或一年而死。其块将溃时寒热特甚，不可妄与败毒散、小柴胡汤等寒冷药。陈氏用木香流气
饮，然此证多属虚，其初宜益气养荣汤。虚惫者，宜十全大补汤。又流注发小腹者，疑似肠
痈。盖流注属虚，肠痈属实。故治法有补泻之别，不可混焉。
肺痈之为病，其气塞不通，热聚于肺中而致脓溃也。《金匮》所谓口中辟辟燥咳，则胸
中阴阴
痛者，尤为的证。当早辨知之，临其未吐脓前施之。治若失期，则不可救。其初寒热往来，
咳逆脓臭，短气不能侧卧，胸中痛，咽喉不利，呼吸宛如吹笛，是有物碍肺管故也，其脉滑
实而数，未吐脓血，时咳，则有如嗅瓶中腐水之臭气。病久者，其臭满一室，终吐脓血而死
。吐脓血则如吹笛者忽止，即碍滞肺管者去也。古人试脓法，投水沉者为脓，浮者为痰。今
视之痰唯粘稠而已，至脓如炼葛粉，不可切断，是为辩矣。
支饮之为痞，古人以为心藏痞塞，或为脾胃虚弱，或为肾气不足，其说不一。余熟考之
，心
肺下有膈膜，其形如薄绢，横覆心肺，水饮支乘于此处，则上使肺气不利，喘急烦满，下使
胃气逆，至心下痞坚，是为支饮之候。《病源候论》云∶水饮过多，停积于胸膈之间，支乘
于心，故曰支饮是也。其脉弦紧或沉紧，至夜半后，则必气急促迫极甚，其证疑似喘哮然。
喘哮者，胸中不利之所为，故唯觉咽如塞而已。支饮者，其初有胸痛而发喘，或手足厥冷不
得卧，必面部及腹中四肢为微肿，或气急后有大浮肿者，其状虽似水肿之气急。水肿者，初
无气急，渐至肿满而气急。支饮者，初为气急而渐至为肿，是为其别矣。治支饮法，以禁食
为
第一，严忌油腻辣酱等。若肿甚者，要断盐，其法同水肿。又支饮似悬饮，而痛剧者，可以
控喘丹下之，又与木防己汤。水气益甚气急者，可兼用甘遂末。若气急甚，呕逆者，宜甘遂
半夏汤。与此等方一旦虽得效，再发者难治。凡此证经一二年不愈者，不可妄攻，攻之则速
虚虚之害。若实者，有因攻击脱死者。此病近世极伙，当悉意而治之。
白虎风始见于《圣济总录》。其证自肩端连头脑痛如啮，至夜半后，则其痛益甚而无肿
气者
也。凡痛至夜半后甚者，阴气凝结故也。又有白虎历节风相似而少异，历节者，散见诸书，
风湿共通称之谓，有热而骨节痛者。白虎者，谓无热，但阴气凝结而痛者。又有痛风者，谓
有肿而痛，与此证自异。白虎风宜《圣济》羌活汤，兼用《本事方》麝香圆亦可，若与此方
不知者，可与《金匮》乌头汤。
香港脚说以《巢源》及《千金》、《外台》为确，《外台》中苏恭说最可据。
肺胀为病，与肺痿肺痈自异。盖斥肺叶怒张而言，其证咳而上气，有喘而气急。其状似
支饮
，然支饮之喘，其初有胸痛，或手足厥冷，气急不能侧卧。肺胀者，热势甚。上气卒发，目
如脱，面部下部共浮肿而不至，难侧卧，是为其分也，其说详见于金匮要略。
香港脚，精神恍惚，发妄语，热甚有肿，上冲头面而赤，惊悸者，世医认为痫证疗之，非
也。凡大病见痫之形状者，多至死。此非真痫证，《素问》所谓六经尽证也。
疝本因水气与瘀血，为痛之病也。余故于大黄牡丹汤，取牡丹皮、大黄、桃仁于牡丹五
等散
，取桂枝于无忧散，取牵牛子、木通于四乌汤，乌沉汤取乌药又加延胡索一味，立为一方，
以治脐下及脚挛急，阴囊肿或痛，或妇人引腰而痛，或痛引阴门，或阴户突出者，莫不有效
矣。(世所谓福井八味疝气方是也。)
脾劳证心下痞，腹中雷鸣，无痛而下利，利后心下不快，反痞胀者，半夏泻心汤主之
。若
脾劳下利而腹痛无热，心下有水气而咳，或下部有水气，腹痛下利者，真武汤主之，此方亦
用五更泻效。
钱氏白术散治脾瘅。脾瘅多属虚，消渴病中多兼此证，食物偏觉甘者也。
下血多属脾劳，而脾劳下血忌妄止血，是古所谓肠风属也，宜赤小豆当归散。若动悸甚
下血
者，宜香艾汤。若牵挛下焦者，宜铁刷汤。此诸汤非止血剂，而下血自治也。(香艾汤、艾
叶、香附子、甘草、生姜四味，系福井氏家方，铁刷汤出《局方》。)
凡失精者，多因下焦冷而起，故以汤火温腰，且每夜临卧灸三阴交，则免其患矣。
古以失精属虚证，今视不必然。实者间有之，其人过食，则往往为此证，故以节饮食为
第一也。(按远行者，往往患之，亦同一般。又屡失精者，屈两脚而卧，则免此患。)
