学士徐检老，体丰浓，善饮，致有肠风，计下血不下数桶，因而委顿。己卯仲冬，右胁
极疼
痛，上至耳后，夜分尤甚，左右不能转动，转动则痛甚，饮食减，面色青，闭目汗出如雨，
湿透衣被，故不敢合睫而睡。族医皆投以香附、青皮，及辛散之剂，痛愈甚，汗愈多，面愈
青。逆予诊之，两寸短弱，左关弦而搏指，右关沉滑，六脉皆近七至。予曰∶据痛在少阳经
分野，始必动于怒，木火之性上而不下，故上冲耳后而皆痛也。夜痛甚者，盖夜属肝气用事
，《内经》云∶司疏泄者肝也。邪在肝胆，故阖目汗即大出，中焦原有湿痰，法当调肝清热
解毒为主，兼利小便，不可遽止汗而使邪无出路。今脉大数，如遽敛汗，是逆其木火之性，
不惟痛加，且将发肿毒而害非浅矣。《内经》云∶膏粱之变，足生大疔，当预防之。公曰∶
何为敛剂而谓不宜？予曰；当归六黄汤内有地黄、当归、黄 ，皆滞痰闭气之味，桔梗亦非
所宜。书曰下虚者及怒气上升者皆不可用，故当慎也。因以柴胡、黄连为君，白芍、甘草、
天花粉为臣，红花、连翘为佐，龙胆草为使，服后汗虽仍旧，痛即减三分之一，不妨睡矣。
次日仍用前药，痛又减半，第三日又服，左右转动如常，饮食也加。予未至，公已先迎姑苏
盛氏，盛公幼时窗友也，家世受医。公初不急予，日引领期盛到，可刈枯铲朽也。盛至诊毕
，遂诘曾用何剂，公出予发剂示盛，盛大叫称谬，谓当隆冬之候，汗多如此，阳气大泄，何
敢以柴胡为君，喉中痰既未清，又何不用桔梗当归六黄汤。前贤已试之药置而不用，是舍纪
律而务野战出。即取六黄汤加桔梗以进。公雅信盛，乃倾心以从，速煎服之，未超时而旧病
随作，色色加恶，左右复不能转动，自戌而至子丑，苦不能支。有内侍语之曰∶服孙君药虽
未全可，亦已去泰去甚，彼曾言二药不可用，何为轻犯而受此苦？宜急取孙君药煎饮，饮下
即伏枕鼾鼾，达旦始寤。命使速予至而叩予曰∶人言隆冬汗出不当用柴胡，而公用为君，何
旨？予曰∶胆与肝为表里，肝胆之火郁而不发故痛，痛极而汗，汗出而痛减者，是火从汗出
，盖汗乃邪出之门也。予故曰∶汗不可敛。本草云∶柴胡泻肝胆火，而以黄连佐之。《内经
》云∶木郁则达，火郁则发。言当顺其性而利导之。势则易克。古人治火之法，轻则正治，
重则从其性而升之者。以此，盖医贵通变，如阴虚火动而汗出者，内无有余邪，故以六黄汤
敛而降之，常治法也。今内有余邪未出，遽敛降之，邪无从出，势必成毒，故变常而从治者
，使邪有出路，木火之性不逆，则毒不成而痛可减也。公曰∶善哉。孙君之剂，奇正相生，
不下孙武子兵法，何轻以无纪律议之，愿投剂而奏凯也。予曰∶公数日后疮疡大发，两胯且
有
兴块作痛，此毒出之征，公于时无恐。改用柴胡、白芍、甘草、丹参、苦参、茯苓、瞿麦、
车前子、黄柏、金银花、连翘服三日，而痛全减，汗全收，左右不能转动矣。逾日，公谓
肌肤甚痒，累累然似瘾疹，岂疮出欤，欲以药浴之可乎？予曰∶可。再三日，两胯果发兴块
，如棋子大者数枚，且痛。予业已制蜡矾丸以待，至是授服之。疮果遍身大发，两腿为甚，
一月余而瘳。公始信予防毒之言不谬，披愫交欢，且作序识胜，期与终身不替云。
徐学士检老，身体肥胖浓重，喜欢饮酒，因此患上了肠风（一种以便血为主要表现的疾病），累计下血量不下数桶，导致身体极度虚弱疲惫。己卯年仲冬时节，他右胁部剧烈疼痛，痛感向上延伸至耳后，夜间尤为严重，左右无法转动，一旦转动则疼痛加剧，饮食减少，面色发青，闭眼时汗出如雨，湿透了衣物和被褥，因此不敢闭眼睡觉。同族医生都给他投用香附、青皮以及辛散的药物，结果疼痛更加严重，出汗更多，面色更青。
我替他诊脉，两寸脉短弱，左关脉弦且搏指有力，右关脉沉滑，六脉均接近七至（快速）。我说：根据疼痛位于少阳经的分布区域，起初必定是因为动怒所致，木火之性向上而不向下，所以向上冲撞耳后而全部疼痛。夜间疼痛加重，是因为夜间属于肝气当令，《内经》说：主管疏泄的是肝脏。邪气在肝胆，所以闭目时汗水大量流出。中焦原本就有湿痰，治疗法则应当以调理肝脏、清热、解毒为主，兼以利小便，不可急于止汗而使邪气没有出路。现在脉象大且数，如果急于收敛汗液，这是违背了木火的特性，不仅疼痛会加重，而且将会引发肿毒，危害非浅。《内经》说：膏粱厚味的变化，足以产生大的疔疮，应当预防它。
徐公问：为什么收敛剂被认为不宜使用？我说：当归六黄汤内含有地黄、当归、黄芩等，都是阻滞痰湿、闭塞气机的药味，桔梗也不适宜。医书说：下虚者及怒气上升者皆不可用，所以要谨慎。于是我用柴胡、黄连作为君药，白芍、甘草、天花粉作为臣药，红花、连翘作为佐药，龙胆草作为使药。服用后，虽然出汗依旧，但疼痛减少了三分之一，可以安睡了。第二天仍用前药，疼痛又减半，第三天再服，左右转动如常，饮食也增加了。
