〔垣〕医之可法，自伏羲神农、黄帝而下，名医虽多，可法者有数人。至于华氏之剖腹，
王氏之针法，术非不神也。后人安得而效之。非若岐伯之圣经，雷公之炮炙，伊芳挚之汤液，
箕子之五行，越人之问难，仲景之《伤寒论》，叔和之《脉诀》，士安之《甲乙》，启玄子
之述作，钱仲阳之议论，洁古之方书，皆活法所可学人。岂千方万论，印定后人眼目者，所
能比哉。其间德高行远，奇人异士，与夫居缙绅隐草莽者，虽有一法一节之可观，非百世可
行之活法，皆不取也。予岂好辨哉！欲使学人观此数圣贤而知所向慕而已。或有人焉，徒欲
广览泛涉，自以为多学而用之无益者，岂为知本。
〔海〕钱氏、《活人》、王朝奉、王德孚所论，皆宋人，易老、守真，皆金人，所用之剂
寒热之不同者，盖本诸此。读此数书而用之，亦当以地方世代所宜责之。然莫若取法于洁古
，折衷于仲景汤液，则万世不易之大法也。
〔《素》〕邪风之至，疾如风雨。故善治者治皮毛，其次治肌肤，其次治筋脉，其次治六
腑，其次治五脏，治五脏者，半死半生也。
病之始起也，可刺而已。其盛，可待衰而已。故因其轻而扬之，因其重而减之，因其衰
而彰之。形不足者，温之以气；精不足者，补之以味；其高者，因而越之；其下者，引而竭
之；中满者，泻之于内；其有邪者，渍形以为汗；其在皮者，汗而发之；其 悍者，按而收
之；其实者，散而泻之。审其阴阳，以别柔刚，阳病治阴，阴病治阳。定其血气，各守其乡
。血实宜决之，气虚宜掣引之。（并见《阴阳应象论》）
〔仲〕大法春宜吐，夏宜汗，秋宜下，冬宜温及灸。
〔海〕病在天之无形，当汗；病在天之有形，当吐；病在地之无形，当利小便；病在地之
有形，当利大便。
〔《脉》〕夫欲治病，当先知其证何起，乃可攻之耳。
〔垣〕假令治病，无问伤寒、蓄血、结胸、发黄等诸证，并一切杂证等，各当于六经中求
责之。如发黄症，或头痛、腰脊强、恶寒，即有太阳证；或身热目痛、鼻干、不得卧，即有
阳明证；余仿此。（不独六经中求责，五脏求责，尤急务也。假令面青、脉弦、善怒、淋溲
、便难、转筋，即有肝证也；或面赤脉洪善笑，口干身热烦心，心痛，掌中热而 ，即有心证
也；余仿此）
〔丹〕治病必求其本病之有本，犹草木之有根也，去叶不去根，草犹在也。治病犹去草
，病在脏而治腑，病在表而攻里，非惟戕贼胃气，抑且资助病邪，医云乎哉。
一法，治疟积下痢，吐痰而愈。一法治污血哽噎，用韭汁开污血而愈。一法，治下疳疮
自痢，用龙荟丸、柴胡汤而愈。其详分见各门。
〔海〕治病必求其本假令腹痛，桂枝加芍药；大实痛，桂枝加大黄。何为不只用芍药大
黄等，而于桂枝内加之？要从太阳中来，以太阳为本也。又如结胸证，自高而下，脉浮者，
不可下，故先用麻黄汤解表。表已脉沉，后以陷胸汤下之，是亦求其本也。至于蓄血下焦，
血结膀胱，是从太阳中来，侵尽无形之气，乃侵膀胱中有形血也。
〔《素》〕先病而后逆者，治其本。先逆而后病者，治其本。先寒而后生病者，治其本。
先病而后生寒者，治其本。先热而后生病者，治其本。先热而后生中满者，治其标。先病而
后泄者，治其本。先泄而后生他病者，治其本，必且调之，乃治其他病。先病而后生中满者
，治其标。先中满而后烦心者，治其本。人有客气，有同气。小大不利，治其标。小大利，
治其本。病发而有余，本而标之，先治其本，后治其标。病发而不足，标而本之，先治其标
，后治其本。谨察间甚，以意调之，间者并行，甚者独行。先小大不利而后生病者，治其本
。（《标本病传论》）
〔仲〕夫病痼疾，加以卒病，当先治其卒病，后乃治其痼疾也。
〔海〕初治之道，法当峻猛者，谓所用药势疾痢猛峻也。缘病得之新暴感，虽轻得之重，
皆宜以疾痢之剂急去之。中治之道，法当宽猛相济，为病得之非新非久，宜以缓疾得中之药
，养正去邪，相济而治之。假令如见邪气多，正气少，宜以去邪药多，养正药少。凡加减法
如此之类，更宜临证消息增减用之。仍根据时令行之，无妄也。更加针灸，其病即愈。末治之
道，法宜宽缓，宽者察药性平和，缓者广服无毒以养气血安中。盖为病证已久，邪气伏潜至
深而正气微少，故以善药广服，养正气而邪气自去，更加针灸，其效必速。
治病之道有五法∶和、取、从、折、属也。一治各有五，五五二十五，如火之属衰于戌
，金之属衰于辰是也。一治曰和，假令小热之病，当以凉药和之，和之不已，次用取。二治
曰取，为热势稍大，当以寒药取之，取之不已，又用从。三治曰从，为势已甚，当以温药从
之，为药气温也，味随所用，或以寒因热用，或以热因寒用，或以汗发之，发之不已，又用
折。四治曰折，为病势极甚，当以逆制之，制之不已，当以下夺之，下夺之不已，又用属。
五治曰属，为求其属以衰之，缘热深陷在骨髓间，无法可出，针药取之不能及，故求其属以
衰之（求属之法，同声相应，同气相求）。经曰∶陷下者衰之。夫衰热气之法，同前所云，火
衰于戌，金衰于辰之类是也。如或又不已，当广其法而治之。譬孙子之用兵，若在山谷则塞
渊泉，有水则把渡口，在平川广野当清野千里。塞渊泉者，刺 穴。把渡口者，夺病发时前
。清野千里者，如肌羸瘦弱，宜广服大药以养正气。夫病有中外，治有缓急。在内者，以内
治法和之。在外者，以外治法和之。气微不和，以调气法调之。其次大者，以平气法平之。
盛甚不已，则夺其气，令其衰也。故经曰∶调气之方，必别阴阳，定其中外，各守其乡。内
者内治，外者外治，微者调治，其次平治，盛者夺之，汗之下之，寒热温凉，衰之以属，随
其攸利。
〔《难》〕脏病难治，腑病易治，何谓也？然，脏病所以难治者，传其胜也。腑病易治者
，传其子也。与七传间脏同法也。
〔海〕脉之不病，其神不言，当自有也。脉之即病，当求其中神之有与无焉。谓如六数七
极，热也，脉中有力，即有神也。三迟二败，寒也，脉中有力，即有神也。热则有神也，当
