治妇人虽有别科，然亦有不能尽圣人之法者。今豪足之家，居奥室之中，处帷幔之内，
复以
帛（蒙手臂，既不能行望色之神，又不能殚切脉之巧，四者有二缺焉。黄帝有言曰∶凡治病
，察其形气色泽，形气相得，谓之可治；色泽以浮，谓之易已；形气相失，谓之难治；色夭
不泽，谓之难已。又曰∶诊病之道，观人勇怯，骨肉、皮肤，能知其情，以为诊法。若患人
脉病不相应，既不得见其形，医人只据脉供药，其可得乎？如此言之，乌能尽其术也。此医
家之公患，世不能革。医者不免尽理质问。病家见所问繁，还为医业不精，往往得药不肯服
，似此甚多。扁鹊见齐侯之色，尚不肯信，况其不得见者乎？呜呼！可谓难也已！
又妇人病温已十二日，诊之，其脉六七至而涩，寸稍大，尺稍小，发寒热，颊赤、口干，
不
了了，耳聋。问之，病后数日，经水乃行，此属少阳热入血室也。若治不对病，则必死。乃
按
其证，与小柴胡汤服之。二日，又与小柴胡汤加桂枝干姜汤，一日，寒热遂已。又云∶我脐
下急痛，又与抵当丸，微利，脐下痛痊。身渐凉和，脉渐匀，尚不了了，乃复与小柴胡汤。
次日云∶我但胸中热燥，口鼻干。又少与调胃承气汤，不得利。次日又云∶心下痛。又与大
陷胸丸半服，利三行。而次日虚烦不宁，时妄有所见，时复狂言。虽知其尚有燥屎，以其极
虚，不敢攻之。遂与竹叶汤，去其烦热。其夜大便自通，至晓两次，中有燥屎数枚。而狂言
虚烦尽解。但咳嗽唾沫，此肺虚也。若不治，恐乘虚而成肺痿，遂与小柴胡去人参、大枣、
生姜，加干姜、五味子汤。一日咳减，二日而病悉愈。以上皆用张仲景方。
有妇人病吐逆，大小便不通，烦乱、四肢冷，渐无脉，凡一日半，与大承气汤两剂，至
夜半
渐得大便通，脉渐生，翌日乃安。此关格之病，极难治，医者当审谨也。《经》曰∶关则吐
逆，格则不得小便。如此亦有不得大便者。
有小儿病虚滑，食略化，大便日十余次，四肢柴瘦、腹大，食讫又饥。此疾正是大肠移
热于
胃，善食而瘦。又谓之食 者。时五、六月间，脉洪大，按之则绝。今六脉既单洪，则夏之
气独然，按之绝，则无胃气也。《经》曰∶夏脉洪，洪多胃气，少曰病，但洪无胃气曰死。
夏以胃气为本，治疗失于过时，后不逾旬，果卒。
有人病久嗽，肺虚生寒热，以款冬花焚三两芽，俟烟出，以笔管吸其烟，满口则咽之，
至倦
则已。凡数日之间五七作，瘥。
有人病疟月余日，又以药吐下之，气遂弱，疾未愈。观其病与脉，乃夏伤暑，秋又伤风，
乃
与柴胡汤一剂。安后，又饮食不节，寒热复作。此盖前以伤暑，今以饮食不慎遂致吐逆不食
，胁下牵急而痛，寒热无时，病名痰疟。以十枣汤一服，下痰水数升，明日又与理中散二钱
，遂愈。
有人苦风痰、头痛、颤掉、吐逆，饮食减，医以为伤冷物，遂以药温之，不愈。又以丸
药下
之，遂厥。复与金液丹后，谵言，吐逆，颤掉，不省人，狂若见鬼，循衣摸床，手足冷，脉
伏。此胃中有结热，故昏瞀不省人；以阳气不能布于外，阴气不持于内，即颤掉而厥。遂与
大承气汤，至一剂，乃愈。方见仲景。后服金箔丸，方见《删繁》。
有男子，年六十一，脚肿生疮，忽食猪肉不安。医以药利之，稍愈时出外中风，汁出后，
头
面暴肿起，紫黑色，多睡，耳叶上有浮泡小疮，黄汁出，乃与小续命汤中加羌活一倍，服之
遂愈。
有人年五十四，素羸，多中寒，近服菟丝有效。小年常服生硫黄数斤，脉左上二部、右
下二
部弦紧有力。五七年来，病右手足筋急拘挛，言语稍迟，遂与仲景小续命汤，加薏苡仁一两
，以治筋急，减黄芩、人参、芍药各半，以避中寒，杏仁只用一百五枚。后云尚觉大冷，因
令尽去人参、芍药、黄芩三物，却加当归一两半，遂安。今人用小续命汤者，比比皆是，既
不能逐证加减，遂至危殆，人亦不知。今小续命汤，世所须也。故举以为例，可不谨哉！
夫八节之正气，生活人者也；八节之虚邪，杀人者也。非正气则为邪，非真实则为虚。
所谓
正气者，春温、夏热、秋凉、冬寒，此天之气也。若春在经络，夏在肌肉，秋在皮肤，冬在
骨髓，此人之气也。在处为实，不在处为虚。故曰，若以身之虚，逢时之虚邪不正之气，两
虚
相感，始以皮肤、经络，次传至脏腑；逮于骨髓，则药力难及矣。如此则医家治病，正宜用
药抵截散补，防其深固而不可救也。又尝须保护胃气。举斯为例，余可效此。
