罗谦甫于至元己亥。治廉台王千户。年四十五。领兵镇涟水。此地卑湿。因劳役过度。
饮食失节。至深秋。疟痢并作。月余不愈。饮食全减。形羸瘦。仲冬舆疾归。罗诊得脉弦而
微如蛛丝。身体沉重。手足寒逆。时复麻木。皮肤痂疥如疠之状。无力以动。心腹痞满。呕
逆不止。此皆寒湿为病。久淹。真气衰弱。形气不足。病气亦不足。针经云。阴阳皆不足。
针所不为。灸之则宜。内经曰。损者益之。劳者温之。十剂曰。补可去弱。先以理中汤加附
子。温养脾胃。散寒湿。涩可去脱。养脏汤加附子。固肠胃。止泻痢。仍灸诸穴以并除之。
经云。府会太仓。即中脘也。先灸五七壮。以温养脾胃之气。进美饮食。次灸气海百壮。生
发元气以荣百脉。充实肌肉。复灸足三里。胃之合也。三七壮。引阳气下交阴分。亦助胃气
后灸阳辅二七壮。接阳气。令足胫温暖。散清湿之邪。迨月余。病气去。神完如初。
震按温补固涩以治疟痢虚证。其效犹迟。得诸灸法。参、附之力加倍矣。遇险病。宜宗
滑伯仁治一妇。年五十余。患疟。寒热涌呕。中满而痛。下利不食。殊困顿。医药不效
伯仁诊其脉。沉而迟。曰。是积暑与食。伏痰在中。当下之。或曰。人疲倦若是。且下利
不食。焉可下。方拟进参、附。滑曰。脉虽沉迟。按之有力。虽利而后重下迫。不下则积不
能去。病必不已。乃以消滞丸。微得通利。觉少快。明日再服之。宿积肠垢尽去。向午即思
食。旋以姜、橘、参、苓。淡渗和平饮子调之。旬余乃复。
震按此条疟痢兼呕。竟以消导药愈。较之专以发散药愈者。可作两大局。但须着眼中满
而痛。脉沉有力。知其病在里不在表也。
南浔董宗伯。门下有马厨者。七月初旬病。病二十余日。愈剧。其证大发寒热。寒至不
惮入灶。热至不惮下井。痢兼红白。日夜八十余行。腹痛恶心。神气倦甚。时孙东宿在宗伯
家。问向来医者言脉何如。有客曰脉不吉。下痢脉洪大者死。细微者生。今洪大。逆也。东
宿曰。痢固忌洪大。寒热亦非细微所宜。其中必有故。试往视之。见面色微红。汗淋淋下。
因究病所由起。渠谓过客众。厨门燥热。食瓜果菱藕过多。晚又过饮御内。而寝于楼檐之下
次日即寒热腹痛。因而下痢。病情虽述。治法难谐。因沉思之。告宗伯曰。偶有一得。乃
背水阵也。人参、白术、石膏、滑石各五钱。知母、炮姜各三钱。大附子、炙甘草各二钱。
作一大剂煎之。服后倘得一睡。则阴阳始和。和则汗可敛。而寒热呕恶可止也。至夜。痢减
其半。汗吐全无。脉亦敛矣。再用参、术、白芍、石膏、滑石各三钱。炮姜、肉桂、知母各
二钱。炙甘草、附子各一钱。服后疟止。痢又减半。饮食渐进。神气渐转。改用酒炒白芍五
钱。去石膏、附子。余药各减一钱。三剂全愈。客问曰。公寒热均投。此为何证。而剂何名
耶。东宿曰。此滑公所谓混沌汤也。经云。夏伤于暑。秋必疟痢。白虎汤、益元散。皆解暑
之剂。瓜果寒凉。伤其中气。酒后御色。损其下元。故合附子理中汤温中补下。若以寒热均
用为疑。则仲景附子泻心汤、大黄、芩、连与附子并用。此何说哉。盖假对假。真对真也。
震按古方中寒热并用者诚多。如仲景五泻心汤、黄连汤、乌梅丸、麻黄升麻汤。为后贤
连理汤、左金丸诸方之祖。夷考其义。泻心汤用芩、连之苦以泻痞热。姜、夏之辛以散结气
即寒因热用也。黄连汤则以桂枝代柴胡。黄连代黄芩。干姜代生姜。喻西昌所谓换小柴之
和表里者。为通上下法也。乌梅丸则以厥阴一经。本阴标热。故用姜、附之辛热。佐连、柏
之苦寒。柯韵伯引经文所谓伏其所主而先其所因也。麻黄升麻汤以知母、石膏。合麻、桂、
干姜。犹是越婢汤成例。其参入归、芍、苓、术、天冬、玉竹。则因邪陷厥阴。寒郁热伏。
又为下药重亡津液。故以辛温升散其邪。必兼凉润以制药之燥。仲景诸方。精义入神。岂如
混沌汤清暑回阳一网兜乎。乃引附子泻心汤为证。不知大黄、芩、连。以麻沸汤浸。而附子
别煮取汁。是重剂固阳为君。略寓泄热之意为佐。法律固森然也。节庵祖之。制回阳返本汤
以腊茶、黄连、地浆。作人参四逆之向导。方为妥贴。奈何以参、术、桂、附、炮姜。与
知母、石膏、滑石。杂然并进。譬之演剧者。合三班为一班。将琵琶千金杀狗记一齐登场混
演。有是理乎。再考仲景证象阳旦条。厥逆咽中干两胫拘急而谵语。亦是寒热并现。乃先与
桂枝加附子汤。增桂令汗出。虽阳明内结。谵语烦乱。更饮甘草干姜汤。俟阳回足热。乃与
芍药甘草汤以伸其脚。然后用承气汤以止其谵语。先后缓急之间。不为病所惑。而次第合节
方称仙手。若使孙公当此。应将四方合而煎饮之。不反笑仲景之跋涉耶。然余之录之者。
其书载其效如神。则亦姑存其说而已。
