自愈。明明以热之日数定厥之痊期也。又云∶厥多热少则病进，热多厥少则病退。厥愈而热过久者，必便脓血
发痈。厥应下而反汗之，必口伤烂赤。先厥后热，利必自止。见厥复利，利止反汗出咽痛者，其喉为痹。厥而
能食，恐为除中，厥止思食，邪退欲愈。凡此之类，莫非热深发厥之旨，原未论及于阴厥也。至于阳分之病，
而妄汗妄吐妄下，以致势极。如汗多亡阳，吐利烦躁，四肢逆冷者，皆因用药差误所致，非以四逆、真武等汤
挽之，则阳不能回，亦原不为阴症立方也。盖伤寒才一发热发渴，定然阴分先亏，以其误治，阳分比阴分更亏，
不得已从权用辛热，先救其阳，与纯阴无阳，阴盛格阳之症，相去天渊。后人不窥制方之意，见有成法，转相
效尤，不知治阴症以救阳为主，治伤寒以救阴为主。（此一语，为治传经症之秘旨。）伤寒纵有阳虚当治，必
看其人血肉充盛，阴分可受阳药者，方可回阳。若面黧舌黑，身如枯柴，一团邪火内燔者，则阴已先尽，何阳
可回耶？故见厥除热，存津液元气于什一，已失之晚，况敢助阳劫阴乎？证治方云∶若证未辨阴阳，且以四顺
丸试之。《直指方》云∶未辨疑似，且与理中丸试之。亦可见从前未透此关，纵有深心，无可奈何耳。因为子
辈详辨，并以告后之业医者云。
成无己云∶凡厥，若始得之，手足便厥而不温者，是阴经受邪，阳气不足，可用四逆汤温之。若手足自热
而至温，从四逆而至厥者，传经之邪也，四逆散主之。必须识此，勿令误也，又当兼以外症别之。予尝治过一
中年妇人，恶热身热而渴，脉数细弱，先厥后热，用温药反剧，后以四逆散兼参、术各半两服之，厥即愈，脉
出洪大而痊。
按∶成所论阴经受邪，及传经之邪二厥，一用四逆汤温治，一用四逆散凉治，已昭然若揭，喻氏或未之
见耳，故列其案于此。
陆平叔文学，平素体虚气怯，面色萎黄，药宜温补，不宜寒凉，固其常也，秋月偶患三疟，孟冬复受外寒，
虽有寒热一症。而未至大寒大热。医者以为疟后虚邪，不知其为新受实邪也，（因旧病感新邪，最易误人。）
投以参、术补剂，转至奄奄一息。迁延两旬，间有从外感起见者，用人参白虎汤，略无寸效，昏昏默默，漫无主
持，已治木矣。喻诊之，察其脉未大坏，腹未大满，小水尚利，谓可治。但筋脉牵掣不停，只恐手足痿废。
仲景云∶筋脉动惕者，久而成痿。今病已二十余日，血枯筋燥，从可知矣。今治则兼治，当于仲景之外，另施手
眼。以仲景虽有大柴胡汤两解表里之法，而无治痿之法。（治痿独取阳明，清阳明之热邪，则痿不治而愈。况
此症原属暴伤，非损也。）变用防风通圣散成方减白术，以方中防风、荆芥、薄荷、麻黄、桔梗为表药，大黄、
芒硝、黄芩、连翘、栀子、石膏、滑石为里药。原与大柴胡之制略相仿，且内有当归、川芎、白芍，正可领诸药
深入血分而通经脉。减白术者，以前既用之贻误，不可再误耳。当晚连进二剂，一剂殊相安，二剂大便始通，少
顷睡去，津津汗出。次早诊之，筋脉不为牵掣，但阳明胃脉洪大反加，随用白虎汤，石膏、知母每各两许，次加柴
胡、花粉、芩、柏、连翘、栀子，一派苦寒。连进十余剂，（要之，前误用温补之剂亦不少矣。）神识清，饮
食进，半月起于床，一月步于地。忽略啖，即腹痛泄泻，俨似虚症。喻不之顾，但于行滞药中，加柴胡、桂枝升散
余邪，不使下溜变痢，然后改用葳蕤、二冬，略和胃气，间用人参不过五分。前后治法一一不违矩 ，始克起九
死于一生也。
徐国桢伤寒六七日，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，辗转不快，更
求入井。一医汹汹，急以大承气与服。喻诊其脉，洪大无伦，重按无力。谓曰∶此用人参、附子、干姜之症，
奈何认为下症耶？医曰∶身热目赤，有余之邪，躁急若此，再与姜、附，逾垣上屋矣。喻曰∶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，况敢以纯阴之药，重劫其阳乎？观其得水不欲咽，（热在阳
明经者，亦漱水不欲咽。）情已大露，岂水尚不欲咽，而反可咽大黄、芒硝乎？天气懊蒸，必有大雨，此症倾刻大汗，
不可救矣。且既认大热为阳症，则下之必成结胸，更可虑也。惟用姜、附，所谓补中有发，并可散邪退热，一
举两得，不必疑虑。以附子、干姜各五钱，人参三钱，甘草二钱，煎成，冷服后寒战戛齿有声，以重棉和头覆
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。（一戴阳症耳。说得甚奇，然此症实不多见。）
张卿子治塘栖妇人，伤寒十日，热不得汗。或欲以锦黄下之，主人惧。延卿子诊之，曰∶脉强舌黑而有芒，
投锦黄为宜。今舌黑而润不渴，此附子症也。不汗者，气弱也，非参、 助之不可。一剂而汗。《仁和县志》。
张路玉治范主事求，先患伤寒营症，恶寒三日不止。曾用发散二剂，第七日，躁扰不宁，脉亦不至，手足
厥逆。诊之，独左寸厥厥动摇，（心主汗故也。）知是欲作战汗之候，令勿服药，（宜记省。）但与热姜汤助其
作汗，若误药必热不止。后数日，枉驾谢别，询之果如所言，不药而愈。（战汗治法。）
吴氏子，年二十余，素有梦交之疾。十月间，患伤寒，头痛足冷，用发散消导，屡汗而昏热不除，反加喘
逆。更医用麻黄，头面大汗，喘促愈甚。或以为邪热入里，主用芩、连；或以为元气大虚，议用冬、地，争持
未决。张诊之，六脉瞥瞥，按之欲绝，正阳欲脱亡之兆，急须参、附，庶可望其回阳，（此喻嘉言所谓误治致阳虚也。）
遂疏回阳返本汤，加童便以敛阳。三啜安卧，改用大剂独参汤加童便，调理数日，频与稀糜而安。
一人，途次患伤寒，经吴门，泊舟求治。询之，自渡淮，露卧受寒，恣饮烧酒，发热，在京口服药，行过
两次，热势略减，而神昏不语，不时烦扰。见其唇舌赤肿燥裂，以开水与之则咽，不与则不思。察其两寸，瞥
瞥虚大，关寸小弱，按久六脉皆虚，曰∶此热传手少阴经也。与导赤泻心汤，一啜神识稍宁。泊舟一日夜，
又进二帖，便溺自知。次早解维再诊，脉静神安，但与小剂五苓去桂易门冬，二帖，嘱其频与稀糜，可收功。
吴介臣伤寒，余热未尽，曲池壅肿，不溃不消，日发寒热。疡医禁止饮食，日服消毒清火药，上气形脱，
倚息不得卧，渴饮开水一二口，腹胀满急，大便燥急不通。两月中，用蜜导四五次，所去甚艰，势大危。诊之，
其脉初按绷急，按久绝无，此中气逮尽之兆，岂能复胜药力耶？乃令续进稀糜，榻前以鸭煮之，香气透达，徐
以汁啜之。是夕，大便去结粪甚多，喘胀顿止，饮食渐进。数日后，肿赤渐消。此际虽可进保元、独参之类，
然力不能支，仅惟谷肉调理而安。近一人过饵消导，胃气告匮，闻谷气则欲呕，亦用上法，不药而痊。
高鼓峰治徐五宜长君，伤寒危甚。延诊，顷之有人来言∶病者晚来狂叫，晕去五六次，早起一晕竟绝，不
必往矣。问病来几日？云∶九日矣。又问胸尚热否？曰∶胸但不冷耳。曰∶可救也。急往视之，至则僵尸在床，
口鼻无气，面色青黯，口噤目闭，手撒，独唇色紫黑。高笑曰∶此人不死，阴虚症，误服白虎所致耳。切其脉，
两尺尚在，（脉在仍是厥耳。）遂取人参一两，熟地二两，炮姜五钱，浓煎汤挖而灌之。尽剂口开，面色转红，
不及一时，大叫冷甚，连以热汤饮之，即发壮热，通身淋漓汗下而苏，此晚，腹胀不便。曰∶无忧也，大汗
