《金匮》论饮，重在阳衰，治法重在逐水。逐水之法贵因势利导，或使之外出从汗解，或使之内泄而从利解，无多歧也。其中浅深表里之别，大要以身之胸中为里之表，肌肉为表之表，脏腑为里之里。表之表者皆可发汗，里之表者皆可利小便，里之里者皆可利大便。发汗以身重疼痛四字为关键。利小便以支满眩冒四字为关键。利小便以辣坚满痛四字为关键。见证虽错出不一，立主方虽轻重有殊，然能握此意为治饮心法，已恢恢乎游刃有余矣。
治饮证无吐补法论
探吐之法本之仲景，独至饮症二十余条未有一语论及，后人以痰赅饮，遂各以吐法争长，贻害于人，至今尤烈。不知痰由内生，风火所成，其质胶黏，其性炎上，故痰有吐法，饮由外之寒冷所蓄，其性润下，其质濡柔，故饮无吐法。况水饮上出为逆，下趋为顺，故仲景施治，但分浅深远近，使由地中行耳。其浅者、近者，用青龙、苓桂术甘泽等汤，如疏瀹决排，使之注江注海而会归有所。其深者、远者，用甘遂、半夏、十枣、厚朴、大黄、葶苈泻肺等汤，如开导昆仑，通调星宿，使流远而源清。后之学者昧于至理，不辨为饮为痰，辄行吐法，致冲胃之气上逆，胸中之阳大伤，目眩神昏，饮仍不出，中气一馁，反逼处一团，为害益甚。间有明哲之士，不行吐法，又疑《金匮》治饮诸方为峻猛而不敢用，日进参芪术甘培土制水，不知水未泛滥而培土，则土厚而水不能浸。水既泛滥而培土，则土厚而水益壅闭，譬淫雨似暴注，平地成渠，将疏导以行之乎抑提防以壅之乎试观今之黄河，日夜官吏巡视，鸠工奋筑无间，而西风一浪，终罹其祸。可见治水不师神禹则无功，治饮不宗长沙则多害。明乎此，则知吐法固断无之理，即温补亦属善后之方，而非正治之法也。
咳嗽大纲
先哲谓咳无痰而有声，嗽有声而有痰。如此分别，以咳专属火，而嗽则专属乎湿，遂开出后人许多清火清痰之法，致治咳者百无一效。及考之《内经》，但有咳论而无嗽论。而咳论一篇又谓属寒，何彼此相悬若此耶余谓咳嗽一症，有咳而不嗽者，未有嗽而不咳者。是嗽不可以赅咳，而咳已足以赅嗽也。但阅名家方论，每专责之于肺，而《内经》则言五脏六腑皆令人咳。且详言五脏六腑所见之症，盖以咳之为病，虽见端于肺，而所以致咳之原，则变现而难测。有肺经自受邪气而病咳者，即《内经》所谓皮毛先受邪气，其寒饮食入胃，从胃脉上至于肺，肺寒则内外合邪，因而咳之，则为肺咳是也。有因他经先受邪气，传入肺而病咳者，即《内经》所谓乘春、乘夏、乘至阴、乘冬，五脏各以其时受病，非其时各传以与之，而为心咳、肝咳、肾咳、脾咳之类是也。又有因咳久牵动他经之气，而他经之气上逆于肺，而病咳愈甚者，即《内经》所谓五脏之久咳乃移于六腑，而为胃咳、胆咳、大肠咳、小肠咳、膀胱咳、三焦咳之类是也。大抵肺经本病之咳多属于寒，以肺为体阴而用阳，内外之寒邪相合以伤其用，所以必咳也。若他经传入之咳恒乎暑湿燥火，以他经各传其类而受邪，从肝传入则兼风兼燥，从心脾肾传入则兼暑兼湿兼火，各以其邪合之而成咳也。盖肺之为脏，脉络窍管甚多，有脉络、丝络、孙络，有大管一小管二十四，其位至高，其体至虚，不能客纤毫之物，惟一团清肃之气弥论于内，呼则气出，吸则气入，为一身之橐龠。外邪犯之则呼气为之不舒，阿邪侵之则吸气为之不转。设于此时不解散其相合之邪，使之呼吸自利，则本经之水精既不能四布，而脉络窍管中所蕴伏之阳气反郁蒸而化火化痰。咳病其何时已耶彼君相火之刑金，土虚不能生金，木盛反侮其所不胜。咳之见端虽在于肺，而致咳之原仍在于心肾肝脾也。又安得见咳治咳，而专责之肺乎余是以折衷仲景之五方，而深服嘉言先生此类之说也。
治咳大法
《内经》论咳，博而且详。但文义浩衍，学者有望洋之叹。余遑不自安，虽于大纲中已发明其扼要，然有论无方，终未为后学周行也。因再取论咳一篇，反覆穷研，乃知其总结处全在聚于胃、关于肺二语，虽不言治而治法已寓其中矣。盖肺为脏腑之华盖，而气为之主，胃为脏腑之海而气为之统，气之出入在于肺，气之枢机在于胃。咳嗽虽有五脏六腑之分，内伤外感之别，而咳嗽之因大要有三：一由于气之滞而不宣，一由气之逆而不顺，一由气之虚而不固。外感者，其气多滞，当于散邪中兼利气。内伤者，其气多逆，当于养阴中兼纳气。久咳者，其气多虚，当审其由。由于外感也，于补气之中兼以散表。由于内伤也，于补气之中兼以滋阴。总以气之未动者无扰，已动者得平。不碍其气之出入枢机，为治咳第一关键。