孙公原案又云。实者邪气实也。故以白虎汤、益元散应之。虚者正气虚也。故以理中汤
应之。今考此方分两。纯是少阴经阴盛格阳治法。若果有暑邪。岂五钱之石膏、滑石。能与
大剂参、术、姜、附并取其效哉。案载脉洪大。不载有力无力。亦不载口渴与否。舌胎及小
便若何。何以放胆用温补。若痢兼红白。腹痛恶心。面红汗多。寒热大作诸证。确系暑邪为
病。温补殊属反背。若果能取效。则的系虚寒。其细微之知母、石膏。正如白通加人尿猪胆
汁汤耳。不得牵扯暑邪二字以混之也。然病经二十余日。虚寒证早已亡阳矣。能待孙公用药
又考虞天民治妇人疫病。以三方合为一方。曰三合汤。不过于血药中加寒下药。却是一
路。与混沌汤风马牛不相及也。混沌汤之名。出于白云集。乃滑伯仁治陈伯英肺气焦满。而
告之曰。病由多愁善饮。且殚营虑。中积痰涎。外受风邪。发即喘喝痰咳。不能自安。为制
清肺泄满降火润燥苦辛之剂。服之既安。众诘出何方书。名何汤散。伯仁应之曰。是混沌汤
然观其制方之义。实非混沌。不似孙公之真混沌也。
又治金达泉疟兼痢。日夜四十余度。小腹痛甚。每登厕。汗出如雨。下迫后重。小水涩
痛。头疼口渴。下午发热。天明始退。左脉浮弦而数。右软弱。中部稍滑。此内伤饮食。外
感风邪所致。先与柴苓汤一剂。小便即清。不痛。疟发时寒多热少。晚与人参败毒散。去羌
独。加葛根、防风、桂枝、白芍。次日头痛痢疾俱减。夜才起三次。改与补中益气汤加酒
芩、桂枝、白芍。其夜疟止。但微热。再改胃风汤。人参、白术、桂皮各二钱。白芍四钱。
酒炒芩连各一钱。当归、茯苓、川芎佐之。炮姜、地榆为使。服后寒热殄迹。夜起一次是粪
前方减去桂枝。再三剂而巾栉出户矣。
震按此案用方妥当出色。可以效法。若王金坛治邑令刘蓉川深秋患疟而洞泄不止。欲先
去其一为快。乃用局方双解饮子。一服而二病俱愈。更觉神妙。是得法于澹寮所谓用药多一
冷一热半熟半生分利阴阳之义也。然窃思疟痢并作。初起者专用发散如羌、防、柴、葛等。
佐以赤苓、神曲。见血痢参入归身、川芎。右关脉大可加浓朴。使在腑之邪提并于经而外解
最为捷法。倘或不应。审其挟热挟寒而用表里分散之法。热者去羌、防。加芩、连、香薷
滑石。寒者去柴、葛。加桂枝、干姜。若热甚者多实证。风药不宜矣。大柴胡汤加黄连、
滑石。寒甚者多虚证。风药当戒矣。真武汤加桂枝、人参。此仍表里双解之法。至如人参败
毒散、补中益气汤。虚证之表药也。理中汤、八味丸。虚证之里药也。表证之虚而挟热者。
小柴胡汤。里证之虚而挟热者。连理汤。表证之虚而挟寒者。麻黄附子细辛汤。里证之实而
挟寒者。温脾汤。以此诸法。将脉证配合审用。无不手到成功。如此条右脉 弱为虚。疟发
寒多热少亦为虚。故第二剂即用人参。但汗出如雨。而于败毒散去羌、独。加桂枝、白芍是
矣。又加葛根、防风。尚觉太过。
罗谦甫在至元己亥年，治疗廉台的王千户。患者四十五岁，率领军队镇守涟水。此地地势低洼潮湿，因过度劳累，饮食不规律，到了深秋时节，疟疾和痢疾同时发作，一个多月没有痊愈。食欲完全减退，身体消瘦虚弱，仲冬时节带病回家。罗医生诊察发现脉象弦细且微弱如蛛丝，身体沉重，手足冰冷逆冷，时常麻木，皮肤结痂生疥，如同麻风病的症状，无力活动，心腹部痞塞胀满，呕吐不止。这些都是寒湿致病，病程长久拖延，真气衰弱，形体与正气不足，病邪之气也不足。《针经》说：阴阳都虚弱的情况，针刺不宜采用，艾灸则适宜。《内经》说：亏损的要用补益法，劳损的要用温养法。《十剂》说：补益可以去除虚弱。先用理中汤加附子，温养脾胃，散除寒湿。“涩可去脱”，用养脏汤加附子，固护肠胃，止住泻痢。同时艾灸各个穴位以一并祛除病邪。《内经》说：腑会太仓，即中脘穴。先灸五到七壮，以温养脾胃之气，增进饮食。接着灸气海穴一百壮，生发元气以滋养全身血脉，充实肌肉。再灸足三里穴，这是胃经的合穴，灸三七壮，引导阳气下行交入阴分，也有助于胃气。随后灸阳辅穴十四壮，接续阳气，使小腿温暖，散除湿冷之邪。经过一个多月，病邪去除，精神恢复如初。
俞震按语：用温补固涩的方法治疗疟痢虚证，疗效往往迟缓。配合各种灸法后，人参、附子的效力加倍了。
遇到险重病证，应当效法滑伯仁治疗一位五十多岁妇女的案例。她患疟疾，寒热往来，呕吐剧烈，胸中胀满疼痛，下利不能进食，非常困顿疲惫。医药无效。滑伯仁诊察她的脉象，沉而迟。他说：这是暑气与食积，伏痰在中焦。应当用攻下法。有人问：人已经疲倦到这种地步，况且又下利不能进食，怎么可以用攻下法？原本打算进服人参、附子。滑伯仁说：脉象虽然沉迟，但按之有力。虽然有下利，但伴有里急后重感。如果不攻下，积滞不能去除，病一定不会好。于是用消滞丸，微微得到通利，感觉稍微舒适。第二天再服用，宿积肠垢全部排出。中午就开始想吃东西。随即用生姜、橘皮、人参、茯苓等淡渗平和的饮子调理。十多天后康复。
