阿胶为补血圣药，不论何经，悉其所任。味浓为阴，阿胶之味最浓，用必以补，不宜补
者勿用。白头翁汤加阿胶，则曰下利虚极。内补当归汤，则曰去血过多加阿胶。仲圣、孙真
人皆有明训。然非填补比，不得与熟地山药同论也。阿胶以济水黑驴皮煎炼而成，性易下行，
且滑大肠，于下利非宜。何以白头翁加甘草阿胶汤治下利？不知此乃滞下之热痢，正借其滑
利之功。故张洁古加减平胃散治热痢，以脓多而用之。渴者非热烁其液，即下焦阴液不上朝。
阿胶不能清热而性下行，何能止渴；乃猪苓汤治发热而渴，又治下利而渴，证不宜阿胶而偏
佐以阿胶。不知此皆因热而渴而利，水畜于中而热与水得，液既大伤，更与以猪苓辈淡渗燥
劫之物，液不几涸矣乎。佐阿胶所以润液而救猪苓辈之偏，非治其渴与利也。推之黄土汤燥
湿，鳖甲煎丸破结，温经汤行瘀，大黄甘遂汤下血逐水，亦断非滋柔浊腻之阿胶所能为力。
盖其补血润液而下行，不致掣燥湿、破结、行瘀、下血、逐水之肘，且能辅其不逮，故有需
于阿胶。若执黄土汤诸方，而以燥湿各事责阿胶，则何异扪烛扣 之见矣。
犀角一物，或谓胃药，或谓心药，或谓性升，或谓性降，或谓取汗最捷，或谓治血与经
旨不合。夫毒物入土即化，牛属土而犀角黑中有黄花，黄中有黑花，虽水畜未尝不秉土德，
谓为胃药无愧。释名∶心纤也，所识纤微无不贯也。犀角中有白星彻端，夜视光明，谓为心
药无愧。其角长而且锐，空而通气气味苦酸而兼咸寒，故能至极上极下，亦能至极内极外，
其实非升非降，不发汗，不逐实，心胃药而不专走心胃，血药而不泛治血证。观千金、外台
两书，用犀角之证，在上者有之，在中在下者有之，在表者有之，在里者有之，无分于上下
表里，而总惟血热而有毒者宜之。诸家之说，不免皆有所偏。
论犀角之精者，必首推邹氏。然谓用犀角必外有表证而兼肌肤有故，乃其所引外台诸证，
则并无表证。夫表证者，有表邪宜发汗之谓，犀角与麻黄并用有之，不能专任以发汗。邹氏
又以金匮升麻鳖甲汤无犀角为无表证，外台治喉痛有犀角为有表证，而升麻鳖甲汤证非无喉
痛，不解何以疏舛若是。
邹氏引魏培之犀角是倒大黄之戏语，鬯发大黄治火之自中及下，犀角治火之自下及上，
义至精矣，而犹有未尽者。本经大黄主下瘀血，犀角主解百毒，就此绎之，大黄除血分之热
结，是逐而下之。犀角除血分之热毒，是解而散之。大黄不言解毒，是热结于虚处，致用多
在肠胃。犀角不言下瘀，是热淫于实处，致用多在肌肤。大黄之味至苦，色至黄，性复猛厉，
自能逐物而下。犀角灵异之品，无论何处，遇毒辄赴，谓其自上而降，自下而升，则誉之不
当矣。
陆九芝世补斋医书犀角升麻辨，看似精详，细核之则疏舛殊甚。升麻代犀角，孙真人千
金方已有此语，不始于朱奉议活人书。二物皆中空通气入阳明经，味苦能发，故本经皆主解
百毒。然升麻主气，犀角主血。升麻升阳气而解毒，犀角清血热而解毒。原有不同，似未可
以相代。不知孙真人用犀角之方不一，独于伤寒杂治门木香汤，则云热毒盛者加犀角，无犀
角以升麻代之。盖其所治疮烦疼，是阳气为阴邪所郁，故方中用木香等辛温宣阳之药，热盛
则有毒。升麻能解毒而升阳亦无所妨，故可以代犀角。朱奉议以此法施于犀角地黄汤等方，
固宜见讥于陆，而陆实亦不能无误。提邪外出引邪内陷之说，由来已久，愚何敢辟以臆见；
独是仲圣伤寒金匮两书，发表攻里，分别甚严。即在阴经而用汗法，非兼见太阳脉证，则必
邪在于表在于上。若邪离本经入他经，则治以他经之药，邪得药而自解，非提出之，使他徙
而后解也。其邪虽不在里而不得用汗法者，仲圣又常反复叮咛以致意，此皆凿凿可证者。陆
氏亦知提邪外出之非发汗不外出乎，可以发汗之邪，邪本在表在上，未闻有从里从下提而出
之以发其汗者。或谓升麻之名，以升得之，自属以升为治。不知所谓升麻者，为能升阳气于
至阴之下也。周慎斋云∶凡生病处，皆为阴为火，为阳气不到。升麻升阳气以愈病，非提邪
气以离病，不得并为一谈。至于引邪内陷，只可谓之致，不可谓之引。凡无病之处，先为药
伤，邪因乘虚而入，是为药误所致，非如物交物之得以相引。若寒药治寒病，热药治热病，
可谓邪为药引矣。然此是滋蔓以益其本病，非陷入而别有变病。陆引喻氏论赵某室人，误用
犀角领邪攻心一案，以明犀角非胃药之据。夫犀角误用，为祸诚烈。谓犀角非胃药，则其测
犀角何浅。又以犀角治热入血室，为能从至幽至隐拔邪外出，故谓之升。微论犀角之治邪，
