愚按张通一先生曰∶治有逆从者以病有微甚。病有微甚者以证有真假也。寒热有真假。
治法
亦有真假。真者正治。治之无难。假者反治。乃为难耳。如寒热之有真假者。真寒则脉沉而
细。或沉而迟。为厥逆。为呕吐。为腹痛。为餐泄下利。为小便清频。即有发热。必欲得衣
此浮热在外而沉寒。在内也。真热则脉有力而数。滑大而实。为烦躁喘满。为音声壮厉。或
大便秘结。或小利赤涩。或发热掀衣或胀疼热渴。此皆真病真寒者。宜温其寒真热者。直解
其热是。皆正治者也。假寒者。阳证似阴火极似水也。外虽寒而内则热。脉数而有力。或沉
而鼓击。或身寒恶衣。或便热秘结。或烦渴引饮。或肠垢臭秽。此则恶寒非寒明是热证所谓
热极反兼寒化亦曰阳盛隔阴也。假热者阴证似阳水极似火也。外虽热而内则寒。脉微而弱。
或数而虚。或浮大无根。或弦芤断续。身虽炽热而神则静。语虽谵妄而声则微。或虚狂起倒
。
而禁之即止。或蚊迹发斑。浅红细碎。或喜冷水而所用不多。或舌苔面赤。而衣被不撤。或
小水多利。或大便不结。此则恶热非热明是寒证所谓寒极反兼热化亦曰阴盛隔阳也。此皆假
病假寒者清其内热内清则浮热退舍矣。假热者温其真阳中温则虚火归原矣。是当从治也。又
如虚
实之治。实则泻之。虚则补之。此不易之法也。然至虚有盛候则为假实矣。大实有羸状则为
假虚矣。总之虚者正气虚也。为色惨神疲。为神衰气怯。或自汗不收。或二便失禁。或梦寐
精滑。或呕吐隔塞。或病久攻多。或气短如喘。或劳伤过度。或暴困失志。虽外证似实。而
脉弱无神者。皆虚证之。当补也。实者邪气实也。或外闭于经络。或内结于脏腑。或气壅而
不行。或血流而凝滞。必脉病俱盛者。乃实证之当攻也。然而虚实之间最多疑似有不可不辨
其真耳。如通评虚实论曰。邪气盛则实。精气夺则虚。此虚实之大法也。设有人焉正已夺而
邪方盛者将顾其正而补之乎。抑先其邪而攻之乎。见有不的。生死系之。此所以宜慎也。夫
正者本也。邪者标也。若正气既虚。则邪气虽盛。亦不可攻。盖恐邪未去。而正先脱呼吸虚
生。则措手无及。故治虚邪者当先顾正气正气存则不致于害且补中自有攻意。盖补阴即所以
攻热。补阳即所以攻寒。世未有正气复而邪不退者。亦未有正气竭而命不倾者。如必不得已
。亦当酌量缓急。暂从权宜。从多从少。寓战于守。斯可矣。此治虚之道也。若正气无损者
邪气虽微。自不宜补。盖补之则正无预而邪反盛。适足以藉寇兵而资盗粮。故治实证者当直
去其邪。邪去则身安。但法贵专精。便臻速效。此治实之道也。要之能胜攻者方是实证。实
者可攻。何虑之有。不能胜攻者便是虚证气去不返。可不寒心。此邪正之本末有不可不知也
。惟是假虚之证不多见。而假实之证最多也。假寒之证不难治。而假热之治多。误也然实者
多热。虚者多寒。如丹溪曰气有余便是火。故实能受寒。而余续之曰。气不足便是寒故虚能
受热。世有不明真假标本。而曰知医者余则未敢许也。
我考察张通一先生的观点说：治疗有逆治和从治的区别，是因为病情有轻微和严重的不同。病情有轻微和严重，是因为证候有真和假的分别。寒热证也有真和假之分。治疗方法也有真和假之别。真正的病证采用正治法，治疗起来没有困难；虚假的病证采用反治法，这才是难点所在。
关于寒热证的真假：
真正的寒证，脉象沉细，或者沉迟，表现为四肢厥冷、呕吐、腹痛、完谷不化的泄泻或下利、小便清长频数。即使有发热症状，患者也一定想要穿衣盖被。这是浮热在外而沉寒在内的表现。
真正的热证，脉象有力且数，滑大坚实，表现为烦躁、气喘胸闷、声音洪亮粗厉。或者大便秘结，或者小便短赤涩痛，或者发热掀开衣被，或者腹胀疼痛、口渴喜冷饮。这些都是真病、真热证。对于真寒证，应当温散其寒；对于真热证，应当直接清解其热。这都属于正治法。
假寒证，是阳证似阴，火极似水。外表虽然寒冷，但内部却是热的。脉象数而有力，或者沉取时鼓击有力。或者身体寒冷却厌恶穿衣，或者大便燥结且灼热，或者烦渴引饮，或者排泄物如肠垢般臭秽。这就是恶寒并非真寒，明明白白是热证，所谓“热极反兼寒化”，也称为“阳盛隔阴”。
假热证，是阴证似阳，水极似火。外表虽然发热，但内部却是寒的。脉象微细虚弱，或者数而无力，或者浮大无根，或者弦芤且断续不定。身体虽然炽热但神志安静，说话虽然谵妄但声音微弱，或者虚性狂躁起倒，制止后即停止。或者皮肤出现蚊迹般的发斑，颜色浅红细碎，或者喜欢冷水但饮用不多，或者舌苔面赤但穿着衣被不撤去，或者小便多利，或者大便不干结。这就是恶热并非真热，明明白白是寒证，所谓“寒极反兼热化”，也称为“阴盛隔阳”。
对于假寒证（内热外寒），应当清解其内热，内热清除则浮热自然消退。对于假热证（内寒外热），应当温补其真阳，真阳温补则虚火自然归原。这属于从治法。
又如虚实的治疗：实证用泻法，虚证用补法，这是不变的原则。然而，极度虚弱的病证可能出现盛实的假象，称为假实；极度实盛的病证可能出现羸弱的假象，称为假虚。
