: Guizhi Er Mahuang Yi Tang treats cases where Guizhi Tang indications predominate and Mahuang Tang indications are minor. Guizhi Mahuang Gehan Tang (Cinnamon Twig and Ephedra Half-Half Decoction) treats cases where Guizhi Tang and Mahuang Tang indications are equal. This statement is plausible yet incorrect, causing difficulty in measurement. I select formulas based on symptoms: whenever fever and aversion to cold occur simultaneously, use Guizhi Tang if there is sweating, and Mahuang Tang if there is no sweating; when fever and aversion to cold occur alternately, from twice to ten-plus times a day, choose among Guizhi Er Mahuang Yi and other three formulas. The hierarchy is clear, with absolutely no confusion.
Cao Yingfu said: The difference between Shaoyang disease and Taiyang disease lies in the presence of intervals. If it occurs twice a day or two to three times, there is no interval. The difference between Taiyang disease and Yangming disease lies in the presence of aversion to cold; if there is only heat without aversion to cold, it should directly be called Yangming disease, how can it be called Taiyang disease? Therefore, knowing that alternating chills and heat circulating throughout the day characterizes Taiyang disease, while chills and heat occurring daily with intervals like a healthy person characterizes Shaoyang disease, explains the difference between combining Mahuang and Guizhi tangs versus using Chaihu tang alone. Once the pathology is clear, medication can be prescribed according to the syndrome.
Indication for Guizhi Er Mahuang Yi Tang - Case 2 (Including Student's Treatment Record)
Patient Shi, residing at No. 2, Rende Li, Zhaozhou Road, Tangjiawan.
[Commentary] On July 15th of this year, I treated Patient Shi at Guangyi Traditional Chinese Medicine Hospital. A Mrs. Shi approached me with a furrowed brow, stating: "Sir, yesterday I took a prescription from another doctor outside the hospital, and my condition worsened; I am suffering unbearably." I was startled, asked to see the prescription, and recorded it as follows: Chao Jingjie (Stir-fried Schizonepeta) 1.5 qian, Chao Tianxin (Stir-fried Scutellaria) 1.5 qian, Quan Danggui (Whole Angelica Sinensis) 2 qian, Da Chuanxiong (Large Ligusticum) 0.8 qian, Chao Danpi (Stir-fried Moutan Cortex) 1.5 qian, Chi Baishao (Red and White Peony Roots) 1.5 qian each, Jinlingzi (Violet Fruit) 2 qian, Zhi Xiangfu (Processed Cyperus) 1.5 qian, Yuanhusuo (Corydalis Rhizome) 1.5 qian, Guanzhong Tan (Charred Osmunda) 3 qian, Heye (Lotus Leaf) 1 corner.
I said: The prescription is not erroneous; how could it worsen? The woman replied: "No, initially my sleep at night was relatively peaceful, and my bowel movements were normal. Since taking yesterday's medicine, I have suffered severe heart pain at night, tossing and turning unable to sleep, and my bowels have turned loose. Please treat me." Following protocol, I first asked about her medical history. She said: "Half a month." Then I asked about chills and fever. She said: "Sudden cold and sudden heat, regardless of frequency." Hearing this, I felt as though I had gained insight. She described her abnormal symptoms: sweating stops from the head to the chest, neither reaching below the chest nor extending to the arms. I recalled the phrase "stopping at the neck" in the Treatise, and wondered if this was "stopping at the chest"? Examining her tongue, it was black near ink color but not scorched; her mouth was strangely dry.
I suspected she had consumed Chenpi Mei (Preserved Plum with Tangerine Peel) or Songhua Dan (Century Egg). She said: "No, for these past days, my tongue coating has been black, always looking like this." Palpating her pulse, fortunately, it was not faint and thin. Her shoulders to arms were quite numb. Added to the continuous dripping menstruation, she could hardly fully describe her condition. Facing this complex syndrome, I also felt almost helpless in prescribing. If I treated symptom by symptom trivially, would the prescription approach dozens of herbs? However, this is not what I do. So I wrote the prescription: First Visit, July 15th. Alternating chills and fever, occurring 7-8 times daily, lasting two weeks. Sweating stopping at the chest, continuous dripping menstruation. The treatment principle should prioritize releasing the exterior. Due to heart pain, add Shengdi (Rehmannia Root) and double the Gancao (Licorice Root).
