局方发挥
朱丹溪著
無或曰::仲景治傷寒，著三百一十三方。治雜病，著金匱要略。曰：二十有三門，歷代名方，汗牛充棟，流傳至今，明效大驗，顯然耳目。今吾子致疑於局方無失，乃之謬妄乎。予曰：醫之視病，問證已得病之情矣。然病者一身血氣有淺深，體段有上下，臟腑有內外，時月有久近，形志有若樂，資稟有厚薄，能毒有可否，標本有先後，年有老弱，治有五方，令有四時，某藥治某病，某經用某藥，孰為正治反治，孰為君臣佐使，合是數者，計較分毫，議方治療，貴乎適中，今觀局方，別無病源，議論止於各方條述證候，繼以藥石之分兩，脩製藥餌之法度，而又勉其多服常服久服，殊不知一方通治諸病。似乎立法簡便，廣絡原野，冀獲一免，寧免許學士之誚乎。仲景諸方，實萬世醫門之規矩準繩也，後之欲為方圓平直者，必於是而取則焉，然猶設為問難，藥作何應，處以何法。許學士亦曰：我善讀仲景書而知其意，然未嘗全用其方。局方制作，將擬仲景耶。故不揣荒陋，敢陳管見，儻蒙改而正諸實，為醫道之幸，今世所謂風病，大率與諸痿證混同論治，良由局方多以治風之藥，通治諸痿也。古聖論風論痿，各有萹目，源流不同，治法亦異，不得不辨，按風論，風者，百病之長，至其變化，乃為他病。又曰：善行數變。曰：因於露風。曰：先受邪。曰：在腠理。曰：客。曰：入。曰：傷。曰：中。歷陳五臟，與胃之傷皆多汗而惡風，其發明風邪，係外感之病，有臟腑內外虛實寒熱之不同，若是之明且盡也，別無癱瘓，痿弱，卒中，不省，僵朴，喎斜，攣縮，眩暈，語澀，不語之文，新舊所錄，治風之方，凡十道，且即至寶丹，靈寶丹。論之曰：治中風不語，治中風語澀，夫不語與語澀，其可一例看乎？有失音不語，有舌強不語，有神昏不語，有口禁不語，有舌縱語澀，有舌麻語澀，治大腸風祕，祕有風熱，有風虛，曾謂一方可通治乎？又曰：治口鼻血出。夫口鼻出血，皆是陽盛陰虛，有升無降，血隨氣上越，出上竅。法當補陰抑陽，氣降則血歸經，豈可以輕揚飛竄之腦麝，佐之以燥悍之金石乎。又曰：治皮膚燥痒。經曰：諸痒為虛，血不榮肌腠，所以痒也。當與滋補藥，以養陰血，血和肌潤，痒自不作，豈可以一十七兩重之金石，佐以五兩重之腦麝香桂，而欲以一兩重之當歸和血，一升之童便活血，一升之生地黃汁生血，夫枯槁之血果能和而生乎？果能潤澤肌肉之乾瘦乎？又曰：治難產死胎，血脈不行，此血氣滯病也。又曰：治神昏恍惚，久在床枕，此血氣虛弱也。夫治血以血藥，治虛以補藥，彼燥悍香竄之劑，固可以劫滯氣，果可以治血而補虛乎？潤體丸等三十餘方，皆曰治諸風，治一切風，治一應風，治男子三十六種風，其為主治，甚為浩博，且寒熱虛實，判然迥別，一方通治，果合經意乎？果能去病乎？龍虎丹，排風湯，俱係治五臟風，而排風又曰風發，又似有內出之意，夫病既在五臟，道遠而所感深，一則用麻黃三兩，以發其表，一則用腦麝六兩，以瀉其衛，而謂可以治臟病乎？借曰：在龍虎，則有寒水石一斤以為鎮墜，在排風，則有白朮當歸以為補養，此殆與古人輔佐因用之意，合吁臟病屬裏而用發表瀉衛之藥，寧不犯誅伐無過之戒乎？寧不助病邪而伐根本乎？骨碎補丸，治肝腎風虛，乳香宣經丸，治體虛，換腿丸，治足三陰經虛，或因感風而虛，或因虛而感風，既曰體虛，肝腎虛，足三陰經虛，病非輕小，理宜補養，而自然銅，半夏，葳靈仙，荊芥，地龍，川楝，烏藥，防風，牽牛，靈脂，草烏，羌活，石南，天麻，南星，檳榔等，疏通燥疾之藥，居補劑之太半，果可傷以補虛乎？七聖散之治風濕，流注活血。應痛丸之治風濕客腎經，衛汗以散風，導水以行濕，仲景法也。觀其用藥，何者為散風，何者謂行濕，吾不得而知也。三生飲之治外感風寒，內傷喜怒，或六脈沉伏，或指下浮盛，及痰厥氣虛，大有神效。治外感以發散，仲景法也。治內以補養，東垣法也。誰能易之，脈之沉伏浮盛，其寒熱表裏虛實之相遠，若水火然，似難同藥，痰厥因於寒，或能成功，血氣虛者，何以收救。已上諸疑，特舉其顯者耳，若毫分縷析，更僕未可盡也。姑用寘之忘言。
無或曰::吾子謂內經風論，主於外感，其用麻黃桂枝烏附輩，將以解風寒也。其用腦麝葳靈仙黑牽牛輩，將以行凝滯也。子之言過矣。予應之曰：風病外感，善行數變，其病多實少虛，發表行滯，有何不可，治風之外何為，又歷述神魂恍惚，起便須人，手足不隨，神志昏憒，癱瘓嚲曳，手足筋衰，眩運倒仆，半身不遂，腳膝緩弱，四肢無力，顫掉拘攣，不語語澀，諸痿等證，悉皆治之，攷諸痿論，肺熱葉焦，五臟因而受之，發為痿躄，心氣熱，生脈痿，故脛縱不任地。肝氣熱，生筋痿，故宗筋弛縱。脾氣熱，生肉痿，故痺而不仁，腎氣熱，生骨痿，故足不任身。又曰：諸痿皆屬於上，謂之上者，皆病之本在肺也。又曰昏惑，曰瘲，曰瞀悶，曰瞀昧，曰暴病，曰鬱冒，曰曚昧，曰暴瘖，曰瞀瘛，皆屬於火。又曰：四肢不舉，曰舌本強，曰足痿不收，曰痰涎有聲，皆屬土。又禮記註曰，魚肉天產也，以養陽作陽德，以為倦怠，悉是濕熱內傷之病，當作諸痿治之，何局方治風之方兼治痿者，十居其九，不思諸痿皆起於肺熱，傳入五臟，散為諸證，大抵只宜補養，若以外感風邪治之，寧免實實虛虛之禍乎，
無或曰:經曰：諸風掉眩，皆屬於肝。諸暴強直，皆屬於風。至於振振不能久立，善暴僵仆皆以為木病，肝屬木，風者，木之氣。曰掉。曰掉振。非顫掉乎？曰眩，非眩運乎？曰不能久立，非筋衰乎？非緩弱無力乎？曰諸暴強直，非不隨乎？曰善暴僵仆，非倒仆乎？又曰瞀悶，曰瞀昧，曰暴病，曰鬱冒，曚昧暴瘖，曰瞀瘛，與土交，所謂屬肝，屬風，屬木之病相似，何為皆屬於火，曰舌本強，曰痰涎有聲，何為皆屬於土痿，論俱未嘗言及，而吾子合火土二家之病，而又與倦怠並言，總作諸痿治之，其將有說以通之乎。予應之曰：按原病式曰，風病多因熱甚，俗云，風者，言末而忘其本也，所以中風而有癱瘓諸證者，非謂肝木之風實甚而卒中之也，亦非外中於風。良由將息失宜，腎水虛甚，則心火暴盛，水不制火也，火熱之氣鬱怫，神明昏冒，筋骨不用而卒倒無所知也。亦有因喜怒思悲恐，五志過極而卒中者，五志過熱甚故也，又原病曰：脾之脈，連舌本，散舌下，今脾臟受邪，故舌強。又河間曰：謂膈熱甚，火氣炎上，傳化失常，故津液湧，而為痰涎潮上，因其稠粘難出，故作聲也。一以屬脾，一以為胃熱，謂之屬火與土，不亦宜乎。雖然岐伯，仲景，孫思邈之言風大意，似指外邪之感，劉河間之言風，明指內傷熱證，實與痿論所言，諸痿生於熱相合，外感之邪有寒熱虛實，而挾寒者多。內傷之熱皆是虛證，無寒可散，無實可瀉，局方本為外感立方，而以內傷熱證混同出治，其為害也，似非細故，
