着《温疫论》，谓疫邪率在膜原，专用达原饮及重剂大黄，俱为一得之论。间亦中病，而未
自仲景以来，论治病者，皆知宜分表里。谓足太阳膀胱，为表中之表，足阳明胃为表中
之里，足少阳胆为半表半里，自是而三阴脾肾肝皆为里，几成千古不易之论矣。
本朝叶天士治病，独于表里之外，必分三焦，实为发前人所未发。肺为上焦，心脾为中
焦，
里，由外而内，如天之有纬度也。人之三焦，由下而下，如天之有经度也。一纵一横，交相为用，不可偏废。且风寒中
人，多从毛窍
人之一身，阴阳而已矣。阴阳所分，营卫而已矣。营卫所主，血气而已矣。血属阴，气
属阳，血属营，气属卫，人人共知。因谓气欲其升，不欲其降，血欲其降，不欲其升。然气下陷
，则为泄为脱；而气上冲，则为喘为呃；血上涌，则为吐为衄；而血下泄，则为崩为漏，皆
病也。故参、 补气，皆取升提，而必辅以补阴之药，则升中有降。归、地补阴，皆取润下
，而必辅以补阳之药，则降中有升。
凡用药，甘以和中，苦以燥湿，酸以收敛，辛以发散，咸以软坚，淡以渗泄，此正治也
。寒因寒用，热因热用，通因通用，塞因塞用，此从治也。虚则补其母，又曰子能令母实；实则
泻其子，又曰子能盗母气，因相生而兼相为用，此常法也。脾病平肝，肝病壮脾，肾病清心
，心病滋肾，此隔二治法也，肝病益肺(左金汤之类)，脾胃病暖肾，或助命门火，此隔三治
世人以张、李、刘、朱四家并称，皆以张为仲景。窃思仲景系东汉时人，所立方论，悉
本《素》、《灵》。实百代医家之祖，岂三子所能肩随者，后阅陆定圃学博杂识，谓仲景不在四
家之列，张应指张子和，乃与东垣、河间、丹溪相伯仲，其治法亦各明一义，卓然成家，此
论甚允，实获我心，因亟录之。
补气药多温而少凉，补血药多凉而少温，此阴阳之所分也。然肺主出气，肾主纳气，气
虚之
，非所以助正气也。阳生则阴生，气壮则摄血。血虚之人，有宜扶阳补气者，温药亦所宜用
，而要不得以硫、附、椒、姜、为血少人用，以过于温热，适足以耗血也。
人参为扶元极品，无论表散攻泻，皆宜用之。故古方用参极多，但所用人参，出于上党
，地居中土，性味和平。本朝用辽东参，偏居东方，故性温而上行。至高丽参来自朝鲜，东洋参
来自日本，则地愈东，而性愈偏，补虚之功不足，助热之势有余，受外邪及素患肝病者，皆
须酌用，非可执古方而用今药也。推之白术非野生，则性薄而枯燥，桂心非窑洞，则味辛而
上炎(安南桂已无有)，皆不足以济事，而稍不合宜，转多流弊，亦医家之所宜知也。
六淫以风为首。天地之间，惟风无所不入，故人之受病，风症最重，又能兼及诸淫，变
生百病。其兼诸淫者，如寒曰风寒，湿曰风湿，暑曰暑风，燥曰风燥，火曰风火，盖各症皆能生
风也。其变百病者，如头风、脑风、喉风、肝风、胃风、肠风、鹤膝风、肾囊风、历节风，
以及风气、风痹、风痱、风疹、风瘫、风癫之类是也。而且轻则为伤，重则为中，总由真气
先虚，营卫空疏，而后风邪得乘虚以袭之，是以风症多虚而少实。东垣、河间、丹溪诸家治
法，有顺气、养血、化痰、清热之不同，不专用驱风之剂也。
仲景着书名《伤寒论》，盖以寒病为诸症之纲也。夫人之一身，阳盛则生，阴盛则死。
寒者阴惨之气，中人则为病，而阳气衰矣。故仲景立方多主温剂，除攻下诸方之外，寒邪在表，
则温散以汗之，如麻黄汤、桂枝汤、大青龙汤之类；寒邪在里，则温热以祛之，如理中汤、
四逆汤之类，此实治寒病之心法，而为后人所宜遵守者也。若四时之邪，或温、或湿、或暑
，亦有似伤寒者，治法大不相同，切勿专用温热，以致贻误。犹中暑中湿诸症，与中风迥别
，故随时制宜，为医家之要诀焉。
暑者，夏令之阳邪从口鼻入，脾经实先受其病，而心肺次之。乃热症多阳，属气有余，
暑症多阴，属气不足。与治感受寒邪之法大异，宜温散而不宜过热，宜清凉而不宜过寒，仲景方多
不可用。且暑之兼症甚多，有兼伤风者，有兼伤寒者，有兼伤湿者，有兼伤食者，而要惟兼
湿与食为最多。盖夏月土润溽暑，暑必多湿，而内无积食，亦断不致为大患也。然或疟或痢
，或霍乱吐泻，发于当时者为轻，入秋病为伏暑，极难痊愈，秋深更甚，若至霜降后发病，十
五行六气之理，脾为湿土。湿者、土之气也。从地而上，其着于人，则有内感外感之不
同。
雨水，汗浴淋漓，其伤在皮肤经络，而亦有兼风、兼寒、兼热、兼暑各症。且有中湿甚重，
而口眼 斜，舌强语涩，筋骨拘挛，四肢麻木者，形如中风，而不可作中风治。大约湿在表
宜汗，谓解肌也。湿在里宜泄，谓通二便也。又须扶脾以实之，温中以祛之，而治湿之能事
经曰∶燥乃阳明秋金之气所化。金能生水，燥则无以滋肾阴而化源绝，肾水既绝，不能
灌溉五脏，滋养百骸，则周身皆槁而愈燥矣。其病多由酒色过度而起，火盛水衰，遂至渐剧。亦
有因肺受风火，咳嗽多痰，唾久伤液，而成燥症者。或皮肤甲错，或肌肉枯瘠，或嗌干声哑
，总宜以甘寒生水之味治之。轻者天冬、地黄、梨浆、藕粉，重者龟鳖胶、牛羊乳及燕窝等
物，尤宜清心寡欲，嗽口咽津，自能渐愈。若再用温剂，或酒色不戒，必致伤生，慎毋忽诸
五脏六腑，各具真气。气有余便是火，故诸经皆有火，而心肝命门三经实主之。劳伤郁
闷，盛怒极乐，悉能生火。肝火盛则伤脾，心火炎则伤肺，命门火炽则伤肾，此火由内生者也。
至内寒暑湿诸症，身发壮热，久郁而成火，则四时之邪所传变也。又肝移热于胆，心移热于
小肠，肺移热于大肠，肾移热于膀胱，而其患不可胜穷矣。火既为患，必宜泻之，而有以散
为泻者，柴、葛之类。有以泄为泻者，芩、连之类，有以滋阴为泻者，知、柏、元参之类。
有以补气为泻者，参、 、甘草之类(所谓甘温胜大热)。是在善用者之变而通之耳。
