论头疼 论目痛
天师曰∶常治者，可以常法而常治之者也。如人病头疼，则以头疼常法治之∶目痛，则以目痛常法
治之是也。何必头疼而治之于两足，目痛而治之以两手乎。虽头疼实有治之两足而愈，目痛实有治之两
手而痊者，然彼必常治之而不愈不痊，然后以变法治之，非可以常治，而先求之于变法也。故一遇头
疼，即以蔓荆子一钱，川芎五钱，白芷一钱，甘草一钱，半夏一钱，细辛一钱治之，病去如扫。（〔批〕
止疼汤。）一遇目痛，以柴胡一钱，白芍三钱，当归一钱，白蒺藜二钱，甘菊花一钱，荆芥、防风
各一钱，半夏一钱，甘草五分，栀子二钱，水煎服。（〔批〕全目饮。）二剂即愈。皆无事舍常而思
变也。此常治之法，可为师也。
张公曰∶常病用常法极是，予亦不再言变也。
华君曰∶无。
论伤寒变结胸 论疟变下痢 论中风变狂 论中暑变亡阳 论反胃变噎膈
天师曰∶变法者，不可以常法治，不得已而思变之也。变症不同，用药各异，吾举其大者言之。如
伤寒变为结胸，
疟疾变为下痢，中风变为发狂，中暑变为亡阳，反胃而变成噎膈，若不以变法治之，仍以平常药饵相
治，吾见其坐毙而已矣。然则结胸之症，乃伤寒之变也，可不以变法治之乎。伤寒火邪正炽，原不可急
与饮食。若不知禁忌与之，胃中得食，不啻如宝，故茹而不出，而他脏见胃中有食，群起而争，其势猖
狂，非杯水可解，必当以变法治之。急须以栝蒌一枚捶碎，入甘草一钱，同煎服之。夫栝蒌乃陷胸之胜
物，平常人服之，必至心如遗落，今病患一旦服之，不畏其虚乎？谁知无病常人，断断不可服此，而伤
寒结胸之症，却有相宜。盖食结在胸，非大黄、芒硝、枳壳、槟榔、浓朴之类可能祛逐，必得栝蒌，始
能陷之。入于脾中，尤恐其过于下也，少加甘草留之，且得甘草之和，不致十分推荡。此变症而用变法，
真胜于用正也。
疟疾本是常症，只可以平常消导而发散之。今忽为下利等症，则变轻为重。欲发汗，则身已亡
阴，欲祛邪，则下已便物。顾上则虑下，顾下则碍上。倘仍以常法治之，奏功实少。今用人参一两，鳖甲
一两，白术三两，茯苓一两，当归一两，白芍三两，柴胡一钱，枳壳一钱，槟榔一钱，水煎服。（〔批〕补
阳消疟丹。）此方奇在用人参、白术。盖疟病则亡阳，若不急补其阳气，则下多亡阴，势必立亡。惟急
补其阳气之不足，阳生阴长，始有生机。尤妙白芍、当归之多，以滋润其肠中之阴。盖下利多。则阴亡亦
多，今用补阴之剂，则阴生阳降，自然春意融和，冰泮化水，分消水道，污秽全无，况方中又加枳壳、槟
榔，仍然去积。又妙少用柴胡，微舒肝气，使木气相安，不来克土，自然土克水之多，水润木之下，内气
既生，外邪亦散。此治下利，而疟病同除。此种治变之法，何可不知。
中风系是危症，况变发狂，死在眉睫。倘不以变法救之，何以得免于垂绝耶。方用人参三两，菖
蒲三钱，半夏三钱。南星三钱，生用附子一钱，丹砂末三钱，先将参、苓、附子等项煎汤，调入丹砂
末灌之。（〔批〕救绝至神丹。）十人中亦可救三四。盖天下无真中风之人，不过中气、中痰、中湿
而已，若不用人参、附子，大剂煎饮，何能返已去之元阳，回将绝之心气哉。况人将死之时，未有不痰上
涌者，妙在用半夏、南星以祛逐之。尤妙用菖蒲以引入心经，使附子、半夏得施其荡邪之功，而丹砂又
能镇定心气，所以往往返危为安。倘仍以寻常二陈之类以消痰，痰未必消，而心气已绝。此又症变而法
变者也。
中暑原是热症，然而热之中也，亦由于气之虚。人若气实形壮者，多难中暑。然则中暑之病，宜
补气为先，解暑为次。无如人以为热也，治表为急，治本为末。先以香薷饮治之，不效，又改用白虎汤，
又不效，乃用发散之剂，杂然并进，则火邪乘热气外走，尽趋皮肤而出，而不可止，以变为亡阳之症者多
矣。法当以人参三两，元参三两，甘草一钱，北五味一钱，生地三两救之。此方之妙，全在用人参以补元
气，用元参以凉血。盖血得凉，则气自止而不走，又有五味子之酸，以收敛肺金之气，此不止汗而汗自止
也。倘惟以四君子汤平常治法。则一杯之水，何能止车薪之发焰哉。此又变法之宜知也。
反胃症初起之时，未尝非胃病也，当时以逍遥散加黄连一钱，立止也。无如世医不知治法，乃用香砂、
浓朴、枳壳、砂仁之类，纷纷投之。不应，又改用大黄、巴豆之类下之。
又不应，乃改用黄连、黄柏、黄芩、栀子、知母大寒之品以凉之。又不应，乃改用桂枝、白果、肉桂、附
子、干姜、吴茱萸之类以热之。又不应，乃始用柴胡、荆芥、桔梗、防风、苏子之类以散之，遂成噎膈之
症矣。吾今悯之，乃传一方，用熟地一两，山茱萸四两，麦冬三钱，北五味一钱，元参一钱，当归三
钱，白芥子一钱，牛膝二钱，水煎服。（〔批〕转食至神丹。）此方之妙，全在不治翻胃，正所以治翻胃
也。盖人之反胃，乃是肾中阴水竭也。肾水不足，则大肠细小，水不足以润之，故肠细而干涸。肠既细小，
则饮食入胃不能下行，必反而上吐。治之之法，不可治上，而宜治下。方中用熟地、山茱之类，纯是补肾
中之水也。肾水足，而大肠有水相资，则大肠仍复宽转，可以容物。水路既宽，则舟楫无碍，大舸小舶，
可以顺行，又何惧区区小舟不可以转运粮食哉。此肾中虚而水不足以润大肠者，宜如是治法。若肾中寒凉而
虚者，又不如是治也。盖翻胃之名虽同，翻胃之实各异。肾中无水而翻胃者，食下喉即吐；肾中无火而翻
胃者，食久而始吐也，譬如今日食之，明日始尽将今日之物吐出者是也。方用熟地一两，附子一钱，肉桂
一钱，山茱萸四钱，麦冬五钱，北五味一钱，茯苓二钱，山药二钱，丹皮一钱，泽泻一钱，牛膝一钱，水
