右胁
而火乘之。其病为逆如此者。例不可补泻。盖补金则虑金与火持。而喘咳益增。泻火则虑火
不退位而 癖反盛。正宜补中益气汤也。先状元气少。少以治病药和之。闻已用药而不获效
。意必病势苦逆而药力未到也。当与宽甫熟论。远期秋凉。庶就使平复。盖肺病恶春夏火气
。至秋冬则退也。正宜于益气汤中。随四时阴阳升降。浮沉温凉寒热。升降浮沉则顺之。寒
热温凉则反之。顺其理和其气。为治之大方也及见有证。增损服之。或觉气壅。间服加减枳
术丸。或有服间服加减枳术汤。数月后庶逆气稍回逆气回则治法可施但恐已至色青色赤。脉
弦脉洪。则无及矣。
近世论医有主河间刘氏者。有主易州张氏者盖张氏用药根据准四时阴阳
升降。而增损之。正内经四气调神之义。医而不知此是妄行也。刘氏用药务在推陈致新。不
使少有怫郁。正造化新新不停之义医而不知此是无术也。然而主张氏者。或未尽张氏之妙则
瞑。眩之药。终莫敢投。至失机后时而不救者多矣。主刘氏者。未悉刘氏之蕴则劫效目前。
阴损正气遗祸于后日者多矣。能用二家之长。而无二家之弊则治法其庶几乎。
史副使病不见色脉。不能解料然以既愈复发言之则亦恐宜取张氏根据准
四时阴阳升降用药以扶元气庶他日既愈。而遂愈也。宽甫病候初感必深。所伤物恐当时消导
不尽
。停滞淹延变生他证。以至于今恐亦宜仿刘氏推陈致新之意少加消导药于益气汤中。庶有渐
缓之期也。圆明膏太医王教授传
槐英（半斤河水四斤浸二宿熬槐英取汁二升） 黄连（四
以上五味。锉如绿豆大。用河水六升。
浸一宿。熬取汁三升。将槐英渣并此五味渣再用水四升。熬取二升。通前共五升。相合铜锅
内。用木炭文武火熬。入去 净蜜四斤。净蜜法取蜜四升入锅内微熬。勿令滚。其 沫尽浮
在面上。急取下。以纸覆蜜面。候冷取纸 自随纸去。再温蜜热以绵虑入药汁内同煎一时许
。入下项飞石一十三两。
金星石 银星石 代赭石 菩萨石 寒水石 紫石英 云母石（
并白矾少许同捣细） 滑石 井泉石 玄精石（各一两另研为细末） 黄丹（三两研令极细）
以上
淬
焙干净秤二两。入药汁内。又熬一时。入下项药。铜绿（半两研） 青盐（半两研） 雄猪胆（七枚
取汁） 白丁香（一合水浸研取清汁） 鹰条（三钱如取上汁用）
以上药同熬万转成膏。凡熬时用槐柳枝不住手搅。
勿令尘入锅中。须于净室内熬膏盛入瓷器中。假冷入下项细末药不可热。热则药力去矣
乳香 没药 轻粉 蕤仁（去皮各半两用） 朱砂 牛黄 脑子 血竭（各一钱） 杏仁（去皮
半两） 南硼砂（一钱）
上件各别研令极细。
珍珠 珊瑚 紫贝 砂 石獬 白矾 绿矾 朴硝（各一钱） 盆硝（半钱）
上用预留元熟清药汁。同研极细烂搅入药中令匀。如常法点之神效。
右胁部位，火邪乘袭。其病症表现为气逆如此。这类情况通常不宜采用补法或泻法。因为补益肺气（金），则担心肺与火相持，导致喘咳更加严重；泻火，则担心火邪不退位，而积聚之癖病反而加重。此时正适宜使用补中益气汤。先服用少量状元气（此处指代补气类药物或方剂，结合语境理解为补气以固本）作为先导，再用治疗疾病的药物调和它。听说已经用药但未获效，想必是病势苦于气逆，而药力尚未到达病所。应当与宽甫深入讨论，预期等到秋季凉爽时，或许能使病情平复。因为肺病厌恶春夏的火气，到了秋冬季节火气就会退去。正宜在益气汤的基础上，顺应四时阴阳的升降、浮沉、温凉、寒热变化。对于升降浮沉的趋势要顺从其理，对于寒热温凉的性质要反向调节（即寒者热之，热者寒之）。顺应其理，调和其气，这是治疗的根本大法。等到见到具体证候后，再增减药物服用。如果感觉气机壅滞，间歇性服用加减枳术丸；或者有人间歇服用加减枳术汤。几个月后，气逆稍微缓解。气逆回缓之后，其他治法方可施行。但恐怕如果面色已现青或赤色，脉象已现弦或洪大，那就来不及救治了。
近代论述医学，有主张河间刘氏（刘完素）学说的，有主张易州张氏（张元素）学说的。大概张氏用药根据四时阴阳的升降规律，进行增减调整，这正符合《内经》“四气调神”的意义。医生如果不了解这一点，就是妄行。刘氏用药致力于推陈致新，不让体内稍有郁结，这正符合造化生生不息不停止的意义。医生如果不了解这一点，就是无术。然而，主张张氏学说的人，有的未能尽得张氏之妙，对于那些引起瞑眩反应的药物，最终不敢投用，以至于错失良机、延误时机而不能挽救的情况很多。主张刘氏学说的人，有的未透彻理解刘氏的深意，只顾眼前见效，劫夺正气，给日后留下祸患的情况也很多。如果能运用两家的长处，而避免两家的弊端，那么治疗方法就差不多完善了吧。
史副使的病，看不见面色和脉象，无法推断。既然已经痊愈又发表言论，那么恐怕也适宜取法张氏，根据四时阴阳升降来用药，以扶持元气，希望他日既愈之后，能彻底痊愈。宽甫的病，初感邪气一定很深，所伤之物恐怕当时消导不尽，停滞拖延，变生其他证候，以至于到现在。恐怕也适宜仿效刘氏推陈致新的意思，在益气汤中稍加消导药，希望能有逐渐缓解的时期。
圆明膏：由太医王教授传授。
