自《内经》阐明“胃者，五脏六腑之海也”以后，历代医家都很重视脾胃在人体的重要性，金·李杲更著《脾胃论》以阐明之，称“则元气之充足，皆由脾胃之气无所伤，而后能滋养元气，若胃气之本弱，饮食自倍，则脾胃之气既伤，而元气亦不能充，而诸病所由生也。”并称脏气之升降亦有赖于脾胃，所以强调脾胃一病则五脏六腑四肢九窍俱病，然其诸脏发病损及脾胃者又当如何?大多医家绝少论及。余从临床诸病观之，若诸病之引起脾胃异常，或纳呆，或呕吐，或泄泻者，大都为由轻转重，若脾胃之证日渐恢复者，则为由重转轻，此脾胃为五脏六腑之海含义之二也。
治有缓急
自《素问·至真要大论》提出“治有缓急”之后，张仲景又在《伤寒论》一书中明确地阐明了具体的治有缓急应用方法。称：一表里证俱在者，一般应先解表后治里，但若里证急者，又当先治里后解表，他说：“太阳病，外证未解，不可下也，下之为逆；欲解外者，宜桂枝汤。”“太阳病先发汗，不解，而复下之，脉浮者不愈。浮为在外，而反下之，故令不愈。今脉浮，故知在外，当须解外则愈，宜桂枝汤。”“伤寒，不大便六七日，头痛有热者，与承气汤；其小便清者，知不在里，仍在表也，当须发汗。若头痛者，必衄，宜桂枝汤。”“阳明病，脉浮，无汗而喘者，发汗则愈，宜麻黄汤。”“下利，腹胀满，身体疼痛者，先温其里，乃攻其表，温里宜四逆汤，攻表宜桂枝汤。”“伤寒，医下之，续得下利清谷不止，身疼痛者，急当救里；后身疼痛，清便自调者，急当救表。救里，宜四逆汤；救表，宜桂枝汤。”“病发热头痛，脉反沉，若不差，身体疼痛，当救其里，宜四逆汤。”“本发汗而复下之，此为逆也，若先发汗，治不为逆。本先下之而反汗之，为逆，若先下之，治不为逆。”二虚实证俱在者，若里实特急而危及生命者，当急攻其实邪，如仲景云：“少阴病，得之二三日，口燥咽干者，急下之，宜大承气汤。”“少阴病，自利清水，色纯青，心下必痛，口干燥者，急下之，宜大承气汤。”“少阴病六七日，腹胀不大便者，急下之，宜大承气汤。”若实证为主虚证为次，当采用祛邪的缓中补虚法，仲景云：“五劳虚极赢瘦，腹满不能饮食，食伤，忧伤，饮伤，房室伤，饥伤，劳伤，经络营卫气伤，内有干血，肌肤甲错，两目黯黑。缓中补虚，大黄廑虫丸主之。”“妇人乳中虚，烦乱呕逆，安中益气，竹皮大丸主之。”若虚证为主，实证仅居次要地位。应补其正气，缓者可采用补中佐泻法。其后医家论述急缓者亦多，然总以正气的盛衰为根基。
方有大小
偶睹彭泽民先生之处方均用仲景原方原量之斤、两治病，后又见山西省中医研究所已故名老中医白清佐、王雅轩之处方用量，不但方方常至斤许，而且每味药物动辄至两，甚者半斤，观其疗效亦常显著。再察东垣先生之处方，药味虽多而用量甚少，而山西省中医研究所已故名老中医李翰卿、韩玉辉先生，非但每味药物量小，亦且药味极精，常以几钱至1两为一方，而其疗效极佳。何者正确?何者错误?难下定夺，亦难遵从。
细读《吴鞠通医案》言陈氏所列治法与吴鞠通同而效却异，乃因药量不同所致，颇受启发，再品《伤寒》、《金匮》诸文之味，才更明白，若邪大盛而正不虚者宜大药，若正虚邪微者宜小药。曾治患者刘姓，男，45岁。久患腹满感冒，诸医治疗数年不效，余亦处方20余次无功。思之正虚邪亦微，何能用大药，何不小药治之，处以苏叶1分、陈皮1分、甘草1分，3剂，竟得痊愈。患者云：诸药店、医院医、药人员，均讥笑此方处之甚愚，然余坚持服下，不意，三剂竞愈矣。其后，但见此证者，恒以此意处治，往往获效。
适事为故
在治病的时候，用不用毒药?怎么用?用多少?常常是临床工作者非常重视的问题。
有人说：毒药不但用，而且要大用特用。因为毒药不但能治病，而且能治大病，治沉疴，所以要想力挽沉疴者，非用毒药不可。然而由于毒药有毒，稍用不慎轻则致害，重则害命，所以应用起来有很多值得注意的地方。根据《内经》的意见，其应用时的注意点大致有五：一正治，即逆其病用毒药。《素问·至真要大论》说：“寒者热之，热者寒之，微者逆之，甚者从之，坚者削之，客者除之，劳者温之，结者散之，留者攻之，燥者濡之，急者缓之，散者收之，损者益之，逸者行之，惊者平之，上之下之，摩之，浴之，薄之，劫之，开之，发之。”二反治，即采用与症状相同的治法，这种治法的关键在于伏其所主，先其所因，《素问·至真要大论》说：“帝日：反治何谓?岐伯日：热因寒用，寒因热用，塞因塞用，通因通用，必伏其所主，而先其所因。”三药量与配伍，《素问·至真要大论》说：“有毒无毒所治为主，适大小为制也……君一臣二，制之小也；君一臣三佐五，制之中也；君一臣三佐九，制之大也。”四程度，毒药治病只可见效即止，不可太过，《素问·五常政大论》说：“帝日：有毒无毒服有约乎?岐伯日：病有久新，方有大小，有毒无毒固宜常制矣。大毒治病，十去其六；常毒治病，十去其七；小毒治病，十去其八；无毒治病，十去其九。谷肉果菜，食养尽之，无使过之，伤其正也。”五有故始用，《素问·六元正纪大论》说：“有故无殒，亦无殒也……大积大聚其可犯也，衰其大半而止，过者死。”总之，毒药要用必须注意有是证才能用是药，用是药必须恰当，正如《素问·至真要大论》所说：“观其事也”，“适事为故”。
调和法
《内经》治病，一者用毒药以攻邪，二者调和，并称调和之法为诸法之最神圣者。云：“凡阴阳之要，阳密乃固。两者不和，若春无秋，若冬无夏，因而和之，是谓圣度。(《素问·生气通天论》)
《内经》谓所谓调和者乃调其气也，调其气者，调其气之阴阳也。《素问·至真要大论》日：“辛甘发散为阳，酸苦涌泄为阴，咸味涌泄为阴，淡味渗泄为阳，六者，或收，或散，或缓，或急，或燥，或润，或软，或坚，以所利而行之，调其气，使其平也……帝日：善。气调而得者何如?岐伯日：逆之，从之，逆而从之，从而逆之，疏令气调，则其道也……调气之方，必别阴阳，定其中外，各守其乡，内者内治，外者外治，微者调之，其次平之，盛者夺之，汗之下之，寒热温凉，衰之以属，随其攸利，谨道如法，万举万全，气血正平，长有天命。”
