再温热之病，看舌之后，亦须验齿。齿为骨之余，龈为胃之络。热邪不燥胃津，必耗肾
液，
且二经之血，皆走其地。病深动血，结瓣于上。阳血者，色必紫，紫如干漆。阴血者，色必
黄，黄如酱瓣。阳血若见，安胃为主；阴血若见，救肾为要。然豆瓣色者多险，若症还不逆
者，尚可治，否则难治矣。何以故耶？盖阴液竭，阳上厥也。
齿若光燥如石者，卫热甚也。若无汗恶寒，卫偏胜也，辛凉泄胃透汗为要。若如枯骨色
者，
肾液竭也，为难治。若上半截润，水不上承，心火炎上也，急急清水救水，俟枯处转润为妥
。若切牙嚼齿者，湿热化风痉病。但切牙者，胃热气走其络也。若切牙而脉症皆衰者，胃虚
无谷以为荣，亦切牙也。何以故耶？虚则喜实也。舌本不缩而硬，而牙关咬定难开者，此非风
痰阻络，即欲作痉症，用酸物擦之即开。酸走筋，木来泄土故也。
若齿垢如灰糕样者，胃气无权，津亡湿浊而重多死。而初病齿缝流清血痛者。胃火冲激
也，不痛者，龙火内燔也。齿焦无垢者死；齿焦有垢者，肾热胃劫也，当微下之，或玉女煎清胃
东垣之久病不知饥饱，不见皮枯毛瘁，乃痰饮为患。
叶案中风门，用人参必于病势已退后，用以培元养气。当病甚时，亦与于驱风之药同用
，其分两亦不过几分至钱，无不中度。余病用参可类推。(肝风)火盛者，叶先生用羚羊角、山栀
、连翘、花粉、元参、鲜生地、丹皮、桑叶，以清泄上焦窍络之热，此先从胆治也。痰多者
，必理阳明，消痰如竹沥、姜汁、菖蒲、橘红、二陈汤之类，中虚则用人参，外台茯苓饮是
也。下虚者，必从肝治，补肾滋肝，育阴潜阳，镇摄之治是也。久嗽而用建中汤诸法，治中
宫之虚，乃补母之义，真古圣相传之正法。若阴火虚劳之嗽，与建中正相反，此老用此得手
，而误施于虚劳，亦辨之不审耳。
凡上实者下必虚，薄味清其上焦，正以安下，令其藏纳也。(吐血)凡咳血之脉，右坚者
，治
，乃肝肾阴伤所致，宜地黄、阿胶、枸杞、五味等类。脉弦肋痛者，宜苏子、桃仁、降香、
郁金等类。成盆盈碗者，葛可久花蕊石散，仲景大黄黄连泻心汤。一症而条分缕晰，从此再
加分别，则于症自有据矣。
凡属有病必有留邪，须放出路，方不成痼疾。惟气血欲脱，一时急救，不在此例，稍定
即当思治病之去矣。
诸项失音，皆有可愈之理，惟用麦冬、五味、熟地、桔梗等药，补住肺家痰火，以致
失音，则百无一生，独不言及何也？又麦冬、五味，是失音之灵丹。
大凡内损精血形气，其胃旺纳食者，务在滋填。如食减不纳，后天生气不振，浓浓填补
，于
理难进，当用生脉四君子汤。脾肾双顾，清邪在上，必用轻清气药。如苦寒治中下，上结更
闭。
湿无阳气不发，阳伸之极，湿发亦重。
凡久患虚损之弱体，吸受温邪，脘闷渴饮，气机阻塞，不敢照平人迳行开泄(如杏仁、
桔梗、蔻仁、牛蒡子之类。)应清扬涌上，淡以和气，庶上焦得行，可进养胃等法。
大凡六气伤人，因人而化。阴虚者火旺，邪归营分为多。阳虚者湿胜，邪伤气分为多，
一则
耐清，一则耐温，腻性之阴阳，从可知也。瘦人之病，虑涸其阴。肥人之病，虑虚其阳。
古人论病，必究寝食。今食未加餐难寐，神识未清，为病伤元气。而热病必消烁真阴，
议用三才汤意。
凡卫气攻痛，从背而上者，系督脉主病，治在少阴。从腹而上者，治在厥阴，系冲任主
病；或填补阳明，此治病之宗旨也。
大凡津液结而为患者，必佐辛通之气味。精血竭而为患者，必藉血肉以滋填。大凡邪在
阳可散，入阴之邪，必温经可托出留邪，为解之化之不同法也。
上实下虚，医为肾虚，萸、地填阴原不为过。但肾水内寓真火宜温，肝木相火宜凉。凡
益肾
取乎温养，必佐凉肝以盐制，方无偏党(如肉苁蓉、巴戟肉、枸杞子加白芍之类。)(肿胀)经
云∶从上之下者，治其上。又云∶从上之下而甚于下者，必先治其上而后治其下。
《内经》肝病，不越三法。辛散以理肝，酸泄以体肝，甘缓以益肝，宜辛甘润温之补。
