因知甘草安肠一说，不为无见。盖疾病由上传下，由表入里，由寒化热，既为必然之趋势，今安和其肠，即所以保其在里在下之津者，自为着要之法矣。至于大小二承气汤证因病已传肠，邪已内实，故不必用甘草。及其邪去肠虚，又当重用甘草以益之，不待再计者也。学者当知此九方者处同等重要之地位，各有专功，不容漠视。集此九方，即成《防寒论》中太阳阳明二经之骨干。识此九方，即能治伤寒，亦能治温病。学者将疑吾言之夸乎？吾敢实陈读者。
尤氏在泾曰：无汗必发其汗，麻黄汤所以去表实，而发邪气。有汗不可更发汗。桂枝汤所以助表气，而逐邪气。学者但当分病证之有汗无汗，以严麻黄桂枝之辨，不必执营卫之孰虚孰实，以证中风伤寒之殊。是无汗为表实，反云卫虚，麻黄之去实，宁独遗卫？能不胶于俗说者，斯为豪杰之士！柯氏韵伯曰：桂枝汤证唯以脉弱自汗为主耳。粗工妄谓桂枝汤专治中风，印定后人耳目，而所称中风者又与此方不合，故置之不用。愚常以此汤治自汗盗汗虚疟虚痢，随手而愈。
又曰：予治冷风吹与风寒湿三气合成痹等证，用麻黄汤辄效，非伤寒证可拘也。
其言何等精辟，然则尤氏柯氏皆能识麻桂二汤者也。陆氏九芝曰：葛根芩连一方独见遗于阳明者，以人必见下利始用之，不下利即不用，而不以为是阳明主方也。孰知此方之所用者宏，而所包者广也。然则陆氏能识葛根芩连汤者也。又曰：无人知温热之病，本隶于伤寒论中，而温热之方，并不在伤寒论外。然则陆氏又能看破伤寒温病之画地为牢者也。
吴氏又可曰：应下之证，见下无结粪，以为下之早，或以为不应下之证，误投下药。殊不知承气本为逐邪而设，非专为结粪而设也。必侯其粪结，血液为热所搏，变证迭起，是犹养虎遗患，医之咎也。况多有溏粪失下，但蒸作极臭，如败酱，或如藕泥，临死不结者。但得秽恶一去，邪毒从此而消，脉证从此而退，岂徒孜孜粪结而后行哉？此言超拔非凡，然则吴氏能识诸承气汤者也。叶氏天士曰：温邪上受，首先犯肺。吴氏鞠通曰：凡病温者，始于上焦，在手太阴。
法曰辛凉轻平，方号桑菊银翘。虽无麻杏甘石之名，而有泛治肺热之实。苟吾人不求酷论，谓叶氏吴氏能识麻杏甘石汤可也。而吴氏之用白虎，或以化斑，或以解暑，颇具变化之观。苟吾人不吝誉语，可称之曰微有仲圣用桂枝之风，然则吴氏亦能识白虎汤者也。由是言之，诸氏皆仲圣之功臣也。
中卷
桂枝二麻黄一汤证其一
王右六月二十二日寒热往来，一日两度发，仲景所谓宜桂枝二麻黄一汤之证也。前医用小柴胡，原自不谬，但差一间耳！川桂技五钱白芍四钱生草三钱生麻黄二钱光杏仁五钱生姜三片红枣五枚
【按】病者服此，盖被自卧，须臾发热，遍身漐漐汗出，其病愈矣。又服药时，最好在寒热发作前约一二小时许，其效为著。依仲圣法，凡发热恶寒自一日再发（指发热二次，非谓合发热恶寒为二次）以至十数度发，皆为太阳病。若一日一发，以至三数日一发，皆为少阳病。少阳病多先寒而后热，太阳如疟证却有先热而后寒者，观大论称少阳曰寒热往来，称太阳如疟曰发热恶寒，热多寒少，不无微意于其间欤。以言治法，少阳病宜柴胡剂，太阳病宜麻桂剂，证之实验，历历不爽。若反其道以行之，以柴胡剂治寒热日数度发之太阳如疟，每每不效，以麻桂剂治寒热一作之少阳病，虽偶或得效，究未能恰中规矩。
《方极》云：桂枝二麻黄一汤治桂枝汤证多，麻黄汤证少。桂枝麻黄各半汤治桂枝汤麻黄汤二方证相半者。此言似是而非，将令人有无从衡量之苦。余则凭证用方，凡发热恶寒同时皆作，有汗者用桂枝汤，无汗者用麻黄汤，发热恶寒次第间作，自再发以至十数度发者，择用桂二麻一等三方，层次厘然，绝无混淆。
曹颖甫曰：少阳病之所以异于太阳者，以其有间也。若日再发或二三度发，则为无间矣。太阳所以异于阳明者，以其有寒也，若但热不寒，直谓之阳明可矣，恶得谓之太阳病乎？固知有寒有热，一日之中循环不已者为太阳病，寒热日发，有间隙如无病之人者为少阳病，此麻桂二汤合用与柴胡汤独用之别也。病理既明，随证用药可矣。
桂枝二麻黄一汤证其二（附列门人治验）
施右住唐家湾肇周路仁德里二号
【按】本年七月十五日，予施诊于广益中医院，有施姓妇者蹙頞告诉曰：先生，我昨服院外他医之方，病转剧，苦不堪言。余为之愕然，令陈其方，照录如下：经事淋漓，入夜寒热，胸闷泛恶，苔灰腻，治宜荆芩四物汤加味。
炒荆芥钱半炒条芩钱半全当归二钱大川芎八分炒丹皮钱半赤白芍各钱半金铃子二钱制香附钱半元胡索钱半贯仲炭三钱荷叶一角余曰：方未误，安得转剧？妇曰：否，初我夜寐粗安，大便如常，自进昨药，夜中心痛甚剧，辗转不能成寐，且大便转为泄泻，乞先生一治之。予按例首问其病历，妇曰：半月矣。次问其寒热，妇曰：倏冷倏热，不计其次。余闻其言，若有所得焉。妇自陈其异状，汗出自首至胸而止，既不达于胸下，亦不及于两臂。予思论有剂颈而还之语，此殆剂胸而还乎？察其舌，黑近墨而不焦，口奇干。
余疑其方进陈皮梅、松花蛋之属。妇曰：非是，日来苔黑，常作此状。按其脉，幸尚不微细。两肩至臂颇麻木。加以经事淋漓不止，妇几不能悉陈其状。予对此错杂之证，亦几有无从下笔之苦。使从所谓对症治法，琐琐而治之，则用药得毋近数十味？然而此非我所能也，因书方曰：初诊七月十五日寒热往来，每日七八度发，已两候矣。汗出，剂胸而还，经事淋漓，法当解表为先，以其心痛，加生地，倍甘草。
净麻黄一钱川桂枝二钱生甘草三钱生苡仁一两杏仁三钱生白芍钱半生地五钱制川朴一钱生姜二片红枣六枚二诊七月十六日昨进药后，汗出，遍身漐漐，心痛止，经事停，大便溏薄瘥，麻木减，仅自臂及指矣。黑苔渐退，口干渐和，夜中咳嗽得痰，并得矢气，是佳象。前方有效，不必更张。
净麻黄一钱川桂枝钱半生甘草二钱生白芍钱半大生地五钱制小朴一钱杏仁三钱生姜二片红枣六枚
【按】子遵仲圣脉证治法，而疏昨方，心未尝不惴惴也！以为次日彼诊，能得寒热略除，即是大功，乃喜出望外，非但热退神振，抑且诸恙并差，有如方案所云，斯亦奇矣！试求其所以能愈病之理，以证状学之立场言之，必曰能治其主证，斯一切客证或副证不治自愈也。此言不误，然而无补于病理之了解。幸有博雅君子，阅吾此案，赐予说明其中一切病理。如苔黑口干，何以反立麻桂？发汗伤津，何以反除心痛？经水淋漓，大便溏泄，犹风马牛之不相及，何以戛然并止？所深愿也。
曹颖甫曰：太阳水气留于心下，则津不上承而渴，此意丁甘仁先生常言之。舌黑不焦，大便又溏，知非阳明热证，而黑色亦为水气，水气凌心，心阳不振，故痛。大便溏，则为条芩之误，不用条芩，溏薄自止，非本方之功也。水气不能化汗外泄，故脾阳不振，而指臂麻。经水淋漓，亦水分多于血分，为水气所压故也。知病之所从来，即知病之所由去，不待烦言矣。
三诊七月十七日寒热如疟渐除，大便已行，舌苔黑色亦淡，麻木仅在手指间。惟余咳嗽未楚，胸胁牵痛，有喘意，参桂枝加厚朴杏子法。
杏仁四钱厚朴钱半川桂枝二钱生草三钱白芍二钱大生地六钱丝瓜络四钱生姜一片红枣六枚
【按】服此大佳，轻剂调理而安。
顾左住方斜路十月二十一寒热交作，一日十数度发，此非疟疾，乃太阳病，宜桂枝麻黄各半汤。
