针头散（外一四四去腐管）
代针膏（一四五溃头）
透骨丹（外一四三溃头）
猪蹄汤（外一二五洗腐）
立斋曰∶经云∶诸痛痒疮，皆属于心。若肿赤烦躁，发热大痛，饮冷便秘作渴，脉洪数
实者，为纯阳，虽在严冬之时，必用大苦寒之剂，以泻热毒。若不肿不痛，脉细皮寒，泻利
肠鸣，饮食不入，呕吐无时，手足厥冷，是为纯阴，虽在盛暑之时，必用大辛温热之剂，以助
阳气。不拘严寒盛暑，但当舍时从证。若微肿微痛，似溃不溃，时出清脓者，为半阴半阳，
宜用辛热之剂，温补胃气，此亦治阴阳法也。经曰∶用寒远寒，用热远热，有假者反之。虽
违其时，必从其证。若执常法，无不误矣。壬午仲冬，金台一男子患腹痛，误服干姜理中丸，
实时口鼻出血，烦躁发狂，入井而死。辛卯冬，一吏患伤寒，误服附子药一钟，下咽发躁，
奔走跌死。夫盛暑之际，附子姜桂三药并用，连进三四剂无事；严冬时令，三药单用一味，
止进一剂者，即死。可见罗谦甫先生有舍时从证，权宜用药之妙。余宗此法，凡冬间疮证，
如脉沉实洪数，大便秘，疮 痛，烦躁，或饮冷不绝者，即用硝黄芩连之剂攻之。虽在夏令
而脉见虚弱，或浮大，疮不溃，脓清稀，恶寒饮者，即用姜桂参 之剂补之。如脉见沉细，
疮不溃不痛作呃逆，手足冷，大便不实，或泻利，或腹痛，更加附子，皆获大效。昧者反以
为非，惑乱患人。恪守常法，必使冬用温热，夏用清凉，以致误人，深可哀也。（薛按）
至元壬午五月二十八日，王伯禄年逾五旬有七，右臂膊肿甚，上至肩，下至手指，色变
皮肤凉，六脉沉细而微，此乃脉证俱寒。余与疡医孙彦和视之曰，此乃附骨痈，开发已迟，
以燔针启之，脓清稀解。次日肘下再开之，加呃逆不绝。彦和以丁香柿蒂散两剂，稍缓。次
日，呃逆尤甚，自利，脐腹冷痛，腹满，饮食减少，时发昏愦。于左乳下黑尽处，灸二七壮
，又处托里温中汤，用干姜、附子、木香、沉香、茴香、羌活等药， 咀一两半，欲与服。
或者曰∶诸痛痒疮，疡皆属心火，又当盛暑之时，用干姜附子可乎。予应之曰∶理所当然，不得
不然。《内经》曰∶脉细皮寒，泻利前后，饮食不入，此谓五虚。况呃逆者，胃中虚寒故也
。诸痛痒疮，皆属心火，是言其定理也。此证内外相反，须当舍时从证，非大方辛热之剂急
治之，则不能愈也。遂投之，诸证悉去，饮食倍进，疮势温，脓色正。彦和复用五香汤数服
，后月余平复。噫。守常者，众人之见，知变者，知者之能。知常不知变，因细事而取败者
，亦多矣，况乎医哉。（见罗氏《卫生宝鉴》）
愚意，罗先生以舍时从证之法，垂训后人，诚百世不磨之要道也。但时之迁变，本所难
知，而证之幽显，尤不易识。何也。盖常人之所谓时者，春夏秋冬之时也，岁岁时常之主气
也，谁不得而知之。而不知五六周环，则长夏有寒淫之令，三冬有炎暑之权，此则虽若舍时
，而实以从时，昧者固能知此乎。又如察证之法，则凡脉细皮寒，泄泻厥冷之类，是皆已见
之寒证也，又谁不得而知之。不知其来有源，其甚有渐，即诸证未见之前，而本来已具，此
际便难错认，使必待焦头烂额，而后曲突徙薪，则已晚矣。此罗先生之所以明已然，而余则
更为虑未然，盖恐人之见之迟，而无及于事也。虽然余常见今人之于已然者尚不能见，而复
欲其见未然，诚哉迂矣。然余慨然之念，则不能不道其详，而深望于知音者。
针头散（外用方剂编号一四四，用于去腐生肌）
代针膏（方剂编号一四五，用于溃破疮头）
透骨丹（外用方剂编号一四三，用于溃破疮头）
猪蹄汤（外用方剂编号一二五，用于清洗腐肉）
薛立斋说：《内经》记载：“各种疼痛、瘙痒和疮疡，都归属于心。”如果患处红肿发热、烦躁不安、身体高热、剧烈疼痛、想喝冷水、大便干结且口渴，脉象洪大、数而有力，这属于纯阳证。即使在严寒的冬天，也必须使用大苦寒的药物，以泻除热毒。如果不红肿不疼痛，脉象细微、皮肤发冷、腹泻肠鸣、饮食无法入口、呕吐频繁、手足冰冷，这属于纯阴证。即使在盛夏酷暑，也必须使用大辛大热的药物，以助长阳气。无论严寒还是酷暑，都应当舍弃季节因素而顺从病症表现。如果轻微肿胀疼痛，似溃非溃，时常流出清稀脓液，这属于半阴半阳证，适宜使用辛热药物，温补胃气，这也是治疗阴阳失调的方法。《内经》说：“用寒药要避开寒时，用热药要避开热时”，如果有假象则相反。虽然违背了季节常规，但必须顺从病症。如果拘泥于常规治法，没有不造成误治的。壬午年仲冬，金台有一位男子患腹痛，误服干姜理中丸，立刻口鼻出血，烦躁发狂，跳井而死。辛卯年冬天，一位官吏患伤寒，误服附子药一杯，咽下后发作躁动，奔跑跌倒而死。在盛暑之际，附子、干姜、肉桂三药并用，连续服用三四剂却无事发生；而在严冬时令，这三药单用一味，只进一剂，就导致死亡。可见罗谦甫先生有“舍时从证”、权宜用药的精妙之处。我遵循此法，凡是冬季发生的疮证，如脉象沉实洪数，大便秘结，疮痛剧烈，烦躁，或不断想喝冷水者，立即使用硝石、大黄、黄芩、黄连等药物攻下清热。虽然在夏季，但如果脉象虚弱，或浮大，疮口不溃破，脓液清稀，恶寒喜饮者，立即使用干姜、肉桂、人参等药物温补。如果脉象沉细，疮口不溃不痛并出现呃逆，手足冰冷，大便不成形，或腹泻，或腹痛，再加用附子，都能获得极大疗效。愚昧之人反而认为不对，迷惑患者。恪守常规治法，必定导致冬天用温热药、夏天用清凉药，从而误人，实在令人悲哀。（薛己按语）至元壬午年五月二十八日，王伯禄年龄超过五十七岁，右臂膊肿胀严重，上至肩部，下至手指，肤色改变，皮肤凉，六脉沉细而微弱，这是脉证俱寒。我与外科医生孙彦和查看后说，这是附骨痈，切开引流已经太迟，用燔针（烧红的针）刺开，流出清稀脓液。第二天肘部下方再次切开，加上呃逆不止。彦和给予丁香柿蒂散两剂，稍见缓解。次日，呃逆更加严重，自利（腹泻），脐腹冷痛，腹胀满，饮食减少，时常昏愦。在左乳下黑色尽处，灸七壮，又处方托里温中汤，使用干姜、附子、木香、沉香、茴香、羌活等药，切碎一两半，准备给他服用。有人问：“各种疼痛瘙痒疮疡，都属于心火，又在盛暑之时，使用干姜附子可以吗？”我回答说：“理所当然，不得不这样。《内经》说：‘脉细皮寒，前后泄利，饮食不入，这叫五虚。’况且呃逆，是胃中虚寒的缘故。各种疼痛瘙痒疮疡，都属于心火，这是讲一般规律。此证内外表现相反，必须舍时从证，不用大方辛热药物急治，就不能痊愈。”于是投药，所有症状全部消除，饮食加倍增加，疮势温和，脓色正常。彦和又复用五香汤几服，一个月后平复。唉！守常规的是众人的见识，知变通的是智者的能力。知常不知变，因小事而失败的人，也很多了，何况是医学呢。（见于罗氏《卫生宝鉴》）
