答曰：男子禀乾之体，女子禀坤之质，乾主施化，坤主生成，以其有胎前、产后、经期之殊耳。余病皆同，惟此三者，动关生死，不可不知，不可不亟讲也。先以经期言之。经期者何？经者常也，期者信也，女子二七而天癸至，经脉始通，经血一月下行一次，以象月之盈而缺，缺而复盈，循环不已。但人之禀赋不齐，盛衰损伤不一，故有先期而血即下行者，气之有馀也，气有馀便是火，法宜清热。有后期而血始下行者，气之不足也，气不足便是寒，法宜温中。中也者，生化精血之所也，言调经之大主脑也。他如经水来而色淡者，火化不足也，法宜补火；经水来而黑紫块者，火化太过也，法宜清热；经来过多而心烦者，血骤虚也，法宜养血；经来少而腹痛者，气之滞也，法宜调气；经行衍期，淋漓不断者，气衰脾弱，不能统约也，法宜甘温扶阳；经过后而腹空痛者，气血之骤虚也，法宜调和气血；当期过月而不行者，有妊有不妊也，妊者不必治，不妊者经之闭也。闭者宜开，因气而闭者，法宜行气；因寒而闭者，法宜散寒；因热而闭者，法宜清热；因血枯而闭者，法宜补血。病原不一，审其因而治之。至于带下、崩、漏，妇女之大症也，十有八九。带分五色，不出阴阳，照阴阳辨法治之。凡带症之脉，余阅之甚多，往往两寸浮大无力。两关、两尺细微甚者，是阳竭于上，而下元无火也，以温中回阳法治之多效。有两寸大实有力，两关滑而两尺细者，心肺移热于下，脾湿下注也，以除湿、清热法治之甚效。崩症与漏症有别，漏者病之浅也，亦将崩之兆也，崩者势大而来如决堤，漏则势小而淋漓不止，二症俱当照阳虚、阴虚辨法治之，便得有馀不足之机关也。至于逆经而吐血者，照上吐血条法辨之，治法自在其中矣。胎前者何？以其夫妇交媾，精血凝聚，二五合一，具生生化化之道，人之性命有始基矣，故曰胎。
俗语云："胎前不宜热"，此语举世信之，而不知非确论也。夫坤厚载物，全赖二气维持，一动一静，阴阳互相化育，元阴化生五脏，合包络则为六也，元阳化生六腑，合之则为十二官也，故曰阳六六，阴六六。阳六六，即乾为天卦，阴六六，即坤为地卦。乾坤化生五行，五行不出二气之中，二气不出五行之内，故曰天数五，地数五。婴儿在母腹中，母呼亦呼，母吸亦吸，十月功圆，性与命立，打破一元，坎、离立极。未生以前，寒、热各别。胎寒不温，胎亦易损；胎热不清，胎亦易堕。以此为准，经旨方畅。前贤有逐月养胎之说，其实在可从、不可从之间。以余细维，阴、阳合一，养于坤宫，此刻十二经经血，无时无刻不在，真不啻北辰居所而众星拱之也。其中有恶阻者，胎初凝结，养于坤宫，土气卒然不舒，故生呕吐等情，法宜温中而行脾气。
有子眩者，胎气之上逼也，法宜平气。有子满者，气之壅也，法宜破滞行气。有子瘖者，胞胎压少阴连舌本之脉络也，法宜升举胎气，如不应，生娩自能言。有子鸣者，因卒伸手取物，母之呼吸，骤不与婴儿接也，法宜掬身片刻以就之。有腹痛小便点滴不出者，胞胎下压膀胱之腑也，法宜升举。有胎尚漏下血者，审是火逼而下行者，法宜清火；审是元阳不足而不能收束者，法宜补阳。有子肿者，水停而不行也，法宜化气行水。有子嗽者，肺气为胎火所逼也，法宜清胎热。有胎不长者，母之气血不足也，法宜大补气血。有挟食而吞酸者，法宜消食。有因外邪闭塞而大热身痛者，照外感六经法治之。有吐泻交作而胎不安者，法宜温中。有大渴饮冷，谵语、大热、汗出、便闭者，法宜攻下。有身冷汗出，人事昏沉，精神困倦，喜极热汤者，法宜回阳。胎前诸症，略举数端，学者宜留心讨究。产后者何？以其婴儿下地，周身百脉开张，努力送出，十二经护胎之血，一齐下注，此刻气血两虚，与常不同，用药不可错误。婴儿下地，即有昏晕而人事不省者，血瘀之不下行而反上也，法宜行瘀。有腹硬而痛剧者，血瘀滞而无阳以运化也，法宜温中行滞。有空疼而腹不硬者，气血之骤虚也，法宜大补气血。有冷汗出而昏晕甚者，阳欲脱也，法宜回阳。有大热、大渴而思冷饮者，血虚阳无所附，而外越也，法宜峻补其血。有顶巅痛头如火焚者，血骤虚，阳无所依，而暴浮于上也，法宜大补其血。
有气喘息高，寒战汗出，身冷者，阴阳不交，阳欲脱也，法宜回阳。
有胎未全而即产者，俗名小产，较正产更甚。正产乃瓜熟自落，得阴阳之正，调养贵乎得宜。小产如生果摘下，损伤太甚，一切诸症，治法与正产同，而调养更宜周密。愚夫愚妇，视为寻常，不知保养，而致死亡者，不胜慨叹也。亦有胎儿死腹中而不下者，必有所伤也，法宜下之。病症亦多，何能尽述？举其大纲，不越规矩，学者再为广览。
至于方药，《济阴纲目》甚详，亦可参看。
问曰：小儿另列一科何也？
答曰：小儿初生下地，不能言语，食则母之精血，即有病症，医家全是猜想，并无几个一见便知。未食五谷者，外感尚多，内伤即少；食五谷者，外感内伤俱有。更有痘、麻，动关生死，所以小儿科之外，又有痘科也。俗云哑科，真是不谬。最可怪者，小儿初生下地，世俗皆用大黄、银花、勾藤、甘草之类，以下胎毒、血粪，余深为不然。
