东垣、丹溪治病，多自制方，盖二公深明本草药性，洞究《内经》处方要法，故能自制。自宋以来，
《局方》盛行，人皆遵用，不敢轻率自为。《局方》论症治病，虽多差谬，丹溪曾辨论之，然方皆名医所制，
其君臣佐使、轻重缓急、大小多寡之法则不瘥也。近见东垣、丹溪之书大行，世医见其不用古方，也率皆
效颦，治病辄自制方，然药性不明，处方之法莫究，卤莽乱杂，反致生无甚有变症多端，遂难识治耳！且
夫药之气味不同，如五味子之味浓，故东垣方少者五、六粒，多者十数粒，今世医或用二、三钱；石膏味淡
薄，故白虎汤用半两，今世医不敢多用；补上治上剂宜轻小，今不论上下，率用大剂；丸散汤液各有攸宜，
今不论缓急，率用汤煎。如此类者多矣。今之医者，若不熟读《本草》，深究《内经》，而轻自制方，鲜不误
人也！
愚按方仿也，仿彼而准此也。至于应用，更贵权宜，非曰确然不可移而HT 然不可动者也。是以《素问》
无方，《难经》亦无方，汉时才有方，盖仿病因以立
方也。
或问∶今人有言，东垣之法宜用于北，丹溪之法可行于南，如何？曰∶东垣北医也，罗谦甫传其法，
以闻于江浙；丹溪南医也，刘宗浓世其学，以鸣于陕西。果如人言，则《本草》、《内经》皆神农皇帝、
岐伯之说，亦止宜施于北方耶？夫五方所生异病，及治之异宜，《内经》异法方宜论、五常政大论已详言之
矣。又如北方多寒，南方多热，江湖多湿，岭南多瘴，谓其得此气多，故亦多生此病，非谓北病无热、南病
无寒也。至于治寒以热，治热以寒，则五方皆同，岂有南北之异耶？但人之脏腑，火各居二，天之六气，
热居三分又半，故天下之病，热多而寒少，观《内经》至真要大论病机一篇可见。又湿热相火致病甚多，
自太仆注文湮没，以致《局方》偏用湿热之药，故丹溪出而阐《内经》之旨，辨《局方》之偏论湿热相火
之病，以补前人之未备耳！后人不识，见其多用芩、连、栀、柏等苦寒之药，遂以为宜于南，浅矣哉！
愚按前论内云火症固多，但虚实不同，治法亦异，故王太仆先生曰∶大寒而甚，热之不热，是无火
也；大热而甚，寒之不寒，是无水也。昼见夜伏，夜
见昼止，不时而动，是无火也。大抵病热，作渴饮冷，便秘，此症属实，为热故也。或恶寒发热，引衣蜷
卧，或四肢逆冷，大便清利，此属真寒；或躁扰狂越，欲入水中，不欲近衣，此症属虚∶外假热而内真寒
也。故虚劳发热之症，治以寒药而不愈者，为此故也。由此观之，则热症常少，而寒症常多矣。故无火者，
当用八味丸，益火之源以消阴翳；无水者，用六味丸，壮水之主以镇阳光。然其所以致疾者，皆由气血方
长，而劳心亏损，或精血未满，而纵情恣欲，根本不固，火不归经，以致见症难名。虽宜常补其阴以制其
火，然而二尺各有阴阳，水火互相生化，当于二脏中各分阴阳虚实，求其所属而平之。若左尺脉虚弱而细
数者，是左肾之真阴不足也，用六味丸；右尺脉迟软，或沉细而数欲绝者，是命门之相火不足也，用八味
丸；至于两尺微弱，是阴阳俱虚，用十补丸。此皆滋其化源也。设使概服黄柏、知母沉阴泻火之药，反戕脾
胃，多致不起。（详见《玉机微义》。治验见内科方。）
李东垣和朱丹溪治疗疾病，大多自行创制方剂，这是因为两位先生深刻通晓本草药性，透彻探究了《黄帝内经》中处方的核心法则，所以能够自行创制。自宋代以来，《太平惠民和剂局方》广泛流行，人们都遵循使用，不敢轻易擅自另立处方。《局方》在论述病症和治疗方面，虽然存在许多差错谬误，但朱丹溪曾对此进行过辩驳评论；然而其中的方剂都是由名医所制定，其君臣佐使的配伍原则、药味的轻重缓急以及剂量大小多少的法度并没有大的偏差。近来见到李东垣、朱丹溪的著作大为盛行，世俗医生看到他们不使用古方，便都盲目效仿，治病时辄自行创制方剂，然而对药性不明，对方剂处方的法则没有深入研究，粗疏混乱杂乱，反而导致原本无病或轻症变得严重，变证多端，于是难以识别和治疗！况且药物的气味各不相同，例如五味子的味道浓厚，所以李东垣的方子中少则用五、六粒，多则用十数粒，而现在的医生有时却用二、三钱；石膏的味道淡薄，所以白虎汤中使用半两，现在的医生不敢多用；治疗上部的药剂应当轻小，现在不论病情在上还是在下，都一律使用大剂量；丸剂、散剂、汤剂、液剂各有适宜的用途，现在不论病情缓急，都一律使用汤剂煎服。像这类情况很多。现在的医生，如果不熟读《本草》，不深入探究《内经》，就轻易自行创制方剂，很少有不误人的！
我按语：所谓“仿”，就是模仿，模仿前人然后以此为准绳应用于当下。至于实际应用，更贵在灵活变通，并不是说绝对不可改变且僵化不动的。因此《素问》中没有具体的方剂，《难经》也没有方剂，到了汉代才有方剂，大概是模仿病因来确立方剂的。
