吴德甫戊申春病伤寒。先寒后热。项筋强急。脚蜷缩不得伸。医者欲以麻黄辈除其颈强。又
欲桂枝加附除其足缩。予曰。皆非治也。此时行疫气。病。为青筋牵引。投以柴胡地黄汤。三服
而病已。
论曰。庞安常论四时受乖气。而成脏腑阴阳湿毒者。春名青筋牵。夏曰赤脉攒。秋名白气狸。
冬名黑骨温毒。四季中十八日名黄肉。随毒瓦斯在头项。使人青筋牵急。故先寒后热。脚缩不得伸。
盖谓此。夫天行之病。大则流毒天下。小则方次一乡。亦有遍着一家者。悉由气运郁结。变成乖
戾之气。人命遭之所成病者。能调护将理。庶可免耳。
远族人患伤寒。他医以阴证治之。硫黄附子相继而进。旬日大胀下脓血。或如赤豆汁。医尚
作少阴证治。复下桃花汤治之。予因诊视曰所误多矣。表里虚。热气乘虚入肠胃。而又投以燥药。
是以下脓血也。遂投梅煎散。数剂愈。
庚戌五月。李氏病伤寒。身热头痛无汗。浑身疼痛。脉浮大而紧。予投以麻黄汤。数服。终不得
汗。又多用张苗烧蒸之法。而亦不得。予教令刺阳明。少间汗出 遍身。一时间。是夕身凉病退。
论曰。刺热论云。热病先手臂痛。刺阳明而汗出。又曰刺阳出血如大豆。病已。盖谓刺也。
阳明穴。在手大指内侧。去爪甲角。手阳明脉之所出也。刺可入同身寸之一分。留一呼。大凡伤
寒热病。有难取汗者。莫如针之为妙。仲景云凡治温病可刺五十九穴。素问云病甚者为五十九刺。
其详在注中。
吴德甫在戊申年春季患伤寒。先出现恶寒，随后发热。颈部筋脉僵硬拘急，双脚蜷缩无法伸展。医生想要用麻黄类药物来解除颈项强直，又打算用桂枝加附子汤来治疗足部蜷缩。我说：这些都不是正确的治法。这是时行疫气致病，属于“青筋牵引”证，投以柴胡地黄汤，服用三剂后病愈。
论述说：庞安常论述四季感受乖戾之气，形成脏腑阴阳湿毒的情况：春季称为“青筋牵”，夏季称为“赤脉攒”，秋季称为“白气狸”，冬季称为“黑骨温毒”，每季最后十八天称为“黄肉”。随着毒气停留在头项部位，使人出现青筋牵拉拘急的症状，所以表现为先恶寒后发热，脚部蜷缩不能伸展。大概说的就是这种情况。凡是天行疫病，大的可以流毒天下，小的可以波及一个乡里，也有只传染一家的。这都是由于运气郁结，变成乖戾之气，人遭受这种邪气而形成的疾病，如果能妥善调护调理，或许可以避免死亡。
远房族人患伤寒。其他医生按照阴证治疗，硫黄和附子相继使用。十天后腹部严重胀大并排出脓血，有的像赤豆汁一样。医生仍然当作少阴证治疗，再次使用桃花汤治疗。我因此诊视说：误治已经很多了。表里俱虚，热气乘虚侵入肠胃，而又投以燥热药物，所以下脓血。于是投以梅煎散，服用几剂后痊愈。
庚戌年五月，李氏患伤寒。身体发热、头痛、无汗，浑身疼痛，脉象浮大而紧。我投以麻黄汤，服用数剂，始终未能出汗。又多次使用张苗的烧蒸发汗方法，也未能奏效。我教令他针刺阳明经穴位，过了一会儿遍身出汗，片刻之间，当晚身体凉爽，病势退去。
论述说：《刺热论》说：热病先手臂痛，针刺阳明经而汗出。又说：针刺阳经出血如大豆大小，病即愈。大概指的就是针刺疗法。阳明穴，在手大拇指内侧，距离爪甲角处，是手阳明脉所发出的穴位。针刺可深入同身寸的一分，留针一次呼吸的时间。大凡伤寒热病，有难以取汗的，没有比针刺更巧妙的了。仲景说：凡是治疗温病可以针刺五十九个穴位。《素问》说：病情严重的进行五十九刺。详细内容在注释中。
Wu Defu contracted Shanghan (Cold Damage) in the spring of the Wushen year. He first experienced aversion to cold, followed by fever. His neck tendons were stiff and tight, and his legs were curled up and unable to extend. The physician intended to use herbs like Mahuang (Ephedrae Herba) to relieve the neck stiffness, and also planned to use Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction with Aconite Root) to treat the leg curling. I said: Neither is the correct treatment. This is a disease caused by epidemic qi, classified as "Qingjin Qianyin" (Green Tendon Pulling). Prescribed Chaihu Dihuang Tang (Bupleurum and Rehmannia Decoction), after three doses the illness resolved.
