医津一筏
（一名《内经释要》）
歙县 江之兰 含征 著
和县 高思潜 考 正
吴县 张炳翔 叔鹏校录
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治病必求其本
脾喜燥，伤于寒湿则不能消磨水谷，宜术附以温燥之。然脾阴不足而谷亦不化，又不可以温燥为治。
有思虑伤脾，脾虚不能统血而矢出者；有思虑伤脾，脾虚不能消谷而作泻者。此皆以回护中气为本，勿治其标。
有肺虚不统卫血，血溢妄行，随气出于鼻为衄。如动气在右，汗之令衄是也。脾虚不能行津于三阴，胃虚不能行气于三阳，气日以衰，脉道不利，其血悉皆中积，此而欲消，其留瘀当以参耆监之。
胎已数月，忽下血不止，有癥痼害者，当下其癥而胎始安。设不知此，但一味养血安胎，是为癥痼树帜也，胎可安乎?
刘澹庵曰：下癥安胎，必用驱逐峻剂，虽有故无殒。然不定其虚实而施之，恐非定法也。
火气逆上是肝肾之阴失其龙雷蛰伏之性而上逆者，至于胃中湿热下流，又是邪气乘其木而阴气反走于上，俾上焦之阳不伸而肺中治节之令不行，故见为鼻塞、胸满、涎溢、恶寒战栗之证。又咳嗽烦冤，是肾气之逆也，其所以上逆之故，亦有此二者虚实之异。推此则治痰莫先于降火，降火之法，亦须识此二者虚实之异。又平脉云：少阴脉不至，肾气微，少精血，奔气迫促，上入胸膈。夫少阴脉不至，是先天元阴元阳受伤。肾者，先天也；脾胃者，后天也。先天既已受伤，则不能生乎后天，故脾胃之阴阳亦伤，不能运化水谷而生湿热，热下流则膀胱之气化不行，浊气因而上入，浊气上入，肺气便壅，脾气愈滞，于是为痰为饮而腹胀食滞之症形焉。其少阳生发之气郁而不得升，为周身刺痛，为呕逆吐酸。心主之阳，为浊阴所乘，则为心悸怔忡。是肾之一脏病，而五脏六府皆为之不宁，故养身莫妙于节欲也。若不知此，而但以行痰利气为治则燥，痰伤其阴，利气伤其阳，不坐困乎?此又专主肾虚而言也。
心肾不足，小便浑浊，中气不足，溲便为之变；金衰则水涸，溺色变为黄赤。此皆正气虚而生邪热，当推原其本而补之，苟徒执水液浑浊皆属于火一语而施治，病安能愈?
饮食劳倦，损伤脾胃，始受热中，末传寒中，要知始受之热，因谷气不得升举，壅而为热又火，与元气不两立之热，非实热也。故在始受之时，已云劳者温之，损者温之矣。病久安得不为寒中耶?东垣谓冲任之火传之督脉，督脉挟太阳寒气逆克丙火，似失之凿。
子母情牵，仇仇肆虐，或胜克乘薄之不一，又本脏本脉其别者，或走他脏他脉，一脏病往往挟他脏而见证者。
邪之所凑，其气必虚。邪乘虚而入，是虚为本邪为标，故去邪不可不加以养正，此一注脚，人所同也。然亦有身体壮盛之人，暴受邪气，如外感风寒，内伤饮食之类，本气未必皆虚，受病之后，反显虚象，若营卫受邪，则屈伸不利，动作衰之；脾胃受邪，则四肢无力，恶食呕泄之类。此邪气既凑之后，其气亦必虚，是虚因邪而显，邪为本虚为标，斯时但当亟去其邪，而正自复，不必顾虑其虚，用药牵制，此一注脚，余所独也。
治病当知标本矣。然犹不可不知标中之标，本中之本，如脾胃虚而生湿热，是虚为本，湿热为标也。至湿热下流膀胱之气化不利，是湿热为标气化不利为标中之标。至气化不利逆而上行，嗌塞喘逆，又标中标之标也。推此而逆求之，则本中之本亦可得矣。
阳旺生阴，气不足亦令人口干而津液不通。
喘而短气，须别寒热虚实，分类治之。至于哮则素有之痰之火，风寒所束而发，但看其人之强弱，用药轻重可耳。
肺本金寒水冷之脏，然既已汗吐下损津液而成肺痿矣，岂清凉之品所能复其津液乎?此仲景之竟用桂枝人参姜枣所宜详究也。
火与痰本气与津液也，无病则为气与津液，有病则为火为痰。然致病之由，不过内伤外感，有余不足而已。求其本而治之，则痰消火灭，故曰见痰莫治痰，见热莫治热者以此。
内伤外感悉能致劳，苟不察其虚实，但施养阴清热之套剂，则虚者未必受补，而实者愈实矣。
失血证毕竟属热者，多世有用寒凉而反剧者，盖有气虚之火，有血虚之火耳。冲气上逆有上焦之阳不足而阴气上于者，有下焦之阴不足而阴火上逆者，有脾胃之湿热下流而肝肾之气不能固守于下者，俱挟冲脉故耳。
邪火内炽，阳事反痿，苦寒泻之，阳事勃然，火与真阳势不两立，如此世人以助火之剂，冀回真阳，非徒无益，而又害之。
所谓虚风者，似风非风也。然亦有阴阳之别，阴虚是热则生风，阳虚是阳气不能卫外。
卫为阳，阳虚不能卫外，故中风。风为阳邪，以类相召故也。但风为阳邪，既中之后，每多显阳热之症，此不可不推求其受病之本，而务从事于见病之标也。诸病皆治其本，唯中满与大小便不利当治其标，以证之危急，不暇为本计也。余谓果系实证，则不难消导之，通利之治其标可也。若涉虚证，其法可行乎?仍当治其本。
东方常实，有泻无补，其说有二。一者肝为将军之官，其性刚劲急速；一者木火同居，风乘火势，火助风威，皆毋赞其胜也。若言其本，则乙癸同源，养血与滋阴并急。
颠、狂、痫皆主于痰。颠是虚而致痰；狂是实而致痰；痫是风而致痰。虚实风为本，痰为标也。
痰在肺曰燥痰，又曰气痰，以肺为燥金而主气也。燥为本，气为标，其痰涩而难出见为证也。往往胸膈阻塞，关节不利，不知者以辛香燥热利其气，燥者益燥，气愈不利。
肺虚咳者何也?失其降下之令也。徒降其气，咳愈频矣。
