大有羸状，误补益疾，至虚有盛候，反泻衔冤。阴症似乎阳，清之必毙∶阳症似乎阴，温之必
亡。盖积聚在中，按之则痛，色红气粗，脉来有力，实也；甚则嘿嘿不欲语，肢体不欲动，或眩晕
昏花，或泄泻不止，是大实有羸状也。若误补之，是盛盛也。心下痞痛，按之则止，色悴声短，脉
来无力，虚也；甚则胀极而食不得入，气不得舒，便不得利，是至虚有盛候也。若误泻之，是虚虚也。
阴盛之极，往往格阳，身热面红，口干喜冷，手足躁扰，语言 妄，脉来洪大，悉似阳症，但身虽
炽热，而欲得衣被，口虽喜冷，而不得下咽，手足虽躁扰，而神则静，语言虽 妄，而声则微，
脉虽洪大，而按之无力，若误清之，是以水济水也。阳盛之极，往往发厥，手足逆冷，自汗发呃，身
卧如塑，六脉细微，悉似阴症；审其内症，必气喷如火，咽干口臭，舌苔芒刺，渴欲饮冷， 语太
息，喜凉恶热，心腹胀满，按之痛甚，小便必黄赤短少，大便必臭秽殊常，若误温之，是以火济火也。
外感则人迎脉大，内伤则气口脉大，外感恶寒，虽近烈火不除；内伤恶寒，得就温暖即解。外感鼻
气不利，内伤口不知味。外感邪气有余，故发言壮厉；内伤元气不足，故出言懒怯。外感头痛，常痛不
休，内伤头痛，时作时止。外感手背热，内伤手心热。
真疟有邪，由卫气之会，以为止作；似疟无邪，由水火争胜，以为盛衰。此则一责在表，一责在里，
一治在邪，一治在正。
东垣以手扪热有三法∶以轻手扪之则热，重按之则不热，是热在皮毛血脉也。重按之筋骨之间则
热，轻摸之则不热，是热在骨髓也。轻手扪之不热，重手按之亦不热，不轻不重按之而热者，是热在肌
肉，正内伤劳倦之热也。若内伤真阴者，以手扪热，亦有二法∶扪之烙手，骨中如火炙者，肾中之真阴
虚∶扪之烙手，按之筋骨之间反觉寒者，肾中之真阳虚也。面必赤者，阴虚于下，阳浮于上也；口必渴
者，肾水枯干，引水自救也；骨痛如折者，骨髓衰而火乘也；腰胁痛者，肾肝虚也；足心如烙者，涌泉
涸竭也，口咯痰如沫者，水沸为痰，阴火熬煎，口必渴也；若口吐痰多如清水者，肾水泛上为痰，口必
不渴也；膝以下冷者，命门火衰也；尺脉数者，阴火旺也；尺脉弱而无力，或欲绝者，真阳衰也。
阳病则昼重而夜轻，阳气与病气交旺也；阴病则昼轻而
夜重，阴气与病气交旺也。若夫阳虚病则昼轻，阴虚病则夜轻，阴阳各归其分也。此亦言其变耳，
勿泥。此着治之者，既定其时，以证其病，若未发之时，当迎而导之，若正发之际，当避其锐锋，
若势已杀，当击其惰归。至于或昼或夜，时作时止，不时而动，是纯虚之症，又不拘于昼夜之定
候，当广服补药，以养其正。
夫人之病痰火者，十之八、九，老人不宜速降其火，虚人不宜尽祛其痰，攻之太甚，则病转剧而
致危殆，须以固元气为本。凡病推类而行之，亦思过半矣。盖药以胜病，乃致脾胃不能胜药，犹不
加察，元气一坏，变症多端。如脾虚而气短不能续，变而似喘促，尚用降气定喘之药；如脾虚卫
气不行，变而为浮肿，尚用耗气利水之药∶如脾虚菀滞，变而作寒热，尚谓外感，用发散之药，虚而
益虚，直令气尽身亡，全不悔悟，复以此法施之他人，展转残生，可胜诛哉！经论人有逆气喘息不
能卧，有肺胃肾三脏之异。在肺络者，起居如故，而息有音也，病之微者也；在胃者不得卧，
而息有音也，甚于肺者也∶在肾者不得卧，卧则喘也，又其甚者也。夫息之有音者，即喘之渐，喘
出于肾，则病在根本矣，故愈深煮必愈甚。凡虚劳之喘，义亦犹此，不可不察也。酸者肝木之味，由
火盛刑金，不能平木，则肝自盛，故为酸也。如饮热则酸矣，或言吐酸为寒者非也。是以肝热则
口酸，心热则口苦，脾热则口甘，肺热则口辛，肾热则口咸，或口淡者胃热也。胃属土，土为万物之
母，故胃为一身之木，淡为五味之本，然则吐酸岂为寒者欤！
五脏逆气，上干于心，而为痛者谓之厥心痛。盖肾心痛者，多由于阴邪上冲，故善 ，如从背后
触其心而伛偻
。胃心痛者，多有停滞，故胸腹满胀。脾心痛者，多由寒逆中焦，故如锥针刺其心而痛甚。肝心
痛者，多有木火之郁，病在血分，故色苍苍如死状。肺心痛者，多由上焦不清，病在气分，故动作
则痛益甚。若知其在气则顺之，在血则行之，郁则开之，滞则逐之。火多实，则或散或清之，寒
多虚，则或温或补之，必真心痛，乃不可治，否则但得其本，则必随手而应。
少年有阳痿，有因志意不遂所致者，宣其抑郁，则阳气舒而痿立起，勿概作阳虚补火。又有膏
粱富贵人，暑月阳事痿顿，此属湿热，皆不可不知。
伤寒传足不传手之说谬也。夫人之血气，营运周身，流注不息，岂传遇手经而邪有不入者哉？且
寒之中人，必先皮毛，皮毛者肺之合，故在外则有寒栗鼻塞等症，在内则有咳喘短气等症，谓不传于
肺乎？其入手少阴厥阴也，则有舌苔拂郁，神昏错乱等症，谓不传于心主包络乎？其入手阳明也，则
有泄泻秘结等症，谓不传于大肠乎？其入手太阳也，则有癃闭不化等症，谓不传于小肠乎？其入手
少阳也，则有上下不通，五官失职，痞满燥实俱全等症，谓不传于三焦乎？观经言三阴三阳，五脏六腑
皆受病，岂手经不在内乎？所以仲景有五脏绝症，义又可知。
经论两感于寒，而病必不免于死者，本言一腑一脏，表里感邪同病，愚请广其义，而谓脏腑内外俱
伤，亦便是两感。今见少阴先溃于内，而太阳继感于外者，即纵情肆欲之两感也；太阴受伤于里，而阳
明重感于表者，即劳倦竭力，饮食失调之两感也；厥阴气逆于脏，而少阳伤感于腑者，即七情不慎，疲
筋败血之两感也。人知两感为伤寒，而不知
伤寒之两感，内外俱困，病斯剧矣。但感有轻重，医有贤不肖，则死生系之。
大病后脉症俱平，饮食渐进，忽肢体浮肿，别无所苦，此气复也。盖大病后，血未成而气暴
复，血乃气之根据，气无所根据，故为浮肿，食加，肿自消，若投行气利水药则谬。
小儿腠理未密，易于外感，易于发热，轻则为鼻塞咳嗽，重则为伤寒，世医不识，妄称惊风。