有人问：现在有人说，李东垣的治疗方法适宜用于北方，朱丹溪的治疗方法可行于南方，这是怎么回事？回答说：李东垣是北方的医生，罗谦甫传承了他的方法，并在江浙地区闻名；朱丹溪是南方的医生，刘宗浓继承了他的学问，并在陕西地区闻名。如果真像人们所说的那样，那么《本草》、《内经》都是神农皇帝、岐伯的说法，也只适宜施行于北方吗？关于五方所生的疾病不同，以及治疗的适宜方法不同，《黄帝内经·异法方宜论》、《五常政大论》已经详细论述过了。又如北方多寒冷，南方多炎热，江湖地带多湿气，岭南地区多瘴气，说是因为人们得到这些气候之气较多，所以也多发此类疾病，并不是说北方的病没有热证、南方的病没有寒证。至于治疗寒证用热药，治疗热证用寒药，这在五方都是一样的，难道有南北的差异吗？只是人的脏腑中，火各居其二，天的六气中，热占三分又半，所以天下的疾病，热证多而寒证少，观察《内经·至真要大论》中的病机一篇就可以明白。另外湿热相火致病的非常多，自从王冰（太仆）注解被埋没后，导致《局方》偏重于使用湿热性质的药物，所以朱丹溪出来阐发《内经》的宗旨，辩驳《局方》的偏颇，论述湿热相火的疾病，以补充前人的不足！后人不能理解，看到他多用黄芩、黄连、栀子、黄柏等苦寒的药物，就认为适宜于南方，这太浅陋了！
我按语：前面的论述中说火热病症固然多，但虚实不同，治疗方法也不同，所以王太仆先生说：非常寒冷而且严重，用热药治疗却不回暖的，是无火；非常热而且严重，用寒药治疗却不退热的，是无水。白天症状显现晚上潜伏，晚上症状显现白天停止，不时发作，是无火。大致来说，患病发热，口渴想喝冷水，大便便秘，这些症状属实，是因为热邪的缘故。或者恶寒发热，喜欢蜷缩身体睡觉，或者四肢逆冷，大便清稀通畅，这些属于真寒；或者烦躁扰乱狂乱超越常度，想要进入水中，不喜欢靠近衣物，这些症状属虚：外表假热而内里真寒。所以虚劳发热的病症，用寒凉药物治疗而不痊愈的，就是这个原因。由此看来，热证常常少，而寒证常常多。所以无火的，应当使用八味丸，补益火的源头以消除阴翳；无水的，使用六味丸，壮大水的根本以镇摄阳光。然而导致疾病的根本原因，都是因为气血正当生长旺盛时期，却用心过度导致亏损，或者精血尚未充盈，却放纵情欲恣意妄为，根本不坚固，火不归经，以致出现的症状难以命名。虽然应该经常滋补阴液以制约火邪，然而左右两尺脉各有阴阳，水火互相生化，应当在两脏中分别辨别阴阳虚实，探求其所属并加以平衡。如果左尺脉虚弱而细数，这是左肾的真阴不足，使用六味丸；右尺脉迟软，或者沉细而数近乎消失，这是命门的相火不足，使用八味丸；至于两尺脉微弱，是阴阳俱虚，使用十补丸。这些都是滋养生化的源头。假如一概服用黄柏、知母这种沉阴泻火的药物，反而会伤害脾胃，多数会导致死亡。（详见《玉机微义》。治验见内科方。）
Li Dongyuan and Zhu Danxi treated diseases mostly by creating their own prescriptions. This is because both masters had a profound understanding of the properties of materia medica (herbs) and thoroughly investigated the essential methods of prescription formulation in the *Huangdi Neijing* (Yellow Emperor's Inner Canon), thus enabling them to create prescriptions independently. Since the Song Dynasty, the *Tai Ping Hui Min He Ji Ju Fang* (Prescriptions of the Bureau of People's Welfare) had been widely popularized, and people followed its use without daring to arbitrarily formulate their own prescriptions. Although the *Ju Fang* contained many errors in discussing symptoms and treating diseases, Zhu Danxi had once debated and criticized it; however, the prescriptions therein were formulated by famous physicians, and their principles of Jun-Chen-Zuo-Shi (Sovereign, Minister, Assistant, Courier roles in herbal formulas), the lightness/heaviness, urgency/slowness, and size/quantity rules were not