亏损先天坎中一点真阳耳。真阳一衰，群阴蜂起，故现子午潮热，子午二时，乃阴阳相交之时，阳不得下交于阴，则阳气浮而不藏。故潮热生，阴不得上交于阳，则阴气发腾，无阳以镇纳，则潮热亦生。医者不得此中至理，一见潮热便称阴虚，用一派滋阴养阴之品，每每酿成脱绝危候，良可悲也。自汗盗汗出。凡自汗、盗汗皆是阳虚之征，各书具称盗汗为阴虚者，是言其在夜分也，夜分乃阳气潜藏之时，然而夜分实阴盛之候，阴盛可以逼阳于外，阳浮外亡，血液随之，故汗出，曰盗汗。医者不知其为阳虚，不能镇纳阴气，阴气外越，血液亦出，阴盛隔阳于外，阳不得潜，亦汗出。此旨甚微，学者务须在互根处理会。咳吐白痰，真阳一衰，则阴邪上逆，逆则咳嗽作。白痰虽非血，实亦血也，由其火衰而化行失职，精气不得真火煅炼，而色未赤也。近来多称陈寒入肺［1］，实是可笑。腹满不实，阴气闭塞，阳微不运故也。面黄肌瘦，真火衰则脾土无生机，土气发泄，欲外亡，故面黄，土衰则肌肉消，以脾主肌肉故也。腹时痛时止，阳衰则寒隔于中，阻其运行之机，邪正相拒，故进痛时止，大便溏泄，胃阳不足，脾湿太甚故也。困倦嗜卧，少气懒言，皆气弱之征。种种病情，不可枚举，惟有甘温固元一法，实治虚劳灵丹。［眉批］知非氏曰：虚劳之人，五神无主，四大不收。夫五神者，五官之神也，五官不能自为用，其中有主之者，《仙经》曰：譬如弄傀儡，中有工机轴是也。四大者，地、水、火、风也。毛发爪指、皮肤者，地也：津、液、涎、沫者，水也：运转、运作者，风也：暖气者，火也。然此四大全要元神、元气为主宰收摄。虚劳之人，元神昏散，视听混淆，是五神无主宰。元气耗散，举止疲惫，是四大［2］不收摄。夫人身元阳为本，是生真气，真气聚而得安，真气弱而成病，虚劳者，真气耗散，元阳失走，迨至元阳尽，纯阴成呜呼死矣。钦安指出大法，惟有甘温固元，是姜、附、草，不是参，芪、术，学者不可不知也。
昧者多作气血双补，有云大剂滋阴，有等专主清润，有等开郁行滞，不一而足，是皆杀人不转瞬者也。予非言大而矜，妄自争辩，实不得不辩也。
[1] 肺 原本作""，据文义改。
[2] 大 原本作"牙"，据文义改。
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厥 证
按厥证一条，有阳厥，阴厥之别。阳厥者何？由其外邪入内，合阳［1］经热化，热极则阴生，阳伏于内，阴呈于外，故现四肢冰冷，或脉如丝，或无脉，其人虽外见纯阴，而口气必蒸手，小便必短赤，精力不衰。法宜清热下夺为主，如大小承气，调胃承气汤等是也。
阴厥者何？由其正气已虚，阴寒四起，阴盛阳微，闭塞经络，阳气不能达于四肢，故见四肢冰冷，其人目瞑倦卧，少气懒言。法宜回阳祛阴，如四逆汤，回阳饮之类，此阴阳生死攸关，不容不辩。［眉批］知非氏曰：阴证发厥，内伤已极，诸人能认，治多不谬。惟阳证发厥，热极成寒，仲景有厥证用白虎之条，人多不辩。钦安此论，两两对言，重在热厥一面，学者能认出热厥，评者之心亦慰矣。
谵 语
按谵语一证，有阴阳之别，不可不知。阳证之谵语，由其外邪伏热，热乘于心，浊火乱其神明，神明无所主，蕻人口中妄言，必见张目不眠，口臭气粗，身轻恶热，精神不衰。轻者可用导赤散加黄连，重者可用大小承气汤，三黄石膏汤。
阴证之谵语，由其正气已衰，阴邪顿起，神为阴气蔽塞，则神识不清。其人多闭目妄言，四肢无力，倦卧畏寒，身重汗出，即有欲饮冷水一二口者，其人无神，定当以回阳为准，切不可以为饮冷，而即以凉药投之，则害人多矣。须知积阴在内，生有微热，积阴一化，热自消亡，此处下手，便是高一着法。
[1] 阳 原本作"汤"，据文义改。
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予曾经验多人，不问发热、汗出、谵语、口渴饮冷，但见无神，便以大剂回阳饮治之，百治百生。［眉批］知非氏曰：谵语本是神昏气沮，此论精当，治法绝妙，后言不问其证，决之早也。但见无神，眼之明也。便以大剂，手之快也。百治百生，效之必也。学者先要学此手眼。
女科门
按女科与男子稍有不同，以其质秉坤柔，具资生之德，而有经期、胎前、产后，病情与男子不同，其余皆同。诸书分辩详，实可择取。予于女科一门，亦稍有见解，因于闲暇，又从而直切畅言之，以补诸书未言之旨，恐见解不当，高明谅之。［眉批］知非氏曰：女子之病，多于男子，奈何多多一病耳。虽曰五漏成体一，两耳不须治一，两乳不须治一，经水则其要也。治之奈何，在知本，知本于太阴，无他谬巧矣。夫太阴者，月也。三五而盈，三五而缺。盈者，阴进，为阳，主长。缺者，阳退，为阴，主消。阳长阳消，以阳为运用。长者生之，徒升发不泄；消者死之，徒降下不留，月事以时下。一月一降，为不病之恒，降下无所苦，又不爽其期，谓曰月信。苟阳失健运，则坤中之阴精不藏，如先期而至，是月受日魂未足，阴中阳微，不得谓为有火，而用苓、连、知、柏。如后期而至，是月受日魂未足，阴中阳虚，阳虚阴亦无准，不得谓为有寒，而用四物、桂、附。淋漓不断者，少则非崩，崩者多而不止，皆由元阳行德不下，以致阴精流溢不守，不得仅以热论，色紫成块，色淡不鲜，同为阳气不足。将行腹痛，行后腹痛，均是阳虚气凝。至于处子、妇人经闭不通，皆由虚损，先宜扶阳，继须通利。通利之方，桃核承气汤，不遗余力，若姑息养奸，百日而劳瘵成，不可救药矣。非医之过而何？所有带证，处子、妇人，皆多患此，不在经证之例，亦非带脉为病。非白淫，即寒湿，浊恶不堪，法宜升散，不宜燥熯，致烁阴精，皆治本之决也。至于内伤外感，亦能伤太阴而有以上诸条，触类而伸之，比类而参之，有形证，有理路，何患无治法乎。钦安分门别类，博学而详说之，妙在窥透阳不化阴之玄理，反复论辩，只重一阳字，握要以图，立法周密，压倒从世诸家，何况庸手。知非良深佩服，而胎前不言证，归于六经矣，产后不言，法尽于阴阳矣，知非亦可无言矣。
