至元壬午五月二十八日。王伯禄年逾五旬有七。右臂膊肿盛。上至肩。下至手指。色变。皮肤
凉。六脉沉细而微。此乃脉证俱寒。予举疡医孙彦和视之。曰。此乃附骨痈。开发已迟。以燔针起
之。脓清稀解。次日肘下再开之。加呃逆不绝。彦和与丁香柿蒂散两服。稍缓。次日。呃逆尤甚。
自利。脐腹冷痛。腹满。饮食减少。时发昏愦。于左乳下黑尽处。灸二七壮。又处托里温中汤。用
干姜、附子、木香、沉香、茴香、羌活等药。 咀一两半。欲与服。或者曰。诸痛痒疮疡。皆属心
火。又当盛暑之时。用干姜附子可乎。予应之曰。理所当然。不得不然。内经曰。脉细皮寒、泻利
前后。饮食不入。此谓五虚。况呃逆者。胃中虚寒故也。诸痛痒疮疡。皆属心火。是言其定理也。
此证内外相反。须当舍时从证也。非大方辛热之剂急治之。则不能愈也。遂投之。诸证悉去。饮
食倍进。疮势温。脓色正。彦和复用五香汤数服。后月余平复。噫。守常者众人之见。知变者知者
之事。知常而不知变。细事因而取败者亦多矣。况医乎哉。守常知变。岂可同日而语乎哉。
【托里温中汤】治疮为寒变而内陷者、脓出清解。皮肤凉。心下痞满。肠鸣切痛。大便微
溏。食则呕逆。气短促。呃逆不绝。不得安卧。时发昏愦。
沉香 丁香 益智仁 茴香
陈皮（各一钱） 木香（一钱半） 甘草（炙。二钱） 羌活
干姜（炮。三钱） 黑附子（炮。去皮脐。四钱）
上 咀。作一服。水三盏。生姜五片。煎至一盏。去渣。温服。无时。忌一切冷物。内经云。
寒淫于内。治以辛热。佐以苦温。故以附子、干姜大辛热。温中外。发阳气自里之表。故以为君。
羌活味苦辛温。透关节。炙甘草甘温。补脾胃、行经络。通血脉。胃寒则呕吐呃逆不下食。益智仁
、丁香、沉香。大辛热。以散寒为佐。疮气内攻气聚而为满。木香、茴香、陈皮。苦辛温。治痞散
满为使也。
On the 28th day of the fifth month in the Renwu year of Zhiyuan, Wang Bolu was over fifty-seven years old. His right arm was severely swollen, extending up to the shoulder and down to the fingers. The skin color changed, and the skin felt cold. The six pulses were deep, fine, and faint. This indicated that both the pulse and the syndrome manifested as Cold. I invited Sun Yanhe, a surgeon specializing in sores and ulcers, to examine the patient. He said: "This is Aggu Yong (deep-seated abscess involving bone). Treatment has been delayed; it should be treated with burning needles (Fanzhen) to drain the pus. The discharged pus was clear and thin. The following day, another incision was made below the elbow. Subsequently, hiccups became incessant. Sun Yanhe prescribed Dingxiang Shidi San (Clove and Persimmon Calyx Powder) for two doses, which provided slight relief. The next day, the hiccups worsened significantly. There was spontaneous diarrhea, cold pain around the navel and abdomen, abdominal fullness, reduced food intake, and episodes of mental confusion. I applied moxibustion at the point where the blackness ended under the left breast, fourteen moxa cones. I then prescribed Tuoli Wenzhong Tang (Supporting Interior and Warming Middle Decoction), using Ganjiang (Dried Ginger), Fuzi (Prepared Aconite Root), Muxiang (Costus Root), Chenxiang (Agarwood), Huixiang (Fennel Seed), Qianghuo (Notopterygium Rhizome), etc. The herbs were coarsely powdered to one tael and half, ready for administration. Someone remarked: 'All pain, itching, sores, and ulcers belong to Heart Fire.' Moreover, it is the height of summer heat; can we use Ganjiang and Fuzi?" I replied: "It is logically necessary and unavoidable. The *Neijing* states: 'Fine pulse, cold skin, diarrhea from both bowels, and inability to eat—this is called the Five Deficiencies.' Furthermore, hiccups are caused by deficiency-cold in the Stomach. 'All pain, itching, sores, and ulcers belong to Heart Fire' refers to the general principle. In this case, the internal and external manifestations are contradictory; one must abandon the seasonal factor and follow the syndrome. Without urgent treatment using large doses of acrid-hot agents, recovery is impossible." Consequently, the medicine was administered. All symptoms disappeared, food intake doubled, the sore became mild, and the pus color normalized. Sun Yanhe again used Wuxiang Tang (Five Fragrances Decoction) for several doses, and after more than a month, the patient fully recovered. Alas! Adhering to convention is the view of ordinary people; knowing how to adapt is the deed of the wise. Knowing the constant but not knowing change leads to failure even in trivial matters, let alone in medicine. Can adhering to convention and knowing change be compared?
[Tuoli Wenzhong Tang] Treats cases where sores/ulcers undergo cold transformation and sink inward, characterized by clear and thin pus discharge, cold skin, epigastric stuffiness and fullness, loud borborygmi with cutting pain, slightly loose stools, vomiting and regurgitation upon eating, shortness of breath, incessant hiccups, inability to lie down comfortably, and occasional mental confusion.
Chenxiang (Aquilaria Wood), Dingxiang (Clove Bud), Yizhiren (Alpinia Oxyphylla Fruit), Huixiang (Fennel Seed) (each 1 qian); Muxiang (Costus Root) (1.5 qian); Gancao (Licorice Root, honey-fried) (2 qian); Qianghuo (Notopterygium Rhizome); Ganjiang (Dried Ginger, processed) (3 qian); Hei Fuzi (Black Prepared Aconite Root, processed, skin and umbilical scar removed) (4 qian).
Coarsely powder the above ingredients to constitute one dose. Add three cups of water and five slices of fresh ginger. Decoct until one cup remains, strain, and take warm at any time. Avoid all cold foods. The *Neijing* states: "When Cold invades internally, treat with acrid-hot agents, assisted by bitter-warm agents." Therefore, Fuzi and Ganjiang, being greatly acrid and hot, are used as Sovereign herbs to warm the interior and exterior, and to stimulate Yang Qi to emerge from the interior to the exterior. Qianghuo is bitter, acrid, and warm, penetrating the joints; honey-fried Gancao is sweet and warm, tonifying the Spleen and Stomach, unblocking meridians, and circulating blood vessels. Stomach Cold causes vomiting, hiccups, and anorexia. Yizhiren, Dingxiang, and Chenxiang are greatly acrid and hot, serving as Assistant herbs to disperse Cold. Pathogenic Qi from the sore attacks inward, causing Qi stagnation and fullness. Muxiang, Huixiang, and Chenpi (Aged Tangerine Peel) are bitter, acrid, and warm, treating stuffiness and dispersing fullness, serving as Envoy herbs.