戊申正月。有一武弁在仪真。为张遇所虏。日夕置于舟 板下。不胜 伏。后数日得脱。因
饱食。解衣扪虱以自快。次日遂作伤寒。医者以因饱食伤。而下之。一医以解衣中邪。而汗之。
杂治数日。渐觉昏困。上喘。息高。医者怆惶罔知所指。予诊之曰。太阳病。下之。表未解。微
喘者。桂枝加浓朴杏子汤。此仲景法也。医者争曰。某平生不曾用桂枝。况此药热。安可愈喘。
予曰非汝所知也。一投而喘定。再投而 汗出。至晚。身凉而脉已和矣。医者曰。予不知仲景
之法。其神如此。岂诳惑后世也哉。人自寡学。无以发明耳。
乡人邱忠臣。寓毗陵荐福寺。病伤寒。予为诊视。其发热。头疼。烦渴。脉虽浮数无力。自
尺以下不至。予曰虽麻黄证。而尺迟弱。仲景云。尺中迟者。营气不足。血气微少。未可发汗。
予于建中汤。加当归黄 。令饮之。翌日病者不耐。其家晓夜督发汗药。其言至不逊。予以乡人隐忍之。但以建中调理
而已。及六七日。尺脉方应。遂投以麻黄汤。啜第二服。狂言烦躁且闷。须臾稍定。已中汗矣。五日愈。
论曰。仲景虽云不避晨夜。即宜便治。医者亦须顾其表里虚实。待其时日。若不循次第。虽
临时得安。亏损五脏。以促寿限。何足尚哉。昔范云为陈霸先属。霸先有九锡之命。期在旦夕矣。
云偶感寒疾。恐不及豫盛事。请徐文伯诊视之。恳曰。便可得愈乎。文伯曰。便瘥甚易。但恐二
年后不复起尔。云曰。朝闻道夕死可矣。况二年乎。文伯以火烧地。布桃柏叶。设席置其卧上。
顷刻汗解。以温粉扑之。翌日愈。甚喜。文伯曰。不足喜也。后二年果卒矣。夫取汗先期。尚促
寿限。况罔顾表里。不待时日。便欲速愈乎。每见病家不耐三四日。昼夜促汗。医者顾利。恐别
更医。随情顺意。鲜不致毙。故书此以为龟鉴。
In the first month of the Wushen year, a military officer was in Yizhen and was captured by Zhang Yu. He was confined beneath the ship's planks day and night, unable to endure the humiliating prone position. After several days, he escaped. Consequently, he overate and undressed to catch lice for his own pleasure. The next day, he contracted Cold Damage (Shanghan). Physicians treated him as if injured by overeating and used purgation. Another physician treated him as if infected by exposure to pathogens and used diaphoresis. After several days of miscellaneous treatments, he gradually became confused and lethargic, with upper-body wheezing and shallow breathing (high respiration). The physicians were panicked and did not know how to proceed. I examined him and said, "This is Taiyang disease. After incorrect purgation, the exterior syndrome remains unresolved, accompanied by slight wheezing. Guizhi Jia Houpo Xingzi Tang (Cinnamon Twig Decoction plus Magnolia Bark and Apricot Seed) should be used. This is the method of Zhang Zhongjing." The physicians argued, "I have never used Guizhi (Cinnamon Twig) in my life. Moreover, this medicine is hot; how can it cure wheezing?" I replied, "This is beyond your understanding." After one dose, the wheezing ceased. After a second dose, sweating occurred. By evening, his body was cool and his pulse had harmonized. The physician said, "I did not know that the methods of Zhang Zhongjing were so miraculous. Is he deceiving posterity? It is merely that people are too ignorant to elucidate the principles."
Qiu Zhongchen, a fellow townsman, was staying at Jianfu Temple in Piling when he fell ill with Cold Damage. I examined him. He had fever, headache, restlessness, and thirst. Although his pulse was floating and rapid, it was weak, and the chi position below the wrist was imperceptible. I said, "Although this presents as a Mahuang Tang (Ephedra Decoction) pattern, the chi pulse is slow and weak. Zhang Zhongjing stated: 'If the chi pulse is slow, Ying Qi is insufficient, and blood and qi are slightly deficient. Diaphoresis should not be used.'" I prescribed Jianzhong Tang (Construct the Middle Decoction) added with Danggui (Angelicae Sinensis Radix) and Huangqi (Astragali Radix) for him to drink. The next day, the patient could not tolerate it. His family urged the administration of diaphoretic medicines day and night, their words becoming increasingly disrespectful. As a fellow townsman, I endured this silently and simply used Jianzhong Tang for regulation. After six or seven days, the chi pulse finally appeared. Then I administered Mahuang Tang. After the second dose, he spoke deliriously, felt restless and stifled, but soon stabilized. Sweating ensued. He recovered in five days.
Commentary: Zhang Zhongjing stated that treatment should be immediate regardless of morning or night. However, physicians must also consider the interior and exterior, deficiency and excess, and wait for the appropriate time. If one does not follow the proper sequence, although temporary relief may be achieved, the five zang organs will be damaged, and lifespan shortened. What is there to praise in such an approach? In the past, Fan Yun entrusted matters to Chen Baxian. Chen Baxian was about to receive the Nine Bestowals. Fan Yun accidentally contracted a cold disease and feared he would not live to see the grand event. He requested Xu Wenbo to examine him, earnestly asking, "Can I recover immediately?" Wenbo replied, "Recovering immediately is very easy, but I fear you will not rise again after two years." Yun said, "If I hear the Dao in the morning, I can die content in the evening; what more can I ask than two years?" Wenbo heated the floor with fire, spread peach leaves and cypress leaves, set up a mat for him to lie on, and within moments, the pathogen was resolved through sweating. Warm powder was applied to his body. He recovered the next day and was very pleased. Wenbo said, "There is no need to be pleased. Two years later, you indeed passed away." Taking sweat prematurely still shortens lifespan; how much more so to ignore interior and exterior conditions and rush for quick recovery without waiting for the right time? I often see patients who cannot endure three or four days, urging diaphoresis day and night. Physicians, caring for profit and fearing the patient might seek another doctor, indulge the patient's wishes. Few do not meet death. Therefore, I record this as a warning.