【按】桂枝麻黄各半汤方，原法分为三服，桂枝二麻黄一汤方，原法分为再服。取前方原量三之一，后方原量二之一而较之，得麻杏同量，而后方之桂芍姜草枣悉比前方约多一倍，故前方名各半，而后方名桂二麻一也。然而近代煎服法，率分二次煎服，与古者不同，况其分量上下，又甚微细，故吾人但知此二方之应用足矣，初不必过分斤斤于铢两之间也。
曹颖甫曰：此证甚轻，故轻剂而病易愈，不徒与铢两不合已也。
庆孙七月二十七日起病由于暴感风寒，大便不行，头顶痛，此为太阳阳明同病。自服救命丹，大便行，而头痛稍愈。今表证未尽，里证亦未尽，脉浮缓，身常有汗，宜桂枝加大黄汤。
【按】治病当先解其表，后攻其里，此常法也，前固言之稔矣。余依临床所得，常有表解之后，其里自通，初不须假药力之助者。缘先表束之时，病者元气只顾应付表证，不暇及里，及表解之后，则元气自能反旌对里。夫元气之进退往返，谁能目之者，然而事实如此，勿可诬也。故余逢表束里张之证，若便闭未越三日者，恒置通里于不问，非不问也，将待其自得耳。
若本汤之合解表通里药为一方者，又是一法。然其间解表者占七分，通里者占三分，不无宾主之分。以其已用里药，故通里为宾，以其未用表药，故解表为主，双管齐下，病去而元气乃无忧。
余二十五岁时，能读医书，而尚不善于治病。随表兄陈尚白买舟赴南京，应秋试。陈夫妇同宿中舱，余宿前舱。天方褥暑，骄阳如炽。
舟泊无锡，陈夫妇相偕登陆，赴浴惠泉，嘱余守舱中。余汗出侠背，又不便易衣，令其自干。饮食起居又不适，因是心恒悒悒然。舟泊五日，方启锭。又五日，乃抵镇江。下榻后，部署初定，即卧病矣。延医疏方，不外鲜藿香、鲜佩兰之属。服之数日，病反加剧。汗出，热不清，而恶寒无已。当夜乘轮赴京。时觉天昏地黑，不知人事。比抵石城，诸友扶住堂子巷寓所。每小便，辄血出，作殷红色，且觉头痛。
时为八月初五日，距进场之期仅三天矣。是时，姻丈陈葆厚先生已先余到南京。丈精于医，诊脉一过，即亲出市药，及荷叶露三大瓶，生梨十余枚以归。并属先饮露，饮已，口即不干。顷之又渴，复啖生梨，梨皮不遑削，仅弃其心，顷刻尽十枚。迨药煎成，即进一大碗，心中顿觉清朗，倦极而睡。醒后，头已不痛，惟汗未出。更进二煎，浓倍于前。服后，又睡。醒时，不觉周身汗出，先小汗，后大汗，竟至内衣夹袄被褥上下皆湿，急起更易，反被以盖。于是方觉诸恙悉除，腹中知饥，索热粥。侍者曰：粥已备，盖陈丈所预嘱者也。初吸一小碗，觉香甜逾恒。稍停，又续进，竟其夜，竟尽二大碗。初七日，即能进场。试期达九日夜，毫无倦容。余乃惊陈丈医术之神。叩其药，则桂枝石膏二味同捣也。问其价，曰：适逢新开药铺，共费钱六文而已。遂相与大笑。
【按】头痛而恶寒，此太阳病未罢也，法当令其汗出而解。然小便已见血出，安复有余液可以作汗？故先饮荷叶露及生梨者，增其液以为作汗之张本也。于是与石膏以清其内蕴之热，与桂枝以祛其外束之寒。寒因汗解，热因凉除。醒来索粥，是即白虎汤之粳米，向之饮露，亦犹加参汤之人参。看其啖梨啜露之顷，孰知已含圣法。呜呼，化冲圣方活而用之，其功效必无穷也。
【又按】白虎加挂枝汤证多见于夏日，诚以炎暑蒸人，胃肠本已热化，入夜凉风习习，未免贪享，故致表里交病。表为寒束，则热无外泄之机，势必愈炽。
热既内炽，则更易伤津，使无从作汗以解表。惟有投白虎汤以治其本（肠胃之热），同时加桂枝以治其标（表证之寒），标本并治，方可热除津复，汗出表解。依余经验，桂枝轻至一钱，生石膏轻至三钱，亦可有效。设不尔者，但用白虎以清热，则表证将愈甚，但用桂枝以解表，则内热将愈炽，终不免坏病之变，此乃桂枝石膏二药必须合作而不可分离之理也。或曰：君前谓石膏凉胃，桂枝温胃，何能温凉并进，反获奇功耶？曰：仲圣方温凉并用者，诸泻心汤即在其例，若桂枝与石膏犹其始焉者尔。盖人体之机构复杂繁沓，灵敏万分，及其病时，作用尤显。各部机构每自能吸取其所需，而放任其所不需者。若论本汤证，则胃取石膏之凉而消热，动脉取桂枝之散而致汗，故二者非但不相左，抑且相成。
前桂枝加大黄汤为七分太阳，三分阳明。今白虎加桂枝汤为七分阳明，三分太阳。二汤之对仗，堪称工整。医者能合用仲圣诸方，即可曲应万变之病，兹二汤特发其凡耳。
麻黄附子甘草汤证（附列门人治验）
余尝治上海电报局高君之公子，年五龄，身无热，亦不恶寒，二便如常，但欲寐，强呼之醒，与之食，食已，又呼呼睡去。按其脉，微细无力。余曰：此仲景先圣所谓少阴之为病，脉微细，但欲寐也。
顾余知治之之方，尚不敢必治之之验，请另乞诊于高明。高君自明西医理，能注射强心针，顾又知强心针仅能取效于一时，非根本之图，强请立方。余不获已，书：熟附片八分净麻黄一钱炙甘草一钱与之，又恐其食而不化，略加六神曲、炒麦芽等消食健脾之品。
因此可知，甘草能够安和肠道这一说法，并非没有道理。因为疾病往往由上焦传变至下焦，由体表侵入体内，由寒证转化为热证，这既是必然的趋势；如今安和其肠道，就是保护其体内在下部的津液，这自然是重要的治疗方法。至于大承气汤和小承气汤的适应证，是因为病邪已经传入肠道，邪气在体内结实，所以不需要使用甘草。等到邪气去除、肠道虚弱时，又应当重用甘草来补益，这是不言而喻的。学者们应当知道这九个方剂处于同等重要的地位，各有专长功效，不容轻视。汇集这九个方剂，就构成了《防寒论》中太阳经和阳明经的骨干。掌握了这九个方剂，既能治疗伤寒，也能治疗温病。学者们或许会怀疑我的话是否夸大？我敢向读者如实陈述。
尤在泾说：无汗必须发汗，麻黄汤是用来解除表实，发散邪气的。有汗则不可再发汗。桂枝汤是用来助长表气，驱逐邪气的。学者们只应当根据病症是否有汗，严格区分麻黄汤和桂枝汤的使用，不必拘泥于营卫孰虚孰实，来证明中风和伤寒的区别。如果说无汗是表实，反而说是卫气虚，那么麻黄汤用来祛除实邪，难道唯独遗漏了卫气吗？能不拘泥于世俗说法的人，这才是豪杰之士！柯韵伯说：桂枝汤的适应证主要以脉弱、自汗为主。庸医错误地认为桂枝汤专门治疗中风，误导了后人的视听，而且他们所称的中风与此方并不相符，所以将其搁置不用。我常常用此方治疗自汗、盗汗、虚疟、虚痢，随手而愈。
又说：我治疗冷风吹袭以及风寒湿三气合而成的痹证等病症，使用麻黄汤往往有效，这并不局限于伤寒证的范畴。
他的话何等精辟，既然这样，那么尤氏和柯氏都能识别麻黄汤和桂枝汤。陆九芝说：葛根芩连汤一方唯独被遗落在阳明病的讨论之外，是因为人们一定要见到下利才使用它，不下利就不使用，而不把它当作阳明病的主方。谁知道这个方剂的适用范围很广，涵盖的内容很多。既然这样，那么陆氏能识别葛根芩连汤。又说：没有人知道温热病原本隶属于《伤寒论》中，而温热病的方剂，也并不在《伤寒论》之外。既然这样，那么陆氏又能看破伤寒与温病画地为牢的界限。
吴又可说：应当使用下法的证候，用了下法却没有燥屎排出，认为是下得太早，或者认为是不应使用下法的证候，误投了下药。殊不知承气汤本来是为了驱逐邪气而设立的，并非专为燥屎而设。一定要等到粪便结硬，血液被热邪搏结，各种变证接连出现，这如同养虎为患，是医生的过错。况且有很多大便溏泄却未能及时攻下的情况，只是蒸腾出极臭的气味，像败酱草或藕泥一样，直到死也不会结硬。只要秽恶之物一去，邪毒从此消除，脉象和症状从此消退，哪里只是孜孜不倦地等待粪便结硬后才行动呢？这番话超拔非凡，既然这样，那么吴氏能识别各种承气汤。叶天士说：温邪从上面受入，首先侵犯肺脏。吴鞠通说：凡是得温病的人，开始于上焦，在手太阴肺经。