盖肝为刚脏，必柔以济之，自臻效验耳。
虚劳之脉必数，而有浮大细小之别。浮大而数，阴虚甚也。细小而数，阴中之阳绝矣。
又有一种阳虚者，脉不数，但缓而大不收，奄奄无力。
土为五行之本，土无定位，分发四季寄体中宫。火藉之而不焰，水藉之而不泛，金藉之
而能
生，木藉之而不凋，故脾神为黄婆，心神为婴儿，肾神为 女。修炼家升坎填离，欲男女交
妒，须赖黄婆牵合，以脾胃为后天之根本也，然非专以补脾胃而言也。仲景因胃实致心肾不
交，用承气汤下之。用和因脾虚，致心肾不交，制归脾汤补之，皆是黄婆牵合之义。心肺为
一身之主宰，六经之纲领。凡病皆以气血为主持，气血若足，即邪犯六经，亦无所害；气血
不足，则君忧臣辱，君辱臣危矣。故初病之时，气血未伤，犹兵多粮足国固，用军之得其宜
，则贼自散。若因循苟且，坐失机宜，则姑息养奸，贼势自盛，正气日哀，再思背城一战，
纵得贼去，而国未有不俱败者也。所以过经坏病，或补正逐邪，或养阴退热，其法不可不知
也。凡用药治病，当因人而施。如皮肤娇嫩，气虚多痰者，宜用温燥。色苍体燥，血虚多火
者，是宜清凉。皮浓肉坚，则表必实，解肌应施。胃强脾健，则内多坚，通里当用。素生疮
疖，胎毒必盛，攻毒须投。此皆因人治症之良法，不独痘科为然。
两肾为气血之本，肾火为气之原，肾水为血之海。火足始能生土生金，水足始能生木生
火也
。盖凡人具一太极，若阴阳和平则无病。如肾中阴虚，则肝心之病起。肾中阳虚，则脾肺之
症生。至于阳盛阴涸，阴盛阳衰之症，皆造极中极之候也。一宜救阴以抑阳，一宜扶阳以制
阴。若平治之法，滋阴可以降火，补火即可生气，悟得此中理，方是医中杰。不独痘科为然
，即百病莫不知是。
老人少气少血，宜阴阳并补，(如八味丸、右归饮丸之类。)小儿为嫩阳，又为稚阳。本
是无
阴，赖此一点稚阳，以生阴血。寒凉之剂，最伐真阳，若因病致热，自当凉解，非谓小儿纯
阳，素应凉寒也。
经言误汗亡阳，必先亡离家之阴，再亡坎中之阳，阴虚阳无所附也。误下亡阴，必先亡
胃家之阳，再亡脾中之阴，阳亡阴不独存也(四损不可正治)。实症误服桂、麻，得经妙手，尚可
挽回。损症误服硝、黄，虽有明医，不可救药。治虚损六症，可不慎欤？故孔以立用人参云
∶虽能固邪，然气虚不能传化者，非人参何以砥柱中流；地黄虽腻膈，然阴虚不能作汗者，
非地黄何以泽枯润燥。倘执祛邪存正说，擅用攻泻，不知正气衰微，必不能敷布津液，坐
令虚人多致暴脱，亦必毒邪沉匿，终至不救。所以程芝田先生治实热之症，议用逐邪存正之
法。虚损之症，议用补正祛邪之法。其气虚者，于祛邪解毒中，倍加人参以补气托邪，贫者以党参、沙参代之。其血虚
者，于祛邪解毒中，倍用地黄以养血作汗。但疫
症之中，惟阴血虚者居多。因疫症多属热病，热邪最伤阴血。故余治阴虚热甚者，惟玉女煎
诸养荣汤之辈。阳盛而热甚者，惟三黄解毒犀角地黄之类。间有阳虚者，惟参麦四君辈，桂
、附究不轻投(因论疫症。)即有过服寒凉者，暂与一剂，阴气潜消，即止后服，仍以养阴为
主。固不可以实症，而报虚损之方，更不可以虚症，而用实热之法。虚实一差，毫厘千里，
未有不夭枉民命者也。故临症时，务宜于虚实上细心求之。
此外，温热类疾病，在观察舌象之后，也必须检查牙齿。牙齿是骨骼的余气所生，牙龈是胃经的络脉所在。热邪如果不耗伤胃中的津液，就一定会消耗肾中的阴液，而且足阳明胃经和足少阴肾经的血液，都流经牙齿这一部位。病情深重时动血，血液凝结在齿面上形成瓣状。属阳分的出血，血色必定紫暗，像干漆一样；属阴分的出血，血色必定枯黄，像酱色的豆瓣一样。如果见到阳血的表现，治疗以调理胃气为主；如果见到阴血的表现，救补肾阴是关键。然而，如果血色像豆瓣那样枯黄的，大多预后险恶，如果症状还没有出现逆证，还可以治疗，否则就难以治愈了。这是什么原因呢？这是因为阴液枯竭，阳气上逆厥脱的缘故。
