上卷葛根芩连汤证，师用退一步法，余用进一步法者，遥遥对映，正可相得益彭。学者当知一病之来，每非一方可奏全功，见其实则进，虑其虚则退；惟其急则顾标，因其缓则保本。必也进退合度，标本无误，病乃速已。抑进退之外，尚有旁敲侧击之法，标本之间，更有中气逆从之调。一隅三反，又岂待焦唇之喋喋乎？曹颖甫曰：治病不经实地考验，往往失之悬断。孟子有言：为高必自邱陵，为下必因川泽。今佐景乃因仲师所言之病情，进而求其所以然，则见证用药，随在有得心应手之妙，要不惟奔豚为然也。又按奔豚向称肾积，而方治实为肝病。
陈修园谓奔豚汤畅肝气而逐客邪，黄坤载发明桂枝解达肝郁，按中所述某同学所言肝气亦自有理。但以奔豚证属肝病则可，泛称肝病，并不知为奔豚证则不可耳。
耿右初诊八月二十七日一身肢节疼痛，脚痛，足胫冷，日晡所发热，脉沈而滑，此为历节，宜桂枝芍药知母汤。瘰疬，从缓治。
川桂技五钱赤白芍各三钱生甘草三钱生麻黄三钱熟附块五钱生白术五钱肥知母五钱青防风五钱生姜一块打二诊九月一日服桂枝芍药知母汤，腰痛略减，日晡所热度较低，惟手足痠痛如故，仍宜前法。
川桂技五钱赤白芍各五钱生甘草三钱净麻黄四钱苍白术各五钱肥知母五钱青防风四钱生姜一块打咸附子三钱生用勿泡
【按】吾师又曾治一戴姓妇人妊娠八月，为其夫病求医，抱夫乘车，胎儿竟为夫身压毙，遂作腹痛。一医药而堕之，腐矣，妇本属血虚体质，死胎既下，因贫不能善后，即病历节。手足拘挛，节骱剧痛，旦日较缓。拖延二年，方求师诊。
师用一方，二剂不应。二诊改用某药，汗乃大出。两剂，肢节便可屈伸，足肿亦小，独手发出大泡，有浓有水，将成溃烂。乃采丁甘仁先贤法，用大小蓟各五钱，丹皮一两，地骨皮四钱，清其血热，二剂而痂成，四剂而痂脱。遂与未病时无异。
以为可无恙矣，妇忽阴痒难忍，盖湿毒未尽，而下注也。师因令其用蛇床子煎汤薰洗，良瘥。未几，入市购物，卒然晕倒，诸恙退而血虚之真象见。师乃用大熟地一两，潞党参五钱，川芎、当归各四钱，龙骨、牡蛎各一两，凡二十余剂全愈，后竟抱子云云。
曹颖甫曰：肢节疼痛，病名历节。此证起于风邪外感，汗出不畅，久久湿流关节，脉迟而滑，属寒湿。其微者用桂枝芍药知母汤。其剧者宜乌头扬。尝治一吴姓少病，予用净麻黄三钱，生白芍三钱，生绵耆三钱，炙甘草三钱，乌头二枚切片，用蜜糖一碗另煎，煎至半碗，盖悉本《金匮》法也。
人体外证之属寒者，除流注外，发背脑疽最为重大。惟世传阳和汤一方与仲师当发其痈之旨最合，若误投寒凉败毒之品，十不活一。所以然者，为血络凝于寒湿，非疔毒流火之属于阳证者比也。附阳和汤方如下：麻黄三钱去根节炮姜三钱熟地黄一两鹿角胶三钱肉桂一钱（寒重加附子）
【按】友人周慕莲君患脑疽，初起，察其属阴性，法当与阳和汤，顾大便五日未行，疑其有热结，为之踌躇者再。谁知服汤后，次早项背转动便易，大便畅下，乃悟其大便之闭，亦属寒性故也。其外用膏药，为阳和膏。
又有友人周焕根君患脑疽，发于项后偏右，皮色不变而结块，脉微细，大便亦不行。采邻居之言，购番泻叶值铜元十枚服之，大下，而自止，疽反日剧。予仍以阳和汤投之，二日不应。易医，又投阳和汤加减，二日，又不应。易名医，投和荣通络轻剂，不更衣，则无暇问也。如是二日，疽依然，而大便之不行也如故。无已，予乃嘱用甘油锭以润之，因用之不得法，无效。次日详告以术，乃下燥矢四五颗，随以溏薄矢液，自是得安寐竟日。醒来知饥索粥，精神大振。便下皆溏者，湿既有去处，疽乃以渐告愈。事后，余乃悟此为先鞕后溏证，原不可攻，其所以有燥矢结于肠中者，必是番泻叶之流弊，盖大下亡阴，液去而矢在，故结而致燥也。病家之药误，医者可不留意哉？曹颖甫曰：阳和汤一方不惟脑疽发背为宜，即膝盖忽然酸疼，为鹤膝风初步，用之亦多效。若华母于去冬今春两次患此，临睡时服药，醒即不痛。施之骨槽风病，亦能一服定痛，真神方也。
汗后致虚
若华母案缺。
生半夏三钱炙草五钱当归三钱陈皮三钱白术三钱生黄耆三钱熟附块五钱党参四钱熟地二两干姜三钱川芎三钱炙乳没各三钱生米仁一两
【按】师母体素瘦削，而微有痰饮之疾。数日前，偶感风寒，恶寒，头痛，发热，师硫表剂予之，稍瘥而未了了。再予之，如是者屡。余曾检得其一方，为桂枝三钱，白芍三钱，生草二钱，浮萍三钱，姜三片，盖桂枝汤去大枣加浮萍也。
服后，汗出甚多，微恶寒，神疲心痛，叉手自冒，徐按稍瘥，筋肉不舒，有如针刺，皮肤干燥，血脉色转褐，心时悸，头时眩，坐立不稳，自觉摇摇然，脉细小而弱。师母固知医者，因谓师曰：我今虚，法当补。互商之下，乃得上方。师母且曰：倘熟附而不效者，我明日当易生附也。其时方暮，心痛甚剧，筋肉牵掣亦良苦。进初煎，旋得安睡。夜半醒来，痛随大减。次早进次煎，精神大振。皮色较润，而行动渐渐如常矣。
事后，余推测本案之病理药效，其有可得而言者，师母似系血液衰少，痰浊凝据之体，虽有表证，本不宜发汗过多。论曰：脉浮紧者，法当身疼痛，宜以汗解之。假令尺中迟者，不可发汗。何以知然，以荣气不足，血少故也。可以见之。况桂枝汤去大枣加浮萍，其发汗之力较桂枝原汤为尤猛。因大枣本为保存津液者，今反易以伤津液之浮萍故也。以不宜发汗之人，令大发其汗，自有变证。
大论曰：发汗过多，其人叉手自冒心，心下悸，欲得按者，桂枝甘草汤主之。
此盖为无痰饮者言之耳。又曰：太阳病，发汗，汗出不解，其人仍发热，心下悸，头眩，身瞤动，振振欲擗地者，真武汤主之。此盖为有痰饮者言之。又曰：发汗，病不解，反恶寒者，虚故也。芍药甘草附子汤主之。此盖为虚者言之。
今师母所服之方，虽非桂枝甘草汤，亦非真武汤，又非芍药甘草附子汤，然相去匪远，而周详或且过之，故能效也。由是观之，仲圣教人用麻桂以表邪，固又教人有不宜用麻桂之证，而又教人误用后补救之法。其意也苦，其法也备，观本案而益信。读《伤寒论》者，又安可执其一而舍其二哉？曹颖甫曰：虚人发汗，是谓重虚。重虚之人，必生里寒。血不养筋，故筋脉牵掣。血不充于脉道，故微细。不补气血则筋脉不调，不调水藏则表阳不达。又因其有水气也，加干姜半夏。因其体痛也，加乳香没药。因其心悸也，重用炙甘草。因其夹湿也，而加生苡仁。大要随证酌加，初无成方之可据。而初意却在并用术附，使水气得行于皮中。盖救逆之方治，原必视病体为进退也。
太阳转阳明其一
姚左发热，头痛，有汗，恶风，脉浮缓，名曰中风，桂枝汤加浮萍主之。
