人患发热恶寒自汗。脉浮而微弱。予以三服桂枝投之。遂愈。仲景云太阳中风。阳浮而阴弱
者。汗自出。啬啬恶寒。淅淅恶风。翕翕发热。宜桂枝汤。
论曰。仲景云假令寸口脉微。名曰阳不足。阴气上入阳中。则洒淅恶寒也。尺脉弱。名曰阴
不足。阳气下陷入阴中。则发热。此医发其汗。使阳气微。又大下之。使阴气弱。此为医所病而
然也。大抵阴不足阳从之。故阳内陷发热。阳不足阴往乘之。故阴上入阳中。则恶寒。阴阳不归
其分。是以发热恶寒也。故孙真人云有热。不可大攻之。热去则寒起。
维扬李寅始病。头疼。发热。恶风。医者下之。忽尔心下坚硬。项强。短气。宛然结胸中证
也。予曰幸尔脉不浮。心不烦躁。非陷胸汤不可。投之。一宿乃下。
论曰。仲景言病发于阳而反下之。热入于胸。因作结胸者。以下之太早故也。盖恶寒尚有表
证未罢。而下之。故阳气内陷。阳内拒痛。脉浮者不可下。下之则死。结胸烦躁者必死。此是恶
证。辩者仔细。
城东李氏子。年十八。病伤寒结胸。状如 。自心至脐。手不可近。短气心烦。真结胸也。
医者便欲下之。予适过其门。见其怆惶面无色。予曰公有忧色何也。曰以长子病伤寒作结胸证。
医者将下之。而犹豫。予就为诊之。自关以上浮大。表证未罢。不可下也。曰事急矣。予以黄连
饼子。灸脐中数十壮。得气下。心腹软。继以和气解肌药。数日瘥。当时若下。定是医杀。
患者出现发热、恶寒且自汗的症状，脉象浮而微弱。我给予三服桂枝汤投治，随即痊愈。张仲景说：太阳中风证，表现为阳脉浮而阴脉弱，汗自出，怕冷啬啬，怕风淅淅，发热翕翕，适宜用桂枝汤。
论述说：张仲景曾说，假如寸口脉微，称为阳气不足，阴气上入阳分，则会出现洒淅般的恶寒。尺脉弱，称为阴气不足，阳气下陷入阴分，则会出现发热。这是医生发汗过度，使阳气微弱；又大幅使用泻下法，使阴气虚弱。这是因误治导致的疾病。大抵而言，阴气不足时阳气随之内陷，所以内部发热；阳气不足时阴气乘虚而入，所以阴气进入阳分，则出现恶寒。阴阳之气不能各归其位，因此出现发热和恶寒。所以孙思邈说：有热证，不可猛烈攻伐，热邪去除后寒证就会兴起。
维扬人李寅起初患病，头痛，发热，怕风。医生使用了泻下法，忽然心下部坚硬，项部强直，呼吸短促，俨然呈现结胸证的典型症状。我说：幸好你的脉象不浮，心中没有烦躁感，非陷胸汤不可治疗。投药后，过了一夜才排出病邪。
论述说：张仲景言及病发于阳证却反而使用泻下法，热邪陷入胸中，因而形成结胸证，这是因为泻下过早的缘故。大概因为恶寒表明表证尚未解除，此时若使用泻下法，会导致阳气内陷。阳气内陷并抗拒邪气则疼痛。脉象浮者不可使用泻下法，误用则致死。结胸证伴有烦躁者必死，这是危重恶证，辨证时必须仔细。
城东李家的儿子，十八岁，患伤寒结胸证，症状严重，从心窝到肚脐，手不能触碰，呼吸短促，心烦意乱，是真正的结胸证。医生打算立即使用泻下法。我恰好经过他家门前，见他神色凄惶面无血色。我问：“您面露忧色是因为什么？”他说：“因为长子患伤寒形成结胸证，医生准备泻下，但他犹豫不决。”我便上前为他诊脉，关脉以上脉象浮大，说明表证未解，不可使用泻下法。我说：“情况紧急了。”我使用黄连饼子灸脐中数十壮，待得气后病邪下行，心腹部变软。随后服用调和气血、解除肌表的药物，几天后痊愈。当时如果直接泻下，必定是医生害死了他。
A patient suffered from fever, aversion to cold, and spontaneous sweating. The pulse was floating and weak. I administered Guizhi Tang (Cinnamon Twig Decoction) in three doses, and the condition was cured. Zhang Zhongjing stated: In Taiyang Wind Strike syndrome (Taiyang Fengzheng), where the Yang aspect of the pulse is floating and the Yin aspect is weak, there is spontaneous sweating, severe aversion to cold, chilly aversion to wind, and mild fever; Gui Zhi Tang is appropriate.
