可遽概为阴、为寒、为不足、为虚损也。要知外感脉浮，而病现头疼身痛，发热恶风、自汗、鼻筑流清，始可以言风也。若内伤已久，元气将脱之候，脉象亦浮，犹得以风言之乎。洪、大、实、数之脉，而病现发热恶热，烦躁，口渴饮冷，谵语，口臭气粗，二便闭塞之类，始可以言火、言热也。若内伤已久，元气将脱之候，脉象有极洪、极长、极实、极数、极劲之类，又尚得以时行火热证言之乎？紧寒、滑痰之脉，而病现身疼，发热畏寒，与吐痰不体之类，始可言寒邪痰湿也。若内伤已久，元气将脱之候，脉象亦有极紧、极滑之形，又尚得以寒痰目之乎？沉、迟、细、微、虚、弱之脉，而病现面白唇青，少气懒言，困倦嗜卧之类，乃可以言不足，言虚寒，言阴阳两伤。若外邪深入，协火而动，闭其清道，热伏于中，阳气不达于四末，四肢冰冷，惟口气蒸手，小便短赤而痛，此为阳极似阴，又尚得以气血虚损言之乎？总之，脉无定体，认证为要，阴阳内外，辩察宜清。虽二十八脉之详分，亦不过资顾问已耳。学者苟能识得此中变化，便不为脉所囿矣。
切 脉 金 针
夫脉者，气与血浑而为一者也。其要在寸口，百脉皆会于此。其妙在散于周身，随邪之浅深、脏腑之盛衰，人性之刚柔、身体之长短、肌肉之肥瘦、老幼男女之不同，变化万端。其纲在浮、沉、迟、数，其妙在有神、无神。即有力、无力也。有神无神者，即盈缩机关，内外秘决。他如浮、洪、长、大、数、实，皆为盈，为有余之候。果病情相符，则为脉与病合，当从有余立法施治。如脉虽具以上等象，而病现不足已极，则为脉不合病，当舍脉从病，急宜扶其不足，培其本源。切
-100 -
勿惑于浮风、洪火之说。若按浮风、洪火治去，则为害非浅。沉迟、细、微虚、弱皆为缩，为不足。果病情相符，则为脉与病合，当照不足立法施治。如脉虽具以上等象，而病现有余以极，又当舍脉从病。切勿惑于沉、迟、细、微为虚损。若按虚损治去，则为祸不浅。予恒曰：一盈一缩，即阴阳旨归，万病绳墨。切脉知此，但易认证，庶不为脉所囿矣。
相 舌 切 要
舌上白苔
病人虽舌现白苔，并未见头疼身痛，发热恶寒，恶热等情，切不可认为表证，认为瘟证。当于脉息，声音、起居动静，有神无神处探求病情，自有着落。切切不可猛浪。如果有表证足征，始可照解表法施治。
舌上黄苔
病人虽舌现黄苔，无论干黄色、润黄色、老黄色、黑黄色，并未见口渴饮冷，烦躁，恶热，便闭等情，切不可便谓大旺热极，当于阳虚，真气不上升处理会，病情上理会，治法即在其中。如果见便闭，口臭气粗，身轻恶热，必烦饮冷，精神有余等情，便当攻下，不可迟延。
舌上黑苔
病人虽舌现黑苔，无论干黑色、青黑色、润黑色、虽现阴象，切不可即作阴证施治。如其人烦躁，口渴饮冷，恶热
- 101 -
身轻，气粗口臭，二便闭结，即当攻下，不可迟延。如其人安静懒言，困倦，不渴不食，二便自利，即当回阳，不可迟延。
舌上红黑色 舌上润白苔 舌根独黄色 舌上白黄色 舌上黄芒刺 舌尖独青色 舌上黑黄色 舌上黑芒刺 舌根独黑色 舌上青黄色 舌上白芒刺 舌尖惨红色 舌上粉白苔 舌上青红色 舌心独黄色 舌上干白苔 舌上淡黄色 舌边独白色 舌裂而开瓣 舌如猪腰色
舌之分辩，实属繁冗，亦难尽举。姑无论其舌之青、黄、赤、白、黑、干润、燥裂、芒刺满口、红白相间、黄黑相兼，统以阴阳两字尽之矣。是阴证则有阴象足征，是阳证则有阳证可凭。识得此旨，则不专以舌论矣。诸书纷纷论舌，言某舌当某药，某舌当某方，皆是刻舟求剑之流，不可为法。学者务于平日，先将阴阳病情，真真假假，熟悉胸中，自然一见便知，亦是认证要着。
万病一气说
病有万端，发于一元。一元者，二气浑为一气者也。一气盈缩，病即生焉。有余即火，不足即寒。他如脉来洪大，气之盈也，脉来数实，脉来浮滑，气之盈也。间亦不足。脉来洪大数实浮滑，乃邪实火盛，此为有余。久病暴脱，亦有此脉象，不可不知。脉来迟细，气之缩也，脉来短小，脉来虚弱，气之缩也。间亦有余。脉来迟细短小虚弱，皆为不足。若温病热极脉伏，亦有此脉，不可不知。脉来劈石，脉来鱼尾，脉来雀啄，脉来釜沸，脉来掉尾，脉来散乱，气之绝也。
推之面色如珠，气盈之验。亦有缩者。素乎面赤，不作病看。新病面赤恶热，则为邪实火旺。久病无神，虚极之人而面赤，则为阳竭于上，脱绝
- 102 -
之候，色如鸡冠者吉，色如瘀血者死。面青有神，气盈之验。亦有缩者。素平面青有神，不作病看。有病而始面青，则为肝病。有神主肝旺、无神主肝虚。色如翠羽者吉，色如枯草者凶。面白有神、气盈之验。亦有缩者。素乎面白，不作病看。有病而始见面白者，方以病论。白而有神，肺气尝旺。白而无神，肺虚之征。自如猪膏者吉，色如枯骨者危。面黄有神，气盈之验。亦有缩者。素乎面黄，不作病看。有病而始面黄，方以病论。黄而有神，胃积之盛。黄而无神，气弱之征。黄而鲜明者吉，黄如尘埃色者凶。面黑有神，气盈之验。亦有缩者。素乎面黑，不作病看。有病而始面黑，方以病论。黑而有神，肾气尚旺。黑而无神，肾气衰弱。黑如鸟羽者吉，色如炭煤者危。此论五色之盛衰，其中尚有生克。额属心，而黑气可畏。鼻属土，而青色堪惊。骸下黄而水病，腮左白而肝伤，腮右赤兮火灼，唇上黑兮水泱。气色之变化多端，明暗之机关可据。
至若审音察理，五音细详。五音指宫、商、角、微、羽，以应人身五脏也。声如洪钟，指邪火之旺极。素来音洪，不作病看。有病而始见声洪，则为邪实火旺，法宜泻火为主。语柔而细，属正气之大伤。素来声细，不作病看，有病而始见声低息短，则为不足。忽笑忽歌，心脾之邪热已现。笑主心旺，歌主脾旺。或狂或叫，阳明之气实方张。狂叫乃胃热极。瞑目而言语重重，曰神曰鬼。瞑目而妄言鬼神，是正气虚极，神不守舍也。张目而呼骂叨叨，最烈最横。肝火与心胃邪旺，其势其不可扑灭。
曰饮食，曰起居也，须考证。食健力健，言气之盈，食少力少，本气之缩。饮冷饮滚兮，阴阳之形踪已判。好动好卧兮，虚实之病机毕陈。
