因素秉不足，生化太微而致者，盖以不足之人，多病，多痰，多不食，或多泄泻，或多汗出，元气泄多蓄少，不能如常，应期而下。要知血注多，则下行之势易。血注少，则下行之势难。务宜看其何处病情为重，相其机而治之。或宜甘温，或宜辛温，或宜苦温，又当留意。
因外感风寒而闭者，按六经提纳治之，自然中肯。切不可一见经闭，即急于通经，专以四物加桃仁、红花、玄胡、香［1］附、苏木、丑牛之类，胡乱瞎撞，为害非浅，学者宜知。更有寡妇、室女经闭，要不出此，不过多一思交不遂，抑郁一层，终不外开郁行滞而已。
崩
阳虚者何？或素秉不足，饮食不健。或经血不调，过服清凉。或偶感风寒，过于宣散。或纵欲无度，元气剥削。如
[1] 香 原本作"杏"，据文义改。
-71 -
此之人，定见起居动静、言语、脉息、面色，一切无神。元气太虚，不能统摄，阴血暴下，故成血崩。实乃脱绝之征，非大甘大温不可挽救，如大剂回阳饮，甘草干姜汤之类。切切不可妄以凉血、止血之品施之。
因阴虚者何？夫阴之虚，由于火之旺，或忿怒而肝火频生，或焦思而心火顿起，或过饮醇醪，而胃火日炽。如此之人，精神饮食，动静起居，一切有余，缘以火邪助之也。火动于中，血海沸腾，伤于阳络，则妄行于上。伤于阴络，则妄行于下。卒然暴注，若决江河。急宜凉血清热以止之，如十灰散，凉血汤之类。切切不可妄用辛温，要知此刻邪火动极，俟火一去，即宜甘温甘凉，以守之复之，又不可固执。须知道血下既多，元气即损，转瞬亦即是寒，不可不细心体会。
带
按带证一条，诸书言带脉伤，发为带疾。《宝产》云，带下有三十六疾。《汇参》有赤白带，室女带下，胎前带下之别，《女科仙方》又分为五带，是就五色而立五方，亦颇近理。予常用其方，多获效验。予思万病不出乎阴阳，各家纷纷议论，究意旨归无据。后人不得不直记其方也。予细思阳证十居五六，即湿热下注是也。阴证十居六七，即下元无火是也。
湿热注者何？或素喜辛燥醇酒椒姜，或素多忿怒暴戾，或素多淫欲，摇动相火，合水谷之湿，与脾之湿，流入下焦，时时下降，陆续不断，其形似带，故名之曰带。其人定多烦躁，精神、饮食不衰，脉必有神，其下之物，多胶粘极臭者是也。法宜除湿清热为主，如葛根芩连汤，黄连泻心汤加茯苓、泽泻、滑石之类。
- 72 -
或伤［1］于食，而消导太过，则损胃脾之阳。或房事过度，而败精下流，则损肾阳。如此之人，定见头眩心惕，饮食减少，四肢无力，脉必两寸旺，而两尺弱甚，浮于上而不潜于下，其下之物，必清淡而冷，不臭不粘。法宜大补元阳，收纳肾气，如潜阳丹加敌纸、益智，回阳饮加茯苓、安桂，或桂苓术甘汤加附片、砂仁之类。更有五色杂下，不必多求妙方，总以大温大甘，收固元气为要。诸书所载，亦可择取。
求 嗣 约 言
大凡中年无子这人，宜多积善功，夫妇好生保养节欲，果然精神安舒，百脉和畅。务于天癸至三日内，乘其子宫未闭，易于中鹄，当交媾际，夫妇二人彼此留神，勿将心放他去，如此施之，百发百中。切勿多蓄媵妾，以取败德丧身灭亡之祸。［眉批］知非氏曰：人之生也，性赋于天，命悬于地，各有善恶，因缘以成报施，知非存而不论。
妊 娠
凡妇人经水不行，二三月内，腹中隐隐［眉批］知非氏曰：稳。微微频动者，乃有喜之征。设或无频动者，可用验胎法以验之。验胎方，归、芎各三钱，为末，艾汤吞，吞后腹频动，有胎定无疑。若是腹不动，脉息细详求。亦有四五月始动者。
妊娠产后诸疾约言
按妊娠已确，固说着重安胎。［眉批］知非氏曰：要。产后已毕，固说着重补养。此皆举世相传至要之语。予谓胎前产后，不必执此，当以认证去病为主。认证去病之要，外感仍按定
[1] 伤 原本在此字后还有一"伤"，据文义删。
-73 -
六经提纲病情，内伤仍握定阴阳盈缩为准，如此方不见病治病了。到于胎前产后，一切病证，亦当留心。如《万氏女科》、《女科仙方》、《女科心法》、《汇参女科》、《济阴纲目》皆当熟玩，以广见识。
小儿诸疾约言