在我未到之前，徐公已经先去迎接姑苏盛氏，盛公是他幼时的窗友，家世世代代行医。徐公起初不急着请我，每天伸长脖子期盼盛公到来，认为可以铲除腐朽（指纠正错误的治疗）。盛公到达诊脉完毕后，随即责问曾用过什么药剂，徐公拿出我开的方子给盛公看，盛公大声惊呼称错误，认为正当隆冬季节，出汗如此之多，阳气大泄，怎么敢以柴胡为君药？喉中痰既未清，又为何不用桔梗和当归六黄汤？前贤已经验证过的药置而不用，这是舍弃纪律而追求野战（指不按常规治疗）。于是取来六黄汤加桔梗进服。徐公一向信任盛公，便倾心听从，迅速煎服，不到一个时辰，旧病随即发作，各种症状加重，左右再次不能转动，从戌时直到子丑时，痛苦难以支撑。
有内侍对他说：服用孙君的药虽然未能全愈，但也去除了过度严重的症状，他曾说过这两种药不可用，为何轻率冒犯而受此苦？应该立即取孙君的药煎饮，喝下后即伏枕熟睡，到天亮才醒来。派人速召我来，叩问我：人说隆冬汗出不当用柴胡，而您却用作君药，是何用意？我说：胆与肝互为表里，肝胆之火郁结而不能发散故疼痛，疼痛至极而出汗，汗出后疼痛减轻，这是火随汗出，盖汗乃是邪气排出的门户。所以我曾说：汗不可收敛。本草说：柴胡泻肝胆火，而以黄连辅助它。《内经》说：木郁则达，火郁则发。意思是应当顺应其特性而引导它。势态就容易克服。古人治火的方法，轻症用正治法，重症则顺从其特性而升发它。以此为例，医术贵在通变，如阴虚火动而汗出者，体内没有多余的邪气，所以用六黄汤收敛并下降它，这是常规治疗方法。如今体内有余邪未出，急于收敛下降，邪气无从排出，势必成毒，所以变常规而从治法，使邪气有出路，木火的特性不逆乱，则毒不成而疼痛可减。
徐公说：好啊！孙君的药剂，奇正相生，不亚于孙武子的兵法，为何轻视地议论无纪律呢？愿投药而奏凯歌。我说：公数日后疮疡大发，两胯且有肿块作痛，这是毒气外发的征兆，公此时不要惊恐。改用柴胡、白芍、甘草、丹参、苦参、茯苓、瞿麦、车前子、黄柏、金银花、连翘，服用三日，疼痛全减，汗全收，左右又能转动了。过了几天，公说肌肤很痒，累累然像瘾疹，难道是疮出来了吗？想用药物洗浴可以吗？我说：可以。再过三天，两胯果然发出如棋子大小的肿块数枚，并且疼痛。我已经制备好蜡矾丸等待此时，到这时授给他服用。疮果然遍身大发，两腿尤其严重，一月多而痊愈。徐公开始相信我省毒的话不谬误，倾诉真情交欢，并作序记述胜利，期望终身不废弃。
Scholar Xu Jianlao had a robust and fleshy physique and enjoyed drinking, which led to "Changfeng" (Intestinal Wind, a condition characterized by hematochezia). The amount of blood he passed amounted to several buckets, leaving him extremely debilitated. In the mid-winter of the Ji-Mao year, he suffered from severe pain in his right hypochondrium, radiating up to behind the ear, worsening at night. He could not turn his body left or right; movement exacerbated the pain. His appetite decreased, his complexion turned greenish, and he sweated profusely like rain when closing his eyes, soaking his clothes and bedding, so he dared not close his eyes to sleep. Clan physicians administered Xiangfu (Cyperi Rhizoma), Qingpi (Aurantii Fructus Pericarpium), and acrid-dispersing formulas, but the pain intensified, sweating increased, and his complexion became greener.
I examined his pulse: both Cun positions were short and weak; the Left Guan position was wiry and forceful against the finger; the Right Guan position was deep and slippery; all six pulses were rapid, approaching seven beats per breath cycle. I said: Based on the pain located in the Shaoyang meridian distribution, it likely