人以阳气为主，阴常有余，阳常不足。近世医工乃倡为补阴之议，其方以黄柏为君，以
知母、地黄诸寒药为佐，合服升斗以为可以保生，噫！左矣。人之虚劳不足，怠情嗜卧，眩运
痹塞，诸厥上逆，满闷痞隔，谁则使之？阳气亏损之所致也，乃助其阴而耗其阳乎？人之一
身，饮食男女，居处运动，皆由阳气。若阴气则随阳运动而主持诸血者也。故人之阳损，但当
补之、温之，温补既行，则阳气长盛而百病除焉。
医之用术，惟吐利汗下与解表攻里之法耳，不能一病而自为一法也。今人遇病立方，
动辄二十余品，少亦不下数品，岂知仲景诸名医之心法哉！吾观古人率用成方加减，不过一
二味，非有违戾，未尝辄易，正谓宜汗、宜吐、宜下、宜解表里者。病情有限，故攻病之法，亦
有限也，岂得动用已见，随意立方耶？药性有刑反忌宜，处味既多，莫识其性，为害不少。故
余欲世人，须洞识病情，恪遵古剂而后可。
药笼中物，何所不可用，贵当病情耳。今医工见药味平缓者，肆意增损，呼为医中王
道，人亦利其无患而药就之。若稍涉性气猛利之药，则束手不敢用。稍用之人，争指为野狼虎，
不之近噫。工师断木，尚取斧斤之利者，于用药，则取其钝而舍其利何哉？以此知不敢用猛
烈之药，皆不深脉理，不明病情者也。
邵尧夫曰∶百病起于情，情轻。病亦轻诸病孰非起于情耶？盖人生以气为主，情过喜则
气散，怒则气升，哀则气消，劳则气耗，惊则气乱，思则气结，欲则气倾，寒则气收，灵则气
泄，病由之作矣。识破知节，病亦少损。若着物不止，不为有生患哉？故君子贵保性而不任
情，斯养气延年之术也。
病者去而来复已而复作者，阳衰而不能制疾故耳。今不能养阳而屡事攻击，有疾者，
利则易生矣。有寒者，寒去则里虚矣。有疾者，积下则胃寒矣。其病至复作也奚疑？故凡病
情一去之后，即当颐神养性，放下万缘，调息百日，以生阳气，迨于阳气既盛，则阴邪不能
干，而旧疾无自作矣。若病情少事闲，即事酬应，啸傲如常，至于复作，则危期将至矣。
先大夫有训云，元气与脾气原无二致，人之元气充足，则脾气自然磨运而元气愈充，若
元气虚眇，则脾不能运而胀满，痞气之疾作矣。不肖素禀衰弱年来，脾眚时作，因有感于
先君至，教谨识于此。
余幼抱脾眚饮食下辄作胀满，思之未得其原，尝读东垣论云∶气聚于脾中不得散，故
时作胀满诚中现情矣，但未解治之之方也。后读《医学拾遗》治痞论云∶热既在上，则内中寒
凝而气不下行，故当用热药以温中焦，而下引其热，使热得降也。又《产后论》云∶非由血能
抢心，乃荣卫不充，中焦不治，气失所根据，而上奔于心耳。夫气聚则行寒则凝，行则病散，凝
则疾生。邪气乘虚，不在淤血之有无，故干姜为产后要药，辛热故也。但当温暖正气，以致
和平，则百疾无由生也。以此互观，则东垣气聚脾中之旨，昭昭明矣。
附子、大黄，医者俱畏而不用，然往往有因而得力者。尝闻许北门云∶昔患脾泄，经年
不愈，请教于郑澹泉，令用枣附丸。附子用童便煮制，经日末之枣肉炼为丸根据服，神验。近
学院谢蚪蜂，每日进枳壳大黄丸二三服，神才清爽。都宪张庐山止之弗听，而谢体质愈充。
药性之宜于人，非庸医所能识也。
今之治目者，大都用凉药点治，不知目
者，血之华，血得热则行，得寒则凝。古人点目以冰片、干姜，所以散其邪于外也。故精明之
府，不可一毫楂滓，当外传热药以散其邪，则睛膜舒转；内用温药以和其血，则血脉通利。
目未有不可治者，但外用热药，若甚痛不可忍，然拔去邪毒，所谓一劳永佚者，此医药拾
遗之论揭之。
目得血而能视，血冷则凝，此理易明也，而医则罕知之。邻有管连云之乃眷目患沿眶
红烂，数年愈甚，百计治之，不能疗为。延吴御医诊之，曰∶吾得之矣。为治大热之剂，数服，
其病如脱，目复明。问之曰∶此不难知也。此女人进凉药多矣。用大热剂则凝血复散，前药
皆得奏功，此可为治眼之良法。吴忘其名，专用附子、人呼为吴附子云。
高安姚姓年三十时，患弱气息仅属，亦涉医书，欲取附子服之，初皆疑弗与，后病将殆，
不得已听之，服至一斤许，疾遂愈，生三子。今近七旬，常疑其或作附毒，竟无也，虽老犹间服之不辍。
顾色泉老医，年六十有五，因盛怒，疽发于背，大如盂，四围色黑。召疡医治之，用冷药
敷贴，敷已觉凉，约七八日后，为用刀去淤肉。顾俟其去，曰∶四围色黑乃血滞，更加冷药，非
其治也。乃更治热敷药，去旧药敷之，觉甚痒，终夜，明日色鲜红， 肿亦消，惟中起数十孔
如蜂房。一日许，又觉恶心作哕，视一人头如两人头，自胗曰∶此虚极证也。用参附大剂，进
二服，视已正矣。不数日竟愈，终无刀针之苦。噫！用药系人生死，若此证危如累卵，稍一误投难乎哉。
顾色泉云∶凡疮毒属阴者，必用热药，如天雄、附子之类，皆生用，庶可起死回生。余问
其证，曰∶如对口阴发、伏疽，扪不知痛，疽不起泡，四围如墨黑者，是老人虚弱之症，尤宜
用之。窃以为，疮之阴阳一时难辨，疡医遇此，率用寒凉，杀人多矣。热药回生，其功甚巨，稍
涉迟疑，生死反掌。
丹溪之治吐衄，率用黄柏一味，或并用芩
连生地门冬等味，名曰滋阴降火。近有议其后者，曰∶元气亏损之人，有何火降？乃虚证耳，
复令脾胃冰寒，阳气衰败，何以自全？此所以沉困累年而后己也。余以为丹溪之见，未可全
非，而议之者意良，是今遇前证，应以丹溪之法降其上升浮游之火，俟炎火退，然后逐其淤
血，而以补助元阳，温和血气之药收功，不亦可乎！
家仆名贯者，之金陵路遘寒证，饵药少瘥，故好酒即饮酒一二瓯及水饭一盂，病乃大
作，气喘急，吐痰竟夕，不寐，连三日。余曰∶病且急矣。奈何？请医与商榷，以瓜蒂散吐之，
遂吐痰几半桶，后吐一块如猪脑血，食相裹，不二三日遂起。
妇女病患，率多心腹疼痛，痞满诸疾，大都由于气血凝聚致然。庸医妄投药饵，补之则
益患，稍削之则损元气，治之当有法。先大夫宦长沙张碧泉夫人病血蛊，腹痛，甚已死。先
大夫令用姜、葱、麝香、真血竭熨其脐，经行而病愈。一妇人患血痞，服药多方未效，张小泉
