戊申正月。有一武弁在仪真。为张遇所虏。日夕置于舟 板下。不胜 伏。后数日得脱。因
饱食。解衣扪虱以自快。次日遂作伤寒。医者以因饱食伤。而下之。一医以解衣中邪。而汗之。
杂治数日。渐觉昏困。上喘。息高。医者怆惶罔知所指。予诊之曰。太阳病。下之。表未解。微
喘者。桂枝加浓朴杏子汤。此仲景法也。医者争曰。某平生不曾用桂枝。况此药热。安可愈喘。
予曰非汝所知也。一投而喘定。再投而 汗出。至晚。身凉而脉已和矣。医者曰。予不知仲景
之法。其神如此。岂诳惑后世也哉。人自寡学。无以发明耳。
乡人邱忠臣。寓毗陵荐福寺。病伤寒。予为诊视。其发热。头疼。烦渴。脉虽浮数无力。自
尺以下不至。予曰虽麻黄证。而尺迟弱。仲景云。尺中迟者。营气不足。血气微少。未可发汗。
予于建中汤。加当归黄 。令饮之。翌日病者不耐。其家晓夜督发汗药。其言至不逊。予以乡人隐忍之。但以建中调理
而已。及六七日。尺脉方应。遂投以麻黄汤。啜第二服。狂言烦躁且闷。须臾稍定。已中汗矣。五日愈。
论曰。仲景虽云不避晨夜。即宜便治。医者亦须顾其表里虚实。待其时日。若不循次第。虽
临时得安。亏损五脏。以促寿限。何足尚哉。昔范云为陈霸先属。霸先有九锡之命。期在旦夕矣。
云偶感寒疾。恐不及豫盛事。请徐文伯诊视之。恳曰。便可得愈乎。文伯曰。便瘥甚易。但恐二
年后不复起尔。云曰。朝闻道夕死可矣。况二年乎。文伯以火烧地。布桃柏叶。设席置其卧上。
顷刻汗解。以温粉扑之。翌日愈。甚喜。文伯曰。不足喜也。后二年果卒矣。夫取汗先期。尚促
寿限。况罔顾表里。不待时日。便欲速愈乎。每见病家不耐三四日。昼夜促汗。医者顾利。恐别
更医。随情顺意。鲜不致毙。故书此以为龟鉴。
戊申年正月。有一位武官在仪真。被张遇俘虏。日夜被关在船板下面。忍受不了这种屈辱的伏卧姿势。几天后得以逃脱。于是暴饮暴食。解开衣服捉虱子来让自己痛快。第二天就患上了伤寒。医生认为他是因饱食而受伤。用了攻下的方法治疗。另一位医生认为他是因脱衣受邪。用了发汗的方法治疗。经过几天的杂乱治疗。病情逐渐加重。出现神志昏沉困倦。上部气喘。呼吸浅表（息高）。医生们惊慌失措。不知道该如何处理。我诊察后说。这是太阳病。误用下法后。表证未解。出现轻微气喘。应当使用桂枝加厚朴杏子汤。这是张仲景的法度。医生们争辩说。我平生从未用过桂枝。况且这药性热。怎么能治愈气喘呢。我说。这不是你们所能理解的。服用一剂后气喘平息。再服用后出汗。到了晚上。身体凉爽且脉象调和了。医生说。我不知道张仲景的法度竟然如此神奇。难道是欺骗迷惑后世的人吗。是人们自己学识浅薄。无法阐明其中的道理罢了。
同乡人邱忠臣。寄住在毗陵荐福寺。患了伤寒。我为他诊视。他发热。头痛。心烦口渴。脉象虽然浮数但无力。尺部以下的脉搏摸不到。我说。虽然是麻黄汤证。但是尺脉迟弱。张仲景说。尺脉迟的。是营气不足。气血微弱。不可以发汗。我在小建中汤中加入当归、黄芪。让他服用。第二天病人难以忍受。他的家人昼夜催促发汗药。言语甚至很不恭敬。我以同乡的身份隐忍下来。只是用小建中汤调理而已。等到六七天。尺脉才显现出来。于是投以麻黄汤。喝第二服药后。出现胡言乱语、烦躁且胸闷。片刻后稍微安定。已经中了汗法的效果。五天痊愈。
论述说。张仲景虽然说无论早晚。都应立即治疗。但医生也必须顾及病人的表里虚实。等待合适的时日。如果不遵循治疗次第。虽然临时得到安宁。但会亏损五脏。缩短寿命。有什么值得推崇的呢？从前范云嘱托陈霸先。陈霸先接受九锡之命。指日可待了。范云偶然感染寒疾。担心来不及参与盛事。请徐文伯诊治。恳切地问。可以立刻痊愈吗。徐文伯说。立刻痊愈很容易。但恐怕两年后就不能再起床了。范云说。朝闻道夕死可矣。何况是两年呢。徐文伯用火烤热地面。铺上桃叶和柏叶。设置席子让他躺在上面。顷刻间通过发汗解除病邪。用温粉扑身。第二天痊愈。非常高兴。徐文伯说。不值得高兴。两年后果然去世了。提前取汗。尚且缩短寿命。何况不顾表里。不等待时日。就想快速痊愈呢？经常见到病人不能忍耐三四天。昼夜催促发汗。医生顾惜利益。怕病人另请名医。顺从病人的心意。很少有不导致死亡的。所以写下这些作为借鉴。
In the first month of the Wushen year, a military officer was in Yizhen and was captured by Zhang Yu. He was confined beneath the ship's planks day and night, unable to endure the humiliating prone position. After several days, he escaped. Consequently, he overate and undressed to catch lice for his own pleasure. The next day, he contracted Cold Damage (Shanghan). Physicians treated him as if injured by overeating and used purgation. Another physician treated him as if infected by exposure to pathogens and used diaphoresis. After several days of miscellaneous treatments, he gradually became confused and lethargic, with upper-body wheezing and shallow breathing (high respiration). The physicians were panicked and did not know how to proceed. I examined him and said, "This is Taiyang disease. After incorrect purgation, the exterior syndrome remains unresolved, accompanied by slight wheezing. Guizhi Jia Houpo Xingzi Tang (Cinnamon Twig Decoction plus Magnolia Bark and Apricot Seed) should be used. This is the method of Zhang Zhongjing." The physicians argued, "I have never used Guizhi (Cinnamon Twig) in my life. Moreover, this medicine is hot; how can it cure wheezing?" I replied, "This is beyond your understanding." After one dose, the wheezing ceased. After a second dose, sweating occurred. By evening, his body was cool and his pulse had harmonized. The physician said, "I did not know that the methods of Zhang Zhongjing were so miraculous. Is he deceiving posterity? It is merely that people are too ignorant to elucidate the principles."
