赵景翕太史。闻昌来虞谭医。一旦先之以驷马。昌心仪其贤。欲敬事而效药笼之用久矣。孟冬末。三公
郎令室。患伤寒。医药无功。渐至危笃。先日进白虎汤。其热稍缓。次日进人参白虎汤。其势转重。皇皇求
医。因而召诊。昌闻其咳声窘迫。诊其脉数无力。壮热不退。肌肤枯涩。沉困不食。语景翕先生曰。此
病大难为。惟不肖尚可悉心图成。以报知己。疏方用仲景麻黄杏仁甘草石膏汤四味。先生颇疑麻黄僭汗。因问
钱宗伯。公郎服西河柳犀角而疾瘳。今可用乎。昌曰。论太阳阳明两经合病。其症颇似。但彼病秋热。此病冬
寒。安得比而同治。况病中委曲多端。河柳犀角。原非正法。惟仲景麻杏甘石一汤。允为此病天造地设。有一
无二之良法。先生韪之。其房中女伴。以不省宜话。兼未悉昌之生平。争用本地经验名家。乃至服河柳而表终
不解。服犀角而里终不解。且引热邪直攻心脏。其颠悖无伦。较胃实谵语更增十倍。医者始辞心偏。不可救
药。吁嗟。人心位正中央。皇建有极。而何以忽偏耶。伤寒膀胱蓄血。有如狂一证。
其最剧者。间一发狂。旋复自定。即心脏最虚。元神飞越者。间有惊狂卧起不安一证。未闻有心偏之说也。而
病者何以得此乎。未几阳反独留。形如烟熏。发直头摇。竟成心绝之候。此段疑案。直若千古不决。孰知有
麻杏甘石为持危扶颠之大药也哉。门人请曰。麻杏甘石汤。不过一发表药耳。何以见其能起危困。万一用之罔
效。又何以起后学之信从耶。余曰。此渊源一脉。仲景创法于前。吾阐扬于后。如锥入木。如范 金。所以称
为天造地设。有一无二之法。用则必效。确无疑也。盖伤寒一证。虽云传足不传手。其实足经而兼手经者恒
多。医者每遇足经六传之病。尚尔分证模糊。至遇兼手十二经之证。鲜不五色无主矣。足经譬西北也。手经譬
东南也。道理之近远不同。势自不能以飞渡。然乘舋召邪。阻险割据。岂曰无之。今病家为足太阳膀胱。
足阳明胃。两经合病。既已难任。更加两经之邪。袭入手太阴肺经。所以其重莫支。手太阴肺者。主统一身之
气者也。气通则汗出。气闭则汗壅。从前发汗而不得汗。驯至肌肤枯涩。岂非肺主皮毛。肺气壅闭。津液不
通。漫无润泽耶。任用柴胡葛根河柳辛凉解肌。如以水投石。有拒无纳。职此故耳。病者为昆邑开府王
澄川先生之女。孝敬夙成。皎然与女曜争光。澄川先生。尝患鼻 。诸女禀之。咸苦肺气不清。鼻间窒塞。
所以邪易凑入。才病外感。盒饭蚤为足经传手之虑。通其肺气之壅。俾得汗出邪去。始称明哲。此病为足太阳
膀胱。足阳明胃。两经合病。则足太阳之邪。繇背而贯胸。足阳明之邪。由胸而彻背。肺为华盖。覆于
胸背之上。如钱孝廉素无肺患者。病时尚且咳嗽紧逼。岂居尝肺气不清之体。可堪两经之邪交射乎。其用白虎
汤。为秋令清肃之药。肺金所喜。故病势稍持。才加人参五分。即转沉重。岂非肺热反伤之左券乎。至于犀
角。乃手少阴心经之药。夏月心火亢甚。间有可用。冬月水盛火衰。断非所宜。又况手少阴心
经。与手太阴肺经。膜属相联。以手经而传手经。其事最便。所
以才一用之。随领注肺之邪。直攻心脏。正如足太阳误用葛根。即领其邪传入阳明之例耳。不然。伤寒之邪。
过经不解。蕴祟日久。不过袭入厥阴心胞络已耳。岂有直攻心脏之理哉。吾用麻黄发肺邪。杏仁下肺气。石膏
清肺热。甘草缓肺急。盖深识仲景制方之妙。颛主足经太阳者。复可过于手经太阴用之。一举而解手足两经之
危。游刃空虚。恢恢有余。宁致手复传手。而蹈凶祸乎。乃知肺脏连心。正如三辅接壤王畿。误用犀角领邪
攻心。无异献门迎贼。天之报施圣君贤女。抑何惨耶。余非乏才无具者。而袖手旁观。不禁言之亲切。有如子
规之啼血也已。
赵景翕太史听说我来到虞谭行医，立刻先派四匹马拉的车子来请。我心中一直仰慕他的贤德，想要恭敬地侍奉并效法药笼中备用的良方，已经很久了。孟冬（农历十月）末，赵三公的儿媳患伤寒，用药无效，病情逐渐加重到危险的地步。前一天使用了白虎汤，她的发热稍微缓解；第二天使用了人参白虎汤，病情反而加重。她惊慌失措地求医，因此召我来诊察。
我听到她咳嗽声音急促窘迫，诊察她的脉搏数而无力，壮热不退，肌肤干枯涩滞，精神沉困不想进食。我对景翕先生说：“这个病很难治，只有我不才之人还可以尽心竭力去图谋治愈，以报答知己之情。”于是开方使用张仲景的麻黄杏仁甘草石膏汤这四味药。先生颇为怀疑麻黄会导致过度发汗，于是询问钱宗伯说：“赵公郎之前服用西河柳和犀角后疾病痊愈，现在可以用吗？”我说：“讨论太阳经和阳明经两经合病的情况，症状颇为相似。但是那个病是秋季的热病，这个病是冬季的寒病，怎么能相比而同治呢？况且病中的情况复杂多变，西河柳和犀角原本就不是正治之法。只有张仲景的麻杏甘石汤，确实是为此病天造地设、独一无二的好方法。”先生认为我说得对。
他房中的女伴们，因为不懂适宜的道理，加上不了解我的生平，争相使用本地经验丰富的名医的方法，结果服用西河柳后表证始终不解，服用犀角后里证始终不解，而且引动热邪直接攻击心脏，导致患者神志颠狂悖乱，比胃实谵语的症状更严重十倍。医生们这才推辞说是心气偏衰，不可救药。唉！人心位居正中，建立有极致的准则，为什么忽然会偏斜呢？伤寒中有膀胱蓄血证，出现如狂的症状，最严重的偶尔会出现发狂，随即又自行安定；即使是心脏最虚、元神飞越的情况，偶尔也有惊狂、卧起不安的症状，从未听说过“心偏”的说法。那病人怎么会得这种病呢？不久阳气反独留，形体如烟熏，头发直竖头摇，最终成为心绝的征候。这段疑案简直像千古未决之谜，谁知道有麻杏甘石汤作为扶持危局的大药呢？
