初诊立方，宜小其制，不及可以补进，太过恐挽救为难也。如遇伤寒，似可以用麻黄汤
，而
姑用羌、防。江南无正伤寒，麻黄汤甚不合用。昔陶节庵制九味羌活汤，以代麻黄汤，煞有
苦心。知人伤于寒则病热，于方中特少加生地、黄芩以预防之，真良法也。然予思初受寒邪
，芩、地究虑其早，往往去芩、地，加当归、赤芍，兼加二陈以和畅阳明，使痰不生而邪无
所踞，寒颇易解，而热亦不甚，似亦刍荛之一得。遇阴虚不能化汗者，当归用至八钱，一汗
而解。曾医李青原着有成效。此等运用，学人宜知。至于伤风，亦不必骤用桂枝。南方之风
气柔弱，非比北方之风气刚劲，只须苏杏二陈加防风钱许可解。如果头痛、项强，伤及太阳
，不见有汗，则羌、防亦可稍加。如果畏风兼畏寒，则桂枝亦可加用，但不宜多耳。
至于时邪症候，乃天地六淫之气，非尽寒邪，亦非尽热邪也。如受风寒，则按上法治之
。如
受暑，则多从口鼻而入，侵及心胞，三阳之药全不合用，宜清暑益气汤，六一散或生脉散，
于医书暑门内参酌而用之。惟暑能伤气，不可妄用温散；暑能伤阴，不可妄用刚燥也。如受
热，则所谓阳邪，不同暑乃阴邪也。故受暑必有汗，而受热必无汗；受暑则心中懊 ，受热
则神情烦躁。人参白虎汤、天生白虎汤服之，一汗而解。有治之已迟，热入心胞者，则犀角
地黄汤在所必用。诊此须分析明白，切不可暑、热混为一门也。若夫长夏伤于湿，有宜燥者
，有宜利者。但长夏受湿，往往兼暑，暑伤气，暑伤阴，专于燥、利，又恐转伤阴气，湿更
难化。昔人以补中益气汤调理脾胃，湿自不能困脾；以六味地黄汤治下焦湿热，而湿热因养
阴而化。此皆治其本也。若先治其标，则五苓散、四苓散、平胃散、小厘清饮、渗湿汤，皆
可相宜而用。要之，湿有未化热者宜燥；渐化热者宜湿热兼治，古方所以有二妙、三妙也；
湿有全化热者，则宜专治其热。今人总言曰湿热，而不分此三等治之，所以鲜效也。至于冬
伤于寒，春伤于风，夏伤于暑，秋伤于湿，此《内经》之言也。而喻西昌增为长夏伤于湿，
秋伤于燥，实有至理，足补《内经》之缺。常见秋分以前，或暑气未尽，即湿气亦未尽，秋
分以后，暑湿俱退，金风拂拂，燥火侵人，肺不耐燥，故生咳嗽，喻氏清燥救肺汤实可获效
。乃柯韵伯以为多事，此不过欲抹煞前人，自诩高明耳!即其伤寒注释之书，何能如喻氏之
深入而显出?吾辈宜宗喻氏，即秋燥一层，毋庸疑议，庶可备六淫之气，而详审时邪之病也
。
但用药之道，宜小其制，得效乃渐加增。李士材云∶将欲用凉，先之以清；将欲用热，
先之
以温。后人万不及前人，安得任意妄用乎?至于大寒、大热之药，尤宜谨慎。寒药如水，热
药如火。譬如一卷书，错落水中，急急捞起，难免破烂矣；错落火中，急急救起，难免枯焦
矣。病患之脏腑，岂堪破烂、枯焦乎?若夫用下，更宜慎之又慎。六淫之邪，如风寒便闭，
腹痛拒按，热邪传里，神糊谵语，可以用下，然非瘟疫，亦下不可早。至暑湿亦可用下乎?
