夫人之有生者，皆精气神具备而成之也。少年遇事敏捷，老大应物模糊，亦精气
神之强弱殊之。其间盛衰修短，疾病安危，总不外此三者，故鱼一刻无水即死，人一刻
无气即亡，试思人之能行能立能坐，及能运用持重，高声大语，皆赖一气为之。假气一
弱，则行立坐卧、持重言语者无力矣。设遇外邪，乘虚而袭，正气愈伤，身益野狼狈，不
能起床矣。气足而神生，气弱而神困矣。气化而精生，气虚而精散矣。《经》曰∶精者，
身之本也。故藏于精者，春不病温，要知外邪之触，必乘正气之虚。治之者，乘其表邪
初客，急为疏解，使无深入以伤于里，继以调和之剂，则表邪散而中气和，自可相安无
恙。若外感少，内伤多，只须温补，不必发散，正气得力，自能推出寒邪。盖元气极虚
之人，虽即微邪，易能感受，惟助正气一旺而健行，则微邪不攻而自退。若罔顾正气之
虚，而徒以逐邪为事，则元气转伤，犹迫良民而为寇，即微邪，反乘虚伏匿而为病矣
况有毫无外感，因劳而发热者，谓之劳发，只须补中，尤忌疏解。即有头痛、恶风、口
渴等症，殊不知头痛者，非虚火上浮，即血虚作痛也。恶风者，阳虚不能卫表也。口渴
者，脏腑津液不足，或肾虚引水自救也。以脉消息，病无遁情，不论浮沉大小，但重按
无力，便非实症，奈何泥于上古多歧、传经支离等语，凡有发热头痛，即用古方太阳经
药，重加发散，津液耗亡，欲不口喝发热其可得乎！复谓阳明经症见矣。忍饿以虚其
里，疏散以虚其表，化源之机既绝，阴道之消烁日深，欲不胁痛、耳聋，其可得乎！复
谓少阳经症见矣。芩柴和解之剂一投，引邪深入之害实大，以致脾虚气弱，欲不腹满嗌
干，其可得乎！复谓太阴经症见矣。重为峻攻其里，脾阴愈耗，欲不口干大渴、便秘、
烦躁，其可得乎！复谓少阴经症见矣。寒凉峻利之药一投，肝肾之阴愈槁，欲不烦满舌
卷囊缩，其可得乎！尚谓厥阴经症见矣。不知种种症侯，皆由调治失宜，以令邪气日
深，正气日消所致，直至手足厥冷，脉细欲绝，乃认虚寒，方议温补，已无及矣。故古
人伤寒类方，初则麻黄、葛根、柴胡等汤，继则调胃、大小承气，未列回阳救急汤、温
经益元等汤，重用参、 、姜、桂、术、附，以追失散之元阳。殊不知寒凉久进，热
药难温，克削久投，补药难挽，奈何后人不详此旨，徒遵上古证治真伤寒之旧例，引治
今人禀赋虚弱者之类同，凡遇本元虚损，发热、口干、烦躁，正气不足之症，以作外邪
深入有余之治，纵得苟延残喘，而不至精神消耗殆尽者未之有也。盖古人传经等论，不
过明为寒邪，自阳及阴，由表入里，然邪之所凑，岂有定位！况阴阳相关，表里输应，
表病不解，里亦随病，阳病不除，阴亦随伤，此表里阴阳本气为病之必然，岂必待有
邪传处所致乎！故始或因外邪感袭者，亦有之，然继则累及阴阳本气自病矣，故名伤
寒，夏云病热。伤寒者，已往之病原，病热者，现下之实害，寒既为热，则所伤之寒早
已消弭。《经》曰∶藏于精者，春不病温。原由阴精不足，而致病热、病温。今既病而
阴精愈消愈竭，此时虽寒邪消散，奈真阴正气受伤，更热更损，莫可发生，以制阳光，
故久热不已耳，岂寒邪既出表入里而为热，复能变寒，由里出表再传而为二候、三候
乎，此必无之理也。若能以外邪为始病之因，以阴阳本气自病，为继病之实，善为调
之适之，则何有久病不解之候也。如始终以寒邪为实迹，传变为定期，反复攻逐，是犹
缚妻子以为贼，指路人以为父，何其冤哉！抑皆未究致热之所由来，而不达经，所谓
“阳强不能密，阴气乃绝，阴平阳秘，精神乃治”之至理也。况天人一理，相生所以相
继相克，所以相成，故天之火，深藏于水土之中，凡井水气蒸，上中温暖，则地表清
肃，犹人之丹田，元阳封固，则火不浮游于上，中宫脾元充足，则火不散越于表。盖火
之藏纳，不外乎水土之中，故发热者，即我身内之火，因正气虚而不能按纳，邪乘虚而
激出之，乃阴阳本气反常之变，实非外来之火也。凡遇客邪一退，脾元虚者，调中以敛
阳；阴中水虚者，补水以配火；阴中火虚者，补火以藏源，则故物仍归病斯愈矣。如
不知此，竟以火为外邪，重汗以亡其阳，阳无归源之力矣；重下以耗其阴，阴无配阳之
能矣；复加寒凉峻削，脾元益伤，肌表之浮阳，何能敛纳，将此身内必妄之火驱灭。必
欲其尽，将此有限之精神磨灭，必欲其完，以有形之猛剂，攻无迹之阴阳。况火者，生
身之始，而精气神，亦因之以生者也。试思人与物不热，则无气矣。故气生于火，而火
为气之祖也。人但恶火之为热而清之，独不思火去而气亦绝矣。虽欲不死，其可得乎！
此（张）心痛时表，幸慈寿者进思之，务求要领，毋事支离，必详虚实，勿拘故套。既知
百病之来，莫不乘虚而入。则以正虚为本，而外邪为标，保精气神，以治客病则客病
退，而正气无伤。若伤精气神，以治客病，则病不退，而正气徒耗，舍本从末，适足以
伤生矣。惟初病正气尚旺，客病牢固者，急为驱逐，勿致蔓延，若一概瞻顾因循，犹似
闭门留寇，岂其治乎？
人的生存，都是依靠精、气、神三者具备而形成的。少年时遇事反应敏捷，年老时应付事物模糊迟钝，这也是因为精气神的强弱不同所致。其中的盛衰、长短、疾病的安危，总离不开这三者。所以鱼没有水一刻就会死亡，人没有气一刻就会灭亡，试想人能行走、站立、坐卧，以及能运用自如、持重沉稳、高声说话，都依赖一气在支撑。假如气一旦虚弱，那么行走、站立、坐卧、持重、说话都会无力。如果遭遇外邪，趁虚侵袭，正气更加受伤，身体越发狼狈，不能起床了。气充足则神生发，气虚弱则神困顿。气化则精生，气虚则精散。《内经》说：“精，是身体的根本。”所以善于藏精的人，春天不会患温病。要知道外邪的触动，必定是乘正气之虚。治疗时，趁着表邪刚刚客居，急忙疏解，使邪气不深入以伤害里部，接着用调和的药剂，那么表邪解散而中气平和，自然可以平安无事。如果外感少，内伤多，只需温补，不必发散，正气得力，自然能推出寒邪。大概元气极虚的人，即使是微弱的邪气，也容易感受，只有帮助正气旺盛而健行，那么微邪不攻自退。如果不顾正气的虚弱，只把驱逐邪气作为事务，那么元气反而受伤，这就像逼迫良民成为寇贼一样，即使微邪，反而乘虚伏匿致病。况且有毫无外感，因劳累而发热的人，称为劳发，只需补中气，尤其忌讳疏解。即使有头痛、恶风、口渴等症状，殊不知头痛，不是虚火上浮，就是血虚作痛。恶风，是阳虚不能卫护体表。口渴，是脏腑津液不足，或肾虚引水自救。