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经水先期而至或十七八九日，二十四王日者是也
按经水先期而来，诸书皆称虚中有热，为太过，为气之盈，多以四物汤加芩、连、阿胶之类治之，以为血中有热，热清而血不妄动，经自如常。予谓不尽属热，多有元气太虚，血稍存注，力不能载，故先期而下。其人定见面白无神，少气懒言，稍有劳动，心惕气喘，脉细而微，亦或浮空。此等法当温固元气为主，不得妄以芩连四物治之。果系可服芩连四物者，人必精神健旺，多暴怒，抑郁，言语、起居、动静一切有神，如此分处，用药庶不错误。
经水后期而至或三十七八日，四五十日，及两三月者是也
按经水后期而至，诸书称为虚中有寒，为不及，为气之缩，多以桂、附之类加入四物汤治之，以为血中有寒，寒得温而散，血自流通，经即如常。予谓不尽属寒。其中多有暗泄处，不可不知。暗泄者何？其人或常自汗不止，或夜多盗汗，或常流鼻血，或偶吐血，或多泄水，或饮食减少。如此之人，切不可照常通经、赶经法施治，当审其病而调之。如其人当经期将至，前四五日，常自汗出者，是气机上浮而不下降，汗出即血出也，察其是卫阳不固者固之，如芪附汤，建中汤是也。察其系内有热伏，热蒸于外，而汗出者，宜凉之，如益元散，生地四物之类治之。
若是盗汗，察其系阴盛隔阳于外，阳气不得藏，气机上浮，故盗汗出，法宜收纳，如封髓丹，潜阳丹之类。察其系血分有热，热蒸于外，盗汗亦作，法宜清润，如鸡子黄连汤之类。
若是鼻血、吐血、审是火旺，逼血外行，自有火形可征，
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法宜清凉，如桃仁、地黄、犀角汤之类。审是阳虚不能镇纳阴气，阴血上僭外越，自有阳虚病情可考，不得即为倒经，而妄用通经凉血止血之方，惟有扶阳抑阴，温中固土为准，如甘草干姜汤，潜阳，建中等汤。
若是时常泄水，饮食减少，多由元气下泄，阴血暗耗，法宜温中收固。况饮食减少，生化机微［1］，天真之液不能如常流注，学者须知，切切不可见其经之后至，而即以通套等法施之。
其中尚有外感寒邪，闭束营卫气机，亦能使经期后至。可按六经提纲治之。更有经期将至，偶食生冷，或洗冷水，亦能使经期后至，须当细问明白，切不可粗心。
经来淋漓不断
按经来淋漓不断一证，有元气太虚，统摄失职者；有因冲任伏热，迫血妄行者。
因元气太弱者，或由大吐、大泻伤中，或过服宣散、克伐，或房劳忧思过度，种种不一，皆能如此。其人起居动静，脉息声音，一切无神，法宜温固，如附子理中、黄芪建中、香砂六君之类。
因冲任伏热，热动于中，血不能藏，其人起居动静，脉息声音，一切有神，法宜养阴清热，如黄莲泻心汤，生地芩连汤之类，总要握其阴阳，方不误事。
经水来多而色紫成块
按经水紫色成块一证，诸书皆称火化太过，热盛极矣。多以凉血汤，及生地四物加芩、连之类，法实可从，其病形
[1] 微 原本作"征"，笔误，据文义改。
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定是有余可征。若无有余足征，而人见昏迷、困倦嗜卧，少气懒言，神衰已极，又当以气虚血滞，阳不化阴，阴凝而色故紫，故成块。不得妄以清凉施之，法宜温固本元为主，如理 加香附，甘草干姜汤，建中汤之类，方不为害。总之众人皆云是火，我不敢即云是火，全在有神无神处，仔细详情，判之自无差矣。
经水来少而色淡
按经水少而色淡一证，诸书皆称血虚，统以四物加人参汤主之，以为血虚者宜补其血。予谓此证，明是火化不足，阳衰之征。阳气健则化血赤，阳气微则化血淡。阳气盛则血自多，阳气衰则血自少，乃一定之理，法当扶阳以生血，即天一生水的宗旨。何得专以四物人参汤，一派甘寒之品乎？此皆后人不识阴阳盈虚之妙，故有如此之说也。予见当以黄芪建中汤，当归补血汤加附子，或甘草干姜汤合补血汤，如此治此，方不误事。
经水将行而腹痛
按经水将行腹痛一证，诸书皆言血中有滞也，多用通滞汤，及桃仁四物汤。予思此二方，皆是着重血中有滞也。如果属热滞，此二方固可治之。苟因寒邪阻滞，以及误食生冷，又当以温中行滞为主，无专以此二方为是。如此分处治去，庶不至误事。
经水行后而腹痛
按经水行后腹痛一证，诸书皆云虚中有滞也，统以八珍汤加香附治之，亦颇近理。予思经后腹痛，必有所因，非外
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寒风冷之侵，必因内阳之弱，不概以气血两虚有滞为准，又当留心审察。如系外寒风冷，必有恶风畏寒，发热身痛，仍宜发散，如桂枝汤是也。若系内阳不足，则寒从内生，必有喜揉按、热熨之情，法宜温里，如附子理中加丁香、砂仁之类。
予常治经后腹痛，其人面白唇淡者，以甘草干姜汤加丁香、官桂治之，或以补血汤加安桂治之，必效。
妇人经闭不行或四五十日，或两三月者是也
按闭经一证，关系最重，诊视探问，必须留心。如诊得六脉迟涩不利者，乃闭之证。若诊得六脉流利，往来搏指，妊娠之兆，切切不可直口说出。先要问明何人，看丈夫在家否？如丈夫在家，称云敝内，他先请问，方可言说是喜，不是经闭。设或言寡居，或方言丈夫出外，数载未归；设或言室女年已过大，尚未出阁。访问的确，审无痰饮证形，痰疾脉亦多滑利。虽具喜脉，切切不可说出，但云经闭。如在三两月内，不妨于药中多加破血耗胎之品，使胎不成，亦可以曲全两家祖宗脸面，亦是阴德。即服药不效，而胎成者，是恶积之不可掩，而罪大之不可解也。倘一朝遇此，主家向医说明，又当暗地设法，曲为保全，不露主角，其功更大。设或室女，于归期促，不得不从权以堕之。不堕则女子之终身无依，丑声扬，则两家之面目何存？舍此全彼，虽在罪例，情有可原。自古圣贤，无非在人情天理上，体会轻重而已。