The commentary states: Zhang Zhongjing said that if the Cun Kou (inch position) pulse is faint, it is named Yang insufficiency. When Yin Qi ascends into the Yang region, it causes shivering aversion to cold. If the Chi (cubit position) pulse is weak, it is named Yin insufficiency. When Yang Qi sinks and traps within the Yin region, it causes fever. This results from a physician inducing excessive sweating, thereby weakening Yang Qi, and subsequently using strong purgatives, thereby weakening Yin Qi. This is an iatrogenic disease. Generally speaking, when Yin is insufficient, Yang follows inward, causing internal heat; when Yang is insufficient, Yin takes advantage of the deficiency to enter the Yang region, causing aversion to cold. Since Yin and Yang fail to return to their proper positions, fever and aversion to cold occur. Therefore, Sun Simiao stated: In cases of heat, one must not attack vigorously; once the heat is removed, cold will arise.
Li Yin from Weiyang initially presented with headache, fever, and aversion to wind. A physician used purgation, after which his epigastrium suddenly became hard, his neck became stiff, and he experienced shortness of breath, resembling the typical presentation of Jie Xiong (Chest Binding). I said: Fortunately, your pulse is not floating, and you have no mental restlessness; only Xian Xiong Tang (Draining Chest Decoction) is suitable. After administration, the pathogenic factor was expelled overnight.
The commentary states: Zhang Zhongjing mentioned that if a disease originating in the Yang stage is incorrectly treated with purgation, heat enters the chest, resulting in Jie Xiong (Chest Binding); this occurs because purgation was applied too early. Generally, if aversion to cold persists, the exterior syndrome has not yet resolved; applying purgation at this time causes Yang Qi to sink inward. When Yang Qi sinks and resists, pain occurs. If the pulse is floating, purgation is contraindicated; misuse leads to death. If Jie Xiong (Chest Binding) is accompanied by mental restlessness, death is inevitable. This is a critical adverse syndrome, requiring careful differentiation.
The son of Mr. Li in the east of the city, aged eighteen, suffered from Taiyang Cold Damage complicated by Jie Xiong (Chest Binding). The condition was severe: from the heart region down to the umbilicus, touch was intolerable, accompanied by shortness of breath and mental restlessness, constituting true Jie Xiong (Chest Binding). The physician intended to use purgation immediately. I happened to pass his door and saw him looking pale and distressed. I asked: "Why do you look worried?" He replied: "My eldest son suffers from Taiyang Cold Damage presenting as Jie Xiong (Chest Binding). The physician proposes purgation, but we hesitate." I proceeded to diagnose him. The pulse above the Guan (bar) position was floating and large, indicating that the exterior syndrome had not yet resolved; purgation is contraindicated. I said: "The situation is urgent." I applied moxibustion using Huanglian Bing Zi (Coptis Cake) on the umbilicus for dozens of moxa cones. Upon obtaining De Qi (arrival of Qi), the pathogenic factor moved downward, and the epigastrium and abdomen softened. Subsequently, I administered herbs to harmonize Qi and Blood and release the muscle layer. After several days, he recovered. Had purgation been used at that time, it would certainly have resulted in medical error leading to death.