1964年冬，尝治一患者，男，78岁。食后胃脘灼热疼痛，嗳气数年。医诊食管裂孔疝。遍用中、西药物治疗，其效不著，邀李翰卿先生诊治。先生云：饮食积滞所致。治宜消食导滞。乃处山楂化滞丸，1次半丸，1日3次。服药3天，诸证均减。患者云：如此小小丸药，每次仅仅服用半丸，哪能取速效?不如每次改为3九，每日3次服之，余听后颇感有理，乃嘱其改为每次3丸，1日3次服之。连服3日后，不但胃脘灼痛未减，且感到日渐气短乏力。于是再次求教于李翰卿先生。云：你不知《伤寒论》116条之文乎?该文云：微数之脉，慎不可灸，因火为邪，则为烦逆，追虚逐实，血散脉中，火气虽微，内攻有力，焦骨伤筋，血难复也。诸家释文多云：微数之脉，即脉数而无力，多主阴虚火旺，治宜养阴清热，故谓慎不可灸。若误用艾灸，不仅不能疗疾，而反伤阴助热，则为炊逆。追虚逐实，是说火为邪，一面追正气之虚，而另一方圃义逐邪气之实。即阴本虚，反用灸法则更伤其阴；热本实，反用灸法则助阳增热，这种迫虚逐实的结果，则导致血液散乱于豚中，而受到严重损伤。可见灸火虽微，内攻却是有力，它可导致阴血难复，肌肤筋骨失却濡养，形成肌肤枯燥，焦骨伤筋等严重后果。通过举一反三之理，我们可以得出如下结论：任何疾病，只要是正气大衰而又邪实的严重疾病，都是攻补两难的疾病，稍予扶正则易使邪气更炽，稍予克伐则易使正气难支。故处方用药之时，只可扶正而不得助邪，只可祛邪不得伤正，只可补阴而不得伤阳，只可补阳而不得伤阴。因此不管是祛邪，还是扶正，不管是补阳，还是益阴，只可小剂予之。今之患者，所以用半丸有效，3丸不效者，因患者已年近八旬，可谓正衰邪实，故稍增祛邪则正气受伤，正如《伤寒论》所云之“火邪虽微，内攻有力”耳。余听后仍感疑信参半，不以为然。
1965年冬，尝治一患者，女，41岁。风湿性心脏病，二尖办狭窄与闭锁不全，心力衰竭2年多，遍用中、西药物治疗不效。查其浮肿尿少，胸腹积水，咳喘短气，不得平卧，心烦，心悸，身热口渴，舌质红绛，苔净，脉细疾促而无力。急邀某医诊治。云：此心肾阴虚。宜加减复脉汤养阴清热。处方：生地15克，麦冬15克，五味子12克，白芍12克，人参15克，阿胶10克，天花粉15克，石斛15克，元参15克。药进1剂，诸证加剧。不得已，改邀李翰卿先生治之，云：治宜真武汤加减。处方：附子0．6克，人参0．4克，茯苓1克，白术0．6克，白芍0．6克，杏仁0．3克，服药2剂后，诸证大减，尿多肿减，呼吸微平。此时患者家属睹见所用之药剂量既小，药味又少。乃怒斥我云：如此危重之疾，竟予些许小药，岂能治病!不得已，乃以原方10倍量为方予之，服药2剂，诸证加剧，家属亦慌恐备至。急求李翰卿先生再治，云：原方原量可也，不必改动。余遵嘱，再处：附子0．6克，人参0．4克，茯苓1克，白术0．6克，白芍0．6克，杏仁0．3克。药后诸证果减，患者家属云：余只知重剂能挽危重证，实误也。
尝治患者，苏××，女，53岁。支气管哮喘合并喘息性支气管炎30余年。其始仅为遇见花粉、灰尘时喘咳发作。近2年来，诸证加剧，尤其是近七八个月以来，几乎昼夜时时俱喘，不得平卧，且饮食全废。医以中、西药物近万元，均不稍减。邀余诊治。查其除气短不足以息，整日端坐不得平卧外，并见指、趾、额、颏、耳壳均冷如冰，舌淡苔白，脉细而促。综合脉证，诊为心肾阴阳俱虚，阳虚为主，兼水饮不化。治以真武汤加减。处方：附子1克，茯苓1克，白术1克，白芍1．5克，人参1克，杏仁1克。服药2剂后，喘咳短气大减，并稍能平卧，微进饮食：某医睹见药味、药量既少又小，颇有微辞。云：前医所用诸方药物少者十五、六味，多者竟达30余味，所用药量轻者10克，重者竟达40克，然服后均无效果。此方药物仅仅6味，药量重者才1．5克，如此重疾，用此小药，岂能济事!乃将原方药量增大10倍子之。4剂之后，渚证又明显加剧。乃再邀余前往治之。余诊后，云：此病阴阳俱衰，阳虚为主，治疗之时只可微培阳气以助少火之生长，若以10倍之附子则成壮火而耗气损阴矣，故仍宜原方小量服之。服药1剂，果然诸证大减。1个月后，诸证消失而出院。
耿××，女，50岁。流行性乙型脑炎，高热昏迷7个昼夜。医予西药和中药清瘟败毒饮、安宫牛黄丸、银翘白虎汤加减等治之不效。邀余诊治。查其神昏，二便失禁，舌苔薄白，舌质淡黯，肢厥脉微。综合脉证，诊为亡阳证：急处四逆汤为；方：附子4克，干姜4克，炙甘草4克。服药1剂后，神清肢温，体温由38．9℃降到37．5℃。某医目睹此状，云：此病如此之严重，反用微剂微量治之，岂能挽生命于顷刻之间，为了对病人负责任，必须用大方大剂治之。且人参大补元气，亦当加之。乃处：附子40克，干姜40克，人参40克，炙甘草10克。药进1剂后，是夜又见神昏肢厥，身热，体温39．8℃。急邀余再次往诊。余云：此病正虚邪实，只可以微药以助少火，不可以大剂以实壮火，否则邪盛正衰难挽矣。先宜三甲复脉以补阴敛阳，后宜四逆微量以助少火。愈。
适其至所
在临床过程中，经常遇见：①先用小方小剂无效，而改用大方大剂后取效者。②先用大方大剂无效，而改用小方小剂后取效者。③先用大方大剂有害，而改用小方小剂后取效者。④先用小方小剂无益而延误病期，而改用大方大剂后立起沉疴者。⑤有原方不予改动无效，而加人一二味药后始效者。⑥有原方不予改动有效，而加入一二味药后反无效者。⑦有原方不予改动无效，而减一二味药后却取效者。⑧有原方不予改动有效，而减一二味药后即无效者。何故?细究其原因有四：即①未适事为故。②未求其属。③未疏令气调。④未适至其所。然其最多见者为未适至其所也。
