气虚补气，用四君子汤；血虚补血，用四物汤。虚甚者，俱加熟附子。盖四君、四物，皆和平宽缓之
剂，须得附子健悍之剂行之，方能成功。附子热药，本不可轻用，但当病，虽在暑热时月，亦可用也。予尝
治一仆人，五月间病热，口渴，唇干，谵语。诊其脉细而迟，用四君子汤加黄 、当归、芍药、熟附子，
进一服，热愈甚，狂言狂走。或曰附子差矣，诊其脉如旧，仍增附子，进一大服，遂汗出而热退，脉还四
至矣。又尝治一妇人，亦夏间病热，初用平调气血，兼清热和解之剂，服二、三服不应，热愈甚，舌上焦
黑，膈间有火，漱水不咽。诊其脉两手皆虚微，而右手微甚。六七日内谵语撮空，循衣摸床，恶症俱
见。后用四物汤加黄 、人参、白术、陈皮、麦门、知母、熟附子，服之一、二时汗出而热退，次日复
热，再服仍退，又次日复发，知其虚极也，遂连进十
服，皆加附子而安。
愚按前论正所谓舍时从症，舍症从脉，真有定见者也。
一男子，发热，烦渴，头痛，误行发汗，喘急，腹痛，自汗，谵语，用十全大补加附子治之，熟睡唤而
不醒，及觉，诸症顿退，再剂而痊。
黄武选，饮食劳倦，发热恶寒，误用解表，神思昏愦，胸发赤斑，脉洪数而无力。余曰∶此内伤元
气，非外邪也，急用温补之剂。彼不从，后果殁。
气虚应当补气，使用四君子汤；血虚应当补血，使用四物汤。虚损严重的，都加入熟附子。因为四君子汤和四物汤，都是药性平和、作用宽缓的方剂，必须依靠附子这样药性刚健猛烈的药物来推动，才能取得疗效。附子是热性药物，本来不可轻易使用，但当病情需要时，即使在暑热季节，也可以使用。我曾经治疗一个仆人，五月间患热病，口渴，嘴唇干燥，说胡话。诊察他的脉象细而迟，使用四君子汤加黄芩（注：原文“黄”后缺字，结合语境及常用配伍，此处疑为黄芪或黄芩，但根据后文“黄 、当归”，通常指黄芪，然前文“黄 ”若为黄芪则与后文重复，若为黄芩则清热。考虑到患者“热愈甚”，且后续用附子回阳，此处原文可能有脱漏或特指。根据王纶《明医杂着》通行本，此处多为“黄芪”。但若严格按字面“黄 ”，且后文有“黄 ”，推测均为黄芪。然而，若为清热，可能是黄芩。鉴于后文明确列出“黄 、人参...”，此处暂译为“黄芪”，若依部分版本为“黄芩”需斟酌。但在中医古籍整理中，常因避讳或传抄致误。此处依据常见校勘，多作“黄芪”。不过，若看症状“热愈甚”，用黄芪恐助热，除非是甘温除热法。结合后文“舍时从症”，此为真寒假热或虚阳外越，故用黄芪补气固表配合附子回阳是合理的。因此，“黄”指黄芪）、当归、芍药、熟附子，服下一剂后，发热更加严重，胡言乱语，狂奔乱走。有人说附子用错了，我诊察他的脉象依然如旧（细迟），于是增加附子的用量，服下一大剂后，随即出汗而热退，脉象恢复至一息四至。又曾经治疗一个妇人，也是在夏季患热病，起初使用调和气血、兼清热的和解剂，服了两三剂没有见效，发热更加严重，舌上出现焦黑苔，胸膈间有火感，想含水漱口却不吞咽。诊察她的脉象两手都虚微，而右手尤为微弱。六七天里出现说胡话、手抓空、摸床沿等危重症状全部显现。后来使用四物汤加黄芪、人参、白术、陈皮、麦门冬、知母、熟附子，服用后一两个时辰出汗而热退，第二天再次发热，再服药仍然退热，又第二天复发，知道这是极度虚弱，于是连续进服十剂，都加入附子才安定下来。
我按语认为，前面的论述正是所谓的“舍时从症”、“舍症从脉”，真是有坚定见解的人啊。
有一个男子，发热，烦躁口渴，头痛，错误地使用了发汗法，导致气喘急促，腹痛，自汗，说胡话，使用十全大补汤加附子治疗，他熟睡不醒，等到醒来，各种症状顿时消退，再服两剂就痊愈了。
黄武选，因饮食不节和劳累过度，出现发热恶寒，错误地使用了发散解表的药物，神志昏沉糊涂，胸部发出赤色斑疹，脉象洪数但无力。我说：“这是内伤元气，不是外邪，急需使用温补的方剂。”他不听从，后果去世了。
Qi deficiency should be treated by tonifying Qi, using Sijunzi Tang (Four Gentlemen Decoction); blood deficiency should be treated by nourishing blood, using Siwu Tang (Four Substance Decoction). In cases of severe deficiency, cooked Fuzi (Prepared Aconite Root) is added to both. This is because Sijunzi Tang and Siwu Tang are both mild and gentle formulas; it requires the vigorous and potent action of Fuzi to facilitate their efficacy. Although Fuzi is a hot-natured herb and should not be used lightly, it can be used when the condition warrants it, even during the hot summer months. I once treated a servant who suffered from heat disease in May, presenting with thirst, dry lips, and delirium. His pulse was fine and slow. I prescribed Sijunzi Tang supplemented with Huangqi (Astragalus Root), Danggui (Angelica Sinensis Root), Shaoyao (Peony Root), and cooked Fuzi. After one dose, the fever intensified, and he became delirious and ran about wildly. Some said that the use of Fuzi was incorrect. Upon re-examining his pulse, which remained fine and slow, I increased the dosage of Fuzi. After administering a large dose, he sweated profusely, the fever subsided, and his pulse returned to four beats per breath.
