罗谦甫治王侍郎之婿。年二十五。十一月间。因劳役忧思烦恼。饮食失节而病。时发燥
热。困倦盗汗。湿透其衾。不思饮食。气不足以息。面色青黄不泽。罗诊其脉浮数而短涩。
两寸极小。告之曰。此危证也。治虽粗安。至春必死。当令亲家知之。夫人不以为然。遂易
医。至正月。果躁热而卒。异日侍郎谓罗曰。吾婿果如君言。愿闻其理。罗曰。此非难知也
内经曰。主胜逆。客胜从。天之道也。盖时令为客。人身为主。冬三月人皆惧寒。独渠躁
热盗汗。是令不固其阳。时不胜其热。天地时令。尚不能制。药何能为。冬乃闭藏之月。阳
气当伏于九泉之下。至春发为雷。动为风鼓拆万物。此奉生之道也。如冬藏不固。则春生不
茂。且有疫疠之灾。故人身阴气。亦当伏潜于内。不敢妄扰。毋泄皮肤。使气亟夺。此冬藏
之应也。令婿汗出于闭藏之月。肾水已涸。至春何以生木。阳气内绝。无所滋荣。不死何侍
因叹息而去。
震按此论可为损怯病之秦镜。何以类案不收。又罗君治韩子玉父。六十。病消渴。至冬
添躁热。须裸袒。以冰置胸腋乃快。其脉沉细而疾。罗亦曰。人身为主。时令为客。大寒之
令。其热更甚。经谓当所胜之令。而不能制。名曰真强。乃孤阳绝阴。必死之证也。与此条
义同。
薛立斋治州同韩用之。年四十六。仲夏色欲过度。烦热作渴。饮水不绝。小便淋涩。大
便秘结。唾痰如涌。面目俱赤。满舌生刺。两唇燥裂。遍身发热。或时如芒刺而无定处。两
足心如烙。以水折之作痛。脉洪而无伦。此肾阴虚阳无所附而发于外。非火也。盖大热而甚
寒之不寒。是无水也。当峻补其阴。遂以加减八味丸料一斤。内肉桂一两。以水顿煎六碗
冰冷与饮。半向已饮大半。睡觉而食温粥一碗。复睡至晚。又以前药温饮一碗。乃睡至晓
食热粥二碗。诸证悉退。翌日畏寒。足冷至膝。诸证仍至。或以为伤寒。薛曰。非也。大
寒而甚。热之不热。是无火也。阳气亦虚矣。急以八味一剂。服之稍缓。四剂诸证复退。大
便至十三日不通。以猪胆导之。诸证复作。急用十全大补汤四剂。方应。
震按此条与伤寒门顾大有父七十九岁证脉颇同。而此不列之伤寒者。以所叙证。先述烦
渴引饮。溺淋唾痰。面赤舌燥。而后继之以遍身发热云云。其情形殊不似伤寒之先发热。而
渐见烦渴溺淋舌燥也。顾姓证叙起即首载头痛发热。细看自有分晓。立斋治法诚奇。然曰阴
虚而用肉桂一两。似难矜式。况前云无水。以加减八味料一斤。所谓加减者不过去附子加五
味耳。后云无火。以八味丸一剂。则较之前用一斤。桂一两。仅得十分之一矣。何先后轻重
如此耶。且存其说。质之高明。
立斋又治府庠王以道。元气素弱。复以考试积劳。于冬月大发热。泪出随凝。目赤露胸
气息沉沉欲绝。脉洪大鼓指。按之如无。舌干如刺。此内真寒而外假热也。令服十全大补
汤。嘱曰。服此药其脉当收敛为善。少顷熟睡。觉而恶寒增衣。脉顿微细如丝。此虚寒之真
象也。以人参一两。熟附三钱。水煎顿服而安。夜间脉复脱。乃以参二两。熟附五钱。仍愈
后以大剂参、术、归身、炙草等药。调理而愈。
震按壮热露胸。目赤泪凝。舌干如刺。纯是火象。惟气息沉沉欲绝。是虚象。脉洪大鼓
指。按之如无。则可决其内虚寒而外假热矣。服温补药后。脉当收敛为善。此是格言。所当
熟记。又立斋治七十九岁老人。于少外家入房后。头痛发热。见诸火象。脉洪大无伦。按之有
力。较之此案证同脉异。更宜细参。
李时珍自记年二十时。因感冒。咳嗽既久。且犯戒。遂病骨蒸发热。肤如火燎。每日
吐
痰碗许。暑月烦渴。寝食几发。六脉微洪。遍服柴胡、麦冬、荆沥诸药。月余益剧。其尊君
偶思李东垣治肺热如火燎。烦躁引饮而昼盛者。气分热也。宜一味黄芩汤。以泻肺经气分之
火。乃按方用片芩一两。水煎顿服。次日身热尽退。而痰嗽皆愈。药中肯綮。如鼓应桴如此
震按此案与立斋治法。有天渊之别。故病者如人面之不同。千态万状。无有定形。治病
者能如以镜照面。使随其形而呈于镜。则妍媸自别。不至误认矣。
高果哉治陈几亭。病身热。自卯辰以后。上半身热。申酉时。中半身热。亥子时。下半
身热。热至足底更甚。周而复始。一日一夜。循环无间。服药久而不效。展转沉重。高诊之
脉微无力。右尺脉伏而不起。因思尺脉沉伏者。肾虚也。日夜之热。上下循环者。肾火之
浮游也。至子时而足底大热。则肾火之归就于下也。若当归下之时。而能摄住其性。不使上
走。则热自无矣。须效烧丹法治之。夫丹家用二个阳城罐。一盛水银丹药。填塞其中。一则
空而无物。以两罐对合两口。扎住。盐泥封固。然后 炼。其上之空罐。当烧红时。必用湿
纸搭于罐底。频以冷水润之。盖下罐丹药。为火久逼。则渐渐望空罐中来矣。如升药之望上
