居中制之，必关脾而后转运，胀者故中枵而下涩，误以悍剂伐之，脉有死征，不可为矣。众曰∶否。即中气
匮乏，遇下且如建瓴，何不为动？桥曰∶公等信知脾虚，不任寒凉，不知脾毙，则寒凉无所用矣。诸子跪曰∶
诚得一剂借手，庶毋恝于人子之心。曰∶进独参汤当下，其下亦薄，于治无裨。既得剂则肠鸣而溲，腹胀亏三之
一。张乃张目问状，人人以为更生。诸子问曰∶大黄不行，而人参行何说？桥曰∶否，中权废矣，即前茅安所
受命哉！补中而建招摇，摧坚者始为之用，此亦人参用大黄，非自用而能下之也。顾病少间而脉不归，终于不
治。深者复至，将攘为己功，大诟诸子曰∶尔曹以不治治家大人，无人子礼。兹更一下而起，复何待乎？桥故
避深，度复争之无益。适诸子问可否？乃徐应曰∶等死尔。下则死疾，不下则死迟，公等自裁，桥何敢与？深
诟愈急，卒复下之，不旋踵死矣。（《太函集》。）
王生病发热头痛腹胀甚，医为之解散，热退而痛如故，且不得前后溲。又以大黄通之，大便稍行，小溲赤
涩，胀痛特甚。仍以为热结，将复下之。桥诊曰∶病得之劳且内，复食冷尔。内则损肾，劳倦食冷则损脾。肾
主大小溲，肾损则不能转，故作湿热而为满。藉令亟下，则将亡阴，胀满有加矣，危之道也。王俯首叩枕曰∶
诚如公言，三者皆如见。遂投人参五苓散，一服得前溲，再乃大通，痛亦寻减。病者求通后溲急。桥曰∶公六
脉沉微且数，必假信宿，脾气始回。脾得主，湿热则将自行。毋欲速，明日大溲自下。调理月余而愈。（同上。）
维持中焦气机运转的关键在于脾胃，若中气虚弱导致腹部胀满而大便干结不通，误用峻猛寒凉之药攻伐，会出现死脉征象，病情便无法救治了。众人说：“不对。即使中气匮乏，遇到泻下药也应当像从高屋建瓴一样顺畅下行，怎么会不动呢？”汪机（字省之，号桥）说：“你们只知道脾虚不耐寒凉，却不知道如果脾脏功能衰竭，那么寒凉药物也就失去作用对象了。”众弟子跪下说：“确实希望能有一剂药借以施展医术，以免辜负为人子女者救父的心意。”汪机说：“服用独参汤后大便可能会通下，但效果微弱，对治疗没有太大帮助。”既然得到了药方，患者肠鸣并排出小便，腹胀减轻了三成。张深（指另一位医生或家属，此处语境似为家属或另一医者介入）于是睁眼询问情况，大家都认为患者获得了新生。众弟子问：“大黄不能通便，而人参却能通便，这是什么道理？”汪机说：“不对，中焦权柄废弛，前方的命令又怎能传达下去呢！补益中气如同树立旗帜指挥，此时攻坚破积的药物才能发挥作用，这也是人参借助大黄之力，并非人参自己就能通便。”然而病情稍有好转后脉象仍未恢复，最终未能治愈。张深再次到来，想将功劳据为己有，便大声斥责众弟子说：“你们用‘不治’来对待家父，毫无为人子女的礼节。现在只要再通下一次便能起身，还等什么？”汪机事先已避开张深，预料到再争论也无益。恰逢众弟子询问是否可以？于是慢慢回答说：“都是死路罢了。通下则因正气不支而死，不通下则是缓慢死亡，各位自行决断，我怎敢干预？”张深的斥责愈发急切，最终还是进行了通下治疗，不久患者便去世了。（出自《太函集》。）
王某患病，发热头痛，腹部胀满严重。医生为他使用解表发散法治疗后，热退但疼痛依旧，且大小便均不通利。后又用大黄通导大便，大便稍通，但小便赤涩，胀痛特别剧烈。仍认为是热邪结聚，准备再次攻下。汪机诊察后说：“此病源于劳累和房事内伤，加之食用生冷食物。房事内伤会损伤肾脏，劳累和食冷则会损伤脾脏。肾主管大小便，肾受损则气化无权，故产生湿热而导致胀满。假如急于攻下，将会导致亡阴，胀满症状会更加严重，这是危险的做法。”王某低头叩枕说：“确实如您所说，这三种病因我都符合。”于是投用人参五苓散，服一次后前阴（小便）得通，第二次服药后大便大通，疼痛也随之减轻。病人急于通后阴（大便）。汪机说：“您的六脉沉微且数，必须等待两三天，脾气才能恢复。脾的功能恢复，湿热自然就会消除。不要追求速效，明天大便自然会通下。”经过一个多月的调理而痊愈。（同上。）
The regulation of the central Jiao (Middle Burner) relies on the Spleen and Stomach for transformation and transportation. When abdominal distension occurs due to emptiness in the middle with dryness and obstruction below, mistakenly using harsh agents to attack will result in fatal pulse signs, rendering the condition incurable. The crowd said, "No. Even if the Middle Qi is deficient, encountering purgatives should cause it to flow down as smoothly as water from a high roof, how could it not move?" Qiao (Wang Ji) said, "You only know that the Spleen is deficient and cannot tolerate cold and cool properties, but you do not know that if the Spleen perishes, then cold and cool agents have no target to act upon." The disciples knelt and said, "Indeed, if we can obtain one prescription to lend our hands, we might not feel indifferent regarding the heart of a filial son." He said, "Administering Dushen Tang (Single Ginseng Decoction) may lead to bowel movement, but the effect will be thin; it offers little benefit to the treatment. Once the prescription is obtained, there will be borborygmus (intestinal rumbling) and urination, and abdominal distension will decrease by one-third." Zhang then opened his eyes to ask about the condition, and everyone considered him reborn. The disciples asked, "Dahuang (Rhubarb Rhizome) does not