通过脉象来审察，病情没有隐瞒的，不论脉浮沉大小，只要重按无力，就不是实证，为何拘泥于上古多歧义、传经支离破碎等说法，凡是有发热头痛，就用古方太阳经的药，重加发散，导致津液耗亡，想要不口渴发热，怎么可能呢！又说阳明经症状出现了。忍受饥饿以使其里虚，疏散以使其表虚，化源之机既然断绝，阴道的消烁日益加深，想要不胁痛、耳聋，怎么可能呢！又说少阳经症状出现了。黄芩、柴胡和解的药剂一投，引邪深入的害处实在很大，以致脾虚气弱，想要不腹满咽干，怎么可能呢！又说太阴经症状出现了。再次峻猛攻下其里，脾阴更加耗损，想要不口干大渴、便秘、烦躁，怎么可能呢！又说少阴经症状出现了。寒凉峻猛的利药一投，肝肾之阴更加枯槁，想要不烦闷舌卷囊缩，怎么可能呢！还说厥阴经症状出现了。不知道种种症候，都是由调治失宜，使得邪气日益深入，正气日益消耗所致，直到手足厥冷，脉细欲绝，才认识是虚寒，方才议论温补，已经来不及了。所以古人伤寒类方，初则麻黄汤、葛根汤、柴胡汤等，继则调胃承气汤、大承气汤、小承气汤，未列回阳救急汤、温经益元等汤，重用参、术、姜、桂、附子，以追回失散的元阳。却不知道寒凉久进，热药难温；克削久投，补药难挽。为何后人不详察此旨意，只遵循上古证治真伤寒的旧例，引用治疗今人禀赋虚弱者的类似情况，凡遇到本元虚损，发热、口干、烦躁，正气不足的症候，当作外邪深入有余的实证来治，纵使得以苟延残喘，而不致精神消耗殆尽的，是没有的。大概古人传经等论，不过是明确为寒邪，自阳及阴，由表入里，然而邪气所凑集的地方，哪里有固定位置！况且阴阳相关，表里输应，表病不解，里也随病，阳病不除，阴也随伤，这是表里阴阳本气为病的必然，难道一定要等待有邪气传变之处所致吗！所以开始或许因外邪感袭的，也有这种情况，然而随后则累及阴阳本气自病了，所以名为伤寒，夏天说是病热。伤寒，是过去的病原，病热，是现在的实害，寒既然化为热，那么所伤的寒早已消弭。《内经》说：“藏于精者，春不病温。”原由阴精不足，而导致致病热、病温。现在既已生病而阴精愈消愈竭，此时虽然寒邪消散，奈何真阴正气受伤，更热更损，莫可发生，以制约阳光，所以久热不已罢了，难道寒邪既出表入里而为热，又能变寒，由里出表再传变为二候、三候吗，这一定是无稽之谈。如果能以外邪为始病之因，以阴阳本气自病为继病之实，善于调理适应它，那么怎么会有久病不解的症候呢。如果始终以寒邪为实迹，传变为定期，反复攻逐，这就像绑缚妻子儿女当作贼，指认路人当作父亲，何其冤枉啊！再者都没有探究致热的由来，而不通达《内经》所谓“阳强不能密，阴气乃绝，阴平阳秘，精神乃治”的大道理。况且天人一理，相生所以相继，相克所以相成，所以天的火，深藏于水土之中，凡是井水气蒸，上中温暖，则地表清肃，犹如人的丹田，元阳封固，则火不浮游于上，中宫脾元充足，则火不散越于表。大概火的藏纳，不外乎水土之中，所以发热者，就是我身内的火，因正气虚而不能按纳，邪气乘虚而激出之，乃是阴阳本气反常的变化，实在不是外来的火。凡遇到客邪一退，脾元虚者，调中以敛阳；阴中水虚者，补水以配火；阴中火虚者，补火以藏源，那么故物仍归，病就痊愈了。如不知道这些，竟把火当作外邪，重汗以亡其阳，阳无归源之力了；重下以耗其阴，阴无配阳的能力了；再加寒凉峻削，脾元更加受伤，肌表的浮阳，怎么能敛纳，将此身内必妄之火驱灭。必须让它尽，将此有限的精神磨灭，必须让它完，以有形的猛剂，攻无迹的阴阳。况且火，是生身的开始，而精气神，也因而产生。试想人与物不热，就没有气了。所以气生于火，而火为气之祖。人们只厌恶火之为热而清之，独不思火去而气也绝了。虽然想不死，怎么可能呢！这（张）心痛时表，幸好慈寿者进思之，务必寻求要领，不要从事支离破碎，必须详查虚实，不要拘泥于老套。既然知道百病的到来，无不乘虚而入。就以正虚为本，而外邪为标，保精气神，以治疗客病则客病退，而正气无伤。如果伤精气神，以治疗客病，则病不退，而正气徒耗，舍本从末，恰好足以伤生罢了。只有初病正气尚旺，客病牢固者，急忙驱逐，勿致蔓延，如果一概瞻顾因循，好像闭门留寇，难道是治病吗？
Human life is formed through the presence of Essence (Jing, 精), Qi (Vital Energy, 气), and Spirit (Shen, 神). In youth, one responds to events with agility; in old age, one’s response to things becomes blurred. This difference lies in the strength or weakness of Jing, Qi, and Shen. Their flourishing or decline, longevity or brevity, and the safety or peril of disease all revolve around these three factors. Thus, a fish dies instantly without water, and a person perishes instantly without Qi. Consider that the ability to walk, stand, sit, move with control, speak loudly, and act decisively all depend on Qi. If Qi becomes weak, the abilities to walk, stand, sit, lie down, bear weight, and speak become powerless. If external pathogenic factors (Exogenous Pathogens, 外邪) invade due to deficiency, the Healthy Qi (Zhengqi, 正气) is further damaged, the body becomes increasingly distressed, and