元素曰∶病在头面及皮肤者，药须酒炒；在咽下脐上者，酒洗之；在下者，生用。寒药
须酒浸曝干，恐伤胃也。当归酒浸，助发散之用也。
嘉谟曰∶制药贵在适中，不及则功效难求，太过则气味反失。火制四∶ 、炮、炙、炒
水制三∶渍、泡、洗也。水火共制，蒸、煮二者焉。法造虽多，不离于此。酒制升提，
姜制发散。入盐走肾而软坚，用醋注肝而住痛。童便制，除劣性而降下；米泔制，去燥性而
和中。乳制润枯生血，蜜制甘缓益元。陈壁土制，窃真气骤补中焦；麦麸皮制，抑酷性勿伤
上膈。乌豆汤、甘草汤渍曝，并解毒致令平和；羊酥油、猪脂油涂烧，咸渗骨容易脆断。去
瓤者
欲疗病，先察其源，先候病机。五脏未虚，六腑未竭，血脉未乱，精神未散，服药必活。
若病已成，可得半愈。病势已过，命将难全。
弘景曰∶自非明医听声、察色、诊脉，孰能知未病之病乎？且未病之人，亦无肯自疗。
故齐侯怠于皮肤之微，以致骨髓之痼，非但识悟之为难，亦乃信受之弗易。仓公有言∶信巫
不信医，死不治也。
时珍曰∶《素问》云∶上古作汤液，故为而弗服。中古道德稍衰，邪气时至，服之万全。
当今之世，必齐毒药攻其中， 石针艾治其外。又曰∶中古治病，至而治之，汤液十日不已，
从，病形已成，以为可救，故病未已，新病复起。
淳于意曰∶病有六不治∶骄恣不论于理，一不治；轻身重财，二不治；衣食不适，三不
治；阴阳脏气不定，四不治；形羸不能服药，五不治；信巫不信医，六不治。六者有一，则
难治也。
宗 曰∶病有六失∶失于不审，失于不信，失于过时，失于不择医，失于不识病，失于
不知药。六失有一，即为难治。又有八要∶一曰虚，二曰实，三曰冷，四曰热，五曰邪，六
曰正，七曰内，八曰外也。《素问》言∶凡治病，察其形气色泽，观人勇怯、骨肉、皮肤，
能知其情，以为诊法。若患人脉病不相应，既不得见其形，医止据脉供药，其可得乎？今豪
富之家，妇人居帷幔之内，复以帛蒙手臂。既无望色之神，听声之圣，又不能尽切脉之巧，
未免详问。病家厌繁，以为术疏，往往得药不服。是四诊之术，不得其一矣，可谓难也。呜
呼！
若用毒药疗病，先起如黍粟，病去，即止；不去，倍之；不去，十之，取去为度。
弘景曰∶今药中单行一两种有毒，只如巴豆、甘遂、将军，不可便令尽剂。如《经》所
云∶一物一毒，服一丸如细麻；二物一毒，服二丸如大麻；三物一毒，服三丸如胡豆；四物
一毒，服四丸如小豆；五物一毒，服五丸如大豆；六物一毒，服六丸如梧子；从此至十，皆
以梧子为数。其中又有轻重，且如野狼毒、钩吻，岂如附子、芫花辈耶？此类皆须量宜。
宗曰∶虽有此例，更合论人老少虚实，病之新久，药之多毒少毒，斟量之，不可执为
定法。
疗寒，以热药；疗热，以寒药；饮食不消，以吐下药；鬼疰蛊毒，以毒药；痈肿疮瘤，
以疮药；风湿，以风湿药，各随其所宜。
弘景曰∶药性一物兼主十余病者，取其偏长为本，复观人之虚实补泻，男女老少，苦乐
荣悴，乡壤风俗，并各不同。褚澄疗寡妇尼僧，异乎妻外家，此是达其性怀之所致也。
时珍曰∶气味有浓薄，性用有躁静，治体有多少，力化有浅深。正者正治，反者反治。
用热远热，用寒远寒，用凉远凉，用温远温。发表不远热，攻里不远寒；不远热则热病至，
不远寒则寒病至。治热以寒，温而行之；治寒以热，凉而行之；治温以清，冷而行之；治清
以温，热而行之。木郁达之，火郁发之，土郁夺之，金郁泄之，水郁折之。气之胜也，微者
随之，甚者制之；气之复也，和者平之，暴者夺之。高者抑之，下者举之，有余折之，不足
补之，坚者削之，客者除之，劳者温之，结者散之，留者行之，燥者濡之，急者缓之，散者
收之，损者益之，逸者行之，惊者平之，吐之、汗之、下之、补之、泻之，久新同法。又曰∶
逆者正治，从者反治。反治者，热因寒用，寒因热用，塞因塞用，通因通用。必伏其所主，
而先其所因。其始则同，其终则异。可使破积，可使溃坚，可使气和，可使必已。又曰∶诸
寒之而热者取之阴，热之而寒者取之阳，所谓求其属以衰之也。此皆约取《素问》之粹言。
病在胸膈以上者，先食后服药；病在心腹以下者，先服药而后食。病在四肢血脉者，宜
空腹而在旦；病在骨髓者，宜饱满而在夜。
弘景曰∶今方家先食后食，盖此义也。
又有须酒服者，饮服者，冷服者，热服者。服汤则有疏、有数，煮汤则有生、有熟。各
有法用，并宜详审。
杲曰∶古人服药活法∶病在上者，不厌频而少；病在下者，不厌顿而多。
少服，则滋荣于上；多服，则峻补于下。凡云分再服、三服者，要令势力相及，并视人
之强
夫大病之主，有中风伤寒，寒热温疟，中恶霍乱，大腹水肿，肠 下痢，大小便不通，
奔豚上气，咳逆呕吐，黄胆消渴，留饮癖食，坚积症瘕，惊邪癫痫鬼疰，喉痹齿痛，耳聋目