予思经闭不行， 亦各有所因。有因经行而偶洗冷水闭者，有因将行而偶食生冷闭者，有因将行而偶忿气闭者，有因素秉中气不足，生化太微而致者，有因偶感风寒，闭塞而致者，不可不知。
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因洗冷水而闭者，盖以经血之流动，全在得温以行，得寒而凝，理势然也。今得冷水以侵之，气机忽然闭塞，血液不流，法当温经，如麻黄附子细辛汤、阳旦汤、或补血汤加丁香、肉桂之类。
因食生冷而闭者，诚以天真之液如雾露之气，全赖中宫运转，血自流通。今为生冷停积中宫，闭其运转之机，血液故不得下降。法当温中，如理中汤加砂仁、丁香、肉桂，或甘草干姜汤加丁香、胡椒之类。
因忿气而闭者，盖以忿争则气多抑郁，抑郁则气滞而不舒，气不舒，则血不流，故闭。法宜理气舒肝为主，如小柴胡汤加香附、川芎、麦芽之类。
先天肾阳亏损。真阳一旦衰弱，群阴便乘势而起，因此出现子时和午时的潮热。子时和午时是阴阳交替的时刻，阳气不能下行交于阴分，则阳气浮越而不能潜藏，所以产生潮热；阴气不能上行交于阳气，则阴气升腾，没有阳气来镇守收纳，也产生潮热。医生如果不明白其中的至理，一见潮热就诊断为阴虚，使用大量滋阴养阴的药物，往往酿成阳气脱绝的危重证候，实在可悲。
自汗和盗汗并见。凡是自汗、盗汗都是阳虚的表现，各医书都称盗汗为阴虚，这是指发生在夜半时分而言。夜半是阳气潜藏的时候，然而此时实际上是阴气旺盛的阶段，阴气盛可以逼迫阳气外越，阳气浮越外亡，血液随之而出，所以出汗，称为盗汗。医生不知道这是阳虚，不能镇纳阴气，导致阴气外越，血液也随之流出；阴盛格拒阳气于外，阳气不能潜藏，也会出汗。这个旨意非常微妙，学者务必在阴阳互根的道理上领会。
咳嗽吐白痰。真阳一衰，阴邪就会上逆，气逆则咳嗽发作。白痰虽然不是血，但实际上也是血的范畴，由于命门火衰，气化功能失职，精气得不到真火的煅炼，所以颜色不红。近来很多人称之为“陈寒入肺”，实在可笑。
腹部胀满但按之柔软不实，是因为阴气闭塞，阳气微弱不能运化所致。面色黄、肌肉消瘦，是因为真火衰微，脾土失去生机，脾气外泄，想要向外耗散，所以面色发黄；土气衰败则肌肉消减，因为脾主肌肉的缘故。
腹部有时疼痛、有时停止，是因为阳气衰微，寒邪阻隔于中焦，阻碍了气机运行，邪正相争，所以疼痛时进时止。大便溏泄，是因为胃阳不足，脾湿太甚所致。
困倦嗜睡，气短懒言，都是气弱的表现。种种病情，不可一一列举，只有甘温固元这一法，确实是治疗虚劳的神丹妙药。［眉批］知非氏说：虚劳病人，五神无主，四大不收。所谓五神，是五官之神，五官不能自行发挥作用，其中有主宰它的东西，《仙经》说：就像玩弄傀儡，中间有工巧的机轴一样。所谓四大，是指地、水、火、风。毛发爪甲、皮肤，属于地；津液、涎沫，属于水；运转、运作，属于风；暖气，属于火。然而这四大完全需要元神、元气作为主宰来收摄。虚劳病人，元神昏乱散失，视听混淆，这是五神没有主宰。元气耗散，举止疲惫，这是四大不能收摄。人的身体以元阳为本，由此生发真气，真气聚集则安康，真气虚弱则生病。虚劳病人，真气耗散，元阳走失，等到元阳耗尽，纯阴独存，也就死了。钦安指出大法，只有甘温固元，用的是干姜、附子、甘草，而不是人参、黄芪、白术，学者不可不知道。
无知的人多主张气血双补，有的说用大剂量滋阴，有的专门主张清润，有的专门疏郁行滞，各种说法不一而足，这些都是转瞬之间就能杀人的方法。我并不是夸大其词或好胜争辩，实在是不得不辩驳。
[1] 肺 原文作“”，根据文义改正。
[2] 大 原文作“牙”，根据文义改正。
厥证
关于厥证这一条，有阳厥和阴厥的区别。什么是阳厥？是由于外邪入里，与阳经热邪结合，热极则生阴象，阳气伏郁于内，阴象呈现于外，所以出现四肢冰冷，或者脉象如丝线般细微，或者无脉。其人虽然外表呈现纯阴之象，但口气必然熏手，小便必然短赤，精力不衰。治法应当以清热攻下为主，如大承气汤、小承气汤、调胃承气汤等。
什么是阴厥？是由于正气已经虚弱，阴寒四起，阴盛阳微，闭塞经络，阳气不能通达于四肢，所以见到四肢冰冷。其人眼睛闭合，疲倦嗜卧，气短懒言。治法应当回阳祛阴，如四逆汤、回阳饮之类。这是阴阳生死攸关的问题，不容不辨明。［眉批］知非氏说：阴证发厥，内伤已极，众人能辨认，治疗大多不错误。只有阳证发厥，热极成寒，张仲景有厥证用白虎汤的条文，人们多不辨明。钦安这一论述，两相对照，重在热厥一面，学者能认出热厥，评者的心也就欣慰了。
谵语
关于谵语这一证候，有阴阳的区别，不可不知。阳证的谵语，是由于外邪伏热，热邪侵犯心脏，浊火扰乱神明，神明无所主宰，胡乱从口中说出妄言，必定见到睁眼不眠，口臭气粗，身体轻爽厌恶热，精神不衰。轻症可用导赤散加黄连，重症可用大承气汤、小承气汤、三黄石膏汤。
阴证的谵语，是由于正气已经衰微，阴邪突然兴起，神志被阴气蔽塞，则神识不清。其人多半闭目妄言，四肢无力，疲倦嗜卧，畏寒，身体沉重出汗，即使有想喝一两口冷水的情况，其人也是无神，定当以回阳为准则，千万不要以为他想喝冷水，就立即投以凉药，那样害人就多了。须知积阴在内，会产生微热，积阴一旦化解，热自然消亡，从这里下手，就是高一着的治法。
[1] 阳 原文作“汤”，根据文义改正。
