汉·张仲景治伤寒，立一百十三方，此用方之祖也。其中增减分合，立法最善。如桂枝
汤加
葛根，则为桂枝加葛根汤，此增法也。桂枝汤去芍药，则为桂枝去芍药汤，此减法也。桂枝
汤去芍药加附子，此增减并用法也。桂枝二麻黄一汤，桂枝二越婢一汤，此合法也。桂枝麻
黄各半汤，此合而兼分之法也。盖病情百变，方难胶一。故有一方之中，寒热并用，仲景附
子泻心汤是也。攻补并用，陶氏黄龙汤是也。若药性相反而兼用者，胡洽治痰癖，十枣汤加
甘草，丹溪治劳瘵，莲心饮与芫花同行是也。又如丹溪治一妇，用四物汤去川芎倍地黄加白
术黄 黄柏甘草人参一帖，腹大泄，目无视，口无言，知其病势深而药无反佐之功也，仍用
前药炒熟与之而愈。此同一方，而一生一熟，相悬天壤也。至于君臣佐使，尤不可不知。如
六君子专补气，故以人参为君，四物汤专补血，故以当归为君，切不可凌乱杂用，致昧要领
。欲为医者，能先明制方之法，无难奏效。余治汪妇两目赤肿，左关脉沉数而微涩，此郁火
伤肝症，宜用逍遥散。然时值暑令，恐柴胡复升动其火，因去之，加青蒿而病除。又治谢某
，火旺水亏，宜用六味丸，但目有星障，不宜酸敛，因去萸肉加女贞而病除。又治谢某两目
，红丝下坠，此由操劳过度，思虑伤脾，以致脾火刑金，宜用归脾汤。但脾中尚有郁火
，恐木香太燥，且能破气，因去之，加麦冬以润肺而病除。又治吴某厥阴头痛，气血素亏，
脾肾两经复感受寒邪，致左目凝翳赤障，下起伤痕，宜用温补之剂。但仅祛脾脏之寒，则水
不得温，仅祛肾脏之寒，则土不得暖。余以理中汤理阴煎，合治之而病除。凡兹各法，未可
概述，但能随证应变，自免刻舟求剑之弊。若症有相似，方无参用，如阴症似阳者，其人目
肿面赤，烦躁咽痛，身有微热，大便秘结，有似阳症，但渴欲饮水，复不能饮，切其脉沉细
迟微或轻按洪数，重按沉弱无力，此乃水极似火。王太仆所谓身热脉数，按之不鼓击者，名
阴盛格阳，非热也，宜用通脉四逆汤，倍加附子人参，以接其真阳之气。设投寒凉，下咽即
毙。阳证似阴者，其人目微赤，身寒逆冷，神气昏昏，状若阴证，然渴能饮水，大便硬秘，
小便赤涩，设有稀粪利出者，乃旁流之物，非冷利也。其脉虽沉，切之必滑数有力，王太仆
所谓病患身寒厥冷，其脉滑数，按之鼓击者，名阳盛格阴，非寒也。轻者白虎汤，重者承气
汤。倘投温热，医杀之也。又有隔治一法，如六节脏象论曰∶未至而至，此为太过，则薄所
不胜而乘所胜也。张介宾谓凡五行之气，克我者为所不胜，我克者为所胜，假如木气有余，
金不能制，而木反侮金，薄所不胜也。余尝治一目痛脾泄呕吐之证，专用四君子而愈。盖此
症由脾土衰弱，不能生金制木，时值春令，少阳用事，金气休囚，木挟相火，反刑肺金，故
致目痛呕吐，复克脾土，故致泄泻。若从伐肝木，木必不能受制，惟用隔治一法，补土以生
金，生金以制木，则金有生扶，木不能薄所不胜也。此即东垣补土平肝之意也。但天下之病
无穷，古人之方，不能尽其变态，则因证立方，当抒独见。曾有干某，某目为锻石所伤，黑
珠已损，视物不明，两眶肿痛。又有瘳妇，左目为火烙伤，黑珠已坏，疼痛难忍，此两症，
如《飞鸿集》、《龙木论》、《银海精微》、《原机启微》、《审视瑶函》等书，及各大家
集中，均所未载。余思石本属阳，又因火化灰，其性更烈，目为所伤，则血凝水涸，遂处一
方，以韭菜地上蚯蚓泥煎汤令服，其肿痛立消，继以凉血之剂，目遂还光。盖蚓本土德，而
星应轸，水味性咸寒，最能清热，其泥尤甘寒，泻热解毒，必用韭菜地上者。韭入血分而行
气，气血行则肿消，热毒清则痛止也。至火性燥烈，烙目尤酷，遂用陈菜子油令其灌洗，其
肿痛亦立消。盖菜子辛温无毒，陈则辛温之气稍泄，目方苦燥，得此润之，痛可少减。且味
带辛温，则能散其凝滞，而肿亦消矣。学人能细认病源，熟谙本草，何患症之难治哉。
汉代张仲景治疗伤寒，创立了一百一十三首方剂，这是使用方剂的始祖。其中增减、分合的立法最为精妙。例如桂枝汤加入葛根，就成为桂枝加葛根汤，这是增法。桂枝汤去掉芍药，就成为桂枝去芍药汤，这是减法。桂枝汤去掉芍药再加入附子，这是增减并用法。桂枝二麻黄一汤、桂枝二越婢一汤，这是合法（合并两方之意）。桂枝麻黄各半汤，这是合并兼分开的用法。因为病情变化多端，方剂难以拘泥于一种定式。所以有一方之中寒热药物并用的情况，如张仲景的附子泻心汤就是此类。攻邪与补益并用的情况，如陶华（陶氏）的黄龙汤就是此类。如果药性相反却兼用的情况，如胡洽治疗痰癖，在十枣汤中加入甘草；朱丹溪治疗劳瘵，让莲心饮与芫花同用，就是此类。又如朱丹溪治疗一位妇人，使用四物汤去掉川芎，加倍地黄，加入白术、黄芪、黄柏、甘草，服用一帖后，出现腹部胀大腹泻，眼睛看不见，口不能言的情况。朱丹溪判断其病势深重而药物缺乏反佐之功，于是仍将前药炒熟给她服用，结果痊愈。这是同一首方剂，但生用与熟用，效果相差悬殊。至于君臣佐使的配伍原则，尤其不可不知。例如六君子汤专门补气，所以以人参为君药；四物汤专门补血，所以以当归为君药。切不可杂乱无章地混用，以致迷失要领。想要成为医生，如果能先明白制方的法则，奏效并不难。
