Library

Zhou Yujiu suffered from Shanghan (Cold Damage) for five days, presenting with fever, abdominal pain, and vomiting/nausea. He required three or four people to fan him to cool down, and any medicine administered was immediately vomited. Upon pulse diagnosis, the Cun (Inch) pulses were empty and large, while the Guan (Bar) and Chi (Cubit) pulses were deficient and small. I stated: The emptiness and largeness of both Cun pulses indicate that Yang Qi is attempting to escape upwards; the deficiency and smallness of the Guan and Chi pulses indicate that Yin Qi is attempting to collapse downwards. If profuse sweating occurs leading to a complete exhaustion of both Yin and Yang, it would be incurable. Therefore, Baotong Tang (White Passage Decoction) was administered with added human urine and pig bile. After ingestion, the vomiting and nausea ceased immediately, the Cun pulse became balanced, and the Guan pulse recovered its rising quality. Later, the patient developed dry mouth, abdominal pain, and a solid pulse, so Chengqi Tang (Stomach Power Decoction) was used to purge the bowels. Subsequently, macules and rashes appeared all over the body, and swelling occurred on both cheeks. The condition was then treated with Huanglian Jiedu Tang (Coptis Decoction to Relieve Toxicity), resulting in recovery.

The servant of Mr. Zhang had been ill for five days, presenting with fever, a deep and faint pulse, dry mouth, restlessness, and insomnia. I stated: Fever belongs to Yang, while a deep and faint pulse belongs to Yin; this is a Shaoyin syndrome resembling Taiyang syndrome. Dry mouth and restlessness indicate internal disturbance by pathogenic factors. Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) should be used to warm the Shaoyin meridians and expel the internally trapped pathogens. Someone asked, "How could the patient himself have a Yin syndrome?" Suggesting an alternative method using Gualou (Trichosanthes Root) to nourish Yin and resolve the exterior, the symptoms worsened. Upon re-palpation, the pulse changed from deep and faint to deficient and scattered, violating standard protocols. Reluctantly, only Si Ni Tang (Four Reversal Decoction) remained as a potential remedy to salvage the situation. Two doses were administered consecutively; that night, the patient slept, and by the next day, the fever subsided, the pulse recovered, and he stabilized.

Miao Zhongchun said: Zhao Heqi, aged sixty, fell ill. I visited him at his request. He said, "Due to occasional fatigue and overwork, my body feels weak, and I wish to seek advice." Upon examination, carefully palpating the six positions and observing his form and spirit, I told him, "Your illness is due to external pathogens, not caused by chronic depletion. You must take great care." Ge Cuncheng, present at the time, privately remarked, "This is a severe external contraction with signs of pathogen sinking inward; it may be difficult to save." Three days later, upon being invited again, the patient's spiritual essence had collapsed, and the pulse was chaotic. Asked what medicine he had taken, he replied, Shigao Tang (Gypsum Decoction). I said, "Although the disease was severe, the medication was incorrect. There was no sweating with fever, so it was not a Yangming syndrome; how could Gypsum be used? This was a Taiyang syndrome that had not been induced to sweat, allowing the pathogen to transmit inward. With interior deficiency and depleted fluids, the body could not withstand the pathogenic heat, and the True Qi had already collapsed; it was undoubtedly incurable." At the time, people still considered my words absurd, but within two months, the patient died. (Guang Biji.)

Zhang Yitian treated a man who contracted Shanghan in spring. Seven days later, he presented with restlessness, sore throat, chest oppression, and diarrhea. Physicians treated it as Damp-Heat without effect. The pulse was fine and rapid, characteristic of Shaoyin. Shaoyin governs Fire above and Water below, acting as the pivot. When Water and Fire do not interact, the pulse becomes rapid, accompanied by chest fullness and restlessness; Fire ascending causes sore throat, while Water descending causes diarrhea. This indicates the Shen Mechanism is depressed internally, unable to rotate and circulate throughout the interior and exterior, consistent with the theory of Shaoyin diarrhea, sore throat, chest fullness, and vexation. Zhu Fu (Swine Skin) was prescribed: six liang of swine skin, scraping off the white epidermis, decocted in one large bowl. After removing dregs and floating oil, five qian of white honey and one liang of Gu Ya (Sprouted Grain), fried until fragrant and powdered, were added. Simmered over low heat to half a bowl, taken warm, symptoms slightly alleviated. The pulse was fine, short, and choppy, indicating a disharmony between Wu and Gui (Spleen/Stomach), leading to insufficient generation of Yangming blood and meridian blockage. Zhigancao Tang (Licorice Decoction) was given to unblock the meridians and harmonize with Yangming, resulting in a slow pulse and recovery.

