丁巳冬十月。予从军回、至汴梁。有伶人李人爱谓予曰。大儿自今岁七月间。因劳役渴饮凉茶。及
食冷饭。觉心下痞。请医治之。医投药一服。下利两行。其证遂减。不数日。又伤冷物。心腹复痞
满。添呕吐恶心。饮食无味。且不饮食。四肢困倦。懒于言语。复请前医诊。视曰。此病易为。更利
几行即快矣。遂以无忧散对。加牵牛末。白汤服。至夕。腹中雷鸣而作阵痛。少焉既吐又泻。烦渴
不止。饮冷无度。不复能禁。时发昏愦。再命前医视之。诊其脉。不能措手而退。顷之冷汗如洗。
口鼻气渐冷而卒矣。小人悔恨无及。敢以为问。予曰。未尝亲见。不知所以然。既去。或曰。予亲
见之。果药之罪欤而非欤。对曰。此非药之罪。乃失其约量之过也。夫药用之无据。反为气贼。内
经云。约方犹约囊也。囊满弗约则输泄。方成弗约则神与气弗俱。故仲景以桂枝汤治外伤风邪。则
曰若一服汗出。病瘥停后服。不必尽剂，大承气汤下大满大实。则曰得更衣止后服。不必尽剂。其
慎如此。此为大戒。盖得圣人约囊之旨也。治病必求其本。盖李人以 优杂剧为戏。劳神损气而其
中疹然。因时暑热。渴饮凉茶。脾胃气弱。不能运化而作痞满。以药下之。是重困也。加以不慎。又
损其阳。虚而复伤。伤而复下。阴争于内。阳扰于外。魄汗未藏。四逆而起。此仲景所谓一逆尚引
日。再逆促命期。如是则非失约量之过而何。故内经戒云。上工平气。中工乱脉。下工绝气。危生
下工。不可不慎也。
丁巳年冬十月，我随军返回，到达汴梁。有一位名叫李人爱的戏曲演员对我说：“我的大儿子从今年七月起，因为劳累过度、口渴饮用凉茶，又吃了冷饭，感觉心窝部痞塞不适。请医生治疗，医生给了一服药，服后腹泻两次，症状于是减轻。没过几天，他又吃了生冷食物，心腹部再次出现痞满，并增添了呕吐、恶心、食欲不振、不想进食、四肢困倦乏力、懒得说话等症状。再次请之前的医生诊治。医生看后说：‘这个病容易治，再泻几次就会舒服了。’于是用无忧散，加入牵牛子末，用白开水送服。到了傍晚，腹中肠鸣如雷并阵发性疼痛。不久之后，既吐又泻，烦渴不止，大量饮水无法节制，神志时而昏乱。再次让之前的医生来看，医生诊脉时不知所措，退下离去。过了一会儿，病人冷汗淋漓如洗澡一般，口鼻气息逐渐变冷，最终死亡。小人悔恨莫及，斗胆向您请教。”我说：“我没有亲眼见过（发病过程），不知道其中的原因。”他离开后，有人问：“我亲眼所见，这确实是药物的罪过吗？”回答说：“这不是药物的罪过，而是医生失去了用药法度的过错。《黄帝内经》说：‘约束方剂就像约束口袋一样。口袋满了如果不加以约束，就会漏泄；方剂开成而不加约束，神气就不能与之俱存。’所以张仲景用桂枝汤治疗外感风邪时说：如果一服药汗出，病就好了，就停止后续服用，不必喝完所有药剂；用大承气汤攻下大满大实之证时说：如果病情缓解就停止后续服用，不必喝完所有药剂。他们如此谨慎，这是最大的警戒，大概是得到了圣人‘约束口袋’的要旨吧。治病必须探求根本。大概李人的儿子以优杂剧为业，劳神耗气，身体本就虚弱。因当时暑热，口渴饮用凉茶，导致脾胃气弱，不能运化水谷而产生痞满。此时用下药攻伐，是使正气更加困顿。加上不慎起居饮食，又损伤了阳气，虚证又受伤害，受伤后又用下法，导致阴气在内部争斗，阳气在外部扰乱，卫气不固而汗出，四肢厥逆而起。这就是张仲景所说的‘一次误治还能拖延时日，二次误治则加速死亡’。像这样，如果不是失去用药法度的过错，那是什么呢？所以《黄帝内经》告诫说：‘上工（高明的医生）调和气机，中工（一般的医生）扰乱脉象，下工（低劣的医生）断绝生气。危及其生命的往往是下工，不可不谨慎啊。’
In the tenth month of winter in the Ding Si year, I returned with the army to Bianliang. A performer named Li Ren'ai said to me, "My eldest son has felt epigastric fullness and obstruction (epigastric stuffiness) since July this year. This was caused by overwork, drinking cold tea due to thirst, and eating cold rice. He sought medical treatment, and after taking one dose of medicine prescribed by a doctor, he experienced two episodes of diarrhea, and his symptoms subsequently alleviated. However, within a few days, he consumed cold foods again, causing his heart and abdomen to become distended and full once more. He developed vomiting, nausea, loss of taste for food, anorexia, fatigue in the four limbs, and reluctance to speak. We invited the previous doctor to diagnose him again. The doctor examined him and said, 'This illness is easy to treat; a few more bowel movements will bring relief.' Consequently, he administered Wuyou San (Worry-Free Powder) compounded with powdered Qian Niu (Pharbitis Seed), taken with plain boiled water. By evening, borborygmus (intestinal rumbling) arose in the abdomen accompanied by paroxysmal pain. Shortly thereafter, he suffered from both vomiting and diarrhea, with incessant irritability and thirst, consuming cold liquids without limit, unable to restrain himself. He occasionally fell into confusion and unconsciousness. We asked the