按中痰一证，予思中字不甚恰切。未痰之所以生，半由太阳失运，水液不行，聚而为痰。或由中宫火衰，转输失职，水湿生痰。或由心阳亏损，不能镇纳浊阴，水泛于上，而痰证生。种种不一。是痰皆由内而生，并非由外而致。由外而入内，始可以言中，由内而出外，决不可以言中。凡为痰迷之人，必素秉阳衰，积阴日盛，饮食不运，气机不宣，忽然外邪引之，内气滞之，阴邪窃发，寒痰上通，堵塞清道，人事昏迷，喉中痰响，脉必滑利。平素多病多痰，法宜扶阳为先，祛痰为末，如姜附汤，姜桂茯半汤，真武汤之类，皆可施之。即曰痰闭可也，何必曰中。［眉批］中字之义驳得倒，痰字之理认得真，治痰之法自尔超妙，非庸手所得知。患疾之人遇之病可愈，学医之人入手不得错，此救世之法，医医之意也。
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按中食一证，中字亦不恰切。夫食以养生，虽由外入内，并非食能害人，必其人素缘中气不足，运化气衰，阴邪已经发动，偶遇饮食入内，阻滞不进，忽然闭其清道，人事卒倒，形如死人，皆是气机偶闭为之耳，何得谓食之能中乎。即如平常气实之人，日日酒食厌饱，而胡不中？以此推之，内本先虚也。虽探吐之，一吐即愈，愈后急温补脾土，自无失矣。［眉批］此数语包一切，扫一切，元箸超超，颠扑不破，神曲、麦芽、槟榔、山楂可以扫除，而干姜、附子又能治食矣，可发一噱。
因下焦阳衰而致者，由其人或房劳过度，或大吐大泻大病后，元气损伤，不能收束。其人定见少气懒言，精神萎靡，面白唇青，喜食辛竦热物者是也。法宜温固脾肾之阳，阳回气足，肛脱自收，如附子理中汤加葛根，黄芪建中汤，与市习之补中益气汤之类。
因火旺逼出者，或由过食厚味、醇酒、椒、姜辛辣之物，热毒流注下焦，或感受外热燥热邪，流注肠胃，热邪从下发泄，火气下趋，渐渐副迫，直肠遂出。其人定见躁烦，善饮［1］清凉，或大便不利，或小便赤热，或善食易饥，种种病情者是也。法宜清热，如黄连解毒汤，三黄石膏汤之类，专清肠胃之热，热清而肠自收矣。［眉批］知非氏曰：巽为股，为风。风性属阳，主升。平人不脱肛者，风木之气生升不已民。今病脱肛，生升之气机失权。钦安
[1] 饮 原本作"分"，据文义改。
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参悟其理，指出温升之法。所谓火旺者，火急风生，直步广肠，肛头顺势脱出，亦当升阳散火，桃花汤可用。必见实热之病情，方可直折，火熄风平，遂其升达之性，其肛自举。一二［1］剂即止，所谓中病即已，安过用以伤生气。否则旋举旋脱，久久遂漏，又不可不知也。
近来市习，多用补中益气倍升麻，或用槟、麻仁捣泥涂囟门穴，亦多见效。但于阴阳攸分，全无定见，终不若握此阴阳法度，治之庶可无差。第所列药方，亦未尽善。不过明其理法之当然，学者从中神而明之，自然发无不中也。
按痔疮一证，诸书分别牡痔、牝痔、气痔、血痔、酒痔、脉痔、内痔、外痔。又俗称：翻花痔、鸡冠痔、营花痔、蜂窠痔、鼠奶痔、牛奶痔，种种不一。予谓形象虽异，其源则同，不必细分，总在阳火、阴判之而已。
因阳火而致者，或平素喜食厚味、醇酒、椒、姜，一切辛辣之物，热积肠胃，从下发泄。肛门乃属下窍，终非时刻大开邪下趋，发泄不畅，蕴积而痔乃生焉。其痔定然痛甚，肛门红肿，精神不衰，饮食如常，粪硬溺赤，喜饮清凉者是也。法宜专清肠胃之热，如大小承气，调胃承气，葛根芩连等汤，皆可酌用。又或燥邪发泄不畅，辩认与上同，而时今不同，法宜清燥为主。如黄连玉竹阿胶汤，清燥汤，甘桔二冬汤之类。
因阴火而致者，或由房劳过度，君火下流，前阴发泄不畅，直逼的，蕴积亦能生痔。又或火病，用心过度，忧思过度，元气虚极，涣散欲从下脱，而不得即脱，蕴积亦能生痔。其痔我青色、黑色、白色，微痛微肿，坐卧不安，人必无神，困倦喜卧，畏寒身重，面色唇口青白，脉或浮空，两
[1] 二 原本作"立"，据文义改。
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尺或弦劲，此是元气发泄不藏之故，不得照寻常通套等方施治。法宜收固，如附子理中汤加葛根，潜阳丹，回阳饮，封髓丹倍砂、草之类。
近来治论纷纷，愈出愈奇，理法将泯，不得不为之一正。［眉批］知非氏曰：治疮亦贵理法明晰。钦安兼习外证，的是妙人。
赤 白 浊
按赤白浊一证，诸书所载，有云赤属血，白属气。有云败精流溢，乃谓白浊；血不及变，乃为赤浊。有云入房太甚，发为白淫。有云脾移热于肾。有云白浊乃劳伤肾。肾冷所致。种种分辩，果从谁说？予谓不必拘分，握定阴阳，治之便了。［眉批］析言居要。
夫赤浊、白浊，俱从溺管而出，有云败精流溢。既云败精，不过一二次见之，未必日日见之，况精窍与尿窍不并开。即云元阳不固，关锁不牢，而败精有如此之多，不几元阳有立绝之势乎。予亦常见患浊证之人，精神不衰者亦多，可知其非败精也明矣。予细维此证，总缘二气不调，中宫运化机关失职。所以然者，先天赖后天以生，水谷之精气生血，水谷之悍气生精，血入于营，精行于卫，皆从中宫转输，转输失权，或精或血，流注阑门，阑门乃秘清别浊之所，从此渗入膀胱，渗入者赤，溺便赤，渗入者白，溺便白，非膀胱之自能为赤白也。方书多用利水，尚未窥透此中消息。又有云湿热流注于下，此说实为有理，卓见颇超，清热利水，大约从此。须知中宫不调，有寒热之别。寒主胃阳之不足，阻滞中宫，转输即能失职。其人定见面白无神，饮食短少，因倦嗜卧，不问赤白，但以温暖中宫，俾寒邪去而转输复常，如香砂六君，附子理中之类。［眉批］知非氏曰：阳虚不能运动精微，一语