治法讲究辛凉轻平，方剂名为桑菊饮和银翘散。虽然没有麻杏甘石汤的名号，却有泛治肺热的实效。如果我们不苛求评论，可以说叶氏和吴氏能识别麻杏甘石汤。而吴氏使用白虎汤，有时用于化斑，有时用于解暑，颇具变化之妙。如果我们不吝惜赞誉，可以称他略微具有仲景使用桂枝汤的风范，既然这样，那么吴氏也能识别白虎汤。由此而言，各位医家都是仲景的功臣。
中卷
桂枝二麻黄一汤证其一
王姓患者，六月二十二日，寒热往来，一天发作两次，这是张仲景所说的适宜用桂枝二麻黄一汤的证候。前医用小柴胡汤，原本没有错误，只是差了一点点！川桂枝五钱，白芍四钱，生甘草三钱，生麻黄二钱，光杏仁五钱，生姜三片，红枣五枚。
【按】病人服用此方后，大概盖着被子躺下，不一会儿发热，全身微微出汗，病就好了。另外服药时间，最好在寒热发作前约一二小时左右，效果更为显著。依照仲圣的方法，凡是发热恶寒从一天发作两次（指发热两次，不是说发热恶寒加起来算两次）以至十几次发作，都属于太阳病。如果一天发作一次，以至三四天发作一次，都属于少阳病。少阳病多先恶寒而后发热，太阳病如疟疾的证候却有先发热而后恶寒的情况，观察《伤寒论》称少阳为“寒热往来”，称太阳如疟疾为“发热恶寒，热多寒少”，其中似乎蕴含着微妙的用意吧。从治疗方法来说，少阳病适宜用柴胡剂，太阳病适宜用麻桂剂，验证于临床实验，历历不爽。如果反其道而行之，用柴胡剂治疗寒热一天发作几次的太阳如疟疾，每每无效；用麻桂剂治疗寒热发作一次的少阳病，虽然偶尔有效，终究不能恰好符合规矩。
《方极》说：桂枝二麻黄一汤治疗桂枝汤证多，麻黄汤证少的情况。桂枝麻黄各半汤治疗桂枝汤和麻黄汤两个方剂的证候各占一半的情况。这种说法似是而非，将让人无从衡量之苦。我则是依据证候选用方剂，凡是发热恶寒同时出现，有汗的用桂枝汤，无汗的用麻黄汤；发热恶寒交替出现，从发作两次以至十几次发作的，选择桂枝二麻黄一等三方，层次清晰，绝无混淆。
曹颖甫说：少阳病之所以不同于太阳病，是因为它有间歇。如果一天发作两次或两三次，就没有间歇了。太阳病之所以不同于阳明病，是因为它有恶寒，如果只有发热没有恶寒，直接称之为阳明病就可以了，怎么能称之为太阳病呢？所以知道既有恶寒又有发热，一天之中循环不已的是太阳病；恶寒发热每天发作，有间隙像没病的人一样的是少阳病，这是麻黄汤和桂枝汤合用与单独使用柴胡汤的区别。病理既然明确，随证用药即可。
桂枝二麻黄一汤证其二（附列门人治验）
施姓患者，住在唐家湾肇周路仁德里二号。
【按】本年七月十五日，我在广益中医院为施姓患者诊治，有一位施姓妇女皱着眉头告诉我说：“先生，我昨天服用了院外其他医生的方子，病情加重，痛苦不堪。”我感到愕然，让她出示方子，照录如下：荆芥穗炒钱半，黄芩炒钱半，全当归二钱，川芎八分，丹皮炒钱半，赤芍和白芍各钱半，金铃子二钱，制香附钱半，元胡索钱半，贯众炭三钱，荷叶一角。
我说：方子没有错误，怎么会加重？妇女说：不是的，起初我夜里睡眠还算安稳，大便正常，自从吃了昨天的药，夜里心痛剧烈，辗转不能入睡，而且大便转为泄泻，请求先生治疗。我按照惯例首先询问她的病史，妇女说：半个月了。接着问寒热情况，妇女说：忽冷忽热，不计次数。我听了她的话，好像有所领悟。妇女自述异常状况，出汗从头部到胸部停止，既不达到胸下，也不及于双臂。我想《伤寒论》中有“剂颈而还”的说法，这大概是“剂胸而还”吧？观察她的舌头，黑近墨色但不焦枯，口奇干。
我怀疑她方子里进了陈皮梅、松花蛋之类的东西。妇女说：不是，这几天舌苔黑，常是这个样子。诊她的脉，幸好还不微细。双肩到手臂颇麻木。加上月经淋漓不止，妇女几乎无法完全陈述病情。面对这种错综复杂的证候，我也几乎有无从下笔的痛苦。如果按照所谓的对症治法，琐碎地治疗，那么用药岂不是接近几十味？然而这不是我能做的，于是开方说：初诊七月十五日，寒热往来，每天发作七八次，已经两周了。出汗，止于胸部，月经淋漓，治法应当先解表，因其心痛，加生地，倍用甘草。
净麻黄一钱，川桂枝二钱，生甘草三钱，生苡仁一两，杏仁三钱，生白芍钱半，生地五钱，制厚朴一钱，生姜二片，红枣六枚。
二诊七月十六日：昨天服药后，出汗，全身微微出汗，心痛停止，月经停止，大便溏薄好转，麻木减轻，仅从手臂及手指。黑苔渐退，口干渐缓，夜里咳嗽有痰，并能排气，这是好现象。前方有效，不必更改。
净麻黄一钱，川桂枝钱半，生甘草二钱，生白芍钱半，大生地五钱，制厚朴一钱，杏仁三钱，生姜二片，红枣六枚。
【按】我遵循仲圣的脉证治法，开出昨天的方子，心里未曾不忐忑不安！以为第二天复诊，如果能得到寒热稍微缓解，就是大功告成，没想到喜出望外，不仅热退神振，而且诸症并除，就像方案所说的那样，这也太奇妙了！试着寻求它能治愈疾病的原理，从症状学的立场来说，必定是能治疗主证，那么一切客证或副证不治自愈。这话不错，然而对病理的了解没有帮助。幸而有博雅君子，阅读我的此案，赐予说明其中一切病理。比如舌黑口干，为什么反而用麻黄和桂枝？发汗伤津，为什么反而去除了心痛？月经淋漓，大便溏泄，犹如风马牛不相及，为什么戛然而止？这是我深切的愿望。
曹颖甫说：太阳水气停留于心下，津液不能上承而口渴，这个意思丁甘仁先生经常说。舌黑不焦，大便又溏，知道不是阳明热证，而黑色也是水气，水气凌心，心阳不振，所以痛。大便溏，是黄芩的错误，不用黄芩，溏薄自然停止，不是本方的功劳。水气不能化为汗液外泄，所以脾阳不振，而手指手臂麻木。月经淋漓，也是水分多于血分，被水气压迫的缘故。知道病从哪里来，就知道病从哪里去，不用说多了。
三诊七月十七日：寒热如疟疾逐渐消除，大便已行，舌苔黑色也淡了，麻木仅在手指间。只剩下咳嗽未清，胸胁牵痛，有喘息之意，参考桂枝加厚朴杏子汤的方法。
杏仁四钱，厚朴钱半，川桂枝二钱，生甘草三钱，白芍二钱，大生地六钱，丝瓜络四钱，生姜一片，红枣六枚。
【按】服用此方非常好，轻剂调理而安。
顾姓患者，住在方斜路，十月二十一日，寒热交作，一天发作十几次，这不是疟疾，而是太阳病，适宜用桂枝麻黄各半汤。
桂枝三钱，甘草钱半，杏仁五钱，麻黄钱半，白芍钱半，生姜二片，大枣四枚。
【按】桂枝麻黄各半汤方，原法分为三服，桂枝二麻黄一汤方，原法分为再服。取前方原量的三分之一，后方原量的一半进行比较，得到麻黄和杏仁同量，而后方的桂枝、芍药、生姜、甘草、大枣都比前方大约多一倍，所以前方名叫各半，而后方名叫桂二麻一。然而近代煎服法，通常分两次煎服，与古代不同，况且其分量上下，又非常细微，所以我们只要知道这两个方剂的应用就够了，起初不必过分计较毫厘之间。
曹颖甫说：这个证候很轻，所以轻剂而病容易痊愈，不只是与分量不合而已。