治疗妇人疾病虽然属于不同的专科，但其中也有不能完全遵循圣人（古代名医）诊疗法则的情况。如今富贵人家，居住在深宅大院之中，身处帷幔之内，又用丝绸蒙住手臂，这样既不能施展观察气色的高超技艺，也不能充分发挥切脉的巧妙手法，这四种诊法中有两项存在缺失。黄帝曾说：“大凡治病，要观察病人的形体、气息、色泽。如果形体与气息相协调，称为可治；如果色泽浮润明亮，称为容易痊愈；如果形体与气息不相协调，称为难治；如果面色枯槁无光泽，称为难以痊愈。”又说：“诊断疾病的道理，在于观察人的勇敢或怯懦，以及骨骼、肌肉、皮肤的状态，从而了解病情，作为诊断的方法。”如果患者的脉象与病症不相符合，医生又无法看到其形体，仅凭脉象来提供药物，这能行得通吗？这样说起来，怎么能穷尽医术呢？这是医家的普遍困境，世人无法改变。医者不得不尽力详细询问。病人看到问得太多，反而认为医生医术不精，往往拿到药也不肯服用，类似情况很多。扁鹊见到齐侯的气色，尚且不被相信，何况是根本见不到病人的情况呢？唉！真是难啊！
又有妇人气温病已经十二天，诊察时，脉搏一呼一吸跳动六七次且涩滞，寸脉稍大，尺脉稍小，出现恶寒发热，脸颊发红、口干，神志不清，耳聋。询问得知，月经在发病后几天才来，这属于少阳热邪陷入血室的情况。如果治疗不对症，必然死亡。于是根据证候，给予小柴胡汤服用。两天后，又给予小柴胡汤加桂枝干姜汤。一天后，寒热症状随即消失。又说：“我感到脐下急痛”，又给予抵当丸，轻微通便后，脐下疼痛痊愈。身体逐渐凉爽平和，脉象逐渐均匀，但神志仍有些不清，于是再次给予小柴胡汤。第二天说：“我只觉得胸中燥热，口鼻干燥。”又少量给予调胃承气汤，未能通便。第二天又说：“心窝处疼痛。”又给予大陷胸丸半剂，排便三次。到了第三天，出现虚烦不安，时而胡言乱语，时而发狂。虽然知道体内还有燥屎，但因为病人极度虚弱，不敢攻下。于是给予竹叶汤，去除烦热。当晚大便自然通畅，直到天亮共两次，其中有几枚燥屎。于是狂言和虚烦全部解除。只是咳嗽吐沫，这是肺虚的表现。如果不治疗，恐怕会乘虚导致肺痿，于是给予小柴胡汤去掉人参、大枣、生姜，加入干姜、五味子的方子。一天后咳嗽减轻，两天后病全愈。以上都使用了张仲景的方剂。
有一位妇人患呕吐逆气，大小便不通，心烦意乱、四肢冰冷，逐渐摸不到脉搏，持续了一天半，给予大承气汤两剂，到半夜逐渐大便通畅，脉搏逐渐恢复，第二天才安定。这是关格病，极难治疗，医者应当审慎。《内经》说：“关则呕吐逆气，格则小便不通。”像这样的也有大便不通的。
有一个小儿患虚滑泄泻，食物略消化，每天大便十多次，四肢消瘦、腹部胀大，吃完饭后又觉得饿。这种病正是大肠的热邪移注于胃，表现为能吃但消瘦。又称为“食啗”病。当时正值五六月间，脉象洪大，重按则感觉绝迹。现在六脉都呈现单一的洪大之象，说明夏季的邪气独盛，重按绝迹，说明没有胃气。《内经》说：“夏脉洪大，如果洪大中带有胃气，若胃气少则为病，如果只有洪大而没有胃气则主死。”夏季以胃气为本，治疗失当错过时机，后来不超过十天，果然猝死。
有人患久咳，肺虚产生寒热，用款冬花焚烧三两芽，等烟冒出，用笔管吸入烟雾，满口后咽下，感到疲倦就停止。几天之间发作五七次，病愈。
有人患疟疾一个多月，又用药催吐泻下，气力遂弱，疾病未愈。观察其病症与脉象，乃是夏季伤暑，秋季又伤风，于是给予柴胡汤一剂。病安之后，又因饮食不节制，寒热再次发作。这大概是先前因伤暑，现在因饮食不慎导致呕吐逆气、不能进食，胁下牵引急痛，寒热无常，病名痰疟。给予十枣汤一服，吐出痰水数升，第二天又给予理中散二钱，于是痊愈。
有人苦于风痰、头痛、颤抖、呕吐逆气，饮食减少，医生认为是受冷物所致，于是用药温补，无效。又用丸药攻下，导致厥逆。随后服用金液丹后，出现谵语、呕吐逆气、颤抖，不省人事，狂躁如见鬼魅，循衣摸床，手足冰冷，脉伏。这是胃中有结聚的热邪，所以昏沉不省人事；因为阳气不能布达于外，阴气不能固持于内，所以颤抖而厥逆。于是给予大承气汤，服用一剂后，病愈。方剂见张仲景著作。后来服用金箔丸，方剂见《删繁》一书。
有一名男子，六十一岁，脚肿生疮，忽然吃猪肉后不适。医生用药利导，稍微好转时外出中风，出汗后，头面突然肿胀，呈紫黑色，嗜睡，耳叶上有浮泡小疮，流出黄汁，于是给予小续命汤中加倍羌活，服用后痊愈。
有人五十四岁，素体虚弱，多受寒，近来服用菟丝子有效。年轻时常服用生硫黄数斤，脉象左上部、右下部弦紧有力。五七年来，病右手足筋脉拘挛紧急，言语稍迟缓，于是给予张仲景的小续命汤，加入薏苡仁一两，以治疗筋急，减去黄芩、人参、芍药各半量，以避免加重中寒，杏仁只用一百五十枚。后来还说觉得非常冷，因此令去掉人参、芍药、黄芩三味药，却加入当归一两半，于是安定。现在人们使用小续命汤的比比皆是，既然不能根据证候加减，以至于危险，人们也不知道。现在小续命汤是世所必需的。所以举这个例子，能不谨慎吗！
