金鉴春月病温。误治二旬。酿成极重死证。壮热不退。谵语无伦。皮肤枯涩。胸膛板结。舌卷唇焦。
身蜷足冷。二便略通。半渴不渴。面上一团黑滞。从前诸医所用之药。大率不过汗下和
温之法。绝无一效。求救于余。余曰。此证与两感伤寒无异。但两感证日传二经。三日传经已尽即死。不
死者。又三日再传一周。定死矣。此春温证不传经。故虽邪气留连不退。亦必多延几日。待元气竭绝乃死。
观其阴证阳证。两下混在一区。治阳则碍阴。治阴则碍阳。与两感证之病情符合。仲景原谓死证。不立治
法。然曰发表攻里。本自不同。又谓活法在人。神而明之。未尝教人执定勿药也。吾有一法。即以仲景表里
二方为治。虽未经试验。吾天机勃勃自动。忽生变化。若有鬼神相助。必可效也。于是以麻黄附子细辛汤。
两解其在表阴阳之邪。果然皮间透汗。而热全清。再以附子泻心汤。两解其在里阴阳之邪。果然胸前
柔活。人事明了。诸证俱退。次日即思粥。以后竟不需药。只此二剂。而起一生于九死。快哉。
徐国祯伤寒六七日。身热目赤。索水到前。复置不饮。异常大躁。将门牖洞启。身卧地上。展转不快
。更求入井。一医 急以承气与服。余证其脉洪大无伦。重按无力。谓曰。此用人参
附子干姜之证。奈何认为下证耶。医曰。身热目赤。有余之邪。躁急若此。再以人参附子干姜服之。逾垣
上屋矣。余曰。阳欲暴脱。外显假热。内有真寒。以姜附投之。尚恐不胜回阳之任。况敢纯阴之药。重劫
其阳乎。观其得水不欲咽。情已大露。岂水尚不欲咽。而反可咽大黄芒硝乎。天气燠蒸。必有大雨。此证顷刻
一身大汗。不可救矣。且既认大热为阳证。则下之必成结胸。更可虑也。惟用姜附。可谓补中有发。
并可以散邪退热。一举两得。至稳至当之法。何可致疑。吾在此久坐。如有差误。吾任其咎。
于是以附子干姜各五钱。人参三钱。甘草二钱。煎成冷服。服后寒战。戛齿有声。以重绵和头覆之。缩
手不肯与诊。阳微之状始着。再与前药一剂。微汗热退而安。
胡卣臣先生曰。先生雄辩。可以当仁。
金鉴在春季患温病。经过误治二十天。酿成了极其严重的死证。高热不退。胡言乱语没有条理。皮肤干枯粗糙。胸部僵硬板结。舌头卷缩嘴唇焦黑。
身体蜷曲脚部发冷。大小便勉强通畅。口渴与不渴之间交替。面部呈现一团黑浊停滞之色。之前各位医生所用的药物。大体不过是发汗、攻下、和解和温补的方法。完全没有效果。于是向我求救。我说。这个病症与两感伤寒没有区别。只是两感证每天传变两条经络。三天传遍经络就会死亡。不死的人。再过三天再传变一周。必定死亡。这个春温证不传变经络。所以虽然邪气留恋不退。也必然多拖延几天。等到元气竭绝才会死亡。
观察他的阴证阳证。两者混杂在一起。治疗阳证则妨碍阴证。治疗阴证则妨碍阳证。与两感证的病情相符。张仲景原本将其列为死证。没有设立治疗方法。但是他说发表和攻里。本来是不同的。又说活法在于人。神妙地领悟它。并没有教人固执地不用药。我有一种方法。就用张仲景的表里两个方剂来治疗。虽然未经过试验。但我天机勃勃自动产生。忽然生出变化。好像有鬼神相助。一定可以见效。于是用麻黄附子细辛汤。同时解除他在表阴阳两方面的邪气。果然皮肤间透出汗水。而热势完全清除。再用附子泻心汤。同时解除他在里阴阳两方面的邪气。果然胸前变得柔软灵活。人事清醒明白。各种症状都消退了。第二天就想喝粥。以后竟然不需要吃药。只用了这两剂药。就把一个人从九死中救活。痛快啊。
徐国祯患伤寒六七天。身体发热眼睛发红。索要水送到面前。又放下不喝。异常烦躁。把门窗大开。身体躺在地上。辗转反侧感到不快。更要求跳入井中。一个医生急忙给他服用承气汤。我诊察他的脉象洪大无比。重按无力。对医生说。这是用人参、附子、干姜的证候。为什么认为是下法（攻下）的证候呢？医生说。身体发热眼睛发红。是有余的邪气。如此躁急。如果再给人参、附子、干姜服用。就要爬墙登屋了。我说。阳气将要暴脱。外表显现假热。内部有真寒。用姜、附投药。还担心不能胜任回阳的任务。何况敢用纯阴的药物。重重劫夺其阳气吗？看他得到水却不想要咽下。真情已经大大暴露。难道水尚且不想咽下。反而可以咽下大黄、芒硝吗？天气闷热蒸腾。必然有大雨。这个病症顷刻间一身大汗。就无法救治了。况且既然认定大热为阳证。那么攻下必然形成结胸。更令人担忧。只有使用姜、附。可以说是补中有发。并且可以散邪退热。一举两得。是最稳妥最恰当的方法。有什么可怀疑的。我坐在这里很久。如果有差错。我承担罪责。
于是用附子、干姜各五钱。人参三钱。甘草二钱。煎成后冷服。服药后出现寒战。牙齿打颤有声。用厚绵毯子把头盖住。缩手不肯让人诊脉。阳气微弱的症状才明显显露。再给前一剂药。微微出汗热退而安定。
胡卣臣先生说。先生的雄辩。足以担当仁德。
Jin Jian contracted a warm disease in spring. After twenty days of mismanagement, it developed into an extremely severe fatal syndrome. High fever persisted without abatement. Delirious speech was incoherent. The skin was dry and rough. The chest felt stiff and board-like. The tongue was curled and the lips scorched.
