孙真人曰∶凡欲服五石诸大汤丸补益者，先服利汤，以荡涤肠胃痰涎蓄水也。初亦赞此
法之
善，乃今益有味乎其言也。凡人服人参、白术、黄 、地黄而中满者，皆为中有邪气也。盖
服此药之人，总因虚弱，虚弱之人，中气不运，肠胃必积有湿热痰水，格拒正气，使不流通
；补药性缓守中，入腹适与邪气相值，不能辟易邪气，以与正气相接也，故反助邪为患矣。
故凡服补益者，必先重服利汤，以攘辟其邪，以开补药资养之路也；或间攻于补，必须攻力
胜于补力，此非坏补药之性也。如人参、白术，合槟榔、浓朴用，即初力大损，合黄柏、茯
苓、桃仁、木香用，乃分道扬镳，清湿热以资正气者也。抑又有要焉，胃中痰水，不先涤去
，遽行健脾补气，气力充壮，将鼓激痰水四溢，窜入经络，为患更大。每见有服补药，反见
遍身骨节疼痛；或有块大如桃李，行走作痛；或肢节忽然不便；或皮肤一块 肿麻木，冷痛
如冰，如刺如割；或脉伏结不调；人以为补药将痰补住，非也，是补药将痰鼓出也。张石顽
谓∶有一种肥盛多痰之人，终日劳动，不知困倦，及静息，反困倦身痛者，是劳动之时气鼓
痰行，静息即痰凝阻其气血也。夫痰饮既已窜入经络，断不能复化精微，从此败痰流注，久
郁腐坏，而痈痿、瘫缓、痹痛、偏枯不遂之根基此矣。不知者，以为补药之祸，非也，不肯
攻泄之祸也。喻嘉言亦谓∶痰盛之人，常须静息，使经络之痰退返于胃，乃有出路，不宜贪
服辛热之剂，反致激痰四溃，莫由通泄也。然但禁辛热，不如用苦涩沉降之剂，轻轻频服，
以吸摄膜络之浊恶，挟之而俱下，斯胃中常时空净，而可受温补，亦不妨辛热矣。凡药味辛
麻者，最能循筋而行，亦最能引痰入络也。
孙思邈说：凡是想要服用五石散等大的汤剂或丸药进行补益的人，必须先服用通利之汤，以清除肠胃中的痰涎和停聚的水饮。起初我也称赞这种方法的好处，如今越发觉得他的话意味深长。凡是服用人参、白术、黄芪、地黄等药物后出现胸脘痞满症状的人，都是因为体内有邪气存在。大概服用这些补药的人，总归是因为身体虚弱；身体虚弱的人，中焦之气运行不畅，肠胃必然积存有湿热、痰浊和水饮，这些病理产物格拒正气，使其不能流通；补药的药性缓和且守中（固守中焦），进入腹中恰好与邪气相遇，无法驱除邪气，从而使正气得以接续，所以反而助长了邪气造成危害。因此，凡是服用补益药物的人，必须先重服通利之汤，以排斥驱除邪气，为补药滋养身体开辟道路；或者在补益之中穿插攻邪之法，必须使攻邪的力量大于补益的力量，这并非破坏补药的本性。例如，人参、白术如果与槟榔、厚朴同用，其补力就会大大减弱；如果与黄柏、茯苓、桃仁、木香同用，则是分道扬镳，通过清利湿热来资助正气的做法。其中还有更为关键的一点，胃中的痰饮水湿如果不先清除干净，就急于进行健脾补气，气血力量充盛壮大，将会鼓动激荡痰水四处泛滥，窜入经络，造成的危害更大。经常见到有人服用补药后，反而出现全身骨节疼痛；或者有肿块大如桃李，行走时疼痛；或者肢体关节突然活动不便；或者皮肤某一块肿胀麻木，冷痛如冰，像针刺刀割一样；或者脉象沉伏、结代不调。人们以为是补药将痰浊固住了，其实不是这样，是补药将痰浊鼓动出来了。张石顽说：有一种形体肥胖多痰的人，整天劳动却不知道疲倦，等到安静休息时，反而感到疲倦身痛，这是因为劳动时气机鼓动使痰随气行，静止休息时痰浊凝滞阻碍了气血运行。既然痰饮已经窜入经络，绝对不能再次化为精微物质，从此败坏的痰浊流注体内，长久郁结腐坏，那么痈疽、痿证、瘫痪、痹痛、半身不遂等疾病的根基就在这里形成了。不了解情况的人，认为是补药造成的祸害，其实不是，是不肯攻逐泻下的祸害。喻嘉言也说：痰盛的人，常常需要静息，使经络中的痰浊退返到胃中，从而有出路排出，不应该贪恋服用辛热性质的药剂，否则反而会导致痰浊激惹四溃，没有途径通泄。然而，仅仅禁止辛热药物，不如使用苦涩沉降性质的药剂，轻轻频频服用，以吸纳摄取膜络中的浊恶之物，挟带它们一起下行，这样胃中常保持空净状态，就可以接受温补，也不妨服用辛热药物了。凡是药味辛麻的药物，最能沿着筋脉运行，也最能引导痰浊进入络脉。
Sun Simiao stated: Whenever one intends to take large decoctions or pills such as the Five-Mineral Powder for tonification, one must first take a purgative decoction to cleanse the intestines and stomach of phlegm-rheum and accumulated fluid. Initially, I also praised the merit of this method; now, I find his words even more profound. Those who experience abdominal fullness after taking herbs such as Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Huangqi (Astragali Radix), and Dihuang (Rehmanniae Radix) do so because there is pathogenic factor present within. Generally, those taking these tonifying herbs are weak due to deficiency. In individuals with deficiency, the Qi of the Middle Jiao fails to circulate, leading to the accumulation of damp-heat, phlegm-turbidity, and water-fluid in the intestines and stomach. These pathological products obstruct the Zheng Qi (Upright Qi), preventing its free flow. Since tonifying herbs have a mild nature and tend to remain in the Middle Jiao, upon entering the abdomen, they encounter the pathogenic factors directly. Unable to dispel the pathogens to allow the Zheng Qi to connect, they instead exacerbate the pathogenic factors, causing harm. Therefore, anyone taking tonifying herbs must first take a heavy dose of purgative decoction to repel and expel the pathogens, thereby opening the