按小儿初生，只要安静，审无胎中受寒，无胎中受热，切不可用药以戕之，以伐生生之气。今人每每小儿下地，多用银花、黄连、大黄、钩藤、甘草，取其清胎毒，小儿少生疮癣。此说似近有理，究意皆是婆婆经。此说省城最重，不知山野乡村小儿下地，大人常无药服，何况小儿，难道皆生疮，皆死亡了。但食乳之子，外感病多，饮食病少。设或有虚损病出，多半从母乳上来，审其阴阳之盈缩治之。食五谷之子，多半饮食，或是外感，按定病情治之。［眉批］知非氏曰：好，抽掣务中业已详论，故不复赘。至于痘证，初发热，以调和营卫之气为主，桂枝汤是也。初现点，以升解发透、出透为主，升麻葛根汤是也。痘现齐，以养浆为主，理中汤是也。浆足疮熟，以收回为主，潜阳丹，封髓丹是也。此乃痘科首尾不易之法。至于坏证，如灰黑平塌不起，空壳，无脓者，真元之气衰也。法宜回阳，白通汤，回阳饮是也。如紫红顶焦，烦燥口臭，气之有余，血之不足也，法宜清凉，如导赤散、凉血散、人参白虎、当归补血汤之类。
近来痘科，一见痘点，专以解毒、升散、清凉，如赤芍、生地、连翘、枳壳、银花、大力、黄芩、当归、麦冬［1］、花粉、荆芥之类。不知痘证，全在随机变换，当其初发热，气机勃勃向外，正宜应机而助之，以发透为妙。如以上药品，
[1] 冬 原本脱，据文义补。
-74 -
虽有升散、其中一派苦寒之品，每多阻滞向外气机，以致痘不透发，酿出许多证候，非痘之即能死人，实药杀之也。
予每于痘出现点，只用二三味轻清之品，多见奇功，如升麻一二钱，葛根一二钱，虫退五六个，甘草一钱。即吐，亦当服之。所谓吐者何？毒邪已壅于阳明，吐则毒邪发泄于外，故以轻清之品，助其升腾之机，使其出透。若加苦寒阻之，危亡之道也。司命者，当留意于此，方不误人。
外 科 约 言
外科者，疮科谓也。凡疮之生，无论发于何部，统以阴阳两字判之为准。［眉批］知非氏曰：妙。
阴证其疮皮色如常，漫肿微疼，疮溃多半清水，清脓，黄水，血水，豆汁水，辛臭水。其人言语、声音、脉息、起居动静，一切无神，口必不渴，即渴定喜滚饮，舌必青滑，大小便必成疮。阴盛阳微，不能化阴血以成脓，故见以上病形。法宜辛甘化阳为主。化阳者，化阴气为阳气也，阴气化去，真正自复，脓自稠粘，疮自收敛而病即愈。初起无论现在何部，或以桂枝汤加香附、麦芽、附子，调和营卫之气。佐香附、麦芽者，取其行滞而消凝也。加附子者，取其温经而散寒也。或麻黄附子细辛汤，阳旦汤皆可。疮溃而脓不稠，可用黄芪建中汤，附子理中汤。阴最盛者，可用回阳饮，白通汤，或黄芪、甜酒炖七孔猪蹄，羊肉生姜汤之类，皆可酌用。
阳证其疮红肿痛甚，寒热往来，人多烦躁，喜清凉而恶热，大便多坚实，小便多短赤，饮食精神如常，脉息有力，声音响亮，疮溃多稠脓。此等疮最易治，皆由邪火伏于其中，火旺则血伤。法宜苦甘化阴为主。化阴者，化阳气为阴气也，
- 75 -
阳气化去，正气自复，疮自收敛而病自愈。初起无论发于何部，或以桂枝汤部白芍，加香附、麦芽、栀子治之。或麻杏石甘汤，或人参败毒散加连翘、花粉之类。疮溃可用当归补血汤加银花、生地、白芍之类；或补中益气汤加生地、银花之类，皆可用也。
总之，阴阳理明，法自我立，药自我施，不无妙处也。
更有一等真阳暴脱之征，其来骤然，无论发于何部，其疮痛如刀劈，忽然红肿，其色虽红，多含青色，人必困倦无神，脉必浮大中空，或大如绳，或劲如石，其唇口舌必青黑。务在脉息、声音、颜色四处搜求，使能识此等证候，切勿专在疮上讲究。凡此等证，每多旦发夕死，惟急于回阳收纳，庶可十中救二三。若视为寻常之疮治之，则速其死矣。不可不慎欤。
知非氏曰：钦安先生，性敏而巧，学博而优，运一缕灵思妙绪，贯诸名家之精义，不啻若自其口出，认证只分阴阳，活人直在反掌，高而不高，使人有门可入，可谓循循善诱矣。知非之评，乃一意孤行，空诸倚傍，恐词义多未精核，议论太涉放纵，然紫不能夺朱，郑不能乱雅，阅者谅之［1］。
[1] 知非氏曰……阅者谅之。原本此段文字与正文同，按文义当为眉批。
-76 -
卷三
伤寒溯源解
仲景为医林之祖，著《伤寒》一书，以开渡世津梁，揭出三阳三阴，包含乾坤二气之妙，后贤始有步趋。无奈相沿日久，注家日多，纷纷聚讼，各逞已见，舍本逐末，已至于今，故读《伤寒》书者寡矣。亦并不知"伤寒"何所取义也。取注《伤寒》者，亦只是照原文敷衍几句，并未道及《伤寒》宗旨，与万病不出《伤寒》宗旨，教后人何由得入仲景之门。予特直解之。夫曰伤寒者，邪伤于寒水之经也。太阳为三阳三阴之首，居于寒水这地，其卦为坎。阳为阴根［1］。坎中一阳，即人身立极真种子，至尊无二，故称之曰太阳。［眉批］考之即在六合之中。卷之即在坎中一点，以坎中一点示气在血中，皆喻言也。如天之日也，太阳从水中而出，子时一阳发动，真机运行，自下而上，自内而外，散水精之气于周身，无时无刻无息不运行也。故《经》云：膀胱者，州都之官，津液藏焉。气化二字乃《伤寒》书一部的真机。要知气化行于外，从皮肤毛窍而出水气，水即阴，气即阳，外出是气上而水亦上也。气化行于内，从溺管而出水气。内出是水降而气亦降也。外出者，轻清之气，如天之雾露也。内出者，重浊之气，如沟渠之流水也。
