用药意解
按黄土汤一方，乃先、后并补之方也。夫先便后血，是脾阳之衰，补脾必先助火，故用附子以壮元阳而补脾阳，又以白术、甘草、黄土，专助脾中之气，最妙在地黄、阿胶、黄芩，甘寒苦寒，以滋脾中之阴，水土合德，火土生成，不寒不燥，乃温和之妙方，可使脾阴立复，而无漏血之虞，何忧此病之不除哉!
按赤小豆当归散一方，乃解毒清热之方也。病人既先血后便，是湿热蕴酿已在大肠，而不在脾胃，大肠血液为热所伤，失其常度。当大便欲出，气机下行，而肠中之血，不啻若沟渠之水，得一团土草以赶之，而流行不已也。此方重在赤小豆，以清肠中之湿热，又佐以当归活血行气之品，自然病可立瘳。仲景又立此方于狐惑门，详《金匮要略》。
问曰：小便下血者，何故？
答曰：小便下血，其要有二，有痛不痛之分，痛则为血淋，照上治淋法治之，不痛则为尿血，多由脾中之阳不能摄脾中之阴血，流注阑门，（秘）〔泌〕清别浊之处，与水谷之湿气，同渗入膀胱，而与尿俱出，故曰尿血。饮食定然减少，人困无神，法宜理中汤加桂元，或甘草干姜汤加五味，以复脾中阴阳，自然尿血不作。若渴喜饮冷，善消食者，则为胃中风火妄动，逼血下行，法宜清胃，如人参白虎汤之类。亦有心移热于小肠，而致血下行者，法宜清心，如导赤散之类。
亦有冲、任有伏热，逼血而致者，法宜清热，如赤小豆当归散，小柴胡加芩、连之类是也。学者即在上下四旁搜求病情，便可识也。
问曰：反胃之病，起于何因？
答曰：反胃者，胃中之气，逆而不下也。有因胃火上冲，阻其下行之机者，法宜下夺，如大、小承气等汤之类是也。有因胃阳不足，中寒顿起，蔽其下行之机者，法宜温中降逆，如理中汤加吴萸、半夏之类是也。有冲、任气逆，挟肝气而致食上逆者，法宜疏肝、降逆，如大半夏汤、小柴胡汤加吴萸、半夏之类是也。有朝食而暮吐者，下元无火不能薰蒸脾胃也，法宜补火，如吴茱萸汤、吴萸四逆汤之类是也。有食而即吐者，胃气不降，因火上冲也，法宜清胃、降逆，如人参白虎重加半夏之类是也。有为胃槁而作，贲门不展者，法宜柔润，如启（隔）〔膈〕饮之类是也。总而言之，反胃是一个逆字，虽十二经皆能致逆，不出阴阳两法，用药之妙，在人变通。
答曰：自汗、盗汗者，阴、阳两虚之候也。其说有二，诸书称自汗为阳虚，盗汗为阴虚，总未畅言其旨，余特为解之。夫阳虚自汗者，是卫外之阳不足，而不能统卫外之血液也，大象从¤|；盗汗为阴虚，是阴不足，而阴中之火浮于外，血亦随之外出，大象从¤￥。人身立命，就是这二物。凡人昼起目张从¤|，则真气行于阳分，阴在内而阳在外，阳不足则不能统内之阴，故自汗出；夜卧目瞑从¤￥，则真气行于阴分，阴在外而阳在内，阴不足，则真气上浮，而液随之，故盗汗作，此二汗之实据也。自汗者法宜补阳，如建中加附子汤、芪附汤之类是也；盗汗者法宜补阴，如参枣汤、补血汤之类是也。亦有阳盛而逼阴于外者，如阳明之白虎症是也；亦有阴盛逼阳于外者，如厥阴之四逆回阳是也。汗症虽多，不出此列。
答曰：消症生于厥阴，风木主气，盖以厥阴下木而上火，风火相煽，故生消渴诸症。消者化之速，如风前之烛，易于化烬。诸书称渴而多饮者为上消，为心包之火挟肝风而上刑于肺，肺金受克，不能资其化源，海枯水涸，不能上升，欲乞外水为援，故渴而多饮，古人用人参白虎汤以救之。心包之火挟肝风而刑于胃，胃中风火相煽，食入犹如转轮，食而易饥，故为中消，以调胃承气汤治之。心包之火挟肝风而搅动海水，肾气不能收摄，遂饮一溲二而为下消，以大剂麦味地黄汤治之。此皆对症之方，法可遵从。更有先天真火浮游于上，而成上消，浮游于中，而成中消，浮游于下，而成下消，即以辨阳虚诀辨之，法宜导龙归海，如潜阳、封髓二丹，或四逆、白通，皆可酌用。
查此病缘因风、火为本，厥阴风木在下，厥阴心包在上，风借火势，火借风威，澈上澈下，而消症从此生矣。但治其火，火熄而风亦熄；治其风，风散而火亦亡。推其至极，风即是气，气即是火，以一火字统之便了，即以一风字括之亦可。风字宜活看，一年六气，即是六风，佛家以风轮主持大世界，人之一呼一吸，便是风，离风人即死，人活风犹鱼之活水，鱼离水顷刻即死，学者须知。
问曰:吐蛔之症，起于何因？
答曰:吐蛔之症，生于湿热，化于厥阴。盖以厥阴者，生生化化之首也。胎卵湿化四生，形体固属不同，推其旨归，俱从一片春风鼓荡，万物赖以化生。仲景列蛔虫于厥阴，虽道一个虫字，隐隐将天地化生万物机关，露其圭角也。要知人即百虫之长，天地包罗万物，人身一小天地，却含天地之至理。故孟子云：万物皆备于我，岂特化生一虫而已哉。故病有千端，漫云易为窥测，苟能识得阴、阳两字，而万变万化之机，亦可由此而推也。仲景剖晰三阴、三阳，配六经以明乾坤之功用，各部发病不同。此症小儿居多，由于过食生冷，损伤脾胃，脾胃受伤，不能传运水谷之湿气，积湿生热，得肝风鼓舞，而蛔虫食虫遂生矣。故曰蛔虫禀风木之气所化也。仲景立乌梅丸一方以主之。
乌梅三百枚细辛六两干姜十两黄连一斤川椒四两当归四两桂枝六两附子六两人参六两黄柏六两
用药意解
按乌梅丸一方，乃寒热互用，补肝燥湿杀虫之方也。夫手厥阴居上主心包，足厥阴居下主肝木，其为病消渴，气上冲心，心中疼热，饥而不欲食，食则吐蛔，下之利不止，此本经手足全体为病提纲。至于虫症，论其一端也。推其生虫之源，由于风木所化，仲景立乌梅丸一方，并非专为虫设，凡属厥阴之为病，皆可服也。然虫多因内有湿热，挟肝木之气而化生，木曰曲直，曲直作酸，酸乃木之味，木性喜酸，木为至阴之脏，一阳在下，其卦象为。木气不舒，一阳之气上浮，而与湿热混合，上撞则心疼，侮土则不食，吐蛔尚轻，下利为重。仲景着重乌梅，取大酸之气，以顺木之性，佐以桂、附、辛、姜、川椒，一派辛热之品，导一阳之气下降，又能温中杀虫。复得连柏泻心包无形之热，更兼燥湿，苦寒药品，惟此二味，能清能燥。继以参归，滋养脾阴，庶几虫去而中土立复，厥阴之气畅达而无滞机矣。
