风疟。发于夏至后、处暑前者，近而暴也，受病浅，可截而已。发于霜降后者，远而 也，受病深，三日一发，
名曰 疟。 ，老疟也，久而不已，成疟母。）若瘅疟，但用清肌；（瘅疟者，但热不寒，清肌解表热自已。）
在阴分，勿行截药。（老疟者，多发于下午阴分，脏病也，不可截之，宜用血药，引入阳分，方可截之，斯无
害于元气也。）人参养胃治寒多热少而虚；柴胡清脾理热多寒少而
渴。（邪盛气虚，故寒多热少，名曰寒疟，人参养胃汤。热多寒少而渴者，暑疟也，大、小柴胡汤及清脾饮。）
自汗阳亏，盗汗阴弱。（阳虚则腠理不密，故自汗。阴虚则相火动，故盗汗出于夜，寐出寤敛，有似于盗，故
名“盗汗”）。嗽而无声有痰兮，脾受湿侵；咳而有声无痰兮，肺由火烁。（无声有痰曰“嗽”，有声无痰曰
“咳”。脾受湿而不运，故多痰。肺受克而不清，
故上逆，火郁其痰也。）霍乱有寒有暑，何局方泥乎辛温？！（寒、暑皆令霍乱，寒者温之，暑者清之。局方
独以寒立论，不及之暑，误人多矣！当阅戴人之论，则思过半矣。）积聚有虚有实，岂世俗偏于峻削！（五积
者，五脏之所生；六聚者，六腑之所成。世俗不辨虚实，一概巴、 破耗之药攻削，盖不知洁古有养正积自除
论。）当知木郁可令吐达，（木郁达之，是吐之令其条达也。）金郁泄而土郁夺，水郁折而火郁发泄。发即汗、
利之称；折、夺是攻、抑之别。（金郁泄之，谓利窍兼分导，令其渗利也。火郁发之，谓汗之，令其疏泄也。
土郁夺之，谓攻下，使无壅滞也。木郁折之，谓抑之制其冲逆也。）倒仓廪、去陈 ，中洲荡涤良方；（二法
皆所以荡涤肠胃之宿垢积滞，推陈而致新也。）开鬼门、洁净府，上下分消妙法。（开鬼门者，谓开腠理，使
汗，泄其上部之湿；洁净府者，谓清水道，以利下部之湿。）如斯瞑眩，反掌生杀。（《尚书》云∶若药不瞑
眩，厥疾弗瘳。凡施瞑眩之剂者，死生反掌耳。）辄有一失，悔噬脐之莫追；因而再逆，耻方成之弗约。
（经云∶一逆尚引日，再逆促命期。可不慎之！稍有差失，悔之勿追矣！罗谦甫云∶粗工绝气危生，不能约方
故也。盖约方犹约囊，囊弗约则倾溢，方弗约则戕人生，初学人当玩“方成弗约”之论。）
大抵暴病匪热，久病匪寒。（盖寒中人不能藏蓄，实时而发，若积久则变而为热。故暴病者多寒，久病
者多热。）臀背生疽，良由热积所致；心腹卒痛，却乃暴寒所干。（举斯二证，盖所以明暴病匪热，久病匪寒
之意。）五泄、五疸因湿热，惟利水为尚；（五泄者，胃、大肠、小肠、肾、大瘕泄也；五疸者，谷、酒、湿、
女劳、黄汗是也。皆湿热而成，惟利水以泄其湿，故治湿不利小便，非其治也。）三消、三衄为燥火，滋阴自
安。（三消者，消渴、消中、肾消是也；三衄者，鼻、舌、茎衄也。消本燥热，衄本血热，若滋阴养血，则燥
热自除。）呕吐、咳逆，咎归于胃；（有声无物曰呕，声物俱出曰吐，咳逆，吃忒也。三者皆足阳明胃经之病
也。）阴 、疝、瘕，统属于肝。（ 者，气，水、肠、卵四 也；疝者，寒、水、筋、血、气、狐、 七疝
也；瘕者，青、黄、燥、血、脂、狐、蛇、鳖八瘕也。《难经》云∶男子为七疝，女子为瘕聚，皆足厥阴肝之
所主。盖厥阴肝经之脉循阴器，故统属于肝。）液归心而作汗，敛之者黄 六一，（汗为心液，汗多者黄 六
一汤。）热内炽而发疹，消之者人参化斑。（阳明、少阳火热炽甚者，必发空疹，人参化斑汤。）身不安兮为
躁，心不宁兮为烦。（烦躁者，内外烦热。亦有阴极而反发烦躁者，宜审之。）忽然寒僵起栗，昏冒者，名为
尸厥；（卒然僵仆不知人，肌肤寒栗者，名曰尸厥，此由入庙登冢、问病吊丧所得。）卒而跌仆流涎，时醒者，
号曰癫痫。（卒然跌仆，昏不知人，痰涎有声，流于口角，须臾苏醒者，名曰癫痫。不醒，角弓反张者曰 。）
腹满吞酸，此是胃中留饮，（留饮者，故腹满吞酸。）胸膨嗳气，盖缘膈上停痰。（丹溪云∶胃中有火，膈上
有痰，故成嗳气。）欲挽回春之力，当修起死之丹。
窃惟阴、阳二证，疗各不同，（阴证则身寒，阳证则身热。二者主治若霄壤之不侔。）内、外两伤，治须
审别。内伤、外伤辨口鼻呼吸之情；（内伤，饮食劳役所致；外伤，风、寒、暑、湿所致。故内伤则口为之不
利，鼻息调匀。外伤则口中和，鼻息不利。盖鼻受无形，口受有形故也。）阴证、阳证察尺寸往来之脉。（阴证
则寸弱而尺浮，来往无力。阳证则尺微而寸大，来往有力。盖寸阳尺阴，故脉应之也。）既明内外阴阳，便知
虚实冷热。（内伤为不足，外伤为有余，阳证为热，阴证为寒。能究内外之伤，阴阳之证，则补虚、泻实，温
寒、清热之法无差忒也。）曰浊、曰带，有赤、有白，（男子赤、白二浊，女子赤、白二带。）或属痰而或属
火。白干气而赤干血，本无寒热之分，但有虚实之说。（浊、带者，属痰与火，干于气分则白，干于血分则赤。
世俗多以白为寒，非也。但有气虚、血虚之不同，
更有挟痰、挟火之病状。）痢亦同然，瘀积湿热，勿行淡渗、兜涩汤丸，可用汗、下、寒、温、涌、泄。（痢
因瘀积湿热，而肠中所滞之积下，故曰“滞下”。有赤、有白，有赤、白杂下，有如豆汁、鱼脑、尘腐屋漏水，
其色不一，皆有形物。不可以淡渗独利小便，亦不可用兜涩之剂及巴、 毒药下之，当用仲景法。表挟风寒者
汗之，身有热者疏之，在里者承气下之，内寒者姜、附温之，虚者参、术补之，在上者涌之，小便不通者分导
