治大病后阴阳不相维系。阳欲上脱，或喘逆，或自汗，或目睛上窜，或心中摇摇如悬旌；阴
欲下脱，或失精，或小便不禁，或大便滑泻。一切阴阳两虚，上热下凉之证。
大熟地（一两） 萸肉（去净核,一两） 生山药（六钱） 生龙骨（捣细,六钱）
生牡蛎（捣细,六钱） 茯苓（三钱） 生杭芍（三钱） 乌附子（一钱）
或问∶既济汤原为救脱之药，方中何以不用人参？答曰∶人参之性补而兼升，以治上脱，转有气高不返之虞。喻嘉
言《寓意草》中论之甚详。惟与赭石同用，始能纳气归根。而证兼下脱者，赭石又不宜用，为不用赭石，所以不敢用人
参。且阳之上脱也，皆因真阴虚损，不能潜藏元阳，阳气始无所系恋而上奔。故方中重用熟地、山药以峻补真阴，俾阴
足自能潜阳。而佐以附子之辛热，原与元阳为同气，协同芍药之苦降（《神农本草经》味苦），自能引浮越之元阳下归其
宅。更有萸肉、龙骨、牡蛎以收敛之，俾其阴阳固结，不但元阳不复上脱，而真阴亦永不下脱矣。
一人，年二十余，禀资素羸弱，又耽烟色，于秋初患疟，两旬始愈。一日大便滑
泻数次，头面汗出如洗，精神颓愦，昏昏似睡。其脉上盛下虚，两寸摇摇，两尺欲无，数至
七至。延医二人皆不疏方。愚后至为拟此汤，一剂而醒，又服两剂遂复初。
友人张××，曾治一少年，素患心疼，发时
昼夜号呼。医者屡投以消通之药，致大便滑泻，虚气连连下泄，汗出如洗，目睛上泛，心神
惊悸，周身 动，须人手按，而心疼如故。延医数人皆不敢疏方。张××投以此汤，将方中萸
肉倍作二两，连服两剂，诸病皆愈，心疼竟从此除根。
或问∶此方能治脱证宜矣，而并能治心疼者何也？答曰∶凡人身内外有疼处，皆其气血痹而
不通。《神农本草经》谓“山茱萸主心下邪气、寒热、温中、逐寒湿痹”，是萸肉不但酸敛，而更
善开通可知。李士材治肝虚作疼，萸肉与当归并用。愚治肝虚腿疼，曾重用萸肉随手奏效（
详案在曲直汤下）。盖萸肉得木气最浓，酸敛之中大具条畅之性
，故善于治脱，尤善于开痹也。大抵其证原属虚痹，气血因虚不能流通而作疼。医者不知，惟事
开破，迨开至阴阳将脱，而其疼如故，医者亦束手矣。而投以此汤，惟将萸肉加倍，竟能于
救脱之外，更将心疼除根。此非愚制方之妙，实张××之因证施用，而善于加减也。
治疗大病之后，阴阳失去相互维系。阳气想要向上脱失，表现为气喘逆乱，或自汗出，或眼球上翻，或心中动荡不安如同悬挂的旗帜；阴气想要向下脱失，表现为遗精，或小便失禁，或大便滑泄不禁。这是所有阴阳两虚，上部有热下部发凉的证候。
大熟地黄（一两） 山茱萸（去掉干净的核，一两） 生山药（六钱） 生龙骨（捣碎成细粉，六钱） 生牡蛎（捣碎成细粉，六钱） 茯苓（三钱） 生白芍（三钱） 乌附子（一钱）
有人问：既济汤原本是用于急救脱证的方剂，为什么方中不使用人参？回答说：人参的药性补益且兼有升提作用，用来治疗上部脱失，反而会有气机上逆不能下降的担忧。喻嘉言在《寓意草》中对此论述得非常详细。只有与人参同用赭石，才能纳气归根。而证候兼有下部脱失时，又不宜使用赭石，因为不用赭石，所以不敢用人参。况且阳气的上部脱失，都是因为真阴亏损，不能潜藏元阳，阳气才开始无所系恋而向上奔逸。所以方中重用熟地黄、山药来峻补真阴，使得阴液充足自然能够潜藏阳气。并佐以附子的辛热之性，原本与元阳是同气相求，协同白芍的苦降之性（《神农本草经》记载其味苦），自然能引导浮越的元阳回归其宅。更有山茱萸、龙骨、牡蛎来收敛固涩，使得阴阳固结，不但元阳不再向上脱失，而且真阴也永远不再向下脱失了。
