凡有热病，喜热饮食，睡卧不得，衣被不可近者，俱是阳虚之病。（炳章按∶此亦未可
为的据，凡胸有痰饮者，多喜热饮，若误认阳虚而用热药，久必受其害。）
凡泄泻、肠风等证，小肠薄，不能传送，故渗入于大肠。
凡干燥等证，大肠虚，不能润泽，故涩滞而难出。
脾虚食不磨，有宿食则酸，胃虚饮不消，有宿饮则嘈。
脾实，食消肌滑，脾虚，体瘦，四肢不举。
汗至颈而还者，阳不发越；至脐而还者，阳气将动；至足者，阳气周流一身，病将自愈
肺病则周身不摄，脾病则四肢不举。
凡浑身胀痛，俱属阴分血亏，大热亦属血分。微寒微热，或有热不退者，汗至颈而还者
是气分。气分宜补中益气汤，见证加减；血分宜芎归汤加肉桂，或四物汤，加麻黄肉桂。胸
中胀满，四物汤加苏梗。
口不知味，有实热者，有虚热者。口不知谷味，中虚可知。盖谷气入脾胃，中气赖以养
不喜非不足而何？二者各自不同，中气实则空，空则上通下达；中气虚则实，实则痰凝气滞
如扑打损伤，服破血药，不得去者，必成中满，其毒瓦斯入脾故也。
凡有表证，俱属里虚。（王胥山曰∶此即邪实皆由本虚之义，盖示学人治病，不可不求
其本
说，为节印板注脚，大失周氏立言救世之一片婆心，且使不学无术之庸人得起而议其非矣。
炳章按∶此说究竟非是，果系里虚即当用补，岂有以补愈表证乎？即补中益气之法，原非为
外感而设，于此误认受害不浅，王胥山先生虽曲为之说以时会之，不足以掩其失也。）
自热，蒸蒸发热，似烦非烦，补中益气汤。寒热似疟，补中益气汤加二陈。微寒微热，
阴中之阳虚，宜补上焦，八珍汤加黄 。如胸膈不宽，加入痰药。自汗微热，阳中之阴虚，
八珍汤加肉桂。如腹中痛，加干姜、吴茱萸。
寒热似疟，表之阳虚也。表阳者，即剽悍之胃气，升于巅顶，浮于皮毛者也。升浮之气
，无时或息。胃气虚，则有时不能升浮，郁于半表半里，外与太阳争则寒，内与阳明争则热
，补而升发之，何寒热之有？久而不治，则胃气之升渐少，升少则阳微而恶寒，升少则降亦
少，降少则血少而发热，宜八珍汤、十全大补汤治之。微寒者，阳虚也。微热者，阴无从生
，虚阳无附耳，八珍阴阳并补，加黄 则补阳之功居多。自汗虽属阳虚，然津液少，则阴益
虚，故发微热，八珍加肉桂，则补阴之功居多。
凡读书人，精神恍惚，汗出不睡，或泄泻，或多痰，病虽不一，要之皆发于心脾。盖思
虑多则心火乘脾，君不主令，相火用事，倘不清其源，正其本，阳气愈陷，病气愈盛，归脾
汤之类，是为对证。（张东扶曰∶心火乘脾，脾阴受亏，宜补脾之阴，不当补脾之阳。凡五
脏相乘，各当察其阴阳，伤阴则补阴，伤阳则补阳，设或阴阳误施，为害不小。炳章按∶此
条不的亦非归脾汤所能治，凡思虑多则心血虚，脾无所受气而亦亏，归脾汤专补脾阳，乌能
治之？薛一瓢治病发心脾，以归脾汤合天王补心丹加减为丸，庶几近之张东扶之注甚精，可
凡人夜间多思，致睡不宁者，淡竹叶、枣仁二味，煎服即安。
凡下焦有病，六味丸可通用。若遇泄泻，其要只在调理脾胃元气，又不可轻用地黄。（
张东扶曰∶地黄能制得极熟，亦不致有坏脾气，大约泄泻者用之，监以山药、茯苓之类，斯
可矣。炳章按∶泄泻者多兼湿，熟地究宜斟酌。）
凡泄泻属脾宜燥，脾恶湿也。属肾宜润，肾恶燥也。肾之泄泻，失闭藏之令，不能收摄
二便也。（王胥山曰∶治泄泻之法，数言已尽，今人但知治脾，不知顾肾，宜其得失相半也
凡治病见证虽多，有吐只宜止吐，有泻只宜止泻。止吐后，须用六君子调理，止泻后，
须用参苓白术散，加木香调理。
凡上焦病，宜开发之；中焦病，宜和之；下焦病，宜达宜缓。
见病医病，医家大忌。盖病有标本，多有本病不见而标病见者，有标本相反不相符者，
若见一证，即医一证，必然有失。惟见一证，而能求其证之所以然，则本可识矣。如头痛发热恶
寒，筋骨疼痛，此外感实证也。然阳虚则恶寒，阴虚则发热，血虚则筋骨枯而多疼痛，胃虚
、肝虚、肾虚，皆有头痛之证。（不是外感实证。）如默默不语，四肢无力，气短身寒，此内
伤虚证也。然胃实脾不运，而默默不语者有之，阴气升腾，阳不得令，而身寒者有之。（不
是内伤虚证。）种种变幻，实似虚，虚似实，外似内，内似外，难以枚举，皆宜细心求其本
也。本必有因，或因寒热，或因食气，或因虚实，或兼时令之旺衰，故治寒者温之，热者清
之，食者消之，气者通之，实者平之，虚者补之，再兼时令之味，而病已矣。（此法当知。）
诸病不愈，必寻到脾胃之中，方无一失。何以言之？脾胃一伤，四脏皆无生气，故疾病
矣。万物从土而生，亦从土而归，补肾不若补脾，此之谓也。治病不愈。寻到脾胃而愈者甚
多。凡见咳嗽自汗，发热，肺虚生痰，不必理痰清热，土旺而痰消热退。四君子，加桂、姜
、陈皮、北五味，后调以参苓白术散。（炳章按∶知本之论，然脾胃之用在升降运化，拨转
气机，尤为要着，未可徒以四君、六君为足尽脾胃之治法也。）
脾胃不足，当责其无阳，亦有阳亢热不退，自汗怕寒，四肢倦怠乏力之证。中虚表热，
或潮热自汗，莫离补中正方。表热加羌活；腹中胀满，加附子、姜、桂、吴茱萸、青皮、神曲之
类；调理，用八珍汤；气血两虚，十全大补汤；阴虚火动，脉洪大而不作泻，六味汤加人参
