凡风、寒、湿、热，散漫于周身之腠理者，无聚歼之术也，则因其散而发之；痰、血、
水、
食，结积于胃与二肠、膀胱之内者，已属有形，势难消散，则因其聚而泄之、渗之；邪在上
脘，愠愠欲吐，是欲升不遂也，则因而吐之；邪在大肠，里急后重，是欲下不畅也，则因而
利之。此顺乎病之势而利导之之治也。温热无形，散处于肠胃膜络之中，既不外越，又不内
结，则以酸敛入泄剂，撮其邪而竭之；瘀血有形，结聚于肠胃膜络之中，其质凝滞，不能撮
而去也，则以辛温入攻血剂，温其血而化之。肾气不纳，根本浮动，喘、呕、晕眩，酸咸重
镇，高者抑之，中气虚陷，泄利无度，呼吸不及，固涩升补，下者举之。此矫乎病之势而挽
回之之治也。凡病误降者，欲救之，不可急升
也；误升者，欲救之，不可急降也；误寒者，欲救之，不可急以大热也；误热者，欲救之，
不可急以大寒也。寒、热犹或可急也，升、降断不可急也。尝见先以承气误下，中气下陷，
急以参、 升之，虚气上越，喘逼不能食而死矣。此当健中涩下，不可升提其上也。
凡病皆宜攻也，而有时兼补者，以其内虚也。内虚之义有二∶一为内之正气自虚也；一
为邪
气在表，其表为实，邪未入里，其内尚虚也。新病邪浅，加补气血药于攻病剂中，故病去
而无余患；若久病正气受伤，邪已内陷，一加补药，便与邪值，而攻药不能尽其所长矣。故
华元化、张仲景、孙真人书中，治久病诸方，反重用攻击，不佐以补者，为邪气在里故也。
此法率以丸而不以汤者，急药缓服也。待至攻去其邪，里邪势杀，而后以补药尽其余焰，故
效捷而亦无余患也。后人识力不及，每谓风寒初起，正气未亏，无庸兼补，更有谓邪气在表
，兼补即引邪入里者，往往攻药不得补药之力，邪气纠缠不尽，或攻伤正气，邪转内陷者，
其弊由于不识古人急补之义也。及治久病，邪气胶固，反夹杂补药，更有专补不攻，谓正气
充足，病自渐瘳者，殊不知邪气盘踞于里，补药性力皆走里而守中，其气正与邪气相值，不
能与正气相接也，往往使邪气根株愈牢，坚不可拔，迁延不救者，其弊由于不识古人急攻之
义也。大凡攻补兼施者，须详虚处有邪无邪，为第一要义；虚处有邪，则补虚之药，不免
固
邪矣。此施治之最棘手者。古人补母泻子之法，殆起于此。如肺气既虚，而又有风热或痰饮
之实邪，此宜补脾而攻肺，不得补肺与攻肺并用也。
凡是风、寒、湿、热这些病邪，散漫分布于全身腠理（皮肤肌肉间的间隙）中的，没有集中歼灭的方法，就顺应其散漫之势而发散它；痰、血、水饮、食积，结聚在胃与大小肠、膀胱内部的，已经属于有形之邪，势力难以消散，就顺应其结聚之势而通泄它、渗利它；邪气在上脘部位，感到心中烦闷想呕吐，这是气机想要上升却受阻不畅，就顺应其势而催吐它；邪气在大肠，出现腹痛窘迫、肛门重坠感，这是气机想要下行却排泄不畅，就顺应其势而通便导滞。这是顺应病邪的趋势而加以引导的治疗方法。温热病邪无形质，散处于肠胃的膜络之中，既不从体表外越，又不向内部结聚，就用酸味收敛药配合泄热药，捕捉并清除病邪；瘀血是有形之邪，结聚在肠胃的膜络之中，其质地凝滞，不能被药物轻易撮取而去掉，就用辛温性质的药物配合活血攻逐药，温通血液使其化散。肾气不能摄纳，根本浮动，出现气喘、呕吐、头晕目眩等症状，用酸咸重镇的药物，抑制上逆之气；中气虚弱下陷，导致腹泻痢疾无度，呼吸短促无力，用固涩升提补益的药物，举陷升阳。这是矫正病邪趋势而挽回局面的治疗方法。凡是误用降法治疗的疾病，想要补救它，不可急于使用升提法；误用升法治疗的疾病，想要补救它，不可急于使用降法；误用寒法治疗的疾病，想要补救它，不可急于使用大热药；误用热法治疗的疾病，想要补救它，不可急于使用大寒药。寒热之误或许还可以急救，但升降之误绝对不可急于纠正。我曾见到先用承气汤类方剂误用攻下，导致中气下陷，又急于用人参、升麻等升提，导致虚气上越，气喘逼迫不能进食而死。这种情况应当健运中气、涩肠止泻，不可再升提上部之气。
