钱仲昭患时气外感三五日。发热头痛。服表汗药。疼止热
不清。口干唇裂。因而下之。遍身红 。神昏谵语。食饮不入。大
便复秘。小便热赤。脉见紧小而急。谓曰。此证全因误治。阳明胃经表里不清。邪热在内。如火燎原。津
液尽干。以故神昏谵语。若 转紫黑。即刻死矣。目今本是难救。但其面色不枯。声
音尚朗。乃平日保养。肾水有余。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。
尚可治之。不用表里。单单只一和法。取七方中小方。而气味甘寒者用之。惟如神白虎汤一方。足以疗此。
盖中州元气已离。大剂急剂复剂俱不敢用。而虚热内炽。必甘寒气味。方可和之耳。但方须宜小。而服药则
宜频。如饥人本欲得食。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。若小其剂复旷其日。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 自化。
胡卣臣先生曰。病与药所以然之地。森森警发。
张令施乃弟伤寒坏证。两腰偻废。卧床彻夜痛叫。百治不效。求诊于余。其脉亦平顺无患。其痛则
比前大减。余曰。病非死证。但恐成废人矣。此证之可以转移处。全在痛如刀刺。尚有邪正互争之象。若全然
不痛。则邪正混为一家。相安于无事矣。今痛觉大减。实有可虑。宜速治之。病者曰。此身既废。命安从
活。不如速死。余蹙额欲为救全。而无治法。谛思良久。谓热邪深入两腰。血脉久闭。不能复出。只有攻散一
法。而邪入既久。正气全虚。攻之必不应。乃以桃仁承气汤。多加肉桂附子二大剂与服。服后即能强起。再
仿前意为丸。服至旬余全安。此非昔人之已试。乃一时之权宜也。然有自来矣。仲景于结胸证。有附
子泻心汤一法。原是附子与大黄同用。但在上之证气多。故以此法泻心。然则在下之证血多。
独不可仿其意。而合桃仁肉桂以散腰间之血结乎。后江古生乃弟。伤寒两腰偻废痛楚。不劳
思索。径用此法二剂而愈。
胡卣臣先生曰。金针虽度。要解铸古熔今。始能下手。
钱仲昭患有时气外感病，经过三五天。出现发热、头痛的症状。服用了发汗解表的药物后，疼痛停止但热势未退。出现口干、嘴唇干裂的情况。因此又使用了泻下法治疗。导致全身出现红色斑疹，神志昏迷并胡言乱语，饮食无法进入，大便再次秘结不通，小便灼热且颜色深红。脉象表现为紧、细而急促。我对他说：这个病症完全是因为误治造成的。阳明胃经的表里之气不清爽，邪热蕴结在体内，就像大火燎原一样，津液已经全部枯竭。所以出现神志昏迷、胡言乱语的症状。如果舌苔转为紫黑色，就会立即死亡。目前病情本来难以救治，但是他的面色没有枯槁，声音依然洪亮，这是因为他平日注重保养，肾水充足。就像干旱田地的一侧，还有地下泉水没有枯竭。所以虽然神志昏乱，但小便仍然通畅，这是阴气尚未断绝的迹象。还可以进行治疗。不使用解表和攻下的方法，单单只用“和法”。选取七方中的小方，采用气味甘寒的药物来使用。只有如神白虎汤这一张方子，足以治疗此病。因为中焦脾胃的元气已经离散，大剂量、急剂量、重复剂量的药物都不敢使用。而虚热在内炽盛，必须用甘寒气味的药物，才能调和它。但是药方剂量必须适宜小巧，而服药则应该频繁。就像饥饿的人本想进食，不得不逐渐给予他。必须在一昼夜内频繁服用五到七剂，采取浸灌的方法。这样或许能让邪热逐渐解除，元气逐渐恢复。如果减小药量却拉长服药间隔时间，即使用药得当，也来不及挽救了。按照这种方法治疗，过了一昼夜后，病人热退神清，脉象平和，能够进食，身上的斑疹自然消退。
胡卣臣先生评价说：对疾病与药物之所以然的原因分析得清清楚楚，令人警醒启发。
张令施的弟弟患有伤寒坏证（伤寒病迁延不愈或误治后的变证）。两腰弯曲僵硬无法伸直，整夜躺在床上痛苦呼叫。各种治疗方法都无效，于是向我求诊。他的脉象平顺无危险。疼痛比之前大大减轻。我说：这不是死证，但恐怕会沦为残疾人。这个病症可以转变的关键点在于，疼痛像刀刺一样，说明还有正气与邪气相互抗争的现象。如果完全不痛，那么邪气与正气混为一体，相安无事于表面了。现在疼痛感觉大大减轻，实在值得忧虑。应当迅速治疗。病人说：这身体既然已经废掉，性命从哪里存活？不如快速死去。我皱起眉头想要救活他，却想不出治疗方法。仔细思考了很久，认为热邪深入两腰，血脉长期闭塞，不能复出。只有攻散这一种方法。但是邪气侵入已久，正气完全虚弱，攻伐必然没有反应。于是使用桃仁承气汤，多加肉桂、附子两大剂给病人服用。服用后就能勉强起身。再仿照前面的意思制成丸药，服用十多天后完全康复。这不是前人已经尝试过的成法，而是一时的权宜之计。然而也是有源头的。张仲景在治疗结胸证时，有附子泻心汤这一种方法，原本就是附子与大黄同用。但在上部的证候气分病变多，所以用这种方法泻心火。那么在下的证候血分病变多，难道不可以仿效其意，合用桃仁、肉桂来消散腰间的血结吗？后来江古生的弟弟，患伤寒导致两腰弯曲僵硬疼痛，不需要多费思索，直接应用这种方法两剂就痊愈了。
胡卣臣先生评价说：金针虽然传授了，但要解释古代医理并融合现代临床实际，才能下手施治。
Qian Zhongzhao suffered from an external contraction of seasonal pathogenic factors. After three or five days, he developed fever and headache. He took diaphoretic (sweating-inducing) medicines; the pain ceased but the heat did not clear. His mouth became dry and lips cracked. Consequently, purgatives were administered. This resulted in red macules all over the body, coma with delirious speech, inability to take food or drink, constipation again, and hot, dark-red urine. The pulse was tight, fine, and rapid. I said to him: This condition is entirely due to mismanagement. The exterior and interior of the Yangming Stomach Meridian are unclear, with pathogenic heat trapped inside, like a prairie fire burning out of control, having exhausted all body fluids. Hence, coma and delirium occur. If the tongue turns purple-black, death will ensue immediately. Although the condition is currently difficult to save, his facial complexion is not withered, and his voice remains resonant. This indicates that he has maintained himself well in daily life, and his Kidney Water is abundant. It is like a side spring in a drought-stricken field that has not yet dried up. Therefore, although his spirit is confused, his urination remains patent, which is a sign that Yin Qi has not yet perished. Treatment is still possible. Do not use exterior-releasing or interior-purging methods; solely employ the Harmonizing Method (He Fa). Select a Minor Formula (Xiao Fang) from the Seven Categories of Formulas, using herbs with sweet and cold properties. Only the Rushen Baihu Tang (Miraculous White Tiger Decoction) is sufficient to treat this. Because