Qiu Zhongchen, a fellow townsman, was staying at Jianfu Temple in Piling when he fell ill with Cold Damage. I examined him. He had fever, headache, restlessness, and thirst. Although his pulse was floating and rapid, it was weak, and the chi position below the wrist was imperceptible. I said, "Although this presents as a Mahuang Tang (Ephedra Decoction) pattern, the chi pulse is slow and weak. Zhang Zhongjing stated: 'If the chi pulse is slow, Ying Qi is insufficient, and blood and qi are slightly deficient. Diaphoresis should not be used.'" I prescribed Jianzhong Tang (Construct the Middle Decoction) added with Danggui (Angelicae Sinensis Radix) and Huangqi (Astragali Radix) for him to drink. The next day, the patient could not tolerate it. His family urged the administration of diaphoretic medicines day and night, their words becoming increasingly disrespectful. As a fellow townsman, I endured this silently and simply used Jianzhong Tang for regulation. After six or seven days, the chi pulse finally appeared. Then I administered Mahuang Tang. After the second dose, he spoke deliriously, felt restless and stifled, but soon stabilized. Sweating ensued. He recovered in five days.
Commentary: Zhang Zhongjing stated that treatment should be immediate regardless of morning or night. However, physicians must also consider the interior and exterior, deficiency and excess, and wait for the appropriate time. If one does not follow the proper sequence, although temporary relief may be achieved, the five zang organs will be damaged, and lifespan shortened. What is there to praise in such an approach? In the past, Fan Yun entrusted matters to Chen Baxian. Chen Baxian was about to receive the Nine Bestowals. Fan Yun accidentally contracted a cold disease and feared he would not live to see the grand event. He requested Xu Wenbo to examine him, earnestly asking, "Can I recover immediately?" Wenbo replied, "Recovering immediately is very easy, but I fear you will not rise again after two years." Yun said, "If I hear the Dao in the morning, I can die content in the evening; what more can I ask than two years?" Wenbo heated the floor with fire, spread peach leaves and cypress leaves, set up a mat for him to lie on, and within moments, the pathogen was resolved through sweating. Warm powder was applied to his body. He recovered the next day and was very pleased. Wenbo said, "There is no need to be pleased. Two years later, you indeed passed away." Taking sweat prematurely still shortens lifespan; how much more so to ignore interior and exterior conditions and rush for quick recovery without waiting for the right time? I often see patients who cannot endure three or four days, urging diaphoresis day and night. Physicians, caring for profit and fearing the patient might seek another doctor, indulge the patient's wishes. Few do not meet death. Therefore, I record this as a warning.