凡人皆禀二气所生，有自然之理，小儿初生，犹若瓜果初出土之萌芽，以冷水灌之不可，以热汤灌之亦不可，生机原是自然，换肚换肠亦是自然，何待大黄、银花之类，以（催）〔摧〕之毒之？只要小儿不偏于寒、热两字，即不可妄施药品，以种病根。苟有胎中受热者，小儿必面赤、唇红，气粗、口热，以苦甘一二味投之便了。有胎中受寒者，小儿必面青，唇、口淡白，气微、口冷，以辛甘一二味投之便了。至于外感一切，务察时令，小儿虽不能言，而发热之有汗、无汗，口热、不热，二便之利、不利，只此数端，亦可以知其病矣。其至要者，太阳主皮肤，统营卫，为第一层，六客中人，必先犯此，学者须知。切勿惑于小儿穉阳之体，原无伤寒之说，不知小儿气轻力薄，正易伤寒也。伤寒二字，四时皆有，盖所谓伤寒者，伤及太阳地界也。太阳本气主寒，六气从太阳而入内，故皆可以名伤寒也。其中有称为惊风者，有称为慢脾风者，是皆不经之论也。余为活人计，不得不直切言之。
所谓惊风者，因小儿发热抽掣，角弓反张，项强、摇头、吐舌，有时卒然掣动，若惊之状，前人不按经旨，见其惊状，即以惊风名之，而不知是外邪客于太阳之经络也。太阳之经络为外邪蔽束，气机不畅，抑郁为热，热甚则风生，而抽掣角弓等情所以有也。此际正当用桂、麻二汤，或麻杏石膏等汤，以解太阳之邪，邪气解而风热即不生，何抽掣等症之有乎？市医遵守惊风一语，更立无数名目，以讹传讹，妄拟一派镇惊祛风逐痰之方，小儿屈死于此者，不知几百亿兆矣。况人身皮肤第一层，属太阳主事，岂有外邪入内，而不伤及者乎？业斯道者，何不于此经三致意也！至于慢脾风者，因小儿素病，调养失宜，饮食不健，自汗、盗汗不觉，呕、吐、泻、利不觉，积之久久，元气日薄，酿成虚极之候，元气虚极，则神无主，不能支持上下四旁，故有战动、发热、汗出不止，似惊之状，其实非惊风也。外验人必无神，面青、唇白，困倦、目瞑，此刻正当大补元阳，元阳气足，则神安而体泰，何动摇之有乎？若以惊风治之，是速其亡也。前人称曰慢脾，因其来之非骤也。论惊多在三阳，乃有余之疴，论慢脾属三阴，乃不足之候。惊风从外感得来，六气须知，气即风也，风字宜活看。慢脾由内伤所积，吐泻汗出，停滞食少，酿久生端，分阴分阳，察之辨之，不可不密，用方用药，补之泻之宜清。此乃活人之业，性命生死攸关之际，学者毋忽视之。更有痘、麻，动关生死，《幼幼集成》，《活幼心法》二书，讲说最详，宜阅。以余拙见，和平、有余、不足，三法尽之矣。但痘出于脏，麻出于腑，痘喜温和，麻喜清解。痘本胎毒，藏于命根，初起由太阳真机鼓动，运毒外出，法宜用桂枝汤调和阴阳，以助太阳外出之气机，使无一毫毒邪之滞于内；次归阳明，血水化为脓浆，未出透时，法宜用升麻葛根汤以解肌，而使毒气发透；已出透时，法宜用理中汤以培中气；中气健旺，易于化血为脓，熟透结疤，欲结疤时，法宜用回阳、封髓等方，使这一点真气复还于内。此四法者，乃顺其阴阳气机出入之道，为治痘用药不易之法也。至于和平之痘，二便、饮食如常，微烧而精神不倦，疮根红活，顶润充盈，颗颗分明，粒粒精光，乃和平第一等痘，勿药有喜。最可忧者，有馀不足两症，有偏馀于气而不足于血者，如气至而血不至之白泡无红根是也；有偏馀于血而不足于气者，如血至而气不至之红泡无脓是也。偏于气而不足于血者，法宜养阴以配阳；偏于血而不足于气者，法宜补阳以配阴。盖有余者气之盈，如暴出，一齐涌出，紫红顶干，焦枯、便闭、烦躁、饮冷，谵语之类，法宜清火养阴，甚极者宜下。不足者气之缩，如慢出，下陷平塌，色嫩、二便自利，饮热、目瞑，困倦已极之类，法宜补火。火即气，补火一字，人多忽略，一味在后天肺气上用药，而不知在人身立命之火种上用药。故近来痘科，一见下陷不足之症，用药总在这参、芪、鹿茸、归、芍，以为大补气血，究竟致死者多，深为可慨也，由其未得仲景之心法耳。观于仲景之用四逆汤，姜、附、草三味，起死回生，易如反掌，非专补立极之火种，何能如斯之速乎？
世医不求至理，以为四逆汤乃伤寒之方，非痘科之方，不知此方正平塌下陷痘症之方，实补火种之第一方也。今人亦有知得此方者，信之不真，认之不定，即用四逆，而又加以参、归、熟地，羁绊附子回阳之力，亦不见效，病家待毙，医生束手，自以为用药无差，不知用药之未当甚矣。麻疹一条，较痘症稍异，麻疹往往兼时气传染而成，为病发热、咳嗽，目如醉人，鼻流清涕，乃将出之候也。太过色紫红，不及则色淡，始终治法，只宜升解清凉发透为主，所有一切变症，总以阴、阳、虚、实四字括之。《幼幼集成》说最妥，兹不赘。
附不解说
俗传出痘一事，余甚不解，沿古及今，俱称痘为胎毒，人人俱要出痘，方可无忧，未出痘者，务要借出痘之苗，以引之外出，取其知是出痘，按痘法治之有准，以免用药错误。此说一开，而婴儿之夭亡者，不啻恒河沙数矣。余深谓不然，人俱要出痘，何以有不放而终身不出者？有放而亦不出者？又何得遽谓人人俱要出痘？即要出痘，亦当听其自然，何必定要用痘以引之哉？窃念人禀二气以立命，风、寒、饮食，一切俱要谨慎，惟恐疏虞，以致外邪深入，有戕生命，独于此痘，何不避之，而偏要使之从鼻窍以入内，明明叫出痘，何尝是痘一定要出哉？人之一身，如一穴空地，种麻即麻，种豆即豆，此理之常，但种疮痘一法，仲景尚且不具，而独于六气立法，盖六气即是六经，主一年之事，循环不已，人身二气不调，六邪始能入内为病，故法可立而病可穷，方可定也。今之痘、麻，又列一科，以其知得痘、麻之始终，如人之种瓜果，而知其结实时也，法虽可从，而陋习不可不急正也。嗟乎！俗染成风，牢不可破，犹人之愚而甘于愚也。余目见邻里小儿，康健嬉嬉，以痘疮之毒苗种之，十数日而即死者，不胜屈指矣。想来不种痘苗，未必即死，虽曰天命，又岂非人事哉!
