熟地（八钱） 山茱（二钱） 丹皮（二钱） 茯苓（二钱） 山药（二钱） 泽泻（一钱五分）
制黄柏（盐酒炒褐色，八分） 制附子（二钱） 加灯心十根，建莲子二十粒，去心，水煎八分，空心温服。
人参（三钱，保元固中） 黄 （二钱，助表达卫） 枣仁（炒研，三钱，既补神明之
脏，复益疏泄之官） 鸡腿白术（炒黄，三钱，助脾胜湿） 当归身（酒炒，一钱五分
，和养气血） 白茯苓（二钱，淡渗浊气） 炙甘草（八分，即和药性而补脾，且令诸药暂
缓中宫而去病也蜜酒炒） 升麻（四分，升清则浊自降） 酒炒嫩防风（六分，助升
麻以提下陷之气） 加姜枣，水煎，日中食一服，渣煎晚服，探吐之。
一壮年作宦失意，退归林下，抑郁成疾，即《经》所谓∶尝贵后贱，名曰脱营，
尝富后贫，名曰失精，以致气血日消，神不外扬，六脉弦细而涩。凡饮食入胃，尽化为
痰，必咳吐痰涎尽出，而始能卧，不尽不已，是以津液内耗于里，焉能润泽于表！所
以肌肉渐削，恶寒懒食，余思卫气者，充皮毛，温肉分、司开阖肥腠里，以卫护于肌表
者也。然营气常随卫气而行，所以润皮肤荣脉络者也。今中气既弱而且郁，则气结聚不
宣，何能充皮毛温肉分、而开发腠里也。气失卫护于表则恶寒，血无气运于表则肌槁，
中气既虚，脾失健运，饮食既蒸，郁而为痰，则不能复成津液而为血，是以不但肌表
之腠里干枯闭塞，而肠胃之腠里焉能温而充之，开而发之，是以亦致密而不通，焉能津
液流行于脉络肌表之外乎？且津液既凝滞而为痰，则痰愈多，而津液愈竭矣。余以人参
保元固中以为君，黄 助表达卫以为臣，当归和养气血，白术助脾胜湿，麦门冬保护肺
中之气，五味子收敛耗散之精，炙甘革和药性而补脾，并以为佐，桂枝辛甘之性，能调
荣卫而温肌达表，麻黄轻扬力猛，率领群药，遍彻皮毛，驱逐阴凝之伏痰，化作阳和
之津液，并以为使，但恐桂麻辛烈，有耗营阴，入白芍和肝，以抑其二药之性，此即东
垣先生治外感寒邪，内伤蕴热而吐血者之麻黄桂枝汤，余更加入白术者，取其性刚而益
速，必能固中而断，不为物所挠也。引子则增生姜胶枣者，取味辛甘，能助脾而致津
液，更助神明而得清扬振作也。投服二三剂后，脉气渐充有神，痰涎嗽吐俱愈，余继以
十补丸空心吞服补肾，日中以归脾养荣加减，调养心脾气血而安。
医家切须自养精神，并专心道业，勿涉一毫外务为主，盖医者意也。审脉辨症处
方，全赖以意为主，倘自己精神不足，则辨症处方未免厌烦苟率，而艰深心用意矣。且
专心道业，则学问精进，触类傍通，俱可格物济人，倘奔兢外务，则神驰意乱，欲图默
会精微，专心利物，安可得乎。
夫人身以脾胃为主，即百病莫不以有胃气则生，无胃气则死，奈何？凡遇疾病，不
问外感内伤，禁其饮食，药饵妄投，将脾胃水谷之海，竟作药囊之具，徒乱清纯之气，
反生胜复之端，草木攻补，寒热之戾气搏击于中，谷肉长养，和平之常味竭绝于内，胃
气日衰，脏腑俱困，名治病而实做病也。盖脏各有神，凡酷嗜一物，皆其脏神所欲，斯
藏之精气不足，则求助斯味以自救。如妊妇肝肾不足，则嗜酸盐，老人精血不足，则嗜
肉食，故凡病患所嗜之物，只可节之不可绝之，若久药厌烦者，则可缓之病，不妨暂停
药饵，调进所喜之味，胃气一旺，便可长养精神。若病势不能勿药者，则宜冲和之药
味，易于入口，勿伤胃气。若不知此，绝其脏神所欲之饮食，强其胃气所伤之药饵，胃
气既伤，化源绝减，而欲病退神强者难矣。况多非是病而服是药者乎！
【早晨服用二妙地黄汤方】
熟地（八钱） 山茱萸（二钱） 牡丹皮（二钱） 茯苓（二钱） 山药（二钱） 泽泻（一钱五分）
制黄柏（用盐和酒炒至褐色，八分） 制附子（二钱） 加入灯心草十根，建莲子二十粒（去芯），加水煎煮至剩余八分药液，空腹温服。
【中午服用加减补中益气汤】