之后，虚不能出耳，再饮药一钟，即得解。次日诸病悉除，但多妄言怒骂，如有鬼神驱之者。调治数日，至
夜半，诊其脉，曰∶虚至此乎？复以大剂附子理中、建中投之，数日而愈。
杭友沈侨如甥，病伤寒。诊其脉，浮数有力，舌黑，胸胁痛胀，此得之劳倦，后复伤饮食。（战汗而解，
不得单谓饮食劳倦。）医以寒凉消导攻之，火受遏抑，无所归也。急以大剂参、术、归、 、炮姜救之。戒其家人
曰∶夜半当发战，战则汗而解矣。如战时，频频以粥与之。高卧天长寺，四鼓时，病家急叩门，曰∶服药后果
寒甚索被，顷之大热，昏沉而死矣。先生尚有法救之否？曰∶不足虑也，汗来矣。但战时曾进粥否？曰∶实未也。
曰∶吾语汝，战时须与粥，要以助胃气，使汗来速，不至困乏耳。今亦无妨，第归，此时当得汗矣。果如言，
睡而安。（与粥助汗，亦仿仲景桂枝治法。）
张隐庵治一少年，伤寒三四日，头痛发热，胸痛不可忍。病家曰∶三日前因食面而致病。张曰∶不然。面
饭粮食，何日不食？盖因外感风寒，以致内停饮食，非因食面而为头痛发热证也。故凡停食感寒，只宜解表，
不可推食，如里气一松，外邪即陷入矣。（为庸师说法。）且食停于内，在胸下胃脘间，按之而痛。今胸上痛不
可按，此必误下而成结胸。病家云∶昨延某师，告以食面，故用消食之药，以致胸中大痛。因诊其外症尚在，
仍用桂枝汤加减，一服而愈。
张令韶治一妇人，患伤寒十余日，手足躁扰，口目 动，面白身冷，谵语发狂，不知人事，势甚危笃。其
家以为风，缚其手足。或以为痰迷心窍，或以为虚，或以为寒，或辞不治。张诊之，切其脉全无，问其证不知，
按其身不热。张曰∶此非人参、附子证，即是大黄、芒硝证，出此入彼，死生立判。因坐视良久，聆其声重而
且长，（亦有中焦停食，而奄奄似不属者，亦下之而愈。见缪仲淳治姚平之案。）曰∶若是虚寒证，到脉脱之
时，气沉沉将绝，那得有如许气力，大呼疾声，久而不绝？即作大承气汤，牙关紧闭，挖开去齿，药始下咽，
黄昏即解黑粪半床。次早脉出身热，人事亦知，舌能伸出而黑，又服小陷胸汤二剂而愈。
一妇人素有虚弱之症，后患伤寒。一医以为阴虚发热，用滋阴之药，命食鸡子火肉，而病更甚。所用皆玉
竹、骨皮、丹皮、归、芍之类，十余日，死症悉具。延张至，其人已死。张请视之，气虽绝，而脉尚在且带滑。
曰∶此症不死，乃误服补药，使邪不解，胃络不通，胃家实也。幸正气未败，可治，少顷果苏，（亦以厥故。）
用调胃承气汤，一服而结粪解，诸症愈。次日大汗如雨，此虚象也，用人参三钱， 、术、枣仁各五钱而愈。
一男子新婚，吐蛔发热。医以为阴症，用理中汤，而吐愈甚。张诊其脉，缓而长，一日夜吐蛔十余条，以
为风木生虫，湿热相蒸则虫顿然而生，随生随吐，欲用黄连等清湿热之药。不信，复易一医。用归、芍、玉竹
之类，吐益甚，虫愈多。复延张，张曰∶必欲治，非黄连不可。遂用黄连、浓朴、枳实、广皮、半夏各等分煎
服，其吐稍止。再服不吐，神清，虫从大便而出，约数十余，大小不等。后加白术等以补之，即胀不安。共享
黄连、枳实二十剂而愈。此乃千百中偶见之症，不可以为常有也。
按∶发热脉缓而长，则是阳明经症。案中但与治蛔，似多脱略，俟再考。
陆养愚治周两峰，头痛身热，又舟行遇风，几覆。比至家，胁大痛，耳聋，烦渴谵语。医来诊，忽吐血盘
许。医曰∶两尺不应，寸关弦紧，烦渴谵语，是阳症也。弦乃阴脉，仲景曰阳病见阴脉者死，况两尺乃人之根
蒂，今不起，根蒂已绝，孤阳上越，逼血妄行，据症脉不可为矣。辞去。陆至，血已止而喘定。脉之，两寸关
弦而微数，两尺果沉而不起。盖症属少阳，弦数宜矣；胁痛耳聋，亦少阳本症；两尺不起，亦自有故。经云南
政之岁，阳明燥金司天，少阴君火在泉，故不应耳。吐血者，因舟中惊恐，血菀而神摄，为热所搏也。谵语者，
三阳表症已尽，将传三阴也。先以小柴胡和之，俟坚实而下之，旬日当愈，因与二剂。明日胁痛减，耳微闻，
但仍谵语，胸膈满闷，舌上薄黄苔，仍以小柴胡加桔梗、黄连，日服一剂，二日胸膈少宽而苔黑有刺，大便不
行约七日矣，乃以润字丸三钱，煎汤送下。至夜，更衣身洁，诸症顿失。后去枳、桔，加归、芍，调理旬日而起。
王野溪病伤寒六七日，已发表矣。忽身热烦躁，口渴咽干，大小便利而不任风寒。或用凉膈散，反胸前见
斑数十点，色微红。乃投消斑青黛饮，又发谵语，手足厥逆。谓热深之故，拟用承气下之。陆脉之，浮数六七
至，按之而空，曰∶此阴盛格阳症也，下之立毙。《内经·至真要论》云∶病有脉从而病反者，何也？岐伯
曰∶脉至而从，按之不散，诸阳皆然。今脉浮之而数，按之而空，乃阳虚为阴所拒，不能内入而与阴交。身热
烦躁，口渴咽干，浮阳外越之故也。恶风畏寒，阳气不足也。发斑者，因寒药激之，致无根之火聚于胸中，上
熏于肺，传之皮肤也。谵语者，神不守舍也。厥逆者，阳将竭也。若冷至肘膝，则无及矣。此与东垣治冯内翰
自然痊愈。这明确地以发热日数的多少来判定厥逆证痊愈的期限。又说：厥逆多而发热少，则病情进展；发热多而厥逆少，则病情退却。厥逆已愈但发热时间过长的人，必然会出现大便脓血或发生痈疽。厥逆证应当用下法治疗却反而使用发汗法，必然导致口腔损伤、糜烂发红。先出现厥逆后出现发热，腹泻必然会自行停止。再次见到厥逆则腹泻复发，腹泻停止反而出现出汗、咽喉疼痛的，其喉部会发生痹阻（喉痹）。厥逆期间如果能进食，要担心是“除中”（胃气将绝的假象）；厥逆停止且想吃东西，说明邪气退去，即将痊愈。凡此种种，都不外乎热深厥深的宗旨，原本没有论述到阴寒厥逆的情况。至于阳分的热病，如果误用发汗、催吐、攻下等法，导致病情危重。如出汗过多导致亡阳，呕吐腹泻伴烦躁、四肢逆冷的，都是因为用药错误所致，如果不使用四逆汤、真武汤等方剂挽回阳气，阳气就不能回复，这也原本不是为了阴证设立方剂的缘故。大概伤寒只要一开始发热口渴，必然是阴分先有亏损，因为误治，阳分比阴分更加亏损，不得已权宜使用辛热药物，先急救其阳气，这与纯阴无阳、阴盛格阳的病证，相差如天壤之别。后人不明制方的本意，看到有成法，互相效仿，不知道治疗阴证以救阳为主，治疗伤寒以救阴为主。（这一句话，是治疗传经证的秘诀。）伤寒纵然有阳虚需要治疗，也必须看其人血肉充盛，阴分能够承受阳药的情况下，才可以回阳。如果面色黧黑、舌苔黑、身体像枯柴一样，一团邪火在内焚烧的，那么阴液已经耗尽，哪里还有阳气可以回复呢？所以见到厥逆除去热邪，保存十分之一的津液元气，已经失之太晚，何况敢助阳劫夺阴液呢？《证治方》说：如果证候尚未辨别阴阳，暂且试用四顺丸。《直指方》说：未辨疑似情况，暂且给予理中丸试用。也可以看出从前未能透彻理解这一关窍，纵然有深心研究，也无可奈何罢了。因此为子辈详细辨析，并以此告知后世行医的人。
成无己说：凡是厥逆，如果刚发病时，手足就厥冷不温的，这是阴经受邪，阳气不足，可以使用四逆汤温补。如果手足从发热转为温暖，从四逆（寒冷）转为厥逆的，这是传经之邪，主治方剂是四逆散。必须认识这一点，不要弄错，还应当结合外部症状来辨别。我曾经治疗过一个中年妇女，恶风身热且口渴，脉象数而细弱，先厥逆后发热，使用温药反而加重，后来用四逆散加入人参、白术各半两服用，厥逆立即痊愈，脉象变得洪大从而康复。
