戊午冬。予从军住冬于成武县。有贾仓使父。年逾六旬。冬至后数日。疽发于背。五七日肿势
约七寸许。不任其痛。疡医视之。曰脓已成。可开发矣。公惧不从。越三日。医曰。不开恐变证生
矣。遂以燔针开之。脓泄痛减。以开迟之故。迨二日变证果生。觉重如负石。热如 火。痛楚倍常
。六脉沉数。按之有力。此膏粱积热之变也。邪气酷热。固宜以寒药治之。时月严凝。复有用寒远
寒之戒。乃思内经云。有假者反之。虽违其时。以从其证可也。与疡医议。急作清凉饮子加黄连。
秤一两五钱。作一服服之。利下两行。痛减七分。翌日复进
前药。其证悉除。后月余平复。又陈录判母。年七十有余。亦冬至后脑出疽。形可瓯面大。命疡医
诊视。俟疮熟以针出脓。因怒笞侍外家。疮辄内陷。凹一韭叶许。面色青黄不泽。四肢逆冷。汗出身
清。时复呕吐。脉极沉细而迟。盖缘衰老之年。严寒之时。病中苦楚。饮食淡薄。已涤肥脓之气。
独存瘦瘁之形。加之暴怒。精神愈损。故有此寒变也。病与时同。与疡医议。速制五香汤一剂。加丁
香、附子各五钱。剂尽疡复大发。随证调治而愈。内经曰。凡治病必察其下。谓察时下之宜也。诸
痛疮疡。皆属心火。言其常也。如疮盛形羸。邪高痛下。始热终寒。此反常也。固当察时下之宜而
权治。故曰。经者常也。法者用也。医者意也。随所宜而治之。可收十全之功矣。
戊午年冬天，我随军驻扎在成武县过冬。有一位贾仓使的父亲，年龄超过六十岁。冬至后的几天里，他的背部生疽（一种严重的化脓性感染）。五到七天后，肿胀范围大约七寸左右，疼痛难以忍受。外科医生检查后说：“脓液已经形成，可以切开排脓了。”这位老人害怕，没有听从。过了三天，医生说：“如果不切开，恐怕会产生变证（病情恶化或出现并发症）。”于是用燔针（烧红的针）进行切开引流，脓液排出后疼痛减轻。但因为切开得晚的缘故，到了第二天，变证果然发生了。患者感觉身体沉重得像背着石头一样，发热如火烧，痛苦程度比平时加倍。六脉（寸、关、尺，左右手）沉而数（快），重按有力。这是因长期食用膏粱厚味积聚的热毒所引发的病变。邪气酷热，本来应该用寒凉药物治疗。但当时正值严寒季节，又有“用寒远寒”（使用寒凉药要避开寒冷时节）的禁忌。于是我思考《内经》所说的：“有假者反之”，虽然违背了时令，但应当顺从病症治疗。我与外科医生商议，紧急配制清凉饮子加黄连。黄连称一两五钱，作为一剂服用。服药后腹泻两次，疼痛减轻了七分。第二天再次服用前药，症状全部消除。一个多月后完全康复。
又有一位陈录判的母亲，年龄七十多岁，也是在冬至后头部生疽，疮面大小如同一个盆底。命令外科医生诊治，等待疮口成熟后用针排出脓液。因为生气鞭打侍候她的外家仆人，导致疮口内陷，凹陷约一片韭菜叶大小，面色青黄无光泽，四肢逆冷，出汗且身体发凉，时常呕吐，脉象极沉细而迟。这是因为年老体衰，又逢严寒时节，患病期间痛苦，饮食清淡，已经耗尽了肥甘厚味的热气，只剩下瘦弱憔悴的身体。再加上暴怒，精神进一步受损，所以出现了这种寒性变证。病情与季节气候相符。我与外科医生商议，迅速制作五香汤一剂，加入丁香、附子各五钱。药服完后，疮口重新大发（红肿溃烂），随后根据症状调理而痊愈。《内经》说：“凡治病必察其下”，意思是观察当下时宜是否适宜。各种疼痛疮疡，都属于心火，这是指一般规律而言。如疮势盛大而形体消瘦，邪气在上而疼痛在下，起初发热最终转寒，这是反常情况。确实应当观察当下时宜并权衡治疗。所以说：“经是常规，法是运用，医是意会。”根据适宜的情况进行治疗，就可以收到十全十美的疗效了。
In the winter of the Wumu year, I accompanied the army and stayed in Chengwu County for the winter. The father of Jia Cangshi, a government official, was over sixty years old. A few days after the Winter Solstice, he developed a carbuncle (a severe suppurative infection) on his back. Five to seven days later, the swelling covered an area of about seven cun, and the pain was unbearable. The surgeon examined it and said, "The pus has formed; it can be incised." The patient, fearing surgery, did not comply. Three days later, the doctor said, "If not incised, adverse changes (complications or worsening condition) may occur." Thus, a cauterizing needle (red-hot needle) was used to open the abscess. After the pus drained, the pain decreased. However, due to the delay in incision, adverse changes indeed occurred on the second day. The patient felt as heavy as carrying a stone, feverish as if burning with fire, and the suffering was twice as severe as usual. The six pulses (cun, guan, chi positions on both hands) were deep and rapid (fast), and forceful upon heavy pressure. This was a transformation caused by accumulated heat from long-term consumption of rich, fatty foods. The pathogenic factor was intensely hot, so cold-natured herbs should theoretically be used. However, it was the season of severe cold, and there was a warning against using