我治疗汪姓妇人的双眼红肿，左关脉沉数而微涩，这是郁火伤肝的症状，适宜使用逍遥散。然而当时正值暑令，担心柴胡再次升动其火，因此去掉柴胡，加入青蒿，病就好了。又治疗谢某，火旺水亏，适宜使用六味丸，但眼中有关星障，不宜使用酸敛之品，因此去掉山茱萸，加入女贞子，病就好了。又治疗谢某双眼红丝下坠，这是由于操劳过度，思虑伤脾，导致脾火刑克肺金，适宜使用归脾汤。但脾中尚有郁火，担心木香过于燥烈且能破气，因此去掉木香，加入麦冬以润肺，病就好了。又治疗吴某的厥阴头痛，患者气血素来亏虚，脾肾两经又感受寒邪，导致左目凝翳赤障，下方出现伤痕，适宜使用温补的药剂。但如果仅祛除脾脏的寒邪，则肾水不得温暖；仅祛除肾脏的寒邪，则脾土不得暖煦。我将理中汤与理阴煎合并治疗，病就好了。以上各种方法，无法一一概述，只要能随证应变，自然能避免刻舟求剑的弊端。
如果症状相似，方剂不能随意参用。例如阴症似阳者，其人目肿面赤，烦躁咽痛，身体有微热，大便秘结，看似阳症，但口渴想喝水却又喝不下，切其脉象沉细迟微，或者轻按洪数，重按沉弱无力，这是水极似火。王太仆所说的“身热脉数，按之不鼓击者”，名为阴盛格阳，并非热症，适宜使用通脉四逆汤，加倍加入附子和人参，以接续其真阳之气。如果投用寒凉药物，咽下即死。阳证似阴者，其人眼目微赤，身体寒冷逆冷，神气昏昏，状若阴证，然而能饮水，大便硬秘，小便赤涩，即使有稀粪排出，也是旁流之物，并非冷利。其脉虽沉，切之必滑数有力，王太仆所说的“病患身寒厥冷，其脉滑数，按之鼓击者”，名为阳盛格阴，并非寒症。轻者用白虎汤，重者用承气汤。如果投用温热药物，是医生害死了病人。
又有隔治这一方法，如《素问·六节脏象论》所说：“未至而至，此为太过，则薄所不胜而乘所胜也。”张介宾说凡是五行之气，克我者为所不胜，我克者为所胜。假如木气有余，金不能制约，而木反而侮金，这就是“薄所不胜”。我曾治疗一例目痛、脾泄、呕吐的病症，专门使用四君子汤而痊愈。因为这个病症是由于脾土衰弱，不能生金制木，当时正值春季，少阳当令，金气休囚，木挟带相火，反而刑克肺金，所以导致目痛呕吐，进而克制脾土，所以导致泄泻。如果从伐肝木入手，木必然不能受制，只有使用隔治这一方法，补土以生金，生金以制木，那么金有生扶，木就不能侵犯所不胜了。这就是李东垣补土平肝的意思。但是天下的疾病无穷无尽，古人的方剂不能完全穷尽病情的变态，因此应当因证立方，抒发独到见解。
曾经有一位干某，右目被锻石所伤，黑珠已损，视物不明，眼眶肿痛。又有一位瘳妇，左目被火烙伤，黑珠已坏，疼痛难忍。这两个病症，在《飞鸿集》、《龙木论》、《银海精微》、《原机启微》、《审视瑶函》等书，以及各家医集中，均未记载。我思考锻石本属阳，又因火化成灰，其性质更猛烈，眼睛被它伤害，则血凝水涸，于是开出一方，用韭菜地上的蚯蚓泥煎汤令其服用，肿痛立刻消除，继以凉血药剂，眼睛便恢复了光明。大概蚯蚓得土德之气，而星宿对应轸宿，水性味咸寒，最能清热，其泥土尤其甘寒，能泻热解毒，必须用韭菜地上的。韭菜入血分而行气，气血行则肿消，热毒清则痛止。至于火性燥烈，烙眼尤其酷烈，于是用陈年的菜子油令其灌洗，肿痛也立刻消除。大概菜子辛温无毒，陈久则辛温之气稍减，眼睛苦燥，得到此油滋润，疼痛可稍减轻。而且味道带辛温，则能消散其凝滞，肿胀也就消除了。学医者如果能仔细辨认病源，熟谙本草知识，还担心病症难治吗？
Han Dynasty's Zhang Zhongjing treated Shanghan (Cold Damage), establishing 113 formulas, which is the ancestor of using formulas. Among them, the principles of addition, subtraction, separation, and combination are most excellent. For example, adding Gegen (Puerariae Radix) to Guizhi Tang (Cinnamon Twig Decoction) results in Guizhi Jia Gegen Tang (Cinnamon Twig with Pueraria Decoction); this is the method of addition. Removing Shaoyao (Paeoniae Radix Alba) from Guizhi Tang results in Guizhi Qu Shaoyao Tang (Cinnamon Twig without White Peony Root Decoction); this is the method of subtraction. Removing Shaoyao and adding Fuzi (Aconiti Lateralis Radix Praeparata) to Guizhi Tang is the method of simultaneous addition and subtraction. Guizhi Er Mahuang Yi Tang (Two Parts Cinnamon Twig and One Part