未绝耳，故半身虽不运用，然亦未至于机息而死也。古所谓瘫痪者，亦有深意存焉。言痈者坦也，筋脉弛纵坦然而不举
也。痪者涣也，血气散慢涣然而不用也。或曰∶其为治之法，与诸痹同乎？曰∶不同也。经谓风、寒、湿三气合而
成痹，故曰痛痹（筋骨掣痛），曰着痹（着而不行），曰行痹（走痛不定），曰周痹（周身疼痛），皆邪气有余之候也。其
瘫痪者，或血虚，或气虚，皆正气不足之证。其治法故不同也。惟痿痹属血虚，麻痹属气虚，与瘫痪治法大同而小异焉。
学人宜加详察，毋蹈乎实实虚虚之复辙云。
或问∶雀目之证，遇晚则目不见物，至晓复明，此何病使然？曰∶是则肝虚之候也。或曰∶肝常虑其有余，然亦有
不足者乎？曰∶邪气盛则实，正气夺则虚。其人素禀血虚，适遇寅申二年，少阳相火司天，厥阴风木在泉，火炎于上，
木郁于下。夫胞络相火既盛，则心血沸淖而干涸。经曰∶天明则日月不明，邪害空窍。盖心出血，肝纳血，心血既涸，
则肝无攸受。经又曰∶目得血而能视。缘肝开窍于目，肝既无血，则目瞀而不明矣。或曰∶目瞀不明，既得闻命矣，其
晚暗而晓复明者何也？曰∶木生于亥、旺于卯而绝于申，至于酉戌之时，木气衰甚，遇亥始生，至日出于卯之地，木气
稍盛而目复明矣。虽然，终不能了然如故。或曰∶雀目之患，终变为黄胀而死，何也？曰∶木绝于申，乃水土长生之地，
木气萎和，土气敦阜，经谓气有余则制已所胜而侮所不胜，此土气有余而侮所不胜之木也。或曰∶治法何如？曰∶先宜
地黄、芎、归等药，以补益其肾肝之不足；次用浓朴、苍术、陈皮之类，平其土气之有余。此乃略示端倪耳，医者自宜
临证斟酌而处治之，慎不可按图而索骥也。
或问∶小儿气喘，世俗例以为犯土，谓犯其土皇也。或安碓，或作灶，或浚井填塞、开通沟渠等事，适遇小儿气喘，
遂云犯土无疑矣。信听术士退土，或书符命贴于动土之处，或咒法水焚符调服，或按家之九宫，谓土皇居于何宫，太阳
落在何宫，当取太阳之土与儿饮之，能释土皇之厄而喘定，间亦有验者。夫历代医书汗牛充栋，何不该载而遗此证为黄
冠之流医治欤？请明以告我。曰∶夫小儿发喘，多因风寒外束，腠理壅遏，而肺气不得宣通而为病耳。治法当用钱氏泻
白散或三拗汤等剂，使腠理开通，肺气舒畅而喘息定矣。或因吐泻之后而中气不足，亦使短气而喘。治用钱氏益黄散、
东垣补中益气汤，或用伏龙肝，汤泡放温饮之，其喘立定者有之。盖脾土大虚，必借土气以培益之。其术士窥窃此意，
而巧立名色，而谓太阳之土能安土也。夫小儿之证不一，或慢惊直视而喘，或肺胀气促而喘，纵取太阳土盈盎以沃之，
亦莫能救其万一。医者自宜检方按法调治，毋听末流之俗以致惑焉。
或问∶妇人怀鬼胎者何欤？曰∶昼之所思，为夜之所见。凡男女之性淫而虚者，则肝肾之相火无时不起，故劳怯之
人多梦与鬼交。夫所谓鬼胎者，伪胎也。非实有鬼神交接而成胎也。古方有云∶思想无穷，所愿不遂，为白淫白浊，流
于子宫，结为鬼胎，乃本妇自己之血液淫精，聚结成块，而胸腹胀满，俨若胎孕耳，非伪胎而何。或曰∶尝阅滑伯仁医
验，谓仁孝庙庙祝杨天成一女，薄暮游庙庑，见黄衣神觉心动，是夕梦与之交，腹渐大而若孕，邀伯仁治，诊
之，曰此鬼胎也，其母道其由，与破血坠胎之药，下如蝌蚪鱼目者二升许遂安，此非与神交乎？曰∶有是事而实无是理，
岂有土木为形，能与人交而有精成胚胎耶。噫！非神之惑于女，乃女之惑于神耳。意度此女，年长无夫，正所谓思想无
穷，所愿不遂也。有道之士，勿信乎邪说之惑焉。
或问∶鳌峰熊氏纂集《运气全书》及撰为《伤寒钤法》，以病者之所生年月日时，合得病之日期，推算五运六气，与
伤寒六经证候无不吻合，谓某日当得某经，某经当用某药，而以张仲景一百一十有三方按法施治，如太阳无汗麻黄汤、
有汗桂枝汤之类，使后学能推此法，不须问证察脉，但推算病在此经，即用此经之药，实为医家之快捷方式妙诀也，吾子可
不祖述乎？曰∶此马宗素无稽之术，而以世之生灵为戏玩耳。窃谓上古圣人，仰观天文，俯察地理，以十干配而为五运，
以十二支合而为六气，天以六方寓之，岁以六气纪之，以天之六气，加临于岁之六节，五行胜复盈亏之理，无有不验。
传曰∶天之高也，星辰之远也，苟求其故，千岁之日至可坐而致也。今草莽野人，而以人之年命，合病日而为运气钤法，
取仲景之方以治之，是盖士师移情而就法也，杀人多矣。知理君子，幸勿蹈其复辙云。
或问∶庞安常《伤寒总病论》所载时行瘟疫，谓春有青筋牵证，其候颈背双筋牵急，先寒后热，腰强急，脚缩不伸，
中欲折，或眼黄，项背强直。夏有赤脉KT 证，其候口干舌裂咽塞，战掉惊动不定。秋有白气狸证，其候经络壅滞，
皮毛坚竖发泄，体热生斑，气喘引饮。冬有黑骨瘟证，其候腰痛欲折，胸胁如刀刺切痛，心腹膨胀。四季有黄肉随证，
其候颈下结核，头重项直，或皮肉强硬而隐隐发热。尝闻医有贤愚，疾无今古，近年以来，未尝有以上诸证，何今古
之不同欤？请明言其故，幸甚！曰∶瘟疫之证，素无定体，或气运之变迁，或世情之不古。愧予年逾八旬，略未见此异
证，或世有之而予未之见欤？抑亦见之而予未之识欤？安常禀出类拔萃之资，为一代名世之士，着述方书以为后学之规
范，岂好为异说以欺世罔俗哉，姑录之以俟达者再论。
或问∶庞安常《伤寒总病论》所载《圣散子方》，谓出于苏子瞻尚书所传，又谓其方不知所从来，而故人巢君谷世宝
之，以治瘟疫之疾，百不失一。安常赞曰∶自古论病，惟伤寒至为危急，表里虚实，日数证候，应汗应下之法，差之毫
厘，辄至不救，而用圣散子者，一切不问。阴阳二感，或男女相易，状至危笃者，连饮数剂，则汗出气通，饮食渐进，
神宇完复，更不用诸药，连服取瘥；其余轻者，心额微汗，正尔无恙。药性少热，而阳毒发狂之类，入口即觉清凉，殆
不可以常理论也。时疫流行，平旦辄煮一釜，不问老少良贱，各饮一大盏，则时气不入其门。平居无病，能空腹一服，
则饮食甘美，百疾不生，真济世卫家之宝也。吾子何不遵其法多合，以济世之瘟疫，岂非积德之一事乎？曰∶予阅其方，
殆与医道不合，盖其药味，止是燥热助火之剂，别无祛邪除瘴之能。如黑附子、高良姜、吴茱萸、石菖蒲、麻黄、细辛、
半夏、浓朴、肉豆蔻、防风、藿香，岂非辛烈燥热之剂乎。其茯苓、苍术、 本、猪苓、泽泻、独活、甘草，稍温不
热。虽有柴胡、芍药、枳壳三味之凉，恐一杯之水，难救一车薪之火。夫热药治热病，《素问》谓之从治，又谓之反治，
又谓之劫剂。然此方必当时适遇瘟疫之身热无汗，或日期已过，邪气欲去正气将复之际，偶投一服二服，劫而散之者有
之。由是众皆以为得神仙之法，争录其方以传于世，正所谓讹上传讹也，岂可以大釜煎煮令一家俱饮乎，又岂可令无病
之人空腹服此热药乎。用药者若不执之以理，而谓不杀人者，予未之信也。安常为一代之名医，而载此方于伤寒论中，
而谓能博施济众，亦贤者之过焉。