俞震按语：这一条疟痢兼有呕吐，竟然用消导药治愈，比起专门用发散药治愈的，可以看作两种大局。但必须注意“中满而痛”、“脉沉有力”，知道病位在里不在表。
南浔董宗伯家中，有个叫马厨的仆人，七月上旬生病。病了二十多天，病情加重。症状是大发寒热，冷得不怕进灶房，热得不怕下井。痢疾红白相兼，一天一夜八十多次。腹痛恶心，神气极度疲倦。当时孙东宿在董宗伯家，询问之前的医生说脉象如何。有位客人说脉象不吉利。下痢见洪大脉者死，细微脉者生。现在脉洪大，是逆证。孙东宿说：痢疾确实忌讳洪大脉，但寒热往来也不是细微脉所适宜的。其中必有缘故。试着去看看。见面色微红，汗淋淋地下淌。于是追问病因。他说因为过客众多，厨房燥热，吃瓜果菱藕过多，晚上又过量饮酒行房，睡在楼檐下。第二天就出现寒热腹痛，因而下痢。病情虽然陈述清楚了，但治法难以协调。于是沉思之后，告诉董宗伯说：偶然有一个想法，乃是背水一战之法。用人参、白术、石膏、滑石各五钱，知母、炮姜各三钱，大附子、炙甘草各二钱。作为一大剂煎服。服药后如果能睡一觉，那么阴阳开始调和。调和则汗可收敛，而寒热呕恶可以停止。到了晚上，痢疾减少了一半，出汗呕吐全无，脉象也收敛了。再用参、术、白芍、石膏、滑石各三钱，炮姜、肉桂、知母各二钱，炙甘草、附子各一钱。服药后疟疾停止，痢疾又减半，饮食逐渐增加，神气逐渐好转。改用酒炒白芍五钱，去掉石膏、附子，其余药物各减一钱。三剂后完全痊愈。客人问：您寒热药并用，这是什么证？方子叫什么名字？孙东宿说：这就是滑伯仁所说的混沌汤。《内经》说：夏伤于暑，秋必疟痢。白虎汤、益元散，都是解暑的方剂。瓜果寒凉伤了中气，酒后御色损伤了下元。所以合用附子理中汤温中补下。如果对寒热药并用感到疑惑，那么张仲景的附子泻心汤，大黄、黄芩、黄连与附子并用，这又作何解释呢？大概是假对假，真对真吧。
俞震按语：古方中寒热并用的确实很多，如张仲景的五泻心汤、黄连汤、乌梅丸、麻黄升麻汤，是后世贤者连理汤、左金丸等方的祖方。考察其义理，泻心汤用黄芩、黄连的苦味来泻痞热，干姜、半夏的辛味来散结气，这就是寒因热用。黄连汤则是用桂枝代替柴胡，黄连代替黄芩，干姜代替生姜，正如喻嘉言所说，换用小柴胡汤和解表里的方法，是通调上下之法。乌梅丸则是针对厥阴一经，本阴标热，所以用干姜、附子的辛热，佐以黄连、黄柏的苦寒，柯韵伯引用经文所谓“伏其所主而先其所因”。麻黄升麻汤用知母、石膏，合麻黄、桂枝、干姜，还是越婢汤的成例。其中加入当归、白芍、茯苓、白术、天冬、玉竹，是因为邪气陷入厥阴，寒郁热伏，又是由于下药重伤津液，所以用辛温升散来驱邪，必须兼用凉润来制约药物的燥性。张仲景的各首方剂，精义入神，哪里像混沌汤那样清暑回阳一网打尽呢？却引用附子泻心汤为证据，不知道大黄、黄芩、黄连是用沸水浸泡，而附子另外煮取汁，这是重用附子固阳为君，略微寓泄热之意为辅佐。法度森严。节庵继承此意，制定回阳返本汤，用腊茶、黄连、地浆，作为人参四逆汤的向导，方为妥帖。怎么能将参、术、桂、附、炮姜，与知母、石膏、滑石杂乱并进呢？这就好比演戏的人，把三个戏班合并为一个班，将琵琶记、千金记、杀狗记一齐登场混演，有这样的道理吗？再考察张仲景证象阳旦条，厥逆咽中干，两胫拘急而谵语，也是寒热并现。却是先给桂枝加附子汤，增加桂枝令其出汗。虽然阳明内结，谵语烦乱，再饮甘草干姜汤，等到阳气回复脚热，然后给芍药甘草汤来舒展双脚。然后用承气汤来止住谵语。先后缓急之间，不被病邪迷惑，而次第合乎节拍，才称为仙手。如果让孙公遇到这种情况，应该将四方合在一起煎服饮用，岂不是要嘲笑张仲景的跋涉吗？然而我记录这个案例，是因为书中记载其效如神，所以姑且保存他的说法罢了。
孙公原案又说：实证是邪气实，所以用白虎汤、益元散应对。虚证是正气虚，所以用理中汤应对。现在我考察这个方的分量，完全是少阴经阴盛格阳的治法。如果真的有暑邪，难道五钱的石膏、滑石，能和大剂量的参、术、姜、附一起取得效果吗？案中记载脉洪大，没记载有力无力，也没记载是否口渴，舌苔及小便如何，凭什么大胆使用温补？如果痢疾红白相兼，腹痛恶心，面红汗多，寒热大作诸证，确实是暑邪为病，温补确实违背常理。如果真能取效，那确实是虚寒。其中的微量知母、石膏，正如白通加人尿猪胆汁汤一样。不得牵扯暑邪二字来混淆视听。然而病已二十多天，虚寒证早已亡阳了。能等到孙公用药……
