论痿症 论肾虚如白虎汤症 论汗出如雨不止 论直中阴经 论治阳明之火
天师曰∶大治法，周身有病，统上下左右尽治之也。如气血全亏，一身多病；或头痛未已，而身
骨痛；或腹痛未已，而四肢尽痛是也。虽此等病，乃痿症居多，自宜专治阳明胃火。然而胃火既盛，一身
上下四肢尽行消瘦，又不可专治胃经一门也。方用人参三钱，茯苓三钱，薏苡仁五钱，当归三
钱，黄 三钱，甘菊花一钱，元参五钱，麦冬一两，陈皮五分，神曲五分，白
芥子三
钱，白芍三钱，熟地一两，水三大碗，煎一碗服之。（〔批〕双补至神丹。）盖阳明火盛，理宜用竹
叶石膏汤矣，而此偏不用，反用参、苓、 、熟为君，补其气血者，何也？胃火过盛，已铄气血，再用白
虎汤，虽一时解其火势之燎原，然而焦头烂额，必致重亡其津液。不若用补气血之药，大剂煎饮，使水足
而火自息。方中宜用元参、麦冬、甘菊之品，纯是退阳明之味；而阳明即有火势之燎原，亦能扑灭。况又
重加之当归生血之类，以滋化源乎。但诸药若小其剂，则不特无益，而反助火势之飞扬，此大治之所以妙也。
大约大治之法，施之于虚症最宜，乘其初起，胃火有余，即以大剂与之，可以转败为胜。若因循时日，
畏首畏尾，初时不敢用大剂，乃至胃气已衰，而后悔悟，始用大剂迟矣。其病宜用大剂者，则发背痈疽，
切忌小治，尤当以大剂与之。另有专门，兹不再赘。
张公曰∶大治实阳明胃火之患，不止痈疽发背，更有症如肾虚而火沸腾，如白虎汤症者，亦宜用大
剂六味地黄汤治之。更有肾水泛上，吐痰倾盆者，亦宜用六味汤，加附子、肉桂，煎汤数碗，大碗饮之而
愈，皆不可小治之也。凡肾水肾火之虚，上焦虽现热症，而其舌终滑而不燥，非若阳症之干极而起刺也。
更有大汗之症，汗如雨出，不可止抑，气息又复奄奄，不是发狂热症，若不急用大补之药，则顷刻亡阳而
死矣。方用人参三两，白术四两，当归三两，桑叶十片，麦冬三两，北五味三
钱，黄 三
两，水煎服。（〔批〕止汗定神丹。）此方纯是补气之药，气足则汗止，而阳返于命门之宫矣。倘以小小之剂
治之，又何以补生元气于无何有之乡哉，吾见其立亡而已矣。更有直中阴经之症，阴寒之气，斩关直入于肾
宫，命门之火
逃亡，而将越出于躯壳之外，非用大剂补火之药，何以追散失之元阳而返其宅哉。方用人参一两，白
术三两，附子二钱，肉桂一钱，干姜二钱，水三碗煎服。一剂而愈。（〔批〕参术附桂汤）。此方
用人参、白术，实有妙用，驱寒之品，而不用此二味，寒去而气随之去矣，故必用二味，且必须多加，而
元阳始足可留于将绝之顷也。此皆大治之法，不可不知。
华君曰∶天师不曾传，予有一论可参观。阳明之火势，最盛最急，若不以大剂退火之药与之，立刻将
肾水烧干矣。然过用寒凉，必致转伤胃气，胃气既伤，则胃火益胜。虽石膏汤中有人参以救胃气，然终不
胜攻之大烈也。愚意石膏用一两者，人参必须亦用一两；或石膏用至二三两；则人参断不可止用一两，必
须多加为妙。即不敢加至三两，亦必须加至一两五钱。与其火退之后，再用人参，何若乘其火盛之时，
而倍用之。攻补兼施，火势衰，而胃气又不复损之为得也。予治阳明火盛，往往奏功如响者，人参同石
膏兼用，而无偏重之势故耳。此予独得之秘，因远公为天师所爱，不惜尽传无隐。愿远公谨听吾言，必与
参同用，无分轻重也。此段再请教天师与长沙公何如？（〔批〕雷公曰∶华君之言至当也。）
天师曰∶妙论不刊。
（诸病凡胃气衰者，用药不可大剂，不可不知。更有暴病中寒，脉微欲绝，四肢冰冷者，初服须急服
生附、干姜各五钱救之，参、术又在所缓。此说本之嘉言喻氏。李子永识。）
论痿症（肢体软弱无力、运动障碍的病证） 论肾虚表现为类似白虎汤证的症状 论汗出如雨且不止 论病邪直接侵入阴经 论治疗阳明经的火邪
