五味异功散、治中汤一二服。五日得平。此仿完颜小将军暑月内伤发斑治法也。
副枢张息轩伤寒逾月。既下而内热不已。胁及小腹偏左满。肌肉色不变。俚医以为风所
中。膏其手摩之。浃旬。其毒循宗筋流入于睾丸。赤肿若匏。刺溃之。而左胁肿痛如故。召
吕诊。吕以关及尺中皆滑数而且芤。因告之曰。脉数不时。则生恶疮。关内逢芤则内痈作
胁之肿。痈作脓也。下之勿晚。乃用保生膏作丸。衣之以乳香。而用硝黄作汤下之。下脓
五升许。明日再圊下余脓。立痊。
震按此条以伤寒而变肠痈。虽不多见。亦不可不知。观其所告之言。两句出仲景伤寒论
两句出高阳生脉诀。因思自明以前。皆用此诀。何近贤之痛诋不堪耶。
芮子玉病伤寒。乃阴隔阳证。面赤足蜷。躁扰不得眠而下利。论者有主寒主温之不一。
愈不能决。吕元膺以紫雪匮理中丸进。徐以冰渍甘草干姜汤饮之愈。且告之曰。下利足蜷。
四逆证也。苟用常法。则上焦之热弥甚。今以紫雪折之。徐引辛甘以温里。此热因寒用也。
闻者皆叹服。
震按此为阴盛隔阳。亦曰下寒上热。沧州翁以寒药裹热药。与热药冷服义同。其理精矣
然阅各家医案。能识此证者亦不少。至如阴中伏阳。则惟有许学士一案。其治乡人李信道
头疼身温烦躁。指末皆冷。胸中满。恶心。六脉沉伏不见。深按至骨则若有力。更两医矣。
皆不识。止用调气药。许诊之。曰。此阴中伏阳也。仲景法中无此证。世人患此者多。若用
药以助之。则为阴所隔绝。不能导引真阳。反生客热。用冷药则所伏真火愈见澌灭。非其治
也。须用破散阴气导达真火之药。使水升火降。然后得汗而解矣。乃授破阴丹二百粒。作一
服。冷盐汤下。不时烦躁狂热。手足躁扰。其家大惊。许曰。俗所谓换阳也。须臾稍定。略
睡。身已得汗。自昏达旦方止。热退而病除矣。今考破阴丹方。乃硫黄、水银等分。熔结成
砂。加陈皮、青皮分两减半。各为细末。面糊丸如桐子大。而用至二百丸。非许学士其谁能
之。此与阴隔阳用参附者似是而非。从古无人论及。可不谓发仲景之所未发哉。
孙兆治一人。伤寒五六日。头汗出。自颈以下无汗。手足冷。心下痞闷。大便秘。脉沉
紧。或者以为阴结。孙曰。此即仲景所谓半在表。半在里。脉虽沉紧。不得为少阴病也。投
以小柴胡汤而愈。盖四肢冷。脉沉紧。似乎少阴。然少阴多自利。不当大便硬。况头者三阳
同聚。若三阴经则至胸而还。今有头汗出。似乎阳虚。故曰汗出为阳微。然少阴额上冷汗。
同为阴毒矣。故曰阴不得有汗。今头汗出。知非少阴也。与小柴胡汤。设不了了者。得屎而
解。仲景虽不立方。可知其为大柴胡汤矣。此亦阳症似阴之一种也。
一道者患伤寒。发热。汗出多。惊悸目眩身战掉。众医有欲发汗者。有作风治者。有欲
以冷药解者。延孙兆至。兆曰。太阳经病得汗而不解。若欲解。必复作汗。肾气不足。汗不
来。所以心悸目眩身战。遂与真武汤。三服。微汗自出。即解。盖真武汤附子、白术和其肾
气。肾气得行。故汗得来。仲景云。尺脉弱者。营气不足。不可发汗。以此知肾气怯则难汗
震按此二条深得力于仲景。可与许学士媲美。
滑伯仁治一人。病伤寒。已经汗下。病去而背独恶寒。脉细如线。汤熨不应。伯仁以理
中汤加姜、桂、附子大作服。外以荜茇、良姜、吴茱、桂、椒诸品大辛热药为末。姜汁调敷
满背。以纸覆之。稍干即易。如是半月。竟平复不寒矣。此治法之变者也。
震按此以热药外敷。又开一法。
一人七月内。病发热。多服小柴胡汤。恶寒甚。肉 筋惕。滑伯仁诊之。脉细欲绝。曰
此升发太过。多汗亡阳。表虚极而恶寒甚也。肉 筋惕者。里虚极而阳不复也。以真武汤
进七八服而愈。
吴绶治一人。伤寒未经发汗。七八日。经脉动惕。潮热来尤甚。其肉不 。大便秘结不
行。小便赤涩。以手按脐旁硬痛。此有燥屎也。用加味大柴胡汤下之而愈。
又一人伤寒十余日。曾三四次发汗过多。遂变肉 身振摇。筋脉动惕。此汗多气血俱虚
故也。用加味人参养营汤二剂而愈。
又一人汗后。虚烦不得眠。筋惕肉 。内有热。用加味温胆汤而愈。可见虚实不同。岂
容执一说以施治。
震按肉 筋惕四条治法不同。首条载脉。三条不载脉。须看其病因病形之不同。分别得
清。故用药恰当。
朱丹溪治一人。素嗜酒。因暴风寒。衣薄。遂觉倦怠。不思饮食。至夜大发热。遍身疼
痛如被杖。微恶寒。天明诊之。六脉浮大。按之豁然。左为甚。因作极虚受风寒治之。人参
为君。黄 、白术、归身为臣。苍术、甘草、木通、干葛为佐。使大剂与之。至五帖后。通
身汗如雨。凡三易被。得睡。觉来诸证悉除。
卢兄年四十九岁。自来大便下血。脉沉迟涩。面黄神倦者。二年矣。九月间。因劳倦发
热。自服参苏饮二帖。热退。早起小劳遇寒。两手背与面紫黑。昏仆。少时却醒。身大热。
妄语口干。身痛至不可眠。丹溪脉之。三部不调。微带数。重取虚豁。左手大于右手。以人
参二钱半。带节麻黄、黄 各一钱。白术二钱。当归五分。与三五帖。得睡。醒来大汗如雨
即安。两日后。再发胁痛咳嗽。若睡时。嗽不作而妄语。且微恶寒。诊其脉似前。而左略
带紧。丹溪曰。此体虚再感寒也。仍以前药加半夏、茯苓。至十余帖。再得大汗而安。后身
倦不可久坐。不思饮食。用补中益气去凉药。加神曲、半夏、砂仁。五七十帖而安。
一人五月内。大发热而谵语。肢体不能举。喜冷冻饮料。丹溪诊其脉洪大而数。用黄 、茯
苓浓煎如膏。却用凉水调与之。三四服后。病者昏愦如死状。但颜色不改。气息如常。至次
早方醒。诸证悉退而安。
又治一老人。饥寒作劳。患头疼恶寒发热。骨节疼。无汗。妄语时作时止。自服参苏饮
取汗。汗大出而热不退。至第四日。诊其脉洪数而左甚。朱曰。此内伤证因饥而胃虚。加以
作劳。阳明虽受寒气。不可攻击。当大补其虚。俟胃气充实。必自汗而解。遂以参、 、归
术、陈皮、甘草。加附子二片。一昼夜尽五帖。至三日。口稍干。言有次序。诸证虽解。