用通利行气之药为饼，贴其脐半日，频气泄而散。可见病在下者，汤饮未易效，须以意揣量
治之，使消散于下可也。
痘疹之发，根于骨髓脏腑，与诸疮不同。曾有人年十五岁而出者，问之，云∶极痛不可
忍，浑身如列铁钉，殆不能展侧。沉虚明善幼科，一贵公止一子，将之官与别沉嘱之曰∶出
痘切莫用药，用药则反伤生，上痘不必用药，下痘用药亦无功；中痘则须药扶持，然未必得
人，则不如不药之为愈也。既而贵公之任其子出痘，不药而愈，竟如沈言。
家妹年七岁，下痢纯血，时丁倭乱徒，避吴中，医者已辞，救矣。先宪副公语∶不肖当可
救否？曰∶痢疾起于气滞，儿欲饮以万病解毒丹下之，疏通其气，庶几可治。乃磨服一锭，未
可，因再磨服一锭，厥明大下，即进粥两瓯，其病遂愈。以此知解毒丹之效，神妙莫比。一名
紫金锭子，具载方书。
王典者，徽人，寓京师，通籍太医院徐南
湖为侍御时，尝识之，且屡验其方药，每记忆之。晚归乡，患肠癖下血，诸医治弗愈且殆，南
湖曰∶吾思用王典医，为致书召之。王至，诊其病，曰∶非肠癖也。连进黄硝之剂大下之。复
诊曰∶病未尽也，再进前剂，复下痰积桶。余曰∶可以治矣，调理而愈。所下秽更无血积肠
癖遂除。以此见，腹为热滞不能通血，肠胃逼窄而血下耳，众医皆以血治，故不效也。南湖
自此更十年，患他病殂。
曾忆某医书论倒仓一法，非丹溪心印，乃云传自西域异人者，恐门人妄记也。夫虚羸之
人虽有积聚，止宜养正积除，岂宜倾泻仓廪，以损正气，此可戒也。其言良是。南都一医者，
最称知名士，又善导引术，偶苦壅滞，因用前法大泻，不能起于厕，遂殒。余问其年，则六十
余矣。夫六十余者，岂宜行大吐下之法哉！以是知医者，不贵知法，及又贵知理，此医岂能
明于盈虚消息之理哉！
一富室患中寒阴证，名医盈座，最后延吴御医。至，诊之曰∶非附子莫救，但忘携来，令
人之市拣极重者三枚，生切，为一剂，计重三两，投之。众医吐舌潜减其半，以两半为剂，进
之，病遂已。吴复诊曰∶何减吾成药也？问之，知减其半，噫嘻，吾投三枚，将令活三年也，今
止活年半耳。后年余复病而卒，脉药之神如此。
张鹤仙，名医也。其医效有足采者，张嘉兴人，少孤，始携药囊入吾郡，未知名也。
一日郁温州水轩患阳证，伤寒禀气又薄，群医束手，不敢下。曰∶脉已绝矣，下之则死。
张胗其足脉，其独大。曰∶可治。遂投大承气汤，一而愈，名遂振。后有巡院杨裁庵者，按脉
证如前，郁荐之，复愈。由是，吴之称名医者，首鹤仙。召视者满吴，下终其身取效无虑数
百，多以大黄之功，俗遂称张大黄云。自己常进大黄丸子合许，曰∶此泻南方补北方，人弗知也，年九十卒。
钱渐川，幼文勤苦，久之抱郁成疾，上焦苦咽闭，中焦苦隔噎烦闷，下焦则苦遗浊，极
而呕血，几殆众医治之，罔效。偶值常熟顾爱杏至，以疾叩请，询众治，按曰∶诸君治法未尝
误也，而弗效者，证杂而药淆也。今请分治之，上焦用药清火解毒，食饱服之；中焦用药开郁
除食，后服之，下焦用药升降水火，空心服之。品不过三四，剂不过五六，俱奏验，病若失，后
强健如故。登仕版此明医不失治之效与。
因病服药，喻如因漏 船，舱久木朽，则油料无所用矣。是知舟之载以木，非以舱人之
生以气非以药。今人竭精神以遂外物，疲有用以事无用曰∶吾有药焉，是以凿舟沉舸，而恃
哉！先辈沉东老，性澹泊，五旬余，合服人乳药丸子，久不辍，年八十五卒。卒之前半岁药不能进矣。
制附子须大熟，不尔，则有痈疽之祸耳。闻中附子毒而发疡者，如武林童南恒是已童
年五十，好长生术交与多方士，有进热药以助阳者，童信之，中有附子，全剂百丸，仅进四十
五丸，疽发于脑，竟卒。询知附子性毒多上升，故中其毒者，未尝不发毒脑背，多至不救，药
不可不慎也。虽然童所进药当不止附子，应是群诸热药为剂，故其祸极烈耳。
世人相传，灸不着抵吃药，遂比屋，不拘何病，一概攻至。有因灸反甚，荏苒年月以亡
者，可惜也。不知藏寒而病满，与体浓而形充者，法宜灸，安有病弱之人，肢体羸瘦而顾，概
施火攻为也？火攻为病百端，而耗血为尤盛，不可不知。或问其目，曰∶虚者不灸，弱者不
灸，脉浮者不灸，脉微数者不灸，湿家身痛烦者不灸。若不审其宜而概加灸， 其不至于危殆者几希。
俗传花香不宜嗅，嗅之易生痨瘵。余尝验之。晨起见夜合花，其时含蕊将放，窥中有细，
黑虫，纵横不计其数。少顷花大开复窥其中无有矣。其花傍坐，亦未见有一虫飞出，倏忽之
间，何以始伙而终？无以此见，嗅得花香，非得香也，得虫也，香盛则成虫，其理有不可测者。
人以阳气为主导，阴气往往有余，而阳气常常不足。近世的医生却提倡补阴的议论，他们的方剂以黄柏为君药，以知母、地黄等寒性药物为佐使药，合起来服用达到一斗的量，认为这样可以保全生命，唉！这是错误的。人的虚劳不足，倦怠嗜睡，眩晕昏沉，各种厥逆上冲，胀闷痞塞，是谁造成的呢？这是阳气亏损所导致的，难道还要助长阴气而耗损阳气吗？人的一身，饮食男女，居住处所和运动，都依赖阳气。至于阴气，则是随着阳气的运动而主持血液运行的。所以人的阳气受损，只应当补益它、温煦它，温补的方法施行后，阳气就会强盛，百病也就消除了。
医生使用医术，不过是吐法、下法、汗法、下法以及解表攻里的方法罢了，不能针对一种病就自创一种方法。现在的人遇到疾病就开方子，动辄二十多味药，少的也不下几味，哪里懂得张仲景等名医的心法呢！我看古人大多使用成方进行加减，不过一两味药，如果没有违背病情，就不轻易更改，正是为了适宜用汗法、适宜用吐法、适宜用下法、适宜解表里之邪。病情是有限的，所以攻治病邪的方法也是有限的，怎么能随意发挥己见，任意开立方剂呢？药物的性质有相刑、相反、相忌、相宜的区别，如果处方味道太多，就无法认清其药性，带来的危害不少。所以我希望世人，必须透彻了解病情，严格遵循古方之后才可以用药。