significantly flawed. Recently, the books of Li Dongyuan and Zhu Danxi have become highly prevalent. Secular physicians, seeing that they did not use ancient prescriptions, blindly imitated them, often creating their own prescriptions for diseases. However, lacking clarity on drug properties and failing to investigate the laws of prescription formulation, they acted rashly and chaotically, causing conditions that were previously non-existent or mild to become severe, with numerous variable syndromes arising, making diagnosis and treatment difficult! Moreover, the flavors and aromas of drugs differ. For example, Wuweizi (Schisandrae Chinensis Fructus) has a strong flavor, so Li Dongyuan’s prescriptions used only five or six berries, or up to ten-plus berries; yet modern physicians sometimes use two or three qian (approx. 6-9 grams). Shigao (Gypsum Fibrosum) has a light and thin flavor, so Baihu Tang (White Tiger Decoction) uses half a liang (approx. 15 grams); yet modern physicians dare not use much more. Prescriptions for treating the upper body should be light and small; yet now, regardless of whether the disease is in the upper or lower part, large doses are uniformly used. Wan (Pills), San (Powders), Tang (Decoctions), and Ye (Liquids) each have their appropriate applications; yet now, regardless of urgency, decoctions are uniformly used. There are many such cases. Modern physicians who do not carefully study the *Bencao* (Materia Medica) and deeply investigate the *Neijing*, but lightly create their own prescriptions, rarely fail to harm people!
I note: "Fang" (imitation/model) means imitating others to establish a standard for current application. In practical application, flexibility is even more valued; it is not something rigid and unchangeable. Therefore, the *Suwen* (Basic Questions) contains no specific prescriptions, nor does the *Nanjing* (Classic of Difficult Issues). Prescriptions only appeared during the Han Dynasty, presumably established by modeling after etiology (causes of disease).
