之侄目赤烦渴，王海藏之治侯辅之发斑谵语同例。一用真武，一用理中，此先哲之成验，后学不知取法耳。急
用大料参、术、姜、附峻补回阳，麦冬、五味、甘草、白芍敛而和之，浓煎俟冷，徐徐服之，日夜令药不断。
三日夜病势始减，旬日后稍加减之，月余而起。
吴子玉病发热，头痛腰疼，烦躁，口渴无汗。有主麻黄汤者，有主羌活冲和汤者。脉之，阳部浮数而不甚
有力，阴部沉弱而涩，谓曰∶此症此脉，有两感之象，必重有所用力，兼之房劳而得者，不可轻汗，宜先投补
剂，托住其气血，待日期而汗之。或曰∶太阳症而用补，仲景有此治法乎？曰∶虽无此治法，而未尝无此论。
太阳症宜汗，假令尺中迟，不可发汗。何以知之？以荣气不足，血少故也。今寸脉浮数而无力，表症不甚急，
尺脉沉弱而涩，则里虚可知。伤寒有失汗而传里者，亦有误汗而传里者，此症是矣。众不决，姑服羌活冲和汤，
一日夜二剂，前症俱剧，仍不得汗。拟麻黄者，以药轻病重，欲大汗之。陆曰∶若服麻黄汤，亡阳谵语即见，
毙可立俟也。乃用补气养荣汤二剂，病未减，亦不剧。诊之，寸关如故，两尺稍有神。再二剂，又约一日夜，
方以参苏饮微汗之，汗后诸症悉愈。（通人之论，所谓凡病必有两面也。）
凌东阳患伤寒，已经汗下，身体外不热，扪之则热极，不能食而饥不可忍，及强进稀粥，即胀不可任，必
用力揉之一二时，始下大腹，甫下，又饥不能支，大便五六日不行，而少腹不硬满。医以汗下体凉，而用开胃
养血顺气剂，病日甚。诊之，两寸关浮数，两尺沉数有力，曰∶此蓄血症也。因下之太早，浊垢虽去，邪热尚留，
致血结成瘀。胃中饥甚者，火也。食即胀者，邪热不杀谷也。揉下仍饥者，胃中空涸，邪热尚在也。法宜清上
焦之热，去下焦之瘀，而后议补。或曰∶许学士谓血在上则喜忘，血在下则发狂，今云瘀血，何以无此症也？
曰∶成无己固深于伤寒者也，谓不大便六七日之际，无喜忘如狂之症，又无少腹硬满之候，何以知其有蓄血？
盖以脉浮数故也。浮则热客于气，数则热客于血，下后浮数俱去，则病已。如数去而浮仍在，则邪热独留于卫，
善饥而不杀谷，潮热及渴也。浮去而数仍在，则邪独留于荣，血热下行，血得泄必便脓血。若大便六七日不行，
血不得泄，必蓄在下焦而为瘀，须以抵当汤下之，此前贤之成案也。乃用淡盐汤送抵当丸三钱，取咸走血之意，
以去荣中之结热；随浓煎人参汤，调凉膈散五钱，以去卫中之结热。用人参汤者，病久数下，恐元气不能支也。
如此两日，结血去，浮热解，饮食进。后以清气养荣汤，调理旬日而愈。
汤二老病伤寒，已发汗矣。后忽下利身热，头痛昏愦。或谓合病下利，复用解肌发表药，反增剧，自汗恶
风。或谓阴虚，用理中合四物，遂不眠，妄见，躁烦谵语。或云此协热下利也，用白头翁汤二剂，病略可。数
日，诸症不减，四肢厥逆。脉之，浮按散大而数，沉按细数而有力，曰∶向云协热者是也，第宜调胃承气汤下
之，不当止用白头翁汤耳。或云∶下利厥逆，可复下乎？曰∶《内经》云，塞因塞用，通因通用。王太仆云，大
热内结，淫泻不止，热宜寒疗，结热自除。以寒药下之，结散利止，此通因通用之法也。又仲景云，下利谵语，
有燥屎也。厥逆者，热深厥亦深也，承气下之。第此症初见时，下之即愈，今日数已久，元气将脱，不得竟下，
因用人参二钱，浓煎送润字丸五钱。半日许，出燥屎数十枚，利减半，手足稍温。第昏沉更甚，问之不语，左
脉微浮略数，右脉少沉微数无力，再用人参五钱，浓煎，送润字丸二钱。少时，又去燥屎数枚，溏便少许，遂
能语，索食，稀粥与之。次日，身凉神爽。后用调养气血，少佐清热之品，旬日渐愈，而大便常结，用八物倍
生地，月余而瘳。
陆肖愚治臧苕泉，患伤寒，发热鼻燥，口干呕恶，胸胁痛满，小水短赤，大便泻利。或投柴芩汤，反增头
痛如破，彻夜不寐，已三日。脉之，左弦右洪，寸关数，两尺稍和，以柴葛解表为君，黄芩、石膏、知母清腑
为臣，枳、桔宽中为佐，竹茹、甘草平逆为使，一日二剂，呕止痛减。热仍未退，卧仍未安，溺赤便泻如故，
因去知母、黄芩、竹茹，倍柴、葛，加生姜五片，亦一日二剂，热退安卧，泻亦止矣。口尚微渴，以花粉、麦
冬、甘草、陈皮、黄芩、桔梗、枳壳扶元气，清余热。四帖已而安。后十余日，复身热谵语，如见鬼状，舌
黑有刺，大便三日不行，日轻夜重，脉沉有力，两尺带弦，用枳实、黄连、蒌仁、桃仁、白芍、槟榔、元明粉
二剂，诸症悉减。而大便未行，用桃仁十枚煎汤，下润字丸一钱五分，全愈。后以清气养荣汤调理之。（此少阳
阳明证，初治不误，以表力未至，故余证如故。去知母、黄芩太骤，故表解后变为里证，待下而后愈。桔梗、
枳壳，亦未合法。）
吴煦野子，年二十三，精神素旺。清明自馆中归，有房事，五更小解，忽脐下作痛，肠中雷鸣，小便不利，
明日遂发寒热头痛。医来，告以酒后犯远归之戒，医疑是阴症伤寒，以理中汤二剂，令一日夜服之。次日，呕
逆大作，烦躁口渴，饮食不进，昼夜不卧，已三日矣。诊之，其脉左弦右洪，寸关有力，尺部尚和，面赤戴阳，
乃与柴葛解肌二剂。病家因述远归阴虚，投理中不减，咸拟倍加参、附。陆曰∶脉症俱阳，纵有房事，阴未尝
虚，若再投参、附，不可为矣。令今夜必服此二剂，庶不传里。病者心虚，止服一剂。明早诊之，症不增剧，
脉仍洪大，并两尺亦大，曰∶热邪已入腑，日晡必剧。以白虎汤二剂与之，病者犹豫。谓曰∶今日怕石膏，明
日大黄也怕不得。延挨未服，而烦渴躁热大作，且有谵语，遂连进二服。热略不减，再以前方二剂与之。至五
更，始得少睡。早间诊视，两尺沉实，舌苔已浓，改用小陷胸汤送润字丸一钱。至晚，又进一钱，夜半出燥屎
数十枚，热减泻止。又服枳实、黄连至数十剂。少用滋补，即痞隔，饮食不能进。调治二月，方得全愈。（面赤，
胃火上炎，非尽阴虚阳格也。）
陆祖愚治顾玉岩，年六十，患伤寒。服药头疼骨痛已除，身热烦躁，兼发赤斑而狂。诊之，六脉沉数有力，
目瞪直视，噤不出声，舌黑芒刺，四肢冰冷。询其大便，二十日不行。谓年虽高，脉尚有神，力任无事。投以
大承气汤，目闭昏沉，咸谓决死。一二时顷，腹中鸣响，去燥屎若干，诸症脱然，仅存一息，改用人参、麦冬、
归、芍、 、术，调理而安。
吴开之，二月间患头痛身热，服药已逾旬日矣。忽耳后红肿作痛，大发寒热。或以为毒，用花粉、连翘解
表，数剂不效。或以为痰核，用南星、半夏，数剂反甚，胸胁满痛，饮食不进，气喘而粗，夜卧不安。脉之，
两寸关弦数，两尺和。此本伤寒少阳之邪不解，所以发颐。耳之前后上下，乃少阳部分，寸关弦数，亦少阳不
和之脉，宜小柴胡汤和解之。用软柴胡七钱，干葛、黄芩各三钱，生甘草、桔梗、苏子、白芥子各一钱，姜、
枣煎服，二剂喘定，四剂肿痛全消而愈。
治陈湖一男子，患伤寒，仰卧一月，且耳聋。意其病尚在少阳，故胁痛不能转侧及耳聋也。与小柴胡汤加
山栀，一剂即能转，尾闾处内溃皆蛆，耳亦有闻。盖少阳属风木，而风木能生虫也。
