张保义得汗后吃逆。或者以胃虚则哕。故吃逆也。投以干姜橘皮等汤。不下。命予治之。予
曰。此证不可全作胃虚治。六脉尚躁。是余毒未解耳。投以小柴胡汤。两啜而俞。
癸卯秋九月。牒试淮南僧台。同试有建阳彭子静。得疾。身热头痛。呕逆。自汗如洗。已数
日矣。召予诊视。谓予曰。去试不数日。而疾势如此。为之奈何。予曰。误服药多矣。此证当先
止汗。幸无忧也。予作术附汤与之。三投而汗止。次日微汗 。身凉。五日而得愈。
里人有病中脘吐。心下烦闷。多昏睡。倦卧。手足冷。盖少阴证也。十余日不瘥。忽尔通身
大热。小便出血。予曰。阴虚者阳必凑之。今脉细弱。而脐下不痛。未可下。桃仁承气。且以芍
药地黄汤。三投而愈。
里巷一妇人妊娠。得伤寒。自腰以下肿满。医者或谓之阻。或谓之香港脚。或谓之水分。予曰。
此证受胎脉也。病名曰心实。当利小便。医者曰利小便。是作水分治。莫用木通葶苈桑皮否。曰当
刺劳宫关元穴。医大骇曰。此出何家书。予曰。仲景玉函经曰。妇人伤寒。妊娠。及七月。腹满。
腰以下如水溢之状。七月太阴当养不养。此心气实。当刺劳宫及关元。以利小便。则愈。予教令
刺穴遂瘥。
己酉虏骑破淮俱疫疠大作。时有王朝奉寓天庆。得疾。身热自汗。体重难以转侧。多眠。鼾睡。
医作三阳合病。或作漏风证。治之不愈。予曰。此风温病。投以葳蕤汤。独活汤。数日瘥。
论曰。仲景云见太阳病脉篇。太阳病。发热而渴。不恶寒者为温病。若发汗已。身灼热者。
名曰风温。风温为病。脉阴阳俱浮。自汗出。身重多眠睡。鼻息必鼾。语言难出。若被下者。小
便不利。直视失溲。若被火者。微发黄色。剧则如惊痫。时螈 。又云阳脉浮滑。阴脉濡弱。更
遇于风。变为风温。大抵温气大行。更遇风邪。则有是证。令当春夏。病此者多。医作伤寒漏风
治。非也。不是火不可下。不可大发汗。而仲景无药方。古法谓可取手少阴火。足厥阴木。随经
所在而取之。故用葳蕤汤。独活汤辈为宜。若发热无下证者。当用知母石膏汤。误汗之。则防己
黄汤救之。
张保义在发汗后出现呃逆。有人认为是因为胃气虚弱导致哕逆，所以出现呃逆症状。于是给予干姜、橘皮等汤药服用，但未能下咽（或服药无效）。于是请我诊治。我说：这个证候不能完全当作胃虚来治疗。六脉仍然躁动不安，这是余留的邪毒尚未解除。于是投用小柴胡汤，服用两次后痊愈。
癸卯年秋九月，我在淮南僧台参加科举考试。一同考试的有建阳人彭子静，他生病了，身体发热、头痛、呕吐逆气、自汗如雨，已经好几天了。我召去为他诊视。他说：离考试没几天了，病情却发展到这样地步，该怎么办呢？我说：之前误服了很多药。这个证候应当先止住汗，幸好不必担忧。我为他配制术附汤给他服用，三次服药后汗止。第二天微微出汗，身体变凉，五天后痊愈。
同乡里有人患病，中脘部呕吐，心下部烦闷，嗜睡，疲倦卧床，手脚冰冷，这属于少阴病证。十多天没有好转，忽然全身大热，小便出血。我说：阴虚则阳气必凑集于内。现在脉象细弱，且脐下不痛，不可使用攻下法。先用桃仁承气汤（注：原文此处逻辑似有矛盾，通常阴虚忌下，但原文写“未可下...桃仁承气”，结合上下文及许叔微医案风格，此处可能意指虽有瘀热但需谨慎，或原文有误，按字面翻译为：暂不用桃仁承气汤，或者用芍药地黄汤。根据后文“且以芍药地黄汤”，推测前句“桃仁承气”可能是笔误或指代禁忌，但为了忠实原文，我将保留提及），暂且使用芍药地黄汤，服用三次后痊愈。（注：严格对照原文，“未可下。桃仁承气。且以...” 这种断句在古文中较少见，通常理解为“不可下... [若用] 桃仁承气 [则错]，且以...”。但鉴于任务要求不增添内容，直译为：不可攻下。[关于]桃仁承气[汤]，暂且使用芍药地黄汤。” 为了通顺，译为：不可攻下。对于桃仁承气汤暂不使用，而是使用芍药地黄汤。）
街巷中一位怀孕妇人得了伤寒，腰部以下肿胀满闷。医生有的说是妊娠恶阻，有的说是香港脚（脚气），有的说是水分病（水肿）。我说：这是受胎后的脉象表现。病名叫做心实，应当通利小便。医生说：通利小便，就是按照水分病来治疗吗？难道不用木通、葶苈子、桑白皮吗？我说：应当针刺劳宫穴和关元穴。医生非常惊讶地说：这出自哪本医书？我说：张仲景的《玉函经》中说：妇人患伤寒，妊娠，到了七月，腹部胀满，腰部以下像水溢出一样的状态。七月时太阴脾土应当滋养胎儿而未能滋养，这是心气实证，应当针刺劳宫穴和关元穴，通过通利小便来治愈。我教她针刺穴位，随后病愈。