而飞也。但水银甚活。虽上入空罐。又能复入旧罐。必得凉冷之处。方能摄住其质。故
用湿纸搭于罐底。丹必稳贴矣。今仿此法以制方。用童便炙龟板一两。熟地、枸杞各七钱。
麦冬五钱。萸肉四钱。此五味皆补肾滋阴之药。犹水银与丹药也。附子二钱。以从治而导火
归元。犹炼丹之火也。又用黄柏七钱以降其火。犹罐底之湿纸与水也。黄昏煎好。子时方服
从前服药。皆积于胸中而难下。服此药。觉胸中易下。三剂而热除病愈。
震按此案认为肾虚火不归原。大剂补肾。寒因热用。与证极合。与脉似乎未合。然其讲
理取医。真堪贻后训则。
孙东宿治徐三泉令郎。每下午发热。直至天明。夜热更甚。右胁胀痛。咳嗽吊疼。以疟
治罔效。延及二十余日。热不退。后医谓为虚热。投以参、术。痛益增。孙诊之。左弦大。
右滑大搏指。乃曰。内经云。左右者。阴阳之道路。据脉肝胆之火为痰所凝。必勉强作文。
过思不决。木火之性。不得通达。郁而致疼。夜甚者。肝邪实也。初治只当通调肝气。一剂
可
瘳。误以为疟。燥动其火。补以参、术。闭塞其气。致汗不出而舌胎如沉香色。热之极矣。
乃以小陷胸汤。用大栝蒌一两。黄连三钱。半夏二钱。加前胡、青皮各一钱。煎服。夜以当
归龙荟丸微下之。遂痛止热退。两帖全安。
潘见所一小价。年十六七。发热于午后。医者以为阴虚。用滋阴降火药。三十余剂。热
益加。且腹中渐胀。面色青白。仍以六味地黄汤加知、柏、麦冬、五味之类。又三十剂而腹
大如斗。坚如石。饮食大减。发黄成穗。额亮口渴。两腿大肉消尽。眼大面小。肌肤枯燥
如
松树皮。奄奄一骷髅耳。孙东宿至。观其目之神。尚五分存。乃曰。证非死候。为用药者误
耳。譬之树木。若根本坏而枝叶枯焦。非力可生。今焦枯。乃斧斤伤其枝叶而根本仍在也。
设灌溉有方。犹可冀生。以神授丹。日用一丸。煮猪肉四两饲之。十日腹软其半。热亦消其
半。神色渐好。潘问此何证。孙曰。此疳积证也。误认为肾虚而用滋阴之药。是以滞益滞。
腹焉得不大不坚。况此热乃湿热。由脾虚所致。补阴之剂皆湿类。热得湿而益甚矣。盖脾属
土。喜燥恶湿。今以大芦荟丸、肥儿丸。调理一月。即可全瘳。
震按发热有两大局。一系外因。内经所谓热病者。皆伤寒之类也。一系内因。内经所谓
阴虚则发热也。然伤寒之类。已有风、暑、湿、湿热、风湿、温病、热病、风温、瘅疟、脚
气十余种分别。若内因。自阴虚之外。如劳倦内伤、阴盛格阳、气虚、血虚、火郁、阳郁、
停食、伤酒、伏痰、积饮、瘀血、疮疡。头绪不更多乎。得其因。又当分其经。而十二经之
外。又有奇经。如阳维为病发寒热。此非可以疟治者。故临证贵乎细辨也。即如孙东宿二案
一系肝经郁火。一系疳积似痨。非具明眼。岂能奏功。
罗谦甫治疗王侍郎的女婿。患者二十五岁。十一月间。因为劳累、忧虑、思虑和烦恼。饮食不节制而生病。时常发作燥热。疲倦乏力并盗汗。汗水湿透被褥。不想吃东西。气息微弱不足以喘息。面色青黄无光泽。罗诊察他的脉象浮数且短涩。两寸脉极小。告诉他道。这是危重的证候。治疗虽然能暂时缓解。到了春天必定死亡。应当让亲家知道这件事。妻子不以为然。于是更换了医生。到了正月。果然因躁热而去世。有一天侍郎对罗说。我的女婿果然像您说的那样。希望听听其中的道理。罗说。这并不难理解。《内经》说。主气胜为逆。客气胜为从。这是天道的规律。大概时令是客。人身是主。冬三月人们都害怕寒冷。唯独他躁热盗汗。这是时令不能固护其阳气。时邪不能胜过体内的热。天地时令。尚且不能制约。药物又能做什么呢。冬季是闭藏的月份。阳气应当潜伏在九泉之下。到春天才发为雷。动而为风鼓荡拆裂万物。这是顺应生发的道理。如果冬天收藏不牢固。那么春天生长就不茂盛。并且会有疫疠的灾害。所以人身阴气。也应当潜伏在内。不敢妄自扰动。不要泄露皮肤。使气频繁耗夺。这是冬季闭藏的对应表现。令郎的汗出在闭藏的月份。肾水已经枯竭。到了春天怎么能够生发肝木呢。阳气在内断绝。没有滋荣之源。不死还等待什么呢。于是叹息着离开。
俞震按：这个论述可以作为虚损怯弱病的明镜。为什么类案中没有收录。另外罗君治疗韩子玉的父亲。六十岁。患消渴病。到了冬天增添躁热。必须裸露身体。把冰放在胸腋下才舒服。他的脉象沉细而疾速。罗也说。人身是主。时令是客。大寒的时令。他的热反而更严重。经书说当所胜的时令。却不能制约。名叫真强。乃是孤阳绝阴。必死的证候。与此条义理相同。
