论大渴 大汗 大吐 大泻 阴阳脱
天师曰∶重治者，病出非常，非轻淡可以奏功，或用之数两，或用半斤、一斤，而后可以获效。如
大渴、大汗、大吐、大泻、阴阳脱之症，从前俱已罄谈，而方法亦尽，余可不言。然而尚未尽者，大渴
之症，必用石膏，往往有一昼夜而用至斤许者。盖热之极，药不得不用之重，此时倘守定不可多与之言，
反必杀之矣。第此等症，乃万人中一有之，不
可执之以治凡有胃火之人也。
张公曰∶大渴之症，用石膏以平胃火，无人不知矣，尚有未知其故者。胃火沸腾奔越，不啻
如火之燎原，必得倾盆之雨，始能滂沛而息灭之。原取一时权宜之计，故可以临时用之，多能取
效。必不可久用，久用则败亡也。
天师曰∶大汗之症，必用参 ，往往有用参斤许者。然亦偶尔有之，不可拘执以治凡有汗亡阳
之症。盖阳药不宜偏多，而阴药可以重用故耳。
张公曰∶大汗势必用补气之药，以救亡阳之症。然而，过用补气之药，仍恐阳旺而阴消。服数剂
补气之后，即宜改用补阴之品。况亡阳之后，阴血正枯，进以补水之药，正投其所好也。阴定则阳
生，而阴阳无偏胜之弊矣。
天师曰∶大吐之症，明是虚寒，亦有用参至数两者。然而吐不可一类同观。其势不急，不妨少
用，可以徐加。倘寒未深，而吐不甚，亦以参数两加之，恐增饱满之症矣。
张公曰∶大吐之症，虚寒居多，然亦有热而吐者。不可不讲。热吐者，必随痰而出，不若寒吐之
纯是清水也。热吐不可用参，以二陈汤饮之得宜。若寒吐，必须加人参两许，而杂之辛热之品，始能
止呕而定吐。第人参可以暂用，而不可日日服之。吐多则伤阴，暂服人参止吐则可，若日日服之。
必至阳有余而阴不足，胃中干燥，恐成闭结之症矣。所以，人参可暂而不可常也。
大泻之症，往往用止泻之药至数两者，亦一时权宜之计，而不可执之为经久之法。
大泻，涩之始能止泻。若过于酸收，则大肠细小矣，下不能出，又返而上。故止泻之药，止可一
时用之，而不可经久用之也。
阴阳脱，亦有用参至数斤者。然脱有不同，有火盛而脱有水虚而脱。水虚者，用人参数斤，实为
对药。倘肾中有火，作强而脱，止可用多数两，挽回于一时，而不可日日用参数斤，以夺命于后日
也。盖重治之法，前已备言其功。兹更发明其弊，愿人斟酌善用之。
阴阳脱症，明是气虚之症，用参最宜，最可多服，即肾中有火，亦可用之。但脱后用参以救
脱则可，救活之后，亦当急用熟地、山茱，大剂作汤饮之，使已脱之精重生，则未脱之气可长。否
则，阳旺阴消，恐非善后之策，不特肾中有火者不宜久服人参也。倘能用熟地、山茱、北五味、麦
冬之类于人参之中，又各各相宜，不必避忌人参之不宜用也。
华君曰∶前已明言，然余尚有方并传，以为临症之鉴。大渴不止，方用石膏数两，知母三钱，糯
米一撮，麦冬三两，人参亦数两，与石膏同用，半夏三钱，甘草一钱，竹叶百片，元参二两，水煎服。
大汗方∶用人参四两，北五味三钱，麦冬三两，生地二两，水煎服。一剂即止汗。更有奇方，以救
贫乏之人。黄 三两，当归二两，桑叶十四片，北五味三钱。麦冬二两，水煎服之。（〔批〕消汗至神
丹）。一剂即止汗。
大吐方∶人参一两，陈皮二钱，砂仁三粒。（〔批〕止呕仙丹。）此治有火之吐，倘寒甚而吐，加
丁香二钱，干姜三钱，神效。更有肾火沸腾而吐，食入即出等症，用六味汤一料，煎汤二碗，服之即止
吐。更有肾寒之极，今日饮食，至明日尽情吐出者，用六味汤一料，加附子一个。肉桂二两，煎汤二碗，
服之即不吐。二方予亲试而验者也。
大泻方∶用白术一两，茯苓一两，肉桂五分，泽泻三钱，猪苓三钱，一剂即止泻。更有肾经作泻，
五更时痛下七八次
者，亦用八味地黄汤一料，煎汤二碗与之。当日即减大半，二服愈，四服全愈。
阴阳脱无可说，大约必得人参以救之。天师之说，亦言其变也。
（吐症，张公旋复花汤最妙，宜补入。李子永识。）
【重治法】
天师说：所谓“重治”，是指病情非同寻常，轻淡的药物无法奏效，必须使用数两、半斤甚至一斤的大剂量药物，才能取得疗效。例如大渴、大汗、大吐、大泻、阴阳脱（指阴液和阳气严重耗竭的危重证候）等病症，此前已经详尽论述过，治疗方法也已完备，我本不必再多言。然而尚未尽述的是，对于大渴之症，必须使用石膏（Gypsum Fibrosum, 石膏），往往一昼夜用量可达一斤左右。这是因为热邪极盛，药力不得不重用，此时如果拘泥于不可多用的说法，反而会导致患者死亡。只是这类病症是万人中才有一例，不能将其作为治疗所有胃火（Stomach Fire, 胃中火热之邪）患者的常规方法。
