喻昌曰∶太极动而生阳，静而生阴，阳动而不息，阴静而有常。二气交而人生，二气分而人死，二气偏而病起，二
气乖而病笃。圣神忧之，设为医药，调其偏驳，使归和平，而民寿以永。观于生气通天论中，论人身阳气，如天之与日，
失其所则折寿而不彰。是虽不言阴病，而阴病之机，宛然可识。但三皇之世如春，阳和司令，阴静不扰，所以《内经》
凡言阴病，但启其端，弗竟其说。厥后国政乖讹，阳舒变为阴惨，天之阳气闭塞，地之阴气冒明。冒明者，以阴浊而
冒蔽阳明也，百川沸腾，山冢 崩，高岸为谷，深谷为陵，《诗》言之矣。民病因之，横夭宏多，究莫识其所以横夭之故，
汉末张仲景，着《伤寒论》十卷，治传经阳病；着《卒病论》六卷，治暴卒阴病，生民不病，《卒病论》当世即已失传，
岂非其时贤士大夫莫能深维其义，《金匮玉函》置而弗收，其流布民间者，悉罹兵火之厄耶？仲景已后，英贤辈出，从未
有阐扬其烈者，惟韩祗和于中寒一门，微有发明，诲人以用附子、干姜为急，亦可谓仲景之徒矣。然自有医药以来，只
道其常，仲景兼言其变，诧而按剑，势所必至，越千百年，祗和草泽一家之言，已不似仲景登高之呼。况有丹溪节斋诸
缙绅先生，多主贵阴贱阳立说，曰阳道饶，阴道乏；曰阳常有余，阴常不足；曰阴气难成易亏故早衰，制为补阴等丸，
畸重乎阴，畴非至理。第于此道依样葫芦，未具只眼。然世医莫不奉以为宗，即使《卒病论》传之至今，亦与《伤寒论》
同其悠悠汶汶也已，嗟乎！化日舒长，太平有象。乱离愁惨，杀运繁兴，救时者傥以贵阴贱阳为政教，必国非其国。治
病者，倘以贵阴贱阳为药石，必治乖其治矣，岂通论哉？昌尚论仲景《伤寒论》，于凡阴病见端，当以回阳为急者，一一
表之，吾门已 知所先矣。今欲并度金针，畅言底里，《易》云∶通乎昼夜之道，而知夫昼为阳，群阴莫不潜伏。夜为
阴，群阴得以现形，诸鬼为之夜食。一切山精水怪，扬氛吐焰，伎俩无穷，比鸡鸣则尽隐矣。盖鸡鸣夜虽未央，而时则
为天之阳也，天之阳开，故长夜不至，漫漫而将旦也。阴病之不可方物，此见一斑，而谁为燃犀之照也哉？佛说四百四
病，地水火风，各居百一，是则四百四病，皆为阴病矣。夫水火木金土，在天成象，在地成形，原不独畸于阴。然而五
形皆附地而起，水附子地，而水中有火，火中有风，人所以假合成身，身所以相因致病，率禀四者。金性坚刚，不受和
合，故四大惟金不与。证无生者，必修西方佛土，有由然也。世人但知地气静而不扰，偶见地动，便骇为异，不知地气
小动，则为灾眚，大动则为劫厄。劫厄之来，天地万物，凡属有形，同归于坏。然地气有时大动，而世界得不速坏者，
则以玄天真武坐镇北方，摄伏龙蛇，不使起陆，以故地动而水不动，水不动而水中之火，火中之风自不动也。仲景
于阴盛亡阳之证，必用真武汤以救逆者，非以此乎？至于戌亥混茫，亦非天翻地覆互相混也，天原不混于地，乃地气加
天而混之耳。盖地水火风四轮，同时轰转，雷炮冲射之威，千百亿道，震荡于五天之中，顷之搅毁太空，混为一区，而
父母所生血肉之躯，其阴病之惨烈，又当何如？禅宗有白浪滔天，劫火洞然，大千俱坏等语。岂非四大解散之时，实有
此象乎？究竟地气之加于天者，止加于欲界色界等天，不能加于无色界天。所以上八景中，忉利天宫，万圣朝真，兜率
内脘，诸天听法，各各身除中阴，顶现圆光，由此直接非想非非想天。而入佛界法界，睹大千世界，若掌中一果矣，更
何劫运可加之耶，劫运所加之天，至子而开，阴气下而高复始露，至丑而阴气尽返于地，而太空始廓，两仪分莫厥位。
日月星辰丽乎天，华岳河海附乎地，五天之气，散布于列曜九地之气，会通乎山泽，以清以宁，曰大曰广，庶类以渐萌
生。而天界隙中所余暴悍浊阴，动辄绵亘千万丈，排空直坠，摧残所生，靡有孑遗。天开地辟以后，阴惨余殃，
尚若此其可畏，必至寅而驳劣悉返冲和。天光下济，地德上承，名木嘉卉，累累垂实，光音天人，下食其果，不复升举，
因得施生，乃至繁衍，而成天地人之三界也。此义关系人身性命，病机安危，最宏最巨，儒者且置为不论不议，医者更
蔑闻矣。昌每见病者，阴邪横发，上乾清道，必显畏寒腹痛，下利上呕，自汗淋漓，肉 筋惕等证，即忙把住关门，行
真武坐镇之法，不使龙雷升腾霄汉。一遵仲景已传之秘，其人获安。倘先此不治，顷之浊阴从胸而上入者，咽喉肿痹，
舌胀睛突；浊阴从背而上入者，颈筋粗大，头项若冰，转脱浑身青紫而死。谓非地气加天之劫厄乎？惟是陡进附子、干
姜，纯阳之药，亟驱阴邪，下从阴窍而出，非与迅扫浊阴之气还返地界同义乎？然必尽驱阳隙之阴，不使少留，乃得功
收再造，非与一洗天界余氛，俾返冲和同义乎？会仲景意中之法，行之三十年，治经百人，凡遇药到，莫不生全，虽曰
一时之权宜，即拟为经常之正法可也。医学缺此，诚为漏义，谨立鄙论，以开其端。后有作者，出其广大精微之蕴，是
编或有可采云尔。
论辨中寒证要法 卒中寒者，阳微阴盛，最危最急之候。《经》曰∶阴盛生内寒。因厥气上逆，寒气积于胸中
而不泄，不泄则温气去，寒独留，留则血凝，血凝则脉不通，其脉盛大以涩，故中寒。《内经》之言若此，今欲会仲景表
章《内经》之意，敷陈一二，敢辞饶舌乎？
《经》既言阴盛生内寒矣，又言故中寒者，岂非内寒先生，外寒后中之耶？经既言血凝脉不通矣，又言其脉盛大以