槐英（半斤，用河水四斤浸泡两个晚上，熬煮槐英取汁二升）黄连（四两）...以上五味药，锉碎如绿豆大小，用河水六升，浸泡一个晚上，熬取汁液三升。将槐英渣并此五味药的药渣，再加水四升，熬取二升。与前所得药汁合并共五升，放入铜锅内，用木炭文武火熬制。加入去净杂质之蜜四斤。净蜜之法：取蜜四斤入锅内微熬，不要令其沸腾。其泡沫全部浮在面上，急忙取下，用纸覆盖蜜面，等冷却后取纸，随纸去掉杂质。再将蜜加热，用绵布过滤入药汁内同煎约一时辰。加入下列飞石十三两：金星石、银星石、代赭石、菩萨石、寒水石、紫石英、云母石（并与白矾少许一同捣细）、滑石、井泉石、玄精石（各一两，另研为细末）、黄丹（三两，研令极细）。以上药料淬炼焙干干净称二两，入药汁内，又熬一时辰。加入下列药物：铜绿（半两，研）、青盐（半两，研）、雄猪胆（七枚，取汁）、白丁香（一合，水浸研取清汁）、鹰条（三钱，如取上汁用）。以上药物同熬，万转成膏。凡熬制时用槐柳枝不停地搅拌，不要让灰尘进入锅中。必须在洁净室内熬膏，盛入瓷器中。假冷后加入下列细末药，不可热，热则药力会丧失。乳香、没药、轻粉、蕤仁（去皮各半两用）、朱砂、牛黄、脑子、血竭（各一钱）、杏仁（去皮半两）、南硼砂（一钱）。上述各药分别研令极细。珍珠、珊瑚、紫贝、砂、石獬、白矾、绿矾、朴硝（各一钱）、盆硝（半钱）。上用预留的原熟清药汁，同研极细烂搅入药中令匀。如常法点用，神效。
The right hypochondrium is affected by the Fire pathogen. The pathological condition presents with such rebellious Qi dynamics, for which tonification or purgation are generally contraindicated. Tonifying Metal (Lung) risks causing Metal and Fire to contend, thereby exacerbating wheezing and coughing; purging Fire risks failing to clear the pathogenic factor while allowing the accumulation of *pi* masses (abdominal lumps) to intensify. At this juncture, it is most appropriate to use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). Since Yuanzhuang has deficient Qi, one should harmonize him with medicinal herbs that treat disease. Having heard that medication was administered without effect, I surmise that the rebellious nature of the disease is severe and the medicinal force has not yet reached the site of pathology. One ought to discuss thoroughly with Kuanfu, anticipating that by the time autumn coolness arrives, the condition may stabilize. This is because Lung diseases dislike the Fire qi of spring and summer, which recedes in autumn and winter. It is proper to adjust the Yiqi Tang according to the rising and falling of Yin and Yang across the four seasons, as well as the floating/sinking and warming/cooling/cold/heat properties: follow the principle of rising and sinking, but counteract cold and heat. Following the principles to harmonize the Qi constitutes the general strategy for treatment. Upon observing specific syndromes, modify the prescription accordingly. If one feels Qi stagnation, take Jiannian Zhizhu Wan (Modified Atractylodes and Aurantium Pill) intermittently; or some may take Jiannian Zhizhu Tang (Modified Atractylodes and Aurantium Decoction) intermittently. After several months, the rebellious Qi may slightly return. Once the rebellious Qi returns, other therapeutic methods can be applied. However, if the complexion has already turned cyanotic or crimson, and the pulse has become wiry or flooding, it would be too late.
