问古人治例。有从证不从脉。从脉不从证。一病而治各不同。或愈或不愈者。
其故何也。答曰。此节庵先生以南阳治例。下一注脚也。惜乎有所未尽耳。盖从证从脉。各有其方。如脉浮为
表。治宜汗之。然亦有宜下者。仲景云。脉浮而大。心下反硬。有热属脏者攻之。不令发汗。脉沉为里。治宜
下之。然亦有宜汗者。如少阴病始得之。反发热。脉沉者。麻黄附子细辛汤汗之。脉促为阳盛。当用芩葛清之。
若脉促厥冷。非灸百会以通其阳不可。此非促为阳盛也。脉迟为寒。当用姜附温之。若阳明病脉迟。不恶寒。
身体 然汗出。则用大承气。又非迟为阴寒也。此皆不从脉之治。以其证急也。又如表证汗之。乃常法也。仲
景云。病发热头痛。脉反沉。身体痛。当温之。宜四逆汤。里证下之。亦其常也。日晡发热者属阳明。脉浮虚
者宜发汗。用桂枝汤。结胸证具。当与陷胸下之。脉浮大
者不可下。当与桂枝人参汤温之。身体疼痛。当以麻桂汗之。然尺中脉迟者不可汗。当与小建中汤和之。此皆
不从证治。以其脉虚也，一病而治各不同。或愈或不愈者。良由不明受病之故。尝考内经多有同一见证。而所
受之经各别。所见之脉迥殊。其可执一例治乎。况医有工拙。病有标本。假令正气有权之人。无论治本治标。
但得药力开发病气。元神自复。若正气本虚之人。反现假证假脉。而与苦寒伐根之药。变证莫测矣。故凡治邪
气炎威。正气骤脱之病。制方宜猛。盖暴邪势在急追。骤虚法当峻补。若虚邪久淹。羸弱久困之病。不但制方
宜缓。稍关物议之味。咸须远之。是以巨室贵显之家。一有危疑之证。则遍邀名下相商。补泻杂陈之际。不可
独出己见。而违众处方。即不获已。亦须平淡为主。倘病在危逆。慎勿贪功奏技。以招铄金之谤也。
问：古人治疗病例中，有“从证不从脉”和“从脉不从证”的情况。同一种病，治疗方法却各不相同，有的治愈了，有的没治好。这是什么原因呢？
答：这是节庵先生对张仲景（南阳）治疗法则所作的注解。可惜他有所未尽之处。所谓从证或从脉，各有其适用的方药。例如，脉浮表示病在表，治疗应当用发汗法。然而也有应当用泻下法的。张仲景说：“脉浮而大，心下反而硬满，热邪归入脏腑的，应当攻下，不要发汗。”脉沉表示病在里，治疗应当用泻下法。然而也有应当用发汗法的。例如少阴病刚得病时，反而发热，脉沉的，用麻黄附子细辛汤发汗。脉促表示阳气盛，应当用黄芩、葛根清热。如果脉促且四肢厥冷，不艾灸百会穴来通阳是不行的。这并非因为脉促就是阳气盛。脉迟表示寒证，应当用干姜、附子温补。如果阳明病脉迟，不恶寒，身体濈然汗出，则用大承气汤。这又不是因为脉迟就是阴寒证。这些都是“不从脉”的治疗，因为病情危急。又如，表证用发汗法是常法。张仲景说：“病人发热头痛，脉反而沉，身体痛，应当温补，宜用四逆汤。”里证用泻下法也是常法。日晡时（下午3-5点）发热属于阳明病，但脉浮虚的适宜发汗，用桂枝汤。结胸证具备，应当给予陷胸汤泻下。但如果脉浮大的，不可泻下，应当给予桂枝人参汤温补。身体疼痛，应当用麻黄汤或桂枝汤发汗。但如果尺中脉迟的，不可发汗，应当用小建中汤调和。这些都是“不从证”的治疗，因为脉象虚弱。同一种病，治疗方法各不相同，有的治愈有的未愈，确实是因为不明白受病的根本原因。我曾考察《内经》，发现多有相同的症状表现，但所受的病经各不一样，所见到的脉象也截然不同。怎么能拘泥于一种固定的治法呢？况且医生有技艺高低之分，疾病有标本缓急之别。假如正气充足的人，无论治本还是治标，只要药力能开发病气，元神自然恢复。如果正气本来虚弱的人，反而出现假证假脉，若给予苦寒伤根的药物，就会发生难以预测的变证。所以凡是治疗邪气炽盛、正气突然脱失的疾病，制方应当猛烈。因为暴烈之邪势在急需追击，骤然虚损之法当用峻补。如果是虚邪久留、羸弱久困的疾病，不仅制方应当缓和，稍微引起非议的药味，都必须远离。因此，豪门贵显之家，一旦有危重疑难病症，便广泛邀请名医共同商量。在补泻药物混杂陈列之际，不能独自提出己见而违背众人处方。即使不得已，也必须以平淡为主。倘若病情危重逆乱，千万不要贪图功劳展示技艺，从而招致像“铄金”那样的诽谤（指众口铄金）。
Question: In ancient medical cases, there are instances of "following the syndrome but not the pulse" and "following the pulse but not the syndrome." For the same disease, treatments vary, with some patients recovering and others not. What is the reason for this?
