中书左丞张仲谦。年五十二岁。至元戊辰春正月。在大都患风证。半身麻木。一医欲汗之。未
决可否。命予决之。予曰。治风当通因通用。汗之可也。然此地此时。虽交春令。寒气独存。汗之
则虚其表。必有恶风寒之证。仲谦欲速瘥。遂汗之。身体轻快。后数日。再来邀予视之曰。果如君
言。官事繁剧。不敢出门。常如之何。予曰。仲景云。大法夏宜汗。阳气在外故也。今时阳气尚弱
。初出于地。汗之则使气亟夺。卫气失守。不能肥实腠理。表上无阳。见风必大恶矣。内经曰。阳
气者卫外而为固也。又云。阳气者若天与日。失其所则折寿而不彰。当汗之时。犹有过汗之戒。况
不当汗而汗者乎。遂以黄 建中汤加白术服之。滋养脾胃。生发荣卫之气。又以温粉扑其皮肤。待
春气盛。表气渐实。即愈矣。内经曰。心不可伐。时不可违。此之谓也。
【黄 建中汤】（见劳倦门。于方中加白术）
静江府提刑李君长子。年一十九岁。至元壬午四月间。病伤寒九日。医者作阴证治之。与附子
理中丸数服。其证增剧。别易一医作阳证。议论差互。不敢服药。李君亲来邀请予为决疑。予避嫌
辞。李君拜泣而告曰。太医若不一往。犬子只待死矣。不获已遂往视之。坐间有数人。予不欲直言
其证。但细为分解。使自忖度之。凡阳证者。身须大热而手足不厥。卧则坦然。起则有力。不恶寒
。反恶热。不呕不泻。渴而饮水。烦躁不得眠。能食而多语。其脉浮大而数者。阳证也。凡阴证者
。身不热而手足厥冷。恶寒蜷卧。面向壁卧。恶闻人声。或自引衣盖覆。不烦渴。不欲食。小便自
利。大便反快。其脉沉细而微迟者。皆阴证也。诊其脉沉数得六七至。其母云。夜来叫呼不绝。全
不得睡。又喜冰水。予闻其言。阳证悉具。且三日不见大便。宜急下之。予遂秤酒煨大黄六钱、炙
甘草二钱、芒硝二钱。水煎服之。至夕下数行。燥粪二十余块。是夜汗大出。翌日又往视之。身凉
脉静矣。予思素问热论云。治之各通其脏腑。故仲景述伤寒论。六经各异。传受不同。活人书亦云
。凡治伤寒。先须明经络。若不识经络。触途冥行。前圣后圣。其揆一也。味者不学经络。不问病
源。按寸握尺。妄意疾证。不知邪气之所在。动致颠要。终不肯悔。韩语公曰。医之病病在少思。
理到之言。勉人学问。救生之心重矣。
中书左丞张仲谦，五十二岁。至元戊辰年（1268年）春季正月，在大都患病，表现为风证（此处指外感风邪或类中风症状），半身麻木。一位医生打算用发汗法治疗，但不确定是否可行，于是让我决定。我说：治疗风证应当“通因通用”（即通过疏通的方法来治疗具有闭塞或异常排泄症状的病证），发汗是可以的。然而此地此时，虽然已入春令，但寒气依然独存。如果发汗，会使体表虚弱，必然会出现怕风怕冷的症状。张仲谦希望快速痊愈，于是采用了发汗法。起初身体感觉轻快，但几天后，他再次邀请我去诊治，说：“果然像您说的那样，因为公务繁忙不敢出门，常像这样该怎么办？”我说：“张仲景说：‘大原则是夏季适宜发汗，因为阳气在外。’现在时令阳气尚弱，刚刚从地下生出，发汗会导致正气频繁耗夺，卫气失守，不能使腠理致密充实，体表缺乏阳气保护，见到风就会非常厌恶。”《内经》说：“阳气负责护卫体表并使其固密。”又说：“人体的阳气就像天空中的太阳，失去其正常位置和功能，就会折损寿命而不显赫。”即使在应当发汗的时候，还有过汗的戒律，何况是不当发汗而发汗呢？于是用黄芪建中汤加白术服用，以滋养脾胃，生发荣卫之气。又用温粉扑在皮肤上，等待春气旺盛，表气逐渐结实，病就会痊愈。《内经》说：“心脏不可被过度攻伐，时令不可违背。”说的就是这个道理。
静江府提刑李君的长子，十九岁。至元壬午年（1282年）四月间，患伤寒九天。医生按阴证治疗，给他服用了数剂附子理中丸，病情反而加重。另一位医生认为是阳证，两种意见互相冲突，患者家属不敢服药。李君亲自前来邀请我决断疑难。我为了避嫌推辞了，李君跪拜哭泣着告诉我：“太医如果不肯去，犬子只等死了。”不得已我便前往诊治。坐席上有几个人在场，我不愿直接直言病症，而是详细分解分析，让他们自己揣摩判断。凡是阳证，身体必须大热而手足不厥冷，躺卧时坦然舒适，起身时有力量，不怕冷，反而怕热，不呕吐不腹泻，口渴想喝水，烦躁不得睡眠，能进食且多语，脉象浮大而数的，就是阳证。凡是阴证，身体不热而手足厥冷，怕冷蜷缩而卧，面向墙壁躺卧，讨厌听到人声，或者自己拉衣服盖在身上，不烦渴，不想吃东西，小便自利，大便反而通畅，脉象沉细而微迟的，都是阴证。诊察他的脉象沉数，一息六七至（脉搏较快）。他的母亲说，昨晚叫喊不停，完全无法入睡，又喜欢喝冰水。我听了这些描述，确认阳证具备，而且三天没有大便，应当紧急使用下法。于是我称取酒煨大黄六钱、炙甘草二钱、芒硝二钱，水煎服用。到了傍晚，排便数次，排出燥粪二十多块。当晚大汗出，第二天我又去诊治，身体凉爽，脉象平静了。我思考《素问·热论》说：“治疗疾病要分别疏通脏腑。”所以张仲景阐述《伤寒论》，六经各异，传变不同。《活人书》也说：“凡是治疗伤寒，必须先弄明经络。如果不认识经络，就像在黑暗中行走。前代圣人和后代圣人，其道理是一致的。”庸俗的医生不学习经络，不问病源，只是按寸口握尺泽，随意猜测疾病，不知道邪气所在，动辄导致失误，始终不肯悔改。韩语公说：“医生的毛病在于思考太少。”这是讲到道理的话，勉励人们学问，救人的心很重啊。
