母。补肺之百合知母汤用知母。又其确证也。以辛温之桂枝。与之平配。则桂枝因知母而直入肺家。是以桂
枝之辛。挑动肺气。而以其温通和肺神也。又恐辛甘之性。从上发汗。而不下入肾经之骨缝。故又佐以酸敛
之芍药。少少下引之。而使辛咸温热之附子。一直接入肾脏。然后君以燥湿之白术。散湿之生姜。臣以甘缓
之甘草。使培骨节之土气。总交于发越之麻黄。又从筋骨间。而徐徐透为微汗也。殿之以防风者。防风能密
卫气。恐风湿去。而复为风所袭耳。然则以附子为入肾之向导。以白术、生姜、甘草为除湿之中军。以麻黄为
班师之首领。以防风为留镇之善后。以桂枝、芍药、知母。原为后军之督率。而不意便道中。却收去风之奇捷
矣。神哉方也。六条之少阴血虚。单中风而成历节者。虽无郁汗之湿。其肾气之虚。与中风之宜从汗解俱
同。以鄙意拟之。于本方去除湿之白术、生姜。换补肝血之当归。补肾血之生地。则易一主将。而全军俱变矣。
故其曰主之者。是以此方为主。原与人以神明进退之用。而与他处之曰宜某汤者。其文例不同也。
九条 味酸则伤筋。筋伤则缓。名曰泄。咸则伤骨。骨伤则痿。名曰枯。枯泄相搏。名曰断泄。营气不通。卫
不独行。营卫俱微。三焦无所御。四属断绝。身体羸瘦。独足肿大。黄汗出。胫冷。假令发热。便为历节也。病历节。
不可屈伸。疼痛。乌头汤主之。
乌头汤方 川乌（五枚、 咀、以蜜二升、煎取一升、即出乌头） 麻黄（三两） 黄 （三两）
芍药（三两） 甘草（二两、炙）
上五味。 咀。四味以水三升。煎取一升。去滓。内蜜煎中。更煎之。服七合不知。尽服之。
五行各具阴阳。如甲乙壬癸等类。而其性情好恶。常相反而不相同者。以阳生则阴死。阴生则阳死。故也。比
如甲木生于亥。乙即死于亥。乙木生于午。甲即死于午。壬水生于申。癸即死于申。癸水生于卯。壬即死于卯
之类。夫肝为木脏。木中甲阳而乙阴。甲主阳神。外流其余气以应筋。故性喜调畅。而内经以辛补之。以酸泻
之者是也。乙主阴象。内固其形脏以应肝。故性喜敛束。而金匮以酸补之者是也。然甲生则乙死。过辛而伤
其形脏之肝。乙生则甲死。过酸而伤其余气之筋矣。盖酸则敛肝之阴血者。并敛其养筋之阳气。筋失阳健
之用。故缓。名之曰泄者。肝血不与筋俱。而其气亦渐散泄也。肾为水脏。水中壬阳而癸阴。壬主阳神。外流其
余气以应骨。故性喜镇静。而内经以甘补之。以咸泻之者是也。癸主阴象。内固其形脏以应肾。故性喜降润。
而金匮以咸补之者是也。然壬生则癸死。过甘而伤其形脏之肾。癸生则壬死。过咸而伤其余气之骨矣。盖
咸则抑肾之阴精者。并抑其强骨之阳气。骨失阳健之用。故痿。名之曰枯者。肾精不与骨俱。而其气亦渐枯
槁也。骨之阳病而枯。筋之阳病而泄。两相搏结。则是肝肾断其所养。而筋骨之气渐泄。名曰断泄。不亦宜乎。
以上言肝肾筋骨之自为病也。经络之营气。虽化于胃中之水谷。然实与肝肾之精血相贯通者也。肝肾病
断泄。则营气以不通而渐微。其胃中所化之悍气。又乘营阴而出为外卫者。营气既微。则卫不能独行而自
盛。故营卫俱微矣。此言肝肾病于内。因而营卫亦病于外也。御。如执御之义。上焦胸中之阳。中焦胃分之阳。
下焦命门之阳。皆以精血为车。而御之以周行者也。肝肾之精血。内敛下伏。则三焦之气。无所乘驾。而渐冷
之意。亦在言外矣。此言肝肾病于下。因而胸中胃分。亦病于上矣。四属。即指上下内外也。承上文而言酸收
咸降。使精血内敛下伏。以致肝肾之阳。内病下病。于是营卫外微。三焦上弱。而上下内外之四属。俱捍格而
有断绝之势矣。经络之营卫俱微。故身体羸瘦。肝肾之精血。为酸咸之味所敛伏。故独足肿大。黄汗出也。阴
气自伏。则阳气自微。故胫冷。即上文筋缓骨痿之理也。假令发热。则是阳气不独行。而郁于筋骨之缝。其为
历节无疑。此言历节之外症。以证其四属断绝之意。主乌头汤者。以通阳透节之乌头为主。而用蜜熬以为
煎者。取其留连胃中。以为内通外达之地。然后以甘缓之甘草。破芍药之酸敛。而特令其引乌头之阳气。内
入筋骨。以实表之黄 。监麻黄之发越。而特令其引乌头之阳气。外行营卫。将肝肾之伏阳一起。则蒸其精
血。而与三焦营卫。复得交通矣。至其纯用辛甘之味。不特辛以破酸。甘以救咸。且病机发于补阴而贼阳。故
方意专于升火以运水也。
母。补肺的百合知母汤使用知母。这也是确凿的证据。用辛温性质的桂枝，与它平级配伍，那么桂枝就会因为知母的作用而直接入肺经。因此桂枝的辛味，能挑动肺气，并用其温通之性调和肺神。又担心辛甘的性质，只从上焦发汗，而不能下入肾经的骨缝中。所以又佐以酸敛性质的芍药，稍微向下引导，从而使辛咸温热的附子，直接一次性进入肾脏。然后用燥湿的白术为君药，散湿的生姜为臣药，甘缓的甘草为使药，以此培补骨节处的土气，总汇交于发越的麻黄，再从筋骨之间，徐徐透出微汗。最后用防风收尾，是因为防风能固密卫气，恐怕风湿去除后，身体又会再次被风邪侵袭。既然如此，那么以附子作为入肾的向导，以白术、生姜、甘草作为除湿的中军主力，以麻黄作为班师回朝的首领，以防风作为留守镇守的善后工作，以桂枝、芍药、知母原本作为后军的督率，却不意间在行军途中，却收到了祛风的奇捷效果。这方剂真是神奇啊。第六条提到的少阴血虚，单纯因中风而成为历节病的，虽然没有郁积出汗的湿气，但其肾气虚弱，以及中风适宜从汗解的原理都是相同的。依我个人的推测，在本方中去掉除湿的白术、生姜，换上加补肝血的当归、补肾血的生地，那么就更换了一位主将，全军的气势都变了。所以说“主之”的，是以这个方子为主，原本是给人灵活进退运用的余地，这与别处说“宜某汤”的文字体例是不同的。
第九条 味道酸则伤筋，筋受伤则松弛，名叫泄。味道咸则伤骨，骨受伤则痿弱，名叫枯。枯和泄相互搏结，名叫断泄。营气运行不通，卫气不能单独运行，营气和卫气都微弱，三焦无所统御，四肢失去联系而断绝，身体消瘦，唯独脚部肿大，出黄汗，小腿发冷。假如发热，就是历节病。患历节病，关节不可屈伸，疼痛，用乌头汤主治。
乌头汤方 川乌（五枚，切碎，用蜂蜜二升，煎取一升，即取出川乌） 麻黄（三两） 黄芪（三两） 芍药（三两） 甘草（二两，炙）
以上五味药，切碎。其中四味用水三升，煎取一升，去渣滓。放入蜜煎液中，再一起煎煮。服用七合，若无效，则全部服完。