泄其热，则神在焉。寒则有神也，当去其寒，则神在焉。寒热之脉，无力无神，将何药以泄
热去寒乎？苟不知此而遽泄去之，将何根据以生，所以十亡八九。
〔《素》〕形乐志苦，病生于脉，治之以灸刺。形乐志乐，病生于肉，治之以针石。形苦
志乐，病生于筋，治之以熨引。形苦志苦，病生于咽嗌，治之以百药。形数惊恐，经络不通
，病生于不仁，治之以按摩醪药，是谓五形志也。（《血气形志篇》）
〔海〕缓急辨经云∶治主以缓，治客以急，所当知也。诸有表证当汗。脉浮，急汗之；
脉沉，缓汗之。诸有里证当下。脉浮，缓下之；脉沉，急下之。三阳汗当急，而下当缓。三
阴汗当缓，而下当急。主为病，则缓去之；客为病，则急去之。胸中气病，自病也。为主，
治当缓。胸中血病，他病也。为客，治当急。上无形，下入腹中，即为客也，治当急。下有
形，上入胸中，即为主也，治当缓。岁之六气，主也。司天在泉间气，客也。补上治上制以
缓，不犯血药，便谓之缓，非缓慢之缓也。补下治下制以急，不犯气药，便谓之急，非急速
之急也。热在至高之分，故用轻剂从高而按治从缓也，若急服之，上热未退，而中寒复生矣
；若入有形，当下之者从其急，从其急者从其权也。大肠滑泄，治以收之，服药当以一物压
之，欲其及于下部也，故服在空心食前，若在食后，非徒无益，而又害之，此谓治之缓也。
近者奇之，先急而后缓。远者偶之，先急而后缓。下者奇之，先缓而后急。汗者偶之，先缓
而后急。
〔灵枢〕奇偶汗从九地之下，下从九地之上。
东垣∶诸病四时用药之法不问所病或温或凉，或热或寒，如春时有疾，于所用药内加
清凉风药；夏月有疾，加大寒之药；秋月有疾，加温气药；冬月有疾，加大热药，是不绝生
化之源也。钱仲阳医小儿，深得此理。《内经》曰∶必先岁气，无伐天和，是为至治。又曰
∶无违时，无伐化。又曰∶无伐生生之气，此皆常道也。用药之法，若反其常道，而变生异
证，则当从权施治。假令病患饮酒，或过食寒，或过食热，皆可以增疾。如此，以权衡应变
治之。权变之药，岂可常用乎？权变之药，于时禁药禁，有不暇顾者矣，故不可轻用。
〔丹〕愚阅张子和书，惟务攻击，其意以正气不能自病，因为邪所客，所以为病也，邪去
正气自安。因病有在上、中、下、深、浅之不同，立为吐、汗、下三法以攻之。初看其书，
将谓医之法尽于是矣。复因思《内经》有言∶谓之虚者，精气虚也；谓之实者，邪气实也。
夫邪所客，必因正气之虚，然后邪得而客之。苟正气实，邪无自入之理。由是于子和之书，
不得不致疑于其间。又思《内经》有言∶阴平阳秘，精神乃治，阴阳离决，精气乃绝。又思
仲景有言∶病当汗解，诊其尺脉涩，当与黄 建中汤补之，然后汗之。于是知张子和之书，
非子和之笔也。子和驰名中土，其法必有过于同辈者，何其书之所言，与《内经》仲景之意
，若是之不同也。于是决意于得明师以为之根据归，发其茅塞，遂游江湖，但闻某处有某医，
便往而拜问之，连经数郡，无一人焉。后到真定，始得《原病式》东垣 ，乃大悟子和之孟
浪，然终未得的然之议论，将谓江浙间无可为师者。泰定乙丑夏，始得闻罗太无于陈芝岩之
言，遂往拜之，蒙叱骂者五七次， 趄二阅月，始得降接。因观罗先生治一病僧，黄瘦
倦怠，罗询其病因，乃蜀人出家时，其母在堂，又游浙右，经七年，忽一日念母之心不可遏
，欲归，无腰缠，徒尔昕夕西望而泣，以是得病。时僧二十五岁，罗令隔壁宿泊，每日以牛
肉猪肚甘肥等，煮糜烂与之，凡经半月余，且时以慰论之言劳之，又曰∶我与银拾锭作路费
，我不望报，但欲救汝之死命耳。察其形稍苏，脉稍充，与桃仁承气一日三帖，下之，
皆是血块痰积，方止。次日乃与熟菜稀粥，将息又半月，其人遂如旧，又半月余，与银遂行
。因大悟攻击之法，必其人充实，禀受素壮，乃可行也。否则邪去而正气伤，小病必重，重
病必死。罗每日有求医者，必令某诊视其脉状，回禀罗。但卧听，口授用某药治某病，以某
药监某药，以某药为引经，往来一年半，并无一定之方。至于一方之中，有攻补兼施者，亦
有先攻后补者，有先补后攻者，又大悟用古方治今病，焉能吻合，随时取中，此之谓欤。其
时罗又言，用古方治今病，正如拆旧屋，补凑新屋，其材木非一一再经匠氏之手，其可用乎
？由是又思许学士《发微论》曰∶予读仲景书，用仲景法，然未尝守仲景之方，乃为得仲景
之心也。遂取东垣方稿，手自抄录，乃悟治病患当如汉高祖继暴秦，周武王继商之后，自非
散财发粟，与三章之法，其受伤之气，倦惫之人，何由而平复也。于是知阴易乏，阳易亢，
攻击宜审，正气须保护，以局方为惩戒哉。
〔海藏〕许先生论梁宽父症右胁肺部也，咳而吐血，举动喘逆者，肺诊也。发热脉数不
能食者，火来刑金，肺与脾俱虚也。肺与脾俱虚而火乘之，其病为逆。如此者，例不可补泻
。盖补金则虑金与火持，而喘咳益增。泻火则虑火不退位，而 癖反盛，止宜补中益气汤，
先扶元气，少以治病药和之。闻已用药而未获效，必病势苦逆，而药力未到也。当与宽父熟
论，远期秋凉，庶可平复。盖肺病者恶春夏火气，至秋冬则退，正宜于益气汤中，随四时阴
阳升降浮沉温凉寒热，及见有症增损服之。升降浮沉则顺之，温凉寒热则反之，顺其理，和
其气，为治之大方也。或觉气壅，间与加减枳术丸。或有饮，间服局方枳术汤。数月后，庶
逆气少回，逆气回则治法可施，但恐已至色青色赤，脉弦脉洪则无及矣。近世论医有主河间
刘氏者，有主易州张氏者。张氏用药，根据准四时阴阳升降而增损之，正《内经》四气调神之
义。医而不知此，是妄行也。刘氏用药，务在推陈致新，不使少有怫郁，正造化新新不停之
意。医而不知此，是无术也。然主张氏者，或未尽张氏之妙，则瞑眩之剂，终莫敢投，至失
几后时，而不救者多矣。主刘氏者，或未极刘氏之妙，则取效目前，阴损正气，遗害后日者
多矣。能用二子之长，而无二子之弊，其庶几乎，史副使病，不见色脉，不能悬料，以既愈
