一尼病。恶风。体倦。乍寒乍热。面赤心烦。时或有汗。他医以伤寒温疟治之。见其寒热往
来。时方疫气大作也。大小柴胡杂进。数日愈甚。转剧。予诊之曰。两手不受邪。厥阴。脉弦长
而上鱼际。此非伤寒。乃阴动不得阳也。此正与仓公治一绣女病同。投以抑阴等药。数日愈。
论曰。昔褚澄云。治师尼寡妇。别制方。盖有为也。师尼寡妇。独居怨旷。独阴而无阳。欲
心屡萌。而不适其欲。是以阴阳交争。乍寒乍热。虚汗倦怠。全类温疟。久久成痨瘵矣。尝记史
书仓公传载。济北王侍者绣女病。腰背寒热。众医皆为寒热也。仓公曰病得之欲男子而不可得也。何以知之。诊其脉。
肝部弦出寸口。是以知也。男子以精为主。女子以血为主。男子精溢则思室。女子血盛则怀胎。肝摄血者也。
今肝脉弦长上寸口及鱼际。则血盛欲男子之候也。然则治师尼寡妇。尤不可与寻常妇人一概论也。
里人秦氏子得伤寒。发热。身疼。骨节疼痛。恶风无汗。或者劝其不须服药。待其自安。如
是半月矣。而病不除。不得已召医治之。医至问日数。又不审其脉与外证。但云已过期矣。不可
汗下矣。且与调气药以正气。复延予。予诊其脉。浮涩而紧大。此麻黄证无疑者。但恐当汗不汗。
化为衄血。必有是证。言未已。衄血作。予急以麻黄汤与之。继之以犀角地黄汤。血止汗解愈。
论曰。仲景云凡作汤药。不可避晨夜。觉病须臾。即宜便治。不等早晚。则易愈。或稍迟。
病即传变。虽欲除必难为力。今医不究根源。执以死法。必汗之于四日之前。下之于四日之后。
殊不知此惑也。又云病不服药。犹得中医。此为无医而设也。若大小便不通。必待其自瘥乎。盖
前后不得溲。必下部腹胀。数日死矣。又况结胸蓄血。发狂发斑之类。未有勿药而愈者。知者知
变。愚者执迷。以取祸也。须是随病浅深。在表在里。或阴或阳。早为治疗。如救火及溺然。庶
易瘥。素问云邪风之至。疾如风雨。故善治者治皮毛。其次治肌肤。其次治筋脉。其次治六腑。
其次治五脏。治五脏者半死半生也。扁鹊望齐侯而逃。其斯之谓欤。
一位尼姑患病，表现为怕风、身体疲倦、忽冷忽热、面色发红、心烦意乱，偶尔有出汗。其他医生将其当作伤寒或温疟治疗，看到她寒热往来（症状交替出现），当时正值瘟疫盛行，于是大小柴胡汤混合服用，结果几天后病情加重，变得更加严重。我诊察后说：两手脉象均不受邪气束缚（指脉象异常活跃），这是厥阴经病变；脉象弦长且向上延伸至鱼际部位。这不是伤寒，而是阴气发动而阳气不能制约所致。这与古代名医仓公治疗一位绣女的情况相同。我投用抑阴等药物，几天后痊愈。
论述说：从前褚澄曾说，治疗师尼和寡妇需要另外制定方剂，这是有原因的。师尼和寡妇独自生活，处于怨旷状态（孤独无偶），只有阴气而没有阳气，欲望屡次萌动却无法得到满足，因此阴阳相互交争，出现忽冷忽热、虚汗、倦怠等症状，完全类似于温疟。久而久之就会形成痨瘵（慢性消耗性疾病）。我曾记得史书《仓公传》中记载，济北王的侍妾绣女患病，腰背感到寒热，众医生都认为是普通的寒热病。仓公说：这病是因为想要男子却不可得造成的。怎么知道的呢？诊察她的脉象，肝部脉象弦直超出寸口。因此得知病因。男子以精气为主，女子以血液为主。男子精液外溢后会思念房事，女子血液充盈时会渴望受孕。肝主藏血。现在肝脉弦长超过寸口到达鱼际，这是血液充盈且渴望男子的征象。那么治疗师尼和寡妇，尤其不能与普通妇人一概而论。
同乡秦家的儿子得了伤寒，表现为发热、身体疼痛、骨节疼痛、怕风、无汗。有人劝他不需要服药，等待其自愈。这样过了半个月，病仍未消除，不得已请医生诊治。医生到来询问发病天数，又不仔细诊察脉象和外在证候，只说已经过期了，不可以发汗或攻下。并且给予调气药来扶助正气，随后又延请我诊治。我诊察他的脉象，浮涩而紧大，这无疑是麻黄汤证。只是担心应当发汗而未发汗，转化为衄血（鼻出血），必然会出现这个证候。话还没说完，衄血发作。我急忙给予麻黄汤，继之以犀角地黄汤，血止汗出而痊愈。
论述说：张仲景说凡是制作汤药，不可避开早晚，发觉生病片刻，就应当立即治疗，不等早晚，则容易痊愈。如果稍微延迟，病情就会传变，虽然想去除病邪也难以有力。现在的医生不探究根源，拘泥于死板的法则，必定要求在四日之前发汗，四日之后攻下。殊不知这是迷惑人的说法。又说“生病不服药，尚可得到中等医生的水平”，这是为没有医生可找的情况设立的。如果大小便不通，难道要等待其自愈吗？大概前后二便不通，必然导致下部腹部胀满，数日后死亡。更何况像结胸、蓄血、发狂、发斑之类的病症，没有不服药而痊愈的。聪明的人懂得变通，愚昧的人固执迷恋，从而招致祸患。必须根据病情的深浅，在表在里，属阴属阳，尽早进行治疗，就像救火和救人溺水一样，才容易康复。《素问》说邪风到来，快如风雨，所以善于治疗的医生在皮毛阶段就治疗，其次在肌肤阶段治疗，其次在筋脉阶段治疗，其次在六腑阶段治疗，其次在五臟阶段治疗。治疗五脏病的患者，一半死亡一半存活。扁鹊见到齐侯就逃跑，说的就是这种情况吧。
A nun suffered from illness, presenting with aversion to wind (fear of drafts), physical fatigue, alternating chills and fever (symptoms occurring in turns), flushed face, irritability, and occasional sweating. Other physicians treated it as Taiyang disease (disease affecting the Taiyang meridian) or warm malaria. Observing her alternating chills and fever, and noting that an epidemic was prevalent at the time, they administered a mixture of Xiaochaihu Tang (Minor Bupleurum Decoction) and Da Chaihu Tang (Major Bupleurum Decoction). After several days, the condition worsened significantly. Upon examination, I stated: "The pulse in both hands is not constrained by pathogenic factors, indicating Jueyin disease (disease affecting the Jueyin meridian); the pulse is wiry and long, extending upward to the Yuji area (the fleshy part at the base of the thumb). This is not Taiyang disease, but rather Yin qi activating without Yang qi to restrain it." This case parallels one treated by the ancient physician Cang Gong for a embroiderer girl. I prescribed Yin-yang suppressing medications, and she recovered after several days.
Commentary states: In the past, Chu Cheng remarked that special prescriptions should be formulated for nuns and widows, which was intentional. Nuns and widows live in isolation and frustration, possessing only Yin without Yang. Their desires frequently arise but remain unfulfilled, causing Yin and Yang to contend with each other. This results in alternating chills and fever, deficiency sweating, and fatigue, closely resembling warm malaria. Over time, this may develop into Laozai (chronic consumptive disease). I recall from historical records in the *Biographies of Master Cang* that the embroiderer maid of