或问∶发砂之证，古方多不该载。世有似寒非寒，似热非热，四体懈怠，饮食不甘，俗呼为砂病。其治或先用热水
蘸搭臂膊而以苎麻刮之，甚者或以针刺十指出血，或以香油灯照视身背有红点处皆烙之，以上诸法，皆能使腠理开通，
血气舒畅而愈。此为何病？又何由而得之乎？曰∶《内经》名为解 ，原其所因，或伤酒，或中湿，或感冒风寒，或房事
过多，或妇人经水不调，血气不和，皆能为解 ，证与砂病相似，实非真砂病也。夫砂病者，岭南烟瘴之地多有之矣。
诗云∶为鬼为蜮，则不可得。注云∶蜮，短狐也，江淮间多有之，能含砂以射水中人影。唐诗云∶射工巧俟游人影。亦
谓此也。人不见其形，若被其毒，辄为寒热而病。一曰∶蜮如鳖，有三足，一名射影，病疮如疥。《埤雅》曰∶有一角横
在口前，如弩檐，临其角端，曲如上弩，以气为矢，因水势以射人，俗呼水弩，鹅能食之。本草云∶溪毒、砂虱、水弩、
射工、蜮、短狐、虾须之类，俱能含砂射人。被其毒者，则憎寒壮热，百体分解，若伤寒初发之状，彼土人治法，以手
扪摸痛处，用芋叶或甘蔗叶卷角入肉，以口吸出其砂，外用生大蒜捣膏封贴疮口即愈。诸虫惟虾须最毒，若不早治，十
死七八，其毒深入于骨，若虾须之状，其疮类乎疔肿。彼地有 、 HT 等鸟，专食以上诸虫，凡遇此病，即以此鸟
毛粪
烧灰服之，及笼此鸟于病者身畔吸之，其砂闻气自出而病安也。其他无此诸虫之地，实非真砂证也。管见如斯，学人更
宜博访，以长见闻可也。
或问∶痞与 癖积聚 瘕，病虽似而其名各不同，请逐一条陈其说，以晓后学可乎？曰∶痞者否也，如《易》所谓
天地不交之否，内柔外刚，万物不通之义也。物不可以终否，故痞久则成胀满而莫能疗焉。 癖者悬绝隐僻，又玄妙莫
测之名也。积者迹也，挟痰血以成形迹，亦郁积至久之谓尔。聚者绪也，根据元气以为端绪，亦聚散不常之意云。症者征
也，又精也，以其有所征验，及久而成精萃也。瘕者假也，又遐也，以其假借气血成形，及历年遐远之谓也。大抵痞与
癖乃胸膈间之候，积与聚为肚腹内之疾，其为上中二焦之病，故多见于男子。其症与瘕独见于脐下，是为下焦之疾，
故常得于妇人。大凡腹中有块，不问积聚 瘕，俱为恶候，切勿视为寻常等疾而不求医早治，若待胀满已成，胸腹鼓急，
虽仓扁复生，亦莫能救其万一，HT 斯疾者，可不惧乎！
或问∶……或曰∶今之梦寐中而常魇者，似有鬼神所附之状，何也？曰∶然。梦寐间常魇者，盖火起于下而痰闭
于上，心血亏欠而心神失守故尔，岂有鬼神所附之理哉，贤者愿无惑焉。
或问∶古老医家有禁咒一科，今何不用？曰∶禁咒科者，即《素问》祝由科也，立教于龙树居士，为移精变气之术
耳。可治小病，或男女入神庙惊惑成病，或山林溪谷冲斥恶气，其证如醉如痴，如为邪鬼所附，一切心神惶惑之证，可
以借咒语以解惑安神而已。古有龙树咒法之书行于世，今流而为师巫，为降童，为师婆，而为扇惑民众、哄吓取财之术。
噫！邪术惟邪人用之，知理者勿用也。
或问∶丹溪所谓有外感挟内伤者有内伤挟外邪者，其证何如而见？当以何法而治？请详以语之。曰∶假如先因劳役
过度，饮食失节，而其体已解 ，又为感冒风寒而作，其证必恶寒发热，头身惧痛，右手气口及关脉则大于左手人迎及
关脉二倍，而两手阳脉俱有紧盛之势，此内伤重而外感轻，谓之内伤挟外邪也，治法必以东垣补中益气汤为主，加以防
风、羌活、柴胡之类。或先因秋冬之月触冒风寒，郁积已久欲发未发之间，而加之饮食劳倦触动而发，其证必大恶风寒，
头身大痛而大发热，左手人迎及关中脉则大于右手气口及关脉一二倍，而两手阳脉亦各有紧盛之势，此外感重而内伤轻，
谓之外感挟内伤也，治法必以仲景《伤寒论》六经见证之药为主治，少加以补中健脾之剂。夫外感重者，宜先攻而后补
（攻者汗下之类）；内伤重者，宜先补而后攻；二证俱重，宜攻补兼施。或曰∶劳倦饮食二者俱甚而为大热之证，欲补则
饮食填塞胸中，恐愈增胞闷，欲消导则恐元气愈虚而病益甚，其将何法以处治乎？曰∶此正王安道所论不足中之有余证
也，必宜攻补兼施，以补中益气汤，间与丹溪导痰补脾饮，加神曲、麦芽之属，甚者以东垣枳实导滞丸之类，与补中益
气汤间而服之，食去而虚证亦除，是亦攻补兼施之法也。医者诚能斟酌权宜而处治之，无有不安之理也。
或问∶人之寿夭，各有天命存焉，凡人有生必有死，自古皆然，医何益乎？曰∶夫所谓天命者，天地父母之元气也，
父为天，母为地，父精母血盛衰不同，故人之寿夭亦异。其有生之初，受气之两盛者（父母元气皆壮盛也，余仿此），当
得上中之寿；受气之偏盛者，当得中下之寿；受气之两衰者，能保养仅得下寿，不然多夭折。虽然，又不可以常理拘泥
论也，或风寒暑湿之感于外，饥饱劳役之伤乎内，岂能一一尽乎所禀之元气耶。故上古神农氏尝百草、制医药，乃欲扶
植乎生民各得尽乎天年也。今时人有不信医而信巫枉死者，皆不得尽乎正命而与岩墙桎梏死者何异焉。或曰∶今之推命
者，皆以所生日时之天上星辰，推算其生死安危，无不节节应验。子以父母之元气为天命，恐非至当之语。曰∶天人之
理，盛衰无不吻合，如河出图，洛出书，圣人取以画八卦而成《易》书。凡人之一动一静，与夫吉凶消长之理，进退存
并没有完全断绝，所以虽然半身不能活动，但还没有达到气息停止而死亡的地步。古代所说的“瘫痪”，其中也有深意存在。“瘫”字意为坦，指筋脉松弛弛缓、平坦而不能抬起；“痪”字意为涣，指血气散漫、涣散而不能使用。有人问：治疗这种病的方法，与各种痹证相同吗？回答说：不相同。经典中说风、寒、湿三种邪气结合而成痹证，所以有痛痹（筋骨掣痛）、着痹（疼痛固定不移）、行痹（疼痛游走不定）、周痹（周身疼痛）等名称，这些都是邪气有余的表现。而瘫痪病，或者是血虚，或者是气虚，都是正气不足的证候。因此治疗方法自然不同。只有痿证和痹证属于血虚，麻痹属于气虚，与瘫痪的治疗方法大体相同而细节略有差异。学者应当仔细考察，不要重蹈“实其实、虚其虚”（即对实证用补法、对虚证用泻法，导致病情加重）的错误覆辙。
有人问：雀目（夜盲症）的病症，到了晚上就看不见东西，到天亮又恢复视力，这是什么病导致的呢？回答说：这是肝虚的表现。有人问：人们常担心肝气有余，难道也有不足的时候吗？回答说：邪气盛则表现为实证，正气被剥夺则表现为虚证。这个人平素禀赋血虚，恰逢寅申之年，少阳相火司天，厥阴风木在泉，火炎于上，木郁于下。胞络中的相火既然旺盛，那么心血就会沸腾煎熬而干涸。经典说：“天明则日月不明，邪害空窍。”大概心主血，肝藏血，心血既然枯竭，肝也就没有血液可收纳了。经典又说：“眼睛得到血的滋养才能视物。”因为肝开窍于目，肝既然没有血，眼睛就会昏花不明。有人问：眼睛昏花不明，我已经听明白了，为什么晚上黑暗时看不见，天亮后又复明呢？回答说：木生于亥时，旺于卯时，绝于申时，到了酉、戌之时，木气衰败得很厉害，遇到亥时开始生发，等到日出时的卯地，木气稍微旺盛，眼睛就复明了。虽然如此，终究不能完全像以前那样清晰明亮。有人问：雀目的病患，最终会变成黄胀病而死，为什么呢？回答说：木绝于申，那是水土长生的地方，木气萎弱平和，土气敦厚丰盛。经典说：“气有余则克制它所胜的，侮蔑它所不胜的。”这是土气有余而侮蔑所不胜之木的表现。有人问：治疗方法怎么样？回答说：先宜用地黄、川芎、当归等药物，来补益肾肝的不足；其次用厚朴、苍术、陈皮之类的药物，平抑土气的有余。这只是略微展示端倪罢了，医生应当根据临证情况斟酌处理，千万不要按图索骥、机械套用。
