谵语，宜大承气汤下之则愈。潮热者实也，此外已解，可攻其里，而反汗之，表无阴邪，汗又助阳，阳实而又
补表，表里俱热，不死何待。《外台秘要》云∶表和里病，下之则愈，汗之则死。正此意也。
汗多亡阳 齐大兄冬月因感寒邪，头项强，身体痛，自用酒服灵砂丹四五粒，遂大汗出，汗后身轻。至夜，
前病复来，以前药复汗，其病不愈。复以通圣散发汗，病添，身体沉重，足胫冷而恶寒。是日方命医，医者不
究前治，又以五积散汗之，翌日身重如石，不能反侧，足 如冰，冷及腰背，头汗如贯珠，出而不流，心胸躁
热，烦乱不安，喜饮西瓜、梨、柿、冰水之物，常置左右。病至于此，命予治之，诊得六脉如蛛丝，微微欲绝，
予以死决之。主家曰∶得汗多矣，焉能为害。予曰∶夫寒邪中人者，阳气不足之所致也，而感之有轻重，治之
者岂可失其宜哉。仲景云∶阴盛阳虚，汗之则愈。汗者助阳退阴之意也。且寒邪不能自汗，必待阳气泄，乃能
出也。今以时月论之，大法夏月宜汗，然亦以太过为戒，况冬三月闭藏之时，无扰乎阳，无泄皮肤，使气亟夺，
为养藏之道也，逆之则少阴不藏，此冬气之应也。凡有触冒，宜微汗之，以平为期，邪退乃已。急当衣暖衣，
居密室，服实表补卫气之剂，虽有寒邪，弗能为害，此从权之治也。今非时而大发其汗，乃谓之逆。故仲景有
云∶一逆尚引日，再逆促命期。今本伤而并汗，汗而复伤，伤而复汗，汗出数四，使气亟夺，卫气无守，阳泄
于外，阴乘于内，故经云∶独阳不生，独阴不长，不死何待，虽卢扁亦不能治也。是日至夜将半，项强身体不仁，
手足搐急，爪甲青而死矣。《金匮要略》云∶不当汗而妄汗之，夺其津液，枯槁而死。今当汗之，一过中亦绝其
命，况不当汗而强汗之者乎。
下多亡阴 真定赵客，乙丑岁六月间，客于他方，因乘困伤湿面，心下痞满，躁热时作，卧不得安，遂宿
于寺中，僧妄以大毒食药数丸，下十余行，心痞稍减。越日困睡，为盗劫其财货，心有所动，遂躁热而渴，饮
冷水一大瓯，是夜脐腹胀痛。僧再以前药，复下十余行，病加困笃，四肢无力，躁热身不停衣，喜饮冷水，米
谷不化，痢下如烂鱼肠脑，赤水相杂，全不思食，强食则呕，痞甚于前，噫气不绝，足 冷，少腹不任其痛。
请予治之，诊其脉浮数八九至，按之空虚。予溯流而寻源，盖暑天之热，已伤正气，又以有毒大热之剂下之，
一下之后，其所伤之物已去而无遗矣。遗巴豆之气，流毒于肠胃之间，使呕逆而不能食，胃气转伤而然；及下脓
血无度，大肉陷下，皮毛枯槁，脾气弱而衰也。舌上赤涩，咽干津液不足，下多亡阴之所致也。阴既亡，心火
独旺，故心胸躁热，烦乱不安。经曰∶独阳不生，独阴不长，夭之由也。遂辞而退。后易他医，医至不审其脉，
不究其源，惟见痞满，以枳壳丸下之，病添喘满，痢下不禁而死。《金匮要略》云∶不当下而强下之，令人开肠
洞泄，便溺不禁而死。此之谓也。夫圣人治病，用药有法，不可少越。《内经》曰∶大毒治病，十去其六；小毒
治病，十去其七；常毒治病，十去其八；无毒治病，十去其九。复以谷肉果菜，食养尽之，无使过之，过则伤
其正矣。《记》有之云∶医不三世，不服其药。盖慎之至也。彼僧非医流，妄以大毒之剂下之太过，数日之间，
使人殒身丧命，用药之失，其祸若此。病之择医，可不谨乎，戒之戒之。
方成勿约之失 丁巳冬十一月，予从军回至汴梁，有伶人李人爱谓予曰∶大儿自今岁七月间，因劳役渴饮
凉茶，及食冷饭，觉心下痞。请医治之，医投药一服，下痢两行，其症遂减。不数日，又伤冷物，心腹复痞满，
呕吐恶心，饮食无味，且不饮食，四肢困倦，懒于言语，复请前医诊视，曰∶此病易为，更利几行即快矣。遂
以无忧散对加牵牛末，白汤服，至夕腹中雷鸣而作阵痛，少焉既吐又泻，烦渴不止，饮食无度，不复能禁，时
发昏愦。再命前医视之，诊其脉不能措手而退。顷之冷汗如洗，口鼻气渐冷而卒矣。小人悔恨无及，敢以为问？
予曰∶未尝亲见，不知所以然，既去。或曰∶予亲见之，果药之罪欤而非欤。予曰∶此非药之罪，乃失其约量
之过也。夫药之无据，反为气贼。《内经》云∶约方犹约囊也，囊满弗约，则输泄方成，弗约则神与气弗俱。故
仲景以桂枝治外伤风邪，则曰∶若一服汗出病瘥，停后服，不必尽剂。大承气汤下大实大满，则曰得更衣止后
服，不必尽剂。其慎如此！此为大戒，盖得圣人约囊之旨也。治病必求其本。盖李人以杂剧为戏，劳神损气，
而其中痛，因时暑热渴饮凉茶，脾胃气弱，不能运化而作痞满，以药下之，是重困也。加以不慎，又损其阳，
虚而复伤，伤而复下，阴争于内，阳扰于外，魄汗未藏，四逆内起，仲景所谓一逆尚引日，再逆促命期，如是
则非失约量之过而何？故《内经》戒云∶上工平气，中工乱脉，下工绝气。不可不慎也。
脱营忌泻 疏五过论云∶常贵后贱，虽不中邪，病从内生，名曰脱营。镇阳一士人，躯干魁梧，而意气豪
雄，喜交游而有四方之志，年逾三旬，已入仕至五品，出入从骑塞途，姬侍满前，饮食起居，无不如意。不三
