文贵者，善为族文学，岐原出入子母者也，寓长兴邸中，病发热，昼夜不止，口渴，
齿燥，
鼻干，舌苔黄浓，不得眠。服药不效。予适至雉城，岐原邀诊之。脉俱洪数，呕恶，胸膈痞
懑
，小水短而赤，大便下皆清水。予以石膏七钱、知母五钱，甘草一钱，软柴胡五钱，葛根三
钱，黄芩二钱，枳壳、竹茹、桔梗各一钱，连进三帖，呕恶止，胸膈宽，热仍未退，无汗，
泻
未止也。时有问予者，谓胡不用柴苓汤而退热止泻也。服石膏故益泻耳。予戏之曰∶予乃三
脚猫耶，能认此为何症用柴苓汤也？仍以柴胡、石膏各七钱为君，葛根、知母各五钱为臣，
黄芩、甘草各一钱为佐，生姜五片，速进二帖，汗则津津然出，热退泻止，口不渴而眠矣。
予因他往，留药三帖而嘱之曰∶胃气初回，势必思食，宜谨慎不可多进，若多则余热复作，
必成食复，治将费手也。慎之!慎之!后五日，果以食不慎而复病。予又至，热较前为重，且
加懊 ，夜谵语如见鬼状，口大渴，齿燥，舌焦黑有芒刺，势甚危急，以前方加枳实、栀了
各三钱，淡豆豉二钱煎饮之，二帖懊 止，余症犹然，夜更甚，前方减去豆豉，加黄连、麦
冬、生地、白芍，一日二帖，舌以井水生姜擦去黑苔，用蜜调玄明粉涂之而胎去矣。服三日
，始得微汗，诸症尽减，再四叮咛慎饮食，调理半月而全。岐原问曰∶人始皆认此症为漏底
伤寒，谓叔不用柴苓汤退热止泻，而用石膏为非，乃竟以石膏收功，何也？予曰∶此问甚善
。盖医贵认症，此症乃少阳、阳明合病也，柴胡、白虎汤、葛根为二经对症之药，服之可解
肌热，止口渴。若柴苓汤为太阳、少阳合病之剂，内有五苓散，乃太阳经之里药，症非太阳
，曷敢用之？且其内有人参、白术、肉桂，皆助热发燥之味，误投则必发斑。其齿燥舌干而
焦黑，又何敢用茯苓、泽泻、猪苓利之，使益亡其津液耶？古人谓∶以伤寒为大病，不察症
而
误投，则生死立见。《伤寒论》有言，不得汗，不得下，不得利小便，是谓三禁。故曰∶少
阳、阳明不从标本，从乎中治。小柴胡、白虎汤中治剂也。人徒见其大便作泻为漏底，不察
泻皆清水无糟粕者，为热极所致，症乃春温时疫也。但为发散，使清气上升而微有汗，泻当
自止。此泻岂五苓散所能止哉？止则误事。岐原曰∶夜重如见鬼者，何以故？予曰∶热入血室
故也。岐原曰∶男子亦有血室乎？予曰∶血室男妇同之，冲任二脉为血之海，二脉附于阳明
，今病乃阳明之热，遗入血海也。故加生地、白芍而效。余治伤寒，用柴葛解肌汤及柴胡白
虎汤而热不解者，加此二味，则热无不退，汗无不出矣。且下午与夜又阴分主事，欲解血海
之热，必投此二味以收其功，此亦予一得之愚也。岐原曰∶善。愿记之，以诏后来。
文贵者，擅长为家族撰写文章，是岐原（孙一奎）出入于其母家与父家之间的亲戚，居住在长兴的客栈中。他患病发热，昼夜不停，口渴，牙齿干燥，鼻子干涩，舌苔黄厚浓腻，无法入睡。服药后无效。我恰好到达雉城，岐原邀请我为他诊治。脉象均洪大且数急，伴有呕吐恶心，胸膈部痞塞闷胀，小便短少且颜色红赤，大便排出的全是清水。我给予石膏七钱、知母五钱、甘草一钱、软柴胡五钱、葛根三钱、黄芩二钱、枳壳、竹茹、桔梗各一钱，连续服用三帖后，呕吐恶心停止，胸膈感到宽舒，但热势仍未消退，无汗，腹泻也未停止。当时有人问我，为什么不用柴苓汤来退热止泻呢？认为是服用石膏导致腹泻加重。我开玩笑说：我是那种技艺不精的“三脚猫”吗？能认出这是什么病症而使用柴苓汤呢？仍然以柴胡、石膏各七钱作为君药，葛根、知母各五钱作为臣药，黄芩、甘草各一钱作为佐药，生姜五片，快速进服两帖，随后汗液微微渗出，热退泻止，口不再渴并能安睡。
因为我因其他事情外出，留下三帖药并嘱咐他说：胃气刚刚恢复，必然想要进食，应当谨慎，不可多吃，如果吃多了，余热会再次发作，必定形成“食复”（因饮食不当导致的病情复发），治疗将会棘手。千万小心！千万小心！五天后，果然因为饮食不慎而病情复发。我又赶到，热势比之前更重，并且增加了心中烦闷懊恼、夜间说胡话像看见鬼怪一样的症状，口中极度口渴，牙齿干燥，舌苔焦黑且有芒刺，形势非常危急。我用前方（原方）加入枳实、栀子各三钱，淡豆豉二钱煎服，服用两帖后，懊恼感停止，其余症状依旧，夜间更加严重。我在前方中去掉豆豉，加入黄连、麦冬、生地、白芍，一天服用两帖，用井水浸泡过的生姜擦拭去除舌上黑苔，用蜂蜜调和玄明粉涂抹舌头以去除舌苔。服用三天后，才得到微汗，所有症状全部减轻。我再四叮嘱要谨慎饮食，调理半个月后完全康复。
岐原问道：人们起初都把这个病症认为是“漏底伤寒”，认为您不用柴苓汤退热止泻，而用石膏是错误的，竟然最终靠石膏治愈，这是为什么呢？我说：这个问题问得很好。医学贵在辨识病症，这个病症属于少阳病和阳明病合病。柴胡、白虎汤、葛根是针对这两经对症的药物，服用后可以解除肌表之热，止住口渴。如果柴苓汤是用于太阳病和少阳病合病的方剂，其中含有五苓散，那是针对太阳经里证的药物，此症并非太阳病，怎敢使用它？况且其中含有人参、白术、肉桂，都是助热发燥的药味，误用则必定导致发斑疹。患者牙齿干燥、舌干焦黑，又怎敢使用茯苓、泽泻、猪苓来利尿，使津液进一步亡失呢？古人说：把伤寒当作大病，不仔细辨证而误投药物，那么生死立刻显现。《伤寒论》中有言，不得发汗，不得攻下，不得利小便，这称为“三禁”。所以说：少阳病和阳明病如果不从标本论治，就从“中治”法处理。小柴胡汤和白虎汤属于中治的方剂。人们只看到大便泄泻以为是“漏底”，不观察泻下的全是清水而无食物残渣，这是热极所致，此症乃是春温时疫。只要通过发散的方法，使清气上升并微微出汗，腹泻自然会停止。这种腹泻难道是五苓散所能止住的吗？强行止泻则会耽误病情。