黄昏咳多者，是火气浮于肺，此阴虚之火，故宜五味子敛而降之。
诸痿喘呕皆属于上，上者，肺也，不得以香燥利气。
湿胜则濡泄，当以燥剂治之，然逆秋气则伤肺，冬为飧泄，此肺移热于大肠之病。若以温燥治之，是益其病也。
渴固多热，然内外伤感悉能令津液不行，而渴须求其自。
三阴结是水之本，至肺气不利，发为浮肿、喘嗽、口干、小便涩、腹满、黄汗、身重不能转侧、阴肿。阴湿则又水之标也。
寒邪在标，郁热于经而令咳血、衄血，解表自愈，麻黄汤杏子汤是也。心肺有疾而鼻为之不利，不必主专于风寒也。
治病必求其本。本者，下为本，内为本。故上热下寒，但温其寒而热自降，表寒里热但清其热而寒自已，然须加以反佐之药，以免格拒，至于先伤于风而后伤于寒，先伤于暑而后伤于湿之类，又当相其轻重缓急而施治。
有者求之无者求之，盛者责之虚者责之
四肢无力，动作衰乏，虚也。然邪客营卫则出入之道废，中焦有阻则升降之机穷，亦能见证如此，故曰无者求之。
诸痛无补，言气逆滞也。虽然壮者气行则愈，怯者着而成病，真气虚乏之人，诸邪易于留着，着则逆，逆则痛。疏刷之中不可无补养之品，徒恃攻击，则正愈虚，不能送邪外出，邪愈着而痛无休止也。遇斯疾者，攻补兼施而不愈，遂宜屏弃一切，其要又在断厚味，远房帏，使邪无所助，而正气日胜，然后佐以疏刷，击其惰归，病无不愈。但邪气方炽，病者正在呻吟痛苦之时，医者教之以如此，如此是犹子舆氏教滕君以强为善，鲜不以为迂阔而远于事情者也。又若脾胃亡液，焦燥如割，宜用真生苄脉汤。阳涩阴弦而腹中急痛，当用小建中汤。肝气不足，两胁下满筋急，不能太息，四肢厥冷，发呛，心腹痛，目不明了，爪甲枯口而青，宜补肝汤。房劳过度，肾虚赢怯之人，胸膈间多隐隐痛，此肾虚不能约气，气虚不能生血之故，气血俱虚则凝滞而作痛，宜用破故纸之类，温肾芎归之类养血。又胸痹痛，有真阴虚而然者，有元阳虚地气上干而然者，头痛有气虚者，有血虚者，有肾虚者，皆不可不无补也(苄，地黄也)。
妇人因产，去血过多，腹中急痛，是肝木无血以养，宜当归建中汤，亦是痛而应补者。
妇人居经，血弱气盛，孤阳独呼阴，不能吸阴，为积寒。阳为聚热，故时发洒淅、咽燥、汗出，或溲稠数多，唾涎沫，其脉右浮大左弱涩，此当养其血，所见之证勿计也。
证象白虎，误服白虎汤必死，言治假以真也。
寒邪闭其营卫，当以升发之药散之。然素有痰热之人，遇此升发之药，痰随气上，闭住肺气，皮毛为之壅遏，邪愈不得泄，病反增据，又当以苦泄之。
心火不得越则郁于小肠，肺气不得泄则郁于大肠，小肠下口，即大肠上口故奔迫无度，里急后重而成滞下，此是风寒内缩使然。徒责之湿热，未能万举万当，所以治痢亦当与治疟，半表半里同法。
食积痰留舍肠胃之间，气行则出，有似鱼脑，间以血丝，闭气滑肠，状如痢，利反快，不可作痢疾治也。
热则生风，痿痹不随，而有风象，医以风治之恐不免致痿也。
便泄肛门热有火热有阳陷二端。
先天者，无形之虚神而已矣。后天者，有形之实则气血也。治先天当以神治神，治后天当以形益形也。但神虚则气血不生，神乱则气血不宁，气血虚则神无以养，气血乱则神为之迁，此又当消息之耳。
张汉瓿曰：气血即神之窟宅，不治气血何由治神?以神治神立论，如此尚须着落耳。吾常谓谈医之道不可一语模糊，令人徒作天际真人想也。
天地阴阳，停匀方不崩不拆，人亦如之。禀畀之后，嗜欲不节，起居无时，七情六淫所伤致，此阴阳有所偏损则偏胜，故见以为有余而实也。有余但治其偏损者，而有余自平。
形气有余，病气有余，泻之可也。形气不足，气病。气不足，补之可也。至若形气有余，病气不足，形气不足，病气有余，当责有无真假。东垣云：但补泻病气之有余不足，不必顾其形气之有余不足，似非确论。
幼科大便黄赤，属热是矣，其青白亦未可专以为寒。夫水谷入胃，入大小肠，肠胃无邪，则水谷以传次化者，清入营卫化精微，浊者下广肠成糟粕，粪为之变。设肠胃有寒，水谷不得热腐，故下利清白，完谷不化。然肠胃有热，水谷不得停留，亦下利清白，完谷不化，不得专以为寒也。
肾为先天之本，脾为后天之本固矣。然肺金不足，或不得其平，亦不能生水。心火不足，或不得其平，亦不能生土，徒责之脾肾无益，故病亦有治标而得者百病不离乎火。火者，天地所有之气，亦吾身所有之气也。从外入者，天地亢害之气，吾身中以类相感召，亦令此气为之亢害也。此伤暑受热是矣。至若七情，以及风寒燥湿动乱为火者，以火喜条达而恶遏抑，今以七情及风寒燥湿抑遏之，动乱为害，然发之、泻之、制之、克之可也。迨夫相火则其体藏于右肾之中，所以配左尺之水，俾此水得以彻于上下，周于四表，充肤泽毛，若雾露之溉，虽水为之实火为之也。设使阴虚，此火失其窟宅，游行于四肢百骸，五脏六腑之间，而为大患。阳虚则此火无根而脱出，为患亦然。此不可以湿折水灭，唯当相其人之阴虚阳虚而补养之。独是体虚之人，易于受邪，或内外伤感，抑遏成火，则补虚之中，不可无泻实之药，若六味地黄丸加黄柏知母等方是也。审此则用药不难中肯綮矣。
张永孚曰：相火禀命于命门。真水，先天水火原属同宫，水以火为主，以水为原。下论曰：设使阴虚此，火失其窟宅，阴虚即水亏火脱，出即阳虚，岂六味加知柏反可平之者耶?