盖风寒中人，必先入太阳经。太阳之脉，起于目内 ，上额交巅入脑，还出别下项，挟脊抵腰中。是
以病则筋脉牵强，故生出抽掣搐搦，角弓反张名目，而用金石药镇坠外邪，千中千死。间有禀浓症轻
得愈者，竟为再造奇功，因之杀儿无算。所以凡治小儿之热，但当彻其出表，不当固其入里也。要之
我辟惊风之说，非谓无惊病也，小儿气怯神弱，凡遇异形异声，骤然跌仆，皆生惊怖，其候面青粪青，
多烦多哭，尝过于分别，不比热邪塞窍，神识昏迷，对面撞钟放铳，全然不闻者，临症宜审察明白，治
则不误。
小儿阳则有余，阴则不足，故身内易至于生热，热盛则生痰生风生惊，亦所恒有，又不可一见发热，
概作伤寒治也。
疫者，天地之戾气也。不论富贵贫贱，老少男女，沿门阁境，传染相同，此惟大兵荒之后有之。盖
因死亡甚多，埋葬不深，时至春和，尸秽之气，随地气上升，混入苍天清净之气，而天地生物之气，变
为杀物之气，无形无声，从口从鼻而入，直犯脏腑，正气闭塞，邪气充斥，顷刻云亡，莫可救药。其
受邪不甚者，热淫之气，浮越于某经，即显某经之症，各宜随其经而治之。大抵邪客阳明者为多。邪之所
着，有自受，有传染，所感虽殊，其病则一。但疫之病状，与伤寒不同，伤寒发热，必兼恶寒，疫病
始虽恶寒，既而发热，即不恶寒。伤寒自腠理而入，故宜用药汗之而解；疫病自口鼻而入，须邪内溃，
方得表里融和，自然汗出而解，纵强发之，汗亦不解。伤寒汗解，不定发战，疫病汗解，定发战，伤寒
不皆发斑，疫病多发斑。伤寒多暴发，疫病多恹恹数日，或渐加重，或忽然加重。伤寒不染人，疫病
染人。伤寒初起，宜发表，疫病初起，宜疏利。其所同者，伤寒疫病传胃皆用承气汤辈，导邪而出。疫
病初得之二、三日，其脉不浮不沉而数，昼夜发热，日晡尤甚，虽见头晕身痛，乃邪热浮越于经，不可
认为伤寒汗之，但看舌上白苔如积粉，即与达原饮，药用槟榔疏利伏邪，扫除瘴气为君，浓朴破戾气
所结，草果除伏邪盘错，皆辛烈气雄之品为臣，三味协力，直达巢穴，使邪气溃败，方得离经。热伤津
液，用知母以滋阴，热伤荣气，用白芍以和血，黄芩清热，甘草和中。感轻者一、二剂自解。有三阳症
见者，各加本经的药。如见少阳症加柴胡，阳明症加葛根，若渴者加石膏是也。如清晨服达原饮一剂，
午前舌苔变黄，随现心腹痛满，大渴烦躁，此毒邪传胃，前方加大黄下之。烦渴少减，热去六、七，午后
复烦渴发热，舌苔变黑生刺，鼻如烟煤，此毒邪大重，复瘀于胃，急投大承气汤下之。夜半热退，次早
鼻黑苔刺如失。此因热甚，故传变速，用药不得不急，缓则不救，所谓急症急攻是也。治疫之大纲如此
，吴又可，《瘟疫论》宜参。
疫邪传胃，阻碍正气，火积成热，因之舌苔生刺，心腹满痛，大渴烦躁，午后潮热。宜用承气逐邪，气
行火泄，而
热自除。若用芩、连、栀、柏，专务清热，热终不止。又病热日久，腹皮贴背，此宜调胃承气汤，如
但用寒凉清热，有邪不除，耽误至死，误人不小。盖不知大黄与黄连均为寒药，大黄走而不守，黄连
守而不走，一润一燥，一通一塞，相去远甚。疫邪以通行为治，若用黄连，反招闭塞，邪毒何由以泄，
此以治杂病之法，治外感之道。
疫，病心下胀满，邪在里也。若纯用青皮、枳实、槟榔破气之品，殊谬。不知内壅气闭，原有主
客之分，假令根于郁怒，肝气上升，饮食过度，胃气填塞，主气为病也。投香、砂、豆蔻、枳壳之类，升
者即降，闭者即通。疫毒传胸，以致胀满，但得客气一除，本气自然升降，胀满立除，宜用小承气汤。
大黄本非破气药，以其润而最降，故能逐邪拔毒，破结导滞，加以枳、朴者，不过佐使云耳。若纯用破
气之品，津液愈耗，热结愈固，疫毒无门而泄，乃望其宽胸快膈，惑之甚矣。
【辨证大纲】
病情极度虚弱却呈现类似实证的表现，若误用补法反而会加重疾病；身体极度虚弱却出现类似实证的征候，若误用泻法则会冤枉患者。阴证似乎像阳证，若用清热法治疗必然导致死亡；阳证似乎像阴证，若用温补法治疗必然导致亡失。凡是体内有积聚物，按压时感到疼痛，面色红赤，呼吸粗重，脉搏有力，这是实证；严重时表现为沉默寡言不想说话，肢体不愿活动，或者头晕眼花，或者腹泻不止，这就是大实证呈现出虚弱的假象。如果误用补法，就是使实证更盛（盛盛）。心下部痞塞疼痛，按压时疼痛缓解，面色憔悴，声音短促，脉搏无力，这是虚证；严重时胀满至极导致无法进食，气机不畅，大小便不通利，这就是极度虚弱呈现出实证的假象。如果误用泻法，就是使虚证更虚（虚虚）。
阴寒极盛之时，往往会出现格拒阳气于外的现象，表现为身体发热、面色发红、口干喜欢冷饮、手足躁动不安、胡言乱语，脉搏洪大，这些都似乎像阳证；但是虽然身体炽热，却想要穿衣盖被；虽然口喜冷饮，却无法咽下；虽然手足躁动，但神志却是安静的；虽然胡言乱语，但声音微弱；虽然脉搏洪大，但重按却无力。如果误用清热法，就像是用水去救水（雪上加霜）。阳热极盛之时，往往会出现厥逆，表现为手足冰冷、自汗打呃、身体躺卧如雕塑般不动，六脉细微，这些都似乎像阴证；仔细审视其内部症状，必定是气息喷吐如火、咽喉干燥口臭、舌苔上有芒刺、口渴想喝冷水、谵语太息、喜欢凉爽厌恶炎热、心胸腹胀满、按压时疼痛剧烈、小便必定黄赤短少、大便必定臭秽异常。如果误用温补法，就像是用火去救火（火上浇油）。
外感病则人迎脉（颈动脉）盛大，内伤病则气口脉（桡动脉）盛大；外感病恶寒，即使靠近烈火也不能消除寒冷感；内伤病恶寒，得到温暖即可解除。外感病鼻气不利，内伤病口不知味。外感病邪气有余，所以说话声音壮厉；内伤元气不足，所以说话懒弱怯懦。外感头痛，常常持续疼痛不停；内伤头痛，时作时止。外感病手背发热，内伤病手心发热。
真正的疟疾有邪气，由卫气与邪气相争，从而决定发作和停止；类似疟疾而无邪气，由水火之气争胜，从而决定盛衰。这其中的区别在于：一个责之于表，一个责之于里；一个治疗在于祛邪，一个治疗在于扶正。