無或曰:風分內外，痿病因熱，既得聞命矣。手陽明大腸經，肺之腑也。足陽明胃經，脾之腑也。治痿之法，取陽明一經，此引而未發之言，願明以告我。予曰：諸痿生於肺熱，只此一句，便見治法大意，經曰：東方實，西方虛，瀉南方，補北方。此固是就生剋言補瀉，而大經大法不外於此，東方木，肝也。西方金，肺也。南方火，心也。北方水，腎也。五行之中，惟火有二腎，雖有二水，取其一陽常有餘，陰常不足。故經曰：一水不勝，二火理之。必然肺金體燥而居上，主氣畏火者也。脾土性濕而居中，主四肢，畏水者也。火性炎上，若嗜慾無節，則水失所養，火寡於畏而侮所勝，肺得火邪而熱矣。木性剛急，肺受熱則金失所養，木寡於畏而侮所勝，脾得木邪而傷矣。肺熱則不能管攝一身，脾傷則四肢不能為用，而諸痿之病作。瀉南方則肺金清，而東方不實，何肺傷之有，補北方則心火降，而西方不虛，何肺熱之有，故陽明實則宗筋潤，能束骨而利機關矣。治痿之法，無出於此。駱隆吉亦曰：風火既熾，當滋腎水，東垣先生取黃柏為君，黃耆等補藥之輔佐，以治諸痿，而無一定之方，有兼痰積者，有濕多者，有熱多者，有濕熱相半者，有挾氣者，臨病製方。其善於治痿者乎。雖然藥中肯綮矣，若將理失宜，聖醫不治也。天產作陽，厚味發熱，先哲格言，但是患痿之人，若不淡薄食味，吾知其必不能安全也。
無或曰:小續命湯與要略相表裏，非外感之藥乎，地仙丹治勞傷腎憊，非內傷之藥乎，其將何以議之，予曰：小續命湯比要略少當歸石膏，多附子防風防己，果與仲景意合，否也，仲景謂汗出則止藥，局方則曰，久服差。又曰，久病，風陰晦時更宜與。又曰，治諸風似皆非仲景意，然麻黃防己可久服乎？諸風可通治乎？地仙丹既曰補腎，而滋補之藥，與僣燥走竄之藥，相半用之，腎惡燥而謂可以補腎乎？借曰足少陰經非附子輩不能自達，八味丸，仲景腎經藥也，八兩地黃以一兩附子佐之，觀此則是非可得而定矣。非吾之過論也。又觀治氣一門，有曰，治一切氣，冷氣滯氣逆氣上氣，用安息香丸，丁沉丸，大沉香丸，蘇子丸，勻氣散，如神丸，集香丸，白沉香丸，煨薑丸，鹽煎散，七氣湯丸，痛溫白丸，生薑湯。其治嘔噎也用五膈丸，五膈寬中散，膈氣散，酒癥丸，草豆蔻丸，撞氣丸，人參丁香散，其治吞酸也，用丁沉煎丸，小理中丸，其治痰飲也用倍木丸，消飲丸，溫中化痰丸，五套丸，且於各方條或台曰，口苦失味，曰噫酸，曰舌澀，曰吐清水，曰痞滿，曰氣急，曰脅下急痛，曰五心中熱，口爛生瘡，皆是明著熱證，何為率用熱藥，夫週流於人之一身以為生者，氣也。陽往則陰來，陰往則陽來，一升一降，無有窮已，苟內不傷於七情，外不感於六淫，其為氣也，何病之有，今日冷氣滯氣逆氣上氣，皆是肺受火邪，氣得炎上之化，有升無降，薰蒸清道，甚而至於上焦不納，中焦不化，下焦不滲，輾轉傳變，為吐，為膈，為噎，為痰，為飲，為翻胃，為吞酸，夫治寒以熱，治熱以寒，此正治之法也。治熱用熱，治寒用寒，此反佐之法也。詳味前方，既非正法，又非反佐，此愚之所以不能無疑也，謹按原病式曰：諸嘔吐酸，皆屬於熱，諸積飲，痞膈中滿，皆屬於濕，諸氣逆衝上，嘔涌，溢食不下，皆屬於火。諸堅痞腹滿，急痛，吐腥穢，皆屬於寒。深契仲景之意，金匱要略曰：胸痺，病胸背痛，瓜蔞薤白湯主之。胸痺，心痛徹背，瓜蔞薤白半夏湯主之，心下痞氣，氣結在胸脅下，上逆搶心者，枳實薤白瓜蔞桂枝湯主之，嘔而心下痞者，半夏瀉心湯主之，乾嘔而利者，黃芩加半夏生薑湯主之，諸嘔吐穀不得入者，小半夏湯主之，嘔吐病在膈上者，豬苓湯主之。胃反嘔吐者，半夏參密湯主之。食己即吐者，大黃甘草湯主之。胃反吐而渴者，茯苓澤瀉湯主之。吐後欲飲者，文蛤湯主之。病似嘔不嘔，似噦不噦，心中無奈者，薑汁半夏湯主之。乾嘔手足冷者，陳皮湯主之。噦逆者，陳皮竹茹湯主之。乾嘔下痢者，黃芩湯主之。氣衝土者，皂莢丸主之。上氣脈浮者，厚朴麻黃湯主之。上氣脈沉者，澤瀉湯主之。火逆上氣者，麥門冬湯主之。心下有痰飲，胸脅支滿，目眩，茯苓桂朮湯主之。短氣有微飲，當從小便出之，宜茯苓桂朮甘草湯，腎氣丸亦主之。病者脈浮，其人欲自利，利者反快，雖利心下續堅滿者，此為流飲欲去故也，甘遂半夏湯主之。病懸飲者，十棗湯主之。病溢飲者，當發其汗，宜大青龍湯，又宜用小青龍湯。心下有支飲，其人若冒眩，澤瀉湯主之。支飲胸滿者，厚朴大黃湯主之。支飲不得息，葶藶大棗瀉肺湯主之。嘔家本渴，今反不渴，心中有支飲故也，小半夏湯主之。卒嘔吐，心下痞膈，間有水，眩悸者，小半夏加茯苓湯主之。假令瘦人，臍下有悸者，吐涎沬而頭眩，水也，五苓散主之。心胸有停痰宿水，自吐水後，心胸間虛氣，滿不能食，消痰氣，令能食，茯苓飲主之。先渴後嘔，為水停心下，此屬飲家，半夏加茯苓湯主之。觀其微意，可表者汗之，可下者利之，滯者導之，鬱者揚之，熱者清之，寒者溫之，偏寒偏熱者，反佐而行之，挾濕者，淡以滲之，挾虛者，補而養之，何嘗例用辛香燥熱之劑，以火濟之火，實實虛虛，咎將誰執，
無或曰:，脈訣謂熱則生風，冷生氣，寒主收引，今冷氣上衝矣。氣逆矣，氣滯矣，非冷而何？吾子引仲景之言而斥其非，然則諸氣，諸飲，嘔吐，反胃，吞酸等病，將無寒證耶，予曰：五臟各有火，五志激之，其火隨起，若諸寒為病，必須身犯寒氣，口得寒物乃為病寒，非若諸火，病自內作，所以氣之病寒者，十無一二，
無或曰:，其餘痰氣，嘔吐吞酸，噎膈反胃，作熱作火論治，於理可通，若病人自言冷氣從下而上者，非冷而何。予曰：上升之氣，自肝而出，中挾相火，自下而出，其熱為甚，自覺其冷，非真冷也，火極似水，積熱之甚，陽亢陰微，故見此證，冷生氣者，出高陽生之謬言也，若病果因感寒，當以去寒之劑治之，何至例用辛香燥熱，為方不知權變，寧不誤人，
Ju Fang Fa Hui (Elucidation of the Bureau Formulas)
Written by Zhu Danxi
