病患夜卧，先服百余粒，继以浚川等药投之，五更当下。种种病出，投下少末，再服和膈药
，须以利为度。有五日一下者，三日一下者。病轻者可一二度止，重者五六度方愈。是擒纵
卷舒之妙，临证制宜，非言可谕。观其药虽峻急，认病的确，自非老手谙练有大负荷者，焉
敢见诸行事。予每亲制，用之若符节然。又随人强弱，当根据河间渐次进服。强实之人，根据戴
人治法行之，神效可验。
大圣浚川散
大黄（一两，煨） 甘遂（半钱） 牵牛（一两，头末） 木香（三钱） 郁李仁（一两） 芒硝（三钱半）
评曰∶此下诸积之圣药也。诸湿为土，火热能生湿土，故夏热，则万物湿润；秋凉，则
湿复燥干。湿病本不自生，因于火热怫郁，水液不能宣通，停滞而生水湿也。凡病湿者多自
热生，而热气多为兼病。《内经》云∶明知标本，正行无间者是也。夫湿在上者，目黄而面
浮。在下者，股膝肿厥；在中者，肢满痞膈痿逆。在阳不去者，久则化气；在阴不去者，久
则成形。世俗不详《内经》所言留者攻之，但执补燥之剂，怫郁转加，而病愈甚也。法当求
病之所在而为施治，泻实补虚，除邪养正，以平为期而已。又尝考戴人治法，假如肝木乘脾
土，此土不胜木也。不胜之气，寻救于子。己土能生庚金，庚为大肠，味辛者为金，故大加
生姜，使伐肝木。然不开脾土，无由行也，遂以舟车丸先通闭塞之路，是先泻其所不胜，后
以姜汁调浚川散大下之，是泻其所胜也。戴人每言导水丸必用禹功散继之，舟车丸必以浚川
散随后，如寒疝气发动，腰脚胯急痛者，亦当下之，以泻其寒水。世俗暗于治体，一概卤莽
，有当下而非其药，终致委顿而已。岂知巴豆可以下寒，甘遂、芫花可以下湿，大黄、芒硝
可以下燥，如是分经下药，兼食疗之，非守一方求其备也。故戴人曰∶养生与攻 本自不同
，今人以补剂疗病，宜乎不效，是难言也。
〔丹〕∶六郁（气血冲和，百病不生，一有怫郁，诸病生焉）。
气∶香附 抚芎 苍术
湿∶苍术 川芎 白芷
痰∶海石 香附 栝蒌 南星
热∶青黛 香附 苍术 川芎 栀子
血∶桃仁 红花 青黛 川芎 香附
食∶苍术 香附 山楂 神曲 针砂（加醋炒）
春，加川芎；秋冬，加茱萸；夏，加苦参。
越鞠丸 解诸郁。
苍术 香附 川芎 神曲 栀子
凡郁在中焦，以苍术、抚芎，开提其气以升之。假如食在气上，提其气则食自降矣，余皆仿此。
益阴经血，解五脏结气。用山栀炒令十分有二分焦黑，为末。以姜汁入汤煎饮之。其效捷于他方也。
〔世〕顺气丸 治血郁。
香附半斤，童便浸，晒干，粟糊为丸。
〔《本》〕贝母，能散心胸郁结之气，殊有功。
〔《保》〕论曰∶虚损之人，寒热因虚而感也。感寒则损阳，阳虚则阴盛，故损自上而下
，治之宜以辛甘淡，过于胃则不可治也。感热则损阴，阴虚则阳盛，故损自下而上，治之宜
以甘苦酸咸，过于脾则不可治也。自上而下者，一损损于肺，皮聚而毛落；二损损于心，血
脉虚少，不能荣于脏腑，妇人月水不通；三损损于胃，饮食不为肌肤。自下而上者，一损损
于肾，骨痿不能起于床；二损损于肝，筋缓不能自收持；三损损于脾，饮食不能消克。论曰
∶心肺损而色败，肾肝损而形痿，谷不能化而脾损。感此病者，皆损之病，渐浸之深，皆虚
劳之疾也。
四君子汤 治肺损而皮聚毛落，益气可也。（方见前）
八物汤 治心肺虚损，皮聚而毛落，血脉虚损，妇人月水愆期，益气和血。（方见前）
十全散 治心肺损及胃，饮食不为肌肤，益气和血调食。（方见前）
金刚丸 治肾损，骨痿不能起于床，益精补肾。
萆 杜仲（炒） 苁蓉（酒浸） 菟丝子（酒浸，等分）
上细末，酒煮猪腰子为丸，桐子大。每服五、七十丸，空心酒下。
牛膝丸 治肝肾损，骨痿不能起床，筋缓不能收持，宜益精缓中。
牛膝（酒浸） 萆 杜仲（炒） 苁蓉（酒浸） 防风 菟丝子（酒浸） 白蒺藜（等分） 桂（一分）
上细末，酒煮猪腰子丸，桐子大。空心酒下五、七十丸。
煨肾丸 治肝肾损及脾，食谷不化，宜益精缓中消谷。
牛膝 萆 杜仲 苁蓉 菟丝子 白蒺藜 胡芦巴 破故纸（等分） 桂（半两）
上丸如金刚丸法。治腰痛不起者，神效。
上阴阳虚损诸方，盖谓虚而无热者设也。若虚而有热者，作虚热治之。虚热又分二法，
一治新病属虚热者，反治条求之；一治久病属劳瘵者，骨蒸门求之。
〔《素》〕络气不足，经气有余者，寸口热而尺寒也。秋冬为逆，春夏为从，治主病者
。经满络虚，刺阴灸阳。若经虚络满者，尺热寸口寒涩也，春夏死，秋冬生。络满经虚，灸
阴刺阳。经络皆实，是寸脉急而尺缓也，皆当治之。故曰滑则从，涩则逆也。（《通评虚实
论》）
〔《素》〕夫人之常数，太阳常多血少气，少阳常多气少血，阳明常多气多血，少阴
常多气少血，厥阴常多血少气，太阴常少血多气，此天之常数。（《血气形志论》）
〔许学士〕∶脉浮而有力者，表实也。浮而无力者，表虚也。沉而有力者，里实也。沉而无
力者，里虚也。
〔云〕脉浮诊得六数七极者，为表实也。浮诊得三迟二败者，为表虚也。如中诊得六数七
极者，是中焦之热实也。中诊得三迟二败者，中焦虚也。如沉诊得六数七极者，下焦有实热
也。沉诊得三迟二败者，下焦虚也。
〔《素》〕帝曰∶病之中外何如？岐伯曰∶调气之方，必别阴阳，定其中外，各守其乡，
内者内治，外者外治，微者调之，其次平之，盛者夺之，汗之下之，寒热温凉，衰之以属，
随其攸利，谨道如法，万举万全，气血正平，长有天命（《至真要大论》下同）。帝曰∶病之
中外何如？岐伯曰∶从内之外者调其内，从外之内者治其外。从内之外而盛于外者，先调其
内，而后治其外。从外之内而盛于内者，先治其外，而后调其内。中外不相及，则治主病。
〔垣〕表虚，桂枝、黄 ；表实，麻黄、葛根；里虚，人参、白术；里实，枳实、大黄。
（自汗，脉浮无力，为表虚；无汗，脉浮有力，为表实；自利，脉沉无力，为里虚；不大便
，脉沉有力，为里实）
〔海藏〕实 麻黄汤 实 调胃承气汤 实 大承气汤 浮中 沉虚 桂枝汤
虚 小建中汤 虚 四逆汤 浮可下者，外无六经之形证；沉可汗者，内无便溺之阻隔。
〔云〕麻黄为泻，能泻表之实，不能泻里之实；桂枝为补，能补表之虚，不能补里之虚；
姜附为补，不能补表之虚，而能补里之虚；承气为泻，能泻里之实，而不能泻表之实；建中
为补，能补中焦之虚；而不能补上焦下焦之虚；调胃为泻，能泻中焦之实，而不能泻上焦下
焦之实也。