八节的气候正气，养活人；八节的气候虚邪，杀人。不是正气就是邪气，不是真实就是虚弱。所谓正气，是指春温、夏热、秋凉、冬寒，这是天的气候。如果在春季病在经络，夏季病在肌肉，秋季病在皮肤，冬季病在骨髓，这是人的气机所在。在的地方为实，不在的地方为虚。所以说，如果用身体的虚弱，遇到时令的虚邪不正之气，两虚相感，开始从皮肤、经络传入，接着传至脏腑；等到深入骨髓，药力就很难到达了。像这样，医生治病，正宜用药抵挡截断、消散补益，防止病邪深入牢固而无法救治。又常常需要保护胃气。举这个为例，其余可以效仿此理。
Although the treatment of women's diseases belongs to different specialties, there are cases where the methods of the sages (ancient famous physicians) cannot be fully followed. Nowadays, wealthy families live in deep courtyards, within curtains, and cover their arms with silk. This prevents them from displaying the divine skill of observing complexion and hinders the dexterity of pulse diagnosis. Among these four diagnostic methods, two are deficient. The Yellow Emperor said: "In treating disease, one must observe the patient's form, qi, and color. If form and qi are harmonious, it is called treatable; if the color is floating and bright, it is called easily curable; if form and qi are discordant, it is called difficult to treat; if the complexion is dull and lusterless, it is called difficult to cure." He also said: "The way to diagnose disease lies in observing a person's courage or timidity, as well as the state of bones, muscles, and skin, to understand the condition and establish diagnostic methods." If the patient's pulse does not correspond to the illness, and the physician cannot see the physical form, relying solely on the pulse to prescribe medicine—is this feasible? In this sense, how can one exhaust the art of medicine? This is a common plight of physicians, which society cannot change. Physicians are compelled to ask questions thoroughly. Patients, seeing the numerous inquiries, often suspect the physician's lack of proficiency and frequently refuse to take the prescribed medicine. Such cases are common. Even Bian Que was not believed when he observed the complexion of the Marquis of Qi, let alone situations where the physician cannot see the patient at all. Alas! It is truly difficult!
