Library

In the winter of the Guiwei year, the eldest son of my fellow student Zhang Xiugong, aged fourteen, suffered from external contraction of wind pathogen and internal injury by cold. He presented with headache, fever, thirst, and vomiting. His stool was clear and loose. There was pain and distension in the chest and abdomen, restlessness, stifling sensation, and insomnia. The pulse was floating and rapid but powerless upon deep pressure. Fortunately, the illness had lasted only two days and had not been mismanaged by other physicians. After one dose of Shenfu Lizhong Tang (Ginseng, Aconite, and Bupleurum Decoction), the previous symptoms were halved. Upon taking a second dose, the family suspected that the heat and thirst were unresolved and omitted Ginger (Shengjiang) and Aconite (Fuzi). Consequently, the previous symptoms recurred. I administered the original prescription again, and all symptoms disappeared. Mr. Zhang then asked, "Why use drying/hot agents for fever and irritability with thirst?" I replied, "Although the pulse is floating and rapid, it becomes powerless upon deep pressure; this is a symptom of false heat. With loose stools, abdominal pain, vomiting, and food refusal, this indicates internal closure by accumulated cold and false heat blazing externally. It is also a critical condition. If we had not firmly administered the former formula and instead mistakenly used exterior-releasing drugs, how could true Yang have been restored? Survival would have been impossible." He finally accepted and believed, and still praises me to this day.

The second son of Governor Lin of Guangdong suffered from the aforementioned condition. Eight days later, he developed restlessness and delirious speech. I was invited to examine his pulse; both wrists felt like silk threads, indicating exhaustion of both Yin and Yang. I predicted he would die at the second watch (1:00 AM - 3:00 AM) of the following night and declined treatment. When Zhuang Yanfan arrived, he also stated that the pulse and symptoms were deteriorated due to the mistaken use of cold agents. As predicted, he died at that time. My view is that Shanghan (Cold Damage) is an acute disease with frequent changes. If treatment is inappropriate, life hangs in the balance. Without steady and detailed examination of the pulse and pathogenesis in daily practice, how can one handle such cases with ease? The aforementioned condition belongs to external heat and internal cold, upper false heat and lower true cold, also known as "Jia Yin Shanghan" (Cold Damage with Concomitant Yin Deficiency/Cold). If Lizhong Tang with Ginger and Aconite had been used at the onset to warm the meridians and dispel cold, how could death have resulted from mismanagement and delay? Generally, patients' families fail to select competent physicians wisely and blindly follow those with current fame, often leading to self-inflicted harm.

In mid-winter of the Renwu year, a son-in-law of a Jinyiwei (Embroidered Uniform Guard) officer went to the countryside and was exposed to rain, cold, and dampness internally. Upon returning, he took several doses of exterior-releasing formulas, resulting in restlessness, stifling sensation, hiccups, and obstruction of urination and defecation. Six days later, Zhou Denggao treated him with Guifu Lizhong Tang (Cinnamon Twig, Aconite, Ginseng, Poria, etc. Decoction) without effect. Six days after that, I treated him. The six pulses were deep, minute, intermittent, and scattered. The pulses at Taixi (KI3) and Chongyang (ST42) were completely imperceptible. I predicted he would die the following night. I reluctantly prescribed a formula and advised him to consult other physicians. This condition originally belonged to the Lizhong Tang syndrome; why use acrid-cool agents instead, thereby exacerbating the disease and wasting a human life?