一 缪仲淳治一人患热病，病在阳明，头痛，壮热、鼻干、不卧、渴甚且呕，脉洪大而实。一医
欲投葛根汤。仲淳曰∶不呕吐而解表用葛根汤，今吐甚，是阳明之邪火上升也，葛根升散，用之不宜，
宜应以白虎汤治之。石膏辛能解肌，镇坠能下胃家之痰热，肌解热散，则呕而烦躁壮热皆除矣。遂以大剂
竹叶石膏汤方与之。且嘱之曰∶虏荆非六十万人不可，二十万则奔还矣。临别去，斯时投药，五鼓瘥，
已而果然。或谓呕甚而不用半夏何也？曰∶半夏有三禁，渴家、血家、汗家是也。不用甘草呕家忌甘故也。
二 一妇娠九月，患伤寒阳明病，头痛壮热，渴甚，舌上黑苔有刺，势甚危。仲淳投竹叶石膏汤，
索白药子〔医马者。〕不得，即以井底泥涂脐上，干则易之。一日夜尽石膏十五两五钱〕病瘳。越六日，
产一女，大小俱无恙。
三 一人因出疹不忌肉，兼好饮，作泄八载矣。忽患伤寒，头痛如裂，满面发赤，烦躁口渴，舌
生黑苔，时发谵语，眼不合者七日，洞泄如注，较前益无度，脉洪大而数。仲景疏竹叶石膏汤方，因其
有泻病，石膏用一两，病不减，加至二两。病家曰∶得毋与病相妨乎？曰∶热邪作祟，
此客病也，不治立殆，渠泻已八年，非暴病也，治病须先太甚，急治其邪，徐并其夙恙除之。急进一剂，
夜卧遂安，即省人事。再剂而恶症顿去，不数剂霍然，但泻未止。复疏脾肾双补丸方，加黄连、干葛、
升麻、以痧痢治之，不一月泻止，八载沉 ，一旦若失。
四 一卖豆腐者伤寒发呃，两日夜人事不省，其子乞方。仲淳问曰∶汝父当时曾头疼身热乎？曰∶
然。曰∶曾服汗药乎？曰∶未也。曰∶曾吐下乎？曰∶未。仲淳曰∶伤寒头痛，身热口渴，本属阳明热
邪传里，故身凉发呃，未曾汗吐下，邪从何而出，第其人年老多作劳，于白虎汤加参三钱，二剂服愈。
五 一人患时气外感三、五日，头痛发热，服表汗药虽止，热仍不清，口干唇裂，因而下之。
遍身红斑，神昏谵语，饮食不入，大便复秘，小便热赤，脉紧小而急。嘉言曰∶此症全因误治，阳明胃
经表里不清，邪热在内，如火燎原，津液尽干，以致神昏谵妄，斑转紫黑，立刻死矣。今本难救，但其
面色不枯，声音尚朗，乃平日保养，肾精有余，如旱田之侧，有下泉未竭，故神虽昏乱，而小水仍通，
乃阴气未绝之征，宜化斑白虎汤治之。盖中州元气已离，大剂急剂，俱不得用，而虚热内炽，必甘寒
气味，方可和之耳。但方虽宜小，而服药则宜频，如饥人欲食，不得不渐渐与之，必一昼夜频进五、七
剂，为浸灌之法，庶几邪热以渐而解，元气以渐而生也。若以小剂复旷时日，纵用药得当亦无及矣。如
法治之，更一昼夜，而病者热退神清，脉和食进，其斑自化。
六 一人头痛腹胀，身重不能转侧，口内不和，语言
谵妄。士材曰∶此三阳合病也，头病太阳症也，腹胀身重口不仁谵语，阳明症也，难以转侧少阳
症也。乃以白虎汤连进两服，诸症渐减，更加麦冬、花粉，二剂而安。
七 一人犯房劳，病伤寒，守不服药之戒，身热已退，十余日外，忽然昏沉，浑身战栗，手足
如冰。一医欲役姜、附之药，主家自疑阴症，遂欲用之。嘉言力辨其为热厥，止而弗服。以调胃承气
汤约重五钱，煎成热服半盏。少顷，又热服半盏，厥渐退，人渐苏，仍与前药，服至剂终，人事大清，
忽然浑身壮热，又与大柴胡一剂，热退身安。盖凡伤寒病，初起发热，煎熬津液，鼻干口干渴便秘，
渐至发厥者，不问知其为热也，若阳症忽变阴厥者，万中无一也。盖阴厥得之阴症，严冬寒邪，一起便
直中少阴，无头疼身热，而见唇青面白，凛栗无汗，〔若腠理素虚，则冷汗淋漓，或烦假热烦躁，迫
其阳亡于外之假症。〕骛溏自利，溺清不渴，身蜷多睡，醒则人事了了，与伤寒传经之热邪，转
入转深，人事昏惑，万万不同。〔此症正宜四逆汤急救之，宜参医门法律中寒门用药。〕诸书载阴
阳二厥为一门，即明者犹为所混，况昧者乎？如此病，先犯房劳后成伤寒，世医无不为阴症之名所惑，
往往投以四逆等汤，而促其暴亡。盖犯房劳而病外感者，其势不过比常较重，如发热则热之极，恶寒则
寒之极，所以然者，以阴虚阳往乘之，非阴盛无阳之比。仲景伤寒论中所载辛热诸方，原为妄汗下吐而
制。如汗多亡阳，吐利烦躁，四肢逆冷者，皆因用药差误所致，不以真武四逆等汤挽之，则阳不能回，
非为传经伤寒中
有阴症而立方也。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。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。若面黛舌黑，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？
八 一人伤寒，九日以来口不能言，目不能视，体不能动，四肢俱冷，皆曰阴症。士才诊之，六
脉俱无，以手按腹，两手护之，眉皱作楚，按其冲阳，〔在足面上五寸高骨间动脉也。〕大而有力，乃
知腹有燥粪也。遂与大承气汤下之，得燥粪六、七枚，口能言，体能动矣。
九 一人伤寒，至五日下利不止，懊 目胀，诸药不效。有以山药茯苓与之，虑其泻脱也。士
才诊之，六脉沉数，按其脐则痛，此协热自利，中有结粪，以小承气倍大黄服之，果得结粪数枚，下利遂
止，懊 遂安。
十 一人因房劳食犬肉伤寒，诸医以其虚也，攻补兼施，至发狂，登屋奔走呼号，日夜令壮夫看
守者，几月余。走使延朱远斋，先命煎人参膏二斤以待，用润字号丸药数钱下之，去黑粪无算，势遂定。
奄奄一息，邻于死矣。
徐以人参膏灌入之，至百二十日全愈。
十一 一人食牛肉伤寒，表邪已解，但默默不语，身卧如塑。余按其腹，则双手来护，知其中
有燥粪，此大实有羸状也。以承气投之，惟有极臭粪水，甚至下如血水，旁流不止。余曰∶此病久，
胃气无权，不能推送，承气汤中，须得人参赞助，宿物始动。乃用黄龙汤，腹大痛而下黑粪无
算，逆愈。
十二 一童女伤寒，得阳明胃实下症，以承气下之，惟有或红或黄，或黑粪水，按腹仍痛，胸膈仍
