五味辛以散之，半夏、白芷、防风之辛皆散；甘以缓之，甘草、大枣之甘皆缓；酸以收之，
白芍药、五味子之酸皆收；苦以泻之，大黄、黄连之苦皆泄；咸以软之，芒硝、海石之咸皆软；
淡以渗之，茯苓、白术之淡皆渗是也。
寒者热之，热者寒之，微者逆之，甚者从之。
病之微者，可以逆治，以寒攻热，以热攻寒是也。病之甚者，不可逆治，当顺其性而从之，
所谓以热而攻热也。如伤寒发热，反以麻黄、姜、桂之辛，从其性而攻发之之类是也。
帝曰∶何谓逆从？岐伯曰∶逆者正治，从者反治，从少从多，观其事也。
逆其病而施，谓之正；从其病势而用方，谓之反。反从之方，或一二味而从之，是谓从少；
或三四味而从之，是谓从多。从少从多，当观病之微甚，事之轻重。
帝曰∶反治何谓？岐伯曰∶热因寒用，寒因热用，塞因塞用，通因通用。必伏其所主，而先
其所因，其始则同，其终则异。
汪氏《质疑》注∶经文反治者，即从治之法，上文曰从者反治是也。热因寒用者，谓热药因
病之热，以其本病之寒而用也。如伤寒肾气素本虚寒，而寒盛于内，格阳于外，病变面赤身热，
脉数无力者，经曰脉至而从，按之不鼓，诸阳皆然是也。有因内伤过服凉药，以致肌肤大热，或
谵语口干，脉无力者，此皆本于寒而变病似热，实非热也，宜以热药反治之也。寒因热用者，谓
寒药因病之寒，以其本病之热而用也。如伤寒热甚失于汗下，亢阳内郁，拒阳于外，病变浑身厥
冷而脉实者，经曰∶诸阴之反脉至而从，按之鼓甚而盛也是也。有积热于内，而外反恶寒者，有
火炎于内，反觉冷气自腹冲上者，此皆本于热而变病似寒，实非寒也，宜以寒药反治之也。塞因
塞用者，言补塞之药，因壅塞之病而用也。释者谓气虚中满而用补药，特其一耳。有因气虚而胸
中痞者，有气虚腹中有块作痛，或上或下，或有或无者，有气虚大便里急后重者，有气虚小便秘
涩者，有气虚而肢节肿痛者，有气虚而背肩胀急者，此皆本于气虚不能营运而变病似塞，实非塞
也，宜补气及收涩之药反治，此塞因塞用之类也。通因通用者，言通利之药，因通塞之病而用也。
释者谓热结塞凝而致泄者，以通利之药，亦特其一耳。有因食积而痢者，宜通积化食之药；有下
焦积热而小便不禁，或遗精滞浊者，宜通窍解热之药；有患疟郁热于表，外蒸汗出者，宜清热解
表之药；有伤风热怫于表，外蒸汗出者，宜散风之药；有患痹湿气熏蒸汗出者，宜散湿之药；有
血积于内，以致血隧壅遏而傍流之血妄行者，宜通血之药。此皆本于塞而变病似通，实非通也，
宜通利之药反治。此通因通用之类也。必伏其所主者，正治之法藏诸用也。而先其所因者，因其
势而利导之之意也。伏其吾之所以主治者，而先其所因以顺从而渐杀之法，法主于治其通，而先
通因通用，积去而利止，则先通之者，所以塞之也，而吾主治之意，至是显诸仁矣。反治之法主
于双病，本其始而言，亦正治也，故言乎其始，药治亦顺，与正治之法同。言乎其终，药治似逆，
与正治之法异，故曰始同终异也。夫反治之法微，故宜加深长之思，此章之义博，不可以偏之致
自异也。而释者不察得失相参，如谓中满宜补，泻痢宜下之者可也。至谓蜜煎乌头，醇酒冷冻饮料之
类，皆察其小而遗其大者，余宁已于言哉？
可使破积，可使溃坚，可使气和，可使必已。
此结上文反治之效也。
帝曰∶病之中外何如？岐伯曰∶从内之外者，调其内。
内伤元气，不能外卫腠理，而为汗泄等证，宜补中益气之类以调其内，则外证自除，是
谓治其本也。
从外之内者，治其外。
风寒外郁而为喘嗽，或为鼻衄等证，宜麻黄、桂枝之类以疏其外，则内患自除，是亦治其本也。
从内之外而盛于外者，先调其内而后治其外。
如积热于内而为痈肿疮疡等证，先以苦寒疏其内实，后用通经关郁排脓之剂，或针砭等法，
以治其外，斯则内外悉平，是谓先本而后标者也。
从外之内而盛于内者，先治其外而后调其内。
邪气外郁内热而为痰火壅实等证，先以辛散之味以解其外，后用消痰降火之剂以治其内，斯
则内外俱安，是亦先本而后标之者也。
中外不相及，则治其主病。
病在中，或在外，两不相干，而非从内之外，从外之内者，则于内于外，专治其主病而已矣。
曰∶论言治寒以热，治热以寒，而方士不能废绳墨而更其道也。有病热者寒之而热，有病寒
者热之而寒，二者皆在，新病复起，奈何治？
此问治病不衰，而反因药之寒热，而随生寒热之新病也。
岐伯曰∶诸寒之而热者取之阴，诸热之而寒者取之阳，所谓求其属也。
阴，肾也。阳，心也。其心属火，肾属水也。此言肾之真阴已亏而发热，误投寒药以治，则
热反炽，岂知热之不衰，由于真水之不足乎？宜求滋肾之剂，如山药、枸杞、地黄之类，所谓壮
水之主，以制阳光是也。又如心之元阳已亏而身寒者，误投热药以治，则寒反甚。岂知寒之不衰，
