岁庚申，薄游西冷，卖药葛仙岭下，青山寂历，丹灶空明，稚川有知，应亦笑人千古也
。我
友寿乔，幼耽绣虎，壮悔雕虫，宏景之阁三层，雁湖之水一曲，常日摊书，有时倚棹，寄身
于材不材间，寓巧于元之元外，惜盈盈三十里，赏析为难，玉屑珠霏，空付停云落月中耳。
岁龠初更，嘤鸣綦切，爰偕二三旧雨，访寿乔于一隅草堂，积雨新霁，空翠满庭，延伫既
久，皓魄渐升，乃斟桂醑，载启瑶编，循环雒诵，沁入心脾，半生疑窦，一旦冰释。嘻，幸
已，忆予与寿乔交，迄今垂二十余年矣，屈指故人如雪泉石帆梨谷诸君子，悉皆化为异物，
而计然七荣，沈约一围，犹得鸿爪雪泥，一话当年陈迹，虽青青双鬓，渐复成丝，亦可见吾
两人之长， 白木 术寻苓，未始非人间世大自在法也。二月初吉，寿乔将官广文，间云出
岫，本自无心，而故山猿鹤，有待招寻。爰于诸公祖帐之时，聊将贱子题襟之意，他日者，
春风桃李，收拾药笼，当退出青鞋，与寿乔重问勾漏消息，未识三生一笑，果有旧因缘否也
嘉庆九年陬月二十有六日吴江同研弟沈 拜手跋
烂喉发 疹，近时甚多，在稚年不治者，十有八九。何也？其根由于种痘，近时婴孩禀
质既
薄，痘师防其发点繁多，下苗甚轻，多者数十颗，少者不过数颗，而先天脏腑之毒，未经尽
透。一遇时感传染，乘机而发，治之以寒凉之剂，则必至下陷；治之以透表之剂，则又邪未
达而本先拨，蕴伏咽喉，随即溃烂而亡，其危可胜言哉！读《金匮》书，有“阳毒之为病，
面赤斑斑如锦纹，咽喉痛，吐脓血，五日可治，七日不可治，升麻鳖甲汤主之”之文，盖以
升麻透厉毒，鳖甲泄热守神，当归和血调营，甘草泻火解毒，即《内经》所云∶热淫于内，
治以咸寒，佐以苦甘之旨。绎其意，实与此症相类，而方内有蜀椒、雄黄，似当加于阴毒方
中，或因传写之讹，医者当息心揣度，用古而不泥于古，转机则在于临症活变也。
李云浦云∶烂喉痧一症，风热者宜清透，湿热者宜清渗，痰火凝结者宜消降。盖邪达则
痧透
，痧透则烂自止，若过用寒凉，势必内陷，其害不浅。但其证有可治有不可治，口中作臭者
，谓之回阳，其色或淡黄，或深黄，此系痰火所致，皆可治也。如烂至小舌，鼻塞合眼朦胧
，是毒瓦斯深伏，元气日虚，色白如粉皮样者，皆不可治也。
烂喉发 斑，半由于元虚不正，时邪易于感染，重者用紫背浮萍、生石膏等药，透毒解
热；
稍轻者，只宜用大力子、桑叶、杏仁、连翘、桔梗、荆芥、萆 、花粉，轻清之品，清邪化
热，不得早用大生地、麦冬等以腻之，亦断不可用黄连、黄芩太苦大寒等品以遏。此等时证
，其势危速，须细心详慎审脉察色，庶几不致误治也。
南人多温热病，而少真正伤寒，不可概从六经论治。盖伤寒六日传遍，多有变证，温热
惟留
恋一经，或传入营分，从风从湿，必潜心细究，于舌色尤为先务。叶天士前辈《温热论治》
数条，发前人所未发，最为切要，学人宜宗法焉。
邪之所凑，其气必虚。故曰不能治其虚，焉问其余？然亦不可执也。强壮之人，思虑应
酬之
间，为淫邪贼风所乘，或自恃脾强，过啖甘肥炙 ，酿成胶痰实火，亦宜发表攻里，如河间
推陈致新之法，有何不可。若因循顾忌，治不中肯，久则反伤正气，所谓五虚死，五实亦死
。又云∶毋实实，毋虚虚是也。若不论虚实，动手便用补益，执扶正化邪之说，与胶柱而鼓
者何异耶？
疟病无汗，要有汗固矣，至于有汗要无汗，亦不可不斟酌也。虽有虚实之不同，其根未
有不
因暑邪内藏，阴邪外束所致。暑为阳邪，阳邪多汗，故疟往往有汗，岂可因其汗多，早加固
表之药，以致病情反复。故古人但言久疟扶正为主，未尝言固表也。愚谓∶汗少不妨更发汗
，汗多不必再发汗，但以轻清和解，治之可也。卫属阳，其气 悍，故行速；营属阴，其气
静翕，故行迟。疟邪之间，一日及连二日发者，邪之着于营也，如周天之数，日行过之，月
行不及，亦是阴阳迟速之分耳。
治疫之法，解毒为先务。吴又可专用大黄驱逐毒秽，但近时之人，体气多薄，攻荡难施
，莫
若张路玉用人中黄配葱、豉等解毒药，为起首方。叶天士用银花、金汁凉解之品，最为稳当
。喻氏云∶上焦如雾，升而逐之，佐以解毒；中焦如沤，疏而逐之，佐以解毒；下焦如渎，
决而逐之，佐以解毒。观其旨，病有上中下之分，而独于解毒一言，叮咛再四，岂非急于解毒之法哉？
疫者，秽恶之气，互相传染。吴氏谓∶从口鼻而入，即踞膜原，但口鼻吸受，肺为出入之门户，无有
不先犯肺者。疫皆热毒，肺金所畏，每见此症，身热先有憎寒，肺先病也∶继而充斥三焦，或有迳走心包络者
，所谓厉气，无非郁热也。至于疫邪渐解而肺蓄余热。每多咳呛肌热自汗等证，亦所谓肺先病而未愈之明征也
。今人每遇房劳遗泄之后，偶感风寒发热，即谓之阴证，病者怕虚，医者怕表，不问现症如何，竟用参、地、
附、桂温热峻补之剂，是则先补实其风寒于肾中矣，邪何由出耶？夫所谓阴证者，寒邪中于三阴经也。即使中于肾经，
亦须先散少阴之风寒，如《伤寒论》中少阴发热，仍用麻黄、细辛发表之法是也。若果直中
三阴，身不壮热，有恶寒倦卧，厥冷喜热等症，亦且先宜温散，渐进滋补之法，此理不可不
细辨也。
大概治膏粱者多滋养，治藜藿者多消散。然膏粱之体，易生痰积，由其多食浓味也，亦
散；藜藿之人，易于清减，由其自奉淡薄也，亦宜滋养。所谓人情物理，不可执一以施。
病有在下者，其见证反在上，如蓄血发狂是矣。在上者反在下，如肺气壅，大便频；肺气虚
，小便数是矣；在表者反在里，如三阳合病下利是矣。在里者反在表，如热深厥亦深，及面
反戴阳是矣。治宜细察。
卫为阳，风为阳邪，中风者，阳虚不能卫外，以类相从也，故多显阳热之症。治宜求受
病之本，毋徒事于风药，以重虚其表。
《伤寒论》云∶能食者为中风，不能食者为中寒，则伤寒内中风之症，未尝禁其食也。
又云
∶欲饮水者，稍稍与之。盖实火烦渴，得水则解，未尝禁冷水也。乃医者，凡遇此症，恐其
伤胃，禁止勿与，是亦背先贤之在旨矣。
阴虚则阳无所附，气有升无降，法当以滋阴药为君，敛降之药为佐。苟徒降其气，则浊
未必
降，而清且随虚矣。阳虚则气中断，气有降无升，法当以补中药为君，升举之药为佐，苟徒
升其气，则清未必升，而浊且随干矣，此治阴阳之偏虚也。外此或七情逆滞，或气血饮食痰
阻，碍于中焦，妨其升降出入之路，其人元气未亏，不妨升之降之也。此后天有形之气血，
调治之理，至若先天元阴元阳，则阴虚阳必薄，阳虚阴必乘；但当峻补，阴阳无暇为升降，
标计也。
阳虚而见阳热之症，是真火无根而脱出也；阴虚而见阳热之症，是阴虚阳无所附而然也
；阳盛
而见阴寒之症，是阳盛拒阴也；阴盛而见阳热之症，是阴盛格阳也。四者用药不当，生死反
掌。
肾者，胃之关。从阳则开，从阴则阖；阳太胜则开而为消，阴太胜则阖而为水，明矣。
仲景
治水肿，主之以肾气丸，而治消渴亦然，宁不与阳盛有乖乎？然而此之消，是肾中阳虚不能
收摄也；此之渴，是肾中阴虚，引水自救也。喻氏谓肾水下趋，故消；肾气不上腾，故渴。
均用此丸，蒸动肾气，恐未必然。
咳嗽之症，大半由于火来克金，谓之贼邪，最难速愈。因风寒外袭，而内生实火，急宜
泻之
；若失于提解，久之传变生痰，误服阴药，反成痨瘵。如果系虚火，惟有壮水一法；但养阴
之药，又皆阻气滞痰，是在治之者灵也。如生脉六君汤、金水六君煎之类，最为妥当。
肾虚水泛为痰，有肾中阳虚，肾中阴虚，阳虚津液洋洋泛溢，味淡起沫，治宜补气以生