有人问：小儿气喘，世俗惯例认为犯了“土神”，说是触犯了土皇。或者是在安石臼、建灶台、疏通水井填塞、开通沟渠等动土的事情发生时，恰好遇到小儿气喘，于是就说一定是犯了土神无疑。相信术士退土之法，有的写符咒贴在动土的地方，有的用咒语烧符调水服用，有的按照家中的九宫方位，说土皇居于哪个宫位，太阳星落在哪个宫位，应当取该宫位的土给小儿喝，能解除土皇的厄运而使喘息安定，偶尔也有灵验的。历代医书汗牛充栋，为什么不记载这种病而留给道士一类的人医治呢？请明白地告诉我。回答说：小儿发喘，多是因为风寒外束，腠理闭塞，肺气不得宣通而致病。治疗方法应当用钱氏泻白散或三拗汤等方剂，使腠理开通，肺气舒畅而喘息平息。也有因为吐泻之后中气不足，也导致短气而喘。治疗可用钱氏益黄散、东垣补中益气汤，或者用伏龙肝，开水冲泡放温后饮用，有的能使喘息立刻平息。因为脾土大虚，必须借助土气来培补它。那些术士窥探窃取了这一层意思，而巧立名目，说太阳之土能安土。小儿的病症不一，有的是慢惊风直视而喘，有的是肺胀气促而喘，纵然取满盆的太阳土浇给他喝，也不能挽救万一。医生应当自行检查方剂按照法则调治，不要听信末流俗人的说法以致迷惑。
有人问：妇人怀鬼胎是怎么回事呢？回答说：白天所想的，是夜晚所见到的。凡是男女性情淫乱且身体虚弱的人，肝肾的相火无时无刻不起动，所以患劳损怯弱病的人多梦与鬼神交合。所谓鬼胎，就是伪胎。并不是真的有鬼神交接而成胎。古方有云：“思想无穷，所愿不遂，化为白淫白浊，流于子宫，结为鬼胎。”这是本妇自己的血液和淫精，聚结成块，导致胸腹胀满，俨然像怀孕一样，这不是伪胎又是什么呢？有人问：曾经阅读滑伯仁的医案，说仁孝庙庙祝杨天成的女儿，傍晚在庙廊游玩，看见穿黄衣的神像心动，当晚梦见与他交合，腹部渐渐变大像怀孕，邀请伯仁诊治，诊察后说这是鬼胎，她母亲说明了缘由，给予破血坠胎的药物，排出如蝌蚪鱼目大小的东西约二升，于是平安。这难道不是与神交合了吗？回答说：有这件事而没有这个理，哪有土木构成的形体，能与人交合而有精液形成胚胎的呢？唉！不是神被女子迷惑，而是女子被神迷惑。推测这位女子，年长无夫，正所谓思想无穷，所愿不遂。有道之士，不要相信邪说的迷惑。
有人问：鳌峰熊氏编纂《运气全书》及撰写《伤寒钤法》，根据病人出生的年月日时，结合得病的日期，推算五运六气，与伤寒六经证候无不吻合，说某日当得某经，某经当用某药，并用张仲景的一百一十三个方子按照这种方法施治，比如太阳病无汗用麻黄汤、有汗用桂枝汤之类，让后学能推演这种方法，不需要问诊察脉，只要推算出病在此经，就用此经的药，实在是医家的快捷方式妙诀，您为什么不效法呢？回答说：这是马宗素无稽之术，把世人的生命当作戏玩。我认为上古圣人，仰观天文，俯察地理，以十天干配合成为五运，以十二地支合成为六气，天以六方寓之，岁以六气纪之，以天之六气，加临于岁的六节，五行胜复盈亏的道理，没有不灵验的。传说道：“天很高，星辰很远，如果探究其规律，千年的冬至日可以坐着推算出来。”如今草野之人，却把人的年命与病日结合作为运气钤法，取仲景的方子来治疗，这是移情就法，杀人很多了。知晓道理的君子，希望不要重蹈覆辙。
有人问：庞安常《伤寒总病论》所载的时行瘟疫，说春天有青筋牵证，其症状是颈背双筋牵急，先寒后热，腰强直，脚缩不伸，腰部想折断，或者眼黄，项背强直。夏天有赤脉KT证，其症状是口干舌裂咽塞，战栗惊动不定。秋天有白气狸证，其症状是经络壅滞，皮毛坚竖发泄，身体发热生斑，气喘引饮。冬天有黑骨瘟证，其症状是腰痛想折断，胸胁如刀刺切痛，心腹膨胀。四季有黄肉随证，其症状是颈下结核，头重项直，或者皮肉强硬而隐隐发热。曾听说医生有贤愚之分，疾病没有古今之别，近年来未曾有过以上诸证，为什么古今不同呢？请明确说明原因，幸甚！回答说：瘟疫的证候，本来就没有固定的形态，或者是气运的变化，或者是世风不如古时。惭愧我年过八十，略未见这些异证，或许是世上有而我没见到呢？还是见到了但我没识别出来呢？安常禀赋出类拔萃的资质，是一代名士，著述方书作为后学的规范，难道是喜欢发表异说欺骗世人吗？姑且记录下来等待通达者再讨论。
有人问：庞安常《伤寒总病论》所载的《圣散子方》，说是出于苏子瞻尚书所传，又说此方不知从何而来，而故人巢君谷世代珍视它，用来治疗瘟疫，百不失一。安常称赞说：自古以来论病，只有伤寒最为危急，表里虚实，日数证候，应汗应下的方法，差之毫厘，往往导致无法救治，而用圣散子的，一概不问。阴阳二感，或者男女相互传染，症状极其危重的，连续服用几剂，就能汗出气通，饮食渐进，神志完复，更不用其他药，连服痊愈；其余轻症的，心额微汗，正尔无恙。药性稍热，而阳毒发狂之类，入口即觉清凉，简直不可以常理论。时疫流行，清晨煮一大釜，不问老少贵贱，各饮一大盏，则时气不入其门。平时无病，能空腹服一次，则饮食甘美，百疾不生，真是济世卫家的宝物。您为什么不遵循这个方法多配制，以救济世上的瘟疫，岂不是积德的一件事吗？回答说：我阅读他的方子，大概与医道不合，因为它的药味，只是燥热助火的药剂，没有祛邪除瘴的能力。如黑附子、高良姜、吴茱萸、石菖蒲、麻黄、细辛、半夏、厚朴、肉豆蔻、防风、藿香，难道不是辛烈燥热的药剂吗？茯苓、苍术、本草、猪苓、泽泻、独活、甘草，稍温不热。虽然有柴胡、芍药、枳壳三味的凉性，恐怕一杯水难救一车柴的火。用热药治热病，《素问》称为从治，又称反治，又称劫剂。然而此方必定是当时恰好遇到瘟疫患者身热无汗，或者病程已过，邪气欲去正气将复之际，偶然投服一两剂，劫散邪气的情况有之。由此众人都以为得到了神仙之法，争着记录此方流传于世，正所谓讹上传讹，岂可以用大釜煎煮让一家人都喝呢？又岂可以让无病之人空腹服用此热药呢？用药者如果不以理为准绳，而说不杀人的话，我不相信。安常是一代名医，却将此方载入伤寒论中，说能博施济众，也是贤者的过失啊。