肺，阴经也，而所以通调水道，下输膀胱，水精四布，五经并行者，实阳为之运也。若内外之寒邪相合，阻遏阳气，阳气之郁于内者欲发越而不发越，则咳病生焉。干姜乃辛温横散之品，所以横散内郁之阳气而解散相合之寒邪者也。然肺之阳气固贵有以发越于外，而尤贵者有以退藏于密。盖非发越无以为退藏之用，非退藏无以为发越之根。干姜虽能解散寒邪，而辛温太过设无物以监制之，则肺为娇脏，畏热畏寒，而寒去热留，反耗阴精，变为喘促等症，未可知也。仲景以五味子配之，五味虽酸涩甘苦咸毕具，而酸涩为多。本草言其入肾而有纳气之功，肾者肺之子，正肺气退藏之所也。用之一以制干姜之辛热，一以保肺家之精液，一以使肺气下归于肾，而藏子宫，得金水相生之妙。观仲景于伤寒证中，凡兼咳嗽者，即小青龙、小柴胡等汤，必加五味、干姜，可知五味、干姜乃治咳之圣药。用五味子所以保肺之体，用干姜所以达肺之用，诚有缺一不可者。细考《金匮》治咳五方，止有一方不用干姜，而所不用之故，全在冲气之逆与不通，进退其间，原不在咳满禁忌之例。至于五味，则断未有不用者。今人不知五味与干姜并用之妙，又不解其与表散药并用则有敛而不敛之权，执定表邪禁用之说，置而不用，无怪乎治咳者之百无一效也。
风寒暑湿燥火致咳总论
六气皆能乘肺而令人咳，其寒乘于肺者，仲景有专方，而暑湿燥火之咳亦散见各门，无如后世未得仲景之旨致学者，无处分辨。余因再以暑湿燥火之咳，逐一明辨，庶开卷可了然也。夫暑湿多盛于春夏，以春分后地气上升，天气下降，二气交而土膏水溽润木泽，人身应之，暑湿之病见焉。燥火多盛于秋冬，以秋分后天气不降，地气不升，二气分而草木黄落，山水涸，人身应之，燥火之病见焉。故暑病皆从外之内，郁于阳明，伤胃家之阴。伤于阴者衰其阳，治法不离白虎越婢之类。湿病皆自下之上，乘于太阴，伤脾家之阳。伤于阳者泄其阴，治法不离天水五苓之属，而燥则有内外之分。或津亏而燥淫于内，或风胜而燥淫于外。淫于内者滋润其内，二冬贝母是也。淫于外者凉解其外，薄荷桑皮是也。火则有上下之辨，或从下而之上，相火动而连及君火。或从上而之下，君火动而渐及相火。君火动者折之以黄连，相火动者引之以地黄。至于治法精微各门，另有精蕴，余不过略露一斑，以申明暑湿燥火，皆非肺家本病，见仲景设法之密耳。
申明《金匮》治咳五方
咳嗽一症，《内经》有论而无方，《金匮》有方而无论。余既于《内经》论咳之义一一发明，而又取《金匮》五方再加阐发，犹未申明治气之说也。夫肺统一身之气，气和则水精四布，而宣化有权，气逆则肺窍窒塞，而清浊不行，故咳甚则呕逆。咳久则喘急伤肾，呕逆伤胃。胃者中焦也，肺气之所出入也。喘急伤肾，肾者，下焦也，肺气之所由纳也。然仲景仅言冲气而不及胃气、肾气者，乃古人片言居要之体。盖胃气肾气动尚有不兼冲气者，未有冲气动而不及胃气肾气者。况冲任二脉与肾之大络同起肾下，出胞中，又与胃脉并行，久咳不已，自必胃虚不能统气于中，肾虚不能纳气于下，冲脉之火挟之直行而上，虽以形寒饮冷首推小青龙汤一方为主，而其斡旋之深心，有不可不知者。首条言服小青龙汤，已可知小青龙固治咳之圣药也。一变而至多睡口燥，寸沉尺微，手足逆冷，气从小腹上冲胸咽，即仿伤寒门中之奔豚治法，重用桂苓加五味甘草，治其冲气，冲气即低，又一变而更复渴，冲气复发。仲景于此辗转沉思，或因小青龙汤治合邪而误动冲气，或因五味甘草汤治冲气而移合邪，然治咳满不得不加姜辛，治冲气不得不用桂苓，无如咳满止、冲气发、冲气低、咳满作，顾此失彼，将何以为后学之准绳而孰知仲景有一证即有一方，有一变即有一法云服之当遂渴，可见服之遂渴以细辛、干姜为热药，助冲任之火上熏于面，热如醉状，下流阴股，小便难，今反不渴，其责不在细辛、干姜而在胸中素有支饮，致水气凌心，时冒作呕，故仍用桂苓以防冲气，但纳半夏以去水，水去呕止，又一变而其人形肿，则在内之支饮虽去而在上之肺气未和。有水邪流注皮肤之象，当用表里两解之定法，而麻黄在所必用矣。如察其人手足痿痹则阴血素亏，不能充溉经络。倘用麻黄以动阳气，势不在发，厥而不已，惟独任杏仁之苦降。俾清无上逆朐咽等症，不过胃家津液大耗，热邪上炽可虞。非加大黄急存胃汁，至瓮干杯尽嗟无及矣。观《金匮》六条，仲景层层剥进，商出治法，犹且再三致意详慎，而后学者不讲明其所以然，其意何哉?
