黄长人犯房劳。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。举家
忙乱。亟请余至。一医已合就姜桂之药矣。余适见而骇之。姑俟诊毕。再三辟其差谬。主家自疑阴证。
言之不入。又不可以理服。只得与医者约曰。此一病。药入口中。出生入死。关系重大。吾与丈各立担承。倘
至用药差误。责有所归。医者曰。吾治伤寒三十余年。不知甚么担承。余笑曰。吾有明眼在此。不忍见人活活
就毙。吾亦不得已耳。如不担承。待吾用药。主家方才心安。亟请用药。余以调胃承气汤。约重五钱。煎
成热服半盏。少顷。又热服半盏。其医见厥渐退。人渐苏。知药不误。辞去。仍与前药服至剂终。人事大
清。忽然浑身壮热。再与大柴胡一剂。热退身安。门人问曰。病者云是阴证见厥。先生确认为阳证。而用下
药果应。其理安在。答曰。其理颇微。吾从悟入。可得言也。凡伤寒病。初起发热。煎熬津液。鼻干口渴便
秘。渐至发厥者。不问而知为热也。若阳证忽变阴厥者。万中无一。从古至今无一也。盖阴厥得之阴证。一
起便直中阴经。唇青面白。遍体冷汗。便利不渴。身蜷多睡。醒则人事了了。与伤寒传经之热邪。转入转深。
人事昏惑者。万万不同。诸书类载阴阳二厥为一门。即明者犹为所混。况昧者乎。如此病先犯房室。后成伤寒。
世医无不为阴厥之名所惑。往往投以四逆等汤。促其暴亡。而诿之阴极莫救。致冤鬼夜嚎。尚不知悟。总由传
派不清耳。盖犯房劳而病感者。其势不过比常较重。如发热则热之极。恶寒则寒之极。头痛则痛之极。所以
然者。以阴虚阳往乘之。非阴乘无阳之比。况病者始能无药。阴邪必轻。旬日渐发。尤非暴证。安得以厥阴之
例为治耶。且仲景明言。始发热六日。厥反九日。后复发热三日。与厥相应。则病旦
暮愈。又云。厥五日。热亦五日。设六日当复厥。不厥者自愈。明
明以热之日数。定厥之痊期也。又云。厥多热少则病进。热多厥少则病退。厥愈而热过久者。必便脓血发痈。
厥应下而反汗之。必口伤烂赤。先厥后热。利必自止。见厥复利。利止。反汗出咽痛者。其喉为痹。厥
而能食。恐为除中。厥止思食。邪退欲愈。凡此之类。无非热深热厥之旨。原未论及于阴厥也。至于阳分之
病。而妄汗妄吐妄下。以至势极。如汗多亡阳。吐利烦躁。四肢逆冷者。皆因用药差误所致。非以四逆真
武等汤挽之。则阳不能回。亦原不为阴证立方也。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证。相去天渊。后人不窥制方之意。
见有成法。转相效尤。不知治阴证以救阳为主。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。若面黧舌黑。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。证治方云。若证未辨阴阳。且与四顺丸试
之。直指方云。未辨疑似。且与理中丸试之。亦可见从前未透此关。纵有深心。无可奈何耳。因为子辈详辨。
并以告后之业医者。
胡卣臣先生曰。性灵自启。应是轩岐堂上再来。
黄长人因房事过度而患病，得了伤寒。他坚守不服药的禁忌，身体发热虽然已经消退，但在十多天后，突然陷入昏沉状态，全身战栗，手脚冰凉得像冰块一样，全家忙乱不堪，急忙请我前往诊治。当时有一位医生已经配好了生姜、肉桂的热性药物。我恰好看见对此感到震惊，暂且等待诊脉完毕，再三指出他的错误和谬误。主人家自己怀疑是阴证，但我的话听不进去，也无法用道理说服他们，只得与那位医生约定说：“这一场病，药吃下去，要么生要么死，关系重大。我和你各自承担责任。如果用药出现差错，责任要有所归属。”医生说：“我治疗伤寒三十多年，不知道什么担承。”我笑着说：“我有明眼在此，不忍心看着人活活死去，这也是不得已而为之。如果不肯承担责任，那就等我用药。”主家这才心安，急切地请求用药。
我使用了调胃承气汤，大约重五钱，煎好后热服半盏。过了一会儿，又热服半盏。那位医生见病人四肢厥冷逐渐消退，人渐渐苏醒，知道药没有用错，便告辞离去。随后继续服用前药直到疗程结束，人事变得非常清醒。忽然间浑身壮热，再给予大柴胡汤一剂，热退身安。门人问道：“病人说是阴证出现的厥逆，先生确认为阳证，而使用泻下药果然有效，其中的道理何在？”我回答说：“其中的道理颇为微妙，我是从领悟中得来的，可以说一说。凡是伤寒病，初起时发热，煎熬津液，导致鼻干、口渴、便秘，逐渐发展到出现厥逆的，不用问就知道是热证。如果是阳证突然变成阴厥的，万中无一，从古至今都没有这种情况。因为阴厥得之于阴证，一开始就直接中于阴经，表现为嘴唇青紫、面色苍白、遍体冷汗、大小便通利且不渴、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，导致人事昏惑的情况，万万不同。各种医书将阴阳两种厥逆归为一类记载，即使是明白的人尚且会被混淆，何况是不懂的人呢？像这样的病，先犯房室之劳，后成为伤寒，世间的医生无不被‘阴厥’这个名字所迷惑，往往投以四逆汤等药物，加速其暴亡，却推卸说是阴极无法救治，致使冤鬼夜嚎，还不知醒悟。总归是因为传承派系不清所致。