煎服。此方八味丸汤也，妙在用附子、肉桂于补肾水之中，使去水中补火。补火者，补命门之火也。盖脾胃
之气必得命门之火始生。譬如釜下无火，何以煮爨，未免水冷金寒，结成冰冻，必得一阳初复之气，始
解阳和。人身脾胃亦然。然而寒凉之病，止该腹痛心疼，今反无此症，乃上越而吐者何也？盖脾胃有出路，
则寒邪之气不留于中，今日日
上吐，将胃口咽门已成大道熟径，往来无所阻滞，则径情趋奔，其势甚便，又何必积蓄于中州，盘踞于心
腹，颠寒作热，以苦楚此脾胃哉。此翻胃下寒，心腹之所以不痛也。此又不治反胃，而所以治反胃也。此
变法治病之端也。
张公曰∶说得我闭口无言。汝知而不能言，今可以言矣。无可一言，惟有三叹顿首而已。惟圣者知
之，予亦不能言之也。
华君曰∶余虽有传，不及君之多而且畅。
雷公曰∶无一论不奇辟。真圣人之言，不可测也。
（反胃而用逍遥加黄连，赵养葵先生亦主此方，但此必食入即吐之症，如朝食暮吐者，又为命门无
火，当是八味汤症矣。李子永识。）
On Headache and Eye Pain
The Heavenly Master said: "Chang Zhi" (Routine Treatment) refers to conditions that can be treated with routine methods. For instance, if a person suffers from headache, one should treat it using the routine method for headaches; if they suffer from eye pain, one should treat it using the routine method for eye pain. Why must one treat a headache by addressing the feet, or eye pain by addressing the hands? Although there are indeed cases where treating the feet cures a headache, or treating the hands cures eye pain, these situations arise only after routine treatments have failed to improve or cure the condition, prompting a shift to Bian Zhi (Variable/Alternative Treatment). It is not appropriate to seek alternative treatments first when routine treatment is still applicable. Therefore, upon encountering a headache, one should use Jing Jie (Scutellaria Barbata, though text says Man Jing Zi - *Correction: Man Jing Zi is Vitex Agnus-Castus fruit*) 1 qian, Chuan Xiong 5 qian, Bai Zhi 1 qian, Gan Cao 1 qian, Ban Xia 1 qian, and Xi Xin 1 qian. The illness will be cleared as swiftly as sweeping dust. (Annotation: Zhi Teng Tang / Pain-Relieving Decoction.) Upon encountering eye pain, one should use Chai Hu 1 qian, Bai Shao 3 qian, Dang Gui 1 qian, Bai Ji Li 2 qian, Gao Ju Hua 1 qian, Jing Jie and Fang Feng each 1 qian, Ban Xia 1 qian, Gan Cao 0.5 qian, and Zhi Zi 2 qian, decocted in water. (Annotation: Quan Mu Yin / Complete Eye Drink.) Recovery occurs within two doses. These are all instances where one does not need to abandon routine methods to consider alternative ones. This routine treatment method serves as a standard.
Lord Zhang said: Treating common diseases with common methods is absolutely correct. I will no longer discuss alternative treatments.