A person asked: Zhang Zhongjing treated Shanghan (Cold Damage), composing 313 formulas. For treating miscellaneous diseases, he composed the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet). He said: There are twenty-three categories. The famous formulas of past dynasties are as numerous as oxen sweating and books filling carts, transmitted to this day with clear and great efficacy, evident to the eyes and ears. Now you raise doubts about the lack of errors in the *Ju Fang* (Formulas of the Imperial Medical Bureau), is it not absurd and妄言 (wild talk)? I said: When a physician examines a disease, after asking about symptoms and observing signs, the condition of the disease has been understood. However, the patient's blood and qi have depths and shallowness, body segments have upper and lower distinctions, zang-fu organs have internal and external differences, months of illness have long and short durations, form and mind have joy and suffering, constitution has thickness and thinness, tolerance for toxins has acceptability and unacceptability, biao-ben (branch-root) have sequence, age has old and weak distinctions, treatment varies by five regions, seasons have four changes. Which medicine treats which disease? Which meridian uses which medicine? Who determines the Zheng Zhi (Direct Treatment) and Fan Zhi (Reverse Treatment)? Who determines the Jun-Chen-Zuo-Shi (Monarch-Minister-Assistant-Courier) hierarchy? Integrating these factors, calculating every detail, discussing formulas for treatment, the key lies in appropriateness. Now looking at the *Ju Fang*, there are no discussions on disease origins; the arguments only describe symptoms for each formula, followed by drug dosages, preparation methods, and administration rules, while encouraging frequent, constant, and long-term use. Little do they know that one formula treats all diseases. This seems like simple legislation, casting a wide net over the wilderness, hoping to catch one escapee. Would it not invite ridicule from scholars? Zhang Zhongjing's various formulas are indeed the compass and square for medical doors for ten thousand generations. Those who wish to achieve correctness in future practice must take them as models. Yet, questions and difficulties are still set up: how do medicines respond? What methods are applied? Scholar Xu also said: "I am good at reading Zhang Zhongjing's book and understanding its intent, but I never fully use his formulas." Is the production of the *Ju Fang* attempting to imitate Zhang Zhongjing? Therefore, without presuming upon my ignorance, I dare to present my humble views. If I am fortunate enough to be corrected and rectified, it would be a blessing for the medical way.