庆孙，七月二十七日起病由于暴感风寒，大便不通，头顶痛，这是太阳阳明同病。自己服用救命丹，大便通了，而头痛稍愈。现在表证未尽，里证也未尽，脉浮缓，身体常有汗，适宜用桂枝加大黄汤。
川桂枝三钱，生白芍三钱，生甘草一钱，生大黄三钱，生姜三片，红枣三枚。
【按】治病应当先解表，后攻里，这是常法，前面已经说得很多了。我根据临床经验，常有表解之后，其里自通，起初不需要借助药力帮助的情况。因为先表束的时候，病人的元气只顾应付表证，无暇顾及里，等到表解之后，则元气自然能反过来对付里。元气的进退往返，谁能看见呢？然而事实如此，不可诬蔑。所以我遇到表束里张的证候，如果便秘不超过三天，常常把通里放在一边不问，不是不问，是等待它自行通畅。
如果把这个汤的解表和通里药合为一个方子，又是另一种方法。然而其中解表占七分，通里占三分，不无主次之分。因为已经用了里药，所以通里为宾；因为没用表药，所以解表为主，双管齐下，病去而元气无忧。
我二十五岁时，能读医书，但还不善于治病。跟随表兄陈尚白买船前往南京，参加秋试。陈夫妇同住中舱，我宿在前舱。当时正值盛夏，骄阳似火。
船停泊在无锡，陈夫妇一起上岸，去惠泉洗澡，嘱咐我守舱。我汗出夹背，又不便换衣服，让它自己干。饮食起居又不舒适，因此心中总是郁郁寡欢。船停泊五天，才启航。又五天，才到达镇江。入住旅馆后，部署刚定，就卧病在床。请医生开方，不外乎鲜藿香、鲜佩兰之类。服了几日，病情反而加剧。出汗，热不清，而恶寒不止。当晚乘轮赴京。当时觉得天昏地黑，不知人事。等到抵达南京，朋友们扶住堂子巷寓所。每次小便，就有血出来，呈殷红色，且觉得头痛。
当时是八月初五日，距离进场考试期仅三天了。这时，姻丈陈葆厚先生已经先我到达南京。岳父精通医术，诊脉一遍，就亲自去买药，以及荷叶露三大瓶，生梨十余枚回来。并嘱咐先喝露，喝完，口就不干了。过了一会儿又渴，又吃生梨，梨皮来不及削，仅去掉梨心，顷刻吃完十个。等到药煎成，就进一大碗，心中顿时觉得清朗，疲倦极了就睡了。醒来后，头已经不痛，只是还没出汗。再进二煎，浓度比之前加倍。服后，又睡。醒时，不觉周身出汗，先小汗，后大汗，竟至内衣夹袄被褥上下皆湿，急忙起来更换，反而盖上被子。于是才觉得诸症悉除，腹中知饥，索要热粥。侍者说：粥已备好，是陈岳父预先嘱咐的。初吸一小碗，觉得香甜超过平常。稍停，又继续进，竟然一夜，竟尽两大碗。初七日，就能进场。考试期达九日夜，毫无倦容。我才惊叹陈岳父医术之神。问他药，则是桂枝石膏两味同捣。问价格，说：恰逢新开药铺，共费钱六文而已。于是相视大笑。
【按】头痛而恶寒，这是太阳病未罢，治法应当令其汗出而解。然而小便已见血出，哪还有余液可以作汗？所以先饮荷叶露及生梨，是增加体液作为作汗的基础。于是给予石膏以清除内蕴之热，给予桂枝以祛除外束之寒。寒因汗解，热因凉除。醒来索要粥，这就是白虎汤中的粳米，先前喝的露，也如同加参汤中的人参。看其吃梨喝露的片刻，谁知道已包含圣人的法度。呜呼，灵活化用仲圣的方剂，其功效必无穷也。
【又按】白虎加桂枝汤证多见于夏日，诚因炎热酷暑蒸人，胃肠本已热化，入夜凉风习习，未免贪享凉爽，导致表里交病。表为寒束，则热无外泄之机，势必更炽。
热既内炽，则更易伤津，使无从作汗以解表。唯有投白虎汤以治其本（肠胃之热），同时加桂枝以治其标（表证之寒），标本并治，方可热除津复，汗出表解。依我经验，桂枝轻至一钱，生石膏轻至三钱，也可有效。如果不这样，只用白虎清热，则表证将更甚；只用桂枝解表，则内热将更炽，终不免坏病之变，这是桂枝石膏两药必须合作而不可分离的道理。有人说：你前谓石膏凉胃，桂枝温胃，何能温凉并进，反获奇功耶？答曰：仲圣方温凉并用者，诸泻心汤即在其例，若桂枝与石膏犹其始焉者尔。盖人体之机构复杂繁沓，灵敏万分，及其病时，作用尤显。各部机构每自能吸取其所需，而放任其所不需者。若论本汤证，则胃取石膏之凉而消热，动脉取桂枝之散而致汗，故二者非但不相左，抑且相成。
前桂枝加大黄汤为七分太阳，三分阳明。今白虎加桂枝汤为七分阳明，三分太阳。二汤之对仗，堪称工整。医者能合用仲圣诸方，即可曲应万变之病，兹二汤特发其凡耳。
麻黄附子甘草汤证（附列门人治验）
我曾经治疗上海电报局高君的公子，年五岁，身无热，也不恶寒，二便如常，但想睡觉，强行叫醒他，给他食物，吃完，又呼呼睡去。诊他的脉，微细无力。我说：这是仲景先圣所说的少阴之为病，脉微细，但欲寐。
但我虽知道治疗的方子，尚不敢保证疗效，请另请高明诊治。高君自明西医理，能注射强心针，但又知道强心针仅能取效于一时，非根本之图，强请开方。我不获已，写：熟附片八分，净麻黄一钱，炙甘草一钱给他，又恐其食而不化，略加六神曲、炒麦芽等消食健脾之品。
Therefore, it can be known that the theory of Licorice Root (Gancao) soothing the intestines is not without merit. Since diseases often transmit from the upper jiao to the lower jiao, from the exterior to the interior, and transform from cold syndromes to heat syndromes—this being an inevitable trend—soothing the intestines now is precisely a way to protect the body fluids in the interior and lower parts; thus, it is naturally an important treatment method. Regarding the indications for Da Chengqi Tang (Major Order the Qi Decoction) and Xiao Chengqi Tang (Minor Order the Qi Decoction), because the pathogenic factor has already transmitted to the intestines and become internally solidified, there is no need to use Licorice Root. Once the pathogen is eliminated and the intestines are deficient, one should heavily reuse Licorice Root to tonify them, which goes without saying. Scholars should know that these nine formulas hold