热尚未退。乃去附加芍药。又两日。渐思食。颇清爽。间与肉羹。又三日。汗自出。热退。
脉虽不散。洪数尚存。朱谓此脉洪。当作大论。年高而误汗。以后必有虚证见。又与前药。
至次日。自言病以来。不更衣十三日矣。今谷道虚坐努责。迸痛如痢状不堪。自欲用大黄
物。朱曰。大便非实闭。乃气因误汗而虚。不得充腹。无力可努。仍用前药。间以肉汁粥及
苁蓉粥与之。翌日。浓煎椒葱汤浸下体。方大便。诊其脉。仍未敛。此气血仍未复。又与前
药。两日小便不通。小腹满闷。但仰卧则点滴而出。朱曰。补药未至。与前方倍加参、 。
两日小便方利。又服补药半月而安。
震按此四案。向列于内伤门。以其皆作虚证治也。然外证与伤寒一般。且前二条原因受
寒而起。自非明眼。岂敢用参 大补少加表药乎。盖所凭者在脉虚豁耳。后二条脉洪数不虚
而亦用补者。一凭于肢体不能举。一凭于老年饥寒作劳致病。其审证精细。非粗人所能及
而一用 苓煎膏。凉水调服。一用参、 、归、术佐附子。一周时进五帖。轻重缓急。各
臻其妙。至谓脉洪当作大论。可见洪与大原有分别。非通用字义。
丹溪治一人。年二十。于四月。病发热。脉浮沉皆有不足意。其间得洪数一种。随热进
退不时。知非伤寒也。因问必是过饮。酒毒在内。今为房劳。气血虚乏而病作耶。曰。饮烧
酒。吃犬肉。近一月矣。遂用补气血药。加干葛以解酒毒。服一帖。微汗。反懈怠。热如故
因思是病气血皆虚。不禁葛根之散。乃换枳 子入前药内。一帖而愈。
震按脉浮沉皆有不足意。大象是虚矣。间见洪数。随热进退不时。此非片刻所能得。故
遇疑难证。必须久诊。及一日二三次诊之。斯病无遁情。下条又是问而知之。知其素有下疳
疮。则脉之弦数为疮毒矣。诚哉四诊不可缺一也。
一人素有下疳疮。忽头痛发热自汗。众作伤寒治。反剧。脉弦甚。七至。重取则涩。丹
溪曰。此病在厥阴。而与证不对。以小柴胡加龙胆草、黄连。热服。四帖而安。
陶节庵治一人。伤寒四五日。吐血不止。医以犀角地黄汤、茅花汤。治而反剧。陶切其
脉。浮紧而数。曰。若不汗出。邪何由解。进麻黄汤一服。汗出而愈。或曰。仲景言衄家不
可汗。亡血家不可汗。而此用麻黄。何也。曰。久衄之家。亡血已多。故不可汗。今缘当汗
不汗。热毒蕴结而成吐血。当分其津液。乃愈。故仲景又曰。伤寒脉浮紧。不发汗。因致衄
者。麻黄汤主之。盖发其汗。则热越而出。血自止也。
震按吐血而用麻黄汤。复引经文以申明其故。节庵可为仲景之功臣矣。经文衄字向来只
作鼻衄解。不知吐血为内衄。仲景原不凿定鼻衄也。自非节庵。活书都作死书读耳。但麻黄
汤虽为太阳经正药。然非其时。非其经。非其人之质足以当之。鲜不为害。请勿轻试。怀抱
奇述一医者。素自矜负。秋月感寒。自以麻黄汤二剂饮之。目赤唇焦。裸体罔顾。遂成坏证
一药客感冒风寒。用麻黄五钱服之。吐血不止而毙。此二证亦进黄连解毒、犀角地黄汤解
救之。终不挽回。大可骇也。
〔附〕抱奇一友。积劳后感寒发热。医者好用古方。竟以麻黄汤进。目赤血衄。痰中带
血。继以小柴胡汤。舌干乏津。怀诊之。脉来虚数无力。乃劳倦而兼阴虚候也。误投热药。
能不动血而竭其液耶。连进地黄汤三剂。血止。神尚未清。用生脉散加当归、枣仁、茯神、
远志。神虽安。舌仍不生津。乃曰。肾主五液。而肺为生化之源。滋阴益气。两不见效。何
也。细思之。因悟麻黄性不内守。服之而竟无汗。徒伤其阴。口鼻虽见血。药性终未发泄。
故津液不行。仍以生脉散加葛根、陈皮引之。遂得微汗。舌果津生。后以归脾汤、六味丸而
震按天地人为三才。医者咸知讲究。天道幽微。而司天运气。逐岁变迁。人病应之。推
测殊难。然夏宜于凉。冬宜于热。到处皆然。人亦共晓。惟地之水土不同。怀氏只就松江地
方所见而言。推之嘉苏。亦复如是。若南京人患伤寒。用麻黄者十有二三。若江北人不用麻
黄。全然无效。况直隶陕西乎。所以内经有散而寒之。收而温之。同病异治之论也。赵养葵
曰。太阳之人。虽冬月身不须绵。口常饮水。色欲无度。大便数日一行。芩、连、栀、柏、
硝、黄。恬不知怪。太阴之人。虽暑月不离复衣。饮食稍凉。便觉腹痛泄泻。参、术、姜、
桂。时不绝口。此两等人者。各禀阴阳之一偏。又天令地气所不能拘。故立方用药。总贵变
通。不独麻黄一味。令人推敲也。
节庵治一壮年。夏间劳役后食冷物。夜卧遗精。遂发热痞闷。至晚。头额时痛。两足不
温。医不知头痛为火热上乘。足冷为脾气不下。误认外感夹阴。而与五积散汗之。则烦躁口
干。目赤便秘。明日。便与承气下之。但有黄水。身强如痉。烦躁转剧。腹胀喘急。舌胎黄
黑。已六七日矣。诊其脉。六七至而弦劲。急以黄龙汤。下黑物甚多。下后腹胀顿宽。躁热
顿减。但夜间仍热。舌胎未尽。更与解毒汤合生脉散加生地。二剂热除。平调月余而安。
震按此案可使因遗精而认阴证者释其疑。火热上乘。脾气不下二语。亦辨疑证之金针。
虞天民治一人。四月间。得伤寒证恶寒。发大热而渴。舌上白胎。三日前。身脊百节俱
痛。至第四日。惟胁痛而呕。自利。至第六日。虞诊之。左右手皆弦长而沉实。俱数甚。虞
曰。此本三阳合病。今太阳已罢。而少阳与阳明仍在。与小柴胡合黄连解毒。服三服。胁痛
呕逆皆除。惟热犹甚。九日后。渐加气筑痰响。声如拽锯。出大汗。汗退后。身热愈甚。法
当死。视其面上有红色。洁净而无贼邪之气。言语清亮。间有谵语而不甚含糊。虞故不辞而
复与治。用凉膈散倍大黄。服二服。视其所下复如前。自利清水。其痰气亦不息。与大承气
汤合黄连解毒汤。二服。其所下亦如前。此盖结热不开。而燥屎不来耳。复以二方相间。日
三四服。至五帖。始得结屎十数块。痰气渐平。热渐减。至十五日。热退气和而愈。
震按吴又可温疫论。以承气合白虎。于数日内连服连下。今人多有宗其法以救危病者。
