李琛大夫病伤寒。发热。面目俱赤。气上冲。腹满大小便闭。无汗。脉紧而长。予令服大承
气汤。他医以小柴胡汤与之。不验。又以大柴胡汤与之。亦不效。又增大柴胡汤大剂。大便通。
下燥屎得愈。乃夸曰果不须大承气。予笑曰。公苟图目前。而不知贻祸于后。病虽瘥。必作疮疡
之证。后半月。忽体生赤疮。次日背发肿如盘。坚如石。痛不堪忍。渠以为背疽忧甚。急召予。
予曰。疮疡之证也。若当日服承气。今无此患矣。治以数日瘥。或者问何以知其疮疡之证。予曰
仲景云。趺阳脉滑而紧者。胃气实。脾气强。持实击强。痛还自伤。以手把刃坐作疡。盖病势有
浅深。药力有轻重。治者必察其病者如何耳。疾势深则以重剂与之。疾势轻则以轻剂与之。正如
持衡。锱铢不偏也。不然。焉用七方十剂。今病患毒邪如此深。须藉大黄、朴硝。荡涤脏腑经络
毒瓦斯。利三二行。则邪毒皆去。今医小心谨慎。又不能了了见得根源。但以大柴胡得屎。因谓大
便通行。便得安痊。不知遗祸于后。必疮疡。当时若听予言。岂有斯患。
一尼病头痛身热。烦渴。躁。诊其脉大而虚。问之曰小便赤。背恶寒。毛竦洒洒然。面垢中
暑也。医作热病治。但未敢服药。予投以白虎汤。数日愈。
论曰。仲景云脉虚身热。得之伤暑。又云其脉弦细芤迟何也。素问曰寒伤形。热伤气。盖伤
气不伤形。则气消而脉虚弱。所以弦迟芤细。皆虚脉而可知矣。
李琛大夫患伤寒。发热。面目俱赤。气上冲。腹满大小便闭。无汗。脉紧而长。予令服大承气汤（峻下热结之方）。他医以小柴胡汤（和解少阳之方）与之。不验。又以大柴胡汤（和解少阳、内泻热结之方）与之。亦不效。又增大柴胡汤大剂。大便通。下燥屎得愈。乃夸曰果不须大承气。予笑曰。公苟图目前。而不知贻祸于后。病虽瘥。必作疮疡之证。后半月。忽体生赤疮。次日背发肿如盘。坚如石。痛不堪忍。渠以为背疽忧甚。急召予。予曰。疮疡之证也。若当日服承气。今无此患矣。治以数日瘥。或者问何以知其疮疡之证。予曰仲景云。趺阳脉滑而紧者。胃气实。脾气强。持实击强。痛还自伤。以手把刃坐作疡。盖病势有浅深。药力有轻重。治者必察其病者如何耳。疾势深则以重剂与之。疾势轻则以轻剂与之。正如持衡。锱铢不偏也。不然。焉用七方十剂。今病患毒邪如此深。须藉大黄、朴硝。荡涤脏腑经络毒瓦斯。利三二行。则邪毒皆去。今医小心谨慎。又不能了了见得根源。但以大柴胡得屎。因谓大便通行。便得安痊。不知遗祸于后。必疮疡。当时若听予言。岂有斯患。
一尼病头痛身热。烦渴。躁。诊其脉大而虚。问之曰小便赤。背恶寒。毛竦洒洒然。面垢中暑也。医作热病治。但未敢服药。予投以白虎汤（清热生津之方）。数日愈。
论曰。仲景云脉虚身热。得之伤暑。又云其脉弦细芤迟何也。素问曰寒伤形。热伤气。盖伤气不伤形。则气消而脉虚弱。所以弦迟芤细。皆虚脉而可知矣。
Physician Li Chen suffered from Shanghan (Cold Damage). He had fever, redness of the face and eyes, upward rushing of Qi, abdominal fullness, and obstruction of both urination and defecation. There was no sweating, and the pulse was tight and long. I instructed him to take Dachengqi Tang (Major Order the Qi Decoction). Other physicians gave him Xiaochaihu Tang (Minor Order the Gallbladder Decoction), but it was ineffective. They then administered Daxiaohu Tang (Greater Order the Gallbladder Decoction), which also failed. Finally, they increased the dosage of Daxiaohu Tang significantly. His bowels moved, dry feces were passed, and he recovered. He boasted, "Indeed, Dachengqi Tang was not needed." I smiled and said, "You only sought immediate relief without realizing the disaster you would leave for later. Although the illness has subsided, sores and ulcers will certainly develop." Half a month later, red sores suddenly appeared all over his body. The next day, a swelling like a plate erupted on his back, hard as stone, with unbearable pain. He was extremely worried, thinking it was a carbuncle on the back, and urgently summoned me. I said, "This is a manifestation of sores and ulcers. If you had taken Chengqi Decoction that day, you would have avoided this trouble today." After several days of treatment, he recovered. Someone asked how I knew it would result in sores and ulcers. I said, "Zhang Zhongjing stated: 'If the Duyang pulse is slippery and tight, the Stomach Qi is excess and the Spleen Qi is strong. Holding excess to strike strength causes pain to injure oneself; holding a blade in hand leads to sores.' The progression of disease has depth and shallowness, and the power of medicine has heaviness and lightness. The practitioner must examine the condition of the patient accordingly. If the disease is deep, administer heavy formulas; if the disease is light, administer light formulas. This is just like holding a balance scale, where every grain counts without bias. Otherwise, why use the Seven Formulas and Ten Dosage Forms? Now, the pathogenic toxin in this patient is so deep that one must rely on Radix et Rhizoma Rhei (Dahuang, 大黄) and Natrii Sulfas (Puxiao, 朴硝) to purge the toxic qi from the Zang-Fu organs and meridians. After two or three bowel movements, the pathogenic toxins will be eliminated. These doctors are cautious but fail to clearly see the root cause. Because Daxiaohu Tang produced stool, they assumed that because bowel movement resumed, the patient was cured. They did not realize that leaving the toxin behind would inevitably lead to sores and ulcers. If they had listened to my advice at that time, how could such a disaster have occurred?"
A nun suffered from headache, body heat, vexation, thirst, and restlessness. Her pulse was large and deficient upon examination. When asked, she reported dark urine, aversion to cold on the back, and gooseflesh. This was diagnosed as Zhongshu (Heatstroke) with facial greasiness. The physician treated it as a Rebing (Heat Disease) but dared not administer medication. I prescribed Baihu Tang (White Tiger Decoction), and she recovered after several days.
In commentary: Zhang Zhongjing stated, "A deficient pulse with body heat results from Shangshu (Summerheat Injury)." He also asked, "Why is the pulse wiry, fine, hollow, and slow?" The Suwen (Classic of Difficult Issues) states: "Cold injures the form; Heat injures Qi." Since Heat injures Qi but not the form, Qi diminishes, resulting in a weak and deficient pulse. Therefore, wiry, slow, hollow, and fine pulses are all indicative of deficiency, which can be understood thusly.