我曾经验治愈多人，不问是否有发热、出汗、谵语、口渴饮冷等症状，只要见到无神，就用大剂量的回阳饮治疗，百治百灵。［眉批］知非氏说：谵语本是神昏气沮，此论精当，治法绝妙，后文说不问其证，决断得太早了。但见无神，是眼光明亮。便以大剂，是手法快捷。百治百生，是疗效必然。学者首先要学习这种手眼。
女科门
关于女科与男子稍有不同，是因为女子体质禀受坤柔之气，具备生育的德行，而有经期、胎前、产后，病情与男子不同，其余都一样。各医书分辨得很详细，确实可以择取。我对于女科一门，也稍有见解，因此在闲暇时，又进而直切畅快地阐述，以补充各医书未言之旨，恐怕见解不当，高明之士谅察。［眉批］知非氏说：女子的病，多于男子，奈何多了一个病处罢了。虽说五漏成体，两耳不需要治，两乳不需要治，月经则是关键所在。怎么治疗呢？在于知本，知本于太阴，没有其他谬巧了。所谓太阴，就是月亮。十五月圆，十五月缺。圆的时候，阴进为阳，主生长；缺的时候，阳退为阴，主消亡。阳长阳消，以阳为运用。长的阶段要生发，只升发而不发泄；消的阶段要死灭，只降下而不留驻，月事按时而下。一个月一次下降，是不病的常态，下降时没有痛苦，又不违背其期，称为月信。如果阳气失去健运，则坤中的阴精不能收藏，如提前而至，这是月受日魂不足，阴中阳微，不能说是火旺，而用黄芩、黄连、知母、黄柏。如果推后而至，这是月受日魂不足，阴中阳虚，阳虚阴也没有准度，不能说是寒，而用四物汤、桂枝、附子。淋漓不断的，量少则不是崩漏，崩漏是多且不止，都是由元阳行使德政不下，以致阴精流溢不守，不能仅以热论，色紫成块，色淡不鲜，同为阳气不足。将行经时腹痛，行经后腹痛，均是阳虚气凝。至于处女、妇人经闭不通，都是由虚损引起，先宜扶阳，继须通利。通利的方子，桃核承气汤，不遗余力，如果姑息养奸，百日而成劳瘵，不可救药了。这不是医生的过错吗？所有带下证，处女、妇人，都多患此病，不在经证之列，也不是带脉为病。不是白淫，就是寒湿，浊恶不堪，治法宜升散，不宜燥热，以免灼烁阴精，这都是治本的决断。至于内伤外感，也能损伤太阴而出现以上诸条，触类旁通，比类参详，有形证，有理路，何愁没有治法呢。钦安分门别类，博学而详说之，妙在窥透阳不化阴的玄理，反复论辩，只重一个“阳”字，握要以图，立法周密，压倒世俗诸家，何况庸手。知非深表佩服，而胎前不言证，归于六经了，产后不言，法尽于阴阳了，知非也可以无言了。
经水先期而至，或十七八天、二十四五天的是这样
关于经水先期而来，各医书都称虚中有热，为太过，为气之盈，多以四物汤加黄芩、黄连、阿胶之类治疗，认为血中有热，热清而血不妄动，经水自然如常。我认为不尽属热，多有元气太虚，血稍存注，力不能载，所以先期而下。其人必定见面白无神，少气懒言，稍有劳动，心中惊惕气喘，脉细而微，或者浮空。这类情况治法应当以温固元气为主，不得妄用黄芩、黄连、四物汤治疗。果真是可服黄芩、黄连、四物汤者，人必定精神健旺，多暴怒，抑郁，言语、起居、动静一切有神，如此区分处理，用药才不错误。
经水后期而至，或三十七八天、四五十天，及两三个月的是这样
关于经水后期而至，各医书称为虚中有寒，为不及，为气之缩，多以桂枝、附子之类加入四物汤治疗，认为血中有寒，寒得温而散，血自流通，经水即如常。我认为不尽属寒。其中多有暗泄之处，不可不知。什么叫暗泄？其人或者常自汗不止，或者夜多盗汗，或者常流鼻血，或者偶吐血，或者多泄水，或者饮食减少。这样的人，切不可照常通经、赶经的方法施治，应当审其病因而调治。如其人当经期将至的前四五日，常自汗出者，是气机上浮而不下降，汗出即血出也，察其是卫阳不固的，就固护它，如芪附汤、建中汤等。察其系内有热伏，热蒸于外，而汗出者，宜清凉它，如益元散、生地四物之类治疗。
如果是盗汗，察其系阴盛隔阳于外，阳气不得藏，气机上浮，故盗汗出，治法宜收纳，如封髓丹、潜阳丹之类。察其系血分有热，热蒸于外，盗汗亦作，治法宜清润，如鸡子黄连汤之类。
如果是鼻血、吐血，审是火旺，逼血外行，自有火形可征，
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治法宜清凉，如桃仁、地黄、犀角汤之类。审是阳虚不能镇纳阴气，阴血上僭外越，自有阳虚病情可考，不得即为倒经，而妄用通经凉血止血之方，惟有扶阳抑阴，温中固土为准，如甘草干姜汤、潜阳汤、建中汤等。
如果是时常泄水，饮食减少，多由元气下泄，阴血暗耗，治法宜温中收固。况且饮食减少，生化之机微［1］，天真之液不能如常流注，学者须知，切切不可见其经之后至，而即以通套等方法施之。
其中尚有外感寒邪，闭束营卫气机，亦能使经期后至。可按六经提纲治之。更有经期将至，偶食生冷，或洗冷水，亦能使经期后至，须当细问明白，切不可粗心。
经来淋漓不断
关于经来淋漓不断一证，有元气太虚，统摄失职者；有因冲任伏热，迫血妄行者。
因元气太弱者，或由大吐、大泻伤中，或过服宣散、克伐药物，或房劳忧思过度，种种不一，皆能如此。其人起居动静，脉息声音，一切无神，治法宜温固，如附子理中汤、黄芪建中汤、香砂六君子汤之类。
因冲任伏热，热动于中，血不能藏，其人起居动静，脉息声音，一切有神，治法宜养阴清热，如黄连泻心汤、生地芩连汤之类，总要把握其阴阳，才不误事。
经水来多而色紫成块
关于经水紫色成块一证，各医书皆称火化太过，热盛极矣。多以凉血汤，及生地四物加黄芩、黄连之类，法实可从，其病形
[1] 微 原文作“征”，笔误，据文义改正。