非拔邪也。从至幽至隐以升拔其邪，亦无此治理。仲圣治热入血室用小柴胡汤，似乎升矣。
不知伤寒金匮两书论此证诸条，惟续得寒热发作有时一条，主小柴胡汤，且将发作有时句复
沓言之，明示人以非有此证，不用此汤。盖肝胆二经，互相为用。热虽入于肝脏，寒热如疟，
则邪不离乎少阳，以小柴胡汤和解之，最为合拍。是柴胡尚属和法，犀角更何足言升。乃活
人书，谬于仲圣经水适来昼日明了暮则 语如见鬼状为热入血室一条，增加宜小柴胡汤五字，
竟视小柴胡汤为治热入血室之通剂，可谓粗疏之至矣。
或诘余曰∶子言提邪外出之证，必邪之在表在上者，乃寓意草载周信川患休息痢，喻氏
以逆流挽舟之法，提内陷之邪，从表出而愈，何子之执滞也。余曰∶逆流挽舟之说，后人多
非之；其实非提邪出表，且与仲圣有暗合之处，可两下研核而知也。喻氏痢疾论云∶下痢必
从汗先解其外，后调其内，此治痢初起之要诀，学人所宜切记。至失表而成久痢，邪已深入，
云用逆流挽舟之法，引而出之于外，则不知其挽从何处。若从极下逆挽而上，显犯少阴病在
里不可发汗之戒，引喻过当，不无流弊。金匮下利脉反弦发热身汗者自愈一条，喻氏以此下
利为久痢，非用逆挽之法，无以得此。夫弦为少阳之脉，寒利得之，自属病气将退阳气来复
之征。喻氏强题就我，凭空结撰，实不可为训。然则以此法治周信川休息痢而愈者何也？病
者年已七十有三，面目浮肿，肌肤晦黑，别无他状，非阳虚阴盛而何。痢有冷热两种，此当
是冷痢而湿重热轻。因其阳气下陷，与湿热相搏，故脉沉数而有力。喻氏谓阳邪陷入于阴者
非也。病在肠胃，与少阴无涉。以仲圣阳明病与小柴胡汤取汗之法比例求之，彼为上焦不通，
津液不下，胃因不和，故不大便。此为邪壅肠胃，津液不布，传化无权，故久痢不止。彼以
小柴胡汤和解其外而 然汗出，此以人参败毒散升散其里而皮间得润。小柴胡汤本方无取汗
之文，服之而汗出者，其上焦通也。休息痢本不能发汗，服人参败毒散而亦似有汗者，升阳
以化湿，阴阳和而谷味熏肤充身也。因人参败毒散虽有人参，究属劫剂，故改用补中益气汤
而始收全功，方中柴胡参草姜枣，即小柴胡汤去芩夏。彼为挟热，此为挟寒；彼宜通，此宜
固；故芩夏无所用之。又凡仲圣治寒利之方，不杂一下走之药，甚或用石脂余粮以固下，葱
白以升阴（义详葱白），喻氏则外以布卷垫定肛门，使气不下泄，内服汤以升举之。得仲圣
意而不呆用仲圣之方，非明哲那能如是。虽然，仲圣亦逆流挽舟以治利耳，而喻氏用之，谓
为提邪出表，得毋有不察者存乎。
阿胶是补血的圣药，无论哪一经脉受病，都在其治疗范围内。阿胶味道浓厚，属于阴，其味最为浓烈，使用时必须用于补益，不适合补益的情况则不要使用。白头翁汤中加入阿胶，是因为下利导致正气极度虚弱；内补当归汤中加入阿胶，是因为失血过多。张仲景和孙思邈都有明确的训诫。然而，阿胶并非填补之品，不能与熟地黄、山药相提并论。阿胶由济水黑驴皮煎炼而成，性质容易下行，且能滑润大肠，对于下利（腹泻）并不适宜。为什么白头翁加甘草阿胶汤能治疗下利？这是因为这是湿热阻滞的热痢，正好借助阿胶的滑利之功。所以张洁古在加减平胃散中治疗热痢时，也因脓多而使用它。口渴如果不是因为热邪灼伤津液，就是下焦阴液不能上承。阿胶不能清热且性质下行，怎么能止渴呢？猪苓汤治疗发热而渴，又治疗下利而渴，证候本不宜用阿胶却偏偏佐以阿胶。不知道这些都是因为热导致渴和下利，水湿停聚于中焦，热与水相搏，津液已经大伤，如果再给予猪苓等淡渗燥劫的药物，津液岂不是要枯竭了？加入阿胶是为了滋润津液并纠正猪苓等药的偏性，并不是为了治疗渴与利。推及黄土汤的燥湿、鳖甲煎丸的破结、温经汤的行瘀、大黄甘遂汤的下血逐水，也都绝不是滋柔浊腻的阿胶所能做到的。大概是因为阿胶补血润液且性质下行，不会牵制燥湿、破结、行瘀、下血、逐水药物的作用，并且能辅助它们的不足，所以有需要用到阿胶的地方。如果拘泥于黄土汤等方剂，而要求阿胶去承担燥湿等任务，那跟盲人摸烛、扣瓮听声的见识有什么区别呢？
犀角这一味药，有人说它是胃药，有人说它是心药，有人说它性升，有人说它性降，有人说它发汗最快，有人说它治血与经典旨意不合。毒物入土即化，牛属土，而犀角黑中有黄花，黄中有黑花，虽然水性畜聚但未尝不秉承土的德行，称它为胃药当之无愧。《释名》说：心纤也，所识纤微无不贯也。犀角中有白星通达两端，夜间视物光明，称它为心药当之无愧。它的角长而且锐利，中空而通气，气味苦酸兼咸寒，所以能到达极上极下，也能到达极内极外，其实它非升非降，不发汗，不攻逐实邪，是心胃药但不专走心胃，是血药但不泛治所有血证。观察《千金方》、《外台秘要》两书，使用犀角的证候，有在上部的，有在中下部的，有在体表的，有在体内的，不分上下表里，总之只有血热而有毒者适宜使用。各家说法，不免都有偏颇。
