程松逸兄，患酒疸，遍身皆黄，尿如柏汁，眼若金装，汁出沾衣如染，胸膈痞满，口不
知味
，四肢酸软，脉濡而数。以四苓散加浓朴、陈皮、糖球子、麦芽、葛根，倍加青蒿水煎，临
服加萱草根自然汁一小酒杯，四帖其黄焕然脱去。
太学岐原门下千人，名仲谏者，患跨马痈，大发寒热，红肿疼痛，呕恶不纳饮食。外科
医月
余，肿痛日加，饮食日减，肌肉日削，精神大惫，不能起止。岐原邀予，脉之六部数而无
力，形气殊不胜息。时有专科唐氏为渠调剂将进，予诘何剂？唐曰∶真人活命饮也，曾服四
剂，今始加大黄。予复诘曰∶前此何剂？唐曰∶败毒散，黄连解毒汤。予晓之曰∶此皆治初
起有余之疾，据今症乃气血大不足者，法当大补托而出之，庶保终吉。唐曰∶凡痛为实，痒
为虚。今痛正盛，脉正数，饮食且不进，大补必加饱闷，饮食何由进？热毒何由出也？予正色
语之曰∶《素问》云，数脉所主其邪为热，其症为虚。今痛极者，皆由寒凉败毒之剂伤脾胃
，凝气血，故饮食减而痛增也。又以败毒之剂进，是鸩之尔安望脓出而全其生乎？唐曰∶补
剂迨脓溃后或因脓清而后用之，今脓未出，安可谓虚而补之？吾为专门不敢任其责。予顾岐
原曰∶生死在此一剂，不可不慎。彼谓脓未出无补理，彼排脓内托散，十全大补汤非外科急
剂乎？大抵凡病宁使有余后欲剥之，乃为易易，今野狼狈若此，再株守成法，剥削后，何以措
手？岐原曰∶井蛙之见，岂知有天？惟叔命剂。予用黄 三钱，人参二钱，川芎、当归各一钱
，白芷、官桂、甘草、防风各五分，急煎饮之。一帖痛止而精神回，饮食进。再剂而脓溃。
十
帖肉生能动止矣。唐乃拊膺，啧啧语同列曰∶今而后知补剂能出脓而加食也，吾侪外科当永
识此以为法则。
程松逸的兄长，患了酒疸（因饮酒过度导致的黄疸），全身皮肤发黄，小便颜色像柏树汁一样深黄，眼睛如同镀金一般，汗水流出沾湿衣服就像被染色一样，胸膈部位痞塞胀满，口中尝不出味道，四肢酸软无力，脉象濡缓而数。使用四苓散（利水渗湿方剂）加浓朴、陈皮、糖球子、麦芽、葛根，加倍加入青蒿用水煎煮，服药前加入萱草根的自然汁一小酒杯，服用四帖后，身上的黄色完全褪去。
太学岐原的学生中有一千人，其中名叫仲谏的人，患跨马痈（生于胯部的痈疽），大发寒热，红肿疼痛，呕吐恶心无法进食。外科医生治疗了一个多月，肿痛日益加重，饮食日渐减少，肌肉日渐消瘦，精神极度疲惫，不能自行起坐。岐原邀请我诊治，诊察六部脉象，脉搏快而没有力量，形体和气力都极度虚弱，难以承受呼吸。当时有专科医生唐氏正在为他调配药方即将进服，我质问是什么药方？唐医生说：“是真人活命饮。”曾说已经服用了四剂，现在才开始加大黄。我又追问：“之前用的是什么药方？”唐医生说：“是败毒散，黄连解毒汤。”我开导他说：“这些都是治疗初起邪气有余的病证的，根据现在的症状，这是气血严重不足的病证，治法应当大补气血以托毒外出，这样才能保全最终的好结果。”唐医生说：“凡是疼痛属于实证，瘙痒属于虚证。现在疼痛正剧烈，脉象正快，饮食尚且吃不下，大补必然导致饱闷，饮食怎么能进去呢？热毒又怎么排出来呢？”我严肃地对他说：“《素问》说，数脉所主的邪气是热，但症状表现为虚。现在疼痛极剧，都是由于寒凉败毒的药物损伤了脾胃，凝滞了气血，所以饮食减少而疼痛增加。如果再进用败毒的药物，这简直是毒药啊！哪里还指望脓液排出而保全生命呢？”唐医生说：“补剂等到脓溃之后，或者因为脓液清稀之后才使用，现在脓还没有出来，怎么能说是虚证而用补法呢？我是专科医生，不敢承担这个责任。”我看着岐原说：“生死就在此一剂药上，不可不谨慎。他说脓未出就没有补法的道理，那排脓内托散、十全大补汤难道不是外科急需的药方吗？大抵凡是疾病，宁可让邪气有余而后想要消除它，那是很容易的，现在病人狼狈到这个地步，再死守成法，进一步剥削正气，以后怎么措手治疗呢？”岐原说：“这是井底之蛙的见识，哪里知道天高地厚？只听从孙先生的处方。”我用了黄芪三钱，人参二钱，川芎、当归各一钱，白芷、官桂、甘草、防风各五分，急火煎煮饮用。服用一帖后疼痛停止，精神恢复，饮食进用。再服两帖后脓液溃破。十帖后肌肉生长，能够活动自如了。唐氏于是拍着胸口，啧啧地对同事说：“从今以后才知道补剂能促使脓液排出并增加食欲，我们外科医生应当永远记住这一点作为法则。”
Brother Songyi Cheng suffered from Jiudan (Alcohol-induced Jaundice), with yellowing of the entire body, urine as dark as cypress juice, eyes resembling gold plating, sweat staining clothes like dye, chest and diaphragm fullness and obstruction, loss of taste in the mouth, soreness and weakness in the four limbs, and a soggy and rapid pulse. A prescription of Siling San (Four-Ling Powder) was used with added Houpo (Magnolia Bark), Chenpi (Tangerine Peel), Tangqiuzi, Maiya (Malt), and Gegen (Kudzu Root). Qinghao (Artemisia Annua) was doubled in amount for decoction with water. Before administration, one small cup of fresh juice from Xuanguangen (Daylily Root) was added. After four doses, the jaundice completely disappeared.
