己未岁。一时官病伤寒。发热狂言烦躁。无他恶证。四日死。或者以为两感。然其证初无两
感证候。是岁得此疾。三日四日死者甚多。人窃怪。予叹之。曰是运使然也。己为土运。土运之
岁。上见太阴。盖太乙天符为贵人。中执法者。其病速而危。中行令者。其病徐而持。中贵人者。
其病暴而死。谓之异也。又曰臣为君则逆。逆则其病危。其害速。是年少宫土运。木气大旺。邪
中贵人。故多暴死。气运当然。何足怪也。
陈姓士人。初得病。身热。脉浮。自汗。医者麻黄汤汗之。发热愈甚。夜间不得眠。头重。
烦闷。悸悸然。中风证强责汗之过也。仲景云太阳病。发汗后。大汗出。胃中干燥。不得眠。其人欲得饮水者。少少与
之。令胃气和则愈。予先与猪苓汤。次投之以当归。地黄。麦门冬。芍药。乌梅之类为汤。饮之。不汗而愈。
论曰。黄帝针经曰。卫气者昼行阳。夜行阴。卫气不得入于阴。常行于外。行于外则阳满。
满则阳跷盛而不得入于阴。阴虚则夜不得眠也。今津液内竭。胃中干燥。独恶于阳。阴无所归。
其候如此。故以当归。地黄补血。用乌梅以收之。故不汗自愈。
羽流蒋尊病。其初心烦喜呕。往来寒热。医初以小柴胡汤与之。不除。予诊之曰。脉洪大而
实。热结在里。小柴胡安能除也。仲景云伤寒十余日。热结在里。复往来寒热者。与大柴胡。二
服而病除。
论曰。大黄为将军。故荡涤湿热。在伤寒为要药。今大柴胡汤不用。诚误也。王叔和曰。若
不加大黄。恐不名大柴胡。须是酒洗生用。乃有力。昔后周姚僧坦名善医。上因发热。欲服大黄。
僧坦曰。大黄乃是快药。至尊年高。不宜轻用。上弗从。服之。遂不起。及至元帝有疾。诸医者
为至尊至贵不可轻服。宜用平药。僧坦曰。脉洪而实。必有宿食。不用大黄。病不能除。上从之。
果下宿食而愈。此明合用与不合用之异也。
己未年。当时有一位官员患伤寒。出现发热、胡言乱语、烦躁不安的症状。没有其他严重的恶寒等表证。四天后死亡。有人认为是两感病（同时感受风寒邪气，表里同病）。然而他的症状起初并没有两感的证候。这一年得这种病的人，在第三四天死亡的很多。人们私下感到奇怪。我叹息说：这是运气使然。己年是土运之年。土运之年，上见太阴湿土之气。盖太乙天符（岁运、司天、在泉三者相同）为贵人。中执法者（岁运与司天之气相合），其病势急迫而危险。中行令者（岁运与在泉之气相合），其病势缓慢而持久。中贵人者（岁运、司天、在泉三者皆同），其病势暴烈而致死。这被称为“异”（特殊的运气格局）。又说：臣（岁运）若克制君（司天），则为逆。逆则其病危重，危害迅速。这一年是少宫（土运不及）之年，木气大旺。邪气侵犯贵人（指运气格局特殊之人），所以多发生暴死。这是气运的必然规律，有什么好奇怪的呢。
姓陈的读书人。刚得病时，身体发热，脉象浮，自汗出。医生用麻黄汤让他发汗。结果发热更加严重。夜间无法入睡，头重，烦闷，心悸跳动。这是中风证（太阳中风表虚证）强行发汗导致的过误。张仲景说：太阳病，发汗后，大汗出，胃中干燥，导致不得眠。如果病人想喝水，少量多次给予，使胃气调和就能痊愈。我先给他服用猪苓汤，随后投以当归、地黄、麦门冬、芍药、乌梅等药材煎成的汤剂。服药后，没有再发汗就痊愈了。
论述说：《黄帝针经》说：卫气白天行于阳分，夜晚行于阴分。卫气不能进入阴分，常行于阳分。行于阳分则阳气满盛。满盛则阳跷脉旺盛而不能入于阴分。阴分虚弱则夜间不得眠。现在津液内竭，胃中干燥，唯独厌恶阳气。阴无所归附。症状表现如此。所以用当归、地黄补血，用乌梅来收敛。因此不发汗而自愈。
道士蒋尊患病。起初心烦，喜欢呕吐，寒热往来。医生起初用小柴胡汤给他服用，病未除。我诊察他说：脉象洪大而实，热邪结聚在里。小柴胡汤怎么能去除呢？张仲景说：伤寒十余日，热结在里，又出现寒热往来的，给予大柴胡汤。服用两剂后病除。
论述说：大黄被称为将军，能荡涤湿热，在伤寒治疗中是重要药物。如今大柴胡汤不用大黄，确实是错误。王叔和说：如果不加大黄，恐怕就不叫大柴胡汤。必须是用酒洗过的生大黄，才有力道。从前后周姚僧坦擅长医术。皇帝因发热，想服用大黄。姚僧坦说：大黄是峻猛之药，至尊年事已高，不宜轻用。皇帝不听。服下后，病情加重直至去世。等到元帝生病，众医生认为至尊至贵不可轻用大黄，宜用平和的药物。姚僧坦说：脉象洪大而实，必有宿食。不用大黄，病不能除。皇帝听从了他的建议。果然排出宿食而痊愈。这明确了该用与不该用的区别。
In the Jiwei year, an official contracted Shanghan (Cold Damage). He exhibited fever, delirious speech, and irritability, without other severe exterior symptoms. He died four days later. Some considered it Lianggan disease (simultaneous contraction of pathogenic factors in both Taiyang and Shaoyin meridians). However, his initial symptoms did not present with Lianggan characteristics. Many people who contracted this illness that year died on the third or fourth day. People were secretly puzzled. I sighed and said: This is due to the influence of Qi Yun (Five Movements and Six Qi theory). The Ji year corresponds to Earth Yun (Earth Movement). In years of Earth Yun, the upper aspect manifests as Taiyin (Great Yin) dampness. When Taiyi Tianfu (a rare convergence where the Yearly Movement, Supreme Ruler, and Lower Ruler coincide) acts as a "Noble Person," diseases affecting the "Central Enforcer" (convergence of Yearly Movement and Supreme Ruler) are rapid and critical; those affecting the "Central Messenger" (convergence of Yearly Movement and Lower Ruler) are slow and lingering; those affecting the "Central Noble" (triple coincidence) are violent and fatal. This is termed "Yi" (special anomaly). Furthermore, when the Minister (Yearly Movement) opposes the Sovereign (Supreme Ruler), it creates opposition, leading to critical illness and rapid deterioration. That year was Shaogong (deficient Earth Yun), with Wood Qi flourishing excessively. Pathogens attacked the "Noble" constitution, resulting in many sudden deaths. This is the natural course of Qi Yun; why be surprised?
