武林丁松翁三世兄。患风热喉痈。初起觉微寒。旋即发热。阅三日喉关之内小舌两旁。如有物梗塞。至五六日脓
成痛甚。始患喉内两旁。双发喉痈。先延他医治之。处以辛凉疏风轻剂。至七八日乃召余诊。脉之寸关二部浮数。
两尺虚软无力。余谓症属风热上壅。须以清火解毒为主。幸前方无误。脉象清爽。症虽危而可安。但勿求速效。走
入歧路。致增跋涉耳。松翁深以为然。乃用羚羊角、石膏、知母、银花、僵蚕、薄荷、竹茹、青黛、山栀等清化上焦之
风热。大便闭结。则用大黄、芩、连、元明粉等以通利之。吹以消肿解毒拔脓之药。至二十余日。脓腐未尽。人益困惫。
举家惶惑。乃用斑蝥等外治之药。欲提其毒从外而出。余至急令揭去。用甘草汤洗净。诚以腐脓已化断无外提之理。
徒使毒瓦斯散漫。迁延难愈。至念余日脓腐方尽。脉亦平静。而肿痛依然。方信余言不谬也。乃用生甘草六钱。生绿
豆一盏。煎汤再加化毒清火养阴之药。次日肿痛果瘥。后以养胃安神之剂。出入加减。月余始痊。
金姓子。年二十。患时毒喉痹。初起微寒。继即壮热神昏。两手搐搦。至六七日。医用普济消毒饮法。不效。后闻
丁姓喉症。为余治愈。来延余诊。脉左右六部俱浑浑然。软而无力。至数模糊。神识不清。喉痹肿连上 。其色鲜赤。
舌苔赤而起刺。余曰。此症甚危。恐难奏效。姑且按病施治。然或有变端。莫以余言之不预也。盖脉本不治。闭脱之象
已见。乃处大剂清火解毒之方。如犀角、羚羊角、连翘、山栀、石膏、银花、鲜石斛、芦根、金汁、人中黄、元参、丹
皮、紫雪丹、至宝丹之类。出入更易。服二剂而热瘥。神识稍清。痉厥不作。群以为庆。脉仍躁动模糊。两尺虚软。余
曰。外象虽瘥。脉无转机。虑有变端。须得热净神清。脉象安静。至数清楚。虽肤冷困惫。不足忧也。仍照前法互相出
入。次日果复壮热神昏。胸间发出白 数点。余曰。白 发而未透。汗出而热不衰。其为危候明矣。辞以不治。病家力
恳疏方。余见其坚信不疑。只得勉尽人力。前方分量加重。至第十三日白 浑身发出。舌燥唇焦。齿缝出血。面目俱赤。
烦躁狂越。汗出如浴。热愈炽。脉洪大而数。余曰。生死之机。只在今晚。倘得热退。便得生机。若仍如是。恐华扁亦
难挽回矣。次日热复不退。牙关紧急。至第七日而殁。或问余曰。此症始见尚轻。何君便言死候。丁姓之症。已经危险。
何君力言无妨。余曰。见之于脉耳、外症虽险。而脉尚顺。可保无虞。外症虽轻。而脉已逆。终归不治。如丁姓之症。
风火
上壅。其脉浮数。浮则为风。数则为火。症脉相应。至数并分明也。此症亦属风火。寸口之脉。不鼓至数。浑浑不清。
两尺虚软无力。是少阴之精血内虚。风热之邪从口鼻吸受。伏于募原。得少阳阳热之化。三焦游行之火。内外充斥。不
能从募原达出。而成闭脱之症。况温病多死下元虚弱之人。少阴不藏。精血内虚。肝阳素旺。痉厥立至。叶天士论温
热甚详。法本内经。经云。冬不藏精。春必病温。温病之脉。最忌浑浑模糊。内经云。浑浑革至如涌泉。病进而色敝。
是病内经名曰阴阳交。素问评热病论。帝曰有病温汗出而辄复热。而脉躁疾不为汗衰。狂言不能食。病名为何。岐
伯曰。病名阴阳交。交者死也。人所以汗出者。皆生于谷。谷生于精。今邪气交争于骨肉而得汗者。是邪却而精胜
也精胜则当能食而不复热复热者邪气也汗者精气也今汗出而辄复热者邪气胜也不能食者精无俾也病
而留者。其寿可立而倾也。且热论曰。汗出而脉尚躁盛者死。今脉不与汗相应。此不胜其病也。其死明矣。狂言者。
是失志。失志者死。今见三死。虽愈必死也。是内经有必死之文。其能治之以生乎。
武林的丁松翁先生的三世兄，患了风热喉痈。起初感觉轻微怕冷，随即出现发热。过了三天，喉咙关隘内部小舌两侧，感觉有物体梗塞。到了第五六天，脓液形成，疼痛剧烈，这才发现喉咙内部两侧同时发作了喉痈。起初请其他医生治疗，开具辛凉疏风的轻剂。到了第七八天，才邀请我诊治。诊脉发现寸、关两部脉象浮数，两尺部脉象虚软无力。我对他说，此症属于风热上壅，必须以清火解毒为主。幸好之前的处方没有错误，脉象清爽，虽然症状危重但可以平安度过。只是不要追求速效，以免走入歧路，导致病情加重延误治疗。松翁深以为然。于是使用羚羊角、石膏、知母、银花、僵蚕、薄荷、竹茹、青黛、山栀等药物清化上焦的风热。如果大便闭结，则用大黄、黄芩、黄连、元明粉等药物通利大便。外用消肿解毒拔脓的药物吹入患处。到了二十多天，脓腐未尽，人更加困倦疲惫，全家惶恐疑惑，于是使用斑蝥等外治药物，想要提毒从外部排出。我急忙令其揭去，用甘草汤洗净。因为腐脓已经化尽，绝无外提之理，这样做只会使毒气散漫，迁延难愈。到了念余日（约三十多天），脓腐才完全排尽，脉象也平静下来，但肿痛依然。这时才相信我的话没有错。于是使用生甘草六钱、生绿豆一盏，煎汤后再加上化毒清火养阴的药物。第二天肿痛果然减轻。后来以养胃安神的方剂出入加减，一个多月才痊愈。
