经义
帝曰∶气有多少，病有盛衰，治有缓急，方有大小。愿闻其约，奈何？岐伯曰∶气有高下，病有远近，
证有中外，治有轻重。适其至所为故也。大要曰∶君一臣二，奇之制也；君二臣四，偶之制也；君二臣三，奇
之制也；君二臣六，偶之制也。故曰∶近者奇之，远者偶之。汗者不以偶，下者不以奇。补上治上，制以缓；
补下治下，制以急。急则气味浓，缓则气味薄。适其至所，此之谓也。病所远而中道气味之者，食而过之，无
越其制度也。是故平气之道，近而奇偶，制小其服也；远而奇偶，制大其服也。大则数少，小则数多。多则九
之，少则二之。奇之不去，则偶之，是谓重方。偶之不去，则反佐以取之。所谓寒热温凉，反从其病也。○帝
曰∶非调气而得者，治之奈何？有毒无毒，何先何后，愿闻其道。岐伯曰∶有毒无毒，所治为主，适大小为制
也。帝曰∶请言其制？岐伯曰∶君一臣二，制之小也；君一臣三佐五，制之中也；君一臣三佐九，制之大也。
○帝曰∶方制君臣，何谓也？岐伯曰∶主病之谓君，佐君之谓臣，应臣之谓使。非上下三品之谓也。（《素问》）
约方，犹约囊也。囊满弗约，则输泄；方成弗约，则神与弗俱。（《灵枢》）
总论
方之为言，仿也。仿病而有方也。《素》、《难》无方，非无方也，为仿为活法也。汉世才有方，为备
于仿也。今时奇方疗
疾，倘果可以发无不中，则昔轩、岐、扁、仓神灵之智，慈爱之仁，岂不及此！何不每病只立一方，使后人彰
明显著，用无不当，而乃广为昭析，多立言词以累后学，纷赜难穷，效无十全哉！虽然，方不可泥，亦不可遗。
以古方为规矩，合今病而变通。既详古论之病情，复揣立方之奥旨，病同药异，病异药同。证端蜂起，而线索
井然；变见多危，而执持不乱。诚为良矣！（《冯氏锦囊》）
医当论方，不当论药。当就方以论药，不当执药以论方。（《己任编》）
医者，意也。如对敌之将，操舟之工，贵乎临机应变。方固难于尽用，然非方，则古人之心弗传。望洋捕
风，必有率意而失之者矣。方果可以不用乎？虽然，方固良矣，然必熟之《素问》，以求其本；熟之本草，以
究其用；熟之诊视，以察其证；熟之治疗，以通其变。始于用方而终无俟于方。夫然后医之道成矣。（商辂）
方有七∶大、小、缓、急、奇、偶、复是也。张从正曰∶大方有二，有君一臣三佐九之大方，病邪不一，
不可以一、二味治者宜之；有分两重而顿服之大方，肝肾及下部之病道远者宜之。小方有二，有君一臣二之小
方，病邪专一，可一、二味治者宜之；有分两小而频服之小方，心肺及在上之病宜之，徐徐细呷是也。刘完素
曰∶肝肾位远，数多则其气缓，不能速达于下，必大剂而数少，取其迅速下行也；心肺位近，数少则其气急，
不能升发于上，必小剂而数多，取其易散而上行也。《经》曰∶补上治上制以缓，补下治下制以急。急则气味
浓，缓则气味薄。适其病所而中道，无越其制度也。王冰曰∶假如病在肾，而心气不足，服药宜急过之，不以
气味饲心，肾药凌心，心复益衰矣。刘完素曰∶圣人治上不犯下；治下不犯上；治中上下俱不犯。故曰∶诛伐
无过者，命曰大惑。张从正曰∶缓方有五，有甘以缓之之缓方，甘草、饴蜜之属是也，病在胸膈，取其留恋也；
有丸以缓之之缓方，比之汤散，其行迟慢也；有品件众多之缓方，药聚则递相拘制，
不得独骋其性也；有无毒治病之缓方，无毒则性纯缓也；有气味俱薄之缓方，气味薄则长于治上，及其至下，
药力已衰矣。王好古曰∶治主宜缓，缓则治其本也；治客宜急，急则治其标也。张从正曰∶急方有四，有急病
急攻之急方，中风、关格之病是也；有汤散荡涤之急方，下咽易散而行速也；有毒药之急方，毒药能上通下泄，
以夺病势也；有气味俱浓之急方，直趋于下而力不衰也。奇方有二，有独用一物之奇方，病在上而近者宜之；
有药合阳数，一、三、五、七、九之奇方，宜下不宜汗是也。刘完素曰∶小承气，奇之小者也；大承气、抵当
汤，奇之大者也。因其攻下而为之也。桂枝、麻黄，偶之小者也；葛根、青龙，偶之大者也。因其发汗而用之
也。偶方之制，有两味相配之偶方；有古之二方并用之偶方，古谓之复方。皆病在下而远者宜之。有药合阴数，
二、四、六、八、十之偶方，宜汗不宜下是也。王好古曰∶奇之不去复以偶，偶之不去复以奇，故曰复；复者，
再也。王太仆以偶方为复方，七方之中有偶又有复，岂非偶乃二方相合，复乃数方相合乎？（《怡堂散记》）
许学士云∶余读仲景书，用仲景法，然未尝守其方，乃为得仲景之心也。（李东垣）
或问仲景处方，药品甚少，及东垣用药多至二十余味。丹溪云∶余每治病，用东垣之药，效仲景处方，庶
品味数少，则药力专精。丹溪何以不法东垣而效仲景耶？曰∶明察药性，莫如东垣，盖所谓圣于医者也。故在
东垣则可多，他人而效其多，斯乱杂矣。东垣如韩信将兵，多多益善，丹溪不过能将十万，故不敢效其多。（王节斋）
