治溃烂诸疮，效不可言，不可轻视此方。
木耳（一两，焙干，研末） 白砂糖（一两，和均）
以温水浸如糊，敷之缚之。
此方与刺 皮治遗精，抽葫芦治鼓症，义同。明此义，方可以学医。
治跌打损伤，贴之颇效。
香油（一斤） 白蔹 升麻 当归 川芎 连翘 银花 甲片 川乌 象皮（各四钱）
乳香（一钱半，末） 没药（一钱半，末） 轻粉（三钱，末） 冰片（三分，末） 麝香（三分
，末） 白占（二两）
将前九味药入油内炸枯色，去渣，入官粉三合，离火，再入乳、没、冰、片、麝，搅均
，再
，溃烂诸疮可靠之良方也，不可轻视。
胞侄作砺来京，见《脏腑图记》，问曰∶伯父所绘之图，经络是气管，皆本于卫总管，
由卫
《伤寒》，按足六经之现症，立一百一十三方，分三百九十七法，其方效者颇多？侄不解其
理。余曰∶尔看其首篇，细心研究，便知其方效论错之理。如首篇论足太阳膀胱经，为寒
邪
有汗，是伤风，用桂枝汤治之。所论是足太阳经，足太阳专通两足，而不通两手。其论传邪
，传足六经，不传手六经。尔看初得伤寒，头疼、身痛、项强、发热、恶寒，未有两胳膊两
手不疼痛发热恶寒者，用麻黄汤，亦未有周身皆愈，而独不愈两胳膊、两手者，岂不是方虽
效而论经络实错之明证？若仲景以前，有人亲见脏腑，着明经络贯通，仲景着《伤寒》，必
言外感寒邪入周身之经络，用麻黄汤发散周身之寒邪，一言可了。论有汗是伤风，以桂枝汤
治之，以桂枝、白芍、甘草三味，然从未见治愈一人，桂枝汤所以不见效者，因头疼、身痛
、发热、有汗，非伤风症也，乃吴又可所论之瘟疫也。又问∶寒邪在表，自当见头疼、身痛
、发热、恶寒、无汗之表症，初得伤寒，尚未传里，如何即有作呕之里症？仲景着论，王叔
和等数十人注释，并未帮助表症作呕之所以然。侄实不能明白，求伯父明白指示。余始看尔
不过有读书之志，而无业医之才，今据尔此问，尚有思路，将来不敢粗心，轻忽人命。尔问
寒邪在表，如何有作呕之里症，余详细告汝∶寒邪始入毛孔，由毛孔入皮肤，由皮肤入丝络
，由丝络入阳络，由阳络入经，由经入卫总管，由卫总管横行入心，由心上行入入左右气管，
由左右气管上攻左右气门，故作呕，此表症所以作呕之本源也。用麻黄汤服之入胃，其药汁由
津门流出，入津管，过肝，入脾中之珑管，从出水道渗出，沁入膀胱为尿；其药之气，即药之
性，由津管达卫总管，由卫总管达经，由经达络，由络达丝络，由丝络达皮肤，由皮肤达毛孔，
将寒邪逐之自毛孔而出，故发汗，邪随汗出，汗出邪散，故呕即止。此周身经络，内外贯通，
用麻黄汤发散表邪，随汗而出之次第也。”又问∶“仲景论目痛、鼻干、不得眠，是足阳明胃
经之表症，以葛根汤治之，其方内有葛根，仍有麻黄，此理不甚明白。余曰∶寒邪由表入经
络，正气将寒邪化而为热，故名曰邪热，邪热上攻头顶，脑为邪热所扰，故不得眠。目系通
于脑，邪热由脑入目，故目痛。鼻通于脑，邪热由脑入鼻，故鼻干。明是邪热上攻之火症，
并非足阳明胃经之表寒，用葛根而愈者，莫谓葛根是温散之品，葛根乃清散之药也。其方内
用麻黄者，发散在表未化之寒邪也。此又是方效经络错之明证。又问∶仲景论胸胁痛、耳聋
、口苦、寒热往来而呕，其症在半表半里，是足少阳胆经之症，用小柴胡汤治之，其方神效
。侄思此症，若不在胆经，其方又神效。若在胆经，胆又居膈膜之下，又痛又在胸胁，此一段侄
又不明白。余曰∶尔看脏腑图，膈膜以上之血府便明白。邪热入于血府，攻击其血，故胸胁
作痛；邪向血内攻，血向外抗拒，一攻一拒，故寒热往来；热灼左右气门，气上下不通，故
呕而口苦；邪热上攻，故耳聋目眩；柴胡能解血府之热，热解汗自出，邪随汗解，故效甚速
。此亦是方效论经错之明证。至传变多端，总不外表里虚实。尔若明伤寒，须看吴又可之《
瘟疫》；若见书少，必有偏寒偏热之弊。昨晚尔当客问∶古人言汗在皮肤是血，发于皮肤外是
