火之所为也。夫君火者犹人火也，相火者犹龙火也，人火焚木其势缓，龙火焚木其势速。《内经》之言喉痹，则咽与舌在
其间耳，以其病同是火，故不分也。治喉痹之火与救火同，不容少待。《内经》火郁发之，发谓发汗，然咽喉中岂能发汗？
故出血者，乃发汗之一端也。
酸者肝木之味，由火盛制金，不能平木，则肝木自盛，故为酸也。如饮热则酸矣，或言吐酸为寒者误也。是以肝热
则口酸，心热则口苦，脾热则口甘，肺热则口辛，肾热则口咸。或口淡者胃热也，胃属土，土为物之母，故胃为一身之
本，淡为五味之本，然则吐酸岂为寒者欤？凡中酸法宜温药散之者，亦犹解表之义，以使肠胃结滞开通，怫郁散而和也。
若久酸不已，则不宜温之，宜以寒药下之，后以凉药调之，结散热去，则气和也。（刘河间论吐酸）
仲景论少阴病热极，曰∶溲便遗失，狂言目反视者，肾先绝也。《灵枢经》曰∶肾主二阴，然本衰虚，而怫热客其部分，
二阴郁结，则痿痹而神无所用，故溲便遗失而不能止，然则热证明矣。（刘河间论淋）
冲、任、督三脉，以带脉束之。因余经上下往来，遗热于带脉之间，血积不流，火从金化而为白液，少腹冤热，白
物满溢，随溲而下，绵绵不绝，多不痛也。或有痛者则壅碍，因壅而成痛也。《内经》曰∶少腹冤热，溲出白液。冤者
屈滞也，病非本经，为他经冤郁而成此疾也。治泻利与治带下，皆不可骤用峻热之药燥之，燥之则内水涸，内水涸则必
烦渴，烦渴则小溲不利，小溲不利则足肿面浮，渐至不治。赤白痢者，是邪热传于大肠，下广肠出赤白也。带下者，传
于小肠，入脬经下赤白也。据此二证，皆可同治湿法治之，以导水禹功丸泻讫。次以淡剂降心火，益肾水，下小溲，分
水道，则自愈矣。（子和论带下）
木郁达之，达者通畅之也。如肝性急，怒气逆， 胁或胀，火时上炎，治以苦寒辛散而不愈者，则用升发之药，加
以厥阴报使而从治之。又如久风入中为飧泄，及不因外风之入而清气在下为飧泄。则以轻扬之剂举而散之，凡此之类，
皆达之之法也。虽然木郁固有吐之之理，今以吐字总该达字，则是凡木郁皆当用吐矣，其可乎哉？东垣谓食塞肺分，为
金与土旺于上而克木，吐去其物以伸木气，正高者因而越之之义，恐不劳引木郁之说以治之也。火郁发之，发者汗之也，
升举之也。如腠理外闭，邪恶怫郁，则解表取汗以散之。又如龙火郁甚于内，非苦寒降沉之剂可治，则用升浮之药，佐
以甘温，顺其性而从治之，使势穷则止，如东垣升阳散火汤是也。土郁夺之，夺者攻下也，劫而衰之也。如邪热入胃，
用咸寒之剂以攻去之。又如中满腹胀，湿热内甚，其人壮气实者则攻下之，其或势甚而不能顿除者，则劫夺其势而使之
衰。又如湿热为痢，有非力轻之剂可治者，则或攻或夺以致其平，凡此之类，皆夺之之法也。金郁泄之，泄者渗泄而利
小便也，疏通其壅也。如肺金为肾水上源，金受火烁，其令不行， 郁而渗道闭矣，宜整肃金化，滋以利之。又如肺气
满，胸中仰息，非利肺气之剂，不足以疏通之。凡此之类，皆泄之之法也，王注解表二字，于理未当。水郁折之，折
者御也，伐而挫之也，渐杀其势也。如肿胀之病，水气淫溢，而渗道以塞，夫水之所不胜者土也，今土气衰弱，不能制
之，故反受其侮。治当实其脾土，资其运化，俾可以制水而不敢犯，则渗道达而后愈。或病势既旺，非上法所能遽制，
则用泄水之药，以伐而挫之，或去菀陈 ，开鬼门，洁净府，三治备举，迭用以渐平之。王氏所谓抑之制其冲逆，正欲
折挫其 滥之势也。夫实土者守也，泄水者攻也，兼三治者广略而决胜也。虽俱为治水之法，然不审病者之虚实久近浅
深，杂焉而妄施治之，其不倾跌者寡矣。邪气久客，正气必损，今邪气虽去，苟不平调正气，使各安其位，复其常，犹
未足以尽其妙，故又曰平调其气。苟调之而其气犹或过而未服，则当益其所不胜以制之。如木过者当益金，金能制木，
则木斯服矣。所不胜者所畏者也，故曰过者折之，以其畏也。夫制物者物之所欲也，制于物者物之所不欲也，顺其欲则
喜，逆其欲则恶，今逆之以所恶，故曰所谓泻之。王氏以咸泻肾酸泻肝之类为说，未尽厥旨。（王安道论五郁）
三焦取火能腐物之义，火之性自下而上。三焦者，始于原气，出于中脘，散于膻中，皆相火之自下而上也。其曰上
焦主纳而不出，下焦主出而不纳，其纳其出，皆系乎中焦之腐熟，焦之为义可见矣。
厥阴太阳，少气多血；太阴少阴，少血多气；阳明气血俱多；少阳气多血少，男子妇人均有此气血也。男子多用气，
故常气不足。女人多用血，故常血不足。所以男子病多在气分，妇人病多在血分。世俗乃谓男子多气，女子多血，岂不
谬哉？
邪气盛则实，精气夺则虚。二句为病治之大纲，其辞似显，其义甚微，最当详辨。而辨之有最难者何也？盖实言邪
气，实宜泻也。虚言正气，虚宜补也。凡邪正相搏而为病，则邪实正虚，皆可言也。故主泻者，则曰邪盛则实，当泻也。
主补者，则曰精夺则虚，当补也。各执一句，茫无确见，借口文饰，孰得言非。是以至精之训，反酿莫大之害，不知理
之所在，有必不可移易者，奈时医不能察耳。余请析此为四∶曰孰缓孰急，其有其无也。所谓缓急者，察虚实之缓急也，
