〔丹〕病虽实胃气伤者勿便攻击论 凡言治者，多借医为喻，仁哉斯言也。真气，民也。病邪，盗贼也。
药石，兵也。或有盗起，势须剪除而后已。良将良相，必先审度兵食之虚实，与时势之可否，然后动，动涉轻
妄，则吾民先困于盗，次困于兵，民困则国弱矣。行险侥幸，小人所为，万象森罗，果报昭显。其可不究心乎？
（治吕氏寒战，用 葛愈。一法，治叶先生滞下，用参术而后下之愈。一法治妇人积块，用消石丸大峻后，用
补剂间服愈。详各见本门。）大凡攻击之药，有病则受之，病邪轻，药力重，则胃气受伤。夫胃气者，清纯
冲和之气也，惟与谷肉菜果相宜。盖药石皆是偏胜之气，虽参 辈为性亦偏，况攻击之药乎。忌，春夏不
宜桂枝，秋冬不宜麻黄。药忌，已汗者不可再发，已利者不可再利。病忌，虚人不宜用凉，实人不宜用热。
〔东垣〕凡治病服药，必知时禁、经禁、病禁、药禁。夫时禁者，必本四时升降之理，汗下吐利之宜。大
法，春宜吐，象万物之发生，耕耨砟斫，使阳气之郁者易达也。夏宜汗，象万物之浮而有余也。秋宜下，象万
物之收成，推陈致新，而使阳气易收也。冬宜周密，象万物之闭藏，使阳气不动也。夫四时阴阳者，与万物沉
浮于生长之门，逆其根，伐其本，坏其真矣。用温远温，用热远热，用凉远凉，用寒远寒，无翼其胜也。故冬
不用白虎，夏不用青龙，春夏不用桂枝，秋冬不服麻黄，不失气宜。如春夏而下，秋冬而汗，是失天信，伐天
和也。有过则从权，过则更之。经禁者，足太阳膀胱诸阳之首，行于背，表之表，风寒所伤，则宜汗。传入本，
则宜利小便。若下太早，则变证百出，此一禁也。足阳明胃经行身之前，病主腹满胀，大便难，宜下之。盖阳
明化燥火，津液不能停禁，若发汗利小便，为重损津液，此二禁也。足少阳胆经行身之侧，在太阳阳明之间，
病则往来寒热，口苦胸胁痛，只宜和解。且胆者无出无入，又主发生之气，下则犯太阳，汗则犯阳明，利小便
则使发生之气反陷入阴中，此三禁也。三阴非胃实不当下，为三阴无传本，须胃实得下也。分经用药，有所据
焉。病禁者，如阳气不足阴气有余之病，则凡饮食及药，忌助阴泻阳。诸淡食及淡味药物，泻阳升发以助收敛；
诸苦药皆沉，泻阳气之散浮；诸姜、附、官桂辛热之药及湿面酒大料物之类，助火而泻元气；主冷硬物，能损
阳气；皆所当禁也。如阴火欲衰而退，以三焦元气未盛，必口淡。如咸物，亦所当禁也。药禁者，如胃气不行，
内亡津液而干涸，求汤饮以自救，非渴也，乃口干也。非湿胜也，乃血病也。当以辛酸益之，而淡渗五苓之类
则所当禁也。汗多禁利小便，小便多禁发汗，咽痛禁发汗利小便。若大便快利，不得更利。大便秘涩，以当归、
桃仁、麻子仁、郁李仁、皂角仁，和血润肠，如燥药则所当禁者也。吐多不得复吐，如吐而大便虚软者，此上
气壅滞，以姜、橘之属宣之。吐而大便不通，则利大便药所当禁也。诸病恶疮，小儿 后，大便实者，亦当下
之，而姜、橘之类，则所当禁也。人知脉弦而服平胃散，脉缓而服黄 建中汤，乃实实虚虚，皆所当禁也。人
禀天地之湿化而生胃也，胃之与湿，其名虽二，其实一也。湿能滋养于胃，胃湿有余，亦当泻其太过也。胃之
不足，惟湿物能滋养。仲景云∶胃胜思汤饼。而胃虚食汤饼者，往往增剧。湿能助火，火旺郁而不通，则生大
热。初病火旺，不可食湿以助火也。察其时，辨其经，审其病，而后用药，四者不失其宜，则善矣。
〔丹〕大病虚脱，本是阴虚，用艾灸丹田者，所以补阳，阳生阴长故也。不可用附子，可多服人参。
〔垣〕春宣论 春，蠢也，阳气升浮，草木萌芽，蠢然而动。人气在头，有病宜吐。又曰∶伤寒大法，春
宜吐。宣之为言扬也，谓吐之法自上而出也。今世俗往往有疮痍者，膈满者，虫积者，以为不于春时宣泻毒瓦斯，
不可愈也。医者遂用牵牛、巴豆、大黄、枳壳、防风辈为丸药，名之曰春宣丸，于二月三月服之，谓俾下利而
止。初泻之时，脏腑得通时暂轻快，殊不知气升在上，则在下之阴甚弱，而用利药戕贼真阴，其害何可胜言。
况仲景承气汤等下剂，必有大满大坚实，有燥屎转矢气下逼迫而无表证者，方行此法。可下之证悉具，犹须迟
以待之。泄痢之药，其可轻试之乎。予伯考形肥骨瘦，味浓性沉，五十岁轻于听信，忽于三月半购春宣丸服之，
下二三行甚快，每年习以为常，至五十三岁时，七月初热甚，无病暴死。此岂非妄用春宣为春泻而至祸耶！自
上召下曰宣，宣之一字为吐也明矣。子和已详论之，昔贤岂妄言哉。后之死者，又有数人，愚故表而出之，以
为后人之戒。
夏日伏阴在内论 天地以一元之气，化生万物。根于中者，曰神机。根于外者，曰气血。万物天地，同此
一气。人灵于物，形与天地参而为三者，以其得气之正而通也。故气升亦升，气浮亦浮，气降亦降，气沉亦
沉，人与天地同一 也。子月一阳生，阳初动也。寅月三阳生，阳初出于地，此气之升也。巳月六阳生，阳
尽出于上，此气之浮也，人之腹属地，气于此时浮于肌表，散于皮毛，腹中之阳虚矣。经曰∶夏者经满气溢，
孙络受血，皮肤充实。长夏气在肌肉，所以表实。表实者，里必虚也。世言夏月伏阴在内，此阴字有虚之义，
若作阴冷看，其误甚矣。或曰∶以手扪腹，明知其冷，非冷而何？前人治暑病，有玉龙丹、大顺散、桂苓丸，
单煮良姜与缩脾饮，用草果等，皆温热之剂，何吾子不思之甚也。予曰∶经云∶春夏养阳，王太仆谓春食凉，
夏食寒，所以养阳也，其意可见矣。若夫凉台水阁，大扇风车，阴木寒泉，水果冰雪，寒凉之伤，自内及外，
不用温热，病何由安。详玩其意，实非为内伏阴而用之也。前哲又谓升降浮沉则顺之，寒热温凉则逆之。若于
夏月火令之时，妄投温热，宁免实实虚虚之患乎。或曰∶四月纯阳，于理或通，五月一阴，六月二阴，非阴冷
而何？予曰∶此阴之初动于地下也，四阳浮于地上，焰灼焚燎，流金砾石，何阴冷之有。孙真人制生脉散，令
人夏月服之，非虚而何？东垣经云∶一阴一阳之谓道，偏阴偏阳之谓疾。《圣济经》曰∶阳剂刚胜，积若燎原，
为消渴痈疽之属，则天癸竭而荣涸。阴剂柔胜，积若凝冰，为洞泄寒中之属，则真火微而卫散。故大寒大热之
药，当宜权用之，气平而止。如寒热有所偏胜，令人脏气不平。呜呼，生死之机，捷若影响，殆不可忽。
〔丹〕《局方》地榆散 治痢每用粟壳、地榆，而治疟每用砒丹、常山。然此四五件，亦痢疟之一药，但
以粟壳辈投之一二服，投之不止反闭胃口而有呕逆之证，渐成禁口。常山辈投之一二服，投之不去，反耗损真
气，而寒热缠绵之咎，渐成劳瘵。今《局方》水煮木香丸，以青皮为君，地榆散以枳壳为君，稍可担负，亦须
证明而后可。但枳壳为君，以枳实为臣，非独止痢，且有安胃气止溏泄之功。若止用枳壳，虽亦言其安胃气，
却无止痢止溏泄之功。（《局方》中地榆散当去皮用。）
〔罗〕仲景云∶疮家虽身疼痛，不可发汗，其理何也？予曰∶此荣气不从，逆于肉理，而为疮肿，作身疼
痛，非身感寒邪而作疼痛，故戒之以不可发汗，如汗之则成 。又问∶仲景言鼻衄者不可发汗，复言脉浮紧者
当服麻黄汤发之，衄血自止，所说不同，愿闻其故？答曰∶此与疮家概同。且夫人身血之与汗，异名而同类，
夺血者无汗，夺汗者无血。今衄血妄行，为热所逼，若更发其汗，则反助热邪，重竭津液，必变凶证，故不可
汗。若脉浮则为在表，紧则为寒，寒邪郁遏，阳不得伸，热伏营中，迫血妄行，上出于鼻，则当麻黄汤散其寒
邪，使阳气得伸，其衄自止，又何疑焉。或者叹曰∶知其要者，一言而终。不知其要者，流散无穷。洁古之学，
可谓知其要者矣。（伤寒衄忌汗者脉微。）
〔海〕当汗而不汗则生黄，当利小便而不利亦然。脾主肌肉，四肢寒湿，与内热相合故也。不当汗而汗，