一卒伤寒，大小便不通，予与五苓散而皆通。五苓固利小便矣，而大便亦通者，津液生故也。或小便通而
大便尚不通，宜用蜜煎法导。
施秘监尊人，患伤寒咳甚，医告技穷。试检《针经》于结喉下灸三壮，即瘥。盖天突穴也，神哉。（《资生经》。）
《华佗传》府吏倪寻、李延，二人俱头痛身热，所苦正同。佗曰∶寻当下之，延当发汗。或难其异。佗
曰∶寻外实，延内实，故治宜殊。即各与药，明旦并起。（《三国志》。）
《范汪方》云∶故督邮顾子献，得病已瘥，诣华佗视脉，曰∶尚虚未复，勿为劳事，御内即死，临死吐舌数
寸。其妻闻其病除，从百余里来省之，止宿交接，中间三日，发病如佗言。妇人伤寒虽瘥，未满百日，气血骨
髓未牢实，而合阴阳，当时即不觉恶。经日则令百节解离，经络缓弱，气血虚衰，骨髓空竭，恍恍吸吸，气力
不足，着床不能动摇，起居仰人，食饮如故，是其症也。丈夫亦然。
有士盖正者，疾愈后六十日，已能射猎，一犯房室，即吐涎而死，及热病房室，名为阴阳易，皆难治。近
者有一士大夫，小得伤寒，瘥已十余日，能乘马行，自谓平复，亦以房室后，即小腹急痛，手足拘挛而死。
妇人温病虽瘥，未平复，血脉未和，尚有热毒，而与之交接得病者，名为阴阳易。医者张苗说∶有婢得病，
瘥后数日，有六人奸之，皆为所误。
林观子父，因积寒腹痛，以痧症治之而愈。数日后，神思郁结，胸腹不快，每日食粥二三次，大便溏，日
二三行。杂治二旬余，渐剧。后一医诊之曰∶伤寒之邪尚在，何误至此也。服小柴胡八剂，别下结粪十数枚而
安。此亦脏结之类，所谓饮食如故，时时下利也。（观子注《伤寒折衷》。）
吴仁斋治一人，伤寒十余日，脉沉细，手温而足冷，大便不通，面赤，呕，烦渴，药不能下，惟喜凉水一
二口，或西瓜一块，食下良久吐出。此阴甚于内，逼其浮阳上冲咽嗌，故面赤烦呕也。附子一枚，去皮尖切片，
又以人参三钱，炮姜二钱，水煎取，浸冷水中，待冷，服之而愈。
一人伤寒七八日，服凉药太过，遂变身凉，手足厥冷，通身黑斑，惟心头温暖，乃伏火也。六脉沉细，昏
不知人，不能言语，状如尸厥，遂用人参三白汤，加熟附子半个，干姜二钱。服下一时许，斑渐红，手足渐
暖，苏矣。数日复有余热不清，此伏火未尽，再用黄连解毒、竹叶石膏汤，调治而安。
马元仪治沈某，发热七月，神昏谵语，中州结块高突，拒按作痛。诊之，右脉虚微，左见弦涩，此正
气夺而邪气盛也。症实脉虚，法在不治。不得已，必先补后攻，庶几万一，与人参、桂枝、炮姜、半夏、
枳实、浓朴、广皮补正散结。脉稍起，再附子加桂理中汤，以恢复元气。二剂，右脉已透。四剂，两脉有
神，而前症犹在，中痛转甚，时众议交沮。盖此症原有积滞可攻，两日用药专行温补者，全是顾虑元气，
若早下之，必先脱矣。今已补完胃气，即可施治实之法也。以人参三钱，大黄五钱，浓朴一钱，枳实一钱，
桂枝五分，服未一时，大便连行三次，其块如失，诸症悉平。次与调理脾肾而愈。（藜按∶凡治实症，当
顾其虚处，此案是也。）
卜晋公患伤寒，数日面赤躁烦，手足搐搦，起卧转侧不安，口燥渴，大便结。或用清火发散，俱不应。诊
其脉，虚涩兼结。夫涩则伤阴，结则气滞。得之忧思劳郁，肺胃受伤，津液亏而虚邪结也。散邪清火，适所以
耗其阴，而留其邪耳。治法必须大剂滋解乃可，用栝蒌实一两，紫菀三钱，枳壳、桔梗各一钱，秦艽一钱，杏
仁、苏子、半夏曲等，一剂，便得大睡身安，调理数日而愈。
鲍坤浓病经半月，两寸独鼓，两关尺虚微，头痛如斧劈，汗出不止，谵语神昏。曰 ∶寸大尺小，为上盛下
虚之候。况头痛如破者，虚阳上僭也；汗出不止者，虚阳外散也；谵语神昏者，孤阳气浮，神失其守也。非人
参、附子，无以追散失之元气；非童便、猪胆、葱白，无以通僭逆之阳气。法当用白通汤以急救之。时夜半，
特宰猪取胆，比药成，牙关紧急，不知人事，乃挖而灌之。黎明，神气渐清，此阳气已渐归原，但欲其深根固
蒂，非大剂温补不可，用人参四两，附子二两，肉桂五钱，合附子理中汤法，连投数剂，痛定汗止，调理而安。
一人伤寒六日，两脉微弱不起，面垢遗尿，自汗谵语，身重不能转侧。此三阳合病，汗、下两不可用。仲
景云∶腹满身重，口不仁而面垢，谵语遗尿，自汗者，白虎汤主之。盖三阳合邪，至遗尿谵语，其中州扰乱，
真气与津液并伤可知。故仲景复云∶发汗则谵语，下之则额上生汗，手足逆冷。以汗则偏于阳，而津液益伤；
下则偏于阴，而真气复损。惟白虎一法，解热而不碍表里。但三阳病，其脉当浮大，而反微弱不起者，以邪热
郁遏不得外达，非阳衰脉微之比，但清其壅热，而脉自起矣。用大剂白虎，一服便得大睡，再剂神清脉起。与
补虚清热而痊。
张氏子伤寒四五日，两脉虚微，神气昏乱，烦躁不宁，时欲得水，复置不饮，弃衣而走，勇力倍常，言语
狂妄，不避亲疏。此阴盛格阳欲脱，外假热内真寒也，欲与理中汤。咸谓火热有余之症，欲行寒下。曰∶岂有
大热症而不引水自救者？况两脉微弱，明属阴盛阳微，若不急与温补，大汗一至，不可为矣。前方加人参至四
两，煎成冷服。一二时许，狂乱顿止，反见寒栗，欲覆重被，再与前药一剂，神清热退而安。
我的侄子眼睛发红、心烦口渴，王海藏治疗侯辅之出现发斑和说胡话的病例属于同一类型。一个用真武汤，一个用理中汤，这是先贤的成功经验，只是后辈学者不知道效法罢了。急忙使用大剂量的党参、白术、干姜、附子峻补以回阳救逆，配合麦冬、五味子、甘草、白芍收敛并调和药性，浓煎后等待冷却，慢慢服用，日夜让药效不断绝。经过三昼夜，病势才开始减轻，十天后稍作加减调整，一个多月后痊愈。
吴子玉患病发热，头痛腰痛，烦躁，口渴无汗。有人主张用麻黄汤，有人主张用羌活冲和汤。诊脉发现，寸部（阳部）浮数但不是很有力，尺部（阴部）沉弱且涩。我说：这个症状和脉象，有“两感”（表里同病）的迹象，一定是因为过度劳累，加上房事不节而导致的，不可以轻易发汗，应该先投用补益剂，托住气血，等到时机成熟再发汗。有人说：太阳病应当用汗法，张仲景有这样的治法吗？我说：虽然仲景没有明确列出这种治法条文，但并非没有相关论述。太阳病适宜发汗，假如尺中脉迟，就不可以发汗。怎么知道的呢？因为营气不足，血少的原因。现在寸脉浮数而无力，表证并不紧急，尺脉沉弱而涩，那么里虚就可以知道了。伤寒有因失于发汗而传入里的，也有因误发汗而传入里的，这个病症就属于后者。众人犹豫不决，暂且服用羌活冲和汤，一天一夜服了两剂，前面的症状都加重了，仍然没有出汗。主张用麻黄汤的人，是因为药力轻而病重，想要通过大汗来解表。陆氏说：如果服用麻黄汤，亡阳谵语的症状就会立即出现，死亡就在眼前了。于是改用补气养荣汤两剂，病情没有减轻，也没有加重。再诊脉，寸关脉如故，两尺脉稍微有了神气。又服两剂，大约过了一天一夜，才用参苏饮微微发汗，汗出之后所有症状全部痊愈。（通达之人的议论，所谓凡是疾病都有两面性。）