previous doctor to examine him again. Upon palpating the pulse, the doctor did not know how to proceed and withdrew. Soon after, profuse cold sweat poured out like a bath, and the breath from his mouth and nose gradually turned cold until he passed away. I am filled with regret and remorse, and dare to ask for your explanation." I replied, "I have not witnessed it personally, so I do not know the reason." After he left, someone asked me, "I witnessed it personally. Was it indeed the fault of the medicine?" I answered, "It was not the fault of the medicine, but rather the fault of the physician failing to adhere to proper dosage and restraint. When medicines are used without basis, they become thieves of Qi. The Huangdi Neijing (Yellow Emperor's Inner Canon) states: 'Restricting a prescription is like restricting a bag. If a bag is full and not restricted, its contents will leak out; if a prescription is formulated without restriction, the Shen (Spirit) and Qi will not remain together.' Therefore, Zhang Zhongjing, when using Guizhi Tang (Cinnamon Twig Decoction) to treat external wind pathogen, stated: 'If sweating occurs after one dose and the disease resolves, stop subsequent doses; there is no need to finish the entire preparation.' When using Dachengqi Tang (Major Order the Qi Decoction) to purge severe fullness and excess, he stated: 'Stop subsequent doses once the condition improves; there is no need to finish the entire preparation.' They were so cautious. This serves as a great warning, embodying the essence of the Sage's principle of 'restricting the bag.' In treating diseases, one must seek the root. It is likely that Li Ren'ai's son, whose profession involves theatrical performance, had already damaged his Qi and depleted his spirit through mental exertion, leaving his constitution inherently weak. Due to the summer heat, he drank cold tea when thirsty, weakening the Qi of the Spleen and Stomach, which failed to transform and transport, resulting in fullness and obstruction. Using purgative drugs at this stage further exhausted the healthy Qi. Coupled with imprudence, his Yang Qi was further damaged. With deficiency followed by injury, and injury followed by purging, Yin contended internally while Yang was disturbed externally. Wei Qi (Defensive Qi) failed to consolidate, leading to spontaneous sweating, and the four limbs became cold (cold extremities). This is what Zhang Zhongjing referred to as: 'One error may prolong life for a time, but two errors hasten death.' Under such circumstances, how could this not be attributed to the failure in dosage and restraint? Thus, the Huangdi Neijing warns: 'The superior physician regulates Qi; the average physician disrupts the pulse; the inferior physician severs Qi. Those who endanger lives are often the inferior physicians; one must be extremely cautious.'