察《素问·至真要大论》在阐述“寒者热之，热者寒之，微者逆之，甚者从之，坚者削之，客者除之，劳者温之，结者散之，留者攻之，燥者濡之，急者缓之，散者收之，损者温之，逸者行之，惊者平之，上之下之，摩之浴之，薄之劫之，开之发之。”“热因热用，寒因寒用，塞因塞用，通因通用”，“诸寒之而热者取之阴，热之而寒者取之阳”和“适事为故”，“疏令气调”、“求其属也”的同时，又专文指出这些方法的应用必须适其至所，即既不可太过，又不可不及。他说：“气有高下，病有远近，证有中外，治有轻重，适其至所为故也。大要曰：君一臣二，奇之制也；君二臣四，偶之至也；君二臣三，奇之制也，君二臣六，偶之制也。故曰：近而奇之，远而偶之，汗者不以奇，下者不以偶，补上治上制以缓，补下治下制以急。急则气味厚，缓则气味薄，适其至所，此之谓也。病所远，而中道气味之者，食而过之，无越其制度也。”并在本篇和《五常政大论篇》中谆谆告诫说无使过之，伤其正也。《五常政大论》说：“病有久新，方有大小，有毒无毒，固宜常制矣。大毒治病，十去其六；常毒治病，十去其七，小毒治病，十去其八；无毒治病，十去其九；谷肉果菜，食养尽之，无使过之，伤其正也。”《至真要大论》说：“夫五味人胃，各归所喜，故酸先人肝，苦先人心，甘先人脾，辛先人肺，咸先人肾，久而增气，物化之常也，气增而久，天之由也。”
尝治患者苗××，男，55岁。胃脘胀痛，午后至夜间加重，稍遇冷或吃冷性食物则加剧。舌苔薄白，脉弦紧。余处以桂附理中汤加味治之。处方：附子6克，肉桂6克，党参6克，白术6克，苍术6克，干姜6克，木香6克，沉香6克，丁香6克。服药6剂，其效不著。改请白清佐老先生治疗。云：此脾肾阳虚，寒湿中阻。治宜桂附理中汤加减，处方：黄芪15克，附子30克，肉桂15克，党参12克，白术12克，苍术15克，厚朴12克，沉香10克，毕澄茄10克，木香10克，砂仁15克，小茴香12克。服药1剂，其证大减。余知其状，乃请教白老先生。云：你所用药力不及耳，必须大剂方可有效。余拜曰：治法对而药力不及亦难取效耳。谨记，谨记。
患者刘××，男，46岁。反复感冒5—6年。医有云气虚而予补益证反加重者，有云风寒予解表散寒而汗出难止者，有云风热予辛凉解表腹痛难止者，有云阴虚而予养阴痞满纳呆者。邀余诊治。查其证见全身酸困，头晕头胀，微咳、喷嚏，胸胁微满，舌苔白，脉沉缓。综合脉证，诊为肝郁脾虚，复感外邪，冶以疏肝解表，佐以益气健脾。处以参苏饮加减为方。苏叶0．3克，党参0．2克，陈皮0．2克，枳壳0．2克，杏仁0．2克，茯苓0．1克，香附0．1克。诸医见方，大加非议。有的药店见其量小，不愿售药，然因患者屡服诸药不效，坚持服药以试之，药店才勉强付与之。不意，竟一剂知，三剂已。患者问：为何5分钱之药得愈，而数百元之药竟不效反剧也?答曰：此病正虚邪微，补正则助邪，祛邪则伤正，故可以小量达其病所耳，过者剧，伤其正而不达病所。
患者乔××，女，50岁。右腿从臀至足麻木疼痛半年多。医诊坐骨神经痛。前医以药物封闭、按摩、针灸、中药治疗，诸证不减。邀余诊治。查其除疼痛麻木外，别无所苦。舌苔薄白，脉弦紧。综合脉证，诊为风寒湿痹。予独活寄生汤方(独活10克，桑寄生15克，秦艽10克，防风10克，细辛3克，川芎10克，当归10克，生地10克，白芍10克，肉桂10克，茯苓10克，杜仲10克，川牛膝10克，党参10克，甘草6克)。2剂后，痛麻俱减。因其本人及其爱人均知医，且其友人又多为外科医生或中医医生。认为既为风寒湿痹，何不再加祛风除湿之羌活以增加效力?乃于原方之中加入羌活10克。连服3剂，痛麻又剧。再求余治。云：羌活乃上半身引经之药，加之则药力反不得达其病之所在部位耳。宜去羌活为方。药后果然痛麻俱减。10剂后，诸证俱失而愈。
数脉非仅主热
1964年冬天，我曾治疗一位患者，男性，78岁。进食后胃脘部有灼热疼痛感，伴有嗳气症状已有数年。医生诊断为食管裂孔疝。广泛使用中西药物治疗，效果不明显，于是邀请李翰卿先生诊治。李先生说：这是由饮食积滞引起的。治疗应当消食导滞。于是开具山楂化滞丸，每次半丸，每日3次。服药3天后，各种症状均减轻。患者说：这么小的药丸，每次只吃半丸，怎么能迅速见效？不如每次改为3丸，每日3次服用。我听后觉得很有道理，便嘱咐他改为每次3丸，每日3次服用。连续服用3天后，不仅胃脘灼痛没有减轻，反而感到日渐气短乏力。于是再次向李翰卿先生请教。李先生说：你不知道《伤寒论》第116条的内容吗？该条文说：脉象微数，千万不可用艾灸，因为火邪会导致烦闷逆乱，追虚逐实（即一方面追逐正气的虚弱，另一方面助长邪气的实盛），导致血液散乱于脉中。火气虽然微弱，但内攻的力量很强，会焦骨伤筋，使血液难以恢复。各家解释此条文大多认为：微数之脉，即脉象数而无力，多主阴虚火旺，治疗宜养阴清热，所以说千万不可艾灸。如果误用艾灸，不仅不能治愈疾病，反而会损伤阴液、助长热邪，导致烦闷逆乱。“追虚逐实”，是说火为邪气，一方面追逐正气的虚弱，另一方面助长邪气的实盛。即阴本已虚，反用灸法会更伤其阴；热本已实，反用灸法会助阳增热。这种迫虚逐实的结果，会导致血液散乱于脉中，受到严重损伤。可见灸火虽然微弱，但内攻却有力，它可导致阴血难复，肌肤筋骨失去濡养，形成肌肤枯燥、焦骨伤筋等严重后果。通过举一反三的道理，我们可以得出如下结论：任何疾病，只要是正气大衰而又邪气实盛的严重疾病，都是攻补两难的疾病，稍微扶正就容易使邪气更炽盛，稍微克伐就容易使正气难以支撑。因此处方用药时，只能扶正而不能助邪，只能祛邪而不能伤正，只能补阴而不能伤阳，只能补阳而不能伤阴。所以不管是祛邪还是扶正，不管是补阳还是益阴，只能用小剂量给予。现在的患者，之所以用半丸有效，用3丸无效，是因为患者已年近八旬，可谓正衰邪实，所以稍微增加祛邪的力度就会损伤正气，正如《伤寒论》所说的“火邪虽微，内攻有力”罢了。我听后仍然半信半疑，不以为然。