阴
，则上泛可降；阴虚咳唾痰涎，味咸粘腻，治宜益水以潜阳，则咳唾可平，治不可杂也。
鼓膈为难治之病，然鼓犹可治，膈断不可治。鼓多实证，或痰或血，或气或食，或水凝
结于
中，能先下其滞，继以补养肠胃，渐能运化矣。《内经》鸡矢醴之方，即治法也。至臂细脐
凸，青筋绕腹，手心及背平满，此脏气已绝，死不治。若膈证始由肝火犯胃，木来侮土，谓
之贼邪。所以肝阴素亏，津液不足之体，呕逆不止，久成噎膈，以至胃汁枯槁，痰涎壅塞，
食不下达，仍复吐出。此病在贲门，固与反胃之证，朝食暮吐，暮食朝吐，病在幽门者，判
然两途。经云∶谷入于胃，以传于肺，五脏六腑，皆以受气。今既食不能入，则脏腑之气皆
竭矣。故见此病，少可纳谷，不出一年而死；全不纳谷，不出半年而死。春得病死于秋，秋
得病死于春，金水相克之时也。
心肾不足，小便混浊，中气不足，溲便为之变色。要知金衰则水涸，水涸则小便短数而
混浊
；气不足则易郁，郁则生热，热生则溺色变为黄赤矣，当求其本而治之。若徒执水液混浊，
皆属于火，概施利水清热之品，必致反增其病。
香港脚之病，多由湿热，因浊邪下先受之也。膏粱者，湿热内生，藜藿者，湿热外侵，治
宜分
利渗湿固也。若有阴虚之极，不能吸气归元；阳虚之极，不能摄血归经，阴阳偏胜，升降失
司，于是阳独浮于上，阴独沉于下，足至暮则肿痛矣。治又宜补阴益气，不可概施分利渗湿
，以重伤其阴阳。是在观形察脉，以细求之。
有思虑伤脾，脾虚不能统血而失出者；有思虑伤脾，脾衰不能消谷而泄泻者。失血断不
宜用凉血，泄泻不宜用消导，以致脾气愈伤，皆当扶养脾土为本，勿徒治其标。
《平脉》云∶少阴脉不至，肾气微少，精血奔，气迫促，上入胸膈。夫少阴脉不至，是
先天
元阳元阴受伤。肾者，先天也；脾胃者，后天也。先天既已受伤，则不能生乎后天，故脾胃
之阴阳亦伤，不能运化水谷而生湿热；湿热下流，则膀胱之气化不行，浊气因而上入。浊气
上入，肺气便壅，脾气愈滞，于是为痰为饮，而食滞腹胀之症形焉。其少阳生发之气，郁而
不得升，为周身刺痛，为呕逆吞酸；心主之阳为浊阴所乘，则为心悸怔忡。是肾之一脏腑，
而五脏六腑，皆为之不宁，故养身莫妙于节欲也。若不知此，而但以利气行痰消食为治，则
燥以伤其阴，利以伤其阳，不坐困乎？此专主肾虚而言也。
诸痛无补，言气逆滞也。然壮者，气行则愈；怯者，着而成病。真气虚乏之人，诸邪易
于留
着，着则逆，逆则痛。疏刷之中，不可无补养之品。徒事攻击，则正愈虚，邪愈着而痛无休
止也。所以脾胃亡液，焦燥如割，宜用地黄养阴等以润之；脉阳涩阴弦，腹中急痛，当用小
建中汤；肝血不足，两胁胀满，筋急不得太息，四肢厥冷，心腹引痛，目不明了，爪甲枯面
青，宜补肝汤。肾虚羸怯之人，房劳过度，胸膈间多隐隐痛，此肾虚不能约气，气虚不能生
血之故，往往凝滞而作痛，宜用破故纸、萸肉、枸杞等温肾，归、芍等养血。至于头痛，有
气虚，有血虚，有肾虚，皆不可无补也。
风温温疟之病，其根得之于冬令，中于风寒，遇温而发，其气自内而达于外，故多汗。
不比
风邪外束，闭其营卫，当发汗解肌也。治故以发表为逆，亦不可因汗而敛之。致变别病，务
以清解得宜。
吐血一证，缪氏云∶治有三诀。宜行血不宜止血。血不循经络者，气逆上壅也，行血则
使循
经络，不止自止；若用硬止之剂，血必凝，血凝则发热恶食，病日痼矣。宜补肝不宜伐肝。
肝主藏血，吐者，肝失其职也，养肝则肝气平而血有所归；若使伐肝，则肝愈虚，血愈不止
矣。宜降气不宜降火。气有余便是火，气降则火降，火降则气不上升，血随气行，无溢出上
窍之患矣；若使先降火，必用寒凉之剂，反伤胃气，胃气伤，则脾不能统，血愈不归经矣。
吐血入水，浮者肺血，沉者肝血，半沉半浮者心血，色赤如太阳红者肾血。肺血宜保肺，不
宜泻肺；肝血宜养肝，不宜伐肝；心血宜补心，不宜泻心；肾血宜滋肾，不宜凉肾。若使久
吐不止，血已大虚，当用温补以健脾胃，使脾和则能裹血也。若暴吐不止，急用大剂参、术
，以急固元阳，血脱益气，阳生阴长之理也。如一味以生地、苓、连、知、柏、黑栀，寒凉
阴腻之属清其火，则脾伤作泻，发热咳嗽，势必至于不救矣。
幼科惊证，自喻氏以食、痰、风、惊四字立名，大剖从前之讹，原为确论，然亦有未尽
者。
近多冬令气暖失藏，入春寒温间杂；小儿吸受其邪，先伤肺经，起自寒热，气粗久延，渐入
包络，虽有微汗，而痰多鼻煽，烦躁神昏，病家惶惧，辄云变为惊风。动用香开，妄投金石
庚申年，我短暂游历西冷，在葛仙岭下卖药。那里青山寂静，丹炉空明，如果稚川（葛洪）有知，应该会笑我千古以来徒劳无功吧。
我的朋友寿乔，年轻时沉迷于辞赋写作，壮年后后悔雕虫小技。他住在宏景阁三层楼上，面对雁湖的一曲碧水，平日里摊开书籍阅读，有时倚靠船桨泛舟，寄身于“材与不材”之间，寓巧于玄妙之外。可惜盈盈三十里的距离，赏析交流很难，那些如玉屑珠霏般珍贵的文字，只能白白付之于停云落月的意境中罢了。
岁末年初，朋友间呼唤声急切，于是我和几位老朋友，去拜访角落草堂里的寿乔。连绵阴雨刚停，庭院里满是清新的翠色，久候之后，明月渐渐升起，于是斟上桂花酒，打开精美的书卷，循环诵读，沁入心脾，半生的疑惑，一旦冰释。唉，庆幸啊！回想我与寿乔的交情，到现在将近二十年了，屈指算来，像雪泉、石帆、梨谷诸位君子这样的老朋友，都已经化为异物（去世），而凭借计然七荣（指长寿）、沈约一围（指消瘦或身体变化，此处借指人生际遇）的故事，还能像鸿爪雪泥一样，聊聊当年的陈迹。虽然两鬓青青，渐渐变白如丝，但也可见我们两人的长寿，用白木术和茯苓调理身体，未尝不是人间大自在的方法。二月初吉，寿乔将要去担任广文官（学官），云彩从山穴中飘出，本自无心，但故山的猿鹤，等待招寻。于是在各位前辈设宴饯行时，姑且写下我这个后辈题襟（指赠诗唱和）的心意。他日春风桃李盛开时，收拾药笼，退出青鞋（指隐居生活），将与寿乔重新询问勾漏（地名，传说葛洪在此炼丹成仙）的消息，不知道三生一笑，是否真的有旧因缘呢？
嘉庆九年正月二十六日，吴江同砚弟沈拜手跋
烂喉发疹，近来非常多，在幼童时期如果不治疗，十有八九会出问题。为什么呢？其根源在于种痘。近来的婴儿禀赋体质薄弱，痘医为了防止发出过多的痘点，接种的苗毒很轻，多的几十颗，少的不过几颗，但先天脏腑的毒素，没有完全透发出来。一旦遇到时令邪气传染，乘机发作，如果用寒凉药物治疗，必然导致邪气下陷；如果用透表药物治疗，又会导致邪气未达体表而根本先被动摇，蕴伏在咽喉，随即溃烂死亡，这种危险难道能说尽吗！读《金匮要略》一书，有“阳毒这个病，面部红赤斑斑像锦纹，咽喉痛，吐脓血，五天可治，七天不可治，升麻鳖甲汤主治”的文字，大概是用升麻透发厉毒，鳖甲泄热守神，当归和血调营，甘草泻火解毒，这也就是《内经》所说的：热淫于内，用咸寒药物治疗，佐以苦甘药物之意。推究它的意思，确实与此症相似，但方内有蜀椒、雄黄，似乎应该加在阴毒方中，或许是传写之误，医者应当静心揣度，使用古方而不拘泥于古方，转机在于临证灵活变通。
李云浦说：烂喉痧这一症，风热的宜清透，湿热的宜清渗，痰火凝结的宜消降。大概邪气透出则痧透，痧透则腐烂自然停止，如果过用寒凉，势必内陷，危害不浅。但是此症有可治和不可治之分，口中发臭的，叫做回阳，颜色或淡黄，或深黄，这是痰火所致，都可治。如果烂到小舌，鼻塞眼朦胧，是毒瓦斯深伏，元气日渐虚弱，颜色白如粉皮样的，都不可治。
