〔《素》〕阴胜则阳病，阳胜则阴病。阳胜则热，阴胜则寒。重寒则热，重热则寒。（阴阳应象论 下同）阳胜则
身热，腠理闭，喘粗，为之俯仰，汗不出而热，齿干以烦冤，腹满死，能冬不能夏。阴胜则身寒汗出，身常清，
数栗而寒，寒则厥，厥则腹满死，能夏不能冬。
〔垣〕诸有过，切之涩者，阳气有余也。滑者，阴气有余也。阳气有余，为身热无汗。阴气有余，为多汗身
寒。阴阳有余，则无汗而身寒。阴阳不足，则有汗而身热。予补此句，为病之重者，莫大于此，如刀削肌肉，
危之甚，不能久矣。按经曰∶邪生于阳者，得之风雨寒暑。又曰∶阳虚生外寒。阳受气于上焦，以温皮肤分肉
之间。今寒气在外，则上焦不通，上焦不通，则寒气独留于外，故寒栗。又曰∶阳盛生外热。上焦不通利，则
皮肤致密，腠理闭塞，玄府不通，卫气不得泄越，故外热。经曰∶邪生于阴者，得之饮食居处，阴阳喜怒。又
曰∶阴虚生内热。有所劳倦，形气衰少，谷气不盛，上焦不行，下脘不通，胃气热，热气熏胸中，故内热。又
曰∶阴盛生内寒。厥气上逆，寒气积于胸中而不泻，不泻则温气去，寒独留则血凝，血凝则脉不通，其脉盛大
以涩，故中寒。（余见针灸门。）
〔《灵》〕视其颜色黄赤者，多热气。青白者，少热气。黑色者，多血少气。（五音五味篇）经曰∶凡诊络脉，脉
色青则寒且痛，赤则有热。胃中寒，手鱼际之络多青，胃中有热，鱼际络赤。其暴黑者，留久痹也。其有赤有
黑有青者，寒热气也。其青短者，少气也。浮络多青则痛，多黑则痹，黄赤则热，多白则寒，五色皆见其寒热
也。（余见阴阳通论。）
〔《难》〕经云∶数则为热，迟则为寒，诸阳为热，诸阴为寒。（全文见诊法通论。）经曰∶人迎盛则为热，虚则为
寒。气口盛则胀满寒中，食不化，虚则热中，出糜少气，溺色变。（全文见针灸虚实。）寒者热之，热者寒之，微者逆之，
甚者从之，逆者正治，从者反治，从少从多，观其事也。帝曰∶反治何谓？岐伯曰∶热因寒用，寒因热用，塞
因塞用，通因通用，必伏其所主，而先其所因，其始则同，其终则异，可使破积，可使溃坚，可使气和，可使
必已。（全文见治法通论。）微者调之，其次平之，盛者夺之，汗之下之，寒热温凉，衰之以属，随其攸利。（全文见
治法虚实。）
王注曰。假如小寒之气，温以和之。大寒之气，热以取之，甚寒之气，则下夺之。夺之不已，则逆折之。
折之不尽，则求其属以衰之。小热之气，凉以和之。大热之气，寒以取之。甚热之气，则汗发之。发之不
已，则逆制之。制之不尽，则求其属以衰之。）
〔《难》〕阳盛阴虚，下之则愈，汗之则死。（此热病也。阳盛生外热，阴虚生内热，用寒药下之。仲景云∶桂
枝下咽，阳盛则毙。）阴盛阳虚，汗之则愈，下之则死。（此寒病也。阴盛生内寒，阳虚生外寒，用热药汗之非止发汗也，
为助阳也。仲景云∶承气入胃，阴盛以亡。东垣云∶用甘药以助升浮生长之气。）
〔《素》〕帝曰∶论言治寒以热，治热以寒，方士不能废绳墨而更其术也。有病热者，寒之而热，有病寒者，
热之而寒，二者皆在，新病复起，奈何？岐伯曰∶诸病寒之而热者取之阴，热之而寒者取之阳，所谓求其属也。
（王注云∶益火之源，以消阴翳；壮水之主，以制阳光。）帝曰∶善。服寒而反热，服热而反寒，其故何也？岐
伯曰∶治其王气，是以反也。帝曰∶不治王而然者，何也？岐伯曰∶悉哉问也，不治五味属也。夫五味入胃，
各归所喜，故酸先入肝，苦先入心，甘先入脾，辛先入肺，咸先入肾，久而增气，物化之常也。气增而久，夭
之由也。（至真要大论 下同）王注云∶入肝为温，入心为热，入肺为清，入肾为寒，入脾为至阴，而四气兼之
皆为增其味而益其气，故久服黄连、苦参而反热者，此其类也。故曰∶久而增气，物化之常也。气增不已，
则脏气偏胜。气有偏胜，则脏有偏绝，脏有偏绝，则有暴天者。故曰∶气增而久，夭之由也。）
〔海〕问寒病服热药而寒不退，热病服寒药而热不退，何也？答曰∶启玄子云，热不得寒，是无水也。寒
不得热，是无火也。寒之不寒，责其无水。热之不热，责其无火。经云∶滋其化源，源既已绝，药之假，焉能
滋其真水火也。
帝曰∶脉从而病反者，何如？岐伯曰∶脉至而从，按之不鼓，诸阳皆然。（王注云∶言病热而脉数，按之
不鼓动，乃寒盛格阳而致之，非热也。此一节言症属阳脉亦从，症虽属热而病反寒也。诸阳皆然，谓三阳
紧数而不鼓，太阳标本不同之脉也。）帝曰∶诸阴之反，何如？岐伯曰∶脉至而从，按之鼓盛而甚也。（王注
云∶形症皆寒，按之而脉气鼓击，于指下盛，此为热盛拒阴而生病，非寒也。此一节言症属寒，脉亦
从，症虽属寒，而病反热也。）是故百病之起，有生于本者，有生于标者，有生于中气者。有取本而得者，有
取标而得者，有取中气而得者，有取标本而得者，有逆取而得者，有从取而得者。逆，正顺也。若顺，逆也。
故曰∶知标与本，用之不殆，明知逆顺，正行无问，此之谓也。不知是者，不足以言诊，足以乱经。故
大要曰∶粗工嘻嘻，以为可知，言热未已，寒病复始，同气异形，迷诊乱经，此之谓也。夫标本之道，要
而博，小而大，可以一言而知百病之害。言标与本，易而勿损。察本与标，气可令调，明知胜复，为万民式，天
