柏、麦冬、五味、花粉，甚则石膏、知母以止渴，此皆有形之水，以沃无形之火，徒使
与火相争，安能滋肾中之真阴也。若以六味地黄大剂服之，其渴立愈，何至传至少阴，
而成燥实坚之症乎？既成燥实坚之症，仲景不得已而以承气汤下之。此权宜之霸术，然
谆谆有虚人老弱人之禁，故以大柴胡代之。陶氏以六乙顺气汤代之，岂以二汤为平易
乎？代之而愈，所丧亦多矣。况不愈者十之八九哉！当时若多用六味地黄饮子，大剂服
之，取效虽缓，其益无穷。况阴虚发热者，小便必少，大便必实，其上症口渴烦躁，与
伤寒无异，彼之承气者，不过因亢则害，下之以承真阴之气也。今直探其真阴之源而补
之，如亢旱而甘霖一施，土水皆濡，顷刻为清凉世界矣，何不可哉？！况肾水既虚矣，
复经一下之后，万无可生之理，慎之，慎之！此赵氏之创论，实探本穷源之学也。
按阴盛格阳，阳盛格阴，二症至为难辨，盖阴盛极而格阳于外，外热而内寒，阳
盛极而格阴于外，外冷而内热，《经》所谓∶“重阴必阳，重阳必阴，重寒则热，重热则
寒”是也。当于小便分之，便清者，外虽燥热，而中必寒；便赤者，外虽厥冷，而内必
热。再看口中燥润及舌苔浅深，盖舌为心苗，应南方火邪，在表则未生苔，邪入里，
津液搏结则生苔，而滑苔白者，丹田有热，胸中有寒，邪在半表半里也。热入渐深，则
燥而涩，热聚于胃矣，宜用承气、白虎。若热病口干舌黑，乃肾水行于心火，热益深而
病笃矣。然亦有苔黑属寒者，必舌无亡刺，口有津液也。即小便之赤白，口中之润燥，
舌苔之滑涩，亦皆因乎津液之荣枯，未足凭以遽断寒热也。故尤宜以脉之有力无力细辨
之。总之，医家治者，须随机应变，活泼泼地，不可胶执一方，不可泥滞一药，不必以
药治病，惟以药治脉可也。古今气运不同，旧方新病，何能符合？只可读其书，广其
义，考其方，得其理，潜心默究，自得其神，即罗氏譬之折旧料而改新房，备必工稳
耳。
外感头痛，常常而痛，痛犹外束也。内伤头痛，时作时止，痛犹内胀也。此由血
虚，而虚火冲入泥丸宫也。内伤手心热，手背不热，外感手背热，手心不热。
治阴症以救阳为主，治伤寒以救阴为主。然伤寒纵有阳虚当治，必看其人血肉充
盈，而阴分可受阳药者，方可回阳。若面黧舌黑，身如枯柴，一团邪火内燔者，则阴已
先尽焉。敢回阳益劫其阴耶！
《伤寒论》曰∶阴症得阳脉者，生；阳症得阴脉者，死。人皆奉其言，未知绎其
义，夫正虚邪旺，久而不痊，但与补正，则邪自除，此必见虚衰之阴脉也。正气实者，
多见阳脉，正气虚者，多见阴脉。症之阳者，假实也。脉之阴者，真虚也。陈氏曰∶
凡察阴症，不论热与不热，惟凭脉用药，百无一失。不论脉之浮沉大小，但重按无力便
是伏阴，忌用凉剂，犯之必死。然则沉小者，人果知为阴脉，不知浮大者，亦有阴脉
也。凡内伤心气者，脉皆无力，不可不辨。是知诸病，千变万化，只虚实二字尽之，不
独伤寒一症也。盖一实一虚，邪正相为胜负，正胜则愈，邪胜则死。正气实者，即感
大邪，其病亦轻。正气虚者，即感微邪，其病亦甚。故凡气实而病者，但去其邪。攻之
无难；挟虚而病者，不补其虚，邪何能退？奈有伤寒无补法之语，以致虚症伤寒，固执
束手待毙，良可叹也！独不观仲景为伤寒之祖，立三百九十六法，脉症之虚寒者，一百
有余，定一百十三方，用参者三十，用桂附者五十余，即东垣、丹溪、节庵，亦有补中
益气，回阳返本，温经益元等汤，未尝不补也，孰谓伤寒无补法耶？况今人挟虚患伤寒
者，十尝六七，虚症类伤寒者，十尝八九，每出此语为误，虚而不补，且复攻之，危亡
立待，殊不知发散而汗不出者，津液枯槁，阴气不能外达也。人知汗属于阳，升阳可以
解表，不知汗生于阴，滋水即所以发汗也。清解而热不退者，阳无阴敛，阴不足也。人
但知寒凉可以去热，不知养阴即所以退阳也。元阳中虚以致阴寒内袭者，壮元阳即所
以散外寒也。脾胃正虚，而元阳不能藏纳，以致余热潮热不已者，补脾胃即所以敛浮阳
也，要知正气不足，则邪气有余，正不胜邪，邪必不解，正气一壮，邪无容地，不散
表而表自解，不攻邪而邪自退，今人不论虚实，一见发热等症，便以攻邪为主，邪气未
去而正气受伤，此皆一言之祸也。自仲景以来，名贤代起，立言不患不详，患其多而惑
也。陶节庵曰∶得其要领，易于拾芥，脉证与理而已。求之多歧，则支离繁碎，如涉海
问津矣。脉证者，表里阴阳虚实寒热也。理者，知其常通其变也。多歧者，蔓衍之方书
也。