至于身体，更宜详辩。肌肉丰隆，定见胃气之旺。形瘦如柴，已知正气之微。皮肤干润，判乎吉凶。毛发脱落，知其正败。
- 103 -
要知风气为殃，春温之名已播。火气作崇，暑热之号已工。湿气时行，霍乱之病偏多。燥气行秋，疟痢之病不少。又乃冬布严寒，伤寒名著。一年节令，病气之变化无穷，六气循环，各令之机关可据。六气，即是六经，六经仍是一经。五行分为五气，五气仍是一气。揭太阳以言气之始，论厥阴以言气之终，昼夜循环，周而复始。病也者，病此气也。周身骨节、经络。皆是后天有形之质。全赖一气贯注。虽各处发病，形势不同，总在一气之中，神为气之宰，气伤则神不安，故曰病。气也者，周身躯壳之大用也。身中无气则无神，故曰死。用药以治病，实以治气也。气之旺者宜平。正气不易旺，惟邪气易旺，须当细分。气之衰者宜助，衰有邪衰、正衰之虽，当知。气之升者宜降，泻其亢盛。气之陷者宜举，气之滞者宜行，气之郁者宜解，气之脱者宜固，气之散者宜敛。知其气之平，知其气之变，用药不失宜，匡救不失道，医之事毕矣。
胎 元 图
-104 -
胎 元 图 说
今以一大圈，喻人一身之真气，中有一小圈，喻人身受胎之始基。始基之谓，胎元之消息也，称为祖气，号曰先天。先天，即父母精血中一点真气。［眉批］阳精阴血。各具真气，故曰真气寓于凡精凡血之中。二气浑为一气，一气中含五气，五气，即青黄赤白黑，秉天也。五气即金木水火土，秉地也。在人即心肝脾肺肾。《经》云：二五之精妙合二凝是也。五气发生万物。阴阳配合，迭相运用，化生五脏六腑，百脉经络，天地所有，人身皆具。然未生以前，五行在乾坤之中。既生以后，乾坤即在五行之内。五气生万物，一物一太极，一物一阴阳。阳之用从昼，阴之用从夜，此坎离之功用所由分，而万物之功用所由出，由一而万理攸分，由万而一元合聚。故曰：一粒粟藏大千世界，即此之谓也。孟子云：万物皆备于我，皆是由明善复初，以知得个中这一点机关，这一点胎元消息也。其中这一点真消息，逐日运行，无刻休息。子时发动，由下而中而上，阳根于阴，故由下而发土。由上而中而下，阴根于阳，故由上而趋下，此阴阳互为其根，一元之消息也。循环不已。然由下而中而上，三阳已分，下中上为三部，阳主上升，一气分为三部，即太阳、阳明、少阳也。由上而中而下，三阴已定，上中下为三部。阴主下降，阳从背面，阴从腹面。三阴即太阴、少阴、厥阴是也。合之二三如六，故曰六步而成位。六爻之义于此分，六气六经之所由判，亦无非这一点胎元，流行充周之所化育也。
仲景知得六步之精义，移步换形，移步更名，变化万端，不出范围。予初业斯道，即闻诸师云，万病不出六经，不出阴阳。终不了了。冥心之余，忽得此胎元消息，始识师言之不谬，仲景之骨髓如见矣。
- 105 -
用 药 须 知
凡一切外邪初入，切不可攻下，攻下则引邪入里，变证百出。切不可妄用温固收纳，收纳为关门捉贼，延祸匪轻。切不可妄用滋阴，滋阴则留恋阴邪，病根难除。只宜按定六经提纲病情施治，庶不误人。
凡内伤之人，多半咳嗽，由清阳不升，浊阴不降，闭塞清道而成，只宜辛甘化阳之品，荡去阴邪，清升浊降，咳嗽自己。昧者不识，称为陈寒入脱，纯用一派搜寒宣散之品，每每酿成脱证。不知病既内伤，正虚无疑，而更用此宣散，则一线之正气，又为大伤，岂能久延时刻，而不脱绝者乎。
凡内伤之人，多半胸满不食，痰多。由中宫气衰，转输失职，阴邪痰水堵塞胸中，只宜温中醒脾助正，胸满、痰水自去也。昧者不察，多用一派推荡破滞之品，每每酿成腹胀不治之病，不可不知。
凡内伤之人，多有身热而却不疼，虽然内热，而口不渴。如此等病情，近似外感，近似火症，只宜回阳收纳。收纳则阳不外越，而身热自己。阳回则镇纳阴邪，而阴潮不作。诸书称内热由阴虚，不知阳衰而阴鬼立出，即昼夜亦可知也。昧者不识，一见发热，称为外感，便以发散投之必危；一见内热，称为阴虚，滋阴降火必殆。
- 106 -
凡吐血之人，由正气已衰，中宫不运，阴邪僭居阳位，久久积聚，阳无力以施运行之权，阳无力以申乾刚之令，一触即发，血所以出也。只宜甘温扶阳，以申其正气，正气日申，阴血自降，一定之理。昧者不察，一见吐血，便以滋阴止血之品，希图速效，究意酿成死证。含糊有年，真憾事也。
阴虚吐血忌温补也
凡阴虚吐血之人，多半精神有余，火伏于中，逼血妄行。吐后人不困倦，此乃有余之候，百中仅见一二。只宜清凉，平其有余。若照阳虚吐血治之必殆，不可不知。
凡阳虚之人，多属气衰血盛，无论发何疾病，多缘阴邪为殃，切不可再滋其阴。若更滋其阴，则阴愈盛而阳愈消，每每酿出真阳外越之候，不知不知。
凡阴虚之人，多属气盛血衰，无论何部发病，多缘火邪为殃，切不可再扶其阳。若扶其阳，则阳愈旺而阴愈消，每每酿出亢龙有悔之候，不可不知。
病有宜汗者
太阳病，发热身疼，自汗，恶风者，当发汗。太阳病外症未解，脉浮弱者，当微发汗。太阳病表症未罢，发汗未过，脉浮数者，仍可发汗。阳明病脉迟汗出多，微恶寒者，表未
- 107 -
解也，可发汗。太阴病脉浮者，可发汗。太阴病汗后不解，仍发热，脉浮者，当复汗之。伤寒发汗本无体，随邪之浅深，本气之盛衰，有大发汗，复发汗，微发汗，更有和解，亦得汗而解，温经亦得汗而解，回阳亦得汗而解，不可不知。
病有不宜汗者