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可补钦安之注脚。热主胃气之过旺，盘踞中宫，转输亦能失职。其人多烦躁好动，精神不衰，言语、脉息，一切有神，不问赤白，便以清胃为主，俾热云而转输复常，如导赤散加茯苓前仁，清胃散，凉膈散之类［1］。
血 证 门吐血、鼻血、牙血、毛孔血、耳血、二便血。
按血证虽云数端，究意不出阴阳盈缩定之矣。予于《医理真传》分辩甚详。查近市风，一见血出，红光遍地，人人皆谓之火，医生亦谓之火。细阅其方，大半都是六味地黄汤、回龙汤、生地四物汤加炒芥、藕节、茜草、芧根、牛膝、大黄之类，专主滋阴降火。曷不思火有阴阳之别？血色虽红，由其从火化得来，终属阴体。气从阳，法天居上。血从阴，法地居下。天包乎地，气统乎血，气过旺，可以逼血外越，则为阳火。气过衰，不能统血，阴血上僭外溢，则为阴火。阳火，其人起居，一切有神。阴火，动静起居，一切无神。阳火始可用以上市习之方，阴火决不可用，当以《医理真传》之法为是。［眉批］知非氏曰：火是阴，《内经》曰：阴病治阳，当用阳药。夫火何以能阴？孔子曰：离为火，离是阴卦，火是红色，血亦是红色，故知火盛吐血，正是阴盛，必用阳药而始能愈。此儒者之权衡，非俗子所能窥测，而医亦是名医，故敢论血。要知人周身躯壳，全赖一气一血贯注之而已，不必区分血从何出，当何治，血是某经，主某方。分解愈多，源头即失。予治一切病证与此血证，只要无外感病形，即握定阴阳盈缩治之，见功屡屡，获效多多，真不传之必发秘法，实度世之金［2］针。予经验多年，不了隐秘，故罄［3］所知，以告将
[1] 况精窍与尿窍………凉膈散之类，此段文字原本脱，据光绪丁亥年(1887)五福堂刊本补。
［2］金原本作"食"，据文义改。
［3］罄原本作"馨"，据文义改。
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来。［眉批］老实人说老婆话，知著书之婆心，更知评者之婆必，有同心焉，以为邀誉则非矣。
按发斑一证，有由外入而致者，有由内出而致者。
由外入而致者，由外感一切不正之气，伏于阳明。阳明主肌肉，邪气遏郁，热毒愈旺，忽然发泄，轻则疹痒，重则斑点，或如桃花瓣，或如紫云色，大小块片不等。其人口臭气粗，壮热饮冷，脉大而实，或周身疼痛，二便不利者，此为外感，阳证发斑是也。法宜随其机而导之，如升麻葛根汤，举斑、化斑、消斑等汽，皆可酌用。
因内伤而致者，或饮食伤中，克伐过度；或房劳损阳，过于滋阴；或思虑用心过度；或偶感外邪，过于发散，以致元阳外越，或现斑点，或现通体紫红。其人懒言嗜卧，不渴不食，精神困倦。或现身热，而却无痛苦情状，行动如常。或身不热，而斑片累累，色多娇嫩，或含青色者是也。粗工不识，一见斑点，不察此中虚实，照三阳法治之，为害不浅。法宜回阳收纳为主，如封髓丹，潜阳丹，回阳饮之类。［眉批］知非氏曰：斑发于阳，因外感而致， 证为阳，能治者多，惟斑发于阴，因内伤而致，其证为阴，能识者少。钦安指出两法，重在人所难识一面，学者知其所难，作者之心苦矣。予曾经验多人，实有不测之妙。总之，外证发斑，在三阳，宜升散。内证发斑，在三阴，宜收纳。此二法乃万病治法之要。［眉批］知其要者，一言而终，不知其要者，流散无穷。不仅此证，学者须知。
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为痿躄。又云：治痿独取阳明。阳明为五脏六腑之海，主润宗筋，束骨利关节者也。阳明虚，则宗筋弛。李东垣、丹溪遵《内经》肺热一语，专主润燥泻火，似为有理。但《内经》称治痿独取阳明，乃不易之定法，此中必有定见，当是肺热叶焦之由，起于阳明也。阳明为五脏六腑之海，生精生血，化气行水之源也。《内经》谓阳明虚则宗筋驰。明是中宫转输精气机关失职，精气不输于肺，则肺痿生；精气不输于脉，则心痿生；精气不输于肉，则脾痿生；精气不输于脉，则心痿生；精气不输于肉，则脾痿生；精气不输于筋，则肝痿生；精气不输于骨，则肾痿生。以此分处，则治痿独取阳明一语方成定案，即不能专以润燥泻火为准。［眉批］知非氏曰：是何意态雄且杰，高淡雄辩惊四方。要知人身三百六十骨节，无论何节，精气一节不输，则一节即成枯枝。《黄庭经》曰：泥丸百节皆有神，一节无神，则阴邪起而为病，此理精粹。以此推求，方得痿证之由，肺热叶焦之实，即此可悟。治痿独取阳明一语，实握要之法。予思各经为邪火所侵，并未见即成痿证。即有邪火太甚，亦未见即成痿证，果系火邪为殃，数剂清凉，火灭而正气即复，何［1］得一年半载而不愈。东垣、丹溪见不及此，故专主润燥泻火，是皆未得此中三昧。［眉批］一家之言，未窥全豹。法宜大辛大甘以守中复阳，中宫阳复，转输如常，则痿证可立瘳矣。如大剂甘草干姜汤，甘草附子汤，参附汤，芪附汤，归附汤，术附汤之类，皆可酌选。
虚 劳
按虚劳一证，诸书分别五劳七伤，上损下损。陈修园先生《三字经》、《从众录》分辩甚详，可以熟玩。予思虚劳之人，总缘
[1] 痿躄………火灭而正气即复，何此段文字原本脱，据光绪本《医法圆通》补。
