道之浑沦，莫知其源，道之既判，变化无穷，莫知其端。推其变化之间，凝而为质，五
行名之，化而为气，五运统之，钟而为人，五脏应之，自此而后，物之可名，数之可推，理
之可穷，而道之迹乃可得而言之也，大而天地，小而一身，理或皆然，统而论之，要其所养
，一归之无失而已。故云雾不精，则上应白露不下，白露不下，则苑 不荣，乃至贼风数至
，豪雨数起，天地四时不能相保，与此天气不袭，道之相失也，人之起居乖宜，将养失度，
一藏有余，一藏不足，寒温之不能相交，荣卫之不能相通，风之气乘隙而入，疾如飞矢，奇
病苛疾，应如反掌，此天地之与人，其理未尝不一矣，古之圣人，和于阴阳，调于四时，春
夏养阳，秋冬养阴，与万物浮沉于生长之门，故生身无奇病而寿敝天地，无有终时，此无他
，养无失而生气不竭者也，贤人则上配天以养头，下象地以养足，中傍人事以养五脏而无失
，亦可益寿而有极时，至于庶人，不能法天之纪用地之理，失于所养，天之邪气，感而害五
脏，水谷之寒热，感而伤六腑，地之湿气，感而害皮肉筋脉，百病无端，从斯而至，病之一
生，千变万化，莫能穷究，故世之善医者，不患治病之难，患识病之难，患使药之难，何则
，受病有浅深，使药有重轻，度其浅深，分毫之不可差，明其轻重，锱铢之不可偏，浅深轻
重之间，医者之精粗，病者之性命，差之毫厘，失之千里，得失之间，死生性命之所系，医
之道，不得不为之难也。故善为医者，一病之生，必先考其根源，定其传受，审其刑克，分
其冷热寒温，辨其上下内外，有真有邪，有虚有实，忽隔绝痞塞不通，忽空虚微弱失守，可
针可灸，可下可汗，阙于不精，勇于必验，制之有先后，取之有轻重，条理具存，各有其常
，而不可差之分毫也。夫病之所起，其来有根源，其次有传受，其传有刑克，此非常之证，
劳伤之候也，夫劳之为病，始于丹元髓海之虚，则真病之所生，莫不先在于肾，水能胜火，
故传之于心。火能胜金，故传之于肺，金能胜木，故传之于肝，木能胜土，故传之于脾，五
脏相传，五气相灭，五神耗散，荣泣卫除，而精神荣卫，治之之法，其根在肾，而未传于心
者，投之以肾邪之药，而其气自损也，当于肾之未治，而传之与心，先治于肾，攻其鬼而伐
其根也，次治心，逐其邪，而保安其心气也，当于心之未治，而传之与肺，涕唾胶粘，喘嗽
不安，先治于心，攻其鬼而断其相传之势，火邪扑灭，肺药未投，而喘嗽之消灭，十亦去八
九矣，次治于肺，解其邪，而保安其金气也，后治于肾，清其脏，而还其真气也，当此未治
，而至于肺传之肝，筋骨痿痹，隐伏于床，治之亦徒劳功。如此所为，考其根源，定其传受
，而审其刑克也，夫五脏温和病安从来，将养乖宜，病生于变，是则百病之起，虽千变万化
之几，而要其所归，不出于寒温热冷而已。冷者不可治之以温，名曰不及，凉而治之以热，
名曰太过。不及者，病之不能灭，而太过者，反有所伤于真气也，冷者热之，寒者温之，轻
重得宜，疾徐有制，动无毫厘之失，而所疗之病，举获万全。此所为分其冷热寒温者矣。传
曰∶狂风入林，枯枝先折，猛雨破堙，隙者先坏，则八邪之所以感伤于人，莫非乘隙而入，
此人之所病，不能无内外上下之辨也，肺气喘嗽，胶痰坚实，伏在胸中，潮涎并起，倾损性
命，如此之类，病在上也，脚膝痿软，行步无力，腰胯沉重，如此之类，病在下也，生于皮
毛，染于筋骨，忽寒所中，饮食不消，忽热毒所攻，大府秘涩，百端随人冷热，如此之类，
病在内也，在上者吐之而安，然不可吐者当制之以缓，在下者补之而愈，然不可补者当制之
以急，在外者可针可灸可汗，随其所宜，而在内者可攻可补可下，随其冷热而已，其治之有
方，其辨之有法，亦何患乎所投之药，无必胜之验者哉，此辨其上下内外者也。夫五味爽人
之口，五色盲人之目，嗜欲无穷，贪着不已，忧患迭生，精神 坏，而真残根伐，是人之不
能无虚实也。实者为有余，虚者为不足，有余者泻之，不足者补之，而补泻之间，又有内外
之辨，故形不足者，温之以气，精不足者，补之以味，五脏六腑之内，实者通之以药饵，四
肢八节之外，实者泻之以针石刺，此其补泻之有所不同也，乃所为分其虚实者矣，夫古之人
，年满百而动作不衰，今之人，年未满五十而动作有衰，非天之私于古而祸于今也。古之人
知养道之术，嗜欲不能劳其目，淫邪不能惑其心，血气安和精神内守，故年满百而动作不衰
，盖真全而邪气不能胜也，今之人不知养道之术，务快其心，逆于生乐，血气枯衰，精神耗
散，乃有胎胎相传，病病相孕，受气虚微，肌体羸弱，呼吸喘息之间，而百病臻凑于五脏六
腑者矣，此无他，精虚神乏，而外邪得以干其阴阳之正气也，善为医者，保其真，去其邪，
无使其过剂之药，反有以贼其真也，此所谓分其真邪者矣，乃至有隔绝痞塞不通，空虚微弱
失守，虽三尺之童，亦耳闻而心识者矣，夫病之在内，药饵攻之，病之在外，针石取之，其