闷。余曰∶病久邪热灼耗津液，兼下多伤阴之故。用麦冬〔一两。〕栝蒌∶〔一枚。〕清肺利大肠，以
大肠主津液，与肺为表里，肺主气，而津液由于气化故也。生地〔二两〕滋阴通二便，以五液皆主统于
肾，肾主二便，血主濡之故也。服尽，结粪遂下，即知饥而索粥矣。
十三 一太史春间病外感，头痛身热，口渴吐白沫，昼夜不休，医者误谓罢官初归，妄投解郁行
气药，不效。又投以四物汤，益甚。病二十余日矣。仲淳曰∶病因外感，不解表，又不下，使热邪弥留
肠胃间，幸元气未尽，故不死。用淡豆豉二合炒香，麦冬两许，知母数钱，石膏两许，一剂大汗而
解。大便尚未通。此久病津液未回，乃肠胃燥非有邪也。令日食甘蔗二、三株，兼多饮麦冬汤，不三
日，去燥粪六十余块而愈。
十四 一仆因受寒发热，头痛如裂，两目具裂痛，浑身骨肉疼痛，下元尤甚，状如刀割。不可
忍，口渴甚，大便日解一次，胸膈饱胀，不得眠，以其症来告。仲淳曰∶此太阳阳明合病也。贫人素
多作劳，故下体疼痛尤甚，用羌活〔二钱五分。〕祛太阳之邪，干葛〔三钱。〕竹叶〔一百片。〕
石膏〔一两五钱。〕知母〔三钱五分。〕麦冬〔八钱。〕解阳明之热，栝蒌实〔半枚。〕枳实 桔便〔
各一钱。〕疏利胸膈之留邪，服四剂遂愈。
十五 一妇产后饮食不节，复感风寒，遂致发热谵语，喘咳气逆，恶露绝不至，势甚急迫，仲淳
云∶此症具系外来客邪，尚属可救，设正气虚脱现诸症者，必无幸矣！何以见之，以脉气浮大有力故也。
用大剂疏风消食之药，二剂便霍然。先是有用白术、归、芎等补药，几为所误。
十六 一人患伤寒，第二日头痛发热，正在太阳，士材曰∶方今正月，天令犹寒，服以麻黄汤热饮
之，得汗如雨，密复半日，易被，神已爽矣。至晚索粥，家人不与。士材曰∶邪已解矣，必不传里，食
粥何妨。至明日果愈。不以麻黄汗之，病变深重，非半月不安也。
十七 一人春月病温，嘉言见其头重着枕，身重着席，不能转侧，气止一丝，不能言语，畏闻响
声。此以冬不藏精，体虚不能任病耳。乃于表汗药中，用人参七分，服后汗出势减。次日，又于和解药
中，加人参一钱，即大便一次。谓曰∶此症表已解矣，里已和矣，今后缓调即愈。
十八 一人伤寒，六、七日身热目赤，索水到前，复置不饮，异常烦躁，将门牖洞开，身卧
地上，展转不快，更求入井。医欲与承气汤服之。嘉言诊其脉，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，再以人参、
姜、附之剂，逾垣上屋矣！嘉言曰∶阳欲暴脱，外显假热，内有真寒，以姜、附投之，尚恐不胜其
任，况用纯阴之药，重劫其阳乎？观其得水不欲咽，情已大露，岂水尚不欲咽，而反可咽硝、黄
乎？天气燠蒸，必有大雨，此症顷刻大汗一身，不可救矣！惟用姜、附，所谓补中有发，可以散邪退
热，一举两得，至稳至当之法，何可致疑。乃以人参三钱，姜、附、甘草各二钱，煎成冷服。服后
寒战，戛齿有声，以重绵和头复之，缩手不肯与诊，阳微之状始着。又与前药一齐，微汗热退而安。
〔按传经伤寒，谓之热病者，盖风寒初客皮毛。即毛孔闭，平素有火之人，阳气为风寒所闭，不得外
泄而生热，非风寒能变热也。但是因风寒而生热，所以有风化为热，阳郁为热之说。故仲景以风寒之
邪为热邪，热邪传里，必由皮毛经络而肌肉，而脏腑，积久愈热，决无忽反变寒之理，故直谓之热病。然
人禀赋有偏阴偏阳之不同，如太阴之人，虽暑月不离复衣，食饮稍凉，便腹痛泄泻，其平日阳气衰微
不振，阴寒久已用事，一旦感召风寒，斩关直入阴经，寒复加寒，阴盛于内，则逼阳于外，故有阴极似阳
之症。但此种偏阴之人，假阳之症，乃千百难逢一、二。附
录兹案，欲使学人临症，当知内经所云无者求之也，〕
十九 一妇，患热入血室，发狂欲杀人，医以伤寒治之。仲淳曰∶误矣，令先饮童便，继与
凉血，行血，安心神药，遂定。
二十 一人伤寒，热解后，复下血不止，以痢药投之，更甚。仲淳云∶此伤寒失汗之余症也。
用地榆、麦冬、知母、竹叶以代仲景诸血症药，遂愈。
二十一 一人患伤寒愈，愈而复，复而愈，愈而再复，不知其几。面色黄白，六脉微弱，大便
不通，胸中不快，亦不思食。仲淳曰∶胸中不快，虚而气壅，非实邪也。不大便者，久病津液枯，气弱
不能送也。投以人参五钱，麦冬两许，枳壳八钱，尽剂而愈。
二十二 崇明蒋中尊，病伤寒临危，求肉汁淘饭半碗，食毕，大叫一声而逝。人问其故，嘉言曰∶
今人外感病，兼内伤者多，用药解全用分别。如七分外感，三分内伤，则治外感药中，宜用缓剂小剂，
及姜、枣和中为引，庶无大动正气汗血等累。若七分内伤，三分外感，则用药全以内伤为主，但加入透
表药一味，而热服以助药势，则外感自散。盖以内伤之人，才有些微外感，实时发病，不似壮盛之
人，必所感深重，其病乃发也。蒋中尊者，向曾见其满面油光，已知其精神外用，非永寿之人也。人惟
歉然不足，方有
余地、可以应世，可以当病。若夫神采外扬，中之所存，宁复有几耶？近闻其宦情与声色交浓，宵征
海面，冒蜃烟蛟雾之气，尚犯比目之戒，则其病纯是内伤，而外感不过受雾露之气耳。雾露之邪，其
中人也，但入气厘清道，原不传经，故非发表攻里所能驱，惟培元气，浓谷气，则邪不驱而自出。设以
其头晕发热，认为太阳之症，误表其汗，则内伤必转增，而危殆在所必至矣。且内伤之人，一饱一饥，
早已生患，又误以为伤寒，而绝其食，已虚益虚，致腹中馁惫，求救于食，食入大叫一声者，肠断而死
也。此理甚明，如饥民仆地即死，气从中断，不相续也。又如膈病，展转不能得食，临危每多大叫而
逝，以无外感之邪乱其神明，是以炯炯自知其绝也。果有外邪与正交争，其人未死前，先已昏惑
不省矣。问曰∶每见人之神采外扬者，病发恒多汗而躁急，不识何药可以治之？曰∶上药在以神治神。
盖神既外扬，必须内守，方能逆挽。若夫草木之性，则取其下达而味沉浓者，用之恒使勿缺，仿灌园之