1965年冬天，我曾治疗一位患者，女性，41岁。患有风湿性心脏病，二尖瓣狭窄与闭锁不全，心力衰竭2年多，广泛使用中西药物治疗无效。检查发现其浮肿尿少，胸腹积水，咳喘短气，不能平卧，心烦，心悸，身热口渴，舌质红绛，苔净，脉细疾促而无力。急忙邀请某位医生诊治。医生说：这是心肾阴虚。适宜用加减复脉汤养阴清热。处方：生地15克，麦冬15克，五味子12克，白芍12克，人参15克，阿胶10克，天花粉15克，石斛15克，元参15克。药进1剂后，各种症状加剧。不得已，改邀李翰卿先生诊治，李先生说：治疗适宜用真武汤加减。处方：附子0.6克，人参0.4克，茯苓1克，白术0.6克，白芍0.6克，杏仁0.3克。服药2剂后，各种症状大减，尿多肿减，呼吸微平。此时患者家属看见所用的药剂量既小，药味又少。于是愤怒地斥责我说：如此危重的疾病，竟然给予些许小药，怎么能治病！不得已，就以原方10倍量的方子给予患者，服药2剂，各种症状加剧，家属也惊慌恐惧到了极点。急忙请求李翰卿先生再次诊治，李先生说：原方原量即可，不必改动。我遵照嘱咐，再次开具：附子0.6克，人参0.4克，茯苓1克，白术0.6克，白芍0.6克，杏仁0.3克。药后各种症状果然减轻，患者家属说：我只知道重剂能挽救危重证，实在错了。
曾治疗患者苏××，女性，53岁。支气管哮喘合并喘息性支气管炎30余年。起初只是遇见花粉、灰尘时喘咳发作。近2年来，各种症状加剧，尤其是近七八个月以来，几乎昼夜时时都喘，不能平卧，且饮食全废。医生用中西药物花费近万元，均无稍许减轻。邀请我诊治。检查发现除气短不足以息，整日端坐不能平卧外，并见指、趾、额、颏、耳壳均冷如冰，舌淡苔白，脉细而促。综合脉证，诊为心肾阴阳俱虚，阳虚为主，兼水饮不化。治疗以真武汤加减。处方：附子1克，茯苓1克，白术1克，白芍1.5克，人参1克，杏仁1克。服药2剂后，喘咳短气大减，并能稍能平卧，微进饮食。某位医生看见药味、药量既少又小，颇有微辞。说：前医所用诸方药物少的十五六味，多的竟达30余味，所用药量轻者10克，重的竟达40克，然而服后均无效果。此方药物仅仅6味，药量重的才1.5克，如此重疾，用此小药，怎么能成事！于是将原方药量增大10倍给予。4剂之后，各种症状又明显加剧。于是再邀请我前往诊治。我诊后说：此病阴阳俱衰，阳虚为主，治疗之时只能微培阳气以助少火之生长，如果用10倍的附子则成壮火而耗气损阴了，所以仍宜原方小量服用。服药1剂，果然各种症状大减。1个月后，各种症状消失而出院。
耿××，女性，50岁。流行性乙型脑炎，高热昏迷7个昼夜。医生给予西药和中药清瘟败毒饮、安宫牛黄丸、银翘白虎汤加减等治疗无效。邀请我诊治。检查发现神昏，二便失禁，舌苔薄白，舌质淡黯，肢厥脉微。综合脉证，诊为亡阳证：急忙开具四逆汤为方：附子4克，干姜4克，炙甘草4克。服药1剂后，神清肢温，体温由38.9℃降到37.5℃。某位医生目睹此状，说：此病如此之严重，反而用微剂微量治疗，怎么能挽生命于顷刻之间，为了对病人负责任，必须用大方大剂治疗。且人参大补元气，也应当加上。于是处方：附子40克，干姜40克，人参40克，炙甘草10克。药进1剂后，是夜又见神昏肢厥，身热，体温39.8℃。急忙邀请我再次往诊。我说：此病正虚邪实，只可以用微药以助少火，不可以大剂以实壮火，否则邪盛正衰难挽矣。先宜三甲复脉以补阴敛阳，后宜四逆微量以助少火。痊愈。
适其至所
在临床过程中，经常遇见：①先用小方小剂无效，而改用大方大剂后取效者。②先用大方大剂无效，而改用小方小剂后取效者。③先用大方大剂有害，而改用小方小剂后取效者。④先用小方小剂无益而延误病期，而改用大方大剂后立起沉疴者。⑤有原方不予改动无效，而加入一二味药后始效者。⑥有原方不予改动有效，而加入一二味药后反无效者。⑦有原方不予改动无效，而减一二味药后却取效者。⑧有原方不予改动有效，而减一二味药后即无效者。何故？细究其原因有四：即①未适事为故。②未求其属。③未疏令气调。④未适至其所。然其最多见者为未适至其所也。
考察《素问·至真要大论》在阐述“寒者热之，热者寒之，微者逆之，甚者从之，坚者削之，客者除之，劳者温之，结者散之，留者攻之，燥者濡之，急者缓之，散者收之，损者温之，逸者行之，惊者平之，上之下之，摩之浴之，薄之劫之，开之发之。”“热因热用，寒因寒用，塞因塞用，通因通用”，“诸寒之而热者取之阴，热之而寒者取之阳”和“适事为故”，“疏令气调”、“求其属也”的同时，又专文指出这些方法的应用必须适其至所，即既不可太过，又不可不及。他说：“气有高下，病有远近，证有中外，治有轻重，适其至所为故也。大要曰：君一臣二，奇之制也；君二臣四，偶之至也；君二臣三，奇之制也，君二臣六，偶之制也。故曰：近而奇之，远而偶之，汗者不以奇，下者不以偶，补上治上制以缓，补下治下制以急。急则气味厚，缓则气味薄，适其至所，此之谓也。病所远，而中道气味之者，食而过之，无越其制度也。”并在本篇和《五常政大论篇》中谆谆告诫说无使过之，伤其正也。《五常政大论》说：“病有久新，方有大小，有毒无毒，固宜常制矣。大毒治病，十去其六；常毒治病，十去其七，小毒治病，十去其八；无毒治病，十去其九；谷肉果菜，食养尽之，无使过之，伤其正也。”《至真要大论》说：“夫五味入胃，各归所喜，故酸先入肝，苦先入心，甘先入脾，辛先入肺，咸先入肾，久而增气，物化之常也，气增而久，天之由也。”
曾治疗患者苗××，男性，55岁。胃脘胀痛，午后至夜间加重，稍遇冷或吃冷性食物则加剧。舌苔薄白，脉弦紧。我处以桂附理中汤加味治疗。处方：附子6克，肉桂6克，党参6克，白术6克，苍术6克，干姜6克，木香6克，沉香6克，丁香6克。服药6剂，其效不著。改请白清佐老先生治疗。说：这是脾肾阳虚，寒湿中阻。治疗适宜桂附理中汤加减，处方：黄芪15克，附子30克，肉桂15克，党参12克，白术12克，苍术15克，厚朴12克，沉香10克，毕澄茄10克，木香10克，砂仁15克，小茴香12克。服药1剂，其证大减。我知道这种情况，于是请教白老先生。说：你所用药力不及耳，必须大剂方可有效。我拜谢说：治法对而药力不及亦难取效耳。谨记，谨记。