复发言之，则恐亦宜取张氏根据准四时阴阳升降用药以扶元气，庶他日既愈而不发也。宽父病
后，初感必深，所伤物恐当时消导不尽，停滞淹延，变生他症，以至于今，恐亦宜效刘氏推
陈致新之法，少加消导药于益气汤中，庶可以取效也。
【李东垣】值得效法的医学，从伏羲、神农、黄帝开始，虽然名医众多，但真正值得效法的只有几个人。至于华佗的剖腹手术，王叔和的针法，技术并非不神奇。后人怎么能效仿呢？不像岐伯的经典著作，雷公的药物炮制，伊尹的汤液制作，箕子的五行理论，扁鹊的问答疑难，张仲景的《伤寒论》，王叔和的《脉诀》，皇甫谧的《甲乙经》，王冰（启玄子）的注释著作，钱乙（钱仲阳）的议论，张元素（洁古）的方书，这些都是活法，可以供人学习。哪里是那些千方万论，用来固定后人眼光的东西所能比拟的呢？其中德行高尚、行为深远，奇人异士，以及那些隐居在官僚阶层或民间的人，虽然有一技之长或一节之可取，但不是可以百世通行的活法，都不予采纳。我难道喜欢辩论吗！只是希望学习者通过观察这几位圣贤来知道所向往的方向罢了。如果有人，只想广泛浏览泛泛涉猎，自以为多学而应用无益，这难道是懂得根本吗。
【王海藏】钱乙、《活人书》、王朝奉、王德孚所论述的，都是宋代人；易老（张元素）、守真（刘完素），都是金代人。他们所用药物寒热不同的原因，大概都基于此。读这几本书并应用它们，也应当根据地方和时代适宜的情况来责求。然而不如效法张元素，折衷于张仲景的汤液，这是万世不变的大法。
【《黄帝内经·素问》】邪风到来，快如风雨。所以善于治疗的医生在皮毛阶段就治疗它，其次治疗肌肤，其次治疗筋脉，其次治疗六腑，其次治疗五脏。治疗五脏病的，一半死亡一半存活。
疾病刚开始起病时，可以用针刺治疗。如果病势强盛，可以等待其衰退后再治疗。所以对于轻浅的病，用发散的方法；对于沉重的病，用削减的方法；对于虚弱的病，用彰显正气的方法。形体不足的，用气分药温补；精气不足的，用味厚药滋补；病位高的，用涌吐法使之上越；病位低的，用通利法使之下泄；中焦痞满的，从内部泻除；有邪气的，用水渍身体使其出汗；邪在皮表的，用发汗法发散；邪气悍猛的，按压收敛它；实证，用消散和泻下法。审察阴阳，以区分柔刚，阳病治阴，阴病治阳。确定血气，各守其位。血实宜决破，气虚宜牵引提升。（均见于《阴阳应象大论》）
【张仲景】大法：春季适宜吐法，夏季适宜汗法，秋季适宜下法，冬季适宜温法和灸法。
【王海藏】病在天的无形之气，应当用汗法；病在天的有形之邪，应当用吐法；病在地面的无形之气，应当利小便；病在地面的有形之邪，应当利大便。
【《脉经》】想要治病，应当先知道证候从何而起，然后才可以攻伐它。
【李东垣】假如治病，不论伤寒、蓄血、结胸、发黄等各种证候，以及一切杂证等，都应当在六经中寻求责任所在。比如发黄症，如果有头痛、腰脊强直、恶寒，就是太阳证；如果有身热目痛、鼻干、不能卧，就是阳明证；其余仿照此类。（不仅要在六经中寻求，在五脏中寻求更是紧急事务。比如面色青、脉弦、易怒、小便淋涩、大便困难、转筋，就是有肝证；或者面色赤、脉洪大、易笑、口干身热心烦、心痛、掌心发热，就是有心证；其余仿照此类）
【朱丹溪】治病必须探究其根本。病有根本，就像草木有根一样，去叶不去根，草还在。治病就像除草，病在脏却治腑，病在表却攻里，不仅伤害胃气，而且资助病邪，这算什么医生呢。
一种方法，治疗疟疾积聚和下痢，通过吐痰而痊愈。一种方法治疗污血导致的噎膈，用韭菜汁化解污血而痊愈。一种方法治疗下疳疮引起的自痢，用龙荟丸、柴胡汤而痊愈。详细分类见各门类。
【王海藏】治病必须探究其根本。比如腹痛，用桂枝加芍药汤；大实痛，用桂枝加大黄汤。为什么不只用芍药大黄等，而在桂枝汤中加入？因为要从太阳经入手，以太阳经为本。又比如结胸证，病势由上向下，脉浮的，不可用下法，所以先用麻黄汤解表。表解后脉沉，后用陷胸汤下之，这也是探究其根本。至于蓄血在下焦，血结在膀胱，是从太阳经而来，侵尽了无形之气，进而侵犯膀胱中有形的血。
【《黄帝内经·素问》】先患病而后出现逆乱的，治其本。先逆乱而后患病的，治其本。先受寒而后患病的，治其本。先患病而后生寒的，治其本。先发热而后患病的，治其本。先发热而后产生中满的，治其标。先患病而后泄泻的，治其本。先泄泻而后生其他病的，治其本，必须先调理好，然后再治其他病。先患病而后产生中满的，治其标。先中满而后心烦的，治其本。人有客气，有主气。大小便不通利的，治其标。大小便利的，治其本。病发而有余的，先治其本后治其标；病发而不足的，先治其标后治其本。仔细察看病情的轻重缓急，用心调治，病情轻的标本兼治，病情重的单治其一。先大小便不利而后患病的，治其本。（《至真要大论》/《标本病传论》）
【张仲景】患有久病痼疾，又加上突发急病，应当先治其突发急病，然后再治其久病痼疾。
【王海藏】初治之道，方法应当峻猛，是指所用药物气势猛烈迅疾。因为病是新近突然感受的，即使病轻得像重病一样，也都应该用迅疾猛烈的药剂急去之。中治之道，方法应当宽猛相济，因为病得之非新非久，宜用缓急适中的药物，扶正祛邪，相辅相治。比如见到邪气多，正气少，宜多用祛邪药，少用扶正药。凡加减法如此之类，更应临证斟酌增减使用。仍根据时令施行，不要妄为。再加上针灸，病就会痊愈。末治之道，方法宜宽缓，宽是指察药性平和，缓是指广服无毒药物以养气血安中。因为病证已久，邪气潜伏极深而正气微弱稀少，所以用好药广服，养正气而邪气自然去除，再加上针灸，效果必然迅速。