例，频频予沃之以水，而防其枯竭可也。问曰∶临危索饭之时，尚有药可救否？曰∶独参汤可以救之。
一、缪仲淳治疗一人患热病，病位在阳明经，症状为头痛、高热、鼻干、无法安卧、极度口渴且呕吐，脉象洪大且实。一位医生打算使用葛根汤。缪仲淳说：“如果不呕吐而需要解表，才用葛根汤；现在呕吐严重，这是阳明邪火上升所致，葛根具有升散之性，使用它不合适，应当用白虎汤来治疗。石膏味辛能解除肌表之热，其质重能下行清除胃中的痰热，肌表之热散去，那么呕吐、烦躁和高热都会消除。”于是开大剂量的竹叶石膏汤给他服用。并且嘱咐说：“这就像攻打城池，没有六十万大军攻不下来，二十万兵力就会败退回来。”临别时离开，此时投药，五更天时病就好了，后来果然如此。有人问：“呕吐严重却不用半夏，为什么呢？”回答说：“半夏有三禁，即口渴者、血证患者、多汗者禁用。不用甘草是因为呕吐者忌讳甘味药物。”
二、一位怀孕九个月的妇女，患伤寒阳明病，头痛、高热、极度口渴，舌上有黑苔且有芒刺，病情非常危险。缪仲淳给予竹叶石膏汤，索要白药子（一种用于治马病的药材）未得到，就用井底泥涂抹在肚脐上，干了就更换。一天一夜用掉石膏十五两五钱，病好了。过了六天，生下一个女儿，母子都平安无事。
三、一个人因为出疹子期间不忌口吃肉，又喜欢喝酒，导致腹泻长达八年。忽然患上伤寒，头痛如裂，满面发红，烦躁口渴，舌生黑苔，时常说胡话，眼睛闭着七天不能睁开，腹泻如水注，比以前更加严重，脉象洪大而数。张仲景的《伤寒论》中记载了竹叶石膏汤方，因为他有慢性腹泻病，石膏只用一两，病没减轻，加到二两。病人家属说：“这样会不会与他的旧病冲突呢？”缪仲淳说：“热邪作祟，这是新得的客病，不治疗立刻会有生命危险，他的腹泻已经八年，不是突发急病，治病必须先解决最紧急的问题，急治其邪气，慢慢再处理他多年的旧疾。”急忙进服一剂，晚上就能安稳睡觉，随即清醒人事。再服一剂，危重症状顿时去除，没过几剂药就痊愈了，只是腹泻还没停止。又开具脾肾双补丸方，加入黄连、干葛、升麻，按照治疗痧痢的方法治疗，不到一个月腹泻停止，八年的沉疴，一下子消失了。
四、一个卖豆腐的人患伤寒打呃逆，两天两夜人事不省，他的儿子来求方。缪仲淳问：“你父亲当时有头疼身热吗？”回答说：“有。”问：“吃过发汗药吗？”回答说：“没有。”问：“用过催吐或泻下药吗？”回答说：“没有。”缪仲淳说：“伤寒头痛、身热、口渴，本来属于阳明热邪传入体内，所以身体凉下来后出现呃逆，既然没有经过汗、吐、下法治疗，邪气从哪里排出呢？只是这个人年老且经常劳累，所以在白虎汤中加入人参三钱，服两剂后痊愈。
五、一个人患时气外感三、五天，头痛发热，服用发汗药后虽然热止，但余热不清，口干唇裂，因此用了泻下药。遍身出现红斑，神志昏迷说胡话，饮食不进，大便再次秘结，小便热赤，脉紧小而急。喻嘉言说：“这个病症完全是因为误治，阳明胃经表里不清，邪热在内，像火烧原野一样，津液全部干枯，导致神志昏迷说胡话，斑疹转为紫黑色，立刻就会死亡。现在本来难以救治，但他的面色不枯槁，声音还响亮，这是他平日保养得当，肾精有余，就像旱田旁边有地下泉水未枯竭，所以虽然神志昏乱，但小便仍通，这是阴气未绝的迹象，应该用化斑白虎汤治疗。因为中焦元气已经离散，大剂量和急剂量都不适用，而虚热内炽，必须用甘寒气味的药物，才能调和它。但是方子虽然宜小，服药则宜频繁，就像饥饿的人想吃饭，不得不渐渐给他吃，必须一昼夜频繁进服五、七剂，采用浸灌的方法，这样邪热才能逐渐解除，元气才能逐渐恢复。如果用少量药又拖延时日，即使用药得当也来不及了。如果按此法治疗，再过一昼夜，病人热退神清，脉象平和能进食，斑疹自然消退。
六、一个人头痛腹胀，身体沉重不能翻身，口中感觉不适，语言错乱谵妄。尤在泾说：“这是三阳合病。头痛是太阳症，腹胀、身重、口不知味、谵语是阳明症，难以翻身是少阳症。”于是连续服用两服白虎汤，各种症状逐渐减轻，再加麦冬、花粉，服两剂后安定。
七、一个人因房事过度患病伤寒，遵守不服药的禁忌，身热已退，十多天后，忽然昏沉，浑身战栗，手脚冰凉。一位医生想用姜、附等温热药，主人自己怀疑是阴症，就想用这些药。喻嘉言极力辩驳说是热厥，制止不让服用。用调胃承气汤约重五钱，煎好后热服半盏。过了一会儿，又热服半盏，四肢厥冷逐渐消退，人逐渐苏醒，仍然给前药，服完一剂，人事完全清醒，忽然浑身高热，又给一大柴胡汤一剂，热退身安。大概凡是伤寒病，初起发热，煎熬津液，鼻干口干渴便秘，逐渐发展到发厥的，不问可知它是热证，如果是阳症突然变成阴厥的，万中无一。阴厥得之于阴症，严冬寒邪，一开始就直接中伤少阴，没有头疼身热，而是见嘴唇青、面色白，凛冽战栗无汗，〔如果腠理素来虚弱，则冷汗淋漓，或有烦热的假象，这是阳气外亡的假症。〕腹泻清稀自利，小便清长不渴，身体蜷缩多睡，醒来则神志清楚，这与伤寒传经的热邪，转入转深，人事昏惑，万万不同。〔此症正适合四逆汤急救，参看《医门法律》寒门用药。〕诸书将阴阳二厥归为一门，即使是明眼人也容易被混淆，何况糊涂的人呢？像这种病，先犯房劳后成伤寒，世间的医生无不迷惑于“阴症”之名，往往投以四逆等汤，反而加速其暴亡。大概犯房劳而病外感的，其势头不过比常人较重，如发热则热至极点，恶寒则寒至极点，之所以这样，是因为阴虚阳气往乘之，并非阴盛无阳的情况。张仲景《伤寒论》中所载的辛热诸方，原本是为误用汗、下、吐法而制定的。如汗多亡阳，吐利烦躁，四肢逆冷者，都是因为用药错误所致，不用真武、四逆等汤挽回，则阳气不能回复，并不是为了传经伤寒中有阴症而立方。大概伤寒才一发热发渴，定然阴分先亏，因为误治，阳分比阴分更亏，不得已从权用辛热，先救其阳，这与纯阴无阳、阴盛格阳的症候相差甚远。后人不明制方之意，见到有成法，互相效仿，不知道治阴症以救阳为主，治伤寒以救阴为主。伤寒纵有阳虚当治，也必须看其人血肉充盛，阴分能承受阳药者，才可以回阳。如果面黑舌黑，身体如枯柴，一团邪火内焚者，则阴已先尽，何谈回阳？所以见到厥逆除热，保存十分之一的津液元气，已经失之晚矣，何况敢助阳劫阴呢？
