吴江吴太仆长君肖峰令政，太宗伯董浔老次女也。患咳嗽、体倦、多汗、腹痛，呻吟不
绝口者半月，吴江之医不效，访远近名最着者，如姑苏盛氏后湖，王氏后山，震泽沈氏竹亭
，先后递治之而痛愈加。予适寓苕城，龙山公邀予乘快舡兼程而进。至则诊其脉，左手三
五不调，右手沉弦，面色青而息甚微，腹中漉漉有声。予因问上年夏月曾病否？肖峰曰∶曾
头痛体倦多汗，动止无力，不能亲事，但不咳嗽，不腹痛。今五月初，病如上年，而市医谓
伤风所致，用参苏饮表之，始咳嗽。沉为其清嗽，则加腹痛；王与盛谓通则不痛，以沉香滚
痰丸下之，则势惫而不可支。予方殚思，谓此乃疰夏病。仲景谓春夏剧，秋冬瘥者是也。而
龙山公诘问∶疰夏何为咳嗽？予曰∶原不咳嗽，由参苏饮而咳嗽也。汗多又重发汗，肺金受
伤，故燥而嗽。何为腹痛？予曰∶原不腹痛，因治嗽而寒其中气，腹故痛也。
后事者，又不究其因寒而痛，乃谓通则不痛，而用寒凉滚
痰之剂，重伤其中气。不思五月六阳之气皆散于外，汗而又汗，汗多则亡阳，夏至一
阴将萌，腹中尚虚，虚而复下，下多则亡阴，阴阳俱亡，不惫何待。予欲酌一方以起之，恐
从
事者又将议其后。龙山促之，乃用洒炒白芍五钱，甘草、黄 各三钱，桂枝二钱，大枣
二枚，水煎，临服加饴糖一合。吴下诸公，果群然又辩。龙山公曰∶不必辩，病者望此以苏其
生，速煎饮之。饮讫而睡，自已至申不醒。先事者，皆摇首，命仆急携药囊将去，且语龙
山公曰∶夺令妹之速者，孙君也。《本草》云∶夏不用桂，伐天和也。诸痛不补，助邪气也
。故一饮而不醒，吾侪行矣。龙山公以其言语余，因诘病者之熟睡。予曰∶所善者，以其睡也
。睡则阴气生，阴生则汗可敛，痛可止也。假令药不对症，安得有此。又诘所投之剂何名。
予曰∶此仲景小建中汤也，出《金匮要略》。盖建者，立也，中者，阳明所主，今腹痛如缚
，带脉急缩也。东垣治例，腹痛以芍药为君，恶寒而痛，加桂。甘草，缓带脉之急缩，用
以为臣。经曰，急者缓之。面青脉弦，肝气盛也，肝属木，木盛则脾土受制，而又误下，因
伤之极，故痛之猛也。经云∶木得桂而枯。佐以黄 ，伐肝补脾，又能敛汗止痛，此建中
之
所由名也。语未竟，内报病者醒而索粥，予曰∶与之，谷气进则有本矣。粥后又睡。至天明
，腹全不痛，惟稍咳嗽，加五味子、麦门冬，兼治疰夏而全瘳焉。龙山公述病之始末，剂之
药味，报大宗伯，宗伯公致书于予曰∶足下以四味之常药，振不起之危 ，名震三吴，声溢
两
浙。昔宋景濂为朱丹溪立传，吾固不敏，幸先生以所治节条敷之，俾序以传于后，俾工是
术者，有所籍乎!予怃然语龙山公曰∶何修而得老先生宠幸之深也。第令妹被克伐太过，阴阳
俱亡，今病虽愈，而脉弦不退，犹可为虑，幸叮咛戒暴怒、节饮食，谢去人事，恬澹多补
，庶可永年。不然亥月阴极阳生，恐不能保无患也，慎之慎之。后至期，与肖峰龃龉，怒而
绝药，果以凶闻。苕人多予之直与先见云。
吴江吴太仆的长子肖峰先生的夫人，是太宗伯董浔老的次女。她患有咳嗽、身体疲倦、多汗、腹痛的症状，呻吟声不绝于口长达半个月。吴江当地的医生治疗无效，于是寻访远近最著名的名医，如姑苏的盛后湖、王后山，震泽的沈竹亭，先后轮流诊治，但疼痛反而加剧。
我恰好寓居在苕城（今浙江湖州），龙山公邀请我乘坐快船兼程赶路前往。到达后诊察她的脉象：左手脉三五不调（节律不齐），右手脉沉弦；面色发青，呼吸微弱，腹中有漉漉的水声。我问：“去年夏天是否生过病？”肖峰说：“曾患头痛、身体疲倦、多汗，行动无力，不能处理家务，但没有咳嗽和腹痛。”今年五月初，病情与去年相似，但市井医生认为是伤风所致，使用了参苏饮（人参苏叶散）进行解表治疗，这才开始咳嗽。随后医生为了清肃咳嗽，又用了沉香滚痰丸（一种泻下剂）攻下，导致病情危重，难以支撑。
我深思熟虑后认为，这是“疰夏”病（夏季常见的虚弱性疾病）。张仲景所说的春夏加重、秋冬缓解的情况正是如此。但龙山公追问：“疰夏为什么会引起咳嗽？”我说：“原本不咳嗽，是因为用了参苏饮才导致咳嗽。出汗多又再次发汗，损伤了肺金，所以干燥而咳。为什么会腹痛？”我说：“原本不腹痛，因为治疗咳嗽时寒凉药物伤了中气，腹部因此疼痛。”
后来的医生，不探究因寒致痛的病因，反而信奉“通则不痛”的理论，使用寒凉的滚痰类药物攻下，严重损伤了中气。他们没考虑到五月六阳之气都发散于体表，汗而又汗，汗多则亡阳；夏至时节一阴初生，腹部尚且空虚，本已虚损又用攻下法，下法过多则亡阴。阴阳俱亡，不出现衰竭状态还等待什么呢？
我想斟酌一方来挽救她，又怕主治医生会追究我的责任。龙山公催促我开方，于是我用了洒炒白芍五钱，甘草、黄芪各三钱，桂枝二钱，大枣两枚，水煎，临服用时加入饴糖一合。吴地各位医生果然纷纷辩论反对。龙山公说：“不必辩论，病人指望靠这个方子恢复生命，赶快煎服。”服药后入睡，从巳时一直睡到申时未醒。之前的医生都摇头，命令仆人收拾药囊准备离开，并对龙山公说：“让令妹迅速死亡的，是孙君啊。《本草》说：夏天不用桂枝，以免伐天和。各种疼痛不可补益，以免助长邪气。所以喝了一剂就不醒了，我们走吧。”
