戊午冬。予从军住冬于成武县。有贾仓使父。年逾六旬。冬至后数日。疽发于背。五七日肿势
约七寸许。不任其痛。疡医视之。曰脓已成。可开发矣。公惧不从。越三日。医曰。不开恐变证生
矣。遂以燔针开之。脓泄痛减。以开迟之故。迨二日变证果生。觉重如负石。热如 火。痛楚倍常
。六脉沉数。按之有力。此膏粱积热之变也。邪气酷热。固宜以寒药治之。时月严凝。复有用寒远
寒之戒。乃思内经云。有假者反之。虽违其时。以从其证可也。与疡医议。急作清凉饮子加黄连。
秤一两五钱。作一服服之。利下两行。痛减七分。翌日复进
前药。其证悉除。后月余平复。又陈录判母。年七十有余。亦冬至后脑出疽。形可瓯面大。命疡医
诊视。俟疮熟以针出脓。因怒笞侍外家。疮辄内陷。凹一韭叶许。面色青黄不泽。四肢逆冷。汗出身
清。时复呕吐。脉极沉细而迟。盖缘衰老之年。严寒之时。病中苦楚。饮食淡薄。已涤肥脓之气。
独存瘦瘁之形。加之暴怒。精神愈损。故有此寒变也。病与时同。与疡医议。速制五香汤一剂。加丁
香、附子各五钱。剂尽疡复大发。随证调治而愈。内经曰。凡治病必察其下。谓察时下之宜也。诸
痛疮疡。皆属心火。言其常也。如疮盛形羸。邪高痛下。始热终寒。此反常也。固当察时下之宜而
权治。故曰。经者常也。法者用也。医者意也。随所宜而治之。可收十全之功矣。
In the winter of the Wumu year, I accompanied the army and stayed in Chengwu County for the winter. The father of Jia Cangshi, a government official, was over sixty years old. A few days after the Winter Solstice, he developed a carbuncle (a severe suppurative infection) on his back. Five to seven days later, the swelling covered an area of about seven cun, and the pain was unbearable. The surgeon examined it and said, "The pus has formed; it can be incised." The patient, fearing surgery, did not comply. Three days later, the doctor said, "If not incised, adverse changes (complications or worsening condition) may occur." Thus, a cauterizing needle (red-hot needle) was used to open the abscess. After the pus drained, the pain decreased. However, due to the delay in incision, adverse changes indeed occurred on the second day. The patient felt as heavy as carrying a stone, feverish as if burning with fire, and the suffering was twice as severe as usual. The six pulses (cun, guan, chi positions on both hands) were deep and rapid (fast), and forceful upon heavy pressure. This was a transformation caused by accumulated heat from long-term consumption of rich, fatty foods. The pathogenic factor was intensely hot, so cold-natured herbs should theoretically be used. However, it was the season of severe cold, and there was a warning against using cold remedies during cold weather ("avoid cold when using cold"). I then recalled the statement in the *Neijing*: "When there is a false condition, treat contrary to it." Although this violated seasonal norms, treatment should follow the syndrome. I consulted with the surgeon and urgently prepared Qingliang Yinzi (Cooling Drink Decoction) with added Huanglian (Coptidis Rhizoma). One liang and five qian of Huanglian was measured as a single dose. After taking it, the patient had two bowel movements, and the pain decreased by seventy percent. The next day, the previous medicine was administered again, and all symptoms disappeared. Over a month later, he fully recovered.
Another case involved the mother of Chen Lupan, a government official, who was over seventy years old. She also developed a carbuncle on her head after the Winter Solstice, with the lesion being as large as the bottom of a bowl. The surgeon was instructed to examine it and wait for the sore to mature before draining the pus with a needle. However, due to anger, she whipped her female servant attending her, causing the sore to sink inward, forming a depression about the size of a leek leaf. Her complexion was bluish-yellow and lusterless, her four limbs were cold, she sweated and felt chilled, and she vomited intermittently. Her pulse was extremely deep, fine, and slow. This was because at an advanced age, during severe cold weather, suffering from illness, and eating bland food, the qi of rich and greasy foods had been exhausted, leaving only a emaciated and frail form. Added to this was sudden anger, which further damaged the spirit. Thus, this cold-type transformation occurred. The disease matched the season. I consulted with the surgeon and quickly prepared one dose of Wuxiang Tang (Five-Aromatic Decoction), adding Dingxiang (Caryophylli Flos) and Fuzi (Aconiti Lateralis Radix Praeparata), each five qian. After finishing the dose, the sore flared up significantly again. Subsequently, treatment was adjusted according to the symptoms, and she recovered. The *Neijing* states: "In treating any disease, one must observe the 'xia' (the appropriateness of the current time/season)." This means observing whether the timing is suitable. All pains and sores generally belong to Heart Fire, which refers to the general rule. However, when the sore is extensive but the body is emaciated, the pathogen is high while the pain is low, or it starts with heat and ends with cold, these are abnormal situations. One must indeed observe the appropriateness of the current time and weigh the treatment accordingly. Therefore, it is said: "Jing (Classics) represents constancy; Fa (Methods) represents application; Yi (Physician) represents intuition." Treating according to what is appropriate can achieve perfect success.