观花溪此案。先开其端。然愚者奉为快捷方式。卤莽灭裂。亦不少矣。试读仲景阳明少阴篇中。
急下、可下、微和、更与等义。缓急轻重。法详且密。吴又可连下之法。亦不过仲景法中之
一法耳。未可以一法废诸法也。即如许学士治一家而病两人。皆旬日矣。一则身热无汗。大
便不通。小便短涩。神昏而睡。诊其脉长大而实。用承气下之而愈。一则阳明自汗。大便不
服用五味异功散、治中汤，一二剂后，五日病情平复。这是仿照完颜小将军暑月内伤发斑的治疗方法。
副枢使张息轩患伤寒超过一个月。已经使用下法治疗后，体内余热仍不消退。胁部及小腹左侧胀满。肌肉颜色没有变化。庸医认为是被风邪击中。用膏药涂抹并用手按摩。过了十天，毒气沿着宗筋流入睾丸，红肿得像匏瓜一样。针刺溃破排脓后，左胁肿痛依旧。邀请吕医生诊治。吕医生诊察关脉和尺脉，都滑数且芤。于是告诉他说：脉搏数而不时，就会生恶疮；关脉出现芤象，则内痈发作。胁部的肿胀，是痈脓形成。下法不可延误。于是用保生膏制成丸药，外裹乳香，并用硝黄煎汤送服。排出脓液约五升。第二天再次排便，排出剩余脓液，立刻痊愈。
俞震按语：此条因伤寒转变为肠痈，虽然不多见，也不可不知道。看他所说的话，两句出自《仲景伤寒论》，两句出自高阳生《脉诀》。因此想到明朝以前，都用此脉诀，为什么近世贤者痛斥它不堪入目呢？
芮子玉患伤寒，这是阴隔阳证。面赤足蜷缩，烦躁扰乱无法入睡且腹泻。议论的人有主张用寒药、有主张用温药的，意见不一，难以决断。吕元膺用紫雪丹配合理中丸进服，慢慢用冰水浸过的甘草干姜汤饮用，病愈。并且告诉他说：腹泻足蜷缩，是四逆证。如果按照常规方法治疗，那么上焦的热邪会更加严重。现在用紫雪折其热势，慢慢引导辛甘之品以温补里虚。这就是“热因寒用”的方法。听的人都叹服。
俞震按语：这是阴盛格阳，也称为下寒上热。沧州翁用寒药包裹热药，与热药冷服的义理相同。道理很精妙。然而翻阅各家医案，能识别此证的人也不少。至于像阴中伏阳这种证候，只有许学士的一则医案。他治疗乡人李信道，头疼身温烦躁，手指末端皆冷，胸中胀满，恶心，六脉沉伏不见，深按至骨则感觉有力。经过两位医生诊治，都不认识，只用调气药。许医生诊察后说：这是阴中伏阳证。《仲景法》中没有这个证候，世人患此病的人很多。如果用药物助长阳气，就会被阴气隔绝，不能导引真阳，反而产生客热。用冷药则潜伏的真火更加熄灭，这不是正确的治法。必须用破除阴气、导达真火的药物，使水升火降，然后出汗而解。于是给予破阴丹二百粒，一次服下，用冷盐汤送服。不时出现烦躁狂热，手足躁扰，家属非常惊恐。许医生说：俗称为换阳。片刻后稍定，略睡一觉，身体已经出汗，从黄昏到早晨才停止。热退而病除。现在考证破阴丹方，是硫黄、水银等分，熔结成为砂，加陈皮、青皮分量减半，各研为细末，面糊做成梧桐子大小的丸药，用量达到二百丸。如果不是许学士，谁能做到这样？这与阴隔阳用参附的方法似是而非，从古以来没有人论述过，难道不是发挥《仲景》所未曾阐发的理论吗？
孙兆治疗一个人。伤寒五六天，头汗出，自颈部以下无汗，手脚冷，心下痞闷，大便秘结，脉沉紧。有人以为是阴结。孙兆说：这就是《仲景》所说的半在表、半在里。脉虽然沉紧，但不能诊断为少阴病。投以小柴胡汤而痊愈。因为四肢冷，脉沉紧，似乎像少阴病。然而少阴病多自利，不应当大便硬。况且头部是三阳经汇聚之处，如果是三阴经，则止于胸部而还。现在有头汗出，似乎像阳虚，所以说“汗出为阳微”。然而少阴病额上出冷汗，同为阴毒证。所以说“阴不得有汗”。现在有头汗出，知道不是少阴病。给予小柴胡汤，如果还不舒服，通大便即可解。《仲景》虽然没有列出方剂，可以推断是大柴胡汤了。这也是阳症似阴的一种情况。
一位道士患伤寒，发热，汗出多，惊悸目眩，身体颤抖。众医生有的想发汗，有的按风邪治疗，有的想用冷药解除。请孙兆来诊治。孙兆说：太阳经病得汗而不解，如果要解，必定再次出汗。肾气不足，汗出不来，所以心悸目眩身体颤抖。于是给予真武汤，服用三剂，微微出汗自然而出，随即痊愈。因为真武汤中的附子、白术调和肾气，肾气得以运行，所以汗能出来。《仲景》说：尺脉弱者，营气不足，不可发汗。由此可知肾气怯弱则难以出汗。
滑伯仁治疗一个人。患伤寒，已经经过发汗和下法治疗，病去但唯独背部怕冷，脉细如线，汤熨无效。滑伯仁用理中汤加姜、桂、附子，大量煎服。外用荜茇、良姜、吴茱萸、桂枝、花椒等大辛热药研为末，姜汁调匀敷满背部，用纸覆盖，稍干即更换。如此半个月，最终平复不再怕冷。这是治法的变通。
一个人在七月内，患发热，多服小柴胡汤，恶寒严重，肌肉跳动，筋惕肉瞤。滑伯仁诊察，脉细欲绝。说：这是升发太过，多汗亡阳，表虚极而恶寒严重。肌肉跳动、筋惕肉瞤，是里虚极而阳气不复。给予真武汤，服用七八剂而痊愈。
吴绶治疗一个人。伤寒未经发汗，七八天，经脉动惕，潮热来时尤其严重，肌肉不跳动，大便秘结不行，小便赤涩，用手按压脐旁硬痛，这是有燥屎。用加味大柴胡汤下之而痊愈。
又一人患伤寒十余日，曾三四次发汗过多，于是变成肌肉跳动，身体振摇，筋脉动惕。这是因为汗多气血俱虚的缘故。用加味人参养营汤二剂而痊愈。
又一人汗后，虚烦不得眠，筋惕肉瞤，内有热。用加味温胆汤而痊愈。可见虚实不同，岂能固执一种说法来施治。
俞震按语：关于肌肉跳动、筋惕肉瞤的四条治法不同。首条记载脉象，三条不载脉象。必须看清其病因病形的不同，分别清楚，所以用药恰当。
朱丹溪治疗一个人。平时嗜酒，因暴风寒，衣服单薄，于是觉得倦怠，不思饮食，到了夜晚大发热，遍身疼痛如被杖打，微恶寒，天明诊察，六脉浮大，按之豁然空虚，左脉更甚。于是作为极虚受风寒治疗。人参为君药，黄芪、白术、当归身为臣药，苍术、甘草、木通、干葛为佐药，使大剂量给予。到五帖后，通身汗如雨下，凡换了三次被子，得以睡觉，醒来诸证悉除。
