出不彻。）舌生黑苔，烦躁口渴，时发谵语，两眼不合者七日，（皆属阳明。）洞泄如注，较前益无度。（协
热也。）脉之，洪大而数，（实热。）为疏竹叶石膏汤方。因其有腹泻之病，石膏只用一两。病初不减，此兄
素不谨，一友疑其虚也，云宜用肉桂、附子。（凡诊病，浅见者反若深虑，多令病者无所适从。）或以其言来告。
缪曰∶诚有是理，但前者按脉，似非此症，
岂不数日而脉顿变耶？复往视，仍洪大而数，曰∶此时一投桂、附，即发狂登屋，必不救矣。一照前方，但加
石膏至二两。或曰∶得毋与泻有妨乎？曰∶邪热作祟，此客病也，不治立殆。渠泄泻已八年，非暴病也。治病
须先太甚，急治其邪，徐并其夙恙除之。急进一剂，夜卧遂安，即省人事。再剂而前恶症顿去，数日霍然，但泻
未止耳。为疏脾肾双补丸，更加黄连、干葛、升麻，以痧痢法治之，不一月泻竟止。八载沉 ，一旦若失。
（藜按∶此亦温热症，非伤寒也。）
庄钦之一庄仆，因受寒发热，头痛如裂，（太阳。）两目俱痛，（阳明。）浑身骨内疼痛，下元尤甚，（劳伤。）
状如刀割，不可忍耐，（热甚伤寒。）口渴甚，大便日解一次，胸膈饱胀，下不解，已待毙矣。为疏一方∶
干葛三钱，石膏一两五钱，麦冬八钱，知母三钱五分，羌活二钱五分，大栝蒌半个连子打碎，枳壳一钱，桔梗一
钱，竹叶一百片，河水煎服，四剂而平。此太阳阳明病也，贫人素多作劳，故下体疼痛尤甚。以羌活去太阳之邪，
石膏、竹叶、干葛、麦冬、知母解阳明之热，栝蒌、桔梗、枳壳疏利胸膈之留邪，故遂愈。
又庄一仆，因伤寒后劳复，发热头痛，腹中作泻，势甚危急。为疏一方∶山栀仁四钱，枳实二钱，豆豉一
两，川黄连二钱，干葛三钱，调六一散五钱，服二剂，热退泻止，头痛亦愈。但不思饮食，为去山栀、枳实、
黄连，加鳖甲四钱，炙甘草二钱五分，麦冬五钱，不数剂而愈。
朱远齐治从祖近湖公。少年，因房劳食犬肉伤寒，诸医以其虚也，攻补兼施，至发狂登屋，奔走号呼，（阳
明腑症实热。）日夜令壮夫看守，几月余矣。急走使延朱。朱先令煎人参膏二斤以待，用润字号丸药数钱下之，
去黑粪无算，热遂定，奄奄一息，邻于死矣。徐以参膏灌之，至一百二十日全瘳。（以上《广笔记》。）
龚子才治一人，头疼发热，憎寒身痛，发渴谵语，日久不出汗。以大梨一枚，生姜一块，同捣取汁，入童
便一碗，重汤煮熟食之，汗出如水，即愈。（制方甚佳，愈于甘露，且免地黄之忌。）
太守刘云亭，患伤寒发热，面红唇赤，面壁蜷身而卧。诸医以小柴胡汤、解毒汤之类，数剂弗效。诊之，
六脉浮大无力，此命门无火也，（合脉与症，即是戴阳。）以人参、附子、沉香服之立愈。三服全安。
一妪年七旬，伤寒，初起头痛身疼，发热憎寒。医以发散，数剂不效。淹延旬日，渐不饮食，昏沉，口不
能言，眼不能开，气微欲绝，（纯见阴证。凡实证而见此，亦宜独参猛进。贫者，以重剂杞、地，少入干姜。）
与人参五钱煎汤，徐徐灌之，须臾稍省。欲饮水，煎渣服之，顿愈。又十年乃卒。（当与疫症内苏韬光一案同参。）
李士材治一人伤寒，九日以来，口不能言，目不能视，体不能动，四肢俱冷，咸谓阴症。诊之，六脉皆无；
以手按腹，两手护之，（拒按是也。）眉皱作楚；（实邪。）按其趺阳，大而有力，乃知腹有燥矢也。欲与大承气汤，
病家惶惧不敢进。李曰∶吾郡能辨是症者，惟施笠泽耳。（此等症，人便稀识，可为浩叹。）延诊之，若合符节。
遂下之，得燥失六七枚，口能言，体能动矣。故按手不及足者，何以救此垂绝之症耶？
一人伤寒，烦躁面赤，乱闷欲绝，时索冷水，手扬足踢，难以候脉，五六人制之，方得就诊，洪大无伦，
按之如丝。李曰∶浮大沉小，阴症似阳也，与附子理中汤，当有生理。其弟骇曰∶医者十辈至，不曰柴胡、承
气，则曰竹叶石膏，今反用此热剂，乌乎敢？李曰∶温剂犹生，凉剂立毙矣。卜之吉，遂用理中汤加人参四钱，
附子一钱，煎成，入井水冷与饮。甫及一时，狂躁定矣，再剂而神爽。服参至五斤而安。（得力在入井水冷服。）
凡遇此等伤寒，能以全料六味，减苓、泻，加麦冬、杞子，用大砂罐浓煎与之，必数杯而后酣寝，汗出
而愈。于时此法未开，惟倚仗人参之力取效。本阴竭之症，乃峻补其阳，复生阴而愈，故用参每多至数斤。
使在今时，非猗顿之家，不可为矣。
一人伤寒至五日，下利不止，懊 目胀，诸药不效。有以山药、茯苓与之，虑其泻脱也。李诊之，六脉沉
数，按其脐则痛。此协热自利，中有结粪。小承气倍大黄服之，果下结粪数枚，遂利止，懊 亦痊。
一人伤寒，第二日头痛发热。李曰∶方今正月，时令犹寒，必服麻黄汤，两日愈矣。若服冲和汤，不惟不
得汗，即使得汗，必致传经。遂以麻黄汤热饮之，更以滚水入浴桶，置床下熏之，得汗如雨，密覆半晌易被，
神已爽矣。晚索粥，家人不与。李曰∶邪已解矣，必不传里，食粥何妨？明日果愈。不以麻黄汗之，传变深重，
非半月不安也。（藜按∶用麻黄取汗，须防太过。）
吴光禄患伤寒，头痛腹胀，身重不能转侧，口内不和，语言谵妄。有云表里俱有邪，宜以大柴胡下之。李
曰∶此三阳合病也，误下之，决不可救。乃以白虎汤连进两服，诸症渐减。更加花粉、麦冬，两剂而安。（
藜按∶此亦温热之症。）
杨与师外家，发热头疼，六日后忽见红疹。众皆以为发斑，用升麻、犀角等汤，凡五日不效。李视之曰∶此
疹也，非斑也。斑为阳明火毒，疹为太阴风热，一表一里，判如天渊。乃用防风二钱，黄芩一钱，甘草五分，