凌东阳患伤寒，已经经过发汗和攻下治疗，身体外部摸起来不热，但一摸就觉得热极，不能进食却饥饿得难以忍受，勉强吃稀粥，就腹胀得无法忍受，必须用力揉搓一两个小时，才能排出大便，刚排完，又饥饿得支撑不住，大便五六天不通行，但小腹部不硬满。医生认为经过汗下治疗后身体变凉，便使用开胃养血顺气的药剂，病情日益严重。诊脉发现，两寸关脉浮数，两尺脉沉数有力。我说：这是蓄血症。因为攻下太早，浊垢虽然去了，但邪热还留着，导致血液凝结成瘀。胃中极度饥饿，是火旺的表现。吃东西就胀，是邪热不能消化食物（不杀谷）。揉搓排便后仍然饥饿，是因为胃中空虚枯竭，邪热还在。治疗方法应当清除上焦的热，去除下焦的瘀血，然后再考虑补益。有人说：许学士说血在上则健忘，血在下则发狂，现在说是瘀血，为什么没有这些症状呢？我说：成无己确实精通伤寒，他说在大便不通六七天之际，如果没有健忘或发狂的症状，又没有小腹部硬满的征候，怎么知道有蓄血呢？大概是因为脉浮数的缘故。浮表示热客居在气分，数表示热客居在血分。攻下之后浮数和脉象都消失了，病就好了。如果数脉消失而浮脉仍在，那么邪热独留在卫分，表现为善饥但不消化食物，潮热和口渴。如果浮脉消失而数脉仍在，那么邪热独留在营分，血热下行，血液得到宣泄必然会出现便脓血。如果大便六七天不通行，血液得不到宣泄，必然蓄积在下焦形成瘀血，需要用抵当汤攻下，这是前人的成功案例。于是用淡盐汤送服抵当丸三钱，取咸味入血的用意，以去除营分中的结热；随即浓煎人参汤，调服凉膈散五钱，以去除卫分中的结热。用人参汤的原因，是因为病久多次攻下，恐怕元气不能支撑。这样过了两天，结血去除了，浮热解除了，饮食进来了。后来用清气养荣汤调理十天而痊愈。
汤二老患伤寒，已经发过汗了。后来突然腹泻伴有身热，头痛昏沉。有人说这是合病下利，再用解肌发表的药，反而加重，出现自汗恶风。有人说这是阴虚，用理中汤合四物汤，结果导致不眠、幻视、躁烦说胡话。有人说这是协热下利，用白头翁汤两剂，病情略微好转。几天后，各种症状不减，四肢厥冷。诊脉，轻按散大而数，重按细数而有力。我说：先前说是协热下利是对的，只宜用调胃承气汤攻下，不应当只用白头翁汤。有人说：腹泻且四肢厥冷，还可以再次攻下吗？我说：《内经》说，塞因塞用，通因通用。王太仆说，大热内结，淫泻不止，热应当用寒法治，结热自然消除。用寒药攻下，结散利止，这就是通因通用的方法。另外张仲景说，腹泻说胡话，是有燥屎。四肢厥冷，是热深厥亦深，应用承气汤攻下。只是这个病症在初见时，攻下就能痊愈，今天日子已久，元气将要脱失，不能直接攻下，因此用党参二钱，浓煎送服润字丸五钱。半天左右，排出几十枚燥屎，腹泻减半，手脚稍微变暖。只是昏沉更严重了，问他不说话，左脉微浮略数，右脉稍沉微数无力，再用党参五钱，浓煎，送服润字丸二钱。不久，又排出几枚燥屎和少许溏便，于是能说话了，索要食物，给他喝稀粥。第二天，身凉神爽。后用调养气血，稍加清热药物，十天逐渐痊愈，但大便常结，用八物汤倍加生地黄，一个多月才好。
陆肖愚治疗臧苕泉，患伤寒，发热鼻干，口干呕吐恶心，胸胁痛满，小便短赤，大便泻利。有人投用柴芩汤，反而增加头痛如破，彻夜不眠，已经三天了。诊脉，左弦右洪，寸关数，两尺稍和。以柴葛解肌汤为君药，黄芩、石膏、知母清腑热为臣药，枳壳、桔梗宽中为佐药，竹茹、甘草平逆为使药，一天两剂，呕吐停止疼痛减轻。热仍未退，卧睡仍不安，尿赤便泻如故，于是去掉知母、黄芩、竹茹，加倍柴胡、葛根，加生姜五片，也是一天两剂，热退安卧，腹泻也停止了。口尚微渴，用天花粉、麦冬、甘草、陈皮、黄芩、桔梗、枳壳扶助元气，清余热。四帖后已安。十多天后，再次身热说胡话，像看见鬼一样，舌黑有刺，大便三天不行，白天轻晚上重，脉沉有力，两尺带弦，用枳实、黄连、瓜蒌仁、桃仁、白芍、槟榔、元明粉两剂，所有症状都减轻。但大便未行，用桃仁十枚煎汤，送服润字丸一钱五分，完全痊愈。后用清气养荣汤调理。（这是少阳阳明证，初治没有错误，但因为表邪力量未到，所以余症依旧。去掉知母、黄芩太急躁，所以表解后变为里证，等待攻下后才愈。桔梗、枳壳的使用，也不符合法度。）
吴煦野的儿子，二十三岁，精神素来旺盛。清明时节从馆舍回家，有房事，五更时小便，忽然脐下作痛，肠中雷鸣，小便不利，第二天就发寒热头痛。医生来，告诉他酒后犯远归的禁忌，医生怀疑是阴症伤寒，用理中汤两剂，令一天一夜服完。第二天，呕吐逆气大作，烦躁口渴，饮食不进，昼夜不卧，已经三天了。诊脉，其脉左弦右洪，寸关有力，尺部尚和，面赤戴阳（虚阳上浮），于是给予柴葛解肌汤两剂。病人家属因为叙述远归阴虚，投用理中汤不减，大家都打算加倍加入参、附子。陆氏说：脉症都是阳证，纵然有房事，阴也未尝虚，如果再投参、附子，就无法挽回了。命令今晚必须服这两剂，或许不会传里。病人心里虚弱，只服了一剂。第二天早上诊脉，症状没有加重，脉仍洪大，连两尺脉也大了。我说：热邪已经进入腑，傍晚时分一定会加剧。给予白虎汤两剂，病人犹豫。我说：今天怕石膏，明天大黄也怕不得。拖延没服，而烦渴躁热大作，且有说胡话，于是连续进服两剂。热略有不减，再用前方两剂。到五更，才开始睡了一点觉。早上诊视，两尺沉实，舌苔已厚，改用小陷胸汤送服润字丸一钱。到了晚上，又进一钱，半夜排出几十枚燥屎，热减泻止。又服枳实、黄连至几十剂。稍用滋补，就会痞隔，饮食不能进。调理两个月，才得全愈。（面赤，是胃火上炎，不完全是阴虚阳格。）
陆祖愚治疗顾玉岩，六十岁，患伤寒。服药后头疼骨痛已除，身热烦躁，兼发赤斑而狂。诊脉，六脉沉数有力，目瞪直视，咬牙不出声，舌黑芒刺，四肢冰冷。询问其大便，二十天不行。说年纪虽高，脉尚有神，能够胜任治疗。投以大承气汤，目闭昏沉，大家都认为必死无疑。一两个时辰后，腹中鸣响，排出若干燥屎，诸症突然解除，仅存一口气，改用人参、麦冬、当归、白芍、茯苓、白术，调理而安。
吴开之，二月间患头痛身热，服药已超过十天了。忽然耳后红肿作痛，大发寒热。有人以为是毒，用天花粉、连翘解表，数剂无效。有人以为是痰核，用南星、半夏，数剂反而加重，胸胁满痛，饮食不进，气喘而粗，夜卧不安。诊脉，两寸关弦数，两尺和。这本来是伤寒少阳之邪不解，所以发颐（腮腺炎类疾病）。耳之前后上下，乃少阳部分，寸关弦数，也是少阳不和之脉，宜用小柴胡汤和解。用软柴胡七钱，干葛、黄芩各三钱，生甘草、桔梗、苏子、白芥子各一钱，姜、枣煎服，两剂喘定，四剂肿痛全消而愈。
治疗陈湖一男子，患伤寒，仰卧一个月，且耳聋。推测病尚在少阳，所以胁痛不能转侧及耳聋。给予小柴胡汤加山栀，一剂即能转动，尾闾处内溃皆蛆虫，耳朵也能听见了。盖少阳属风木，而风木能生虫也。
一名士兵患伤寒，大小便不通，我给予五苓散而大小便皆通。五苓固然是利小便的，而大便也通的原因是津液生了。或者小便通而大便尚不通，宜用蜜煎法导引。
施秘监的父亲，患伤寒咳嗽厉害，医生告技穷。试着检查《针经》，在结喉下灸三壮，即痊愈。那是天突穴，神奇啊。（《资生经》。）
