门人问曰。崇明蒋中尊病伤寒。临危求肉汁淘饭半碗。食
毕。大叫一声而逝。此何故也。答曰。今人外感病。兼内伤者多。用药全要分别。如七分外感。三分内伤。
则治外感药中。宜用缓剂小剂。及姜枣和中为引。庶无大动正气汗血等累。若七分内伤。三分外感。则用药
全以内伤为主。但加入透表药一味。而热服以助药势。则外感自散。盖以内伤之人。才有些微外感。实时
发病。不似壮盛之人。必所感深重。其病乃发也。蒋中尊者。向曾见其满面油光。已知其精神外用。非永寿
之人也。人惟 然不足。方有余地。可以应世。可以当病。若夫神采外扬。中之所
存。宁复有几耶。近闻其宦情与声色交浓。宵征海面。冒蜃烟蛟雾之氛。尚犯比顽之戒。则其病纯是内伤。
而外感不过受雾露之气耳。雾露之邪。其中人也。但入气厘清道。原不传经。故非
发表攻里所能驱。惟培元气。浓谷气。则邪不驱而自出。设以其头晕发热。认为太阳之证。误表其汗。则内
伤必转增。而危殆在所必致矣。且内伤之人。一饱一饥。早已生患。又误以为伤寒而绝其食。已虚益虚。
致腹中馁惫。求救于食。食入大叫一声者。肠断而死也。此理甚明。如饥民仆地即死。气从中断。不相
续也。又如膈病。展转不能得食。临危每多大叫而逝。以无外感之邪乱其神明。是以炯炯自知其绝也。果有
外邪与正交争。其人未死前。先已昏惑不省矣。安得精明若是哉。子于望闻问切之先。早清其鉴可矣。
门人又问曰。每见人之神采外扬者。病发恒多汗而躁急。不识何药可以治之。答曰。上药在以神治神。盖
神既外扬。必须内守。方可逆挽。老子所谓知其雄守其雌。知其白守其黑。真对证之药也。若夫草木之性。则
取其气下达而味沉浓者。用之恒使勿缺。仿灌园之例。频频预沃之以水。而防其枯竭可也。
门人又问曰。临危索饭之时。尚有药可救否。曰。独参汤可以救之。吾尝治一孕妇伤寒。表汗过后。忽
唤婢作伸冤之声。知其扰动阳气。急迫无奈。令进参汤。不可捷得。遂以白术三两。
熬浓汁一碗与服。实时安妥。况人参之力百倍白术耶。
学生问道：“崇明县的蒋中尊得了伤寒病。在病情危重时，他要求用肉汤淘半碗饭吃。吃完后，大叫一声便去世了。这是什么原因呢？”
我回答说：“现在的人患外感病，往往兼有内伤，用药必须严格区分。如果是七分外感、三分内伤，那么治疗外感的药物应当使用缓和的剂量和小剂量的方药，并加入生姜、大枣作为调和脾胃的引经药，这样才能避免过度耗动正气，导致大汗淋漓或耗伤血液等弊端。如果是七分内伤、三分外感，那么用药应完全以内伤为主，只需加入一味透表散邪的药物，并热服以助药力发挥，这样外感之邪自然消散。这是因为内伤之人，只要有一点轻微的外感，就会立刻发病，不像身体强壮的人，必须感受深重的邪气才会发病。
蒋中尊这个人，我曾见过他满面油光，就知道他是精神向外耗散的人，不是能够长寿的人。人只有内在精气不足（指内敛含蓄），才有余地应对世事和疾病。如果神采外露张扬，那么体内所存的真元还有多少呢？近来听说他的做官欲望与声色享乐交织浓厚，夜间在海面上奔波，冒着海市蜃楼和蛟龙雾气般的恶劣环境，还触犯了好斗的禁忌。那么他的病纯粹是内伤，而所谓的外感不过是受了雾露之气罢了。雾露这种邪气，侵入人体时，只进入气道清肃之道，原本不会传入经络，所以不是发汗解表或攻下里实所能驱除的。只有培补元气、充实谷气，邪气不驱自退。假如因为头晕发热，就认为是太阳病（太阳经受邪所致的病证），误用发汗法，那么内伤必然加重，危殆局面在所难免。况且内伤之人，一饱一饥早已产生隐患，又误以为是伤寒而禁止饮食，使得本已虚弱的身体更加虚弱，导致腹中饥饿疲惫，向食物求救。食物入口后大叫一声而死，是因为肠断而亡。这个道理很明白，就像饥饿的百姓倒在地上立即死亡，是因为气从中断，不能接续。又如膈噎病（食管阻塞类疾病）患者，辗转反侧无法进食，临终前往往大叫一声而逝，这是因为没有外感邪气扰乱神明，所以清楚地知道自己即将离世。如果确实有外邪与正气交争，人在死之前，早就已经神志昏乱、不省人事了，怎么能如此精明清醒呢？你在望、闻、问、切四诊之前，就应该早看清本质了。”
学生又问道：“经常看到那些神采外露的人，发病时常多汗且急躁不安，不知道用什么药可以治疗？”
我回答说：“上等的治疗方法是以神治神。既然神气已经外扬，必须使其内守，才能逆转挽回。老子所说的‘知其雄，守其雌；知其白，守其黑’，就是针对这种情况的真正对症之药。至于草木药物的性质，则选取气味下达且味道沉浓的药物，使用时务必不要间断。这好比浇灌园圃一样，频繁地预先浇水，以防止干枯。”
学生又问道：“在临终索要米饭的时候，还有药可以救治吗？”
我说：“独参汤（单用人参煎煮的汤剂）可以救治它。我曾经治疗过一个孕妇患伤寒，经过发汗解表治疗后，忽然叫婢女为她喊冤，我知道这是扰动阳气，急切无奈所致，于是让人进服人参汤。因为人参一时难以得到，就用白术三两，熬成浓汁一碗让她服用，随即安稳下来。何况人参的力量是白术的百倍呢。”
A student asked, "Mr. Jiang Zhongzun from Chongming contracted Shanghan (Cold Damage). When his condition became critical, he requested half a bowl of rice washed with meat broth. After eating it, he let out a loud cry and passed away. What is the reason for this?"
