三十年前之我，开始研究中医，这五行学说，就是我进步的第一个阻力，第一座难关，我想好好一个人，血肉之躯，肚子里那里会包着这许多金呀、木呀、火呀、土呀、水呀的，误认五行为五件东西，再也通不过，直到后来，悟到了“行”字的意义，才能够明白。
病因果之异同徐灵胎先生，果然是我们中医界前辈，他的学说，我也很钦佩，只是他说疟疾柴胡汤加减，痢疾黄芩汤加减，我却不敢附和，非但不敢附和，并且很是怀疑。
天下的万事万理，研究它的起因。种种不同，瞧着它的结果，又种种不同，偏有结果同而起因不同的，也偏有结果不同而起因偏同的，即如士农工商，所操之业不同，聪明才智-所禀之质不同，等到他埋头苦干，一旦成功，一般的立业兴家，应上句老话，行行出状元，远不是结果同而起因不同么，嫖赌吃着四件事，各具个性，老话“嫖是精空，赌是对冲，吃是最凶，着是威风，”岂不是各各不同，大大不同么，但是只要你犯上了它，恁凭那一件，到结果收场，身败名裂是一般的，这又不是结果同而起因不同么。
一群的嫖客，一群的赌客，灯红酒绿，花天酒地时的豪兴是同的，呼卢喝雉，一掷万金时的豪举是同的，到家产败尽之后，有做小窃的，有做强盗的，有做叫化子的，也有做帮闲度日的，这岂不是结果不同而起因偏同的么。
事理如此，病理也是如此，事情如此，病情也是如此。
疟疾的原因，就是风寒两邪之潜伏，风为阳邪，寒为阴邪，所以先伤于寒后伤于风者，疟疾发作起来，便是先寒而后热，名叫寒疟。先伤于风后伤于寒者，疟疾发作起来，便是先热而后寒，名叫温疟。还有但热不寒的，叫做瘅疟，那是阴气先绝，阳气独发的缘故，它的见证是少气烦冤，手足咸热。
疟疾为伏邪病之一种，所伏有浅深之不同，浅的伏在经络，深的伏在膜原，最深的伏在脏腑，却又分出伏在六腑为轻，五脏为重。逐日发的，名叫疟疾；间日发的，名叫痃疟；间两日三日发的，名叫三阴疟。逐日发的，邪不过伏在经络；间日发的。浅者伏在膜原，深者伏在六腑；间两日三日发的三阴疟，多深伏在五脏了。
从前黄帝问岐伯，痎疟皆生于风，为什么发作有时呢?岐伯回称，痃疟的发动，先起于毫毛，伸欠乃作，寒傈鼓领，腰脊俱痛，寒去内外就热，头痛如破，渴欲冷饮。黄帝问他，何气使然?岐伯回之，阴阳上下交争，虚实更作，阴阳相移呢，阳并于阴，阴就实，阳就虚。
总之一句话。疟疾之因不一其邪，疟邪之伏，不一其处，徐灵胎竟欲以柴胡一汤，统治诸疟，虽可随症加减，究嫌呆板，不能不有所疑问也。
痢疾一症，古称肠澼，有协热的，有协寒的，有入气分的，有入血分的，尤须分别出一个虚实，黄芩一汤何能统治诸痢？
我是极崇拜徐氏的，不过对于此等处，不敢曲为回护，还要证明确是前辈千虑中之一失。
病因病果，复杂异常，现在西医证明疟有疟菌，痢有痢菌，然彼只能知道有菌，不能分别出疟菌共有几类，痢菌共有几种，表面看来虽似很精，其实是极粗的，于病之情形上，病之疗治上，全无补益。
我很想把黄帝岐伯的问答，翻成极浅显极明白的白话，使大众都知道中医的真价值，只是穷忙，此愿只好俟诸异日了。
论湿温湿温这一症，夏秋时节最多，湿温古时原叫做湿热，那么热是天之气。湿是地之气，我们人恰在这气交之中，不能不有呼吸，不能不有饮食，口食味归乎胃，胃为水谷之海，鼻食气通乎肺，肺为治节之脏，湿热两邪，不知不觉的感受进去，更有什么法子可以抵抗?什么法子可以避免呢？
肺胃与大肠，本来是一气相通，肺称清金，大肠称浊金。所以肺与大肠是表里，胃属足阳明，大肠属手阳明，所以手足阳明是同气，就是别种温病专究三焦，也以此一脏二腑为最要。肺开窍于鼻，吸入之邪先犯于肺，肺经不解，就要传到胃，这就叫顺传，你道它什么叫做顺传?一、肺是五脏之一。胃是六腑之一，驻病传腑，驳轻不少。二、肺的部位在上，胃的部位在中，肠的部位在下，自上及中。顺流而下，无论讲脏腑，讲上讲下，都是顺的，所以叫做顺传。
还有逆传温病，温邪犯肺，若不下传于胃，必致内陷于心包络，这内陷心包络，一、肺主气属卫，心主血属营，邪由气分八营，是进了一层。二、肺是脏，心也是脏，虽然心包络不在五脏之内。一、心包属厥阴，也是阴经。二、心包络代心宣化，称为膻中，也可以算得脏，所以以脏传脏，病势为进，这就叫逆传。
还有犯肺之温邪，既不顺传于胃，又不逆传心包，偏偏传到膜原的，这膜原就是膈，一层的薄膜，遮在胃口之上，心肺之下，天造地设好去处，使心与肺得有遮蔽，胃中之浊气不致上熏，温邪传到膜原的也很多。
邪传心包络，就要神昏谵语；邪传胃腑，就要壮热口渴，不大便，；邪传膜原，就要胸闷懊侬、发欬，以上所讲的，还是普通温病，不曾专谈到湿温。
谈到湿温这一病，须要辨清湿有几分，热有几分，究竟是湿多，还是热多，湿与热已否纠结不解，尚可分治否?就为湿邪与热邪，极易狼狈为奸，热得了湿的帮助，那么郁遏不宣。热势必然愈炽；湿得了热的帮助，那么蒸腾上熏，湿浊必然愈横。湿邪与热邪两分，尚属病轻势缓；湿邪与热邪两合，实已病重势急；假使湿多而热少，那就蒙上流下，可以三焦分治；假定湿热俱多，那必要上闭下壅，三焦俱困了。