亡其津液，令毒瓦斯扰阳之极，极则侵阴矣，故燥血而蓄之胸中。或利小便过多亦然。若犯发汗多蓄血，上焦为
衄。若利小便多蓄血，为发狂。或问曰∶伤寒杂症一体，若误下，变有轻重，何也？答曰∶伤寒误下，变无定
体。杂症误下，变有定体。何以然？曰∶伤寒自外而入，阳也，阳主动。杂证自内而出，阴也，阴主静。动者
犯之，其变无穷。静者犯之，其变止痞与腹、胁痛而已。故变无穷者为重病，痞与胁痛者为轻也。
〔罗〕无病服药辨谚 云∶无病服药，如壁里安柱。此无稽之说，为害甚大。夫天之生物，五味备焉，食
之以调五脏，过则生疾。故经云∶阴之所生，本在五味。阴之五宫，伤在五味。又曰∶五味入胃，各随其所喜。
故酸先入肝，辛先入肺，苦先入心，甘先入脾，咸先入肾，久而增气，气增而久，夭之由也。又云∶酸走筋，
辛走气，苦走骨，咸走血，甘走肉。五味者，口嗜而欲食之，必自裁制，勿使过焉。至于五谷为养，五果为助，
五畜为益，五菜为充，气味合而食之，补精益气。倘用之不时，食之不节，犹或生疾，况药乃攻邪之物，无病
而可服乎。《圣济经》云∶彼修真者，蔽于补养，轻饵药石，阳剂刚胜，积若燎原，为消渴痈疽之属，则天癸绝
而阴涸；阴剂柔胜，积若凝冰，为洞泄寒中之属，则真火微而卫散。一味偏胜，一脏偏伤，一脏受伤，四脏安
得不病。唐孙思邈言药势有所偏胜，令人脏气不平。裴 谏唐宪宗曰∶夫药以攻病，非朝夕常用之物，况金石
性酷烈有毒，又加炼以火气，非人五脏所能禁。至于张皋谏穆宗曰∶神虑淡则气血和，嗜欲多而疾 作，夫药
以攻疾，无病不可饵。故昌黎伯铭李子之墓曰∶余不知服食说自何世起，杀人不可计，而世慕尚之益至，此其惑
也。今直取目见亲与之游而以药败者六七公，以为世诫∶工部尚书归登，殿中御史李虚中，刑部尚书李逊第，
刑部侍郎常建，襄阳节度使工部尚书孟简，东川节度使御史大夫卢植，金吾将军李道古。今又复取目见者言之∶
僧阎仲章服火炼丹砂二粒，项出小疮，肿痛不任，牙痒不能嚼物，服凉膈散半斤，始缓。后饮酒辄发，药以寒
凉之剂则缓，终身不愈。镇人李润之身体肥盛，恐生风疾，至春服搜风丸，月余便下无度，饮食减少，舌不知
味，口干气短，脐腹痛，足胫冷，眩晕欲倒，面色青黄不泽，日加困笃，乃告亲知曰∶妄服药祸，悔将何及。
后添烦躁喘满，至秋而卒。张秀才者，亦听方士之说，服四生丸推陈致新，服月余，大便或溏或泻，饮食妨阻，
怠惰嗜卧，目见黑花，耳闻蝉声，神虚头旋，飘飘然身不能支，至是方知药之误也。遂调饮食，慎起居，谨于
保养，二三年间，其证犹存。逾十年后，方平复。刘氏子闻人言，腊月晨饮凉水一杯，至春无目疾，遂饮之。
旬余，腹中寒痛不任，咳嗽呕吐，全不思食，恶水而不欲见，足胫寒而逆，医以除寒燥热之剂急救之，终不能
效。此皆无故求益生之祥，反生病焉，或至于丧身殒命。壁里安柱，果安在哉？且夫高堂大厦，梁栋安，基址
固，坏涂毁 ，安柱壁中，甚不近人情。洁古老人云∶无病服药，无事生事。此诚不易之论。人之养身，幸五
脏之安泰，六腑之和平，谨于摄生，春夏奉以生长之道，秋冬奉以收藏之理，饮食之有节，起居而有常，少思
寡欲，恬淡虚无，精神内守，此无病之时，不药之药也。噫，彼数人者，既往不咎矣，后人当以此为龟鉴哉。
阴盛阳虚不宜下辨 阴盛阳虚，汗之则愈，下之则死，此言邪气在表之时也。夫寒邪属阴，身之外皆属阳，
各脏腑之经络亦属阳也。盖阳气为卫，卫气者所以温肌肉，充皮毛，肥腠理，司开阖，此皆卫外而为固也。或
烦劳过度，阳气内损，不能为固，阳为之虚。阳虚者阴必凑之，故阴得以胜，邪气胜则实，阴盛阳虚者此也。
阴邪既胜，腠理致密，阳气伏郁，不得通畅，所以发热恶寒，头项痛，腰脊强，应解散。而药用麻黄者，本草
云∶轻可去实，葛根、麻黄之属是也。盖麻黄能退寒邪，使阳气伸越作汗而解。故曰∶阴盛阳虚，汗之则愈。
里气和平而反下之，中气既虚，表邪乘虚而入，由是变症百出，故曰下之则死。《外台秘要》云∶表病里和，汗
之则愈，下之则死。正此意也。
阳盛阴虚不宜汗辨 阳盛阴虚，下之则愈，汗之则死，此言邪气在里之时也。夫寒邪始伤于表，不解而渐
传入于里，变而为热。人之身在里者为阴，华佗云∶一日在皮，二日在肤，三日在肌，四日在胸，五日在腹，
六日入胃。入胃谓之入腑也，腑之为言聚也，若府库而聚物焉，又为水谷之海，荥卫之源。邪气入于胃而不复
传流水谷，水谷不消去，郁而为实也，此阳盛阴虚者此也。故潮热引饮，腹满而喘，手足 汗出，大便难而
[Background Information]
Book: Medical Outline (Yixue Gangmu)
Author: Lou Ying
Dynasty: Ming
Chapter: Appropriate Prohibitions in Medication (Part 1/2)
Category: Medical Discourse
[Danxi] Discussion on Not Attacking When Stomach Qi is Damaged Even if the Disease is Excess
Those who speak of treatment often use medicine as a metaphor. How benevolent this saying is! True Qi (Zhenqi, vital energy) is like the people; pathogenic factors are like bandits; medicinal herbs and stones are like soldiers. If bandits rise up, it is necessary to eliminate them before stopping. A good general or prime minister must first carefully assess the strength and weakness of troops and provisions, and whether the timing is appropriate, before acting. If action is rash and reckless, our people will first be distressed by bandits, then by war; if the people are distressed, the state becomes weak. Acting recklessly for luck is what petty men do. All phenomena are manifest, and retribution is clear. Should one not study this carefully?