Currently, what is called "Wind Disease" in the world is generally treated together with various Wei Syndromes (Atrophy Syndromes). This is largely because the *Ju Fang* often uses wind-dispelling medicines to treat all atrophy syndromes. The ancient sages discussed Wind and Atrophy separately, each with its own chapters, having different sources and flows, and different treatment methods. It is necessary to distinguish them. According to the *Feng Lun* (Discourse on Wind): Wind is the leader of a hundred diseases. Regarding its changes, it becomes other diseases. It is also said: "It moves quickly and changes frequently." It is said: "Caused by exposure to wind." It is said: "First receives pathogenic factors." It is said: "In the Cou Li (interstices)." It is said: "Guest pathogen." It is said: "Enters." It is said: "Damages." It is said: "Strikes." Listing injuries to the five zang organs and the stomach, most involve excessive sweating and aversion to wind. These elaborations on wind pathogens belong to exterior contraction diseases, differing in zang-fu interior/exterior, deficiency/excess, cold/heat, so clearly and thoroughly explained. There is no text regarding paralysis, weakness, stroke, unconsciousness, stiff falling, deviation of mouth and eye, spasm and contraction, dizziness, slurred speech, or inability to speak. Among the newly and oldly recorded wind-treating formulas, there are ten in total. Taking Zhi Bao Dan (Precious Treasure Pill) and Ling Bao Dan (Spirit Precious Pill) as examples: They discuss treating wind-stroke with inability to speak, and wind-stroke with slurred speech. Can "inability to speak" and "slurred speech" be viewed in the same category? There is aphonia with inability to speak, tongue stiffness with inability to speak, divine confusion with inability to speak, jaw lock with inability to speak, tongue relaxation with slurred speech, and tongue numbness with slurred speech. Treating Large Intestine wind constipation, constipation can be due to wind-heat or wind-deficiency. How can one formula treat them all? It also says: Treats bleeding from mouth and nose. Bleeding from mouth and nose is always due to excess yang and yin deficiency, rising without descending, blood following qi upwards and escaping through the upper orifices. The method should be tonifying yin and suppressing yang; when qi descends, blood returns to its vessels. How can light and soaring Brain Musk (Bing Pian, Xiang Fu - Camphor and Musk) be assisted by dry and fierce mineral metals? It also says: Treats dry and itchy skin. The Classic says: "All itching belongs to deficiency." Blood fails to nourish muscle and cou li, hence itching. One should give nourishing and tonifying medicines to nourish yin blood. When blood harmonizes and muscles moisten, itching naturally ceases. How can seventeen taels of heavy mineral metals be assisted by five taels of Brain Musk, Cinnamon, and Frankincense, while trying to use one tael of Dang Gui (Angelica Sinensis) to harmonize blood, one sheng of Tong Bian (Child's Urine) to invigorate blood, and one sheng of Sheng Di Huang (Rehmannia Root Juice) to generate blood? Can truly dried and withered blood really harmonize and generate? Can it truly moisten dry and emaciated muscles? It also says: Treats difficult labor and dead fetus, where blood vessels do not flow. This is a disease of blood and qi stagnation. It also says: Treats divine confusion and trance, lying in bed for a long time. This is a disease of blood and qi deficiency. Treating blood requires blood medicines; treating deficiency requires tonifying medicines. Can those dry, fierce, aromatic, and penetrating preparations certainly劫滞气 (rob stagnant qi), and can they truly treat blood disorders and tonify deficiency? Run Ti Wan (Moistening Body Pill) and more than thirty other formulas all say they treat various winds, all winds, any wind, and thirty-six types of wind in men. Their main indications are very extensive. Cold, heat, deficiency, and excess are distinctly different. Can one formula treat them all? Does it truly conform to the Classic's intent? Can it truly remove disease? Long Hu Dan (Dragon Tiger Pill) and Pai Feng Tang (Dispersing Wind Decoction) are both said to treat five zang organ winds, while Pai Feng Tang also mentions "wind emergence," seemingly implying an internal origin. Since the disease is in the five zang organs, the path is distant and the infection deep. On one hand, using three liang of Ma Huang (Ephedra) to release the exterior; on the other hand, using six liang of Brain Musk to drain the Wei Qi. How can this be said to treat zang organ diseases? Let us assume that in Long Hu Dan, there is one jin of Han Shui Shi (Halloysitum Rubrum) for sedation and descent; in Pai Feng Tang, there is Bai Zhu (Atractylodes Macrocephala) and Dang Gui for tonification and nourishment. This might align with the ancients' intention of auxiliary support. However, zang organ diseases belong to the interior, yet using exterior-releasing