《华佗传》记载府吏倪寻、李延，二人俱头痛身热，所苦正同。华佗说：倪寻当下之（攻下），李延当发汗。有人质疑为何不同。华佗说：倪寻外实，李延内实，所以治疗适宜不同。即各给药物，第二天早晨都起来了。（《三国志》。）
《范汪方》云：原督邮顾子献，得病已瘥，诣华佗视脉，说：尚虚未复，勿为劳事，御内（行房事）即死，临死吐舌数寸。其妻听说他病好了，从百余里外来探望，住宿交接，中间三日，发病如华佗所言。妇人伤寒虽瘥，未满百日，气血骨髓未牢实，而合阴阳，当时即不觉恶。经日则令百节解离，经络缓弱，气血虚衰，骨髓空竭，恍恍吸吸，气力不足，着床不能动摇，起居仰人，食饮如故，是其症也。丈夫亦然。
有士人叫盖正者，疾愈后六十日，已能射猎，一犯房室，即吐涎而死，及热病房室，名为阴阳易，皆难治。近来有一士大夫，小得伤寒，瘥已十余日，能乘马行，自谓平复，亦以房室后，即小腹急痛，手足拘挛而死。
妇人温病虽瘥，未平复，血脉未和，尚有热毒，而与之交接得病者，名为阴阳易。医者张苗说：有婢女得病，瘥后数日，有六人奸之，皆为所误。
林观子的父亲，因积寒腹痛，以痧症治之而愈。数日后，神思郁结，胸腹不快，每日食粥二三次，大便溏，日二三行。杂治二旬余，渐剧。后一医诊之说：伤寒之邪尚在，何误至此也。服小柴胡八剂，别下结粪十数枚而安。这也是脏结之类，所谓饮食如故，时时下利也。（观子注《伤寒折衷》。）
吴仁斋治疗一人，伤寒十余日，脉沉细，手温而足冷，大便不通，面赤，呕，烦渴，药不能下，惟喜凉水一二口，或西瓜一块，食下良久吐出。此阴甚于内，逼其浮阳上冲咽嗌，故面赤烦呕也。附子一枚，去皮尖切片，又以人参三钱，炮姜二钱，水煎取汁，浸冷水中，待冷，服之而愈。
一人伤寒七八日，服凉药太过，遂变身凉，手足厥冷，通身黑斑，惟心头温暖，乃伏火也。六脉沉细，昏不知人，不能言语，状如尸厥，遂用人参三白汤，加熟附子半个，干姜二钱。服下一时许，斑渐红，手足渐暖，苏醒过来。数日复有余热不清，此伏火未尽，再用黄连解毒汤、竹叶石膏汤，调治而安。
马元仪治疗沈某，发热七月，神昏谵语，中州结块高突，拒按作痛。诊脉，右脉虚微，左见弦涩，这是正气夺而邪气盛也。症实脉虚，法在不治。不得已，必先补后攻，庶几万一，与人参、桂枝、炮姜、半夏、枳实、浓朴、广皮补正散结。脉稍起，再附子加桂理中汤，以恢复元气。两剂，右脉已透。四剂，两脉有神，而前症犹在，中痛转甚，时众议交沮。盖此症原有积滞可攻，两日用药专行温补者，全是顾虑元气，若早下之，必先脱矣。今已补完胃气，即可施治实之法也。以人参三钱，大黄五钱，浓朴一钱，枳实一钱，桂枝五分，服未一时，大便连行三次，其块如失，诸症悉平。次与调理脾肾而愈。（藜按：凡治实症，当顾其虚处，此案是也。）
卜晋公患伤寒，数日面赤躁烦，手足搐搦，起卧转侧不安，口燥渴，大便结。或用清火发散，俱不应。诊其脉，虚涩兼结。夫涩则伤阴，结则气滞。得之忧思劳郁，肺胃受伤，津液亏而虚邪结也。散邪清火，适所以耗其阴，而留其邪耳。治法必须大剂滋解乃可，用栝蒌实一两，紫菀三钱，枳壳、桔梗各一钱，秦艽一钱，杏仁、苏子、半夏曲等，一剂，便得大睡身安，调理数日而愈。
鲍坤浓病经半月，两寸独鼓，两关尺虚微，头痛如斧劈，汗出不止，谵语神昏。说：寸大尺小，为上盛下虚之候。况头痛如破者，虚阳上僭也；汗出不止者，虚阳外散也；谵语神昏者，孤阳气浮，神失其守也。非人参、附子，无以追散失之元气；非童便、猪胆、葱白，无以通僭逆之阳气。法当用白通汤以急救之。时夜半，特宰猪取胆，比药成，牙关紧急，不知人事，乃挖而灌之。黎明，神气渐清，此阳气已渐归原，但欲其深根固蒂，非大剂温补不可，用人参四两，附子二两，肉桂五钱，合附子理中汤法，连投数剂，痛定汗止，调理而安。
一人伤寒六日，两脉微弱不起，面垢遗尿，自汗谵语，身重不能转侧。此三阳合病，汗、下两不可用。张仲景说：腹满身重，口不仁而面垢，谵语遗尿，自汗者，白虎汤主之。盖三阳合邪，至遗尿谵语，其中州扰乱，真气与津液并伤可知。故仲景复说：发汗则谵语，下之则额上生汗，手足逆冷。以汗则偏于阳，而津液益伤；下则偏于阴，而真气复损。惟白虎一法，解热而不碍表里。但三阳病，其脉当浮大，而反微弱不起者，以邪热郁遏不得外达，非阳衰脉微之比，但清其壅热，而脉自起矣。用大剂白虎，一服便得大睡，再剂神清脉起。与补虚清热而痊。
张氏儿子伤寒四五日，两脉虚微，神气昏乱，烦躁不宁，时欲得水，复置不饮，弃衣而走，勇力倍常，言语狂妄，不避亲疏。这是阴盛格阳欲脱，外假热内真寒也，欲与理中汤。大家都认为是火热有余之症，欲行寒下。说：岂有大热症而不引水自救者？况两脉微弱，明属阴盛阳微，若不急与温补，大汗一至，不可为矣。前方加人参至四两，煎成冷服。一二时许，狂乱顿止，反见寒栗，欲覆重被，再与前药一剂，神清热退而安。
My nephew suffered from red eyes, vexation, and thirst. Wang Haizang's treatment of Hou Fuzhi, who presented with macules (skin eruptions) and delirium, was of the same category. One used Zhenwu Tang (True Warrior Decoction), the other Lizhong Tang (Regulate the Middle Decoction). This is the proven experience of former sages; it is merely that later scholars do not know to follow this example. I urgently used a large dose of Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Ganjiang (Zingiberis Rhizoma), and Fuzi (Aconiti Lateralis Radix Praeparata) to vigorously tonify and restore Yang. I combined these with Maidong (Ophiopogonis Radix), Wuweizi (Schisandrae Chinensis Fructus), Gancao (Glycyrrhizae Radix et Rhizoma), and Baishao (Paeoniae Radix Alba) to astringe and harmonize. The decoction was prepared thickly, allowed to cool, and administered slowly, ensuring the medicine was taken continuously day and night. After three days and nights, the disease condition began to subside. After ten days, slight modifications were made to the prescription, and he recovered after more than a month.