有病势之急，而药石之功缓而难制，圣人不能灸之法，类而举之，若今阴毒伤寒，其四肢八
节皆冷，面青唇黑，不知人事，急于气海灸之，一灸不过十数壮，而人神气完复矣，又有夏
暑之月，任意取凉，频饮凉水，忽饮冷酒后，恣贪色欲，精气至虚，阴邪壮盛，阴阳相夺，
阴气偏胜，独守下元，阳气虚微，上攻头项，其病脚冷如雪，四肢八节俱寒，脉气深伏，但
有其热如火，其痛难忍，方此之际，针石何济，急于气海上灸之，一灸不过数十壮，而日前
之所饮凉水冷酒皆转下，须臾四肢八节俱暖，而阴阳之气仍相交际者，又有冷热之痈肿，忽
鲜赤而疼痛，忽坚硬而不痛，急以湿纸帖其上，寻其纸之先干处，便灸，一灸至百壮余而后
止，若以冷肿而纸上不得其先干处，即于肿处当头着灸，亦以百壮而止，但量肌体浓薄，方
可安灸，瘦薄者少灸，肥浓者多灸，忽是冷肿，灸而不痛，则以闻痛而止，因吃硫黄后有此
病，更在虚处不请安灸，夫病之可汗可下，可针可灸，其缓急之序，重轻之别，操之不失其
宜，施之各有其度，又何患乎人之不安，病之不愈者哉。呜呼！
天地无全功，圣人无全能，虽黄帝、岐伯之论，尚有不治之病，则今有非常之候，不得
其详，未明其实，阙而勿治，医者不为之辱也，苟其病之炽盛，人之危笃，医者既明其理，
又识其详，当此之时，不可有分毫之怯，急以毒药验针，回其生于万死之地，举必万全，然
非至神，无能与此，愚者行之，无异于操刀杀人也，如此所为，阙于不精，勇于必验者矣，
此皆持之有术，治之有统，不可相逾于规矩权衡者也，至于病之有非五行之所传化，若寒壅
之相交，阴阳之相伏，忽似热而反寒，忽似寒而反热，忽两寒两热之相攻，忽有余不足之相
碍，千变万化而生人之大病苦，今若肺藏本有实热。反因临大风，冒大雨，极感于寒邪之气
，寒邪之气客于肺经，寒热相交发而成嗽，医者治之，投以凉药，顺其肺气，则助其寒邪之
势，而嗽愈增，投以暖药，则激其本藏之热，而加喘急，寒温之药，俱难以进，则修方使药
之轻重，当见于此，或有以羌活。
黄橘皮 麻黄（去根） 紫菀 杏仁（去双仁皮尖） 细辛 独活 防风 桔梗
上为末，每服二钱，沸汤点，（空心服，）不过数服而嗽止，此轻□□解其寒邪，空心赚
其寒邪之气流出于胃也。此所谓治其寒热相交者矣，忽有人之脏腑根本实热，却因履天暑，
冒大热，骤入凉处，顿饮凉水，寒气胜，畏其热气，阴阳相伏，阴气固而不散，阳气伏而不
动，其病结为一块，伏在胸中，此病名为伏暑者也。其候忽寒，心中烦躁，状似伤寒，而脉
不甚数，医者治之，妄投转药，虽六腑之精华，悉皆荡尽，而心前之结块，愈增坚固，此无
他，所下之药助其寒邪之势，阴气转坚而不散也，治之之法。
芎 细辛 藿香 黄橘皮
上为末，每服二钱，水一盏，煎至七分为汤，空心服之，先解其寒邪之气，不移时而心
前之结块顿然消散，然后更审其脉气，察其暑毒之轻重，必投药以解之，则亦何患乎药之不
验者哉。如此所谓治其阴阳之相伏者矣，夫病有似热而反寒者，若今有产后之病，五脏积冷
，阴气偏胜，乳汁倍多，无故流出，口舌常干，非时发渴，头旋目晕，饮食减少，肠胃虚空
，身体羸瘦，每思登后，忽又不通，浅学治之，不过曰口舌常干，非时发渴，上焦之有热也
，头旋目晕，血热而生风也，每思登后又忽不通者，大肠之秘涩也，是不知乳汁倍多，无故
流出，则口干而发热，从可知矣，体气虚弱，头旋目晕，肠胃空虚，而传送之气不足，则每
思登后，又忽不通，从可知矣，一旦误以为热，而投之冷药岂不倾人性命于顷刻哉，病有似
寒而反热者，若今壮岁之男子，志在淫邪，恣贪补药，以昏求色欲，热药所攻，荣卫结涩，
上气有余，下气不足，上下之气不相交际，脚膝痿弱，行步无力，两足多冷，或时增寒，肌
体黑瘦，饮食减少，才吃咸味，即便恶心，医者治之不过曰，此五脏六腑之虚弱也，投以暖
药，譬犹抱薪救火，与甚亡益也，才以清凉之药，解利肺经，散其毒热上攻之气，荣卫一通
，则其阴阳之气、仍相交际，手足自暖，脚膝损轻，而平复如故矣，此所谓似寒而反热也，
夫岁阳太过，天地不无旱干之灾，岁阴太过，天地不无水潦之患，以虚生寒，以实生热，则
人之脏腑、不能无两寒两热之相攻也，若今伤寒所谓阳毒之类，皆两寒两热之相攻者矣。哀
哉，色欲无厌，丧身之本，世人多以迷心，恣其所欲，反餐毒热之药，以希苟活，其丹元髓
海，虽已空虚，而脏腑骨槽，虚热转盛，此病之所生，不能无有余不足之相碍也，若今人
之患大肠秘涩，忽五六日，忽十日，出后不通，小肠虚惫，日夜五六十次，每次小便，仍有
一盏半盏已来，其清如水，忽时黄色，临小便时，其痛难忍，甚则心神烦躁，此肝心脾肺四
脏之毒热有余，而肾与小肠主气不足也。脾肺心积热，则肠干涩，肾与小肠虚惫，则水道滑，
肝心积热，则其血沸溢甚则血黯黑，热毒之气，如烟如雾，镇在中焦，因其小肠虚惫，水道