金姓人家的儿子，二十岁，患时毒喉痹。起初轻微怕冷，接着出现高热神志昏迷，双手抽搐痉挛。到了第六七天，医生使用普济消毒饮的方法治疗，无效。后来听说丁姓人的喉症被我治愈，便来邀请我诊治。诊脉发现左右六部脉象都浑浑然，软而无力，至数模糊，神识不清。喉痹肿胀连及上部，颜色鲜红。舌苔赤红且起刺。我说，此症非常危险，恐怕难以见效。姑且按照病症施治，然而可能会有变化，请不要认为我没有预先告知。因为脉象本属不治，闭脱的征象已经出现。于是开大剂清火解毒的方子，如犀角、羚羊角、连翘、山栀、石膏、银花、鲜石斛、芦根、金汁、人中黄、元参、丹皮、紫雪丹、至宝丹之类，根据情况出入更替。服用两剂后热势减退，神识稍清，痉厥不再发作，大家都为此庆幸。但脉象仍然躁动模糊，两尺虚软。我说，外表症状虽然好转，但脉象没有转机，担心会有变故。必须等到热退净、神志清、脉象安静、至数清楚，即使皮肤冷、身体困倦，也不必担忧。仍然照前法互相出入调整。第二天果然又出现高热神志昏迷，胸部发出几处白疹。我说，白疹发出但未透发，出汗而热势不消退，这显然是危候。我以无法治愈为由推辞，病家极力恳求开方。我看他们坚信不疑，只得勉强尽力。前方药量加重。到第十三日，白疹遍布全身，舌燥唇焦，齿缝出血，面目俱红，烦躁狂越，汗出如浴，热势更炽，脉象洪大而数。我说，生死的关键就在今晚，如果热退，便有生机；如果仍像现在这样，恐怕华佗、扁鹊也难以挽回。第二天热势仍不退，牙关紧急，到第七天死亡。有人问我，此症开始时还较轻，为何您就说死候？丁姓人的症，已经危险，为何您力言无妨？我说，关键在于脉象。外症虽然险恶，但脉象尚顺，可以保全无虞；外症虽然轻微，但脉象已逆，最终归为不治。如丁姓人的症，风火上壅，脉象浮数，浮则为风，数则为火，症脉相应，至数分明。此症也属风火，但寸口脉不鼓动至数，浑浑不清，两尺虚软无力，这是少阴精血内虚。风热邪气从口鼻吸入，伏于募原，得少阳阳热之化，三焦游行之火，内外充斥，不能从募原透出，而成闭脱之症。况且温病多死于下元虚弱之人，少阴不藏，精血内虚，肝阳素旺，痉厥立至。叶天士论述温热病非常详细，其法本于《内经》。《内经》说：“冬不藏精，春必病温。”温病的脉象，最忌浑浑模糊。《内经》说：“浑浑革至如涌泉，病进而色敝。”这在《内经》中名为阴阳交。《素问·评热病论》记载：黄帝问，有病温病，汗出后就再次发热，脉象躁疾不因出汗而衰减，胡言乱语不能进食，这是什么病？岐伯说，病名阴阳交，交者死也。人之所以出汗，都源于水谷精气，水谷精气生于精。现在邪气与精气在骨肉间交争而得出汗，是邪气退却而精气胜利。精气胜利就应当能进食而不复发热。如果再次发热，那是邪气胜。出汗的是精气，现在出汗后就再次发热，是邪气胜。不能进食，是因为精气得不到补充。病邪留滞不去，寿命立刻就会倾覆。而且《热论》说：汗出而脉象还躁盛的，死。现在脉象不与汗相应，这是不胜其病，死亡是明确的。胡言乱语，是失志，失志者死。现在见到三种死征，即使暂时痊愈也必死无疑。《内经》有必死的条文，怎么能用生法治疗呢？
Wulin's Ding Songweng's third-generation elder brother suffered from wind-heat throat abscess (Fengre Houyong). Initially, he felt slight chills, followed by fever. After three days, a sensation of obstruction was felt on both sides of the uvula inside the throat gate. By the fifth or sixth day, pus formed causing severe pain, revealing bilateral throat abscesses in the throat. He was initially treated by other physicians with light formulas for acrid-cool dispersing wind (Xinliang Shufeng). On the seventh or eighth day, I was consulted. The pulse at the Cun and Guan positions was floating and rapid (Fushu), while the Chi positions were deficient, soft, and powerless. I stated that this condition