张公说：大渴之症，用石膏来清平胃火，无人不知，但还有人不明白其中的道理。胃火沸腾奔涌，就像烈火燎原一样，必须像倾盆大雨那样猛烈的药力，才能使其滂沛而熄灭。这原本是一时的权宜之计，所以可以临时重用，通常能取效。但绝不可长期服用，久服则会损伤身体导致败亡。
天师说：大汗之症，必须用人参（Panax Ginseng Radix et Rhizoma, 人参），往往有用到一斤许的情况。但这也是偶尔为之，不可拘泥固执地用于所有汗出亡阳（Sweating leading to Yang collapse, 因大汗导致阳气外脱）的病症。因为阳药不宜偏多，而阴药可以重用的缘故。
张公说：大汗势必需要用补气（Tonifying Qi, 补益元气）的药物，来救治亡阳之症。然而，如果过度使用补气药，仍担心阳气过旺而阴液消减。服用几剂补气药后，就应当改用补阴（Nourishing Yin, 滋养阴液）的药物。况且亡阳之后，阴血正枯竭，进补水液之药，正是顺应其需求。阴液安定则阳气生发，这样阴阳就不会出现偏胜的弊病。
天师说：大吐之症，明显是虚寒，也有用人参至数两的情况。然而呕吐不可一概而论。如果病势不急，不妨少量使用，可以逐渐增加。如果寒邪不深，呕吐不严重，也加入数两人参，恐怕会增加脘腹胀满的症状。
张公说：大吐之症，多为虚寒，但也有因热而吐的，不可不讲清楚。热吐（Heat-induced Vomiting, 热邪引起的呕吐）必然随痰而出，不像寒吐（Cold-induced Vomiting, 寒邪引起的呕吐）那样纯粹吐出清水。热吐不可用人参，适宜饮用二陈汤（Erchen Decoction, 燥湿化痰、理气和中的方剂）。若是寒吐，必须加入约一两的人参，并混杂辛热性质的药物，才能止呕定吐。只是人参可以暂时使用，不可每日服用。呕吐过多会伤阴，暂时服用人参止吐是可以的，若每日服用，必然导致阳气有余而阴液不足，胃中干燥，恐怕形成便秘（Constipation, 大便干结难解）之症。所以，人参可暂用而不可常服。
大泻之症，往往使用止泻药物至数两，也是一时的权宜之计，不可将其作为长久的治疗方法。
大泻，只有收敛涩肠始能止泻。但如果过于酸收，会使大肠变得细小，粪便下不出，反而返逆向上。所以止泻药只可一时使用，不可经久服用。
阴阳脱，也有用人参至数斤的情况。然而脱证有所不同，有因火盛而脱的，也有因水虚而脱的。水虚者，用人参数斤，确实是对症之药。倘若肾中有火，因作强（Kidney governing strength and vigor, 肾主作强之官）功能亢进而脱，只能使用多数两人参，挽回于一时，而不可每日用人参数斤，以免日后夺人性命。关于重治之法，前文已备言其功效。此处更阐明其弊端，希望人们斟酌善用。
阴阳脱症，明显是气虚之症，用人参最合适，最可多服，即使肾中有火，也可使用。但在脱证后用参以救脱是可以的，救活之后，也应当紧急使用熟地黄（Rehmanniae Radix Praeparata, 熟地）、山茱萸（Corni Fructus, 山茱）等大剂量煎汤服用，使已脱的精气重新生长，那么未脱的气就能长久保存。否则，阳气旺而阴液消，恐怕不是善后的良策，不仅肾中有火者不宜久服人参。倘若能在人参中加入熟地黄、山茱萸、北五味子（Schisandrae Fructus, 北五味）、麦冬（Ophiopogonis Radix, 麦冬）之类，又各自相宜，不必避忌人参的不宜用之处。
华君说：前面已经明确说明，但我仍有方剂一并传授，作为临症参考。大渴不止，方用石膏数两，知母（Anemarrhenae Rhizoma, 知母）三钱，糯米一撮，麦冬三两，人参亦数两，与石膏同用，半夏（Pinelliae Rhizoma, 半夏）三钱，甘草（Glycyrrhizae Radix et Rhizoma, 甘草）一钱，竹叶（Bambusae Folium, 竹叶）百片，玄参（Scrophulariae Radix, 元参）二两，水煎服。
大汗方：用人参四两，北五味三钱，麦冬三两，生地（Rehmanniae Radix, 生地）二两，水煎服。一剂即可止汗。更有奇方，用来救治贫乏之人。黄芪（Astragali Radix, 黄）三两，当归（Angelicae Sinensis Radix, 当归）二两，桑叶（Mori Folium, 桑叶）十四片，北五味三钱，麦冬二两，水煎服。（批注：消汗至神丹）。一剂即止汗。
