甲申腊姜子社有朱氏甥。年十七。因往乡患外感。初杂投增剧。历四旬延余诊视。及询
后一
医。乃专用补药。服三十余剂。面黄将疸。虚烦不寐。六脉弦数。此误补所致抵今是遗热症
。投小柴竹叶汤。两剂顿愈。再剂平复。
壬午春有上街乡民林姓者年五旬。患夹阴伤寒。初延治不知投何药。越九日请余正诊脉
时。
手拈一蛔而出。六部虚大无力。日发呃十数声。余曰脉。为假热症乃真寒投理中汤一剂烦渴
减半次早脉亦敛余归仍遗人参三白汤与服数剂。起居如常。但渴未退彼乘便于洪塘求治。误
服疗实渴药滑石干葛之属。至夜发燥谵妄。次日促余脉症已败越旦而殁。
愚按此症。每见时医不分伤寒杂病。不论虚实寒热。一概投以辛凉。枉毙多矣。故不得
不详
辨于后。夫咽痛病源非一也。有伤寒咽痛。有杂病咽痛之不同者。属伤寒者。有太阳。有阳
明。有阳毒。有阴毒。有少阴之为不同者。即少阴一经。有客热。有客寒。有寒热相搏之又
不同者。又有三阴直中阴寒而成咽痛者。又有太阴肺经初感风邪。便成咽痛者。以上皆伤寒
外感之咽痛也属杂病有风痰上壅者。有郁火上升者。有胃经积热者。有饮食中毒者。有肾虚
阴火上炎者。有虚劳咳嗽咯血者。有痰蛾 胀火蛾冷蛾之别者。则又有不同也以上皆杂病之
咽痛也其伤寒属太阳者当一二日见则治以升麻六物汤辛凉之剂属阳明阳毒者当二三日见此为
热毒上攻。则治以六物汤。或凉膈饮诸辛寒之剂其属少阴客热此为传经当四五日见则当治以
甘草汤或苦酒汤猪肤汤诸平缓微凉之剂少阴寒热相搏者此亦为传经咽痛则当治以桔梗汤和缓
之剂至少阴客寒一症此本肾寒伏藏于经络隐曲之间初治未及温经散寒。及至病久。或经旬日
。或越旬余。以致寒极上冲而成咽痛。治以半夏汤。用半夏桂枝甘草辛热之剂。若其兼症吐
利。手足厥逆。则进用四逆汤大热之剂。属三阴直中与阴毒则用姜附汤。肺经冒风。则用金
沸草汤以上俱当察其兼症而施治者也其属杂病风痰上壅者则治以二陈汤。或星香散加甘桔汤
郁火上升者则治以加味逍遥散加桔梗牛蒡子胃经积热者则治以三黄汤或泻黄散饮食中毒者则
治以苦寒消毒之剂肾虚阴火上炎咽亦痛则当治以八味丸。内有桂附纳气归源其虚劳咳嗽咯血
咽痛声哑者亦须治以壮水之剂以上总应察其兼症。与脉之虚实而施治者也。奈何一概混治致
人枉死。谁之咎乎。
癸未孟冬庠友郑能仁患风痰上壅咽痛。初治数剂增剧。余察其六脉浮弦无力。以补中益
气汤。
加胆星肉桂两剂顿愈。痰壅如失。及闻数日前能仁一胞侄年十余岁病少阴咽痛。经旬日每飧
尚能啜粥碗许。动止如常。一句医投辛凉之剂。饮下半晌。即转厥逆烦躁至三更而殁。如此
投剂少瘥。生死反掌。可不谨欤。
又仲冬府庠王介人之内患少阴客寒咽痛。项背腰膝疼痛不堪。手足逆冷。大便滑利。六
脉弦
强。复少胃气。余断以越三日当殁。辞不治。及察病因初起冒寒。一女科为其体虚素郁。投
四物汤加减。是助寒闭邪不得发越矣。过数日寒极上冲。喉咽痹痛。复延一医误以为火。而
用玄参甘桔之属。益增烦躁。至十五日延余诊视备察脉症病期久近乃属少阴寒痛余谓脉症已
败。法应不起。彼不信再更治。有名医某又以为郁火上升。坚投凉剂。至十八日而殁。
甲申季春均铺王门少妇患肝经郁火上升咽痛。累治不瘥。余投以逍遥散。加牛蒡桔梗黄
芩香附两剂如失。
又季秋都阃连擎天之内患肺经风热咽痛。脉浮洪有力。余以金沸草汤加牛蒡倍甘草一剂
而愈
甲申季夏邻妇王氏喜啖辛辣。病胃热咽痛脉洪滑征数。余投以甘桔汤。加芩连栝蒌玄参两剂
即愈。若如此三妇病恙脉实症实。投以寒剂。效若桴鼓。即使庸手治之。亦不过如摧朽耳。
果何难。第所难者于虚实寒热疑似真假之间。直中病情。易危为安斯得之矣。
甲申孟秋建宁太学魏与参久客三山。萦恋花柳。病阴火咽痛。前治误为实火。历投凉剂
。益
增烦痛。察其六脉洪数无力。余曰肾虚已极。火不归源而浮于上也。以六味料加肉桂麦冬人
参少佐附子两剂即愈。彼以为奇。
甲申年腊月，姜子社有一位朱姓的外甥。当时十七岁。因为去乡下得了外感病。起初胡乱用药导致病情加重。经过四十天延请我诊治。等到询问之前的医生。原来是专门使用补药。服用了三十多剂后。面色发黄快要出现黄疸。心中虚烦无法入睡。六脉弦而数。这是误用补药导致的至今遗留的热症。投用小柴胡竹叶汤。两剂后立刻痊愈。再服两剂后完全康复。
壬午年春季，有位上街乡的林姓百姓。年龄五十岁。患夹阴伤寒。起初请医生治疗不知用了什么药。过了九天请我正式诊脉时。手捏出一条蛔虫出来。六部脉象虚大无力。每天打呃十几次。我说：脉象显示为假热症，其实是真寒证，投予理中汤一剂，烦渴症状减半。第二天早上脉象也收敛了。我回家后仍让他服用人参三白汤继续服药几剂。起居恢复正常。只是口渴未退。他趁着方便到洪塘求治。误服了治疗实热口渴的药物如滑石、干葛之类。到了夜里出现烦躁谵语妄言。第二天急忙让我诊脉，认为病症已经败坏。次日早晨就去世了。
