炳兄禀质多火，喜凉恶热，夏月常以冷水灌汗，露卧石地为快，素患痰火，方用生地、
丹皮
、麦冬、山栀、栝蒌、黄芩、知母等味，发时服之即安，乃至他病亦服此方，并食肚肺馄饨
汤，汗出即解。暇时向予道及，予曰∶痰火药应用凉，若凡病守服一方，似无其理。倘属伤
寒阴证，恐其误事，后当慎之。一日果患阴暑感证，寒热身痛，脉细肢冷，予投以附子理中
汤不应，再强服之，病反加重，坚不服药。索食馄饨肚肺汤，予谓荤油腻邪，戒勿与食，不
听。食后得汗反安，欲服常治痰火方，家人劝阻不可，竟服之。病却，后亦无损。予思咫尺
间，人病体质之殊若此。则南北地土不同，风气各异，其人其病又何如耶。《素问》异法方
宜论，不可不玩索也。
嘉庆甲子秋，予在邻村，偶值余朗亭先生云∶日前往富谒视一女子，病甚奇。初起无故
发
，医言是火，多投凉药，渐变损怯，今脉证俱败，此何故也?予曰∶无故发 ，事属罕闻。
若云变怯，大都清凉过剂，元气被戕耳。越日荫兄令爱，两胫 出，密密形如锦纹，诊脉和
平，询其寝食如常，别无他疾。予曰∶勿药。荫兄曰∶ 乃重候，安可勿药。因以余公所云
告之，竟听予言。后 退无恙，设当时杂投汤药，不几踵富谒女子之覆辙乎?
炳南兄的体质偏于火旺，喜欢凉爽而厌恶炎热。夏季常常用冷水冲洗汗水，露天躺在石地上感到痛快。他平时患有痰火证，处方使用生地、丹皮、麦冬、山栀、栝蒌、黄芩、知母等药物，发病时服用就能缓解。甚至其他疾病也服用这个方子，并食用肚肺馄饨汤，出汗后病症即解。闲暇时向我谈起此事，我说：“治疗痰火的药物应当用凉性药，但如果所有疾病都坚守服用同一个方子，似乎没有道理。如果属于伤寒阴证，恐怕会误事，以后应当谨慎。”
一天，他果然患上了阴暑感证（因贪凉受寒引起的暑病），出现寒热交替、身体疼痛、脉象细弱、四肢冰冷的症状。我给他投用附子理中汤（温中散寒的方剂），但不见效；再强行让他服用，病情反而加重，于是坚决不再服药。他索要食用馄饨肚肺汤，我对他说荤腥油腻之物会助长邪气，告诫不要给他吃，但他不听。吃完后出了汗，病情反而安定下来。他想服用平时治疗痰火的方子，家人劝阻说不可，他最终还是服用了。结果病愈了，后来也没有造成损害。我思考近在咫尺之间，人的体质差异竟然如此之大。那么南北地域不同，风气各异，那里的人和他们的病情又会是怎样的呢？《素问》中的《异法方宜论》，是不可不深入研读探讨的。
嘉庆甲子年秋天，我在邻村，偶然遇到余朗亭先生说：“前几天去富家拜访并诊治一位女子，病情非常奇怪。起初无故发热，医生说这是火证，大量投用凉药，逐渐变成了虚损怯弱的病证，现在脉象和症状都败坏了，这是什么原因呢？”我说：“无故发热，事情很少听说。如果说变成了虚怯，大都是因为清凉药物使用过量，损伤了元气罢了。”第二天，荫南兄的女儿，两小腿皮肤出现皮疹，密密麻麻形状像锦纹一样，诊察脉象平和，询问她的睡眠饮食如常，没有其他疾病。我说：“不用吃药。”荫南兄说：“现在是重婚之期（指临近婚嫁的重要时期），怎么能不吃药呢？”我把余先生的话告诉了他，他竟然听从了我的建议。后来皮疹消退，安然无恙。假如当时杂乱地投用汤药，岂不是要重蹈富家女子的覆辙吗？
Brother Bingnan has a constitution prone to Fire, preferring coolness and disliking heat. In summer, he often rinses sweat with cold water and finds pleasure in sleeping exposed on stone floors. He has long suffered from Phlegm-Fire (a pathological condition characterized by phlegm and heat), for which the prescription uses Shengdi (Rehmanniae Radix), Danpi (Moutan Cortex), Maidong (Ophiopogonis Radix), Shanzhi (Gardeniae Fructus), Gualou (Trichosanthis Fructus), Huangqin (Scutellariae Radix), and Zhimu (Anemarrhenae Rhizoma). Taking this when symptoms flare up brings immediate relief. He even took this formula for other ailments, along with consuming tripe and lung wonton soup, with sweating resolving the condition.
During leisure time, he mentioned this to me. I said, "Medicines for treating Phlegm-Fire should indeed be cooling. However, adhering to a single formula for all diseases seems illogical. If it were a Yin syndrome of Cold Damage (Shanghan), it might cause harm; one must be cautious in the future."
One day, he indeed contracted an Yin-Shu pattern (summerheat-cold injury due to excessive cooling), presenting with alternating chills and fever, body pain, fine pulse, and cold limbs. I administered Fuzi Lizhong Tang (Aconite Decoction to Regulate the Middle) without effect. After forcing him to take more, his condition worsened, so he firmly refused further medication. He requested tripe and lung wonton soup. I told him that meaty, greasy foods would aid the pathogenic factors and advised against giving them, but he did not listen. After eating, he sweated and felt relieved. He wished to take his usual Phlegm-Fire formula, but his family dissuaded him. Nevertheless, he took it. The illness subsided, and there was no subsequent harm. I reflected that within such close proximity, human constitutions differ so greatly. Thus, considering the differences in geography and climate between North and South, how much greater must the variations in people and their diseases be? The *Yi Fa Fang Yi Lun* (Treatise on Different Methods and Appropriate Prescriptions According to Regions) in the *Suwen* (Basic Questions) cannot fail to be carefully studied.
In the autumn of the Jiazi year of the Jiaqing reign, while I was in a neighboring village, I happened to meet Mr. Yu Langting, who said: "A few days ago, I visited and treated a woman in the Fu household. Her condition was very strange. Initially, she had unexplained fever. The physician diagnosed it as Fire and administered many cooling medicines. Gradually, it transformed into a consumptive weakness (Xu Qie). Now both her pulse and symptoms are deteriorated. What is the reason?" I said, "Unexplained fever is rarely heard of. If it has transformed into weakness, it is mostly because cooling medicines were overdosed, damaging the Primordial Qi (Yuan Qi)."
The next day, Brother Yinnan's daughter developed eruptions on her lower legs, dense and resembling brocade patterns. Her pulse was harmonious, and upon inquiry, her sleep and appetite were normal with no other illnesses. I said, "No medicine is needed." Brother Yinnan said, "She is approaching a critical period for marriage; how can we abstain from medicine?" I informed him of what Mr. Yu had said, and he finally followed my advice. Later, the eruptions receded, and she remained safe. Had we indiscriminately prescribed decoctions at that time, would we not have followed the same disastrous path as the woman in the Fu household?