之。此为活法。）导赤散通小便癃闭；（癃者，罢也。闭者，急痛不通也。导赤散者，分利之圣药。）温白丸
解大肠痛结。（寒与食积痞结不开，腹满痛而便结者，温白丸主之，量虚实而用。）地骨皮散退劳热偏宜；
（劳热者，骨蒸烦热也，地骨皮散主之。）青礞石丸化结痰甚捷。（结痰非礞石不能开。丹溪曰∶此药重在风
化硝，盖取其咸寒软坚镇坠也。）火郁者，必扪其肌；（郁热与寻常发热不同，其热在于筋骨及四肢，肌肤不
觉热甚，或一时火热如燎，以手扪之烙手是也。由胃虚过食冷物，抑遏阳气于内故也。）胎死者，可验其舌。
（妇人胎死于腹中，若不早行，多致不救。若伏而不动，舌黑者，胎死也，舌红者不死，以此验之，无疑也。）
玄胡苦楝医寒疝控引于二丸；（寒疝控引睾丸痛者，玄胡苦楝汤。）当归龙荟泻湿热痛攻于两胁。（湿热攻注
两胁作痛，及肝木旺盛者，此药泻之。）谙晓阴阳虚实之情，便是医家玄妙之诀。
当以诸痛为实，诸痒为虚。（痛者，邪乘之，故实；痒者，血虚气不充，故虚。河间以痛、痒分火热微甚，
亦虚、实之意。）虚者，精气不足；实者，邪气有余。（经云∶邪气盛则实，精气夺则虚。）泄泻有肠垢、
溏，若滑脱则兜涩为当；（肠垢者，所下粘垢稠秽，挟热也。 溏者。所下澄澈清冷，如鸭粪，挟寒也。滑脱
者，所下不禁，大孔如筒，虚甚也。故热者清之，寒者温之。若脱者，须用诃子散急兜之。）腹痛有食积、郁
热，倘阴寒则姜附可施。（郁热痛者，时痛时止也。食积者，食已即痛，大便通后痛减是也。热者清之，食者
消之。若阴寒腹痛者，绵绵痛而无增减，手足逆冷者，急以姜、附温之。）厥心痛者，客寒犯胃，手足和者，温散而已；
胃脘当心而痛，非心痛，故曰“厥”。若客寒犯胃，手足和温，寒不太甚也，草豆蔻丸发散即已。若真心痛者，
其痛甚，手足寒至节，则死矣。真头痛者，入连于脑，爪甲黑者，危笃难医。（真头痛者，旦发夕死，夕发
旦死。）结阳则肢肿有准，结阴则便血无疑。（诸阳不行，阴府留结成热，则四肢肿满。阴气内结不得通行，
气血无宗，渗入肠胃，则下血。）足膝屈弱曰香港脚，肿痛者，湿多热盛；（香港脚由湿热而成，故足胫屈弱。湿
盛则肿，热甚则痛。）腰痛不已曰肾虚，挫闪者，气滞血瘀。（肾虚腰痛者，绵绵痛之不已，转侧不能，青娥
丸。挫闪而痛，必气滞血瘀。气滞者行气，血瘀者行血即已。）巅顶苦疼，药尊 本；（东垣云∶巅顶苦疼，寒气
客于巨阳经，须用 本。）鼻渊不止，方选辛夷。（鼻渊者，鼻流臭浊涕，如彼渊泉。《内经》云∶胆移热于
脑，令人辛 鼻渊，传为衄蔑瞑目，辛夷丸。）手麻有湿痰、死血，手木缘风湿、气虚。（丹溪云∶十指麻，
是死血、湿痰阻滞隧道，气不流通故也，手术者，风湿与气虚，盖气不充于手故也。）淋沥似欲通不通，气虚
者，清心莲子；淋沥者，小便滴沥涩痛，欲通而不通故也。有砂淋、膏淋、血淋、肉淋、劳淋五种，大抵总
属于热。若气虚而协热者，清心莲子饮。便血审先粪后粪，阴结者，平胃地榆。（便血者，湿热乘于大肠也。
先粪者，其血来也近；后粪者，其血来也远。《内经》云∶结阴者，便血一升，再结二升，三结三升，罗谦甫
制平胃地榆汤主之。）盖闻溲便不利谓之关，饮食不下谓之格，乃阴阳有所偏乘，故脉息因而覆、溢。（经云∶
阳气太盛，阴气不得相营也，故曰关，关则不得大、小便。阴气太盛，阳气不得相营也，故曰格，格则不得下
食。《难经》云∶关之前者，阳之动也，脉当现九分而浮，过曰太过，减曰不及，遂上鱼为溢，此阴乘之脉也。
关以后者，阴之动也，脉当现一寸而沉，过曰太过，减曰不及，遂入尺为覆，此阳乘之脉也。故曰∶覆、溢是
真脏之脉，人不病而死也。）咳血与呕血不同，咳血嗽起，呕血逆来；（咳血者，嗽动有血，出于肺也。呕血，
呕全血也，逆出上窍，属于胃也。）吞酸与吐酸不同，吞酸刺心，吐酸涌出。（吞酸由湿热积于肺胃，咯不上，
咽不下，酸味刺心也。吐酸是平时津液随上升之气郁积
湿热，遂成酸味，吐出酸水如醋是也。）水停心下曰饮，水积胁下曰癖。行水以泽泻、茯苓，攻癖以芫花、
大戟。（胃寒强饮冷水，无热不能消化，停滞心下，名曰停饮。蓄积留滞于胁，结成痞积，久而硬痛曰癖饮。
轻者茯苓、泽泻淡渗行之，甚者芫花、大戟之剂 逐之。）控涎丹虽云峻利，可逐伏痰；（伏痰、留饮、结癖，
非此不除。）保和丸性味温平，能消食积。（保和丸治一切食积。）溺血则血去无痛，有痛者自是赤淋；（溺血
者，小便血也，去血不痛是也，四物汤对五苓散。赤淋，血淋也，又滴沥涩痛，小蓟汤。）短气乃气难布息，
粗息者却为喘急。（短气者，气不续也，故曰难布息。喘急者，息粗气逆，出多入少也。）胃脘当心而痛，要
分客热、客寒；（胃脘痛客寒，呕水恶寒，绵绵而痛，手足厥逆。客热者，心烦躁渴，时作时止也。）遍身历
节而疼，须辨属风、属湿。（遍身肢节痛，名曰“白虎历节风”，在上痛属风，在下痛属湿。）通圣散专疗诸
风，（通圣散，一名双解散祛风热之圣药。）越鞠丸能开六郁。（六郁者，气、血、食、湿、痰、热郁也，越
鞠丸通治之。）虚弱者，目眩头晕，亦本痰火而成；（目眩头晕，虚候也，亦由痰火而致。丹溪云∶痰在上，
火在下，多作眩晕。）湿热者，精滑梦遗，或为思想而得。（梦中交感泄精曰梦遗，不因梦交自泄曰精滑，皆