总之，虚证是正气虚衰，表现为面色惨淡、精神疲惫、神气衰弱怯弱，或者自汗不止，或者大小便失禁，或者睡梦中遗精滑泄，或者呕吐膈塞不通，或者久病攻伐过多，或者气短如同喘息，或者劳伤过度，或者突然困顿意志消沉。虽然外在证候似实，但脉象软弱无神的，都是虚证，应当补益。
实证是邪气盛实，或者邪气闭阻于经络，或者结聚于脏腑，或者气机壅滞不行，或者血液凝滞。必须脉象和病证都盛实的，才是实证，应当攻逐。
然而虚实之间最容易混淆，不可不辨别其真伪。正如《通评虚实论》所说：“邪气盛则实，精气夺则虚。”这是虚实的大法。假设有人正气已受损而邪气正盛，此时是顾护正气先进行补益呢，还是先祛除邪气进行攻逐呢？如果见解不确切，生死攸关，所以必须谨慎。
正气是本，邪气是标。如果正气已经虚弱，那么即使邪气很盛，也不可攻伐。因为恐怕邪气未去，正气先脱，呼吸间产生变化，就来不及措手了。所以治疗虚邪夹杂的病证，应当先顾护正气。正气存在就不会受害，而且补益之中自有攻邪之意。补阴就是用来清热，补阳就是用来散寒。世上没有正气恢复而邪气不退的情况，也没有正气枯竭而生命不倾覆的情况。如果迫不得已，也应当斟酌缓急，暂时权宜处理，根据情况决定攻补的多寡，寓攻于守，这样就可以。这是治疗虚证的方法。
如果正气没有损伤，即使邪气轻微，也不宜补益。因为补益则正气无益而邪气反而更盛，这恰恰是给敌人提供武器、资助盗贼粮食。所以治疗实证应当直接去除邪气，邪气去除则身体平安。但方法贵在专精，才能迅速见效。这是治疗实证的方法。
总而言之，能够承受攻伐治疗的才是实证，实证可以攻伐，有什么可忧虑的呢？不能承受攻伐治疗的便是虚证，气去而不返，怎能不令人寒心。这是邪正的本末关系，不可不知道。
只是假虚的证候不多见，而假实的证候最多。假寒的证候不难治疗，而假热的证候治疗容易出错。一般来说，实证多热，虚证多寒。如朱丹溪所说：“气有余便是火。”所以实证能耐受寒凉药。我接着说：“气不足便是寒。”所以虚证能耐受温热药。世间有不明白真假标本，却自称懂医的人，我不敢苟同。
I have examined Mr. Zhang Tongyi's view, which states: Treatment involves either contrary (Ni) or following (Cong) methods because diseases vary in severity. Disease severity varies because syndromes present as either true (Zhen) or false (Jia). Cold and Heat syndromes also have true and false distinctions. Consequently, treatment methods also have true and false applications. True conditions are treated with standard treatment (Zheng Zhi), which is not difficult. False conditions require reverse treatment (Fan Zhi), which is the challenging aspect.
Regarding the true and false nature of Cold and Heat:
True Cold presents with a deep (Chen) and fine (Xi) pulse, or a deep and slow (Chi) pulse. Symptoms include cold limbs (Jue Ni), vomiting, abdominal pain, diarrhea with undigested food (Can Xie), watery diarrhea (Xia Li), and clear, frequent urination. Even if fever occurs, the patient desires to wear clothes. This indicates floating heat on the exterior and sinking cold within.
