章次公医案
说明
一、本篇共集章次公先生临证医案720余则，分为内、妇、儿、外四科，大都是先生在1940年前后的诊案。其中有些病种如回归热、登革热、脚气、性病等，现已少见或绝迹，书中保留有关典型病例，意在展示先生于此是如何辨证、辨病与治疔的。
二、各科分类，大多沿用中医病名，少数采用现代医学病名。方药剂量改用克为单位。医案后的"按"，或论病机，或释方义，或议诊断，或从药测证，或提示临床注意要点。
三、案内处方所用药量，由于三四十年代药材多为天然生药，药力较强，故用量较轻;今则植物药多为人工种植，药力大减，用量均增大，故用量需根据现行使用之剂量而酌定，以免影响药效。
四、本篇在1979年曾由先生的门人朱良春、刘季和、蒋敏达姚守诚、陈继农、王冠庭、杨友林、史惠甫、翁绍和、李树仁等集体整理，经朱良春执笔汇总，门人何绍奇、朱步先协助，于1980年由江苏科学技术出版社出版。此次又重加审订，并增入部分医案，以飨读者。汤叔良、石坚如二位同志提供部分病案，顺此致谢。
1.男。壮热骤然而起，无前驱症，腰腿剧痛，苔白薄满布。非温散不可。
生麻黄3克，川桂枝5克，羌独活各6克，秦艽、西河柳、六神曲各9克，杏仁泥12克，粉甘草3克。
生麻黄3克，杏仁泥9克，杭白芍5克，羌活6克，蔓荆子9克，桂枝5克，香白芷9克，川芎5克，甘草3克。
[按]先生对感冒一类病证，如突然头痛、发热、恶寒、骨节疼痛者，或此等症状持续不超过1周者，恒用麻黄汤加味温散而取效。又麻、桂合用，作为辛温解表时，其用量常不如麻黄用于平喘，桂枝用于通络为大。这是"轻可去实"之意。
生麻黄3克，川桂枝5克，杏仁泥12克，淡吴萸5克，姜半夏9克，橘皮6克，六神曲9克，生姜3片，甘草3克，太乙丹1粒。
[按]此为外感寒邪、胃失和降之证。恶寒特甚，故用麻桂辛温以散寒;胸闷作呕，故用吴萸、半夏、生姜、杏仁降逆止呕;橘皮、神曲、甘草以和胃。太乙丹又名玉枢丹，具有辟秽、解毒、止呕的作用。
4.男。形寒骨楚，风寒束于太阳之表，腠理不得疏泄也。不更衣7日，仲景有桂枝汤加大黄之例，今师其意。
川桂枝(后下)、生麻黄、蔓荆子各3克，羌活9克，生锦纹3克(判细末分吞)，郁李仁12克，杏仁泥18克，晚蚕沙9克(包)，粉甘草3克。
[按]表里俱实，则表里两解，用桂枝加大黄汤。以其形寒骨楚，更益麻黄、羌活等以增强解表之力;以其不大便者7日，故重加郁李仁、杏仁以润肠;大黄小量生用者，以取其轻泻之功。师古方意而不泥于成方。
5.女。形寒骨楚，一身拘急不舒，此风寒外束之象;胸闷，喜太息，舌前光红，虽渴欲饮冷，而其脉不见洪大。仍当温散。
麻黄2克，荆芥5克，紫苏叶6克，川芎5克，枳实、神曲各9克，全瓜蒌12克，晚蚕沙9克(包)，杏仁泥12克，甘草3克。
二诊:药后，渴欲饮冷者抟为思沸饮，此露出申寒之本质矣。可见胸闷、喜太息与两脉软而数，皆寒为之也。
生麻黄3克，炮附片5克(先煎)，细辛3克，白芷、白芥子各9克，羌活、陈皮各6克，荜澄茄、晚蚕沙(包)各9克，生姜3片。
[按]此病初诊胸闷，渴欲饮冷，喜太息，舌前光红，皆假热象也。先生不为假象所惑，而抓住风寒外束之病因病机要点，主以温散。二诊由渴欲饮冷转为思沸饮，系中寒之本质毕露，可知辨证之准确。
6.男。有表证，以剧烈之头痛、腰痛为苦，兼有便秘，溲少而痛。木香槟榔丸、九味羌活汤主之。
防风、羌活各6克，细辛3克，苍术5克，白芷9克，川芎、黄芩各5克，生地9克，甘草3克，生姜3片，葱白5茎。另:木香槟榔丸9克，1次吞服。
[按]先生曾嘱先服丸剂以通便，后服汤剂以解表。这是破前人先解表而后攻里的方法。其他如急性肠炎的初起，用之也有显效。
7.女。骤然而热，恶寒，无汗，头痛，一身酸楚，胸中苫闷，苔薄白而腻，脉不数。感冒之象毕露，一般非一候不能解。
荆芥、防风各6克，大川芎5克，薤白头9克，春砂壳3克，生枳实6克，粉甘草3克。
[按]先生于此案，初用辛温解表轻剂2剂，效果不显，迸而加重辛温之剂，改用加味麻黄汤。所谓加味麻黄汤者，即h用羌活、藁本以助麻、桂温散之力。患者胸中苦闷，苔白腻，得砂壳、薤白头、枳实等辛香宣化之品而症情改善;继以佩兰、砂壳、神曲等芳香化浊、理气消导之药，以奏全功。先生应用辛温解表药，或麻、佳，或荆、防，每叮嘱病人温服、覆被，以助发汗。此是张仲景《8服。、"复取微似汗"之意。病人经依法服加味麻黄汤2剂后，果然汗出身凉，渚症悉解。
8.徐女。3日来恶寒发热，头痛骨楚，而温温欲吐，舌苔白腻。用此方辛温解表以退热，芳香化浊以镇呕。
荆芥穗、紫苏叶、川桂枝(后下)各5克，藁本、川羌活各9克，香白芷5克，姜半夏9克，陈广皮5克，六神曲6克，生姜2片。
二诊:胃肠型感冒与肠伤寒，在难于肯定之际，用发汗剂可以得其梗概。今药后热己退净，两日未再升，非肠伤寒也。胃果，大便难，食后有泛恶现象，以此法调其肠胄。
佩兰梗5克，薤白、姜半夏各9克，陈广皮5克，云苓、生枳实各9克，白豆蔻5克，六神曲、谷芽、麦芽各9克，佛手5克。
[按)先生一贯主张"发皇古义，融会新知"，各取所长，以补其短。故其医案中往往应用酉医学病名。此案即以其实践经验，来鉴别胄肠型感冒与肠伤寒，值得珍视。初诊解表化浊，得汗而热即退净，可知并非肠伤寒，而是外寒夹湿之感冒。二诊乃用二陈加芳香化浊、通利气机之品，以调整肠胃功能。
9.女。用麻桂发汗，其热依然不下挫;舌苔厚腻，胸闷泛恶，湿阻中焦，当疏邪化湿。凡邪之夹湿者，其热往往不能迅速下挫，大攻其表无益也。
川桂枝5克，生苍术、橘皮各3克，姜竹茹、带叶佩兰、炒枳壳各6克，姜半夏3克，生姜1片，六神曲9克，晚蚕沙12克(包)。
[按]风寒袭于表分，湿浊内蕴中焦，治之大要:疏邪必兼化湿。"凡邪之夹湿者，其热往往不能迅速下挫"，伤寒如此，温病更如此。此乃经验之谈。
桂枝、当归、白芷、草果各9克，蚕沙12克(包)，秦艽9克，川芎6克，细辛3克，灵仙、神曲各9克。
11.男。所谓表邪夹湿者，即感冒影响于消化系之谓也;洒然有寒意，胸闷，苔白，指尖冷，皆其候也。
荆芥、佩兰、白芷、半夏、草果(去壳)、陈皮各9克，厚朴花6克，郁金9克，杏仁、米仁各12克，枳壳6克。
[按]湿为阴邪，最易令气机失于流畅，故胸闷、苔白腻为必有之症状。临床多用芳香开泄，轻则藿、佩、橘、蔻，重则枳实、半夏、草果。沈案以湿为主，侧重在辛开;杨案恶寒特甚，两足不温，以寒为主，侧重在温散。
