凡医家治病之诚，当无存富贵贫贱之分，然欲求病之情，应有富贵贫贱之别，何
也？富贵之人，多劳心而中虚，筋柔骨脆；贫贱之人，多劳力而中实，骨劲筋强。富贵
者，青粱自奉，脏腑恒娇；贫贱言，藜藿苟充。脏腑恒固；富贵者，曲房广厦，玄府疏
而六淫易客；贫贱者，茅茨陋巷，腠理密而外邪难干；富贵者，纵情极欲，虑远思多，
销铄无非心肾之脂膏；贫贱者，少怒寡欲，愿浅易足，所伤无非日生之气血。故富贵之
病多从本，贫贱之病每从标，实有异耳。
天虚者宜补，然有不受补者，乃补之不得其当也。必须凭脉用药，不可问病执方
六脉一部，或大或小之间，便有生克胜负之别∶一方分两，或加或减之中，便存重此轻
彼之殊。脉有真假，药有逆从，假如六脉洪大有力者，此真阴不足也，六味地黄汤。右
寸更洪更大者，麦味地黄汤。如洪大而数者，人谓阴虚阳盛，而用知柏地黄汤则误
矣。如果真阳盛实，则当济其光明之用，资始资生，而致脉有神，疾徐得次，以循其常
经矣。惟其真阳不足，假阳乘之，如天日不
彰，而乃尤雷之火妄炽，疾乱变常也，宜六味加五味子、肉桂、助天日之阳光，以逐龙
雷之假火。若至弦数、细数，则更系真阴真阳亏损，盒饭重用六味少加桂、附，以火济
火，数既可从，承乃可制，火既制而阴易长矣。况脉之微缓中和胃之气也，不微而洪
大，不缓而弦数，近乎无胃，用此既补真阳，以息假阳，复借真火，以保脾土，此补
肾中真阴真阳之至论也。更有劳心运用太过，饥饱劳役失调，以致后天心脾气血亏损
者，设以根本为论，从事补肾，则元气反随下陷，化源既绝于上，肾气何由独足于下，
纵下实而上更虚矣。理直六脉浮大无力者，此中气不足，荣阴有亏，而失收摄元气之
用，宜于温补气血之中，加以敛纳之味，如养荣汤，用五味子，更宜减去陈皮是也。六
脉沉细无力者，此元阳中气大虚，大宜培补中州，温补气血，盖脾胃既为气血之化源，
而万物之滋补，亦必仗脾胃营运而始得，故古方诸剂，必用姜、枣，即此义也。况中气
既虚，营运不健，故用辛温鼓舞，使药力自行，药力不劳于脾胃之转输，如归脾汤之
剂，木香十全汤之用肉桂是也。如六脉迟缓甚微者，则无阳大虚，纯以挽救阳气为主，
轻则人参理中汤，重则附子理中汤，不得杂一阴分之药，盖阳可生阴，阴能化阳耳。如
六脉细数，久按无神者，此先天后天之阴阳并亏也，早服八味地黄丸，晚服人参养荣汤
去陈皮，或十全大补汤去川芎、生地换熟地可也。如两寸洪大，两尺无力者，此上热下
寒，上盛下虚也，宜八味地黄汤，加牛膝、五味子，服至尺寸俱平而无力，则照前方，
另煎参汤冲服。如两尺有力，两寸甚弱者，此元气下陷，下实上虚也，宜补中汤升举
之。地既上升，天必下降，二气交通，乃成雨露，此气行而生气不竭矣。先天之阳虚补
命门，后天之阳虚温胃气；先天之阴虚补肾水，后天之阴虚补心肝，盖心为血之主，而
肝为血之脏也。然更重乎太阴，盖脾者，荣之本，化源之基，血之统也。且一方之中，
与脉有宜、有禁，宜者加之，禁者去之、如应用十全大补汤，而肺脉洪大者，则芎 应
去，而麦味应加者也，盖芎味辛而升， 味虽甘，气浓于味，故功专脾肺而走表也。六
脉无力，则十全最宜，倘无力服参者， 术倍加，止用当归，勿用地芍，盖重于补气，
则归为阴中之阳，地芍为阴中之阴耳。至于地黄一汤，根据脉轻重变化，百病俱见神功。
但六脉沉微，亡阳之症，暂所忌之。盖虽有桂附之热，终属佐使，而地茱一队阴药，乃
系君臣，故能消阴翳之火也。其熟地重可加至二三两，山茱只可加至三四钱，盖酸味独
浓，能掩诸药之长，况过酸强于吞服，便伤胃气矣。此张姑取数端，以证变化之无尽，
学人类推之，而自得其神矣。
凡是医生治病，应当秉持诚心，不分富贵与贫贱；然而想要探求病情的本质，则必须区分富贵者与贫贱者。为什么呢？因为富贵之人，多用心劳神而中气虚弱，筋骨柔嫩脆弱；贫贱之人，多用力劳作而中气充实，筋骨强劲有力。富贵者，饮食精美自奉，脏腑常常娇弱；贫贱者，饮食粗劣仅能果腹，脏腑常常坚固。富贵者，居住在幽深宽敞的房舍中，汗孔疏松，六淫邪气容易侵袭；贫贱者，居住在茅草屋陋巷里，腠理致密，外邪难以侵犯。富贵者，放纵情欲，思虑深远繁多，耗损的无非是心肾的精血脂膏；贫贱者，少怒寡欲，愿望浅显容易满足，所耗伤的无非是日常生成的气血。所以富贵人的病多从本虚论治，贫贱人的病多从标实论治，确实有所不同。
身体虚弱的人适宜进补，但有的人接受不了补药，这是因为补益不得当。必须依据脉象来用药，不可拘泥于病症而固定方剂。六脉的每一部，或大或小之间，便存在相生相克、胜负盛衰的区别；一方药的剂量，或加或减之中，便存有侧重此症或轻彼症的差异。脉象有真假之分，用药有逆从之别。假如六脉洪大有力，这是真阴不足，应用六味地黄汤（Six-Flavor Rehmannia Decoction）。如果右寸脉更洪大，应用麦味地黄汤（Lonicera and Schisandra Rehmannia Decoction）。如果脉象洪大而数，世人认为这是阴虚阳盛，若使用知柏地黄汤（Anemarrhena, Phellodendron and Rehmannia Decoction）则是错误的。如果是真正的阳气盛实，则应当辅助其光明的功能，资助始生和化生，使脉象有神，疾徐有序，以遵循常经。正因为是真阳不足，假阳乘虚而入，就像太阳不显，却像雷电之火妄自炽盛，导致病情紊乱失常，适宜用六味地黄汤加五味子、肉桂，以助天日之阳光，驱逐龙雷之假火。如果脉象弦数、细数，这更是真阴真阳亏损，应当重用六味地黄汤，少加肉桂、附子，以火济火，数脉既可从缓，承制之法才可生效，火既被制约，阴液就容易生长了。况且脉象微缓中和，反映的是胃气；如果不微而洪大，不缓而弦数，就接近于无胃气。使用上述方法既能补真阳以平息假阳，又能借真火以保护脾土，这是补肾中真阴真阳的最高理论。更有因劳心运用太过，饥饱劳役失调，导致后天心脾气血亏损的情况，如果只从根本论治，从事补肾，那么元气反而随之下陷，化源在上既已断绝，肾气怎能独自在下充足，即使下实而上更虚了。如果六脉浮大无力，这是中气不足，营阴有亏，失去了收摄元气的功能，应当在温补气血之中，加入收敛纳气的药物，如养荣汤（Yangying Decoction），使用五味子，并且更适宜减去陈皮。如果六脉沉细无力，这是元阳和中气大虚，非常适宜培补中焦脾胃，温补气血，因为脾胃既是气血的化源，而且万物的滋补，也必须依靠脾胃的运化才能吸收，所以古方诸剂，必定使用生姜、大枣，就是这个道理。况且中气既虚，运化不健，所以使用辛温药物鼓舞，使药力自行运行，药力不依赖脾胃的转输，如归脾汤（Guipi Decoction）中的木香，十全大补汤（Shiquan Dabu Decoction）中使用肉桂就是如此。如果六脉迟缓甚微，这是阳气大虚，纯粹以挽救阳气为主，轻症用人参理中汤（Renshen Lizhong Decoction），重症用附子理中汤（Fuzi Lizhong Decoction），不得夹杂任何阴分药物，因为阳可生阴，阴能化阳。