The commentary states: Pang Anchang discussed how different seasons' exposure to aberrant qi leads to damp-toxin affecting the zang-fu organs and yin-yang. In spring it is named "Qingjin Qian" (Green Tendon Pulling); in summer, "Chimai Can" (Red Vein Gathering); in autumn, "Baiqi Li" (White Qi Cat); in winter, "Heigu Wendu" (Black Bone Warm Toxin); and during the last eighteen days of each season, it is called "Huangrou" (Yellow Flesh). As the toxic qi settles in the head and neck, it causes the green tendons to pull and tighten, resulting in initial aversion to cold followed by fever, and legs curled up unable to extend. This refers to such cases. Epidemic diseases vary in scale; some spread throughout the world, others affect only a village, and some infect only one household. All arise from the stagnation of cosmic qi transforming into aberrant qi. When humans are afflicted by this, if they can properly care for themselves and manage their condition, they may avoid death.
A distant relative suffered from Shanghan. Other physicians treated him as a Yin syndrome, administering Liuhuang (Sulfur) and Fuzi (Prepared Aconite Root) in succession. After ten days, he developed severe abdominal distension and passed pus and blood, sometimes resembling red bean juice. The physicians still treated it as Shaoyin syndrome and administered Taohua Tang (Peach Kernel Decoction) again. Upon examination, I said: There has been much mismanagement. The exterior and interior are both deficient, allowing heat qi to enter the intestines and stomach through the deficiency, and further administration of drying-hot drugs resulted in passing pus and blood. Consequently, I prescribed Meijian San (Plum Decoction Powder), and after several doses, he recovered.
In the fifth month of the Gengxu year, Li suffered from Shanghan. Symptoms included fever, headache, absence of sweating, and whole-body pain. The pulse was floating, large, and tight. I prescribed Mahuang Tang (Ephedra Decoction). After several doses, no sweat appeared. Multiple applications of Zhang Miao's steaming method for inducing sweat also failed. I instructed him to puncture the Yangming meridian points. After a short while, sweat appeared all over his body. Within a moment, that evening his body became cool and the illness receded.
The commentary states: The *Ci Re Lun* (Treatise on Puncturing Heat) says: For heat diseases starting with arm pain, puncture Yangming to induce sweating. It also says: Puncture yang meridians until bleeding occurs in droplets the size of soybeans, and the disease will resolve. This refers to acupuncture therapy. The Yangming point is located on the medial side of the thumb, near the corner of the nail, where the Hand-Yangming meridian originates. Needles may be inserted to a depth of one fen (cun) using the same-body measurement method, retained for one breath. Generally, for Shanghan heat diseases where sweating is difficult to achieve, there is no method more effective than acupuncture. Zhongjing stated: For treating warm diseases, fifty-nine acupoints may be used. The *Suwen* states: For severe cases, perform the "Fifty-nine Stabs." Details are found in the annotations.