川桂枝三钱生白芍三钱生草钱半浮萍三钱生姜三片大枣三枚服药后进热粥一碗，汗出后，诸恙可愈。汗出热不除，服后方，热除不必服。
【按】上列二方乃师初诊时一次疏予者也。他医似无此例，然师则常为之。
师曰：我今日疏二方，病者明日可以省往返之劳，节诊金之费，不亦善哉？虽然，苟我师无先见之明，能预知明日之变证者，其亦安肯若是耶？浮萍为我师暑天常用之药，多加于桂枝汤中。师每赞其功。病者姚君持方去后，竟不敢服。质疑于恽铁樵先生之门人某君。某君曰：先解其表，后攻其里，是乃仲圣之大法也，安用疑为？卒从其言。服后汗出，果如方案所记，诸恙悉愈。不意半日许，复热，病者固不知此热却非彼热，姑壮胆服后方，竟便行而热除。三日，悉如常人。
余问曰：桂枝汤之后，有宜继以承气者，有无须继以承气者，其间岂无辨认之点耶？师曰：病者初诊，吾见其有作黄色而且厚，吾以是用承气也。余曰：诺，举一反三，又岂惟苔黄厚而已？则凡便之不畅或不行者，口渴者，阙上痛者，或素体热盛者，莫非皆承气之预见证乎？予自是亦能效吾师之法，一诊而疏二方矣。
以余临床实验所得，凡服桂枝汤后，桂枝证除而转为阳明轻证，又服承气而病愈不传者，甚多。状此事实，则一日太阳，二日阳明八字恰甚贴切。虽然，此仅就太阳病服药者言，若不服药，恐又非如是矣。余固不谓内经之一日至六日相传一说，尽合于事实者也。
曹颖甫曰：予治伤寒学，早于仲师大论中证明七日为一候，一候为一经，二候为再经，六经传遍当在四十二日。然亦有不作再经者，由其肠胃中本不燥实也。
若太阳之病初起，阳明先见燥实，则先解其表，后攻其里，即为正治。予昔治赵庭槐之妻常以一方笺书二方，治愈者不止一二次。又尝治缪桂堂亦用二方并书一笺，缪不识字，误以二方之药并煎，亦汗出便通而愈。
太阳转阳明其二
徐柏生初诊微觉恶寒，头痛，腰脚痠，左脉甚平，右脉独见浮缓，饮暖水，微有汗，而表热不去，此风邪留于肌腠也。宜桂枝汤加浮萍。
川桂枝三钱生白芍三钱生草一钱浮萍三钱生姜三片枣七枚二诊汗出身凉，大便不行，宜麻仁丸。
拙巢注：药后大便行，愈矣。
太阳转阳明其三
净麻黄三钱桂枝三钱生草一钱光杏仁三钱二诊汗出，热除，头痛恶寒止，惟大便三日不行，胸闷恶热，脉浮大，宜承气汤，所谓先解其表后攻其里也。
生川军三钱后入枳实四钱川朴二钱芒硝二钱冲拙巢注：服药后，下四次，病全愈。
太阳转阳明其四
王左初诊二十四年三月五日起病于浴后当风，恶寒而咳，一身尽痛，当背尤甚，脉弦，法当先解其表。得汗后，再行攻里。大便七日不行，从缓治。
生麻黄三钱川桂枝三钱光杏仁三钱北细辛二钱干姜三钱五味子二钱生甘草一钱制半夏三钱白前四钱
【按】本案病者王君平素有疾必就师诊，每诊一二次，疾必良已。者番又来，自谓病重甚，不知能如前速愈否？师笑谓无妨，汗出续诊一次可矣。君欣然告辞。
二诊三月六日发汗已，而大便未行，食入口甜，咽肿脘胀，右脉滑大，下之可愈。
【按】诊后病者问明日尚须覆诊否，察其神清，盖已非昨日病象矣。师笑曰，无须再劳驾矣，后如师言。
学者当知疾病之传变，绝无一定之成规。若我前所谓桂枝汤证一变而为白虎汤证，麻黄汤证一变而为麻杏甘石汤证，葛根汤证一变而为葛根芩连汤证，此皆言其至常者也。若以上太阳转阳明诸案，或由桂枝证传为承气证或麻子仁丸证，或由麻黄汤证或由小青龙汤证传为承气证，又皆不失其常者也。若其他种种传变，或由葛根汤证传为承气证，或由大青龙汤证传为承气证，又悉在可能之中，何必一一赘列？是故医者但求能辨证用方，初不必虑其病变多端，但求能大胆细心，初不必泥于温热伤寒也。
邪之着人，如饮酒然。凡人醉酒，脉必洪而数，气高身热，面目俱赤，乃其常也。及言其变，各有不同。有醉后妄言妄动，醒后全然不知者，有虽沈醉，而神思终不乱者，醉后应面赤而反刮白者，应委顿而反刚强者，应壮热而反恶寒战栗者，有易醉而易醒者，有难醉而难醒者，有发呼欠及喷嚏者，有头眩眼花及头痛者。因其气血虚实之不同，脏腑禀斌之各异，更兼过饮少饮之别。考其情状，各自不同。至论醉酒一也，及醒，一时诸态如失。此吴氏又可借饮酒以喻邪之传变无定者也。因其言通俗易晓，故借录之。
暑天阳明
病血热壮盛之人，遇天时酷蒸，往往以多汗而胃中化燥。始则大便不行，继则口燥饮冷。夏令伏阴之体，饮冷太暴，或且转为下利。究之利者自利，胃中燥实依然不去，故仍宜用大承气汤以下之。予子湘人辛未六月在红卍字会治一山东人，亲见之。一剂后，不再来诊，盖已瘥矣。壬申六月，复见此人来诊。诊其脉，洪大而滑疾，已疏大承气汤方治矣。其人曰，去岁之病承先生用大黄而愈，湘人告以亦用大黄，其人欣然持方去，不复来，盖又瘥矣。又江阴街烟纸店主严姓男子，每年七月上旬，大便闭而腹痛，予每用调胃承气汤，无不应手奏效。
【按】此又天时之关系于疾病者也，吾人但知其理足矣。至疏方用药，仍当一以脉证为依归，设在盛夏遇真寒之霍乱证，脉伏肢冷，吾知四逆又为必用之方矣。
曹颖甫曰：以上所列二证不过欲证明至其年月日时复发之理由，而病之变化，要必视其人之本体为断。其人血热过重，则易于化燥，水分过多，则易于化湿，燥热当泻，寒湿当温，诚当如佐景所云矣。
产后阳明病
上卷中关于葛根芩连汤证的治疗，老师采用退一步的策略，而我采用进一步的方法，两者遥相呼应，正可相得益彰。学者应当知道，一种疾病的发生，往往不是单一方剂就能完全治愈的；看到实证就进取，顾虑虚证就后退；病情急迫时顾护标症，病情缓和时保全本元。只有进退有度，标本无误，病才能迅速痊愈。此外，在进退之外，还有旁敲侧击的方法；在标本之间，更有调理中气逆从关系的技巧。举一反三的道理，又岂需要像焦唇那样喋喋不休地解释呢？曹颖甫说：治病如果不经过实地考验，往往会失于主观臆断。孟子有句话说：筑高台必须从山丘开始，挖深池必须依凭川泽。现在佐景我是依据仲师所说的病情，进而探求其所以然，那么见证用药，随时随地都有得心应手的妙处，这不仅仅适用于奔豚病（一种自觉气从少腹上冲胸咽的疾病）。另外按语：奔豚过去被称为肾积，但实际治疗却是针对肝病。
陈修园认为奔豚汤能疏畅肝气并驱逐客邪，黄坤载阐明了桂枝能解达肝郁，按照文中所述某同学所言，肝气的说法也自有道理。但是将奔豚证归属于肝病是可以的，如果泛泛地称为肝病，而不知道这是奔豚证的表现，那就不对了。
历节病