岐原问：夜间症状加重像看见鬼怪一样，是什么原因？我说：这是热邪陷入血室的原因。岐原问：男子也有血室吗？我说：男女都有血室，冲脉和任脉是血的海洋，这两条经脉依附于阳明经，现在的病症是阳明经的热邪，传入血海之中。所以加入生地、白芍而见效。我治疗伤寒，使用柴葛解肌汤及柴胡白虎汤而热势不退的，加上这两味药，则热无不退，汗无不出。而且下午和夜晚又是阴分主事的时间，想要解除血海之热，必须投用这两味药才能收效，这也是我的一点心得愚见。岐原说：好。愿意记录下来，以告知后来的人。
Wen Gui, who was skilled in composing literary works for his clan, was a relative of Qiyuan (Sun Yikui) moving between his maternal and paternal households. He resided in an inn in Changxing. He suffered from fever that persisted day and night, accompanied by thirst, dry teeth, dry nose, thick yellow tongue coating, and insomnia. Medication proved ineffective. I happened to arrive at Zhicheng, and Qiyuan invited me to diagnose him. The pulse was uniformly surging (Hong) and rapid (Shu), with vomiting and nausea, chest and diaphragm fullness and oppression, scanty dark red urine, and the passage of only clear water in the stool. I prescribed Shigao (Gypsum Fibrosum) 7 qian, Zhimu (Anemarrhenae Rhizoma) 5 qian, Gancao (Licorice Root) 1 qian, Ruan Chaihu (Bupleuri Radix) 5 qian, Gegen (Puerariae Lobatae Radix) 3 qian, Huangqin (Scutellariae Radix) 2 qian, Zhike (Aurantii Fructus Immaturus), Zhuru (Bambusae Caulis in Taenia), and Jiegeng (Platycodonis Radix) each 1 qian. After taking three doses consecutively, the vomiting and nausea ceased, and the chest and diaphragm felt relaxed, but the fever remained unsubsided, there was no sweat, and diarrhea continued.
Someone asked me why I did not use Chailing Tang (Bupleurum and Pinellia Decoction) to reduce fever and stop diarrhea, suggesting that the Gypsum had exacerbated the diarrhea. I jokingly replied, "Am I an incompetent doctor ('three-legged cat')? How could I recognize this as a syndrome suitable for Chailing Tang?" I retained Chaihu (Bupleuri Radix) and Shigao (Gypsum Fibrosum) each at 7 qian as the sovereign drugs (Jun), Gegen (Puerariae Lobatae Radix) and Zhimu (Anemarrhenae Rhizoma) each at 5 qian as the minister drugs (Chen), Huangqin (Scutellariae Radix) and Gancao (Licorice Root) each at 1 qian as the assistant drugs (Zuo), along with five slices of Shengjiang (Zingiberis Rhizoma Recens). Administered quickly over two doses, profuse sweating ensued, the fever subsided, diarrhea stopped, thirst ceased, and sleep returned.