李东垣提出用手触摸热度有三种方法：如果用轻手触摸感到热，重按时不热，说明热在皮毛血脉之间。如果重按至筋骨之间感到热，轻摸不热，说明热在骨髓中。如果轻手触摸不热，重手按压也不热，只有不轻不重地按压时才感到热，这说明热在肌肉层，正是内伤劳倦引起的发热。如果是内伤真阴亏损，用手触摸热度也有两种情况：触摸时感觉烫手，骨头里像被火烤一样，这是肾中真阴虚；触摸时感觉烫手，但按至筋骨之间反而觉得寒凉，这是肾中真阳虚。面部必定发红的，是因为下焦阴虚，阳气浮越于上；口必定口渴的，是因为肾水枯干，引水自救；骨骼疼痛如折断的，是因为骨髓衰败而火邪乘袭；腰胁部疼痛的，是因为肝肾虚损；脚心像被烙铁烫一样的，是因为涌泉穴枯竭；口中咯出泡沫状痰的，是因为水液沸腾化为痰，阴火煎熬所致，口必定口渴；如果口吐大量像清水一样的痰，是因为肾水泛溢上行化为痰，口必定不渴；膝盖以下冰冷的，是因为命门火衰；尺脉数动的，是因为阴火旺盛；尺脉弱而无力，或者几乎摸不到的，是真阳衰微。
阳病则白天重晚上轻，因为阳气与病气交相旺盛；阴病则白天轻晚上重，因为阴气与病气交相旺盛。如果是阳虚病则白天轻，阴虚病则晚上轻，这是因为阴阳各归其位。这也是说变化的情况，不要拘泥于此。对于这类病症的治疗者，既然确定了时间以验证病情，那么在未发作时，应当迎而导之；在正发作之际，应当避开其锐气；在势已衰退时，应当攻击其懈怠回归之时。至于有时在白天有时在夜晚，时作时止，不时而动，这是纯虚的病症，又不拘泥于昼夜固定的征候，应当广泛服用补药，以养护正气。
患痰火病的人，十之八九，老年人不宜迅速降火，体虚之人不宜完全祛除痰浊，攻伐太过，则病情转剧而导致危殆，必须以固护元气为根本。凡是治病推类而行，也就思过半了。药物是用来战胜疾病的，但如果脾胃不能承受药力，如果不加观察，一旦元气受损，变症百出。比如脾虚而气短不能接续，变化后似喘促，还使用降气定喘的药物；比如脾虚卫气不行，变化为浮肿，还使用耗气利水的药物；比如脾虚郁滞，变化为寒热往来，还认为是外感，使用发散的药物，虚而又虚，直接导致气尽身亡，全然不悔悟，再用这种方法施用于他人，辗转残害生命，罪过怎能说得完呢！经论中说人有逆气喘息不能卧，有肺、胃、肾三脏的不同。在肺络的，起居如常，只是呼吸有声音，这是病轻微的；在胃的，不能卧，呼吸有声音，比肺的病严重；在肾的，不能卧，卧下就喘，这是更严重的。呼吸有声音的，就是喘的渐进，喘出于肾，那么病就在根本了，所以病越深重必然越严重。凡虚劳的喘，意义也与此相同，不可不察。酸味是肝木的味道，由于火盛克金，不能平抑木气，则肝气自盛，所以表现为酸。比如喝热水就会反酸，有人说吐酸是寒证，这是不对的。所以肝热则口酸，心热则口苦，脾热则口甘，肺热则口辛，肾热则口咸，口淡的是胃热。胃属土，土是万物的母体，所以胃是一身的根本，淡是五味的本原，那么吐酸难道是寒证吗？
五脏的逆气上犯于心，引起疼痛的称为厥心痛。肾心痛，多由于阴邪上冲，所以善恐，好像从背后触及其心而弯腰曲背。胃心痛，多有停滞，所以胸腹满胀。脾心痛，多由寒逆中焦，所以像锥针刺心而疼痛剧烈。肝心痛，多有木火之郁，病在血分，所以面色青苍如死状。肺心痛，多由上焦不清，病在气分，所以动作则疼痛加剧。如果知道病在气则顺其气，在血则行其血，郁结则开散它，停滞则驱逐它。火多属实，则或散或清；寒多属虚，则或温或补。必须是真心痛，才是不可治的，否则只要找到病本，必然随手应验。
少年阳痿，有因意志不遂导致的，宣畅其抑郁，则阳气舒展而痿症立起，不要一概当作阳虚补火。又有膏粱富贵之人，暑月阳事痿顿，这属于湿热，这些都不可以不知道。
伤寒只传足经不传手经的说法是错误的。人的血气，营运周身，流注不息，难道遇到手经邪气就不进入吗？况且寒邪中人，必先侵犯皮毛，皮毛是肺的合部，所以在外则有寒栗鼻塞等症状，在内则有咳喘短气等症状，能说没有传给肺吗？传入手少阴、厥阴，则有舌苔拂郁、神昏错乱等症状，能说没有传给心主包络吗？传入手阳明，则有泄泻秘结等症状，能说没有传给大肠吗？传入手太阳，则有癃闭不化等症状，能说没有传给小肠吗？传入手少阳，则有上下不通、五官失职、痞满燥实俱全等症状，能说没有传给三焦吗？看经文说三阴三阳，五脏六腑皆受病，难道手经不在其中吗？所以仲景说有五脏绝症，义理又可知了。
经论两感于寒，而病必不免于死的，原本是说一腑一脏，表里感受邪气同病，我请扩展其义，认为脏腑内外俱伤，也就是两感。现在见到少阴先溃于内，而太阳继感于外，这就是纵情肆欲的两感；太阴受伤于里，而阳明重感于表，这就是劳倦竭力、饮食失调的两感；厥阴气逆于脏，而少阳伤感于腑，这就是七情不慎、疲筋败血的两感。人们知道两感是伤寒，却不知道伤寒的两感，内外俱困，病就剧烈了。但感受有轻重，医生有贤良或不肖，则生死系于此。
大病后脉症都平和，饮食逐渐增加，忽然肢体浮肿，别无所苦，这是气复元。盖大病后，血未成而气暴复，血是气的凭借，气无所凭借，所以为浮肿，饮食增加，肿自然消退，如果投用行气利水药则是错误的。
小儿腠理不紧密，易于外感，易于发热，轻则为鼻塞咳嗽，重则为伤寒，世医不认识，妄称惊风。盖风寒中人，必先入太阳经。太阳经脉，起于目内眦，上额交巅入脑，还出别下项，挟脊抵腰中。所以生病则筋脉牵强，因此生出抽掣搐搦、角弓反张的名目，而用金石药镇坠外邪，千中千死。间有禀赋浓厚、症状轻而得愈的，竟被视为再造奇功，因而杀儿无算。所以凡是治疗小儿的热病，只应当透邪出表，不应当固涩使其入里。总之，我破除惊风之说，并非谓无惊病，小儿气怯神弱，凡遇异形异声，骤然跌仆，皆生惊怖，其候面青粪青，多烦多哭，尝过于分别，不比热邪塞窍，神识昏迷，对面撞钟放铳，全然不闻者，临症宜审察明白，治疗则不误。
