癸未仲秋比邻林楚畹之母劳力感寒。头眩发热。前医误以为太阳表症而投辛发之药。连
五剂
不痊。及延余治六脉洪缓无力两手微见 动此乃过饮表剂因致元气大虚血不荣筋法应温补遂
用补中益气汤。加肉桂炒芍。两服热退身凉脉亦敛。再剂 动亦止。至十余日。病大便秘塞
。余仍用前汤。去柴胡倍人参。加秦艽枣仁。以大枣为引。服二剂。大便润通。小便清利顿
觉爽然设使妄用硝黄攻泻之药大泄真阴必致不起。
甲申春内翰陈伯全弟伯容。患前症。服表剂不瘥。益见昏晌。余脉其心部沉结。诸部虚
浮无
力。得之劳郁。彼以为确中病情。服补中益气汤。加羌活黑栀。少佐肉桂两服即愈。询之盖
为年来与一豪家构讼。仆仆公庭。未免触事恼意。神思为病耳。嗟乎此亦可以表剂而潜耗其
真气乎。东垣辨惑论云举世医者。皆以饮食失节。劳役所伤。中气不足当补之症认作外感风寒
客邪有余之病重泻其表使荣卫之气外绝其死只在旬日之间所谓差之毫厘谬之千里可不详辨乎。
所谓挟虚者。乃平昔饮食起居失宜。劳役房帷所致天真隐耗触邪易袭倘初犯而即温经理
寒。
不一二剂。便可顿愈。何至误投丧生乎。崇祯癸未仲冬嘉禾司理孙鹤林弟墨林年仅四旬。患
前症。初延一名医作外感治。因他出。授以小柴汤七帖。令连日服之。经旬渐剧。再延范曰
生。生惊告曰。脉已变。当奈何。令再别请。及陈雪潭至。作伤寒坏症论。议用人参二两。
熟附二钱。煎服随吐。至次晚介王则奚来请诊其六脉俱脱。且已发燥。予曰此症本属因虚感
寒。初治得无错服凉药乎。渠二子曰政为某所误耳。予又云今已发燥而脉沉绝。法在不治。
即投参附汤亦无及矣。彼再三强。复云昨雪潭政投前汤。柰不纳何予又曰此病已阳脱而浮于
上乃外假热而内真寒也治须真热假寒之剂方得入令其将已煎前汤。再加附子二钱。吴萸数分
。煎停冷与服。得静睡半日。小便清长。举家惊喜。次日再诊。脉毫不转。余曰须越三日。
乃可望苏墨。林虽悦索前汤。但仅支两日之半。次夜果殁。嗟乎病得经两旬方死者非属本应
死之病也特为误剂而枉死耳误人者何独某被误者又何独孙乎夫伤寒传变旦晚不定至小柴凉剂
连授七服今古亦无此法。
癸未年仲秋，邻居林楚畹的母亲因过度劳累后感冒受寒。出现头晕、发热的症状。之前的医生误认为是太阳经表证，使用了辛温发汗的药物。连续服用五剂后病情未见好转。等到请我诊治时，发现六脉洪大但缓而无力，两手微微颤动。这是因为过量使用解表发汗药，导致元气大虚，血液不能濡养筋脉。按照治法应当温补，于是使用了补中益气汤，加入肉桂和炒白芍。服用两剂后，热退身凉，脉搏也收敛平和。再服两剂，手部颤动也停止了。到了十多天后，病人出现大便秘结的情况。我仍然使用前面的方剂，去掉柴胡，加倍人参用量，加入秦艽和酸枣仁，以大枣作为药引。服用两剂后，大便润通，小便清利，顿时感觉清爽舒适。假如当时妄用芒硝、大黄等攻下泻实的药物，严重损伤真阴，必定会导致死亡。
甲申年春季，翰林院官员陈伯全的弟弟陈伯容，患同样的病症。服用解表药后不仅没好，反而更加昏沉。我诊察他的心部脉象沉而结滞，其他部位脉象虚浮无力。这是因劳倦和郁结所致。他认为我的诊断确实切中病情，服用补中益气汤，加入羌活和黑栀子，稍加肉桂佐使，服用两剂即痊愈。询问病因，原来是因为近年来与一个豪强家庭打官司，奔波于公堂之上，难免遇事恼怒，导致神思受损致病。唉！这难道能用解表药来暗中耗损真气吗？李东垣在《辨惑论》中说：世间的医生，都将因饮食不节、劳役所伤导致的“中气不足当补”的病症，误认为是外感风寒邪气有余的病证，重用泻表之法，使得营卫之气在外断绝，其死亡只在十天半月之间。所谓差之毫厘，谬以千里，怎能不仔细辨别呢？
所谓的“挟虚伤寒”，是指平时饮食起居不合规律，因劳役或房事过度导致先天真气隐耗，此时容易感受外邪。如果初起时就及时温理调理，一二剂药便可顿愈，怎么会因为误治而丧生呢？崇祯癸未年仲冬，嘉兴府推官孙鹤林的弟弟孙墨林，年仅四十岁。患上上述病症。起初延请一位医生按外感治疗，因医生外出，留下小柴胡汤七帖，令连日服用。经过十天病情逐渐加重。再次延请范曰生，范先生惊讶地告知说：脉象已经改变，该怎么办？让家属再去另请名医。等到陈雪潭到来，诊断为伤寒坏病，商议使用人参二两、熟附子二钱煎服，服药后随即呕吐。到了第二天晚上，介王则奚前来请诊，发现六脉俱脱，且病人已出现烦躁燥热。我说：此症本属因虚感寒，初治时莫非错服了凉药吗？他两个儿子说：正是被那位医生误害的。我又说：现在已出现烦躁燥热且脉象沉绝，按治法属于不治之症，即使投用参附汤也来不及了。他们再三恳求，又说昨天陈雪潭正好投用了前面的汤药，无奈病人无法吞咽下去。我又说：此病已是阳气外脱而浮越于上，是外假热而内真寒，必须使用针对真热假寒的药剂才能入咽。让他们将已煎好的前汤，再加附子二钱、吴茱萸数分，煎好后放冷给病人服用。病人得以安静睡眠半天，小便清长，全家惊喜。第二天再诊，脉象毫无转机。我说：须过三天，才有望苏醒。孙墨林虽然高兴索要前汤，但仅支撑了两天半，次日夜里果然去世。唉！患病经过二十天才死的，并非原本就该死的病，而是因为误用药物枉死罢了。误人的医生何止某位？被误的病人又何止孙家呢？伤寒传变早晚不定，至今古以来也没有让小柴胡汤这类凉剂连续服用七帖的方法。