患者刘××，男性，46岁。反复感冒5—6年。医生有的说是气虚而予补益证反加重者，有的说是风寒予解表散寒而汗出难止者，有的说是风热予辛凉解表腹痛难止者，有的说是阴虚而予养阴痞满纳呆者。邀请我诊治。检查发现证见全身酸困，头晕头胀，微咳、喷嚏，胸胁微满，舌苔白，脉沉缓。综合脉证，诊为肝郁脾虚，复感外邪，冶以疏肝解表，佐以益气健脾。处以参苏饮加减为方。苏叶0.3克，党参0.2克，陈皮0.2克，枳壳0.2克，杏仁0.2克，茯苓0.1克，香附0.1克。各位医生看见方子，大加非议。有的药店看见其量小，不愿售药，然而因患者屡服诸药不效，坚持服药以试之，药店才勉强付与之。不意，竟一剂知，三剂已。患者问：为何5分钱之药得愈，而数百元之药竟不效反剧也？答曰：此病正虚邪微，补正则助邪，祛邪则伤正，故可以小量达其病所耳，过者剧，伤其正而不达病所。
患者乔××，女性，50岁。右腿从臀至足麻木疼痛半年多。医生诊断坐骨神经痛。前医以药物封闭、按摩、针灸、中药治疗，诸证不减。邀请我诊治。检查发现除疼痛麻木外，别无所苦。舌苔薄白，脉弦紧。综合脉证，诊为风寒湿痹。予独活寄生汤方（独活10克，桑寄生15克，秦艽10克，防风10克，细辛3克，川芎10克，当归10克，生地10克，白芍10克，肉桂10克，茯苓10克，杜仲10克，川牛膝10克，党参10克，甘草6克）。2剂后，痛麻俱减。因其本人及其爱人均知医，且其友人又多为外科医生或中医医生。认为既为风寒湿痹，何不再加祛风除湿之羌活以增加效力？乃于原方之中加入羌活10克。连服3剂，痛麻又剧。再求余治。说：羌活乃上半身引经之药，加之则药力反不得达其病之所在部位耳。宜去羌活为方。药后果然痛麻俱减。10剂后，诸证俱失而愈。
数脉非仅主热
In the winter of 1964, I treated a patient, male, 78 years old. He experienced burning pain in the epigastrium after eating and belching for several years. The physician diagnosed him with hiatal hernia (Esophageal hiatus hernia). Various Chinese and Western medicines were used extensively, but their efficacy was not significant, so he invited Mr. Li Hanqing to diagnose and treat him. Mr. Li said: This is caused by food stagnation (Food retention). The treatment should focus on promoting digestion and guiding out stagnation (Promote digestion and guide out stagnation). Therefore, Shanzhua Huazhi Wan (Hawthorn Pill for Resolving Stagnation) was prescribed, half a pill each time, three times a day. After taking the medicine for 3 days, all symptoms decreased. The patient said: Such a small pill, taking only half a pill each time, how can it achieve rapid effect? It is better to change to 3 pills each time, taken three times a day. I heard this and felt it made sense, so I instructed him to change to 3 pills each time, three times a day. After continuously taking it for 3 days, not only did the epigastric burning pain not decrease, but he also felt increasingly short of breath and weak. Thus, he sought advice from Mr. Li Hanqing again. Mr. Li said: Do you not know the text of Article 116 of Shanghan Lun (Treatise on Cold Pathogenic Diseases)? The text says: With a pulse that is slightly rapid (Wei Shu Zhi Mai), moxibustion must be avoided. Because fire becomes an evil pathogen, it leads to irritability and rebellion. It pursues deficiency and drives excess (Zhui Xu Zhu Shi), scattering blood within the vessels. Although the fire energy is slight, its internal attack is powerful, scorching bones and injuring tendons, making