Library

Chapter 13 of the Ping Mai Fa (Method of Assessing Pulse) in the Shang Han Lun. A question was asked: What is meant by "Zai Guai" (Disaster and Wonder/Monster) in pulse diagnosis? The Master replied: Suppose a person is ill, and the pulse indicates Tai Yang disease (a syndrome caused by pathogenic invasion of the Tai Yang channel), which corresponds with the physical signs and symptoms. Consequently, a decoction is prescribed. However, upon returning home to take the medicine, after about the time it takes to eat a meal, the patient suddenly experiences severe vomiting, or diarrhea accompanied by abdominal pain. The Master said: "I did not observe these symptoms during my initial examination; the condition has now changed abruptly. This is called 'Zai Guai'." Another question was raised: "What causes such vomiting and diarrhea?" The answer was: "It may be due to medication taken previously by the patient, which is only now taking effect. Hence, it is termed 'Zai Guai'."

Cheng Jiaoqian commented: Observation and inquiry are indeed duties of the physician, but they require the patient to be completely candid without concealment, so as to fully utilize the physician's expertise. Therefore, this clause is added as a warning against patients concealing their prior medication from doctors. The disaster stems from one's own actions, yet blame is shifted to the physician, hence the term "Zai Guai". However, there exists another type of illness known as "Guai Zai Bing" (Monster Disaster Disease), which must not be overlooked. If one follows the methods of Zhang Zhongjing and prescribes his formulas, the patient may find it strange and use this to demonstrate to other physicians. Those who shake their heads and stick out their tongues in exaggerated surprise will instead treat illnesses that do not present such strange features. Mild cases become severe, severe cases lead to death, and disaster befalls the body, leaving them unable to identify the nature of the disease. In recent times, such diseases have become epidemics, spreading house to house. Zhang Zhongjing did not mention this; perhaps in his era, there were only "Zai Guai Bing" but no "Guai Zai Bing". It is quite amusing.

In an annotation: Cheng Jiaoqian stated that for "Guai Zai Bing", the fault does not lie with quack doctors spreading rumors, but with patients valuing hearsay over direct observation. They consult popular versions of Ben Cao Gang Mu (Compendium of Materia Medica) to check prescriptions of famous doctors, and use clichés from common texts to criticize and refute the treatment methods of renowned physicians. This causes famous doctors to sigh and refuse to argue, leaving decisively. Is this not disaster brought upon oneself?

Recalling the spring of the Wuchen year, Li Taishou, named Fuqing, suffered from shortness of breath. I recommended alternating Gui Ling Gan Zhu Tang (Cinnamon Twig, Poria, Licorice, and Atractylodes Macrocephala Decoction) with Shen Qi Wan (Kidney Qi Pill), promising efficacy within half a month. Soon, he heard rumors, was startled and suspicious, and stopped taking the medicine. He hired an old doctor, Lao Tao, from Tianjin. After taking more than thirty doses of Ting Li Zi (Descurainiae Semen), Xing Ren (Armeniacae Semen), Pi Pa Ye (Loquat Leaf), and Mu Tong (Akebiae Caulis), among others, he died due to abdominal distension, edema, and urinary retention.