太阳之气也无乖，一切外邪无由得入。太阳之气偶衰，无论何节何候中，不正之气干之，一年六气，即风、寒、暑、湿、燥、火。六气乃是正气，六气中不正之气，才是客气。六气，每司六十日有
[1] 根原本作"恨"，据文义改。
-77 -
零，一年中三百六十日，而一年之事毕，循环之理寓矣。必先从毛窍而入，闭其太阳运行外出之气机，而太阳之经症即作，故曰伤寒。
今人只知冬月为伤寒，不知一年三百六十日，日日皆有伤寒，只要见得是太阳经证的面目［1］，即是伤寒也。太阳为六经之首，初为外邪所侵，邪尚未盛，正未大衰，比际但奶按定太阳经施治，邪可立去，正可立复。
因近来不按经施治，用药不当，邪不即去，正气日衰，邪气日盛，势必渐渐入内，故有传经不传腑，传腑不传经，二阳并病，三阳并病，两感为病，渐入厥阴，邪苟未罢，又复传至太阳。迁延日久，变证百出，邪盛正衰，酿成阴阳脱绝种种危候。
仲景立三百九十七法，一百一十三方，以匡其失而辅其正，邪在太阳经腑，则以太阳经腑之法治之。邪在阳明经腑，则以阳明经腑之法治之。邪在少阳经腑，则以少阳经腑之法治之。邪在［2］太阴、少阴、厥阴，或从本化，或从中化，或从标化，按定标本中法治之。举伤寒而万病已具，揭六经，明六气，而一年节候已该。论客邪由外入内，剥尽元气，能令人死，步步立法，扶危为安，似与内伤无涉。不知外邪入内，剥削元气，乃是六。七情由内而戕，剥削元气，毋乃非六经乎？不过外邪之感，有传经之分，七情之伤，无经腑之变。由外入内固有提纲，由内出外，亦有考据。不过未一一指陈，未明明道破，总在学者深思而自得之。［眉批］客邪由外入内，以升散清解，不使入内为要。元气由内出外，以温固而收纳，不使外出为要。只此两法，诚为度世金针。
[1] 目原本作"日"，据文义改。
[2] 在原本脱，据文义补。
-78 -
Due to congenital insufficiency, leading to extremely weak physiological transformation and generation (Sheng Hua), causing amenorrhea. Generally speaking, individuals with weak constitutions are prone to illness, have excessive phlegm-dampness, poor appetite, or frequent diarrhea, or frequent sweating. The Yuan Qi (Primal Qi) is depleted excessively while accumulation is scarce, preventing it from functioning normally and menstruating on schedule. It must be understood that when menstrual blood volume is abundant, the downward momentum is easy; when menstrual blood volume is scanty, the downward momentum is difficult. One must carefully examine which aspect of the pathology is most severe and treat according to the pathogenesis. Treatment may require Sweet-Warm methods, Acrid-Warm methods, or Bitter-Warm methods, and attention should be paid to this distinction.