八、一个人患伤寒，九天以来口不能言，目不能视，身体不能动，四肢俱冷，大家都说是阴症。尤在泾诊察，六脉俱无，用手按压腹部，病人双手护住腹部，皱眉表示疼痛，按其冲阳穴（在足背上五寸高骨间的动脉），脉大而有力，才知道腹中有燥屎。于是给予大承气汤泻下，排出燥屎六七枚，口能言，身体能动了。
九、一个人患伤寒，到第五天腹泻不止，心中烦闷懊恼，眼睛胀痛，各种药无效。有人用山药、茯苓给他，担心他泻脱。尤在泾诊察，六脉沉数，按脐部则痛，这是协热自利，中间有结粪，用小承气汤加倍大黄服用，果然排出结粪数枚，腹泻停止，烦闷懊恼遂安。
十、一个人因房劳食犬肉患伤寒，各位医生认为他虚，攻补兼施，导致发狂，登屋奔走呼号，日夜让壮汉看守，几个月了。派人请朱远斋，先命煎人参膏二斤备用，用润字号丸药数钱让他服下，排出无数黑粪，势头才稳定。奄奄一息，临近死亡。徐缓地用人参膏灌入，至一百二十日全愈。
十一、一个人食牛肉患伤寒，表邪已解，只是默默不语，身体躺着像塑像一样。我按压他的腹部，他双手来护住，知道其中有燥屎，这是大实证却有羸弱表现。用承气汤投之，只排出极臭的粪水，甚至下如血水，旁流不止。我说：“这病久了，胃气无权，不能推送，承气汤中，须得人参赞助，宿物才会动。”于是用黄龙汤，腹痛剧烈而下黑粪无数，逆症痊愈。
十二、一个童女患伤寒，得了阳明胃实下的症候，用承气汤泻下，只排出或红或黄或黑的粪水，按腹部仍痛，胸膈仍闷。我说：“病久邪热灼耗津液，加上泻下过多损伤阴分的缘故。”用麦冬（一两）、栝蒌（一枚），清肺利大肠，因为大肠主津液，与肺为表里，肺主气，而津液由于气化产生的缘故。生地（二两）滋阴通利二便，因为五液皆统摄于肾，肾主二便，血主濡养的缘故。服完后，结粪遂下，随即知道饥饿要粥喝。
十三、一位太史春天患外感，头痛身热，口渴吐白沫，昼夜不休，医生误以为他是刚罢官归来，妄投解郁行气药，无效。又投以四物汤，病情加重。病二十多天了。缪仲淳说：“病因是外感，不解表，又不攻下，使热邪弥留肠胃间，幸亏元气未尽，所以不死。”用淡豆豉二合炒香，麦冬一两许，知母数钱，石膏一两许，一剂大汗而解。大便尚未通。这是久病津液未回，是肠胃燥而非有邪气。令每天吃甘蔗二、三株，兼多饮麦冬汤，不到三天，排出燥粪六十余块而愈。
十四、一个仆人因受寒发热，头痛如裂，两眼俱裂痛，浑身骨肉疼痛，下元尤其严重，状如刀割。不可忍受，口渴甚，大便日解一次，胸膈饱胀，不得眠，以其症状来告知。缪仲淳说：“这是太阳阳明合病。穷人平时多劳作，所以下体疼痛尤其严重，用羌活（二钱五分）祛太阳之邪，干葛（三钱）、竹叶（一百片）、石膏（一两五钱）、知母（三钱五分）、麦冬（八钱）解阳明之热，栝蒌实（半枚）、枳实、桔梗（各一钱）疏利胸膈之留邪，服四剂遂愈。
十五、一妇产后饮食不节，又感受风寒，导致发热谵语，喘咳气逆，恶露绝不至，形势非常急迫，缪仲淳说：“此症全是外来客邪，尚属可救，假如正气虚脱现诸症者，必无幸矣！何以见得，因为脉气浮大有力。”用大剂疏风消食之药，二剂便霍然痊愈。先前有用白术、当归、川芎等补药，差点被误导。
十六、一人患伤寒，第二日头痛发热，正在太阳经，尤在泾说：“如今正月，天气还寒，服用麻黄汤热饮，得汗如雨，严密覆盖半天，换衣后，神志已清爽。”到了晚上要喝粥，家人不给。尤在泾说：“邪气已解，必不传里，喝粥有什么妨碍。”到明天果然痊愈。如果不以麻黄汤发汗，病变深重，非半个月不安宁。
十七、一人春月病温，喻嘉言见他头重着枕，身重着席，不能翻身，气息仅一丝，不能言语，害怕听到响声。这是因为冬天不藏精，体质虚弱不能承受病邪。于是在发汗药中加入人参七分，服后汗出势头减弱。次日，又在和解药中加入人参一钱，即大便一次。说道：“此症表已解，里已和，今后缓调即愈。
十八、一人伤寒，六、七日身热目赤，索水到前，又放下不喝，异常烦躁，把门窗大开，身体躺在地上，辗转不快，更要求跳井。医生想用承气汤给他服。喻嘉言诊其脉，洪大无伦，重按无力。说道：“这是用人参、附子、干姜的症候，怎么认为是下症呢？”医生说：“身热目赤，是有余之邪，躁急若此，再用人参、姜、附之剂，会让他爬墙跳屋！”喻嘉言说：“阳气欲暴脱，外显假热，内有真寒，用姜、附投之，还怕不胜任，何况用纯阴之药，重重劫夺其阳呢？看他得水不欲咽，情状已大暴露，难道水尚不欲咽，反而可咽硝石、大黄乎？天气燠蒸，必有大雨，此症顷刻大汗一身，不可救了！只有用姜、附，所谓补中有发，可以散邪退热，一举两得，至稳至当之法，有何可疑。”于是用人参三钱，姜、附、甘草各二钱，煎成冷服。服后寒战，牙齿打颤有声，用厚绵裹头复之，缩手不肯让人诊脉，阳微之状始显著。又与前药一起，微汗热退而安。〔按：传经伤寒，称为热病的，大概风寒初客皮毛，毛孔闭塞，平素有火之人，阳气为风寒所闭，不得外泄而生热，并非风寒能变热。但是因为因风寒而生热，所以有风化为热，阳郁为热的说法。故张仲景以风寒之邪为热邪，热邪传里，必由皮毛经络而肌肉，而脏腑，积久愈热，决无忽反变寒之理，故直称之为热病。然而人禀赋有偏阴偏阳的不同，如太阴之人，虽暑月不离厚衣，饮食稍凉，便腹痛泄泻，其平日阳气衰微不振，阴寒久已用事，一旦感召风寒，斩关直入阴经，寒复加寒，阴盛于内，则逼阳于外，故有阴极似阳之症。但这种偏阴之人，假阳之症，乃千百难逢一、二。附录此案，欲使学人临症，当知《内经》所说‘无者求之’的道理。〕
十九、一妇人，患热入血室，发狂欲杀人，医生以伤寒治之。缪仲淳说：“错了，令先饮童便，继与凉血、行血、安心神之药，遂定。
二十、一人伤寒，热解后，复下血不止，以治痢药投之，更甚。缪仲淳说：“这是伤寒失汗后的余症。”用地榆、麦冬、知母、竹叶代替张仲景诸血症药，遂愈。