由于真火之不足乎？宜求补心之剂，如人参、附子之类，所谓益火之原，以消阴翳是也。如果益
心，寒亦通行；如果强肾，热之犹可。心也，肾也，水火之原也，阴阳之本，所谓属也。
服寒而反热，服热而反寒，治其旺气，是以反也。
旺气，时旺之气也。如夏月感寒，郁而为热，宜辛散之药。医见其身热，其时旺之气亦热，
乃以寒药治之。寒性收敛，表邪不能发散而热反甚矣。发冬月伤寒，失于汗下，邪气传变，亢阳
内郁而身寒者，宜苦攻之。医见身寒，时旺之气亦寒，乃以热药治之。热性 悍，内邪未得疏通
而寒反甚矣。是皆治其旺气而有所失也，正发表不远热，攻裹不远寒，相同一意。
曰∶不治旺而然者何也？曰∶不味旺味属也。
此承上文而言，上味玩味也，下味药味也。如肺之气虚而身寒，其寒也由于肺气之不足也，
宜补其气则生阳矣。若误投以辛热之药味。则阳虚阴必凑而身寒反甚。盖徒知寒者热之，而不玩
味乎味之辛者旺于秋，而属于肺，辛先入肺，以散肺气，如之何其弗寒也？如心血虚内身热，其
热也由于心血之不足也，宜补其血则生阴矣。若误投以苦寒之味，则阴虚阳必乘而身热反炽。盖
徒知热者寒之，而不玩味乎味之苦者旺于夏，而属于心，苦先入心，以泻心血，如之何其弗热也？
故曰不味旺味，而有所犯也。
五味入胃，各归所喜攻，酸先入肝，苦先入心，甘先入脾，辛先入肺，咸先入肾，久而增气，
物化之常也。气增而久，夭之由也。
五味久服，各增其气，如黄连服久而反热，故曰久而增气，物化之常。增气不已，脏气
偏胜，气有偏胜则有偏绝，故曰夭之由也。
五常政大论曰∶必先岁气，无伐天和，无盛盛，无虚虚，而遗人夭殃；无致邪，无失
正，绝人长命。
此言人应天地阴阳，虚实寒热，治之宜各察其岁气天和，无实实虚虚之误，庶不失其正
而夭人命也。
《大要》曰∶无伐化，无违时，必养必和，待其来复，此之谓也。
此承上文而言，引古经以证无伐天和之义也。
五脏别论 曰∶拘于鬼神者，不可与言至德；恶于针石者，不可与言至巧。
藏气法时论 曰∶肝色青，宜食甘，粳米牛肉枣葵皆甘。心色赤，宜食酸，小豆犬肉
李齑皆酸。肺色白，宜食苦，麦羊肉杏薤皆苦。脾色黄，宜食咸，大豆豕肉栗藿皆咸。肾色黑，
宜食辛，黄黍鸡肉桃葱皆辛。毒药攻邪，五谷为养，五果为助，五畜为益，五菜为充，气味合而
服之，以补精益气。
毒药，谓金玉土石草木菜果虫鱼鸟兽之类，然辟邪安正，惟毒药为能，故通谓毒药也。五谷，
粳米小豆大豆麦黄黍；五果，桃李杏栗枣；五菜，葵藿薤葱韭。食以存性，药以防命，气味温补
以存精形，此谓气味合，而服之以补精益气也。
宣明五气篇 五味所禁∶辛走气，气病无多食辛；咸走血，血病无多食咸；苦走骨，
骨病无多食苦；甘走肉，肉病无多食甘；酸走筋，筋病无多食酸。是谓五禁，无令多食。
五味太过则致病，病者则愈甚，故无多食。下文之义可见矣。
五脏生成篇 多食咸，则脉凝泣而色变；多食苦，则皮槁而毛拔；多食辛，则筋急而
爪枯；多食酸，则肉胝KT 而唇揭；多食甘，则骨痛而发落。此五味之所伤也。
五味入口，内养五脏，各有所欲。所欲太过，则互有所伤，故不宜过欲也。
阴阳应象大论 阳为气，阴为味。味浓者为阴，薄为阴之阳。气浓者为阳，薄为阳
之阴。味浓则泄，薄则通。气薄则发泄，浓则发热。辛甘发散为阳，酸苦涌泄为阴。
味浓者为阴中之阴则泄，如大黄之类。味薄者为阴中之阳则通，如苦茶之类。气浓者为阳
中之阳则发热，如附子之类。气薄者为阳中之阴则发泄，如麻黄、桂枝之类是也。故辛甘发散为
阳，酸苦涌泄为阴也。
五味中，辛味能发散，半夏、白芷、防风的辛味都具有发散作用；甘味能缓急，甘草、大枣的甘味都具有缓急作用；酸味能收敛，白芍药、五味子的酸味都具有收敛作用；苦味能泻下，大黄、黄连的苦味都具有泻下作用；咸味能软坚，芒硝、海浮石的咸味都具有软坚作用；淡味能渗湿，茯苓、白术的淡味都具有渗湿作用。
寒证用热药治疗，热证用寒药治疗，病情轻浅的用逆治法（即正治），病情深重的用从治法（即反治）。
病情轻浅的病，可以用逆治法，即用寒药攻治热证，用热药攻治寒证。病情深重的病，不能用逆治法，应当顺从其表象而采用从治法，这就是所谓的“以热治热”。例如伤寒发热，反而使用麻黄、生姜、桂枝等辛温药物，顺从其发热的表象而进行发散治疗，就是这样。
黄帝问：什么是逆治和从治？岐伯回答：逆治就是正治，从治就是反治，从少或从多，要观察病情的具体情况。
违背病势进行治疗，称为正治；顺应病势用药，称为反治。反治的药物，如果只有一两味是顺从病势的，这叫从少；如果有三四味是顺从病势的，这叫从多。从少还是从多，应当观察病情的轻重深浅和具体情形。
黄帝问：什么是反治？岐伯回答：热因寒用，寒因热用，塞因塞用，通因通用。必须制服疾病的主因，先探求疾病的病因，开始用药时性质似乎相同，但最终效果却不同。