汗，言汗即血化，此理尔不解。彼时不告汝者，非谓尔当客多言，因客粗知医，并非名手，故
不当客告汝。汗即血化，此丹溪朱震亨之论，张景岳虽议驳其非，究竟不能指实出汗之本源
。古人立论之错，错在不知人气血是两管，气管通皮肤有孔窍，故发汗，血管通皮肤无孔窍
，故不发汗。何以知血管通皮肤无孔窍？尔看生疮破流黄水者，其毒由气管而来，每日常流
黄水，其皮肤不红；疮毒若在血管，初起皮肤必红，必待皮肤溃烂，所流必是脓血。尔再看
瘟毒、发斑、出疹、小儿出痘，色虽红而不流血，岂不是血管通皮肤无孔窍之明证乎？侄作
砺来京，因闲谈问余，彼时是书业已刻成，故书于卷末以记之。
治疗各种溃烂的疮疡，疗效无法用言语形容，不可轻视此方。
木耳（一两，焙干，研成粉末） 白砂糖（一两，与木耳粉混合均匀）
用温水浸泡调成糊状，敷在患处并包扎固定。
这个方子与治疗遗精的刺蒺藜、治疗鼓胀病的抽葫芦，道理是相同的。明白这个道理，才可以学习医学。
治疗跌打损伤，贴敷效果很好。
香油（一斤） 白蔹 升麻 当归 川芎 连翘 金银花 穿山甲 川乌 象皮（各四钱）
乳香（一钱半，研末） 没药（一钱半，研末） 轻粉（三钱，研末） 冰片（三分，研末） 麝香（三分，研末） 黄蜡（二两）
将前九味药放入油中炸至枯焦变色，滤去药渣，加入官粉三合，离火后，再加入乳香、没药、冰片、麝香，搅拌均匀，再熬制片刻。这是治疗溃烂诸疮的可靠良方，不可轻视。
胞侄王作砺来到京城，看到《脏腑图记》，问道：“伯父所绘制的解剖图，经络实际上是气管，都依据于卫总管。请问《伤寒论》按照足六经的现症，设立了一百一十三首方剂，分三百九十七种治法，其中有效的方剂很多吗？侄儿不理解其中的道理。”我说：“你看它的首篇，细心研究，就知道方剂有效但经络理论错误的道理。比如首篇论述足太阳膀胱经，认为寒邪侵入人体，如果有汗，就是伤风，用桂枝汤治疗。这里论述的是足太阳经，足太阳经专门连通两腿，而不连通两手。文中论述病邪传变，只传足六经，不传手六经。你看刚得伤寒时，头痛、身痛、项背强直、发热、恶寒，没有两只胳膊和双手不疼痛、不发热、不恶寒的情况；使用麻黄汤后，也没有全身都好了，唯独两只胳膊和双手不好的情况。这难道不是方剂虽然有效，但论述经络却是明显错误的证明吗？如果在张仲景之前，有人亲眼见过脏腑，明确知道经络贯通全身，张仲景写《伤寒论》，一定会说外感寒邪侵入周身经络，用麻黄汤发散周身寒邪，一句话就可以说明白了。论述有汗是伤风，用桂枝汤治疗，由桂枝、白芍、甘草三味药组成，然而从未见治愈一人。桂枝汤所以不见效，是因为头痛、身痛、发热、有汗，不是伤风症，而是吴又可所论述的瘟疫症。”又问：“寒邪在体表，自然应当出现头痛、身痛、发热、恶寒、无汗等表症。刚得伤寒，尚未传入里证，怎么立刻就有作呕这种里证呢？张仲景的论述，以及王叔和等几十人的注释，都没有帮助解释表症为何会作呕的原因。侄儿实在不能明白，请求伯父明白指示。”我起初看你还只有读书的志向，而没有行医的才能，现在根据你的这个问题，你还有思路，将来不敢粗心大意，轻视人命。你问寒邪在体表，怎么会有作呕的里证，我详细告诉你：寒邪刚开始进入毛孔，从毛孔进入皮肤，从皮肤进入丝络，从丝络进入阳络，从阳络进入经脉，从经脉进入卫总管，从卫总管横行进入心脏，从心脏上行进入左右气管，从左右气管上攻左右气门，所以作呕，这就是表症之所以作呕的根本原因。服用麻黄汤后，药汁通过津门流出，进入津管，经过肝脏，进入脾中的珑管，从出水道渗出，沁入膀胱成为尿液；药的气，即药的性，通过津管到达卫总管，从卫总管到达经脉，从经脉到达络脉，从络脉到达丝络，从丝络到达皮肤，从皮肤到达毛孔，将寒邪驱逐出毛孔，所以发汗，邪气随着汗液排出，汗出邪散，所以呕吐立即停止。这就是周身经络内外贯通，使用麻黄汤发散表邪，随汗而出的次第过程。”