A question was asked: Some people say today that Li Dongyuan’s methods are suitable for the North, and Zhu Danxi’s methods are viable for the South. What is your view? I replied: Li Dongyuan was a physician from the North; Luo Qianfu transmitted his methods, bringing fame to Jiangzhe (Jiangsu and Zhejiang regions). Zhu Danxi was a physician from the South; Liu Zongnong inherited his learning, bringing fame to Shaanxi. If this were true as people claim, would the *Bencao* and *Neijing*, which are teachings of Shennong (Divine Farmer) and Qibo, only be applicable in the North? The *Neijing*, specifically the chapters *Yifa Fangyi Lun* (Discourse on Different Methods and Appropriate Treatments for Different Regions) and *Wuchang Zheng Da Lun* (Great Discourse on the Five Constant Policies), has already detailed how diseases generated in the five directions differ, and how treatments must vary accordingly. Furthermore, while the North is cold and the South is hot, the river-lake areas are damp, and Lingnan is miasmic, stating that people acquire these climatic qi excessively and thus suffer related diseases does not mean northern diseases lack heat syndromes or southern diseases lack cold syndromes. As for treating cold with heat and heat with cold, this principle is uniform across all five directions; how could there be a north-south difference? It is simply that among human zang-fu organs, fire resides in two places, and among the six climatic qi of heaven, heat accounts for three parts and a half. Thus, globally, heat diseases are more common than cold diseases, as can be seen in the *Bingji* (Pathogenesis) chapter of the *Zhizhen Yao Da Lun* (Supreme Essential Reliability Great Discourse) in the *Neijing*. Additionally, diseases caused by damp-heat and ministerial fire are very numerous. Since Wang Bing’s (Grand Master of Records) annotations were obscured, the *Ju Fang* biased towards using damp-heat promoting drugs. Consequently, Zhu Danxi emerged to elucidate the purport of the *Neijing*, critique the bias of the *Ju Fang*, and discuss diseases of damp-heat and ministerial fire, supplementing the deficiencies of predecessors. Later generations failed to understand; seeing his frequent use of bitter-cold drugs like Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhizi (Gardeniae Fructus), and Huangbai (Phellodendri Cortex), they concluded he was suitable only for the South. This is shallow!
I note: The previous discussion stated that although fire syndromes are numerous, deficiency and excess differ, so treatment methods also differ. Thus, Mr. Wang Taipu (Wang Bing) said: Severe cold that does not warm even with heat therapy indicates absence of Fire (Kidney Yang); severe heat that does not cool even with cold therapy indicates absence of Water (Kidney Yin). Symptoms appearing by day and vanishing by night, or vice versa, occurring irregularly, indicate absence of Fire. Generally, fever with thirst for cold drinks and constipation indicates Excess Heat. Chills with fever, desire to curl up, cold limbs, and clear loose stools indicate True Cold. Restlessness, mania, desire to enter water, and aversion to clothing indicate Deficiency: False Heat externally and True Cold internally. Therefore, febrile sensations in consumptive diseases that do not resolve with cold herbs are due to this reason. From this perspective, heat syndromes are often few, while cold syndromes are often many. For those lacking Fire, Bawei Wan (Eight-Ingredient Pill with Rehmannia) should be used to tonify the source of Fire to dissipate yin shadows; for those lacking Water, Liuwei Wan (Six-Ingredient Pill with Rehmannia) should be used to strengthen the master of Water to suppress solar glare. However, the root cause of these illnesses lies in damaging the heart-mind during youth when qi and blood are flourishing, or indulging in lust before essence and blood are fully matured, leading to an insecure foundation, fire failing to return to its meridian, and resulting in symptoms difficult to name. Although one should frequently nourish yin to control fire, the left and right Chi (cun-guan-chi pulse positions at the wrist) pulses each contain yin and yang, and water and fire generate each other. One must differentiate yin and yang, deficiency and excess in these two viscera, seek their affiliation, and balance them. If the left Chi pulse is weak, fine, and rapid, it indicates insufficiency of True Yin in the Left Kidney; use Liuwei Wan. If the right Chi pulse is slow and soft, or deep, fine, and nearly imperceptible, it indicates insufficiency of Ministerial Fire in the Mingmen (Gate of Life); use Bawei Wan. If both Chi pulses are weak, it indicates dual deficiency of yin and yang; use Shibu Wan. These all nourish the source of transformation. If one indiscriminately administers heavy, yin-natured, fire-draining drugs like Huangbai and Zhimu, it will instead damage the Spleen and Stomach, often leading to death. (See *Yuji Wei Yi*. Clinical cases see Internal Medicine Formulas.)