征南元帅不 吉歹。辛酉八月初三戌时生。年七旬。丙辰春东征。南回至楚丘。诸路迎迓。多
献酒醴。因而过饮。遂腹痛肠鸣。自利日夜约五十余行。咽嗌肿痛。耳前后赤肿。舌本强。涎唾稠
粘。欲吐不能出。以手曳之方出。言语艰难。反侧闷乱。夜不得卧。使来命予。诊得脉浮数。按之
沉细而弦。即谓中书粘公曰。仲景言下利清谷。身体疼痛。急当救里。后清便自调。急当救表。救
里四逆汤。救表桂枝汤。总帅今胃气不守。下利清谷。腹中疼痛。虽宜急治之。比之咽嗌。犹可少
待。公曰。何谓也。答曰。内经云。疮发于咽嗌。名曰猛疽。此疾治迟则塞咽。塞咽则气不通。气
不通则半日死。故宜急治。于是遂砭刺肿上。紫黑血出。顷时肿势大消。遂用桔梗、甘草、连翘、
黍粘、酒制黄芩。升麻。防风等分。 咀。每服约五钱。水煮清。令热漱。冷吐去之。咽之恐伤
脾胃。自利转甚。再服涎清肿散。语言声出。后以神应丸辛热之剂。以散中寒。解化宿食。而燥脾
湿。丸者、取其不即施化。则不犯其上热。至其病所而后化。乃治主以缓也。不数服。利止痛定。
后胸中闭塞。作阵而痛。予思灵枢有云。上焦如雾。宣五谷味。熏肤充身泽毛。若雾露之溉。是为
气也。今相公年高气弱。自利无度。致胃中生发之气、不能滋养于心肺。故闭塞而痛。经云。上气
不足。推而扬之。脾不足者。以甘补之。再以异功散甘辛微温之剂。温养脾胃。加升麻、人参上升。
以顺正气。不数服而胸中快利而痛止。内经云。调气之方。必别阴阳。内者内治。外者外治。微者
调之。其次平之。胜者夺之。随其攸利。万举万全。又曰。病有远近。治有缓急。无越其制度。又
曰。急则治其标。缓则治其本。此之谓也。
Marshal of the Southern Expedition, Buji Dai, was born in the Xu hour on the third day of the eighth month in the Xinyou year. He lived to be seventy years old. In the spring of the Bingchen year, during the eastern campaign, upon returning south and passing through Chuqiu, officials from various routes came to welcome him, offering much sweet wine (Jiuli). Consequently, he drank excessively, leading to abdominal pain and borborygmus. He suffered from diarrhea approximately fifty times a day and night, with soreness and swelling of the pharynx and throat, redness and swelling around the ears, stiffness of the tongue base, and thick, sticky saliva that could not be expectorated unless pulled out by hand. Speech was difficult, accompanied by restlessness and confusion, preventing sleep at night. An envoy came to summon me. The pulse was floating and rapid, but deep, fine, and wiry upon pressure. I told Chancellor Zhan: "Zhongjing stated that for diarrhea with undigested food and body pain, one should urgently treat the interior first; after bowel movements normalize, then urgently treat the exterior. For treating the interior, use Sini Tang (Four Reversal Decoction); for treating the exterior, use Guizhi Tang (Cinnamon Twig Decoction). Currently, the Marshal's stomach qi is unsecured, presenting with diarrhea of undigested food and abdominal pain. Although urgent treatment is indicated, compared to the condition of the pharynx and throat, it can wait slightly." Zhan asked, "What do you mean?" I replied, "The Neijing states: 'A carbuncle arising in the pharynx and throat is called Mengju (Fierce Carbuncle). If this disease is treated late, it will block the throat. Blocking the throat leads to obstruction of qi flow, which results in death within half a day.' Therefore, urgent treatment is required." Thus, I used bi-stone to prick the swollen area, releasing dark purple-black blood. Shortly after, the swelling subsided significantly. Subsequently, I prescribed equal parts of Jiegeng (Platycodonis Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Lianqiao (Forsythiae Fructus), Shuniu (Arctii Fructus), Jiuzhi Huangqin (Scutellariae Radix processed with wine), Shengma (Cimicifugae Rhizoma), and Fangfeng (Saposhnikoviae Radix). These were coarsely crushed, about five qian per dose, boiled in water to extract the clear liquid, and kept warm for gargling. It was spat out when cool, as swallowing might damage the spleen and stomach and worsen the diarrhea. After another dose, the saliva cleared, the swelling dispersed, and speech and voice returned to normal. Later, Shenying Wan (Miraculous Response Pill), a pungent-hot preparation, was used to disperse middle-jiao cold, resolve retained food, and dry spleen dampness. The pill form was chosen because it does not act immediately, thus avoiding aggravating the upper-heat, and only acts after reaching the disease site. This represents treating the root with a slow approach. After a few doses, the diarrhea stopped, and pain resolved. Subsequently, there was chest oppression and paroxysmal pain. I recalled the Ling Shu stating: "The Upper Jiao is like mist, distributing the flavors of grain and food, steaming the skin, filling the body, and moistening hair and fur, like the irrigation of mist and dew; this is Qi." Now, the Chancellor is elderly and weak, suffering from excessive diarrhea, causing the generating qi of the stomach to fail to nourish the heart and lungs, resulting in obstruction and pain. The classics state: "For insufficiency of upper qi, push and elevate it; for insufficiency of the spleen, tonify with sweet flavors." I then prescribed Yigong San (Extraordinary Efficacy Powder), a sweet-pungent and slightly warm agent, to warm and nourish the spleen and stomach, adding Shengma and Renshen (Ginseng Radix et Rhizoma) to assist ascending qi and harmonize righteous qi. After a few doses, the chest felt comfortable and free, and pain ceased. The Neijing states: "Formulas for regulating qi must distinguish yin and yang. Internal diseases are treated internally, external diseases externally. Mild cases are regulated, moderate cases balanced, severe cases subdued. Follow what is advantageous, and ten thousand attempts will yield complete success." It also says: "Diseases have distant and near origins; treatments have slow and urgent approaches; do not exceed established protocols." And again: "In acute situations, treat the branch (symptoms); in chronic situations, treat the root (cause)." This is what is meant.