按语：成无己所论述的阴经受邪及传经之邪两种厥逆，一种用四逆汤温治，一种用四逆散凉治，已经非常明显了，喻昌或许未曾见过，所以将此案例列于此。
陆平叔文学，平时体质虚弱、气怯，面色萎黄，药物适宜温补，不适宜寒凉，这是常规情况。秋季偶然患了三疟疾，孟冬时节又感受外寒，虽然有寒热的症状，但未至大寒大热。医生认为是疟疾后的虚邪，不知道是新感实邪，（因旧病感新邪，最容易误导人），投以人参、白术的补剂，反而导致气息奄奄。拖延了二十天，偶尔有人从外感角度考虑，用人参白虎汤，毫无效果，患者昏昏沉沉，漫无主张，已经视为不治之症。喻昌诊察，发现脉象未大坏，腹部未大满，小便尚通利，认为可治。但筋脉牵掣不停，只恐怕手足会痿废。张仲景说：筋脉动惕者，久则成痿。现在病已二十多天，血枯筋燥，由此可知。现在治疗应当兼治，应当在张仲景之外，另施手段。虽然张仲景有大柴胡汤表里双解的方法，但没有治疗痿证的方法。（治疗痿证独取阳明，清阳明之热邪，则痿证不治而愈。况且此症原属暴伤，不是虚损。）变通使用防风通圣散原方减去白术，方中防风、荆芥、薄荷、麻黄、桔梗作为表药，大黄、芒硝、黄芩、连翘、栀子、石膏、滑石作为里药。原来与大柴胡汤的体制大致相似，且内有当归、川芎、白芍，正好可以引领诸药深入血分而通经脉。减去白术的原因，是因为之前已经用过导致失误，不可再误。当晚连续服用两剂，第一剂相安无事，第二剂大便才通畅，过了一会儿睡去，微微出汗。次日早晨诊察，筋脉不再牵掣，但阳明胃脉洪大反而加重，随即使用白虎汤，石膏、知母各一两左右，随后加入柴胡、花粉、黄芩、黄柏、连翘、栀子，一派苦寒药物。连续服用十余剂，（总之，前误用的温补药物也不少。）神识清醒，饮食增加，半个月能起床，一个月能行走。如果忽略忌口吃不当食物，就会腹痛泄泻，俨然是虚证的样子。喻昌不顾这些，只在行滞药中加入柴胡、桂枝升散余邪，不让邪气下溜变成痢疾，然后改用葳蕤、天冬、麦冬，稍微调和胃气，间或使用人参不过五分。前后的治法一一符合规矩，才使得他从九死一生之中恢复过来。
徐国桢患伤寒六七天，身热目赤，索要水送到面前，却又放下不喝，异常躁动，把门窗大开，身体躺在地上，辗转不安，更要求跳入井中。一个医生惊慌失措，急忙给予大承气汤服用。喻昌诊察其脉，洪大无比，重按无力。说道：这是需要使用人参、附子、干姜的证候，怎么认为是下法的证候呢？医生说：身热目赤，是有余之邪，躁急如此，再用姜、附，就会让人爬墙跳屋。喻昌说：阳气将要暴脱，外表显现假热，内里有真寒，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？看他得水却不欲咽，（热在阳明经者，也是漱水不欲咽。）真情已经暴露，难道水尚且不想咽，反而可以咽下大黄、芒硝吗？天气闷热，必有大雨，此症顷刻间大汗淋漓，就无法救治了。况且既然认定大热为阳证，那么用下法必然形成结胸，更令人担忧。只有使用姜、附，所谓补中有发，并可散邪退热，一举两得，不必疑虑。使用附子、干姜各五钱，人参三钱，甘草二钱，煎好后，冷服后出现寒战、牙齿打颤的声音，用厚棉被裹头覆盖，缩手不肯让人诊脉，阳气微弱的症状才明显显露出来。再给前一剂药，微汗出，热退而安。（这是一个戴阳证。说得非常奇特，然而此症确实不多见。）
张卿子治疗塘栖一位妇人，患伤寒十天，发热不得汗。有人想用锦纹大黄攻下，主人害怕。请张卿子诊治，说：脉强舌黑且有芒刺，投用锦纹大黄为宜。现在舌黑而润且不渴，这是附子证。不出汗，是气弱，非用人参、黄芪辅助不可。一剂药后出汗。出自《仁和县志》。
张路玉治疗范主事求，先前患伤寒营分证，恶寒三天不止。曾用发散药两剂，第七日，躁扰不宁，脉也不到了，手足厥逆。诊察，唯独左寸脉厥厥动摇，（心主汗的缘故。）知道是想要发生战汗的征兆，命令不要服药，（应当记住省悟。）只给热姜汤帮助其作汗，如果误服药物必然热不止。后来几天，枉驾致谢告别，询问果然如所言，不服药而痊愈。（战汗治法。）
吴氏的儿子，二十多岁，素有梦交的毛病。十月间，患伤寒，头痛足冷，用发散消导药，多次发汗但昏热不退，反而加重气喘。换医生用麻黄，头面大汗，喘促更甚。有人认为邪热入里，主张用黄芩、黄连；有人认为元气大虚，议用冬虫夏草、地黄，争论不决。张诊察，六脉飘忽不定，按之欲绝，正是阳气将要脱亡的征兆，急需人参、附子，才有望回阳，（这是喻嘉言所说的误治导致阳虚。）于是开具回阳返本汤，加入童便以收敛阳气。服用三次后安静入睡，改用大剂量独参汤加童便，调理数日，频繁给予稀粥而安。
一个人，途中患伤寒，经过苏州，停船求治。询问得知，从渡淮河开始，露宿受寒，恣意饮用烧酒，发热，在京师口服药物，排泄过两次，热势略微减轻，但神昏不语，不时烦扰。见其唇舌赤肿燥裂，给开水喝则咽，不给则不想喝。察其两寸脉飘忽虚大，关脉小弱，按久六脉皆虚，说：这是热传入手少阴经。给予导赤泻心汤，一服后神识稍安宁。停船一天一夜，又进两帖，大小便自知控制。次日早晨解缆再诊，脉静神安，只给小剂量五苓散去掉桂枝换成麦冬，两帖，嘱咐其频繁给予稀粥，可以收功。
吴介臣患伤寒，余热未尽，曲池穴处壅肿，不溃不消，每天发作寒热。外科医生禁止饮食，每天服用消毒清火药，上气形脱，倚息不能卧，渴饮开水一二口，腹胀满急，大便燥结不通。两个月中，用蜜导法四五次，排出非常艰难，形势危急。诊察，其脉初按绷急，按久绝无，这是中气竭尽的征兆，怎么能再承受药力呢？于是令继续进食稀糜，在榻前用鸭子煮之，香气透达，慢慢用汁液啜饮。当天晚上，大便排出很多结粪，喘胀顿时停止，饮食逐渐增加。数日后，肿赤逐渐消退。此时虽然可以进保元汤、独参汤之类，但体力不能支撑，仅靠谷肉调理而安。最近一人过服消导药，胃气告匮，闻谷气则想呕，也用上述方法，不服药而痊愈。
高鼓峰治疗徐五宜的长子，伤寒危重。延请诊治，一会儿有人来说：病人晚上狂叫，晕过去五六次，早起一次晕倒竟然断气，不必去了。问病来几天？说：九天了。又问胸口还热吗？说：胸口只是不冷而已。说：可以救。急忙前往视诊，到了则是僵尸在床上，口鼻无气，面色青黯，口噤目闭，手撒开，唯独嘴唇色紫黑。高笑说：此人不会死，是阴虚证，误服白虎汤所致。切其脉，两尺脉还在，（脉在仍然是厥逆。）于是取人参一两，熟地二两，炮姜五钱，浓煎汤挖开灌之。喝完药后口开，面色转红，不到一时辰，大叫很冷，连续用热汤饮之，即发壮热，全身淋漓汗下而苏醒。这天晚上，腹胀不便。说：不用担心，大汗之后，虚不能出罢了，再饮药一杯，即可解出。次日诸病悉除，但多妄言怒骂，如有鬼神驱使之者。调治数日，至半夜，诊其脉，说：虚到这种地步了吗？又用大剂量附子理中汤、建中汤投之，数日而愈。
杭州朋友沈侨如的外甥，患伤寒。诊其脉，浮数有力，舌黑，胸胁痛胀，这是得之于劳倦，后又伤饮食。（战汗而解，不能单说是饮食劳倦。）医生用寒凉消导药攻之，火受遏抑，无处归依。急忙用大剂量人参、白术、当归、黄芪、炮姜救之。告诫其家人说：半夜当发战，战则汗而解。如战时，频频给粥喝。住在天长寺，四更天时，病家急叩门，说：服药后果然很冷索被，片刻后大热，昏沉而死。先生还有法救吗？说：不必忧虑，汗来了。但战时曾进粥吗？说：实在没有。说：我告诉你，战时必须给粥，要以助胃气，使汗来得快，不至于困乏。现在也无妨，只管回去，此时应当得汗了。果然如所言，睡而安。（与粥助汗，也是仿效张仲景桂枝汤治法。）