有人问：发砂的病症，古方大多不记载。世间有似寒非寒，似热非热，四肢懈怠，饮食不甘，俗呼为砂病。治疗有时先用热水蘸搭胳膊然后用苎麻刮之，严重的或用针刺十指出血，或用香油灯照视身背有红点处皆烙之，以上诸法，都能使腠理开通，血气舒畅而愈。这是什么病？又是如何得的呢？回答说：《内经》名为解 ，追溯其原因，或者是伤酒，或者是中湿，或者是感冒风寒，或者是房事过多，或者是妇人经水不调，血气不和，都能导致解 ，证候与砂病相似，实际上不是真砂病。所谓砂病，岭南烟瘴之地多有。诗云：“为鬼为蜮，则不可得。”注云：“蜮，短狐也，江淮间多有之，能含砂以射水中人影。”唐诗云：“射工巧俟游人影。”也是指这个。人看不见它的形状，如果被它毒气所伤，就会寒热生病。一说：蜮如鳖，有三足，一名射影，病疮如疥。《埤雅》曰：有一角横在口前，如弩檐，临其角端，曲如上弩，以气为矢，因水势以射人，俗呼水弩，鹅能食之。本草云：溪毒、砂虱、水弩、射工、蜮、短狐、虾须之类，俱能含砂射人。被其毒者，则憎寒壮热，百体分解，若伤寒初发之状，彼地人治法，用手摸痛处，用芋叶或甘蔗叶卷角入肉，用口吸出其砂，外用生大蒜捣膏封贴疮口即愈。诸虫中虾须最毒，若不早治，十死七八，其毒深入于骨，若虾须之状，其疮类似疔肿。彼地有 、 HT 等鸟，专食以上诸虫，凡遇此病，即以这些鸟毛粪烧灰服用，以及笼此鸟在病人身边吸引它，其砂闻气自出而病安。其他地方没有这些虫，实在不是真砂证。我的见解如此，学者更应该广泛访问，以增长见闻。
有人问：痞与 癖积聚 瘕，病虽相似而其名各不相同，请逐条陈述其说，以晓谕后学可以吗？回答说：痞者否也，如《易》所谓天地不交之否，内柔外刚，万物不通的意思。事物不可能一直闭塞，所以痞久则成胀满而无法治疗。 癖者悬绝隐僻，又是玄妙莫测的名字。积者迹也，挟痰血以成形迹，也是郁积至久的意思。聚者绪也，根据元气以为端绪，也是聚散不常的意思。症者征也，又精也，因为它有所征验，及久而成精萃。瘕者假也，又遐也，因为它假借气血成形，及历年遐远的意思。大抵痞与癖乃胸膈间的证候，积与聚为肚腹内的疾病，它们属于上中二焦的病，所以多见于男子。症与瘕独见于脐下，是为下焦的疾病，所以常得于妇人。大凡腹中有块，不问积聚 瘕，都是恶候，切勿视为寻常等疾病而不求医早治，若待胀满已成，胸腹鼓急，即使是仓公扁鹊再生，也不能挽救万一，患此疾的人，能不害怕吗！
有人问：……有人说：现在做梦时常魇住，好像有鬼神附身的样子，为什么呢？回答说：是的。梦寐间常魇住，大概是火起于下而痰闭于上，心血亏欠而心神失守的缘故，哪里有鬼神附身的道理呢，贤者希望不要迷惑。
有人问：古老医家有禁咒一科，现在为什么不用？回答说：禁咒科，就是《素问》祝由科，立教于龙树居士，是移精变气之术罢了。可以治小病，或者男女入神庙惊惑成病，或者山林溪谷冲斥恶气，其证如醉如痴，如为邪鬼所附，一切心神惶惑之证，可以借咒语以解惑安神而已。古有龙树咒法之书行于世，现在流变为师巫、降童、师婆，成为扇惑民众、哄吓取财之术。唉！邪术只有邪人用，知理者不要用。
有人问：丹溪所谓有外感挟内伤者，有内伤挟外邪者，其证候如何表现？应当用什么方法治疗？请详细告诉我。回答说：假如先因劳役过度，饮食失节，而其体已解 ，又为感冒风寒而作，其证必恶寒发热，头身惧痛，右手气口及关脉比左手人迎及关脉大二倍，而两手阳脉都有紧盛之势，这是内伤重而外感轻，称为内伤挟外邪，治法必以东垣补中益气汤为主，加以防风、羌活、柴胡之类。或者先因秋冬之月触冒风寒，郁积已久欲发未发之间，而加之饮食劳倦触动而发，其证必大恶风寒，头身大痛而大发热，左手人迎及关中脉比右手气口及关脉大一二倍，而两手阳脉也各有紧盛之势，这是外感重而内伤轻，称为外感挟内伤，治法必以仲景《伤寒论》六经见证之药为主治，少加以补中健脾之剂。外感重者，宜先攻而后补（攻者汗下之类）；内伤重者，宜先补而后攻；两证俱重，宜攻补兼施。有人说：劳倦饮食二者俱甚而为大热之证，想补则饮食填塞胸中，恐更增闷，想消导则恐元气愈虚而病益甚，将用什么方法处理呢？回答说：这正是王安道所论不足中之有余证，必宜攻补兼施，以补中益气汤，间与丹溪导痰补脾饮，加神曲、麦芽之类，严重的以东垣枳实导滞丸之类，与补中益气汤间而服之，食去而虚证亦除，这也是攻补兼施的方法。医生如果能斟酌权宜而处理，没有不安的道理。
有人问：人的寿夭，各有天命存在，凡人有生必有死，自古皆然，医学有什么用呢？回答说：所谓天命，是天地父母的元气。父为天，母为地，父精母血盛衰不同，所以人的寿夭也不同。有生之初，受气之两盛者（父母元气皆壮盛），当得上中之寿；受气之偏盛者，当得中下之寿；受气之两衰者，能保养仅得下寿，不然多夭折。虽然，也不可以常理拘泥而论，或者风寒暑湿之感于外，饥饱劳役之伤乎内，岂能一一尽乎所禀之元气耶。所以上古神农氏尝百草、制医药，是想扶持植养百姓各自尽享天年。今时人有不信医而信巫枉死者，都与不得尽乎正命而与岩墙桎梏死者何异。有人说：现在推命者，都以所生日时之天上星辰，推算其生死安危，无不节节应验。您以父母之元气为天命，恐怕不是至当之语。回答说：天人道理，盛衰无不吻合，如河出图，洛出书，圣人取以画八卦而成《易》书。凡人之一动一静，与夫吉凶消长之理，进退存
The meridians have not completely severed, so although half of the body cannot move, it has not yet reached the state where vital qi ceases and death occurs. The ancient term "paralysis" (Tan Huan) contains profound meaning. "Tan" implies smoothness or flaccidity, referring to sinews and vessels that are relaxed and slack, unable to lift; "Huan" implies dispersion, referring to blood and qi that are scattered and loose, unable to function. One might ask: Is the treatment method for this condition the same as for various Bi syndromes? I reply: It is not. The classics state that Wind, Cold, and Dampness combine to form Bi syndromes. Thus, there