戴北山《瘟疫明辨》，较胜于吴又可《瘟疫论》。然其书止辨气一条，谓瘟疫必作尸气，不
作腐气，可见时邪、瘟疫之分，而其余所论，则皆时邪也，何不云时邪明辨，而曰《瘟疫明
辨》耶?其最误人者，谓下法至少用三剂，多则有一、二十次者。人之肠胃无血肉，不得已
而用下，未尝不伤气血，下至一、二十次，岂不邪正俱亡耶?戴北山究治何人，具有成效，
并无医案，而为此妄言，其害不更胜于吴氏耶?今之医者，轻率用下，往往以此为辞。现有
乡医某姓，在城悬壶，好用下法，屡次误事，每以下迟下少为说。予亲见李氏子出麻，被其
再下而死，而犹执戴氏之说以为辨，岂不深可痛恨哉!予此篇真可谓之明辨，我后人宜细玩
之，切忌之，毋负老人苦心也。
初诊制定处方时，药量宜小。如果药力不够可以逐步增加，如果药力太过恐怕难以挽救。如果遇到伤寒证，似乎可以用麻黄汤（发汗解表剂），但姑且先用羌活、防风。江南地区没有真正的伤寒病，麻黄汤非常不合适用。过去陶节庵制定了九味羌活汤，用来代替麻黄汤，煞费苦心。知道人受寒邪侵袭会化热生病，所以在方中特别少加生地黄、黄芩来预防，真是好方法。然而我思考，初次感受寒邪，使用黄芩、生地黄终究担心太早，往往去掉黄芩、生地黄，加入当归、赤芍，同时加入二陈汤（燥湿化痰基础方）来调和畅达阳明经，使痰液不产生而邪气无处占据，寒邪颇易解除，热象也不严重，这也算是我的浅见之一。遇到阴虚不能化汗的人，当归用到八钱，一次发汗即可痊愈。曾经治疗李青原取得了成效。这种运用方法，学医的人应该知道。至于伤风证，也不必立刻用桂枝汤（解肌发表剂）。南方的风气柔弱，不像北方的风气刚劲，只需要苏叶、杏仁、二陈汤加上许可量的防风就可以解决。如果确实头痛、项背强直，伤及太阳经，不见有汗，那么羌活、防风也可以稍微加一点。如果确实怕风兼怕冷，那么桂枝也可以加用，但不宜多用罢了。
至于时行邪气的症候，是天地六淫之气，并不全是寒邪，也不全是热邪。如果受风寒，就按照上面的方法治疗。如果受暑邪，则多从口鼻而入，侵及心包络，三阳经的药物全都不合适用，宜用清暑益气汤、六一散或生脉散，在医书暑病门类内参考斟酌而使用。只有暑邪能伤气，不可妄用温散法；暑邪能伤阴，不可妄用刚燥药。如果受热邪，就是所谓的阳邪，不同于暑邪乃阴邪。所以受暑邪一定有汗，而受热邪一定无汗；受暑邪则心中烦闷懊恼，受热邪则神情烦躁。服用人参白虎汤、天生白虎汤，一次发汗即可痊愈。有治疗已经迟误，热邪进入心包络的，那么犀角地黄汤在所必用。诊断此病必须分析明白，切不可将暑邪、热邪混为一谈。如果是长夏季节受湿邪，有的适宜用燥湿法，有的适宜用利湿法。但长夏受湿，往往兼夹暑邪，暑邪伤气，暑邪伤阴，专门只用燥湿、利湿法，又恐怕转而损伤阴气，湿气更难化解。过去的人用补中益气汤调理脾胃，湿气自然不能困脾；用六味地黄汤治疗下焦湿热，而湿热因滋养阴气而化解。这都是治其根本的方法。如果先治其标症，那么五苓散、四苓散、平胃散、小厘清饮、渗湿汤，都可以相宜而使用。总之，湿气未化热的适宜燥湿；逐渐化热的适宜湿热兼治，古方所以有二妙丸、三妙丸；湿气完全化热的，则适宜专治其热。现在的人总说湿热，而不分这三种情况治疗，所以很少见效。至于冬天受寒邪，春天受风邪，夏天受暑邪，秋天受湿邪，这是《内经》的话。而喻西昌增加为长夏受湿邪，秋天受燥邪，实在有至理，足以补充《内经》的缺失。常见秋分以前，或者暑气未尽，湿气也未尽，秋分以后，暑湿都退去，金风拂拂，燥火侵入人体，肺脏不耐燥，所以产生咳嗽，喻氏的清燥救肺汤确实可获效。可是柯韵伯认为多事，这不过是想抹杀前人，自夸高明罢了！即使他的伤寒注释之书，怎么能像喻氏那样深入而显明呢？我们应当尊崇喻氏，对于秋燥这一层，无需怀疑议论，这样才能备齐六淫之气，而详细审察时行邪气的疾病。
但是用药的道理，宜小其剂量，取得疗效后再逐渐增加。李士材说：将要使用凉药，先用清法；将要使用热药，先用温法。后人万万不及前人，怎能任意妄用呢？至于大寒、大热的药物，尤其应该谨慎。寒药如水，热药如火。譬如一卷书，错落在水中，急急捞起，难免破烂了；错落火中，急急救起，难免枯焦了。病患的脏腑，哪里能承受破烂、枯焦呢？如果使用下法，更应慎之又慎。六淫之邪，如风寒导致便秘，腹痛拒按，热邪传入里部，神志模糊谵语，可以用下法，然而如果不是瘟疫，也不可过早使用下法。至于暑湿也可以用下法吗？戴北山的《瘟疫明辨》，比吴又可的《瘟疫论》更好。然而他的书只辨别“气”一条，谓瘟疫必定产生尸气，不产生腐气，可见时邪、瘟疫的区别，而其余所论述的，都是时邪，为什么不叫《时邪明辨》，而叫《瘟疫明辨》呢？他最误导人的地方，谓下法至少用三剂，多的有一、二十次的。人的肠胃没有血肉，不得已而用下法，未尝不损伤气血，下至一、二十次，难道不是邪气和正气都亡失了吗？戴北山究竟治疗什么人具有成效，并没有医案，却为此妄言，他的害处不更胜过吴氏吗？现在的医者，轻率使用下法，往往以此为借口。现有乡医某姓，在城里行医，好用下法，屡次误事，每次以下迟下少作为说辞。我亲眼见到李家的孩子出麻疹，被他再次攻下而死，而他仍然执着戴氏的说法作为辩解，岂不深可痛恨哉！我这篇文章真可谓之明辨，我后人应该仔细玩味它，切忌这些错误，不要辜负老人的一片苦心。