A scholar surnamed Chen initially presented with body heat, floating pulse, and spontaneous sweating. A physician administered Mahuang Tang (Ephedra Decoction) to induce sweating. Consequently, the fever worsened. He suffered from insomnia at night, heavy head, vexation, and palpitations. This resulted from forcibly inducing sweat in a Fengzheng (Wind Strike/Solar Wind pattern) case. Zhang Zhongjing stated: In Taiyang disease, after sweating, if excessive sweating occurs, causing dryness in the Stomach, insomnia results. If the patient desires water, provide it in small amounts frequently; harmony of Stomach Qi leads to recovery. I first administered Zhuling Tang (Polyporus Decoction), followed by a decoction containing Danggui (Angelicae Sinensis Radix), Dihuang (Rehmanniae Radix), Maimendong (Ophiopogonis Radix), Shaoyao (Paeoniae Radix), and Wumei (Mume Fructus). He recovered without further sweating.
The commentary states: The Huangdi Zhenjing (Yellow Emperor's Classic of Acupuncture) says: Wei Qi (Defensive Qi) travels through Yang during the day and Yin at night. If Wei Qi cannot enter Yin and remains in Yang, Yang becomes full. Fullness causes the Yang Qiao vessel to flourish, preventing entry into Yin. Yin deficiency leads to nighttime insomnia. Here, internal fluids are exhausted, Stomach dryness prevails, and there is aversion to Yang. Yin has no place to return. Given these signs, Danggui and Dihuang were used to nourish Blood, and Wumei to astringe. Thus, recovery occurred without sweating.
The Daoist priest Jiang Zun fell ill. Initially, he experienced mental restlessness, frequent vomiting, and alternating chills and fever. The physician initially prescribed Xiaochaihu Tang (Minor Bupleurum Decoction), but the condition persisted. Upon examination, I noted a surging and excess pulse, indicating heat accumulation in the interior. How could Xiaochaihu Tang resolve this? Zhang Zhongjing stated: In Shanghan lasting over ten days, with heat accumulated internally and accompanied by alternating chills and fever, Da Chaihu Tang (Major Bupleurum Decoction) should be given. After two doses, the illness resolved.
The commentary states: Dahuang (Rhei Radix et Rhizoma) is known as the General; it purges damp-heat and is a crucial herb for Shanghan. Omitting Dahuang in Da Chaihu Tang is indeed an error. Wang Shuhe stated: Without Dahuang, it cannot rightly be called Da Chaihu Tang. It must be raw and wine-washed to be effective. Previously, Yao Sengt'an of the Later Zhou dynasty was renowned for his medical skill. When the Emperor had a fever and wished to take Dahuang, Yao advised: Dahuang is a drastic medicine. Given Your Majesty's advanced age, it should not be used lightly. The Emperor did not listen and took it, leading to his demise. Later, when Emperor Yuan fell ill, physicians argued that such a noble figure should not take harsh medicines like Dahuang but rather mild ones. Yao Sengt'an replied: A surging and excess pulse indicates retained food stagnation. Without Dahuang, the illness cannot be cured. The Emperor agreed. Indeed, retained food was expelled, and he recovered. This illustrates the difference between appropriate and inappropriate usage.