问曰：癫痫起于何因？
答曰：癫痫二症，缘由先天真阳不运，寒痰阻塞也。夫癫者，神之乱也，痫者，痰之阻也。二症大同小异，癫者言语重复不止，痫者不言不语若痴。按人身立命，无非活一口真气，真气一足，万窍流通，一切阴邪，无从发起，真气一衰，寒湿痰邪顿生，阳虚为痰所扰，则神志不清，顽痰流入心宫，则痫呆并起。古人立五痫之名，因其有作羊犬猪牛马声之情形，以决痫之由来也。以余所论，真气衰为二病之本，痰阻是二病之因，治二症贵宜峻补元阳，元阳鼓动，阴邪痰湿立消，何癫痫之有乎？
至于实际治疗，则须视具体情况而定。
答曰：关格者，气之有升无降也。前贤云：上不得入为格，下不得出为关，为中枢不运所致。又云：食不得入，是有火也；下不得出，是有寒也。喻嘉言先生之进退黄连汤，即可用于此病。余谓上不得入，胸有逆也；下不得出，火不降也。人身以气血两字为主，气机运转，百脉流通，关窍开阖有节。今病人气机有升无降，全是一个逆字为主。
食不得入，未必尽皆是火；下不得出，未必尽皆是寒。务要审察的确。
若唇口红活，舌黄喜冷，脉息有神，精神不倦，则是阳旺火逆，以致气之有升无降也，但去其火之逆，则气机自然下降，气机降而下窍自开也。若病人唇口面舌青白无神，则为阴气上干为逆，阴盛则阳衰，即不能化下焦之阴，故下窍闭而不开也。火逆而致者，法宜泻火，以大承气汤主之。阴寒上逆而致者，法宜温中降逆，以吴萸四逆汤主之。
问曰：怔忡起于何因？
答曰：此心阳不足，为阴邪所干也。夫心者，神之主也，心君气足，则百魅潜踪，心君气衰，则群阴并起。今病人心内怔忡，怔忡者，不安之象也。阳虚之人，心阳日亏，易为阴邪所侮，上侮故心不安，觉有忡之者，忡乃自下而上之谓，明明阴邪自下而上为殃，非大补心阳不可，方用桂枝龙骨牡蛎汤，再重加附子。亦有水停心下而作悸者，悸亦心动不安之貌，与怔忡相同，怔忡重在心阳不足，悸则重在水停心下，必有水声为据。水停甚者，心下痛峻，仲景主以十枣汤，悸而不痛，芩桂术甘汤，悸而兼喘咳者，小青龙汤。芩桂术甘汤见阳虚门。
桂枝一两白芍六钱龙骨四钱牡蛎四钱甘草二钱生姜五钱大枣六枚附子四钱
麻黄六钱白芍六钱细辛六钱干姜六钱甘草六钱桂枝六钱半夏半升五味半升
用药意解
按桂枝龙骨牡蛎汤一方，乃调和阴阳，交通上下之方也。夫此方乃桂枝汤加龙骨、牡蛎耳。桂枝本方，乃调和阴阳之第一方，凡气血不调之人，外感易生，内伤亦易生，仲景立此方内外通治，不专重在发汗一节也。果有外邪伤及太阳营、卫，闭其气、血外出之机，遏郁而为热为疼，取此方协和阴阳，鼓动运行之机，俾外入者，仍从外出，故一汗而病可立解。若无外邪，而用桂枝汤，必不出汗，何也？气机原未闭塞，血液畅流，何汗之有？此方本意，非专为太阳而设，实为阴阳不调而设，要知阴阳调和之人，六邪不侵，七情不损。阳不调之人，必有阳不调之实据，以辨阳虚法辨之；阴不调之人，必有阴不调之实据，以辨阴虚法辨之。阳不调之人，用此方，桂、甘、姜、枣宜重，稍加白芍以敛阴；阴不调之人，芍药、甘、枣宜重以调阴，少加桂以宣阳。阴阳两不足之人，分两平用，彼此不偏，此立法之苦心，亦变通之道。如大、小建中与此方，皆桂枝汤之变局也。识得阴阳至理者，始信余非妄说也。今加龙、牡二物，又加附子，以治怔忡，取龙、牡有情之物，龙禀阳之灵，牡禀阴之灵，二物合而为一，取阴、阳互根之意，加附子者，取其助真火以壮君火也。君火壮而阴邪立消，怔忡自然不作矣。此方功用最多，治遗精更妙，世人谓龙、牡濇精，失二物之性，并失立方之意也。
按十枣汤一方，乃决堤行水第一方也。本方原因风寒伤及太阳之气，太阳主寒水，气机闭塞，水道不利，逆行于上，聚于心下，水火相搏，故作疼，非五苓散可治。盖五苓之功独重在下，此刻非直决其水，为害匪轻，故取芫花、大戟、甘遂三味苦寒辛散之品，功专泻水行痰。又虑行之太烈而伤中。欲用甘草以守中，甘草与甘遂相反，用之恐为害。仲景故不用甘草，而择取与甘草相同而不与甘遂相反者，莫如大枣。大枣味甘，力能补中，用于此方，行水而不伤中，逐水而不损正，立法苦心，真是丝丝入彀之方也。
按小青龙一方，乃发汗、行水之方也。因太阳表邪未解，以致水气不行，聚于心下，为咳、为喘、为悸，是皆水气上逆之咎也。今得麻、桂、细辛，发太阳之表，行少阴之水，（甘）〔干〕姜、半夏、五味，降上逆之水下行，甘草补土，白芍敛阴，最为妥切。此方重在解表，表解而水自不聚，以龙名汤。是取麻黄轻清发汗行水，如龙之得雨水而飞腾变化莫测也。岂果若龙哉？
问曰：妇女另列一科何也？
地黄八钱，白术一两，附片一两，阿胶八钱，黄芩五钱，甘草八钱，黄土二两。
用药意解
按黄土汤这一方剂，是先后并补的方子。凡是先大便后出血，这是脾阳衰弱，补脾必须先助火，所以用附子来壮元阳而补脾阳，又用白术、甘草、黄土，专门辅助脾中的气，最妙的是地黄、阿胶、黄芩，甘寒苦寒，用来滋脾中的阴，水土合德，火土相生，不寒不燥，是温和的妙方，可以使脾阴立刻恢复，而没有漏血的忧虑，何必担忧这种病不能消除呢！
按赤小豆当归散这一方剂，是解毒清热的方子。病人既然先出血后大便，说明湿热蕴酿已经在大肠，而不在脾胃，大肠血液被热邪所伤，失去了常态。当大便想排出时，气机下行，而肠中的血，就像沟渠里的水，得到一团土草堵塞，从而流动不止。这个方子重在赤小豆，用来清肠中的湿热，又佐以当归活血行气的药物，自然病可以立刻痊愈。仲景又将此方列在狐惑篇中，详见《金匮要略》。