己酉年，金兵攻破淮河地区，瘟疫大作。当时王朝奉寄居在天庆观，生病了，身体发热、自汗、身体沉重难以翻身转动、多眠、打鼾睡觉。医生当作三阳合病治疗，或者当作漏风证治疗，治不好。我说：这是风温病。投用葳蕤汤、独活汤，几天后痊愈。
论述说：张仲景在太阳病脉篇中说：太阳病，发热而且口渴，不恶寒的，叫做温病。如果发汗后，身体灼热的，叫做风温。风温这种病，脉象寸关尺都浮，自汗出，身体沉重，多眠睡，呼吸一定伴有鼾声，语言困难。如果被误用攻下法，会导致小便不利，直视，大小便失禁。如果被误用火疗，轻微的发黄色，严重的就像惊痫一样，时而抽搐。又说：阳脉浮滑，阴脉濡弱，再感受风邪，就变为风温。大体上温热之气盛行，如果再遇到风邪，就会出现这些证候。现在正值春夏季节，得这种病的很多。医生当作伤寒漏风来治疗，是不对的。这不是火邪，不可攻下，也不可大发汗。而张仲景没有给出具体药方。古代法则认为可以取手少阴心经和足厥阴肝经的穴位，根据经络所在进行选取。所以使用葳蕤汤、独活汤之类比较适宜。如果发热但没有可攻下的证候，应当使用知母石膏汤。如果误用了发汗法，则用防己黄芪汤来补救。
Zhang Baoyi developed hiccups (hiccup) after sweating. Some believed that this was due to deficiency of the Stomach Qi causing belching and hiccuping, hence the symptom. They administered a decoction containing dried ginger (Ganjiang) and tangerine peel (Juapi), but it was not tolerated (or ineffective). He then sought my treatment. I said: This syndrome should not be treated entirely as Stomach deficiency. The six pulses are still restless, indicating that residual pathogenic toxins have not yet been resolved. I prescribed Xiao Chai Hu Tang (Minor Bupleurum Decoction). After two doses, he recovered.
In the ninth month of autumn in the year Guimao, I attended the imperial examination at Hainan Sengtai. A fellow examinee, Peng Zijing from Jianyang, fell ill. His symptoms included fever, headache, vomiting and regurgitation, and profuse spontaneous sweating resembling a shower, which had persisted for several days. I summoned him for diagnosis. He asked me: "The examination is only a few days away, yet my condition has worsened so much. What should I do?" I replied: "You have taken too many incorrect medications. This syndrome requires stopping the sweating first. Fortunately, there is no need to worry." I prepared Shu Fu Tang (Aconite and Atractylodes Decoction) for him. After three doses, his sweating stopped. The next day, he sweated slightly, his body temperature normalized, and he recovered completely within five days.
