肥人气虚生寒，寒生湿；湿生痰。瘦人血虚生热，热生火，火生燥。故肥人多寒湿，瘦
人多热燥也。夫以人形分寒湿热燥，此得之于外，然其中脏腑为病，亦有寒湿热燥之殊，不
可不知。《玉匮金钥》曰∶肝脏由来同火治，三焦包络都无异，脾胃常将湿处求，肺与大肠
同湿类，肾与膀胱心小肠，寒热临时旋商议，恶寒表热小膀湿，发热表寒心肾炽，十二经最
端的，四经属火四经湿，四经有热有寒时，攻里解表细消息，里热表寒宜越竭，表热表寒宜
汗释，湿同寒，火同热，寒热到头无两说，六分分来火热寒，寒热中停真浪舌，热寒格拒病
机深，亢则害兮承乃制，紧寒数热脉正邪，标本治之真妙诀，休治风，休治燥，治得火时风
燥了，当解表时莫攻里，当攻里时莫解表，表里如或两可攻，后先内外分多少，治湿无过似
决川，此个筌蹄最分晓，感谢轩岐万世恩，争奈醯鸡笑天小。
夫疾病之生也，皆因外感内伤生火生湿，湿而生热，火而生痰，四者而已。审其为少壮
新病，是湿则燥之，是火则泻之，是湿而生热则燥湿而兼清热，是火而生痰则泻火而兼豁痰，
无余蕴矣。审其为老衰久病，又当半攻半补焉。如气虚而有湿热痰火，则以四君子汤补气而
兼燥湿清热、豁痰泻火；如血虚而有痰火湿热，则以四物汤补血而兼泻火豁痰、清热燥湿。
如此则攻补兼施，庶乎可也。予故曰∶少壮新病攻邪为主，老衰久疾补虚为先。若夫阴虚火
动，脾胃衰弱，真阴者水也。脾胃者土也，土虽喜燥，然太燥则草木枯槁；水虽喜润，然太
润则草木湿烂。是以补脾胃补肾之剂务在润燥得宜，亦随病加减焉。
肥胖之人因气虚而生寒，寒生湿，湿生痰。消瘦之人因血虚而生热，热生火，火生燥。因此，肥胖的人多患寒湿证，消瘦的人多患热燥证。根据人的形体来区分寒、热、湿、燥，这是从外部观察所得，然而脏腑内部发生的疾病，也有寒、热、湿、燥的不同，这一点不可不知道。《玉匮金钥》中说：肝脏的治疗由来与火证相同，三焦和心包络的治疗也与此无异；脾胃的病常在湿气中寻求病因，肺和大肠的病变也归属于湿类；肾与膀胱、心与小肠，则需根据寒热情况临时斟酌商议。恶寒且体表发热者，病在膀胱（太阳经）；发热且体表发冷者，病在心肾（火热炽盛）。十二经脉中最确切的规律是：四条经脉属火，四条经脉属湿，还有四条经脉有时有热有时有寒，治疗时需仔细审察攻里或解表。里热表寒适宜用越鞠丸（Yueju Wan, Pill for Resolving Depression）治疗，表热表寒适宜用发汗法解除。湿证同于寒证治疗，火证同于热证治疗，到了寒热辨证的关键处没有两种说法。将病情分为六分，火热与寒证各占其半，若寒热之中止不前则是空谈。热与寒相互格拒，病机深奥，亢盛则为害，承制方能平衡。脉紧主寒，脉数主热，这是判断正邪的标准，标本兼治才是真妙诀。不要单纯治风，不要单纯治燥，治好了火证，风和燥也就随之解决了。应当解表时不要攻里，应当攻里时不要解表。如果表里两证都可以攻治，则需分清先后内外及用药多少。治疗湿证没有比决流导水更好的方法，这个要领最为明白。感谢轩辕黄帝赐予万世之恩，无奈像醋坛里的虫子那样嘲笑天太小。
疾病的产生，都是因为外感或内伤导致生火、生湿，湿而生热，火而生痰，归结起来只有这四种情况。如果是青壮年新得的病，属于湿证的就用燥湿法，属于火证的就用泻火法，属于湿而生热的就燥湿兼清热，属于火而生痰的就泻火兼豁痰，这样就没有遗漏了。如果是年老体衰久病的人，又应当半攻邪半补虚。如气虚而有湿热痰火，就用四君子汤（Sijunzi Tang, Four Gentlemen Decoction）补气并兼燥湿清热、豁痰泻火；如血虚而有痰火湿热，就用四物汤（Siwu Tang, Four Substance Decoction）补血并兼泻火豁痰、清热燥湿。如此则攻邪与补虚兼施，就可以了。所以我常说：青壮年新病以攻邪为主，年老体衰久病以补虚为先。至于阴虚火动，脾胃衰弱，真阴属水，脾胃属土，土虽然喜欢干燥，但太干燥草木就会枯槁；水虽然喜欢滋润，但太滋润草木就会湿烂。因此，补脾胃和补肾的方剂务必在润燥之间取得适宜，也要随病情加减变化。
Qi deficiency in obese individuals generates cold; cold generates dampness; dampness generates phlegm. Blood deficiency in thin individuals generates heat; heat generates fire; fire generates dryness. Therefore, obese people are prone to cold-damp conditions, while thin people are prone to heat-dry conditions. Distinguishing cold, heat, dampness, and dryness based on body shape is derived from external observation. However, diseases occurring within the Zang-Fu organs also differ in terms of cold, heat, dampness, and dryness, which must be known. The *Yu Kui Jin Yao* states: "The treatment of the Liver has always been similar to that of Fire; the Sanjiao (Triple Burner) and Pericardium are no different. For the Spleen and Stomach, seek the cause in dampness; the Lung and Large Intestine belong to the category of dampness. For the Kidney and Bladder, Heart and Small Intestine, discuss cold and heat flexibly according to the situation. Chills with exterior heat indicate involvement of the Bladder (Taiyang channel); fever with exterior cold indicates blazing fire in the Heart and Kidney. Among the twelve channels, the most definitive rule is: four channels belong to Fire, four channels belong to Dampness, and four channels have both heat and cold at times. Carefully consider whether to attack the interior or release the exterior. Interior