湿热相火也。珍珠粉丸。若思想而得者，其病在心，当宁其心。）
缘杂病绪繁无据，机要难明；非伤寒经络有凭，形证可识。临证若能三思，用药终无一失，略举众疾之
端，俾为后学之式。
风疟。在夏至之后、处暑之前发作的，病势近且急骤，受邪较浅，可以截断治愈。在霜降之后发作的，病程远且缓慢，受邪较深，每隔三日发作一次，名叫“三日疟”。（这是老疟疾，日久不愈，形成“疟母”。）如果是瘅疟，只用清解肌表热邪的方法；（瘅疟表现为只有发热没有恶寒，清解肌表热邪后热自退。）如果病在阴分，不要用截疟药。（老疟疾多在下午阴气盛时发作，属于脏病，不可强行截断，宜用养血药，将病邪引入阳分，然后方可截断，这样才不损伤元气。）人参养胃汤治疗寒多热少且体虚的疟疾；柴胡清脾饮治疗热多寒少且口渴的疟疾。（邪气盛而正气虚，所以寒多热少，名叫寒疟，用人参养胃汤。热多寒少且口渴的，是暑疟，用大柴胡汤或小柴胡汤及清脾饮。）
自汗是阳气亏虚，盗汗是阴液虚弱。（阳虚则腠理不紧密，所以自汗。阴虚则相火妄动，所以夜间睡着时出汗，醒来即止，像盗贼一样，所以叫“盗汗”。）咳嗽无声但有痰，是脾受湿邪侵袭；咳嗽有声但无痰，是肺被火邪灼伤。（无声有痰叫“嗽”，有声无痰叫“咳”。脾受湿邪不能运化，所以多痰。肺受火克而不能清肃，所以上逆，火郁结其痰所致。）霍乱有寒证和暑证，为什么拘泥于局方只用辛温药物？！（寒邪和暑邪都能导致霍乱，寒者用温法，暑者用清法。局方只从寒立论，忽略了暑邪，误导了很多人！应当阅读戴元礼的论述，就能明白大半道理了。）积聚有虚证和实证，怎么能世俗之人偏重于使用峻猛攻伐的药物呢！（五积由五脏产生；六聚由六腑形成。世俗之人不辨别虚实，一概用巴豆、硇砂等破耗药物攻削，不知道洁古老人有“养正积自除”的理论。）应当知道木郁可以用吐法使其条达，（木郁达之，就是用吐法使其舒展条达。）金郁用泄法，土郁用夺法，水郁用折法，火郁用发汗法。发、利是指汗法和下法；折、夺是指攻法和抑法。（金郁泄之，指通利窍道兼分导，使其渗利排出。火郁发之，指发汗，使其疏泄。土郁夺之，指攻下，使无壅滞。木郁折之，指抑制其冲逆之气。）倒仓法、去陈莝法，是中焦荡涤肠胃宿垢积滞的好方法；（这两种方法都是用来荡涤肠胃中的宿垢积滞，推陈出新。）开鬼门（发汗）、洁净府（利小便），是上下分消湿邪的妙法。（开鬼门，指开发腠理，使汗出，泄去上部湿邪；洁净府，指通利水道，以利去下部湿邪。）如此使用瞑眩之剂，生死往往在反掌之间。（《尚书》说：如果服药后没有出现瞑眩反应，重病就不会痊愈。凡是施用瞑眩药剂的，生死就在反掌之间。）一旦有一失误，后悔莫及；如果因此导致病情逆转，连方子都来不及修改。（经书说：一次误治还能拖延时日，再次误治就会加速死亡。能不谨慎吗！稍有差失，后悔就来不及了！罗谦甫说：粗劣的医生断绝病人的生气，挽救垂危的生命，是因为不能精简约束方药。大概精简方药就像扎紧口袋，口袋不扎紧就会倾覆溢出，方药不精简就会伤害人的生命，初学的人应当玩味“方成弗约”的理论。）
大抵暴发的疾病不是热证，久病的疾病不是寒证。（大概寒邪中人不能蓄积，随即发作，如果积累久了则变为热证。所以暴发疾病多属寒，久病多属热。）臀背生疽，良由热毒积聚所致；心腹突然疼痛，却是暴寒所侵犯。（举这两个例子，是为了说明暴发疾病多非热证，久病多非寒证的意思。）五泄、五疸因为湿热引起，只有利小便为最上策；（五泄指胃泄、大肠泄、小肠泄、肾泄、大瘕泄；五疸指谷疸、酒疸、湿疸、女劳疸、黄汗疸。都是由湿热而成，只有利水以泄其湿，所以治疗湿病不利小便，就不是正确的治法。）三消、三衄因为燥火引起，滋阴自然安宁。（三消指消渴、消中、肾消；三衄指出血部位在鼻、舌、茎。消渴本属燥热，衄血本属血热，如果滋阴养血，则燥热自然消除。）呕吐、咳逆，过错归于胃；（有声无物叫呕，声物俱出叫吐，咳逆即呃逆。这三者都是足阳明胃经的病。）阴疝、瘕聚，统属于肝。（阴疝包括气、水、肠、卵四种疝；疝包括寒、水、筋、血、气、狐、厥七种疝；瘕包括青、黄、燥、血、脂、狐、蛇、鳖八种瘕。《难经》说：男子为七疝，女子为瘕聚，都由足厥阴肝经所主。大概厥阴肝经的脉循行经过阴器，所以统属于肝。）津液归于心化为汗，收敛汗液用黄耆六一汤；（汗为心之液，汗多者用黄耆六一汤。）热邪内炽而发疹，消除它用人参化斑汤。（阳明、少阳火热炽盛的，必然发空疹，用人参化斑汤。）身体不安叫做躁，心神不宁叫做烦。（烦躁是内外烦热。也有阴极反发烦躁的，应当仔细审察。）忽然身体僵硬起栗，昏冒的，名叫尸厥；（突然僵仆不知人事，肌肤寒冷战栗的，名叫尸厥，这通常是由进入庙宇、登上坟墓、探病吊丧等感受秽浊之气引起的。）突然跌倒流涎，时而清醒的，叫做癫痫。（突然跌倒，昏迷不知人，痰涎有声，流于口角，须臾苏醒的，名叫癫痫。如果不醒，角弓反张的叫做痫证。）腹部胀满吞酸，这是胃中有留饮；（留饮的缘故，所以腹满吞酸。）胸部膨隆嗳气，是因为膈上有停痰。（丹溪说：胃中有火，膈上有痰，所以形成嗳气。）想要挽回春天的生机，应当修炼起死回生的丹药。