大吐方：人参一两，陈皮（Citri Reticulatae Pericarpium, 陈皮）二钱，砂仁（Amomi Fructus, 砂仁）三粒。（批注：止呕仙丹。）此治有火之吐，倘若寒甚而吐，加丁香（Caryophylli Flos, 丁香）二钱，干姜（Zingiberis Rhizoma, 干姜）三钱，神效。更有肾火沸腾而吐，食入即出等症，用六味地黄汤（Liujunzi Dihuang Tang, 六味汤）一料，煎汤二碗，服之即止吐。更有肾寒之极，今日饮食，至明日尽情吐出者，用六味地黄汤一料，加附子（Aconiti Lateralis Radix Praeparata, 附子）一个，肉桂（Cinnamomi Cortex, 肉桂）二两，煎汤二碗，服之即不吐。这两方是我亲自试验而验证有效的。
大泻方：用白术（Atractylodis Macrocephalae Rhizoma, 白术）一两，茯苓（Poria, 茯苓）一两，肉桂五分，泽泻（Alismatis Rhizoma, 泽泻）三钱，猪苓（Polyporus, 猪苓）三钱，一剂即止泻。更有肾经作泻，五更时痛下七八次者，亦用八味地黄汤（Bawei Dihuang Tang, 八味丸/金匮肾气丸类方）一料，煎汤二碗与之。当日即减轻大半，二服痊愈，四服全愈。
[Method of Heavy Treatment]
The Heavenly Master said: The so-called "Heavy Treatment" refers to conditions that are extraordinary; light and mild medications cannot achieve efficacy. One must use large doses, such as several taels, half a jin, or even one jin, to obtain results. For symptoms such as extreme thirst (Da Ke), profuse sweating (Da Han), severe vomiting (Da Tu), severe diarrhea (Da Xie), and collapse of Yin and Yang (Yin Yang Tuo - a critical syndrome characterized by severe depletion of Yin fluids and Yang Qi), the discussions have been exhaustive, and methods fully presented in the past. I need not speak further. However, what remains to be mentioned is that for extreme thirst, Gypsum Fibrosum (Shigao) must be used, often reaching up to one jin within a day and night. This is because the heat is extreme, necessitating heavy medication. At this time, if one adheres strictly to the notion that it should not be used in large quantities, it will inevitably lead to death. Yet, such cases occur in only one out of ten thousand people; one cannot rigidly apply this method to treat all individuals with Stomach Fire (Wei Huo).