又考虞天民治疗妇人疫病，将三方合为一方，叫三合汤，不过是在血药中加入寒下药，这是一路思路，与混沌汤风马牛不相及。混沌汤之名，出自《白云集》，是滑伯仁治疗陈伯英肺气焦满，告诉他：病由多愁善饮，且耗竭营虑，中积痰涎，外受风邪，发作时喘喝痰咳，不能自安。为他配制清肺泄满降火润燥苦辛之剂，服用后既安。众人追问出自何方书，名何汤散。伯仁回答说：是混沌汤。然而观察其制方之义，其实并非混沌，不像孙公的那个真是混沌。
又治疗金达泉疟疾兼痢疾，一天一夜四十多次，小腹痛甚，每次上厕所，汗出如雨，下迫后重，小便涩痛，头疼口渴，下午发热，天明才退。左脉浮弦而数，右软弱，中部稍滑。这是内伤饮食，外感风邪所致。先给柴苓汤一剂，小便即清，不痛。疟疾发作时寒多热少，晚上给人参败毒散，去掉羌活、独活，加葛根、防风、桂枝、白芍。次日头痛痢疾俱减，夜里才起三次。改给补中益气汤加酒芩、桂枝、白芍。当晚疟疾停止，只有微热。再改胃风汤，人参、白术、桂皮各二钱，白芍四钱，酒炒芩连各一钱，当归、茯苓、川芎佐之，炮姜、地榆为使。服用后寒热消失，夜里起一次。前方减去桂枝，再三剂而出门梳洗矣。
俞震按语：此案用药妥当出色，可以效法。如果王金坛治疗县令刘蓉川深秋患疟而洞泄不止，想要先去其一为快，于是用局方双解饮子，一服而二病俱愈，更觉神妙。这是得法于澹寮所谓用药多一冷一热半熟半生分利阴阳之义。但我私下思考，疟痢并作，初起者专用发散如羌活、防风、柴胡、葛根等，佐以赤茯苓、神曲，见血痢参入当归身、川芎，右关脉大可加浓朴，使在腑之邪提并于经而外解，最为捷法。倘若不应，审其挟热挟寒而用表里分散之法。热者去羌活、防风，加黄芩、黄连、香薷、滑石。寒者去柴胡、葛根，加桂枝、干姜。若热甚者多实证，风药不宜了。大柴胡汤加黄连、滑石。寒甚者多虚证，风药当戒了。真武汤加桂枝、人参。这仍是表里双解之法。至于如人参败毒散、补中益气汤，是虚证的表药。理中汤、八味丸，是虚证的里药。表证之虚而挟热者，用小柴胡汤。里证之虚而挟热者，用连理汤。表证之虚而挟寒者，用麻黄附子细辛汤。里证之实而挟寒者，用温脾汤。以此诸法，将脉证配合审用，无不手到成功。如此条右脉弱为虚，疟发寒多热少亦为虚，所以第二剂就用人参。但汗出如雨，而在败毒散去羌活、独活，加桂枝、白芍是对的。又加葛根、防风，尚觉太过。
Luo Qianfu, in the Jihai year of the Zhiyuan era, treated Wang Qianhu from Liantai. The patient was forty-five years old and led troops to garrison Lianshui. This area was low-lying and damp. Due to excessive labor and irregular diet, by late autumn, malaria (Nüe Ji) and dysentery (Li Ji) occurred simultaneously and persisted for over a month without resolution. Appetite was completely lost, and the body became emaciated and weak. By mid-winter, he returned home while still ill. Dr. Luo’s pulse diagnosis revealed a string-taut (Xian) yet faint pulse, as thin as a spider’s thread. The body felt heavy, hands and feet were cold and reversed, numbness occurred intermittently, and the skin presented with crusts and scabies resembling leprosy. He lacked the strength to move. There was epigastric and abdominal