虚劳大纲
虚劳一症，《内经》所谈甚广，析无尽义。凡外感六淫，内伤七情，正气日亏，邪火日炽，展转乘于脏腑而成偏胜，或大骨枯槁，或大肉陷下，如先贵后贱，病从内生，名曰脱营。先富后贫，病从外生，名曰失精。始乐后苦，皆伤精气，纵酒多欲，精气竭绝。又曰：阴伤者，烦劳则张，精绝，因而强力，肾气乃伤，高骨乃坏。因而大怒，则形气绝而血菀于上。仲景统括《内经》之义而知劳伤则精伤，精伤则气伤，气伤则形伤。《内经》之见证不能尽举，而可一以贯之也。于是立虚劳一门，独以劳为首重，以劳未有不虚，亦《内经》精气夺则虚之旨也。而其扼要，又以精气二字为主。夫精充则能生气，气足则能化精，精气两相眷恋，方为平人。精亏则不能生气，气衰则不能化精，精气而相离失则成劳证。虽有盗汗、自汗、午后发热、咯血、咳嗽、饮食少进，甚则咳痰泄血，咳血吐血，衄血，身热脉数，肌肉消瘦，怠堕嗜卧，足软足酸，骨软，种种见证不一，要不外自外而内者，从上而之下，自内而外者，从下而之上，以致伤精伤气也。学者诚能于上下内外之间权其轻重，握奇之要，将在斯矣。后人不知仲景之意，妄分五蒸六极，七伤，二十三蒸，二十六蒸，三十三种注，九十九种注。欲识源于万派，寻大道于歧途，良可慨也。
治劳大法
虚劳证治，自《金匮》而下，方书汗牛充栋，一切滋阴降火、补肾补心、补肝补脾补肺之说，各各不同。较之《金匮》，洵加详尽。而按方施治，每无定效。盖虚劳一症，未有不始于营卫不和而渐至上损下损者，亦未有不终于营卫不通而甚至过胃过脾者。夫营为水谷之精气，卫为水谷之悍气，卫气行阳二十五度，营气行阴二十五度，日夜流行不息，充周脏腑，何劳之有惟其不和则营之在内者不能为阴之守，而有亡血失精等证。卫之在外者不能为阳之固而有盗汗烦热等证，不和则有偏胜。营属阴而易偏于弱，卫为阳而易偏于强，偏强偏弱，势必相失而不通。营不通于卫而弱者益弱，卫不通于营而强者益强。弱者益弱，非脱出于外即匿伏于内。强者益强，非蒸灼于上即煎熬于下。脏腑之阴津且有立尽之势，而气急声哑骨痿等证所必至也。惟长沙早见及此，于将成未成之际，不离桂枝建中为加减，渐和其营卫而不嫌其缓。于既成之后，不离大黄廑虫为加减，急通其营卫而不嫌其峻。后人不解此旨，设出补肾、补心、补肝、补脾、补肺等汤，干蹊万径，徒眩耳目，岂知营卫不和不通，纵有仙丹，亦不能舍营卫而运行脏腑。有心斯道者，可不知通和营卫为治劳第一义耶按，劳之为病，形与精多不足之证也。《内经》云：形不足者，温之以气，精不足者，补之以味。仲景大小建中等汤气温而平，味甘而厚，正《内经》补形补精之旨。今人置而不用何其愦愦耶(育附)!
申明《难经》虚劳论
《金匮要略》论述水饮病，重点在于阳气衰微，治疗方法重在驱逐水饮。驱逐水饮的方法贵在顺应病势进行引导，或者使水饮从体表通过发汗排出，或者使水饮从体内通过利小便或利大便排出，没有其他的歧路。其中深浅表里的区别，大要以身体的胸中作为“里”的表层，肌肉作为“表”的表层，脏腑作为“里”的深层。位于表之表的病证都可以用发汗法治疗，位于里之表的病证都可以用利小便法治疗，位于里之里的病证都可以用利大便法治疗。使用发汗法的关键在于身体沉重、疼痛这八个字。使用利小便法的关键在于胸胁胀满、眩晕昏冒这四个字。使用利大便法的关键在于腹部坚硬、胀满、疼痛这四个字。虽然临床表现错综复杂不一，确立主方虽有轻重之别，但如果能掌握这一核心思想作为治疗水饮的心法，就已经能够从容不迫、游刃有余了。
探求催吐之法本源于张仲景，但在《金匮要略》中涉及水饮证的二十多条条文里，没有一条提到使用催吐法。后人将痰与饮混为一谈，于是各自推崇催吐法，贻误病人，至今这种风气依然严重。不知道痰是由内生，由风火所成，其质地胶黏，其性质炎上，所以痰有催吐法；而饮是由外感寒冷蓄积而成，其性质润下，其质地濡柔，所以饮没有催吐法。况且水饮向上吐出为逆乱，向下排泄为顺行，所以张仲景施治，只是区分病位的浅深远近，让水饮从地下通道（经络/三焦）排出罢了。病位浅、近者，使用小青龙汤、苓桂术甘汤等方剂，如同疏通河道决堤排水，使其注入江河大海而有归处。病位深、远者，使用甘遂、半夏、十枣汤、厚朴大黄汤、葶苈大枣泻肺汤等方剂，如同开导昆仑山源头，通调星宿水系，使水流长远而源头清澈。后世的学者不明白这一至理，不分辨是饮还是痰，就随意施行催吐法，导致胃气上逆，胸中阳气大伤，出现目眩神昏，水饮仍然排不出，中气一旦衰竭，反而逼迫水饮聚结在一处，危害更加严重。偶尔有明智之士，不行催吐法，又怀疑《金匮要略》治疗水饮的诸方过于峻猛而不敢使用，每天进服人参、黄芪、白术、甘草来培土制水，却不知道在水未泛滥时培土，则土厚而水不能浸渍；水已经泛滥时培土，则土厚而水更加壅闭，就像暴雨如注，平地成渠，是将它疏导流通呢，还是提防堵塞呢？试看今天的黄河，日夜都有官吏巡视，聚集工匠奋力修筑不间断，但西风一吹起波浪，终究难免遭受祸患。可见治理水患不效法大禹就没有功效，治疗水饮不尊崇张仲景（长沙太守）就会多遭害处。明白这一点，就知道催吐法确实是没有道理的，即使是温补也属于善后调理的方法，而不是正治的方法。
咳嗽的大纲
先哲说，咳是有声音而没有痰，嗽是有痰而没有声音。这样区分，认为咳专门归属于火，而嗽专门归属于湿，于是开启了后世许多清火、清痰的方法，导致治疗咳嗽的人百无一效。等到考察《黄帝内经》，只有咳嗽的论述而没有单独的嗽论。而咳嗽论一篇又说咳嗽属于寒，为什么彼此相差如此之大呢？我认为咳嗽这一症状，有只咳不嗽的情况，却没有只嗽不咳的情况。所以嗽不能涵盖咳，而咳足以涵盖嗽。但是阅读名家方论，往往专门责备于肺，而《黄帝内经》却说五脏六腑都能让人咳嗽。并且详细说明了五脏六腑所见到的症状，大概是因为咳嗽这个病，虽然表现端倪在肺，但导致咳嗽的根本原因，则变化显现而难以预测。有肺经自身感受邪气而生病咳的，就是《黄帝内经》所说的皮毛先受邪气，如果寒凉饮食入胃，从胃脉上行至于肺，肺寒则内外合邪，因而咳嗽，这就是肺咳。有因其他经脉先受邪气，传入肺而生病咳的，就是《黄帝内经》所说的乘春、乘夏、乘至阴、乘冬，五脏各在其当令之时受病，非当令之时则传给它，从而成为心咳、肝咳、肾咳、脾咳之类。又有因咳嗽日久牵动其他经脉之气，而其他经脉之气上逆于肺，导致咳嗽更严重的，就是《黄帝内经》所说的五脏久咳乃移于六腑，从而成为胃咳、胆咳、大肠咳、小肠咳、膀胱咳、三焦咳之类。大抵肺经本病的咳嗽多属于寒，因为肺体阴而用阳，内外寒邪相合损伤其用，所以必然咳嗽。如果是其他经传入的咳嗽，常兼夹暑、湿、燥、火，因为其他经各自传其同类而受邪，从肝传入则兼风兼燥，从心、脾、肾传入则兼暑兼湿兼火，各自以其邪气结合而形成咳嗽。大概肺这个脏器，脉络窍管很多，有脉络、丝络、孙络，有大管一小管二十四根，其位置最高，其体质最虚，不能容纳丝毫异物，只有一团清肃之气弥漫于内，呼气则气出，吸气则气入，是全身的气机枢纽。外邪侵犯它，则呼气为之不畅；邪气侵扰它，则吸气为之不转。如果在这个时候不解散其相合之邪，使之呼吸自然通畅，那么本经的水精既不能四布，而脉络窍管中所蕴伏的阳气反而郁蒸而化火化痰。咳嗽的病什么时候才能结束呢？那是君相之火刑克肺金，土虚不能生金，木盛反侮其所不胜。咳嗽的见端虽然在肺，但致咳的根本原因仍在于心、肾、肝、脾。又怎么能见到咳嗽就治咳嗽，而专门责备于肺呢？我因此折衷张仲景的五方，而深深信服嘉言先生（李中梓）这类说法。