有人问：朱老，何以您在《难病奇治》一书中强调调肝以治疑难之病?答日：《素问·六节藏象论》日：“凡十一脏取决于胆也。”李杲云：“胆者，少阳春生之气，春气生则万化安，故胆气春升，则余脏从之，所以十一脏取决于胆也。”肝者，与胆相表里也，所以肝胆气郁则诸脏随之而郁，因此疏其肝胆，调其肝胆之气的阴阳则诸脏之气随之调和而无疾，所以调肝胆以愈百病也。
气增而久，夭之由也
临床过程中，经常遇见一些患者，虚证用补而益虚，实证用泻而益实，热证用清而愈炽，寒证用热而愈寒的患者，究其所因，大致有三：一者，不知其所属也。《素问．至真要大论》说：“诸寒之而热者，取之阴；热之而寒者，取之阳，所谓求其属也。”《类经》云：“诸寒之而热者，谓以苦寒治热而热反增，非火之有余，乃真阴之不足也。阴不足则阳有余而为热，故当取之于阴，谓不宜治火也，只补阴以配阳，则阴气复而热自退矣。热之而寒者，谓以辛热治寒而寒反甚，非寒之有余，乃真阳之不足也，阳不足则阴有余而为寒，故当取之于阳，谓不宜攻寒也，但补水中之火，则阳气复而寒自消也。故启玄子注日：益火之源以消阴翳，壮水之主以治阳光。又日：脏腑之原有寒热温凉之主，取心者不必齐以热，取肾者不必齐以寒，但益心之阳，寒亦通行，强肾之阴，热之犹可，故或治热以热，治寒以寒，万举万全。”二者，治其王气也。《素问·至真要大论》说：“帝日：善。服寒而反热，服热而反寒，其故何也?岐伯日：治其王气是以反也。”《类经》云：“治其王气者，谓病有阴阳，气有衰王，则治之反甚。如阳盛阴衰者，阴虚火王也，治之者不知补阴以配阳，而专用苦寒治火之王，岂知苦寒皆沉降，沉降则亡阴，阴愈亡则火愈盛，故服寒而反热者，阴虚不宜降也，又如阳衰阴盛者，气弱生寒也，治之者不知补阳以消阴，而专用辛温治阴之王，岂知辛温多耗散，耗散则亡阳，阳愈亡则寒愈甚，故服热反寒者，阳虚不宜耗也，此无他，皆以专治王气，故其病反如此。”三者，久而增气也。《类经》云：“凡五味必先人胃，而后各归所喜之脏，喜攻者，谓五味五脏各有所属也。如九针论日：病在筋无食酸，病在气无食辛，病在骨无食咸，病在血无食苦，病在肉无食甘，犯之者，即所谓五味属也。”又说：“凡五味之性各有所人，若味有偏用，则气有偏病，偏用既久，其气必增，此物化之常也。气增而久，则脏有偏胜，则必有偏绝矣。此致天之由也。”《素问·至真要大论》说：“夫五味人胃，各归所喜攻，酸先人肝，苦先人心，甘先人脾，辛先入肺，咸先入肾。久而增气，物化之常也，气增而久，天之由也。”
近世医家多不重视三种情况，而妄言虚而不受补，实而不受泻，热而不受寒者多矣。
壮火散气，少火生气
予读《素问·阴阳应象大论》中：“壮火之气衰，少火之气壮；壮火食气，气食少火；壮火散气，少火生气。”一节，阅张景岳《类经》注：“火，天地之阳气也。天非此火，不能生物；人非此火，不能有生。故万物之生，皆由阳气。但阳和之火则生物，亢烈之火反害物，故火太过气反衰，火和平则气乃壮。”马莳《黄帝内经素问注证发微》注：“气味太厚者，火之壮也。用壮火之品，则吾人之气不能当之而反衰矣，如乌、附之类，而吾人之气不能胜之，故发热。气味之温者，火之少也。用少火之品，则吾人之气渐尔生旺，血亦壮矣，如参、归之类，而气血渐旺者是也。”所论之火时，颇感费解。其所谓壮火、少火者何?是天地之火?是人之火?是药物之火?药物之火中，壮火者何?少火者何?乌、附既为壮火者，何仲景反用附、桂于肾气丸中而补少火?参、归之为少火，何子和反畏之如虎蝎?反复阅读《素问·阴阳应象大论》首句：“阴阳者，天地之道也，万物之纲纪，变化之父母，生杀之本始，神明之府也，治病必求于本。”与《血证论》“阴阳二字，即是水火”之论时，始稍有悟。所谓火者，既非仅指自然之火，亦非仅指药物之火。壮火，少火者，既非仅指天地之壮火、少火，人之壮火、少火。药物之壮火、少火，既非仅指乌、附为壮火，亦非仅指参、归为少火。然而究竟何谓壮火?何谓少火?仍然不甚明了。
后来，通过临床反复体会，才对壮火、少火之含义有了进一步的理解。30年前，曾遇一患者，女性，40岁。4年前，因风湿性心脏病，二尖瓣狭窄，反复咳血，在某院行二尖瓣分离术。术后虽然咯血已经停止，但却出现心房纤颤，全心衰竭。症见气短心悸，水肿尿少等。前后住院近4年，病情未能控制，转请中医治疗。某医云：身热口渴，舌质红少苔，脉细数，为心阴不足，气血大衰，处以养阴清热，补心安神之剂：生地13克，天花粉15克，人参15克，麦冬15克，五味子15克，知母15克，元参9克，炒枣仁30克，玉竹15克，茯苓15克。次日，家属来诉：服药1个多小时以后，见其气短不足以息，神色慌张，时或神迷。急请某西医以西药抢救之，始能维持至今晨。病情危重，吾急邀恩师李翰卿，老师正要外出开会，不能出诊，嘱可用真武汤加减治之。处方：附子15克，白芍15克，茯苓15克，白术15克，人参15克，杏仁9克。当日下午再诊。家属代诉云：服药之后气短心悸更甚，且滴尿皆无。再察患者，见其气短不足以息，浮肿至甚，神志时清时昧。复求师诊，云：患者阴阳大衰，水邪又甚，稍益其阴则阳气不支，稍补其阳则阴精不济，前方之不效者恐在此耳。《内经》曾云：壮火之气衰，少火之气壮；壮火散气，少火生气。前方用附子15克，人参15克，显系壮火，不如减量用之，以助少火。处方：附子0．3克，白芍O．6克，茯苓0．6克，白术O．6克，人参0．3克，杏仁O．3克。次日往诊，患者云：昨夜服下本药第一煎一个小时以后，自感气短心悸开始好转，至夜间2时左右，感到气短心悸明显好转，并连续排尿数次，浮肿、腹胀减轻。服第二煎后，今晨精神大见改善，并有饥饿感。其后，又以本方治疗30天，浮肿基本消失，精神、食欲明显改善。当时，因我接受新的工作，不能再诊。改由某医诊治，谓病重药轻，岂能医重疾。处方：附子12克，白芍12克，白术15克，茯苓15克，人参15克，五味子15克，天花粉15克，生地30克。5天后，突然逝世。家属云：服该医之方的次日，患者突然感到气短胸满如窒息状，浮肿无尿，身热口渴，进而神志不清而死亡。余闻之三思：附子、人参均有少火、壮火之分，人体亦有少火、壮火之别，贵在用药之量与证相吻合耳。