如果牙齿光亮干燥像石头一样，这是卫分热邪炽盛。如果没有汗出且怕冷，说明卫气偏胜，治疗以辛凉药物清泄胃热、透发汗液为关键。如果牙齿颜色像枯骨一样，这是肾中阴液枯竭，属于难治之症。如果牙齿上半截湿润，下半截干燥，这是肾水不能上承，心火炎上的表现，必须紧急使用清热生津的药物来救阴，等到干燥处转为湿润才稳妥。如果出现咬牙嚼齿的现象，这是湿热化风导致的痉病。只是单纯咬牙的，是胃热之气走窜经络所致。如果咬牙且脉象症状都衰微，这是胃气虚弱，没有水谷精微作为营气来源，也会引起咬牙。这是什么原因呢？因为虚证往往表现出假实的征象（喜实）。舌根不缩短但僵硬，牙关紧闭难以张开的，这不是风痰阻滞经络，就是即将发生痉病，用酸味药物擦拭牙齿即可张开。因为酸味入筋，木气能疏泄土气（脾胃）的缘故。
如果齿垢像灰白色的糕饼样，这是胃气无权运化，津液亡失而湿浊内盛，大多死亡。初病时齿缝流出清血并伴有疼痛的，是胃火冲激所致；不痛的，是相火（龙火）在内燔灼。牙齿焦黑没有齿垢的，主死；牙齿焦黑但有齿垢的，是肾热兼胃阴被劫，应当轻微攻下，或者使用玉女煎清胃热。李东垣治疗久病不知饥饱、不见皮肤干枯毛发憔悴的，认为是痰饮为患。
叶天士医案中中风门的治疗，用人参必须在病势已经消退后，用来培补元气、滋养正气。当病情严重时，也与人参同用于驱风的药物中，其分量也不过几分到一钱，没有不合度的。我治病用人参的方法可以由此类推。（肝风）火盛的，叶先生使用羚羊角、山栀、连翘、花粉、元参、鲜生地、丹皮、桑叶，来清泄上焦窍络的热邪，这是先从胆经论治。痰多的，必须调理阳明胃经，消除痰浊如竹沥、姜汁、石菖蒲、橘红、二陈汤之类，中气虚弱则用人参，即外台茯苓饮的方法。下焦虚弱的，必须从肝经论治，补肾滋肝，育阴潜阳，这是镇摄的治疗方法。久咳而使用建中汤等方法，治疗中焦脾胃的虚弱，这是“补母”的含义，真是古圣相传的正法。如果是阴虚火旺导致的虚劳咳嗽，与建中汤的作用正好相反，这位老先生使用建中汤得心应手，但如果误施于虚劳病人，也是辨证不够审察的缘故。
凡是上部实证，下部必然虚弱，饮食清淡以清利上焦，正是为了安固下焦，使其能够藏纳精气。（吐血）凡是咳血的脉象，右手脉坚硬的，是肝肾阴伤所致，适宜用地黄、阿胶、枸杞、五味子等类药物。脉弦且胁肋疼痛的，适宜用苏子、桃仁、降香、郁金等类药物。如果出血量大成盆盈碗的，可用葛可久的花蕊石散，或张仲景的大黄黄连泻心汤。对一种病症如此条分缕析，从此再加分别，那么对于病症自然就有依据了。
凡是患有疾病，必然有留滞的邪气，必须给邪气以出路，才不会成为顽固的疾病。只有气血将要脱失的时候，需要一时急救，不在此例，稍定之后就要考虑去除病根。
各种类型的失音，都有可以治愈的道理，唯独使用麦冬、五味子、熟地黄、桔梗等药物，补住了肺家的痰火，导致失音，这种情况百无一活，为什么独独没有提到呢？又说麦冬、五味子是治疗失音的灵丹妙药。
大凡内部损伤精血形气，如果胃气旺盛能进食的，务必采用滋腻填补的方法。如果食欲减退不能进食，后天生气不振作，浓腻填补的药物在道理上难以进服，应当使用生脉散合四君子汤。脾肾双顾，清解在上部的邪气，必须使用轻清宣气的药物。如果用苦寒药物治疗中下部，会使上部的结滞更加闭塞。
湿气没有阳气就不能发散，阳气伸展到极致，湿气的发散也会很重。
凡是长期患有虚损病的瘦弱体质，吸入温邪，出现脘腹闷胀口渴想喝水，气机阻塞，不敢按照平常人的方法直接进行开泄（如杏仁、桔梗、蔻仁、牛蒡子之类）。应该用清扬升浮、淡味和气的药物，使上焦气机得以运行，才可以进养胃等治疗方法。