我私下认为阴证、阳二证，治疗各不相同，（阴证则身体寒冷，阳证则身体发热。两者的主治如同天地之差。）内伤、外感两种病因，治疗必须审慎辨别。内伤、外伤通过口鼻呼吸的情况来辨别；（内伤由饮食劳役引起；外伤由风寒暑湿引起。所以内伤则口为之不利，鼻息调匀。外伤则口中调和，鼻息不利。大概鼻受无形之气，口受有形之物所致。）阴证、阳证通过寸尺脉往来的情况来察辨。（阴证则寸脉弱而尺脉浮，往来无力。阳证则尺脉微而寸脉大，往来有力。大概寸属阳尺属阴，所以脉象相应。）既然明白了内外阴阳，便知道虚实冷热。（内伤为不足，外伤为有余，阳证为热，阴证为寒。能究明内外之伤，阴阳之证，那么补虚、泻实，温寒、清热的方法就没有差错。）称为浊、称为带，有赤色、有白色，（男子有赤白二浊，女子有赤白二带。）有的属于痰，有的属于火。白色干犯气分，红色干犯血分，本来没有寒热之分，只有虚实的说法。（浊、带，属于痰与火，干犯气分则白，干犯血分则赤。世俗人多以白色为寒，这是不对的。只有气虚、血虚的不同，更有挟痰、挟火的病状。）痢疾也与此相同，瘀积湿热，不要用淡渗、兜涩的汤丸，可用汗、下、寒、温、涌、泄等方法。（痢疾因瘀积湿热，而肠中所滞之积下行，所以叫“滞下”。有赤色、有白色，有赤白杂下，有如豆汁、鱼脑、尘腐屋漏水，颜色不一，都有形之物。不可以只用淡渗药独利小便，也不可用兜涩剂及巴豆、硇砂毒药下之，应当用张仲景的方法。表挟风寒的用汗法，身有热的用疏解法，在里的用承气汤下法，内寒的用姜、附温法，虚的用参、术补法，在上的用涌吐法，小便不通的用分导法。这是活法。）导赤散通利小便癃闭；（癃，罢也。闭，急痛不通也。导赤散是分利的圣药。）温白丸解除大肠痛结。（寒与食积痞结不开，腹满痛而大便结滞的，温白丸主治，根据虚实用量使用。）地骨皮散退除劳热特别适宜；（劳热，即骨蒸烦热，用地骨皮散主治。）青礞石丸化解结痰非常快捷。（结痰非礞石不能开。丹溪说：此药重在风化硝，取其咸寒软坚镇坠的作用。）火郁者，必须触摸其肌肤；（郁热与寻常发热不同，其热在于筋骨及四肢，肌肤不觉很热，或一时火热如燎，用手摸上去烫手。这是由于胃虚过食冷物，抑遏阳气于内所致。）胎死者，可以验其舌头。（妇人胎死于腹中，如果不早处理，多致不救。如果胎儿伏而不死，舌头黑的，是胎死，舌头红的不死，以此验证，毫无疑问。）玄胡苦楝汤治疗寒疝牵引睾丸疼痛的二丸；（寒疝牵引睾丸痛的，用玄胡苦楝汤。）当归龙荟丸泻湿热痛攻于两胁。（湿热攻注两胁作痛，及肝木旺盛的，此药泻之。）精通阴阳虚实的情况，就是医家的玄妙秘诀。
应当以诸痛为实证，诸痒为虚证。（痛，是邪气乘袭，所以实；痒，是血虚气不充，所以虚。河间以痛、痒分火热微甚，也是虚实的意思。）虚证，是精气不足；实证，是邪气有余。（经书说：邪气盛则实，精气夺则虚。）泄泻有肠垢、溏薄，如果滑脱则兜涩为当；（肠垢，所下的粘垢稠秽，挟热。溏薄，所下澄澈清冷，如鸭粪，挟寒。滑脱，所下不禁，肛门如筒，虚甚。所以热者清之，寒者温之。如果脱者，须用诃子散急兜之。）腹痛有食积、郁热，倘若是阴寒则姜附可施。（郁热痛，是时痛时止。食积，是食后即痛，大便通后痛减。热者清之，食者消之。若阴寒腹痛，绵绵痛而无增减，手足逆冷的，急以姜、附温之。）厥心痛，是客寒犯胃，手足温和的，温散而已；胃脘当心而痛，不是心痛，所以叫“厥”。若客寒犯胃，手足和温，寒不太甚，草豆蔻丸发散即已。若真心痛，其痛剧烈，手足寒至关节，则死矣。真头痛，入连于脑，爪甲黑的，危笃难医。（真头痛，旦发夕死，夕发旦死。）结阳则肢体肿胀有定准，结阴则便血无疑。（诸阳不行，阴府留结成热，则四肢肿满。阴气内结不得通行，气血无宗，渗入肠胃，则下血。）足膝屈弱叫做香港脚，肿痛的是湿多热盛；（香港脚由湿热而成，故足胫屈弱。湿盛则肿，热甚则痛。）腰痛不已叫做肾虚，挫闪的是气滞血瘀。（肾虚腰痛，绵绵痛之不已，转侧不能，用青娥丸。挫闪而痛，必气滞血瘀。气滞者行气，血瘀者行血即已。）巅顶苦疼，药物首选藁本；（东垣说：巅顶苦疼，寒气客于巨阳经，须用藁本。）鼻渊不止，方选辛夷。（鼻渊，鼻流臭浊涕，如彼渊泉。《内经》说：胆移热于脑，令人辛螫鼻渊，传为衄蔑瞑目，用辛夷丸。）手麻有湿痰、死血，手木（麻木）缘风湿、气虚。（丹溪说：十指麻，是死血、湿痰阻滞隧道，气不流通所致。手木，是风湿与气虚，盖气不充于手所致。）淋沥似欲通不通，气虚者，用清心莲子饮；淋沥者，小便滴沥涩痛，欲通而不通故也。有砂淋、膏淋、血淋、肉淋、劳淋五种，大抵总属于热。若气虚而协热者，用清心莲子饮。便血审先粪后粪，阴结者，用平胃地榆汤。（便血，是湿热乘于大肠也。先粪者，其血来也近；后粪者，其血来也远。《内经》说：结阴者，便血一升，再结二升，三结三升，罗谦甫制平胃地榆汤主治。）盖闻溲便不利谓之关，饮食不下谓之格，乃阴阳有所偏乘，故脉息因而覆、溢。（经书说：阳气太盛，阴气不得相营也，所以叫关，关则不得大小便。阴气太盛，阳气不得相营也，所以叫格，格则不得下食。《难经》说：关之前者，阳之动也，脉当现九分而浮，过曰太过，减曰不及，遂上鱼际为溢，此阴乘之脉也。关以后者，阴之动也，脉当现一寸而沉，过曰太过，减曰不及，遂入尺为覆，此阳乘之脉也。所以说：覆、溢是真脏之脉，人不病而死也。）