张隐庵治疗一个少年，伤寒三四天，头痛发热，胸痛不可忍受。病家说：三天前因吃面条而致病。张说：不对。面食粮食，哪天不吃？这是因为外感风寒，以致内停饮食，不是因为吃面条而导致头痛发热证。所以凡是停食感寒，只宜解表，不可推卸于食积，如果里气一松，外邪即陷入矣。（为庸医说法。）且食停于内，在胸下胃脘间，按之而痛。现在胸上痛不可按，这一定是误下而成结胸。病家说：昨天请某医生，告知吃面条，故用消食药，以致胸中大痛。因诊察其外症尚在，仍用桂枝汤加减，一服而愈。
张令韶治疗一个妇人，患伤寒十多天，手足躁扰，口眼歪斜抽动，面白身冷，谵语发狂，不知人事，形势危笃。其家人以为是风，绑缚其手足。有人以为是痰迷心窍，有人以为是虚，有人以为是寒，有人辞谢不治。张诊察，切其脉全无，问其证不知，按其身不热。张说：这不是人参、附子证，就是大黄、芒硝证，出此入彼，死生立判。因坐视良久，聆听其声重而且长，（也有中焦停食，而奄奄似不属者，也是下之而愈。见缪仲淳治姚平之案。）说：如果是虚寒证，到脉脱之时，气沉沉将绝，哪得有如许力气，大呼疾声，久而不绝？即作大承气汤，牙关紧闭，挖开去齿，药始下咽，黄昏即解黑粪半床。次日早晨脉出身热，人事亦知，舌能伸出而黑，又服小陷胸汤两剂而愈。
一个妇人素有虚弱之症，后患伤寒。一个医生认为是阴虚发热，用滋阴药，命食鸡蛋肥肉，而病更甚。所用皆是玉竹、地骨皮、丹皮、当归、白芍之类，十多天，死症悉具。延请张至，其人已经死了。张请求视诊，气虽绝，而脉尚在且带滑。说：此症不死，乃误服补药，使邪不解，胃络不通，胃家实也。幸正气未败，可治，少顷果苏，（也是因为厥逆的缘故。）用调胃承气汤，一服而结粪解，诸症愈。次日大汗如雨，这是虚象，用人参三钱、黄芪、白术、枣仁各五钱而愈。
一个男子新婚，吐蛔发热。医生认为是阴证，用理中汤，而吐更甚。张诊其脉，缓而长，一日夜吐蛔十余条，认为是风木生虫，湿热相蒸则虫顿然而生，随生随吐，欲用黄连等清湿热之药。不信，复易一医。用当归、白芍、玉竹之类，吐益甚，虫愈多。复延请张，张说：必欲治，非黄连不可。遂用黄连、厚朴、枳实、陈皮、半夏各等分煎服，其吐稍止。再服不吐，神清，虫从大便而出，约数十余，大小不等。后加白术等以补之，即胀不安。共享黄连、枳实二十剂而愈。此乃千百中偶见之症，不可以为常有也。
按语：发热脉缓而长，则是阳明经证。案中只提及治蛔，似乎多有脱略，等待再考证。
陆养愚治疗周两峰，头痛身热，又在舟行遇风，几乎翻船。等到家，胁大痛，耳聋，烦渴谵语。医生来诊，忽然吐血盘许。医生说：两尺不应，寸关弦紧，烦渴谵语，是阳证。弦乃阴脉，张仲景说阳病见阴脉者死，何况两尺乃人之根蒂，现在不起，根蒂已绝，孤阳上越，逼血妄行，据症脉不可为矣。辞去。陆至，血已止而喘定。脉之，两寸关弦而微数，两尺果沉而不起。盖症属少阳，弦数宜矣；胁痛耳聋，亦少阳本症；两尺不起，亦自有故。经云南政之岁，阳明燥金司天，少阴君火在泉，故不应耳。吐血者，因舟中惊恐，血菀而神摄，为热所搏也。谵语者，三阳表症已尽，将传三阴也。先以小柴胡和之，俟坚实而下之，旬日当愈，因与二剂。明日胁痛减，耳微闻，但仍谵语，胸膈满闷，舌上薄黄苔，仍以小柴胡加桔梗、黄连，日服一剂，二日胸膈少宽而苔黑有刺，大便不行约七日矣，乃以润字丸三钱，煎汤送下。至夜，更衣身洁，诸症顿失。后去枳、桔，加归、芍，调理旬日而起。
王野溪患伤寒六七天，已经发表。忽身热烦躁，口渴咽干，大小便利而不任风寒。或用凉膈散，反胸前见斑数十点，色微红。乃投消斑青黛饮，又发谵语，手足厥逆。谓热深之故，拟用承气下之。陆脉之，浮数六七至，按之而空，说：此阴盛格阳证也，下之立毙。《内经·至真要论》说：病有脉从而病反者，何也？岐伯说：脉至而从，按之不散，诸阳皆然。今脉浮之而数，按之而空，乃阳虚为阴所拒，不能内入而与阴交。身热烦躁，口渴咽干，浮阳外越之故也。恶风畏寒，阳气不足也。发斑者，因寒药激之，致无根之火聚于胸中，上熏于肺，传之皮肤也。谵语者，神不守舍也。厥逆者，阳将竭也。若冷至肘膝，则无及矣。此与东垣治冯内翰
Spontaneous recovery. This clearly uses the number of days with fever to determine the period for the resolution of Jue (cold limbs). It also states: If Jue is frequent and fever is rare, the disease progresses; if fever is frequent and Jue is rare, the disease recedes. If Jue has resolved but fever persists for too long, pus and blood in the stool or carbuncles will inevitably occur. If Jue should be treated with purgation but sweating is used instead, oral injury and redness will inevitably result. If Jue appears first followed by fever, diarrhea will stop spontaneously. If Jue reappears, diarrhea returns; if diarrhea stops but sweating and sore throat appear, Bi syndrome of the throat (throat obstruction) will occur. If one can eat during Jue, one must fear Chu Zhong (a false sign of stomach Qi exhaustion); if Jue stops and appetite returns, it indicates that pathogenic factors are retreating and recovery is imminent. All these cases fall under the principle of "deep heat causing deep Jue," and originally did not discuss Yin Jue (cold-type cold limbs). As for diseases of the Yang aspect, if mistaken sweating, vomiting, or purging leads to extreme conditions—such as excessive sweating causing Yang