一、寒方之制，为清火也，为除热也。夫火有阴阳，热分上下。据古方书，咸谓黄连清
心，黄芩清肺，石斛、芍药清脾，龙胆清肝，黄柏清肾。今之用者，多守此法，是亦胶柱法
也。大凡寒凉之物，皆能泻火，岂有凉此而不凉彼者，但当分其轻清重浊，性力微甚，用得
其宜则善矣。夫轻清者，宜以清上。如黄芩、石斛、连翘、天花之属是也。重浊者，宜于清
下。如栀子、黄柏、龙胆、滑石之属也。性力之浓者，能清大热。如石膏、黄连、芦荟、苦
参、山豆根之属也。性力之缓者，能清微热。如地骨皮、玄参、贝母、石斛、童便之属也。
以攻而用者，去实郁之热。如大黄、芒硝之属也。以利而用者，去癃闭之热。如木通、茵陈
、猪苓、泽泻之属也。以补而用者，去阴虚枯燥之热。如生地、二冬、芍药、梨浆、细甘草
之属也。方书之分经用药者，意正在此，但不能明言其意耳。然火之甚者，在上亦宜重浊；
火之微者，在下亦可轻清。夫宜凉之热，皆实热也。实热在下，自宜清利；实热在上，不可
升提。盖火本属阳，宜从阴治，从阴者宜降，升则反从其阳矣。经曰∶高者抑之，义可知也
。外如东垣有升阳散火之法，此以表邪生热者设，不得与伏火内炎者并论。
一、热方之制，为除寒也。夫寒之为病，有寒邪犯于肌表者，有生冷伤于脾胃者，有阴
寒中于脏腑者，此皆外来之寒，去所从来，则其治也，是皆人所易知者。至于本来之寒，生
于无形无响之间，初无所感，莫测其因，人之病此者最多，人之知此者最少，果何谓哉？观
丹溪曰∶气有余便是火。余续之曰∶气不足便是寒。夫今人之气有余者，能十中之几？其有
或因禀受，或因丧败，以致阳气不足者，多见寒从中生，而阳衰之病，无所不致。第其由来
者渐，形见者微，当其未觉也，孰为之意？及其既甚也，始知治难。矧庸医多有不识，每以
假热为真火，因复毙于无形无响者，又不知其几许也，故惟高明见道之士，常以阳衰根本为
忧，此热方之不可不预也。
凡用热之法，如干姜能温中，亦能散表，呕恶无汗者宜之。肉桂能行血，善达四肢，血
滞多痛者宜之。吴茱萸善暖下焦，腹痛泄泻者极妙。肉豆蔻可温脾肾，飧泄滑利者最奇。胡
椒温胃和中，其类近于荜拨。丁香止呕行气，其暖过于豆仁。补骨脂性降而散闭，故能纳气
定喘，止带浊泄泻。制附子性行如酒，故无处不到，能救急回阳。至若半夏、南星、细辛、
乌药、良姜、香附、木香、茴香、仙茅、巴戟之属，皆性温之当辨者。然用热之法，尚有其
要∶以散兼温者，散寒邪也；以行兼温者，行寒滞也；以补兼温者，补虚寒也。第多汗者忌
姜，姜能散也。失血者忌桂，桂动血也。气短气怯者忌故纸，故纸降气也。大凡气香者，皆
不利于气虚证。味辛者，多不利于见血证，所当慎也。是用热之概也。
至于附子之辨，凡今之用者，必待势不可为，不得已然后用之，不知回阳之功，当用于
阳气将去之际，盒饭渐用，以望挽回。若用于既去之后，死灰不可复然矣，尚何益于事哉。
但附子性悍，独任为难，必得大甘之品如人参、熟地、炙甘草之类，皆足以制其刚而济其勇
，以补倍之，无往不利矣。此壶天中大将军也，可置之无用之地乎？但知之真而用之善，斯
足称将将之手矣。
一、寒凉方剂的制定，是为了清除火邪，为了去除热证。火分阴火和阳火，热证有上焦和下焦之分。根据古代医书，都说黄连清心火，黄芩清肺热，石斛、芍药清脾热，龙胆草清肝火，黄柏清肾热。现在使用这些药物的人，大多拘泥于这种固定方法，这也是像胶住琴柱一样不知变通的做法。大凡寒凉性质的药物，都能泻火，难道有只凉这个部位而不凉那个部位的吗？关键在于区分药物的轻清与重浊，以及药力的微弱与猛烈，用得恰当就好。那些药性轻清的，适宜用于清上焦之热。如黄芩、石斛、连翘、天花粉等属于此类。药性重浊的，适宜用于清下焦之热。如山栀子、黄柏、龙胆草、滑石等属于此类。药力浓烈的，能清除大热。如石膏、黄连、芦荟、苦参、山豆根等属于此类。药力缓和的，能清除微热。如地骨皮、玄参、贝母、石斛、童便等属于此类。以攻逐法使用的，是去除实邪郁结的热。如大黄、芒硝等属于此类。以利水法使用的，是去除小便不通畅的热。如木通、茵陈、猪苓、泽泻等属于此类。以补益法使用的，是去除阴虚枯燥引起的热。如生地黄、天冬、麦冬、芍药、梨汁、细甘草等属于此类。医书中按经络用药的意图，正在于此，只是不能明确说出其中的道理罢了。然而火势严重的，在上焦也宜用重浊的药物；火势轻微的，在下焦也可用轻清的药物。凡是适宜用凉药治疗的热证，都是实热。实热在下焦，自然适宜用清热利湿的方法；实热在上焦，不可用升提的方法。因为火本属阳，适宜从阴分来治疗，从阴分治疗适宜用降法，如果用升法反而顺应了它的阳性了。《内经》说：“病位高的要抑制它”，这个道理就显而易见了。另外如李东垣提出的升阳散火法，这是为表邪引起发热而设立的，不能与伏火内炎的情况混为一谈。