之道毕矣。（六气之病，标本相反者，唯太阳少阴之病为最。盖太阳标阳本寒，少阴标阴本热。王注释诸
阳脉至而从为病热脉数者，太阳之标也。按之不鼓为寒盛格阳者，寒水之本与标相反也。释诸阴脉
至而从为脉证是寒者，少阴之标也。按之鼓甚为热甚拒阴者，君火之本与标相反也。是故不知相反者，逆标气之阴阳
而正治，则顺本气之寒热而病加。知相反者，顺标气之阴阳而反治，则逆本气之寒热而病愈。故曰∶逆，正顺也。
知标与本，用之不殆，明知逆顺，正行无问也。）
右脉从病反，言症似阳者，脉亦从症似阳，而其病反是寒也。症似阴者，脉亦从症似阴，而其病反是热
也。故皆反其脉症施治，如身热微热，烦躁面赤，其脉沉而微者，阴症似阳也。身热者，里寒故也。烦躁
者，阴盛故也。面戴阳者，下虚故也。若医者不知脉，误为实热，反与凉药，则气消成大病矣。《外台秘
要》云∶阴盛发躁，名曰阴躁，欲坐井中，宜以热药治之。故仲景少阴症面赤者，四逆汤加葱白治之。（东
垣云∶寒凉之药入腹，周身之火得水则升走，阴燥之极故欲坐井中。是阴已先亡，医犹不悟，复认为热，重
以寒药投之，其死也何疑焉。）
逆气象阳。（全文见五脏。）
〔垣〕或因吐因呕因嗽，而发躁蒸蒸，身热如坐甑中，欲得去衣，居寒处，或饮寒水，则便如故，振寒复
至则气短促速，胸中满闷欲绝。甚则口开目瞪，声闻于外，而泪涕涎痰大作，其发躁须臾而已。如前，六脉细
弦而涩，按之而虚，此大寒症也。以辛甘寒甘温之剂大泻南方，北方则愈。
〔《活》〕手足逆冷，大便秘，小便赤，或大便黑色，脉沉而滑者，阳症似阴也。轻者白虎汤，重者承气汤。
伤寒失下，血气不通，令四肢逆冷，此是伏热深，故厥亦深，速以大承气汤加腻粉下之，汗出立愈。盖热厥与
阴厥自不同，热厥者，微厥即发热，阴厥即不发热，四肢逆冷恶寒，脉沉细，大小便滑泄。
上二节言症似阳而脉病属阴，症似阴而脉病属阳，故反其症而治之。盖症似阳而脉病属阴者，世尚能辨。
若脉症俱是阴，而病独属阳者，举世莫辨，而致夭折者，滔滔皆是。许学士云∶熙宁中 守迪，因其犹子
病伤寒，见其烦渴而汗多，以凉药治之，遂成阴毒，数日卒。迪痛悼之，遂着阴毒形症诀三篇，盖伤世之意深矣。
〔垣〕足太阳膀胱之经，乃热因寒用。且膀胱本寒，其经老阳也。太阳为标，有阳之名，无阳之实，谓其将
变阴也。其脉紧而数，按之不鼓而空虚，是外见虚阳，而内有真寒也。故仲景以姜附汤久久熟煎，不温服而寒
服之，亦是寒治也。姜、附气味俱阳，加之久久熟煎，取重阳之热，泻纯阴之寒，是治其本也。不温服而寒服，
此以假寒治太阳标之假阳也，故为真假相对之治法。因药处治者，当知其脉之空虚，则是内伏阴寒之气，外显
热症，大渴引饮，目赤口干，面赤身热，四肢热如火者，此浮阳将绝于外，而内则为寒所拒也。手少阴心之经，
乃寒因热用，且少阴之经真阴，其心病根，本是真火也。故曰∶少阴经标阴本热，是内则心阳为本，外则真阴
为标，其脉沉细，按之洪大紧甚而盛者，心火在内则紧甚洪大，真阴为标，则得脉之沉细，寒水之体也。故仲
景以大承气汤，酒制大黄煎成热服之以除标寒，用大黄、芒硝辛苦大寒之气味，以泻本热。以此用药，可以
为万世法矣。
〔《素》〕治热以寒，温而行之。（五常政大论即寒因热用之类。如前大黄、芒硝，大寒之药热服是已。）
丹溪治色目妇人恶寒，用八物汤去芎加炒柏治之，反剧，知其病热深，而药无反佐之过也，仍取前药熟
炒与之而愈。此治热以寒，借火之力温而行之也。
〔垣〕治热以寒，温而行之有三∶皆因大热在身，止用黄 、人参、甘草此三味者，皆甘温，虽表里皆热，
燥发于内，扪之肌热于外，能和之，汗自出而解矣，此温能除大热之至理，一也。热极生风，乃左迁入地，补
母以虚其子，使天道右迁顺行，诸病得天令行而必愈，二也。况大热在上，其大寒必伏于内，温能退寒，以助
地气，地气者，在人乃胃之生气，使真气旺，三也。
〔《素》〕治寒以热，凉而行之。（即热因寒用之类，如用干姜、附子大热之药，须冷服是已。）
仲景治少阴病下痢脉微者，与白虎汤。痢不止，厥逆无脉，干呕烦热，白通加猪胆汁汤主之。此治寒以
热，借胆汁之凉而行之也。
〔东垣〕治寒以热，凉而行之有三∶北方之人，为大寒所伤，其足胫胀，乃寒胜则浮，理之然也。若火炙
汤浴，必脱毛见骨，须先以新汲水浴之，则时见完复矣。更有大寒冻其面或耳，若近火汤，必脱皮成疮，须先
于凉房处浴之，少时以温手熨烙，必能完复，此凉而行之，除其大寒之理，一也。大寒之气，必令母实，乃地
道左迁入肺，逆行于天，以凉药投之，使天道右迁而顺天令，诸病得天令行而必愈，二也。况大寒在外，其大
热伏于地下者，乃三焦包络天真之气所居之根蒂也，热伏于中，元气必伤，在人之身乃胃也，以凉药和之，则
元气充盛而不伤，三也。
〔丹〕恶寒非寒恶热非热论经曰∶恶寒战栗者，皆属于热。又曰∶战栗如丧神守，皆属于火。恶寒者，
虽当炎月，若遇风霜，重绵在身，如觉凛凛战栗，如丧神守，恶寒之甚也。《原病式》曰∶病热症而反觉自冷，
此为病热，实非寒也。或曰∶往往见有服热药而可愈者，何也？病热之人，其气炎上，郁为痰饮，抑遏清道，