；恶寒，八珍丸；腹痛，理中丸；虚损，虎潜丸。病证多端，颠倒难明，必从脾胃调理，乃
岐黄之正法也。
诸病有吐泻见证，莫忘脾胃，虽有杂证，以末治之。气短脉有力属实，无力属虚。气脉
俱长者易治，虚损气促者难调，久病不宜脱形。若内伤虚损不足之证，不拘药之多少，宜久服有
效，如药力未至，必不能成功。补中益气汤加附子，无汗加羌活，若自汗发热，保元汤，加
白术、桂、附、归、芍、二陈必愈。凡病日久，阳虚无疑，盖因胃失生发之气，保元甘温退
热之圣药也，舍此而用寒凉，必死无疑矣。虽大便燥结，阳陷于阴分，切勿下之。诸病必寻
到脾胃之中，乃东垣之高见。胃主生发之气，七情六欲，皆足以伤胃。至于不思饮食，十二
经络有一处之滞，则生发之气不行，生发之气不行，四藏皆无生气，病日多矣。医家于气血
、寒热、虚实不辨，忘脾胃而投药石者，十常八九，所以往往害人也。
验案
一人左手寸脉中候微数，重按无力不清，关脉中候沉候皆有力，尺脉沉细有力。右寸中
候涩，重按不见脉，关脉中候若有力，下微不清，尺脉沉数无力。此内伤不足之证，脾肺二经受
病也。治以补中益气汤，使阳得生而阴得长，加盐水炒黄柏二分以救肾，加枣仁一钱以安心
神，小水或热或不利，加远志、莲须各五分以达之。（炳章按∶凡治病未有舍证，而专言脉
者，亦未有舍脉，而专言证者，必脉证合参，乃得其真，此病未知所现何证，据脉则土强木
弱肾水亦亏，何能任升柴之升散，虽有黄柏炒二分，亦不足以救肾。）
一人左寸脉短涩，乃心血不足，关脉微弦无力，左尺沉细。右寸微浮而散，右关按之若
有力，举之不足，重按无力不清，右尺沉而无力。责其无火，宜大补气血，治以十全大补汤。
一人五十八岁，右脉带弦，左脉豁大有力。弦为木脉，见于右手，胃受木克而虚也。左
脉豁大有力，邪火盛也。不治之证。（炳章按∶此未见即为不治之症，特非补中益气所能治耳。）
一妇人年三十，左寸浮大，左关大，左尺洪大，右寸浮大，右关尺俱沉细无力。治方用
山茱萸、白茯苓、生地黄各一钱，泽泻、陈皮各五分，川附子、生甘草各二分，姜枣煎。盖浮与
洪大属火，故壮水以制火，泽泻、白茯苓引火下行。关尺沉细无力，真火不足，故加附子以
一妇人六脉纯阴，或二、三至，或四、五至见歇，此血中之气虚也。四君子加白芍、肉
桂，理脾和肝，山药糊丸。血中之气脾为主，脾土旺则上焦肺气亦足。盖脾为太阴，肺亦太阴，
二阴皆赖阳以生。用桂则土温而金不寒，气血自然生发也。
一人两尺脉沉微，脾胃脉弱，肺脉中候沉涩，此火不能生土，寒在下焦，痰在上焦，必
转咳嗽，然后阳气发生，方为佳兆也。用药之妙，须虚处着力，一落在实处，再难长进矣。（炳
章按∶据脉而论，所议原不谬，但赘以须从虚处着议，云云，则似无论何脉何证，总以补虚
凡是有热病，却喜欢喝热饮食，睡觉躺卧时烦躁不安，连衣被都不能靠近的，都是阳虚的病证。（炳章按：这也不能作为确切的依据。凡是胸中有痰饮的人，大多喜欢喝热饮，如果误认为是阳虚而使用热性药物，时间久了必然会受到伤害。）
凡是泄泻、肠风等证候，是因为小肠壁薄，不能正常传送糟粕，所以渗入到大肠中。
凡是干燥等证候，是因为大肠虚弱，不能润泽肠道，所以大便涩滞难以排出。
脾虚则食物无法消化，如果有宿食积滞就会泛酸；胃虚则饮水无法消受，如果有宿饮停聚就会产生嘈杂感。
脾实，则食物能消化，肌肉光滑润泽；脾虚，则身体消瘦，四肢无力抬举。
出汗只到颈部就停止的，是阳气不能发散；出汗到肚脐就停止的，是阳气将要发动；出汗到达足部，说明阳气在全身周流顺畅，病将自愈。
凡是浑身胀痛，都属于阴分血亏；大热也属于血分病变。微寒微热，或者发热不退，以及出汗只到颈部就停止的，属于气分病变。气分病变适宜用补中益气汤，根据见证加减；血分病变适宜用芎归汤加肉桂，或者四物汤加麻黄、肉桂。胸中胀满的，用四物汤加苏梗。
口不知味，有实热的情况，也有虚热的情况。口不知谷物味道，可知中气虚弱。因为谷气进入脾胃，中气依靠它来滋养，如果不喜进食，难道不是因为不足吗？这两种情况各自不同：中气实则空虚，空虚则上下通达；中气虚实则壅塞，壅塞则痰凝气滞。比如像扑打损伤，服用破血药后，瘀血不得去除，必然形成中满，这是因为毒瓦斯进入脾脏的缘故。
凡是有表证的，都属于里虚。（王胥山说：这就是邪气盛实皆由本虚的道理，大概是教导学习的人治病，不可不探求其根本原因。这种说法，只是机械地注解，大大失去了周慎斋先生立言救世的一片苦心，而且让那些不学无术的庸人得以指责他的非议。炳章按：这种说法终究是不对的，果真是里虚就应当用补法，哪有通过补法治愈表证的道理呢？即使是补中益气的方法，原本也不是为外感病设立的，在这里误认受害不浅，王胥山先生虽然曲意为之解说以迎合时俗，也不足以掩盖他的失误。）
自热，蒸蒸发热，似烦非烦，用补中益气汤。寒热往来像疟疾一样，用补中益气汤加二陈汤。微寒微热，是阴中之阳虚，适宜补上焦，用八珍汤加黄芪。如果胸膈不宽畅，加入化痰药。自汗微热，是阳中之阴虚，用八珍汤加肉桂。如果腹中痛，加干姜、吴茱萸。
