41．乌梅丸证之特征即上热下寒，如发现呕吐蛔虫，心中痛热，气上冲胸，并有腹泻，即属此证，细心体会，不难辨识。久痢之寒热夹杂者，亦可用之。曾治一胆道蛔虫症，疗效很好，但必须符合上述证候特征，才会有效。
42．伤寒论小建中汤小柴胡汤条，阳脉涩，阴脉弦，法当腹中急痛者，先予小建中汤不瘥者，小柴胡汤主之。这两种证候常易混淆，示人以腹痛胀之证候，须先分清这两个方面，前者属于虚寒，后者属于肝气不舒，即小柴胡汤去黄芩加芍药之意，非叫人先用小建中试之，而后再用小柴胡也。
43．补中益气汤治中气下陷变生诸证，问题在于什么是中气下陷，我们如何去辨识它，只有辨清是中气下陷，用之才效。如临床见到久泻、久痢、脱肛、子宫脱垂、胃下垂、崩漏不止、白带日久而多、小便多而频等，都可首先考虑是否中气下陷，再审其全身症状，必有倦怠懒言，多汗，气短，脉虚，或大而无力，则不难辨识。
44．礞石滚痰丸主治顽痰怪证，应用目标为体格壮实，有热，口苦，痰粘稠，便秘者，脉象必沉滑而有力，舌苔粘腻。至于控涎丹，为逐饮之剂，无此证之热象，痰为清稀者宜之。
45．升麻葛根汤，宜于麻疹将出未出之际，而伴有腹泻者宜之。其表证常兼有目痛鼻干不得眠，口稍渴。阳明热甚者禁用。无下陷之机者，亦勿用。至于发斑者，宜犀角化斑汤，勿须透表。疹则必须透达，故多宜升散之剂。
46．月经痛连乳胀痛者，多属肝经，兼腰困者，多属肾。前者逍遥散加减，后者川断、杜仲等选用，但临床多混合出现，孰轻孰重，用药当权衡之。
47．曾治一女性患者，呕吐较剧，饮食人口即吐，伴有月经过多疾患，左脉沉，已20天，胃部尚有拒按、便秘。此病为肝郁导致胃气不降，为寒热虚实夹杂之证。仿干姜黄芩黄连人参汤之意，加半夏、当归、大黄、旋覆花、代赭石等品，效果很好。
48．白带一证，总的来说不外湿热、寒湿郁结几个方面，问题在于我们如何辨其性质，这就需从全身症状来鉴别。如兼胸满、胁胀、嗳气、寒热，脉沉弦(尤其左脉)，即可考虑肝郁的一面，同时肝郁可影响心，又可影响脾，临床务须随机应变。例如，用逍遥散时，如有心悸失眠、血虚诸症之时，可合归脾；有肝热之征时，宜加丹栀；如日久，又兼肾虚者，可合六味。必须是审证明确用之才有效，否则乱用妄用是不会有效的。
49．黄带，为妇科常见的证候。傅青主有易黄汤的方子，然黄带也有不同情况，究竟哪一种黄带适用易黄汤呢?以药测证，当为子宫有湿热，兼脾肾两虚者，可以用之。同时，不是脾阳虚而是脾阴虚的情况下可用，症见带如浓茶，气味臭秽，饮食减少，不喜燥热，腰困带多。
50．病情是复杂的，寒热虚实常交互出现，临床须在这些方面多留意。如曾治一妇女产后之病，表现为呕吐、腹泻、口苦、胃脘有压痛，平素是虚寒体质，当然产后为虚，腹泻为虚象，兼有体质偏寒，拒按为实，口苦为热，证情是复杂的，给以人参补虚，干姜温中祛寒，半夏止呕，大黄去其实兼清泄其热，一剂即愈。
51．一产后病患者，系剖腹产，产后腹胀，经西医检查，为继发性肠梗阻。经会诊，发现两个特征：一是吐痰清稀量多；二是腹虽胀，无明显拒按，鼓肠较剧，微热。拟方二陈汤加莱菔子、大腹皮、柴胡、桃仁、益母草等，服后即减轻。又治一例产后鼓肠，审证系瘀血，拟归、芎、桃仁、乳、没、腹皮、台参，亦治愈．因无明显寒热，故药亦不用温凉之品。总之，必须抓住主要环节，用药恰如其分，自然见效。
治法撮要
52．治病必须找到其根源，不能头痛医头，足痛医足。如一人舌质红，用滋阴之法而不愈．珍之脘腹拒按。并无其他阴虚症状，以消导之法即愈，一月经闭止者，曾用大承气而愈，一神昏谵语者，亦以承气而愈等等，均是认定病因均在肠胃，所以取效的。
53．对一症的治疗，必须了解它的产生原因。如治疗发烧，不能单纯退烧，要了解烧是怎样发生的，如系表热，则予解表即愈，如系阴虚，则必须滋阴才会取效。假如一味地退热，不究其原因，就达不到治愈的目的。《内经》言：“治病必求其本。”即是这个意思。