门人问道：“麻杏甘石汤不过是一首发表的药，怎么看出它能挽救危困？万一用了没有效果，又怎么能兴起后学者的信服之心呢？”我说：“这是渊源一脉相承，张仲景在前创立法则，我在后阐扬发扬。就像锥子刺入木头，像铸造金属的模子，所以称为天造地设、独一无二的方法。用了必定有效，确实毫无疑问。大概伤寒这一病症，虽然常说传足经不传手经，其实足经兼及手经的情况很多。医生们每当遇到足经六经传变的病，尚且分证模糊，至于遇到兼及手十二经的证候，无不惊慌失措。足经好比西北，手经好比东南，道理的近远不同，形势自然不能飞跃跨越。然而乘着缝隙招致邪气，阻险割据，难道没有这种情况吗？现在的病家是足太阳膀胱经和足阳明胃经两经合病，已经难以承受，再加上这两经的邪气，侵袭入手太阴肺经，所以病情重得无法支撑。手太阴肺经，主管统摄一身之气。气通则出汗，气闭则汗液壅滞。从前发汗却不得汗，逐渐导致肌肤干枯涩滞，这难道不是肺主皮毛，肺气壅闭，津液不通，漫无润泽吗？任用柴胡、葛根、西河柳等辛凉解肌的药物，如同把水投在石头上，有拒绝没有接纳，就是这个缘故。
这位病者是昆邑开府王澄川先生的女儿，孝敬之心素来养成，皎洁明亮与女曜争辉。澄川先生曾经患有鼻疾，各位女儿都禀受了这种体质，都苦于肺气不清，鼻间窒塞。所以邪气容易凑入，刚病外感，就应当早为足经传入手经的顾虑，通利肺气的壅滞，使得汗出邪去，这才称得上明智。此病为足太阳膀胱、足阳明胃两经合病，那么足太阳的邪气，从背部贯穿到胸部；足阳明的邪气，从胸部彻达背部。肺为华盖，覆盖在胸背之上。像钱孝廉素来没有肺病，生病时还咳嗽紧逼，何况平时肺气就不清的身体，怎能承受两经邪气的交叉射击呢？
使用白虎汤，是因为它是秋季清肃的药物，是肺金所喜好的，所以病势稍微维持住。才加上五分人参，病情就转重，这难道不是肺热反而受伤的证据吗？至于犀角，是手少阴心经的药物，夏季心火亢盛时，偶尔可以使用，冬季水盛火衰时，绝对不是适宜的。更何况手少阴心经与手太阴肺经，膜原相连属，用手经药传到手经，事情最为便利。所以才一用犀角，随即领受注肺的邪气，直接攻击心脏。正如足太阳误用葛根，就是引领邪气传入阳明的例子罢了。不然的话，伤寒的邪气，经过经络不解，蕴积日久，也不过是袭入厥阴心包络而已，哪里有直接攻击心脏的道理呢？
我用麻黄发散肺邪，杏仁降下肺气，石膏清泄肺热，甘草缓和肺急。这是因为深刻认识到张仲景制方的奥妙，专主足经太阳的，也可以过于手经太阴使用。一举而解除手足两经的危机，游刃有余，宽绰有余，难道要导致手经复传手经，而陷入凶祸吗？由此可知肺脏连心，正如三辅接壤王畿。误用犀角引领邪气攻心，无异于开门迎贼。上天报施给圣君贤女的，为何如此惨烈呢？我并非缺乏才能和见识的人，但袖手旁观，不禁说得亲切，就像杜鹃啼血一样啊。
Zhao Jingxi, a Grand Historian, heard that I had come to Yutan to practice medicine and immediately sent a carriage drawn by four horses to invite me. I had long admired his virtue in my heart and wished to serve him respectfully and utilize remedies as one would use items from a well-stocked medicine cabinet. At the end of the first month of winter (lunar October), the wife of Zhao San Gong's son contracted Shanghan (Cold Damage). Medical treatment proved ineffective, and her condition gradually deteriorated to a critical state. On the previous day, Baihu Tang (White Tiger Decoction) was administered, and her fever subsided slightly; on the next day, Renshen Baihu Tang (Ginseng White Tiger Decoction) was given, but her condition worsened. Panicked, she sought medical help, leading to my summons for consultation.
I observed her coughing with a strained and urgent sound and palpated her pulse, which was rapid yet forceless. She suffered from persistent high fever, dry and rough skin, mental lethargy, and loss of appetite. I said to Mr. Jingxi, "This illness is extremely difficult to treat. Only I, though unworthy, can devote myself entirely to attempting a cure, to repay the kindness of a confidant." I then prescribed the four-herb formula Ma Huang Xing