Xue Lizhai said: Zheng Rudong’s brother-in-law suffered from Shanghan and developed a completely black tongue. Physician Zeng Xi suggested using Fuzi Lizhong Tang (Aconite and Poria Decoction to Warm the Middle), causing shock among observers, so treatment was halted. When the condition became critical and coffins were prepared, Zeng visited and insisted on using the previous prescription, stating there was still hope. The family, desperate, agreed. After several doses, he recovered. Generally, a black tongue can result from extreme Heat mimicking Cold (like wood burning to charcoal), suitable for Liangge San (Cooling the Chest Powder) to clear Yang Heat; or from Water overcoming Fire (as in Zeng’s case), suitable for Lizhong Tang to dispel Yin Cold. Additionally, rubbing the tongue with fresh ginger can help: if the color fades slightly, it is treatable; if hard and unchanged, it is untreatable. (Alternatively: slice ginger flat, dip in honey, and rub.)

In the Xin You year of Hongzhi, Jiang Menghui from Jintai suffered from Shanghan with a completely black tongue, cold extremities, and incessant hiccups. Other physicians treated it as Heat, nearly causing death. Vice President Wu Renzhai cured him with Fuzi Lizhong Tang (Aconite and Poria Decoction to Warm the Middle). Medicine follows the principle that every disease has its corresponding remedy. Aconite treats Cold effectively; why is it regarded as absolutely unusable today, letting people die rather than saving them? For conditions where extreme Heat mimics Cold, appropriate medication yields good results; it is not futile to abandon treatment. (Shanghan Zhezhong.)

In the Geng Chen year, Lady Yang, wife of the Vice Minister, contracted Shanghan and mistakenly took a cup of Aconite medicine. Immediately, her throat became red and swollen. Xue Lizhai was urgently summoned. Xue cited Zhang Zhongjing: "If Guizhi Tang is ingested in cases of Exuberant Yang, death ensues; how much more so for Aconite?" He declined to treat, and she indeed died that day.

In the Xin Mao year, a clerk contracted Shanghan and mistakenly took a cup of Aconite medicine. He became restless, ran about, and died after falling. In midsummer, combining Aconite, Cinnamon Twig, and Ginger for three to four doses caused no harm. In deep winter, using just one of these three herbs in a single dose resulted in death. This demonstrates the efficacy of Luo Qianfu’s principle of "abandoning seasonal considerations in favor of symptom differentiation" and flexible prescribing.

Wu Yang treated the wife of Wang Bozhi’s elder brother. Physicians were exhausted. Upon arrival, Wu Yang told the family, "This is easy to treat; simply give her cold water." Relatives objected, "She hasn't eaten in three days; how can we give water?" Wu Yang said, "This is severe Yangming Heat in Shanghan. Relying on medicine might be too late; administer the appropriate remedy directly, even without other drugs." He ordered a bed prepared, gave one cup first. The patient felt refreshed and drank a whole dou. The illness resolved, followed by Ren Shen Baihu Tang (Ginseng and White Tiger Decoction) to stabilize. (Tai Han Ji.)

Wu Qiao treated his nephew Fang Lu. Returning from Zhejiang with Shanghan, previous treatments failed. On the journey home, he caught cold again. Fever persisted for days, slight deafness, fatigue, and irritability. Physicians hastily administered tonics, leading to stupor, refusal of food, and picking at clothes/bed (a sign of severe delirium). Coffins were prepared. Wu Qiao diagnosed a string-tight and rapid pulse in all six positions. The disease originated from unresolved Shanghan compounded by new cold exposure. Fortunately, the patient was young and strong; sweating was necessary for cure. Mahuang Shigao Tang (Ephedra and Gypsum Decoction) was administered, inducing sweat and resolving the condition. (Ibid.)

Chen Mengzhu’s father contracted cold in a Shandong inn in June during the Wuwu year, lingering ill. By February of the next year, he suddenly suffered acute pain in the lower abdomen and waist, requiring tight support of the testicles; slight relaxation caused near-death agony. Lu used Huoqu (Notopterygium), Huangbai (Phellodendron), Fuling (Poria), Rougui (Cinnamon Bark), etc., and instructed scraping the Weizhong acupoint. Pain stopped, legs softened. By May, with hot weather, purple spots appeared on the body; health returned only when sweat reached the feet. This is a Small Intestine organ disease. The Classic states: "Small Intestine disease involves pain in the lower back and spine radiating to the testicles." Since Huoqu enters the Taiyang Small Intestine meridian, the pain resolved. However, full recovery awaited the right season because the root cause—cold pathogen stagnating and transforming into fire—required summer heat to fully mobilize blood vessels and expel pathogens. Thus, the appearance of spots and foot sweat indicated the thorough expulsion of cold and free flow of fire.