阴气不升，病热尤甚。积痰得热，亦为暂退，热势助邪，其病益深。或曰∶寒势如此，谁敢以寒凉药与之，非
杀而何？予曰∶古人遇战栗之症，有以大承气汤下燥粪而愈者。恶寒战栗明是热症，但有虚实之分耳。
经曰∶阴虚则发热。夫阳在外，为阴之卫。阴在内，为阳之守。精神外驰，嗜欲无节，阴气耗散，阳无所
附，遂致浮散于肌表之间而恶热，实非有热，当作阴虚治之，而用补养之法可也。或曰∶伤寒恶寒恶热者亦是
耶？予曰∶若病伤寒者，自外入内，先贤论之详矣，愚奚庸赘。
【《黄帝内经·素问》】阴气偏胜则损伤阳气，阳气偏胜则损伤阴气。阳气偏胜则表现为热证，阴气偏胜则表现为寒证。寒邪极盛则转化为热象，热邪极盛则转化为寒象。（出自《阴阳应象大论》，以下同）阳气偏胜则身体发热，腠理（皮肤纹理及汗孔）闭塞，呼吸急促粗重，身体随之起伏不定，无汗而身热，牙齿干燥且心中烦闷冤屈，若出现腹部胀满则为死证，患者能耐受冬季而不能耐受夏季。阴气偏胜则身体寒冷，出汗，身体常感清冷，频繁战栗发冷，寒冷至极则四肢厥逆，四肢厥逆若伴有腹部胀满则为死证，患者能耐受夏季而不能耐受冬季。
【李东垣】凡是脉象涩的，是阳气有余。脉象滑的，是阴气有余。阳气有余，表现为身体发热而无汗。阴气有余，表现为多汗且身体寒冷。阴阳俱有余，则无汗且身体寒冷。阴阳俱不足，则有汗且身体发热。我补充这一句：对于重病而言，没有比这更严重的了，如同刀削肌肉般消瘦，非常危险，不能长久存活。按经文所说：邪气生于阳分，是由于风雨寒暑所致。又说：阳虚则生外寒。阳气受气于上焦，用以温煦皮肤和分肉之间。如今寒气在体表，则上焦不通畅，上焦不通畅，则寒气独留于体表，所以发生寒战。又说：阳盛则生外热。上焦不通利，则皮肤致密，腠理闭塞，玄府（汗孔）不通，卫气不得宣泄越出，所以产生外热。经文说：邪气生于阴分，是由于饮食起居、情绪喜怒所致。又说：阴虚则生内热。由于劳倦过度，形体之气衰少，谷气不盛，上焦不能运行，下脘不通畅，胃气郁而化热，热气熏蒸于胸中，所以产生内热。又说：阴盛则生内寒。厥逆之气上逆，寒气积聚于胸中而不能消散，不能消散则温煦之气离去，寒气独留则血液凝滞，血液凝滞则脉道不通，其脉象盛大而涩，所以产生中寒。（其余内容见针灸门。）
【《黄帝内经·灵枢》】观察面色，黄赤色的，多有热气。青白色的，热气较少。黑色的，多血少气。（出自《五音五味篇》）经文说：凡诊察络脉，脉色青则主寒且痛，赤色则主热。胃中有寒，手鱼际部的络脉多呈青色；胃中有热，鱼际络脉呈红色。突然变黑的，是久痹留滞所致。有赤、黑、青各色并见的，是寒热错杂之象。脉形短小的，是少气。浮络多青则痛，多黑则痹，黄赤则热，多白则寒，五色皆见则可知寒热情况。（其余内容见阴阳通论。）
【《难经》】经文说：脉数则为热，脉迟则为寒，诸阳脉主热，诸阴脉主寒。（全文见诊法通论）经文说：人迎脉盛则为热，虚则为寒。气口脉盛则腹胀满、寒中、食物不消化，虚则热中、呕吐糜烂物、少气、小便颜色改变。（全文见针灸虚实）寒证用热药治疗，热证用寒药治疗，病轻者用逆治法，病重者用从治法，逆治即正治，从治即反治，根据病情决定用药多少，观察具体情况。皇帝问：什么是反治？岐伯说：热因寒用，寒因热用，塞因塞用，通因通用，必须制服其主要病邪，先探求其病因，开始用药性质可能与病性相同，但最终效果不同，这样可以破除积滞，溃散坚结，调和气血，使疾病痊愈。（全文见治法通论）病轻者调理它，其次平复它，邪气盛者攻夺它，或用汗法，或用下法，寒热温凉各药，根据其所属性质来衰减病势，顺应其有利条件。（全文见治法虚实）
王冰注解说：假如是小寒之气，用温和的药来调和它。是大寒之气，用热药来祛除它。甚寒之气，则用泻下法攻夺它。攻夺不止，则用逆折法抑制它。抑制不尽，则寻求其所属脏腑来衰减病势。小热之气，用凉药来调和它。是大热之气，用寒药来祛除它。甚热之气，则用发汗法发散它。发散不止，则用逆制法控制它。控制不尽，则寻求其所属脏腑来衰减病势。
【《难经》】阳盛阴虚，用下法则愈，用汗法则死。（这是热病。阳盛生外热，阴虚生内热，应用寒药下之。张仲景说：桂枝汤服下，若遇阳盛证则致死。）阴盛阳虚，用汗法则愈，用下法则死。（这是寒病。阴盛生内寒，阳虚生外寒，应用热药发汗，这里不仅指发汗，更是为了助阳。张仲景说：承气汤入胃，若遇阴盛证则致死。李东垣说：用甘味药以助升浮生长之气。）
【《黄帝内经·素问》】皇帝问：医论说治寒用热药，治热用寒药，方士不能废除规矩而改变方法。但有患热病的，用寒药治疗后热不退；患寒病的，用热药治疗后寒不退。这两种情况都存在，新病又起，怎么办？岐伯说：各种病用寒药治疗后反而热的，应取治阴分；用热药治疗后反而寒的，应取治阳分，这就是所谓“求其属”（探求病之本源）。（王冰注云：补益火之源，以消除阴翳；壮补水之主，以制约阳光。）皇帝说：好。服用寒药反而发热，服用热药反而发冷，这是什么原因？岐伯说：因为只治疗了亢盛的表象之气（王气），所以反而加重。皇帝问：不治疗王气却这样，是什么原因？岐伯说：问得真详细啊，是因为没有治疗五味所属的脏腑根本。五味入胃，各归其所喜好的脏腑，所以酸味先入肝，苦味先入心，甘味先入脾，辛味先入肺，咸味先入肾，长期服用会增强相应脏腑之气，这是事物变化的常态。气机长期偏增，是早夭的原因。（出自《至真要大论》，以下同）王冰注云：入肝为温，入心为热，入肺为清，入肾为寒，入脾为至阴，兼有四气特点，都是增加其味而增益其气，所以长期服用黄连、苦参反而发热的，就是这类情况。所以说：长期服用会增强相应之气，这是事物变化的常态。气机偏增不已，则脏气偏胜。气有偏胜，则脏气有偏绝，脏气有偏绝，则有暴死的可能。所以说：气机长期偏增，是早夭的原因。）