There was a woman who had suffered from warm disease for twelve days. Upon diagnosis, her pulse beat six or seven times per respiration and was choppy; the cun position was slightly large, and the chi position was slightly small. She presented with aversion to cold and fever, flushed cheeks, dry mouth, mental confusion, and deafness. Inquiry revealed that menstruation occurred several days after the onset of illness. This belongs to Shaoyang heat entering the blood chamber. If the treatment does not match the disease, death is inevitable. Based on the syndrome, Xiao Chai Hu Tang (Minor Bupleurum Decoction) was administered. Two days later, Xiao Chai Hu Tang plus Guizhi Ganjiang Tang (Cinnamon Twig and Dried Ginger Decoction) was given. One day later, the chills and fever subsided. She then stated, "I feel urgency and pain below the umbilicus," so Didang Wan (Didang Pill) was administered. After mild purgation, the pain below the umbilicus resolved. Her body gradually became cool and harmonious, and her pulse became even, though mental clarity remained incomplete. Thus, Xiao Chai Hu Tang was administered again. The next day, she reported, "I only feel heat and dryness in the chest, and dryness in the mouth and nose." A small amount of Tiaowei Chengqi Tang (Regulating the Stomach and Directing Downward Decoction) was given, but defecation did not occur. The next day, she complained of pain in the epigastrium. Half a dose of Daxiexiong Wan (Major Scrofula Pill) was given, resulting in three bowel movements. On the following day, she experienced empty irritability and restlessness, occasionally speaking deliriously and acting madly. Although dry feces were known to remain, due to her extreme deficiency, aggressive purgation was avoided. Instead, Zhuye Tang (Bamboo Leaf Decoction) was used to clear irritability and heat. That night, stool passed naturally, twice by dawn, containing several pieces of dry feces. Consequently, the delirium and empty irritability were completely resolved. However, she continued to cough and expectorate froth, indicating Lung deficiency. If untreated, it might lead to Fei Wei (Lung Withering) due to deficiency. Therefore, Xiao Chai Hu Tang was modified by removing Renshen (Ginseng), Dazao (Jujube), and Shengjiang (Fresh Ginger), and adding Ganjiang (Dried Ginger) and Wuweizi (Schisandra). Cough decreased after one day, and the disease was completely cured after two days. All the above cases utilized formulas from Zhang Zhongjing.
A woman suffered from vomiting and regurgitation, obstruction of both urination and defecation, mental agitation, cold limbs, and a gradually imperceptible pulse. This lasted for one and a half days. Two doses of Dachengqi Tang (Major Order the Qi Decoction) were administered. By midnight, defecation gradually resumed, the pulse returned, and she stabilized the next day. This is Guan Ge disease (Obstruction and Rejection), which is extremely difficult to treat, requiring utmost caution from physicians. The Classics state: "Guan leads to vomiting and regurgitation; Ge leads to inability to urinate." In such cases, inability to defecate may also occur.
A child suffered from deficiency-type loose stools, slight digestion of food, more than ten bowel movements daily, emaciated limbs, distended abdomen, and hunger immediately after eating. This disease is precisely the transfer of heat from the Large Intestine to the Stomach, characterized by good appetite but emaciation. It is also called Shi Dan disease. During May and June, the pulse was surging and large, but vanished upon heavy pressure. The current six pulses showed a singular surging quality, indicating that summer pathogenic factors were dominant. The absence of pulse upon pressure indicated a lack of Stomach qi. The Classics state: "Summer pulse is surging. If surging with Stomach qi, it is normal; if surging with little Stomach qi, it is pathological; if surging without Stomach qi, it indicates death." Summer relies on Stomach qi as the foundation. Due to improper treatment and missed timing, the patient died suddenly within ten days.
