医门理法至微玄。大要胸中有转旋。望闻审切四件事。缺一偏枯不备全。第一看他神气
色。
润枯肥瘦起和眠。活润死枯肥是实。瘦为虚弱古今传。谦体即知腰内苦。攒眉头痛与头眩。
手不举兮肩背痛。步行艰苦脚间疼。叉手按胸胸内痛。按中脐腹痛相连。但起不眠痰夹热。
贪眠虚冷使之然。面壁蜷身多是冷。仰身舒挺热相煎。身面目黄脾湿热。唇青面黑冷同前。
第二应声清与浊。鉴他真语及狂言。声浊即知痰壅滞。声清寒内是其源。言语真诚非实热。
狂言号叫热深坚。称神说鬼逾墙屋。胸膈停痰证号癫。更有病因循日久。音声遽失命归泉。
三问病因经几日。日间便利几番行。饮食少多宜冷热。更兼多少不同论。饮食稍通容易治。
不进之时疗必难。喜冷定知心内热。好温乃属脏中寒。尿色赤黄真内热。尿清定是冷相干。
切脉是居为四末。浮沉迟数病之端。四事略陈通梗概。举隅善反一同看。
凡欲疗病。先察其源。先候病机。五脏未虚。六腑未竭。血脉未乱。精神未散。服药必
活。
若病已成。可得半愈。病势已过。命将难全。自非明医。听声察色。至于真脉。其孰能知。
未病之病。
肝胆由来从火治。三焦包络都无异。脾胃常将湿处求。肺与大肠同湿类。肾与膀胱心小
肠。
寒热临时旋商议。恶寒表热小膀温。发热表寒心肾炽。十二经。最端的。四经属火四经湿。
四经有热有寒时。攻里解表细消息。里热里寒宜越竭。表热表寒宜汗释。湿同寒。火同热。
寒热到头无两说。六分分来火热寒。寒热中停直浪舌。热寒格拒病机深。亢则害。承乃制。
别紧寒。数热脉。正邪标本求之真妙诀。休治风。休治燥。治得火时风燥了。当解表时莫攻
里。当攻里时莫解表。表里如或两可攻。后先内外分多少。治湿无过似决川。此个筌蹄最分
晓。感谢轩岐万世恩。争奈醯鸡笑天小。
医家的理法精微而玄妙，关键在于胸中要有灵活转旋的机枢。望、闻、问、切这四诊方法，如果缺少任何一项，诊断就会偏颇且不完整。
第一是观察患者的神气与面色。看其润泽或枯槁，肥壮或消瘦，以及睡眠状况。色泽鲜活润泽为生机，枯槁则为死象；形体肥壮多属实证，形体消瘦多属虚证，这是古今相传的经验。身体前倾蜷缩，通常知道腰部内部有苦痛；皱眉表示头痛或头晕目眩。手臂抬不起来，说明肩背疼痛；行走艰难，说明脚部疼痛。双手交叉按压胸部，说明胸内疼痛；按压脐部感到疼痛相连，说明腹痛。只能起身无法安卧，多是痰热夹杂；贪睡嗜卧，则是虚寒所致。面向墙壁蜷缩身体，多半是寒证；仰卧伸挺身体，多半是热证煎熬。身体、面目发黄，是脾经湿热；嘴唇发青、面色发黑，与前面的寒证类似。
第二是听声音的清浊。辨别是真语还是狂言。声音浑浊，可知是痰湿壅滞；声音清亮，根源在于内寒。言语真诚并非实热；狂言叫号，是热邪深重坚固。胡言乱语、称神说鬼、甚至逾墙越屋，胸膈停聚痰涎，证候称为癫证。更有病因拖延日久，导致声音突然丧失，性命难保。
第三是询问病因经过几天，白天大小便次数多少。饮食量的多少，喜冷还是喜热，都要分别讨论。饮食尚能通进，容易治疗；完全不能进食时，治疗必然困难。喜欢冷饮，确定是心内热；喜欢温热，属于脏腑寒。尿液颜色赤黄，真是内热；尿液清长，确定是寒邪干扰。
第四是切脉，居于四诊之末。浮、沉、迟、数脉是判断疾病的开端。以上四诊略述梗概，举一反三，可以类推看待。
大凡想要治疗疾病，先要考察病源，先探候病机。在五脏尚未虚弱、六腑尚未衰竭、血脉尚未紊乱、精神尚未散失的时候服药，必定有效。如果病已经形成，只能获得一半痊愈。如果病势已经过去（指正气衰败），生命将难以保全。如果不是明医，通过听声音、察面色，直到探究真脉，谁能真正知晓呢？对于未病之病……
肝胆由来按照火来治疗，三焦和心包络也都与此无异。脾胃常从湿的角度去求治，肺和大肠同属于湿类。肾、膀胱、心和小肠，寒热需要临时斟酌商议。恶寒且体表发热，是小膀胱温煦不足；发热且体表寒冷，是心肾火热炽盛。十二经脉，最确切的是：四条经属火，四条经属湿，四条经有时有热有时有寒。攻里和解表要仔细斟酌。里热里寒适宜用越鞠丸等方剂疏解（注：原文“越竭”疑为方剂名或特定治法代称，此处依文意译为疏解郁结之意，若指具体方剂则保留原名，但古籍中“越竭”非标准通用方名，结合上下文“攻里解表”，此处更偏向治法描述，故译为疏解郁结/泻下等，鉴于“越竭”二字特殊，暂按字面理解为特定的泻下或疏泄手段，但在现代语境下，建议理解为针对里证的攻逐之法）。表热表寒适宜用汗法解除。湿同寒治，火同热治，到了寒热的极致没有两种说法。六分地划分火热寒，寒热中间停滞直接浪费舌苔（意指误治）。热寒格拒，病机深奥。亢盛则有害，承制才能平衡。辨别紧急的寒证，数脉主热，正邪标本寻求真正的妙诀。不要治风，不要治燥，治好了火，风和燥也就解决了。应当解表时不要攻里，应当攻里时不要解表。如果表里都可以攻，要根据先后内外区分轻重多少。治疗湿邪没有超过像决堤川流一样的方法，这个要领最为清楚明了。感谢轩辕岐伯万世的恩情，无奈像醯鸡（小虫）那样嘲笑天太小。
The principles and methods of medicine are subtle and profound. The key lies in having a flexible pivot within the chest (metaphor for mental acuity and diagnostic flexibility). Observation, Auscultation and Olfaction, Inquiry, and Palpation (Wang, Wen, Wen, Qie) are four essential tasks; if any one is missing, the diagnosis will be biased and incomplete.
