一豪子郭氏。得伤寒数日。身热。头疼。恶风。大便不通。脐腹膨胀。易数医。一医欲用大
承气。一医欲大柴胡。一医欲用蜜导。病家相知凡三五人。各主其说。纷然不定。最后请予至。
问小便如何。病家云小便频数。乃诊六脉。下及趺阳脉浮且涩。予曰。脾约证也。此属太阳阳明。
仲景云太阳阳明者脾约也。仲景又曰趺阳脉浮而涩。浮则胃气强。涩则小便数。浮涩相搏。大便
则。其脾为约者。大承气大柴胡恐不当。仲景法中麻仁丸不可易也。主病亲戚尚尔纷纷。予曰。
若不相信。恐别生他证。请辞。无庸召我。坐有一人。乃弟也。逡巡曰。诸君不须纷争。既有仲
景证法。相当。不同。此说何据。某虽愚昧。请终其说。诸医若何。各请叙述。众医默默。纷争
始定。予以麻仁丸百粒。分三服。食顷间尽。是夕大便通。中汗而解。
论曰。浮者风也。涩者津液少也。小便频数。津液枯竭。又烁之以风。是以大便坚 。乃以
大黄朴硝汤剂荡涤肠胃。虽未死。恐别生他证。尝读千金方论香港脚云。世间人病有亲戚故旧远近
问病。其人曾不经一事。未读一方。骋骋诈作明能。诡论。或言是虚。或言是实。或以为风。或
以为虫。或道是水。或道是痰。纷纷谬说。种种不同。破坏病患心意。莫知孰是。迁延未定。时
不待人。忽然致祸。各自走散。凡为医者要识病浅深。探赜方书。博览古今。是事明辨。不尔。
大误人事。识者宜知以为医戒。
Guo, a wealthy gentleman, had suffered from Cold Damage (Shanghan) for several days. He presented with fever, headache, aversion to wind, constipation, and abdominal distension around the navel. He consulted several physicians in succession. One physician proposed using Dachengqi Tang (Major Order the Qi Decoction), another suggested Xiaochaihu Tang (Minor Order the Gallbladder Decoction - *Note: Text says Da Chaihu, but context implies differentiation of purgatives*), and a third recommended honey suppositories. Three or five relatives and acquaintances of the patient each supported their own opinions, leading to confusion and indecision. Finally, I was invited to attend.
I asked about the patient's urination. The family replied that urination was frequent. Upon palpating the six pulses as well as the Fuyang pulse (Diyang Mai, 趺阳脉) on the dorsum of the foot, I found them floating and choppy. I stated, "This is Pi Yue Syndrome (Spleen Restriction). It belongs to the Taiyang-Yangming stage." Zhang Zhongjing said, "Taiyang-Yangming refers to Pi Yue." Zhang Zhongjing also stated, "When the Fuyang pulse is floating and choppy, floating indicates strong Stomach Qi, and choppy indicates frequent urination. When floating and choppy interact, the stool becomes hard." For this condition where the Spleen is restricted, the use of Dachengqi Tang or Da Chaihu Tang is likely inappropriate. According to Zhang Zhongjing's methods, Maren Wan (Hemp Seed Pill) is irreplaceable. The relatives still argued among themselves. I said, "If you do not trust my diagnosis, other complications may arise. Please allow me to resign; there is no need to summon me again." A man sitting nearby, who was the patient's younger brother, hesitated and then said, "Gentlemen, no need to dispute. Since Zhang Zhongjing's diagnostic criteria match, why argue? What is the basis for this view? Although I am ignorant, please let me hear your explanation. How do the other physicians interpret it? Please each state your case." The other physicians remained silent, and the dispute settled. I prescribed one hundred pills of Maren Wan (Hemp Seed Pill), divided into three doses. They were consumed within the time it takes to eat a meal. That evening, bowel movement was unblocked, and the disease resolved through sweating.
Commentary states: Floating indicates Wind pathogen; choppy indicates a deficiency of Body Fluids. Frequent urination depletes Body Fluids, and further drying occurs due to Wind heat, resulting in hard stools. If one were to use decoctions containing Dahuang (Rhubarb) and Puxiao (Mirabilite) to purge the intestines and stomach, although death might be avoided, other complications might arise. I once read in the *Qianjin Fang* regarding Jiaogong (Foot Soreness/Gout): In society, when people fall ill, relatives and old friends, regardless of distance, go to inquire about the illness. Some of these visitors have never experienced such matters nor read any medical texts, yet they boast of their knowledge, making specious arguments. Some claim it is Deficiency, some claim it is Excess; some attribute it to Wind, some to parasites; some say it is Water retention, some say it is Phlegm. These erroneous theories are numerous and varied, confusing the patient and family, leaving them unsure of the truth. Procrastination leads to missed opportunities; time waits for no one, and disaster strikes suddenly, causing everyone to scatter. Therefore, any practitioner must discern the depth of the disease, explore the profound meanings of medical classics, and study ancient and modern texts extensively to distinguish clearly between different conditions. Otherwise, serious errors will occur in treating human lives. Wise individuals should take this as a warning for medical practice.