originated from anger. The nature of Wood and Fire moves upward rather than downward, hence the upward rush to the area behind the ear causing pain. The worsening of pain at night is because the night belongs to Liver Qi dominance. As stated in the *Neijing* (Classic of Internal Medicine): The Liver governs free flow and excretion. With pathogenic factors in the Liver and Gallbladder, closing the eyes triggers massive sweating. There is originally damp-phlegm in the Middle Jiao. The treatment principle should focus on regulating the Liver, clearing heat, and resolving toxicity, combined with promoting urination. One must not hastily stop sweating, as this would block the exit for pathogens. Currently, the pulse is large and rapid. If one hastily astringes sweat, it goes against the nature of Wood and Fire. Not only will the pain worsen, but carbuncles may erupt, causing grave harm. The *Neijing* states: Changes from rich and fatty foods can generate major Ding sores; prevention is necessary.
The Duke asked: Why are astringent formulas considered unsuitable? I replied: Danggui Liuhuang Tang contains Dihuang (Rehmanniae Radix), Danggui (Angelicae Sinensis Radix), and Huangqin (Scutellariae Radix), which are substances that stagnate phlegm and obstruct Qi. Jiegeng (Platycodonis Radix) is also inappropriate. Medical texts state: These are contraindicated for those with deficiency below and those whose Qi rises due to anger; thus, caution is required. Therefore, I used Chaihu (Bupleuri Radix) and Huanglian (Coptidis Rhizoma) as Sovereign herbs, Baishao (Paeoniae Radix Alba), Gancao (Glycyrrhizae Radix et Rhizoma), and Tianhuafen (Trichosanthis Radix) as Ministers, Honghua (Carthami Flos) and Lianqiao (Forsythiae Fructus) as Assistants, and Longdancao (Gentianae Radix) as Envoys. After ingestion, although sweating persisted, the pain reduced by one-third, allowing him to sleep. The next day, using the same prescription, the pain halved again. On the third day, after another dose, he could turn his body normally, and his diet improved.