Wu Ziyu suffered from fever, headache, lower back pain, vexation, thirst, and absence of sweating. Some advocated Mahuang Tang (Ephedra Decoction), while others advocated Qianghuo Chonghe Tang (Notopterygii and Perillae Harmonizing Decoction). Upon palpating the pulse, the Yang positions (cun) were floating and rapid but not very forceful, while the Yin positions (chi) were deep, weak, and choppy. I said: "This symptom and pulse pattern indicates 'Lianggan' (simultaneous involvement of exterior and interior). It must have been caused by excessive physical exertion combined with sexual indiscretion. Light sweating should not be induced lightly. Instead, tonifying agents should be administered first to support Qi and Blood, waiting for the appropriate time before inducing sweating." Someone asked: "Taiyang syndrome (Syndrome of the Bladder Channel) requires sweating therapy; did Zhang Zhongjing have such a treatment method?" I replied: "Although there is no direct record of this specific method, the theoretical basis exists. Taiyang syndrome is suitable for sweating; however, if the chi pulse is slow, sweating is contraindicated. Why? Because Ying Qi (Nutritive Qi) is insufficient and Blood is scant. Now, the cun pulse is floating and rapid but weak, indicating the exterior syndrome is not urgent. The chi pulse is deep, weak, and choppy, indicating interior deficiency. In Shanghan (Cold Damage), there are cases where failure to sweat leads to transmission inward, and cases where improper sweating leads to transmission inward. This case belongs to the latter." The group was undecided and temporarily administered Qianghuo Chonghe Tang, two doses over one day and night. The previous symptoms worsened, and still no sweating occurred. Those advocating Mahuang Tang believed the medicine was too light for the severity of the illness and desired heavy sweating. I said: "If Mahuang Tang is taken, Yang collapse with delirium will appear immediately, and death can be expected forthwith." Therefore, Buqi Yangrong Tang (Tonify Qi and Nourish Blood Decoction) was used for two doses. The illness neither decreased nor worsened. Upon re-examination, the cun and guan positions remained unchanged, but the chi positions showed slight vitality. Two more doses were given. After approximately another day and night, Shen Su Yin (Ginseng and Perilla Infusion) was used to induce mild sweating. After sweating, all symptoms resolved completely. (The argument of the enlightened person: every disease has two sides.)