bedridden. When Qi is sufficient, Shen arises; when Qi is weak, Shen is troubled. When Qi transforms, Jing is generated; when Qi is deficient, Jing scatters. The *Classic* states: "Essence is the root of the body." Therefore, those who preserve their Essence will not suffer from Warm diseases (Wen Bing, 温病) in spring. It must be understood that external pathogens strike only when Healthy Qi is deficient. Treatment should seize the moment when the exterior pathogen has just invaded, urgently releasing and resolving it to prevent deep invasion and internal damage. Subsequently, using harmonizing formulas allows the exterior pathogen to disperse and the Middle Jiao Qi (Zhongqi, 中气) to harmonize, ensuring peace and health. If external contraction is slight and internal injury is significant, only warming and tonifying are needed, without dispersing methods. Once Healthy Qi gains strength, it naturally expels cold pathogens. Generally, individuals with extremely deficient Yuan Qi (Primordial Qi, 元气) easily contract even minor pathogens. Only by strengthening Healthy Qi so it moves vigorously can minor pathogens retreat without direct attack. If one ignores the deficiency of Healthy Qi and focuses solely on expelling pathogens, Yuan Qi is further injured. This is akin to forcing commoners to become bandits; even minor pathogens may take advantage of the deficiency to hide and cause disease. Furthermore, there are cases of fever due to overwork without any external contraction, termed "Labor Fever" (Lao Fa, 劳发). These require tonification of the Middle Jiao and strictly forbid dispersing methods. Even if symptoms such as headache, aversion to wind, and thirst appear, one must realize that headache is either due to floating Deficient Fire (Xu Huo, 虚火) or Blood deficiency causing pain. Aversion to wind indicates Yang deficiency failing to protect the exterior. Thirst indicates insufficient fluids in the Zang-Fu organs or Kidney deficiency drawing water for self-rescue. By examining the pulse, the nature of the disease is revealed regardless of whether it is floating, sunken, large, or small; if it feels weak under heavy pressure, it is not an Excess syndrome (Shi Zheng, 实证). Why cling to ancient theories of multiple divergences and fragmented transmission of meridians? Whenever fever and headache occur, using ancient formulas for the Taiyang Meridian (Taiyang Jing, 太阳经) with heavy dispersing agents consumes body fluids. How can one avoid thirst and fever then? One might claim Yangming Meridian (Yangming Jing, 阳明经) symptoms have