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关于“中痰”这一证候，我认为用“中”字并不恰当。痰产生的原因，一半是因为太阳经气失于运化，水液无法正常输布，积聚而成痰；或者是由于中焦脾胃火气衰微，转输功能失职，导致水湿内生而化为痰；又或者是心阳亏损，不能镇摄和收纳浊阴之气，致使水气上泛，从而产生痰证。情况多种多样，不一而足。这些痰都是由体内自身产生的，并非由外部侵入所致。只有从外部进入体内的，才可以称为“中”（即邪气直中脏腑）；如果是从内部产生并向外表现的，绝对不可以称为“中”。凡是患有痰迷心窍的人，必定平素阳气衰弱，阴寒之气日益盛长，饮食无法运化，气机不得宣通，忽然受到外邪引动，内气郁滞，阴寒之邪趁机发作，寒痰上逆，堵塞了清阳之道，导致人事昏迷，喉间有痰鸣声，脉象必然滑利。这类人平时多病且多痰，治疗法则应当以扶助阳气为优先，祛除痰浊为次要，如姜附汤、姜桂茯半汤、真武汤等方剂，都可以施用。即使称之为“痰闭”也可以，何必非要说成是“中”呢？［眉批］驳斥“中”字的含义非常到位，认清“痰”字的原理十分真切，治疗痰证的方法自然高超精妙，这不是平庸医生所能理解的。患病之人遇到这样的诊治，病可以痊愈；学医之人如果入门不致出错，这是救世的方法，也是医者仁心的体现。
关于“中食”这一证候，“中”字同样使用得不恰当。食物是用来滋养生命的，虽然是从外部摄入体内，但并不是食物本身能害人，一定是因为这个人平素中气不足，运化能力衰退，阴寒之邪已经发动，偶然遇到饮食进入体内，阻滞而不能前进，忽然闭塞了清阳之道，使人突然昏倒，形体像死人一样，这都是气机偶然闭塞造成的罢了，怎么能说是食物“中”伤了人体呢？就像平常气血充实的人，每天饮酒饱食，为什么没有“中食”呢？由此推论，根本原因在于内部先已虚弱。即使是采用探吐的方法，一吐之后即刻痊愈，痊愈后急需温补脾土，就不会有失误了。［眉批］这几句话包罗万象，扫除谬误，见解超群，坚不可摧。神曲、麦芽、槟榔、山楂可以消食导滞，但干姜、附子也能治食积吗？这足以让人发笑。
关于脱肛这一证候，有的因下焦阳气衰微，不能固摄约束所致；有的因三焦火旺，逼迫直肠脱出所致。
因下焦阳气衰微而导致者，是由于此人或房事过度，或在大吐大泻大病之后，元气受损，不能收摄固束。这种人必定表现为少气懒言，精神萎靡，面色苍白嘴唇发青，喜欢吃辛辣温热食物的特点。治疗法则应当温补固涩脾肾之阳气，阳气回复，气力充足，肛门脱出自然收回，如附子理中汤加葛根，黄芪建中汤，以及市面上流行的补中益气汤等方剂。
因火旺逼迫脱出者，或者由于过食肥甘厚味、醇酒、花椒、生姜等辛辣之物，热毒流注于下焦；或者感受外界的燥热邪气，流注于肠胃，热邪从下部发泄，火气下趋，逐渐逼迫，直肠遂脱出。这种人必定表现为烦躁不安，喜欢喝清凉饮料，或者大便不通畅，或者小便赤热，或者食欲旺盛容易饥饿等各种病情特点。治疗法则应当清热，如黄连解毒汤、三黄石膏汤等方剂，专门清除肠胃之热，热清则肠道自然收缩。［眉批］知非氏说：巽卦代表大腿，代表风。风的性质属阳，主升发。普通人不会脱肛，是因为风木之气生升不已。现在病人脱肛，是因为生升的气机失去了权柄。钦安参悟其中的道理，指出温升的方法。所谓火旺，是指火急风生，直接冲击大肠，肛头顺势脱出，也应当升阳散火，桃花汤可以使用。必须见到实热的病情表现，才可以直折其火，火熄风平，顺应其升达的性态，肛门自然举起。一二剂即可停止用药，这就是所谓的“中病即止”，岂可滥用而损伤生气？否则就会刚刚举回又脱落，久而久之形成漏症，这也是不可忽视的。
近来市井习俗，多用补中益气汤倍加升麻，或者用槟榔、麻仁捣成泥涂抹囟门穴，也多见效。但在阴阳分辨上，完全没有定见，终究不如掌握这套阴阳法度来治疗，才可能没有差错。只是所列出的药方，也不尽完善。不过是为了阐明理法的必然性，学者从中领悟并明辨，自然能够无往不利。
关于痔疮这一证候，各种书籍分别将其分为牡痔、牝痔、气痔、血痔、酒痔、脉痔、内痔、外痔。又有俗称：翻花痔、鸡冠痔、营花痔、蜂窠痔、鼠奶痔、牛奶痔等等，种类繁多。我认为虽然形象各异，但其根源相同，不必细分，总在于辨别是阳火还是阴寒而已。
因阳火而导致者，或者平素喜欢吃肥甘厚味、醇酒、花椒、生姜等一切辛辣之物，热积在肠胃，从下部发泄。肛门属于下窍，终非时刻大开让邪气下趋，发泄不畅，蕴积而痔疮乃生。这种痔疮必然疼痛剧烈，肛门红肿，精神不衰，饮食如常，粪便干硬，小便赤红，喜欢喝清凉饮料。治疗法则应当专门清除肠胃之热，如大小承气汤、调胃承气汤、葛根芩连汤等，都可以酌情选用。又或者燥邪发泄不畅，辨证与上述相同，但时令不同，治疗法则应当以清燥为主。如黄连玉竹阿胶汤、清燥汤、甘桔二冬汤等方剂。
因阴火而导致者，或者由于房劳过度，君火下流，前阴发泄不畅，直接逼迫局部，蕴积也能生痔。或者因为火病，用心过度，忧思过度，元气极度虚弱，涣散欲从下部脱出，而又不能立即脱出，蕴积也能生痔。这种痔疮颜色呈青色、黑色、白色，微痛微肿，坐卧不安，人必定没有神采，困倦喜卧，畏寒身重，面色嘴唇口唇青白，脉象或浮空无力，两尺脉或弦劲有力，这是元气发泄而不藏敛的缘故，不得按照寻常通用的方剂进行治疗。治疗法则应当收敛固涩，如附子理中汤加葛根，潜阳丹，回阳饮，封髓丹倍加砂仁、甘草等方剂。
近来治疗理论纷纷扰扰，愈出愈奇，理法将要泯灭，不得不为之纠正。［眉批］知非氏说：治疗疮疡也贵在理法明晰。钦安兼习外科病症，确实是妙人。
关于赤白浊这一证候，各种书籍记载，有的说红色属血，白色属气。有的说败精流溢，称为白浊；血液不及变化，称为赤浊。有的说房事太甚，发为白淫。有的说脾脏移热于肾脏。有的说白浊是由于劳伤肾脏，肾冷所致。种种分辨，到底听从谁说？我认为不必拘泥于区分，把握定阴阳原则，治疗就可以了。［眉批］分析言语居于关键地位。
