孤精于内，气耗于外，形不可与衣相保，此四极亟而动中，是气拒于内，而形施于外，治之奈何？
此水气胀满之病，其本不从毫毛生，五脏阳气竭耗，而脉气孤危，故魄独居。此四极亟而
动中，气拒内，形施外，故不与衣相保。
岐伯对曰∶平治于权衡，去宛陈 ，是以微动四极，温衣，缪刺其处，以复其形，开鬼门，
洁净府。
此言量其内外轻重而施治，如水气在内，则用以微动四极，缪剌其处，以复其形，以牵牛、
甘遂之类泻之，去其积，故曰去宛陈 ；水气在表，用苍术、羌活之类汗之，故曰开鬼门；水气
在下，用五苓散之类，以利小水，故曰洁净府。
藏气法时论 曰∶肝病者，两胁下痛引小腹，令人善怒，虚则目KT KT 无所见，耳
无所闻，善恐如人将捕之，取其经厥阴与少阳，气逆则头痛耳聋不聪颊肿。取血者。
此肝经之病，而合于胆。凡经络到处，皆为之病，两胁下痛引小腹，善怒，此为肝经实病。
目KT KT 无见，耳无所闻，善恐，此肝脉系胆脉，风火上攻故也。胁中血满，独异于常，随其
左右而利之也。
心病者，胸中痛，胁支满，胁下痛，膺背肩甲间痛，两臂内痛，虚则胁腹大，胁下与腰相引
而痛，取其经，少阴太阳舌下血者。其变病，剌 中血者。
此心经之病，而合于小肠。舌下，为舌本，心之系。 中，为心脉，在掌后去腕半寸。
脾病者，身重善饥肉痿，足不收行，善 脚下痛，虚则腹满肠鸣，飧泄食不化，取其经，太
阴阳明少阴血者。
此脾经之病，而合于脾者，善行 ，故取足太阴阳明少阴出血也。
肺病者，喘咳逆气，肩背痛，汗出，尻阴股膝髀 足皆痛，虚则少气不能报息，耳聋咽干，
取其经，太阴足太阳之外厥阴内血者。
此肺经之病，实则喘咳逆气，肩背股膝俱痛，虚则少气耳聋，太阳之外，厥阴之内，有血满
异于常者则取之。
肾病者，腹大胫肿，喘咳身重，寝汗出憎风，虚则胸中痛，大腹小腹痛，清厥意不乐。取其
经，少阴太阳血者。
此肾经之病，凡剌虚则补，剌实则泻，不盛不虚以经取之，是谓得道。经络有血，剌而去
之，是谓守法，犹当揣形定气，先取血脉，而后乃调有余不足。
腹中论 帝曰∶夫子数言热中消中，不可服膏粱芳草石药，石药发颠，芳草发狂。夫
热中消中者，皆富贵人也，今禁膏粱，是不合其心，禁芳草石药，是病不愈，愿闻其说。
热中多饮溲数，消中多食数溲，皆脾气上溢，肥甘所致，故禁膏粱石药芳草之浓美也。
岐伯对曰∶夫芳草之气美，石药之气悍，二者其气急疾坚劲，故非缓心和人，不可以服此二
者。曰∶不可以服此者，何以然？曰∶夫热气 悍，（ ，疾也。）药气亦然。二者相遇，恐内
伤脾，脾者土也，而恶木，服此药者，至甲乙日更论。
热气 盛，则木气有余，躁怒伤脾，故至甲乙日，更论脾病之增减。
五常政大论篇 帝曰∶天不足西北，左寒而右凉；地不满东南，右热而左温，其故
何也？岐伯对曰∶阴阳之气，高下之理，大小之异也。东南方，阳也，阳者其精降于下，故右热
而左温。西北方，阴也，阴者其精奉于上，故左寒而右凉。是以地有高下，气有温凉，高者气寒，
下者气热，故适寒凉者胀，之温热者疮。下之则胀已，汗之则疮已。此腠理开闭之常，大小之异
耳。曰∶其于寿夭何如？曰∶阴精所奉其人寿，阳精所降其人夭。
阴精所奉，高之地也。阴方之地，阳不妄泄，寒气外持，邪不数中，而正坚守，故寿延。
阳精所降，地之下也。阳方之地，阳气耗散，发泄无度，风湿数中，真气倾竭，故夭折。即事验
之，今中原之境，西北方人多寿，东南方人多夭，其中各有微甚耳。此方土之异也。
帝曰∶其病治之奈何？曰∶西北之气散而寒之，东南之气收而温之，所谓同病异治也。
西北方皮肤闭腠理密，人皆食热，故宜散宜寒。东南方人腠理疏，冬皆长冷，故宜收宜温
散，不解表。
故曰∶气寒气凉，治以寒凉，行水渍之。气温气热，治以温热，强其内守。必同其气，可使
平也，假者反之。
寒方以寒，热方以热，是正治也。西北方有病冷，假热方以除之；东南方有病热，假凉方
以除之。是则假者，反上之正法以取之。
岐伯曰∶补上下者从之，治上下者逆之。
上者天气，下者地气。不及则顺而和之，太过则逆而治之也。
以所在寒热盛衰而调之，故曰∶上取下取，内取外取，以求其过。能毒者以浓药，不胜毒者
以薄药，此之谓也。