难道可以一概认为是阴证、寒证、虚证、虚损吗？要知道，外感病脉象浮，且病症表现为头痛身痛、发热恶风、自汗、鼻塞流清涕，才可以说是风邪。如果是内伤日久，元气即将脱失的候象，脉象也浮，难道还能说是风邪吗？脉象洪大、实数，且病症表现为发热恶热、烦躁、口渴喜冷饮、胡言乱语、口臭气粗、大小便闭塞等，才可以说是火证、热证。如果是内伤日久，元气即将脱失的候象，脉象出现极洪、极长、极实、极数、极劲等，难道还能说是时行火热证吗？脉象紧主寒、滑主痰，且病症表现为身体疼痛、发热畏寒、呕吐痰涎等，才可以说是寒邪痰湿。如果是内伤日久，元气即将脱失的候象，脉象也有极紧、极滑的表现，难道还能说是寒痰吗？脉象沉、迟、细、微、虚、弱，且病症表现为面色苍白嘴唇青紫、少气懒言、困倦嗜卧等，才可以说是不足、虚寒、阴阳两伤。如果是外邪深入，与火邪相合而发动，闭塞清窍，热伏于体内，阳气不能通达四肢末端，导致四肢冰冷，只有口气蒸手，小便短赤而痛，这是阳极似阴（真热假寒），难道还能说是气血虚损吗？总之，脉象没有固定的形态，关键在于准确辨证，阴阳内外，辨别考察必须清晰。虽然二十八脉有详细的分类，但也只是供参考罢了。学者如果能识得其中的变化，就不会被脉象所局限了。
切脉金针
脉，是气和血浑融为一体的表现。其关键在寸口，百脉都汇聚于此。其奥妙在于散布于周身，随着邪气的浅深、脏腑的盛衰、人性刚柔、身体长短、肌肉肥瘦、老幼男女的不同，变化万端。其纲领在浮、沉、迟、数，其奥妙在于有神、无神，也就是有力、无力。所谓有神无神，就是盈缩的机关，内外的秘决。其他如浮、洪、长、大、数、实，都属于盈，属于有余的候象。如果病情相符，就是脉与病合，应当从有余立法施治。如果脉象具备以上等象，但病症表现为极度不足，就是脉不合病，应当舍脉从病，急宜扶持不足，培补本源。千万不要被浮为风、洪为火的说法迷惑。如果按照浮风、洪火来治疗，危害就不轻了。沉、迟、细、微、虚、弱都属于缩，属于不足。如果病情相符，就是脉与病合，应当按照不足立法施治。如果脉象具备以上等象，但病症表现为极度有余，又应当舍脉从病。千万不要被沉、迟、细、微为虚损的说法迷惑。如果按照虚损来治疗，祸患就不浅了。我常说：一盈一缩，就是阴阳的宗旨，万病的准绳。切脉知道这一点，就容易辨证，才不会为脉象所局限。
相舌切要
舌上白苔
病人虽然舌现白苔，并没有见到头痛身痛、发热恶寒、恶热等情况，切不可认为是表证，认为是瘟证。应当在脉息、声音、起居动静、有神无神处探求病情，自然就有着落。千万不可鲁莽。如果有表证的充分证据，才可以按照解表法施治。
舌上黄苔
病人虽然舌现黄苔，无论干黄色、润黄色、老黄色、黑黄色，并没有见到口渴饮冷、烦躁、恶热、便秘等情况，切不可就说是大旺热极，应当在阳虚、真气不上升处理会，在病情上理会，治法就在其中。如果见到便秘、口臭气粗、身轻恶热、必烦饮冷、精神有余等情况，就应当攻下，不可迟延。
舌上黑苔
病人虽然舌现黑苔，无论干黑色、青黑色、润黑色，虽然现出阴象，切不可立即作为阴证施治。如果其人烦躁、口渴饮冷、恶热、身轻、气粗口臭、二便闭结，就应当攻下，不可迟延。如果其人安静懒言、困倦、不渴不食、二便自利，就应当回阳，不可迟延。
舌上红黑色 舌上润白苔 舌根独黄色 舌上白黄色 舌上黄芒刺 舌尖独青色 舌上黑黄色 舌上黑芒刺 舌根独黑色 舌上青黄色 舌上白芒刺 舌尖惨红色 舌上粉白苔 舌上青红色 舌心独黄色 舌上干白苔 舌上淡黄色 舌边独白色 舌裂而开瓣 舌如猪腰色
舌的分辨，确实繁冗，也难以尽举。姑且不论其舌的青、黄、赤、白、黑、干润、燥裂、芒刺满口、红白相间、黄黑相兼，统统用阴阳两个字概括了。是阴证就有阴象可征，是阳证就有阳证可凭。识得这个宗旨，就不专以舌论了。诸书纷纷论舌，说某舌当某药，某舌当某方，都是刻舟求剑一类的人，不可效法。学者务必在平时，先将阴阳病情，真真假假，熟悉于心，自然一见便知，这也是辨证的关键。
万病一气说
病有万端，发于一元。一元，就是二气浑为一气。一气盈缩，病就产生了。有余就是火，不足就是寒。其他如脉来洪大，是气的盈；脉来数实，脉来浮滑，也是气的盈。间或也有不足。脉来洪大数实浮滑，是邪实火盛，这是有余。久病暴脱，也有此脉象，不可不知。脉来迟细，是气的缩；脉来短小，脉来虚弱，也是气的缩。间或也有有余。脉来迟细短小虚弱，都是不足。如果温病热极脉伏，也有此脉，不可不知。脉来劈石，脉来鱼尾，脉来雀啄，脉来釜沸，脉来掉尾，脉来散乱，是气的绝。
推之面色如珠，是气盈的验证。也有缩者。素来面赤，不作病看。新病面赤恶热，就是邪实火旺。久病无神，虚极之人而面赤，就是阳竭于上，脱绝的候象，色如鸡冠者吉，色如瘀血者死。面青有神，是气盈的验证。也有缩者。素平面青有神，不作病看。有病而始面青，就是肝病。有神主肝旺，无神主肝虚。色如翠羽者吉，色如枯草者凶。面白有神，是气盈的验证。也有缩者。素乎面白，不作病看。有病而始见面白者，才以病论。白而有神，肺气常旺。白而无神，肺虚之征。自如猪膏者吉，色如枯骨者危。面黄有神，是气盈的验证。也有缩者。素乎面黄，不作病看。有病而始面黄，才以病论。黄而有神，胃积之盛。黄而无神，气弱之征。黄而鲜明者吉，黄如尘埃色者凶。面黑有神，是气盈的验证。也有缩者。素乎面黑，不作病看。有病而始面黑，才以病论。黑而有神，肾气尚旺。黑而无神，肾气衰弱。黑如鸟羽者吉，色如炭煤者危。这是论述五色之盛衰，其中尚有生克。额属心，而黑气可畏。鼻属土，而青色堪惊。颏下黄而水病，腮左白而肝伤，腮右赤兮火灼，唇上黑兮水泱。气色之变化多端，明暗之机关可据。
至于审音察理，五音细详。五音指宫、商、角、徵、羽，以应人身五脏也。声如洪钟，指邪火之旺极。素来音洪，不作病看。有病而始见声洪，就是邪实火旺，法宜泻火为主。语柔而细，属正气之大伤。素来声细，不作病看，有病而始见声低息短，就是不足。忽笑忽歌，心脾之邪热已现。笑主心旺，歌主脾旺。或狂或叫，阳明之气实方张。狂叫乃胃热极。瞑目而言语重重，曰神曰鬼。瞑目而妄言鬼神，是正气虚极，神不守舍也。张目而呼骂叨叨，最烈最横。肝火与心胃邪旺，其势其不可扑灭。
曰饮食，曰起居也，须考证。食健力健，言气之盈，食少力少，本气之缩。饮冷饮滚兮，阴阳之形踪已判。好动好卧兮，虚实之病机毕陈。