寒热往来像疟疾，是表阳虚。表阳，就是剽悍的胃气，升于头顶，浮于皮毛。升浮之气，无时无刻不在运行。胃气虚，则有时不能升浮，郁结在半表半里，外与太阳经争则恶寒，内与阳明经争则发热，通过补益并升发之，哪里还有寒热呢？久了不治疗，则胃气的升发逐渐减少，升发少则阳气微弱而恶寒，升发少则降下也少，降下少则血少而发热，适宜用八珍汤、十全大补汤治疗。微寒，是阳虚。微热，是阴无从生，虚阳无所依附，八珍汤阴阳并补，加黄芪则补阳的功效居多。自汗虽然属于阳虚，但是津液少，则阴更虚，所以发微热，八珍汤加肉桂，则补阴的功效居多。
凡是读书人，精神恍惚，出汗不睡，或者泄泻，或多痰，病虽然不一，总之都发于心脾。因为思虑多则心火乘袭脾土，君火不主令，相火用事，如果不清其源头，正其根本，阳气愈陷，病气愈盛，归脾汤之类，才是对症的方剂。（张东扶说：心火乘脾，脾阴受亏，适宜补脾之阴，不应当补脾之阳。凡是五脏相乘，各应当观察其阴阳，伤阴则补阴，伤阳则补阳，假如阴阳误施，危害不小。炳章按：这条注释也不确切，并非归脾汤所能治。凡是思虑多则心血虚，脾无所受气而亦亏损，归脾汤专补脾阳，怎么能治疗呢？薛一瓢治病发于心脾，用归脾汤合天王补心丹加减制成丸药，比较接近。张东扶的注非常精辟，可以……）
凡人夜间多思，导致睡不宁静的，用淡竹叶、枣仁两味药，煎服即安。
凡下焦有病，六味丸可以通用。如果遇到泄泻，关键只在调理脾胃元气，又不可轻用地黄。（张东扶说：地黄如果能制得极熟，也不会损害脾气，大约泄泻者使用它，监制以山药、茯苓之类，就可以了。炳章按：泄泻者多兼湿，熟地黄究竟适宜斟酌使用。）
凡是泄泻属脾的适宜燥湿，因为脾恶湿；属肾的适宜润燥，因为肾恶燥。肾的泄泻，是失去了闭藏的命令，不能收摄二便。（王胥山说：治泄泻的方法，这几句话已经说尽了，现在的人只知道治脾，不知道顾护肾，所以得失参半。）
凡治病，见证虽多，有呕吐只适宜止吐，有腹泻只适宜止泻。止吐后，须用六君子汤调理；止泻后，须用参苓白术散加木香调理。
凡上焦病，适宜开发宣通；中焦病，适宜调和；下焦病，适宜通达且缓和。
见病医病，是医家的大忌。因为病有标本，多有本病不见而标病显现的，有标本相反不相符的，如果见到一个证候，就治疗一个证候，必然会有失误。只有见到一个证候，而能探求这个证候之所以然，那么本病就可以认识了。比如头痛、发热、恶寒、筋骨疼痛，这是外感实证。然而阳虚则恶寒，阴虚则发热，血虚则筋骨枯槁而多疼痛，胃虚、肝虚、肾虚，都有头痛的证候。（这不是外感实证。）比如默默不语，四肢无力，气短身寒，这是内伤虚证。然而胃实脾不运化，而有默默不语的情况；阴气升腾，阳气不得令行，而有身寒的情况。（这不是内伤虚证。）种种变幻，实似虚，虚似实，外似内，内似外，难以枚举，都应当细心探求其根本。根本必有原因，或因寒热，或因食气，或因虚实，或兼时令的旺衰，所以治寒的用温法，治热的用清法，食积的用消法，气滞的用通法，实的用平法，虚的用补法，再兼按时令的口味，病就好了。（这种方法应当知晓。）
各种病不愈，必须寻查到脾胃之中，方才无一失误。为什么这样说呢？脾胃一受伤，四脏都没有生气，所以疾病产生。万物从土而生，也从土而归，补肾不如补脾，说的就是这个道理。治病不愈，寻查到脾胃而痊愈的很多。凡是见到咳嗽、自汗、发热，是肺虚生痰，不必理痰清热，土旺而痰消热退。用四君子汤，加桂枝、干姜、陈皮、北五味子，后来用参苓白术散调理。（炳章按：知道根本的理论，然而脾胃的作用在于升降运化，拨转气机，尤为重要，不可以仅仅以为四君、六君就足以尽脾胃的治疗法则。）
脾胃不足，应当责其无阳，也有阳亢热不退，自汗怕寒，四肢倦怠乏力的证候。中虚表热，或者潮热自汗，不要离开补中的方子。表热加羌活；腹中胀满，加附子、姜、桂、吴茱萸、青皮、神曲之类；调理，用八珍汤；气血两虚，用十全大补汤；阴虚火动，脉洪大而不作泻，用六味汤加人参；恶寒，用八珍丸；腹痛，用理中丸；虚损，用虎潜丸。病证多端，颠倒难明，必须从脾胃调理，这才是岐黄的正法。
诸病有吐泻见证，不要忘记脾胃，虽然有杂证，也要从末梢（症状）治疗。气短脉有力属实，无力属虚。气脉俱长的易治，虚损气促的难调，久病不宜脱形。如果是内伤虚损不足之证，不拘药量的多少，适宜久服有效，如果药力未至，必然不能成功。补中益气汤加附子，无汗加羌活，如果自汗发热，用保元汤，加白术、桂、附、归、芍、二陈汤必愈。凡是病日久，阳虚无疑，因为胃失生发之气，保元汤是甘温退热的圣药，舍弃这个而用寒凉，必死无疑了。即使大便燥结，也是阳陷于阴分，切勿攻下。诸病必须寻查到脾胃之中，这是李东垣的高见。胃主生发之气，七情六欲，都足以伤胃。至于不思饮食，十二经络有一处之滞，则生发之气不行，生发之气不行，四脏都没有生气，病日益增多。医家在气血、寒热、虚实不辨，忘记脾胃而投药石的，十常八九，所以往往害人。
验案