凡感受时疫，初起总觉寒毛洒淅，或四肢发冷。故俗人遇外感，无论风温暑湿，皆称为
伤寒，而治以表散。日久邪入中焦，或自表而里，总觉化热，将有口渴便秘烦躁谵语等症，故俗
人皆称为火症，而治以凉泻。不知其中三因所受，变化多端，必须随症分经论治，方能奏效
。否则一方之内，不必全误，但有一二味不宜服者，非惟诸药无功，亦且其弊立见。后来者
不知何药未投，又复变法治之，如此则误人必多矣。
治病之法，望、闻、问、切，四端并重。今人专取诊脉，已多遗漏。况病患赋性有偏，
脉亦各异，或迟或数，或大或小，医者素不相习，而病家所告，症候又多 驳，甚或轻重例置，
虚实互移，如此而欲凭所诊之脉，便与定方治病，多不相宜。故凡初诊切宜审慎，必须揆情
度理，确有见地，而后立方，且于初方中预防其变症。如善弈者，开局下子，算至数十着以
后，自能全局得手。若待用药未合，而后别筹治法，即能疗病，终非良医，谓其人抱恙已久
故也。矧或变症迅速，不及改弦，又虑病家更易庸手，辗转蹉跎，人命至重，岂得一误再误
养生家当于平日调和气血，保惜精神。酒色嗜欲，一无沉溺，喜怒悲恐，一无过伤，
则自不
效。此固非医者所得居功也。
少年酒色不谨之徒，猝受时邪，必然头眩身重，气体困惫，此由正气早伤之故。经曰∶
邪之
泄亡阴，延至日久，而神昏气蹙，痉厥之症，交发而并至，医者因前次已服攻散之药，辄投
以参、 、归、地，其或加入桂、附，若是者，决无生理，深可悼也。治法当于邪未入里时
，用参苏饮、枳术丸等方，加减调理之。倘至八九日，症犹未退，且必增剧，即宜用复脉汤
(即炙甘草汤加减。)助其正气，滋其真阴，而后其邪自解。若药饵误投，势已危殆，则牛黄
丸、至宝丹、紫雪丹之类，酌而用之，亦可救其十之二三，此皆余所经验者。
嘉道间，越中某医，颇有名，而过于慎重，明知是症当攻当导，而不肯骤进补方。约需
多日，始稍稍补之，而其人已极惫矣。余诘其故。则曰∶古人立方，表散则有大青龙、小青龙，
攻里则有大承气、小承气、大陷胸、小陷胸、和解则有大柴胡、小柴胡，亦是审慎之意，先
轻后重，如轻者得效，则重者不必施也。余笑而不答。夫仲景设方，各有专治，宜重宜轻，
丝毫不容假借，岂有先试轻剂，后用重剂之理乎？
俗云∶百病皆由痰起。痰之名，不见于《内经》。仲景书有五饮，痰饮居其一。自后医
家言治痰者浸多，而要必以治脾为先，盖痰本饮食所化。脾气健运，则痰无从生，脾气一弱，则
痰多而上出于肺窍，故治痰之方，大抵皆脾肺药也。但痰有因寒而生者，有因火而生者，有因
风而生者，有因湿而生者，治之各有其本，皆实痰也。而虚痰又有两种，一则由脾虚不能化
食，火郁为痰，痰稠而浊；一则由肾虚不能制水，水泛为痰，痰稀而清。法当分阴阳以治之
，或补其气，或补其阴，不专主乎消痰也。今人多嗜烟草，终日吸之，兼餍酒肉，故晨起痰
嗽必盛，此即日服药饵不易消除，至积病既深，痰声咯咯，由丹田而上至胸膈，则危在顷刻
左氏传言，非鬼非食，鬼亦病之一端。蛮 回部，酷信巫鬼，每病必祷，越中妇女多好
之。
，即霍然愈。但元气稍弱，此因鬼得病者也，其或病已数日，神气薄弱，忽有鬼物，凭以求
食，祈祷后，鬼去而病仍在，尚须医治，此因病生鬼者也。总之，既遇鬼疾，自应祛遣，切
勿恃迂儒无鬼之论，与之作难，致使病者受累。不过以医药为主，毋徒听命于鬼而已。若夫
夙世冤缠，三生孽报，时至相逢，必取其命，虽佛偈仙经，亦无从为之挽救耳。
形肥之人多痰，宜六君子汤之类。形瘦之人多火，宜琼玉膏之类。童稚之人多阴虚，宜
六味地黄汤之类。老年之人多阳虚，宜七宝美髯丹之类。此平时调理法也。治病三法，针灸与药
饵并重，《左传》所谓攻之达之者也。今针灸已失真传，灸法根据铜人图按穴炷艾，犹有治病
奏功者，但亦惟劳损未成，及风湿痿痹之症为宜耳。至于太乙雷火神针，尚传数方，率无全
效。乃近二十年来治痧之术盛行，无论老幼男妇，冬寒夏暑，遇有心痛腹痛，肝胃气痛，以
及感冒发热吐泻等病，率皆名之曰痧，辄用刀针刺舌下，与两臂等处之血，谓之放痧，间亦
有得愈者，哄然同声，以为神技，遍行城乡。故寒热不节之时，民间之得免刺 者鲜矣。夫
痧非惟《内经》不载，诸名家皆莫之言，惟阴阳水治干霍乱，俗名绞肠痧，见于后人。本草
方书，亦未闻有刺取其血之说。大抵邪入血分，郁结而成，故刺血多变黑色。若血色不变，
则非痧也。本非痧而刺之，徒伤气血，经络空虚，适足以召邪而生病。故放痧之人，必多感
胃，愈病愈刺，久之则成弱症而毙矣。要之，针砭本系古法，久已无传，苟非极闷极痛，命
在呼吸者，皆可用药调治，切勿轻试刀针。余尝苦口劝人，多未见信，岂劫运所定，或以此
代刀兵之数邪。吁，可慨也已！
迩来鸦片烟遍行宇内，半由游手好闲之子，花柳娱情；半由幕友吏胥之徒，深宵办案，
此外
则有因借以治病而吸之者。鸦片系罂粟苞浆，性本涩肠敛肺，夷人和以毒物，煎成烟膏，惟
久泻久嗽滑脱之症，及肝病不犯上焦者，吸之颇为有效。然病未除而瘾已成，犹进野狼以驱虎
，而服之无效者，反添一吸烟之患。且即治病果痊，全资烟力，久之气血亏损，嗽泻肝病，
一旦复后，必然加重，烟亦不效，并非他药之所能治，而成必死之症矣。夫《本草纲目》、
《证治准绳》两书，无数佳品，无数良方，何病不可医？何药不可用？而必假此毒物也哉！
撰写《温疫论》的医家认为，疫邪大多停留在膜原（半表半里的部位），因此专门使用达原饮以及重剂量的大黄，这确实是一种独到的见解。偶尔也能治愈疾病，但……
自张仲景以来，论述治病的人，都知道应当区分表证和里证。足太阳膀胱经，是表证中的表证；足阳明胃经，是表证中的里证；足少阳胆经，是半表半里证。从此推演，三阴经（太阴脾、少阴肾、厥阴肝）都属于里证，这几乎成了千古不变的定论。