Zhongshu Zuocheng Zhang Zhongqian, aged fifty-two. In the first month of spring in the year Wuchen of Zhiyuan (1268), he fell ill in Dadu with a wind syndrome (here referring to exogenous wind pathogen or stroke-like symptoms), characterized by numbness on one side of the body. A physician intended to treat him with sweating method but was uncertain whether it was appropriate, so he asked me to decide. I said: "To treat wind syndrome, one should employ 'treating obstruction with unblocking' (i.e., using dredging methods to treat diseases presenting with blockage or abnormal discharge); sweating is permissible. However, in this place and time, although the spring season has begun, cold qi still prevails alone. If sweating is induced, it will weaken the exterior, inevitably leading to aversion to wind and cold." Zhang Zhongqian desired a rapid recovery and thus underwent sweating therapy. Initially, his body felt light and refreshed, but several days later, he invited me again for consultation, saying, "Indeed as you predicted. Due to heavy official duties, I dare not go out. What should I do?" I said: "Zhang Zhongjing stated: 'The general principle is that sweating is suitable in summer because yang qi is on the exterior.' Currently, the seasonal yang qi is still weak, just emerging from the earth. Sweating will cause frequent depletion of qi, loss of defense qi control, and failure to make the couli (pores) dense and substantial. With no yang qi on the exterior, exposure to wind will cause severe aversion." The *Neijing* states: "Yang qi guards the exterior and maintains solidity." It also says: "Human yang qi is like the sun in the sky; if it loses its proper function, lifespan is shortened and brilliance is obscured." Even during times when sweating is indicated, there are warnings against excessive sweating, let alone sweating when it is contraindicated. Therefore, Huangqi Jianzhong Tang (Astragalus Decoction to Establish the Middle) with added Baizhu (Atractylodis Rhizoma) was prescribed to nourish the spleen and stomach, and generate Ying-Wei (nutritive and defensive) qi. Additionally, warm powder was applied to the skin. Once the spring qi became vigorous and the exterior qi gradually solidified, the illness would resolve. The *Neijing* says: "The Heart must not be excessively attacked; seasonal timing must not be violated." This refers to such cases.