薛立斋治疗州同韩用之。四十六岁。仲夏时节色欲过度。烦热作渴。饮水不停。小便淋沥涩痛。大便秘结。唾痰如涌出。面目都红赤。满舌生刺。两唇干燥破裂。遍身发热。有时像芒刺一样但没有固定位置。两足心像被烙铁烫过。用水擦拭则疼痛。脉象洪大而无条理。这是肾阴虚而阳无所依附而发散于外。不是实火。大概大热而甚。用寒凉药不能退热。是没有水（阴液）。应当峻补其阴。于是用加减八味丸料一斤。内加肉桂一两。用水急煎六碗。冰冷后给患者饮用。不到一炷香时间已喝掉大半。睡醒后吃温粥一碗。再睡到晚上。又以前药温饮一碗。于是睡到天亮吃热粥二碗。各种症状全部消退。第二天怕冷。脚冷至膝盖。各种症状又出现。有人认为是伤寒。薛说。不是。大寒而甚。用温热药不能复温。是没有火（阳气）。阳气也虚弱了。急忙用八味丸一剂。服用后稍缓解。四剂后各种症状再次消退。大便到十三日不通。用猪胆汁导便。各种症状又发作。急忙用十全大补汤四剂。才见效。
俞震按：这一条与伤寒门顾大有父亲七十九岁的证脉颇为相似。而不将其列在伤寒中。是因为所述症状。先叙述烦渴引饮。溺淋唾痰。面赤舌燥。然后继之以遍身发热等。其情形特别不像伤寒先发热。而后逐渐出现烦渴溺淋舌燥。顾姓病例叙述起即首先记载头痛发热。仔细看自然有分别。立斋的治疗方法确实奇特。然而说阴虚而用肉桂一两。似乎难以作为典范。况且前面说无水。用加减八味料一斤。所谓加减不过是去掉附子加上五味子罢了。后面说无火。用八味丸一剂。则较之前用的一斤。桂一两。仅仅得到十分之一了。为什么前后轻重如此不同呢。姑且保存这种说法。向高明之士请教。
立斋又治疗府庠王以道。元气素来虚弱。又因为考试积劳。在冬天大发热。流泪随即凝固。目赤露胸。气息沉沉欲绝。脉象洪大鼓指。按之却如无。舌干如刺。这是内真寒而外假热。命令服用十全大补汤。嘱咐道。服用此药脉象应当收敛才好。不久熟睡。醒来后恶寒增加衣物。脉象顿时微细如丝。这是虚寒的真象。用人参一两。熟附子三钱。水煎顿服而安。夜间脉象又脱失。于是用人参二两。熟附子五钱。仍然痊愈。后来用大剂量人参、白术、当归身、炙甘草等药。调理而愈。
俞震按：壮热露胸。目赤泪凝。舌干如刺。完全是火象。只有气息沉沉欲绝。是虚象。脉象洪大鼓指。按之却如无。就可以断定其内虚寒而外假热。服用温补药后。脉象应当收敛才好。这是格言。应当熟记。另外立斋治疗七十九岁老人。在少室家入房后。头痛发热。出现各种火象。脉象洪大无伦。按之有力。与此案证同脉异。更应仔细参详。
李时珍自己记录二十岁时。因为感冒。咳嗽已久。并且犯了戒律（指房事）。于是病骨蒸发热。皮肤如火燎。每天吐痰约一碗。暑月烦渴。寝食几乎废弛。六脉微洪。遍服柴胡、麦冬、荆沥等各种药物。一个多月病情加重。他的父亲偶然想到李东垣治疗肺热如火燎。烦躁引饮而白天盛者。是气分热。宜用一味黄芩汤。以泻肺经气分之火。于是按方用片芩一两。水煎顿服。第二天身热尽退。而痰嗽都好了。药中肯綮。如鼓应桴这样灵验。
俞震按：此案与立斋治法。有天渊之别。所以病人如人面之不同。千态万状。没有定形。治病者能如以镜照面。使其随其形而呈于镜。则美丑自然区别。不至于误认。
高果哉治疗陈几亭。病身热。从卯辰时以后。上半身热。申酉时。中半身热。亥子时。下半身热。热至足底更甚。周而复始。一日一夜。循环无间。服药久而不效。辗转沉重。高诊察其脉微无力。右尺脉伏而不起。因而思考尺脉沉伏者。是肾虚。日夜的热。上下循环者。是肾火之浮游。到子时而足底大热。则是肾火之归就于下。如果在当归下的时候。能摄住其性。不使上走。那么热自然就没有了。须效仿烧丹法治之。炼丹家用两个阳城罐。一个盛水银丹药。填塞其中。一个是空而无物。将两罐对合两口。扎住。盐泥封固。然后炼。其上之空罐。当烧红时。必用湿纸搭于罐底。频以冷水润之。盖下罐丹药。为火久逼。则渐渐望空罐中来矣。如升药之望上而飞也。但水银很活。虽上入空罐。又能复入旧罐。必得凉冷之处。方能摄住其质。故用湿纸搭于罐底。丹必稳贴矣。现在仿此法以制方。用童便炙龟板一两。熟地、枸杞各七钱。麦冬五钱。萸肉四钱。这五味都是补肾滋阴的药。犹如水银与丹药。附子二钱。以从治而导火归元。犹如炼丹之火。又用黄柏七钱以降其火。犹如罐底之湿纸与水。黄昏煎好。子时方服。从前服药。皆积于胸中而难下。服此药。觉胸中易下。三剂而热除病愈。
俞震按：此案认为肾虚火不归原。大剂补肾。寒因热用。与证极合。与脉似乎未合。但其讲理取医。真堪贻后训则。
孙东宿治疗徐三泉的儿子。每下午发热。直至天明。夜热更甚。右胁胀痛。咳嗽牵拉疼痛。以疟疾治疗无效。延及二十余日。热不退。后医认为是虚热。投以参、术。痛更加重。孙诊察其脉。左弦大。右滑大搏指。于是说。《内经》说。左右者。是阴阳的道路。据脉肝胆之火为痰所凝。必定勉强作文。过思不决。木火之性。不得通达。郁而致疼。夜甚者。是肝邪实。初治只当通调肝气。一剂可愈。误以为疟。燥动其火。补以参、术。闭塞其气。导致汗不出而舌苔如沉香色。热之极矣。于是用小陷胸汤。用大栝蒌一两。黄连三钱。半夏二钱。加前胡、青皮各一钱。煎服。夜间以当归龙荟丸微下之。遂痛止热退。两帖全安。