薄荷、桔梗、蝉蜕各一钱，四剂霍然矣。
一人伤寒六日，谵语狂笑，头痛有汗，大便不通，小便自利。众议承气汤下之。脉之，洪而大。因思仲景
云∶伤寒不大便六七日，头疼有热，小便清，知不在里，仍在表也。方今仲冬，宜与桂枝汤。众皆咋舌掩口，
谤甚力，以谵语为阳盛，桂枝入口必毙矣。李曰∶汗多神昏，故发谵妄，虽不大便，腹无所苦，和其营卫，必
自愈矣。遂违众用之，及夜笑语皆止，明日大便自通。故夫病变多端，不可胶执。向使狐疑而用下药，其可活
乎？（有汗不可用麻黄，无汗不可用桂枝，古人之定例也。此症明明有汗，岂可执谵妄一端，而误用下药乎？
且不大便，腹无所苦，即不可下之的据。）
卢不远治来熙庵侄，身体丰硕，伤寒已二十八日，人事不省，不能言语，手足扬掷，腹胀如鼓，而热烙手，
目赤气粗，齿槁舌黑，参、附、石膏、硝、黄、芩、连，无一不服，诸医告退矣。诊之，脉浊鼓指，用大黄一
两，佐以血药，（以血药佐下，稳妥微妙。）一剂下黑血一二斗，少苏，四剂始清。盖此症寒邪入胃，蓄血在
中。其昏沉扬掷，是喜妄如狂之深者也。当时大黄未尝不用，而投非其时，品剂轻小，不应则惑矣，宁望放
胆哉。（先时虽用大黄，仍是失下，合脉与症，复大下之，非高手不能。）
蜀孝廉阮太和，病寓吴山下。召诊，披衣强坐，对语甚庄，神气则内索也。身热进退，舌苔黄而浓。盖自
吴门受寒，以肉羹为补，而时啜之，遂缠绵匝月。卢用疏散轻剂，热退。又复强啖，再热不能起坐。越五日诊
之，谵妄呼笑，不识人，已三日，形骨立，汗雨下，而内热特甚，胸胁之热，扪之烙手，第脉尚有神，乃用人
参八钱，加四逆散中，一剂而谵妄定，三剂而热邪清矣。自言其神魂穷天之上，极地之下，飞扬奇变，得太乙
神符召之，始得返生。愈后问药状，曰∶此寒伤心气，荏苒厥深而凑于胸也。以不第南旋，病淹中道，骨肉辽
远，药石弗周，则心已伤矣。又反复再四，汗液多亡，内无主宰，热遂入胸。胸为心主之宫城，精神因而涣散，
是以游魂为变也。用四逆使热外出，加入参俾神内凝，邪气散，是以主耳。（有此二端，便非阴证。）
吴孚先治一人伤寒，身寒逆冷，时或战栗，神气昏昏，大便秘，小便赤，（有此二端，便非阴证。）六脉
沉伏。或凭外象谓阴症，投热剂；或以脉沉伏，亦作阴治。吴诊之，脉沉伏，而重按之则滑数有力，愈按愈甚，
视其舌则燥，探其足则暖。曰∶此阳症似阴，设投热药，火上添油矣。乃用苦寒峻剂，煎成乘热顿饮而痊。（
寒因热用法。）
按∶内真寒而外假热，诸家尝论之矣。至内真热而外假寒，论及者罕。此案故宜熟玩。
一人病昏昏默默，如热无热，如寒无寒，欲卧不能卧，欲行不能行，虚烦不耐，若有神灵，莫可名状。此
病名百合，虽在脉，实在心肺两经，以心合血脉，肺潮百脉故也。盖心藏神，肺藏魄，神魄失守，故见此症。
良由伤寒邪热，失于汗下和解，致热伏血脉而成。用百合一两，生地汁半钟，煎成两次服，必候大便如漆乃瘥。
（论百合病深得真谛。）
张景岳治王生，年三旬，病阴虚伤寒。（叶天士曰∶阴虚二字，尚要讲明。阴虚者，水因火耗，当用滋阴。
若用桂、附，则非阴虚，乃虚寒火衰之症，或戴阳格阳，阴症似阳，乃可用矣。此处关头，宜细详察。）其舌芒
刺干裂，焦黑如炭，身热便结，大渴喜冷，而脉则无力，神则昏沉。群谓阳症阴脉，必死无疑。察其形气未脱，
遂以甘温壮水等药，大剂进之，以救其本。仍间用凉水，以滋其标。盖水为天一之精，凉能解热，甘可助阴，非
苦寒伤气可比。故于津液干燥，阴虚便结，而热渴火盛之症，在所不忌。由是水药并进，（叶天士曰∶若用桂、
附、人参，此虚寒之证，冷水必不喜饮，岂可饮一二斗乎？此言甚觉谬妄。惟邪热炽盛，可饮冷水。）然后诸症渐
退，饮食渐进，神气俱复矣。但察其舌则如故，心甚疑之。阅数日，忽舌上脱一黑壳，其内新肉灿然，始悟其
肤腠焦枯，死而复活。使非大合添补，安望再生？若此一症，特举其甚者。凡舌黑用补，得以保全者甚多。盖
伤寒之舌，则热固能黑，以火盛而焦也；虚亦能黑，以水亏而枯也。（叶天士曰∶水亏之黑，岂可用
热？若以舌黄舌黑悉为实热，则阴虚之症，万无一生之矣。）
按∶是症既云阴虚燥渴，用凉水是矣。而又杂与桂、附各数两，治法未能无疵。至舌苔成壳脱落，恐桂、
附之投，不能无过也。
一衰翁，年过七旬，陡患伤寒，初起即用温补调理。至十日之外，正气将复，忽尔作战，自旦至辰，不能
得汗，寒栗危甚，用六味回阳饮，入人参一两，姜、附各三钱，煎服。下咽少顷，即大汗如浴，时将及午，而
浸汗不收，身冷如脱，鼻息亦几无，令以前药复煎与之。曰∶先服此药，已大汗不堪，今又服此，尚堪再汗乎？
笑谓曰∶此中有神，非尔所知也。急令再进，遂汗收神复，不旬日起矣。呜呼，发汗用此，而收汗复用此，无
怪乎人之疑之也。不知汗之出与汗之收，皆元气为之枢机耳。
喻嘉言治黄长人犯房劳，病伤寒，守不服药之戒，身热渐退。十余日外，忽然昏沉，浑身战栗，手足如冰。
（乃热深厥亦深也。）亟请喻至，一医已合就姜、附之药矣。见而骇之，诊毕，再三辟其差谬。主人自疑阴症，言之不
入，又不可以理服。乃与医者约曰∶此一病，药入口中，出生入死，关系重大，吾与丈各立担承，倘用药
差误，责有所归。医者云∶吾治伤寒三十余年，不知甚么担承。喻笑曰∶有吾明眼在此，不忍见人活活就毙，