治病之道有五种方法：和、取、从、折、属。每种治法各有五种变化，五五二十五种，如火的属性在戌时衰退，金的属性在辰时衰退就是这样。第一种治法叫“和”，比如小热的病，应当用凉药调和，调和无效，接着用“取”。第二种治法叫“取”，因为热势稍大，应当用寒药攻取，攻取无效，再用“从”。第三种治法叫“从”，因为病势已很严重，应当用温药顺从病势，因为药气温和，味道随所用而定，有的以寒因热用，有的以热因寒用，有的用发汗法，发汗无效，再用“折”。第四种治法叫“折”，因为病势极甚，应当用逆向制约它，制约无效，应当用下夺法，下夺无效，再用“属”。第五种治法叫“属”，因为寻求其同类以衰减病势，因为热深陷在骨髓间，无法排出，针药攻取不能达到，所以寻求其同类以衰减它（求属的方法，同声相应，同气相求）。经文说：下陷的用衰减法。衰减热气的方法，同前面所说，火衰于戌，金衰于辰之类。如果仍然无效，应当广开思路治疗。比如孙子用兵，如果在山谷就堵塞水源，有水就把守渡口，在平川旷野就实行清野千里。堵塞水源，指刺穴。把守渡口，指在病发之前夺取先机。清野千里，比如肌肉消瘦瘦弱，宜广服大药以养正气。病有内外，治有缓急。在内部的，用内治法调和。在外部的，用外治法调和。气轻微不和，用调气法调治。其次严重的，用平气法平复。盛大至极不止，则夺取其气，令其衰退。所以经文说：调气的方剂，必须辨别阴阳，确定内外，各守其位。内部的用内治，外部的用外治，轻微的调治，其次平治，盛大的夺取，汗之下之，寒热温凉，用属法衰减，随其所利。
【《难经》】脏病难治，腑病易治，为什么呢？回答说，脏病难治是因为传克其所胜之脏。腑病易治是因为传生子脏。这与七传间脏的道理相同。
【王海藏】脉象没有病，其神不言语，应当自有神气。脉象有病，应当探求其中神气的有无。比如六数七极，是热证，脉中有力，就是有神。三迟二败，是寒证，脉中有力，就是有神。热证有神，应当泄其热，神就在。寒证有神，应当去其寒，神就在。寒热之脉，无力无神，用什么药来泄热去寒呢？如果不知道这一点而急于泄去，将凭借什么生存，所以十死八九。
【《黄帝内经·素问》】形体安逸但精神痛苦，病生于脉，用灸刺治疗。形体安逸精神快乐，病生于肉，用针石治疗。形体辛苦精神快乐，病生于筋，用熨引治疗。形体辛苦精神痛苦，病生于咽喉，用百药治疗。经常惊恐，经络不通，病生于麻木不仁，用按摩醪药治疗，这叫五形志。（《血气形志篇》）
【王海藏】《缓急辨经》说：治主病用缓法，治客病用急法，应当知晓。所有表证应当发汗。脉浮，急汗之；脉沉，缓汗之。所有里证应当攻下。脉浮，缓下之；脉沉，急下之。三阳病汗法当急，下法当缓。三阴病汗法当缓，下法当急。主病，则缓去之；客病，则急去之。胸中气病，是自病。为主，治当缓。胸中血病，是他病。为客，治当急。上无形，下入腹中，即为客，治当急。下有形，上入胸中，即为主，治当缓。岁之六气，是主气。司天在泉间气，是客气。补上治上制方以缓，不犯血药，便谓之缓，不是缓慢的缓。补下治下制方以急，不犯气药，便谓之急，不是急速的急。热在至高之分，所以用轻剂从高而按治从缓，如果急服，上热未退，中寒复生；如果入有形，当下之者从其急，从其急者从其权变。大肠滑泄，治以收涩，服药应当以一物压制它，欲使其到达下部，所以空腹食前服用，如果在食后，不仅无益，反而有害，这叫治之缓。近者奇之，先急后缓。远者偶之，先急后缓。下者奇之，先缓后急。汗者偶之，先缓后急。
【《灵枢》】奇偶汗法从九地之下，下法从九地之上。
李东垣：诸病四时用药之法，不问所患何病，或温或凉，或热或寒，如春时有病，在所用药内加清凉风药；夏月有病，加大寒之药；秋月有病，加温气药；冬月有病，加大热药，这是不绝生化之源。钱乙医小儿，深得此理。《内经》说：必先岁气，无伐天和，这是最高境界的治疗。又说：无违时，无伐化。又说：无伐生生之气，这都是常道。用药之法，如果违反常道，而变生异证，则应当权变施治。比如病人饮酒，或过食寒，或过食热，都可以增加疾病。如此，以权衡应变治之。权变之药，岂可常用？权变之药，有时禁药禁，有不暇顾及者，故不可轻用。
【朱丹溪】我阅读张子和的书，只致力于攻击，他的意思是以正气不能自病，因为被邪气所客，所以为病，邪去正气自安。因病有在上、中、下、深、浅的不同，立为吐、汗、下三法以攻之。初看他的书，以为医之法尽于此了。后来思考《内经》有言：谓之虚者，精气虚也；谓之实者，邪气实也。邪气所客，必因正气之虚，然后邪得而客之。如果正气实，邪无自入之理。由此对张子和的书，不得不对其间内容产生怀疑。又思考《内经》有言：阴平阳秘，精神乃治，阴阳离决，精气乃绝。又思考张仲景有言：病当汗解，诊其尺脉涩，当与黄芪建中汤补之，然后汗之。于是知道张子和的书，不是张子和的本意。张子和驰名中土，其法必有超过同辈之处，为何书中所言，与《内经》张仲景之意，如此不同呢？于是决心寻找明师作为依靠，启发茅塞，于是游历江湖，只要听说某处有某医，便前往拜问，连续经过几郡，没有一个人。后来到真定，才得到《原病式》和李东垣，才大悟张子和的孟浪，但最终未得到确切的议论，以为江浙间无可为师者。泰定乙丑年夏，才听到罗太无在陈芝岩那里的名声，便前往拜见，蒙受叱骂五六次，犹豫两个月，才得到接待。因为观察罗先生治疗一个病僧，黄瘦倦怠，罗询问病因，原来是蜀人出家时，母亲在家，又游历浙右，经过七年，忽然一日思念母亲之心不可遏制，想回家，没有路费，徒然早晚西望而泣，因此得病。当时僧人二十五岁，罗让他在隔壁住宿，每天用牛肉猪肚甘肥等，煮糜烂给他吃，总共经过半月多，并且时常以安慰的话慰劳他，又说：我给银十锭作路费，我不指望报答，只想救你的死命罢了。观察他的形体稍微苏醒，脉稍微充实，给予桃仁承气汤一天三帖，下之，排出的都是血块痰积，才停止。第二天给予熟菜稀粥，调养又半月，那人便恢复如旧，又半月多，给银便行。于是大悟攻击之法，必须其人充实，禀赋素壮，才可以施行。否则邪去而正气伤，小病必重，重病必死。罗每日有求医者，必令某人诊视其脉状，回禀罗。只是躺着听，口授用某药治某病，以某药监某药，以某药为引经，往来一年半，并无一定之方。至于一方之中，有攻补兼施者，也有先攻后补者，有先补后攻者，又大悟用古方治今病，焉能吻合，随时取中，这就是所谓的欤。那时罗又说，用古方治今病，正如拆旧屋，补凑新屋，其材木非一一再经匠氏之手，其可用乎？由此又思考许学士《发微论》说：我读仲景书，用仲景法，然而未曾守仲景之方，这才是得仲景之心。于是取东垣方稿，亲手抄录，才悟到治病患应当像汉高祖继暴秦，周武王继商之后，如果不是散财发粟，与三章之法，那受伤之气，疲倦之人，如何能平复呢。于是知道阴易乏，阳易亢，攻击宜审慎，正气须保护，以局方为惩戒啊。