fullness and distension, accompanied by incessant vomiting. These were all manifestations of Cold-Damp pathogenic factors. The disease had lingered for a long time, depleting True Qi (Zhen Qi), resulting in insufficiency of both form and Qi, as well as an insufficiency of pathogenic factors. The *Classic of Acupuncture* (*Zhen Jing*) states: "When both Yin and Yang are insufficient, acupuncture is not suitable; moxibustion is appropriate." The *Inner Canon* (*Nei Jing*) states: "For deficiency, apply tonification; for exhaustion, apply warming." The *Ten Categories of Medicinals* (*Shi Ji*) states: "Tonification can remove weakness." First, Li Zhong Tang (Regulate the Middle Decoction) with added Fuzi (Prepared Aconite Root) was used to warm and nourish the Spleen and Stomach, dispersing Cold-Damp. "Astringency can prevent collapse," so Yang Zang Tang (Nourish Viscera Decoction) with added Fuzi was used to consolidate the intestines and stop diarrhea and dysentery. Moxibustion was applied to various acupoints to eliminate the pathogens simultaneously. The Classics state: "The Hui-Point of the Fu organs is Tai Cang, which is Zhongwan (CV12)." Initially, five to seven moxa cones were burned to warm and nourish the Qi of the Spleen and Stomach, promoting appetite. Next, one hundred moxa cones were burned at Qihai (CV6) to generate Yuan Qi (Original Qi) to nourish all vessels and fill the muscles. Then, Zusanli (ST36), the He-Sea point of the Stomach meridian, was moxibusted with three times seven cones to guide Yang Qi downward into the Yin aspect, further assisting Stomach Qi. Subsequently, Yangfu (GB38) was moxibusted with fourteen cones to connect Yang Qi, warming the lower legs and dispersing Cold-Damp pathogens. After more than a month, the pathogenic factors were eliminated, and spirit and vitality returned to normal.