论述犀角的精妙之处，必定首推邹氏。然而他说使用犀角必须有表证且兼肌肤有病变，但他引用的《外台秘要》诸证，其实并没有表证。所谓表证，是指有表邪宜用发汗法，犀角与麻黄并用是有这种情况，但不能专门用来发汗。邹氏又以《金匮要略》升麻鳖甲汤无犀角为无表证，《外台秘要》治喉痛有犀角为有表证，而升麻鳖甲汤证并非没有喉痛，不解为何疏漏错误如此严重。
邹氏引用魏培关于犀角是倒大黄的说法，阐发了大黄治火自中及下，犀角治火自下及上的道理，意义非常精妙，但还有未尽之处。《本经》说大黄主下瘀血，犀角主解百毒，就此推演，大黄清除血分的热结，是驱逐而下之；犀角清除血分的热毒，是解散而散之。大黄不言解毒，是因为热结于虚处，致使其应用多在肠胃。犀角不言下瘀，是因为热淫于实处，致使其应用多在肌肤。大黄的味至苦，色至黄，性复猛厉，自然能逐物而下。犀角是灵异之品，无论何处，遇毒辄赴，称它自上而降，自下而升，则是赞誉不当。
陆九芝《世补斋医书·犀角升麻辨》，看似精详，细核之则疏漏错误甚多。用升麻代替犀角，孙思邈《千金方》已有此语，并非始于朱奉议《活人书》。两药皆中空通气入阳明经，味苦能发，所以《本经》都主解百毒。然而升麻主气，犀角主血。升麻升阳气而解毒，犀角清血热而解毒。原有不同，似乎不可以互相替代。不知道孙思邈用犀角的方子不止一个，唯独在伤寒杂治门的木香汤中说热毒盛者加犀角，无犀角以升麻代之。大概他所治疗的疮烦疼，是阳气被阴邪郁遏，所以方中用木香等辛温宣阳之药，热盛则有毒。升麻能解毒而升阳也无妨碍，所以可以代替犀角。朱奉议将此法施用于犀角地黄汤等方，固然会被陆九芝讥笑，而陆九芝实际上也有错误。提出“提邪外出”、“引邪内陷”的说法由来已久，我怎敢凭臆见来驳斥；只是张仲景《伤寒论》、《金匮要略》两书，发表攻里，分别得很严格。即使在阴经使用汗法，若非兼见太阳脉证，则必是邪在于表在于上。若邪离本经入他经，则治以他经之药，邪得药而自解，不是提出它，使它迁徙后才解。其邪虽不在里而不得用汗法者，张仲景又常反复叮咛以致意，这些都是确凿可证的。陆氏也知道提邪外出不是发汗就不外出吗？可以发汗之邪，邪本在表在上，没听说过有从里从下提而出之以发其汗的。或说升麻之名，以升得之，自属以升为治。不知道所谓升麻者，是能升阳气于至阴之下。周慎斋说：凡生病处，皆为阴为火，为阳气不到。升麻升阳气以愈病，不是提邪气以离病，不得并为一谈。至于引邪内陷，只可谓之致，不可谓之引。凡无病之处，先为药伤，邪因乘虚而入，是为药误所致，不像物体交物体那样得以相互吸引。若寒药治寒病，热药治热病，可谓邪为药引矣。然而这是滋蔓以益其本病，不是陷入而别有变病。陆氏引用喻氏论赵某室人误用犀角领邪攻心一案，以证明犀角非胃药的依据。夫犀角误用，为祸确实猛烈。谓犀角非胃药，则其推测犀角太浅薄。又以犀角治热入血室，为能从至幽至隐拔邪外出，故谓之升。别说犀角治邪，不是拔邪也。从至幽至隐以升拔其邪，也没有这种治理方法。张仲景治热入血室用小柴胡汤，似乎升了。不知道《伤寒论》、《金匮要略》两书论此证诸条，惟续得寒热发作有时一条，主小柴胡汤，且将发作有时句反复言之，明示人以非有此证，不用此汤。大概肝胆二经，互相为用。热虽入于肝脏，寒热如疟，则邪不离乎少阳，以小柴胡汤和解之，最为合拍。是柴胡尚属和法，犀角更何足言升。乃《活人书》，谬于《仲圣经》水适来昼日明了暮则谵语如见鬼状为热入血室一条，增加宜小柴胡汤五字，竟视小柴胡汤为治热入血室之通剂，可谓粗疏之至矣。