True Heat presents with a forceful and rapid (Shu) pulse, slippery (Hua), large (Da), and solid (Shi). Symptoms include restlessness (Fan Zao), asthma and chest fullness (Man), loud and harsh voice, constipation, or scanty, red, and painful urination. The patient may throw off clothes due to fever, or experience abdominal distension, pain, heat, and thirst for cold drinks. These are all true diseases and true Heat syndromes. For true Cold, one should warm the cold; for true Heat, one should directly resolve the heat. Both are examples of standard treatment (Zheng Zhi).
False Cold is when Yang syndromes mimic Yin, or extreme Fire mimics Water. Although the exterior feels cold, the interior is hot. The pulse is rapid and forceful, or deep but beating forcefully upon palpation. The patient may feel cold and dislike clothing, yet have dry, bound stools that are hot, or experience irritability, thirst with desire to drink, or foul-smelling intestinal discharge. This is "aversion to cold" that is not true cold, clearly a Heat syndrome. It is referred to as "extreme heat manifesting with cold transformations," also known as "Yang excess blocking Yin."
False Heat is when Yin syndromes mimic Yang, or extreme Water mimics Fire. Although the exterior feels hot, the interior is cold. The pulse is faint (Wei) and weak (Ruo), or rapid but empty (Xu), or floating and large without root, or wiry (Xian) and hollow (Kou) with intermittent beats. The body may be burning hot, but the spirit is calm; speech may be delirious, but the voice is weak; or there may be virtual mania with falling, which stops when restrained. Skin spots may appear like mosquito bites, light red and fragmented. The patient may prefer cold water but drink little, or have a red tongue coating but refuse to remove blankets. Urination may be frequent, and stools may not be bound. This is "aversion to heat" that is not true heat, clearly a Cold syndrome. It is referred to as "extreme cold manifesting with heat transformations," also known as "Yin excess blocking Yang."