Jing Mahuang (Purified Ephedra) 1 qian, Chuan Guizhi (Sichuan Cinnamon Twig) 2 qian, Sheng Gancao (Raw Licorice Root) 3 qian, Sheng Yiren (Raw Coix Seed) 1 liang, Xingren (Apricot Kernel) 3 qian, Sheng Baishao (Raw White Peony Root) 1.5 qian, Shengdi (Rehmannia Root) 5 qian, Zhi Chuanpu (Processed Magnolia Bark) 1 qian, Shengjiang (Fresh Ginger) 2 slices, Hongzao (Red Date) 6 pieces.
Second Visit, July 16th: After taking the medicine yesterday, sweating occurred, slight sweating over the whole body, heart pain stopped, menstruation ceased, loose stool improved, numbness reduced, limited only to arms and fingers. Black coating gradually receded, dry mouth缓和, coughing up phlegm at night, and passing gas—all good signs. The previous formula was effective; no need to change.
Jing Mahuang (Purified Ephedra) 1 qian, Chuan Guizhi (Sichuan Cinnamon Twig) 1.5 qian, Sheng Gancao (Raw Licorice Root) 2 qian, Sheng Baishao (Raw White Peony Root) 1.5 qian, Da Shengdi (Large Rehmannia Root) 5 qian, Zhi Xiaopu (Small Magnolia Bark) 1 qian, Xingren (Apricot Kernel) 3 qian, Shengjiang (Fresh Ginger) 2 slices, Hongzao (Red Date) 6 pieces.
[Commentary] I followed Zhongsheng's pulse-syndrome-treatment methods to prescribe yesterday's formula, feeling anxious! I thought that by the next day's visit, if chills and fever were slightly relieved, it would be a great success. Instead, I was overjoyed: not only did the fever subside and spirit revive, but all ailments disappeared as described in the case record. How miraculous! Trying to find the reason for curing the disease, from a symptomatology standpoint, one must say: if the main syndrome is treated, all secondary or accessory syndromes heal themselves. This statement is correct but adds little to understanding pathology. Fortunately, learned gentlemen reading this case will provide explanations for all pathological aspects. For example, why use Mahuang and Guizhi for black tongue and dry mouth? Why does diaphoresis damaging body fluids remove heart pain? Menstrual dripping and loose stool seem unrelated, yet suddenly stop? This is my deep wish.
Cao Yingfu said: When Taiyang water qi stagnates under the heart, body fluids cannot ascend, causing thirst; Ding Ganren frequently expressed this idea. Black tongue not scorched, loose stool—indicating not Yangming heat syndrome. The black color is also water qi. Water qi harassing the heart causes heart yang deficiency, hence pain. Loose stool was due to the error of using Tianxin (Scutellaria); without Tianxin, loose stool stops naturally, not due to this formula's merit. Water qi failing to transform into sweat and exit externally causes spleen yang deficiency, leading to numbness in fingers and arms. Menstrual dripping is also due to water qi exceeding blood qi, compressed by water qi. Knowing where the disease comes from allows one to know where it goes; no need for lengthy explanation.
Third Visit, July 17th: Chills and fever resembling malaria gradually resolved, bowel movement resumed, black tongue coating faded, numbness confined to fingertips. Only lingering cough remains, with chest and hypochondriac pulling pain and a sense of wheezing. Referencing Guizhi Houpo Xingzi Tang (Cinnamon Twig, Magnolia Bark, and Apricot Kernel Decoction) method.
Xingren (Apricot Kernel) 4 qian, Houpo (Magnolia Bark) 1.5 qian, Chuan Guizhi (Sichuan Cinnamon Twig) 2 qian, Sheng Gancao (Raw Licorice Root) 3 qian, Baishao (White Peony Root) 2 qian, Da Shengdi (Large Rehmannia Root) 6 qian, Sigualuo (Luffa Reticulum) 4 qian, Shengjiang (Fresh Ginger) 1 slice, Hongzao (Red Date) 6 pieces.
[Commentary] Taking this formula yielded excellent results; mild regulation brought peace.
Indication for Guizhi Mahuang Gehan Tang (Cinnamon Twig and Ephedra Half-Half Decoction)
Patient Gu, residing at Fangxie Road. October 21st: Alternating chills and fever, occurring ten-plus times a day. This is not malaria, but Taiyang disease, suitable for Guizhi Mahuang Gehan Tang.
Guizhi (Cinnamon Twig) 3 qian, Gancao (Licorice Root) 1.5 qian, Xingren (Apricot Kernel) 5 qian, Mahuang (Ephedra) 1.5 qian, Baishao (White Peony Root) 1.5 qian, Shengjiang (Fresh Ginger) 2 slices, Dazao (Jujube) 4 pieces.