诸疮将结痂时，必极痒，盖痒为虚。先时邪盛则痛，今邪去则虚，虚则痒，邪去则痂。若痈疽初发便痒，是邪盛正虚也。
上有绝阳之络，下有破阴之纽，皆是气虚不能缉续故也，补之所以辑续之耳。但正气一虚，邪火便盛，又谷气不得升举，壅而为热。又气虚不续，而有留气，为喘、为满、为痛，往往见有余之证，令人异首畏尾，而不敢径行施补，迁延就毙者有之。
肺出气，肾纳气，所谓一呼天根，一吸地穴，循环无端，应刻而不疾徐者也。此气一虚，则断而不续，或短气不足以息，或壅而为满，虽云气不归原，其实只是气虚也。若阴虚阳无所附，上见喘满，此则真是气不归元耳。
言而微，终日乃复言者，此夺气也。湿家短气，声如从瓮中出，此气为湿所持而然，然则有形之伤，悉能令气短，不能定以为夺气也。
诸痛皆主于气滞，但气滞之由，有虚有实，不得专主疏刷。
脚肿无非湿热，盖浊邪下先受之也。膏粱厚味之人，由湿热下流，田野耕凿之人，由寒湿外侵，是为实邪。中气素馁，土虚不能制湿之人，是为虚邪。二者虽有虚实之不同，然皆本于湿，唯是一种。形瘦多热，年老阴虚者，每至日午脚面浮肿，此何以故?予尝思之，阴虚而至暮年，阴愈虚矣。虚极之阴，便不能吸气归原，而升举其阴，于是阳独浮于上，阴独沉于下，而脚至暮浮肿也。
汗多亡阳，下多亡阴，言阳主外阴主内也。然岂无辛热而损盖覆之阴，岂无苦寒而伤闭蛰之阳?必以见证何等而参之以脉，方为不误。
刘澹庵曰：汗多亡卫外之阳，下多亡主内之阴，二者应之速。汗，不过一汗再汗；下，不过一下再下，而遂亡阳亡阴。辛热损阴，苦寒伤阳，则有渐积使然。
医津一筏
（又名《内经释要》）
歙县 江之兰 含征 著
和县 高思潜 考正
吴县 张炳翔 叔鹏校录
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治病必求其本
脾脏喜欢干燥，若受寒湿所伤，则无法消化水谷，适宜用白术、附子来温燥脾土。然而，若是脾阴不足导致食物也无法消化，又不可以用温燥的方法治疗。
有因思虑过度损伤脾气，脾气虚弱不能统摄血液而导致便血的情况；有因思虑过度损伤脾气，脾气虚弱不能运化食物而导致腹泻的情况。这些情况都应以顾护中焦脾胃之气为根本，不要只治疗其表象。
有肺气虚弱不能统摄卫气与血液，导致血液溢出妄行，随着气息从鼻腔流出成为鼻衄（鼻出血）。如气机动于右侧，发汗反而导致鼻衄加重，就是这种情况。脾气虚弱不能将津液输送至三阴经，胃气虚弱不能将气输送至三阳经，正气日益衰弱，脉道运行不畅，血液全都积滞在中焦，此时若想消除瘀血，应当用人参、黄芪来监制攻逐药物，以防伤正。
怀孕数月后，突然下血不止，若有癥瘕（腹内结块）为害，应当攻下癥瘕，胎儿才能安稳。如果不知道这个道理，只是一味地养血安胎，这等于是在为癥瘈树立旗帜（助长邪气），胎儿怎么能安稳呢？
刘澹庵说：攻下癥瘕以安胎，必须使用峻猛的驱逐药剂，这就是“有故无殒”（有病则病受之，不伤人体）的道理。然而，如果不辨别虚实而施用，恐怕不是固定的法则。
火气上逆，是肝肾之阴失去了龙雷之火潜藏伏匿的习性而上逆所致。至于胃中湿热下流，又是邪气乘袭肝木，导致阴气反而走上，使得上焦阳气不能伸展，肺主治节的职能不能行使，所以出现鼻塞、胸满、涎液溢出、恶寒战栗等症状。又有咳嗽烦闷，这是肾气上逆的表现，其上逆的原因，也有虚和实两种区别。推究此理，治疗痰证没有比降火更重要的了，而降火的方法，也必须识别这两种虚实区别。另外，《平脉法》说：少阴脉不至，肾气微弱，精血亏少，奔豚之气迫促，向上冲入胸膈。所谓少阴脉不至，是先天元阴元阳受到了损伤。肾属于先天，脾胃属于后天。先天既然已经受伤，就不能滋生后天，所以脾胃的阴阳也受损，不能运化水谷而产生湿热，热向下流则膀胱的气化功能不行，浊气因此向上侵入，浊气上侵，肺气就会壅塞，脾气更加停滞，于是形成痰饮，腹胀食滞的症状就出现了。少阳生发之气郁结而不能上升，导致周身刺痛，呕吐逆酸。心主之阳被浊阴所乘，就会出现心悸怔忡。这是一脏肾脏生病，而五脏六腑都不安宁，所以养生没有比节制欲望更好的了。如果不懂这个道理，只是用化痰利气的方法治疗，那么化痰会伤阴，利气会伤阳，岂不是让自己陷入困境吗？这又是专门针对肾虚而言的。
心肾不足，小便浑浊，中气不足，大小二便就会发生变化；金（肺）衰则水（肾）涸，尿液颜色变为黄赤。这些都是正气虚弱而生邪热，应当推究本源进行补益，如果仅仅执着于“诸液浑浊皆属于火”这一句话而施治，病怎么能痊愈呢？
饮食劳倦损伤脾胃，起初感受热中（内热），后来传变为寒中（内寒），要知道最初感受的热，是因为谷气不能升举，壅滞而成热，这种热与元气是不两立的，并非实热。所以在初感之时，就已经说要“劳者温之，损者温之”了。病情久了，怎么会不变成寒中呢？李东垣说冲任之火传入督脉，督脉挟带太阳寒气逆克丙火（小肠/胆），似乎失之牵强。
母子之情牵连，仇敌肆虐，或者胜克乘薄（五行相乘相侮）各不相同，又有本脏本脉的区别，有的侵犯他脏他脉，一脏生病往往夹杂他脏的症状而出现。
邪气聚集的地方，正气必定虚弱。邪气乘虚而入，这是虚为本、邪为标，所以祛邪不可不加上扶正，这是一个注脚，人们都是同意的。然而也有身体壮盛的人，突然遭受邪气，如外感风寒、内伤饮食之类，本气未必都虚，患病之后，反而显现出虚象，如营卫受邪，则屈伸不利，动作乏力；脾胃受邪，则四肢无力，厌恶饮食、呕吐腹泻等。这是邪气既已聚集之后，正气也必然虚弱，这是因邪气而显现出的虚，邪为本、虚为标，这时只应当急切地去邪，正气自然恢复，不必顾虑其虚，用药牵制，这是我独有的见解。