涩者，岂非以外寒中，故脉盛大？血脉闭，故脉涩耶？此中伏有大疑，请先明之。一者人身卫外之阳最固，太阳卫身之
背，阳明卫身之前，少阳卫身之两侧。今不由三阳，而直中少阴，岂是从天而下？盖厥气上逆，积于胸中则胃寒，胃寒
则口食寒物，鼻吸寒气，皆得入胃。肾者胃之关也，外寒斩关直入少阴肾藏，故曰中寒也、此《内经》所隐而未言者也。
一者其脉盛大以涩，虽曰中寒，尚非卒病。卒病中寒，其脉必微，盖《内经》统言伤寒中寒之脉，故曰盛大以涩。仲景
以伤寒为热病，中寒为寒病，分别言之。伤寒之脉，大要以大浮数动滑为阳，沉涩弱弦微为阴。阳病而见阴脉，且主死，
况阴病卒急，必无反见阳脉之理，若只盛大以涩，二阳一阴，亦何卒急之有哉？此亦《内经》所隐而难窥者也。
再推仲景以沉涩弱弦微为阴脉矣，其伤寒传入少阴经，则曰脉微细。今寒中少阴，又必但言脉微，不言细矣。盖微
者阳之微也，细者阴之细也，寒邪传肾，其亡阳亡阴，尚未可定。至中寒则但有亡阳，而无亡阴，故知其脉必不细也。
若果见细脉，则其阴先已内亏，何繇而反盛耶？
在伤寒证，惟少阴有微脉，他经则无。其太阳膀胱，为少阴之府，才见脉微恶寒，仲景蚤从少阴施治，而用附子、
干姜矣。盖脉微恶寒，正阳微所至。《诗》云∶彼月而微，此日而微，今此下民，亦孔之哀。在天象之阳，且不可微，然
则人身之阳，顾可微哉？肾中既已阴盛阳微，寒自内生，复加外寒，斩关直中，或没其阳于内，灭顶罹殃；或逼其阳于
外，隙驹避舍，其人顷刻云亡，故仲景以为卒病也。
人身血肉之躯，皆阴也。父母媾精时，一点真阳，先身而生，藏于两肾之中，而一身之元气，由之以生，故谓生气
之原。而六淫之外邪，毫不敢犯，故谓守邪之神。暗室一灯，炯然达旦，耳目赖之以聪明，手足赖之以持行者矣。昔人
傲雪凌寒，寻诗访友，犹曰一时之兴到。至如立功异域，啮雪虏庭，白首犹得生还，几曾内寒生而外寒中耶，故以后天
培养先天，百年自可常享。苟为不然，阳微必至阴盛，阴盛愈益阳微，一旦外寒卒中，而以经常之法治之，百中能有一
活耶？卒病之旨，其在斯乎。
肾中真阳，得水以济之；留恋不脱，得土以堤之；蛰藏不露，除施泄而外，屹然不动。而手足之阳，为之役使，流
走周身，固护腠理而捍卫于外。而脾中之阳，法天之健，消化饮食，传布津液而营运于内。而胸中之阳，法日之驭，离
照当空。消阴除 ，而宣布于上。此三者丰亨，有象肾中真阳，安享太宁。故有八十而御女生子，余勇可贾者矣。即或
施泄无度，阳痿不用，尚可迁延岁月。惟在外、在上、在中之阳，衰微不振，阴气乃始有权，或肤冷不温，渐至肌硬不
柔，卫外之阳不用矣。或饮食不化，渐至呕泄痞胀，脾中之阳不用矣。或当膺阻碍，渐至窒塞不开，胸中之阳不用矣。
乃取水土所封之阳，出而任事，头面得阳而戴赤，肌肤得阳而 燥，脾胃得阳而除中，即不中寒，其能久乎？
论治中寒病用药八难
寒中少阴，行其严令，埋没微阳，肌肤冻裂，无汗而丧神守。急用附子、干姜，加葱白以散寒，加猪胆汁引入阴分。
然恐药力不胜，熨葱灼艾，外内协攻，乃足破其坚凝。少缓须臾，必无及矣，此一难也。
若其人真阳素扰，腠理素疏，阴盛于内，必逼其阳亡于外，魄汗淋漓，脊项强硬。用附子、干姜、猪胆汁，即不可
加葱及熨灼，恐助其散，令气随汗脱，而阳无繇内返也。宜扑止其汗，陡进前药，随加固护腠理，不尔恐其阳复越，此
二难也。
用附子、干姜以胜阴复阳者，取飞骑突入重围，搴旗树帜，使既散之阳，望帜争趋，顷之复合。不知此义者，加增
药味，和合成汤，反牵制其雄入之势，必至迂缓无功，此三难也。
其次前药中即须首加当归、肉桂，兼理其荣，以寒邪中入，先伤荣血故也。不尔药偏于卫，弗及于荣，与病即不相
当。邪不尽服，必非胜算，此四难也。其次前药中即须加入人参、甘草，调元转饷。收功帷幄，不尔姜附之猛，直将犯
上无等矣，此五难也。
用前药二三剂后，觉其阳明在躬，运动颇轻，神情颇悦，更加黄 、白术、五味、白芍，大队阴阳平补，不可歇手。
盖重阴见 ，浪子初归，斯时摇摇靡定，怠缓不为善后，必堕前功，此六难也。
用群队之药，以培阴护阳，其人即素有热痰，阳出早已从阴而变寒，至此无形之阴寒虽散，而有形之寒痰阻塞，窍
隧者无繇遽转为热。姜附固可勿施，其牛黄、竹沥，一切寒凉，断不可用。若因其素有热痰，妄投寒剂，则阴复用事，
阳即躁扰，必堕前功，此七难也。
前用平补后，已示销兵放马，偃武崇文之意。兹后总有顽痰，留积经络，但宜甘寒助气开通，不宜辛辣助热壅塞。
盖辛辣始先不得已而用其毒，阳既安堵，既宜休养其阴，何得喜功生事。徒令病去药存，转生他患，漫无宁宇，此八难
也。
昌粗陈病概，明告八难，良工苦心，此道庶几可明可行矣。然卤莽拘执之辈，用法必无成功，愚昧鲜识之人，服药
必生疑畏。谨合阴病论，请正明哲巨眼，恳祈互相阐发，俾卒病之旨，人人共明，坦然率由，讵非生民之浓幸乎？
论朱丹溪述中寒
丹溪曰∶中寒者，仓卒受寒，其病即发而暴。盖中寒之人，乘其腠理疏豁，一身受邪，难分经络，无热可散，温补
自解。此胃之大虚，不急治去生甚远，法当温散理中汤，甚者加附子，其见解超出寻常矣。然又曰∶有卒中天地之寒气、
口伤生冷之物、有外感、无内伤、用仲景法。若挟内伤，补中益气汤加发散之药，必先用参 托住正气，可见丹溪宗尚