blood difficult to restore. Most scholars interpret this text as follows: A slightly rapid pulse refers to a rapid yet forceless pulse, mostly indicating Yin deficiency with hyperactive fire (Yin deficiency and fire hyperactivity). The treatment should nourish Yin and clear heat, hence it is said that moxibustion must be avoided. If moxibustion is mistakenly used, not only will it fail to cure the disease, but it will also damage Yin and assist heat, leading to irritability and rebellion. "Pursuing deficiency and driving excess" means that fire as an evil pathogen pursues the deficiency of healthy Qi on one hand, and drives the excess of pathogenic factors on the other. That is, if Yin is originally deficient, using moxibustion will further damage Yin; if heat is originally excess, using moxibustion will assist Yang and increase heat. The result of this forcing deficiency and driving excess is that blood scatters chaotically in the vessels, suffering severe damage. Thus, although moxa fire is slight, its internal attack is powerful. It can lead to difficulty in restoring Yin and blood, causing skin and muscles, bones and tendons to lose nourishment, resulting in serious consequences such as dry skin, scorched bones, and injured tendons. Through reasoning by analogy, we can draw the following conclusion: Any disease where healthy Qi is severely depleted and pathogenic factors are abundant is a disease difficult to treat by both attacking and tonifying. Slightly tonifying healthy Qi may easily make pathogenic factors more vigorous, while slightly attacking may easily make healthy Qi unable to support itself. Therefore, when prescribing medication, one can only tonify healthy Qi without assisting pathogens, only dispel pathogens without damaging healthy Qi, only tonify Yin without damaging Yang, and only tonify Yang without damaging Yin. Thus, whether dispelling pathogens or tonifying healthy Qi, whether tonifying Yang or benefiting Yin, only small doses should be given. In the case of the current patient, why half a pill was effective but 3 pills were not, is because the patient is nearly eighty years old, representing depleted healthy Qi and abundant pathogens. Therefore, slightly increasing the dosage to dispel pathogens damages healthy Qi, just as stated in Shanghan Lun: "Although fire evil is slight, its internal attack is powerful." I still felt skeptical upon hearing this and did not fully agree.
