势急难施缓治，邪实重剂相当，理中承气斡旋分，用者验如神应。峻治之法，死生所系
，应
善用其法，可谓上工也矣。又患似伤寒，应汗不汗，其势不解，心中烦躁不安，势已极矣。
宜大剂补中益气，加麻黄、姜、附，一服即解。此皆峻治之一法也。
初验难分真伪，欲施攻补狐疑，全凭一探实和虚，此是医家妙计。凡治病，内外不辨，
又虚实不分，妄施药物，服之不能保其无失。医家通活变者，临证察脉之时，问前医所用何药，
作何调理，若果能见其实有失处，我则对证施治，必无不治。（王胥山曰∶前医用药未效，
后之接手者多务翻案以求胜之，久寒则用热，久热则用寒，久泻则用补，久补则用泻，以为
讨巧出奇之计。然而脉与因故在也，苟据脉审因，
确见前医识力未到，自当改弦易辙，以正其误，若不据脉审因，而妄生歧论，只图求异于前人而网其利，
竟置病患吉凶于度外，其居心不可问矣。）嗟乎！惟有初治之时最难，虚实两途，犹豫未决。
（张东扶曰∶古人知其难而难之，今人知其难而易之，亦并不知其难也。冤哉！）知机者，用
意调和，如按琴瑟，药中则气和，自然之理。但实可受寒，虚可受热，攻补之诀，在其中矣
实虚相杂损元阳，攻补兼施细酌量，先理脾家为切要，气行无滞补何妨。兼治之法，攻
补并
泻，或腹痛，或胸胁满闷。怒气挟食伤肝，皆损中气，虽兼内外劳伤，头痛发热，务以调理
脾胃为先。凡治吐泻腹痛满闷等证，先用温补，加香砂辛热之味，使诸证平复，而脾气营运
，再用纯补之药，以俟汗解而愈。古云∶气滞物伤，补益兼行消导，此之谓也。
病情危急难以采用缓和的治疗，邪气实盛需用重剂来对应，通过理中汤和承气汤来斡旋调理、分清虚实，使用得当效果灵验如神。峻猛治疗的方法，关系到病人的生死存亡，应当善于运用这种治法，可以称为高明的医生了。又有患病症状类似伤寒，应当发汗却未发汗，病势没有解除，心中烦躁不安，病情已经非常严重了。适宜用大剂量的补中益气汤，加入麻黄、生姜、附子，服用一次即可缓解。这都属于峻猛治疗的一种方法。
初次诊断难以分辨病情的真伪，想要实施攻法或补法时犹豫不决，完全依靠仔细诊察以确认是实证还是虚证，这是医家的巧妙策略。凡是治病，如果不辨别内外病因，又不区分虚实性质，胡乱用药，服药后不能保证不出差错。精通灵活变通的医家，在临证诊脉时，会询问之前的医生使用了什么药物，做了怎样的调理，如果确实发现前医有失误之处，我就针对病症进行治疗，必定没有治不好的。（王胥山说：前医用药无效，接手治疗的医生大多致力于推翻前案以求胜过前人，久寒就用热药，久热就用寒药，久泻就用补药，久补就用泻药，以此作为讨巧出奇的手段。然而脉象和病因依然存在，如果依据脉象审察病因，确见前医见识能力不足，自然应当改变治疗方法以纠正错误；如果不依据脉象审察病因，而凭空产生不同的议论，只图与前人不同以谋取利益，竟然置病人的吉凶于度外，其用心就不可问了。）唉！只有最初治疗的时候最难，面对虚实两条路径，犹豫不决。（张东扶说：古人知道难而谨慎对待，今人知道难却轻视它，甚至根本不知道它的难处。真是冤枉啊！）懂得把握时机的人，用心调和，就像弹奏琴瑟一样，药物对症则气血平和，这是自然的道理。但实证可以耐受寒凉，虚证可以耐受温热，攻法和补法的诀窍，就在这里面了。
虚实夹杂损伤元阳，攻法和补法同时施用时需仔细斟酌，先调理脾胃最为关键，只要气机运行通畅无阻滞，补益又有什么妨碍呢？兼治的方法，攻法和补法并用，或者出现腹痛，或者胸胁部满闷。怒气挟带饮食积滞损伤肝脏，都会损害中气，虽然兼有内伤和外感劳损，出现头痛发热等症状，务必以调理脾胃为先。凡是治疗呕吐、腹泻、腹痛、满闷等证候，先用温补的药物，加入香附、砂仁等辛热的味道，使各种证候平复，脾气得以运化，然后再用纯补的药物，等待出汗而痊愈。古话说：气滞物伤，补益的同时兼用消导之法，说的就是这个道理。
When the condition is urgent and difficult to treat with mild methods, heavy doses are required to match the excess pathogenic factors. Utilizing Lizhong Tang (Regulate the Middle Decoction) and Chengqi Tang (Descend the Qi Decoction) to mediate and differentiate between excess and deficiency, when applied correctly, yields miraculous results. The method of峻治 (Jun Zhi, vigorous/intensive treatment) determines life or death; one who masters its application can be considered a superior physician (Shang Gong). Furthermore, in cases resembling Shaoyang disease (Taiyang disease) where sweating should have been induced but was not, and the condition remains unresolved with severe restlessness and irritability in the chest, the situation is critical. It is appropriate to use a large dose of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), added with Ephedrae Herba (Mahuang, 麻黄), Zingiberis Rhizoma Recens (Jiangsheng, 生姜), and Aconiti Lateralis Radix Preparata (Fuzi, 附子); relief may occur after a single dose. This constitutes one method of vigorous treatment.