When prescribing at the initial diagnosis, the dosage should be small. If the therapeutic effect is insufficient, it can be gradually increased; if it is too strong, rescue may be difficult. When encountering Cold Damage (Shanghan), one might think of using Mahuang Tang (Ephedra Decoction), but for now, Qianghuo (Notopterygii Rhizoma et Radix) and Fangfeng (Saposhnikoviae Radix) should be used tentatively. In the Jiangnan region, there are no true cases of Cold Damage, so Mahuang Tang is very inappropriate. In the past, Tao Jie'an formulated Jiwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction) to replace Mahuang Tang, showing great care. Knowing that humans suffering from cold pathogen develop heat diseases, he specifically added small amounts of Shengdi Huang (Rehmanniae Radix) and Huangqin (Scutellariae Radix) in the formula to prevent this, which is indeed a good method. However, I consider that when initially affected by cold pathogen, using Huangqin and Shengdi Huang may be premature. Often, Huangqin and Shengdi Huang are removed, and Danggui (Angelicae Sinensis Radix) and Chishao (Paeoniae Radix Rubra) are added. Simultaneously, Erchen Tang (Two-Aged Phlegm Resolving Decoction) is added to harmonize and smooth the Yangming channel, preventing phlegm formation so that pathogens have no place to reside. The cold pathogen is then easily resolved, and heat symptoms are not severe. This is also a humble insight of mine. For patients with Yin deficiency unable to transform sweat, Danggui is used up to 8 qian (approx. 30g); a single sweating resolves the condition. I once treated Li Qingyuan with effective results. Practitioners should understand such applications. As for Wind Injury (Shangfeng), there is no need to immediately use Guizhi Tang (Cinnamon Twig Decoction). The wind energy in the South is gentle, unlike the vigorous wind energy in the North. Simply adding Zisu (Perillae Folium), Xingren (Armeniacae Semen), Erchen Tang, and an appropriate amount of Fangfeng can resolve the issue. If there is indeed headache and neck stiffness, indicating involvement of the Taiyang channel, with no sweating, Qianghuo and Fangfeng can be slightly increased. If there is aversion to wind combined with aversion to cold, Guizhi can also be added, but not in large amounts.