药之浓薄，药之气味浓薄也。上下内外求治其过，当因人之体气浓薄而施，则可以求其过也。
气反者，病在上，取之下；病在下，取之上；病在中，傍取之。
气反者，谓病下而反上，病上而反下。病反在上，而治取于下，病反在下，而治取于上，
病在中，而治取于傍。如寒逆于下，热反攻于上，不利于下，气盈于上，则温下以调之，余仿此。
治热以寒，温而行之；治寒以热，凉而行之；治温以清，冷而行之；治清以温，热而行之。
故消之削之，吐之下之，补之泻之，久新同法。
治法要审轻重刚柔逆顺以施之，新久则皆同一理法也。
曰∶病在中而不实不坚，且聚且散奈何？曰∶无积者求其藏，虚则补之，药以祛之，食以随
之，行水渍之，和其中外，可使必已。曰∶有毒无毒，服有约乎？曰∶病有新久，方有大小，有
毒无毒，固宜常制矣。（有约，常制，即下文云。）大毒治病，十去其六，常毒治病，十去其七，
小毒治病，十去其八，无毒治病，十去其九，谷肉菜果，食养尽之，无使过之，伤其正也。不尽，
行复如法。
约，节约也。假如无毒治病，病已十去其九，须以此为节约，再勿药也。须以谷肉菜果，
随五脏所宜，食之养之，以尽其余病也。若违约节而过用之，必至于伤正气也。
六元正纪论 帝曰∶论言热无犯热，寒无犯寒，予欲不远热，不远寒奈何？
上之寒热二字，所用之寒热也，下之寒热二字，因气之寒热也。远，犹避也。不远寒，不
远热，犹言可以热治热，而寒治寒者也。
岐伯对曰∶发表不远热，攻里不远寒。
出汗宜热药，故不避热。下利宜寒药，故不避寒。如是则夏亦可用寒，皆谓不获已而用之也。
帝曰∶不发不攻而犯寒犯热何如？曰∶寒热内贼，其病益甚。曰∶愿闻无病何如？曰∶无者
生之，有者甚之。
犯寒热者，其病益甚，无病犯禁，犹能生病故曰∶无则生，有则甚。
曰∶生者何如？曰∶不远热则热至，不远寒则寒至。寒至则坚痞腹满，痛急下利之病生矣。
热至则身热，吐下霍乱，痈疽疮疡，瞀（音冒。闷也。）郁注下， 肿胀，呕鼽衄头痛，骨节
变肉痛，血溢血泄，淋闭之病生矣。曰∶治之奈何？曰∶时必顺之，犯者治以胜也。
春宜凉，夏宜寒，秋宜温，冬宜热，此时之宜，不可不顺。犯热治以酸寒，犯寒治以甘热，
犯凉治以苦温，犯温治以辛凉，所谓胜也。
帝曰∶妇人重身，毒之何如？岐伯曰∶有故无殒，亦无殒也。曰∶愿闻其故何谓也？岐伯曰∶
大积大聚，其可犯也，衰其大半而止，过者死。帝曰∶善。
重身，谓怀妊也。毒之，谓有毒病用毒药以攻之。有大积大聚之故，治其大半则止，过之
者死。非重身者，大毒治病，十去其六而止，当有约也。况重身者，岂无约乎？
曰∶郁之甚者，治之奈何？曰∶木郁达之，火郁发之，土郁夺之，金郁泄之，水郁折之，然
调其气，过者折之，以其畏也，所谓泻之。
郁，郁滞也。达发夺泄折五者，欲其通达之意也。王注以达为吐，以发为汗，以夺为下，
以泄为利小水，皆非也。如气凄清之甚，则肺金太过，而木郁之病生焉。治以轻扬味薄之剂散之，
使之郁气解，而肝木之气伸矣。治郁之余，仍以辛热之味，以泻肺气，畏其热则气斯服。肝肺之
气，各得其平，无获郁滞之患，故曰∶过者折之，以其畏也。余皆仿此。王安道曰∶此段十三句，
通为一章，当分三节。自帝曰至水郁折之九句为一节，治郁法之问答也，然调其气一句为一节，
治郁之余法也。过者折之，以其畏也，所谓泻之三句为一节，调气之余法也。过病之起，多由乎
郁，郁者，滞而不通之义。或因所乘而为郁；或不因所乘而本气自郁，皆郁也。岂惟五运之变，
能使然哉？郁既非五运之变可拘，则达之、发之、夺之、泻之、折之之法，固可扩而充之矣。可
扩而充，其应变不穷之理也。且夫达者，通畅之也，如肝性急怒，气逆 胁，或胀大时上炎，
治以苦寒辛散而不愈者，则用升发之药，加以厥阴报使，而从治之。又如久风入中为飧泄，及不因外
风之入而清气在下为飧泄，则以轻扬之剂举而散之。凡此之类皆达之之法也。王氏以吐训达，以
汗为发，不能使人无疑。以为肺金盛，而抑制肝木欤？则泻肺气，举肝气可矣，不必吐也；以为
脾胃浊气下流，而少阳清气不升欤？则益胃升阳可矣，不必吐也。虽然，木郁固有吐之之理，今
以吐宇总该达字，则凡木郁皆当用吐矣，其可乎哉？
帝曰∶假者何如？岐伯曰∶有假其气，则无禁也。所谓主气不足，客气胜也。