For False Cold (internal heat with external cold symptoms), one should clear the internal heat; once internal heat is cleared, the floating heat will retreat. For False Heat (internal cold with external heat symptoms), one should warm the true Yang; once true Yang is warmed, the defire fire will return to its origin. This constitutes following treatment (Cong Zhi).
Regarding the treatment of Deficiency (Xu) and Excess (Shi): Excess is treated by purging (Xie), and Deficiency is treated by tonifying (Bu). This is an unchangeable principle. However, extreme Deficiency can present with signs of Excess, called False Excess; extreme Excess can present with signs of Debility, called False Deficiency.
In summary, Deficiency refers to the deficiency of Right Qi (Zheng Qi). It manifests as a dismal complexion and mental fatigue, weak spirit and cowardly Qi, spontaneous sweating that does not stop, incontinence of urine and feces, nocturnal emission during sleep, vomiting and obstruction, excessive purgation over a long illness, shortness of breath resembling asthma, excessive labor injury, or sudden exhaustion and loss of will. Although external signs may resemble Excess, if the pulse is weak and lacks spirit, it is a Deficiency syndrome and should be tonified.
Excess refers to the abundance of Pathogenic factors (Xie Qi). Pathogens may close the meridians and collaterals externally, or knot in the zang-fu organs internally. Qi may be stagnant and unable to move, or blood may coagulate and stagnate. Only when both the pulse and disease manifestations are vigorous is it an Excess syndrome requiring attack/purging.
However, Deficiency and Excess are often confused, and their truth must be distinguished. As stated in *Tong Ping Xu Shi Lun*: "When pathogenic factors are abundant, it is Excess; when essential qi is depleted, it is Deficiency." This is the general principle of Deficiency and Excess. Suppose a person has depleted Right Qi while Pathogenic factors are abundant. Should one protect the Right Qi and tonify first, or eliminate the Pathogen and purge first? If the judgment is inaccurate, life and death depend on it, so caution is required.
Right Qi is the root (Ben); Pathogenic factors are the branch (Biao). If Right Qi is already deficient, even if Pathogenic factors are abundant, one must not attack. For fear that the Pathogen may not be expelled before the Right Qi collapses, leading to immediate changes in respiration and life, making it impossible to handle the situation. Therefore, when treating mixed Deficiency and Pathogenic conditions, one must first protect the Right Qi. If Right Qi is preserved, harm will not occur. Moreover, tonification contains the intent of purging. Tonifying Yin clears Heat; tonifying Yang disperses Cold. There is no case where Right Qi recovers while Pathogens remain, nor is there a case where Right Qi exhausts while life is preserved. If absolutely necessary, one must weigh urgency and slackness, adopt temporary expedients, and adjust the ratio of tonification and purging, embedding attack within defense. This is the method for treating Deficiency.
If Right Qi is undamaged, even if Pathogenic factors are slight, tonification is inappropriate. Tonification would benefit neither the Right Qi nor the Pathogen, but rather strengthen the Pathogen, akin to providing weapons to bandits and grain to thieves. Therefore, when treating Excess, one should directly eliminate the Pathogen. Once the Pathogen is gone, the body is safe. The method must be precise and specialized to achieve rapid effects. This is the method for treating Excess.
Ultimately, only those who can withstand purging are truly Excess; Excess can be attacked, so why worry? Those who cannot withstand purging are Deficient; if Qi departs and does not return, one should be terrified. This understanding of the root and branch of Pathogenic and Right Qi is indispensable.
False Deficiency syndromes are rare, while False Excess syndromes are common. False Cold is not difficult to treat, whereas False Heat is often mistreated. Generally, Excess tends toward Heat, and Deficiency tends toward Cold. As Zhu Danxi said: "Excess of Qi becomes Fire." Thus, Excess conditions can tolerate Cold herbs. I add: "Deficiency of Qi becomes Cold." Thus, Deficiency conditions can tolerate Warm herbs. In the world, those who do not understand the true and false, root and branch, yet claim to know medicine, I dare not endorse.