我按语说：这种病症。经常见到当时的医生不分伤寒和杂病。不论虚实寒热。一概投以辛凉药物。枉死的人很多。所以不得不在后面详细辨别。咽痛病的病因不止一种。有伤寒引起的咽痛。有杂病引起的咽痛，两者不同。属于伤寒的。有太阳经的。有阳明经的。有阳毒的。有阴毒的。有少阴经的，又有不同之处。即使是少阴一经。有客热。有客寒。有寒热相搏的，又有所不同。还有三阴直中阴寒而成咽痛的。还有太阴肺经初感风邪。便成咽痛的。以上都是伤寒外感引起的咽痛。属于杂病的有风痰上壅的。有郁火上升的。有胃经积热的。有饮食中毒的。有肾虚阴火上炎的。有虚劳咳嗽咯血的。有痰蛾、胀火蛾、冷蛾的区别。则又有不同之处。以上都是杂病引起的咽痛。其属于伤寒属太阳经的，当在一二日出现，则用升麻六物汤等辛凉药物治疗。属于阳明经阳毒的，当在二三日出现，这是热毒上攻。则用六物汤。或凉膈饮等辛寒药物治疗。属于少阴经客热的，这是传经之病，当在四五日出现，则应当用甘草汤或苦酒汤、猪肤汤等平缓微凉的药物治疗。少阴经寒热相搏的，这也是传经咽痛，则应当用桔梗汤等和缓药物治疗。至于少阴经客寒这一症，这本是肾寒伏藏在经络隐曲之间，初治未能及时温经散寒。等到病久。或者过了十天。或者超过十多天。以致寒气极盛上冲而成咽痛。用半夏汤治疗。使用半夏、桂枝、甘草等辛热药物。如果兼有呕吐下利。手足厥冷。则进用四逆汤等大热药物。属于三阴直中与阴毒的则用姜附汤。肺经冒风的。则用金沸草汤。以上都应当观察其兼症而施治。其属于杂病风痰上壅的则用二陈汤。或星香散加甘桔汤。郁火上升的则用加味逍遥散加桔梗、牛蒡子。胃经积热的则用三黄汤或泻黄散。饮食中毒的则用苦寒消毒的药物。肾虚阴火上炎咽亦痛则应当用八味丸。内有桂附纳气归源。其虚劳咳嗽咯血咽痛声哑的也必须用壮水之剂治疗。以上总应观察其兼症。与脉象的虚实而施治。奈何一概混治导致人枉死。是谁的过错呢？
癸未年孟冬，庠友郑能仁患风痰上壅咽痛。起初治疗几剂后病情加重。我观察他的六脉浮弦无力。用补中益气汤。加胆南星、肉桂。两剂后立刻痊愈。痰壅症状消失。后来听说几天前郑能仁的一个堂侄，年龄十几岁，患少阴咽痛。过了十天每天吃饭还能喝一碗粥。行动举止如常。一位医生投以辛凉药物。喝下半个时辰。立即转为四肢厥冷烦躁。到三更天就去世了。如此用药，稍微好转。生死就在反掌之间。能不谨慎吗？
又仲冬，府庠王介人的妻子患少阴客寒咽痛。项背腰膝疼痛不堪忍受。手足逆冷。大便滑利。六脉弦强。复没有胃气。我判断说三天后应当去世。推辞不治疗。后来考察病因，初起冒受寒邪。一位女科医生认为她体质虚弱素来郁滞。投以四物汤加减。这是助长寒气闭阻邪气不得发散。过了几天寒气极盛上冲。喉咽痹痛。又请一位医生误以为是火邪。而用玄参、甘桔之类。更加增加烦躁。到十五日延请我诊治，仔细考察脉症、病期长短，才属于少阴寒痛。我对他说脉症已败。法度上应该不能存活。他不相信，再次更换治疗。有名医某又认为是郁火上升。坚决投以凉剂。到十八日就去世了。
甲申年季春，均铺王家少妇患肝经郁火上升咽痛。多次治疗不愈。我投以逍遥散。加牛蒡子、桔梗、黄芩、香附。两剂后症状消失。
又季秋，都阃连擎天的妻子患肺经风热咽痛。脉浮洪有力。我用金沸草汤加牛蒡子、倍量甘草。一剂就痊愈了。
甲申年季夏，邻居王氏妇人喜欢辛辣食物。患胃热咽痛。脉洪滑数。我投以甘桔汤。加黄芩、黄连、瓜蒌、玄参。两剂就痊愈了。像这三个妇女的病，脉实症实。投以寒剂。效果显著。即使庸手治疗。也不过像摧枯拉朽一样容易。有什么难的。只是难的是在虚实寒热疑似真假之间。直击病情要害。化险为夷，这才是关键啊。
甲申年孟秋，建宁太学魏与参长期客居三山。沉迷声色。患阴火咽痛。之前的治疗误认为是实火。连续投以凉剂。更加增加烦痛。观察他的六脉洪数无力。我说：肾虚已极。火不归源而浮于上。用六味地黄料加肉桂、麦冬、人参，少量佐以附子。两剂就痊愈了。他认为很神奇。
