乡里豪子得伤寒。身热。目痛。鼻干。不眠。大便不通。尺寸俱大。已数日矣。自昨夕汗大
出。予曰。速以大柴胡下之。众医骇然。曰。阳明自汗。津液已竭。当用蜜兑。何故用大柴胡药。
予曰。此仲景不传妙处。诸公安知之。予力争。竟用大柴胡。两服而愈。
论曰。仲景论阳明云。阳明病。多汗者。急下之。人多谓己自汗。若更下之。岂不表里俱处
也。论少阴云。少阴病一二日。口干燥者。急下之。人多谓病发于阴。得之日浅。但见干燥。若
更下之。岂不阴气愈盛也。世人罕读。予以为不然。仲景称急下之者。亦犹急当救表。急当救里。
凡称急者。急下之。有三处。才觉汗出。多。未至津液干燥。速下之。则为径捷。免致用蜜兑也。
盖用蜜兑。已是失下。出于不得已耳。若胸中识得了了。何疑殆之有哉。
闽人李宗古得疾。口中气热。唇干。屈体卧。足冷。舌上有苔。予诊之。尺寸俱紧。或者谓
气热口干。疑其阳胜。蜷足卧。足冷。疑其阴胜。而又阴阳俱紧。是诚可疑也。若不熟读仲景方
法。何能治。予曰尺寸俱紧。是寒邪胜也。仲景云阴阳俱紧。法当清。邪中于下焦。又云阴阳俱
紧。口中气出。唇干舌燥。蜷卧。足冷。鼻中涕出。舌上苔滑。勿妄治也。到七日以来。其人发
热。手足温者。此为欲解。盖以上证候。皆是阴盛阳弱。故仲景云勿妄治者。诚恐后人之疑也。
故予以抑阴助阳温剂与之。紧脉渐退。四体和。不汗而自解矣。
乡里一位豪强子弟得了伤寒。身体发热，眼睛疼痛，鼻子干燥，无法入睡，大便不通畅，寸脉和尺脉都呈现大脉象，这种情况已经持续好几天了。从昨天傍晚开始大汗淋漓。我说：“必须立即用大柴胡汤攻下。”众医生感到震惊，说：“阳明病自汗出，津液已经枯竭，应当使用蜜导（蜂蜜栓剂）通便，为什么还要用大柴胡汤？”我说：“这是张仲景不轻易传授的妙处，各位怎么知道呢？”我极力争辩，最终使用了大柴胡汤，服用两剂后痊愈。
论述说：张仲景在论述阳明病时提到：“阳明病，多汗者，急下之。”人们常说既然已经自汗出，如果再攻下，岂不是表里都受损吗？在论述少阴病时提到：“少阴病一二日，口干燥者，急下之。”人们常说病发于阴经，发病时间尚短，只是见到口干燥，如果再攻下，岂不是使阴气更盛吗？世人很少研读这些内容，我认为不是这样。张仲景称“急下之”，也就像“急当救表”、“急当救里”一样。凡是称为“急”的情况，需要“急下之”的有三处：刚觉得出汗多，但尚未到津液干枯的地步，迅速攻下，就是捷径，可以避免使用蜜导。因为使用蜜导，已经是错失了下法的时机，是出于不得已。如果胸中认识清楚明白，还有什么疑虑呢？
福建人李宗古患病，口中呼出的气热，嘴唇干燥，蜷缩身体躺卧，脚冷，舌头上有苔。我诊察他的脉象，寸脉和尺脉都呈现紧脉。有人怀疑他气热口干是阳胜，蜷足卧、脚冷是阴胜，而且阴阳脉俱紧，这确实可疑。如果不熟读张仲景的方法，怎么能治疗呢？我说：“寸尺俱紧，是寒邪盛的表现。”张仲景说：“阴阳俱紧，法当清（此处指病情性质或治法指向，结合下文‘勿妄治’及后世注疏，通常理解为寒邪束表或特定病机，原文语境下许叔微引用旨在说明不可误治），邪中于下焦。”又说：“阴阳俱紧，口中气出，唇干舌燥，蜷卧，足冷，鼻中涕出，舌上苔滑，不要胡乱治疗。”到了第七天左右，如果这个人发热，手足温暖，这是将要自愈的迹象。因为上述证候，都是阴盛阳弱，所以张仲景说“勿妄治”，确实是担心后人产生疑惑。因此我用抑制阴气、辅助阳气的温补药剂给他服用，紧脉逐渐消退，四肢调和，没有发汗而病自然解除。
A local wealthy youth contracted *Shanghan* (Cold Damage). He presented with fever, eye pain, nasal dryness, insomnia, and constipation. Both the Cun (Inch) and Chi (Cubit) pulses were large. This condition had persisted for several days. Since the previous evening, he had sweated profusely. I stated, "One must immediately administer Da Chai Hu Tang (Major Bupleurum Decoction) to purge." The other physicians were shocked, saying, "Yangming disease with spontaneous sweating indicates that body fluids are already exhausted; one should use honey suppositories (Mi Dui). Why use Da Chai Hu Tang?" I replied, "This is a subtle point not readily transmitted by Zhang Zhongjing. How could you know it?" I argued strongly and ultimately used Da Chai Hu Tang. After two doses, he recovered.
The commentary states: In discussing Yangming disease, Zhang Zhongjing wrote, "In Yangming disease, if there is excessive sweating, one must urgently purge." People often argue that since there is already spontaneous sweating, purging again would damage both the exterior and interior. In discussing Shaoyin disease, he wrote, "In Shaoyin disease, on the first or second day, if the mouth and throat are dry, one must urgently purge." People often argue that the disease originates in the Yin aspect, has been present for only a short time, and merely shows dryness; purging again would make the Yin qi even more abundant. Few people read these passages carefully. I believe this is incorrect. When Zhang Zhongjing says "urgently purge," it is similar to "urgently rescue the exterior" or "urgently rescue the interior." Whenever "urgent" is mentioned, there are three situations requiring "urgent purging": when one just notices excessive sweating but before body fluids become dried up, one must purge quickly. This is the direct and expedient method, avoiding the need for honey suppositories. Using honey suppositories means one has missed the opportunity for purging and is doing so out of necessity. If one's understanding is clear, what doubts remain?
Li Zonggu, a man from Fujian, fell ill. His breath was hot, his lips were dry, he lay curled up, his feet were cold, and there was coating on his tongue. Upon diagnosis, both the Cun and Chi pulses were tight. Some suspected that hot breath and dry mouth indicated Yang excess, while curling up and cold feet indicated Yin excess. With both Yin and Yang pulses being tight, this was indeed suspicious. Without familiarity with Zhang Zhongjing's methods, how could one treat this? I said, "Tight pulses at both Cun and Chi indicate an excess of Cold Evil." Zhang Zhongjing stated, "When Yin and Yang pulses are both tight, the method suggests clarity/purification [Note: Contextual interpretation varies, often linked to specific cold patterns]; if evil invades the Lower Jiao..." He also said, "If Yin and Yang pulses are both tight, accompanied by hot breath, dry lips and tongue, curled posture, cold feet, runny nose, and a slippery coating on the tongue, do not treat rashly." By the seventh day, if the patient develops fever and warm hands and feet, this indicates impending resolution. Because the aforementioned symptoms all reflect Yin excess and Yang weakness, Zhang Zhongjing said "do not treat rashly" precisely to prevent confusion among later generations. Therefore, I administered warming tonics to suppress Yin and assist Yang. The tight pulse gradually receded, the four limbs became harmonious, and the disease resolved spontaneously without sweating.