盲，金疮 折，痈肿恶疮，痔 瘿瘤；男子五劳七伤，虚乏羸瘦；女子带下崩中，血闭阴蚀；
虫蛇蛊毒所伤。此大略宗兆，其间变动枝叶，各宜依端绪以取之。
弘景曰∶药之所主，止说病之一名，假令中风乃有数十种，伤寒证候亦有二十余条，更
复就中求其类例，大体归其始终，以本性为根宗，然后配证以合药尔。病之变状，不可一概
言之。所以医方千卷，犹未尽其理。春秋以前，及和、缓之书蔑闻，而《道经》略载扁鹊数
法，其用药犹是本草家意。至汉淳于意及华佗等方，今时有存者，亦皆条理药性。惟张仲景
一部，最为众方之祖，又悉依本草，但其善诊脉、明气候以意消息之尔。至于刳肠剖臆、刮
骨续筋之法，乃别术所得，非神农家事。自晋代以来，有张苗、宫泰、刘德、史脱、靳邵、
赵泉、李子豫等，一代良医。其贵胜阮德如、张茂先辈，逸民皇甫士安，及江左葛洪、蔡谟、
殷仲堪诸名人等，并研精药术。宋有羊欣、元徽、胡洽、秦承祖，齐有尚书褚澄、徐文伯、
嗣伯群从兄弟，疗病亦十愈八九。凡此诸人，各有所撰用方，观其指趣，莫非本草者。或时
用别药，亦循其性度，非相逾越。
《范汪方》百余卷，及葛洪《肘后》，其中有细碎单行经用者，或田舍试验之法，或
殊域异识之术。如藕皮散血，起自庖人；牵牛逐水，近出野老。饼店蒜齑，乃是下蛇之
药；路边地菘，而为金疮所秘。此盖天地间物，莫不为天地间用，触遇则会，非其主对矣
。颜光禄亦云∶道经仙方，服食断谷，延年却老，乃至飞丹炼石之奇，云腾羽化之妙，莫
不以药道为先。用药之理，一同本草，但制御之途，小异世法。所用不多，远至二十余物
，或单行数种。岁月深积，便致大益，即本草所云久服之效，不如俗人微觉便止。今庸医
处疗，皆耻看本草，或倚约旧方，或闻人传说，便揽笔疏之，以此表奇。其畏恶相反，故
自寡昧，而药类违僻，分两参差，不以为疑。偶尔值瘥，则自信方验；旬月未瘳，则言病
源深结，了不反求诸己，虚构声称，自应贻谴矣。其五经四部，军国礼服，少有乖越，止
于事迹非宜尔。至于汤药，一物有谬，便
宗 曰∶人有贵贱少长，病当别论；病有新久虚实，理当别药。盖人心如面，各各不
同，惟其心不同，脏腑亦异。欲以一药通治众人之病，其可得乎？
张仲景曰∶有土地高下不同，物性刚柔食居亦异。是故黄帝兴四方之问，岐伯举四治之
能。且如贵豪之家，形乐志苦者也。衣食足则形乐而外实，思虑多则志苦而内虚。故病生于
脉，与贫下异，当因人而治。后世医者，委此不行，所失甚矣。又凡人少、长、老，其气血
有盛、壮、衰三等。故岐伯曰∶少火之气壮，壮火之气衰。盖少火生气，壮火散气，况衰火
乎。故治法亦当分三等。其少日服饵之药，于壮、老之时皆须别处，决不可忽。
又云∶人以气血为本。世有童男室女，积想在心，思虑过当，多致劳损。男则神色先散
，女则月水先闭。盖忧愁思虑则伤心，心伤则血逆竭，故神色先散而月水先闭也。火既受病
，不能营养其子，故不嗜食。脾既虚则金气亏，故发嗽。嗽既作，水气绝，故四肢干。木气
不充，故多怒，鬓发焦，筋痿。俟五脏传遍，故卒不能死，然终死矣。此于诸劳最为难治。
或能改易心志，用药扶接，间得九死一生耳。
有人病久嗽，肺虚生寒热。以款冬花焚三两芽，俟烟出，以笔管吸其烟，满口则咽之，
至倦乃已。日作五、七次，遂瘥。
有人病疟月余，又以药吐下之，气遂弱。观其脉病，乃夏伤暑，秋又伤风。因与柴胡汤
一剂，安。后又饮食不节，寒热复作，吐逆不食，胁下急痛，此名痰疟。以十枣汤一服，下
痰水数升；服理中散二钱，遂愈。
有妇人病吐逆，大小便不通，烦乱，四肢冷，渐无脉，凡一日半。与大承气汤二剂，至
夜半大便渐通，脉渐生，翌日乃安。此关格之病，极难治。《经》曰∶关则吐逆，格则不得
小便，亦有不得大便者。
有人苦风痰头痛，颤掉吐逆，饮食减。医以为伤冷物，温之不愈，又以丸下之，遂厥。
复与金液丹，后谵言吐逆，颤掉，不省人，狂若见鬼，循衣摸床，手足冷，脉伏。此胃中有
结热，故昏瞀不省人。以阳气不能布于外，阴气不持于内，即颤掉而厥。遂与大承气汤，至
一剂，乃愈。
有妇人病温，已十二日。诊其脉，六七至而涩，寸稍大，尺稍小。发寒热，颊赤口干，
不了了，耳聋。问之，病后数日，经水乃行。此属少阳热入血室，治不对症，必死。乃与小
柴胡汤。二日，又加桂枝干姜汤，一日寒热止。但云∶我脐下急痛。与抵当丸，微利，痛止
身凉，尚不了了，复与小柴胡汤。次日云∶我胸中热燥，口鼻干。又少与调胃承气汤，不利
，与大陷胸丸半服，利三行。次日虚烦不宁，妄有所见，狂言。知有燥屎，以其极虚，不敢
攻之。与竹叶汤，去其烦热，其大便自通，中有燥屎数枚，狂烦尽解。惟咳嗽唾沫，此肺虚
也，不治恐乘虚作肺痿。以小柴胡去人参、姜、枣，加干姜、五味子汤，一日咳减，二日悉
痊。
有人年六十，脚肿生疮，忽食猪肉，不安。医以药下之，稍愈。时出外中风，汗出，头