(Treating Mrs. Lü’s chills, Ge Gen [Kudzu Root] cured her. One method: treating Mr. Ye’s dysentery, using Renshen [Ginseng] and Baizhu [Atractylodes Macrocephala] followed by purgation cured him. Another method: treating a woman’s abdominal mass, using Xiaoshi Pill [Calcite Pill] strongly first, then taking tonics intermittently cured her. See respective sections for details.) Generally, attacking medicines are accepted when there is disease. If the pathogen is light but the medicinal force is heavy, Stomach Qi (Wei Qi, digestive function) will be injured. Stomach Qi is pure, clear, and harmonious Qi, suitable only for grains, meats, vegetables, and fruits. Medicinal herbs all possess biased properties; even Renshen [Ginseng] has a biased nature, let alone attacking medicines. Taboos: Gui Zhi [Cinnamon Twig] is unsuitable in spring and summer; Ma Huang [Ephedra] is unsuitable in autumn and winter. Medicinal taboos: those who have sweated should not sweat again; those who have had diarrhea should not be purged again. Disease taboos: deficient persons should not use cooling agents; excess persons should not use warming agents.
[Dongyuan] In treating diseases and taking medication, one must know seasonal prohibitions, meridian prohibitions, disease prohibitions, and medicinal prohibitions. Seasonal prohibitions are based on the principles of rising and falling of the four seasons and the appropriateness of sweating, purging, vomiting, and draining. The general rule is: Spring is suitable for inducing vomiting, resembling the sprouting of all things; plowing and cutting allow stagnant Yang Qi to reach easily. Summer is suitable for sweating, resembling the floating and abundance of all things. Autumn is suitable for purging, resembling the harvest of all things; pushing out the old and bringing in the new allows Yang Qi to gather easily. Winter is suitable for secrecy and density, resembling the hibernation of all things; keeping Yang Qi from moving. The Yin and Yang of the four seasons float with all things in the gate of growth. Reversing their roots and destroying their foundations ruins their true essence. Use warmth far from warmth, heat far from heat, coolness far from coolness, cold far from cold; do not assist their dominance. Therefore, do not use Bai Hu Tang [White Tiger Decoction] in winter, Qing Long Tang [Azure Dragon Decoction] in summer, Gui Zhi [Cinnamon Twig] in spring and summer, or Ma Huang [Ephedra] in autumn and winter; this does not lose the appropriateness of Qi. If purging in spring and summer, or sweating in autumn and winter, this loses heavenly trust and destroys heavenly harmony. If there is an error, adapt flexibly; if there is excess, correct it. Meridian prohibitions: Foot-Taiyang Bladder Meridian is the head of all Yang meridians, running along the back, the exterior of the exterior. If injured by wind-cold, sweating is suitable. If transmitted to its interior, promoting urination is suitable. If purging is too early, hundreds of transformed symptoms will appear; this is the first prohibition. Foot-Yangming Stomach Meridian runs along the front of the body; diseases mainly involve abdominal fullness and distension, difficult defecation, which