至于身体，更宜详辩。肌肉丰隆，定见胃气之旺。形瘦如柴，已知正气之微。皮肤干润，判乎吉凶。毛发脱落，知其正败。
要知风气为殃，春温之名已播。火气作崇，暑热之号已工。湿气时行，霍乱之病偏多。燥气行秋，疟痢之病不少。又乃冬布严寒，伤寒名著。一年节令，病气之变化无穷，六气循环，各令之机关可据。六气，即是六经，六经仍是一经。五行分为五气，五气仍是一气。揭太阳以言气之始，论厥阴以言气之终，昼夜循环，周而复始。病也者，病此气也。周身骨节、经络，皆是后天有形之质。全赖一气贯注。虽各处发病，形势不同，总在一气之中，神为气之宰，气伤则神不安，故曰病。气也者，周身躯壳之大用也。身中无气则无神，故曰死。用药以治病，实以治气也。气之旺者宜平。正气不易旺，惟邪气易旺，须当细分。气之衰者宜助，衰有邪衰、正衰之异，当知。气之升者宜降，泻其亢盛。气之陷者宜举，气之滞者宜行，气之郁者宜解，气之脱者宜固，气之散者宜敛。知其气之平，知其气之变，用药不失宜，匡救不失道，医之事毕矣。
胎元图
-104 -
胎元图说
今以一大圈，喻人一身之真气，中有一小圈，喻人身受胎之始基。始基之谓，胎元之消息也，称为祖气，号曰先天。先天，即父母精血中一点真气。［眉批］阳精阴血。各具真气，故曰真气寓于凡精凡血之中。二气浑为一气，一气中含五气，五气，即青黄赤白黑，秉天也。五气即金木水火土，秉地也。在人即心肝脾肺肾。《经》云：二五之精妙合二凝是也。五气发生万物。阴阳配合，迭相运用，化生五脏六腑，百脉经络，天地所有，人身皆具。然未生以前，五行在乾坤之中。既生以后，乾坤即在五行之内。五气生万物，一物一太极，一物一阴阳。阳之用从昼，阴之用从夜，此坎离之功用所由分，而万物之功用所由出，由一而万理攸分，由万而一元合聚。故曰：一粒粟藏大千世界，即此之谓也。孟子云：万物皆备于我，皆是由明善复初，以知得个中这一点机关，这一点胎元消息也。其中这一点真消息，逐日运行，无刻休息。子时发动，由下而中而上，阳根于阴，故由下而发土。由上而中而下，阴根于阳，故由上而趋下，此阴阳互为其根，一元之消息也。循环不已。然由下而中而上，三阳已分，下中上为三部，阳主上升，一气分为三部，即太阳、阳明、少阳也。由上而中而下，三阴已定，上中下为三部。阴主下降，阳从背面，阴从腹面。三阴即太阴、少阴、厥阴是也。合之二三如六，故曰六步而成位。六爻之义于此分，六气六经之所由判，亦无非这一点胎元，流行充周之所化育也。
仲景知得六步之精义，移步换形，移步更名，变化万端，不出范围。予初业斯道，即闻诸师云，万病不出六经，不出阴阳。终不了了。冥心之余，忽得此胎元消息，始识师言之不谬，仲景之骨髓如见矣。
- 105 -
用药须知
凡一切外邪初入，切不可攻下，攻下则引邪入里，变证百出。切不可妄用温固收纳，收纳为关门捉贼，延祸匪轻。切不可妄用滋阴，滋阴则留恋阴邪，病根难除。只宜按定六经提纲病情施治，庶不误人。
凡内伤之人，多半咳嗽，由清阳不升，浊阴不降，闭塞清道而成，只宜辛甘化阳之品，荡去阴邪，清升浊降，咳嗽自己。昧者不识，称为陈寒入脱，纯用一派搜寒宣散之品，每每酿成脱证。不知病既内伤，正虚无疑，而更用此宣散，则一线之正气，又为大伤，岂能久延时刻，而不脱绝者乎。
凡内伤之人，多半胸满不食，痰多。由中宫气衰，转输失职，阴邪痰水堵塞胸中，只宜温中醒脾助正，胸满、痰水自去也。昧者不察，多用一派推荡破滞之品，每每酿成腹胀不治之病，不可不知。
凡内伤之人，多有身热而却不疼，虽然内热，而口不渴。如此等病情，近似外感，近似火症，只宜回阳收纳。收纳则阳不外越，而身热自己。阳回则镇纳阴邪，而阴潮不作。诸书称内热由阴虚，不知阳衰而阴鬼立出，即昼夜亦可知也。昧者不识，一见发热，称为外感，便以发散投之必危；一见内热，称为阴虚，滋阴降火必殆。
- 106 -
凡吐血之人，由正气已衰，中宫不运，阴邪僭居阳位，久久积聚，阳无力以施运行之权，阳无力以申乾刚之令，一触即发，血所以出也。只宜甘温扶阳，以申其正气，正气日申，阴血自降，一定之理。昧者不察，一见吐血，便以滋阴止血之品，希图速效，究意酿成死证。含糊有年，真憾事也。
阴虚吐血忌温补也
凡阴虚吐血之人，多半精神有余，火伏于中，逼血妄行。吐后人不困倦，此乃有余之候，百中仅见一二。只宜清凉，平其有余。若照阳虚吐血治之必殆，不可不知。
凡阳虚之人，多属气衰血盛，无论发何疾病，多缘阴邪为殃，切不可再滋其阴。若更滋其阴，则阴愈盛而阳愈消，每每酿出真阳外越之候，不知不知。
凡阴虚之人，多属气盛血衰，无论何部发病，多缘火邪为殃，切不可再扶其阳。若扶其阳，则阳愈旺而阴愈消，每每酿出亢龙有悔之候，不可不知。
病有宜汗者
太阳病（太阳经受邪所致的病证），发热身疼，自汗，恶风者，当发汗。太阳病外症未解，脉浮弱者，当微发汗。太阳病表症未罢，发汗未过，脉浮数者，仍可发汗。阳明病脉迟汗出多，微恶寒者，表未解也，可发汗。太阴病脉浮者，可发汗。太阴病汗后不解，仍发热，脉浮者，当复汗之。伤寒发汗本无体，随邪之浅深，本气之盛衰，有大发汗，复发汗，微发汗，更有和解，亦得汗而解，温经亦得汗而解，回阳亦得汗而解，不可不知。
病有不宜汗者