and Wei-draining medicines—does this not violate the warning against punishing the innocent? Does it not aid the pathogenic factor and attack the root? Gu Sui Bu Wan (Bone Mending Pill) treats Liver-Kidney wind deficiency; Ru Xuan Jing Wan (Frankincense Meridian Spreading Pill) treats body deficiency; Huan Tui Wan (Leg Changing Pill) treats deficiency of the Three Yin meridians of the foot, whether caused by wind invasion leading to deficiency or deficiency leading to wind invasion. Since it is stated as body deficiency, Liver-Kidney deficiency, and Foot Three Yin deficiency, the disease is not minor. Logic dictates tonification and nourishment. Yet, Zi Ran Tong (Native Copper), Ban Xia (Pinellia), Wei Ling Xian (Clematis Root), Jing Jie (Schizonepeta), Di Long (Earthworm), Chuan Lian Zi (Toosendan Fruit), Wu Yao (Lindera Root), Fang Feng (Saposhnikovia), Qian Niu Zi (Morning Glory Seed), Ling Zhi (Trogopterus Dung), Cao Wu (Aconitum Carmichaelii), Qiang Huo (Notopterygium), Shi Nan Teng (Smilax Riparia), Tian Ma (Gastrodia), Nan Xing (Arisaema), Bin Lang (Areca Seed), etc., are dredging and drying medicines occupying more than half of the tonifying agents. Can such medicines truly tonify deficiency? Qi Sheng San (Seven Sages Powder) treats wind-dampness, flowing accumulation, and activating blood; Ying Tong Wan (Pain Relief Pill) treats wind-dampness invading the Kidney Meridian, using Wei sweat to disperse wind and guiding water to move dampness. This is Zhang Zhongjing's method. Observing its medication, what disperses wind and what moves dampness, I cannot know. San Sheng Yin (Three Lives Decoction) treats exterior contraction of wind-cold and interior injury from anger and joy, or six pulses being deep and hidden, or floating and vigorous under the fingers, as well as phlegm-jue and qi deficiency, showing great efficacy. Treating exterior contraction with dispersion is Zhang Zhongjing's method. Treating interior injury with tonification is Li Dongyuan's method. Who can change this? The difference between deep-hidden and floating-vigorous pulses, regarding cold-heat, exterior-interior, deficiency-excess, is vast, like water and fire. It seems difficult to use the same medicine. Phlegm-jue due to cold might succeed, but for blood and qi deficiency, how is rescue achieved? The above doubts are merely the obvious ones listed. If analyzed thread by thread, there would be no end even if servants were replaced many times. I temporarily place them aside in silence.
A person asked: You state that the *Nei Jing* Discourse on Wind focuses on exterior contraction. Using Ma Huang, Gui Zhi, Wu Tou, Fu Zi, etc., is to resolve wind-cold? Using Brain Musk, Wei Ling Xian, Black Qian Niu, etc., is to move stagnation? Your words are wrong. I replied: Wind disease from exterior contraction moves quickly and changes frequently; its pathology is mostly excess and little deficiency. Releasing the exterior and moving stagnation, what is unacceptable? But besides treating wind, why does it list divine confusion and trance, needing assistance to rise, limbs unable to follow, spirit and will confused, paralysis and dragging, limb tendon衰 (weakness), dizziness and falling, hemiplegia, knee and foot slackness, four limbs powerless, tremors and spasms, inability to speak or slurred speech, and various atrophy syndromes, treating them all? Examining the *Wei Lun* (Discourse on Atrophy): Lung heat scorches leaves, the five zang organs receive it, developing into Wei Bi (Atrophy Paralysis); Heart Qi heat generates Mai Wei (Vessel Atrophy), hence calves are flaccid and cannot bear weight. Liver Qi heat generates Jin Wei (Tendon Atrophy), hence Zong Jin (General Tendons) relax. Spleen Qi heat generates Rou Wei (Muscle Atrophy), hence numbness and insensitivity. Kidney Qi heat generates Gu Wei (Bone Atrophy), hence feet cannot support the body. It also says: All atrophies belong to the Upper (Shang), meaning the root of the disease is in the Lung. It also says: Hun Huo (Confusion), Yi Zhong (Spasms), Mao Men (Dizziness/Obscuration), Mao Mei (Blindness/Darkness), Bao Bing (Sudden Illness), Yu Mao (Depression/Swooning), Meng Mei (Muddled), Bao Yin (Sudden Aphonia), Mao Chi (Confusion/Spasm), all belong to Fire. It also says: Four limbs unable to lift, tongue root stiff, feet atrophic and unreceptive, phlegm-saliva with sound, all belong to Earth. Also, the commentary on *Li Ji* says: Fish and meat are products of heaven, used to nourish Yang as Yang Virtue, causing fatigue. These are all diseases of interior injury from Damp-Heat, and should be treated as various atrophies. Why do the wind-treating formulas in the *Ju Fang* treat atrophy in nine out of ten cases? Not pondering that all atrophies originate from Lung Heat, transmitting to the five zang organs, scattering into various syndromes, generally only suitable for tonification. If treated with exterior wind-pathogen methods, how can one avoid the disaster of "exaggerating excess and depleting deficiency"?