collapse, vomiting and diarrhea accompanied by irritability and cold limbs—the cause is medication error. Without using formulas like Sini Tang (Four Reversal Decoction) or Zhenwu Tang (True Warrior Decoction) to rescue Yang, Yang cannot return. These were originally not prescribed for Yin syndromes. Generally, once Shanghan (Cold Damage) presents with fever and thirst, Yin deficiency must have existed initially. Due to mistreatment, Yang deficiency becomes worse than Yin deficiency. Reluctantly, acrid-hot medicines are used temporarily to rescue Yang first. This differs vastly from pure Yin without Yang, or Yin excess repelling Yang syndromes. Later generations, unaware of the intent behind formula creation, blindly follow established methods, failing to realize that treating Yin syndromes prioritizes rescuing Yang, while treating Shanghan prioritizes rescuing Yin. (This statement is the secret key to treating transmitted syndromes.) Even if Shanghan involves Yang deficiency requiring treatment, one must assess whether the patient's flesh and blood are robust enough to tolerate Yang-tonifying medicines before attempting to restore Yang. If the face is dark, tongue black, body emaciated like dry firewood, and internal pathogenic heat blazes, Yin fluids are exhausted, leaving no Yang to restore. Thus, preserving even a fraction of body fluids and Yuan Qi when addressing Jue and heat is already late; how could one dare to assist Yang by劫 (plundering) Yin? *Zhengzhi Fang* states: If Yin and Yang syndromes are undifferentiated, try Sixun Wan (Six Smooth Pill) first. *Zhizhi Fang* states: If doubt remains, try Lizhong Wan (Regulate the Middle Pill) first. This shows that previously, this critical point was not fully understood; despite deep study, there was no way forward. Therefore, I clarify this for my descendants and inform future practitioners.
Cheng Wuji said: Regarding all Jue, if at onset hands and feet are immediately cold and unwarmed, it is pathogen invading the Yin meridians with insufficient Yang Qi; Sini Tang can be used to warm it. If hands and feet go from hot to warm, or from reversed cold to Jue, it is a transmitted pathogen; Sini San (Four Reversal Powder) is the primary formula. One must recognize this to avoid errors, and differentiate based on external symptoms. I once treated a middle-aged woman with aversion to wind, body heat, and thirst, with a rapid, thin, and weak pulse. She presented with initial Jue followed by fever; warming medicines worsened her condition. Later, Sini San combined with Ginseng and Atractylodes Macrocephala (each 1.5g) cured her Jue immediately, and her pulse became surging and large, leading to recovery.
Commentary: Cheng’s discussion of two types of Jue—Yin meridian invasion and transmitted pathogen—one treated with warming Sini Tang and the other with cooling Sini San—is clear. Yu Chang may not have seen this, hence listing this case here.