Can one generally categorize it as Yin syndrome, Cold syndrome, deficiency, or consumptive disease? It must be known that in exogenous diseases, the pulse is floating, and symptoms such as headache, body ache, fever, aversion to wind, spontaneous sweating, nasal congestion with clear discharge appear; only then can it be said to be Wind pathogen. If internal injury has lasted for a long time, and the primordial Qi is on the verge of collapse, the pulse may also be floating; how could it still be attributed to Wind pathogen? When the pulse is surging (Hong), large, full, and rapid, and symptoms such as fever with aversion to heat, restlessness, thirst with desire for cold drinks, delirium, foul breath, coarse breathing, and obstruction of urination and defecation appear, only then can it be said to be Fire or Heat. If internal injury has lasted for a long time, and the primordial Qi is on the verge of collapse, the pulse may show extreme surging, extreme length, extreme fullness, extreme rapidity, or extreme stiffness; how could it still be attributed to epidemic Heat-Fire syndrome? A tight pulse indicates Cold, and a slippery pulse indicates Phlegm; when symptoms such as body pain, fever with aversion to cold, and vomiting of phlegm appear, only then can it be said to be Cold pathogen and Phlegm-Dampness. If internal injury has lasted for a long time, and the primordial Qi is on the verge of collapse, the pulse may also show extreme tightness or extreme slipperiness; how could it still be categorized as Cold-Phlegm? When the pulse is deep, slow, fine, minute, deficient, and weak, and symptoms such as pale complexion with cyan lips, shortness of breath with reluctance to speak, fatigue, and drowsiness appear, only then can it be said to be deficiency, deficiency-Cold, or dual injury of Yin and Yang. If exogenous pathogens penetrate deeply, combine with Fire pathogen, block the clear orifices, and heat lies concealed within, preventing Yang Qi from reaching the four extremities, resulting in cold limbs while the breath feels hot to the touch, with scanty, dark red, and painful urination, this is "Extreme Yang resembling Yin" (True Heat False Cold); how could it still be said to be Qi and Blood deficiency? In summary, pulses do not have fixed forms; accurate differentiation of syndromes is key. Yin and Yang, interior and exterior must be clearly distinguished. Although the twenty-eight pulses are detailed, they merely serve as reference. If scholars can understand these variations, they will not be confined by the pulse alone.