【朱丹溪】问：患寒病服用热药而寒不退，患热病服用寒药而热不退，为什么？答：启玄子（王冰）说，热证不能用寒药治愈，是因为无水（阴虚）。寒证不能用热药治愈，是因为无火（阳虚）。寒之不寒，责任在于无水。热之不热，责任在于无火。经文说：滋养其化源，如果化源已绝，药物的假借之力，怎能滋养真正的真水真火呢？
皇帝问：脉象顺从病证但症状相反，是怎么回事？岐伯说：脉象顺从病证，但重按之下不鼓动，所有阳脉都如此。（王冰注云：言病热而脉数，重按之不鼓动，乃是寒盛格拒阳气所致，并非真热。这一节讲症状属阳脉也顺从，症状虽属热但病反为寒。诸阳皆然，谓三阳脉紧数但不鼓动，太阳标本脉象不同。）皇帝问：诸阴脉的反常情况是怎样的？岐伯说：脉象顺从病证，但重按之下鼓击有力且盛大。（王冰注云：形症皆寒，重按而脉气鼓击指下盛大，此为热盛拒阴而生此病，并非真寒。这一节讲症状属寒，脉也顺从，症状虽属寒但病反为热。）因此百病的发生，有的生于本，有的生于标，有的生于中气。有取本而愈的，有取标而愈的，有取中气而愈的，有取标本而愈的，有逆取而愈的，有从取而愈的。逆治，看似不顺，实为正顺。若顺从表象，则是逆治。所以说：知道标与本，运用就不会危险，明知逆顺，正确施行无需疑问，说的就是这个道理。不知道这些，不足以谈论诊病，只会扰乱经脉理论。所以大要说：庸医嘻嘻哈哈，以为可知，刚说完热病，寒病又起，同气异形，迷惑诊法扰乱经脉，说的就是这种情况。标本之道，简要而广博，微小而宏大，可以一言而知百病的危害。言标与本，容易而不损减。察本与标，气机可令调和，明知胜复规律，可为万民示范，天道就完备了。（六气之病，标本相反的，唯太阳少阴之病最明显。盖太阳标阳本寒，少阴标阴本热。王冰注释诸阳脉至而从为病热脉数者，是太阳之标。按之不鼓为寒盛格阳者，是寒水之本与标相反。释诸阴脉至而从为脉证是寒者，是少阴之标。按之鼓甚为热甚拒阴者，是君火之本与标相反。因此不知相反者，逆标气之阴阳而正治，则顺本气之寒热而病加重。知相反者，顺标气之阴阳而反治，则逆本气之寒热而病愈。所以说：逆，正顺也。知标与本，用之不殆，明知逆顺，正行无问也。）
以上脉从病反，说的是症状似阳，脉也随症状似阳，但其病反是寒。症状似阴，脉也随症状似阴，但其病反是热。所以都要反其脉症施治，如身体发热微热，烦躁面赤，其脉沉而微者，是阴症似阳。身热，是因为里寒。烦躁，是因为阴盛。面戴阳（面色泛红如妆），是因为下虚。如果医者不知脉象，误认为实热，反而给予凉药，则正气消亡而成大病。《外台秘要》说：阴盛发躁，名叫阴躁，想坐在井中，宜用热药治疗。所以张仲景治少阴症面赤者，用四逆汤加葱白治疗。（李东垣说：寒凉之药入腹，周身之火得水则升走，阴燥之极故想坐在井中。此时阴气已先亡，医者仍不醒悟，还认为是热，再用重剂寒药投之，其死有何怀疑？）
【李东垣】或因吐、因呕、因嗽，而发躁蒸蒸，身体热如坐蒸笼中，想要脱衣，居住在寒冷处，或饮冷水，则大便如常，振寒再次发作则气短促速，胸中满闷欲绝。严重时口开目瞪，声音传于体外，且泪涕涎痰大作，这种发躁须臾而已。如前所述，六脉细弦而涩，重按而虚，这是大寒症。用辛甘寒、甘温的药剂大泻南方（心火），北方（肾水）则愈。
【《活人书》】手足逆冷，大便秘结，小便赤，或大便黑色，脉沉而滑者，是阳症似阴。轻者用白虎汤，重者用承气汤。伤寒失于攻下，血气不通，导致四肢逆冷，这是伏热深，所以厥亦深，速以大承气汤加腻粉下之，汗出立愈。盖热厥与阴厥自不相同，热厥者，轻微厥冷即发热，阴厥者即不发热，四肢逆冷恶寒，脉沉细，大小便滑泄。
上两节讲的是症状似阳而脉病属阴，症状似阴而脉病属阳，所以反其症而治之。盖症状似阳而脉病属阴者，世人尚能辨别。若脉症俱是阴，而病独属阳者，举世无人能辨，而导致夭折者，滔滔皆是。许学士说：熙宁年间，守迪，因其侄子患伤寒，见他烦躁口渴而汗多，用凉药治疗，遂成阴毒，数日后死亡。守迪悲痛悼念，于是著《阴毒形症诀》三篇，大概是对世人的警示之意很深啊。