吾亦不得已也。如不担承，待吾用药，主家方安心请治。与以调胃承气汤，约重五钱，煎成热服半盏，少顷又
热服半盏。其医见厥渐退，人渐苏，知药不误，辞去。仍与前药服至剂终，人事大清。忽然浑身壮热，（厥止则阳
回，复现热症。）再与大柴胡一剂，热退身安。门人问曰∶病者云系阴症见厥，先生确认为阳症，而用下药果
应，其理安在？答曰∶其理颇微，吾从悟入，可得言也。凡伤寒病初起发热，煎熬津液，鼻干、口渴、便秘，渐
至发厥者，不问可知其为热也。若阳症忽变阴厥者，万中无一，从古至今无一也。盖阴厥得之厥症，一起便直中阴
经，唇青面白，遍身冷汗，便利不渴，身蜷多睡，醒则人事了了，与伤寒传经之热邪转入转深，人事昏惑者，
万万不同。诸书类载阴阳二厥为一门，即明者犹为所混，况昧者乎。如此病，先犯房劳，后成伤寒，世医无不
为阴症之名所惑，往往投以四逆等汤，致阴竭莫救，促其暴亡，尚不知悟，总由传派不清耳。盖犯房劳而病感
者，其势不过比常较重，如发热则热之极，恶寒则寒之极，头痛则痛之极。所以然者，以阴虚阳往乘之，非阴
盛无阳之比，况病者始能勿药，阴邪必轻，旬日渐发尤非暴症，安得以阴厥之例为治耶？且仲景明言∶始发热
六日，厥反九日，后复发热三日，与厥相应，则病旦暮愈。又云∶厥五日，热亦五日，设六日当复厥，不厥者，
(Sweating was) not thorough.) Black coating on the tongue, restlessness, thirst, occasional delirium, eyes unable to close for seven days, (all belong to Yangming disease). Diarrhea like a gush, more severe and uncontrolled than before. (This is heat-collateral diarrhea caused by heat pathogen sinking inward.) Pulse diagnosis reveals a surging (Hong), large, and rapid pulse, (indicating excess-heat). Therefore, I prescribed Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction). Because of his diarrhea, only one tael of Shigao (Gypsum Fibrosum) was used. The condition did not improve initially. This brother was usually imprudent; a friend suspected deficiency-cold and suggested using Rougui (Cortex Cinnamomi) and Fuzi (Radix Aconiti Lateralis Preparata). (In medical diagnosis, those with superficial insight often appear to think deeply, causing patients to be at a loss.) Someone reported this to me. Miao said: "There is indeed some logic to this, but based on the previous pulse diagnosis, it does not seem to fit this syndrome. Could the pulse change so drastically in just a few days?" Upon revisiting, the pulse remained surging, large, and rapid. I said: "If Guizhi (Ramulus Cinnamomi) and Fuzi are administered now, he will go mad and climb onto the roof; he will certainly not be saved." I adhered to the previous prescription but increased Shigao (Gypsum Fibrosum) to two taels. Someone asked: "Will this not hinder the treatment of diarrhea?" I replied: "The evil heat is wreaking havoc; this is an acute external contraction. If untreated, danger is imminent. His diarrhea has persisted for eight years; it is not an acute sudden