治病应当知道标本。然而还不可不知标中之标，本中之本，如脾胃虚弱而生湿热，虚是本，湿热是标。至于湿热下流导致膀胱气化不利，湿热是标，气化不利是标中之标。至于气化不利逆行而上，咽喉阻塞、气喘逆上，又是标中标之标。推究此理逆向寻求，那么本中之本也可以得到了。
阳气旺盛能生阴，气不足也会让人口干而津液不通。
喘促且短气，必须辨别寒热虚实，分类治疗。至于哮证，则是素有的痰火，被风寒束缚而发作，只看病人的强弱，用药轻重即可。
肺是金寒水冷之脏，然而既然已经因为汗、吐、下法损伤津液而成了肺痿，难道清凉的药物能恢复其津液吗？这是仲景竟然使用桂枝人参姜枣汤，值得详细研究的地方。
火与痰，原本就是气与津液，无病时就是气与津液，有病时就变成了火与痰。然而致病的原因，不过是内伤外感，有余和不足罢了。探求其本源进行治疗，那么痰消火灭，所以说“见痰莫治痰，见热莫治热”就是这个道理。
内伤外感都能导致虚劳，如果不察辨虚实，只施用养阴清热的套方，那么虚的人未必受补，而实的人会更实。
失血证毕竟属于热的多，但世上有用寒凉药反而加重的案例，大概因为有气虚之火，有血虚之火罢了。冲气上逆，有上焦阳不足而阴气上冲的，有下焦阴不足而阴火上逆的，有脾胃湿热下流而肝肾之气不能固守于下的，都挟带冲脉的缘故。
邪火在内炽盛，阳事反而痿软，用苦寒药泻火，阳事反而勃起，这是因为火与真阳势不两立，像世人用助火的药剂，希望挽回真阳，不仅无益，反而有害。
所谓虚风，像是风又不是风。然而也有阴阳的区别，阴虚生热则生风，阳虚是阳气不能卫护体表。
卫气属阳，阳虚不能卫外，所以中风。风是阳邪，同类相召的缘故。但风是阳邪，一旦中之后，往往多显现阳热的症状，这不可不推求其受病的本源，务必从事于治疗疾病的表象。各种病都治其本，唯独中满（脘腹胀满）与大小便不利当治其标，因为证候危急，无暇顾及根本。我认为如果是实证，不难通过消导、通利来治标。如果涉及虚证，这种方法可行吗？仍应当治本。
东方（肝）常实，有泻无补，这种说法有两点原因。一是肝为将军之官，其性刚劲急速；二是木火同居，风借火势，火助风威，都不能助长其亢盛。如果说根本，则乙癸同源（肝肾同源），养血与滋阴同样紧急。
癫、狂、痫都以痰为主。癫是虚而致痰；狂是实而致痰；痫是风而致痰。虚实风是本，痰是标。
痰在肺叫燥痰，又叫气痰，因为肺为燥金而主气。燥是本，气是标，其痰涩滞难出，表现为证候。往往胸膈阻塞，关节不利，不知情的人用辛香燥热药利气，燥的更燥，气更不利。
肺虚咳嗽是怎么回事？是失去了肃降下行的命令。只降其气，咳嗽会更频繁。
黄昏时咳嗽多的，是火气浮于肺，这是阴虚之火，所以宜用五味子收敛并降气。
各种痿证、喘证、呕证都归属于上焦，上焦指肺，不能用香燥药利气。
湿胜则濡泄（大便稀溏），应当用燥剂治疗，然而违背秋气则会伤肺，冬天发生飧泄（完谷不化的腹泻），这是肺移热于大肠的病。如果用温燥药治疗，是增加病情。
口渴固多因热，然而内外伤感都能令津液不行，而口渴必须探求其自身原因。
三阴结是水之本，至于肺气不利，发为浮肿、喘嗽、口干、小便涩、腹满、黄汗、身重不能转侧、阴肿。阴湿则是水之标。
寒邪在表，郁热在经络而令咳血、衄血，解表自愈，麻黄汤、杏子汤就是这类方剂。心肺有疾而鼻子不通利，不一定专主于风寒。
治病必求其本。本者，下为本，内为本。所以上热下寒，只要温其寒而热自降，表寒里热只要清其热而寒自止，然而须加入反佐药，以免格拒。至于先伤于风而后伤于寒，先伤于暑而后伤于湿之类，又应当观察其轻重缓急而施治。
有的病要探究其无（无形之气），无的病要探究其有（有形之质），盛的病责其虚，虚的病责其盛。
四肢无力，动作衰乏，是虚证。然而邪气客于营卫，则出入之道废弛，中焦有阻滞，则升降之机穷尽，也能见证如此，所以说“无者求之”。
各种疼痛不可补，是说气逆滞涩。虽然壮年人气行则愈，体弱之人着邪而成病，真气虚乏之人，各种邪气易于留着，留着则气逆，气逆则痛。疏刷（疏通清理）之中不可没有补养之品，徒恃攻击，则正气更虚，不能送邪外出，邪气更留着而疼痛无休止。遇到这种病，攻补兼施而不愈，遂宜屏弃一切，关键又在断绝厚味，远离房事，使邪气无所助，而正气日胜，然后辅以疏刷，击其惰归，病无不愈。但邪气正炽盛，病人正在呻吟痛苦之时，医生教他以这样做，就像子舆氏教滕君以强行善一样，很少有不认为迂阔而不切实际的。又如脾胃亡失津液，焦燥如割，宜用真生地黄汤。脉象阳涩阴弦而腹中急痛，当用小建中汤。肝气不足，两胁下满筋急，不能太息，四肢厥冷，发呛，心腹痛，目不明了，爪甲枯青，宜用补肝汤。房劳过度，肾虚羸怯之人，胸膈间多隐隐痛，这是肾虚不能约束气，气虚不能生血的缘故，气血俱虚则凝滞而作痛，宜用破故纸之类温肾，芎归之类养血。又有胸痹痛，有真阴虚而导致的，有元阳虚地气上干而导致的，头痛有气虚的，有血虚的，有肾虚的，都不可不补（苄，即地黄）。
妇人因生产，去血过多，腹中急痛，是肝木无血以滋养，宜用当归建中汤，这也是痛而应补的情况。
妇人居经（月经停止），血弱气盛，孤阳独呼阴，不能吸阴，为积寒。阳聚为热，所以时常发作洒淅（恶寒）、咽燥、汗出，或小便稠数多，唾涎沫，其脉右浮大左弱涩，这应当养其血，所见之证不要计较。
证象白虎（大热、大汗、大渴、脉洪大），误服白虎汤必死，说的是治疗假象要用真法。
寒邪闭塞营卫，应当用升发药散之。然而素有痰热的人，遇到这种升发药，痰随气上，闭住肺气，皮毛为之壅遏，邪气更不得泄，病反而增剧，又应当用苦泄药。
心火不得越则郁于小肠，肺气不得泄则郁于大肠，小肠下口即大肠上口，所以奔迫无度，里急后重而成滞下（痢疾），这是风寒内缩使然。只责备于湿热，未能万举万当，所以治痢亦当与治疟一样，半表半里同法。
食积痰留舍肠胃之间，气行则出，有似鱼脑，间以血丝，闭气滑肠，状如痢，利反快，不可作痢疾治。