小儿阳则有余，阴则不足，故身内易至于生热，热盛则生痰生风生惊，也是常有的，又不可一见发热，一概当作伤寒治疗。
疫气，是天地间的戾气。不论富贵贫贱，老少男女，沿门阖境，传染相同，这惟有大兵荒之后才有。因为死亡甚多，埋葬不深，时至春和，尸秽之气，随地气上升，混入苍天清净之气，而天地生物之气，变为杀物之气，无形无声，从口从鼻而入，直犯脏腑，正气闭塞，邪气充斥，顷刻云亡，莫可救药。其受邪不甚者，热淫之气，浮越于某经，即显某经之症，各宜随其经而治之。大抵邪客阳明者为多。邪之所着，有自受，有传染，所感虽殊，其病则一。但疫病的病状，与伤寒不同，伤寒发热，必兼恶寒，疫病始虽恶寒，既而发热，即不恶寒。伤寒自腠理而入，故宜用药汗之而解；疫病自口鼻而入，须邪内溃，方得表里融和，自然汗出而解，纵强发之，汗亦不解。伤寒汗解，不定发战，疫病汗解，定发战，伤寒不皆发斑，疫病多发斑。伤寒多暴发，疫病多恹恹数日，或渐加重，或忽然加重。伤寒不染人，疫病染人。伤寒初起，宜发表，疫病初起，宜疏利。其所同者，伤寒疫病传胃皆用承气汤辈，导邪而出。疫病初得之二、三日，其脉不浮不沉而数，昼夜发热，日晡尤甚，虽见头晕身痛，乃邪热浮越于经，不可认为伤寒汗之，但看舌上白苔如积粉，即与达原饮，药用槟榔疏利伏邪，扫除瘴气为君，厚朴破戾气所结，草果除伏邪盘错，皆辛烈气雄之品为臣，三味协力，直达巢穴，使邪气溃败，方得离经。热伤津液，用知母以滋阴，热伤营气，用白芍以和血，黄芩清热，甘草和中。感轻者一、二剂自解。有三阳症见者，各加本经的药。如见少阳症加柴胡，阳明症加葛根，若渴者加石膏是也。如清晨服达原饮一剂，午前舌苔变黄，随现心腹痛满，大渴烦躁，此毒邪传胃，前方加大黄下之。烦渴少减，热去六、七，午后复烦渴发热，舌苔变黑生刺，鼻如烟煤，此毒邪大重，复瘀于胃，急投大承气汤下之。夜半热退，次早鼻黑苔刺如失。此因热甚，故传变速，用药不得不急，缓则不救，所谓急症急攻是也。治疫的大纲如此，吴又可，《瘟疫论》宜参。
疫邪传胃，阻碍正气，火积成热，因此舌苔生刺，心腹满痛，大渴烦躁，午后潮热。宜用承气逐邪，气行火泄，而热自除。若用芩、连、栀、柏，专务清热，热终不止。又病热日久，腹皮贴背，此宜调胃承气汤，如但用寒凉清热，有邪不除，耽误至死，误人不小。盖不知大黄与黄连均为寒药，大黄走而不守，黄连守而不走，一润一燥，一通一塞，相去远甚。疫邪以通行为治，若用黄连，反招闭塞，邪毒何由以泄，此以治杂病之法，治外感之道。
疫，病心下胀满，邪在里也。若纯用青皮、枳实、槟榔破气之品，殊谬。不知内壅气闭，原有主客之分，假令根于郁怒，肝气上升，饮食过度，胃气填塞，主气为病也。投香、砂、豆蔻、枳壳之类，升者即降，闭者即通。疫毒传胸，以致胀满，但得客气一除，本气自然升降，胀满立除，宜用小承气汤。大黄本非破气药，以其润而最降，故能逐邪拔毒，破结导滞，加以枳、朴者，不过佐使云耳。若纯用破气之品，津液愈耗，热结愈固，疫毒无门而泄，乃望其宽胸快膈，惑之甚矣。
[General Principles of Syndrome Differentiation]
When a condition presents with extreme debility but mimics excess, misapplying tonification will exacerbate the disease; when extreme deficiency manifests with symptoms resembling excess, misapplying purgation will wrongfully harm the patient. Yin syndromes may resemble Yang syndromes; applying clearing methods will surely lead to death. Yang syndromes may resemble Yin syndromes; applying warming methods will surely lead to collapse. Generally, if there is accumulation in the interior, tenderness upon palpation, red complexion, coarse breathing, and a forceful pulse, this indicates Excess (Shi). In severe cases, it may present as silence, unwillingness to speak or move limbs, dizziness, blurred vision, or unceasing diarrhea; this is "Great Excess presenting with Debility-like signs." Misapplying tonification here constitutes "making Excess more Excessive" (Sheng Sheng). If there is epigastric fullness and pain that alleviates upon pressure, a sallow complexion, short voice, and a weak pulse, this indicates Deficiency (Xu). In severe cases, it may present as extreme distension preventing food intake, qi stagnation, and inability to urinate or defecate; this is "Extreme Deficiency presenting with Excess-like signs." Misapplying purgation here constitutes "making Deficiency more Deficient" (Xu Xu).