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定是有余可征。若无有余足征，而人见昏迷、困倦嗜卧，少气懒言，神衰已极，又当以气虚血滞，阳不化阴，阴凝而色故紫，故成块。不得妄以清凉施之，治法宜温固本元为主，如理中汤加香附、甘草干姜汤、建中汤之类，方不为害。总之众人皆云是火，我不敢即云是火，全在有神无神处，仔细详情，判之自无差矣。
经水来少而色淡
关于经水少而色淡一证，各医书皆称血虚，统以四物加人参汤主之，认为血虚者宜补其血。我认为此证，明是火化不足，阳衰之征。阳气健则化血赤，阳气微则化血淡。阳气盛则血自多，阳气衰则血自少，乃一定之理，治法当扶阳以生血，即天一生水的宗旨。何得专以四物人参汤，一派甘寒之品乎？这都是后人不识阴阳盈虚之妙，故有如此之说也。我认为当以黄芪建中汤、当归补血汤加附子，或甘草干姜汤合补血汤，如此治此，方不误事。
经水将行而腹痛
关于经水将行腹痛一证，各医书皆言血中有滞也，多用通滞汤，及桃仁四物汤。我思考这两个方子，皆是着重血中有滞也。如果属热滞，这两个方子固可治之。苟因寒邪阻滞，以及误食生冷，又当以温中行滞为主，无专以此二方为是。如此区分处理去，庶不至误事。
经水行后而腹痛
关于经水行后腹痛一证，各医书皆云虚中有滞也，统以八珍汤加香附治之，亦颇近理。我思考经后腹痛，必有所因，非外
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寒风冷之侵，必因内阳之弱，不概以气血两虚有滞为准，又当留心审察。如系外寒风冷，必有恶风畏寒，发热身痛，仍宜发散，如桂枝汤是也。若系内阳不足，则寒从内生，必有喜揉按、热熨之情，治法宜温里，如附子理中汤加丁香、砂仁之类。
我常治经后腹痛，其人面白唇淡者，以甘草干姜汤加丁香、官桂治之，或以补血汤加安桂治之，必效。
妇人经闭不行，或四五十天，或两三个月的是这样
关于闭经一证，关系最重，诊视探问，必须留心。如诊得六脉迟涩不利者，乃是闭经之证。若诊得六脉流利，往来搏指，妊娠之兆，切切不可直口说出。先要问明何人，看丈夫在家否？如丈夫在家，自称敝内，他先请问，方可言说是喜（怀孕），不是经闭。设或言寡居，或方言丈夫出外，数载未归；设或言室女年已过大，尚未出阁。访问的确，审无痰饮证形，痰疾脉亦多滑利。虽具喜脉，切切不可说出，但云经闭。如在三两月内，不妨于药中多加破血耗胎之品，使胎不成，亦可以曲全两家祖宗脸面，亦是阴德。即服药不效，而胎成者，是恶积之不可掩，而罪大之不可解也。倘一朝遇此，主家向医说明，又当暗地设法，曲为保全，不露主角，其功更大。设或室女，于归期促，不得不从权以堕之。不堕则女子之终身无依，丑声扬，则两家之面目何存？舍此全彼，虽在罪例，情有可原。自古圣贤，无非在人情天理上，体会轻重而已。
我思考经闭不行，亦各有所因。有因经行而偶洗冷水闭者，有因将行而偶食生冷闭者，有因将行而偶忿气闭者，有因素秉中气不足，生化太微而致者，有因偶感风寒，闭塞而致者，不可不知。
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因洗冷水而闭者，盖以经血之流动，全在得温以行，得寒而凝，理势然也。今得冷水以侵之，气机忽然闭塞，血液不流，治法当温经，如麻黄附子细辛汤、阳旦汤、或补血汤加丁香、肉桂之类。
因食生冷而闭者，诚以天真之液如雾露之气，全赖中宫运转，血自流通。今为生冷停积中宫，闭其运转之机，血液故不得下降。治法当温中，如理中汤加砂仁、丁香、肉桂，或甘草干姜汤加丁香、胡椒之类。
因忿气而闭者，盖以忿争则气多抑郁，抑郁则气滞而不舒，气不舒，则血不流，故闭。治法宜理气舒肝为主，如小柴胡汤加香附、川芎、麦芽之类。
Deficiency of the True Yang (Zhen Yang, True Fire) in the Kidney (Shen, 肾) (the source of congenital vitality). Once True Yang declines, Yin pathogens (Yin Xie, 阴邪) rise like a swarm of bees, thus presenting with tidal fever at Zi (子, 11 PM - 1 AM) and Wu (午, 11 AM - 1 PM) hours. These two periods are when Yin and Yang intersect. If Yang cannot descend to interact with Yin, Yang Qi floats and fails to store, generating tidal fever. If Yin cannot ascend to interact with Yang, Yin Qi rises without Yang to anchor and consolidate it, also generating tidal fever. Physicians who do not comprehend this profound principle, upon seeing tidal fever, immediately diagnose Yin Deficiency (Yin Xu, 阴虚) and use a regimen of Yin-nourishing herbs, often precipitating critical conditions of Yang collapse (Yang Tuo, 阳脱), which is truly lamentable.