羚羊角治下血，其效优于犀角。犀角所主，多在吐血衄血。
后世吐血用升麻，下血用黄芩，一偏见也。升麻亦治下血，故《千金》云∶无犀角，以
升麻代之。
阴毒病发于阴经，阳毒病发于阳经，故异名而已。朱肱以阴毒手足冷为阴寒盛者，用乌
头、附子类，误矣。王安道辨之是也。此病《医宗金鉴》以为今痧病，似可从。
天泡者，为火烁疮，酷暑时发细疹，其色正赤，其初自胁下至肩背痛如针刺而后发触衣
被则痛益甚。后皆为水泡也，用解毒泻心汤，与荆防败毒散亦佳。
有的患者一年后就死亡了。当肿块即将溃破时，寒热症状特别严重，不可随意使用败毒散、小柴胡汤等寒凉药物。陈氏使用木香流气饮，然而此证多属于虚证，初期适宜用益气养荣汤。身体极度虚弱者，适宜用十全大补汤。另外，流注病发于小腹部位，容易与肠痈混淆。因为流注属于虚证，而肠痈属于实证。所以治疗方法有补法和泻法的区别，不可混淆。
肺痈这种病，气息堵塞不通，热气聚集在肺中导致化脓溃烂。《金匮要略》所说的口中干燥，咳嗽时胸中隐隐作痛的症状，尤为确切的指征。应当尽早辨别知晓，在未吐出脓液之前进行治疗。如果治疗错过了时机，就无法挽救了。初期表现为寒热往来，咳嗽气逆，咳出脓液且有臭味，气短不能侧卧，胸中疼痛，咽喉不利，呼吸声像吹笛子一样，这是因为有形之物阻碍了肺管，其脉象滑实而数。尚未吐出脓血时，时常咳嗽，闻起来就像嗅到瓶中腐水的臭味。病程长久者，臭味充满整个房间，最终吐出脓血而死。吐出脓血后，像吹笛子一样的声音突然停止，即是因为阻碍肺管的病理产物排除了。古人测试脓液的方法，投入水中下沉的是脓，上浮的是痰。现在观察，痰只是粘稠而已，而脓像熬炼过的葛粉，拉不断，这是辨别的关键。
支饮形成痞塞感，古人认为是心包痞塞，有的说是脾胃虚弱，有的说是肾气不足，说法不一。我仔细考证发现，心肺之下有膈膜，形状像薄绢，横向覆盖在心肺之上，水饮支撑停留在此处，向上使肺气不利，出现喘急、烦闷胀满；向下使胃气上逆，导致心下痞硬，这就是支饮的候象。《诸病源候论》说：水饮过多，停滞积聚在胸膈之间，支撑于心，所以叫支饮。其脉象弦紧或沉紧，到了半夜之后，必然气息急促紧迫非常严重，症状类似喘哮。喘哮是由于胸中气机不利造成的，所以只感觉咽喉如被堵塞。支饮初期有胸痛并引发气喘，或者手足厥冷不能平卧，必然面部及腹部四肢轻微浮肿，或者气喘后有严重浮肿的情况，其状态虽然类似水肿引起的气喘。水肿病，起初没有气喘，逐渐发展到全身肿胀才出现气喘。支饮病，起初是气喘，逐渐发展到浮肿，这是它们的区别。治疗支饮的方法，以禁食为第一要务，严格忌口油腻、辛辣酱料等。如果浮肿严重，必须断盐，方法同治疗水肿。另外支饮类似悬饮，但疼痛剧烈者，可以用控喘丹攻下，也可以用木防己汤。水气加重且气喘者，可以兼用甘遂末。如果气喘严重，伴有呕吐逆气者，适宜用甘遂半夏汤。使用这些方剂即使暂时见效，复发后则难以治疗。凡是此病经过一两年不愈的，不可妄用攻伐之法，攻伐则会加速“虚虚”（使虚者更虚）的危害。如果是实证，也有因过度攻伐而脱气死亡的案例。此病近代非常多见，应当尽心竭力治疗。
白虎风最早见于《圣济总录》。其症状是从肩端连带头脑疼痛，像被咬噬一样，到了半夜之后，疼痛更加严重但没有肿胀。凡是疼痛在半夜之后加重的，是因为阴气凝结所致。又有与白虎历节风相似但略有不同的情况，历节风散见于各种书籍，风湿共同称为它，特点是发热且骨节疼痛。白虎风，是指没有发热，仅仅是阴气凝结而疼痛。还有痛风，是指有肿胀且疼痛，与此证不同。白虎风适宜用《圣济总录》的羌活汤，兼用《本事方》的麝香圆也可以，如果不了解这些方子，可以用《金匮要略》的乌头汤。
关于香港脚（脚气病）的说法，以《诸病源候论》及《千金方》、《外台秘要》为准确，其中《外台秘要》里苏恭的说法最可依据。
肺胀这种病，与肺痿、肺痈自然不同。大概是指肺叶怒张而言，其症状是咳嗽且气逆，有气喘且气急。其状态类似支饮，然而支饮的气喘，初期有胸痛，或者手足厥冷，气喘不能侧卧。肺胀病，热势很盛。气逆突然发作，眼睛像要脱出一样，面部下部共同浮肿但不波及全身，难以侧卧，这是它们的区分，详细说法参见《金匮要略》。