heat with exterior cold is suitable for Yueju Wan (Pill for Resolving Depression); exterior heat with exterior cold is suitable for sweating to resolve. Dampness is treated like Cold; Fire is treated like Heat. When it comes to distinguishing cold and heat, there are no two ways. Divide the condition into six parts; if Fire/Heat and Cold stop midway, it is empty talk. When Heat and Cold repel each other, the pathogenesis is profound. Excess leads to harm, while control brings balance. A tight pulse indicates Cold, a rapid pulse indicates Heat; this is the correct distinction between Zheng (Excess) and Xie (Deficiency). Treating both root and branch is the true wonderful principle. Do not treat Wind alone; do not treat Dryness alone. Once Fire is treated, Wind and Dryness will be resolved. When releasing the exterior, do not attack the interior; when attacking the interior, do not release the exterior. If both exterior and interior can be attacked, distinguish the order and the proportion of internal and external treatments. There is nothing better than draining water like a river to treat dampness; this principle is very clear. Gratitude to Xuanyuan Huangdi (Yellow Emperor) for his grace to all generations, yet alas, vinegar-jar chickens laugh at the smallness of the sky."
The generation of diseases is due to external contraction or internal injury leading to Fire and Dampness; Dampness generating Heat; Fire generating Phlegm. These are the only four factors. If it is a new disease in young and strong individuals, if it is Dampness, use drying methods; if it is Fire, use purging methods; if Dampness generates Heat, use drying dampness combined with clearing heat; if Fire generates Phlegm, use purging fire combined with resolving phlegm. This leaves no room for omission. If it is an old, weak person with a chronic disease, one should half-attack and half-nourish. For Qi deficiency with damp-heat, phlegm, and fire, use Sijunzi Tang (Four Gentlemen Decoction) to tonify Qi while simultaneously drying dampness, clearing heat, resolving phlegm, and purging fire. For Blood deficiency with phlegm-fire and damp-heat, use Siwu Tang (Four Substance Decoction) to nourish Blood while simultaneously purging fire, resolving phlegm, clearing heat, and drying dampness. In this way, attacking evil and tonifying deficiency are applied together, which is acceptable. Thus I say: For young and strong people with new diseases, attacking evil is primary; for old and weak people with chronic diseases, tonifying deficiency is paramount. As for Yin deficiency with moving Fire, and Spleen/Stomach weakness: True Yin belongs to Water; Spleen and Stomach belong to Earth. Although Earth likes dryness, too much dryness causes vegetation to wither; although Water likes moisture, too much moisture causes vegetation to rot. Therefore, formulas for tonifying the Spleen/Stomach and Kidney must achieve an appropriate balance of moistening and drying, and should be modified according to the disease.