Spontaneous sweating (Zi Han, 自汗) and night sweats (Dao Han, 盗汗) occur together. All spontaneous and night sweats are signs of Yang Deficiency. Various texts attribute night sweats to Yin Deficiency because they occur at night. Night is when Yang Qi should be stored; however, at night, Yin is actually abundant. Excess Yin can force Yang outward. As Yang floats and escapes externally, Blood (Xue, 血) follows and exits as sweat, termed night sweat. Physicians fail to recognize this as Yang Deficiency, unable to anchor Yin Qi, causing Yin to escape externally and Blood to follow. When Yin excess repels Yang to the exterior, preventing Yang from storing, sweating also occurs. This principle is subtle; scholars must understand it through the concept of mutual root (Hu Gen, 互根) of Yin and Yang.
Coughing up white phlegm: Once True Yang declines, Yin pathogens reverse upward, causing cough due to rebellious Qi. Although white phlegm is not blood, it is related to blood. Due to deficient Ming Men Fire (Ming Men Huo, 命门火), transformation functions fail, and Essence (Jing, 精) is not refined by True Fire, hence its color is not red. Recently, many call this "old cold entering the Lung" (Fei, 肺), which is laughable.
Abdominal fullness without hardness: Caused by Yin Qi obstruction and weak Yang failing to transport.
Yellow complexion and emaciation: When True Fire declines, Spleen Earth loses vitality. Earth Qi dissipates and tends to escape externally, causing a yellow complexion. As Earth declines, muscles waste away because the Spleen governs muscles.
Intermittent abdominal pain: Yang decline causes Cold (Han, 寒) to block the middle Jiao (San Jiao, 三焦), obstructing movement. Pathogenic and righteous Qi resist each other, causing pain that comes and goes. Loose stools result from insufficient Stomach Yang and excessive Spleen dampness.
Fatigue, drowsiness, shortness of breath, and reluctance to speak are all signs of Qi weakness. Various symptoms are too numerous to list. The only method is Sweet-Warm Yuan-Solidifying (Gan Wen Gu Yuan, 甘温固元), which is indeed a spiritual elixir for treating Consumption (Xu Lao, 虚劳). [Marginal Note]: Zhi Fei says: In Consumption, the Five Spirits (Wu Shen, 五神) have no master, and the Four Elements (Si Da, 四大) are uncontrolled. The Five Spirits are the spirits of the five sense organs; they cannot function independently but require a master. The *Immortal Classic* states: It is like manipulating puppets, where an internal mechanism controls them. The Four Elements refer to Earth, Water, Fire, and Wind. Hair, nails, skin are Earth; fluids, saliva are Water; movement and operation are Wind; warmth is Fire. However, these four entirely require Primordial Spirit (Yuan Shen, 元神) and Primordial Qi (Yuan Qi, 元气) as masters to control them. In Consumption, Yuan Shen is confused and scattered, vision and hearing are mixed, meaning the Five Spirits lack a master. Yuan Qi is depleted, movements are weary, meaning the Four Elements are uncontrolled. The body's Primordial Yang is the root, generating True Qi. When True Qi gathers, there is health; when weak, disease arises. In Consumption, True Qi scatters, Primordial Yang flees. When Primordial Yang is exhausted, Pure Yin remains, leading to death. Qin An points out the major principle: only Sweet-Warm Yuan-Solidifying works, using Gan Jiang (Dried Ginger), Fu Zi (Aconite), and Gan Cao (Licorice), not Ren Shen (Ginseng), Huang Qi (Astragalus), or Bai Zhu (Atractylodes). Scholars must know this.
Ignorant practitioners often advocate dual tonification of Qi and Blood, some recommend large doses of Yin-nourishing herbs, others focus on clearing and moistening, others on resolving stagnation, etc. These methods kill people instantly. I am not boasting or arguing vainly; I must refute this.
[1] Lung (Fei) originally written as "", corrected according to context.
[2] Si Da originally written as "Ya", corrected according to context.
**Jue Syndrome (Reversal Condition)**
Regarding Jue Syndrome, there are Yang Jue and Yin Jue. What is Yang Jue? External pathogens enter internally, combining with heat transformation in Yang meridians. Extreme heat generates Yin phenomena; Yang is trapped internally, while Yin manifests externally, causing cold limbs, thread-like pulse, or absent pulse. Although the exterior appears purely Yin, the breath is hot to the touch, urine is short and red, and energy is not depleted. The treatment should focus on clearing heat and purging downward, such as Da Cheng Qi Tang (Major Order the Qi Decoction), Xiao Cheng Qi Tang (Minor Order the Qi Decoction), or Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction).
What is Yin Jue? Righteous Qi is already deficient, Yin-Cold rises everywhere, Yin is excess and Yang is weak, blocking meridians so Yang cannot reach the limbs, causing cold limbs. The patient closes their eyes, lies fatigued, has shortness of breath, and reluctance to speak. Treatment should restore Yang and dispel Yin, such as Si Ni Tang (Four Reversals Decoction) or Hui Yang Yin (Restore Yang Drink). This concerns life and death between Yin and Yang, requiring distinction. [Marginal Note]: Zhi Fei says: Yin syndrome Jue indicates extreme internal injury; most can recognize it, and treatment is rarely wrong. Only Yang syndrome Jue, where extreme heat becomes cold, is misunderstood. Zhang Zhongjing has clauses for using Bai Hu Tang (White Tiger Decoction) for Jue, but few distinguish it. Qin An’s argument contrasts both, emphasizing Heat Jue. If scholars can identify Heat Jue, the reviewer is comforted.
