纂《仁斋》及《编注病机》、《药性》等书。
百病难逃乎八要，
经曰∶病有八要。不知其要，病将安去？表、里、寒、热、虚、实、邪、正而已。
治法必遵乎三法；
新病去邪，大剂猛治；稍久去邪养正，宽猛兼治；久病药必平和，宽治缓治。
正气在人，阳为表而阴为里，上古名言；邪气害人，表为阴而里为阳，仲景妙诀。实者脉盛、皮热、腹胀、
前后不通是为五实，虚者脉虚、皮寒、气弱、泄利、少食。
是为五虚。实者得汗便利则活，虚者糜粥入胃，泄止则生。凡言实者，皆指邪气；凡言虚者，皆指正衰。
泄久五虚不治。
新病多寒，久病反热。
新病正气壮而属寒湿者多，久则五气衰而属湿热者多。即如外感风寒，内伤生冷，初病为寒，郁久则反
热矣。惟初病过服凉药，久则为虚。
内伤五邪，全要调停；外感六淫，须善汗发。
五邪，正、微、虚、实、贼；六淫，风寒、暑、湿、燥、火。
风自火出，
或外感风邪，久必归肝；或肾枯肝木妄动，血燥而为内风。故一切痹痛瘫痪等症，不可纯用风药。
寒乃虚孽。
诸阴为虚。《经》曰∶邪之所凑，其气必虚。故伤寒多犯下虚之人，宜壮阳温散。
暑耗气液精神，甘酸敛补常投（敛汗补虚；）
湿伤皮肉筋骨，苦辛汗升暂咽。
外湿宜汗。忌麻黄、干葛，宜羌活、苍术之类。经云∶土湿甚则热，治以苦温，佐以甘辛。内湿宜渗，
用猪苓，不效者宜升。经云；气升则水降。赋云∶春当散火升阳，夏须生脉益气。枳术丸、草蔻丸，宜可秋吞；
异功散、浓朴温中汤，却堪冬饵。
燥分实虚，
实燥大便秘而腹胀急，宜量体通利；虚燥大便秘而腹不作胀，多属血虚，宜润之而已。
火辨补泄。
外感实火，宜分表里泻之；内伤虚火，宜分阴阳补之。赋云∶实火可泻，或泻表而泻里；虚火可补，或
补阳而补阴。
祛邪犹追盗蔻，歼魁而恕胁从；养正若待小人，正已而无过察。
邪宜祛除，正宜安抚。痰不可吐尽，火不可降过，气不可耗极，血不可太补，湿不可利伤。过则剧，剧
则变也。
且如伤食积在肠胃，荡涤（下）自愈（也）；停饮块居经络，消补兼行。口腹纵而湿热盛，燥脾
土以复中气。
内伤中虚，久则中寒。
房劳过而相火动，滋肾水以固阴精。
法当滋阴降火。但滋降过则损阳，中气愈虚，血无所化，则火愈盛而水愈涸矣。
气有余而喘满痞塞，火轻可降；
重者从其性而升之。
血不足而吐衄怯痨，金分宜清。
阴虚火动，火逼血而妄行，故宜清金。
气病调气，而血有根据附；血病调血，而气无滞凝。
赋云∶阳气为阴血之导引，阴血为阳气之根据归。但调气之剂，如木香、官桂、莪术、香附之类，以之调
血而两得；调血之剂，如当归、地黄之类，以之调气而乖张。若瘀血滞气，养其血而气自流行，又不可不知。
调气必辛凉以散其热，
气属阳，无形者也。阳气郁则发热，调以辛凉之药以散之。
和血必辛热以化其形。
血属阴，有形者也。阴血积则作痛，宜以辛热之药以开之。
至于痰因（七情）火动，治火勿缓；
痰因火而生者，当治火为先；亦有因痰而生火者，痰火两治。大概暴病多火，怪病多痰。
火因气郁，理气宜增。
赋云∶痰因火动，治火为先；火因气郁，理气为本。
痰有清温润燥散之异类，
热痰清之，寒痰温之，燥痰润之，湿痰燥之，风痰散之。坚者削之，客者除之，寒者温之，结者散之，留
者行之，燥者润之，急者缓之，散者收之，损者益之，劳者逸之，惊者平之，上之下之，摩之浴之，薄之劫之，
开之发之，皆大法也。
郁有达发夺泄折之殊名。
木郁达之，吐也。盖肺主收降，当居下体，今因食塞胸中，反居于上，抑遏厥阴风木，是不得上达，故
令其吐，以升达肝木而降肺金。火郁发之，汗也。当看在何经，如腠理外郁，则取汗以散之；龙火内郁，非苦
寒以降之，或用升浮之药，佐以甘温，顺其性而从治之，使势极则止，如升阳散火汤是也。土郁夺之，下也。
邪热入胃，及中满腹胀，湿热下痢，气实者则攻下以夺其势，而使之衰。金郁渗之，利小便也。肺为水源，气
郁胸满而渗道闭矣，宜清金利气以疏通之。水郁折之，谓折制其冲逆，伐而挫之也。如肿胀水气淫溢，而渗道
以塞，当实脾土以制水，则渗道达而愈。或病势既旺，非上法所能遽制，则用泻水之药以伐而挫之。或汗或下，
或渗以平之，此治之大体。虽然邪气久客，正气必损，苟不平调正气，使各安其位，复其常于治郁之余，则犹
未足以尽治法之妙。
郁久生痰生火，而病愈甚；
或郁气久而痰火成病，或病久而气血滞郁，郁气微则调理，甚则究其源而发散。
病则耗气耗血，而虚由成。阳虚畏外寒，而湿热滞则浮肿；阴虚生内热，而风燥盛则痿羸。
气虚不能外蔽，故恶外寒；血虚不能配气，故生内热。阳虚生寒，寒生湿，湿生热，湿热滞气，则周身浮
肿。阴虚生火，火生燥，燥生风，风燥伤筋，则痿痹羸瘦。凡疝气带下，亦风之属，全蝎为治疝要药。
阳虚（真）火衰，甘温易于补益；阴虚（真）水乏，苦寒难以滋荣。阴阳两虚，惟补其阳而阴自长；
气血俱病，只调其气而血自宁。
血病则不仁，而不知痛痒；气病则不用，而四肢不运；气血俱病则不仁不用。
治热以寒，寒之气壅，而火食不入；攻寒以热，热之气壅，而昏躁即生。
治热病以寒药，因气壅药不及行，故火食不入；治寒以热药，因气壅而热不及行，故发昏躁也。善治者，
须通其气脉，和顺阴阳。如服大黄不通，加以热熨其脐；服附子发躁，少加
童便或冷冻饮料以和阴。
寒之不寒者，当益心府；热之不热者，宜滋肾经。
赋云∶治诸寒者，当益心阳；治诸热者，当滋肾水。
有寿者，阳平阴秘；无病者，火降水升。抑又闻男子阳多乎阴，宜补阴以配阳；女子气滞于血，宜开血而行
气。肥人气虚多痰，豁痰补气自古传；瘦人血虚有火，泻火滋阴为定议。少壮病浅兮，攻标何疑？老弱病深兮，
固本乃是。
痰火湿热，百病关键。少壮新病，燥湿、清热、豁痰、泻火；老衰久病，攻补兼施。气虚以四君子汤补气，