A person asked: The Classic says: "All wind diseases with tremors and dizziness belong to the Liver." "All sudden stiffness and straightness belong to Wind." As for trembling unable to stand for long, easily suffering sudden stiff falling, all are considered Wood diseases. Liver belongs to Wood, Wind is the Qi of Wood. Saying "tremor," saying "trembling vibration," is it not chan dou (trembling)? Saying "dizziness," is it not xuan yun (vertigo)? Saying "unable to stand long," is it not tendon weakness? Is it not slackness and powerlessness? Saying "all sudden stiffness," is it not inability to move? Saying "easily sudden stiff falling," is it not falling down? It also says: Mao Men, Mao Mei, Bao Bing, Yu Mao, Meng Mei, Bao Yin, Mao Chi, interacting with Earth. So-called belonging to Liver, Wind, Wood diseases seem similar. Why do they all belong to Fire? Saying "tongue root stiff," saying "phlegm-saliva with sound," why do they all belong to Earth? The Atrophy Discourse never mentions this, yet you combine Fire and Earth diseases and speak of fatigue together, treating them all as atrophy. Do you have an explanation to connect them? I replied: According to *Yuan Bing Shi* (Original Pattern of Diseases), wind diseases are mostly due to severe heat. Common people say "wind," focusing on the branch and forgetting the root. Thus, wind-stroke with paralysis syndromes is not because Liver Wood wind is excessively real and suddenly strikes, nor is it external wind striking. It is indeed due to improper care, severe Kidney Water deficiency, causing Heart Fire to erupt violently, with Water unable to control Fire. The Qi of Fire and Heat is depressed and stifled, divine consciousness is confused and obscured, tendons and bones fail to function, leading to sudden collapse and loss of awareness. There are also cases of stroke due to extreme anger, joy, thought, sorrow, and fear, where the Five Emotions reach their limit, due to extreme heat of the Five Emotions. Again, *Yuan Bing Shi* says: The Spleen meridian connects to the tongue root and spreads under the tongue. Now the Spleen organ receives pathogenic factors, hence tongue stiffness. Also, He Jian said: "Diaphragm heat is severe, Fire Qi flares upward, transformation and transportation fail, thus fluids surge and become tidal phlegm-saliva rising up. Because it is thick and sticky and hard to expectorate, it makes sound." One belongs to Spleen, one is considered Stomach Heat. Calling them belonging to Fire and Earth, is it not appropriate? Although Qi Bo, Zhang Zhongjing, and Sun Simiao's general meaning regarding wind seems to point to external pathogen sensation, Liu He Jian's discussion of wind clearly points to interior injury heat syndromes. This actually aligns with the *Wei Lun*'s statement that "all atrophies arise from heat." Exterior contraction pathogens have cold, heat, deficiency, and excess, and those clashing with cold are many. Interior injury heat is all deficiency syndrome, with no cold to disperse and no excess to drain. The *Ju Fang* was originally created for exterior contraction, yet mixes interior injury heat syndromes for treatment. Its harm seems not trivial.
A person asked: Wind divides into interior and exterior, atrophy etiology is heat. I have heard your instructions. Hand-Yangming Large Intestine Meridian is the Fu organ of the Lung. Foot-Yangming Stomach Meridian is the Fu organ of the Spleen. The method for treating atrophy is to select the Yangming Meridian alone. This is a statement drawn but not fully developed. I wish you to explain it clearly to me. I said: "All atrophies arise from Lung Heat." In these six words, the general idea of treatment is visible. The Classic says: "East is Excess, West is Deficient. Drain South, Tonify North." This is indeed discussing tonification and draining based on generation and restriction, but the great classics and major laws do not go beyond this. Eastern Wood is Liver. Western Metal is Lung. Southern Fire is Heart. Northern Water is Kidney. Among the Five Elements, only Fire has two (Ministerial Fire and Sovereign Fire). Although Kidney has two Waters, extracting its one Yang, there is often surplus, while Yin is often deficient. Hence the Classic says: "One Water cannot overcome Two Fires." Naturally, Lung Metal is dry in nature and resides superiorly, governing Qi, fearing Fire. Spleen Earth is damp in nature and resides centrally, governing four limbs, fearing Water. Fire nature flares upward. If desires are unregulated, Water loses nourishment. Fire, lacking restraint, insults what it conquers. Lung receives Fire pathogen and becomes hot. Wood nature is rigid and urgent. Lung receiving heat causes Metal to lose nourishment. Wood, lacking restraint, insults what it conquers. Spleen receives Wood pathogen and is injured. Lung heat cannot manage and control the whole body. Spleen injury means four limbs cannot be used. Thus, various atrophy diseases arise. Draining the South clears Lung Metal, so East is not excess. How can Lung be injured? Tonifying the North lowers Heart Fire, so West is not deficient. How can Lung be hot? Thus, when Yangming is full, Zong Jin (General Tendons) are moistened, able to bind bones and facilitate joints. The method for treating atrophy does not go beyond this. Luo Longji also said: When Wind and Fire are blazing, one must nourish Kidney Water. Dong Yuan Mr. took Huang Bo (Phellodendron) as Monarch, assisted by Huang Qi (Astragalus) and other tonifying medicines, to treat various atrophies, without a fixed formula. Some have concomitant phlegm accumulation, some have much dampness, some have much heat, some have half-damp half-heat, some have concomitant Qi stagnation. Formulate according to the disease. This is good at treating atrophy. Although the medicine hits the mark, if management is improper, even a sage physician cannot cure. Heavenly products promote Yang, rich flavors generate heat. These are maxims of former sages. Anyone suffering from atrophy, if not eating bland food, I know they cannot remain safe.