54．治病要结合病机，关注病变趋势。病情向纵深发展者，可以阻截之；向愈的阶段，可以诱导之。如肝炎久治不愈，即有向肝硬化转变的趋势。为什么会硬化呢?因津液受伤，脉络阻滞的结果。如何阻截呢?滋阴养血通络等法是也。考虑其肾虚者，更当滋肾，当然亦须避免色欲，戒酒，以免重伤其阴。
55．治病当结合气候环境不同而施治。例如在久旱无雨的干燥气候下，明明需要宣透，但用药就不能过分温燥；反之，在淫雨缠绵的湿润气候之中，纵然需要滋阴，用药也不必过度濡润，否则对于疾病是有害的。
56．表证，遇有表寒、表热不明显，或似是而非之际，用药宁可偏其凉而不可偏其温。
57．温病邪在卫分的主要治法是辛凉解表，但在恶寒重、发热轻、无汗、头身痛、舌苔白、口渴不甚的情况下，亦有用辛温解表的时候。例如春温之用荆防解表汤，阴暑之用三物香薷饮，凉燥之用杏苏饮等。
58．表证汗解是千古不易的定法，但不管内部有无兼证，片面地进行发汗，不但不能达到应有的效果，反而有汗不出或使病情加剧的可能，所以发汗之法也必须根据一定法则，不是随便使用的。
59．伤寒病愈后气虚滓液朱复，余热未尽，而有喜冷、少气、欲呕等现象吋，最忌一般溫补药品，如人参、黄芪等药。因为这些药品虽能补虚，但不能清热，最易留邪为患。
60．伤寒病解后，周身发热，汗出即解，须臾又热而汗，如此多次，汗出如洗，目上窜不露黑睛，寒热往来，气喘，怔仲，气虚不足以息，以及左脉微细，按之即无，屆肝胆虚极，肝风将动，元气欲脱之证，药重用山萸肉30～60克，方用来复汤．
61．治内伤吋要考虑到有无外感，治外感时要考虑到有无内伤。如有夹杂，要考虑其孰轻孰重，孰宾孰主，治法上或先表后里，或表里兼顾。只有辨清夹杂，审清其主次量比，对证下药，才能得当。
62．甘温除大热，其热为内伤热，而非外感热，内伤与外感之区别，均可作为其鉴别的依据。又，甘温所除之热为虚热，而非实热，其脉象以虚而大为特点，手心烧(应与阴虚、停食之手心热相区別)，伴有倦怠(须与清暑益气汤证区别，从时令上区别)等特征。须综合分析，细心体会，方不致误。
63．滋阴剂应用一个阶段后，须回头用补阳之法一二次，然后再继续用滋阴，则阴复反能增速。同理，回阳剂用一个阶段之后，改用滋阴剂一二次，再接着用回阳之法，则阳升更旺。此阳生阴长、阴阳互根之意也。
64．热自足直冲股内，上入腹中，为肾经火旺证，治宜滋肾丸或知柏地黄丸。
65．气有余便是火，故理气可治火证。
66．眼花，两目干涩，属肝伤血少证者，治宜和肝养血，方取逍遥散。
41. The characteristic of Wu Mei Wan (Mume Pill) syndrome is heat above and cold below. If vomiting of roundworms, pain with a burning sensation in the heart region, Qi rushing upward to the chest, and diarrhea are observed, it belongs to this syndrome. With careful observation, it is not difficult to identify. It can also be used for chronic dysentery with mixed cold and heat patterns. A case of biliary ascariasis was treated with good efficacy, but it must conform to the aforementioned syndrome characteristics to be effective.