Lord Hua said: No objection.
On Tai Yang Disease Evolving into Jie Xiong, on Malaria Evolving into Dysentery, on Stroke Evolving into Madness, on Heatstroke Evolving into Collapse of Yang, on Regurgitation Evolving into Dysphagia
The Heavenly Master said: "Bian Zhi" (Variable/Alternative Treatment) refers to conditions that cannot be treated with routine methods, necessitating a change in approach due to circumstances. Different evolving symptoms require different medications. I will discuss the major cases. For example, Tai Yang disease evolving into Jie Xiong (Chest Binding), malaria evolving into dysentery, stroke evolving into madness, heatstroke evolving into collapse of Yang, and regurgitation progressing to dysphagia—if these are not treated with alternative methods but instead with ordinary medicines, I fear the patients will simply sit and die. Thus, Jie Xiong, being an evolution of Tai Yang disease, certainly requires alternative treatment. In Tai Yang disease, fire pathogenic factors are rampant, and food intake should initially be avoided. If one ignores this contraindication and provides food, the stomach treats it like treasure, retaining it without vomiting. Other organs, seeing food in the stomach, compete fiercely, creating a chaotic situation that cannot be resolved with a cup of water. Alternative treatment is necessary. One should crush one Gua Lou (Trichosanthes Fruit), add 1 qian of Gan Cao, and decoct together for administration. Gua Lou is a superior agent for resolving chest binding. Ordinary people taking it might experience mental confusion, as if losing something. Would a patient not fear weakness from such intake? Yet, while healthy individuals must absolutely avoid this, it is suitable for Tai Yang disease complicated by Jie Xiong. Food stagnation in the chest cannot be expelled by Da Huang, Mang Xiao, Zhi Ke, Bing Lang, or Hou Po alone; Gua Lou is required to sink and resolve it. To prevent excessive purgation affecting the spleen, a small amount of Gan Cao is added to retain the medicine and harmonize, preventing violent purging. Treating an evolving symptom with an alternative method truly surpasses using standard methods.