In the winter of 1965, I treated a patient, female, 41 years old. She suffered from rheumatic heart disease (Rheumatic heart disease), mitral stenosis and insufficiency, and heart failure for over 2 years. Extensive use of Chinese and Western medicines was ineffective. Examination revealed edema and oliguria, pleural and abdominal effusion, coughing and wheezing with shortness of breath, inability to lie flat, irritability, palpitations, fever, thirst, red and crimson tongue body, clean coating, and a fine, rapid, surging, and forceless pulse. A certain doctor was urgently invited to diagnose and treat her. He said: This is Heart and Kidney Yin deficiency (Heart and Kidney Yin deficiency). It is suitable to use Jiajian Fumai Tang (Modified Decoction to Restore the Pulse) to nourish Yin and clear heat. Prescription: Shengdi Huang (Rehmanniae Radix) 15g, Maidong (Ophiopogonis Radix) 15g, Wuweizi (Schisandrae Fructus) 12g, Baishao (Paeoniae Radix Alba) 12g, Renshen (Ginseng Radix et Rhizoma) 15g, Ejiao (Asini Corii Colla) 10g, Tianhuafen (Trichosanthis Radix) 15g, Shihu (Dendrobii Caulis) 15g, Yuanshen (Scrophulariae Radix) 15g. After taking one dose, all symptoms worsened. Out of necessity, Mr. Li Hanqing was invited again. He said: The treatment should use Zhenwu Tang (True Warrior Decoction) with modifications. Prescription: Fuzi (Aconiti Lateralis Radix Praeparata) 0.6g, Renshen (Ginseng Radix et Rhizoma) 0.4g, Fuling (Poria) 1g, Baizhu (Atractylodis Macrocephalae Rhizoma) 0.6g, Baishao (Paeoniae Radix Alba) 0.6g, Xingren (Armeniacae Semen Amarum) 0.3g. After taking two doses, all symptoms greatly decreased, urine output increased, edema subsided, and breathing became slightly calm. At this time, the patient's family members saw that the dosage was small and the number of herbs was few. They angrily rebuked me, saying: For such a critical illness, how can giving such small amounts of medicine cure it! Out of necessity, the prescription was given at 10 times the original amount. After taking two doses, all symptoms worsened, and the family was extremely panicked. Urgently seeking Mr. Li Hanqing again, he said: The original prescription and original dosage are fine, no need to change. I followed his instructions and prescribed again: Fuzi (Aconiti Lateralis Radix Praeparata) 0.6g, Renshen (Ginseng Radix et Rhizoma) 0.4g, Fuling (Poria) 1g, Baizhu (Atractylodis Macrocephalae Rhizoma) 0.6g, Baishao (Paeoniae Radix Alba) 0.6g, Xingren (Armeniacae Semen Amarum) 0.3g. After taking the medicine, all symptoms indeed decreased. The patient's family said: I only knew that heavy doses could save critical conditions; I was truly mistaken.
I once treated a patient, Su XX, female, 53 years old. Bronchial asthma complicated with asthmatic bronchitis for over 30 years. Initially, wheezing and coughing only occurred when encountering pollen or dust. In the past 2 years, all symptoms worsened, especially in the last seven or eight months, wheezing occurred almost day and night, preventing lying flat, and diet was completely abandoned. Nearly 10,000 yuan was spent on Chinese and Western medicines by doctors, with no slight reduction. I was invited to diagnose and treat. Examination showed shortness of breath insufficient to sustain respiration, sitting upright all day unable to lie flat, and fingers, toes, forehead, chin, and ear shells were cold as ice. The tongue was pale with white coating, and the pulse was fine and surging. Synthesizing pulse and symptoms, the diagnosis was dual deficiency of Heart and Kidney Yin and Yang, primarily Yang deficiency, accompanied by untransformed fluid retention (Fluid retention). Treatment employed Zhenwu Tang (True Warrior Decoction) with modifications. Prescription: Fuzi (Aconiti Lateralis Radix Praeparata) 1g, Fuling (Poria) 1g, Baizhu (Atractylodis Macrocephalae Rhizoma) 1g, Baishao (Paeoniae Radix Alba) 1.5g, Renshen (Ginseng Radix et Rhizoma) 1g, Xingren (Armeniacae Semen Amarum) 1g. After taking two doses, wheezing, coughing, and shortness of breath greatly decreased, ability to lie flat slightly improved, and diet intake slightly resumed. A certain doctor, seeing the few herbs and small dosages, had complaints. He said: Previous prescriptions used by other doctors contained 15-16 herbs at minimum, up to over 30 herbs. Dosages ranged from light 10g to heavy 40g, yet none were effective. This prescription has only 6 herbs, with the heaviest being 1.5g. For such a severe illness, how can such small medicine work! So he increased the original prescription dosage by 10 times. After 4 doses, all symptoms significantly worsened. I was invited again. After diagnosis, I said: This disease involves dual deficiency of Yin and Yang, primarily Yang deficiency. During treatment, one can only slightly cultivate Yang Qi to aid the growth of "Lesser Fire" (Shao Huo). Using 10 times the amount of Fuzi would create "Greater Fire" (Zhuang Huo), consuming Qi and damaging Yin. Therefore, the original prescription with small dosage should still be used. After taking one dose, all symptoms indeed greatly decreased. One month later, all symptoms disappeared, and the patient was discharged.
Geng XX, female, 50 years old. Epidemic encephalitis B (Japanese encephalitis), high fever and coma for 7 days and nights. Doctors gave Western medicines and Chinese medicines including Qingwen Baidu Yin (Clear Heat and Resolve Toxin Decoction), Angong Niuhuang Wan (Golden Pill for Resuscitation), and modified Yinqiao Baihu Tang (Yinqiao and White Tiger Decoction), but these were ineffective. I was invited to diagnose and treat. Examination revealed coma, incontinence of stool and urine, thin white tongue coating, pale and dark tongue body, cold limbs, and faint pulse. Synthesizing pulse and symptoms, the diagnosis was collapse of Yang (Yang collapse). Urgently, Sini Tang (Decoction to Reverse the Cold) was prescribed: Fuzi (Aconiti Lateralis Radix Praeparata) 4g, Ganjiang (Zingiberis Rhizoma) 4g, Zhigancao (Glycyrrhizae Radix et Rhizoma Preparatum) 4g. After taking one dose, consciousness cleared, limbs warmed, and temperature dropped from 38.9°C to 37.5°C. A certain doctor witnessing this said: The disease is so severe, how can treating it with micro-doses save life in an instant? To be responsible for the patient, large prescriptions with heavy doses must be used. Moreover, Renshen greatly tonifies Yuan Qi (Primal Qi), so it should be added. The prescription was: Fuzi (Aconiti Lateralis Radix Praeparata) 40g, Ganjiang (Zingiberis Rhizoma) 40g, Renshen (Ginseng Radix et Rhizoma) 40g, Zhigancao (Glycyrrhizae Radix et Rhizoma Preparatum) 10g. After taking one dose, that night, coma, cold limbs, fever, and temperature of 39.8°C reappeared. Urgently inviting me again, I said: This disease involves deficiency of healthy Qi and abundance of pathogens. Only micro-medicines can aid Lesser Fire; large doses cannot strengthen Greater Fire. Otherwise, with excess pathogens and depleted healthy Qi, recovery will be difficult. First, Sanjia Fumai Tang (Three Shell Decoction to Restore the Pulse) should be used to tonify Yin and consolidate Yang, followed by micro-doses of Sini Tang to aid Lesser Fire. The patient recovered.