equally important positions, each with specific functions, and cannot be ignored. Collecting these nine formulas constitutes the backbone of the Taiyang (Greater Yang) and Yangming (Yang Brightness) meridians in "Fanghan Lun" (Treatise on Preventing Cold). Mastering these nine formulas enables one to treat both Shanghan (Cold Damage) and Wenbing (Warm Diseases). Scholars may suspect my words are exaggerated? I dare to state this truthfully to the readers.
You Zaijing said: For cases without sweating, diaphoresis must be induced; Mahuang Tang (Ephedra Decoction) is used to resolve exterior excess and disperse pathogenic factors. For cases with sweating, further diaphoresis is contraindicated. Guizhi Tang (Cinnamon Twig Decoction) is used to assist exterior qi and expel pathogenic factors. Scholars should only distinguish between the use of Mahuang Tang and Guizhi Tang based on whether the syndrome presents with sweating or not, and need not adhere to the debate on whether Ying (Nutritive) and Wei (Defensive) qi are deficient or excess to differentiate between Zhongfeng (Wind Strike) and Shanghan. If one argues that lack of sweating indicates exterior excess but claims Wei qi deficiency, then when Mahuang Tang removes excess, does it uniquely neglect Wei qi? Those who do not stick to vulgar theories are truly heroic scholars! Ke Yunbo said: The main indications for Guizhi Tang are weak pulse and spontaneous sweating. Crude practitioners wrongly claim that Guizhi Tang specifically treats Zhongfeng, misleading later generations' perceptions, and the so-called Zhongfeng they describe does not match this formula's indications, so they discard its use. I often use this formula to treat spontaneous sweating, night sweats, deficiency-type malaria, and deficiency-type dysentery, achieving immediate cures.
He also said: When I treat conditions caused by cold wind blowing or the combination of cold, wind, and dampness pathogens forming Bi (Obstruction) syndromes, using Mahuang Tang often yields effective results; this is not restricted to Shanghan syndromes.
His words are profoundly insightful. Thus, both You and Ke could recognize Mahuang Tang and Guizhi Tang. Lu Jiuzhi said: Gegen Qinlian Tang (Kudzu, Scutellaria, and Coptis Decoction) is uniquely omitted from the discussion of Yangming syndromes because people only use it when diarrhea is present; if there is no diarrhea, they do not use it, and do not consider it the principal formula for Yangming. Who knows that the scope of application for this formula is broad and comprehensive? Thus, Lu could recognize Gegen Qinlian Tang. He also said: No one realizes that warm-heat diseases originally belong within the context of Shanghan Lun, and the formulas for warm-heat diseases are not outside Shanghan Lun. Thus, Lu could also see through the artificial boundaries drawn between Shanghan and Wenbing.