五行各自具备阴阳，如甲乙壬癸等类别，而其性情好恶，常常相反且不相同，这是因为阳生则阴死，阴生则阳死的缘故。比如甲木生于亥月，乙木即死于亥月；乙木生于午月，甲木即死于午月；壬水生于申月，癸水即死于申月；癸水生于卯月，壬水即死于卯月等等。肝为木脏，木中有甲阳和乙阴。甲主阳神，外流其余气以应合筋，所以性情喜欢调畅，而《内经》说用辛味补它，用酸味泻它，就是这个道理。乙主阴象，内固其形脏以应合肝，所以性情喜欢敛束，而《金匮要略》说用酸味补它，就是这个道理。然而甲生则乙死，过用辛味会伤害其形脏之肝；乙生则甲死，过用酸味会伤害其余气之筋。大概酸味收敛肝之阴血的同时，也收敛了养筋的阳气。筋失去了阳气的健运作用，所以松弛，名叫泄，意思是肝血不与筋俱存，而其气也逐渐散泄。肾为水脏，水中有壬阳和癸阴。壬主阳神，外流其余气以应合骨，所以性情喜欢镇静，而《内经》说用甘味补它，用咸味泻它，就是这个道理。癸主阴象，内固其形脏以应合肾，所以性情喜欢降润，而《金匮要略》说用咸味补它，就是这个道理。然而壬生则癸死，过用甘味会伤害其形脏之肾；癸生则壬死，过用咸味会伤害其余气之骨。大概咸味抑制肾之阴精的同时，也抑制了强骨的阳气。骨失去了阳气的健运作用，所以痿弱，名叫枯，意思是肾精不与骨俱存，而其气也逐渐枯槁。骨的阳气病变而枯，筋的阳气病变而泄，两者相互搏结，这就是肝肾断绝了其所养之物，而筋骨之气逐渐泄散，名叫断泄，不也是应该的吗？以上讲的是肝肾筋骨自身的病变。经络中的营气，虽然化源于胃中的水谷，但实际上与肝肾的精血是相贯通的。肝肾病变导致断泄，则营气因不通而逐渐微弱。胃中所化的悍气，又乘着营阴而出表成为卫气，既然营气微弱，则卫气不能单独运行而自身也盛极转衰（此处意指卫气失去营气依附而独盛或紊乱，结合上下文“营卫俱微”，指整体正气衰弱），所以营气和卫气都微弱了。这是说肝肾病变在内，因而营卫也病变在外。“御”，如同执掌驾驭的意思。上焦胸中之阳，中焦胃分之阳，下焦命门之阳，都是以精血为车驾，并依靠它们来周行全身。肝肾的精血内敛下伏，则三焦之气，没有可以乘驾的东西，而渐冷的意思也在言外了。这是说肝肾病变在下，因而胸中、胃分也病变在上。“四属”，即指上下内外。承接上文来说，酸收咸降，使精血内敛下伏，导致肝肾之阳在内、在下发生病变，于是营卫在外变得微弱，三焦在上变得虚弱，而上下内外的四属，都抵触格拒而有断绝的趋势了。经络的营卫都微弱，所以身体消瘦。肝肾的精血，被酸咸之味所敛伏，所以唯独脚部肿大，出黄汗。阴气自然潜伏，则阳气自然微弱，所以小腿发冷，即上文筋缓骨痿的道理。假如发热，则是阳气不能单独运行，而郁结在筋骨的缝隙中，这无疑是历节病。这是说历节病的外症，用来证明四属断绝的意思。主治乌头汤，是以通阳透节的乌头为主药，而用蜂蜜熬制作为煎剂，是取其留恋于胃中，作为内通外达的基础。然后用甘缓的甘草，破除芍药的酸敛，特别让它引导乌头的阳气，内入筋骨，以充实体表；用实表的黄芪，监视麻黄的发越，特别让它引导乌头的阳气，外行于营卫。将肝肾中潜伏的阳气一并升起，则蒸腾其精血，而与三焦营卫，重新得到交通。至于其纯用辛甘的味道，不仅辛能破酸，甘能救咸，而且病机发于补阴而贼害阳气，所以方义专门在于升火以运水。
Mother (referring to the previous context/lineage). The Baihe Zhimu Tang (Lily and Anemarrhena Decoction) for tonifying the Lung uses Zhi Mu (Anemarrhenae Rhizoma). This is also definitive evidence. By pairing Gui Zhi (Cinnamomi Ramulus, acrid-warm nature) equally with it, Gui Zhi, due to Zhi Mu, enters directly into the Lung organ system. Thus, the acridity of Gui Zhi stirs up Lung Qi, and its warm-natured unblocking harmonizes the Shen (Spirit) of the Lung. Furthermore, fearing that the acrid-sweet nature might only induce sweating from the upper jiao without descending into the bone crevices of the Kidney meridian, Sour-astringent Shao Yao (Paeoniae Radix Alba) is added as an assistant to guide it slightly downward. This allows the acrid-salty-warm Fu Zi (Aconiti Lateralis Radix Praeparata) to enter the Kidney organ directly in one go. Then, Bai Zhu (Atractylodis Macrocephalae Rhizoma), which dries dampness, is used as the sovereign herb; Sheng Jiang (Zingiberis Rhizoma Recens), which disperses dampness, as the minister herb; and Gan Cao (Glycyrrhizae Radix et Rhizoma), which is sweet and緩 (moderating), as the envoy herb. Together they cultivate the Earth qi of the bone joints, converging with the dispersing Ma Huang (Ephedrae Herba), which then slowly penetrates through the sinews and bones to produce a slight sweat. Fang Feng (Saposhnikoviae Radix) serves as the rear guard because it can consolidate the Wei Qi (Defensive Qi), fearing that after the wind-dampness is expelled, the body might be attacked by wind again. Therefore, using Fu Zi as the guide entering the Kidney, Bai Zhu, Sheng Jiang, and Gan Cao as the central army for removing dampness, Ma Huang as the commander returning from campaign, Fang Feng as the garrison for aftermath, and Gui Zhi, Shao Yao, and Zhi Mu originally