我的意见，罗先生以“舍时从证”的方法，垂训后人，确实是百世不磨的重要道理。但是时间的变迁变化，本来难以知晓，而病症的隐显，尤其不容易识别。为什么呢？因为常人所说的“时”，是指春夏秋冬的季节，每年四季的主气，谁不知道呢？却不知道五六周环（运气循环），长夏会有寒淫的命令，三个冬天会有炎暑的权变，这虽然看似舍时，实际上是以从时，愚昧的人固然能知道这些吗？又如察证的方法，那么凡脉细皮寒、泄泻厥冷之类，都是已显现的寒证，又有谁不知道呢？不知道其来有源，其发展有渐进过程，即在诸证尚未显现之前，本质已经具备，此时便很难不错认，如果一定要等到焦头烂额之后，才去曲突徙薪（比喻事先预防），那就太晚了。这就是罗先生之所以阐明已然之证，而我则更为忧虑未然之证的原因，大概是担心人们看得太迟，而无济于事。虽然如此，我常见今人对已然之证尚且不能看见，又想让他们看见未然之证，确实迂阔啊。然而我感慨的念头，却不能不详述，并深切希望知音者理解。
Zhentou San (External Formula No. 144, for removing necrotic tissue and promoting healing)
Daizhen Gao (Formula No. 145, for opening abscess heads)
Tougu Dan (External Formula No. 143, for opening abscess heads)
Zhuti Tang (External Formula No. 125, for washing away necrotic tissue)
Xue Lizhai said: The *Neijing* states: "All pain, itching, and sores belong to the Heart." If there is swelling, redness, fever, restlessness, high body heat, severe pain, thirst for cold drinks, constipation, and a flooding, rapid, and full pulse, this is a Pure Yang syndrome. Even in the depths of winter, one must use strongly bitter-cold medications to drain heat and toxicity. If there is no swelling or pain, a fine pulse, cold skin, diarrhea with borborygmus, inability to eat, frequent vomiting, and cold extremities, this is a Pure Yin syndrome. Even in the height of summer, one must use strongly acrid-hot medications to assist Yang Qi. Regardless of severe cold or intense heat, one should discard the season and follow the syndrome. If there is slight swelling and pain, apparent but not actual ulceration, and frequent discharge of clear pus, this is a Half-Yin Half-Yang syndrome. It is appropriate to use acrid-hot medications to warm and tonify Stomach Qi; this is also a method for treating Yin-Yang imbalance. The *Neijing* says: "When using cold remedies, avoid cold times; when using hot remedies, avoid hot times," but reverse this if there are false manifestations. Although violating seasonal norms, one must follow the syndrome. Adhering rigidly to conventional methods inevitably leads to misdiagnosis and mistreatment. In the mid-winter of the Renwu year, a man in Jintai suffered from abdominal pain and mistakenly consumed Ganjiang Lizhong Wan, resulting in immediate bleeding from the mouth and nose, restlessness, madness, and death by jumping into a well. In the winter of the Xinmao year, an official suffered from Shanghan (Cold Damage) and mistakenly consumed a cup of Fuzi medication; upon swallowing, he became agitated, ran around, fell, and died. During the height of summer, the simultaneous use of Fuzi (Aconite Root), Ganjiang (Dried Ginger), and Guizhi (Cinnamon Twig) over three to four doses caused no harm; yet in the depths of winter, using just one of these three herbs in a single dose led to death. This demonstrates