面暴肿，起紫黑色，多睡，耳叶上有浮泡小疮，黄汁出。乃与小续命汤，倍加羌活服之，遂
愈。
有人年五十四，素羸，多中寒，少年常服生硫黄数斤，近服菟丝有效。脉左上二部、右
下二部弦紧有力。五七年来，病右手足筋急拘挛，言语稍迟。遂与仲景小续命汤，加薏苡仁
一两以治筋急；减黄芩、人参、芍药各半，以避中寒；杏仁只用一百五枚。后云∶尚觉大冷
，因尽去人参、芩、芍，加当归一两半，遂安。小续命汤，今人多用，不能逐证加减，遂至
危殆，故举以为例。
元素说：病位在头面及皮肤者，药物需用酒炒制；病位在咽喉以下、肚脐以上者，药物需用酒洗制；病位在下焦者，药物宜生用。寒性药物须用酒浸泡后晒干，以防损伤胃气。当归用酒浸泡，是为了增强其发散的功效。
嘉谟说：制药的关键在于程度适中，药力不及则难以取得疗效，药力太过则药物的气味反而会丧失。火制法有四种：煿（bó，一种烘烤方法）、炮、炙、炒；水制法有三种：渍、泡、洗。水火共同作用的制法，有蒸和煮两种。制药的方法虽然繁多，但不离这些范畴。酒制能提升药势，姜制能发散药性。入盐制能引药入肾并软化坚硬之物，用醋制能引药入肝并止痛。童便制能去除药物的劣性并使药力下行；米泔水制能去除燥性并调和脾胃。乳汁制能滋润枯槁、生成血液，蜂蜜制能甘缓药性、补益元气。陈壁土制能窃取真气、迅速补益中焦；麦麸皮制能抑制药物的酷烈之性，以免伤害上膈。乌豆汤、甘草汤浸泡后晒干，都能解毒使药性平和；羊酥油、猪脂油涂抹后烧制，能使药物渗入骨骼，容易脆断（便于粉碎或吸收）。
治病之前，先要考察病因，先审察病机。五脏尚未虚损，六腑尚未衰竭，血脉尚未紊乱，精神尚未耗散时服药，必定能治愈。如果病已经形成，只能治好一半。如果病势已过，生命将难以保全。
弘景说：如果不是明医通过听声音、观察面色、诊察脉搏，谁能知道那些尚未显现为疾病的潜在病变呢？而且没有生病的人，也没有愿意主动去治疗的。所以齐侯轻视皮肤表面的小病，导致了骨髓深处的顽疾，这不仅仅是因为认识领悟的困难，更是因为让人相信并接受治疗的艰难。仓公曾说：相信巫术而不相信医学，是死症，无法治疗。
时珍说：《素问》记载：上古时代制作汤液，只是预备着而不服用。中古时代道德稍微衰退，邪气时常到来，服用汤液就能万无一失。当今之世，必须用毒药攻治体内的疾病，用砭石、针法和艾灸治疗体表的疾病。又说：中古时代治病，病邪刚来就进行治疗，服用汤液十天如果不好，顺着病势继续治疗，病形已经形成，认为还可以救治，所以旧病未愈，新病又起。
淳于意说：疾病有六种情况是不易治疗的：骄横放纵不讲道理，是一不治；轻视身体看重钱财，是二不治；衣食不能适应环境，是三不治；阴阳脏气不稳定，是四不治；形体消瘦不能服药，是五不治；相信巫术不相信医学，是六不治。这六种情况只要有一种存在，就很难治疗。
宗奭说：疾病有六种失误：失误于不审慎，失误于不信任，失误于延误时机，失误于不选择好医生，失误于不认识疾病，失误于不了解药物。这六种失误只要有一种存在，就是难治。又有八种要领：一是虚，二是实，三是冷，四是热，五是邪，六是正，七是内，八是外。《素问》说：凡是治病，要观察人的形体、气色、光泽，观察人的勇敢怯懦、骨肉、皮肤，能了解病情，以此作为诊法。如果病人的脉象与病症不相符合，既看不到病人的形体，医生只凭脉象开药，这行得通吗？现在富贵人家，妇女躲在帷幔之内，又用丝帛蒙住手臂。既然没有望色的神技，听声的圣耳，又不能尽施切脉的技巧，难免需要详细询问。病人家属厌烦繁琐，认为医术疏漏，往往拿到药也不服用。这样四诊的方法，连一种都没做到，可以说是很难啊！唉！
如果用毒药治疗疾病，刚开始像黍米、粟米那样小的剂量开始，病好了，就停药；病没好，加倍剂量；再没好，增加到十倍，以病去掉为限度。
弘景说：现在的方剂中单味使用一两味有毒的药物，就像巴豆、甘遂、将军（大黄），不可以让病人一次性喝完一剂药。如《经》所说：一味药有毒，服用如细麻大小的丸药；两味药有毒，服用如大麻大小的丸药；三味药有毒，服用如胡豆大小的丸药；四味药有毒，服用如小豆大小的丸药；五味药有毒，服用如大豆大小的丸药；六味药有毒，服用如梧子大小的丸药；从此到十味，都以梧子大小为数量标准。其中又有轻重之分，比如野狼毒、钩吻，难道能和附子、芫花这类药相比吗？这类药物都必须根据适宜的情况斟酌用量。
宗奭说：虽然有这个例子，更应该讨论病人的老少虚实，疾病的新久，药物的多毒少毒，斟酌衡量，不可固执地当作定法。
治疗寒证，用热药；治疗热证，用寒药；饮食不消化，用吐下法；鬼疰蛊毒，用毒药；痈肿疮瘤，用疮科专用药；风湿病，用祛风湿药，各自随其所宜。