12.男。脉数为热，苔滑为湿;热从外来，湿由内生;外来不外风寒，内生者多由食积。
荆芥6克，前胡9克，杏仁12克，桔梗9克，白芷6克，苏梗6克，紫菀9克，神曲9克，枳实6克，槟榔9克，萝「子9克。
13.男。阳虚之人，重受风寒而咳，身半以下，其痛如刺;热虽不高，而合目有迷蒙状。夫实则谵语，虚则郑声，而脉沉细，虚象也。柯氏有"太阳虚便是少阴"之说，予麻黄附子细辛汤加味。
蜜炙麻黄3克，炮附块6克，北细辛3克，全当归9克，杭白芍9克，炙紫菀9克，炙远志5克，旋覆花9克(包)，炙款冬9克，清炙草3克。
[按]素体阳虚。复感风寒，表散则伤正，温补则留邪，惟麻黄附子细辛汤标本兼顾，两全其美。先生化裁古方，以麻黄辛温散表邪;附子温阳强心;炙草益气扶正;归、芍和营养血而缓麻、附之辛燥;再加紫菀、款冬、远志以化痰止咳。处方照顾周到，值得效法。
14.女。在感冒流行之际，虚人最易感染，其发亦异于常人。今恶寒特甚，手足厥冷，脉细欲绝，盖当归四逆汤证也。
全当归9克，川桂枝6克(后下)，杭白芍9克，北细辛3克，梗通草5克，淡吴萸3克，川羌活9克，左秦艽9克，清炙草3克，生姜2片，大枣7枚。
[按]虚人感冒，其发与常人有异，不可徒以解表为法。此人恶寒特甚，手足逆冷，脉细欲绝，乃是平素阳虚血弱，复受外寒，故用当归四逆加吴茱萸生姜汤。以细辛、羌活散寒;吴萸温中;当归、白芍活血养血;木通、桂枝通血脉;生姜、入枣调和营卫。
15.老太。发热旬日不退，而恶寒未罢;渴喜热饮，而两足不温;持其脉时有歇止。此症上热而下寒，是戴阳之渐;热在外而寒在内，是格阳于外。暑令有此证候，温补之剂，效如桴鼓，古人以井水喻之，致知格物，医者亦不可不知。有谓夏令禁用附桂者，实不可从。夫医者药随证转，何可拘泥?！拟四逆汤合玉屏风散。
炮附块9克，炮姜炭5克，清炙草6克，生黄芪12克，生白术9克，蜜炙防风3克，全当归9克，北细辛3克，梗通草6克。
[按]此亦虚人感冒，用四逆汤温少阴之经，复人细辛以散寒;玉屏风散加当归则取补中寓散之意。案语强调辨证论治，实为先生生平毅力所注。
16.男。老年人各部功能皆形衰减，稍有感冒，遂困惫异常，冷汗如潜。予桂枝汤加附，咳加紫菀，苔腻加草果。
桂枝5克(后下)，炮附子5克，白芥子5克，杭芍12克，炙紫菀9克，煨草果6克，粉甘草3克，羌活6克，桑寄生12克，香白芷9克，生姜3片，大枣7枚。
[按]此案冷汗如潘，乃心阳衰微之征，虽有感冒，不可攻表。先生认为准枝汤并非表药，强壮剂也"。机体功能增强，何患外感不愈。方中加附子，力挽衰微之心阳。
17.女。临风洒然毛耸，一身酸楚如被杖，此时气之征也。重身六个月，大便难，不可峻下。
川桂枝5克(后下)，杭白芍9克，粉甘草3克，青防风9克，川羌活9克，左秦艽9克，光否仁15克，炒枳实9克，全瓜蒌12克，六神曲9克，生姜2片，大枣7枚。
[按]此亦表里俱病之证。以表为主，又因患者系孕妇，故用桂枝汤复加羌、防等以解表，又用枳实、神曲、否仁、瓜蒌导滞去积。此与上案有同有异，当互相参证。
18.女。寒热无汗，一身骨节尽痛;经事适来，故精神烦闷特甚。此仲景所谓热人血室。进一步可见精神症状。
软柴胡5克，净麻黄3克，川桂枝5克，川羌活9克，大川芎5克，桃仁泥12克，粉丹皮9克，京赤芍9克，生甘草3克。
二诊:形寒肌热已减，经水时有时无，脐下结块而痛。凡经行而病热，所苦皆倍甚。软柴胡5克，全当归9克，大川芎5克，桃仁泥12克，炙乳香9克，炙没药9克，制香附9克，小青皮9克，延胡索9克，台乌药9克，生艾叶9克。[按]热与血结，便当活血通络，以破其结，血行则邪热可随之而解。此案初诊一面解表，一面行血;二诊则因"经水时有时无，脐下结块"，乃放手逐瘀。
19.女。先是一身骨节酸痛，如有虫行皮中;一周后见高热而右脉沉伏，胸中憎热如炙，不可须臾耐。然则初起之骨节酸痛，实乃经行之前驱。月事不应至而至，入暮神志有昏糊状，是热入血室之候。醋炒柴胡6克，酒炒黄芩9克，净连翘15克，生茜草9克，嫩紫草5克，炒荆芥6克，姜半夏9克，石菖蒲9克，辟瘟丹1粒(研末吞)。
[按]"热人血室"见《伤寒论》太阳篇。指妇女在月经期间感受外邪，邪热与血互结，出现少腹满痛，寒热往来如疟，昼日明了，暮则谵语等症状。治疗轻则刺期门，重则小柴胡汤。此案用其方而去甘、芍。加紫草、茜草、炒荆芥、连翘，以凉血逐瘀清热;菖蒲开窍醒神;复用辟瘟丹以治外邪，正合其病。"辟瘟丹"系成药，上海现改名"解暑片"，由73味中药组成，有解毒、辟秽、止腹痛吐利之效。
20.男。白昼绝对不热，其热作于夜间，连作3夜，热时汗出，其舌苔薄黄带腻，兼见骨节痪痛，则主感冒。感冒亦有此种热型者。醋炒柴胡6克，白芍6克，酒炒黑大豆12克，淡黄芩5克，白薇9克，煨草果5克，秦艽9克，片姜黄5克，威灵仙9克，粉甘草3克。[按]此例舌苔薄黄带腻，关节酸痛，只有三夜，故诊为感冒。如果夜间发热日久不愈，则应考虑为其他疾病。
章次公医案
说明
一、本篇共收集章次公先生临证医案720余则，分为内科、妇科、儿科、外科四科，大都是先生在1940年前后的诊案。其中有些病种如回归热（一种由回归热螺旋体引起的急性传染病）、登革热（一种由登革病毒引起的蚊媒传染病）、脚气（维生素B1缺乏症或中医指湿脚气等）、性病等，现已少见或绝迹，书中保留有关典型病例，意在展示先生在此类疾病上是如何进行辨证（辨析证候）和辨病（确定疾病）与治疗的。
二、各科分类，大多沿用中医病名，少数采用现代医学病名。方药剂量改用克为单位。医案后的“按”，或论述病机（疾病发生发展的机理），或解释方义（方剂的配伍意义），或讨论诊断，或通过药物推测证候，或提示临床注意要点。
三、案内处方所用药量，由于三四十年代药材多为天然生药，药力较强，故用量较轻；现今植物药多为人工种植，药力大减，用量均增大，故用量需根据现行使用的剂量而酌情决定，以免影响药效。
四、本篇在1979年曾由先生的门人朱良春、刘季和、蒋敏达、姚守诚、陈继农、王冠庭、杨友林、史惠甫、翁绍和、李树仁等集体整理，经朱良春执笔汇总，门人何绍奇、朱步先协助，于1980年由江苏科学技术出版社出版。此次又重加审订，并增入部分医案，以飨读者。汤叔良、石坚如二位同志提供部分病案，顺此致谢。
