食塞胃中气不调，越因越用法为高，若然反出因无火，温补中宫积自消。凡饮食不匀，
有伤
升降，心下泛泛然，或兼恼怒，则郁闷难舒，一吐即愈。皆越因越用之法也。若食入反出，
王太仆云∶是无火也。内必兼寒兼积，法宜温补中宫，用理中汤去甘草，加乌梅、生姜、消
痰之药。（钱本多枳壳一味。）此则越法之内，而兼调中之意者也。
治法中间有四应，四应得法可回生，汗温吐下应无失，失却相应命不存。治病之法有四
，汗、温、吐、下，乃医家之准绳也。应汗不汗，失也；汗之不汗，天气不通矣。应温不温，失
也；温之不温，阳气脱矣。（王胥山曰∶虚不受补也。）应吐不吐，失也；吐之不吐，胃气竭
矣。应下不下，失也；下之不下，地道不行矣。凡用汗、温、吐、下之药而病仍不应，俱死
兆也。故曰∶顺之则生，逆之则死。
医家临证要分明，察色观识死生，腹痛按知虚与实，还凭验舌听声音。诸证先观形色，
次察声音。经云∶色之与脉，当相参应。五色有四季之分，惟土为正色，色中见黄，脉中见缓，
乃为有胃气。黄为土色，土位中央、五色之中，稍带微黄，方为佳色。色不可红，色纯红者
，真脏色见也，见则死矣。（王胥山曰∶色纯红者，乃阳气外越之征，故见则必死。真脏色见
者亦必死，然真脏色青、黄、白、黑皆有之，不仅红色一种。）故真脏色不见，知其尚非死
征。若脉气带缓，面色带黄，知其胃气未败，未必死也。目者，一身之精华所萃，色藏于内
而发见于外，有神则精明光彩，黑白如常；实则阳光灿烂，虚则阴翳朦胧，若失其神，则昏
昧不明，远近不辨。再察其脉神，存否如何？或两神俱失，决死无疑矣。舌者，心之苗也，
红为热，白苔为寒，色紫者，心火亢极而实热也。再察其脉，果系有余，法宜急下之。舌黑
色者，热极而无生意也。色黄兼下利，而唇口碎裂，是为水涸，非实热，乃假热也。由肾之
真阳虚极不能化生津液，理宜大剂温补，稍带甘寒，使金水相生，则燥解而生可回。若用纯
凉，反泻真阳，其死决矣。又凡舌短兼囊缩，脉有力为热，脉虚为寒，则死无惑焉。声音从
丹田中出，其音嘹亮，则有神矣。若含糊声嘶者，痰火盛也；前重后轻者虚也；前轻后重者
实也；出言骂詈，其声雄壮者，胃热也；病重失音，死证也；病患不语，虚之甚也，能语则
病方愈；谵语郑声，及呻吟者，皆阴虚中不守，非佳兆也。诊其脉，有神可生，无神者死。
喘息者痰也，治当清金降火。如不效，据脉审因，宜从温补，肾温火降，喘必缓矣。（若兼
外感，亦应发散。）按腹之法，所以验虚实也。按之不痛者虚也，诊其脉果不足，身虽发热
，理宜温补；按之痛者实也，脉果有力，宜急下之，方愈。
人之天庭倾倒，死证也。盖天庭为阳，阳不升，则阴不生；有形之体属阴，阴不生，则
形亦坏不存，故知其为死证无疑矣。
诗曰∶行医不识气，治法将何据？堪笑道中人，未有知音处。见痰莫治痰，见热莫攻热
，喘生休耗气，见血不清血，无汗勿发汗，遗精莫补涩。明得个中机，便是医中杰。
食物停滞在胃中导致气机不调，治疗应遵循“因势利导”的原则，采用涌吐法为最佳策略。如果进食后反而呕吐出来，这是因为体内缺乏阳气（火），此时应当温补中焦脾胃，积滞自然消除。凡是饮食不规律，损伤了人体气机的升降功能，感到心下（胃脘部）泛泛不适，或者伴有恼怒情绪，导致郁闷难以舒展，通过催吐即可痊愈。这些都是运用“因势利导”治法的体现。如果是食入即吐，王冰（王太仆）说：这是无火的表现。内部必然兼有寒邪和积滞，治法适宜温补中焦脾胃，使用理中汤去掉甘草，加入乌梅、生姜以及化痰的药物。（钱乙版本多了一味枳壳。）这属于“因势利导”法之内，同时兼顾调理中焦的意思。
治疗方法中有四种对应的原则，掌握了这四种对应方法可以起死回生。汗法、温法、吐法、下法应当准确无误地应用，如果失去了相应的对应关系，生命就无法保全。治病的方法主要有四种：汗、温、吐、下，这是医家的准则。应当用汗法而不用汗法，是失误；用了汗法却不出汗，说明天气（指体表卫气或外邪闭郁）不通畅。应当用温法而不用温法，是失误；用了温法却不见效，说明阳气已经脱失。（王胥山说：虚证不能承受峻补。）应当用吐法而不用吐法，是失误；用了吐法却吐不出来，说明胃气已经枯竭。应当用下法而不用下法，是失误；用了下法却不下行，说明肠道传导功能不行。凡是使用了汗、温、吐、下的药物而病情仍然没有反应，都是死亡的征兆。所以说：顺应病势则生，违背病势则死。