cold remedies during cold weather ("avoid cold when using cold"). I then recalled the statement in the *Neijing*: "When there is a false condition, treat contrary to it." Although this violated seasonal norms, treatment should follow the syndrome. I consulted with the surgeon and urgently prepared Qingliang Yinzi (Cooling Drink Decoction) with added Huanglian (Coptidis Rhizoma). One liang and five qian of Huanglian was measured as a single dose. After taking it, the patient had two bowel movements, and the pain decreased by seventy percent. The next day, the previous medicine was administered again, and all symptoms disappeared. Over a month later, he fully recovered.
Another case involved the mother of Chen Lupan, a government official, who was over seventy years old. She also developed a carbuncle on her head after the Winter Solstice, with the lesion being as large as the bottom of a bowl. The surgeon was instructed to examine it and wait for the sore to mature before draining the pus with a needle. However, due to anger, she whipped her female servant attending her, causing the sore to sink inward, forming a depression about the size of a leek leaf. Her complexion was bluish-yellow and lusterless, her four limbs were cold, she sweated and felt chilled, and she vomited intermittently. Her pulse was extremely deep, fine, and slow. This was because at an advanced age, during severe cold weather, suffering from illness, and eating bland food, the qi of rich and greasy foods had been exhausted, leaving only a emaciated and frail form. Added to this was sudden anger, which further damaged the spirit. Thus, this cold-type transformation occurred. The disease matched the season. I consulted with the surgeon and quickly prepared one dose of Wuxiang Tang (Five-Aromatic Decoction), adding Dingxiang (Caryophylli Flos) and Fuzi (Aconiti Lateralis Radix Praeparata), each five qian. After finishing the dose, the sore flared up significantly again. Subsequently, treatment was adjusted according to the symptoms, and she recovered. The *Neijing* states: "In treating any disease, one must observe the 'xia' (the appropriateness of the current time/season)." This means observing whether the timing is suitable. All pains and sores generally belong to Heart Fire, which refers to the general rule. However, when the sore is extensive but the body is emaciated, the pathogen is high while the pain is low, or it starts with heat and ends with cold, these are abnormal situations. One must indeed observe the appropriateness of the current time and weigh the treatment accordingly. Therefore, it is said: "Jing (Classics) represents constancy; Fa (Methods) represents application; Yi (Physician) represents intuition." Treating according to what is appropriate can achieve perfect success.