〔仲〕夫诸病在脏欲攻之，当随其所得而攻之，如渴者与猪苓汤，余皆仿此。
〔垣〕头痛须用川芎。如不愈，各加引经药（太阳川芎，阳明白芷，太阴苍术，少阴细辛
，少阳柴胡，厥阴吴茱萸）。顶巅痛须用 本，去川芎（一本作“项颈脑痛”）。肢节痛，须
用羌活。去风湿，亦宜用之。腹痛，须用芍药；恶寒而痛者加桂；恶热而痛者加黄柏；心下
痞用枳实、黄连；肌热及去痰者，须用黄芩；肌热，亦用黄 ；腹胀，用姜制浓朴；虚热，
须用黄 ，止虚汗亦用；胁下痛，往来寒热，日晡潮热，须用柴胡脾胃受湿，沉困无力，怠
堕好卧，去痰用白术；破滞气，用枳壳，高者用之。夫枳壳者，损胸中至高之气，三二服而
已。破滞血，用桃仁、苏木；补血不足，须用甘草；去痰，须用半夏；热痰，加黄芩；风痰
，加南星；胸中寒痰痞塞，用陈皮、白术。多用苦寒，则泻脾胃。腹中窄狭，须用苍术；调
气，须用木香；补气，须用人参；和血，须用当归。凡血受病者，皆当用当归也。去下焦湿
肿及痛，并膀胱有火邪者，必须酒洗防己、草龙胆、黄柏、知母；去上焦湿及热，须用黄芩
，泻肺火故也。去中焦湿热与痛，用黄连，泻心火故也。去滞气，用青皮，勿多服，多服则
泻人真气。渴者，用干葛、茯苓，禁半夏；嗽者，用五味子；喘者，用阿胶；宿食不消，用
黄连、枳实；胸中烦热，须用栀子仁；水泻，须用白术、茯苓、芍药；气刺痛，用枳实，看
何部分，以引经药导使之行则可。血刺痛，用当归，详上下用根梢。疮痛不可忍者，用苦寒
药，如黄柏、黄芩，详上下根梢用，及引经药则可。眼痛不可忍者，用黄连、当归根，以酒
浸煎；小便黄者，用黄柏；数者涩者，或加泽泻。腹中实痛兼热，用大黄、芒硝。小腹痛，
用青皮；茎中痛，用生甘草梢。饮水多致伤者，用白术、茯苓、猪苓。胃脘痛，用草豆蔻。
凡用纯寒纯热药，必用甘草以缓其力也。寒热相杂，亦用甘草调和其性也。中满禁用，经曰
∶中满者勿食甘。
〔洁古〕非白术不能去湿，非枳实不能消痞，非天雄不能补上焦阳之虚，非附子不能补下
焦阴之虚。
〔垣〕如脉缓怠惰嗜卧，四肢不收，或大便泄泻，此湿胜，从平胃散。若脉弦气弱自汗，
四肢发热，或大便泄泻，或皮毛枯槁，发脱落，从黄 建中汤。脉虚而血弱，于四物汤中摘
一味或二味，以本显症中加之。或真气虚弱，及气短脉弱，从四君子汤。或渴或小便秘涩，
赤黄多少，从五苓散去桂，摘一二味加正药中。假令表虚自汗，春夏加黄 ；秋冬加桂。如
腹中急缩，或脉弦，加防风；急甚，加甘草。腹中窄狭，或气短者，亦加之。腹满气不转者
，勿加。虽气不转，而脾胃中气不和者，勿去，但加浓朴以破滞气，然亦不可多用，于甘草
五分中加一分可也。腹中夯闷，此非腹胀，乃散而不收，可加芍药；如肺气短促或不足者，
加人参、白芍；中焦用白芍，则于脾中升阳，使肝胆之邪不敢犯也。腹中窄狭及缩急者，去
之，及诸酸涩药不可用。腹中疼痛者，加甘草、芍药。稼穑作甘，甘者己也。曲直作酸，酸
者甲也。甲己化土，此仲景妙法也。腹痛兼发热，加黄芩；恶寒或腹中觉寒，加桂；怠惰嗜
卧有湿，胃虚不能食，或沉困，或泄泻，加苍术；自汗，加白术；小便不利，加茯苓，渴亦
加之；气弱者，加白茯苓、人参；气盛者，加赤茯苓、缩砂仁；气复不能转运有热者，微加
黄连，心烦乱亦加之。小便少者，加猪苓、泽泻，汗多津液竭于上勿加之，是津液还入胃中
，欲自行也。不渴而小便秘塞，加炒黄柏、知母；小便涩者，加炒滑石；小便淋涩者，加泽
泻，且五苓散治渴，而小便不利无恶寒者，不得用桂；不渴而小便自利，妄见妄闻，乃瘀血
症，用炒黄柏、知母以除肾中燥热；窍不利而淋，加泽泻、炒滑石；只治窍不利者，六乙散
中加木通亦可。心藏热者，用钱氏导赤散；中满或但腹胀者，加浓朴；气不顺，加橘皮。气
滞，加青皮一橘皮三；气短小便利者，四君子汤中去茯苓，加黄 以补之。如腹中气不转者
，更加甘草一半。腹中刺痛，或周身刺痛者，或里急者，腹中不宽快是也，或虚坐而大便不
得者，皆血虚也。血虚则里急，或血气虚弱，而目睛痛者，皆加当归身。头痛，加川芎；苦
头痛加细辛，此少阴头痛也；发脱落及脐下痛者，加熟地黄。如皮毛肌肉之不伸，无大热不
能食而渴者，加葛根半两。燥热及胃气上冲，为冲脉所逆，或作逆气，而里急者，加炒黄柏
、知母；觉胸热而不渴，加炒黄芩。如胸中结滞气涩，或有热者，亦各加之。如食少而小便
少者，津液不足也，勿利之，益气补胃自行矣。如气弱气短者，加人参。只升阳之剂，助阳
之胜，多加参。恶热发热而燥渴，脉洪大者，白虎汤主之。或喘者，加人参。如渴不止，寒
水石、石膏各等分少少与之，即钱氏方中甘露散，主身大热而小便数，或上饮下溲，此燥热
也。气燥，加白葵花；血燥，加赤葵花；如小便行病增者，此内燥津液不能停，当致津液少
加炒黄柏、赤葵花；如心下痞闷者，加黄连一黄芩三，减诸甘药，不能食心下软而痞者，甘
草泻心汤则愈（痞有九种，治有五方，见仲景泻心为的）。如喘满者加炙浓朴（小便不利者加
之，如利为禁药）。如胃虚弱而痞者，加甘草；喘而小便不利者，加苦葶苈；如气短气弱而
腹微满者，不去人参，去甘草，加浓朴；然不若苦味泄之，而不令大便行。如腹微满而气不
转者，加之。如中满者，去甘草，倍黄连，加黄柏，更加三味五苓散少许；此病虽宜升宜汗
。如汁多亡阳，加黄 ；四肢烦热肌热，与柴胡、羌活、升麻、葛根、甘草则愈；如鼻清涕
恶风，或项背脊膂强痛，羌活、防风、甘草等分，黄 倍加，临卧服之。
脉热身热加减法，见发热门。
《禁服篇》云∶约方犹约囊也，囊满弗约则输泄，方成弗约则神与气弗俱。未满而知约
之，可以为工，不可以为天下师。此圣人所以退太过而进不及，以平为期也。大凡气味者有
毒无毒，固宜常制矣。是以大毒治病，十去其六；常毒治病，十去其七；小毒治病，十去其
八；无毒治病，十去其九，余以谷肉菜果食养尽之，无使过之伤其正也。至如君一臣二，奇
之制也。君二臣四，偶之制也。近而奇偶，制小其服。远而奇偶，制大其服。大则数少，小
则数多，多则九之，少则二之。补上治上制以缓，补下治下制以急。急则气味浓，缓则气味
薄。下不以偶，汗不以奇。随其邪之所在高下浅深轻重虚实，影响无间，万举万全，是谓中
行，故可为师也。假如证大而汤剂小，则邪气少屈，故药力已乏，欲不复治，其可得乎。犹
一杯水救一舆薪之火，火竟不灭，是谓不及，故不可以为师而可以为工矣。证小则汤剂大而
邪服，邪已尽而药余力，欲不伤正，何所容哉。犹火炎昆岗，玉石俱焚，莫之能止，是谓太
过，此又不可以为工，是为粗医也。三者之论，惟中而已，过与不及，皆为偏废。然而太过
犹甚于不及，何以明之？盖失于姑息，邪复胜正者，止于劳而无益，犹可勉而适中。或失苛
暴，则血气被伤，因致羸替者有之，危残者有之，灭亡者有之，非徒无益，而又害之，此所
谓犹甚也，可不戒哉。尝考仲景之书，于承气汤下攻里，则曰若更衣止后服。于桂枝方后发
表，乃云 微汗益佳，不可令如水淋漓。皆本乎轩岐之微旨也。
〔仲〕言锉如麻头，与 咀同意。夫 咀，古之制也。古者无铁刃，于口咬细，
令如麻头，为粗末。煎之，使药水清，饮于腹中，则易升易散也，此所谓 咀也，今人
以刀器锉如麻头大，此 咀之易成也。若一概为细末，不厘清浊矣。经云∶清阳
发腠理，浊阴走五脏。果何谓也？又曰∶清阳实四肢，浊阴归六腑。 咀之药，取汁易
行经络故也。若治至高之病，加酒煎；去湿，以生姜；补元气，以大枣；发散风寒，以葱白