When amenorrhea is caused by external contraction of Wind-Cold blocking the meridians, treating according to the Six Meridians differentiation system will naturally hit the mark. One must not, upon seeing amenorrhea, hastily attempt to unblock the menses by exclusively using Si Wu Tang (Four Substance Decoction) added with Tao Ren (Peach Kernel), Hong Hua (Safflower), Yan Hu Suo (Corydalis Rhizome), Xiang Fu (Cyperus Rhizome), Su Mu (Sappan Wood), Niu Xi (Achyranthes Root), and similar herbs, blindly experimenting, which causes significant harm. Scholars should be aware of this. Furthermore, amenorrhea in widows or unmarried women does not exceed this scope, except for an additional layer of frustration due to unfulfilled desires and emotional depression. Ultimately, the treatment boils down to resolving depression and promoting qi circulation.
Metrorrhagia (Beng)
Regarding metrorrhagia, there are Yang-deficiency types and Yin-deficiency types.
What is the Yang-deficiency type? It arises from either congenital insufficiency and poor dietary health, or irregular menstruation treated with excessive cooling herbs, or accidental contraction of Wind-Cold treated with excessive dispersing herbs, or excessive sexual indulgence depleting the Yuan Qi. For such individuals, observing their daily activities, speech, pulse, respiration, and complexion reveals a lack of spirit (Shen) in all aspects. The Yuan Qi is extremely deficient and cannot control the blood, causing sudden massive bleeding downwards, resulting in metrorrhagia. This is actually a sign of Yang collapse. Only large doses of Sweet-Warm herbs can rescue the patient, such as Da Ji Hui Yang Yin (Large Dose Return the Yang Decoction) or Gan Cao Gan Jiang Tang (Licorice and Ginger Decoction). One must absolutely avoid recklessly using blood-cooling or hemostatic agents.
What is the Yin-deficiency type? Yin deficiency stems from excessive Fire. It may arise from anger causing frequent Liver Fire, anxiety causing sudden Heart Fire, or excessive consumption of rich wine causing daily intensification of Stomach Fire. Such individuals exhibit excess signs in spirit, diet, movement, and rest, because Fire pathogens assist this momentum. Fire agitates internally, boiling the Blood Sea. If it injures the Yang collaterals, blood flows recklessly upwards; if it injures the Yin collaterals, blood flows recklessly downwards. Sudden violent bleeding occurs like a breached river. Urgent treatment requires cooling blood and clearing heat to stop bleeding, such as Shi Hui San (Ten Ash Powder) or Liang Xue Tang (Cool Blood Decoction). One must absolutely avoid recklessly using Acrid-Warm herbs. It must be known that at this moment, evil Fire is extremely agitated. Once the Fire subsides, Sweet-Warm or Sweet-Cool herbs should be used to consolidate and restore Zheng Qi (Upright Qi), but one must not be rigid. One must realize that after heavy bleeding, Yuan Qi is damaged, and cold patterns may emerge suddenly. Careful consideration is essential.