假，借也。主气不足，客气胜之，故假借寒热暖凉，以资夫正气，则客可犯之谓也。主气
谓五脏应四时春夏秋冬也。客气谓六气加临之气。
至真要大论 曰∶上淫乎下，所胜平之，外淫乎内，所胜治之。
上淫乎下，天之气也，所谓司天之气。风淫所胜，平以辛凉，佐以苦甘，以甘缓之，以酸
泻之之类是也。外淫乎内，地之气也，所谓在泉之气。风淫于内，治以辛凉，佐以苦甘，以甘缓
之，以辛散之是也，皆随所制胜以平之也。司天之气曰平，在泉之气曰治，此其义见矣。
谨察阴阳所在而调之，以平为期，正者正治，反者反治。
阴病阳不病，阳病阴不病，正也。以寒治热，以热治寒，正治也。阴位以见阳脉，阳位以
见阴脉，反也。以寒治寒，以热治热，反治也。
夫气之胜也，微者随之，甚者制之，气之复也，和者平之，暴者夺之，皆随胜气，安其屈伏，
无问其数，以平为期，此其道也。
随制平夺，皆不以数之多少，以气和平为度。
帝曰∶气有多少，病有盛衰，治有缓急，方有大小，愿闻其约。岐伯对曰∶气有高下，病有
远近，证有中外，治有轻重，适其至所为故也。
脏腑有高下远近，证候有表里，药治有轻重。调其多少，和其紧慢，令药气之病所为故，
勿令太过与不及也。
《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；君三臣六，偶之制也。
古之单方，独用一物曰奇。病在上而近者，宜奇方。古之复方曰偶，有二味相配之偶，有
二方相合之偶。病在下而远者，宜偶方。制者，谓因时制宜之义，以病有远近，治有轻重所宜，
故云制也。若以君臣药味数之，阴阳奇偶则亦然也。
故曰∶近者奇之，远者偶之，汗者不可以奇，下者不可以偶。
奇者单行而力微，故近者奇之可也；偶者并行而力大，故远者必以偶也。汗不可以奇，盖谓
汗难出，故以偶；下不以偶，谓下易行，故以奇。及观仲景制方，桂枝汤汗药也，亦以三味为奇。
大承气汤下药也，亦以四味为偶。此见方因时制宜，不必拘泥奇偶，而失其治之大体。
补上治上制以缓，补下治下制以急。急则气味浓，缓则气味薄，适其所至，此之谓也。
王注谓补上治上之方，若迅急则上不住而反迫于下，所以宜制气味之薄方，欲其升浮而使之
至于病所，而后可以疗其病也。补下治下之方，若慢缓则滋道路而力微，所以宜制气味之浓方，
欲其降沉急而至于病所，而后可以疗其病也。适，宜也。凡制方须宜至其病所，而无太过不及之谓也。
病所远而中道气味之者，食而过之，无越其制度也。
又有病在于下焦，其势不容于遽急而用和缓之气味者，虑其中道而止也，宜于药后，以食
送之至病所，要亦无违上下之制。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。
大方有二∶有药味数少专攻之大方；有君一臣二佐九之大方。凡治肝肾及在下而远者，宜服
数少之大方。病有兼证而邪不专，不可以一二味治者，宜服君一臣二佐九之大方，故肾之二服，
可分作肺之九服、肝之三服也。
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。
重方则复方也。奇偶不去则反复以取之，所谓寒热温凉反从其病。如黄连治口疮，佐以干姜
而速之类是也，故曰∶反佐取之。
帝曰∶五味之用何如？岐伯对曰∶辛甘发散为阳，酸苦涌泄为阴，咸味涌泄为阴，淡味渗泄
为阳。六者或收或散，或缓或急，或燥或润，或 或坚，以所利而行之，调其气使其平也。
Isolated yin essence depletes internally, while qi dissipates externally; the emaciated body cannot fill the clothes. This indicates extreme emaciation of the four limbs and internal instability, signifying that qi is obstructed internally while the form deteriorates externally. How should this be treated?