你道为何?就为了湿无热，只能够蒙蔽清阳，有的是阻在上焦，有的是阻在中焦，有的是阻在下焦罢了。要是湿邪与热邪一合，那么本身固有之热，悉化为病热，犹之好人都被歹人带坏，一鼻孔出气，蛮而无理，没法处置，到了那时，热得湿助，宛然火上添油，上下充斥，内外煎熬，最是酷烈不过。
前辈治湿必治脾经，治热必治胃经，实是扼要之图，但是湿热倘已胶结，那便如油入面，虽然对症发药，治之得法，也不能够速愈，为什么呢?此时的病状，宛如剥蕉检茧，去了一层又一层，往往热退身凉之后，忽又壮热起来，在不识病情的人，未免心慌意乱。举棋不定，难免动手便错，遂至有误大局，所以郎中遇到此种症候，须有一定之见识，舒徐晦豫，接步就班，才可以从容对付。
湿温之外，更有风湿、寒湿、暑湿几种，都是以风寒暑为主要症，湿不过是副要症，那治法尽管着重主要症，副要的湿邪，不过带上一点子就是。
湿邪之在人身，犹之雾露之在地上，昏昏沉沉，弥弥漫漫，抬头不见天日，伸手不见五指，拨开云雾见青天，不过是一句快意语，谁有这个手段呢，所以治这病的人，须要安心定意，害这病的人，尤要安心定意。
论医者意也“乖人吃亏一半，呆人吃亏一半”，那不是老话么。我想呆人，呆头呆脑，受尽人的欺，吃尽人的亏，是该的。乖人乖手乖脚，很该处处讨便宜，在在占上风，怎么呆人吃的亏只有一半，乖人吃的亏倒也有一半？
我做的是中医，本地风光就把中医医学来讲，中医有五千年来历史，神农、黄帝、伊尹、扁鹊、仓公、仲景、华佗、叔和、陶弘景、徐之才、王焘、思邈等，圣君贤相，名师往哲，那一时那一代没有，论到他的功用效验，著手成春，覆杯即愈的，更不知有多少，论理，早该横行大地，五洲之广，无远勿届了。为什么在今日，还是偏居本国，还要受西医的侵袭，我细细推求，那传统上的坏处，就受了乖人吃亏的缘故。
中医的学说，大别之可分作两种，一种是依据《内经》，偏重说理的。一种是依据《伤寒论》，偏重认证的。就可惜历来注释《伤寒论》的几位名家，《内经》的主观太重，总用《内经》的见解来解释《伤寒论》，以致《伤寒》一书，不解倒还明白，愈解愈糊涂，什么标本中见，什么寒化、热化、湿化，一大堆不上相干的话，听得人家莫明其妙，正如翠屏山戏中潘老丈所讲，你不说我倒明白，你一说我越糊涂。
医不是仙人，病不会开口，因此偏重认证的，总说症者证也，要认清是表是里，属虚属实，在经在络，还须辨出个寒热，辨出个脏腑，旁敲侧击，审之必确，问之必详，就为病症关系人命出入，不敢草草，亦不忍草草。
偏偏依据《内经》的，好为理论，自作聪明，创出“医者意也”的谬说，用演绎法推测百病，不用归纳法归纳病症，毫厘之谬，差及千里，一人有过，遗及全体，我们中医吃亏的地方，即在于此。
照我偏见，大家研究仲景之书，研究入手，照武进前辈邹润庵夫子的《本经疏证》做去，我们中医才有光明的一日。
做学问须要从呆的一方面做起，不要从乖的一方面做起，敢要世兄们，千万不要偷私乖，千万不要偷私乖!
论煎药煎药这工作，人家看来，不过是一件很小很小的小事，几味草根树皮，加上一二碗清水，在风炉上煎几滚就得了。那里知道煎药于病症上、医治上，都有极重要的关系，决不是随随便便的人，可以随随便便干得的，诸位且请静心听我道来。
桂枝汤的煎法，是要用微火缓煎的，倘然猛火急煎，就不对了。
小建中汤的煎法，是先把药五味以水七升，煮取三升，去滓，才纳胶饴一味，更上微火消解，倘然同煮，就不对了。
茯苓桂枝甘草大枣汤的煎法，是以清水二斗，扬之万遍，水珠千百相逐，成为甘澜水，以甘澜水一斗，先煮茯苓，减二升，纳诸药煮，倘然用寻常水，不用甘澜水，就不对。用甘澜水，而茯苓不是先煎，又不对。
桂枝加葛根汤的煎法，以水一斗，先煮葛根一味，减二升去上沫，然后纳诸药煎，取三升，去渣。倘使葛根与诸药同煎，就不对了。麻黄汤的煎法，以水九升，先煮麻黄一味，煮至减三升，去上沫，然后纳诸药煮，取二升半，去滓，温服。倘使麻黄与诸药同煮，就不对了。
麻黄杏仁甘草石膏汤煎法，是以水七升，先煮麻黄，减二升，去上沫，纳诸药煮。倘合麻黄与诸药同煎，就不对了。
大青龙汤的煎法，是以水九升，先煮麻黄、减二升，去上涑，纳诸药煎，取三升，去滓，温服一升。倘使麻黄与诸药同煮，就不对了。且大青龙汤中的石膏，须敲碎绵裹。麻杏甘膏汤之石膏，也需绵裹，与白虎汤之石膏，又是不同。倘然不用绵裹，又不对了。
小青龙汤煎法，八味药，以水一斗，先煮麻黄，减去二升，去上沫，纳诸药煮，取三升，去滓。假使麻黄与诸药同煎，就不对了。
麻黄附子细辛汤，与麻黄附子甘草汤，两方同用麻黄，而煎法偏是大大不同。麻黄附子细辛汤，是先煮麻黄，减二升，去上沫，纳诸药煮，取三升，去渣，温服。麻黄附子甘草汤，虽也先煮麻黄，却只一两沸，去上沫，纳诸药煮，休言诸药同煎，就使你知道麻黄先煮，诸药后纳，两方同一个法子，还是不对，须要辨出一方煎到水减三升，一方却只煮一二沸，有少煎多煎之不同。
葛根汤的煎法，是七味药，以水一斗，先煮麻黄葛根，减去二升，去上沫，纳诸药煮，取三升，去渣。倘使同煎就不对了。
葛根黄芩黄连汤，是以水八升，先煮葛根，减二升。纳诸药煮，取二升，去渣。倘使同煎就不对了。