至于赤浊、白浊，都是从尿道排出，有人说败精流溢。既然说是败精，不过是一两次出现，未必天天出现，况且精窍与尿窍不同时开启。即使说是元阳不固，关锁不牢，而败精有如此之多，岂不是元阳有立刻断绝的危险吗？我也常见患浊证的人，精神不衰的也很多，可知其不是败精也就很明白了。我仔细思考这个证候，总归是因为二气不调，中焦脾胃运化机关失职。之所以这样，是因为先天依赖后天来滋生，水谷的精气生成血，水谷的悍气生成精，血进入营分，精运行于卫分，都从中焦转输，转输失去权柄，无论是精还是血，流注到阑门，阑门是秘藏清气别出浊气的地方，从此渗入膀胱，渗入的多则为赤，溺便赤；渗入的少则为白，溺便白，这并不是膀胱自己能够变成赤白的。方书多用利水之法，尚未窥透其中的奥秘。又有说湿热流注于下部，这种说法确实有理，见解颇高，清热利水，大约从此入手。须知中焦不调，有寒热之别。寒主要是胃阳不足，阻滞中焦，转输就能失职。这种人必定表现为面白无神，饮食短少，因疲倦嗜睡，不问赤白，只以温暖中焦为主，使寒邪去除而转输恢复常态，如香砂六君子汤、附子理中汤等类。［眉批］知非氏说：阳虚不能运动精微，一句话可以补充钦安的注解。热主要是胃气过旺，盘踞中焦，转输也能失职。这种人大多烦躁好动，精神不衰，言语、脉息，一切有神，不问赤白，便以清胃为主，使热云消散而转输恢复常态，如导赤散加茯苓、车前子，清胃散，凉膈散等类。
血证门：吐血、鼻血、牙血、毛孔血、耳血、二便血。
关于血证虽然号称有多种端绪，究其根本不出阴阳盈缩所决定。我在《医理真传》中分辨得很详细。查看近来的市井风气，一见出血，红光遍地，人人都说是火，医生也说是火。细看他们的处方，大半都是六味地黄汤、回龙汤、生地四物汤加炒荆芥、藕节、茜草、茅根、牛膝、大黄之类，专门主张滋阴降火。何不想想火有阴阳的区别？血色虽然红，由其从火化得来，终究属于阴体。气属阳，效法天居上；血属阴，效法地居下。天包裹着地，气统帅着血，气过旺，可以逼迫血液外越，这就叫阳火。气过衰，不能统摄血液，阴血上僭外溢，这就叫阴火。阳火证，人的起居行动，一切都有神采。阴火证，动静起居，一切都没有神采。阳火证才开始可以用上面市井流行的方子，阴火证绝对不可用，应当以《医理真传》的方法为正确。［眉批］知非氏说：火是阴，《内经》说：阴病治阳，当用阳药。火为什么能阴？孔子说：离卦为火，离是阴卦，火是红色的，血也是红色的，所以知道火盛吐血，正是阴盛，必须用阳药才能痊愈。这是儒者的权衡标准，不是俗子所能窥测的，而医者也自认为是名医，所以敢于论述血证。要知道人的周身躯壳，全赖一气一血贯注而已，不必区分血从哪里出来，应当怎么治，血是哪条经络，主治哪个方子。分解得越多，源头就丢失了。我治疗一切病证与此血证，只要没有外感病的形征，就把握定阴阳盈缩来治疗，见功屡屡，获效多多，真是不可传授的必发秘法，实在是渡世的金针。我经验多年，不隐瞒隐秘，所以倾尽所知，告知后来人。［眉批］老实人说老婆话，知道著书的婆心，更知道评者的婆心，有同心焉，以为邀誉则非矣。
关于发斑这一证候，有的由外部侵入所致，有的由内部发出所致。
由外部侵入所致者，由外感一切不正之气，伏留于阳明经。阳明经主肌肉，邪气遏郁，热毒愈旺，忽然发泄，轻则疹痒，重则斑点，或如桃花瓣，或如紫云色，大小块片不等。这种人口臭气粗，壮热饮冷，脉大而实，或者周身疼痛，二便不利者，此为外感，阳证发斑是也。治疗法则应当随其机理而引导它，如升麻葛根汤，举斑、化斑、消斑等剂，都可以酌情选用。
因内伤而导致者，或者饮食伤及中焦，克伐过度；或者房劳损伤阳气，过于滋阴；或者思虑用心过度；或者偶感外邪，过于发散，以致元阳外越，或者现斑点，或者现通体紫红。这种人懒言嗜卧，不渴不食，精神困倦。或者现身热，却没有痛苦情状，行动如常。或者身不热，而斑片累累，颜色多娇嫩，或者含有青色者是也。粗疏的医生不认识，一见斑点，不察其中的虚实，照三阳法治之，危害不浅。治疗法则应当以回阳收纳为主，如封髓丹，潜阳丹，回阳饮等类。［眉批］知非氏说：斑发于阳，因外感而致，证为阳，能治者多，惟斑发于阴，因内伤而致，其证为阴，能识者少。钦安指出两法，重在人所难识一面，学者知其所难，作者之心苦矣。我曾经验多人，实有不测之妙。总之，外证发斑，在三阳，宜升散。内证发斑，在三阴，宜收纳。此二法乃万病治法之要。［眉批］知其要者，一言而终，不知其要者，流散无穷。不仅此证，学者须知。
关于痿躄这一证候，《内经》说：肺热叶焦，五脏因而受之，发为痿躄。又说：治痿独取阳明。阳明为五脏六腑之海，主润宗筋，束骨利关节者也。阳明虚，则宗筋弛缓。李东垣、朱丹溪遵循《内经》肺热一语，专门主张润燥泻火，似乎有理。但《内经》称治痿独取阳明，是不变的定法，其中必有定见，应当是肺热叶焦的原因，起于阳明。阳明为五脏六腑之海，生精生血，化气行水之源也。《内经》谓阳明虚则宗筋弛缓。明显是中焦转输精气机关失职，精气不输于肺，则肺痿生；精气不输于脉，则心痿生；精气不输于肉，则脾痿生；精气不输于筋，则肝痿生；精气不输于骨，则肾痿生。以此分处，则治痿独取阳明一语方成定案，即不能专以润燥泻火为准。［眉批］知非氏说：是何意态雄且杰，高谈雄辩惊四方。要知人身三百六十骨节，无论何节，精气一节不输，则一节即成枯枝。《黄庭经》曰：泥丸百节皆有神，一节无神，则阴邪起而为病，此理精粹。以此推求，方得痿证之由，肺热叶焦之实，即此可悟。治痿独取阳明一语，实握要之法。我思考各经为邪火所侵，并未见即成痿证。即使有邪火太甚，亦未见即成痿证，果系火邪为殃，数剂清凉，火灭而正气即复，何得一年半载而不愈。东垣、丹溪见不及此，故专主润燥泻火，是皆未得此中三昧。［眉批］一家之言，未窥全豹。治疗法则应当大辛大甘以守中复阳，中宫阳气回复，转输如常，则痿证可立愈矣。如大剂甘草干姜汤，甘草附子汤，参附汤，芪附汤，归附汤，术附汤等类，都可以酌情选用。