are Painful Bi (Jing Gu Che Tong, characterized by pulling pain in bones and muscles), Fixed Bi (Zhuo Bi, characterized by fixed pain without movement), Wandering Bi (Xing Bi, characterized by migrating pain), and Generalized Bi (Zhou Bi, characterized by whole-body pain). These are all manifestations of excess pathogenic factors. In contrast, paralysis is caused either by Blood deficiency or Qi deficiency, representing a syndrome of deficient healthy qi. Therefore, the treatment methods differ. Only Wei syndrome (Waste Syndrome) and Bi syndrome belong to Blood deficiency, while numbness belongs to Qi deficiency; their treatment methods are largely similar but slightly different from those for paralysis. Scholars should examine this carefully and avoid repeating the error of reinforcing an excess and depleting a deficiency (Shi Shi Xu Xu).
One asks: Regarding the condition of Night Blindness (Que Mu), where one cannot see at night but vision recovers at dawn, what disease causes this? I reply: This is a sign of Liver deficiency. One asks: People often worry about Liver excess, can there also be insufficiency? I reply: When pathogenic factors are vigorous, it manifests as Excess; when healthy qi is depleted, it manifests as Deficiency. If a person is constitutionally deficient in Blood, and happens to live during a Yin-Shen year where Shaoyang Ministerial Fire governs the Heaven (upper half of the year) and Jueyin Wind Wood governs the Earth (lower half of the year), Fire blazes upward while Wood stagnates downward. Since the Ministerial Fire in the Pericardium Collateral is vigorous, Heart Blood boils and dries up. The classics say: "When heaven is bright, the sun and moon lose their clarity, and pathogens harm the empty orifices." Roughly speaking, the Heart governs Blood, and the Liver stores Blood. Once Heart Blood is exhausted, the Liver has no Blood to receive. The classics also say: "The eyes can see only when nourished by Blood." Since the Liver opens into the eyes, if the Liver lacks Blood, the eyes become dim and unclear. One asks: I understand why the eyes are dim and unclear, but why do they fail at night and recover at dawn? I reply: Wood is born at Hai hour, prospers at Mao hour, and perishes at Shen hour. By You and Xu hours, Wood qi is extremely weak. It begins to generate again at Hai hour, and by the time the sun rises at Mao hour, Wood qi becomes slightly vigorous, allowing vision to recover. Although so, it never fully returns to its former clarity. One asks: Why does Night Blindness eventually turn into Yellow Distension (Huang Zhang) leading to death? I reply: Wood perishes at Shen, which is the place of birth for Earth and Water. Wood qi withers and harmonizes, while Earth qi becomes