illness. In treating diseases, one must first address the most urgent severity, urgently dispel the pathogen, and then gradually eliminate the chronic ailment." He took one dose quickly, slept peacefully that night, and regained consciousness. After two doses, the previous severe symptoms vanished completely. Within a few days, he recovered, except for the persistent diarrhea. I then prescribed Pishen Shuangbu Wan (Spleen and Kidney Double-Tonifying Pill), adding Huanglian (Rhizoma Coptidis), Qiange (Radix Bupleuri), and Shengma (Rhizoma Cimicifugae), treating it according to the method for sha-dysentery. Within a month, the diarrhea stopped completely. An eight-year chronic illness disappeared as if lost. (Li's Note: This is also a warm-heat syndrome, not Shanghan.)
Zhuang Qinzhi's servant suffered from cold-induced fever, headache feeling like splitting, (Taiyang channel involvement), pain in both eyes, (Yangming channel involvement), and deep bone pain throughout the body, especially in the lower origin, (due to labor injury). The pain felt like knife cuts, unbearable. Extreme thirst, bowel movement once daily, chest and diaphragm fullness and distension, inability to relieve below, awaiting death. I prescribed a formula: Qiange (Radix Bupleuri) 3 qian, Shigao (Gypsum Fibrosum) 1.5 liang, Maidong (Radix Ophiopogonis) 8 qian, Zhimu (Rhizoma Anemarrhenae) 3.5 qian, Qianghuo (Rhizoma et Radix Notopterygii) 2.5 qian, Da Gualou (Fructus Trichosanthis) half, crushed with seeds, Zhike (Fructus Aurantii) 1 qian, Jiegeng (Radix Platycodonis) 1 qian, Zhuye (Folium Bambusae) 100 leaves. Decoct in river water. After four doses, the condition stabilized. This is a Taiyang-Yangming combined disease. Poor people often engage in heavy labor, hence the severe lower body pain. Qianghuo (Rhizoma et Radix Notopterygii) dispels Taiyang pathogens; Shigao (Gypsum Fibrosum), Zhuye (Folium Bambusae), Qiange (Radix Bupleuri), Maidong (Radix Ophiopogonis), and Zhimu (Rhizoma Anemarrhenae) clear Yangming heat; Gualou (Fructus Trichosanthis), Jiegeng (Radix Platycodonis), and Zhike (Fructus Aurantii) regulate stagnation in the chest and diaphragm. Thus, he recovered.