；去膈上痰，以蜜。细末者，不循经络，止去胃中及脏腑之积。气味浓者，白汤调；气味薄
者，煎之和渣服。去下部之疾，其丸极大，而光且圆，治中焦者次之，治上焦者极小。用稠
面糊，取其迟化，直至下焦。或酒或醋，取其收其散之意也。如半夏、南星，欲去湿者，以
生姜汁稀糊为丸，取其易化也。水浸宿炊饼者，易化。滴水丸者，又易化。炼蜜丸者，取其
迟化，而气循经络也。蜡丸者，取其难化而旋旋取效也。大抵汤者荡也，去久病者用之。散
者，散也，去急病者用之。丸者，缓也，不能速去之，取用药之舒缓而治之意也。病在心上
者，先食而后药。病在心下者，先药而后食，病在四肢者，宜饥食而在旦。病在骨髓者，宜
饱食而在夜。古之方剂，锱铢分两，与今不同。云一升者，今之大白盏也。云铢者，六铢为
一分，即二钱半也。二十四铢，为一两也。三两者，今之一两。二两者，今之六钱半也。料
例大者，合三分之一足矣。大黄恐寒则损胃气，须煨。至于川乌、附子，须炮，以制毒也。
黄柏、知母下部药也，久弱之人须合用之，酒浸曝干，恐寒伤胃气也。熟地黄酒洗亦然。当
归酒浸，助发散之意也。
〔垣〕至元庚辰六月，许伯威年五十四，中气本弱，病伤寒八九日。医者见其热甚，以凉
药下之。又食梨三四枚，痛伤脾胃，四肢冷，时发昏愦。余诊其脉动而中止，有时自还，乃
结脉也。心亦悸动，吃噫不绝。色变青黄，精神减少，目不欲开，倦卧，恶人语笑，以炙甘
草汤治之。成无己云∶补可去弱，人参、大枣之甘，以补不足之气。桂枝、生姜之辛，以益
正气。五脏痿弱，荣卫涸流，湿剂所以润之，故用麻仁、阿胶、麦门冬、地黄之甘，润经益
血复脉通心是也。加以人参、桂枝急扶正气，生地黄减半，恐伤阳气。锉一两剂服之，不效
。予再候之，脉证相对，莫非药有陈腐，故不效乎？再市药之气味浓者煎服，其证减半，再
服而安。凡药之昆虫草木，产之有地，根叶花实，采之有时，失其地则性味少异，失其时则
气味不全。又况新陈之不同，精粗之不等，倘不择而用之，其不效者，医之过也。《内经》
曰∶司岁备物，气味之精专也。修合之际，宜加谨焉。
病患服药，必择人煎熬制度，令亲信恭诚至意者为之。煎药铫器，除油垢腥秽，必用新
净甜水为上。量水多少，斟酌以慢火煎熬分数，用纱滤去渣，取清汁服之，无不效也。
【张仲景】凡是脏腑之病想要攻逐治疗时，应当根据病邪所结聚的部位进行攻治。例如，对于口渴的患者，使用猪苓汤，其余情况都仿照这个原则处理。
【李杲（东垣）】头痛必须使用川芎。如果无效，应根据经络添加引经药（太阳经用川芎，阳明经用白芷，太阴经用苍术，少阴经用细辛，少阳经用柴胡，厥阴经用吴茱萸）。头顶痛必须使用藁本，去掉川芎（另一版本作“项颈脑痛”）。肢体关节痛，必须使用羌活。去除风湿，也适宜使用羌活。腹痛，必须使用芍药；怕冷且痛的加桂枝；怕热且痛的加黄柏；心下痞满用枳实、黄连；肌表发热及祛痰者，必须使用黄芩；肌表发热，也使用黄芩；腹胀，使用姜制的厚朴；虚热，必须使用黄芩，止虚汗也使用黄芩；胁下痛，往来寒热，日晡时分潮热，必须使用柴胡。脾胃受湿，身体沉重困倦无力，懒怠好卧，祛痰用白术；破滞气，用枳壳，用于上部。枳壳会损伤胸中至高之气，只需服用二三次即可。破滞血，用桃仁、苏木；补血不足，必须使用甘草；祛痰，必须使用半夏；热痰，加黄芩；风痰，加天南星；胸中寒痰痞塞，用陈皮、白术。多用苦寒药，则会泻脾胃之气。腹中狭窄感，必须使用苍术；调气，必须使用木香；补气，必须使用人参；和血，必须使用当归。凡是血分受病的，都应当使用当归。去除下焦湿肿及疼痛，以及膀胱有火邪的，必须用酒洗过的防己、草龙胆、黄柏、知母；去除上焦湿及热，必须使用黄芩，因为要泻肺火。去除中焦湿热与疼痛，使用黄连，因为要泻心火。去除滞气，用青皮，不要多服，多服则泻人真气。口渴者，用干葛、茯苓，禁用半夏；咳嗽者，用五味子；气喘者，用阿胶；宿食不消化，用黄连、枳实；胸中烦热，必须使用栀子仁；水样腹泻，必须使用白术、茯苓、芍药；气刺痛，用枳实，看属于哪个部位，用引经药引导其运行即可。血刺痛，用当归，详细辨别上下使用根或梢。疮痛不可忍受的，用苦寒药，如黄柏、黄芩，详细辨别上下使用根或梢，并配合引经药即可。眼痛不可忍受的，用黄连、当归根，用酒浸泡煎煮；小便黄的，用黄柏；尿频而涩的，或加泽泻。腹中实痛兼有热，用大黄、芒硝。小腹痛，用青皮；尿道痛，用生甘草梢。饮水过多导致损伤的，用白术、茯苓、猪苓。胃脘痛，用草豆蔻。凡是使用纯寒或纯热的药物，必须用甘草来缓和药力。寒热夹杂的，也用甘草调和药性。但是中满者禁用甘草，经上说：中满者不要吃甘味食物。
【张洁古】不用白术不能去湿，不用枳实不能消痞，不用天雄不能补上焦阳之虚，不用附子不能补下焦阴之虚。
【李杲（东垣）】如果脉缓怠惰嗜卧，四肢不收，或者大便泄泻，这是湿胜，从平胃散治疗。如果脉弦气弱自汗，四肢发热，或者大便泄泻，或者皮毛枯槁，头发脱落，从黄芪建中汤治疗。脉虚而血弱，在四物汤中摘取一味或两味，加入当前明显症状对应的药物中。如果是真气虚弱，以及气短脉弱，从四君子汤治疗。如果有渴或小便秘涩，尿色赤黄程度不同，从五苓散去桂枝，摘取一二味加入正药中。假如表虚自汗，春夏加黄芪；秋冬加桂枝。如果腹中急缩，或者脉弦，加防风；急甚，加甘草。腹中狭窄感，或者气短的，也加上它。腹满气不转的，不要加。虽然气不转，但脾胃中气不和的，不要去掉，只加厚朴以破滞气，然而也不可多用，在五分甘草中加入一分即可。腹中夯闷，这不是腹胀，而是气散而不收，可加芍药；如果肺气短促或不足者，加人参、白芍；在中焦用白芍，则能在脾中升发阳气，使肝胆之邪不敢侵犯。腹中狭窄及缩急者，去掉芍药，以及诸酸涩药不可用。腹中疼痛者，加甘草、芍药。稼穑作甘，甘味属土（己）；曲直作酸，酸味属木（甲）。甲己化土，这是张仲景的妙法。腹痛兼发热，加黄芩；怕冷或腹中觉寒，加桂枝；怠惰嗜卧有湿，胃虚不能食，或者沉困，或者泄泻，加苍术；自汗，加白术；小便不利，加茯苓，口渴也加上；气弱者，加白茯苓、人参；气盛者，加赤茯苓、缩砂仁；气复不能转运且有热者，微加黄连，心烦乱也加上。小便少者，加猪苓、泽泻，汗多津液竭于上的不要加，这是津液还入胃中，想要自行恢复。不渴而小便秘塞，加炒黄柏、知母；小便涩者，加炒滑石；小便淋涩者，加泽泻，而且五苓散治渴，而小便不利无恶寒者，不得用桂枝；不渴而小便自利，妄见妄闻，乃是瘀血症，用炒黄柏、知母以除肾中燥热；窍不利而淋，加泽泻、炒滑石；只治窍不利者，六乙散中加木通也可以。心藏热者，用钱氏导赤散；中满或但腹胀者，加厚朴；气不顺，加橘皮。气滞，加青皮一、橘皮三；气短小便利者，四君子汤中去茯苓，加黄芪以补之。如果腹中气不转的，再加一半甘草。腹中刺痛，或周身刺痛者，或者里急者，腹中不宽快是也，或者虚坐而大便不得者，都是血虚。血虚则里急，或者血气虚弱，而目睛痛者，都加当归身。头痛，加川芎；苦头痛加细辛，这是少阴头痛；头发脱落及脐下痛者，加熟地黄。如果皮毛肌肉伸展不开，无大热不能食而渴者，加葛根半两。燥热及胃气上冲，为冲脉所逆，或者作逆气，而里急者，加炒黄柏、知母；觉得胸热而不渴，加炒黄芩。如果胸中结滞气涩，或者有热者，也都加上。如果食少而小便少者，是津液不足，不要利小便，益气补胃自然会恢复。如果气弱气短者，加人参。只升阳之剂，助阳之胜，多加人参。恶热发热而燥渴，脉洪大者，白虎汤主治。或者喘者，加人参。如果渴不止，寒水石、石膏各等分少量给予，这就是钱氏方中的甘露散，主治身大热而小便数，或者上饮下溲，这是燥热。气燥，加白葵花；血燥，加赤葵花；如果小便行病增者，这是内燥津液不能停，应当致津液少，加炒黄柏、赤葵花；如果心下痞闷者，加黄连一份、黄芩三份，减诸甘药，不能食心下软而痞者，甘草泻心汤则愈（痞有九种，治有五方，见张仲景泻心汤证）。如果喘满者加炙厚朴（小便不利者加上，如果利则为禁药）。如果胃虚弱而痞者，加甘草；喘而小便不利者，加苦葶苈；如果气短气弱而腹微满者，不去人参，去甘草，加厚朴；然而不如苦味泄之，而不令大便行。如果腹微满而气不转者，加上它。如果中满者，去甘草，倍黄连，加黄柏，再加三味五苓散少许；此病虽宜升宜汗。如果汁多亡阳，加黄芪；四肢烦热肌热，与柴胡、羌活、升麻、葛根、甘草则愈；如果鼻清涕恶风，或者项背脊膂强痛，羌活、防风、甘草等分，黄芪倍加，临卧服之。