Appropriateness to the Target Site
In clinical practice, we often encounter: ① Cases where small prescriptions/doses are ineffective initially, but large prescriptions/heavy doses become effective. ② Cases where large prescriptions/heavy doses are ineffective initially, but small prescriptions/doses become effective. ③ Cases where large prescriptions/heavy doses are harmful initially, but small prescriptions/doses become effective. ④ Cases where small prescriptions/doses are useless and delay the disease course, but large prescriptions/heavy doses immediately cure chronic diseases. ⑤ Cases where the original prescription is ineffective unchanged, but becomes effective after adding one or two herbs. ⑥ Cases where the original prescription is effective unchanged, but becomes ineffective after adding one or two herbs. ⑦ Cases where the original prescription is ineffective unchanged, but becomes effective after removing one or two herbs. ⑧ Cases where the original prescription is effective unchanged, but becomes ineffective after removing one or two herbs. Why? Careful investigation reveals four reasons: ① Not adapting to the specific cause. ② Not seeking the root category. ③ Not regulating Qi flow. ④ Not reaching the target site appropriately. However, the most common is failing to reach the target site appropriately.
Examining Suwen: Zhenshi Yao Da Lun (The Supreme Basic Principles of the Yellow Emperor’s Classic of Medicine: On the Most Essential and Important Discourse), while elaborating on "Cold is treated with heat, heat is treated with cold, minor cases are treated oppositely, severe cases are treated similarly, hardness is reduced, invaders are removed, exhaustion is warmed, knots are dispersed, retention is attacked, dryness is moistened, urgency is eased, scattering is consolidated, loss is warmed, rest is moved, fright is calmed, upper is lowered, massaged and bathed, pressed and robbed, opened and released," "Heat is treated with heat, cold is treated with cold, obstruction is treated with obstruction, patentness is treated with patentness," "For those who are heated by cold treatments and remain hot, seek Yin; for those who are cooled by heat treatments and remain cold, seek Yang," and "Adapt to the cause," "Regulate Qi flow," "Seek the category," it specifically points out that the application of these methods must be appropriate to the target site, meaning neither excessive nor insufficient. He said: "Qi has high and low positions, diseases have distant and near locations, symptoms have interior and exterior aspects, treatments have light and heavy intensities. Appropriateness to the target site is the principle. Generally speaking: One sovereign and two ministers constitute an odd formula; Two sovereigns and four ministers constitute an even formula; Two sovereigns and three ministers constitute an odd formula; Two sovereigns and six ministers constitute an even formula. Thus it is said: Near and odd, far and even. Diaphoresis does not use odd formulas, purgation does not use even formulas. Tonifying the upper and treating the upper requires slow preparation; tonifying the lower and treating the lower requires urgent preparation. Urgent preparation yields thick flavor and qi; slow preparation yields thin flavor and qi. Appropriateness to the target site is what is meant here. If the disease is distant and the flavor/qi of the medicine is intercepted midway, food should be used to pass it through, without exceeding the system." In this chapter and Wuchang Zheng Da Lun (Discourse on the Great Regularity of Normal Conditions), he earnestly warns against exceeding limits and damaging healthy Qi. Wuchang Zheng Da Lun says: "Diseases have long-standing and new onset; prescriptions have large and small sizes; medicines have toxicity and non-toxicity. These should follow standard regulations. For highly toxic medicines, remove 60% of the disease; for commonly toxic medicines, remove 70%; for slightly toxic medicines, remove 80%; for non-toxic medicines, remove 90%. Use grains, meats, fruits, and vegetables to complete the nourishment. Do not exceed limits, lest they damage healthy Qi." Zhenshi Yao Da Lun says: "When five flavors enter the stomach, each returns to its preference. Sour enters Liver first, bitter enters Heart first, sweet enters Spleen first, pungent enters Lung first, salty enters Kidney first. Long-term use increases Qi, which is the normal transformation of substances. If Qi increases for too long, it is due to Heaven's way."