【李东垣】足太阳膀胱之经，乃热因寒用。且膀胱本寒，其经为老阳。太阳为标，有阳之名，无阳之实，谓其将变阴也。其脉紧而数，重按之不鼓而空虚，是外见虚阳，而内有真寒也。所以张仲景用姜附汤久久熟煎，不温服而寒服之，这也是寒治。姜、附气味俱阳，加之久久熟煎，取重阳之热，泻纯阴之寒，是治其本。不温服而寒服，此以假寒治太阳标之假阳也，故为真假相对之治法。因药处治者，当知其脉之空虚，则是内伏阴寒之气，外显热症，大渴引饮，目赤口干，面赤身热，四肢热如火者，此浮阳将绝于外，而内则为寒所拒也。手少阴心之经，乃寒因热用，且少阴之经为真阴，其心病根，本是真火也。所以说：少阴经标阴本热，是内则心阳为本，外则真阴为标，其脉沉细，重按之洪大紧甚而盛者，心火在内则紧甚洪大，真阴为标，则得脉之沉细，寒水之体也。所以张仲景用大承气汤，酒制大黄煎成热服之以除标寒，用大黄、芒硝辛苦大寒之气味，以泻本热。以此用药，可以为万世法矣。
【《黄帝内经·素问》】治热以寒，温而行之。（即寒因热用之类。如前大黄、芒硝，大寒之药热服是已。）
朱丹溪治一位有色目人特征的妇人恶寒，用八物汤去川芎加炒黄柏治疗，反而加剧，知其病热深，而药无反佐之过也，仍取前药熟炒与之而愈。此治热以寒，借火之力温而行之也。
【李东垣】治热以寒，温而行之有三：皆因大热在身，只用黄芪、人参、甘草这三味药，皆甘温，虽表里皆热，燥发于内，扪之肌热于外，能和之，汗自出而解矣，此温能除大热之至理，一也。热极生风，乃左迁入地，补母以虚其子，使天道右迁顺行，诸病得天令行而必愈，二也。况大热在上，其大寒必伏于内，温能退寒，以助地气，地气者，在人乃胃之生气，使真气旺，三也。
【《黄帝内经·素问》】治寒以热，凉而行之。（即热因寒用之类，如用干姜、附子大热之药，须冷服是已。）
张仲景治少阴病下痢脉微者，与白虎汤。痢不止，厥逆无脉，干呕烦热，白通加猪胆汁汤主之。此治寒以热，借胆汁之凉而行之也。
【李东垣】治寒以热，凉而行之有三：北方之人，为大寒所伤，其足胫胀，乃寒胜则浮，理之然也。若火炙汤浴，必脱毛见骨，须先以新汲水浴之，则时见完复矣。更有大寒冻其面或耳，若近火汤，必脱皮成疮，须先于凉房处浴之，少时以温手熨烙，必能完复，此凉而行之，除其大寒之理，一也。大寒之气，必令母实，乃地道左迁入肺，逆行于天，以凉药投之，使天道右迁而顺天令，诸病得天令行而必愈，二也。况大寒在外，其大热伏于地下者，乃三焦包络天真之气所居之根蒂也，热伏于中，元气必伤，在人之身乃胃也，以凉药和之，则元气充盛而不伤，三也。
【朱丹溪】恶寒非寒恶热非热论经文说：恶寒战栗者，皆属于热。又说：战栗如丧神守，皆属于火。恶寒者，虽当炎月，若遇风霜，重绵在身，如觉凛凛战栗，如丧神守，恶寒之甚也。《原病式》说：病热症而反觉自冷，此为病热，实非寒也。有人说：往往见有服热药而可愈者，为什么？病热之人，其气炎上，郁为痰饮，抑遏清道，阴气不升，病热尤甚。积痰得热，亦为暂退，热势助邪，其病益深。有人说：寒势如此，谁敢以寒凉药与之，不是杀他是什么？我说：古人遇战栗之症，有大承气汤下燥粪而愈者。恶寒战栗明是热症，但有虚实之分耳。
经文说：阴虚则发热。夫阳在外，为阴之卫。阴在内，为阳之守。精神外驰，嗜欲无节，阴气耗散，阳无所附，遂致浮散于肌表之间而恶热，实非有热，当作阴虚治之，而用补养之法可也。有人说：伤寒恶寒恶热者亦是耶？我说：若病伤寒者，自外入内，先贤论之详矣，愚奚庸赘。
[Suwen] When Yin prevails, Yang becomes diseased; when Yang prevails, Yin becomes diseased. Yang prevalence manifests as heat, and Yin prevalence manifests as cold. Extreme cold transforms into heat, and extreme heat transforms into cold. (From *Treatise on the Correspondences of Yin and Yang*, same below) Yang prevalence causes body heat, closure of interstices (skin pores and texture), rapid and coarse breathing, bodily undulation, anhidrosis with fever, dry teeth, and vexation/oppression. If abdominal fullness occurs, it is a death sign; the patient can endure winter but not summer. Yin prevalence causes body cold, sweating, constant chilliness, frequent shivering/chills, and cold extremities. If cold extremities are accompanied by abdominal fullness, it is a death sign; the patient can endure summer but not winter.