弘景说：药物性质中，一味药主治十余种病的，取其特长为本，再观察人的虚实补泻，男女老少，苦乐荣悴，乡壤风俗，都各不相同。褚澄治疗寡妇尼僧，不同于治疗妻子的娘家亲属，这是通达她们性情怀抱所致。
时珍说：气味有浓薄，性用有躁静，治疗体制有多少，力化有浅深。正病用正治法，反病用反治法。用热药要避开热天，用寒药要避开寒天，用凉药要避开凉天，用温药要避开温天。发表不远热，攻里不远寒；不远热则热病至，不远寒则寒病至。治疗热证用寒药，但需温服；治疗寒证用热药，但需凉服；治疗温证用清药，但需冷服；治疗清证用温药，但需热服。木郁结则宣达它，火郁结则发散它，土郁结则夺泄它，金郁结则宣泄它，水郁结则折抑它。气有余，轻微的顺从其势，严重的制约它；气来复，平和的使之平衡，暴烈的夺其势。病位高的抑制它，病位低的举升它，有余的折损它，不足的补益它，坚硬的削磨它，客邪的祛除它，劳倦的用温法，结聚的发散它，留滞的行气它，干燥的润燥它，紧急的缓急它，散漫的收敛它，亏损的增益它，安逸的行之，惊恐的平之，吐法、汗法、下法、补法、泻法，无论久病新病都适用同样的法则。又说：逆证用正治，从证用反治。反治法，是用热药治热病（热因寒用，此处指真寒假热，以热治热，但机理不同），用寒药治寒病（寒因热用，此处指真热假寒，以寒治寒），塞因塞用（用补法治闭塞不通之证），通因通用（用通利法治通利之证）。必须制服其主要矛盾，而先解决其原因。起初看似相同，最终却不同。可以破除积滞，可以溃散坚结，可以使气和顺，可以使病必愈。又说：各种寒凉药治疗而发热的，取阴分来调理；温热药治疗而发冷的，取阳分来调理，这就是所谓求其所属以衰减病势。这些都是简要选取《素问》中的精粹之言。
病在胸膈以上的，先吃饭后服药；病在心腹以下的，先服药后吃饭。病在四肢血脉的，宜空腹并在早晨服用；病在骨髓的，宜饱腹并在夜间服用。
又有需要用酒送服的，用水送服的，冷服的，热服的。服用汤药有疏有数，煎煮汤药有生有熟。各有用法，都应详细审视。
杲说：古人服药的活法：病在上部的，不厌其烦频服少量；病在下部的，不厌其烦顿服大量。
少服，则滋养荣气于上部；多服，则峻补于下部。凡是说分两次服、三次服的，要使药力持续相接，并视人的强弱而定。
大病的主要病种，有中风伤寒，寒热温疟，中恶霍乱，大腹水肿，肠澼下痢，大小便不通，奔豚上气，咳逆呕吐，黄疸消渴，留饮癖食，坚积症瘕，惊邪癫痫鬼疰，喉痹齿痛，耳聋目盲，金疮骨折，痈肿恶疮，痔瘿瘤；男子五劳七伤，虚乏羸瘦；女子带下崩中，血闭阴蚀；虫蛇蛊毒所伤。这大概是主要的纲领，其间变化的枝叶，各自应当依据端绪来获取治疗方法。
弘景说：药物所主治的，只说疾病的一个名称，例如中风就有数十种，伤寒证候也有二十余条，更要从中寻求其类例，大体归结其始终，以本性为根宗，然后配合证候以合用药。病的变状，不能一概而论。所以医方千卷，还没有穷尽其理。春秋以前，以及和、缓的书信很少听说，而《道经》略载扁鹊的几种方法，其用药还是本草家的意趣。到了汉代淳于意及华佗等人的方子，现在偶尔还有存留的，也都条理药性。只有张仲景的一部书，最为众方之祖，又完全依据本草，但他善于诊脉，明了气候以心意斟酌病情罢了。至于刳肠剖臆、刮骨续筋的方法，乃是别的技术所得，不是神农家的事。自晋代以来，有张苗、宫泰、刘德、史脱、靳邵、赵泉、李子豫等，是一代的良医。那些贵胜阮德如、张茂先辈，隐士皇甫士安，以及江左葛洪、蔡谟、殷仲堪诸名人等，都钻研精通药术。宋代有羊欣、元徽、胡洽、秦承祖，齐代有尚书褚澄、徐文伯、嗣伯群从兄弟，治疗疾病也十愈八九。凡此这些人，各自有所撰写的方子，看他们的旨趣，没有不是基于本草的。有时使用别的药，也遵循其性度，没有相互逾越。
《范汪方》百余卷，以及葛洪《肘后备急方》，其中有细碎的单行经验用药，或是田舍试验的方法，或是殊域异识的技术。如藕皮散血，起自厨师；牵牛逐水，近出野老。饼店蒜齑，乃是下蛇的药；路边地菘，而为金疮所秘藏。这大概是天地间的事物，没有不为天地间所用的，触遇就会结合，并不是主对的关系。颜光禄也说：道经仙方，服食断谷，延年却老，乃至飞丹炼石的奇特，云腾羽化的美妙，无不以药道为先。用药的道理，同于本草，只是制御的途径，稍异于世法。所用不多，远至二十余种，或单行数种。岁月深积，便致大益，即本草所说的久服的效果，不如俗人微觉不适就停止。现在庸医处方治疗，都耻于看本草，或倚靠约略的旧方，或听人传说，便揽笔书写，以此标榜新奇。其畏恶相反，本来自己寡闻浅陋，而药类违僻，分量参差，却不以为疑。偶然碰巧痊愈，则自信方子灵验；旬月未愈，则说病源深结，完全不反求诸己，虚构声称，自然应该受到谴责。那五经四部，军国礼服，少有乖越，止于事迹不适宜罢了。至于汤药，一物有误，便...