Wu Keyi said: For syndromes requiring purgation, if purgation is administered but no dry feces are expelled, it is considered that purgation was done too early, or it is deemed that the syndrome did not require purgation and the medicine was mistakenly administered. Little do they know that Chengqi formulas were established to expel pathogens, not specifically for dry feces. One must wait until the feces are hardened, blood is constrained by heat, and various complicated syndromes arise; this is like raising a tiger and leaving trouble behind—it is the physician's fault. Moreover, there are many cases where loose stools persist due to failure to purge in time; the stool steams with an extremely foul odor, resembling fermented bean curd dregs or lotus root paste, and will not harden even at death. As long as the foul matter is expelled, the pathogenic toxin dissipates, and the pulse and symptoms recede. Why merely strive for hardened feces before acting? This statement is extraordinary and profound. Thus, Wu could recognize the various Chengqi formulas. Ye Tianshi said: Warm pathogens enter from above and first attack the Lung. Wu Jutong said: All warm diseases begin in the upper jiao, affecting the Hand-Taiyin Lung meridian.
The treatment method advocates pungent-cool and light-neutral approaches, with formulas named Sangju Yin (Mulberry Leaf and Chrysanthemum Drink) and Yinqiao San (Honeysuckle and Forsythia Powder). Although they lack the name of Maxing Gan Shi Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction), they possess the practical effect of broadly treating Lung heat. If we do not demand harsh criticism, we can say that Ye and Wu could recognize Maxing Gan Shi Tang. Wu's use of Baihu Tang (White Tiger Decoction), sometimes for resolving macules and sometimes for clearing summerheat, shows considerable flexibility. If we do not spare praise, we can say he slightly resembles Zhongjing's style in using Guizhi Tang. Thus, Wu could also recognize Baihu Tang. From this perspective, all these physicians are meritorious contributors to Zhongjing.
Volume 2
Indication for Guizhi Er Mahuang Yi Tang (Two Parts Cinnamon Twig and One Part Ephedra Decoction) - Case 1
Patient Wang, June 22nd: Alternating chills and fever, occurring twice a day. This is the indication described by Zhang Zhongjing for Guizhi Er Mahuang Yi Tang. The previous physician used Xiaochaihu Tang (Minor Bupleurum Decoction), which was originally not wrong, but missed by a small margin! Sichuan Guizhi (Cinnamon Twig) 5 qian, Baishao (White Peony Root) 4 qian, Sheng Gancao (Raw Licorice Root) 3 qian, Sheng Mahuang (Raw Ephedra) 2 qian, Guang Xingren (Apricot Kernel) 5 qian, Shengjiang (Fresh Ginger) 3 slices, Hongzao (Red Date) 5 pieces.
[Commentary] After taking this prescription, the patient likely lay covered with a blanket. Soon after, fever arose, followed by slight sweating over the entire body, and the illness resolved. Additionally, the best time to take the medicine is approximately one to two hours before the onset of chills and fever, yielding better efficacy. According to Zhongsheng's method, whenever fever and aversion to cold occur twice a day (referring to two episodes of fever, not counting fever and aversion to cold together as two) up to ten or more times a day, it belongs to Taiyang disease. If it occurs once a day, or every few days, it belongs to Shaoyang disease. Shaoyang disease usually presents with chills first and then fever; Taiyang disease resembling malaria often presents with fever first and then chills. Observing that Shanghan Lun refers to Shaoyang as "alternating chills and fever" and Taiyang resembling malaria as "fever and aversion to cold, with more heat than cold," there seems to be subtle intent here. In terms of treatment methods, Shaoyang disease is suitable for Chaihu agents, while Taiyang disease is suitable for Mahuang-Guizhi agents. Clinical verification confirms this without fail. Conversely, using Chaihu agents to treat Taiyang-like malaria with multiple daily episodes of chills and fever is often ineffective; using Mahuang-Guizhi agents to treat Shaoyang disease with single episodes of chills and fever may occasionally work but ultimately fails to strictly conform to principles.
"Fangji" states: Guizhi Er Mahuang Yi Tang treats cases where Guizhi Tang indications predominate and Mahuang Tang indications are minor. Guizhi Mahuang Gehan Tang (Cinnamon Twig and Ephedra Half-Half Decoction) treats cases where Guizhi Tang and Mahuang Tang indications are equal. This statement is plausible yet incorrect, causing difficulty in measurement. I select formulas based on symptoms: whenever fever and aversion to cold occur simultaneously, use Guizhi Tang if there is sweating, and Mahuang Tang if there is no sweating; when fever and aversion to cold occur alternately, from twice to ten-plus times a day, choose among Guizhi Er Mahuang Yi and other three formulas. The hierarchy is clear, with absolutely no confusion.
Cao Yingfu said: The difference between Shaoyang disease and Taiyang disease lies in the presence of intervals. If it occurs twice a day or two to three times, there is no interval. The difference between Taiyang disease and Yangming disease lies in the presence of aversion to cold; if there is only heat without aversion to cold, it should directly be called Yangming disease, how can it be called Taiyang disease? Therefore, knowing that alternating chills and heat circulating throughout the day characterizes Taiyang disease, while chills and heat occurring daily with intervals like a healthy person characterizes Shaoyang disease, explains the difference between combining Mahuang and Guizhi tangs versus using Chaihu tang alone. Once the pathology is clear, medication can be prescribed according to the syndrome.
Indication for Guizhi Er Mahuang Yi Tang - Case 2 (Including Student's Treatment Record)
Patient Shi, residing at No. 2, Rende Li, Zhaozhou Road, Tangjiawan.
[Commentary] On July 15th of this year, I treated Patient Shi at Guangyi Traditional Chinese Medicine Hospital. A Mrs. Shi approached me with a furrowed brow, stating: "Sir, yesterday I took a prescription from another doctor outside the hospital, and my condition worsened; I am suffering unbearably." I was startled, asked to see the prescription, and recorded it as follows: Chao Jingjie (Stir-fried Schizonepeta) 1.5 qian, Chao Tianxin (Stir-fried Scutellaria) 1.5 qian, Quan Danggui (Whole Angelica Sinensis) 2 qian, Da Chuanxiong (Large Ligusticum) 0.8 qian, Chao Danpi (Stir-fried Moutan Cortex) 1.5 qian, Chi Baishao (Red and White Peony Roots) 1.5 qian each, Jinlingzi (Violet Fruit) 2 qian, Zhi Xiangfu (Processed Cyperus) 1.5 qian, Yuanhusuo (Corydalis Rhizome) 1.5 qian, Guanzhong Tan (Charred Osmunda) 3 qian, Heye (Lotus Leaf) 1 corner.
I said: The prescription is not erroneous; how could it worsen? The woman replied: "No, initially my sleep at night was relatively peaceful, and my bowel movements were normal. Since taking yesterday's medicine, I have suffered severe heart pain at night, tossing and turning unable to sleep, and my bowels have turned loose. Please treat me." Following protocol, I first asked about her medical history. She said: "Half a month." Then I asked about chills and fever. She said: "Sudden cold and sudden heat, regardless of frequency." Hearing this, I felt as though I had gained insight. She described her abnormal symptoms: sweating stops from the head to the chest, neither reaching below the chest nor extending to the arms. I recalled the phrase "stopping at the neck" in the Treatise, and wondered if this was "stopping at the chest"? Examining her tongue, it was black near ink color but not scorched; her mouth was strangely dry.