热则生风，痿痹不随，而有风象，医生以风治之恐不免致痿。
便泄肛门热有火热和阳陷两端。
先天者，是无形的虚神而已。后天者，是有形的实则气血也。治先天当以神治神，治后天当以形益形。但神虚则气血不生，神乱则气血不宁，气血虚则神无以养，气血乱则神为之迁，这又应当斟酌处理。
张汉瓿说：气血即神之窟宅，不治气血何由治神？以神治神立论，如此尚须着落耳。我常说谈医之道不可一语模糊，令人徒作天际真人想。
天地阴阳，停匀方不崩不拆，人也一样。禀赋之后，嗜欲不节，起居无时，七情六淫所伤，此阴阳有所偏损则偏胜，所以见以为有余而实。有余但治其偏损者，而有余自平。
形气有余，病气有余，泻之可也。形气不足，气病。气不足，补之可也。至于形气有余，病气不足，形气不足，病气有余，当责有无真假。李东垣说：但补泻病气之有余不足，不必顾其形气之有余不足，似乎不是确论。
儿科大便黄赤，属热是对的，其青白也不可专以为寒。水谷入胃，入大小肠，肠胃无邪，则水谷依次转化，清入营卫化精微，浊者下广肠成糟粕，粪为之变。设肠胃有寒，水谷不得热腐，故下利清白，完谷不化。然肠胃有热，水谷不得停留，亦下利清白，完谷不化，不得专以为寒。
肾为先天之本，脾为后天之本固然正确。然而肺金不足，或不得其平，也不能生水。心火不足，或不得其平，也不能生土，只责备脾肾无益，所以病也有治标而得的。百病不离乎火。火者，天地所有之气，也是吾身所有之气。从外入者，是天地亢害之气，吾身中以类相感召，也令此气为之亢害。这伤暑受热是对的。至于七情，以及风寒燥湿动乱为火者，因为火喜条达而恶遏抑，现在以七情及风寒燥湿抑遏之，动乱为害，然而发之、泻之、制之、克之即可。等到相火，其体藏于右肾之中，所以配左尺之水，使此水得以彻于上下，周于四表，充肤泽毛，若雾露之溉，虽水为之，实火为之也。假设阴虚，此火失去其窟宅，游行于四肢百骸，五脏六腑之间，而为大患。阳虚则此火无根而脱出，为患亦然。这不可以湿折水灭，唯当相其人之阴虚阳虚而补养之。独是体虚之人，易于受邪，或内外伤感，抑遏成火，则补虚之中，不可无泻实之药，如六味地黄丸加黄柏知母等方就是。审此则用药不难中肯綮矣。
张永孚说：相火禀命于命门。真水，先天水火原属同宫，水以火为主，以水为原。下论曰：假设阴虚此，火失其窟宅，阴虚即水亏火脱出即阳虚，岂六味加知柏反可平之者耶？
各种疮疡将结痂时，必极痒，盖痒为虚。先前邪盛则痛，现在邪去则虚，虚则痒，邪去则痂。若痈疽初发便痒，是邪盛正虚。
上有绝阳之络，下有破阴之纽，皆是气虚不能缉续故也，补之所以辑续之耳。但正气一虚，邪火便盛，又谷气不得升举，壅而为热。又气虚不续，而有留气，为喘、为满、为痛，往往见有余之证，令人畏首畏尾，而不敢径行施补，迁延就毙者有之。
肺出气，肾纳气，所谓一呼天根，一吸地穴，循环无端，应刻而不疾徐者也。此气一虚，则断而不续，或短气不足以息，或壅而为满，虽云气不归原，其实只是气虚也。若阴虚阳无所附，上见喘满，这则真是气不归元耳。
说话声音细微，终日才再说一次，这是夺气。湿家短气，声如从瓮中出，这是气为湿所持而然，然而则有形之伤，悉能令气短，不能定以为夺气。
各种疼痛都主于气滞，但气滞的原因，有虚有实，不得专主疏刷。
脚肿无非湿热，盖浊邪下先受之也。膏粱厚味之人，由湿热下流，田野耕凿之人，由寒湿外侵，是为实邪。中气素馁，土虚不能制湿之人，是为虚邪。二者虽有虚实之不同，然皆本于湿，唯是一种。形瘦多热，年老阴虚者，每至日午脚面浮肿，这何以故？我曾思考过，阴虚而至暮年，阴愈虚矣。虚极之阴，便不能吸气归原，而升举其阴，于是阳独浮于上，阴独沉于下，而脚至暮浮肿也。
汗多亡阳，下多亡阴，言阳主外阴主内也。然而岂无辛热而损盖覆之阴，岂无苦寒而伤闭蛰之阳？必须以见证何等而参之以脉，方为不误。
刘澹庵说：汗多亡卫外之阳，下多亡主内之阴，二者应之速。汗，不过一汗再汗；下，不过一下再下，而遂亡阳亡阴。辛热损阴，苦寒伤阳，则有渐积使然。
Yi Jin Yi Fa (A Raft Across the Medical River)
(Also known as *Jing Nei Shi Yao* / Essential Interpretation of the Inner Canon)
Authored by Jiang Zhi Lan (Han Zheng) of She County
Corrected by Gao Si Qian of He County
Proofread and Recorded by Zhang Bing Xiang (Shu Peng) of Wu County
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In Treating Disease, One Must Seek the Root
The Spleen favors dryness; when injured by Cold-Dampness, it cannot digest food and fluids. It is appropriate to use Bai Zhu (Atractylodis Rhizoma) and Fu Zi (Aconiti Lateralis Radix Praeparata) to warm and dry it. However, if Spleen Yin deficiency leads to indigestion, one must not treat it with warming and drying methods.
