有脱血后而大动怒气者。必先调气以平肝。继则养血兼调气。有阴虚证而误服提补者。先救药误以消降之。继
用甘凉救液以清滋之。尤必明其气血偏胜。调剂之以归于平。
即阳盛格阴症。内经所谓大实有羸状是也。
【荣斋按】本节所谓“大实有羸状”，其病理机转，原文不加帮助，特根据现代学说补充如下∶凡大实大热
之症，则体内各组织各官能必异常兴奋亢进，亢进之极，则物质与势力的消耗必多；于是，它结果势必陷于疲
劳及衰弱。譬如散温机能亢盛，汗腺分泌太多，它结果必至汗腺疲劳，失掉收缩作用，所以有自汗不止的状
态。又如心脏弛张亢进，则喷射于体表末梢之血液必多，以事救济，结果亢进之极，也必发现了神经衰弱，所
以脉搏终至迟细无力；体温过于放散，其结果必至造温机能应付不及，而陷于疲惫及衰弱，始而全身壮热者，
继则肢冷如冰了。这都是体内的物质和势力消耗太多，又没有别的给它补充，势必至于反热为虚，反热为寒的
阶段，而呈现出“大实有羸状”的假证。题材所说“血真实而气假虚”，是不够明确的。至于上节所谓“阴盛
格阳症”，其病理机转，即是热力外越。它的证状，最难辨别；根据恽铁樵先生经验说∶“凡阴盛格阳大虚盛
候之病，色、脉、证三项，必有异乎寻常之现象，与其病候不相应。例如∶阳明面赤，脉则洪滑，色与脉相应
也，神气则见有余；戴阳为病，面如妆朱，脉数甚，无圆滑意，色与脉均异常，而神色若明若昧，色与脉不相
应矣。若当衰弱而见衰弱症象为相应，衰弱而见有余症象──且有余异常，即是不相应；不相应，大虚之盛
候也。”（见恽铁樵药物讲义）我认为本书中这两节最简略，简略得不成文理，主题也不够相称；本章第七、
八两节，也不能自圆其说。这四节，可说是全书中最难于理解的。
总而言之。纯虚证不多见。纯实证则常有。虚中夹实。虽通体皆现虚象。一二处独见实证。则实症反为
吃紧。实中夹虚。虽通体皆现实象。一二处独见虚症。则虚证反为吃紧。景岳所谓独处藏奸是也。医必操独见以治之。
有因失血之后又大动肝火的人。必须先调理气机以平抑肝木，随后再养血兼以调气。有阴虚证候却误服了升提补益药物的人。先要用消降的药物来解救药误，随后再用甘凉滋润的药物来救阴液、清虚热。尤其必须辨明气血的偏盛情况，进行调剂使其恢复平衡。
这就是阴寒内盛格拒阳气于外的证候。《内经》所说的“大虚而有盛实之假象”就是指的这种情况。
这就是阳热内盛格拒阴气于外的证候。《内经》所说的“大实而有羸弱之假象”就是指的这种情况。
【徐荣斋按】本节所说的“大实而有羸弱之假象”，其病理机制，原文没有加以解释，特根据现代医学学说补充如下：凡是属于大实大热的病证，体内各组织器官的功能必然异常兴奋亢进；亢进到极点，物质与能量的消耗必然极多；于是结果势必陷入疲劳和衰弱。例如散热功能亢盛，汗腺分泌过多，结果必然导致汗腺疲劳，失去收缩作用，所以出现自汗不止的状态。又如心脏搏动亢进，喷射到体表末梢的血液必然增多，试图进行救济，结果亢进到极点，也必然表现出神经衰弱，所以脉搏最终变得迟细无力；体温过度散发，结果必然导致产热功能应付不及，而陷入疲惫及衰弱，起初全身壮热，随后四肢冰冷如冰。这都是因为体内的物质和能量消耗太多，又没有其他来源予以补充，势必至于由热转虚，由热转寒的阶段，从而呈现出“大实而有羸弱之假象”的假证。本节标题所说的“血真实而气假虚”，表述是不够明确的。至于上一节所说的“阴盛格阳症”，其病理机制，即是热力外越。它的症状，最难辨别；根据恽铁樵先生的经验说：“凡是阴盛格阳、大虚而有盛实之假象的病，色、脉、证三项，必有异乎寻常的现象，与其病候不相适应。例如：阳明病面色红赤，脉象洪滑，色与脉是相应的，神气表现为有余；戴阳证为病，面色像化妆过的朱砂一样，脉数且急，没有圆滑之意，色与脉均异常，而神色若明若暗，色与脉不相适应。如果在衰弱时见到衰弱的症状为相应，而在衰弱时见到有余的症状——且这种有余是异常的，就是不相应；不相应，就是大虚的盛实假象。”（见恽铁樵药物讲义）我认为本书中这两节内容最为简略，简略得不成文理，主题也不够贴切；本章第七、八两节，也不能自圆其说。这四节，可以说是全书中最难于理解的。
总而言之。纯粹的虚证不多见。纯粹的实证则常有。虚证中夹杂实证，虽然全身都呈现虚象，但在一两处单独见到实证，那么实证反而成为关键。实证中夹杂虚证，虽然全身都呈现实象，但在一两处单独见到虚证，那么虚证反而成为关键。这就是张景岳所说的“独处藏奸”。医生必须抓住这“独见”之处进行治疗。
There are cases where, after severe blood loss, the patient becomes extremely angry. One must first regulate Qi to calm the Liver, followed by nourishing Blood while simultaneously regulating Qi. In cases of Yin deficiency where tonifying and ascending herbs were mistakenly administered, one must first use descending and resolving agents to counteract the medicinal error, followed by using sweet-cool fluids to rescue Yin and clear deficient heat. It is essential to clearly distinguish whether Qi or Blood is in excess, and adjust accordingly to restore balance.