Malaria is typically a common condition, treatable with routine digestion-promoting and dispersing methods. However, if it suddenly evolves into diarrhea, the condition has worsened from mild to severe. Sweating is contraindicated as yin fluids are already depleted; expelling pathogens is hindered by lower bowel evacuation. Addressing the upper affects the lower, and vice versa. Routine treatment yields little success. Now, use Ren Shen 1 liang, Bie Jia 1 liang, Bai Zhu 3 liang, Fu Ling 1 liang, Dang Gui 1 liang, Bai Shao 3 liang, Chai Hu 1 qian, Zhi Ke 1 qian, and Bing Lang 1 qian, decocted in water. (Annotation: Bu Yang Xiao Nue Dan / Yang-Supplementing Malaria-Resolving Pill.) The brilliance of this formula lies in using Ren Shen and Bai Zhu. Malaria depletes yang qi; failing to urgently tonify yang leads to further yin loss through diarrhea, resulting in imminent death. Urgently supplementing insufficient yang allows yang generation to foster yin growth, restoring vitality. The generous use of Bai Shao and Dang Gui moistens intestinal yin. Since frequent diarrhea causes significant yin loss, tonifying yin promotes yin generation and yang descent, creating a harmonious state like melting ice, clearing turbid matter through the water pathways. Furthermore, Zhi Ke and Bing Lang remove stagnation. The subtle use of Chai Hu gently soothes liver qi, ensuring wood does not overact on earth, allowing earth to control water properly, moistening wood below. Internal qi generates, external pathogens disperse. This treats diarrhea while simultaneously resolving malaria. How can one ignore such methods for evolving conditions?
Stroke is a critical condition; evolving into madness implies imminent death. Without alternative rescue methods, how can one avoid near-death? Use Ren Shen 3 liang, Shi Chang Pu 3 qian, Ban Xia 3 qian, Nan Xing 3 qian (raw), Fu Zi 1 qian, and Zhu Sha powder 3 qian. Decoct Ren Shen, Fu Ling, Fu Zi, etc., in water, mix in Zhu Sha powder, and administer. (Annotation: Jiu Jue Zhi Shen Dan / Spirit-Emergency Resuscitation Pill.) Three out of ten patients may be saved. There are no true "wind strokes"; rather, they involve qi blockage, phlegm obstruction, or dampness. Without large doses of Ren Shen and Fu Zi, how can one restore lost primordial yang and revive fading heart qi? Near death, phlegm surges upward; Ban Xia and Nan Xing effectively expel phlegm. Shi Chang Pu guides the herbs into the Heart meridian, allowing Fu Zi and Ban Xia to dispel pathogens, while Zhu Sha calms the heart qi, often turning danger into safety. Using routine Er Chen Tang to resolve phlegm fails to clear phlegm and results in heart qi failure. This illustrates changing methods for changing symptoms.
Heatstroke is originally a heat condition, yet susceptibility arises from qi deficiency. Robust individuals rarely suffer heatstroke. Thus, tonifying qi takes precedence over resolving heat. Ignoring this, physicians mistakenly prioritize superficial treatment over root treatment. Initial use of Xiang Ru Yin fails, followed by Bai Hu Tang, also failing. Subsequently, various dispersing agents are mixed indiscriminately, causing fire pathogens to follow heat outward to the skin uncontrollably, leading to collapse of Yang. The correct method uses Ren Shen 3 liang, Xuan Shen 3 liang, Gan Cao 1 qian, Bei Wu Wei Zi 1 qian, and Sheng Di 3 liang. The efficacy relies on Ren Shen tonifying primordial qi and Xuan Shen cooling blood. Cooling blood stops erratic qi movement. The sour taste of Wu Wei Zi收敛 (astringes) lung qi, stopping sweating without explicit antiperspirants. Using routine Si Jun Zi Tang would be like trying to extinguish a burning cartload of firewood with a cup of water. Knowledge of alternative methods is essential here.