Master Zhang said: Everyone knows that for extreme thirst, Gypsum Fibrosum is used to clear and calm Stomach Fire, but some do not understand the rationale. When Stomach Fire boils and surges, it is like a prairie fire; only a torrential rain-like potency can extinguish it effectively. This is originally a temporary expedient measure, so it can be used heavily on an emergency basis and usually yields results. However, it must never be used long-term, as prolonged use leads to deterioration and collapse.
The Heavenly Master said: For profuse sweating, Ren Shen (Radix et Rhizoma Ginseng) must be used, sometimes up to a jin. However, this is also occasional and should not be rigidly applied to all cases of sweating leading to Yang collapse (Wang Yang). This is because Yang-tonifying herbs should not be excessively dominant, whereas Yin-nourishing herbs can be used in heavy doses.
Master Zhang said: Profuse sweating necessarily requires Qi-tonifying (Bu Qi) herbs to rescue Yang collapse. However, overuse of Qi-tonifying herbs may still cause excessive Yang and consumption of Yin. After taking several doses of Qi-tonifying medicine, one should switch to Yin-nourishing (Bu Yin) agents. Moreover, after Yang collapse, Yin blood is dried up; administering water-nourishing medicine aligns with the body's needs. Once Yin is stabilized, Yang generates, preventing the imbalance of Yin and Yang.
The Heavenly Master said: Severe vomiting is clearly deficiency-cold, yet Ren Shen is sometimes used in amounts of several taels. However, vomiting cannot be viewed uniformly. If the condition is not urgent, a small dose can be used and gradually increased. If the cold is not deep and vomiting is not severe, adding several taels of Ren Shen might exacerbate abdominal fullness.
Master Zhang said: Severe vomiting is mostly due to deficiency-cold, but there are also cases caused by heat, which must be distinguished. Heat-induced vomiting (Re Tu) occurs with phlegm, unlike cold-induced vomiting (Han Tu) which purely expels clear water. Ren Shen should not be used for heat vomiting; Erchen Decoction (Erchen Tang) is appropriate. For cold vomiting, approximately one tael of Ren Shen must be added along with acrid-hot substances to stop retching. However, Ren Shen can only be used temporarily, not daily. Excessive vomiting damages Yin; while temporary use stops vomiting, daily use leads to excess Yang and insufficient Yin, causing dryness in the Stomach and potentially constipation (Bi Jie). Thus, Ren Shen is suitable for temporary use but not for chronic administration.
For severe diarrhea, anti-diarrheal herbs are often used in doses of several taels, which is also a temporary expedient and should not be regarded as a long-term method.
Severe diarrhea requires astringent herbs to stop. However, excessive sour astringency may constrict the Large Intestine, preventing downward discharge and causing upward regurgitation. Therefore, anti-diarrheal medicines should only be used temporarily, not long-term.
Collapse of Yin and Yang may involve using Ren Shen up to several jin. However, collapse varies: some result from excessive fire, others from fluid deficiency. In cases of fluid deficiency, several jin of Ren Shen is indeed the correct remedy. If the collapse is due to Kidney fire and hyperactive function (Zuo Qiang), only several taels of Ren Shen can be used to temporarily reverse the condition. Using several jin daily would be fatal later. The efficacy of heavy treatment has been previously explained; here, its drawbacks are clarified for prudent application.