自《黄帝内经》阐明“胃是五脏六腑的营养源泉”之后，历代医家都非常重视脾胃在人体中的重要性。金元时期的李杲（李东垣）更撰写了《脾胃论》来阐述这一观点，称：“元气的充足，都依赖于脾胃之气不受损伤，然后才能滋养元气；如果胃气根本虚弱，饮食过量，那么脾胃之气就会受伤，而元气也不能充盈，各种疾病也就由此产生了。”并且认为脏腑之气的升降也有赖于脾胃，所以强调脾胃一旦生病，则五脏六腑、四肢及九窍都会患病。然而，其他脏腑发病损害到脾胃的情况又该如何处理呢？大多数医家极少论及这一点。我从临床各种疾病的观察来看，如果各种疾病引起脾胃功能异常，出现食欲不振、呕吐或腹泻等症状的，大多是由轻症转为重症；而如果脾胃的症状日渐恢复，则是由重症转为轻症，这也是“脾胃为五脏六腑之营养源泉”含义的第二层意思。
治疗有缓急之分
自从《素问·至真要大论》提出“治疗有缓急”之后，张仲景又在《伤寒论》一书中明确阐明了具体的“治有缓急”的应用方法。他说：如果表证和里证同时存在，一般应该先解表后治里；但如果里证紧急，又应当先治里后解表。他说：“太阳病（太阳经受邪所致的病证），外证未解除，不可用泻下法，用泻下法是逆治；想要解除外邪，适宜用桂枝汤（Cinnamon Twig Decoction）。”“太阳病先发汗，病未愈，又用泻下法，脉仍浮者，病不愈。浮脉表示病邪在外，反而用泻下法，所以导致病不愈。现在脉浮，所以知道病邪仍在表，应当通过解表使病痊愈，适宜用桂枝汤。”“伤寒，大便不通六七天，头痛且有发热的，给予承气汤（Ephedra Decoction, 此处指调胃承气汤或大/小承气汤，视具体语境，通常指通下剂）；如果小便清长，知道病不在里，仍在表，应当发汗。如果有头痛，可能会流鼻血，适宜用桂枝汤。”“阳明病，脉浮，无汗且气喘的，发汗则痊愈，适宜用麻黄汤（Ephedra Decoction）。”“腹泻，腹胀满，身体疼痛的，先温补其里，再攻伐其表。温里适宜用四逆汤（Four Reversal Decoction），攻表适宜用桂枝汤。”“伤寒，医生误用泻下法，随后出现下利清谷（排出未消化的食物）不止，身体疼痛的，紧急应当救里；后来身体疼痛，大小便正常者，紧急应当救表。救里，适宜用四逆汤；救表，适宜用桂枝汤。”“病人发热头痛，脉象反而沉，如果病不愈，身体疼痛，应当救其里，适宜用四逆汤。”“本来应当发汗却反而用泻下法，这是逆治；如果先发汗，治疗就不算逆。本来应当先泻下却反而发汗，这是逆治；如果先泻下，治疗就不算逆。”
二是虚证和实证同时存在时，如果里实特别紧急且危及生命，应当紧急攻伐其实邪，如仲景说：“少阴病（少阴经受邪所致的病证），得病二三天，口燥咽干的，紧急泻下，适宜用大承气汤（Major Order the Yang Decoction）。”“少阴病，自利清水，颜色纯青，心下部必定疼痛，口干燥的，紧急泻下，适宜用大承气汤。”“少阴病六七天，腹胀且不大便的，紧急泻下，适宜用大承气汤。”如果以实证为主，虚证为次，应当采用祛邪兼缓中补虚的方法，仲景说：“五种劳损导致极度消瘦，腹部胀满不能饮食，由饮食、忧思、饮酒、房事、饥饿、劳累等损伤，经络营卫之气受损，体内有干血，肌肤粗糙如鳞甲，两眼暗黑。缓中补虚，大黄廑虫丸（Dahuang Zhenzhu Wan）主治。”“妇女哺乳期气血虚弱，烦乱呕逆，安中益气，竹皮大丸（Zhupi Da Wan）主治。”如果以虚证为主，实证仅居次要地位，应补益正气，病情较缓者可采用补中佐以泻下的方法。其后医家论述急缓的也很多，但总以正气的盛衰为基础。
方剂有大小之分
偶然看到彭泽民先生的处方均使用张仲景原方原量的斤、两来治病，后来又见到山西省中医研究所已故名老中医白清佐、王雅轩的处方用量，不但每方常达一斤左右，而且每味药物动辄一两，甚至半斤，观察其疗效也常常显著。再考察李东垣先生的处方，药味虽多但用量很少，而山西省中医研究所已故名老中医李翰卿、韩玉辉先生，不仅每味药物量小，而且药味极其精简，常以几钱至一两为一方的剂量，而其疗效极佳。哪种正确？哪种错误？难以定夺，也难以遵从。
细读《吴鞠通医案》，提到陈氏所列治法与吴鞠通相同但疗效却不同，是因为药量不同所致，颇受启发。再品味《伤寒论》、《金匮要略》诸文的深意，才更明白，如果邪气大盛而正气不虚，宜用大剂量药物；如果正气虚弱而邪气微弱，宜用小剂量药物。曾治疗一位姓刘的患者，男，45岁。长期患有腹满感冒，各位医生治疗数年无效，我也处方20余次无功。思考之后认为，此乃正气虚而邪气微，为何能用大药？何不用小药治疗？于是处以苏叶1分、陈皮1分、甘草1分，3剂，竟然痊愈。患者说：各药店、医院医生和药剂人员，都讥笑这个处方非常愚蠢，但我坚持服用，没想到三剂竟治愈了。此后，凡见此证者，恒以此意处方治疗，往往获得疗效。
做事以恰当为原则
在治病的时候，用不用毒药？怎么用？用多少？这常常是临床工作者非常重视的问题。