关于虚劳这一证候，各种书籍分别分为五劳七伤，上损下损。陈修园先生的《三字经》、《从众录》分辨得很详细，可以熟读玩味。我思考虚劳之人，总归是因为
Regarding the syndrome of "Zhong Tan" (Central Phlegm), I consider the term "Zhong" (Central/Struck) to be inappropriate. The generation of phlegm is half due to the failure of the Taiyang (Greater Yang) meridian qi to transport, causing fluid metabolism to stagnate and accumulate into phlegm. It may also arise from the decline of fire in the Middle Jiao (Spleen/Stomach), leading to a loss of transformation and transportation function, resulting in water-dampness generating phlegm. Or it may stem from the deficiency of Heart Yang, which fails to anchor and assimilate turbid Yin, causing water to flood upwards and generate phlegm. There are various situations. All such phlegm is generated internally, not caused by external invasion. Only when pathogenic factors enter from the exterior can one speak of "Zhong" (direct strike); if it originates from within and manifests outwardly, it absolutely cannot be termed "Zhong". Patients suffering from phlegm misting the mind must have a constitutional deficiency of Yang, with accumulating Yin-cold, impaired digestion of food, and stagnant Qi mechanism. Suddenly triggered by external pathogens and internal Qi stagnation, Yin-pathogens emerge stealthily, cold-phlegm ascends, blocking the clear orifices, leading to coma and rattling phlegm in the throat, with a slippery pulse. Such patients typically suffer from frequent illnesses and excessive phlegm. The treatment principle should prioritize supporting Yang and secondarily dispelling phlegm. Formulas such as Jiang Fu Tang (Ginger and Aconite Decoction), Jiang Gui Fu Ban Tang (Ginger, Cinnamon, Poria, and Pinellia Decoction), and Zhen Wu Tang (True Warrior Decoction) are all applicable. It might be called "Phlegm Obstruction," why insist on calling it "Zhong"? [Marginal Note]: The refutation of the term "Zhong" is sound; the understanding of the principle of "Tan" (Phlegm) is true; thus, the methods for treating phlegm become naturally exquisite, beyond the comprehension of mediocre practitioners. For the patient, encountering this leads to recovery; for the student of medicine, avoiding error at the outset is the method of saving lives and the intent of physicians.
