大宗伯董浔老门下有马厨者，七月初旬病。病二十余日愈剧，而势甚獗。时宗伯对余弈
正酣
，而蒋虹桥、沈乐闲报曰∶马厨危在旦夕。宗伯闻之，推枰叹息曰；吾命吾命!予叩其故，
语曰；能厨者，不下二十人，独此厨适吾意，将恃之以怡晚节，今病不可起，奈何？予诘何
病，翁顾蒋与沈曰∶第详道其状。蒋、沈述其症，大发寒热，寒至不惮入灶，热至不惮下井
，痢兼红白，日夜八十余行，腹痛、恶心、汗多，神气倦甚。究其脉，曰；脉不吉，下痢脉
洪大者死，细微者生，今洪大逆也。予曰；痢固忌洪大，寒热亦非细微所宜，其中必有故。
二公曰∶幸一往决之。浔翁不可，谓何可以细人而劳长者。予曰；医寄人生死，何论巨细
，矧事翁之人，犹不可坐视不救也。浔翁欣然握余手偕行，至宅后桥，余入门，同居数十家
，皆执香拱立以伺。诊其脉，察其症，果如蒋、沈所言。其面色微红，汗淋淋下。予究病所
由起
，渠谓过客众，厨间燥热，食瓜果菱藕过多，晚又过饮御内，而寝于楼檐之下，次日即寒热
腹痛，因而下痢。虽得其病情，尚未融通一治法，因沉思之，不觉行至桥，而浔老犹立而
俟予，见予无婉容，知病重，遂置不问，如前握余手而回。蒋、沈问余可治否？予曰∶侥幸
先生宠灵，偶有一得，乃背水阵也。人参、白术、石膏、滑石各五钱，知母、炮姜各三钱
，大附子、炙甘草各二钱，作一大剂煎之。蒋、沈将问予，浔翁即命近侍煎于其侧，不欲蒋
、沈问也。熟则付饮之，饮讫即睡。老先生曰∶服后何状为佳？予曰∶倘得一睡，
则阴阳始和，和则汗可敛，而寒热呕恶可止也。蒋、沈
曰∶闻已睡矣。明日巳刻，二公鼓掌来言，夜来痢减半，汗吐全无，脉亦敛矣。再用人参、
石
膏、白术、白芍药、滑石各三钱，炮姜、肉桂、知母各二钱，炙甘草、附子各一钱，服后疟
止，痢又减半，饮食渐进，神气渐转。改用白芍药酒炒五钱，人参、白术、滑石各二钱，
甘草、陈皮、炮姜、肉桂各一钱，三剂而痢全止，饮食加，渐就安矣。蒋、沈问曰∶公寒热
均投，此为何症？而剂何名也？予笑曰∶此滑公所谓混沌汤也。浔老又问，予对曰∶经云∶夏
伤于暑，秋必疟痢。白虎汤、益元散皆解暑之剂。瓜果寒凉伤其中气，酒后御色，损其下元
，附子理中汤正所以温中补下者。《内经》又云∶实者，邪气实也。故以白虎汤、益元散应
之。虚者，正气虚也。故以理中汤应之。若以寒热均用为疑，而张仲景附子甘草泻心汤，即
用大黄、黄连，又用干姜、附子，此何说哉!盖假对假，真对真也。浔翁跃然喜曰∶
先生惟是，故能起垂毙之人而生之，余诗册中临淄虢国之谈，非虚语矣。
大宗伯董浔老先生的门客中有一位马姓厨师，在七月上旬患病。病情持续二十多天愈发严重，势头非常猛烈。当时宗伯正与我下棋兴致正浓，蒋虹桥和沈乐闲跑来报告说：“马厨生命垂危。”宗伯听后，推开棋盘叹息道：“我的命啊，我的命啊！”我询问原因，他说：“能做饭的人不下二十个，唯独这个厨师合我的心意，我想依靠他来安度晚年，如今他病重无法起身，这可怎么办？”我追问是什么病，宗伯回头对蒋、沈二人说：“详细说说他的症状。”蒋、沈描述了他的病症：剧烈地忽冷忽热，冷得厉害时不怕进灶房，热得厉害时不怕下井；痢疾兼有红白脓血，一天一夜腹泻八十多次，伴有腹痛、恶心、出汗多，精神极度疲惫。再探究其脉象，他们说：“脉象不吉利，患痢疾而脉洪大的主死，脉细微的主生，现在脉象洪大，这是逆证。”我说：“痢疾确实忌讳脉洪大，但寒热往来也不适合脉细微，其中必有缘故。”二位先生说：“幸好请您去诊断一下。”浔翁不同意，说怎么能因为一个小人物而劳累长者。我说：“医生寄托着人的生死，哪分大小？况且侍奉您的这个人，也不能坐视不救。”浔翁高兴地握住我的手一同前往，到了宅后的桥边，我进门后，同住几十家的人都拿着香拱手站立等待。我诊察他的脉象，观察他的症状，果然如蒋、沈所说。他面色微红，汗水淋漓而下。我追问病因，他说因为过往客人多，厨房燥热，吃瓜果菱藕过多，晚上又过度饮酒行房，睡在屋檐下，第二天就出现寒热、腹痛，进而导致痢疾。虽然了解了病情，但我尚未完全贯通治法，于是沉思默想，不知不觉走到了桥边，而浔老还站着等我，见我没有喜悦的神色，知道病重，便不再追问，像之前一样握着我的手回去。蒋、沈问我能否治愈？我说：“侥幸先生眷顾，偶然有一点心得，但这如同背水一战。”处方：人参、白术、石膏、滑石各五钱，知母、炮姜各三钱，大附子、炙甘草各二钱，作为一大剂煎服。蒋、沈正要问我，浔翁立即命令近侍在旁边煎药，不想让蒋、沈过问。药煎好后喂服，喝完即入睡。老先生问：“服药后什么状态算好？”我说：“如果能睡一觉，那么阴阳开始调和，调和则汗可收敛，寒热呕吐恶心即可停止。”蒋、沈说：“听说已经睡着了。”第二天巳时，二位先生鼓掌来说，夜里痢疾减半，出汗呕吐全无，脉象也收敛了。再次使用人参、石膏、白术、白芍药、滑石各三钱，炮姜、肉桂、知母各二钱，炙甘草、附子各一钱，服用后疟疾停止，痢疾又减半，饮食逐渐增加，精神逐渐恢复。改用白芍药酒炒五钱，人参、白术、滑石各二钱，甘草、陈皮、炮姜、肉桂各一钱，服用三剂后痢疾完全停止，饮食增加，渐渐安稳下来。蒋、沈问道：“您寒热药并用，这是什么症？方剂叫什么名字？”我笑着说：“这就是滑公所说的混沌汤。”浔老又问，我回答说：“《内经》说：夏天伤于暑气，秋天必定发生疟疾和痢疾。白虎汤（清热生津）、益元散（清暑利湿）都是解暑的方剂。瓜果寒凉伤了中焦之气，酒后行房损了下焦元气，附子理中汤正是温补中下焦的方剂。《内经》又说：实证，是邪气盛实。所以用白虎汤、益元散来应对。虚证，是正气虚弱。所以用理中汤来应对。如果怀疑寒热药并用，张仲景的附子甘草泻心汤，既用大黄、黄连，又用干姜、附子，这怎么解释呢！这是假证对假证，真证对真证。”浔翁高兴地说：“先生正是如此，所以能让濒临死亡的人起死回生，我诗册中记载的临淄虢国太子复生的故事，并非虚言啊。”
Among the retainers of Grand Secretary Dong Xunlao, there was a surnamed Ma who fell ill in early July. The illness persisted for over twenty days, becoming increasingly severe and aggressive. At that time, the Grand Secretary was deeply engrossed in a game of Go with me when Jiang Hongqiao and Shen Lexian rushed to report: "Chef Ma is on his deathbed." Upon hearing this, the Grand Secretary pushed aside the chessboard and sighed, "My fate! My fate!" I asked for the reason, and he said, "There are no fewer than twenty