When Yin cold reaches its extremity, it often repels Yang outward (Ge Yang), manifesting as body heat, red face, dry mouth preferring cold drinks, restless limbs, delirious speech, and a flooding pulse, all resembling Yang syndromes. However, despite intense heat, the patient desires clothing and blankets; despite preferring cold drinks, they cannot swallow them; despite restless limbs, their spirit is calm; despite delirious speech, their voice is faint; despite a flooding pulse, it is powerless upon deep pressure. Misapplying clearing methods here is like adding water to water (exacerbating the condition). When Yang heat reaches its extremity, it often causes Jue (cold extremities), manifesting as cold hands and feet, spontaneous sweating, hiccups, a statue-like stillness, and subtle pulses, all resembling Yin syndromes. Examining internal symptoms reveals breath hot as fire, dry throat, foul odor, prickly tongue coating, thirst for cold drinks, sighing, preference for coolness and aversion to heat, chest and abdominal fullness with severe pain on pressure, yellow-red scanty urine, and foul stool. Misapplying warming methods here is like adding fire to fire (exacerbating the condition).
In external contraction diseases, the Renying pulse (carotid) is large; in internal injury diseases, the Qikou pulse (radial) is large. External contraction involves aversion to cold that persists even near intense fire; internal injury involves aversion to cold that resolves with warmth. External contraction causes nasal obstruction; internal injury causes loss of taste. External contraction, having excess pathogenic factors, results in loud speech; internal injury, having deficient Yuan Qi, results in lazy and timid speech. External contraction headache is continuous; internal injury headache comes and goes. External contraction causes heat on the back of the hand; internal injury causes heat in the palm.