一人左手寸脉中候微数，重按无力不清，关脉中候沉候皆有力，尺脉沉细有力。右寸中候涩，重按不见脉，关脉中候若有力，下微不清，尺脉沉数无力。这是内伤不足之证，脾肺二经受病。治疗用补中益气汤，使阳得生而阴得长，加盐水炒黄柏二分以救肾，加枣仁一钱以安心神，小水或热或不利，加远志、莲须各五分以达之。（炳章按：凡治病没有舍去证候而专言脉的，也没有舍去脉而专言证候的，必须脉证合参，才能得到真相，此病未知所现何证，据脉则土强木弱肾水亦亏，怎么能承受升麻、柴胡的升散呢？虽然有黄柏炒二分，也不足以救肾。）
一人左寸脉短涩，是心血不足，关脉微弦无力，左尺沉细。右寸微浮而散，右关按之若有力，举之不足，重按无力不清，右尺沉而无力。责其无火，适宜大补气血，治疗用十全大补汤。
一人五十八岁，右脉带弦，左脉豁大有力。弦为木脉，见于右手，是胃受木克而虚。左脉豁大有力，是邪火盛。不治之证。（炳章按：此未见即为不治之症，特别不是补中益气所能治疗的。）
一妇人年三十，左寸浮大，左关大，左尺洪大，右寸浮大，右关尺俱沉细无力。治疗方用山茱萸、白茯苓、生地黄各一钱，泽泻、陈皮各五分，川附子、生甘草各二分，姜枣煎。盖浮与洪大属火，故壮水以制火，泽泻、白茯苓引火下行。关尺沉细无力，真火不足，故加附子以……
一妇人六脉纯阴，或二、三至，或四、五至见歇，这是血中之气虚。四君子汤加白芍、肉桂，理脾和肝，山药糊丸。血中之气脾为主，脾土旺则上焦肺气亦足。盖脾为太阴，肺亦太阴，二阴皆赖阳以生。用桂则土温而金不寒，气血自然生发也。
一人两尺脉沉微，脾胃脉弱，肺脉中候沉涩，这是火不能生土，寒在下焦，痰在上焦，必然转咳嗽，然后阳气发生，方为佳兆也。用药之妙，须虚处着力，一落在实处，再难长进矣。（炳章按：据脉而论，所议原不谬，但赘以须从虚处着议，云云，则似无论何脉何证，总以补虚……）
Any febrile disease where the patient prefers hot food and drink, cannot sleep or lie down comfortably, and cannot bear clothing or bedding, is a disease of Yang deficiency. (Bingzhang notes: This cannot be taken as an absolute basis. Those with phlegm-fluid retention in the chest often prefer hot drinks; if mistakenly treated as Yang deficiency with hot herbs, harm will inevitably result over time.)
In cases of diarrhea and intestinal wind, the small intestine is thin and unable to transport waste properly, causing it to seep into the large intestine.
In cases of dryness, the large intestine is deficient and unable to moisten, resulting in constipation and difficulty in defecation.
Spleen deficiency leads to indigestion; retained food causes sourness. Stomach deficiency leads to inability to digest fluids; retained fluids cause epigastric discomfort (clanging sensation).
When the Spleen is excess, food is digested and muscles are smooth and lustrous. When the Spleen is deficient, the body is emaciated, and the limbs are weak and difficult to move.
Sweat stopping at the neck indicates that Yang Qi is not dispersing; sweat stopping at the navel indicates that Yang Qi is about to move; sweat reaching the feet indicates that Yang Qi is circulating throughout the body, and the disease will heal spontaneously.
Lung disease results in a lack of control over the whole body; Spleen disease results in the inability to move the limbs.