1. 男。壮热（高热）骤然而起，无前驱症状，腰腿剧痛，苔白薄满布。非温散（用温性药物发散表邪）不可。
生麻黄3克，川桂枝5克，羌活6克，独活6克，秦艽9克，西河柳9克，六神曲9克，杏仁泥12克，粉甘草3克。
2. 男。发热6日，未得畅汗，腰部酸楚难以忍受，头部为之疼痛。
生麻黄3克，杏仁泥9克，杭白芍5克，羌活6克，蔓荆子9克，桂枝5克，香白芷9克，川芎5克，甘草3克。
[按]先生对感冒一类病证，如突然头痛、发热、恶寒（怕冷）、骨节疼痛者，或此等症状持续不超过1周者，恒用麻黄汤（发汗解表，宣肺平喘的方剂）加味温散而取效。又麻黄、桂枝合用，作为辛温解表时，其用量常不如麻黄用于平喘，桂枝用于通络为大。这是“轻可去实”（轻清之品可以祛除实邪）之意。
生麻黄3克，川桂枝5克，杏仁泥12克，淡吴茱萸5克，姜半夏9克，橘皮6克，六神曲9克，生姜3片，甘草3克，太乙丹1粒。
[按]此为外感寒邪、胃失和降之证。恶寒特别严重，故用麻黄、桂枝辛温以散寒；胸闷作呕，故用吴茱萸、半夏、生姜、杏仁降逆止呕；橘皮、神曲、甘草以和胃。太乙丹又名玉枢丹，具有辟秽（驱除污浊之气）、解毒、止呕的作用。
4. 男。形寒（感觉寒冷）骨楚（骨头酸痛），风寒束于太阳之表（足太阳膀胱经主一身之表），腠理（皮肤毛孔及纹理）不得疏泄也。不大便7日，仲景（张仲景）有桂枝汤加大黄之例，今师其意。
川桂枝（后下）、生麻黄、蔓荆子各3克，羌活9克，生锦纹3克（研细末分吞），郁李仁12克，杏仁泥18克，晚蚕沙9克（包煎），粉甘草3克。
[按]表里俱实，则表里两解，用桂枝加大黄汤。以其形寒骨楚，更益麻黄、羌活等以增强解表之力；以其不大便者7日，故重加郁李仁、杏仁以润肠；大黄小量生用者，以取其轻泻之功。师古方意而不泥于成方。
5. 女。形寒骨楚，一身拘急不舒，此风寒外束之象；胸闷，喜太息（长叹气），舌前光红，虽渴欲饮冷，而其脉不见洪大。仍当温散。
麻黄2克，荆芥5克，紫苏叶6克，川芎5克，枳实9克，神曲9克，全瓜蒌12克，晚蚕沙9克（包煎），杏仁泥12克，甘草3克。
二诊：药后，渴欲饮冷者转为思沸饮（想喝热水），此露出中寒之本质矣。可见胸闷、喜太息与两脉软而数，皆寒为之也。
生麻黄3克，炮附片5克（先煎），细辛3克，白芷9克，白芥子9克，羌活6克，陈皮6克，荜澄茄9克，晚蚕沙（包煎）9克，生姜3片。
[按]此病初诊胸闷，渴欲饮冷，喜太息，舌前光红，皆假热象也。先生不为假象所惑，而抓住风寒外束之病因病机要点，主以温散。二诊由渴欲饮冷转为思沸饮，系中寒之本质毕露，可知辨证之准确。
6. 男。有表证，以剧烈之头痛、腰痛为苦，兼有便秘，溲少而痛。用木香槟榔丸、九味羌活汤主治。
防风6克，羌活6克，细辛3克，苍术5克，白芷9克，川芎5克，黄芩5克，生地9克，甘草3克，生姜3片，葱白5茎。另：木香槟榔丸9克，1次吞服。
[按]先生曾嘱先服丸剂以通便，后服汤剂以解表。这是破前人先解表而后攻里的方法。其他如急性肠炎的初起，用之也有显效。
7. 女。骤然而热，恶寒，无汗，头痛，一身酸楚，胸中苦闷，苔薄白而腻，脉不数。感冒之象毕露，一般非一候（五天）不能解。
荆芥6克，防风6克，大川芎5克，薤白头9克，春砂壳3克，生枳实6克，粉甘草3克。
[按]先生于此案，初用辛温解表轻剂2剂，效果不显，进而加重辛温之剂，改用加味麻黄汤。所谓加味麻黄汤者，即用羌活、藁本以助麻黄、桂枝温散之力。患者胸中苦闷，苔白腻，得砂壳、薤白头、枳实等辛香宣化之品而症情改善；继以佩兰、砂壳、神曲等芳香化浊、理气消导之药，以奏全功。先生应用辛温解表药，或麻黄、桂枝，或荆芥、防风，每叮嘱病人温服、覆被，以助发汗。此是张仲景《伤寒论》“复取微似汗”之意。病人经依法服加味麻黄汤2剂后，果然汗出身凉，诸症悉解。
8. 徐女。3日来恶寒发热，头痛骨楚，而温温欲吐，舌苔白腻。用此方辛温解表以退热，芳香化浊以镇呕。
荆芥穗5克，紫苏叶5克，川桂枝（后下）5克，藁本9克，川羌活9克，香白芷5克，姜半夏9克，陈广皮5克，六神曲6克，生姜2片。
二诊：胃肠型感冒与肠伤寒，在难于肯定之际，用发汗剂可以得其梗概。今药后热已退净，两日未再升，非肠伤寒也。胃果（疑为“胃纳”或“肠胃”之误，结合语境指肠胃功能），大便难，食后有泛恶现象，以此法调其肠胃。
佩兰梗5克，薤白9克，姜半夏9克，陈广皮5克，云苓9克，生枳实9克，白豆蔻5克，六神曲9克，谷芽9克，麦芽9克，佛手5克。
[按]先生一贯主张“发皇古义，融会新知”，各取所长，以补其短。故其医案中往往应用西医病名。此案即以其实践经验，来鉴别胃肠型感冒与肠伤寒，值得珍视。初诊解表化浊，得汗而热即退净，可知并非肠伤寒，而是外寒夹湿之感冒。二诊乃用二陈汤加芳香化浊、通利气机之品，以调整肠胃功能。
9. 女。用麻黄、桂枝发汗，其热依然不下挫；舌苔厚腻，胸闷泛恶，湿阻中焦，当疏邪化湿。凡邪之夹湿者，其热往往不能迅速下挫，大攻其表无益也。
川桂枝5克，生苍术3克，橘皮3克，姜竹茹6克，带叶佩兰6克，炒枳壳6克，姜半夏3克，生姜1片，六神曲9克，晚蚕沙12克（包煎）。
[按]风寒袭于表分，湿浊内蕴中焦，治之大要：疏邪必兼化湿。“凡邪之夹湿者，其热往往不能迅速下挫”，伤寒如此，温病更如此。此乃经验之谈。
桂枝9克，当归9克，白芷9克，草果9克，蚕沙12克（包煎），秦艽9克，川芎6克，细辛3克，灵仙9克，神曲9克。
11. 男。所谓表邪夹湿者，即感冒影响于消化系之谓也；洒然有寒意，胸闷，苔白，指尖冷，皆其候也。
荆芥9克，佩兰9克，白芷9克，半夏9克，草果（去壳）9克，陈皮9克，厚朴花6克，郁金9克，杏仁12克，米仁12克，枳壳6克。
[按]湿为阴邪，最易令气机失于流畅，故胸闷、苔白腻为必有之症状。临床多用芳香开泄，轻则藿香、佩兰、橘皮、白豆蔻，重则枳实、半夏、草果。沈案以湿为主，侧重在辛开；杨案恶寒特甚，两足不温，以寒为主，侧重在温散。
12. 男。脉数为热，苔滑为湿；热从外来，湿由内生；外来不外风寒，内生者多由食积。
荆芥6克，前胡9克，杏仁12克，桔梗9克，白芷6克，苏梗6克，紫菀9克，神曲9克，枳实6克，槟榔9克，萝卜子9克。
13. 男。阳虚之人，重受风寒而咳，身半以下，其痛如刺；热虽不高，而合目有迷蒙状。夫实则谵语，虚则郑声，而脉沉细，虚象也。柯氏有“太阳虚便是少阴”之说，予麻黄附子细辛汤加味。
