余尝治一少年，素好火酒，适于夏月，醉则露卧，不畏风寒。此其食性脏气，皆有大过
人者，因致热结三焦，二便俱闭。余先以大承气汤，用大黄五七钱，如石投水。又用神佑丸
及导法，俱不能通，且前后俱闭，危剧益甚。遂仍以大承气汤加生黄二两，芒硝三钱，加牙
皂二钱，煎服。黄昏进药，四鼓始通，大便通而后小便渐利。此所谓盘根错节，有非斧斤不
可者，即此之类。若优柔不断，鲜不害矣。
朱翰林太夫人，年近七旬，于五月时，偶因一跌，即致寒热。群医为之滋阴清火，用生
地、芍药、丹皮、黄芩、知母之属，其势日甚。及余诊之，见其六脉无力，虽头面、上身有
热，而口则不渴，且足冷至股。余曰∶此阴虚受邪，非跌之为病，实阴证也。遂以理阴煎加
人参、柴胡，二剂而热退，日进粥食二三碗；而大便以半月不通，腹且渐胀，咸以为虑，群
议燥结为火，复欲用清凉等剂。余坚执不从，谓其如此之脉，如此之年，如此之足冷，若再
一清火，其原必败，不可为矣。经曰∶肾恶燥，急食辛以润之，正此谓也。乃以前药更加姜
、附，倍用人参、当归，数剂而便即通，胀即退，日渐撤消矣。病起之后，众始服其定见。
承气汤（攻一） 黄龙汤（攻二一） 五君子煎（新热六） 浓朴汤（和三三六） 八正散（寒
百十五） 大补元煎（新补一） 凉膈散（攻十九） 大营煎（新补十四） 补中益气汤（补三十）
理中汤（热一） 理阴煎（新热三） 当归地黄饮（新补二十） 温胃饮（新热五） 归脾汤
（补三二） 加味归脾汤（补三三） 左归饮（新补二） 右归饮（新补三） 加味清胃饮（寒五五）
左归丸（新补四） 五福饮（新补六） 人参固本丸（补百六） 济川煎（新补二一） 豕膏（新
因二九） 《元戎》四物汤（攻二六） 六味丸（补百二十） 八味丸（补一二一） 丹溪补阴丸（
寒百六十） 麻仁丸（攻九二） 玉烛散（攻二四） 竹叶黄 汤（寒七） 脾约丸（攻九三） 八
珍汤（补十九） 东垣润肠丸（和三百四十） 三仁丸（和三三八） 百顺丸（新攻六） 大厘清饮
（新寒五） 《卫生》润肠汤（和三三三） 七宣丸（攻九四） 清凉饮子（攻二五） 苁蓉润肠丸
（和三四一） 神佑丸（攻四八） 大金花丸（攻五五） 导滞通幽汤（和三三五） 大黄硝石汤（
攻十四） 搜风顺气丸（和三四三）
我曾治疗一位少年，他平时喜好喝烈性酒，正值夏季，醉酒后便露天躺卧，不畏惧风寒。他的饮食习性和脏腑之气都有超过常人的地方，因此导致热邪结聚于三焦，大小便都闭塞不通。我先用大承气汤，重用大黄五到七钱，药力如石头投入水中般迅猛。接着又用了神佑丸以及导法（灌肠等通便方法），都不能使大便通畅，而且前后二便完全闭塞，病情危急严重。于是仍然使用大承气汤，加入生大黄二两、芒硝三钱、牙皂二钱，煎煮后服用。黄昏时服药，直到半夜才排便通畅，大便通利之后小便也逐渐顺畅。这就是所谓的盘根错节之症，非用斧斤般的猛药不能解决，就是这类情况。如果犹豫不决、优柔寡断，很少有不造成危害的。
朱翰林太夫人，年龄近七十岁，在五月时，偶然因跌倒，随即出现寒热症状。众医生为她滋阴清火，使用了生地、芍药、丹皮、黄芩、知母等药物，病情日益加重。到我诊察时，发现她六脉无力，虽然头面、上身有热象，但口不渴，且脚冷至大腿。我说：这是阴虚受邪，并非跌打损伤所致，实际上是阴证。于是用理阴煎加入人参、柴胡，服两剂后热退，每天能喝两三碗粥；然而大便已经半个月不通，腹部逐渐胀满，大家都为此担忧，众人议论认为是燥结为火，又想使用清凉剂等药物。我坚决反对，认为以这样的脉象、这样的年龄、这样脚冷的症状，如果再清火，根本一定会败坏，无法救治了。《内经》说：肾恶燥，急食辛以润之，正是这个意思。于是以前方为基础更加入姜、附子，倍用人参、当归，数剂后大便即通，腹胀即退，日渐消散。病起之后，众人才佩服我的定见。
I once treated a young man who was fond of drinking strong liquor. During summer, after getting drunk, he would sleep outdoors without fear of wind and cold. His dietary habits and visceral qi were excessive beyond ordinary people, leading to heat accumulation in the Sanjiao (Triple Burner), resulting in complete obstruction of both urination and defecation. I initially administered Dachengqi Tang (Major Order the Qi Decoction) with 5–7 qian of Dahuang (Rhubarb Rhizome), acting swiftly like a stone thrown into water. Subsequently, I used Shenyuan Wan (Divine Protection Pill) and enema methods, but neither succeeded in relieving the obstruction. The condition worsened with total blockage of both bowels and urine, becoming critical. Therefore, I reverted to Dachengqi