〔《本事》〕有人病伤寒身热头疼，予视之曰∶邪在表，此表实证也，当汗之，以麻黄汤
。或问曰∶伤寒大抵因虚，故邪得以入之。今邪在表，何以云表实也？予曰∶古人称邪之所
凑，其气则虚，留而不去，其病则实。盖邪之入人也，始因虚入，及邪居中，则反为实矣。
大抵调治伤寒，先要明表里虚实，能明此四字，则仲景三百九十七法，可立而定也。何以言
之？有表实，有表虚，有里实，有里虚，有表里俱实，有表里俱虚。予于表里虚实歌中，常
论其事矣。仲景麻黄汤之类，为表实而设也；桂枝汤之类，为表虚而设也；里实，则承气之
类是也；里虚，则四逆之类是也。表里俱实，所谓阳盛阴虚，下之则愈也；表里俱虚，所谓
阳虚阴盛，汗之则愈也。常读华佗传，有府吏倪寻、李延，其证俱头痛身热，所苦正同，佗
曰∶寻外实当下之，延内实当发汗。或难其异，佗曰∶寻外实，延内实，故治之异耳。
麻黄汤 桂枝汤 承气汤（三方并见伤寒部） 四逆汤（方见伤寒门）
上仲景治表里虚实法，万世之准绳也。
〔垣〕戊申六月初，枢判白文举，年六十二，素有脾胃虚损病，目疾时作，身面目睛俱黄
，小便或黄或白，大便不调，饮食减少，气短上气，怠惰嗜卧，四肢不收。至六月中，目疾
复作，医以泻肝散下数行，而前疾增剧。予谓大黄、牵牛，虽能除湿热，而不能走经络，下
咽不入肝经，先入胃中，大黄苦寒重虚其胃，牵牛其味至辛，能泻肺气，重虚肺本，故嗽大
作。盖标实不去，本虚愈甚，加之适当暑雨之际，素有黄证之人，所以增剧也。此当补脾胃
肺之本脏，泻外经之湿热，制清神益气汤主之而愈。
防风（三分） 生姜（五分） 苍术（三分） 茯苓（三分） 泽泻（三分） 升麻（二分）
此药能走经，除湿热而不守，故不泻本脏，补肺与脾胃本脏中气之虚弱。
橘皮（二分） 青皮（一分） 人参（三分） 生甘草 白术 白芍药（各二分）
此药能守本而不走经，不走经者不滋经络中邪，守者能补五脏之元气。
五味子（三分） 麦门冬（二分） 人参（三分） 黄柏（一分）
此药去时令虚热湿蒸。
上锉如麻豆大。都作一服，水二盏，煎至一盏，去渣。稍热，空心服。
火炽之极，金伏之际，而寒水绝体于斯时也，故急救之以生脉散。除其湿热，以恶其太
甚。肺欲收，心苦缓，皆酸以收之。心火盛，则甘以泻之。故用人参之甘，佐以五味子之酸
。孙思邈曰∶夏月常服五味子，以补五脏气是也。麦门冬微苦寒，能滋水之源于金之位而清
肃肺气，又能除火刑金之嗽而敛其痰邪。复微加黄柏之苦寒，以为守位滋水之流，以镇坠其
浮气，而除两足之痿弱也。
上举东垣一法为例，余可触类而长也。
〔仲〕病有急当救里救表者，何也？师曰∶病医下之，续见下利清谷不止，身体疼痛者，
急当救里。后身体疼痛，清便自调者，急当救表也。救里，四逆汤；救表，桂枝汤。
〔罗〕征南帅不邻吉歹，肠鸣自利，咽溢肿痛，先治咽塞，后治下痢，愈。（方见《外热
内寒》）
〔本事〕后周姚僧垣，名医也。帝因发热，欲服大黄药。僧垣曰∶大黄乃急快药，至
尊年高，不宜轻用，帝不从，服之，遂至不起。及元帝有疾，诸医皆谓至尊至贵，不可轻服
大黄，宜用平药。僧垣曰∶脉洪而实，必有宿食，不用大黄，必无瘥理。元帝从之，果下宿
食，乃愈。合用与不用，必心下明得谛当，然后可。
〔海、仲景〕∶浮汗而沉下。右手沉实，调胃承气；左手沉实，桃仁、抵当。
〔《难经》〕沉汗而浮下。右手浮实，枳实、牵牛；左手浮实，桃仁、四顺。
右手∶杂病是为之表，伤寒是为之里。
左手∶杂病是为之里，伤寒是为之表。
患者夜间卧床休息时，先服用百余粒药物，随后投用浚川散等泻下药，通常在五更天（凌晨3-5点）应当排便。各种病邪随之下出，待泻下少量后，再服用和膈药，必须以通利为度。有的患者五日排便一次，有的三日排便一次。病情轻的患者一二次的排泄即可停止治疗，病情重的则需要五六次排泄才能痊愈。这是运用擒纵、卷舒手法的精妙之处，临证时需灵活制宜，不是言语可以完全说明白的。观察其药物虽然峻猛急迫，但只要辨证准确，如果不是经验丰富、担当重任的老医生，怎么敢付诸实施呢？我每次亲自配制，使用它就像符节相合一样灵验。又根据患者体质的强弱，应当参照河间学派的方法逐渐进服。体质强壮结实的人，参照戴人（张从正）的治法施行，神效可以验证。
大圣浚川散
大黄（一两，煨制） 甘遂（半钱） 牵牛子（一两，头末） 木香（三钱） 郁李仁（一两） 芒硝（三钱半）
评论说：这是攻下诸种积滞的圣药。各种湿邪属于土，火热能生湿土，所以夏天炎热，万物就湿润；秋天凉爽，湿气就恢复干燥。湿病本来不是自己产生的，是因为火热郁结，水液不能宣通，停滞而生成了水湿。凡是患湿病的，大多由热产生，而热气多作为兼夹的病邪。《内经》说：明知道标本，正确执行而不间断的就是这个道理。湿邪在上的，眼睛发黄而面部浮肿；在下的，大腿膝盖肿胀厥冷；在中间的，肢体胀满痞塞膈部痿弱逆乱。在阳分不去的，时间久了会化气；在阴分不去的，时间久了会成形。世俗之人不了解《内经》所说的“留者攻之”（有留滞的就要攻逐），只执着于补燥的药物，导致郁结加重，病情更加严重。治疗方法应当探求病邪所在的地方而施治，泻实补虚，祛除邪气养护正气，以平衡为准则罢了。又曾考证戴人的治法，假如肝木乘克脾土，这是土不胜木。不胜之气，向子脏求救。己土能生庚金，庚对应大肠，味辛的属金，所以大量加入生姜，来伐肝木。然而如果不打开脾土的闭塞，没有途径运行，于是先用舟车丸疏通闭塞的道路，这是先泻其所不胜（肝木），后用姜汁调服浚川散大力攻下，这是泻其所胜（脾土）。戴人常说导水丸必须用禹功散继之，舟车丸必须用浚川散随后，比如寒疝气发动，腰脚胯部急痛的患者，也应当攻下，以泻其寒水。世俗之人暗于治疗的体制，一概鲁莽行事，有应当攻下却用了不对的药，最终导致身体委顿而已。哪里知道巴豆可以下寒，甘遂、芫花可以下湿，大黄、芒硝可以下燥，像这样分经下药，兼用食疗，不是固守一方以求完备。所以戴人说：养生与攻邪本自不同，现在人用补剂治病，应该不效，这很难说啊。
〔丹溪〕：六郁（气血冲和，百病不生，一旦有郁结，诸病就产生了）。
气郁：香附 抚芎 苍术
湿郁：苍术 川芎 白芷
痰郁：海浮石 香附 瓜蒌 南星
热郁：青黛 香附 苍术 川芎 栀子
血郁：桃仁 红花 青黛 川芎 香附
食郁：苍术 香附 山楂 神曲 针砂（加醋炒）
春季，加川芎；秋冬，加茱萸；夏季，加苦参。