the Yuan Qi (Original Qi) of the Middle Jiao has already dispersed, large doses, urgent doses, or repeated doses dare not be used. Since deficiency-heat blazes internally, only sweet-cold properties can harmonize it. However, the formula dosage must be small, while medication should be taken frequently. Like a starving person who desires food but must be given it gradually. Five or seven doses must be administered frequently within one day and night, employing the method of soaking and irrigating. Thus, pathogenic heat may gradually resolve, and Yuan Qi may gradually regenerate. If the dose is reduced but the interval between doses is prolonged, even if the medication is appropriate, it will be too late. Following this treatment, after one day and night, the patient’s heat subsided, spirit cleared, pulse became harmonious, and appetite returned; the macules transformed and disappeared naturally.
Mr. Hu Youchen commented: The analysis of the reasons behind the disease and the medicine is clear and strikingly enlightening.
Zhang Lingshi’s younger brother suffered from a Ruined Syndrome of Cold Damage (Shanghan Huai Zheng). His lower back was bent and paralyzed, lying in bed crying out in pain throughout the night. Various treatments failed. He sought my diagnosis. His pulse was smooth and regular without danger. The pain had decreased significantly compared to before. I said: This is not a fatal syndrome, but he may become disabled. The key point for potential recovery in this condition lies in the pain feeling like knife-stabbing, indicating a struggle between pathogenic factors and healthy Qi. If there were no pain at all, pathogenic factors and healthy Qi would merge into one family, coexisting peacefully on the surface. Now that the pain sensation has greatly diminished, it is truly concerning. Immediate treatment is necessary. The patient said: Since my body is already disabled, how can my life survive? It is better to die quickly. I frowned, wanting to save him, but could not find a treatment method. After deep contemplation for a long time, I reasoned that heat pathogens had penetrated deeply into the lower back, causing long-term closure of blood vessels, preventing them from reopening. Only the method of attacking and dispersing remained viable. However, since the pathogens had invaded for a long time, healthy Qi was completely deficient, and attacking would likely yield no response. Therefore, I prescribed Taoren Chengqi Tang (Peach Kernel and Rhubarb Decoction), adding large doses of Rougui (Cinnamon Bark) and Fuzi (Prepared Aconite Root). After taking it, he was able to rise with effort. Again, following the previous intention, I made pills. After more than ten days of intake, he fully recovered. This was not a pre-tested method by ancients, but a temporary expedient measure. Yet, it had its origins. Zhang Zhongjing, in treating Chest Binding Syndromes (Jie Xiong Zheng), employed the Fuzi Xiexin Tang (Aconite and Pinellia Decoction to Drain the Heart) method, originally combining Fuzi with Dahuang (Rhubarb Root and Rhizome). In upper-level syndromes where Qi pathology predominates, this method drains the Heart Fire. Then, in lower-level syndromes where Blood pathology predominates, why not imitate this intent and combine Taoren (Peach Seed) and Rougui to disperse blood stasis in the waist region? Later, Jiang Gusheng’s younger brother suffered from Cold Damage resulting in lower back bending, paralysis, and pain. Without much deliberation, I directly applied this method for two doses, and he was cured.
Mr. Hu Youchen commented: Although the golden needle has been passed on, one must interpret ancient principles and melt them into modern practice to effectively apply treatment.