年，以事罢去。心思郁结，忧虑不已，以致饮食无味，精神日减，肌肤渐至瘦弱。无如之何，遂耽嗜于酒，久
而中满。始求医，医不审得病之情，；辄以丸药五粒，温水送，下二十余行。时值初秋，暑热犹盛，因而烦渴，
饮冷过多，遂成肠鸣腹痛而为痢疾，有如鱼脑，以至困笃。命予治之，诊其脉乍大乍小，其症反复闷乱，兀兀
欲吐，叹息不绝。予料曰∶此病难治。启玄子云∶神屈故也。以其贵之尊荣，贱之屈辱，心怀慕恋，志结忧惶，
虽不中邪，病从内生，血脉虚减，名曰脱营。或曰∶愿闻其理，《黄帝针经》有曰∶宗气之道，内谷为主，谷入
于胃，乃传入于脉，流溢于中，布散于外，精专者行于经隧，周而复始，常营无已，是为天地之纪。故气始从
手太阴起，注于阳明，传流而终于足厥阴，循腹里，入缺盆，下注肺中，于是复注手太阴，此营气之所行也。
故昼夜气行五十营，漏水下百刻，凡一万三千五百息。所谓交通者，并行一数也，故五十营备得尽天地之寿矣。
今病者始乐后苦，皆伤精气，精气竭绝，形体毁阻，暴喜伤阳，暴怒伤阴，喜怒不能自节。盖心为君主，神明
出焉，肺为辅相，主行营卫，制节由之。主贪人欲，天理不明，则十二官相使各失所司，使道闭塞而不通，由
是则经营之气脱去，不能灌溉周身，百脉失其天度，形乃大伤，以此养生则殃，何疑之有。
泻火伤胃 经历晋才卿膏粱而饮，至春病衄。医曰∶诸见血为热，以清凉饮子投之即止。越数日，其疾复
作。医又曰∶药不胜病故也。遂投黄连解毒汤。既而或止，止而复作。易医数四，皆用苦寒之剂，俱欲胜其热，
然终不愈。而饮食起居，浸不及初，肌寒而时躁，言语无声，口气臭秽，如冷风然，其衄之余波则未绝也。或
曰∶诸见血者热，衄热也，热而寒之理也，今不惟不愈，而反害之，何哉？予言∶《内经》曰∶五脏以平为期。
又云∶下工绝气，不可不慎也。彼惟知见血为热，而以苦寒攻之，抑不知苦寒能泻脾胃。夫脾胃土也，乃人身
之所以为本者也，今火为病而泻其土，火固未尝除，而土已病矣。土病则胃虚，胃虚则荣气不能滋荣百脉，元
气不循天度，气随阴化而变无声与肌寒也。噫，粗工嘻嘻，以为可治，言热未已，寒病复起，此之谓也。
下工绝气危生 丁巳予从军至开州，夏月有千户高国用谓予曰∶父亲年七十有三，于去岁七月间，因内伤
饮食，又值霖雨，泻痢暴下数行，医以药止之。不数日，又伤又泻，止而复伤，伤而复泻。至十月间，肢体瘦
弱，四肢倦怠，饮食减少，腹痛肠鸣。又以李医治之，处以养脏汤，治之数日，泄止，后添呕吐。又易以王医，
用丁香、人参、藿香、橘红、甘草同为细末，生姜煎，数服而呕吐止。延至今正月间，饮食不进，扶而后起。
又数日不见大便。予问医曰∶父亲不见大便，何以治之？医曰∶老官人年过七旬，血气俱衰弱，又况泻痢半载，
脾胃久虚，津液耗少，以麻仁丸润之可也。众亲商议，一亲曰∶冯村牛山人见证不疑，有果决，遂请治之。诊
其脉，问其病，曰∶此是风结也，以搜风丸百余丸服之，利数行而死。予悔恨不已，敢以为问？予曰∶人以水
谷为本，今高年老人久泻，胃中津液耗少，又重泻之，神将何根据？《灵枢经》曰∶形气不足，病气不足，此阴阳
俱不足也，不可泻之，泻之则重不足，重不足则阴阳俱竭，血气皆尽，五脏空虚，筋骨髓枯，老者绝灭，少者
不复矣。又曰∶上工平气，中工乱脉，下工绝气危生。绝气危生，其牛山人之谓欤。
用药无据反为气贼 北京按察书吏李仲宽，年五旬，至元已巳春，患风症，半身不遂，麻痹，言语謇涩，
精神昏愦。一友处一法，用大黄半斤，黑豆三升，水一斗，同煮豆熟，去大黄，新汲水淘净，每日服二三合。
则风热自去。服之过半，又一友云，用通圣散、四物汤、黄连解毒汤相合服之，其效尤速。服月余，精神愈困。
遂还真定，归家养病，亲旧献方无数，不能悉录，又增喑哑不能言，气冷手足寒。命予诊视，细询前由，尽得
其说。予诊之，六脉如蛛丝细。予谓之曰∶夫病有表里虚实寒热不等，药有君臣佐使大小奇偶之制，君所服药
无考凭，故病愈甚。今已无救，君自取耳。未几而死。有吏曹通甫妻萧氏，年六旬有余，孤寒无根据，春月忽患
风疾，半身不遂，言语謇涩，精神昏愦，口眼 斜，与李仲宽症同。予刺十二经井穴接其经络，不通。又灸肩
井、曲池，详病时月处药，服之减半。予曰∶不须服药，病将自愈。明年春，在张子敬郎中家，见其行步如旧。
予叹曰∶夫人病痊，得不乱服药之故。由此论之，李仲宽乱服药，终身不救。萧氏贫困，恬 自如，《内经》曰∶
用药无据，反为气贼，圣人戒之。一日，姚雪斋举许先生之言曰∶富贵有二事，反不如贫贱，有过恶不能匡救，
有病不能医疗。噫，李氏之谓欤。
戒妄下 真定钞库官李提举，年逾四旬，体干魁梧，肌肉丰盛，有僚友师君告之曰∶肥人多风证，今君如
此，恐后致中风，搜风丸其药推陈致新化痰，宜服之。李从其言∶遂合一料，每日服之，至夜下五行，如是半
月，觉气短而促。至月余，添怠惰嗜卧，便白脓，小便不禁，足至膝冷，腰背沉痛，饮食无味，仍不欲食，心