Ephedra Decoction) and Guizhi Er Yueshi Yi Tang (Two Parts Cinnamon Twig and One Part Yuebi Decoction) represent the method of combination (merging two formulas). Guizhi Mahuang Ban Ge Tang (Half-and-Half Cinnamon Twig and Ephedra Decoction) represents a method of combination combined with separation. Since disease conditions change in myriad ways, formulas cannot be rigidly fixed. Therefore, there are instances where cold and hot herbs are used together in one formula, such as Zhang Zhongjing's Fuzi Xie Xin Tang (Aconite Draining the Epigastrium Decoction). There are instances where purgation and tonification are used together, such as Tao Hua's (Tao Shi's) Huanglong Tang (Yellow Dragon Decoction). There are also cases where herbs with opposing properties are used together, such as Hu Qia treating phlegm-stasis by adding Gancao (Licorice Root) to Shizao Tang (Ten Jujube Decoction), or Zhu Danxi treating consumption by administering Lianxin Yin (Lotus Plumule Infusion) together with Yuanhua (Genkwa Flower). Furthermore, Zhu Danxi treated a woman using Siwu Tang (Four Substance Decoction), removing Chuanxiong (Ligustici Rhizoma et Radix), doubling Dihuang (Rehmanniae Radix), and adding Baizhu (Atractylodis Macrocephalae Rhizoma), Huangqi (Astragali Radix), Huangbai (Phellodendri Cortex), Gancao (Licorice Root), and Renshen (Ginseng Radix). After one dose, she suffered abdominal distension and diarrhea, blindness, and muteness. Zhu Danxi deduced that the disease was deep-seated and the medication lacked the effect of counteracting assistance (fan zuo). He then administered the same decoction after stir-frying it, and she recovered. This demonstrates that for the same formula, raw versus cooked application yields vastly different results. The principles of Jun (Sovereign), Chen (Minister), Zuo (Assistant), and Shi (Envoy) must especially be understood. For instance, Liujunzi Tang (Six Gentlemen Decoction) specifically tonifies Qi, so Renshen (Ginseng Radix) is the Sovereign herb; Siwu Tang (Four Substance Decoction) specifically tonifies Blood, so Danggui (Angelicae Sinensis Radix) is the Sovereign herb. One must not mix them chaotically, lest one lose the main objective. To become a physician, if one first understands the methods of formulating prescriptions, achieving efficacy will not be difficult.