This is a disease of water qi distension and fullness. Its root does not originate from the hair follicles (exterior), but stems from the exhaustion of yang qi in the five zang organs, leading to isolated and precarious pulse qi, hence "Po resides alone" (yin essence remains while yang qi vanishes). This condition of extreme limb emaciation and internal unrest, with qi obstructed inside and form decaying outside, results in the body becoming so thin that it no longer fills the garments.
Qibo replied: "Balance the treatment according to the scale of severity; remove the accumulated stagnation (Qu Wan Chen Cuo). Facilitate slight movement of the four limbs, keep warm with clothing, apply Miu Ci (cross-point needling) at corresponding locations to restore the form, open the 'ghost gates' (sweat pores via diaphoresis), and purify the 'clean mansion' (bladder via diuresis)."
This passage explains treating based on the severity of interior and exterior conditions. If water qi accumulates internally, use slight limb movement and Miu Ci to restore form, and employ herbs like Qian Niu Zi (Pharbitis Seed) or Gan Sui (Kansui Root) to purge accumulation; thus it is called "removing accumulated stagnation." If water qi is at the exterior, use herbs like Cang Zhu (Atractylodes Rhizome) or Qiang Huo (Notopterygium Rhizome) to induce sweating; thus it is called "opening the ghost gates." If water qi is in the lower jiao, use formulas like Wu Ling San (Five-Ingredient Powder with Poria) to promote urination; thus it is called "purifying the clean mansion."
The *Su Wen: Zang Qi Fa Shi Lun* states: "In liver diseases, pain radiates from the hypochondrium to the lower abdomen, causing irritability. In deficiency patterns, vision blurs, hearing diminishes, and there is excessive fear, as if being hunted. Treat by selecting points from the Jueyin (Liver) and Shaoyang (Gallbladder) meridians. For qi rebellion causing headache, deafness, tinnitus, and facial swelling, select blood vessels for bleeding."
This is a disease of the Liver Meridian, harmonizing with the Gallbladder. Pathology occurs along the meridian pathways. Hypochondriac pain radiating to the lower abdomen and irritability indicate Liver Meridian excess. Blurred vision, hearing loss, and fear result from wind-fire attacking upward due to the connection between Liver and Gallbladder meridians. When blood stagnates in the hypochondrium, deviating from normal, treat by draining according to the side (left or right).
In heart diseases, there is chest pain, distending fullness in the hypochondrium, pain under the ribs, pain in the precordium, back, and scapula, and pain in the inner aspect of both arms. In deficiency patterns, the hypochondrium and abdomen become distended, with pulling pain between the hypochondrium and waist. Treat by selecting points from the Shaoyin (Heart) and Taiyang (Small Intestine) meridians, and bleed the sublingual vessels. For altered patterns, needle the blood vessels at the center of the palm (Shenmen point).
This is a disease of the Heart Meridian, harmonizing with the Small Intestine. The sublingual area is the root of the tongue, the connection of the Heart. "Zhong" refers to Shenmen, located half a cun proximal to the wrist crease on the radial side, the Yuan-Source point of the Heart Meridian.
In spleen diseases, the body feels heavy, there is hunger with muscle flaccidity, inability to hold the feet or walk properly, and pain in the soles. In deficiency patterns, there is abdominal fullness, borborygmus, undigested stool diarrhea, and food intolerance. Treat by selecting blood vessels from the Taiyin (Spleen), Yangming (Stomach), and Shaoyin (Kidney) meridians.
This is a disease of the Spleen Meridian, relating to Spleen function. Spleen deficiency leads to impaired transport, so bleeding from the Foot-Taiyin, Yangming, and Shaoyin meridians is indicated.
In lung diseases, there is wheezing, coughing, rebellious qi, shoulder and back pain, sweating, and pain in the sacrum, genitals, thighs, knees, calves, and feet. In deficiency patterns, there is shortness of breath, inability to complete inhalation, deafness, and dry throat. Treat by selecting blood vessels from the Taiyin (Lung), the lateral aspect of the Taiyang (Bladder), and the medial aspect of the Jueyin (Liver) meridians.
