真定府赵吉夫。约年三旬有余。至元丙寅五月间。因劳役饮食失节。伤损脾胃。时发烦躁而渴
。又食冷物过度。遂病身体困倦头痛。四肢逆冷呕吐。而心下痞。医者不审。见其四肢逆冷。呕吐
心下痞。乃用桂末三钱。以热酒调服。仍以绵衣覆之。作阴毒伤寒治之。须臾汗大出。汗后即添口
干。舌涩。眼白睛红。项强硬。肢体不柔和。小便淋赤。大便秘涩。循衣摸床。如发狂状。问之则
言。语错乱。视其舌则赤而欲裂。朝轻暮剧。凡七八日。家人皆自谓危殆不望生全。邻人吉仲元举
予治之。诊其脉六七至。知其热证明矣。遂用大承气汤苦辛大寒之剂一两。作一服服之。利下三行
。折其胜势。翌日。以黄连解毒汤大苦寒之剂二两。使徐徐服之以去余热。三日后。病十分中减之
五六。更与白虎加人参汤约半斤。服之。泻热补气。前证皆退。戒以慎起居。节饮食。月余渐得平
复。内经曰。凡用药者。无失天时。无逆气宜。无翼其胜。无赞其复。是谓至治。又云。必先岁气
。无伐天和。当暑气方盛之时。圣人以寒凉药。急救肾水之原。补肺金之不足。虽有客寒伤人。仲
景用麻黄汤内加黄芩知母、石膏之类。发黄发狂。又有桂枝汤之戒。况医者用桂末热酒调服。此所
谓差之毫厘。谬之千里。此逆仲景之治法。经云。不伐天和。不赞其复。不翼其胜。不失气宜。不
然。则故病未已。
新病复起矣。
真定府的赵吉夫，年龄大约三十多岁。在至元丙寅年五月期间，因为劳累过度且饮食不规律，损伤了脾胃。时常出现烦躁和口渴的症状。后来又因过量食用生冷食物，导致身体困倦、头痛、四肢冰冷、呕吐，并且胃脘部痞塞不适。医生没有仔细辨证，看到他有四肢冰冷、呕吐和胃脘痞塞的症状，就使用三钱肉桂末，用热酒调匀后让他服用，并用棉衣覆盖身体，将其当作阴毒伤寒来治疗。不久之后，患者大汗淋漓，出汗后随即增添了口干、舌苔干涩、眼白充血发红、颈部僵硬、肢体不柔和、小便短赤涩痛、大便秘结不通等症状，甚至出现手抓衣被、摸床沿的行为，像发狂一样。询问他时，他言语错乱。观察他的舌头，颜色红赤且似乎要裂开，病情早晨较轻，傍晚加重。这样持续了七八天，家人们都认为情况危急，不指望他能活下来。邻居吉仲元推荐我来诊治。我诊察他的脉搏，一呼一吸间跳动六七次，判断这是热证无疑。于是使用大承气汤（大黄、芒硝、厚朴、枳实组成的方剂），这是一味苦辛大寒的药剂，用量为一两，分一次服下。服药后腹泻三次，遏制了亢盛的病势。第二天，使用黄连解毒汤（黄连、黄芩、黄柏、栀子组成的方剂），这是一味大苦寒的药剂，用量为二两，让患者慢慢服用以清除余热。三天后，病症减轻了五六成。再给予白虎加人参汤（石膏、知母、甘草、粳米、人参组成的方剂）约半斤服用，以此泻热补气，之前的症状全部消退。告诫患者要注意起居作息，节制饮食，一个多月后逐渐恢复健康。《内经》说：凡是用药，不要违背天时，不要逆反气候适宜的原则，不要助长邪气的胜势，不要赞助邪气的复返。这叫做最高明的治疗。又说：必须首先了解当年的岁气，不要破坏人体的自然和谐之气。当暑气正盛的时候，圣人使用寒凉药物，紧急救助肾水的本源，补充肺金的不足。即使有外感寒邪伤人，张仲景在麻黄汤中也加入黄芩、知母、石膏之类的药物。如果出现发黄、发狂的症状，又有使用桂枝汤的禁忌。何况医生用肉桂末配合热酒调服，这就是所谓的“差之毫厘，谬以千里”。这是违背了张仲景的治疗法则。经书说：不破坏天和，不赞助复邪，不助长胜邪，不违背气宜。如果不这样做，那么旧病未愈，新病又起。
Zhao Jifu from Zhengding Prefecture was a man in his early thirties. In the fifth month of the Bingyin year of Zhiyuan, due to overwork and irregular diet, he injured his Spleen and Stomach. He frequently experienced irritability and thirst. Subsequently, excessive consumption of cold foods led to symptoms of physical fatigue, headache, cold limbs, vomiting, and fullness/oppression in the epigastrium (Xin Xia). The physician failed to examine the condition carefully; seeing the cold limbs, vomiting, and epigastric fullness, he administered three qian of Cinnamon Bark powder (Guixin), mixed with hot wine, and covered the patient with cotton clothes, treating it as Yin Toxin Cold Damage (Yin Du Shang Han). Shortly after, profuse sweating occurred. Following the sweat, new symptoms emerged: dry mouth, rough tongue, redness of the whites of the eyes, neck stiffness, lack of flexibility in the limbs, scanty dark urine, and constipation. The patient exhibited behaviors such as picking at clothes and touching the bed, resembling madness. When questioned, his speech was disordered. His tongue appeared bright