问：小便下血，是什么原因？
答：小便下血，关键有两点，有痛和不痛的区别，痛的就是血淋，按照上面治疗淋证的方法治疗；不痛的就是尿血，多由脾中的阳气不能统摄脾中的阴血，流注到阑门（秘）〔泌〕清别浊的地方，与水谷的湿气一起渗入膀胱，与尿液一起排出，所以叫尿血。饮食一定减少，人困倦没有精神，治法适宜理中汤加桂圆，或者甘草干姜汤加五味子，来恢复脾中的阴阳，自然尿血就不会发作。如果口渴喜欢喝冷饮，善于消化食物，就是胃中风火妄动，逼迫血液下行，治法适宜清胃，如人参白虎汤之类。也有心将热移于小肠，而导致血液下行的，治法适宜清心，如导赤散之类。
也有冲脉、任脉有伏热，逼迫血液导致的，治法适宜清热，如赤小豆当归散，小柴胡汤加黄芩、黄连之类是也。学者只要在上下四旁搜求病情，就可以认识了。
问：反胃的病，起因是什么？
答：反胃，是胃中的气逆乱而不下降。有因胃火上冲，阻碍其下行的机制的，治法适宜攻下夺实，如大承气汤、小承气汤等方剂是也。有因胃阳不足，中寒突然兴起，遮蔽其下行的机制的，治法适宜温中降逆，如理中汤加吴茱萸、半夏之类是也。有冲脉、任脉气逆，挟带肝气导致食物上逆的，治法适宜疏肝、降逆，如大半夏汤、小柴胡汤加吴茱萸、半夏之类是也。有早上吃晚上吐的，是下元无火不能熏蒸脾胃，治法适宜补火，如吴茱萸汤、吴茱萸四逆汤之类是也。有吃了就吐的，是胃气不降，因为火上冲，治法适宜清胃、降逆，如人参白虎汤重加半夏之类是也。有为胃干枯而作的，贲门不舒展的，治法适宜柔润，如启（隔）〔膈〕饮之类是也。总而言之，反胃是一个“逆”字，虽然十二经都能导致逆乱，不出阴阳两种治法，用药的奥妙，在于人的变通。
答：自汗、盗汗，是阴、阳两虚的征候。说法有两种，各书称自汗为阳虚，盗汗为阴虚，总没有透彻阐述其旨意，我特别解释它。所谓阳虚自汗，是卫外的阳气不足，而不能统摄卫外的血液；大象从¤|；盗汗为阴虚，是阴不足，而阴中的火浮越于外，血也随之外出，大象从¤￥。人身立命，就是这二物。凡人白天起床眼睛睁开从¤|，则真气运行于阳分，阴在内而阳在外，阳不足就不能统摄内之阴，所以自汗出；夜晚睡觉眼睛闭合从¤￥，则真气运行于阴分，阴在外而阳在内，阴不足，则真气上浮，而津液随之，所以盗汗发作，这是这两种汗的真实依据。自汗者治法适宜补阳，如建中加附子汤、芪附汤之类是也；盗汗者治法适宜补阴，如参枣汤、补血汤之类是也。也有阳盛而逼迫阴于外的，如阳明病的白虎症是也；也有阴盛逼迫阳于外的，如厥阴病的四逆回阳是也。汗症虽然多，不出这个范围。
答：消渴症生于厥阴，风木主气，大概因为厥阴下木而上火，风火相煽，所以产生消渴诸症。消是化得快，像风前的蜡烛，容易化为灰烬。各书称渴而多饮的为上消，是心包之火挟肝风而上刑于肺，肺金受克，不能资助其化源，海枯水涸，不能上升，想要乞求外水援助，所以渴而多饮，古人用人参白虎汤来救它。心包之火挟肝风而刑于胃，胃中风火相煽，食物进入犹如转轮，食而易饥，所以为中消，用调胃承气汤治疗。心包之火挟肝风而搅动海水，肾气不能收摄，于是喝一溲二而为下消，用大剂量麦味地黄汤治疗。这些都是对症的方子，治法可以遵从。更有先天真火浮游于上，而成上消，浮游于中，而成中消，浮游于下，而成下消，就用辨别阳虚诀来辨别，治法适宜导龙归海，如潜阳丹、封髓丹二方，或者四逆汤、白通汤，都可以酌情使用。
查此病缘因风、火为本，厥阴风木在下，厥阴心包在上，风借火势，火借风威，彻上彻下，而消症从此产生了。但治其火，火熄而风亦熄；治其风，风散而火亦亡。推究其至极，风即是气，气即是火，用一个“火”字统括就可以了，即用一个“风”字概括也可以。“风”字宜活看，一年六气，即是六风，佛家以风轮主持大世界，人的一呼一吸，便是风，离了风人就会死，人活着风犹鱼之活水，鱼离水顷刻即死，学者须知。
问：吐蛔虫的症状，起因是什么？
答：吐蛔虫的症状，生于湿热，化于厥阴。大概因为厥阴，是生生化化的首端。胎卵湿化四生，形体固然属于不同，推究其旨归，都从一片春风鼓荡，万物赖以化生。仲景列蛔虫于厥阴篇，虽然道一个“虫”字，隐隐将天地化生万物的机关，露出其圭角。要知道人即百虫之长，天地包罗万物，人身一小天地，却含天地之至理。所以孟子说：万物皆备于我，岂只是化生一个虫而已哉。所以病有千端，漫云容易窥测，如果能识得阴、阳两个字，而万变万化的机理，也可以由此而推演。仲景剖晰三阴、三阳，配六经以明乾坤的功用，各部发病不同。此症小儿居多，由于过食生冷，损伤脾胃，脾胃受伤，不能传运水谷的湿气，积湿生热，得肝风鼓舞，而蛔虫食虫遂生了。所以说蛔虫禀风木之气所化。仲景立乌梅丸一方来主治它。
乌梅三百枚，细辛六两，干姜十两，黄连一斤，川椒四两，当归四两，桂枝六两，附子六两，人参六两，黄柏六两。
用药意解
按乌梅丸这一方剂，是寒热互用，补肝燥湿杀虫的方子。手厥阴居上主心包，足厥阴居下主肝木，其为病消渴，气上冲心，心中疼热，饥而不欲食，食则吐蛔，下之利不止，这是本经手足全体为病的提纲。至于虫症，论其一端罢了。推究其生虫之源，由于风木所化，仲景立乌梅丸一方，并非专为虫设，凡属厥阴之为病，皆可服。然而虫多因内有湿热，挟肝木之气而化生，木曰曲直，曲直作酸，酸乃木之味，木性喜酸，木为至阴之脏，一阳在下，其卦象为震。木气不舒，一阳之气上浮，而与湿热混合，上撞则心疼，侮土则不食，吐蛔尚轻，下利为重。仲景着重乌梅，取大酸之气，以顺木之性，佐以桂、附、辛、姜、川椒，一派辛热之品，导一阳之气下降，又能温中杀虫。复得连柏泻心包无形之热，更兼燥湿，苦寒药品，惟此二味，能清能燥。继以参归，滋养脾阴，庶几虫去而中土立刻恢复，厥阴之气畅达而无滞机了。