问曰：外科工专金、疮诸症，其故何也？
答曰：凡一切疮症，皆起于二气不调，气、血偏盛，壅滞流行不畅之过，病原从内出外，以其有金、疮、折骨，化腐生肌一事，稍不同耳。然疮形已具，即当分辨阴、阳，不可忽略。阳症，疮色红肿痛甚，高凸发热，口渴心烦，小便短赤，大便闭结，喜冷，用药重在活血行气，养阴清火为主。阴症，疮色不红活，皮色如常，慢起不痛，或微痛，二便自利，精神短少，用药大补元阳为主。大凡疮症，《内经》云："皆属于火"。人身立命，就是这一个火字，火即气，气有馀便是火，气不足便是寒。气有余之疮，即阳症，必由阻滞而成，用药故要清火养阴，活血行气，方用桂枝汤倍白芍，加麦芽、香附、枝子主之。气不足之疮，即阴症，必由阳不化阴而成，法当大补元阳，方用桂枝汤倍桂，加麦芽、附子、香附主之。此乃调和气血之妙法，原不在芩、连、银花、山甲、大黄之类，专以清火。要知气血壅滞，方得成疮，调气即是行气，调血即是行血，桂枝重在调阳，白芍重在调阴，气有余则阴易亏，故倍芍药加枝子，气不足则阴更盛，而阳愈弱，故倍桂而加附子。学者切勿以此方为伤寒之方，非疮科之方。仲景以此方，冠一百一十三方之首，而曰调和阴阳，试问人身阴阳调和，尚可得生病也否？尚可得生疮也否？若刀伤、折骨，跌打、闪挫，另有治法，又有手法，不与内因同治，故曰外科。
问曰：目病皆原内起，何以另列一科也？
答：男子禀受乾卦之体，女子禀受坤卦之质。乾主施予化育，坤主生成万物，其区别在于胎前、产后及经期不同罢了。其余病症大多相同，唯独这三者关系生死，不可不知，不可不深入研究。先说经期。什么是经期？经是常道，期是信约。女子十四岁时天癸（促进生殖功能发育的物质）至，经脉开始通畅，经血每月下行一次，以象征月亮的盈亏变化，缺了又满，循环不止。但人的禀赋各不相同，盛衰损伤也不一样，所以有的提前来血，这是气有余的表现，气有余就是火，治法应当清热；有的推后来血，这是气不足的表现，气不足就是寒，治法应当温中。中焦是生化精血的场所，这是调经的关键所在。其他的如经血色淡的，是火化不足，治法宜补火；经血色黑紫有块的，是火化太过，治法宜清热；经量过多且心烦的，是血突然亏虚，治法宜养血；经量少且腹痛的，是气机阻滞，治法宜调气；经期延长、淋漓不断的，是气衰脾弱，不能统摄血液，治法宜用甘温药扶助阳气；月经结束后腹部空痛的，是气血突然亏虚，治法宜调和气血；到了该来月经的时间却不来，可能是怀孕也可能不是。怀孕的不必治疗，不是怀孕的是闭经。闭经应当开通，因气滞而闭的，治法宜行气；因寒凝而闭的，治法宜散寒；因热结而闭的，治法宜清热；因血枯而闭的，治法宜补血。病因不一，审察病因后治疗。至于带下病、崩漏，是妇女的大病，十有八九都有。带下分五色，不出阴阳范畴，按照阴阳辨证法治之即可。凡是带下病的脉象，我看得很多，往往两寸脉浮大无力。两关、两尺脉细微严重的，是阳气竭于上，而下元无火，用温中回阳法治之多有效。有两寸脉大实有力，两关滑而两尺细的，是心肺移热于下，脾湿下注，用除湿、清热法治之很有效。崩症和漏症有区别，漏症是病浅，也是将发崩症的征兆；崩症势大而像决堤一样，漏症势小而淋漓不止，这两种症候都应当根据阳虚、阴虚辨证治疗，就能掌握有余不足的机关了。至于逆经吐血，参照上吐血的条法辨证，治法自然在其中了。
什么是胎前？因为夫妇交媾，精血凝聚，二五合一，具备生生化化的道理，人的性命有了基础，所以叫胎。
俗语说：“胎前不宜热”，这句话举世信奉，却不知道这不是确论。坤德厚载物，全赖二气维持，一动一静，阴阳互相化育，元阴化生五脏，加上心包络就是六腑中的脏，元阳化生六腑，合起来就是十二官，所以说阳六六，阴六六。阳六六，即乾为天卦；阴六六，即坤为地卦。乾坤化生五行，五行不出二气之中，二气不出五行之内，所以说天数五，地数五。婴儿在母腹中，母亲呼气他也呼气，母亲吸气他也吸气，十月期满，性与命确立，打破一元，坎离立极。未出生以前，寒热各有分别。胎寒不温，胎也容易受损；胎热不清，胎也容易堕掉。以此为准，经旨才能畅达。前贤有逐月养胎的说法，其实在可跟从与不可跟从之间。据我仔细思考，阴阳合一，养于坤宫，此刻十二经的经血，无时无刻不在，真就像北极星居所而众星拱卫它一样。其中有恶阻（妊娠呕吐）的，是胎初凝结，养于坤宫，土气突然不舒，所以产生呕吐等情况，治法宜温中行脾气。