医生临证时要分辨清楚，观察面色和神色以判断生死，按压腹部疼痛可知虚实，还要依靠验舌和听声音来诊断。各种病症先观察形色，其次察听声音。经书说：面色与脉象，应当相互参照印证。五色对应四季的划分，只有黄色属土为正色，面色中见到黄色，脉象中见到缓脉，才是有胃气的表现。黄色是土的颜色，土位居中央，在五色之中，稍微带有微黄，才是好的颜色。面色不可过红，面色纯红的，是真脏色显现，出现这种情况就会死亡。（王胥山说：面色纯红，是阳气外越的征象，所以出现就必定死亡。真脏色显现也必定死亡，然而真脏色青、黄、白、黑都有，不仅仅是红色一种。）所以只要不见真脏色，就知道还不是死亡的征兆。如果脉气带有缓象，面色带有黄色，就知道胃气尚未败坏，未必会死。眼睛是一身精华汇聚的地方，神气藏于内而发见于外，有神则目光精明光彩，黑白分明如常；实证则阳光灿烂，虚证则阴翳朦胧，如果失去神气，则昏昧不明，无法分辨远近。再察看病人的脉神，是否存在？如果眼神和脉神都丧失了，决定死亡无疑了。舌头是心的苗窍，舌红表示热，白苔表示寒，舌色紫的，是心火亢盛至极且属实热。再察其脉象，果真是有余之脉，治法应当紧急攻下。舌黑色的，表示热极而没有生机。舌色黄兼有大便泄泻，且嘴唇口角破裂，这是津液枯竭，不是实热，而是假热。由于肾的真阳极度虚弱不能化生津液，理应使用大剂量的温补药，稍加甘寒药物，使肺金和肾水相生，那么燥热解除而生命可挽回。如果使用纯凉药，反而泻掉真阳，死亡是必然的。另外，凡是舌短缩兼有阴囊收缩，脉有力的是热证，脉虚的是寒证，这就毫无疑问是死证。声音从丹田发出，声音嘹亮，就是有神的体现。如果声音含糊嘶哑，是痰火旺盛；前重后轻的是虚证；前轻后重的是实证；说话骂人，声音雄壮的，是胃热；病重失音，是死证；病人不说话，是虚损非常严重，能说话则病才可能痊愈；胡言乱语（谵语）、语言重复无力（郑声）以及呻吟，都是阴虚中气不守，不是好兆头。诊察其脉象，有神则可生，无神则死。喘息是由于痰浊，治疗应当清肺降火。如果无效，根据脉象审察病因，适宜从温补入手，肾气温煦则火降，喘息必然缓解。（如果兼有外感，也应当发散解表。）按压腹部的方法，是用来验证虚实的。按压不痛的属于虚证，诊察脉象果然不足，身体虽然发热，理应温补；按压痛的属于实证，脉象果然有力，应当紧急攻下，才能痊愈。
人的天庭部位塌陷倾倒，是死证。因为天庭属阳，阳气不升，则阴气不生；有形的躯体属阴，阴气不生，则形体也会败坏不存在，所以知道它是死证无疑了。
诗中说：行医如果不认识气机，治疗方法将依据什么？可笑那些行医中人，没有知音之处。见到痰不要只治痰，见到热不要只攻热，喘息产生不要耗伤正气，见到出血不要只清热止血，没有汗不要强行发汗，遗精不要只补涩收敛。明白其中的机理，就是医学中的豪杰。
Food stagnation in the stomach leads to disharmony of Qi mechanism. The treatment should follow the principle of "guiding according to the trend," employing emesis (inducing vomiting) as the optimal strategy. If food is vomited out immediately after ingestion, it indicates a lack of Yang fire (Yang Qi). In this case, warming and tonifying the Middle Jiao (Spleen and Stomach) is appropriate, and the accumulation will naturally dissipate. Whenever irregular diet damages the ascending and descending functions of Qi, causing a sensation of nausea or discomfort in the epigastrium (heart below), possibly accompanied by anger leading to stifled depression, recovery can be achieved through emesis. These are all applications of the method of "guiding according to the trend." If vomiting occurs immediately after eating, Wang Bing (Wang