而兼燥湿、清热、泻火，豁痰；血虚则以四物汤补血，而兼泻火、豁痰、清热、燥湿。
老人气多血少，只宜调和；小儿纯阳无阴，不可过治。西北风高土燥，常苦渴秘痈疽；
宜清热润燥，调养金水二脏。以滋化源，不可过用凉药。
东南地卑水湿，多患肿痛疟痢。
肿，活血则消；痛，利便则减。治疟利便在阴分者忌截，治痢下气虽溺少者忌渗。疟不食者伤食，痢
能食者胃热。东南之人，木动火明，阳气易升；西北之人，水流土旺，阴气易降。凡人阴常不足，阳常有余，
故病气升者多。
膏粱无厌（食毒多，生痈疽，）清热润燥是奇方；淡泊不堪（损中气，多肿胀，）散湿温寒为妙剂。
吁！病有微甚，治有逆从，微则逆治。
以寒药治热，以热药治寒，此逆其气以正治，使其从顺也。
甚者从攻。
以寒治热，佐以热药；以热治寒，佐以寒药。此从其病以反取，令其和调也。
寒因寒用兮，而热则因热；塞因塞用兮，而通则因通。
塞如肿胀补中，通如痢疾宜下。尝考手足少阴、太阳四经，标本寒热不定，标寒本热者，宜辛苦大寒，入
酒热服，以泻其热，是亦寒因热用也；本寒标热者、宜辛热大温而冷冻饮料，以扶其真阳，是亦热因寒用也。手、
足太阴，主收主藏，痞满窒塞，或苦寒以泻其满，或甘温以助其气，是亦寒因寒用、塞因塞用也。手、足少阳
风木，禁汗者恐自汗，禁下者恐损阴，禁渗者恐损阳，宜辛温上通天气，顺其春升之令，是亦通因通用也。凡
标本相反不顺者，故立反治之法。惟手足阳明、厥阴四经，不从标本，从乎中治。盖厥阴为生化之源，其支在
卯；阳明惟肃杀之司，其支在酉，卯酉阴阳之分，《内经》谓其分则气异也。是以手阳明大肠，喜热恶清；
足阳明胃，喜清恶热；足厥阴肝，喜润恶燥；手厥阴心胞络，乃胞络十二经之总，不系五行，乃坤元一正之土，
虽主生长，喜静恶燥，禀乎少阳元气，乃能生育。故曰∶三焦为元气之父，胞络乃阴血之母。是四经好恶不
同，法不可泥，故从中治。中非中外、中下之中，乃随时以取中也。
收惊者之神，妙医师之击凳；
昔有妇，宿楼上被惊，自后闻响昏倒。子和曰∶惊则伤胆，非心疾也。乃命坐椅，前置一凳，令其下视，
又令一人击凳，徐徐惊定。《经》曰∶惊者平之。平常见之必无惊，惊者神上越也。从下击凳，使之下视。
所以收神也。
止伤者之痛，信军吏之炒葱。
昔有贵客，因伤指甲，索金疮药裹之，遂饮酒，痛不止。有军吏取新葱入灰火中煨，劈开其间有涕，
取罨损处，凡十数易，用热葱并涕裹缠，遂毕席笑语。
尸厥形若死，而脉动如常者，百会一穴可灸；息积气久逆，而饮食如故者，导引一法收功。
不在胃，故不妨饮食，不宜针灸，宜导引法，见保养类。
溏泄无定，
或发或止，久不痊愈。
只因真水欠旺；
宜三白汤加故纸、五味子之类，补肾为主。
呕逆不纳，
饮食不浆，全然不纳。
莫非邪火上冲。
宜芩连二陈汤之类，补脾降火。
噫！药不执方，中病为妙；法无定体，随时取中。
参酌脉证，自立主意。
黄连苦参，赋云多服反热；
以苦入心为热，邪火降而真水盛矣。一说凉药虚中，外之潮热反盛。
干姜附子，谁知久饮遭凶？
赋云∶附子干姜，久饮反冷。盖真阴烁而真阳衰矣。非补旺而致偏胜之愆，必习熟而招见化之害。当本
脏旺时，补益旺气太甚，则脏气偏而夭。凡用药不宜偏胜，而招见化之害。故曰∶药不具五味，不备四气，
虽获胜益，久必暴夭。
真中误而误中真，机关要识；
真中有误者，泥古方，执常法，恋已效，自以为真，而不知其误也；误中有真者，曾有患额痈，久不愈，
诸医无效，偶被店门打破，血流即愈。
虚则补而实则泻，统会有宗。
杂病虽绪多无据，惟凭经络虚实断之，则得其宗矣。
昔人谓读仲景书，须得仲景之本意；予亦谓遵丹溪法，须有丹溪之心胸。要之，伤寒熟者，则杂病愈
加明决；杂证熟者，则伤寒益以浑融。
伤寒从外之内，法当先治外而后治内；杂病从内之外，法当先治内而后治外；至于中外俱伤，治法一也。
伤寒不离乎表，杂病不离乎里。表则汗，里则下，中则和，剂有轻重缓急之殊耳。后世分科，而医道支离，
既不能融会贯通，又何以随机应变，而救人于危亡之际耶？
医道一贯，制作原于先圣；后学时思，不可自恃其聪。
编纂《仁斋直指》及《编注病机》、《药性》等书籍。
百种疾病难以逃脱八项关键要素，
经典记载：疾病有八项关键。如果不了解这些关键，疾病将如何去除？不过是表、里、寒、热、虚、实、邪、正这八项罢了。
治疗方法必须遵循三种法则；
新发疾病去除邪气，用大剂量猛烈治疗；病程稍久，去邪同时扶正，宽缓与猛烈兼治；久病药物必须平和，以宽缓之法缓慢治疗。
正气存在于人体，阳代表表而阴代表里，这是上古的名言；邪气侵害人体，表属于阴而里属于阳，这是张仲景的妙诀。实证表现为脉象盛大、皮肤发热、腹部胀满、大小便不通，这称为五实；虚证表现为脉象虚弱、皮肤寒冷、气息微弱、泄泻痢疾、进食减少，这称为五虚。实证患者如果出汗且大小便通畅则能存活，虚证患者如果米粥进入胃中，泄泻停止则能生存。凡是说实的，都是指邪气盛；凡是说虚的，都是指正气衰弱。
泄泻日久导致五虚则难以治愈。
新发疾病多属寒证，久病反而出现热证。
新发疾病正气壮盛而属于寒湿的多，时间久了五脏之气衰败而属于湿热的多。就像外感风寒，内伤生冷，初起为寒证，郁积久了反而变成热证了。只有初起时过服凉药，时间久了就会变成虚证。
内伤于五邪，全在于调理得当；外感于六淫，须善于通过发汗来驱散。
五邪，指正、微、虚、实、贼五种邪气；六淫，指风、寒、暑、湿、燥、火六种外邪。
风邪自火而出，
或是外感风邪，时间久了必归于肝；或是肾精枯竭导致肝木妄动，血燥而生内风。所以一切痹痛、瘫痪等症状，不可单纯使用祛风药。
寒证乃是虚损产生的孽生。
诸阴经为虚。《内经》说：邪气聚集的地方，正气必然虚弱。所以伤寒多侵犯下元虚弱的人，应当壮阳温散。