有人说：毒药不但要用，而且要大胆重用。因为毒药不仅能治病，还能治大病、治沉疴（久治不愈的重病），所以要想力挽沉疴者，非用毒药不可。然而由于毒药有毒，稍有不慎轻则致害，重则害命，所以应用起来有很多值得注意的地方。根据《黄帝内经》的意见，其应用时的注意点大致有五：一是正治，即逆着病势用毒药。《素问·至真要大论》说：“寒者热之，热者寒之，病轻者逆其病性治疗，病重者顺其病性治疗，坚硬的削去它，客邪去除它，劳倦者温养它，郁结者疏散它，留滞者攻逐它，干燥者滋润它，急迫者缓和它，散漫者收敛它，亏损者补益它，逸惰者行导它，惊恐者平复它，上逆者降下它，摩挲它，沐浴它，迫近它，劫夺它，开泄它，发汗它。”二是反治，即采用与症状表象相同的治法，这种治法的关键在于伏制病主因，先究病根源，《素问·至真要大论》说：“皇帝问：什么是反治？岐伯说：热因寒用，寒因热用，塞因塞用，通因通用，必须伏制其病主因，而先究其病根源。”三是药量与配伍，《素问·至真要大论》说：“以有毒无毒所治的病为主，适当决定方剂的大小……君药一，臣药二，制方为小；君药一，臣药三，佐药五，制方为中；君药一，臣药三，佐药九，制方为大。”四是程度，毒药治病只可见效即止，不可太过，《素问·五常政大论》说：“皇帝问：有毒无毒的药物服用有限度吗？岐伯说：病有久新，方有大小，有毒无毒固然应有常规制度。大毒治病，去掉六成病邪；常毒治病，去掉七成病邪；小毒治病，去掉八成病邪；无毒治病，去掉九成病邪。用谷肉果菜，食养来尽除余邪，不要使其过度，伤害正气。”五是有故始用，《素问·六元正纪大论》说：“有病故而无伤，亦无伤也……大积大聚可以犯之，病邪衰退大半就停止，过用会致死。”总之，毒药要用必须注意有是证才能用是药，用是药必须恰当，正如《素问·至真要大论》所说：“观察病情”，“以恰当为准则”。
调和法
《黄帝内经》治病，一是用毒药以攻邪，二是调和，并称调和之法为诸法中最神圣的。说：“凡是阴阳的要领，阳气致密则阴精固守。两者不和，就像春天没有秋天，冬天没有夏天，因此调和它们，这叫圣人的法度。（《素问·生气通天论》）
《黄帝内经》谓所谓调和就是调其气，调其气就是调其气的阴阳。《素问·至真要大论》说：“辛甘发散属阳，酸苦涌泄属阴，咸味涌泄属阴，淡味渗泄属阳，这六种气味，有的收涩，有的发散，有的缓和，有的急迫，有的燥湿，有的润燥，有的软坚，有的坚硬，顺着有利的方向而行，调其气，使其平衡……皇帝说：好。气调而得的是什么情况？岐伯说：逆治，从治，逆而从之，从而逆之，疏令气调，这就是道……调气的方剂，必须辨别阴阳，确定内外，各守其乡，内病内治，外病外治，病轻者调之，其次平之，病盛者夺之，汗之下之，寒热温凉，根据其属性衰减，随其有利之处，谨慎遵循法则，万举万全，气血平和，长寿天命。”
有人问：朱老，为什么您在《难病奇治》一书中强调调肝以治疑难之病？回答说：《素问·六节藏象论》说：“凡十一脏取决于胆也。”李杲说：“胆，是少阳春生之气，春气生则万物安定，所以胆气春升，则其余脏腑随之，所以十一脏取决于胆也。”肝，与胆相表里，所以肝胆气郁则诸脏随之而郁，因此疏其肝胆，调其肝胆之气的阴阳，则诸脏之气随之调和而无病，所以调肝胆以愈百病也。
气增而久，夭之由也
临床过程中，经常遇见一些患者，虚证用补而益虚，实证用泻而益实，热证用清而愈炽，寒证用热而愈寒的患者，究其所因，大致有三：第一，不知其所属也。《素问·至真要大论》说：“诸寒之而热者，取之阴；热之而寒者，取之阳，所谓求其属也。”《类经》说：“诸寒之而热者，谓以苦寒治热而热反增，非火之有余，乃真阴之不足也。阴不足则阳有余而为热，故当取之于阴，谓不宜治火也，只补阴以配阳，则阴气复而热自退矣。热之而寒者，谓以辛热治寒而寒反甚，非寒之有余，乃真阳之不足也，阳不足则阴有余而为寒，故当取之于阳，谓不宜攻寒也，但补水中之火，则阳气复而寒自消也。所以启玄子注曰：益火之源以消阴翳，壮水之主以治阳光。又说：脏腑之原有寒热温凉之主，取心者不必齐以热，取肾者不必齐以寒，但益心之阳，寒亦通行，强肾之阴，热之犹可，故或治热以热，治寒以寒，万举万全。”第二，治其王气也。《素问·至真要大论》说：“皇帝说：好。服寒而反热，服热而反寒，其故何也？岐伯说：治其王气是以反也。”《类经》说：“治其王气者，谓病有阴阳，气有衰王，则治之反甚。如阳盛阴衰者，阴虚火旺也，治之者不知补阴以配阳，而专用苦寒治火之王，岂知苦寒皆沉降，沉降则亡阴，阴愈亡则火愈盛，故服寒而反热者，阴虚不宜降也，又如阳衰阴盛者，气弱生寒也，治之者不知补阳以消阴，而专用辛温治阴之王，岂知辛温多耗散，耗散则亡阳，阳愈亡则寒愈甚，故服热反寒者，阳虚不宜耗也，此无他，皆以专治王气，故其病反如此。”第三，久而增气也。《类经》说：“凡五味必先入胃，而后各归所喜之脏，喜攻者，谓五味五脏各有所属也。如九针论曰：病在筋无食酸，病在气无食辛，病在骨无食咸，病在血无食苦，病在肉无食甘，犯之者，即所谓五味属也。”又说：“凡五味之性各有所人，若味有偏用，则气有偏病，偏用既久，其气必增，此物化之常也。气增而久，则脏有偏胜，则必有偏绝矣。此致天之由也。”《素问·至真要大论》说：“夫五味入胃，各归所喜攻，酸先入肝，苦先入心，甘先入脾，辛先入肺，咸先入肾。久而增气，物化之常也，气增而久，夭之由也。”
近世医家多不重视这三种情况，而妄言虚而不受补，实而不受泻，热而不受寒者多矣。
壮火散气，少火生气
我读《素问·阴阳应象大论》中：“壮火之气衰，少火之气壮；壮火食气，气食少火；壮火散气，少火生气。”一节，看张景岳《类经》注：“火，天地之阳气也。天非此火，不能生物；人非此火，不能有生。故万物之生，皆由阳气。但阳和之火则生物，亢烈之火反害物，故火太过气反衰，火和平则气乃壮。”马莳《黄帝内经素问注证发微》注：“气味太厚者，火之壮也。用壮火之品，则吾人之气不能当之而反衰矣，如乌、附之类，而吾人之气不能胜之，故发热。气味之温者，火之少也。用少火之品，则吾人之气渐尔生旺，血亦壮矣，如参、归之类，而气血渐旺者是也。”所论之火时，颇感费解。其所谓壮火、少火者何？是天地之火？是人之火？是药物之火？药物之火中，壮火者何？少火者何？乌头、附子既为壮火者，为何张仲景反用附子、桂枝于肾气丸中而补少火？人参、当归之为少火，为何张子和反畏之如虎蝎？反复阅读《素问·阴阳应象大论》首句：“阴阳者，天地之道也，万物之纲纪，变化之父母，生杀之本始，神明之府也，治病必求于本。”与《血证论》“阴阳二字，即是水火”之论时，始稍有悟。所谓火者，既非仅指自然之火，亦非仅指药物之火。壮火、少火者，既非仅指天地之壮火、少火，人之壮火、少火。药物之壮火、少火，既非仅指乌头、附子为壮火，亦非仅指人参、当归为少火。然而究竟何谓壮火？何谓少火？仍然不甚明了。