Regurgitation initially stems from stomach issues; at onset, Xiao Yao San plus 1 qian of Huang Lian could stop it immediately. Unaware physicians use Xiang Fu, Sha Ren, Hou Po, Zhi Ke, etc., without effect. They then try Da Huang and Ba Dou for purging. Still ineffective, they switch to cold herbs like Huang Lian, Huang Bo, Huang Qin, Zhi Zi, and Zhi Mu. Still ineffective, they use warm herbs like Gui Zhi, Rou Gui, Fu Zi, Gan Jiang, and Wu Zhu Yu. Still ineffective, they use dispersing herbs like Chai Hu, Jing Jie, Jie Geng, Fang Feng, and Su Zi, finally resulting in dysphagia. Pitying this, I transmit a formula: Shu Di Huang 1 liang, Shan Zhu Yu 4 liang, Mai Dong 3 qian, Bei Wu Wei Zi 1 qian, Xuan Shen 1 qian, Dang Gui 3 qian, Bai Jie Zi 1 qian, Niu Xi 2 qian, decocted in water. (Annotation: Zhuan Shi Zhi Shen Dan / Food-Turning Spirit-Emergency Pill.) Its brilliance lies in treating regurgitation by not directly targeting the stomach but addressing the root. Regurgitation results from exhaustion of kidney yin water. Insufficient kidney water leads to narrow, dry intestines, preventing food descent and causing upward vomiting. Treatment should focus downward, not upward. Shu Di and Shan Zhu Yu tonify kidney water. Sufficient kidney water nourishes the large intestine, widening it to accommodate food. With wide waterways, vessels move freely; why worry about small boats failing to transport grain? This applies to regurgitation due to kidney deficiency and lack of moisture. For kidney cold-deficiency, the approach differs. Though named similarly, regurgitation varies in nature. Kidney water deficiency causes immediate vomiting after eating; kidney fire deficiency causes delayed vomiting (e.g., eating today, vomiting tomorrow). For the latter, use Shu Di Huang 1 liang, Fu Zi 1 qian, Rou Gui 1 qian, Shan Zhu Yu 4 qian, Mai Dong 5 qian, Bei Wu Wei Zi 1 qian, Fu Ling 2 qian, Shan Yao 2 qian, Mu Dan Pi 1 qian, Ze Xie 1 qian, Niu Xi 1 qian, decocted in water. This is Ba Wei Wan in decoction form. Its subtlety lies in adding Fu Zi and Rou Gui to tonify water, thereby supplementing fire within water. Supplementing fire means tonifying Ming Men (Gate of Life) fire, which generates spleen-stomach qi. Without fire under the pot, cooking is impossible; cold water and metal freeze. Only with the return of yang warmth can thawing occur. Similarly, spleen-stomach needs this warmth. Cold diseases usually cause abdominal pain, but here, vomiting predominates because the exit is open, allowing cold pathogens to escape upward easily rather than stagnating in the center. This explains the absence of abdominal pain in lower-cold regurgitation. This is treating regurgitation by not directly attacking it. This marks the beginning of treating diseases via alternative methods.
Lord Zhang said: Your words leave me speechless. You knew but could not express it; now you can. I have nothing more to say, only three sighs and bows. Only sages understand; I cannot explain it further.
Lord Hua said: My transmission is inferior to yours in both quantity and clarity.
Lord Lei said: Every discussion is unique and profound. Truly the words of a sage, unfathomable.
(Note: Regarding using Xiao Yao San with Huang Lian for regurgitation, Mr. Zhao Yangkui also advocated this formula, but it applies specifically to immediate vomiting after eating. For morning eating and evening vomiting, indicating lack of Ming Men fire, Ba Wei Wan decoction is indicated. Recorded by Li Ziyong.)