Among the thousand students under Qiyuan of the Imperial Academy, there was one named Zhongjian who suffered from Kuma Yong (Cross-Horse Carbuncle, a carbuncle occurring across the groin). He experienced severe chills and fever, redness, swelling, pain, vomiting, nausea, and inability to retain food. An external medicine physician treated him for over a month, yet the swelling and pain increased daily, food intake decreased daily, muscles wasted away daily, and his spirit became extremely exhausted, rendering him unable to rise or move on his own. Qiyuan invited me to examine him. His pulses in all six positions were rapid but forceless; his physical form and qi were extremely deficient, barely able to sustain respiration. At that time, a specialist physician, Mr. Tang, was preparing a prescription for him to take. I asked what the prescription was. Tang replied, "It is Zhenren Huoming Yin (True Man's Life-Sustaining Decoction). He has already taken four doses, and now Rhubarb is being added." I asked again, "What was prescribed before?" Tang said, "Baidu San (Detoxification Powder) and Huanglian Jiedu Tang (Coptis Decoction for Detoxifying Heat)." I explained to him, "These are treatments for diseases in their initial stage characterized by excess pathogenic factors. Based on the current symptoms, this is a condition of severe deficiency of both qi and blood. The treatment method should be major tonification to support the expulsion of toxins, so that ultimate safety may be preserved." Tang said, "Generally, pain indicates excess, while itching indicates deficiency. Now the pain is intense, the pulse is rapid, and he cannot even eat; major tonification will surely cause bloating and fullness. How can food enter? How can heat toxins exit?" I spoke seriously to him, saying, "The Suwen states that a rapid pulse indicates heat pathogens, but the symptoms manifest as deficiency. The current extreme pain is caused by cold-natured detoxifying agents damaging the spleen and stomach, congealing qi and blood, thus reducing food intake and increasing pain. To administer more detoxifying agents now would be akin to administering poison. How can you expect pus to discharge and life to be saved?" Tang said, "Tonifying prescriptions are used after the abscess ruptures or when the pus is clear. Since the pus has not yet emerged, how can it be considered deficiency requiring tonification? I am a specialist and dare not assume responsibility for this." I looked at Qiyuan and said, "Life and death depend on this single dose; caution is essential. He claims there is no rationale for tonification before pus emergence, but are Paion Neituo San (Pus-Discharging and Interior-Supporting Powder) and Shiquan Dabu Tang (Complete Great Tonifying Decoction) not urgent remedies in external medicine? Generally speaking, in any disease, it is better to have excess pathogens that can later be easily cleared than to face such a desperate situation where further depletion of healthy qi makes treatment impossible. If we rigidly adhere to established methods, depleting the patient further, how will we manage the case?" Qiyuan said, "This is the view of a frog in a well; how could it know the vastness of the sky? I follow your prescription entirely." I prescribed Huangqi (Astragalus Root) 3 qian, Renshen (Ginseng Root) 2 qian, Chuanxiong (Sichuan Lovage Rhizome) and Danggui (Angelica Sinensis Root) each 1 qian, Baizhi (Angelica Dahurica Root), Guigui (Cinnamon Twig), Gancao (Licorice Root), and Fangfeng (Saposhnikovia Root) each 5 fen. It was decocted rapidly and administered. After one dose, the pain ceased, spirit returned, and food intake resumed. After two more doses, the abscess ruptured. After ten doses, flesh regenerated, and movement was restored. Tang then slapped his chest, clicking his tongue and saying to his colleagues, "From now on, I realize that tonifying agents can promote pus discharge and increase appetite. We practitioners of external medicine must forever remember this as our rule."