大凡六淫邪气伤人，会因人体质的不同而发生不同的转化。阴虚的人火旺，邪气多归于营分和血分。阳虚的人湿气胜，邪气多伤及气分。一则耐清（清热），一则耐温（温补），腻性药物的阴阳属性，从这里就可以知道了。瘦人的病，担心耗竭其阴液。肥人的病，担心损伤其阳气。
古人论述疾病，一定要究查睡眠和饮食情况。现在饮食未增加却难以入睡，神识不清，这是疾病损伤了元气。而热病必然会消烁真阴，建议采用三才汤的意旨。
凡是卫气攻痛，从背部向上走的，属于督脉主病，治疗在少阴经。从腹部向上走的，治疗在厥阴经，属于冲任脉主病；或者填补阳明经，这是治病的基本原则。
大凡津液凝结而为害的，必须佐以辛通气味的药物。精血枯竭而为害的，必须借助血肉有情之品来滋填。大凡邪气在阳分可以发散，进入阴分的邪气，必须温经托毒外出。留滞的邪气，根据化解方法的不同而有不同的治法。
上实下虚，医生诊断为肾虚，用山茱萸、地黄填补阴精原本不算过错。但是肾水中内寓的真火宜温，肝木中的相火宜凉。凡是益肾取乎温养，必须佐以凉肝的药物并用盐制，方无偏颇（如肉苁蓉、巴戟天、枸杞子加白芍之类）。（肿胀）《内经》说：从上往下发展的病，治疗其上端。又说：从上往下发展且在下面加重的，必须先治疗上面而后治疗下面。
《内经》关于肝病的治疗，不超过三种方法。辛散以疏理肝气，酸泄以收敛肝体，甘缓以补益肝气，适宜用辛甘润温的补法。因为肝是刚脏，必须用柔润的方法来济助它，自然能达到疗效。
虚劳病的脉象必定数，但有浮大细小之别。浮大而数的，是阴虚严重。细小而数的，是阴中之阳绝灭。又有一种阳虚的病人，脉不数，只是缓大而无力收摄，奄奄一息没有力气。
土是五行的根本，土没有固定的位置，分发于四季寄居在中宫（脾）。火依靠土而不燃烧过度，水依靠土而不泛滥，金依靠土而能生成，木依靠土而不凋谢，所以脾神称为黄婆，心神称为婴儿，肾神称为姹女。修炼家提升坎水填补离火，想要男女交媾，必须依赖黄婆牵合，这是以脾胃为后天的根本，然而并不是专门讲补脾胃。张仲景因为胃实导致心肾不交，用承气汤攻下。李东垣因为脾虚导致心肾不交，制作归脾汤补益，都是黄婆牵合的意义。心肺是一身的主宰，六经的纲领。凡是疾病都以气血为主要持守，气血充足，即使邪气侵犯六经，也没有危害；气血不足，就会君忧臣辱，君辱臣危。所以在初病之时，气血未受损伤，就像兵多粮足国家稳固，用兵得当，贼寇自然消散。如果因循苟且，坐失良机，姑息养奸，贼势自然强盛，正气日益衰败，再想背城一战，即使赶走贼寇，国家也没有不全部败亡的。所以经过传变后的坏病，或者补正逐邪，或者养阴退热，这些方法不可不知道。凡是用药治病，应当因人而异。如皮肤娇嫩，气虚多痰的，适宜用温燥药。面色青苍身体干燥，血虚多火的，适宜用清凉药。皮肤厚肌肉坚实，表必实，解肌法应当施用。胃强脾健，体内多有积滞，通里法应当使用。素来生疮疖，胎毒必然旺盛，攻毒必须投用。这些都是因人治症的良法，不只是痘科如此。
两肾是气血的根本，肾火是气的源头，肾水是血的海洋。火充足才能生土生金，水充足才能生木生火。大概人具备一个太极，如果阴阳平和就没有病。如果肾中阴虚，则肝心的病起。肾中阳虚，则脾肺的病生。至于阳盛阴涸，阴盛阳衰的病证，都是达到极致的候象。一种适宜救阴以抑制阳，一种适宜扶阳以制约阴。如果平治的方法，滋阴可以降火，补火即可生气，悟得其中的道理，才是医学中的豪杰。不只是痘科如此，百病没有不知道这个道理的。
老人气少血少，适宜阴阳并补（如八味丸、右归饮丸之类）。小儿是嫩阳，又是稚阳。本来是无阴，依赖这一点稚阳，来生阴血。寒凉的药剂，最伐伤真阳，如果因病导致发热，自然应当凉解，并不是说小儿纯阳，平时就应该用凉寒药。