耿右初诊，八月二十七日，全身肢节疼痛，脚痛，足胫发冷，下午申酉时发热，脉象沉而滑，这是历节病（以关节剧烈疼痛、变形为特征的痹证），适宜用桂枝芍药知母汤。瘰疬（颈部淋巴结结核），从缓治疗。
川桂枝五钱，赤芍、白芍各三钱，生甘草三钱，生麻黄三钱，熟附子块五钱，生白术五钱，肥知母五钱，青防风五钱，生姜一块（捣碎）。
二诊，九月一日，服用桂枝芍药知母汤后，腰痛略微减轻，下午申酉时的热度较低，只是手足酸痛如故，仍然适宜用前面的方法。
川桂枝五钱，赤芍、白芍各五钱，生甘草三钱，净麻黄四钱，苍术、白术各五钱，肥知母五钱，青防风四钱，生姜一块（捣碎），咸附子三钱（生用，不要浸泡）。
【按语】我的老师曾经治疗一位戴姓妇人，妊娠八个月，因为丈夫生病求医，抱着丈夫乘车，胎儿竟然被丈夫的身体压死，于是出现腹痛。医生用药导致流产，死胎腐烂排出。这位妇人本来属于血虚体质，死胎既已下行，因为贫穷不能妥善调养，于是病历节病。手足拘挛，关节剧痛，早晨较轻。拖延了两年，才来求老师诊治。
老师使用一个方剂，两剂没有见效。二诊改用某种药物，汗液大量排出。两剂之后，肢节就可以屈伸，足肿也消退了一些，唯独手上发出大水泡，里面有脓有水，将要溃烂。于是采用丁甘仁先贤的方法，用大蓟、小蓟各五钱，丹皮一两，地骨皮四钱，清泄血热，两剂后结痂，四剂后痂脱。于是和没生病时一样。
以为可以平安无事了，妇人突然阴部瘙痒难忍，原来是湿毒未尽，向下流注所致。老师因此让她用蛇床子煎汤熏洗，很快好转。不久，去市场购物，突然晕倒，各种症状消退，血虚的真实面目显现出来。老师于是用大熟地黄一两，潞党参五钱，川芎、当归各四钱，龙骨、牡蛎各一两，共二十多剂后完全痊愈，后来竟然抱子云云（意指后来生育或恢复健康）。
曹颖甫说：肢节疼痛，病名叫历节。此证起于风邪外感，汗出不畅，久而久之湿气流入关节，脉迟而滑，属于寒湿。轻微的用桂枝芍药知母汤。严重的适宜用乌头汤。曾经治疗一个姓吴的年轻人患病，给予净麻黄三钱，生白芍三钱，生绵黄芪三钱，炙甘草三钱，乌头二枚切片，用蜜糖一碗另煎，煎至半碗，大概都遵循《金匮要略》的方法。
人体外部病症属于寒性的，除了流注（多发于肌肉深处的脓肿）以外，发背（背部痈疽）和脑疽（项后痈疽）最为重大。然而世间流传的阳和汤一方与仲师“当发其痈”的宗旨最相符合，如果误投寒凉败毒的药物，十个人里活不到一个。之所以这样，是因为血络凝滞于寒湿，不同于疔毒流火属于阳证的性质。附上阳和汤方如下：麻黄三钱（去根节），炮姜三钱，熟地黄一两，鹿角胶三钱，肉桂一钱（寒重加附子）。
【按语】友人周慕莲先生患脑疽，初起时，观察其属于阴性，法度上应当给予阳和汤，但是大便五天未行，怀疑有热结，为此犹豫再三。谁知服用汤药后，第二天早上项背转动变得容易，大便通畅排出，这才领悟到大便闭塞也是属于寒性所致。其外用膏药，是阳和膏。
又有友人周焕根先生患脑疽，发于项后偏右侧，皮色不变而结成硬块，脉微细，大便也不通。采纳邻居的建议，购买番泻叶花费铜元十枚服用，导致严重腹泻，然后自行停止，疽反而日益加重。我仍然给予阳和汤投服，两天没有见效。更换医生，又投予阳和汤加减方，两天，又没有见效。更换名医，投予和荣通络的轻剂，病人不排便，也就无暇过问了。像这样过了两天，疽依然如故，大便不通也如旧。没有办法，于是我嘱咐使用甘油栓来润肠，因为使用方法不得当，无效。第二天详细告知正确方法，于是排出干燥粪便四五颗，随后排出稀薄粪便，从此得以安稳睡眠一整天。醒来知道饥饿索要粥喝，精神大振。大便都是稀薄的，湿气既然有了去处，疽也就逐渐告愈。事后，我才悟到这是先硬后溏证，原本不可攻下，其所以有燥屎结于肠中，必定是番泻叶的流弊，因为大下亡阴，津液亏去而粪便残留，所以结聚而致干燥。病人的药误治，医者怎能不留意呢？曹颖甫说：阳和汤这一方，不仅适合脑疽发背，即使是膝盖忽然酸疼，是鹤膝风（膝关节肿大变形如鹤膝的痹证）的初期，使用它也多有效。比如华母在去年冬天今年春天两次患此病，临睡前服药，醒来就不痛了。施用于骨槽风（颌骨骨髓炎等病），也能一服定痛，真是神方啊。
汗后致虚
若华母案缺（此处原文可能有缺失或指代前文案例）。
生半夏三钱，炙甘草五钱，当归三钱，陈皮三钱，白术三钱，生黄芪三钱，熟附子块五钱，党参四钱，熟地黄二两，干姜三钱，川芎三钱，炙乳香、没药各三钱，生薏苡仁一两。
【按语】师母身体素来瘦削，且有轻微的痰饮疾病。数日前，偶然感受风寒，恶寒，头痛，发热，老师给予解表剂，稍微好转但未彻底痊愈。再次给予同样的药，像这样多次。我曾经查到其中一个方子，是桂枝三钱，白芍三钱，生甘草二钱，浮萍三钱，生姜三片，大概是桂枝汤去掉大枣加上浮萍。
服用后，出汗非常多，轻微恶寒，神疲心痛，双手交叉按压心前区，慢慢按压稍有好转，筋肉不舒展，有如针刺感，皮肤干燥，血脉颜色转为褐色，心脏时常悸动，头部时常眩晕，坐立不稳，自觉摇摇欲坠，脉象细小而弱。师母本来懂得医术，因此对老师说：我现在是虚证，法度上应当补益。互相商量之下，得到了上面的方子。师母还说：如果熟附子不生效，我明天应当换成生附子。当时正是傍晚，心痛非常剧烈，筋肉牵掣也很痛苦。进服第一煎，随即安睡。半夜醒来，疼痛大幅减轻。第二天早上进服第二煎，精神大振。肤色较滋润，行动渐渐恢复正常。
事后，我推测本案的病理药效，有些可以说的，师母似乎是血液衰少，痰浊凝据的体质，虽然有表证，本来不宜发汗过多。医论说：脉浮紧者，法度上应当身体疼痛，适宜用汗法解除。假如尺中脉迟者，不可发汗。为什么知道是这样，因为营气不足，血少的缘故。由此可见。何况桂枝汤去掉大枣加上浮萍，其发汗的力量比原方的桂枝汤更为猛烈。因为大枣本来是保存津液的，现在反而换成了损伤津液的浮萍。对于不宜发汗的人，让他大发其汗，自然会有变证。
大论说：发汗过多，其人双手交叉按压心前区，心下悸动，想要按压的，用桂枝甘草汤主治。
这大概是对没有痰饮的人说的。又说：太阳病，发汗，汗出病不解，其人仍然发热，心下悸动，头晕，身体肌肉跳动，震颤得快要跌倒的，用真武汤主治。这大概是对有痰饮的人说的。又说：发汗，病不解，反而恶寒的，是虚证。用芍药甘草附子汤主治。这大概是对虚证的人说的。