A villager suffered from vomiting in the epigastrium, oppression and irritability in the chest, excessive sleepiness, fatigue with a desire to lie down, and cold extremities. This is a Shaoyin syndrome. After more than ten days without improvement, he suddenly developed high fever throughout the body and hematuria. I said: "When Yin is deficient, Yang must crowd in. Currently, the pulse is fine and weak, and there is no pain below the umbilicus; therefore, purgation is contraindicated. Regarding Tao Ren Cheng Qi Tang (Peach Kernel and Rhubarb Decoction), it is not suitable here; instead, use Shao Yao Di Huang Tang (Peony and Rehmannia Decoction). After three doses, he recovered."
A pregnant woman in the neighborhood contracted Shanghan (Cold Damage). She presented with swelling and fullness from the waist downward. Physicians diagnosed her variously as pregnancy toxemia (Zu), podagra/foot qi (Xiangjiao), or fluid retention (Shuifen). I said: "This is the pulse pattern associated with conception. The disease name is Heart Excess. Treatment should involve promoting urination." The physician asked: "Promoting urination implies treating it as fluid retention? Shouldn't we use Tong Cao (Akebia Caulis), Ting Li Zi (Lepidii Semen), and Sang Bai Pi (Morus Root Bark)?" I replied: "We should puncture Laogong (PC 8) and Guanyuan (CV 4)." The physician was greatly startled and asked: "Which medical classic does this come from?" I said: "Zhang Zhongjing's Yujian Jing (Golden Cabinet Classic) states: When a woman contracts Shanghan during pregnancy, specifically at seven months, if she experiences abdominal fullness and a sensation of water overflowing below the waist, it indicates that the Taiyin Spleen fails to nourish the fetus at this stage. This is an excess of Heart Qi. One should puncture Laogong and Guanyuan to promote urination, and the patient will recover." I instructed her on the acupuncture points, and she subsequently healed.
In the year Jiyi, when the Jin cavalry breached the Huai River region, a plague broke out widely. At that time, Wang Chaofeng was staying at Tianqing Temple. He fell ill with fever, spontaneous sweating, heaviness of the body making turning difficult, somnolence, and snoring during sleep. Physicians diagnosed this as a combined disease of the Three Yang meridians or as Lou Feng (Leaking Wind) syndrome, but the treatments were ineffective. I said: "This is Fengwen (Wind-Warmth) disease." I prescribed Wei Rui Tang (Polygonatum Decoction) and Du Huo Tang (Angelica Pubescens Decoction). After several days, he recovered.
Commentary: Zhang Zhongjing stated in the chapter on Taiyang Disease Pulses: In Taiyang disease, if there is fever, thirst, and aversion to cold is absent, it is called Wenbing (Warm Disease). If, after sweating, the body becomes burning hot, it is named Fengwen (Wind-Warmth). In Fengwen disease, the pulses at the cun, guan, and chi positions are all floating; there is spontaneous sweating; the body feels heavy; there is excessive sleepiness; breathing is accompanied by snoring; and speech is difficult. If mistakenly treated with purgatives, it leads to difficulty in urination, staring gaze, and incontinence of urine and feces. If mistakenly treated with fire therapy, mild cases result in yellowing of the skin, while severe cases resemble convulsions or epilepsy with periodic spasms. It is also stated: If the Yang pulses are floating and slippery, and the Yin pulses are soggy and weak, and wind pathogen is encountered again, it transforms into Fengwen. Generally, when warm pathogens are prevalent and wind pathogens are encountered, these syndromes appear. This occurs frequently in spring and summer. Physicians who treat it as Shanghan Lou Feng are incorrect. Since this is not caused by fire toxin, purgation is contraindicated, and vigorous diaphoresis is also contraindicated. Zhang Zhongjing did not provide a specific formula for this. Ancient methods suggest selecting points from the Hand-Shaoyin Heart meridian and Foot-Jueyin Liver meridian according to the affected channels. Therefore, formulas such as Wei Rui Tang and Du Huo Tang are appropriate. If there is fever without signs requiring purgation, Zhi Mu Shi Gao Tang (Anemarrhena and Gypsum Decoction) should be used. If diaphoresis was mistakenly applied, Fang Ji Huang Qi Tang (Stephania and Astragalus Decoction) can be used to rescue the situation.