夫秋冬伤寒，真伤寒也。春夏伤寒，寒疫也。与受久而后发之温病、热病，自是两
途，岂可同治？且人惟知有外伤寒，而不知有内伤寒，即讹作房劳阴症，非也。凡冷物
伤中而得，便是内伤阴症，不独房劳然也。房劳未常不病，阳症头痛发热者，但不可轻
用凉药耳。若以曾犯房劳，便为阴症，必用温药。若以并无房事，便为阳症，必用凉
药，不据脉而惟问候，则杀人多矣。故曰阳症多得之于风寒暑湿，邪生于太阳，外入者
也。阴症多得之于饮食起居七情，邪生于少阴内起者也。伤寒内伤者，十居八九，救里
解表，霄壤不同，桂枝下咽，阳盛则毙，承气入胃，阴盛则亡，可不辨乎？合而言之，
真知其为阳虚也，则用补中益气汤；真知其为阳虚直中也，则用附子理中汤；真知其为
阴虚也，则用六味肾气汤；真知其为阴虚无火也，则用八味肾气汤。其间有似阴似阳之
假症也，则用寒因热用之法从之，不可少误，惟以补正为主，不必攻邪，正气得力，
自然推出寒邪，汗出而愈。攻之一字，仁人之所恶也，百战百胜战之善者也。不战而屈
人之兵，善之善者也，故曰善战者，服上刑。
有元气素弱，色欲过度，腠理疏豁，寒邪乘虚而直入于三阴之经，故曰∶阴症初
起，乃不见热症之暴病也。若不即治，反逼虚阳上攻，而见面赤烦躁等热症，名阴盛格
阳，一名阴极似阳，其躁时欲坐卧于泥水井中，口虽烦渴，不欲饮水，如脉洪数无力
者，是阴虚而假阳上乘也，八味地黄汤加牛膝、五味子主之。六脉沉微无力者，阳虚之
真象也，参、术、附、桂之类主之。有病本属阳，未传入里，误服凉药，过饮冷水变为
阴症，或过食冷物，或食物后复饮冷水，变为食阴之病者，皆当从阴治，但重在温中，
故止用炙草、术、附、姜、桂，而不用地、茱、桂、附也。若脉虽无力，外症身热，自
汗体倦，手足心热，忽时作寒，口不知味，出言懒怯者，此属内伤元气，自当补中，如
人参养荣汤，或补中益气汤，不必用峻补及桂、附大热之药也。然人之有生者，惟赖一
阳气也。凡亡阳六脉沉微者，则元阳欲脱，命悬如缕，即峻加补益，无如草木之性，亦
必假人正气以发生。若人本气不固，药力从何鼓舞，势如脱空填补，故少旺复虚，虚复
峻补，药力一过，势复虚嬴，惟宜细心详察，阴长救阳，阳长救阴，接续勿间，不可
少偏，不可少缓，务使阳先生而阴后长，勿使阴气胜而阳乃亡，七日五脏传遍，半月节
令一交，则真气借此发生，根固方无暴脱。然脱症惟以救阳为重者，盖人阳气一分不
尽，则不死，故阳为生长之机。若以补阴，阴道难长，徒使亡阳也，况命火安于位者，
百病不生。凡诸疾之作者，皆由真火离于位也。是以治者，百病虽殊，可不保重此火，
以为去病之基耶！（张）陈管见，明者达之。
凡七分外感，三分内伤，则治外感药中，宜用缓剂小剂，及姜枣和中为引，则无
大动正气之患。若六分内伤，三分外感，则用药全以内伤为主，略加表药一味，或热服
以助药势，则邪自散，盖中虚之人，稍有外感，即能致病。非若壮者之人，必邪气重
盛，方能发病也。况外感微邪，止犯气厘清道，并不传经，犯内故无重汗重下之法。惟
调和荣卫，则邪自解于表，调和谷气，则元自复于中。若妄攻绝食，益虚其虚，愈增其困矣。
麦冬、五味子、天花粉，严重时用石膏、知母来止渴，这些都是有形的水液，用来浇灌无形的火邪，只会让水与火相互争斗，怎么能滋养肾中的真阴呢？如果大量服用六味地黄丸，口渴会立刻痊愈，怎么会传变到少阴经，形成燥、实、坚的症状呢？既然已经形成了燥实坚的症状，张仲景不得已才用承气汤来攻下。这是一种权宜之计的霸道手段，但他反复告诫有虚人、老弱者的禁忌，所以有时用大柴胡汤替代。陶华（陶节庵）用六乙顺气汤替代，难道是因为这两方药性平和吗？虽然替代后病愈了，但损耗元气也很多。何况不痊愈的患者占十之八九呢！当时如果多用六味地黄饮子，大剂量服用，虽然见效慢，但益处无穷。况且阴虚发热的患者，小便必然短少，大便必然干结，他们上部的症状如口渴烦躁，与伤寒无异，那些使用承气汤的人，不过是顺应“亢盛则害”的道理，通过泻下来承接和保护真阴之气。现在直接探究真阴的源头并加以补益，就像大旱之时降下甘霖，土地和水源都得到滋润，顷刻间变成清凉世界，这有什么不可以的呢？况且肾水已经虚弱，如果再经过一次攻下，就完全没有生存的道理了，务必谨慎，务必谨慎！这是赵献可提出的创论，确实是探求根本、穷尽源头的学问啊。
