大光禄庞公子远，吴江人也。其太夫人病头痛恶寒，胸膈懑且痛，时发寒热。吴医王后
山者，有时名，吴人最所笃信。延治五日不瘥。闻予居吴，礼致为治。诊其脉，右滑大，左浮弦而数。问服何
剂？光禄公曰∶不识，而有药在。予视之，偶失言曰∶左矣!时有西席项姓者，闻言而厉声曰∶此三吴最名士也
。渠发剂而有议者，辄面唾之，幸不在尔。予笑曰∶渠是而议者
非，则当唾人；渠非而议者是，是自唾且不暇，何暇唾人。四物汤、玄胡索、牡丹皮、香附
子，养血调经剂也。太夫人
七十余矣，而有经可调哉!投剂之左，由生平守常套，而不知因人因症随俗为变也。项子曰
∶此
何症？予曰∶仲景有云，头痛恶寒，外感病也。浮弦而数，胸膈懑痛，少阳脉症俱在，右
脉滑，饮食滞而为痰。彼用当归、地黄、芍药，皆滞痰闭气之味，内伤何由得消，外感何由得
出？此症
只宜用柴胡汤合平胃散，一二帖可瘳也。项犹有言，光禄公曰∶勿辩，饮药而泾渭明矣。一
饮而寒热除，再饮而胸膈泰。光禄喜曰∶奇公名不虚附矣!予私问项子何极誉王？光禄曰∶
项初受业于王，未睹大方，而独是其师说，多见其识之不广也。
光禄公后有事于庄所，值中秋，乘酒步月，失足一跌，扶起便胁痛不能立，昼夜不宁，
行血散血活血之剂，一日三进，阅三月服二百余帖，痛不少减，因迎予治。诊之，脉左弦右滑数，
予曰∶此痰火症也。公曰∶否，贱躯虽肥，生平未尝有痰，徒以遭跌，积血于胁间作痛尔。
予曰∶据脉，实痰火也，痰在经络间，不在肺，故不咳嗽，而亦不上出。脉书云∶滑为痰，
弦为饮。予据脉而认痰火。如瘀血，脉必沉伏，或芤或涩也，面色亦必带黄。前诸君认瘀血
治者，皆徇公言，不以色脉为据。且多服峻厉克伐破坚之剂无效，此非瘀血之积明矣。公欣
然请药，即用大栝蒌壳者二枚，重二两，研碎，枳实、甘草、前胡各一钱，贝母二钱，与四
帖。公以为少。予曰∶愚见犹以为多，此症服之一二剂可瘳，又即报我，为制补益之药可也
。公得药一更矣，仍煎服，五更腹中漉漉有声，天明大泻一二次，皆痰无血，痛减大半。再
服又下痰数碗许，痛全止，随能挺立。三服
腹中不复有声，亦不泻。盖前由痰积泻也，今无痰，故不泻。公曰∶望闻问切四者，医之
要务，人人皆着之口吻，有先生独见之行事，即予母子之疾，先有事者，皆吴之名流，微先
生，吾殆撞壁矣!何能还辕而生哉，吾于是益服先生之高。
大光禄庞公的公子名叫远，是吴江人。他的母亲（太夫人）患有头痛、怕冷，胸膈部胀闷且疼痛，时常出现忽冷忽热的症状。吴地有一位名叫王后山的医生，当时很有名气，吴地百姓对他深信不疑。请他诊治了五天，病情没有好转。听说我居住在吴地，便以礼聘请我来治疗。我诊察她的脉象，右手脉滑而大，左手脉浮、弦且数。我问她之前服用了什么药方？庞公说：不知道是什么方子，但药还在那里。我看了一下药方，忍不住失言说道：用错方向了！当时有一位姓项的家庭教师在场，听到这话严厉地说：这是三吴地区最有名的士大夫，他开出的方子如果有人议论，人们就会当面吐口水，幸好议论的不是你。我笑着说：如果他是正确的而议论的人是错的，那就该唾骂别人；如果他是错误的而议论的人是对的，那他自己羞愧都来不及，哪有空闲去唾骂别人。四物汤、玄胡索、牡丹皮、香附子，这些都是养血调经的药方。太夫人已经七十多岁了，哪里还有月经可以调理呢！用药方向错误，是因为他生平墨守成规，不知道根据病人和病症随俗变通。项先生说：这是什么病症？我说：张仲景说过，头痛恶寒，是外感病。脉象浮弦而数，胸膈胀闷疼痛，少阳病的脉症都具备。右手脉滑，说明饮食停滞而生痰。他们使用当归、地黄、芍药，这些都是滋腻碍胃、阻滞痰气运行的药物，内伤如何能消除，外感如何能发散？这个病症只适宜用柴胡汤合平胃散，吃一两帖就可以痊愈。项先生还想争辩，庞公说：不要辩论，喝了药自然泾渭分明。喝了一次药，寒热症状就消除了；再喝一次，胸膈部就舒泰了。庞公高兴地说：孙先生的名声果然不是虚传的！我私下问项先生为什么极力称赞王医生？庞公说：项先生起初拜王医生为师，还没见过大的医案，却独自推崇老师的学说，这充分显示了他的见识不够广博。
庞公后来在庄园里有事，正值中秋节，借着酒兴在月下散步，不慎失足跌倒，扶起来后就胁肋疼痛，无法站立，昼夜不得安宁。服用活血、散血、行血的药剂，一天进三次，过了三个月吃了两百多帖，疼痛丝毫未减，于是请来我治疗。我诊察他的脉象，左手脉弦，右手脉滑数。我说：这是痰火症。庞公说：不对，我虽然身体肥胖，生平从未生过痰，只是因为遭遇跌打，瘀血积聚在胁间导致疼痛罢了。我说：根据脉象，确实是痰火症。痰在经络之间，不在肺脏，所以不咳嗽，也不会咳出体外。脉书说：滑脉主痰，弦脉主饮。我依据脉象判断为痰火症。如果是瘀血，脉象必定沉伏，或者芤脉或者涩脉，面色也一定发黄。之前各位医生按瘀血治疗，都是顺从您的言语，而不以面色和脉象为依据。况且大量服用峻猛攻伐、破坚消积的药物无效，这就明显不是瘀血积聚了。庞公欣然请求开药，我就用了两个大的栝蒌壳，重二两，研碎，加上枳实、甘草、前胡各一钱，贝母二钱，共四帖。庞公觉得药量太少。我说：我的见解还认为药量多了，这个病症吃一两帖就可以痊愈，之后再来找我，我再为您配制补益的药物。庞公拿到药后一个时辰左右，煎服下去，五更天时腹中漉漉有声，天亮时大便泻下了一两次，排出的都是痰而没有血，疼痛减轻了一半以上。再服药又排出痰液几碗左右，疼痛完全停止，随即能够挺直站立。服用三帖后，腹中不再有声，也不腹泻了。这是因为之前是因为痰积导致的腹泻，现在没有痰了，所以不腹泻。庞公说：望、闻、问、切四诊，是医生的重要事务，人人都挂在嘴边，只有先生能在行动中独具慧眼。就拿我和儿子的疾病来说，之前诊治的都是吴地的名流，如果没有先生，我们恐怕要碰壁失败了！怎么能起死回生呢，我因此更加佩服先生的高明。
The eldest son of Grand Commandant Pang, named Yuan, was from Wujiang. His mother (Grand Matron) suffered from headache and aversion to cold, with fullness and pain in the chest and diaphragm, accompanied by alternating chills and fever. In Wu, there was a physician named Wang Houshan who was famous at the time and deeply trusted by the locals. He treated her for five days without improvement. Hearing that I resided in Wu, they invited me with