庚戌仲春。艾道先染伤寒。近旬日。热而自汗。大便不通。小便如常。神昏多睡。诊其脉。
长大而虚。予曰。阳明证也。乃兄景先曰。舍弟全似李大夫证。又属阳明。莫可行承气否。予曰。
虽为阳明。此证不可下。仲景。阳明。自汗。小便利者。为津液内竭。虽坚不可攻。宜蜜兑导之。
作三剂。三易之。先下燥粪。次泄溏。已而汗解。
论曰。二阳明证虽相似。然自汗小便利者。不可荡涤五脏。为无津液也。然则伤寒大证相似。
脉与证稍异。通变为要。仔细斟酌。正如以格局看命。虽年月日时皆同。贵贱穷通不相侔者。于
一时之顷。又有浅深也。
朱保义抚辰。庚戌春。权监务。予一日就务谒之。见拥炉忍痛。若不禁状。予问所苦。小肠
气痛。求予诊之。予曰。六脉虚浮而紧。非但小肠气。恐别生他疾。越数日再往。卧病已五日矣。
入其室。见一市医孙尚者供药。予诊之曰。此阴毒证。肾虚阳脱。脉无根蒂。独见于皮肤。黄帝
所谓悬绝。仲景所谓瞥如羹上肥也。早晚喘急。未几而息已高矣。孙生尚与术附汤。灸脐下。予曰。
虽卢扁之妙无及矣。是夕死。故论伤寒以真气为主。
论曰。伤寒不拘阴证阳证。阴毒阳毒。要之真气强壮者易治。真气不守。受邪才重。便有必
死之道。何也。阳证宜下。真气弱。则下之便脱。阴证宜温。真阴弱。温之则客热便生。故医者
难于用药。非病不可治也。主本无力也。经曰。阳胜则身热。腠理闭。喘粗。为之俯仰。汗不出
而热。齿干。以烦冤腹满死。阴胜则身寒。寒则厥。厥则腹满死。帝曰。调此二者奈何。岐伯曰。
女子二七天癸至。七七止。男子二八精气溢。八八止。妇人月事。以时下。故七欲损也。男子精。
欲满不欲竭。故八欲益也。如此则男妇身常无病。无病精气常固。虽有寒邪。易于调治。故曰二
者可调。是知伤寒真气壮者易治也。
庚戌年仲春时节，艾道先感染了伤寒。将近十天，身体发热且自汗出，大便不通畅，小便正常，神志昏沉嗜睡。诊察他的脉象，脉形长大但按之空虚。我说：这是阳明病证。他的哥哥景先说：我弟弟的症状完全像李大夫所描述的证候，又属于阳明病，是否可以服用承气汤攻下？我说：虽然属于阳明病，但这个证候不可使用攻下法。张仲景指出，阳明病出现自汗、小便通利的情况，是因为体内津液枯竭，即使大便干结坚硬也不可强行攻下，适宜用蜜导法（蜂蜜栓剂）引导排便。制作了三剂蜜导，更换了三次，先排出干燥的粪便，随后排出稀便，之后通过发汗而痊愈。
论述说：两种阳明病证虽然相似，但是出现自汗和小便通利的情况，不可使用峻猛药物荡涤五脏，因为此时体内没有津液。既然这样，伤寒的大证候虽然相似，但脉象和症状稍有差异，关键在于灵活变通，仔细斟酌判断。这正如用八字格局来看命运，虽然年月日时都相同，但贵贱穷通的结局并不相同，就在片刻之间，又有深浅的区别。
朱保义抚辰，在庚戌年春季，暂时代理监务一职。我有一天去公务处拜访他，看见他围着火炉忍受疼痛，好像无法承受的样子。我问他的痛苦所在，他说小肠气痛，请求我为他诊脉。我说：六脉虚浮而紧，不仅仅是小肠气痛，恐怕会生出其他疾病。过了几天再去探望，他已经卧病五天了。进入他的房间，看见一位名叫孙尚的市井医生正在给药。我诊察后说：这是阴毒证，肾虚导致阳气外脱，脉象没有根基，只浮越在皮肤表面。这就是黄帝所说的“悬绝”脉，张仲景所说的“瞥如羹上肥”（像漂浮在肉汤表面的油脂一样散乱无根）。早晚呼吸急促，不久之后气息已高亢衰竭。孙生尚给予术附汤，并灸脐下穴位。我说：即使是卢医和扁鹊那样的神医妙手也无法挽救了。当天晚上病人就去世了。所以论述伤寒必须以保护真气为主。
论述说：伤寒不拘泥于阴证或阳证，也不拘泥于阴毒或阳毒，总之真气强壮的人容易治疗，真气不能固守，感受邪气稍重，就会有必死的道理。为什么呢？阳证适宜攻下，如果真气虚弱，攻下就会导致正气脱失；阴证适宜温补，如果真阴虚弱，温补就会产生客热。所以医者难以用药，并不是病不可治，而是根本无力支撑。经典记载：阳胜则身体发热，腠理闭塞，呼吸粗重，坐卧不安，不出汗而身热，牙齿干燥，因烦闷腹满而死；阴胜则身体寒冷，寒则四肢厥冷，厥冷则腹满而死。黄帝问：调理这两者该怎么办？岐伯说：女子十四岁天癸至，四十九岁停止；男子十六岁精气溢泻，六十四岁停止。妇女月经按时来潮，所以七数宜于损耗；男子精气，宜充盈不宜枯竭，所以八数宜于增益。如此则男女身体常无疾病，无病则精气常固，虽然有寒邪侵袭，也易于调治。所以说二者可以调和，由此可知伤寒病患者中真气壮盛者容易治疗。
In the mid-spring of the Gengxu year, Ai Daoxian contracted Shanghan (Cold Damage). For nearly ten days, he experienced fever with spontaneous sweating, constipation, normal urination, lethargy, and excessive sleepiness. Upon palpating his pulse, it was found to be large and long but empty upon pressure. I stated: This is a Yangming syndrome. His brother, Jingxian, remarked: My younger brother's symptoms resemble those described by Dr. Li, and since it also belongs to Yangming, can we administer Chengqi Tang (Bowel-Regulating Decoction) for purgation? I replied: Although it is a Yangming condition, this specific presentation must not be treated with purgation. Zhang Zhongjing pointed out that in Yangming disease, spontaneous sweating combined with free urination indicates exhaustion of body fluids internally; even if the stool is hard and dry, it cannot be forcibly purged. Instead, honey suppositories (Mi Dui) should be used to guide evacuation. Three doses were prepared, changed three times. First, dry feces were expelled, followed by loose stools, and subsequently, the patient recovered through sweating.