**Delirious Speech (Chan Yu, 谵语)**
Regarding Chan Yu, there are Yin and Yang distinctions. Yang Chan Yu results from external pathogens trapping heat, which attacks the Heart (Xin, 心). Turbid fire disrupts the Spirit (Shen, 神), which loses mastery, causing random speech. Symptoms include wide-open eyes, insomnia, foul breath, coarse breathing, light body, aversion to heat, and preserved spirit. Mild cases may use Dao Chi San (Guide Out the Red Powder) plus Huang Lian (Coptis); severe cases may use Da/Xiao Cheng Qi Tang or San Huang Shi Gao Tang (Three Yellows and Gypsum Decoction).
Yin Chan Yu results from deficient righteous Qi and sudden rise of Yin pathogens. The Spirit is blocked by Yin, causing unclear consciousness. The patient speaks randomly with closed eyes, has weak limbs, lies fatigued, fears cold, feels heavy, and sweats. Even if they desire one or two sips of cold water, the lack of spirit dictates restoring Yang. Do not assume cold water desire means using cooling herbs, or you will harm many. Accumulated Yin generates slight heat; once Yin transforms, heat vanishes. Treating here is superior.
I have successfully treated many cases regardless of fever, sweating, delirium, or thirst for cold water, provided there is a lack of spirit, using large doses of Hui Yang Yin. Hundred cures, hundred recoveries. [Marginal Note]: Zhi Fei says: Delirium is essentially spirit confusion and Qi depression; this theory is precise, treatment excellent. The statement "regardless of symptoms" is decisive. Seeing lack of spirit shows clear vision. Using large doses shows swift hands. Hundred cures show certain efficacy. Scholars must learn this skill and insight.
**Women's Medicine Section**
Women's medicine differs slightly from men's due to their Kun-Yin constitution and reproductive nature, specifically regarding menstruation, pregnancy, and postpartum conditions; otherwise, they are the same. Books detail this well. I have some insights into women's medicine and discuss them here to supplement existing texts. [Marginal Note]: Zhi Fei says: Women suffer more diseases than men due to extra organs. Though five leaks exist, ears and breasts need not be treated; menstruation is key. Treatment depends on knowing the root, which is Tai Yin (Spleen/Lung). Tai Yin corresponds to the moon. Fullness represents Yin advancing to Yang, governing growth; emptiness represents Yang retreating to Yin, governing decline. Growth requires Yang movement. Growth alone without release leads to life; decline alone without retention leads to death. Menstruation occurs monthly. Monthly descent is normal health. If Yang fails to move healthily, Kun-Yin essence does not store, leading to early periods. This is insufficient sun influence, weak Yang within Yin, not fire excess; do not use Huang Qin, Huang Lian, Zhi Mu, or Huang Bo. Late periods indicate insufficient sun influence, Yang deficiency within Yin; do not assume cold, avoid Si Wu Tang, Gui Zhi, or Fu Zi. Prolonged bleeding is not necessarily Bing (flooding); flooding is heavy and continuous, caused by Yuan Yang failing to exercise virtue, leading to uncontrolled essence flow. Do not judge solely by heat. Purple clots or pale color both indicate Yang insufficiency. Abdominal pain before or after menstruation indicates Yang deficiency and Qi stagnation. Virgin or married women with amenorrhea are due to deficiency; first support Yang, then promote circulation. Use Tao He Cheng Qi Tang (Peach Pit Order the Qi Decoction) relentlessly. Indulgence leads to Consumption in 100 days, incurable. Is this not the doctor's fault? Leukorrhea affects virgins and married women, not classified under menstrual disorders, nor Dai Mai (Belt Vessel) disease. It is either Bai Yin (white turbidity) or Cold-Dampness, foul and unbearable. Treatment should lift and disperse, not dry and parch, to avoid burning Yin essence. This is the decision for treating the root. Internal injuries and external infections can also damage Tai Yin. Apply these principles flexibly. Qin An categorizes meticulously, demonstrating broad knowledge. His brilliance lies in penetrating the mystery of Yang failing to transform Yin. He emphasizes "Yang," establishing strict laws, surpassing contemporary schools. Zhi Fei deeply admires this. Prenatal conditions return to Six Meridians; postnatal conditions exhaust Yin-Yang methods. Zhi Fei has nothing more to add.
**Early Menstruation**
Early menstruation (e.g., 17-18 days, 24-25 days) is often attributed in books to deficiency with heat, excess Qi, and treated with Si Wu Tang plus Huang Qin, Huang Lian, E Jiao, assuming blood heat clears and menstruation normalizes. I argue it is not always heat. Often, Yuan Qi is too deficient to carry blood, causing early descent. Patients show pale face, lack of spirit, shortness of breath, palpitations upon exertion, fine/weak or floating-empty pulses. Treatment should warm and solidify Yuan Qi, avoiding Huang Qin/Huang Lian/Si Wu Tang. If Si Wu Tang with Huang Qin/Huang Lian is appropriate, the patient must have robust spirit, frequent anger/depression, and energetic behavior. Distinguish carefully to avoid error.
**Late Menstruation**
Late menstruation (e.g., 37-38 days, 40-50 days, 2-3 months) is often attributed to deficiency with cold, contracted Qi, and treated with Si Wu Tang plus Gui Zhi/Fu Zi, assuming blood cold disperses with warmth. I argue it is not always cold. There are hidden bleedings. Hidden bleeding includes spontaneous sweating, night sweats, epistaxis, hematemesis, diarrhea, or poor appetite. Such patients must not be treated with standard regimens to induce menstruation. Assess the cause. If sweating occurs 4-5 days before menstruation, Qi floats upward instead of descending; sweat implies blood loss. If Wei Yang is insecure, secure it with Qi Fu Tang or Jian Zhong Tang. If internal heat steams outward causing sweat, cool it with Yi Yuan San or Sheng Di Si Wu Tang.
For night sweats, if Yin excess repels Yang, preventing storage and causing Qi float, treat with收纳 (collection), e.g., Feng Sui Dan or Qian Yang Dan. If blood heat steams outward, treat with clearing/moistening, e.g., Ji Zi Huang Lian Tang.