有人责问我道：你说提邪外出之证，必是邪之在表在上者，那么《寓意草》载周信川患休息痢，喻氏以逆流挽舟之法，提内陷之邪，从表出而愈，为何你如此执滞呢？我说：逆流挽舟之说，后人多非议；其实并非提邪出表，且与张仲景有暗合之处，可两下研核而知也。喻氏《痢疾论》云：下痢必从汗先解其外，后调其内，这是治痢初起之要诀，学人所宜切记。至失表而成久痢，邪已深入，云用逆流挽舟之法，引而出之于外，则不知其挽从何处。若从极下逆挽而上，显犯少阴病在里不可发汗之戒，引喻过当，不无流弊。《金匮要略》下利脉反弦发热身汗者自愈一条，喻氏以此下利为久痢，非用逆挽之法，无以得此。夫弦为少阳之脉，寒利得之，自属病气将退阳气来复之征。喻氏强题就我，凭空结撰，实不可为训。然则以此法治周信川休息痢而愈者何也？病者年已七十有三，面目浮肿，肌肤晦黑，别无他状，非阳虚阴盛而何。痢有冷热两种，此当是冷痢而湿重热轻。因其阳气下陷，与湿热相搏，故脉沉数而有力。喻氏谓阳邪陷入于阴者非也。病在肠胃，与少阴无涉。以张仲景阳明病与小柴胡汤取汗之法比例求之，彼为上焦不通，津液不下，胃因不和，故不大便。此为邪壅肠胃，津液不布，传化无权，故久痢不止。彼以小柴胡汤和解其外而濈然汗出，此以人参败毒散升散其里而皮间得润。小柴胡汤本方无取汗之文，服之而汗出者，其上焦通也。休息痢本不能发汗，服人参败毒散而亦似有汗者，升阳以化湿，阴阳和而谷味熏肤充身也。因人参败毒散虽有人参，究属劫剂，故改用补中益气汤而始收全功，方中柴胡参草姜枣，即小柴胡汤去芩夏。彼为挟热，此为挟寒；彼宜通，此宜固；故芩夏无所用之。又凡张仲景治寒利之方，不杂一下走之药，甚或用石脂余粮以固下，葱白以升阴（义详葱白），喻氏则外以布卷垫定肛门，使气不下泄，内服汤以升举之。得张仲景意而不呆用张仲景之方，非明哲那能如是。虽然，张仲景亦逆流挽舟以治利耳，而喻氏用之，谓为提邪出表，得毋有不察者存乎。
A-Jiao (Donkey-Hide Gelatin) is the supreme medicine for nourishing blood; regardless of which meridian is affected, it falls within its therapeutic scope. Its flavor is rich and yin in nature; A-Jiao has the richest flavor among medicines, so it must be used for tonification, and should not be used when tonification is inappropriate. When added to Baitouweng Tang (Coptis Decoction), it is indicated for severe deficiency due to dysentery; when added to Neibu Danggui Tang (Internal Nourishment Angelica Decoction), it is indicated for excessive blood loss. Both Zhang Zhongjing and Sun Simiao have given clear instructions on this. However, A-Jiao is not a substance for filling voids and cannot be discussed on par with Shudi Huang (Rehmanniae Radix Preparata) or Shanyao (Dioscoreae Rhizoma). A-Jiao is prepared by decocting black donkey hide from Ji River water; its nature tends to descend and it lubricates the large intestine, making it unsuitable for diarrhea. Why then does Baitouweng Jia Gancao E'jiao Tang (Baitouweng Decoction plus Licorice and Donkey-Hide Gelatin) treat diarrhea? This is because it treats heat-dysentery with stagnation, precisely utilizing its lubricating property. Thus, Zhang Jiegu uses