二十一、一人患伤寒愈，愈而复，复而愈，愈而再复，不知其几次。面色黄白，六脉微弱，大便不通，胸中不快，也不思食。缪仲淳说：“胸中不快，是虚而气壅，非实邪也。不大便者，久病津液枯，气弱不能送也。”投以人参五钱，麦冬一两许，枳壳八钱，服完一剂而愈。
二十二、崇明蒋中尊，病伤寒临危，求肉汁淘饭半碗，食毕，大叫一声而逝。人问其故，喻嘉言说：“今人外感病，兼内伤者多，用药解全用分别。如七分外感，三分内伤，则治外感药中，宜用缓剂小剂，及姜、枣和中为引，庶无大动正气汗血等累。若七分内伤，三分外感，则用药全以内伤为主，但加入透表药一味，而热服以助药势，则外感自散。大概以内伤之人，才有些微外感，实时发病，不像壮盛之人，必所感深重，其病乃发也。蒋中尊者，向来曾见他满面油光，已知其精神外用，非长寿之人。人惟歉然不足，方有馀地、可以应世，可以当病。如果神采外扬，其中所存，还有多少呢？近闻他宦情与声色交浓，夜间征海面，冒蜃烟蛟雾之气，尚犯比目之戒，则其病纯是内伤，而外感不过受雾露之气耳。雾露之邪，其中人也，但入气厘清道，原不传经，故非发表攻里所能驱，惟培元气，浓谷气，则邪不驱而自出。设以其头晕发热，认为太阳之症，误表其汗，则内伤必转增，而危殆在所必至矣。且内伤之人，一饱一饥，早已生患，又误以为伤寒，而绝其食，已虚益虚，致腹中馁惫，求救于食，食入大叫一声者，肠断而死也。此理甚明，如饥民仆地即死，气从中断，不相续也。又如膈病，辗转不能得食，临危每多大叫而逝，以无外感之邪乱其神明，是以炯炯自知其绝也。果有外邪与正交争，其人未死前，先已昏惑不省矣。”问曰：“每见人之神采外扬者，病发恒多汗而躁急，不识何药可以治之？”曰：“上药在以神治神。盖神既外扬，必须内守，方能逆挽。如果草木之性，则取其下达而味沉浓者，用之恒使勿缺，仿灌园之例，频频予沃之以水，而防其枯竭可也。”问曰：“临危索饭之时，尚有药可救否？”曰：“独参汤可以救之。”
1. Miao Zhongchun treated a patient with a febrile disease located in the Yangming channel, presenting with headache, high fever, dry nose, inability to lie down, extreme thirst, and vomiting, with a surging and excess pulse. A physician intended to administer Gegen Tang (Pueraria Decoction). Miao Zhongchun said: "If there were no vomiting and exterior resolution was needed, Gegen Tang would be used; now that vomiting is severe, this indicates rising pathogenic fire of the Yangming. Gegen has ascending and dispersing properties, so its use is inappropriate. One should treat with Baihu Tang (White Tiger Decoction). Shigao (Gypsum Fibrosum) is pungent and can resolve the muscle layer heat, while its heavy nature can descend and clear phlegm-heat from the stomach. Once the muscle-layer heat dissipates, vomiting, irritability, and high fever will all be eliminated." He then prescribed a large dose of Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) for him. He also advised: "This is like attacking a city; without six hundred thousand troops it cannot be taken, and two hundred thousand will retreat in defeat." After leaving and administering the medicine, the patient recovered by the fifth watch (early morning), which proved true. Someone asked: "Why is Banxia (Pinelliae Rhizoma) not used despite severe vomiting?" The answer was: "Banxia has three contraindications: patients with thirst, blood disorders, and those who sweat profusely. Gancao (Glycyrrhizae Radix et Rhizoma) is not used because patients with vomiting should avoid sweet flavors."