Collapse of Yin and Yang is essentially a Qi-deficiency syndrome, making Ren Shen most suitable and allowing for higher doses, even if Kidney fire is present. While Ren Shen rescues collapse, once revived, Shu Di Huang (Prepared Rehmannia Root), Shan Zhu Yu (Cornus Fruit), and other substantial doses should be administered immediately to regenerate lost essence, thereby preserving remaining Qi. Otherwise, excess Yang and deficient Yin will prevail, which is not a proper follow-up strategy. Not only those with Kidney fire should avoid long-term Ren Shen. If Shu Di Huang, Shan Zhu Yu, Bei Wu Wei Zi (Schisandra Fruit), and Mai Dong (Ophiopogon Root) are combined with Ren Shen, they complement each other well, removing the need to fear Ren Shen's contraindications.
Master Hua said: As stated before, I transmit additional formulas for clinical reference. For unrelenting extreme thirst: Gypsum Fibrosem (Shi Gao) several taels, Zhi Mu (Anemarrhena Rhizome) 3 qian, glutinous rice a pinch, Mai Dong 3 liang, Ren Shen several taels (used together with Shi Gao), Ban Xia (Pinellia Rhizome) 3 qian, Gan Cao (Licorice Root) 1 qian, Zhu Ye (Bamboo Leaf) 100 leaves, Xuan Shen (Scrophularia Root) 2 liang. Decoct in water and take orally.
Formula for Profuse Sweating: Ren Shen 4 liang, Bei Wu Wei Zi 3 qian, Mai Dong 3 liang, Sheng Di Huang (Raw Rehmannia Root) 2 liang. Decoct in water and take. One dose stops sweating. Another miraculous formula for the poor: Huang Qi (Astragalus Root) 3 liang, Dang Gui (Angelica Sinensis Root) 2 liang, Sang Ye (Mulberry Leaf) 14 leaves, Bei Wu Wei Zi 3 qian, Mai Dong 2 liang. Decoct in water and take. (Comment: Divine Pill for Eliminating Sweat). One dose stops sweating.
Formula for Severe Vomiting: Ren Shen 1 liang, Chen Pi (Tangerine Peel) 2 qian, Sha Ren (Amomum Fruit) 3 grains. (Comment: Immortal Pill for Stopping Vomiting). This treats vomiting with fire. If cold is severe, add Ding Xiang (Clove) 2 qian, Gan Jiang (Dried Ginger) 3 qian for miraculous effect. For vomiting due to boiling Kidney fire where food is expelled immediately upon ingestion, use one dose of Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction), decocted into two bowls of soup; vomiting stops upon ingestion. For extreme Kidney cold where food eaten today is vomited completely tomorrow, use one dose of Liuwei Dihuang Tang plus one Fu Zi (Prepared Aconite Lateral Root) and Rou Gui (Cinnamon Bark) 2 liang, decocted into two bowls of soup; vomiting ceases. Both formulas have been personally tested and verified by me.
Formula for Severe Diarrhea: Bai Zhu (Atractylodes Macrocephala Rhizome) 1 liang, Fu Ling (Poria) 1 liang, Rou Gui 5 fen, Ze Xie (Alisma Rhizome) 3 qian, Zhu Ling (Polyporus) 3 qian. One dose stops diarrhea. For diarrhea originating from the Kidney meridian, characterized by pain and defecation seven or eight times during the fifth watch (early morning), use one dose of Bawei Dihuang Tang (Eight-Ingredient Rehmannia Decoction), decocted into two bowls of soup. Symptoms reduce by more than half on the same day, cured after two doses, fully recovered after four doses.
Regarding collapse of Yin and Yang, nothing more needs to be said; generally, Ren Shen is essential for rescue. The Heavenly Master's remarks describe the variations.
(Note regarding vomiting: Master Zhang considers Xuan Fu Hua Tang (Inula Flower Decoction) the most excellent; it should be added. Recorded by Li Ziyong.)