陈某子年十六岁，夏月患感证，壮热神昏，面赤烦渴，唇燥舌焦，口鼻牙根出血，俱属
热象
。惟脉息沉细，四肢厥冷，诸医不效。时届九朝，延予商之。予曰∶此非阴证，乃阳证也。
今日本应重用凉药，恐汝家畏而不服，姑以小柴胡汤去半夏人参，加生地、花粉、山栀、丹
皮试之。无如歙俗以为吃坏热药有救，凉药无救。因见方有凉药果畏不服。三日后势更剧，
复来迓予，予辞不往，乃浼友人胡君景三代请。予曰∶救病如救焚，彼病已重，况复迁延，
恐难治矣。胡君曰∶试往一决，可治则治之。至诊其脉，前之沉细者，今竟绝，抚扪其肢，
则冷过肘膝，更加腹痛拒按，欲便不解，惊狂不定。予曰疾急矣，非承气汤下之不可。疏方
讫，胡君私叩予曰∶从来伤寒阴阳二证，凭脉用药，不拘浮沉大小，总以有力无力分之。有
力为阳，无力为阴，今按脉全无，四肢冷甚，恐属阴证奈何。予曰∶此乃阳极似阴，证载吴
又可《瘟疫论》中，所谓体脉二厥也。归检书与阅，胡君以为然，竟服下剂，夜间便行二次
，比晓厥回脉出，改用甘露饮，后易生脉地黄汤，匝月而痊。
陈某子病愈后，其妇忧劳传染。初起头疼寒热，予与香苏饮一服汗解。旋又劳复发热，
口苦
耳聋，兼值经期，恐其热入血室，酌以柴芩煎加生地、赤芍、丹皮，热犹不退，更加面赤舌
黄，谵语脉数。予曰∶邪犯少阳阳明也。仿生生子小白汤，炒黄芩换生黄芩，加竹叶灯心为
引。并语某曰∶予适有他出，倘明日迟到，可请胡君商之，或照原方先服一渣亦可。次日午
刻予归，渠已着人相促数次，急造其庐，其泣曰∶病大变矣。问其何状，曰昨服尊剂，夜来
烦热不眠，今早忽切牙闭目，昏厥遗尿，已请胡君斟酌，并照原方煎服一渣，迄今不转奈何
。予曰∶昨病虽重，然已加增药味，即不应验，亦不至此。岂更服他医药欤?某曰∶小儿病
承救活，深为感佩，今且专心倚仗，曷敢易医。胡君恍然曰∶往日市药，吾未之阅，今早阅
剂内生黄芩，药店错发生黄 ，比令换去，得无昨剂中误服黄 耶?因验昨倾之药渣，果
然。予曰∶此病受邪本重，前药悉力驱之，尚不能解，误服黄 ，将邪热补住，内攻心包，
迷塞窍隧，故致变若此。惟有急泻心包之热，通窍避邪，庶有生机。拟导赤各半汤，除人参
，加银花金汁，外用紫雪点舌。饮药至墓，神采略回，连投四剂，浸有起色。惟神呆耳聋，
时多妄语，易以服蛮煎两服，神明稍清。后用养阴定志之品，月余始平。是役也，使非胡君
验明药误，在病家必归咎于医，而医亦不自知其故矣。识此凡治重病，所市药剂，医须亲验
，不可忽也。
陈某的儿子十六岁，夏季患外感热病，高热神志昏迷，面色红赤，烦躁口渴，嘴唇干燥，舌苔焦黑，口鼻及牙根出血，这些都是热象的表现。唯独脉象沉细，四肢冰冷，其他医生治疗无效。当时已过了九天，请我去商量诊治。我说：这不是阴证，而是阳证。今天本应重用凉性药物，恐怕你们家害怕而不服用，暂且用小柴胡汤去掉半夏和人参，加入生地、花粉、山栀、丹皮来尝试服用。无奈歙县风俗认为吃坏热药有救星，凉药无救星。因为看到方中有凉药果然畏惧不服。三天后病情更加严重，再次来迎接我，我推辞不去，于是恳求朋友胡景三代为邀请。我说：治病如同救火，病人已经病重，况且又拖延时间，恐怕难以治愈了。胡君说：试着去诊断一下，如果可治就治。到了诊脉时，之前的沉细脉竟然消失，触摸其肢体，冷过肘膝，加上腹痛拒按，想排便却排不出，惊狂不定。我说：病势危急了，非用承气汤攻下不可。开完方子后，胡君私下问我：历来伤寒阴阳二证，凭脉用药，不拘泥于浮沉大小，总是以有力无力来区分。有力为阳，无力为阴，现在按脉全无，四肢极冷，恐怕属于阴证怎么办。我说：这是阳极似阴，证候记载在吴又可的《瘟疫论》中，所谓体脉二厥。回去检书给他看，胡君认为对，最终服用了下剂，夜间大便行了两次，到早晨厥逆回温，脉象复出，改用甘露饮，后来换用生脉地黄汤，一个月痊愈。
陈某的儿子病愈后，他的妻子因忧劳感染疾病。初起头痛寒热，我给香苏饮一服汗解。随即又因劳累复发发热，口苦耳聋，正值经期，担心热邪陷入血室，斟酌使用柴芩煎加生地、赤芍、丹皮，热仍不退，更加面赤舌黄，谵语脉数。我说：邪气侵犯少阳阳明。仿照生生子的白虎汤（注：原文“小白汤”疑为白虎汤之误或特定变方，此处依原文意译），炒黄芩换为生黄芩，加竹叶灯心为引。并告诉某人说：我刚才有事外出，如果明天迟到，可以请胡君商量，或者照原方先服一次药渣也可以。第二天中午我回来，他已经派人催促好几次，急忙赶到他家，他哭着说：病情大变样了。问是什么情况，说昨天服用尊方的药，夜里烦热不眠，今早突然咬牙闭目，昏厥遗尿，已经请胡君斟酌，并照原方煎服一次药渣，到现在没有好转怎么办。我说：昨天的病虽然重，但是已经增加了药味，即使不灵验，也不至于这样。难道又服用了其他医药吗？某人说：小儿的病承蒙您救治活命，深为敬佩，现在专心倚仗您，怎敢更换医生。胡君恍然大悟说：往日买药，我没有查看，今天早上查看药方中的生黄芩，药店错配成了生大黄，于是让人换掉，莫非昨天的药方中误服了大黄吗？于是检验昨天倒掉的药渣，果然是这样。我说：这个病感受邪气本来很重，前面的药尽力驱除它，尚且不能解除，误服大黄，将邪热补住，内攻心包，迷塞窍隧，所以导致变化如此。只有急泻心包之热，通窍避邪，或许有生机。拟定导赤各半汤，除去人参，加银花金汁，外用紫雪点舌。服药到傍晚，神采略微恢复，连续投药四剂，渐渐有好转。只是神情呆滞耳聋，时常多妄语，换用蛮煎两服，神明稍微清醒。后用养阴定志的药物，一个多月才平复。这次诊疗，如果不是胡君查验明确是药物错误，在病人家属一定会归咎于医生，而医生也不知道原因了。记录此事，凡是治疗重病，所买的药剂，医生必须亲自查验，不可忽视啊。