Yu Zhen commented: Treating deficiency-type malaria and dysentery with warming, tonifying, and astringent methods often yields slow results. When combined with various moxibustion techniques, the efficacy of Renshen (Ginseng Root) and Fuzi is doubled.
In cases of critical illness, one should emulate Hua Borén’s treatment of a woman in her fifties who suffered from malaria, alternating chills and fever, violent vomiting, central fullness and pain, diarrhea, inability to eat, and extreme debility. Medical treatments had failed. Hua Borén diagnosed her pulse as deep (Chen) and slow (Chi). He stated: "This is summer-heat and food retention, with phlegm-fluids stagnating in the middle. Purging is indicated." Someone asked: "The patient is this exhausted, and has diarrhea with anorexia; how can purging be used?" They originally planned to administer Renshen and Fuzi. Hua Borén said: "Although the pulse is deep and slow, it is forceful upon pressure. Although there is diarrhea, there is tenesmus. If not purged, the accumulation cannot be removed, and the disease will not resolve." He then administered Xiao Zhi Wan (Eliminate Stagnation Pills), which produced mild bowel movement, bringing slight relief. On the second day, another dose was given, expelling all accumulated fecal matter. By noon, she desired food. She was subsequently regulated with a mild, permeating, and harmonizing decoction containing Shengjiang (Fresh Ginger Rhizome), Juhua (Tangerine Peel), Renshen, and Fuling (Poria). She recovered within ten days.
Yu Zhen commented: This case of malaria and dysentery complicated by vomiting was cured using digestive-promoting herbs, contrasting with cases cured solely by diaphoretic herbs, representing two major approaches. However, one must focus on "central fullness and pain" and "deep, forceful pulse" to understand that the pathology is interior rather than exterior.
Dong Zongbo of Nanxun had a servant named Ma Chu who fell ill in early July. After twenty-plus days, the condition worsened. Symptoms included severe alternating chills and fever; feeling so cold he did not fear entering the stove, and so hot he did not fear jumping into the well. Dysentery with red and white discharge occurred eighty to ninety times daily. Abdominal pain, nausea, and extreme mental fatigue were present. At that time, Sun Dongsu was staying at Dong Zongbo’s residence. Asking about previous physicians' pulse diagnoses, a guest remarked: "The pulse is inauspicious. In dysentery, a洪大 (Huge and Large) pulse indicates death, while a细微 (Fine and Minute) pulse indicates survival. The current huge pulse is a counter-indication." Sun Dongsu replied: "While a huge pulse is indeed contraindicated in dysentery, alternating chills and fever are also not typical for a fine/minute pulse. There must be a cause. Let us examine him." The patient’s face was slightly red, and sweat poured down. Upon investigating the etiology, he explained that due to many visitors, the kitchen was dry and hot, and he had consumed excessive melons, water chestnuts, and lotus roots. That night, he drank excessively and engaged in sexual activity, sleeping under the eaves. The next day, chills, fever, abdominal pain, and dysentery began. Although the history was clear, the treatment strategy was difficult to harmonize. After deep contemplation, Sun told Dong Zongbo: "I have a sudden insight; this is a 'back-to-the-river battle' strategy." The prescription consisted of Renshen, Baizhu (Atractylodes Macrocephala Rhizome), Shigao (Gypsum Fibrosum), Huashi (Talcum), each 5 qian; Zhimu (Anemarrhena Rhizome), Paojiang (Processed Ginger Rhizome), each 3 qian; Dafuzi (Large Prepared Aconite Root), Zhi Gancao (Honey-fried Licorice Root), each 2 qian. This large dose was decocted and taken. If sleep followed, Yin and Yang would begin to harmonize. Harmonization would allow sweat to收敛 (consolidate), stopping chills, fever, vomiting, and nausea. By night, dysentery reduced by half, sweating and vomiting ceased entirely, and the pulse consolidated. A second formula used Renshen, Baizhu, Baishao (White Peony Root), Shigao, and Huashi, each 3 qian; Paojiang, Rougui (Cinnamon Bark), and Zhimu, each 2 qian; Zhi Gancao and Fuzi, each 1 qian. After ingestion, malaria stopped, dysentery halved again, diet improved, and spirit revived. The formula was modified to use Jiuchaobaishao (Wine-fried White Peony Root) 5 qian, removing Shigao and Fuzi, reducing other herbs by 1 qian each. Three doses resulted in complete recovery. The guest asked: "You used both cold and hot herbs. What syndrome is this? What is the name of the formula?" Sun Dongsu replied: "This is what Hua Gong called Hundun Tang (Chaos Decoction). The Classic states: 'Summer injury by summer-heat leads to malaria and dysentery in autumn.' Baihu Tang (White Tiger Decoction) and Yiyuan San (Benefit Origin Powder) are all summer-heat resolving agents. Cold melons and fruits injured the Middle Qi; alcohol and sexual excess damaged the Lower Yuan. Thus, Fuzi Lizhong Tang was combined to warm the middle and tonify the lower. If you doubt the simultaneous use of cold and hot herbs, consider Zhang Zhongjing’s Fuzi Xie Xin Tang, where Dahuang (Rhubarb Root), Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), and Fuzi are used together. How do you explain that? It is essentially false addressing false, and true addressing true."