should be purged. Since Yangming transforms into dry fire, fluids cannot be retained; if sweating and promoting urination are used, fluids are doubly damaged; this is the second prohibition. Foot-Shaoyang Gallbladder Meridian runs along the side of the body, between Taiyang and Yangming. Diseases involve alternating chills and fever, bitter taste in the mouth, chest and hypochondriac pain, which should only be harmonized. The Gallbladder has no exit or entry and governs the Qi of generation. Purging offends Taiyang, sweating offends Yangming, promoting urination causes the Qi of generation to sink into Yin; this is the third prohibition. Three Yin meridians should not be purged unless the Stomach is excess, because Three Yin has no interior transmission; purging is only possible when the Stomach is excess. Using medicines according to meridians has a basis. Disease prohibitions: For diseases where Yang Qi is insufficient and Yin Qi is excessive, all foods and medicines that assist Yin and drain Yang should be avoided. All bland foods and bland-flavored medicines drain Yang’s ascending and dispersing nature to assist convergence; all bitter medicines sink, draining the dispersing and floating Yang Qi; all ginger, Fu Zi [Aconite], Guan Gui [Cassia Bark], pungent-hot medicines, and damp noodles, wine, and strong spices assist fire and drain Yuan Qi; main cold and hard foods can damage Yang Qi; all these should be prohibited. If Yin Fire wants to decline and retreat, because Sanjiao Yuan Qi is not yet vigorous, there must be a bland taste. Salty foods should also be prohibited. Medicinal prohibitions: If Stomach Qi does not move, internal loss of fluids leads to dryness, seeking soup or drink to save oneself; this is not thirst, but dry mouth. It is not dampness excess, but blood disease. Sour and pungent substances should be added to benefit it, while bland-draining formulas like Wu Ling San [Five-Ingredient Powder with Poria] should be prohibited. Excessive sweating prohibits promoting urination; excessive urination prohibits sweating; sore throat prohibits sweating and promoting urination. If stool is loose, do not purge again. If stool is constipated, use Dang Gui [Angelica Sinensis], Tao Ren [Peach Seed], Humaoren [Hemp Seed], Yuliren [Bush Cherry Seed], and Zaorao Ren [Gleditsia Seed] to harmonize blood and moisten intestines; drying medicines should be prohibited. Excessive vomiting prohibits further vomiting. If vomiting occurs with loose stool, this is upper Qi stagnation; use ginger and tangerine peel to disperse. If vomiting occurs with constipation, laxatives should be prohibited. For various malignant sores, after children’s diseases, if stool is solid, purging may be used, but ginger and tangerine peel should be prohibited. People know to take Ping Wei San [Calm the Stomach Powder] for wiry pulses and Huang Qi Jian Zhong Tang [Astragalus Decoction to Establish the Middle] for slow pulses; this makes excess more excess and deficiency more deficient, both of which should be