大概犯房劳而感病的人，病情不过比平常较重，如发热则热到极点，恶寒则寒到极点，头痛则痛到极点。之所以这样，是因为阴虚，阳气去乘虚侵袭，并不是阴邪乘袭导致无阳的情况。况且病人起初能做到不服药，阴邪必然较轻；过了十天逐渐发作，尤其不是暴发的重症，怎么能按照厥阴病的例子来治疗呢？况且张仲景明确说过：开始发热六天，厥逆反而九天，后来又重新发热三天，与厥逆的天数相应，那么病将在早晚之间痊愈。又说：厥逆五天，发热也五天，假设第六天应当再次厥逆，如果不厥逆，病就会自愈。明明是以发热的天数来确定厥逆痊愈的期限。又说：厥逆多、发热少，则病势进展；发热多、厥逆少，则病势衰退。厥逆愈后如果发热时间过长，必定会出现大便脓血或发痈疽。厥逆应当用下法却反而用汗法，必定导致口腔损伤溃烂发红。先厥逆后发热，腹泻必定自行停止；见到厥逆又出现腹泻。腹泻停止，反而出汗、咽喉痛的，喉部会闭塞不通。厥逆时还能吃东西，恐怕是除中证（胃气将绝的假象）；厥逆停止想吃东西，是邪气退去想要痊愈的迹象。凡此种种，无非是热深厥深的宗旨，原本就没有论述过阴厥。至于阳分的病，而妄用汗法、吐法、下法，以至于病势极重，如汗多亡阳、呕吐腹泻烦躁、四肢逆冷的，都是因为用药差错所致。如果不是用四逆汤、真武汤等挽回，阳气就不能回复，这原本也不是为阴证设立的方子。
大概伤寒才一发热发渴，定然阴分先已亏损。因为误治，阳分比阴分更加亏损，不得已权宜使用辛热药物先救其阳，这与纯阴无阳、阴盛格阳的病证，相差如天地之远。后人不去探究制方的本意，看到有成法，就相互效仿，不知道治疗阴证以救阳为主，治疗伤寒以救阴为主。伤寒纵然有阳虚需要治疗，也必须看其人血肉充盛，阴分可以承受阳药的情况下，才可以回阳。如果面色黧黑、舌苔黑、身体像枯柴一样，一团邪火在内焚烧的，则阴气已经先耗尽，哪里还有阳气可回呢？所以见到厥逆，去除热邪，保存十分之一的津液元气，已经失之太晚，何况敢助阳劫夺阴液呢？《证治方》说：如果病症未分辨阴阳，暂且给四顺丸试试。《直指方》说：未分辨疑似症状，暂且给理中丸试试。这也可见从前的人未能透彻这一关，纵有深心，也是无可奈何罢了。因此为子孙辈详细辨析，并告知后来的行医者。
Huang Changren fell ill with Cold Damage (Shanghan) due to sexual exhaustion. He adhered strictly to the taboo of not taking medicine. Although his fever had subsided, more than ten days later, he suddenly fell into a comatose state, trembling all over, with hands and feet as cold as ice. The whole family was in a panic and urgently requested my presence. At that time, another physician had already prepared a decoction containing Ginger (Shengjiang) and Cinnamon Twig (Guizhi). I happened to see this and was shocked. I waited until after completing the pulse diagnosis, and repeatedly pointed out his errors and fallacies. The host suspected it was a Yin Syndrome (Yin Zheng), but my words were not accepted, nor could reason persuade them. I therefore made an agreement with the physician: "This illness is critical; once the medicine enters the mouth, life or death hangs in the balance. You and I shall each bear responsibility. If there is any error in medication, the blame must fall on someone specific." The physician said, "I have treated Cold Damage for over thirty years; I do not know what 'bearing responsibility' means." I smiled and said, "I have clear insight here and cannot bear to watch people die alive. This is also a matter of necessity. If you refuse to take responsibility, then let me administer the medicine." Only then did the host feel at ease and urgently request treatment.