courtesy to treat her. Upon examining her pulse, the right side was slippery and large, while the left side was floating, wiry, and rapid. I asked what medicine she had taken. Grand Commandant Pang said, "I do not know the prescription, but the medicine is here." I looked at it and inadvertently remarked, "The treatment direction was wrong!" At that moment, a tutor surnamed Xiang was present. Hearing this, he sternly said, "This is a most distinguished gentleman in the Three Wu regions. If anyone criticizes his prescriptions, people spit in their faces. Fortunately, you are not the one being criticized." I smiled and said, "If he is correct and the criticizer is wrong, then spitting at others is justified; if he is wrong and the criticizer is right, he would be too ashamed even to spit at himself, let alone spit at others. Siwu Tang (Four Substances Decoction), Yanhusuo (Corydalis Rhizome), Mudanpi (Moutan Cortex), and Xiangfuzi (Cyperi Rhizoma) are formulas for nourishing blood and regulating menstruation. The Grand Matron is over seventy years old; does she still have menstruation to regulate? The error in medication stems from lifelong adherence to routine protocols, failing to adapt according to the patient and symptoms." Mr. Xiang asked, "What is this syndrome?" I replied, "Zhang Zhongjing stated that headache and aversion to cold indicate an external contraction. A floating, wiry, and rapid pulse, along with chest and diaphragmatic fullness and pain, confirms Shaoyang disease (Lesser Yang disorder) patterns. The slippery right pulse indicates food stagnation generating phlegm. They used Danggui (Angelicae Sinensis Radix), Dihuang (Rehmanniae Radix), and Shaoyao (Paeoniae Radix), all of which are cloying substances that obstruct phlegm and qi. How can internal injury resolve or external pathogen exit under such conditions? This case should only be treated with Chaihu Tang (Bupleurum Decoction) combined with Pingwei San (Powder for Peaceful the Stomach). One or two doses will suffice." Mr. Xiang still wished to argue, but Grand Commandant Pang said, "Do not debate; clarity will emerge after taking the medicine." After one dose, the chills and fever ceased; after the second dose, the chest and diaphragm felt comfortable. Grand Commandant Pang joyfully said, "Your reputation, Master Sun, is indeed well-deserved!" I privately asked Mr. Xiang why he praised Dr. Wang so highly. Grand Commandant Pang explained, "Mr. Xiang initially studied under Dr. Wang. Having not yet seen major medical cases, he exclusively upheld his teacher's theories, revealing his limited insight."