King Jibei suffered from chills and heat in the waist and back. Most physicians diagnosed it as ordinary chills and heat. Master Cang said, "This illness arises from desiring a man but being unable to obtain one." How did he know? By diagnosing her pulse, he found the Liver pulse wiry and extending beyond the Cun Kou (inch position). Thus, he identified the cause. Men are primarily governed by Jing (essence), while women are primarily governed by Blood. When men's essence is discharged, they crave sexual intercourse; when women's blood is abundant, they desire conception. The Liver stores blood. Now, the Liver pulse is wiry and long, exceeding the Cun Kou and reaching the Yuji area, which indicates abundant blood and a desire for a male partner. Therefore, treating nuns and widows must not be approached in the same manner as treating ordinary women.
A local man named Qin contracted Taiyang disease, presenting with fever, body pain, joint pain, aversion to wind, and absence of sweating. Someone advised him not to take medicine and to wait for spontaneous recovery. This continued for half a month, yet the illness persisted. Reluctantly, he summoned a physician. The physician asked about the duration of the illness but failed to carefully examine the pulse and external symptoms, stating only that the critical period had passed and that diaphoresis (sweating therapy) or purgation were contraindicated. He provided Qi-regulating herbs to support healthy Qi, then referred the patient to me. I examined his pulse, finding it floating, choppy, tight, and large. This was undoubtedly a Mahuang Tang (Ephedra Decoction) pattern. However, I feared that because diaphoresis was indicated but not performed, it might transform into Xuebi (epistaxis/nosebleed). Indeed, before I finished speaking, epistaxis occurred. I urgently administered Mahuang Tang, followed by Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). The bleeding stopped, sweat appeared, and he recovered.
Commentary states: Zhang Zhongjing stated that when preparing herbal decoctions, one should not avoid morning or night. As soon as illness is detected, treatment should begin immediately, regardless of time, facilitating easier recovery. If delayed slightly, the pathogen may transmit and change, making eradification difficult. Current physicians fail to investigate the root cause, adhering rigidly to fixed rules—insisting on diaphoresis within four days and purgation after four days. They do not realize this is misleading. It is also said, "If one takes no medicine for an illness, one still receives care equivalent to a mediocre physician"; this applies only when no doctor is available. If urination and defecation are obstructed, must one wait for spontaneous resolution? Generally, if both upper and lower orifices are blocked, abdominal distension in the lower jiao will occur, leading to death within days. Furthermore, conditions such as Jie Xiong (chest binding), Xu Xue (blood accumulation), mania, and macules have never resolved without medication. The wise understand adaptability, while the foolish remain stubborn, bringing disaster upon themselves. Treatment must be initiated early based on the depth of the disease, whether in the exterior or interior, Yin or Yang, akin to extinguishing a fire or rescuing someone from drowning, so that recovery is likely. The *Su Wen* states that evil winds arrive swiftly like wind and rain. Therefore, skilled physicians treat at the skin and hair level first, then muscle and skin, then sinews and vessels, then the Six Fu organs, and finally the Five Zang organs. Treating diseases of the Five Zang organs results in half dying and half surviving. Bian Que fled from Duke Huan of Qi; this is precisely what is meant.