越鞠丸 解诸郁。
苍术 香附 川芎 神曲 栀子
凡郁结在中焦，用苍术、抚芎，开提其气使其上升。假如食物停滞在气之上，提起气则食物自然下降，其余都仿照这个原则。
益阴经血，解五脏结气。用山栀炒至十二分焦黑，研为末。用姜汁入汤煎饮。其疗效比其他方剂快捷。
〔世医〕顺气丸 治血郁。
香附半斤，童便浸泡，晒干，粟米糊为丸。
〔《保命集》〕论说：虚损之人，寒热因虚而感受外邪。感受寒邪则损伤阳气，阳虚则阴盛，所以损伤自上而下，治疗宜用辛甘淡味，如果伤及胃则不可治了。感受热邪则损伤阴液，阴虚则阳盛，所以损伤自下而上，治疗宜用甘苦酸咸味，如果伤及脾则不可治了。自上而下的，一损损于肺，皮毛聚缩而毛发脱落；二损损于心，血脉虚少，不能滋养脏腑，妇女月经不通；三损损于胃，饮食不能化为肌肤。自下而上的，一损损于肾，骨痿不能起床；二损损于肝，筋缓不能自我收持；三损损于脾，饮食不能消化。论说：心肺受损则面色败坏，肾肝受损则形体痿弱，谷气不能化生而脾受损。感受这些病的，都是损病，浸淫渐深，都是虚劳的疾病。
四君子汤 治肺损而皮聚毛落，益气即可。（方见前文）
八物汤 治心肺虚损，皮聚而毛落，血脉虚损，妇女月经延期，益气和血。（方见前文）
十全散 治心肺损及胃，饮食不能化为肌肤，益气和血调食。（方见前文）
金刚丸 治肾损，骨痿不能起床，益精补肾。
萆薢 杜仲（炒） 肉苁蓉（酒浸） 菟丝子（酒浸，等分）
以上研细末，酒煮猪腰子为丸，梧桐子大。每服五、七十丸，空腹酒送下。
牛膝丸 治肝肾损，骨痿不能起床，筋缓不能收持，宜益精缓中。
牛膝（酒浸） 萆薢 杜仲（炒） 肉苁蓉（酒浸） 防风 菟丝子（酒浸） 白蒺藜（等分） 桂枝（一分）
以上研细末，酒煮猪腰子为丸，梧桐子大。空腹酒送下五、七十丸。
煨肾丸 治肝肾损及脾，食谷不化，宜益精缓中消谷。
牛膝 萆薢 杜仲 肉苁蓉 菟丝子 白蒺藜 胡芦巴 破故纸（等分） 桂枝（半两）
以上按金刚丸的方法制丸。治腰痛不起者，神效。
上述阴阳虚损诸方，大概是针对虚而无热的情况设立的。如果虚而有热，按虚热治疗。虚热又分两种方法，一是治新病属虚热的，在反治条中寻求；一是治久病属劳瘵的，在骨蒸门中寻求。
〔《素问》〕络气不足，经气有余的，寸口脉热而尺部脉寒。秋冬出现是逆证，春夏出现是从证，治疗主病。经气满络气虚，刺阴经灸阳经。如果经气虚络气满，尺部热寸口寒涩，春夏死，秋冬生。络气满经气虚，灸阴经刺阳经。经络皆实，是寸脉急而尺脉缓，都应当治疗。所以说滑脉为顺，涩脉为逆。（《通评虚实论》）
〔《素问》〕人体的常数，太阳经常多血少气，少阳经常多气少血，阳明经常多气多血，少阴经常多气少血，厥阴经常多血少气，太阴经常少血多气，这是天的常数。（《血气形志论》）
〔许学士〕：脉浮而有力的，是表实。浮而无力的，是表虚。沉而有力的，是里实。沉而无力的，是里虚。
〔云岐子〕：脉浮诊得六数七极的，为表实。浮诊得三迟二败的，为表虚。如中诊得六数七极的，是中焦的热实。中诊得三迟二败的，是中焦虚。如沉诊得六数七极的，下焦有实热。沉诊得三迟二败的，下焦虚。
〔《素问》〕黄帝问：病在内外怎么样？岐伯答：调气的方剂，必须辨别阴阳，确定其中外，各守其位，内病内治，外病外治，轻微的调治，其次平复，盛的夺除，汗法下法，寒热温凉，按其属性衰退，随其便利，谨慎道法，万举万全，气血正平，长有天命（《至真要大论》下同）。黄帝问：病的内外怎么样？岐伯答：从内之外者调其内，从外之内者治其外。从内之外而盛于外的，先调其内，而后治其外。从外之内而盛于内的，先治其外，而后调其内。中外不相及，则治主病。
〔李东垣〕：表虚，用桂枝、黄芪；表实，用麻黄、葛根；里虚，用人参、白术；里实，用枳实、大黄。（自汗，脉浮无力，为表虚；无汗，脉浮有力，为表实；自利，脉沉无力，为里虚；不大便，脉沉有力，为里实）
〔张元素/海藏〕：实证用麻黄汤，实证用调胃承气汤，实证用大承气汤，浮中脉虚用桂枝汤；虚证用小建中汤，虚证用四逆汤。浮脉可下者，外无六经形证；沉脉可汗者，内无便溺阻隔。
〔云岐子〕：麻黄为泻，能泻表之实，不能泻里之实；桂枝为补，能补表之虚，不能补里之虚；姜附为补，不能补表之虚，而能补里之虚；承气为泻，能泻里之实，而不能泻表之实；建中为补，能补中焦之虚；而不能补上焦下焦之虚；调胃为泻，能泻中焦之实，而不能泻上焦下焦之实也。
〔《本事方》〕有人患伤寒身热头疼，我看后说：邪在表，这是表实证，应当发汗，用麻黄汤。有人问：伤寒大体因虚，所以邪得以侵入。现在邪在表，为什么说表实呢？我说：古人称邪之所凑，其气则虚，留而不去，其病则实。大概邪进入人体，开始因虚而入，等到邪居中，则反而为实了。大体调治伤寒，首先要明白表里虚实，能明白这四个字，那么仲景三百九十七法，可以确立而定。为什么这么说？有表实，有表虚，有里实，有里虚，有表里俱实，有表里俱虚。我在表里虚实歌中，常论述此事。仲景麻黄汤之类，是为表实而设的；桂枝汤之类，是为表虚而设的；里实，则是承气之类；里虚，则是四逆之类。表里俱实，所谓阳盛阴虚，下之则愈；表里俱虚，所谓阳虚阴盛，汗之则愈。常读华佗传，有府吏倪寻、李延，他们的症状都是头痛身热，所痛苦的一样，华佗说：倪寻外实当下之，李延内实当发汗。有人质疑其差异，华佗说：倪寻外实，李延内实，所以治疗不同。
麻黄汤 桂枝汤 承气汤（三方并见伤寒部） 四逆汤（方见伤寒门）
上述仲景治表里虚实法，是万世的准绳。
〔李东垣〕：戊申年六月初，枢判白文举，六十二岁，素有脾胃虚损病，眼疾时常发作，身面目睛都黄，小便或黄或白，大便不调，饮食减少，气短上气，怠惰嗜卧，四肢不收。到六月中，眼疾复发，医生用泻肝散下泄数次，而前面的病加剧。我说大黄、牵牛，虽能除湿热，但不能走经络，咽下不入肝经，先入胃中，大黄苦寒重虚其胃，牵牛其味至辛，能泻肺气，重虚肺本，所以咳嗽大作。大概标实不去，本虚愈甚，加之正当暑雨之际，素有黄证之人，所以加剧。这应当补脾胃肺之本脏，泻外经之湿热，制清神益气汤主之而愈。
防风（三分） 生姜（五分） 苍术（三分） 茯苓（三分） 泽泻（三分） 升麻（二分）
此药能走经，除湿热而不守，所以不泻本脏，补肺与脾胃本脏中气之虚弱。
橘皮（二分） 青皮（一分） 人参（三分） 生甘草 白术 白芍药（各二分）