药笼中的物品，没有什么不可以用的，贵在适合病情罢了。现在的医生见到药性平缓的药物，就肆意增减，称之为医中的“王道”，人们也因为贪图没有祸患而顺从用药。如果稍微涉及药性猛烈峻利的药物，就束手不敢使用。稍微有人使用，大家就争着指责为“野狼虎”（指凶险的药），不肯亲近，唉。工匠砍断木头，还选取锋利的斧头，对于用药，却选取钝拙的而舍弃锋利的，为什么呢？由此可知，不敢使用猛烈的药物，都是不深究脉理、不明白病情的人。
邵尧夫说：“百病起于情志，情志轻则病也轻。”哪些病不是起于情志呢？大概人生以气为主，情志过喜则气散乱，愤怒则气上升，悲哀则气消减，劳累则气耗损，惊恐则气紊乱，思虑则气结聚，欲望则气倾覆，寒冷则气收敛，炎热则气泄越，疾病由此产生。识破情志并加以节制，疾病也会减少。如果执着于外物不止息，难道不会对生命造成祸患吗？所以君子重视保养本性而不放纵情志，这是养气延年的方法。
病人病情去除后又复发，已经好转又发作的，是因为阳气衰弱而不能制约病邪的缘故。现在不能养护阳气而屡次从事攻击性的治疗，有热病的，利湿后容易再生热邪；有寒病的，寒气去除后里气就虚弱了；有积滞的，攻下后胃气就寒冷了。病情到了再次发作，有什么可怀疑的呢？所以凡是病情刚去之后，就应当颐养精神，修养性情，放下万般牵挂，调息百日，以生发阳气，等到阳气既已强盛，那么阴邪就不能干扰，旧疾也不会自行发作了。如果病情稍事闲暇，就忙于应酬，啸傲如常，以至于再次发作，那么危险时期就要到了。
先父有教诲说，元气与脾气原本没有两样，人的元气充足，脾气自然磨运消化，元气也就更加充盛；如果元气虚少，脾就不能运化，导致胀满，痞气之类的疾病就发作了。我不才，向来禀赋衰弱，近年来脾胃的病时常发作，因为有感于先君的至理教诲，谨记于此。
我小时候患有脾胃病，饮食一下咽就感到胀满，思考未找到根源，曾经读李东垣的论述说：“气聚在脾中不得疏散，所以时常发生胀满”，这确实是中焦的表现情况，只是没理解治疗的方子。后来读《医学拾遗》治痞论说：“热邪既然在上部，那么内部寒凝而气不下行，所以应当用热药来温煦中焦，并向下引导热邪，使热邪得以降下。”又读《产后论》说：“并非由血能抢心，而是营卫不充实，中焦不治，气失去依托，而上奔于心。”气聚则行，寒则凝，行则病散，凝则疾生。邪气乘虚而入，不在于淤血有没有，所以干姜是产后的要药，因为它是辛热的。只要温暖正气，以达到平和，那么百病就没有产生的途径了。以此互相参照，那么李东垣关于气聚在脾中的旨意，就非常明白了。
附子、大黄，医生们都畏惧而不使用，然而往往有因此得力的例子。曾经听说许北门说：以前患脾泄（脾虚泄泻），经年不愈，向郑澹泉请教，让他用枣附丸。附子用童便煮制，经过一天研末，用枣肉炼为丸，根据体质服用，神效。近来学院谢蚪蜂，每天进服枳壳大黄丸二三服，神气才清爽。都宪张庐山阻止他不听，而谢蚪蜂的体质更加充实。药性是否适宜于人，不是庸医所能认识的。
现在治疗眼病的人，大都用凉药点治，不知道眼睛，是血的精华，血得热则运行，得寒则凝结。古人点目用冰片、干姜，是为了将邪气散于体外。所以精明的府窍，不可有一毫渣滓，应当外用热药以散其邪，则睛膜舒展转动；内用温药以调和其血，则血脉通利。眼睛没有不可治疗的，只是外用热药，如果非常疼痛难以忍受，然而拔去邪毒，所谓一劳永逸，这是医药拾遗中的论点揭示出来的。
眼睛得到血才能视物，血冷则凝结，这个道理很容易明白，但医生很少知道。邻居管连云的妻子眼睛患病，眼眶周围红烂，几年越来越严重，百计治疗，不能治愈。请吴御医诊治，说：“我明白病因了。”为她治疗大热之剂，服用几次，病像脱落一样好了，眼睛复明。问他说：“这不难知道。这个女人进服凉药太多了。用大热剂则凝结的血重新散开，前面的药都得以奏效，这可以作为治疗眼病的好方法。”吴御医忘了他的名字，专门用附子，人们称他为“吴附子”。
高安姚姓的人三十岁时，患弱气病气息仅存，也涉猎医书，想取附子服用，起初大家都怀疑不给，后来病势危急，不得已听从，服用到一斤左右，疾病于是痊愈，生了三个儿子。现在将近七十岁，常怀疑他或许会因附子中毒，竟然没有，虽然年老还间断服用不停止。
顾色泉老医生，年龄六十五岁，因为大怒，背上发了疽，大如盂，四周颜色黑。召疡医治疗，用冷药敷贴，敷完觉得凉，大约七八天后，用刀去除淤肉。顾色泉等待他去，说：“四周颜色黑是血滞，再加冷药，不是正确的治疗方法。”于是改用热敷药，去掉旧药敷上，觉得很痒，整夜，第二天颜色鲜红，肿也消了，只有中间起了几十个孔像蜂巢一样。一天多，又觉得恶心作呕，看一个人的头像两个人的头，自己诊脉说：“这是极度虚弱的证候。”用参附大剂，进服两次，看头已经正常了。没过几天竟然痊愈，始终没有刀针的痛苦。唉！用药关系到人生死，像这种证候危险得像累卵，稍微误投就很难啊。
顾色泉说：“凡是疮毒属于阴证的，必须用热药，如天雄、附子之类，都要生用，才可以起死回生。”我问他的证候，他说：“如对口阴发、伏疽，摸不知痛，疽不起泡，四周如墨黑者，是老人虚弱之症，尤其适宜使用。”我私下认为，疮的阴阳一时难辨，疡医遇到此症，大多用寒凉，杀人很多。热药回生，功劳很大，稍微迟疑，生死就在反掌之间。
朱丹溪治疗吐血衄血，大多只用黄柏一味，或者并用黄芩、黄连、生地、麦冬等味，名叫滋阴降火。最近有议论他后期做法的人说：“元气亏损的人，有什么火可降？这是虚证罢了，再令脾胃冰寒，阳气衰败，凭什么保全自己？这就是沉困多年才停止的原因。”我认为丹溪的观点，未必全非，而议论他的人心意良善，是如今遇到前证，应该用丹溪之法降其上升浮游之火，等到炎火退去，然后逐除淤血，而以补助元阳、温和血气的药收功，不也可以吗！
家仆名叫贯的，去金陵路途中患上寒证，服药后稍微好转，所以喜欢喝酒就饮酒一二杯及水饭一碗，病于是大作，气喘急促，吐痰整夜，不睡觉，连续三天。我说：“病很紧急了。怎么办？”请医生商量，用瓜蒂散催吐，于是吐出痰几乎半桶，后来吐出一块像猪脑的血，裹着食物，不到两三天就好了。