按：阴盛格阳和阳盛格阴这两个病症，最难辨别。因为阴寒极盛而将阳气格拒于外，表现为外热内寒；阳热极盛而将阴气格拒于外，表现为外冷内热。这就是《内经》所说的：“重阴必阳，重阳必阴，重寒则热，重热则寒”。应当从小便来区分，小便清长的，虽然外表燥热，但体内必定寒冷；小便赤涩的，虽然外表厥冷，但体内必定发热。再看口中干燥湿润情况及舌苔的深浅。舌为心之苗窍，对应南方火邪，在表时不生苔，邪气入里，津液搏结才会生苔。滑白苔者，是丹田有热，胸中有寒，邪气在半表半里之间。热邪深入，就会变得干燥涩滞，热邪聚积在胃了，适宜用承气汤、白虎汤。如果是热病导致口干舌黑，这是肾水不能制约心火，热势更深，病情危重了。然而也有舌苔黑属于寒证的，一定没有芒刺，口中有津液。即使小便利与不利、口中润与燥、舌苔滑与涩，也都取决于津液的盈亏，不足以据此贸然判断寒热。所以更应当仔细辨别脉象的有力无力。总之，医生治病，必须随机应变，灵活机动，不可固执于一方，不可拘泥于一药，不必单纯以药治病，只应以药治脉即可。古今运气不同，旧方新病，怎能完全符合？只能读其书，广其义，考其方，得其理，潜心默究，自然能领悟其神髓，就像罗天益比喻的那样，用废旧材料改建新房，必定精巧稳妥。
外感头痛，持续疼痛，痛感如同被外邪束缚。内伤头痛，时作时止，痛感如同内部胀满。这是由于血虚，虚火上冲入泥丸宫所致。内伤的手心热，手背不热；外感的手背热，手心不热。
治疗阴证以救阳为主，治疗伤寒以救阴为主。然而伤寒纵然有阳虚需要治疗，也必须看其人血肉充盈，阴分能够承受阳药，才可以回阳。如果面色黧黑，舌苔黑，身体像枯柴一样，一团邪火在内焚烧，那么阴气已经先耗尽了，岂敢再用回阳药进一步劫夺阴液呢！
《伤寒论》说：阴证得阳脉者生，阳证得阴脉者死。人们都信奉这句话，却不知推究其中的含义。正气虚弱邪气旺盛，久治不愈，只要补益正气，邪气自然消除，这时必然见到虚衰的阴脉。正气充实者，多见阳脉；正气虚弱者，多见阴脉。症状表现为阳证，是假实的表现；脉象表现为阴脉，是真虚的表现。陈氏说：凡是诊察阴证，不论是否有热，只凭脉象用药，百无一失。不论脉象浮沉大小，只要重按无力就是伏阴，忌用凉剂，犯了必死。既然如此，沉小的脉，人们果然知道是阴脉，却不知道浮大的脉，也有阴脉的情况。凡是内伤心气的，脉象都无力，不可不辨别。由此可知各种疾病，千变万化，只用虚实二字就能概括，不仅仅是伤寒这一种病症。盖因一实一虚，邪正相互胜负，正气胜则病愈，邪气胜则死亡。正气实者，即使感受大邪，病也轻；正气虚者，即使感受微邪，病也重。所以凡是气实而病的，只要去除邪气，攻伐不难；挟带虚损而病的，不补其虚，邪气怎么能退去？无奈有人说“伤寒无补法”，导致虚症伤寒者，固执己见束手待毙，实在令人叹息！难道没看到张仲景作为伤寒之祖，创立三百九十六法，其中脉症属虚寒的一百多种，制定一百一十三方，用人参的三十首，用桂枝附子的五十多首，就连李东垣、朱丹溪、罗天益，也有补中益气、回阳返本、温经益元等汤剂，未尝不补益，谁说伤寒无补法呢？况且现在人挟带虚损患伤寒的，十有六七，虚症类似伤寒的，十有八九，每每说出这种话造成误治，虚而不补，反而攻伐，危险灭亡就在眼前，殊不知发散而汗不出来的，是津液枯槁，阴气不能外达。人们只知道汗属于阳，升阳可以解表，不知道汗生于阴，滋水也就是发汗。清热解表而热不退的，是阳无阴敛，阴不足。人们只知道寒凉可以去热，不知道养阴也就是退阳。元阳中虚导致阴寒内袭的，壮元阳也就是散外寒。脾胃正虚，元阳不能藏纳，导致余热潮热不已的，补脾胃也就是收敛浮阳。要知道正气不足，则邪气有余，正不胜邪，邪气必然不解，正气一旦强壮，邪气无处容身，不散发表而表自解，不攻邪而邪自退。现在的人不论虚实，一见发热等症状，就以攻邪为主，邪气未去而正气受伤，这都是这一句话带来的祸害。自从张仲景以来，名贤代起，立言不担心不详细，担心的是太多而使人困惑。陶节庵说：得其要领，容易得像拾取草芥一样，关键在于脉证与理。追求过多歧路，就会支离破碎，如同渡海问津。脉证，指表里阴阳虚实寒热。理，指知其常通其变。多歧，指蔓衍的方书。