胸痞满，时有躁热，健忘恍惚不安。凡三易医，皆无效，因陈其由，请予治之。予日，孙真人云∶药势有所偏
助，令人脏气不平。药本攻疾，无疾不可饵。平人谷入于胃，脉道乃行，水入于经，其血乃成，水去则荣散，
谷消则卫亡，荣散卫亡，神无所根据。君本身体康强，五脏安泰。妄以小毒之剂日下数行，初服一日，且推陈矣。
陈积已去，又何推焉？今饮食不为肌肤，水谷不能运化精微，灌溉五脏六腑，周身百脉，神将何根据？故气短而
促者，真气损也。怠惰嗜卧者，脾气衰也。小便不禁者，膀胱不藏也。便下脓血者，胃气下脱也。足胫寒而逆
者，阳气微也。时有躁热，心下虚痞者，胃气不能上营也。恍惚健忘者，神明乱也。《金匮》云∶不当下而强下之，
令人开肠洞泄，便溺不禁而死。前证所生，非天也，君自取之。治虽粗安，促命期矣。李闻之惊恐，汗浃于背，
起谓予曰∶妄下之过，悔将何及！虽然，君当尽心救其失。予以为病势过半，病将难痊，固辞而退。至秋，疾
甚，医以夺命散下之，燥热喘满而死。《内经》曰∶诛罚无过，是谓大惑。如李君者，《内经》所谓大惑之人也。
卫生君子，可不戒哉。
谵语（神志不清，胡言乱语），适宜用大承气汤攻下治疗即可痊愈。出现潮热（发热如潮水般定时增高）属于里实证，此时表证已解，可以攻逐里实，如果反而使用发汗法，体表没有阴邪，发汗又会助长阳气，导致阳热更盛且补益了表分，造成表里俱热，不死还等什么？《外台秘要》说：表证和解而里有病，用泻下法可愈，用发汗法会导致死亡。正是这个意思。
汗多亡阳（因过度发汗导致阳气耗散）：齐大的哥哥在冬天感受寒邪，出现头项强直、身体疼痛，自行饮酒送服灵砂丹四五粒，于是大汗出，出汗后身体感觉轻松。到了夜晚，之前的病症复发，再次服用前药发汗，病情未愈。又用通圣散发汗，病情加重，身体沉重，小腿发冷且恶寒。当天才请医生，医生不探究之前的治疗经过，又用五积散发汗，第二天身体重如石头，不能翻身侧卧，脚冷如冰，寒冷延伸至腰背，头部出汗如贯珠，流出但不流淌，心胸躁热，烦乱不安，喜欢饮用西瓜、梨、柿子、冰水等物，常放在身边。病情发展到这种地步，主人请求我诊治，诊得六脉像蛛丝一样细微，微弱欲绝，我判定为死证。主人家说：已经出了很多汗，怎么能成为危害呢？我说：寒邪中人，是因为阳气不足所致，感邪有轻重之分，治疗者岂能失当？张仲景说：阴盛阳虚，发汗则愈。发汗是助阳退阴的意思。况且寒邪不能自汗，必须等待阳气发泄，才能排出。现在从时令来看，大体上夏季适宜发汗，但也以不过分为戒，何况冬三月是闭藏之时，不应扰动阳气，不应使皮肤开泄，导致正气屡次被夺，这是养藏之道，违背它则少阴不藏，这是顺应冬气的做法。凡是有触犯外邪，适宜微汗之，以平和为期，邪气退去才停止。应当急穿暖衣，居住在密室，服用固表补卫气的药剂，即使有寒邪，也不能为害，这是权宜之计。现在非时而大发其汗，这叫做逆治。所以张仲景说：一次误治还能拖延时日，两次误治就会加速死亡。现在本是伤寒却并用了发汗，汗后又伤正，伤了又发汗，汗出数次，导致正气屡次被夺，卫气无守，阳气泄于外，阴邪乘于内，所以经书说：独阳不生，独阴不长，不死还等什么，即使是卢医、扁鹊也不能治了。这天夜里将近半夜，项强身体麻木不仁，手足抽搐拘急，指甲青紫而死。《金匮要略》说：不当汗而妄汗之，夺其津液，枯槁而死。现在正当汗之，一次过中也会断绝其命，何况是不当汗而强行发汗的呢？
下多亡阴（因过度泻下导致阴液耗损）：真定的一位赵姓客人，乙丑年六月间，客居他乡，因为乘困倦时受湿，心下痞满，躁热时作，卧不得安，于是寄宿在寺庙中，僧人胡乱给吃了几丸大毒药物，腹泻十多次，心痞稍减。第二天困倦嗜睡，被盗贼抢劫财物，心中有所触动，于是躁热而渴，喝了一大碗冷水，当晚脐腹胀痛。僧人再用前药，又腹泻十多次，病情更加危重，四肢无力，躁热身体不停换衣，喜欢饮冷水，米谷不化，痢下如烂鱼肠脑，赤水相杂，全不思食，强食则呕，痞塞比之前更甚，嗳气不绝，足冷，小腹部承受不住疼痛。请求我诊治，诊其脉浮数八九至，按之空虚。我追溯源头，大概是暑天之热，已伤正气，又以有毒大热的药物泻下，一下之后，所伤之物已去而无遗。遗留巴豆之气，流毒于肠胃之间，使呕逆而不能食，胃气转伤而然；以及下脓血无度，大肉陷下，皮毛枯槁，脾气弱而衰也。舌上赤涩，咽干津液不足，是下多亡阴所致。阴既亡，心火独旺，故心胸躁热，烦乱不安。经书说：独阳不生，独阴不长，夭折的原因。于是我辞别退出。后来换了其他医生，医生到后不审察脉象，不探究病因，只见痞满，用枳壳丸泻下，病情加重出现喘满，痢下不禁而死。《金匮要略》说：不当下而强下之，令人开肠洞泄，便溺不禁而死。说的就是这种情况。圣人治病，用药有法度，不可稍有逾越。《内经》说：大毒治病，去其六分；小毒治病，去其七分；常毒治病，去其八分；无毒治病，去其九分。再用谷肉果菜，食疗尽除余邪，不要过分，过分则损伤正气。《礼记》说：医不三世，不服其药。这是极其谨慎的态度。那个僧人不是医流，胡乱用大毒之剂泻下太过，数日之间，使人殒身丧命，用药的失误，祸患如此。病人选择医生，能不谨慎吗？戒之戒之。