In recent times, medical theorists have advocated either Liu Hejian (Liu Wansu) or Zhang from Yizhou (Zhang Yuansu). Zhang’s medication is based on the rising and falling of Yin and Yang across the four seasons, with additions and subtractions, which aligns with the meaning of "Regulating Spirit According to the Four Qi" in the *Neijing*. A physician who does not understand this acts recklessly. Liu’s medication focuses on pushing out the old and bringing forth the new, preventing any slight stagnation, which aligns with the principle of continuous creation in nature. A physician who does not understand this lacks skill. However, those advocating Zhang may not fully grasp his subtleties and thus dare not administer drugs that might cause *mingxuan* reactions (severe adverse reactions indicating a turning point), leading to many cases of missed opportunities and untimely death. Those advocating Liu may not fully comprehend Liu’s depth, achieving only immediate effects at the cost of damaging Yin and righteous Qi, leaving disasters for later days. If one can utilize the strengths of both schools while avoiding their drawbacks, the therapeutic methods will likely succeed.
Regarding Vice Commissioner Shi, without seeing the complexion and pulse, prediction is impossible. Given that he recovered but symptoms recurred, it is advisable to adopt Zhang’s approach, using medication based on the seasonal Yin-Yang rising and falling to support the Primordial Qi, hoping that upon recovery, he will remain cured. For Kuanfu, the initial pathogenic invasion must have been deep, and the ingested harmful substances were likely not fully digested and guided out at the time. Stagnation and delay may have generated other syndromes, leading to the current state. It is advisable to emulate Liu’s principle of pushing out the old and bringing forth the new, adding mild digestive herbs to the Yiqi Tang, hoping for gradual relief.
Yuanming Gao (Round Brightness Ointment), transmitted by Professor Wang, the Imperial Physician.
Huaiying (Sophorae Flos, half jin, soaked in four jin of river water for two nights, decocted to yield two sheng of juice); Huanglian (Coptidis Rhizoma, four liang); Huangqin (Scutellariae Radix, three liang); Dahuang (Rhei Radix et Rhizoma, one liang); Zhizi (Gardeniae Fructus, fourteen seeds). The above five herbs are cut into pieces the size of mung beans, soaked in six sheng of river water overnight, and decocted to yield three sheng of juice. The Huaiying dregs and the dregs of the five herbs are combined with four sheng of water and decocted to yield two sheng. Combining these with the previous five sheng of juice, place them in a copper pot. Use charcoal fire, alternating between moderate and low heat. Add four jin of purified honey. To purify honey: heat four sheng of honey in a pot gently without boiling. When foam floats to the surface, remove immediately, cover with paper, let cool, then remove impurities adhering to the paper. Warm the honey again, filter through silk cloth into the medicinal juice, and simmer for approximately one double-hour (shi). Add thirteen liang of calcined stones: Jinxingshi (Auripigmentum), Yinxingshi (Orpiment), Daizheshi (Haematitum), Pusaishi (Kaolinite), Hanshuishi (Natrii Sulfas), Zishiyingshi (Fluoritum), Yunmushi (Muscovite) (all pounded fine with a small amount of Baifan/Alumen); Huashi (Talcum); Jingquanshi (Sodalite); Xuanjingshi (Natron) (each one liang, separately ground to fine powder); Huangdan (Minii Oxidum, three liang, ground extremely fine). The above materials are quenched and baked clean, weighed at two liang, added to the juice, and simmered for another shi. Add the following: Tonglv (Chalcanthite, half liang, ground); Qingyan (Halitum, half liang, ground); Xiongzhu dan (Sus scrofa domestica gall bladder juice, seven bladders); Baixiangding (Vomica, one he, soaked in water, ground, and the clear juice extracted); Ying tiao (Accipiter gentilis muscle, three qian, or its juice). Simmer all medicines until transformed into ointment. Stir constantly with locust or willow branches during simmering to prevent dust entry. Simmer in a clean room and store in porcelain vessels. After cooling, add the following fine powders; do not add while hot, as heat destroys medicinal potency. Ruxiang (Olibanum), Moyao (Myrrha), Qingfen (Calomel), Ruiren (Pruni Armeniacae Semen, peeled, each half liang); Zhusha (Cinnabaris); Niuhuang (Bovis Calculus); Naobi (Borneolum Syntheticum); Xuexie (Dracaenae Sangue); Xingren (Armeniacae Semen Amarum, peeled, half liang); Nanbengsha (Borax, one qian). Each of the above is separately ground to an extremely fine powder. Zhenzhu (Margarita), Shanhu (Corallium), Zi Bei (Concha Arcae), Sha (Realgar), Shixie (Calcitum), Baifan (Alumen), Lüfan (Chalcanthite), Pu Xiao (Natrii Sulfas) (each one qian); Pen Xiao (Natrii Sulfas crystallized, half qian). Mix these with the reserved original clear medicinal juice, grind together until extremely fine and smooth, stir into the ointment to ensure uniformity. Apply as usual for miraculous efficacy.