【王海藏】许先生论述梁宽父的症状，右胁肺部，咳嗽而吐血，举动喘逆，这是肺诊。发热脉数不能食，是火来刑金，肺与脾俱虚。肺与脾俱虚而火乘之，其病为逆。像这样的情况，例不可补泻。因为补金则担心金与火相持，而喘咳增加。泻火则担心火不退位，而癖积反盛，只宜用补中益气汤，先扶元气，少量用治病药调和。听说已用药而未获效，必定病势苦逆，而药力未到。应当与宽父深入讨论，远期秋凉，或许可以平复。因为肺病者厌恶春夏火气，至秋冬则退，正宜于益气汤中，随四季阴阳升降浮沉温凉寒热，及见有症增损服用。升降浮沉则顺之，温凉寒热则反之，顺其理，和其气，为治之大法。或者觉得气壅，间或给予加减枳术丸。或者有饮，间服局方枳术汤。数月后，或许逆气少回，逆气回则治法可施，但恐怕已到色青色赤，脉弦脉洪则来不及了。近代论医有主河间刘氏者，有主易州张氏者。张氏用药，根据准四时阴阳升降而增损之，正合《内经》四气调神之义。医而不知此，是妄行。刘氏用药，务在推陈致新，不使少有怫郁，正造化新新不停之意。医而不知此，是无术。然而主张氏者，或未尽张氏之妙，则瞑眩之剂，终莫敢投，至失几后时，而不救者多矣。主刘氏者，或未极刘氏之妙，则取效目前，阴损正气，遗害后日者多矣。能用二子之长，而无二子之弊，其庶几乎。史副使病，不见色脉，不能悬料，以既愈复发言之，则恐亦宜取张氏根据准四时阴阳升降用药以扶元气，庶他日既愈而不发也。宽父病后，初感必深，所伤物恐当时消导不尽，停滞淹延，变生他症，以至于今，恐亦宜效刘氏推陈致新之法，少加消导药于益气汤中，庶可以取效也。
[Li Dongyuan] Medicine worthy of emulation, starting from Fuxi, Shennong, and the Yellow Emperor, although there are many famous doctors, only a few are truly worthy of emulation. As for Hua Tuo's abdominal surgery and Wang Shuhe's acupuncture techniques, their skills were indeed miraculous. How could later generations emulate them? They are not comparable to Qibo's classic writings, Leigong's herbal processing, Yi Yin's decoctions, Jizi's Five Elements theory, Bian Que's diagnostic inquiries, Zhang Zhongjing's *Treatise on Cold Damage*, Wang Shuhe's *Pulse Classic*, Huangfu Mi's *Jia Yi Jing* (Classics of A-Bian), Wang Bing's (Qixuanzi) commentaries, Qian Yi's (Qian Zhongyang) discussions, and Zhang Yuansu's (Jiegu) formularies. These are all "living methods" that can be learned by others. How can they be compared to those myriad prescriptions and theories that merely fixate the eyes of later practitioners? Among them, those with high virtue and far-reaching conduct, strange men and unusual scholars, as well as those who live in seclusion among officials or commoners, may have one skill or principle worth observing, but they are not "living methods" applicable for a hundred generations, so I do not adopt them. Do I enjoy debating? No, I simply wish for students to observe these sages and know where to direct their admiration. If someone merely wishes to browse widely without depth, thinking that much learning yields no practical benefit, is this understanding the root?