秋冬得的伤寒，是真伤寒。春夏得的伤寒，是寒疫。与受邪久而后发的温病、热病，自然是两条路，怎么可以同治？而且人们只知道有外伤寒，不知道有内伤寒，即使讹传为房劳阴症，也不对。凡是吃冷物伤中而得的，就是内伤阴症，不只是房劳如此。房劳不一定都致病，阳症头痛发热的，只是不可轻用凉药罢了。如果因为曾犯房劳，就认为是阴症，必须用温药；如果因为并无房事，就认为是阳症，必须用凉药，不依据脉象而只询问病史，那就杀人很多了。所以说阳证多得之于风寒暑湿，邪气生于太阳，从外而入；阴证多得之于饮食起居七情，邪气生于少阴，从内而起。伤寒内伤的，十居八九，救里与解表，霄壤之别，桂枝汤喝下去，阳盛则死；承气汤进入胃，阴盛则亡，能不辨别吗？综合来说，真正知道是阳虚的，就用补中益气汤；真正知道是阳虚直中的，就用附子理中汤；真正知道是阴虚的，就用六味肾气汤；真正知道是阴虚无火的，就用八味肾气汤。其中有似阴似阳的假症，就用寒因热用的反佐法顺从其假象，不可稍有错误，只以补正为主，不必攻邪，正气得力，自然推出寒邪，汗出而愈。“攻”字，是仁人所厌恶的，百战百胜是战中的善者，不战而屈人之兵，是善中的善者，所以说善于作战的人，反而受到刑罚（意指好战者终遭灾祸）。
有元气素来虚弱，色欲过度，腠理疏松，寒邪乘虚直入三阴经，所以说：阴证初起，不见暴发的热症。如果不立即治疗，反而逼迫虚阳上攻，出现面赤烦躁等热症，名叫阴盛格阳，一名阴极似阳，其躁动时想坐在泥水井中，口中虽烦渴，却不欲饮水，如果脉象洪数无力，是阴虚而假阳上乘，用八味地黄汤加牛膝、五味子主治。六脉沉微无力，是阳虚的真象，用人参、白术、附子、肉桂之类主治。有病本属阳，未传入里，误服凉药，过饮冷水变为阴症，或过食冷物，或食物后复饮冷水，变为食阴之病的，都应当从阴证治疗，但重在温中，所以只用炙甘草、白术、附子、干姜、肉桂，而不用地黄、山茱萸、肉桂、附子（注：此处原文逻辑可能有误或特指某类配伍，依原文翻译）。如果脉虽无力，外症身热，自汗体倦，手足心热，忽时而恶寒，口不知味，说话懒怯，这属于内伤元气，自当补中，如人参养荣汤，或补中益气汤，不必用峻补及桂枝、附子大热之药。然而人的生存，只依赖这一阳气。凡是亡阳六脉沉微的，元阳欲脱，命悬一线，即使峻加补益，也无如草木之性，也必须借助人自身的正气来发生。如果人本气不固，药力从何鼓舞？形势如同填补虚空，所以稍旺又复虚，虚又峻补，药力一过，形势又复虚弱羸弱，只宜细心详察，阴长救阳，阳长救阴，接续不断，不可稍有偏颇，不可稍有迟缓，务使阳气先生而阴气后长，勿使阴气胜而阳气乃亡。七日五脏传遍，半月节气一交，则真气借此发生，根基稳固方才没有暴脱。然而脱症只以救阳为重，大概人阳气一分不尽，则不死，所以阳是生长的机枢。如果用补阴，阴道难长，徒然使阳气亡失，况且命门之火安于其位，百病不生。凡各种疾病的发生，都是由真火离开其位所致。所以治疗者，百病虽然不同，可不保重此火，作为去病的基础吗！（张）陈管见，明者达之。
凡是七分外感，三分内伤，则在治外感的药中，宜用缓剂小剂，以及姜枣和中作为引子，就没有大动正气的祸患。如果是六分内伤，三分外感，则用药全以内伤为主，略加一味表药，或者热服以助药势，邪气自然消散，盖因中虚之人，稍有外感，就能致病。不像壮年之人，必须邪气重盛，方能发病。况且外感微邪，只侵犯气厘清道，并不传经，犯内故无重汗重下之法。只有调和营卫，邪气自然解于表；调和谷气，元气自然恢复于中。如果妄行攻伐绝食，更加虚其虚，增加其困顿罢了。
Mu Dong (Ophiopogonis Radix), Wu Wei Zi (Schisandrae Fructus), Hua Fen (Tetrastigomatis Rhizoma), and in severe cases Shi Gao (Gypsum Fibrosum) and Zhi Mu (Anemarrhenae Rhizoma) are used to quench thirst. These are all tangible fluids used to irrigate intangible fire, merely causing water and fire to contend with each other; how can they nourish the True Yin within the Kidney? If Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) is taken in large doses, the thirst will