龙山公把这话转告给我，我便询问病人熟睡的情况。我说：“我所欣慰的，正是她睡着了。睡着则阴气生，阴气生则汗可收敛，疼痛可停止。假如药不对症，怎么能这样呢？”他又问所投用的方剂叫什么名字。我说：“这是张仲景的小建中汤，出自《金匮要略》。‘建’的意思是建立/稳固，‘中’指阳明胃土所主。现在腹痛如被束缚，是带脉紧急收缩。李东垣的治疗法则中，腹痛以芍药为君药，恶寒而痛加桂枝。甘草能缓解放带脉的紧急收缩，作为臣药。经书说：急者缓之。面色青、脉弦，说明肝气盛。肝属木，木盛则克制脾土，再加上误用攻下，损伤极重，所以疼痛剧烈。经云：木得桂而枯。佐以黄芪，既能伐肝补脾，又能敛汗止痛，这就是‘建中’命名的由来。”
话还没说完，里面报告病人醒来要喝粥。我说：“给她喝，有了谷气就有根本了。”喝完粥后又睡了。到了天亮，腹部完全不痛了，只是稍微有点咳嗽，于是加了五味子、麦门冬，兼治疰夏，最终完全痊愈。
龙山公叙述了病情的始末和用药情况，报告给大宗伯（董浔老）。大宗伯写信给我说：“您用四味寻常药物，挽救了垂危的生命，名震三吴，声誉溢满两浙。昔日宋景濂为朱丹溪立传，我虽然不才，希望先生将治疗的经过条理清晰地写出来，让我作序流传后世，使从事医术的人有所借鉴！”我怅然对龙山公说：“我修养何德何能，得到老先生如此深厚的宠幸。只是令妹被克伐太过，阴阳俱亡，现在病虽愈，但脉弦不退，仍值得忧虑，务必叮嘱戒除暴怒、节制饮食，谢绝人事往来，保持恬淡并多加补益，或许可以长寿。不然到了亥月（农历十月）阴极阳生之时，恐怕难免有祸患，务必谨慎！务必谨慎！”后来到了那个时期，肖峰与人发生争执，愤怒之下停药，果然传来了凶信。苕城的人都称赞我的诊断正确且有先见之明。
The wife of Xiao Feng, the eldest son of Wu Tai Pu from Wujiang, was the second daughter of Dong Xun Lao, the Grand Secretary of Rites. She suffered from cough, fatigue, excessive sweating, and abdominal pain, groaning incessantly for half a month. The physicians in Wujiang were ineffective. Seeking renowned doctors from near and far, such as Sheng Houhu from Gusu, Wang Houshan, and Shen Zhuting from Zhenze, they treated her in succession, yet the pain intensified.
I happened to be residing in Tiaocheng (modern Huzhou). Longshan Gong invited me to travel by fast boat with all possible speed. Upon arrival, I palpated her pulse: the left hand pulse was irregular (Sanwu Budiao), while the right hand pulse was deep and wiry (Chen Xian). Her complexion was greenish, respiration was faint, and there was a gurgling sound in her abdomen. I asked, "Did you suffer from illness last summer?" Xiao Feng replied, "I had headache, fatigue, and excessive sweating, with weakness in movement, unable to manage household affairs, but no cough or abdominal pain." In early May this year, the symptoms resembled those of last year. However, city physicians attributed it to wind-cold invasion and administered *Shensu Yin* (Ginseng and Perilla Decoction) to release the exterior, which induced the cough. Subsequently, to clear the lungs, they used *Chenxiang Untan Wan* (Agarwood and Phlegm-Draining Pill), a purgative, leading to a critical condition that seemed insupportable.