方成勿约（处方完成却不约定剂量/疗程）的过失：丁巳年冬十一月，我从军回到汴梁，有伶人李人爱对我说：大儿子从今年七月间，因为劳役口渴饮凉茶，及吃冷饭，觉得心下痞。请医生治疗，医生投药一服，下痢两行，症状遂减。不几天，又伤冷物，心腹复痞满，呕吐恶心，饮食无味，且不饮食，四肢困倦，懒于言语，又请前医诊视，说：这病容易治，再利几行就快矣。于是用无忧散加牵牛末，白汤服，至傍晚腹中雷鸣而作阵痛，一会儿既吐又泻，烦渴不止，饮食无度，不能再禁，时常发昏愦。再请前医看，诊其脉不能措手而退。不久冷汗如洗，口鼻气渐冷而卒。小人悔恨无及，敢以此问？我说：未曾亲眼见到，不知所以然，既然离开了。有人说：我亲眼见到的，确实是药的罪过吗？还是不是？我说：这不是药的罪过，而是失去约量（剂量和疗程控制）的过错。夫药无据，反为气贼。《内经》说：约方犹约囊也，囊满弗约，则输泄方成，弗约则神与气弗俱。所以张仲景用桂枝治外伤风邪，说：若一服汗出病瘥，停后服，不必尽剂。大承气汤下大实大满，说得更衣止后服，不必尽剂。其谨慎如此！这是大戒，大概得圣人约囊之旨。治病必求其本。李人以杂剧为戏，劳神损气，而其中痛，因时暑热渴饮凉茶，脾胃气弱，不能运化而作痞满，以药下之，是重困也。加上不慎，又损其阳，虚而复伤，伤而复下，阴争于内，阳扰于外，魄汗未藏，四逆内起，张仲景所谓一逆尚引日，再逆促命期，像这样，不就是失约量的过错吗？所以《内经》戒云：上工平气，中工乱脉，下工绝气。不可不慎也。
脱营忌泻：《疏五过论》说：常贵后贱，虽不中邪，病从内生，名曰脱营。镇阳一位士人，躯干魁梧，意气豪雄，喜交游而有四方之志，年逾三旬，已入仕至五品，出入从骑塞途，姬侍满前，饮食起居，无不如意。不到三年，因事罢去。心思郁结，忧虑不已，以致饮食无味，精神日减，肌肤渐至瘦弱。无可奈何，于是沉迷于酒，久而中满。开始求医，医生不审得病之情，辄以丸药五粒，温水送，下二十余行。时值初秋，暑热犹盛，因而烦渴，饮冷过多，遂成肠鸣腹痛而为痢疾，有如鱼脑，以至困笃。命我诊治，诊其脉乍大乍小，其症反复闷乱，兀兀欲吐，叹息不绝。我预料说：此病难治。启玄子说：神屈故也。以其贵之尊荣，贱之屈辱，心怀慕恋，志结忧惶，虽不中邪，病从内生，血脉虚减，名曰脱营。有人说：愿闻其理，《黄帝针经》有曰：宗气之道，内谷为主，谷入于胃，乃传入于脉，流溢于中，布散于外，精专者行于经隧，周而复始，常营无已，是为天地之纪。故气始从手太阴起，注于阳明，传流而终于足厥阴，循腹里，入缺盆，下注肺中，于是复注手太阴，此营气之所行也。故昼夜气行五十营，漏水下百刻，凡一万三千五百息。所谓交通者，并行一数也，故五十营备得尽天地之寿矣。今病者始乐后苦，皆伤精气，精气竭绝，形体毁阻，暴喜伤阳，暴怒伤阴，喜怒不能自节。盖心为君主，神明出焉，肺为辅相，主行营卫，制节由之。主贪人欲，天理不明，则十二官相使各失所司，使道闭塞而不通，由是则经营之气脱去，不能灌溉周身，百脉失其天度，形乃大伤，以此养生则殃，何疑之有。
泻火伤胃：经历晋才卿膏粱而饮，至春病衄（鼻出血）。医生说：诸见血为热，以清凉饮子投之即止。越数日，其疾复作。医生又说：药不胜病故也。遂投黄连解毒汤。既而或止，止而复作。易医数四，皆用苦寒之剂，俱欲胜其热，然终不愈。而饮食起居，浸不及初，肌寒而时躁，言语无声，口气臭秽，如冷风然，其衄之余波则未绝也。有人说：诸见血者热，衄热也，热而寒之理也，今不惟不愈，而反害之，何哉？我说：《内经》说：五脏以平为期。又说：下工绝气，不可不慎也。彼惟知见血为热，而以苦寒攻之，抑不知苦寒能泻脾胃。夫脾胃土也，乃人身之所以为本者也，今火为病而泻其土，火固未尝除，而土已病矣。土病则胃虚，胃虚则荣气不能滋荣百脉，元气不循天度，气随阴化而变无声与肌寒也。噫，粗工嘻嘻，以为可治，言热未已，寒病复起，此之谓也。
下工绝气危生：丁巳年我从军至开州，夏月有千户高国用对我说：父亲年七十有三，于去年七月间，因内伤饮食，又值霖雨，泻痢暴下数行，医以药止之。不几天，又伤又泻，止而复伤，伤而复泻。至十月间，肢体瘦弱，四肢倦怠，饮食减少，腹痛肠鸣。又以李医治之，处以养脏汤，治之数日，泄止，后添呕吐。又换王医，用丁香、人参、藿香、橘红、甘草同为细末，生姜煎，数服而呕吐止。延至今正月间，饮食不进，扶而后起。又数日不见大便。我问医生：父亲不见大便，何以治之？医生说：老官人年过七旬，血气俱衰弱，又况泻痢半载，脾胃久虚，津液耗少，以麻仁丸润之可也。众亲商议，一亲说：冯村牛山人见证不疑，有果决，遂请治之。诊其脉，问其病，说：此是风结也，以搜风丸百余丸服之，利数行而死。我悔恨不已，敢以此问？我说：人以水谷为本，今高年老人久泻，胃中津液耗少，又重泻之，神将何根据？《灵枢经》说：形气不足，病气不足，此阴阳俱不足也，不可泻之，泻之则重不足，重不足则阴阳俱竭，血气皆尽，五脏空虚，筋骨髓枯，老者绝灭，少者不复矣。又说：上工平气，中工乱脉，下工绝气危生。绝气危生，其牛山人之谓欤。