卢兄四十九岁，自来大便下血，脉沉迟涩，面色黄精神疲倦，两年了。九月间，因劳倦发热，自服参苏饮两帖，热退，早起小劳遇寒，两手背与面部紫黑，昏仆，少时却醒，身体大热，妄语口干，身痛至不可眠。丹溪诊察，三部不调，微带数，重取虚豁，左手大于右手。用人参二钱半，带节麻黄、黄芪各一钱，白术二钱，当归五分，给予三五帖，得睡，醒来大汗如雨即安。两日后，再发胁痛咳嗽，若睡觉时，嗽不作而妄语，且微恶寒，诊其脉似前，而左略带紧。丹溪说：这是体虚再感寒。仍以前药加半夏、茯苓，到十余帖，再得大汗而安。后来身体疲倦不可久坐，不思饮食，用补中益气汤去掉凉药，加神曲、半夏、砂仁，五七十帖而安。
一人在五月内，大发热而谵语，肢体不能举，喜冷冻饮料。丹溪诊其脉洪大而数，用黄芪、茯苓浓煎如膏，却用凉水调与之。三四服后，病者昏愦如死状，但颜色不改，气息如常。到次日早才醒，诸证悉退而安。
又治疗一老人，饥寒作劳，患头疼恶寒发热，骨节疼，无汗，妄语时作时止。自服参苏饮取汗，汗大出而热不退。至第四日，诊其脉洪数而左甚。朱丹溪说：这是内伤证因饥而胃虚，加以作劳，阳明虽受寒气，不可攻击，当大补其虚。等到胃气充实，必自汗而解。遂以人参、黄芪、当归、白术、陈皮、甘草，加附子二片，一昼夜尽五帖。至三日，口稍干，言有次序，诸证虽解，热尚未退，乃去附子加芍药。又两日，渐思食，颇清爽，间与肉羹。又三日，汗自出，热退，脉虽不散，洪数尚存。朱丹溪谓此脉洪，当作大论。年高而误汗，以后必有虚证见。又与前药。至次日，自言病以来，不更衣十三日矣。今谷道虚坐努责，迸痛如痢状不堪，自欲用大黄物。朱丹溪说：大便非实闭，乃气因误汗而虚，不得充腹，无力可努，仍用前药，间以肉汁粥及苁蓉粥与之。翌日，浓煎椒葱汤浸下体，方大便。诊其脉，仍未敛，此气血仍未复，又与前药。两日小便不通，小腹满闷，但仰卧则点滴而出。朱丹溪说：补药未至，与前方倍加人参、黄芪。两日小便方利。又服补药半月而安。
俞震按语：这四案，向来列于内伤门，因为其皆作虚证治疗。然而外证与伤寒一般，且前两条原因受寒而起，自非明眼人，岂敢用参芪大补少加表药乎？所凭借的是脉虚豁耳。后两条脉洪数不虚而亦用补者，一条凭借于肢体不能举，一条凭借于老年饥寒作劳致病。其审证精细，非粗人所能及。而一条用苓芪煎膏，凉水调服，一条用参、芪、归、术佐附子，一周时进五帖，轻重缓急，各臻其妙。至于谓脉洪当作大论，可见洪与大原有分别，非通用字义。
丹溪治疗一个人，二十岁，在四月，患发热，脉浮沉皆有不足之意，其间得洪数一种，随热进退不时，知道不是伤寒。于是问必定是过饮，酒毒在内，现在为房劳，气血虚乏而病作耶？回答说：饮烧酒，吃犬肉，近一月矣。于是用补气血药，加干葛以解酒毒，服一帖，微汗，反懈怠，热如故。于是想是病气血皆虚，不禁葛根之散，于是换枳壳子入前药内，一帖而愈。
俞震按语：脉浮沉皆有不足之意，大象是虚矣。间见洪数，随热进退不时，此非片刻所能得。所以遇到疑难证，必须久诊，及一日二三次诊之，斯病无遁情。下条又是问而知之，知其素有下疳疮，则脉之弦数为疮毒矣。诚哉四诊不可缺一也。
一人素有下疳疮，忽头痛发热自汗，众作伤寒治，反剧，脉弦甚，七至，重取则涩。丹溪说：此病在厥阴，而与证不对。用小柴胡加龙胆草、黄连，热服，四帖而安。
陶节庵治疗一个人。伤寒四五日，吐血不止，医以犀角地黄汤、茅花汤，治而反剧。陶切其脉，浮紧而数，说：若不汗出，邪何由解。进麻黄汤一服，汗出而愈。有人说：《仲景》言衄家不可汗，亡血家不可汗，而此用麻黄，何也？回答说：久衄之家，亡血已多，故不可汗。今缘当汗不汗，热毒蕴结而成吐血，当分其津液，乃愈。故《仲景》又曰：伤寒脉浮紧，不发汗，因致衄者，麻黄汤主之。盖发其汗，则热越而出，血自止也。
俞震按语：吐血而用麻黄汤，复引经文以申明其故，节庵可为《仲景》之功臣矣。经文衄字向来只作鼻衄解，不知吐血为内衄，《仲景》原不凿定鼻衄也。自非节庵，活书都作死书读耳。但麻黄汤虽为太阳经正药，然非其时，非其经，非其人之质足以当之，鲜不为害。请勿轻试。怀抱奇述一医者，素自矜负，秋月感寒，自以麻黄汤二剂饮之，目赤唇焦，裸体罔顾，遂成坏证。一药客感冒风寒，用麻黄五钱服之，吐血不止而毙。此二证亦进黄连解毒、犀角地黄汤解救之，终不挽回，大可骇也。
〔附〕抱奇一友，积劳后感寒发热，医者好用古方，竟以麻黄汤进，目赤血衄，痰中带血，继以小柴胡汤，舌干乏津，怀诊之，脉来虚数无力，乃劳倦而兼阴虚候也。误投热药，能不动血而竭其液耶？连进地黄汤三剂，血止，神尚未清，用生脉散加当归、枣仁、茯神、远志，神虽安，舌仍不生津，乃曰：肾主五液，而肺为生化之源，滋阴益气，两不见效，何也？细思之，因悟麻黄性不内守，服之而竟无汗，徒伤其阴，口鼻虽见血，药性终未发泄，故津液不行，仍以生脉散加葛根、陈皮引之，遂得微汗，舌果津生，后以归脾汤、六味丸而安。
俞震按语：天地人为三才，医者咸知讲究。天道幽微，而司天运气，逐岁变迁，人病应之，推测殊难。然夏宜于凉，冬宜于热，到处皆然，人亦共晓。惟地之水土不同，怀氏只就松江地方所见而言，推之嘉苏，亦复如是。若南京人患伤寒，用麻黄者十有二三，若江北人不用麻黄，全然无效，况直隶陕西乎。所以内经有散而寒之，收而温之，同病异治之论也。赵养葵曰：太阳之人，虽冬月身不须绵，口常饮水，色欲无度，大便数日一行，芩、连、栀、柏、硝、黄，恬不知怪。太阴之人，虽暑月不离复衣，饮食稍凉，便觉腹痛泄泻，参、术、姜、桂，时不绝口。此两等人者，各禀阴阳之一偏，又天令地气所不能拘，故立方用药，总贵变通，不独麻黄一味，令人推敲也。