There are cases where excessive worry injures the Spleen Qi, causing Spleen deficiency that fails to control blood, resulting in hematochezia (blood in stool); there are cases where excessive worry injures the Spleen Qi, causing Spleen deficiency that fails to transform food, resulting in diarrhea. In all these cases, the root lies in protecting the Middle Jiao Qi; do not merely treat the branch symptoms.
There are cases of Lung Qi deficiency failing to control Wei Qi and blood, leading to blood overflowing and flowing out of the nose as epistaxis (nosebleed). For instance, if the moving Qi is on the right, sweating may worsen the epistaxis. When Spleen Qi is deficient and cannot transport fluids to the Three Yin meridians, and Stomach Qi is deficient and cannot transport Qi to the Three Yang meridians, healthy Qi declines daily, and the pulse channels become obstructed, causing blood to accumulate centrally. If one attempts to eliminate stasis in such a condition, one must use Ren Shen (Ginseng Radix et Rhizoma) and Huang Qi (Astragali Radix) to monitor and moderate the purgative actions, preventing damage to healthy Qi.
If a woman pregnant for several months suddenly experiences continuous bleeding due to an existing mass (Zheng Gu), the mass must be expelled to stabilize the fetus. If this principle is ignored and one merely employs blood-nourishing and fetal-calming methods, it essentially supports the pathogenic mass, making fetal stabilization impossible.
Liu Dan An stated: Expelling masses to calm the fetus requires potent purgative agents; this follows the principle of "You Gu Wu Yun" (When there is a disease, there is no injury [to the healthy body]). However, applying this without distinguishing between deficiency and excess is not a fixed rule.
Upward rebellion of Fire Qi results from Liver and Kidney Yin failing to maintain the latent nature of Dragon and Tiger Fire. Conversely, Damp-Heat in the Stomach flowing downward occurs when pathogenic Qi attacks Wood, causing Yin Qi to move upward abnormally. This prevents Upper Jiao Yang from extending and impairs the Lung's regulatory function, leading to nasal congestion, chest fullness, salivation, aversion to cold, and shivering. Cough and irritability indicate Kidney Qi rebellion; the causes of this rebellion also differ between deficiency and excess. Therefore, treating Phlegm prioritizes descending Fire. The method of descending Fire must also distinguish between these two types of deficiency and excess. Furthermore, *Ping Mai* states: "When the Shaoyin pulse is absent, Kidney Qi is weak, Jing-Blood is scant, and rushing Qi presses urgently, entering the chest and diaphragm." Absence of the Shaoyin pulse indicates injury to primordial Yuan Yin and Yuan Yang. The Kidney is congenital (Pre-Heaven); the Spleen and Stomach are acquired (Post-Heaven). Once the Pre-Heaven is injured, it cannot generate the Post-Heaven, so Spleen and Stomach Yin-Yang are damaged, failing to transform food and fluids, generating Damp-Heat. Heat flowing downward impairs Bladder Qi transformation, allowing turbid Qi to ascend. Ascending turbid Qi congests the Lung and stagnates the Spleen, forming Phlegm and Fluid retention, manifesting as abdominal distension and food stagnation. Depressed Shao Yang ascending Qi fails to rise, causing stabbing pain throughout the body and vomiting of sour fluid. When turbid Yin overcomes Heart Yang, palpitations and fright occur. Thus, a disease in one organ (Kidney) disturbs all five zang and six fu organs. Hence, nothing is better for health preservation than restraining desires. If one ignores this and treats only with phlegm-resolving and Qi-moving methods, resolving phlegm damages Yin, and moving Qi damages Yang, leading to distress. This specifically addresses Kidney deficiency.
Deficiency of Heart and Kidney causes turbid urine; deficiency of Middle Qi causes changes in urination and defecation; Metal (Lung) deficiency leads to Water (Kidney) depletion, turning urine yellow-red. These are all caused by healthy Qi deficiency generating pathogenic heat. One must trace the root and tonify. If one blindly adheres to the saying "all turbid fluids belong to Fire" and treats accordingly, the disease will not heal.
Dietary irregularities and fatigue injure the Spleen and Stomach, initially presenting as Heat Zhong (Internal Heat), later transmitting to Cold Zhong (Internal Cold). The initial heat arises because Grain Qi cannot ascend, stagnating to form heat. This heat opposes Yuan Qi and is not Excess Heat. Thus, at the onset, the principle "Fatigue requires warming, loss requires warming" applies. How can a prolonged illness not become Cold Zhong? Li Dongyuan claimed that Fire from Chong and Ren meridians transmits to the Du Meridian, which carries Taiyang Cold Qi to counteract Bing Fire (Small Intestine/Gallbladder); this seems far-fetched.
Emotional attachments and enmities, or various interactions of overcoming and insulting (Five Elements theory), along with distinctions within the primary organ and pulse, may affect other organs and pulses. A disease in one organ often presents with symptoms involving others.
Where pathogenic Qi gathers, Healthy Qi must be deficient. Pathogenic Qi enters through deficiency; thus, deficiency is the root, and pathogen is the branch. Therefore, eliminating pathogens must include nourishing healthy Qi. This is a common understanding. However, robust individuals suffering sudden pathogenic invasion (e.g., external Wind-Cold, internal dietary injury) may not have inherent deficiency. After illness, they may appear deficient: Ying-Wei invasion causes stiffness and weakness; Spleen-Stomach invasion causes limb weakness, anorexia, vomiting, and diarrhea. Here, deficiency appears due to the pathogen; the pathogen is the root, and apparent deficiency is the branch. At this stage, one should urgently eliminate the pathogen, and Healthy Qi will recover naturally, without worrying about deficiency or using restrictive medications. This is my unique perspective.
Treating disease requires knowing the root and branch. Yet, one must also know the branch within the branch, and the root within the root. For example, Spleen-Stomach deficiency generating Damp-Heat: deficiency is the root, Damp-Heat is the branch. Damp-Heat flowing downward impairing Bladder Qi transformation: Damp-Heat is the branch, impaired Qi transformation is the branch within the branch. Impaired Qi transformation reversing upward causing throat obstruction and asthma: this is the branch within the branch within the branch. By tracing this backward, the root within the root can be found.
Abundant Yang generates Yin; insufficient Qi causes dry mouth and blocked fluids.