True malaria involves pathogens, determined by the interaction of Wei Qi and pathogens, causing paroxysms; malaria-like conditions without pathogens are determined by the struggle between Water and Fire, causing fluctuations in strength. The distinction lies in: one being attributed to the Exterior, the other to the Interior; one treated by expelling pathogens, the other by supporting Zheng Qi.
Li Dongyuan proposed three methods of palpating heat: light palpation revealing heat but heavy pressure not revealing it indicates heat in the skin and vessels; heavy pressure revealing heat but light touch not revealing it indicates heat in the bone marrow; neither light nor heavy pressure revealing heat, but moderate pressure revealing it, indicates heat in the muscles, characteristic of internal injury from overwork. For internal injury involving True Yin deficiency, two methods exist: heat felt intensely on touch, with bones feeling like burning, indicates Kidney True Yin deficiency; heat felt intensely on touch, but cold sensation upon pressing to the bones and muscles, indicates Kidney True Yang deficiency. A red face indicates Yin deficiency below with floating Yang above; thirst indicates dried-up Kidney Water seeking self-rescue; bone pain like breaking indicates marrow decline with Fire attacking; waist and flank pain indicate Liver and Kidney deficiency; burning soles indicate exhaustion of Yongquan; frothy sputum indicates boiling fluids transforming into phlegm due to Yin Fire, accompanied by thirst; copious clear watery sputum indicates Kidney Water flooding upward, without thirst; cold knees and lower legs indicate Mingmen Fire decline; rapid Chi pulse indicates vigorous Yin Fire; weak or imperceptible Chi pulse indicates True Yang decline.
Yang diseases worsen during the day and improve at night, as Yang Qi and Pathogenic Qi interact vigorously; Yin diseases improve during the day and worsen at night, as Yin Qi and Pathogenic Qi interact vigorously. Yang Deficiency diseases improve during the day; Yin Deficiency diseases improve at night, as Yin and Yang return to their respective domains. This describes variations; do not be rigid. For treatment, once timing confirms the disease, treat before onset by guiding the Qi, avoid peak intensity during onset, and attack during the decline phase. Paroxysmal, irregular symptoms indicate pure Deficiency, not bound by day/night patterns; treat with broad tonification to nourish Zheng Qi.
