有一言而可以该医之旨者，其惟发表攻里乎？虽千枝万派，不过在表在里而已矣
。欲攻其里者，宜以寒为主；欲发其表者，宜以热为主。虽千万世，不可易也。《内经》言之详
矣！今人多错解其旨，故重为之笺。发表不远热，攻里不远寒。此寒热二字，谓六气中司气
之寒热。司气用寒时，用药者不可以寒药；司气用热时，用药者不可以热药，此常理也。惟
攻里发表则反之。
然而攻里发表，常分作两涂。若病在表者，虽畏日流金之时，不避司气之
热，亦必以热药发其表；若病在里者，虽坚冰积雪之时，不避司气之寒，亦必以寒药攻其里
，所谓发表者。出汗是也；所谓攻里者，涌泄是也。王太仆注云∶汗泄下痢，皆以其不住于
中也。夫不住其中，则其药一去不留，虽以寒药犯司气之寒，热药犯司气之热，亦无害也。
若其药留而不出，适足以司气增邪，是谓不发不攻。寒热内贼，其病益甚，无病者必生病，
有病者必甚，若司气用寒之时，病在表而不在里，反以寒药冰其里，不涌不泄，坚腹满痛
急，下痢之病生矣；若司气用热之时，病在里而不在表，反以热药燥其中，又非发汗，则身
热、吐下、霍乱、痈疽、疮痒、瞀郁、注下、 螈、肿
胀、呕吐、鼽衄、头痛、骨节挛、肉痛、血泄、淋闭之病生矣。以
此知非热不能解表，非寒不能攻里。是解表常宜热，攻里常宜寒。若反此法，是谓妄造。
今之用
药者，以荆黄汤解表，以姜桂药攻里，此与以水济水，以火济火何异哉？故非徒不效，轻
者危，甚者死。夫《本草》一书，不过酸、苦、甘、辛、咸、淡六味而已。圣人既以辛甘发散为
阳，酸苦涌泄为阴；又以淡味渗泄为阳。是辛、甘、淡三味以解表，酸、苦、咸三味以攻里。发表与渗
泄，非解表而何？涌泄非攻里而何？此二者，圣人之法尽矣！蔑以加矣！
然则医之法，果多乎哉？攻
里以寒，解表以热而已矣。虽然，表病而里不病者，可专以热药发其表；里病而表不病者，
可专以寒药攻其里；表里俱病者，虽可以热解表，亦可以寒攻里，此仲景之大、小柴胡汤，
虽解表亦兼攻里，最为得体。今之用药者，只知用热药解表，不察里之已病，故前所言热证皆
作矣。医者不知罪由己作，反谓伤寒变证，以诬病患，非一日也。故刘河间自制通圣散加益
元散，名为双解。千古之下，得仲景之旨者，刘河间一人而已。然今之议者，以为双解不可
攻里，谤议纷纭，坐井小天，诚可憾也！岂知双解煎以葱须、豆豉，涌而汗之，一剂立雪所
苦。纵不全瘥，亦可小瘳。向所谓热证，亦复不作。俟六经传毕，微下而已。今医者不知其济
物无穷之功，乃妄作损胃无穷之谤，愤刘河间有能医之名，设坚白之论，以求世誉。孰肯剖
璞一试，而追悔和氏之刖足哉？
余之所以屡书此者，叹知音之难遇也。近者，余之故人某官，
不欲斥言其名，因病头项强，状类伤寒，服通圣散，虽不得其法，犹无害也，医者见其因通
圣散也，立毁其非仲景之药也。渠不察其热已甚矣，复以辛热发之。汗出不解，发黄血泄
竟如前所言。后虽以承气下之，不能已。又复下之，至绝汗出，其脉犹搏击。然余亲见其子，
言之甚详。至今士大夫，皆不知辛热一发之过也，独归罪于通圣散。呜呼！甚矣，道之难明也！
顷，余之旧契，读孟坚《汉书·艺文志》，载五苦六辛之说，而颜师古辈，皆无注解。渠特以问余
。余顾其《内经》诸书中，亦不见其文。既相别矣，乘蹇且十里外，飒然而悟。欲复
回以告，予之旧契，已归且远。乃令载之以示来者。夫五者，五脏
；六者，六腑也，腑者，表也。病在里者，属阴分，宜以苦寒之药，涌之、泄之；病在表者
，属阳分，宜以辛温之剂，发之、汗之。此五苦六辛之意也。颜师古不注，盖阙其疑也。乃
知学不博而欲为医，难矣！余又徐思∶五积六聚，其用药亦不外于是。夫五积在脏，有常形
属里，宜以苦寒之药，涌之、泄之；六聚在腑，无常形，属表，宜以辛温之药，发之、汗之
。与前五苦六辛亦合。亦有表热而可用柴胡之凉者，犹宜热而行之。里寒而可用姜附之热者，
犹宜寒而行之。余恐来者，不明《内经》发表攻里之旨，故并以孟坚五苦六辛之说，附于卷