appeared. Starving to weaken the interior and dispersing to weaken the exterior cuts off the source of transformation. As Yin consumption deepens daily, how can one avoid hypochondriac pain and deafness? One might then claim Shaoyang Meridian (Shaoyang Jing, 少阳经) symptoms have appeared. Administering Heqiao (Harmonizing) formulas like Qin (Scutellariae Radix, 黄芩) and Chaihu (Bupleuri Radix, 柴胡) greatly harms by drawing pathogens deeper, leading to Spleen deficiency and Qi weakness. How can one avoid abdominal fullness and dry throat? One might then claim Taiyin Meridian (Taiyin Jing, 太阴经) symptoms have appeared. Harsh purgation further depletes Spleen Yin. How can one avoid dry mouth, extreme thirst, constipation, and restlessness? One might then claim Shaoyin Meridian (Shaoyin Jing, 少阴经) symptoms have appeared. Administering harsh cold and draining medicines dries up Liver and Kidney Yin. How can one avoid irritability, tongue curling, and testicular retraction? One might then claim Jueyin Meridian (Jueyin Jing, 厥阴经) symptoms have appeared. These various symptoms result from improper treatment, allowing pathogens to deepen and Healthy Qi to diminish. Only when hands and feet become cold and the pulse is fine and nearly imperceptible does one recognize Cold-Deficiency and consider warming tonification, but it is too late. Ancient Shanghan (Cold Damage, 伤寒) formula classifications began with Mahuang Tang (Ephedra Decoction, 麻黄汤), Gegen Tang (Puerariae Radix Decoction, 葛根汤), and Chaihu Tang (Bupleuri Decoction, 柴胡汤), followed by Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Bowel-Holding Decoction, 调胃承气汤), Dachengqi Tang (Major Direct Downward Bowel-Holding Decoction, 大承气汤), and Xiaochengqi Tang (Minor Direct Downward Bowel-Holding Decoction, 小承气汤). They did not list Huiyang Jiuji Tang (Restore Yang and Save from Crisis Decoction, 回阳救急汤) or Wenjing Yiyuan Tang (Warm Meridians and Benefit Primordial Source Decoction, 温经益元汤), which heavily use Renshen (Ginseng Radix et Rhizoma, 人参), Baizhu (Atractylodis Macrocephalae Rhizoma, 白术), Shengjiang (Zingiberis Rhizoma Recens, 生姜), Guizhi (Cinnamomi Ramulus, 桂枝), and Fuzi (Aconiti Lateralis Radix Praeparata, 附子) to recover lost Yuan Yang. Not knowing that long-term use of cold medicines makes hot medicines ineffective, and long-term use of draining medicines makes tonics unable to restore, later generations failed to understand this principle. They blindly followed ancient examples for true Shanghan, applying them to modern individuals with weak constitutions. For conditions of primordial