董千云卖花为业,年逾四旬,外状丰腴,冬月患伤寒,诊脉沉细无力,证见寒热烦躁,
头身
疼痛,面红目赤,舌吐唇外数寸,病来势暴。询因房劳感受寒邪,逼其虚阳外露,即格阳证
也。方定六味回阳饮,令其煎成冷服。无如饮药旋呕,并吐蛔虫,躁扰如故,甚为踌躇。其
母跪求救治,勉取前药半盏,冲入猪胆汁数匙,试服不呕,良久又与半盏,夜间尽剂。晨诊
躁象略安,舌收吐止,仍照原方再进,次易八味地黄汤。时届九朝,忽口噤不语,十一二日
,又寒热如疟,有从外感起见者,予曰∶温中即可以散邪,强主正所以逐寇。力排众议,
坚持数日,稍见转机,此后尚多枝节,极力扶住正气,守至两旬,寝食虽安,神采欠爽。因
思前病重时,只图固正,未暇驱邪,温补药多,未免留邪闭窍,曾记方书论伤寒时疫,愈后
神识不清,有属邪滞心包之语,与服蛮煎两剂,神明顿清,续为调理而痊。
许妪冬月病伤寒,寒热头痛,医投疏表和解不应,渐致昏谵口渴,更进芩连清之亦不应
。便
秘经旬,用大黄亦不下。予初望其面赤烦躁,意属阳证,及切脉细涩,又疑阳证阴脉,思维
未决,因问其汗自病起,至今未出,扪之肤 而枯,予曰是矣。且不立方,姑先与药一剂,
有验再商。幸彼农家不谙药性,与药即服。次日往视,面红稍退,烦躁略平,肤腠微润。予
曰生矣。疏方付之,乃大青龙汤也。又服一剂,更见起色,转为调理而安。渠族人佩之兄与
予善,亦知医理。问曰∶君治此病,殆有神助,不然如斯重候,何药之奇效之速也。予曰仲
圣云,太阳病不罢,面色缘缘正赤者,此阳气怫郁在表,其人躁烦不知痛处,但坐以汗出不
彻,更发汗则愈。何以知之?脉涩故也。子能参悟此篇,自知此病之治法矣。
董千云以卖花为生,年龄超过四十岁。他外表体态丰满,冬季患了伤寒。诊察其脉象沉细无力,症状表现为寒热交替、烦躁不安、头部和身体疼痛、面色发红、眼睛充血、舌头伸出嘴唇外数寸,发病势头猛烈。询问病因是房事后感受寒邪,导致虚弱的阳气被逼迫外露,这就是格阳证。于是拟定六味回阳饮,嘱咐他将药煎好后冷服。无奈服药后立即呕吐,并且吐出蛔虫,烦躁依旧,让人十分犹豫不决。他的母亲跪地请求救治,勉强取前药半盏,冲入几匙猪胆汁,试服后没有呕吐,过了很久又给了半盏,夜间将整剂药服完。早晨诊察时,躁动的症状略微平息,舌头收回不再伸出,仍按原方继续服用,随后改用八味地黄汤。到了第九天,突然牙关紧闭不能说话,第十一二天,又出现像疟疾一样的寒热症状。有人主张从外感角度治疗,我说:温中就可以散除邪气,扶助正气正是为了驱逐病邪。我力排众议,坚持治疗数日,病情稍见转机,此后还有诸多波折,极力扶持正气,坚守治疗直到二十天,虽然睡眠饮食安稳,但精神神采仍不够清爽。因为想到之前重病时,只顾固护正气,无暇驱除邪气,温补药物过多,难免留滞邪气闭塞心窍,曾记得医书论述伤寒时疫,痊愈后神识不清,有属于邪气滞留心包的说法,于是给他服用蛮煎两剂,神明立刻清醒,随后进行调理而痊愈。
许姓老妇人冬季患伤寒,出现寒热、头痛症状,医生投用疏表和解的药物无效,逐渐导致神志昏乱谵语、口渴,再用黄芩、黄连清热也无效。便秘长达十天,使用大黄也不通下。我起初看她面红烦躁,认为是阳证,等到切脉发现脉象细涩,又怀疑是阳证阴脉,思考未决,于是问她是否出汗,她说从发病至今一直未出汗,触摸皮肤干枯,我说:“这就对了。”并且不立即开方,先给一剂药,如果有疗效再商量。幸好她是农家妇女不懂药性,给药就服下。第二天去探望,面红稍微消退,烦躁略微平复,皮肤腠理微微湿润。我说:“有生机了。”于是开方给她,是大青龙汤。又服一剂,病情更有起色,转为调理而安宁。她的族人佩之兄与我交好,也懂医理。问道:“您治疗这个病,大概有神助吧,否则如此重症,为何药效如此神奇迅速?”我说:仲景说,太阳病不愈,面色持续正红的,这是阳气怫郁在体表,病人烦躁不知道痛处,只是因为汗出不彻底,再次发汗就会痊愈。怎么知道是这样呢?因为脉涩的缘故。你能参悟这一篇的内容,自然就知道这个病的治疗方法了。
Dong Qianyun made a living selling flowers and was over forty years old. His exterior appearance was robust. In winter, he contracted Cold Damage (Shanghan). His pulse was deep, fine, and powerless. The symptoms included alternating chills and fever, irritability, headache, body pain, facial redness, bloodshot eyes, and the tongue protruding several inches beyond the lips; the onset of the disease was sudden and violent. Inquiry revealed that the cause was contracting cold pathogens after sexual intercourse, which forced the deficient Yang Qi to float outward; this is known as Ge Yang Syndrome (Gridlock Yang Syndrome). A prescription of Liuwei Huiyang Yin (Six-Ingredient Decoction to Return Yang) was formulated, and he was instructed to take it cold after decoction. However, upon drinking the medicine, he immediately vomited, expelling roundworms, and remained irritable, causing great hesitation. His mother knelt and begged for treatment. Reluctantly, half a cup of the previous medicine was taken, mixed with several spoons of Pig Bile (Zhu Dan), and tested; there was no vomiting. After a long while, another half cup was given, and the entire dose was consumed during the night. Upon morning examination, the agitation had slightly subsided, and the tongue had retracted. The original formula was continued, followed by a change to Bawei Dihuang Tang (Eight-Ingredient Rehmannia Root Decoction). By the ninth day, he suddenly developed lockjaw and inability to speak. On the eleventh or twelfth day, he experienced chills and fever resembling malaria. Some suggested treating it from the