有患子眩（妊娠头晕）的，是胎气上逼所致，治法宜平气。有患子满（妊娠肿胀）的，是气壅滞，治法宜破滞行气。有患子瘖（妊娠失音）的，是胞胎压迫少阴经连舌本的脉络，治法宜升举胎气，如果无效，分娩后自然能说话。有患子鸣（妊娠呻吟）的，是因为突然伸手取物，母亲的呼吸骤然不与婴儿相接，治法宜捧身片刻以顺应它。有腹痛小便点滴不出的，是胞胎下压膀胱，治法宜升举。有胎尚存但漏下的，审察如果是火逼下行，治法宜清火；审察如果是元阳不足不能收束，治法宜补阳。有患子肿（妊娠水肿）的，是水停而不行，治法宜化气行水。有患子嗽（妊娠咳嗽）的，是肺气被胎火所逼，治法宜清胎热。有胎不长（胎儿发育迟缓）的，是母亲气血不足，治法宜大补气血。有挟食吞酸的，治法宜消食。有因外邪闭塞而大热身痛的，照外感六经法治之。有吐泻交作而胎不安的，治法宜温中。有大渴饮冷、谵语、大热、汗出、便秘的，治法宜攻下。有身冷汗出、人事昏沉、精神困倦、喜喝极热汤的，治法宜回阳。胎前诸症，略举几端，学者应当留心探讨研究。
什么是产后？因为婴儿落地，周身百脉开张，努力送出，十二经护胎的血，一齐下注，此刻气血两虚，与平常不同，用药不可错误。婴儿落地，就有昏晕人事不省的，是血瘀不下行反而上逆，治法宜行瘀。有腹硬而痛剧的，是血瘀滞而无阳气温运化，治法宜温中行滞。有空疼而腹不硬的，是气血突然亏虚，治法宜大补气血。有冷汗出而昏晕严重的，是阳气欲脱，治法宜回阳。有大热、大渴而想喝冷饮的，是血虚阳无所依附而外越，治法宜峻补其血。有顶巅痛头如火焚的，是血骤虚，阳无所依，而暴浮于上，治法宜大补其血。
有气喘声高、寒战汗出、身冷的，是阴阳不交，阳气欲脱，治法宜回阳。
有胎未全而即产的，俗名小产，比正产更严重。正产是瓜熟自落，得阴阳之正，调养贵在得当。小产如生果摘下，损伤太甚，一切诸症，治法与正产相同，而调养更应周密。愚夫愚妇视为寻常，不知保养，而导致死亡的，不胜慨叹。也有胎儿死在腹中而不下来的，必定有所伤，治法宜下之。病症也多，怎能尽述？举其大纲，不越规矩，学者再广泛阅览。
至于方药，《济阴纲目》很详细，也可以参看。
问：小儿另列一科是什么原因？
答：小儿刚生下地，不能言语，吃的是母亲的精血，即使有病，医生全是猜想，并没有几个一见便知。没吃五谷的，外感还多，内伤就少；吃了五谷的，外感内伤都有。更有痘、麻疹，动关生死，所以小儿科之外，又有痘科。俗语称哑科，确实不假。最奇怪的是，小儿刚生下地，世俗都用大黄、银花、钩藤、甘草之类，来下胎毒、血粪，我深以为不然。
凡人都禀受二气所生，有自然之理。小儿初生，犹如瓜果刚出土的萌芽，用冷水灌它不行，用热汤灌它也不行，生机原是自然的，换肚换肠也是自然的，何须用大黄、银花之类去摧残毒害它？只要小儿不偏于寒、热两字，就不可以妄施药品，以种病根。如果有胎中受热的小儿，必然面赤、唇红、气粗、口热，用苦甘一二味药投之即可。有胎中受寒的小儿，必然面青、唇口淡白、气微、口冷，用辛甘一二味药投之即可。至于外感一切，务必察时令，小儿虽不能言，而发热之有汗、无汗，口热、不热，二便之利、不利，只此数端，也可以知道他的病了。其中最重要的，太阳主皮肤，统营卫，是第一层，六淫中人，必先犯此，学者须知。切勿被小儿稚阳之体原无伤寒之说所迷惑，不知道小儿气轻力薄，正易伤寒。伤寒二字，四时皆有，所谓伤寒，是伤及太阳地界。太阳本气主寒，六气从太阳而入内，故都可以名伤寒。其中有称为惊风的，有称为慢脾风的，都是不经之论。我为活人计，不得不直切言之。