Ye Mingjun, a waiting magistrate, accidentally contracted cough with slight fever and difficulty urinating. I stated that one dose of Xiao Qing Long Tang (Minor Green Dragon Decoction) would yield results. He found this strange and refused to take it, instead consulting another doctor who prescribed herbs such as Bei Mu (Fritillariae Bulbus) as adjuvants. More than twenty days later, we met at the official residence in Beiguan. He said his cough had healed, but he felt short of breath early in the morning, with no other ailments. I observed a latent bluish-dark discoloration in the skin and subcutaneous tissue of his face, particularly around the mouth. Palpating his pulse, it was rapid, wiry, and hollow (Kou); upon heavy pressure, it was scattered and lacked spirit. I told him directly: "This is a sign of Yin pathogens prevailing and Yang light about to extinguish. You should discard previous medications. Boil Bai Zhu (Atractylodis Macrocephalae Rhizoma) and Fu Zi (Aconiti Lateralis Radix Preparata) strongly, mix with half a cup of fresh Ginger Juice (Sheng Jiang Zhi), and take six to seven doses. Emergency rescue is still possible." Lord Ye did not respond, considering my words too radical. That night, he felt exceptionally fatigued. The previous doctor continued prescribing Shu Di Huang (Rehmanniae Radix Preparata) 1 liang, Dang Shen (Codonopsis Radix) 5 qian, Gou Qi Zi (Lycii Fructus), Mai Dong (Ophiopogonis Radix), and E Jiao (Asini Corii Colla) each 3 qian, Du Zhong (Eucommiae Cortex), Jiu Shao Yao (Paeoniae Radix Alba preparata with wine), and Dang Gui (Angelicae Sinensis Radix) each 2 qian, and Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata) 1 qian. The next morning after ingestion, the patient fell into coma, unable to speak, with surging phlegm and saliva. His brother informed me in alarm: "You previously mentioned a wisp of residual Yang; supporting it might barely suffice, let alone using Shu Di Huang etc. to aid its Yin-damp energy. Now, Yin-damp energy fills the sky, phlegm surges, resembling Stroke (Zhong Feng). Since the Liver is the organ of Wind-Wood, when the vital Qi of the East is about to collapse, such external manifestations often appear. This syndrome is indistinguishable from Stroke." Palpating his pulse, it was wiry, rapid, scattered, irregular, and inconsistent. I explicitly stated I would not treat further. Indeed, he passed away at Wei hour the next day.

In the autumn of the Gengwu year, July, Ding Mingpanlong, former Prefect of Tianjin, visited my lodging. I saw dark black discoloration in his facial skin and subcutaneous tissue, especially around the lips. The area under the eyes (Wocan) was slightly swollen, and there was a hint of bluish color on the nose. I told him directly: "You have a root cause of Water-Drink pathology, carrying Liver Qi to act recklessly. Urgent treatment now can cure it. If delayed by twenty days, once the disease erupts, doctors will multiply, and prescriptions will become chaotic. It will all revolve around Qi, Blood, Phlegm, and Stagnation, resulting in ineffective standard formulas. Even if Water-Drink is discussed, mild treatment uses Liu Jun Zi Tang (Six Gentlemen Decoction) or Er Chen Tang (Two Aged Substances Decoction) modifications; severe treatment uses Gun Tan Wan (Rolling Phlegm Pill) or Hei Xi Dan (Black Tin Pill). These are perfunctory approaches, missing the essence of the case. Testing drugs on the disease until exhausted leads to changing strategies; even Bian Que could not help. Lord Ding thought my words were too extreme and did not listen. By late July, the disease erupted. After Mid-Autumn Festival, it worsened. In late September, he invited me to diagnose. I told him: "The faults I previously described have now occurred one by one. My earlier statement that no medication is needed after onset was not an excuse. However, creating treatments out of nothing, the only instance in the Cough Chapter of Jin Gui Yao Lue (Essential Prescriptions from the Golden Cabinet) using Shi Zao Tang (Ten Jujubes Decoction) states: 'For patients with cough and wiry pulse, indicating water retention, this formula is indicated.' It also says: 'For patients with Branch-Drink suffering cough, irritability, and chest pain, if they do not die suddenly, even after 100 days or a year, this formula is suitable.' Inferring the root cause formed in early winter last year, less than a year has passed, and the current onset is only over 60 days, still within 100 days. Yu Jiayan detailed this in Yi Men Fa Lv (Medical Laws of the Medical Gate) - Cough Continuation Discussion. Wait for someone with insight and courage to use it; I cannot. An old doctor in the room strongly argued against it. I tentatively prescribed Long Gu (Fossilia Ossis Mastodi), Mu Li (Concha Ostreae), Gan Cao (Licorice), and Fu Ling (Poria) for draining water and transforming Qi, along with Fu Zi (Prepared Aconite Root), Rou Gui (Cinnamon Bark), and Ren Shen (Ginseng Root). The patient took them continuously, gradually developing severe panting, swelling, hematemesis, massive hemorrhage, bleeding from ears and eyes, complete anuria, and finally died. These are all new cases of Guai Zai Bing."