本朝叶天士在治疗疾病时，独自在表里之外，进一步区分上、中、下三焦，这确实是阐发了前人未曾阐发的理论。肺属于上焦，心脾属于中焦，肾属于下焦。人体的三焦，由上而下，就像天空有纬度一样；人的三焦，由下而上，就像天空有经度一样。一纵一横，相互为用，不可偏废。况且风寒侵袭人体，多从毛孔进入。
人的一身，不过是阴阳罢了。阴阳所分化的，不过是营气和卫气罢了。营卫所主宰的，不过是血和气罢了。血属于阴，气属于阳；血属于营，气属于卫，这是人人都知道的常识。于是人们认为气应该上升而不应该下降，血应该下降而不应该上升。然而，如果气下陷，就会导致泄泻或脱证；而气上冲，就会导致气喘或呃逆；血上涌，就会导致吐血或鼻衄；而血下泄，就会导致崩漏，这些都是病态。所以，用人参、黄芪补气，都是取其升提的作用，但必须辅以补阴的药物，这样在升之中就有降。用当归、地黄补阴，都是取其滋润下行的作用，但必须辅以补阳的药物，这样在降之中就有升。
大凡用药，甘味药用来调和脾胃，苦味药用来燥湿，酸味药用来收敛，辛味药用来发散，咸味药用来软坚散结，淡味药用来渗湿泄浊，这是正治法。寒因寒用（用寒凉药治疗具有假寒症状的真热证），热因热用（用温热药治疗具有假热症状的真寒证），通因通用（用通利药治疗具有实性通泄症状的病证），塞因塞用（用补益药治疗具有虚性闭塞症状的病证），这是从治法。虚证则补其母脏，又说子能令母实；实证则泻其子脏，又说子能盗母气，因为相生关系而兼有相互为用的作用，这是常法。脾病要平抑肝木，肝病要壮健脾土，肾病要清心火，心病要滋肾水，这是隔二治法；肝病益肺（如左金汤之类），脾胃病温补肾阳，或者助命门之火，这是隔三治法。
世人将张元素、李东垣、刘完素、朱丹溪四家并称，都把张仲景列为其中。我私下思考，张仲景是东汉时期的人，他所创立的方论，完全依据《素问》和《灵枢》。他实际上是百代医家的祖师，难道其他三人所能追随的吗？后来阅读陆定圃学博的杂识，说张仲景不在四家之列，这里的“张”指的是张子和（张从正），他才与东垣、河间、丹溪相伯仲，他们的治法也各自阐明了一方面的义理，卓然成家，这个论点非常公允，确实符合我的心意，于是急忙记录下来。
补气药多温性而少凉性，补血药多凉性而少温性，这是阴阳的分野。然而肺主呼气，肾主纳气，气虚的时候……（原文此处似有缺漏，依文意推测为气虚需补气等），这不是用来扶助正气的方法。阳气生发则阴气随之而生，气壮盛则能统摄血液。血虚的人，有的适宜扶持阳气、补益肺气，温性的药物也是适宜的，但是绝不能把硫黄、附子、花椒、生姜这些过于温热的药物给血少的人使用，因为这足以耗伤血液。
人参是扶持元气极品药材，无论用于解表发散还是攻下泻实，都适宜使用。所以古方中使用人参极多，但当时所用的人参，出自上党地区，地处中原，药性平和。本朝使用辽东参，偏居东方，所以药性温而上行。至于高丽参来自朝鲜，东洋参来自日本，那么地方越向东，药性就越偏颇，补虚的功效不足，助热的势头有余，患有外感邪气及平时患有肝病的人，都必须斟酌使用，不能拘泥于古方而使用现在的药材。推而言之，白术如果不是野生的，那么药性就薄弱而且枯燥；桂心如果不是窑洞种植的，那么味道就辛辣而上炎（安南肉桂已经没有了），都不足以成事，稍微不合宜，就会转而产生很多弊端，这也是医生所应当知道的。
六淫（风、寒、暑、湿、燥、火六种外感病邪）以风邪为首。天地之间，只有风邪无所不入，所以人受病，风症最重，又能兼及其他五淫，变生百病。它兼及其他五淫的，如寒与风结合叫风寒，湿与风结合叫风湿，暑与风结合叫暑风，燥与风结合叫风燥，火与风结合叫风火，大概各种病症都能生风。它变生百病的，如头风、脑风、喉风、肝风、胃风、肠风、鹤膝风、肾囊风、历节风，以及风气、风痹、风痱、风疹、风瘫、风癫之类的病症。而且轻则为伤风，重则为中风，总归是因为真气先虚，营卫空疏，然后风邪得以乘虚侵袭，所以风症多虚而少实。李东垣、刘河间、朱丹溪诸家的治法，有顺气、养血、化痰、清热等不同，不专门使用驱风的药剂。
张仲景著书名为《伤寒论》，大概是以寒病作为各种病症的纲领。人的一身，阳气盛则生，阴气盛则死。寒是阴惨之气，侵入人体就成为病，而阳气就衰微了。所以张仲景创立的方剂多主温剂，除了攻下的各方之外，寒邪在表，就用温散的方法使其出汗，如麻黄汤、桂枝汤、大青龙汤之类；寒邪在里，就用温热的方法祛除它，如理中汤、四逆汤之类，这确实是治疗寒病的心法，而为后人所应当遵守的。至于四季的邪气，或温、或湿、或暑，也有类似伤寒的，治法大不相同，千万不要专用温热药，以致贻误病情。比如中暑、中湿等各种病症，与中风截然不同，所以要随时制宜，这是医生的要诀。
暑邪，是夏令的阳邪，从口鼻而入，脾经首先受到侵害，心肺其次。热症多属阳，属于气有余；暑症多属阴，属于气不足。这与治疗感受寒邪的方法大相径庭，适宜温散而不适宜过热，适宜清凉而不适宜过寒，张仲景的方剂大多不可用。而且暑邪的兼症很多，有兼伤风的，有兼伤寒的，有兼伤湿的，有兼伤食的，而最重要的是兼湿与食最多。大概夏季土地湿润、湿热交蒸，暑邪必然多夹湿，而体内没有积食，也断然不会成为大患。然而或者疟疾或者痢疾，或者霍乱吐泻，在当时发作的为轻症，入秋后发病的为伏暑，极难痊愈，深秋更严重，如果到霜降后发病，根据五行六气的道理……
