细绎病源，阳分比阴分更亏之候也。阴亏而用十全养荣等法，责重乎阴，寓以阳药，本
属和平之剂。良以秋分在即，燥气加临，不敢责重乎阳，以燥就燥反增燥病焉耳。然于膏方
下之后，日可附桂斟酌用之，一语早已言之，非见不到也。盖天地之气清矣半月一更，人身
之气亦半月一更。八月而至九月，气已二更，病势不除，饮食反减。明明阴得膏滋而无病，
阳得膏滋而更衰，一月之间阴阳偏胜，一膏之内功过相抵。可叹补偏救弊，因时制宜，应接
无暇也。所言念七念八九两日，霜降始寒，寒气外侵，痰饮内动，动见青黄绿色水，尚属阳
明胃腑。至于黑这一色，已自阳明胃底而来，肾虚水泛，脾虚积饮，已见一班。然神气困倦，
面色青浮，脉见双弦，以始阳气不充，痰饮内聚宜矣，而反忽然牙齿浮疼，加以口舌酸泔，
呃忒于胃，卫逆于胁，变出一番火气者，肝火也，肝气也。气火之横逆，不外肾虚，无以涵
木，木须顺乘脾土。此等气不足，即是寒之根柢；及见气有余便是火之形状，所谓本寒标热
症是也。夫惟本寒标热，岂阳气之虚，较之阴气更进一层耶？此时论坎离，当然不定，始可
阴霾四散，宗风虚则炽痰寒则壅之训而出一星附散法，以助脾阳。俾虚风寒痰不相互结，
非独分解病情，而且土旺用事更合机宜。如一立冬，又不可以纯阳无阴之品施于久病阴血
本亏之体。冬月宜藏之令者，以此方分两三次，一日进一服。参入前定滋方中，只取五钱，
清晨服下，傍晚再服水泛金匮肾气丸钱半，淡
盐汤送下，以占冬至阳生，弗药有喜。至于黑锡丹、控涎丹，本来合式因病处方，随机应变，
相时而动者，须烦两先生权之。
仔细推究病源，这是阳气分比阴气分亏损更严重的证候。因阴液亏虚而采用十全大补汤、养荣汤等治法，重在滋补阴液，同时寓含阳药，这本来属于平和的方剂。主要是因为秋分将至，燥气盛行，不敢过分重用温阳药物，以免以燥助燥反而加重燥邪为患。然而我在膏方服用之后，曾提到可以酌情使用附子、肉桂，这话早已说过，并非见识不到。大概天地之气每半个月更替一次，人身之气也是如此。从八月到九月，气已更替两次，病情未除，饮食反而减少。明眼人可见，阴分得到膏方的滋养而没有生病（指阴伤得补），但阳分得到膏方滋养后反而更加衰弱，短短一个月之间阴阳偏胜，一料膏方之内功效与过失相互抵消。可叹的是，纠正偏颇、补救弊端，顺应时节变化制宜，真是忙得不可开交。
所说二十七、二十八、二十九这几天，霜降节气开始变冷，寒气从外侵袭，痰饮在体内发动，吐出青、黄、绿色的水样物，这还属于阳明胃腑的病证。至于黑色这一种颜色，已经是从阳明胃底而来，这是肾虚导致水气泛滥，脾虚导致停饮积聚，已经显露出端倪。然而患者神气困倦，面色青浮，脉象呈现双侧弦脉，这是因为起初阳气不充盛，痰饮内聚是理所当然的，但却忽然出现牙齿浮动疼痛，加上口舌酸腐如泔水状，呃逆出于胃，卫气逆乱于胁肋，变幻出一番火气的症状，这是肝火、肝气作祟。气火的横逆，不外乎是因为肾虚，无法涵养肝木，肝木必须顺乘脾土。这种气不足的情况，就是寒的根本；等到出现气有余便是火的形状时，这就是所谓的“本寒标热”症。既然是本寒标热，难道阳气的虚损，比阴气的虚损更进一层吗？此时讨论坎离（心肾）的关系，当然不能确定，这才符合“宗风虚则炽，痰寒则壅”的训诫，于是提出用附子散法，以辅助脾阳。使得虚风、寒痰不相互结聚，这不仅分解了病情的复杂性，而且土旺当令也更合时机。到了立冬，又不可以对久病阴血本已亏虚的体质施用纯阳无阴的药物。冬月宜遵循闭藏的时令，因此将此方分为两三次，一日服用一服。参入之前确定的滋阴方中，只取五钱，清晨服用，傍晚再服用金匮肾气丸一钱半，用淡盐汤送下，以应冬至阳气初生之象，不用重药也有喜兆。至于黑锡丹、控涎丹，本来是合乎体式、因病处方、随机应变、相时而动的药物，需要烦请两位先生权衡决定。
Carefully analyzing the source of the disease, this is a condition where the deficiency in the Yang aspect is more severe than that in the Yin aspect. When treating Yin deficiency with methods such as Shiquan Dabu Tang (Ten Great Tonifying Decoction) and Rongying Decoction, the emphasis is placed on nourishing Yin while incorporating Yang-tonifying herbs; this originally belongs to a mild and harmonious formula. The primary reason is that the Autumn Equinox is approaching, and dryness Qi is prevailing. One dares not heavily emphasize Yang-tonifying herbs, as using dryness to address dryness would only exacerbate the dryness pathology. However, after the administration of the paste prescription, I had already mentioned that Fuzi (Aconite Lateral Root) and Rougui (Cinnamon Bark) could be used cautiously; this was stated long ago, indicating that it was not a matter of lacking insight. Generally, the Qi of Heaven and Earth changes every half-month, and so does the Qi of the human body. From the eighth month to the ninth month, the Qi has changed twice. The disease trend persists, and appetite decreases further. It is evident that while the Yin aspect receives nourishment from the paste and remains stable, the Yang aspect becomes even more depleted despite the paste's nourishment. Within just one month, there is an imbalance of Yin and Yang, and within one dose of paste, its merits and faults cancel each other out. It is lamentable that correcting imbalances and remedying defects according to seasonal changes leaves one constantly busy.