无虚者，急在邪气，去之不速，留则生变也。多虚者，急在正气，培之不早，临期无济也。微虚微实者，亦治其实，可
一扫而除也。甚虚甚实者，所畏在虚，但固守根本，以先为己之不可胜，则邪无不退也。二虚一实者兼其实，开其一面
也。二实一虚者兼其虚，防生不测也。总之实而误补，固必增邪，犹可解救，其祸小。虚而误攻，真气忽去，莫可挽回，
其祸大。此虚实之缓急，不可不察也。所谓有无者，察邪气之有无也，凡风寒暑湿火燥，皆能增邪，邪之在表在里，在
府在藏，必有所居，求得其本则直取之，此所谓有，有则邪之实也。若无六气之邪，而病出三阴，则皆情欲以伤内，劳
倦以伤外，非邪似邪，非实似实，此所谓无，无则病在元气也。不明虚实有无之义，必至以逆为从，以标作本，绝人长
命，损德多矣，可不惧且慎哉？
损分五脏，而五脏所藏，则无非精与气耳。夫精为阴人之水也，气为阳人之火也。水火得其正，则为精为气；水火
失其和，则为热为寒。此因偏损，所以致有偏胜，故水中不可无火，无火则阴胜而寒病生。火中不可无水，无水则阳胜
而热病起，但当详辨阴阳，则虚损之治无余义矣。如水亏者阴虚也，只宜大补真阴，切不可再伐阳气。火虚者阳虚也，
只宜大补元阳，切不可再伤阴气，盖阳气不足，而复伐其阴，阴亦损矣。阴已不足，而再伤其阳，阳亦亡矣。夫治虚治
实，本自不同，实者阴阳因有余，但去所余，则得其平。虚者阴阳有不足，再去所有，则两者俱败，其能生乎？故治虚
之要，凡阴虚多热者，最嫌辛燥，恐助阳邪也；尤忌苦寒，恐伐生气也；惟喜纯甘壮水之剂，补阴以配阳，则刚为柔制，
虚火自降，而阳归乎阴矣。阳虚多寒者，最嫌凉润，恐助阴邪也；尤忌辛散，恐伤阴气也；只宜甘温益火之品，补阳以
配阴，则柔得其主，沉寒自敛，而阴从乎阳矣。是以气虚者宜补其上，精虚者宜补其下，阳虚者宜补而兼暖，阴虚者宜
补而兼清，此固阴阳之治辨也。其有气因精而虚者，自当补精以化气；精因气而虚者，自当补气以生精；又如阳失阴而
离者，非补阴何以收散亡之气？水失火而败者，非补火何以苏随绝之阴？此又阴阳相济之妙用也。故善补阳者，必于阴
中求阳，则阳得阴助而生化无穷。善补阴者，必于阳中求阴，则阴得阳升而泉源不竭。故以精气分阴阳，则阴阳不可离。
以寒热分阴阳，则阴阳不可混，此又阴阳邪正之离合也。知阴阳邪正之治，则阴阳和而生道得矣。
《本神篇》曰∶心怵惕思虑则伤神，伤神则恐惧自失。《邪气脏腑病形篇》曰∶忧愁恐惧则伤心。《口问篇》曰∶悲
哀忧愁则心动，心动则五脏六腑皆摇。可见心为五脏六腑之大主，而总统魂魄，兼该志意，故忧动于心则肺应，思动于
心则脾应，怒动于心则肝应，恐动于心则肾应，此所以五志惟心所使也。设能善养此心，而居处安静，无为惧惧，无为
欣欣，婉然从物而不争，与时变化而无我，则志意和，精神定，悔怒不起，魂魄不散，五脏俱宁，邪亦安从奈我何哉？
人知阴虚唯一，而不知阴虚有二。如阴中之水虚，则病在精血，阴中之火虚，则病在神气。盖阳衰则气去，故神志
为之昏乱，非火虚乎。阴亏则形坏，故肢体为之废弛，非水虚乎。今以神离形坏之证，乃不求水火之源，而犹以风治，
鲜不危矣！试以天道言之，其象亦然。凡旱则多燥，燥则多风，是风木之化从乎燥，燥则阴虚之候也。故凡治类风者，
专宜培补真阴以救根本，使阴气复，则风燥自除矣。然外感者，非曰绝无虚证，气虚则虚也。内伤者，非曰必无实证，
有滞则实也。治虚者当察其在阴在阳而直补之，治实者但察其因痰因气而暂开之，此于内伤外感及虚实攻补之间，最当
察其有无微甚，而酌其治也。甚至有元气素亏，猝然仆倒，上无痰，下失禁，瞑目昏沉，此厥竭之证，尤与风邪无涉。
使非大剂参附，或七年之艾，破格挽回，又安望其复真气于将绝之顷哉？倘不能察其表里，又不能辨其虚实，但以风之
为名，多用风药，不知风药皆燥，燥复伤阴；风药皆散，散复伤气；以内伤作外感，以不足为有余，是促人之死也。
五脏失治，皆为心痛，刺治分经，理甚明悉。至若舍针用药，尤宜察此详义。盖肾心痛者，多由阴邪上冲，故善 ，
如从后触其心。胃心痛者，多由停滞，故胸腹胀满。脾心痛者，多由寒逆中焦，故其病甚。肝心痛者，多由木火之郁，
病在血分，故色苍苍如死状。肺心痛者，多由上焦不清，病在气分，故动作则病益甚。若知其在气则顺之；在血则行之；
郁则开之；滞则逐之；火多实，则或散或清之；寒多虚，则或温或补之。必真心痛者，乃不可治，否则但得其本，则
必随手而应，其易如探囊也。
天之六气，惟火有二。君者上也，相者下也，阳在上者，即君火也；阳在下者，即相火也。上者应离，阳在外也，
故君火以明。下者应坎，阳在内也，故相火以位。火一也，而上下幽显，其象不同，此其所以有辨也。然以凡火观之，
则其气质上下，亦自有君相明位之辨。盖明者光也，火之气也。位者形也，火之质也。如一寸之灯，光被满室，此气之
为然也。盈炉之炭，有热无焰，此质之为然也。夫焰之与炭皆火也，然焰明而质暗，焰虚而质实，焰动而质静，焰上而