42. In the "Shanghan Lun" (Treatise on Cold Damage), regarding Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) and Xiao Chai Hu Tang (Minor Bupleurum Decoction), the text states: "If the Yang pulse is choppy and the Yin pulse is string-like, abdominal cramping pain is expected; first administer Xiao Jian Zhong Tang. If ineffective, then Xiao Chai Hu Tang should be administered." These two syndromes are often easily confused. When presented with symptoms of abdominal pain and distension, one must distinguish between these two aspects: the former belongs to deficiency-cold, while the latter belongs to Liver Qi stagnation (which implies the modification of Xiao Chai Hu Tang by removing Huang Qin [Scutellariae Radix] and adding Shao Yao [Paeoniae Radix]). It does not mean trying Xiao Jian Zhong Tang first and then using Xiao Chai Hu Tang.
43. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) treats various syndromes arising from Sinking of Middle Qi. The key lies in understanding what Sinking of Middle Qi is and how to identify it. Only when it is clearly identified as Sinking of Middle Qi will the treatment be effective. For example, if chronic diarrhea, chronic dysentery, rectal prolapse, uterine prolapse, gastric ptosis, metrorrhagia and metrostaxis that do not stop, prolonged and abundant leukorrhea, or frequent urination are seen clinically, one should first consider whether it is Sinking of Middle Qi. Then, examining the systemic symptoms, there must be fatigue and reluctance to speak, spontaneous sweating, shortness of breath, a deficient pulse, or a large but forceless pulse, making it easy to identify.
44. Meng Shi Gun Tan Wan (Lapis Rolling Phlegm Pill) treats stubborn and strange phlegm syndromes. Its indications include a robust physique, presence of heat, bitter taste in the mouth, sticky sputum, and constipation. The pulse must be deep, slippery, and forceful, and the tongue coating greasy. As for Kong Xian Dan (Control Fluids Pill), it is a formula for expelling fluid retention. It lacks the heat signs of the aforementioned syndrome and is suitable for cases with clear and thin sputum.
45. Sheng Ma Ge Gen Tang (Cimicifugae and Puerariae Decoction) is suitable when measles are about to erupt but have not yet appeared, especially if accompanied by diarrhea. The exterior syndrome often includes eye pain, dry nose, insomnia, and slight thirst. It is contraindicated in cases of severe Yangming heat. It should not be used if there is no tendency toward sinking. For macules (spots), Xi Jiao Hua Ban Tang (Rhinoceros Horn Macule-Transforming Decoction) is suitable, without the need for exterior-releasing methods. Rashes (papules) must be vented outward, so dispersing and ascending formulas are mostly appropriate.
46. Menstrual pain radiating to breast distension and pain usually belongs to the Liver Meridian. Accompanying soreness and heaviness in the lower back usually belongs to the Kidney. The former can be treated with modifications of Xiao Yao San (Free and Easy Wanderer Powder), and the latter with herbs such as Xu Duan (Dipsaci Radix) and Du Zhong (Eucommiae Cortex). However, in clinical practice, they often appear mixed. One must weigh the severity of each to determine the medication.
47. A female patient was treated who suffered from severe vomiting, regurgitating food immediately after ingestion, accompanied by menorrhagia. The left pulse was deep, and the condition had lasted 20 days. There was still tenderness upon pressure in the stomach area and constipation. This disease was caused by Liver Stagnation leading to failure of Stomach Qi to descend, representing a complex syndrome of mixed cold, heat, deficiency, and excess. Following the principle of Gan Jiang Huang Qin Huang Lian Ren Shen Tang (Ginger, Scutellaria, Coptis, and Ginseng Decoction), Ban Xia (Pinelliae Rhizoma), Dang Gui (Angelicae Sinensis Radix), Da Huang (Rhei Radix et Rhizoma), Xuan Fu Hua (Inulae Flos), and Dai Zhe Shi (Haematitum) were added. The effect was very good.
48. Leukorrhea generally falls into a few categories: damp-heat or cold-damp stagnation. The issue lies in how to differentiate its nature, which requires distinguishing based on systemic symptoms. If accompanied by chest fullness, hypochondriac distension, belching, and alternating chills and fever, with a deep and string-like pulse (especially on the left side), one should consider Liver Stagnation. Simultaneously, Liver Stagnation can affect the Heart and the Spleen. Clinical practice requires flexibility. For example, when using Xiao Yao San, if palpitations, insomnia, and blood deficiency symptoms are present, it can be combined with Gui Pi Tang (Restore the Spleen Decoction); if signs of Liver Heat are present, Mu Dan Pi (Moutan Cortex) and Zhi Zi (Gardeniae Fructus) should be added; if prolonged and accompanied by Kidney Deficiency, Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) can be combined. Effectiveness depends on accurate syndrome differentiation; random use will not work.