有一句可以概括医学宗旨的话，大概就在于“发表”和“攻里”吧？虽然医理千枝万派，不过只是在表证和里证的区别罢了。想要攻治里证的，应当以寒性药为主；想要发散表证的，应当以热性药为主。即使经过千万年，这也是不可改变的原则。《黄帝内经》对此阐述得非常详细了！如今的人大多误解了其宗旨，所以我重新为此作笺注。“发表不远热，攻里不远寒”，这“寒热”二字，指的是六气中主令之气的寒热属性。当主令之气为寒时，用药者不可以用寒性药；当主令之气为热时，用药者不可以用热性药，这是常规的道理。唯独在攻里和发表时则相反。
然而，攻里和发表，通常分为两条途径。如果病在表，即使在烈日熔化金石的高温时节，也不回避主令之气的炎热，也必定要用热性药来发散表邪；如果病在里，即使在坚冰积雪的严寒时节，也不回避主令之气的寒冷，也必定要用寒性药来攻治里邪。所谓“发表”，就是通过出汗来解除表邪；所谓“攻里”，就是通过涌吐或泻下来清除里邪。王太仆（王冰）注释说：汗、泄、下痢，都是因为药力不住留在体内中部。既然药力不住留于中，那么药物一去便不留存，此时即使使用寒性药去触犯主令之气的寒，或使用热性药去触犯主令之气的热，也没有害处。如果药力停留而不出，反而足以助长主令之气的邪气，这就叫作既不发散也不攻逐。寒热之气在内成为贼邪，病情就会更加严重，没病的人一定会生病，有病的人病情一定会加重。如果在主令之气为寒的时候，病在表而不在里，反而用寒性药使内部像结冰一样寒冷，如果不通过涌吐或泻下，就会导致腹部坚硬、胀满、疼痛、紧急，产生下痢的疾病；如果在主令之气为热的时候，病在里而不在表，反而用热性药使内部干燥，又不通过发汗，就会产生身体发热、呕吐、腹泻、霍乱、痈疽、疮疡瘙痒、神志昏蒙郁结、急骤腹泻、抽搐、肿胀、呕吐、鼻塞流涕及鼻出血、头痛、骨节拘挛、肌肉疼痛、便血、淋证闭涩等疾病。由此可知，不是热性药不能解表，不是寒性药不能攻里。所以解表常宜用热性药，攻里常宜用寒性药。如果违背这种方法，就叫做妄自造作。
如今用药的人，用荆黄汤来解表，用姜桂类药来攻里，这与用水救水、用火救火有什么区别呢？所以不仅无效，轻的会危及生命，重的会导致死亡。《本草》一书，不过是酸、苦、甘、辛、咸、淡六种味道而已。圣人既然认为辛、甘味发散属于阳，酸、苦味涌泄属于阴；又认为淡味渗泄属于阳。因此，辛、甘、淡三味药用来解表，酸、苦、咸三味药用来攻里。发表与渗泄，不就是解表吗？涌泄不就是攻里吗？这两者，圣人的法度已经完备了！没有比这更高的了。
那么医生的治疗方法，果真很多吗？不过是攻里用寒，解表用热罢了。虽然如此，如果是表病而里不病，可以专门用热性药发散表邪；如果是里病而表不病，可以专门用寒性药攻治里邪；如果表里都病了，虽然可以用热性药解表，也可以用寒性药攻里，张仲景的大柴胡汤和小柴胡汤，虽然解表也兼有攻里的作用，最为得体。如今用药的人，只知道用热性药解表，不考察里部是否已经生病，所以前面所说的热证都会出现。医生不知道错误是由自己造成的，反而说是伤寒变证，以此诬陷病患，这不是第一天的事了。所以刘河间自制通圣散并加入益元散，名为双解。千古之下，能得张仲景宗旨的，只有刘河间一人罢了。然而如今的议论者，认为双解法不可用于攻里，诽谤议论纷纷，坐井观天，实在令人遗憾！哪里知道双解煎剂用葱须、豆豉煎煮，通过涌吐和发汗的方法，一剂药就能立刻消除患者的痛苦。纵然不能完全痊愈，也可以稍微减轻。之前所说的热证，也不会再出现。等到六经传变完毕，轻微泻下即可。如今的医生不知道它救济万物无穷的功效，却妄加损害胃气的诽谤，嫉妒刘河间有能医的名声，设立坚白论般的诡辩，以求世俗的赞誉。谁肯剖开璞玉试一试，从而追悔和氏璧被砍断脚那样的悲剧呢？
我之所以多次书写这些内容，是感叹知音难遇啊。最近，我的一位老朋友某官员，不想公开他的名字，因病头项强直，症状类似伤寒，服用通圣散，虽然不得其法，但也无害。医生看到他因服用通圣散，立即诋毁说这不是张仲景的药。他不察患者热势已经很重，又用辛热药发散。汗出后病不解，出现发黄、便血，竟然像前面所说的那样。后来虽然用承气汤泻下，也不能治愈。又再次泻下，导致绝汗出，脉象仍然搏击有力。然而我亲眼见到他的儿子，讲述得很详细。至今士大夫们，都不知道辛热发散过度的过错，只归罪于通圣散。唉！道义难以阐明，太过严重了！