脾属湿土。湿，是土的气化。从地而上，它附着于人，则有内感和外感的不同。雨水淋漓，汗浴满身，其伤害在皮肤经络，而也有兼风、兼寒、兼热、兼暑的各种病症。而且有中湿很重的，出现口眼歪斜、舌强语涩、筋骨拘挛、四肢麻木，形状像中风，但不能按中风治疗。大约湿在表宜用汗法，即解肌；湿在里宜用泄法，即通利二便。又须扶脾以充实它，温中以祛除它，这就是治疗湿病的能事。
经文说：燥是阳明秋金之气所化。金能生水，燥则无法滋润肾阴而化源断绝，肾水既已断绝，不能灌溉五脏，滋养全身骨骼，那么周身都会干枯而更加干燥。这种病多由酒色过度引起，火盛水衰，遂至逐渐加剧。也有因为肺受风火，咳嗽多痰，久咳伤津液，而成燥症的。或者皮肤甲错，或者肌肉枯瘦，或者咽喉干燥声音嘶哑，总宜用甘寒生津味的药物来治疗。轻的用天冬、地黄、梨浆、藕粉，重的用龟鳖胶、牛羊乳及燕窝等物，尤其宜清心寡欲，嗽口咽津，自然能逐渐痊愈。如果再使用温性药剂，或者不戒酒色，必定导致丧命，千万不要忽视。
五脏六腑，各具真气。气有余便是火，所以各条经脉都有火，而心、肝、命门三条经脉实际上主宰着它们。劳伤郁闷，盛怒极乐，都能生火。肝火盛则伤脾，心火炎则伤肺，命门火炽则伤肾，这种火是由内产生的。至于内寒暑湿各种病症，身体发出壮热，久郁而成火，这是四季邪气所传变的结果。又有肝移热于胆，心移热于小肠，肺移热于大肠，肾移热于膀胱，而其祸患不可穷尽。火既然为患，必须泻之，而有以散为泻的，如柴胡、葛根之类；有以泄为泻的，如黄芩、黄连之类；有以滋阴为泻的，如知母、黄柏、玄参之类；有以补气为泻的，如人参、[缺字]、甘草之类（所谓甘温胜大热）。这在于善于使用者灵活变通罢了。
凡是感受时疫，初起总觉得寒毛竖立，或者四肢发冷。所以俗人遇到外感，无论风温暑湿，都称为伤寒，而用解表发散的方法治疗。日子久了邪气进入中焦，或者由表入里，总觉得化为热，将有口渴、便秘、烦躁、谵语等症状，所以俗人都称为火症，而用凉泻的方法治疗。不知道其中三因所受，变化多端，必须随症分经论治，才能奏效。否则一方之内，不必全误，但只要有一两味不宜服用，不仅各种药物无效，而且弊端立刻显现。后来者不知道什么药没投对，又变换方法治疗，这样误人必多。
治病的方法，望、闻、问、切，四个方面并重。现在的人专取诊脉，已经多有遗漏。何况病患禀赋性格有偏差，脉象也各异，或迟或数，或大或小，医者平时不熟悉，而病家所告知的症状又多混杂，甚至轻重颠倒，虚实互移，如此而想凭借所诊得的脉象，就确定方剂治病，大多不适宜。所以凡是初诊切脉务必审慎，必须揣度情理，确有见地，然后才开立方剂，并且在初方中预防其变症。就像善于下棋的人，开局落子，算计到几十步以后，自然能全局得手。如果等到用药不合，然后再筹划治法，即使能治好病，终究不是良医，说是因为那人抱病已久缘故。况且如果变症迅速，来不及改变策略，又担心病家更换庸医，辗转蹉跎，人命至重，怎么能一误再误？
养生家应当在平日调和气血，保惜精神。酒色嗜欲，一无沉溺，喜怒悲恐，一无过伤，那么自然……（原文此处似有缺漏，意译为自然健康无病）。这固然不是医生所能居功的。
少年酒色不谨慎的人，猝然感受时邪，必然头晕身重，气体困惫，这是由于正气早已被损伤的缘故。经文说：邪气……（原文此处似有缺漏，意译为邪气盛则实，精气夺则虚等），泄亡阴，拖延日久，而神昏气短，痉厥之症，交替发作而至，医生因为前次已经服用了攻散的药物，就投以人参、[缺字]、当归、地黄，或者加入桂枝、附子，像这样的，绝对没有生机，深可哀悼。治法应当在邪气未入里时，用人参苏饮、枳术丸等方，加减调理。如果到了八九天，症状仍未退去，且必定加剧，就宜用复脉汤（即炙甘草汤加减），助其正气，滋其真阴，然后邪气自然解除。如果药饵误投，形势已经危殆，那么牛黄丸、至宝丹、紫雪丹之类，斟酌使用，也可以救活十分之二三，这都是我所经验过的。
嘉庆、道光年间，越地某位医生，颇有名气，但过于慎重，明知该症应当攻下导滞，却不肯骤然进补方。大约需要多天，才开始稍稍补益，而那个人已经极度疲惫了。我责问他原因。他说：古人立方，解表有大青龙、小青龙，攻里有大承气、小承气、大陷胸、小陷胸，和解有大柴胡、小柴胡，也是审慎的意思，先轻后重，如果轻症得效，那么重症就不必施用了。我笑而不答。张仲景设立方剂，各有专治，宜重宜轻，丝毫不容假借，哪里有先试轻剂，后用重剂的道理呢？
俗语说：百病皆由痰起。痰的名称，不见于《内经》。张仲景的书中有五饮，痰饮是其中之一。此后医家谈论治疗痰症的渐渐增多，而一定要以治脾为先，大概痰本是饮食所化。脾气健运，则痰无从产生，脾气一弱，则痰多而上出于肺窍，所以治疗痰症的方剂，大抵都是脾肺药。但痰有因寒而生的，有因火而生的，有因风而生的，有因湿而生的，治疗它们各有根本，都是实痰。而虚痰又有两种，一种是由脾虚不能化食，火郁为痰，痰稠而浊；一种是由肾虚不能制水，水泛为痰，痰稀而清。治法应当分阴阳来治疗，或者补其气，或者补其阴，不专门主抓消痰。现在的人多嗜好烟草，终日吸食，加上饱食酒肉，所以晨起痰嗽一定厉害，这就是即使服药也不易消除，到积病既深，痰声咯咯，由丹田而上至胸膈，则危在顷刻。
左氏传言，非鬼非食，鬼也是病的一种。蛮夷回部，酷信巫鬼，每次生病必祈祷，越地妇女多好此道。……（原文此处似有缺漏，意译为祈祷后病愈），就豁然痊愈。但元气稍弱，这是因鬼得病的人，或者病已数日，神气薄弱，忽有鬼物，凭以求食，祈祷后，鬼去而病仍在，尚须医治，这是因病生鬼的人。总之，既然遇鬼疾，自应祛遣，切勿倚仗迂腐儒生无鬼的言论，与之作难，致使病者受累。不过以医药为主，不要徒然听命于鬼而已。至于夙世冤缠，三生孽报，时至相逢，必取其命，虽然佛偈仙经，也无从为之挽救耳。