Asthma with shortness of breath requires differentiation of Cold, Heat, Deficiency, and Excess for treatment. Asthma (Xiao) involves pre-existing Phlegm-Fire constrained by Wind-Cold; treatment depends on the patient's strength, adjusting dosage accordingly.
The Lung is a cold metal and cold water organ. However, if Lung Wei (Flaccidity) has formed due to sweat, vomit, or purge damaging fluids, can cooling herbs restore them? This explains why Zhang Zhongjing used Gui Zhi Tang (Cinnamon Twig Decoction), Ren Shen, Ginger, and Jujube, warranting detailed study.
Fire and Phlegm are originally Qi and Body Fluids. Without disease, they are Qi and Fluids; with disease, they become Fire and Phlegm. Causes are limited to internal injury, external contraction, excess, or deficiency. Treating the root eliminates Phlegm and Fire. Hence, "Do not treat Phlegm when seeing Phlegm; do not treat Heat when seeing Heat."
Both internal injuries and external contractions can lead to Consumption (Lao). If deficiency and excess are not distinguished, and generic Yin-nourishing and Heat-clearing formulas are used, the deficient may not tolerate tonification, while the excess will become more excessive.
Hemorrhage is mostly Heat-related, yet cold-cooling herbs sometimes worsen it due to Qi-deficiency Fire and Blood-deficiency Fire. Rebellion of Chong Qi includes: Upper Jiao Yang insufficiency allowing Yin to rise; Lower Jiao Yin insufficiency allowing Yin Fire to rebel; Spleen-Stomach Damp-Heat flowing down while Liver-Kidney Qi fails to secure below. All involve the Chong Mai (Penetrating Vessel).
Intense internal pathogenic Fire may cause impotence. Bitter-cold purgatives clear Fire, restoring erection, because Fire and True Yang cannot coexist. Using fire-assisting herbs to restore True Yang is futile and harmful.
"Deficient Wind" resembles wind but is not wind. It has Yin and Yang distinctions: Yin deficiency generates Heat producing Wind; Yang deficiency means Yang Qi cannot defend the exterior.
Wei Qi belongs to Yang; Yang deficiency fails to defend the exterior, leading to Wind Stroke. Wind is a Yang pathogen, attracting similar energies. After invasion, Yang-Heat symptoms often appear. One must investigate the root while treating the branch. Generally, diseases are treated by the root, except for Fullness (Man) and difficulty in urination/defecation, which require branch treatment due to urgency. If Excess, clearing and draining the branch suffices. If Deficiency, the root must still be treated.
The East (Liver) is often Excess, treated by purging rather than tonifying. Reasons: 1. Liver is the General, rigid and rapid; 2. Wood and Fire reside together; Wind aids Fire, Fire empowers Wind. Neither should be supported. Fundamentally, Yi and Gui (Liver and Kidney) share the same source; nourishing Blood and Yin is urgent.
Mania, Madness, and Epilepsy are primarily Phlegm-based. Madness stems from Deficiency producing Phlegm; Mania from Excess producing Phlegm; Epilepsy from Wind producing Phlegm. Wind/Excess/Deficiency is the root; Phlegm is the branch.
Phlegm in the Lung is called Dry Phlegm or Qi Phlegm, as Lung is Dry Metal governing Qi. Dryness is the root, Qi movement is the branch; Phlegm is sticky and hard to expectorate, causing chest oppression and joint stiffness. Misusing pungent-aromatic-dry-hot Qi-moving herbs increases dryness and Qi stagnation.
Why does Lung Deficiency cause cough? Loss of descending function. Merely descending Qi worsens cough.
Evening cough indicates Floating Fire in the Lung (Yin Deficiency Fire); Wu Wei Zi (Schisandrae Fructus) should be used to astringe and descend.
Flaccidity, Asthma, and Vomiting all relate to the Upper Jiao (Lung). Do not use aromatic-dry Qi-moving herbs.
Excess Dampness causes loose stools; treat with drying agents. However, violating Autumn Qi injures the Lung, causing winter diarrhea (Sun Xie), indicating Lung Heat transferring to Large Intestine. Warming-drying herbs would worsen this.
Thirst is mostly Heat, but internal/external injuries can block fluids. Thirst requires investigating its specific cause.
Three Yin Knotting is the root of Water. Lung Qi impairment causes edema, asthma, dry mouth, dysuria, abdominal fullness, yellow sweat, heaviness, inability to turn, and genital swelling. Yin-Dampness is the branch of Water.
Cold pathogen at the branch,郁热 (stagnant heat) in meridians causes hemoptysis and epistaxis. Releasing the exterior cures it naturally, e.g., Ma Huang Tang (Ephedra Decoction) or Xing Zi Tang (Apricot Seed Decoction). Nasal obstruction due to Heart-Lung issues is not solely Wind-Cold.
Treating disease seeks the root. Root refers to lower and interior. Upper Heat/Lower Cold: warm the Cold, and Heat descends. Exterior Cold/Internal Heat: clear the Heat, and Cold resolves. Use counter-agent herbs to avoid rejection. For sequential invasions (Wind then Cold, Summerheat then Dampness), treat according to severity and urgency.
"Seek the non-existent in the existent; seek the existent in the non-existent; blame excess for deficiency; blame deficiency for excess."
Limb weakness and fatigue indicate Deficiency. However, pathogen in Ying-Wei blocks entry/exit; obstruction in Middle Jiao halts ascent/descent, mimicking Deficiency. Hence, "seek the non-existent."
"Pain is never tonified," referring to Qi rebellion and stagnation. Strong people recover as Qi moves; weak people suffer lingering disease. Those with deficient True Qi easily retain pathogens, causing rebellion and pain. Tonification must accompany clearing. Pure attack depletes Qi, trapping pathogens and prolonging pain. If attack and tonification fail, abandon all treatments, cut rich foods, abstain from sex, let Healthy Qi prevail, then assist with clearing. But during acute agony, advising this is impractical. For Spleen-Stomach fluid loss with burning pain, use Zhen Sheng Di Huang Tang (True Raw Rehmannia Decoction). For wiry-choppy pulse with acute abdominal pain, use Xiao Jian Zhong Tang (Minor Construct the Middle Decoction). For Liver Qi deficiency with hypochondriac fullness, tendon tension, sighing, cold limbs, choking, heart/abdominal pain, blurred vision, and dry blue nails, use Bu Gan Tang (Tonify Liver Decoction). For post-coital Kidney deficiency with chest pain due to Qi/Blood stagnation, use Gu Zhi (Psoraleae Fructus) to warm Kidney and Xiong Gui (Angelicae Sinensis Radix + Ligustici Chuanxiong Rhizoma) to nourish Blood. For Chest Bi pain due to True Yin/Yang deficiency, or headache due to Qi/Blood/Kidney deficiency, tonification is necessary.