《禁服篇》说：约束方剂就像约束口袋一样，口袋满了不约束就会泄漏，方剂成了不约束则神与气不能俱存。未满而知约之，可以成为医生，不可以成为天下老师。这是圣人所以退太过而进不及，以平为期。大凡气味有毒无毒，固然应该常制。因此大毒治病，十去其六；常毒治病，十去其七；小毒治病，十去其八；无毒治病，十去其九，剩下的用谷肉菜果食养尽之，不要使其过度伤害正气。至于君一臣二，是奇之制。君二臣四，是偶之制。近而奇偶，制小其服。远而奇偶，制大其服。大则数少，小则数多，多则九之，少则二之。补上治上制以缓，补下治下制以急。急则气味浓，缓则气味薄。下不以偶，汗不以奇。随其邪之所在高下浅深轻重虚实，影响无间，万举万全，这叫中行，所以可以为师。假如证大而汤剂小，则邪气少屈，故药力已乏，想不再治，可能吗？犹一杯水救一车薪之火，火竟不灭，这叫不及，所以不可以为师而可以为工了。证小则汤剂大而邪服，邪已尽而药余力，想不伤正，哪里容得下呢？犹火炎昆岗，玉石俱焚，莫之能止，这叫太过，这又不可以为工，是为粗医也。三者之论，惟中而已，过与不及，皆为偏废。然而太过犹甚于不及，何以明之？盖失于姑息，邪复胜正者，止于劳而无益，犹可勉而适中。或失苛暴，则血气被伤，因致羸替者有之，危残者有之，灭亡者有之，非徒无益，而又害之，此所谓犹甚也，可不戒哉。曾考张仲景之书，于承气汤下攻里，则曰若更衣止后服。于桂枝方后发表，乃云微汗益佳，不可令如水淋漓。皆本乎轩岐之微旨也。
【张仲景】说锉如麻头，与咀同意。夫咀，古之制也。古者无铁刃，于口咬细，令如麻头，为粗末。煎之，使药水清，饮于腹中，则易升易散也，此所谓咀也，今人以刀器锉如麻头大，此咀之易成也。若一概为细末，不厘清浊矣。经云：清阳发腠理，浊阴走五脏。果何谓也？又曰：清阳实四肢，浊阴归六腑。咀之药，取汁易行经络故也。若治至高之病，加酒煎；去湿，以生姜；补元气，以大枣；发散风寒，以葱白；去膈上痰，以蜜。细末者，不循经络，止去胃中及脏腑之积。气味浓者，白汤调；气味薄者，煎之和渣服。去下部之疾，其丸极大，而光且圆，治中焦者次之，治上焦者极小。用稠面糊，取其迟化，直至下焦。或酒或醋，取其收其散之意也。如半夏、南星，欲去湿者，以生姜汁稀糊为丸，取其易化也。水浸宿炊饼者，易化。滴水丸者，又易化。炼蜜丸者，取其迟化，而气循经络也。蜡丸者，取其难化而旋旋取效也。大抵汤者荡也，去久病者用之。散者，散也，去急病者用之。丸者，缓也，不能速去之，取用药之舒缓而治之意也。病在心上者，先食而后药。病在心下者，先药而后食，病在四肢者，宜饥食而在旦。病在骨髓者，宜饱食而在夜。古之方剂，锱铢分两，与今不同。云一升者，今之大白盏也。云铢者，六铢为一分，即二钱半也。二十四铢，为一两也。三两者，今之一两。二两者，今之六钱半也。料例大者，合三分之一足矣。大黄恐寒则损胃气，须煨。至于川乌、附子，须炮，以制毒也。黄柏、知母下部药也，久弱之人须合用之，酒浸曝干，恐寒伤胃气也。熟地黄酒洗亦然。当归酒浸，助发散之意也。
【李杲（东垣）】至元庚辰六月，许伯威年五十四，中气本弱，病伤寒八九日。医者见其热甚，以凉药下之。又食梨三四枚，痛伤脾胃，四肢冷，时发昏愦。我诊其脉动而中止，有时自还，乃是结脉也。心亦悸动，吃噫不绝。色变青黄，精神减少，目不欲开，倦卧，恶人语笑，用炙甘草汤治疗。成无己说：补可去弱，人参、大枣之甘，以补不足之气。桂枝、生姜之辛，以益正气。五脏痿弱，荣卫涸流，湿剂所以润之，故用麻仁、阿胶、麦门冬、地黄之甘，润经益血复脉通心是也。加以人参、桂枝急扶正气，生地黄减半，恐伤阳气。锉一两剂服之，不效。我再候之，脉证相对，莫非药有陈腐，故不效乎？再市药之气味浓者煎服，其证减半，再服而安。凡药之昆虫草木，产之有地，根叶花实，采之有时，失其地则性味少异，失其时则气味不全。又况新陈之不同，精粗之不等，倘不择而用之，其不效者，医之过也。《内经》曰：司岁备物，气味之精专也。修合之际，宜加谨焉。
病患服药，必择人煎熬制度，令亲信恭诚至意者为之。煎药铫器，除油垢腥秽，必用新净甜水为上。量水多少，斟酌以慢火煎熬分数，用纱滤去渣，取清汁服之，无不效也。
[Zhang Zhongjing] When treating diseases located in the Zang organs that require purgation, one should attack according to where the pathogen has gathered. For example, for patients with thirst, use Zhu Ling Tang (Polyporus Decoction); other cases should follow this principle.
[Li Dongyuan] Headache requires the use of Chuanxiong Rhizoma (Chuanxiong). If ineffective, add meridian-guiding herbs according to the affected channel: Taiyang channel uses Chuanxiong Rhizoma (Chuanxiong), Yangming channel uses Angelicae Dahuricae Radix (Baizhi), Taiyin channel uses Atractylodis Rhizoma (Cangzhu), Shaoyin channel uses Asari Radix et Rhizoma (Xixin), Shaoyang channel uses Bupleuri Radix (Chaihu), Jueyin channel uses Evodiae Fructus (Wuzhuyu). Pain at the vertex requires the use of Ligustici Rhizoma et Radix (Gaoben) and removal of Chuanxiong Rhizoma (Chuanxiong) (another version reads "neck, nape, and brain pain"). Limb and joint pain require the use of