蜜炙麻黄3克，炮附块6克，北细辛3克，全当归9克，杭白芍9克，炙紫菀9克，炙远志5克，旋覆花9克（包煎），炙款冬9克，清炙草3克。
[按]素体阳虚。复感风寒，表散则伤正，温补则留邪，惟麻黄附子细辛汤标本兼顾，两全其美。先生化裁古方，以麻黄辛温散表邪；附子温阳强心；炙草益气扶正；归、芍和营养血而缓麻、附之辛燥；再加紫菀、款冬、远志以化痰止咳。处方照顾周到，值得效法。
14. 女。在感冒流行之际，虚人最易感染，其发亦异于常人。今恶寒特甚，手足厥冷，脉细欲绝，盖当归四逆汤证也。
全当归9克，川桂枝6克（后下），杭白芍9克，北细辛3克，梗通草5克，淡吴茱萸3克，川羌活9克，左秦艽9克，清炙草3克，生姜2片，大枣7枚。
[按]虚人感冒，其发与常人有异，不可徒以解表为法。此人恶寒特甚，手足逆冷，脉细欲绝，乃是平素阳虚血弱，复受外寒，故用当归四逆加吴茱萸生姜汤。以细辛、羌活散寒；吴茱萸温中；当归、白芍活血养血；木通、桂枝通血脉；生姜、大枣调和营卫。
15. 老太。发热旬日不退，而恶寒未罢；渴喜热饮，而两足不温；持其脉时有歇止。此症上热而下寒，是戴阳之渐；热在外而寒在内，是格阳于外。暑令有此证候，温补之剂，效如桴鼓，古人以井水喻之，致知格物，医者亦不可不知。有谓夏令禁用附桂者，实不可从。夫医者药随证转，何可拘泥？！拟四逆汤合玉屏风散。
炮附块9克，炮姜炭5克，清炙草6克，生黄芪12克，生白术9克，蜜炙防风3克，全当归9克，北细辛3克，梗通草6克。
[按]此亦虚人感冒，用四逆汤温少阴之经，复入细辛以散寒；玉屏风散加当归则取补中寓散之意。案语强调辨证论治，实为先生生平毅力所注。
16. 男。老年人各部功能皆形衰减，稍有感冒，遂困惫异常，冷汗如潜。予桂枝汤加附，咳加紫菀，苔腻加草果。
桂枝5克（后下），炮附子5克，白芥子5克，杭芍12克，炙紫菀9克，煨草果6克，粉甘草3克，羌活6克，桑寄生12克，香白芷9克，生姜3片，大枣7枚。
[按]此案冷汗如潘（泉），乃心阳衰微之征，虽有感冒，不可攻表。先生认为桂枝汤并非表药，强壮剂也”。机体功能增强，何患外感不愈。方中加附子，力挽衰微之心阳。
17. 女。临风洒然毛耸，一身酸楚如被杖，此时气之征也。重身六个月（怀孕六个月），大便难，不可峻下。
川桂枝5克（后下），杭白芍9克，粉甘草3克，青防风9克，川羌活9克，左秦艽9克，光杏仁15克，炒枳实9克，全瓜蒌12克，六神曲9克，生姜2片，大枣7枚。
[按]此亦表里俱病之证。以表为主，又因患者系孕妇，故用桂枝汤复加羌活、防风等以解表，又用枳实、神曲、杏仁、瓜蒌导滞去积。此与上案有同有异，当互相参证。
18. 女。寒热无汗，一身骨节尽痛；经事适来，故精神烦闷特甚。此仲景所谓热入血室。进一步可见精神症状。
软柴胡5克，净麻黄3克，川桂枝5克，川羌活9克，大川芎5克，桃仁泥12克，粉丹皮9克，京赤芍9克，生甘草3克。
二诊：形寒肌热已减，经水时有时无，脐下结块而痛。凡经行而病热，所苦皆倍甚。软柴胡5克，全当归9克，大川芎5克，桃仁泥12克，炙乳香9克，炙没药9克，制香附9克，小青皮9克，延胡索9克，台乌药9克，生艾叶9克。[按]热与血结，便当活血通络，以破其结，血行则邪热可随之而解。此案初诊一面解表，一面行血；二诊则因“经水时有时无，脐下结块”，乃放手逐瘀。
19. 女。先是一身骨节酸痛，如有虫行皮中；一周后见高热而右脉沉伏，胸中憎热如炙，不可须臾耐。然则初起之骨节酸痛，实乃经行之前驱。月事不应至而至，入暮神志有昏糊状，是热入血室之候。醋炒柴胡6克，酒炒黄芩9克，净连翘15克，生茜草9克，嫩紫草5克，炒荆芥6克，姜半夏9克，石菖蒲9克，辟瘟丹1粒（研末吞）。
[按]“热入血室”见《伤寒论》太阳篇。指妇女在月经期间感受外邪，邪热与血互结，出现少腹满痛，寒热往来如疟，昼日明了，暮则谵语等症状。治疗轻则刺期门，重则小柴胡汤。此案用其方而去甘、芍。加紫草、茜草、炒荆芥、连翘，以凉血逐瘀清热；菖蒲开窍醒神；复用辟瘟丹以治外邪，正合其病。“辟瘟丹”系成药，上海现改名“解暑片”，由73味中药组成，有解毒、辟秽、止腹痛吐利之效。
20. 男。白昼绝对不热，其热作于夜间，连作3夜，热时汗出，其舌苔薄黄带腻，兼见骨节痠痛，则主感冒。感冒亦有此种热型者。醋炒柴胡6克，白芍6克，酒炒黑大豆12克，淡黄芩5克，白薇9克，煨草果5克，秦艽9克，片姜黄5克，威灵仙9克，粉甘草3克。[按]此例舌苔薄黄带腻，关节酸痛，只有三夜，故诊为感冒。如果夜间发热日久不愈，则应考虑为其他疾病。
Zhang Cigong's Medical Cases
Explanation
I. This section collects more than 720 clinical medical cases of Mr. Zhang Cigong, categorized into Internal Medicine, Gynecology, Pediatrics, and Surgery. Most are consultation records from around 1940. Some diseases mentioned, such as Relapsing Fever (an acute infectious disease caused by relapsing fever spirochetes), Dengue Fever (a mosquito-borne viral infection caused by the dengue virus), Jiaoqi (Vitamin B1 deficiency or specific TCM patterns like damp-Jiaoqi), and Venereal Diseases, are now rare or extinct. Typical cases are retained in the book to demonstrate how Mr. Zhang conducted syndrome differentiation (bianzheng) and disease differentiation (bianbing) and treatment for these conditions.