又问：“张仲景论述目痛、鼻干、不得眠，认为是足阳明胃经的表症，用葛根汤治疗，方中有葛根，仍有麻黄，这个道理不太明白。”我说：“寒邪由表进入经络，正气将寒邪化而为热，所以名叫邪热，邪热上攻头顶，脑被邪热扰乱，所以不得眠。目系通于脑，邪热从脑进入眼睛，所以目痛。鼻通于脑，邪热从脑进入鼻子，所以鼻干。这明明是邪热上攻的火症，并不是足阳明胃经的表寒。用葛根而痊愈，不要说葛根是温散之品，葛根其实是清散的药物。方中使用麻黄，是为了发散在表尚未化热的寒邪。这又是方剂有效但经络理论错误的明显证据。”又问：“张仲景论述胸胁痛、耳聋、口苦、寒热往来且呕吐，这些症状在半表半里，是足少阳胆经的症状，用小柴胡汤治疗，其方神效。侄儿想，如果这个症状不在胆经，这个方子又如此神效。如果在胆经，胆又位于膈膜之下，疼痛又在胸胁，这一段侄儿又不明白。”我说：“你看脏腑图，膈膜以上的血府就明白了。邪热进入血府，攻击血液，所以胸胁作痛；邪气向血内进攻，血液向外抗拒，一攻一拒，所以寒热往来；热灼烧左右气门，气上下不通，所以呕吐且口苦；邪热上攻，所以耳聋目眩；柴胡能解除血府的热，热解则汗自出，邪气随汗而解，所以见效很快。这也是方剂有效但经络理论错误的明显证据。至于传变多种多样，总不外乎表里虚实。你若想精通伤寒，必须看吴又可的《瘟疫论》；如果见识书少，必然有偏寒或偏热的弊端。昨晚你有客人问：古人说汗在皮肤内是血，发于皮肤外是汗，说汗是由血化生的，这个道理你不理解。当时没有告诉你，不是说你当客多言，因为客人粗知医术，并非名医，所以不当着客人的面告诉你。‘汗即血化’，这是丹溪朱震亨的理论，张景岳虽然议论驳斥其错误，究竟不能指出出汗的本源。古人立论的错误，错在不知道人气血是两条管子，气管通向皮肤且有孔窍，所以发汗；血管通向皮肤但没有孔窍，所以不发汗。怎么知道血管通向皮肤没有孔窍？你看生疮破溃流黄水的，其毒邪来自气管，每天常流黄水，皮肤不红；如果疮毒在血管，初起皮肤必定红，必须等到皮肤溃烂，所流的必定是脓血。你再看瘟毒、发斑、出疹、小儿出痘，颜色虽然红但不流血，这难道不是血管通向皮肤没有孔窍的明显证据吗？”侄儿王作砺来京城，因闲谈问我，那时这本书已经刻印完成，所以写在卷末以记录此事。
For treating various ulcerating sores, the efficacy is beyond words; do not underestimate this prescription.
Wood ear mushroom (50 g, dried over low heat, ground into powder) White granulated sugar (50 g, mixed evenly with the mushroom powder)
Soak in warm water to form a paste, apply to the affected area, and bandage securely.
The principle of this prescription is the same as that of Tribulus terrestris for treating spermatorrhea and Cucurbita ficifolia stem for treating abdominal distension (Gu Zhen). Understanding this principle is essential for studying medicine.
For treating traumatic injuries, application yields considerable effect.