不久前，我的旧交读孟坚（班固）的《汉书·艺文志》，其中记载了“五苦六辛”的说法，但颜师古等人，都没有注解。他特意以此问我。我回顾《内经》诸书中，也没见到这句话。我们分别之后，我骑着驴走了十里外，忽然领悟了。想回去告诉他，我的旧交已经回去且走远了。于是让他记录下来展示给后来者。所谓的“五”，指五脏；“六”，指六腑。腑属表。病在里的，属于阴分，适宜用苦寒药，涌吐或泻下；病在表的，属于阳分，适宜用辛温药，发散或发汗。这就是“五苦六辛”的意思。颜师古不注解，大概是保留疑问吧。由此可知，学识不渊博却想行医，太难了！我又慢慢思考：五积六聚，其用药也不过是这个道理。五积在脏，有固定形态，属里，适宜用苦寒药，涌吐或泻下；六聚在腑，无固定形态，属表，适宜用辛温药，发散或发汗。这也与前面的“五苦六辛”相合。也有表热而可用柴胡之凉性的，仍宜用热性药引导而行；里寒而可用姜附之热性的，仍宜用寒性药引导而行。我担心后来者不明白《内经》发表攻里的宗旨，所以一并附上孟坚关于“五苦六辛”的说法，附于卷末。
There is one phrase that can summarize the essence of medicine, which is likely "releasing the exterior" (Fa Biao) and "attacking the interior" (Gong Li). Although medical theories branch out into thousands of streams, they are merely distinguished by whether the pathology is in the exterior or the interior. To attack the interior, cold-natured medicines should be primarily used; to release the exterior, hot-natured medicines should be primarily used. This principle remains unchangeable for ten thousand generations. The *Huangdi Neijing* (Yellow Emperor's Inner Canon) has elaborated on this in detail! Nowadays, many people misunderstand its essence, so I am re-annotating it here. "Releasing the exterior does not avoid heat; attacking the interior does not avoid cold." These two characters, "cold" and "heat," refer to the cold and heat attributes of the dominant Qi (Si Qi) among the Six Qi (Liu Qi). When the dominant Qi is cold, physicians should not use cold medicines; when the dominant Qi is hot, physicians should not use hot medicines. This is the general rule. However, regarding attacking the interior and releasing the exterior, the approach is reversed.