For epistaxis/hematemesis, if fire excess forces blood outward, use cooling herbs like Tao Ren, Di Huang, Xi Jiao Tang. If Yang deficiency fails to anchor Yin, causing blood rebellion, treat by supporting Yang and suppressing Yin, warming the middle and solidifying earth, e.g., Gan Cao Gan Jiang Tang, Qian Yang Tang, or Jian Zhong Tang.
For chronic diarrhea/poor appetite, Yuan Qi leaks downward, consuming Yin blood. Treat by warming the middle and consolidating. Poor appetite weakens transformation; Tian Zhen fluid fails to flow. Do not simply use standard methods for late menstruation.
External cold binding Ying and Wei Qi can also delay menstruation. Treat according to Six Meridians outlines. Eating cold/raw food or washing with cold water near menstruation can also delay it; inquire carefully.
**Prolonged Menstruation**
Prolonged menstruation involves Yuan Qi deficiency failing to control, or Chong/Ren vessel latent heat forcing blood recklessly.
If Yuan Qi is weak (due to vomiting/diarrhea, overuse of dispersing/draining herbs, sexual excess/worry), the patient lacks spirit in movement, pulse, and voice. Treat by warming/solidifying, e.g., Fu Zi Li Zhong Tang, Huang Qi Jian Zhong Tang, or Xiang Sha Liu Jun Zi Tang.
If Chong/Ren latent heat moves internally, preventing blood storage, the patient retains spirit. Treat by nourishing Yin and clearing heat, e.g., Huang Lian Xie Xin Tang or Sheng Di Qin Lian Tang. Grasp Yin/Yang to avoid error.
**Heavy Menstruation with Purple Clots**
Books attribute purple clots to excessive fire/heat, treating with cooling blood herbs like Sheng Di Si Wu Tang plus Huang Qin/Huang Lian. This may be correct if excess signs are present. However, if the patient is comatose, fatigued, short of breath, and spirit-depleted, it is Qi deficiency with blood stasis, Yang failing to transform Yin, causing Yin coagulation and purple color/clots. Do not use cooling herbs. Treat by warming/solidifying Yuan Yuan, e.g., Li Zhong Tang plus Xiang Fu, Gan Cao Gan Jiang Tang, or Jian Zhong Tang. While others say it is fire, I hesitate; judgment depends on the presence or absence of spirit. Careful analysis prevents error.
**Scanty Pale Menstruation**
Books attribute scanty pale menstruation to Blood Deficiency, treating with Si Wu Tang plus Ren Shen. I argue this indicates insufficient fire transformation and Yang decline. Strong Yang produces red blood; weak Yang produces pale blood. Abundant Yang yields abundant blood; deficient Yang yields scarce blood. This is a fixed principle. Treatment should support Yang to generate blood, following the principle of "Heaven One Generates Water." Why use only Si Wu Tang and Ren Shen (sweet-cold herbs)? Later generations failed to understand Yin/Yang balance. I recommend Huang Qi Jian Zhong Tang, Dang Gui Bu Xue Tang plus Fu Zi, or Gan Cao Gan Jiang Tang combined with Bu Xue Tang.
**Abdominal Pain Before Menstruation**
Books attribute pre-menstrual pain to blood stagnation, using Tong Zhi Tang or Tao Ren Si Wu Tang. These target blood stagnation. If heat stagnation, they work. If cold obstruction or raw food intake, prioritize warming the middle and moving stagnation. Do not rigidly apply these formulas. Distinguish to avoid error.
**Abdominal Pain After Menstruation**
Books attribute post-menstrual pain to deficiency with stagnation, using Ba Zhen Tang plus Xiang Fu. I consider post-menstrual pain has specific causes: external wind-cold or internal Yang weakness. Do not assume general Qi/Blood deficiency. If external wind-cold, expect aversion to wind/cold, fever, body ache; use dispersing methods like Gui Zhi Tang. If internal Yang deficiency, cold generates internally; expect preference for rubbing/warming; use interior-warming methods like Fu Zi Li Zhong Tang plus Ding Xiang and Sha Ren.
I often treat post-menstrual pain with pale face/lips using Gan Cao Gan Jiang Tang plus Ding Xiang and Guan Gui, or Bu Xue Tang plus An Gui, with certainty of effect.
**Amenorrhea**
Amenorrhea is critical. Diagnosis requires care. Slow/choppy pulses indicate amenorrhea. Smooth/vibrant pulses suggest pregnancy; do not announce pregnancy immediately. Verify marital status. If husband is present, confirm wife's status before mentioning pregnancy. If widow or husband absent long-term, or virgin past marriage age, verify carefully. Even with pregnancy pulse, if phlegm-fluid signs are absent (phlegm pulses are slippery), suspect amenorrhea. Within 2-3 months, use blood-breaking/fetus-consuming herbs to prevent conception, preserving family honor (merit). If treatment fails and fetus develops, it is unavoidable evil accumulation. If the family explains the situation, secretly help preserve dignity. For virgins nearing marriage, abortion may be necessary to avoid lifelong dependence and scandal. Choosing one over the other, though sinful, is excusable by circumstance. Sages weigh human emotion and heavenly principle.
Causes of amenorrhea vary: washing with cold water during period, eating cold food before period, anger/stress, inherent Spleen Qi deficiency, or external wind-cold.
**Cold Water Exposure:** Blood flows with warmth, congeals with cold. Cold water blocks Qi mechanism, stopping blood flow. Treat by warming meridians, e.g., Ma Huang Fu Zi Xi Xin Tang, Yang Dan Tang, or Bu Xue Tang plus Ding Xiang/Rou Gui.
**Raw Food Intake:** Tian Zhen fluid relies on Middle Jiao rotation for blood flow. Raw food accumulates in Middle Jiao, blocking rotation, preventing blood descent. Treat by warming the middle, e.g., Li Zhong Tang plus Sha Ren/Ding Xiang/Rou Gui, or Gan Cao Gan Jiang Tang plus Ding Xiang/Hu Jiao.
**Anger/Stress:** Anger causes Qi depression and stagnation. Stagnant Qi stops blood flow, causing closure. Treat by regulating Qi and soothing Liver, e.g., Xiao Chai Hu Tang plus Xiang Fu, Chuan Xiong, Mai Ya.