Sesame oil (500 g) Bai Lian (Ampelopsis radix), Sheng Ma (Cimicifugae Rhizoma), Dang Gui (Angelicae Sinensis Radix), Chuan Xiong (Ligusticum chuanxiong Rhizoma), Lian Qiao (Forsythiae Fructus), Yin Hua (Lonicerae Japonicae Flos), Jia Pian (Trionycis Carapax), Chuan Wu (Aconiti Radix), Xiang Pi (Rhinocerotis Cornu substitute or similar material) (each 12.5 g)
Ru Xiang (Frankincense, 4.7 g, powdered) Mo Yao (Myrrh, 4.7 g, powdered) Qing Fen (Calomelas, 9 g, powdered) Bing Pian (Borneolum Syntheticum, 0.9 g, powdered) She Xiang (Moschus, 0.9 g, powdered) Huang La (Beeswax, 100 g)
Fry the first nine herbs in the oil until they turn dark and crisp, remove the dregs, add 45 g of lead acetate (Guan Fen), remove from heat, then add Ru Xiang, Mo Yao, Bing Pian, and She Xiang, stir well, and simmer briefly. This is a reliable excellent prescription for treating ulcerating sores; do not underestimate it.
My cousin's son, Wang Zuoli, came to Beijing and saw the *Illustrations of Viscera*. He asked: "Uncle, regarding the anatomical diagrams you drew, the meridians are actually air tubes, all based on the 'Wei Zong Guan' (Master Tube of Wei Qi). Regarding the *Shanghan Lun* (Treatise on Cold Damage), which establishes 113 prescriptions and 397 methods based on the symptoms of the six foot meridians, many of these prescriptions are effective? I do not understand the rationale." I said: "Read the first chapter carefully, and you will understand why the prescriptions are effective while the meridian theory is erroneous. For example, the first chapter discusses the Foot-Taiyang Bladder Meridian, stating that when cold pathogen invades, if there is sweating, it is wind-strike, treated with Guizhi Tang (Cinnamon Twig Decoction). It discusses the Foot-Taiyang Meridian, which connects only the two legs, not the two arms. It states that pathogenic transmission occurs through the six foot meridians, not the six hand meridians. Look at the initial stage of Shanghan: headache, body ache, neck stiffness, fever, and aversion to cold. There is no case where the two arms and hands do not hurt, feel feverish, or experience aversion to cold. After using Mahuang Tang (Ephedra Decoction), there is no case where the whole body recovers but the two arms and hands remain unaffected. Is this not clear proof that although the prescriptions are effective, the discussion of meridians is fundamentally wrong? If before Zhang Zhongjing, someone had personally seen the viscera and clearly understood that meridians connect throughout the body, Zhang Zhongjing writing the *Shanghan Lun* would have simply stated that external cold pathogen enters the meridians of the whole body, and Mahuang Tang disperses the cold pathogen from the whole body. One sentence would suffice. The statement that sweating indicates wind-strike, treated with Guizhi Tang composed of Guizhi (Cinnamomi Ramulus), Baishao (Paeoniae Radix Alba), and Gancao (Glycyrrhizae Radix et Rhizoma), has never cured a single person. The reason Guizhi Tang fails is that headache, body ache, fever, and sweating are not wind-strike, but rather the plague discussed by Wu Keyou. He asked again: "If cold pathogen is on the exterior, one should naturally see exterior symptoms like headache, body ache, fever, aversion to cold, and anhidrosis. In the early stage of Shanghan, before transmission to the interior, how can there be retching, an interior symptom? Neither Zhang Zhongjing's treatise nor the annotations by Wang Shuhe and dozens of others explain the cause of retching accompanying exterior symptoms. I truly cannot understand; please instruct me clearly." At first, I thought you only had the ambition to study books, not the talent for medicine. However, based on your question, you still have logical thinking. In the future, I dare not be careless or slight human lives. You ask how cold pathogen on the exterior causes retching in the interior. Let me tell you in detail: Cold pathogen first enters the hair pores, then the skin, then the silk collaterals, then the yang collaterals, then the main meridians, then the Wei Zong Guan (Master Tube of Wei Qi), then horizontally enters the heart, then ascends into the left and right air tubes, then attacks the left and right qi gates, causing retching. This is the origin of retching in exterior syndromes. When Mahuang Tang is taken, the medicinal juice flows out through the Jin Men (Gate of Fluids), enters the Jin Guan (Fluid Tube), passes through the liver, enters the Long Guan (Dragon Tube) in the spleen,渗s out through the water exit channel, seeps into the bladder to become urine. The qi of the medicine, i.e., its nature, travels from the Jin Guan to the Wei Zong Guan, from the Wei Zong Guan to the meridians, from the meridians to the collaterals, from the collaterals to the silk collaterals, from the