质下，以此证之，则其气之与质，固自有上下之分，亦岂非君相之辨乎？是以君火居上，为日之明，以昭天道，故于人
也属心，而神明出焉。相火居下，为原泉之温，以生养万物，故于人也属肾，而元阳蓄焉。所以六气之序，君火在前，
相火在后，前者肇物之生，后者成物之实。而三百六十日中，前后二火所主者，止四五六七月，共一百二十日，以成一
岁化育之功，此君相二火之为用也。
六气之分，属阴者三∶湿燥寒是也。属阳者二∶风热而已。使火无君相之化，则阴胜于阳，而杀甚于生矣，此二火
之所以必不可无也。若因惟火有二，便谓阳常有余，而专意仰之，则伐天之和，伐生之本，莫此为甚。此等大义，学人
最当详察。
三阳所在，其脉无不应者，气之盈也。三阴所在，其脉有不应者，以阳气有不及，气之虚也。然三阴之列，又惟少
阴独居乎中，此又阴中之阴也，所以少阴所在为不应，盖亦应天地之虚耳，岂君不主事之谓乎？
五行胜复之理，不期然而然。天地万物，固无往而非五行，而亢害承制，又安往而不然哉？故求之于人，则五脏更
相平也，五志更相胜也，五气更相移也，五病更相变也。故火极则寒生，寒极则湿生，湿极则风生，风极则燥生，燥极
则热生，皆其化也。第承制之在天地者，出乎气化之自然，而在人亦为有之，则在挽回运用之得失耳。使能知其微，得
其道，则把握在我，何害之有？设承制之盛衰不明，似是之真假不辨，则败乱可立而待也。
故用以太阳之人，而遇流衍之纪；以太阴之人，而逢赫曦之纪；强者有制，弱者遇扶，气得其平，何病之有？或以
强阳遇火，则炎烈生矣，阴寒遇水，则冰霜及矣。天有天符，岁有岁会，人得无人和乎？
王荆公解痛利二字，曰∶治法云诸痛为实，痛随利减，世俗以利为下也。假令痛在表者实也，痛在里者实也，痛在
气血者亦实也。故在表者汗之则愈，在里者下之则愈，在血气者散之行之则愈，岂可以利为下乎？宜作通字训则可，此
这是火邪致病的情况。君火就像人间的火，相火就像龙火。人火烧木头火势缓慢，龙火烧木头火势迅速。《内经》中提到的喉痹，是指咽喉和舌头之间的病变，因为病因都是火，所以不加以区分。治疗喉痹的火邪与救火一样，不容片刻延误。《内经》说“火郁发之”，发是指发汗，但咽喉部位怎么能发汗呢？因此，放血疗法是发汗的一种形式。
酸味是肝木的味道。由于火盛克制肺金，导致肺金不能平抑肝木，于是肝木自盛，从而产生酸味。比如喝热饮后口中会感到酸，有人说吐酸是因为寒证，这是错误的。所以肝热则口酸，心热则口苦，脾热则口甘，肺热则口辛，肾热则口咸。口淡则是胃热的表现。胃属土，土是万物的母亲，所以胃是身体的根本；淡是五味的根本。那么吐酸怎么会是寒证呢？凡是治疗吐酸宜用温药散之的，也如同解表的道理，旨在使肠胃结滞开通，怫郁消散而调和。如果长期吐酸不止，就不宜用温药，而应用寒药攻下，随后用凉药调理，待结散热去，气机自然调和。（刘河间论吐酸）
张仲景论述少阴病热极时说：小便和大便失禁，胡言乱语，眼睛上翻直视的，是肾气先绝的表现。《灵枢经》说：肾主二阴（前阴和后阴）。但如果本元衰虚，而怫热客居在二阴部位，导致二阴郁结，就会痿痹而神志无法发挥作用，所以大小便失禁而不能止住，这显然是热证。（刘河间论淋证）
冲脉、任脉、督脉三脉，由带脉约束。其他经脉上下往来，将余热遗留在带脉之间，导致血液积聚不流，火从金化而为白色液体，少腹冤热，白色物质满溢，随小便排出，绵绵不绝，大多不痛。如果有痛的，是因为壅塞阻碍，因壅而成痛。《内经》说：少腹冤热，小便出白液。“冤”是指屈曲阻滞，此病并非本经所致，而是他经冤郁导致的疾病。治疗泻痢和治疗带下，都不可骤然使用峻烈的热药来燥湿，燥湿则体内津液枯竭，津液枯竭则必然烦渴，烦渴则小便不利，小便不利则足肿面浮，逐渐发展到不可救治的地步。赤白痢疾，是邪热传于大肠，从广肠排出赤白之物。带下病，是邪热传于小肠，进入胞经排出赤白之物。根据这两种病症，都可以用治湿的方法来治疗，先用导水禹功丸泻下。其次用淡味药降心火，益肾水，通利小便，分流水道，则自愈了。（子和论带下）
木郁达之，“达”就是通畅的意思。比如肝性急，怒气逆乱，胁肋胀满，火气时常上炎，用苦寒辛散的方法治疗无效时，就用升发药物，加入厥阴经的引经药进行从治。又如久风入中导致完谷不化的泄泻，以及不因外风入侵而因清气在下导致的泄泻。就用轻扬的药物提升并疏散它。凡此类情况，都是“达”的方法。虽然木郁确实有吐法的原理，但现在用“吐”字总括“达”字，那就意味着凡是木郁都应当用吐法，这可以吗？东垣认为食物堵塞肺分，是因为金与土旺于上而克伐木，通过吐去积物以伸展木气，这正是“高者因而越之”的意义，恐怕不必引用木郁的说法来治疗。火郁发之，“发”就是发汗，提升举散。如腠理闭塞，邪气怫郁，就解表取汗以疏散它。又如龙火郁甚于内，不能用苦寒沉降的药物来治疗，就用升浮的药物，佐以甘温，顺应其性而从治，使火势穷尽即止，如东垣的升阳散火汤就是这类。