This is a disease of the Lung Meridian. Excess presents as wheezing, coughing, rebellious qi, and pain in shoulders, back, thighs, and knees. Deficiency presents as shortness of breath and deafness. At the lateral aspect of the Taiyang and medial aspect of the Jueyin meridians, if blood stagnation deviates from normal, select these sites for bleeding.
In kidney diseases, there is abdominal distension, calf edema, wheezing, coughing, heavy body, night sweats, and aversion to wind. In deficiency patterns, there is chest pain, lower abdominal pain, cold extremities, and depression. Treat by selecting blood vessels from the Shaoyin (Kidney) and Taiyang (Bladder) meridians.
This is a disease of the Kidney Meridian. Generally, tonify deficiency and drain excess; for neither excess nor deficiency, treat the affected meridian directly—this is the correct method. If blood stasis exists in the meridians, needle to remove it—this is observing the rules. One must assess the form and determine qi status, first removing blood stasis, then regulating excess and deficiency.
The *Su Wen: Fu Zhong Lun* states: The Emperor said, "You often mention that Re Zhong (Heat Center) and Xiao Zhong (Consumption Center) patients should not consume Gao Liang (rich/fatty foods), Fang Cao (aromatic herbs), or Shi Yao (mineral drugs). Mineral drugs cause Dian (mania/epilepsy), and aromatic herbs cause Kuang (madness). Re Zhong and Xiao Zhong patients are usually wealthy. Prohibiting rich foods goes against their habits; prohibiting mineral/aromatic herbs leaves the disease uncured. I wish to hear your explanation."
Re Zhong involves polydipsia and polyuria; Xiao Zhong involves polyphagia and polyuria. Both result from Spleen Qi overflowing upward due to sweet and fatty foods; thus, rich foods and potent mineral/aromatic herbs are prohibited.
Qibo replied: "The qi of aromatic herbs is beautiful, and the qi of mineral drugs is fierce. Both have urgent, firm, and strong properties. Therefore, unless one has a calm and gentle disposition, they should not take these two types of drugs." The Emperor asked, "Why can they not be taken?" Qibo answered, "Internal heat is fierce, and drug qi is similar. Their meeting may injure the Spleen internally. The Spleen belongs to Earth and dislikes Wood. Patients taking these drugs will see changes in Spleen pathology on Jia-Yi days (Wood days)."
When heat qi is excessive, Wood qi becomes surplus, leading to irritability that injures the Spleen. Thus, on Jia-Yi days, the fluctuation of Spleen disease must be reassessed.
The *Su Wen: Wu Chang Zheng Da Lun* states: The Emperor said, "Heaven is deficient in the northwest, where the left is cold and the right cool; Earth is incomplete in the southeast, where the right is hot and the left warm. What is the reason?" Qibo replied, "It is the principle of Yin-Yang qi, high-low geography, and size differences. The southeast is Yang; Yang essence descends, making the right hot and left warm. The northwest is Yin; Yin essence ascends, making the left cold and right cool. Thus, ground has height and depth, climate has warmth and cold. High places are cold, low places are hot. Going to cold/cold climates causes distension; going to warm/hot climates causes sores. Purging resolves distension; sweating resolves sores. This is the normal opening and closing of Cou Li (pores), differing only in degree." The Emperor asked, "How does this affect longevity?" Qibo replied, "Where Yin essence is nourished, people live long; where Yang essence descends, people die young."
Yin essence nourishment occurs in high lands. In Yin regions, Yang does not leak recklessly, cold holds the exterior, pathogens rarely strike, and Zheng Qi (Upright Qi) remains firm, extending life.
Yang essence descent occurs in low lands. In Yang regions, Yang Qi dissipates, excretion is uncontrolled, wind-damp strikes frequently, and True Qi exhausts, leading to premature death. Verifying this, in central China, people in the northwest live longer, while those in the southeast have shorter lifespans, with minor variations. This is due to geographical differences.
The Emperor asked, "How should these diseases be treated?" Qibo replied, "Qi in the northwest should be dispersed and cooled; Qi in the southeast should be gathered and warmed. This is called 'Same Disease, Different Treatment.'"
In the northwest, skin is dense and Cou Li tight, and people eat hot foods; thus, dispersal and cooling are suitable. In the southeast, Cou Li is loose, and people wear heavy winter clothes; thus, gathering and warming dispersion are suitable. Without resolving the exterior, the disease will not clear.