In the mid-autumn of the Guiwei year, the mother of Lin Chuwan, a neighbor, contracted cold due to overexertion. She experienced dizziness (Xuanxuan) and fever (Fare). The previous physician mistakenly diagnosed this as a Taiyang exterior syndrome (Taiyang biao zheng) and administered acrid-releasing herbs (Xinfa zhi yao). After five doses, there was no improvement. When I was consulted, her six pulses were surging yet slow and powerless, with slight tremors in both hands. This resulted from excessive use of exterior-releasing agents, leading to severe deficiency of Yuan Qi (primordial qi), causing blood to fail to nourish the sinews. According to the treatment principle, warming and tonification were required. Thus, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was prescribed, augmented with Rougui (Cortex Cinnamomi) and Chao Shaoyao (Stir-fried Radix Paeoniae Alba). After two doses, the fever subsided, the body became cool, and the pulse stabilized. After another two doses, the tremors ceased. Ten days later, the patient suffered from constipation. I continued using the previous formula, removing Chaihu (Radix Bupleuri), doubling the dosage of Renshen (Radix Ginseng), adding Qinjiao (Rhizoma Gentianae Macrophyllae) and Zaoren (Semen Ziziphi Spinosae), with Dazao (Fructus Jujubae) as an guiding herb. After two doses, the bowels moved smoothly, urination became clear and profuse, and she felt refreshed. Had one recklessly used Xiaoxie drugs like Xiaoshi (Natrii Sulfas) and Dahuang (Radix et Rhizoma Rhei) to purge, it would have severely depleted True Yin (Zhenyin), inevitably leading to death.