用药无据反为气贼：北京按察书吏李仲宽，年五旬，至元己巳春，患风症，半身不遂，麻痹，言语謇涩，精神昏愦。一友处一法，用大黄半斤，黑豆三升，水一斗，同煮豆熟，去大黄，新汲水淘净，每日服二三合。则风热自去。服之过半，又一友云，用通圣散、四物汤、黄连解毒汤相合服之，其效尤速。服月余，精神愈困。遂还真定，归家养病，亲旧献方无数，不能悉录，又增喑哑不能言，气冷手足寒。命我诊视，细询前由，尽得其说。我诊之，六脉如蛛丝细。我对他说：夫病有表里虚实寒热不等，药有君臣佐使大小奇偶之制，君所服药无考凭，故病愈甚。今已无救，君自取耳。未几而死。有吏曹通甫妻萧氏，年六旬有余，孤寒无根据，春月忽患风疾，半身不遂，言语謇涩，精神昏愦，口眼斜，与李仲宽症同。我刺十二经井穴接其经络，不通。又灸肩井、曲池，详病时月处药，服之减半。我说：不须服药，病将自愈。明年春，在张子敬郎中家，见其行步如旧。我叹曰：夫人病痊，得不乱服药之故。由此论之，李仲宽乱服药，终身不救。萧氏贫困，恬淡自如，《内经》说：用药无据，反为气贼，圣人戒之。一日，姚雪斋举许先生之言曰：富贵有二事，反不如贫贱，有过恶不能匡救，有病不能医疗。噫，李氏之谓欤。
戒妄下：真定钞库官李提举，年逾四旬，体干魁梧，肌肉丰盛，有僚友师君告之曰：肥人多风证，今君如此，恐后致中风，搜风丸其药推陈致新化痰，宜服之。李从其言：遂合一料，每日服之，至夜下五行，如是半月，觉气短而促。至月余，添怠惰嗜卧，便白脓，小便不禁，足至膝冷，腰背沉痛，饮食无味，仍不欲食，心胸痞满，时有躁热，健忘恍惚不安。凡三易医，皆无效，因陈其由，请我诊治。我说：孙真人说：药势有所偏助，令人脏气不平。药本攻疾，无疾不可饵。平人谷入于胃，脉道乃行，水入于经，其血乃成，水去则荣散，谷消则卫亡，荣散卫亡，神无所根据。君本身体康强，五脏安泰。妄以小毒之剂日下数行，初服一日，且推陈矣。陈积已去，又何推焉？今饮食不为肌肤，水谷不能运化精微，灌溉五脏六腑，周身百脉，神将何根据？故气短而促者，真气损也。怠惰嗜卧者，脾气衰也。小便不禁者，膀胱不藏也。便下脓血者，胃气下脱也。足胫寒而逆者，阳气微也。时有躁热，心下虚痞者，胃气不能上营也。恍惚健忘者，神明乱也。《金匮》说：不当下而强下之，令人开肠洞泄，便溺不禁而死。前证所生，非天也，君自取之。治虽粗安，促命期矣。李闻之惊恐，汗浃于背，起谓我说：妄下之过，悔将何及！虽然，君当尽心救其失。我以为病势过半，病将难痊，固辞而退。至秋，疾甚，医以夺命散下之，燥热喘满而死。《内经》说：诛罚无过，是谓大惑。如李君者，《内经》所谓大惑之人也。卫生君子，可不戒哉。
Delirium (confusion with incoherent speech) should be treated with Da Cheng Qi Tang (Major Order the Qi Decoction) to purge, which will lead to recovery. Tidal fever (fever that rises like the tide at specific times) indicates an excess syndrome in the interior. At this point, the exterior syndrome has resolved, and the interior can be attacked; however, if sweating is used instead, there is no Yin pathogen on the surface, and sweating further assists Yang. This results in Yang excess and supplements the exterior, leading to heat in both the interior and exterior. If death does not follow, what else could? The *Waitai Miyao* states: "When the exterior is harmonized but the interior is diseased, purging leads to recovery, while sweating leads to death." This expresses exactly this meaning.