东垣者，犹在仲景宫墙之外，未知其中宗庙百官之富美也。
论戴元礼述中寒
戴元礼曰∶中寒是身受肃杀之气，日食冰水瓜果冷物，病者必脉沉细，手足冷，息微身倦，虽身热亦不渴，倦言语。
或遇热病，误服此药，轻者至重，重者至死。任脉数者，或饮水者，烦躁动摇者皆是热病。寒热二证，若水火也，不可
得而同治，误则杀人，学人慎之。按元礼国朝名医中之翘楚也，其于中寒略窥大意，未识奥旨。且不曰以热病法治之则
死，反曰热病用此药即死，殊失主客，然二老外更无有言及中寒者，昌又推其登坛建帜之功矣。
【律三条】
凡治阴寒暴病，恣用清凉药者，百无一活。如此死者，医杀之也。
凡治暴寒病，胸中茫无真见，虽用辛热，或以渐投，或行监制，时不待人，倏然而逝，医之罪也。
凡医起一阴病者，即可免一劫厄，天理人事必至之符也。其不能起人卒病而求幸免劫厄，自不可得，世有蔼蔼吉人，
其择术当何如耶？
喻昌说：太极运动而产生阳，静止而产生阴。阳的运动永不停息，阴的静止有其常规。阴阳二气交合则人出生，阴阳二气分离则人死亡，阴阳二气偏颇则疾病发生，阴阳二气乖违则病情加重。圣人对此感到忧虑，于是设立医药，调和人体的偏颇驳杂，使其回归平和，从而让百姓长寿。观察《素问·生气通天论》中关于人身阳气的论述，将其比作天与太阳，如果阳气失其所居的功能，就会折损寿命而不显赫。这里虽然未直接谈论阴病（由阴邪盛或阳气虚引起的疾病），但阴病的机理已清晰可辨。
然而在三皇时代，社会状况如同春天，阳气温和主令，阴静不被扰乱，所以《黄帝内经》凡是提到阴病，只是开启个头，没有详尽阐述其说。后来国家政策乖谬错误，阳气舒展变为阴惨肃杀，天上的阳气闭塞，地上的阴气遮蔽光明。“冒明”是指阴浊之气遮蔽了阳明之气。正如《诗经》所言：“百川沸腾，山陵崩塌，高岸变为深谷，深谷变为丘陵。”百姓的疾病因此增多，横死早夭者极多，人们究其根源却不知为何会横死早夭。
到了汉末，张仲景撰写了《伤寒论》十卷，治疗传经的阳病；撰写了《卒病论》六卷，治疗突然发作的阴病，使百姓不再患病。但《卒病论》在当时就失传了，这难道不是因为当时的贤士大夫不能深刻理解其义理，《金匮玉函》被放置而不收藏，流传在民间的版本都遭受兵火之灾吗？张仲景之后，英才辈出，却从未有人发扬光大其功烈，只有韩祗和在中寒这一门类上，略有发明，教导人们急用附子、干姜，也可以说是张仲景的弟子了。
然而自从有医药以来，只讲述常法，张仲景兼讲变法，世人惊诧并持反对态度，这是势所必然的。经过千百年，韩祗和作为草野医家的一家之言，已不像张仲景登高呼号那样有力。况且有朱丹溪、节斋等各位缙绅先生，大多主张贵阴贱阳的理论，说“阳道饶，阴道乏”；说“阳常有余，阴常不足”；说“阴气难成易亏故早衰”，制作补阴等丸药，过分重视阴，谁不认为这是至理呢？只是在此道上依样画葫芦，没有独到的见解。然而世间的医生无不奉为宗师，即使《卒病论》流传至今，也会像《伤寒论》一样被世人漠视糊涂地对待。唉！太平盛世，景象祥和。战乱离愁，杀劫繁兴，救时的人如果把贵阴贱阳作为政教方针，国家一定不成其为国家。治病的人如果把贵阴贱阳作为用药原则，一定治错了病，这难道是通论吗？
我尚论张仲景《伤寒论》，对于凡见阴病的端倪，应当以回阳为急务的情况，一一加以表彰，我的门人已知道先做什么了。现在想要把金针度人，畅言底里，《易经》说：通晓昼夜之道，就知道昼为阳，群阴无不潜伏。夜为阴，群阴得以现形，各种鬼怪为之夜食。一切山精水怪，扬氛吐焰，伎俩无穷，等到鸡鸣时分就全部隐没了。大概鸡鸣时夜晚虽未结束，但时辰属于天之阳，天之阳开启，所以长夜不至于漫长而即将天亮。阴病的不可名状，从这里可见一斑，而谁能像燃犀角那样照见真相呢？
佛说四百四病，地、水、火、风各占一百一，那么四百四病都是阴病了。夫水火木金土，在天形成象，在地形成形，原本不只偏于阴。然而五形都依附地而起，水依附于地，而水中有火，火中有风，人之所以假借合成身体，身体之所以相互因循致病，都禀受这四者。金性坚刚，不接受和合，所以四大之中唯独金不与。证候无生机的，必须修西方佛土，是有原因的。世人只知道地气静而不扰，偶尔见到地震，便惊骇为怪异，不知道地气小动就是灾祸，大动就是劫难。劫难来临，天地万物，凡是有形的，都一同归于毁灭。然而地气有时大动，而世界不迅速毁灭的原因，是因为玄天真武坐镇北方，摄伏龙蛇，不让它们起陆，所以地动而水不动，水不动而水中的火，火中的风自然也不动。
张仲景对于阴盛亡阳的证候，必定用真武汤来救逆，难道不是因为这个道理吗？至于戌亥之时混沌迷茫，也不是天翻地覆互相混淆，天原本不与地混，是地气加于天而使之混。大概地、水、火、风四轮，同时轰转，雷炮冲射的威力，千百亿道，震荡于五天之中，一会儿搅毁太空，混为一区，而父母所生的血肉之躯，其阴病的惨烈，又该是怎样的呢？禅宗有白浪滔天，劫火洞然，大千俱坏等语。难道不是四大解散之时，确实有此景象吗？