[Commentary] The original method for Guizhi Mahuang Gehan Tang divides the dose into three servings; the original method for Guizhi Er Mahuang Yi Tang divides it into two servings. Comparing one-third of the former's original amount with half of the latter's original amount, we find Mahuang and Xingren are equal in quantity, while the latter's Guizhi, Baishao, Shengjiang, Gancao, and Dazao are approximately double those of the former. Hence, the former is named "Half-Half," and the latter "Guizhi Two Mahuang One." However, modern decoction methods usually divide into two servings, differing from ancient practice. Moreover, the dosage differences are very minute. Thus, we only need to know the application of these two formulas; there is no need to overly scrutinize minute weights.
Cao Yingfu said: This syndrome is very mild, so a mild formula easily cures the disease, not just differing in weight.
Indication for Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction)
Qingsun: Illness began on July 27th due to sudden exposure to wind-cold. Bowels were unmovable, head top painful. This is simultaneous Taiyang and Yangming disease. Self-administering Jiming Dan (Life-Saving Pill), bowels moved, and headache slightly improved. Now, exterior syndrome is not fully resolved, interior syndrome is not fully resolved. Pulse is floating and slow, body often sweats. Suitable for Guizhi Dahuang Tang.
Chuan Guizhi (Sichuan Cinnamon Twig) 3 qian, Sheng Baishao (Raw White Peony Root) 3 qian, Sheng Gancao (Raw Licorice Root) 1 qian, Sheng Chuanjun (Raw Rhubarb) 3 qian, Shengjiang (Fresh Ginger) 3 slices, Hongzao (Red Date) 3 pieces.
[Commentary] Treating disease requires resolving the exterior first, then attacking the interior; this is the standard method, stated previously many times. Based on clinical experience, often after the exterior resolves, the interior clears itself, initially not needing medicinal assistance. Because during initial exterior constraint, the patient's yuan qi (vital energy) focuses solely on coping with the exterior syndrome, having no leisure to attend to the interior. Once the exterior resolves, yuan qi naturally turns back to address the interior. Who can see the retreat and advance of yuan qi? Yet facts are so; do not deny it. Therefore, encountering syndromes of exterior constraint and interior tension, if constipation has not exceeded three days, I often leave internal purgation aside—not ignoring it, but waiting for natural passage.
If combining exterior-releasing and interior-purgative medicines into one formula, it is another method. However, exterior release accounts for seven parts, interior purgation for three parts, implying primary and secondary distinctions. Since interior medicine has been used, interior purgation is secondary; since exterior medicine has not been used, exterior release is primary. Attacking both ends simultaneously, the disease departs, and yuan qi needs no worry.
Indication for Baihu Jia Guizhi Tang (White Tiger Plus Cinnamon Twig Decoction)
When I was twenty-five, I could read medical books but was not yet skilled in treating diseases. Accompanying my cousin Chen Shangbai, I took a boat to Nanjing for the autumn imperial examinations. Chen and his wife stayed in the middle cabin; I stayed in the front cabin. It was midsummer, scorching hot.
The boat docked in Wuxi. Chen and his wife went ashore together to bathe in Hui Spring, asking me to guard the cabin. Sweat ran down my back; inconvenient to change clothes, I let it dry naturally. Diet and起居 were uncomfortable, so my heart was constantly depressed. The boat docked for five days before setting sail. Five more days passed before arriving in Zhenjiang. After checking into the inn and settling in, I fell ill. Physicians prescribed mainly fresh Huoxiang (Patchouli) and Peilan (Aglaia), etc. After taking them for several days, the condition worsened. Sweating, fever unresolved, aversion to cold endless. That night, I took a wheelbarrow/boat to Beijing. Feeling dizzy and dark, losing consciousness. Upon arriving in Shicheng (Nanjing), friends helped me to my residence in Tangzi Alley. Every time I urinated, blood came out, bright red, accompanied by headache.