此药能守本而不走经，不走经者不滋经络中邪，守者能补五脏之元气。
五味子（三分） 麦门冬（二分） 人参（三分） 黄柏（一分）
此药去时令虚热湿蒸。
以上锉如麻豆大。都作一服，水二盏，煎至一盏，去渣。稍热，空腹服。
火炽之极，金伏之际，而寒水绝体于斯时也，所以急救之以生脉散。除其湿热，以恶其太甚。肺欲收，心苦缓，都用酸味以收敛之。心火盛，则用甘味以泻之。所以用人参之甘，佐以五味子之酸。孙思邈说：夏月常服五味子，以补五脏气是也。麦门冬微苦寒，能滋水之源于金之位而清肃肺气，又能除火刑金之嗽而敛其痰邪。再微加黄柏之苦寒，以为守位滋水之流，以镇坠其浮气，而除两足之痿弱也。
以上列举东垣一法为例，其余可触类而长。
〔仲景〕：病有急当救里救表的，为什么呢？老师说：病人被医生误下，接着出现下利清谷不止，身体疼痛的，急当救里。后来身体疼痛，清便自调的，急当救表。救里，用四逆汤；救表，用桂枝汤。
〔罗谦甫〕：征南帅不邻吉歹，肠鸣自利，咽溢肿痛，先治咽塞，后治下痢，痊愈。（方见《外热内寒》）
〔《本事方》〕后周姚僧垣，名医。皇帝因发热，想服大黄药。僧垣说：大黄乃急快药，至尊年高，不宜轻用，皇帝不听，服之，遂至不起。等到元帝有病，众医都说至尊至贵，不可轻服大黄，宜用平药。僧垣说：脉洪而实，必有宿食，不用大黄，必无痊愈之理。元帝听从，果然下宿食，乃愈。合用与不用，必须心里明白得当，然后才可以。
〔张元素、仲景〕：浮脉汗法而沉脉下法。右手沉实，用调胃承气；左手沉实，用桃仁、抵当汤。
〔《难经》〕：沉脉汗法而浮脉下法。右手浮实，用枳实、牵牛；左手浮实，用桃仁、四顺散。
右手：杂病以此为表，伤寒以此为里。
左手：杂病以此为里，伤寒以此为表。
When the patient lies down to rest at night, first take over a hundred pills, followed by administering Jun Chuan San (Jun Chuan Powder) and other purgatives. Bowel movements should occur around Wugeng time (5:00-7:00 AM). Various pathogens will be expelled with the stool. After a small amount of purgation, administer He Ge Yao (Harmonizing Diaphragm Medicine), ensuring the condition is relieved through unblocking. Some patients may have bowel movements every five days, others every three days. For mild cases, one or two treatments may suffice; for severe cases, five or six treatments are needed for recovery. This demonstrates the subtlety of employing grasping/releasing and rolling/unrolling techniques, requiring flexible application in clinical practice, which cannot be fully explained by words alone. Although the medicines used are potent and urgent, as long as the disease pattern is accurately identified, only experienced physicians capable of bearing heavy responsibilities would dare to apply them. I prepare them personally each time, and their efficacy is as reliable as a tally matching its counterpart. Furthermore, dosage should be adjusted gradually according to the patient's constitution, referencing He Jian's methods. For robust individuals, Dai Ren's (Zhang Congzheng) treatment methods can be applied, yielding miraculous results.
Da Sheng Jun Chuan San (Great Sage Jun Chuan Powder)
Da Huang (Rhubarb Root and Rhizome, 1 liang, roasted) Gan Sui (Kansui Root, half qian) Qian Niu (Pharbitis Seed, 1 liang, first powder) Mu Xiang (Vladimiria Root, 3 qian) Yu Li Ren (Bush Cherry Kernel, 1 liang) Mang Xiao (Mirabilite, 3.5 qian)