问：癫痫起因是什么？
答：癫痫二症，缘由先天真阳不运，寒痰阻塞。癫者，神的混乱；痫者，痰的阻塞。二症大同小异，癫者言语重复不止，痫者不言不语若痴呆。按人身立命，无非活一口真气，真气一足，万窍流通，一切阴邪，无从发起，真气一衰，寒湿痰邪顿生，阳虚为痰所扰，则神志不清，顽痰流入心宫，则痫呆并起。古人立五痫之名，因其有作羊犬猪牛马声的情形，以决痫的由来。以我所论，真气衰为二病之本，痰阻是二病之因，治二症贵宜峻补元阳，元阳鼓动，阴邪痰湿立刻消除，何癫痫之有乎？
至于实际治疗，则须视具体情况而定。
问：病有关格，是什么意思？
答：关格，是气有升无降。前贤说：上不得入为格，下不得出为关，为中枢不运所致。又说：食不得入，是有火；下不得出，是有寒。喻嘉言先生的进退黄连汤，即可用于此病。我认为上不得入，胸有逆气；下不得出，火不降。人身以气血两字为主，气机运转，百脉流通，关窍开阖有节。现在病人气机有升无降，全是一个逆字为主。
食不得入，未必尽皆是火；下不得出，未必尽皆是寒。务必审察确切。
如果唇口红活，舌黄喜冷，脉息有神，精神不倦，则是阳旺火逆，以致气有升无降，只要去掉火的逆乱，则气机自然下降，气机降而下窍自然开了。如果病人唇口面舌青白无神，则为阴气上干为逆，阴盛则阳衰，即不能化下焦之阴，所以下窍闭而不开。火逆而致的，治法适宜泻火，以大承气汤主治。阴寒上逆而致的，治法适宜温中降逆，以吴茱萸四逆汤主治。
问：怔忡起因是什么？
答：这是心阳不足，被阴邪干扰。心是神的主宰，心君气足，则百魅潜踪，心君气衰，则群阴并起。现在病人心内怔忡，怔忡，是不安的征象。阳虚之人，心阳日亏，易为阴邪所侮，上侮故心不安，觉有忡之者，忡乃自下而上之称，明明阴邪自下而上为殃，非大补心阳不可，方用桂枝龙骨牡蛎汤，再重加附子。也有水停心下而作悸的，悸也是心动不安的样子，与怔忡相同，怔忡重在心阳不足，悸则重在水停心下，必有水声为依据。水停严重的，心下痛剧，仲景主以十枣汤，悸而不痛，用苓桂术甘汤，悸而兼喘咳的，用小青龙汤。苓桂术甘汤见阳虚门。
桂枝一两，白芍六钱，龙骨四钱，牡蛎四钱，甘草二钱，生姜五钱，大枣六枚，附子四钱。
麻黄六钱，白芍六钱，细辛六钱，干姜六钱，甘草六钱，桂枝六钱，半夏半升，五味半升。
用药意解
按桂枝龙骨牡蛎汤这一方剂，是调和阴阳，交通上下方的方子。此方乃桂枝汤加龙骨、牡蛎罢了。桂枝本方，是调和阴阳的第一方，凡气血不调之人，外感易生，内伤亦易生，仲景立此方内外通治，不专重在发汗一节。果有外邪伤及太阳营、卫，闭其气、血外出之机，遏郁而为热为疼，取此方协和阴阳，鼓动运行之机，使外入者，仍从外出，所以一汗而病可立刻解除。若无外邪，而用桂枝汤，必不出汗，为什么呢？气机原未闭塞，血液畅流，何汗之有？此方本意，并非专为太阳而设，实为阴阳不调而设，要知道阴阳调和之人，六邪不侵，七情不损。阳不调之人，必有阳不调的实据，以辨阳虚法辨之；阴不调之人，必有阴不调的实据，以辨阴虚法辨之。阳不调之人，用此方，桂、甘、姜、枣宜重，稍加白芍以敛阴；阴不调之人，芍药、甘、枣宜重以调阴，少加桂以宣阳。阴阳两不足之人，分量平用，彼此不偏，这是立法的苦心，也是变通的道理。如大、小建中与此方，都是桂枝汤的变局。识得阴阳至理的人，才相信我不是胡说。现在加龙、牡二物，又加附子，来治怔忡，取龙、牡有情之物，龙禀阳之灵，牡禀阴之灵，二物合而为一，取阴、阳互根之意，加附子者，取其助真火以壮君火。君火壮而阴邪立刻消除，怔忡自然不发作了。此方功用最多，治遗精更妙，世人谓龙、牡涩精，失二物之性，并失立方之意。
按十枣汤这一方剂，是决堤行水第一方。本方原因风寒伤及太阳之气，太阳主寒水，气机闭塞，水道不利，逆行于上，聚于心下，水火相搏，故作疼，非五苓散可治。盖五苓之功独重在下，此刻非直决其水，为害匪轻，所以取芫花、大戟、甘遂三味苦寒辛散之品，功专泻水行痰。又虑行之太烈而伤中。欲用甘草以守中，甘草与甘遂相反，用之恐为害。仲景故不用甘草，而择取与甘草相同而不与甘遂相反者，莫如大枣。大枣味甘，力能补中，用于此方，行水而不伤中，逐水而不损正，立法苦心，真是丝丝入扣的方子。
按小青龙一方，是发汗、行水的方子。因太阳表邪未解，以致水气不行，聚于心下，为咳、为喘、为悸，这都是水气上逆的罪过。现在得麻、桂、细辛，发太阳之表，行少阴之水，（甘）〔干〕姜、半夏、五味，降上逆之水下行，甘草补土，白芍敛阴，最为妥切。此方重在解表，表解而水自不聚，以龙名汤。是取麻黄轻清发汗行水，如龙之得雨水而飞腾变化莫测。难道果若是龙吗？
问：妇女另列一科为什么？
Radix Rehmanniae Preparata (Shu Di Huang) 8 qian, Rhizoma Atractylodis Macrocephalae (Bai Zhu) 1 liang, Radix Aconiti Lateralis Preparata (Fu Pian) 1 liang, Cortex Colla Corii Asini (E Jiao) 8 qian, Fructus Scutellariae (Huang Qin) 5 qian, Radix Glycyrrhizae Uralensis (Gan Cao) 8 qian, Lutea Terra (Huang Tu) 2 liang.
