省郎中张子敬。六十七岁。病眼目昏暗。唇微黑色。皮肤不泽。六脉弦细而无力。一日出示治
眼二方。问予可服否。予曰。此药皆以黄连大苦之药为君。诸风药为使。凡人年五十。胆汁减而目
始不明。内经云。土位之主。其泻以苦。诸风药亦皆泻土。人年七十。脾胃虚而皮肤枯。重泻其土
。使脾胃之气愈虚。而不能营运营卫之气。滋养元气。胃气不能上行。膈气吐食诸病生焉。又已年
高衰弱。起居皆不同。此药不可服。只宜慎言语。节饮食。惩忿窒欲。此不治之治也。子敬以为然
。明年春。除关西路按察使。三年致仕还。精神清胜。脉遂平和。此不妄服寒药之效也。内经曰。
诛罚无过。是谓大惑。解之可也。
省掾曹德裕男妇。三月初病伤寒八九日。请予治之。脉得沉细而微。四肢逆冷。自利腹痛。目
不欲开。两手常抱腋下。昏昏嗜卧。口舌干燥。乃曰前医留白虎加人参汤一服。可服否。予曰。白
虎虽云治口燥舌干。若执此一句亦未然。今此证不可用白虎者有三。伤寒论云。立夏以前。处暑以
后。不可妄用。一也。太阳证无汗而渴者不可用。二也。况病患阴证悉具。其时春气尚寒。不可用
。三也。仲景云。下利清谷。急当救里。宜四逆汤。遂以四逆汤三两加人参一两。生姜十余片。连
须葱白九茎。水五大盏。同煎至三盏。去渣。分三服。一日服之。至夜利止。手足温。翌日大汗而
解。继以理中汤数服而愈。孙真人习业篇云。凡欲为太医。必须谙甲乙、素问。黄帝针经、明堂流
注、十二经、三部九候、本草、药性。仲景、叔和。并须精熟。如此方为太医。不尔。犹
无目夜游。动致颠陨。执方用药者。再斯可矣。
Provincial Vice Director Zhang Zijing, aged sixty-seven, suffered from dim vision, slightly blackened lips, and lusterless skin. His six pulses were wiry, thin, and weak. One day, he presented two prescriptions for treating eye diseases to me, asking if they could be taken. I said: These medicines use Coptis Rhizome (Huanglian, 黄连), a very bitter herb, as the sovereign drug, with various wind-dispelling drugs as ministers. When a person reaches fifty, the gallbladder juice decreases, and vision begins to decline. The *Neijing* states: "For the ruler of the Earth position, purgation should be achieved using bitter flavors." Various wind-dispelling drugs also drain the Earth. When a person reaches seventy, the Spleen and Stomach become deficient, and the skin becomes withered. Heavily draining the Earth further depletes the Qi of the Spleen and Stomach, preventing it from circulating Ying and Wei Qi to nourish Yuan Qi. If Stomach Qi cannot ascend upward, disorders such as Diaphragm Qi stagnation and vomiting will arise. Moreover, given his advanced age and frailty, his daily routine differs from that of younger people; these medicines are unsuitable. He should only speak cautiously, regulate his diet, restrain anger, and curb desires. This is the method of "treating without direct intervention." Mr. Zijing agreed. In the spring of the following year, he was appointed Inspector-General of Guanxi Road. Three years later, upon retirement, his spirit was clearer and better than before, and his pulse became harmonious. This demonstrates the efficacy of not recklessly taking cold-natured medicines. The *Neijing* says: "Punishing those who have committed no fault is called great confusion." This can be explained as follows.
The daughter-in-law of Provincial Clerk Cao Deyu fell ill with Shanghan (Cold Damage) for eight or nine days in early March and requested my treatment. Her pulse was deep, fine, and faint. Her four limbs were cold, she experienced spontaneous diarrhea with abdominal pain, did not wish to open her eyes, often held her hands under her armpits, felt drowsy and lethargic, and had dry mouth and tongue. I asked: The previous physician left a dose of Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng); can it be taken? I said: Although Baihu Tang is said to treat dry mouth and tongue, adhering strictly to this single indication is incorrect. There are three reasons why Baihu Tang cannot be used in this case: The *Shanghan Lun* states that it should not be used recklessly before Lixia (Start of Summer) or after Chushu (End of Heat). This is the first reason. It is contraindicated in Taiyang syndrome cases where there is no sweating accompanied by thirst. This is the second reason. Furthermore, the patient exhibits all signs of Yin syndrome, and the spring Qi is still cold. This is the third reason. Zhongjing stated: "In cases of diarrhea with undigested food, urgent rescue of the Interior is required." Si Ni Tang (Frigid Extremities Decoction) is appropriate. Therefore, I prescribed Si Ni Tang (3 liang), added Ren Shen (Ginseng Root, 1 liang), more than ten slices of Sheng Jiang (Fresh Ginger), and nine stalks of Cong Bai (Scallion White with roots). Boiled with five large bowls of water until reduced to three bowls, filtered, and divided into three doses to be taken within one day. By nightfall, the diarrhea stopped, and the extremities warmed. The next day, profuse sweating occurred, and the disease resolved. Subsequently, several doses of Lizhong Tang (Regulate the Middle Decoction) were administered, leading to recovery. Sun Simiao's *Xiyepian* (Chapter on Professional Study) states: "Anyone wishing to become a Grand Physician must be proficient in the *Jiayi Jing*, *Suwen*, *Huangdi Zhenjing*, *Mingtang Liuzhu*, the twelve meridians, Sanbu Jiuhou (Three Regions and Nine Appearances), *Bencao*, and drug properties. The works of Zhongjing and Shuhe must also be thoroughly mastered. Only then does one qualify as a Grand Physician; otherwise, one is like wandering at night without eyes, liable to stumble and fall at every step." Those who rigidly adhere to formulas and medications should reflect on this again.