甲申孟夏闽庠古友讳兆甲者患前症发热咽干。昏眩不寐。二便如常。杂治数剂不瘥。及
察方
药。乃解表而兼利水泽泻赤苓之属余曰解表须用辛散上行之味若利水是引邪下行故外热不得
发越因而遗留不愈耳投以羌活葛根汤加减两服而愈。夫如此病症治何难事而乃以五苓散治太
阳传本热结膀胱之药而治太阳阳明未退之热实相反矣。
癸未秋上街林华远患前症。脉洪数。余投以辛凉之剂。一服即愈。未几食后劳复。皆如
法治之。随痊。
甲申夏对邻唐英患前症。发热自汗。呕逆胀闷。夜则狂谵。便秘溺涩。六脉洪数有力。
余以
大剂三黄汤加知母淡竹木通大黄石膏与服。仍令昼夜饮水。投数剂。热退汗敛。二便清顺。
断以七日当战汗而解至期果然。夫如此脉症相符。实邪之病。本非难治若不投以苦寒之剂未
免遗热脏腑淹困生变往往医于此际。亦有灼知属热但妨碍于呕逆喘胀。不敢峻攻。未免胆小
误事耳。
癸未夏西关外阮姓一男子患前症。外症已罢咽干腹痛。后泄赤黄。脉微浮。余投以桂枝
大黄汤加减与服。一剂即愈。
甲申腊闽清庠友罗君宠患前症。烦渴腹胀后便滑泄。手足温。脉沉细有力。复兼往来寒
热。余以黄芩白芍知母浓朴柴胡大黄诸辛寒之剂。投两服而愈。
癸未季秋泾县明经吴胤虞。入闽患前症。越六日身无大热。咽微干。虽昏倦少神。脉却
平匀
和缓余告以次日当战汗而解不须药。至期果愈。甲申秋西河一魏姓男子。患前症。舌卷四逆
。呕吐昏倦。六脉沉散。及察前方乃过服承气所误遂致胃败莫疗。少顷而殁。切三承气乃辛
寒峻厉之剂。非其人素禀壮健。脉症俱实。岂容轻投。枉毙人命。
甲申年孟夏（初夏），福建府学的老友兆甲先生患前述病症，表现为发热、咽干、昏眩、失眠。大小便正常。经过多种药物杂治数剂后病情未好转。等到查看其处方用药，发现是解表药兼以利水药如泽泻、赤茯苓之类。我说：解表必须使用辛散上行的药物，如果利水则是引邪气下行，因此体表的邪热不能发散透达，从而遗留病根导致不愈。于是投用羌活葛根汤加减，服用两剂后痊愈。像这样的病症治疗有什么困难呢？却用五苓散来治疗太阳病传入本经、热结膀胱的药物，去治疗太阳阳明二经余热未退的病症，这实在是背道而驰了。
癸未年秋天，上街林华远患前述病症。脉象洪大且数。我投以辛凉性质的药剂，服用一剂即痊愈。不久后因饭后劳累导致复发，都按照上述方法治疗，随即康复。
甲申年夏天，邻居唐英患前述病症。发热、自汗、呕吐逆气、腹胀闷。夜间出现狂躁胡言乱语。便秘、小便涩痛。六脉洪大、数急且有力。我用大剂量三黄汤加知母、淡竹、木通、大黄、石膏给他服用。仍然让他昼夜饮水。服用数剂后，热退汗止，大小便清利顺畅。断言七日当通过战汗而解，到了期限果然如此。像这样脉症相符，属于实邪之病，本来并不难治。如果不投用苦寒药剂，难免遗热于脏腑，缠绵困顿产生变证。往往医生在此时，也有明知属热证，但碍于呕吐、逆气、喘促、胀满等症状，不敢峻猛攻下，未免因胆小而误事。
癸未年夏天，西关外阮姓一名男子患前述病症。外在症状已消退，仅余咽干、腹痛，随后排泄赤黄色稀便。脉象微浮。我投以桂枝大黄汤加减服用，一剂即愈。
甲申年腊月，闽清府学的友人罗君宠患前述病症。烦渴、腹胀、大便滑泄。手足温暖。脉象沉细但有力。又兼有往来寒热的症状。我用黄芩、白芍、知母、浓朴、柴胡、大黄等辛寒性质的药剂，服用两剂后痊愈。
癸未年季秋（深秋），泾县明经吴胤虞入福建患前述病症。过了六天，身体没有大热，咽喉微干，虽然昏倦少神，脉象却平和均匀和缓。我告诉他次日应当通过战汗而解，不需要服药。到了期限果然痊愈。甲申年秋天，西河一名魏姓男子患前述病症。舌卷缩、四肢厥冷。呕吐、昏倦。六脉沉散。等到查看前方用药，乃是过服承气汤所致失误，遂导致胃气败绝无法救治。不久便死亡。切记三承气汤是辛寒峻猛的药剂，如果不是素体壮健、脉症俱实的患者，岂能轻易投用？枉毙人命。
In the early summer of the Jiashen year, Mr. Zhaojia, an old friend from the Fujian Academy, suffered from the aforementioned condition, presenting with fever (Fe), dry throat (Yan Gan), dizziness and vertigo (Hun Xuan), and insomnia (Bu Mei). His urination and defecation were normal. After several doses of miscellaneous treatments, his condition did not improve. Upon examining the prescription, it was found to include exterior-releasing herbs combined with diuretics such as Alisma Rhizoma (Zexie) and Poria Cocos with Red Core (Chiling). I said: To release the exterior, one must use acrid and dispersing herbs that ascend; if diuretics are used, they guide the pathogenic factor downward, thus preventing the external heat from being vented, which leads to lingering illness. Therefore, I prescribed Qianghuo Gegen Tang (Notopterygium and Pueraria Decoction) with modifications. After two doses, he recovered. Treating such a condition should not be difficult; yet, using Wuling San (Five-Ingredient Powder with Poria) — intended for Taiyang disease transmitting to its interior with heat binding in the Bladder — to treat residual heat in both Taiyang and Yangming stages is fundamentally contradictory.