Before my arrival, the Duke had gone to welcome Sheng Shi from Gusu, a childhood friend who came from a family of physicians. Initially, the Duke did not urgently summon me, eagerly awaiting Sheng’s arrival to correct the errors ("cut away the dead and clear the rot"). When Sheng arrived and finished diagnosing, he questioned what formulas had been used. The Duke showed Sheng my prescription. Sheng loudly exclaimed it was a mistake, arguing that in the depth of winter, with such profuse sweating indicating massive Yang Qi depletion, how could Chaihu be used as the Sovereign herb? Furthermore, since phlegm remained in the throat, why not use Jiegeng and Danggui Liuhuang Tang? Disregarding proven prescriptions of past sages is like abandoning military discipline for reckless battle. Sheng then prepared Liu Huang Tang added with Jiegeng for administration. Trusting Sheng implicitly, the Duke complied, and the decoction was taken quickly. Within a short time, the old illness returned, all symptoms worsened, and he could no longer turn his body. From Xu hour until Zi-Chou hours, he suffered unbearable agony.
An attendant told him: Although Sun Jun’s medicine did not fully cure you, it had alleviated the extreme severity. He explicitly warned against these two types of medicines. Why did you recklessly violate this advice and suffer thus? You should immediately take Sun Jun’s medicine. Upon drinking it, he fell into a deep sleep on his pillow, waking only at dawn. The Duke sent for me and asked: People say Chaihu should not be used in winter with sweating, yet you used it as the Sovereign herb. What is your rationale? I replied: The Gallbladder and Liver are exterior-interior pairs. Pain arises from the stagnation and inability to disperse Fire in the Liver and Gallbladder. Extreme pain leads to sweating; the reduction of pain after sweating indicates that Fire exits via sweat. Sweat is the gateway for pathogen expulsion. Hence, I said sweat should not be astringed. Materia Medica states: Chaihu drains Liver-Gallbladder Fire, assisted here by Huanglian. The *Neijing* states: When Wood is stagnant, facilitate its flow; when Fire is stagnant, vent it. This means one should follow their nature to guide them, making the pathological trend easier to overcome. Ancient methods for treating Fire involve direct treatment for mild cases and following the nature to ascend/vent for severe cases. Medicine values adaptability. For instance, in cases of Yin deficiency with Fire hyperactivity causing sweating, where there are no excess pathogens internally, Liu Huang Tang is used to astringe and descend; this is the standard method. However, now there are excess pathogens internally that have not exited. Hasty astringency and descent would trap the pathogens, inevitably leading to toxicity. Therefore, deviating from the standard to treat according to the nature allows an exit for pathogens. If the nature of Wood and Fire does not rebel, toxicity will not form, and pain will subside.
The Duke said: Excellent! Sun Jun’s formula employs the interplay of orthodox and unorthodox strategies, rivaling Sun Tzu’s Art of War. How could one dismiss it as undisciplined? I wish to administer the medicine and achieve victory. I predicted: In a few days, sores will erupt vigorously, and masses will appear in both groins causing pain. This is a sign of toxin expelling outward. Do not fear. I changed the prescription to Chaihu, Baishao, Gancao, Danshen (Salviae Miltiorrhizae Radix), Kushen (Sophorae Flavescentis Radix), Fuling (Poria), Qumai (Dianthi Herba), Cheqianzi (Plantaginis Semen), Huangbai (Phellodendri Cortex), Jinyinhua (Lonicerae Japonicae Flos), and Lianqiao. After three days, pain ceased completely, sweating stopped, and mobility returned.
Later, the Duke reported intense itching over his skin, resembling urticaria, asking if sores were emerging and if herbal baths were appropriate. I agreed. Three days later, nodules the size of chess pieces appeared in both groins, accompanied by pain. I had prepared La Fan Wan (Beeswax and Alum Pills) for this occasion and administered them. Sores indeed erupted all over the body, especially on the legs. After more than a month, he recovered. The Duke finally believed my warning about preventing toxicity was correct. We shared sincere friendship, and he wrote a preface commemorating the success, pledging our lifelong professional alliance.