土郁夺之，“夺”就是攻下，劫夺使其衰弱。如邪热入胃，用咸寒药物攻逐它。又如中满腹胀，湿热内盛，其人正气壮实者则攻下；如果势态严重不能立刻消除，就劫夺其势使其衰弱。又如湿热导致的痢疾，有非轻力药物可治的，就或攻或夺以达到平衡。凡此类情况，都是“夺”的方法。金郁泄之，“泄”就是渗泄而利小便，疏通其壅塞。如肺金为肾水上源，肺金受火灼烧，其功能不行，郁而渗道闭塞，宜整肃金气，滋润以利之。又如肺气满，胸中喘息，不用利肺气的药物，不足以疏通。凡此类情况，都是“泄”的方法。王冰注解“表”字，于理不当。水郁折之，“折”就是抵御，攻伐挫败它，逐渐削弱其势。如肿胀病，水气淫溢，而渗道阻塞。水的所不胜者是土，现在土气衰弱，不能制约水，反而受水侮。治疗应当充实脾土，资助运化，使其能制水而不被侵犯，则渗道通达而后痊愈。或者病势既旺，上述方法不能立即控制，就用泄水药物，攻伐挫败它，或去除郁积陈腐，开鬼门（发汗），洁净府（利小便），三种治疗方法兼备并举，交替使用以逐渐平息。王氏所谓抑制以制约冲逆，正是想要挫败其泛滥之势。充实脾土是守，泄水是攻，兼用三种方法是广泛策略以求决胜。虽然都是治水的方法，但不审察病人的虚实、病程长短、病位浅深，混杂而妄施治疗，能不失败的是很少的。邪气久留，正气必损，现在邪气虽去，如果不平调正气，使其各安其位，恢复常态，还不足以尽其妙用，所以说要平调其气。如果调治后气仍有过盛而未服，就应当补其所不胜以制约它。如木过盛当补金，金能制木，则木就顺服了。所不胜者就是所畏惧的，所以说“过者折之”，以其畏惧故。制约万物是万物所希望的，被万物制约是万物所不希望的，顺应其欲则喜，违背其欲则恶，现在用其所厌恶的方式来制约，所以说这叫“泻”。王氏以咸泻肾、酸泻肝等说法来解释，未能完全领会其旨意。（王安道论五郁）
三焦取用火能腐熟食物的意义，火的性质是自下而上。三焦，始于原气，出于中脘，散于膻中，都是相火自下而上的运行。说上焦主纳而不出的，下焦主出而不纳的，其纳与出，都取决于中焦的腐熟作用，焦的含义可见一斑。
厥阴和太阳经，气少血多；太阴和少阴经，血少气多；阳明经气血俱多；少阳经气多血少，男子妇人都具有这些气血。男子多用气，所以常气不足。女人多用血，所以常血不足。因此男子的病多在气分，妇人的病多在血分。世俗却说男子多气，女子多血，难道不是谬误吗？
邪气盛则实，精气夺则虚。这两句是治疗疾病的纲领，辞义似乎明显，含义却很微妙，最应当详细辨别。而最难辨别的是什么？大概“实”指邪气，实证宜泻；“虚”指正气，虚证宜补。凡是邪正相搏而为病，则邪实正虚，两种情况都可以说。所以主张泻的人，就说“邪盛则实，当泻”；主张补的人，就说“精夺则虚，当补”。各执一句，茫然没有确切见解，借口文饰，谁说谁不对。因此至精的训诫，反而酿成巨大的危害，不知道道理的所在，有必不可移易的原则，只是当时的医生不能察觉罢了。我请求将此分析为四点：一是孰缓孰急，二是其有其无。所谓缓急，是察虚实之缓急。无虚者，急在邪气，去之不速，停留则生变。多虚者，急在正气，培之不早，临期无济于事。微虚微实者，也治其实，可以一扫而除。甚虚甚实者，所畏在虚，只要固守根本，先使自己不可战胜，则邪气无不退却。二虚一实者兼治其实，打开一面。二实一虚者兼治其虚，防止发生不测。总之，实证误补，固然会增加邪气，尚可解救，祸患小。虚证误攻，真气忽去，无可挽回，祸患大。这是虚实缓急，不可不察。所谓有无，是察邪气之有无。凡风寒暑湿火燥，都能增邪，邪在表在里，在腑在脏，必有所居，求得根本则直取之，这叫“有”，有则邪实。若无六气之邪，而病出三阴，则皆因情欲伤内，劳倦伤外，非邪似邪，非实似实，这叫“无”，无则病在元气。不明虚实有无之义，必至以逆为从，以标作本，断人长命，损德多矣，可不恐惧且谨慎吗？
损伤分五脏，而五脏所藏，无非精与气罢了。精为阴，是人之水；气为阳，是人之火。水火得其正，则为精为气；水火失其和，则为热为寒。这是因为偏损，所以导致偏胜，故水中不可无火，无火则阴胜而寒病生。火中不可无水，无水则阳胜而热病起，只当详细辨别阴阳，则虚损的治疗就没有遗漏了。如水亏者阴虚，只宜大补真阴，切不可再伐阳气。火虚者阳虚，只宜大补元阳，切不可再伤阴气，盖阳气不足，又去伐其阴，阴也受损。阴已不足，再伤其阳，阳也亡失了。治虚治实，本来不同。实者阴阳因有余，只去掉所余，则得其平。虚者阴阳有不足，再去掉所有，则两者俱败，怎能生存？所以治虚的要领，凡阴虚多热者，最嫌辛燥，恐助阳邪；尤忌苦寒，恐伐生气；惟喜纯甘壮水之剂，补阴以配阳，则刚为柔制，虚火自降，而阳归乎阴。阳虚多寒者，最嫌凉润，恐助阴邪；尤忌辛散，恐伤阴气；只宜甘温益火之品，补阳以配阴，则柔得其主，沉寒自敛，而阴从乎阳。是以气虚者宜补其上，精虚者宜补其下，阳虚者宜补而兼暖，阴虚者宜补而兼清，这固然是阴阳治疗的辨别。其中有气因精而虚者，自当补精以化气；精因气而虚者，自当补气以生精；又如阳失阴而离者，不补阴何以收散亡之气？水失火而败者，不补火何以苏随绝之阴？这又是阴阳相济的妙用。所以善补阳者，必于阴中求阳，则阳得阴助而生化无穷。善补阴者，必于阳中求阴，则阴得阳升而泉源不竭。故以精气分阴阳，则阴阳不可离。以寒热分阴阳，则阴阳不可混，这又是阴阳邪正的离合。知阴阳邪正之治，则阴阳和而生道得矣。