Excessive sweating leads to loss of Yang (disipation of Yang Qi due to excessive diaphoresis): The elder brother of Qi Da contracted cold pathogens in winter, presenting with stiffness of the head and neck and body pain. He self-administered four or five pills of Lingsha Dan (Cinnabar Pill) taken with wine, resulting in profuse sweating, after which he felt light. By night, the previous symptoms returned. He took the same medicine again to induce sweating, but the illness did not resolve. He then used Tongsheng San (Universal Salvation Powder) to sweat, and the condition worsened: his body became heavy, his calves were cold, and he had aversion to cold. Only on that day did he summon a physician. The physician did not investigate the previous treatments and administered Wuji San (Five Accumulations Powder) to induce sweating. The next day, his body was as heavy as stone, unable to turn over; his feet were cold as ice, with coldness extending to the waist and back. Sweat on the head flowed like beads but did not drip, his chest and heart were restless and hot, he was agitated and uneasy, and desired to drink watermelon, pear, persimmon, and ice water, keeping them constantly by his side. When the condition reached this state, the family asked me to treat him. I palpated the six pulses, finding them fine as spider silk, faint and nearly imperceptible, and pronounced it a fatal case. The family said, "He has sweated profusely; how can this be harmful?" I replied, "Cold pathogens invading the human body are caused by insufficient Yang Qi. The severity of invasion varies; how can treatment be inappropriate? Zhang Zhongjing stated: 'In cases of Yin excess and Yang deficiency, sweating promotes recovery.' Sweating is intended to assist Yang and retreat Yin. Moreover, cold pathogens cannot cause spontaneous sweating; they require the release of Yang Qi to exit. Considering the season, generally, summer is suitable for sweating, but one must beware of excess. How much more so during the three winter months, which are times of closure and storage? One should not disturb Yang or open the skin pores, causing frequent depletion of Qi; this is the way to nourish storage. Violating this causes Shaoyin (Kidney system) to fail to store, which contradicts the adaptation to winter Qi. For any external contraction, slight sweating is appropriate, aiming for balance, stopping when pathogens recede. One should urgently wear warm clothes, reside in a sealed room, and take formulas that consolidate the exterior and supplement Wei Qi (Defensive Qi). Even if cold pathogens exist, they cannot cause harm; this is a flexible treatment. Now, inducing profuse sweating out of season is called 'contrary' treatment. Thus, Zhang Zhongjing said: 'One error may delay death, two errors accelerate it.' Here, the patient was injured by cold and simultaneously subjected to sweating; after sweating, injury occurred again, followed by more sweating. Profuse sweating several times caused frequent Qi depletion, leaving Wei Qi unguarded, Yang leaking outward, and Yin attacking inward. Hence, the classics say: 'Solitary Yang does not generate, solitary Yin does not grow.' If death does not follow, what else? Even Lu Yi (Bian Que) could not treat it. That night, near midnight, he developed neck stiffness, bodily numbness, convulsions of the hands and feet, and cyanosis of the nails, then died. The *Jingui Yaolue* states: 'Sweating when one should not, depletes fluids and leads to withered death.' Even proper sweating, if excessive, can cut off life; how much more so improper forced sweating?
Excessive purging leads to loss of Yin (depletion of Yin fluids due to excessive catharsis): A guest surnamed Zhao from Zhengding, in the sixth month of the Yichou year, was traveling. Due to fatigue and dampness exposure, he experienced epigastric fullness and oppression, intermittent restlessness and heat, and inability to sleep peacefully. He stayed in a temple where a monk recklessly gave him several pills of highly toxic medicine, causing more than ten episodes of diarrhea, slightly reducing the epigastric fullness. The next day, exhausted and sleeping, he was robbed of his belongings. Emotional agitation led to restlessness, heat, and thirst. He drank a large bowl of cold water, and that night suffered umbilical and abdominal distension and pain. The monk gave the same medicine again, causing another ten-plus diarrheal episodes. The illness worsened significantly: limbs were weak, restlessness persisted requiring constant clothing changes, desire for cold water remained, food was undigested, dysentery resembled rotten fish intestines mixed with red and yellow fluids, appetite was absent, forced eating caused vomiting, epigastric obstruction was worse than before, belching was incessant, feet were cold, and lower abdominal pain was unbearable. He requested my treatment. His pulse was floating and rapid, 8-9 beats per breath, empty upon pressure. Tracing the origin, the summer heat had already damaged righteous Qi. Administering highly toxic, hot-purgative medicine caused further damage. After one purge, the offending matter was expelled completely. However, the residual properties of Croton seed (Badou) remained, spreading toxicity in the stomach and intestines, causing nausea and inability to eat, further injuring Stomach Qi; continuous passage of pus and blood caused muscle wasting and dry skin/hair, indicating Spleen Qi weakness and decline. Redness and roughness on the tongue, dry throat, and insufficient fluids resulted from excessive purging depleting Yin. With Yin depleted, Heart Fire flared alone, causing chest/heart restlessness and agitation. The classics state: 'Solitary Yang does not generate, solitary Yin does not grow'; this is the cause of premature death. I declined the case and left. Later, other physicians treated him. Without examining the pulse or investigating the cause, seeing only fullness, they used Zhike Wan (Aurantii Fructus Pill) to purge. The condition worsened with wheezing and fullness, uncontrollable dysentery, and death. The *Jingui Yaolue* states: 'Purging when one should not causes intestinal opening and洞泄 (profuse watery diarrhea), leading to death with incontinence.' This describes the situation perfectly. Sages treat diseases with method; medication must not exceed limits. The *Neijing* says: 'For highly toxic medicines, remove 60%; for mildly toxic, 70%; for commonly toxic, 80%; for non-toxic, 90%. Then use grains, meats, fruits, and vegetables to complete recovery. Do not overdo it, as excess damages righteous Qi.' The *Liji* says: 'If a doctor has not practiced for three generations, do not take their medicine.' This shows extreme caution. That monk was not a medical professional; recklessly using highly toxic purgatives excessively killed the patient within days. The disaster of improper medication is thus. Choosing a doctor requires caution. Beware, beware.