be cured immediately, so why would it transmit to the Shao Yin channel and form symptoms of dryness, excess, and hardness? Once these symptoms of dryness, excess, and hardness have formed, Zhang Zhongjing had no choice but to use Cheng Qi Tang (Purgative Decoction) to purge them. This is a temporary, coercive measure, yet he repeatedly warned against its use in patients with deficiency, the elderly, and the weak, thus sometimes substituting Da Chai Hu Tang (Major Bupleurum Decoction). Tao Hua (Tao Jie'an) substituted Liu Yi Shun Qi Tang (Six-Yi Regulating Qi Decoction); did he consider these two decoctions to be mild? Although substitution led to recovery, much was lost in terms of vital energy. Moreover, how many failed to recover—eight or nine out of ten! At that time, if Liu Wei Di Huang Yin Zi (Six-Ingredient Rehmannia Drink) had been used more frequently and taken in large doses, although the effect might have been slow, the benefits would have been infinite. Furthermore, patients with Yin deficiency fever necessarily have scanty urine and constipation; their upper symptoms such as thirst and irritability are no different from those in Shang Han (Cold Damage). Those who used Cheng Qi Tang were merely following the principle that "excess causes harm," using purgation to support and preserve the Qi of True Yin. Now, by directly exploring the source of True Yin and tonifying it, it is like rain falling during a severe drought, moistening both earth and water, instantly turning the world cool and refreshing. Why should this not be done? Moreover, once Kidney Water is deficient, another round of purgation leaves no hope for survival. Be cautious, be cautious! This is Zhao Xianke's innovative theory, truly a scholarship that probes the root and exhausts the source.