宗奭说：人有贵贱老少，病应当分别论述；病有新久虚实，理应当分别用药。盖人心如同人脸，各不相同，惟其心不同，脏腑也异。想用一种药通治众人的病，这行得通吗？
张仲景说：有土地高下不同，物性刚柔，饮食居住也各异。因此黄帝兴起四方之问，岐伯举起四治之能。且如贵豪之家，形乐志苦者也。衣食充足则形乐而外实，思虑多则志苦而内虚。所以病生于脉，与贫下不同，应当因人而治。后世医者，忽略这一点不行，损失很大了。又凡人少、长、老，其气血有盛、壮、衰三等。所以岐伯说：少火之气壮，壮火之气衰。盖少火生气，壮火散气，何况衰火呢。所以治法也应当分三等。其少日服饵之药，于壮、老之时皆须别处，决不可忽视。
又说：人以气血为本。世间有童男室女，积想在心，思虑过当，多致劳损。男则神色先散，女则月水先闭。盖忧愁思虑则伤心，心伤则血逆竭，故神色先散而月水先闭也。火既受病，不能营养其子，故不嗜食。脾既虚则金气亏，故发嗽。嗽既作，水气绝，故四肢干。木气不充，故多怒，鬓发焦，筋痿。俟五脏传遍，故卒不能死，然终死矣。此于诸劳最为难治。或能改易心志，用药扶接，间得九死一生耳。
有人患久嗽，肺虚生寒热。用款冬花焚三两芽，待烟出，用笔管吸其烟，满口则咽之，至倦乃已。每日做五、七次，于是痊愈。
有人患疟疾月余，又用药物吐下之，气遂弱。观其脉病，乃夏伤暑，秋又伤风。因而给予柴胡汤一剂，安定。后又饮食不节，寒热复作，吐逆不食，胁下急痛，此名痰疟。给予十枣汤一服，下痰水数升；服用理中散二钱，于是痊愈。
有妇人患吐逆，大小便不通，烦乱，四肢冷，渐无脉，共一日半。给予大承气汤二剂，至夜半大便渐通，脉渐生，翌日乃安。此为关格之病，极难治。《经》说：关则吐逆，格则不得小便，亦有不得大便者。
有人苦于风痰头痛，颤掉吐逆，饮食减少。医生以为是伤冷物，温之不愈，又以丸药下之，遂厥。复给予金液丹，后谵言吐逆，颤掉，不省人事，狂若见鬼，循衣摸床，手足冷，脉伏。此为胃中有结热，故昏瞀不省人事。因阳气不能布于外，阴气不持于内，即颤掉而厥。遂给予大承气汤，至一剂，乃愈。
有妇人患温病，已十二日。诊其脉，六七至而涩，寸稍大，尺稍小。发寒热，颊赤口干，不了了，耳聋。问之，病后数日，经水乃行。此属少阳热入血室，治不对症，必死。乃给予小柴胡汤。二日，又加桂枝干姜汤，一日寒热止。但说：我脐下急痛。给予抵当丸，微利，痛止身凉，尚不了了，复给予小柴胡汤。次日说：我胸中热燥，口鼻干。又少给予调胃承气汤，不利，与大陷胸丸半服，利三行。次日虚烦不宁，妄有所见，狂言。知有燥屎，以其极虚，不敢攻之。给予竹叶汤，去其烦热，其大便自通，中有燥屎数枚，狂烦尽解。惟咳嗽唾沫，此肺虚也，不治恐乘虚作肺痿。以小柴胡去人参、姜、枣，加干姜、五味子汤，一日咳减，二日悉痊。
有人年六十，脚肿生疮，忽食猪肉，不安。医生以药下之，稍愈。时出外中风，汗出，头面暴肿，起紫黑色，多睡，耳叶上有浮泡小疮，黄汁出。乃给予小续命汤，倍加羌活服之，遂愈。
有人年五十四，素羸，多中寒，少年常服生硫黄数斤，近服菟丝有效。脉左上二部、右下二部弦紧有力。五七年来，病右手足筋急拘挛，言语稍迟。遂给予仲景小续命汤，加薏苡仁一两以治筋急；减黄芩、人参、芍药各半，以避中寒；杏仁只用一百五枚。后说：尚觉大冷，因尽去人参、芩、芍，加当归一两半，遂安。小续命汤，今人多用，不能逐证加减，遂至危殆，故举以为例。
Yuan Su said: For diseases located in the head, face, and skin, medicinal materials should be stir-fried with wine; for those located below the throat and above the umbilicus, they should be washed with wine; for those located in the lower jiao (lower burner), they should be used raw. Cold-natured medicinal materials must be soaked in wine and then dried in the sun to prevent damaging the Stomach Qi. Dang Gui (Angelicae Sinensis Radix) soaked in wine is to enhance its dispersing action.