Leukorrhea (Dai)
Regarding leukorrhea, various texts state that injury to the Dai Mai (Girdle Vessel) causes leukorrhea disease. *Bao Chan* states there are thirty-six types of leukorrhea diseases. *Hui Can* distinguishes between red-and-white leukorrhea, leukorrhea in virgins, and antepartum leukorrhea. *Nu Ke Xian Fang* further divides it into five types based on five colors and five directions, which is quite reasonable. I frequently use these formulas and often achieve effective results. I ponder that all diseases stem from Yin and Yang. Various schools debate endlessly, but their core principles lack solid foundation. Later generations had no choice but to record formulas directly. Upon careful reflection, Yang-patterns account for 50-60%, specifically damp-heat pouring downward. Yin-patterns account for 60-70%, specifically firelessness in the Lower Yuan.
What is damp-heat pouring downward? It arises from a preference for pungent, dry, alcoholic, pepper, and ginger foods, or frequent anger and irritability, or excessive sexual desire stirring the Ministerial Fire. This combines with dampness from food and spleen, flowing into the Lower Jiao, descending continuously. Its form resembles a belt, hence the name "Dai" (Leukorrhea). Such individuals are often irritable, with undiminished spirit and appetite, and a spirited pulse. The discharge is sticky and foul-smelling. The treatment principle should focus on removing dampness and clearing heat, such as Ge Gen Qin Lian Tang (Kudzu, Coptis, and Scutellaria Decoction) or Huang Lian Xie Xin Tang (Coptis Decoction to Drain the Epigastrium) added with Fu Ling (Poria), Ze Xie (Alisma), and Hua Shi (Talc).
What is meant by firelessness in the Lower Yuan? It arises from congenital insufficiency combined with excessive mental labor damaging Heart Yang, or dietary injury treated with excessive digestive herbs damaging Spleen and Stomach Yang, or excessive sexual activity causing essence leakage damaging Kidney Yang. Such individuals present with dizziness and palpitations, reduced appetite, weakness in the four limbs, a vigorous pulse at both Cun positions but extremely weak at both Chi positions, floating above but not sinking below. The discharge is clear, thin, cold, odorless, and non-sticky. The treatment principle should be to greatly tonify Yuan Yang and gather Kidney Qi, such as Qian Yang Dan (Submerge Yang Powder) added with Du Zhong (Eucommia Bark) and Yi Zhi Ren (Alpinia Oxyphylla Fruit), Hui Yang Yin (Return the Yang Decoction) added with Fu Ling (Poria) and Rou Gui (Cinnamon Bark), or Gui Ling Zhu Gan Tang (Atractylodes, Poria, Licorice, and Cinnamon Twig Decoction) added with Fu Pian (Prepared Aconite) and Sha Ren (Amomum Fruit). In cases of mixed-color discharge, there is no need to seek miraculous formulas; the key is to use great warmth and sweetness to consolidate Yuan Qi. Formulas recorded in various books can also be selected.
Guidelines for Seeking Offspring
Generally, middle-aged individuals without offspring should accumulate merit through good deeds. Couples should maintain good health preservation and practice sexual moderation. If spirit is peaceful and harmonious, and all pulses are smooth, conception should be attempted within three days after menstruation begins, while the uterus is still open, making conception easier. During intercourse, both partners should remain focused and not let their minds wander. Doing so ensures success. One must not keep many concubines, inviting disaster through moral corruption and loss of life. [Marginal Note] Zhi Fei says: Human birth endows nature from Heaven and destiny from Earth, with varying good and evil, forming retribution through karma. Zhi Fei leaves this unspoken.
Pregnancy
When a woman's menstruation stops, and within two to three months she feels faint, frequent movements in the abdomen, this is a sign of pregnancy. If there are no frequent movements, a fetal verification method can be used. The fetal verification formula consists of Dang Gui (Angelica Sinensis) and Chuan Xiong (Ligusticum Wallichii), each 3 qian, ground into powder, taken with Mugwort water. If abdominal movement occurs after ingestion, pregnancy is certain. If the abdomen does not move, the pulse must be examined carefully. Some women do not feel movement until the fourth or fifth month.