Therefore: In cold/cold climates, treat with cold/cool methods, using herbal baths. In warm/hot climates, treat with warm/hot methods, strengthening internal retention. One must align with local Qi to achieve balance; for false patterns, do the opposite.
Cold regions use cold treatments, hot regions use hot treatments—this is Zheng Zhi (Direct Treatment). Northwest diseases presenting with cold but false heat are treated with cold formulas; southeast diseases presenting with heat but false cold are treated with warm formulas. This applies reverse direct treatment to false patterns.
Qibo said: "For disorders above and below, follow the trend; for disorders involving reversal, oppose the trend."
Above refers to Heaven Qi, below to Earth Qi. If deficient, harmonize following the trend; if excessive, treat opposing the trend.
Regulate based on the abundance and deficiency of cold and heat in the affected area. Thus, "treat above by accessing below, treat below by accessing above, treat interior by accessing exterior," seeking the deviation. Those who can tolerate toxicity receive strong medicines; those who cannot tolerate toxicity receive weak medicines.
"Strong" and "weak" refer to the potency of drug flavors. Treating deviations above, below, interior, and exterior requires adjusting dosage strength according to the patient's constitution.
In cases of Qi Reversal (Qi Fan): Disease above, treat below; disease below, treat above; disease in the middle, treat laterally.
Qi Reversal means disease originating below manifests above, or vice versa. If disease manifests above but originates below, treat below; if manifesting below but originating above, treat above; if in the middle, treat the periphery. For example, if Cold rebels below and Heat attacks above, with Qi surging upward, warm the lower part to regulate it. Similar logic applies elsewhere.
Treat Heat with Cold, but administer warm; treat Cold with Heat, but administer cool; treat Warmth with Clearing, but administer cold; treat Coolness with Warming, but administer hot.
Thus, reducing,削 (cutting away), vomiting, purging, tonifying, and draining follow the same principles for new and old diseases.
Treatment must assess light/heavy, rigid/flexible, and reverse/conforming patterns. New and old diseases share the same underlying logic.
Question: What if disease is in the middle, neither solid nor hard, and gathers and scatters intermittently? Answer: If there is no accumulation, investigate the Zang organs. Tonify deficiency. Use medicine to expel pathogens, food to support recovery, and herbal baths to harmonize interior and exterior. The disease can be cured. Question: Is there a limit to taking toxic or non-toxic drugs? Answer: Diseases vary in newness/oldness, and formulas vary in size. There are standard protocols for toxic and non-toxic drugs. (The "limit" refers to the following protocol.) For highly toxic drugs, stop when 60% of the disease is resolved; for moderately toxic drugs, stop at 70%; for slightly toxic drugs, stop at 80%; for non-toxic drugs, stop at 90%. Use grains, meats, vegetables, and fruits to complete the recovery through dietary therapy. Do not overdo it, lest you injure Zheng Qi. If unresolved, repeat the process.
"Limit" means restraint. If non-toxic drugs resolve 90% of the disease, one must stop here. Use grains, meats, vegetables, and fruits suited to the Five Zang to nourish and clear residual pathogenic factors. Violating this restraint and overusing drugs will inevitably injure Zheng Qi.
The *Su Wen: Liu Yuan Zheng Ji Da Lun* states: The Emperor said, "Discussions say 'Do not violate heat with heat, do not violate cold with cold.' I wish to know why I should not avoid heat when using heat, nor avoid cold when using cold."
The first "heat/cold" refers to drug properties; the second refers to climatic conditions. "Avoid" means to shun. Not avoiding heat/cold implies using heat to treat heat, and cold to treat cold.
Qibo replied: "When releasing the exterior, do not avoid heat; when attacking the interior, do not avoid cold."
Diaphoresis suits hot drugs, so heat is not avoided. Purgatives suit cold drugs, so cold is not avoided. Thus, cold drugs can be used in summer, provided they are necessary.
The Emperor asked, "What if one violates cold/heat without releasing the exterior or attacking the interior?" Qibo replied, "Cold and heat become internal thieves, worsening the disease." The Emperor asked, "What about healthy individuals?" Qibo replied, "For those without disease, it generates illness; for those with disease, it worsens it."
Violating cold/heat禁忌 worsens disease. Even healthy people violating prohibitions can fall ill; hence, "no disease becomes sick, existing disease becomes severe."
The Emperor asked, "How does illness arise?" Qibo replied, "Not avoiding heat brings heat; not avoiding cold brings cold. Cold arrival causes hardness,痞 (masses), abdominal fullness, acute pain, and diarrhea. Heat arrival causes fever, vomiting, diarrhea, Huo Luan (cholera-like syndrome), abscesses, sores, mental confusion, stagnation, dysentery, swelling, vomiting, nasal congestion, epistaxis, headache, bone joint deformation, muscle pain, hemorrhage, strangury, and urinary retention." The Emperor asked, "How to treat?" Qibo replied, "Comply with the seasons. For violations, treat with the controlling element."