Eight or nine out of ten patients with Phlegm-Fire should not have Fire rapidly reduced (especially the elderly) or Phlegm completely expelled (especially the debilitated); excessive attacking worsens the condition and leads to danger; securing Yuan Qi is fundamental. Understanding this analogy aids diagnosis significantly. Medicines defeat disease, but if the Spleen and Stomach cannot withstand them, and Yuan Qi is damaged, complications arise. For example, Spleen Deficiency causing shortness of breath mimicking asthma should not be treated with Qi-descending drugs; Spleen Deficiency causing edema due to defensive Qi stagnation should not be treated with Qi-consuming diuretics; Spleen Deficiency causing alternating chills and fever mimicking external contraction should not be treated with dispersing drugs. Such errors deplete Qi and cause death. Classics distinguish wheezing unable to lie down by Lung, Stomach, and Kidney involvement: Lung involvement has normal activity but noisy breathing (mild); Stomach involvement prevents lying down with noisy breathing (severe); Kidney involvement prevents lying down, with wheezing upon lying (most severe). Noisy breathing is the precursor to asthma; asthma originating from the Kidney indicates root disease, which worsens with depth. Similar logic applies to consumptive asthma. Sour taste belongs to Liver Wood; it arises when Fire overacts on Metal, failing to control Wood, leading to Liver excess. Drinking hot water may induce sourness; claiming acid regurgitation is Cold is incorrect. Thus, Liver Heat causes sour taste, Heart Heat bitter, Spleen Heat sweet, Lung Heat pungent, Kidney Heat salty, and Stomach Heat bland. As Earth is the mother of all things and Stomach is the root, and bland is the basis of flavors, acid regurgitation cannot be Cold.
Rebellious Qi from the Five Viscera affecting the Heart causes pain, termed Jue Heartache. Kidney Heartache stems from Yin Evil rushing upward, causing fear and stooping. Stomach Heartache involves stagnation, causing chest and abdominal fullness. Spleen Heartache stems from Cold rebelling in the Middle Jiao, causing piercing pain. Liver Heartache involves Wood-Fire depression in the Blood level, causing a pale-green, corpse-like appearance. Lung Heartache stems from unclear Upper Jiao in the Qi level, worsening with movement. Treat Qi disorders by smoothing, Blood disorders by invigorating, depression by opening, stagnation by expelling. Fire excess requires dispersing or clearing; Cold deficiency requires warming or tonifying. Only Zhen Xin Tong (True Heartache) is incurable; otherwise, addressing the root ensures efficacy.
Young men with impotence due to frustrated will should have depression relieved to allow Yang Qi to expand, rather than assuming Yang Deficiency requiring fire-tonification. Wealthy individuals enjoying rich foods may experience impotence in summer due to Damp-Heat. These distinctions are crucial.
The theory that Shanghan transmits only through Foot meridians and not Hand meridians is false. Blood and Qi circulate throughout the body; why would pathogens avoid Hand meridians? Cold enters via skin/hair, associated with the Lung, causing exterior chills/nasal congestion and interior cough/shortness of breath—clearly transmitting to the Lung. Transmission to Hand Shaoyin/Jueyin causes coated tongue and confusion—transmitting to the Pericardium. Transmission to Hand Yangming causes diarrhea/constipation—transmitting to the Large Intestine. Transmission to Hand Taiyang causes urinary retention—transmitting to the Small Intestine. Transmission to Hand Shaoyang causes blockage and organ dysfunction—transmitting to the Sanjiao. Classics state all Six Yin-Yang and Five Viscera/Six Bowels can be diseased; Hand meridians are included. Zhang Zhongjing’s concept of Five Viscera Collapse confirms this.
Classics state Lianggan (Double Contraction) with Cold is fatal because Exterior and Interior are simultaneously affected. I expand this: simultaneous damage to Viscera and Bowels, inside and outside, also constitutes Lianggan. Shaoyin failure internally followed by Taiyang contraction externally results from licentiousness; Taiyin injury internally followed by Yangming contraction externally results from overwork and poor diet; Jueyin Qi rebellion internally followed by Shaoyang injury externally results from emotional stress and physical exhaustion. People know Lianggan as Shanghan, but fail to realize that simultaneous internal/external distress makes the disease severe. Severity and physician competence determine survival.
After severe illness, if pulses and symptoms normalize and appetite returns, sudden limb edema without other discomfort indicates Qi recovery. Post-illness, Blood is not yet formed while Qi rebounds abruptly; since Blood supports Qi, unsupported Qi causes edema. Edema resolves with increased food intake; using Qi-moving diuretics is erroneous.