小柴胡汤的煎法，偏又比众不同，是以药七味，水一斗二升，煮取六升，去渣再煎，取三升。倘使你不是去渣再煎，还是不对。
柴胡桂枝汤的煎法，偏是九味药，七升水同煮，取三升，去渣，就是与普通汤药一般了。
柴胡加龙骨牡蛎汤，偏是以十二味药，八升水，煮取四升，然后纳大黄，更煮一二沸，去渣，温服，又是一个法子。
柴胡桂枝干姜汤，偏又是以水一斗二升，煮取六升，去渣再煎，取三升，偏又与大、小二柴胡汤同法了。柴胡加芒硝汤，偏又是以药八味，水四升，煮取二升，去渣，纳芒硝，再煮微沸了，说它是一定的，偏又不一定，说它不是一定罢，偏又是一定的。
栀子豉汤煎法，以水四升，先煮栀子得二升半，然后纳豉再煮，取升半，并且豉这一味药，是要绵裹的。那栀子甘草豉汤，是先煮栀子甘草。栀子生姜豉汤，是先煮栀子生姜，那豉总是后入的。只有栀子干姜汤，栀子厚朴枳实汤，栀子柏皮汤，是与普通煎药法一般。
最奇怪不过的煎法，是枳实栀子豉汤，是先用清浆水七升空煮，取四升，纳枳实栀子，煮取三升，下豉更煮五六沸，去渣分温再服。那清浆水就是淘米的泔水，久贮味酸为佳者。
大承气汤的煎法，又与他方不同，药只四味，却分作三回工作，以水一斗，先煮厚朴、枳实，取五升，去渣，然后纳入大黄，取二升去渣，加入芒硝，更上微火一两沸，分温再服。倘使枳、朴、大黄同煎，就是小承气汤，不是大承气汤了。
调胃承气汤煎法，是以水三升，先煮大黄、甘草，取一升，去渣，纳芒硝。更上火微煮令沸，少少温服之，与大、小二承气汤又不同了。桃核承气汤的煎法。也与调胃承气汤差不多。
抵当丸虽是丸药，也是煎服的。
十枣汤的煎法，只煮枣子一味，其余三药，是捣作药散用枣子汤调服的。
三十年前，我开始研究中医时，“五行学说”是我进步路上的第一个阻力，也是第一道难关。我想，人既然是有血有肉的身躯，肚子里怎么会装着金、木、火、土、水这许多东西呢？当时我误以为“五行”是五种具体的实物，怎么也通不过这个关，直到后来领悟了“行”字的真正含义，才终于明白。
关于病因果的异同，徐灵胎先生确实是中医界的前辈，我很钦佩他的学说。只是他说疟疾用柴胡汤加减治疗，痢疾用黄芩汤加减治疗，我却不敢附和，甚至非常怀疑。
天下的万事万理，研究其起因，种种不同；观察其结果，也种种不同。偏偏有结果相同而起因不同的，也有起因相近而结果不同的。就像士、农、工、商四业，所从事的职业不同，禀赋的聪明才智也不同，等到他们埋头苦干，一旦成功，都是立业兴家，正如老话所说“行行出状元”，这难道不是结果相同而起因不同吗？又如嫖、赌、吃、喝四件事，各有个性，老话说“嫖是精空，赌是对冲，吃是最凶，喝是威风”，岂不是各不相同，差异巨大吗？但是只要你沾染了其中任何一件，到了最终收场，身败名裂的结果都是一样的，这难道不是结果相同而起因不同吗？
一群嫖客，一群赌客，在灯红酒绿、花天酒地时的豪兴是相同的，在呼卢喝雉、一掷万金时的豪举也是相同的。但在家产败尽之后，有的做小偷，有的做强盗，有的做乞丐，有的做帮闲度日，这难道不是起因相近（都沉迷享乐）而结果不同吗？
事理如此，病理也是如此；事情如此，病情也是如此。
疟疾的原因，是风寒两邪潜伏体内。风为阳邪，寒为阴邪，所以先伤于寒后伤于风的，发作时先冷后热，名叫寒疟；先伤于风后伤于寒的，发作时先热后冷，名叫温疟。还有只发热不恶寒的，叫做瘅疟，那是阴气先绝，阳气独发的缘故，其症状是气短烦闷，手足发热。
疟疾属于伏邪病的一种，所伏之邪有浅深之分：浅的伏在经络，深的伏在膜原，最深的伏在脏腑。其中伏在六腑的为轻证，伏在五脏的重证。逐日发作的叫疟疾；间日发作的叫痃疟；隔两三日发作的叫三阴疟。逐日发的，邪气不过伏在经络；间日发的，浅者伏在膜原，深者伏在六腑；隔两三日发的三阴疟，多深伏在五脏。
从前黄帝问岐伯：“痎疟皆生于风，为什么发作有定时？”岐伯回答说，痃疟的发动，先从毫毛开始，伸欠乃作，寒栗鼓颔，腰脊俱痛，寒去内外就热，头痛如破，渴欲冷饮。黄帝问他，是什么气使然？岐伯回答，阴阳上下交争，虚实更作，阴阳相移。阳并于阴，阴就实，阳就虚。
总而言之，疟疾的病因不一，疟邪潜伏的部位也不一。徐灵胎竟想用柴胡一汤统治所有疟疾，虽然可以随症加减，但终究嫌呆板，不能不有所疑问。
痢疾这一病症，古称肠澼，有协热的，有协寒的，有入气分的，有入血分的，尤其须要分辨虚实。黄芩一汤怎能统治所有痢疾？
我非常崇拜徐氏，但对于此类问题，不敢曲意回护，还要证明这确是前辈千虑中的一失。
病因病果复杂异常，现在西医证明疟疾有疟菌，痢疾有痢菌，然而他们只知道有菌，不能分别出疟菌共有几类，痢菌共有几种。表面看来虽似很精密，其实是极粗糙的，对于病情的判断和治疗，全无补益。
我很想把黄帝与岐伯的问答，翻译成极其浅显明白的白话，使大众都知道中医的真价值，只是忙于生计，此愿只好留待异日了。
论湿温：湿温这一病症，夏秋时节最多。湿温古时原叫湿热，那么热是天之气，湿是地之气，我们人恰在这气交之中，不能不呼吸，不能不饮食。口食味归乎胃，胃为水谷之海；鼻食气通乎肺，肺为治节之脏。湿热两邪不知不觉感受进去，又有什么法子可以抵抗？什么法子可以避免呢？