II. The categorization of each department mostly follows traditional Chinese medicine (TCM) disease names, with a few adopting modern medical disease names. Dosages of prescriptions have been converted to grams. The "Commentary" (An) following each case discusses pathogenesis (bingji), explains the rationale of the prescription (fangyi), deliberates on diagnosis, infers syndromes from herbs, or highlights key clinical points.
III. The dosages in the prescriptions within the cases were lighter because medicinal materials in the 1930s and 1940s were mostly natural raw drugs with stronger potency. Today, most plant medicines are artificially cultivated with significantly reduced potency, so dosages have generally increased. Therefore, dosages should be adjusted according to current usage standards to avoid affecting efficacy.
IV. This section was collectively compiled in 1979 by Mr. Zhang's disciples, including Zhu Liangchun, Liu Jihe, Jiang Mindda, Yao Shoucheng, Chen Jinong, Wang Guanting, Yang Youlin, Shi Huifu, Weng Shaohé, and Li Shuren. It was summarized by Zhu Liangchun, assisted by disciples He Shaoqi and Zhu Buxian, and published by Jiangsu Science and Technology Publishing House in 1980. This edition has been carefully revised again, with some additional cases added for readers. Comrades Tang Shuliang and Shi Jianru provided some medical cases; thanks are extended here.
Common Cold
1. Male. Sudden onset of high fever (Zhuangre) without prodromal symptoms, severe pain in the lower back and legs, coating is thin white and covers the tongue completely. Warm dispersal (Wen San - using warm-natured herbs to disperse exterior pathogens) is indispensable.
Raw Ephedrae Herba (Mahuang, 麻黄) 3g, Sichuan Cinnamon Twig (Guizhi, 桂枝) 5g, Notopterygii Rhizoma et Radix (Qianghuo, 羌活) 6g, Angelicae Pubescentis Radix (Duhuo, 独活) 6g, Gentianae Macrophyllae Radix (Qinjiao, 秦艽) 9g, Salicis Matsudanae Ramulus (Xi Heliu, 西河柳) 9g, Medicated Leaven (Liushenqu, 六神曲) 9g, Almond Paste (Xingren Ni, 杏仁泥) 12g, Glycyrrhizae Radix et Rhizoma Preparata (Fen Gancao, 粉甘草) 3g.
2. Male. Fever for 6 days, no profuse sweating achieved, severe soreness in the lower back intolerable, headache ensues.
Raw Ephedrae Herba (Mahuang, 麻黄) 3g, Almond Paste (Xingren Ni, 杏仁泥) 9g, Paeoniae Radix Alba (Hang Baishao, 杭白芍) 5g, Notopterygii Rhizoma et Radix (Qianghuo, 羌活) 6g, Viticis Fructus (Manjingzi, 蔓荆子) 9g, Cinnamon Twig (Guizhi, 桂枝) 5g, Angelicae Dahuricae Radix (Xiang Baizhi, 香白芷) 9g, Ligustici Chuanxiong Rhizoma (Chuanxiong, 川芎) 5g, Licorice Root (Gancao, 甘草) 3g.
[Commentary] For common cold-type conditions characterized by sudden headache, fever, aversion to cold (Ehan), and joint pain, or where these symptoms persist for no more than one week, Mr. Zhang consistently used modified Ma Huang Tang (Cinnamon Twig and Ephedra Decoction) with warm dispersal to achieve efficacy. When Ephedra and Cinnamon Twig are combined for acrid-warm exterior-resolving therapy, their dosages are often smaller than when Ephedra is used for wheezing or Cinnamon Twig for unblocking collaterals. This embodies the principle that "light substances can dispel excess" (Qing Ke Qu Shi).
3. Male. Severe aversion to cold, chest oppression with nausea. Treat primarily with Ma Huang plus Wu Zhu Yu Tang (Evodia Decoction).
Raw Ephedrae Herba (Mahuang, 麻黄) 3g, Sichuan Cinnamon Twig (Guizhi, 桂枝) 5g, Almond Paste (Xingren Ni, 杏仁泥) 12g, Evodiae Fructus (Dan Wuyu, 淡吴萸) 5g, Pinelliae Rhizoma Preparatum (Jiang Banxia, 姜半夏) 9g, Citri Reticulatae Pericarpium (Jupi, 橘皮) 6g, Medicated Leaven (Liushenqu, 六神曲) 9g, Fresh Ginger (Shengjiang, 生姜) 3 slices, Licorice Root (Gancao, 甘草) 3g, Tai Yi Dan 1 pill.
[Commentary] This is a pattern of external contraction of cold pathogen with stomach failing to descend properly. Due to severe aversion to cold, Mahuang and Guizhi are used for their acrid-warm properties to disperse cold; due to chest oppression and nausea, Evodia, Pinellia, Fresh Ginger, and Almond are used to direct rebellious qi downward and stop vomiting; Citrus peel, Medicated Leaven, and Licorice harmonize the stomach. Tai Yi Dan, also known as Yu Shu Dan, has effects of dispelling turbidity, detoxifying, and stopping vomiting.
4. Male. Feeling cold with bone soreness, wind-cold binding the exterior of the Taiyang (Greater Yang) channel, pores unable to vent. No bowel movement for 7 days. Zhongjing (Zhang Zhongjing) had an example of Gui Zhi Tang adding Rhubarb; I follow his intent now.