咳血与呕血不同，咳血嗽起，呕血逆来；（咳血，是嗽动有血，出于肺。呕血，是呕全血，逆出上窍，属于胃。）吞酸与吐酸不同，吞酸刺心，吐酸涌出。（吞酸由湿热积于肺胃，咯不上，咽不下，酸味刺心。吐酸是平时津液随上升之气郁积湿热，遂成酸味，吐出酸水如醋。）水停心下叫做饮，水积胁下叫做癖。行水用泽泻、茯苓，攻癖用芫花、大戟。（胃寒强饮冷水，无热不能消化，停滞心下，名叫停饮。蓄积留滞于胁，结成痞积，久而硬痛叫做癖饮。轻者茯苓、泽泻淡渗行之，甚者芫花、大戟之剂逐之。）控涎丹虽然说是峻利，可逐伏痰；（伏痰、留饮、结癖，非此不除。）保和丸性味温平，能消食积。（保和丸治一切食积。）溺血则血去无痛，有痛者自是赤淋；（溺血，是小便血，去血不痛，用四物汤对五苓散。赤淋，血淋也，又滴沥涩痛，用小蓟汤。）短气乃气难布息，粗息者却为喘急。（短气，气不续，故曰难布息。喘急，息粗气逆，出多入少。）胃脘当心而痛，要分客热、客寒；（胃脘痛客寒，呕水恶寒，绵绵而痛，手足厥逆。客热者，心烦躁渴，时作时止。）遍身历节而疼，须辨属风、属湿。（遍身肢节痛，名叫“白虎历节风”，在上痛属风，在下痛属湿。）通圣散专疗诸风，（通圣散，一名双解散祛风热之圣药。）越鞠丸能开六郁。（六郁，气、血、食、湿、痰、热郁也，越鞠丸通治之。）虚弱者，目眩头晕，亦本痰火而成；（目眩头晕，虚候也，亦由痰火而致。丹溪说：痰在上，火在下，多作眩晕。）湿热者，精滑梦遗，或为思想而得。（梦中交感泄精叫梦遗，不因梦交自泄叫精滑，皆湿热相火也。珍珠粉丸。若思想而得者，其病在心，当宁其心。）
因为杂病绪繁无据，机要难明；不像伤寒经络有凭，形证可识。临证若能三思，用药终无一失，略举众疾之端，俾为后学之式。
Wind Malaria. Those occurring after the Summer Solstice and before the End of Heat are near and sudden, with shallow pathogenic invasion, and can be intercepted and cured. Those occurring after the Frost Descent are distant and slow, with deep pathogenic invasion, occurring every three days, named "Sanri Malaria" (Three-Day Malaria). (This is chronic malaria; if prolonged without resolution, it forms a "Malaria Mother" [splenomegaly].) If it is Dan Malaria (Febrile Malaria), only clear the muscle layer heat; (Dan Malaria presents with fever but no chills; clearing the muscle layer heat will resolve the fever.) If the disease is in the Yin aspect, do not use malaria-intercepting drugs. (Chronic malaria often occurs in the afternoon during the Yin phase, involving the Zang organs; it cannot be forcibly intercepted. It is advisable to use blood-nourishing herbs to guide the pathogen into the Yang phase before intercepting, so as not to damage the Yuan Qi.) Renshen Yangwei Tang (Ginseng Stomach-Nourishing Decoction) treats malaria with more cold than heat and deficiency; Chaihu Qingspi Yin (Bupleurum Spleen-Clearing Drink) treats malaria with more heat than cold and thirst. (Excess pathogen and deficient Qi result in more cold than heat, named Cold Malaria, treated with Renshen Yangwei Tang. More heat than cold with thirst is Summerheat Malaria, treated with Da Xiaohu Tang or Xiao Xiaohu Tang and Qingspi Yin.)