Nevertheless, attacking the interior and releasing the exterior are usually treated as two separate paths. If the disease is in the exterior, even during times when the sun is hot enough to melt metal and stone, one should not shy away from the heat of the dominant Qi, but must still use hot medicines to release the exterior. If the disease is in the interior, even during times of hard ice and accumulated snow, one should not shy away from the cold of the dominant Qi, but must still use cold medicines to attack the interior. What is meant by "releasing the exterior" is inducing sweating; what is meant by "attacking the interior" is inducing vomiting or purging. Wang Taipu (Wang Bing) annotated: Sweating, purging, and dysentery all occur because the medicine does not stay in the middle. Since the medicine does not stay in the middle, it passes through without lingering. Therefore, even if cold medicines are used to confront the cold of the dominant Qi, or hot medicines are used to confront the heat of the dominant Qi, there will be no harm. However, if the medicine lingers and does not exit, it will only add to the pathogenic influence of the dominant Qi. This is called neither releasing nor attacking. If cold and heat become internal thieves, the disease will worsen. Those without disease will fall ill, and those with disease will suffer severely. If, during a time when the dominant Qi is cold, the disease is in the exterior and not the interior, but cold medicines are used to freeze the interior, and without vomiting or purging, it will lead to abdominal hardness, fullness, pain, and urgency, causing dysentery. Conversely, if, during a time when the dominant Qi is hot, the disease is in the interior and not the exterior, but hot medicines are used to dry the interior, and without inducing sweating, it will cause fever, vomiting, diarrhea, cholera, carbuncles and sores, itching ulcers, mental confusion and depression, sudden profuse diarrhea, convulsions, swelling, vomiting, nasal congestion and epistaxis, headache, joint stiffness, muscle pain, bloody stool, stranguria, and urinary retention. From this, we know that without heat, the exterior cannot be resolved; without cold, the interior cannot be attacked. Thus, resolving the exterior usually requires hot medicines, and attacking the interior usually requires cold medicines. To reverse this method is considered reckless fabrication.
Today's physicians use Jinghuang Tang (Bramble and Rhubarb Decoction) to release the exterior and Jianggui medicines (Ginger and Cinnamon preparations) to attack the interior. How is this different from using water to save water or fire to save fire? Consequently, not only is it ineffective, but mild cases may become critical, and severe cases may result in death. The *Bencao* (Materia Medica) book contains only six flavors: sour, bitter, sweet, pungent, salty, and bland. The Sages established that pungent and sweet flavors disperse and belong to Yang; sour and bitter flavors induce vomiting and purging and belong to Yin; and bland flavors promote drainage and belong to Yang. Therefore, the three flavors of pungent, sweet, and bland are used to release the exterior, while the three flavors of sour, bitter, and salty are used to attack the interior. Releasing the exterior and promoting drainage—what else is this but releasing the exterior? Inducing vomiting and purging—what else is this but attacking the interior? These two principles encompass the methods of the Sages completely; nothing can surpass them.