Another servant of Zhuang suffered from recurrence due to labor after Shanghan, with fever, headache, and abdominal diarrhea, in critical condition. I prescribed: Zhiren (Semen Gardeniae) 4 qian, Zhishi (Fructus Aurantii Immaturus) 2 qian, Chidouchi (Semen Sojae Preparatum) 1 liang, Huanglian (Rhizoma Coptidis) 2 qian, Qiange (Radix Bupleuri) 3 qian, mixed with Liuyisan (Six-to-One Powder) 5 qian. After two doses, fever subsided, diarrhea stopped, and headache resolved. However, he had no appetite. I removed Zhiren (Semen Gardeniae), Zhishi (Fructus Aurantii Immaturus), and Huanglian (Rhizoma Coptidis), added Biejia (Carapax et Plastrum Testudinis) 4 qian, Zhi Gancao (Radix Glycyrrhizae Preparata) 2.5 qian, and Maidong (Radix Ophiopogonis) 5 qian. He recovered after a few doses.
Zhu Yuanqi treated his great-granduncle, Lord Jinhu. In his youth, he contracted Shanghan after excessive sexual activity and eating dog meat. Physicians, considering him deficient, applied both attacking and tonifying methods, leading to madness, climbing roofs, running, and shouting. (This is Yangming Fu-organ excess-heat.) Strong men guarded him day and night for over a month. Urgently, they sent for Zhu. Zhu first ordered the preparation of two taels of Renshen Gao (Ginseng Paste) for later use, administered several qian of Runzi Hao pills to induce defecation, expelling countless black stools. The heat settled, leaving him weak and near death. Slowly, Renshen Gao (Ginseng Paste) was infused into him. After 120 days, he fully recovered. (From *Guang Biji*.)
Gong Zicai treated a man with headache, fever, aversion to cold, body pain, thirst, and delirium, who had not sweated for many days. One large pear and one piece of ginger were mashed together to extract juice, mixed with one bowl of Tongbian (Child's Urine), cooked thoroughly in hot water, and eaten. Profuse sweating ensued, and he recovered immediately. (An excellent prescription, superior to Ganlu Yin, avoiding the cloying nature of Dihuang.)
Prefect Liu Yunting suffered from Shanghan fever, red face and lips, lying curled up facing the wall. Physicians used Xiaochaihu Tang (Minor Bupleurum Decoction) and Jiedu Tang (Detoxification Decoction) for several doses without effect. Pulse diagnosis showed floating, large, and forceless pulses in all six positions. This indicates Mingmen Fire Deficiency. (Combining pulse and symptoms, this is Daiyang Syndrome.) He was treated with Renshen (Radix Ginseng), Fuzi (Radix Aconiti Lateralis Preparata), and Chenxiang (Aquilaria Lignum), recovering immediately. After three doses, he was fully restored.
A seventy-year-old woman contracted Shanghan, initially presenting with headache, body pain, fever, and aversion to cold. Physicians used dispersing agents for several doses without effect. After ten days, she stopped eating, became lethargic, unable to speak or open her eyes, with faint breath nearing extinction. (Pure Yin syndrome signs. Even if seen in excess syndromes, single-use high-dose Renshen should be considered. For the poor, heavy doses of Gouqi and Dihuang with small amounts of Ganjiang may be used.) Five qian of Renshen (Radix Ginseng) were decocted and slowly infused. She slightly recovered shortly after. Thirsty, she drank the dregs of the decoction and recovered instantly. She lived another ten years before passing. (Should be cross-referenced with the case of Su Taoguang in epidemic febrile diseases.)
Li Shicai treated a man with Shanghan for nine days, unable to speak, see, move, with cold limbs. All considered it a Yin syndrome. Pulse was absent in all six positions. Pressing the abdomen, the patient protected it with both hands (indicating rejection of pressure), frowned in pain (excess pathogen). Palpating the Duyang pulse, it was large and forceful, indicating dry fecal impaction in the abdomen. Wanting to administer Dachengqi Tang (Major Order the Qi Decoction), the family was terrified and refused. Li said: "In our prefecture, only Shi Lizé can identify this syndrome." (Such cases are hard to recognize, causing sighs.) Shi Lizé was summoned, and the diagnosis matched perfectly. The purgative was administered, yielding six or seven pieces of dry stool. Speech and movement resumed. Why neglect foot pulse palpation when saving such critical cases?