I suspected she had consumed Chenpi Mei (Preserved Plum with Tangerine Peel) or Songhua Dan (Century Egg). She said: "No, for these past days, my tongue coating has been black, always looking like this." Palpating her pulse, fortunately, it was not faint and thin. Her shoulders to arms were quite numb. Added to the continuous dripping menstruation, she could hardly fully describe her condition. Facing this complex syndrome, I also felt almost helpless in prescribing. If I treated symptom by symptom trivially, would the prescription approach dozens of herbs? However, this is not what I do. So I wrote the prescription: First Visit, July 15th. Alternating chills and fever, occurring 7-8 times daily, lasting two weeks. Sweating stopping at the chest, continuous dripping menstruation. The treatment principle should prioritize releasing the exterior. Due to heart pain, add Shengdi (Rehmannia Root) and double the Gancao (Licorice Root).
Jing Mahuang (Purified Ephedra) 1 qian, Chuan Guizhi (Sichuan Cinnamon Twig) 2 qian, Sheng Gancao (Raw Licorice Root) 3 qian, Sheng Yiren (Raw Coix Seed) 1 liang, Xingren (Apricot Kernel) 3 qian, Sheng Baishao (Raw White Peony Root) 1.5 qian, Shengdi (Rehmannia Root) 5 qian, Zhi Chuanpu (Processed Magnolia Bark) 1 qian, Shengjiang (Fresh Ginger) 2 slices, Hongzao (Red Date) 6 pieces.
Second Visit, July 16th: After taking the medicine yesterday, sweating occurred, slight sweating over the whole body, heart pain stopped, menstruation ceased, loose stool improved, numbness reduced, limited only to arms and fingers. Black coating gradually receded, dry mouth缓和, coughing up phlegm at night, and passing gas—all good signs. The previous formula was effective; no need to change.
Jing Mahuang (Purified Ephedra) 1 qian, Chuan Guizhi (Sichuan Cinnamon Twig) 1.5 qian, Sheng Gancao (Raw Licorice Root) 2 qian, Sheng Baishao (Raw White Peony Root) 1.5 qian, Da Shengdi (Large Rehmannia Root) 5 qian, Zhi Xiaopu (Small Magnolia Bark) 1 qian, Xingren (Apricot Kernel) 3 qian, Shengjiang (Fresh Ginger) 2 slices, Hongzao (Red Date) 6 pieces.
[Commentary] I followed Zhongsheng's pulse-syndrome-treatment methods to prescribe yesterday's formula, feeling anxious! I thought that by the next day's visit, if chills and fever were slightly relieved, it would be a great success. Instead, I was overjoyed: not only did the fever subside and spirit revive, but all ailments disappeared as described in the case record. How miraculous! Trying to find the reason for curing the disease, from a symptomatology standpoint, one must say: if the main syndrome is treated, all secondary or accessory syndromes heal themselves. This statement is correct but adds little to understanding pathology. Fortunately, learned gentlemen reading this case will provide explanations for all pathological aspects. For example, why use Mahuang and Guizhi for black tongue and dry mouth? Why does diaphoresis damaging body fluids remove heart pain? Menstrual dripping and loose stool seem unrelated, yet suddenly stop? This is my deep wish.
Cao Yingfu said: When Taiyang water qi stagnates under the heart, body fluids cannot ascend, causing thirst; Ding Ganren frequently expressed this idea. Black tongue not scorched, loose stool—indicating not Yangming heat syndrome. The black color is also water qi. Water qi harassing the heart causes heart yang deficiency, hence pain. Loose stool was due to the error of using Tianxin (Scutellaria); without Tianxin, loose stool stops naturally, not due to this formula's merit. Water qi failing to transform into sweat and exit externally causes spleen yang deficiency, leading to numbness in fingers and arms. Menstrual dripping is also due to water qi exceeding blood qi, compressed by water qi. Knowing where the disease comes from allows one to know where it goes; no need for lengthy explanation.
Third Visit, July 17th: Chills and fever resembling malaria gradually resolved, bowel movement resumed, black tongue coating faded, numbness confined to fingertips. Only lingering cough remains, with chest and hypochondriac pulling pain and a sense of wheezing. Referencing Guizhi Houpo Xingzi Tang (Cinnamon Twig, Magnolia Bark, and Apricot Kernel Decoction) method.
Xingren (Apricot Kernel) 4 qian, Houpo (Magnolia Bark) 1.5 qian, Chuan Guizhi (Sichuan Cinnamon Twig) 2 qian, Sheng Gancao (Raw Licorice Root) 3 qian, Baishao (White Peony Root) 2 qian, Da Shengdi (Large Rehmannia Root) 6 qian, Sigualuo (Luffa Reticulum) 4 qian, Shengjiang (Fresh Ginger) 1 slice, Hongzao (Red Date) 6 pieces.
[Commentary] Taking this formula yielded excellent results; mild regulation brought peace.
Indication for Guizhi Mahuang Gehan Tang (Cinnamon Twig and Ephedra Half-Half Decoction)
Patient Gu, residing at Fangxie Road. October 21st: Alternating chills and fever, occurring ten-plus times a day. This is not malaria, but Taiyang disease, suitable for Guizhi Mahuang Gehan Tang.
Guizhi (Cinnamon Twig) 3 qian, Gancao (Licorice Root) 1.5 qian, Xingren (Apricot Kernel) 5 qian, Mahuang (Ephedra) 1.5 qian, Baishao (White Peony Root) 1.5 qian, Shengjiang (Fresh Ginger) 2 slices, Dazao (Jujube) 4 pieces.
[Commentary] The original method for Guizhi Mahuang Gehan Tang divides the dose into three servings; the original method for Guizhi Er Mahuang Yi Tang divides it into two servings. Comparing one-third of the former's original amount with half of the latter's original amount, we find Mahuang and Xingren are equal in quantity, while the latter's Guizhi, Baishao, Shengjiang, Gancao, and Dazao are approximately double those of the former. Hence, the former is named "Half-Half," and the latter "Guizhi Two Mahuang One." However, modern decoction methods usually divide into two servings, differing from ancient practice. Moreover, the dosage differences are very minute. Thus, we only need to know the application of these two formulas; there is no need to overly scrutinize minute weights.
Cao Yingfu said: This syndrome is very mild, so a mild formula easily cures the disease, not just differing in weight.
Indication for Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction)
Qingsun: Illness began on July 27th due to sudden exposure to wind-cold. Bowels were unmovable, head top painful. This is simultaneous Taiyang and Yangming disease. Self-administering Jiming Dan (Life-Saving Pill), bowels moved, and headache slightly improved. Now, exterior syndrome is not fully resolved, interior syndrome is not fully resolved. Pulse is floating and slow, body often sweats. Suitable for Guizhi Dahuang Tang.
Chuan Guizhi (Sichuan Cinnamon Twig) 3 qian, Sheng Baishao (Raw White Peony Root) 3 qian, Sheng Gancao (Raw Licorice Root) 1 qian, Sheng Chuanjun (Raw Rhubarb) 3 qian, Shengjiang (Fresh Ginger) 3 slices, Hongzao (Red Date) 3 pieces.
