夫病有浅深，治有缓急。（体认病情，而用药缓急合当，乃医家第一要着。）若急病而用缓药，是养杀人也。缓
病而用急药，是逼杀人也。庸医遇病，不能必其何名，亦不能必其当用何药，概以温平试之。若缓病尚可，设遇大病则
为误不小，故名养杀人。若缓病投以急药，是欲速其效，殊不知攻急则变生，所谓逼杀人也。（二者之误，今世医家比
比，胆怯者蹈养杀之弊，心粗者逞逼杀之害。医本生人，乃为杀薮，悲哉！）
余观京师名医吕实者，亦熟此法，但不早用，惟先用温平药调治，及至危笃，方议灼艾丹附等事，多不效，乃曰∶
此天命也。殊不知救挽已迟，藏气败绝，虽灵丹妙药，无能为矣。余亲见彼治一伤寒第五日，昏睡谵语，六脉洪大，以
为胃中有热，以承气下之，四更即死矣。六脉之大，非洪也，乃阳气将脱，故见此耳。治以下药，更虚其阴，则阳无
所附而死速矣。若先于脐下灸三百壮，固住脾肾之气；内服
保元丹、敛阳丹，饮姜附汤，过三日，自然汗出而愈。余治一伤寒，亦昏睡妄语，六脉弦大。余曰脉大而昏睡。
定非实热，乃脉随气奔也，强为之治。（先生真仁人也，强治之心，余颇有之，第以人不我信，且又碍于言讷
而不肯为，究非真行仁术之人，常以此自愧。）用烈火灸关元穴，初灸病患觉痛，至七十壮遂昏睡不疼，灸至
三鼓，病患开眼，思饮食，令服姜附汤。至三日后，方得元气来复，大汗而解。（今时姑息成风，灸法难行，
余尝叹曰∶人参虽救命之品，姜附尤有回阳之功，无如世人不识，俗医痛扫，良可慨也。）余思前证，少阴病
也。发昏谵语，全似阳证，若时投以承气，岂得不死。故耳聋不呻吟，身生赤黑靥，而十指冷至脚面，身重如
山，口多痰唾，时发躁热者，皆少阴证也。仲景以耳聋系之少阳，谵语归之阳明，用柴胡承气辈误人不少。夫
但知少阳脉循胁络耳，却不思耳窍属肾，以耳聋归少阳，此仲景所未到之处也。（耳聋仲景作宗气虚论，未尝
归少阳。至于谵语，论中言神气虚者多，若阳明证中不过数条而已，先生故加贬驳，未免有意索瘢。）
疾病有浅层和深层的区别，治疗也有缓慢和紧急的不同。（认清病情，从而选择用药的缓急得当，这是医家的第一要务。）如果急症却使用缓药，这是在助长病邪而杀人。如果是慢性病却使用急药，这是在逼迫病势而杀人。平庸的医生遇到疾病，不能确定是什么病名，也不能确定应当用什么药，一概用温和平和的药物来试探。如果是慢性病还可以，如果遇到大病就会造成不小的误治，所以称为“养杀”（因延误而致死）。如果在慢性病上投以急药，是想要快速见效，却不知道攻伐过急会导致变证产生，这就是所谓的“逼杀”（因攻伐太过而致死）。（这两种错误，当今世间的医生比比皆是，胆怯的人陷入“养杀”的弊端，粗心的人逞强导致“逼杀”的危害。医学本是救人的，却成了杀人的渊薮，可悲啊！）
我观察京师的名医吕实，也熟悉这种方法，只是不早点使用，总是先用温和平和的药物调理，等到病情危重时，才讨论施灸、使用丹剂和附子等事情，大多没有效果，于是说：“这是天命。”殊不知此时挽救已经太迟，脏腑之气败绝，即使是灵丹妙药，也无能为力了。我亲眼见他治疗一例伤寒第五天的病人，昏睡且胡言乱语，六脉洪大，他认为胃中有热，用承气汤攻下，病人四更天就死了。那六脉之大，并非洪脉，而是阳气即将脱失，所以出现这种脉象。用下药治疗，更加虚弱其阴液，那么阳气无所依附而死得更快了。如果先在脐下灸三百壮，以固住脾肾之气；内服保元丹、敛阳丹，饮用姜附汤，过了三天，自然出汗而痊愈。
我治疗一例伤寒病人，也是昏睡且胡言乱语，六脉弦大。我说：脉大而昏睡，定不是实热，而是脉随气机奔散所致，勉强进行治疗。（先生真是仁人，我也常有这种强行救治之心，只是因人不信任我，且又碍于口拙而不肯去做，终究不是真正施行仁术的人，常以此自愧。）我用烈火灸关元穴，刚开始灸时病人觉得痛，灸到七十壮时便昏睡不再疼痛，灸至三更天，病人睁开眼睛，想吃东西，让他服用姜附汤。到了三天后，元气才恢复，大汗出而病解。（如今姑息养奸之风盛行，灸法难以推行，我曾感叹说：人参虽是救命的药物，姜附更有回阳的功效，无奈世人不懂，庸医极力排斥，实在令人感慨。）
我思考前面的病例，属于少阴病。出现昏睡胡言乱语，完全像阳证，如果当时投用承气汤，岂能不死。所以耳聋不呻吟，身上生赤黑色斑点，十个手指冷至脚面，身体沉重如山，口中多痰唾，时常发作躁热的，都是少阴证。张仲景将耳聋归属于少阳经，将胡言乱语归属于阳明经，使用柴胡、承气之类的方剂误人不小。只知道少阳经脉循行经过胁肋联络耳朵，却不思考耳窍属于肾，将耳聋归为少阳，这是张仲景未曾深入探讨的地方。（耳聋在张仲景著作中作宗气虚论述，并未归为少阳。至于胡言乱语，论中说神气虚的多，若阳明证中不过几条而已，先生故加贬驳，未免有些吹毛求疵。）
Diseases vary in depth, and treatments differ in urgency. (Recognizing the condition of the disease and selecting the appropriate pace of medication is the primary concern for physicians.) If urgent conditions are treated with slow-acting remedies, it nurtures the pathogen and kills; if chronic conditions are treated with aggressive remedies, it forces the pathology and kills. Mediocre doctors, upon encountering a disease, cannot determine its name nor the appropriate medication, generally testing with mild and neutral drugs. For chronic conditions, this may suffice, but for major diseases, it causes significant mismanagement, hence termed "nurturing death" (death due to delay). If aggressive drugs are used for chronic conditions, it seeks rapid efficacy, not realizing that excessive attack generates complications, which is termed "forcing death" (death due to over-treatment). (These two errors are common among modern physicians; those who are timid fall into the trap of "nurturing death," while those who are careless cause "forcing death." Medicine is meant to save lives, yet becomes a reservoir of killing—how tragic!)