[Li Dongyuan] In all cases, if the pulse is choppy, it indicates excess Yang Qi. If the pulse is slippery, it indicates excess Yin Qi. Excess Yang Qi manifests as body heat without sweat. Excess Yin Qi manifests as profuse sweating and body cold. Excess of both Yin and Yang manifests as anhidrosis and body cold. Deficiency of both Yin and Yang manifests as sweating and body heat. I add this sentence: Among severe diseases, none is more critical than this, resembling muscles being carved by knives; it is extremely dangerous and cannot last long. According to the classics: Pathogens arising from the Yang aspect result from wind, rain, cold, and heat. It also states: Yang deficiency generates external cold. Yang receives Qi from the Upper Jiao to warm the skin and muscle spaces. Now, if cold pathogen remains outside, the Upper Jiao becomes obstructed. Obstruction of the Upper Jiao causes cold pathogen to remain solely on the exterior, resulting in chills. It also states: Yang excess generates external heat. If the Upper Jiao is not unobstructed, the skin becomes dense, interstices close, and xuanfu (sweat pores) are blocked, preventing Wei Qi (Defensive Qi) from venting, thus generating external heat. The classics state: Pathogens arising from the Yin aspect result from diet, lifestyle, and emotional fluctuations. It also states: Yin deficiency generates internal heat. Due to overwork and fatigue, form and Qi decline, Grain Qi fails to flourish, the Upper Jiao fails to circulate, and the lower Stomach opening is blocked. Stomach Qi stagnates and generates heat, which steams upward into the chest, causing internal heat. It also states: Yin excess generates internal cold. Rebellious Qi ascends, and cold pathogen accumulates in the chest without dispersing. Without dispersal, warming Qi departs, leaving only cold. Cold causes blood coagulation, leading to blocked vessels. The pulse becomes large and choppy, indicating middle cold. (See Acupuncture section for details.)
[Lingshu] Observing complexion: yellow-red indicates abundant heat Qi; blue-white indicates deficient heat Qi; black indicates abundant blood and deficient Qi. (From *Chapter on Five Tones and Five Flavors*) The classics state: Generally, inspecting collaterals, blue color indicates cold and pain, red indicates heat. Cold in the Stomach makes the collateral at the thenar eminence appear blue; heat in the Stomach makes it appear red. Sudden blackness indicates long-standing Bi syndrome. Mixed red, black, and blue indicate mixed cold and heat. Short pulse indicates deficient Qi. Blue floating collaterals indicate pain; black indicates Bi; yellow-red indicates heat; white indicates cold. Seeing all five colors reveals cold and heat patterns. (See General Treatise on Yin and Yang for details.)
[Nan Jing] The classics state: Rapid pulse indicates heat, slow pulse indicates cold; all Yang pulses relate to heat, all Yin pulses relate to cold. (Full text in General Treatise on Diagnosis) The classics state: A full Renying pulse indicates heat, a deficient one indicates cold. A full Qikou pulse indicates abdominal fullness, cold in the middle, and indigestion; a deficient one indicates heat in the middle, vomiting of mucoid matter, deficient Qi, and altered urine color. (Full text in Acupuncture: Excess and Deficiency) Cold conditions are treated with heat; heat conditions are treated with cold. Mild cases are treated inversely (Zheng Zhi); severe cases are treated according to symptoms (Fan Zhi). Inverse treatment is standard treatment; following treatment is counter-treatment. Dosage depends on the situation. The Emperor asked: What is counter-treatment? Qibo replied: Heat used with cold agents, cold used with heat agents, obstruction treated with obstruction methods, diarrhea treated with purgatives. One must subdue the main pathogen and address its cause initially. Though starting similarly, the outcome differs. This can break accumulations, dissipate hardness, harmonize Qi, and ensure cure. (Full text in General Treatise on Therapeutics) Mild cases are regulated; next, balanced; excess is drained via sweating or purging. Cold, heat, warmth, and coolness are used according to their nature to reduce pathology, following what is beneficial. (Full text in General Treatise on Therapeutics: Excess and Deficiency)
Wang Bing’s commentary: For mild cold, use warm harmonizing agents. For severe cold, use hot resolving agents. For extreme cold, use purgative draining. If draining fails, use inverse suppression. If suppression fails, seek the affiliated organ to reduce pathology. For mild heat, use cool harmonizing agents. For severe heat, use cold resolving agents. For extreme heat, use diaphoretic dispersing. If dispersing fails, use inverse control. If control fails, seek the affiliated organ to reduce pathology.
[Nan Jing] Yang excess and Yin deficiency: Purging leads to recovery, sweating leads to death. (This is a heat disease. Yang excess generates external heat; Yin deficiency generates internal heat. Use cold purgatives. Zhang Zhongjing said: Once Guizhi Tang enters the throat, Yang excess leads to death.) Yin excess and Yang deficiency: Sweating leads to recovery, purging leads to death. (This is a cold disease. Yin excess generates internal cold; Yang deficiency generates external cold. Use hot diaphoretics—not just to induce sweat, but to assist Yang. Zhang Zhongjing said: Once Chengqi Tang enters the stomach, Yin excess leads to demise. Li Dongyuan said: Use sweet herbs to assist ascending and growing Qi.)