So, are the methods of medicine truly numerous? They are merely attacking the interior with cold and releasing the exterior with heat. Nevertheless, if the disease is in the exterior but not the interior, one can exclusively use hot medicines to release the exterior; if the disease is in the interior but not the exterior, one can exclusively use cold medicines to attack the interior. If both the exterior and interior are diseased, although one can use hot medicines to release the exterior, one can also use cold medicines to attack the interior. Zhang Zhongjing's Da Chaihu Tang (Major Bupleurum Decoction) and Xiao Chaihu Tang (Minor Bupleurum Decoction), while releasing the exterior, also concurrently attack the interior, which is most appropriate. Today's physicians only know how to use hot medicines to release the exterior and do not examine whether the interior is already diseased. Therefore, the heat syndromes mentioned earlier all arise. Physicians do not realize that the fault lies with themselves; instead, they falsely claim that these are transformed syndromes of Shanghan (Cold Damage), thereby blaming the patients. This has not been an isolated incident. Therefore, Liu Hejian independently formulated Tongsheng San (Universal Rescue Powder) added with Yiyuan San (Benefit Origin Powder), named Shuangjie (Double Resolution). Among all ages since antiquity, Liu Hejian is the only one who understood the essence of Zhang Zhongjing. However, contemporary critics argue that Shuangjie should not be used for attacking the interior, leading to widespread slander and discussion. Sitting in a well and viewing a small sky, this is indeed regrettable! How could they know that Shuangjie decocted with green onion roots and fermented soybeans, inducing vomiting and sweating, can immediately relieve the patient's suffering with just one dose. Even if not fully cured, it can provide slight relief. The previously mentioned heat syndromes will not recur. After the transmission through the Six Channels (Liu Jing) is complete, mild purging suffices. Today's physicians do not understand its infinite merit in benefiting beings, but instead recklessly slander it as infinitely damaging to the stomach. Out of jealousy for Liu Hejian's reputation as a skilled physician, they set up sophistical arguments to seek worldly praise. Who would dare to test the uncut jade and then regret the fate of Bian He having his foot cut off?
The reason I have written this repeatedly is to sigh at the difficulty of meeting true connoisseurs. Recently, an old friend of mine, an official whose name I will not disclose due to illness, suffered from stiffness in the head and neck, resembling Shanghan. He took Tongsheng San. Although he did not follow the correct method, it caused no harm. A physician saw that he had taken Tongsheng San and immediately condemned it as not being a prescription from Zhang Zhongjing. The physician failed to observe that the heat was already severe and again administered pungent-hot medicines to disperse. After sweating, the disease did not resolve, and jaundice and bloody stool appeared, exactly as described earlier. Later, although Chengqi Tang (Chengqi Decoction) was used to purge, it could not cure him. Purging was repeated until sweat became continuous (Jue Han), yet the pulse remained forceful. I personally witnessed his son describe this in detail. To this day, the scholar-officials do not recognize the error of excessive pungent-hot dispersion, but solely blame Tongsheng San. Alas! It is too difficult to clarify the Dao!
Recently, my old acquaintance read Ban Gu's *Han Shu: Yi Wen Zhi* (Book of Han: Treatise on Literature), which records the concept of "Five Bitters and Six Pungents" (Wu Ku Liu Xin), but Yan Shigu and others provided no annotations. He specifically asked me about it. I reviewed the various books of the *Neijing* but did not find this text. After we parted, while riding my donkey more than ten li away, I suddenly realized the meaning. I wanted to return to tell my old acquaintance, but he had already returned and was far away. So I instructed him to record it to show future generations. The "Five" refers to the Five Zang Organs (Zang); the "Six" refers to the Six Fu Organs (Fu). The Fu organs correspond to the exterior. Diseases in the interior belong to the Yin division and are suitable for treatment with bitter-cold medicines to induce vomiting or purging. Diseases in the exterior belong to the Yang division and are suitable for treatment with pungent-warm medicines to disperse or induce sweating. This is the meaning of "Five Bitters and Six Pungents." Yan Shigu did not annotate it, likely leaving it as a doubt. Thus, we know that attempting to practice medicine without broad learning is extremely difficult! I further pondered: Wu Ji (Five Accumulations) and Liu Ju (Six Gatherings) also follow this principle. Wu Ji are located in the Zang organs, have fixed forms, and belong to the interior; they are suitable for treatment with bitter-cold medicines to induce vomiting or purging. Liu Ju are located in the Fu organs, have no fixed forms, and belong to the exterior; they are suitable for treatment with pungent-warm medicines to disperse or induce sweating. This also aligns with the previous concept of "Five Bitters and Six Pungents." There are also cases of exterior heat where cool Chaihu (Bupleurum) can be used, yet it is still advisable to guide it with warm properties. There are cases of interior cold where hot Ginger (Shengjiang) and Aconite (Fuzi) can be used, yet it is still advisable to guide them with cold properties. Fearing that future generations will not understand the essence of releasing the exterior and attacking the interior from the *Neijing*, I have appended the theory of "Five Bitters and Six Pungents" from Ban Gu to this volume.