人参（三钱，用于保元固中） 黄芪（二钱，用于助表达卫） 酸枣仁（炒后研碎，三钱，既能补益神明之脏，又能辅助疏泄之官） 鸡腿白术（炒至黄色，三钱，帮助脾脏胜湿） 当归身（酒炒，一钱五分，调和滋养气血） 白茯苓（二钱，淡渗浊气） 炙甘草（八分，即调和药性并补脾，且让诸药在中宫暂缓以祛除疾病，用蜜酒炒） 升麻（四分，提升清气则浊气自然下降） 酒炒嫩防风（六分，协助升麻提起下陷之气） 加入生姜、大枣，加水煎煮，中午饭后服用一次，药渣再煎晚上服用，并采用探吐法。
一位壮年做官失意，辞官归隐山林，因抑郁而成病，这就是《内经》所说的：曾经尊贵后来卑贱，名叫脱营；曾经富裕后来贫穷，名叫失精。导致气血日渐消耗，神气不能外扬，六脉弦细而涩滞。凡是饮食进入胃中，全部化为痰，必须将痰涎咳吐干净，才能入睡，不吐尽不停止，因此津液在体内耗损，怎么能润泽体表呢！所以肌肉逐渐消瘦，怕冷懒食。我思考卫气的作用，是充实皮毛，温暖肌肉间隙，主管开阖肥腠理，以护卫肌表的。然而营气常随着卫气而行，用来滋润皮肤、荣养脉络的。现在中气既虚弱又郁结，那么气结聚而不宣通，怎么能充实皮毛、温暖肌肉间隙、开发腠理呢？气失去卫护于体表就会怕冷，血没有气的运化到达体表就会肌肤枯槁，中气既然虚弱，脾脏失去健运功能，饮食经过蒸腾，郁结而为痰，就不能再转化为津液进而成为血，因此不仅是肌表的腠理干枯闭塞，肠胃的腠理怎么能被温暖充盈、开启发散呢？因此也导致致密而不通，津液怎么能流行于脉络肌表之外呢？况且津液既凝滞成为痰，那么痰越多，津液就越枯竭了。我用保元固中的人参作为君药，助表达卫的黄芪作为臣药，当归调和滋养气血，白术帮助脾脏胜湿，麦门冬保护肺中之气，五味子收敛耗散的精气，炙甘草调和药性并补脾，并作为佐药，桂枝具有辛甘的性质，能调和营卫并温暖肌肤通达体表，麻黄轻扬力猛，率领群药，遍彻皮毛，驱逐阴凝的伏痰，化作阳和的津液，并作为使药。只是担心桂枝、麻黄的辛烈之性会耗伤营阴，所以加入白芍调和肝脏，以抑制这两味药的药性。这就是东垣先生治疗外感寒邪、内伤蕴热而吐血者的麻黄桂枝汤，我再加入白术，是取其性质刚劲而见效迅速，一定能固守中焦而断绝病源，不被外物所干扰。引子则增加生姜、大枣，是取其味道辛甘，能帮助脾脏滋生津液，更辅助神明而使其清扬振作。投服二三剂后，脉气逐渐充盈有神，痰涎咳嗽都痊愈了，我接着让他在空腹时吞服十补丸来补肾，中午用归脾养荣加减方，调养心脾气血而安顿身心。
医家务必自我修养精神，并专心于医学道业，不要涉及丝毫外部事务为主，因为医者意也。审察脉象、辨别症状、处方用药，全赖意念为主导。如果自己精神不足，那么辨证处方难免厌烦草率，而难以深入用心思考。况且专心于医学道业，学问就会精进，触类旁通，都可以格物济人；如果奔波竞逐于外部事务，就会心神驰散、意念混乱，想要默会精微、专心利他，怎么可能做到呢？
人的身体以脾胃为主，也就是百病莫不以有胃气则生，无胃气则死，为什么呢？凡是遇到疾病，不问外感内伤，禁止饮食，乱投药物，将脾胃这个水谷之海，竟然当作药囊的工具，徒然扰乱清纯之气，反而产生胜负反复的端绪，草木攻补、寒热偏性的戾气搏击于体内，谷肉长养的和平常味竭绝于内部，胃气日渐衰弱，脏腑都困顿，名义上是治病实际上是致病。大概五脏各有神志，凡是特别嗜好某种食物，都是其脏神所想要的，这是因为该脏的精气不足，所以求助这种味道来自救。比如孕妇肝肾不足，就嗜好吃酸咸之物；老人精血不足，就嗜好吃肉食。所以凡是病患所嗜好的食物，只可以节制不可以断绝，如果长期服药感到厌烦的，就可以暂缓病情，不妨暂停药物，调进喜欢的味道，胃气一旦旺盛，就可以长养精神。如果病势严重不能不用药的，就宜用平和的药物味道，易于入口，不要损伤胃气。如果不明白这个道理，断绝其脏神所想要的饮食，强行给予损伤胃气的药物，胃气既已受伤，化源减少，想要病退神强就很难了。何况有很多并不是这个病却服用这种药的情况呢！
[Morning: Er Miao Di Huang Tang Decoction]