[Wang Haizang] The discussions by Qian Yi, the *Huo Ren Shu* (Book of Vitality), Wang Chaofeng, and Wang Defu are all from the Song Dynasty; Yi Lao (Zhang Yuansu) and Shouzhen (Liu Wansu) are from the Jin Dynasty. The differences in the cold and hot nature of the medicines they used stem from this foundation. When reading and applying these books, one must also consider the suitability based on locality and era. However, it is best to emulate Zhang Yuansu and synthesize with Zhang Zhongjing's decoctions, which constitutes the unchanging great method for ten thousand generations.
[*Suwen* (Yellow Emperor's Inner Canon)] Pathogenic winds arrive swiftly like wind and rain. Therefore, skilled physicians treat at the hair and skin level; next, at the muscle level; next, at the sinew and vessel level; next, at the six fu organs; and finally, at the five zang organs. Treating diseases at the zang organ stage results in half dying and half surviving.
When a disease first begins, it can be treated with acupuncture. If the pathogen is strong, wait for it to decline before treating. Thus, for light/shallow conditions, use dispersing methods; for heavy/deep conditions, use reducing methods; for declining/weak conditions, use methods to manifest righteousness. For deficiency of form, warm with qi-tonifying agents; for deficiency of essence, tonify with flavor-rich agents. For conditions located high, induce vomiting to expel upwards; for conditions located low, use draining methods to expel downwards. For fullness in the middle, drain internally. For those with pathogens, soak the body to induce sweating. For pathogens in the skin, use diaphoresis. For fierce/harsh pathogens, press and gather them. For excess conditions, disperse and drain. Examine yin and yang to distinguish soft and hard; treat yin diseases by addressing yang, and yang diseases by addressing yin. Stabilize blood and qi, keeping each in its proper place. For blood excess, use drainage/puncture; for qi deficiency, use traction/lifting. (All found in *Yin Yang Ying Xiang Lun*)
[Zhang Zhongjing] The general rule: Spring favors emesis, summer favors diaphoresis, autumn favors purgation, and winter favors warming and moxibustion.
[Wang Haizang] Diseases affecting the formless qi of heaven should be treated with diaphoresis; diseases affecting the formed pathogens of heaven should be treated with emesis; diseases affecting the formless qi of earth should be treated by promoting urination; diseases affecting the formed pathogens of earth should be treated by promoting defecation.
[*Mai Jing* (Pulse Classic)] To treat a disease, one must first know the origin of the syndrome before attacking it.
[Li Dongyuan] For example, when treating diseases, regardless of whether it is Cold Damage, Blood Stasis, Chest Binding, Jaundice, or other miscellaneous syndromes, one must seek the cause within the Six Channels. For instance, if Jaundice presents with headache, stiffness of the waist and spine, and aversion to cold, it indicates a Taiyang syndrome; if it presents with fever, eye pain, dry nose, and inability to lie down, it indicates a Yangming syndrome; the rest follow this pattern. (It is urgent to seek causes not only in the Six Channels but also in the Five Zang organs. For example, if the face is green, pulse is wiry, prone to anger, has dysuria, difficult defecation, and tendon spasms, it indicates a Liver syndrome; if the face is red, pulse is surging, prone to laughter, has dry mouth, body heat, vexation, heart pain, and heat in the palms, it indicates a Heart syndrome; the rest follow this pattern.)
[Zhu Danxi] Treating disease requires seeking its root. Disease having a root is like grass having roots; removing leaves but not roots means the grass remains. Treating disease is like weeding; treating the zang when the disease is in the zang, or treating the interior when the disease is in the exterior, not only damages stomach qi but also aids pathogenic factors. What kind of doctor is this?
One method treats malaria accumulation and dysentery by inducing vomiting until cured. One method treats dysphagia caused by foul blood using chive juice to resolve the foul blood until cured. One method treats chancre-induced spontaneous dysentery using Long Hui Wan (Dragon Gallbladder Pill) and Chai Hu Tang (Bupleurum Decoction) until cured. Details are found in respective categories.
[Wang Haizang] Treating disease requires seeking its root. For example, abdominal pain is treated with Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction plus Peony); severe excess pain is treated with Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction plus Rhubarb). Why add Shaoyao and Dahuang to Guizhi Tang rather than using them alone? Because one must address the Taiyang channel, taking Taiyang as the root. Similarly, for Chest Binding syndrome progressing downward, if the pulse is floating, do not purge; instead, first use Mahuang Tang (Ephedra Decoction) to release the exterior. After the exterior is resolved and the pulse becomes sunken, then use Xianxiong Tang (Depress the Chest Decoction) to purge. This is also seeking the root. Regarding Blood Stasis in the lower jiao, blood binding in the Bladder, this originates from the Taiyang channel, invading the formless qi first, then invading the formed blood in the Bladder.