经文说误用发汗导致亡阳，必须先亡失离家之阴，再亡失坎中之阳，阴虚则阳无所依附。误用攻下导致亡阴，必须先亡失胃家之阳，再亡失脾中之阴，阳亡则阴不能独存（四损不可正治）。实证误服桂枝、麻黄，遇到妙手医生，还可以挽回。虚损证误服芒硝、大黄，虽然有明医，也不可救药。治疗虚损六症，能不谨慎吗？所以孔以立说用人参：虽然能固护邪气，但如果气虚不能传输转化的，不是人参怎么能砥柱中流；地黄虽然腻膈，但如果阴虚不能作汗的，不是地黄怎么能润泽枯燥。如果执着于祛邪存正的说法，擅自使用攻泻，不知道正气衰微，一定不能敷布津液，坐视让虚人多致暴脱，也必然导致毒邪沉匿，最终无法救治。所以程芝田先生治疗实热的病证，建议用逐邪存正的方法。虚损的病证，建议用补正祛邪的方法。其中气虚的，在祛邪解毒中，倍加人参以补气托邪，贫者用党参、沙参代替。其中血虚的，在祛邪解毒中，倍用地黄以养血作汗。但在疫病之中，只有阴血虚的居多。因为疫病多属热病，热邪最伤阴血。所以我治疗阴虚热甚的，只用玉女煎等养荣汤之类的药。阳盛而热甚的，只用三黄解毒犀角地黄之类的药。间或有阳虚的，只用参麦四君之类，桂枝、附子终究不轻易投用（因为讨论疫病）。即使有过服寒凉的，暂时给一剂，阴气潜消，就停止后服，仍以养阴为主。决不可以用治实症的方法，去报复虚损的方剂，更不可以用治虚症的方法，去用实热之法。虚实一旦差错，毫厘千里之差，没有不夭折枉害民命的。所以临症时，务必在虚实上细心求索。
Furthermore, in warm-heat diseases (Wenre Bing), after examining the tongue, one must also inspect the teeth. Teeth are the surplus of bone (Chi wei gu zhi yu), and the gums are the collaterals of the Stomach meridian (Yin wei wei zhi luo). If pathogenic heat does not dry up Stomach fluids (Wei Jin), it will inevitably consume Kidney Yin (Shen Ye). Moreover, the blood of these two meridians flows through this area. When the disease is deep and moves blood, clots form on the teeth. Yang-type bleeding appears purple, like dried lacquer; Yin-type bleeding appears yellowish-brown, like soybean paste. If Yang-type bleeding is seen, treatment focuses on stabilizing the Stomach; if Yin-type bleeding is seen, saving the Kidney is essential. However, a color resembling soybean paste indicates a dangerous prognosis. If the symptoms are not yet adverse, it may still be treatable; otherwise, it is difficult to treat. Why? Because Yin fluids are exhausted, and Yang Qi rebels upward (Yang Shang Jue).
