《灵枢》曰∶五脏者，所以藏精神魂魄者也∶六腑者，所以受水谷而化行物者也。
其气内于五脏，而外络支节，其浮气之不循经者为卫气，其经气之行于经者为营气，阴
阳相随，内外相实，如环之无端，故《经》曰∶治病之道，气内为宝。真万世医旨之格
言也。《灵枢》曰∶审察卫气为百病母。盖人身之中，惟气而已。宗气者，丹田先天之
大气也，犹天地之有太极也。卫气者，建运周身之阳气也，犹太极之动而生阳也，营气
者，根中守固之阴气也，犹太极之静而生阴也。天地间惟气以为升降，而水则从气者
也，故天包水，水承地。一元之气升降于太虚之中，水不得而与也，故潮之往来，特随
气耳，非潮自能然也。人身亦惟以气为主，而血则犹水，不可以血即为营气也，彼谓血
即为营者，非经旨也。《灵枢·营卫生会》篇谓∶营气化血，以奉生身。则营气始能化血
焉，何以血为营耶？故气而云宗者，无气之宗也∶气而云卫者，围表而捍外也∶气而云
营者，守营而固中也。宗气也，卫气也。营气也，可不细辨欤。
凡治适病者易，治矢病者难。今工者尽难，盖知虚实之变幻，寒热假真之不齐也。
庸者反易，盖不知虚虚实实之利害，阴阳造化之深微，常多一时之偶中也。况千端万
绪，宁能悉诸简编，即载藉极博，尤必赖乎
灵敏，丹溪曰∶医者，临机应变，如对敌之将，操舟之工，自非随时取中，宁无愧乎？
洁古云∶运气不齐，古今易辙，旧方新病，难相符合。许学士云∶予读仲景书，守仲景
法，未尝守仲景方。乃为得仲景心也。故医术之要，先寻大意，大意既晓，则条分缕
晰，脉络方明。《内经》曰∶知其要者，一言而终。不知其要，流散无穷。历观名论，
皆以别症为先，嗟嗟别症，甚未易也。脉有雷同，症有疑似，水火亢制，阴阳相类，太
实有羸状，误补益疾，至虚行盛势，反泻衔冤。阴症似乎阳，清之必毙；阳症似乎阴，
温之转伤哉！积聚在中，实也。甚则嘿嘿不欲语，肢体不欲动，或眩晕眼花，或泄泻不
实，皆大实有羸状，正如食而过饱，反倦怠嗜卧也。脾胃损伤，虚也，甚则胀满而食不
得入，气不得舒，便不得利，皆至虚有盛候，正如饥而过时，反不思食也。脾肾虚
寒，真阴症也，阴盛之极，往往格阳，面目红赤，口舌破裂，手扬足掷，语言错妄，有
似乎阳，正如严冬惨肃，而水泽复坚，坚为阳刚之象也。邪热未解，五阳症也。阳
盛之极，往往发厥，厥则口鼻无气，手足逆冷，有似乎阴，正如盛夏炎灼，而林木流
津，津为阴柔之象也。大抵症既不足凭，当参之脉理，脉又不足凭，当取诸沉侯、久
侯。彼假症之发现，皆在表也，故浮取脉而脉亦假焉；真症之隐伏，皆在里也，故沉侯
脉而脉可辨耳。且脉之实者，终始不受；脉之虚者，乍大乍小，如与人初交，未得性情
善恶之确，必知交既久，方能洞见情性善恶之真。适当乍大之时，便以为实。适当乍小
之时，便以为虚，岂不误甚！必反复久候，则虚实之真假判然矣。然脉辨已真，犹未敢
恃，更察禀之浓薄，症之久新，医之误否，合参共究，自无循情，且脏之发也，类于
腑；血之变也，近于气。调气者，主阳而升；调血者，主阴而降。差之毫厘，失之千
里，独不思人以生死寄我，我岂可以轻试图功！彼祸人者，无足论矣。即偶中者，讵可
对衾影哉！然难明者，意。难尽者，言。惟愿有志仁寿者，读书之外，而于起居嗜卧，
触类傍通。至于临症，即病机浅易，必审察昭昭，既标本彰明，必小心翼翼，明矣，慎
矣！必以精详操独断之权，毋以疑惧起因循之弊，设有未确阙疑，务以脉候反复参详，
宁可多从不处用力，要知医为司命，功专去病以长生，慎勿舍生而治病，犹徒宅亡身，
标本何在！未大虚而过加温补，诒误不至伤生，继以寒凉投之，其功愈效。若不足误加
苦寒克削，犹死者不复生，断者不可续，纵加温补，莫可挽回，试思古云∶阳气一分不
尽，则不死，诚然也。
《灵枢》说：五脏，是储藏精神魂魄的地方；六腑，是接受水谷并使其消化运行的器官。
人体的气内通于五脏，外连络四肢关节，其中浮散不循经脉运行的是卫气，沿经脉正常运行的经气则是营气，阴阳相互跟随，内外相互充实，像圆环一样没有尽头，所以《内经》说：治病的道理，以体内的正气为宝贵。这真是千秋万代医学宗旨的格言啊。《灵枢》又说：审察卫气，它是百病产生的根源。大概人身之中，只有“气”最重要。宗气，是丹田中先天的元气，就像天地之间有太极一样。卫气，是运行周身维持生命的阳气，就像太极运动而生出阳气一样；营气，是根植体内守固的阴气，就像太极静止而生出阴气一样。天地间只有气在升降，而水是随着气运动的，所以天包裹着水，水承载着地。一元之气在太虚之中升降，水不能参与其中，所以潮汐的往来，只是随着气罢了，并不是潮水自己能这样。人身也主要以气为主，而血就像水，不能说血就是营气，那些认为血就是营的说法，不符合经典原意。《灵枢·营卫生会》篇说：营气化生血液，来奉养身体。那么必须是营气才能化生血，怎么能说血就是营呢？所以说气称为“宗”，是因为它是气的宗主；气称为“卫”，是因为它护卫体表抵御外邪；气称为“营”，是因为它守持内部巩固中焦。宗气、卫气、营气，难道可以不仔细分辨吗？