究竟地气加于天的，只加于欲界、色界等天，不能加于无色界天。所以上八景中，忉利天宫，万圣朝真，兜率内院，诸天听法，各自身除中阴，头顶显现圆光，由此直接通向非想非非想天。而入佛界法界，目睹大千世界，如掌中一果，还有什么劫运可以施加呢？劫运所加之天，到子时而开，阴气下而高复始露，到丑时而阴气尽返于地，而太空才开阔，两仪分开各归其位。日月星辰附着于天，华岳河海附着于地，五天的气散布于列曜，九地的气会通于山泽，清静安宁，广大无边，众庶类逐渐萌生。而天界缝隙中剩余的暴悍浊阴，动辄绵延千万丈，排空直坠，摧残所生之物，无一幸存。天开地辟以后，阴惨余殃，尚且如此可怕，一定要到寅时才驳劣之气完全返回冲和。天光下济，地德上承，名木嘉卉，累累垂实，光音天人，下食其果，不再升举，因而得以施生，乃至繁衍，而成天地人的三界。
此义关系到人身性命，病机安危，最宏大最巨大，儒者暂且置为不论不议，医者更是很少听闻。我每次见到病人，阴邪横发，上犯清道，必显畏寒腹痛，下利上呕，自汗淋漓，肌肉跳动、筋脉拘挛等证候，急忙把住关门，行真武坐镇之法，不让龙雷之气升腾霄汉。一律遵循张仲景已传的秘法，其人得以平安。如果在此之前不治，不久浊阴从胸而上入，咽喉肿痹，舌胀睛突；浊阴从背而上入，颈筋粗大，头项若冰，转瞬间浑身青紫而死。这难道不是地气加天的劫难吗？
只是骤然进用附子、干姜，纯阳之药，急驱阴邪，下从阴窍而出，这不与迅扫浊阴之气还返地界的意义相同吗？然而必须尽驱阳隙之阴，不让少留，才能收功再造，这不与一洗天界余氛，使其返回冲和的意义相同吗？领会张仲景意中之法，实行三十年，治疗近百人，凡遇到药到之处，没有不保全生命的，虽说是一时的权宜之计，即拟为经常的正法也可以。医学缺少这一点，诚然是漏义，谨立鄙论，以开其端。后有作者，拿出其广大精微的蕴蓄，这部书或许有所采纳。
论辨中寒证要法
突然中寒，是阳微阴盛，最危重最紧急的征候。《内经》说：阴盛生内寒。因为厥气上逆，寒气积于胸中而不泄，不泄则温气离去，寒独留，留则血凝，血凝则脉不通，其脉盛大而涩，所以中寒。《内经》的话是这样说的，现在想要会通张仲景表彰《内经》之意，敷陈一二，敢辞饶舌吗？
《内经》既然说了阴盛生内寒，又说了故中寒者，难道不是内寒先产生，外寒后中伤的吗？《内经》既然说了血凝脉不通，又说了其脉盛大以涩的，难道不是以外寒中伤，所以脉盛大？血脉闭阻，所以脉涩吗？这其中潜伏着大疑问，请先阐明它。一是人身卫外之阳最坚固，太阳卫护身体背部，阳明卫护身体前面，少阳卫护身体两侧。现在不由三阳，而直中少阴，难道是从天而下？盖厥气上逆，积于胸中则胃寒，胃寒则口食寒物，鼻吸寒气，都得入胃。肾是胃的关隘，外寒斩关直入少阴肾脏，所以叫中寒。这是《内经》所隐含而未说的。
一是其脉盛大以涩，虽然叫中寒，尚非卒病（突然发生的疾病）。卒病中寒，其脉必微，大概《内经》统言伤寒中寒之脉，所以说盛大以涩。张仲景以伤寒为热病，中寒为寒病，分别言之。伤寒之脉，大要以大浮数动滑为阳，沉涩弱弦微为阴。阳病而见阴脉，尚且主死，何况阴病卒急，必无反见阳脉的道理，如果只是盛大以涩，二阳一阴，又有什么卒急的呢？这也是《内经》所隐含而难窥见的。
再推究张仲景以沉涩弱弦微为阴脉，其伤寒传入少阴经，则说脉微细。今寒中少阴，又必只说脉微，不说细了。盖微者是阳之微，细者是阴之细，寒邪传肾，其亡阳亡阴，尚未可定。至中寒则只有亡阳，而无亡阴，所以知其脉必不细。如果果然见到细脉，则其阴先已内亏，怎么会反而盛大呢？
在伤寒证中，只有少阴有微脉，他经则无。其太阳膀胱，为少阴之府，才见脉微恶寒，张仲景早就从少阴施治，而用附子、干姜了。盖脉微恶寒，正是阳微所致。《诗经》云：彼月而微，此日而微，今此下民，亦孔之哀。在天象之阳，尚且不可微，那么人身之阳，岂可微哉？肾中既已阴盛阳微，寒自内生，再加外寒，斩关直中，或没其阳于内，灭顶罹殃；或逼其阳于外，隙驹避舍（比喻时间飞逝，生命短暂），其人顷刻云亡，所以张仲景认为是卒病。
人身血肉之躯，都是阴。父母媾精时，一点真阳，先身而生，藏于两肾之中，而一身之元气，由之以生，所以谓生气之原。而六淫之外邪，毫不敢犯，所以谓守邪之神。暗室一灯，炯然达旦，耳目赖之以聪明，手足赖之以持行了。昔人傲雪凌寒，寻诗访友，还说是一时兴致所至。至于立功异域，啮雪虏庭，白首犹得生还，何曾内寒生而外寒中呢？所以以后天培养先天，百年自可常享。如果不这样，阳微必至阴盛，阴盛愈益阳微，一旦外寒卒中，而以经常之法治之，百中能有一活吗？卒病的旨意，就在这里。
肾中真阳，得水以济之；留恋不脱，得土以堤之；蛰藏不露，除施泄而外，屹然不动。而手足之阳，为之役使，流走周身，固护腠理而捍卫于外。而脾中之阳，法天之健，消化饮食，传布津液而营运于内。而胸中之阳，法日之驭，离照当空。消阴除翳，而宣布于上。此三者丰亨，有象肾中真阳，安享太宁。所以有八十而御女生子，余勇可贾的了。即使或施泄无度，阳痿不用，尚可迁延岁月。惟在外、在上、在中之阳，衰微不振，阴气乃始有权，或肤冷不温，渐至肌硬不柔，卫外之阳不用矣。或饮食不化，渐至呕泄痞胀，脾中之阳不用矣。或当膺阻碍，渐至窒塞不开，胸中之阳不用矣。乃取水土所封之阳，出而任事，头面得阳而戴赤，肌肤得阳而燥，脾胃得阳而除中，即使不中寒，能久乎？
论治中寒病用药八难
寒中少阴，行其严令，埋没微阳，肌肤冻裂，无汗而丧神守。急用附子、干姜，加葱白以散寒，加猪胆汁引入阴分。然恐药力不胜，熨葱灼艾，外内协攻，乃足破其坚凝。少缓须臾，必无及矣，这是一难。