Later, Grand Commandant Pang had business at his estate during the Mid-Autumn Festival. While walking under the moonlight after drinking wine, he slipped and fell. Upon being helped up, he experienced severe hypochondriac pain and could not stand, suffering day and night. He took blood-invigorating, blood-scattering, and blood-moving agents three times a day. Over three months, he consumed more than two hundred doses, yet the pain did not diminish. He then invited me to treat him. My examination revealed a wiry left pulse and a slippery, rapid right pulse. I said, "This is a Phlegm-Fire syndrome." Grand Commandant Pang replied, "No. Although my body is fat, I have never produced phlegm in my life. It is merely due to the fall causing blood stasis accumulating between the ribs." I said, "According to the pulse, it is indeed Phlegm-Fire. The phlegm resides in the meridians, not the lungs, hence no coughing and no expectoration. Pulse classics state: 'Slippery indicates phlegm; wiry indicates fluid retention.' I diagnose Phlegm-Fire based on the pulse. If it were blood stasis, the pulse would necessarily be deep and hidden, or knotted or choppy, and the complexion would likely be yellow. Previous physicians treated it as blood stasis, following your words rather than relying on complexion and pulse. Moreover, the failure of numerous harsh, attacking, and breaking-hardness agents proves clearly that this is not blood stasis accumulation." Grand Commandant Pang happily requested medicine. I prescribed two large Gualou Qiao (Trichosanthis Pericarpium), weighing two taels, ground into powder, along with Zhishi (Aurantii Fructus Immaturus), Gancao (Glycyrrhizae Radix et Rhizoma), and Qianhu (Peucedani Radix), each one qian, and Beimu (Fritillariae Thunbergii Bulbus), two qian, for four doses. Grand Commandant Pang thought the dosage was too small. I said, "My opinion is that even this amount is excessive. One or two doses will cure this syndrome. You may return later for tonic preparations." About one shichen (two hours) after receiving the medicine, he decocted and took it. By the fifth watch (early morning), his abdomen gurgled loudly. At dawn, he defecated once or twice, expelling only phlegm, no blood, and the pain decreased by more than half. After another dose, several bowls of phlegm were expelled, the pain completely stopped, and he could stand upright. After three doses, abdominal sounds ceased, and diarrhea stopped. Previously, diarrhea was caused by phlegm accumulation; now that the phlegm is gone, diarrhea has ceased. Grand Commandant Pang said, "Observation, auscultation/olfaction, inquiry, and palpation are the essential tasks of a physician. Everyone speaks of them, but only Master Sun demonstrates unique insight in practice. Regarding the illnesses of my son and myself, previous treatments were handled by famous figures in Wu. Without you, we would have surely hit a dead end! How could we have been revived? I therefore admire your profound expertise even more."