Notopterygii Rhizoma et Radix (Qianghuo). To dispel wind-dampness, Qianghuo is also appropriate. Abdominal pain requires the use of Paeoniae Radix Alba (Shaoyao); if accompanied by aversion to cold, add Cinnamomi Ramulus (Guizhi); if accompanied by aversion to heat, add Phellodendri Cortex (Huangbai); epigastric fullness and stuffiness require Zizyphi Fructus (Zhishi) and Coptidis Rhizoma (Huanglian); fever in the muscles and phlegm resolution require Scutellariae Radix (Huangqin); muscle fever also uses Huangqin; abdominal distension requires Zingiberis Rhizoma Recens processed with ginger (Jiang Zhi Houpo); deficiency heat requires Huangqin, and stopping deficiency sweating also uses Huangqin; hypochondriac pain, alternating chills and fever, afternoon tidal fever require Bupleuri Radix (Chaihu). Spleen and stomach dampness causing heaviness, fatigue, and desire to lie down, phlegm resolution uses Atractylodis Macrocephalae Rhizoma (Baizhu); breaking stagnant Qi uses Aurantii Fructus (Zhiqiao), used for upper parts. Zhiqiao damages the highest Qi in the chest; two or three doses are sufficient. Breaking stagnant blood uses Persicae Semen (Taoren) and Callicophyllum Multiflorum Stem (Sumu); insufficient blood tonification requires Glycyrrhizae Radix et Rhizoma (Gancao); phlegm resolution requires Pinelliae Rhizoma (Banxia); hot phlegm adds Huangqin; wind-phlegm adds Arisaematis Rhizoma (Nanxing); cold-phlegm obstruction in the chest requires Citri Reticulatae Pericarpium (Chenpi) and Baizhu. Excessive use of bitter-cold herbs drains Spleen and Stomach Qi. Narrowness in the abdomen requires Cangzhu; regulating Qi requires Aucklandiae Radix (Muxiang); tonifying Qi requires Ginseng Radix et Rhizoma (Renshen); harmonizing blood requires Angelicae Sinensis Radix (Danggui). Any disease affecting the Blood level should use Danggui. Removing lower jiao damp-swelling and pain, and bladder fire pathogens, requires alcohol-washed Stephaniae Tetrandrae Radix (Fangji), Gentianae Macrophyllae Radix (Caolongdan), Huangbai, and Anemarrhenae Rhizoma (Zhimu); removing upper jiao dampness and heat requires Huangqin, as it clears Lung Fire. Removing middle jiao damp-heat and pain uses Huanglian, as it clears Heart Fire. Removing stagnant Qi uses Citri Reticulatae Pericarpium Viride (Qingpi); do not take excessively, as it drains true Qi. Thirst uses Puerariae Radix (Gegen) and Polyporus (Fuling); Banxia is contraindicated. Cough uses Schisandrae Fructus (Wuweizi); wheezing uses Ecliptae Herba (Ejiao - *Note: Text says Ejiao, usually Donkey-hide gelatin, but context might imply other herbs, sticking to text*) ; retained food not digesting uses Huanglian and Zhishi; vexatious heat in the chest requires Gardeniae Fructus (Zhizi); watery diarrhea requires Baizhu, Fuling, and Shaoyao; stabbing pain due to Qi uses Zhishi, guided by meridian herbs according to the location. Stabbing pain due to Blood uses Danggui, using root or tip depending on upper/lower location. Unbearable sore pain uses bitter-cold herbs like