潘见所的一个仆役。年龄十六七岁。午后发热。医者认为是阴虚。用滋阴降火药。三十多剂。热更加重。且腹中渐胀。面色青白。仍以六味地黄汤加知母、黄柏、麦冬、五味子之类。又三十剂而腹大如斗。坚如石。饮食大减。发黄成穗。额亮口渴。两腿大肉消尽。眼大面小。肌肤枯燥如松树皮。奄奄一骷髅耳。孙东宿至。观其目之神。尚有五分存。于是说。证非死候。为用药者误耳。譬如树木。若根本坏而枝叶枯焦。非力可生。今焦枯。乃斧斤伤其枝叶而根本仍在也。设灌溉有方。犹可冀生。以神授丹。日用一丸。煮猪肉四两饲之。十日腹软其半。热亦消其半。神色渐好。潘问此何证。孙曰。此疳积证也。误认为肾虚而用滋阴之药。是以滞益滞。腹焉得不大不坚。况此热乃湿热。由脾虚所致。补阴之剂皆湿类。热得湿而益甚矣。盖脾属土。喜燥恶湿。今以大芦荟丸、肥儿丸。调理一月。即可全瘳。
俞震按：发热有两大局。一系外因。《内经》所谓热病者。皆伤寒之类也。一系内因。《内经》所谓阴虚则发热也。然伤寒之类。已有风、暑、湿、湿热、风湿、温病、热病、风温、瘅疟、脚气十余种分别。若内因。自阴虚之外。如劳倦内伤、阴盛格阳、气虚、血虚、火郁、阳郁、停食、伤酒、伏痰、积饮、瘀血、疮疡。头绪不更多乎。得其因。又当分其经。而十二经之外。又有奇经。如阳维为病发寒热。此非可以疟治者。故临证贵乎细辨也。即如孙东宿二案。一系肝经郁火。一系疳积似痨。非具明眼。岂能奏功。
Luo Qianfu treated the son-in-law of Vice Minister Wang. The patient was twenty-five years old. In November, due to physical exertion, worry, overthinking, and vexation, combined with irregular diet, he fell ill. He frequently experienced dry heat, fatigue, and night sweats that soaked his bedding. He had no appetite, shortness of breath, and a sallow, lusterless complexion. Luo palpated his pulse as floating, rapid, short, and choppy, with both Cun positions extremely small. He told him, "This is a critical condition. Although treatment may bring temporary relief, he will certainly die in spring. You should inform his parents-in-law." His wife did not accept this and changed doctors. By January, he indeed died from restlessness and heat. One day, Vice Minister Wang said to Luo, "My son-in-law died exactly as you predicted. I wish to hear the reasoning." Luo replied, "This is not difficult to understand. The *Neijing* states: 'When the host wins, it is adverse; when the guest wins, it follows. This is the way of Heaven.' Generally speaking, the seasonal climate is the guest, and the human body is the host. During the three winter months, everyone fears