Sichuan Cinnamon Twig (add later), Raw Ephedrae Herba, Viticis Fructus each 3g, Notopterygii Rhizoma et Radix 9g, Raw Rheum Palmatum (Sheng Jinwen, 生锦纹) 3g (finely powdered, taken separately), Prunus Semen (Yuliren, 郁李仁) 12g, Almond Paste (Xingren Ni, 杏仁泥) 18g, Bombyx Batryticatus (Wan Can Sha, 晚蚕沙) 9g (wrapped), Glycyrrhizae Radix et Rhizoma Preparata 3g.
[Commentary] When both exterior and interior are excess, resolve both simultaneously using Gui Zhi Jia Da Huang Tang (Cinnamon Twig Decoction with Added Rhubarb). To address feeling cold and bone soreness, add Ephedra and Notopterygium to enhance exterior resolution; due to constipation for 7 days, heavily add Prunus Seed and Almond to moisten the intestines; small dose of raw Rhubarb is used for its mild purgative effect. Learn from ancient formulas without being rigidly bound by them.
5. Female. Feeling cold with bone soreness, whole body stiff and uncomfortable, indicating wind-cold binding externally; chest oppression, sighing frequently, anterior tongue red and smooth. Although thirsty for cold drinks, pulse is not flooding. Still requires warm dispersal.
Ephedrae Herba 2g, Schizonepetae Spica (Jingjie, 荆芥) 5g, Perillae Folium (Zi Su Ye, 紫苏叶) 6g, Ligustici Chuanxiong Rhizoma 5g, Aurantii Fructus Immaturus (Zhishi, 枳实) 9g, Medicated Leaven 9g, Trichosanthis Fructus (Quan Gualou, 全瓜蒌) 12g, Bombyx Batryticatus 9g (wrapped), Almond Paste 12g, Licorice Root 3g.
Second Visit: After medication, craving for cold drinks turned to craving for hot water, revealing the true nature of middle jiao cold. Thus, chest oppression, frequent sighing, and soft rapid pulses are all due to cold.
Raw Ephedrae Herba 3g, Prepared Aconiti Lateralis Radix (Pao Fupian, 炮附片) 5g (decoct first), Asari Radix et Rhizoma (Xixin, 细辛) 3g, Angelicae Dahuricae Radix 9g, Sinapis Semen (Baijiezi, 白芥子) 9g, Notopterygii Rhizoma et Radix 6g, Citri Reticulatae Pericarpium 6g, Litseae Fructus (Bichengqie, 荜澄茄) 9g, Bombyx Batryticatus 9g (wrapped), Fresh Ginger 3 slices.
[Commentary] In the initial visit, chest oppression, thirst for cold drinks, sighing, and red anterior tongue were false heat signs. Mr. Zhang was not confused by false appearances but grasped the key etiology and pathogenesis of wind-cold binding externally, prioritizing warm dispersal. The shift from craving cold to craving hot water in the second visit fully exposed the essence of middle jiao cold, demonstrating accurate differentiation.
6. Male. Exterior syndrome present, suffering from severe headache and low back pain, accompanied by constipation, scanty painful urination. Treat with Mu Xiang Bing Lang Wan (Aucklandia and Areca Pill) and Jiu Wei Qiang Huo Tang (Nine-Ingredient Notopterygium Decoction).
Saposhnikoviae Radix (Fangfeng, 防风) 6g, Notopterygii Rhizoma et Radix 6g, Asari Radix et Rhizoma 3g, Atractylodis Rhizoma (Cangzhu, 苍术) 5g, Angelicae Dahuricae Radix 9g, Ligustici Chuanxiong Rhizoma 5g, Scutellariae Radix (Huangqin, 黄芩) 5g, Rehmanniae Radix (Shengdi, 生地) 9g, Licorice Root 3g, Fresh Ginger 3 slices, Scallion White (Congbai, 葱白) 5 stalks. Additionally: Mu Xiang Bing Lang Wan 9g, taken once orally.
[Commentary] Mr. Zhang instructed taking the pill first to relieve constipation, then the decoction to resolve the exterior. This breaks the precedent of resolving the exterior before attacking the interior. It is also effective for early-stage acute enteritis.
7. Female. Sudden fever, aversion to cold, no sweat, headache, whole body soreness, chest bitterness and oppression, thin white greasy coating, pulse not rapid. Signs of common cold are fully manifest; generally, it takes one five-day period (yi hou) to resolve.
Schizonepetae Spica 6g, Saposhnikoviae Radix 6g, Ligustici Chuanxiong Rhizoma 5g, Allii Macrostemonis Bulbus (Xie Bai Tou, 薤白头) 9g, Amomi Fructus (Chun Sha Qiao, 春砂壳) 3g, Immature Bitter Orange Fruit (Sheng Zhishi, 生枳实) 6g, Glycyrrhizae Radix et Rhizoma Preparata 3g.
[Commentary] In this case, Mr. Zhang initially used two doses of a light acrid-warm exterior-resolving agent with little effect, then intensified the acrid-warm formula, switching to Modified Ma Huang Tang. Modified Ma Huang Tang uses Notopterygium and Levisticum Root to assist Ephedra and Cinnamon Twig in warm dispersal. The patient's chest oppression and white greasy coating improved with aromatic transforming agents like Amomum fruit, Allium bulb, and Immature Bitter Orange. Subsequently, Eupatorium, Amomum, and Medicated Leaven were used for aromatic transformation of turbidity and regulating qi digestion to complete the cure. Mr. Zhang always instructed patients to take acrid-warm exterior-resolving herbs warm and cover themselves to aid sweating, following Zhang Zhongjing's instruction in Shang Han Lun to "take slightly perspiring." After two doses of Modified Ma Huang Tang, the patient sweated, cooled down, and all symptoms resolved.
8. Ms. Xu. For 3 days, aversion to cold with fever, headache and bone soreness, slight nausea, white greasy tongue coating. Use this formula for acrid-warm exterior resolution to reduce fever, and aromatic transformation of turbidity to calm vomiting.
Schizonepetae Spica 5g, Perillae Folium 5g, Sichuan Cinnamon Twig (add later) 5g, Levistici Radix (Gaoben, 藁本) 9g, Notopterygii Rhizoma et Radix 9g, Angelicae Dahuricae Radix 5g, Pinelliae Rhizoma Preparatum 9g, Tangerine Peel (Chen Guangpi, 陈广皮) 5g, Medicated Leaven 6g, Fresh Ginger 2 slices.
Second Visit: Between gastro-intestinal type common cold and typhoid fever, if differentiation is difficult, diaphoretic agents can provide a general idea. Now, after medication, fever has completely subsided and has not risen for two days; it is not typhoid fever. Gastrointestinal function shows difficulty with stool and nausea after eating; adjust gastrointestinal function with this method.
Eupatorium Stem (Peilan Geng, 佩兰梗) 5g, Allii Macrostemonis Bulbus 9g, Pinelliae Rhizoma Preparatum 9g, Tangerine Peel 5g, Poria (Yun Ling, 云苓) 9g, Immature Bitter Orange Fruit 9g, Cardamom Seed (Baidoukou, 白豆蔻) 5g, Medicated Leaven 9g, Barley Sprout (Guyá, 谷芽) 9g, Malt (Maiya, 麦芽) 9g, Bergamia Fruit (Foshou, 佛手) 5g.