Regarding the syndrome of "Zhong Shi" (Central Food Stagnation), the term "Zhong" is also inappropriate. Food nourishes life; although it enters from the exterior, food itself does not harm. It is only when a person has a pre-existing deficiency of Middle Qi and weak transformation capacity, with Yin-pathogens already activated, that accidental ingestion of food causes obstruction, suddenly closing the clear orifices, leading to sudden collapse and a corpse-like state. This is merely an偶然 (accidental) closure of the Qi mechanism, how can it be said that food "Zhong" (struck) the body? Consider healthy individuals with robust Qi who consume alcohol and rich food daily without suffering from "Zhong Shi." By analogy, the root cause is internal deficiency. Even if emesis is induced, recovery is immediate upon vomiting; afterwards, urgently warming and tonifying Spleen Earth ensures no error. [Marginal Note]: These few words encompass everything and sweep away fallacies; the insights are superlative and unassailable. Shen Qu, Mai Ya, Bing Lang, and Shan Zha can resolve food stagnation, but Gan Jiang and Fu Zi can also treat it? This is laughable.
Hemorrhoids (Tuo Gang)
Regarding hemorrhoids, some cases are due to the decline of Lower Jiao Yang, failing to hold and bind; others are due to flourishing Fire in the Three Jiao forcing prolapse.
Those caused by Lower Jiao Yang decline result from excessive sexual activity or post-illness depletion after severe vomiting/diarrhea, damaging Yuan Qi and preventing retention. Definite signs include shortness of breath, reluctance to speak, listlessness, pale face with bluish lips, and a preference for pungent, hot foods. The treatment principle is to warm and secure Spleen and Kidney Yang. Once Yang returns and Qi is sufficient, the prolapse retracts spontaneously. Formulas like Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction) plus Gegen (Kudzu Root), Huangqi Jianzhong Tang (Astragalus Build the Middle Decoction), or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) are suitable.
Those forced out by flourishing Fire result from overconsumption of rich flavors, alcohol, pepper, and ginger, causing heat-toxins to flow to the Lower Jiao, or from contracting external dry-heat pathogens flowing to the intestines. Heat pathogens vent downward, Fire Qi trends down, gradually pressing, causing the rectum to protrude. Definite signs include irritability, preference for cool drinks, constipation, dark hot urine, or polyphagia. The treatment principle is to clear heat, using formulas like Huanglian Jiedu Tang (Coptis Detoxification Decoction) or Sanhuang Shigao Tang (Three Yellows and Gypsum Decoction) to specifically clear intestinal heat; once heat clears, the intestine retracts. [Marginal Note]: Zhifei says: Xun represents the thigh and wind. Wind nature belongs to Yang, governing ascent. Healthy people do not suffer prolapse because Wood-Qi ascends endlessly. Now, disease causes loss of this ascending authority. Qin An comprehends this reason, pointing out warming and ascending methods. What is meant by "Fire Flourishing" is urgent Fire generating Wind, directly attacking the large intestine, causing the anal head to protrude顺势 (following the trend). One should also ascend Yang and scatter Fire; Taohua Tang (Peach Kernel Decoction) can be used. Only when definite excess-heat signs appear can one directly subdue the Fire. When Fire extinguishes and Wind calms, following its ascending nature, the anus lifts itself. Stop after 1-2 doses; this is "stop when hitting the target," lest overuse damage vital Qi. Otherwise, it will repeatedly prolapse, eventually becoming a fistula, which must be known.
Recently, market habits often use Buzhong Yiqi Tang with doubled Shengma, or apply Binglang and Huma paste to the Fontanelle acupoint, which is often effective. However, lacking definite views on Yin-Yang differentiation, it is inferior to grasping these Yin-Yang principles for treatment to avoid errors. The listed prescriptions are not perfect. They merely clarify the necessity of principles and methods; students who comprehend them spiritually will naturally hit the mark every time.
