操持经营，劳思过度，病起咯血，后加咳嗽，孟秋诊过，告以肺肾阴亏久咳。虚火上升
，津
液生痰不生血，治当补水制火则其痰自除，第此甘醇静药，本无速功，更医参附养阳，服至
半月，诸证倍增。经曰∶刚与刚阳气破散，阴气乃消亡。是知证有阴阳，药有动静。阳主动
，以动济动，火上添油也，不焦烂乎。且一星之火，能烧千仞之山，一杯之水，难救车薪之
火。恙本火多水少，救阴尚恐不逮，岂堪燥烈更灼其阴乎。三冬肾水枯涸，来春奉生者少。
语云∶昌阳引年，欲进 苓，其斯之谓欤。
年届五旬，心事内伤，兼挟外邪，误药因循。邪留不解，脉濡无神，汗多头晕，交午寒
热。
此阴阳衰惫，邪正交争，乌可与传经少阳之寒热同语?张介宾云∶邪气如贼，其来在外，元
气如民，其守在中。足民即所以强中，强中即所以御外。斯证斯时，曰但驱邪可以却病，吾
不信也。曰舍辅正可以拯援，亦不信也。仲圣云∶伤寒若吐，若汗，若下，若温，针不解者
，名曰坏病。知犯何逆，随证治之。虽然理固如斯，而病已濒危。大厦欲覆，一木恐难撑持
。劳感经旬，因循误治，邪陷正亏。喻氏所谓轻则半出不出，重则反随元气缩入。观其晕汗
，每现于寒热之顷，此阴阳交争，正不胜邪，离线显露。如盗入人家，门户洞开，藩篱不固
，主惫如斯，何堪与贼角胜负邪。请先救人，后医病。
安波按∶病到此等地步，虽有卢扁，于命云何。
操持家务与经营事务，思虑过度，导致疾病发作出现咯血，随后加重为咳嗽。孟秋时节诊察后，告知其病因为肺肾阴液亏虚导致的久咳。虚火上升，津液凝聚成痰而非化生血液，治疗应当通过滋补肾水来制约虚火，则痰浊自然消除。然而这些甘润静谧的药物，本来就没有立竿见影的功效。后来改由其他医生使用人参、附子等温补阳气的药物，服用半个月后，各种症状加倍严重。《内经》说：“刚燥之药与刚燥之体相遇，阳气破散，阴气随之消亡。”由此可知，病症有阴阳之分，药物有动静之别。阳气主静中带动，若以动性之药去补助动性之病，无异于火上浇油，难道不会导致焦枯烂坏吗？况且星星之火，能烧毁千仞高山；一杯之水，难以扑灭装满柴草的大车燃烧的火势。此病本属火多水少，救治阴液尚且担心来不及，哪里还能承受燥烈之药进一步灼伤阴液呢？三冬季节肾水枯竭，到了来年春天，能够奉养生命的气机就少了。俗话说：昌蒲（菖蒲）可延年益寿，想要进服茯苓，大概说的就是这个道理吧。
患者年近五十，心事内伤，兼夹外感邪气，因误治而拖延。邪气滞留不能解除，脉象濡软而无神气，汗出多且头晕，中午时分出现寒热往来。这是阴阳衰败疲惫，邪气与正气相互交争，怎么能与传经至少阳经的寒热往来进行类比呢？张介宾说：“邪气如同盗贼，从外部入侵；元气如同百姓，守卫在内部。使百姓富足就是加强内部，加强内部就是为了抵御外部。对于这种证候和时机，如果说仅仅驱除邪气就能治愈疾病，我不相信；如果说放弃扶助正气就可以挽救病情，我也不相信。”仲景说：“伤寒如果经过吐法、汗法、下法、温法或针刺治疗后仍未痊愈的，称为坏病。需要知道犯了什么错误，根据当前的证候进行治疗。”虽然道理确实如此，但病情已经接近危重。大厦即将倾覆，一根木头恐怕难以支撑。劳倦感受外邪经过旬日，因拖延误治，邪气陷入体内，正气亏损。喻嘉言所说的“轻症则半出不出，重症则反而随着元气缩入体内”。观察其眩晕和出汗，每每出现在寒热发作之际，这是阴阳交争，正气不胜邪气，离决之象显露。就像强盗进入人家，门户大开，篱笆不牢固，主人疲惫不堪，怎么还能与盗贼角力胜负呢？请先救人命，然后再治病。
安波按语：病情发展到这种地步，即使有卢医、扁鹊再生，对性命又能如何呢。
Managing household affairs and business operations, excessive mental labor led to the onset of hemoptysis (coughing up blood), which later worsened into coughing. During the early autumn period, upon diagnosis, it was informed that the condition resulted from prolonged coughing due to deficiency of Lung and Kidney Yin (deficiency of the yin substances of the lung and kidney meridians). The deficient fire flared upward, causing body fluids to condense into phlegm rather than generating blood; treatment should focus on nourishing water (Kidney Yin) to control fire, thereby eliminating phlegm naturally. However, these sweet, mellow, and tranquil herbs inherently lack rapid efficacy. Subsequently, other physicians prescribed Ren Shen (Ginseng Root) and Fu Zi (Aconite Lateralis Radix Preparata) to nourish Yang (the active, warming aspect of Qi). After half a month of consumption, all symptoms doubled in severity. The Classic states: "When rigid [yang-drugs] meet rigid [conditions], Yang Qi is scattered, and Yin Qi perishes." Thus, we know that conditions have Yin and Yang distinctions, and medicines have dynamic and static properties. Yang governs movement; using dynamic drugs to treat a dynamic condition is like adding oil to a fire—will it not lead to scorching and decay? Moreover, a single spark can burn a mountain thousands of feet high, yet a cup of water