暑邪耗伤气、液、精神，常投用甘酸收敛补益之品（收敛汗液，补益虚损）；
湿邪伤害皮肉筋骨，暂用苦辛升散发汗之药服用。
外湿宜用发汗法。忌用麻黄、干葛，宜用羌活、苍术之类。经云：土湿甚则生热，治疗用苦温药，佐以甘辛药。内湿宜用渗利法，
用猪苓，无效者宜用升提法。经云：气上升则水下降。赋云：春季应当疏散火邪、升发阳气，夏季须要生脉益气。枳术丸、草蔻丸，适宜秋季服用；
异功散、浓朴温中汤，却适宜冬季服用。
燥邪分实证和虚证，
实证燥结大便干秘且腹部胀满急迫，宜根据体质通利大便；虚证燥结大便干秘但腹部不胀，多属于血虚，宜滋润即可。
火邪辨别补法和泻法。
外感实火，宜分清在表在里进行泻法；内伤虚火，宜分清阴阳进行补法。赋云：实火可泻，或泻表而泻里；虚火可补，或
补阳而补阴。
祛除邪气如同追捕盗贼，诛杀魁首而宽恕胁从；扶助正气如同对待小人，端正自身而无须过分苛察。
邪气应当祛除，正气应当安抚。痰浊不可吐尽，火邪不可降得太过头，元气不可耗竭，血液不可补得太猛，湿气不可利得太伤阴。过度则病情加剧，加剧则产生变证。
况且如伤食积滞在肠胃，荡涤（攻下）自然痊愈；停饮成块居于经络，消导与补益兼行。口腹放纵而湿热盛，燥脾
土以恢复中气。
房事过度而相火妄动，滋补肾水以固守阴精。
治法应当滋阴降火。但是滋阴降火过度则损伤阳气，中气更加虚弱，血液无法化生，则火更盛而水更枯竭了。
血不足而吐血衄血怯弱劳损，金脏宜清。
阴虚火动，火逼迫血液妄行，所以宜清肺金。
气病调气，而血有所依附；血病调血，而气无滞凝。
赋云：阳气是阴血的引导，阴血是阳气的依托归宿。但是调气的药剂，如木香、官桂、莪术、香附之类，用来调血而两得其利；调血的药剂，如当归、地黄之类，用来调气则显得格格不入。如果有瘀血滞气，滋养血液而气自然流通，又不可不知道这一点。
调气必须用辛凉药以疏散其热，
气属阳，是无形的。阳气郁结则发热，用辛凉药物调治以疏散它。
和血必须用辛热药以化解其形质。
血属阴，是有形的。阴血积聚则作痛，宜用辛热药物开散它。
至于痰因（七情）火动，治火勿缓；
痰因火而生成的，当以治火为先；也有因痰而生火的，痰火两治。大概暴病多火，怪病多痰。
火因气郁，理气宜增。
赋云：痰因火动，治火为先；火因气郁，理气为本。
痰有清、温、润、燥、散的不同类别，
热痰清之，寒痰温之，燥痰润之，湿痰燥之，风痰散之。坚硬的削之，客邪除之，寒者温之，结者散之，留者行之，燥者润之，急者缓之，散者收之，损者益之，劳者逸之，惊者平之，上之下之，摩之浴之，薄之劫之，
开之发之，都是大法。
郁有达、发、夺、泄、折的不同名称。
木郁达之，即吐法。盖肺主收降，应当居下体，现在因食物堵塞胸中，反居于上，抑制厥阴风木，使其不能上达，故令其吐，以升达肝木而降肺金。火郁发之，即汗法。应当看在何经，如腠理外郁，则取汗以散之；龙火内郁，非苦寒以降之，或用升浮之药，佐以甘温，顺其性而从治之，使势极则止，如升阳散火汤就是此类。土郁夺之，即下法。
邪热入胃，及中满腹胀，湿热下痢，气实者则攻下以夺其势，使之衰。金郁渗之，即利小便。肺为水源，气
郁胸满而渗道闭矣，宜清金利气以疏通之。水郁折之，谓折制其冲逆，伐而挫之也。如肿胀水气淫溢，而渗道
以塞，当实脾土以制水，则渗道达而愈。或病势既旺，非上法所能遽制，则用泻水之药以伐而挫之。或汗或下，
或渗以平之，此治之大体。虽然邪气久客，正气必损，苟不平调正气，使各安其位，复其常于治郁之余，则犹
未足以尽治法之妙。
郁久生痰生火，而病愈甚；
或郁气久而痰火成病，或病久而气血滞郁，郁气微则调理，甚则究其源而发散。
病则耗气耗血，而虚由成。阳虚畏外寒，而湿热滞则浮肿；阴虚生内热，而风燥盛则痿羸。
气虚不能外蔽，故恶外寒；血虚不能配气，故生内热。阳虚生寒，寒生湿，湿生热，湿热滞气，则周身浮
肿。阴虚生火，火生燥，燥生风，风燥伤筋，则痿痹羸瘦。凡疝气带下，亦风之属，全蝎为治疝要药。
阳虚（真）火衰，甘温易于补益；阴虚（真）水乏，苦寒难以滋荣。阴阳两虚，惟补其阳而阴自长；
气血俱病，只调其气而血自宁。
血病则不仁，而不知痛痒；气病则不用，而四肢不运；气血俱病则不仁不用。
治热以寒，寒之气壅，而火食不入；攻寒以热，热之气壅，而昏躁即生。
治热病以寒药，因气壅药不及行，故火食不入；治寒以热药，因气壅而热不及行，故发昏躁也。善治者，
须通其气脉，和顺阴阳。如服大黄不通，加以热熨其脐；服附子发躁，少加
童便或冷冻饮料以和阴。
寒之不寒者，当益心府；热之不热者，宜滋肾经。
赋云：治诸寒者，当益心阳；治诸热者，当滋肾水。
有寿者，阳平阴秘；无病者，火降水升。抑又闻男子阳多乎阴，宜补阴以配阳；女子气滞于血，宜开血而行
气。肥人气虚多痰，豁痰补气自古传；瘦人血虚有火，泻火滋阴为定议。少壮病浅兮，攻标何疑？老弱病深兮，
固本乃是。
痰火湿热，百病关键。少壮新病，燥湿、清热、豁痰、泻火；老衰久病，攻补兼施。气虚以四君子汤补气，
而兼燥湿、清热、泻火，豁痰；血虚则以四物汤补血，而兼泻火、豁痰、清热、燥湿。
老人气多血少，只宜调和；小儿纯阳无阴，不可过治。西北风高土燥，常苦渴秘痈疽；
宜清热润燥，调养金水二脏。以滋化源，不可过用凉药。
东南地卑水湿，多患肿痛疟痢。
肿，活血则消；痛，利便则减。治疟利便在阴分者忌截，治痢下气虽溺少者忌渗。疟不食者伤食，痢
能食者胃热。东南之人，木动火明，阳气易升；西北之人，水流土旺，阴气易降。凡人阴常不足，阳常有余，
故病气升者多。
膏粱无厌（食毒多，生痈疽，）清热润燥是奇方；淡泊不堪（损中气，多肿胀，）散湿温寒为妙剂。
吁！病有微甚，治有逆从，微则逆治。