Jia Mo said: The key to processing medicinal materials lies in achieving a moderate degree. If insufficient, efficacy is hard to achieve; if excessive, the flavor and nature of the medicinal materials are lost. Fire-processing methods include four types: bo (a roasting method), pao (scorching), zhi (roasting with liquid), and chao (stir-frying). Water-processing methods include three types: zi (soaking), pao (steeping), and xi (washing). Methods involving both water and fire include zheng (steaming) and zhu (boiling). Although there are many processing techniques, they do not go beyond these categories. Wine-processing promotes ascending and lifting actions; ginger-processing promotes dispersing actions. Salt-processing guides the medicine to the Kidney and softens hardness; vinegar-processing guides the medicine to the Liver and alleviates pain. Processing with human urine removes inferior properties and directs the action downward; processing with rice washing water removes dryness and harmonizes the Spleen and Stomach. Processing with milk moistens dryness and generates blood; processing with honey moderates harshness and benefits Yuan Qi (Primary Qi). Processing with earth from old walls steals true Qi and rapidly tonifies the Middle Jiao (Middle Burner); processing with wheat bran suppresses violent properties to prevent injury to the Upper Jiao (Upper Burner). Soaking in black soybean decoction or licorice decoction and then drying detoxifies and makes the properties mild; coating with mutton suet oil or lard and then burning allows penetration into bones, making them brittle (for easier crushing or absorption).
Before treating disease, one must investigate the etiology and examine the pathogenesis. If the Five Zang Organs are not yet deficient, the Six Fu Organs are not yet exhausted, the Blood vessels are not yet chaotic, and the Spirit is not yet scattered, taking medicine will surely cure the disease. If the disease has already formed, only half can be cured. If the disease momentum has passed, life will be difficult to preserve.
Hong Jing said: Unless it is a enlightened physician who listens to sounds, observes complexion, and diagnoses pulses, who can know the diseases that have not yet manifested? Moreover, people who are not sick are unwilling to treat themselves. Thus, Duke Qi neglected minor skin issues, leading to deep bone marrow ailments. This is not only due to the difficulty of understanding, but also the difficulty of gaining trust and acceptance. Cang Gong said: Believing in witchcraft rather than medicine leads to incurable death.
Shizhen said: The *Suwen* states: In ancient times, decoctions were prepared but not consumed. In middle antiquity, virtue declined slightly, and evil qi frequently arrived; consuming decoctions ensured complete safety. In the present world, toxic medicines must be used to attack internal diseases, while bian stones, needles, and moxibustion are used to treat external diseases. It also says: In middle antiquity, when treating diseases, if decoctions taken for ten days do not resolve the issue, one should follow the disease progression. Once the disease form is established, it is considered salvageable, so old diseases persist and new ones arise.
Chunyu Yi said: There are six conditions under which diseases are difficult to treat: 1. Arrogance and disregard for reason; 2. Valuing wealth over health; 3. Inability to adapt clothing and food to the environment; 4. Instability of Yin-Yang and Zang-Fu Qi; 5. Emaciation preventing medication intake; 6. Believing in witchcraft rather than medicine. If any one of these exists, treatment is difficult.
Zong Shi said: There are six errors in treating disease: error in lack of prudence, error in lack of trust, error in delaying timing, error in not selecting a good doctor, error in not recognizing the disease, and error in not understanding the medicine. If any one of these exists, the disease is difficult to treat. There are also eight essentials: 1. Deficiency, 2. Excess, 3. Cold, 4. Heat, 5. Evil, 6. Righteousness, 7. Internal, 8. External. The *Suwen* states: When treating, observe the body shape, Qi, color, and luster; observe courage and timidity, bones, muscles, and skin to understand the condition, forming the basis of diagnosis. If pulse and disease do not correspond, and the body shape cannot be seen, relying solely on pulse for prescription is ineffective. Now, wealthy families keep women behind curtains and cover their arms with silk. Lacking the divine sight for observation and holy hearing for auscultation, and unable to fully apply pulse diagnosis, detailed questioning is unavoidable. Patients' families find this tedious, suspecting poor skill, and often refuse medication. Thus, none of the Four Diagnostic Methods are fully utilized, which is truly difficult! Alas!
When using toxic medicines to treat disease, start with a dose as small as millet grains. If the disease resolves, stop; if not, double the dose; if still not, increase tenfold, stopping when the disease is removed.