Regarding the 27th, 28th, and 29th days, when Frost Descent begins and coldness sets in, external Cold invades, and Phlegm-Fluids stir internally. The expectoration of green, yellow, or greenish water indicates involvement of the Yangming Stomach Fu organ. As for the black color, it originates from the depths of the Yangming Stomach, signaling Kidney Deficiency leading to Water Overflow and Spleen Deficiency causing Fluid Accumulation, which has already manifested clearly. Although the patient presents with mental fatigue, a bluish-floating complexion, and a wiry pulse on both sides—consistent with initial Yang insufficiency and internal Phlegm-Fluid accumulation—there is suddenly onset of floating tooth pain, sourness in the mouth and tongue resembling rice washings, hiccuping originating from the Stomach, and rebellious Wei Qi in the hypochondrium. These symptoms manifest as Fire Qi, specifically Liver Fire and Liver Qi. The horizontal rebellion of Qi and Fire stems essentially from Kidney Deficiency failing to nourish Liver Wood, causing Liver Wood to overact upon Spleen Earth. This state of Qi insufficiency constitutes the root of Cold; however, when signs of "excess Qi becoming Fire" appear, it represents a syndrome of "Root Cold and Branch Heat." Given this Root Cold and Branch Heat pattern, is the Yang Qi deficiency indeed deeper than the Yin Qi deficiency? At this stage, discussing the relationship between Kan (Water/Kidney) and Li (Fire/Heart) is indeterminate. Following the principle that "Wind deficiency leads to blazing heat, and Phlegm-Cold leads to obstruction," I proposed using Sanfu Powder (Fuzi-based powder) to assist Spleen Yang, preventing the mutual binding of deficient Wind, Cold, and Phlegm. This not only clarifies the pathological complexity but also aligns with the timing when Earth Qi is dominant. Upon the Start of Winter, one must not administer purely Yang, Yin-depleting substances to a constitution already suffering from chronic Yin-Blood deficiency. Since winter is the season for storage, this formula should be divided into two or three doses, taken once daily. Combined with the previously determined nourishing Yin formula, take five qian in the morning. In the evening, take one and a half qian of Jin Kui Shenqi Wan (Kidney Qi Pill from the Golden Cabinet), delivered with light salt water, to correspond with the generation of Yang at the Winter Solstice, hoping for improvement without heavy medication. As for Heixi Dan (Black Tin Pill) and Kongxian Dan (Controlling Phlegm-Fluids Pill), although they are appropriate formulas tailored to the disease, adaptable to circumstances, and timed appropriately, their use requires the discretion of the two senior physicians.