凡是治疗与病情相符的病容易，治疗与病情不符（假象）的病难。现在的医生都感到困难，大概是因为知道虚实变化多端，寒热真假不一。庸医反而觉得容易，大概是因为不知道虚证误补或实证误泻的危害，不了解阴阳造化的深奥微妙，常常只是一时侥幸中的而已。况且病情千头万绪，怎么能全部记载在书册上？即使书籍极其渊博，也必定依赖医生的灵敏悟性。朱丹溪说：医生要能临机应变，就像面对敌人的将领，驾船的水手，如果不能随时取中病机，难道不感到惭愧吗？李东垣（洁古）说：运气不齐，古今规律改变，旧有的方子治疗新的病症，很难完全符合。许叔微（许学士）说：我读张仲景的书，遵守张仲景的法度，但不死守张仲景的方剂。这才是真正得到了张仲景的心法。所以医术的关键，在于先寻找大意，大意明白了，那么条理分析清晰，脉络自然明了。《内经》说：懂得要领的人，一句话就能终结（讲清道理）；不懂得要领的人，就会流散无穷无尽。纵观名家论述，都把辨别症状放在首位，唉，辨别症状，实在是不容易啊。脉象有雷同，症状有疑似，水火亢盛制约，阴阳相似，大实证却有虚弱之状，误用补药会加重疾病；极度虚弱却呈现旺盛之势，误用泻药会蒙受冤屈。阴证似乎阳证，用清热法必致死；阳证似乎阴证，用温补法反而受伤。积聚在体内，是实证。严重时默默不想说话，肢体不想活动，或者眩晕眼花，或者泄泻不成形，这都是大实有羸状，正好像吃得太饱，反而倦怠嗜睡一样。脾胃损伤，是虚证，严重时胀满且食物进不去，气不得舒展，大便不通利，这都是至虚有盛候，正好像饥饿过了时间，反而不想吃东西一样。脾肾虚寒，是真阴证，阴气极盛，往往格拒阳气于外，面目红赤，口舌破裂，手足躁动，言语错乱妄言，看起来似乎阳证，正好像严冬肃杀寒冷，而水泽冻结，坚硬是阳刚之象。邪热未解，是五阳证。阳气极盛，往往发生厥逆，厥逆则口鼻无气，手足逆冷，看起来似乎阴证，正好像盛夏炎热灼人，而林木流淌汁液，汁液是阴柔之象。大抵症状既然不足以凭信，应当参考脉理；脉理又不足以凭信，应当通过沉取、久按来诊察。那些假象的出现，都在体表，所以浮取脉象也是假的；真象的隐伏，都在体内，所以沉取久候脉象可以辨别。而且脉象实的，始终不变；脉象虚的，忽大忽小，就像与人初次交往，未能确切知道性情善恶，必须交往久了，才能洞察性情善恶的真谛。正当脉象乍大之时，就认为是实证；正当脉象乍小之时，就认为是虚证，这岂不谬误得很！必须反复久候，那么虚实的真假就判然分明了。然而脉象辨别已经真实，还不敢倚仗，更要考察体质的浓薄，症状的新久，医生是否误治，综合参详探究，自然没有因循苟且的弊病。而且脏腑发病，类同于腑；血的病变，近于气。调气者，主阳而升；调血者，主阴而降。差之毫厘，失之千里，难道不想想人以生死寄托于我，我怎么可以轻率图功！那些害人的医生，不值一提。即使是偶尔治中的，难道能对得起自己的良心吗！然而难以阐明的是“意”，难以穷尽的是“言”。只希望有志于仁术长寿的人，在读书之外，还要从起居嗜卧等生活细节中触类旁通。至于临症，即使病机浅易，也必须审察得清清楚楚，既然标本彰明，必须小心翼翼，明白了，谨慎了！必须以精详的操作行使独断的权力，不要因为疑惧而引起因循苟且的弊端，如果有不确定的地方存疑，务必通过脉候反复参详，宁可多观察而不轻易用药，要知道医生掌握着人的性命，功效专门在于去除疾病以延长生命，千万不要舍弃生命去治病，这就好比为了房子而牺牲身体，标本在哪里呢！对于不是大虚的患者而过加温补，造成的错误不至于伤及生命，继而又投以寒凉药，其疗效会更好。如果不足的患者误加了苦寒克削的药，就像死者不能复生，断肢不可接续，纵然再加温补，也无法挽回，试想想古人说：只要有一分阳气未尽，就不会死，确实是这样啊。
According to the *Ling Shu* (Spiritual Pivot): The Five Zang Organs are where the Spirit, Huna, Po, Yi, and Shen are stored; the Six Fu Organs receive food and fluids and facilitate their transformation and transportation.