妇女病患，大多有心腹疼痛、痞满等疾病，大都由于气血凝聚导致。庸医妄投药饵，补之则加重病患，稍加削伐则损伤元气，治疗应当有法度。先父在长沙做官时，张碧泉夫人患血蛊病，腹痛，已经很严重甚至濒死。先父让人用姜、葱、麝香、真血竭熨烫她的肚脐，经过一段时间而行气，病就好了。一个妇人患血痞，服药多方未见效，张小泉用通利行气的药做成饼，贴在她的肚脐半天，频繁排气而消散。可见病在下部的，汤饮不容易见效，须用心意揣量治疗，使消散于下部才可以。
痘疹的发出，根于骨髓脏腑，与各种疮不同。曾经有人十五岁出痘，问他，说：“极痛不可忍，浑身像排列铁钉，几乎不能翻身。”沈虚明善是幼科医生，一位贵公只有一个儿子，将要赴任告别，沈嘱咐他说：“出痘千万不要用药，用药反而伤生，上痘不必用药，下痘用药也无功；中痘则需要药物扶持，然而未必得人，那不如不药更好。”不久贵公的儿子出痘，不药而愈，完全像沈所说。
家妹七岁，下痢纯血，当时正值倭寇战乱，躲避在吴中，医生已经拒绝救治。先宪副公问：“我不才之人可以救吗？”医生说：“痢疾起于气滞，小儿想要给他万病解毒丹下之，疏通其气，或许有机会治疗。”于是磨服一锭，不行，因为再磨服一锭，第二天大大泻下，随即进粥两碗，病于是痊愈。由此知道解毒丹的功效，神妙无比。又名紫金锭子，详细记载在方书中。
王典，徽县人，寓居京师，通过太医院徐南湖侍御的关系认识，并且多次验证他的方药，每次都记忆下来。晚年回乡，患肠癖下血，众医治不好且病危，南湖说：“我想用王典医生，写信召他来。”王典到，诊察他的病，说：“不是肠癖。”连续进服黄硝之剂大下之。再诊说：“病未尽也，再进前剂，又下痰积满桶。”我说：“可以治了，调理而愈。”所下的秽物更没有血积肠癖遂除。由此看见，腹为热滞不能通血，肠胃逼窄而血下耳，众医都以血治，所以不效也。南湖从此再过十年，患其他病去世。
曾经记得某医书论倒仓一法，不是丹溪心印，却说传自西域异人，恐怕是门人妄记。那些虚羸的人虽然有积聚，只宜养正积除，岂宜倾泻仓廪，以损正气，这可以警戒。他的话很好。南都一个医生，最称知名士，又善于导引术，偶然苦于壅滞，因而用前法大泻，不能在厕所起来，于是死亡。我问他的年龄，则六十多了。六十多岁的人，岂宜行大吐下之法哉！由此知道医生，不贵知法，又贵知理，这个医生岂能明于盈虚消息之理哉！
一个富室患中寒阴证，名医满座，最后请吴御医。到，诊察说：“非附子莫救，但忘记带来，让人去市场挑选极重的三枚，生切，为一剂，计重三两，投之。众医吐舌悄悄减半，以一两半为剂，进之，病于是好了。吴复诊说：“为什么减去我的成药？”问之，知道减其半，唉嘻，我投三枚，将令活三年也，今只活年半耳。后年余复病而卒，脉药之神如此。
张鹤仙，名医也。其医效有足采者，张嘉兴人，少孤，始携药囊入吾郡，未知名也。一日郁温州水轩患阳证，伤寒禀气又薄，群医束手，不敢下。曰：“脉已绝矣，下之则死。”张诊其足脉，其独大。曰：“可治。”遂投大承气汤，一而愈，名遂振。后有巡院杨裁庵者，按脉证如前，郁荐之，复愈。由是，吴之称名医者，首鹤仙。召视者满吴，下终其身取效无虑数百，多以大黄之功，俗遂称张大黄云。自己常进大黄丸子合许，曰：“此泻南方补北方，人弗知也，年九十卒。”
钱渐川，幼文勤苦，久之抱郁成疾，上焦苦咽闭，中焦苦隔噎烦闷，下焦则苦遗浊，极而呕血，几殆众医治之，罔效。偶值常熟顾爱杏至，以疾叩请，询众治，按曰：“诸君治法未尝误也，而弗效者，证杂而药淆也。今请分治之，上焦用药清火解毒，食饱服之；中焦用药开郁除食，后服之，下焦用药升降水火，空心服之。品不过三四，剂不过五六，俱奏验，病若失，后强健如故。登仕版此明医不失治之效与。”
因病服药，喻如因漏船，舱久木朽，则油料无所用矣。是知舟之载以木，非以舱人之生以气非以药。今人竭精神以遂外物，疲有用以事无用曰：“吾有药焉，是以凿舟沉舸，而恃哉！”先辈沉东老，性澹泊，五旬余，合服人乳药丸子，久不辍，年八十五卒。卒之前半岁药不能进矣。
制附子须大熟，不尔，则有痈疽之祸耳。闻中附子毒而发疡者，如武林童南恒是已童年五十，好长生术交与多方士，有进热药以助阳者，童信之，中有附子，全剂百丸，仅进四十五丸，疽发于脑，竟卒。询知附子性毒多上升，故中其毒者，未尝不发毒脑背，多至不救，药不可不慎也。虽然童所进药当不止附子，应是群诸热药为剂，故其祸极烈耳。
世人相传，灸不着抵吃药，遂比屋，不拘何病，一概攻至。有因灸反甚，荏苒年月以亡者，可惜也。不知藏寒而病满，与体浓而形充者，法宜灸，安有病弱之人，肢体羸瘦而顾，概施火攻为也？火攻为病百端，而耗血为尤盛，不可不知。或问其目，曰：“虚者不灸，弱者不灸，脉浮者不灸，脉微数者不灸，湿家身痛烦者不灸。若不审其宜而概加灸，其不至于危殆者几希。”
俗传花香不宜嗅，嗅之易生痨瘵。余尝验之。晨起见夜合花，其时含蕊将放，窥中有细黑虫，纵横不计其数。少顷花大开复窥其中无有矣。其花傍坐，亦未见有一虫飞出，倏忽之间，何以始伙而终？无以此见，嗅得花香，非得香也，得虫也，香盛则成虫，其理有不可测者。