汪氏在《质疑》中的注释说：经文所说的反治，就是从治的方法，上文说“从者反治”就是这个意思。“热因寒用”，是指热性药物因为患者表现出热象，但实际上是因为本质的寒邪而使用的。例如伤寒肾气原本虚寒，内寒盛极，格拒阳气于外，导致面部发红、身体发热、脉数但无力的症状，经书说“脉至而从，按之不鼓，诸阳皆然”。还有因为内伤过度服用凉药，导致肌肤大热，或者胡言乱语、口干、脉无力的情况，这些都是本质为寒而变生类似热的假象，实际上不是热证，应该用热药进行反治。“寒因热用”，是指寒性药物因为患者表现出寒象，但实际上是因为本质的热邪而使用的。例如伤寒热邪严重，失于发汗或攻下，亢盛的阳气内郁，格拒阴气于外，导致全身厥冷但脉实有力，经书说：“诸阴之反脉至而从，按之鼓甚而盛”。还有体内有积热，体表反而怕冷的；体内火炎上冲，反而觉得冷气从腹部向上冲的，这些都是本质为热而变生类似寒的假象，实际上不是寒证，应该用寒药进行反治。“塞因塞用”，是说补益固涩的药物，因为壅塞的病证而使用。解释的人认为气虚导致的中满胀满而用补药，只是其中一种情况。还有因为气虚导致胸中痞闷的，气虚导致腹中有块状物作痛、上下移动、时有时无的，气虚导致大便里急后重的，气虚导致小便便秘涩滞的，气虚导致肢体关节肿痛的，气虚导致背肩部胀急的，这些都是本质为气虚不能运行而导致类似壅塞的假象，实际上不是真正的壅塞，应该用补气及收涩的药物进行反治，这就是塞因塞用的例子。“通因通用”，是说通利导下的药物，因为通泄的病证而使用。解释的人认为热结凝滞导致泄泻，用通利药物治疗，也只是其中一种情况。还有因为食积导致痢疾的，应该用消积化食的药物；下焦有积热导致小便不禁，或者遗精、尿液浑浊的，应该用通窍解热的药物；患疟疾，郁热在表，体表蒸腾出汗的，应该用清热解表的药物；伤风热邪郁滞在表，体表蒸腾出汗的，应该用疏散风邪的药物；患痹症，湿气熏蒸导致出汗的，应该用祛湿的药物；体内有血积，导致血脉壅遏而旁流妄行的出血，应该用活血通络的药物。这些都是本质为壅塞而变生类似通泄的假象，实际上不是真正的通泄，应该用通利药物进行反治，这就是通因通用的例子。“必伏其所主者”，是说正治的方法隐藏在效用之中。“而先其所因者”，是说顺着病势加以引导的意思。制服我之所以主治的原因，并先探求病因以顺应它从而逐渐削弱病势的方法，主要在于治疗其通泄的症状，而先用通因通用的方法，积滞去除则泄泻停止，那么先通利的目的，就是为了止住泄泻（即“塞”），而我主治的意图，在此时显现出仁爱之心了。反治的方法主要针对复杂病症，从其开始而言，也是正治，所以说开始时，药物性质也顺应病势，与正治方法相同。说到最终，药物性质看似违背病势，与正治方法不同，所以说“始同终异”。反治的方法微妙，所以应该加深思考，这一章的意义广博，不可以偏颇导致自我差异。而那些解释的人没有考察得失相互参杂的情况，比如认为中满应该补，泻痢应该下是可以的。至于说蜜煎乌头、醇酒冷冻饮料之类，都是察其小节而遗漏大义的，我对此还有什么可说的呢？
可以使积滞破除，可以使坚结溃散，可以使气血调和，可以使疾病痊愈。
这是总结上文反治的效果。
黄帝问：病由内传外或由外传内的情况是怎样的？岐伯回答：病由内传外的，调理内部。
内伤元气，不能在外护卫腠理，而出现汗出等证候，宜用补中益气之类的药物来调理内部，那么外部证候自然消除，这叫做治本。
病由外传内的，治疗外部。
风寒郁滞在外部导致气喘咳嗽，或者鼻衄等证候，宜用麻黄、桂枝之类的药物来疏解外部，那么内部隐患自然消除，这也是治本。
病由内传外且在外部表现严重的，先调理内部然后再治疗外部。
如体内有积热导致痈肿疮疡等证候，先用苦寒药物疏解内部的实热，后用通经开郁排脓的药剂，或者针刺砭石等方法，来治疗外部，这样内外都平复，这叫做先治本后治标。
病由外传内且在内部表现严重的，先治疗外部然后再调理内部。
邪气郁滞在外部导致内热，出现痰火壅实等证候，先用辛散药物解除外部邪气，后用消痰降火的药剂治疗内部，这样内外都安宁，这也是先治本后治标。
内外互不相关的，就治疗其主要病证。
病在内部，或在外部，两者互不干扰，而不是由内传外、由外传内的，那么就针对内部或外部，专门治疗其主要病证罢了。
有人问：医论说治寒用热药，治热用寒药，但方士不能废弃规矩而改变其道。现在有患热病的用寒药治疗后热不退，患寒病的用热药治疗后寒不减，这两种情况都存在，新病又起，怎么治疗？
这是询问治病不见效，反而因为药物的寒热属性，随之产生新的寒热病证。
岐伯回答：各种用寒药治疗热证而热不退的，要取治阴分；各种用热药治疗寒证而寒不减的，要取治阳分，这就叫寻求疾病的根本归属。