Jin Jian contracted a Warm Disease in spring. (Since it occurred in spring, Yu Jia Yan named it Warm Disease, though it was essentially Shanghan. If it were truly Warm Disease, Mahuang Fuzi Xixin Tang would be contraindicated.) Mistreated for twenty days, it developed into a critical fatal condition. High fever persisted, delirious speech, sticky/dry skin, rigid chest, curled tongue, scorched lips, curled body with cold feet, scanty urination/bowel movements, partial thirst, and a dark, stagnant complexion. Yu Jia Yan observed: "This resembles Lianggan Shanghan (Dual Contraction Cold Damage). Lianggan transmits two meridians daily, dying after three days if transmission completes. If not dead, transmission continues weekly until death." (Note: Shanghan does not always transmit; this statement is not absolute.) This Spring Warmth did not transmit meridians (though Spring Warmth can have reverse or smooth transmission). Thus, despite lingering pathogens, death comes only after Yuan Qi (Primal Qi) exhausts. Observing mixed Yin/Yang symptoms matching Lianggan, Yu prescribed Zhang Zhongjing’s exterior-interior formulas. Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) resolved the exterior Yin-Yang pathogens, inducing sweat and reducing fever. Fuzi Xie Xin Tang (Aconite and Pinellia Decoction to Drain the Epigastrium) resolved interior Yin-Yang pathogens, clearing the chest, restoring consciousness, and eliminating symptoms, leading to recovery without further medication.

Zhang Lingzhi’s brother suffered from a complicated Shanghan syndrome, with lumbar stiffness and screaming pain all night. Yu Jia Yan diagnosed a smooth, safe pulse, yet pain decreased significantly. Yu stated: "The key to transformation here is the stabbing pain, indicating struggle between Pathogen and Righteous Qi. If pain ceases completely, Pathogen and Qi merge peacefully. Heat pathogen has deeply entered the lumbar region, blocking blood vessels long-term. Only dispersing attack works. But with long-standing pathogen and deficient Righteous Qi, direct attack fails. Taoren Chengqi Tang (Peach Kernel and Stomach Power Decoction) was used with added Cinnamon Twig and Aconite, two large doses. Afterward, he could rise strongly. Pills made similarly were taken for ten days, leading to peace. Zhang Zhongjing used Fuzi Xie Xin Tang for Jie Xiong (Chest Binding) syndrome, combining Aconite and Rhubarb. Upper disorders involve Qi, hence draining the Heart. Lower disorders involve Blood; can we not imitate this to disperse blood stasis in the waist? Later, Jiang Gusheng’s younger brother relapsed and was cured in two doses using this method."

Pei Zhaoqi treated a noblewoman post-Sanghan sweating/purging. Pulse was surging with persistent fever, no thirst, no abdominal fullness, no chills/heat, only Qi deficiency, spirit fatigue, coma-like sleep, unresponsive to calls. Physicians suggested Phlegm, Huxuan Shanghan, Dry Stool needing purgation, or residual pathogens needing harmonization. Pei said: "None are correct; it is severe Yuan Qi deficiency." Ren Shen (Ginseng) 5 qian, Chao Hei Gan Jiang (Fried Black Ginger) 2 qian, Dang Gui (Angelica Sinensis) 3 qian, Wu Wei Zi (Schisandra) 30 grains were given frequently, day and night. Result: body cooled, pulse quieted, Qi and Spirit cleared, recovery achieved.

Li Huaizi treated a woman, constitutionally weak, with excessive childbirth history, often suffering headaches and extreme aversion to cold on the back (wearing cotton in summer). Early winter Shanghan brought fever, severe headache, body ache, cold knees/arms but hot palms, normal chest/digestion. Exterior-releasing medicines failed, worsening cold sensation, chest stuffiness, and difficult urination/bowel movements. Li used Buzhong Yiqi Tang (Middle-Warming and Qi-Boosting Decoction) plus Man Jing Zi (Vernonia Fruit), inducing slight sweat and peace. This woman had chronically failing Rising Yang; headache/back cold exacerbated by dispersing medicines damaged Wei Qi (Defensive Qi). Buzhong Yiqi Tang lifts Clear Yang; Wei Qi, aided by Ginseng, expels pathogens externally. This reflects Li Dongyuan’s subtle principles.

