东嘉项昕氏云坚痛为热本指疮疡而言经曰诸痛肿痒疮疡皆属心火盖心主热化故痛属热即
不以寒言至于急痛因寒故举痛论诸痛为寒之说经曰寒淫于内以辛热散之
佐以苦寒张长沙以辛热之剂散其错乱风寒之
气良以此耳凡所临症固当察脉之阴阳验人之虚实不可专以为有热而无寒亦不可专以为有寒而
无
热斯能尽折衷之道也
弘治末年 孝宗皇帝之崩病热也院判刘文泰误以热剂进 上服之渴甚索水饮文泰执不
可内侍有进西瓜者 上啖之仅能出
言召大臣刘健等受顾命于是文泰下狱然仅谪广西戍而死昔后周姚僧坦名医也帝因发热欲服
大
黄药僧坦曰大黄乃快药耳至尊年高不宜轻用帝不从服之遂至不起及明帝有疾诸医皆谓至尊至
贵不可轻脱宜用乎药僧坦曰脉洪而实必有宿食不用大黄必无差理帝从之果下宿食乃愈医者当
先明强弱虚实又察脉之沉浮非大黄之罪医者之误也
太医院院判刘公(观)常侍 太宗左右大暑中 上方束一带乃片脑合成者问观曰此带何
如观
对曰片脑性寒伤肾惟有香耳 上遽命解去按本草云片脑性大辛善走故能散热今刘谓之性寒
何也丹溪云龙脑属火诸香皆属阳岂有至香之物而反寒乎噫刘观漫言盖不学无术之过欤
陈汝中尝病脾胃郁火之症求治于盛用美盛诊其脉曰如此治可生如彼治可以死如此治可以
少生
如彼治可以速死既而治之汝中迟其效或以浮屠善医荐者汝中惑其说遂求治饮其药呕血一升遂
死
噫医以用药药以攻疾疾不能去而反以致死则何以医药为哉彼浮屠者乃庸妄人也目不知医经口
不
辩药性指不察脉候人之虚实病之新久一切置之不问而惟药攻击之其杀人盖亦多矣予咎汝中之
不善择医而致速死书此以为世轻服药者之戒
东嘉项昕先生认为，疼痛剧烈且坚硬属于热证，这是专门针对疮疡而言的。《内经》说：“各种痛肿、瘙痒、疮疡，都归属于心火。”因为心主热化，所以疼痛属于热证，就不必用寒证来解释。至于急性的疼痛是因为寒邪所致，所以《举痛论》中提出了各种疼痛由寒引起的说法。《内经》又说：“寒邪侵入体内，要用辛热药物来发散它，辅以苦寒药物。”张仲景（长沙）使用辛热的方剂来发散错乱的风寒之气，正是基于这个原理。凡是临症诊治，固然应当观察脉象的阴阳，检验病人的虚实，不能专断地认为只有热而没有寒，也不能专断地认为只有寒而没有热，这样才能达到折衷平衡的道理。
弘治末年，孝宗皇帝去世前患病发热，太医院院判刘文泰错误地进献了热性药剂。皇帝服用后口渴非常严重，索要水喝，刘文泰坚决阻止。内侍有人献上西瓜，皇帝吃了一些，才勉强能说话，召见大臣刘健等人接受遗诏托付后事。于是刘文泰被下狱，但仅仅被贬谪到广西戍守而死。从前，后周的姚僧坦是名医，皇帝因发热想服用大黄药，姚僧坦说：“大黄是峻猛的药，至尊年事已高，不宜轻易使用。”皇帝不听，服用了它，结果病情加重直至不起。等到明帝有病时，众医都说至尊身份尊贵，不可轻易攻下，应该用缓和的药物。姚僧坦说：“脉象洪大而实，必定有宿食积滞，如果不使用大黄，一定无法痊愈。”皇帝听从了他，果然排出了宿食，病就好了。医生应当先辨明体质的强弱虚实，又观察脉象的沉浮，这不是大黄的罪过，而是医生的误诊。
太医院院判刘观先生常侍奉在太宗身边。大暑天中，皇上腰间束着一条带子，那是用片脑（冰片）合成的。皇上问刘观：“这条带子怎么样？”刘观回答说：“片脑性寒，会伤肾，只有香才对身体好。”皇上立刻命令解下来。按《本草》记载，片脑性大辛，善于走窜，所以能散热。现在刘观却说它性寒，为什么呢？朱丹溪说：“龙脑（片脑）属火，各种香料都属阳，哪有极香之物反而性寒的呢？”唉，刘观随意发言，大概是不学无术造成的过错吧。
陈汝中曾经患有脾胃郁火的症状，向盛用美求治。盛用美诊察他的脉象说：“像这样治疗可以生，像那样治疗可以死；像这样治疗可以稍微好转，像那样治疗可以加速死亡。”后来进行治疗，陈汝中觉得见效慢，有个擅长医术的僧人推荐给他，陈汝中迷惑于这种说法，就去求治，喝了那个僧人的药，呕吐出一升血，随即死去。唉，医生用药是为了攻治病邪，病邪不能去除反而导致死亡，那还要医药做什么呢？那个僧人是庸俗狂妄的人，眼睛不懂医经，口里不辨药性，手指不察脉候和人的虚实、病的新久，一切都不加询问，只是一味地用药攻击身体。他杀的人大概也多了。我责怪陈汝中不善选择医生而导致快速死亡，写下此文作为世人轻率服药的警戒。
Mr. Xiang Xin of Dongjia stated that severe and hard pain belongs to heat, which specifically refers to sores and ulcers. The *Classic* says: "All kinds of pain, swelling, itching, sores, and ulcers belong to Heart Fire." Since the Heart governs heat transformation, pain belongs to heat, thus there is no need to explain it in terms of cold. As for acute pain caused by cold, the *Treatise on Pain* (Jutong Lun) proposed the theory that various pains are due to cold. The *Classic* also states: "When cold invades the interior, disperse it with acrid-hot herbs, assisted by bitter-cold herbs." Zhang Zhongjing (of Changsha) used acrid-hot formulas to disperse the chaotic wind-cold qi, precisely based on this principle. In clinical practice, one must certainly observe the yin and yang of the pulse and verify the deficiency and excess of the patient. One should not exclusively assume there is only heat without cold, nor exclusively assume there is only cold without heat; only then can one achieve a balanced approach.