Children have loose pores, prone to external contraction and fever. Mild cases cause nasal congestion/cough; severe cases cause Shanghan. Untrained physicians mistakenly call this Jing Feng (Wind Shock). Wind-Cold enters the Taiyang Meridian first, which starts at the inner eye, crosses the vertex, enters the brain, descends the neck, and reaches the waist. Illness causes muscle tension, leading to convulsions and opisthotonos. Using mineral sedatives to suppress exterior pathogens kills most patients. Rarely, robust children recover, falsely attributing success to these dangerous treatments. Treating pediatric fever should focus on releasing pathogens to the exterior, not consolidating them inward. My refutation of Jing Feng does not deny fright illnesses; children are timid and frightened by strange sights/sounds/falls, showing green face/stool, irritability, and crying. This differs from Heat blocking orifices causing coma where the child is unresponsive. Careful differentiation prevents error.
Children have surplus Yang and insufficient Yin, prone to internal heat generating Phlegm, Wind, and Fright. Fever should not always be treated as Shanghan.
Yi (Plague) is a malignant Qi of Heaven and Earth. It affects all regardless of status, spreading door-to-door, typically after wars/famines due to shallow graves and rising miasma mixing with clean air, turning generative Qi into destructive Qi. Entering via mouth/nose, it blocks Zheng Qi and fills with Pathogens, causing rapid death. Mild cases show Heat floating in specific meridians, treating according to the meridian. Most affect the Yangming Meridian. Acquisition can be direct or contagious; pathology is similar. Unlike Shanghan (fever with aversion to cold), Yi starts with mild aversion to cold then high fever without aversion. Shanghan enters via pores, resolved by sweating; Yi enters via mouth/nose, requiring internal resolution for natural sweating; forced sweating fails. Yi sweating involves shivering; Shanghan may not. Yi often causes macules; Shanghan rarely. Shanghan is acute; Yi is lingering or suddenly worsening. Shanghan is non-contagious; Yi is contagious. Shanghan initial stage requires releasing the exterior; Yi initial stage requires venting and draining. Both use Chengqi Tang formulas if transmitting to the Stomach to guide pathogens out.
For Yi in days 2-3, pulse is neither floating nor sinking but rapid, with constant fever worsening in the afternoon. Despite headache/body ache, this is Heat floating in meridians, not Shanghan. If tongue has white coating like accumulated powder, administer Da Yuan Yin. Betel nut (Binglang) guides latent pathogens and clears miasma as Sovereign; Magnolia bark (Houpo) breaks stagnant Qi; Tsaoko cardamom (Caoguo) removes tangled pathogens, both Ministers. Together they reach the nest, defeating pathogens. Anemarrhena (Zhimu) nourishes Yin injured by Heat; Paeonia (Baishao) harmonizes Ying Qi injured by Heat; Scutellaria (Huangqin) clears Heat; Licorice (Gancao) harmonizes the Middle. Mild cases resolve in 1-2 doses. Add meridian-specific herbs for Three Yang symptoms: Bupleurum (Chaihu) for Shaoyang, Pueraria (Gegen) for Yangming, Gypsum (Shigao) for thirst.
If morning Da Yuan Yin dose turns tongue coating yellow by noon, with epigastric pain, severe thirst, and irritability, Toxic Heat has transmitted to the Stomach. Add Rhubarb (Dahuang) to purge. If symptoms lessen slightly but fever returns in the afternoon with black, prickly tongue coating and sooty nose, Toxic Heat is severe and stagnant in the Stomach. Urgently administer Da Chengqi Tang. Fever subsides by midnight; symptoms resolve next morning. Rapid transmission requires urgent treatment; delay is fatal. This is the general principle for treating Yi. Consult Wu Youke’s *Wenyi Lun*.
Yi pathogens transmitting to the Stomoblock Zheng Qi, accumulating Fire into Heat, causing prickly tongue coating, abdominal pain/thirst/irritability, and afternoon tidal fever. Use Chengqi to expel pathogens; as Qi moves and Fire dissipates, Heat clears. Using Huangqin, Huanglian, Zhizi, or Huangbai solely to clear Heat is ineffective. For prolonged heat with abdomen adhering to the back, Tiaowei Chengqi Tang is appropriate. Using only cold-clearing herbs leaves pathogens, leading to death. Note: Both Dahuang and Huanglian are Cold, but Dahuang moves and does not stay, while Huanglian stays and does not move; one is moistening/opening, the other drying/blocking. Yi treatment requires moving/unblocking; Huanglian causes blockage, preventing toxin expulsion. Applying chronic disease methods to acute exterior diseases is erroneous.
Yi presenting with epigastric fullness indicates Interior pathogens. Using purely Qi-breaking drugs like Qingpi, Zhishi, and Binglang is wrong. Internal obstruction has Host and Guest aspects. If rooted in anger (Liver Qi rising) or overeating (Stomach Qi blocked), it is a Host Qi disorder. Using Xiangfu, Sharen, Doukou, or Zhike lowers rising Qi and opens blockage. If Yi toxins transmit to the chest causing fullness, removing Guest Qi allows Host Qi to regulate, resolving fullness. Xiao Chengqi Tang is suitable. Dahuang is not a Qi-breaking drug; its moistening nature descends effectively, expelling pathogens and breaking stagnation. Zhishi and Houpo are merely assistants. Pure Qi-breaking drugs consume fluids and fix Heat結, leaving no exit for Yi toxins, hoping for chest relief is misguided.