A person suffered from chronic cough, with Lung deficiency generating cold and heat. Three taels of buds of Kua Dong Hua (Adenophora Flower) were burned. As smoke emerged, it was inhaled through a brush tube until the mouth was full, then swallowed. When tired, the process stopped. This was done five or seven times over several days, leading to recovery.
A person suffered from malaria for over a month. Emetics and cathartics were administered, weakening the qi, yet the disease persisted. Observing the symptoms and pulse, it was determined that summer heat injury occurred first, followed by wind injury in autumn. One dose of Chaihu Tang (Bupleurum Decoction) was given. After stabilization, irregular diet caused the recurrence of chills and fever. This was likely due to prior heat injury combined with recent dietary indiscretion, leading to vomiting, anorexia, pulling pain in the hypochondrium, and irregular chills and fever. The disease was named Tan Nue (Phlegm Malaria). One dose of Shizao Tang (Ten Jujube Decoction) was administered, expelling several sheng of phlegm-water. The next day, Lizhong San (Regulate the Middle Powder) was given, leading to recovery.
A person suffered from wind-phlegm, headache, tremors, vomiting, and reduced appetite. The physician attributed this to cold-damage and applied warming medicines, but to no avail. Pill-based purgatives were then used, causing jue (cold extremities). Subsequently, Jin Ye Dan (Golden Liquid Pill) was administered, leading to delirium, vomiting, tremors, unconsciousness, manic behavior resembling ghost-seeing, picking at clothes and bed sheets, cold hands and feet, and a hidden pulse. This indicated accumulated heat in the Stomach causing coma; yang qi could not distribute outward, and yin qi could not sustain inward, resulting in tremors and jue. Dachengqi Tang (Major Order the Qi Decoction) was administered. One dose led to recovery. The formula is found in Zhang Zhongjing's works. Later, Jinbo Wan (Gold Foil Pill) was taken, found in the book *Shanfan*.
A sixty-one-year-old man suffered from swollen legs with sores. After eating pork, he felt uncomfortable. Medicines promoting drainage were used, and he improved slightly. However, upon going outside, he contracted wind. After sweating, his face and head swelled suddenly, turning purple-black. He slept excessively, and blisters with yellow discharge appeared on his earlobes. Xiao Xuming Tang (Minor Continuation of Life Decoction) with double the amount of Qianghuo (Notopterygium Rhizome) was administered, leading to recovery.
A fifty-four-year-old man was constitutionally weak and prone to cold injuries. Recently, Tusizi (Cuscuta Seed) proved effective. In his youth, he consumed several jin of raw Liuhuang (Sulfur). His pulse was wiry and tight in the left upper and right lower positions. For five to seven years, he suffered from spasms and contractures of the tendons in the right hand and foot, with slightly delayed speech. Zhang Zhongjing's Xiao Xuming Tang (Minor Continuation of Life Decoction) was prescribed, with Yiyiren (Coix Seed) added in one liang to treat tendon spasms. Huangqin (Scutellaria Root), Renshen (Ginseng), and Shaoyao (Peony Root) were each reduced by half to avoid aggravating cold damage. Only 150 Xingren (Apricot Seeds) were used. He later reported feeling very cold. Therefore, Renshen, Shaoyao, and Huangqin were removed, and Danggui (Angelica Sinensis) was added in one and a half liang, leading to stability. Nowadays, many use Xiao Xuming Tang indiscriminately. Without adjusting according to syndromes, patients face danger, often unaware of the cause. Since Xiao Xuming Tang is widely needed today, this case is cited as an example. Can one not be cautious?
The righteous qi of the eight solar terms sustains life; the deficient evil of the eight solar terms kills. What is not righteous qi becomes evil; what is not substantial becomes deficiency. Righteous qi refers to spring warmth, summer heat, autumn coolness, and winter cold—these are the qi of heaven. If disease occurs in the meridians in spring, muscles in summer, skin in autumn, and marrow in winter, these are the locations of human qi. Where qi is present is excess; where it is absent is deficiency. Thus, if the body's deficiency meets the seasonal deficient evil and unrighteous qi, the two deficiencies interact. Initially affecting skin and meridians, it then transmits to zang-fu organs; once reaching the marrow, medicinal power becomes ineffective. Therefore, physicians should use medicines to block, scatter, and tonify, preventing the pathogen from becoming deep-seated and incurable. Furthermore, protecting Stomach qi is essential. Taking this as an example, other cases can follow suit.