A man with Shanghan presented with restlessness, red face, extreme mental distress, craving cold water, thrashing limbs, making pulse diagnosis difficult. Five or six people restrained him for examination. The pulse was surging and large but thread-like upon deep pressure. Li said: "Floating-large and deep-small indicates Yin syndrome resembling Yang. Administer Fuzi Lizhong Tang (Aconite and Ginger Decoction to Regulate the Middle); there is hope." His brother was horrified: "Ten doctors came, suggesting Chaihu, Chengqi, or Zhuye Shigao Tang. Now you suggest a hot formula? How dare we?" Li said: "Warm formulas will save him; cold formulas will kill him instantly." Divination was auspicious. Lizhong Tang was used with 4 qian Renshen (Radix Ginseng) and 1 qian Fuzi (Radix Aconiti Lateralis Preparata). The decoction was cooled in well water before administration. Within one hour, agitation ceased. After two doses, spirit cleared. Total Renshen (Radix Ginseng) intake reached five taels for stability. (Effectiveness relied on cooling the decoction in well water.)
For such Shanghan cases, if Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) is modified by removing Fuling (Poria) and Zexie (Alisma), adding Maidong (Radix Ophiopogonis) and Gouqi (Fructus Lycii), and decocted thickly in a clay pot, the patient will sleep soundly after a few cups and recover through sweating. This method was not yet established then; efficacy relied solely on Renshen (Radix Ginseng). This was originally a Yin-fluid exhaustion syndrome, yet Yang was vigorously tonified to restore Yin. Hence, large doses of Renshen (Radix Ginseng) were needed. Today, only wealthy families could afford this.
A man with Shanghan on the fifth day suffered continuous diarrhea, inner restlessness, and eye distension. Various drugs failed. Some used Shanyao (Rhizoma Dioscoreae) and Fuling (Poria) fearing collapse. Li's pulse diagnosis showed deep and rapid pulses in all six positions; tenderness upon pressing the umbilicus. This is heat-collateral spontaneous diarrhea with internal fecal impaction. Xiao Chengqi Tang (Minor Order the Qi Decoction) with doubled Dahuang (Radix et Rhizoma Rhei) was administered. Several pieces of impacted stool were passed, stopping diarrhea and relieving restlessness.
A man with Shanghan on the second day had headache and fever. Li said: "It is January, still cold. Must use Mahuang Tang (Ephedra Decoction) to cure in two days. If Chonghe Tang (Harmonizing Decoction) is used, sweat will not occur; even if it does, transmission will follow." Mahuang Tang (Ephedra Decoction) was given hot, followed by steaming in a tub of boiling water placed under the bed. Profuse sweating occurred. Covered tightly for half a day, spirit cleared. Evening hunger for porridge was denied by family. Li said: "Pathogen is resolved, unlikely to transmit inward. Eating porridge is fine." He recovered the next day. Without Mahuang Tang (Ephedra Decoction) to induce sweat, transmission would have been severe, taking half a month to settle. (Li's Note: When using Mahuang (Herba Ephedrae) for sweat, prevent excess.)
Wu Guanglu suffered from Shanghan with headache, abdominal distension, heavy body unable to turn, oral discomfort, and delirious speech. Some suggested excess in both exterior and interior, recommending Dachaihu Tang (Major Bupleurum Decoction). Li said: "This is a Three-Yang combined disease. Misusing purgatives will be fatal." Baihu Tang (White Tiger Decoction) was given twice consecutively, reducing symptoms. Huafen (Radix Angelicae Dahuricae) and Maidong (Radix Ophiopogonis) were added. Recovery after two doses. (Li's Note: This is also a warm-heat syndrome.)
Yang Yushi's mother-in-law had fever and headache. On the sixth day, red rashes appeared. Everyone thought it was macules (ban), using Shengma (Rhizoma Cimicifugae) and Xijiao (Cornu Bubali) without effect for five days. Li observed: "These are papules (zhen), not macules. Macules are Yangming fire-toxin; papules are Taiyang wind-heat. Exterior vs. Interior, vastly different." Fangfeng (Radix Saposhnikoviae) 2 qian, Huangqin (Radix Scutellariae) 1 qian, Gancao (Radix Glycyrrhizae) 5 fen, Bohe (Herba Menthae), Jiegeng (Radix Platycodonis), and Chantui (Periostracum Cicadae) each 1 qian were used. Recovery after four doses.
A man with Shanghan for six days had delirious laughter, headache with sweat, constipation, and free urination.众人 discussed using Chengqi Tang (Order the Qi Decoction). Pulse was surging and large. Recalling Zhang Zhongjing: "Shanghan with constipation for 6-7 days, headache with heat, clear urine indicates pathogen is not in the interior but remains in the exterior." It is mid-winter; Guizhi Tang (Cinnamon Twig Decoction) is appropriate.众人 scoffed, arguing delirium indicates Yang excess; Guizhi (Ramulus Cinnamomi) would be fatal. Li said: "Profuse sweating causes spirit confusion, leading to delirium. Though constipated, there is no abdominal distress. Harmonizing Ying and Wei will lead to self-healing." Defying众人, Guizhi Tang (Cinnamon Twig Decoction) was used. By night, laughter ceased. Next day, bowel movement occurred naturally. Disease changes are manifold; do not be rigid. Had hesitation led to purgatives, survival would be impossible. (Sweating precludes Mahuang (Herba Ephedrae); no sweating precludes Guizhi (Ramulus Cinnamomi). This case clearly has sweat; relying solely on delirium to use purgatives is erroneous. Constipation without abdominal distress is a definitive sign against purgation.)