节庵治疗一壮年，夏间劳役后食冷物，夜卧遗精，遂发热痞闷，至晚，头额时痛，两足不温。医不知头痛为火热上乘，足冷为脾气不下，误认外感夹阴，而与五积散汗之，则烦躁口干，目赤便秘。明日，便与承气下之，但有黄水，身强如痉，烦躁转剧，腹胀喘急，舌胎黄黑，已六七日矣。诊其脉，六七至而弦劲，急以黄龙汤，下黑物甚多。下后腹胀顿宽，躁热顿减，但夜间仍热，舌胎未尽，更与解毒汤合生脉散加生地，二剂热除，平调月余而安。
俞震按语：此案可使因遗精而认阴证者释其疑。火热上乘，脾气不下二语，亦辨疑证之金针。
虞天民治疗一个人，四月间，得伤寒证恶寒，发大热而渴，舌上白胎，三日前，身脊百节俱痛，至第四日，惟胁痛而呕，自利，至第六日，虞诊之，左右手皆弦长而沉实，俱数甚。虞说：此本三阳合病，今太阳已罢，而少阳与阳明仍在，与小柴胡合黄连解毒，服三服，胁痛呕逆皆除，惟热犹甚。九日后，渐加气筑痰响，声如拽锯，出大汗，汗退后，身热愈甚，法当死。视其面上有红色，洁净而无贼邪之气，言语清亮，间有谵语而不甚含糊，虞故不辞而复与治，用凉膈散倍大黄，服二服，视其所下复如前，自利清水，其痰气亦不息，与大承气汤合黄连解毒汤，二服，其所下亦如前，此盖结热不开，而燥屎不来耳，复以二方相间，日三四服，至五帖，始得结屎十数块，痰气渐平，热渐减，至十五日，热退气和而愈。
俞震按语：吴又可温疫论，以承气合白虎，于数日内连服连下，今人多有宗其法以救危病者。观花溪此案，先开其端，然愚者奉为快捷方式，卤莽灭裂，亦不少矣。试读仲景阳明少阴篇中，急下、可下、微和、更与等义，缓急轻重，法详且密，吴又可连下之法，亦不过仲景法中的一法耳，未可以一法废诸法也。即如许学士治一家而病两人，皆旬日矣，一则身热无汗，大便不通，小便短涩，神昏而睡，诊其脉长大而实，用承气下之而愈，一则阳明自汗，大便不
Take Wuweiyigong San (Five-Ingredient Powder for Extraordinary Efficacy) and Zhizhong Tang (Spleen-Harmonizing Decoction), one or two doses. After five days, the condition stabilized. This imitates the treatment method for Wan Yan Xiao Jiangjun's macules caused by internal injury during summer heat.
Vice Marshal Zhang Xixuan suffered from Shanghan (Cold Damage) for over a month. After purgation, internal heat persisted. There was fullness in the hypochondrium and the left lower abdomen. The muscle color remained unchanged. Quack doctors believed it was struck by wind. They applied ointment and massaged the area. After ten days, the toxin flowed along the Zongjin (Genital Tendon) into the testicles, causing redness and swelling like a gourd. It was punctured and drained, but the left hypochondriac swelling and pain remained. Doctor Lv was invited to diagnose. Dr. Lv found both Guan (Bar) and Chi (Cunam) pulses slippery, rapid, and Kou (Hollow). He told him: "A rapid pulse that is irregular generates malignant sores; a Kou pulse at the Guan position indicates an internal abscess. The swelling in the hypochondrium is due to pus formation from the abscess. Purgation should not be delayed." He then prepared Baosheng Gao (Life-Preserving Paste) into pills, coated them with Ruxiang (Frankincense), and administered them with a decoction of Xiaoyao Huang (Rhubarb) and Mangxiao (Mirabilite). About five sheng (approx. 5 liters) of pus were discharged. The next day, upon another bowel movement, the remaining pus was discharged, and he recovered immediately.
