脾土上应于天亦属湿化所以水谷津液不行即停聚而为痰饮也夫人之病痰火者十之八九老
人不
宜速降其火虚人不宜尽去其痰攻之大甚则病转剧而致危殆须以固元气为本凡病推类而治之亦
思过半矣(空同子)
医者识脉方能识病病与药对古人惟用一药治之气纯而功愈速今之人不识病源不辩脉理品
数多
每至十五六味攻补杂施弗能专力故治病难为功也韩天爵医通云处方正不必多品但看仲景方何
等简任丹溪谓东垣用药如韩信用兵多多益善者盖讳之也
夏文靖公云夫人之痈疽伏于身未溃则忧不测已溃则可缓治宜进和平之剂加之资补俟血
气
调和而自愈若不小忍而惟毒之是攻侵淫不已心腹内虚恐患复生于他处不可不虑此虽文靖借喻
国政之言深得病情故表出之
医乃人之司命不可妄意为之须心中晓然指下明白以形症脉以脉究病按指当有法而指无大
遽
病必有源而病必详推然后察人之虚实视时之寒燠体之肥瘠以至风土异宜如西北之地山广土浓
其
俗所食黍麦粱肉故其禀差壮而多风痹之疾东南之地土薄水深其俗所食粳稻鱼虾故其禀受差弱
而多脾胃之疾苟能察此用药则庶乎可以言医矣
吴球诸证辩云处州地阜岚气湿热每行辛凉之药多效金华连境相隔百余里民俗有病动辄便
施附子姜
桂以为常事地之相近尚且不同况南北之地相去千里者乎余尝闻台州村落愚民有病单服附子是
以患喉症死者多矣陈无择三因论有云附子不宜单服须佐以人参甘草生姜方可以制其毒经云六
分分来一分寒故热病多而寒病少也医者用姜桂乌附 燥之药不审寒热虚实岁运迁移犹如抱薪
救火为害滋甚可不慎乎
脾土在人体上部对应于天，其气化属性也属于湿。因此，如果水谷精微和津液运行不畅，就会停滞积聚而形成痰饮。大凡患有痰火病证的人，十有八九（占大多数）。对于老年人，不宜迅速猛烈地降泻其火热之邪；对于正气虚弱之人，不宜彻底清除其体内的痰浊。如果攻伐太过，病情反而会加重，甚至导致危险。治疗必须以巩固元气为根本。凡是疾病，若能推究其类同之理而施治，也就掌握了大半要领了。（空同子）
医生只有能够辨识脉象，才能真正认识疾病。古人在用药时，往往只使用一味药来治疗，因为药性纯粹，所以疗效更加迅速。如今的人不认识疾病的根源，不辨别脉理的细微变化，处方中药味数量很多，常常达到十五六味，攻邪与补虚混杂施用，不能集中药力，因此治病难以取得成效。韩天爵在《医通》中说，开处方并不一定要多用几种药材，只要看看张仲景的方剂，何等简洁即可。朱丹溪曾说李东垣用药像韩信带兵一样“多多益善”，这其实是讳言（指李东垣用药并非杂乱无章，而是有法度）。
夏文靖公说：大凡人的痈疽毒疮潜伏在体内，未溃破时令人担忧会有不可测知的变故；一旦溃破后，则可以从容缓治。适宜进用平和的药剂，并加以滋补，等待气血调和后自然痊愈。如果不能稍加忍耐，只是一味地攻伐毒邪，导致侵蚀不止，心腹内部空虚，恐怕病患会在身体其他部位复发，这是不可不忧虑的。这虽然是夏文靖公借用比喻国政的话，但深得病情之理，所以将其列出以资参考。
医学是掌管人生命运的学问，不可随意妄为。必须心中明白透彻，手指切脉感觉清晰，通过形体症状和脉象来探究病因。按诊手指应当有法度，而不能过于仓促。疾病必有源头，必须详细推究，然后观察病人的虚实状况，审视当时的寒暖气候，体型的肥瘦，以及风土习俗的差异。例如西北地区，山多土厚，当地风俗食用黍、麦、高粱、肉类，所以人们体质较强壮，但多患风痹类疾病；东南地区，土薄水深，当地风俗食用粳米、稻米、鱼虾，所以人们禀赋较弱，但多患脾胃类疾病。如果能考察这些情况再用药，差不多就可以称为懂医了。
吴球在《诸证辩》中说：处州地势低洼，雾气湿热，常用辛凉性质的药物大多有效；金华与处州接壤，相隔仅百余里，但民俗有病就动辄使用附子、干姜、肉桂等温热药物作为常事。地域相近尚且不同，何况南北两地相距千里呢？我曾听说台州乡村愚昧百姓患病时单独服用附子，因此患喉症而死的人很多。陈无择在《三因论》中也有云：附子不宜单独服用，必须佐以人参、甘草、生姜，才可以制约其毒性。《内经》说：“六分热，一分寒”，所以热病多而寒病少。医生使用干姜、肉桂、乌头、附子等燥热药物，如果不审察寒热虚实，随着岁运的变化而迁移，就像抱着柴草去救火，危害更加严重，怎么可以不谨慎呢？
The Spleen Earth corresponds to Heaven in the upper part of the body, and its Qi transformation also belongs to Dampness (Shi Hua). Therefore, if the fluids from food and drink (Shui Gu Jin Ye) fail to circulate, they stagnate and accumulate to form Phlegm-Fluids (Tan Yin). Among people suffering from Phlegm-Fire (Tan Huo), nine or ten out of ten are common. For the elderly, it is inappropriate to rapidly descend their Fire; for those with deficient constitution, it is inappropriate to completely eliminate their Phlegm. If the attack is too severe, the disease will worsen and lead to danger. One must take consolidating Yuan Qi (Primal Qi) as the root. In treating any disease, if one applies reasoning by analogy, one has grasped more than half of the essential principles. (Kongtongzi)
Only when a physician can identify the pulse can they truly recognize the disease. In ancient times, physicians often used only a single herb to treat, because the medicinal nature was pure, thus the effect was faster. Today's physicians do not understand the source of the disease nor distinguish pulse patterns; they prescribe many herbs, often fifteen or sixteen flavors, mixing attacking and tonifying methods without focusing their strength, making it difficult to achieve therapeutic success. Han Tianjue stated in *Yi Tong* that prescriptions need not contain many ingredients; one should look at how concise the formulas of Zhang Zhongjing were. Zhu Danxi said that Li Dongyuan’s use of herbs was like Han Xin leading troops: "the more the better." This statement is actually an evasion (implying Li Dongyuan's prescriptions were systematic, not merely numerous).