I also once treated a woman who contracted heat disease in summer. Initially, she was given formulas to harmonize Qi and blood while clearing heat and resolving exterior pathogens. After two or three doses, there was no improvement, and the fever worsened. She developed black scorched coating on her tongue, a sensation of fire in the chest and diaphragm, and desired to rinse her mouth with water but did not swallow. Her pulse was weak and minute in both hands, particularly so in the right hand. Over six to seven days, she exhibited severe symptoms including delirium, picking at empty air, and groping at bedsheets. Subsequently, I prescribed Siwu Tang supplemented with Huangqi (Astragalus Root), Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Chenpi (Tangerine Peel), Maimendong (Ophiopogon Tuber), Zhimu (Anemarrhena Rhizome), and cooked Fuzi. After one to two hours of ingestion, she sweated and the fever subsided. The fever recurred the next day, subsided again after another dose, and recurred on the third day. Recognizing extreme deficiency, I continued to administer ten doses consecutively, all containing Fuzi, until she stabilized.
In my opinion, the preceding discussion exemplifies "abandoning the season in favor of the symptoms" and "abandoning the symptoms in favor of the pulse," demonstrating truly firm diagnostic insight.
A male patient presented with fever, irritability, thirst, and headache. Due to an erroneous use of diaphoretic methods, he developed panting, abdominal pain, spontaneous sweating, and delirium. He was treated with Shiquan Dabu Tang (Ten Great Tonics Decoction) plus Fuzi (Aconite Root). He fell into a deep sleep and could not be awakened initially. Upon waking, all symptoms suddenly subsided, and he recovered after two additional doses.
Huang Wuxuan suffered from fever and aversion to cold due to improper diet and overwork. An erroneous use of exterior-resolving herbs led to mental confusion and red macules on the chest. His pulse was surging and rapid yet powerless. I stated, "This is internal injury to Yuan Qi (Original Qi), not an external pathogen. Urgent treatment with warming and tonifying formulas is required." He did not follow my advice and subsequently died.