deficiency with fever, dry mouth, restlessness, and insufficient Healthy Qi, they treated them as Excess syndromes of deep-penetrating external pathogens. Even if survival is prolonged, exhaustion of spirit and essence is inevitable. Ancient theories of meridian transmission merely clarified that cold pathogens move from Yang to Yin, from exterior to interior. However, where pathogens gather, there is no fixed location. Yin and Yang are related; exterior and interior correspond. If exterior disease is unresolved, interior disease follows; if Yang disease is not removed, Yin is also damaged. This is the natural course of disease arising from the fundamental Qi of exterior/interior and Yin/Yang, not necessarily requiring pathogen transmission. Initially, some cases may start with external invasion, but subsequently involve dysfunction of the fundamental Qi of Yin and Yang. Hence named Shanghan, while summer heat diseases are called Bing Re (Disease Heat, 病热). Shanghan refers to the past pathogenic origin; Bing Re refers to the current actual harm. Since cold transforms into heat, the original cold injury has already dissipated. The *Classic* states: "Those who preserve Essence will not suffer Warm diseases in spring." This originates from insufficient Yin Essence leading to Heat disease or Warm disease. Now that illness has occurred, Yin Essence continues to deplete. Although cold pathogens have dissipated, the True Yin and Healthy Qi are injured. With increased heat and damage, generation ceases, failing to control excessive Yang, resulting in persistent fever. Could cold pathogens, having moved from exterior to interior and transformed into heat, revert to cold and transmit again from interior to exterior in subsequent stages? This is impossible. If one regards external pathogens as the initial cause and fundamental Qi dysfunction as the subsequent reality, and treats them appropriately, long-standing unresolved disease would not occur. If one insists cold pathogens are the solid reality and transmission follows a fixed schedule, repeatedly attacking and purging is like binding wives and children as thieves or pointing at passersby as fathers—how unjust! Moreover, few investigate the origin of heat production and fail to comprehend the *Classic*'s principle: "When Yang is strong and cannot secure, Yin Qi perishes; when Yin is level and Yang is secret, Spirit governs." Heaven and humanity share the same principles. Mutual generation ensures continuity; mutual restriction ensures completion. Heavenly fire is deeply hidden within