cold, yet he alone experiences restlessness, heat, and night sweats. This indicates that the seasonal climate cannot secure his Yang Qi, and the external pathogen cannot overcome the internal heat. Even the heavenly and earthly seasonal climates cannot control it, so how can medicine help? Winter is the month of closure and storage. Yang Qi should lie dormant deep underground, only to emerge in spring as thunder and wind, stirring and opening all things. This is the way of nurturing life. If winter storage is not secure, spring growth will not be lush, and there will be epidemics. Therefore, the Yin Qi of the human body should also lie dormant within, not disturbing itself, and not leaking through the skin, causing frequent depletion of Qi. This corresponds to winter storage. Your son-in-law sweats during the month of storage, meaning his Kidney Water is already exhausted. How can Liver Wood generate in spring? With Yang Qi cut off internally and lacking nourishment, if he does not die, what else can he wait for?" He sighed and left.
Yu Zhen commented: This discussion serves as a clear mirror for consumptive and weak diseases. Why was it not included in similar cases? Additionally, Master Luo treated Han Ziyu's father, who was sixty years old. He suffered from Xiao Ke (Wasting and Thirsting syndrome). In winter, he developed increased restlessness and heat, requiring him to be naked and placing ice on his chest and armpits for relief. His pulse was deep, fine, and rapid. Luo also said, "The human body is the host, and the seasonal climate is the guest. In severe cold weather, his heat became even more intense. The Classics state that when one cannot control the controlling season, it is called 'True Excess' (Zhen Qiang). This is a sign of isolated Yang and severed Yin, which is invariably fatal." The principle is the same as the previous case.