肺、胃与大肠，本来是一气相通。肺称清金，大肠称浊金，所以肺与大肠是表里关系。胃属足阳明，大肠属手阳明，所以手足阳明是同气。就是别种温病专究三焦，也以此一脏二腑为最要。肺开窍于鼻，吸入之邪先犯于肺，肺经不解，就要传到胃，这就叫顺传。你道它什么叫做顺传？一、肺是五脏之一，胃是六腑之一，病由脏传腑，病势减轻不少。二、肺的部位在上，胃的部位在中，肠的部位在下，自上及中，顺流而下，无论讲脏腑，讲上讲下，都是顺的，所以叫做顺传。
还有逆传温病，温邪犯肺，若不下传于胃，必致内陷于心包络。这内陷心包络，一、肺主气属卫，心主血属营，邪由气分入营，是进了一层。二、肺是脏，心也是脏，虽然心包络不在五脏之内，但心包属厥阴，也是阴经；心包络代心宣化，称为膻中，也可以算得脏，所以以脏传脏，病势为进，这就叫逆传。
还有犯肺之温邪，既不顺传于胃，又不逆传心包，偏偏传到膜原的。这膜原就是膈，一层薄膜，遮在胃口之上，心肺之下，是天造地设的好去处，使心与肺得有遮蔽，胃中之浊气不致上熏，温邪传到膜原的也很多。
邪传心包络，就要神昏谵语；邪传胃腑，就要壮热口渴，不大便；邪传膜原，就要胸闷懊侬、发咳。以上所讲的，还是普通温病，不曾专谈到湿温。
谈到湿温这一病，须要辨清湿有几分，热有几分，究竟是湿多，还是热多，湿与热已否纠结不解，尚可分治否？就为湿邪与热邪，极易狼狈为奸，热得了湿的帮助，那么郁遏不宣，热势必然愈炽；湿得了热的帮助，那么蒸腾上熏，湿浊必然愈横。湿邪与热邪两分，尚属病轻势缓；湿邪与热邪两合，实已病重势急；假使湿多而热少，那就蒙上流下，可以三焦分治；假定湿热俱多，那必要上闭下壅，三焦俱困了。
你道为何？就为了湿无热，只能够蒙蔽清阳，有的是阻在上焦，有的是阻在中焦，有的是阻在下焦罢了。要是湿邪与热邪一合，那么本身固有之热，悉化为病热，犹之好人都被歹人带坏，一鼻孔出气，蛮而无理，没法处置。到了那时，热得湿助，宛然火上添油，上下充斥，内外煎熬，最是酷烈不过。
前辈治湿必治脾经，治热必治胃经，实是扼要之图，但是湿热倘已胶结，那便如油入面，虽然对症发药，治之得法，也不能够速愈。为什么呢？此时的病状，宛如剥蕉检茧，去了一层又一层，往往热退身凉之后，忽又壮热起来。在不识病情的人，未免心慌意乱，举棋不定，难免动手便错，遂至有误大局。所以郎中遇到此种症候，须有一定之见识，舒徐晦豫，接步就班，才可以从容对付。
湿温之外，更有风湿、寒湿、暑湿几种，都是以风寒暑为主要症，湿不过是副要症，那治法尽管着重主要症，副要的湿邪，不过带上一点子就是。
湿邪之在人身，犹之雾露之在地上，昏昏沉沉，弥弥漫漫，抬头不见天日，伸手不见五指。拨开云雾见青天，不过是一句快意语，谁有这个手段呢？所以治这病的人，须要安心定意；害这病的人，尤要安心定意。
论医者意也：“乖人吃亏一半，呆人吃亏一半”，那不是老话么。我想呆人，呆头呆脑，受尽人的欺，吃尽人的亏，是该的。乖人乖手乖脚，很该处处讨便宜，在在占上风，怎么呆人吃的亏只有一半，乖人吃的亏倒也有一半？
我做的是中医，本地风光就把中医医学来讲。中医有五千年来历史，神农、黄帝、伊尹、扁鹊、仓公、仲景、华佗、叔和、陶弘景、徐之才、王焘、思邈等圣君贤相、名师往哲，那一时那一代没有？论到他的功用效验，著手成春，覆杯即愈的，更不知有多少。论理，早该横行大地，五洲之广，无远勿届了。为什么在今日，还是偏居本国，还要受西医的侵袭？我细细推求，那传统上的坏处，就受了“乖人吃亏”的缘故。
中医的学说，大别之可分作两种，一种是依据《内经》，偏重说理的；一种是依据《伤寒论》，偏重认证的。就可惜历来注释《伤寒论》的几位名家，《内经》的主观太重，总用《内经》的见解来解释《伤寒论》，以致《伤寒》一书，不解倒还明白，愈解愈糊涂。什么标本中见，什么寒化、热化、湿化，一大堆不上相干的话，听得人家莫明其妙，正如翠屏山戏中潘老丈所讲：“你不说我倒明白，你一说我越糊涂。”
医不是仙人，病不会开口，因此偏重认证的，总说“症者证也”，要认清是表是里，属虚属实，在经在络，还须辨出个寒热，辨出个脏腑，旁敲侧击，审之必确，问之必详。就为病症关系人命出入，不敢草草，亦不忍草草。
偏偏依据《内经》的，好为理论，自作聪明，创出“医者意也”的谬说，用演绎法推测百病，不用归纳法归纳病症。毫厘之谬，差及千里，一人有过，遗及全体。我们中医吃亏的地方，即在于此。
照我偏见，大家研究仲景之书，研究入手，照武进前辈邹润庵夫子的《本经疏证》做去，我们中医才有光明的一日。
做学问须要从呆的一方面做起，不要从乖的一方面做起。敢要世兄们，千万不要偷私乖，千万不要偷私乖！
论煎药：煎药这工作，人家看来，不过是一件很小很小的小事，几味草根树皮，加上一二碗清水，在风炉上煎几滚就得了。那里知道煎药于病症上、医治上，都有极重要的关系，决不是随随便便的人，可以随随便便干得的。诸位且请静心听我道来。