乘虚，只行于小肠此所以小便虽清，其痛难忍，其病有似于淋，而非淋疾，天下物理，有似
是而非者，正谓此也，医者治之，投暖药以固小肠，而则滋其肝心热毒之气，而痛愈加，下
凉药通大府，则药随水道，只行于小肠，而病愈盛，冷热之药，俱难以进，此有余不足之相
碍也，治之之法，当以通气药为汤，洗其谷道，先引其五脏之气，归入于胃，使其汤水稍随
气而下入于胃，第二度，使水渐取得一两个下气，相次如药取得些小干粪，气归大肠，所余
汤水，亦随气行，归入大肠，则未吃小肠气药，而小便自止也，渐次使药通其肝心，热毒之
气使出后，稍通便下药，取其热毒，所取下物，如半腐烂者，淤血之类，如此，然后得其病
根之消减也。所下之药，具在方中，此谓治其不足有余之相碍也，吁，医术如林，余之所得
，芽孽而已，医道如海，余之所得，涓滴而已，因其所得，虽无寸长，稽其用心，实非古人
之形于笔舌者，今略举数条，论之于前，以明医道之大略而已。
道的整体浑沦，没有人知道它的源头；道一旦分化，变化无穷无尽，没有人能知晓它的开端。推究这变化之间，凝聚而成物质，用五行来命名它；化生而为气，由五运来统摄它；汇聚而成为人，由五脏来对应它。从此以后，事物的名称、数理的推演、道理的穷尽，道的迹象才可以被言说。大到天地，小至人体，道理或许都是如此。总括而言，关键在于调养得当，不出现失误罢了。
所以，如果云雾不精纯，就会上应导致白露不下；白露不下，草木就不能繁荣；以至于贼风频繁吹袭，暴雨多次降下，天地四季不能相互保全。这与天气不相继承、道相背离是一样的。人的起居违背适宜，调养失去法度，一脏有余，一脏不足，寒与温不能相交，营与卫不能相通，风气乘虚而入，疾病像飞箭一样迅速，奇病恶疾，发生得易如反掌。这是天地与人，其道理未曾有二的体现。
古代的圣人，与阴阳和谐，与四时调适，春夏养阳，秋冬养阴，与万物一起在生长的大门中浮沉，所以身体没有奇病，寿命可以比肩天地，没有终结之时。这没有别的原因，只是调养没有失误，生气就不会枯竭。贤人则上配天以养护头部，下象地以养护足部，中间傍借人事以养护五脏而没有失误，也可以益寿并且有确定的寿命极限。至于平民百姓，不能效法天的纲纪和地的理数，在调养上出现失误，天的邪气侵入伤害五脏，水谷的寒热之气侵入损伤六腑，地的湿气侵入伤害皮肉筋脉，百病无端产生，由此而来。
疾病一旦产生，千变万化，无法穷尽探究。所以世上善于治病的人，不担心治病的难处，只担心识别疾病的难处，担心使用药物的难处。为什么呢？因为受病有浅深之分，用药有轻重之别。衡量其浅深，分毫都不能差错；明确其轻重，锱铢都不能偏颇。在浅深轻重之间，是医生技艺精湛或粗疏的分野，也是病人性命攸关的时刻。得失之间，系于死生性命，医道不得不说是难的。
所以善于行医的人，一种病产生，必须先考察其根源，确定其传变，审察其克制关系，分辨其冷热寒温，辨别其上下内外。有的真是邪气，有的是虚证，有的是实证。有时隔绝痞塞不通，有时空虚微弱失守。可以用针，可以用灸，可以攻下，可以发汗。对于不精通的要缺漏，对于必须验证的要勇敢。制方有先后顺序，取穴用药有轻重之分，条理具备，各有常规，不可有分毫差错。
疾病的发生，其来有根源，其次有传变，其传变有克制关系。这是非常见的证候，劳伤的征候。所谓劳伤之病，始于丹元髓海的虚弱，那么真病的发生，无不先在于肾。水能胜火，所以传变到心；火能胜金，所以传变到肺；金能胜木，所以传变到肝；木能胜土，所以传变到脾。五脏相传，五气相灭，五神耗散，营血凝滞，卫气消散。精神营卫的治疗之法，其根本在肾。而未传变到心的时候，投以治疗肾邪的药物，其气自然受损。应当在肾未治之前，传变给心时，先治肾，攻其鬼邪而伐其根；其次治心，驱逐其邪气而保安其心气。当在心未治之前，传变给肺时，涕唾胶粘，喘嗽不安，先治于心，攻其鬼邪而断绝其传变之势，火邪扑灭，肺药未投，而喘嗽消除十之八九了。其次治肺，解除其邪气而保安其金气。后治肾，清其脏腑而恢复其真气。当此时未治，而至于肺传变到肝，筋骨痿痹，隐伏于床，治疗也是徒劳无功。这样做，就是考察其根源，确定其传变，并审察其克制关系。
五脏温和，病从哪里来呢？调养违背适宜，病生于变异。这就是百病兴起，虽然千变万化的机微，但归结其去向，不出于寒温热冷而已。冷的不能用温法治，名叫不及；凉而用热法治，名叫太过。不及者，病不能消灭；太过者，反而伤害真气。冷的用热治，寒的用温治，轻重得宜，快慢有节制，动作没有毫厘的失误，所治疗的病，全部获得万全。这就是分辨冷热寒温的道理。
传说：狂风进入树林，枯枝先折；猛雨冲破堤坝，有缝隙的先坏。那么八邪之所以感伤于人，无非是乘隙而入。这是人的疾病，不能没有内外上下的辨别。肺气喘嗽，胶痰坚实，伏在胸中，潮涎并起，倾损性命，这类情况，病在上部。脚膝痿软，行走无力，腰胯沉重，这类情况，病在下部。生于皮毛，染及筋骨，忽然受寒邪中伤，饮食不消化，忽然受热毒攻击，大便秘结涩滞，各种情况随人的冷热不同，这类情况，病在内里。