The Qi within connects internally to the Five Zang Organs and externally links to the collateral branches of the joints. The floating Qi that does not follow the meridians is called Wei Qi (Defensive Qi), while the Qi that travels along the meridians is Ying Qi (Nutritive Qi). Yin and Yang follow each other, and the interior and exterior supplement each other, forming a cycle without beginning or end. Therefore, the *Classic* states: In treating disease, the internal Qi is the treasure. This is truly an eternal maxim for medical practice across all generations. The *Ling Shu* also says: Examine the Wei Qi, for it is the mother of a hundred diseases. Essentially, within the human body, only Qi matters. Zong Qi (Pectoral/Ancestral Qi) is the great primordial Qi in the Dantian, just as Taiji exists between Heaven and Earth. Wei Qi is the Yang Qi that operates throughout the body, akin to Taiji moving to generate Yang; Ying Qi is the Yin Qi that remains rooted and secure within, akin to Taiji stillness generating Yin. Within the world, only Qi ascends and descends, while water follows Qi; thus, Heaven envelops Water, and Water supports Earth. A unified Qi ascends and descends in the Great Void, and Water does not participate in this movement; therefore, the ebb and flow of tides merely follow Qi, they do not occur independently. Similarly, the human body is primarily governed by Qi, while Blood is like Water; one cannot equate Blood with Ying Qi. Those who claim that Blood is Ying Qi contradict the intent of the Classics. The chapter "Ying Wei Sheng Hui" (Meeting of Ying and Wei) in the *Ling Shu* states: "Ying Qi transforms into Blood to nourish the living body." Thus, it is Ying Qi that transforms into Blood, so how can Blood be considered Ying? Hence, Qi is called "Zong" because it is the master of Qi; it is called "Wei" because it encircles the exterior and defends against external pathogens; it is called "Ying" because it guards the interior and consolidates the center. Zong Qi, Wei Qi, and Ying Qi—can these be distinguished too roughly?