I treated a Mrs. Wang for redness and swelling of both eyes. Her left Guan pulse was deep, rapid, slightly choppy, and faint. This indicated Liver injury by constrained fire, suitable for Xiaoyao San (Free and Easy Wanderer Powder). However, since it was the summer season, I feared Chaihu (Bupleuri Radix) might further ascend and agitate the fire, so I removed it and added Qinghao (Artemisiae Annuae Herba), resulting in recovery. I also treated Mr. Xie, who had excessive Fire and deficient Water, suitable for Liuwei Wan (Six-Ingredient Pill with Rehmannia). However, he had star-shaped opacities in the eyes, making astringent herbs unsuitable, so I removed ShanYuzhu (Corni Fructus) and added Nvzhenzi (Ligustri Lucidi Fructus), resulting in recovery. I also treated another Mr. Xie whose eyes showed red veins drooping downwards. This was due to overwork and excessive worry injuring the Spleen, leading to Spleen Fire punishing Lung Metal. GuiPi Tang (Restore the Spleen Decoction) was appropriate. However, there was still constrained fire in the Spleen, and I feared Muxiang (Aucklandiae Radix) was too drying and could break Qi, so I removed it and added Maidong (Ophiopogonis Radix) to moisten the Lung, resulting in recovery. I also treated Mr. Wu for Jueyin headache. His Qi and Blood were inherently deficient, and his Spleen and Kidney meridians were affected by Cold pathogens, causing a white opacity and red barrier in the left eye with scars below. A warming and tonifying agent was appropriate. But if only Spleen Cold is dispelled, Kidney Water is not warmed; if only Kidney Cold is dispelled, Spleen Earth is not warmed. I combined Lizhong Tang (Regulate the Middle Decoction) and Liyin Jian (Infusion to Nourish Yin) to treat him, resulting in recovery. These various methods cannot be fully summarized here. As long as one adapts to the syndrome, one can avoid the error of carving a mark on the boat to find the sword.