烂喉发斑，一半由于元气虚损不正，时邪易于感染，重的用紫背浮萍、生石膏等药，透毒解热；稍轻的，只宜用牛蒡子、桑叶、杏仁、连翘、桔梗、荆芥、萆薢、花粉，这些轻清的药品，清邪化热，不得早用大生地、麦冬等滋腻的药物，也绝对不可用黄连、黄芩等大苦大寒的药品来遏制。这种时行病症，病情危急迅速，必须细心详慎地审脉察色，才不至于误治。
南方人多是温热病，而少真正的伤寒，不能一概从六经论治。大概伤寒六天传遍，多有变证，温热病只留恋一经，或传入营分，从风从湿，必须潜心细究，对于舌色的观察尤为首要任务。叶天士前辈《温热论治》几条内容，发前人所未发，最为切要，学人应当宗法它。
邪气所聚集的地方，正气必定虚弱。所以说不能治其虚，哪里问其余？但是也不可固执。强壮的人，在思虑应酬之间，被淫邪贼风乘虚而入，或者自恃脾强，过食甘肥炙烤之物，酿成胶痰实火，也宜发表攻里，如河间刘完素推陈致新的方法，有什么不可以。如果因循顾忌，治疗不中肯綮，久了反而伤正气，所谓五虚死，五实亦死。又说：不要实实，不要虚虚。如果不分虚实，动手就用补益，执着扶正化邪的说法，与胶柱鼓瑟的人有什么不同呢？
疟病无汗，要有汗固然对，至于有汗要无汗，也不可不斟酌。虽然有虚实不同，其根源无不因为暑邪内藏，阴邪外束所致。暑为阳邪，阳邪多汗，所以疟疾往往有汗，岂可因其汗多，早早加固表的药，以致病情反复。所以古人只说久疟扶正为主，未曾说固表。我认为：汗少不妨再发汗，汗多不必再发汗，只要用轻清和解的方法治疗即可。卫属阳，其气悍烈，所以运行快；营属阴，其气静敛，所以运行慢。疟邪侵犯，一天或连续两天发作的，是邪气着于营分，如同周天之数，太阳运行超过，月亮运行不及，这也是阴阳迟速的区别。
治疗疫病的方法，解毒为先务。吴又可专用大黄驱逐毒秽，但近时之人，体气多薄弱，攻荡难以施用，不如张路玉用人中黄配葱、豉等解毒药，作为起首方。叶天士用银花、金汁凉解的药品，最为稳当。喻氏说：上焦如雾，升而逐之，佐以解毒；中焦如沤，疏而逐之，佐以解毒；下焦如渎，决而逐之，佐以解毒。看他的旨意，病有上中下之分，而唯独在解毒一言上，叮咛再三，岂不是急于解毒的方法吗？
疫者，是秽恶之气，互相传染。吴氏说：从口鼻而入，就占据膜原，但口鼻吸受，肺为出入的门户，没有不先犯肺的。疫病都是热毒，肺金所畏惧，每每见此症，身热先有憎寒，肺先病了；继而充斥三焦，或者有径直走心包络的，所谓厉气，无非郁热罢了。至于疫邪渐解而肺蓄余热，每多咳呛肌热自汗等证，也是所谓肺先病而未愈的明显征象。今人每每遇到房劳遗泄之后，偶感风寒发热，就称之为阴证，病人怕虚，医生怕表，不问现症如何，竟用参、地、附、桂温热峻补的药剂，这是先补实了风寒在肾中了，邪气从哪里出来呢？所谓阴证，是寒邪中于三阴经。即使中于肾经，也必须先散少阴的风寒，如《伤寒论》中少阴发热，仍用麻黄、细辛发表的方法。如果果直中三阴，身不壮热，有恶寒倦卧，厥冷喜热等症，也且先宜温散，渐进滋补的方法，这个道理不可不细辨。
大概治疗吃膏粱厚味的人多滋养，治疗吃藜藿粗食的人多消散。然而膏粱之体，易生痰积，由其多食浓味也，也宜散；藜藿之人，易于清减，由其自奉淡薄也，也宜滋养。所谓人情物理，不可执一以施。
病有在下者，其见证反在上，如蓄血发狂就是。在上者反在下，如肺气壅，大便频；肺气虚，小便数就是；在表者反在里，如三阳合病下利就是。在里者反在表，如热深厥亦深，及面反戴阳就是。治疗宜细察。
卫为阳，风为阳邪，中风者，阳虚不能卫外，以类相从，所以多显阳热之症。治疗宜求受病的根本，不要只从事于风药，以重虚其表。
《伤寒论》说：能食者为中风，不能食者为中寒，那么伤寒内中风之症，未曾禁止饮食。又说：想喝水的，稍微给他喝。大概实火烦渴，得水则解，未曾禁止冷水。然而医者，凡遇此症，恐其伤胃，禁止不给，这也是违背先贤的本旨了。
阴虚则阳无所附，气有升无降，法当以滋阴药为君，敛降之药为佐。如果只降其气，则浊未必降，而清且随虚矣。阳虚则气中断，气有降无升，法当以补中药为君，升举之药为佐，如果只升其气，则清未必升，而浊且随干矣，这是治阴阳之偏虚。此外或七情逆滞，或气血饮食痰阻，碍于中焦，妨其升降出入之路，其人元气未亏，不妨升之降之也。这是后天有形之气血，调治的道理，至于先天元阴元阳，则阴虚阳必薄，阳虚阴必乘；但当峻补，阴阳无暇为升降，标计也。
阳虚而见阳热之症，是真火无根而脱出也；阴虚而见阳热之症，是阴虚阳无所附而然也；阳盛而见阴寒之症，是阳盛拒阴也；阴盛而见阳热之症，是阴盛格阳也。四者用药不当，生死反掌。
肾者，胃之关。从阳则开，从阴则阖；阳太胜则开而为消，阴太胜则阖而为水，明矣。仲景治水肿，主之以肾气丸，而治消渴亦然，宁不与阳盛有乖乎？然而此之消，是肾中阳虚不能收摄也；此之渴，是肾中阴虚，引水自救也。喻氏谓肾水下趋，故消；肾气不上腾，故渴。均用此丸，蒸动肾气，恐未必然。
咳嗽之症，大半由于火来克金，谓之贼邪，最难速愈。因风寒外袭，而内生实火，急宜泻之；若失于提解，久之传变生痰，误服阴药，反成痨瘵。如果系虚火，惟有壮水一法；但养阴之药，又皆阻气滞痰，是在治之者灵也。如生脉六君汤、金水六君煎之类，最为妥当。
肾虚水泛为痰，有肾中阳虚，肾中阴虚，阳虚津液洋洋泛溢，味淡起沫，治宜补气以生阴，则上泛可降；阴虚咳唾痰涎，味咸粘腻，治宜益水以潜阳，则咳唾可平，治不可杂也。
鼓膈为难治之病，然鼓犹可治，膈断不可治。鼓多实证，或痰或血，或气或食，或水凝结于中，能先下其滞，继以补养肠胃，渐能运化矣。《内经》鸡矢醴之方，即治法也。至臂细脐凸，青筋绕腹，手心及背平满，此脏气已绝，死不治。若膈证始由肝火犯胃，木来侮土，谓之贼邪。所以肝阴素亏，津液不足之体，呕逆不止，久成噎膈，以至胃汁枯槁，痰涎壅塞，食不下达，仍复吐出。此病在贲门，固与反胃之证，朝食暮吐，暮食朝吐，病在幽门者，判然两途。经云：谷入于胃，以传于肺，五脏六腑，皆以受气。今既食不能入，则脏腑之气皆竭矣。故见此病，少可纳谷，不出一年而死；全不纳谷，不出半年而死。春得病死于秋，秋得病死于春，金水相克之时也。
心肾不足，小便混浊，中气不足，溲便为之变色。要知金衰则水涸，水涸则小便短数而混浊；气不足则易郁，郁则生热，热生则溺色变为黄赤矣，当求其本而治之。若徒执水液混浊，皆属于火，概施利水清热之品，必致反增其病。
香港脚之病，多由湿热，因浊邪下先受之也。膏粱者，湿热内生，藜藿者，湿热外侵，治宜分利渗湿固也。若有阴虚之极，不能吸气归元；阳虚之极，不能摄血归经，阴阳偏胜，升降失司，于是阳独浮于上，阴独沉于下，足至暮则肿痛矣。治又宜补阴益气，不可概施分利渗湿，以重伤其阴阳。是在观形察脉，以细求之。
有思虑伤脾，脾虚不能统血而失出者；有思虑伤脾，脾衰不能消谷而泄泻者。失血断不宜用凉血，泄泻不宜用消导，以致脾气愈伤，皆当扶养脾土为本，勿徒治其标。