桂枝汤的煎法，是要用微火缓煎的，倘然猛火急煎，就不对了。
小建中汤的煎法，是先把药五味以水七升，煮取三升，去滓，才纳胶饴一味，更上微火消解，倘然同煮，就不对了。
茯苓桂枝甘草大枣汤的煎法，是以清水二斗，扬之万遍，水珠千百相逐，成为甘澜水，以甘澜水一斗，先煮茯苓，减二升，纳诸药煮，倘然用寻常水，不用甘澜水，就不对。用甘澜水，而茯苓不是先煎，又不对。
桂枝加葛根汤的煎法，以水一斗，先煮葛根一味，减二升去上沫，然后纳诸药煎，取三升，去渣。倘使葛根与诸药同煎，就不对了。麻黄汤的煎法，以水九升，先煮麻黄一味，煮至减三升，去上沫，然后纳诸药煮，取二升半，去滓，温服。倘使麻黄与诸药同煮，就不对了。
麻黄杏仁甘草石膏汤煎法，是以水七升，先煮麻黄，减二升，去上沫，纳诸药煮。倘合麻黄与诸药同煎，就不对了。
大青龙汤的煎法，是以水九升，先煮麻黄、减二升，去上涑，纳诸药煎，取三升，去滓，温服一升。倘使麻黄与诸药同煮，就不对了。且大青龙汤中的石膏，须敲碎绵裹。麻杏甘膏汤之石膏，也需绵裹，与白虎汤之石膏，又是不同。倘然不用绵裹，又不对了。
小青龙汤煎法，八味药，以水一斗，先煮麻黄，减去二升，去上沫，纳诸药煮，取三升，去滓。假使麻黄与诸药同煎，就不对了。
麻黄附子细辛汤，与麻黄附子甘草汤，两方同用麻黄，而煎法偏是大大不同。麻黄附子细辛汤，是先煮麻黄，减二升，去上沫，纳诸药煮，取三升，去渣，温服。麻黄附子甘草汤，虽也先煮麻黄，却只一两沸，去上沫，纳诸药煮，休言诸药同煎，就使你知道麻黄先煮，诸药后纳，两方同一个法子，还是不对，须要辨出一方煎到水减三升，一方却只煮一二沸，有少煎多煎之不同。
葛根汤的煎法，是七味药，以水一斗，先煮麻黄葛根，减去二升，去上沫，纳诸药煮，取三升，去渣。倘使同煎就不对了。
葛根黄芩黄连汤，是以水八升，先煮葛根，减二升。纳诸药煮，取二升，去渣。倘使同煎就不对了。
小柴胡汤的煎法，偏又比众不同，是以药七味，水一斗二升，煮取六升，去渣再煎，取三升。倘使你不是去渣再煎，还是不对。
柴胡桂枝汤的煎法，偏是九味药，七升水同煮，取三升，去渣，就是与普通汤药一般了。
柴胡加龙骨牡蛎汤，偏是以十二味药，八升水，煮取四升，然后纳大黄，更煮一二沸，去渣，温服，又是一个法子。
柴胡桂枝干姜汤，偏又是以水一斗二升，煮取六升，去渣再煎，取三升，偏又与大、小二柴胡汤同法了。柴胡加芒硝汤，偏又是以药八味，水四升，煮取二升，去渣，纳芒硝，再煮微沸了，说它是一定的，偏又不一定，说它不是一定罢，偏又是一定的。
栀子豉汤煎法，以水四升，先煮栀子得二升半，然后纳豉再煮，取升半，并且豉这一味药，是要绵裹的。那栀子甘草豉汤，是先煮栀子甘草。栀子生姜豉汤，是先煮栀子生姜，那豉总是后入的。只有栀子干姜汤，栀子厚朴枳实汤，栀子柏皮汤，是与普通煎药法一般。
最奇怪不过的煎法，是枳实栀子豉汤，是先用清浆水七升空煮，取四升，纳枳实栀子，煮取三升，下豉更煮五六沸，去渣分温再服。那清浆水就是淘米的泔水，久贮味酸为佳者。
大承气汤的煎法，又与他方不同，药只四味，却分作三回工作，以水一斗，先煮厚朴、枳实，取五升，去渣，然后纳入大黄，取二升去渣，加入芒硝，更上微火一两沸，分温再服。倘使枳、朴、大黄同煎，就是小承气汤，不是大承气汤了。
调胃承气汤煎法，是以水三升，先煮大黄、甘草，取一升，去渣，纳芒硝。更上火微煮令沸，少少温服之，与大、小二承气汤又不同了。桃核承气汤的煎法，也与调胃承气汤差不多。
抵当丸虽是丸药，也是煎服的。
十枣汤的煎法，只煮枣子一味，其余三药，是捣作药散用枣子汤调服的。
Thirty years ago, when I began studying Traditional Chinese Medicine (TCM), the Theory of Five Elements (Wu Xing) was the first obstacle to my progress and the first hurdle I had to overcome. I thought, since a human body is made of flesh and blood, how could it contain so many things like Metal, Wood, Fire, Earth, and Water inside? At that time, I mistakenly believed that "Five Elements" referred to five specific physical objects, and I simply could not accept this concept. It was only later, after I grasped the true meaning of the character "Xing" (Movement/Function), that I finally understood.