Initial assessment often makes it difficult to distinguish truth from falsehood, leading to hesitation between using purgative (Gong) or tonifying (Bu) methods. Relying entirely on careful palpation to ascertain whether the pattern is Excess (Shi) or Deficiency (Xu) is the subtle strategy of a skilled physician. In treating any illness, if internal and external causes are not differentiated, and Excess and Deficiency are not distinguished, arbitrary administration of drugs cannot guarantee the absence of adverse effects. Physicians who are adept at flexible adaptation, when examining the pulse, inquire about the medications and regimens used by previous doctors. If they indeed identify errors in the previous treatment, they will prescribe according to the current syndrome, ensuring success. (Wang Xushan stated: When previous prescriptions fail, succeeding physicians often seek to overturn the previous case to demonstrate superiority, applying hot remedies for chronic cold, cold remedies for chronic heat, tonics for chronic diarrhea, and purgatives for chronic over-tonification, as a clever tactic. However, the pulse and etiology remain. If one examines the pulse and investigates the cause, confirming the previous physician's lack of insight, one ought to change course to correct the error. If, without examining the pulse and cause, one fabricates divergent theories merely to differ from predecessors for personal gain, disregarding the patient's prognosis, their intentions are questionable.) Alas! The initial treatment is the most difficult, as one hesitates between the paths of Excess and Deficiency. (Zhang Dongfu said: The ancients knew it was difficult and treated it with caution; moderns know it is difficult yet treat it lightly, or do not even recognize its difficulty. How unjust!) Those who understand the timing harmonize with intention, like tuning a lute or zither; when the medicine matches the syndrome, the Qi and Blood become peaceful, which is the natural law. Although Excess patterns can tolerate Cold, and Deficiency patterns can tolerate Heat, the secret of employing purgatives and tonics lies herein.
When Excess and Deficiency are mixed, the Yuan Yang (Primal Yang) is damaged; when employing both purgative and tonifying methods, careful deliberation is required. Regulating the Spleen and Stomach first is paramount; as long as Qi flows without stagnation, what harm is there in tonification? The method of combined treatment involves using both purgative and tonifying actions simultaneously, presenting symptoms such as abdominal pain or fullness and oppression in the chest and hypochondrium. Anger combined with food stagnation injures the Liver, all damaging the Middle Qi. Even if there are concurrent internal injuries and external exhaustion manifesting as headache and fever, regulating the Spleen and Stomach must be the priority. For conditions such as vomiting, diarrhea, abdominal pain, and fullness, initially use warm tonification, adding aromatic and acrid-hot herbs such as Cyperi Rhizoma (Xiangfu, 香附) and Amomi Fructus (Sharen, 砂仁), until the symptoms subside and the Spleen Qi functions normally. Subsequently, use pure tonifying medicines, awaiting resolution through sweating. As the ancients said: When Qi stagnation and material injury coexist, tonification should be combined with digestion-promoting methods; this is what is meant.