天师说：所谓“大治法”，是指周身患病，对上下左右进行全面治疗的方法。例如气血完全亏虚，全身多处生病；或者头痛未愈，身体骨骼又痛；或者腹痛未止，四肢全部疼痛，就是这种情况。虽然这类疾病中，痿症居多，按理应当专门治疗阳明胃火。然而胃火既然旺盛，导致全身上下四肢都消瘦，就不能只专注于治疗胃经这一方面。方剂用人参三钱，茯苓三钱，薏苡仁五钱，当归三钱，黄芩三钱，甘菊花一钱，玄参五钱，麦冬一两，陈皮五分，神曲五分，白芥子三钱，白芍三钱，熟地黄一两，用水三大碗，煎至一碗服用。（批注：双补至神丹。）按理说阳明火盛，应该使用竹叶石膏汤，但这里偏偏不用，反而用人参、茯苓、黄芩、熟地黄作为君药，来补益气血，这是为什么呢？因为胃火过盛，已经煎熬消耗了气血，如果再用白虎汤，虽然能暂时解除火势燎原之势，但会导致焦头烂额，必然造成津液严重亡失。不如使用补气血的药物，大剂量煎服，使水液充足而火势自然平息。方中适宜使用玄参、麦冬、甘菊花这类药物，它们纯粹是清除阳明经热邪的；即使阳明经有如火势燎原般的火热，也能将其扑灭。况且又重用当归等生血之品，以滋养化源。但是这些药物如果剂量过小，不仅无益，反而会助长火势飞扬，这就是“大治法”的精妙之处。大概“大治法”，应用于虚证最为适宜，趁着疾病初起，胃火有余时，就给予大剂量药物，可以转败为胜。如果拖延时日，畏首畏尾，起初不敢用大剂量，等到胃气已经衰弱，才后悔醒悟，此时再使用大剂量就太迟了。那些病情适宜使用大剂量药物的，如发背痈疽，切忌用小剂量治疗，尤其应当给予大剂量药物。另有专门论述，此处不再赘述。
张公说：“大治法”实际上是针对阳明胃火的病患，不仅仅是痈疽发背，还有症状如同肾虚而火气沸腾，表现为白虎汤证的患者，也适宜使用大剂量六味地黄汤治疗。还有肾水泛溢上行，吐痰如倾盆大雨的情况，也适宜使用六味地黄汤，加入附子、肉桂，煎煮数碗汤，大碗饮用即可痊愈，这些都不可用小剂量治疗。凡是肾水、肾火虚损，上焦虽然出现热症，但其舌苔始终滑润而不干燥，不像阳证那样极度干燥而起刺。还有大汗淋漓的症状，汗水如雨流出，无法遏制，气息微弱奄奄一息，这不是发热的狂症，如果不紧急使用大补的药物，就会顷刻间亡阳而死。方剂用人参三两，白术四两，当归三两，桑叶十片，麦冬三两，北五味子三钱，黄芪三两，用水煎服。（批注：止汗定神丹。）此方纯粹是补气药物，气充足则汗止，阳气返回命门宫邸。如果用小小的剂量治疗，又怎能从无何有之乡（指元气根本之地）补回生发的元气呢？我看他只会立刻死亡罢了。还有病邪直接侵入阴经的症状，阴寒之气，斩关直入肾宫，命门之火逃亡，即将越出躯壳之外，不使用大剂量补火药物，怎么能追回散失的元阳并使其返回宅邸呢？方剂用人参一两，白术三两，附子二钱，肉桂一钱，干姜二钱，用水三碗煎服。一剂即愈。（批注：参术附桂汤）。此方使用人参、白术，确有妙用，驱寒的药物，如果不使用这两味，寒气去除后元气也会随之而去，所以必须使用这两味，而且必须多加，这样元阳才能在将绝之时得以留存。这些都是“大治法”，不可不知道。
华君说：天师未曾传授，我有一篇论述可供参考。阳明之火势，最盛最急，如果不以大量退火药物给予患者，立刻会将肾水烧干。然而过度使用寒凉药物，必定会转而损伤胃气，胃气既已受伤，那么胃火会更加旺盛。虽然石膏汤中有人参来救胃气，但最终终究抵不过攻伐的大烈程度。我的意思是石膏用量一两，人参也必须用一两；或者石膏用到二三两，那么人参绝对不可以只用一两，必须多加才好。即便不敢加到三两，也必须加到一两五钱。与其在火退之后，再用人参，哪里比得上趁火势正盛之时，加倍使用呢？攻补兼施，火势衰退，而胃气又不受损害，这才是得当的。我治疗阳明火盛，往往奏效迅速，就是因为人参同石膏兼用，而没有偏重一方的缘故。这是我独得的秘密，因为远公是天师所喜爱的人，我不惜毫无保留地全部传授。希望远公仔细听我的话，人参必须与石膏同用，不分轻重。这一段再请教天师和长沙公（指张仲景）如何？（批注：雷公说：华君的话非常恰当。）
天师说：精妙的言论不可删改。
（各种疾病凡胃气衰弱的，用药不可用大剂量，不可不知道。更有暴病中寒，脉微欲绝，四肢冰冷的情况，初服须紧急服用生附子、干姜各五钱来救治，人参、白术又在所缓后考虑。此说本之于嘉言喻氏。李子永识。）
On Wei Syndrome (Flaccidity Syndrome), on Kidney Deficiency presenting as symptoms similar to Baihu Tang Syndrome, on Profuse Sweating Unstoppable, on Direct Invasion of Yin Meridians, on Treating Fire in the Yangming Channel.