The body was curled up with cold feet. Bowel and bladder movements were barely patent. Thirst fluctuated between present and absent. The face presented a patch of dark, stagnant hue. The medicines used by previous physicians were generally limited to methods of sweating (releasing the exterior), purging (draining downward), harmonizing, and warming. None had any effect. They sought help from me. I said, "This syndrome is no different from Lianggan Shanghan (Two-Channel Cold Damage). However, in Lianggan syndromes, the pathogen transmits through two meridians daily; death occurs when the transmission cycle completes in three days. If the patient survives, they will die after another three-day cycle of transmission. This Spring Warmth syndrome does not transmit through meridians; therefore, although the pathogenic factor lingers without receding, it inevitably prolongs for several more days until the primordial Qi is exhausted and death ensues."
Observing his Yin and Yang syndromes, both are mixed together. Treating the Yang aspect hinders the Yin, and treating the Yin hinders the Yang. This conforms to the pathology of Lianggan syndromes. Zhang Zhongjing originally classified this as a fatal syndrome and did not establish treatment methods. Yet he stated that releasing the exterior and purging the interior are fundamentally different. He also said that living methods depend on the practitioner's ingenuity and divine understanding; he never taught people to rigidly abstain from medication. I have a method: use Zhang Zhongjing's formulas for the exterior and interior to treat this. Although untested, my innate intuition spontaneously generates changes, as if aided by spirits or gods. It must be effective. Thus, I employed Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) to simultaneously resolve the pathogenic factors of both Yin and Yang at the exterior. Indeed, sweat permeated the skin, and the heat completely cleared. Then, I used Fuzi Xiexin Tang (Aconite and Rhubarb Decoction) to simultaneously resolve the pathogenic factors of both Yin and Yang at the interior. Indeed, the chest became soft and flexible, mental clarity returned, and all symptoms receded. The next day, he desired congee. Thereafter, no further medication was needed. With merely these two doses, one life was rescued from the brink of nine deaths. How gratifying!
Xu Guozhen suffered from Shanghan (Cold Damage) for six or seven days. His body was hot, eyes red. He demanded water brought before him, but upon receiving it, he put it down without drinking. He exhibited extreme restlessness. He opened doors and windows wide, lay on the ground, and rolled about dissatisfied. He even begged to enter a well. A physician hastily administered Chengqi Tang (Rhubarb Decoction). I palpated his pulse: it was boundlessly surging (Hong) yet powerless upon deep pressure. I told the physician, "This is a case requiring Renshen (Ginseng), Fuzi (Prepared Aconite Root), and Ganjiang (Dried Ginger). Why do you consider it a syndrome suitable for purgation?" The physician replied, "Body heat and red eyes indicate excess pathogenic factors. Such extreme restlessness suggests that administering Renshen, Fuzi, and Ganjiang would cause him to climb walls and roofs." I said, "Yang Qi is about to violently collapse, manifesting false heat externally while true cold exists internally. Even with Ginger and Aconite, we might fear failing to fulfill the task of restoring Yang. How dare we use purely Yin-cold drugs to severely deplete his Yang? Observe that he obtains water but does not wish to swallow it; his true condition is already largely exposed. If he cannot bear to swallow water, how could he possibly tolerate Da Huang (Rhubiz Radix et Rhizoma) and Mangxiao (Natrii Sulfas)? When the weather is sultry and steaming, heavy rain is inevitable. This syndrome will soon result in profuse sweating over the entire body, which will be incurable. Furthermore, if you mistakenly identify great heat as a Yang syndrome and purge it, Jie Xiong (Chest Binding) will certainly form, which is even more alarming. Only the use of Ginger and Aconite can be considered 'tonification with dispersion,' capable of scattering pathogens and reducing fever, achieving two goals with one stroke. It is the most stable and appropriate method. What doubt remains? I will sit here for a long time. If there is any error, I shall bear the responsibility."
Thus, I prescribed Fuzi (Prepared Aconite Root) and Ganjiang (Dried Ginger), each 5 qian, Renshen (Ginseng) 3 qian, and Gancao (Licorice Root) 2 qian. The decoction was prepared and administered cold. After ingestion, he experienced chills and teeth chattering. We covered his head with thick cotton blankets. He withdrew his hand, refusing pulse diagnosis, indicating that the signs of minute Yang finally became apparent. Another dose of the same prescription was given. He sweated slightly, the heat subsided, and he stabilized.
Mr. Hu Youchen said, "Your eloquence is sufficient to embody Ren (Benevolence)."