如今师母所服的方子，虽然不是桂枝甘草汤，也不是真武汤，又不是芍药甘草附子汤，然而相差并不远，而且周全或许还超过它们，所以能生效。由此看来，仲圣教导人用麻黄、桂枝解表邪，固然又教导人有不宜用麻黄、桂枝的证候，又教导人误用后的补救方法。他的心意良苦，他的法度完备，看了这个案例更加相信。读《伤寒论》的人，怎么可以执着其一而舍弃其二呢？曹颖甫说：虚人发汗，叫做重虚。重虚的人，必然产生里寒。血不养筋，所以筋脉牵掣。血不充盈于脉道，所以脉微细。不补气血则筋脉不调，不调水脏则表阳不达。又因为有水气，所以加干姜、半夏。因为身体疼痛，加乳香、没药。因为心悸，重用炙甘草。因为夹湿，加生薏苡仁。大要是随证酌情加入，起初并没有固定的成方可依据。而初衷却在于并用白术、附子，使水气得行于皮中。大概救逆的方治，原本必须视病体情况而定进退。
太阳转阳明其一
姚左发热，头痛，有汗，恶风，脉浮缓，名叫中风，用桂枝汤加浮萍主治。
川桂枝三钱，生白芍三钱，生甘草一钱半，浮萍三钱，生姜三片，大枣三枚。服药后进热粥一碗，汗出后，诸病可愈。汗出热不退，服后方（承气汤类），热除不必服。
生大黄三钱，枳实三钱，厚朴一钱半，芒硝二钱（冲服），生甘草一钱半。
【按语】上面两个方子是老师初诊时一次开出的。其他医生似乎没有这种例子，然而老师经常这样做。
老师说：我今天开出两个方子，病人明天可以省去往返的劳累，节省诊金的费用，不是很好吗？虽然如此，如果我没有先见之明，能预知明天的变证，我又怎肯这样做呢？浮萍是我老师在夏天常用的药，多加于桂枝汤中。老师每每称赞它的功效。病人姚君拿着方子离开后，竟然不敢服用。向恽铁樵先生的门人某君质疑。某君说：先解其表，后攻其里，这是仲圣的大法，有什么好怀疑的？最终听从了他的话。服用后汗出，果然像方案记载的那样，诸病悉愈。没想到半天左右，又发热，病人本来不知道这个热却不是那个热，姑且壮胆服下方子，竟然大便通行而热除。三天后，完全像正常人一样。
我问：桂枝汤之后，有适宜继以承气汤的，有无须继以承气汤的，其间难道没有辨认的点吗？老师说：病人初诊，我看到他的舌苔黄色而且厚，所以我用承气汤。我说：诺，举一反三，又岂止是苔黄厚而已？那么凡是排便不畅或不行的，口渴的，阙上（眉心上方）痛的，或者素体热盛的，莫非都是承气汤的预见证候吗？我从此也能效法老师的方法，一诊就开出两个方子了。
根据我临床实验所得，凡是服用桂枝汤后，桂枝证消除而转为阳明轻证，又服用承气汤而病愈不传变的，很多。描述这个事实，那么“一日太阳，二日阳明”八个字恰好非常贴切。虽然如此，这只是就太阳病服药者而言，如果不服药，恐怕就不是这样了。我固然不认为《内经》的一日至六日相传一说，完全符合事实。
曹颖甫说：我研究伤寒学，早在仲师大论中证明七日为一候，一候为一经，二候为再经，六经传遍应当在四十二日。然而也有不作再经的，由其肠胃中本来不燥实。
如果太阳病初起，阳明先见燥实，那么先解其表，后攻其里，就是正治。我以前治疗赵庭槐的妻子，常用一张纸书写两个方子，治愈的不止一二次。又曾经治疗缪桂堂也用二方并书一笺，缪不识字，误将两个方子的药一起煎煮，也汗出便通而痊愈。
太阳转阳明其二
徐柏生初诊，微觉恶寒，头痛，腰脚酸，左脉很平，右脉独见浮缓，喝温水，微有汗，而表热不去，这是风邪留于肌腠。适宜桂枝汤加浮萍。
川桂枝三钱，生白芍三钱，生甘草一钱，浮萍三钱，生姜三片，枣七枚。
拙巢注：药后大便行，痊愈了。
太阳转阳明其三
二诊，汗出，热除，头痛恶寒止，只是大便三日不行，胸闷恶热，脉浮大，适宜承气汤，所谓先解其表后攻其里。
拙巢注：服药后，下四次，病全愈。
太阳转阳明其四
王左初诊，二十四年三月五日起病于浴后当风，恶寒而咳，一身尽痛，背部尤其严重，脉弦，法度上应当先解其表。得汗后，再行攻里。大便七日不行，从缓治疗。
生麻黄三钱，川桂枝三钱，光杏仁三钱，北细辛二钱，干姜三钱，五味子二钱，生甘草一钱，制半夏三钱，白前四钱。
【按语】本案病人王先生平时有病必找老师诊治，每诊一二次，病必良愈。这次又来，自称病重得很，不知道能否像以前那样快速痊愈？老师笑着说没关系，汗出后再诊一次即可。君欣然告辞。
二诊，三月六日，发汗已毕，而大便未行，食入口甜，咽肿脘胀，右脉滑大，下之可愈。
【按语】诊后病人问明天是否还需要复诊，观察他神情清醒，大概已经不是昨天的病象了。老师笑着说，无须再劳驾了，后来像老师所说。
学者应当知道疾病的传变，绝无一定的成规。如果我前面所说的桂枝汤证一变而为白虎汤证，麻黄汤证一变而为麻杏甘石汤证，葛根汤证一变而为葛根芩连汤证，这都是说其最常见的情况。如果以上太阳转阳明诸案，或由桂枝证传为承气证或麻子仁丸证，或由麻黄汤证或小青龙汤证传为承气证，又都不失其常规。如果其他种种传变，或由葛根汤证传为承气证，或由大青龙汤证传为承气证，又都在可能之中，何必一一赘列？所以医者只要能做到辨证用方，起初不必忧虑病变多端，只要能做到大胆细心，起初不必拘泥于温热或伤寒。
邪气附着于人，就像喝酒一样。凡人醉酒，脉必洪大而数，气高身热，面目俱赤，这是常态。及至谈论其变化，各有不同。有醉后妄言妄动，醒后全然不知的，有虽沉醉，而神思终不乱者，醉后应面赤而反刮白的，应委顿而反刚强者，应壮热而反恶寒战栗者，有易醉而易醒者，有难醉而难醒者，有打哈欠及打喷嚏者，有头晕眼花及头痛者。因其气血虚实之不同，脏腑禀赋之各异，更兼过量饮酒或少量饮酒的区别。考察其情状，各自不同。至于论述醉酒一事，等到醒来，一时各种状态消失。这是吴氏又可借饮酒来比喻邪气传变无定的说法。因为其言语通俗易晓，所以借录于此。
暑天阳明
患有血热壮盛之人，遇到天气酷热蒸腾，往往因多汗而导致胃中化燥。开始时大便不行，接着口燥想喝冷水。夏令伏阴体质的人，喝冷水太猛，或者转而转为下利。究其根本，利者自利，胃中燥实依然不去，所以仍适宜用大承气汤以下之。我的儿子湘人在辛未年六月在红卍字会救治一个山东人，亲眼所见。一剂后，不再来就诊，已经痊愈了。壬申年六月，又见到此人来就诊。诊其脉，洪大而滑疾，已经开具大承气汤方治了。那人说，去年的病承蒙先生用大黄而愈，湘人告诉他这次也用大黄，那人高兴地拿着方子离开，不再回来，又痊愈了。又江阴街烟纸店主严姓男子，每年七月上旬，大便闭结而腹痛，我每次用调胃承气汤，无不应手奏效。