Commentary: This is the supreme medicine for purging various accumulations. Dampness belongs to Earth; fire and heat generate damp earth. Thus, in summer heat, all things are moist; in autumn coolness, dampness returns to dryness. Damp diseases do not arise spontaneously but result from fire-heat stagnation preventing the free flow of body fluids, leading to accumulation and generation of water-dampness. Most damp diseases originate from heat, and heat often acts as a concurrent pathogen. The *Nei Jing* states: "Clearly understanding the root and branch, and executing correctly without interruption." When dampness is above, there is yellowing of the eyes and facial edema; when below, swelling and coldness of the thighs and knees; when in the middle, limb fullness, diaphragmatic obstruction, flaccidity, and rebellion. If lingering in Yang channels, it transforms into qi disorders over time; if lingering in Yin channels, it forms physical masses. Laypeople, unaware of the *Nei Jing*'s principle "Attack what remains," cling to drying tonics, worsening stagnation and aggravating the disease. Treatment must target the location of the pathogen, draining excess and tonifying deficiency, expelling evil and nourishing righteousness, aiming for balance. Examining Dai Ren's methods: if Liver Wood overacts on Spleen Earth, Earth fails to control Wood. The deficient Qi seeks relief from its "son" organ. Ji Earth generates Geng Metal; Geng corresponds to the Large Intestine, and pungent flavors belong to Metal. Therefore, large amounts of Sheng Jiang (Fresh Ginger) are added to subdue Liver Wood. However, without opening Spleen Earth blockage, movement is impossible. Thus, Zhou Che Wan (Boat and Cart Pill) is used first to clear obstructions, draining the "non-conquering" element (Liver). Then, Jun Chuan San mixed with ginger juice is administered to forcefully purge, draining the "conquered" element (Spleen). Dai Ren often stated that Dao Shui Wan (Water-Guiding Pill) must be followed by Yu Gong San (Yu Gong Powder), and Zhou Che Wan must be followed by Jun Chuan San. For example, in Cold Hernia attacks causing acute pain in the waist, legs, and hips, purgation is indicated to drain cold-water. Laypeople, ignorant of treatment principles, act rashly, using inappropriate purgatives, leading to debility. They fail to realize that Ba Dou (Croton Seed) drains cold, Gan Sui and Yuan Hua (Genkwa Flower) drain dampness, while Da Huang and Mang Xiao drain dryness. Medicines should be selected based on channel affinity, combined with dietary therapy, rather than rigidly adhering to a single formula. Thus, Dai Ren said: "Nourishing life and attacking pathogens are fundamentally different." Using tonics to treat disease often yields no effect, which is difficult to explain.