仲景立方，精而不杂，其中以六方为主，诸方从而加减焉。凡汗剂，皆本桂枝；吐剂，皆本栀豉；攻剂，
皆本承气；和剂，皆本柴胡；寒剂，皆本泻心；温剂，皆本四逆。混而数之，为一百十三方者，未之审也。○
仲景方备十剂之法∶轻可散实，麻黄、
葛根诸汤是已；宣可决雍，栀豉、瓜蒂二方是已；通可行滞，五苓、十枣之属是已；泄可去闭，陷胸、承气、
抵当是已；滑可去着，胆导、蜜煎是已；涩可固脱，赤石脂、桃花汤是已；补可扶弱，附子、理中丸是已；重
可镇怯，禹余粮、代赭石是已；湿可润燥，黄连阿胶汤是已；燥可去湿，麻黄连翘赤小豆汤是已；寒能胜热，
白虎、黄连汤是已；热能制寒，白通、四逆诸汤是已。○仲景制方，随方立禁，使人受其功不蹈其弊也。如用
发表药，一服汗者停后服。若脉紧发热汗不出者，不可与桂枝；脉微弱汗出恶风者，不可服青龙；脉浮发热无
汗表不解者，不可与白虎；诸亡血虚家，不可用瓜蒂；病患旧微溏者，不可与栀子；阳明病汗出多者，不可与
猪苓；外未解其热不潮者，未可与承气；呕家不可与建中。此仲景慎重之心。○仲景用攻、下二字，不专指大
便。凡与桂枝汤欲攻其表，此指发汗言；表解者乃可攻之，指利水言；有热属脏者攻之，指清火言也。寒湿在
里不可下，指利水言，以有热故也。当以汤下之，指清火言也。○六经各有主方，而他经有互相通用之妙。如
麻、桂二汤，为太阳营卫设，阳明之病在营卫者亦用之。真武汤，为少阴水气设，太阳之汗后亡阳者亦用之。
四逆汤，为太阴下利清谷设，太阳之脉反沉者亦宜之。五苓散，为太阳消渴水逆设，阳明之饮水多者亦宜之。
猪苓汤，为少阴下利设，阳明病小便不利者亦宜之。抵当汤，为太阳淤血在里设，阳明之蓄血亦宜之。瓜蒂散，
为阳明胸中痞硬设，少阴之温温欲吐亦宜之。合是证便用是方。方各有经，而用不拘，是仲景法也。方虽有表、
里、寒、热、虚、实之不同，并无伤寒、中风杂证之分别，且风、寒有两汤迭用之妙，表、里有二方更换之奇。
或以全方取胜，或以加减奏功。后人论方不论证，故反以仲景方为难用耳。○桂枝，汗剂中第一品也。麻黄之性，
直透皮毛，生姜之性，横散肌肉，故桂枝佐麻黄则开元府，而逐卫分之邪，令无汗者有汗而解，故曰发汗。
桂枝率生姜则开腠理，而驱营分
之邪，令有汗者复汗而解，故曰解肌。解肌肉之邪，正在营分，何立三纲者反立麻黄主营、桂枝主卫耶？麻黄
不言解肌，而肌未尝不解。桂枝之解肌，正所以发汗。要知麻黄、桂枝二汤，是发汗分深浅之法，不得以解肌
与发汗对讲。○麻黄、桂枝，太阳、阳明表之表药；瓜蒂、栀豉，阳明里之表药；小柴胡，少阳半表之全药。
太阴表药，桂枝汤；少阴表药，麻黄附子细辛汤；厥阴表药，当归四逆汤。六经之用表药，为六经风寒之出路
也。○凡治病必分表里，而表里偏有互呈之证。如麻黄之喘，桂枝之自汗，大青龙之烦躁，小青龙之咳，皆病
在表而夹里证也。用杏仁以治喘，芍药以止汗，石膏以治烦躁，五味、干姜以治咳，是于表剂中兼治里也。○
麻黄汤，于发表中降气；桂枝汤，于发表中滋阴；葛根汤，于发表中生津；大青龙汤与麻杏甘膏汤、麻翘赤小
豆汤，于发表中清火；小青龙汤与五苓散，于发表中利水。○葛根与大、小青龙，皆合麻、桂二方加减。葛根
减麻黄之杏仁者，以不喘故；加葛根者，和太阳之津，升阳明之液也。大青龙减桂枝之芍药者，以汗不出故；
加石膏者，以烦躁故也。若小青龙减麻黄之杏仁，桂枝之姜、枣，既加细辛、干姜、半夏、五味，而又立加减
法，神而明之，不可胜用矣。○小青龙治伤寒未解之水气，故用温剂汗而发之；十枣汤治中风已解之水气，故
用寒剂引而竭之。此寒水、风水之异治也。小青龙之水，动而不居；五苓散之水，留而不行；十枣汤之水，纵
横不羁；大陷胸之水，痞硬坚满；真武汤之水，四肢沉重。水气为患不同，所以治法各异。○膀胱主水，为太
阳之里。十枣、五苓，为太阳水道之下药。胃腑主谷，为阳明之里。三承气为阳明谷道之下药。胆腑主气，为
少阳之里。大柴胡为少阳气分之下药。三阳实邪之出路也。大肠、小肠，皆属于胃。胃家实，则二肠俱实矣。
若三分之，则调胃承气，胃家之下药；小承气，小肠之下药；大承气，大肠之下药。戊为燥土，庚为燥金，故
加芒硝以润其燥也。桂枝加大黄，太阳转属阳明之
下药，桂枝加芍药，太阳转属太阴之下药。凡下剂兼表药，以未离于表故也。柴胡加芒硝，少阴转属阳明之下
药。大柴胡，下少阳无形之邪；柴胡加芒硝，下少阳有形之邪也。桂枝加芍药，下太阴无形之邪；三物白散，
下太阴有形之邪也。四逆散，下少阴、厥阴无形之邪；承气汤，下诸经有形之邪也。其间有轻重之分∶下剂
之轻者，只用气分；下剂之重者，兼用血分。酸苦涌泄，下剂之轻，故芍药、枳实为轻；咸苦涌泄，下剂之重，
