〔仲〕云病患身大热，反欲得近衣者，热在皮肤，寒在骨髓也。（《活人》云∶先与桂枝汤治寒，次
与小柴胡汤治热也。）
〔罗〕病有远近有缓急征南帅不邻吉歹年七旬，丙辰冬南征至楚丘，诸路迎送，多献酒醴，因而过饮太
多，遂腹痛肠鸣自利，日夜约有五十余行，咽嗌肿疼，耳前后赤肿，舌本强，涎唾稠粘，欲吐不吐，以手泄之
方出，言语艰难，反侧闷乱，夜不得卧。予诊得脉浮数极，按之沉细而弦。即谓中丞粘公曰∶仲景言下利清谷，
身体疼痛，急当救里；清便自调，急当救表。救里四逆汤，救表桂枝汤。今胃气不守，下利清谷，腹中疼痛，
虽宜急治之，比之咽嗌痛犹可少待。公曰∶何谓也？答曰∶《内经》云，疮发咽嗌，名曰猛疽。此疾治迟则咽塞，
咽塞则气不通，气不通则半日死，故宜急治。于是遂砭刺肿上紫黑血出，顷时肿势大消，遂用桔梗、甘草、连
翘、黍粘、酒制黄芩、升麻、防风等分， 咀，每服约五钱，水煮清令热 ，冷吐去之，咽之恐伤脾胃，自利转
甚，再服涎清肿散，声出，后以神应丸辛热之剂以散中寒，解化宿食，而燥脾湿。丸者取其不即化，则不犯上
焦，至病所而后化，乃治主以缓也。不数服，利止痛定，后胸中闭塞，作阵而痛，思《灵枢》云∶上焦如雾，
宣五谷味，蒸肤充身泽毛，若雾露之溉，是为气也。今相公年高气弱，自利日久，致脾胃中生发之气不能滋养
于心肺，故使闭塞而痛。经云∶上气不足，推之扬之。脾不足者，以甘补之。再与发散甘辛之味，温养脾胃，
加以升麻、人参，上升以顺正气，不数服而胸中快利，痛止。《内经》云∶调气之方，必别阴阳，内者内治，外
者外治，微者调之，其次平之，盛者夺之，随其攸利，万举万全。又曰∶病有远近，治有缓急，无越其制。又
曰∶急则治其标，缓即治其本。此之谓也。
〔仲〕云∶病患身大寒，反不欲近衣者，寒在皮肤，热在骨髓也。《活人》云∶先与白虎加人参汤治热，
次与桂枝麻黄各半汤，以解其外。）
[张仲景]说：病人身体大热，反而想要靠近衣物取暖的，是热邪在体表（皮肤），寒邪在体内深层（骨髓）。（《活人书》说：先用桂枝汤治疗寒证，再用小柴胡汤治疗热证。）
[罗天益]说：疾病有远近之分，治疗有缓急之别。征南元帅不邻吉歹，七十岁，丙辰年冬天随军南征到达楚丘，各路官员迎接送别，大多献上甜酒，因此饮酒过多，导致腹痛、肠鸣、自发性腹泻，每天大约五十多次，咽喉肿痛，耳朵前后红肿，舌根僵硬，唾液稠粘，想吐却吐不出来，只有用手抠挖才能吐出，言语困难，辗转反侧感到烦闷混乱，夜晚无法入睡。我诊察发现脉象浮数至极，重按则沉细而弦。随即对中丞粘公说：张仲景说过，下利清谷（排出未消化的食物），身体疼痛，应当紧急救治里证；大小便正常，应当紧急救治表证。救里用四逆汤，救表用桂枝汤。现在胃气不能固守，下利清谷，腹中疼痛，虽然应该紧急治疗，但比起咽喉痛还可以稍作等待。粘公问：这是什么意思？我回答说：《内经》说，疮疡发于咽喉，名叫猛疽。这个病如果治疗迟缓会导致咽喉堵塞，咽喉堵塞则气机不通，气机不通半天就会死亡，所以应该紧急治疗。于是就用砭石刺破肿胀处，放出紫黑色的血，一会儿肿胀大势消退，接着使用桔梗、甘草、连翘、黍粘子（牛蒡子）、酒制黄芩、升麻、防风各等分，切碎，每次服用约五钱，用水煎煮澄清后趁热服用，若冷却则吐出，因为担心冷饮损伤脾胃，使腹泻加重。再次服用后，涎液变清，肿胀消散，声音发出，后来用神应丸这种辛热的药物来散除中焦寒邪，化解积食，燥化脾湿。丸剂取其不易立即溶解，从而不侵犯上焦，到达病灶部位后才溶解，这是以缓和的方法治疗主要病证。服了几次后，腹泻停止，疼痛缓解，随后胸中闭塞，阵发性疼痛。思考《灵枢》说：上焦如雾，宣发五谷的精微气味，蒸腾肌肤，充实身体，润泽毛发，像雾露灌溉一样，这就是气。现在相公年纪大，正气虚弱，长期腹泻，导致脾胃中生发之气不能滋养心肺，所以造成闭塞和疼痛。经书说：上焦气不足，要推扬它。脾不足的，用甘味药补益。再给予发散性的甘辛药物，温养脾胃，加入升麻、人参，提升阳气以顺应正气，服了几次后胸中畅快通利，疼痛停止。《内经》说：调理气机的方剂，必须辨别阴阳，内病从内治，外病从外治，轻微的调顺它，其次平复它，盛实的攻夺它，顺着其有利的方向，万无一失。又说：疾病有远近之分，治疗有缓急之别，不要超越法度。又说：急则治其标，缓则治其本。说的就是这个道理。
[张仲景]说：病人身体大寒，反而不想靠近衣物的，是寒邪在体表（皮肤），热邪在体内深层（骨髓）。《活人书》说：先用白虎加人参汤治疗热证，再用桂枝麻黄各半汤，以解除表邪。）
[Zhang Zhongjing] states: When a patient presents with high fever but desires to wrap themselves in clothing, it indicates heat at the superficial level (skin) and cold at the deep level (marrow/internal). ([The Huo Ren Shu] states: First administer Guizhi Tang [Cinnamon Twig Decoction] to treat the cold, followed by Xiaochaihu Tang [Minor Bupleurum Decoction] to treat the heat.]