形体肥胖的人多痰，宜用六君子汤之类。形体消瘦的人多火，宜用琼玉膏之类。童稚之人多阴虚，宜用六味地黄汤之类。老年之人多阳虚，宜用七宝美髯丹之类。这是平时的调理方法。治病三法，针灸与药饵并重，《左传》所谓攻之达之者也。现在针灸已失真传，灸法根据铜人图按穴炷艾，还有治病奏效的，但也只适用于劳损未成，及风湿痿痹的病症为宜。至于太乙雷火神针，还流传几个方子，都没有全效。乃近二十年来治痧之术盛行，无论老幼男妇，冬寒夏暑，遇有心痛腹痛，肝胃气痛，以及感冒发热吐泻等病，都称之为痧，就用刀针刺舌下，与两臂等处出血，谓之放痧，间或有得愈的，哄然同声，以为神技，遍行城乡。所以在寒热不节之时，民间免于刺血的人很少了。夫痧不仅在《内经》不载，诸名家也都未提及，只有阴阳水治干霍乱，俗名绞肠痧，见于后人。本草方书，也未听说有刺取其血的说法。大概邪入血分，郁结而成，所以刺血多变黑色。如果血色不变，则不是痧。本非痧而刺之，徒伤气血，经络空虚，适足以召邪而生病。所以放痧的人，必多感染胃病，愈病愈刺，久之则成弱症而死。总之，针砭本是古法，久已无传，苟非极闷极痛，命在呼吸者，都可以用药调治，切勿轻试刀针。我曾苦口劝人，多未见信，难道是劫运所定，或者以此代替刀兵之数吗？唉，可悲啊！
近来鸦片烟遍行宇内，一半由游手好闲之子，花柳娱情；一半由幕友吏胥之徒，深宵办案，此外则有因借以治病而吸之者。鸦片系罂粟苞浆，性本涩肠敛肺，夷人和以毒物，煎成烟膏，惟久泻久嗽滑脱之症，及肝病不犯上焦者，吸之颇为有效。然而病未除而瘾已成，犹如进野狼以驱虎，而服之无效的，反添一吸烟之患。且即使治病果痊，全资烟力，久之气血亏损，嗽泻肝病，一旦复发，必然加重，烟也不效，并非他药所能治，而成必死之症矣。夫《本草纲目》、《证治准绳》两书，无数佳品，无数良方，何病不可医？何药不可用？而必假此毒物也哉！
The author of *Wen Yi Lun* (Treatise on Pestilential Fevers) posited that epidemic pathogens generally reside in the Mo Yuan (Membrane Source, a location between the exterior and interior), and therefore specifically utilized Da Yuan Yin (Reach the Origin Decoction) along with heavy doses of Rhubarb. This was indeed a unique insight. Occasionally, it could cure the disease, but...
Since Zhang Zhongjing, those discussing treatment have known to distinguish between Exterior (Biao) and Interior (Li) syndromes. The Foot-Taiyang Bladder Meridian is the Exterior within the Exterior; the Foot-Yangming Stomach Meridian is the Interior within the Exterior; the Foot-Shaoyang Gallbladder Meridian is the Half-Exterior Half-Interior. From this deduction, the Three Yin meridians (Taiyin Spleen, Shaoyin Kidney, Jueyin Liver) all belong to the Interior. This has almost become an unchangeable doctrine for millennia.
In our dynasty, Ye Tianshi, in treating diseases, uniquely distinguished among the Upper, Middle, and Lower Jiao (Triple Burner) beyond just Exterior and Interior. This truly elucidated theories not previously expounded by predecessors. The Lung belongs to the Upper Jiao, the Heart and Spleen to the Middle Jiao, and the Kidney to the Lower Jiao. The human Jiao runs from top to bottom, like latitude in the sky; the human Jiao runs from bottom to top, like longitude in the sky. One vertical, one horizontal, they use each other mutually and cannot be neglected. Moreover, when Wind-Cold invades the body, it mostly enters through the pores.