二、热性方剂的制定，是为了祛除寒邪。寒邪致病，有寒邪侵犯肌表的，有生冷食物损伤脾胃的，有阴寒之气侵入脏腑的，这些都是外来的寒邪，去除其来源，治疗起来，都是人们容易知道的。至于原本就存在的寒证，产生于无形无声之间，起初没有感觉，无法猜测其原因，患这种病的人最多，了解这种病的人最少，这究竟是怎么回事呢？看朱丹溪说：“气有余就是火。”我接着说：“气不足就是寒。”现在的人中，气有余的能有几个？那些因为先天禀赋或后天损耗，导致阳气不足的人，多见寒气从中而生，阳气衰败的病证，无所不致。只是这种病由来已久，逐渐形成，显现出来的症状轻微，当还没有察觉时，谁会去在意它？等到病情严重了，才知道治疗困难。况且庸医大多不认识这一点，常把假热当作真火，因此又有很多人在无形无声中死去，不知道有多少人了。所以只有高明见道的医生，常常担忧阳气衰败的根本问题，这就是热性方剂不可不预先准备的原因。
凡是使用热性药的方法，如干姜能温中焦，也能发散表寒，呕吐恶心无汗者适宜使用。肉桂能行血，善于通达四肢，血滞多痛者适宜使用。吴茱萸善于温暖下焦，腹痛泄泻者效果极佳。肉豆蔻可温补脾肾，完谷不化的泄泻最为奇特有效。胡椒温胃和中，其性质接近荜拨。丁香止呕行气，其温热程度超过豆仁（肉豆蔻）。补骨脂药性沉降且能散闭，所以能纳气定喘，止带浊泄泻。制附子药性运行如酒一般，所以无处不到，能救急回阳。至于半夏、天南星、细辛、乌药、高良姜、香附、木香、茴香、仙茅、巴戟天等类药物，都是需要仔细辨别其温性的药物。然而使用热性药的方法，还有其要点：以发散兼温补的，是发散寒邪；以行气兼温补的，是行散寒滞；以补益兼温补的，是补虚寒。只是多汗者忌用生姜，因为生姜能发散。失血者忌用肉桂，因为肉桂动血。气短气怯者忌用补骨脂（故纸），因为补骨脂降气。大凡气味芳香的药物，都不利于气虚证。味道辛烈的药物，多不利于出血证，应当谨慎。这是使用热性药的概况。
至于对附子的辨析，现在使用它的人，一定要等到病情危重、无可奈何时才不得已使用，却不知道回阳的功效，应当在阳气即将脱失的时候使用，应当逐渐服用，以期望挽回生机。如果用在阳气已经脱失之后，就像死灰不能再燃烧一样，还有什么益处呢？但是附子药性猛烈，单独使用很难驾驭，必须得到甘味大的药物如人参、熟地黄、炙甘草之类，都足以制约它的刚烈并辅助它的勇猛，加倍使用，就没有不利的了。这是医家中的大将军啊，怎么能放在无用的地方呢？但只有真正了解它并善于使用它，才足以称为善于驾驭将领的手腕。
1. The formulation of cold-natured prescriptions is intended to clear fire and eliminate heat. Fire is divided into yin-fire and yang-fire, while heat is categorized into upper and lower jiao (upper and lower body regions). According to ancient medical texts, it is commonly stated that Huanglian (Coptidis Rhizoma) clears heart-fire, Huangqin (Scutellariae Radix) clears lung-heat, Shihu (Dendrobii Caulis) and Shaoyao (Paeoniae Radix) clear spleen-heat, Longdancao (Gentianae Radix) clears liver-fire, and Huangbai (Phellodendri Cortex) clears kidney-heat. Practitioners today often adhere rigidly to this method, which is akin to playing a zither with glued bridges—lacking flexibility. In general, all cold-natured substances can purge fire; there is no substance that cools one area without affecting another. The key lies in distinguishing between light-and-clear (qing) and heavy-and-turbid (zhuo) properties, as well as the intensity of their efficacy. Proper application is ideal. Light-and-clear agents are suitable for clearing heat in the upper jiao, such as Huangqin (Scutellariae Radix), Shihu (Dendrobii Caulis), Lianqiao (Forsythiae Fructus), and Tianhua Fen (Trichosanthis Radix). Heavy-and-turbid agents are suitable for clearing heat in the lower jiao, such