thick and abundant. The classics say: "When qi is excessive, it controls what it overcomes and insults what it cannot overcome." This is Earth qi being excessive and insulting the Wood it cannot overcome. One asks: What is the treatment method? I reply: First, use herbs such as Shu Di Huang (Rehmanniae Radix Preparata), Chuan Xiong (Ligustici Chuanxiong Rhizoma), and Dang Gui (Angelicae Sinensis Radix) to tonify the insufficiency of Kidney and Liver. Second, use herbs such as Hou Po (Magnoliae Officinalis Cortex), Cang Zhu (Atractylodis Rhizoma), and Chen Pi (Citri Reticulatae Pericarpium) to pacify the excess of Earth qi. This merely hints at the principle; physicians must deliberate based on clinical presentation. Do not mechanically follow formulas like searching for a steed by its picture.
One asks: Pediatric asthma is commonly believed by laypeople to be caused by offending the "Earth Deity," specifically touching off construction activities like installing mortar blocks, building stoves, digging wells, or clearing ditches. When a child develops asthma coincidentally with such activities, it is deemed certain offense to the Earth Deity. Believing in exorcists who perform rituals to appease the Earth, some paste talismans on construction sites, drink water mixed with burned talismans using spells, or calculate the Nine Palaces to determine where the Earth Deity resides and where the Sun Star falls, then drinking soil from that palace to relieve the Earth Deity's curse and stop the asthma, occasionally with apparent efficacy. Medical books are numerous; why is this condition omitted and left to Daoist priests? Please explain clearly. I reply: Pediatric asthma is mostly due to external constraint by Wind-Cold, obstruction of the interstices (Cou Li), and failure of Lung Qi to diffuse and descend. Treatment should employ Qian's Xie Bai San (Drain White Powder) or San Ao Tang (Three Unbinding Decoction) to open the interstices, soothe Lung Qi, and calm the asthma. Alternatively, after vomiting and diarrhea, Middle Qi may be insufficient, causing shortness of breath and asthma. Treat with Qian's Yi Huang San (Benefit Yellow Powder), Dongyuan's Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), or drink warm decoction of Fu Long Gan (Caulis Longan or Fossilized Soil). This works because Spleen Earth is greatly deficient and requires Earth qi to nourish it. Charlatans stole this concept, inventing names claiming Sun Earth can calm the Earth. Pediatric conditions vary: slow convulsions with staring and asthma, or lung distension with rapid breathing. Even pouring a basin of Sun Earth would save none. Physicians should consult formulas and treat according to principles, avoiding confusion by vulgar practices.
