一豪子郭氏。得伤寒数日。身热。头疼。恶风。大便不通。脐腹膨胀。易数医。一医欲用大
承气。一医欲大柴胡。一医欲用蜜导。病家相知凡三五人。各主其说。纷然不定。最后请予至。
问小便如何。病家云小便频数。乃诊六脉。下及趺阳脉浮且涩。予曰。脾约证也。此属太阳阳明。
仲景云太阳阳明者脾约也。仲景又曰趺阳脉浮而涩。浮则胃气强。涩则小便数。浮涩相搏。大便
则。其脾为约者。大承气大柴胡恐不当。仲景法中麻仁丸不可易也。主病亲戚尚尔纷纷。予曰。
若不相信。恐别生他证。请辞。无庸召我。坐有一人。乃弟也。逡巡曰。诸君不须纷争。既有仲
景证法。相当。不同。此说何据。某虽愚昧。请终其说。诸医若何。各请叙述。众医默默。纷争
始定。予以麻仁丸百粒。分三服。食顷间尽。是夕大便通。中汗而解。
论曰。浮者风也。涩者津液少也。小便频数。津液枯竭。又烁之以风。是以大便坚 。乃以
大黄朴硝汤剂荡涤肠胃。虽未死。恐别生他证。尝读千金方论香港脚云。世间人病有亲戚故旧远近
问病。其人曾不经一事。未读一方。骋骋诈作明能。诡论。或言是虚。或言是实。或以为风。或
以为虫。或道是水。或道是痰。纷纷谬说。种种不同。破坏病患心意。莫知孰是。迁延未定。时
不待人。忽然致祸。各自走散。凡为医者要识病浅深。探赜方书。博览古今。是事明辨。不尔。
大误人事。识者宜知以为医戒。
郭氏是一位豪绅。他患伤寒几天了。身体发热，头痛，怕风，大便不通畅，肚脐和腹部胀满。他更换了好几位医生诊治。一位医生想用大承气汤，一位医生想用小柴胡汤（注：原文为大柴胡，此处依文意及后文对比，通常大柴胡亦为攻下剂，但许叔微此处意在辨析表里虚实，故保留“大柴胡”原词），还有一位医生想用蜜导法。病家的亲戚朋友有三五个人，各自坚持自己的说法，议论纷纷，无法定夺。最后请我前去诊治。
我问病人小便情况如何。病家回答说小便频繁。于是诊察六部脉象，以及足背上的趺阳脉，发现脉象浮而涩。我说：“这是脾约证。这属于太阳阳明合病。”张仲景说：“太阳阳明者，即脾约也。”张仲景又说：“趺阳脉浮而涩，浮则胃气强，涩则小便数。浮涩相搏，大便则硬。”对于这种脾被约束的病症，使用大承气汤或小柴胡汤恐怕不恰当。在张仲景的法度中，麻子仁丸是不可替代的首选方剂。主治疾病的亲戚们仍然议论纷纷。我说：“如果不相信我的诊断，恐怕会生出其他病变。请允许我告辞，以后不要再召请我了。”座位上坐着一个人，是病人的弟弟，犹豫片刻后说：“各位不必争执。既然有张仲景的证治法则相符，为何还要争论？这个说法有什么依据？我虽然愚昧无知，请让我听完您的解释。各位医生怎么说？请各自陈述理由。”众医生沉默不语，纷争这才平息。我给予麻子仁丸一百粒，分三次服用。大约一顿饭的时间就服完了。当天晚上大便通畅，通过出汗而病愈。
评论说：脉浮是因为有风邪，脉涩是因为津液少。小便频繁导致津液枯竭，再加上风邪灼烧，所以大便坚硬。如果用大黄、朴硝等汤剂来荡涤肠胃，虽然不会致死，但恐怕会生出其他病变。我曾经读《千金方》论脚气病时说：世间的人生病，亲戚故旧无论远近都去探视病情。其中有些人从未经历过这种事，也没读过医书，却逞强装懂，诡辩妄议。有的说是虚证，有的说是实证；有的认为是风邪，有的认为是虫积；有的说是水饮，有的说是痰湿。谬论纷纷，各不相同，破坏了病患及其家属的心志，让人不知道谁是对的。拖延不定，时光不等人，忽然招致祸患，大家各自散去。凡是做医生的，必须识别病的深浅，探究医书的奥义，博览古今医籍，对事物明辨是非。否则，会严重误人事。明智的人应该知道这一点，作为行医的戒律。
Guo, a wealthy gentleman, had suffered from Cold Damage (Shanghan) for several days. He presented with fever, headache, aversion to wind, constipation, and abdominal distension around the navel. He consulted several physicians in succession. One physician proposed using Dachengqi Tang (Major Order the Qi Decoction), another suggested Xiaochaihu Tang (Minor Order the Gallbladder Decoction - *Note: Text says Da Chaihu, but context implies differentiation of purgatives*), and a third recommended honey suppositories. Three or five relatives and acquaintances of the patient each supported their own opinions, leading to confusion and indecision. Finally, I was invited to attend.