as the supervisors of the rear army, unexpectedly achieved the miraculous effect of expelling wind on the way. How divine this formula is! For the sixth clause regarding Blood deficiency in Shaoyin, where simple Wind-strike becomes Li Jie disease (Rheumatoid Arthritis/Joint Bi), although there is no dampness from stagnant sweating, the deficiency of Kidney Qi and the suitability of resolving Wind-strike through sweating are the same. In my humble opinion, if we remove the dampness-removing Bai Zhu and Sheng Jiang from this formula, and replace them with Dang Gui (Angelicae Sinensis Radix) to tonify Liver Blood and Sheng Di Huang (Rehmanniae Radix) to tonify Kidney Blood, then changing one general changes the momentum of the entire army. Hence, saying "Zhu Zhi" (mainly treats) means taking this formula as the mainstay, originally giving people the flexibility to advance or retreat spiritually/intellectually, which differs from the textual convention of saying "Yi Mou Tang" (should use such-and-such decoction) elsewhere.
Clause 9: Acrid taste injures the sinews; when sinews are injured, they become flaccid, named Xie (Leakage/Flaccidity). Salty taste injures the bones; when bones are injured, they become atrophic, named Ku (Withering). Withering and Leakage intermingling is named Duan Xie (Severance and Leakage). Ying Qi (Nutritive Qi) does not flow smoothly, Wei Qi cannot move independently; both Ying and Wei Qi become deficient. The Three Jiao (Triple Burner) has nothing to command; the Four Belongings (limbs/extremities) are severed. The body becomes emaciated, while only the feet swell. Yellow sweat appears, the shins feel cold. If fever occurs, it is definitely Li Jie disease. Patients with Li Jie disease cannot flex or extend their joints and experience pain. Wu Tou Tang (Aconite Decoction) is mainly indicated.
Wu Tou Tang Formula: Chuan Wu Tou (Sichuan Aconite Root) (5 pieces, crushed, boiled with 2 sheng of honey until 1 sheng remains, then remove the Wu Tou); Ma Huang (3 liang); Huang Qi (Astragali Radix) (3 liang); Shao Yao (3 liang); Gan Cao (Licorice Root) (2 liang, roasted).
The above five herbs are crushed. Take four of them (excluding Wu Tou initially processed with honey) and boil with 3 sheng of water to obtain 1 sheng. Strain the dregs. Add this liquid to the honey-Wu Tou mixture and boil further. Take 7 he of the decoction; if ineffective, consume the remainder.