Humans are dominated by Yang Qi (Vital Energy), while Yin (Cold/Dark/Passive principle) is often in excess and Yang is often deficient. Physicians of recent times have advocated the theory of tonifying Yin, using Phellodendri Cortex (Huangbai, 黄柏) as the sovereign drug, with Anemarrhenae Rhizoma (Zhimu, 知母) and Rehmanniae Radix (Dihuang, 地黄) and other cold-natured drugs as ministers and assistants, taking them in quantities amounting to a dou, believing this can preserve life. Alas! This is erroneous. Who causes deficiency exhaustion, lethargy, drowsiness, vertigo, numbness and obstruction, various types of Jue (reversal) with upward counterflow, distension, fullness, and epigastric blockage? It is caused by the depletion of Yang Qi. Should we then assist Yin and consume Yang? The entire human body, including diet, sexual activity, dwelling, and movement, relies on Yang Qi. Yin Qi, on the other hand, follows the movement of Yang to govern the blood. Therefore, when human Yang is damaged, it should only be tonified and warmed. Once warming and tonification are applied, Yang will flourish, and all diseases will be eliminated.
The medical arts employed by physicians consist merely of emesis, purgation, sweating, and methods for releasing the exterior or attacking the interior; one cannot create a unique method for every disease. Nowadays, when prescribing for illnesses, doctors often use more than twenty ingredients, rarely fewer than several. How do they understand the core principles of Zhang Zhongjing and other famous physicians? I observe that ancients mostly used established formulas with minor modifications, changing no more than one or two herbs, and did not readily alter prescriptions unless there was a deviation from the condition. This precisely refers to situations where sweating, emesis, purgation, or resolving the exterior-interior relationship is indicated. Since pathological conditions are limited, so too are the methods of attacking disease. How can one arbitrarily exercise personal opinion and compose formulas at will? Drug properties have relationships of punishment, opposition, contraindication, and compatibility. If too many flavors are prescribed, their true natures become unrecognizable, causing significant harm. Thus, I desire that people thoroughly understand pathological conditions and strictly adhere to ancient formulas before prescribing.