治疗咳嗽的大法
《黄帝内经》论述咳嗽，广博而详细。但文义浩繁衍伸，学者有面对汪洋大海般的感叹。我不安于现状，虽然在大纲中已经阐明了其扼要之处，然而有论述无方剂，终究没有为后学提供周全的指引。因此再次取论咳一篇，反复穷究研究，才知道总结之处全在“聚于胃、关于肺”这两句话，虽然没直接说治疗，但治法已蕴含其中了。大概肺是脏腑的华盖，而气为其主宰；胃是脏腑的海，而气为其统帅。气的出入在于肺，气的枢机在于胃。咳嗽虽然有五脏六腑之分，内伤外感之别，但咳嗽的原因大要有三：一是由于气滞而不宣通，一是由于气逆而不顺降，一是由于气虚而不固摄。外感者，其气多滞，应当在散邪中兼以利气。内伤者，其气多逆，应当在养阴中兼以纳气。久咳者，其气多虚，应当审察其原因。由于外感引起的，在补气之中兼以散表。由于内伤引起的，在补气之中兼以滋阴。总原则是以气未动者不打扰，已动者使其平复。不阻碍气的出入枢机，这是治疗咳嗽的第一关键。
肺，是阴经，但之所以能通调水道，下输膀胱，水精四布，五经并行，实际上是靠阳气来运作的。如果内外寒邪相合，阻遏阳气，阳气郁结在内想要发散而不能发散，咳嗽病就产生了。干姜是辛温横散的药材，用来横散内部郁结的阳气并解散相合的寒邪。然而肺的阳气固然贵在能够发散于外，尤其可贵的是能够退藏于密。大概不是发散就无法实现退藏的作用，不是退藏就无法成为发散的根基。干姜虽然能解散寒邪，但辛温太过，如果没有药物来监制它，肺为娇脏，畏热畏寒，寒去热留，反而耗伤阴精，变成喘促等症状，也是不可知的。张仲景用五味子配合它，五味子虽然酸涩甘苦咸都具备，但酸涩居多。本草说它入肾而有纳气之功，肾是肺的子脏，正是肺气退藏的地方。使用它一方面制约干姜的辛热，一方面保护肺家的精液，一方面使肺气下归于肾，而藏子宫，得到金水相生的妙用。观察张仲景在治疗伤寒证中，凡是兼有咳嗽的，即小青龙汤、小柴胡汤等，必定加五味子和干姜，可知五味子和干姜是治疗咳嗽的圣药。用五味子是为了保全肺的体，用干姜是为了通达肺的用，确实是有缺一不可的。仔细考证《金匮要略》治疗咳嗽的五方，只有一方不用干姜，而之所以不用，全在于冲气之逆与不通，进退其间，原本不在咳满禁忌的例子范围内。至于五味子，则断然没有不用的。现在的人不知道五味子与干姜并用的妙处，又不理解其与表散药并用则有敛而不敛的权变，执着于表邪禁用的说法，放置不用，难怪治疗咳嗽的人百无一效。
风寒暑湿燥火导致咳嗽的总论
六气都能乘袭肺脏而让人咳嗽，其中寒邪乘于肺，张仲景有专方，而暑湿燥火的咳嗽也散见于各门，无奈后世没有得到张仲景的宗旨，导致学者无处分辨。我因此再以暑湿燥火的咳嗽，逐一明确辨别，希望读者开卷就能了然。暑湿多在春夏盛行，因为春分后地气上升，天气下降，二气交合而土膏水溽润木泽，人身应之，暑湿的病就出现了。燥火多在秋冬盛行，因为秋分后天气不降，地气不升，二气分离而草木黄落，山水枯竭，人身应之，燥火的病就出现了。所以暑病皆从外之内，郁于阳明，伤胃家之阴。伤于阴的，要衰减其阳，治法不离白虎汤、越婢汤之类。湿病皆自下之上，乘于太阴，伤脾家之阳。伤于阳的，要泄其阴，治法不离天水散、五苓散之类。而燥则有内外的分别。或是津亏而燥淫于内，或是风胜而燥淫于外。淫于内的，滋润其内，二冬、贝母是也。淫于外的，凉解其外，薄荷、桑皮是也。火则有上下的辨别，或是从下而上，相火动而连及君火。或是从上而下，君火动而渐及相火。君火动的，用黄连折之；相火动的，用地黄引之。至于治法的精微在各门另有精蕴，我不过略露一斑，以申明暑湿燥火，都不是肺家的本病，体现张仲景设法的严密罢了。
申明《金匮要略》治疗咳嗽的五方
咳嗽这一症状，《黄帝内经》有论述而无方剂，《金匮要略》有方剂而无论述。我既然对《黄帝内经》论咳的意义一一阐明，而又取《金匮要略》五方再加阐发，还没有申明治气的说法。肺统一身之气，气和则水精四布，而宣化有权，气逆则肺窍窒塞，而清浊不行，所以咳甚则呕逆。咳久则喘急伤肾，呕逆伤胃。胃是中焦，是肺气出入的地方。喘急伤肾，肾是下焦，是肺气所由纳的地方。然而张仲景仅言冲气而不及胃气、肾气，乃是古人片言居要的风格。大概胃气肾气动尚有不兼冲气的，未有冲气动而不及胃气肾气的。况且冲任二脉与肾之大络同起于肾下，出于胞中，又与胃脉并行，久咳不已，自然胃虚不能统气于中，肾虚不能纳气于下，冲脉之火挟之直行而上，虽然以形寒饮冷首推小青龙汤一方为主，但其斡旋的深心，有不可不知道的。首条说服用小青龙汤，已可知小青龙固然是治疗咳嗽的圣药。一变而至多睡口燥，寸沉尺微，手足逆冷，气从小腹上冲胸咽，即仿照伤寒门中的奔豚治法，重用桂枝茯苓加五味甘草，治疗其冲气，冲气即低，又一变而更复渴，冲气复发。张仲景于此辗转沉思，或因小青龙汤治合邪而误动冲气，或因五味甘草汤治冲气而移合邪，然而治咳满不得不加姜辛，治冲气不得不用桂苓，无奈咳满止、冲气发、冲气低、咳满作，顾此失彼，将何以为后学的准绳？然而谁知道张仲景有一证即有一方，有一变即有一法呢？服用之后应当遂渴，可见服用之后遂渴是因为细辛、干姜为热药，助冲任之火上熏于面，热如醉状，下流阴股，小便难，现在反而不渴，其责不在细辛、干姜而在胸中素有支饮，致水气凌心，时冒作呕，故仍用桂苓以防冲气，但纳半夏以去水，水去呕止，又一变而其人形肿，则在内之支饮虽去而在上之肺气未和。有水邪流注皮肤之象，当用表里两解的定法，而麻黄在所必用了。如察其人手足痿痹则阴血素亏，不能充溉经络。倘若用麻黄以动阳气，势不在发厥而不已，惟独任杏仁之苦降。俾清无上逆胸咽等症状，不过是胃家津液大耗，热邪上炽可虞。非加大黄急存胃汁，至瓮干杯尽嗟无及矣。观察《金匮要略》六条，张仲景层层剥进，商出治法，犹且再三致意详慎，而后学者不讲明其所以然，其意何在？
虚劳的大纲