perspective of external contraction. I stated: "Warming the middle can disperse pathogens; strengthening the upright Zheng Qi is precisely how to drive out the寇 (invading evil)." I firmly opposed other opinions and persisted in this approach for several days. There was slight improvement, but many complications arose thereafter. We focused on strongly supporting the Zheng Qi. Adhering to this for twenty days, although sleep and appetite stabilized, his spiritual luster remained lacking. Recalling that during the severe phase of the illness, we only sought to consolidate the upright Qi without attending to expelling pathogens, the abundance of warming and tonifying herbs likely retained pathogens and closed the orifices. I recalled medical texts stating that after recovery from Cold Damage or seasonal epidemics, unclear consciousness may be attributed to pathogenic stagnation in the Pericardium. Therefore, Man Jian (Barbarian Decoction) was administered for two doses, resulting in immediate clarity of spirit. Subsequent regulation led to full recovery.
An elderly woman surnamed Xu contracted Cold Damage in winter, presenting with chills, fever, and headache. Physicians administered formulas to release the exterior and harmonize, but to no avail. Her condition gradually worsened to delirium, confusion, and thirst. Further administration of Scutellariae Radix (Huangqin) and Coptidis Rhizoma (Huanglian) to clear heat also failed. She suffered constipation for ten days; even the use of Rhei Radix et Rhizoma (Dahuang) did not induce bowel movement. Initially, seeing her facial redness and irritability, I suspected a Yang syndrome. However, palpating her pulse as fine and choppy, I doubted whether it was a Yang syndrome with a Yin pulse. While deliberating, I asked if she had sweated since the onset; she replied that she had not sweated at all. Touching her skin, it felt dry and withered. I said, "Now I understand." I did not prescribe a formula immediately but gave one dose first, promising to discuss further if there was efficacy. Fortunately, being a farmer's wife unfamiliar with medicinal properties, she took the medicine immediately. Visiting the next day, her facial redness had slightly receded, irritability had somewhat calmed, and her skin pores were slightly moist. I said, "There is life." I then prescribed a formula, which was Da Qinglong Tang (Major Green Dragon Decoction). After taking another dose, her condition improved further, and she recovered through subsequent regulation. Her clansman, Brother Pei, who was friendly with me and knowledgeable in medical principles, asked: "Your treatment of this case must have divine assistance; otherwise, how could such a severe condition respond so miraculously and quickly?" I replied: "Zhongjing stated: 'In Taiyang disease that does not resolve, if the face is persistently bright red, this indicates Yang Qi is constrained and stagnant in the exterior. The patient is irritable and unaware of specific pain sites, solely because sweating has been incomplete. Re-inducing sweating will lead to cure.' How do I know this? Because the pulse is choppy. If you can comprehend this passage, you will naturally know the treatment method for this disease."