Spontaneous sweating indicates Yang deficiency; night sweating indicates Yin weakness. (Yang deficiency leads to loose interstices, causing spontaneous sweating. Yin deficiency causes ministerial fire to move, leading to night sweating; sweat occurs during sleep and stops upon waking, resembling a thief, hence the name "Night Sweating".) Cough without sound but with phlegm indicates Spleen invaded by dampness; cough with sound but without phlegm indicates Lung scorched by fire. (No sound with phlegm is called "Sou"; sound without phlegm is called "Ke". Spleen invaded by dampness fails to transform, resulting in much phlegm. Lung constrained by fire fails to descend, leading to upward rebellion and fire stagnating the phlegm.) Huoluan (Acute Vomiting and Diarrhea) has cold and summerheat patterns; why stick to the Ju Fang (Formulary of the Bureau of Medical Practitioners) using only acrid-warm medicines? (Both cold and summerheat can cause Huoluan; cold requires warming, summerheat requires clearing. The Ju Fang discusses only cold, ignoring summerheat, misleading many! One should read Dai Renli's discussions to understand half the principle.) Ji Ju (Accumulations and Gatherings) have deficiency and excess patterns; how can laypeople偏重 (bias towards) using harsh attacking drugs? (The Five Accumulations arise from the Five Zang organs; the Six Gatherings form from the Six Fu organs. Laypeople do not distinguish deficiency and excess, indiscriminately using harsh breaking and consuming drugs like Ban Dou (Ephedra Seed/Brucine) and Nao Sha (Ammonium Chloride) to attack, unaware of Jiegu's theory that "nourishing the righteous eliminates accumulation".) One should know that Wood stagnation can be resolved by vomiting to promote free flow; Metal stagnation by draining, Earth stagnation by purging, Water stagnation by restraining, and Fire stagnation by inducing sweating. Fa (inducing) and Li (draining) refer to sweating and purging methods respectively; Zhe (restraining) and Duo (purging) refer to suppressing and attacking methods. (Metal stagnation drained means opening orifices and guiding fluids to promote diuresis. Fire stagnation induced means sweating to promote dispersion. Earth stagnation purged means purging to remove obstruction. Wood stagnation restrained means suppressing its rebellious qi.) Dao Cang Lin (Liver Purging Method) and Qu Chen Cuo (Removing Old Debris) are excellent formulas for cleansing the middle jiao of accumulated filth; (These two methods cleanse the stomach and intestines of old accumulations, pushing out the old to bring in the new.) Kai Gui Men (Opening Ghost Gates/Sweating) and Jing Ji Fu (Purifying the House/Urination) are wonderful methods for dispersing dampness from above and below. (Kai Gui Men means opening interstices to induce sweating and drain upper dampness; Jing Ji Fu means clearing water passages to drain lower dampness.) Using such Ming Xuan (dazzling/toxic) agents, life and death can turn in the palm of a hand. (The Book of Documents says: "If the medicine does not produce a dizzying reaction, the severe illness will not heal." Those who administer Ming Xuan agents hold life and death in their hands.) A single mistake brings regret too late; if this leads to further reversal, even the formula cannot be revised quickly enough. (The Classics say: One error may prolong life, two errors hasten death. Must one not be cautious! Any slight error makes regret futile. Luo Qianfu said: Crude doctors cut off vital energy and fail to save critical lives because they cannot constrain their prescriptions. Constraining a prescription is like tying a bag; if not tied, it spills. If a prescription is not constrained, it harms life. Beginners should ponder the argument of "Prescription Made Without Constraint".)
Generally, acute diseases are not heat patterns, and chronic diseases are not cold patterns. (Cold invading the body cannot accumulate; it manifests immediately. If accumulated over time, it transforms into heat. Thus, acute diseases are mostly cold, and chronic diseases are mostly heat.) Carbuncles on the buttocks and back are caused by accumulated heat toxicity; sudden pain in the heart and abdomen is due to violent cold invasion. (These two examples illustrate that acute diseases are rarely heat, and chronic diseases are rarely cold.) Wu Xie (Five Diarrheas) and Wu Dan (Five Jaundices) are caused by damp-heat; promoting urination is the best approach. (Wu Xie refers to Wei, Large Intestine, Small Intestine, Kidney, and Da Jia diarrhea; Wu Dan refers to Grain, Wine, Damp, Female Labor, and Yellow Sweat jaundice. All are caused by damp-heat; only by promoting urination to drain dampness is the correct treatment. Treating dampness without promoting urination is incorrect.) San Xiao (Three Wasting-Thirsts) and San Nu (Three Epistaxes) are caused by dryness-fire; nourishing Yin ensures peace. (San Xiao refers to Xiao Ke, Xiao Zhong, and Shen Xiao; San Nu refers to epistaxis from nose, tongue, and penis. Wasting-thirst originates from dryness-heat, epistaxis from blood-heat; nourishing Yin and blood eliminates dryness-heat naturally.) Vomiting and Ke Ni (Hiccup/Cough-Reversal) blame the Stomach; Yin Han (Yin Hernia) and Jia Ju (Masses) belong to the Liver. (Vomiting without matter is Ou; vomiting with matter is Tu; Ke Ni is hiccup. These three are diseases of the Foot-Yangming Stomach Meridian. Yin Han includes Qi, Shui, Chang, and Luan hernias; Han includes Cold, Water, Sinew, Blood, Qi, Fox, and Jue hernias; Jia includes Green, Yellow, Dry, Blood, Fat, Fox, Snake, and Turtle masses. The Nan Jing states: Men have Seven Hernias, Women have Jia Ju, all governed by the Foot-Jueyin Liver Meridian. Since the Jueyin Liver meridian circulates around the genitalia, they all belong to the Liver.) Fluids return to the Heart to become sweat; to restrain sweat, use Huang Qi Liu Yi Tang (Astragalus Six-to-One Decoction). (Sweat is the fluid of the Heart; for excessive sweating, use Huang Qi Liu Yi Tang.) Internal blazing heat causing rashes is cleared by Ren Shen Hua Ban Tang (Ginseng Spot-Resolving Decoction). (When Yangming and Shaoyang fire is blazing, empty rashes must appear, treated with Ren Shen Hua Ban Tang.) Body unrest is called Zao (Restlessness); Heart unease is called Fan (Irritability). (Fan Zao is internal and external irritant heat. There are also cases of extreme Yin reversing to cause Fan Zao, which must be carefully examined.) Sudden stiffening and shivering with coma is named Shi Jue (Corpse Fainting); (Sudden collapse and unconsciousness with cold, shivering skin is Shi Jue, often contracted from entering temples, climbing tombs, visiting the sick, or attending funerals.) Sudden falling with salivation, occasionally waking, is called Dian Xian (Epilepsy); (Sudden fall, unconsciousness, noisy phlegm saliva flowing from the mouth corner, recovering shortly after, is Dian Xian. If unconsciousness persists with opisthotonos, it is called Xian Zheng.) Abdominal fullness and acid regurgitation indicate retained fluids in the Stomach; (Retained fluids cause abdominal fullness and acid regurgitation.) Chest distension and belching stem from stagnant phlegm above the Diaphragm. (Danjun said: Fire in the Stomach and phlegm above the Diaphragm cause belching.) To restore the power of spring, one must cultivate the elixir of resurrection.