Yu Zhen commented: Ancient formulas frequently combine cold and hot herbs, such as Zhang Zhongjing’s Five Xie Xin Tangs, Huanglian Tang, Wumei Wan, and Mahuang Shengma Tang, which are ancestors to later formulas like Lianli Tang and Zuojin Wan. Examining their principles: Xie Xin Tang uses the bitterness of Huangqin and Huanglian to drain Pi-re (epigastric heat) and the pungency of Jiang and Banxia to disperse knot-Qi; this is "treating cold with heat." Huanglian Tang replaces Chaihu with Guizhi, Huangqin with Huanglian, and Shengjiang with Ganjiang, analogous to Yu Jiyang’s description of modifying Xiao Chaihu Tang to harmonize exterior and interior, serving as a method to unblock upper and lower. Wumei Wan addresses the Jueyin channel, which is Yin in substance but Heat in manifestation, thus using the pungent-hot of Jiang and Fuzi assisted by the bitter-cold of Lian and Bo. Ke Yunbo cites the Classic: "Subdue the dominant factor and address the primary cause first." Mahuang Shengma Tang combines Zhimu and Shigao with Mahuang, Guizhi, and Ganjiang, following the pattern of Yebipao Tang. The addition of Danggui, Baishao, Fuling, Baizhu, Tiandong, and Yuzhu addresses pathogen sinking into Jueyin, Cold stagnation with Heat entrapment, and fluid depletion caused by harsh purgatives; thus, pungent-warm ascending-dispersing herbs are used to expel pathogens, necessitating cool-moistening herbs to counteract dryness. Zhang Zhongjing’s formulas possess profound spiritual essence; they are far superior to Hundun Tang’s indiscriminate clearing of summer-heat and restoration of Yang. Citing Fuzi Xie Xin Tang as evidence ignores that Dahuang, Huangqin, and Huanglian are steeped in boiling water, while Fuzi is separately boiled for juice; this prioritizes strong Yang consolidation as the sovereign herb, with heat-draining as the assistant. The methodology is rigorous. Jie’an inherited this idea, creating Huiyang Fanben Tang, using Laicha (Aged Tea), Huanglian, and Dizhang (Earth Slurry) as guides for Renshen Sini Tang, which is appropriate. How can one杂乱 (clumsily) combine Renshen, Baizhu, Guizhi, Fuzi, Paojiang with Zhimu, Shigao, and Huashi? This is like merging three theater troupes into one, performing Pipa Ji, Qianjin Ji, and Shagou Ji simultaneously on stage—is this logical? Re-examining Zhang Zhongjing’s Yangdan presentation: cold extremities, dry throat, calf cramping, and delirium represent mixed cold and heat. Yet, Guizhi Jia Fuzi Tang was given first, increasing Guizhi to induce sweating. Although Yangming interior binding caused delirium and agitation, Ganjiang Gancao Tang was drunk next to restore Yang and warm the feet. Only then was Shaoyao Gancao Tang given to extend the legs, followed by Chengqi Tang to stop delirium. Between sequence and urgency, not confused by the disease, and adhering to rhythm, one earns the title of "Immortal Hand." If Mr. Sun faced this, he would likely mix four formulas into one decoction, mocking Zhang Zhongjing’s arduous step-by-step approach. However, I record this because the book claims miraculous efficacy, so I preserve his theory tentatively.
Mr. Sun’s original case note adds: "Excess refers to pathogenic excess, addressed by Baihu Tang and Yiyuan San. Deficiency refers to Zheng Qi (Upright Qi) deficiency, addressed by Lizhong Tang." Now examining this formula’s dosage, it strictly follows the Shaoyin channel method for Yin Excess repelling Yang. If summer-heat truly existed, could 5 qian of Shigao and Huashi achieve efficacy alongside large doses of Renshen, Baizhu, Jiang, and Fuzi? The case records a huge pulse but omits whether it is forceful or not, nor does it mention thirst, tongue coating, or urination. Why boldly use warming and tonifying? If dysentery with red/white discharge, abdominal pain, nausea, red face, profuse sweating, and severe chills/fever confirm summer-heat pathology, warming and tonifying is fundamentally contrary. If efficacy is achieved, it confirms deficiency-cold. The minute amounts of Zhimu and Shigao act like Baitong Tang plus human urine and pig bile. One must not invoke "summer-heat" to confuse the issue. Moreover, after twenty days, deficiency-cold would have already depleted Yang. Can one wait for Mr. Sun’s medication...