The Five Elements each possess Yin and Yang, such as the categories of Jia, Yi, Ren, Gui, etc. Their natures and preferences often oppose each other and differ because when Yang is born, Yin dies, and when Yin is born, Yang dies. For example, Jia Wood is born in Hai month, so Yi Wood dies in Hai month; Yi Wood is born in Wu month, so Jia Wood dies in Wu month; Ren Water is born in Shen month, so Gui Water dies in Shen month; Gui Water is born in Mao month, so Ren Water dies in Mao month, and so on. The Liver is the Wood organ. Within Wood, there is Jia Yang and Yi Yin. Jia governs the Yang Spirit, flowing outward its residual Qi to correspond to the sinews. Thus, its nature prefers smoothness and free flow. The *Neijing* states that Acrid flavor tonifies it and Sour flavor drains it, which is correct. Yi governs the Yin Image, internally solidifying the Form Organ to correspond to the Liver. Thus, its nature prefers gathering and binding. The *Jinkui Yaolue* states that Sour flavor tonifies it, which is correct. However, when Jia is born, Yi dies; excessive Acrid flavor injures the Form Organ Liver. When Yi is born, Jia dies; excessive Sour flavor injures the residual Qi sinews. Generally, Sour flavor gathers the Yin Blood of the Liver but also gathers the Yang Qi that nourishes the sinews. Without the healthy function of Yang Qi, the sinews become flaccid, named Xie (Leakage), meaning Liver Blood does not accompany the sinews, and its Qi gradually leaks away. The Kidney is the Water organ. Within Water, there is Ren Yang and Gui Yin. Ren governs the Yang Spirit, flowing outward its residual Qi to correspond to the bones. Thus, its nature prefers tranquility and stillness. The *Neijing* states that Sweet flavor tonifies it and Salty flavor drains it, which is correct. Gui governs the Yin Image, internally solidifying the Form Organ to correspond to the Kidney. Thus, its nature prefers descending and moistening. The *Jinkui Yaolue* states that Salty flavor tonifies it, which is correct. However, when Ren is born, Gui dies; excessive Sweet flavor injures the Form Organ Kidney. When Gui is born, Ren dies; excessive Salty flavor injures the residual Qi bones. Generally, Salty flavor suppresses the Yin Essence of the Kidney but also suppresses the Yang Qi that strengthens the bones. Without the healthy function of Yang Qi, the bones become atrophic, named Ku (Withering), meaning Kidney Essence does not accompany the bones, and its Qi gradually withers. Bone Yang pathology leads to withering; Sinew Yang pathology leads to leakage. When these two intermingle, it signifies that the Liver and Kidney have severed their nourishment, and the Qi of sinews and bones gradually leaks. Is it not appropriate to name this Duan Xie (Severance and Leakage)? The above discusses the self-pathology of Liver, Kidney, sinews, and bones. The Ying Qi in the meridians, although transformed from food and drink in the Stomach, is actually connected with the Essence and Blood of the Liver and Kidney. When Liver and Kidney pathology causes severance and leakage, Ying Qi becomes blocked and gradually diminishes. The fierce Qi (Han Qi) transformed in the Stomach, which usually emerges via Ying Yin to become external Wei Qi, finds that since Ying Qi