虚劳这一症状，《黄帝内经》所谈很广，分析不尽其义。凡外感六淫，内伤七情，正气日亏，邪火日炽，展转乘于脏腑而成偏胜，或大骨枯槁，或大肉陷下，如先贵后贱，病从内生，名曰脱营。先富后贫，病从外生，名曰失精。始乐后苦，皆伤精气，纵酒多欲，精气竭绝。又说：阴伤者，烦劳则张，精绝，因而强力，肾气乃伤，高骨乃坏。因而大怒，则形气绝而血菀于上。张仲景统括《黄帝内经》的意义而知道劳伤则精伤，精伤则气伤，气伤则形伤。《黄帝内经》的见证不能尽举，而可一以贯之。于是立虚劳一门，独以劳为首重，因为劳没有不虚的，也是《黄帝内经》精气夺则虚的宗旨。而其扼要，又以精气二字为主。精充则能生气，气足则能化精，精气两相眷恋，方为平人。精亏则不能生气，气衰则不能化精，精气而相离失则成劳证。虽然有盗汗、自汗、午后发热、咯血、咳嗽、饮食少进，甚则咳痰泄血，咳血吐血，衄血，身热脉数，肌肉消瘦，怠堕嗜卧，足软足酸，骨软，种种见证不一，但不外乎自外而内者，从上而之下，自内而外者，从下而之上，以致伤精伤气。学者如果能于上下内外之间权衡其轻重，把握奇正的要点，就在这里了。后人不知道张仲景的意思，妄分五蒸六极，七伤，二十三蒸，二十六蒸，三十三种注，九十九种注。欲识源于万派，寻大道于歧途，实在令人慨叹。
治疗虚劳的大法
虚劳证的治疗，自《金匮要略》以下，方书汗牛充栋，一切滋阴降火、补肾补心、补肝补脾补肺的说法，各各不同。较之《金匮要略》，确实更加详尽。而按方施治，每每没有定效。大概虚劳这一症，没有不是始于营卫不和而渐至上损下损的，也没有不是终于营卫不通而甚至过胃过脾的。营是水谷的精气，卫是水谷的悍气，卫气行阳二十五度，营气行阴二十五度，日夜流行不息，充周脏腑，有什么劳的呢？只有不和则营在内者不能为阴之守，而有亡血失精等证。卫在外者不能为阳之固而有盗汗烦热等证，不和则有偏胜。营属阴而易偏于弱，卫为阳而易偏于强，偏强偏弱，势必相失而不通。营不通于卫而弱者益弱，卫不通于营而强者益强。弱者益弱，非脱出于外即匿伏于内。强者益强，非蒸灼于上即煎熬于下。脏腑之阴津且有立尽之势，而气急声哑骨痿等证所必至也。只有长沙（张仲景）早见及此，于将成未成之际，不离桂枝建中汤为加减，渐和其营卫而不嫌其缓。于既成之后，不离大黄廑虫丸为加减，急通其营卫而不嫌其峻。后人不解此旨，设出补肾、补心、补肝、补脾、补肺等汤，干蹊万径，徒眩耳目，岂知营卫不和不通，纵有仙丹，亦不能舍营卫而运行脏腑。有心斯道者，可不知通和营卫为治劳第一义耶？按，劳之为病，形与精多不足之证也。《黄帝内经》云：形不足者，温之以气，精不足者，补之以味。张仲景大小建中等汤气温而平，味甘而厚，正《黄帝内经》补形补精的宗旨。现在的人放置不用何其糊涂啊！（育附！）
申明《难经》虚劳论
The *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) discusses fluid retention (Yin, 饮), emphasizing yang deficiency (Yang Shuai, 阳衰) as the root cause, with treatment focusing on expelling water (Zhu Shui, 逐水). The method of expelling water values guiding according to the momentum of the disease: either allowing it to exit from the exterior via sweating (Fa Han, 发汗), or allowing it to drain internally via urination (Li Xiao Bian, 利小便) or defecation (Li Da Bian, 利大便); there are no other divergent paths. Regarding the distinctions of depth and superficiality, the general principle is that the chest is the superficial layer of the interior (Li Zhi Biao, 里之表), muscles are the superficial layer of the exterior (Biao Zhi Biao, 表之表), and zang-fu organs are the deep layer of the interior (Li Zhi Li, 里之里). Diseases at the superficial layer of the exterior can all be treated by sweating; diseases at the superficial layer of the interior can all be treated by promoting urination; diseases at the deep layer of the interior can all be treated by promoting defecation. The key to using sweating lies in the symptoms of heavy body and pain. The key to promoting urination lies in chest/hypochondriac fullness, dizziness, and vertigo. The key to promoting defecation lies in abdominal hardness, fullness, and pain. Although clinical manifestations vary intricately, and primary prescriptions differ in severity, grasping this core intent as the essential method for treating fluid retention allows one to handle the situation with ease and proficiency.