it in Jiajian Pingwei San (Modified Pingwei Powder) for heat-dysentery with abundant pus. Thirst that is not caused by heat consuming fluids implies that yin fluids from the lower jiao fail to ascend. A-Jiao cannot clear heat and its nature descends, so how can it stop thirst? Zhu Ling Tang (Polyporus Decoction) treats fever with thirst and also diarrhea with thirst; although the syndrome is generally unsuitable for A-Jiao, it is paradoxically combined with it. This is because the thirst and diarrhea are caused by heat, with water retention in the middle jiao where heat and water interact, leading to severe fluid injury. If one were to administer diuretic and drying agents like Zhu Ling (Polyporus), would not the fluids be nearly exhausted? Therefore, adding A-Jiao serves to moisten fluids and correct the bias of Zhu Ling and similar herbs, rather than treating the thirst and diarrhea directly. Extending this logic, Huotu Tang (Yellow Earth Decoction) dries dampness, Biejia Jian Wan (Turtle Shell Pill for Breaking Stagnation) breaks accumulations, Wenjing Tang (Warming the Menses Decoction) moves blood stasis, and Dahuang Gansui Tang (Rhubarb and Kansui Decoction) purges blood and drives out water; none of these actions can be achieved by the moistening, greasy, and descending nature of A-Jiao. Generally, because A-Jiao nourishes blood and moistens fluids while descending, it does not hinder the actions of drying dampness, breaking stagnation, moving stasis, purging blood, or driving out water, and it can assist where they fall short, hence its necessity. If one rigidly applies the principles of Huotu Tang and demands that A-Jiao perform tasks like drying dampness, it would be no different from the limited perception of touching a candle in the dark or listening to a pot.