[Suwen] The Emperor asked: Discussions say treat cold with heat and heat with cold. Physicians should not abandon rules. But some heat patients do not improve with cold drugs; some cold patients do not improve with heat drugs. Both exist, and new diseases arise. How to handle this? Qibo replied: For diseases that become hotter after cold treatment, treat the Yin; for those that become colder after heat treatment, treat the Yang. This is called "seeking the affiliation" (root cause). (Wang Bing notes: Nourish the source of Fire to eliminate Yin shadows; strengthen the master of Water to control Yang brilliance.) The Emperor asked: Good. Why does taking cold drugs cause heat, and heat drugs cause cold? Qibo replied: Because you treated the Wang Qi (excessive manifest Qi), hence the reversal. The Emperor asked: What if not treating Wang Qi still causes this? Qibo replied: Excellent question! It is because you did not treat the五味 (Five Flavors) affiliations. Five flavors enter the Stomach and go to their preferred organs: Sour to Liver, Bitter to Heart, Sweet to Spleen, Pungent to Lung, Salty to Kidney. Long-term use increases the Qi of these organs, which is the normal transformation of things. However, prolonged increase of Qi leads to premature death. (From *Treatise on the Great Essentials of True Demand*, same below) Wang Bing notes: Entering Liver is Warm, Heart is Hot, Lung is Clear, Kidney is Cold, Spleen is Supreme Yin combining four temperatures. All increase flavor to benefit Qi. Thus, long-term Coptis or Picrorhiza may cause heat. This is why long-term use increases Qi, the norm of transformation. Prolonged Qi increase leads to organ excess. Organ excess leads to organ exhaustion. Organ exhaustion leads to sudden death. Hence, prolonged Qi increase is the cause of premature death.
[Zhu Danxi] Question: Why does cold disease not resolve with heat drugs, and heat disease not resolve with cold drugs? Answer: Qixuanzi (Wang Bing) said: Heat cannot be cured by cold due to lack of Water (Yin deficiency). Cold cannot be cured by heat due to lack of Fire (Yang deficiency). Failure to warm cold blames Water deficiency. Failure to clear heat blames Fire deficiency. The classics say: Nourish the source of transformation. If the source is exhausted, how can drug assistance nourish true Water and Fire?
The Emperor asked: What about pulses conforming to symptoms but symptoms being opposite? Qibo replied: Pulse conforms, but pressure reveals no pulsation; this applies to all Yang pulses. (Wang Bing notes: Heat disease with rapid pulse, but non-pulsating upon pressure, indicates Cold excess repelling Yang, not true heat. Symptoms belong to Yang, pulse conforms, but pathology is cold. "All Yang" refers to tight/rapid San Yang pulses lacking pulsation, differing in Sun Taiyang root and branch.) The Emperor asked: What about Yin pulse reversals? Qibo replied: Pulse conforms, but pressure reveals strong, vigorous pulsation. (Wang Bing notes: Cold symptoms, but strong pulsation upon pressure, indicates Heat excess rejecting Yin, not true cold. Symptoms belong to Yin, pulse conforms, but pathology is heat.) Therefore, diseases arise from Root (Ben), Branch (Biao), or Middle Qi. Treatment can target Root, Branch, Middle Qi, Root-Branch combination, Inverse method, or Following method. Inverse treatment appears contrary but is actually correct compliance. Blind compliance is actually inverse treatment. Thus: Knowing Root and Branch ensures safety; knowing Inverse and Following ensures correct action without doubt. Ignorance here prevents diagnosis and disrupts meridians. The Great Summary says: Crude physicians laugh, thinking they know; speaking of heat while cold disease starts anew, confusing similar Qi with different forms, disrupting meridians. The Root-Branch doctrine is concise yet broad, small yet great, summarizing hundred diseases' harms. Discussing Root and Branch is easy but vital. Examining Root and Branch harmonizes Qi; knowing Sheng-Fu cycles serves as a model for people, completing Heavenly Dao. (Among Six Qi diseases, Root-Branch opposition is most prominent in Sun Taiyang and Shao Yin. Taiyang Branch is Yang, Root is Cold; Shao Yin Branch is Yin, Root is Heat. Wang Bing explains: Rapid pulse conforming to heat is Taiyang Branch; non-pulsating pressure indicates Cold excess repelling Yang, opposing Root/Branch. Slow pulse conforming to cold is Shao Yin Branch; strong pulsating pressure indicates Heat excess rejecting Yin, opposing Root/Branch. Not knowing opposition, treating Branch oppositely with standard method worsens Root pathology. Knowing opposition, treating Branch oppositely with counter-method heals Root pathology. Thus: Inverse is correct compliance. Knowing Root/Branch ensures safety; knowing Inverse/Following ensures correct action.)
Above describes pulse conforming to symptoms but pathology reversing: Symptoms like Yang, pulse like Yang, but pathology is Cold. Symptoms like Yin, pulse like Yin, but pathology is Heat. Thus, treat opposite to pulse/symptoms. E.g., body heat, slight fever, irritability, red face, but deep/faint pulse indicates Yin disease mimicking Yang. Body heat is due to interior cold. Irritability is due to Yin excess. Face redness (floating Yang) is due to lower deficiency. If doctors ignore pulse, mistaking for excess heat, and give cooling drugs, Qi dissipates, causing major illness. *Waitai Miyao* says: Yin excess causing agitation is called Yin Agitation; patient wants to sit in a well; treat with hot drugs. Thus, Zhang Zhongjing treats Shao Yin disease with red face using Si Ni Tang plus Scallion White. (Li Dongyuan says: Cold drugs entering abdomen make fire rise with water; extreme Yin dryness causes desire to sit in well. Yin is already lost, yet doctors mistake for heat and give heavy cold drugs; death is inevitable.)
Inverse Qi resembles Yang. (Full text in Five Zang Organs.)
[Li Dongyuan] Vomiting, retching, or coughing may trigger restlessness, steaming heat, feeling like sitting in a steamer, wanting to remove clothes, stay in cold places, or drink cold water, yet stool remains normal. Chills return, causing shortness of breath and chest oppression nearing death. Severe cases involve open mouth, fixed eyes, loud voice, excessive tears, snot, saliva, and phlegm. Restlessness lasts briefly. Six pulses are fine, wiry, choppy, and deficient upon pressure. This is Major Cold Disease. Use pungent-sweet-cold and sweet-warm formulas to greatly drain South (Heart Fire), restoring North (Kidney Water).
*[Huoyan Shu]* Cold hands/feet, constipation, red urine, or black stool, with deep-slippery pulse indicates Yang disease mimicking Yin. Mild cases: Bai Hu Tang. Severe cases: Cheng Qi Tang. Typhoid missed by purging causes Qi/Blood blockage and cold limbs; this is deep latent heat causing deep厥 (Jue). Quickly purge with Da Cheng Qi Tang plus Calomel; sweating brings immediate cure. Heat Jue differs from Yin Jue. Heat Jue: mild cold limbs followed by fever. Yin Jue: no fever, cold limbs, aversion to cold, deep-thin pulse, loose stools/urine.