In the twelfth lunar month of Jiashen year, at Jiangzi She, there was a nephew of the Zhu family. He was seventeen years old. He contracted an external contraction (wai gan) while traveling to the countryside. Initially, miscellaneous medications were administered indiscriminately, exacerbating the condition. After forty days, he invited me for consultation. Upon inquiring about previous treatments, it was revealed that only tonifying medicines had been used exclusively. After taking more than thirty doses, his face turned yellow, approaching jaundice; he suffered from deficiency vexation and insomnia. The six pulses were wiry and rapid. This was a residual heat syndrome caused by erroneous tonification. I prescribed Xiao Chai Hu Zhu Ye Tang (Minor Bupleurum and Bamboo Leaf Decoction). After two doses, he recovered instantly. After another two doses, he returned to normal health.
In the spring of Renwu year, a Lin surnamed villager from Shangjie Township, aged fifty, suffered from Jia Yin Shang Han (Cold Damage with internal yin deficiency). Initially, a physician was consulted, but the medication used is unknown. Nine days later, when I formally took his pulse, he expelled a roundworm from his hand. The pulses in all six positions were deficient, large, and powerless. He belched more than ten times daily. I stated: "The pulse indicates a false heat syndrome, which is actually true cold." I prescribed Li Zhong Tang (Regulate the Middle Decoction). After one dose, his vexation and thirst were reduced by half. By the next morning, the pulse had also stabilized. Upon returning home, I advised him to continue taking Renshen San Bai Tang (Ginseng and Three Whites Decoction) for several more doses. His daily activities normalized, though thirst persisted. Taking advantage of convenience, he sought treatment in Hongtang. There, he mistakenly ingested cooling herbs intended for excess heat-thirst, such as Hua Shi (Talcum) and Ge Gen (Kudzu Root). That night, he developed restlessness and delirious speech. The following day, he urgently summoned me. I assessed that the disease pattern had deteriorated beyond recovery, and he passed away the next morning.