故大黄、芒硝为重。○仲景方，每用粥为佐者，以草木之性各有偏胜，惟稼穑作甘，为冲和之味，人之精神血
气，皆赖之以生。故桂枝汤，以热粥发汗；理中汤，以热粥温中；白散，以热粥导利，复以冷粥止利。神哉！
今人服大黄后，用冷粥止利，尚是仲景遗意乎？（柯韵伯）
桂枝、麻黄之辈，在皮毛者汗而发之也；葛根、升麻之辈，因其轻而扬之也；承气、陷胸之辈，下者引
而竭之也；泻心、十枣之辈，中满者泄之于内也；瓜蒂、栀豉之辈，高者因而越之也。此仲景因病制方之法也。
（刘河间）
小柴胡汤，主少阳之半表里也；五苓散，分利膀胱之半表里也；理中汤，治吐泻不定，上下之半表里也。
（《医学入门》）
古人立方取名，非无故而然。顾名思义，昔者，胡不名之曰汤中、汤尾，而必名之曰汤头？盖头者，头目
之意也。能领群药直至患所，如将之统兵剿贼以逐寇也。柯氏云∶如大将立旗鼓，使人知有所向。如某方之入
某经，某药之走某络；某方利于攻策，某方善于守法；某方其功在补，某方得力在泻；某方止宜陆路，某方精
于水路；某方惯使奇法，某方可遵正法；某方得法用机，某方用法使巧；某方升而成功，某方降而获效。方法
之妙，乌可忽视哉！夫某方入某经络者，如养心汤之入心，固金汤之入肺，补中汤之入脾，左金丸之入肝，固
本丸之入肾之类。又如攻剂大、小承气之类，守剂理中、四逆之类；补剂十全、归脾之类，泻剂
大、小柴胡之类；陆剂五味异功、六君之类，水剂五苓、八正之类；升剂升阳散火之类，降剂苏子降气之类；
奇剂滋肾丸、栀子干姜汤之类，正剂附子、理中汤、三黄散之类；机剂附子热药冷探之类，巧剂六君汤吞养正
丹、四物汤吞活络丹、四六君送香连丸之类。李子云∶用药之难，非顺用之难也，逆用而与病情恰当之难也。
今之医师，知以寒治热，以热治寒，寒者热之，热者寒之，独不闻诸《内经》曰∶通因通用，塞因塞用，寒因
热用，热因寒用，用热远热，用寒远寒耶？盖塞因塞用者，若脾虚作胀，治以参、术，脾得补而胀自消也。通
因通用者，若伤寒挟热下利，或中有燥屎，用调胃承气汤乃安；滞下不休，用芍药汤通之而愈也，寒因热用者，
药本寒也，而反佐之以热；热因寒用者，药本热也，而反佐之以寒，俾无拒格之患。所谓必伏其所主，而先其
所因也。用热远热，用寒远寒者，如寒病宜投热药，热病宜投寒药，仅使中病而已，勿使过焉。过用则反为伤
矣。古人之法，妙用如此。柯氏有云∶方外有方，法外有法。诚哉斯言也！（《医学阶梯》）
[Scriptural Meaning]
The Yellow Emperor asked: Qi has variations in quantity, diseases have fluctuations in severity, treatment has differences in urgency, and prescriptions have distinctions in size. I wish to hear the general principles; how should this be done? Qibo replied: Qi has positions high or low, disease locations are near or far, syndromes manifest internally or externally, and treatments vary in intensity. The key is to ensure the medicinal force reaches precisely where the pathology lies. The Great Summary states: One sovereign herb and two minister herbs constitute a singular (Qi) prescription; two sovereign and four minister herbs constitute an even (Ou) prescription; two sovereign and three minister herbs constitute a singular prescription; two sovereign and six minister herbs constitute an even prescription. Therefore it is said: For distant conditions, use even prescriptions; for near conditions, use singular