Ling Dongyang suffered from Shanghan. He had already undergone sweating and purging therapies. His body surface was not hot, but felt extremely hot to the touch. He could not eat yet felt unbearable hunger. When he forced himself to eat thin porridge, he experienced severe abdominal distension that could only be relieved by vigorous rubbing for one or two hours until large bowel movements occurred. Immediately after defecation, he again felt unbearable hunger. Bowel movements were absent for five to six days, yet the lower abdomen was not hard or full. Physicians, noting his body cooled after sweating and purging, prescribed formulas to open the stomach, nourish blood, and regulate Qi, but the disease progressed daily. Pulse diagnosis revealed floating and rapid pulses at both cun and guan positions, and deep, rapid, and forceful pulses at both chi positions. I said: "This is Xuezheng (Blood Accumulation Syndrome). Because purging was performed too early, although turbid waste was removed, pathogenic heat remained, causing blood to coagulate into stasis. Extreme hunger in the stomach indicates Fire. Distension upon eating indicates pathogenic heat failing to digest food. Hunger persisting after rubbing and defecation indicates the stomach is empty and dry, with pathogenic heat remaining. The treatment method should clear heat from the Upper Jiao (Upper Burner) and remove stasis from the Lower Jiao (Lower Burner), followed by tonification." Someone asked: "Xu Xueshi stated that blood accumulation above causes forgetfulness, and below causes mania. If this is blood stasis, why are these symptoms absent?" I replied: "Cheng Wuji was indeed profound in understanding Shanghan. He stated that during six to seven days of constipation, without symptoms of forgetfulness or mania, and without lower abdominal hardness and fullness, how does one know there is blood accumulation? It is because of the floating and rapid pulse. Floating indicates heat residing in Qi; rapid indicates heat residing in Blood. If both floating and rapid disappear after purging, the disease is cured. If rapid disappears but floating remains, pathogenic heat remains alone in the Wei (Defensive) level, causing hunger without digestion, tidal fever, and thirst. If floating disappears but rapid remains, pathogenic heat remains alone in the Ying (Nutritive) level, blood heat moves downward, and bleeding results in pus and blood in stool. If bowels remain unopened for six to seven days, blood cannot exit, accumulating in the Lower Jiao as stasis, requiring Dandang Tang (Shoulder Block Decoction) to purge. This is a successful precedent of former experts." Thus, Dangdang Wan (Dandang Pill) three qian was sent down with light salt water, taking advantage of the salty flavor entering the Blood level to remove constrained heat in the Ying level. Subsequently, a thick Ginseng decoction was used to mix with Liangge San (Cool the Chest Powder) five qian to remove constrained heat in the Wei level. Ginseng decoction was used because prolonged illness and multiple purgations threatened the Yuan Qi (Original Qi). After two days, the accumulated blood was removed, floating heat resolved, and diet resumed. Later, Qingqi Yangrong Tang (Clear Qi and Nourish Blood Decoction) was used for ten days until recovery.
Tang Erlao suffered from Shanghan and had already sweated. Suddenly, he developed diarrhea with fever, headache, and mental confusion. Some argued it was Hebing (Combined Disease) diarrhea and suggested using muscle-relieving and exterior-releasing medicines, which aggravated the condition, causing spontaneous sweating and aversion to wind. Others diagnosed Yin deficiency and prescribed Lizhong Tang combined with Siwu Tang, leading to insomnia, hallucinations, restlessness, and delirium. Another claimed it was Xi Re Xia Li (Diarrhea accompanying Heat) and prescribed Baitouweng Tang (Pulsatilla Decoction) for two doses, resulting in slight improvement. However, after several days, symptoms persisted, and limbs became cold. Pulse diagnosis showed scattering, large, and rapid pulses on superficial pressure, and fine, rapid, and forceful pulses on deep pressure. I said: "The previous diagnosis of Xi Re was correct. Only Tiaowei Chengqi Tang (Harmonize the Stomach and Direct Downward Decoction) should have been used for purging, not solely Baitouweng Tang." Someone asked: "In cases of diarrhea and cold limbs, can purging be repeated?" I said: "The Neijing states: 'Use obstruction to treat obstruction, use flow to treat flow.' Wang Taipu stated: 'Severe internal heat binding causes incessant diarrhea; heat should be treated with cold, and the bound heat will naturally resolve.' Using cold medicines to purge resolves the binding and stops the diarrhea; this is the method of 'flow to treat flow' (Tong Yin Tong Yong). Furthermore, Zhang Zhongjing stated: 'Diarrhea with delirium indicates dry feces. Cold limbs indicate deep heat causes deep cold; use Chengqi to purge.' However, in this case, purging at the onset would have cured him. Given the long duration and impending collapse of Yuan Qi, direct purging is unsafe. Therefore, Renshen (Ginseng) two qian was decocted thickly to send Runzi Wan (Moistening Pill) five qian. After half a day, dozens of dry feces were passed, diarrhea halved, and hands and feet warmed slightly. However, confusion worsened. He did not respond to questions. The left pulse was slightly floating and rapid; the right pulse was slightly deep, micro, and weak without force. Five qian of Renshen was decocted thickly to send Runzi Wan two qian. Soon, several more dry feces and some loose stools were passed. He could then speak and requested food; thin porridge was given. The next day, body temperature normalized, and spirit refreshed. Later, Qi and Blood were regulated with minor additions of heat-clearing herbs. Over ten days, he gradually improved, though constipation persisted. Baye Tang (Eight Substance Decoction) with doubled Shengdi Huang (Rehmanniae Radix) was used, and he recovered after over a month.
Lu Xiaoyu treated Zang Tiaoquan, who suffered from Shanghan, fever, dry nose, dry mouth, nausea, chest and hypochondriac pain/fullness, scanty dark urine, and diarrhea. Someone administered Chaiqin Tang (Bupleurum and Scutellaria Decoction), which aggravated headache to the point of breaking, insomnia all night, lasting three days. Pulse diagnosis showed wiry on the left,洪 (large) on the right, rapid at cun and guan, and slightly harmonious at chi. Chai Ge Jie Ji Tang (Bupleurum and Kudzu Muscle-Releasing Decoction) was used as the sovereign herb; Huangqin (Scutellariae Radix), Shigao (Gypsum Fibrosum), and Zhimu (Anemarrhenae Rhizoma) cleared fu-organ heat as minister herbs; Zhike (Aurantii Fructus) and Jiegeng (Platycodonis Radix) widened the middle as assistant herbs; Zhuru (Bambusae Caulis in Taenia) and Gancao (Licorice Root) directed counterflow downward as envoy herbs. Two doses per day reduced vomiting and pain. Fever persisted, sleep remained disturbed, and urination/stool issues continued. Zhimu, Huangqin, and Zhuru were removed; Chaihu (Bupleuri Radix) and Gegen (Puerariae Lobatae Radix) were doubled; five slices of Shengjiang (Zingiberis Rhizoma Recens) were added. Also two doses per day. Fever subsided, sleep improved, and diarrhea stopped. Slight thirst remained. Huafen (Trichosanthis Radix), Maidong, Gancao, Chenpi (Citri Reticulatae Pericarpium), Huangqin, Jiegeng, and Zhike were used to support Yuan Qi and clear residual heat. After four prescriptions, he was stable. Ten days later, fever and delirium recurred, resembling seeing ghosts, tongue black with prickles, no bowel movement for three days, worse at night. Pulse was deep and forceful, chi positions slightly wiry. Zhishi (Aurantii Fructus Immaturus), Huanglian (Coptidis Rhizoma), Louren (Trichosanthis Semen), Tao Ren (Persicae Semen), Baishao, Binglang (Arecae Semen), and Yuanning Fen (Mirabilite) were used for two doses, significantly reducing symptoms. Bowels still unopened. A decoction of ten Tao Ren was used to send Runzi Wan 1.5 qian. Full recovery ensued. Qingqi Yangrong Tang was used for convalescence. (This is Shaoyang-Yangming syndrome. Initial treatment was not wrong, but exterior force was insufficient, so residual symptoms persisted. Removing Zhimu and Huangqin was too abrupt, transforming the exterior resolution into interior syndrome, requiring purging for cure. Jiegeng and Zhike were also not perfectly matched.)