Generalized distension and pain belong to Blood deficiency in the Yin aspect. High fever also belongs to the Blood aspect. Mild chills and fever, persistent fever, or sweat stopping at the neck belong to the Qi aspect. For Qi aspect disorders, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is suitable, modified according to symptoms; for Blood aspect disorders, Xionggui Tang (Peony and Angelica Decoction) with Rougui (Cinnamon Bark) or Siwu Tang (Four Substances Decoction) with Mahuang (Ephedra) and Rougui (Cinnamon Bark) is suitable. For chest fullness, Siwu Tang (Four Substances Decoction) with Sujing (Perilla Stem) is used.
Loss of taste may be due to excess heat or deficient heat. Loss of taste for grain foods indicates Middle Jiao deficiency. Grain Qi enters the Spleen and Stomach, and Middle Qi relies on it for nourishment; if one does not desire food, it is surely due to insufficiency. These two conditions are distinct: when Middle Qi is excess, it is empty, allowing free communication between upper and lower; when Middle Qi is deficient, it becomes obstructed, leading to phlegm condensation and Qi stagnation. For example, after trauma, if blood-breaking herbs fail to resolve stasis, abdominal fullness will form because toxic factors enter the Spleen.
All exterior syndromes belong to interior deficiency. (Wang Xushan states: This implies that all pathogenic excess stems from root deficiency, teaching students that treatment must seek the root. However, this view merely serves as a rigid footnote, failing to honor Zhou Shenzhai's compassionate intent to save lives, and inviting criticism from unskilled practitioners. Bingzhang notes: This view is ultimately incorrect. If it were truly interior deficiency, tonification should be used; how can tonification cure an exterior syndrome? Even Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was not originally designed for external contraction. Misinterpreting this causes significant harm. Although Mr. Wang Xushan tried to justify it to suit the times, it does not cover his error.)