Guidelines for Diseases during Pregnancy and Postpartum
Once pregnancy is confirmed, emphasis is rightly placed on calming the fetus. [Marginal Note] Zhi Fei says: Important. After delivery, emphasis is rightly placed on nourishment. These are universally accepted essential truths. However, I believe one should not rigidly adhere to this for antepartum and postpartum periods; instead, diagnosis and treatment of diseases should be primary. The key to diagnosis and treatment is: for external contractions, follow the Six Meridians outline; for internal injuries, grasp the balance of Yin and Yang. Only then can one avoid merely treating symptoms. One must also pay attention to all pathological conditions during pregnancy and postpartum. Texts such as *Wan Shi Nu Ke*, *Nu Ke Xian Fang*, *Nu Ke Xin Fa*, *Hui Can Nu Ke*, and *Ji Yin Gang Mu* should be studied thoroughly to broaden knowledge.
Guidelines for Pediatric Diseases
For newborns, tranquility is key. One must ascertain whether there was cold or heat contracted in the womb. Medications should not be administered to damage the vital energy. Nowadays, upon birth, people often use Jin Yin Hua (Honeysuckle), Huang Lian (Coptis), Da Huang (Rhubarb), Gou Teng (Uncaria), and Gan Cao (Licorice) to clear fetal toxins and prevent skin diseases. This argument seems reasonable but is merely conventional wisdom. This view is prevalent in provincial cities, but in rural areas, adults rarely take medicine, let alone infants. Do all infants get skin diseases or die? Breastfed infants suffer more from external contractions and fewer from dietary issues. If deficiency diseases arise, they likely come from the mother's milk; treat based on Yin-Yang balance. Infants eating solid foods mostly suffer from dietary issues or external contractions; treat according to the condition. [Marginal Note] Zhi Fei says: Good. Convulsions were discussed in detail elsewhere, so no repetition here. Regarding smallpox, initial fever should be treated by harmonizing Ying and Wei Qi, using Gui Zhi Tang (Cinnamon Twig Decoction). Initial eruption should be treated by lifting and resolving to promote full emergence, using Sheng Ma Ge Gen Tang (Cimicifuga and Kudzu Decoction). When pustules are fully formed, nourish the pus using Li Zhong Tang (Regulate the Middle Decoction). When pus is sufficient and scabs mature, resolve using Qian Yang Dan (Submerge Yang Powder) and Feng Sui Dan (Seal Marrow Powder). This is the unchanging method for smallpox. For severe cases, such as gray-black flat lesions, empty shells, or lack of pus, it indicates decline of True Yuan Qi. Treatment should return Yang, using Bai Tong Tang (White Pass Decoction) or Hui Yang Yin (Return the Yang Decoction). For purple-red scabs with burning tops, restlessness, and bad breath, indicating excess Qi and deficient Blood, treatment should be cooling, using Dao Chi San (Direct Out Red Powder), Liang Xue San (Cool Blood Powder), Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction), or Dang Gui Bu Xue Tang (Angelica Tonify Blood Decoction).
Recent smallpox practitioners, upon seeing spots, exclusively use detoxifying, ascending, dispersing, and cooling herbs such as Chi Shao (Red Peony Root), Sheng Di Huang (Rehmannia Root), Lian Qiao (Forsythia Fruit), Zhi Ke (Bitter Orange), Jin Yin Hua (Honeysuckle), Da Li Zi (Arctium Fruit), Huang Qin (Scutellaria Root), Dang Gui (Angelica Sinensis), Mai Dong (Ophiopogon Tuber), Hua Fen (Trichosanthes Root), and Jing Jie (Schizonepeta). They fail to realize that smallpox treatment requires flexibility. During initial fever, when Qi mechanism vigorously moves outward, one should assist this process to promote eruption. Herbs like those listed above, despite having ascending properties, contain many Bitter-Cold substances that often obstruct the outward Qi mechanism, preventing eruption and causing complications. It is not the smallpox itself that kills, but the medication.
When smallpox spots appear, I use only two or three light and clear herbs, often achieving remarkable results: Sheng Ma (Cimicifuga) 1-2 qian, Ge Gen (Kudzu) 1-2 qian, Chan Tui (Cicada Slough) 5-6 pieces, Gan Cao (Licorice) 1 qian. Even if vomiting occurs, these should be taken. What is vomiting? It indicates toxin stagnation in the Yangming channel. Vomiting expels toxins outward. Thus, light and clear herbs assist the ascending mechanism to ensure full eruption. Adding Bitter-Cold herbs to obstruct this leads to danger. Physicians must pay attention to this to avoid harming patients.
Guidelines for External Medicine
External medicine refers to the treatment of sores and ulcers. Regardless of location, all sores are judged by Yin and Yang. [Marginal Note] Zhi Fei says: Excellent.