所谓惊风，是因为小儿发热抽掣，角弓反张，项强、摇头、吐舌，有时突然掣动，像受惊的样子，前人未按经旨，见其惊状，就以惊风名之，而不知道这是外邪客于太阳经络。太阳经络被外邪蔽束，气机不畅，抑郁为热，热甚则风生，所以有抽掣角弓等情况。此时正当用桂枝汤、麻黄汤，或麻杏石甘汤等，以解太阳之邪，邪气解而风热即不生，哪有抽掣等症呢？市医遵守惊风一语，更立无数名目，以讹传讹，妄拟一派镇惊祛风逐痰之方，小儿屈死于此的，不知几百亿兆了。况且人身皮肤第一层，属太阳主事，难道有外邪入内，而不伤及的吗？业医者，何不在此经三致意呢！至于慢脾风，是因为小儿素病，调养失宜，饮食不健，自汗、盗汗不觉，呕、吐、泻、利不觉，积之久久，元气日薄，酿成虚极之候，元气虚极，则神无主，不能支持上下四旁，所以有战动、发热、汗出不止，似惊之状，其实非惊风也。外验人必无神，面青、唇白，困倦、目瞑，此刻正当大补元阳，元阳气足，则神安而体泰，哪有动摇的呢？若以惊风治之，是速其亡也。前人称为慢脾，因其来之非骤也。论惊多在三阳，乃有余之疴；论慢脾属三阴，乃不足之候。惊风从外感得来，六气须知，气即风也，风字宜活看。慢脾由内伤所积，吐泻汗出，停滞食少，酿久生端，分阴分阳，察之辨之，不可不密，用方用药，补之泻之宜清。这是活人之业，性命生死攸关之际，学者毋忽视之。更有痘、麻疹，动关生死，《幼幼集成》、《活幼心法》二书，讲说最详，宜阅。以我拙见，和平、有余、不足，三法尽之矣。但痘出于脏，麻出于腑，痘喜温和，麻喜清解。痘本胎毒，藏于命根，初起由太阳真机鼓动，运毒外出，治法宜用桂枝汤调和阴阳，以助太阳外出之气机，使无一毫毒邪之滞于内；次归阳明，血水化为脓浆，未出透时，治法宜用升麻葛根汤以解肌，而使毒气发透；已出透时，治法宜用理中汤以培中气；中气健旺，易于化血为脓，熟透结疤，欲结疤时，治法宜用回阳、封髓等方，使这一点真气复还于内。这四法是顺其阴阳气机出入之道，为治痘用药不易之法。至于和平之痘，二便、饮食如常，微烧而精神不倦，疮根红活，顶润充盈，颗颗分明，粒粒精光，乃和平第一等痘，勿药有喜。最可忧者，有余不足两症，有偏余于气而不足于血的，如气至而血不至之白泡无红根是也；有偏余于血而不足于气的，如血至而气不至之红泡无脓是也。偏于气而不足于血的，治法宜养阴以配阳；偏于血而不足于气的，治法宜补阳以配阴。盖有余者是气之盈，如暴出，一齐涌出，紫红顶干，焦枯、便闭、烦躁、饮冷，谵语之类，治法宜清火养阴，甚极者宜下。不足者是气之缩，如慢出，下陷平塌，色嫩、二便自利，饮热、目瞑，困倦已极之类，治法宜补火。火即气，补火一字，人多忽略，一味在后天肺气上用药，而不知在人身立命之火种上用药。故近来痘科，一见下陷不足之症，用药总在这参、芪、鹿茸、归、芍，以为大补气血，究竟致死者多，深为可慨也，由其未得仲景之心法耳。观于仲景之用四逆汤，姜、附、草三味，起死回生，易如反掌，非专补立极之火种，何能如斯之速乎？
世医不求至理，以为四逆汤乃伤寒之方，非痘科之方，不知此方正平塌下陷痘症之方，实补火种之第一方也。今人亦有知得此方者，信之不真，认之不定，即用四逆，而又加以参、归、熟地，羁绊附子回阳之力，亦不见效，病家待毙，医生束手，自以为用药无差，不知用药之未当甚矣。麻疹一条，较痘症稍异，麻疹往往兼时气传染而成，为病发热、咳嗽，目如醉人，鼻流清涕，乃将出之候也。太过色紫红，不及则色淡，始终治法，只宜升解清凉发透为主，所有一切变症，总以阴、阳、虚、实四字括之。《幼幼集成》说最妥，兹不赘。
附不解说
俗传出痘一事，我甚不解，沿古及今，俱称痘为胎毒，人人俱要出痘，方可无忧，未出痘者，务要借出痘之苗，以引之外出，取其知是出痘，按痘法治之有准，以免用药错误。此说一开，而婴儿之夭亡者，不啻恒河沙数矣。我深谓不然，人俱要出痘，何以有不放而终身不出者？有放而亦不出者？又何得遽谓人人俱要出痘？即要出痘，亦当听其自然，何必定要用痘以引之哉？窃念人禀二气以立命，风、寒、饮食，一切俱要谨慎，惟恐疏虞，以致外邪深入，有戕生命，独于此痘，何不避之，而偏要使之从鼻窍以入内，明明叫出痘，何尝是痘一定要出哉？人之一身，如一穴空地，种麻即麻，种豆即豆，此理之常，但种疮痘一法，仲景尚且不具，而独于六气立法，盖六气即是六经，主一年之事，循环不已，人身二气不调，六邪始能入内为病，故法可立而病可穷，方可定也。今之痘、麻，又列一科，以其知得痘、麻之始终，如人之种瓜果，而知其结实时也，法虽可从，而陋习不可不急正也。嗟乎！俗染成风，牢不可破，犹人之愚而甘于愚也。我目见邻里小儿，康健嬉嬉，以痘疮之毒苗种之，十数日而即死者，不胜屈指矣。想来不种痘苗，未必即死，虽曰天命，又岂非人事哉!