Rehmanniae Radix Preparata (8 qian), Corni Fructus (2 qian), Paeoniae Rubra Cortex (2 qian), Poria (2 qian), Dioscoreae Rhizoma (2 qian), Alismatis Rhizoma (1.5 qian).
Phellodendri Cortex Preparata (stir-fried with salt and wine until brown, 0.8 fen), Aconiti Lateralis Radix Preparata (2 qian). Add ten stalks of Juncus effusus (Dengxincao) and twenty seeds of Nelumbinis Semen (Jianlianzi, pitted). Decoct in water to yield 80% of the original volume. Take warm on an empty stomach.
[Noon: Modified Bu Zhong Yi Qi Tang Decoction]
Ginseng Radix (3 qian, to preserve primordial qi and secure the middle), Astragali Radix (2 qian, to assist the exterior and protect Wei Qi), Ziziphi Spinosae Semen (stir-fried and crushed, 3 qian, to tonify the organ governing spirit and assist the official of dispersion), Atractylodis Macrocephalae Rhizoma (stir-fried yellow, 3 qian, to aid Spleen in overcoming dampness), Angelicae Sinensis Radix (wine-stir-fried, 1.5 qian, to harmonize and nourish Ying and Blood), Poria (2 qian, to gently leach out turbid qi), Glycyrrhizae Radix et Rhizoma Preparata (0.8 fen, i.e., to harmonize drug properties and tonify Spleen, allowing drugs to linger in the Middle Jiao to expel disease; stir-fried with honey and wine), Cimicifugae Rhizoma (0.4 fen, raising clear Yang causes turbid Yin to descend naturally), Saposhnikoviae Radix (wine-stir-fried tender root, 0.6 fen, assisting Cimicifugae to lift sunken Qi). Add fresh Ginger and Jujube. Decoct in water. Take one dose after noon meal. Decoct the dregs again for evening use, followed by inducing vomiting.