Xue Lizhai treated Han Yongzhi, a provincial official, aged forty-six. In mid-summer, excessive sexual activity led to irritability, heat, thirst, incessant drinking, dysuria with astringency, constipation, profuse expectoration, redness of the face and eyes, prickles all over the tongue, dry and cracked lips, generalized fever, sometimes feeling like thorns without fixed locations, and burning pain in the soles of the feet exacerbated by water application. His pulse was surging and disordered. This indicated Kidney Yin deficiency with Yang having no attachment, manifesting externally. It was not excess Fire. Generally, great heat that does not respond to cooling indicates a lack of Water (Yin). One must vigorously tonify the Yin. Thus, he used one jin of Jiajian Bawei Wan (Modified Eight-Ingredient Pill) material, adding one liang of Rougui (Cinnamon Twig). It was boiled rapidly in water to make six bowls, served cold. Within half an hour, most was consumed. Upon waking, he ate a bowl of warm porridge, then slept until evening, drinking another bowl of the warm medicine. He slept until dawn, ate two bowls of hot porridge, and all symptoms subsided. The next day, he felt cold, with coldness extending to his knees, and symptoms returned. Some thought it was Shanghan (Cold Damage). Xue said, "No. Severe cold that does not respond to warming indicates a lack of Fire (Yang). Yang Qi is also deficient." He urgently prescribed one dose of Bawei Wan. Symptoms eased slightly. After four doses, symptoms receded again. Stool was not passed for thirteen days. Zhu Dan (Pig Gallbladder) was used for enema. Symptoms returned. Urgently, Shiquan Dabu Tang (Complete Great Tonifying Decoction) was given for four doses, finally taking effect.
Yu Zhen commented: This case is quite similar in symptoms and pulse to the seventy-nine-year-old father of Gu Dayou in the Shanghan section, but it is not listed under Shanghan because the described symptoms first mention irritability, thirst, drinking, dysuria, expectoration, red face, and dry tongue, followed by generalized fever. This situation is distinctly unlike Shanghan, which typically starts with fever and gradually presents with irritability, thirst, dysuria, and dry tongue. The Gu case begins with headache and fever, which clearly distinguishes it. Lizhai's treatment method is indeed unique. However, using one liang of Cinnamon Twig for Yin deficiency seems hard to justify as a standard. Moreover, earlier it was stated there was no Water, using one jin of Modified Eight-Ingredient material, where "modified" merely meant removing Fuzi (Aconite Root) and adding Wuweizi (Schisandra Berry). Later it was stated there was no Fire, using one dose of Bawei Wan, which is only one-tenth of the previous amount. Why such disparity in weight and importance before and after? I preserve this theory for discussion with experts.
Lizhai also treated Wang Yidao, a student at the prefectural academy. His Yuan Qi (Primal Qi) was inherently weak. Due to accumulated fatigue from examinations, he developed high fever in winter. Tears froze upon exiting the eyes. His eyes were red, chest exposed, breathing shallow and nearly absent. His pulse was surging and large, beating against the finger, but empty upon pressure. His tongue was dry and prickly. This was true cold inside and false heat outside. He was ordered to take Shiquan Dabu Tang (Complete Great Tonifying Decoction). He was instructed, "After taking this medicine, your pulse should converge, which would be good." Soon after, he fell into a deep sleep. Upon waking, he felt aversion to cold and added clothing. His pulse suddenly became minute and thread-like. This was the true image of deficiency-cold. He was given one liang of Renshen (Ginseng Root) and three qian of Shufu Zi (Prepared Aconite Child), decocted in water and taken in one dose, bringing peace. At night, his pulse collapsed again. Two liang of Renshen and five qian of Shufu Zi were given, leading to recovery. Later, large doses of Renshen, Baizhu (Atractylodes Macrocephala Rhizome), Dangshen (Codonopsis Root - *Note: Text says Guishen, likely Danggui*), and Zhigancao (Honey-fried Licorice Root) were used for conditioning, resulting in full recovery.