Wu Xuye's son, aged twenty-three, was naturally vigorous. Returning from school during Qingming Festival, he engaged in sexual activity. At dawn during urination, sudden pain below the navel and borborygmus occurred, with dysuria. The next day, chills, fever, and headache developed. The physician informed him of the taboo against returning from afar after drinking. Suspecting Yin-type Shanghan, the physician prescribed Lizhong Tang for two doses to be taken over one day and night. The next day, severe vomiting, irritability, thirst, anorexia, and insomnia occurred, lasting three days. Pulse diagnosis showed wiry left, large right, forceful cun and guan, and harmonious chi. Face was red (floating Yang). Chai Ge Jie Ji Tang was prescribed for two doses. The family cited Yin deficiency from distant travel and lack of response to Lizhong Tang, suggesting doubling Renshen and Fuzi. Lu said: "Pulse and symptoms are all Yang. Even with sexual activity, Yin is not deficient. Doubling Renshen and Fuzi would be disastrous." He insisted on taking the two doses that night to prevent transmission inward. The patient, being timid, took only one dose. Next morning, symptoms did not worsen, but pulse remained large and洪, including chi positions. Lu said: "Heat pathogen has entered the Fu organs. Symptoms will worsen in the afternoon." Baihu Tang (White Tiger Decoction) was prescribed for two doses. The patient hesitated. Lu warned: "Fear of Shigao today will lead to fear of Dahuang tomorrow." Delaying administration led to severe irritability, thirst, restlessness, and delirium. Two doses were administered consecutively. Fever barely decreased. Two more doses of the same formula were given. By dawn, slight sleep was achieved. Morning examination showed deep and solid chi pulses, thick tongue coating. Xiao Xianxiong Tang (Small Chest-Harshening Decoction) was used to send Runzi Wan 1 qian. Evening dose increased to 1 qian. By midnight, dozens of dry feces were passed, fever reduced, and diarrhea stopped. Dozens of doses of Zhishi and Huanglian were taken. Minor tonification caused stagnation and anorexia. Convalescence took two months for full recovery. (Red face indicates Stomach Fire flaming upward, not solely Yin deficiency with Yang repulsion.)
Lu Zuyu treated Gu Yuyan, aged sixty, with Shanghan. After medication, headache and bone pain resolved, but fever, irritability, red macules, and mania appeared. Pulse diagnosis showed deep, rapid, and forceful pulses in all six positions. Eyes stared fixedly, jaw clenched silent, tongue black with prickles, limbs ice-cold. Bowel movement had been absent for twenty days. Lu said: "Though old, the pulse shows vitality. I will take responsibility." Da Chengqi Tang (Major Order the Qi Decoction) was administered. Eyes closed, confused. Everyone predicted death. Within one to two hours, abdominal rumbling occurred, and dry feces were passed. Symptoms vanished instantly, leaving only faint breath. Formula changed to Renshen, Maidong, Danggui (Angelicae Sinensis Radix), Baishao, Fuling (Poria), and Baizhu for regulation and peace.
Wu Kaizhi, in February, suffered headache and fever. Medication lasted over ten days. Suddenly, swelling and pain behind the ears occurred with severe chills and fever. Some suspected toxin and used Huafen and Lianqiao (Forsythiae Fructus) to release exterior; ineffective after several doses. Others suspected phlegm nodules and used Nanxing (Arisaematis Rhizoma) and Banxia (Pinelliae Rhizoma); symptoms worsened after several doses, with chest/hypochondriac fullness/pain, anorexia, coarse breathing, and insomnia. Pulse showed wiry and rapid cun/guan, harmonious chi. This was unresolved Shaoyang pathogen from Shanghan causing parotitis (Fa Yi). The area around the ear belongs to Shaoyang. Wiry/rapid cun/guan indicates Shaoyang disharmony. Xiao Chaihu Tang (Minor Bupleurum Decoction) was indicated for harmonizing. Ruan Chaihu (Soft Bupleurum) 7 qian, Gegen, Huangqin 3 qian each, Sheng Gancao, Jiegeng, Suzi (Perillae Fructus), Baijiezi (Sinapis Semen) 1 qian each, decocted with Jiang and Zao. Two doses stopped wheezing; four doses eliminated swelling/pain. Recovery.
Treatment of a man from Chen Lake: Shanghan, supine for one month, deaf. Assumed pathogen remained in Shaoyang, causing hypochondriac pain preventing turning and deafness. Xiao Chaihu Tang plus Zhizi (Gardeniae Fructus) was given. One dose allowed turning. Internal ulceration occurred at the tailbone with maggots; hearing returned. Shaoyang belongs to Wind-Wood, and Wind-Wood can generate worms.
A soldier with Shanghan had obstructed urination and defecation. I gave Wuling San (Five-Ingredient Powder with Poria). Both opened. Wuling promotes urination, but bowel movement also opened due to generation of Jin Ye (Body Fluids). If urination opens but defecation remains obstructed, Mi Jian Fa (Honey Suppository Method) should be used for guidance.
Shi Bijian's father suffered severe cough due to Shanghan. Physicians exhausted their skills. Consulting the Zhenjing (Classic of Acupuncture), three moxa cones were applied below the larynx (Tiantu CV-22). Cured immediately. Divine! (Zisheng Jing.)
Huatu Zhuan: Officials Ni Xun and Li Yan both had headache and fever, suffering identically. Huato said: "Ni Xun requires purging; Li Yan requires sweating." Someone questioned the difference. Huato said: "Ni Xun has exterior excess; Li Yan has interior excess. Treatments differ." Each received medicine. Both rose the next morning. (San Guo Zhi.)
Fan Wang Fang: Former Inspector Gu Zixian recovered from illness, visited Huato for pulse check. Huato said: "Still deficient and unrecovered. Avoid labor. Sexual intercourse will cause death, with tongue protruding inches at death." His wife, hearing of his recovery, traveled over a hundred li to visit. They slept together and had intercourse. Three days later, illness recurred exactly as Huato predicted. Although women's Shanghan may seem recovered, within one hundred days, Qi, Blood, Bone Marrow are not firm. Intercourse causes immediate harm. After a day, joints separate, meridians weaken, Qi/Blood decline, marrow empties. Spirit floats, strength fails, unable to move from bed, dependent on others for care, appetite normal. This is the syndrome. Men are similar.
Scholar Gai Zheng: Sixty days after recovery, able to hunt. One instance of sexual activity caused salivation and death. Similarly, sexual activity during febrile illness is called Yin Yang Yi (Yin-Yang Exchange), difficult to treat. Recently, a scholar contracted mild Shanghan. Recovered after ten days, able to ride horses, considered fully healed. After sexual activity, acute lower abdominal pain and limb spasms led to death.
