郝道宁友人刘巨源。时年六十有五。至元戊寅夏月。因劳倦饮食不节。又伤冷冻饮料。得疾。医者
往往皆以为四时证。治之不愈。逮十日。道宁请太医罗谦甫治之。诊视曰。右手三部脉沉细而微。
太阴证也。左手三部脉微浮而弦。虚阳在表也。大抵阴多而阳少。今所苦身体沉重。四肢逆冷。自
利清谷。引衣自覆。气难布息。懒语言。此脾受寒湿。中气不足故也。仲景言下利清谷。急当救里
。宜四逆汤温之。内经复有用热远热之戒。口干但欲嗽水。不欲咽。早晨身凉而肌生粟。午后烦躁
。不欲去衣。昏昏睡而面赤。隐隐红斑见于皮肤。
此表实里虚故也。内虚则外证随时而变。详内外之证。乃饮食劳倦。寒伤于脾胃。非四时之证明矣
。治病必察其下。今适当大暑之时。而得内寒之病。以标本论之。时为标也。病为本也。用寒则顺
时而违本。用热则从本而逆时。此乃寒热俱伤。必当从乎中治。中治者、温之是也。遂以钱氏白
术散。加升麻。就本方加葛根、甘草以解其斑。少加白术、茯苓以除湿而利其小便也。人参、藿香
、木香。安脾胃。进饮食。 咀。每服一两煎服。再服斑退而身温。利止而神出。次服异功散、治
中汤辛温之剂。一二服。五日得平。止药主人曰。病虽少愈。勿药可乎。罗君曰。药。攻邪也。内经
曰。治病以平为期。邪气既去。强之以药。变证随起。不若以饮食调养。待其真气来复。此不药而
药、不治而治之理存焉。从之。旬日良愈。噫。谦甫之为医。深究内经之旨。以为据根据。不为浮议
之所摇。胸中了然而无所滞。岂验方而用药者比也。巨源友旧。朝夕往视之。故得其详。不可不录
之以为戒。五月二十五日郝道宁谨题。
郝道宁的朋友刘巨源，当时六十五岁。至元戊寅年夏季，因劳累过度、饮食不节制，又误食冷冻饮料而致病。医生们通常都将其当作四季常见病症治疗，但久治不愈。到了第十天，郝道宁请太医罗谦甫诊治。
罗谦甫诊察后说：“患者右手三部脉象沉细而微弱，这是太阴证（足太阴脾经受邪所致的病证）的表现；左手三部脉象微浮且弦，说明虚阳浮越于体表。总体来看，阴气盛而阳气少。目前患者痛苦的症状包括：身体沉重，四肢厥冷，自发性腹泻且大便中有未消化的食物，喜欢裹着衣服保暖，呼吸短促困难，懒于说话。这是因为脾胃受寒湿侵袭，中焦之气不足所致。”
张仲景曾说：“出现下利清谷（腹泻且大便中有未消化食物），应当紧急救治里证。”适宜用四逆汤（附子、干姜、甘草组成的回阳救逆方剂）来温补。《内经》也有“用热远热”（在炎热季节使用温热药物时要谨慎，以免助热伤阴）的告诫。患者虽然口干只想漱口而不想吞咽，早晨身体凉爽甚至皮肤起鸡皮疙瘩，但午后烦躁不安，不想脱去衣物，昏昏欲睡且面色发红，皮肤上隐约可见红斑。
这是因为表实里虚的缘故。内部虚弱则外部症状会随时间变化。详细分析内外症状，可知这是由于饮食劳倦，寒气损伤了脾胃，并非普通的四季时令病症。治病必须考察二便情况。如今正值大暑时节，却得了内寒之病。以标本理论来分析，时令为标，疾病为本。如果用寒凉药，则是顺应时令却违背了病本；如果用温热药，则是顺从病本却违背了时令。这属于寒热两难的局面，必须采取“从乎中治”的方法。“中治”即指温和调理。
于是，罗谦甫使用了钱氏白术散（宋代钱乙创制的健脾益气方剂），加入升麻，并在原方基础上加葛根、甘草以解肌透疹退斑；稍加白术、茯苓以祛除湿邪并通利小便；用人参、藿香、木香来安顿脾胃，促进食欲。将药材切碎，每次服用一两，煎汤服用。服药两次后，红斑消退，身体转温，腹泻停止，神志清醒。随后服用异功散（人参、白术、茯苓、甘草、陈皮组成的健脾益气方剂）和治中汤（理中汤加减，具有温中散寒功效）等辛温性质的药剂，一二剂后，五天病情平稳，停药。
主人问：“病虽稍有好转，是否可以不再服药？”罗君说：“药物是用来攻伐邪气的。《内经》说：‘治病以求平衡为目的’。既然邪气已去，强行用药反而会引起变证。不如通过饮食调养，等待人体真气恢复。这其中蕴含着‘不药而药、不治而治’的道理。”主人听从了他的建议。十天后，患者完全康复。
唉！罗谦甫行医，深入探究《内经》的宗旨，以此作为依据，不被浮泛的议论所动摇，心中了然清楚而无滞碍，岂是那些仅凭验方用药的医生所能比拟的？因为刘巨源与郝道宁是旧友，我朝夕探望，所以得知这些详情，不可不记录下来作为警示。五月二十五日，郝道宁谨题。
Hao Daoning’s friend, Liu Juyuan, was sixty-five years old at the time. In the summer of the Wuyin year of the Zhiyuan era, he fell ill due to overwork, irregular diet, and consumption of frozen beverages. Physicians generally treated him for common seasonal conditions, but his condition did not improve. On the tenth day, Hao Daoning requested the Imperial Physician Luo Qianfu to treat him.