cooks capable of preparing meals, but only this one suits my taste. I relied on him to enjoy his twilight years, but now he is too ill to rise. What shall I do?" I pressed him to ask what the illness was. The Grand Secretary turned to Jiang and Shen and said, "Describe his condition in detail." Jiang and Shen recounted his symptoms: severe alternating chills and fever; so cold that he did not fear entering the kitchen stove, so hot that he did not fear descending into a well; dysentery with both red (blood) and white pus, occurring more than eighty times day and night; abdominal pain, nausea, profuse sweating, and extreme mental fatigue. Regarding his pulse, they said, "The pulse is inauspicious. In dysentery, a洪大 (hóng dà, flooding/large) pulse indicates death, while a细微 (xì wēi, fine/minute) pulse indicates survival. A flooding pulse here is contrary/rebellious." I replied, "While a flooding pulse is indeed contraindicated in dysentery, a fine pulse is also unsuitable for alternating chills and fever. There must be a deeper cause." The two gentlemen said, "Fortunately, please go and diagnose him." Master Xun refused, saying how could a minor servant warrant the labor of an elder? I said, "Medicine entrusts life and death; why distinguish between major and minor? Moreover, since it is someone serving you, we cannot sit idly by without rescue." Master Xun happily took my hand and we went together. Arriving at the bridge behind the residence, upon entering, dozens of co-residents stood holding incense with hands clasped in anticipation. I palpated his pulse and observed his symptoms, which indeed matched Jiang and Shen's description. His complexion was slightly red, and sweat poured down. I investigated the origin of the disease. He stated that due to many passing guests, the kitchen was dry and hot, and he had eaten too many melons, watermelons, lotus roots, and other fruits. That night, he drank excessively and engaged in sexual activity, then slept under the eaves. The next day, he developed chills, fever, and abdominal pain, leading to dysentery. Although I understood the pathology, I had not yet fully integrated a treatment strategy. I pondered deeply, walking unconsciously back to the bridge where Master Xun was still waiting. Seeing my solemn expression, he realized the gravity of the illness and stopped asking, simply taking my hand again as before. Jiang and Shen asked if he could be cured. I said, "By the grace of your master, I have a fleeting insight, but this is like fighting a battle with one's back to the river (a desperate situation)." The prescription consisted of Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Shigao (Gypsum Fibrosum), Huashi (Talcum), each 5 qian; Zhi Mu (Anemarrhenae Rhizoma), Paojiang (Prepared Ginger Rhizome), each 3 qian; Dafuzi (Aconiti Lateralis Radix Praeparata), Zhigancao (Glycyrrhizae Radix et Rhizoma Preparata), each 