Regarding the similarities and differences between causes and effects in disease, Mr. Xu Lingtai was indeed a senior figure in the TCM community, and I greatly admire his theories. However, regarding his statement that Malaria should be treated with modified Chaihu Tang (Bupleurum Decoction) and Dysentery with modified Huangqin Tang (Scutellaria Decoction), I dare not agree, and in fact, I am quite skeptical.
In all matters and principles under heaven, if we study their causes, they are diverse; if we observe their results, they are also diverse. Yet, there are cases where the results are the same but the causes differ, and cases where the causes are similar but the results differ. For instance, among the four occupations—scholars, farmers, artisans, and merchants—their professions differ, and their innate intelligence and talent vary. Once they toil diligently and achieve success, they all establish families and careers. As the old saying goes, "Every trade produces its champion." Is this not an example of different causes leading to the same result? Conversely, consider the four vices: whoring, gambling, gluttony, and drinking. Each has its own nature. The old saying goes, "Whoring drains essence and empties wealth; gambling is a zero-sum game; eating is the most fierce; drinking displays power." Are these not vastly different? Yet, once one indulges in any of them, the final outcome is invariably ruin and disgrace. Is this not another example of different causes leading to the same result?
A group of prostitutes' clients and a group of gamblers may share the same豪情 (heroic spirit/excitement) amidst wine and lights, and the same extravagant acts when betting huge sums. But after their family fortune is exhausted, some become petty thieves, some bandits, some beggars, and some idle dependents. Is this not an example of similar causes leading to different results?
The logic of affairs applies equally to pathology; the nature of events applies equally to clinical conditions.
The cause of Malaria lies in the latent pathogenic factors of Wind and Cold. Wind is a Yang pathogen, and Cold is a Yin pathogen. Therefore, those injured by Cold first and then by Wind will experience chills followed by fever upon onset, known as Han Malaria (Cold Malaria). Those injured by Wind first and then by Cold will experience fever followed by chills, known as Wen Malaria (Warm Malaria). There is also a type characterized by fever without chills, called Dan Malaria (Fever Malaria), which occurs due to the exhaustion of Yin Qi and the solitary flourishing of Yang Qi. Its manifestations include shortness of breath, irritability, and heat in the hands and feet.
Malaria is a type of disease caused by latent pathogens. The depth of latency varies: superficially in the meridians, deeply in the Mo Yuan (Membrane Source), and deepest in the Zang-Fu organs. Latency in the Six Fu organs is considered mild, while latency in the Five Zang organs is severe. Daily attacks are called Malaria; every-other-day attacks are called Xuan Malaria; attacks every two or three days are called San Yin Malaria. Daily attacks imply the pathogen is merely in the meridians; every-other-day attacks imply shallow latency in the Mo Yuan or deep latency in the Six Fu organs; San Yin Malaria implies deep latency in the Five Zang organs.
Previously, the Yellow Emperor asked Qibo: "All Jie Malaria arises from Wind, why does it have a specific timing?" Qibo replied that the onset of Xuan Malaria begins at the fine hairs, followed by yawning, shivering, chattering teeth, and pain in the waist and spine. After the cold subsides, internal and external heat arise, causing headache as if splitting, and thirst for cold drinks. The Yellow Emperor asked what Qi causes this. Qibo answered that it is the struggle between Yin and Yang above and below, alternating deficiency and excess, and the shifting of Yin and Yang. When Yang merges into Yin, Yin becomes excessive and Yang deficient.
In short, the etiology of Malaria is not uniform, nor is the site of pathogen latency. That Xu Lingtai would attempt to govern all types of Malaria with a single Chaihu Tang formula, even with modifications, seems too rigid, warranting doubt.
Dysentery, anciently called Chang Pi (Intestinal Flux), can involve Heat, Cold, Qi level involvement, or Blood level involvement. One must distinguish between Deficiency and Excess. How can a single Huangqin Tang govern all types of Dysentery?
I hold Mr. Xu in high esteem, but on such matters, I dare not flatter him. I must demonstrate that this is indeed a lapse in the judgment of a senior expert.
The complexity of disease causes and effects is extraordinary. Modern Western medicine proves that Malaria has malaria parasites and Dysentery has dysentery bacteria. However, they only know that bacteria exist; they cannot classify how many types of malaria parasites or dysentery bacteria there are. Superficially precise, this approach is actually crude and offers no benefit to understanding disease patterns or treatment.
I wish to translate the dialogue between the Yellow Emperor and Qibo into plain vernacular so the public may understand the true value of TCM. However, due to busy livelihoods, I must leave this wish for another day.
On Shi Wen (Damp-Warmth): This condition is most common in summer and autumn. Anciently called Re Shi (Heat-Dampness), Heat is the Qi of Heaven, and Dampness is the Qi of Earth. Humans live within this intersection of Qi, breathing and eating inevitably. Flavors enter the Stomach, the Sea of Water and Grain; Air enters the Lungs, the Organ of Regulation. Unknowingly, we absorb Damp-Heat pathogens. What method can resist or avoid this?
The Lungs, Stomach, and Large Intestine are connected by one Qi. The Lung is Clear Metal, and the Large Intestine is Turbid Metal, making them interior-exterior pairs. The Stomach belongs to Foot-Yangming, and the Large Intestine to Hand-Yangming, sharing the same Qi. Even in other Warm diseases focusing on the Triple Burner, this one Zang and two Fu organs are paramount. The Lung opens into the nose; inhaled pathogens first attack the Lung. If unresolved, they transmit to the Stomach, called Shun Chuan (Smooth Transmission). Why smooth? First, the Lung is a Zang organ, the Stomach a Fu organ; transmission from Zang to Fu reduces severity. Second, the Lung is superior, the Stomach middle, and the Intestines inferior; transmission flows downward naturally. Thus, it is "smooth."