In the autumn of the Guiwei year, Lin Huayuan from Shangjie suffered from the aforementioned condition. His pulse was surging and rapid (Hong Shu). I administered acrid-cool agents, and he recovered after one dose. Shortly thereafter, relapse occurred due to exertion after eating. He was treated according to the same method and subsequently recovered.
In the summer of the Jiashen year, Tang Ying, my neighbor, suffered from the aforementioned condition. Symptoms included fever, spontaneous sweating, vomiting and regurgitation, abdominal distension and oppression, and delirious speech at night. He had constipation and dysuria. All six pulses were surging, rapid, and forceful. I administered a large dose of Sanhuang Tang (Three-Yellow Decoction) supplemented with Anemarrhenae Rhizoma (Zhimu), Bambusae Folium (Danzhu), Akebia Caulis (Mutong), Rheum Palmatum (Dahuang), and Gypsum Fibrosum (Shigao). I instructed him to drink water day and night. After several doses, the fever subsided, sweating ceased, and urination and defecation became clear and smooth. I predicted that he would recover through shaking sweat (Zhan Han) on the seventh day, which indeed happened. When pulse and symptoms correspond, indicating a true excess pattern, the disease is inherently not difficult to treat. If bitter-cold agents are not used, heat may linger in the zang-fu organs, causing lingering distress and complications. Often, physicians at this juncture, although knowing it is a heat pattern, hesitate to use strong purgatives due to symptoms like vomiting, regurgitation, wheezing, and distension, thereby failing due to timidity.
In the summer of the Guiwei year, a male surnamed Ruan from outside West Gate suffered from the aforementioned condition. The exterior symptoms had resolved, leaving only a dry throat and abdominal pain, followed by diarrhea with red-yellow stool. His pulse was slightly floating. I administered Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction) with modifications. He recovered after one dose.
In the twelfth lunar month of the Jiashen year, Mr. Luo Chong, a friend from the Minqing Academy, suffered from the aforementioned condition. He experienced irritability, thirst, abdominal distension, and loose stools. His hands and feet were warm. His pulse was deep, fine, yet forceful. He also presented with alternating chills and fever. I administered acrid-cold agents including Scutellariae Radix (Huangqin), Paeoniae Radix Alba (Baishao), Anemarrhenae Rhizoma (Zhimu), Magnoliae Officinalis Cortex (Noupu), Bupleuri Radix (Chaihu), and Rheum Palmatum (Dahuang). He recovered after two doses.
In the late autumn of the Guiwei year, Wu Yinyu, a Jingyi from Jingxian County, contracted the aforementioned condition while in Fujian. Six days later, his body had no significant fever, his throat was slightly dry, and although he was lethargic and lacked spirit, his pulse was balanced, even, and gentle. I informed him that he would recover through shaking sweat the next day and required no medication. He indeed recovered as predicted. In the autumn of the Jiashen year, a male surnamed Wei from Xihe contracted the aforementioned condition. He presented with tongue retraction, cold limbs (Ni), vomiting, and lethargy. His six pulses were deep and scattered. Upon examining previous prescriptions, it was found that excessive use of Chengqi Tangs caused the error, leading to stomach qi exhaustion and untreatable condition. He died shortly thereafter. It must be noted that the three Chengqi Decoctions are harsh and potent acrid-cold agents. They should not be lightly administered unless the patient has a robust constitution and presents with both pulse and symptoms of excess. Misuse can result in wrongful death.