[Danxi]: Six Stagnations (When Qi and Blood are harmonious, no disease arises; once stagnation occurs, various diseases emerge).
Qi Stagnation: Xiang Fu (Cyperus Rhizome), Fu Xiong (Ligusticum Chuanxiong), Cang Zhu (Atractylodes Rhizome)
Damp Stagnation: Cang Zhu, Chuan Xiong, Bai Zhi (Angelica Dahurica)
Phlegm Stagnation: Hai Shi (Floating Lithostes), Xiang Fu, Gua Lou (Trichosanthes Fruit), Nan Xing (Arisaema Cum Bile)
Heat Stagnation: Qing Dai (Indigo Naturalis), Xiang Fu, Cang Zhu, Chuan Xiong, Zhi Zi (Gardenia Fruit)
Blood Stagnation: Tao Ren (Peach Kernel), Hong Hua (Carthamus Flower), Qing Dai, Chuan Xiong, Xiang Fu
Food Stagnation: Cang Zhu, Xiang Fu, Shan Zha (Hawthorn Fruit), Shen Qu (Medicated Leaven), Zhen Sha (Magnetite, stir-fried with vinegar)
In Spring, add Chuan Xiong; in Autumn/Winter, add Zhu Yu (Cornus Fruit); in Summer, add Ku Shen (Sophora Root).
Yue Ju Wan (Resolving Stagnation Pill) resolves various stagnations.
Ingredients: Cang Zhu, Xiang Fu, Chuan Xiong, Shen Qu, Zhi Zi.
For stagnation in the Middle Jiao, use Cang Zhu and Fu Xiong to lift and ascend Qi. If food stagnates above Qi, lifting Qi causes food to descend naturally; apply this principle to others.
Tonifies Yin channel blood, resolves knotting Qi in the Five Zang organs. Use Zhi Zi (Gardenia Fruit) fried until 12 parts are charred black, powdered. Decoct with Jiang Zhi (Ginger Juice) in water and drink. Its efficacy is faster than other formulas.
[World Physicians]: Shun Qi Wan (Regulate Qi Pill) treats Blood Stagnation.
Xiang Fu (8 liang), soaked in child's urine, dried, formed into pills with millet paste.
[Ben Cao]: Bei Mu (Fritillaria Bulb) can dissipate knotting Qi in the chest and heart, with significant merit.
[Bao Ming Ji]: Discussion: In deficiency damage, cold and heat are contracted due to deficiency. Contracting cold damages Yang; Yang deficiency leads to Yin excess, so damage proceeds from top to bottom. Treatment should use Pungent, Sweet, and Bland flavors; if it reaches the Stomach, it is incurable. Contracting heat damages Yin; Yin deficiency leads to Yang excess, so damage proceeds from bottom to top. Treatment should use Sweet, Bitter, Sour, and Salty flavors; if it reaches the Spleen, it is incurable. From top to bottom: First damage affects Lung, causing skin contraction and hair loss; Second damage affects Heart, causing blood vessel deficiency, inability to nourish Zang organs, and amenorrhea in women; Third damage affects Stomach, causing food not transforming into flesh. From bottom to top: First damage affects Kidney, causing bone flaccidity and inability to rise from bed; Second damage affects Liver, causing tendon laxity and inability to grasp; Third damage affects Spleen, causing inability to digest food. Discussion: Damage to Heart/Lung causes complexion deterioration; damage to Kidney/Liver causes physical flaccidity; inability to transform grain indicates Spleen damage. These are all damage diseases, deeply infiltrated, constituting Deficiency Consumption illnesses.
Si Jun Zi Tang (Four Gentlemen Decoction) treats Lung damage with skin contraction and hair loss; tonify Qi. (Formula seen previously)
Ba Wu Tang (Eight Substance Decoction) treats Heart/Lung deficiency damage, skin/hair loss, blood vessel deficiency, delayed menstruation in women; tonify Qi and harmonize Blood. (Formula seen previously)
Shi Quan San (Ten Complete Powder) treats Heart/Lung damage extending to Stomach, food not transforming into flesh; tonify Qi, harmonize Blood, and regulate diet. (Formula seen previously)
Jin Gang Wan (Diamond Pill) treats Kidney damage, bone flaccidity, inability to rise; tonify Essence and tonify Kidney.
Bi Xie (Dioscorea Hypoglauca Rhizome), Du Zhong (Eucommia Bark, stir-fried), Rou Cong Rong (Cistanche Stem, wine-soaked), Tu Si Zi (Cuscuta Seed, wine-soaked, equal parts).
Grind into fine powder, decoct pig kidneys in wine to form pills, size of paulownia seeds. Take 50-70 pills per dose, with wine on an empty stomach.
Niu Xi Wan (Achyranthes Pill) treats Kidney/Liver damage, bone flaccidity, inability to rise, tendon laxity; tonify Essence and soothe the Middle.
Niu Xi (Achyranthes Root, wine-soaked), Bi Xie, Du Zhong (stir-fried), Rou Cong Rong (wine-soaked), Fang Feng (Saposhnikovia Root), Tu Si Zi (wine-soaked), Bai Ji Li (Tribulus Fruit, equal parts), Gui Zhi (Cinnamon Twig, 1 fen).
Grind into fine powder, decoct pig kidneys in wine to form pills, size of paulownia seeds. Take 50-70 pills with wine on an empty stomach.
Wei Shen Wan (Roasted Kidney Pill) treats Kidney/Liver damage affecting Spleen, undigested food; tonify Essence, soothe Middle, and aid digestion.
Niu Xi, Bi Xie, Du Zhong, Rou Cong Rong, Tu Si Zi, Bai Ji Li, Hu Lu Ba (Trigonella Foenum-graecum Seed), Po Gu Zhi (Cibotium Rhizome, equal parts), Gui Zhi (0.5 liang).
Prepare pills following the method for Jin Gang Wan. Miraculous for treating back pain preventing rising.
The above formulas for Yin/Yang deficiency damage are designed for deficiency without heat. If deficiency involves heat, treat as Deficiency Heat. Deficiency Heat has two approaches: treat new-onset deficiency heat under "Contrary Treatment"; treat chronic deficiency heat (consumption) under "Bone Steaming".