阴，指肾。阳，指心。心属火，肾属水。这里说的是肾的真阴已经亏损而发热，误投寒药治疗，热反而更炽盛，哪里知道热的不退，是由于真水不足呢？应该寻求滋补肾阴的药剂，如山药、枸杞、地黄之类，这就叫“壮水之主，以制阳光”。又如心的元阳已经亏损而身体寒冷的，误投热药治疗，寒反而更严重。哪里知道寒的不退，是由于真火不足呢？应该寻求补益心阳的药剂，如人参、附子之类，这就叫“益火之原，以消阴翳”。如果能补益心阳，寒邪也能通行；如果能强补肾阴，热邪也可以消退。心和肾，是水火的源头，阴阳的根本，这就叫“属”。
服用寒药反而发热，服用热药反而发寒，是因为治疗了当令的旺气，所以反而出错。
旺气，是指时令旺盛之气。如夏季感受寒邪，郁滞而化为热，宜用辛散药物。医生见其身热，当时的旺气也是热的，就用寒药治疗。寒性收敛，表邪不能发散而热反而更甚。冬季发生伤寒，失于发汗或攻下，邪气传变，亢阳内郁而身寒的，宜用苦寒攻下。医生见其身寒，当时的旺气也是寒的，就用热药治疗。热性悍烈，内邪未得疏通而寒反而更甚。这都是因为治疗了当令的旺气而有所失误，正是发表不远热、攻里不远寒，道理相同。
问：不治疗旺气而致错的原因是什么？答：是不辨别旺气的属性和药味的属性。
此承接上文而言，“玩味”指品味探究，“味”指药味。如肺气虚而身体寒冷，这种寒冷是由于肺气不足所致，宜补其气则生发阳气。若误投辛热性质的药味，则阳虚阴必凑聚而身体寒冷反而更甚。大概只知道“寒者热之”，而不品味探究辛味在秋季旺盛，且归属于肺，辛味先入肺，以疏散肺气，怎么能不感到寒冷呢？如心血虚而身体发热，这种发热是由于心血不足所致，宜补其血则生发阴液。若误投苦寒性质的药味，则阴虚阳必乘袭而身体发热反而更炽盛。大概只知道“热者寒之”，而不品味探究苦味在夏季旺盛，且归属于心，苦味先入心，以泻耗心血，怎么能不感到发热呢？所以说如果不辨别旺气的属性和药味的属性，就会有所触犯。
五味进入胃中，各自归向所喜好的脏腑，酸味先入肝，苦味先入心，甘味先入脾，辛味先入肺，咸味先入肾，长期服用会增加相应脏腑的气，这是事物变化的常态。气增加久了，是导致夭折的原因。
五味久服，各增加其对应脏腑的气，如黄连服用久了反而发热，所以说“久而增气”，这是事物变化的常态。气增加不停止，脏气偏胜，气有偏胜就会导致偏绝，所以说这是夭折的原因。
《五常政大论》说：必须先了解岁气，不要破坏天和，不要使实证更实，不要使虚证更虚，从而给人带来夭折的灾祸；不要招致邪气，不要失去正气，断绝人的长寿。
这是说人应合天地阴阳，虚实寒热，治疗时应当各自考察岁气和天和，不要犯实实虚虚的错误，才不至于失去正气而使人夭折。
《大要》说：不要破坏生化之机，不要违背时令，必须养护和谐，等待其恢复，说的就是这个道理。
此承接上文而言，引用古经来证明不破坏天和的意义。
《五脏别论》说：拘泥于鬼神的人，不可与他谈论高深的医德；厌恶针石的人，不可与他谈论高明的医术。
《藏气法时论》说：肝色青，宜食甘味，粳米、牛肉、枣、葵菜都属甘味。心色赤，宜食酸味，小豆、犬肉、李、酸菜都属酸味。肺色白，宜食苦味，麦、羊肉、杏、薤都属苦味。脾色黄，宜食咸味，大豆、猪肉、栗、藿都属咸味。肾色黑，宜食辛味，黄黍、鸡肉、桃、葱都属辛味。毒药攻伐邪气，五谷作为滋养，五果作为辅助，五畜作为补益，五菜作为充实，气味配合起来服用，以补精益气。
毒药，指金、玉、石、土、草、木、菜、果、虫、鱼、鸟、兽之类，然而辟除邪气、安定正气，只有毒药能做到，所以通称为毒药。五谷，指粳米、小豆、大豆、麦、黄黍；五果，指桃、李、杏、栗、枣；五菜，指葵、藿、薤、葱、韭。饮食以保存本性，药物以防备性命，气味温和滋补以保存精气形体，这叫气味配合起来服用以补精益气。
《宣明五气篇》五味禁忌：辛味走气，气病不要多吃辛味；咸味走血，血病不要多吃咸味；苦味走骨，骨病不要多吃苦味；甘味走肉，肉病不要多吃甘味；酸味走筋，筋病不要多吃酸味。这叫五禁，不要让病人多吃。
五味太过则致病，有病者则更加严重，所以不要多吃。下文的意义可见一斑。
《五脏生成篇》多吃咸味，则血脉凝涩而面色改变；多吃苦味，则皮肤枯槁而毛发脱落；多吃辛味，则筋脉拘急而指甲枯败；多吃酸味，则肌肉厚硬如茧而口唇掀揭；多吃甘味，则骨痛而头发脱落。这是五味所造成的伤害。
五味入口，内养五脏，各有喜好。喜好太过，则互相伤害，所以不宜过分喜好。
《阴阳应象大论》阳为气，阴为味。味浓者为阴中之阴，味薄者为阴中之阳。气浓者为阳中之阳，气薄者为阳中之阴。味浓则泄，味薄则通。气薄则发泄，气浓则发热。辛甘发散为阳，酸苦涌泄为阴。