as Zhizi (Gardeniae Fructus), Huangbai (Phellodendri Cortex), Longdancao (Gentianae Radix), and Huashi (Talcum). Agents with potent efficacy can clear severe heat, such as Shigao (Gypsum Fibrosum), Huanglian (Coptidis Rhizoma), Lvhui (Aloe), Kushen (Sophorae Flavescentis Radix), and Shandougen (Sophorae Tonkinensis Radix). Agents with mild efficacy can clear slight heat, such as Digupi (Lycii Cortex), Xuanshen (Scrophulariae Radix), Beimu (Fritillariae Bulbus), Shihu (Dendrobii Caulis), and Tongbian (Urine of Children). Used via purgation, they remove heat from excess stagnation, such as Dahuang (Rhei Radix et Rhizoma) and Mangxiao (Natrii Sulfas). Used via diuresis, they remove heat associated with urinary obstruction, such as Mutong (Akebiae Caulis), Yichen (Artemisiae Scopariae Herba), Zhuling (Polyporus), and Zexie (Alismatis Rhizoma). Used via tonification, they remove heat caused by yin-deficiency and dryness, such as Shengdi Huang (Rehmanniae Radix), Dongchun (Asparagi Radix and Ophiopogonis Radix), Shaoyao (Paeoniae Radix), Lizhi (Pericarpium Citri Reticulatae juice/pear juice), and Xigancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle). The intent behind classifying drugs by meridians in medical books lies here, though the rationale is rarely explicitly stated. However, when fire is severe, even if located in the upper jiao, heavy-and-turbid agents may be appropriate; when fire is mild, even if located in the lower jiao, light-and-clear agents may suffice. All heat requiring cooling treatment is excess heat. Excess heat in the lower jiao should naturally be treated with clearing and draining methods; excess heat in the upper jiao must not be treated with ascending methods. Since fire belongs to yang, it should be treated via yin; treating via yin implies descending. Ascending would merely follow its yang nature. As the Classics state: "For those high up, suppress them." The meaning is clear. Furthermore, Li Dongyuan's method of "ascending yang and dispersing fire" was designed for heat generated by exterior pathogens and cannot be equated with internal inflammation of latent fire.