prescriptions. Diaphoretic methods do not use even prescriptions; purgative methods do not use singular prescriptions. Tonifying the upper or treating upper body disorders requires a slow-acting formulation; tonifying the lower or treating lower body disorders requires a rapid-acting formulation. Rapid action implies strong flavor and aroma; slow action implies weak flavor and aroma. Ensuring the medicine reaches its target is what is meant here. If the disease location is distant but the medicinal qi is consumed en route, one should take the medicine after meals to guide it, without violating these regulations. Thus, the principle of balancing Qi is: for near conditions using singular or even prescriptions, reduce the dosage; for distant conditions using singular or even prescriptions, increase the dosage. Large prescriptions have fewer ingredients; small prescriptions have more ingredients. Many ingredients can reach nine; few ingredients may be two. If a singular prescription fails, switch to an even one; this is called a compound prescription (Chong Fang). If an even prescription fails, employ counter-assistance (Fan Zuo) to achieve efficacy. This refers to cold, heat, warm, and cool properties being used in accordance with the disease nature.
The Yellow Emperor further asked: For those not cured by regulating Qi alone, how should they be treated? Regarding toxic and non-toxic herbs, which should be used first or last? I wish to hear the method. Qibo said: Whether toxic or non-toxic, the primary consideration is the disease being treated; the size of the prescription is determined accordingly. The Yellow Emperor said: Please explain the rules of formulation. Qibo said: One sovereign and two minister herbs make a small prescription; one sovereign, three ministers, and five assistant herbs make a medium prescription; one sovereign, three ministers, and nine assistant herbs make a large prescription.