若其人真阳素扰，腠理素疏，阴盛于内，必逼其阳亡于外，魄汗淋漓，脊项强硬。用附子、干姜、猪胆汁，即不可加葱及熨灼，恐助其散，令气随汗脱，而阳无繇内返也。宜扑止其汗，陡进前药，随加固护腠理，不尔恐其阳复越，这是二难。
用附子、干姜以胜阴复阳者，取飞骑突入重围，搴旗树帜，使既散之阳，望帜争趋，顷之复合。不知此义者，加增药味，和合成汤，反牵制其雄入之势，必至迂缓无功，这是三难。
其次前药中即须首加当归、肉桂，兼理其荣，以寒邪中入，先伤荣血故也。不尔药偏于卫，弗及于荣，与病即不相当。邪不尽服，必非胜算，这是四难。其次前药中即须加入人参、甘草，调元转饷。收功帷幄，不尔姜附之猛，直将犯上无等矣，这是五难。
用前药二三剂后，觉其阳明在躬，运动颇轻，神情颇悦，更加黄芪、白术、五味、白芍，大队阴阳平补，不可歇手。盖重阴见阳，浪子初归，斯时摇摇靡定，怠缓不为善后，必堕前功，这是六难。
用群队之药，以培阴护阳，其人即素有热痰，阳出早已从阴而变寒，至此无形之阴寒虽散，而有形之寒痰阻塞，窍隧者无繇遽转为热。姜附固可勿施，其牛黄、竹沥，一切寒凉，断不可用。若因其素有热痰，妄投寒剂，则阴复用事，阳即躁扰，必堕前功，这是七难。
前用平补后，已示销兵放马，偃武崇文之意。兹后总有顽痰，留积经络，但宜甘寒助气开通，不宜辛辣助热壅塞。盖辛辣始先不得已而用其毒，阳既安堵，既宜休养其阴，何得喜功生事。徒令病去药存，转生他患，漫无宁宇，这是八难。
我粗略陈述病概，明确告知八难，良工苦心，此道庶几可明可行矣。然而卤莽拘执之辈，用法必无成功，愚昧鲜识之人，服药必生疑畏。谨合阴病论，请正明哲巨眼，恳祈互相阐发，俾卒病之旨，人人共明，坦然率由，讵非生民之浓幸乎？
论朱丹溪述中寒
丹溪说：中寒者，仓卒受寒，其病即发而暴。盖中寒之人，乘其腠理疏豁，一身受邪，难分经络，无热可散，温补自解。此胃之大虚，不急治去生甚远，法当温散理中汤，甚者加附子，其见解超出寻常矣。然而又说：有卒中天地之寒气、口伤生冷之物、有外感、无内伤、用仲景法。若挟内伤，补中益气汤加发散之药，必先用参芪托住正气，可见丹溪宗尚东垣者，犹在仲景宫墙之外，未知其中宗庙百官之富美也。
论戴元礼述中寒
戴元礼说：中寒是身受肃杀之气，日食冰水瓜果冷物，病者必脉沉细，手足冷，息微身倦，虽身热亦不渴，倦言语。或遇热病，误服此药，轻者至重，重者至死。任脉数者，或饮水者，烦躁动摇者皆是热病。寒热二证，若水火也，不可得而同治，误则杀人，学人慎之。按元礼国朝名医中之翘楚也，其于中寒略窥大意，未识奥旨。且不曰以热病法治之则死，反曰热病用此药即死，殊失主客，然二老外更无有言及中寒者，昌又推其登坛建帜之功矣。
【律三条】
凡是治疗阴寒暴病，恣意使用清凉药的，百无一活。如此死者，是医生杀死的。
凡是治疗暴寒病，胸中茫无真见，虽然用辛热药，或以渐投，或行监制，时不待人，倏然而逝，是医生的罪过。
凡是医生治起一个阴病，就可以免一劫厄，这是天理人事必至的符验。那些不能起人卒病而求幸免劫厄的，自己不可得，世间有蔼蔼吉人，其择术当如何耶？
Yu Chang stated: Taiji moves to generate Yang, and remains still to generate Yin. Yang's movement is ceaseless, while Yin's stillness has its regularity. When the two Qi (vital energies) intersect, human life begins; when they separate, death occurs; when they become biased, disease arises; and when they deviate from harmony, illness becomes severe. The sages were concerned about this and established medicine to adjust the bias and impurity, restoring balance and peace, thereby allowing people to live long lives. Observing the discussion on human Yang Qi in the *Shengqi Tongtian Lun* (Treatise on the Connection between Vital Energy and Heaven), which compares it to heaven and the sun, if it loses its proper function, lifespan is shortened and brilliance is obscured. Although Yin diseases are not explicitly discussed here, the mechanism of Yin diseases can be clearly understood.