is weak, Wei Qi cannot move independently and itself becomes depleted/disordered. Thus, both Ying and Wei Qi become deficient. This describes how internal pathology of Liver and Kidney leads to external pathology of Ying and Wei. "Yu" (Command/Drive) implies driving like a chariot. The Yang of the Upper Jiao (chest), the Yang of the Middle Jiao (Stomach area), and the Yang of the Lower Jiao (Mingmen) all use Essence and Blood as the chariot and drive them to circulate throughout the body. When the Essence and Blood of Liver and Kidney gather inward and sink downward, the Qi of the Three Jiao has nothing to ride upon, implying a gradual cooling. This describes how lower pathology of Liver and Kidney leads to upper pathology of the chest and Stomach. "Si Shu" (Four Belongings) refers to the upper, lower, interior, and exterior. Continuing from the above, Sour astringency and Salty descending cause Essence and Blood to gather inward and sink, leading to internal and lower pathology of Liver and Kidney Yang. Consequently, external Ying and Wei become weak, and Upper Jiao becomes deficient. The Four Belongings (upper, lower, interior, exterior) all face obstruction and tend toward severance. Because Ying and Wei in the meridians are both deficient, the body becomes emaciated. Because the Essence and Blood of Liver and Kidney are gathered and suppressed by Sour and Salty flavors, only the feet swell, and yellow sweat appears. As Yin Qi naturally sinks, Yang Qi naturally weakens, hence the cold shins, which aligns with the logic of flaccid sinews and atrophic bones mentioned earlier. If fever occurs, it means Yang Qi cannot move independently but stagnates in the sinew-bone crevices, undoubtedly indicating Li Jie disease. This discusses the external symptoms of Li Jie to prove the concept of the severance of the Four Belongings. Wu Tou Tang is mainly indicated because Wu Tou (Aconite) acts as the sovereign herb to unblock Yang and penetrate the joints. Using honey to decoct it allows it to linger in the Stomach, serving as a base for internal penetration and external reach. Then, sweet and moderating Gan Cao breaks the astringency of Shao Yao, specifically directing the Yang Qi of Wu Tou to enter the sinews and bones internally to strengthen the exterior. Exterior-consolidating Huang Qi monitors the dispersing action of Ma Huang, specifically directing the Yang Qi of Wu Tou to circulate externally through Ying and Wei. By raising together the latent Yang of Liver and Kidney, it steams the Essence and Blood, allowing reconnection with the Ying and Wei of the Three Jiao. Regarding its pure use of Acrid and Sweet flavors, not only does Acrid break Sour and Sweet rescue Salty, but since the pathogenesis arises from tonifying Yin and harming Yang, the formula's intent focuses on raising Fire to transport Water.