In the spring of the Jiashen year, Chen Borong, younger brother of Hanlin Academician Chen Boquan, suffered from the same condition. He took exterior-releasing herbs without recovery; instead, he became increasingly lethargic. Upon palpation, his heart region pulse was deep and knotted, while other regions showed deficient and floating pulses. This was caused by fatigue and emotional constraint. He agreed that my diagnosis hit the mark precisely. He took Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), augmented with Qianghuo (Rhizoma Notopterygii) and Heizhi (Fructus Gardeniae Jasminoidis Preparatus), with a small amount of Rougui (Cortex Cinnamomi) as an assistant. After two doses, he recovered. Inquiry revealed that for years he had been involved in litigation with a wealthy family, running back and forth in court, which caused anger and disturbance of Shen Si (spiritual thought). Alas! How could exterior-releasing herbs be used to secretly deplete True Qi (Zhenqi)? Li Dongyuan stated in *Bianhuo Lun* (Treatise on Resolving Doubts): Physicians of the world mistake conditions of "deficiency of Zhong Qi (middle qi) requiring tonification" caused by irregular diet and labor injury for excess conditions of external wind-cold pathogens. They heavily purge the exterior, severing Ying Wei (nutritive and defensive qi) from the outside, leading to death within ten days or half a month. A difference of a hair's breadth leads to an error of a thousand miles; how can one not distinguish carefully?
The so-called "Shaohan with Deficiency" (Jiaxu Shaohan) refers to cases where improper diet and lifestyle, along with fatigue or sexual excess, cause hidden depletion of Tianzhen (innate true qi). In such states, pathogens are easily invaded. If treated promptly with warming and regulating methods, one or two doses suffice for immediate cure. How could misdiagnosis lead to death? In the mid-winter of the Guiwei year of the Chongzhen era, Sun Molin, younger brother of Sun Helin, Chief Magistrate of Jiahe, aged forty, suffered from the aforementioned condition. Initially, a doctor treated him for external contraction. Due to the doctor's absence, seven doses of Xiao Chai Hu Tang (Minor Bupleurum Decoction) were left for continuous daily intake. After ten days, the condition worsened. Fan Yuesheng was then consulted. Startled, he said, "The pulse has changed; what shall we do?" He advised seeking another physician. When Chen Xuetan arrived, he diagnosed it as a "Shanghan Huai Zheng" (complicated/ruined cold damage) and proposed Ren Shen (Radix Ginseng) 2 liang and Shu Fuzi (Prepared Radix Aconiti Lateralis) 2 qian decocted and taken orally. However, the patient vomited immediately after ingestion. By the next evening, Wang Zuoxi came to consult. All six pulses were absent (Tuoluo), and the patient exhibited irritability and dryness. I said, "This condition originally belongs to cold invasion due to deficiency. Was cold medicine mistakenly administered initially?" His sons replied, "It was indeed harmed by that doctor." I added, "Now that irritability and dryness have appeared with deep and absent pulses, according to treatment principles, it is incurable. Even administering Shen Fu Tang (Ginseng and Aconite Decoction) would be too late." They pleaded repeatedly, stating, "Yesterday Chen Xuetan just administered the previous decoction, but unfortunately, it could not be retained." I said again, "This disease involves Yang collapse floating upward; it presents as false heat externally and true cold internally. Only agents suitable for true heat/false cold patterns can be tolerated." They were instructed to take the previously decocted medicine, add 2 qian of Fuzi (Radix Aconiti Lateralis Preparata) and a few fen of Wuyu (Fructus Evodiae), decoct, let it cool, and administer. The patient slept quietly for half a day, urination became clear and long, and the family was overjoyed. On the second day, upon re-examination, the pulse showed no change. I said, "Wait three days; only then might there be hope of revival." Although Sun Molin was pleased and requested the decoction, he survived only two and a half days more, passing away the following night. Alas! Those who die after twenty days of illness are not necessarily destined to die; they die wrongly due to erroneous prescriptions. Who among physicians errs? Whom among patients is wrongly harmed? The transmission of Shanghan varies rapidly; since ancient times, there has been no method of continuously administering seven doses of cooling agents like Xiao Chai Hu Tang.