prohibited. Humans are born from the heaven and earth’s damp transformation, generating the Stomach. The Stomach and dampness, though two names, are essentially one. Dampness nourishes the Stomach; if Stomach dampness is excessive, it should be drained. If the Stomach is deficient, only damp substances can nourish it. Zhang Zhongjing said: "When Stomach Qi is excessive, one craves soup and cakes." But those with Stomach deficiency eating soup and cakes often worsen. Dampness assists fire; if fire is vigorous and stagnant without flow, great heat is generated. Initially, when fire is vigorous, one should not eat dampness to assist fire. Observe the season, distinguish the meridian, examine the disease, and then use medicine; if these four do not lose appropriateness, it is good.
[Danxi] Severe disease with collapse is fundamentally Yin deficiency. Using moxibustion on Shendian (CV4, Sea of Qi) supplements Yang; because Yang generates, Yin grows. Do not use Fu Zi [Aconite]; one can take much Renshen [Ginseng].
[Yuan] Discussion on Spring Dispersion
Spring means stirring; Yang Qi rises and floats, grass and trees sprout, stirring and moving. Human Qi is in the head; if diseased, vomiting is suitable. It is also said: The general rule for Cold Damage is that spring is suitable for vomiting. "Xuan" (disperse) means to raise; it means the method of vomiting comes from above. Nowadays, common people often have sores, chest fullness, or parasite accumulation, believing that if toxic gases are not dispersed and drained in spring, they cannot be cured. Physicians therefore make pills using Qian Niu [Pharbitis Seed], Ba Dou [Croton Seed], Da Huang [Rhubarb], Zhi Ke [Bitter Orange], Fang Feng [Saposhnikovia], etc., naming them Chun Xuan Wan [Spring Dispersal Pill], taken in February and March, claiming they stop after causing diarrhea. At the beginning of purging, organs and bowels get through and feel temporarily relieved; little do they know that Qi rises upward, making Yin below very weak, and using purgatives destroys True Yin; the harm is incalculable. Moreover, Zhang Zhongjing’s Cheng Qi Tang [Ordering Qi Decoction] and other purgatives require great fullness, firmness, dry feces, passing flatus, lower pressure, and no exterior symptoms before this method is used. Even if all indications for purging are present, one must still wait. Can laxative medicines be lightly tried? My grandfather was fat but thin-boned, rich in flavor and deep in nature. At fifty, he轻信ly listened and believed, suddenly buying Chun Xuan Wan in mid-March to take. He passed two or three times quickly, making it a habit every year. At fifty-three, in early July, heat was severe, and he died suddenly without illness. Was this not the disaster caused by wrongly using Spring Dispersal as Spring Purging? Calling down from above is called "Xuan"; it is clear that "Xuan" means vomiting. Hezi discussed this in detail; how could former sages speak falsely? Later deaths included several more people; I thus record them to warn future generations.