Ren Gan Cao Shi Gao Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction) created by Zhang Zhongjing. Mr. Zhao suspected that Ma Huang (Ephedra) might cause excessive sweating and asked Qian Zongbo, "When Zhao Gong Lang recovered after consuming Xi He Liu (Tamarisk Twig) and Xi Jiao (Rhinoceros Horn), could we use them now?" I replied, "Discussing the combined disease of the Taiyang (Greater Yang) and Yangming (Yang Brightness) meridians, the symptoms are indeed similar. However, his illness was an autumnal heat pathogen, whereas this is a winter cold pathogen. How can they be treated identically? Moreover, the pathology is complex. Xi He Liu and Xi Jiao are not the orthodox methods. Only Zhang Zhongjing's Ma Huang Xing Ren Gan Cao Shi Gao Tang is truly heaven-sent and uniquely suited for this disease." Mr. Zhao agreed.
The female companions in her room, lacking knowledge of appropriate treatments and unfamiliar with my background, insisted on using local experienced physicians' methods. Consequently, after taking Xi He Liu, the exterior syndrome remained unresolved; after taking Xi Jiao, the interior syndrome remained unresolved. Furthermore, these herbs drew the heat pathogen directly into the Heart, causing severe delirium and irrational behavior, ten times worse than the delirium seen in Yangming excess patterns. The physicians then excused themselves, claiming heart qi deviation and declaring the case incurable. Alas! The Heart resides in the center, establishing the ultimate standard, so why did it suddenly deviate? In Shanghan, there is a pattern of Bladder Blood Stasis presenting as 'resembling madness'; at its most severe, occasional full madness occurs, followed by spontaneous recovery. Even in cases of extreme Heart deficiency where the Yuan Shen (Primal Spirit) flies away, occasional patterns of fright-induced madness, restlessness, and inability to lie still exist, but never a concept of 'Heart Deviation.' How did this patient acquire such a condition? Soon, yang qi remained alone, the body appeared smoked, hair stood straight, and the head shook, eventually becoming a sign of Heart exhaustion. This puzzling case seemed like an ancient mystery unsolved for millennia, who knew that Ma Huang Xing Ren Gan Cao Shi Gao Tang serves as a great medicine to support critical conditions?