《平脉》说：少阴脉不至，肾气微少，精血奔，气迫促，上入胸膈。夫少阴脉不至，是先天元阳元阴受伤。肾者，先天也；脾胃者，后天也。先天既已受伤，则不能生乎后天，故脾胃之阴阳亦伤，不能运化水谷而生湿热；湿热下流，则膀胱之气化不行，浊气因而上入。浊气上入，肺气便壅，脾气愈滞，于是为痰为饮，而食滞腹胀之症形焉。其少阳生发之气，郁而不得升，为周身刺痛，为呕逆吞酸；心主之阳为浊阴所乘，则为心悸怔忡。是肾之一脏腑，而五脏六腑，皆为之不宁，故养身莫妙于节欲也。若不知此，而但以利气行痰消食为治，则燥以伤其阴，利以伤其阳，不坐困乎？此专主肾虚而言也。
诸痛无补，言气逆滞也。然壮者，气行则愈；怯者，着而成病。真气虚乏之人，诸邪易于留着，着则逆，逆则痛。疏刷之中，不可无补养之品。徒事攻击，则正愈虚，邪愈着而痛无休止也。所以脾胃亡液，焦燥如割，宜用地黄养阴等以润之；脉阳涩阴弦，腹中急痛，当用小建中汤；肝血不足，两胁胀满，筋急不得太息，四肢厥冷，心腹引痛，目不明了，爪甲枯面青，宜补肝汤。肾虚羸怯之人，房劳过度，胸膈间多隐隐痛，此肾虚不能约气，气虚不能生血之故，往往凝滞而作痛，宜用破故纸、萸肉、枸杞等温肾，归、芍等养血。至于头痛，有气虚，有血虚，有肾虚，皆不可无补也。
风温温疟之病，其根得之于冬令，中于风寒，遇温而发，其气自内而达于外，故多汗。不比风邪外束，闭其营卫，当发汗解肌也。治故以发表为逆，亦不可因汗而敛之。致变别病，务以清解得宜。
吐血一证，缪氏说：治有三诀。宜行血不宜止血。血不循经络者，气逆上壅也，行血则使循经络，不止自止；若用硬止之剂，血必凝，血凝则发热恶食，病日痼矣。宜补肝不宜伐肝。肝主藏血，吐者，肝失其职也，养肝则肝气平而血有所归；若使伐肝，则肝愈虚，血愈不止矣。宜降气不宜降火。气有余便是火，气降则火降，火降则气不上升，血随气行，无溢出上窍之患矣；若使先降火，必用寒凉之剂，反伤胃气，胃气伤，则脾不能统，血愈不归经矣。吐血入水，浮者肺血，沉者肝血，半沉半浮者心血，色赤如太阳红者肾血。肺血宜保肺，不宜泻肺；肝血宜养肝，不宜伐肝；心血宜补心，不宜泻心；肾血宜滋肾，不宜凉肾。若使久吐不止，血已大虚，当用温补以健脾胃，使脾和则能裹血也。若暴吐不止，急用大剂参、术，以急固元阳，血脱益气，阳生阴长之理也。如一味以生地、苓、连、知、柏、黑栀，寒凉阴腻之属清其火，则脾伤作泻，发热咳嗽，势必至于不救矣。
幼科惊证，自喻氏以食、痰、风、惊四字立名，大剖从前之讹，原为确论，然亦有未尽者。近多冬令气暖失藏，入春寒温间杂；小儿吸受其邪，先伤肺经，起自寒热，气粗久延，渐入包络，虽有微汗，而痰多鼻煽，烦躁神昏，病家惶惧，辄云变为惊风。动用香开，妄投金石
In the Gengshen year, I briefly traveled to Xiling and sold medicine at the foot of Gexian Ridge. The green mountains were silent, and the cinnabar furnace was empty and bright; if Zhichuan (Ge Hong) had knowledge, he would surely laugh at my thousand years of futility.
My friend Shouqiao, in his youth, was obsessed with writing ci-fu (rhymed prose), and in his prime, he regretted practicing trivial literary skills. He lived on the third floor of Hongjing Pavilion, facing a bend of Yanhu Lake. On ordinary days, he spread out books to read, and sometimes leaned on an oar to boat. He entrusted himself between "useful and useless," hiding skill beyond the profound mystery. Alas, within a mere thirty li, appreciation and exchange were difficult; those precious words like jade chips and pearl showers were vainly given to the imagery of lingering clouds and falling moon.
At the beginning of the new year, the calls among friends were urgent, so I accompanied two or three old acquaintances to visit Shouqiao in a corner thatched cottage. After the accumulated rain cleared, the courtyard was filled with fresh greenery. After waiting for a long time, the bright moon gradually rose. We then poured osmanthus wine and opened exquisite book volumes, reading them in cycles. It penetrated the heart and spleen, and doubts from half a lifetime were suddenly resolved as ice melting. Oh, how fortunate! Recalling my friendship with Shouqiao, it has been nearly twenty years until now. Counting on fingers, old friends like Mr. Xuequan, Shifan, Ligu, etc., have all turned into other things (passed away). Yet, relying on stories like Jiran's seven prosperities and Shen Yue's one circumference (referring to life experiences), we can still talk about past traces like goose prints on snow mud. Although our temples are still black, gradually turning white like silk, this also shows the longevity of the two of us. Using Bai Mu Zhu (Atractylodes Macrocephala Rhizome) and Ling Zhi (Poria) to regulate the body is by no means not a great method of freedom in the human world.