promote defecation, but Renshen (Ginseng Root) does; what is the explanation?" Qiao said, "No. If the central authority is abolished, how can the vanguard receive orders? By tonifying the middle and establishing the banner (command), those who destroy hardness begin to be used. This is also Renshen utilizing Dahuang, not Renshen itself being able to induce defecation." However, although the illness slightly improved, the pulse did not return to normal, and ultimately, he was not cured. Shen (Zhang Shen) came again, intending to claim the merit for himself, and severely scolded the disciples: "You treated your father with 'non-treatment', lacking the propriety of a filial son. Now that he has risen after just one purge, what more is there to wait for?" Qiao had previously avoided Shen, estimating that further arguing would be useless. Just as the disciples asked whether it was permissible, he slowly replied, "It is merely death either way. Purging leads to death from this disease; not purging leads to delayed death. You gentlemen decide yourselves; how dare I interfere?" Shen's scolding became more urgent, and eventually, they purged again. Before long, he died. (From *Taihan Ji*.)
Wang suffered from fever, headache, and severe abdominal distension. The physician administered dispersing and releasing methods; the fever subsided, but the pain remained, and both anterior and posterior orifices were obstructed (inability to urinate or defecate). Subsequently, Dahuang (Rhubarb Rhizome) was used to unblock the bowels. Bowel movements occurred slightly, but urination was red and difficult, and distension and pain were particularly severe. It was still believed to be heat accumulation, and another purge was planned. Qiao diagnosed: "This illness originated from fatigue and internal injury (sexual excess), compounded by eating cold foods. Internal injury damages the Kidney; fatigue and cold food damage the Spleen. The Kidney governs both anterior and posterior orifices. When the Kidney is damaged, it cannot transform and transport, thus generating damp-heat leading to fullness. If one were to purge urgently, Yin would be lost, and distension and fullness would increase, which is a dangerous path." Wang bowed his head and knocked against the pillow, saying, "Truly as you say; all three conditions apply to me." Thus, Renshen Wuling San (Ginseng and Five-Ingredient Powder with Poria) was administered. After one dose, anterior orifice (urine) flowed freely; after the second dose, there was a major bowel movement, and pain soon decreased. The patient urgently sought relief for the posterior orifice (bowel movement). Qiao said, "Your six pulses are deep, thready, and rapid. You must wait two nights; only then will the Spleen Qi recover. When the Spleen obtains its mastery, damp-heat will dissipate on its own. Do not desire speed; tomorrow the large stool will naturally pass." After more than a month of regulation, he recovered. (Ibid.)