2. A woman nine months pregnant suffered from Taiyang-Shaoyang-Yangming cold damage (Shanghan) involving the Yangming pattern, with headache, high fever, extreme thirst, and a black tongue coating with prickles, indicating a critical condition. Miao Zhongchun administered Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction). When Baizhi Zi (Arisaema Cum Bile, specifically prepared for veterinary use) was unavailable, he applied mud from the bottom of a well to the umbilicus, replacing it when dry. In one day and night, fifteen taels and five qian of Shigao (Gypsum Fibrosum) were used, and the illness subsided. Six days later, she delivered a healthy daughter, and both mother and child were safe.
3. A man had suffered from diarrhea for eight years due to dietary indiscretion (eating meat during rash eruption) and alcohol consumption. Suddenly, he contracted Shanghan (cold damage), presenting with splitting headache, flushed face, irritability, thirst, black tongue coating, occasional delirium, eyes closed for seven days, profuse watery diarrhea worse than before, and a surging, rapid pulse. According to Zhang Zhongjing's formula for Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction), because of his chronic diarrhea, only one tael of Shigao (Gypsum Fibrosum) was used initially. When the illness did not improve, the dose was increased to two taels. The family asked: "Will this conflict with his old disease?" Miao Zhongchun replied: "The pathogenic heat is the active issue; if untreated, death is imminent. His diarrhea has lasted eight years and is not an acute emergency. Treatment must address the most urgent aspect first—clearing the pathogen—and then gradually address the chronic ailment." One dose was administered urgently, allowing him to sleep peacefully at night and regain consciousness. Two doses cleared the critical symptoms, and within a few doses he recovered, though diarrhea persisted. Subsequently, Pipai Shuangbu Wan (Spleen and Kidney Dual Tonification Pill) was prescribed, added with Huanglian (Coptidis Rhizoma), Ge Gen (Puerariae Radix), and Sheng Ma (Cimicifugae Rhizoma), treating it as a dysentery-like condition. Within a month, the diarrhea stopped, and the eight-year chronic ailment vanished instantly.
4. A tofu seller contracted Shanghan (cold damage) with hiccups, remaining unconscious for two days and nights. His son sought a prescription. Miao Zhongchun asked: "Did your father have headache and fever initially?" "Yes." "Did he take sweating medicines?" "No." "Was emesis or purgation used?" "No." Miao Zhongchun said: "Headache, fever, thirst, and dry mouth in Shanghan belong to Yangming heat pathogen transmitting inward. Thus, the body cools and hiccups appear. Since no sweating, emetic, or purgative methods were used, where could the pathogen exit? This person is elderly and overworks. Therefore, Renshen (Ginseng Radix et Rhizoma) three qian was added to Baihu Tang (White Tiger Decoction). Two doses resulted in recovery."
5. A patient suffered from seasonal qi external contraction for three to five days, with headache and fever. Although sweating medicines stopped the fever, residual heat remained, causing dry mouth and cracked lips. Consequently, purgatives were used. Red macules appeared all over the body, along with coma, delirium, inability to eat, constipation, hot red urine, and a tight, small, and rapid pulse. Yu Jiayan said: "This condition is entirely due to mismanagement. The exterior and interior of the Yangming Stomach channel are unclear, with pathogenic heat inside burning like a prairie fire, drying up all body fluids, leading to coma and delirium, and macules turning purple-black, resulting in immediate death. Although difficult to save now, his complexion is not withered, and his voice is still loud, indicating sufficient kidney essence from daily care, like underground springs remaining in a drought-stricken field. Thus, although confused, urination continues, a sign that yin qi is not exhausted. Huaban Baihu Tang (Macule-Resolving White Tiger Decoction) should be used. Since the central yuan qi has dispersed, large and urgent doses are unsuitable. With internal blazing deficiency heat, only sweet-cold flavor profiles can harmonize it. However, while the formula should be small, administration should be frequent. Like feeding a starving person gradually, five to seven doses should be given frequently throughout a day and night using an 'immersion' method, so pathogenic heat resolves gradually and yuan qi regenerates. If small doses are used over long periods, even correct medication will be too late. Following this treatment, after another day and night, the patient's fever subsided, spirit clarified, pulse normalized, appetite returned, and macules resolved spontaneously."
6. A patient presented with headache, abdominal distension, heavy body unable to turn, oral discomfort, and delirious speech. You Zaijing said: "This is a combined disease of the Three Yangs. Headache is a Taiyang symptom; abdominal distension, heaviness, insensitivity of the mouth, and delirium are Yangming symptoms; difficulty turning is a Shaoyang symptom." Two doses of Baihu Tang (White Tiger Decoction) were administered continuously, gradually reducing symptoms. Maidong (Ophiopogonis Radix) and Huafen (Trichosanthis Radix) were added, and stability was achieved after two doses.