[Luo Tianyi] states: Diseases have distinctions of distance and urgency; treatments must be adjusted accordingly. The Southern Expedition Marshal Bulin Jidai, aged seventy, during the winter of the Bingchen year, traveled south to Chuqiu. Officials from various regions welcomed and escorted him, offering abundant sweet wine. Consequently, he overindulged, resulting in abdominal pain, borborygmus, and spontaneous diarrhea, occurring approximately fifty times daily. He suffered from sore throat, swelling and redness around the ears, stiffness of the tongue base, and thick, sticky saliva that was difficult to expectorate unless manually induced. Speech was difficult, accompanied by restlessness and inability to sleep at night. Upon diagnosis, his pulse was floating and rapid to an extreme degree, yet sinking and fine-chord-like upon heavy pressure. I then said to Vice Censor-in-Chief Zhan Gong: Zhang Zhongjing stated that in cases of diarrhea with undigested food and body pain, one should urgently treat the interior; if bowel movements are normal, one should urgently treat the exterior. To treat the interior, use Sini Tang [Four Reversal Decoction]; to treat the exterior, use Guizhi Tang [Cinnamon Twig Decoction]. Currently, the stomach qi is unsecured, with diarrhea of undigested food and abdominal pain. Although urgent treatment is indicated, compared to the throat condition, this can wait slightly. He asked, "What do you mean?" I replied, "The Nei Jing states that sores arising in the throat are called Meng Ju [Fierce Abscess]. If this disease is treated late, the throat will become obstructed; obstruction leads to qi stagnation, and qi stagnation results in death within half a day. Therefore, urgent treatment is required." Thus, we used bian stone [stone lancet] to puncture the swollen area, releasing dark purple blood. The swelling subsided significantly shortly after. We then prescribed equal parts of Jiegeng [Platycodonis Radix], Gancao [Glycyrrhizae Radix et Rhizoma], Lianqiao [Forsythiae Fructus], Shuniu [Arctii Fructus], Jiuzhi Huangqin [Scutellariae Radix prepared with wine], Shengma [Cimicifugae Rhizoma], and Fangfeng [Saposhnikoviae Radix]. These were coarsely crushed, and each dose of approximately five qian was decocted in water until clear and taken hot. It was advised to spit out the medicine if it cooled down, as cold liquids might damage the spleen and stomach, worsening the diarrhea. After subsequent doses, the saliva cleared, swelling dissipated, and voice returned. Later, Shenying Wan [Shenying Pill], a pungent-hot preparation, was used to disperse middle-jiao cold, resolve retained food, and dry spleen dampness. Pills were chosen because they do not dissolve immediately, thus avoiding irritation to the upper jiao, only dissolving upon reaching the lesion site. This represents treating the root cause with a slow approach. After several doses, diarrhea ceased, and pain resolved. Subsequently, chest oppression and paroxysmal pain occurred. Recalling the Ling Shu: "The Upper Jiao is like mist, distributing the essence of grains, steaming the skin, filling the body, and moistening hair, akin to fog and dew irrigation; this is Qi." Now, due to advanced age and weak constitution, coupled with prolonged diarrhea, the ascending qi generated by the spleen and stomach failed to nourish the heart and lungs, causing obstruction and pain. The Classics state: "When Upper Qi is insufficient, push and uplift it. For deficiency of the Spleen, tonify with sweet flavors." We administered dispersing sweet-pungent herbs to warm and nourish the spleen and stomach, adding Shengma [Cimicifugae Rhizoma] and Renshen [Ginseng Radix et Rhizoma] to ascend and support upright qi. After a few doses, the chest felt open and comfortable, and pain stopped. The Nei Jing states: "Formulas for regulating qi must distinguish yin and yang. Internal diseases are treated internally, external diseases externally. Mild conditions are regulated, moderate ones balanced, excessive ones subdued. Following what is beneficial ensures success in every attempt." It further states: "Diseases have distances; treatments have urgency. Do not exceed the proper limits." And again: "In acute cases, treat the branch/symptom; in chronic cases, treat the root/cause." This illustrates the principle.
[Zhang Zhongjing] states: When a patient presents with severe chills but does not desire to wrap themselves in clothing, it indicates cold at the superficial level (skin) and heat at the deep level (marrow/internal). ([The Huo Ren Shu] states: First administer Baihu Jia Renshen Tang [White Tiger Decoction plus Ginseng] to treat the heat, followed by Guizhi Mahuang Ban Ge Tang [Half-and-Half Decoction of Cinnamon Twig and Ephedra] to release the exterior.])