味浓者为阴中之阴则具有泄下作用，如大黄之类。味薄者为阴中之阳则具有通利作用，如苦茶之类。气浓者为阳中之阳则具有发热作用，如附子之类。气薄者为阳中之阴则具有发泄作用，如麻黄、桂枝之类。所以辛甘发散为阳，酸苦涌泄为阴。
Among the Five Flavors, Pungent (Xin) disperses; the pungency of Banxia (Pinellia Rhizome), Baizhi (Angelicae Dahuricae Radix), and Fangfeng (Saposhnikoviae Radix) all have dispersing effects. Sweet (Gan) moderates; the sweetness of Gancao (Licorice Root) and Dazao (Jujube Fruit) all have moderating effects. Sour (Suan) astringes; the sourness of Baishaoyao (White Peony Root) and Wuweizi (Schisandra Fruit) all have astringing effects. Bitter (Ku) purges; the bitterness of Dahuang (Rhubarb Rhizome) and Huanglian (Coptis Rhizome) all have purging effects. Salty (Xian) softens hardness; the salinity of Mangxiao (Mirabilite) and Haishi (Calcitum) all have softening effects. Bland (Dan) promotes leaching out dampness; the blandness of Fuling (Poria) and Baizhu (Atractylodis Macrocephalae Rhizome) all have leaching effects.
Cold syndromes are treated with Heat therapies; Heat syndromes are treated with Cold therapies. Mild cases are treated by contraries (Zhengzhi, or Orthodoxy); severe cases are treated by similars (Fanzhi, or Heterodoxy).
Mild diseases can be treated by contraries, using Cold to attack Heat, and Heat to attack Cold. Severe diseases cannot be treated by contraries; one must follow their apparent nature and treat by similars. This is referred to as "using Heat to treat Heat." For example, in Shanghan (Cold Damage) with fever, one might instead use Xing substances like Mahuang (Ephedra Herb), Shengjiang (Zingiberis Rhizoma Recens), and Guizhi (Cinnamon Twig) to disperse according to the apparent nature of the fever.
The Yellow Emperor asked: What are contrary treatment and similar treatment? Qibo answered: Contrary treatment is Zhengzhi (Orthodox Treatment); similar treatment is Fanzhi (Heterodox Treatment). Whether to follow slightly or greatly depends on observing the specific circumstances.