water and earth. Just as well water vaporizes, becoming warm above and below, keeping the surface cool, so too, when the Dantian (Lower Abdomen, 丹田) seals Yuan Yang, fire does not float upward. When the Middle Palace (Spleen/Stomach, 中宫) Yuan Qi is sufficient, fire does not scatter to the exterior. Fire resides primarily within water and earth. Thus, fever is the internal fire of the body, which, due to deficient Healthy Qi, cannot be contained, and pathogens excite it out of deficiency. This is an abnormal change of fundamental Yin and Yang Qi, not external fire. Once guest pathogens recede, if Spleen Yuan is deficient, regulate the Middle to gather Yang; if Yin Water is deficient, tonify Water to match Fire; if Yin Fire is deficient, tonify Fire to store the Source. Then the original state returns, and the disease heals. If one fails to understand this and treats fire as an external pathogen, heavy sweating destroys Yang, leaving Yang without the power to return to its source. Heavy purging consumes Yin, leaving Yin without the ability to match Yang. Adding harsh cold and draining medicines further injures Spleen Yuan, making it impossible to gather floating Yang on the muscle surface. Driving out this妄 (errant) internal fire completely exhausts limited spirit and essence. Using有形 (substantial) fierce agents to attack无形 (formless) Yin and Yang is misguided. Fire is the beginning of life generation; Jing, Qi, and Shen arise from it. Consider that without heat, humans and objects have no Qi. Thus, Qi is born from Fire, and Fire is the ancestor of Qi. People dislike the heat of fire and clear it, forgetting that if fire goes, Qi also perishes. Though wishing to avoid death, is it possible? This [Zhang] heartache and superficial presentation, fortunately, Ci Shou should reflect upon it. Seek the essential principles, avoid fragmentation, detail deficiency and excess, and do not stick to old routines. Knowing that all diseases enter via deficiency, take Healthy Qi deficiency as the root and external pathogens as the branch. Preserve Jing, Qi, and Shen to treat guest diseases; then guest diseases retreat, and Healthy Qi remains unharmed. If treating guest diseases damages Jing, Qi, and Shen, the disease will not retreat, and Healthy Qi is wasted. Abandoning the root for the branch only harms life. Only when Healthy Qi is still robust and guest disease is firm at the onset should one urgently expel it to prevent spread. If one hesitates and delays in all cases, it is like locking the door and leaving the thief inside—is this treatment?