Any item in a medicine cabinet can be used, provided it suits the condition. Modern physicians see mild drugs and arbitrarily add or subtract them, calling them the "King's Way" of medicine. People accept them because they seek safety without adverse effects. However, if a drug has a fierce or potent nature, they clasp their hands in fear and dare not use it. Those who use such drugs are accused of wielding "wild wolves and tigers," and people refuse to approach them. Alas. A carpenter cutting wood still selects an axe for its sharpness; why, in using medicine, do we choose dullness over sharpness? From this, we know that those who dare not use potent drugs are those who do not deeply understand pulse pathology and fail to comprehend the condition.
Shao Yaofu said: "A hundred diseases arise from emotions; if emotions are light, the disease is light." Which disease does not arise from emotions? Life is primarily governed by Qi. Excessive joy scatters Qi; anger causes Qi to rise; sorrow consumes Qi; labor exhausts Qi; fright disorders Qi; thinking knots Qi; desire tilts Qi; cold gathers Qi; heat leaks Qi. Diseases arise from these. Recognizing and regulating emotions reduces illness. If one clings to external objects without cessation, will it not bring harm to life? Therefore, gentlemen value preserving nature and not indulging emotions; this is the method for nourishing Qi and prolonging life.
When a patient's illness recedes but returns, or improves then relapses, it is because Yang is weak and unable to control the pathogen. Now, instead of nurturing Yang, frequent aggressive treatments are used. For heat pathogens, draining benefits may generate new heat; for cold pathogens, removing cold leaves the interior deficient; for stagnation, purging makes the stomach cold. Is it surprising that the disease recurs? Therefore, after the condition subsides, one must nurture the spirit, cultivate character, let go of worldly concerns, regulate breathing for a hundred days to generate Yang Qi. When Yang is strong, Yin pathogens cannot interfere, and old diseases will not recur. If the condition is slightly relaxed, engaging in social interactions and behaving as usual leads to recurrence, signaling impending danger.
My late father instructed: Yuan Qi (Original Qi) and Pi Qi (Spleen Qi) are essentially the same. When Yuan Qi is sufficient, Pi Qi naturally transforms and transports, further enriching Yuan Qi. If Yuan Qi is deficient, the Spleen cannot transport, leading to distension and the onset of Pi (mass/stagnation) diseases. I, being constitutionally weak, suffer from occasional Spleen ailments. Moved by my late father's profound teachings, I record this here.