Treating against the disease's trend is called Zhengzhi; prescribing formulas that follow the disease's trend is called Fanzhi. In Fanzhi formulas, if only one or two ingredients follow the trend, it is "following slightly"; if three or four ingredients follow the trend, it is "following greatly." One must observe the severity of the disease and the weight of the condition to decide between following slightly or greatly.
The Yellow Emperor asked: What is Fanzhi? Qibo answered: "Re treating heat with cold," "treating cold with heat," "obstruction treated by obstruction," and "patency treated by patency." One must subdue the primary cause and first address the etiology. Initially, the treatment may seem similar, but ultimately, it differs.
Wang’s commentary in *Zhiyi* states: The Fanzhi mentioned in the classic text refers to the method of Congzhi (Following Treatment), as stated above: "Congzhe Fanzhi" (Those who follow are heterodox). "Re treating heat with cold" means using Hot medicines because the patient presents with Heat symptoms, but the underlying pathology is Cold. For instance, in Shanghan, if Kidney Qi is originally deficient and Cold, with internal Cold excess repelling Yang to the exterior, causing facial redness, body heat, and a rapid but forceless pulse, the Classic says: "When the pulse arrives and follows [the symptom], but upon pressing, does not drum [feel strong], all Yang manifestations appear thus." Another case involves excessive consumption of Cooling medicines due to internal injury, leading to intense skin heat, delirium, dry mouth, and a forceless pulse. These are fundamentally Cold but manifest as apparent Heat, which is not true Heat; thus, Hot medicines should be used for Fanzhi. "Treating cold with heat" means using Cold medicines because the patient presents with Cold symptoms, but the underlying pathology is Heat. For example, in severe Shanghan where sweating or purging was neglected, hyperactive Yang is internally constrained, repelling Yin to the exterior, causing whole-body cold limbs but a solid pulse. The Classic says: "For Yin reversals, when the pulse arrives and follows, upon pressing, it drums vigorously and strongly." There are cases of internal accumulated Heat with external aversion to cold, or internal Fire flaring up causing a sensation of cold air rushing from the abdomen upward. These are fundamentally Heat but manifest as apparent Cold, which is not true Cold; thus, Cold medicines should be used for Fanzhi. "Obstruction treated by obstruction" means using tonifying and astringent medicines for obstructive diseases. Commentators note that using tonics for Qi deficiency causing abdominal fullness is just one example. Other cases include chest stuffiness due to Qi deficiency, abdominal masses causing pain moving up and down due to Qi deficiency, tenesmus due to Qi deficiency, difficult urination due to Qi deficiency, swelling and pain in joints due to Qi deficiency, and tightness in the back and shoulders due to Qi deficiency. All these are fundamentally Qi deficiency failing to circulate, manifesting as apparent obstruction, which is not true obstruction; thus, Qi-tonifying and astringent medicines should be used for Fanzhi, which is an example of "obstruction treated by obstruction." "Patency treated by patency" means using draining and purgative medicines for patent/discharging diseases. Commentators note that using draining medicines for diarrhea caused by heat accumulation and stagnation is just one example. Other cases include dysentery due to food stagnation, requiring medicines to unblock accumulation and digest food; involuntary urination or seminal emission with turbid urine due to lower jiao heat accumulation, requiring medicines to open orifices and clear heat; malaria with stagnant heat at the exterior causing sweating, requiring clearing heat and releasing the exterior; wind-heat trapped at the exterior causing sweating, requiring dispersing wind; bi syndrome with dampness steaming causing sweating, requiring dispersing dampness; and internal blood stasis causing vessel obstruction with collateral bleeding, requiring blood-invigorating medicines. All these are fundamentally obstruction but manifest as apparent patency, which is not true patency; thus, draining medicines should be used for Fanzhi, which is an example of "patency treated by patency." "Subduing the primary cause" implies that the method of Zhengzhi is hidden within its application. "Addressing the etiology first" means guiding along the trend. Subduing the cause of my primary treatment and first addressing the etiology to follow and gradually weaken the pathogen focuses on treating the patency; initially using "patency treated by patency," once accumulation is removed and diarrhea stops, the initial patency serves to obstruct (stop) it, revealing my benevolent intent. Fanzhi primarily addresses complex diseases; speaking from the beginning, it is also Zhengzhi, so initially, the drug nature follows the trend, same as Zhengzhi. Speaking from the end, the drug nature seems contrary to the trend, different from Zhengzhi, hence "initially similar, finally different." The method of Fanzhi is subtle, requiring deep contemplation. The meaning of this chapter is broad; one should not deviate due to bias. Those commentators who fail to examine the interplay of gain and loss, such as saying fullness should be tonified and diarrhea/purging should be purged, are acceptable. However, citing honey-prepared Aconite or chilled wine as examples shows they observe small details while missing the big picture; what more is there for me to say?
[These methods] can break up accumulations, dissipate hardness, harmonize Qi, and ensure recovery.
This concludes the efficacy of the aforementioned Fanzhi.
The Yellow Emperor asked: How do diseases transmit from interior to exterior and vice versa? Qibo answered: When transmitting from interior to exterior, regulate the interior.
Internal injury to Yuan Qi fails to protect the exterior Couli, leading to sweating etc.; use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) to regulate the interior, then exterior symptoms will naturally resolve. This is treating the root.