Postpartum blood loss causing abdominal pain indicates Liver Wood lacking Blood nourishment; use Dang Gui Jian Zhong Tang (Angelica Tonify the Middle Decoction).
Menopause with weak Blood and strong Qi, isolated Yang calling without Yin absorption, causes accumulated Cold. Yang aggregation creates Heat, causing chills, dry throat, sweating, or frequent thick urine and saliva. Right pulse floating-large, left pulse weak-choppy. Nourish Blood; ignore symptoms.
Symptoms resembling Bai Hu Tang syndrome (White Tiger Syndrome): misusing Bai Hu Tang is fatal. Treat false appearances with true methods.
Cold blocking Ying-Wei requires ascending/dispersing herbs. However, in patients with pre-existing Phlegm-Heat, these herbs raise Phlegm, blocking Lung Qi and skin pores, worsening the condition. Use bitter-draining herbs instead.
Heart Fire trapped in Small Intestine; Lung Qi trapped in Large Intestine. Since Small Intestine outlet is Large Intestine inlet, urgency and tenesmus (Dysentery) result from internal contraction of Wind-Cold. Blaming only Damp-Heat is insufficient. Dysentery treatment parallels Malaria (Half-Exterior/Half-Interior).
Food stagnation and Phlegm in intestines, exiting with Qi like fish brains mixed with blood strands, causing gas and slippery bowels resembling dysentery but feeling better after evacuation, should not be treated as dysentery.
Heat generating Wind causes flaccidity and numbness with Wind-like symptoms. Treating as Wind may worsen flaccidity.
Diarrhea with anal heat stems from either Fire Heat or Yang sinking.
Pre-Heaven is formless Spirit; Post-Heaven is substantial Qi and Blood. Treat Pre-Heaven with Spirit; treat Post-Heaven with Substance. Spirit deficiency hinders Qi/Blood generation; Spirit chaos disrupts Qi/Blood peace. Qi/Blood deficiency starves Spirit; Qi/Blood chaos displaces Spirit. Balance is key.
Zhang Han Bu said: Qi and Blood are the dwelling of Spirit; how to treat Spirit without treating Qi and Blood? The theory of "treating Spirit with Spirit" needs grounding. Medical discourse must not be vague.
Heaven and Earth Yin-Yang must be balanced. Imbalance from lifestyle and emotions causes excess/deficiency. Treat the imbalance, and excess resolves.
If Form/Qi and Pathogen are both Excess, purge. If Form/Qi is Deficient and Pathogen is Excess, tonify. If Form/Qi is Excess but Pathogen is Deficient, or vice versa, discern truth/falsehood. Li Dongyuan's claim to treat only Pathogen excess/deficiency ignoring Form/Qi is questionable.
Pediatric yellow-red stool indicates Heat; green-white stool is not exclusively Cold. Normal digestion transforms clear essence to Ying-Wei and turbid waste to feces. Cold intestines cause undigested white stool; Heat intestines cause rapid transit of undigested white stool. Do not assume Cold exclusively.
Kidney is Pre-Heaven root; Spleen is Post-Heaven root. However, Lung Metal deficiency fails to generate Water; Heart Fire deficiency fails to generate Earth. Blaming only Spleen/Kidney is useless. Some diseases are cured by treating the branch. All diseases relate to Fire. Fire is Heaven/Earth Qi and Body Qi. External Fire comes from Heaven/Earth excess; internal Fire resonates. Summerheat/Heat injury fits this. Seven Emotions and Wind/Cold/Damp/Dry also generate Fire by suppressing its free flow. Release, drain, control, or overcome it. Ministerial Fire resides in Right Kidney, pairing with Left Chi Water, circulating throughout the body. Yin deficiency loses Fire's home, causing widespread harm. Yang deficiency loses Fire's root, causing similar harm. Do not extinguish with dampness; tonify Yin/Yang based on diagnosis. For deficient bodies prone to external/internal injury causing suppressed Fire, combine tonification with purging (e.g., Liu Wei Di Huang Wan plus Huang Bai and Zhi Mu).
Zhang Yong Fu said: Ministerial Fire receives orders from Ming Men. True Water and Fire originate together. If Yin deficiency causes Fire to lose its home, it implies Water deficit and Fire escape (Yang deficiency). Can Liu Wei plus Zhi Bai balance this?
Sores itching before scabbing indicate Deficiency. Earlier pain indicated Excess Pathogen; now itching indicates Deficiency after Pathogen leaves. Early itching in carbuncles indicates Excess Pathogen and Deficient Healthy Qi.
Upper severed Yang collaterals and lower broken Yin knots result from Qi deficiency failing to connect. Tonification reconnects them. Qi deficiency allows Pathogenic Fire to flourish and Grain Qi to stagnate as Heat. Unconnected Qi causes lingering Qi, leading to asthma, fullness, and pain, appearing as Excess. Fear of tonification delays treatment. Lung exhales, Kidney inhales. Qi deficiency causes disconnection, shortness of breath, or fullness. "Qi not returning to origin" is actually Qi deficiency. If Yin deficiency leaves Yang unattached, causing upper asthma/fullness, this is true Qi not returning to origin.
Faint speech resuming after a day indicates Qi deprivation. Dampness patients have short breath with muffled voice due to Qi held by Dampness. Physical injury also causes short breath, not just Qi deprivation.
All pain relates to Qi stagnation, which can be Deficient or Excess. Do not solely rely on clearing.
Leg edema is mostly Damp-Heat (turbid pathogen sinking). Rich diet causes Damp-Heat sinking; manual labor causes Cold-Damp invasion (Excess). Weak Middle Qi/Spleen deficiency causes Dampness retention (Deficiency). Both stem from Dampness. Thin, elderly Yin-deficient people have afternoon leg edema because extreme Yin deficiency fails to absorb Qi to origin and lift Yin, leaving Yang floating up and Yin sinking down.
Excessive sweating destroys Yang; excessive purging destroys Yin. Yang governs exterior, Yin governs interior. Pungent-hot herbs damage covering Yin; bitter-cold herbs damage closing Yang. Diagnosis must match pulse and symptoms.
Liu Dan An said: Sweating destroys exterior-protecting Yang; purging destroys interior-governing Yin. Effects are rapid. Pungent-hot herbs gradually damage Yin; bitter-cold herbs gradually damage Yang.