问：外科工专金、疮诸症，其原因是什么？
答：凡一切疮症，皆起于二气不调，气、血偏盛，壅滞流行不畅之过，病原从内出外，以其有金、疮、折骨，化腐生肌一事，稍不同耳。然疮形已具，即当分辨阴、阳，不可忽略。阳症，疮色红肿痛甚，高凸发热，口渴心烦，小便短赤，大便闭结，喜冷，用药重在活血行气，养阴清火为主。阴症，疮色不红活，皮色如常，慢起不痛，或微痛，二便自利，精神短少，用药大补元阳为主。大凡疮症，《内经》云：“皆属于火”。人身立命，就是这一个火字，火即气，气有余便是火，气不足便是寒。气有余之疮，即阳症，必由阻滞而成，用药故要清火养阴，活血行气，方用桂枝汤倍白芍，加麦芽、香附、栀子主之。气不足之疮，即阴症，必由阳不化阴而成，法当大补元阳，方用桂枝汤倍桂，加麦芽、附子、香附主之。此乃调和气血之妙法，原不在芩、连、银花、山甲、大黄之类，专以清火。要知气血壅滞，方得成疮，调气即是行气，调血即是行血，桂枝重在调阳，白芍重在调阴，气有余则阴易亏，故倍芍药加栀子，气不足则阴更盛，而阳愈弱，故倍桂而加附子。学者切勿以此方为伤寒之方，非疮科之方。仲景以此方，冠一百一十三方之首，而曰调和阴阳，试问人身阴阳调和，尚可得生病也否？尚可得生疮也否？若刀伤、折骨，跌打、闪挫，另有治法，又有手法，不与内因同治，故曰外科。
问：目病皆原内起，为何另列一科？
Answer: Men inherit the constitution of Qian (Heaven), and women inherit the constitution of Kun (Earth). Qian governs bestowal and transformation, while Kun governs generation and production. The distinction lies in the differences during pregnancy, postpartum, and menstruation. Other diseases are mostly the same, but these three aspects are critical to life and death; they must be known and studied urgently. Let us first discuss menstruation. What is menstruation? "Jing" (Menstruation) means constancy, and "Qi" (Period) means punctuality. At age fourteen, Tian Gui (a substance promoting reproductive development) arrives, meridians become patent, and menstrual blood flows downward once a month, symbolizing the waxing and waning of the moon—waning then waxing again, in an endless cycle. However, individual constitutions vary, and their flourishing or declining states due to injury differ. Thus, some have early menstruation, which indicates excess Qi; excess Qi transforms into Fire, so the treatment method should clear Heat. Some have late menstruation, indicating deficient Qi; deficient Qi transforms into Cold, so the treatment method should warm the Middle Jiao. The Middle Jiao is the source for generating essence and blood; it is the key principle of regulating menstruation. For example, pale menstrual blood indicates insufficient Fire transformation, treated by tonifying Fire; dark purple clotted blood indicates excessive Fire transformation, treated by clearing Heat; excessive flow with irritability indicates sudden Blood deficiency, treated by nourishing Blood; scanty flow with abdominal pain indicates Qi stagnation, treated by regulating Qi; prolonged dripping bleeding indicates weak Qi and Spleen deficiency failing to control blood, treated by sweet-warm methods to support Yang. Empty abdominal pain after menstruation ends indicates sudden Qi and Blood deficiency, treated by harmonizing Qi and Blood. If menstruation does not occur when expected, it may be pregnancy or amenorrhea. Pregnancy requires no treatment; amenorrhea requires opening the blockage. Amenorrhea due to Qi stagnation is treated by moving Qi; due to Cold by dispersing Cold; due to Heat by clearing Heat; due to Blood dryness by tonifying Blood. Etiologies vary; treat according to the cause. Regarding leukorrhea, metrorrhagia, and metrostaxis, these are major gynecological diseases affecting eight or nine out of ten cases. Leukorrhea has five colors but falls within Yin and Yang; treat according to Yin-Yang differentiation. In my experience, the pulse in leukorrhea often shows floating and large but powerless pulses at both Cun positions. Severe fine and minute pulses at Guan and Chi positions indicate Yang exhaustion above and lack of Fire in the lower origin; warming the Middle and restoring Yang is often effective. Large, solid, and powerful pulses at Cun, slippery at Guan, and fine at Chi indicate Heart-Lung Heat transferring downward and Spleen Dampness pouring down; removing Dampness and clearing Heat is very effective. Metrorrhagia and metrostaxis differ: metrostaxis is superficial and a precursor to metrorrhagia; metrorrhagia is severe like a bursting dam, while metrostaxis is slight and continuous. Both should be treated based on Yin or Yang deficiency to grasp the principles of excess and deficiency. For retrograde menstruation with hematemesis, refer to the section on upper hematemesis; the treatment method is inherent therein.
What is the prenatal period? It arises from the union of husband and wife, where essence and Blood condense, combining two fives into one, embodying the way of endless generation. This forms the foundation of human life, hence called "Tai" (Fetus).
The common saying "prenatal stage should not involve heat" is widely believed but incorrect. Kun's thickness supports all things, relying on the maintenance of two Qi. Movement and stillness allow Yin and Yang to nurture each other. Original Yin generates the Five Zang organs, plus the Pericardium making six Yin organs; Original Yang generates the Six Fu organs, totaling twelve officials. Thus, Yang is six-six, and Yin is six-six. Yang six-six corresponds to the Qian Heaven hexagram; Yin six-six corresponds to the Kun Earth hexagram. Qian and Kun generate the Five Elements, which do not exist outside the Two Qi, nor do the Two Qi exist outside the Five Elements. Hence, Heavenly number is five, Earthly number is five. While in the womb, the fetus breathes with the mother. After ten months, nature and destiny are established, breaking the primordial unity, establishing Kan and Li. Before birth, cold and heat are distinct. A cold fetus is easily damaged if not warmed; a hot fetus is easily aborted if not cleared. Using this as a standard, the classic teachings become clear. Ancients spoke of monthly fetal nourishment, which is debatable. In my view, Yin and Yang unite and are nourished in the Kun Palace. At this time, the meridian blood of the Twelve Meridians is constantly present, much like the North Star surrounded by stars. Nausea and vomiting (E Zu) occur because the newly formed fetus disturbs the Stomach Qi in the Kun Palace; treat by warming the Middle and moving Spleen Qi.