以寒药治热，以热药治寒，此逆其气以正治，使其从顺也。
甚者从攻。
以寒治热，佐以热药；以热治寒，佐以寒药。此从其病以反取，令其和调也。
寒因寒用兮，而热则因热；塞因塞用兮，而通则因通。
塞如肿胀补中，通如痢疾宜下。尝考手足少阴、太阳四经，标本寒热不定，标寒本热者，宜辛苦大寒，入
酒热服，以泻其热，是亦寒因热用也；本寒标热者、宜辛热大温而冷冻饮料，以扶其真阳，是亦热因寒用也。手、
足太阴，主收主藏，痞满窒塞，或苦寒以泻其满，或甘温以助其气，是亦寒因寒用、塞因塞用也。手、足少阳
风木，禁汗者恐自汗，禁下者恐损阴，禁渗者恐损阳，宜辛温上通天气，顺其春升之令，是亦通因通用也。凡
标本相反不顺者，故立反治之法。惟手足阳明、厥阴四经，不从标本，从乎中治。盖厥阴为生化之源，其支在
卯；阳明惟肃杀之司，其支在酉，卯酉阴阳之分，《内经》谓其分则气异也。是以手阳明大肠，喜热恶清；
足阳明胃，喜清恶热；足厥阴肝，喜润恶燥；手厥阴心胞络，乃胞络十二经之总，不系五行，乃坤元一正之土，
虽主生长，喜静恶燥，禀乎少阳元气，乃能生育。故曰∶三焦为元气之父，胞络乃阴血之母。是四经好恶不
同，法不可泥，故从中治。中非中外、中下之中，乃随时以取中也。
收惊者之神，妙医师之击凳；
昔有妇，宿楼上被惊，自后闻响昏倒。子和曰∶惊则伤胆，非心疾也。乃命坐椅，前置一凳，令其下视，
又令一人击凳，徐徐惊定。《经》曰∶惊者平之。平常见之必无惊，惊者神上越也。从下击凳，使之下视。
所以收神也。
止伤者之痛，信军吏之炒葱。
昔有贵客，因伤指甲，索金疮药裹之，遂饮酒，痛不止。有军吏取新葱入灰火中煨，劈开其间有涕，
取罨损处，凡十数易，用热葱并涕裹缠，遂毕席笑语。
尸厥形若死，而脉动如常者，百会一穴可灸；息积气久逆，而饮食如故者，导引一法收功。
不在胃，故不妨饮食，不宜针灸，宜导引法，见保养类。
溏泄无定，
或发或止，久不痊愈。
只因真水欠旺；
宜三白汤加故纸、五味子之类，补肾为主。
呕逆不纳，
饮食不浆，全然不纳。
莫非邪火上冲。
宜芩连二陈汤之类，补脾降火。
噫！药不执方，中病为妙；法无定体，随时取中。
参酌脉证，自立主意。
黄连苦参，赋云多服反热；
以苦入心为热，邪火降而真水盛矣。一说凉药虚中，外之潮热反盛。
干姜附子，谁知久饮遭凶？
赋云∶附子干姜，久饮反冷。盖真阴烁而真阳衰矣。非补旺而致偏胜之愆，必习熟而招见化之害。当本
脏旺时，补益旺气太甚，则脏气偏而夭。凡用药不宜偏胜，而招见化之害。故曰∶药不具五味，不备四气，
虽获胜益，久必暴夭。
真中误而误中真，机关要识；
真中有误者，泥古方，执常法，恋已效，自以为真，而不知其误也；误中有真者，曾有患额痈，久不愈，
诸医无效，偶被店门打破，血流即愈。
虚则补而实则泻，统会有宗。
杂病虽绪多无据，惟凭经络虚实断之，则得其宗矣。
昔人谓读仲景书，须得仲景之本意；予亦谓遵丹溪法，须有丹溪之心胸。要之，伤寒熟者，则杂病愈
加明决；杂证熟者，则伤寒益以浑融。
伤寒从外之内，法当先治外而后治内；杂病从内之外，法当先治内而后治外；至于中外俱伤，治法一也。
伤寒不离乎表，杂病不离乎里。表则汗，里则下，中则和，剂有轻重缓急之殊耳。后世分科，而医道支离，
既不能融会贯通，又何以随机应变，而救人于危亡之际耶？
医道一贯，制作原于先圣；后学时思，不可自恃其聪。
Compiling books such as *Ren Zhi Zhi Fang* (Direct Guidance from Renzhai), *Bian Zhu Bing Ji* (Annotated Pathogenesis), and *Yao Xing* (Properties of Medicinals).
A hundred diseases cannot escape the eight essentials.
The Classics state: Diseases have eight essentials. If one does not understand these essentials, how can the disease be removed? They are merely Exterior (Biao), Interior (Li), Cold (Han), Heat (Re), Deficiency (Xu), Excess (Shi), Evil (Xie), and Righteous Qi (Zheng).
Treatment methods must follow three principles;
For new diseases, eliminate the evil with large doses and vigorous treatment; for slightly longer-standing diseases, eliminate evil while supporting righteousness, combining mild and vigorous approaches; for chronic diseases, medicines must be mild, treating gently and slowly.