有一人，二十多岁，体质素来虚弱，又沉迷于吸烟和女色，在初秋患疟疾，二十天痊愈。一天后大便滑泄数次，头面部出汗如水洗一般，精神萎靡困顿，昏昏沉沉似睡非睡。其脉象上部盛而下部虚，两手寸脉动摇不定，两手尺脉微弱欲无，脉搏频率达到每息七至。请了两位医生都不开处方。我后来为他拟定此汤，服用一剂后清醒，又服用两剂便恢复如初。
友人张××，曾治疗一名少年，素来患有心痛，发作时昼夜号哭呼叫。医生多次投用消导通利的药物，导致大便滑泄，虚气连连下泄，出汗如水洗，眼球上泛，心神惊悸，周身肌肉跳动，需要人手按压才稍安，而心痛依旧。请了几位医生都不敢开处方。张××投以此汤，将方中的山茱萸加倍用到二两，连续服用两剂，各种病症都痊愈了，心痛竟然从此除根。
有人问：此方治疗脱证固然适宜，但也能治疗心痛的原因是什么呢？回答说：凡是人身内外有疼痛之处，都是气血痹阻而不通畅。《神农本草经》说“山茱萸主治心下邪气、寒热、温中、驱逐寒湿痹”，这说明山茱萸不仅酸涩收敛，而且更善于开通。李士材治疗肝虚引起的疼痛，将山茱萸与当归并用。我治疗肝虚引起的腿疼，曾重用山茱萸随手奏效（详细医案在曲直汤下方）。大概山茱萸得木气最浓，在酸涩收敛之中具备条畅的特性，所以善于治疗脱证，尤其善于开通痹阻。大抵这种证候原本属于虚痹，气血因虚弱不能流通而产生疼痛。医生不知道这一点，只一味地使用开破之法，等到开到阴阳即将脱失时，而疼痛依旧，医生也就束手无策了。而投以此汤，只要将山茱萸加倍，竟能在救脱之外，还将心痛除根。这并非我制方的奇妙，实在是张××根据证候施用，并且善于加减变化啊。
Treatment for conditions after severe illness where Yin and Yang fail to maintain mutual connection. When Yang Qi is about to float upward and escape, symptoms may include panting and rebellious Qi, spontaneous sweating, eyes rolling upward, or a feeling of inner restlessness as if a suspended banner were fluttering; when Yin Essence is about to sink downward and escape, symptoms may include seminal emission, urinary incontinence, or loose diarrhea with incontinence. This covers all patterns of dual deficiency of Yin and Yang, characterized by heat above and cold below.