【按语】这又是天时关系于疾病的情况，我们只要知道这个道理就够了。至于开方用药，仍应当一概以脉证为依据，设在盛夏遇到真寒的霍乱证，脉伏肢冷，我知道四逆汤又是必用的方剂了。
曹颖甫说：以上所列二证不过是想证明至其年月日时复发的理由，而病的变化，一定要视其人的本体来判断。其人血热过重，则易于化燥，水分过多，则易于化湿，燥热当泻，寒湿当温，确实应当像佐景所说的那样。
产后阳明病
In Volume 1, regarding the syndrome of Gegen Qinlian Decoction (Kudzu and Coptis Decoction), the Master adopted a "step back" strategy, while I adopted a "step forward" method. The two correspond remotely and complement each other perfectly. Students should know that the onset of a disease is often not fully curable by a single formula; when excess patterns are observed, advance treatment; when deficiency patterns are considered, retreat. When the condition is urgent, address the branch symptoms; when it is mild, preserve the root. Only when advancement and retreat are measured correctly, and root and branch are addressed without error, can the disease be rapidly resolved. Furthermore, beyond advancement and retreat, there are methods of indirect approach; between root and branch, there is the regulation of the reversal and compliance of Middle Qi. One corner reflects three; why wait for verbose explanations? Cao Yingfu said: Treating diseases without practical verification often leads to subjective speculation. Mencius said: To build high, one must start from hills; to dig deep, one must follow rivers and marshes. Now, Zuojing follows the disease conditions described by Master Zhongjing to seek their underlying causes. Thus, in prescribing based on manifestations, one can achieve ease and effectiveness at any time, not just for Ben Tun (a disease characterized by the sensation of Qi rushing upward from the lower abdomen). Additionally, note: Ben Tun was traditionally called Kidney Accumulation, but its actual treatment targets Liver pathology.
Chen Xiuyuan believed that Bentun Tang (Pulsatilla Decoction) soothes Liver Qi and expels pathogenic factors, while Huang Kunzai elucidated that Guizhi Tang (Cinnamon Twig Decoction) resolves Liver depression. According to the student's statement mentioned in the text, the theory of Liver Qi has its own merit. However, attributing Ben Tun syndrome to Liver pathology is acceptable; if one generally refers to Liver pathology without recognizing it as Ben Tun syndrome, that is incorrect.
Lijie (Joint Bi Syndrome)
Geng You, First Visit, August 27: Pain in all limbs and joints, foot pain, coldness in calves, fever in the afternoon (Shen-You hours), pulse deep and slippery. This is Lijie, suitable for Guizhi Shaoyao Zhimu Tang (Cinnamon Twig, Peony, and Anemarrhena Decoction). Luoli (Scrofula) should be treated gradually.