Chi Xiao Dou Dang Gui San (Red Bean and Angelica Decoction)
Adzuki Bean (Chi Xiao Dou) 3 sheng (i.e., small red bean, not Taiji bean), Radix Angelicae Sinensis (Dang Gui) 10 liang.
Explanation of Medicinal Intent
According to the analysis, Huang Tu Tang (Yellow Earth Decoction) is a formula that tonifies both prior and posterior aspects simultaneously. When bleeding occurs after defecation, it indicates the decline of Spleen Yang. To tonify the Spleen, one must first assist Fire; thus, Radix Aconiti Lateralis Preparata (Fu Zi) is used to strengthen Primordial Yang and tonify Spleen Yang. Additionally, Rhizoma Atractylodis Macrocephalae (Bai Zhu), Radix Glycyrrhizae Uralensis (Gan Cao), and Lutea Terra (Huang Tu) are used to specifically assist Qi within the Spleen. The most ingenious aspect lies in the use of Radix Rehmanniae Preparata (Shu Di Huang), Cortex Colla Corii Asini (E Jiao), and Fructus Scutellariae (Huang Qin). Their sweet-cold and bitter-cold properties nourish Yin within the Spleen. Water and Earth harmonize their virtue, Fire and Earth generate each other; neither cold nor dry, it is a mild and wonderful formula. It can instantly restore Spleen Yin without the risk of hemorrhage. Why worry about this disease not being cured?
Regarding Chi Xiao Dou Dang Gui San (Red Bean and Angelica Decoction), it is a formula for resolving toxicity and clearing heat. If a patient bleeds before defecating, it indicates that damp-heat has accumulated in the Large Intestine, not in the Stomach or Spleen. The blood in the Large Intestine is injured by heat, losing its normal state. When the urge to defecate arises, Qi mechanism moves downward, but the blood in the intestines flows incessantly like water in a ditch blocked by soil and grass. This formula focuses on Adzuki Bean (Chi Xiao Dou) to clear damp-heat in the intestines, assisted by Radix Angelicae Sinensis (Dang Gui) to invigorate blood and move Qi. Naturally, the disease will be cured immediately. Zhang Zhongjing also included this formula in the section on Hu Huo Disease (Foxes' Disease); see *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) for details.