The human body consists merely of Yin and Yang. What Yin and Yang differentiate are merely Ying (Nutritive Qi) and Wei (Defensive Qi). What Ying and Wei govern are merely Blood and Qi. Blood belongs to Yin, Qi belongs to Yang; Blood belongs to Ying, Qi belongs to Wei. This is common knowledge. Thus, people believe Qi should ascend and not descend, while Blood should descend and not ascend. However, if Qi sinks, it leads to diarrhea or collapse; if Qi rushes upward, it leads to asthma or hiccups; if Blood surges upward, it leads to hematemesis or epistaxis; if Blood leaks downward, it leads metrorrhagia or uterine bleeding. These are all pathological states. Therefore, using Ginseng and Astragalus to tonify Qi takes advantage of their ascending properties, but must be assisted by Yin-tonifying herbs, so that within ascent there is descent. Using Angelica Sinensis and Rehmannia to tonify Yin takes advantage of their moistening and descending properties, but must be assisted by Yang-tonifying herbs, so that within descent there is ascent.
Generally speaking, sweet herbs harmonize the Middle Jiao, bitter herbs dry dampness, sour herbs astringe, pungent herbs disperse, salty herbs soften hardness, and bland herbs promote diuresis. This is the Direct Treatment (Zheng Zhi). Treating cold with cold (using cold herbs for true heat presenting as false cold), treating heat with heat (using warm herbs for true cold presenting as false heat), treating obstruction with purgatives (using draining herbs for excess-type obstructive symptoms), and treating stagnation with tonics (using tonifying herbs for deficiency-type stagnant symptoms) constitute the Contrary Treatment (Cong Zhi). For deficiency, tonify the Mother organ; also, the Child can make the Mother full. For excess, drain the Child; also, the Child can steal the Mother's Qi. Because of the generating relationship, they mutually utilize each other; this is the Constant Method. For Spleen disease, soothe the Liver; for Liver disease, strengthen the Spleen; for Kidney disease, clear the Heart Fire; for Heart disease, nourish the Kidney Water. This is the Two-Step Treatment (Ge Er Zhi Fa). For Liver disease, benefit the Lung (such as Zuo Jin Tang); for Spleen/Stomach disease, warm the Kidney Yang, or assist the Ming Men (Gate of Life) Fire. This is the Three-Step Treatment (Ge San Zhi Fa).
The world groups Zhang Yuansu, Li Dongyuan, Liu Wansu, and Zhu Danxi together, yet lists Zhang Zhongjing among them. I pondered that Zhang Zhongjing was a person of the Eastern Han Dynasty, and his formulas and theories were entirely based on the *Su Wen* (Basic Questions) and *Ling Shu* (Spiritual Pivot). He is actually the ancestor of medical practitioners for a hundred generations; how could the other three merely follow him? Later, reading Lu Dingpu’s miscellaneous notes, it stated that Zhang Zhongjing is not in the list of the Four Masters; the "Zhang" refers to Zhang Zihe (Zhang Congzheng), who was on par with Dongyuan, Hejian, and Danxi. Their treatment methods each elucidated a specific principle, establishing distinct schools. This argument is very fair and aligns with my own views, so I hastily recorded it.
Qi-tonifying herbs are mostly warm and rarely cool; Blood-tonifying herbs are mostly cool and rarely warm. This is the differentiation of Yin and Yang. However, the Lung governs exhalation, and the Kidney governs inhalation. When Qi is deficient... [text missing], this is not the method to assist Righteous Qi. When Yang generates, Yin generates; when Qi is strong, it controls Blood. In cases of Blood deficiency, some are suitable for supporting Yang and tonifying Lung Qi, and warm herbs are appropriate. However, one must absolutely not use overly warm herbs like Realgar, Aconite, Sichuan Pepper, or Ginger for those with little Blood, as these are sufficient to consume the Blood.
Ginseng is the supreme herb for supporting Yuan Qi (Original Qi). It is suitable regardless of whether used for releasing the Exterior or purging the Interior. Therefore, ancient formulas used Ginseng extensively. However, the Ginseng used then came from Shangdang, located in the Central Plains, with a mild nature and flavor. Our dynasty uses Liaodong Ginseng, which is located偏 (biased) to the East, thus having a warm nature that ascends. As for Goryeo Ginseng from Korea and Japanese Ginseng, the further east the origin, the more biased its nature. Its efficacy in tonifying deficiency is insufficient, while its tendency to aid Heat is excessive. Those with external pathogens or chronic Liver disease must use it with discretion. One cannot rigidly apply ancient formulas to modern herbs. By extension, if Atractylodes Macrocephala is not wild, its nature is thin and dry; if Cinnamon Bark is not grown in kiln caves, its flavor is pungent and causes Heat to flare upward (Annam Cinnamon is no longer available). Neither is sufficient for success. Slight impropriety leads to many adverse effects, which doctors should know.
Among the Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire), Wind is primary. Among heaven and earth, only Wind penetrates everywhere. Thus, in human illness, Wind syndromes are heaviest and can combine with the other five excesses, generating hundreds of diseases. Combinations include: Cold-Wind, Damp-Wind, Summerheat-Wind, Dryness-Wind, Fire-Wind. Essentially, various syndromes can generate Wind. Variations include Head Wind, Brain Wind, Throat Wind, Liver Wind, Stomach Wind, Intestinal Wind, Crisscross Knee Wind, Scrotal Wind, Joint Wind, as well as Wind Pathogen, Wind Bi (Arthralgia), Wind Paralysis, Wind Urticaria, Wind Hemiplegia, Wind Mania, etc. Light severity is Wind Injury; severe severity is Wind Stroke. Ultimately, it is because True Qi is first deficient, and Ying/Wei are sparse, allowing Wind Pathogens to invade via deficiency. Hence, Wind syndromes are mostly Deficiency and rarely Excess. The treatment methods of Dongyuan, Hejian, and Danxi vary in promoting Qi circulation, nourishing Blood, resolving Phlegm, and clearing Heat, without exclusively using Wind-dispelling agents.