Prepared Rehmanniae Radix (Shu Di Huang) – 1 liang
Cornus Officinalis Fructus (Yu Rou) – 1 liang, pits removed completely
Raw Dioscoreae Rhizoma (Shan Yao) – 6 qian
Raw Longgu (Fossilized Bones) – 6 qian, finely crushed
Raw Muli (Oyster Shell) – 6 qian, finely crushed
Poria (Fu Ling) – 3 qian
Raw Paeoniae Radix Alba (Bai Shao) – 3 qian
Aconitum Lateralis Radix Preparata (Wu Fu Zi) – 1 qian
Question: Ji Ji Tang (Decoction for the Completion of Interaction) is originally a medicine for rescuing collapse. Why is not Ginseng Radix et Rhizoma (Ren Shen) used in this formula? Answer: The nature of Ren Shen is tonifying and ascending. Using it to treat upper collapse carries the risk of Qi rising excessively without descending. Yu Jiayan discussed this in detail in *Yi Yi Cao* (Meaningful Grass). Only when used together with Hematitum (Zhe Shi) can Qi be guided back to its root. However, in cases accompanied by lower collapse, Zhe Shi is not suitable. Because Zhe Shi is not used, Ren Shen dare not be used. Moreover, the upward escape of Yang Qi is due to the deficiency of True Yin, which fails to anchor Yuan Yang (Original Yang), causing Yang Qi to have no attachment and rush upward. Therefore, this formula heavily uses Prepared Rehmanniae Radix (Shu Di Huang) and Raw Dioscoreae Rhizoma (Shan Yao) to vigorously tonify True Yin, so that sufficient Yin naturally anchors Yang. It is assisted by the acrid-hot nature of Aconitum Lateralis Radix Preparata (Wu Fu Zi), which shares the same affinity as Yuan Yang. Together with the bitter-descending property of Paeoniae Radix Alba (Bai Shao) [as recorded in *Shen Nong Ben Cao Jing*: "bitter"], it naturally guides the floating Yuan Yang back to its residence. Furthermore, Cornus Officinalis Fructus (Yu Rou), Raw Longgu (Fossilized Bones), and Raw Muli (Oyster Shell) are used to astringe and consolidate, ensuring the firm union of Yin and Yang. Not only will Yuan Yang no longer escape upward, but True Yin will also never escape downward.
Case 1: A patient, over twenty years old, had always been constitutionally weak and indulged in smoking and sexual activity. In early autumn, he contracted malaria (Nue Ji), which took twenty days to resolve. One day later, he experienced several episodes of loose diarrhea, profuse sweating on the head and face like being washed, mental exhaustion and lethargy, appearing drowsy. His pulse was strong at the upper positions and deficient at the lower positions; the Cun (inch) pulses on both sides were trembling, the Chi (cubit) pulses on both sides were faint and nearly imperceptible, beating seven times per breath. Two physicians were consulted but did not prescribe any formula. I subsequently prescribed this decoction. After one dose, he regained consciousness; after two more doses, he recovered completely.
Friend Zhang XX once treated a young man who suffered from heart pain (Xin Tong). During attacks, he cried out day and night. Physicians repeatedly administered formulas for resolving stagnation and promoting circulation, resulting in loose diarrhea, continuous leakage of deficient Qi, profuse sweating like being washed, eyes rolling upward, mental palpitations and fright, twitching of the whole body requiring manual pressure to alleviate, while the heart pain remained unchanged. Several doctors were consulted but dared not prescribe. Zhang XX administered this decoction, doubling the dosage of Cornus Officinalis Fructus (Yu Rou) to 2 liang. After two consecutive doses, all diseases were cured, and the heart pain was eradicated from the root.
Question: This formula is indeed suitable for treating collapse patterns, but why can it also treat heart pain? Answer: Any painful area inside or outside the human body is caused by the bi obstruction (blockage) of Qi and Blood. *Shen Nong Ben Cao Jing* states that "Cornus Officinalis Fructus (Yu Rou) treats evil Qi under the heart, cold-heat sensations, warms the middle, and expels cold-dampness bi." This indicates that Yu Rou is not only sour and astringent but also excels at unblocking. Li Shicai treated liver deficiency pain by combining Yu Rou with Dang Gui. I treated leg pain due to liver deficiency by heavily using Yu Rou, achieving immediate effect (detailed case under Qu Zhi Tang). Generally, Yu Rou absorbs the strongest Wood Qi; within its sour and astringent nature lies a free-flowing quality. Thus, it is good at treating collapse and especially good at opening bi obstruction. Essentially, these patterns belong to deficiency-bi, where pain arises because Qi and Blood cannot circulate freely due to deficiency. Physicians do not realize this and only focus on breaking stagnation. By the time they break until Yin and Yang are about to collapse, the pain remains, and the physicians are at a loss. However, administering this formula, simply by doubling Yu Rou, can not only rescue from collapse but also eradicate the heart pain from the root. This is not merely the brilliance of my formula creation, but rather Zhang XX's skillful application and modification according to the specific syndrome.