The son of Mr. Chen, aged sixteen, suffered from an exogenous febrile disease in summer. He presented with high fever and coma, flushed face, irritability, thirst, dry lips, scorched tongue, and bleeding from the mouth, nose, and gum roots, all indicating heat syndromes. However, his pulse was deep and fine, and his four extremities were cold; treatments by other physicians were ineffective. By the ninth day, he invited me to consult. I said: This is not a Yin syndrome, but a Yang syndrome. Today, cool-natured medicines should be heavily used, but fearing your family's reluctance due to apprehension, I will tentatively prescribe Xiao Chai Hu Tang (Minor Bupleurum Decoction) without Banxia (Pinelliae Rhizoma) and Renshen (Ginseng Radix et Rhizoma), adding Shengdi Huang (Rehmanniae Radix), Huafen (Trichosanthis Radix), Zhizi (Gardeniae Fructus), and Danpi (Moutan Cortex) for trial. Unfortunately, the local custom in Xi County holds that overdosing on hot medicines can be remedied, whereas cool medicines cannot. Seeing cool medicines in the prescription, they indeed refused to take them. Three days later, the condition worsened, and they came again to fetch me. I declined, so they entreated my friend, Mr. Hu Jing San, to invite me again. I said: Saving a life is like putting out a fire; the patient is already critically ill, and further delay makes it difficult to treat. Mr. Hu said: Let us go and decide; if treatable, we shall treat. Upon examining the pulse, the previous deep and fine pulse had vanished. Palpating the limbs, they were colder than the elbows and knees. Additionally, there was abdominal pain with refusal to press, desire to defecate but inability to do so, and restlessness with惊狂 (fright and mania). I said: The disease is urgent; only Cheng Qi Tang (Major Order the Qi Decoction) for purgation will suffice. After prescribing, Mr. Hu privately asked: In treating Taiyang and Shaoyin syndromes of Cold Damage, medication is based on the pulse, regardless of floating or deep, large or small, distinguished primarily by forcefulness. Forceful indicates Yang, weak indicates Yin. Now, the pulse is imperceptible, and the limbs are extremely cold; this seems to be a Yin syndrome. What should we do? I said: This is extreme Yang mimicking Yin, as recorded in Wu Youke's "Wen Bing Lun" (Treatise on Pestilential Diseases), known as "Jue of Body and Pulse." Go check the book and read it. Mr. Hu agreed and administered the purgative. That night, two bowel movements occurred. By morning, the cold extremities warmed, and the pulse reappeared. We then switched to Gan Lu Yin (Sweet Dew Drink) and later to Sheng Mai Di Huang Tang (Generate the Pulse and Rehmannia Decoction), resulting in recovery within a month.