2. The formulation of hot-natured prescriptions is intended to dispel cold. Cold diseases include cold pathogens invading the muscle-surface, raw or cold foods injuring the spleen and stomach, and yin-cold penetrating the zang-fu organs. These are all external colds; removing their source makes treatment straightforward, which is generally understood. However, innate cold arises formless and soundless, initially imperceptible and unpredictable in origin. Many suffer from this condition, yet few understand it. What is it? Zhu Danxi stated: "Excess qi becomes fire." I add: "Deficient qi becomes cold." How many people today have excess qi? Those with deficient yang due to congenital endowment or acquired depletion often generate cold from within, leading to various diseases of yang decline. This process is gradual, with subtle manifestations. When unnoticed, who pays attention? Only when it becomes severe does one realize the difficulty of treatment. Moreover, mediocre physicians often fail to recognize this, mistaking false heat for true fire, resulting in countless deaths from unseen causes. Therefore, only wise physicians worry about the root of yang decline, highlighting the necessity of preparing hot-natured prescriptions in advance.
Methods for using hot-natured drugs include: Ganjiang (Zingiberis Rhizoma) warms the middle and disperses exterior cold, suitable for vomiting, nausea, and absence of sweat. Rougui (Cinnamomi Cortex) promotes blood circulation and reaches the four limbs, suitable for blood stasis and pain. Wuzhuyu (Evodiae Fructus) warms the lower jiao, excellent for abdominal pain and diarrhea. Roudoukou (Myristicae Semen) warms the spleen and kidneys, uniquely effective for undigested stool in diarrhea. Hujiao (Piperis Longi Fructus) warms the stomach and harmonizes the middle, similar to Bibo (Piperis Kadsurae Fructus). Dingxiang (Caryophylli Flos) stops vomiting and moves qi, warmer than Dou Ren (Myristicae Semen). Buguzhi (Psoraleae Fructus) has a descending nature and opens blockages, thus gathering qi to calm asthma and stop leukorrhea and diarrhea. Zhi Fuzi (Aconiti Lateralis Radix Praeparata) moves like wine, reaching everywhere, capable of saving emergencies and restoring yang. Other warm-natured drugs requiring distinction include Banxia (Pinelliae Rhizoma), Nanting (Arisaematis Tuber), Xixin (Asari Radix et Rhizoma), Wuyao (Linderae Radix), Jiangliangjiang (Galangal Rhizome), Xiangfu (Cyperi Rhizoma), Muxiang (Aucklandiae Radix), Huixiang (Foeniculi Fructus), Xianmao (Curculiginis Rhizoma), and Ba Ji Tian (Morinda Officinalis Radix). Key principles for using hot-natured drugs include: dispersing combined with warming to dispel cold pathogens; moving combined with warming to resolve cold stagnation; tonifying combined with warming to supplement deficiency-cold. However, excessive sweating contraindicates Jiang (Ginger/Zingiberis Rhizoma) because it disperses. Hemorrhage contraindicates Gui (Cinnamon/Cinnamomi Cortex) because it agitates blood. Shortness of breath and timidity contraindicate Guzhi (Buguzhi/Psoraleae Fructus) because it descends qi. Generally, aromatic drugs are unfavorable for qi-deficiency syndromes. Pungent drugs are often unfavorable for bleeding syndromes; caution is required. This summarizes the use of hot-natured drugs.
Regarding the differentiation of Fuzi (Aconiti Lateralis Radix Praeparata): practitioners today often wait until the situation is hopeless before using it reluctantly. They do not know that the merit of restoring yang should be applied when yang is on the verge of departure, using it gradually to hope for recovery. If used after yang has already departed, it is like trying to reignite dead ash, serving no purpose. However, Fuzi is fierce; using it alone is difficult. It must be combined with sweet-tonic herbs like Renshen (Ginseng Radix), Shudi Huang (Rehmanniae Radix Preparata), and Zhi Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) to restrain its harshness and assist its vigor. With doubled dosage, it will be effective everywhere. It is the Great General among medicines; how can it be left unused? But only those who truly understand it and use it skillfully can be called masters of commanding generals.