It is easy to treat diseases that match the symptoms, but difficult to treat those with deceptive presentations. Currently, skilled physicians find this difficult, largely because they understand the变幻 (changes/variations) of Deficiency and Excess, and the discrepancies between true and false Cold and Heat. Unskilled physicians, on the contrary, find it easy, largely because they are unaware of the dangers of tonifying Deficiency when it is actually Excess, or purging Excess when it is actually Deficiency, and fail to grasp the profound subtleties of Yin-Yang creation and transformation; their success is often merely accidental. Moreover, given the myriad complexities of symptoms, how can they all be recorded in books? Even if literature is extremely extensive, it must rely on the physician's sensitivity and insight. Zhu Danxi said: A physician must adapt to circumstances on the spot, like a general facing an enemy or a boatman navigating waters. If one cannot hit the mark according to the changing situation, would one not feel ashamed? Li Dongyuan (Jiegu) said: The movements of the Six Qi are uneven, and the rules of ancient and modern times have changed; old prescriptions for new diseases rarely fit perfectly. Xu Xueshi said: I read Zhang Zhongjing’s books and adhere to his methods, but I do not rigidly stick to his formulas. This is truly grasping the essence of Zhang Zhongjing. Therefore, the key to medical art lies first in grasping the general principle. Once the general principle is understood, details can be analyzed clearly, and the meridians become distinct. The *Nei Jing* states: He who knows the essentials needs only one word to conclude; he who does not know the essentials will scatter endlessly. Reviewing famous discussions, all prioritize distinguishing symptoms. Alas, distinguishing symptoms is indeed not easy. Pulse patterns may resemble each other, and symptoms may appear similar. Water and Fire may be hyperactive and restraining each other; Yin and Yang may look alike. Severe Excess may present with signs of Emaciation (weakness); mistakenly using tonification will aggravate the disease. Extreme Deficiency may present with vigorous manifestations; mistakenly using purgation will cause unjust suffering. Yin syndromes may resemble Yang syndromes; clearing heat will surely lead to death. Yang syndromes may resemble Yin syndromes; warming will further injure. Accumulations in the middle jiao indicate Excess. In severe cases, the patient may be silent and unwilling to speak, limbs unwilling to move, or suffer from dizziness, blurred vision, or loose stools. These are all examples of "Severe Excess presenting with Weak Signs," just as overeating leads to lethargy and a desire to lie down. Spleen and Stomach damage indicates Deficiency. In severe cases, there may be distension, inability to eat, Qi stagnation, and difficulty defecating. These are examples of "Extreme Deficiency presenting with Vigorous Signs," just as prolonged hunger leads to loss of appetite. Spleen and Kidney Deficiency-Cold constitute a True Yin Syndrome. When Yin is extremely abundant, it often repels Yang to the exterior, causing redness of the face and eyes, cracking of the mouth and tongue, tossing of hands and feet, and confused speech. This resembles Yang syndrome, just as in the harsh cold of deep winter, water freezes; hardness is a sign of Yang strength. Unresolved pathogenic heat constitutes a Yang Syndrome. When Yang is extremely abundant, it often leads to Jue (Cold Extremities). In Jue, there is no breath at the nose and mouth, and the hands and feet are cold. This resembles Yin syndrome, just as in the scorching heat of midsummer, trees exude sap; sap is a sign of Yin softness. Generally, since symptoms cannot always be trusted, one should refer to pulse diagnosis. If the pulse is also untrustworthy, one must rely on deep palpation and prolonged observation. False symptoms manifest on the surface, so superficial pulse taking yields false results; true symptoms hide within, so deep and prolonged palpation can distinguish them. An Excess pulse remains consistent throughout; a Deficient pulse fluctuates, becoming large and small intermittently. It is like meeting someone for the first time; one cannot immediately know their true character. Only after knowing them for a long time can one see their true nature. If one judges Excess based on a momentary large pulse, or Deficiency based on a momentary small pulse, how erroneous would that be! One must observe repeatedly and for a long time, then the truth of Deficiency and Excess becomes clear. However, even if the pulse diagnosis is accurate, one should not rely solely on it. One must also examine the constitution (thick or thin), the duration of the illness, and whether previous treatment was mistaken, integrating all factors. Otherwise, one falls into the trap of following conventions blindly. Furthermore, Zang organ disorders often mimic Fu organ disorders; Blood changes are close to Qi dynamics. Regulating Qi focuses on Yang and ascending; regulating Blood focuses on Yin and descending. A difference of a hair's breadth leads to a mistake of a thousand miles. Do we not consider that people entrust their lives to us? How can we seek merit lightly? Those who harm people are not worth discussing. Even if one occasionally succeeds, how can one face one's conscience? What is hard to clarify is intuition; what is hard to exhaust is words. I only wish that those aspiring to benevolence and longevity, beyond reading books, will learn to connect insights from daily life and habits. When treating patients, even if the pathogenesis seems simple, one must examine it thoroughly. Once the root and branch are clear, one must proceed with extreme caution. Being aware and prudent is essential. One must exercise independent judgment with precision and detail, avoiding negligence due to doubt or fear. If uncertain, one must repeatedly consult the pulse. It is better to observe more and prescribe less. Remember, medicine controls life and death; its purpose is to cure disease and prolong life. Do not sacrifice life to treat disease, which is like sacrificing the body for the house—where are the root and branch? For patients who are not severely deficient, excessive use of warming and tonifying herbs may cause errors but will not necessarily kill; subsequent administration of cooling herbs can restore efficacy. However, if a deficient patient is mistakenly treated with bitter-cold draining herbs, it is like trying to revive the dead or reattach severed limbs; even with subsequent warming and tonification, recovery is impossible. Consider the ancient saying: "As long as one point of Yang Qi remains, death does not occur." This is truly correct.