At the end of the Hongzhi reign, Emperor Xiaozong fell ill with fever before his death. Liu Wentai, the President of the Imperial Medical Academy, mistakenly administered hot-natured medicines. After taking them, the Emperor became extremely thirsty and demanded water, but Liu Wentai firmly refused. A eunuch offered watermelon, which the Emperor ate, allowing him to barely speak and summon ministers such as Liu Jian to receive his临终嘱托 (last will and testament). Consequently, Liu Wentai was imprisoned, though he was merely exiled to guard Guangxi and died there. Previously, Yao Sengtan of the Later Zhou dynasty was a renowned physician. When the Emperor had a fever and wished to take Dahuang (Rhei Radix et Rhizoma), Yao Sengtan said, "Dahuang is a drastic medicine. Your Majesty is advanced in age and should not use it lightly." The Emperor did not listen, took it, and his condition deteriorated until he passed away. Later, when Emperor Ming was ill, other physicians argued that His Majesty's noble status precluded drastic purgation and suggested mild medicines. Yao Sengtan said, "The pulse is flooding and full, indicating retained food stagnation. Without using Dahuang, recovery is impossible." The Emperor followed his advice, expelled the retained food, and recovered. Physicians must first distinguish the strength and weakness, deficiency and excess of the constitution, and observe the floating and sunken nature of the pulse. This error lies not with Dahuang, but with the physician's misdiagnosis.
Liu Guan, President of the Imperial Medical Academy, often attended upon Emperor Taizong. During intense summer heat, the Emperor wore a belt made of Pian Nao (Borneolum Syntheticum). He asked Liu Guan, "What do you think of this belt?" Liu Guan replied, "Pian Nao is cold in nature and damages the Kidney; only fragrance is beneficial." The Emperor immediately ordered it removed. According to the *Materia Medica*, Pian Nao is acrid-hot and moves freely, thus able to dissipate heat. Why does Liu Guan claim it is cold? Zhu Danxi stated, "Long Nao (Borneol) belongs to Fire, and all aromatics belong to Yang. How can something extremely aromatic be cold?" Alas, Liu Guan spoke carelessly, likely due to ignorance and lack of skill.
Chen Ruzhong once suffered from symptoms of stagnant fire in the Spleen and Stomach and sought treatment from Sheng Yongmei. Sheng Yongmei palpated his pulse and said, "If treated this way, he will live; if treated that way, he will die. If treated this way, he may slightly recover; if treated that way, he will die quickly." Subsequently, during treatment, Chen Ruzhong felt the effect was slow. A monk known for medical skills recommended himself, and Chen Ruzhong, confused by this suggestion, sought treatment from him. After drinking the monk's medicine, he vomited a sheng (approx. 500ml) of blood and died. Alas, physicians use medicine to attack disease; if the disease is not removed but death results, what is the purpose of medicine? That monk was a quack who knew neither medical classics nor herb properties, could not palpate pulses or assess constitution and disease duration, ignoring all these factors to simply attack the body with drugs. He likely killed many people. I blame Chen Ruzhong for failing to choose a physician wisely, leading to his rapid death. I record this as a warning to those who take medicine lightly.