Duke Xia Wenjing said: Regarding carbuncles and sores lurking in the body, before ulceration, one worries about unpredictable changes; after ulceration, treatment can be leisurely. It is appropriate to administer mild agents combined with nourishment, waiting for the harmonization of Blood and Qi for natural recovery. If one cannot endure slight discomfort and solely attacks the toxin, causing continuous erosion and internal emptiness of the heart and abdomen, there is fear that the illness may recur elsewhere. This is something not to be overlooked. Although this was Duke Xia Wenjing using a metaphor for state governance, it deeply captures the essence of pathology, so it is presented here.
Medicine governs human life and must not be done arbitrarily. The mind must be clear, and the fingers' palpation precise. By examining physical symptoms and pulses, one investigates the disease. Finger pressure during palpation must follow method and not be hasty. Diseases have sources and must be deduced in detail. Then, observe the patient's deficiency or excess, the current cold or heat, the body's fat or thinness, and the suitability of local customs. For example, in the Northwest, mountains are abundant and soil is thick; people eat millet, wheat, sorghum, and meat, so their constitution is strong but they often suffer from Wind-Bi (Wind-Cold-Damp Obstruction) diseases. In the Southeast, soil is thin and water is deep; people eat rice and fish/shrimp, so their constitution is weaker but they often suffer from Spleen-Stomach diseases. If one considers these factors before prescribing, one can arguably claim to know medicine.
Wu Qiu stated in *Zhu Zheng Bian*: Chuzhou has low terrain with misty, damp-heat conditions;辛凉 (Acrid-Cool) medicines are often effective. Jinhua borders Chuzhou, separated by over a hundred li, yet locals habitually use Fuzi (Aconite), Shengjiang (Ginger), and Rougui (Cinnamon Bark) for illnesses. Even nearby regions differ; how much more so between North and South, thousands of li apart? I once heard that ignorant villagers in Taizhou who took Fuzi alone died frequently from throat disorders. Chen Wuyi wrote in *San Yin Lun*: Fuzi should not be taken alone; it must be assisted by Renshen (Ginseng), Gancao (Licorice), and Shengjiang (Fresh Ginger) to control its toxicity. The *Classic* states: "Six parts heat, one part cold"; thus, heat diseases are more common than cold diseases. Physicians using drying-hot drugs like Jiang (Ginger), Gui (Cinnamon), Wu Tou (Aconite Root), and Fu Zi (Prepared Aconite Root) without assessing cold/heat and deficiency/excess, while ignoring shifting annual Qi movements, are like carrying firewood to save a fire, causing even greater harm. How can one not be cautious?