First, observe the patient's Shen (Spirit/Mental activity) and complexion. Look at whether it is lustrous or withered, plump or emaciated, and examine sleep patterns. Lively and moist indicates life, while withered indicates death; plumpness often signifies Excess syndromes, while emaciation signifies Deficiency syndromes, as passed down through ancient and modern times. Leaning forward and curling up suggests pain inside the waist; furrowing the brow indicates headache or dizziness. Inability to raise the arms indicates shoulder and back pain; difficulty walking indicates leg pain. Crossing hands to press the chest indicates chest pain; tenderness upon pressing the umbilicus indicates abdominal pain. Being able to sit up but unable to lie flat suggests phlegm-heat complex; excessive sleeping is caused by Deficiency-cold. Facing the wall and curling up mostly indicates cold syndrome; lying on the back with body extended indicates heat syndrome tormenting. Yellowing of the body, face, and eyes indicates Spleen damp-heat; blue lips and black complexion are similar to the aforementioned cold syndromes.
Second, listen to the clarity or turbidity of the voice. Distinguish between truthful speech and delirious words. A turbid voice indicates phlegm obstruction; a clear voice originates from internal cold. Truthful speech is not Excess-heat; delirious shouting indicates deep and solidified heat. Speaking of spirits and ghosts, climbing over walls and houses, with phlegm retained in the chest and diaphragm, is diagnosed as Dian syndrome (Manic-depressive psychosis). Furthermore, if the cause persists for a long time, sudden loss of voice may lead to death.
Third, inquire about the duration of the illness, the frequency of urination and defecation during the day, and the quantity of food intake, as well as preferences for cold or hot foods. These must be discussed differently based on circumstances. If appetite is slightly maintained, treatment is easy; if no food can be taken, treatment is difficult. Preference for cold drinks confirms internal heart heat; preference for warmth belongs to Zang organ cold. Red and yellow urine truly indicates internal heat; clear urine definitely indicates interference by cold pathogens.
Fourth, Pulse-taking (Qie Mai) is the last of the four diagnostics. Floating, Deep, Slow, and Rapid pulses are the beginnings of disease differentiation. The above four diagnostics briefly outline the general principles; one should infer other cases from these examples.
Generally, to treat a disease, one must first investigate its source and probe the Bing Ji (Pathogenesis). When the Five Zang organs are not yet deficient, the Six Fu organs are not yet exhausted, the blood vessels are not yet chaotic, and the Jing Shen (Spirit) has not scattered, taking medicine will surely be effective. If the disease has already formed, only half recovery can be expected. If the disease momentum has passed (referring to the collapse of healthy Qi), life will be hard to preserve. Unless one is a enlightened physician, who can truly know by listening to sounds, observing colors, and examining the true pulse? Regarding diseases before they manifest...
Gallbladder and Liver have always been treated according to Fire. San Jiao (Triple Burner) and Pericardium (Bao Luo) are no different. Spleen and Stomach are often sought from the perspective of Dampness. Lung and Large Intestine belong to the same category of Dampness. Kidney, Bladder, Heart, and Small Intestine require temporary deliberation on Cold and Heat. Chills with exterior heat indicate warming deficiency of the Small Bladder; fever with exterior cold indicates blazing fire in the Heart and Kidney. Of the Twelve Meridians, the most definitive are: four meridians belong to Fire, four to Dampness, and four have alternating Heat and Cold. Attack the interior and release the exterior with careful consideration. Interior Heat and Interior Cold are suitable for Yueju Wan (Venture Exhaustion Decoction - *Note: Interpreted as resolving stagnation/purgation based on context*) or purging methods. Exterior Heat and Exterior Cold are suitable for sweating methods. Dampness is treated like Cold, Fire like Heat; when reaching the extremes of Cold and Heat, there are no two ways. Divide into six parts for Fire, Heat, and Cold. If Cold and Heat stall in the middle, it is a direct waste of tongue diagnosis (misdiagnosis). Heat and Cold rejecting each other indicates deep pathogenesis. "Excess leads to harm, control follows balance." Distinguish urgent Cold, count [pulse] for Heat, seek the truth of Zheng (Righteous) and Xie (Evil) via Root and Branch theory. Do not treat Wind, do not treat Dryness; once Fire is treated, Wind and Dryness are resolved. When releasing the exterior, do not attack the interior; when attacking the interior, do not release the exterior. If both exterior and interior can be attacked, distinguish the degree of priority and location (internal/external). Treating Dampness is nothing short of draining a river; this principle is very clear. Gratitude to Xuanyuan and Qibo for their grace to ten thousand generations, though alas, like a vinegar-jar fly mocking the smallness of the sky.