Note: Yin Excess Repelling Yang and Yang Excess Repelling Yin are two conditions extremely difficult to distinguish. When Yin is excessively strong, it repels Yang to the exterior, resulting in external heat and internal cold; when Yang is excessively strong, it repels Yin to the exterior, resulting in external cold and internal heat. This is what the Classic states: "Extreme Yin transforms into Yang, extreme Yang transforms into Yin; extreme cold generates heat, extreme heat generates cold." Differentiation should be based on urination: clear urine indicates that despite external dryness and heat, the interior is cold; dark urine indicates that despite external cold limbs, the interior is hot. Observe the moisture of the mouth and the depth of the tongue coating. The tongue is the sprout of the Heart, corresponding to the Fire of the South. When the pathogen is in the exterior, no coating forms; when the pathogen enters the interior, body fluids bind together to form a coating. A slippery white coating indicates heat in the Dantian and cold in the chest, with the pathogen at the half-exterior half-interior level. As heat penetrates deeper, the tongue becomes dry and rough, indicating heat gathering in the Stomach; in such cases, Cheng Qi Tang (Purgative Decoction) and Bai Hu Tang (White Tiger Decoction) are appropriate. If a heat disease causes a dry mouth and black tongue, it signifies that Kidney Water fails to control Heart Fire, indicating deep heat and critical illness. However, there are also cases of black coating due to cold, characterized by the absence of prickles on the tongue and the presence of saliva in the mouth. Even the clarity or turbidity of urine, the moisture or dryness of the mouth, and the slipperiness or roughness of the tongue coating all depend on the flourishing or withering of body fluids, and are insufficient grounds for hasty judgment of cold or heat. Therefore, one must carefully differentiate based on whether the pulse is forceful or feeble. In summary, physicians must adapt flexibly to changing circumstances, remaining agile and not rigidly adhering to a single formula or herb. One need not treat the disease solely with herbs, but rather use herbs to regulate the pulse. The Qi and Yun (Luck/Climate) of ancient and modern times differ; old formulas cannot perfectly match new diseases. One should read the books, expand their meaning, examine the formulas, grasp the principles, and through quiet contemplation, naturally acquire their spirit. As Luo Tianyi比喻ed, it is like rebuilding a new house from old materials, ensuring precision and stability.
External contraction headache presents as continuous pain, feeling as if bound by external pathogens. Internal injury headache comes and goes, feeling like internal distension. This arises from Blood deficiency, with deficient Fire rushing up to the Ni Wan Palace (the brain). In internal injury, the palms are hot while the backs of the hands are not; in external contraction, the backs of the hands are hot while the palms are not.
Treating Yin syndromes focuses on rescuing Yang; treating Shang Han (Cold Damage) focuses on rescuing Yin. However, even if Shang Han involves Yang deficiency requiring treatment, one must first assess if the patient has sufficient flesh and blood, and if the Yin aspect can tolerate Yang-tonifying herbs, before attempting to restore Yang. If the face is sallow/black, the tongue is black, and the body is like dried firewood with a mass of pathogenic fire burning internally, the Yin has already been exhausted. How dare one use Yang-restoring herbs to further deplete Yin?
The *Shang Han Lun* states: "Yin syndromes with Yang pulses indicate survival; Yang syndromes with Yin pulses indicate death." Everyone reveres this statement without exploring its meaning. When Zheng Qi (Upright Qi) is deficient and Xie Qi (Pathogenic Qi) is vigorous, leading to prolonged non-recovery, tonifying Zheng Qi will cause Xie Qi to eliminate itself; this typically presents with a deficient, fading Yin pulse. Those with substantial Zheng Qi often show Yang pulses; those with deficient Zheng Qi often show Yin pulses. Yang symptoms represent false excess; Yin pulses represent true deficiency. Chen氏 said: "When examining Yin syndromes, regardless of the presence or absence of heat, rely solely on the pulse for medication, and you will rarely fail." Regardless of whether the pulse is floating, sunken, large, or small, if it is feeble upon heavy pressure, it indicates hidden Yin; cooling agents are contraindicated, and violating this leads to death. Thus, while people know that sunken/small pulses are Yin pulses, they do not realize that floating/large pulses can also be Yin pulses. Any internal injury to Heart Qi results in a feeble pulse, which must not be overlooked. Hence, all diseases, with their myriad changes, can be summarized by the two characters "Excess" and "Deficiency," not just Shang Han. It is a struggle between one Excess and one Deficiency, where Zheng and Xie vie for supremacy; if Zheng wins, recovery occurs; if Xie wins, death ensues. Those with substantial Zheng Qi suffer only mild illness even from major pathogens; those with deficient Zheng Qi suffer severe illness even from minor pathogens. Therefore, for diseases caused by Excess Qi, removing the pathogen is straightforward; for diseases complicated by Deficiency, if Deficiency is not tonified, how can the pathogen retreat? Unfortunately, the saying "Shang Han