Library

In cases where yin syndromes are present from the onset of illness, if treatment is not initiated early or is inappropriate, and after several days symptoms such as restlessness and mania-like behavior (Yin Zao, Yin Dryness) appear, this is known as "Yin Zao." Often, physicians mistakenly treat this as Yang mania, accelerating the patient's death, which is truly lamentable. The difficulty in treating Shanghan (Cold Damage) lies precisely in these ambiguous critical junctures; if analysis and judgment are inadequate, errors occur. Among contemporary physicians, only Cheng Fengshan could recognize this condition.

In the summer of the Guiwei year, the eldest son of Zheng Si from Purwei, having performed liver-cutting to save his father (an ancient act of filial piety), soon contracted wind-cold with pathogenic factors entering the interior. After six days, Yi Zhi examined him and identified symptoms of Yin Zao with mania-like behavior; the pulse was knotted, intermittent, and weak. He declined to treat the case. The following day, the patient indeed died. Generally, for Yang syndromes of Shanghan, if seven to nine days pass, they become difficult to treat; for Yin syndromes, if four to six days pass, they are considered untreatable; for Yang toxicity, if five to seven days pass, they are difficult to treat; for Yin toxicity, if two to four days pass, they are untreatable. If Yang mania is treated even slowly, one out of a hundred may die; if Yin Zao is treated early, one out of a hundred may survive. However, Yang syndromes can also recover after seven, nine, or even fourteen days. If the constitution is strong and the pulse is robust, and the cold pathogen remains in the meridians without affecting the zang-fu organs, recovery will occur naturally upon the restoration of meridian qi, even without medication; there are no cases where medication fails to cure. In contrast, for Yin syndromes, cold pathogens invade the zang-fu organs, further damaging yuan qi (Original Qi). Even with correctly indicated medications administered slowly, death may still occur; those who do not receive medication are less likely to die; and those receiving incorrect medications die rapidly. The *Neijing* states: "When the disease momentum has passed, life is hard to preserve." How can one not reflect deeply? If one does not distinguish between yin and yang, deficiency and excess, nor assess the duration of the illness, but applies remedies indiscriminately, it is ignorance of auspicious and inauspicious outcomes, truly inviting slander.

In the winter of the Guiwei year, Shengzhi, the nephew of Mingjing Li Yuanfu, suffered from mixed-yin Shanghan with dryness/restlessness. Initially, he was treated by a secular physician and a monk-physician, who prescribed herbs such as Zhimu (Anemarrhenae Rhizoma), Chaihu (Bupleuri Radix), Baishao (Paeoniae Radix Alba), Shengma (Cimicifugae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma), Qianghuo (Notopterygii Rhizoma et Radix), and Gegen (Puerariae Lobatae Radix). I judged that he would not survive beyond three days and declined treatment. As predicted, he died at the appointed time. Li Dongyuan stated: "When Yin Zao reaches its extreme, the patient desires to sit in a well [to cool down]; Yang qi has already perished." Yet physicians remain unaware, misidentifying it as heat syndrome and administering heavy doses of cold-natured medicines. Is there any doubt about their death? Cheng Wuji said: "Although the patient is restless and wants to sit in a well, they desire water but cannot swallow it." The *Neijing* states: "Do not exacerbate excess, do not deplete deficiency, lest you bring premature death upon people; do not aid evil, do not neglect righteousness, lest you cut off long life." Such individuals only know how to treat visible symptoms without considering true and false, deficiency and excess; they kill with a flip of the hand. Can their crimes be fully condemned?