Yu Zhen commented: This case involves Shanghan transforming into Changyong (Intestinal Abscess). Although rare, it must be known. Observing his words, two sentences are from Zhang Zhongjing's Shanghan Lun, and two are from Gao Yangsheng's Maijue (Pulse Canon). I recall that before the Ming Dynasty, this pulse canon was used. Why do recent sages condemn it so severely?
Rui Ziyu suffered from Shanghan, which was a Yin-intercepting-Yang syndrome. His face was red, legs curled up, he was restless and unable to sleep, accompanied by diarrhea. Discussants differed on whether to use cold or warm methods, unable to decide. Lv Yuanying administered Zixue Dan (Purple Snow Pill) combined with Lizhong Wan (Regulate the Middle Pill), slowly drinking Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) cooled with ice water. The patient recovered. He explained: "Diarrhea and curled legs indicate Sini Syndrome (Four Cold Extremities). If treated with standard methods, upper jiao heat would intensify. Now, using Zixue Dan to subdue heat and slowly guiding acrid-sweet herbs to warm the interior exemplifies 'treating heat with cold' (Re Yin Han Yong). Listeners were amazed and convinced.
Yu Zhen commented: This is Yin-excess repelling Yang, also called Lower Cold Upper Heat. Cangzhou Weng's method of wrapping hot medicine in cold medicine is equivalent to taking hot medicine cold. The principle is profound. However, reviewing various medical cases, many can identify this syndrome. As for "Yang hidden within Yin," there is only one case by Scholar Xu. He treated a villager, Li Xindao, who had headache, warm body, restlessness, cold fingertips, chest fullness, nausea, and six pulses deep and hidden, feeling strong when pressed to the bone. Two other doctors failed to recognize it, prescribing only Qi-regulating herbs. Scholar Xu diagnosed: "This is Yang hidden within Yin. This syndrome is not in Zhang Zhongjing's methods, yet many suffer from it. Using drugs to assist Yang will be blocked by Yin, failing to guide True Yang, instead generating guest heat. Using cold drugs will extinguish the hidden True Fire further, which is incorrect. One must use drugs to break Yin qi and guide True Fire, allowing Water to rise and Fire to descend, leading to sweating and resolution." He prescribed 200 pills of Poyin Dan (Yin-Breaking Pill), taken once with cold salt water. The patient experienced intermittent restlessness and fever, tossing limbs, alarming the family. Scholar Xu said: "Commonly called 'changing Yang.' In a moment, he settled, slept slightly, then sweated profusely. From dusk till dawn, it stopped. Heat receded, disease vanished." Examining the Poyin Dan formula: equal parts Sulfur and Mercury, melted into cinnabar-like grains, plus half dose each of Chenpi (Tangerine Peel) and Qingpi (Green Tangerine Peel), ground fine, pill-sized as paulownia seeds, dosage reaching 200 pills. Only Scholar Xu could do this. This is similar yet different from treating Yin-intercepting-Yang with Renshen (Ginseng) and Fuzi (Aconite). No one discussed this before. Is this not expanding upon Zhang Zhongjing's unexpressed theories?
Sun Zhao treated a man. Shanghan for five or six days, head sweating, no sweat below neck, cold hands and feet, epigastric oppression, constipation, pulse deep and tight. Some thought it was Yin Knot. Sun Zhao said: "This is what Zhang Zhongjing calls 'half exterior, half interior.' Although the pulse is deep and tight, it cannot be Shaoyin disease." He administered Xiaochaihu Tang (Minor Bupleurum Decoction) and cured him. Cold limbs and deep-tight pulse resemble Shaoyin, but Shaoyin usually has spontaneous diarrhea, not hard stool. Moreover, the head is where the Three Yang meridians converge; if it were Three Yin, it would stop at the chest. Head sweating suggests Yang deficiency ("sweating indicates weak Yang"). However, Shaoyin forehead cold sweat is Yin Poison. Thus, "Yin cannot have sweat." Head sweating indicates it is not Shaoyin. Give Xiaochaihu Tang. If unresolved, bowel movement brings resolution. Although Zhang Zhongjing did not prescribe a formula here, it implies Dachaihu Tang (Major Bupleurum Decoction). This is a type of Yang syndrome resembling Yin.
A Daoist priest suffered from Shanghan, fever, excessive sweating, palpitations, dizziness, and tremors. Doctors suggested diaphoresis, wind treatment, or cold clearing. Sun Zhao was summoned. He said: "Taiyang disease persists after sweating. To resolve, it must sweat again. Kidney Qi is insufficient, preventing sweat, causing palpitations, dizziness, and tremors." He prescribed Zhenwu Tang (True Warrior Decoction). After three doses, slight sweating occurred naturally, and he recovered. Zhenwu Tang uses Fuzi and Baizhu to harmonize Kidney Qi. Once Kidney Qi moves, sweat comes. Zhang Zhongjing said: "Weak Chi pulse indicates deficient Ying Qi; do not induce sweating." Thus, weak Kidney Qi makes sweating difficult.
Yu Zhen commented: These two cases benefit greatly from Zhang Zhongjing and rival Scholar Xu.
Slip Bo Ren treated a man. Shanghan, already treated with sweating and purging. Disease gone except for back chills. Pulse thread-thin. Hot compresses ineffective. Slip Bo Ren used Lizhong Tang (Regulate the Middle Decoction) with Shengjiang (Fresh Ginger), Rougui (Cinnamon Bark), and Fuzi (Prepared Aconite), brewed strongly. Externally, he powdered Bibo (Long Pepper), Liangjiang (Galangal), Wuzhuyu (Evodia), Guizhi (Cinnamon Twig), and Huajiao (Sichuan Pepper), mixed with ginger juice, and applied fully over the back, covered with paper, changing when dry. After half a month, he recovered completely without chills. This is a variation in treatment method.
Yu Zhen commented: External application of hot medicine opens a new method.
A person in July suffered fever, took too much Xiaochaihu Tang, severe aversion to cold, muscle twitching, and fascial trembling. Slip Bo Ren diagnosed a pulse nearly imperceptible. He said: "Over-elevation led to excessive sweating and loss of Yang. Extreme exterior deficiency causes severe cold aversion. Muscle twitching and fascial trembling indicate extreme interior deficiency and failure of Yang recovery." He administered Zhenwu Tang (True Warrior Decoction) for seven or eight doses, curing him.
Wu Shou treated a man. Shanghan untreated with sweating. Seven or eight days later, meridians felt agitated, tidal fever intensified, muscles did not twitch, constipation, dark scanty urine, hardness and pain around umbilicus upon pressure. This indicated Dry Stool. He used Jiawei Dachaihu Tang (Modified Major Bupleurum Decoction) to purge, curing him.