When transmitting from exterior to interior, treat the exterior.
Wind-Cold trapped externally causing cough/asthma or epistaxis; use Mahuang Tang (Ephedra Decoction) or Guizhi Tang (Cinnamon Twig Decoction) to release the exterior, then internal troubles will naturally resolve. This is also treating the root.
When transmitting from interior to exterior and becoming severe externally, first regulate the interior, then treat the exterior.
For example, internal accumulated heat causing carbuncles, sores, and ulcers; first use Bitter-Cold medicines to drain internal excess, then use formulas to unblock meridians, resolve depression, and expel pus, or acupuncture/bian stones to treat the exterior. Thus, both interior and exterior are pacified. This is treating root before branch.
When transmitting from exterior to interior and becoming severe internally, first treat the exterior, then regulate the interior.
Exterior pathogen trapping leading to internal heat, causing phlegm-fire congestion; first use Pungent-Dispersing flavors to resolve the exterior, then use expectorant and fire-clearing formulas to treat the interior. Thus, both interior and exterior are safe. This is also treating root before branch.
If interior and exterior are unrelated, treat the primary disease.
If the disease is in the interior or exterior, mutually unrelated, and not transmitting from interior to exterior or vice versa, then focus solely on treating the primary disease in either location.
Someone asked: The theory states treating Cold with Heat and Heat with Cold, yet physicians cannot abandon rules and change their path. If a Heat patient treated with Cold remains hot, and a Cold patient treated with Heat remains cold, with new diseases arising, how should they be treated?
This asks about ineffective treatment where new Cold/Heat symptoms arise due to the Cold/Heat nature of the medicines.
Qibo answered: For those whose Heat persists despite Cold treatment, treat the Yin; for those whose Cold persists despite Heat treatment, treat the Yang. This is called seeking the affiliation.
Yin refers to the Kidney; Yang refers to the Heart. The Heart belongs to Fire; the Kidney belongs to Water. This refers to Fever due to depletion of Kidney True Yin. Misusing Cold medicines exacerbates the Heat. Does one not realize the Heat persists due to insufficiency of True Water? Use Kidney-nourishing agents like Shanyao (Dioscorea Rhizome), Gouqi (Lycium Fruit), and Dihuang (Rehmannia Root). This is "Strengthening the Master of Water to control Solar Flare." Similarly, for Chills due to depletion of Heart Original Yang, misusing Heat medicines exacerbates the Cold. Does one not realize the Cold persists due to insufficiency of True Fire? Use Heart-tonifying agents like Renshen (Ginseng Root) and Fuzi (Aconite Lateralis Radix Preparata). This is "Enlarging the Source of Fire to dispel Yin Shadows." If Heart Yang is strengthened, Cold will circulate; if Kidney Yin is fortified, Heat will recede. Heart and Kidney are the sources of Water and Fire, the roots of Yin and Yang, referred to as "Affiliation."
Taking Cold medicines resulting in increased Heat, or taking Heat medicines resulting in increased Cold, occurs because one treated the Exuberant Qi (Wang Qi), hence the reversal.
Exuberant Qi refers to the Qi exuberant in the current season. E.g., contracting Cold in Summer, transforming into Heat; use Pungent-Dispersing medicines. Seeing fever and knowing the seasonal Qi is also Hot, the physician uses Cold medicines. Cold nature is constricting; exterior pathogens cannot disperse, so Heat worsens. In Winter Shanghan, neglecting sweating/purging leads to pathogen transmission, hyperactive Yang constrained internally causing chills; use Bitter-Purgatives. Seeing chills and knowing the seasonal Qi is also Cold, the physician uses Heat medicines. Heat nature is fierce; internal pathogens are not unblocked, so Chills worsen. These are errors in treating the Exuberant Qi, consistent with the principle that releasing the exterior does not avoid Heat, and attacking the interior does not avoid Cold.
Question: Why does failure occur when not treating the Exuberant Qi? Answer: It is failing to distinguish between the Exuberance of Flavor and the Affiliation of Flavor.
Here, "flavor" in the upper context refers to savoring/analyzing, and in the lower context, it refers to medicinal taste. E.g., Lung Qi deficiency causing chills; the chill is due to Lung Qi insufficiency. Tonify Qi to generate Yang. If mistakenly given Pungent-Hot tastes, Yang deficiency allows Yin to gather, worsening chills. One knows "Cold treated with Heat" but fails to analyze that Pungent flavor is exuberant in Autumn and affiliated with the Lung; Pungent enters the Lung first to disperse Lung Qi, thus causing cold. E.g., Heart Blood deficiency causing fever; the fever is due to Heart Blood insufficiency. Tonify Blood to generate Yin. If mistakenly given Bitter-Cold tastes, Yin deficiency allows Yang to invade, worsening fever. One knows "Heat treated with Cold" but fails to analyze that Bitter flavor is exuberant in Summer and affiliated with the Heart; Bitter enters the Heart first to drain Heart Blood, thus causing heat. Hence, "not distinguishing Exuberance of Flavor from Affiliation of Flavor" leads to violation.