[Commentary] Mr. Zhang consistently advocated "developing ancient principles and integrating new knowledge," taking strengths to compensate for weaknesses. Thus, his cases often use Western medical disease names. This case uses practical experience to differentiate gastro-intestinal type common cold from typhoid fever, which is valuable. Initial visit resolved exterior and transformed turbidity; sweating led to complete fever subsidence, confirming it was not typhoid fever but common cold with external cold and internal dampness. Second visit used Er Chen Tang plus aromatic turbidity-transforming and qi-moving agents to adjust gastrointestinal function.
9. Female. Sweating with Ephedra and Cinnamon did not reduce fever; thick greasy coating, chest oppression and nausea, dampness obstructing Middle Jiao. Must disperse pathogen and transform dampness. For pathogens complicated by dampness, fever often cannot subside rapidly; aggressive exterior attack is useless.
Sichuan Cinnamon Twig 5g, Raw Atractylodis Rhizoma 3g, Citri Reticulatae Pericarpium 3g, Bamboo Shavings (Jiang Zhuru, 姜竹茹) 6g, Eupatorium with Leaves 6g, Stir-fried Bitter Orange Fruit (Chao Zhike, 炒枳壳) 6g, Pinelliae Rhizoma Preparatum 3g, Fresh Ginger 1 slice, Medicated Leaven 9g, Bombyx Batryticatus 12g (wrapped).
[Commentary] Wind-cold attacks the exterior, turbid dampness accumulates in the Middle Jiao. The main treatment principle: dispersing pathogens must include transforming dampness. "For pathogens complicated by dampness, fever often cannot subside rapidly," applies to both Cold Damage and Warm Diseases. This is empirical wisdom.
10. Male. External contraction complicated by dampness. Dampness is a yin pathogen, hence severe aversion to cold and cold feet.
Cinnamon Twig 9g, Angelicae Sinensis Radix 9g, Angelicae Dahuricae Radix 9g, Tsaoko Fructus (Caoguo, 草果) 9g, Bombyx Batryticatus 12g (wrapped), Gentianae Macrophyllae Radix 9g, Ligustici Chuanxiong Rhizoma 6g, Asari Radix et Rhizoma 3g, Saposhnikoviae Radix (Lingxian, 灵仙) 9g, Medicated Leaven 9g.
11. Male. What is called exterior pathogen complicated by dampness refers to cold affecting the digestive system; shivering chills, chest oppression, white coating, cold fingertips are all signs.
Schizonepetae Spica 9g, Eupatorium 9g, Angelicae Dahuricae Radix 9g, Pinellia 9g, Tsaoko Fructus (shelled) 9g, Tangerine Peel 9g, Magnolia Flower (Houpo Hua, 厚朴花) 6g, Curcumae Radix (Yujin, 郁金) 9g, Almond 12g, Coix Seed (Reni, 米仁) 12g, Bitter Orange Fruit 6g.
[Commentary] Dampness is a yin pathogen, easily causing stagnation of qi mechanism, so chest oppression and white greasy coating are mandatory symptoms. Clinically, aromatic opening and draining are used: lightly with Agastache, Eupatorium, Citrus peel, Cardamom; heavily with Immature Bitter Orange, Pinellia, Tsaoko. Case Shen focuses on dampness, emphasizing acrid opening; Case Yang has severe aversion to cold and cold feet, focusing on cold, emphasizing warm dispersal.
12. Male. Rapid pulse indicates heat, slippery coating indicates dampness; heat comes from outside, dampness generates inside; external sources are wind-cold, internal generation is mostly food retention.
Schizonepetae Spica 6g, Peucedani Radix (Qianhu, 前胡) 9g, Almond 12g, Platycodonis Radix (Jiegeng, 桔梗) 9g, Angelicae Dahuricae Radix 6g, Perillae Caulis (Sugeng, 苏梗) 6g, Asteris Radix (Ziwán, 紫菀) 9g, Medicated Leaven 9g, Immature Bitter Orange Fruit 6g, Arecae Semen (Binglang, 槟榔) 9g, Raphani Semen (Luóbo Zi, 萝卜子) 9g.
[Commentary] This is also a method of resolving both exterior and interior. Suitable for common cold complicated by dampness (or food).
13. Male. Person with yang deficiency, severely affected by wind-cold leading to cough, stabbing pain below half the body; fever is not high, but closing eyes causes dizziness. Excess leads to delirious speech, deficiency leads to murmuring speech, and deep fine pulse indicates deficiency. Ke Shi said "Taiyang deficiency becomes Shaoyin"; prescribe Modified Ma Huang Fu Zi Xi Xin Tang.
Honey-fried Ephedrae Herba 3g, Prepared Aconiti Radix (Pao Fu Kuai, 炮附块) 6g, Northern Asari Radix et Rhizoma 3g, Whole Angelicae Sinensis Radix 9g, Paeoniae Radix Alba 9g, Honey-fried Asteris Radix 9g, Honey-fried Polygalae Radix (Yuanzhi, 远志) 5g, Inulae Flos (Xuanfu Hua, 旋覆花) 9g (wrapped), Honey-fried Farfarae Flos (Kuandonghua, 款冬) 9g, Clear Honey-fried Licorice Root 3g.
[Commentary] Constitutionally yang deficient. Re-contracted wind-cold. Exterior dispersal damages healthy qi, tonification retains pathogen. Only Ma Huang Fu Zi Xi Xin Tang addresses both root and branch beautifully. Mr. Zhang modified the ancient formula: Ephedra acrid-warm to disperse exterior pathogen; Aconite warms yang and strengthens heart; Honey-fried Licorice tonifies qi and supports healthy qi; Angelica and Paeonia nourish blood and ease the acrid-dryness of Ephedra and Aconite; added Aster, Farfara, and Polygala to transform phlegm and stop cough. The prescription is comprehensive and worthy of emulation.
14. Female. During a common cold epidemic, deficient persons are most susceptible, and their presentation differs from normal people. Now severe aversion to cold, cold extremities, fine pulse nearly imperceptible, likely Dang Gui Si Ni Tang syndrome.
Whole Angelicae Sinensis Radix 9g, Sichuan Cinnamon Twig (add later) 6g, Paeoniae Radix Alba 9g, Northern Asari Radix et Rhizoma 3g, Tetrapanacis Medulla (Geng Tong Cao, 梗通草) 5g, Evodiae Fructus 3g, Notopterygii Rhizoma et Radix 9g, Left Gentianae Macrophyllae Radix 9g, Clear Honey-fried Licorice Root 3g, Fresh Ginger 2 slices, Jujube Date 7 pieces.
[Commentary] Common cold in deficient persons presents differently; cannot rely solely on exterior resolution. Severe aversion to cold, cold extremities, fine pulse nearly absent indicate chronic yang deficiency and blood weakness compounded by external cold. Hence, Dang Gui Si Ni Tang plus Evodia and Fresh Ginger. Asari and Notopterygium disperse cold; Evodia warms middle; Angelica and Paeonia invigorate and nourish blood; Tetrapanax and Cinnamon unblock vessels; Fresh Ginger and Jujube harmonize Ying and Wei.