Golden Needle for Pulse Diagnosis
The pulse is the fusion of Qi and Blood into one. Its key point is at the Cun-Kou (radial artery), where all vessels converge. Its subtlety lies in its distribution throughout the body, changing endlessly according to the depth of pathogens, the excess or deficiency of Zang-Fu organs, human temperament (rigid or soft), body height, muscle thickness, and differences among the old, young, male, and female. Its outline lies in Floating, Deep, Slow, and Rapid; its subtlety lies in having Spirit (Shen) or lacking Spirit, which corresponds to forceful or forceless. Having or lacking Spirit refers to the mechanism of expansion and contraction, the secrets of interior and exterior. Others such as Floating, Surging, Long, Large, Rapid, and Full all belong to expansion and indicate excess conditions. If the pulse matches the condition, it is "pulse matching disease," and treatment should follow the principle of treating excess. If the pulse exhibits the above characteristics but the disease manifests extreme deficiency, it is "pulse not matching disease," and one should abandon the pulse and follow the disease, urgently supporting deficiency and nourishing the root. Do not be confused by the notions that Floating indicates Wind or Surging indicates Fire. Treating based on these misconceptions causes significant harm. Deep, Slow, Fine, Minute, Deficient, and Weak all belong to contraction and indicate deficiency. If the pulse matches the condition, it is "pulse matching disease," and treatment should follow the principle of treating deficiency. If the pulse exhibits the above characteristics but the disease manifests extreme excess, one should again abandon the pulse and follow the disease. Do not be confused by the notion that Deep, Slow, Fine, and Minute indicate consumptive disease. Treating based on this misconception causes great disaster. I often say: Expansion and contraction are the essence of Yin and Yang and the standard for all diseases. Understanding this in pulse diagnosis makes differentiation easier and prevents being confined by the pulse.
Essentials of Tongue Diagnosis
White Coating on Tongue
Although the patient presents a white coating on the tongue, if there are no symptoms such as headache, body ache, fever, aversion to cold, or aversion to heat, one must not consider it an Exterior syndrome or Plague syndrome. One should explore the condition through pulse, voice, daily activities, and the presence or absence of Spirit. There will naturally be a basis for judgment. One must never act rashly. Only when there is sufficient evidence of an Exterior syndrome should one treat according to the method of releasing the Exterior.
Yellow Coating on Tongue
Although the patient presents a yellow coating on the tongue, whether dry yellow, moist yellow, old yellow, or black-yellow, if there are no symptoms such as thirst with desire for cold drinks, restlessness, aversion to heat, or constipation, one must not immediately conclude it is extreme Heat flourishing. One should consider Yang deficiency and the failure of True Qi to ascend. The treatment method lies within this understanding. If symptoms such as constipation, foul breath, coarse breathing, lightness of body, aversion to heat, strong desire for cold drinks, and surplus spirit appear, purgation should be employed without delay.
Black Coating on Tongue
Although the patient presents a black coating on the tongue, whether dry black, green-black, or moist black, and even if Yin signs appear, one must not immediately treat it as a Yin syndrome. If the patient is restless, thirsty with desire for cold drinks, averse to heat, feels light, has coarse breath and foul odor, and suffers from obstruction of urination and defecation, purgation should be employed without delay. If the patient is quiet, reluctant to speak, fatigued, not thirsty, not eating, and has normal urination and defecation, restoring Yang should be employed without delay.
Red-Black Tongue, Moist White Coating, Yellow Root Only, White-Yellow Tongue, Yellow Prickles, Cyan Tip Only, Black-Yellow Tongue, Black Prickles, Black Root Only, Green-Yellow Tongue, White Prickles, Crimson Tip, Pink-White Coating, Green-Red Tongue, Yellow Center Only, Dry White Coating, Pale Yellow Tongue, White Edges Only, Split Tongue, Pig Kidney-Colored Tongue
Differentiating the tongue is indeed tedious and difficult to exhaust. Regardless of whether the tongue is green, yellow, red, white, black, dry, moist, cracked, covered with prickles, intermixed red and white, or intermixed yellow and black, it can all be summarized by Yin and Yang. If it is a Yin syndrome, there are sufficient Yin signs; if it is a Yang syndrome, there are sufficient Yang signs. Understanding this principle means not relying solely on the tongue. Various books discuss tongues extensively, stating specific herbs or formulas for specific tongues; these are like carving marks on a boat to find the sword, and should not be followed. Scholars must familiarize themselves with Yin and Yang conditions, true and false, in their minds beforehand. Naturally, they will recognize them at a glance, which is also a key aspect of differentiation.
Theory of All Diseases Stemming from One Qi
Diseases are myriad but originate from the Primordial One. The Primordial One is two Qi fused into one Qi. Expansion and contraction of this one Qi give rise to disease. Excess is Fire, deficiency is Cold. For instance, a surging pulse indicates Qi expansion; a rapid, full, floating, and slippery pulse also indicates Qi expansion. Occasionally, there is deficiency. A surging, rapid, full, and slippery pulse indicates pathogenic excess and flourishing Fire, which is excess. However, sudden collapse after chronic illness may also present this pulse; this must be known. A slow, fine pulse indicates Qi contraction; a short, small, deficient, and weak pulse also indicates Qi contraction. Occasionally, there is excess. Slow, fine, short, small, and weak pulses all indicate deficiency. However, in warm diseases with extreme heat, the pulse may vanish; this must be known. Pulses like striking stone, fish tail, sparrow pecking, boiling pot, wagging tail, and scattered indicate the extinction of Qi.