患香港脚（脚气病）的人，精神恍惚，说胡话，热势严重且有肿胀，气机上冲头部面部而发红，惊悸不安，世间的医生认为是痫证来治疗，这是错误的。凡是重病出现痫证形态的，大多会导致死亡。这不是真正的痫证，是《素问》所说的六经尽证（邪气传入六经的危重阶段）。
疝气本是由水气和瘀血引起的疼痛疾病。所以我从大黄牡丹汤中取牡丹皮、大黄、桃仁，从牡丹五等散中取桂枝，从无忧散中取牵牛子、木通，从乌沉汤中取乌药又加入延胡索一味药，创立了一个方子，用来治疗脐下及腿部抽筋拘急，阴囊肿大或疼痛，或者妇人牵引腰部疼痛，或者疼痛牵引阴门，或者阴户突出的情况，没有不有效的。（这就是世人所说的福井八味疝气方。）
脾劳证出现心下痞塞，腹中雷鸣般作响，没有疼痛但腹泻，腹泻后心下不舒服，反而痞塞胀满的，用半夏泻心汤主治。如果是脾劳导致的腹泻且腹痛无热，心下有停水且咳嗽，或者下部有水气，腹痛腹泻的，用真武汤主治，这个方子治疗五更泻也有效。
钱氏白术散治疗脾瘅。脾瘅多属于虚证，消渴病中常兼有此证，表现为对食物中的甜味特别敏感。
便血多属于脾劳，而脾劳导致的便血忌讳盲目止血，这属于古书所说的肠风范畴，适宜用赤小豆当归散。如果心悸动得很厉害且便血者，适宜用香艾汤。如果牵连到下焦拘挛者，适宜用铁刷汤。这些汤剂不是单纯的止血剂，而是通过调理使便血自愈。（香艾汤由艾叶、香附子、甘草、生姜四味药组成，是福井氏家传方；铁刷汤出自《太平惠民和剂局方》。）
凡是失精症，多因下焦寒冷而起，所以用汤火温熨腰部，并且每晚临睡前灸三阴交穴，就可以避免这种祸患了。
古人认为失精属于虚证，现在看并不一定如此。实证中间或有之，如果此人饮食过量，往往会出现此证，所以节制饮食是第一要务。（按：远行的人，往往也会患病，也与一般情况相同。另外，屡次失精的人，弯曲两脚侧卧，就可以避免此患。）
后世治疗吐血用升麻，治疗便血用黄芩，这是一种片面的见解。升麻也能治疗便血，所以《千金方》说：如果没有犀角，可以用升麻代替。
阴毒病发于阴经，阳毒病发于阳经，所以名称不同罢了。朱肱认为阴毒手足冰冷是阴寒盛的表现，使用乌头、附子类药物治疗，这是错误的。王安道的辨析是正确的。此病《医宗金鉴》认为是现在的痧病，似乎可以采纳。
天泡疮，是火毒灼伤形成的疮疡，酷暑时节发作细小疹子，颜色正红，起初从胁下至肩背疼痛如针刺，随后触碰衣服被子则疼痛更加严重。后来都变成水泡，用解毒泻心汤治疗，配合荆防败毒散也很好。
Some patients may die within one year. When the mass is about to ulcerate, the chills and fever are particularly severe; it is inadvisable to indiscriminately administer cold-natured medicines such as Baidu San (Decoction for Resolving Toxins) or Xiaochaihu Tang (Minor Bupleurum Decoction). Chen Shi used Muxiang Liqi Yin (Wood Fragrance Qi-Flowing Drink), yet this condition often belongs to deficiency patterns. In the initial stage, Yiqi Yangrong Tang (Qi-Nourishing and Blood-Supplementing Decoction) is appropriate. For those with extreme debility, Shiquan Dabu Tang (Complete Ten Tonics Decoction) is