I prescribed Tiaowei Chengqi Tang (Regulate the Stomach Purge Decoction), weighing approximately five qian. After decocting, half a cup was taken hot. A short while later, another half cup was taken hot. Seeing that the extremity coldness gradually receded and the patient gradually regained consciousness, the other physician realized the medication was correct and left. The previous prescription was continued until the course was finished, and the patient's mental state became very clear. Suddenly, the patient developed intense systemic heat. Another dose of Daxiehu Tang (Major Bupleurum Decoction) was administered, after which the heat subsided and the body felt comfortable. A student asked, "The patient claimed it was Jue (extremity coldness) presenting as a Yin Syndrome, yet you firmly identified it as a Yang Syndrome and used purgative herbs, which proved effective. What is the rationale?" I replied, "The rationale is subtle. I arrived at this through deep understanding, so I can explain. In cases of Cold Damage, initial fever consumes body fluids, leading to dry nose, thirst, and constipation. When this progresses to Jue, one can know without asking that it is a Heat Syndrome. It is virtually impossible for a Yang Syndrome to suddenly transform into Yin Jue; throughout history, such cases are non-existent. Yin Jue arises from Yin Syndromes, where pathogens directly strike the Yin meridians from the onset, presenting with blue lips, pale face, profuse cold sweat, free urination and defecation without thirst, curled-up posture, and excessive sleep. Upon waking, the person is lucid. This is vastly different from the Heat Pathogens transmitted via meridians in Cold Damage, which deepen progressively and cause confusion and loss of consciousness. Various medical texts group Yin and Yang Jue together, confusing even the wise, let alone the ignorant.
In this case, the patient first suffered from sexual exhaustion and then contracted Cold Damage. Physicians of the world are often misled by the name 'Yin Jue,' frequently administering Sini Tang (Frigid Extremities Decoction) and similar formulas, hastening sudden death, and attributing it to 'extreme Yin being incurable,' causing wailing ghosts at night, yet remaining unenlightened. This stems entirely from unclear transmission of lineage and theory. Generally, illness contracted after sexual exhaustion is merely heavier than usual: if there is fever, it reaches its extreme; if there is aversion to cold, it reaches its extreme; if there is headache, it reaches its extreme. This occurs because Yin deficiency allows Yang to invade; it is not a case of Yin pathogen overwhelming Yang. Moreover, since the patient initially abstained from medicine, the Yin pathogen must have been mild. The gradual onset after ten days indicates it was certainly not a sudden, severe acute condition. How could it be treated according to the principles of Jueyin Disease? Furthermore, Zhang Zhongjing explicitly stated: 'If fever lasts six days, followed by nine days of Jue, and then three days of renewed fever corresponding to the Jue period, the disease will heal within a day or two.' He also said: 'If Jue lasts five days and fever lasts five days, assuming the sixth day should bring Jue again, if Jue does not return, the disease heals spontaneously.' Clearly, the number of fever days determines the recovery period for Jue. He further stated: 'More Jue and less Heat indicates disease progression; more Heat and less Jue indicates disease retreat.' If Jue resolves but Heat persists too long, pus and blood in stool or carbuncles will develop. If Jue requires purgation but sweating is induced instead, oral ulcers and redness will occur. If Jue precedes Heat, diarrhea will stop naturally; if Jue returns, diarrhea returns. If diarrhea stops but sweating and sore throat appear, the throat will become obstructed (Bi). If the patient can eat during Jue, it may indicate Chuzhong (stomach qi exhaustion); if Jue stops and appetite returns, it indicates pathogen retreat and impending recovery. All these examples illustrate the principle of 'deep heat causing deep Jue'; they never discuss Yin Jue.
Regarding diseases of the Yang aspect, reckless use of sweating, vomiting, or purging methods can lead to critical conditions, such as excessive sweating causing Yang collapse, vomiting and diarrhea with restlessness, and cold extremities. These result solely from medication errors. Without using Sini Tang or Zhenwu Tang to rescue Yang, Yang Qi cannot return. These formulas were originally not designed for Yin Syndromes. Generally, when Cold Damage begins with fever and thirst, Yin deficiency is inherently present. Due to mismanagement, Yang deficiency becomes worse than Yin deficiency. Desperately, one might resort to acrid-hot herbs to temporarily rescue Yang. However, this is worlds apart from Pure Yin without Yang, or Yin Excess repelling Yang. Later generations failed to understand the intent behind formula creation, copying established prescriptions blindly. They did not realize that treating Yin Syndromes focuses on rescuing Yang, whereas treating Cold Damage focuses on rescuing Yin. Even if Cold Damage involves Yang deficiency requiring treatment, one must ensure the patient has sufficient flesh and blood, and that the Yin aspect can tolerate Yang-tonifying herbs, before attempting to restore Yang. If the face is dark, tongue black, body emaciated like dried firewood, and internal evil heat blazing, Yin essence is already exhausted; how can Yang be restored? Thus, encountering Jue and clearing Heat, preserving only one-tenth of body fluids and Yuan Qi, is already too late. How dare one assist Yang and plunder Yin? *Zhengzhi Fang* states: 'If Yin and Yang syndromes are not distinguished, try Six-Directional Pill (Sishun Wan).' *Zhizhi Fang* states: 'If doubt remains, try Lizhong Pill (Lizhong Wan).' This shows that predecessors failed to penetrate this crucial point; despite good intentions, they were helpless. Therefore, I have detailed this analysis for my descendants and future practitioners.
Mr. Hu Youchen said: 'Naturally endowed with spiritual insight, he must be a reincarnation from the hall of Xuanyuan and Qibo.'