Discussion on Not Using Emesis or Tonification Methods for Treating Fluid Retention Syndromes
The method of inducing vomiting originates from Zhang Zhongjing. However, among the more than twenty clauses concerning fluid retention in the *Jingui*, not a single word mentions it. Later generations conflated phlegm (Tan, 痰) with fluid retention, leading each to compete for the superiority of emetic therapy, causing harm to patients, a trend that remains severe today. It is unknown that phlegm is generated internally, formed by wind and fire, has a sticky consistency, and an inflammatory nature ascending upwards; thus, phlegm has an emetic method. Fluid retention, however, is accumulated due to external cold, has a moistening and descending nature, and a soft consistency; thus, fluid retention does not have an emetic method. Moreover, water/fluid retention exiting upwards is rebellious (Ni, 逆), while moving downwards is smooth (Shun, 顺). Therefore, Zhang Zhongjing’s treatment merely distinguishes between shallow/deep and near/far positions, allowing the fluid to exit through the "earthly channels" (meridians/sanjiao). For shallow/near cases, formulas such as Xiao Qing Long Tang (Minor Blue Dragon Decoction) and Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractodes, and Licorice Decoction) are used, akin to dredging rivers and draining floods so they flow into rivers and seas. For deep/far cases, formulas containing Kansui Radix (Gansui, 甘遂), Pinellia Rhizome (Banxia, 半夏), Ten Jujube Formula (Shi Zao Tang, 十枣汤), Magnolia Bark (Houpo, 厚朴), Rhubarb (Dahuang, 大黄), and Descurainia Seed/Lactucae Semen to Drain the Lungs (Tingli Dazao Xiefei Tang, 葶苈大枣泻肺汤) are used, akin to opening the source of Kunlun and regulating the stars, ensuring long-flowing streams and clear sources. Later scholars ignorant of this profound truth fail to distinguish between fluid retention and phlegm, arbitrarily employing emetics, causing stomach qi to rebel upwards and severely damaging yang qi in the chest, resulting in dizziness and confusion. The fluid retention still does not exit; once middle qi collapses, it forces the fluid retention to cluster together, causing even greater harm. Occasionally, wise individuals avoid emetics but doubt the harshness of the *Jingui*’s fluid retention formulas and dare not use them. Instead, they daily administer Ginseng Radix (Renshen, 人参), Astragalus Membranaceus Root (Huangqi, 黄芪), Atractodes Macrocephala Rhizome (Baizhu, 白术), and Licorice Root (Gancao, 甘草) to strengthen earth to control water. They do not realize that strengthening earth before water overflows results in thick earth that water cannot penetrate; strengthening earth after water overflows results in thick earth that further blocks water. This is like heavy rain turning flat land into canals: should one guide it or block it? Observe the modern Yellow River: officials patrol day and night, gathering workers to build embankments without rest, yet a single wave from the west wind brings disaster. Thus, controlling water without following Yu the Great yields no merit; treating fluid retention without honoring Changsha (Zhang Zhongjing) invites much harm. Understanding this, one knows emesis is fundamentally unreasonable, and even warming tonification belongs to post-treatment care, not primary treatment.
General Outline of Cough
Ancient sages stated that cough (Ke, 咳) has sound but no phlegm, while clearing throat/phlegm (Sou, 嗽) has phlegm but no distinct sound. Such distinction attributes cough exclusively to fire and sou exclusively to dampness, thereby initiating many later methods for clearing fire and phlegm, resulting in almost no efficacy in treating cough. Examining the *Neijing* (Inner Canon), there is only a discussion on cough, no separate discussion on sou. The cough chapter states cough belongs to cold. Why the discrepancy? I believe there are cases of cough without sou, but never sou without cough. Thus, sou cannot encompass cough, but cough suffices to encompass sou. However, reviewing famous physicians' prescriptions, they often blame the lung exclusively. The *Neijing* states that all five zang and six fu organs can cause cough. It details symptoms for each, implying that although cough manifests in the lung, its root causes are variable and hard to predict. Some coughs arise from the lung meridian itself receiving pathogenic factors, as described in the *Neijing*: skin and hair first receive pathogens; if cold food/drink enters the stomach and travels up the stomach meridian to the lung, lung cold combines with internal/external pathogens, causing lung cough. Others arise from other meridians receiving pathogens first, transmitting to the lung, as described in the *Neijing*: receiving pathogens in spring, summer, etc., where each zang organ receives disease in its season, or transmits to others off-season, becoming heart cough, liver cough, kidney cough, spleen cough, etc. Still others arise from prolonged cough affecting other meridians, whose qi rebels upward to the lung, worsening cough, as described in the *Neijing*: prolonged cough of five zangs transfers to six fus, becoming stomach cough, gallbladder cough, large intestine cough, small intestine cough, bladder cough, sanjiao cough, etc. Generally, lung-origin coughs belong to cold because the lung has yin substance but yang function; combined internal/external cold damages its function, necessitating cough. Transmitted coughs often involve summerheat, dampness, dryness, or fire, depending on the originating meridian (e.g., liver adds wind/dryness; heart/spleen/kidney add summerheat/dampness/fire). The lung has many vessels and orifices, is high in position, and extremely deficient in constitution, unable to tolerate any foreign matter. Only a mass of pure,肃 (clear/resolute) qi fills it internally; exhalation releases qi, inhalation draws it in, serving as the bellows of the body. External pathogens obstruct exhalation; pathogens invade obstructing inhalation. If these combined pathogens are not dispersed to allow natural breathing, the lung's fluids cannot distribute, and latent yang qi in vessels/orifices stagnates, transforming into fire and phlegm. When will cough end? This involves ministerial/monarch fire punishing metal, earth deficiency failing to generate metal, wood excess insulting what it cannot overcome. Although cough starts in the lung, its root lies in heart, kidney, liver, and spleen. How can one treat only the symptom and blame the lung? I therefore synthesize Zhang Zhongjing’s five formulas and deeply endorse Mr. Jiayan’s (Li Zhongzi) views.