Extending this, a lustrous complexion indicates Qi expansion. There are also cases of contraction. A naturally ruddy complexion is not considered a disease. A new onset of ruddy complexion with aversion to heat indicates pathogenic excess and flourishing Fire. A prolonged illness with no Spirit, in a person of extreme deficiency, presenting a ruddy complexion, indicates Yang exhaustion at the upper Jiao and impending collapse. A chicken-comb color is auspicious; a blood-stasis color is fatal. A green complexion with Spirit indicates Qi expansion. There are also cases of contraction. A naturally green complexion with Spirit is not considered a disease. A new onset of green complexion indicates Liver disease. Spirit indicates Liver excess; lack of Spirit indicates Liver deficiency. A kingfisher-feather color is auspicious; a withered-grass color is ominous. A white complexion with Spirit indicates Qi expansion. There are also cases of contraction. A naturally white complexion is not considered a disease. A new onset of white complexion is analyzed as disease. White with Spirit indicates Lung Qi prosperity; white without Spirit indicates Lung deficiency. A pig-fat color is auspicious; a withered-bone color is critical. A yellow complexion with Spirit indicates Qi expansion. There are also cases of contraction. A naturally yellow complexion is not considered a disease. A new onset of yellow complexion is analyzed as disease. Yellow with Spirit indicates Stomach accumulation excess; yellow without Spirit indicates Qi weakness. A bright yellow color is auspicious; a dust-like yellow color is ominous. A black complexion with Spirit indicates Qi expansion. There are also cases of contraction. A naturally black complexion is not considered a disease. A new onset of black complexion is analyzed as disease. Black with Spirit indicates Kidney Qi prosperity; black without Spirit indicates Kidney Qi decline. A bird-feather color is auspicious; a charcoal color is critical. This discusses the prosperity and decline of the five colors, involving mutual generation and restriction. The forehead belongs to Heart, so black Qi here is frightening. The nose belongs to Earth, so green Qi here is alarming. Yellow under the chin indicates Water disease; white on the left cheek indicates Liver injury; red on the right cheek indicates Fire burning; black on the lips indicates Water flooding. Changes in Qi and color are manifold, and brightness/darkness provides clues.
Regarding voice and reasoning, the Five Tones require detailed analysis. The Five Tones refer to Gong, Shang, Jue, Zhi, and Yu, corresponding to the five Zang organs. A voice like a bell indicates extreme flourishing of Pathogenic Fire. A naturally loud voice is not considered a disease. A new onset of loud voice indicates pathogenic excess and flourishing Fire; treatment should focus on draining Fire. Soft and thin speech indicates severe injury to Righteous Qi. A naturally thin voice is not considered a disease. A new onset of low voice and short breath indicates deficiency. Sudden laughter and singing indicate Heat-Pathogen in Heart and Spleen. Laughter indicates Heart excess; singing indicates Spleen excess. Mania and shouting indicate flourishing Yangming Qi. Manic shouting indicates extreme Stomach Heat. Eyes closed while speaking heavily, referring to gods and ghosts, indicates extreme deficiency of Righteous Qi and loss of Shen. Eyes open while cursing and muttering indicates the most violent and aggressive state, where Liver Fire and Pathogenic Fire in Heart and Stomach are unstoppable.
Regarding diet and daily life, verification is necessary. Good appetite and strength indicate Qi expansion; poor appetite and weakness indicate Qi contraction. Preference for cold or hot drinks distinguishes Yin and Yang. Preference for movement or lying down reveals deficiency or excess.
Regarding the body, detailed differentiation is required. Plump muscles indicate prosperous Stomach Qi; emaciation indicates weak Righteous Qi. Dry or moist skin determines auspiciousness or inauspiciousness. Hair loss indicates defeat of Righteous Qi.
It must be known that Wind Qi brings disaster, spreading the name of Spring Warmth. Fire Qi causes havoc, establishing the title of Summer Heat. Dampness circulates, causing many cases of Cholera. Dryness acts in Autumn, causing many cases of Malaria and Dysentery. Winter brings severe cold, making Cold Damage famous. Seasonal changes bring infinite variations in disease Qi. The Six Qi cycle, each with its mechanisms. The Six Qi are the Six Channels, and the Six Channels are still one Channel. The Five Elements divide into Five Qi, and the Five Qi are still one Qi. Taiyang marks the beginning of Qi; Jueyin marks the end. Day and night cycle, repeating endlessly. Disease is the disease of this Qi. Bones, joints, and meridians are postnatal material forms, relying entirely on the penetration of one Qi. Although diseases occur in various places with different manifestations, they all reside within one Qi. Shen is the master of Qi; when Qi is injured, Shen is unsettled, hence "disease." Qi is the great function of the body. Without Qi, there is no Shen, hence "death." Medicines treat disease by treating Qi. Flourishing Qi should be balanced. Righteous Qi rarely flourishes; Pathogenic Qi easily flourishes, requiring careful distinction. Declining Qi should be assisted; decline differs between Pathogenic decline and Righteous decline, which must be known. Ascending Qi should be descended by draining hyperactivity. Sunken Qi should be raised. Stagnant Qi should be circulated. Depressed Qi should be resolved. Collapsing Qi should be secured. Scattered Qi should be gathered. Knowing the balance and variation of Qi, using medicines appropriately, and saving correctly completes the medical art.
Diagram of Fetal Origin
-104 -
Explanation of the Diagram of Fetal Origin
Now, a large circle represents the True Qi of the whole body, and a small inner circle represents the foundation of conception. This foundation is the message of the Fetal Origin, called Ancestral Qi, named Pre-heaven. Pre-heaven is a point of True Qi within the True Essence and Blood of parents. [Marginal Note]: Yang Essence and Yin Blood. Each possesses True Qi, hence True Qi resides in ordinary Essence and Blood. Two Qi fuse into one Qi, containing Five Qi within one Qi. Five Qi are Green, Yellow, Red, White, Black, inheriting from Heaven. Five Qi are Metal, Wood, Water, Fire, Earth, inheriting from Earth. In humans, they are Heart, Liver, Spleen, Lung, Kidney. The Classic says: "The essence of Two and Five combines beautifully." Five Qi generate all things. Yin and Yang cooperate, operating alternately, transforming into Five Zang and Six Fu organs, hundred vessels, and meridians. Everything in heaven and earth exists in the human body. Before birth, Five Elements exist within Qian and Kun. After birth, Qian and Kun exist within Five Elements. Five Qi generate all things; each thing is a Taiji, each thing is Yin and Yang. Yang functions during the day; Yin functions during the night. This divides the function of Kan and Li, and the function of all things emerges. From one, ten thousand principles divide; from ten thousand, one Yuan gathers. Hence, "A grain of millet hides a vast world," which is what this means. Mencius said: "All things are complete within me." This comes from understanding goodness and returning to the beginning, knowing this mechanism and the message of the Fetal Origin. This true message runs daily without rest. At Zi hour, it moves from lower to middle to upper. Yang roots in Yin, so it rises from below. From upper to middle to lower, Yin roots in Yang, so it descends from above. This is Yin and Yang rooting in each other, the message of one Yuan, cycling endlessly. Rising from lower to middle to upper, Three Yang are divided. Lower, middle, upper are three parts. Yang governs rising; one Qi divides into three parts: Taiyang, Yangming, Shaoyang. Descending from upper to middle to lower, Three Yin are established. Upper, middle, lower are three parts. Yin governs descending. Yang is on the back surface; Yin is on the abdominal surface. Three Yin are Taiyin, Shaoyin, Jueyin. Combining two and three makes six, hence "Six steps establish positions." The meaning of Six Lines divides here, and the judgment of Six Qi and Six Channels arises. This is nothing but the transformation nurtured by the circulation of this Fetal Origin.