I privately believe Yin and Yang patterns require different treatments. (Yin pattern presents with cold body; Yang pattern with hot body. Their treatments differ as much as heaven and earth.) Internal and external injuries require careful differentiation. Internal vs. external injury is distinguished by mouth and nose respiration; (Internal injury is caused by diet and overwork; external injury by wind, cold, summerheat, and dampness. Internal injury causes mouth dysfunction but regular nasal breathing. External injury leaves the mouth normal but nasal breathing difficult. This is because the nose receives formless qi, while the mouth receives有形 substances.) Yin and Yang patterns are observed through the pulse at Cun and Chi positions. (Yin pattern: weak Cun, floating Chi, weak pulse movement. Yang pattern: faint Chi, large Cun, strong pulse movement. Since Cun is Yang and Chi is Yin, the pulse reflects this.) Having clarified internal/external and Yin/Yang, one knows deficiency/excess and cold/heat. (Internal injury is deficiency, external injury is excess; Yang pattern is heat, Yin pattern is cold. Understanding these allows accurate application of tonifying deficiency, purging excess, warming cold, and clearing heat without error.) Called Zhuo (Turbidity) and Dai (Leukorrhea), there are red and white types. (Men have red and white Zhuo; women have red and white Dai.) Some belong to phlegm, some to fire. White affects Qi, Red affects Blood; originally there is no cold/heat distinction, only deficiency/excess. (Zhuo and Dai involve phlegm and fire. Affecting Qi results in white; affecting Blood results in red. Laypeople wrongly consider white as cold. Differences lie in Qi/Blood deficiency and accompanying phlegm/fire.) Dysentery is similar; due to stagnant damp-heat, avoid bland leeching and astringent pills/powders; use sweating, purging, cold, warm, emetic, and draining methods. (Dysentery, or "Stagnant Downward Flow", is caused by stagnant damp-heat expelling intestinal accumulation. Colors vary: red, white, mixed, bean juice, fish brain, dust/water, etc., all with visible matter. Do not rely solely on bland diuretics, nor use astringents or harsh purgatives like Ban Dou/Nao Sha. Use Zhang Zhongjing's methods: sweating for exterior wind-cold, resolving for heat, purging with Chengqi Tang for interior excess, warming with Ginger/Aconite for interior cold, tonifying with Ginseng/Atractylodes for deficiency, emesis for upper location, and guiding fluids for urinary obstruction. This is the flexible method.) Dao Chi San (Guide Out the Red Powder) unblocks Long Bi (Strangury); (Long means cessation; Bi means urgent blockage. Dao Chi San is the holy medicine for guiding fluids.) Wen Bai Wan (Warm White Pill) resolves Large Intestine pain and constipation. (Cold and food stagnation causing blockage, abdominal fullness/pain, and constipation are treated with Wen Bai Wan, dosed according to deficiency/excess.) Di Gu Pi San (Lycium Bark Powder) is suitable for retreating labor-fever; (Labor-fever is bone-steaming fever, treated with Di Gu Pi San.) Qing Meng Shi Wan (Green Rock Pill) rapidly resolves condensed phlegm. (Condensed phlegm cannot be opened without Qing Meng Shi. Danxi said: This drug relies on Fenghua Xiao (weathered sal ammoniac), taking advantage of its salty-cold nature to soften hardness and suppress.) For Fire stagnation, palpate the skin; (Stagnant heat differs from ordinary fever; heat lies in sinews/bones and limbs, skin feels not very hot, or suddenly feels burning hot to touch. Caused by Stomach deficiency and cold food suppressing Yang qi internally.) For dead fetus, verify via the tongue. (If a fetus dies in the uterus and is not expelled early, it is often fatal. If the fetus is dormant and the tongue is black, the fetus is dead; if red, it lives. Verify thus, without doubt.) Xuan Hu Ku Lian Tang (Corydalis and Melia Decoction) treats cold hernia radiating to the testicles; (For cold hernia radiating to testicles, use Xuan Hu Ku Lian Tang.) Dang Gui Long Hui Wan (Angelica Dragon Bile Pill) drains damp-heat pain attacking both hypochondria. (For damp-heat attacking hypochondria causing pain, or hyperactive Liver wood, this pill drains it.) Knowing Yin/Yang and deficiency/excess thoroughly is the mysterious secret of physicians.