One asks: What is meant by a woman carrying a "Ghost Fetus"? I reply: Thoughts by day manifest as visions by night. Those with licentious natures and deficiency experience constant stirring of Liver-Kidney Ministerial Fire, leading laboring patients to dream of intercourse with ghosts. The so-called Ghost Fetus is a pseudo-fetus, not formed by actual spiritual union. Ancient texts state: "Endless thoughts and unfulfilled desires lead to white discharge flowing into the uterus, knotting into a ghost fetus." This is actually the woman's own blood and essence gathering into a mass, causing abdominal fullness resembling pregnancy. It is indeed a pseudo-fetus. One cites Hua Borren's case of Yang Tiancheng's daughter who dreamed of a yellow-robed deity, became pregnant, and expelled material resembling tadpoles after taking blood-breaking abortifacients. Was this truly spiritual union? I reply: There is the event, but not the principle. How can wood and earth take form and produce semen for conception? Alas! It is not the god being confused by the woman, but the woman being confused by her own mind. She was likely an unmarried adult woman with endless desires. Wise men should not believe such heresies.
One asks: Xiong Shi compiled *Yunqi Quanshu* and *Shanghan Qianfa*, calculating Five Movements and Six Qi based on birth date/time and illness date, matching Shanghan Six Meridian symptoms perfectly. He claims specific days correspond to specific meridians and herbs, using Zhang Zhongjing's 113 formulas (e.g., Mahuang Tang for Taiyang without sweat, Guizhi Tang with sweat). This allows students to treat without pulse diagnosis, simply by calculation. Is this not a brilliant shortcut? Should you not follow it? I reply: This is Ma Zongsu's baseless theory, playing with lives. Ancient sages observed astronomy and geography, pairing Ten Heavenly Stems into Five Movements and Twelve Earthly Branches into Six Qi. Heaven places Six Qi in six directions; years record Six Qi in six segments. The principles of Five Elements' victory, recovery, surplus, and deficit are infallible. As the commentary says: "Heaven is high, stars are far; seek their causes, and you can calculate solstices millennia hence." Now, commoners mix human fate dates with illness dates for these calculations, applying Zhongjing's formulas. This is shifting emotion to law, killing many. Gentlemen knowing reason should not repeat this error.
One asks: Pang Anchang's *Shanghan Zongbing Lun* describes epidemic diseases: Spring has Green Tendon Pulling (neck/back tendon tightness, chills then fever, stiff waist, curled legs, broken feeling, yellow eyes, stiff neck/back); Summer has Red Vessel KT (dry mouth, cracked tongue, blocked throat, trembling, fright); Autumn has White Qi Li (meridian obstruction, erect hair, fever, spots, panting, thirst); Winter has Black Bone Plague (broken-feeling lower back, stabbing chest/flank pain, abdominal distension); Four Seasons have Yellow Flesh Following (neck lumps, heavy head, stiff neck, hard skin with hidden fever). Doctors vary in wisdom, but diseases do not change with time. Recently, these syndromes are unseen. Why the difference? Please explain. I reply: Epidemic syndromes have no fixed form; they change with climate or social customs. Though I am over eighty and have not seen them, perhaps they exist unseen or unrecognized. Anchang was outstanding and wrote for future generations; he did not invent strange theories to deceive. I record this for experts to discuss.
One asks: Pang Anchang praises *Sheng San Zi Fang* (Holy Dispersion Substances Formula), attributed to Su Zhe, unknown origin, treasured by Chao Gu, curing epidemics with near-perfect success. Anchang says: Shanghan is critical; slight errors in sweating/purging lead to death. But *Sheng San Zi* works regardless of Yin/Yang infection or gender transmission. For severe cases, continuous doses bring sweat, clear qi, restore appetite and spirit, curing without other drugs. For mild cases, slight forehead sweat ensures health. The formula is slightly hot, yet feels cool for Yang Toxicity mania. During epidemics, boiling a large pot and giving everyone a cup prevents infection. Taken fasting daily, it promotes appetite and prevents disease. It is a treasure. Why not prepare more to save lives? I reply: This formula contradicts medical principles. Its ingredients—Hei Fu Zi (Aconiti Lateralis Radix Preparata), Gao Liang Jiang (Galangal Rhizome), Wu Zhu Yu (Evodiae Fructus), Shi Chang Pu (Acori Tatarinowii Rhizoma), Ma Huang (Ephedrae Herba), Xi Xin (Asari Radix), Ban Xia (Pinelliae Rhizoma), Hou Po (Magnoliae Officinalis Cortex), Rou Dou Kou (Myristicae Semen), Fang Feng (Saposhnikoviae Radix), Huo Xiang (Pogostemonis Herba)—are acrid, fierce, drying, and hot. Fu Ling (Poria), Cang Zhu (Atractylodis Rhizoma), Ben Cao (Ligustici Rhizoma), Zhu Ling (Polyporus), Ze Xie (Alismatis Rhizoma), Du Huo (Angelicae Pubescentis Radix), Gan Cao (Glycyrrhizae Radix) are slightly warm. Despite Chai Hu (Bupleuri Radix), Shao Yao (Paeoniae Radix Alba), Zhi Ke (Aurantii Fructus Immaturus) being cool, a cup of water cannot extinguish a cartload of burning fire. Using hot herbs for heat diseases is called Cong Zhi (Following Treatment) or Fan Zhi (Reverse Treatment) or Jie Ji (Plundering Agent). This formula likely worked only when coinciding with early-stage heat-no-sweat epidemics or late-stage recovery, forcibly dispersing pathogens. People mistook this for divine magic. Boiling large pots for families or giving hot herbs to healthy people is dangerous. Without reasoning, I do not believe it harmless. Anchang, a famous doctor, including this in *Shanghan Lun* claiming universal benefit, is an error of the wise.