Tang, adding 2 liang of raw Dahuang (Rhubarb Rhizome), 3 qian of Mangxiao (Mirabilite), and 2 qian of Yazao (Gleditsia Sinensis Fruit), decocted and administered orally. The medicine was taken at dusk, and bowel movement occurred only around midnight. After the stool was passed, urination gradually became smooth. This is what is meant by "knotted roots and tangled branches," which require the force of an axe; this case exemplifies such a situation. If one hesitates or acts indecisively, harm is inevitable.
Madam Zhu, the mother of Hanlin Academician Zhu, was nearly seventy years old. In May, following a fall, she developed alternating chills and fever. Other physicians treated her by nourishing yin and clearing fire, using herbs such as Shengdi (Rehmanniae Radix Preparata), Shaoyao (Paeoniae Radix Alba), Danpi (Moutan Cortex), Huangqin (Scutellariae Radix), and Zhimu (Anemarrhenae Rhizoma). Her condition deteriorated daily. Upon my examination, her six pulses were weak. Although there was heat in the head, face, and upper body, she had no thirst, and her feet were cold up to the thighs. I stated: This is yin deficiency with pathogenic invasion, not caused by trauma, but actually a Yin syndrome. I prescribed Liyin Jian (Nourish Yin Decoction) supplemented with Renshen (Ginseng Radix et Rhizoma) and Chaihu (Bupleuri Radix). After two doses, the fever subsided, and she could consume two to three bowls of porridge daily. However, she had not had a bowel movement for half a month, and her abdomen gradually distended. Everyone was concerned, and the consensus was that dryness and constipation were due to fire, suggesting the use of cooling agents again. I firmly opposed this, arguing that given her pulse, age, and cold feet, further clearing of fire would destroy her root vitality, making recovery impossible. As the Classic states: "The Kidney dislikes dryness; urgently feed pungent substances to moisten it." This precisely applies here. Thus, I added Jiang (Zingiberis Rhizoma) and Fuzi (Aconiti Lateralis Radix Praeparata) to the previous formula, doubled the dosage of Renshen (Ginseng Radix et Rhizoma) and Danggui (Angelicae Sinensis Radix). After several doses, her bowels moved, abdominal distension receded, and symptoms gradually resolved. Only after the illness did others admire my decisive judgment.