Question: What is the cause of hematuria (blood in urine)?
Answer: Hematuria has two key distinctions: painful and painless. Painful hematuria is Xue Lin (Blood Strangury), treated according to methods for treating Lin syndrome. Painless hematuria is Niao Xue (Urinary Bleeding), often caused by Spleen Yang failing to control Spleen Yin-blood, which flows into the Lan Men (Gate of the阑), the area separating clear from turbid fluids, and mixes with dampness from food and drink to seep into the Bladder, exiting with urine. Consequently, appetite decreases, and the person feels fatigued and listless. The treatment should employ Li Zhong Tang (Regulate the Middle Decoction) with Longan Arillus (Gui Yuan) or Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction) with Schisandra Chinensis Fructus (Wu Wei Zi) to restore Spleen Yin and Yang, naturally stopping urinary bleeding. If there is thirst with a preference for cold drinks and good digestion, it indicates Wind-Fire stirring wildly in the Stomach, forcing blood downward. The treatment should clear the Stomach, such as using Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction). Alternatively, Heart Heat transferring to the Small Intestine may cause blood to flow downward; treat by clearing the Heart, such as with Dao Chi San (Direct Outward Red Powder).
There are also cases where latent heat in the Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel) forces blood out; treat by clearing heat, such as with Chi Xiao Dou Dang Gui San (Red Bean and Angelica Decoction) or Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with Huang Qin (Scutellaria) and Huang Lian (Coptis). Scholars should search for the condition's signs in all directions to recognize it.
Question: What causes Fan Wei (Reverse Stomach/Regurgitation)?
Answer: Fan Wei (Reverse Stomach) is characterized by Stomach Qi reversing instead of descending. Causes include:
1. Stomach Fire rushing upward, obstructing descent: Treat by purging and draining, such as with Da Cheng Qi Tang (Major Order the Qi Decoction) or Xiao Cheng Qi Tang (Minor Order the Qi Decoction).
2. Insufficient Stomach Yang causing sudden Middle Cold, obscuring descent: Treat by warming the Middle and directing rebellious Qi downward, such as with Li Zhong Tang (Regulate the Middle Decoction) added with Evodia Fruit (Wu Yu) and Pinellia Tuber (Ban Xia).
3. Rebellious Qi in Chong and Ren vessels, carrying Liver Qi causing food to regurgitate: Treat by soothing the Liver and directing rebellious Qi downward, such as with Ban Xia Hou Po Tang variants or Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with Wu Yu and Ban Xia.
4. Eating in the morning and vomiting at night: Caused by lack of Fire in the Lower Origin unable to steam and digest Spleen and Stomach. Treat by tonifying Fire, such as with Wu Zhu Yu Tang (Evodia Decoction) or Wu Yu Si Ni Tang (Evodia Four Reversal Decoction).
5. Vomiting immediately after eating: Stomach Qi fails to descend due to Fire rushing upward. Treat by clearing the Stomach and directing rebellious Qi downward, such as with Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) heavily adding Ban Xia.
6. Dryness of the Stomach causing the贲门 (Cardia) to fail to open: Treat by moistening and softening, such as with Qi Ge Yin (Open the Obstruction Drink).
In summary, Fan Wei is essentially "Rebellion." Although all twelve meridians can cause rebellion, it falls under Yin or Yang treatments. The subtlety of medication lies in flexible application.
Question: What causes Zi Han (Spontaneous Sweating) and Dao Han (Night Sweating)?
Answer: Zi Han and Dao Han are signs of deficiency in both Yin and Yang. Books often call spontaneous sweating Yang deficiency and night sweating Yin deficiency, but do not fully explain the essence. I clarify: Spontaneous sweating due to Yang deficiency means insufficient Defensive Yang cannot control Defensive blood. Night sweating due to Yin deficiency means insufficient Yin allows Fire within Yin to float outward, taking blood with it. Human life relies on these two. During the day, when eyes are open, True Qi circulates in the Yang aspect, Yin inside, Yang outside. If Yang is insufficient, it cannot control internal Yin, causing spontaneous sweating. At night, when eyes close, True Qi circulates in the Yin aspect, Yin outside, Yang inside. If Yin is insufficient, True Qi floats upward, bringing fluids with it, causing night sweating. This is the basis. For spontaneous sweating, treat by tonifying Yang, e.g., Jian Zhong Jia Fu Zi Tang (Middle-Building Plus Aconite Decoction) or Qi Fu Tang (Astragalus and Aconite Decoction). For night sweating, treat by tonifying Yin, e.g., Shen Zao Tang (Ginseng and Jujube Decoction) or Bu Xue Tang (Tonify Blood Decoction). There are also cases of Excess Yang forcing Yin outward (e.g., Yangming Bai Hu Syndrome) or Excess Yin forcing Yang outward (e.g., Jueyin Si Ni Recovery Yang). Though many sweat disorders exist, they fall within these categories.
Answer: Xiao Ke (Wasting-Thirst) originates in Jue Yin, governed by Wind-Wood. Jue Yin has Wood below and Fire above; Wind and Fire stir each other, generating Wasting-Thirst. "Xiao" means rapid transformation, like a candle in wind. Books classify excessive drinking as Upper Xiao, caused by Pericardium Fire carrying Liver Wind punishing Lung Metal, depleting source fluids, leading to thirst. Treat with Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction). Pericardium Fire carrying Liver Wind punishing Stomach Fire causes Middle Xiao (rapid hunger), treated with Tiao Wei Cheng Qi Tang (Regulate the Bowels Order the Qi Decoction). Stirring Kidney Essence causes Lower Xiao (drinking one, urinating two), treated with large doses of Mai Wei Di Huang Tang (Lily Seed and Schisandra Rehmannia Decoction). These are symptomatic formulas. However, if Primordial Fire floats upward/middle/lower causing Upper/Middle/Lower Xiao, identify Yang deficiency and use Dao Long Gui Hai (Guide Dragon Return to Sea) method, such as Qian Yang Dan (Subdue Yang Pill) or Feng Sui Dan (Seal Marrow Pill), or Si Ni Tang (Four Reversal Decoction) and Bai Tong Tang (White Pass Decoction).