If the teeth are shiny and dry like stone, it indicates severe Heat in the Wei (Defensive) level (Wei Re Shen). If there is no sweat and aversion to cold, it indicates an excess of Wei Qi; the key treatment is to use pungent-cool herbs to clear Stomach Heat and induce sweating. If the teeth look like dead bones, it indicates exhaustion of Kidney fluids, which is difficult to treat. If the upper half is moist but the lower half is dry, it indicates that Water fails to ascend due to blazing Heart Fire (Xin Huo Yan Shang); urgently use cooling fluids to nourish Yin until the dryness turns moist. If teeth grinding or clenching occurs, it indicates wind-spasm transformed from damp-heat. Simple clenching is caused by Stomach Heat moving into its collaterals. If clenching occurs with weak pulse and symptoms, it is due to Stomach deficiency lacking grain essence to nourish Ying (Nutritive) Qi; this also causes clenching. Why? Deficiency often manifests as false excess. If the root of the tongue is stiff without shortening, and the jaw is locked tight, it is either phlegm-wind blocking collaterals or impending spasm; wiping with sour substances can open the jaw. Sour enters the sinews, and Wood energy drains Earth (Spleen/Stomach).
If dental plaque resembles gray cake, it indicates powerless Stomach Qi, loss of fluids, and heavy damp-turbidity, usually leading to death. If clear blood flows from tooth gaps with pain at the onset of illness, it is Stomach Fire rushing outward; without pain, it is Dragon Fire (Ministerial Fire) burning internally. Blackened teeth without plaque indicate death; blackened teeth with plaque indicate Kidney Heat and Stomach Yin depletion, requiring mild purgation or Yung Nu Jian (Jade Maiden Decoction) to clear Stomach Heat. Li Dongyuan treated long-term illness with unknown hunger/fullness and non-withered skin/hair as disorders of Phlegm-Fluids.
In Ye Tianshi’s cases for Wind Stroke, Ginseng is used only after the pathogenic force has receded, to cultivate Yuan Qi and nourish Zheng Qi. During severe illness, it is combined with wind-dispelling herbs in small doses (a few fen to one qian). My approach to using Ginseng can be inferred similarly. For Liver Wind with excessive Fire, Mr. Ye uses Antelope Horn (Lingyang Jiao), Gardenia (Shan Zhi), Forsythia (Lian Qiao), Trichosanthes Root (Hua Fen), Scrophularia (Yuan Shen), Fresh Rehmannia (Xian Sheng Di), Moutan Bark (Dan Pi), and Mulberry Leaf (Sang Ye) to clear Heat from the Upper Jiao orifices and collaterals, treating primarily from the Gallbladder. For excessive Phlegm, regulate the Yangming (Stomach), eliminating phlegm with Bamboo Sap (Zhu Li), Ginger Juice (Jiang Zhi), Acorus (Chang Pu), Tangerine Peel (Ju Hong), and Er Chen Tang. For Middle Jiao deficiency, use Ginseng, as in Waitai Fuling Yin. For Lower Jiao deficiency, treat from the Liver: tonify Kidney and nourish Liver, nurture Yin and subdue Yang, using sedative methods. For chronic cough, use Jianzhong Tang methods to treat Middle Jiao deficiency, following the principle of "tonifying the mother," a true orthodox method passed down from ancient sages. For cough due to Yin Fire and consumptive disease, this opposes Jianzhong Tang; the master used it effectively but misapplied it to consumptive disease due to imprecise differentiation.