《本神篇》说：心怵惕思虑则伤神，伤神则恐惧自失。《邪气脏腑病形篇》说：忧愁恐惧则伤心。《口问篇》说：悲哀忧愁则心动，心动则五脏六腑皆摇。可见心为五脏六腑之大主，而总统魂魄，兼该志意，所以忧动于心则肺应，思动于心则脾应，怒动于心则肝应，恐动于心则肾应，这就是五志惟心所使的原因。如果能善养此心，居处安静，无为惧惧，无为欣欣，婉然从物而不争，与时变化而无我，则志意和，精神定，悔怒不起，魂魄不散，五脏俱宁，邪亦安从奈我何哉？
人知道阴虚唯一，而不知阴虚有二。如阴中之水虚，则病在精血；阴中之火虚，则病在神气。盖阳衰则气去，故神志为之昏乱，这不是火虚吗？阴亏则形坏，故肢体为之废弛，这不是水虚吗？现在以神离形坏之证，却不求水火之源，而仍用治风的方法，鲜有不危险的！试以天道言之，其象亦然。凡旱则多燥，燥则多风，是风木之化从乎燥，燥则阴虚之候也。所以凡治类风者，专宜培补真阴以救根本，使阴气复，则风燥自除矣。然而外感者，并非绝无虚证，气虚则虚。内伤者，并非必无实证，有滞则实。治虚者当察其在阴在阳而直补之，治实者但察其因痰因气而暂开之，这在内外伤及虚实攻补之间，最当察其有无微甚，而酌其治。甚至有元气素亏，猝然仆倒，上无痰，下失禁，瞑目昏沉，这是厥竭之证，尤其与风邪无关。如果不是大剂参附，或七年之艾，破格挽回，又怎望其复真气于将绝之顷哉？倘不能察其表里，又不能辨其虚实，但以风之名，多用风药，不知风药皆燥，燥复伤阴；风药皆散，散复伤气；以内伤作外感，以不足为有余，这是促人之死也。
五脏失治，皆为心痛，刺治分经，理甚明悉。至于舍针用药，尤宜察此详义。盖肾心痛者，多由阴邪上冲，故善伛偻，如从后触其心。胃心痛者，多由停滞，故胸腹胀满。脾心痛者，多由寒逆中焦，故其病甚。肝心痛者，多由木火之郁，病在血分，故色苍苍如死状。肺心痛者，多由上焦不清，病在气分，故动作则病益甚。若知其在气则顺之；在血则行之；郁则开之；滞则逐之；火多实，则或散或清之；寒多虚，则或温或补之。必真心痛者，乃不可治，否则但得其本，则必随手而应，其易如探囊也。
天之六气，只有火有两种。君在上，相在下。阳在上者，即君火也；阳在下者，即相火也。上者应离卦，阳在外也，故君火以明。下者应坎卦，阳在内也，故相火以位。火是一样东西，而上下幽显，其象不同，这就是之所以有辨别的原因。然而以凡火观之，则其气质上下，也自有君相明位之辨。盖明者是光，是火之气。位者是形，是火之质。如一寸之灯，光被满室，这是气的作用。盈炉之炭，有热无焰，这是质的作用。焰与炭都是火，然焰明而质暗，焰虚而质实，焰动而质静，焰上而质下，以此证之，则气与质，固自有上下之分，这难道不是君相之辨吗？所以君火居上，为日之明，以昭天道，故于人属心，而神明出焉。相火居下，为原泉之温，以生养万物，故于人属肾，而元阳蓄焉。所以六气之序，君火在前，相火在后，前者肇物之生，后者成物之实。而在三百六十日中，前后二火所主者，止四五六七月，共一百二十日，以成一岁化育之功，这是君相二火之为用。
六气之分，属阴的有三种：湿、燥、寒是也。属阳的有两种：风、热而已。假使火无君相之化，则阴胜于阳，而杀甚于生矣，这就是二火之所以必不可无的原因。如果因为惟火有二，便谓阳常有余，而专意仰之，则伐天之和，伐生之本，莫此为甚。这些大义，学人最当详察。
三阳所在，其脉无不应者，是气之盈也。三阴所在，其脉有不应者，以阳气有不及，是气之虚也。然而三阴之列，又惟少阴独居乎中，这又是阴中之阴也，所以少阴所在为不应，盖亦应天地之虚耳，难道是君主不主事的意思吗？
五行胜复之理，不期然而然。天地万物，固无往而非五行，而亢害承制，又安往而不然哉？故求之于人，则五脏更相平也，五志更相胜也，五气更相移也，五病更相变也。故火极则寒生，寒极则湿生，湿极则风生，风极则燥生，燥极则热生，皆其化也。第承制之在天地者，出乎气化之自然，而在人亦为有之，则在挽回运用之得失耳。使能知其微，得其道，则把握在我，何害之有？设承制之盛衰不明，似是之真假不辨，则败乱可立而待也。
所以用以太阳之人，而遇流衍之纪；以太阴之人，而逢赫曦之纪；强者有制，弱者遇扶，气得其平，何病之有？或以强阳遇火，则炎烈生矣，阴寒遇水，则冰霜及矣。天有天符，岁有岁会，人得无人和乎？
王荆公解释痛利二字，说：治法云诸痛为实，痛随利减，世俗以利为下法。假令痛在表者实也，痛在里者实也，痛在气血者亦实也。故在表者汗之则愈，在里者下之则愈，在血气者散之行之则愈，岂可以利为下法乎？宜作通字训则可，此...