belongs to wind-heat obstructing upwards, requiring clearing fire and resolving toxicity as the primary treatment. Fortunately, the previous prescriptions were not erroneous, and the pulse image was clear. Although the symptoms were critical, recovery was possible. However, one must not seek quick effects to avoid deviating into wrong paths and worsening the condition. Songweng agreed deeply. Thus, Antelope Horn (Lingyangjiao), Gypsum (Shigao), Anemarrhena (Zhimu), Honeysuckle (Yinjinhua), Silkworm (Jiangcan), Mint (Bohe), Bamboo Sap (Zhuru), Indigo Naturalis (Qingdai), and Gardenia (Shanzhi) were used to clear and transform wind-heat in the Upper Jiao. If constipation occurred, Rhubarb (Dahuang), Scutellaria (Huangqin), Coptis (Huanglian), and Mirabilite (Yuanmingfen) were used to unblock the bowels. External medications for reducing swelling, resolving toxicity, and drawing out pus were insufflated into the lesion. After more than twenty days, when the necrotic pus had not fully cleared and the patient became increasingly exhausted, the family panicked. They attempted external treatments with Mylabris (Banmao) to draw the toxin outwards. I urgently ordered their removal and cleansing with Licorice Decoction (Gancao Tang), reasoning that once pus is resolved, there is no rationale for external extraction; doing so would only scatter the toxic qi, leading to prolonged difficulty in healing. By around thirty days, the necrotic pus finally cleared, the pulse calmed, but swelling and pain persisted. Only then did they believe my words were correct. A formula containing six qian of raw Licorice (Sheng Gancao) and one zhan of raw Mung Bean (Sheng Lvdou), decocted, plus herbs for resolving toxicity, clearing fire, and nourishing yin, was administered. The next day, swelling and pain indeed subsided. Subsequently, formulas for nourishing the stomach and calming the spirit were adjusted over time, leading to full recovery after more than a month.