Furthermore, Yu Tianmin treated a woman with epidemic disease by combining three formulas into one, called Sanhe Tang, merely adding cold-purgative herbs to blood-invigorating herbs—a different approach altogether, unrelated to Hundun Tang. The name Hundun Tang originates from *Baiyun Ji*, where Hua Borén treated Chen Boying for lung Qi scorching and fullness. He explained: "Illness stems from excessive worry and drinking, exhausting Ying and causing mental strain, accumulating phlegm-fluids internally, and contracting Wind externally. Attacks manifest as wheezing, coughing with phlegm, and unrest." He prescribed a bitter-pungent formula to clear Lung, drain fullness, descend Fire, and moisten dryness. After taking it, the patient recovered. When asked for the source and name, Hua replied: "It is Hundun Tang." However, observing its formulation principle, it is truly not chaotic, unlike Mr. Sun’s actual chaos.
He also treated Jin Daquan’s malaria complicated by dysentery, occurring forty times daily. Severe lower abdominal pain, profuse sweating during defecation, tenesmus, painful/difficult urination, headache, thirst, afternoon fever subsiding at dawn. Left pulse: floating, string-taut, rapid. Right pulse: weak. Middle: slightly slippery. This resulted from internal dietary injury and external Wind contraction. First, Chai Ling Tang was given for one dose; urination cleared, pain ceased. During malaria attacks, chills predominated over fever. At night, Renshen Baidu San (Ginseng Detoxication Powder) was given, removing Qianghuo and Duhuo, adding Gegen (Kudzu Root), Fangfeng (Saposhnikovia Root), Guizhi, and Baishao. The next day, headache and dysentery decreased; nocturnal visits dropped to three. Modified to Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with wine-fried Huangqin, Guizhi, and Baishao. That night, malaria stopped, leaving only slight fever. Changed to Weifeng Tang (Stomach Wind Decoction): Renshen, Baizhu, Guipi (Cinnamon Bark), each 2 qian; Baishao 4 qian; wine-fried Huangqin and Huanglian, each 1 qian; Danggui, Fuling, Chuanxiong as assistants; Paojiang and Diyu (Sanguisorba Root) as guides. After ingestion, chills and fever vanished; nocturnal visits reduced to once. Guizhi was removed from the previous formula. After several doses, he recovered and left bed.
Yu Zhen commented: This case’s prescription is appropriate and excellent, worthy of emulation. Consider Wang Jin Tan treating Prefect Liu Rongchuan, who suffered from malaria and profuse diarrhea in late autumn. Wanting to eliminate one ailment quickly, he used Ju Fang Shuangjie Yinzi (Official Formulation Double-Resolution Decoction), curing both diseases with one dose, appearing even more miraculous. This derives from Danliao’s principle of using one cold and one hot herb, half-cooked and half-raw, to separate and benefit Yin and Yang. However, I privately reflect that for concurrent malaria and dysentery at onset, exclusively using diaphoretics like Qianghuo, Fangfeng, Chaihu, and Gegen, assisted by Chifuling and Shenqu, adding Dangguishen and Chuanxiong for bloody dysentery, and adding Houpo if the right Guan pulse is large, to lift Fu-pathogens to the channels for exterior resolution, is the most rapid method. If ineffective, assess Cold or Heat involvement and use exterior-interior dispersion. For Heat, remove Qianghuo/Fangfeng, add Huangqin, Huanglian, Xiangru, and Huashi. For Cold, remove Chaihu/Gegen, add Guizhi and Ganjiang. Severe Heat usually indicates Excess; wind herbs are unsuitable. Use Daxiehu Tang with Huanglian and Huashi. Severe Cold usually indicates Deficiency; wind herbs should be avoided. Use Zhenwu Tang with Guizhi and Renshen. This remains an exterior-interior dual resolution method. Regarding Renshen Baidu San and Buzhong Yiqi Tang, these are exterior herbs for deficiency. Lizhong Tang and Bawei Wan are interior herbs for deficiency. Exterior deficiency with Heat: Xiao Chaihu Tang. Interior deficiency with Heat: Lianli Tang. Exterior deficiency with Cold: Mahuang Fuzi Xixin Tang. Interior excess with Cold: Wenpi Tang. By matching pulse and symptoms to these methods, success is assured. In this case, the weak right pulse indicates deficiency; chills exceeding fever in malaria also indicate deficiency. Hence, Renshen was used in the second dose. Given profuse sweating, removing Qianghuo and Duhuo from Baidu San and adding Guizhi and Baishao was correct. Adding Gegen and Fangfeng, however, seems excessive.