My commentary: In this type of case, contemporary physicians often fail to distinguish between Shang Han (Cold Damage) and miscellaneous diseases, and do not differentiate between deficiency/excess or cold/heat. They indiscriminately administer acrid-cooling agents, resulting in many wrongful deaths. Therefore, detailed differentiation is necessary below. The etiology of sore throat is not singular. There are sore throats due to Shang Han and those due to miscellaneous diseases, which differ. Those belonging to Shang Han include Tai Yang (Greater Yang), Yang Ming (Yang Brightness), Yang Du (Yang Toxin), Yin Du (Yin Toxin), and Shao Yin (Lesser Yin), each distinct. Even within the Shao Yin channel alone, there are guest-heat, guest-cold, and cold-heat struggling patterns, which further differ. Additionally, there are cases where direct invasion of the three Yin channels by yin-cold causes sore throat, and cases where initial wind-pathogen invasion of the Tai Yin Lung channel causes sore throat. All the above are sore throats due to external contraction in Shang Han. Those belonging to miscellaneous diseases include phlegm-wind obstructing upward, stagnant fire ascending, stomach meridian accumulated heat, food poisoning, kidney deficiency with yin-fire flaming upward, consumptive cough with hemoptysis, and distinctions among tan e (phlegm swelling), zhuang huo e (fire swelling), and leng e (cold swelling), which also differ. All the above are sore throats due to miscellaneous diseases.
For those belonging to Shang Han and Tai Yang, appearing on the first or second day, treat with Sheng Ma Liu Wu Tang (Cimicifuga Six Substances Decoction) or other acrid-cooling preparations. For Yang Ming Yang Du, appearing on the second or third day, indicating heat-toxin attacking upward, treat with Liu Wu Tang or Liang Ge Yin (Cool the Diaphragm Drink) or other acrid-cold preparations. For Shao Yin guest-heat, resulting from transmitted disease, appearing on the fourth or fifth day, treat with Gan Cao Tang (Licorice Decoction), Ku Jiu Tang (Bitter Wine Decoction), or Zhu Fu Tang (Pig Skin Decoction), which are mild and slightly cooling. For Shao Yin cold-heat struggle, also a transmitted sore throat, treat with Jie Geng Tang (Platycodon Decoction), a mild preparation. Regarding Shao Yin guest-cold, this originates from kidney-cold hidden within the meridians and deep tissues. If initial treatment fails to warm the meridians and dissipate cold promptly, and the disease persists for ten days or more, extreme cold rushes upward causing sore throat. Treat with Ban Xia Tang (Pinellia Decoction) using acrid-hot herbs like Ban Xia (Pinellia Rhizome), Gui Zhi (Cinnamon Twig), and Gan Cao (Licorice Root). If accompanied by vomiting, diarrhea, and cold extremities, advance to Si Ni Tang (Frigid Extremities Decoction), a strongly hot preparation. For direct invasion of the three Yin channels and Yin Du, use Jiang Fu Tang (Ginger and Aconite Decoction). For Lung channel wind invasion, use Jin Fei Cao Tang (Boil Grass Decoction). All these require observing accompanying symptoms for treatment.
For miscellaneous disease phlegm-wind obstruction, treat with Er Chen Tang (Two Aged Substances Decoction) or Xing Xiang San (Arisaema and Citrus Powder) plus Gan Jie Tang (Licorice and Platycodon Decoction). For stagnant fire ascending, treat with Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) plus Jie Geng (Platycodon) and Niu Bang Zi (Arctium Fruit). For stomach meridian accumulated heat, treat with San Huang Tang (Three Yellows Decoction) or Xie Huang San (Drain Yellow Powder). For food poisoning, use bitter-cold detoxifying agents. For kidney deficiency with yin-fire flaming upward causing sore throat, treat with Ba Wei Wan (Eight Ingredients Pill), containing Gui Zhi and Fu Zi to guide qi back to its source. For consumptive cough, hemoptysis, sore throat, and hoarseness, also use water-nourishing agents. All these require observing accompanying symptoms and pulse deficiency/excess for treatment. How can indiscriminate mixed treatment lead to wrongful death? Whose fault is it?