Chuan Guizhi (Cinnamomi Ramulus) 5 qian, Chi Shao (Red Peony Root) and Bai Shao (White Peony Root) 3 qian each, Sheng Gancao (Raw Licorice Root) 3 qian, Sheng Mahuang (Raw Ephedrae Herba) 3 qian, Shu Fukuai (Prepared Aconiti Lateralis Radix) 5 qian, Sheng Baizhu (Raw Atractylodis Macrocephalae Rhizoma) 5 qian, Fei Zhimu (Anemarrhenae Rhizoma) 5 qian, Qing Fangfeng (Saposhnikoviae Radix) 5 qian, Shengjiang (Fresh Ginger) 1 piece (beaten).
Second Visit, September 1: After taking Guizhi Shaoyao Zhimu Tang, lower back pain slightly decreased, afternoon fever was lower, but soreness and pain in hands and feet remained. Continue with the previous method.
Chuan Guizhi 5 qian, Chi Shao and Bai Shao 5 qian each, Sheng Gancao 3 qian, Jing Mahuang (Cleaned Ephedrae Herba) 4 qian, Cang Zhu (Atractylodis Rhizoma) and Bai Zhu 5 qian each, Fei Zhimu 5 qian, Qing Fangfeng 4 qian, Shengjiang 1 piece (beaten), Xian Fuzi (Salted Prepared Aconiti Lateralis Radix) 3 qian (raw, do not soak).
[Note] My Master once treated a woman surnamed Dai, who was eight months pregnant. She carried her sick husband in a cart, and the fetus was crushed by her husband's body, causing abdominal pain. A doctor administered medicine to induce abortion, resulting in the expulsion of putrefied dead fetus. The woman had a constitution of Blood deficiency. Since the dead fetus was expelled and she could not afford proper aftercare due to poverty, she developed Lijie. She suffered from spasms of hands and feet, severe joint pain, which was milder in the morning. After dragging on for two years, she sought the Master's diagnosis.
The Master prescribed a formula, but two doses were ineffective. In the second visit, another medicine was used, resulting in profuse sweating. After two doses, limbs and joints could flex and extend, and foot swelling subsided slightly. However, large blisters appeared on the hands, containing pus and fluid, threatening to ulcerate. Adopting the method of the late Ding Garen, the Master used Da Ji (Cirsii Japonici Herba) and Xiao Ji (Cirsii Herba) 5 qian each, Mudan Pi (Moutan Cortex) 1 liang, Digupi (Lycii Cortex) 4 qian to clear blood heat. After two doses, scabs formed; after four doses, scabs fell off. She returned to normal.
Thinking she was safe, she suddenly experienced unbearable vaginal itching, caused by residual damp-toxin flowing downward. The Master instructed her to fumigate and wash with decoction of Shechuangzi (Cnidii Fructus), which led to significant improvement. Soon after, while shopping in the market, she fainted. All other symptoms receded, revealing the true picture of Blood deficiency. The Master then used Shu Dihuang (Prepared Rehmanniae Radix) 1 liang, Lu Dangshen (Codonopsis Radix) 5 qian, Chuan Xiong (Ligustici Chuanxiong Rhizoma) and Danggui (Angelicae Sinensis Radix) 4 qian each, Longgu (Fossilia Ossis Mastodi) and Muli (Concha Ostreae) 1 liang each. After more than twenty doses, she was completely cured, and later gave birth to a child.
Cao Yingfu said: Joint pain is named Lijie. This syndrome originates from external wind-pathogen invasion, with incomplete sweating, leading to dampness accumulating in joints over time. Pulse slow and slippery indicates Cold-Damp. Mild cases use Guizhi Shaoyao Zhimu Tang; severe cases require Wutou Tang (Aconite Decoction). He once treated a young man surnamed Wu, using Jing Mahuang 3 qian, Sheng Baishao 3 qian, Sheng Huangqi (Raw Astragali Radix) 3 qian, Zhi Gancao (Honey-fried Licorice Root) 3 qian, Wutou (Aconiti Radix) 2 pieces sliced, boiled separately with honey until half remains. This largely follows the method in *Jin Gui Yao Lue*.
Faback and Brain Abscess
External cold-type lesions in the human body, aside from Liuzhu (flowing abscesses), include Faback (back carbuncle) and Naoju (brain/neck abscess), which are most serious. The world-transmitted Yanghe Tang (Yang-Nourishing Decoction) aligns best with Master Zhongjing's principle of "venting the carbuncle." If cold-cooling detoxifying drugs are mistakenly used, less than one in ten survives. This is because blood collaterals are congealed by Cold-Damp, unlike Dingdu (carbuncles) or Liuhuo (flowing fire) which belong to Yang syndromes. Yanghe Tang formula is attached below: Mahuang 3 qian (remove roots and nodes), Pao Jiang (Baked Ginger) 3 qian, Shu Dihuang 1 liang, Lujiao Jiao (Deer Antler Glue) 3 qian, Rougui (Cinnamon Bark) 1 qian (add Fuzi if Cold is severe).
[Note] Friend Mr. Zhou Mulin suffered from a brain abscess. Initially, observing it as Yin-type, the method dictated Yanghe Tang. However, his stool had not passed for five days, raising suspicion of Heat accumulation, causing hesitation. Who would have thought that after taking the decoction, his neck and back became easier to move the next morning, and stool passed freely? He realized the constipation was also due to Cold. The external plaster used was Yanghe Gao (Yanghe Plaster).
Another friend, Mr. Zhou Huangen, suffered from a brain abscess on the right posterior neck. Skin color unchanged, but a lump formed. Pulse was faint and thin, and stool did not pass. Following a neighbor's advice, he bought Fanxieye (Sennae Folium) for ten copper coins and took it. It caused severe diarrhea, then stopped, but the abscess worsened daily. I still administered Yanghe Tang, but no effect after two days. Another doctor tried modified Yanghe Tang, no effect after two days. A famous doctor prescribed a mild formula to harmonize nutrients and unblock collaterals. Since the patient did not defecate, I had no time to inquire further. Two days passed, the abscess remained, and constipation persisted. Finally, I advised using glycerin suppositories to moisten the intestines. Due to improper use, it was ineffective. The next day, I explained the correct method, and he passed four or five hard stools, followed by loose stools. He then slept peacefully all day. Waking up, he felt hungry and asked for porridge, with great revitalization of spirit. Since the stool was loose, dampness had an outlet, and the abscess gradually healed. Afterwards, I realized this was a case of initial hardness followed by looseness, originally unsuitable for purgation. The hard stool stuck in the intestines was likely due to the side effects of Fanxieye; severe purgation depleted Yin, leaving fluids gone but feces remaining, thus becoming dry and stuck. How can physicians neglect such medical errors by patients? Cao Yingfu said: Yanghe Tang is suitable not only for brain abscesses and back carbuncles but also for sudden knee soreness, which is the early stage of Hexikeng Feng (Crane-Knee Wind/Bilateral Knee Swelling). It is often effective. For example, Mother Hua suffered from this twice last winter and early spring. Taking medicine before sleep relieved pain upon waking. Applied to Gucaofeng (Bone Channel Wind/Mandibular Osteomyelitis), it also relieves pain with one dose. Truly a miraculous formula.