The Yellow Emperor asked: What is meant by the Sovereign-Minister system in prescriptions? Qibo replied: The herb that primarily treats the disease is called Sovereign (Jun); the herb assisting the Sovereign is called Minister (Chen); the herb responding to the Minister is called Envoy (Shi). This does not refer to the Upper, Middle, and Lower categories of the *Shennong Bencao Jing*. (From *Suwen*)
Restraining a prescription is like tying a bag. If a full bag is not tied, it leaks; if a prescription is formed but not restrained (controlled), the spirit and efficacy will not accompany it. (From *Lingshu*)
[General Discussion]
The character "Fang" (Prescription) means imitation. It imitates the characteristics of the disease to formulate a treatment plan. The *Suwen* and *Nanjing* did not contain fixed prescriptions, not because there were no prescriptions, but to demonstrate flexible and living methods. Fixed prescriptions only appeared in the Han Dynasty to fully accommodate the imitation of diseases. Today, if singular prescriptions could truly treat every disease without fail, would the divine wisdom and benevolent kindness of Xuanyuan, Qibo, Bian Que, and Cang Gong be inferior to ours? Why not establish just one prescription per disease for future generations to use clearly and correctly, rather than extensively analyzing and creating verbose theories that burden learners, making them complex and difficult to master, resulting in imperfect efficacy? Nevertheless, prescriptions must neither be rigidly adhered to nor discarded. Use ancient prescriptions as standards, adapting them to contemporary diseases. Study the pathological conditions described in ancient theories and ponder the profound principles of formulation, achieving the ability to use different herbs for the same disease and the same herbs for different diseases. Although syndromes arise in swarms, the threads remain orderly; although changes often appear critical, adherence remains steady. This is indeed excellent! (From *Feng Shi Jin Nang*)
Physicians should discuss prescriptions, not merely individual herbs. One should discuss herbs within the context of prescriptions, not discuss prescriptions by fixating on individual herbs. (From *Jiren Bian*)
Medicine relies on intent (Yi). It is like a general facing an enemy or a boatman navigating waters; agility in adapting to circumstances is prized. Prescriptions cannot be applied exhaustively, yet without them, the minds of the ancients cannot be transmitted. Acting blindly or grasping at wind will surely lead to errors due to rashness. Can prescriptions really be abandoned? Although prescriptions are good, one must thoroughly study the *Suwen* to seek the root, master the *Bencao* to investigate usage, become proficient in diagnosis to observe syndromes, and understand treatment to navigate changes. One begins by using prescriptions and ultimately reaches a state where reliance on prescriptions is unnecessary. Only then is the Way of Medicine perfected. (Shang Lu)
There are seven types of prescriptions: Large, Small, Slow, Rapid, Singular, Even, and Compound. Zhang Congzheng stated: There are two types of Large Prescriptions. One consists of one sovereign, three ministers, and nine assistants, suitable for diseases with diverse pathogens that cannot be treated with one or two herbs. The other involves heavy dosages taken in a single dose, suitable for diseases of the liver, kidneys, or lower parts where the distance is great. There are also two types of Small Prescriptions. One consists of one sovereign and two ministers, suitable for diseases with specific pathogens treatable by one or two herbs. The other involves light dosages taken frequently, suitable for diseases of the heart, lungs, or upper parts, sipped slowly. Liu Wansu stated: The liver and kidneys are located far away; many ingredients make the qi slow, preventing rapid arrival below. Thus, large doses with few ingredients are used to ensure rapid descent. The heart and lungs are near; few ingredients make the qi urgent, preventing ascent. Thus, small doses with many ingredients are used to facilitate dispersion and ascent. The Classics state: Tonifying/treating the upper requires slow formulations; tonifying/treating the lower requires rapid formulations. Rapid means strong flavor/aroma; slow means weak flavor/aroma. Ensure the medicine reaches the disease site without deviating midway or exceeding regulations. Wang Bing said: If the disease is in the kidney but heart qi is deficient, the medicine should pass through quickly without nourishing the heart with strong flavors, so that kidney medicine does not oppress the heart, causing further decline. Liu Wansu said: The Sage treats the upper without offending the lower, treats the lower without offending the upper, and treats the middle without offending either. Thus, punishing