has no tonification method" has led many with deficient Shang Han to remain stubborn and wait for death, which is lamentable! Have we not seen that Zhang Zhongjing, the ancestor of Shang Han treatments, established 396 methods? Over 100 involved pulse and symptom patterns of deficiency and cold. Among his 113 prescribed formulas, 30 contained Ren Shen (Codonopsis Ginseng Radix), and over 50 contained Gui Zhi (Cinnamomi Ramulus) and Fu Zi (Aconiti Lateralis Radix Preparata). Even Li Dongyuan, Zhu Danxi, and Luo Tianyi utilized formulas like Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), Hui Yang Fan Ben Tang (Restore Yang and Return to the Root Decoction), and Wen Jing Yi Yuan Tang (Warm the Channels and Enrich the Primordial Qi Decoction). They certainly included tonification. Who says Shang Han has no tonification method? Moreover, nowadays, six or seven out of ten Shang Han cases involve underlying deficiency, and eight or nine out of ten deficiency-like conditions mimic Shang Han. Repeating this erroneous phrase leads to mistreatment: failing to tonify deficiency and instead attacking it brings imminent danger. People do not realize that failure to sweat after dispersing agents indicates withered body fluids, preventing Yin Qi from reaching the exterior. People know sweat belongs to Yang and that raising Yang can release the exterior, but they do not know that sweat is born from Yin; nourishing Water is equivalent to inducing sweating. If clearing heat fails to reduce fever, it is because Yang lacks Yin to contain it, indicating Yin insufficiency. People know cold-natured herbs can remove heat, but they do not know that nourishing Yin reduces Yang. For internal invasion of Yin Cold due to deficiency of Primordial Yang, strengthening Primordial Yang dispels external cold. For lingering or tidal fever due to Spleen-Stomach deficiency failing to store and accept Primordial Yang, tonifying Spleen-Stomach converges floating Yang. Know that when Zheng Qi is insufficient, Xie Qi is excessive; if Zheng cannot overcome Xie, Xie will not resolve. Once Zheng Qi is strengthened, Xie Qi has no place to reside; the exterior resolves without dispersing, and Xie retreats without attacking. Today, people ignore deficiency and excess, and upon seeing fever, prioritize attacking Xie Qi, injuring Zheng Qi before Xie Qi is gone. This disaster stems from a single phrase. Since Zhang Zhongjing, worthy scholars have arisen continuously; their writings are detailed, but the abundance confuses practitioners. Tao Jie'an said: "Grasping the essence makes it easy as picking up a mustard seed; it lies in pulse, symptoms, and principle." Seeking too many divergent paths leads to fragmentation, like asking for directions while crossing the sea. Pulse and symptoms refer to Exterior/Interior, Yin/Yang, Excess/Deficiency, Cold/Heat. Principle refers to knowing the constant and adapting to change. Divergent paths refer to proliferating medical texts.
Shang Han contracted in Autumn and Winter is True Shang Han. Shang Han contracted in Spring and Summer is Cold Epidemic. These are distinct from Warm Diseases and Heat Diseases that manifest after a long latency period; they cannot be treated identically. People only know of external cold contraction and ignore internal cold injury. Even mislabeling it as "sexual exhaustion Yin syndrome" is incorrect. Any condition caused by consuming cold foods damaging the Middle is an internal injury Yin syndrome, not limited to sexual exhaustion. Sexual exhaustion does not always cause disease; Yang syndrome headaches with fever simply require avoiding cold-natured herbs lightly. Assuming any history of sexual activity mandates Yin syndrome and warm herbs, or assuming no sexual activity mandates Yang syndrome and cold herbs, without relying on pulse diagnosis but only on inquiry, kills many. Thus, Yang syndromes mostly arise from Wind-Cold-Damp-Heat, with pathogens originating in the Tai Yang channel entering from outside. Yin syndromes mostly arise from diet, daily routine, and Seven Emotions, with pathogens originating in the Shao Yin channel rising from within. Internal injury in Shang Han accounts for eight or nine out of ten cases. Rescuing the Interior and releasing the Exterior are worlds apart. If Gui Zhi Tang (Cinnamon Twig Decoction) is ingested in Yang Excess, death follows; if Cheng Qi Tang (Purgative Decoction) enters the Stomach in Yin Excess, death follows. Can one neglect differentiation? Generally, if one truly knows it is Yang deficiency, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction); if truly Yang deficiency with direct transmission, use Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction); if truly Yin deficiency, use Liu Wei Shen Qi Tang (Six-Ingredient Kidney Qi Decoction); if truly Yin deficiency without Fire, use Ba Wei Shen Qi Tang (Eight-Ingredient Kidney Qi Decoction). For pseudo-symptoms resembling Yin or Yang, use the method of "treating cold with heat" (counter-assimilation) to follow the false presentation, without error. Focus primarily on tonifying Zheng Qi; there is no need to attack Xie Qi. When Zheng Qi gains strength, it naturally expels Cold Xie Qi, leading to sweating and recovery. The character "attack" is abhorrent to benevolent people. Winning every battle is good at war; subduing the enemy without fighting is the best of the best. Thus, it is said that those skilled in war receive punishment (implying warfare is ultimately disastrous).