It was August 5th, only three days before the exam entry date. My father-in-law, Mr. Chen Baohou, had arrived in Nanjing before me. He was proficient in medicine. After palpating the pulse, he personally bought medicine, three large bottles of Heluye Lu (Lotus Leaf Dew), and over ten raw pears. He instructed me to drink the dew first; upon drinking, my mouth was no longer dry. Shortly after, I became thirsty again, ate raw pears, peeling none, just removing the core, finishing ten in an instant. When the medicine boiled, I drank a large bowl, feeling instantly clear-headed, exhausted, and slept. Upon waking, headache was gone, only sweating remained. Took the second decoction, twice as concentrated. Slept again. Upon waking, noticed whole-body sweating, starting slight, then heavy, soaking inner clothes, jacket, and bedding. Urgently changed, covered myself. Only then did I feel all ailments removed, stomach hungry, requesting hot porridge. Attendant said: Porridge is ready, pre-ordered by Father-in-law Chen. Initially drank one small bowl, finding it exceptionally sweet. Paused, continued drinking, finishing two large bowls that night. On the 7th, I entered the examination hall. Exam lasted nine days and nights, showing no fatigue. I marveled at Father-in-law Chen's divine medical skill. Asking about the medicine, it was Guizhi (Cinnamon Twig) and Shigao (Gypsum) pounded together. Asking the price, he said: Coincided with a new pharmacy opening, costing only six coins. We laughed together.
[Commentary] Headache with aversion to cold indicates Taiyang syndrome has not ceased; treatment should induce sweating for resolution. However, blood in urine means there is no surplus fluid to make sweat. Thus, drinking Lotus Leaf Dew and raw pears first increases fluids as the basis for sweating. Then giving Shigao (Gypsum) to clear internal heat, and Guizhi (Cinnamon Twig) to dispel external constriction. Cold resolves via sweat, heat clears via cooling. Requesting porridge upon waking represents the Rice (Jingmi) in Baihu Tang; the dew drunk earlier is akin to Ginseng in Jia Shen Tang. Looking at the moments of eating pears and drinking dew, who knew it contained Sage's method? Alas, flexibly applying Zhongsheng's formulas yields infinite efficacy.
[Additional Commentary] Baihu Jia Guizhi Tang indications are mostly seen in summer. Indeed, scorching heat steams the body, making the gastrointestinal tract inherently heat-transformed. At night, cool breezes blow, tempting indulgence in coolness, causing simultaneous exterior and interior disease. Exterior constrained by cold, heat has no outlet, inevitably intensifying. Internal heat flaring easily damages fluids, preventing sweating to resolve the exterior. Only by administering Baihu Tang to treat the root (GI heat) while adding Guizhi to treat the branch (exterior cold) can heat be removed, fluids restored, sweat produced, and exterior resolved. Based on my experience, Guizhi as light as 1 qian and Raw Shigao as light as 3 qian can also be effective. If not, using only Baihu to clear heat makes exterior syndrome worse; using only Guizhi to resolve exterior makes internal heat worse, inevitably leading to deteriorated syndromes. This is the principle that Guizhi and Shigao must cooperate and cannot be separated. Some say: You previously stated Shigao cools the Stomach and Guizhi warms the Stomach; how can warming and cooling proceed together to achieve miraculous results? Answer: Zhongsheng's formulas using warming and cooling together include the Xiexin Tangs; Guizhi and Shigao are but the beginning. Human bodily structures are complex and sensitive; during illness, their actions are prominent. Each part absorbs what it needs and discards what it doesn't. Regarding this formula's syndrome, the Stomach takes Shigao's coolness to eliminate heat, while arteries take Guizhi's dispersing nature to induce sweat. Thus, they not only do not conflict but complement each other.
The previous Guizhi Dahuang Tang was seven parts Taiyang, three parts Yangming. The current Baihu Jia Guizhi Tang is seven parts Yangming, three parts Taiyang. The symmetry of these two formulas is impeccable. Physicians who can combine Zhongsheng's various formulas can adapt to ever-changing diseases; these two formulas merely illustrate this principle.
Indication for Mahuang Fuzi Gancao Tang (Ephedra, Aconite, and Licorice Decoction) (Including Student's Treatment Record)
I once treated the son of Mr. Gao from the Shanghai Telegraph Bureau, aged five. No fever, no aversion to cold, bowel and urinary functions normal, but desire to sleep. Waking him forcibly, feeding him food, after eating, he fell asleep again. Palpating his pulse, it was faint, thin, and powerless. I said: This is what Zhongjing the Sage described as Shaoyin disease: faint, thin pulse, desire to sleep.
Although I knew the treatment formula, I dared not guarantee efficacy, suggesting seeking another expert. Mr. Gao understood Western medicine, capable of injecting cardiac stimulants, but knew they only worked temporarily, not fundamentally. He insisted on a prescription. Reluctantly, I wrote: Shu Fupian (Prepared Aconite Slice) 0.8 fen, Jing Mahuang (Purified Ephedra) 1 qian, Zhi Gancao (Honey-fried Licorice Root) 1 qian. To prevent indigestion, I added slightly Liu Shen Qu (Six Divine Qu) and Chao Maiya (Stir-fried Malt) for digestion and spleen strengthening.