在上部的，用吐法使其安宁，然而不可吐的应当用缓法制之；在下部的，用补法使其痊愈，然而不可补的应当用急法制之；在外部的，可用针、可灸、可汗，随其所宜；在内里的，可攻、可补、可下，随其冷热而已。其治疗有方法，其辨别有法则，又何必担心所投的药物没有必胜的效果呢？这就是辨别上下内外的道理。
五味爽口，五色盲目，嗜欲无穷，贪着不已，忧患迭生，精神败坏，而真元残破根基动摇，这是人不能没有虚实之分。实者为有余，虚者为不足。有余的泻之，不足的补之。而在补泻之间，又有内外之辨。所以形体不足的，用气来温养；精气不足的，用味来滋补。五脏六腑之内，实的用药物通导；四肢八节之外，实的用针石刺泻。这就是补泻的不同之处，也就是分辨虚实的道理。
古代的人，年满百岁而动作不衰；现在的人，年龄未满五十而动作已有衰象。这不是天偏爱古人而祸害今人。古代的人懂得养生的道术，嗜欲不能劳累他的眼睛，淫邪不能迷惑他的心，血气安和，精神内守，所以年满百岁而动作不衰，大概是因为真元保全而邪气不能战胜。现在的人不懂得养生的道术，追求快乐其心，逆于生乐，血气枯衰，精神耗散，于是有胎胎相传，病病相孕，受气虚微，肌体羸弱，呼吸喘息之间，百病聚集于五脏六腑。这没有别的原因，精虚神乏，而外邪得以干扰其阴阳的正气。
善于行医的人，保全其真元，去除其邪气，不让过量的药物反而伤害其真元。这就是所谓分辨真邪的道理。乃至有隔绝痞塞不通，空虚微弱失守，即使是三尺高的儿童，也能耳闻而心识。病在内里的，用药物攻治；病在外面的，用针石取治。如果有病势紧急，而药物石疗的功效缓慢难以控制，圣人不能施灸的情况，列举如下：比如现在的阴毒伤寒，四肢八节都冷，面青唇黑，不知人事，急于气海穴施灸，一次灸不超过十几壮，人的神气就完复了。又有夏暑月份，任意取凉，频饮凉水，忽然喝冷饮酒后，恣意贪恋色欲，精气极虚，阴邪壮盛，阴阳相夺，阴气偏胜，独守下元，阳气虚微，上攻头项，其病脚冷如雪，四肢八节俱寒，脉气深伏，只有热如火，疼痛难忍。在此之际，针石有什么帮助？急于气海穴施灸，一次灸不过几十壮，而日前所饮的凉水冷水酒都转下，须臾四肢八节俱暖，而阴阳之气仍相互交际。又有冷热之痈肿，忽然鲜红而疼痛，忽然坚硬而不痛，急用湿纸贴在上面，寻找纸上先干的地方，便施灸，一次灸到一百多壮才停止。如果是冷肿而纸上找不到先干处，就在肿处当头施灸，也以百壮为限，但要量肌肉的浓薄，方可安放艾灸，瘦薄的少灸，肥厚的多灸。忽然遇到冷肿，灸而不痛，则以闻到痛感为止。因为吃硫黄后有此病，更要在虚处不请安灸（注：此处原文可能有误或特定语境，意指谨慎施灸）。
病可汗可下，可针可灸，其缓急的顺序，轻重的区别，操持不失适宜，施行各有法度，又何必担心人不平安，病不痊愈呢？
唉！天地没有全功，圣人没有全能，即使黄帝、岐伯的论述，还有不治的病。那么现在有非常见的征候，不得其详细，不明其实际，空缺而不治，医生不以此为耻辱。如果病势炽盛，人的危笃，医生既然明了其理，又识得其详，在这个时候，不能有丝毫的怯懦，急用毒药验针，将其从万死之地救回生机，举动必获万全。然而如果不是至高神明，无人能与此事。愚者施行，无异于拿刀杀人。这就是所谓对不精通的要缺漏，对必须验证的要勇敢。这都是持之有术，治之有统，不可逾越规矩权衡的。
至于病有非五行所传化的，若寒壅的相交，阴阳的相伏，忽然似热而反寒，忽然似寒而反热，忽然两寒两热相互攻击，忽然有余不足相互妨碍，千变万化而产生人的大病苦。如今如果肺藏本有实热，反而因临大风，冒大雨，极感于寒邪之气，寒邪之气客于肺经，寒热相交发作而成咳嗽。医者治疗，投以凉药，顺其肺气，则助其寒邪之势，而咳嗽愈增；投以暖药，则激发其本脏之热，而加重喘急。寒温之药，都难以进用。则修方使药的轻重，应当见于此。或者用羌活、黄橘皮、麻黄（去根）、紫菀、杏仁（去双仁皮尖）、细辛、独活、防风、桔梗。以上研为末，每服二钱，沸汤点服（空心服），不过数服而咳嗽止。这是轻剂解其寒邪，空心使其寒邪之气流出于胃。这就是所谓治疗寒热相交的方法。
忽然有人脏腑根本实热，却因履天暑，冒大热，骤入凉处，顿饮凉水，寒气胜，畏其热气，阴阳相伏，阴气固而不散，阳气伏而不动，其病结为一块，伏在胸中，此病名为伏暑。其候忽寒，心中烦躁，状似伤寒，而脉不甚数。医者治疗，妄投转药，虽六腑之精华，悉皆荡尽，而心前之结块，愈增坚固。这没有别的原因，所下之药助其寒邪之势，阴气转坚而不散。治疗之法：川芎、细辛、藿香、黄橘皮。以上研为末，每服二钱，水一盏，煎至七分为汤，空心服之。先解其寒邪之气，不移时而心前之结块顿然消散，然后更审其脉气，察其暑毒之轻重，必投药以解之，则亦何患乎药之不验呢？这就是所谓治疗阴阳相伏的方法。