A young man who held an official position but suffered disappointment resigned and returned to a reclusive life. His depression led to illness, which corresponds to what the *Neijing* calls "Tuo Ying" (Loss of Essence) when one goes from high status to low, and "Shi Jing" (Loss of Spirit) when one goes from wealth to poverty. This resulted in daily consumption of Qi and Blood, and the Spirit failing to manifest outwardly. The pulse was wiry, fine, and choppy at all six positions. Any food entering the Stomach transformed entirely into Phlegm. He could only sleep after coughing up all phlegm and saliva; if not fully expelled, he would not stop. Thus, body fluids were consumed internally, unable to moisten the exterior. Consequently, muscles gradually wasted away, chills occurred, and appetite was poor. I reasoned that Wei Qi (Defensive Qi) fills the skin and hair, warms the muscle intervals, controls opening and closing of the pores, and protects the body surface. However, Ying Qi (Nutritive Qi) usually follows Wei Qi to moisten the skin and nourish the collaterals. Now, since Middle Qi is both weak and depressed, Qi stagnates and fails to circulate freely. How can it fill the skin, warm the muscles, and open the pores? Without Wei Qi protection on the exterior, chills occur; without Qi transportation to the exterior, blood fails to nourish, leading to dry skin. With deficient Middle Qi and impaired Spleen transport, food steams and stagnates into Phlegm, preventing its transformation into body fluids and then Blood. Therefore, not only do the pores of the body surface become dry and blocked, but the pores of the intestines and stomach also fail to be warmed, filled, opened, and dispersed, becoming dense and obstructed. How can body fluids flow outside the collaterals and skin? Moreover, as body fluids stagnate into Phlegm, the more Phlegm there is, the more depleted the body fluids become. I used Ginseng Radix to preserve primordial Qi and secure the Middle as the Sovereign drug, Astragali Radix to assist the exterior and protect Wei Qi as the Minister drug, Angelicae Sinensis Radix to harmonize and nourish Ying and Blood, Atractylodis Macrocephalae Rhizoma to aid Spleen in overcoming dampness, Ophiopogonis Radix to protect Lung Qi, Schisandrae Fructus to astringe scattered essence, and Glycyrrhizae Radix et Rhizoma Preparata to harmonize drug properties and tonify Spleen as the Assistant drugs. Cinnamon Twig (Guizhi) has acrid-sweet properties that harmonize Ying and Wei, warm the muscles, and reach the exterior. Ephedrae Herba (Mahuang) is light, ascending, and potent, leading the other drugs to penetrate the skin and hair, driving out latent Yin-congealed Phlegm and transforming it into Yang-harmonious body fluids, serving as the Guide drug. Fearing that the acrid-hot nature of Cinnamon Twig and Ephedra might consume Ying Yin, I added White Peony Root (Baishao) to harmonize the Liver and suppress the harshness of these two drugs. This is essentially the Mahuang Guizhi Tang used by Master Dongyuan to treat bleeding due to external cold invasion and internal heat accumulation. I further added Atractylodis Macrocephalae Rhizoma because its rigid nature acts quickly, firmly securing the Middle and cutting off the disease source without being disturbed by external factors. The guiding agents included fresh Ginger and Jujube, chosen for their acrid-sweet taste to aid Spleen in generating body fluids and assist the Spirit in rising clearly and vigorously. After taking two or three doses, the pulse energy gradually became full and spirited, and phlegm-cough resolved. I then instructed him to take Shibu Wan (Ten Tonics Pill) on an empty stomach to tonify Kidney, and during the day, use a modified Guipi Yangying Decoction to regulate Heart and Spleen Qi and Blood for peace.
Physicians must cultivate their own spirit and focus exclusively on their medical practice, avoiding any external affairs, because medicine relies on intention. Diagnosing pulses, differentiating symptoms, and prescribing formulas rely entirely on mental focus. If one's spirit is insufficient, differentiation and prescription will inevitably be tedious and hasty, lacking deep contemplation. Furthermore, focusing on medical practice leads to academic progress and broad understanding, enabling one to investigate things and benefit humanity. If one rushes after external affairs, the mind scatters and intention becomes chaotic, making it impossible to intuitively grasp subtleties or dedicate oneself to benefiting others.
The human body prioritizes the Spleen and Stomach. All diseases depend on the presence of Stomach Qi for life and its absence for death. Why? When encountering illness, regardless of external contraction or internal injury, forbidding diet and indiscriminately administering drugs turns the Stomach and Spleen—the sea of water and grain—into mere containers for medicine. This merely disturbs pure Qi, triggering cycles of excess and deficiency. The aggressive nature of herbal tonification and purgation, and the conflicting energies of cold and heat, battle within, while the peaceful flavors of grains and meats that nourish are exhausted internally. Stomach Qi declines daily, and all Zang-Fu organs become distressed. This is nominally treating disease but actually causing it. Each Zang organ has its spirit. Intense cravings for specific foods reflect the desires of the respective organ spirits, seeking self-rescue due to insufficiency of that organ's essence and blood. For example, pregnant women with deficient Liver and Kidney may crave sour and salty foods; elderly people with deficient essence and blood may crave meat. Therefore, foods desired by patients should only be moderated, never completely cut off. If patients tire of long-term medication, the condition can be temporarily managed by pausing drugs and introducing preferred foods. Once Stomach Qi strengthens, spirit can be nourished. If the disease severity necessitates medication, choose mild-flavored herbs that are easy to ingest without damaging Stomach Qi. Ignoring this principle—cutting off desired foods and forcing damaging drugs—injures Stomach Qi, depletes the source of transformation, and makes recovery difficult. Moreover, many cases involve taking medicines for conditions they do not have!