These two sections discuss symptoms mimicking Yang but pathology belonging to Yin, and symptoms mimicking Yin but pathology belonging to Yang; thus, treat opposite to symptoms. People can distinguish symptoms-like-Yang/pathology-Yin. But when pulse/symptoms are Yin yet pathology is Yang, few recognize it, leading to many deaths. Scholar Xu said: During Xining era, Shou Di’s nephew had typhoid with irritability, thirst, and sweating. Treated with cooling drugs, he developed Yin Du (Yin Toxin) and died days later. Shou Di mourned, writing *Three Chapters on Yin Du Forms/Symptoms*, deeply warning society.
[Li Dongyuan] Foot-Taiyang Bladder Meridian uses "Heat due to Cold application." Bladder Root is Cold, Meridian is Old Yang. Taiyang is Branch, having Yang name but not substance, implying transition to Yin. Pulse is tight-rapid, non-pulsating/vacuous upon pressure, showing external false Yang and internal true Cold. Thus, Zhang Zhongjing uses Jiang Fu Tang (Ginger-Aconite Decoction), boiled long, served cold. This is cold treatment. Ginger/Aconite are Yang in nature; long boiling extracts double Yang heat to drain pure Yin cold, treating the Root. Serving cold uses fake cold to treat Taiyang Branch's fake Yang, a true-false relative method. When treating with drugs, know vacuous pulse indicates internal hidden Yin Cold manifesting as heat symptoms: extreme thirst, red eyes/mouth, red face/body heat, fiery limbs. This is floating Yang perishing externally, rejected by internal cold. Hand-Shaomin Heart Meridian uses "Cold due to Heat application." Shaomin Meridian is True Yin; Heart disease root is True Fire. Thus: Shaomin Branch is Yin, Root is Heat. Internally, Heart Yang is Root; externally, True Yin is Branch. Pulse is deep-thin; if pressure reveals large-tight-strong, Heart Fire is internal (tight-large), while True Yin Branch shows deep-thin (Cold Water nature). Thus, Zhang Zhongjing uses Da Cheng Qi Tang, with wine-processed Rhubarb boiled hot to remove Branch Cold, using bitter-cold Da Huang and Mang Xiao to drain Root Heat. This medication method serves as a eternal model.
[Suwen] Treat heat with cold, administer warm. (Similar to "Cold due to Heat application," e.g., hot administration of cold Da Huang/Mang Xiao.)
Zhu Danxi treated a woman of Western Regions features with aversion to cold using Ba Wu Tang minus Chuanxiong plus fried Phellodendron, worsening condition. He realized deep heat and lack of counter-agent, so he reheated the decoction and administered it, curing her. This is treating heat with cold, borrowing fire's power to administer warmly.
[Li Dongyuan] Treating heat with cold, administering warm, has three principles: 1. For major heat, use Huang Qi, Ren Shen, Gan Cao (sweet-warm). Though interior/exterior heat exists, internal dryness manifests externally as skin heat. These harmonize, inducing sweat and resolution. This is the principle of "Warmth removing major heat." 2. Extreme heat generates Wind, moving left into Earth. Tonify Mother to empty Child, allowing Heavenly Dao to move right forward. Diseases heal under Heavenly Command. 3. Major heat above implies hidden major cold inside. Warmth retreats cold, assisting Earth Qi (Stomach's generating Qi), strengthening True Qi.
[Suwen] Treat cold with heat, administer cool. (Similar to "Heat due to Cold application," e.g., cold administration of hot Gan Jiang/Fu Zi.)
Zhang Zhongjing treated Shao Yin dysentery with faint pulse using Bai Hu Tang. If dysentery persisted, with cold limbs, absent pulse, dry retching, and irritability, use Bai Tong Tang plus Pig Gallbladder Bile. This is treating cold with heat, borrowing bile's coolness to administer.
[Li Dongyuan] Treating cold with heat, administering cool, has three principles: 1. Northerners injured by major cold have swollen calves (Cold excess causes floatiness). Fire baths cause hair loss/bone exposure; first wash with fresh water for recovery. Frozen face/ears near fire cause peeling/sores; first bathe in cool room, then warm hand compresses restore integrity. This is "Cool administration" removing major cold. 2. Major cold causes Mother excess, moving left into Lung against Heaven. Cool drugs allow Heavenly Dao to move right forward, healing diseases. 3. Major cold outside hides major heat underground (Root of San Jiao/Bao Luo True Qi). Heat hiding injures Yuan Qi (Stomach). Cool drugs harmonize, protecting Yuan Qi.
[Zhu Danxi] Aversion to Cold is not Cold; Aversion to Heat is not Heat. Classics: Aversion to cold/shivering belongs to Heat. Shivering losing spiritual control belongs to Fire. Aversion to cold: even in summer, facing wind/rain, wearing thick layers, shivering violently, losing spiritual control, is extreme cold aversion. *Yuan Bing Shi* says: Heat disease feeling cold is heat disease, not cold. Some ask: Why do heat drugs cure some? Heat patients have rising Qi, stagnating as phlegm-fluid, blocking clear pathways, preventing Yin ascent, worsening heat. Phlegm gets heat, temporarily recedes, but heat aids pathogen, deepening disease. Some ask: Who dares give cold drugs for such cold? Isn't it killing? I say: Ancients cured shivering with Da Cheng Qi Tang purging dry feces. Aversion to cold/shivering is clearly heat, differing in excess/deficiency. Classics: Yin deficiency generates heat. Yang is outside, guarding Yin; Yin is inside, guarding Yang. Wandering spirit, unrestrained desires, consume Yin Qi. Yang loses attachment, floats to muscle surface, causing aversion to heat (not true heat). Treat as Yin deficiency with tonification. Some ask: Is typhoid aversion to cold/heat the same? I say: Typhoid enters from outside; ancients discussed this in detail; I need not add.