In the first winter month of Guiwei year, my colleague Zheng Nengren suffered from phlegm-wind obstruction and sore throat. Initial treatments exacerbated the condition upon observation of floating, wiry, and powerless pulses in all six positions. I prescribed Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with Dan Xing (Arisaema prepared with bile) and Rou Gui (Cinnamon Bark). After two doses, he recovered instantly, and phlegm obstruction vanished. Later, I learned that Zheng Nengren's cousin, a boy over ten years old, suffered from Shao Yin sore throat. After ten days, he could still eat a bowl of porridge per meal and move normally. However, a physician administered acrid-cooling agents. Half an hour after ingestion, he developed cold extremities and irritability, dying by the third watch. Such medication errors can turn life into death in an instant. Must one not be cautious?
In the second winter month, the wife of Wang Jieren, a government school student, suffered from Shao Yin guest-cold sore throat. Pain in the neck, back, waist, and knees was unbearable. Cold extremities and loose stools were present. The six pulses were wiry and strong, lacking stomach qi. I predicted death within three days and declined treatment. Upon investigating the cause, she had initially caught cold. A gynecologist, noting her constitutional weakness and chronic stagnation, prescribed Si Wu Tang (Four Substances Decoction) modified. This aided cold and trapped pathogens, preventing their expulsion. Days later, extreme cold rushed upward, causing throat blockage and pain. Another physician mistakenly diagnosed fire and used Xuan Shen (Scrophularia) and Gan Jie (Licorice and Platycodon), increasing irritability. On the fifteenth day, I examined the pulses and symptoms, determining the long-standing nature of the disease indicated Shao Yin cold pain. I told them the pulse and symptoms had deteriorated, and survival was impossible according to medical principles. Disbelieving, they sought further treatment. A famous physician diagnosed stagnant fire ascending and firmly administered cooling agents. He died on the eighteenth day.
In the late spring of Jiashen year, a young woman of the Wang family in Junpu suffered from liver meridian stagnant fire ascending causing sore throat. Multiple treatments failed. I prescribed Xiao Yao San (Free and Easy Wanderer Powder) with Niu Bang Zi (Arctium Fruit), Jie Geng (Platycodon), Huang Qin (Scutellaria Root), and Xiang Fu (Cyperus Rhizome). After two doses, symptoms disappeared.
In the late autumn, the wife of Lian Qingtian, a military commander, suffered from lung meridian wind-heat sore throat. The pulse was floating, large, and forceful. I prescribed Jin Fei Cao Tang (Boil Grass Decoction) with Niu Bang Zi and doubled Gan Cao (Licorice Root). She recovered after one dose.
In the mid-summer of Jiashen year, a neighbor, Mrs. Wang, who enjoyed spicy foods, suffered from stomach heat sore throat. The pulse was large, slippery, and rapid. I prescribed Gan Jie Tang (Licorice and Platycodon Decoction) with Huang Qin (Scutellaria), Huang Lian (Coptis Rhizome), Gua Lou (Trichosanthes Fruit), and Xuan Shen (Scrophularia). She recovered after two doses. For these three women, with solid pulses and solid symptoms, administering cooling agents yielded immediate results, like striking a drum. Even mediocre physicians could achieve success easily, like crumbling rotten wood. What difficulty is there? The true difficulty lies in distinguishing between deficiency/excess and cold/heat amidst apparent similarities and true/false presentations. Hitting the disease pattern accurately transforms danger into safety; this is the key.
In the first autumn month of Jiashen year, Wei Yu Can, a scholar from Jianning, who had resided long-term in Sanshan and indulged in sensual pleasures, suffered from yin-fire sore throat. Previous treatments misdiagnosed it as excess fire, continuously administering cooling agents, which increased vexation and pain. Observation of the six pulses showed them to be large, rapid, and powerless. I stated: "Kidney deficiency is extreme; fire does not return to its source but floats upward." I prescribed Liu Wei Di Huang material (Six Flavor Base) with Rou Gui (Cinnamon Bark), Mai Dong (Ophiopogon Tuber), and Renshen (Ginseng Root), with a small amount of Fu Zi (Aconite Lateral Root). After two doses, he recovered. He considered it miraculous.