The son of a surnamed Jin, aged twenty, suffered from epidemic toxic pharyngitis (Shidu Houbi). Initially slight chills, followed by high fever, coma, and spasms of the hands. By the sixth or seventh day, treatment with Puji Xiaodu Yin proved ineffective. Hearing that I had cured the surnamed Ding's throat condition, he sought my consultation. The pulse in all six positions on both left and right sides was turbid and indistinct (Hunhun), soft and powerless, with an unclear rate and disoriented consciousness. The pharyngitis swelling extended upwards, appearing bright red. The tongue coating was crimson with prickles. I stated, "This condition is very critical; effectiveness is unlikely. I will treat according to the disease, but changes may occur. Do not say I did not warn you." The pulse indicated incurability, with signs of closure and collapse already present. Therefore, a large dose of fire-clearing and toxicity-resolving formula was prescribed, including Rhinoceros Horn (Xijiao - now substituted), Antelope Horn (Lingyangjiao), Forsythia (Lianqiao), Gardenia (Shanzhi), Gypsum (Shigao), Honeysuckle (Yinjinhua), Fresh Dendrobium (Xian Shihu), Reed Rhizome (Lugen), Gold Juice (Jinzhi), Human Excrement Yellow (Renzhonghuang), Ophiopogon (Yuanshen), Moutan Bark (Danpi), Zi Xue Dan, and Zhi Bao Dan, modified as needed. After two doses, heat subsided, consciousness slightly cleared, and spasms ceased, bringing relief to all. However, the pulse remained restless and indistinct, with deficient and soft Chi positions. I said, "Although external symptoms improved, the pulse shows no turnaround. I fear complications. Recovery requires complete heat clearance, clear consciousness, calm pulse, and distinct rate. Even if skin is cold and body exhausted, do not worry." Treatment continued with modifications. The next day, high fever and coma returned, with several white rashes appearing on the chest. I said, "White rashes have emerged but are not fully expressed; sweating has not reduced the heat. This is clearly a critical sign." I declined to prescribe due to incurability, but the family insisted. Seeing their firm belief, I reluctantly tried my best, increasing the dosage of the previous formula. By the thirteenth day, white rashes covered the whole body, tongue was dry, lips scorched, gums bled, face and eyes were red, restlessness and mania prevailed, sweating profusely like bathing, heat intensified, and the pulse became surging and rapid. I said, "Life and death hinge on tonight. If heat recedes, there is hope. If it continues thus, even Hua Tuo or Bian Que cannot save him." The next day, heat persisted, jaw locked, and the patient died on the seventh day. Someone asked, "Why did you declare death so early when symptoms seemed mild initially? Why did you say Ding's case was safe despite its danger?" I replied, "It lies in the pulse. For Ding, although external symptoms were dangerous, the pulse was compliant, ensuring safety. For Jin, although external symptoms were mild, the pulse was rebellious, leading to inevitable death. Ding's case involved wind-fire obstructing upwards, with a floating and rapid pulse—floating indicates wind, rapid indicates fire. Symptoms and pulse corresponded, with distinct rates. Jin's case also involved wind-fire, but the Cun position pulse did not drum to the rate, being turbid and unclear, with deficient and soft Chi positions indicating deficiency of Essence and Blood in Shaoyin. Wind-heat pathogen entered via nose and mouth, lodged in the Mu Yuan, transformed by Shaoyang Yang heat, and filled internally and externally by wandering fire of the San Jiao, unable to exit from Mu Yuan, resulting in closure-collapse syndrome. Warm diseases often kill those with weak lower origin. Shaoyin fails to store, Essence and Blood are internally deficient, Liver Yang is naturally hyperactive, leading to immediate spasms and convulsions. Ye Tianshi discussed warm-heat diseases in detail, based on the Nei Jing. The Nei Jing states: 'If one does not store essence in winter, one will suffer from warm diseases in spring.' The pulse of warm diseases most忌讳s being turbid and indistinct. The Nei Jing says: 'Turbid and sudden arrival like surging springs, disease advances and complexion deteriorates.' This is named Yin-Yang Intersection in the Nei Jing. In Suwen Ping Re Bing Lun, the Emperor asked: 'In warm disease, sweating is followed immediately by recurrent fever, restless pulse not declining with sweat, delirium, and inability to eat. What is this disease?' Qibo answered: 'Named Yin-Yang Intersection. Intersection means death.' Humans sweat due to grain essence, which generates Jing. Now, pathogen and Jing struggle in muscles and bones, producing sweat, meaning pathogen retreats and Jing wins. Winning Jing should allow eating and no recurrent fever. Recurrent fever means pathogen wins. Sweat is Jing essence. Now sweating leads to recurrent fever, meaning pathogen wins. Inability to eat means Jing lacks support. Disease lingering implies life ends instantly. Also, Relun says: 'Sweating with still restless and vigorous pulse indicates death.' Now pulse does not correspond with sweat, meaning it cannot overcome the disease. Death is clear. Delirium indicates loss of Zhi (willpower); loss of Zhi leads to death. Seeing three death signs, even if temporarily recovered, death is certain. The Nei Jing has texts declaring certain death; how can it be treated with life-giving methods?"