This disease's root is Wind and Fire. Jue Yin Wind-Wood is below, Pericardium is above. Wind borrows Fire's power, Fire borrows Wind's might. Treating Fire extinguishes Wind; treating Wind disperses Fire. Ultimately, Wind is Qi, Qi is Fire. View "Wind" flexibly; the Six Qi of the year are Six Winds. Breathing is Wind. Without Wind, humans die. Scholars must understand this.
Question: What causes vomiting of roundworms?
Answer: Vomiting roundworms arises from damp-heat transforming in Jue Yin. Jue Yin is the beginning of generation. All forms of life depend on the stirring of Spring Wind. Zhang Zhongjing places roundworms in Jue Yin, hinting at the mechanism of Heaven and Earth generating all things. Humans are the leaders of hundred insects; the body is a small universe containing profound truths. Mencius said, "All things are complete within me." Diseases are myriad, but understanding Yin and Yang allows deduction of changes. Zhang Zhongjing analyzed Three Yin and Three Yang, matching Six Meridians to clarify Heaven and Earth functions. This symptom is common in children, caused by overeating raw/cold foods damaging Spleen/Stomach. Damaged Spleen/Stomach cannot transport dampness, accumulating damp-heat. Stirred by Liver Wind, roundworms are generated. Thus, roundworms are transformed from Wind-Wood Qi. Zhang Zhongjing established Wu Mei Wan (Mume Pill) to treat it.
Wu Mei Wan (Mume Pill)
Fructus Mume (Wu Mei) 300 pieces, Radix Asari (Xi Xin) 6 liang, Rhizoma Zingiberis Preparatum (Gan Jiang) 10 liang, Radix Coptidis (Huang Lian) 1 jin, Fructus Zanthoxyli (Chuan Jiao) 4 liang, Radix Angelicae Sinensis (Dang Gui) 4 liang, Ramulus Cinnamomi (Gui Zhi) 6 liang, Radix Aconiti Lateralis Preparata (Fu Zi) 6 liang, Radix Ginseng (Ren Shen) 6 liang, Cortex Phellodendri (Huang Bo) 6 liang.
Explanation of Medicinal Intent
Wu Mei Wan uses cold and hot herbs together to tonify the Liver, dry dampness, and kill parasites. Hand Jue Yin governs Pericardium above; Foot Jue Yin governs Liver Wood below. Symptoms include wasting-thirst, Qi rushing to the heart, heart pain/heat, hunger without desire to eat, vomiting roundworms upon eating, and diarrhea if purged. This is the outline for whole-body Jue Yin disease. Parasites are just one aspect. The source is Wind-Wood transformation. Wu Mei Wan is not solely for parasites but for all Jue Yin diseases. Parasites arise from internal damp-heat carrying Liver Wood Qi. Wood is "curved and straight," producing sour taste. Sour is Wood's flavor. Wood is a Yin organ with one Yang below (Zhen Hexagram). Uncomfortable Wood Qi causes floating Yang to mix with damp-heat, hitting the heart (pain), insulting Earth (no appetite), vomiting roundworms (mild), or diarrhea (severe). Zhang Zhongjing emphasizes Wu Mei for its strong sourness to follow Wood's nature. Assisted by Gui Zhi, Fu Zi, Xi Xin, Gan Jiang, Chuan Jiao (pungent-hot), it guides Yang downward, warms the Middle, and kills parasites. Huang Lian and Huang Bo clear Pericardium heat and dry dampness. Ren Shen and Dang Gui nourish Spleen Yin. Thus, worms leave, Middle Earth recovers, and Jue Yin Qi flows freely.
Question: What causes Dian Xian (Epilepsy)?
Answer: Dian and Xian stem from failure of Primordial Yang to circulate and obstruction by Cold-Phlegm. Dian is spirit confusion; Xian is phlegm obstruction. Dian involves repetitive speech; Xian involves muteness/stupor. Life depends on True Qi. Abundant True Qi unblocks orifices and repels Yin pathogens. Declining True Qi generates Cold-Damp-Phlegm. Yang deficiency disturbed by phlegm leads to unclear spirit; stubborn phlegm entering the Heart Palace causes Xian and stupor. Ancients named Five Epilepsies based on animal sounds. I argue True Qi decline is the root, phlegm obstruction is the cause. Treatment requires strongly tonifying Primordial Yang. Once moved, Yin pathogens and phlegm-damp vanish. Actual treatment depends on specific conditions.
Question: What is Guan Ge (Obstruction and Reflux)?
Answer: Guan Ge is Qi rising without descending. Ancients say: Upper inability to enter is Ge; lower inability to exit is Guan, caused by central pivot failure. Food refusal implies Fire; exit refusal implies Cold. Yu Jiayan's Jin Tui Huang Lian Tang (Advance-Retreat Coptis Decoction) applies here. I say: Upper refusal is chest rebellion; lower refusal is Fire failing to descend. Body relies on Qi and Blood. Qi movement ensures meridian flow and orifice opening/closing. Now, Qi only rises, entirely rebellious.
Food refusal isn't always Fire; exit refusal isn't always Cold. Examine carefully.
If lips/tongue are red/vivid, tongue yellow, prefers cold, pulse energetic, spirit alert: Yang excess/Fire rebellion causing Qi rise-only. Remove Fire rebellion, Qi descends, lower orifice opens.
If lips/tongue are blue-white, listless: Yin Qi invading upward, Yin excess/Yang decline failing to transform Lower Jiao Yin, closing lower orifice.
Fire rebellion: Purge Fire with Da Cheng Qi Tang (Major Order the Qi Decoction).
Yin-Cold rebellion: Warm Middle and direct rebellion with Wu Yu Si Ni Tang (Evodia Four Reversal Decoction).
Question: What causes Zheng Chong (Palpitations/Anxiety)?