the profound skill of Mr. Luo Qianfu in "discarding the season to follow the syndrome" and employing flexible medication strategies. I adhere to this method: for any sore conditions occurring in winter, such as a deep, solid, flooding, and rapid pulse, constipation, severe sore pain, restlessness, or incessant desire for cold drinks, I immediately use formulas containing Xiaoshi (Niter), Dahuang (Rhubarb Root and Rhizome), Huangqin (Scutellaria Root), and Huanglian (Coptis Rhizome) to purge and clear heat. Even in summer, if the pulse is weak or floating and large, the sore does not ulcerate, the pus is clear and thin, and there is aversion to cold with a desire for drinks, I immediately use formulas containing Ganjiang (Dried Ginger), Guizhi (Cinnamon Twig), and Renshen (Ginseng Root and Rhizome) to tonify. If the pulse is deep and fine, the sore does not ulcerate or hurt but presents with hiccups, cold extremities, loose stools, diarrhea, or abdominal pain, adding Fuzi (Aconite Root) yields great efficacy. Ignorant people oppose this, confusing patients. Rigidly adhering to conventional laws—using warming herbs in winter and cooling herbs in summer—inevitably harms people, which is deeply lamentable. (Note by Xue Ji): On May 28th of the Renwu year in the Zhiyuan era, Wang Bolu, aged over fifty-seven, had severe swelling in his right arm extending from the shoulder to the fingers, with changed skin color and cold skin. His six pulses were deep, fine, and faint, indicating both pulse and syndrome were cold. I and the surgeon Sun Yanhe examined him and said, "This is Fusgu Yong (Bone-Adherent Abscess); drainage was delayed." We used a burning needle (Fanzhen) to open it, releasing clear, thin pus. The next day, we opened it again below the elbow, after which hiccups became incessant. Yanhe prescribed Dingxiang Shidi San (Clove and Persimmon Calyx Powder) for two doses, providing slight relief. The following day, hiccups worsened, accompanied by spontaneous diarrhea, cold pain in the umbilical and abdominal region, abdominal fullness, reduced food intake, and occasional confusion. We moxa-burned seven cones at the point where blackness ended under the left breast and prescribed Tuoli Wenzhong Tang (Support Interior and Warm Middle Decoction) containing Ganjiang (Dried Ginger), Fuzi (Aconite Root), Muxiang (Aucklandia Root), Chenxiang (Agarwood), Huixiang (Fennel Fruit), and Qianghuo (Notopterygium Rhizome), chopped to one tael and half, preparing to administer it. Someone asked, "All pain, itching, and sores belong to Heart Fire; moreover, it is the height of summer, can we use Ganjiang and Fuzi?" I replied, "It is logically necessary and cannot be otherwise. The *Neijing* states: 'Fine pulse, cold skin, diarrhea before and after, inability to eat—this is called Five Deficiencies.' Furthermore, hiccups are due to deficiency-cold in the Stomach. 