Taipu) stated: this is due to the absence of Fire. Internally, there must be concomitant Cold and accumulation. The treatment should focus on warming and tonifying the Middle Jiao, using Lizhong Tang (Regulate the Middle Decoction) with Licorice removed, adding Mume Fructus (Wumei), Fresh Ginger (Shengjiang), and phlegm-resolving herbs. (The Qian Ben version includes an additional herb, Aurantium Fructus (Zhike).) This belongs to the method of "guiding according to the trend" while simultaneously incorporating the intent of regulating the Middle Jiao.
There are four corresponding principles among treatment methods; mastering these correspondences can restore life. Diaphoresis (sweating), Warming, Emesis, and Purgation (draining down) must be applied accurately without error. If these correspondences are lost, life cannot be preserved. There are four main methods for treating diseases: diaphoresis, warming, emesis, and purgation; these are the standards for physicians. Failing to use diaphoresis when indicated is an error; if diaphoresis fails to induce sweating, it indicates that the Wei Qi (Defensive Qi) or external pathogens are obstructed. Failing to use warming when indicated is an error; if warming fails to take effect, it indicates that Yang Qi has collapsed. (Wang Xushan said: Deficiency patterns cannot tolerate harsh tonification.) Failing to use emesis when indicated is an error; if emesis fails to expel contents, it indicates that Stomach Qi has exhausted. Failing to use purgation when indicated is an error; if purgation fails to promote bowel movement, it indicates that the intestinal transmission function is blocked. Whenever diaphoretic, warming, emetic, or purgative herbs are used but the condition remains unresponsive, these are omens of death. Therefore, it is said: following the disease trend leads to survival, opposing it leads to death.