Dizziness during pregnancy (Zi Xuan) is caused by upward pressure of fetal Qi; treat by calming Qi. Abdominal fullness (Zi Man) is due to Qi obstruction; treat by breaking stagnation and moving Qi. Loss of voice (Zi Yin) is due to the fetus pressing the Shaoyin meridian connecting to the tongue base; treat by lifting fetal Qi. If ineffective, speech returns naturally after delivery. Groaning (Zi Ming) occurs when the mother suddenly reaches for something, disrupting the connection between her breathing and the fetus; treat by adjusting posture briefly. Abdominal pain with urinary retention is due to the fetus pressing the Bladder; treat by lifting. Bleeding during pregnancy with a viable fetus: if due to Fire forcing blood downward, clear Fire; if due to Original Yang deficiency failing to consolidate, tonify Yang. Edema (Zi Zhong) is due to stagnant Water; treat by transforming Qi and moving Water. Cough (Zi Sou) is due to Lung Qi being pressured by Fetal Heat; treat by clearing Fetal Heat. Poor fetal growth is due to maternal Qi and Blood deficiency; treat by greatly tonifying Qi and Blood. Acid regurgitation due to food stagnation is treated by digesting food. Severe fever and body pain due to external pathogenic closure are treated according to the Six Meridians of Exterior Syndrome. Vomiting and diarrhea causing fetal unrest are treated by warming the Middle. Thirst for cold drinks, delirium, high fever, sweating, and constipation are treated by purging. Cold limbs, sweating, unconsciousness, fatigue, and preference for hot drinks indicate Yang collapse; treat by restoring Yang. These are examples of prenatal conditions; scholars should study them carefully.
What is the postpartum period? After delivery, the hundred vessels open, and effort expels the fetus. The Blood protecting the fetus in the Twelve Meridians rushes downward simultaneously. Qi and Blood are severely deficient, different from normal states; medication must not be erroneous. Unconsciousness immediately after delivery is due to Blood stasis failing to descend and rising instead; treat by moving stasis. Hard, painful abdomen indicates Blood stasis without Yang to transform it; treat by warming the Middle and moving stagnation. Empty abdominal pain without hardness indicates sudden Qi and Blood deficiency; treat by greatly tonifying Qi and Blood. Profuse cold sweat and severe fainting indicate impending Yang collapse; treat by restoring Yang. High fever, extreme thirst for cold drinks indicate Blood deficiency with Yang floating outward; treat by vigorously tonifying Blood. Vertex headache feeling like burning indicates sudden Blood deficiency with Yang floating violently upward; treat by greatly tonifying Blood.
High-pitched panting, chills, sweating, and cold body indicate Yin-Yang disconnection and impending Yang collapse; treat by restoring Yang.
Premature delivery (miscarriage) is more severe than term delivery. Term delivery is like a ripe melon falling naturally, following correct Yin-Yang balance; care should be appropriate. Miscarriage is like picking unripe fruit, causing severe damage; treatment is similar to term delivery, but care must be more meticulous. Ignorant people neglect this, leading to death, which is lamentable. Fetal death retained in the uterus requires expulsion due to injury; treat by purging. Many symptoms exist; only the outline is given here. Scholars should read widely.
Regarding prescriptions, *Ji Yin Gang Mu* is detailed and can be consulted.
Question: Why is pediatrics a separate specialty?
Answer: Newborns cannot speak and rely on maternal essence and Blood. Physicians must guess symptoms, rarely diagnosing accurately at first sight. Infants not yet eating grain have more exterior syndromes and fewer interior injuries; those eating grain have both. Measles and smallpox are critical to life and death, hence the separate Smallpox specialty. It is truly called the "Mute Specialty." Most strangely, newborns are given Da Huang (Rhubarb Root and Rhizome), Yin Hua (Honeysuckle Flower), Gou Teng (Uncaria Ramulus), and Gan Cao (Licorice Root) to purge fetal toxins and meconium. I strongly disagree.
All humans are born of Two Qi, following natural laws. A newborn is like a sprout emerging from soil; pouring cold water or hot soup is harmful. Vitality is natural; changing intestines is natural. Why poison them with Da Huang or Yin Hua? As long as the infant is not biased toward Cold or Heat, do not administer drugs to plant disease roots. Infants heated in the womb show red face, red lips, rough breath, and hot mouth; treat with bitter-sweet herbs. Infants cooled in the womb show blue face, pale lips/mouth, weak breath, and cold mouth; treat with acrid-sweet herbs. For exterior syndromes, observe the season. Though infants cannot speak, sweating or not, hot or cool mouth, and bowel/bladder function reveal the illness. Crucially, Taiyang governs skin and controls Ying and Wei, the first layer. External pathogens attack here first. Do not be misled by the notion that infants' tender Yang precludes Taiyang syndrome; their thin Qi makes them susceptible. "Taiyang syndrome" applies in all seasons, meaning injury to the Taiyang domain. Taiyang's native Qi is Cold; when Six Qi enter via Taiyang, they are named Taiyang syndrome. Terms like "Wind Striking" (Jing Feng) or "Slow Spleen Wind" (Man Pi Feng) are unfounded. I speak plainly to save lives.
"Wind Striking" involves fever, spasms, opisthotonos, neck stiffness, head shaking, and tongue protrusion. Ancients misdiagnosed this as "Wind" due to convulsive appearance, ignoring that it is external pathogens blocking Taiyang meridians, causing Qi stagnation, depression into Heat, and subsequent Wind. Use Guizhi Tang or Mahuang Tang, or Maxing Shigan Tang to resolve Taiyang pathogens. Once resolved, Wind-Heat ceases, and spasms disappear. Market physicians perpetuate "Wind Striking," creating countless names and prescribing sedating/stopping-Wind/phlegm-resolving formulas, killing countless children. Skin belongs to Taiyang; how can external pathogens enter without affecting it? Physicians should focus on this meridian.