A person asked: Xiao Xu Ming Tang (Small Continuation of Life Decoction) is correlated with *Yao Lue*, is it not an exterior contraction medicine? Di Xian Dan (Earth Immortal Pill) treats exhaustion from labor injuring the Kidney, is it not an interior injury medicine? How will you discuss them? I said: Compared to *Yao Lue*, Xiao Xu Ming Tang lacks Dang Gui and Shi Gao, but adds Fu Zi, Fang Feng, and Fang Ji. Does it truly agree with Zhang Zhongjing's intent? No. Zhang Zhongjing said stop medicine when sweating occurs; the *Ju Fang* says "take for a long time until cured." It also says "for chronic disease, especially give during windy and cloudy weather." It also says "treating various winds seems not to match Zhang Zhongjing's intent." However, can Ma Huang and Fang Ji be taken for a long time? Can various winds be treated by one formula? Di Xian Dan, since it says tonifies Kidney, yet tonifying medicines and aggressive, dry, wandering medicines are used equally. Kidney dislikes dryness, how can it be said to tonify Kidney? Suppose Foot-Shaoyin Meridian cannot reach itself without Fu Zi and peers. Ba Wei Wan (Eight-Ingredient Pill) is a Kidney Meridian medicine of Zhang Zhongjing. Eight liang of Di Huang (Rehmannia) assisted by one liang of Fu Zi. Observing this, right and wrong can be determined. This is not my overstatement. Again, looking at the Qi Treatment section, it says: Treat all Qi, Cold Qi, Stagnant Qi, Counter-flow Qi, Ascending Qi, using An Xi Xiang Wan (Benzoin Pill), Ding Chen Wan (Clove and Amber Pill), Da Chen Xiang Wan (Large Agarwood Pill), Su Zi Wan (Perilla Seed Pill), Yun Qi San (Harmonizing Qi Powder), Ru Shen Wan (Like God Pill), Ji Xiang Wan (Gathering Fragrance Pill), Bai Chen Xiang Wan (White Agarwood Pill), Wei Jiang Wan (Roasted Ginger Pill), Yan Jian San (Salt-Fried Powder), Qi Qi Tang Wan (Seven Qi Decoction Pill), Tong Wen Bai Wan (Pain-Warming White Pill), Sheng Jiang Tang (Fresh Ginger Decoction). For treating dysphagia, it uses Wu Ge Wan (Five Diaphragm Pill), Wu Ge Kuan Zhong San (Five Diaphragm Middle-Widening Powder), Ge Qi San (Diaphragm Qi Powder), Jiu Zheng Wan (Wine Stasis Pill), Cao Dou Kou Wan (Cardamom Pill), Zhuang Qi Wan (Impelling Qi Pill), Ren Shen Ding Xiang San (Ginseng and Clove Powder). For treating acid regurgitation, it uses Ding Chen Jian Wan (Clove and Amber Decoction Pill), Xiao Li Zhong Wan (Small Regulate Center Pill). For treating Phlegm-Fluid, it uses Bei Mu Wan (Fritillaria Pill), Xiao Yin Wan (Eliminate Fluid Pill), Wen Zhong Hua Tan Wan (Warm Center Transform Phlegm Pill), Wu Tao Wan (Five Hoop Pill). And in the description of each formula, it mentions: Bitter taste and loss of flavor, belching acid, dry tongue, vomiting clear water, fullness and obstruction, rapid breathing, acute pain under ribs, heat in five centers, mouth ulcers. These are all clear heat syndromes. Why use hot medicines indiscriminately? Qi circulating throughout the body sustains life. When Yang goes, Yin comes; when Yin goes, Yang comes. Rising and descending, endless. If internally not injured by Seven Emotions, externally not contracted by Six Pathogens, what disease would Qi have? Today's Cold Qi, Stagnant Qi, Counter-flow Qi, Ascending Qi are all due to Lung receiving Fire pathogen. Qi undergoes flaming upward transformation, rising without descending, steaming the clear pathways. Eventually, Upper Jiao fails to receive, Middle Jiao fails to transform, Lower Jiao fails to渗 (seep). Rotating transmission leads to vomiting, diaphragm obstruction, choking, phlegm, fluid, reverse stomach, acid regurgitation. Treating cold with heat, treating heat with cold, this is Zheng Zhi (Direct Treatment). Treating heat with heat, treating cold with cold, this is Fan Zuo (Reverse Assistance). Studying the previous formulas, neither is Direct Treatment nor Reverse Assistance. This is why I cannot help but doubt. Carefully consulting *Yuan Bing Shi*: "All vomiting and acid regurgitation belong to Heat." "All accumulated fluids, fullness, diaphragm obstruction, middle jiao fullness belong to Dampness." "All Qi counter-flowing upward, vomiting surging, overflowing food not going down belong to Fire." "All hard fullness, abdominal fullness, acute pain, vomiting fishy filth belong to Cold." This deeply契合 (fits) Zhang Zhongjing's intent. *Jin Gui Yao Lue* says: Chest Bi, disease of chest and back pain, Gua Lou Xie Bai Tang (Trichosanthes and Macrostemon Decoction) governs it. Chest Bi, heart pain penetrating to back, Gua Lou Xie Bai Ban Xia Tang (Trichosanthes, Macrostemon, and Pinellia Decoction) governs it. Fullness below heart, Qi knot in chest and hypochondrium, ascending to rush heart, Zhi Shi Xie Bai Gua Lou Gui Zhi Tang (Immature Bitter Orange, Trichosanthes, Akebia, and Cinnamon Twig Decoction) governs it. Vomiting with fullness below heart, Ban Xia Xie Xin Tang (Pinellia Drain Heart Decoction) governs it. Dry vomiting with diarrhea, Huang Qin Jia Ban Xia Sheng Jiang Tang (Scutellaria plus Pinellia and Fresh Ginger Decoction) governs it. All vomiting grain not entering, Xiao Ban Xia Tang (Minor Pinellia Decoction) governs it. Vomiting disease in upper diaphragm, Zhu Ling Tang (Polyporus Decoction) governs it. Wei