Discussion on Hidden Yin Inside in Summer
Heaven and Earth transform all things with one Qi. Rooted inside is Shen Ji (Spirit Mechanism); rooted outside is Blood and Qi. All things and heaven and earth share this one Qi. Humans are spiritual among things; form participates with heaven and earth to become three, because it obtains Qi correctly and connects. Thus, Qi rises, it rises; Qi floats, it floats; Qi sinks, it sinks; Qi settles, it settles; humans and heaven and earth are the same. In Zi month, one Yang is born; Yang initially moves. In Yin month, three Yangs are born; Yang initially emerges from the earth; this is Qi rising. In Si month, six Yangs are born; Yang completely emerges above; this is Qi floating. Human abdomen belongs to earth; at this time, Qi floats on muscle surface, scatters in skin and hair, and Yang in the abdomen is deficient. The Classic says: In summer, meridians are full and Qi overflows; collateral vessels receive blood; skin is充实 (solid). In late summer, Qi is in muscles, so the exterior is solid. If the exterior is solid, the interior must be deficient. The world says hidden Yin is inside in summer; this "Yin" character has the meaning of deficiency. If viewed as cold, the error is great. Some say: Touching the abdomen with hand, knowing it is cold, what else is it? Former predecessors treating summerheat disease had Yu Long Dan [Jade Dragon Pill], Da Shun San [Great Harmony Powder], Gui Ling Wan [Cinnamon and Polyporus Pill], boiling Liang Jiang [Galangal] alone and Suo Pi Yin [Spleen-Restraining Drink], using Cao Guo [Black Cardamom], etc., all warm-hot agents. Why do you not think deeply? I say: The Classic says: Nourish Yang in spring and summer. Wang Taipu said: Eat cool in spring, eat cold in summer, to nourish Yang; the intent is visible. As for cool terraces, water pavilions, large fans, windmills, shady woods, cold springs, fruits, ice and snow, cold injuries go from inside to outside; without using warm-hot agents, how can the disease be calmed? Studying the intent, it is actually not for hidden Yin inside. Former sages also said: Follow rising, falling, floating, sinking; reverse cold, heat, warm, cool. If in summer during fire command, wrongly throwing warm-hot agents, how can one avoid the danger of making excess more excess and deficiency more deficient? Some say: April is pure Yang, logic might pass; May is one Yin, June is two Yin, what else is it but cold? I say: This is Yin initially moving underground; four Yangs float on ground, flames burn, melting metal and stones, what cold is there? Sun Simiao made Sheng Mai San [Generate Pulse Powder], letting people take it in summer; is it not deficiency? Dongyuan’s Classic says: One Yin and one Yang is called Dao; biased Yin and biased Yang is called disease. "Shengji Jing" says: Yang agents are rigid and dominant, accumulating like a prairie fire, leading to diabetes and carbuncles, then Tian Gui ends and Ying Blood dries. Yin agents are soft and dominant, accumulating like frozen ice, leading to profuse diarrhea and cold middle, then True Fire is weak and Wei Qi scatters. Therefore, great cold and great heat medicines should be used flexibly, stopping when Qi is balanced. If cold and heat are biased, it makes Zang Qi unbalanced. Alas, the mechanism of life and death is swift as shadow; it must not be ignored.
[Danxi] Ju Fang Di Yu San treats dysentery often using Su Ke [Poppy Shell] and Di Yu [Sanguisorba], and treats malaria often using Pi Dan [Arsenic Pill] and Chang Shan [Dichroa]. However, these four or five items are also medicines for dysentery and malaria. But if Su Ke is given for one or two doses, if it does not stop, it closes the stomach opening and causes nausea and vomiting, gradually becoming Jin Kou Li Ji [Forbidden Mouth Dysentery]. If Chang Shan is given for one or two doses, if it does not remove the pathogen, it consumes True Qi, and the lingering chills and fever cause Lao Zhai [Consumption]. Now Ju Fang Shui Zhu Mu Xiang Wan uses Qing Pi [Green Tangerine Peel] as Sovereign; Di Yu San uses Zhi Ke [Bitter Orange] as Sovereign; slightly bearable, but must prove the syndrome first. But if Zhi Ke is Sovereign and Zhi Shi [Immature Bitter Orange] is Minister, it not only stops dysentery but also stabilizes Stomach Qi and stops loose stools. If only Zhi Ke is used, although it is said to stabilize Stomach Qi, it has no effect of stopping dysentery and loose stools. (In Ju Fang, Di Yu San should use peeled material.)