Upon examination, Luo Qianfu stated: "The pulse in the three positions on the right hand is deep, fine, and faint, indicating a Taiyin syndrome (a disease pattern caused by pathogenic invasion of the Foot-Taiyin Spleen meridian). The pulse in the three positions on the left hand is slightly floating and wiry, indicating deficient Yang floating on the exterior. Generally, Yin is excessive while Yang is deficient. His current suffering includes heavy body sensation, cold extremities, spontaneous diarrhea with undigested food (xia li qing gu), a desire to wrap himself in clothes, difficulty in breathing, and reluctance to speak. This is due to Cold-Dampness invading the Spleen and Stomach, resulting in insufficiency of Middle Qi."
Zhang Zhongjing stated: "In cases of diarrhea with undigested food, urgent rescue of the interior is required." It is appropriate to use Si Ni Tang (Four Reversal Decoction) to warm the interior. However, the *Neijing* (Inner Canon) also issues a warning regarding "using heat far from heat" (exercising caution when using warming herbs during hot seasons to avoid damaging Yin). Although the patient had a dry mouth and desired only to rinse his mouth without swallowing, felt cool in the morning with gooseflesh on the skin, yet experienced irritability in the afternoon, refused to remove clothing, felt drowsy, had a red face, and faint erythematous macules appeared on the skin.
This indicates an excess on the exterior and deficiency on the interior. When the interior is deficient, external symptoms may vary with time. A detailed analysis of internal and external signs reveals that this was caused by dietary indiscretion and fatigue, where Cold damaged the Spleen and Stomach; it was clearly not a typical seasonal disease. Treating illness requires examining defecation and urination. Currently, it is the height of summer, yet he suffers from an internal Cold disease. Analyzing via the Biao-Ben (Branch-Root) theory, the season is the Branch, and the disease is the Root. Using Cold-natured herbs would follow the season but violate the root cause; using Heat-natured herbs would follow the root cause but violate the season. This presents a dilemma of both Cold and Heat injury, necessitating treatment "according to the Middle" (Cong Hu Zhong Zhi). "Middle treatment" refers to mild regulation.
Therefore, Luo Qianfu prescribed Qian Shi Bai Zhu San (Dr. Qian's Atractylodes Macrocephala Powder), adding Sheng Ma (Cimicifugae Rhizoma). He further added Ge Gen (Puerariae Lobatae Radix) and Gan Cao (Glycyrrhizae Radix et Rhizoma) to resolve the rash. He slightly increased the dosage of Bai Zhu (Atractodis Macrocephalae Rhizoma) and Fu Ling (Poria) to drain Dampness and promote diuresis. Ren Shen (Ginseng Radix), Huo Xiang (Agastaches Herba), and Mu Xiang (Aucklandiae Radix) were used to stabilize the Spleen and Stomach and stimulate appetite. The herbs were decocted, with one tael taken per dose. After two doses, the rash receded, the body warmed, diarrhea ceased, and mental clarity returned. Subsequently, Yi Gong San (Extraordinary Efficacy Powder) and Zhi Zhong Tang (Regulate the Middle Decoction), both acrid-warm formulas, were administered. After one or two doses, the condition stabilized within five days, and medication was stopped.
The host asked, "Although the illness has slightly improved, can we dispense with medicine?" Luo Jun replied, "Medicine is used to attack pathogens. The *Neijing* states: 'Treatment aims for balance.' Since the pathogen has been eliminated, forcing more medication may induce new pathological changes. It is better to rely on dietary regulation and wait for the True Qi to recover. This embodies the principle of 'healing without medicine' and 'treating without intervention.'" The host followed this advice. Ten days later, he recovered completely.
Alas! Luo Qianfu’s medical practice deeply investigated the principles of the *Neijing*, using them as a foundation. He was not swayed by superficial opinions, maintaining clear insight without obstruction. How could he be compared to those who merely apply empirical prescriptions? As Liu Juyuan was an old friend of mine, I visited him daily and thus obtained these details. They must be recorded as a warning. Recorded respectfully by Hao Daoning on the 25th of May.