夫气盛者,夏酷暑而不热,冬严寒而不冷,此里实而寒暑不能侵之也。禀气弱者,未寒
先寒,未热先热,故未有十日天寒,日阴则感寒湿而濡泻,未有十日天温,日明则伏热而中
,虚弱之人常态也。盖先知节气者,能辨阴阳寒暑出入之盛衰。《素问》云∶阳盛人能冬
不能夏,阴盛人能夏不能冬。此亦人之虚实与寒暑相为否泰者矣。且立夏气变纯阳,万物茂
盛,用药者用热远热,如桂枝麻黄大青龙汤,并诸热药,必加知母升麻石膏辈,是不尽其热
药也。且立冬两阴俱尽,气合纯阴,用药者用寒远寒,如服诸凉剂,服汤利过者止后服,不
必尽剂,是不尽用凉药也。是寒月不尽用凉药,若尽用凉药,表里皆寒,人不能当故也。治
疮疹亦当根据此,随虚实寒温,阴阳出入而用药也,岂可拘一证一药为尽而已矣。病患素有盛
实,或素有虚者,并用古方,不在加减尔。且春分阳渐在外,而阴渐在内,秋分阳渐在内,
而阴渐在外,用药者岂得而同诸?此按四时阴阳,迎合脏腑内外虚实而用之,故时当阳出而
阴入,则实者愈,阴出而阳入,则虚者愈,故阳出而阴入者虚者病,阴出而阳入者实者病,
此其常理不变者也。如冬温虚者安而实者病,夏寒则实者安而虚者病,此皆节气阴阳虚实使
之也。冬温暖,夏寒凉,非节气为病者,在人将摄而可尔。所以钱氏治疮痘,言春夏顺而秋
冬逆者,是论阴阳出入迎合表里之意也。
Those with abundant Qi do not feel hot in the intense heat of summer, nor cold in the severe cold of winter; this is because their interior is solid, preventing the invasion of cold and heat pathogens. Those with weak constitutive Qi feel cold before it becomes cold, and feel hot before it becomes hot. Thus, if the weather remains cold and cloudy for ten days, they may contract cold-dampness leading to loose stools (Ru Xie); if the weather remains warm and sunny for ten days, latent heat may cause internal disorder. This is the normal state of those with weak constitutions. Generally, those who understand solar terms can distinguish the flourishing and decline, entry and exit of Yin, Yang, cold, and heat. The *Su Wen* states: "Those with Yang excess can endure winter but not summer; those with Yin excess can endure summer but not winter." This illustrates how human deficiency or excess interacts with cold and heat climates to produce favorable or unfavorable outcomes. At the beginning of Summer (Li Xia), the climate shifts to pure Yang, and all things flourish. When prescribing, one should "avoid heat when using hot remedies" (Yong Re Yuan Re). For instance, Guizhi Tang (Cinnamon Twig Decoction), Mahuang Tang (Ephedra Decoction), Da Qing Long Tang (Major Green Dragon Decoction), and other hot medicines must be combined with Zhi Mu (Anemarrhenae Rhizoma), Sheng Ma (Cimicifugae Rhizoma), and Shi Gao (Gypsum Fibrosum). In doing so, they are no longer purely hot medicines. At the beginning of Winter (Li Dong), both Yin energies are exhausted, and the qi combines into pure Yin. When prescribing, one should "avoid cold when using cold remedies" (Yong Han Yuan Han). For example, when taking various cooling agents, if diarrhea occurs excessively after taking the decoction, subsequent doses should be stopped without completing the full prescription. This means not fully utilizing cold medicines. Therefore, in cold months, one does not fully use cold medicines; if one did, the exterior and interior would both become cold, which the body cannot withstand. Treating variola (Chuang Zhen) should also follow this principle, adjusting medications according to deficiency/excess, cold/warmth, and the entry/exit of Yin/Yang. How can one rigidly adhere to a single syndrome and a single herb as the ultimate treatment? Patients with chronic excess or chronic deficiency should simply use ancient formulas without modification. At the Spring Equinox, Yang gradually moves outward while Yin gradually moves inward; at the Autumn Equinox, Yang gradually moves inward while Yin gradually moves outward. How can medication be applied uniformly? This involves aligning with the four seasons' Yin and Yang, accommodating the interior/exterior and deficiency/excess of the Zang-Fu organs. Thus, when Yang exits and Yin enters, excess syndromes resolve; when Yin exits and Yang enters, deficiency syndromes resolve. Therefore, "Yang exiting and Yin entering" characterizes deficiency diseases, while "Yin exiting and Yang entering" characterizes excess diseases; this is the unchanging constant principle. For example, in a warm winter, deficiency patients are comfortable while excess patients fall ill; in a cold summer, excess patients are comfortable while deficiency patients fall ill. These are all caused by the changes in solar terms, Yin/Yang, and deficiency/excess. If winter is abnormally warm or summer abnormally cold—conditions not dictated by normal solar terms—one can avoid illness through proper self-care. Therefore, when Qian Yi treated variola, stating that spring and summer follow the norm while autumn and winter reverse it, he was discussing the meaning of Yin/Yang entry/exit and its accommodation of the exterior and interior.