如果六脉细数，久按无神，这是先天后天阴阳并亏，早晨服用八味地黄丸（Bawei Dihuang Wan），晚上服用人参养荣汤去陈皮，或者十全大补汤去川芎、生地换熟地也可以。如果两寸脉洪大，两尺脉无力，这是上热下寒，上盛下虚，适宜用八味地黄汤（Bawei Dihuang Tang）加牛膝、五味子，服用至尺寸脉俱平而无力，则照前方，另煎人参汤冲服。如果两尺脉有力，两寸脉甚弱，这是元气下陷，下实上虚，适宜用补中益气汤（Buzhong Yiqi Decoction）升举之。地气既上升，天气必下降，二气交通，乃成雨露，这样气行而生生气就不会枯竭了。先天的阳虚补命门，后天的阳虚温胃气；先天的阴虚补肾水，后天的阴虚补心肝，因为心是血的主宰，而肝是藏血的脏器。然而更重视太阴脾脏，因为脾是营气的根本，化源的基地，血液的统帅。而且一方药之中，与脉象有宜忌之分，适宜的加上，禁忌的去掉。比如应用十全大补汤，如果肺脉洪大，则川芎应当去掉，而麦冬、五味子应当加上，因为川芎味辛而升散，麦冬虽甘，但气浓于味，所以功效专走脾肺而达表。六脉无力，则十全大补汤最合适，倘若无力服用人参者，白术加倍，只用当归，不要用白芍，因为重在补气，则当归为阴中之阳，白芍为阴中之阴罢了。至于地黄这一类方剂，根据脉象轻重变化，百病都能见到神奇功效。但是六脉沉微，亡阳的症状，暂时是禁忌使用的。因为虽然有肉桂、附子的热性，终究属于佐使药，而熟地、山茱萸一队阴药，乃是君臣药，所以能消除阴翳之火。其中熟地重量可加至二三两，山茱萸只可加至三四钱，因为酸味特别浓厚，能掩盖其他药物的长处，况且过酸强行吞服，就会损伤胃气。以上张景岳选取几个例子，以证明变化的无穷无尽，学习的人类推它，自然就能得其神妙了。
In treating diseases, physicians should maintain sincerity without distinction between the rich and the poor; however, to ascertain the nature of the disease, one must differentiate between those of high status and those of low status. Why is this? The wealthy often exert their minds excessively, leading to deficiency in the middle jiao (Middle Burner), with soft sinews and fragile bones; the poor often engage in physical labor, resulting in solidity in the middle jiao, with strong sinews and tough bones. The wealthy enjoy fine foods, making their zang-fu organs delicate; the poor subsist on coarse food, keeping their zang-fu organs robust. The wealthy reside in deep, spacious houses, where their couli (skin pores) are loose, making them susceptible to invasion by the six exogenous pathogens (Liu Yin); the poor live in thatched huts and narrow alleys, with dense couli, making them resistant to external pathogens. The wealthy indulge in desires and harbor excessive thoughts, depleting the essence and marrow of the heart and kidney; the poor have few anger outbursts and desires, are easily satisfied, and only deplete the daily generated qi and blood. Therefore, diseases among the wealthy often stem from root deficiency, while those among the poor often manifest as branch excess, which is indeed different.
Those with constitutional weakness are suitable for tonification, but some cannot tolerate tonics due to improper application. Medication must be prescribed based on pulse diagnosis, not merely fixed formulas for specific diseases. Between the six pulses, variations in magnitude indicate differences in generating and overcoming cycles, and victory or defeat; within a prescription, adjustments in dosage reflect emphasis on certain aspects over others. Pulses can be true or false, and treatments can be contrary or conforming. For instance, if all six pulses are surging and forceful, this indicates deficiency of true yin, and Liuwei Dihuang Tang (Six-Flavor Rehmannia Decoction) should be used. If the right Cun pulse is even more surging, Maiwei