后来，通过临床反复体会，才对壮火、少火之含义有了进一步的理解。30年前，曾遇一患者，女性，40岁。4年前，因风湿性心脏病，二尖瓣狭窄，反复咳血，在某院行二尖瓣分离术。术后虽然咯血已经停止，但却出现心房纤颤，全心衰竭。症见气短心悸，水肿尿少等。前后住院近4年，病情未能控制，转请中医治疗。某医说：身热口渴，舌质红少苔，脉细数，为心阴不足，气血大衰，处以养阴清热，补心安神之剂：生地13克，天花粉15克，人参15克，麦冬15克，五味子15克，知母15克，元参9克，炒枣仁30克，玉竹15克，茯苓15克。次日，家属来诉：服药1个多小时以后，见其气短不足以息，神色慌张，时或神迷。急请某西医以西药抢救之，始能维持至今晨。病情危重，吾急邀恩师李翰卿，老师正要外出开会，不能出诊，嘱可用真武汤（Zhenwu Decoction）加减治之。处方：附子15克，白芍15克，茯苓15克，白术15克，人参15克，杏仁9克。当日下午再诊。家属代诉云：服药之后气短心悸更甚，且滴尿皆无。再察患者，见其气短不足以息，浮肿至甚，神志时清时昧。复求师诊，云：患者阴阳大衰，水邪又甚，稍益其阴则阳气不支，稍补其阳则阴精不济，前方之不效者恐在此耳。《内经》曾云：壮火之气衰，少火之气壮；壮火散气，少火生气。前方用附子15克，人参15克，显系壮火，不如减量用之，以助少火。处方：附子0.3克，白芍0.6克，茯苓0.6克，白术0.6克，人参0.3克，杏仁0.3克。次日往诊，患者云：昨夜服下本药第一煎一个小时以后，自感气短心悸开始好转，至夜间2时左右，感到气短心悸明显好转，并连续排尿数次，浮肿、腹胀减轻。服第二煎后，今晨精神大见改善，并有饥饿感。其后，又以本方治疗30天，浮肿基本消失，精神、食欲明显改善。当时，因我接受新的工作，不能再诊。改由某医诊治，谓病重药轻，岂能医重疾。处方：附子12克，白芍12克，白术15克，茯苓15克，人参15克，五味子15克，天花粉15克，生地30克。5天后，突然逝世。家属云：服该医之方的次日，患者突然感到气短胸满如窒息状，浮肿无尿，身热口渴，进而神志不清而死亡。余闻之三思：附子、人参均有少火、壮火之分，人体亦有少火、壮火之别，贵在用药之量与证相吻合耳。
Since the *Huangdi Neijing* (Yellow Emperor's Inner Canon) elucidated that "the Stomach is the sea of the Five Zang and Six Fu organs," physicians of successive dynasties have attached great importance to the role of the Spleen and Stomach in the human body. Li Gao (Li Dongyuan) of the Jin Dynasty further wrote *Pi Wei Lun* (Treatise on the Spleen and Stomach) to expound this view, stating: "The sufficiency of Yuan Qi (Original Qi) depends entirely on the Qi of the Spleen and Stomach being unharmed, thereby nourishing Yuan Qi; if the root of Stomach Qi is weak and food intake doubles, the Qi of the Spleen and Stomach will be injured, and Yuan Qi cannot be filled, leading to the onset of various diseases." He also believed that the ascending and descending of Zang organ Qi relies on the Spleen and Stomach. Therefore, he emphasized that if the Spleen and Stomach become diseased, all Five Zang and Six Fu organs, limbs, and nine orifices will suffer. However, how should one handle cases where other Zang organs' diseases damage the Spleen and Stomach? Most physicians rarely discuss this. From my observation of various clinical diseases, if various diseases cause abnormalities in the Spleen and Stomach, manifesting as poor appetite, vomiting, or diarrhea, they generally progress from mild to severe. Conversely, if Spleen and Stomach symptoms gradually recover, it indicates a progression from severe to mild. This is the second meaning of "the Spleen and Stomach are the sea of the Five Zang and Six Fu organs."