2 qian. These were decocted together as a large dose. As Jiang and Shen were about to question me, Master Xun ordered his attendants to decoct it nearby, wishing to spare them the inquiry. After decoction, it was administered. He drank it and immediately fell asleep. The old gentleman asked, "What state after administration would be considered good?" I said, "If he can sleep once, then Yin and Yang will begin to harmonize. Once harmonized, sweat will cease, and chills, fever, vomiting, and nausea will stop." Jiang and Shen reported, "He has fallen asleep." At Si hour (9-11 AM) the next day, the two gentlemen came clapping their hands, saying that during the night, dysentery halved, sweating and vomiting completely ceased, and the pulse had converged. The second prescription used Renshen, Shigao, Baizhu, Baishao (Paeoniae Radix Alba), Huashi, each 3 qian; Paojiang, Rougui (Cinnamomi Cortex), Zhi Mu, each 2 qian; Zhigancao, Fuzi (Aconiti Lateralis Radix Praeparata), each 1 qian. After ingestion, malaria/chills ceased, dysentery halved again, diet gradually increased, and spirit gradually recovered. The third prescription modified to use Baishao stir-fried with wine, 5 qian; Renshen, Baizhu, Huashi, each 2 qian; Gancao (Licorice Root), Chenpi (Citri Reticulatae Pericarpium), Paojiang, Rougui, each 1 qian. After three doses, dysentery completely stopped, diet improved, and he gradually became stable. Jiang and Shen asked, "You used both cold and hot herbs. What syndrome is this? And what is the name of this formula?" I smiled and said, "This is what Master Hua calls Hun Dun Tang (Chaos Decoction)." Master Xun asked further, and I replied, "The Classic says: Summer injury from heat leads to malaria and dysentery in autumn. Baihu Tang (White Tiger Decoction) and Yiyuan San (Benefit Origin Powder) are both agents to resolve summerheat. Cold melons and fruits injured the Middle Qi; alcohol and sexual excess damaged the Lower Yuan. Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction) is precisely for warming the middle and tonifying the lower. The Neijing also states: Excess refers to pathogenic qi being excessive. Thus, Baihu Tang and Yiyuan San respond to this. Deficiency refers to healthy qi being deficient. Thus, Lizhong Tang responds to this. If you doubt the simultaneous use of cold and hot herbs, consider Zhang Zhongjing's Fuzi Gancao Xiexin Tang (Aconite Licorice Drain the Epigastrium Decoction), which uses Dahuang (Rhei Radix et Rhizoma) and Huanglian (Coptidis Rhizoma) alongside Ganjiang (Dried Ginger Rhizome) and Fuzi. How is this explained? It is false syndromes treated with false (hot/cold) methods, and true syndromes treated with true methods." Master Xun joyously exclaimed, "Master is exactly right, thus enabling you to revive the near-dead. The story of the Guo State prince revived in Linzi, recorded in my poetry album, was not empty words."