In my youth, I suffered from Spleen ailments, experiencing distension immediately after eating. I pondered the cause until reading Li Dongyuan's treatise: "Qi gathers in the Spleen and cannot disperse, hence periodic distension." This confirmed the manifestation in the Middle Jiao, though I did not yet understand the treatment. Later, reading *Medical Supplement* on treating Pi: "Heat above causes internal cold coagulation and downward failure of Qi; thus, hot drugs should warm the Middle Jiao and guide heat downward." Also, *Postpartum Treatise*: "It is not Blood robbing the Heart, but insufficient Ying and Wei, untreated Middle Jiao, and Qi losing its foundation, rushing up to the Heart." Qi gathers and moves; Cold coagulates. Movement disperses disease; coagulation generates illness. Pathogens exploit deficiency, regardless of Blood stasis. Hence, Dried Ginger (Ganjiang, 干姜) is essential postpartum due to its pungent and hot nature. By warming Zheng Qi (Upright Qi) to achieve harmony, diseases do not arise. Comparing these, Li Dongyuan's insight on Qi gathering in the Spleen becomes clear.
Fuzi (Prepared Aconite Root) and Dahuang (Rhubarb) are feared and avoided by physicians, yet often yield results. Xu Beimen once said: He suffered from Pi diarrhea for years without cure. Zheng Danquan prescribed Zao Fu Wan (Jujube and Aconite Pills). Fuzi was boiled in child's urine, processed, powdered, and formed into pills with jujube paste. It was miraculous. Recently, Xie Doufeng took Zhike Dahuang Wan (Citrus Aurantium and Rhubarb Pills) two to three times daily, gaining mental clarity. Chancellor Zhang Lushan advised against it, but Xie's constitution improved. Whether a drug suits a person is beyond the recognition of mediocre physicians.
Modern eye treatments largely use cooling drops, unaware that eyes are the essence of Blood. Blood flows with heat and coagulates with cold. Ancients used Borneol (Bingpian, 冰片) and Dried Ginger for eye drops to scatter pathogens externally. The organ of vision must be free of debris; external hot drugs scatter pathogens, relaxing the membranes; internal warm drugs harmonize Blood, ensuring smooth flow. No eye disease is incurable. External hot drugs may cause pain, but they remove toxins—the proverbial "one labor, eternal rest." This argument is highlighted in *Medical Supplement*.
Eyes see through Blood; cold Blood coagulates—a simple truth often ignored. Neighbor Guan Lianyun's wife had red, ulcerated eyelids for years, resistant to treatment. Imperial Physician Wu diagnosed her, stating: "I know the cause." He prescribed strong hot agents. After a few doses, the disease vanished, and sight returned. Explaining: "This woman took too many cooling drugs. Strong hot agents dispersed the coagulated Blood, allowing previous ineffective treatments to work. This is a good method for eye diseases." Dr. Wu, forgetting her name, specialized in Fuzi, earning the title "Wu Fuzi."
Yao from Gao'an, aged thirty, suffered from weak Qi, barely surviving. He read medical texts and wanted to take Fuzi. Initially refused, he took it when critical, consuming about one jin (500g). He recovered and sired three sons. Now nearly seventy, he occasionally continues taking it without toxicity.
Old physician Gu Sequan, aged sixty-five, developed a large carbuncle on his back after extreme anger, black around the edges. Surgeons applied cold compresses. After seven to eight days, when debriding necrotic tissue, Gu observed: "Black edges indicate Blood stasis; adding cold drugs is wrong." He switched to hot compresses. The area became itchy, then bright red, swelling subsided, leaving honeycomb-like holes. Next day, nausea and vomiting occurred, and he saw double. Self-pulsing, he declared: "Extreme deficiency." Large doses of Shenfu Tang (Ginseng and Aconite Decoction) cured him without surgery. Alas! Medicine determines life and death; such critical cases require precision.
Gu Sequan stated: "Yin-type sores must use hot drugs like Tianxiong and Fuzi, raw, to revive the dying." He described Yin-type boils (e.g., neck carbuncles, hidden abscesses) with no pain, no blisters, and black margins as suitable for this. I believe distinguishing Yin/Yin sores is hard; surgeons often use cold, killing many. Hot drugs save lives; hesitation costs lives.
Zhu Danxi treated hematemesis and epistaxis mainly with Huangbai alone or combined with Huangqin, Lianmu, Shengdi, and Maidong, named "Nourishing Yin and Descending Fire." Critics argue: "Deficient Yuan Qi has no fire to descend; this is deficiency. Freezing the Spleen/Stomach destroys Yang. How can one survive?" They claim this causes chronic debility. I think Zhu's view isn't entirely wrong, nor are the critics' intentions bad. For such cases, use Zhu's method to descend floating fire first. Once inflammation subsides, remove stasis, then tonify Yuan Yang and warm Blood/Qi to conclude treatment.
My servant Guan contracted a cold syndrome in Jinling. Medication helped slightly, so he drank wine and ate rice. The illness worsened: rapid breathing, all-night phlegm expectoration, insomnia for three days. I said: "Critical. What to do?" We consulted a doctor and used Gouti San (Melon Seed Powder) to induce vomiting. Half a bucket of phlegm was expelled, followed by a brain-like clot. Within two days, he recovered.
Women often suffer abdominal pain, fullness, and stagnation due to Qi and Blood binding. Mediocre doctors prescribe blindly: tonics worsen the condition, draining drugs damage Yuan Qi. Treatment requires method. My father, serving in Changsha, treated Mrs. Zhang Biquan's Blood Gu (abdominal mass) with abdominal pain near death. He applied ginger, green onion, musk, and genuine Dragon's Blood (Xuejie, 血竭) to her umbilicus. Qi moved, and she healed. Another woman with Blood Pi (stagnation) failed multiple treatments. Zhang Xiaoquan applied a cake of Qi-moving drugs to her umbilicus for half a day, causing frequent gas release and resolution. For lower-body diseases, decoctions may fail; strategic topical application is needed.