Hemorrhoids (Zhi Chuang)
Regarding hemorrhoids, books distinguish between Male (Mu), Female (Pin), Qi, Blood, Wine, Pulse, Internal, and External types. Common names include Fan Hua, Ji Guan, Ying Hua, Feng Ke, Shu Nai, Niu Nai, etc. I believe although shapes differ, the source is the same; detailed classification is unnecessary, focusing always on distinguishing Yang-Fire from Yin-Cold.
Caused by Yang-Fire: Often due to habitual consumption of rich foods, alcohol, pepper, ginger, and spicy items, accumulating heat in the intestines/stomach, venting downward. The anus is a lower orifice; if venting is blocked, accumulation generates hemorrhoids. Signs include severe pain, red swollen anus, undiminished spirit, normal diet, hard stool, dark urine, and preference for cool drinks. Treatment focuses on clearing intestinal heat, using Da Chengqi Tang, Xiao Chengqi Tang, Tiaowei Chengqi Tang, or Gegen Qinlian Tang. If dryness prevents venting, differentiation is similar but seasonal context differs; treatment prioritizes clearing dryness, using Huanglian Yuzhu Ejiao Tang, Qingzao Tang, or Ganjie Erdong Tang.
Caused by Yin-Fire: Due to excessive sexual activity causing Minister Fire to flow downward, or excessive mental exertion/worry depleting Yuan Qi, causing dispersion and tendency to prolapse from below without immediate release, leading to accumulation. Signs include blue/black/white colored hemorrhoids, slight pain/swelling, restlessness, lack of spirit, fatigue, aversion to cold, heavy body, pale/bluish complexion, floating/hollow pulse, or wiry/tense Chi pulses. This is due to Yuan Qi venting without storage; standard generic formulas are inappropriate. Treatment focuses on astringing and securing, using Fuzi Lizhong Tang plus Gegen, Qianyang Dan, Huiyang Yin, or Fengsui Dan with increased Sha Ren and Gan Cao.
Recent theories are chaotic and increasingly bizarre, obscuring principles. Correction is necessary. [Marginal Note]: Zhifei says: Treating sores requires clear principles. Qin An, practicing both internal and external medicine, is truly a wonderful person.
Red and White Turbidity (Chi Bai Zhuo)
Regarding red and white turbidity, books vary: some say Red belongs to Blood, White to Qi; some say leaking rotten semen is White Turbidity, blood failing to transform is Red Turbidity; some attribute White Yin to excessive intercourse; some say Spleen heat transfers to Kidney; some say White Turbidity is due to Kidney Cold from labor injury. Whose view to follow? I say distinction is unnecessary; grasp Yin-Yang, and treatment follows. [Marginal Note]: Analyzing speech is key.
Red and White Turbidity exit via the urinary duct. Some say leaking rotten semen. If rotten semen, it occurs rarely, not daily, and the semen orifice does not open simultaneously with the urine orifice. Even if Yuan Yang is insecure, such massive leakage would imply imminent death of Yuan Yang. I often see patients with turbidity having undiminished spirit, proving it is not rotten semen. Careful reflection shows this syndrome stems from disharmony of two Qi and failure of the Middle Jiao transformation mechanism. Pre-natal essence relies on Post-natal nutrition; grain essence generates Blood, grain fierce Qi generates Jing. Blood enters Ying, Jing moves in Wei, all transported via the Middle Jiao. If transport loses authority, Jing or Blood flows to Lanmen (the gate separating clear and turbid), seeping into the Bladder. More seepage causes red urine; less causes white urine. It is not the Bladder itself changing color. Prescriptions often use diuretics, missing the secret. Some say damp-heat flows downward; this is reasonable and insightful. Clearing heat and promoting urination roughly follows this. Note that Middle Jiao disharmony has cold and heat distinctions. Cold is insufficient Stomach Yang blocking the Middle, losing transport. Signs: pale face, no spirit, poor appetite, fatigue, sleepiness. Regardless of red/white, warm the Middle to remove cold and restore transport, using Xiangsha Liujun Zi Tang or Fuzi Lizhong Tang. [Marginal Note]: Zhifei says: Yang deficiency failing to move fine essences is summarized in one phrase, supplementing Qin An's notes. Heat is excessive Stomach Qi occupying the Middle, losing transport. Signs: irritability, movement, undiminished spirit, energetic speech/pulse. Regardless of red/white, clear the Stomach to dissipate heat and restore transport, using Daochi San plus Fuling and Cheqian Zi, Qingwei San, or Liangge San.
Blood Syndrome Section: Hematemesis, Epistaxis, Gingival bleeding, Capillary bleeding, Auricular bleeding, Hematochezia/Hematuria.