The Heavenly Master said: The so-called "Great Treatment Method" refers to treating the whole body comprehensively when diseases affect all parts, addressing both upper and lower, left and right. For instance, when Qi and Blood are completely deficient, causing multiple illnesses throughout the body; or when headache persists while bone pain follows; or when abdominal pain continues while pain spreads to all four limbs—these are such cases. Although these diseases often involve Wei Syndrome, it is appropriate to specifically treat the Fire of the Stomach in the Yangming channel. However, since Stomach Fire is flourishing, causing emaciation of the entire body, upper and lower, and four limbs, one cannot focus solely on treating the Stomach meridian. The prescription uses Ren Shen (Ginseng Radix) 3 qian, Fu Ling (Poria) 3 qian, Yi Yi Ren (Coicis Semen) 5 qian, Dang Gui (Angelicae Sinensis Radix) 3 qian, Huang Qin (Scutellariae Radix) 3 qian, Gan Ju Hua (Chrysanthemi Flos) 1 qian, Xuan Shen (Scrophulariae Radix) 5 qian, Mai Dong (Ophiopogonis Tuber) 1 liang, Chen Pi (Citri Reticulatae Pericarpium) 5 fen, Shen Qu (Massa Medicata Fermentata) 5 fen, Bai Jie Zi (Sinapis Semen) 3 qian, Bai Shao (Paeoniae Radix Alba) 3 qian, Shu Di Huang (Rehmanniae Radix Praeparata) 1 liang. Decoct with three large bowls of water until one bowl remains, then take orally. (Commentary: Shuang Bu Zhi Shen Dan - Double Tonifying Supreme Spirit Elixir.) Logically, for flourishing Yangming Fire, Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) should be used. Yet here it is not used; instead, Ren Shen, Fu Ling, Huang Qin, and Shu Di Huang are employed as sovereign drugs to tonify Qi and Blood. Why? Because excessive Stomach Fire has already scorched and consumed Qi and Blood. Using Baihu Tang (White Tiger Decoction) might temporarily quell the raging fire, but it would lead to severe damage ("scorched head and ruined forehead"), inevitably causing a massive loss of Body Fluids. It is better to use large doses of Qi- and Blood-tonifying herbs, decocted heavily, so that sufficient fluids naturally extinguish the fire. The prescription appropriately includes Xuan Shen, Mai Dong, and Gan Ju Hua, which are purely clearing Yangming heat; even if Yangming Fire rages like a prairie fire, they can extinguish it. Moreover, heavy use of Dang Gui and other blood-nourishing agents nourishes the source of transformation. However, if the dosage of these herbs is too small, it will not only be ineffective but also exacerbate the soaring fire. This is the subtlety of the "Great Treatment Method." Generally, the Great Treatment Method is most suitable for deficiency syndromes. When applied at the onset, when Stomach Fire is still abundant, administering large doses can turn defeat into victory. If one delays, hesitates, and dares not use large doses initially, waiting until Stomach Qi declines before regretting and using large doses, it will be too late. For conditions requiring large doses, such as Back Carbuncle and Ulcers (Fa Bei Yong Ju), small treatments must be strictly avoided; large doses are especially indicated. There are specialized discussions elsewhere, so I will not elaborate further.