red and cracked. The condition was mild in the morning and severe in the evening. This persisted for seven or eight days. His family believed he was critically ill and did not expect him to survive. A neighbor, Ji Zhongyuan, recommended me to treat him. I palpated his pulse, which beat six or seven times per respiration cycle, confirming that this was clearly a Heat syndrome. Therefore, I used Da Cheng Qi Tang (Major Order the Qi Decoction), a bitter, acrid, and greatly cold formula, one liang in dose, taken in one serving. The patient had three bowel movements, which checked the excess pathogenic factor. The next day, I prescribed Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity), a greatly bitter and cold formula, two liang in dose, to be taken slowly to eliminate residual heat. After three days, the illness had reduced by five or six parts out of ten. I then administered approximately half a jin of Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) to clear heat and tonify Qi. All previous symptoms receded. I advised him to be cautious with daily activities and regulate his diet. Over more than a month, he gradually recovered. The Nei Jing states: "When using medicine, do not lose sight of the timing of heaven, do not go against the suitability of qi, do not assist the victory [of pathogens], and do not praise the recurrence [of pathogens]. This is called perfect treatment." It also says: "First determine the annual qi, and do not harm the harmony of heaven [natural bodily functions]." When summer heat qi is flourishing, the sages use cold and cool medicines to urgently rescue the source of Kidney Water and supplement the insufficiency of Lung Metal. Even if there is an invasion of exogenous cold damaging the body, Zhang Zhongjing would add herbs like Huang Qin (Scutellariae Radix), Zhi Mu (Anemarrhenae Rhizoma), and Shi Gao (Gypsum Fibrosum) within Ma Huang Tang (Ephedra Decoction). If jaundice or madness occurs, there are warnings against using Gui Zhi Tang (Cinnamon Twig Decoction). Moreover, the physician used Cinnamon Bark powder mixed with hot wine. This is what is meant by "a miss is as good as a mile" (a slight error leads to a huge mistake). This violates Zhang Zhongjing's therapeutic principles. The classics state: Do not harm Tian He (Heavenly Harmony), do not praise Fu Xie (Recurrent Pathogens), do not assist Sheng Xie (Victorious Pathogens), and do not lose Qi Yi (Suitability of Qi). Otherwise, the old disease will not cease, and new diseases will arise.