Righteous Qi resides in the person; Yang represents the Exterior and Yin represents the Interior, a famous saying from antiquity; Evil harms the person; the Exterior is Yin and the Interior is Yang, a subtle secret of Zhang Zhongjing. Excess patterns present with surging pulse, hot skin, abdominal distension, and obstruction of urination and defecation, known as Five Excesses; Deficiency patterns present with deficient pulse, cold skin, weak breath, diarrhea/dysentery, and reduced food intake, known as Five Deficiencies. In excess cases, survival is indicated if sweating occurs and urination/defecation become unobstructed; in deficiency cases, survival is indicated if congee enters the stomach and diarrhea stops. Whenever "Excess" is mentioned, it refers to pathogenic evil; whenever "Deficiency" is mentioned, it refers to the decline of righteous Qi.
If diarrhea persists leading to Five Deficiencies, it is difficult to treat.
New diseases are mostly Cold; chronic diseases often turn into Heat.
New diseases with strong righteous Qi are mostly due to Cold-Dampness; after a long time, when the Five Qi decline, they are mostly due to Damp-Heat. For example, external contraction of Wind-Cold or internal injury from raw/cold food starts as Cold, but after stagnation for a long time, it turns into Heat. Only if cooling medicines are overused at the beginning will it become Deficient in the long run.
Internal injuries from the Five Evils require careful regulation; external contractions from the Six Exuberances must be well-dispersed through sweating.
The Five Evils refer to Zheng, Wei, Xu, Shi, Zei; the Six Exuberances refer to Wind, Cold, Summerheat, Dampness, Dryness, Fire.
Wind arises from Fire.
Whether externally contracted Wind-Evil eventually returns to the Liver, or Kidney dryness causes Liver Wood to move recklessly leading to blood dryness and internal Wind, all conditions like Bi syndrome pain and paralysis should not be treated solely with Wind-expelling herbs.
Cold is a product of Deficiency.
All Yin aspects are Deficient. The Classics say: Where evil gathers, Qi must be deficient. Thus, Shanghan (Cold Damage) often affects those with lower Jiao deficiency, requiring warming Yang and dispersing cold.
Summerheat consumes Qi, fluids, and spirit; sweet and sour astringent tonics are frequently used (to arrest sweating and tonify deficiency);
Dampness injures skin, flesh, sinews, and bones; bitter and acrid diaphoretic agents are temporarily swallowed.