凡疾病都适宜攻邪，但有时需要兼用补法，是因为体内正气虚弱。内虚的含义有两点：一是体内的正气自然虚弱；二是邪气在体表，体表表现为实证，但邪气尚未入里，体内尚且虚弱。新发病邪浅表，在攻邪药剂中加入补气血的药物，所以病去而无后患；如果是久病正气受伤，邪气已经内陷，一旦加入补药，就会与邪气相抵触，导致攻邪药不能充分发挥其作用。所以华元化、张仲景、孙思邈书中的治疗久病的方剂，反而重用攻邪药物，不佐以补药，是因为邪气在里的缘故。这种方法通常制成丸剂而不制成汤剂，是为了让急性的药物缓慢服用。等到攻去了邪气，里部的邪气势头减弱之后，再用补药清除残余的病邪，所以疗效迅速且无后患。后人见识能力不及古人，常常认为风寒初起时，正气未亏，不需要兼用补法；更有甚者认为邪气在表时，兼用补法会引邪深入体内，往往导致攻邪药得不到补药的支持，邪气纠缠不尽，或者攻邪伤了正气，邪气反而内陷，这种弊端是由于不认识古人“急补”的意义。等到治疗久病，邪气胶着牢固，反而夹杂补药，更有专门只用补法不用攻法，认为正气充足，病自然会逐渐痊愈的，殊不知邪气盘踞在体内，补药的性力都趋向于里部且守中，其气正与邪气相对抗，不能与正气相接合，往往使邪气的根基更加牢固，坚不可拔，拖延至无法救治的地步，这种弊端是由于不认识古人“急攻”的意义。大凡攻补兼施的方法，必须详细辨别虚弱之处是否有邪气，这是第一要义；如果虚弱之处有邪气，那么补虚的药物，难免会固留邪气。这是施治中最棘手的情况。古人“补母泻子”的方法，大概就起源于此。例如肺气已经虚弱，同时又有风热或痰饮等实邪，这应该补脾脏而攻伐肺脏，不得同时补肺和攻肺。
When wind, cold, dampness, and heat pathogens are scattered throughout the *couli* (interstices of skin and muscles) of the entire body, there is no method to annihilate them all at once; therefore, one should follow their scattered nature and disperse them. When phlegm, blood stasis, fluid retention, and food stagnation accumulate within the stomach, large intestine, small intestine, and bladder, they have already become tangible pathogens that are difficult to dissipate by force; thus, one should follow their aggregated nature to purge and渗利 (percolate/drain) them. When pathogens reside in the upper epigastrium (*Shangwan*), causing a sense of oppression and the urge to vomit, this indicates an attempt to ascend that is obstructed; hence, one should induce vomiting to follow this trend. When pathogens reside in the large intestine, causing tenesmus (*lijihouzhong*), this indicates an obstruction in descending and defecating; hence, one should promote bowel movement to follow this trend. This constitutes treatment that facilitates the disease's momentum.