Deficiency Caused by Sweating
Case of Ruo Huamu missing.
Sheng Banxia (Raw Pinelliae Tuber) 3 qian, Zhi Cao 5 qian, Danggui 3 qian, Chenpi (Tangerine Peel) 3 qian, Baizhu 3 qian, Sheng Huangqi 3 qian, Shu Fukuai 5 qian, Dangshen 4 qian, Shu Dihuang 2 liang, Ganjiang (Dried Ginger) 3 qian, Chuan Xiong 3 qian, Zhi Ruxiang (Frankincense) and Moyao (Myrrh) 3 qian each, Sheng Yiren (Coix Seed) 1 liang.
[Note] The Master's wife was naturally slender and had slight Phlegm-Fluid retention. A few days ago, she accidentally contracted Wind-Cold, with aversion to cold, headache, and fever. The Master gave her exterior-releasing agents. She improved slightly but not completely. Repeated administration occurred several times. I found one formula: Guizhi 3 qian, Baishao 3 qian, Sheng Cao 2 qian, Fuping (Azolla Herba) 3 qian, Ginger 3 slices. This was essentially Guizhi Tang minus Dazao (Jujube) plus Fuping.
After taking it, she sweated profusely, with slight aversion to cold, mental fatigue, heart pain, crossing arms over the chest, pressing slowly brought slight relief, muscles uncomfortable with needle-like sensations, dry skin, brownish blood vessels, palpitations, dizziness, instability sitting or standing, feeling dizzy. Pulse was fine, small, and weak. Knowing medicine, she told the Master: "I am now deficient; the method requires tonification." After discussion, the above formula was obtained. She added: "If Shu Fuzi (Prepared Aconite) doesn't work, I will switch to Sheng Fuzi (Raw Aconite) tomorrow." It was evening, heart pain was severe, and muscle spasms were painful. After the first decoction, she slept peacefully. Waking at midnight, pain greatly reduced. Next morning, after the second decoction, spirit revived. Skin became moist, and movement gradually normalized.
Later, analyzing the pathology and efficacy: The Master's wife seemed to have low blood volume and phlegm-turbidity stagnation. Although having exterior symptoms, excessive sweating was inappropriate. The treatise states: With floating-tight pulse, body pain is expected, suitable for sweating. But if Chi pulse is slow, do not sweat. Why? Because Ying Qi is insufficient and Blood is scant. See? Moreover, Guizhi Tang minus Dazao plus Fuping has stronger diaphoretic power than original Guizhi Tang. Dazao preserves fluids; Fuping damages them. Giving excessive sweat to someone unsuited for it inevitably causes transformation of syndrome.
The Great Treatise says: Excessive sweating leads to crossing arms over the heart, palpitations, desire to press—treat with Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction). This applies to those without Phlegm-Fluid. It also says: Taiyang disease, sweating fails to resolve, fever persists, palpitations, dizziness, muscle twitching, trembling desire to fall—treat with Zhenwu Tang (True Warrior Decoction). This applies to those with Phlegm-Fluid. It also says: Sweating fails to resolve disease, aversion to cold returns—this is deficiency. Treat with Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction). This applies to deficiency.
The formula taken by the Master's wife was neither Guizhi Gancao Tang nor Zhenwu Tang nor Shaoyao Gancao Fuzi Tang, yet close, perhaps even more comprehensive, hence effective. Thus, Master Zhongjing teaches using Mahuang and Guizhi for exterior pathogens, but also teaches contraindications for these herbs, and rescue methods for misuse. His intent is earnest, methods complete. This case confirms it. Readers of *Shanghan Lun* cannot cling to one aspect while ignoring others. Cao Yingfu said: Sweating a deficient person is called "double deficiency." Double deficiency leads to interior Cold. Blood failing to nourish tendons causes spasms. Blood failing to fill vessels causes faint/small pulse. Without tonifying Qi and Blood, tendons/vessels remain disordered; without regulating Water organs, Exterior Yang cannot reach surface. Due to Water Qi, add Ganjiang and Banxia. Due to body pain, add Ruxiang and Moyao. Due to palpitations, heavily use Zhi Gancao. Due to dampness, add Sheng Yiren. Generally, add according to syndrome; initially no fixed formula exists. The original intent was using Baizhu and Fuzi together to move Water Qi in the skin. Rescue formulas must adjust based on the patient's condition.
Taiyang Transforming to Yangming I
Yao Zuo: Fever, headache, sweating, aversion to wind, floating-slow pulse. Named Fengzhong (Wind Strike). Treat with Guizhi Tang plus Fuping.
Chuan Guizhi 3 qian, Sheng Baishao 3 qian, Sheng Cao 1.5 qian, Fuping 3 qian, Shengjiang 3 slices, Dazao 3 pieces. Drink hot porridge after medication. After sweating, symptoms resolve. If heat persists after sweating, take the subsequent formula (Chengqi Tang); if heat clears, do not take it.
Sheng Chuanjun (Raw Rhubarb) 3 qian, Zhishi (Immature Bitter Orange) 3 qian, Houpo (Magnolia Bark) 1.5 qian, Mangxiao (Mirabilite) 2 qian (dissolve), Sheng Gancao 1.5 qian.
[Note] These two formulas were prescribed together during the first visit. Other doctors rarely do this, but the Master often does.
Master said: Prescribing two formulas today saves the patient往返 (round trips) tomorrow and reduces consultation fees, is it not good? Although, if I lacked foresight to predict tomorrow's changes, would I dare do this? Fuping is commonly used by my Master in summer, often added to Guizhi Tang. He praised its efficacy. Patient Mr. Yao left with the prescription but dared not take it. He questioned a disciple of Mr. Yun Tieqiao. The disciple said: Release the exterior first, then attack the interior; this is Master Zhongjing's major principle. Why doubt? He finally followed the advice. Sweating occurred, and as recorded, all symptoms resolved. Unexpectedly, half a day later, fever returned. The patient didn't realize this fever was different from the previous one. Bravely taking the second formula, stool passed, and heat cleared. Three days later, he was normal.
I asked: After Guizhi Tang, some need Chengqi Tang, others don't. Is there a distinguishing point? Master said: At first visit, I saw yellow and thick tongue coating, so I used Chengqi Tang. I said: Understand. Does "infer three from one" mean only yellow-thick coating? What about difficult/unformed stool, thirst, pain above the glabella, or constitutions prone to Heat? Are these not precursors for Chengqi Tang? From then on, I could emulate the Master, prescribing two formulas in one visit.
From my clinical experience, many cases where Guizhi syndrome clears after Guizhi Tang, transforming into mild Yangming syndrome, and resolving with Chengqi Tang without transmission, are common. Describing this fact, "Day 1 Taiyang, Day 2 Yangming" fits well. However, this is only for Taiyang patients taking medicine. Without medicine, it might differ. I do not believe the *Neijing* theory of transmission from Day 1 to Day 6 fully matches reality.