External dampness should be treated by sweating. Avoid Ephedrae Herba (Mahuang) and Puerariae Radix (Gegen); use Notopterygii Rhizoma et Radix (Qianghuo) and Atractylodis Rhizoma (Cangzhu) instead. The Classics state: When Earth-dampness is severe, heat arises; treat with bitter-warm herbs, assisted by sweet-acrid ones. Internal dampness should be treated by leaching out; use Polyporus (Zuling). If ineffective, use ascending methods. The Classics state: When Qi ascends, water descends. The Fu states: In spring, disperse fire and ascend Yang; in summer, generate pulses and benefit Qi. Zhizhu Wan (Immature Bitter Orange and Atractylodes Macrocephala Pill) and Cao Kou Wan (Black Cardamom Pill) are suitable for autumn ingestion; Yigong San (Extraordinary Power Powder) and Houpo Wenzhong Tang (Magnolia Bark Decoction to Warm the Middle) are suitable for winter ingestion.
Dryness is distinguished into Excess and Deficiency.
Excess dryness involves constipation with urgent abdominal distension; treat according to constitution to promote unobstruction. Deficiency dryness involves constipation without abdominal distension, mostly due to Blood deficiency; treat with moistening.
Fire is distinguished by tonification and purgation.
Externally contracted Excess Fire should be differentiated by Exterior/Interior and purged; internally injured Deficient Fire should be differentiated by Yin/Yang and tonified. The Fu states: Excess Fire can be purged, either by purging the Exterior or the Interior; Deficient Fire can be tonified, either by tonifying Yang or Yin.
Eliminating evil is like chasing thieves; kill the ringleader but pardon the accomplices; nourishing righteousness is like dealing with petty people; rectify oneself without excessive scrutiny.
Evil should be eliminated; righteousness should be pacified. Phlegm should not be expectorated completely; Fire should not be descended too much; Qi should not be exhausted; Blood should not be tonified excessively; Dampness should not be drained to the point of injury. Excess leads to aggravation, and aggravation leads to transformation.
For instance, food stagnation in the intestines and stomach heals itself after purgation; retained fluid forming masses in collaterals requires both resolving and tonifying. Indulgence in diet leads to abundant Damp-Heat; dry Spleen Earth to restore Middle Qi.
Internal injury to Middle Deficiency eventually leads to Middle Cold.
Overindulgence in sexual activity stirs Ministerial Fire; nourish Kidney Water to consolidate Yin Essence.
The method should be to nourish Yin and descend Fire. However, excessive nourishing and descending damages Yang, making Middle Qi more deficient, Blood harder to transform, Fire more flourishing, and Water more depleted.
Qi surplus causing wheezing, fullness, and obstruction: if Fire is light, it can be descended;
if heavy, follow its nature and ascend it.
Blood insufficiency causing hematemesis, epistaxis, timidity, and consumptive disease: Metal organ should be cleared.
Yin deficiency with Fire stirring forces Blood to flow recklessly, so clearing Lung Metal is appropriate.
Qi disorders regulate Qi, and Blood has its foundation; Blood disorders regulate Blood, and Qi has no stagnation.
The Fu states: Yang Qi guides Yin Blood; Yin Blood is the foundation and return of Yang Qi. However, Qi-regulating herbs like Aucklandiae Radix (Muxiang), Cinnamomi Cortex (Guirui), Curcumae Radix (Ezhu), and Cyperi Rhizoma (Xiangfu) can also regulate Blood to mutual benefit; Blood-regulating herbs like Angelicae Sinensis Radix (Danggui) and Rehmanniae Radix (Dihuang) act awkwardly on Qi. If there is stagnant Blood and Qi, nourishing Blood allows Qi to flow naturally, which must be known.
Regulating Qi must use acrid-cool herbs to dissipate Heat.
Qi belongs to Yang and is formless. When Yang Qi stagnates, Fever arises; treat with acrid-cool herbs to dissipate it.
Harmonizing Blood must use acrid-hot herbs to transform its form.
Blood belongs to Yin and is有形 (form/material). When Yin Blood accumulates, Pain arises; treat with acrid-hot herbs to open it.
As for Phlegm stirred by Fire (due to Seven Emotions), treat Fire without delay;
When Phlegm is generated by Fire, treating Fire is primary; when Fire is generated by Phlegm, treat both. Generally, acute diseases involve much Fire, and strange diseases involve much Phlegm.
Fire caused by Qi stagnation requires increasing Qi regulation.
The Fu states: Phlegm stirred by Fire, treat Fire first; Fire caused by Qi stagnation, regulate Qi as the root.
Phlegm varies in clearing, warming, moistening, drying, and dispersing.
Clear Hot Phlegm, warm Cold Phlegm, moisten Dry Phlegm, dry Damp Phlegm, disperse Wind Phlegm. Cut hard masses, remove invading pathogens, warm the cold, scatter clumps, move retention, moisten dryness,缓急 (relieve urgency), avert scattering, tonify loss, rest the fatigued, calm fright, induce vomiting for upper excess, purge for lower excess, massage, bathe, bind,劫 (forcefully resolve), open, and develop—all are major principles.
Stagnation has different names: Da (reaching), Fa (emitting), Duo (seizing), Xie (draining), Zhe (breaking).
Wood stagnation is reached via emesis. Since Lung governs gathering and descending, it should reside below; now food blocks the chest, residing above, suppressing Jueyin Wind Wood, preventing it from reaching up, so induce vomiting to ascend Liver Wood and descend Lung Metal. Fire stagnation is emitted via sweating. Determine the meridian; if exterior collateral stagnation, sweat to disperse; if Dragon Fire interiorly stagnated, do not just use bitter-cold to descend, but use floating herbs assisted by sweet-warm to follow its nature and treat reversely, stopping when force peaks, as in Shengyang Sanhuo Tang (Ascending Yang Dispersing Fire Decoction). Earth stagnation is seized via purgation. When pathogenic heat enters Stomach, or middle fullness/distension, damp-heat dysentery occur, attack with purgatives to seize momentum and weaken it. Metal stagnation is drained via diuresis. Lung is the source of water; Qi stagnation causes chest fullness and closes drainage channels; clear Lung and benefit Qi to unblock. Water stagnation is broken by restraining its counterflow, attacking and crushing it. In edema with overflowing water qi blocking drainage, strengthen Spleen Earth to control Water, opening drainage for cure. If disease is too fierce for these methods, use water-draining drugs to attack and crush. Whether sweating, purging, or draining to calm—this is the general approach. Although long-standing evil inevitably damages righteous Qi, if righteous Qi is not balanced to return to its proper place after treating stagnation, the subtlety of treatment is not fully realized.