[Su Wen]: When Luo Qi is insufficient and Jing Qi is excessive, Cun Kou pulse is hot while Chi pulse is cold. This is adverse in Autumn/Winter, favorable in Spring/Summer. Treat the primary disease. When Jing Qi is full and Luo Qi is deficient, puncture Yin channels and moxa Yang channels. If Jing Qi is deficient and Luo Qi is full, Chi pulse is hot and Cun Kou pulse is cold and choppy; fatal in Spring/Summer, survivable in Autumn/Winter. When Luo Qi is full and Jing Qi is deficient, moxa Yin channels and puncture Yang channels. When both Jing and Luo are excess, Cun pulse is rapid/tight and Chi pulse is slow/soft; both require treatment. Thus, Slippery pulse indicates favorable prognosis, Choppy pulse indicates unfavorable. (*Tong Ping Xu Shi Lun*)
[Su Wen]: The constant numbers of the human body: Tai Yang channel often has much Blood and little Qi; Shao Yang channel often has much Qi and little Blood; Yang Ming channel often has much Qi and much Blood; Shao Yin channel often has much Qi and little Blood; Jue Yin channel often has much Blood and little Qi; Tai Yin channel often has little Blood and much Qi. These are heavenly constants. (*Xue Qi Xing Zhi Lun*)
[Xu Xueshi]: Floating pulse with force indicates Exterior Excess. Floating pulse without force indicates Exterior Deficiency. Deep pulse with force indicates Interior Excess. Deep pulse without force indicates Interior Deficiency.
[Yun Qizi]: Floating pulse with 6 rapid/7 extreme beats indicates Exterior Excess. Floating pulse with 3 slow/2 failing beats indicates Exterior Deficiency. Mid-pulse with 6 rapid/7 extreme beats indicates Middle Jiao Heat Excess. Mid-pulse with 3 slow/2 failing beats indicates Middle Jiao Deficiency. Deep pulse with 6 rapid/7 extreme beats indicates Lower Jiao Real Heat. Deep pulse with 3 slow/2 failing beats indicates Lower Jiao Deficiency.
[Su Wen]: Emperor asked: How are diseases internal and external? Qibo answered: Methods for regulating Qi must distinguish Yin and Yang, determine internal and external, keeping each in its place. Internal diseases treated internally, external diseases treated externally. Mild cases regulated, next level balanced, severe cases drained. Use sweating or purging methods. Cold, Heat, Warm, Cool therapies reduce according to their nature. Follow benefits carefully, adhere to the Way, and success is assured. Qi and Blood become balanced, granting longevity. (*Zhi Zhen Yao Da Lun*). Emperor asked again: How are diseases internal and external? Qibo answered: Diseases originating internally manifest externally should be treated internally; diseases originating externally manifest internally should be treated externally. If internal disease manifests severely externally, treat internal first, then external. If external disease manifests severely internally, treat external first, then internal. If internal and external are unrelated, treat the primary disease.
[Li Dongyuan]: Exterior Deficiency uses Gui Zhi (Cinnamon Twig) and Huang Qi (Astragalus Root); Exterior Excess uses Ma Huang (Ephedra Herb) and Ge Gen (Kudzu Root); Interior Deficiency uses Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Macrocephala Rhizome); Interior Excess uses Zhi Shi (Immature Bitter Orange) and Da Huang (Rhubarb Root). (Spontaneous sweating, floating pulse without force = Exterior Deficiency; No sweating, floating pulse with force = Exterior Excess; Spontaneous diarrhea, deep pulse without force = Interior Deficiency; Constipation, deep pulse with force = Interior Excess)
[Zhang Yuansu/Hai Zang): Excess: Ma Huang Tang (Ephedra Decoction), Excess: Tiao Wei Cheng Qi Tang (Regulate Stomach and Direct to Sorrow Decoction), Excess: Da Cheng Qi Tang (Great Direct to Sorrow Decoction), Floating/Middle Deficiency: Gui Zhi Tang (Cinnamon Twig Decoction); Deficiency: Xiao Jian Zhong Tang (Minor Construct the Middle Decoction), Deficiency: Si Ni Tang (Four Reversal Decoction). If Floating pulse allows purging, there are no Six Channel manifestations externally; if Deep pulse allows sweating, there are no urinary/fecal obstructions internally.
[Yun Qizi]: Ma Huang is draining; it drains Exterior Excess but cannot drain Interior Excess. Gui Zhi is tonifying; it tonifies Exterior Deficiency but cannot tonify Interior Deficiency. Jiang (Ginger) and Fu Zi (Aconite Root) are tonifying; they cannot tonify Exterior Deficiency but can tonify Interior Deficiency. Cheng Qi formulas are draining; they drain Interior Excess but cannot drain Exterior Excess. Jian Zhong is tonifying; it tonifies Middle Jiao Deficiency but cannot tonify Upper/Lower Jiao Deficiency. Tiao Wei is draining; it drains Middle Jiao Excess but cannot drain Upper/Lower Jiao Excess.
[Ben Shi Fang): A patient had Shang Han (Cold Damage) with fever and headache. I diagnosed: Pathogen in Exterior, this is Exterior Excess, should sweat, prescribe Ma Huang Tang. Questioned: Shang Han is generally due to deficiency, allowing pathogen entry. Now pathogen is in Exterior, why call it Exterior Excess? Answer: Ancients say where pathogen gathers, Qi is deficient; if it stays, the disease becomes excess. Pathogen enters due to initial deficiency, but once centered, it becomes excess. Treating Shang Han requires clarifying Exterior/Interior and Excess/Deficiency. Understanding these four characters allows mastering Zhang Zhongjing's 397 methods. There is Exterior Excess, Exterior Deficiency, Interior Excess, Interior Deficiency, Both Exterior/Interior Excess, Both Exterior/Interior Deficiency. I discussed this in the Song of Exterior/Interior Excess/Deficiency. Zhang's Ma Huang Tang is for Exterior Excess; Gui Zhi Tang is for Exterior Deficiency; Cheng Qi formulas are for Interior Excess; Si Ni Tang is for Interior Deficiency. Both Exterior/Interior Excess is Yang Excess/Yin Deficiency, cured by purging. Both Exterior/Interior Deficiency is Yang Deficiency/Yin Excess, cured by sweating. Reading Hua Tuo's biography, officials Ni Xun and Li Yan both had headache and fever. Hua Tuo said: Ni Xun has Exterior Excess, purge him; Li Yan has Interior Excess, sweat him. Criticized for difference, Hua Tuo explained: Ni Xun is Exterior Excess, Li Yan is Interior Excess, hence different treatments.