[*Suwen*] If illness precedes reversal/disorder, treat the root. If reversal/disorder precedes illness, treat the root. If cold precedes illness, treat the root. If illness precedes cold, treat the root. If heat precedes illness, treat the root. If heat precedes middle-fullness, treat the branch. If illness precedes diarrhea, treat the root. If diarrhea precedes other illnesses, treat the root; one must regulate first, then treat other illnesses. If illness precedes middle-fullness, treat the branch. If middle-fullness precedes vexation, treat the root. People have guest qi and host qi. If urination and defecation are obstructed, treat the branch. If urination and defecation are free, treat the root. If the disease manifests with excess, treat the root first, then the branch. If the disease manifests with deficiency, treat the branch first, then the root. Carefully observe severity and mildness to adjust accordingly; for mild cases, treat both root and branch simultaneously; for severe cases, treat exclusively. If obstruction of urination/defecation precedes illness, treat the root. (*Biao Ben Bing Zhuan Lun*)
[Zhang Zhongjing] If a patient has a chronic entrenched disease and acquires an acute sudden disease, treat the acute sudden disease first, then treat the chronic entrenched disease.
[Wang Haizang] The initial treatment approach should be vigorous and fierce, meaning the medicinal potency is rapid and harsh. Since the disease is newly acquired suddenly, even if the symptoms seem light, one should use rapid and harsh formulas to eliminate them quickly. The intermediate treatment approach should balance gentleness and harshness, as the disease is neither new nor long-standing; use medicines of moderate speed to nourish righteousness and dispel pathogens synergistically. For example, if pathogens are abundant and righteous qi is scarce, use more dispelling medicines and fewer nourishing medicines. Such加减 (addition/subtraction) methods require clinical judgment. Follow seasonal timing and do not act recklessly. Add acupuncture, and the disease will heal. The final treatment approach should be broad and slow; "broad" means observing mild medicinal properties, and "slow" means administering non-toxic medicines broadly to nourish blood, qi, and center. Because the disease has been long-standing, pathogens are deeply latent, and righteous qi is weak, use good medicines broadly to nourish righteous qi while pathogens naturally depart. Adding acupuncture ensures rapid effect.
There are five methods of treating disease: Harmonizing (He), Taking/Attacking (Qu), Following (Cong), Breaking/Restraining (Zhe), and Belonging/Matching (Shu). Each has five variations, totaling twenty-five, such as Fire declining in Xu hour and Metal declining in Chen hour.
1. Harmonizing (He): For slight heat, use cool medicines to harmonize. If ineffective, proceed to Qu.
2. Taking (Qu): For slightly greater heat, use cold medicines to attack. If ineffective, proceed to Cong.
3. Following (Cong): For severe conditions, use warm medicines to follow the pathogen's nature. Medicines are warm in temperature, flavors vary. Use cold with heat, or heat with cold, or induce sweating. If ineffective, proceed to Zhe.
4. Breaking (Zhe): For extreme conditions, use counteracting methods. If ineffective, use purgative methods. If ineffective, proceed to Shu.
5. Belonging (Shu): Seek the belonging category to reduce the disease. If heat is deep in the marrow, unreachable by needles and herbs, seek its belonging to reduce it (seeking belonging follows resonance and affinity). The Classic says: For sinking conditions, use reduction. Reducing heat follows previous principles (Fire declines in Xu, Metal in Chen). If still ineffective, broaden the methods. Like Sun Tzu's warfare: in valleys, block springs; near water, guard crossings; in plains, clear fields for a thousand li. Blocking springs refers to acupuncture points. Guarding crossings refers to preempting the disease onset. Clearing fields refers to using major medicines to nourish righteous qi in emaciated patients.
Diseases have interior/exterior aspects; treatments have slow/fast aspects. Interior diseases are treated internally; exterior diseases externally. Slight disharmony of qi is regulated; greater disharmony is pacified; excessive conditions are drained/reduced. The Classic says: Regulate qi by distinguishing yin/yang, determining interior/exterior, keeping each in place. Interior treated internally, exterior externally, mild cases regulated, greater cases pacified, excessive cases drained via sweating or purging, cold/heat/warm/cool reduced by matching, following advantages.
[*Nanjing* (Classic of Difficult Issues)] Zang diseases are difficult to treat; Fu diseases are easy to treat. Why? Zang diseases are difficult because they transmit to the organ they overcome. Fu diseases are easy because they transmit to their offspring organ. This aligns with the Seven Transmissions and Intercalating Zang methods.
[Wang Haizang] If the pulse shows no disease, the Shen (Spirit) is silent but present. If the pulse shows disease, examine the presence or absence of Shen within the pulse. For example, rapid/excessive pulses indicate Heat; if forceful, there is Shen. Slow/defective pulses indicate Cold; if forceful, there is Shen. In Heat with Shen, drain the Heat, and Shen remains. In Cold with Shen, remove the Cold, and Shen remains. If Cold/Heat pulses are forceless and lack Shen, what medicine can drain Heat or remove Cold? Ignoring this and hastily draining leads to death in 80-90% of cases.
[*Suwen*] Form at ease, mind suffering: disease arises in vessels, treat with moxibustion and acupuncture. Form at ease, mind at ease: disease arises in flesh, treat with needles and stones. Form suffering, mind at ease: disease arises in sinews, treat with warming applications and stretching. Form suffering, mind suffering: disease arises in throat/esophagus, treat with various medicines. Frequent fear/startle: meridians blocked, disease arises in numbness/insensitivity, treat with massage and wine medicines. This is the Five Forms and Minds. (*Xue Qi Xing Zhi Pian*)
[Wang Haizang] *Huan Ji Bian Jing* states: Treat main diseases slowly, treat guest diseases urgently. All exterior syndromes require sweating. Floating pulse: sweat urgently; Sunken pulse: sweat slowly. All interior syndromes require purging. Floating pulse: purge slowly; Sunken pulse: purge urgently. Yang channels: sweat urgently, purge slowly. Yin channels: sweat slowly, purge urgently. Main disease: remove slowly. Guest disease: remove urgently. Qi disease in chest is self-disease (Main), treat slowly. Blood disease in chest is other-disease (Guest), treat urgently. Formless above entering abdomen below is Guest, treat urgently. Formed below entering chest above is Main, treat slowly. The Six Qi of the year are Host. Si Tian/Zai Quan intercalary Qi are Guests. Tonifying upper/treating upper uses slow formulation (avoiding blood medicines); Tonifying lower/treating lower uses urgent formulation (avoiding qi medicines). Heat in the highest region uses light agents applied gently; urgent administration causes middle-cold. If entering formed substances requiring purging, follow urgency/power. For large intestine slippage, use astringents; administer singly to reach lower parts, empty stomach before meals. Post-meal administration is harmful. This is slow treatment. Near diseases use Odd numbers (urgent then slow). Far diseases use Even numbers (urgent then slow). Lower diseases use Odd numbers (slow then urgent). Sweating uses Even numbers (slow then urgent).