However, in the era of the Three Sovereigns, the social condition was like spring, with gentle Yang Qi presiding and Yin stillness undisturbed. Therefore, whenever the *Neijing* (Inner Canon) mentions Yin diseases, it only hints at the beginning without elaborating fully. Later, due to political deviations, the舒展 (expansive) nature of Yang turned into Yin's grim severity. Heavenly Yang Qi became blocked, and earthly Yin Qi obscured brightness. "Obscuring brightness" refers to turbid Yin Qi covering the Yangming Qi. As the *Book of Songs* describes: "Rivers boil over, mountain peaks collapse, high banks become valleys, deep valleys become mounds." Consequently, diseases among the people increased, and many died prematurely. People investigated but could not understand the cause of such premature deaths.
At the end of the Han Dynasty, Zhang Zhongjing wrote ten volumes of *Shanghan Lun* (Treatise on Cold Damage) to treat Yang diseases transmitted through meridians, and six volumes of *Zubing Lun* (Treatise on Sudden Diseases) to treat sudden Yin diseases, aiming to prevent illness among the people. However, *Zubing Lun* was lost during his lifetime. Was it because scholars of that era failed to deeply comprehend its principles? Was *Jingui Yufan* discarded and not collected, while versions circulating among the common people suffered from war and fire? After Zhang Zhongjing, many talents emerged, yet none vigorously promoted his profound work. Only Han Zhihe made slight discoveries in the category of "Zhonghan" (Sudden Cold Invasion), teaching people to urgently use Fuzi (Aconite Root) and Ganjiang (Dried Ginger). He can be considered a disciple of Zhang Zhongjing.
Since the advent of medicine, only constant laws were discussed. Zhang Zhongjing also discussed variable conditions. People were astonished and opposed, which was inevitable. Over a thousand years later, Han Zhihe's views as a folk doctor were no longer as influential as Zhang Zhongjing's calls from high places. Moreover, scholars like Zhu Danxi and Jiezhai advocated valuing Yin and despising Yang, stating "Yang is abundant, Yin is deficient," "Yang is often in excess, Yin is often insufficient," and "Yin Qi is hard to form and easy to lose, leading to early aging." They formulated pills to nourish Yin, heavily emphasizing Yin. Who would not consider this supreme truth? However, they merely imitated others without unique insight. Yet, physicians revered them as masters. Even if *Zubing Lun* had survived, it would have been ignored just like *Shanghan Lun*. Alas! In times of peace, everything is harmonious. In times of chaos, disasters abound. If rulers governed by valuing Yin and despising Yang, the state would fail. If doctors treated by valuing Yin and despising Yang, they would treat incorrectly. This cannot be a universal principle.
I review Zhang Zhongjing's *Shanghan Lun*, highlighting cases where Yin disease signs appear and urgent return of Yang is required. My disciples now know what to prioritize. Now, I wish to pass on the golden needle (secret knowledge) and speak openly. The *I Ching* says: "Understanding the way of day and night allows one to know that day is Yang, where all Yin hides. Night is Yin, where all Yin reveals itself, and ghosts feed at night. All mountain spirits and water monsters display endless tricks until cockcrow, when they hide completely." Although night is not over at cockcrow, the time belongs to Heavenly Yang. Since Heavenly Yang opens, the long night does not last, and dawn approaches. From this, we see a glimpse of the indescribable nature of Yin diseases. Who can illuminate the truth like burning a rhino horn?
Buddha spoke of 444 diseases, with Earth, Water, Fire, and Wind each accounting for 111. Thus, all 444 diseases are Yin diseases. Heaven and Earth manifest forms and images, not solely biased toward Yin. However, all five elements arise from Earth. Water adheres to Earth, containing Fire within it, and Wind within Fire. Humans borrow these four elements to form bodies, and illnesses arise from their interaction. Metal is hard and rigid, resisting harmony, so it is excluded from the four major elements in this context. Cases without hope require cultivating the Western Pure Land. People only know Earth Qi is still and undisturbed; when earthquakes occur, they are shocked. Small movements bring disasters; large movements bring kalpas (cosmic cycles of destruction). During a kalpa, all有形 (form-bearing) things perish. Why doesn't the world destroy quickly despite Earth's movement? Because Xuanzhen Zhenwu guards the North, subduing dragons and snakes, preventing them from rising. Thus, Earth moves but Water remains still; Water still, then Fire and Wind within remain still.
For syndromes of Yin excess and Yang exhaustion, Zhang Zhongjing uses Zhenwu Tang to rescue deviation. Is this not based on this principle? At Xu-Hai hours (9-11 PM), chaos prevails. It is not Heaven mixing with Earth, but Earth Qi adding to Heaven causing confusion. The four wheels of Earth, Water, Fire, and Wind rotate simultaneously, with thunder and lightning shaking the heavens. Space is搅毁 (destroyed/mixed) into one region. How tragic must Yin diseases be in flesh-and-blood bodies? Zen Buddhism speaks of white waves surging, kalpa fires blazing, and the great thousand worlds destroying. Isn't this the image of the dissolution of the four elements?