Zhongjing knew the profound meaning of the Six Steps, changing form and name with each step, varying endlessly yet staying within scope. When I first practiced this way, I heard masters say: "All diseases do not go beyond Six Channels, do not go beyond Yin and Yang." I remained unclear. After meditating, I suddenly understood this message of the Fetal Origin, realizing the masters were not wrong, and seeing Zhongjing's marrow as if visible.
- 105 -
Knowledge Required for Using Medicines
Contraindication of Retention for Exogenous Wind-Cold
When all exogenous pathogens first enter, purgation must absolutely not be used. Purgation draws pathogens inward, causing hundreds of complications. Warming, consolidating, and retaining methods must not be used recklessly; retention is like closing the door to catch thieves, delaying disaster significantly. Nourishing Yin must not be used recklessly; nourishing Yin retains Yin pathogens, making the root of disease hard to remove. One should only treat according to the outline of Six Channels and the condition, lest one mislead others.
Contraindication of Dispersing for Internal Injury and Consumption
People with internal injury mostly cough due to Clear Yang failing to ascend, Turbid Yin failing to descend, blocking the clear pathways. Only acrid-sweet products transforming Yang should be used to sweep away Yin pathogens, allowing Clear to ascend and Turbid to descend, curing cough naturally. Ignorant people do not understand, calling it old Cold entering collapse, using purely searching-cold and dispersing products, often brewing collapse syndrome. Not knowing that since the disease is internal injury, Righteous Qi is undoubtedly deficient, using such dispersing methods further injures the thread of Righteous Qi. How can it last long without collapsing?
People with internal injury mostly have chest fullness, poor appetite, and excessive phlegm. Due to declining Qi in the Central Palace, failure of transport, Yin pathogens and Phlegm-Water blocking the chest, only warming the middle, awakening Spleen, and assisting Righteous Qi should be used; chest fullness and Phlegm-Water will disappear naturally. Ignorant people do not observe, using pushing and breaking stagnation products, often brewing untreatable abdominal distension. This must be known.
People with internal injury often have body heat but no pain. Although there is internal heat, there is no thirst. Such conditions resemble exogenous diseases or Fire syndromes. Only restoring Yang and retaining should be used. Retention prevents Yang from escaping outward, curing body heat naturally. Restoring Yang suppresses Yin pathogens, stopping Yin tides. Books claim internal heat is due to Yin deficiency, not knowing that Yang decline leads to immediate emergence of Yin ghosts, knowable day and night. Ignorant people do not understand. Seeing fever, they call it exogenous disease and use dispersing methods, which is dangerous. Seeing internal heat, they call it Yin deficiency and use nourishing Yin and draining Fire, which is perilous.
- 106 -
Contraindication of Nourishing Yin for Yang Deficiency Hematemesis
People with hematemesis suffer from declined Righteous Qi, failure of Central Palace transport, Yin pathogens usurping Yang positions, accumulating over time. Yang lacks power to execute movement authority and assert Heavenly Strength commands. Upon contact, bleeding occurs. Only sweet-warm Yang-supporting methods should be used to assert Righteous Qi. As Righteous Qi asserts daily, Yin Blood naturally descends; this is a fixed principle. Ignorant people do not observe. Seeing hematemesis, they use Yin-nourishing and hemostatic products seeking quick effects, ultimately brewing death syndrome. Vague for years, truly a regrettable matter.
Contraindication of Warm Tonification for Yin Deficiency Hematemesis
People with Yin deficiency hematemesis mostly have surplus spirit, Fire concealed within, forcing blood to move recklessly. After vomiting, the person is not fatigued; this is an excess sign, seen in only one or two out of a hundred. Only cooling methods should be used to level the excess. Treating according to Yang deficiency hematemesis will surely fail; this must be known.
Contraindication of Nourishing Yin for All Yang Deficiency Syndromes
People with Yang deficiency mostly have Qi decline and Blood excess. Regardless of any disease, it is mostly caused by Yin pathogens. One must absolutely not nourish Yin further. Nourishing Yin makes Yin more abundant and Yang more consumed, often brewing true Yang escaping outward. This must be known.
Contraindication of Warm Tonification for All Yin Deficiency Syndromes
People with Yin deficiency mostly have Qi excess and Blood decline. Regardless of where disease occurs, it is mostly caused by Fire pathogens. One must absolutely not support Yang further. Supporting Yang makes Yang more vigorous and Yin more consumed, often brewing the regret of the soaring dragon (excess Yang). This must be known.
Conditions Suitable for Sweating
Taiyang disease with fever, body ache, spontaneous sweating, and aversion to wind should be treated with sweating. Taiyang disease with unresolved exterior symptoms and floating-weak pulse should be treated with mild sweating. Taiyang disease with unresolved exterior symptoms, insufficient previous sweating, and floating-rapid pulse can still be treated with sweating. Yangming disease with slow pulse, excessive sweating, and slight aversion to cold indicates unresolved exterior; sweating can be used. Taiyin disease with floating pulse can be treated with sweating. Taiyin disease with unresolved symptoms after sweating, persistent fever, and floating pulse should be treated with repeated sweating. Cold damage sweating has no fixed form; depending on the depth of pathogens and strength of original Qi, there is major sweating, repeated sweating, mild sweating. There is also harmonizing, which resolves via sweating; warming meridians resolves via sweating; restoring Yang resolves via sweating. This must be known.
Conditions Unsuitable for Sweating