Master Zhang said: The "Great Treatment Method" actually addresses ailments caused by Yangming Stomach Fire. It applies not only to Back Carbuncles and Ulcers but also to cases where symptoms resemble Kidney Deficiency with boiling Fire, presenting as Baihu Tang syndrome; these should also be treated with large doses of Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill). Furthermore, in cases where Kidney Water overflows upward, causing profuse expectoration of phlegm like a pouring basin, Liuwei Dihuang Tang added with Fu Zi (Aconiti Lateralis Radix Praeparata) and Rou Gui (Cinnamomi Cortex) should be used. Decoct several bowls, drink from large bowls, and recovery ensues. Such cases must not be treated with small doses. In any deficiency of Kidney Water or Kidney Fire, although Heat symptoms appear in the Upper Jiao, the tongue coating remains slippery and moist, unlike Yang syndromes which present with extreme dryness and prickliness. Additionally, there are cases of profuse sweating, where sweat flows like rain and cannot be stopped, accompanied by faint breath and lethargy. This is not a febrile mania; without urgent administration of large tonic doses, death from collapse of Yang will occur instantly. The prescription uses Ren Shen 3 liang, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 4 liang, Dang Gui 3 liang, Sang Ye (Mori Folium) 10 leaves, Mai Dong 3 liang, Bei Wu Wei Zi (Schisandrae Chinensis Fructus) 3 qian, Huang Qi (Astragali Radix) 3 liang. Decoct with water and take orally. (Commentary: Zhi Han Ding Shen Dan - Stop Sweat Calm Spirit Elixir.) This prescription consists entirely of Qi-tonifying herbs. When Qi is sufficient, sweating stops, and Yang returns to the Palace of Mingmen (Gate of Life). If treated with small doses, how can one replenish the vital Qi from the realm of non-being? I see only immediate death. There are also cases of direct invasion of Yin meridians, where Yin-Cold energy cuts through defenses directly into the Kidney palace, causing the Fire of Mingmen to flee and nearly escape the body shell. Without large doses of Fire-tonifying herbs, how can scattered Yuan Yang (Original Yang) be retrieved and returned to its home? The prescription uses Ren Shen 1 liang, Bai Zhu 3 liang, Fu Zi 2 qian, Rou Gui 1 qian, Gan Jiang (Zingiberis Rhizoma) 2 qian. Decoct with three bowls of water and take orally. One dose brings cure. (Commentary: Shen Zhu Fu Gui Tang - Ginseng, Atractylodes, Aconite, and Cinnamon Decoction.) The use of Ren Shen and Bai Zhu in this formula is ingenious. In cold-dispelling formulas, without these two herbs, once the cold is expelled, Qi will follow it out. Therefore, these two must be used, and in large amounts, so that Yuan Yang can be retained in moments of near-extinction. These are all methods of Great Treatment, which must not be unknown.
Master Hua said: The Heavenly Master did not transmit this; I have an essay for reference. The Fire of Yangming is the most vigorous and urgent. If large doses of fire-clearing herbs are not administered, Kidney Water will be dried up immediately. However, excessive use of cold and bitter herbs will inevitably damage Stomach Qi. Once Stomach Qi is damaged, Stomach Fire becomes even stronger. Although Shi Gao (Gypsum Fibrosum) in Shigao Tang contains Ren Shen to rescue Stomach Qi, it ultimately cannot withstand the fierce attack. My opinion is: if Shi Gao is used in 1 liang, Ren Shen must also be used in 1 liang; or if Shi Gao is increased to 2–3 liang, Ren Shen absolutely cannot remain at 1 liang; it must be increased significantly. Even if one dares not increase it to 3 liang, it must be increased to 1.5 liang. Rather than administering Ren Shen after the fire subsides, is it not better to double the dose while the fire is raging? Combining attack and tonification allows the fire to subside without damaging Stomach Qi, which is optimal. In my treatment of flourishing Yangming Fire, success is often rapid because Ren Shen and Shi Gao are used together without bias toward either side. This is my unique secret. Since Yuan Gong is beloved by the Heavenly Master, I do not hesitate to transmit it fully and without reservation. I hope Yuan Gong listens carefully: Ren Shen must be used concurrently with Shi Gao, regardless of weight proportions. I ask the Heavenly Master and Changsha Gong (referring to Zhang Zhongjing) to comment on this passage. (Commentary: Lei Gong said: Master Hua's words are extremely appropriate.)
The Heavenly Master said: Brilliant discourse, unchangeable.
(Note: For various diseases where Stomach Qi is weak, medication should not be given in large doses; this must be known. In cases of sudden illness with Cold invasion, pulse faint and nearing extinction, and cold limbs, emergency administration of raw Fu Zi and Gan Jiang, each 5 qian, is required initially; Ren Shen and Bai Zhu are secondary. This view originates from Yu Jia Yan (Yu Chang). Recorded by Li Ziyong.)