Spontaneous heat, steaming fever, and apparent irritability without true restlessness are treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). Chills and fever resembling malaria are treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Erchen Tang (Two-Cured Decoction). Mild chills and fever indicate deficiency of Yang within Yin, requiring tonification of the Upper Jiao using Bazhen Tang (Eight Treasures Decoction) plus Huangqi (Astragalus). If the chest and diaphragm feel constricted, add phlegm-resolving herbs. Spontaneous sweating with mild heat indicates deficiency of Yin within Yang, treated with Bazhen Tang (Eight Treasures Decoction) plus Rougui (Cinnamon Bark). If there is abdominal pain, add Ganjiang (Dried Ginger) and Wuzhuyu (Evodia Fruit).
Chills and fever resembling malaria indicate deficiency of Exterior Yang. Exterior Yang refers to the vigorous Wei Qi of the Stomach, which ascends to the crown and floats on the skin and hair. Ascending and floating Qi never ceases. When Stomach Qi is deficient, it sometimes fails to ascend and float, becoming stagnant in the Half-Exterior Half-Interior. Competing externally with the Taiyang channel causes chills; competing internally with the Yangming channel causes fever. Tonifying and ascending resolves these chills and fevers. If untreated for a long time, Stomach Qi's ascending function diminishes. Less ascending leads to weak Yang and chills; less descending leads to less Blood and fever. Treat with Bazhen Tang (Eight Treasures Decoction) or Shiquan Dabu Tang (Ten Great Tonifying Decoction). Mild chills indicate Yang deficiency. Mild heat indicates Yin has no source to generate, leaving deficient Yang without attachment. Bazhen Tang (Eight Treasures Decoction) tonifies both Yin and Yang; adding Huangqi (Astragalus) increases the effect of tonifying Yang. Spontaneous sweating belongs to Yang deficiency, but if Jingye (Body Fluids) are scant, Yin becomes more deficient, causing mild heat. Bazhen Tang (Eight Treasures Decoction) plus Rougui (Cinnamon Bark) increases the effect of tonifying Yin.
Scholars often suffer from mental agitation, sweating, insomnia, diarrhea, or excessive phlegm. Though symptoms vary, they all originate from the Heart and Spleen. Excessive thinking causes Heart Fire to invade the Spleen; the Sovereign Fire loses its command, and Minister Fire takes over. If the source is not cleared and the root not corrected, Yang Qi sinks further, and pathogenic Qi grows stronger. Guipi Tang (Restore the Spleen Decoction) and similar formulas are appropriate. (Zhang Dongfu states: Heart Fire invading the Spleen damages Spleen Yin; one should tonify Spleen Yin, not Spleen Yang. In mutual invasion of the Five Zang organs, one must observe Yin and Yang; damage to Yin requires tonifying Yin, damage to Yang requires tonifying Yang. Misapplying Yin/Yang tonification causes great harm. Bingzhang notes: This annotation is also inaccurate; Guipi Tang (Restore the Spleen Decoction) alone cannot treat this. Excessive thinking depletes Heart Blood, leaving the Spleen without received Qi, causing Spleen deficiency. Guipi Tang (Restore the Spleen Decoction) specifically tonifies Spleen Yang and cannot treat this condition. Xue Yupeng treated Heart-Spleen disorders by combining Guipi Tang (Restore the Spleen Decoction) with Tianwang Buxin Dan (Emperor of Heaven's Special Pill to Nourish the Heart) into pills, which is closer to the truth. Zhang Dongfu's note is very refined...)
For those who think excessively at night, causing restless sleep, decocting Zhuyeqian (Bamboo Leaf) and Zaoren (Ziziphus Seed) provides relief.
For diseases of the Lower Jiao, Liuwei Wan (Six-Ingredient Pill with Rehmannia) can be generally used. However, in cases of diarrhea, the key lies in regulating Spleen and Stomach Yuan Qi, and Dihuang (Rehmannia Root) should not be used lightly. (Zhang Dongfu states: If Dihuang (Rehmannia Root) is prepared thoroughly, it will not damage Spleen Qi. It can be used for diarrhea when monitored with Shanyao (Dioscorea) and Fuling (Poria). Bingzhang notes: Diarrhea patients often have dampness; Shudi (Prepared Rehmannia Root) should be used with caution.)
Diarrhea belonging to the Spleen requires drying, as the Spleen dislikes dampness. Diarrhea belonging to the Kidney requires moistening, as the Kidney dislikes dryness. Kidney diarrhea results from the loss of the storing and grasping function, failing to control urination and defecation. (Wang Xushan states: The methods for treating diarrhea are fully stated here. Modern practitioners only know to treat the Spleen and ignore the Kidney, hence their mixed success and failure.)
In treating diseases, although many symptoms appear, vomiting should only be stopped with anti-emetics, and diarrhea only with anti-diarrheals. After stopping vomiting, Liujunzi Tang (Six Gentlemen Decoction) should be used for regulation. After stopping diarrhea, Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) plus Muxiang (Vladimiria Root) should be used for regulation.
