典藏书目

Carefully examining the medical case, it is known that this is a condition of Stomach Yin deficiency (Stomach Yin deficiency) with rebellious Stomach Qi (rebellious Stomach Qi). It is appropriate to administer substances that nourish Stomach fluids and direct Stomach Qi downward. However, due to the prolonged illness causing Qi deficiency, tonifying Qi herbs should be added as adjuvants.

Therefore, the following prescription is formulated. Take it boldly, and vomiting will surely cease, and bowel movements will become unobstructed. Once food intake no longer causes vomiting and bowel movements return to normal, another prescription can be formulated. The prescription is as follows: Raw Hematitum (Sheng Zhe Shi) 2 liang, Raw Dioscoreae Rhizoma (Sheng Shan Yao) 1 liang, Radix Codonopsis (Lu Dang Shen) 5 qian, Asparagi Radix (Tian Dong) 8 qian. Decoct together to obtain two tea cups of liquid, taken in three divided doses warm. The dregs are decocted again with water to obtain one and a half tea cups of liquid, taken in two divided doses warm. One dose is decocted twice, totaling five doses, consuming one dose per day. After three doses, vomiting will surely stop, and bowel movements will surely smooth out. When using this prescription, the dosage of Hematitum must absolutely not be reduced. If taking this medicine feels cooling, add 4-5 slices of fresh Zingiberis Rhizoma (Sheng Jiang); or adding 4-5 slices of Zingiberis Rhizoma at the beginning of treatment is also acceptable.

For prolapse of the rectum, washing with a strong decoction of Datura Metel (Man Tuo Luo) is very effective. I commonly use 4-5 jin of fresh Datura Metel, decocting to obtain 2-3 large bowls of concentrated juice. Then, decoct Cornus Officinalis Fructus (Yu Rou) 2-3 liang in this juice to obtain one large bowl of concentrated juice. Then, take Radix Codonopsis 2 liang, grind into fine powder, mix into the juice, and dry. Each time, use 4-5 qian, decoct in water until dissolved, and wash the affected area. Several treatments can lead to complete recovery.

Ancient texts should not be blindly believed, nor should they be completely dismissed. Presuming my own limitations, I dare to repeatedly present four doubts raised by Xu XX regarding the Shanghan Lun (Treatise on Cold Damage).

First Doubt: In the Taiyang Chapter, lower compilation, section 20. This section describes a disease in the Taiyang exterior, yet instead of resolving it through sweating, cold water was sprayed and poured. The external cold pathogen, having transformed into heat, was squeezed by internal and external cold water, unable to exit, and became stagnant in the muscles, causing irritability, heat, and gooseflesh. However, the heat is in the muscles, not the Stomach Fu organ, hence there is a desire to drink but no thirst. The treatment should be Wen Ge San (Clam Shell Powder). Wen Ge San is Clam Shell Powder (Wen Ge Fen) before calcination. Taking it, the texture is indigestible, and medicinal power is hard to exert. Moreover, although named Clam Shell, it is actually the shell of a bivalve mollusk; its nature is descending and sinking, and its ability to reach the exterior is originally very weak. Using it to eliminate gooseflesh on the skin seems unlikely to succeed. Hence it continues: "If not improved, give Wu Ling San (Five-Ingredient Powder with Poria)." This formula utilizes its ability to promote urination and vent the exterior, while strengthening Spleen and Stomach transport to assist the motive force for promoting urination and venting the exterior; the disease should then resolve. However, a concern remains: if too much cold water was poured, interacting with the exterior pathogen in the Upper Jiao to form Cold Excess Chest Binding (Han Shi Jie Xiong), neither of the previous two formulas would suffice. Thus, San Wu Xiao Xian Xiong Tang (Three-Ingredient Minor Acridity Opening Chest Decoction) or Bai San (White Powder) should be used. The acrid-warm opening nature of Bai San is appropriate for this condition. As for San Wu Xiao Xian Xiong Tang, if it is indeed Xiao Xian Xiong Tang (Minor Acridity Opening Chest Decoction), using it here to treat cold with cold—would that be appropriate? Commentators call this the "contrary treatment" method. Contrary treatment involves treating cold with heat; fearing rejection, a small amount of cold medicine is used as a guide, acting as an antipode to the hot medicine, rather than purely using cold medicine to treat cold. It seems commentators, intimidated by the lofty reputation of ancients, invariably protect ancient texts even when errors or omissions exist, unaware that this misinterprets the ancients and misleads future generations. Therefore, in my work *Yixue Zhongzhong Canxi Lu* (Records of Medical Studies Integrating Chinese and Western Medicine), for ancient prescriptions that can be trusted, I often vigorously commend them, or adapt and refine them to exhaust their miraculous effects; for those difficult to trust, I temporarily leave them as questions for experts to judge. To strive for progress in medicine, one must act thus.