7. A man contracted Shanghan (cold damage) after sexual exhaustion. Adhering to a taboo against medication, his fever subsided, but more than ten days later, he suddenly became comatose, shivering violently, with ice-cold hands and feet. A physician wanted to use Jiang (Zingiberis Rhizoma) and Fuzi (Aconiti Lateralis Radix Praeparata). The owner suspected a Yin syndrome and desired these drugs. Yu Jiayan strongly argued it was Heat Jue (reversal coldness due to heat) and forbade their use. Diaowei Chengqi Tang (Harmonizing the Stomach and Directing Downward Decoction), weighing about five qian, was decocted and taken warm in half a cup. After a short while, another half cup was taken warm. The reversal coldness gradually receded, and consciousness returned. The same medicine was continued until the dose finished, resulting in full clarity of mind. Suddenly, high fever erupted. Another dose of Daxiehu Tang (Major Bupleurum Decoction) was given, after which fever subsided and the body felt comfortable. Generally, in Shanghan, initial fever consumes body fluids; dry nose, thirst, constipation, and subsequent Jue indicate heat. It is rare for a Yang syndrome to suddenly transform into Yin Jue. Yin Jue arises from Yin syndromes, where winter cold pathogens strike directly into the Shaoyin channel without headache or fever, presenting with blue lips, pale face, trembling, no sweat, loose stools, clear urine, non-thirsty, curled posture, and excessive sleep, waking clear-minded—completely different from the deepening heat of transmitted Shanghan. [This case suits Sini Tang (Frigid Extremities Decoction) for emergency rescue; see *Yimen Falü* Cold Chapter.] Books group Yin and Yang Jue together, confusing even experts. For this case, post-sexual exhaustion Shanghan, physicians often confuse it for Yin syndrome and prescribe Sini Tang, accelerating death. Post-coital external contraction is merely heavier than usual (extreme heat or cold) due to yin deficiency allowing yang to invade, not yin excess excluding yang. Zhang Zhongjing's pungent-hot formulas were designed for errors in sweating, purging, or vomiting (e.g., loss of yang from excessive sweating, restlessness from vomiting/diarrhea, cold limbs). They were not for Yin syndromes in transmitted Shanghan. Once fever and thirst appear in Shanghan, yin is already deficient; mismanagement makes yang more deficient than yin, necessitating temporary pungent-hot use to save yang, vastly different from pure yin/no yang or yin excess repelling yang. Later generations copying formulas without understanding intent fail to realize: treating Yin syndrome prioritizes saving yang; treating Shanghan prioritizes saving yin. Even if Shanghan involves yang deficiency, one must ensure the patient has robust flesh/blood and yin can tolerate yang drugs before restoring yang. If the face is dark, tongue black, body like dried firewood with internal blazing evil heat, yin is exhausted, so what yang can be restored? Preserving even 10% of yin/fluids/energy after clearing heat is late enough; how dare one assist yang and rob yin?
8. A patient with Shanghan for nine days could not speak, see, move, and had cold limbs. All called it a Yin syndrome. You Zaijing palpated six pulses as absent. Pressing the abdomen, the patient protected it with both hands and frowned in pain. Palpating the Chongyang point (pulse on the dorsum of foot, 5 cun above ankle bone), the pulse was large and forceful, indicating dry feces in the abdomen. Dachengqi Tang (Major Order the Qi Decoction) was given to purge. Six or seven pieces of dry stool were passed, and speech and movement resumed.
9. A patient with Shanghan had incessant diarrhea by the fifth day, with mental restlessness and eye swelling, unresponsive to various medicines. Some gave Yam (Dioscoreae Rhizoma) and Poria (Poria) fearing collapse. You Zaijing found sinking, rapid pulses and tenderness at the umbilicus, diagnosing heat-collateral spontaneous diarrhea with bound stool. Xiaochengqi Tang (Minor Order the Qi Decoction) with doubled Dahuang (Rhei Radix et Rhizoma) was given. Bound stool was passed, diarrhea stopped, and restlessness resolved.
10. A man contracted Shanghan after sexual exhaustion and eating dog meat. Physicians, seeing deficiency, used simultaneous attack and tonification, leading to madness, climbing roofs, shouting day and night for months. Zhu Yuanzhai was summoned. He ordered two jin of Renshen Gao (Ginseng Paste) prepared. Several qian of moistening pills were given, expelling countless black stools, stabilizing the condition. Near death, Renshen Gao was slowly infused. Full recovery occurred after 120 days.
11. A man contracted Shanghan after eating beef. Exterior pathogens resolved, but he remained silent, lying motionless. Palpating the abdomen, he protected it with hands, indicating dry stool—a great excess presenting with weakness. Chengqi Tang was administered, expelling extremely foul fecal water, even bloody water flowing sideways. I said: "Long illness weakens stomach qi transport. Renshen (Ginseng Radix et Rhizoma) is needed in Chengqi Tang to assist movement of retained matter." Huanglong Tang (Yellow Dragon Decoction) was used. Severe abdominal pain followed by passage of countless black stools, reversing the critical state.
12. A young girl with Shanghan developed Yangming Stomach excess requiring purgation. Chengqi Tang was given, yielding red, yellow, or black fecal water. Abdominal pain and chest oppression persisted. I said: "Long-standing heat consumes fluids; excessive purgation damages yin." Maidong (Ophiopogonis Radix, 1 liang) and Gualou (Trichosanthis Fructus, 1 piece) clear lung and benefit large intestine (large intestine governs fluids, paired with Lung which governs qi and fluid transformation). Shengdi (Rehmanniae Radix, 2 liang) nourishes yin and unblocks bowels (kidneys govern fluids and bowels, blood moistens). After completion, bound stool passed, hunger arose, and porridge was requested.
13. A Taishi (Grand Secretary) contracted external pathogen in spring: headache, fever, thirst, white foam vomit, ceaselessly day and night. Physicians mistakenly attributed this to recent dismissal, prescribing soothing depression and moving qi herbs ineffectively. Siwu Tang (Four Substances Decoction) worsened it. After 20+ days, Miao Zhongchun said: "External pathogen, neither released nor purged, left heat lingering in intestines/stomach. Fortunately, yuan qi remains, preventing death." Chaidou Chi (Fermented Soybean), fried fragrant (2 he); Maidong (1 liang); Zhimu (Anemarrhenae Rhizoma, several qian); Shigao (1 liang). One dose induced profuse sweating and resolution. Bowels still unopened. Long illness means fluids haven't returned; intestinal dryness exists without pathogen. Advised eating 2-3 sugarcane stalks daily and drinking much Maidong soup. Within three days, over 60 pieces of dry stool passed, and he recovered.
14. A servant contracted cold with fever, splitting headache, tearing eye pain, whole-body bone/muscle pain (worse in lower body, knife-like), unbearable thirst, daily bowel movement, chest fullness, insomnia. Miao Zhongchun diagnosed Taiyang-Yangming combined disease. Poor people often labor, worsening lower body pain. Qianghuo (Notopterygii Rhizoma et Radix, 2.5 qian) dispels Taiyang pathogen. Ge Gen (Puerariae Radix, 3 qian), Zhuye (Bambusae Folium, 100 leaves), Shigao (1.5 liang), Zhimu (3.5 qian), Maidong (8 qian) clear Yangming heat. Gualou Shi (Trichosanthis Fructus, half piece), Zhishi (Aurantii Fructus Immaturus, 1 qian), Jiegeng (Platycodonis Radix, 1 qian) relieve chest stagnation. Four doses cured him.