Physicians must be clear during clinical practice, observing complexion and spirit to determine life and death, pressing the abdomen to distinguish deficiency and excess, and relying on tongue inspection and auscultation/olfaction of voice. For various syndromes, first observe form and color, then inspect sound. The Classics state: complexion and pulse should be examined in conjunction. The Five Colors correspond to the Four Seasons, with Yellow belonging to Earth being the correct color. If Yellow appears in the complexion and a Moderate pulse (Huan Mai) appears in the pulse, it indicates the presence of Stomach Qi. Yellow is the color of Earth; Earth resides in the center and among the five colors. A slight hint of yellow is considered a good complexion. Complexion should not be overly red; a purely red complexion indicates the manifestation of the True Zang Color (True Organ Color), which signifies death. (Wang Xushan said: A purely red complexion is a sign of Yang Qi floating outward, so its appearance inevitably leads to death. The manifestation of True Zang Color also inevitably leads to death; however, True Zang Colors include Green, Yellow, White, and Black, not just Red.) Therefore, as long as the True Zang Color does not appear, one knows it is not yet a sign of death. If the pulse energy carries a moderate quality and the complexion shows a hint of yellow, one knows that Stomach Qi has not failed, and death is not certain. The eyes are the gathering place of the essence of the whole body. Spirit is stored internally and manifested externally; with spirit, the gaze is bright and clear, with normal white and black sclerae; in Excess patterns, the eyes shine brightly; in Deficiency patterns, they appear hazy and dim. If spirit is lost, vision becomes dull and unclear, unable to distinguish near from far. Further inspect the Pulse Spirit (Mai Shen); does it exist? If both eye spirit and pulse spirit are lost, death is undoubtedly decided. The tongue is the sprout of the Heart. Redness indicates Heat; white coating indicates Cold; purple color indicates extreme Hyperactivity of Heart Fire and Excess Heat. Inspect the pulse again; if it is indeed a surplus pulse, the treatment should urgently employ purgation. A black tongue indicates extreme Heat with no vitality. A yellow tongue combined with diarrhea and cracked lips/mouth indicates exhaustion of fluids (Water Drying Up); this is not Excess Heat but False Heat. Due to extreme deficiency of Kidney True Yang failing to transform and generate body fluids, large doses of warming and tonifying herbs are appropriate, slightly mixed with sweet-cold herbs to promote the generation of Metal (Lung) and Water (Kidney), thereby resolving dryness and restoring life. Using purely cooling herbs would instead drain True Yang, leading inevitably to death. Furthermore, short tongue combined with retraction of the scrotum: if the pulse is forceful, it is Heat; if the pulse is deficient, it is Cold; in either case, it is undoubtedly a death sign. Voice originates from the Dantian; a loud and clear voice indicates Spirit. Muffled or hoarse voice indicates Phlegm-Fire abundance; heavy at the beginning and light at the end indicates Deficiency; light at the beginning and heavy at the end indicates Excess. Cursing speech with a strong voice indicates Stomach Heat. Loss of voice in severe illness is a death sign. Silence in the patient indicates extreme Deficiency; ability to speak suggests the disease may resolve. Delirious speech (Zhenyu), repetitive weak speech (Zhengsheng), and moaning all indicate Yin Deficiency with internal instability, which are not auspicious signs. Diagnosing the pulse: if there is Spirit, survival is possible; if there is no Spirit, death ensues. Panting is due to Phlegm; treatment should clear the Lungs and descend Fire. If ineffective, examine the cause based on the pulse, and warming and tonifying should be adopted; warming the Kidney and descending Fire will alleviate panting. (If accompanied by external contraction, dispersing methods should also be used.) Abdominal palpation is used to verify deficiency and excess. Non-tenderness upon pressure indicates Deficiency; if the pulse is indeed insufficient, despite fever, warming and tonifying are appropriate. Tenderness upon pressure indicates Excess; if the pulse is indeed forceful, urgent purgation is required for recovery.
A sunken or collapsing Forehead (Tianting) is a death sign. Because Tianting belongs to Yang, if Yang does not ascend, Yin cannot generate; the有形 (form-based) body belongs to Yin; if Yin does not generate, the form will deteriorate and cease to exist, thus confirming it as a death sign.
The poem states: If practicing medicine without understanding Qi, what basis will treatment methods have? It is laughable for those within the profession to lack true understanding. Do not treat Phlegm merely when Phlegm is seen; do not attack Heat merely when Heat is seen; do not deplete Qi when Panting arises; do not clear blood merely when Bleeding is seen; do not induce sweating when there is no sweat; do not use astringents merely for Spermatorrhea. Understanding the mechanism within is to become a hero among physicians.