Regarding Xi Jiao (Rhinoceros Horn), some say it is a stomach herb, others say it is a heart herb; some claim its nature ascends, others that it descends; some say it induces sweating most rapidly, others that its use for blood disorders contradicts classic teachings. Poisonous substances dissolve upon entering the earth; cattle belong to earth, and Xi Jiao features yellow flowers within black and black flowers within yellow. Although associated with water retention, it embodies the virtue of earth, justifying its classification as a stomach herb. *Shiming* states: "The heart is delicate; what it perceives penetrates even the subtlest details." Xi Jiao contains white stars penetrating both ends and shines brightly at night, justifying its classification as a heart herb. Its horn is long and sharp, hollow and ventilated, with a bitter, sour, salty, and cold taste. Thus, it can reach the highest and lowest extremes, as well as the innermost and outermost extremes. In reality, it neither ascends nor descends, does not induce sweating, and does not purge excess. It is a heart and stomach herb but does not exclusively target them; it is a blood herb but does not indiscriminately treat all blood disorders. Observing *Qianjin Fang* and *Waitai Miyao*, cases using Xi Jiao include those affecting the upper, middle, lower, exterior, and interior. Regardless of location, it is suitable only for blood-heat with toxicity. Various theories are inevitably biased.
When discussing the essence of Xi Jiao, Zou's theory is paramount. However, he claims that using Xi Jiao requires an exterior syndrome accompanied by skin lesions, yet the cases he cites from *Waitai Miyao* show no exterior syndrome. An exterior syndrome refers to pathogenic factors on the exterior requiring sweating. While Xi Jiao is sometimes used with Mahuang (Ephedrae Herba), it cannot be solely relied upon to induce sweating. Zou argues that the absence of Xi Jiao in Shengma Biejia Tang (Cimicifuga and Turtle Shell Decoction) indicates no exterior syndrome, while its presence in *Waitai Miyao* for sore throat indicates an exterior syndrome. However, Shengma Biejia Tang syndrome involves sore throat, so his reasoning is flawed.
Zou quotes Wei Pei's playful remark that Xi Jiao is "upside-down Dahuang" (Rhei Radix et Rhizoma). This elaborates that Dahuang treats fire rising from the center downwards, while Xi Jiao treats fire rising from the bottom upwards. The meaning is profound but incomplete. According to *Ben Jing*, Dahuang treats stagnant blood in the lower body, while Xi Jiao resolves hundred toxins. From this, we deduce that Dahuang clears heat-stagnation in the blood level by purging downwards. Xi Jiao clears heat-toxicity in the blood level by resolving and dispersing. Dahuang does not mention detoxifying because heat-stagnation occurs in deficient areas, primarily affecting the intestines and stomach. Xi Jiao does not mention purging blood because heat-toxicity invades solid areas, primarily affecting the skin and muscles. Dahuang is extremely bitter, yellow, and fierce in nature, naturally driving pathogens downward. Xi Jiao is a spiritual substance that rushes to any location encountering toxicity. Claiming it descends from above and ascends from below is improper praise.