Where there is Upper Excess, there is invariably Lower Deficiency. Light flavors clear the Upper Jiao to stabilize the Lower Jiao and facilitate storage. Regarding Hematemesis (Tu Xue): For hemoptysis with a firm Right pulse, it is caused by Liver-Kidney Yin injury; use Rehmannia (Di Huang), Donkey-hide Gelatin (E Jiao), Goji Berry (Gou Qi), and Schisandra (Wu Wei Zi). For wiry pulse with hypochondriac pain, use Perilla Seed (Su Zi), Peach Kernel (Tao Ren), Aquilaria Wood (Xiang), and Curcuma Tuber (Yu Jin). For massive bleeding filling basins, use Ge Kejiu's Huarui Shi San or Zhang Zhongjing's Da Huang Huang Lian Xie Xin Tang. Such detailed analysis provides a basis for diagnosis.
All diseases involve lingering pathogens that must be expelled to prevent chronicity. Only when Qi and Blood are about to collapse is emergency rescue required, excluding this rule; once stabilized, address the root cause. All types of aphonia have curable principles. Using Ophiopogon (Mai Dong), Schisandra (Wu Wei), Prepared Rehmannia (Shu Di), and Platycodon (Jie Geng) to tonify Lung Phlegm-Fire causing aphonia leads to death in almost all cases. Yet, Mai Dong and Wu Wei are considered spiritual elixirs for aphonia.
Generally, internal damage to Essence, Blood, Form, and Qi requires rich tonification if Stomach function is strong. If appetite is poor and post-heaven Qi is weak, rich tonics are hard to absorb; use Sheng Mai San combined with Si Jun Zi Tang to care for Spleen and Kidney. Clear pathogens in the Upper Jiao with light, clearing, Qi-moving herbs. Bitter-cold herbs for Middle/Lower Jiao worsen Upper Jiao obstruction. Dampness requires Yang to transform; extreme Yang extension leads to heavy damp transformation. In chronic deficiency weakness absorbing Warm Pathogens, with epigastric fullness and thirst, where Qi mechanism is blocked, do not use standard opening/dispersing herbs (like Xing Ren, Jie Geng, Dou Kou Ren, Niu Bang Zi). Instead, use light, ascending, bland harmonizers to move Upper Jiao Qi before proceeding to Stomach-nourishing methods.
Six Qi pathogens transform according to constitution. Yin deficiency leads to Fire dominance, with pathogens entering Ying/Blood levels. Yang deficiency leads to Dampness dominance, with pathogens affecting Qi levels. One tolerates clearing, the other warming; the nature of cloying herbs reflects this Yin-Yang distinction. Thin people risk Yin depletion; fat people risk Yang deficiency. Ancients investigated sleep and diet to diagnose. Current inability to sleep despite normal intake and unclear consciousness indicates Yuan Qi damage. Heat diseases consume True Yin; propose San Cai Tang intent.
Pain attacking Wei Qi from the back involves the Du Meridian, treated in Shaoyin. From the abdomen, it involves Chong/Ren meridians, treated in Jueyin, or by tonifying Yangming. This is the general principle.
Pathogens from coagulated fluids require pungent-unblocking aromatics. Pathogens from exhausted Essence/Blood require flesh-and-blood tonics. Pathogens in Yang can be dispersed; pathogens in Yin require warming meridians to push them out. Lingering pathogens are resolved differently based on method.
Upper Excess and Lower Deficiency: Treating Kidney deficiency with Cornus (Yu) and Rehmannia (Di) is not wrong. But Kidney Water contains True Fire (needs warming), while Liver Wood contains Ministerial Fire (needs cooling). Tonifying Kidney with warmth must be assisted by cooling Liver with salt-prepared herbs to avoid bias (e.g., Cistanche, Morinda, Goji with White Peony). Regarding Edema (Zhong Zhang): The Classic says, treat the upper if pathology descends. If descending and worsening below, treat upper first then lower.
The Neijing states three methods for Liver disease: Pungent to disperse/regulate, Sour to drain/consolidate, Sweet to relax/nourish. Use pungent-sweet-moist-warm tonics. Liver is a rigid organ, requiring softening for efficacy.
Consumptive pulse is always rapid, varying in floating-large-small. Floating-large-rapid indicates severe Yin deficiency. Small-rapid indicates extinction of Yang within Yin. Another type of Yang deficiency shows slow, large, uncollected pulse with faint strength.