Another man suffered Shanghan for over ten days, sweated excessively three or four times, resulting in muscle twitching, body shaking, and meridian agitation. This was due to Qi and Blood deficiency from excessive sweating. He used Jiawei Renshen Yangying Tang (Modified Ginseng Nourishing Ying Decoction) for two doses, curing him.
Another man, after sweating, had empty irritability and insomnia, fascial trembling, and internal heat. He used Jiawei Wendan Tang (Modified Gallbladder-Warming Decoction) and recovered. This shows that deficiency and excess differ; one cannot stick to one theory for treatment.
Yu Zhen commented: The four treatments for muscle twitching and fascial trembling differ. The first records the pulse; the other three do not. One must distinguish causes and manifestations clearly to apply appropriate medication.
Zhu Danxi treated a man who loved alcohol. Due to sudden wind-cold and thin clothing, he felt fatigued, lost appetite, developed high fever at night, and whole-body pain like being beaten, with slight aversion to cold. At dawn, all six pulses were floating and large, hollow upon pressure, stronger on the left. Treated as extreme deficiency with wind-cold invasion. Renshen (Ginseng) as Sovereign, Huangqi (Astragalus), Baizhu (Atractylodes), Danggui Shen (Angelica Root Heart) as Ministers, Cangzhu (Atractylodes Lancea), Gancao (Licorice), Mutong (Akebia), Gegen (Kudzu) as Assistants. Large dose given. After five doses, profuse sweating like rain, changed quilts three times, slept, woke up with all symptoms resolved.
Brother Lu, age 49, had hematochezia for two years, pulse deep-slow-choppy, yellow face, fatigue. In September, fever due to labor/fatigue. Took Sansu Yin (Ginseng-Su Drink) for two doses, fever subsided. Early morning, slight labor met cold, hands and face turned purple-black, fainted, revived shortly, high fever, delirium, dry mouth, painful body unable to sleep. Danxi diagnosed: Three positions irregular, slightly rapid, hollow upon heavy pressure, Left > Right. Prescribed Renshen 2.5 qian, Mahuang (Ephedra) with joints, Huangqi (Astragalus) 1 qian each, Baizhu 2 qian, Danggui 0.5 qian. Given for 3-5 doses. Slept, woke with profuse sweating, recovered. Two days later, hypochondriac pain and cough recurred. During sleep, no cough but delirium, slight aversion to cold. Pulse similar, slightly tight on left. Danxi said: "Deficient constitution re-infected by cold." Continued previous prescription with Banxia (Pinellia) and Fuling (Poria). After 10+ doses, profuse sweating brought recovery. Later, fatigue, poor appetite. Used Buzhong Yiqi Tang (Middle-Boosting Qi-Invigorating Decoction) removing cooling herbs, adding Shenqu (Medicated Leaven), Banxia, Sharen (Amomum). After 50-70 doses, recovered.
A person in May had high fever, delirium, inability to move limbs, desire for cold drinks. Danxi diagnosed pulse flooding and rapid. Used Huangqi and Fuling boiled thick like paste, mixed with cold water. After 3-4 doses, patient appeared dead, but complexion normal, breath regular. Woke next morning, symptoms resolved.
He also treated an elderly man. Labor after hunger/cold, headache, aversion to cold/fever, joint pain, no sweat, intermittent delirium. Took Sansu Yin to sweat, profuse sweat but fever persisted. Day 4, pulse flooding-rapid, stronger on left. Zhu said: "Internal injury due to hunger and stomach deficiency, compounded by labor. Yangming received cold, but attack is contraindicated. Must tonify deficiency greatly. When Stomach Qi fills, spontaneous sweating will resolve." Prescribed Renshen, Huangqi, Danggui, Baizhu, Chenpi, Gancao, plus 2 slices of Fuzi. Five doses in one day. Day 3, mouth slightly dry, speech coherent, symptoms resolved but fever remained. Removed Fuzi, added Shaoyao (Peony). Two days later, appetite returned, felt clear. Ate meat broth. Three days later, spontaneous sweat, fever receded. Pulse still flooding-rapid. Zhu said: "Flooding pulse should be interpreted as 'Large'. Elderly person mistreated with sweating will show deficiency later." Continued previous meds. Next day, stated no bowel movement for 13 days. Straining at anus like dysentery, desired Rhubarb. Zhu said: "Not solid blockage, but Qi deficiency from mistaken sweating, unable to fill intestines, lack strength to strain." Continued previous meds, supplemented with meat broth and Congrong (Cistanche) porridge. Next day, steeped lower body in pepper-onion soup, then had bowel movement. Pulse still not gathered, Qi/Blood not restored. Continued meds. Two days later, urinary retention, lower abdominal fullness, only drops when supine. Zhu said: "Tonics insufficient." Increased Renshen and Huangqi in previous formula. Two days later, urination resumed. Continued tonics for half a month, recovered.
Yu Zhen commented: These four cases were listed under Internal Injury because they were treated as deficiency. However, external signs resemble Shanghan. The first two started with cold exposure. Only a sharp eye dares to use massive Renshen/Huangqi tonification with slight exterior-releasing herbs, relying on the hollow pulse. The latter two had flooding-rapid pulses (not deficient) but still used tonics: one based on inability to move limbs, the other on elderly/labor/hunger/cold etiology. Their diagnostic precision is beyond ordinary men. One used Fuling/Huangqi paste with cold water; the other used Renshen/Huangqi/Danggui/Baizhu with Fuzi, five doses in a week. Light/heavy, slow/fast, all reached perfection. Regarding "Flooding equals Large," it shows Flooding and Large are distinct, not interchangeable terms.
Danxi treated a 20-year-old in April. Fever, pulse floating/deep lacking substance, occasionally flooding-rapid fluctuating with heat. Determined not Shanghan. Asked about diet/activity. Patient drank liquor and ate dog meat for a month. Likely Qi/Blood deficiency from sexual activity exacerbated by alcohol toxicity. Prescribed Qi/Blood tonics plus Gegen (Kudzu) to resolve alcohol toxin. One dose, slight sweat, increased fatigue, fever persisted. Realized Qi/Blood deficiency cannot tolerate Gegen's dispersing nature. Replaced with Zhizi (Gardenia) in previous formula. One dose cured.
Yu Zhen commented: Floating/deep pulses lacking substance indicate deficiency. Intermittent flooding-rapid fluctuating with heat requires long-term observation. For difficult cases, prolonged and frequent diagnosis prevents hiding pathology. The next case was diagnosed via inquiry (history of chancre), explaining string-rapid pulse as toxin. Indeed, Four Diagnostic Methods cannot be missing any.