General Method for Treating Cough
The *Neijing* discusses cough extensively and in detail. However, the text is vast, leaving scholars overwhelmed. I felt uneasy, having clarified the essentials in the outline but lacking formulas, which is insufficient for students. Re-examining the cough chapter, I found the summary lies entirely in "gathering in the stomach, relating to the lung." Though treatment isn't explicitly stated, it is implied. The lung is the canopy of zang-fu, governing qi; the stomach is the sea of zang-fu, commanding qi. Qi enters/exits via the lung; the pivot of qi is in the stomach. Despite divisions among zang-fu and differences between internal injury/external contraction, cough causes generally fall into three: qi stagnation not dispersing, qi rebellion not descending, qi deficiency not securing. External contraction causes qi stagnation; treat by dispelling pathogens while benefiting qi. Internal injury causes qi rebellion; treat by nourishing yin while grasping qi. Prolonged cough causes qi deficiency; investigate the cause. If external, supplement qi while releasing the exterior. If internal, supplement qi while nourishing yin. The total principle: disturb unactivated qi, calm activated qi. Do not hinder the pivot of qi entry/exit; this is the first key to treating cough.
On Using Dried Ginger (Ganjiang, 干姜) and Schisandra Berry (Wuweizi, 五味子) for Cough
The lung is a yin meridian, yet its ability to regulate water passages, transport fluids downward to the bladder, and distribute essence relies on yang qi operation. If external/internal cold combines, obstructing yang, and internal yang desires to disperse but cannot, cough arises. Dried ginger is acrid-warm and horizontally dispersing, used to disperse internal stagnant yang and resolve combined cold. Lung yang must disperse externally but also retreat/store internally. Dispersion enables storage; storage is the root of dispersion. Dried ginger resolves cold, but excessive acrid-warmth without restraint harms the delicate lung, causing heat retention and consuming yin essence, potentially leading to panting. Zhang Zhongjing pairs it with Schisandra berry. Schisandra possesses sour, bitter, sweet, pungent, and salty flavors, predominantly sour/astringent. Materia Medica states it enters the kidney and grasps qi. Kidney is the son of lung, the place where lung qi stores. Using it restrains dried ginger’s acrid-heat, protects lung essence, and guides lung qi downward to the kidney, achieving the wonder of metal-water generation. Observing Zhang Zhongjing’s treatment of cold damage with cough, he always adds Schisandra and Dried Ginger to Xiao Qing Long Tang or Xiao Chai Hu Tang, proving they are holy medicines for cough. Schisandra preserves lung substance; Dried Ginger facilitates lung function. Both are indispensable. Examining the five *Jingui* cough formulas, only one lacks Dried Ginger, specifically when chong qi rebellion/blockage is central, outside standard cough/fullness contraindications. Schisandra, however, is never omitted. Modern practitioners miss the synergy of Schisandra and Dried Ginger, and their interaction with exterior-releasing herbs (astringing without trapping). Clinging to the dogma that exterior pathogens forbid astringents, they omit them, explaining the lack of efficacy.
General Discussion on Cough Caused by Wind-Cold, Summerheat, Dampness, Dryness, and Fire
All six qi can attack the lung causing cough. Cold attacking the lung has specific formulas in Zhang Zhongjing’s work; summerheat/dampness/dryness/fire coughs appear scattered. Later generations missed Zhang’s intent, leaving students confused. I clarify summerheat/dampness/dryness/fire coughs for clarity. Summerheat/dampness prevail in spring/summer: after Spring Equinox, earth qi rises, heaven qi descends, interacting to moisten soil/trees; humans respond, developing summerheat/dampness diseases. Dryness/fire prevail in autumn/winter: after Autumn Equinox, heaven qi doesn’t descend, earth qi doesn’t rise, separating to wither plants/dry waters; humans respond, developing dryness/fire diseases. Summerheat enters from exterior to interior, stagnating in Yangming, damaging stomach yin. Treat yin damage by reducing yang, using Bai Hu Tang (White Tiger Decoction) or Yue Bi Tang (Crossing the House Decoction). Dampness enters from inferior to superior, attacking Taiyin, damaging spleen yang. Treat yang damage by draining yin, using Tian Shui San (Heavenly Water Powder) or Wu Ling San (Five Ingredient Powder with Poria). Dryness has internal/external aspects: internal dryness from fluid deficiency uses moisturizers like Donggu Gen (Ophiopogon Tuber) and Mai Dong (Ophiopogon Tuber), Bei Mu (Fritillaria Bulb); external dryness from wind uses cooling agents like Bohe (Mint) and Sangbai (Mulberry Root). Fire has superior/inferior aspects: inferior fire (ministerial) rising affects superior fire (monarch); superior fire falling affects ministerial fire. Monarch fire is controlled by Huanglian (Coptis Rhizome); ministerial fire is guided by Dihuang (Rehmannia Root). Treatment nuances are detailed elsewhere; I merely highlight that summerheat/dampness/dryness/fire are not primary lung diseases, demonstrating Zhang Zhongjing’s meticulous methodology.