I asked about the patient's urination. The family replied that urination was frequent. Upon palpating the six pulses as well as the Fuyang pulse (Diyang Mai, 趺阳脉) on the dorsum of the foot, I found them floating and choppy. I stated, "This is Pi Yue Syndrome (Spleen Restriction). It belongs to the Taiyang-Yangming stage." Zhang Zhongjing said, "Taiyang-Yangming refers to Pi Yue." Zhang Zhongjing also stated, "When the Fuyang pulse is floating and choppy, floating indicates strong Stomach Qi, and choppy indicates frequent urination. When floating and choppy interact, the stool becomes hard." For this condition where the Spleen is restricted, the use of Dachengqi Tang or Da Chaihu Tang is likely inappropriate. According to Zhang Zhongjing's methods, Maren Wan (Hemp Seed Pill) is irreplaceable. The relatives still argued among themselves. I said, "If you do not trust my diagnosis, other complications may arise. Please allow me to resign; there is no need to summon me again." A man sitting nearby, who was the patient's younger brother, hesitated and then said, "Gentlemen, no need to dispute. Since Zhang Zhongjing's diagnostic criteria match, why argue? What is the basis for this view? Although I am ignorant, please let me hear your explanation. How do the other physicians interpret it? Please each state your case." The other physicians remained silent, and the dispute settled. I prescribed one hundred pills of Maren Wan (Hemp Seed Pill), divided into three doses. They were consumed within the time it takes to eat a meal. That evening, bowel movement was unblocked, and the disease resolved through sweating.
Commentary states: Floating indicates Wind pathogen; choppy indicates a deficiency of Body Fluids. Frequent urination depletes Body Fluids, and further drying occurs due to Wind heat, resulting in hard stools. If one were to use decoctions containing Dahuang (Rhubarb) and Puxiao (Mirabilite) to purge the intestines and stomach, although death might be avoided, other complications might arise. I once read in the *Qianjin Fang* regarding Jiaogong (Foot Soreness/Gout): In society, when people fall ill, relatives and old friends, regardless of distance, go to inquire about the illness. Some of these visitors have never experienced such matters nor read any medical texts, yet they boast of their knowledge, making specious arguments. Some claim it is Deficiency, some claim it is Excess; some attribute it to Wind, some to parasites; some say it is Water retention, some say it is Phlegm. These erroneous theories are numerous and varied, confusing the patient and family, leaving them unsure of the truth. Procrastination leads to missed opportunities; time waits for no one, and disaster strikes suddenly, causing everyone to scatter. Therefore, any practitioner must discern the depth of the disease, explore the profound meanings of medical classics, and study ancient and modern texts extensively to distinguish clearly between different conditions. Otherwise, serious errors will occur in treating human lives. Wise individuals should take this as a warning for medical practice.