There is also Ni Chuan (Reverse Transmission) in Warm diseases. If Warm pathogens attack the Lung and do not transmit downward to the Stomach, they sink inward into the Pericardium. This sinking involves: 1) The Lung governs Qi and Wei (Defensive) Qi, while the Heart governs Blood and Ying (Nutritive) Qi; entering Ying from Qi represents a deeper invasion. 2) Both Lung and Heart are Zang organs. Although the Pericardium is not one of the Five Zang, it belongs to Jueyin (Yin Meridian) and acts as the Envoy of the Heart, also termed Tan Zhong, qualifying it as a Zang-like entity. Thus, Zang-to-Zang transmission indicates worsening condition, hence "reverse."
Furthermore, some Warm pathogens attacking the Lung transmit neither smoothly to the Stomach nor reversely to the Pericardium, but instead to the Mo Yuan (Diaphragm/Membrane Source). The Mo Yuan is a thin membrane covering the stomach opening, beneath the Heart and Lungs, providing protection and preventing turbid Qi from the Stomach from rising upward. Many Warm pathogens reach here.
If pathogens transmit to the Pericardium, confusion and delirious speech occur. If to the Stomach Fu, high fever, thirst, and constipation occur. If to the Mo Yuan, chest oppression, restlessness, and cough occur. These describe general Warm diseases, not specifically Shi Wen.
For Shi Wen, one must distinguish the ratio of Dampness to Heat. Which is dominant? Have they tangled irreversibly? Can they still be treated separately? Damp and Heat easily collude. With Damp's help, Heat becomes stifled and intensifies; with Heat's help, Damp steams and spreads, becoming rampant. Separate Damp and Heat indicate mild/slow progression; combined Damp and Heat indicate severe/urgent progression. If Damp exceeds Heat, it covers above and flows below, allowing treatment by Triple Burner levels. If both are abundant, upper closure and lower obstruction occur, trapping all Three Burners.
Why? Without Heat, Damp merely obscures Clear Yang, blocking Upper, Middle, or Lower Burners respectively. But once Damp and Heat combine, inherent heat transforms into pathological heat, like good people corrupted by bad ones. They act in concert, irrationally and untreatable. Then, Heat aided by Damp is like adding oil to fire, filling upper and lower, roasting inside and out, extremely violent.
Seniors treat Damp by addressing the Spleen and Heat by addressing the Stomach, which is essential. But if Damp and Heat are glued together like oil in dough, even correct medication yields slow recovery. The condition resembles peeling a banana or cocoon, layer after layer. Fever may subside, then suddenly return. Untrained physicians panic and hesitate, making errors that worsen the situation. Physicians must have firm insight, proceeding calmly and step-by-step.
Beyond Shi Wen, there are Feng Shi (Wind-Damp), Han Shi (Cold-Damp), and Shu Shi (Summerheat-Damp). Here, Wind, Cold, or Summerheat are primary, and Damp is secondary. Treatment focuses on the primary, merely touching upon the Damp.
Dampness in the body is like fog and dew on the ground: dim, pervasive, hiding the sky and fingers. "Clearing the clouds to see the blue sky" is just a pleasant phrase; who has such power? Thus, the physician must remain calm and focused; the patient especially must do so.
On "The Physician Relies on Intent": "The clever suffer half the loss, the dull suffer half the loss." Isn't this an old saying? The dull, being foolish, deserve the bullying and losses they endure. The clever, being agile, should gain advantages everywhere. Why do both suffer half the loss?
Speaking as a TCM practitioner, let us discuss TCM. With 5,000 years of history, figures like Shennong, Huangdi, Yi Yin, Bian Que, Cang Gong, Zhang Zhongjing, Hua Tuo, Wang Shuhe, Tao Hongjing, Xu Zhicai, Wang Tao, and Sun Simiao—sages, ministers, masters, and philosophers—have existed in every era. Their efficacy, bringing spring with a touch or healing with a cup overturned, is countless. Logically, TCM should dominate the globe. Why is it confined today, besieged by Western medicine? I deduce this harm stems from the "clever man's loss."
TCM theory broadly divides into two: one based on *Neijing* (Inner Canon), emphasizing theory; the other based on *Shanghan Lun* (Treatise on Cold Damage), emphasizing pattern differentiation. Regrettably, commentators on *Shanghan Lun* often impose *Neijing* subjectivity, explaining *Shanghan* through *Neijing* lenses. This makes *Shanghan* clearer when unexplained, but muddier when interpreted. Concepts like Biao-Ben Zhong-Jian, Han-Hua, Re-Hua, and Shi-Hua confuse listeners, like the character Pan Laozhang in the play *Cuiping Shan*: "Without you telling me, I understood; now that you explain, I'm more confused."
Physicians are not immortals; diseases do not speak. Therefore, those emphasizing pattern differentiation say "Symptom is Evidence," requiring clear identification of Exterior/Interior, Deficiency/Excess, Meridian/Collateral, Cold/Heat, and Zang-Fu. They probe carefully and ask thoroughly because disease affects life and death, leaving no room for carelessness.
Conversely, those relying on *Neijing* love theory, act self-righteously, and create the fallacy "The Physician Relies on Intent." They use deduction to speculate on hundreds of diseases rather than induction to summarize symptoms. A slight error leads to a thousand-mile deviation; one person's fault harms the whole. This is where TCM suffers.
In my biased view, everyone should study Zhang Zhongjing's works. Following the approach of Senior Zou Run'an of Wujin's *Ben Jing Shu Zheng*, TCM will have a bright future.
Scholarship must begin with "dullness" (rigor), not "cleverness" (speculation). I urge young scholars: never seek clever shortcuts!
On Decocting Herbs: To others, decocting herbs seems trivial—root bark and twigs added to water, boiled briefly. Yet, decoction is crucial for efficacy. It cannot be done casually. Listen carefully.