Dihuang Tang (Lonicera and Schisandra Rehmannia Decoction) is indicated. If the pulse is surging and rapid, laypeople might attribute it to yin deficiency with yang hyperactivity and mistakenly use Zhibai Dihuang Tang (Anemarrhena, Phellodendron and Rehmannia Decoction). If there is genuine yang excess, one should support its illuminating function, aiding generation and nourishment, so that the pulse becomes spirited and regular. However, when true yang is deficient, false yang takes advantage, akin to the sun being obscured while lightning fire rages chaotically; in such cases, Liuwei Dihuang Tang added with Wuweizi (Schisandrae Fructus) and Rougui (Cinnamomi Cortex) is appropriate to boost the sun's light and dispel the dragon-fire of false heat. If the pulse is wiry-rapid or thready-rapid, it signifies damage to both true yin and true yang; one should heavily use Liuwei Dihuang Tang with small amounts of Rougui and Fuzi (Aconiti Lateralis Radix Praeparata) to use fire to regulate fire. Once the rapidity subsides, control mechanisms work, and yin can grow. A moderate, slightly slow pulse reflects stomach qi; if it is surging without being slight, or wiry-rapid without being moderate, it suggests a lack of stomach qi. This approach tonifies true yang to quell false yang and uses true fire to protect spleen earth, representing the supreme theory of tonifying true yin and yang in the kidney. Furthermore, excessive mental exertion or irregular diet/labor can damage post-heaven heart-spleen qi and blood. If treatment focuses solely on the root (kidney), yuan qi may sink further; if the source of transformation is cut off above, how can kidney qi suffice below? If the six pulses are floating, large, and powerless, it indicates insufficient middle qi and deficient young yin, failing to secure yuan qi. Tonifying qi and blood with astringent herbs, such as Yangrong Tang (Nourishing Vigor Decoction) with Wuweizi, and removing Chenpi (Citri Reticulatae Pericarpium), is suitable. If the six pulses are deep, thready, and powerless, it indicates severe deficiency of yuan yang and middle qi; strengthening the middle jiao (spleen/stomach) and warming qi and blood is essential, as the spleen and stomach are the source of qi and blood production. Ancient formulas always include Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus) for this reason. When middle qi is weak and transport is impaired, acrid-warm herbs like Muxiang (Aucklandiae Radix) in Guipi Tang (Restore the Spleen Decoction) or Rougui in Shiquan Dabu Tang (Ten Significant Great Supplement Decoction) help move medicinal power without burdening the spleen and stomach. If the six pulses are slow and very faint, indicating severe yang deficiency, rescue yang primarily: Ren Shen Lizhong Tang (Ginseng and Poria Decoction) for mild cases, Fuzi Lizhong