After deep contemplation, I concluded this was *Zhu Xia* disease (Summer-wasting disease). As Zhang Zhongjing stated, conditions worsening in spring and summer and improving in autumn and winter fit this pattern. Longshan Gong questioned, "Why does *Zhu Xia* cause cough?" I explained, "Originally, there was no cough; it was induced by *Shensu Yin*. Excessive sweating followed by further diaphoresis injured Lung Metal, causing dryness and cough. Why abdominal pain?" I said, "Originally, there was no abdominal pain; it resulted from cold damaging the Middle Jiao Qi during the treatment of the cough."
Subsequent physicians failed to investigate the cause of pain due to cold. Instead, adhering to the principle that 'patency relieves pain,' they used cold purgatives like *Untan* agents, severely damaging the Middle Jiao Qi. They overlooked that in the fifth lunar month, Yang Qi is dispersed outward. Sweating repeatedly leads to loss of Yang. At the Summer Solstice, Yin begins to sprout, leaving the abdomen deficient. Purging a deficient state leads to loss of Yin. With both Yin and Yang depleted, collapse is inevitable.
I wished to prescribe a formula to save her but feared reprimand from the attending physicians. Urged by Longshan Gong, I prescribed: Bai Shao (Radix Paeoniae Alba) stir-fried with wine, 5 qian; Gan Cao (Radix Glycyrrhizae) and Huang Qi (Radix Astragali), each 3 qian; Gui Zhi (Ramulus Cinnamomi), 2 qian; Da Zao (Fructus Jujubae), 2 pieces. Decoct in water, and add Yi Tang (Maltose) one he at administration. Physicians in Wujiang indeed debated vehemently. Longshan Gong said, "No need to debate. The patient relies on this for survival. Decoct and administer quickly." After ingestion, she fell into sleep from Si hour (9-11 AM) until Shen hour (3-5 PM) without waking. Previous physicians shook their heads, ordered servants to pack medical kits to leave, and told Longshan Gong, "It is Dr. Sun who hastened your sister's death. The *Bencao* states: Do not use Cinnamon Twig in summer, as it violates Heavenly Harmony. Pain should not be tonified, as it aids pathogenic factors. One dose caused unconsciousness; we are leaving."
Longshan Gong relayed this to me, and I inquired about her deep sleep. I said, "What pleases me is her sleep. Sleep generates Yin; when Yin grows, sweat can be consolidated, and pain stopped. If the prescription were inappropriate, how could this occur?" He asked the name of the formula. I said, "This is Zhang Zhongjing's *Xiao Jianzhong Tang* (Minor Construct the Middle Decoction), from *Jin Gui Yao Lue*. 'Jian' means to establish/steady; 'Zhong' refers to the Spleen/Stomach (Yangming Earth). The current abdominal pain, feeling bound, indicates tension in the Dai Mai (Girdle Vessel). According to Li Dongyuan's principles, for abdominal pain, Bai Shao is the Sovereign herb; if accompanied by aversion to cold, Gui Zhi is added. Gan Cao moderates the tension of the Dai Mai, serving as the Minister herb. The Classics state: For tension, use moderation. Green complexion and wiry pulse indicate excess Liver Qi. Liver belongs to Wood; Wood excess controls Earth. Combined with erroneous purging, the damage is extreme, hence severe pain. The Classics say: Wood withers with Cinnamon. Huang Qi assists by subduing Liver and tonifying Spleen, while also consolidating sweat and stopping pain. This explains the name 'Constructing the Middle.'"
Before I finished speaking, news came that the patient woke and requested porridge. I said, "Give it to her. Intake of grain qi establishes the root." After porridge, she slept again. By dawn, abdominal pain had completely ceased, with only slight cough remaining. I added Wu Wei Zi (Fructus Schisandrae) and Mai Men Dong (Rhizoma Ophiopogonis) to treat *Zhu Xia*, resulting in full recovery.
Longshan Gong reported the case history and prescriptions to the Grand Secretary (Dong Xun Lao). The Grand Secretary wrote to me: "You used four common herbs to revive a critical patient, shaking fame across Three Wu and spreading reputation through Two Zhes. Song Jinglian once wrote a biography for Zhu Danxi. Though I am unskilled, I hope you will detail the treatment steps so I may write a preface for posterity, providing reference for practitioners!" I responded humbly to Longshan Gong, "How have I earned such favor? However, your sister suffered excessive depletion, losing both Yin and Yang. Although cured, the wiry pulse persists, warranting caution. Advise her to avoid rage, regulate diet, withdraw from social affairs, maintain tranquility, and tonify frequently, perhaps ensuring longevity. Otherwise, in Hai month (lunar October), when Yin is extreme and Yang begins to rise, misfortune may occur. Be cautious! Be cautious!" Later, coinciding with that time, Xiao Feng had a dispute, angrily stopped medication, and indeed passed away. People in Tiaocheng praised my diagnosis as accurate and prescient.