A person with chronic chancre suddenly had headache, fever, spontaneous sweating. Others treated as Shanghan, worsened. Pulse very string-like, 7 beats per respiration, choppy on heavy pressure. Danxi said: "Disease in Jueyin, mismatched with symptoms." Prescribed Xiaochaihu Tang + Longdan Cao (Gentian) + Huanglian (Coptis), taken hot. Four doses cured.
Tao Jian'an treated a man. Shanghan 4-5 days, continuous hematemesis. Doctors used Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) and Maohua Tang (Maple Flower Decoction), worsening condition. Tao felt pulse floating-tight-rapid. Said: "Without sweating, how does pathogen exit?" Administered Mahuang Tang (Ephedra Decoction) once. Sweating occurred, cured. Questioned: "Zhang Zhongjing says those with nosebleeds or blood loss cannot sweat. Why Ephedra here?" Answered: "Chronic nosebleed patients have lost much blood, hence contraindication. Here, missed sweating opportunity led to heat-toxin accumulation causing hematemesis. Fluids must be distributed. Hence cure." Citing Zhang Zhongjing: "Shanghan, floating-tight pulse, no sweating leads to nosebleed; Mahuang Tang governs." Sweating allows heat to escape, stopping bleeding.
Yu Zhen commented: Using Mahuang Tang for hematemesis, citing classics to justify, Tao is a merit worker for Zhang Zhongjing. Traditionally, 'Nu' (bleeding) meant epistaxis. Hematemesis is internal Nu. Zhang Zhongjing did not limit it to nosebleeds. Without Tao, living texts become dead. But Mahuang Tang, though correct for Taiyang, if misused regarding time, channel, or constitution, causes harm. Do not try lightly. Bao Qiji recorded a doctor, arrogant, autumn cold, self-prescribed two doses Mahuang Tang. Red eyes, scorched lips, naked disregard, became ruined case. Another herbalist, cold-wind, took 5 qian Mahuang, died of uncontrollable hematemesis. Both tried Huanglian Jiedu Tang and Xijiao Dihuang Tang for rescue, failed. Shocking.
[Appendix] Bao Qiji's friend, accumulated fatigue then cold-fever. Doctor used ancient formula, Mahuang Tang. Red eyes, epistaxis, blood in phlegm, followed by Xiaochaihu Tang. Dry tongue, lack of fluids. Huai diagnosed: pulse void-rapid-weak. Fatigue with Yin deficiency. Mistaken hot drugs caused bleeding and fluid exhaustion. Three doses Dihuang Tang stopped bleeding, spirit unclear. Shengmai San + Danggui, Suanzaoren, Fushen, Yuanzhi calmed spirit, tongue still dry. Huai said: "Kidney governs five fluids, Lung is source of transformation. Yin-nourishing and Qi-tonifying failed. Why?" Realized Mahuang does not retain internally. No sweat, injured Yin. Bleeding from mouth/nose didn't release drug property, thus fluids didn't move. Used Shengmai San + Gegen, Chenpi to guide. Slight sweat, tongue moistened. Later GuiPi Tang and Liuwei Wan cured.
Yu Zhen commented: Heaven, Earth, Man are Three Powers. Physicians study them. Heavenly Dao is subtle, Six Qi changes yearly, human disease responds, prediction is hard. Summer cool, Winter hot, universally known. But Earth's water/soil differs. Huai spoke of Songjiang region, applicable to Jia/Su. Nanjing Shanghan patients, 20-30% use Mahuang. Jiangbei patients, Mahuang ineffective. What about Zhili/Shaanxi? Neijing discusses "scatter and cool, gather and warm, same disease different treatment." Zhao Yangkui said: Taiyang people, winter no need for cotton, drink water constantly, excessive lust, bowel movement every few days, Qin/Lian/Zhi/Bai/Xiao/Huang, unaware of strangeness. Taiyin people, summer wear layers, slight cold food causes abdominal pain/diarrhea, Renshen/Baizhu/Jiang/Gui, never cease mouth. These two types inherit Yin/Yang bias, unconstrained by heaven/earth qi. Thus formulas/drugs value flexibility, not just Mahuang scrutiny.
Jian'an treated a strong man. Summer labor, cold food, nocturnal emission, fever, oppression. Evening, forehead pain, cold feet. Doctor didn't know headache was fire rising, cold feet was Spleen Qi failing to descend. Mistook for exterior cold with Yin involvement, gave Wuji San to sweat. Result: irritability, dry mouth, red eyes, constipation. Next day, Chengqi to purge. Only yellow water, body stiff like spasm, worse irritability, abdominal distension, panting, yellow-black tongue coating, 6-7 days. Pulse 6-7 beats, string-taut. Urgently gave Huanglong Tang. Discharged much black matter. Post-purge, distension eased, irritability reduced, but night fever, tongue coating incomplete. Gave Jiedu Tang + Shengmai San + Shengdi. Two doses fever gone, balanced for month, recovered.
Yu Zhen commented: This case clears doubts identifying Yin syndrome due to emission. "Fire rising, Spleen Qi descending" phrases are golden needles for distinguishing doubtful syndromes.
Yu Tianmin treated a person. April, Shanghan chills, high fever, thirst, white tongue coating. Three days prior, whole body/joint pain. Day 4, only hypochondriac pain/vomiting, spontaneous diarrhea. Day 6, Yu diagnosed: both hands string-long-deep-solid, very rapid. Yu said: "Originally Three Yang combined disease. Taiyang resolved, Shaoyang and Yangming remain." Gave Xiaochaihu Tang + Huanglian Jiedu Tang. Three doses, pain/vomiting stopped, fever remained. Day 9, phlegm rattling like sawing, profuse sweat, post-sweat fever worse, fatal prognosis. Face red, clean, no evil qi, clear speech, slight delirium not confused. Yu continued treatment. Liangge San doubled Dahuang. Two doses, discharge like before, clear water, phlegm noise continued. Dachengqi Tang + Huanglian Jiedu Tang. Two doses, discharge same. Heat knot unopened, dry stool absent. Alternated two formulas, 3-4 times daily. Five doses, 10+ hard stools passed, phlegm calmed, fever reduced. Day 15, fever gone, Qi harmonious, recovered.
Yu Zhen commented: Wu Keyi's Warm Epidemic Theory combines Chengqi with Baihu, consecutive doses/purges within days. Many follow this for critical illness. Huaxi case opened this trend. But fools treat it as shortcut, acting rashly. Read Zhang Zhongjing's Yangming/Shaoyin chapters: urgent purge, permissible purge, mild harmony, give again. Details on speed/weight are precise. Wu's consecutive purge is just one method among Zhang's. Cannot discard others for one. E.g., Scholar Xu treated a family, two sick for 10 days. One: fever no sweat, constipation, scanty urine, coma/sleep, pulse large-solid-real. Purged with Chengqi, recovered. One: Yangming spontaneous sweat, consti