15. Elderly Woman. Fever for ten days unrelenting, yet aversion to cold persists; thirst preferring hot drinks, feet not warm; pulse occasionally skips beats. This pattern is upper heat and lower cold, a precursor to Dai Yang (floating yang); heat outside and cold inside, Ge Yang (repelling yang outward). In summer season, warming and tonifying agents work like drumbeats. Ancients compared this to well water; understanding things is essential for physicians. Some say Aconite and Cinnamon are forbidden in summer; this is unacceptable. Physicians must adapt medicine to syndrome changes, not be rigid! Prescribe Si Ni Tang combined with Yu Ping Feng San.
Prepared Aconiti Radix 9g, Charred Ginger (Pao Jiang Tan, 炮姜炭) 5g, Clear Honey-fried Licorice Root 6g, Raw Astragali Radix 12g, Raw Atractylodis Macrocephalae Rhizoma 9g, Honey-fried Saposhnikoviae Radix 3g, Whole Angelicae Sinensis Radix 9g, Northern Asari Radix et Rhizoma 3g, Tetrapanacis Medulla 6g.
[Commentary] This is also common cold in a deficient person. Si Ni Tang warms the Shaoyin channel, adding Asari to disperse cold; Yu Ping Feng San plus Angelica takes the meaning of tonification containing dispersal. The case commentary emphasizes syndrome differentiation, reflecting Mr. Zhang's lifelong emphasis.
16. Male. Elderly people have declining functions in all parts; slight cold leads to extreme fatigue and cold sweat like seepage. Prescribe Gui Zhi Tang adding Aconite; add Aster for cough; add Tsaoko for greasy coating.
Cinnamon Twig (add later) 5g, Prepared Aconiti Radix 5g, Sinapis Semen 5g, Paeoniae Radix Alba 12g, Honey-fried Asteris Radix 9g, Roasted Tsaoko Fructus 6g, Glycyrrhizae Radix et Rhizoma Preparata 3g, Notopterygii Rhizoma et Radix 6g, Taxilli Herba 12g, Angelicae Dahuricae Radix 9g, Fresh Ginger 3 slices, Jujube Date 7 pieces.
[Commentary] Cold sweat like a spring in this case is a sign of declining Heart Yang. Even with cold, do not attack the exterior. Mr. Zhang considered Gui Zhi Tang not just an exterior drug but a tonic. Enhancing bodily function ensures recovery from external contraction. Adding Aconite in the formula strongly restores declining Heart Yang.
17. Female. Hair stands on end facing wind, whole body soreness as if beaten, signs of Qi deficiency. Pregnant six months, difficulty with bowel movements, cannot use harsh purgatives.
Sichuan Cinnamon Twig (add later) 5g, Paeoniae Radix Alba 9g, Glycyrrhizae Radix et Rhizoma Preparata 3g, Saposhnikoviae Radix 9g, Notopterygii Rhizoma et Radix 9g, Left Gentianae Macrophyllae Radix 9g, Light Almond 15g, Stir-fried Immature Bitter Orange Fruit 9g, Trichosanthis Fructus 12g, Medicated Leaven 9g, Fresh Ginger 2 slices, Jujube Date 7 pieces.
[Commentary] This is a condition involving both exterior and interior. Primarily exterior; since the patient is pregnant, Gui Zhi Tang plus Notopterygium and Saposhnikovia resolves the exterior, while Immature Bitter Orange, Medicated Leaven, Almond, and Trichosanxis guide stagnation and remove accumulation. This shares similarities and differences with the previous case; they should be cross-referenced.
18. Female. Alternating chills and fever, no sweat, whole body joints all painful; menstruation just started, hence severe mental restlessness. This is what Zhongjing called "Heat Entering Blood Chamber." Further mental symptoms may appear.
Soft Bupleuri Radix 5g, Clean Ephedrae Herba 3g, Sichuan Cinnamon Twig 5g, Notopterygii Rhizoma et Radix 9g, Large Ligustici Chuanxiong Rhizoma 5g, Peach Kernel Paste 12g, Moutan Cortex 9g, Red Paeonia Root 9g, Raw Licorice Root 3g.
Second Visit: Chills and muscle heat reduced, menstrual flow intermittent, mass and pain below umbilicus. Whenever fever occurs during menstruation, suffering doubles. Soft Bupleuri Radix 5g, Whole Angelicae Sinensis Radix 9g, Large Ligustici Chuanxiong Rhizoma 5g, Peach Kernel Paste 12g, Honey-fried Frankincense 9g, Honey-fried Myrrh 9g, Processed Cyperi Rhizoma 9g, Small Green Citrus Peel 9g, Corydalis Rhizoma 9g, Linderae Cortex 9g, Raw Mugwort Leaf 9g. [Commentary] Heat and blood congeal, requiring blood-invigorating and collateral-unblocking to break the congealment; as blood moves, pathogenic heat resolves. Initial visit resolved exterior and moved blood; second visit, due to "intermittent flow and abdominal mass," boldly pursued stasis removal.
19. Female. Initially whole body joint soreness, sensation of insects crawling under skin; one week later high fever, right pulse deep and hidden, chest heat feeling like roasting, unbearable. However, initial joint soreness was actually a prelude to menstruation. Menstruation arrived prematurely, evening consciousness became cloudy, signs of Heat Entering Blood Chamber. Vinegar-processed Bupleuri Radix 6g, Wine-processed Scutellariae Radix 9g, Clean Forsythiae Fructus 15g, Raw Rubia Cordifolia Radix 9g, Tender Arnebiae Radix 5g, Stir-fried Schizonepetae Spica 6g, Pinelliae Rhizoma Preparatum 9g, Acori Tatarinowii Rhizoma 9g, Pi Wen Dan 1 pill (powdered, swallowed).
[Commentary] "Heat Entering Blood Chamber" appears in the Taiyang Chapter of Shang Han Lun. It refers to women contracting external pathogens during menstruation, where pathogenic heat binds with blood, presenting with lower abdominal fullness/pain, alternating chills/fever like malaria, clarity during day, delirium at night. Treatment ranges from puncturing Qimen point to Xiao Chai Hu Tang. This case uses the formula removing sweet and sour ingredients, adding Arnebia, Rubia, stir-fried Schizonepeta, and Forsythia to cool blood, expel stasis, and clear heat; Acorus opens orifices and awakens spirit; Pi Wen Dan treats external pathogens, fitting the disease perfectly. "Pi Wen Dan" is a proprietary medicine, now renamed "Jie Shu Pian" in Shanghai, composed of 73 herbs, with effects of detoxifying, dispelling turbidity, and stopping abdominal pain/vomiting/diarrhea.
20. Male. Absolutely no heat during the day, fever occurs at night, consecutive 3 nights, sweating during fever, thin yellow greasy coating, accompanied by joint soreness, thus diagnosed as common cold. Common cold can have this fever pattern. Vinegar-processed Bupleuri Radix 6g, Paeoniae Radix Alba 6g, Wine-processed Black Soybean 12g, Pale Scutellariae Radix 5g, Anemarrhenae Rhizoma 9g, Roasted Tsaoko Fructus 5g, Gentianae Macrophyllae Radix 9g, Turmeric Tuber 5g, Saposhnikoviae Radix 9g, Glycyrrhizae Radix et Rhizoma Preparata 3g. [Commentary] This case has thin yellow greasy coating, joint soreness, lasting only three nights, thus diagnosed as common cold. If night fever persists long-term, other diseases should be considered.