This refers to the pathology caused by Fire pathogen. Jun Fire (Ministerial Fire / Sovereign Fire) is like human fire, while Xiang Fire (Ministerial Fire) is like dragon fire. When human fire burns wood, the momentum is slow; when dragon fire burns wood, the momentum is rapid. The *Neijing* (Classic of Internal Medicine) mentions Hou Bi (Sore Throat), referring to lesions between the throat and tongue. Because the etiology in both cases is Fire, no distinction is made. Treating the Fire causing Hou Bi is akin to extinguishing a fire; it allows for no delay. The *Neijing* states: "For Fire stagnation, promote its dispersal." Dispersal here refers to diaphoresis (sweating). However, how can one induce sweating in the throat? Therefore, bloodletting is considered a form of promoting dispersal.
The Sour taste belongs to Liver Wood. Due to excessive Fire suppressing Lung Metal, preventing Metal from balancing Wood, Liver Wood becomes hyperactive, thus producing sourness. For instance, drinking hot liquids may cause sourness in the mouth. Some claim that vomiting acid is due to Cold; this is erroneous. Thus, Liver Heat causes sour taste, Heart Heat causes bitter taste, Spleen Heat causes sweet taste, Lung Heat causes pungent taste, and Kidney Heat causes salty taste. A bland taste indicates Stomach Heat. The Stomach belongs to Earth; Earth is the mother of all things, so the Stomach is the root of the body. Blandness is the root of the five tastes. Then how can vomiting acid be attributed to Cold? Generally, treating vomiting acid with warm herbs to disperse follows the principle of releasing the exterior, aiming to open intestinal and gastric stagnation, dissipate constraint, and restore harmony. If vomiting acid persists for a long time, warm herbs are contraindicated; instead, cold herbs should be used to purge, followed by cooling herbs to regulate. Once stagnation clears and heat dissipates, Qi harmonizes. (Liu Hejian on Vomiting Acid)
Zhang Zhongjing discusses extreme heat in Shaoyin disease, stating: Incontinence of urine and feces, delirious speech, and eyes rolling upward indicate the exhaustion of Kidney Qi first. The *Ling Shu* (Spiritual Pivot) states: "The Kidneys govern the two yin orifices" (anterior and posterior). However, if the root is deficient and constrained heat lodges in these areas, leading to stagnation in the two yin orifices, flaccidity and numbness occur, and the spirit loses its function. Consequently, incontinence ensues, which clearly indicates a Heat syndrome. (Liu Hejian on Strangury)
The Chong, Ren, and Du meridians are bound by the Dai Meridian. Other meridians circulate up and down, leaving residual heat in the Dai Meridian. This causes blood accumulation and stasis. Fire transforms via Metal into white fluid. There is a sense of unjust heat in the lower abdomen, with white matter overflowing and discharging with urine continuously, usually without pain. If there is pain, it is due to obstruction and congestion. The *Neijing* states: "Unjust heat in the lower abdomen, discharge of white fluid from urine." 'Yuan' (unjust/stagnant) refers to屈滞 (bending and stagnation). This disease does not originate from the primary meridian but results from stagnation in other meridians. In treating dysentery and leukorrhea, one must not abruptly use harsh hot herbs to dry dampness. Drying leads to depletion of internal fluids; depletion of fluids causes vexation and thirst; thirst leads to difficult urination; difficult urination causes edema of feet and face, eventually becoming incurable. Red and white dysentery results from pathogenic heat transmitting to the Large Intestine, discharging red and white matter from the Guang Chang (lower rectum). Leukorrhea results from heat transmitting to the Small Intestine and entering the Bao Jing (uterine vessels), discharging red and white matter. Based on these two syndromes, both can be treated using methods for dampness, first purging with Dao Shui Yu Gong Wan. Subsequently, use bland agents to descend Heart Fire, tonify Kidney Water, promote urination, and separate water pathways, leading to spontaneous recovery. (He Hanzhong on Leukorrhea)
"Mu Yu Da Zhi" means to make Wood stagnant smooth and unobstructed. For example, if Liver nature is urgent, anger causes Qi reversal, rib distension, and frequent upward flaming of Fire, and bitter-cold and acrid-dispersing treatments fail, then use ascending and dispersing herbs, adding Jue Yin guiding herbs for counter-treatment. Similarly, chronic wind entering the interior causes undigested stool diarrhea, as does clear Qi sinking below without external wind invasion. Use light and rising agents to lift and disperse them. All such cases constitute the method of "Da". Although there is a rationale for emesis in Wood stagnation, equating "emesis" entirely with "Da" implies all Wood stagnation requires emesis, which is unreasonable. Dong Yuan argued that food blocking the Lung sector, where Metal and Earth are hyperactive above suppressing Wood, can be resolved by vomiting out the material to extend Wood Qi. This aligns with "those high above should be vomited," and perhaps it is unnecessary to invoke the theory of Wood stagnation for treatment.
"Fire Yu Fa Zhi" means to disperse Fire stagnation through sweating and lifting. If pores are closed and evil Qi is constrained, release the exterior to induce sweating and disperse it. If Dragon Fire is deeply constrained internally, bitter-cold sinking agents are ineffective; instead, use floating herbs assisted by sweet-warm ones, following its nature for counter-treatment, stopping when the pathogen is exhausted, such as in Dong Yuan's Sheng Yang San Huo Tang.
"Tu Yu Duo Zhi" means to attack Earth stagnation via purgation,劫夺 (seizing/overpowering) to weaken it. If pathogenic heat enters the Stomach, use salty-cold agents to purge it. If there is abdominal fullness and distension with severe internal damp-heat, and the patient has strong Qi, use purgatives. If the condition is severe and cannot be removed instantly, seize the momentum to weaken it. For damp-heat dysentery resistant to mild agents, use attacking or seizing methods to achieve balance. These constitute the method of "Duo".
"Jin Yu Xie Zhi" means to drain Metal stagnation by promoting diuresis and clearing obstruction. If Lung Metal, the source of Kidney Water, is scorched by Fire, its functions fail, and drainage pathways close. One should regulate Metal transformation and moisten to promote flow. If Lung Qi is full causing chest distress and仰息 (orthopnea), only Lung-Qi-promoting agents can clear it. These constitute the method of "Xie". Wang Bing's interpretation of "Biao" (exterior) is inappropriate here.