Smallpox originates in marrow and viscera, differing from other sores. A fifteen-year-old suffered excruciating pain, feeling like iron nails piercing the body. Pediatrician Shen Xuming advised a nobleman with a single son: "Do not use medicine for smallpox; it harms life. Upper-stage needs no meds; lower-stage meds are useless; middle-stage needs support but success is uncertain. Better no meds." The boy recovered without meds, as predicted.
My sister, aged seven, passed pure blood due to dysentery during war. Doctors refused treatment. Vice-Commissioner asked if she could be saved. The doctor said: "Dysentery arises from Qi stagnation. Give Wanbing Jiedu Dan (Ten Thousand Disease Detoxifying Pill) to purge and unblock Qi." One pill failed; a second caused massive purging. She drank porridge and recovered. The pill's efficacy is miraculous, also known as Zijin Ding (Purple Gold锭).
Wang Dian, from Huizhou, lived in Beijing. Through Xu Nanhu, I knew him and verified his prescriptions. Returning home, he suffered intestinal bleeding with bloody stools. Doctors failed, and he became critical. Xu Nanhu summoned Wang. Wang diagnosed: "Not intestinal bleeding." He administered Huangxiao (Rhubarb and Niter) heavily, causing massive purging of phlegm and accumulation. I said: "Cured. Regulate and heal." The stool contained no more blood or stasis. This shows abdominal heat stagnation blocks Blood, forcing it out through narrowed intestines. Other doctors treated only the blood, failing. Xu Nanhu died ten years later.
I recall a book claiming "Dao Cang" (Emptying the Granary/purging) was transmitted from Western Regions, not Danxi's method. Perhaps disciples misremembered. For emaciated patients with accumulations, nourishing Righteous Qi removes accumulation; purging harms Righteous Qi. This is a warning. A famous scholar-doctor in Nanjing, skilled in Qigong, used this method for stagnation, purged excessively, died in the toilet at sixty-plus. Sixty-year-olds should not undergo drastic purging. Physicians must know principles, not just methods. Who understands the laws of waxing and waning?
A wealthy man suffered severe cold-Yin syndrome. Famous physicians gathered. Finally, Imperial Physician Wu was called. He said: "Only Fuzi can save him, but I forgot mine. Buy three heavy ones, slice raw, weigh three liang, administer." Other physicians secretly halved the dose to 1.5 liang. The illness resolved. Wu asked: "Why reduce my prescription?" Upon learning the reduction, he sighed: "With three liang, he would live three years; now only half a year." He died a year later. Pulse and medicine are divine.
Zhang Hexian, a famous physician from Jiaxing, orphaned young, brought his medicine bag to our region unknown. Yu Wenzhou Shuixuan had a Yang syndrome, thin constitution, group physicians helpless, afraid to purge. Zhang said: "Pulse is absent; purging kills." But Zhang felt the foot pulse, which was distinctively large. "Treatable." He administered Dachengqi Tang (Major Order the Qi Decoction); one dose cured him. Fame spread. Later, Inspector Yang Cai'an had similar symptoms; Yu recommended Zhang; cured again. Zhang became the top physician in Wu. Hundreds were cured, mostly using Dahuang. Known as "Zhang Dahuang." He took Dahuang pills himself, saying: "Draining South, Tonifying North." Died at ninety.
Qian Jianchuan studied hard, developed depression-induced illness: upper Jiao throat closure, middle Jiao blockage/distress, lower Jiao leakage/turbidity, eventually hematemesis, near death. Many doctors failed. Gu Aixing arrived. Examining others' treatments, he said: "Methods correct, but ineffective due to mixed symptoms and confused drugs. Treat separately: Upper Jiao - clear fire/detox after meals; Middle Jiao - open depression/remove food after meals; Lower Jiao - regulate Water/Fire on empty stomach. Few ingredients, few doses. All effective. Recovered strength. This proves enlightened physicians do not miss cures."
Taking medicine for illness is like patching a leaking boat; if the hull rots, oil is useless. Boats carry wood, not cabins; humans live by Qi, not medicine. People exhaust spirit for externals, wasting vitality on useless things, relying on medicine. This drills holes in the boat, sinking it. Senior Chen Donglao was indifferent, took human milk pills in his fifties, lived to eighty-five. Stopped medicine six months before death.
Processed Fuzi must be thoroughly cooked, otherwise carbuncles may erupt. Tong Nanheng from Wulin, aged fifty, sought longevity, trusted alchemists giving hot drugs containing Fuzi. Took 45 of 100 pills. Carbuncle erupted on head, he died. Fuzi's toxicity rises; poisoning affects head/back, often fatal. Drugs must be handled carefully. Tong likely took a mix of hot drugs, causing severe disaster.
People believe moxibustion is harmless, applying it indiscriminately. Some worsen and die. Those with internal cold/fullness or robust bodies suit moxibustion. Weak, emaciated people should not receive fire therapy. Fire therapy consumes Blood. Do not moxa: deficiency, weakness, floating pulse, faint-rapid pulse, dampness with body pain. Without discernment, danger is imminent.
Popular belief says smelling flowers causes consumption (TB). I tested this. Morning, seeing Mimosa buds opening, I saw tiny black insects inside. When fully open, insects gone. Sitting nearby, no insects flew out. How did they appear/disappear? Smelling flowers attracts insects, not fragrance. Intense fragrance breeds insects—unfathomable logic.