Although blood syndromes seem numerous, they ultimately depend on Yin-Yang fullness or emptiness. I distinguished this in detail in *Yili Zhenchuan*. Recent market trends see blood and redness everywhere, attributing it to Fire. Doctors prescribe Liuwei Dihuang Tang, Huilong Tang, or Shengdi Siwu Tang plus fried Jingjie, Oujie, Qiancao, Menggen, Niuxi, Dahuang, focusing on nourishing Yin and descending Fire. Why not consider Fire has Yin/Yang distinctions? Although blood is red, derived from Fire, it remains Yin substance. Qi is Yang, imitating Heaven above; Blood is Yin, imitating Earth below. Heaven envelops Earth; Qi commands Blood. Excess Qi forces blood outward = Yang Fire. Deficient Qi fails to command blood, Yin blood rebels outward = Yin Fire. Yang Fire patients have spirited起居 (daily activities). Yin Fire patients lack spirit in movement/rest. Yang Fire can use market formulas; Yin Fire absolutely cannot. Use methods from *Yili Zhenchuan*. [Marginal Note]: Zhifei says: Fire is Yin. *Neijing* says: Treat Yin diseases by regulating Yang, using Yang medicines. Why is Fire Yin? Confucius said: Li trigram is Fire, Li is a Yin trigram. Fire is red, Blood is red, so excessive Fire causing hematemesis indicates Yin excess, requiring Yang medicine to cure. This is the scholar's balance, inaccessible to vulgarites. Physicians claiming fame dare discuss blood. Know that the whole body relies on Qi and Blood infusion. Do not distinguish where blood comes from or which meridian/formula applies. Over-analysis loses the source. I treat all syndromes, including blood, by grasping Yin-Yang fullness/emptiness if no external pathogen exists. Success is frequent. This is a secret method, truly a golden needle for saving the world. After years of experience, revealing secrets, I tell future generations. [Marginal Note]: Honest people speak plainly; knowing the author's benevolent heart and the critic's benevolent heart, there is shared sympathy, not seeking fame.
Eruption (Fa Ban)
Regarding eruptions, some arise from external invasion, others from internal emergence.
External origin: External irregular Qi hides in the Yangming Meridian. Yangming governs muscles. Pathogen suppression makes heat-toxin flourish, suddenly venting. Mild cases show rash/itching; severe cases show spots, like peach petals or purple clouds, varying sizes. Signs: bad breath, coarse breathing, high fever craving cold, large/solid pulse, body pain, difficult urination/bowel movements. This is external, Yang syndrome eruption. Treatment guides according to mechanism, using Shengma Gegen Tang, or Ju Ban, Hua Ban, Xiao Ban formulas.
Internal origin: Dietary injury to Middle, excessive suppression; sexual exhaustion damaging Yang, excessive yin-nourishing; excessive mental strain; or external pathogen treated with excessive dispersal, causing Yuan Yang to escape externally, showing spots or whole-body purple-red. Signs: reluctance to speak, sleepiness, no thirst/appetite, fatigue. Or fever without pain, normal movement. Or no fever but numerous spots, tender color, or containing green. Crude doctors see spots, ignore deficiency/excess, treat as Three Yang syndromes, causing great harm. Treatment prioritizes returning Yang and receiving/retaining, using Fengsui Dan, Qianyang Dan, or Huiyang Yin. [Marginal Note]: Zhifei says: Eruptions from Yang (external) are Yang syndromes, many can treat. Eruptions from Yin (internal) are Yin syndromes, few recognize. Qin An points out two methods, emphasizing the hard-to-recognize aspect. Students know the difficulty; the author's heart is bitter. I have experienced many cases with miraculous effects. In short, external eruptions belong to Three Yang, suitable for ascending/dispersing. Internal eruptions belong to Three Yin, suitable for receiving/retaining. These two methods are keys to treating ten thousand diseases. [Marginal Note]: Knowing the key ends in one word; not knowing scatters infinitely. Not just this syndrome; students must know.
Flaccidity (Wei Bi)
Regarding flaccidity, *Neijing* states: Lung heat scorches leaves, affecting five Zang organs, causing flaccidity. Also: Treat flaccidity by exclusively taking Yangming. Yangming is the sea of five Zang and six Fu, moistening Zongjin, binding bones, benefiting joints. Yangming deficiency leads to Zongjin laxity. Li Dongyuan and Zhu Danxi followed "Lung heat," focusing on moistening dryness and purging fire, seemingly reasonable. But *Neijing*'s "exclusively take Yangming" is an unchangeable rule, implying a definite view: Lung heat likely originates from Yangming. Yangming is the source of generating essence/blood and transforming Qi/water. *Neijing* says Yangming deficiency causes Zongjin laxity. Clearly, Middle Jiao transport of essence/Qi fails. Essence not transported to Lung causes Lung flaccidity; not to vessels causes Heart flaccidity; not to flesh causes Spleen flaccidity; not to sinews causes Liver flaccidity; not to bones causes Kidney flaccidity. Thus, "exclusively take Yangming" becomes definitive; cannot solely rely on moistening dryness/purging fire. [Marginal Note]: Zhifei says: Majestic and heroic, high talk shocks the four directions. Know that 360 joints all need essence/Qi. If one joint lacks essence, it becomes a dead branch. *Huangting Jing* says: Ninidan has spirits in all joints; one joint without spirit allows Yin pathogens to cause disease. This logic is refined. Deduce this to find the cause of flaccidity and reality of Lung heat. "Exclusively take Yangming" is indeed grasping the key. I think meridians invaded by evil fire do not immediately become flaccid. Even with severe fire, flaccidity doesn't instantly occur. If fire were the cause, a few doses of cooling would extinguish fire and restore Zheng Qi, why last a year and a half? Dongyuan and Danxi missed this, focusing only on moistening/purging, missing the essence. [Marginal Note]: One school's view, not seeing the whole leopard. Treatment uses large acrid-sweet to guard Middle and restore Yang. Once Middle Yang returns and transport normalizes, flaccidity heals quickly. Use large doses of Gancao Ganjiang Tang, Gancao Fuzi Tang, Shenfu Tang, Qifu Tang, Guifu Tang, or Zhufu Tang.
Deficiency Consumption (Xu Lao)
Regarding deficiency consumption, books distinguish Five Labors, Seven Injuries, Upper Damage, Lower Damage. Chen Xiuyuan's *Sanzi Jing* and *Congzhong Lu* distinguish in detail, worth studying. I think deficiency consumption patients generally originate from...