Loss of dosage control (Fang Cheng Wu Yue): In the eleventh month of the Ding Si winter, returning from military service to Bianliang, a performer named Li Ren'ai told me: "My eldest son, since July this year, consumed cold tea and cold rice after labor and thirst, developing epigastric fullness. A doctor prescribed one dose, causing two bowel movements, reducing symptoms. Not long after, re-exposure to cold foods caused recurrent epigastric/abdominal fullness, vomiting, nausea, tastelessness, anorexia, limb fatigue, and reluctance to speak. The previous doctor examined him and said, 'This is easy to treat; a few more bowel movements will bring relief.' He prescribed Wuyou San combined with powdered Strychnos nux-vomica (Qian Niu), taken with plain water. By evening, borborygmus and colicky pain occurred. Soon, vomiting and diarrhea ensued, unremitting thirst, uncontrolled eating/drinking, and periodic unconsciousness. The doctor was summoned again but withdrew, unable to manage the pulse. Soon, cold sweat poured like washing, breath from mouth/nose grew cold, and he died. I regret deeply; may I ask why?" I said, "I did not witness it personally, so I do not know the exact reason, having left. Someone said, 'I witnessed it. Is it truly the fault of the medicine?' I said, 'It is not the fault of the medicine, but the failure of dosage control. Medicines without basis become thieves of Qi. The Neijing states: 'Regulating a prescription is like tying a bag. If a bag is full but not tied, it leaks. If a prescription is formed but not regulated, Shen and Qi will not accompany it.' Therefore, Zhang Zhongjing, using Guizhi Tang (Cinnamon Twig Decoction) for exterior wind, said: 'If sweating occurs after one dose and the disease resolves, stop subsequent doses; do not finish the decoction.' For Da Cheng Qi Tang treating severe excess/fullness, he said: 'Stop after changing clothes once; do not finish the decoction.' Such caution! This is a major warning, embodying the sage's principle of regulating the bag. Treating disease must seek the root. Li Ren'ai engaged in drama, exhausting Shen and damaging Qi. Epigastric pain arose from summer heat, thirst, drinking cold tea, weakening Spleen/Stomach Qi, failing to transform, causing fullness. Using purgatives further distressed the Spleen. Carelessness damaged Yang; deficiency compounded by injury, injury compounded by purging. Yin contends internally, Yang disturbs externally. Po Han (sweat) is not stored, Four Reversals arise internally. As Zhang Zhongjing said: 'One error delays death, two errors accelerate it.' Is this not a failure of dosage control? Thus, the Neijing warns: 'Superior doctors regulate Qi, middle doctors disrupt pulses, inferior doctors exhaust Qi.' One must be cautious.
Contraindication of purging in Tuo Ying (Depletion of Camp): The *Shu Wu Guo Lun* states: "Once noble, now humble; although not struck by pathogens, disease arises internally, named Tuo Ying." A scholar from Zhenyang was robust and heroic, sociable with ambitions, over thirty years old, holding a fifth-rank official position, surrounded by attendants and concubines, with all desires satisfied. Within three years, dismissed due to affairs. Mental depression and worry led to loss of appetite, declining spirit, and emaciation. Helpless, he indulged in alcohol, leading to abdominal fullness. Seeking a doctor, the physician failed to assess the condition properly and administered five pills with warm water, causing twenty-plus diarrheal episodes. It was early autumn, summer heat still prevalent, causing thirst and excessive cold water intake, leading to borborygmus, abdominal pain, and dysentery resembling fish brains, worsening to critical state. I examined him: pulse fluctuated between large and small, symptoms included repeated confusion, retching, and sighing. I predicted: "This is difficult to treat." Qixuanzi said: "Due to spiritual constriction." From nobility to humiliation, lingering attachment, knotting of will, worry, and fear, though not struck by pathogens, disease arises internally, blood vessels become deficient, named Tuo Ying. Someone asked for the rationale. The *Huangdi Zhenjing* states: "The path of Zong Qi relies on grain. Grain enters the stomach, transmits to vessels, flows溢出 (overflows) internally, spreads externally. Refined essence travels through meridians, cycling endlessly, nourishing continuously, constituting the rhythm of heaven and earth. Qi begins at Hand Taiyin, moves to Yangming, circulates to Foot Jueyin, follows the abdomen, enters the collarbone region, descends to the Lung, then returns to Hand Taiyin. This is the path of Ying Qi (Nutritive Qi). Day and night, Qi circulates fifty cycles, measuring 100 clepsydra drops, totaling 13,500 breaths. Communication implies parallel movement of one number; thus, fifty cycles prepare one to enjoy the lifespan of heaven and earth. Now, the patient went from joy to suffering, both damaging Jing Qi. Exhaustion of Jing Qi destroys the form. Sudden joy damages Yang, sudden anger damages Yin, inability to regulate emotions. Heart is the monarch, issuing Shen Ming (Spirit); Lung is the minister, managing Ying and Wei, providing regulation. Greed for desires obscures Heavenly Principle, causing the twelve organs to lose their functions, pathways blocked. Consequently, Jingying Qi departs, unable to irrigate the body, hundred vessels lose their natural measure, form is severely damaged. Using this for health preservation brings disaster; what doubt remains?"
Fire-clearing injures Stomach: Jingli Jin Caiqing consumed rich foods and drinks, developing epistaxis (nosebleed) in spring. The doctor said: "All bleeding indicates heat; administer Qingliang Yin Zi (Cooling Drink) to stop it." Days later, relapse. Doctor said: "Medicine was insufficient for the disease." Prescribed Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxins). Intermittently stopped and relapsed. Changed doctors several times, all using bitter-cold agents to overcome heat, yet never cured. Diet and lifestyle deteriorated compared to initial state; muscles cold with occasional restlessness, voice lost, foul breath like cold wind, though epistaxis waves continued. Someone asked: "Bleeding indicates heat; cooling heat is logical. Why no cure and worsening?" I said: "The Neijing states: 'The five Zang aim for balance.' Also: 'Inferior doctors exhaust Qi; one must be cautious.' They only see bleeding as heat and attack with bitter-cold, ignoring that bitter-cold drains Spleen and Stomach. Spleen and Stomach are Earth, the foundation of the body. Now, fire pathology attacks Earth; fire may not be removed, but Earth is diseased. Earth disease causes Stomach deficiency; Stomach deficiency prevents Ying Qi from nourishing vessels; Yuan Qi fails to follow natural measures; Qi transforms with Yin, losing voice and warming muscles. Alas, crude doctors laugh, thinking it curable. Heat persists, cold disease arises anew; this is what is meant."