Treatment Has Urgency and Slowness
Since the *Suwen: Zhenshi Yao Dalun* chapter proposed "treatment has urgency and slowness," Zhang Zhongjing further clarified the specific application methods of "urgency and slowness in treatment" in the *Shanghan Lun* (Treatise on Cold Damage Diseases). He stated: When both exterior and interior syndromes are present, generally one should first resolve the exterior and then treat the interior; but if the interior syndrome is urgent, one should first treat the interior and then resolve the exterior. He said: "In Taiyang disease (disease of the Taiyang channel), if the exterior signs are not resolved, purgation must not be used; using purgation is contrary to principle. To resolve the exterior, Guizhi Tang (Cinnamon Twig Decoction) is appropriate." "In Taiyang disease, if sweating was administered first but the disease did not resolve, and purgation was subsequently used, and the pulse remains floating, the disease will not resolve. A floating pulse indicates the pathogen is outside; using purgation in error leads to non-resolution. Since the pulse is now floating, we know the pathogen is still in the exterior, and resolving the exterior will lead to recovery; Guizhi Tang is appropriate." "In Shanghan (Cold Damage), if there is constipation for six or seven days accompanied by headache and fever, Chengqi Tang (Ephedra Decoction, referring to purgative formulas like Tiaowei Chengqi Tang, Dachengqi Tang, or Xiaochengqi Tang) may be given; however, if urination is clear, we know the disease is not in the interior but still in the exterior, and sweating is required. If headache persists, epistaxis may occur, and Guizhi Tang is appropriate." "In Yangming disease, if the pulse is floating, there is no sweat, and wheezing occurs, sweating will lead to recovery; Mahuang Tang (Ephedra Decoction) is appropriate." "If there is diarrhea, abdominal fullness, and body pain, first warm the interior, then attack the exterior. Warming the interior is appropriate with Sini Tang (Four Reversal Decoction), and attacking the exterior is appropriate with Guizhi Tang." "In Shanghan, if a physician mistakenly used purgation, followed by incessant diarrhea with undigested food and body pain, urgently save the interior; later, if body pain persists but bowel movements normalize, urgently save the exterior. Saving the interior is appropriate with Sini Tang; saving the exterior is appropriate with Guizhi Tang." "If a patient has fever and headache, but the pulse is unexpectedly deep, and if the condition does not improve, accompanied by body pain, save the interior; Sini Tang is appropriate." "Originally indicated for sweating but purgation was used instead; this is contrary treatment. If sweating had been done first, the treatment would not have been contrary. Originally indicated for purgation but sweating was used instead; this is contrary treatment. If purgation had been done first, the treatment would not have been contrary."
Secondly, when deficiency and excess syndromes coexist: if interior excess is particularly urgent and life-threatening, urgently attack the excess pathogen, as Zhongjing said: "In Shaoyin disease (disease of the Shaoyin channel), after two or three days, if there is dry mouth and throat, urgently purge; Dachengqi Tang (Major Order the Yang Decoction) is appropriate." "In Shaoyin disease, if there is spontaneous diarrhea of clear water, pure green in color, with必 pain in the epigastrium and dry mouth/throat, urgently purge; Dachengqi Tang is appropriate." "In Shaoyin disease, after six or seven days, if there is abdominal fullness and constipation, urgently purge; Dachengqi Tang is appropriate." If excess is primary and deficiency is secondary, adopt a method of dispelling pathogens while gently tonifying deficiency. Zhongjing said: "Due to five types of overwork leading to extreme emaciation, abdominal fullness, inability to eat, caused by dietary injury, emotional distress, drinking injury, sexual excess, hunger injury, labor injury, and damage to meridians, Ying (Nutritive) and Wei (Defensive) Qi, with internal dried blood, rough skin resembling scales, and dark eyes. Gently tonify deficiency and benefit the middle; Dahuang Zhenzhu Wan (Rhubarb and Ground Beetle Pill) is the main treatment." "For women with deficiency during lactation, restlessness, and vomiting, to calm the middle and boost Qi; Zhupi Da Wan (Bamboo Peel Large Pill) is the main treatment." If deficiency is primary and excess is secondary, tonify righteous Qi. For slower conditions, use a method of tonifying the middle with auxiliary purging. Later physicians discussed urgency and slowness extensively, but always based it on the strength or weakness of righteous Qi.
Formulas Have Large and Small Dosages
I once observed Mr. Peng Ze-min's prescriptions using Zhang Zhongjing's original formulas and original dosages in jin and liang. Later, I saw the prescription dosages of renowned late-life TCM practitioners Bai Qingzuo and Wang Yaxuan from the Shanxi Provincial Institute of Traditional Chinese Medicine. Their prescriptions often reached around one jin per formula, with individual herbs frequently measuring one liang, or even half a jin. Observing their efficacy, it was often significant. In contrast, examining Mr. Li Dongyuan's prescriptions, although they contained many herbs, the dosages were very small. Similarly, renowned late-life TCM practitioners Li Hanqing and Han Yuhui from the Shanxi Provincial Institute of TCM used very small dosages for each herb and extremely refined formulas, often consisting of just a few qian to one liang per formula, yet their efficacy was excellent. Which is correct? Which is wrong? It is difficult to decide or follow either strictly.
Reading the *Wujutong Yi'an* (Medical Cases of Wu Jutong), I was inspired by the note that Chen's listed treatments were identical to Wu Jutong's but yielded different results due to differences in dosage. Further pondering the texts of *Shanghan Lun* and *Jingui Yaolue*, I realized: if pathogens are abundant and righteous Qi is not deficient, large doses of medicine are suitable; if righteous Qi is deficient and pathogens are slight, small doses are suitable. I once treated a male patient, surnamed Liu, aged 45, who suffered from chronic abdominal fullness and cold-like symptoms. Various doctors failed to cure him after years of treatment, and my own 20+ prescriptions were also ineffective. Reflecting that his righteous Qi was deficient and pathogens slight, why use large doses? Why not try small doses? I prescribed Su Ye (Perilla Leaf) 1 fen, Chen Pi (Tangerine Peel) 1 fen, and Gan Cao (Licorice Root) 1 fen, for 3 doses. He recovered completely. The patient stated that pharmacists and hospital staff mocked the prescription as foolish, but he persisted and was cured in three doses. Thereafter, whenever I encountered such cases, I applied this principle and often achieved success.
Appropriateness as the Goal
Whether to use toxic medicines, how to use them, and in what quantities are issues highly valued by clinicians.
Some argue: Toxic medicines should not only be used but used boldly and heavily. Because toxic medicines can treat major diseases and chronic incurable conditions, those aiming to reverse severe chronic illnesses must use toxic medicines. However, due to their toxicity, improper use can cause harm or death. Thus, several precautions are necessary. According to the *Neijing*, there are roughly five points: First, Zhengzhi (Direct Treatment), i.e., treating against the nature of the disease with toxic medicine. *Suwen: Zhenshi Yao Dalun* states: "Cold is treated with heat, heat with cold; mild cases are treated oppositely, severe cases similarly; hardness is reduced, invaders removed, fatigue warmed, stagnation dispersed, retention attacked, dryness moistened, urgency relieved, scattering gathered, loss replenished, lethargy moved, fright calmed, rising lowered, massaged, bathed, pressed, robbed, opened, and released." Second, Fanzi (Contrary Treatment), i.e., adopting a treatment method similar to the symptom's appearance. The key lies in subduing the main cause and addressing the origin. *Suwen: Zhenshi Yao Dalun* states: "The Yellow Emperor asked: What is contrary treatment? Qibo answered: Heat used with cold properties, cold used with heat properties, obstruction treated with obstruction, diarrhea treated with purgation. One must subdue the main cause and address the origin." Third, dosage and compatibility. *Suwen: Zhenshi Yao Dalun* states: "The treatment depends on whether the medicine is toxic or not, determining the size of the formula... One Sovereign, Two Ministers, a small formula; One Sovereign, Three Ministers, Five Assistants, a medium formula; One Sovereign, Three Ministers, Nine Auxiliaries, a large formula." Fourth, degree. Toxic medicines should stop upon seeing effect, not be overused. *Suwen: Wuchang Zheng Dalun* states: "The Yellow Emperor asked: Is there a limit to taking toxic or non-toxic medicines? Qibo answered: Diseases vary in duration and newness, formulas vary in size. There are standard regulations for toxic and non-toxic medicines. Treating with highly toxic medicine removes 60% of the disease; moderately toxic removes 70%; slightly toxic removes 80%; non-toxic removes 90%. Use grains, meats, fruits, and vegetables to complete the nourishment. Do not exceed these limits, lest you injure righteous Qi." Fifth, use only when indicated. *Suwen: Liuyuan Zhengji Dalun* states: "When there is a cause, there is no destruction, nor destruction to the body... Major accumulations and masses can be attacked, but stop when the pathogen is reduced by more than half; exceeding this leads to death." In summary, toxic medicines must be used only when the syndrome matches, and the usage must be appropriate, as stated in *Suwen: Zhenshi Yao Dalun*: "Observe the situation," "Take appropriateness as the goal."