Lu Pingshu, a scholar, had a constitution of deficiency and timidity, with sallow complexion. Medicines suitable for him should be warming and tonifying, not cold and clearing, which is standard. In autumn, he contracted San Nüe (tertian malaria), and in early winter, caught an external cold. Although he had chills and fever, they were not severe. Physicians thought it was post-malaria deficiency pathogen, not realizing it was a new excess pathogen. (Old illness compounded by new pathogen easily misleads.) They administered tonics of Ginseng and Atractylodes Macrocephala, causing his breath to become faint. After twenty days, occasionally considered as external contraction, Ren Shen Bai Hu Tang (Ginseng and White Tiger Decoction) was used with no effect. He was dazed and confused, with no clear direction, deemed incurable. Yu Chang examined him, finding the pulse not severely damaged, abdomen not distended, and urination still free, concluding it was treatable. However, continuous muscle twitching raised fear of limb flaccidity. Zhang Zhongjing stated: Twitching muscles eventually lead to flaccidity. Now, after twenty days, blood depletion and tendon dryness are evident. Treatment must address both; outside Zhang’s methods, new approaches are needed. Although Zhang had Da Chai Hu Tang (Major Bupleurum Decoction) for simultaneous exterior-interior resolution, there was no method for flaccidity. (Treating flaccidity focuses on the Yangming channel; clearing Yangming heat cures flaccidity. Moreover, this is acute injury, not chronic depletion.) Modified Fangfeng Tongsheng San (Wind-Protecting Universal Relief Powder) was used, removing Baizhu (Atractylodes Macrocephala). Fangfeng, Jingjie, Bohe, Mahuang, Jiegeng served as exterior herbs; Dahuang, Mangxiao, Huangqin, Lianqiao, Zhizi, Shigao, Huashi served as interior herbs. This resembles Da Chai Hu Tang’s structure, and includes Danggui, Chuanxiong, Baishao to guide herbs into the blood level and unblock meridians. Baizhu was removed because previous use caused error. Two doses were taken that night; the first was tolerated, the second resulted in bowel movement, followed by sleep and slight sweating. Next morning, twitching ceased, but Yangming stomach pulse became more surging. Baihu Tang was used with Shigao and Zhimu (approx. 30g each), followed by Chaihu, Huafen, Huangqin, Huangbai, Lianqiao, Zhizi—a batch of bitter-cold herbs. Over ten doses later, consciousness cleared, diet improved, bedridden status lifted in half a month, walking resumed in one month. Ignoring dietary restrictions caused abdominal pain and diarrhea, resembling deficiency. Yu Chang ignored this, adding Chaihu and Guizhi to moving stagnation herbs to disperse residual pathogen upward, preventing downward flow into dysentery. Then Weirui, Dongtianma, and Maidong were used to harmonize Stomach Qi, with occasional Ginseng (approx. 1.5g). Adhering strictly to principles allowed recovery from near-death.