Women's Wenbing (Warm Disease): Though recovered, if not fully restored, Blood/Vessels not harmonized, residual heat-toxin remains. Intercourse causes illness called Yin Yang Yi. Physician Zhang Miao said: A maid recovered, and within days, six men assaulted her. All were misled/harmed.
Lin Guanzi's father: Collected cold abdominal pain, cured by treating as Sha syndrome (plague/miasma). Days later, mental depression, chest/abdominal discomfort. Ate porridge 2-3 times daily, loose stools 2-3 times daily. Mixed treatments for 20+ days worsened condition. Later physician diagnosed: Shanghan pathogen remains. How could this error occur? Eight doses of Xiao Chaihu Tang, plus separate passage of several hard feces. Peace. This is also Zang Jie (Organ Binding) type, described as "appetite normal, frequent loose stools." (Guanzi annotated Shanghan Zhezhong.)
Wu Renzhai treated a man: Shanghan ten+ days, deep/fine pulse, warm hands/cold feet, constipation, red face, vomiting, irritability/thirst. Medicine rejected, only liked 1-2 sips cold water or a piece of watermelon, vomited after a while. This is severe Yin internally forcing floating Yang upward to throat, causing red face/vomiting. One Fuzi (peeled/sliced), Renshen 3 qian, Pao Jiang (Prepared Ginger) 2 qian. Decocted, immersed in cold water, cooled, administered. Cured.
Another man: Shanghan 7-8 days, excessive cooling medicines led to cold body, cold limbs, black spots all over, only heart center warm (hidden fire). Six pulses deep/fine, unconscious, mute, like corpse rigidity. Ren San Bai Tang (Ginseng Three Whites Decoction) plus half Shu Fuzi (Prepared Aconite), Ganjiang 2 qian. After ~1 hour, spots reddened, limbs warmed, revived. Days later, lingering heat. Hidden fire not exhausted. Huanglian Jiedu Tang (Coptis Detoxification Decoction) and Zhuye Shigao Tang (Phyllostachys Leaf and Gypsum Decoction) used for regulation. Peace.
Ma Yuanyi treated Shen Mou: Fever for seven months, confusion/delirium, mass protruding in middle jiao, painful on pressure. Right pulse void/micro, left wiry/choppy. Zheng Qi depleted, Xie Qi abundant. Excess symptoms with deficient pulse, untreatable by law. Reluctantly, tonify first, then attack. Renshen, Guizhi (Cinnamon Twig), Pao Jiang, Banxia, Zhishi, Houpo (Magnolia Bark), Guangpi (Tangerine Peel) to tonify righteousness and dissipate knots. Pulse slightly rose. Then Fuzi Jia Gui Lizhong Tang (Aconite Added Cinnamon Regulate Middle Decoction) to restore Yuan Qi. Two doses, right pulse penetrated. Four doses, both pulses vital, but previous symptoms remained, mid-abdominal pain worsened. Group discussion discouraged. This case originally had stagnation to attack. Two days of pure warming/tonifying were due to concern for Yuan Qi. Early purging would have caused collapse. Now Stomach Qi is replenished, excess treatment can be applied. Renshen 3 qian, Dahuang (Rhubarb Root) 5 qian, Houpo 1 qian, Zhishi 1 qian, Guizhi 0.5 qian. Within one shi (2 hours), bowels moved three times, mass disappeared, symptoms平息. Then regulate Spleen/Kidney. Cured. (Li notes: Treating excess must consider deficiency. This case exemplifies it.)
Bu Jingong: Shanghan, several days red face/restlessness, limb twitching, restless lying/sitting, dry mouth/thirst, constipation. Cooling/dispersing failed. Pulse void/choppy/knotted. Choppy injures Yin; knotted stagnates Qi. Caused by worry/labor/depression, injuring Lung/Stomach, depleting fluids, allowing deficient pathogen to bind. Dispersing pathogen/clearing fire consumes Yin and retains pathogen. Treatment requires large dose of moistening/resolving. Gualou Shi (Trichosanthes Fruit) 1 liang, Ziwan (Asteris Radix) 3 qian, Zhike/Jiegeng 1 qian each, Qinjiao (Gentianae Macrophyllae Radix) 1 qian, Xingren (Pruni Semen), Suzi, Banxia Qu (Pinellia Fermented). One dose, deep sleep, body peaceful. Regulated several days. Cured.
Bao Kun Nong: Ill half month, cun pulses only drumming, guan/chi void/micro. Headache like axe splitting, profuse sweating, delirium/confusion. Said: Large cun/small chi indicates upper excess/lower deficiency. Headache like breaking is floating Yang usurping upward; profuse sweating is floating Yang dispersing outward; delirium/confusion is solitary Yang floating, spirit losing its hold. Without Renshen/Fuzi, scattered Yuan Qi cannot be追回; without Tongbian (Child's Urine), Zhu Dan (Pig Gallbladder), Congbai (Green Onion White), usurping Yang cannot be guided. Method: Use Baitong Tang (White Connect Decoction) for emergency rescue. Midnight, slaughtered pig for gall. Before medicine ready, jaw locked, unconscious. Forced open and灌. Dawn, spirit clarified. Yang returning to root. To deepen root/firm base, large dose warming/tonifying required. Renshen 4 liang, Fuzi 2 liang, Rougui (Cinnamon Bark) 5 qian, combined with Fuzi Lizhong Tang method. Several doses administered. Pain stopped, sweating ceased. Regulated. Peace.
One man: Shanghan six days, both pulses weak/non-rising, dirty face, enuresis, spontaneous sweating, delirium, heaviness unable to turn. This is Sanyang Hebing (Combined Disease of Three Yangs). Sweating/Purging both contraindicated. Zhang Zhongjing said: Abdominal fullness/heaviness, mouth insensitivity/dirty face, delirium/enuresis/spontaneous sweating, Baihu Tang governs. Combined Sanyang pathogen reaching enuresia/delirium indicates Middle Jiao disturbance, loss of True Qi and fluids. Zhongjing further said: Sweating causes delirium; purging causes sweat on forehead/cold limbs. Sweating biases Yang, injuring fluids; purging biases Yin, damaging True Qi. Only Baihu clears heat without hindering exterior/interior. But Sanyang pulse should be floating/large. Weak/non-rising here indicates pathogenic heat constrained, unable to reach exterior, not Yang collapse. Clearing congestion raises pulse. Large dose Baihu. One dose, deep sleep. Two doses, spirit clear, pulse rises. Tonify deficiency/clear heat. Cured.
Zhang's son: Shanghan 4-5 days, both pulses void/micro, confused spirit, restlessness, desires water but refuses to drink, discards clothes, runs, superhuman strength, wild speech, ignores kin/strangers. This is Yin excess repelling Yang, impending collapse, false heat outside/true cold inside. Wanted Lizhong Tang. Everyone thought excess heat, wanted cold purging. I said: "How can great heat not seek water to save itself? Pulses weak clearly indicate Yin excess/Yang micro. Without urgent warming/tonifying, once heavy sweating occurs, it is incurable." Front formula added Renshen to 4 liang, decocted, taken cold. 1-2 hours, madness stopped, shivering occurred, desired heavy blankets. Another dose of same medicine. Spirit cleared, fever retreated. Peace.