The Five Flavors enter the Stomach and each return to their preferred organ: Sour first enters the Liver, Bitter first enters the Heart, Sweet first enters the Spleen, Pungent first enters the Lung, Salty first enters the Kidney. Long-term intake increases Qi, which is the normal transformation of things. However, prolonged increase of Qi leads to premature death.
Long-term intake of Five Flavors increases their respective organ Qi. E.g., long-term Huanglian (Coptis) causes Heat. Thus, "long-term intake increases Qi" is normal transformation. Unchecked increase leads to organ Qi excess; excess leads to exhaustion. Hence, it is the cause of premature death.
*Wuchang Zheng Da Lun* states: First know the annual Qi, do not violate Tianhe (Heavenly Harmony); do not reinforce excess or deplete deficiency, thereby avoiding causing premature death; do not invite pathogens or lose righteousness, thereby preserving longevity.
This means humans correspond to Heaven and Earth Yin-Yang, Deficiency-Excess, Cold-Heat. Treatment must observe annual Qi and Tianhe, avoiding errors of reinforcing excess/depleting deficiency, so as not to lose righteousness and cause premature death.
*Da Yao* states: Do not violate transformation, do not go against seasons; must nourish and harmonize, wait for recovery. This is it.
This continues the previous text, citing ancient classics to prove the meaning of not violating Tianhe.
*Wuzang Bie Lun* states: Those bound by ghosts and spirits cannot be spoken to regarding supreme virtue; those averse to needles and stones cannot be spoken to regarding supreme skill.
*Zangqi Fashi Lun* states: Liver color is Green; eat Sweet. Jingmi (Glutinous Rice), Niurou (Beef), Zao (Jujube), Kui (Malva Leaf) are Sweet. Heart color is Red; eat Sour. Xiaodou (Adzuki Bean), Quanrou (Dog Meat), Li (Plum), Xi (Pickled Vegetable) are Sour. Lung color is White; eat Bitter. Mai (Wheat), Yangrou (Mutton), Xing (Apricot), Xie (Allium Macrostemon) are Bitter. Spleen color is Yellow; eat Salty. Dadou (Soybean), Shourou (Pork), Li (Chestnut), Huo (Broad Bean Leaf) are Salty. Kidney color is Black; eat Pungent. Huangshu (Yellow Millet), Jirou (Chicken), Tao (Peach), Cong (Scallion) are Pungent. Toxic drugs attack evil; Five Grains nourish; Five Fruits assist; Five Meats benefit; Five Vegetables fill. Take them combined with appropriate flavors to tonify essence and Qi.
"Toxic drugs" refer to metals, gems, stones, earth, herbs, trees, vegetables, fruits, insects, fish, birds, beasts. However, only toxic drugs can dispel evil and stabilize righteousness, so they are collectively termed toxic drugs. Five Grains: Jingmi, Xiaodou, Dadou, Mai, Huangshu. Five Fruits: Tao, Li, Xing, Li, Zao. Five Vegetables: Kui, Huo, Xie, Cong, Jiu. Food preserves nature; medicine protects life; warm and tonifying flavors preserve spirit and form. This is taking combined flavors to tonify essence and Qi.
*Xuanming Wuqi Pian* prohibitions of Five Flavors: Pungent moves Qi; in Qi diseases, do not eat much Pungent. Salty moves Blood; in Blood diseases, do not eat much Salty. Bitter moves Bone; in Bone diseases, do not eat much Bitter. Sweet moves Flesh; in Flesh diseases, do not eat much Sweet. Sour moves Sinews; in Sinew diseases, do not eat much Sour. These are the Five Prohibitions; do not let patients eat too much.
Excessive Five Flavors cause disease; in existing diseases, they worsen it. Hence, do not eat too much. The meaning of the following text is evident.
*Wuzang Shengcheng Pian*: Much Salty causes pulse coagulation and color change; much Bitter causes withered skin and fallen hair; much Pungent causes tense sinews and withered nails; much Sour causes calloused flesh and peeled lips; much Sweet causes bone pain and fallen hair. These are the injuries of the Five Flavors.
Five Flavors enter the mouth and nourish the five zang organs, each having preferences. Excessive preference causes mutual injury; hence, one should not indulge excessively.
*Yinyang Yingxiang Da Lun*: Yang is Qi, Yin is Flavor. Strong flavor is Yin within Yin; thin flavor is Yang within Yin. Strong Qi is Yang within Yang; thin Qi is Yin within Yang. Strong flavor purges; thin flavor unblocks. Thin Qi releases and vents; strong Qi generates Heat. Pungent and Sweet disperse and emit, belonging to Yang; Sour and Bitter induce vomiting and purging, belonging to Yin.
Strong flavor (Yin within Yin) purges, e.g., Dahuang (Rhubarb). Thin flavor (Yang within Yin) unblocks, e.g., bitter tea. Strong Qi (Yang within Yang) generates Heat, e.g., Fuzi (Aconite). Thin Qi (Yin within Yang) releases and vents, e.g., Mahuang (Ephedra), Guizhi (Cinnamon Twig). Hence, Pungent and Sweet disperse/emit belong to Yang; Sour and Bitter vomit/purge belong to Yin.