何保义从王太尉军中。得伤寒。脉浮涩而紧。予曰若头疼。发热。恶风。无汗。则麻黄证也。
烦躁。则青龙汤证也。何曰。今烦躁甚。予投以大青龙汤。三投。汗解。
论曰。桂枝。麻黄。青龙。皆表证发汗药。而桂枝治汗出。恶风。麻黄治无汗。恶寒。青龙
治无汗。而烦。三者皆欲微汗解。若汗多。亡阳。为虚。则烦躁不眠也。
一武弁李姓。在宣化作警。伤寒五六日矣。镇无医。抵郡召予。予诊视之曰。脉洪大而长。
大便不通。身热无汗。此阳明证也。须下。病家曰。病者年逾七十。恐不可下。予曰。热邪毒瓦斯并蓄于阳明。况阳
明经络多血少气。不问老壮。当下。不尔别请医占。主病者曰。审可下。一听所治。予以大承气
汤。半日。殊未知。诊其病。察其证宛然在。予曰。药曾尽否。主者曰。恐气弱不禁。但服其半
耳。予曰。再作一服。亲视饮之。不半时间。索溺器。先下燥粪十数枚。次溏泄一行。秽不可近。
未离已中汗矣。 然周身。一时顷。汗止身凉。诸苦遂除。次日予自镇归。病患索补剂。予曰。
服大承气汤得瘥。不宜服补剂。补则热仍复。自此但食粥。旬日可也。故予治此疾。终身止大承
气。一服而愈。未有若此之捷。
论曰。老壮者形气也。寒热者病邪也。脏有热毒。虽衰年亦可下。脏有寒邪。虽壮年亦可温。
要之与病相当耳。失此。是致速毙也。谨之。
何保义跟随王太尉的军队，患上了伤寒。脉象浮涩而紧。我说：“如果头痛、发热、怕风、无汗，那就是麻黄汤证。”
“如果出现烦躁，那就是大青龙汤证。”何保义说：“现在烦躁非常严重。”我给他服用大青龙汤。服药三次后，出汗而病愈。
论述说：桂枝汤、麻黄汤、大青龙汤，都是治疗表证发汗的药物。但桂枝汤治疗有汗、怕风；麻黄汤治疗无汗、怕冷；大青龙汤治疗无汗且烦躁。这三者都旨在通过微微出汗来解除病邪。如果出汗过多，导致阳气亡失，造成虚证，就会出现烦躁不眠的症状。
一位姓李的武官，在宣化担任警戒职务，患伤寒已经五六天了。当地没有医生，他到郡城请我去诊治。我诊察他的脉象说：“脉象洪大而长，大便不通，身体发热且无汗，这是阳明病证。必须使用下法。”病人家属说：“患者年龄超过七十岁，恐怕不能攻下。”我说：“热邪毒气积聚在阳明经，况且阳明经络多血少气，不分年老体壮，都应当攻下。否则请另请医生负责。”主人说：“确实可以攻下，听凭您治疗。”我给他服用大承气汤。半天过去了，病情毫无变化。我再次诊察他的病症，发现症状依然存在。我问：“药喝完了吗？”主人说：“担心他气弱承受不住，只服了一半。”我说：“再煎一剂，我亲自看着他喝下去。”不到半顿饭的时间，他要拿便盆，先排出干硬的粪便十几枚，接着排出一行稀便，气味秽浊难闻。还没离开房间，身上就开始出汗了。然而全身同时出汗，片刻之后，汗止身凉，各种痛苦随即消除。第二天我自己从驻地回来，病人索要补药。我说：“服用大承气汤后痊愈，不宜服用补药。进补则热邪会复发。从此以后只吃粥，十天就可以恢复。”所以我治疗这个疾病，终身只用大承气汤，一剂药就治愈了，没有比这更快捷的了。
论述说：年老和年轻是指形体和元气而言。寒热是指病邪的性质。脏腑内有热毒，即使是衰老之年也可以攻下；脏腑内有寒邪，即使是壮年也可以温补。关键在于治疗方法要与病邪相当。违背这一点，就会导致迅速死亡。务必谨慎。
He Bao Yi, serving in the army of Grand Marshal Wang, contracted Shanghan (Cold Damage). The pulse was floating, choppy, and tight. I said, "If there is headache, fever, aversion to wind, and anhidrosis (absence of sweating), it is a Mahuang Tang (Ephedra Decoction) pattern."
"If there is irritability, it is a Da Qing Long Tang (Major Blue Dragon Decoction) pattern." He Bao Yi replied, "The irritability is now severe." I administered Da Qing Long Tang. After three doses, he sweated and recovered.
Commentary: Guizhi Tang (Cinnamon Twig Decoction), Mahuang Tang (Ephedra Decoction), and Da Qing Long Tang are all diaphoretic agents for treating exterior patterns. However, Guizhi Tang treats patterns with sweating and aversion to wind; Mahuang Tang treats patterns without sweating and aversion to cold; Da Qing Long Tang treats patterns without sweating accompanied by irritability. All three aim to resolve the pathogen through mild sweating. If sweating is excessive, leading to Yang collapse and deficiency, irritability and insomnia will occur.
A military officer surnamed Li, stationed on guard duty in Xuanhua, had suffered from Shanghan for five or six days. There were no physicians in the garrison, so he went to the prefecture to summon me. Upon examination, I stated, "The pulse is surging, large, and long. There is constipation, body heat, and anhidrosis. This is a Yangming pattern. Purgation is required." The patient's family said, "The patient is over seventy years old; we fear purgation is not suitable." I said, "Heat pathogens and toxic vapors are accumulated in the Yangming channel. Moreover, the Yangming channels have abundant blood but scarce Qi. Purgation is indicated regardless of age or robustness. Otherwise, please consult another physician." The guardian said, "If purgation is indeed appropriate, we submit to your treatment." I prescribed Dachengqi Tang (Major Orderly Descending Decoction). Half a day passed with no significant change. I re-examined the patient and observed that the symptoms persisted. I asked, "Has the medicine been fully consumed?" The guardian replied, "We feared his weak Qi could not tolerate it, so only half was taken." I said, "Prepare another dose, and I will watch him drink it personally." Within less than half an hour, he requested a urinal. First, several hard fecal pellets were expelled, followed by a discharge of loose stool, which was foul-smelling and repulsive. Before leaving the room, sweat began to appear on his body. However, the sweating occurred simultaneously over the entire body. In a short while, the sweating ceased, the body cooled, and all distressing symptoms were eliminated. The next day, upon my return from the garrison, the patient requested tonic medicines. I said, "Having recovered after taking Dachengqi Tang, tonics should not be taken. Tonification would cause the heat to recur. From now on, consume only congee; recovery can be expected within ten days." Thus, in treating this illness, I used only Dachengqi Tang throughout his life, achieving a cure with a single dose. No case has been as swift as this.
Commentary: Old and young refer to physical constitution and Yuan Qi (Original Qi). Cold and heat refer to the nature of the pathogenic factors. If there is heat toxicity in the Zang organs, purgation may be used even in advanced age; if there is cold pathogens in the Zang organs, warming therapy may be used even in youth. The key lies in matching the treatment to the disease. Deviating from this principle leads to rapid death. One must exercise caution.