Xu Guozhen had Shanghan for six to seven days, with body heat, red eyes, seeking water but refusing to drink, extreme restlessness, opening doors/windows wide, lying on the ground, restless, even wishing to enter a well. A panicked physician urgently administered Dachengqi Tang (Major Order the Qi Decoction). Yu Chang found the pulse extremely surging but empty upon heavy pressure. He said: This requires Renshen, Fuzi, and Ganjiang (Ginger). Why treat it as a purgation case? The doctor argued: Body heat and red eyes indicate excess pathogen; such restlessness would cause climbing walls if given Ginger and Aconite. Yu Chang replied: Yang is about to violently collapse, showing false heat externally and true cold internally. Using Ginger and Aconite might barely suffice to restore Yang; how dare we use purely Yin drugs to further deplete Yang? His refusal to swallow water reveals the truth. (Heat in Yangming channel also presents as rinsing mouth without swallowing.) Can one swallow Rhubarb and Mirabilite if one won't even swallow water? Muggy weather brings rain; this patient will sweat profusely and die instantly. If treated as Yang excess with purgation, Jie Xiong (Chest Binding) will form, which is more worrying. Only Ginger and Aconite work, offering both tonification and dispersal, resolving heat and pathogen simultaneously. Fuzi and Ganjiang (15g each), Renshen (9g), Gancao (6g) were decocted and taken cold. Post-ingestion, shivering and teeth chattering occurred; covered with thick cotton, pulling hand away, Yang deficiency signs became apparent. Another dose led to slight sweating, heat reduction, and calm. (This is a Dai Yang syndrome. Unusual but real.)
Zhang Qingzi treated a woman from Tangxi with Shanghan for ten days, fever without sweat. Someone suggested using Jinhuang (Rhubarb) for purgation; the family feared it. Zhang diagnosed: Strong pulse, black tongue with prickles suggests Rhubarb is appropriate. But now the tongue is black, moist, and non-thirsty, indicating Fuzi syndrome. Lack of sweat is due to Qi weakness; Renshen and Huangqi are essential. One dose produced sweat. (*Renhe County Gazetteer*).
Zhang Luyu treated Fan Zhu Shi Qiu, who suffered Shanghan Ying syndrome with three days of unceasing aversion to cold. Two doses of diaphoretics were used. On the seventh day, irritability increased, pulse disappeared, and limbs turned cold. Diagnosis revealed only the left Cun pulse trembling vigorously (Heart governs sweat). Zhang knew this indicated impending Zhan Han (battle sweat). He ordered no medicine, only hot ginger soup to assist sweating. Mistaken medicine would prolong heat. Days later, he thanked Zhang, confirming recovery without medicine. (Treatment of Battle Sweat).
Wu’s son, over twenty, prone to nocturnal emissions, contracted Shanghan in October with headache and cold feet. Diaphoretic and digestive aids failed to resolve confusion and heat despite multiple sweats; wheezing worsened. Another doctor used Mahuang, causing profuse head/face sweating and worsening wheezing. Some attributed it to internal heat, suggesting Huangqin and Huanglian; others to severe Qi deficiency, suggesting Dongchong Xiacao and Dihuang. Dispute ensued. Zhang found six pulses fleeting, nearly imperceptible upon pressure, signaling Yang collapse. Urgent Renshen and Fuzi were needed to restore Yang (Yu Jiayan’s warning against mistreatment causing Yang deficiency). Huayang Fanben Tang (Return Yang Restore Foundation Decoction) was prescribed with Tongbian (Child’s Urine) to consolidate Yang. Three doses brought peace; then large-dose Dushen Tang (Single Ginseng Decoction) with Tongbian restored health over several days with frequent gruel.
A man contracted Shanghan en route, stopping at Suzhou for treatment. He reported exposure to cold while sleeping outdoors after crossing the Huai River, followed by binge drinking liquor. Fever persisted despite two bowel movements and prior medication in Beijing. He was comatose, silent, yet intermittently irritable. Lips and tongue were red, swollen, dry, and cracked; he drank water if offered but refused otherwise. Cun pulses were fleeting and large; Guan pulses small and weak; all pulses empty upon prolonged pressure. Zhang diagnosed: Heat transmitted to Hand Shaoyin channel. Daochi Xiexin Tang was given; one dose calmed consciousness slightly. After two days and two doses, bladder/bowel control returned. Next morning, pulse quiet, spirit calm. Small Wuling San (Five Ling Powder) minus Guizhi plus Maidong was given for two doses, with instructions for frequent gruel. Recovery achieved.
Wu Jiechen had Shanghan with lingering heat, swelling at Quchi point, neither suppurating nor resolving, with daily chills and fever. Surgeons forbade food, prescribing daily detoxifying/clearing herbs. Upper Qi deficiency, emaciation, orthopnea, thirst for small sips of water, abdominal distension, and obstipation developed. Over two months, four honey suppositories yielded little relief; condition critical. Pulse was tense initially but vanished upon pressure, signaling Spleen/Stomach Qi exhaustion. Further medication was impossible. Continued gruel feeding, cooked with duck for aroma, was slowly sipped. That night, significant hard stool passed, wheezing/distension stopped, diet improved. Swelling subsided over days. Although Baoyuan Tang or Dushen Tang were indicated, strength was insufficient; dietary management sufficed. Recently, another patient overusing digestive aids lost Stomach Qi, vomited at smell of food, and recovered similarly without medicine.
Gao Gufeng treated Xu Wuyi’s eldest son, critically ill with Shanghan. Upon arrival, news came: Patient screamed wildly, fainted five-six times, died upon waking. Do not come. Questioned: How many days? Nine. Chest hot? Just not cold. Treatable. Rushed to see corpse-like figure on bed, no breath, blue-black face, clenched jaw, closed eyes, limp hands, purple-black lips. Gao laughed: Not dead. Yin deficiency syndrome, caused by mistaken Baihu Tang. Pulses at Chi positions remained. (Pulse presence indicates Jue.) Renshen (30g), Shudi (60g), Paojiang (15g) were decocted strongly and forced down. Mouth opened, color reddened. Within an hour, complained of intense cold, drank hot soup, developed high fever, profuse sweating, and woke up. That night, abdominal distension and constipation. Don’t worry, post-sweat deficiency prevents evacuation. One more cup of medicine solved it. Next day, all symptoms gone except delirious cursing (spirit unsettled). Several days of regulation, midnight pulse check: Extremely deficient. Large doses of Fuzi Lizhong Tang and Jianzhong Tang cured him.