A young, obese man usually had no sweat on the left side and coldness under the left rib. Days ago, traveling by boat in sudden cold weather, he ate one chopstick of rice which felt cold immediately, causing intense chill. Falling off the boat, he undressed and slept. That night: fever, headache, wheezing, chest fullness, body ache, worse in lower back/left rib, inability to turn left side, still cold/not hot, slightly cold hands/feet. Returned ill on day three. Left pulse: string-fine; Right pulse: slow-slippery. Not typical exterior pattern. Given Xiao Chaihu Tang (Minor Bupleurum Decoction) for string-pulse/costalgia; no effect. Given Xiao Xuming Tang (Minor Rescue Life Decoction) for hemiplegia suspicion; no effect. Formula books suggest Er Chen Tang + Si Wu Tang for unilateral anhidrosis; ineffective. Tongue: thin coating, left white/slippery, right slightly yellow. Bowels moved twice, little volume. Urine slightly yellow/astringent. Asked Fei Feichou: "What disease? What medicine?" Fei said: "Chronic Cold-Fluid accumulation under ribs, compounded by internal/external cold, plus fright/fall/phlegm reversal. Fever/wheeze/headache/body ache are inevitable. Right side (Yang pathway) receives pathogen, transforming to Heat. Left side (Yin pathway/Cold-Fluid boundary) remains cold/sweatless; even with cold invasion, it酿 (brews) Cold. Where Yang Qi doesn't reach, heaviness/stiffness occurs; where Yang doesn't move in vessels, pulse is string-fine. Right slow-slippery pulse and cold hands/feet indicate declining Spleen Qi, weak Heat, hence wet tongue coating and soft stool. Yellow/astringent urine shows Lung/Stomach Qi mechanism failure but intact Lower Jiao True Yang. This person will likely die young, but currently salvageable. Give Wuji San (Five Accumulations Powder) three times day and night. Its Acrid-Warm dispersing power eliminates internal Cold-Stagnation, warms middle blood vessels, and expels exterior pathogens, achieving three goals. Externally, apply heated Baijiezi (White Mustard Seed), Chuanwu (Aconite), and Ginger residue wrapped in cloth. Once exterior resolves and interior harmonizes, use Liu Jun Zi Tang (Six Gentlemen Decoction) with Acrid/Warm herbs (Xixin, Fuzi, Ginger, Rougui) to warm Middle Qi."

A fat youth contracted Shanghan with stuporous fever. Sweating via exterior medicines led to delirium/restlessness. Lianggex San (Cooling Chest Powder) plus Huanglian (Coptis) cleared heat, but headache persisted for a month. Daytime: eye sockets, brow ridge, and temples sore/aching. Nighttime: severe pain, pulling/twitching sensation, feeling of wind blowing in eyes, relieved by pressing with hot palms. Sleep: heavy sweating on head/chest. Left pulse: tight-fine; Right pulse: floating-slow. Chatiao San (Tea Regulating Powder) and nasal insufflation failed. Blood-nourishing medicines failed. Asked Fei Feichou: "Heat pathogen drained internally, but Cold-Phlegm invaded meridians. Due to obesity, cannot exit externally, thus lingering. Neijing says: 'Fat people suffer from Eye Wind and Eye Cold.' Treatment should resolve Ying-level郁闭 (depressed/closed) Fire and remove deep Cold in meridians. Prescribed San Yin Congxin Tang (Three Causes Magnolia and Ligusticum Decoction) plus Ban Liang of raw Shigao (Gypsum). Effective in days. Followed, he recovered."