[Huangqi Jianzhong Tang] (See section on Fatigue and Overwork; add Baizhu [Atractylodis Rhizoma] to the formula)
The eldest son of Li Jun, Tixing of Jingjiang Prefecture, was nineteen years old. In April of the year Renwu of Zhiyuan (1282), he suffered from Shanghan (Cold Damage) for nine days. The physician treated it as a Yin syndrome and administered several doses of Fuzi Lizhong Wan (Aconite Pill to Regulate the Middle). His condition worsened. Another physician diagnosed it as a Yang syndrome, leading to conflicting opinions, and the family dared not administer any medicine. Li Jun personally invited me to resolve the doubt. I declined to avoid suspicion. Li Jun knelt and wept, pleading: "If the Imperial Physician does not come, my son will only wait to die." Reluctantly, I went to examine him. There were several people present in the room. Not wishing to state the diagnosis directly, I analyzed the symptoms in detail, allowing them to deduce the nature of the disease themselves. Generally, for Yang syndromes, the body is highly febrile while the hands and feet are not cold; lying down is comfortable, rising shows strength; there is no aversion to cold but rather aversion to heat; no vomiting or diarrhea; thirst with desire to drink water; restlessness and insomnia; ability to eat and talkativeness; pulse floating, large, and rapid—these constitute a Yang syndrome. For Yin syndromes, the body is not hot but hands and feet are cold; aversion to cold with curled-up posture; lying facing the wall; aversion to human voices; pulling clothes to cover oneself; no烦渴 (restless thirst); lack of appetite; free urination; loose stools; pulse deep, fine, and slow—these constitute a Yin syndrome. Upon palpation, his pulse was deep and rapid, beating six to seven times per respiration. His mother reported that he had been shouting incessantly the previous night, unable to sleep at all, and showed a preference for ice water. Hearing these descriptions, I confirmed that all Yang syndrome signs were present. Moreover, he had not passed stool for three days, requiring urgent purgation. I weighed Liuqian (6 qian) of Jiuhuang Dahuang (Wine-baked Radix et Rhizoma Rhei), Erqian (2 qian) of Zhigancao (Prepared Licorice Root), and Erqian (2 qian) of Mangxiao (Natrii Sulfas), decocted them in water, and administered the mixture. By evening, he defecated several times, passing more than twenty pieces of dry feces. That night, he sweated profusely. The next day, upon re-examination, his body temperature was normal and pulse was calm. Reflecting on the *Suwen: Re Lun*, it states: "Treatment requires differentiating and unblocking the zang-fu organs." Thus, Zhang Zhongjing expounded the *Shanghan Lun*, noting that the Six Channels differ and transmission varies. The *Huoren Shu* also states: "In treating Shanghan, one must first clarify the meridians. Without understanding meridians, one wanders blindly. The principles of former and latter sages are identical." Ignorant physicians who neglect learning meridians, fail to inquire into the origin of disease, merely press the cun and chi pulses, and guess at illnesses without knowing the location of pathogens often cause errors and refuse to repent. Han Yugong said: "The fault of a physician lies in insufficient thought." These are words of profound truth, encouraging study and emphasizing the heavy responsibility of saving lives.