Regarding San Wu Xiao Xian Xiong Tang in this section, Tang Rongchuan suspected it was a separate formula, not identical to Xiao Xian Xiong Tang. However, in Shanghan Taiyang disease, cases of spraying or pouring water are rare. I suspect this section is not original text by Zhang Zhongjing.

Second Doubt: In the Taiyang Chapter, lower compilation, section 32. This section states: "Taiyang disease, the physician induced sweating, leading to fever and aversion to cold; subsequently purging was applied, resulting in epigastric fullness and obstruction (Pi); both exterior and interior are deficient, Yin and Yang Qi are exhausted; without Yang, Yin stands alone; adding moxibustion on needles caused chest irritability, bluish-yellow complexion, and twitching skin indicates a difficult-to-treat case; now with a slightly yellow complexion and warm hands and feet, it is easy to treat." According to the textual meaning, there must be erroneous or missing characters. Chen's interpretation of "Yin and Yang Qi are exhausted" as "failure of Yin and Yang Qi to interact" is very apt. Regarding "without Yang, Yin stands alone," I believe the character "Jie" (knot/stagnation) should follow "Du" (alone). It means that mistaken sweating and purging have depleted Upper Jiao Yang Qi, preventing free circulation, so Yin Qi stagnates alone in the epigastrium forming Pi syndrome.

Third Doubt: In the Taiyang Chapter, lower compilation, section 54. This section discusses Cold Damage with floating and slippery pulse. A slippery pulse indicates heat has entered the interior. However, floating combined with slippery suggests heat has not fully entered the interior; half is in the Yangming Fu organs, half in the Yangming meridians. Meridians belong to the exterior, Fu organs belong to the interior, hence it says "Exterior has heat, Interior has cold." *Neijing* states, "Heat diseases are all categories of Cold Damage." It also states, "When humans are injured by cold, they develop heat diseases." The "Interior has cold" mentioned here likely refers to the Cold Damage heat pathogen having entered the interior. Chen's explanation is exactly this, and I agree. Other commentators suggest the words "cold" and "heat" should be swapped, reading "Exterior has cold, Interior has heat." However, given the floating-slippery pulse, the exterior certainly does not exhibit aversion to cold. Some suggest "cold" is a typo for "phlegm" due to similar pronunciation, and slippery pulse also indicates phlegm. However, in warm diseases, a slippery pulse primarily indicates solidified Yangming heat and proves the patient's Qi and Blood are robust, making treatment easier. If slippery pulse implies phlegm, is Baihu Tang (White Tiger Decoction) a remedy for phlegm?

Fourth Doubt: In the Yangming Chapter, section 76. This section states the patient has no exterior or interior signs, meaning no exterior signs like headache, stiff neck, and aversion to cold, nor interior signs like abdominal fullness and hard stool. It continues: "Fever for 7-8 days, even if the pulse is floating and rapid, purging may be used." These words are astonishing. Floating pulse indicates sweating is indicated; rapid pulse contraindicates purging; everyone knows this. How much more so when floating and rapid pulses appear together, yet purging is used? The disease would not heal, and the pulse would become more rapid. Hence it continues: "Suppose after purging, the rapid pulse persists..." Later, due to voracious appetite and chronic constipation, Didang Tang (Di Dang Decoction) is used to purge. In cold/warm diseases, patients with rapid pulses typically lack appetite; voracious appetite is rarely seen. Even with voracious appetite and constipation, how can one assume blood stasis exists to lightly administer Didang Tang? It further states: "If rapid pulse persists and diarrhea continues..." implying repeated purging led to collapse (Xia Tuo). Using medication to resolve the rapid pulse, yet failing to resolve it and causing collapse, shows the medication was inappropriate step-by-step. Can this still be trusted as original text by Zhang Zhongjing? Observe section 31 of the Yangming Chapter, where Zhang Zhongjing is extremely cautious regarding purging indications. Comparing these two sections, this section being a forgery is evident. Ancient classics inevitably contain forgeries (e.g., modern script *Shangshu*); thus, forgeries in medical texts are not surprising. It is hoped that commentators will carefully distinguish and critique them, avoiding misleading the medical community, which would be fortunate!