Xu Lingtai said: Expelling pathogens relies on two methods: Exterior-Releasing and Interior-Purging. Exterior-releasing opens pores to let pathogens exit via sweat. Use light, pale, aromatic, cooling agents to slowly draw pathogens out through skin, avoiding Middle Jiao and damaging Jin Ye (Body Fluids). Zhang Zhongjing’s Mahuang and Guizhi Tangs exemplify this. To prevent Ying-level Yin Qi from being consumed by Wind-Fire, preventing it from moistening and supporting pathogen expulsion, thin gruel is drunk to boost Stomach Qi and replenish fluids. Later generations ignored this, using heavy, warm-drying herbs like Houpo (Magnolia Bark), Gegen (Kudzu Root), Qianghuo (Notopterygium), Baizhi (Angelica Dahurica), Cangzhu (Atractylodes), Doukou (Cardamom). Even if fluids weren't initially deficient, internal frying by Wind-Fire plus external scorching by drying herbs prevents sweat production. Without sweat, pathogens have no vehicle to exit. Instead, drying herbs agitate pathogens, causing them to rampage, clash with Righteous Qi, spread Fire, damage fluids further, leading to scorched tongue, dry lips, constipation, red eyes, increasing heat, confusion, and myriad evil symptoms. Further sweating triggers extreme Yang Fire, disturbing True Yin; Kidney Water responds, Yuan Yang follows, massive sweating ensues, creating critical Yang Collapse. Mild cases become Spasm Syndrome, becoming complicated/incurable. Many have died from drying-sweat methods. This trend started with Li Dongyuan, whose prescriptions targeted Dampness, unrelated to Shanghan/Mixed Contractions. Later generations applied this to all exterior diseases, causing immense harm. Dampness treatment uses leaching agents (Zhuling, Wuling San), not drying ones. Dampness is an exterior pathogen; it should be driven out combined with dampness-drying herbs. Never use solely dampness-overcoming herbs that drive pathogens inward, clashing with Qi and damaging Yuan Qi. For Cold Invasion, exterior release is primary; never use pure hot herbs to overcome Cold. Only when Cold sinks inward due to deficiency with no exit should Guizhi/Fuzi restore Yang, as per Zhang Zhongjing’s Lizhong method. Today, using drying herbs to sweat mixed contractions violates ancient sage methods and misapplies Li Dongyuan’s principles. Medical Dao is lost; even shallow principles are unknown, let alone profound ones.

Someone asked Pei Zhaoqi: "A Shanghan patient transmitted inward with Heat-Knot obstruction. Purged repeatedly, abdomen feels hard around the navel like an inverted tile. Patient lies prostrate, bedridden for weeks, muscles wasted, refuses food/drink, Qi too weak to breathe. How to proceed when neither attacking nor tonifying seems feasible?" Pei answered: "By standard rules, attack is necessary; otherwise intestines won't clear, food won't enter, Qi won't recover, and life is impossible. But immediate attack on this emaciated, dying form would fail. Plan: Tonify first, then assess Pathogen/Rights Qi urgency/severity to attack. After attack, revert to tonification; after tonification, revert to attack, alternating. Both tonification and attack must be gradual, not abrupt. Start with small dose of Shengmai San (Generate Pulse Powder) plus Chenpi (Tangerine Peel), half a small cup. If no recurrence, give slightly more, then gradually double, discussing attack methods. If interior Heat remains, craving cold drinks, offer oranges, lotus root, melon, pear to moisten throat. Long dietary neglect weakens Stomach; occasionally give burnt rice soup, jujube soup, or mung bean, bamboo shoot, fern, radish, maltose soups according to preference to revive Stomach Qi. These are palatable, non-pathogenic aids complementing medicine—all tonification methods. Once tonification takes effect, discuss attack. Best agent: Yuanming Fen (Mirabilite). Raw Heshouwu (Polygonum Multiflorum) decoction is also good. Honey suppository, gallbladder suppository are excellent methods. Or detail pulse deficiency/excess, Qi strength/weakness, pathogen depth, using Daozhi Wan (Guide Stasis Pill) or Xiao Chengqi Tang plus Dang Gui for mild purgation. After purgation, still monitor Yuan Qi, don't rush forward ignoring deficiency. If able to eat, don't give rich food immediately. First burnt rice soup, then cooked pear/jujube/radish in small amounts. If tolerated, slowly introduce grain porridge/others. Know that internal attack won't clear everything; aim for quiet pulse, cool body, no thirst before attempting food/fluids. Wait for digestion, intestinal filling; elimination may occur naturally. Insisting on total clearance before feeding hastens death. Note: These are Yang-pattern attack/tonification methods. Also, diseases with internal Yuan Qi damage, mistreated, causing repeated loss. Internally Heat-Knotted, but externally hands/feet not cold, nose cold first. Six pulses deep-slow or deficient-rapid chaotic. Next stage: Yang pattern transforming to Yin. Urgently use Guizhi, Fuzi, Renshen, Ganjiang, warming/tonifying according to severity. Cannot be discussed alongside pear, melon, orange, lotus root, Chengqi, Yuanming Fen. Wise men must examine thoroughly and adapt. Not just Shanghan; chronic miscellaneous diseases rarely avoid this pattern."