I observed Lü Shi, a renowned physician in the capital, who was familiar with this method but applied it too late. He initially used mild and neutral drugs for regulation, and only when the condition became critical did he consider moxibustion, pills, and Aconite preparations, mostly without effect. He then claimed, "It is destiny." Little did he know that rescue was already too late; the Zang-Fu Qi had collapsed, rendering even miraculous medicines ineffective. I witnessed him treat a case of Shanghan (Cold Damage) on the fifth day, where the patient was comatose and delirious, with six pulses appearing surging (Hong). He diagnosed heat in the Stomach and administered Chengqi Tang (Gut-Clearing Decoction) to purge. The patient died at the third watch (4–6 AM). The magnitude of the six pulses was not truly surging but indicated impending collapse of Yang Qi. Using purgatives further depleted Yin, leaving Yang without attachment, thus accelerating death. Had he first applied three hundred moxa cones below the navel to secure Spleen and Kidney Qi, and internally administered Baoyuan Dan (Protect the Origin Pill), Lianyang Dan (Astringe Yang Pill), and Jiangfu Tang (Ginger and Aconite Decoction), after three days, natural sweating would have occurred, leading to recovery.
I treated another Shanghan case presenting with coma and delirium, with string-taut and large pulses. I stated: Large pulses with coma indicate not excess heat, but Qi scattering with the pulse; I treated it reluctantly. (The Master is truly benevolent; I share this heart for forced treatment, but due to lack of trust from others and my own speech impediment, I often refrain, feeling ashamed that I am not truly practicing benevolent medicine.) I applied intense fire moxibustion to Guanyuan (CV 4). Initially, the patient felt pain, but by seventy cones, fell into a painless sleep. By the third watch, the patient opened his eyes, desired food, and was given Jiangfu Tang. After three days, Yuan Qi (Primal Qi) recovered, and the disease resolved through profuse sweating. (Today, indulgence has become the norm, and moxibustion is difficult to practice. I sigh: although Ginseng saves lives, Ginger and Aconite restore Yang power. Yet people do not understand, and vulgar physicians vehemently reject them, which is lamentable.)
Reflecting on the previous cases, they were Shaoyin diseases. Coma and delirium resemble Yang syndromes; had Chengqi Tang been administered immediately, death would have been inevitable. Therefore, deafness without groaning, red-black spots on the body, cold fingers extending to the feet, heaviness like a mountain, excessive phlegm and saliva, and intermittent restlessness/heat are all Shaoyin signs. Zhang Zhongjing attributed deafness to Shaoyang and delirium to Yangming, using Chaihu (Bupleurum) and Chengqi formulas, misleading many. Knowing only that the Shaoyang meridian runs along the flanks and connects to the ears, he failed to consider that the ear orifices belong to the Kidney. Attributing deafness to Shaoyang is an area Zhang Zhongjing did not fully explore. (Zhang Zhongjing discussed deafness as deficiency of Zong Qi (Gathering Qi), not attributing it to Shaoyang. Regarding delirium, the text mentions deficiency of Shen Qi (Spirit Qi) frequently, with only a few lines regarding Yangming. The Master’s criticism seems somewhat nitpicking.)