"Shui Yu Zhe Zhi" means to restrain Water stagnation by defending against, attacking, and gradually reducing its momentum. In edema diseases, Water Qi overflows and blocks drainage. Earth controls Water; if Earth Qi is weak and fails to control Water, it suffers Water's insult. Treatment should strengthen Spleen Earth, aid transformation, enabling it to control Water. If the disease is too advanced for this, use water-draining herbs to attack and reduce it, or employ "removing accumulation," "opening ghost gates" (diaphoresis), and "cleaning the residence" (diuresis). Combining these three methods gradually resolves the issue. Wang's concept of suppressing rebellious Qi aims to curb its flooding. Strengthening Earth is defense; draining Water is attack; combining three methods is a comprehensive strategy. Without assessing deficiency/excess, duration, and depth, mixing treatments leads to failure. Long-standing pathogens damage righteous Qi. Even after pathogens are gone, failing to harmonize Qi prevents true recovery. Hence, "harmonize Qi." If Qi remains excessive after regulation, tonify its controlling element. E.g., if Wood is excessive, tonify Metal to control it. Controlling elements are feared elements; hence "excessive elements are restrained by their fear." Controlling things is desired; being controlled is unwanted. Using what they dislike to control them is called "draining." Wang's explanation of salty draining Kidney and sour draining Liver misses the deeper meaning. (Wang Andao on Five Stagnations)
The San Jiao utilizes Fire to rot and cook food. Fire's nature moves upward. San Jiao begins at Yuan Qi, emerges from Zhong Wan, and scatters at Dan Zhong, all representing Xiang Fire moving upward. Upper Jiao receives but does not expel; Lower Jiao expels but does not receive. Both reception and expulsion depend on Middle Jiao's digestion. The meaning of "Jiao" (scorched/cooked) is evident.
Jue Yin and Tai Yang have little Qi and much Blood; Tai Yin and Shao Yin have little Blood and much Qi; Yang Ming has abundant Qi and Blood; Shao Yang has much Qi and little Blood. Both men and women possess these Qi and Blood dynamics. Men use Qi more, often suffering Qi deficiency. Women use Blood more, often suffering Blood deficiency. Thus, men's diseases often involve Qi, while women's involve Blood. The secular view that men have much Qi and women have much Blood is erroneous.
"Pathogen excess constitutes Excess; Essence depletion constitutes Deficiency." These two sentences are the general principles of disease treatment. Their meaning is subtle and requires careful discrimination. The difficulty lies in distinguishing them. "Excess" refers to pathogens, requiring purgation. "Deficiency" refers to righteous Qi, requiring tonification. In pathogen-righteous Qi conflict, both excess and deficiency exist. Proponents of purgation cite "pathogen excess," while proponents of tonification cite "essence depletion." Each clings to one phrase, lacking clarity, leading to confusion and harm. I analyze this into four aspects: urgency and presence/absence. Urgency: If no deficiency, urgency lies in pathogens; remove them quickly to prevent complications. If significant deficiency, urgency lies in righteous Qi; tonify early to prevent collapse. Mild excess/deficiency: treat the excess. Severe excess/deficiency: fear the deficiency; secure the root to become invincible, ensuring pathogen retreat. Two deficiencies, one excess: treat excess partially. Two excesses, one deficiency: treat deficiency partially to prevent unpredictability. Mistaken tonification of excess increases pathogens but is salvageable. Mistaken purgation of deficiency causes sudden loss of True Qi, which is fatal. Presence/Absence: Check for pathogens. Wind, Cold, Summerheat, Damp, Fire, Dryness add pathogens. Pathogens reside in exterior/interior, fu/zang. Finding the root allows direct attack ("Presence"). If no six qi pathogens, but disease arises from Three Yin due to emotional or labor injury, it mimics excess but is actually "Absence," indicating disease in Yuan Qi. Failing to understand this leads to mistaking reversal for compliance and branch for root, shortening life and damaging virtue. Be cautious!
Damage to the Five Zang affects their stored Essence and Qi. Essence is Yin (Water); Qi is Yang (Fire). When balanced, they are Essence and Qi; when imbalanced, they become Heat and Cold. Imbalance causes excess. Water needs Fire; without Fire, Yin excess causes Cold. Fire needs Water; without Water, Yang excess causes Heat. Detailed differentiation of Yin/Yang is key to treating deficiency. For Water deficiency (Yin deficiency), greatly tonify True Yin; do not attack Yang. For Fire deficiency (Yang deficiency), greatly tonify Original Yang; do not injure Yin. Attacking Yin when Yang is deficient harms Yin further; injuring Yang when Yin is deficient destroys Yang. Treating excess involves removing surplus to restore balance. Treating deficiency involves addressing insufficiency; removing what remains causes mutual destruction. Key to treating deficiency: For Yin deficiency with Heat, avoid acrid-dry (assists Yang pathogen) and bitter-cold (injures vital Qi); prefer pure-sweet agents to nourish Water, tonifying Yin to match Yang, allowing softness to control hardness, descending false Fire, returning Yang to Yin. For Yang deficiency with Cold, avoid cool-moistening (assists Yin pathogen) and acrid-dispersing (injures Yin); prefer sweet-warm agents to benefit Fire, tonifying Yang to match Yin, allowing softness to find master, consolidating deep Cold, returning Yin to Yang. Qi deficiency: tonify upper; Essence deficiency: tonify lower. Yang deficiency: tonify with warmth; Yin deficiency: tonify with cooling. This distinguishes Yin/Yang treatment. If Qi deficiency stems from Essence, tonify Essence to generate Qi. If Essence deficiency stems from Qi, tonify Qi to generate Essence. If Yang separates from Yin, tonify Yin to gather scattered Qi. If Water fails without Fire, tonify Fire to revive dying Yin. This is the subtle application of Yin-Yang mutual assistance. Those skilled in tonifying Yang seek Yang within Yin, so Yang gains Yin assistance and generates endlessly. Those skilled in tonifying Yin seek Yin within Yang, so Yin gains Yang ascent and flows inexhaustibly. Dividing Yin/Yang by Essence/Qi shows inseparability; dividing by Cold/Heat shows distinctness. Understanding Yin/Yang pathogen/righteous separation leads to harmony and the Way.