Yu Zhen commented: High fever, exposed chest, red eyes, frozen tears, and a dry, prickly tongue are purely signs of Fire. Only the shallow, nearly absent breathing indicates deficiency. A surging, large pulse beating against the finger but empty upon pressure confirms internal deficiency-cold and external false heat. After taking warming and tonifying medicines, the pulse should converge; this is a golden rule that must be memorized. Additionally, Lizhai treated a seventy-nine-year-old man who, after intercourse, developed headache and fever with various fire signs. His pulse was surging, large, and disordered, but forceful upon pressure. This differs in pulse from the previous case despite similar symptoms, warranting careful study.
Li Shizhen recorded himself: At age twenty, due to a cold, prolonged cough, and violation of abstinence, he suffered from bone-steaming fever, skin feeling like burning embers, expectorating about one bowl of phlegm daily, irritability and thirst in summer, and nearly losing sleep and appetite. His six pulses were slightly surging. He took Chaihu (Bupleurum Root), Maidong (Ophiopogon Tuber), Jingli (Acanthopanacis Senticosi Caulis juice), and other medicines for over a month, worsening significantly. His father偶然ly recalled Li Dongyuan's treatment for lung heat like burning embers, irritability, thirst, worse in daytime, indicating Qi-level heat. The remedy is Yiwei Huangqin Tang (Single-Herb Scutellaria Decoction) to drain Fire from the Lung Qi level. Following the prescription, he used one liang of Pianhuangqin (Scutellaria Baicalensis Root), decocted in water and taken in one dose. The next day, body heat completely subsided, and cough and phlegm resolved. The medicine hit the mark precisely, effective as quickly as a drumbeat.
Yu Zhen commented: This case differs vastly from Lizhai's treatment. Patients are like faces; they vary infinitely without fixed forms. A physician must be like a mirror reflecting the face, showing its shape, so beauty and ugliness are naturally distinguished, avoiding misdiagnosis.
Gao Guozai treated Chen Jiting. He suffered from body heat. From Mao-Chen hours (7-11 AM), upper body heat; Shen-You hours (3-7 PM), middle body heat; Hai-Zi hours (9 PM-1 AM), lower body heat. Heat intensified at the soles of the feet, cycling repeatedly. Day and night, the cycle continued without interruption. Long-term medication was ineffective. He grew progressively weaker. Gao palpated his pulse as minute and weak, with the Right Chi position hidden and unrising. He reasoned that a hidden Chi pulse indicates Kidney deficiency. The day-and-night cycling heat indicates wandering Kidney Fire. Heat at the soles at Zi hour indicates Kidney Fire returning downward. If, upon returning downward, its nature could be secured and prevented from rising, the heat would cease. One must emulate the alchemical furnace method. Alchemists use two Yangcheng jars. One contains mercury and pills, filled tightly. The other is empty. The two jar mouths are joined, tied, and sealed with salt mud, then heated. When the upper empty jar becomes red-hot, wet paper must be placed on its bottom, frequently moistened with cold water. Because the lower jar's contents are driven by fire for a long time, they gradually rise toward the empty jar, like ascending medicine flying upward. However, mercury is very active; even if it enters the empty jar, it can return to the old jar. It must reach a cool place to stabilize its substance. Thus, wet paper on the bottom ensures the pill stays firmly. Now imitating this method to formulate medicine: Use Tongbian Zhi Guiban (Turtle Shell steamed with child's urine) one liang, Shudi (Rehmannia Glutinosa Root prepared) and Gouqi (Lycium Fruit) seven qian each, Maidong (Ophiopogon Tuber) five qian, and Yurou (Cornus Fruit) four qian. These five herbs tonify Kidney and nourish Yin, like mercury and pills. Fuzi (Aconite Lateralis Radix Preparata) two qian guides Fire back to its source via contrary treatment, like the alchemical fire. Huangbai (Phellodendron Bark) seven qian descends Fire, like the wet paper and water at the jar bottom. Decocted at dusk, taken at Zi hour. Previous medicines accumulated in the chest and were hard to pass. This medicine felt easy to pass in the chest. After three doses, heat removed and illness cured.
Yu Zhen commented: This case attributes the issue to Kidney deficiency with Fire not returning to its origin. Large-dose Kidney tonification with "treating heat with cold" (referring to the method or context of guiding fire) fits the symptoms well, though perhaps less so the pulse. However, his theoretical reasoning is worthy of instruction for posterity.