On the auspicious day of the second month, Shouqiao was going to serve as a Guangwen official (academic officer). Clouds emerge from the cave naturally without intent, but the apes and cranes of the old mountain await summoning. Therefore, at the time of the banquet hosted by various elders, I casually wrote down the sentiment of my younger colleague regarding poetry exchange. In the future, when spring breeze and peaches and plums bloom, after packing the medicine basket and retiring from the green shoes (recluse life), I will ask Shouqiao again about the news of Goulou (a place where Ge Hong refined elixirs and became immortal). I wonder if a smile across three lives truly has old affinities?
On the 26th day of the first month of the ninth year of Jiaqing, Shen, younger brother fellow student from Wujiang, bowed and added a postscript.
Rotting throat with rash is very common recently. If untreated in childhood, eight or nine out of ten cases will result in complications. Why? The root lies in smallpox vaccination. Infants nowadays have weak constitutions. To prevent too many spots from erupting, vaccinators use very light vaccine material. There may be dozens of spots, or just a few. However, the toxins of the innate zang-fu organs are not fully expelled. Once exposed to seasonal epidemic pathogens, they take the opportunity to erupt. If treated with cold-cooling agents, the pathogen must sink inward; if treated with exterior-releasing agents, the pathogen has not reached the surface while the root is already disturbed. The toxin accumulates in the throat, leading to ulceration and death. How can the danger be fully described! Reading the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), there is text stating: "Yang Du disease presents with a red face spotted like brocade patterns, sore throat, and vomiting pus and blood. It is treatable within five days, but untreatable after seven days. Shengma Biejia Tang (Cinnamon Twig and Turtle Shell Decoction) is the main prescription." This uses Shengma (Cimicifugae Rhizoma) to release severe toxins, Biejia (Testudinis Carapax et Plastrum) to drain heat and preserve spirit, Danggui (Angelicae Sinensis Radix) to harmonize blood and regulate Ying-nutrient level, and Gancao (Glycyrrhizae Radix et Rhizoma) to purge fire and detoxify. This aligns with the principle in *Nei Jing* (Inner Canon): "When heat dominates internally, treat with salty-cold substances, assisted by bitter-sweet ones." Analyzing its meaning, it is indeed similar to this condition. However, the formula contains Shujiao (Sichuan Pepper) and Xionghuang (Realgar), which seem more appropriate for Yin Du formulas. This might be a transcription error. Physicians should ponder calmly, use ancient formulas without being bound by them, and find the turning point through flexible adaptation during clinical practice.