Fan (Reverse Stomach) vomiting, Ban Shen Mi Tang (Pinellia, Ginseng, and Honey Decoction) governs it. Vomiting immediately after eating, Da Huang Gan Cao Tang (Rhubarb and Licorice Decoction) governs it. Wei Fan vomiting with thirst, Fu Ling Ze Xie Tang (Poria and Alisma Decoction) governs it. Thirst after vomiting, Wen Ge Tang (Clam Shell Decoction) governs it. Disease like vomiting but not vomiting, like hiccups but not hiccups, helpless in heart, Jiang Zhi Ban Xia Tang (Ginger Juice and Pinellia Decoction) governs it. Dry vomiting with cold hands and feet, Chen Pi Tang (Tangerine Peel Decoction) governs it. Hiccups, Chen Pi Zhu Ru Tang (Tangerine Peel and Bamboo Shaving Decoction) governs it. Dry vomiting with diarrhea, Huang Qin Tang (Scutellaria Decoction) governs it. Qi rushing earth, Zao Ying Wan (Soap Pod Pill) governs it. Ascending Qi with floating pulse, Hou Po Ma Huang Tang (Magnolia Bark and Ephedra Decoction) governs it. Ascending Qi with deep pulse, Ze Xie Tang (Alisma Decoction) governs it. Fire counter-flow ascending Qi, Mai Men Dong Tang (Ophiopogon Decoction) governs it. Phlegm-fluid below heart, chest and hypochondrium distension/fullness, dizzy vision, Fu Ling Gui Zhu Tang (Poria, Cinnamon, and Atractylodes Decoction) governs it. Shortness of breath with slight fluid, should exit via urine, Yi Fu Ling Gui Zhu Gan Cao Tang (Poria, Cinnamon, Atractylodes, and Licorice Decoction) is suitable, Shen Qi Wan (Kidney Qi Pill) also governs it. Patient with floating pulse, desires spontaneous diarrhea, relief after diarrhea, though diarrhea continues, fullness below heart remains firm and full, this is flowing fluid wanting to leave, Gan Sui Ban Xia Tang (Kansui and Pinellia Decoction) governs it. Patient with Xuan Yin (Hanging Fluid), Shi Zao Tang (Ten Jujube Decoction) governs it. Patient with Yi Yin (Overflowing Fluid), should induce sweating, Yi Da Qing Long Tang (Major Green Dragon Decoction) is suitable, also Yi Xiao Qing Long Tang (Minor Green Dragon Decoction). Branch-fluid below heart, patient feels dizzy and vertiginous, Ze Xie Tang (Alisma Decoction) governs it. Branch-fluid with chest fullness, Hou Po Da Huang Tang (Magnolia Bark and Rhubarb Decoction) governs it. Branch-fluid unable to breathe, Ting Li Da Zai Xie Fei Tang (Descurainia and Date Decoction to Drain Lung) governs it. Vomiter usually thirsty, now contrary not thirsty, heart has branch-fluid, Xiao Ban Xia Tang (Minor Pinellia Decoction) governs it. Sudden vomiting, fullness below heart and diaphragm, water between, dizziness and palpitations, Xiao Ban Xia Jia Fu Ling Tang (Minor Pinellia plus Poria Decoction) governs it. Suppose thin person, palpitations below umbilicus, vomiting saliva and foam with dizziness, this is water, Wu Ling San (Five-Ingredient Powder with Poria) governs it. Stale phlegm and old water in heart and chest, after vomiting water, empty Qi in heart and chest, fullness unable to eat, eliminate phlegm Qi, enable eating, Fu Ling Yin (Poria Drink) governs it. Thirst then vomiting, water stopped below heart, this belongs to Fluid Family, Ban Xia Jia Fu Ling Tang (Pinellia plus Poria Decoction) governs it. Observing its subtle intent: Those that can be released, sweat them; those that can be purged, drain them; those that are stagnant, guide them; those that are depressed, raise them; those that are hot, clear them; those that are cold, warm them; those偏寒偏热 (biased cold/hot), assist reversely and move them; those夹湿 (clashing damp), leach with blandness; those夹虚 (clashing deficiency), tonify and nourish them. How did they routinely use acrid-aromatic-dry-hot agents, using fire to aid fire, exaggerating excess and depleting deficiency? Whose fault will be held?
A person asked: *Mai Jue* (Pulse Secret) says heat generates wind, cold generates Qi, cold governs contraction and drawing in. Now Cold Qi rushes upward. Qi counter-flows. Qi stagnates. Is it not cold? You cite Zhang Zhongjing's words to refute them. Then, do Qi diseases, Fluid diseases, vomiting, reverse stomach, acid regurgitation, etc., have no cold syndromes? I said: Each of the five zang organs has Fire. Provoked by Five Emotions, its Fire rises随之 (following). If various cold diseases occur, one must physically encounter cold Qi and orally ingest cold substances to become cold disease. It is not like various fires, where disease originates internally. Thus, among Qi diseases becoming cold, ten have none or one.
A person asked: Remaining Phlegm-Qi, vomiting, acid regurgitation, dysphagia, reverse stomach, discussed as heat and fire for treatment, logic allows this. If the patient themselves says Cold Qi rises from below, is it not cold? I said: Ascending Qi emerges from Liver, carrying Ministerial Fire within. Emerging from below, its heat is severe. Self-perceiving cold is not true cold. Extreme Fire resembles Water. Accumulated heat is severe, Yang hyperactive, Yin微弱 (weak), thus seeing this syndrome. "Cold generates Qi" comes from Gao Yang Sheng's erroneous words. If the disease is indeed caused by contracting cold, one should treat with cold-dispelling agents. Why routinely use acrid-aromatic-dry-hot agents? Creating formulas without flexibility—would this not harm people?