Cao Yingfu said: In studying Shanghan, I proved in Master Zhongjing's treatise that seven days is one period (Hou), one period equals one channel, two periods equal re-transmission. Six channels complete in forty-two days. However, some do not re-transmit because their intestines/stomach are not dry/excess.
If Taiyang disease begins with Yangming dry/excess appearing first, releasing exterior then attacking interior is correct treatment. I once treated Mrs. Zhao Tinghuai, often writing two formulas on one paper, curing her more than once or twice. I also treated Miao Guantang, writing two formulas on one paper. Miao was illiterate and mistakenly boiled both formulas together. He sweated, stool passed, and recovered.
Taiyang Transforming to Yangming II
Xu Baisheng, First Visit: Slight aversion to cold, headache, sore waist/legs. Left pulse very level; right pulse uniquely floating-slow. Drinking warm water, slight sweating, but exterior heat persists. Wind-pathogen lingering in muscle interstices. Suitable for Guizhi Tang plus Fuping.
Chuan Guizhi 3 qian, Sheng Baishao 3 qian, Sheng Gancao 1 qian, Fuping 3 qian, Shengjiang 3 slices, Zao (Jujube) 7 pieces.
Second Visit: Sweating occurred, body cooled, but stool did not pass. Suitable for Mahuang Ren Wan (Ephedra and Hemp Seed Pill).
Pi Yue Mahuang Ren Wan 3 qian, Mangxiao (Mirabilite) dissolved in water to swallow.
Zhuochao Note: Stool passed after medication, cured.
Taiyang Transforming to Yangming III
Yu Zhesheng, First Visit: Slight aversion to cold, headache, fever, floating-small-tight pulse. Suitable for Mahuang Tang (Ephedra Decoction).
Jing Mahuang 3 qian, Guizhi 3 qian, Sheng Gancao 1 qian, Guang Xingren (Apricot Seed) 3 qian.
Second Visit: Sweating occurred, heat cleared, headache and aversion to cold stopped. Only stool has not passed for three days, chest tightness, aversion to heat, floating-large pulse. Suitable for Chengqi Tang, meaning "release exterior first, then attack interior."
Sheng Chuanjun 3 qian (add later), Zhishi 4 qian, Chuan Pu 2 qian, Mangxiao 2 qian (dissolve).
Zhuochao Note: Four bowel movements after medication, completely cured.
Taiyang Transforming to Yangming IV
Wang Zuo, First Visit: Illness started March 5, Year 24, after bathing and exposure to wind. Aversion to cold with cough, whole body pain, especially back. Pulse wiry. Method: Release exterior first. After sweating, then attack interior. Stool not passed for seven days, treat gradually.
Sheng Mahuang 3 qian, Chuan Guizhi 3 qian, Guang Xingren 3 qian, Bei Xixin (Asari Radix et Rhizoma) 2 qian, Ganjiang 3 qian, Wuweizi (Schisandra Fruit) 2 qian, Sheng Gancao 1 qian, Zhi Banxia 3 qian, Baiqian (Polygalae Radix) 4 qian.
[Note] Patient Mr. Wang usually seeks the Master's diagnosis for illnesses, typically recovering after one or two visits. This time he claimed severe illness, wondering if recovery would be as fast. Master smiled, saying no harm, just one more visit after sweating. Mr. Wang left happily.
Second Visit, March 6: Sweating completed, but stool not passed. Sweet taste in mouth upon eating, swollen throat, distended epigastrium. Right pulse slippery-large. Purging will cure.
Sheng Chuanjun 3 qian, Zhishi 4 qian, Houpo 1 qian, Mangxiao 3 qian (dissolve).
[Note] After diagnosis, patient asked if a follow-up was needed tomorrow. Observing his clear spirit, he was no longer exhibiting yesterday's symptoms. Master smiled, saying no need for further trouble, as later confirmed.
Students should know disease transmission has no fixed rules. As mentioned, Guizhi syndrome transforming into Baihu Tang syndrome, Mahuang Tang transforming into MaXing Gan Shi Tang syndrome, Gegen Tang transforming into Gegen Qinlian Tang syndrome—these are common examples. Regarding the Taiyang-to-Yangming cases above, whether Guizhi syndrome transmits to Chengqi or Mazirenwan syndrome, or Mahuang/Xiao Qinglong Tang syndrome transmits to Chengqi syndrome, these are also standard. Other transmissions, such as Gegen Tang or Da Qing Long Tang transmitting to Chengqi, are also possible. Why list them all? Physicians should focus on pattern differentiation and formula selection, not worry about varied changes, and be bold yet careful, not rigidly adhering to Warm Disease or Cold Damage categories.
Pathogens attaching to humans are like drinking alcohol. Drunk people have surging-rapid pulses, high breath, body heat, red face and eyes—this is normal. Variations differ. Some talk/move wildly while drunk, forgetting entirely upon waking; some remain mentally clear despite deep intoxication; some should have red faces but turn pale; some should be lethargic but become stiff; some should have high fever but shiver with aversion to cold; some get drunk easily and wake easily; some get drunk hard and wake hard; some yawn/sneeze; some have dizziness/blurred vision/headache. Due to differences in Qi/Blood deficiency/excess and organ constitution, plus varying amounts of alcohol, situations differ. Yet, regarding drunkenness itself, upon waking, all states vanish. Wu又可 (Wu Jutong) used drinking to metaphorize unpredictable pathogen transmission. His words are easy to understand, so quoted here.
Summer Yangming
People with vigorous Blood Heat, encountering hot weather, often develop stomach dryness due to excessive sweating. Initially, constipation; subsequently, dry mouth craving cold drinks. Those with latent Yin constitution in summer, drinking cold water too aggressively, may transform into diarrhea. Ultimately, diarrhea occurs, but stomach dryness/excess remains, so Dachengqi Tang (Major Order the Qi Decoction) is still suitable for purging. My son Xiangren witnessed this in June of Xinwei year at the Red Cross Society treating a Shandong man. One dose, no return visit, cured. In June of Ren Shen year, the same man visited. Pulse surging-large-slippery-rapid. Prescribed Dachengqi Tang. He said last year cured by Master's Rhubarb. Xiangren told him Rhubarb would be used again. Man happily left, cured again. Also, Mr. Yan, owner of a tobacco/paper shop in Jiangyin Street, suffers annual constipation and abdominal pain in early July. Using Weichengqi Tang (Minor Order the Qi Decoction) always works instantly.
[Note] This shows the relationship between climate and disease. We need only understand the principle. Prescribing must still rely on pulse and symptoms. If encountering true Cold Huoluan (Cholera) in midsummer with hidden pulse and cold limbs, Sini Tang (Reverse-Return Decoction) is mandatory.
Cao Yingfu said: The two cases listed above aim to prove the reason for recurrence at specific dates/times. Disease changes depend on the individual's constitution. Excessive Blood Heat leads to dryness; excessive moisture leads to dampness. Dry-Heat requires purging; Cold-Damp requires warming. Indeed, as Zuojing stated.
Postpartum Yangming Disease