Tang (Aconite and Poria Decoction) for severe ones, avoiding yin-nourishing herbs, as yang generates yin. If the six pulses are thready-rapid and powerless upon prolonged pressure, it indicates concurrent deficiency of pre-heaven and post-heaven yin and yang; take Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill) in the morning and Renshen Yangrong Tang (Ginseng Nourishing Vigor Decoction, remove Chenpi) or Shiquan Dabu Tang (remove Chuanxiong, replace Shengdi with Shudi) at night. If both Cun pulses are surging and Chi pulses are powerless, it indicates upper heat/lower cold and upper excess/lower deficiency; use Bawei Dihuang Tang with Niuxi (Achyranthis Bidentatae Radix) and Wuweizi until pulses are level but weak, then administer Ginseng decoction separately. If Chi pulses are forceful and Cun pulses are weak, it indicates sinking yuan qi and lower excess/upper deficiency; use Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) to raise qi. As earth rises, heaven descends, allowing interaction like rain and dew, preserving vital qi. Pre-heaven yang deficiency requires tonifying Mingmen (Gate of Life); post-heaven yang deficiency requires warming stomach qi. Pre-heaven yin deficiency requires tonifying kidney water; post-heaven yin deficiency requires tonifying heart and liver, as the heart governs blood and the liver stores blood. However, the Taiyin spleen is paramount, as it is the root of young qi, the foundation of transformation, and the controller of blood. In any formula, adjust based on pulse indications: add what is suitable, remove what is contraindicated. For example, in Shiquan Dabu Tang, if lung pulse is surging, remove Chuanxiong (Chuanxiong Rhizoma) and add Maidong (Ophiopogonis Radix) and Wuweizi, because Chuanxiong is acrid and ascending, while Maidong is sweet but heavy in qi, acting on spleen/lung and exterior. If all pulses are powerless, Shiquan Dabu Tang is best; if unable to take Ren Shen, increase Baizhu (Atractylodis Macrocephalae Rhizoma), use Danggui (Angelicae Sinensis Radix) only, and avoid Shaoyao (Paeoniae Radix Alba), as the focus is on tonifying qi; Danggui is yang within yin, while Shaoyao is yin within yin. Regarding Rehmannia-based formulas, they show miraculous effects for various diseases depending on pulse variations. However, they are temporarily contraindicated in cases of extreme yang deficiency with deep/faint pulses, as the yin herbs (Shudi, Shanzhuyu) act as sovereign/minister drugs, outweighing the assistant/drug-guiding heat of Rougui and Fuzi. Shudi can be increased to 2-3 liang, but Shanzhuyu (Corni Fructus) should not exceed 3-4 qian, as excessive sourness masks other herbs' efficacy and damages stomach qi. Zhang Jingyue provides these examples to demonstrate endless variations; students should infer from them to grasp the subtleties.