Guizhi Tang (Cinnamon Twig Decoction) requires gentle simmering over low heat. Boiling fiercely is incorrect.
Xiao Jianzhong Tang (Minor Construct the Middle Decoction) requires boiling five herbs in seven sheng of water to three sheng, straining, then adding Yizhima (Malt Sugar) and dissolving gently over low heat. Boiling together is incorrect.
Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) requires stirring clear water ten thousand times until droplets chase each other, creating Ganlan Shui (Ganlan Water). Boil Poria in one dou of this water, reducing by two sheng, then add other herbs. Using ordinary water is incorrect. Using Ganlan water but not boiling Poria first is also incorrect.
Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Kudzu Root) requires boiling Kudzu Root alone in one dou of water, reducing by two sheng, skimming foam, then adding other herbs to yield three sheng. Boiling Kudzu with others is incorrect.
Mahuang Tang (Ephedra Decoction) requires boiling Ephedra alone in nine sheng of water, reducing by three sheng, skimming foam, then adding other herbs to yield two and a half sheng. Boiling Ephedra with others is incorrect.
Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) requires boiling Ephedra in seven sheng of water, reducing by two sheng, skimming foam, then adding other herbs. Boiling Ephedra with others is incorrect.
Da Qinglong Tang (Major Green Dragon Decoction) requires boiling Ephedra in nine sheng of water, reducing by two sheng, skimming foam, then adding other herbs to yield three sheng. Boiling Ephedra with others is incorrect. Additionally, Gypsum in Da Qinglong Tang must be crushed and wrapped in silk. In Mahxing Gan Gao Tang, Gypsum must also be wrapped, differing from Baihu Tang (White Tiger Decoction). Not wrapping it is incorrect.
Xiao Qinglong Tang (Minor Green Dragon Decoction) requires boiling eight herbs in one dou of water, boiling Ephedra first, reducing by two sheng, skimming foam, then adding other herbs to yield three sheng. Boiling Ephedra with others is incorrect.
Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) and Mahuang Fuzi Gancao Tang (Ephedra, Aconite, and Licorice Decoction) both use Ephedra but differ significantly in decoction. The former boils Ephedra first, reducing by two sheng, skimming foam, then adds others to yield three sheng. The latter also boils Ephedra first but only for one or two boils, skims foam, then adds others. Even knowing Ephedra is boiled first, treating them identically is wrong. One reduces water by three sheng; the other boils only briefly. The difference in duration is key.
Gegen Tang (Kudzu Decoction) requires boiling Ephedra and Kudzu first in one dou of water, reducing by two sheng, skimming foam, then adding others to yield three sheng. Boiling together is incorrect.
Gegen Huangqin Huanglian Tang (Kudzu, Scutellaria, and Coptis Decoction) requires boiling Kudzu in eight sheng of water, reducing by two sheng, then adding others to yield two sheng. Boiling together is incorrect.
Xiao Chaihu Tang (Minor Bupleurum Decoction) differs uniquely: boil seven herbs in one dou two sheng of water to six sheng, strain, then decoct again to yield three sheng. Not straining and re-decocting is incorrect.
Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) uses nine herbs and seven sheng of water, boiled together to yield three sheng, strained. This is standard.
Chaihu Jia Longgu Muli Tang (Bupleurum plus Dragon Bone and Oyster Shell Decoction) uses twelve herbs and eight sheng of water, boiled to four sheng, then add Rhubarb, boil one or two boils, strain, and serve warm. This is a distinct method.
Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction) uses one dou two sheng of water, boiled to six sheng, strained, and re-decocted to three sheng, matching Major and Minor Chaihu methods.
Chaihu Jia Mangxiao Tang (Bupleurum plus Mirabilite Decoction) uses eight herbs and four sheng of water, boiled to two sheng, strained, then add Mirabilite and boil gently. It seems fixed yet variable.
Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) requires boiling Gardenia in four sheng of water to two and a half sheng, then adding Fermented Soybeans (Chi) to yield half a sheng. Chi must be wrapped in silk. Zhizi Gancao Chi Tang boils Gardenia and Licorice first; Zhizi Shengjiang Chi Tang boils Gardenia and Ginger first; Chi is always added last. Only Zhizi Ganjiang Tang, Zhizi Houpo Zhishi Tang, and Zhizi Baipi Tang follow standard decoction.
The strangest is Zhishi Zhizi Chi Tang (Immature Bitter Orange, Gardenia, and Fermented Soybean Decoction). Boil seven sheng of Qing Jiang Shui (Clear Fermented Rice Water) alone to four sheng, add Immature Bitter Orange and Gardenia, boil to three sheng, add Chi, boil five or six boils, strain, and divide into two warm doses. Qing Jiang Shui is aged rice-washing water, preferred sour.
Da Chengqi Tang (Major Order the Qi Decoction) differs: four herbs, three steps. Boil Magnolia Bark and Immature Bitter Orange in one dou of water to five sheng, strain, add Rhubarb, boil to two sheng, strain, add Mirabilite, simmer briefly, divide, and serve warm. Boiling Immature Bitter Orange, Magnolia Bark, and Rhubarb together yields Xiao Chengqi Tang (Minor Order the Qi Decoction), not Da Chengqi Tang.
Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction) requires boiling Rhubarb and Licorice in three sheng of water to one sheng, strain, add Mirabilite, simmer briefly, and take small warm doses. This differs from Major and Minor versions. Taohé Chengqi Tang (Peach Pit Order the Qi Decoction) is similar to Tiaowei.
Didang Wan (Stagnation Eliminating Pill) is a pill but taken via decoction.
Shizao Tang (Ten Jujubes Decoction) boils only Jujubes. The other three herbs are powdered and taken with the Jujube decoction.
Daxianxiong Tang (Major Trap the Chest Decoction) takes three steps: three herbs. Boil Rhubarb in six sheng of water to two sheng, strain, add Mirabilite, boil one or two boils, then add Kansui powder, and serve one sheng warm.