Regarding symptoms of seasonal pathogens, these are the six excess energies (Liu Yin) of heaven and earth; they are not entirely cold pathogens, nor entirely heat pathogens. If affected by wind-cold, treat according to the methods mentioned above. If affected by summerheat, it mostly enters through the mouth and nose, invading the Pericardium (Xinbao). Medicines for the Three Yang channels are completely inappropriate. Instead, Qing Shu Yi Qi Tang (Clear Summerheat and Augment Qi Decoction), Liu Yi San (Six-to-One Powder), or Sheng Mai San (Generate Pulse Powder) should be used, referring to the summerheat section in medical texts for reference. Summerheat damages Qi, so warm dispersing methods should not be used recklessly; summerheat damages Yin, so harshly drying drugs should not be used recklessly. If affected by heat pathogen, it is what is called Yang pathogen, different from summerheat which is a Yin pathogen. Therefore, summerheat infection always involves sweating, while heat infection always involves no sweating; summerheat causes mental restlessness and oppression, while heat causes irritability and agitation. Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) or Tian Sheng Bai Hu Tang (Naturally Generated White Tiger Decoction) can resolve the condition with a single sweat. If treatment is delayed and heat enters the Pericardium, Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) becomes essential. Diagnosis must be analyzed clearly; summerheat and heat must not be confused into one category. In late summer, dampness injury may require drying methods or draining methods. However, dampness in late summer often combines with summerheat. Since summerheat damages Qi and Yin, using only drying and draining methods may further damage Yin, making dampness harder to resolve. Previously, people used Bu Zhong Yi Qi Tang (Tonify the Middle and Augment Qi Decoction) to regulate Spleen and Stomach, so dampness could not trap the Spleen; Liu Wei Di Huang Tang (Six-Ingredient Rehmannia Pill) was used to treat lower Jiao damp-heat, resolving it by nourishing Yin. These are all treating the root. If treating the branch first, Wu Ling San (Five-Ingredient Powder with Poria), Si Ling San (Four-Ingredient Powder with Poria), Ping Wei San (Peaceful Stomach Powder), Xiao Li Qing Yin (Minor Clearing Decoction), or Shen Shi Tang (Dampness Draining Decoction) can be used appropriately. In summary, dampness not yet transformed into heat should be dried; dampness gradually transforming into heat requires simultaneous treatment of dampness and heat, hence the ancient formulas Er Miao San (Two Marvels Powder) and San Miao San (Three Marvels Powder); dampness fully transformed into heat requires specific heat treatment. Modern practitioners generally speak of damp-heat without distinguishing these three stages, which is why efficacy is rare. Regarding winter cold injury, spring wind injury, summer summerheat injury, and autumn dampness injury, these are words from the *Neijing* (Inner Canon). Yu Xichang added late summer dampness injury and autumn dryness injury, which has profound logic and supplements the *Neijing*. It is common before the Autumn Equinox that summerheat lingers, and dampness also lingers; after the Autumn Equinox, summerheat and dampness recede, cool winds blow, and dryness-fire invades the body. The Lung cannot tolerate dryness, so cough arises. Yu's Qing Zao Jiu Fei Tang (Clear Dryness and Rescue Lung Decoction) is indeed effective. Yet Ke Yunbo considered this superfluous, merely wanting to erase predecessors' contributions and boast of his own superiority! Even his commentaries on Cold Damage, how can they compare to Yu's depth and clarity? We should follow Yu; regarding autumn dryness, there is no need for doubt, thus completing the six excess energies and allowing detailed examination of seasonal diseases.
However, the principle of medication is to start with small dosages and gradually increase after efficacy is achieved. Li Shicai said: "Before using cooling agents, first use clearing methods; before using heating agents, first use warming methods." Later generations are far inferior to predecessors; how can they use medications arbitrarily? Especially for strongly cold or strongly hot drugs, caution is paramount. Cold drugs are like water, hot drugs are like fire. Imagine a scroll of books falling into water; even if retrieved quickly, it will inevitably be damaged; falling into fire, even if rescued urgently, it will inevitably be scorched. How can a patient's Zang-Fu organs withstand being damaged or scorched? When using purgative methods (Xia Fa), extreme caution is required. For the six excess pathogens, if wind-cold causes constipation, abdominal pain with refusal to press, or heat pathogen transmits inward causing delirium and confusion, purgatives can be used. However, unless it is plague (Wenyi), purgatives should not be used early. Can summer-dampness also be treated with purgatives? Dai Beishan's *Pingyi Mingbian* (Clarification of Plague) is superior to Wu Youke's *Wenyi Lun* (Treatise on Pestilential Diseases). However, his book only distinguishes one point regarding "Qi," stating that plague produces corpse-like Qi, not putrefactive Qi. This shows the distinction between seasonal pathogens and plague, yet the rest of his discussion concerns seasonal pathogens. Why call it *Plague Clarification* instead of *Seasonal Pathogen Clarification*? His most misleading statement is that purgative therapy should use at least three doses, sometimes one or twenty times. Human intestines and stomach lack flesh and blood; using purgatives reluctantly inevitably damages Qi and Blood. Purging one or twenty times would surely cause both pathogen and healthy Qi to perish. Who did Dai Beishan treat successfully? There are no medical records, yet he makes such reckless statements. Is his harm not greater than Wu's? Modern physicians, rashly using purgatives, often use this as an excuse. There is a local physician surnamed Li practicing in the city who loves purgatives, repeatedly causing errors, justifying them by claiming purgation was too late or insufficient. I personally witnessed the son of the Li family die from measles due to repeated purgation by him, yet he still clung to Dai's theory for defense. Is this not deeply hateful? My article here can truly be called a clarification. Future generations should study it carefully, avoid these mistakes, and not fail the old man's painstaking effort.