Those with inherently weak Yuan Qi (Primordial Qi), excessive sexual indulgence, and loose pores allow Cold Xie Qi to enter directly into the Three Yin channels. Hence, Yin syndromes at onset do not present with sudden heat symptoms. If not treated immediately, deficient Yang is forced upward, presenting with red face and irritability, named Yin Excess Repelling Yang, or Extreme Yin Mimicking Yang. The patient may restlessly desire to sit in a mud-well; although thirsty and irritable, they do not wish to drink. If the pulse is flooding and rapid but feeble, it indicates Yin deficiency with floating False Yang; treat with Ba Wei Di Huang Tang (Eight-Ingredient Rehmannia Decoction) plus Niu Xi (Achyranthis Bidentatae Radix) and Wu Wei Zi (Schisandrae Fructus). If all six pulses are sunken, minute, and feeble, it is the true image of Yang deficiency; treat with Ren Shen (Codonopsis Ginseng Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fu Zi (Aconiti Lateralis Radix Preparata), and Gui Zhi (Cinnamomi Ramulus). If a disease originally belonged to Yang, had not transmitted inward, but was mistakenly treated with cold herbs, or excessive cold water was drunk, transforming it into a Yin syndrome, or excessive cold food or cold water after meals caused a "Food Yin" disease, all should be treated as Yin syndromes, focusing on warming the Middle. Thus, use Zhi Gan Cao (Prepared Licorice Root), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fu Zi (Aconiti Lateralis Radix Preparata), Gan Jiang (Zingiberis Rhizoma), and Gui Zhi (Cinnamomi Ramulus), avoiding Di Huang (Rehmanniae Radix) and Zhu Yu (Corni Fructus). If the pulse is feeble, but external symptoms include body heat, spontaneous sweating, fatigue, hot palms and soles, intermittent chills, loss of taste, and hesitant speech, this belongs to internal injury of Yuan Qi and requires tonifying the Middle, such as with Ren Shen Yang Rong Tang (Codonopsis Nourishing the Vigor Decoction) or Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). There is no need for harsh tonics or hot herbs like Gui Zhi and Fu Zi. However, human life relies solely on this one Yang Qi. In cases of Yang collapse with sunken, minute pulses, Yuan Yang is about to escape, life hangs by a thread. Even with harsh tonification, plant properties require the body's own Zheng Qi to generate effects. If the person's fundamental Qi is unstable, from where can the medicinal power be stimulated? It is like filling a void; the patient may briefly improve then relapse into weakness. Harsh tonification again yields only temporary relief. One must carefully observe, nurturing Yin to save Yang, and Yang to save Yin, continuously without pause, avoiding bias or delay. Ensure Yang arises first and Yin grows later; do not let Yin prevail until Yang perishes. After seven days, the Five Zang organs complete their transmission cycle; after half a month, solar terms shift. Then Zheng Qi can generate through this foundation, securing the root against sudden collapse. In collapse syndromes, saving Yang is paramount because as long as one part of Yang remains, death does not occur; thus, Yang is the mechanism of growth. Tonifying Yin makes the Yin path hard to grow, merely allowing Yang to perish. Moreover, if the Ming Men Fire (Gate of Life Fire) remains in its position, no disease arises. All diseases arise because the True Fire has left its position. Therefore, in treatment, although diseases vary, one must cherish this Fire as the foundation for eliminating disease! (Zhang) Chen's humble opinion, understood by the wise.
If the condition is七分 (70%) external contraction and 三分 (30%) internal injury, use mild and small doses of external-contracting medicines, with Ginger and Jujube to harmonize the Middle as guides, avoiding damage to Zheng Qi. If it is 六分 (60%) internal injury and 三分 (30%) external contraction, base the prescription primarily on internal injury, adding only one exterior-releasing herb, or administer hot to boost medicinal momentum, allowing Xie Qi to dissipate naturally. Those with Middle deficiency fall ill easily even with slight external contraction, unlike robust individuals who require heavy pathogenic accumulation to become ill. Moreover, minor external pathogens only affect the Qi and Clear Orifices, not transmitting through channels. Therefore, there is no need for heavy sweating or purging. Harmonizing Ying and Wei releases Xie Qi from the exterior; harmonizing Grain Qi restores Yuan Qi in the Middle.妄 (Wrongful) attacks and fasting only increase deficiency and distress.