'All pain, itching, and sores belong to Heart Fire' refers to the general principle. This case presents contradictory internal and external signs; one must discard the season and follow the syndrome. Without urgently treating with a large formula of acrid-hot herbs, recovery is impossible." Thus, the medicine was administered, all symptoms vanished, food intake doubled, the sore condition became mild, and the pus color normalized. Yanhe subsequently used Wuxiang Tang (Five Fragrances Decoction) several times, leading to full recovery after more than a month. Alas! Those who stick to conventions have the vision of the masses; those who know how to adapt possess the ability of the wise. Many fail due to minor matters because they know the constant but not the variable, let alone medicine. (Seen in Luo's *Weisheng Baojian*)
My opinion is that Mr. Luo’s method of "discarding the season to follow the syndrome" serves as an eternal lesson for posterity, truly an indispensable principle that will never fade. However, the changes of time are inherently difficult to know, and the hidden or manifest nature of syndromes is even harder to discern. Why? Because what ordinary people call "time" refers to the seasons of spring, summer, autumn, and winter, and the dominant Qi of each year, which everyone knows. But they do not realize that within the five-six cycles of climate change, late summer may have commands of excessive cold, and the three winters may have the authority of intense heat. This appears to discard the season but actually follows it; can the ignorant truly understand this? Regarding the method of observing syndromes, anyone can recognize obvious cold syndromes like fine pulses, cold skin, diarrhea, and cold limbs. But they do not know that these have origins and gradual progression; before the syndromes appear, the underlying constitution is already established, making it difficult not to misjudge at this stage. If one waits until the situation is dire ("scorched head and broken forehead") before taking preventive measures ("curving the chimney and moving the firewood"), it is already too late. This is why Mr. Luo clarified existing syndromes, while I am more concerned with potential future syndromes, fearing that people see too late to be of service. Although I often see that contemporary people cannot even perceive existing syndromes, let alone potential ones, which is indeed pedantic, my sighing reflection compels me to detail this, deeply hoping that understanding minds will grasp it.