Answer: This refers to Mr. Jie'an's annotation on Zhang Zhongjing's (from Nanyang) treatment principles. Unfortunately, his explanation is incomplete. Whether one follows the syndrome or the pulse, there are specific formulas for each. For example, a floating pulse (Fú Mài, floating pulse) indicates an exterior condition, and treatment should involve sweating (Han Fa, diaphoresis). However, purgation (Xia Fa, purgation) may also be appropriate. Zhang Zhongjing stated: "If the pulse is floating and large, and the epigastrium feels hard, with heat entering the Zang organs, attack it with purgation; do not induce sweating." A deep pulse (Chén Mài, deep pulse) indicates an interior condition, and treatment should involve purgation. However, sweating may also be appropriate. For instance, in Shaoyin disease (Shàoyīn Bìng, Shaoyin Disease) at its onset, if there is fever and a deep pulse, use Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) to induce sweating. A rapid/intermittent pulse (Cù Mài, rapid pulse) indicates excess Yang, and treatment should involve clearing heat with Huang Qin (Scutellariae Radix) and Ge Gen (Puerariae Lobatae Radix). If the pulse is rapid accompanied by cold extremities, moxibustion at Baihui (GV20) is necessary to unblock Yang. This does not mean that a rapid pulse always indicates excess Yang. A slow pulse (Chí Mài, slow pulse) indicates Cold, and treatment should involve warming with Gan Jiang (Zingiberis Rhizoma) and Fu Zi (Aconiti Lateralis Radix Praeparata). However, in Yangming disease (Yángmíng Bìng, Yangming Disease), if the pulse is slow, there is no aversion to cold, and there is continuous sweating over the body, Da Cheng Qi Tang (Major Order the Qi Decoction) is used. This does not mean that a slow pulse always indicates Yin-Cold. These are all examples of "not following the pulse," because the syndrome is urgent. Furthermore, treating exterior syndromes with sweating is the standard method. Zhang Zhongjing said: "If the patient has fever and headache, but the pulse is unexpectedly deep, and there is body pain, warming is required; Si Ni Tang (Frigid Extremities Decoction) is appropriate." Treating interior syndromes with purgation is also standard. Fever at dusk (Ri Bu, late afternoon) belongs to Yangming, but if the pulse is floating and deficient, sweating is appropriate using Gui Zhi Tang (Cinnamon Twig Decoction). If the symptoms of Jie Xiong (Chest Binding) are complete, Xian Xiong Tang (Sinking Chest Decoction) should be given for purgation. However, if the pulse is floating and large, purgation is contraindicated; instead, Gui Zhi Ren Shen Tang (Cinnamon Twig and Ginseng Decoction) should be used for warming. For body pain, Ma Huang Tang (Ephedra Decoction) or Gui Zhi Tang should be used for sweating. However, if the pulse at the Chi position (Chi Cun, distal radial pulse position) is slow, sweating is contraindicated; Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) should be used for harmonizing. These are all examples of "not following the syndrome," because the pulse indicates deficiency. The reason why the same disease is treated differently, with varying outcomes, lies in the failure to understand the root cause of the disease. I have examined the Nei Jing (Inner Canon), noting that many cases present identical symptoms, yet the affected meridians differ, and the observed pulses are distinct. How can one rigidly adhere to a single treatment principle? Moreover, physicians vary in skill, and diseases have root and branch aspects. If a person has strong Zheng Qi (Righteous Qi), whether treating the root or the branch, as long as the medicinal power can expel the pathogen, the Yuan Shen (Primordial Spirit) will naturally recover. However, if a person has inherent deficiency of Zheng Qi, they may present false syndromes and false pulses. Administering bitter-cold drugs that damage the root in such cases leads to unpredictable complications. Therefore, when treating diseases with fierce pathogens and sudden collapse of Zheng Qi, the prescription should be potent. Acute pathogens require urgent pursuit, and sudden deficiency requires vigorous tonification. Conversely, for diseases where weak pathogens linger and debility persists, the prescription should be mild, avoiding any herbs that might attract criticism. Thus, among wealthy and noble families, when critical and doubtful conditions arise, renowned physicians are invited to consult together. Amidst the mixture of tonifying and purging agents, one must not insist on personal views against the consensus. Even if compelled to act alone, one should prioritize mild formulations. If the condition is critical and adverse, one must not seek credit or display technical prowess, thereby inviting slander akin to "gold melted by gossip."