Huangbai and Huangqin, using root/tip and guiding herbs. Unbearable eye pain uses Huanglian and Danggui root, soaked and decocted in wine; yellow urine uses Huangbai; frequent and difficult urination may add Alismatis Rhizoma (Zexie). Solid abdominal pain with heat uses Rhei Radix et Rhizoma (Dahuang) and Mang Xiao. Lower abdominal pain uses Qingpi; penile pain uses raw Gancao tip. Injury from excessive drinking uses Baizhu, Fuling, and Zhu Ling. Epigastric pain uses Kaempferiae Semen (Caodoukou). When using purely cold or purely hot drugs, Gancao must be used to moderate their force. In mixed cold-heat conditions, Gancao is also used to harmonize properties. However, Gancao is contrainddicated in fullness; the Classic states: "Do not eat sweet foods when there is fullness."
[Zhang Jiegu] Without Baizhu, dampness cannot be removed; without Zhishi, fullness cannot be eliminated; without Tianxiong, deficiency of Upper Jiao Yang cannot be tonified; without Fuzi, deficiency of Lower Jiao Yin cannot be tonified.
[Li Dongyuan] If the pulse is slow, lethargic, drowsy, limbs unreceptive, or stool is loose, this indicates excess dampness; treat with Ping Wei San. If the pulse is wiry, Qi is weak, spontaneous sweating occurs, limbs feel hot, or stool is loose, or skin/hair is dry and hair falls out, treat with Huangqi Jianzhong Tang. If the pulse is deficient and Blood is weak, select one or two herbs from Si Wu Tang and add them to the formula based on prominent symptoms. If True Qi is weak, with shortness of breath and weak pulse, treat with Si Jun Zi Tang. If thirsty or urinary difficulty with varying degrees of red/yellow urine, treat with Wu Ling San removing Guizhi, selecting one or two herbs to add. For example, in exterior deficiency with spontaneous sweating, add Huangqi in spring/summer; add Guizhi in autumn/winter. If abdominal cramping or wiry pulse, add Fangfeng; if severe, add Gancao. Also add for abdominal narrowness or shortness of breath. Do not add if abdominal fullness with non-moving Qi. Even if Qi does not move, if Middle Jiao Qi is disharmonious, do not remove it; just add Houpo to break stagnation, but not excessively (add 1 fen to 5 fen Gancao). Feeling of oppression in the abdomen is not distension, but scattering without gathering; add Shaoyao. If Lung Qi is short or insufficient, add Renshen and Bai Shao; using Bai Shao in Middle Jiao raises Spleen Yang, preventing Liver/Gallbladder pathogens from invading. Remove Shaoyao and all sour/astringent herbs if abdominal narrowness or cramping exists. Add Gancao and Shaoyao for abdominal pain. Sweetness belongs to Earth (Ji); Sourness belongs to Wood (Jia). Jia-Ji transforms into Earth; this is Zhang Zhongjing's subtle method. Add Huangqin for abdominal pain with fever; add Guizhi for aversion to cold or feeling cold in abdomen; add Cangzhu for lethargy/dampness, Spleen/Stomach deficiency anorexia, heaviness, or diarrhea; add Baizhu for spontaneous sweating; add Fuling for difficult urination, also for thirst; add Baifuling