Diseases of the Upper Jiao should be opened and dispersed; diseases of the Middle Jiao should be harmonized; diseases of the Lower Jiao should be unblocked and eased.
Treating symptoms directly is a major taboo for physicians. Diseases have root (Ben) and branch (Biao) aspects. Often, the root disease is hidden while branch symptoms appear, or root and branch contradict each other. Treating only visible symptoms leads to errors. One must investigate the cause of the symptom to identify the root. For example, headache, fever, aversion to cold, and bone/joint pain are exterior excess syndromes. However, Yang deficiency causes aversion to cold, Yin deficiency causes fever, and Blood deficiency causes withered sinews/bones and pain. Stomach, Liver, and Kidney deficiencies can all cause headaches. (These are not exterior excess syndromes.) Silence, limb weakness, shortness of breath, and cold body temperature are interior deficiency syndromes. However, Stomach excess with Spleen failure to transport can cause silence; rising Yin Qi preventing Yang from commanding can cause cold body temperature. (These are not interior deficiency syndromes.) Transformations are countless: excess resembling deficiency, deficiency resembling excess, exterior resembling interior, interior resembling exterior. All require careful investigation of the root. The root has causes: cold/heat, food/Qi, excess/deficiency, or seasonal fluctuations. Treat cold with warming, heat with clearing, food stagnation with digestion, Qi stagnation with unblocking, excess with pacifying, and deficiency with tonifying, adjusted for seasonal tastes, and the disease resolves. (This method should be known.)
If various diseases do not resolve, one must look to the Spleen and Stomach to avoid error. Why? Because once the Spleen and Stomach are damaged, the Four Zang organs lose their vital energy, leading to disease. All things arise from Earth and return to Earth; tonifying the Spleen is superior to tonifying the Kidney. Many diseases resolve when attention turns to the Spleen and Stomach. For cough, spontaneous sweating, and fever caused by Lung deficiency generating phlegm, do not focus on resolving phlegm or clearing heat; strengthen Earth so phlegm dissipates and heat retreats. Use Sijunzi Tang (Four Gentlemen Decoction) plus Guizhi (Cinnamon Twig), Ganjiang (Dried Ginger), Chenpi (Tangerine Peel), and Beiwuweizi (Schisandra Berry), followed by Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) for regulation. (Bingzhang notes: While knowing the root is correct, the Spleen and Stomach function through ascending/descending and transformation, crucial for moving Qi mechanism. Relying solely on Sijunzi Tang (Four Gentlemen Decoction) or Liujunzi Tang (Six Gentlemen Decoction) is insufficient for comprehensive Spleen/Stomach treatment.)
Spleen and Stomach deficiency usually indicates Yang deficiency, but can also present with Yang hyperactivity, persistent heat, spontaneous sweating, aversion to cold, and limb fatigue. For Middle deficiency with exterior heat, tidal fever, or spontaneous sweating, do not depart from Middle-tonifying formulas. Add Qianghuo (Notopterygium Rhizome) for exterior heat; add Fuzi (Aconite Root), Jiang (Ginger), Rougui (Cinnamon Bark), Wuzhuyu (Evodia Fruit), Qingpi (Green Tangerine Peel), and Shenqu (Medicated Leaven) for abdominal fullness. For regulation, use Bazhen Tang (Eight Treasures Decoction); for Qi and Blood dual deficiency, use Shiquan Dabu Tang (Ten Great Tonifying Decoction); for Yin deficiency with fire hyperactivity and surging pulse without diarrhea, use Liuwei Tang (Six-Ingredient Decoction) plus Renshen (Ginseng); for aversion to cold, use Bazhen Wan (Eight Treasures Pills); for abdominal pain, use Lizhong Wan (Regulate the Middle Pills); for consumptive disease, use Huqian Wan (Tiger Crouching Pills). With diverse and confusing symptoms, regulation via the Spleen and Stomach is the orthodox method of Qi Bo and Huang Di.
For diseases with vomiting and diarrhea, do not forget the Spleen and Stomach; even with miscellaneous symptoms, treat the branch. Shortness of breath with a forceful pulse indicates excess; forceless pulse indicates deficiency. Long Qi and pulses are easy to treat; deficiency with rapid breathing is hard to regulate; chronic illness should not lead to emaciation. For internal injury deficiency, long-term administration is effective regardless of dosage; if medicinal power has not reached, success is impossible. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Fuzi (Aconite Root); add Qianghuo (Notopterygium Rhizome) if no sweat; for spontaneous sweating and fever, use Baoyuan Tang (Preserve the Origin Decoction) plus Baizhu (Atractylodes Macrocephala), Gui (Cinnamon), Fu (Aconite), Danggui (Angelica Sinensis), Shaoyao (Peony), and Erchen Tang (Two-Cured Decoction) for certain cure. Chronic illness undoubtedly involves Yang deficiency due to loss of Stomach's generating Qi. Baoyuan Tang (Preserve the Origin Decoction) is a holy medicine for sweet-warm fever reduction; abandoning it for cold-bitter herbs guarantees death. Even with dry stool, if Yang is trapped in the Yin aspect, do not purge. Seeking the Spleen and Stomach in all diseases is Li Dongyuan's profound insight. The Stomach governs generating Qi; emotions and desires damage the Stomach. Lack of appetite indicates stagnation in any of the twelve meridians, halting generating Qi, depriving the Four Zang organs of vitality, and increasing disease. Physicians who fail to distinguish Qi/Blood, Cold/Heat, Excess/Deficiency, and ignore the Spleen and Stomach in prescribing cause harm nine out of ten times.