Lu Jiuzhi's *Xi Jiao Shengma Bian* in *Shibuzhai Yishu* appears detailed but is actually quite flawed. Using Shengma (Cimicifugae Rhizoma) to replace Xi Jiao appears in Sun Simiao's *Qianjin Fang*, predating Zhu Fengyi's *Huo Ren Shu*. Both herbs are hollow and ventilated, enter the Yangming meridian, have bitter flavors that can vent, and thus *Ben Jing* states both resolve hundred toxins. However, Shengma governs Qi, while Xi Jiao governs Blood. Shengma raises Yang Qi and resolves toxicity; Xi Jiao clears blood-heat and resolves toxicity. They are distinct and seemingly not interchangeable. Sun Simiao used various formulas with Xi Jiao, but specifically in *Muxiang Tang* (Costus Decoction) under Cold Damage and Miscellaneous Treatments, stated that for severe heat-toxicity, add Xi Jiao, or substitute with Shengma if unavailable. The treated condition was painful sores where Yang Qi was depressed by Yin pathogens, requiring acrid-warm Yang-promoting herbs like Muxiang (Aucklandiae Radix). Since heat was severe and toxic, Shengma could resolve toxicity and raise Yang without hindrance, allowing substitution. Zhu Fengyi applied this method to Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction), inviting Lu's criticism, yet Lu himself erred. The concepts of "lifting pathogens outward" and "leading pathogens inward" have existed for a long time; I dare not refute them based on personal opinion alone. However, Zhang Zhongjing's *Shanghan Lun* and *Jingui Yaolue* strictly distinguish between releasing the exterior and purging the interior. Even when using sweating methods on Yin meridians, unless Taiyang pulse/syndromes are present, the pathogen is on the exterior or upper body. If the pathogen leaves its original meridian to enter another, treatment targets that specific meridian, allowing the pathogen to resolve naturally through medication, not by "lifting" it to migrate before resolution. Zhang Zhongjing repeatedly warned against sweating when the pathogen is not in the interior, which is well documented. Does Lu know that lifting pathogens outward requires them to be on the exterior/upper body first? Pathogens suitable for sweating are originally on the exterior/upper body; there is no record of lifting them from the interior/lower body to induce sweating. Some argue Shengma's name implies ascending action. However, Shengma raises Yang Qi from the deepest Yin. Zhou Shenzhen said: "All disease sites are Yin or Fire, where Yang Qi does not reach. Shengma raises Yang Qi to cure disease, not to lift pathogenic Qi away from the site; they cannot be conflated." Leading pathogens inward should be termed "causing" rather than "leading." Disease-free areas are first damaged by drugs, allowing pathogens to enter via deficiency due to drug error, unlike objects attracting each other. If cold drugs treat cold diseases and hot drugs treat hot diseases, one might call pathogens "led" by drugs. However, this merely exacerbates the primary disease, causing no new complications. Lu cites Yu's case of Mrs. Zhao, mistakenly using Xi Jiao to lead pathogens to attack the Heart, to prove Xi Jiao is not a stomach herb. Indeed, misuse of Xi Jiao causes severe harm. But claiming it is not a stomach herb shows shallow understanding. He also claims Xi Jiao treats "Heat Entering the Blood Chamber" by extracting pathogens from the deepest obscurity, hence calling it "ascending." Besides, Xi Jiao does not extract pathogens. There is no such treatment principle as extracting pathogens from deep obscurity by ascending. Zhang Zhongjing treats Heat Entering the Blood Chamber with Xiao Chaihu Tang (Minor Bupleurum Decoction), which seems ascending. However, in *Shanghan Lun* and *Jingui Yaolue*, only the case with intermittent chills and fever after initial onset prescribes Xiao Chaihu Tang, emphasizing this symptom to indicate it is not a general formula for this condition. The Liver and Gallbladder meridians function mutually. Although heat enters the Liver, chills and fever resembling malaria indicate the pathogen remains in Shaoyang. Xiao Chaihu Tang harmonizes, which fits best. Chaihu (Bupleuri Radix) belongs to harmonization; how can Xi Jiao be called ascending? *Huo Ren Shu* erroneously adds "Xiao Chaihu Tang is appropriate" to the *Shanghan Lun* line about water flow stopping during menstruation, daytime clarity, and evening delirium as Heat Entering the Blood Chamber, treating Xiao Chaihu Tang as a universal remedy, which is extremely crude.