and Renshen for weak Qi; add Chifuling and Shasaren for strong Qi; add slight Huanglian for Qi stagnation with heat, also for vexation. Add Zhu Ling and Zexie for low urine volume; do not add if sweating caused fluid exhaustion above, as fluids return to Stomach. For no-thirst constipation, add fried Huangbai and Zhimu; for astringent urination, add fried Talcum (Huashi); for dribbling urination, add Zexiw. Wu Ling San treats thirst with difficult urination without aversion to cold; do not use Guizhi. No-thirst with free urination, hallucinations, indicates Blood stasis; use fried Huangbai and Zhimu to clear Kidney dryness-heat. For orifice obstruction with dribbling, add Zexie and Huashi; for orifice obstruction alone, Liu Yi San with Tong Cao is also acceptable. Heart Heat uses Qian Shi Dao Chi San; fullness or abdominal distension adds Houpo; Qi disharmony adds Chenpi. Qi stagnation adds Qingpi (1 part) and Chenpi (3 parts); shortness of breath with free urination removes Fuling from Si Jun Zi Tang and adds Huangqi. If abdominal Qi does not move, add half amount of Gancao. Stabbing pain in abdomen or body, or tenesmus, or feeling unrelieved internally, or straining without stool, all indicate Blood deficiency. Blood deficiency causes tenesmus; add Danggui Shen for Blood/Qi weakness with eye pain. Headache adds Chuanxiong; severe headache adds Xixin (Shaoyin headache); hair loss and umbilical pain add Shu Dihuang. If skin/muscles do not stretch, no high fever, anorexia, and thirst, add Gegen (0.5 liang). Dry-heat and Stomach Qi rushing up via Chong Mai, or rebellious Qi with tenesmus, add fried Huangbai and Zhimu; feeling chest heat without thirst adds fried Huangqin. Chest stagnation with heat adds these as needed. Low food intake with low urine indicates fluid insufficiency; do not promote urination, tonify Qi and Stomach will restore itself. Weak/short Qi adds Renshen. Yang-raising agents aiding Yang excess add more Renshen. Aversion to heat, fever, dry thirst,洪大 pulse: Bai Hu Tang governs. Wheezing adds Renshen. Unceasing thirst: Hanshui Shi and Shigao equal parts, small amounts; this is Qian Shi Gan Lu San, governing high fever and frequent urination, or drinking above and urinating below (dry-heat). Qi dryness adds Bai Kuihua; Blood dryness adds Chi Kuihua. If urination increases pathology, indicating internal dryness and fluid instability, add fried Huangbai and Chi Kuihua. Epigastric stuffiness: add Huanglian (1 part), Huangqin (3 parts), reduce sweet herbs; soft epigastric fullness with anorexia cured by Gancao Xiexin Tang (9 types of Pi, 5 formulas, see Zhang Zhongjing). Wheezing/fullness adds Zhi Houpo (add if difficult urination, contraindicated if loose stool). Stomach deficiency with Pi adds Gancao; wheezing with difficult urination adds Ku Tingli. Short/weak Qi with mild fullness: keep Renshen, remove Gancao, add Houpo; better to use bitter-draining without moving bowels. Mild fullness with non-moving Qi adds it. Fullness: remove Gancao, double Huanglian, add Huangbai, plus small amount of San Wei Wu Ling San. This disease benefits from raising/sweating. Fluid loss causing Yang collapse adds Huangqi; limb restlessness/muscle fever resolves with Chaihu, Qianghuo, Shengma, Gegen, Gancao. Clear nasal discharge, aversion to wind, or neck/back stiffness: Qianghuo, Fangfeng, Gancao equal parts, double Huangqi, taken before sleep.