Lu Bu yuan treated Lai Xi'an's nephew, obese, with Shanghan for 28 days, unconscious, mute, thrashing limbs, drum-like abdominal distension, burning heat, red eyes, coarse breathing, dry teeth, black tongue. Renshen (Radix Ginseng), Fuzi (Radix Aconiti Lateralis Preparata), Shigao (Gypsum Fibrosum), Xiaoshi (Natrii Sulfas), Dahuang (Radix et Rhizoma Rhei), Huangqin (Radix Scutellariae), Huanglian (Rhizoma Coptidis) had all been tried. Physicians withdrew. Pulse was turbid and beating forcefully. Dahuang (Radix et Rhizoma Rhei) 1 liang was used with blood-invigorating herbs. (Using blood herbs to assist purgation is stable and subtle.) One dose expelled 1-2 dou of black blood. Slight recovery. Clarity returned after four doses. Cold pathogen entered stomach, blood stasis accumulated internally. Unconsciousness and thrashing indicate severe manic delirium. Dahuang (Radix et Rhizoma Rhei) was used earlier but at the wrong time and dosage. Bold action requires skill. (Previous Dahuang (Radix et Rhizoma Rhei) use was missed opportunity; combining pulse and symptoms, aggressive purgation is needed, achievable only by experts.)
Ruan Taihe, a scholar from Shu, fell ill staying at Wu Mountain. Examination showed him sitting stiffly, speaking solemnly, but spirit internally depleted. Fever fluctuated, tongue coating yellow and thick. Caught cold in Wu, nourished with meat broth, lingering for a month. Lu used light dispersing agents; fever subsided. Forced eating again caused recurrent fever and immobility. Five days later, delirious laughter, unrecognized for three days, emaciated, profuse sweating, intense internal heat, burning chest/hypochondrium. Pulse still had spirit. Renshen (Radix Ginseng) 8 qian was added to Sini San (Frigid Extremities Powder). Delirium settled after one dose; heat cleared after three. Patient described soul wandering heaven and earth, saved by spiritual talisman. Post-recovery analysis: Cold injured Heart Qi, prolonged jue deepened into chest. Failure in exams, delayed return, distant family, inadequate medicine injured Heart. Repeated sweating depleted fluids, internal lack of control allowed heat into chest. Chest is Heart's palace; spirit scattered, causing wandering soul phenomena. Sini San (Frigid Extremities Powder) expelled heat outward; Renshen (Radix Ginseng) consolidated spirit inward. (These two factors rule out Yin syndrome.)
Wu Fuxian treated a man with Shanghan, cold limbs, tremors, lethargy, constipation, red urine. (These two factors rule out Yin syndrome). Pulse was deep and hidden. Some diagnosed Yin syndrome externally, using hot formulas. Others saw deep pulse and treated as Yin. Wu found deep-hidden pulse becoming slippery-rapid-forceful upon deep pressure, dry tongue, warm feet. "This is Yang syndrome resembling Yin. Hot drugs would add oil to fire." Bitter-cold strong decoction was taken hot. Recovered. (Cold treatment for heat manifestation.)
Note: Internal true cold with external false heat is discussed by many. Internal true heat with external false cold is rarely discussed. This case merits careful study.
A man was lethargic, neither hot nor cold, unable to sleep or walk, restless intolerance, feeling possessed, indescribable. This is Baihe Bing (Lily Disease). Though reflected in pulse, it resides in Heart and Lung channels because Heart governs vessels and Lung directs hundred vessels. Heart stores Shen (Spirit), Lung stores Po (Ethereal Soul). Loss of Shen/Po causes these symptoms. Likely due to Shanghan heat pathogen failing to resolve via sweating/purgation/harmonizing, trapping heat in vessels. Baihe (Bulbus Lilii) 1 liang and Shengdi Zhi (Jucius Rehmanniae) half zhong were decocted and taken twice. Recovery confirmed when stool turned pitch-black. (Insight into Baihe Bing is profound.)