Harmonization Method
The *Neijing* treats diseases by either using toxic medicines to attack pathogens or by harmonizing. Harmonization is called the most sacred of all methods. It states: "The essence of Yin and Yang is that Yang must be dense for Yin to be secure. If the two do not harmonize, it is like spring without autumn, winter without summer. Harmonizing them is the sage's standard. (*Suwen: Shengqi Tongtian Lun*)"
The *Neijing* defines harmonization as regulating Qi, specifically regulating the Yin and Yang of Qi. *Suwen: Zhenshi Yao Dalun* states: "Pungent and sweet disperse and belong to Yang; sour and bitter induce vomiting/drain and belong to Yin; salty induces vomiting/drain and belongs to Yin; bland promotes drainage and belongs to Yang. These six flavors, whether astringent, dispersing, relaxing, urgent, drying, moistening, softening, or hardening, should be used according to what is beneficial to regulate Qi and bring it to balance... The Yellow Emperor asked: How is Qi regulated? Qibo answered: By opposing or following, opposing then following, following then opposing, ensuring Qi flows smoothly. Formulas for regulating Qi must distinguish Yin and Yang, determine interior and exterior, and stay within their domains. Interior diseases are treated internally, exterior diseases externally. Mild cases are regulated, next level balanced, excessive cases subdued via sweating or purgation. Cold, heat, warmth, coolness are used according to their attributes to reduce excess. Follow the principles carefully, and every attempt will succeed, keeping Qi and Blood balanced for longevity."
Someone asked: Old Zhu, why do you emphasize regulating the Liver to treat difficult diseases in your book *Nan Bing Qi Zhi*? I answered: *Suwen: Liujie Zangxiang Lun* states: "All eleven Zang organs depend on the Gallbladder." Li Gao said: "The Gallbladder possesses the Qi of Shaoyang Spring generation. When Spring Qi generates, all transformations are peaceful. Thus, when Gallbladder Qi rises like Spring, the remaining organs follow, so all eleven Zang organs depend on the Gallbladder." The Liver and Gallbladder are exterior-interior paired. Therefore, if Liver and Gallbladder Qi stagnates, all organs stagnate. Thus, soothing the Liver and Gallbladder and regulating their Yin-Yang Qi harmonizes all organ Qi, curing hundred diseases. Hence, regulating the Liver and Gallbladder cures myriad ailments.
Increased Qi Over Time Leads to Premature Death
In clinical practice, patients often appear where deficiency treated with tonification becomes more deficient, excess treated with purging becomes more excess, heat treated with cooling becomes hotter, and cold treated with warming becomes colder. The causes are roughly three: First, not knowing the affiliation. *Suwen: Zhenshi Yao Dalun* states: "For those whose cold makes them hot, seek the Yin; for those whose heat makes them cold, seek the Yang. This is called seeking the affiliation." *Leijing* explains: "Those whose cold makes them hot means using bitter-cold to treat heat but heat increases; this is not excess fire, but deficiency of True Yin. Deficient Yin leads to relative Yang excess causing heat, so treat the Yin, not the Fire. Tonify Yin to match Yang, and heat recedes. Those whose heat makes them cold means using pungent-hot to treat cold but cold worsens; this is not excess cold, but deficiency of True Yang. Deficient Yang leads to relative Yin excess causing cold, so treat the Yang, not Cold. Add fire to water, and Yang recovers, cold dissipates. Thus, Qixuanzi noted: Benefit the source of Fire to eliminate Yin shadows; strengthen the master of Water to control Yang sunlight. Also: Organs have masters of cold, heat, warmth, coolness. Treating Heart need not uniformly use heat; treating Kidney need not uniformly use cold. Boost Heart Yang, and cold circulates; strengthen Kidney Yin, and heat is tolerable. Thus, treating heat with heat, cold with cold, ensures success." Second, treating the Wang Qi (Dominant/Exuberant Qi). *Suwen: Zhenshi Yao Dalun* states: "The Yellow Emperor asked: Good. Taking cold causes heat, taking heat causes cold. Why? Qibo answered: Treating the Wang Qi causes this reversal." *Leijing* explains: "Treating Wang Qi means disease has Yin/Yang, Qi has decline/excess, so treatment reverses. E.g., Yang excess Yin deficiency means Yin deficiency with Fire exuberance. Treators don't tonify Yin to match Yang but use bitter-cold to suppress Fire. Bitter-cold sinks and descends, destroying Yin. As Yin destroys, Fire surges, so taking cold causes heat; Yin deficiency should not be descended. Similarly, Yang deficiency Yin excess means Qi weakness generating cold. Treators don't tonify Yang to eliminate Yin but use pungent-warm to suppress Yin. Pungent-warm consumes and scatters, destroying Yang. As Yang destroys, cold worsens, so taking heat causes cold; Yang deficiency should not be scattered. This happens because exclusively treating Wang Qi." Third, long-term increase of Qi. *Leijing* states: "All five flavors enter the Stomach first, then go to their preferred Zang. 'Preferred attack' means five flavors belong to five Zangs. As per *Jiuzhen Lun*: If disease is in sinews, avoid sour; in Qi, avoid pungent; in bones, avoid salty; in blood, avoid bitter; in flesh, avoid sweet. Violating this is the 'five flavors affiliation.'" It also says: "Each flavor enters specific organs. If flavors are biasedly used, Qi becomes biasedly diseased. Long-term bias increases Qi, which is normal transformation. Increased Qi over time leads to Zang excess and eventual exhaustion. This is the cause of premature death." *Suwen: Zhenshi Yao Dalun* states: "Five flavors enter the Stomach, each goes to its preferred organ. Sour enters Liver first, Bitter Heart, Sweet Spleen, Pungent Lung, Salty Kidney. Long-term use increases Qi, normal transformation. Increased Qi over time is the cause of premature death."