Earth is the root of Five Elements, distributed through seasons via the Central Palace (Spleen). Fire relies on Earth not to blaze; Water relies on Earth not to flood; Metal relies on Earth to generate; Wood relies on Earth not to wither. Thus, Spleen Spirit is the Yellow Matron, Heart Spirit is the Infant, Kidney Spirit is the Maiden. Alchemists raise Kan to fill Li, requiring the Yellow Matron to unite male and female, emphasizing Spleen-Stomach as post-heaven root, not just for tonification. Zhang Zhongjing used Chengqi Tang for Stomach excess causing Heart-Kidney non-interaction. Li Dongyuan used Guipi Tang for Spleen deficiency causing same, both illustrating the Yellow Matron concept. Heart-Lung are masters of the body and leaders of Six Meridians. Diseases center on Qi-Blood. If sufficient, even Six Meridian invasion is harmless; if insufficient, the Ruler worries, ministers suffer disgrace. Early stage, Qi-Blood intact, is like a fortified state with ample troops/grain; proper strategy disperses thieves. Negligence allows thieves to grow,正气 declines, making final battle futile. Thus, for complicated diseases, know methods of tonifying right/draining evil or nourishing Yin/reducing fever. Medication must be individualized. Delicate skin/Qi deficiency/phlegm excess: use warm-dry. Dark complexion/dry body/Blood deficiency/Fire excess: use cool-clear. Thick skin/firm muscle: exterior excess, use muscle-releasing. Strong Stomach/sound Spleen: interior excess, use purgative. History of sores/toxins: heavy fetal toxin, use detoxification. These are good methods for individualized treatment, applicable beyond smallpox.
Two Kidneys are roots of Qi-Blood. Kidney Fire is source of Qi; Kidney Water is sea of Blood. Sufficient Fire generates Earth/Metal; sufficient Water generates Wood/Fire. Humans possess a Taiji; balance means health. Kidney Yin deficiency leads to Liver/Heart disease; Kidney Yang deficiency leads to Spleen/Lung disease. Extreme Yang excess/Yin depletion or Yin excess/Yang decline are critical stages. One requires saving Yin to suppress Yang; the other supporting Yang to control Yin. Flat treatment: Yin tonification lowers Fire; Fire tonification generates Qi. Understanding this makes one a medical hero, applicable to all diseases, not just smallpox.
Elderly have little Qi/Blood, suitable for Yin-Yang dual tonification (e.g., Ba Wei Wan, You Gui Yin/Wan). Children have tender/youthful Yang. Originally Yin-less, relying on youthful Yang to generate Yin-Blood. Cold-cool herbs injure True Yang; if illness causes heat, cool-clear is appropriate, but this doesn't mean children are purely Yang and should always use cold-cold herbs.
Classics say mistaken sweating leads to Yang collapse, first losing离家之阴 (Yin leaving home), then Kan Yang; Yin deficiency leaves Yang unsupported. Mistaken purging leads to Yin collapse, first losing Stomach Yang, then Spleen Yin; Yang collapse prevents Yin survival (Four Damages cannot be treated directly). Excess mistreated with Guizhi/Mahuang can be saved by skilled doctors. Deficiency mistreated with Xiaokui/Huanglian is incurable even by bright physicians. Treat six deficiency symptoms carefully. Kong Yili said: Ginseng solidifies pathogens but is indispensable for Qi deficiency failing to transform; Rehmannia is cloying but essential for Yin deficiency failing to sweat. Clinging to "drain evil preserve right" and using purgatives ignores that weak Zheng Qi cannot distribute fluids, leading to sudden collapse in deficiency patients, and toxins hiding until fatal. Thus, Cheng Zhitian proposed draining evil/preserving right for excess-heat, and tonifying right/draining evil for deficiency. For Qi deficiency, double Ginseng in detoxification to boost Qi and push out evil (use Dangshen/Shashen for poor). For Blood deficiency, double Rehmannia to nourish Blood and induce sweat. In epidemics, Yin-Blood deficiency is common because heat pathogens injure Yin-Blood most. I treat Yin-deficient high heat with Yung Nu Jian or Yangrong Tangs. Yang-excess high heat with San Huang Jiedu or Xijiao Dihuang. Rare Yang deficiency uses Shenmai/Sijunzi; Guizhi/Fuzi are rarely used (discussing epidemics). Even if cold-cold herbs were overused, give one dose, stop when Yin subsides, resume Yin nourishment. Do not use excess formulas for deficiency, nor excess methods for deficiency. A slight error in excess/deficiency leads to disaster, killing patients. Thus, carefully distinguish excess and deficiency during consultation.