This refers to the syndrome of Yin excess repelling Yang outward. This is what the *Neijing* (Classic of Internal Medicine) refers to as "great deficiency presenting with excessive symptoms."
This refers to the syndrome of Yang excess repelling Yin outward. This is what the *Neijing* refers to as "great excess presenting with emaciated/weak signs."
[Commentary by Xu Rongzhai] The pathological mechanism behind the statement "great excess presenting with emaciated signs" mentioned in this section is not explained in the original text. Therefore, I supplement it below based on modern medical theories: In conditions characterized by great excess and great heat, the functions of various tissues and organs in the body must be abnormally excited and hyperactive. When hyperactivity reaches its extreme, the consumption of substances and energy must be significant; consequently, the result inevitably leads to fatigue and debility. For example, if thermoregulatory function is hyperactive and sweat glands secrete excessively, the sweat glands will eventually become fatigued and lose their contractile ability, resulting in spontaneous sweating that does not stop. Similarly, if cardiac contraction is hyperactive, more blood is ejected to the peripheral extremities in an attempt to compensate. However, when this hyperactivity reaches its peak, it manifests as neurasthenia, causing the pulse to eventually become slow, fine, and weak. If body temperature dissipates excessively, the thermogenic function cannot keep up, leading to exhaustion and debility. Initially, there is high fever throughout the body, followed by cold limbs like ice. These occur because the body's substances and energy are consumed excessively without adequate replenishment, inevitably progressing from heat to deficiency, and from heat to cold, thereby presenting the false signs of "great excess manifesting as weakness." The title "Blood is truly excess while Qi is falsely deficient" is insufficiently precise. Regarding the previous section on "Yin excess repelling Yang," the pathological mechanism is the outward floating of heat. Its symptoms are the most difficult to differentiate. According to Mr. Yun Tieqiao's experience: "In diseases of Yin excess repelling Yang, where great deficiency presents with excessive signs, the complexion, pulse, and symptoms must exhibit phenomena abnormal compared to the norm, inconsistent with the disease pattern. For instance, in Yangming disease, the face is red, and the pulse is surging and slippery; the complexion and pulse correspond, and the spirit appears abundant. In Daiyang syndrome, the face is painted red like vermilion, the pulse is rapid and urgent without smoothness; both complexion and pulse are abnormal, yet the spirit is unclear or dim, meaning the complexion and pulse do not correspond. If weakness presents with weak symptoms, it corresponds; but if weakness presents with signs of abundance—and especially if this abundance is abnormal—it does not correspond. Non-correspondence indicates the excessive false signs of great deficiency." (See Yun Tieqiao's Lectures on Materia Medica). I believe these two sections in this book are too brief, so much so that they lack logical coherence and appropriate thematic focus; Sections 7 and 8 of this chapter also fail to be self-consistent. These four sections can be said to be the most difficult to understand in the entire book.
In summary. Pure deficiency syndromes are rare. Pure excess syndromes are common. Deficiency mixed with excess: although the whole body presents deficiency signs, if excess signs appear uniquely in one or two areas, the excess syndrome becomes the critical issue. Excess mixed with deficiency: although the whole body presents excess signs, if deficiency signs appear uniquely in one or two areas, the deficiency syndrome becomes the critical issue. This is what Zhang Jingyue referred to as "the hidden evil lies in the isolated sign." The physician must grasp this "isolated sign" to guide treatment.