I replied, "Currently, many patients suffering from external contraction diseases also have internal injury. Medication must be carefully differentiated. If the condition is seventy percent external contraction and thirty percent internal injury, the medication for the external contraction should use mild agents in small doses, accompanied by Ginger and Jujube as guides to harmonize the middle jiao. This way, there will be no excessive disturbance of the righteous qi, leading to complications such as profuse sweating or loss of blood. If the condition is seventy percent internal injury and thirty percent external contraction, the medication should focus entirely on treating the internal injury, adding only one herb that releases the exterior. It should be taken hot to assist the medicinal power, so that the external contraction will naturally dissipate. This is because people with internal injury will fall ill immediately upon encountering even slight external pathogens, unlike robust individuals who require deep and heavy pathogenic invasion before illness manifests.
Regarding Mr. Jiang, I once observed his face was shiny with oil, knowing he was someone whose spirit was externally dissipated, not one destined for longevity. Only when a person's essence is inwardly contained (lacking outward display) is there room to navigate the world and withstand disease. If one's spiritual brilliance is displayed externally, how much true essence remains within? Recently, I heard that his ambition for officialdom and indulgence in sensual pleasures were intense. He traveled at night on the sea surface, exposing himself to the miasma of mirages and dragon fogs, and still violated taboos against reckless behavior. Thus, his illness was purely internal injury, and the so-called external contraction was merely exposure to mist and dew. The pathogen of mist and dew, upon entering the human body, enters only the clear pathways of the qi mechanism and does not transmit through the meridians. Therefore, it cannot be expelled by diaphoresis (sweating methods) or purgation. Only by tonifying the primordial qi and enriching the grain qi can the pathogen exit spontaneously without being forcibly driven. If one mistakes dizziness and fever for Taiyang disease (a syndrome caused by pathogenic invasion of the Taiyang channel) and erroneously induces sweating, the internal injury will inevitably worsen, leading to a critical and dangerous situation. Moreover, people with internal injury already suffer from fluctuations between fullness and hunger. Misdiagnosing this as Shanghan and denying them food makes their existing deficiency even more severe, causing emptiness and fatigue in the abdomen, leading them to seek relief through food. The loud cry upon eating indicates rupture of the intestines and death. This principle is clear: just as starving people collapse and die instantly because their qi is interrupted and cannot continue, so too do patients with Ge Disease (dysphagia/esophageal obstruction) often cry out loudly before dying as they struggle unable to eat. This occurs because there is no external pathogen disturbing their shen (spirit), allowing them to clearly perceive their impending demise. If there were truly an external pathogen contending with the righteous qi, the person would have become confused and unconscious long before death. How could they remain so lucid? You should have discerned this truth clearly before employing observation, listening/smelling, inquiry, and palpation."
The student asked again, "I often see people with externally displayed spirit who, when ill, sweat excessively and become irritable. I do not know what medicine can treat this."
I replied, "The highest method is to treat the shen with the shen. Since the spirit has flown outward, it must be retained inward to reverse the decline. As Laozi said, 'Know the masculine, keep to the feminine; know the white, keep to the black.' This is the true antidote for this condition. Regarding the nature of herbal medicines, select those with descending qi and heavy, profound flavors. Use them continuously without interruption. This imitates the example of irrigating a garden: frequently watering in advance to prevent drought."
The student asked again, "At the time of requesting rice near death, was there any medicine that could have saved him?"
I said, "Dushen Tang (Decoction of Single Ginseng) could have saved him. I once treated a pregnant woman with Shanghan. After inducing sweating to release the exterior, she suddenly called her maid to cry out her injustice. I realized this indicated disturbance of the yang qi due to urgency and helplessness. I ordered the administration of Ginseng Decoction. Since Ginseng was not readily available, I used three liang of Atractylodis Macrocephalae Rhizoma (Baizhu, 白术), boiled into a concentrated decoction of one bowl, which she took. She stabilized immediately. Besides, the efficacy of Panax Ginseng Radix et Rhizoma (Renshen, 人参) is a hundred times that of Atractylodis Macrocephalae Rhizoma."