Earth Qi adds to Heaven only up to the Desire Realm and Form Realm, not the Formless Realm. In the Upper Eight Scenes, at Trayastrimsa Heaven, myriad saints pay homage; in Tushita Inner Court, deities listen to Dharma. Each removes intermediate existence (antarabhava) and manifests circular light on the crown, directly connecting to the Neither-Perception-Nor-Non-Perception Realm. Entering the Buddha Realm, one sees the great thousand worlds like a fruit in the palm. What kalpa can affect this? Kalpas affect heavens until Zi hour (11 PM-1 AM), when opening occurs, Yin descends, and High Yang reappears. By Chou hour (1-3 AM), Yin returns entirely to Earth, space clears, and Yin-Yang separate. Sun, moon, and stars attach to Heaven; mountains, rivers, and seas attach to Earth. Qi of the Five Heavens scatters among stars; Qi of Nine Earths connects with mountains and marshes. Clear and peaceful, vast and broad, myriad species gradually sprout. Remaining violent turbid Yin in heavenly gaps stretches thousands of zhang, falling straight down, destroying life without leaving a trace. After Heaven opened and Earth formed, the lingering grimness of Yin is still terrifying. Only by Yin hour (3-5 AM) does mixed inferior Qi return to harmony. Heavenly light descends, Earthly virtue ascends. Famous trees and fine plants bear fruit. Light-sound humans eat the fruit and do not ascend, thus enabling life and reproduction, forming the three realms of Heaven, Earth, and Humanity.
This principle relates to human life and health, most grand and significant. Confucians ignore it; physicians rarely hear of it. I often see patients where Yin pathogen erupts violently, attacking clear pathways, showing aversion to cold, abdominal pain, diarrhea, vomiting, profuse sweating, muscle twitching, and tendon tremors. I immediately close the gate, employing Zhenwu's guarding method, preventing Dragon-Lei Qi from soaring. Following Zhang Zhongjing's secret methods, patients recover. If untreated initially, turbid Yin entering from the chest causes throat swelling, tongue protrusion, eye bulging; from the back, neck veins enlarge, head and neck feel icy, turning blue-purple before death. Is this not the disaster of Earth Qi adding to Heaven?
Suddenly administering Fuzi and Ganjiang, pure Yang medicines, drives out Yin pathogens downward through yin orifices. This is equivalent to swiftly sweeping turbid Yin back to Earth. One must drive out all Yin from Yang spaces to achieve rebirth, equivalent to cleansing heavenly remnants to restore harmony. Practicing Zhang Zhongjing's methods for thirty years, treating nearly a hundred patients, every case responded well. Though a temporary expedient, it can serve as a permanent standard. Medicine lacks this, truly an omission. I establish this humble theory to begin. Future authors may find value in it.
On Key Methods for Differentiating Zhonghan Syndromes
Sudden Zhonghan is a critical and urgent syndrome of weak Yang and excess Yin. The *Classic* states: "Excess Yin generates internal cold." Due to rebellious Qi moving upward, cold accumulates in the chest without dispersing. Without dispersal, warm Qi leaves, leaving only cold. Cold coagulates blood, blocking vessels. The pulse is large, forceful, and choppy, hence Zhonghan. The *Neijing* says this. To synthesize Zhang Zhongjing's interpretation of the *Neijing*, I dare to speak.
The *Classic* says excess Yin generates internal cold, then mentions Zhonghan. Does internal cold arise first, followed by external cold invasion? It says blood coagulation blocks vessels, then mentions large, forceful, choppy pulses. Does external cold cause the large pulse? Does vessel closure cause the choppy pulse? There is a major doubt here. First, the body's defensive Yang is strong. Taiyang guards the back, Yangming the front, Shaoyang the sides. Why does cold bypass the Three Yang and strike Shaoyin directly? Rebellious Qi accumulates in the chest, causing stomach cold. Stomach cold allows ingestion of cold food and inhalation of cold air into the stomach. The Kidney is the gate of the Stomach. External cold breaches the gate, striking Shaoyin Kidney directly. This is Zhonghan, hidden in the *Neijing*.
Second, although called Zhonghan, a large/forceful/choppy pulse suggests it is not a sudden disease. Sudden Zhonghan should have a faint pulse. The *Neijing* generally discusses Shanghan and Zhonghan pulses as large/forceful/choppy. Zhang Zhongjing distinguishes Shanghan (heat disease) from Zhonghan (cold disease). Shanghan pulses are typically floating, rapid, active, slippery (Yang), or deep, choppy, weak, string-taut, faint (Yin). Yang diseases showing Yin pulses indicate death. Yin diseases being sudden should not show Yang pulses. Large/forceful/choppy involves two Yang and one Yin, implying urgency. This is also hidden in the *Neijing*.
Zhang Zhongjing considers deep/choppy/weak/string-taut/faint as Yin pulses. For Shanghan transmitting to Shaoyin, he says "faint and thin." For Zhonghan striking Shaoyin, he says only "faint," not "thin." Faint indicates weak Yang; thin indicates weak Yin. Cold transmitting to Kidney makes Yang/Yin loss uncertain. But Zhonghan involves only Yang loss, not Yin loss, so the pulse should not be thin. If thin, Yin was already deficient internally, how could it be excessive?
In Shanghan, only Shaoyin has a faint pulse. Taiyang Bladder is the Fu organ of Shaoyin. Seeing faint pulse and aversion to cold, Zhang Zhongjing treats Shaoyin immediately with Fuzi and Ganjiang. Faint pulse and aversion to cold indicate weak Yang. The *Book of Songs* says: "The moon is faint, the sun is faint, the people below are very sorrowful." Heavenly Yang should not be faint, so Human Yang certainly should not be. With Kidney Yin excess and Yang weakness, cold generates internally. Adding external cold breaches the gate, burying Yang inside (death) or forcing it outside (rapid death). Hence, Zhang Zhongjing calls it a sudden disease.
Human flesh and blood are Yin. At conception, a point of True Yang is born before the body, stored in both Kidneys, generating Yuan Qi (Original Qi). It is the source of vital energy and protects against Six Evils (external pathogens). Like a lamp in a dark room, it enables sight and hearing, and supports movement. Ancients braved snow and cold for poetry or merit, surviving without internal cold arising from external cold. Nourishing先天 (Pre-heaven Essence) with后天 (Post-heaven Qi) ensures longevity. Otherwise, weak Yang leads to excess Yin, which further weakens Yang. Sudden external cold with standard treatment rarely saves anyone. This is the essence of sudden disease.