Long-standing stagnation generates Phlegm and Fire, worsening the disease;
Or stagnation of Qi for a long time forms Phlegm-Fire disease, or long-standing disease causes Qi-Blood stagnation. Mild stagnation requires regulation; severe cases require tracing the source and dispersing.
Disease consumes Qi and Blood, leading to Deficiency. Yang Deficiency fears external Cold, and Damp-Heat stagnation causes edema; Yin Deficiency generates internal Heat, and Wind-Dryness excess causes flaccidity and emaciation.
Qi Deficiency cannot shield the exterior, hence aversion to external Cold; Blood Deficiency cannot harmonize with Qi, hence generating internal Heat. Yang Deficiency generates Cold, Cold generates Dampness, Dampness generates Heat; Damp-Heat stagnating Qi causes whole-body edema. Yin Deficiency generates Fire, Fire generates Dryness, Dryness generates Wind; Wind-Dryness injuring sinews causes flaccidity, numbness, and emaciation. All hernia and leukorrhea belong to Wind; Scorpion (Quanxie) is a key herb for hernia.
Yang Deficiency (True Fire decline) is easily tonified with sweet-warm herbs; Yin Deficiency (True Water lack) is hard to nourish with bitter-cold herbs. In simultaneous Yin-Yang Deficiency, tonify Yang and Yin grows naturally;
In simultaneous Qi-Blood disorder, regulate Qi and Blood calms naturally.
Blood disorder causes insensibility, unawareness of pain and itch; Qi disorder causes dysfunction, immobility of limbs; simultaneous Qi-Blood disorder causes insensibility and dysfunction.
Treating Heat with Cold causes Qi congestion, preventing food intake; attacking Cold with Heat causes Qi congestion, leading to confusion and irritability.
Treating Heat disease with Cold herbs fails due to Qi congestion preventing drug action, so food/fire is rejected; treating Cold with Hot herbs fails due to Qi congestion preventing heat action, causing dizziness and irritability. Skillful practitioners must unblock Qi meridians and harmonize Yin-Yang. If Rhubarb (Dahuang) fails to unblock, apply hot compress to navel; if Aconite (Fuzi) causes irritability, add少许 (a little) child's urine or frozen drink to harmonize Yin.
When Cold cannot be warmed, benefit Heart Fu; when Heat cannot be cooled, nourish Kidney Jing.
The Fu states: To treat all Cold, benefit Heart Yang; to treat all Heat, nourish Kidney Water.
Those with longevity have balanced Yang and secure Yin; those without disease have Fire descending and Water ascending. It is also heard that Men have more Yang than Yin, so nourish Yin to match Yang; Women have Qi stagnating in Blood, so open Blood to move Qi. Fat people have Qi Deficiency and much Phlegm; expelling Phlegm and tonifying Qi is an ancient tradition; Thin people have Blood Deficiency and Fire; clearing Fire and nourishing Yin is the fixed consensus. Young and strong with shallow disease, why doubt attacking the branch? Old and weak with deep disease, consolidating the root is essential.
Phlegm, Fire, Dampness, and Heat are keys to a hundred diseases. Young/new disease: dry dampness, clear heat, expel phlegm, purge fire; Old/decrepit/chronic disease: combine attacking and tonifying. Qi Deficiency uses Sijunzi Tang (Four Gentlemen Decoction) to tonify Qi, combined with drying dampness, clearing heat, purging fire, expelling phlegm; Blood Deficiency uses Siwu Tang (Four Substances Decoction) to tonify Blood, combined with purging fire, expelling phlegm, clearing heat, drying dampness.
Elderly have much Qi and little Blood, only suitable for harmonizing; Children have Pure Yang without Yin, do not over-treat. Northwest winds are high and earth dry, often suffering from thirst, constipation, carbuncles, and ulcers;
clear heat and moisten dryness, nourish Metal and Water organs to nourish the source of transformation, avoiding excessive cooling herbs.
Southeast lands are low and watery, prone to swelling, pain, malaria, and dysentery.
Swelling resolves with activating Blood; pain reduces with promoting urination/defecation. Treating malaria with diuresis in Yin aspect forbids interception; treating dysentery with moving Qi forbids leaching even if urination is scant. Malaria patients not eating indicate food injury; dysentery patients able to eat indicate Stomach Heat. Southeast people have moving Wood and bright Fire, Yang Qi easily ascends; Northwest people have flowing Water and prosperous Earth, Yin Qi easily descends. Generally, human Yin is often insufficient, Yang often in excess, so diseases with ascending Qi are common.
Rich foods without satiety (many food toxins, generating carbuncles/ulcers); clearing heat and moistening dryness is a miraculous formula; bland diet intolerable (damaging Middle Qi, causing swelling); dispersing dampness and warming cold is a wonderful agent.
Alas! Diseases have severity; treatments have reversal and following. Mild cases use reversal treatment.
Using Cold herbs to treat Heat, Hot herbs to treat Cold—this reverses the Qi to achieve correct treatment, making it compliant.
Severe cases follow the attack.
Using Cold to treat Heat, assisted by Hot herbs; using Hot to treat Cold, assisted by Cold herbs. This follows the disease to take the opposite, achieving harmony.
Treat Cold with Cold usage, and Heat with Heat usage; treat Obstruction with Obstruction usage, and Unobstruction with Unobstruction usage.