silk collaterals to the skin, and from the skin to the hair pores, driving the cold pathogen out through the pores, thus inducing sweating. As the pathogen exits with the sweat, the sweat stops, and consequently, the retching ceases. This illustrates the sequence of internal and external connection of the body's meridians, where Mahuang Tang disperses exterior pathogen, which exits with the sweat." He asked again: "Zhang Zhongjing discusses eye pain, dry nose, and insomnia as exterior symptoms of the Foot-Yangming Stomach Meridian, treated with Gegen Tang (Kudzu Decoction), which contains Gegen (Puerariae Lobatae Radix) and Mahuang. I do not fully understand this logic." I said: "When cold pathogen enters the meridians from the exterior, the healthy qi transforms the cold pathogen into heat, hence called 'pathogenic heat'. Pathogenic heat attacks the top of the head; the brain is disturbed by pathogenic heat, causing insomnia. The eye system connects to the brain; pathogenic heat enters the eyes from the brain, causing eye pain. The nose connects to the brain; pathogenic heat enters the nose from the brain, causing nasal dryness. This is clearly a fire syndrome of pathogenic heat attacking upward, not an exterior cold of the Foot-Yangming Stomach Meridian. Healing with Gegen does not mean Gegen is a warming dispersant; Gegen is actually a clearing and dispersing herb. Mahuang is used in the formula to disperse the cold pathogen on the exterior that has not yet transformed into heat. This is another clear proof that the prescriptions are effective while the meridian theory is wrong." He asked again: "Zhang Zhongjing discusses hypochondriac pain, deafness, bitter taste in the mouth, alternating chills and fever, and vomiting. These symptoms are half-exterior half-interior, belonging to the Foot-Shaoyang Gallbladder Meridian, treated with Xiaochaihu Tang (Minor Bupleurum Decoction), which is remarkably effective. I think, if this syndrome is not in the Gallbladder Meridian, why is the prescription so effective? If it is in the Gallbladder Meridian, the gallbladder is located below the diaphragm, yet the pain is in the chest and hypochondrium. I do not understand this part." I said: "Look at the visceral diagram; you will understand the Blood Mansion (Xue Fu) above the diaphragm. Pathogenic heat enters the Blood Mansion and attacks the blood, causing hypochondriac pain. The pathogen attacks inward into the blood, while the blood resists outward; this attack and resistance cause alternating chills and fever. Heat burns the left and right qi gates, blocking the upward and downward flow of qi, causing vomiting and bitter taste. Pathogenic heat attacks upward, causing deafness and vertigo. Chai Hu (Bupleuri Radix) clears heat from the Blood Mansion. When heat clears, sweat appears naturally, and the pathogen resolves with the sweat, hence the rapid effect. This is also a clear proof that the prescription is effective while the meridian theory is wrong. Variations in transmission are numerous, but ultimately do not exceed exterior/interior and deficiency/excess. If you wish to master Shanghan, you must read Wu Keyou's *Wenyi Lun* (Treatise on Plague-Epidemics); if your reading is limited, you will inevitably have biases towards cold or heat. Last night, your guest asked: Ancients said sweat inside the skin is blood, and sweat emerging outside the skin is sweat, claiming sweat is transformed from blood. You did not understand this. I did not tell you then, not because you spoke too much in front of guests, but because the guest had only superficial medical knowledge and was not a renowned expert, so it was inappropriate to explain to him in his presence. 'Sweat is transformed from blood' is the theory of Zhu Zhenheng (Danxi). Although Zhang Jingyue criticized it, he could not pinpoint the true source of sweating. The error in ancient theories lies in not knowing that qi and blood in the human body travel in two separate tubes. The air tube connects to the skin and has pores, thus allowing sweating; the blood vessel connects to the skin but has no pores, thus not allowing sweating. How do we know blood vessels have no pores connecting to the skin? Look at sores that break and ooze yellow fluid; the toxin comes from the air tube, oozing daily without reddening the skin. If the sore toxin were in the blood vessel, the skin would be red initially, and only after ulceration would it ooze pus and blood. Look again at plague toxins, macules, rashes, and smallpox in children; although red, they do not bleed. Is this not clear proof that blood vessels have no pores connecting to the skin?" My cousin's son, Wang Zuoli, came to Beijing and asked me during casual conversation. By then, the book had already been printed, so I wrote this at the end of the volume to record it.