Answer: This is Heart Yang deficiency interfered with by Yin pathogens. Heart governs Spirit. Strong Heart Qi hides demons; weak Heart Qi allows Yin pathogens to rise. Zheng Chong is uneasiness. Yang deficiency leads to declining Heart Yang, easily insulted by Yin. Yin rises from below, disturbing the Heart. Must strongly tonify Heart Yang. Use Gui Zhi Long Gu Mu Li Tang (Cinnamon Twig, Dragon Bone, and Oyster Shell Decoction) plus heavy Fu Zi. Palpitations (Ji) due to Water retention under the Heart are similar but focus on water retention (audible water sounds). Severe water retention with pain: Shi Zao Tang (Ten Date Decoction). Palpitation without pain: Ling Gui Zhu Gan Tang (Poria, Cinnamon, Atractylodes, and Licorice Decoction). Palpitation with cough/wheezing: Xiao Qing Long Tang (Minor Green Dragon Decoction). See Yang Deficiency section for Ling Gui Zhu Gan Tang.
Gui Zhi Long Gu Mu Li Tang (Cinnamon Twig, Dragon Bone, and Oyster Shell Decoction)
Ramulus Cinnamomi (Gui Zhi) 1 liang, Radix Paeoniae Alba (Bai Shao) 6 qian, Os Draconis (Long Gu) 4 qian, Concha Ostreae (Mu Li) 4 qian, Radix Glycyrrhizae Uralensis (Gan Cao) 2 qian, Rhizoma Zingiberis Recens (Sheng Jiang) 5 qian, Fructus Ziziphi Jujubae (Da Zao) 6 pieces, Radix Aconiti Lateralis Preparata (Fu Zi) 4 qian.
Shi Zao Tang (Ten Date Decoction)
Radix Genkwa (Yuan Hua) 2 qian, Radix Kansui (Gan Sui) 1 qian, Radix Euphorbiae Humifusa (Da Ji) 1 qian, Fructus Ziziphi Jujubae (Da Zao) 10 pieces.
Xiao Qing Long Tang (Minor Green Dragon Decoction)
Herba Ephedrae (Ma Huang) 6 qian, Radix Paeoniae Alba (Bai Shao) 6 qian, Radix Asari (Xi Xin) 6 qian, Rhizoma Zingiberis Preparatum (Gan Jiang) 6 qian, Radix Glycyrrhizae Uralensis (Gan Cao) 6 qian, Ramulus Cinnamomi (Gui Zhi) 6 qian, Rhizoma Pinelliae (Ban Xia) half sheng, Fructus Schisandrae (Wu Wei Zi) half sheng.
Explanation of Medicinal Intent
Gui Zhi Long Gu Mu Li Tang harmonizes Yin and Yang, connecting upper and lower. It is Gui Zhi Tang plus Long Gu and Mu Li. Gui Zhi Tang is the premier formula for harmonizing Yin and Yang. For those with disharmonious Qi/Blood, external pathogens and internal injuries arise easily. Zhang Zhongjing created it for both exterior and interior, not just for sweating. If external pathogens injure Taiyang Ying and Wei, blocking Qi/Blood exit, causing heat/pain, this formula harmonizes Yin/Yang, promotes circulation, allowing pathogens to exit via sweat. Without external pathogens, Gui Zhi Tang won't cause sweating because Qi/Blood flow freely. Its intent is for Yin/Yang disharmony, not just Taiyang. Harmonized individuals resist six evils and seven emotions. Disharmonious Yang needs Yang-deficiency identification; disharmonious Yin needs Yin-deficiency identification. For Yang disharmony, increase Gui, Gan, Jiang, Zao, add slight Bai Shao to astringe Yin. For Yin disharmony, increase Bai Shao, Gan, Zao to regulate Yin, add slight Gui Zhi to diffuse Yang. For both deficient, use equal parts. This shows careful legislation and flexibility. Da/Xiao Jian Zhong Tang are variations of Gui Zhi Tang. Understanding Yin/Yang proves my words are not baseless. Adding Long Gu, Mu Li, and Fu Zi treats Zheng Chong. Long Gu (Dragon Bone) embodies Yang spirit; Mu Li (Oyster Shell) embodies Yin spirit. Together, they represent mutual rooting of Yin/Yang. Fu Zi assists Primordial Fire to strengthen Ministerial Fire. Strong Ministerial Fire eliminates Yin pathogens, stopping palpitations. This formula also treats spermatorrhea excellently. Critics claiming Long Gu/Mu Li astringe essence misunderstand their nature and intent.
Shi Zao Tang (Ten Date Decoction) is the premier formula for draining water like breaking a dam. Caused by Wind-Cold injuring Taiyang Qi. Taiyang governs Cold Water. Blocked Qi mechanism obstructs water passages, reversing upward, gathering under the Heart, clashing Water and Fire causing pain. Wu Ling San (Five-Ling Powder) acts mainly on the Lower Jiao and is insufficient here. Direct drainage is needed. Yuan Hua, Da Ji, Gan Sui are bitter-cold/pungent-dispersing, specializing in draining water and phlegm. To prevent damage to the Middle, one might use Gan Cao, but Gan Cao conflicts with Gan Sui. Zhang Zhongjing chose Da Zao (Jujube) instead, which tonifies the Middle, protects against harshness while draining water, preserving healthy Qi. This is meticulous legislation.
Xiao Qing Long Tang (Minor Green Dragon Decoction) releases the exterior and moves water. Due to unresolved Taiyang exterior pathogens, Water Qi stagnates, gathering under the Heart, causing cough, wheeze, palpitations. Ma Huang, Gui Zhi, Xi Xin release Taiyang exterior and move Shaoyin water. Gan Jiang, Ban Xia, Wu Wei Zi direct rebellious water downward. Gan Cao tonifies Earth, Bai Shao astringes Yin. Most appropriate. Focus is releasing exterior; once released, water doesn't gather. Named "Dragon" because Ma Huang's light/clear sweating/water-moving action is like a dragon soaring with rain. Is it really a dragon?
Question: Why is Women's Medicine listed as a separate specialty?