Zhang Jingyue treated Wang Sheng, 30 years old, with Yin-deficiency Shanghan. (Ye Tianshi notes: 'Yin deficiency' needs clarification. Water consumed by fire requires yin-nourishing. Guizhi (Ramulus Cinnamomi) and Fuzi (Radix Aconiti Lateralis Preparata) are for deficiency-cold/fire decline, or Daiyang/Geyang (Yin syndrome resembling Yang). Careful observation is crucial here.) Tongue had prickles, dry cracks, charcoal-black. Fever, constipation, extreme thirst for cold. Pulse forceless, spirit lethargic. All predicted death due to Yang syndrome with Yin pulse. Observing form/qi intact, sweet-warm water-nourishing drugs were given in large doses to save the root. Cool water was intermittently used to nourish the branch. Water is essence of Heaven One; cool clears heat, sweet aids yin, unlike bitter-cold damaging qi. Thus, for dry fluids, yin-deficiency constipation, and heat-thirst, this is not contraindicated. Water and drugs advanced together. (Ye Tianshi argues: If using Guizhi (Ramulus Cinnamomi), Fuzi (Radix Aconiti Lateralis Preparata), Renshen (Radix Ginseng), this is deficiency-cold; cold water would be rejected. Claiming consumption of 1-2 dou of cold water is absurd. Only intense pathogenic heat allows cold water intake.) Symptoms receded, diet improved, spirit restored. Tongue remained unchanged, causing doubt. Days later, a black crust peeled off, revealing fresh flesh. Skin/fascia were scorched; dead yet revived. Without major tonification, regeneration would be impossible. This highlights severe cases where black tongue responds to tonification. Many survive. Shanghan tongue turns black from heat/fire scorching OR from yin/water deficiency/drying. (Ye Tianshi asks: Can heat be used for water-deficiency black tongue? If yellow/black tongue implies excess heat, yin-deficiency cases would have zero survival rate.)
Note: Since yin-deficiency dry thirst was diagnosed, cool water was correct. However, mixing Guizhi (Ramulus Cinnamomi) and Fuzi (Radix Aconiti Lateralis Preparata) in large doses shows therapeutic flaws. The peeling black crust suggests Guizhi (Ramulus Cinnamomi) and Fuzi (Radix Aconiti Lateralis Preparata) may have caused harm.
An elderly man over 70 suddenly contracted Shanghan, treated initially with warm tonics. After ten days, as righteous qi recovered, sudden chills occurred from dawn to Chen hour, no sweat, severe cold trembling. Liuhui Huiyang Yin (Six-Ingredient Return-Yang Decoction) with 1 liang Renshen (Radix Ginseng), 3 qian Ganjiang (Rhizoma Zingiberis Preparatum), and 3 qian Fuzi (Radix Aconiti Lateralis Preparata) was decocted and taken. Shortly after swallowing, profuse sweating like bathing occurred. Near noon, sweat continued uncontrollably, body cold as if detached, breath nearly gone. Previous decoction was rehearsed and offered. Patient questioned: "First dose caused unbearable sweat; can I endure more?" Doctor laughed: "There is divine mechanism here, unknown to you." Urged to take more. Sweat stopped, spirit recovered. Recovery within ten days. Ah! Using this for sweating and then for stopping sweat explains skepticism. Sweating and stopping sweat are both governed by Yuanqi (Original Qi) pivot.
Yu Jiayan treated Huang Changren who contracted Shanghan after sexual indiscretion, abstaining from medicine. Fever subsided gradually. Over ten days later, sudden lethargy, whole-body chills, ice-cold limbs. (Heat deep, jue deep.) Yu was summoned. Another doctor had prepared Jiang (Zingiberis Rhizoma) and Fu (Aconiti Radix) medicine. Yu was horrified, examined pulse, and refuted errors repeatedly. Owner suspected Yin syndrome, refused reason. Agreement made: Each takes responsibility for outcome. Doctor claimed 30 years experience, dismissed liability. Yu said: "My clear vision prevents watching someone die unnecessarily. If no guarantee, let me treat." Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction), approx. 5 qian, was decocted and taken hot in halves. Doctor saw jue recede, patient revive, left satisfied. Continued medication until course finished. Consciousness cleared. Sudden whole-body high fever. (Jue stops, Yang returns, heat reappears.) Dachaihu Tang (Major Bupleurum Decoction) given once. Fever subsided, peace restored. Student asked: "Patient claimed Yin jue, you diagnosed Yang, purgatives worked. Why?" Answer: "Subtle principle. From enlightenment, I explain. Initial Shanghan fever consumes fluids, dry nose, thirst, constipation, progressing to jue indicates heat. Yang turning to Yin jue is extremely rare/non-existent historically. Yin jue strikes Yin meridians directly: blue lips, white face, cold sweat, loose stools, no thirst, curled posture, sleeping, lucid when awake. Contrasts sharply with Shanghan transmitting heat deepening confusion. Books group Yin/Yang jue together, confusing even experts. This case: sexual indiscretion then Shanghan. Physicians confused by 'Yin syndrome,' using Sini Tang (Frigid Extremities Decoction), causing yin exhaustion and sudden death. Unclear transmission leads to error. Sexual indiscretion worsens Shanghan slightly: extreme fever, extreme aversion to cold, extreme headache. Due to yin deficiency allowing yang to invade, not yin excess excluding yang. Patient abstained initially, so yin pathogen light. Gradual onset over ten days is not sudden. Cannot treat as Yin jue. Zhongjing states: Fever 6 days, jue 9 days, fever 3 days matching jue predicts morning/evening cure. Also: Jue 5 days, fever 5 days; if jue recurs on day 6, absence of jue means...