Pulse-heat and body-heat modification methods are in the Fever chapter.
The "Forbidden Treatment Chapter" states: Restricting a prescription is like tying a bag; if full and untied, it leaks. If a prescription is made but not restricted, Spirit and Qi will not accompany it. One who restricts before fullness can be a doctor, but not a teacher for the world. This is why Sages retreat from excess and advance toward insufficiency, aiming for balance. Generally, flavors have toxicity or non-toxicity, which should be regulated. Thus, highly toxic drugs treat disease until 60% resolved; commonly toxic until 70%; slightly toxic until 80%; non-toxic until 90%. Remaining health is restored by grain, meat, vegetables, and fruits. Do not overdo it to damage Righteous Qi. Regarding prescriptions: Monarch 1, Minister 2 is Odd (Qi) system. Monarch 2, Minister 4 is Even (Ou) system. Near and Odd/Even, make dosage small. Far and Odd/Even, make dosage large. Large means few ingredients, small means many (up to 9, minimum 2). Tonifying/curing Upper Jiao uses slow preparation; tonifying/curing Lower Jiao uses rapid preparation. Rapid means strong flavor/aroma; slow means weak. Lower Jiao does not use Even systems exclusively; exterior release does not use Odd exclusively. Follow the pathogen's location (high/low, shallow/deep, heavy/light, empty/full), acting like an echo, ensuring success; this is called the Middle Path, worthy of being a teacher. If syndrome is large but decoction is small, pathogen only partially retreats, drug power is exhausted, and treatment stops? Like one cup of water saving a cart of firewood; fire remains unextinguished. This is insufficiency; cannot be a teacher, only a doctor. If syndrome is small but decoction is large, pathogen submits, but drug power remains after pathogen is gone, risking damage to Righteous Qi? Like fire burning Kun Gang, jade and stone burn together; unstoppable. This is excess; cannot be a doctor, only a crude physician. Among these three, only the Middle is correct. Excess and insufficiency are both deviations. However, excess is worse than insufficiency. Why? Insufficiency (indulgence) allows pathogen to overcome Righteous Qi, resulting in labor without benefit, yet still adjustable to balance. Excess (harshness) damages Blood and Qi, leading to emaciation, danger, or death, causing harm rather than benefit; this is why excess is worse. Beware! Examining Zhang Zhongjing's works: Cheng Qi Tang purges interior, stating "stop after bowel movement." Gui Zhi Tang releases exterior, stating "slight sweat is best, do not let it drip like water." Both follow the subtle principles of Xuanyuan and Qibo.