Hong Jing said: In current prescriptions, single herbs like Ba Dou (Crotonis Fructus), Gan Sui (Kansui Radix), and Jiang Jun (Da Huang, Rhubarb) are toxic and should not be consumed in a full dose at once. As stated in the Classics: One toxic herb, take a pill size of fine hemp seed; two toxic herbs, size of large hemp seed; three, size of broad bean; four, size of small bean; five, size of large bean; six, size of wutong seed. Up to ten, use wutong seed size as the standard. There are degrees of heaviness and lightness; for example, Ye Lang Du (Daphne Genkwa Root) and Gou Wen (Gelsemium) differ from Fu Zi (Aconite) and Yuan Hua (Genkwa Flower). Such medicines must be dosed appropriately.
Zong Shi said: Although such examples exist, one must consider the patient's age, deficiency, or excess, and the chronicity of the disease, as well as the toxicity of the medicine. Dosage must be weighed carefully and not treated as a fixed rule.
To treat Cold syndromes, use Hot medicines; to treat Heat syndromes, use Cold medicines; for indigestion, use emetic or purgative methods; for Gui Zhu (possessing spirits) and Gu Du (poisonous toxins), use toxic medicines; for abscesses and tumors, use dermatological medicines; for Wind-Dampness, use Wind-Damp dispelling medicines, each according to suitability.
Hong Jing said: When one herb treats more than ten diseases, focus on its primary strength, observing the patient's deficiency/excess, gender, age, and lifestyle. Chu Cheng treated widows and nuns differently from his wife's relatives, adapting to their psychological state.
Shizhen said: Flavors vary in density, natures in activity or tranquility, treatment systems in quantity, and transformative power in depth. Correct diseases are treated with correct methods; contrary diseases with contrary methods. Use Hot medicines avoiding Hot seasons; Cold medicines avoiding Cold seasons; Cool medicines avoiding Cool seasons; Warm medicines avoiding Warm seasons. However, for releasing the exterior, do not avoid Hot; for attacking the interior, do not avoid Cold. Avoiding Hot may lead to Heat diseases; avoiding Cold may lead to Cold diseases. Treating Heat with Cold should be administered warm; treating Cold with Hot should be administered cool; treating Warmth with Clearing should be administered cold; treating Clarity with Warming should be administered hot. For Wood stagnation, promote dispersion; for Fire stagnation, vent it; for Earth stagnation, drain it; for Metal stagnation, diffuse it; for Water stagnation, control it. If Qi is excessive, gently follow or severely restrain it; if Qi returns, balance the mild or seize the violent. High conditions are suppressed; low conditions are lifted; excess is reduced; deficiency is tonified; hardness is softened; invaders are expelled; fatigue is warmed; accumulation is dispersed; retention is moved; dryness is moistened; urgency is eased; scattering is consolidated; loss is replenished; lethargy is activated; fright is calmed. Emetic, diaphoretic, purgative, tonifying, and draining methods apply equally to chronic and acute diseases. Contrary conditions are treated correctly; following conditions are treated contrarily (e.g., treating heat with heat, cold with cold, obstruction with astringents, diarrhea with purgatives). Subdue the main factor and address the cause. Initially similar, ultimately different. Break accumulations, dissolve hardness, harmonize Qi, ensure cure. For heat unresponsive to cooling, tonify Yin; for cold unresponsive to warming, tonify Yang. Seek the root to reduce the disease. These are summaries from the *Suwen*.
For diseases above the chest and diaphragm, eat first, then take medicine; for diseases below the heart and abdomen, take medicine first, then eat. For diseases in limbs and vessels, take on an empty stomach in the morning; for diseases in bone marrow, take after fullness at night.
Hong Jing said: Current practitioners' "eat first, then take" follows this principle.
Medicines may be taken with wine, water, cold, or hot. Decoctions may be frequent or sparse, boiled raw or cooked. Each has specific methods requiring careful examination.
Guo Cao said: Ancient flexible dosing: For upper diseases, frequent small doses; for lower diseases, large single doses. Small doses nourish the upper; large doses strongly tonify the lower. Divided doses should maintain continuous effect, adjusted by patient strength.
Major diseases include: Wind-Stroke, Cold Damage, Cold-Heat Warm Malaria, Zhong E (sudden illness), Huo Luan (cholera), abdominal edema, dysentery, urinary/fecal retention, Ben Tun (running piglet syndrome), asthma/cough/vomiting, jaundice/xiao Ke (wasting-thirst), fluid retention, masses, fright/epilepsy, sore throat/toothache, deafness/blindness, trauma/fractures, abscesses/ulcers, hemorrhoids/goiters; men's five labors/seven injuries, emaciation; women's leukorrhea/metrorrhagia, amenorrhea/genital ulcers; insect/snake/poison injuries. These are general guidelines; variations require specific analysis.
Hong Jing said: Medicines target specific disease names. Wind-stroke has dozens of types; Cold Damage has twenty-plus patterns. Classify them, trace origins, base on nature, and match herbs to patterns. Disease variations cannot be generalized. Medical texts number in thousands without exhausting principles. Pre-Spring and Autumn records are rare; Daoist texts mention Bian Que. Han dynasty physicians like Chunyu Yi and Hua Tuo organized herbal properties. Zhang Zhongjing's work is the ancestor of formulas, based on Materia Medica, emphasizing pulse diagnosis and seasonal adaptation. Surgical methods belong to other arts, not Shennong's lineage. Jin dynasty physicians like Zhang Miao, Gong Tai, etc., were excellent. Noble scholars like Ruan Deru, Ge Hong, Cai Mo studied pharmacology. Song and Qi dynasties had physicians like Yu Xi, Chu Cheng, Xu Wenbo, curing 80-90%. Their prescriptions followed herbal principles. Even alternative drugs respected natural properties.