True Yang in Kidneys is balanced by Water, contained by Earth, and dormant unless discharged. Hand-Foot Yang serves it, circulating to protect skin and pores. Spleen Yang mimics Heaven's vigor, digesting food and distributing fluids. Chest Yang mimics the Sun's control, illuminating and dispelling Yin. When these three are abundant, Kidney True Yang rests peacefully. Some live to eighty with vitality. Even with sexual excess or impotence, life continues. But when external, upper, or middle Yang declines, Yin gains power. Skin becomes cold and stiff, defensive Yang fails. Food digestion fails, causing vomiting/diarrhea/bloating, Spleen Yang fails. Chest obstruction occurs, Chest Yang fails. Drawing sealed Yang from Earth/Water to act causes red face, dry skin, and Chu Zhong (deficiency cold syndrome). Can it last long without Zhonghan?
Eight Difficulties in Medicating Zhonghan
1. Cold strikes Shaoyin, burying weak Yang, cracking skin, no sweat, losing spirit. Urgently use Fuzi, Ganjiang, add Congbai (Scallion White) to disperse cold, add Pig Bile to guide into Yin. Fear drug strength insufficient, use moxibustion/warming compresses externally and internally. Delay slightly, and it is too late. Difficulty one.
2. If True Yang is originally disturbed, pores loose, Yin excess forces Yang outward, sweating profusely, stiff neck/back. Use Fuzi, Ganjiang, Pig Bile, but DO NOT add Congbai or moxa. Fear aiding dispersion, causing Qi loss with sweat, preventing Yang return. Stop sweating, suddenly advance drugs, protect pores. Otherwise Yang may escape again. Difficulty two.
3. Using Fuzi/Ganjiang to overcome Yin and restore Yang is like cavalry breaking siege, raising flags to gather scattered Yang. Those who don't understand add more herbs, diluting the powerful effect, causing delay and failure. Difficulty three.
4. Add Danggui (Angelica Sinensis) and Rougui (Cinnamon Bark) to nourish Ying (Nutritive) Blood, as cold first injures Ying. Otherwise, drugs only affect Wei (Defensive) Qi, missing the target. Pathogen remains, victory impossible. Difficulty four.
5. Add Renshen (Ginseng) and Gancao (Licorice) to support Yuan Qi and transport resources. Without them, Fuzi/Ganjiang's ferocity harms the upper body. Difficulty five.
6. After 2-3 doses, if Yangming recovers, movement lightens, spirit improves, add Huangqi (Astragalus), Baizhu (Atractylodes), Wuweizi (Schisandra), Baishao (White Peony) for balanced Yin-Yang tonification. Do not stop. Heavy Yin yielding to Yang is like a prodigal returning; instability remains. Neglecting follow-up ruins progress. Difficulty six.
7. Using group drugs to nourish Yin/protect Yang: if patient has chronic phlegm-heat, Yang emerging changes from Yin to cold. Invisible Yin-cold disperses, but visible cold-phlegm blocks orifices. It won't turn hot quickly. Avoid Niuhuang (Calculus Bovis), Zhuli (Bamboo Sap), and all cooling agents. Using cold meds for chronic phlegm-heat lets Yin dominate, Yang agitates, ruining progress. Difficulty seven.
8. After balancing, show intent to lay down arms. For stubborn phlegm in meridians, use sweet-cold to aid Qi and open blockages. Avoid pungent-hot which aids heat/blockage. Pungent-hot was used out of necessity; once Yang is stable, nourish Yin. Don't seek glory and create trouble. Leaving drugs after disease cures causes new issues. Difficulty eight.
I briefly outline the pathology and eight difficulties. Skilled practitioners can clarify and practice this. Rash or rigid users will fail; ignorant patients will fear meds. Combining with Yin Disease Theory, I ask wise eyes to elucidate, so everyone understands sudden disease, acting calmly. Is this not a great blessing for humanity?
On Zhu Danxi's Description of Zhonghan
Danxi said: Zhonghan is sudden cold exposure, immediate violent onset. Patients have loose pores, whole body affected, meridians indistinguishable, no heat to dissipate, warming/tonifying resolves it. This is severe Stomach deficiency. Untreated, death is near. Method: Warm/disperse Lizhong Tang, add Fuzi for severe cases. His insight exceeds ordinary levels. However, he also said: For sudden heaven-earth cold or raw food injury with exterior pathogen but no interior damage, use Zhang Zhongjing's method. If accompanied by interior damage, use Buzhong Yiqi Tang plus dispersing drugs, first using Renshen/Astragalus to support Zheng Qi. This shows Danxi, following Dongyuan, is still outside Zhang Zhongjing's walls, unaware of its richness.
On Dai Yuanli's Description of Zhonghan
Dai Yuanli said: Zhonghan is exposure to killing Qi, eating ice/cold fruits. Pulse is deep/thin, hands/feet cold, breath weak, body tired. Even with fever, no thirst, lethargic speech. If mistaken for heat disease and given these drugs, mild becomes severe, severe becomes fatal. Rapid Ren Mai pulse, drinking water, restlessness indicate heat disease. Cold and heat are like water and fire, cannot be treated same. Mistake kills. Students beware. Yuanli was a top Ming dynasty doctor. He glimpsed Zhonghan's main idea but missed depth. He didn't say "treating heat disease with cold method kills," but "heat disease taking cold drugs kills," confusing subject/object. Among these two elders, none spoke of Zhonghan. I praise Yuanli's contribution.
[Three Laws]
1. Treating sudden Yin-cold disease with cooling drugs results in almost no survival. Such deaths are caused by the doctor.
2. Treating sudden cold disease without true insight, even using pungent-hot drugs slowly or controlled, delays action. Time waits for no one; patient dies suddenly. This is the doctor's fault.
3. A doctor curing one Yin disease avoids a kalpa disaster. This is natural law. Those failing to cure sudden disease seeking to avoid disaster will fail. Good people, choose your art wisely.