pathway for the tonics to nourish the body. Alternatively, if attacking methods are interspersed with tonification, the force of attack must exceed the force of tonification; this does not destroy the nature of the tonics. For instance, when Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) are combined with Binglang (Arecae Semen) and Houpo (Magnoliae Officinalis Cortex), their tonifying power is significantly reduced. When combined with Huangbai (Phellodendri Cortex), Fuling (Poria), Taoren (Persicae Semen), and Muxiang (Aucklandiae Radix), they act separately, clearing damp-heat to assist the Zheng Qi (Upright Qi). Furthermore, there is a crucial point: if the phlegm-fluid in the stomach is not cleared first, and one hastily proceeds to strengthen the Spleen and tonify Qi, the充盈 (abundant) Qi and Blood will stir up the phlegm-fluid, causing it to overflow and invade the collaterals, resulting in greater harm. It is often observed that after taking tonics, patients suffer from pain in all bone joints; or lumps as large as plums or peaches appear, causing pain during movement; or limb joints suddenly become immobile; or patches of skin become swollen, numb, cold, and painful like ice, feeling like needle pricks or knife cuts; or the pulse becomes deep, knotted, or irregular. People mistakenly believe that the tonic has trapped the phlegm; in fact, the tonic has stirred up the phlegm. Zhang Shiwang stated: There are individuals who are obese and phlegm-dense, working tirelessly without fatigue, but feel fatigued and achy when resting. This is because during labor, Qi stirs and moves the phlegm, while at rest, the phlegm coagulates and obstructs Qi and Blood. Once phlegm-fluid has invaded the collaterals, it cannot be transformed into essence and nutrients again. From then on, this corrupted phlegm flows and accumulates; long-term stagnation and putrefaction lay the foundation for conditions such as carbuncles, flaccidity syndromes, paralysis, bi-syndromes (painful obstruction), and hemiplegia. Those who do not understand this attribute the disaster to the tonic, whereas it is actually the disaster of failing to use purgative methods. Yu Jiayan also stated: Individuals with abundant phlegm should rest frequently to allow phlegm in the collaterals to retreat back to the Stomach, providing an exit route. They should not greedily consume acrid-warm agents, as this may irritate the phlegm, causing it to rupture and spread, making it impossible to drain. However, merely prohibiting acrid-warm drugs is inferior to using bitter-astringent and sinking-depressing agents, taken lightly and frequently, to absorb and extract turbid evils from the membranes and collaterals, carrying them downward together. This keeps the Stomach empty and clean, allowing it to accept warm-tonifying herbs, making the use of acrid-warm herbs acceptable. Herbs with acrid-numbing flavors are most capable of traveling along the sinews and are also most likely to guide phlegm into the collaterals.