The *Ben Shen Pian* states: Fear, alarm, and overthinking damage Shen (Spirit); damaged Shen leads to fear and self-loss. The *Xie Qi Zang Fu Bing Xing Pian* states: Worry and fear damage the Heart. The *Kou Wen Pian* states: Sorrow and grief move the Heart; moved Heart shakes all Zang and Fu. Thus, the Heart is the Great Master of Zang and Fu, commanding Hun and Po, encompassing Zhi and Yi. Worry moves Heart, Lung responds; Thought moves Heart, Spleen responds; Anger moves Heart, Liver responds; Fear moves Heart, Kidney responds. The Five Emotions are commanded by the Heart. Nurturing this Heart, living quietly, avoiding excessive fear or joy, yielding to things without contention, adapting with time without ego, leads to harmonious Zhi, settled Spirit, no regret or anger, stable Hun and Po, peaceful Zang, and immunity to pathogens.
People know Yin deficiency is one, but not that it has two types. Water deficiency within Yin affects Jing and Blood; Fire deficiency within Yin affects Shen and Qi. Yang decline leads to Qi loss, causing confused Shen and Zhi (Fire deficiency). Yin decline leads to physical decay, causing limb flaccidity (Water deficiency). Treating Shen separation and physical decay by seeking Wind rather than Water/Fire sources is dangerous. Analogously, drought causes dryness, dryness causes wind; Wind-Wood transformation follows Dryness, which is a sign of Yin deficiency. Treating wind-like symptoms requires tonifying True Yin to save the root; restoring Yin removes wind and dryness. External pathogens are not devoid of deficiency (Qi deficiency exists). Internal injuries are not devoid of excess (stagnation creates excess). Treat deficiency by locating Yin/Yang and tonifying directly. Treat excess by identifying Phlegm/Qi and temporarily opening. Carefully assess presence/absence and severity in external/internal injuries and tonification/purgation. Sudden collapse with no phlegm, incontinence, and coma indicates Jue Jie (collapse of Qi), unrelated to Wind. Only large doses of Renshen and Fuzi, or aged moxa, can rescue True Qi at the brink of death. Failure to distinguish exterior/interior and deficiency/excess, and blindly using Wind herbs (which are drying and dispersing, harming Yin and Qi), mistaking internal injury for external excess, accelerates death.
Neglecting the Five Zang causes Heart Pain. Acupuncture differentiates by meridian. Herbal treatment requires detailed analysis. Kidney Heart Pain: Yin evil rushing up, causing curvature/back-touch sensation. Stomach Heart Pain: Stagnation, causing chest/abdominal fullness. Spleen Heart Pain: Cold reversing in Middle Jiao, severe pain. Liver Heart Pain: Wood-Fire stagnation in Blood level, pale/deadly complexion. Lung Heart Pain: Upper Jiao unclear, Qi level, worsened by movement. If in Qi, smooth it; in Blood, move it; stagnant, open it; obstructed, drive it out; Fire excess, disperse/clear; Cold deficiency, warm/tonify. True Heart Pain is incurable; otherwise, treating the root yields immediate results.
Of the Six Qi, only Fire has two types. Jun (Sovereign) is above; Xiang (Minister) is below. Yang above is Jun Fire; Yang below is Xiang Fire. Above corresponds to Li (Fire trigram), Yang outside, so Jun Fire illuminates. Below corresponds to Kan (Water trigram), Yang inside, so Xiang Fire maintains position. Fire is one, but upper/lower manifestations differ. Observing ordinary fire, quality differs. Illumination is Qi; Position/Form is Substance. A small lamp lights a room (Qi effect). A furnace of charcoal has heat but no flame (Substance effect). Flame is bright, empty, active, upward; Charcoal is dark, solid, static, downward. This reflects the distinction between Jun and Xiang. Jun Fire resides above, like the sun, governing Heaven, corresponding to Heart and Shenming. Xiang Fire resides below, like spring warmth, nurturing all things, corresponding to Kidney and Yuan Yang. In the sequence of Six Qi, Jun Fire precedes, initiating life; Xiang Fire follows, completing fruition. They dominate months 4-7 (120 days), accomplishing yearly transformation.
Among Six Qi, Yin includes Damp, Dryness, Cold. Yang includes Wind, Heat. Without Jun/Xiang Fire, Yin would exceed Yang, killing more than generating. Thus, Fire is essential. Assuming "Yang is always in excess" because Fire has two types disrupts Heavenly Harmony and Life's Root. Scholars must examine this carefully.
In San Yang locations, pulses are always responsive (Qi abundance). In San Yin locations, pulses may be unresponsive (Yang deficiency/Qi emptiness). Among San Yin, Shao Yin stands alone in the middle, being Yin within Yin. Thus, Shao Yin pulse is unresponsive, reflecting Heaven/Earth's emptiness, not implying the Sovereign does not rule.
The logic of Wu Xing (Five Phases) overcoming and compensating occurs naturally. All things follow Wu Xing;亢害承制 (excess harm and bearing restraint) applies everywhere. In humans, Zang organs balance each other, emotions overcome each other, Qi shifts, diseases transform. Extreme Fire generates Cold; extreme Cold generates Damp; extreme Damp generates Wind; extreme Wind generates Dryness; extreme Dryness generates Heat. Heaven/Nature's restraint is natural; human application depends on skill. Knowing subtleties ensures control. Ignoring strength/weakness and truth/falsehood leads to chaos.
Using a Tai Yang person during Liu Yan cycle; Tai Yin person during He Xi cycle. Strong controlled, weak supported, Qi balances, no disease. Strong Yang meets Fire -> intense heat. Yin Cold meets Water -> frost. Heaven has Tian Fu, Year has Sui Hui; humans must harmonize.
Wang Anshi explained "Tong Li" (pain relief): "All pain is excess; pain decreases with Li." Secularly, "Li" means purgation. But pain in exterior is excess (treat with sweating); pain in interior is excess (treat with purgation); pain in Qi/Blood is excess (treat with dispersing/moving). Why limit "Li" to purgation? It should mean "unblocking/smoothness"...