"Slow Spleen Wind" results from chronic illness, improper care, poor diet, spontaneous/night sweats, vomiting/diarrhea, leading to gradual Yuan Qi depletion. Extreme Yuan Qi deficiency causes loss of Shen (Spirit) support, resulting in tremors, fever, profuse sweating, resembling wind striking. Externally, the patient lacks spirit, has a blue face, white lips, fatigue, and closed eyes. Treat by greatly tonifying Original Yang. When Yuan Qi is sufficient, Shen is calm, and the body is stable. Treating as Wind Striking accelerates death. It is called "Slow Spleen" because onset is gradual. Wind Striking involves Three Yang (excess); Slow Spleen involves Three Yin (deficiency). Wind Striking comes from exterior Six Qi (Qi is Wind); Slow Spleen accumulates from interior injuries (vomiting, diarrhea, sweating, food stagnation). Differentiate Yin/Yang carefully. This is a matter of life and death; scholars must not ignore it. Measles and smallpox are also critical. *You You Ji Cheng* and *Huo You Xin Fa* explain them well. In my view, peace, excess, and deficiency cover all methods. Smallpox originates from Zang organs; measles from Fu organs. Smallpox prefers mild warmth; measles prefers clearing/resolving. Smallpox is fetal toxin stored in the root of life. Initially, Taiyang true mechanism drives toxin outward; use Guizhi Tang to harmonize Yin-Yang and assist Taiyang in expelling toxin. Next, it enters Yangming, where Blood/Water becomes pus. Before eruption, use Shengma Gegen Tang to release muscle layers and vent toxin. After eruption, use Lizhong Tang to strengthen Middle Qi. Healthy Middle Qi converts Blood to pus and forms scabs. Near scabbing, use Huiyang or Fengsui formulas to return True Qi inward. These four methods follow Yin-Yang Qi movement, essential for treating smallpox. Peaceful smallpox presents with normal bowels/diet, slight fever, good spirit, red bases, moist tops, distinct pustules. No medicine needed; rejoice. Worrisome are excess/deficiency types. Excess Qi/Blood deficiency (white pustules without red base) needs nourishing Yin to match Yang. Excess Blood/Qi deficiency (red pustules without pus) needs tonifying Yang to match Yin. Excess Qi manifests as sudden eruption, purple-red dry tops, scorched appearance, constipation, irritability, cold drink preference; treat by clearing Fire and nourishing Yin, purging if extreme. Deficient Qi manifests as slow eruption, sinking/collapsed lesions, tender color, free bowels, hot drink preference, eye closure, extreme fatigue; treat by tonifying Fire. Fire is Qi. Many ignore "tonifying Fire," focusing only on Post-Heaven Lung Qi rather than Pre-Heaven Life-Fire. Recent smallpox doctors use Renshen, Huangqi, Lurong, Danggui, Baishao for deficiency, causing many deaths due to lacking Zhang Zhongjing's method. Zhongjing's Sini Tang (Gan Jiang, Fu Zi, Gan Cao) resurrects the dead quickly by tonifying the primal Fire seed.
Modern physicians think Sini Tang is only for Taiyang syndrome, not smallpox. It is actually the primary formula for collapsed smallpox, tonifying the Fire seed. Some use it with Renshen, Danggui, Shudi, hindering Fuzi's Yang-restoring power, leading to failure. Measles differs slightly; often epidemic, presenting with fever, cough, drunken eyes, runny nose before eruption. Too much color is purple-red; too little is pale. Treatment focuses on ascending, resolving, cooling, and venting. All variations are summarized by Yin, Yang, Deficiency, Excess. *You You Ji Cheng* is accurate; details omitted.
Appendix: Disapproval of Vaccination
I do not understand the custom of variolation. Ancients and moderns call smallpox "fetal toxin," believing everyone must contract it to be safe. Those uninfected seek inoculation to induce it, fearing error in treatment. This practice has killed countless infants. I disagree. Why do some never develop smallpox even without inoculation? Why do some get inoculated but not develop it? One should let nature take its course. Humans rely on Two Qi for life; wind, cold, and diet must be guarded against to prevent external pathogens from harming life. Why invite smallpox through the nose? The body is like empty land; planting hemp yields hemp, beans yield beans. Zhongjing did not prescribe specific methods for smallpox but focused on Six Qi (Six Meridians) governing the year. When internal Two Qi are imbalanced, Six Evils enter. Laws can be established, diseases exhausted, and formulas fixed. Modern smallpox/measles specialties know the progression like farmers knowing fruit ripening. Methods may be followed, but bad habits must be corrected. Customs are stubborn. I have seen healthy neighbors' children die days after inoculation. Not inoculating might not lead to death; is it fate or human action?
Question: Why does surgery specialize in metal wounds and sores?
Answer: All sores arise from Two Qi imbalance, Qi/Blood excess, and stagnation. Pathogens originate internally and manifest externally. Metal wounds, fractures, and ulceration differ slightly. Once sore shape appears, differentiate Yin/Yang. Yang sores are red, swollen, painful, elevated, febrile, with thirst, irritability, dark urine, constipation, and preference for cold. Treatment focuses on activating Blood, moving Qi, nourishing Yin, and clearing Fire. Use Guizhi Tang doubled Baishao, plus Maiya, Xiangfu, Zhizi. Yin sores are non-red, normal skin color, slow onset, painless or mildly painful, with free bowels, low spirit. Treatment focuses on greatly tonifying Original Yang. Use Guizhi Tang doubled Guizhi, plus Maiya, Fuzi, Xiangfu. *Neijing* states sores belong to Fire. Fire is Qi; excess Qi is Fire, deficient Qi is Cold. Yang sores (excess Qi) result from stagnation; treat by clearing Fire, nourishing Yin, activating Blood, moving Qi. Yin sores (deficient Qi) result from Yang failing to transform Yin; treat by tonifying Original Yang. Harmonizing Qi/Blood is key, not just clearing Fire with Huangqin, Huanglian, Yinhua, Shan Jia, or Dahuang. Regulating Qi moves Qi; regulating Blood moves Blood. Guizhi regulates Yang; Baishao regulates Yin. Excess Qi risks Yin deficiency (double Baishao, add Zhizi); deficient Qi increases Yin dominance and weakens Yang (double Guizhi, add Fuzi). Do not mistake this for a Taiyang-only formula. Zhongjing placed Guizhi Tang first among 113 formulas to harmonize Yin-Yang. If Yin-Yang is harmonized, can disease or sores arise? Knife wounds, fractures, bruises have manual treatments distinct from internal causes, hence "Surgery."
Question: Eye diseases originate internally; why a separate specialty?