[Luo] Zhang Zhongjing said: "Even if a patient with sores has body pain, do not induce sweating." What is the reason? I say: This is Ying Qi not following, reversing in flesh texture, forming sores and swelling, causing body pain; it is not body pain caused by feeling cold pathogens, so warned against sweating. If sweated, it becomes... Again asked: Zhang Zhongjing said those with epistaxis should not sweat, but also said those with floating-tight pulse should take Ma Huang Tang [Ephedra Decoction] to sweat, and epistaxis stops itself. The statements differ; I wish to hear the reason. Answer: This is generally the same as sores. Moreover, blood and sweat in the human body are different names but same category. Those who lose blood have no sweat; those who lose sweat have no blood. Now epistaxis flows wildly, forced by heat; if sweating is induced further, it assists heat pathogen, exhausts fluids again, surely transforming into ominous syndromes, so sweating is prohibited. If pulse is floating, it is in the exterior; tight means cold. Cold pathogen is depressed, Yang cannot extend, heat hides in Ying, forcing blood to flow wildly, emerging from nose; then Ma Huang Tang should scatter cold pathogen, allowing Yang to extend, and epistaxis stops itself, what doubt is there? Some sigh: Knowing the key, one word finishes it. Not knowing the key, scattering endlessly. Jiegu’s learning can be said to know the key. (Cold Damage epistaxis taboo sweating when pulse is faint.)
[Hai] Sweating when one should sweat, but not sweating, produces jaundice; promoting urination when one should promote, but not promoting, is the same. Spleen governs muscles; limb cold-damp combines with internal heat. Sweating when one should not sweat, loses fluids, allowing toxic gas to disturb Yang to the extreme; extreme invades Yin, so dries blood and accumulates in chest. Or promoting urination excessively is the same. If violating sweating causes much blood accumulation, upper Jiao has epistaxis. If promoting urination causes much blood accumulation, it causes mania. Asked: Cold Damage and miscellaneous diseases are one body; if wrongly purged, transformations have light and heavy degrees, why? Answer: Cold Damage wrongly purged has no fixed transformation form. Miscellaneous disease wrongly purged has fixed transformation form. Why? Say: Cold Damage enters from outside, is Yang, Yang moves. Miscellaneous disease exits from inside, is Yin, Yin is still. Moving ones offended, transformations are endless. Still ones offended, transformations stop at fullness, abdominal, and hypochondriac pain. So transformations endless are heavy disease; fullness and hypochondriac pain are light.
[Luo] Refuting the Proverb on Taking Medicine Without Illness
Proverb says: "Taking medicine without illness is like installing pillars inside a wall." This is baseless talk, causing great harm. Heaven’s creation of things, Five Flavors are complete; eating them regulates Five Zang; excess generates disease. So Classic says: Yin’s generation, root is in Five Flavors. Yin’s five palaces, injury is in Five Flavors. Also says: Five Flavors enter Stomach, each follows its preference. So sour first enters Liver, pungent first enters Lung, bitter first enters Heart, sweet first enters Spleen, salty first enters Kidney; long-term increases Qi, Qi increased long-term, cause of premature death. Also says: Sour goes to sinews, pungent goes to Qi, bitter goes to bones, salty goes to blood, sweet goes to flesh. Five Flavors, mouth likes and desires to eat, must self-restrain, do not let exceed. As for five grains for nourishment, five fruits for assistance, five animals for benefit, five vegetables for filling, aroma and taste combined eating, benefits essence and Qi. If used untimely, eaten irregularly, still may generate disease, let alone medicines are attacking pathogen things, without illness can take? "Shengji Jing" says: Those cultivating truth, obscured by tonifying, lightly swallowing medicines, Yang agents rigid dominant, accumulating like prairie fire, for diabetes and carbuncles type, then Tian Gui ends and Yin dries; Yin agents soft dominant, accumulating like frozen ice, for profuse diarrhea and cold middle type, then True Fire weak and Wei Qi scatters. One flavor biased dominant, one Zang biased injured, one Zang injured, four Zang how not sick? Tang Sun Simiao said medicine momentum has biased dominant, making people Zang Qi unbalanced. Pei advised Tang Xianzong: Medicine attacks disease, not morning evening commonly used thing, let alone mineral stone nature cruel fierce poisonous, plus refining with fire qi, not human five Zang able to endure. Until Zhang Gao advised Muzong: Spirit thought light then blood Qi harmonious, desire many then disease arises, medicine attacks disease, without illness cannot swallow. So Changli Bo inscribed Li Zi’s tomb: I do not know taking food theory from which dynasty starts, killing