夫病有似热而反寒者，若今有产后之病，五脏积冷，阴气偏胜，乳汁倍多，无故流出，口舌常干，非时发渴，头旋目晕，饮食减少，肠胃虚空，身体羸瘦，每思登后（上厕所），忽又不通。浅学治疗，不过曰口舌常干，非时发渴，是上焦有热；头旋目晕，是血热而生风；每思登后又忽不通，是大肠秘涩。这是不知道乳汁倍多，无故流出，则口干而发热，从可知矣；体气虚弱，头旋目晕，肠胃空虚，而传送之气不足，则每思登后又忽不通，从可知矣。一旦误以为热，而投之冷药，岂不倾人性命于顷刻哉！
病有似寒而反热者，若今壮岁之男子，志在淫邪，恣贪补药，以昏求色欲，热药所攻，荣卫结涩，上气有余，下气不足，上下之气不相交际，脚膝痿弱，行步无力，两足多冷，或时增寒，肌体黑瘦，饮食减少，才吃咸味，即便恶心。医者治疗，不过曰，此五脏六腑之虚弱也，投以暖药，譬犹抱薪救火，与甚亡益也。才以清凉之药，解利肺经，散其毒热上攻之气，荣卫一通，则其阴阳之气、仍相交际，手足自暖，脚膝损轻，而平复如故矣。这就是所谓似寒而反热。
夫岁阳太过，天地不无旱干之灾；岁阴太过，天地不无水潦之患。以虚生寒，以实生热，则人之脏腑、不能无两寒两热之相攻也。若今伤寒所谓阳毒之类，皆两寒两热之相攻者矣。哀哉，色欲无厌，丧身之本，世人多以迷心，恣其所欲，反餐毒热之药，以希苟活。其丹元髓海，虽已空虚，而脏腑骨槽，虚热转盛。此病之所生，不能无有余不足之相碍也。若今人之患大肠秘涩，忽五六日，忽十日，出后不通；小肠虚惫，日夜五六十次，每次小便，仍有半盏一盏已来，其清如水，忽时黄色，临小便时，其痛难忍，甚则心神烦躁。此肝心脾肺四脏之毒热有余，而肾与小肠主气不足也。脾肺心积热，则肠干涩；肾与小肠虚惫，则水道滑；肝心积热，则其血沸溢甚则血黯黑。热毒之气，如烟如雾，镇在中焦，因其小肠虚惫，水道乘虚，只行于小肠。此所以小便虽清，其痛难忍，其病有似于淋，而非淋疾。天下物理，有似是而非者，正谓此也。
医者治疗，投暖药以固小肠，而则滋其肝心热毒之气，而痛愈加；下凉药通大府，则药随水道，只行于小肠，而病愈盛。冷热之药，俱难以进，此有余不足之相碍也。治疗之法，当以通气药为汤，洗其谷道，先引其五脏之气，归入于胃，使其汤水稍随气而下入于胃。第二度，使水渐取得一两个下气，相次如药取得些小干粪，气归大肠，所余汤水，亦随气行，归入大肠，则未吃小肠气药，而小便自止也。渐次使药通其肝心，热毒之气使出后，稍通便下药，取其热毒，所取下物，如半腐烂者，淤血之类。如此，然后得其病根之消减也。所下之药，具在方中。此谓治其不足有余之相碍也。
吁，医术如林，余之所得，芽孽而已；医道如海，余之所得，涓滴而已。因其所得，虽无寸长，稽其用心，实非古人之形于笔舌者。今略举数条，论之于前，以明医道之大略而已。
The totality of the Dao is undifferentiated; no one knows its source. Once the Dao differentiates, changes are infinite and endless; no one can know its beginning. Inferring from these changes, when it condenses into substance, it is named by the Five Elements (Wu Xing); when it transforms into Qi (vital energy), it is governed by the Five Movements (Wu Yun). It gathers to become a human being, corresponding to the Zang-Fu organs (Five Viscera). From then on, the names of things, the deduction of numbers, and the exhaustion of principles allow the traces of the Dao to be spoken of. From the great Heaven and Earth to the small individual body, the principles may all be the same. Summarizing them, the key lies in proper nourishment without error.