cannot extinguish the fire of a cartload of firewood. This illness originally featured excess fire and insufficient water; rescuing Yin might still be insufficient, let alone enduring desiccating and hot drugs that further scorch Yin. In the three winter months, Kidney Water (Kidney Yin) withers and dries up, leaving little to sustain life in the coming spring. As the saying goes: Chang Pu (Rhizoma Acori Tatarinowii) extends life; wishing to administer Fu Ling (Poria) likely refers to this principle.
The patient approached fifty years of age, suffering from internal injury due to emotional distress, complicated by external pathogens. Mismedication led to procrastination. Pathogens remained unresolved; the pulse was soggy (soft and fine, indicating dampness or deficiency) and lacked spirit (vitality). There was profuse sweating, dizziness, and alternating chills and fever around noon. This indicates exhaustion of both Yin and Yang, with pathogens and healthy Qi contending. How can this be equated with the alternating chills and fever of Shaoyang disease (disease of the Gallbladder and Sanjiao channels characterized by alternating chills and fever)? Zhang Jiebin stated: "Pathogens are like thieves, coming from outside; Yuan Qi (Original Qi) is like the people, guarding within. Enriching the people strengthens the center; strengthening the center enables defense against the exterior." For this syndrome at this time, I do not believe that merely expelling pathogens can cure the disease, nor do I believe that abandoning support for healthy Qi can save the patient. Zhong Jing said: "If Taiyang cold damage is treated with vomiting, sweating, purging, warming, or acupuncture without resolution, it is called a 'ruined disease' (bad outcome due to misdiagnosis/treatment). One must ascertain what error was made and treat according to the current syndrome." Although the theory holds true, the condition is already critical. When a large building is about to collapse, one wooden beam may hardly support it. After a decade of labor and pathogenic invasion, compounded by procrastination and mis-treatment, pathogens have sunk inward while healthy Qi is depleted. As Yu Jia Yan described: "In mild cases, pathogens remain half-out and half-in; in severe cases, they retreat inward along with the Original Qi." Observing his dizziness and sweating occurring during episodes of chills and fever reveals that Yin and Yang are contending, Healthy Qi fails to overcome Pathogens, and signs of separation are emerging. It is like robbers entering a home where doors are wide open and fences are insecure; if the master is so exhausted, how can he contend with robbers for victory? First, save the person; then treat the disease.
An Bo's commentary: At this stage of illness, even if Lu Yi (Bian Que) were reborn, what could be done for life?