Hangzhou friend Shen Qiaoru’s nephew had Shanghan. Pulse floating, rapid, forceful; black tongue; chest/hypochondriac pain/distension. Caused by fatigue and dietary injury. (Battle sweat resolution isn't solely due to diet/fatigue.) Doctors used cold/clearing/digestive attacks, suppressing fire, leaving it无处归依 (nowhere to go). Urgent large doses of Renshen, Baizhu, Danggui, Huangqi, Paojiang rescued him. Warned family: Battle sweat will occur at midnight; feed gruel frequently during battle. At Tianchang Temple, 4th watch, family knocked urgently: Severe cold after medicine, then high fever, coma, death. Any hope? No need to worry, sweat is coming. Did you give gruel during battle? No. I told you, gruel aids Stomach Qi for swift sweat without exhaustion. Go home; sweat will come. Indeed, slept peacefully. (Feeding gruel assists sweat, imitating Zhang Zhongjing’s Guizhi Tang method.)
Zhang Yinan treated a youth with Shanghan for 3-4 days, headache, fever, unbearable chest pain. Family blamed noodles eaten three days prior. Zhang disagreed: Noodles are common; this was external cold causing internal food stagnation, not noodle-induced. For food stagnation with cold, release exterior only; do not blame food. If interior Qi loosens, exterior pathogen sinks in. (Critique of mediocre doctors.) Food stagnation causes pain below chest/stomach upon pressure. Current upper chest pain is unpressable, indicating Jie Xiong from mistaken purgation. Family confirmed previous doctor used digestive meds due to noodle story, worsening pain. Exterior signs remained; Guizhi Tang modified cured him in one dose.
Zhanglingshao treated a woman with Shanghan for 10+ days, restlessness, eye/mouth twitching, pale face, cold body, delirium, madness, unconsciousness. Critical. Family bound limbs thinking it was wind. Others suspected phlegm confusing heart, deficiency, or cold. Refused treatment. Zhang found no pulse, no response to questions, no body heat. Said: Either Renshen/Fuzi case or Dahuang/Mangxiao case. Life/death depends on choice. Observed for a while, heard loud, long voice. (Some mid-jiao food stagnation mimics death but responds to purgation, e.g., Miao Zhongchun’s case). If deficiency-cold, Qi would fade silently; why shout loudly and continuously? Prepared Dachengqi Tang. Forced down through clenched teeth. By dusk, half a bed of black stool passed. Next morning, pulse returned, heat appeared, consciousness returned, black tongue extended. Xiao Xianxiong Tang (Small Trap Chest Decoction) for two doses cured her.
A woman with chronic weakness contracted Shanghan. Doctor diagnosed Yin deficiency heat, prescribed Yin-nourishing meds, eggs, fatty meat. Condition worsened. Used Yuzhu, Gubpi, Danpi, Danggui, Baishao for 10+ days; death signs appeared. Zhang arrived after death. Requested examination: Breath stopped, but pulse present and slippery. Said: Not fatal. Mistaken tonics trapped pathogen, blocked Stomach collaterals, causing Stomach excess. Righteous Qi intact, treatable. Soon revived (due to Jue). Tiaowei Chengqi Tang cured hardness and symptoms next dose. Next day, profuse sweat (deficiency sign). Renshen (9g), Huangqi, Baizhu, Suanzaoren (each 15g) cured her.
A newlywed man vomited roundworms with fever. Doctor diagnosed Yin syndrome, gave Lizhong Tang, worsening vomiting. Zhang found slow, long pulse. Vomited 10+ worms overnight. Diagnosed Wind-Wood generating worms, damp-heat steaming them. Proposed Huanglian to clear damp-heat. Disbelieved. Changed doctor. Used Danggui, Baishao, Yuzhu, worsening vomiting and worm count. Zhang insisted on Huanglian. Huanglian, Houpo, Zhishi, Guangpi, Banxia (equal parts) stopped vomiting. Second dose: no vomiting, clear spirit, worms passed in stool (dozens, varying sizes). Added Baizhu etc. for tonification, causing bloating. Total 20 doses of Huanglian/Zhishi cured him. Rare case, not common.
Commentary: Fever with slow-long pulse indicates Yangming channel syndrome. Case focuses on worm treatment, seemingly incomplete; await further verification.
Lu Yangyu treated Zhou Liangfeng with headache, fever, capsizing incident. Arrived home with severe hypochondriac pain, deafness, irritability, thirst, delirium. Doctor diagnosed sudden massive hematemesis. Pulse: Chi absent, Cun/Guan wiry-tight. Irritability/thirst/delirium = Yang syndrome. Wiry = Yin pulse. Zhang Zhongjing: Yang disease with Yin pulse dies. Chi is root; absent root means isolated Yang floating up, forcing blood out. Incurable. Left. Lu arrived, bleeding stopped, breathing stabilized. Pulse: Cun/Guan wiry-slight rapid; Chi sunken-absent. Syndrome belongs to Shaoyang; wiry-rapid fits. Hypochondriac pain/deafness are Shaoyang basics. Chi absence due to year factors: Yangming Dry Metal ruling Heaven, Shaoyin Minister Fire ruling Earth, hence absent. Hematemesis from fright/shock in boat, blood pooling, spirit grasped, heat forcing it. Delirium: Three Yang exterior signs exhausted, transmitting to Three Yin. Started with Xiaochaihu Tang to harmonize, wait for solidity then purge. Expected cure in 10 days. Two doses given. Next day, pain reduced, hearing improved, but delirium persisted, chest fullness, thin yellow coating. Xiaochaihu Tang + Jiegeng, Huanglian daily. Two days later, chest relieved, coating black-prickly, no stool for 7 days. Runzi Wan (3g) with decoction given. Night: Bowel movement, clean body, symptoms vanished. Removed Zhiji/Jiejeng, added Danggui/Baishao, regulated 10 days to rise.
Wang Yexi had Shanghan 6-7 days, released exterior. Suddenly fever, irritability, thirst, dry throat, loose stools, intolerance to wind/cold. Used Liangge San, developed few red spots on chest. Given Xiaoban Qingdai Yin, developed delirium, cold limbs. Attributed to deep heat, planned Chengqi purgation. Lu found pulse floating-rapid (6-7 beats), empty upon pressure. Said: Yin excess repelling Yang. Purgation leads to instant death. *Neijing* says: Pulse follows but disease reverses? Qibo: Pulse follows, pressure doesn't scatter, all Yang similar. Now floating-rapid, empty-pressure, Yang deficiency rejected by Yin, unable to enter/yin-yang interaction. Fever/irritability/thirst/dry throat = floating Yang escaping. Aversion to wind/cold = Yang insufficiency. Spots = cold herbs stimulating rootless fire gathering in chest, steaming lungs/skin. Delirium = spirit not dwelling. Cold limbs = Yang exhausting. If cold reaches elbows/knees, too late. This matches Dongyuan’s treatment of Hanlin Feng...