One asks: Fa Sha (Sand Disease) is rarely recorded. It presents as neither cold nor hot, with limb flaccidity and poor appetite. Treatments include scraping arms with ramie after hot water application, pricking fingers to bleed, or cauterizing red spots under oil lamp light. These open interstices and soothe qi/blood. What is this disease and its cause? I reply: *Neijing* calls it Jie [Character missing/obscured]. Causes include alcohol injury, dampness, Wind-Cold, excessive sex, or irregular menstruation causing qi/blood disharmony. It resembles Sand Disease but is not true Sand Disease. True Sand Disease occurs in Lingnan miasma regions. Classics describe "Yu" (Short Fox/Duck-billed monster) containing sand to shoot shadows. Victims suffer chills and fever. Descriptions vary: turtle-like with three feet, or having a horn like a crossbow bow, shooting air/sand via water current. Goose eats it. Materia Medica lists Xi Du, Sha Shi, Shui Nu, She Gong, Yu, Duan Hu, Xia Xu as capable of shooting sand. Victims suffer severe chills, fever, body decomposition, resembling early Shanghan. Locals suck out sand using taro or sugarcane leaves wrapped around corners, applying raw garlic paste. Among insects, Xia Xu (Shrimp Mustache) is most toxic; if untreated, 70-80% die. Toxin enters bone, resembling carbuncle. Birds eat these insects; their feathers/feces ash cures by drawing out sand. Other regions lack these insects; thus, it is not true Sand Syndrome. Scholars should investigate further.
One asks: Pi (Glomus), Ji (Accumulation), Ju (Gathering), Zheng (Mass), and Jia (Floating Mass) seem similar but have different names. Please explain each to enlighten students. I reply: Pi means blockage, like the Hexagram Pi in *I Ching* (Heaven and Earth not interacting), internal softness, external hardness,万物不通 (ten thousand things blocked). Prolonged Pi leads to distension. Ji/Pi refers to hidden, remote, mysterious locations. Ji (Accumulation) means traces, forming shapes with phlegm-blood, accumulated over long periods. Ju (Gathering) means threads, starting from Yuan Qi, gathering and scattering irregularly. Zheng (Mass) means evidence/refinement, verified over time. Jia (Floating Mass) means false/provisional, formed by borrowed qi/blood, lasting long. Generally, Pi and Ji/Pi are chest/diaphragm issues (Upper/Middle Jiao), common in men. Zheng and Jia are below the umbilicus (Lower Jiao), common in women. Any abdominal mass is ominous. Do not ignore it. If distension and drum-like tension develop, even Cang Gong and Bian Que cannot save. How can one not fear this!
One asks: Why do nightmares feel like spirit possession? I reply: Nightmares often result from Fire rising from below and Phlegm blocking above, with Heart Blood deficiency causing Heart Spirit loss. There is no spirit possession. Wise ones should not be confused.
One asks: Why is the ancient Forbidden Incantation (Jin Zhou) discipline unused today? I reply: Jin Zhou is Zu You (Prayer Transformation) from *Suwen*, established by Longshu, a technique to shift spirit and transform qi. It treats minor illnesses, fright from temples, or evil qi in mountains/rivers causing drunken-like confusion or perceived possession. Spells can resolve confusion and calm spirit. Ancient Longshu spell books existed but degenerated into witchcraft, mediums, and fortune-telling for profit. Evil arts are for evil people; rational people should not use them.
One asks: Danxi distinguished External Pathogens complicating Internal Injury vs. Internal Injury complicating External Pathogens. What are the signs and treatments? I reply: If fatigue/diet imbalance weakens the body first, then Wind-Cold attacks, symptoms include chills, fever, headache/body pain. Right Hand Qi Kou and Guan pulses are twice larger than Left Hand Ying and Guan, with tight/full Yang pulses. This is Heavy Internal Injury with Light External Pathogen (Internal Injury complicating External Pathogen). Treat primarily with Dongyuan's Bu Zhong Yi Qi Tang, adding Fang Feng, Qiang Huo, Chai Hu. Conversely, if Wind-Cold accumulates in autumn/winter, then diet/fatigue triggers it, symptoms include severe aversion to wind/cold, severe pain, high fever. Left Hand Ying and Guan pulses are larger than Right Hand Qi Kou and Guan. This is Heavy External Pathogen with Light Internal Injury (External Pathogen complicating Internal Injury). Treat primarily with Shanghan Six Meridian formulas, adding mild Spleen-tonifying agents. Heavy External Pathogen: Attack first, then tonify (sweat/purge). Heavy Internal Injury: Tonify first, then attack. Both heavy: Attack and tonify simultaneously. If severe heat from fatigue/diet causes chest stuffiness (cannot tonify) or deficiency (cannot purge), use Wang Andao's method for "Deficiency with Excess." Combine Bu Zhong Yi Qi Tang with Danxi's Dao Tan Bu Pi Yin, adding Shen Qu, Mai Ya. Severe cases add Dongyuan's Zhi Shi Dao Zhi Wan. Remove food stagnation and deficiency together. This is simultaneous attack and tonification. Physicians must deliberate wisely.
One asks: Lifespan is determined by Fate. Medicine seems useless since everyone dies. I reply: Fate is the Original Qi of Heaven and Parents. Father is Heaven, Mother is Earth. Variations in sperm and egg quality determine lifespan. Strong parental Qi yields upper-middle longevity; biased Qi yields middle-lower; weak Qi yields lower longevity or premature death, unless preserved well. However, external Wind-Cold-Damp-Heat and internal hunger/fullness/fatigue affect this innate Qi. Shennong tasted herbs to help people fulfill their natural lifespan. Those dying by superstition instead of medicine die unjustly, like those crushed by walls or executed. Some argue astrology predicts life/death accurately. I reply: Heaven and Human principles align, like River Map and Luo Scroll inspiring the *I Ching*. Every movement and stillness, fortune/misfortune, follows these principles.