[Zhang Zhongjing] Crushing to hemp-head size is equivalent to "Ju" (chewing). Ju is an ancient method. Ancient times had no iron blades; herbs were chewed fine to hemp-head size, forming coarse powder. Decocting makes the liquid clear; drinking it in the abdomen allows easy ascending and dispersing. This is Ju. Today, people crush with knives to hemp-head size, making Ju easier. If all ground to fine powder, clear and turbid are not separated. The Classic says: Clear Yang emerges in Cou Li (pores); Turbid Yin enters Five Zang. What does this mean? It also says: Clear Yang fills Four Limbs; Turbid Yin returns to Six Fu. Ju-ed herbs' juice easily travels through meridians. For highest diseases, add wine for decoction; for dampness, add Shengjiang; for tonifying Yuan Qi, add Dazao; for dispersing wind-cold, add Congbai; for removing phlegm above diaphragm, add Mi. Fine powder does not follow meridians, only removing accumulation in Stomach and Zang-Fu. Strong aroma/flavor: mix with white water; weak aroma/flavor: decoct and take with dregs. For lower body diseases, pills are large, smooth, and round; for Middle Jiao, smaller; for Upper Jiao, very small. Use thick flour paste for slow dissolution reaching Lower Jiao. Wine or vinegar for gathering/scattering intent. Banxia, Nanxing for dampness: use Shengjiang juice thin paste for easy dissolution. Water-soaked overnight steamed cake pills dissolve easily. Drop-water pills dissolve easily. Refined honey pills for slow dissolution and meridian circulation. Wax pills for difficult dissolution and gradual effect. Generally, Tang (decoction) sweeps away long-standing diseases. San (powder) disperses acute diseases. Wan (pill) is slow, for diseases not quickly removable, taking advantage of gentle treatment. Disease in Xin Shang (upper heart): food then medicine. Disease in Xin Xia (lower heart): medicine then food. Disease in Four Limbs: hungry state in morning. Disease in Marrow: full state at night. Ancient measurements differ from today. One Sheng is now a large white cup. One Cun is six Zhu, i.e., 2.5 Qian. Twenty-four Zhu is one Liang. Three Liang is now one Liang. Two Liang is now 6.5 Qian. Large dosages need only one-third. Dahuang may damage Stomach Qi if too cold; must be baked. Chuanwu, Fuzi must be roasted to control toxicity. Huangbai, Zhimu are Lower Jiao drugs; for chronic weak persons, combine them, soak in wine and dry to avoid cold damaging Stomach Qi. Shu Dihuang washed in wine similarly. Danggui soaked in wine aids dispersion.
[Li Dongyuan] In June of Gengchen year, Xu Bowei, age 54, had weak Middle Qi and contracted Cold Damage for 8-9 days. Physicians saw intense heat and purged with cold drugs. He ate 3-4 pears, injuring Spleen/Stomach, causing cold limbs and occasional fainting. I palpated his pulse: beating then stopping, returning occasionally, a Jie (knotted) pulse. Heart palpitations, continuous belching. Complexion changed to green-yellow, spirit decreased, eyes unwilling to open, tired lying down, aversion to people speaking/laughing. Treated with Zhi Gancao Tang. Cheng Wuji said: Tonification removes weakness; sweetness of Renshen and Dazao tonifies insufficient Qi. Pungency of Guizhi and Shengjiang benefits Righteous Qi. Five Zang atrophy, Ying-Wei drying up, moist agents moisten them; thus sweetness of Huren, Ejiao, Maimendong, Dihuang moistens channels, benefits Blood, restores pulse, opens Heart. Added Renshen and Guizhi to urgently support Righteous Qi; reduced Sheng Dihuang by half to avoid damaging Yang Qi. Decocted one Liang dose, ineffective. I waited again; pulse and symptoms matched. Was the drug old/stale? Bought fresh, strong-aroma drugs, decocted and took; symptoms halved, cured after second dose. All drugs, insects/plants, have origin places; roots/leaves/flowers/fruits have harvest times. Wrong place alters nature/flavor slightly; wrong time loses aroma/flavor completely. New vs old, fine vs coarse vary. If not selected, ineffectiveness is doctor's fault. Neijing says: Prepare goods according to years, essence of aroma/flavor is concentrated. Mixing requires caution.
Patients taking drugs must choose trustworthy, sincere people for decoction. Decoction vessels must be clean, free of grease/fishy smells; use new, pure, sweet water. Measure water, simmer slowly, filter dregs with gauze, take clear juice; invariably effective.