people cannot count, and world admires崇尚 increasingly, this is confusion. Now directly take seen personally associated and by medicine failed six seven gentlemen, as world warning: Ministry of Works Minister Gui Deng, Palace Censor Li Xuzhong, Ministry of Justice Minister Li Xundi, Ministry of Justice Vice Minister Chang Jian, Xiangyang Military Governor Ministry of Works Minister Meng Jian, Dongchuan Military Governor Censor-in-Chief Lu Zhi, Golden Guard General Li Daogu. Now again take seen say: Monk Yan Zhongzhang took fire refined cinnabar two pills, neck came small sore, swelling pain unbearable, tooth itch cannot chew thing, took Liang Ge San half jin, began ease. Later drinking wine always triggers, medicine by cold cool agent then eases, lifelong not cured. Zhen person Li Runzhi body fat abundant, fear generate wind disease, to spring took Sou Feng Wan, month plus then down unlimited, diet decreases, tongue not know taste, mouth dry Qi short, umbilical abdominal pain, foot calf cold, vertigo want fall, face color green yellow not luster, day add difficult, then tell relatives friends: Wrongly take medicine disaster, regret how arrive. Later add irritability panting full, to autumn then die. Scholar Zhang, also listen alchemist theory, took Si Sheng Wan push old bring new, take month plus, stool or loose or diarrhea, diet obstruct, lazy love sleep, eye see black flowers, ear hear cicada sound, spirit empty head spin, floating body cannot support, to this then know medicine mistake. Then regulate diet, careful daily life, careful preservation, two three years between, syndrome still exist. Over ten years later, then recover. Liu family son heard people say, December morning drink cold water one cup, to spring no eye disease, then drink it. Ten days plus, abdomen cold pain unbearable, cough vomit, completely not want eat, hate water not want see, foot calf cold and reverse, doctor by remove cold dry heat agent urgently save, finally cannot effect. These all无故 seek increase life auspicious, opposite generate disease, or until lose body kill life. Wall inside install pillar, indeed where? And high hall big building, beam pillar safe, foundation solid, bad paint destroy, install pillar wall middle, very not near human emotion. Jiegu Old Man says: Without illness take medicine, without matter generate matter. This truly unchangeable argument. Human’s nourish body, fortunate five Zang peaceful, six Fu harmonious, careful cultivation, spring summer offer by grow long way, autumn winter offer by collect hide principle, diet have limit, daily life have constant, less thought few desire, calm light emptiness, spirit inside guard, this without illness time, not medicine medicine. Alas, those several people, past not blame, later people should take this as tortoise mirror.]
Discussion on Yin Excess Yang Deficiency Not Suitable for Purging
Yin excess Yang deficiency, sweating then cures, purging then dies, this speaks of pathogen in exterior. Cold pathogen belongs to Yin, body exterior all belongs to Yang, each Zang-Fu meridians also belong to Yang. Yang Qi is Wei; Wei Qi warms muscles, fills skin/hair, thickens interstices, controls opening/closing, all these defend outside and solidify. Or fatigue excessive, Yang Qi internally damaged, cannot solidify, Yang becomes deficient. Yang deficient, Yin must gather; so Yin gets to dominate, pathogen dominates then excess, Yin excess Yang deficiency is this. Yin pathogen already dominated, interstices dense, Yang Qi hidden depressed, cannot smooth, so fever chills, head/neck pain, waist/spine stiffness, should disperse. And medicine use Ma Huang, Bencao says: Light can remove excess, Ge Gen, Ma Huang type is this. Ma Huang can retreat cold pathogen, make Yang Qi extend act sweat then resolve. So say: Yin excess Yang deficiency, sweat then cure. Interior Qi peaceful but contrary purge, Middle Qi already weak, exterior pathogen take weakness enter, by this transformed symptoms hundred out, so say purge then die. "Waitai Miyao" says: Exterior disease interior harmonious, sweat then cure, purge then die. Exactly this meaning.
Discussion on Yang Excess Yin Deficiency Not Suitable for Sweating
Yang excess Yin deficiency, purging then cures, sweating then dies, this speaks of pathogen in interior. Cold pathogen initially injures exterior, not resolved then gradually transmits to interior, transforms to heat. Human body interior is Yin, Hua Tuo says: Day one in skin, day two in flesh, day three in muscle, day four in chest, day five in abdomen, day six enters Stomach. Entering Stomach called entering Fu; Fu means gathering, like treasury gathering things, also Water-Grain Sea, Ying-Wei source. Pathogen enters Stomach not again transmit flow water-grain, water-grain not digest remove, depress become excess, this Yang excess Yin deficiency is this. So tidal fever draw drink, abdominal full pant, hand-foot sweat, stool difficult and