I once treated a patient, Miao XX, male, 55 years old. Epigastric distension and pain, worsening from afternoon to night, aggravated by slight cold exposure or cold foods. Tongue coating thin white, pulse string-tight. I prescribed Guifu Lizhong Tang (Cinnamon Twig and Aconite Regulate the Middle Decoction) with modifications. Prescription: Fuzi (Aconiti Lateralis Radix Praeparata) 6g, Rougui (Cinnamomi Cortex) 6g, Dangshen (Codonopsis Radix) 6g, Baizhu (Atractylodis Macrocephalae Rhizoma) 6g, Cangzhu (Atractylodis Rhizoma) 6g, Ganjiang (Zingiberis Rhizoma) 6g, Muxiang (Aucklandiae Radix) 6g, Chenxiang (Aquilariae Lignum Resinatum) 6g, Dingxiang (Eugeniae Flos) 6g. After taking 6 doses, efficacy was not significant. I asked Mr. Bai Qingzuo to treat. He said: This is Spleen and Kidney Yang deficiency with cold-dampness obstructing the middle. Treatment should use Guifu Lizhong Tang with modifications. Prescription: Huangqi (Astragali Radix) 15g, Fuzi (Aconiti Lateralis Radix Praeparata) 30g, Rougui (Cinnamomi Cortex) 15g, Dangshen (Codonopsis Radix) 12g, Baizhu (Atractylodis Macrocephalae Rhizoma) 12g, Cangzhu (Atractylodis Rhizoma) 15g, Houpo (Magnoliae Officinalis Cortex) 12g, Chenxiang (Aquilariae Lignum Resinatum) 10g, Bi Cheng Qie (Galangal Fruit) 10g, Muxiang (Aucklandiae Radix) 10g, Sharen (Amomi Fructus Rotundus) 15g, Xiaohuixiang (Foeniculi Fructus) 12g. After taking one dose, symptoms greatly decreased. Knowing this situation, I consulted Mr. Bai. He said: Your medicinal power is insufficient; only large doses can be effective. I bowed and said: Even if the treatment method is correct, insufficient medicinal power makes it difficult to achieve efficacy. I will remember this, remember this.
Patient Liu XX, male, 46 years old. Recurrent colds for 5-6 years. Some doctors attributed it to Qi deficiency and prescribed tonics, worsening the condition. Others attributed it to Wind-Cold and prescribed diaphoretic and warming herbs, causing uncontrollable sweating. Others attributed it to Wind-Heat and prescribed acrid-cool diaphoretics, causing unbearable abdominal pain. Others attributed it to Yin deficiency and prescribed Yin-nourishing herbs, causing fullness and poor appetite. I was invited to diagnose and treat. Examination revealed whole-body soreness and fatigue, dizziness and head distension, slight cough and sneezing, slight chest and hypochondriac fullness, white tongue coating, and deep-slow pulse. Synthesizing pulse and symptoms, the diagnosis was Liver Qi stagnation with Spleen deficiency, complicated by external pathogenic invasion. Treatment focused on soothing the Liver and releasing the exterior, assisted by boosting Qi and strengthening the Spleen. Shen Su Yin (Ginseng and Perilla Decoction) with modifications was prescribed. Suz Ye (Perillae Folium) 0.3g, Dangshen (Codonopsis Radix) 0.2g, Chenpi (Citri Reticulatae Pericarpium) 0.2g, Zhike (Aurantii Fructus Immaturus) 0.2g, Xingren (Armeniacae Semen Amarum) 0.2g, Fuling (Poria) 0.1g, Xiangfu (Cyperi Rhizoma) 0.1g. Seeing the prescription, other doctors heavily criticized it. Some pharmacies refused to sell due to the small dosage. However, since the patient had failed with previous medications, he insisted on trying, and the pharmacy reluctantly provided it. Unexpectedly, improvement was seen after one dose, and cure after three doses. The patient asked: Why did 5 cents worth of medicine cure me, while hundreds of yuan worth of medicine failed and worsened my condition? I answered: This disease involves deficient healthy Qi and slight pathogens. Tonifying healthy Qi assists pathogens, while dispelling pathogens damages healthy Qi. Therefore, small amounts can reach the disease site. Excessive amounts worsen the condition, damaging healthy Qi without reaching the disease site.
Patient Qiao XX, female, 50 years old. Numbness and pain in the right leg from buttock to foot for over half a year. Diagnosed with sciatica (Sciatic neuralgia). Previous treatments included drug blocks, massage, acupuncture, and Chinese medicine, with no reduction in symptoms. I was invited to diagnose and treat. Examination revealed pain and numbness as the only complaints. Tongue coating thin white, pulse string-tight. Synthesizing pulse and symptoms, the diagnosis was Bi syndrome due to Wind-Cold-Dampness (Wind-Cold-Dampness Bi Syndrome). Du Huo Ji Sheng Tang (Decoction for Expelling Rheumatism and Nourishing the Liver and Kidneys) was prescribed: Du Huo (Angelicae Pubescentis Radix) 10g, Sang Jisheng (Taxilli Herba) 15g, Qin Jiao (Gentianae Macrophyllae Radix) 10g, Fangfeng (Saposhnikoviae Radix) 10g, Xixin (Asari Radix et Rhizoma) 3g, Chuanxiong (Ligustici Chuanxiong Rhizoma) 10g, Danggui (Angelicae Sinensis Radix) 10g, Shengdi Huang (Rehmanniae Radix) 10g, Baishao (Paeoniae Radix Alba) 10g, Rougui (Cinnamomi Cortex) 10g, Fuling (Poria) 10g, Duzhong (Eucommiae Cortex) 10g, Chuan Niuxi (Achyranthis Bidentatae Radix) 10g, Dangshen (Codonopsis Radix) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g. After 2 doses, pain and numbness both decreased. Since she and her husband knew medicine, and many friends were surgeons or TCM doctors, they thought: Since it is Wind-Cold-Dampness Bi, why not add Qiang Huo (Notopterygii Rhizoma et Radix) to enhance the wind-dispelling and dampness-resolving effect? So Qiang Huo 10g was added to the original prescription. After taking 3 doses consecutively, pain and numbness worsened. Seeking my treatment again, I said: Qiang Huo is a guiding herb for the upper body. Adding it prevents the medicinal power from reaching the disease site. It is advisable to remove Qiang Huo. After adjusting the prescription, pain and numbness indeed decreased. After 10 doses, all symptoms disappeared, and the patient recovered.
Rapid pulse is not solely indicative of heat