Therefore, if clouds and mist are not pure, they will fail to correspond to the upper level, causing White Dew (Bai Lu) not to descend. If White Dew does not descend, plants and trees cannot flourish. Consequently, treacherous winds blow frequently, heavy rains fall often, and the four seasons of Heaven and Earth cannot maintain each other. This is akin to the weather failing to succeed one another and the Dao losing its connection. Human daily life deviates from propriety, and nourishment loses its measure. One Zang organ has excess, another has deficiency; Cold and Warmth cannot interact, Ying (Nutritive Qi) and Wei (Defensive Qi) cannot communicate. Wind Qi enters through gaps, and diseases arrive as swiftly as flying arrows. Strange and severe diseases occur as easily as turning a palm. This demonstrates that the principle connecting Heaven and Earth with humans is never different.
Ancient sages harmonized with Yin and Yang, adjusted to the Four Seasons, nourished Yang in Spring and Summer, and nourished Yin in Autumn and Winter. They floated and sank with all things within the gate of growth. Thus, their bodies had no strange diseases, and their lifespan could rival Heaven and Earth, having no end. There is no other reason than that their nourishment was without error, so their vital Qi did not exhaust. The wise person models the head after Heaven for nourishment, the feet after Earth, and the middle after human affairs to nourish the Zang-Fu organs without error. They can also extend their lifespan to a definite limit. As for common people, unable to follow the laws of Heaven and the principles of Earth, they err in their nourishment. Heavenly pathogenic factors invade and harm the Zang organs; cold and heat from food and drink invade and injure the Fu organs; dampness from the earth invades and harms the skin, flesh, sinews, and vessels. Hundred diseases arise without cause from this point.
Once a disease arises, it undergoes thousands of transformations, impossible to fully investigate. Therefore, skilled physicians do not worry about the difficulty of treating diseases, but rather the difficulty of recognizing them and the difficulty of administering medicines. Why? Because the depth of the disease varies, and the weight of the medicine differs. Measuring the depth requires precision down to a hair's breadth; clarifying the weight allows no deviation of a grain. Between depth and weight lies the distinction between a physician's skill and clumsiness, and the life or death of the patient. In the balance of gain and loss, lives are determined; thus, the medical art is necessarily difficult.
Therefore, a skilled physician, upon encountering a disease, must first examine its root origin, determine its transmission, assess its overcoming relationships, distinguish its cold, cool, warm, and hot nature, and differentiate its upper/lower and internal/external locations. Some are true pathogens, some are deficiency, some are excess. Sometimes there is blockage and stagnation; sometimes there is emptiness and weakness with loss of control. Treatment may involve acupuncture, moxibustion, purgation, or diaphoresis. For what is not mastered, leave it blank; for what must be verified, act bravely. Formulation has a sequence of priority; selection has degrees of weight. Principles are clear, each having its norm, allowing no hair's breadth of error.
Diseases originate from a root, follow a transmission, and involve overcoming relationships. These are unusual syndromes and signs of labor injury. Labor injury begins with the deficiency of the Dan Yuan (Elixir Field) and Marrow Sea. Thus, true diseases always start in the Kidney. Water overcomes Fire, so it transmits to the Heart; Fire overcomes Metal, so it transmits to the Lung; Metal overcomes Wood, so it transmits to the Liver; Wood overcomes Earth, so it transmits to the Spleen. The five Zang organs transmit to each other, five Qi extinguish each other, five Spirits dissipate, Ying blood becomes stagnant, and Wei Qi departs. The treatment of Jing Shen (Spirit) and Ying-Wei originates in the Kidney. Before transmission reaches the Heart, if one administers medicine for Kidney pathology, the Qi naturally damages itself. One should treat the Kidney before it transmits to the Heart, attacking the "ghost" (pathogen) and cutting off the root. Then treat the Heart to drive out evil and protect Heart Qi. When transmitting to the Lung, symptoms include sticky saliva and phlegm, wheezing, and coughing. Treat the Heart first to attack the evil and cut off the transmission trend. Once Fire evil is extinguished, even before Lung medicine is administered, most wheezing and coughing will cease. Then treat the Lung to resolve evil and protect Metal Qi. Finally, treat the Kidney to clear the organ and restore True Qi. If left untreated until it transmits to the Liver, resulting in flaccidity and bi-syndrome where the patient is bedridden, treatment is futile. This process involves examining the root, determining transmission, and assessing overcoming relationships.