Clarifying the Five Cough Formulas in *Jingui*
The *Neijing* discusses cough without formulas; *Jingui* has formulas without discussion. Having elucidated *Neijing* theory and expanded *Jingui* formulas, I must clarify qi treatment. Lung unifies body qi; harmonious qi distributes fluids; rebellious qi blocks orifices, causing cough/vomiting. Prolonged cough damages kidney/stomach. Stomach (middle jiao) is qi’s exit/entry; kidney (lower jiao) is qi’s reception. Zhang Zhongjing mentions chong qi but not stomach/kidney qi, using concise language. Stomach/kidney qi movement may not involve chong qi, but chong qi movement always involves stomach/kidney qi. Chong/Ren meridians originate below kidney, emerge from uterus, run parallel to stomach meridian. Prolonged cough causes stomach deficiency (failing to command qi centrally) and kidney deficiency (failing to grasp qi inferiorly), allowing chong fire to rush upward. While Xiao Qing Long Tang is primary for cold/cold drinks, its complex manipulation requires understanding. Clause 1: Xiao Qing Long Tang is a holy medicine for cough. Variation 1: Excessive sleep, dry mouth, sunken pulse at cun, faint pulse at chi, cold extremities, qi rushing from lower abdomen to chest/throat. Treat like Ben Tun (Running Piglet) in cold damage: use Guizhi Fuling Tang with Wuweizi and Gancao to calm chong qi. Variation 2: Thirst returns, chong qi relapses. Zhang contemplates: did Xiao Qing Long Tang disturb chong qi while treating combined pathogens? Did Wuweizi Gancao Tang move combined pathogens while treating chong qi? Treating cough/fullness requires Ginger/Acanthopanax; treating chong qi requires Cinnamon/Poria. Yet stopping cough triggers chong qi, and calming chong qi triggers cough. Who provides a standard? Zhang offers a formula for every condition and method for every variation. If thirst follows administration, it’s because Xixin/Ganjiang are hot, aiding chong/ren fire to scorch face/groin, causing difficult urination. Now, no thirst indicates pre-existing Zhi Yin (branch fluid retention) in chest causing water qi to overwhelm heart, leading to dizziness/vomiting. Continue Guizhi/Fuling to prevent chong qi, add Banxia to remove water. Variation 3: Edema. Internal branch fluid retention removed, but upper lung qi unharmonized. Water qi flows to skin. Use exterior-interior resolving method; Mahuang is essential. If limbs are flaccid, yin-blood is deficient; Mahuang would cause convulsions. Use Xingren (Apricot Seed) to descend. If stomach fluids are depleted and heat blazes, use Dahuang (Rhubarb) urgently to preserve stomach juice. Zhang Zhongjing peels back layers across six clauses, deliberating carefully. Why don’t later students understand the rationale?
General Outline of Consumption (Xu Lao, 虚劳)
Consumption is discussed broadly in *Neijing*. External six excesses, internal seven emotions, daily decline of righteous qi, daily rise of evil fire, transferring to zang-fu causing imbalance, leading to skeletal emaciation or muscle wasting. "Noble to base, disease from within" is Tuo Ying (Stripped Camp); "Rich to poor, disease from outside" is Shi Jing (Lost Essence). Joy to suffering injures essence/qi; alcohol/lust exhausts essence. Yin damage: fatigue causes expansion, essence exhaustion, forced exertion damages kidney qi, breaking high bones. Anger causes qi/blood stagnation above. Zhang Zhongjing synthesizes *Neijing*: labor injures essence, essence injury injures qi, qi injury injures form. He establishes Consumption as a category, prioritizing labor, as labor inevitably leads to deficiency (*Neijing*: "essence/qi depletion is deficiency"). The essence is "essence and qi." Abundant essence generates qi; sufficient qi transforms essence; mutual attachment defines health. Deficient essence fails to generate qi; weak qi fails to transform essence; separation causes consumption. Symptoms include night sweats, spontaneous sweats, afternoon fever, hemoptysis, cough, poor appetite, blood in sputum/vomit, epistaxis, fever, rapid pulse, emaciation, lethargy, weak legs/bones. These stem from external-to-internal (top-down) or internal-to-external (bottom-up) damage to essence/qi. Students should weigh severity in upper/lower/exterior/internal realms. Later scholars wrongly divided conditions into Five Steams, Six Extremes, Seven Injuries, etc., seeking the great way in divergent paths, which is lamentable.
General Method for Treating Consumption
Post-*Jingui* texts on consumption are numerous, advocating yin-nourishing/fire-draining, kidney/heart/liver/spleen/lung tonification. Compared to *Jingui*, they are detailed but often ineffective. Consumption begins with Ying-Wei disharmony progressing to upper/lower damage, ending with Ying-Wei blockage affecting stomach/spleen. Ying is refined grain essence; Wei is fierce grain qi. Wei circulates in yang 25 cycles; Ying circulates in yin 25 cycles, constantly nourishing zang-fu. Disharmony means Ying fails to guard yin (bleeding/essence loss) and Wei fails to secure yang (night sweats/fever). Ying is yin, prone to weakness; Wei is yang, prone to strength. Weakness/strength imbalance leads to blockage. Weak Ying becomes weaker (escaping outward or hiding inward); strong Wei becomes stronger (scorching upward or boiling downward). Organ fluids deplete rapidly, leading to breathlessness, hoarseness, bone痿. Changsha (Zhang Zhongjing) anticipated this: pre-consumption uses Guizhi Jianzhong Tang variations to gently harmonize Ying-Wei; post-consumption uses Dahuang Zhechong Wan variations to urgently unblock Ying-Wei. Later scholars invent kidney/heart/liver/spleen/lung tonics, confusing eyes/ears. Without harmonizing Ying-Wei, even immortal pills cannot nourish organs. Those committed to this path must know harmonizing Ying-Wei is the first principle. Consumption is deficiency of form and essence. *Neijing*: "Form deficiency warms with qi; essence deficiency tonifies with flavor." Zhang’s Jianzhong formulas are warm/mild, sweet/thick, aligning with *Neijing*. Why do moderns ignore them? (Yu Fu!)
Clarifying *Nanjing*’s Discussion on Consumption