Zhang Zhongjing wrote *Shang Han Lun* (Treatise on Cold Damage), likely using Cold Disease as the outline for various syndromes. In the human body, Yang abundance brings life, Yin abundance brings death. Cold is a Yin-miserable Qi; invading the body causes disease and depletes Yang. Therefore, Zhang Zhongjing’s formulas mostly prioritize warm agents. Except for purgative formulas: if Cold Pathogen is in the Exterior, use warm dispersants to induce sweating, such as Ephedra Decoction (Ma Huang Tang), Cinnamon Twig Decoction (Gui Zhi Tang), or Major Green Dragon Decoction (Da Qing Long Tang). If Cold Pathogen is in the Interior, use warm-hot agents to dispel it, such as Center Regulating Decoction (Li Zhong Tang) or Four Reversal Decoction (Si Ni Tang). This is truly the core method for treating Cold Diseases, which later generations should observe. Regarding seasonal pathogens, whether Warm, Damp, or Summerheat, some resemble Cold Damage, but treatments differ greatly. Do not exclusively use warm-hot herbs, lest you cause delay. Symptoms like Summerheat Strike or Dampness Strike are distinctly different from Wind Stroke. Adapting to circumstances is the physician's essential secret.
Summerheat is the Yang Pathogen of summer, entering via mouth and nose. The Spleen Meridian suffers first, followed by the Heart and Lungs. Heat syndromes are mostly Yang, belonging to Qi excess; Summerheat syndromes are mostly Yin, belonging to Qi deficiency. This differs greatly from treating Cold Pathogen invasion. It suits warm dispersal rather than overheating, and cooling rather than over-chilling. Zhang Zhongjing’s formulas are mostly unusable. Summerheat has many combined syndromes: combined with Wind, Cold, Dampness, or Food Stagnation. Most commonly, it combines with Dampness and Food Stagnation. In summer, the earth is humid and muggy; Summerheat inevitably carries Dampness. Without internal Food Stagnation, it will not become a major disaster. However, Malaria or Dysentery, or Cholera-like vomiting and diarrhea occurring at the time are mild. If it becomes Latent Summerheat after autumn, it is extremely difficult to cure, worsening in late autumn. If onset occurs after Frost Descent, according to the theory of Five Elements and Six Qi...
The Spleen belongs to Wet Earth. Dampness is the Qi of Earth. Rising from the ground, attaching to humans, it differs in Internal and External contraction. Rain and sweat soaking the body injure the Skin and Collaterals, potentially combining with Wind, Cold, Heat, or Summerheat. Severe Dampness Invasion can cause facial paralysis, stiff tongue, slurred speech, tendon spasm, and limb numbness, resembling Wind Stroke but must not be treated as such. Generally, Dampness in the Exterior requires sweating (releasing the muscle layer); Dampness in the Interior requires purging (unblocking urination and defecation). One must support the Spleen to solidify it and warm the Middle to dispel it. This completes the task of treating Dampness.
The Classics state: Dryness is transformed from the Metal Qi of Autumn (Yangming). Metal generates Water. Dryness fails to nourish Kidney Yin, cutting off the source. Once Kidney Water is exhausted, it cannot irrigate the Five Zang organs or nourish the bones, causing the whole body to wither and become drier. This disease often arises from excessive alcohol and sexual activity, with Fire abundant and Water deficient, gradually worsening. Some arise from Lung affected by Wind-Fire, chronic cough with phlegm, long-term fluid consumption leading to Dryness Syndromes. Symptoms include skin scaling, emaciation, dry throat, and hoarseness. Generally, treat with sweet-cold fluids that generate Water. Mild cases use Asparagus Root, Rehmannia, Pear Juice, Lotus Root Powder. Severe cases use Turtle and Softshell Turtle Gel, Cow/Sheep Milk, Bird's Nest. Especially advisable to calm the Heart and reduce desires, rinse mouth and swallow saliva, naturally recovering. If warm agents are used again, or alcohol/sex not abstained from, death will result. Do not ignore this.
The Five Zang and Six Fu organs each possess True Qi. Excess Qi becomes Fire. Thus, all meridians have Fire, primarily governed by the Heart, Liver, and Ming Men (Gate of Life). Labor injury, depression, extreme anger, and extreme joy all generate Fire. Liver Fire excess injures the Spleen; Heart Fire flares injures the Lung; Ming Men Fire blazing injures the Kidney. This Fire is internally generated. Regarding internal Cold, Summerheat, and Dampness, if the body develops high fever, long stagnation turns into Fire. This is transmission of seasonal pathogens. Furthermore, Liver transfers Heat to Gallbladder, Heart to Small Intestine, Lung to Large Intestine, Kidney to Bladder. The disasters are endless. Since Fire is a disaster, it must be drained. Draining via dispersal includes Bupleurum and Kudzu. Draining via purging includes Scutellaria and Coptis. Draining via nourishing Yin includes Anemarrhena, Phellodendron, and Ophiopogon. Draining via tonifying Qi includes Ginseng, [Missing Character], and Licorice (the so-called "Sweet-Warm conquers Great Heat"). This depends on the skillful user to adapt and connect.
Whenever contracting Seasonal Epidemics, initially one feels chills or cold limbs. Thus, laypeople call any external contraction Wind-Warmth, Summerheat, or Dampness "Cold Damage" and treat with dispersal. After days, pathogen enters Middle Jiao or moves from Exterior to Interior, turning to Heat, causing thirst, constipation, irritability, and delirium. Laypeople call this "Fire Syndrome" and treat with cooling purgatives. They do not know that the Three Causes received lead to varied changes. One must treat according to syndromes and meridians to be effective. Otherwise, even if most of a formula is correct, if one or two herbs are unsuitable, not only will the drugs fail, but adverse effects will appear immediately. Successors, unaware of what was wrong, change methods. This causes much harm.
Treatment methods rely equally on Observation, Listening/Smelling, Inquiry, and Palpation. Modern physicians focus solely on pulse diagnosis, leading to omissions. Patients have different constitutions, resulting in varied pulses (slow/fast, large/small). If the physician is unfamiliar and patient reports are mixed, or severity/virtue shift, relying solely on pulse to prescribe is inappropriate. Initial palpation must be cautious. One must judge circumstances and principles, have firm insights, then prescribe, preventing complications in the initial formula. Like a skilled chess player calculating dozens of moves ahead. If one waits for mismatched medication to plan anew, even if curative, it is not good medicine, due to prolonged illness. Moreover, if complications arise rapidly, changing course is hard. Fear of patients switching to quacks leads to delays. Human life is precious; how can one err twice?