15. A postpartum woman with irregular diet and wind-cold contraction developed fever, delirium, wheezing/cough, reversed qi flow, and cessation of lochia. Critical urgency. Miao Zhongchun said: "All are external pathogenic factors, salvageable. If righteous qi collapsed, no hope. Why? Floating, large, forceful pulse indicates strength." Large dose of wind-dispersing and food-resolving herbs cured her in two doses. Previously, Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), Xiong (Chuanxiong Rhizoma) tonics nearly caused error.
16. A patient with Shanghan on day two had headache and fever in the Taiyang stage. You Zaijing noted: "First month, weather still cold. Ma Huang Tang (Ephedra Decoction) given hot. Profuse sweat ensued. Covered tightly for half a day, changed clothes, spirit refreshed." Evening: requested porridge. Family refused. You Zaijing: "Pathogen resolved, won't transmit inward. Porridge is fine." Next day: recovered. Without Ma Huang sweating, pathology would deepen, taking half a month to settle.
17. A patient with Warm Disease in spring: head heavy on pillow, body heavy on mat, immobile, faint breath, mute, afraid of noise. Due to winter failing to store essence, weakness couldn't bear disease. Renshen (7 fen) added to sweating herbs; sweating decreased next day. Renshen (1 qian) added to harmonizing herbs; bowel movement occurred. Said: "Exterior resolved, interior harmonized. Gentle regulation will cure."
18. Shanghan patient, days 6-7: fever, red eyes, asked for water, put it down without drinking, extreme irritability, opened doors/windows, lay on ground, restless, wanted to enter well. Physician wanted Chengqi Tang. Yu Jiayan palpated surging, immense pulse, empty on deep pressure. Said: "Indication for Renshen, Fuzi, Ganjiang (Zingiberis Rhizoma). Why treat as purgation indication?" Physician: "Fever/red eyes, excess pathogen, so irritable. Renshen/Ginger/Aconite would make him climb walls!" Yu Jiayan: "Yang about to collapse, false heat outside, true cold inside. Ginger/Aconite might barely suffice; pure yin drugs would severely rob yang. Refusing water shows truth. Would he drink Nitre/Rhubarb if he won't drink water? Hot weather brings rain; this patient will sweat profusely and die. Only Ginger/Aconite works: tonifying with dispersing, scattering pathogen, reducing heat. Safe and appropriate." Renshen (3 qian), Jiang/Fuzi/Gancao (2 qian each), decocted and taken cold. Post-ingestion: chattering teeth, covered with thick cotton, withdrew hand from pulse taking, revealing weak yang signs. Given medicine again: slight sweat, fever subsided, stable. [Note: Transmitted Shanghan is called Heat Disease. Wind-cold closes pores; innate fire trapped generates heat, not wind-cold becoming heat. Hence 'wind transforming to heat', 'yang constraint generating heat'. Zhang Zhongjing calls wind-cold heat pathogen. Heat transmits inward via skin/muscles/organs, accumulating heat, never suddenly becoming cold. Hence 'Heat Disease'. However, constitution varies. Taiyin types wear layers in summer, get diarrhea from cool food; chronic yang deficiency/yin excess. Sudden wind-cold strikes Yin channels, double cold, yin excess forces yang out, causing 'extreme yin resembling yang'. Rare (1 in 1000-2000). Included to teach seeking absence (*Neijing*).]
19. Woman with Heat entering Blood Chamber: madness, wanting to kill. Physician treated as Shanghan. Miao Zhongchun: "Wrong. First give Tongbian (Child's Urine), then cooling-blood, blood-moving, and spirit-calming herbs. Stabilized."
20. Shanghan patient: after fever resolved, persistent bleeding. Dysentery medicines worsened it. Miao Zhongchun: "Residual symptom from missed sweating in Shanghan." Yuyu (Sanguisorbae Radix), Maidong, Zhimu, Zhuye substituted for Zhang Zhongjing's blood-hemostasis formulas. Cured.
21. Patient with recurring Shanghan recovery/recurrence cycles. Yellow-white complexion, weak pulses, constipation, chest discomfort, anorexia. Miao Zhongchun: "Chest discomfort is deficiency with qi stagnation, not excess pathogen. Constipation is long illness fluid depletion, weak qi unable to push. Renshen (5 qian), Maidong (1 liang), Zhike (Aurantii Fructus, 8 qian). One dose cured."
22. Jiang Zhongzun from Chongming, critical Shanghan, requested rice washed in meat broth. Ate half bowl, shouted once, died. Yu Jiayan explained: "Modern external contraction often combines internal injury. Dosage must distinguish. 70% external, 30% internal: use mild/small external herbs, ginger/jujube to harmonize middle, avoiding vigorous sweating/blood loss. 70% internal, 30% external: focus on internal injury, add one exterior-releasing herb, take hot to boost effect, external pathogen disperses. Internal injury patients react immediately to slight external triggers, unlike robust people needing deep infection. Jiang had oily face, showing outward spirit leakage, not longevity. Deficiency allows resilience; outward brilliance depletes reserves. He indulged in official ambition and lust, exposed to mist/fog (external pathogen affecting qi passages, not transmitting). Mist doesn't require exterior release/purgation; tonify yuan qi/grain qi to expel naturally. Misdiagnosing dizziness/fever as Taiyang and sweating would worsen internal injury, causing death. Internal injury patients suffer from feast/fast cycles. Misdiagnosing as Shanghan and fasting increases deficiency. Hungry abdomen seeks food; eating causes shout and death (intestinal rupture/qi interruption). Clear logic: starving people collapse and die from qi interruption. Esophageal cancer patients dying with shouts know their end clearly without external chaos. If external/pathogen struggle existed, confusion would precede death." Asked: "People with outward brilliance sweat/restlessly; what treats them?" Answer: "Highest medicine uses spirit to treat spirit. Outward spirit must return inward to reverse decline. Herbs should be heavy/sinking to nourish, like watering a garden frequently to prevent drought." Asked: "Can medicine save at the moment of craving food?" Answer: "Dushen Tang (Single Ginseng Decoction) can save."