After Mr. Chen's son recovered, his wife contracted the illness due to worry and overwork. Initially, she had headache, aversion to cold, and fever. I prescribed Xiang Su Yin (Aromatic Perilla Infusion), which resolved the condition through sweating. Subsequently, relapse occurred due to overexertion with fever, bitter taste in the mouth, and deafness. Coinciding with her menstrual period, I feared heat entering the Blood Chamber (Xue Shi). I酌情 (discretionarily) prescribed Chai Qin Jian (Bupleurum and Scutellaria Decoction) with added Shengdi Huang (Rehmanniae Radix), Chi Shao (Red Peony Root), and Danpi (Moutan Cortex). The fever persisted, accompanied by a flushed face, yellow tongue coating, delirium, and rapid pulse. I said: The pathogen has invaded the Shaoyang and Yangming channels. I imitated Sheng Sheng Zi's Bai Hu Tang (White Tiger Decoction), substituting stir-fried Huang Qin (Scutellariae Radix) with raw Huang Qin, and added Zhu Ye (Bamboo Leaf) and Deng Xin Cao (Juncus Effusus) as guides. I told the husband: I was away earlier. If I arrive late tomorrow, you may consult Mr. Hu, or simply administer the dregs of the original prescription. When I returned at noon the next day, he had sent people to urge me several times. Rushing to his house, he cried: The condition has changed drastically. I asked for details. He said: After taking your medicine last night, she suffered from irritability, heat, and insomnia. This morning, she suddenly clenched her teeth, closed her eyes, fainted, and lost urine control. Mr. Hu has consulted and administered the dregs of the original prescription, but there is no improvement. What should we do? I said: Although yesterday's condition was severe, additional herbs were included. Even if ineffective, it shouldn't have led to this state. Did you administer other medicines? He replied: Your treatment saved my son's life; we deeply admire you. We rely solely on you now and dare not change doctors. Mr. Hu suddenly realized: Usually, I do not inspect the purchased medicines. This morning, checking the prescription for raw Huang Qin, the pharmacy mistakenly dispensed raw Da Huang (Rhei Radix et Rhizoma). I ordered them to replace it. Could the previous prescription have inadvertently contained Da Huang? Inspecting the discarded dregs from yesterday confirmed this. I said: The pathogenic factor was originally heavy. The previous medicines exerted full effort to expel it but failed. The accidental ingestion of Da Huang likely trapped the pathogenic heat, causing it to attack the Pericardium internally, obstructing the orifices and collaterals, thus leading to such drastic changes. We must urgently clear the heat from the Pericardium, open the orifices, and repel the pathogen to preserve life. I formulated Dao Chi Ge Ban Tang (Half-and-Half Decoction of Dao Chi), removing Renshen (Ginseng Radix et Rhizoma), adding Jin Yin Hua (Lonicerae Japonicae Flos) and Jin Zhi (Gold Juice), and externally applied Zi Xue (Purple Snow) to the tongue. By evening, after drinking the medicine, her spirit slightly recovered. Four doses consecutively administered showed gradual improvement. However, she remained dull, deaf, and prone to delirious speech. I switched to Man Jian (Barbarian Decoction), two doses of which slightly clarified her mind. Later, yin-nourishing and spirit-stabilizing agents were used, and she stabilized after more than a month. In this case, if Mr. Hu had not verified the medicinal error, the family would have blamed the physician, and the physician would not have known the cause. I record this to remind that when treating serious illnesses, physicians must personally verify the purchased medicines and not neglect this step.