Ma Huang Tang, Gui Zhi Tang, Cheng Qi Tang (see Shang Han section), Si Ni Tang (see Shang Han section).
Zhang Zhongjing's methods for treating Exterior/Interior Excess/Deficiency are the standard for eternity.
[Li Dongyuan]: Early June, Wushen year, Vice Director Bai Wenju, age 62, had chronic Spleen/Stomach deficiency damage, recurrent eye disease, jaundice of body/face/eyes, yellow or white urine, irregular bowels, reduced appetite, shortness of breath, lethargy, desire to sleep, limbs unable to move. Mid-June, eye disease recurred. Doctor used Xie Gan San (Drain Liver Powder) several times, worsening previous symptoms. I said: Da Huang and Qian Niu remove damp-heat but do not enter channels. Swallowed, they enter Stomach first. Da Huang's bitter-cold heavily damages Stomach Qi; Qian Niu's pungency drains Lung Qi, heavily damaging Lung Root, causing severe cough. Since Branch Excess was not removed, Root Deficiency worsened. Plus, during summer rains, those with prior jaundice exacerbate. Treatment should tonify Spleen/Stomach/Lung Roots and drain External Channel Damp-Heat. Prescribed Qing Shen Yi Qi Tang (Clear Spirit and Boost Qi Decoction), resulting in cure.
Fang Feng (Saposhnikovia Root, 3 fen), Sheng Jiang (Fresh Ginger, 5 fen), Cang Zhu (Atractylodes Rhizome, 3 fen), Fu Ling (Poria, 3 fen), Ze Xie (Alisma Rhizome, 3 fen), Sheng Ma (Cimicifuga Rhizome, 2 fen).
This drug travels through channels, removes damp-heat without staying, thus not draining Root organs, but tonifying Lung and Spleen/Stomach Qi deficiency.
Chen Pi (Tangerine Peel, 2 fen), Qing Pi (Green Tangerine Peel, 1 fen), Ren Shen (Ginseng Root, 3 fen), Sheng Gan Cao (Raw Licorice Root), Bai Zhu (Atractylodes Rhizome), Bai Shao Yao (White Peony Root, 2 fen each).
This drug stays in Root without traveling channels. Not traveling channels avoids nourishing pathogens in meridians; staying tonifies Yuan Qi of Five Zang organs.
Wu Wei Zi (Schisandra Berry, 3 fen), Mai Men Dong (Ophiopogon Tuber, 2 fen), Ren Shen (Ginseng Root, 3 fen), Huang Bo (Phellodendron Bark, 1 fen).
This drug removes seasonal deficiency heat and damp steaming.
Cut like hemp beans. One dose, 2 cups water, decoct to 1 cup, strain. Drink slightly warm on empty stomach.
When Fire is blazing and Metal is subdued, Water is exhausted. Rescue urgently with Sheng Mai San (Generate Pulse Powder). Remove damp-heat to counteract extremity. Lung desires astringency, Heart suffers from laxity; use Sour flavor to astringe. Heart Fire excess, use Sweet flavor to drain. Thus, use Ren Shen's Sweetness assisted by Wu Wei Zi's Sourness. Sun Simiao said: Taking Wu Wei Zi in summer tonifies Five Zang Qi. Mai Men Dong is slightly bitter-cold, nourishes Water source at Metal position, clears Lung Qi, stops cough from Fire punishing Metal, and consolidates phlegm. Add slight Huang Bo bitterness-cold to guard position, nourish Water flow, settle floating Qi, and eliminate leg flaccidity.
Using Dongyuan's method as an example, others can be extended by analogy.
[Zhongjing]: When disease requires urgent rescue of Interior or Exterior, how to decide? Master said: If doctor purged incorrectly, leading to continuous diarrhea with undigested food and body pain, urgently rescue Interior. Later, if body pain persists but bowels normalize, urgently rescue Exterior. Rescue Interior with Si Ni Tang; Rescue Exterior with Gui Zhi Tang.
[Luo]: Southern Campaign Commander Bu Lin Ji Dai had borborygmus and spontaneous diarrhea, throat swelling/pain. Treated throat obstruction first, then dysentery, resulting in cure. (Formula see "Exterior Heat Interior Cold")
[Ben Shi Fang): Yao Sengyuan of Later Zhou was a famous physician. Emperor had fever, wanted to take Da Huang. Sengyuan said: Da Huang is a harsh drug; Your Majesty is old, do not use lightly. Emperor refused, took it, and died. When Yuan Emperor fell ill, doctors said he is noble, should not take Da Huang lightly, use mild drugs. Sengyuan said: Pulse is洪 (Surging) and Shi (Excess), must have retained food. Without Da Huang, no cure. Yuan Emperor agreed, passed retained food, and recovered. Whether to use or not must be judged clearly in mind.
[Zhang Yuansu/Zhongjing]: Floating pulse -> Sweat; Deep pulse -> Purge. Right Hand Deep Excess: Tiao Wei Cheng Qi Tang. Left Hand Deep Excess: Tao Ren (Peach Kernel), Di Dang (Di Dang Decoction).
[Nan Jing): Deep pulse -> Sweat; Floating pulse -> Purge. Right Hand Floating Excess: Zhi Shi, Qian Niu. Left Hand Floating Excess: Tao Ren, Si Shun (Si Shun San).
Right Hand: Miscellaneous diseases consider this Exterior; Shang Han considers this Interior.
Left Hand: Miscellaneous diseases consider this Interior; Shang Han considers this Exterior.