the innocent is called great confusion. Zhang Congzheng said: There are five types of Slow Prescriptions. One uses sweet herbs to slow, such as licorice and maltose/honey, suitable for chest/diaphragm diseases to retain the effect. One uses pills to slow, which act slower than decoctions/powders. One uses many ingredients, where herbs constrain each other and cannot exert their nature independently. One uses non-toxic herbs, which have pure and gentle natures. One uses weak-flavored herbs, which excel at treating the upper and lose strength by the time they reach the lower. Wang Haogu said: Treating the principal requires slowness to address the root; treating the pathogen requires speed to address the branch. Zhang Congzheng said: There are four types of Rapid Prescriptions. One is for urgent attacks on acute diseases, such as stroke or Guan Ge. One is decoctions/powders that cleanse rapidly upon ingestion. One uses toxic herbs to attack downward and upward, seizing the disease momentum. One uses strong-flavored herbs that go straight down without losing power. There are two types of Singular Prescriptions. One uses a single herb, suitable for near upper diseases. One uses an odd number of herbs (1, 3, 5, 7, 9), suitable for purgation rather than diaphoresis. Liu Wansu said: Xiao Chengqi Tang is a small singular prescription; Da Chengqi Tang and Didang Tang are large singular prescriptions, designed for purgation. Guizhi Tang and Mahuang Tang are small even prescriptions; Gegen Tang and Da Qinglong Tang are large even prescriptions, designed for diaphoresis. Even prescriptions include those with two paired herbs and those combining two ancient prescriptions, known as Compound Prescriptions. These are suitable for distant lower diseases. They involve even numbers of herbs (2, 4, 6, 8, 10), suitable for diaphoresis rather than purgation. Wang Haogu said: If singular fails, use even; if even fails, use singular again; hence "Compound" (Fu), meaning repetition. Wang Taipu considered even prescriptions as compound. In the Seven Prescriptions, there is both Even and Compound. Does this mean Even is two combined, and Compound is multiple combined? (From *Yitang Sanji*)
Scholar Xu said: I read Zhongjing's books and use his methods, but I never rigidly stick to his formulas; this is truly understanding Zhongjing's mind. (Li Dongyuan)
Someone asked: Zhongjing's prescriptions use few herbs, while Dongyuan uses over twenty. Danxi said: When I treat diseases, I use Dongyuan's herbs but follow Zhongjing's prescription style. Fewer ingredients mean concentrated medicinal power. Why does Danxi not emulate Dongyuan but emulate Zhongjing? The answer is: No one understands herb properties better than Dongyuan, the Saint of Medicine. Thus, for Dongyuan, using many is appropriate; for others to emulate this multiplicity leads to chaos. Dongyuan is like Han Xin leading troops: the more, the better. Danxi can only lead a hundred thousand, so he dares not emulate the multiplicity. (Wang Jiezhai)
Zhongjing's prescriptions are precise and uncluttered, centered around six main formulas from which others are derived. All diaphoretics are based on Guizhi Tang; all emetics on Zhizi Chi Tang; all purgatives on Chengqi Tang; all harmonizers on Chaihu Tang; all cooling agents on Xiexin Tang; all warming agents on Sini Tang. Counting them together as 113 formulas shows a lack of careful examination.
Zhongjing's methods embody the Ten Categories: Light disperses solidity (Mahuang Tang, Gegen Tang); Exhale resolves obstruction (Zhizi Chi Tang, Goudi San); Unblock moves stagnation (Wuling San, Shizao Tang); Drain removes closure (Xianxiong Tang, Chengqi Tang, Didang Tang); Slippery removes sticking (Dan Dao, Mi Jian); Astringent secures collapse (Chishizhi Yu Liang Tang, Taohua Tang); Tonify supports weakness (Fuzi Tang, Lizhong Wan); Heavy calms fright (Yuyuliang, Daizheshi); Damp moistens dryness (Huanglian Ejiao Tang); Dry removes dampness (Mahuang Lianqiao Chixiaodou Tang); Cold conquers heat (Baitu Tang, Huanglian Tang); Heat controls cold (Baitong Tang, Sini Tang).
Zhongjing established prohibitions for each prescription to maximize benefit and minimize harm. For example, after one dose of a diaphoretic causes sweating, stop subsequent doses. If pulse is tight, feverish, and sweatless, do not give Guizhi Tang; if pulse is faint, sweaty, and aversive to wind, do not give Qinglong Tang; if pulse is floating, feverish, sweatless, and exterior unresolved, do not give Baitu Tang; blood-deficient patients should not use Goudi San; patients with chronic loose stools should not use Zhizi; Yangming patients with excessive sweating should not use Zhu Ling Tang; exterior unresolved without tidal fever should not receive Chengqi Tang; vomiting patients should not receive Jianzhong Tang. This reflects Zhongjing's caution.