suitable. Furthermore, Liuzhu (Flowing Abscess) occurring in the lower abdomen may be mistaken for Changyong (Intestinal Abscess). Since Liuzhu belongs to deficiency while Changyong belongs to excess, treatment methods differ between tonification and purgation, and they must not be confused.
Feiyong (Lung Abscess) is a disease characterized by blocked qi flow, where heat accumulates in the lungs leading to suppuration and ulceration. The symptom described in *Jinkui Yaolue* (Essential Prescriptions of the Golden Cabinet) of dryness in the mouth and coughing with dull pain in the chest is especially diagnostic. It should be identified early and treated before pus is expectorated. If treatment is delayed, it becomes incurable. Initially, there are alternating chills and fever, coughing with air reversal, foul-smelling sputum/pus, shortness of breath preventing lateral recumbency, chest pain, throat discomfort, and a whistling breathing sound resembling blowing a flute, caused by obstructive matter in the lung passages. The pulse is slippery, full, and rapid. Before expectoration of pus and blood, frequent coughing produces an odor like rotting water in a bottle. In chronic cases, the odor fills the room, and death ensues after expectorating pus and blood. Once pus and blood are expectorated, the whistling sound stops abruptly, indicating the removal of the obstruction from the lung passages. Ancient methods for testing pus involved dropping it into water: sinking indicated pus, floating indicated phlegm. Currently, phlegm is observed merely as viscous, whereas pus resembles refined kudzu starch and cannot be easily severed; this is the key to differentiation.