Inferior doctors exhaust Qi endangering life: In Ding Si year, summer, visiting Kaizhou, Qianhu Gao Guoyong told me: "My father, 73 years old, last July, suffered dietary injury and rainy weather, causing acute diarrhea/dysentery. Doctors stopped it with medicine. Not long after, re-injury and diarrhea; stop then re-injure, injure then purge. By October, emaciated, limbs fatigued, reduced diet, abdominal pain, borborygmus. Doctor Li prescribed Yangzang Tang (Nourish Viscera Decoction); after days, diarrhea stopped, but vomiting began. Doctor Wang used Dingxiang (Clove), Renshen (Ginseng), Huoxiang (Patchouli), Juhong (Tangerine Peel), Gancao (Licorice) as powder, decocted with ginger; vomiting stopped after several doses. By January this year, no intake, needs support to rise. No bowel movement for days. I asked the doctor: 'Father has no bowel movement; how to treat?' Doctor said: 'Old gentleman over seventy, Qi and Blood weak, half-year diarrhea/dysentery, Spleen/Stomach long deficient, fluids depleted. Maziren Wan (Hemp Seed Pill) for moistening is suitable.' Relatives discussed; one suggested Niu Shanshan from Fengcun for decisive diagnosis. Pulse taken, illness asked: 'This is Wind Knot. Take over 100 pills of Soufeng Wan (Wind-Searching Pill). Died after several loose stools. I regret endlessly; may I ask?' I said: "Humans rely on water and grain as root. Elderly with chronic diarrhea has depleted gastric fluids; heavy purging leaves Shen without basis. The *Ling Shu* states: 'Form/Qi insufficient, Pathogen Qi insufficient; this is dual insufficiency of Yin/Yang. Do not purge. Purging increases insufficiency; dual insufficiency leads to exhaustion of Yin/Yang, depletion of Blood/Qi, emptiness of five Zang, withering of sinews/marrow/bone. Elderly perish, young do not recover.' Also: 'Superior doctors regulate Qi, middle disrupt pulses, inferior exhaust Qi endangering life.' Exhausting Qi endangering life refers to Dr. Niu.
Medication without basis becomes thief of Qi: Li Zhongkuan, Beijing surveillance clerk, 50 years old, spring of Ji Si year in Yuan dynasty, suffered wind syndrome: hemiplegia, numbness, slurred speech, mental confusion. A friend prescribed: 0.5 jin Dahuang (Rhubarb), 3 sheng Heidou (Black Soybean), 1 dou water, boil until beans cooked, remove rhubarb, rinse with fresh water, take 2-3 he per day. Wind-heat would depart. Taken halfway, another friend advised combining Tongsheng San, Siwu Tang (Four Substances Decoction), and Huanglian Jiedu Tang for faster effect. Taken for over a month, spirit increasingly fatigued. Returned to Zhengding, home for recovery. Relatives/friends offered countless prescriptions, not fully recorded. Added aphonia, cold Qi, cold hands/feet. Asked me to examine. Detailed inquiry into history. Pulse: six pulses fine as spider silk. I said: "Diseases vary in exterior/interior, deficiency/excess, cold/heat. Medicines have sovereign/minister/assistant/courier roles, sizes, odd/even formulations. Your medications lack basis, hence disease worsens. Now incurable; you brought this upon yourself." Died shortly after. Xiao Shi, wife of Official Cao Tongfu, over 60, poor and isolated, suddenly suffered wind disease in spring: hemiplegia, slurred speech, confusion, facial deviation, same as Li. I punctured Jing-Well points of twelve meridians to connect collaterals, ineffective. Moxibustioned Jianjing (GB21) and Quchi (LI11). Analyzed disease timing/month for medication, halved dosage. I said: "No need for medicine; disease will self-heal." Next spring, saw her walking normally at Langzhong Zhang Zijing's home. I sighed: "Recovery due to不乱服药 (not taking random medicines). Thus, Li Zhongkuan's random medication was incurable. Xiao's poverty allowed tranquility. Neijing states: 'Medication without basis becomes thief of Qi; sages warn against it.' One day, Yao Xuezai quoted Mr. Xu: 'Rich/Noble have two things worse than poor/humble: inability to correct faults, inability to treat illness.' Alas, referring to Li.
Warning against reckless purging: Li Tijuzheng, Zhengding Mint Officer, over 40, robust and fleshy. Colleague Shi Jun warned: "Fat people often suffer wind syndromes. You risk stroke. Soufeng Wan pushes out old, generates new, resolves phlegm; suitable for you." Li agreed, prepared one dose, daily intake. Nightly five bowel movements. Half month later, shortness of breath. Month later, lethargy, drowsiness, white pus in stool, urinary incontinence, coldness from feet to knees, heavy/sore back, tastelessness, anorexia, epigastric fullness, intermittent restlessness, forgetfulness, anxiety. Three doctors changed, ineffective. Explained history, requested treatment. I said: "Sun Simiao stated: 'Medicinal forces have bias, disturbing Zang Qi equilibrium. Medicine attacks disease; without disease, do not ingest. Healthy person: grain enters stomach, pulses flow; water enters channels, blood forms. Water gone, Ying scatters; grain digested, Wei perishes. Ying scattered, Wei perished, Shen has no basis. You are healthy, Zang stable. Recklessly using mildly toxic purgatives daily causes multiple stools. First day pushes out old. Old gone, what to push? Now food does not build flesh, water/grain fail to transform essence, irrigate Zang/Fu/vessels. Where is Shen based? Shortness of breath = True Qi damage. Lethargy = Spleen Qi decline. Incontinence = Bladder fails to store. Pus/blood in stool = Stomach Qi sinking. Cold calves = Yang Qi weak. Restlessness/epigastric empty fullness = Stomach Qi fails to ascend. Forgetfulness/confusion = Shen disorder.' Jingui states: 'Purging when unnecessary causes洞泄 and incontinence, leading to death.' These symptoms are not heavenly fate; you brought them upon yourself. Treatment barely stabilized, but shortened life. Li terrified, sweaty back, rose saying: 'Reckless purging error, how to repent! Though, please save me.' I thought disease advanced past halfway, hard to cure, declined and left. Autumn, illness worsened. Doctor used Duoming San (Life-Seizing Powder) to purge. Died of dry heat, wheezing, fullness. Neijing states: 'Punishing the innocent is called great confusion.' Like Mr. Li, the Neijing calls him confused. Gentleman of health, beware!"