*Fan Wang Fang* and Ge Hong's *Zhouhou Beiji Fang* contain empirical remedies, e.g., lotus bark for blood stasis, morning glory for water retention, garlic paste for snake bites, ground mustard for wounds. All things in heaven and earth have uses. Yan Guanglu noted Daoist elixirs prioritize herbal knowledge. Modern ignorant doctors shame themselves reading Materia Medica, relying on old formulas or hearsay, ignoring incompatibilities and dosage errors. Accidental cures breed arrogance; failures blame deep pathology. Unlike classics or rituals, herbal errors are critical.
Zong Shi said: Patients vary by status and age; diseases vary by chronicity and pattern. Hearts differ like faces; thus organs differ. One drug cannot cure all.
Zhang Zhongjing said: Geography affects material nature and diet. Yellow Emperor asked about regional treatments; Qibo proposed four therapies. Wealthy families have "physical comfort but mental suffering," leading to vessel diseases unlike the poor. Treatment must be individualized. Neglecting this causes great loss. Age groups (young, adult, elderly) have varying Qi/Blood levels. Qibo stated: Young Fire strengthens Qi; Strong Fire dissipates Qi. Treatments must be tiered. Pediatric formulas require adjustment for adults/elderly.
Humans rely on Qi and Blood. Chaste youth with excessive worry suffer labor injuries. Men lose spirit/color; women miss periods. Worry hurts Heart, causing blood reversal and depletion. Fire disease fails to nourish Earth (Spleen), causing anorexia. Spleen deficiency weakens Metal (Lung), causing cough. Cough depletes Water (Kidney), drying limbs. Wood deficiency causes anger, brittle hair, tendon weakness. After transmission through Five Zang, death ensues. This is the hardest labor type. Changing mindset and using supportive herbs may save one in ten.
Case 1: Chronic cough with Lung deficiency and cold-heat. Inhale smoke from burned Dong Hua (Coltsfoot flower) via tube until tired. Do 5-7 times daily. Cured.
Case 2: Malaria for a month, weakened by emetics/purgatives. Summer heat + autumn wind. Given Chai Hu Tang (Bupleurum Decoction), stabilized. Later, dietary indiscretion caused relapse with vomiting and hypochondriac pain (Phlegm Malaria). Given Shi Zao Tang (Ten Date Pill), expelled phlegm-water. Given Li Zhong San (Regulate the Middle Powder), cured.
Case 3: Woman with vomiting, constipation, restlessness, cold limbs, absent pulse for 1.5 days. Given Da Cheng Qi Tang (Great Order the Qi Decoction) twice. Bowels opened, pulse returned, recovered next day. Guan Ge (Obstruction and Rejection) syndrome, very difficult. Classics: Guan = vomiting; Ge = inability to urinate (or defecate).
Case 4: Headache/tremors/vomiting from Wind-Phlegm. Misdiagnosed as Cold, worsened by warming and purging, leading to collapse. Given Jin Ye Dan (Golden Liquid Pill), became delirious, convulsing, unconscious, grasping clothes, cold limbs, hidden pulse. Stomach Heat knot caused coma. Yang failed to reach exterior, Yin failed to hold interior. Given Da Cheng Qi Tang, cured after one dose.
Case 5: Woman with Warm disease for 12 days. Pulse rapid, choppy, larger at Cun, smaller at Chi. Fever, red cheeks, dry mouth, deafness. Menstruation started days after onset. Shaoyang Heat entering Blood Chamber. Given Xiao Chai Hu Tang (Minor Bupleurum Decoction). Added Gui Zhi Gan Jiang Tang (Cinnamon Twig and Dried Ginger Decoction), fever stopped. Reported lower abdominal pain. Given Di Dang Wan (Di Dang Pill), slight stool, pain stopped, body cooled. Still uncomfortable, given Xiao Chai Hu Tang again. Next day, chest heat/dryness. Given Tiao Wei Cheng Qi Tang (Regulate the Waist Order the Qi Decoction), no effect. Given Da Xian Xiong Wan (Great Chest-Piercing Pill) half dose, three stools. Next day, irritability, hallucinations, delirium. Dry feces present, but patient too weak for strong purge. Given Zhu Ye Tang (Bamboo Leaf Decoction) to clear heat, bowels opened naturally, dry feces passed, delirium resolved. Only cough/saliva remained (Lung deficiency). Modified Xiao Chai Hu Tang (remove Ginseng, Ginger, Jujube; add Dried Ginger, Schisandra). Cough reduced in one day, cured in two.
Case 6: 60-year-old man with swollen, ulcerated feet. Ate pork, felt uneasy. Doctor purged him, slight improvement. Went out, caught Wind-Stroke, sweating, sudden facial swelling (purple-black), somnolence, blisters on ears with yellow discharge. Given Xiao Xu Ming Tang (Minor Extending Life Decoction) with doubled Qiang Huo (Notopterygium), cured.
Case 7: 54-year-old man, frail, prone to Cold, took native sulfur since youth, now effective Tian Si Zi (Dodder Seed). Pulse wiry-tight in left upper/right lower positions. 5-7 years of right limb spasticity and slow speech. Given Zhang Zhongjing's Xiao Xu Ming Tang, added Yi Yi Ren (Coix Seed) for tendons, reduced Huang Qin (Scutellaria), Ren Shen (Ginseng), Bai Shao (White Peony) to avoid Cold, used fewer Xing Ren (Apricot Seed). Felt very cold, so removed Ginseng, Scutellaria, Peony, added Dang Gui (Angelica) 1.5 liang, stabilized. Xiao Xu Ming Tang is commonly misused without modification, leading to danger. Cited as example.