Health preservers should harmonize Qi and Blood daily, conserve Spirit. Indulge not in alcohol, sex, or desires. Do not overexert emotions (anger, joy, sorrow, fear). Then naturally... [text missing]. This is indeed not merit attributable to the physician.
Youths careless with alcohol and sex, suddenly contracting seasonal pathogens, suffer dizziness, heaviness, and exhaustion. This is due to early damage to Righteous Qi. The Classics state: [Text Missing]... Drainage leads to Yin loss. Prolonged, it causes confusion, shortness of breath, convulsions, and syncope. Physicians, seeing previous use of dispersing/purgative drugs, administer Ginseng, [Missing], Angelica, Rehmannia, possibly adding Cinnamon and Aconite. Such cases have no hope of survival, deeply lamentable. Treatment should use Ginseng and Perilla Drink or Immature Bitter Orange and Atractylodes Pill before pathogen enters Interior. If after 8-9 days symptoms persist and worsen, use Pulse Restoring Decoction (Modified Zhi Gan Cao Tang) to boost Righteous Qi and nourish True Yin, then pathogen resolves. If medication error leads to critical danger, use Cal Bovis Pills, Treasure of the Ultimate Elixir, or Purple Snow Pills酌情 (discretionarily). Can save 20-30%. These are my experiences.
During Jiaqing and Daoguang reigns, a famous doctor in Yue region was overly cautious. Knowing the syndrome required purging/dredging, he refused sudden tonification. Days passed before slight tonification, by which time the patient was exhausted. I questioned him. He said: Ancients' formulas for Exterior release (Green Dragons), Interior purging (Chengqi, Xianxiong), and Harmonizing (Chaihu) imply caution: light first, heavy later. If light works, heavy is unnecessary. I smiled silently. Zhang Zhongjing’s formulas have specific indications. Heavy or light, no compromise. How could one test light first, then heavy?
Saying: "All diseases arise from Phlegm." Phlegm is not in *Nei Jing*. Zhang Zhongjing mentions Five Drinks, including Phlegm-Drink. Later physicians discuss Phlegm treatment frequently, prioritizing Spleen. Phlegm transforms from food. Strong Spleen transport prevents Phlegm; weak Spleen allows Phlegm to rise to Lung orifices. Thus, Phlegm formulas are mostly Spleen/Lung herbs. Phlegm arises from Cold, Fire, Wind, or Dampness. Each has a root; these are Excess Phlegm. Deficient Phlegm has two types: Spleen deficiency failing to transform food, Fire stagnation creating thick/turbid Phlegm; Kidney deficiency failing to control Water, Water flooding creating thin/clear Phlegm. Treat by distinguishing Yin/Yang, tonifying Qi or Yin, not solely focusing on eliminating Phlegm. Modern people smoke tobacco, eat rich foods. Morning phlegm-cough is severe. Even with medication, hard to eliminate. Deep accumulation, rattling phlegm from Dantian to chest, is critical.
Zuo Zhuan says: Not ghosts, not food. Ghosts are one aspect of disease. Barbarian Hui tribes believe in witchcraft/ghosts, praying when sick. Yue women favor this. ... [Text Missing] ... Prayer cures instantly. But if Original Qi is weak, it is "Ghost-caused Illness." If sick for days, Spirit weak, ghosts demand food, prayer removes ghosts but illness remains, requiring medical treatment. This is "Illness-caused Ghosts."总之 (In short), encountering Ghost Disease, one should dispel it. Do not rely on Confucian denial of ghosts to hinder treatment, burdening the patient. Prioritize medicine, do not blindly obey ghosts. As for karmic retribution from past lives, meeting fate demands death; Buddhist sutras and immortal scriptures cannot save them.
Obese people have much Phlegm; use Six Gentlemen Decoction. Emaciated people have much Fire; use Qiongyu Paste. Children have much Yin Deficiency; use Six Flavor Rehmannia Decoction. Elderly have much Yang Deficiency; use Seven Treasures Beard Beautifying Pill. These are daily regulation methods. Treatment involves Acupuncture/Moxibustion and Herbs equally, as per *Zuo Zhuan* "Attack and Reach." Modern acupuncture lost true transmission. Moxibustion based on Bronze Man diagrams still works for early consumptive diseases and Wind-Damp Bi syndromes. Taiyi Thunder Fire Divine Needle has few formulas, none fully effective. In recent 20 years, Sha (Sand/Plague) treatment is prevalent. All ages/genders, winter/summer, with heart/abdominal pain, Liver/Stomach Qi pain, or cold/fever/vomiting/diarrhea, are called Sha. Prick tongue underside and arm collaterals to bleed, called "Releasing Sha." Sometimes cures, hailed as divine skill, spreading widely. During temperature fluctuations, few avoid pricking. Sha is not in *Nei Jing*, nor mentioned by masters. Only Yin-Yang Water for Dry Cholera (Intestinal Colic Sha) appears later. Materia Medica/Formulary books mention no bloodletting. Generally, pathogen enters Blood level, stagnates, blood turns black upon pricking. If color unchanged, not Sha. Pricking non-Sha harms Qi/Blood, empties collaterals, invites pathogens. Sha-prickers often get Stomach issues; repeated pricking leads to weakness and death. Needles/blades are ancient methods, now lost. Unless extreme suffocation/pain, life hanging by thread, use medication. Do not lightly try blades. I advised earnestly, ignored. Is it fate? Or replacing war casualties? Alas, tragic!
Recently, Opium spreads globally. Half by idle youths seeking pleasure; half by clerks working late nights; some use it for illness. Opium is Poppy sap, astringent intestines/lungs. Foreigners mix poison, boil into paste. Effective for chronic diarrhea/cough with slipping, or Liver disease not affecting Upper Jiao. But addiction forms before cure, like bringing wolves to drive tigers. Ineffective users add smoking hazard. Even if cured, reliant on opium. Long-term Qi/Blood depletion, cough/diarrhea/Liver disease worsens upon cessation. Opium fails, other drugs fail, becoming fatal. *Ben Cao Gang Mu* and *Zheng Zhi Zhun Sheng* have countless good drugs/formulas. Why use this poison?