Yin-pattern sores have normal skin color, diffuse swelling with slight pain, and upon ulceration, discharge clear fluid, clear pus, yellow water, bloody water, bean-water, or foul-smelling water. The patient's speech, voice, pulse, and activities show a lack of spirit. The mouth is not thirsty, or if thirsty, prefers hot drinks. The tongue is blue and slippery. Bowel and bladder functions reflect the pathology. Yin excess and Yang deficiency prevent the transformation of Yin-blood into pus, resulting in the above forms. Treatment should focus on Pungent-Sweet transforming Yang. Transforming Yang means transforming Yin-Qi into Yang-Qi. Once Yin-Qi is transformed, true Yang returns, pus becomes thick and sticky, the sore contracts, and the disease heals. At the onset, regardless of location, use Gui Zhi Tang (Cinnamon Twig Decoction) added with Xiang Fu (Cyperus Rhizome), Mai Ya (Barley Sprout), and Fu Zi (Aconite Root) to harmonize Ying and Wei Qi. Xiang Fu and Mai Ya promote stagnation resolution and dissolve coagulation. Fu Zi warms meridians and dispels cold. Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) or Yang Dan Tang are also suitable. If pus is not thick after ulceration, use Huang Qi Jian Zhong Tang (Astragalus Regulate Middle Decoction) or Fu Zi Li Zhong Tang (Aconite Regulate Middle Decoction). For extreme Yin excess, Hui Yang Yin (Return the Yang Decoction) or Bai Tong Tang (White Pass Decoction) can be used, or Astragalus stewed with sweet wine and seven-hole pig trotters, or lamb with ginger soup.
Yang-pattern sores present with redness, swelling, and severe pain, alternating chills and fever, irritability, preference for coolness and aversion to heat, firm stools, short dark urine, normal diet and spirit, strong pulse, loud voice, and thick pus upon ulceration. These sores are easiest to treat, caused by latent evil fire injuring blood. Treatment should focus on Bitter-Sweet transforming Yin. Transforming Yin means transforming Yang-Qi into Yin-Qi. Once Yang-Qi is transformed, righteous Qi returns, the sore contracts, and the disease heals. At the onset, regardless of location, use Gui Zhi Tang (Cinnamon Twig Decoction) modified by removing Bai Shao (White Peony Root), adding Xiang Fu (Cyperus Rhizome), Mai Ya (Barley Sprout), and Zhi Zi (Gardenia Fruit). Or use Ma Xing Shi Gan Tang (Ephedra, Apricot Seed, Gypsum, and Licorice Decoction), or Ren Shen Bai Du San (Ginseng Detoxify Powder) added with Lian Qiao (Forsythia Fruit) and Hua Fen (Trichosanthes Root). After ulceration, use Dang Gui Bu Xue Tang (Angelica Tonify Blood Decoction) added with Jin Yin Hua (Honeysuckle), Sheng Di Huang (Rehmannia Root), and Bai Shao (White Peony Root); or Bu Zhong Yi Qi Tang (Tonify the Middle and Augment Qi Decoction) added with Sheng Di Huang (Rehmannia Root) and Jin Yin Hua (Honeysuckle).
In summary, if Yin and Yang principles are clear, methods and prescriptions arise naturally, yielding wonderful results.
There is another type of sign indicating sudden collapse of True Yang. It appears abruptly, regardless of location. The sore pain is like being cut by a knife, suddenly becoming red and swollen. Although red, it often contains bluish hues. The patient is exhausted and lacks spirit. The pulse is floating, large, and hollow, or large like a rope, or hard like stone. Lips, mouth, and tongue are blue-black. One must search for signs in pulse, voice, and color to recognize this pattern, rather than focusing solely on the sore. Such cases often result in death from morning to evening. Urgent treatment to return Yang and gather Qi may save two or three out of ten. Treating them as ordinary sores accelerates death. Caution is essential.
Zhi Fei says: Mr. Qin An is agile and skillful, learned and excellent. With a thread of spiritual insight, he integrates the profound meanings of various masters, speaking as if from his own mouth. Diagnosis divides only into Yin and Yang, saving lives with a flip of the hand. His teachings are high yet accessible, guiding students step-by-step. My commentary is independent, avoiding reliance on others. I fear my words may lack precision and arguments too loose. However, purple cannot override vermilion, and Zheng cannot disrupt elegance. Readers please understand.