Li Yunpu said: For Rotting Throat Sha (Scarlet Fever-like illness), wind-heat types should be cleared and released; damp-heat types should be cleared and drained; phlegm-fire congealing types should be reduced and descended. Generally, when the pathogen is released, the sha rash emerges; when the sha rash emerges, the rotting stops. If cold-cooling agents are overused, the pathogen will inevitably sink inward, causing significant harm. However, this condition has treatable and untreatable forms. Bad breath indicates "returning yang"; colors ranging from pale yellow to deep yellow are caused by phlegm-fire and are treatable. If rotting extends to the uvula, nasal congestion, and blurry vision, it indicates deep-seated toxic gases and declining Yuan-qi, which are untreatable. White color like parchment skin is also untreatable.
Rotting throat with macules is half due to deficiency of Yuan-qi and abnormality, making one susceptible to seasonal pathogens. Severe cases use Zi Bei Fu Ping (Heterophyllous Water Primrose Herb) and Sheng Shigao (Gypsum Fibrosum) to release toxins and clear heat. Milder cases should only use Niu Bang Zi (Arctii Fructus), Sang Ye (Mori Folium), Xing Ren (Armeniacae Semen Amarum), Lian Qiao (Forsythiae Fructus), Jie Geng (Platycodonis Radix), Jing Jie (Schizonepetae Spica), Bi Xie (Dioscoreae Hypoglaucae Rhizoma), and Hua Fen (Trichosanthis Radix). These light and clear herbs clear pathogens and transform heat. One must not use Da Sheng Di (Rehmanniae Radix Preparata) or Mai Dong (Ophiopogonis Radix) early to cause cloying, nor absolutely use Huang Lian (Coptidis Rhizoma) or Huang Qin (Scutellariae Radix) which are too bitter and cold to suppress the pathogen. Such seasonal diseases progress rapidly and dangerously. One must carefully examine the pulse and observe the complexion to avoid misdiagnosis.
People in the South mostly suffer from warm-heat diseases and rarely true Shanghan (Cold Damage). Treatment cannot generally follow the Six Meridians theory. Shanghan transmits through six days and often has complicated changes. Warm-heat diseases linger in one meridian or enter the Ying-nutrient level. Whether following wind or dampness, one must investigate deeply. Observing the tongue color is particularly crucial. Ye Tianshi's senior work *Wen Re Lun Zhi* (Discussion on Diagnosis and Treatment of Warm-Heat Diseases) expounds previously unexplored ideas and is most essential. Students should follow its principles.
Wherever the pathogen gathers, the Qi must be deficient. Thus it is said: "If you cannot treat the deficiency, how can you ask about the rest?" However, one must not be rigid. Strong individuals, amidst thinking and socializing, may be attacked by licentious evil and thieving winds. Or, relying on strong Spleen, they overeat sweet, fatty, and roasted foods, brewing sticky phlegm and excess fire. In such cases, releasing the exterior and purging the interior is appropriate, just like Liu Hejian's method of eliminating the old and generating the new. What is wrong with that? If one hesitates and treats ineffectively, it will eventually damage healthy Qi. As stated: "Five Deficiencies lead to death, Five Excesses also lead to death." It is also said: "Do not tonify excess, do not reduce deficiency." If one does not distinguish between deficiency and excess and immediately uses tonics, clinging to the theory of supporting righteousness to transform evil, what is the difference from playing a fixed zither?
Malaria without sweat requires inducing sweat, which is correct. But regarding malaria with sweat requiring cessation of sweat, one must also deliberate. Although there are differences between deficiency and excess, the root is always internal storage of Summerheat evil and external binding of Yin evil. Summerheat is Yang evil, and Yang evil causes sweating, so malaria often presents with sweat. How can one early use exterior-consolidating drugs because of excessive sweating, causing the condition to recur? Thus, ancients only said that for chronic malaria, supporting righteousness is primary, never mentioning consolidating the exterior. I believe: if sweat is scant, it is fine to induce sweat again; if sweat is profuse, there is no need to induce sweat again. Treating with light, clear, and harmonizing methods is sufficient. Wei-Yang belongs to Yang, its Qi is fierce, so it moves fast; Ying-Yin belongs to Yin, its Qi is quiet and convergent, so it moves slowly. When Malaria evil attacks, occurring daily or every two days, the evil attaches to the Ying-nutrient level. Like the cycle of heaven, the Sun passes it, the Moon fails to reach it; this is also a division of Yin-Yin slowness and speed.
The method for treating epidemics prioritizes detoxification. Wu Youke specifically used Da Huang (Rhei Radix et Rhizoma) to drive out toxic filth. However, people nowadays have weak constitutions, making aggressive purging difficult. It is better to use Zhang Luyu's method of combining Ren Zhong Huang (Human excrement charred) with Cong Bai (Allii Fistulosi Bulbus) and Chi Dou (Sojae Semen Praeparatum) as a starting detoxifying formula. Ye Tianshi used Jin Yin Hua (Lonicerae Japonicae Flos) and Jin Zhi (Human feces juice) as cooling and resolving agents, which is the most stable. Yu Shi said: "Upper Jiao is like mist, ascend and expel it, assisted by detoxification; Middle Jiao is like fermentation, disperse and expel it, assisted by detoxification; Lower Jiao is like a drain, drain and expel it, assisted by detoxification." Looking at his intent, although the disease has upper, middle, and lower distinctions, he repeatedly emphasizes detoxification. Is this not a method urgent for detoxification?
Epidemics are foul and dirty Qi that infect each other. Wu Shi said: Entering through the mouth and nose, it occupies the Mo Yuan (Membrane Source). Since the mouth and nose inhale, and the Lung is the portal of entry, the Lung is invariably affected first. Epidemics are all Heat-Toxin, which the Metal of Lung fears. Often seeing this condition, fever begins with aversion to cold, indicating the Lung is diseased first. Subsequently, it fills the San Jiao, or goes directly to the Pericardium Meridian. This so-called severe Qi is nothing but stagnant heat. When the epidemic evil gradually resolves but residual heat remains in the Lung, symptoms like coughing, muscle fever, and spontaneous sweating often occur. This is clear evidence that the Lung was diseased first and not yet healed. Nowadays, people often encounter fever after sexual exhaustion and seminal emission, contracting wind-cold, and call it Yin Syndrome. Patients fear deficiency, doctors fear releasing the exterior. Regardless of current symptoms, they blindly use Shen (Ginseng Radix), Di (Rehmanniae Radix), Fu (Aconiti Lateralis Radix Preparata), and Gui (Cinnamomi Ramulus) as harsh warming tonics. This first tonifies and solidifies wind-cold in the Kidney. How can the evil exit? The so-called Yin Syndrome refers to Cold Evil attacking the Three Yin Meridians. Even if it attacks the Kidney Meridian, one must first dispel wind-cold from Shaoyin. As in *Shang Han Lun* (Treatise on Cold Damage), for Shaoyin fever, Ma Huang (Ephedrae Herba) and Xi Xin (Asari Radix et Rhizoma) are still used to release the exterior. If it directly attacks the Three Yin, without high fever, but with aversion to cold, fatigue, lying down, cold extremities, and preference for warmth, one should first use warming dispersion, then gradually use tonification. This principle must be carefully distinguished.