Modern physicians often ignore these three situations, falsely claiming deficiency cannot accept tonification, excess cannot accept purging, and heat cannot accept cooling.
Strong Fire Scatters Qi, Minor Fire Generates Qi
Reading *Suwen: Yin-Yang Yingxiang Dalun*: "Qi of Strong Fire declines, Qi of Minor Fire strengthens; Strong Fire consumes Qi, Qi feeds on Minor Fire; Strong Fire scatters Qi, Minor Fire generates Qi." I read Zhang Jingyue's *Leijing* annotation: "Fire is the Yang Qi of Heaven and Earth. Without this Fire, Heaven cannot generate things; humans cannot live without it. All life comes from Yang Qi. But gentle Fire generates life, while fierce Fire harms it. Thus, excessive Fire leads to Qi decline, while peaceful Fire leads to Qi strength." Ma Shi's *Huangdi Neijing Suwen Zhu Zheng Fa Wei* notes: "Flavor and aroma too thick constitute Strong Fire. Using Strong Fire products, our Qi cannot withstand it and declines, e.g., Wu Tou (Aconite Root) and Fu Zi (Prepared Aconite Root), causing fever as our Qi fails to overcome it. Warm flavor/aroma constitutes Minor Fire. Using Minor Fire products, our Qi gradually grows strong, and Blood strengthens, e.g., Ren Shen (Ginseng Root) and Dang Gui (Angelica Sinensis Root), where Qi and Blood gradually flourish." I found the discussion on Fire confusing. What are Strong Fire and Minor Fire? Are they Heaven/Earth Fire? Human Fire? Medicinal Fire? Among medicinal fires, what is Strong Fire? What is Minor Fire? If Wu Tou and Fu Zi are Strong Fire, why did Zhang Zhongjing use Fu Zi and Gui Zhi (Cinnamon Twig) in Shenqi Wan (Kidney Qi Pill) to tonify Minor Fire? If Ren Shen and Dang Gui are Minor Fire, why did Zhang Hezi fear them like tigers and scorpions? Re-reading *Suwen: Yin-Yang Yingxiang Dalun*'s opening: "Yin and Yang are the Way of Heaven and Earth, the net of all things, parents of change, origin of life and death, residence of spirit. Treating disease must seek the root." And *Xuezheng Lun*'s argument: "The words Yin and Yang refer to Water and Fire," I began to understand. Fire refers neither solely to natural fire nor solely to medicinal fire. Strong Fire and Minor Fire refer neither solely to Heaven/Earth fire nor human fire. Medicinal Strong/Minor Fire refers neither solely to Wu Tou/Fu Zi nor solely to Ren Shen/Dang Gui. Yet, what exactly are Strong Fire and Minor Fire? Still unclear.
Later, through repeated clinical experience, I gained a deeper understanding. 30 years ago, I encountered a 40-year-old female patient. Four years prior, due to rheumatic heart disease with mitral stenosis and recurrent hemoptysis, she underwent mitral valvotomy at a certain hospital. Post-surgery, hemoptysis stopped, but atrial fibrillation and total heart failure developed. Symptoms included shortness of breath, palpitations, edema, and oliguria. Hospitalized for nearly 4 years with uncontrolled condition, she sought TCM treatment. A doctor said: Body heat, thirst, red tongue with little coating, fine-rapid pulse indicate Heart Yin deficiency and severe Qi/Blood depletion. Prescribed Yin-nourishing, heat-clearing, Heart-calming agents: Sheng Di Huang (Rehmannia Root) 13g, Tian Hua Fen (Trichosanthes Root) 15g, Ren Shen 15g, Mai Dong (Ophiopogon Tuber) 15g, Wu Wei Zi (Schisandra Berry) 15g, Zhi Mu (Anemarrhena Rhizome) 15g, Xuan Shen (Scrophularia Root) 9g, Chao Suan Zao Ren (Fried Ziziphus Seed) 30g, Yu Zhu (Polygonatum Odoratum Rhizome) 15g, Fu Ling (Poria) 15g. Next day, family reported: After 1 hour of medication, her shortness of breath worsened significantly, she looked panicked, and occasionally lost consciousness. Emergency Western medical rescue was required to sustain her until morning. Condition critical, I urgently invited my mentor Li Hanqing. The teacher was about to leave for a meeting and could not visit, but instructed to use modified Zhenwu Tang (True Warrior Decoction). Prescription: Fu Zi 15g, Bai Shao (White Peony Root) 15g, Fu Ling 15g, Bai Zhu (Atractylodes Rhizome) 15g, Ren Shen 15g, Xing Ren (Apricot Seed) 9g. Afternoon re-examination. Family relayed: After medication, shortness of breath and palpitations worsened, and she produced no urine. Re-examining the patient: severe shortness of breath, extreme edema, fluctuating consciousness. Seeking mentor again, he said: Patient has severe Yin-Yang deficiency and severe Water Pathogen. Slightly increasing Yin makes Yang unable to support; slightly tonifying Yang makes Yin Essence unable to supply. The previous prescription's failure likely lies here. *Neijing* stated: "Qi of Strong Fire declines, Qi of Minor Fire strengthens; Strong Fire scatters Qi, Minor Fire generates Qi." The previous prescription used 15g Fu Zi and 15g Ren Shen, clearly constituting Strong Fire. Better to reduce dosage to assist Minor Fire. Prescription: Fu Zi 0.3g, Bai Shao 0.6g, Fu Ling 0.6g, Bai Zhu 0.6g, Ren Shen 0.3g, Xing Ren 0.3g. Next day visit. Patient said: After first decoction for one hour last night, shortness of breath and palpitations began improving. Around 2 AM, significant improvement occurred, with multiple urinations, reducing edema and abdominal distension. After second decoction, spirit improved greatly this morning, with hunger sensation. Subsequently treated with this formula for 30 days; edema basically disappeared, spirit and appetite significantly improved. At that time, due to new work, I could no longer treat. Another doctor took over, saying the illness was heavy but medicine light, how could it cure serious disease. Prescription: Fu Zi 12g, Bai Shao 12g, Bai Zhu 15g, Fu Ling 15g, Ren Shen 15g, Wu Wei Zi 15g, Tian Hua Fen 15g, Sheng Di Huang 30g. Five days later, sudden death. Family reported: Next day after taking this doctor's prescription, patient suddenly felt severe shortness of breath and chest fullness as if suffocating, edema with no urine, body heat and thirst, progressing to unconsciousness and death. Hearing this, I reflected deeply: Fu Zi and Ren Shen both have distinctions between Minor Fire and Strong Fire; the human body also has distinctions between Minor Fire and Strong Fire. The key lies in matching the dosage of medicine with the syndrome.