A student asked, "Ma Huang Xing Ren Gan Cao Shi Gao Tang is merely a releasing-the-exterior formula. How do you know it can rescue critical danger? If it proves ineffective, how will it inspire confidence among future practitioners?" I said, "This lineage is continuous. Zhang Zhongjing established the method previously, and I elucidate it subsequently. It is like an awl piercing wood or a mold casting metal; thus it is called heaven-sent and unique. It will surely be effective, without doubt. Generally, although it is said that Shanghan transmits through the Foot meridians and not the Hand meridians, it is common for Foot meridian diseases to involve Hand meridians. When doctors encounter diseases transmitting through the six Foot meridians, their differentiation is often vague; when encountering syndromes involving the twelve Hand meridians, they are rarely not bewildered. The Foot meridians are like the Northwest; the Hand meridians are like the Southeast. The principles differ in proximity and distance, making transmission across them difficult. However, seizing opportunities for pathogens to enter via gaps and occupying strategic positions—does this not happen? Now, the patient suffers from a combined disease of the Foot Taiyang Bladder Meridian and Foot Yangming Stomach Meridian, already bearing a heavy burden. Adding the pathogenic factors from these two meridians invading the Hand Taiyin Lung Meridian makes the severity unbearable. The Hand Taiyin Lung Meridian governs and unifies the qi of the whole body. When qi flows freely, sweat is produced; when qi is obstructed, sweat is stagnant. Previously, sweating attempts failed, leading to dry and rough skin. Is this not because the Lung governs the skin and hair, and Lung qi obstruction prevents fluid distribution, leaving the body unmoistened? Using Chai Hu (Bupleurum), Ge Gen (Pueraria), and Xi He Liu (Tamarisk Twig) for acrid-cool muscle-releasing is like throwing water on stone—it is rejected, not absorbed. This is the reason.
The patient is the daughter of Wang Chengchuan, Prefect of Kunyi. Her filial piety was formed early, shining brightly alongside the stars. Mr. Chengchuan once suffered from nasal disorders, and all his daughters inherited this constitution, suffering from unclear Lung qi and nasal congestion. Thus, pathogens easily invaded. Upon contracting an external pathogen, one should have anticipated the transmission from Foot to Hand meridians and promoted Lung qi flow to allow sweating and pathogen expulsion, which would be wise. This disease involves the combined pathology of the Foot Taiyang Bladder and Foot Yangming Stomach meridians. The pathogen of Foot Taiyang penetrates from the back to the chest; the pathogen of Foot Yangming extends from the chest to the back. The Lung is the Canopy, covering the chest and back. Even Qian Xiaolian, who had no prior lung issues, suffered from tight coughing during illness. How could a body with chronically unclear Lung qi withstand the cross-fire of pathogens from two meridians?
Using Baihu Tang (White Tiger Decoction) worked initially because it is a clearing and purging herb for autumn, pleasing to Metal (Lung), so the disease momentum was temporarily held. But adding only five fen of Renshen (Ginseng) caused the condition to worsen. Is this not evidence that Lung heat was further injured? As for Xi Jiao (Rhinoceros Horn), it is a herb for the Hand Shaoyin Heart Meridian. It may be used occasionally in summer when Heart fire is hyperactive, but in winter, when Water is abundant and Fire is weak, it is absolutely inappropriate. Moreover, the Hand Shaoyin Heart Meridian and Hand Taiyin Lung Meridian are connected via membranes. Transmitting via Hand meridians is convenient. Thus, upon using Xi Jiao, it led the Lung-infiltrating pathogen directly to attack the Heart. This is analogous to mistakenly using Ge Gen (Pueraria) in Foot Taiyang, which leads the pathogen into Yangming. Otherwise, Shanghan pathogens lingering past their stage and accumulating over time would only invade the Jueyin Pericardium, let alone directly attack the Heart.
I used Ma Huang (Ephedra) to disperse Lung pathogens, Xing Ren (Apricot Seed) to descend Lung qi, Shi Gao (Gypsum) to clear Lung heat, and Gan Cao (Licorice) to缓 (moderate) Lung urgency. This demonstrates a deep understanding of Zhang Zhongjing's prescription wisdom. Although focusing on the Foot Taiyang Meridian, one can appropriately apply it to the Hand Taiyin Meridian, resolving crises in both Hand and Foot meridians in one move, operating with ease and ample room. Why lead the Hand meridian to transmit to itself and fall into disaster? Knowing that the Lung connects to the Heart, just as the Three Commanderies border the Royal Domain, mistakenly using Xi Jiao to guide pathogens to attack the Heart is like opening the gate to welcome thieves. How cruel is Heaven's retribution upon the sage ruler and virtuous daughter! I am not lacking talent or insight, but watching helplessly, I speak with heartfelt urgency, like the cuckoo crying blood.