If the five Zang organs are warm and mild, where do diseases come from? Improper nourishment leads to pathological changes. Although hundred diseases arise with thousands of transformations, their ultimate歸归 (return) is limited to Cold, Heat, Warmth, and Coolness. Cold should not be treated with Warmth; this is called "Insufficiency." Treating Coolness with Heat is called "Excess." Insufficiency means the disease cannot be eliminated; Excess means it damages True Qi. Cold is treated with Heat; Chill is treated with Warmth. With appropriate weight and controlled speed, without the slightest error, the treated disease is completely cured. This is distinguishing Cold, Heat, Warmth, and Coolness.
It is said: When fierce winds enter the forest, dry branches break first; when heavy rain breaks the dam, cracks fail first. Thus, the Eight Evils (Pathogens) infect humans by entering through gaps. Diseases must be distinguished by internal/external and upper/lower. Wheezing, coughing, solid phlegm in the chest, tidal saliva, endangering life—these are diseases in the Upper Jiao. Flaccid legs and knees, weak walking, heavy waist and hips—these are diseases in the Lower Jiao. Arising from skin and hair, affecting sinews and bones, sudden cold invasion, indigestion, sudden heat toxin attack, constipation—these vary by cold/heat and are diseases in the Interior.
For diseases in the Upper, use emesis to bring peace; if emesis is contraindicated, use slow regulation. For diseases in the Lower, use tonification to heal; if tonification is contraindicated, use rapid regulation. For diseases in the Exterior, use acupuncture, moxibustion, or sweating according to suitability. For diseases in the Interior, use attack, tonification, or purgation according to cold/heat. With methods for treatment and rules for differentiation, why worry about the lack of efficacy of prescribed medicines? This is distinguishing upper/lower and internal/external.
Five flavors please the mouth, five colors blind the eyes. Endless desires, unceasing greed, and recurring worries damage Jing Shen (Spirit) and destroy the root. Humans inevitably have Deficiency and Excess. Excess is surplus; Deficiency is lack. Surplus is drained; lack is tonified. Within tonification and drainage, there is further distinction between internal and external. For form deficiency, warm with Qi; for essence deficiency, tonify with Flavor. Inside the Zang-Fu organs, excess is cleared with herbs; outside in the limbs and joints, excess is drained with acupuncture and stone needles. This is the difference in tonification and drainage, i.e., distinguishing Deficiency and Excess.
Ancient people lived past a hundred years without physical decline. Modern people decline before fifty. This is not because Heaven favors ancients and punishes moderns. Ancients knew the art of nourishment; desires did not tire their eyes, licentiousness did not confuse their minds. Blood and Qi were harmonious, Spirit was preserved internally, so they lived past a hundred without decline. Their True Essence was intact, and pathogens could not overcome them. Modern people do not know the art of nourishment; they pursue mental pleasure against the joy of life. Blood and Qi wither, Spirit dissipates. Disease is passed from generation to generation. Qi is deficient, body is emaciated. Within breaths, hundred diseases gather in the Zang-Fu organs. This is due to Jing deficiency and Shen lack, allowing external pathogens to interfere with Yin-Yang Zheng Qi (Upright Qi).
Skilled physicians preserve True Essence and eliminate pathogens, ensuring excessive medicines do not harm True Essence. This is distinguishing True vs. Pathogenic. Even blockage, emptiness, and weakness are known even to children. Internal diseases are treated with herbs; external diseases with acupuncture. For urgent conditions where herbal efficacy is slow, consider cases where moxibustion is indicated. For example, Yin-Du Cold Damage (Yin Toxin Cold Injury) presents with cold limbs, blue face, black lips, and unconsciousness. Urgently apply moxibustion to Qihai (CV6). Ten-plus moxa cones restore Spirit and Qi. In summer, cooling excessively, drinking cold water, indulging in sex leads to extreme Jing deficiency and strong Yin evil. Yin-Yang struggle, Yin prevails, guarding the lower origin. Yang is weak, attacking the head and neck. Feet are cold as snow, limbs cold, pulse deep. Only intense heat and unbearable pain remain. Acupuncture is useless here; urgently moxa Qihai. Dozens of cones cause cold drinks to pass downward, limbs warm up, and Yin-Yang reconnect. For cold-hot abscesses, red/painful or hard/painless, apply wet paper to find the first dry spot and moxa. Up to 100+ cones. For cold swelling without dry spots, moxa the center of the swelling up to 100 cones, adjusting based on body thickness. If moxa causes no pain, stop when pain is felt. After consuming Realgar (or similar mineral drugs like Sulfur), caution is needed.
For diseases treatable by sweating, purging, acupuncture, or moxibustion, order and weight must be correct. Why worry about non-recovery? Alas! Heaven and Earth have no perfect function; Sages have no omnipotence. Even Huangdi and Qibo acknowledged untreatable diseases. If a condition is unusual, unclear, or unknown, leave it untreated without shame. If the disease is severe and the patient critical, and the physician understands the principle and details, they must not hesitate. Use toxic drugs and verify with acupuncture to save life from death. This requires divine wisdom; fools doing so are like murderers wielding knives. This is leaving blanks for ignorance and acting bravely for verification. Rules must not be violated.