Spring suits coolness, Summer suits cold, Autumn suits warmth, Winter suits heat. Seasonal compliance is essential. For heat violation, use sour-cold; for cold violation, use sweet-hot; for cool violation, use bitter-warm; for warm violation, use pungent-cool. This is called "controlling."
The Emperor asked, "How to treat pregnant women with toxic drugs?" Qibo replied, "If there is a pathological cause, there is no injury [to the mother], and no injury [to the fetus]." The Emperor asked, "What is the reason?" Qibo replied, "For large accumulations and masses, toxic drugs may be used, but stop when more than half the disease is resolved. Exceeding this limit causes death." The Emperor said, "Excellent."
"Chong Shen" means pregnancy. "Du Zhi" means using toxic drugs for serious pathological conditions. For large accumulations, stop after resolving more than half. Exceeding this causes death. For non-pregnant patients, stop highly toxic drugs at 60% resolution, observing limits. How much more should pregnant women observe limits?
The Emperor asked, "How to treat severe stagnation?" Qibo replied, "For Wood stagnation, facilitate flow; for Fire stagnation, vent; for Earth stagnation, purge; for Metal stagnation, drain; for Water stagnation, restrain. However, regulate Qi. For excess, restrain using what it fears; this is called draining."
"Yu" means stagnation. "Da, Fa, Duo, Xie, Zhe" aim to promote flow. Wang Bing interpreted "Da" as vomiting, "Fa" as sweating, "Duo" as purging, and "Xie" as diuresis, which is incorrect. For example, if cold climate is severe, Metal (Lung) is excessive, causing Wood (Liver) stagnation. Treat with light, thin-flavored herbs to disperse, resolving stagnation and allowing Liver Qi to extend. After treating stagnation, use pungent-hot flavors to drain Lung Qi; since Lung fears heat, Qi becomes compliant. Liver and Lung Qi achieve balance, preventing stagnation. Thus, "excess is restrained by its fear." Apply similarly to others. Wang Andao stated: This section comprises thirteen sentences, divided into three parts. From "Emperor said" to "Water Yu Zhe Zhi" (nine sentences) is the Q&A on treating Yu. "Ran Tiao Qi" (one sentence) is the supplementary method. "Guo Zhe Zhe Zhi..." (three sentences) is the supplementary method for regulating Qi. Yu arises from blockage, either from being overcome or inherent Qi stagnation. It is not limited to the Five Movements. Thus, methods of Da, Fa, Duo, Xie, Zhe can be expanded. "Da" means smooth flow. For Liver anger and Qi rebellion, if bitter-cold/pungent-dispersing fails, use ascending herbs with Jueyin guiding agents. For chronic wind entering the middle causing undigested stool diarrhea, or clear Qi sinking causing similar diarrhea, use light herbs to lift and disperse. These are methods of "Da." Wang’s interpretation of "Tu" as "Da" is questionable. If Lung Metal suppresses Liver Wood, draining Lung and lifting Liver suffices without vomiting. If Spleen/Stomach turbid Qi sinks and Shaoyang clear Qi fails to rise, tonifying Stomach and raising Yang suffices without vomiting. Although vomiting has merit for Wood Yu, equating all Wood Yu with vomiting is unreasonable.
The Emperor asked, "What about false patterns?" Qibo replied, "When Qi borrows a false nature, there are no prohibitions. This is when Host Qi is deficient and Guest Qi prevails."
"Jia" means borrowing. When Host Qi (Zang organs corresponding to seasons) is deficient and Guest Qi (Six Qi additions) prevails, borrow cold/hot/warm/cool properties to support Zheng Qi, allowing Guest Qi to be addressed.
The *Su Wen: Zhi Zhen Yao Da Lun* states: "Upper invasion affecting the lower (Si Tian Qi), pacify with the controlling element. External invasion affecting the interior (Zai Quan Qi), treat with the controlling element."
Upper invasion refers to Si Tian Qi. For Wind excess, pacify with pungent-cool, assist with bitter-sweet, ease with sweet, drain with sour. External invasion refers to Zai Quan Qi. For Wind within, treat with pungent-cool, assist with bitter-sweet, ease with sweet, disperse with pungent. All follow the controlling element to pacify. Si Tian uses "Pacify"; Zai Quan uses "Treat."
Carefully observe Yin-Yang locations and regulate them, aiming for balance. Correct patterns use Zheng Zhi (Direct Treatment); reversed patterns use Fan Zhi (Reverse Treatment).