Generally, treating those who eat rich food involves nourishment, while treating those who eat coarse food involves dispersal. However, bodies accustomed to rich food easily generate phlegm accumulation due to heavy flavors, so dispersal is also needed. Bodies accustomed to coarse food easily become thin due to light diet, so nourishment is also suitable. Human nature and physical principles cannot be applied rigidly.
Diseases located below may manifest symptoms above, such as Blood Stasis causing mania. Diseases located above may manifest symptoms below, such as Lung Qi obstruction causing frequent bowel movements; Lung Qi deficiency causing frequent urination. Diseases located in the Exterior may manifest symptoms in the Interior, such as Taiyang, Yangming, and Shaoyang combined disease causing diarrhea. Diseases located in the Interior may manifest symptoms in the Exterior, such as deep heat causing deep cold extremities, or false Yang floating on the face. Treatment requires careful observation.
Wei-Yang is Yang, Wind is Yang evil. Those suffering from Wind Strike have Yang deficiency failing to guard the exterior, attracting similar elements, thus showing Yang-heat symptoms. Treatment should seek the root of the disease, not merely use wind-dispersing drugs, which would further weaken the exterior.
*Shang Han Lun* states: "Those who can eat have Wind Strike; those who cannot eat have Cold Strike." Thus, for Shanghan with internal Wind Strike, eating is not prohibited. It also says: "For those wanting water, give it to them slightly." Generally, excess Fire causing thirst is relieved by water, and cold water is not prohibited. Yet, physicians, encountering such conditions, fear damaging the Stomach and forbid giving water. This contradicts the intent of the sages.
Yin deficiency means Yang has no attachment, Qi rises but does not descend. The method should use Yin-nourishing drugs as the sovereign, and astringent-descending drugs as assistants. If only descending Qi is used, turbidity may not descend, and clarity will follow the deficiency. Yang deficiency means Qi interruption, Qi descends but does not rise. The method should use Middle-Jiao-tonifying drugs as the sovereign, and ascending-lifting drugs as assistants. If only rising Qi is used, clarity may not rise, and turbidity will follow dryness. This is treating Yin-Yang partial deficiency. Besides, if Seven Emotions cause stagnation, or Qi-Blood, Diet, Phlegm obstruct the Middle Jiao, hindering the path of ascent/descent and entry/exit, and the person's Yuan-Qi is not depleted, ascending and descending are permissible. This is the principle of regulating postnatal tangible Qi-Blood. Regarding prenatal Yuan-Yin and Yuan-Yang, Yin deficiency leads to Yang thinning, Yang deficiency leads to Yin overpowering. One must strongly tonify; Yin-Yang has no time for ascent/descent calculations; these are superficial considerations.
Yang deficiency presenting with Yang-heat symptoms indicates True Fire lacking roots and escaping; Yin deficiency presenting with Yang-heat symptoms indicates Yin deficiency leaving Yang unattached; Yang excess presenting with Yin-cold symptoms indicates Yang excess rejecting Yin; Yin excess presenting with Yang-heat symptoms indicates Yin excess repelling Yang. If medication for these four is inappropriate, life and death depend on a flip of the palm.
The Kidney is the gate of the Stomach. Following Yang, it opens; following Yin, it closes. If Yang is too excessive, it opens leading to Xiao (Wasting-Thirst); if Yin is too excessive, it closes leading to Shui (Edema/Water swelling). This is clear. Zhang Zhongjing treated Edema primarily with Shen Qi Wan (Kidney Qi Pill), and also treated Xiao Ke (Wasting-Thirst) similarly. Does this not contradict Yang excess? However, this Xiao is due to Kidney Yang deficiency failing to consolidate; this Ke is due to Kidney Yin deficiency drawing water to save itself. Yu Shi said: Kidney water flows downward, hence Xiao; Kidney Qi fails to ascend, hence Ke. Using this pill to vaporize Kidney Qi might not necessarily be correct.
Most coughs are due to Fire overcoming Metal, called Thief Evil, hardest to cure quickly. Due to external Wind-Cold attack generating internal Excess Fire, immediate purging is needed. If neglected, it transforms into Phlegm over time. Misusing Yin-cooling drugs can lead to Lao Fei (Consumption). If it is Deficient Fire, the only method is strengthening Water (nourishing Yin). However, Yin-nourishing drugs often obstruct Qi and stagnate Phlegm. It depends on the practitioner's flexibility. Formulas like Sheng Mai Liu Jun Tang (Generate Pulse Six Gentlemen Decoction) and Jin Shui Liu Jun Jian (Metal-Water Six Gentlemen Decoction) are most appropriate.
Kidney deficiency causing water flooding as Phlegm includes Kidney Yang deficiency and Kidney Yin deficiency. Yang deficiency causes fluids to overflow, tasteless and foamy; treatment should tonify Qi to generate Yin, so upward flooding can descend. Yin deficiency causes coughing up saliva/phlegm, salty and sticky; treatment should benefit Water to submerge Yang, so coughing can calm. Treatments must not be mixed.
Gu (Drum distension) and Ge (Diaphragmatic obstruction) are difficult diseases. Gu is still treatable; Ge is untreatable. Gu is mostly Excess syndrome, whether Phlegm, Blood, Qi, Food, or Water congealing in the middle. If stagnation is purged first, followed by tonifying Stomach and Intestines, digestion can gradually recover. The Ji Shi Li (Chicken Dropping Wine) formula in *Nei Jing* is this treatment method. When arms become thin, umbilicus protrudes, blue veins surround the abdomen, palms and back are flat and full, Zang-Qi is exhausted, death is inevitable. If Ge syndrome starts with Liver Fire invading Stomach, Wood insulting Earth, it is called Thief Evil. Thus, bodies with inherent Liver Yin deficiency and insufficient fluids experience continuous vomiting/regurgitation, eventually becoming Ge, drying up Stomach juices, blocking with phlegm, unable to swallow food, vomiting it back. This disease is at the贲门 (Cardia), clearly distinct from Fan Wei (Regurgitation), where morning food is vomited at evening, evening food at morning, disease at the幽门 (Pylorus). Classics say: Grain enters the Stomach, transmits to the Lung, and all Zang-Fu receive Qi. Now, since food cannot enter, Zang-Fu Qi is exhausted. Seeing this disease, if some grain can be taken, death occurs within a year; if no grain can be taken, death occurs within half a year. Getting sick in Spring and dying in Autumn, or getting sick in Autumn and dying in Spring, occurs during times when Metal and Water overcome each other.
Heart and Kidney deficiency cause turbid urine; Middle Qi deficiency causes discoloration of urine and stool. Know that Metal decline leads to Water drying; Water drying leads to short, frequent, and turbid urine. Qi deficiency leads to easy stagnation; stagnation generates Heat; Heat generation turns urine yellow-red. Seek the root to treat. If one clings to "turbid urine belongs to Fire" and generally applies diuretic and heat-clearing drugs, it will inevitably worsen the disease.