The commentary states: Although these two Yangming syndromes appear similar, when spontaneous sweating and free urination are present, one must not use drastic methods to cleanse the five zang organs, as there are no body fluids available. Thus, although major Shanghan presentations may look alike, slight differences in pulse and symptoms require flexible adaptation and careful deliberation. This is akin to analyzing destiny using Bazi (Four Pillars); even if the year, month, day, and hour are identical, the outcomes of nobility or poverty differ, varying in depth within mere moments.
Zhu Baoyi Fuchen, who temporarily served as supervisor in the spring of the Gengxu year, was visited by me one day at his office. He was seen huddled around a stove, enduring pain as if unbearable. When asked about his suffering, he cited Xiao Chang Qi (Small Intestine Qi disorder) pain and requested a pulse diagnosis. I noted: The six pulses are deficient, floating, and tight. This is not merely Small Intestine Qi disorder; other diseases may arise. A few days later, upon visiting again, he had been bedridden for five days. Entering his room, I saw a local physician named Sun Shang administering medicine. After diagnosing, I said: This is Yin Du (Yin Toxin) syndrome, characterized by Kidney deficiency leading to Yang collapse. The pulse lacks root, appearing only superficially on the skin. This corresponds to what Huangdi termed "Xuan Jue" (Hanging Extinction) and what Zhang Zhongjing described as "Pie Ru Geng Shang Fei" (scattered like fat floating on soup surface). With rapid breathing morning and evening, his breath soon became high-pitched and failing. Sun Shang administered Shu Fu Tang (Atractylodes and Aconite Decoction) and moxa points below the umbilicus. I remarked: Even the miraculous skills of Lu Yi (Bian Que) would be insufficient. That night, the patient died. Therefore, in discussing Shanghan, priority must be given to preserving Zhen Qi (True Vital Energy).
The commentary states: Shanghan is not restricted to Yin or Yang syndromes, nor to Yin or Yang toxins. Ultimately, those with strong Zhen Qi are easier to treat. If Zhen Qi fails to remain secure, even a slight pathogenic invasion leads to inevitable death. Why? Yang syndromes are suitable for purgation; if Zhen Qi is weak, purgation causes collapse. Yin syndromes are suitable for warming; if True Yin is weak, warming generates exogenous heat. Hence, physicians find medication difficult, not because the disease is incurable, but because the fundamental strength is lacking. The Classics state: Excess Yang results in fever, closed pores, coarse breathing, restlessness, anhidrosis with heat, dry teeth, and death due to irritability and abdominal fullness. Excess Yin results in cold limbs, cold-induced rigidity, and death due to abdominal fullness. The Yellow Emperor asked: How to regulate these two? Qibo answered: Women reach Tian Gui (menstrual essence) at age fourteen and cease at forty-nine; men's essence overflows at sixteen and ceases at sixty-four. Women's menstruation occurs regularly, so the number seven implies a tendency toward depletion; men's essence should be full rather than exhausted, so the number eight implies a tendency toward enrichment. In this way, men and women remain healthy, their essence solid, making them resilient to cold pathogens and easy to treat. Thus, it is known that Shanghan patients with robust Zhen Qi are easier to cure.