*Ling Shu*: Odd/Even sweating from below nine earths; purging from above nine earths.
Li Dongyuan: Four-season medication rules apply regardless of disease type. Spring: add cooling wind-dispersing drugs. Summer: add great-cold drugs. Autumn: add warming qi drugs. Winter: add great-hot drugs. This preserves the source of transformation. Qian Yi understood this. *Neijing* says: Respect seasonal qi, do not harm heavenly harmony. Do not violate seasons or transformations. Do not harm vital qi. These are constant laws. If contrary to constants causes abnormal syndromes, use flexible treatment. E.g., alcohol consumption or extreme diet increases disease. Use weighing/adapting treatment. Flexible drugs are rarely used due to seasonal prohibitions.
[Zhu Danxi] I read Zhang Zihe's book, focusing only on attack. His view: Righteous qi cannot be diseased itself; disease occurs when pathogens lodge due to righteous qi deficiency. Removing pathogens restores righteousness. Based on disease location (upper/middle/lower, deep/shallow), he established Emesis, Sweating, and Purging. Initially, I thought this was the entirety of medical method. Then I recalled *Neijing*: Deficiency is essence/qi deficiency; Excess is pathogen abundance. Pathogens lodge only due to righteous qi deficiency. If righteous qi is sufficient, pathogens cannot enter. Thus, I doubted Zhang Zihe. I recalled *Neijing*: Yin flat and Yang secret, spirit governs; Yin/Yang separation, essence/qi ends. I recalled Zhang Zhongjing: If sweating is indicated but Chi pulse is choppy, use Huangqi Jianzhong Tang to tonify, then sweat. Thus, Zhang Zihe's book does not reflect his true intent or match *Neijing*/Zhongjing. Zhang was famous, yet his views differed greatly. I sought a master, traveling widely without success. In Zhen Ding, I found *Yuan Bing Shi* and Li Dongyuan, realizing Zhang Zihe's rashness, but still lacked certainty. In Tai Ding Yi Chou summer, I heard of Luo Taiwu via Chen Zhiyan. I visited him, was scolded several times, hesitated two months, then received him. He treated a monk with jaundice, thinness, fatigue. Cause: Monastic life, mother at home, traveled Zhejiang for 7 years, missed mother, cried daily, got sick. Age 25. Luo had him sleep nearby, fed beef/pork stomach stew for half a month, comforted him, gave silver for travel. Pulse filled slightly, gave Taoren Chengqi Tang three doses/day, expelled blood clots/phlegm. Next day, porridge. Recovered in half a month, left with silver. I realized attack methods require robust constitution. Otherwise, pathogens leave, righteous qi injured, minor illness becomes severe, severe becomes fatal. Luo listened to pulses, dictated prescriptions without fixed formulas, combining attack/tonification. I realized ancient formulas for modern diseases don't fit perfectly; one must adapt. Luo said: Using ancient formulas for modern diseases is like rebuilding an old house; materials must be reworked. I recalled Xu Xueshi: Reading Zhongjing's book, using his methods, but not sticking to his formulas is getting Zhongjing's heart. I copied Li Dongyuan's formulas, realizing treating disease after tyranny (like Han Gaozu/Shang Zhou) requires distributing wealth/grain and simple laws to restore injured qi/fatigue. Yin easily deficient, Yang easily hyperactive. Attacks must be cautious; righteous qi must be protected. Bureau Formulas serve as warning.
[Wang Haizang] Mr. Xu discussed Liang Kuanfu's case: Right hypochondriac lung area, coughing blood, panting on movement = Lung diagnosis. Fever, rapid pulse, inability to eat = Fire insulting Metal, Lung and Spleen deficiency. Lung/Spleen deficient with Fire invasion = adverse condition. Cannot tonify or purge directly. Tonifying Metal fears Metal/Fire conflict increasing cough. Purging Fire fears Fire remaining causing masses. Only use Buzhong Yiqi Tang (Tonify Middle and Augment Qi Decoction) to support Yuan Qi, mixing small amounts of disease-treating medicine. If no effect, disease is adverse, medicine hasn't reached. Discuss with Kuanfu, wait for autumn coolness. Lung diseases dislike Spring/Summer Fire; Autumn/Winter Fire retreats. Adjust Buzhong Yiqi Tang with seasonal yin/yang rising/falling/warm/cool/cold/hot. Rising/falling follow nature; warm/cool reverse nature. Smooth logic, harmonize qi. Occasionally use Jiazhi Zhuzhu Wan for qi stagnation or Ju Fang Zhizhu Tang for fluid retention. Months later, adverse qi returns, treatment proceeds. But if complexion turns blue/red, pulse wiry/surging, it's too late. Modern medicine has Liu Hejian (purge old/new) and Zhang Yizhou (seasonal adjustment). Zhang follows *Neijing* four qi regulation. Liu follows creation's continuous renewal. Neglecting Zhang is reckless; neglecting Liu is skillless. Zhang followers may fear drastic remedies, missing chances. Liu followers may seek quick results, damaging yin/righteous qi. Combining strengths avoids faults. Vice Minister Shi's relapse suggests using Zhang's seasonal method to support Yuan Qi. Liang Kuanfu's deep initial injury may have residual stagnation; adding digestive drugs to Buzhong Yiqi Tang (Liu's method) may yield results.