Zhongjing's use of "Attack" (Gong) and "Purge" (Xia) does not exclusively refer to bowel movements. Using Guizhi Tang to "attack" the exterior refers to sweating; attacking after the exterior is resolved refers to promoting urination; attacking internal heat refers to clearing fire. "Do not purge cold-damp in the interior" refers to urination due to heat. "Purge with decoction" refers to clearing fire.
Each of the Six Channels has a principal formula, with mutual applicability. Mahuang and Guizhi Tangs are for Taiyin Ying-Wei, but also used for Yangming Ying-Wei diseases. Zhenwu Tang is for Shaoyin water qi, but also for Taiyin yang loss after sweating. Sini Tang is for Taiyin diarrhea with undigested food, but also for Taiyin deep pulse. Wuling San is for Taiyin thirst/water reversal, but also for Yangming excessive drinking. Zhu Ling Tang is for Shaoyin diarrhea, but also for Yangming difficult urination. Didang Tang is for Taiyin blood stasis, but also for Yangming blood accumulation. Goudi San is for Yangming chest oppression, but also for Shaoyin nausea. Match the syndrome to the formula. Formulas belong to channels but are applied flexibly; this is Zhongjing's method. Despite differences in Exterior/Interior, Cold/Heat, Deficiency/Excess, there is no distinction between Cold Damage, Wind Strike, or miscellaneous diseases. Wind and Cold have alternating therapies; Exterior and Interior have switching miracles. Some win with whole formulas; some succeed via modifications. Later physicians discussed formulas without discussing syndromes, making Zhongjing's formulas seem difficult to use.
Guizhi is the premier diaphoretic. Mahuang penetrates skin/hair directly; Ginger spreads horizontally in muscles. Guizhi assists Mahuang to open pores and expel Wei-pathogens, inducing sweat in sweatless cases (Diaphoresis). Guizhi leads Ginger to open interstices and expel Ying-pathogens, resolving sweatiness (Muscle-Releasing). Muscle-releasing targets Ying. Why do the Three Guidelines claim Mahuang governs Ying and Guizhi governs Wei? Mahuang doesn't explicitly say "release muscle," yet muscles are released. Guizhi's muscle-release is for diaphoresis. Mahuang and Guizhi Tangs represent depth levels of sweating, not opposing concepts.
Mahuang/Guizhi are exterior herbs for Taiyang/Yangming. Goudi/Zhizi are exterior herbs for Yangming interior. Xiao Chaihu is the complete formula for Shaoyin half-exterior/half-interior. Taiyang exterior herb: Guizhi Tang. Shaoyin exterior herb: Mahuang Fuzi Xixin Tang. Jueyin exterior herb: Danggui Sini Tang. Exterior herbs provide exits for wind-cold in the Six Channels.
Treating diseases requires distinguishing Exterior/Interior, which often overlap. Mahuang's wheezing, Guizhi's spontaneous sweating, Da Qinglong's irritability, Xiao Qinglong's cough—all are exterior diseases with interior involvement. Using Xingren for wheezing, Shaoyao for sweating, Shigao for irritability, Wuweizi/Ganjiang for cough treats the interior within exterior formulas.
Mahuang Tang descends Qi while releasing exterior; Guizhi Tang nourishes Yin while releasing exterior; Gegen Tang generates fluids while releasing exterior; Da Qinglong, Ma Xing Gan Shi, Ma Qiao Chixiaodou clear fire while releasing exterior; Xiao Qinglong, Wuling San promote urination while releasing exterior.
Gegen, Da/Xiao Qinglong modify Mahuang/Guizhi. Gegen Tang removes Xingren (no wheezing) and adds Gegen (harmonize Taiyang fluids, raise Yangming fluids). Da Qinglong removes Shaoyao (no sweat) and adds Shigao (irritability). Xiao Qinglong removes Xingren, Ginger, Jujube, adding Xixin, Ganjiang, Banxia, Wuweizi, with further modifications, demonstrating infinite adaptability.
Xiao Qinglong treats unresolved cold-damage water qi with warm diaphoretics; Shizao Tang treats resolved wind-strike water qi with cold draining. This distinguishes cold-water from wind-water treatments. Xiao Qinglong water moves freely; Wuling San water stagnates; Shizao Tang water runs wild; Da Xianxiong water is obstructed/hard/full; Zhenwu Tang water causes heavy limbs. Different water pathologies require different treatments.