Yin disease without Yang involvement, or Yang without Yin, is correct. Treating Heat with Cold, Cold with Heat, is Zheng Zhi. Yin location showing Yang pulse, or Yang location showing Yin pulse, is reversed. Treating Cold with Cold, Heat with Heat, is Fan Zhi.
For Qi excess: mild cases follow the trend, severe cases control it. For Qi recovery: peaceful cases pacify, violent cases deprive. Follow the prevailing Qi, soothe the suppressed, regardless of frequency, aiming for balance. This is the Dao.
Following, controlling, pacifying, and depriving depend not on quantity but on achieving Qi harmony.
The Emperor asked, "Qi varies in amount, disease in prosperity/decline, treatment in urgency, formulas in size. What is the summary?" Qibo replied, "Qi has high/low positions, disease has near/far locations, symptoms have exterior/interior, treatment has light/heavy intensity. Suit the treatment to reach the disease site."
Zang-Fu have high/low/near/far distances; symptoms have exterior/interior; treatments have light/heavy intensities. Regulate amounts, harmonize tension/speed, ensuring drug Qi reaches the target without excess or deficiency.
The *Da Yao* states: "One Sovereign, two Ministers, is a Qi (Odd) formula; Two Sovereigns, four Ministers, is an Ou (Even) formula; Two Sovereigns, three Ministers, is a Qi formula; Three Sovereigns, six Ministers, is an Ou formula."
Ancient single-herb formulas are Qi. Diseases above and near suit Qi formulas. Compound formulas are Ou. Diseases below and far suit Ou formulas. "Zhi" means adapting to time, as disease location and treatment intensity vary. Using sovereign/minister herb counts, Yin-Yang odd/even principles apply similarly.
Thus: Near diseases use Qi formulas; far diseases use Ou formulas. Diaphoretics should not use Qi; purgatives should not use Ou.
Qi formulas act singly with mild force, suitable for near diseases. Ou formulas act jointly with strong force, suitable for far diseases. Diaphoresis is difficult, so Ou (stronger) is used. Purging is easy, so Qi (milder/direct) is used. However, Zhang Zhongjing’s Guizhi Tang (Cinnamon Twig Decoction) for sweating has three ingredients (Qi). Dachengqi Tang (Major Order the Qi Decoction) for purging has four ingredients (Ou). This shows formulas adapt to time, not rigidly adhering to odd/even, preserving the general principle.
Tonifying/treating above requires slow-acting formulas; tonifying/treating below requires fast-acting formulas. Fast-acting formulas have strong flavors; slow-acting have weak flavors. Suiting the destination is key.
Wang Bing noted: Formulas for above must not be too rapid, or they pass through to below. Weak flavors allow floating/rising to the target. Formulas for below must not be too slow, or they lose strength en route. Strong flavors allow sinking/descending to the target. "Shi" means suitability. Formulas must reach the target without excess or deficiency.
For distant diseases where drug Qi is blocked mid-way, take medicine after meals to guide it to the target, without violating regulations.
For lower Jiao diseases requiring gradual action, fear of mid-way cessation suggests taking medicine followed by food to guide it to the target, respecting upper/lower regulations. Thus, for balancing Qi: near diseases use small doses (odd/even); far diseases use large doses (odd/even). Large formulas have few ingredients; small formulas have many. Many up to nine; few down to two.
Large formulas come in two types: few ingredients for specific attack; or One Sovereign, Two Ministers, Nine Assistants. For Liver/Kidney or distant lower diseases, use few-ingredient large formulas. For combined syndromes with diffuse pathogens, use One Sovereign, Two Ministers, Nine Assistants formulas. Thus, two doses for Kidney can be divided into nine for Lung or three for Liver.
If Qi formulas fail, use Ou formulas; this is Chong Fang (Repeated Formula). If Ou formulas fail, use Fan Zuo (Counter-Assistance), where cold/hot/warm/cool follows the disease nature.
Chong Fang is compound. If Qi/Ou fail, repeat treatment. Counter-assistance follows disease nature, e.g., Huang Lian (Coptis Rhizome) for mouth ulcers assisted by Gan Jiang (Dried Ginger) for speed. This is "counter-assistance."
The Emperor asked, "How are the Five Flavors used?" Qibo replied, "Pungent and Sweet disperse and ascend (Yang); Sour and Bitter induce vomiting and drain (Yin); Salty induces vomiting and drains (Yin); Bland渗泄 (percolates and drains) (Yang). These six flavors either gather or disperse, relax or tense, dry or moisten, soften or harden. Act according to benefit, regulate Qi to achieve balance."