Hong Kong Foot (Beriberi/Lower limb edema) is mostly due to Damp-Heat, as turbid evil affects the lower part first. Those eating rich food have internal Damp-Heat; those eating coarse food have external Damp-Heat invasion. Treatment should separate and drain Dampness. If Yin deficiency is extreme, unable to inhale Qi to return to Yuan; or Yang deficiency is extreme, unable to control Blood to return to meridians, Yin-Yang imbalance, ascent/descent dysfunction, then Yang floats alone above, Yin sinks alone below, feet swell and hurt by evening. Treatment should tonify Yin and benefit Qi. Do not generally apply diuretics to drain Dampness, which would severely injure Yin-Yang. This requires observing form and pulse to investigate carefully.
There are cases where overthinking damages the Spleen, Spleen deficiency fails to control Blood causing hemorrhage; there are cases where overthinking damages the Spleen, Spleen failure fails to digest Grain causing diarrhea. Hemorrhage must not use Blood-cooling drugs; diarrhea must not use Digestion-promoting drugs, which would further injure Spleen Qi. All should support and nurture Spleen Earth as the root, not merely treat the branch.
*Ping Mai* (Plain Pulse) states: "Shaoyin pulse does not arrive, Kidney Qi is slight and scarce, Essence and Blood rush, Qi is forced and hurried, entering the chest and diaphragm." The Shaoyin pulse not arriving indicates injury to prenatal Yuan-Yang and Yuan-Yin. Kidney is Prenatal; Spleen and Stomach are Postnatal. Once Prenatal is injured, it cannot generate Postnatal, so Spleen-Stomach Yin-Yang are also injured, unable to transform Grain-Water and generate Damp-Heat. Damp-Heat flows downward, Bladder Qi transformation fails, Turbid Qi ascends. Turbid Qi ascending blocks Lung Qi, stagnates Spleen Qi, forming Phlegm and Fluid, manifesting as Food Stagnation and Abdominal Distension. Shaoyang generating Qi is depressed and cannot rise, causing whole-body stabbing pain, vomiting, and acid regurgitation. Heart Master Yang is attacked by Turbid Yin, causing palpitations and anxiety. Thus, one Zang organ (Kidney) makes all Five Zang and Six Fu organs restless. Hence, nurturing life is best achieved by restraining desires. If one does not know this and only treats with Qi-moving, Phlegm-resolving, and Food-digesting methods, drying harms Yin, draining harms Yang, leading to distress. This speaks specifically of Kidney deficiency.
"All pains have no tonification," referring to Qi rebellion and stagnation. However, the strong recover when Qi moves; the weak develop disease when evil adheres. Those with deficient genuine Qi easily allow evils to adhere. Adherence causes rebellion, rebellion causes pain. In clearing and sweeping, tonifying substances are necessary. Merely attacking makes Zheng (Righteous Qi) more deficient, Xie (Evil) more adherent, and pain endless. So, Spleen-Stomach fluid loss, burning dryness like cutting, should use Di Huang (Rehmanniae Radix) to nourish Yin and moisten. Pulse Yang rough, Yin stringy, abdominal acute pain, should use Xiao Jian Zhong Tang (Minor Construct the Middle Decoction). Liver Blood deficiency, hypochondriac fullness, tendon tightness preventing deep sighing, cold extremities, heart-abdominal radiating pain, unclear vision, withered nails, blue face, should use Bu Gan Tang (Tonify Liver Decoction). Kidney-deficient and frail individuals, excessive sexual activity, often have hidden pain in chest-diaphragm. This is due to Kidney deficiency failing to constrain Qi, Qi deficiency failing to generate Blood, often stagnating and causing pain. Use Po Gu Zhi (Psoraleae Fructus), Yu Rou (Corni Fructus), Gou Qi (Lycii Fructus) to warm Kidney, Gui (Angelicae Sinensis Radix), Shao (Paeoniae Radix Alba) to nourish Blood. As for headache, whether Qi deficiency, Blood deficiency, or Kidney deficiency, tonification is indispensable.
Wind-Warmth and Warm-Malaria diseases originate in winter, struck by Wind-Cold, erupting upon warmth. Their Qi reaches from inside to outside, hence often sweating. This differs from Wind evil externally binding, closing Ying-Wei, requiring sweating and muscle-releasing. Thus, treatment using exterior-release is contrary, nor should one stop sweating due to existing sweat, causing other diseases. Strive for proper clearing and resolving.
Regarding Hematemesis (vomiting blood), Mi Shi said: There are three keys to treatment. Promote Blood circulation, do not stop bleeding. Blood not following meridians is due to Qi rebellion and congestion upstream. Promoting circulation allows blood to follow meridians, stopping bleeding naturally. Using hard-stopping agents causes blood coagulation; coagulated blood causes fever and aversion to food, making the disease chronic. Tonify Liver, do not attack Liver. Liver stores Blood; vomiting indicates Liver losing its function. Nourishing Liver calms Liver Qi and gives Blood a home. Attacking Liver makes Liver more deficient and bleeding worse. Descend Qi, do not descend Fire. Excess Qi becomes Fire. Descending Qi descends Fire; descending Fire prevents Qi from rising, so Blood follows Qi without overflowing upper orifices. Descending Fire first requires cold-cooling agents, which damage Stomach Qi. Damaged Stomach Qi means Spleen cannot control, and Blood returns to meridians even less. Blood floating in water indicates Lung Blood; sinking indicates Liver Blood; semi-floating/sinking indicates Heart Blood; red like sun indicates Kidney Blood. Lung Blood should protect Lung, not purge Lung; Liver Blood should nourish Liver, not attack Liver; Heart Blood should tonify Heart, not purge Heart; Kidney Blood should nourish Kidney, not cool Kidney. If prolonged bleeding causes severe Blood deficiency, use warming tonics to strengthen Spleen-Stomach, so harmonious Spleen can contain Blood. If sudden violent bleeding continues, urgently use large doses of Shen (Ginseng Radix) and Zhu (Atractylodis Macrocephalae Rhizoma) to urgently secure Yuan-Yang. Blood loss benefits Qi; Yang generation leads to Yin growth. If solely using Sheng Di (Rehmanniae Radix Preparata), Ling (Poria), Lian (Scutellariae Radix), Zhi (Anemarrhenae Rhizoma), Bai (Phellodendri Cortex), Hei Zhi (Charred Gardenia Fruit), cold-cooling and cloying substances to clear Fire, Spleen injury causes diarrhea, fever, and cough, inevitably leading to untreatable conditions.
Pediatric Jing (Convulsion) syndrome, since Yu Shi named it with Food, Phlegm, Wind, and Jing, greatly exposing previous errors, originally a correct theory, yet also incomplete. Recently, winter warmth leads to loss of storage; spring brings mixed cold and warmth. Children inhale this evil, first injuring Lung Meridian, starting with cold and fever, rough breathing prolonging, gradually entering Pericardium. Although slight sweat exists, there is much phlegm, nasal flaring, irritability, and coma. Families panic, claiming it turns into Jing Feng (Convulsive Wind). They use aromatic opening agents and recklessly administer metallic/mineral substances.