Zhiyin (Supporting Fluid Retention) causing a sensation of痞 (fullness/stagnation) was historically attributed to heart pericardium stagnation, spleen-stomach weakness, or kidney qi insufficiency, with varying theories. Upon careful examination, I found that beneath the heart and lungs lies the diaphragm, shaped like thin silk, covering them horizontally. When fluid retention supports and stagnates here, it upwardly obstructs lung qi, causing wheezing, urgency, irritability, and fullness; downwardly, it causes stomach qi to rebel, resulting in hardness and fullness below the heart. This constitutes the manifestation of Zhiyin. *Bingyuan Houlu* (Treatise on Pathogenesis and Symptomatology of Various Diseases) states: excessive fluid retention stagnates in the chest and diaphragm, supporting the heart, hence called Zhiyin. The pulse is wiry-tight or deep-tight. After midnight, breathlessness becomes extremely urgent, mimicking asthma. Asthma results from chest qi obstruction, manifesting only as a feeling of throat blockage. Zhiyin initially presents with chest pain and wheezing, or cold extremities preventing lying down, accompanied by slight edema of the face, abdomen, and limbs, or severe edema following breathlessness. Although similar to edema-induced dyspnea, edema begins without breathlessness, progressing to swelling and then dyspnea. Zhiyin begins with dyspnea, progressing to swelling; this distinguishes them. Treatment of Zhiyin prioritizes dietary restriction, strictly avoiding greasy and spicy condiments. If edema is severe, salt must be eliminated, following the same protocol as edema treatment. Additionally, Zhiyin resembles Xuanyin (Hanging Fluid Retention); if pain is severe, Kongchuan Dan (Breath-Control Pill) can be used for purgation, or Mufangji Tang (Stephania and Coptis Decoction). If water qi worsens with dyspnea, Gansui powder (Kansui Root Powder) can be added. If dyspnea is severe with vomiting and rebellion, Gansui Banxia Tang (Kansui and Pinellia Decoction) is appropriate. Although these formulas may yield temporary effects, recurrence makes treatment difficult. For cases persisting for one or two years, aggressive purgation is contraindicated, as it accelerates the harm of "depleting the deficient." Even in excess patterns, death from qi collapse due to over-purgation has occurred. This disease is prevalent in modern times and requires diligent management.
Baihu Feng (White Tiger Wind) first appeared in *Shengji Zonglu* (General Records of the Sage's Pharmacy). Its symptoms include pain extending from the shoulder tip to the head, feeling like biting, worsening after midnight, without swelling. Pain worsening after midnight is due to yin qi coagulation. It differs slightly from Baihu Lijie Feng (White Tiger Joint-Wandering Wind); Lijie Feng is discussed in various texts as a rheumatic-wind condition characterized by fever and joint pain. Baihu Feng refers to pain without fever, caused solely by yin qi coagulation. Tongfeng (Gout) involves swelling and pain, distinct from this condition. Baihu Feng is treated with Qianghuo Tang (Notopterygium Decoction) from *Shengji*, or combined with Shexiang Wan (Musk Pill) from *Bencao Fang*. If these are unknown, Wutou Tang (Aconite Decoction) from *Jinkui Yaolue* may be used.
Regarding Jiaoxi (Foot Qi/Polyneuritis), *Bingyuan Houlu*, *Qianjin Fang* (Thousand Gold Formulas), and *Waitai Mi Yao* (Secret Essentials of the Outer Hall) are considered authoritative, with Su Gong's commentary in *Waitai Mi Yao* being the most reliable.
Feizhang (Lung Distension) is distinct from Feiwang (Lung Withering) and Feiyong. It refers to the distension of lung lobes. Symptoms include coughing with qi rebellion, wheezing, and dyspnea. It resembles Zhiyin, but Zhiyin's wheezing initially involves chest pain or cold extremities, preventing lateral recumbency. Feizhang features intense heat, sudden onset of qi rebellion, eyes protruding, edema of the lower face not spreading elsewhere, and difficulty lying laterally. Detailed explanations are found in *Jinkui Yaolue*.
Patients with Jiaoxi exhibiting mental confusion, delirium, high fever, swelling, upward rushing of qi reddening the head and face, and palpitations are often misdiagnosed by contemporary physicians as epilepsy. This is incorrect. Serious illnesses presenting with epileptic forms often lead to death. This is not true epilepsy but rather the "completion of the six channels" syndrome described in *Suwen* (Basic Questions).