Sun Dongsu treated the son of Xu Sanquan. Every afternoon he had fever until dawn. Night fever was more severe. Right hypochondriac distension and pain, coughing with pulling pain. Treated as Malaria (Nue) with no effect. It lasted over twenty days with no reduction in fever. Later physicians considered it deficiency heat and administered Renshen (Ginseng) and Baizhu (Atractylodes), increasing pain. Sun palpated his pulse: Left was wiry and large; Right was slippery, large, and pounding against the finger. He said, "The *Neijing* states: 'Left and right are the pathways of Yin and Yang.' Based on the pulse, Liver-Gallbladder Fire is congealed by Phlegm. This likely resulted from forced literary work and excessive overthinking. The nature of Wood and Fire could not flow freely, stagnating and causing pain. Worsening at night indicates excess Liver pathogen. Initial treatment should only regulate Liver Qi; one dose could cure. Mistakenly treating as Malaria agitated the Fire. Tonifying with Renshen and Baizhu blocked Qi, preventing sweating and causing the tongue coating to become like沉香 (Agarwood) color, indicating extreme heat." He prescribed Xiaoxianxiong Tang (Small Trap in the Chest Decoction) using Dagualou (Trichosanthes Fruit) one liang, Huanglian (Coptis Rhizome) three qian, Banxia (Pinellia Tuber) two qian, plus Qianhu (Peucedanum Root) and Qingpi (Citrus Reticulata Pericarpium viride) one qian each, decocted and taken. At night, he gave Danggui Longhui Wan (Angelica and Gardenia Pill) to mildly purge. Pain stopped, heat retreated, and he recovered fully after two doses.
Pan Jiansuo's servant, aged sixteen or seventeen, had afternoon fever. Physicians considered it Yin deficiency and used Yin-nourishing and Fire-descending medicines for over thirty doses. Fever worsened, abdomen gradually bloated, complexion greenish-white. Still prescribed Liuwei Dihuang Tang (Six-Ingredient Pill with Rehmannia) plus Zhimu (Anemarrhena Rhizome), Huangbai (Phellodendron Bark), Maidong (Ophiopogon Tuber), Wuweizi (Schisandra Berry), etc. After another thirty doses, the abdomen was as large as a bucket, hard as stone, food intake greatly reduced, yellow hair forming tufts, shiny forehead, thirst, complete wasting of thigh muscles, large eyes, small face, dry and rough skin like pine bark, looking like a dying skeleton. Sun Dongsu arrived, observed his eye spirit, noting five percent remained. He said, "This is not a death prognosis; it is the error of the prescriber. Like a tree, if the root rots and branches wither, strength cannot revive it. Here, the withering is due to axes damaging branches while the root remains. With proper irrigation, survival is possible." He prescribed Shenshou Dan (Divine Bestowal Pill), one pill daily, fed with four liang of boiled pork. After ten days, the abdomen softened by half, fever reduced by half, spirit and color improved. Pan asked, "What disease is this?" Sun said, "This is Gan Ji (Infestation Accumulation). Mistakenly diagnosed as Kidney deficiency and treated with Yin-nourishing medicines caused further stagnation. How could the abdomen not become large and hard? Moreover, this heat is Damp-Heat caused by Spleen deficiency. Yin-nourishing agents are damp in nature. Heat combined with dampness intensifies. Since the Spleen belongs to Earth, it likes dryness and dislikes dampness." He prescribed Da Luluhuan (Large Aloe Pill) and Fei'er Wan (Fatten Child Pill) for one month of conditioning, resulting in full recovery.
Yu Zhen commented: Fever has two major categories. One is external cause, as the *Neijing* states: "All heat diseases belong to the category of Shanghan." The other is internal cause, as the *Neijing* states: "Yin deficiency generates heat." However, among Shanghan types, there are already distinctions for Wind, Summerheat, Dampness, Damp-Heat, Wind-Damp, Warm Disease, Heat Disease, Wind-Warm, Dan Malaria, and Bi Syndrome of the legs, totaling over ten types. Regarding internal causes, besides Yin deficiency, there are Labor/Fatigue Internal Injury, Yin Excess repelling Yang, Qi Deficiency, Blood Deficiency, Fire Stagnation, Yang Stagnation, Food Retention, Alcohol Injury, Hidden Phlegm, Fluid Accumulation, Blood Stasis, and Sores/Ulcers. Are there not more threads? Once the cause is identified, meridians must be differentiated. Beyond the Twelve Regular Meridians, there are Extraordinary Vessels. For example, Yang Wei Mai pathology causes chills and fever. This cannot be treated as Malaria. Therefore, clinical differentiation must be meticulous. Just as in Sun Dongsu's two cases: one involves Liver Meridian Stagnant Fire, the other Gan Ji resembling Consumption. Without clear insight, how could success be achieved?