Some diseases do not follow Five Element transmission. Cold congestion interacting, Yin-Yang hiding, appearing hot but actually cold, appearing cold but actually hot, two colds and two heats attacking, excess and deficiency hindering each other. These create major suffering. Example: Lung has excess heat, but exposure to wind/rain/cold causes Cold Evil to lodge in the Lung Meridian. Cold and Heat interact causing cough. Cooling herbs aid Cold; warming herbs aggravate Heat. Neither works. Formula: Qiang Huo (Notopterygii Rhizoma et Radix), Huang Ju Pi (Citri Reticulatae Pericarpium), Ma Huang (Ephedrae Herba - remove roots), Zi Wan (Asteris Radix), Xing Ren (Armeniacae Semen Amarum - remove skins/tips), Xi Xin (Asari Radix), Du Huo (Angelicae Pubescentis Radix), Fang Feng (Saposhnikoviae Radix), Jie Geng (Platycodonis Radix). Powder form, 2 qian per dose, mixed with boiling water, taken on an empty stomach. Cough stops in a few doses. This lightly resolves Cold Evil, using the empty stomach to guide Cold Qi out via the Stomach. This treats Cold-Heat interaction.
Another case: Fundamental excess heat in Zang-Fu, exposed to summer heat, suddenly entering cool places, drinking cold water. Cold wins, fearing Heat. Yin-Yang hide. Yin solidifies, Yang stagnates. A lump forms in the chest, named "Fu Shu" (Hidden Summerheat). Symptoms: chills, irritability, resembling Cold Damage but pulse not rapid. Physicians wrongly use purgatives, exhausting Fu essence, making the chest lump harder. Purgatives aided Cold/Yin. Treatment: Chuan Xiong (Ligustici Chuanxiong Rhizoma), Xi Xin (Asari Radix), Huo Xiang (Agastaches Herba), Huang Ju Pi (Citri Reticulatae Pericarpium). Powder, 2 qian, decocted in one cup of water to 70%. Taken on an empty stomach. Resolves Cold Qi; the lump dissipates quickly. Then check pulse, assess Summerheat toxicity, and prescribe accordingly. This treats Yin-Yang hiding.
Diseases appearing hot but actually cold: Postpartum syndrome. Five Zang accumulate cold, Yin prevails. Milk flows excessively without cause. Dry mouth/throat, thirst at irregular times, dizziness, reduced appetite, empty intestines/stomach, emaciation. Desire to defecate but inability to do so. Inexperienced physicians see dry mouth/thirst as Upper Jiao Heat; dizziness as Blood Heat generating Wind; constipation as Large Intestine dryness. They miss that excessive milk flow indicates dryness/heat from deficiency; dizziness/emaciation indicates Qi/Blood deficiency and insufficient transport. Misdiagnosing as Heat and giving Cold herbs kills instantly.
Diseases appearing cold but actually hot: Strong men indulging in lust, taking tonic herbs, seeking sexual pleasure while confused. Heat herbs attack, Ying-Wei stagnate. Upper Qi excess, Lower Qi deficiency. Qi does not connect. Legs/knees weak, feet cold, occasional chills, dark/emaciated body, reduced appetite, nausea with salty food. Physicians diagnose Zang-Fu deficiency and give Warming herbs, like adding wood to fire. Instead, use Cooling herbs to benefit the Lung, scatter toxic heat rising. Once Ying-Wei circulate, Yin-Yang reconnect, hands/feet warm, legs recover. This is appearing cold but actually hot.
Year of Excess Yang brings drought; Year of Excess Yin brings floods. Deficiency generates Cold, Excess generates Heat. Zang-Fu experience conflicting Cold and Heat. Yang Du (Yang Toxin) in Cold Damage is an example. Lust destroys life foundation. People, deluded, take toxic heat herbs hoping for survival. Dan Yuan/Marrow Sea empty, yet Zang-Fu bone cavities have increasing deficiency heat. Excess and deficiency hinder each other. Example: Constipation (5-10 days), frequent urination (50-60 times/day), small amount of urine, clear as water but sometimes yellow, painful urination, irritability. This is Liver/Heart/Spleen/Lung Toxic Heat Excess, while Kidney/Small Intestine Qi is deficient. Spleen/Lung/Heart heat causes dry intestines; Kidney/Small Intestine deficiency causes slippery waterways. Liver/Heart heat causes boiling blood/dark blood. Toxic heat smoke settles in Middle Jiao. Due to Small Intestine deficiency, water flows only through the Small Intestine. Urine is clear but painful, resembling Lin Syndrome (Strangury) but is not. Physicians giving Warming herbs to secure Small Intestine nourish Liver/Heart heat, worsening pain. Giving Cooling herbs to purge Large Intestine sends medicine only through the Small Intestine, worsening disease. Cold/Hot herbs both fail due to Excess/Deficiency hindrance.
Treatment: Use Qi-moving decoction to wash the anus (Gu Dao). Guide Zang Qi to Stomach. Second time, induce bowel movement, moving gas/feces to Large Intestine, remaining water follows. Urination stops without Small Intestine medicine. Gradually use medicine to open Liver/Heart, expel toxic heat via stool. Stool resembles half-rotten matter/blood stasis. Root is reduced. Medicines are in the formula. This treats Excess/Deficiency hindrance.
Alas! Medical arts are like a forest; my knowledge is but a sprout. Medical Dao is like the sea; my knowledge is but a drop. Though I have little merit, my effort is sincere, unlike mere words of ancients. I list a few points to clarify the general outline of the medical Dao.