Generally, all pain is excess, all itching is deficiency. (Pain is caused by pathogen invasion, hence excess; itching is due to blood deficiency and Qi insufficiency, hence deficiency. Hejian differentiated fire-heat severity by pain/itching, implying deficiency/excess.) Deficiency is insufficient Essence/Qi; Excess is abundant Pathogen. (Classics say: Excess is when pathogen is strong, deficiency is when Essence/Qi is lost.) Diarrhea has intestinal mucus or thin stool; if slipping/debilitating, astringents are appropriate. (Intestinal mucus is sticky/thick, indicating heat. Thin stool is clear/cold like duck feces, indicating cold. Slipping/debilitating means uncontrollable loss, severe deficiency. Thus, clear heat, warm cold. For slipping, urgently use He Zi San to astringe.) Abdominal pain has food stagnation and depressed heat; if cold-deficiency, Ginger/Aconite can be applied. (Depressed heat pain comes and goes. Food stagnation pain occurs after eating and reduces after bowel movement. Clear heat, digest food. For cold-deficiency abdominal pain, continuous without fluctuation, with cold extremities, urgently warm with Ginger/Aconite.) Jue Xin Tong (Rebellious Heart Pain) is guest-cold invading the Stomach; if extremities are warm, simply warm and disperse. (Pain in the epigastrium under the heart is not true Heart pain, hence called "Jue". If guest-cold invades Stomach and extremities are warm, cold is not severe; Cao Dou Kou Wan disperses it. If True Heart Pain, pain is severe, extremities cold to joints, then death ensues. True Headache connects to the brain; if nails are black, it is critical and hard to treat. (True Headache: die morning if onset evening, die evening if onset morning.) Jie Yang (Binding Yang) leads to limb swelling; Jie Yin (Binding Yin) leads to hematochezia without doubt. (When Yang qi fails to circulate, Yin stores accumulate heat, causing limb swelling. When Yin qi binds internally without circulation, Blood/Qi lack support, seeping into intestines causing bleeding.) Hong Jiao Jiao (Hongjiao/Jock Itch) is屈弱 (weakness/flexion difficulty) of feet/knees; swelling/pain indicates damp-heat excess. (Hongjiao is caused by damp-heat, causing leg weakness. Damp excess causes swelling, heat excess causes pain.) Unceasing Lower Back Pain is Kidney Deficiency; sprain/strain is Qi stagnation and Blood stasis. (Kidney deficiency lower back pain is continuous, inability to turn, treated with Qing E Wan. Sprain/strain pain involves Qi stagnation and Blood stasis. Regulate Qi, move Blood.) Pain at the vertex prefers Gao Ben; (Dongyuan said: Vertex pain is cold qi invading the Taiyang meridian, requiring Gao Ben.) Bi Yuan (Nasal Sinusitis) selects Xin Yi. (Bi Yuan is foul nasal discharge. Neijing says: Gallbladder heat transfers to Brain, causing Bi Yuan, transmitting to epistaxis/blindness, treat with Xin Yi Wan.) Hand numbness involves damp-phlegm and dead blood; hand stiffness stems from wind-damp and Qi deficiency. (Danxi said: Ten finger numbness is dead blood/damp-phlegm blocking tunnels, Qi not circulating. Hand stiffness is wind-damp/Qi deficiency, Qi not filling hands.) Strangury dripping yet not flowing, Qi deficiency uses Qing Xin Lian Zi Yin; (Strangury is dribbling painful urination, wanting to flow but not. Five types: Sand, Paste, Blood, Flesh, Labor. Generally heat-related. If Qi deficiency with heat, use Qing Xin Lian Zi Yin.) Hematochezia: examine if blood precedes or follows stool; Yin binding uses Ping Wei Di Yu Tang. (Hematochezia is damp-heat in Large Intestine. Preceding stool means proximal source; following stool means distal source. Neijing says: Yin binding causes 1 sheng blood, then 2, then 3. Luo Qianfu's Ping Wei Di Yu Tang treats this.) Urination difficulty is Guan (Obstruction); inability to eat is Ge (Refusal). This is Yin/Yang imbalance, causing Fu/Yi pulses. (Classics say: Excess Yang prevents Yin interaction, called Guan, blocking urination/defecation. Excess Yin prevents Yang interaction, called Ge, blocking food intake. Nan Jing says: Above Guan, Yang moves, pulse should be 9 fen floating. Exceeding is Taigu, lacking is Buji, rising to Fish Border is Yi (Overflow), Yin乘 Yang. Below Guan, Yin moves, pulse should be 1 cun sinking. Exceeding/Lacking applies, sinking to Chi is Fu (Cover), Yang乘 Yin. Thus, Fu/Yi are True Zang pulses; person dies without illness.) Hemoptysis differs from Hematemesis; Hemoptysis starts with cough, Hematemesis reverses up. (Hemoptysis: blood with cough, from Lung. Hematemesis: whole blood vomited up, from Stomach.) Swallowing acid differs from spitting acid; swallowing acid pierces heart, spitting acid gushes out. (Swallowing acid: damp-heat in Lung/Stomach, cannot spit or swallow, acidic taste pierces heart. Spitting acid: daily fluids rise with Qi, stagnant damp-heat becomes acidic, vomited like vinegar.) Water stopping below Heart is Yin (Fluid Retention); water accumulating under ribs is Pi (Mass). Promote water with Ze Xie/Fu Ling; attack Pi with Yuan Hua/Da Ji. (Cold Stomach drinking cold water, no heat to digest, stops below Heart, called Ting Yin. Accumulation under ribs forms mass, hard/painful over time, called Pi Yin. Mild cases use Fu Ling/Ze Xie to leach; severe cases use Yuan Hua/Da Ji to purge.) Kong Xian Dan is harsh but effective for removing hidden phlegm; (Hidden phlegm, retained fluid, condensed mass require this to remove.) Bao He Wan is warm/mild, digests food stagnation. (Bao He Wan treats all food stagnation.) Hematuria has no pain; painful is Chi Lin (Blood Strangury). (Hematuria: blood in urine, painless, use Si Wu Tang combined with Wu Ling San. Chi Lin: bloody strangury, painful/dribbling, use Xiao Ji Tang.) Shortness of breath is difficult Qi distribution; coarse breathing is Asthma/Wheezing. (Shortness of breath: Qi does not continue, difficult to distribute. Asthma: coarse/reverse Qi, more out than in.) Epigastric pain under heart distinguishes Guest Heat/Guest Cold. (Guest Cold: vomiting water, aversion to cold, continuous pain, cold extremities. Guest Heat: restlessness/thirst, intermittent.) Generalized joint pain must distinguish Wind/Damp. (Generalized joint pain is "White Tiger Arthralgia"; upper pain is Wind, lower pain is Damp.) Tong Sheng San specifically treats various winds; (Tong Sheng San, also Shuang Jie San, is holy medicine for dispelling wind-heat.) Yue Ju Wan opens Six Stagnations. (Six Stagnations: Qi, Blood, Food, Damp, Phlegm, Heat; Yue Ju Wan treats all.) Weakness with dizziness/vertigo also stems from Phlegm-Fire. (Dizziness/vertigo is deficiency symptom, also caused by Phlegm-Fire. Danxi said: Phlegm above, Fire below, often causes vertigo.) Damp-heat causes seminal emission/nocturnal dreams or arises from mental thoughts. (Nocturnal emission: semen loss during dream intercourse. Spermatorrhea: spontaneous loss without dream, both damp-heat/ministerial fire. Zhen Zhu Fen Wan. If from thoughts, disease is in Heart, calm the Heart.)
Since miscellaneous diseases are complex and unfounded, principles are hard to clarify; unlike Shanghan meridians which have evidence and recognizable signs. If one thinks thrice before treating, medication will never fail. Briefly listing the beginnings of many diseases, to serve as a model for future learners.