When warm-heat pathogens are intangible and scattered within the membranes and collaterals of the stomach and intestines, neither escaping outward nor aggregating inward, one should use sour-astringent agents combined with purgatives to capture and exhaust the pathogens. When blood stasis is tangible and aggregated within the membranes and collaterals of the stomach and intestines, its quality is coagulated and stagnant, making it impossible to be captured and removed easily; thus, one should use acrid-warm agents combined with blood-invigorating formulas to warm the blood and resolve the stasis. When Kidney Qi fails to receive and anchor, causing root instability, manifesting as asthma, vomiting, and vertigo, one should use sour-saline heavy-settling agents to suppress the upward rebellion. When Middle Qi is deficient and sinking, leading to uncontrolled diarrhea or dysentery and shortness of breath, one should use astringent, ascending, and tonifying agents to lift the sinking Qi. This constitutes treatment that corrects the disease's momentum and restores balance.
For diseases treated erroneously with descending methods, rescue requires avoiding immediate ascending methods. For diseases treated erroneously with ascending methods, rescue requires avoiding immediate descending methods. For diseases treated erroneously with cooling methods, rescue requires avoiding immediate administration of great-hot herbs. For diseases treated erroneously with heating methods, rescue requires avoiding immediate administration of great-cold herbs. Errors of cold and heat may sometimes be corrected urgently, but errors of ascending and descending must never be rushed. I have witnessed cases where *Chengqi Tang* (Gut-Purging Decoction) was mistakenly used for purging, causing Middle Qi to sink, followed by an urgent use of *Renshen* (Ginseng Radix) and *Shengma* (Cimicifugae Rhizoma) to lift, resulting in floating deficiency Qi, severe asthma, inability to eat, and death. In such cases, one should strengthen the Middle and astringe the lower bowels, not lift the Upper Qi.
All diseases generally require attacking pathogens, but sometimes supplementation is necessary due to internal deficiency. "Internal deficiency" has two meanings: first, the body's righteous Qi is inherently deficient; second, pathogens are on the exterior, making the exterior excess, while the interior remains deficient because pathogens have not yet entered the interior. In new diseases with shallow pathogens, adding Qi- and Blood-tonifying herbs to pathogen-attacking formulas allows the disease to be eliminated without residual complications. However, in chronic diseases where righteous Qi is injured and pathogens have sunk inward, adding tonifying herbs will clash with the pathogens, preventing the attacking herbs from exerting their full effect. Therefore, in the works of Hua Yuantuo, Zhang Zhongjing, and Sun Simiao, formulas for treating chronic diseases heavily emphasize attacking pathogens without accompanying tonification, because the pathogens are located in the interior. These methods are usually formulated as pills rather than decoctions to administer potent drugs slowly. After the pathogens are expelled and the interior pathogenic momentum subsides, tonifying herbs are then used to clear any remaining pathogenic remnants, ensuring rapid efficacy without residual issues. Later physicians, lacking the insight of the ancients, often claimed that when wind-cold first arises, righteous Qi is undamaged and supplementation is unnecessary. Others argued that supplementing when pathogens are on the exterior would draw pathogens inward. Consequently, attacking herbs often lack the support of tonics, leading to lingering pathogens, damage to righteous Qi, and inward sinking of pathogens. This drawback stems from a failure to understand the ancients' principle of "urgent tonification." Conversely, when treating chronic diseases with stubborn pathogens, some incorrectly mix in tonifying herbs, or even use only tonification without attack, believing that sufficient righteous Qi will gradually cure the disease. They fail to realize that when pathogens are entrenched in the interior, tonifying herbs tend to act on the interior and remain centered; their energy directly confronts the pathogens rather than supporting the righteous Qi. This often solidifies the pathogenic roots, making them unshakeable and leading to incurable delays. This drawback stems from a failure to understand the ancients' principle of "urgent attack." Generally, when combining attacking and tonifying methods, the primary prerequisite is to carefully determine whether there are pathogens in the deficient areas. If pathogens exist in deficient areas, tonifying herbs will inevitably consolidate the pathogens. This is the most difficult aspect of treatment. The ancient method of "tonifying the mother and draining the child" likely originated from this principle. For example, if Lung Qi is deficient while substantial pathogens like wind-heat or phlegm-fluid are present, one should tonify the Spleen and drain the Lung, rather than simultaneously tonifying and draining the Lung.