Obstruction like edema benefits Middle tonification; Unobstruction like dysentery benefits purgation. Examining Hand/Foot Shaoyin and Taiyang four meridians, standard/root Cold/Heat are不定 (variable). Standard Cold Root Heat: use bitter-acrid great-cold, taken hot with wine to purge Heat—this is Cold used with Heat. Root Cold Standard Heat: use acrid-hot great-warm with frozen drinks to support True Yang—this is Heat used with Cold. Hand/Foot Taiyin govern gathering/storage; fullness/blockage: bitter-cold to purge fullness or sweet-warm to assist Qi—this is Cold used with Cold, Obstruction used with Obstruction. Hand/Foot Shaoyang Wind Wood: forbid sweating (fear spontaneous sweating), forbid purging (fear damaging Yin), forbid leaching (fear damaging Yang); use acrid-warm to connect to Heaven Qi, following Spring ascending command—this is Unobstruction used with Unobstruction. For standards and roots contrary and non-compliant, reverse treatment methods are established. Only Hand/Foot Yangming and Jueyin four meridians do not follow standard/root, but follow Middle treatment. Jueyin is the source of generation, its branch at Mao; Yangming is the department of肃杀 (severity/killing), its branch at You. The division of Mao and You in Yin-Yang, the Neijing says their Qi differs. Thus Hand Yangming Large Intestine likes Heat hates Cooling; Foot Yangming Stomach likes Cooling hates Heat; Foot Jueyin Liver likes Moisture hates Dryness; Hand Jueyin Pericardium Collateral is the head of twelve collaterals, not tied to Five Elements, but Kun Yuan True Earth, though governing growth, likes Quietness hates Dryness, inheriting Shaoyang Original Qi to enable generation. Thus: Sanjiao is Father of Original Qi, Pericardium is Mother of Yin Blood. These four meridians have different preferences, methods cannot be rigid, so treat from Middle. Middle is not middle-upper/lower, but taking Middle according to time.
To gather the Spirit of fright, the skillful physician strikes a stool;
Once a woman stayed upstairs, was frightened, and fainted upon hearing sounds later. Hezi said: Fright injures Gallbladder, not Heart disease. Ordered her to sit on a chair, placed a stool in front, told her to look down, then had someone strike the stool, gradually calming the fright. The Classics state: Fright is calmed by familiarity. Seeing it normally causes no fright; fright is Spirit floating upward. Striking the stool from below makes her look down, thus gathering Spirit.
To stop pain from injury, believe the soldier's fried scallion.
Once a noble guest injured his fingernail, asked for metal wound medicine to wrap it, then drank alcohol, pain did not stop. A soldier took fresh scallions, roasted them in ash fire, split them open having mucus, applied to the injury, changed ten times, wrapped with hot scallion and mucus, finished the banquet laughing and talking.
Corpse-like syncope resembling death but pulse normal: Baihui acupoint can be moxaed; Xi Ji (accumulated Qi from long reversal) with normal diet: Dao Yin method achieves success.
Not in Stomach, so diet is unaffected, acupuncture/moxibustion unsuitable, Dao Yin method suitable, see Preservation category.
Loose stools indefinite,
appearing or stopping, long unresolved.
Only because True Water is insufficient;
use Sanbai Tang plus Psoraleae Fructus (Guzhi) and Schisandrae Fructus (Wuweizi), focusing on tonifying Kidney.
Vomiting/reversal refusing intake,
food/drink completely rejected.
Must be Evil Fire rushing up.
use Qinlian Erchen Tang (Scutellaria and Coptis Two-Chen Decoction) etc., tonify Spleen and descend Fire.
Ah! Medicines do not stick to formulas, hitting the disease is wonderful; methods have no fixed body, taking Middle according to time.
Consult pulse and symptoms, establish own opinion.
Coptidis Rhizoma (Huanglian) and Sophorae Flavescentis Radix (Kushen), the Fu says many doses cause Heat;
Bitter entering Heart is Heat, Evil Fire descends and True Water flourishes. Another view: Cooling herbs damage Middle, external tidal Heat increases.
Zingiberis Rhizoma (Ganjiang) and Aconiti Lateralis Radix Praeparata (Fuzi), who knows long drinking brings disaster?
The Fu states: Fuzi and Ganjiang, long drinking causes Cold. Because True Yin burns and True Yang declines. Not due to tonifying excess causing bias, but habituation inviting transformation harm. When the organ is flourishing, tonifying too much causes organ Qi bias and premature death. Medicines should not be biased, inviting transformation harm. Thus: Medicine without five flavors, without four Qi, although gaining benefit, long-term causes sudden death.
True contains error and error contains true, recognize the mechanism;
True containing error: sticking to ancient formulas, holding to constant methods, clinging to past efficacy, thinking it true, not knowing it is error; Error containing true: once a patient had forehead carbuncle, long unresolved, doctors ineffective, accidentally hit by shop door, bleeding cured immediately.
Deficiency tonifies and Excess purges, unity has a source.
Miscellaneous diseases虽有 (although) many threads without basis, only judging by meridian Excess/Deficiency obtains the source.
Ancients said reading Zhongjing's books requires understanding Zhongjing's original intent; I also say following Danxi's methods requires Danxi's mindset. Basically, mastering Shanghan makes miscellaneous diseases clearer; mastering miscellaneous diseases makes Shanghan more integrated.
Shanghan goes from Outside to Inside, method should treat Outside first then Inside; Miscellaneous diseases go from Inside to Outside, method should treat Inside first then Outside; when both Inside/Outside injured, treatment is same.
Shanghan does not leave Exterior, miscellaneous diseases do not leave Interior. Exterior is sweating, Interior is purging, Middle is harmonizing, dosage has light/heavy/slow/fast differences. Later generations divided specialties, medical way fragmented, unable to integrate, how to adapt to changes and save lives in crisis?
Medical way is consistent, creation originates from Ancient Sages; later students should reflect, not rely on own cleverness.