Shan (Hernia) originates from water qi and blood stasis causing pain. Therefore, I formulated a prescription by combining Mudanpi, Dahuang, and Taoren from Dahuang Mudan Tang (Rhubarb and Moutan Decoction), Guizhi from Mudan Wudeng San (Moutan Five-Equivalents Powder), Qianniu Zi and Mutong from Wuyou San (Carefree Powder), Wuyao from Wuchen Tang (Wu and Chen Decoction), plus Yanhusuo. This formula effectively treats cramping in the lower abdomen and legs, scrotal swelling or pain, lumbar pain radiating in women, pain radiating to the vulva, or prolapse of the labia. (This is known as Fujii's Eight-Ingredient Hernia Formula.)
Sipao (Spleen Fatigue) presenting with epigastric fullness, borborygmus, painless diarrhea, and post-defecation epigastric discomfort and bloating is primarily treated with Banxia Xiexin Tang (Pinellia and Coptis Decoction to Drain the Epigastrium). If Sipao causes diarrhea with abdominal pain but no heat, or if there is fluid retention in the epigastrium with coughing, or fluid retention in the lower jiao with abdominal pain and diarrhea, Zhenwu Tang (True Warrior Decoction) is indicated; this formula is also effective for "Fifth Watch Diarrhea."
Qian Shi Baizhu San (Master Qian's Atractylodes Macrocephala Powder) treats Pidan (Spleen Heat/Excess). Pidan is mostly deficiency-related and often accompanies Xiao Ke (Wasting-Thirst Syndrome), characterized by an aversion to or heightened sensitivity to sweet foods.
Lower gastrointestinal bleeding often belongs to Sipao. In Sipao-induced bleeding, indiscriminate hemostasis is contraindicated; this falls under the ancient category of Changfeng (Intestinal Wind), treated with Chixiaodou Danggui San (Adzuki Bean and Angelica Sinensis Powder). If palpitations are severe with bleeding, Xiang'ai Tang (Cyperus and Mugwort Decoction) is suitable. If there is traction/spasm in the lower jiao, Tieshua Tang (Iron Brush Decoction) is appropriate. These decoctions are not mere hemostatics but cure bleeding through regulation. (Xiang'ai Tang consists of Ai Ye, Xiang Fu, Gan Cao, and Sheng Jiang, a family recipe of the Fujii clan; Tieshua Tang is from *Ju Fang*).
Loss of essence (Shijing) often arises from cold in the lower jiao. Therefore, warming the waist with hot compresses and moxibustion on Sanyinjiao (SP6) every night before sleep can prevent this affliction.
Ancients considered Shijing a deficiency pattern, but this is not always true. Excess patterns occur occasionally, often due to overeating; thus, dietary moderation is paramount. (Note: Travelers often suffer from this, similar to general cases. Also, those with recurrent loss of essence should sleep with knees bent to avoid this problem.)
Lingyangjiao (Antelope Horn) treats lower GI bleeding with efficacy superior to Xijiao (Rhinoceros Horn). Xijiao mainly treats hematemesis and epistaxis.
The later practice of using Shengma (Cimicifuga) for hematemesis and Huangqin (Scutellaria) for lower GI bleeding is one-sided. Shengma also treats lower GI bleeding; thus, *Qianjin Fang* states that if Xijiao is unavailable, Shengma may substitute it.
Yindu Bing (Yin Toxic Disease) originates in the yin meridians, while Yangdu Bing (Yang Toxic Disease) originates in the yang meridians; hence the different names. Zhu Gong believed that cold extremities in Yindu indicated severe yin-cold and prescribed Aconite-type herbs, which was erroneous. Wang Andao's critique is correct. *Yizong Jinjian* (Golden Mirror of Medical Tradition) identifies this as modern Sha Bing (Sand Disease), a view that seems plausible.
Tianpao (Sky Blister/Crusta Maligna) is a burn-like sore caused by fire-toxin. It appears during intense summer heat as fine red rashes. Initially, pain from the hypochondrium to the shoulder and back feels like needle pricks, worsening upon contact with clothing or bedding. Later, blisters form. Jiedu Xiexin Tang (Detoxify and Drain the Heart Decoction) is used; Jingfang Baidu San (Ephedra and Saposhnikovia Decoction for Resolving Toxins) is also excellent.