Bladder governs water, interior of Taiyang. Shizao/Wuling are descending drugs for Taiyang water pathways. Stomach governs grain, interior of Yangming. Three Chengqi are descending drugs for Yangming grain pathways. Gallbladder governs Qi, interior of Shaoyang. Da Chaihu is a descending drug for Shaoyang Qi. These are outlets for Three Yang excess pathogens. Large/Small Intestines belong to Stomach. Stomach excess implies intestinal excess. Divided: Tiaowei Chengqi for Stomach; Xiao Chengqi for Small Intestine; Da Chengqi for Large Intestine. Wu is dry earth, Geng is dry metal; Mangxiao moistens dryness. Guizhi Dahuang is for Taiyang transferring to Yangming; Guizhi Shaoyao is for Taiyang transferring to Taiyin. Descending drugs with exterior herbs are used because the pathogen hasn't left the exterior. Chaihu Jia Mangxiao is for Shaoyin transferring to Yangming. Da Chaihu clears formless Shaoyang pathogens; Chaihu Jia Mangxiao clears material Shaoyang pathogens. Guizhi Shaoyao clears formless Taiyin pathogens; Sanwu Baisan clears material Taiyin pathogens. Sini San clears formless Shaoyin/Jueyin pathogens; Chengqi Tang clears material pathogens in all channels. Light descending drugs use Qi aspect; heavy ones use Blood aspect. Sour/bitter induce vomiting/drainage (light): Shaoyao, Zhishi are light. Salty/bitter induce vomiting/drainage (heavy): Dahuang, Mangxiao are heavy.
Zhongjing uses porridge as an adjunct because plant/herb natures have biases, while grains offer balanced sweetness, sustaining spirit and blood. Guizhi Tang uses hot porridge for sweating; Lizhong Tang uses hot porridge for warming middle; Baisan uses hot porridge to guide drainage, then cold porridge to stop diarrhea. Modern use of cold porridge after Dahuang follows Zhongjing's intent. (Ke Yunbo)
Guizhi/Mahuang release exterior via sweat; Gegen/Shengma lift light pathogens; Chengqi/Xianxiong drain downward; Xiexin/Shizao drain interior fullness; Goudi/Zhizi induce vomiting for high pathogens. This is Zhongjing's method of prescribing based on disease. (Liu Hejian)
Xiao Chaihu Tang governs Shaoyang half-exterior/half-interior; Wuling San separates bladder half-exterior/half-interior; Lizhong Tang treats unstable vomiting/diarrhea, governing upper/lower half-exterior/half-interior. (*Yixue Rumen*)
Ancient prescription names are meaningful. "Tou" (Head) implies leadership. Like a general leading troops to defeat enemies, the head prescription guides herbs to the disease site. Ke said: Like a general setting banners, indicating direction. Which formula enters which channel? Which herb travels which meridian? Which attacks, which defends? Which tonifies, which drains? Which is land-based, which water-based? Which uses unusual methods, which orthodox? Which rises, which descends? Methods are subtle; ignore them at your peril. Examples: Yangxin enters Heart; Gujin enters Lung; Buzhong enters Spleen; Zuojin enters Liver; Guben enters Kidney. Attackers: Da/Xiao Chengqi. Defenders: Lizhong, Sini. Tonics: Shiquan, Guipi. Drainers: Da/Xiao Chaihu. Land-type: Wuwei Yigong, Liu Jun. Water-type: Wuling, Bazheng. Rising: Shengyang Sanhuo. Descending: Suzi Jiangqi. Unusual: Zishen Wan, Zhizi Ganjiang. Orthodox: Fuzi, Lizhong, Sanhuang. Ingenious: Fuzi hot/cold probing. Clever: Liu Jun with Yangzheng Dan; Siwu with Huoluo Dan; Si Liu Jun with Xianglian Wan. Li Zi said: Difficulty lies not in standard use, but in reverse use matching the disease. Physicians know cold treats heat, heat treats cold, but forget *Neijing*: Treat openness with openness, blockage with blockage, cold with heat, heat with cold. Avoid heat when using heat, avoid cold when using cold. Blockage with blockage: Spleen deficiency bloating treated with Renshen/Atractylodes; tonification resolves bloating. Openness with openness: Cold damage with heat diarrhea or dry stool treated with Tiaowei Chengqi; dysentery treated with Shaoyao Tang. Cold with heat: Cold herbs with hot assistants. Heat with cold: Hot herbs with cold assistants, avoiding rejection. Subdue the master, address the cause. Avoid heat/cold extremes to prevent injury. Ancient methods are profound. Ke said: Beyond formulas are formulas; beyond methods are methods. Truly spoken! (*Yixue Jieti*)