[Commentary] Treating disease requires resolving the exterior first, then attacking the interior; this is the standard method, stated previously many times. Based on clinical experience, often after the exterior resolves, the interior clears itself, initially not needing medicinal assistance. Because during initial exterior constraint, the patient's yuan qi (vital energy) focuses solely on coping with the exterior syndrome, having no leisure to attend to the interior. Once the exterior resolves, yuan qi naturally turns back to address the interior. Who can see the retreat and advance of yuan qi? Yet facts are so; do not deny it. Therefore, encountering syndromes of exterior constraint and interior tension, if constipation has not exceeded three days, I often leave internal purgation aside—not ignoring it, but waiting for natural passage.
If combining exterior-releasing and interior-purgative medicines into one formula, it is another method. However, exterior release accounts for seven parts, interior purgation for three parts, implying primary and secondary distinctions. Since interior medicine has been used, interior purgation is secondary; since exterior medicine has not been used, exterior release is primary. Attacking both ends simultaneously, the disease departs, and yuan qi needs no worry.
Indication for Baihu Jia Guizhi Tang (White Tiger Plus Cinnamon Twig Decoction)
When I was twenty-five, I could read medical books but was not yet skilled in treating diseases. Accompanying my cousin Chen Shangbai, I took a boat to Nanjing for the autumn imperial examinations. Chen and his wife stayed in the middle cabin; I stayed in the front cabin. It was midsummer, scorching hot.
The boat docked in Wuxi. Chen and his wife went ashore together to bathe in Hui Spring, asking me to guard the cabin. Sweat ran down my back; inconvenient to change clothes, I let it dry naturally. Diet and起居 were uncomfortable, so my heart was constantly depressed. The boat docked for five days before setting sail. Five more days passed before arriving in Zhenjiang. After checking into the inn and settling in, I fell ill. Physicians prescribed mainly fresh Huoxiang (Patchouli) and Peilan (Aglaia), etc. After taking them for several days, the condition worsened. Sweating, fever unresolved, aversion to cold endless. That night, I took a wheelbarrow/boat to Beijing. Feeling dizzy and dark, losing consciousness. Upon arriving in Shicheng (Nanjing), friends helped me to my residence in Tangzi Alley. Every time I urinated, blood came out, bright red, accompanied by headache.
It was August 5th, only three days before the exam entry date. My father-in-law, Mr. Chen Baohou, had arrived in Nanjing before me. He was proficient in medicine. After palpating the pulse, he personally bought medicine, three large bottles of Heluye Lu (Lotus Leaf Dew), and over ten raw pears. He instructed me to drink the dew first; upon drinking, my mouth was no longer dry. Shortly after, I became thirsty again, ate raw pears, peeling none, just removing the core, finishing ten in an instant. When the medicine boiled, I drank a large bowl, feeling instantly clear-headed, exhausted, and slept. Upon waking, headache was gone, only sweating remained. Took the second decoction, twice as concentrated. Slept again. Upon waking, noticed whole-body sweating, starting slight, then heavy, soaking inner clothes, jacket, and bedding. Urgently changed, covered myself. Only then did I feel all ailments removed, stomach hungry, requesting hot porridge. Attendant said: Porridge is ready, pre-ordered by Father-in-law Chen. Initially drank one small bowl, finding it exceptionally sweet. Paused, continued drinking, finishing two large bowls that night. On the 7th, I entered the examination hall. Exam lasted nine days and nights, showing no fatigue. I marveled at Father-in-law Chen's divine medical skill. Asking about the medicine, it was Guizhi (Cinnamon Twig) and Shigao (Gypsum) pounded together. Asking the price, he said: Coincided with a new pharmacy opening, costing only six coins. We laughed together.
[Commentary] Headache with aversion to cold indicates Taiyang syndrome has not ceased; treatment should induce sweating for resolution. However, blood in urine means there is no surplus fluid to make sweat. Thus, drinking Lotus Leaf Dew and raw pears first increases fluids as the basis for sweating. Then giving Shigao (Gypsum) to clear internal heat, and Guizhi (Cinnamon Twig) to dispel external constriction. Cold resolves via sweat, heat clears via cooling. Requesting porridge upon waking represents the Rice (Jingmi) in Baihu Tang; the dew drunk earlier is akin to Ginseng in Jia Shen Tang. Looking at the moments of eating pears and drinking dew, who knew it contained Sage's method? Alas, flexibly applying Zhongsheng's formulas yields infinite efficacy.
[Additional Commentary] Baihu Jia Guizhi Tang indications are mostly seen in summer. Indeed, scorching heat steams the body, making the gastrointestinal tract inherently heat-transformed. At night, cool breezes blow, tempting indulgence in coolness, causing simultaneous exterior and interior disease. Exterior constrained by cold, heat has no outlet, inevitably intensifying. Internal heat flaring easily damages fluids, preventing sweating to resolve the exterior. Only by administering Baihu Tang to treat the root (GI heat) while adding Guizhi to treat the branch (exterior cold) can heat be removed, fluids restored, sweat produced, and exterior resolved. Based on my experience, Guizhi as light as 1 qian and Raw Shigao as light as 3 qian can also be effective. If not, using only Baihu to clear heat makes exterior syndrome worse; using only Guizhi to resolve exterior makes internal heat worse, inevitably leading to deteriorated syndromes. This is the principle that Guizhi and Shigao must cooperate and cannot be separated. Some say: You previously stated Shigao cools the Stomach and Guizhi warms the Stomach; how can warming and cooling proceed together to achieve miraculous results? Answer: Zhongsheng's formulas using warming and cooling together include the Xiexin Tangs; Guizhi and Shigao are but the beginning. Human bodily structures are complex and sensitive; during illness, their actions are prominent. Each part absorbs what it needs and discards what it doesn't. Regarding this formula's syndrome, the Stomach takes Shigao's coolness to eliminate heat, while arteries take Guizhi's dispersing nature to induce sweat. Thus, they not only do not conflict but complement each other.
The previous Guizhi Dahuang Tang was seven parts Taiyang, three parts Yangming. The current Baihu Jia Guizhi Tang is seven parts Yangming, three parts Taiyang. The symmetry of these two formulas is impeccable. Physicians who can combine Zhongsheng's various formulas can adapt to ever-changing diseases; these two formulas merely illustrate this principle.
Indication for Mahuang Fuzi Gancao Tang (Ephedra, Aconite, and Licorice Decoction) (Including Student's Treatment Record)
I once treated the son of Mr. Gao from the Shanghai Telegraph Bureau, aged five. No fever, no aversion to cold, bowel and urinary functions normal, but desire to sleep. Waking him forcibly, feeding him food, after eating, he fell asleep again. Palpating his pulse, it was faint, thin, and powerless. I said: This is what Zhongjing the Sage described as Shaoyin disease: faint, thin pulse, desire to sleep.
Although I knew the treatment formula, I dared not guarantee efficacy, suggesting seeking another expert. Mr. Gao understood Western medicine, capable of injecting cardiac stimulants, but knew they only worked temporarily, not fundamentally. He insisted on a prescription. Reluctantly, I wrote: Shu Fupian (Prepared Aconite Slice) 0.8 fen, Jing Mahuang (Purified Ephedra) 1 qian, Zhi Gancao (Honey-fried Licorice Root) 1 qian. To prevent indigestion, I added slightly Liu Shen Qu (Six Divine Qu) and Chao Maiya (Stir-fried Malt) for digestion and spleen strengthening.