Volume Three
Tracing the Source of Shang Han
Zhongjing is the ancestor of the medical forest. He wrote *Shang Han Lun* to open the ferry for saving the world, revealing the wonders of Taiyang, Shaoyang, and Yangming (Three Yang) and Taiyin, Shaoyin, and Jueyin (Three Yin), encompassing the mysteries of Qian and Kun energies. Later sages followed. Unfortunately, over time, commentators increased, debating endlessly, each showing their views, abandoning the root for the branch. Thus, few read *Shang Han*. They do not even know the meaning of "Shang Han." Commentators merely elaborate on the original text without mentioning the core purpose of *Shang Han* or how all diseases fall under its purview, leaving later generations unable to enter Zhongjing's gate. I will explain it directly. "Shang Han" means evil injuring the Bladder meridian (Cold Water meridian). Taiyang is the head of the Three Yang and Three Yin, residing in the Cold Water region, corresponding to the Kan hexagram. Yang is the root of Yin. The single Yang line in Kan is the true seed of human existence, supreme and unique, hence called Taiyang. [Marginal Note] Examined, it lies within the six directions. Coiling refers to the point in Kan, symbolizing Qi in Blood, all metaphorical. Like the sun in heaven, Taiyang emerges from water. At Zi hour, one Yang activates, true mechanism runs from bottom to top, inside to outside, scattering water essence throughout the body, constantly operating. Thus, the Classic says: The Bladder is the official of the capital, storing fluids. The term "Qi Transformation" is the true mechanism of *Shang Han*. Qi transformation acting externally exits through skin pores as water vapor. Water is Yin, Qi is Yang. Externally, Qi rises and water rises. Internally, Qi transformation exits through the urethra. Internally, water descends and Qi descends. External exit is light and clear, like sky mist. Internal exit is heavy and turbid, like ditch water.
If Taiyang Qi is harmonious, external evils cannot enter. If Taiyang Qi declines, regardless of season or climate, incorrect Qi interferes. The six Qi of the year—Wind, Cold, Summer Heat, Dampness, Dryness, Fire—are correct Qi. Incorrect Qi within them is guest Qi. Each governs sixty-plus days, totaling 360 days, completing the annual cycle. Evil must first enter through pores, closing the Taiyang outward Qi mechanism, causing Taiyang meridian symptoms, hence called Shang Han.
People today only know winter as Shang Han, not realizing every day has Shang Han. If Taiyang meridian symptoms appear, it is Shang Han. Taiyang is the head of the Six Meridians. Initially invaded by external evil, evil is not yet strong, Zheng Qi not yet weak. Treating according to Taiyang meridian immediately removes evil and restores Zheng Qi.
Recently, failing to treat according to meridians and using inappropriate drugs, evil does not leave, Zheng Qi declines daily, evil grows daily, inevitably entering inward. Thus, transmission occurs between meridians and fu organs, combined diseases of Two Yangs, Three Yangs, simultaneous contraction, gradually entering Jueyin. If evil remains, it transmits back to Taiyang. Prolonged delay causes hundreds of changes, evil strong, Zheng Qi weak,酿成 (brewing) critical conditions of Yin-Yang collapse.
Zhongjing established 397 methods and 113 formulas to correct errors and support righteousness. If evil is in Taiyang meridian/fu organ, treat with Taiyang methods. If in Yangming, use Yangming methods. If in Shaoyang, use Shaoyang methods. If in Taiyin, Shaoyin, or Jueyin, transform according to root, middle, or branch, treating accordingly. Covering Shang Han covers all diseases. Revealing Six Meridians clarifies Six Qi and annual seasons. Discussing guest evil entering inward depleting Yuan Qi, causing death, establishing laws step-by-step to rescue danger, seems unrelated to internal injury. But external evil entering depletes Yuan Qi. Seven Emotions injuring inward deplete Yuan Qi, is this not related to Six Meridians? External evil has transmission stages; Seven Emotions have no meridian/fu changes. Entering inward has outlines; exiting outward has evidence. Not explicitly stated, requiring scholars to think deeply and understand. [Marginal Note] Guest evil entering inward: Ascending, dispersing, clearing, resolving to prevent entry is key. Yuan Qi exiting outward: Warming, consolidating, gathering to prevent exit is key. These two methods are truly golden needles for saving the world.