Case Records
Patient 1: Left Cun pulse is slightly rapid at middle pressure, powerless and unclear at heavy pressure. Guan pulse is forceful at middle and deep pressure. Chi pulse is deep, fine, and forceful. Right Cun pulse is choppy at middle pressure, invisible at heavy pressure. Guan pulse seems forceful at middle pressure but unclear below. Chi pulse is deep, rapid, and powerless. This is an internal injury deficiency syndrome affecting the Spleen and Lung channels. Treat with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to allow Yang to generate and Yin to grow. Add 2 fen of Salt-fried Huangbai (Phellodendron Bark) to rescue the Kidney, and 1 qian of Zaoren (Ziziphus Seed) to calm the Spirit. If urine is hot or difficult, add 5 fen of Yuanzhi (Polygala Root) and Lianxu (Lotus Stamen) to unblock. (Bingzhang notes: Treatment should never rely solely on pulse without symptoms, nor solely on symptoms without pulse; both must be combined for truth. Without knowing the symptoms, the pulse suggests Earth excess, Wood weakness, and Kidney Water deficiency. How can the patient tolerate the ascending and dispersing action of Shengma (Cimicifuga) and Chaihu (Bupleurum)? Even with 2 fen of fried Huangbai (Phellodendron Bark), it is insufficient to rescue the Kidney.)
Patient 2: Left Cun pulse is short and choppy, indicating Heart Blood deficiency. Guan pulse is slightly wiry and powerless. Left Chi pulse is deep and fine. Right Cun pulse is slightly floating and scattered. Right Guan pulse feels forceful upon pressing but insufficient upon lifting and powerless/unclear upon heavy pressing. Right Chi pulse is deep and powerless. Attribute this to lack of Fire. Tonify Qi and Blood greatly with Shiquan Dabu Tang (Ten Great Tonifying Decoction).
Patient 3: 58 years old. Right pulse is slightly wiry; left pulse is hollow, large, and forceful. Wiry is the Wood pulse; appearing on the right hand indicates Stomach deficiency due to Wood overacting. Left pulse being hollow, large, and forceful indicates flourishing pathogenic fire. Incurable. (Bingzhang notes: This appears incurable, and certainly cannot be treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).)
Patient 4: Female, 30 years old. Left Cun is floating and large; Left Guan is large; Left Chi is surging and large. Right Cun is floating and large; Right Guan and Chi are deep, fine, and powerless. Prescription: Shanzhuyu (Cornus Fruit), Baifuling (Poria with White Part), and Shengdihuang (Raw Rehmannia Root) 1 qian each; Zexie (Alisma) and Chenpi (Tangerine Peel) 5 fen each; Chuannaofu (Processed Aconite) and Shenggancao (Raw Licorice Root) 2 fen each. Decoct with Ginger and Jujube. Floating and surging/large pulses belong to Fire; thus, strengthen Water to control Fire. Zexie (Alisma) and Baifuling (Poria with White Part) guide Fire downward. Deep, fine, and powerless Guan/Chi pulses indicate insufficient True Fire; thus, add Fuzi (Aconite Root)...
Patient 5: Female. Six pulses are purely Yin. Intervals of 2-3 or 4-5 beats show pauses. This is Qi deficiency within Blood. Sijunzi Tang (Four Gentlemen Decoction) plus Shaoyao (Peony) and Rougui (Cinnamon Bark) regulates Spleen and harmonizes Liver. Form pills with Shanyao (Dioscorea) paste. Qi within Blood is governed by the Spleen; when Spleen Earth is robust, Upper Jiao Lung Qi is sufficient. Both Spleen and Lung are Taiyin, relying on Yang for generation. Using Gui (Cinnamon) warms Earth and prevents Metal from becoming cold, allowing natural generation of Qi and Blood.
Patient 6: Both Chi pulses are deep and faint; Spleen/Stomach pulses are weak; Lung pulse is choppy at middle pressure. This indicates Fire failing to generate Earth, Cold in the Lower Jiao, and Phlegm in the Upper Jiao. Cough will likely develop, after which Yang Qi generation is a good sign. The subtlety of medication lies in applying effort to deficiency; once applied to excess, progress is difficult. (Bingzhang notes: Based on the pulse, the discussion is not erroneous, but adding that one must always focus on deficiency regardless of pulse or symptom seems to imply...)