49. Yellow leukorrhea is a common gynecological syndrome. Fu Qing Zhu (Fu Qingzhu) has the formula Yi Huang Tang (Change Yellow Decoction). However, yellow leukorrhea presents differently. Which type is suitable for Yi Huang Tang? Inferring the syndrome from the herbs, it applies to cases with damp-heat in the uterus combined with dual deficiency of the Spleen and Kidney. It is applicable when there is Spleen Yin Deficiency rather than Spleen Yang Deficiency. Symptoms include discharge resembling strong tea, foul odor, reduced appetite, aversion to dry heat, lower back soreness, and abundant discharge.
50. Disease conditions are complex, with cold, heat, deficiency, and excess often intermingling. Clinicians must pay attention to these aspects. For instance, a woman postpartum was treated presenting with vomiting, diarrhea, bitter taste in the mouth, and tenderness in the epigastrium. Her constitution was typically deficiency-cold. Postpartum state is inherently deficient, diarrhea indicates a deficiency pattern, and her constitution leans toward cold. Tenderness upon pressure indicates excess, and bitter taste indicates heat. The condition was complex. Ren Shen (Ginseng Radix) was given to tonify deficiency, Gan Jiang (Zingiberis Rhizoma) to warm the middle and dispel cold, Ban Xia (Pinelliae Rhizoma) to stop vomiting, and Da Huang (Rhei Radix et Rhizoma) to purge excess and clear heat. She recovered after one dose.
51. A postpartum patient underwent cesarean section and developed abdominal distension. Western medical examination diagnosed secondary intestinal obstruction. Upon consultation, two features were found: first, copious expectoration of clear and thin sputum; second, although the abdomen was distended, there was no obvious tenderness upon pressure, but significant bowel sounds and mild fever. Er Chen Tang (Two-Cured Decoction) was prescribed with Lai Fu Zi (Radish Seed), Da Fu Pi (Arecae Pericarpium), Chai Hu (Bupleuri Radix), Tao Ren (Persicae Semen), and Yi Mu Cao (Leonuri Herba). Symptoms relieved after administration. Another case of postpartum abdominal distension was diagnosed as Blood Stasis. Dang Gui (Angelicae Sinensis Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Tao Ren (Persicae Semen), Ru Xiang (Olibanum), Mo Yao (Myrrha), Da Fu Pi (Arecae Pericarpium), and Tai Shen (Codonopsis Radix) were prescribed, resulting in cure. Since there were no obvious cold or heat signs, warming or cooling herbs were not used. In summary, one must grasp the main link and use medications appropriately to achieve natural results.
Essentials of Treatment Methods
52. Treating disease must find its root cause; one cannot treat the head when it hurts and the foot when it hurts. For example, a person with a red tongue did not improve with Yin-nourishing methods. Examination revealed tenderness upon pressure in the epigastrium and abdomen, with no other symptoms of Yin deficiency. Digestion-promoting methods cured him. A woman with amenorrhea was cured using Da Cheng Qi Tang (Major Order the Qi Decoction). A person with coma and delirium was also cured with Cheng Qi Tang (Order the Qi Decoction). In all these cases, the cause was identified in the intestines and stomach, hence the effectiveness.
53. To treat a symptom, one must understand its cause. For fever, simply reducing temperature is insufficient; one must understand how the fever arises. If it is Exterior Heat, releasing the exterior cures it. If it is Yin Deficiency, nourishing Yin is required. Blindly reducing fever without investigating the cause fails to achieve a cure. The "Neijing" (Classic of Internal Medicine) states: "In treating disease, one must seek the root." This is the meaning.
54. Treatment must combine pathogenesis and monitor the trend of disease progression. If the disease progresses deeper, it can be intercepted; if it is moving toward recovery, it can be guided. For example, hepatitis that does not heal after long-term treatment may trend toward liver cirrhosis. Why does hardening occur? Due to injury of body fluids and blockage of collaterals. How to intercept it? Methods such as nourishing Yin, tonifying blood, and unblocking collaterals are used. Considering Kidney Deficiency, nourishing the Kidney is even more necessary. Of course, avoiding sexual indulgence and abstaining from alcohol is required to prevent further injury to Yin.