Due to other engagements, I left three additional doses and instructed him: "Your Stomach Qi has just recovered; you will naturally desire food. Be cautious and do not overeat. If you eat too much, residual heat may recur, leading to 'food relapse' (Shi Fu), making treatment difficult. Be very careful!" Five days later, indeed, he fell ill again due to dietary indiscretion. Upon my return, the fever was more severe than before, accompanied by deep restlessness (Ao Nu), delirium at night resembling seeing ghosts, extreme thirst, dry teeth, and a scorched black tongue coating with prickles, indicating a critical condition. I used the previous formula adding Zhishi (Aurantii Fructus) and Zhizi (Gardeniae Fructus) each 3 qian, and Danshidou (Sojae Semen Praeparatum) 2 qian. After two doses, the restlessness ceased, but other symptoms persisted, worsening at night. I removed Danshidou from the formula and added Huanglian (Coptidis Rhizoma), Maidong (Ophiopogonis Radix), Shengdi (Rehmanniae Radix), and Baishao (Paeoniae Radix Alba). Two doses were taken per day. The black tongue coating was scraped off using ginger soaked in well water, and Xuanmingfen (Natrii Sulfas Depuratus) mixed with honey was applied to the tongue to remove the coating. After three days of medication, slight sweating occurred, all symptoms significantly diminished. I repeatedly advised strict dietary control, and after half a month of regulation, he fully recovered.
Qiyuan asked: "People initially believed this syndrome was 'Leak-bottom Shanghan' (Taiyang disease with diarrhea). They argued that your refusal to use Chailing Tang to reduce fever and stop diarrhea, and your use of Gypsum, was incorrect. Yet, Gypsum ultimately achieved the cure. Why?" I said: "This is an excellent question. Medicine values accurate syndrome differentiation. This case is a combined disease of Shaoyang (Lesser Yang) and Yangming (Greater Yang). Chaihu (Bupleuri Radix), Baihu Tang (White Tiger Decoction), and Gegen (Puerariae Lobatae Radix) are specific remedies for these two meridians. Taking them can resolve muscle-layer heat and stop thirst. Chailing Tang is indicated for combined Taiyang-Shaoyang disease. It contains Wuling San (Five-Ingredient Powder with Poria), which treats interior syndromes of the Taiyang meridian. Since this is not a Taiyang syndrome, how dare I use it? Moreover, it contains Ren Shen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Rougui (Cinnamomi Cortex), all of which are hot and drying in nature. Misuse would certainly cause macules/rashes. Given the dry teeth and scorched black tongue, how could I dare use Fuling (Poria), Zexie (Alismatis Rhizoma), and Zhuling (Polyporus) to promote urination, thereby further depleting body fluids? Ancients stated: 'Consider Shanghan a major disease; if one misjudges the syndrome and prescribes wrongly, life and death are immediately decided.' The *Shanghan Lun* states: 'Do not induce sweating, do not purge, do not promote urination'; this is called the 'Three Prohibitions.' Thus, it is said: 'Shaoyang and Yangming diseases, not following the root or branch, follow the middle treatment method.' Xiao Chaihu Tang (Minor Bupleurum Decoction) and Baihu Tang (White Tiger Decoction) are middle-treatment formulas. People only see diarrhea and call it 'leak-bottom,' failing to observe that the discharge is clear water without undigested food residue, which is caused by extreme heat. This syndrome is actually Spring-Warmth seasonal epidemic. By using dispersing methods to raise clear Qi and induce slight sweating, the diarrhea should stop naturally. Could such diarrhea be stopped by Wuling San? Forcing its cessation would be detrimental.
Qiyuan asked: "Why are symptoms worse at night, resembling seeing ghosts?" I said: "This is because heat has entered the Blood Chamber (Xue Shi)." Qiyuan asked: "Do men also have a Blood Chamber?" I said: "Both men and women have a Blood Chamber. The Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel) are the sea of blood. These two vessels attach to the Yangming meridian. In this case, Yangming heat has transmitted into the Sea of Blood. Therefore, adding Shengdi (Rehmanniae Radix) and Baishao (Paeoniae Radix Alba) was effective. In my treatment of Shanghan, when fever persists despite using Chaige Jieji Tang (Bupleurum and Pueraria Decoction to Resolve the Muscle Layer) or Chaihu Baihu Tang (Bupleurum and White Tiger Decoction), adding these two herbs ensures the fever subsides and sweat emerges. Furthermore, afternoon and night are governed by the Yin aspect. To resolve heat in the Sea of Blood, these two herbs must be used to achieve success. This is my humble insight." Qiyuan said: "Excellent. I wish to record this to instruct future practitioners."