If symptoms are similar, formulas should not be used interchangeably. For example, in Yin syndromes resembling Yang, the patient has swollen eyes and red face, irritability, sore throat, slight body heat, and constipation, resembling a Yang syndrome. However, although thirsty, they cannot drink. The pulse is deep, fine, slow, and faint, or superficially rapid and forceful but deeply weak and powerless. This is Water extreme resembling Fire. As Wang Taipu stated: "Body heat with a rapid pulse that does not beat forcefully upon pressure" is named Yin Excess repelling Yang (Yin Sheng Ge Yang), not Heat. Tongmai Sini Tang (Pulse-Reviving Counterflow Cold Decoction) with doubled Fuzi (Aconiti Lateralis Radix Praeparata) and Renshen (Ginseng Radix) is suitable to reconnect True Yang Qi. If cold-natured herbs are administered, death follows immediately. In Yang syndromes resembling Yin, the patient has slightly red eyes, cold limbs, lethargy, resembling a Yin syndrome. However, they can drink water, have hard constipation, and dark scanty urination. Even if loose stool passes, it is side-flowing fluid, not cold diarrhea. The pulse may be deep, but upon palpation, it is slippery, rapid, and forceful. Wang Taipu stated: "Patient with cold body and厥冷 (cold extremities), yet pulse is slippery and rapid, beating forcefully upon pressure" is named Yang Excess repelling Yin (Yang Sheng Ge Yin), not Cold. Mild cases use Baihu Tang (White Tiger Decoction); severe cases use Chengqi Tang (Order the Qi Decoction). If warm-hot herbs are administered, the physician kills the patient.
There is also the method of distant treatment (Ge Zhi). As stated in the *Suwen* Chapter on Six Sections and Viscera Images: "Arrival before time is excess, which attacks the element that does not overcome it and conquers the element it overcomes." Zhang Jiebin said that among the Five Elements, the one that overcomes me is "that which does not overcome me," and the one I overcome is "that which I overcome." For example, if Wood Qi is excessive, Metal cannot control it, and Wood insults Metal, attacking "that which does not overcome me." I once treated a case of eye pain, Spleen diarrhea, and vomiting using only Sijunzi Tang (Four Gentlemen Decoction) with success. This condition arose because Spleen Earth was weak and could not generate Metal to control Wood. During spring, Shaoyang (Lesser Yang) was dominant, Metal Qi was dormant, and Wood carried Ministerial Fire to punish Lung Metal, causing eye pain and vomiting, which then suppressed Spleen Earth, causing diarrhea. If one attacks Liver Wood directly, Wood cannot be controlled. Only by using the distant treatment method—tonifying Earth to generate Metal, and generating Metal to control Wood—can Metal receive support, preventing Wood from attacking "that which does not overcome me." This aligns with Li Dongyuan's idea of tonifying Earth to level Liver. However, diseases are infinite, and ancient formulas cannot cover all variations. Thus, one must formulate prescriptions based on the syndrome, offering unique insights.
Once, a patient named Gan injured his right eye with smelting stone. The black pupil was damaged, vision was unclear, and the eye sockets were swollen and painful. Another patient, Mrs. Chou, burned her left eye with fire. The black pupil was ruined, and pain was unbearable. Neither case was recorded in *Feihong Ji*, *Longmu Lun*, *Yinhai Jingwei*, *Yuanji Qiwei*, *Shenxi Yaohan*, nor in any major physician's collected works. I reasoned that smelting stone is Yang in nature, and when calcined into ash, its nature becomes even more fierce. Injury to the eye causes blood coagulation and fluid depletion. I prescribed a formula using earthworm mud from leek fields boiled in water for oral administration. Swelling and pain subsided immediately. Subsequently, cooling-blood herbs restored vision. Earthworms possess Earth virtue and correspond to the Zhen constellation. Their nature is salty and cold, effectively clearing heat. The mud is particularly sweet and cold, draining heat and detoxifying. Mud from leek fields is essential. Leeks enter the Blood aspect and move Qi; moving Qi reduces swelling, and clearing heat stops pain. Regarding fire burns, the nature is dry and fierce, burning the eye severely. I used aged rapeseed oil for irrigation. Swelling and pain subsided immediately. Rapeseed is pungent, warm, and non-toxic. Aging dissipates some pungency and warmth. The eye suffers from dryness and bitterness; this oil moistens it, reducing pain. Its pungent-warm flavor disperses stagnation, resolving swelling. If students carefully identify the disease source and master Materia Medica, what reason would there be to fear difficult treatments?