55. Treatment should adapt to different climates and environments. For example, in a dry climate with prolonged drought, even if ventilation and dispersion are needed, medications should not be excessively warm and drying. Conversely, in a humid climate with lingering rains, even if Yin-nourishing is needed, medications should not be overly moistening, otherwise it would be harmful to the disease.
56. For Exterior Syndromes, when Exterior Cold and Exterior Heat are not obvious or are ambiguous, medications should lean towards cool rather than warm.
57. The main treatment method for Warm Diseases where pathogens are in the Wei (Defensive) level is Acrid-Cool release of the exterior. However, in cases of severe chills, mild fever, absence of sweat, headache and body ache, white tongue coating, and slight thirst, Acrid-Warm release of the exterior may also be used. For example, Jing Fang Jie Biao Tang (Schizonepeta and Saposhnikovia Exterior-Releasing Decoction) for Spring Warmth, San Wu Xiang Ru Yin (Three-Ingredient Aromatic Mosla Drink) for Yin Summerheat, and Xing Su Yin (Apricot and Perilla Drink) for Cool Dryness.
58. Sweating to resolve Exterior Syndromes is an unchanging method since ancient times. However, regardless of internal accompanying syndromes, one-sided sweating not only fails to achieve the desired effect but may also result in inability to sweat or exacerbate the condition. Therefore, sweating methods must follow specific principles and cannot be used arbitrarily.
59. After recovery from Shanghan (Cold Damage), if Qi deficiency and body fluid depletion persist, with residual heat remaining, manifesting as craving for cold, shortness of breath, and nausea, general warm-tonifying medicines like Ren Shen (Ginseng Radix) and Huang Qi (Astragali Radix) are strictly contraindicated. Although these medicines can tonify deficiency, they cannot clear heat and are most likely to retain pathogens and cause harm.
60. After resolution of Shanghan, if the whole body feels hot, resolving with sweat, but then heating and sweating recur repeatedly, with profuse sweating like washing, eyes rolling up exposing only the whites, alternating chills and fever, panting, palpitations, Qi deficiency causing insufficient breathing, and a faint, fine left pulse that disappears upon pressure, this belongs to extreme deficiency of the Liver and Gallbladder, impending movement of Liver Wind, and collapse of Yuan (Original) Qi. Heavy doses of Shan Yu Rou (Corni Fructus) 30–60g are used, in the formula Lai Fu Tang (Return to Life Decoction).
61. When treating Interior Injuries, consider whether there is an Exterior Pathogen. When treating Exterior Pathogens, consider whether there is an Interior Injury. If mixed, weigh their relative severity and primary/secondary roles. Treatment methods may involve treating the exterior first then the interior, or addressing both simultaneously. Only by clearly identifying the mixture, assessing the primary and secondary ratios, and prescribing according to the syndrome can the treatment be appropriate.
62. Sweet-Warm to remove great heat refers to Interior Injury Heat, not Exterior Pathogen Heat. The distinction between Interior Injury and Exterior Pathogen serves as a basis for differentiation. Furthermore, the heat removed by Sweet-Warm methods is Deficiency Heat, not Excess Heat. Its pulse characteristic is deficient and large. Palms feel hot (to be distinguished from Yin Deficiency or Food Stagnation palm heat), accompanied by fatigue (to be distinguished from Qing Shu Yi Qi Tang syndrome based on season). Comprehensive analysis and careful observation are necessary to avoid errors.
63. After applying Yin-nourishing formulas for a period, return to Yang-tonifying methods once or twice, then continue with Yin-nourishing, which accelerates Yin restoration. Similarly, after using Yang-returning formulas for a period, switch to Yin-nourishing formulas once or twice, then resume Yang-returning methods, which makes Yang rise more vigorously. This reflects the principle of Yang generating Yin and Yin growing, and the mutual root of Yin and Yang.
64. Heat rising directly from the feet into the inner thighs and entering the abdomen indicates Hyperactivity of Fire in the Kidney Meridian. Treatment should utilize Zi Shui Wan (Nourish Water Pill) or Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill).
65. Excess Qi becomes Fire; therefore, regulating Qi can treat Fire syndromes.
66. Blurred vision and dry, gritty eyes belong to Liver Injury and Blood Deficiency. Treatment should harmonize the Liver and nourish Blood, using Xiao Yao San (Free and Easy Wanderer Powder).