Someone questioned me: You state that lifting pathogens outward applies only when pathogens are on the exterior/upper body. Yet *Yuyi Cao* records Zhou Xinchuan's rest dysentery cured by Yu's "Counter-current Boat Pulling" method, lifting internalized pathogens outward. Why are you so rigid? I replied: The "Counter-current Boat Pulling" theory is often criticized by later generations. Actually, it does not literally lift pathogens to the exterior, and it secretly aligns with Zhang Zhongjing's principles, which can be verified by cross-referencing. Yu's *Dysentery Discussion* states: "Dysentery must first resolve the exterior through sweating, then regulate the interior; this is the key for early-stage dysentery, which students must remember." For chronic dysentery resulting from missed exterior release, where pathogens have deeply invaded, claiming "Counter-current Boat Pulling" extracts them externally ignores where the pulling originates. Pulling upward from the extreme lower body violates the prohibition against sweating for Shaoyin interior syndromes. Yu's analogy is excessive and potentially harmful. *Jingui Yaolue* states: "Diarrhea with wiry pulse, fever, and spontaneous sweating will heal spontaneously." Yu interprets this as chronic dysentery requiring counter-current pulling to explain the healing. Wiry pulse belongs to Shaoyang. In cold-type diarrhea, it signifies declining pathogenic Qi and recovering Yang Qi. Yu forces his interpretation, fabricating arguments, which should not serve as a model. So why did this method cure Zhou Xinchuan's rest dysentery? The patient was 73 years old, with puffy face and eyes, dark skin, and no other symptoms, indicating Yang deficiency and Yin excess. Dysentery has cold and hot types; this was likely cold dysentery with heavy dampness and light heat. Due to sinking Yang Qi struggling with damp-heat, the pulse was deep, rapid, and forceful. Yu's claim of Yang pathogens sinking into Yin is incorrect. The disease is in the intestines/stomach, unrelated to Shaoyin. Comparing it to Zhang Zhongjing's use of Xiao Chaihu Tang for Yangming disease to induce sweating: In Yangming, upper jiao blockage prevents fluid descent, causing stomach disharmony and constipation. Here, pathogenic obstruction in intestines/stomach prevents fluid distribution and transmission, causing chronic dysentery. Xiao Chaihu Tang harmonizes the exterior, leading to slight sweating due to upper jiao unblocking. Rest dysentery normally cannot be sweated; taking Renshen Baidu San (Ginseng and Toxin-Expelling Powder) produces apparent sweating because raising Yang transforms dampness, harmonizing Yin and Yang, allowing grain essence to nourish the skin and body. Although Renshen Baidu San contains Renshen (Ginseng Radix), it is ultimately a draining formula, so Bu Zhong Yi Qi Tang (Middle-Warding and Augmenting Qi Decoction) was used to complete the cure. The Chaihu, Renshen, Gancao (Licorice Root), Shengjiang (Fresh Ginger), and Dazao (Jujubae Fructus) in the latter constitute Xiao Chaihu Tang minus Huangqin (Scutellariae Radix) and Banxia (Pinelliae Rhizoma). The former involved heat; this involved cold. The former required unblocking; this required consolidating. Hence, Huangqin and Banxia were unnecessary. Furthermore, Zhang Zhongjing's formulas for cold diarrhea never include purgatives, sometimes using Shizhi Yuliang (Kaolin and Calcined Oyster Shell) to consolidate the lower or Congbai (Allii Fistulosi Bulbus) to raise Yin (see Congbai for details). Yu externally bandaged the anus to prevent Qi leakage and internally administered decoctions to raise it. He grasped Zhang Zhongjing's intent without rigidly copying his formulas; only a wise person could achieve this. Although Zhang Zhongjing also used counter-current boat pulling to treat diarrhea, Yu's application as "lifting pathogens to the exterior" may lack careful observation.