满时痛，多吐清冷痰诞，喜食辛辣椒姜热物。因肝胆之阳不足，不能收束其水，挟龙雷指阴气也，而水泛于上，直干清道而作者，其人腰胁胀痛，足膝时冷，两颧时赤，夜间痰水更甚，咽干不渴。若渴饮冷，便是阴虚火旺。凡此内外两法，不得紊乱。审是从外而入之风邪干者，去其风而咳嗽自己，如桂枝汤，祛风散是也。寒邪干者，散其寒而咳嗽自己，如麻黄汤、小青龙汤是也。暑邪干者，清其暑而咳嗽自己，如益元散、清暑汤是也。湿邪干者，渗其湿而咳嗽自己，如二陈汤、桂苓术甘汤是也。燥邪干者，润其燥而咳嗽自己，如甘桔汤、麦冬饮之类是也。火邪干者，散其火，清其火，而咳嗽自己，如导赤散、葛根苓连汤之类是也。审是从内之心肺阳衰者，扶其阳而咳嗽自止，如姜桂茯半汤、温肺饮之类是也。审是脾胃阳衰者，舒其脾胃而咳嗽自止，如半夏生姜汤、香砂六君汤、甘草干姜汤之类是也。审是肝肾阳衰，水邪泛上者，温其肾而咳嗽自己，如真武汤、滋肾丸、潜阳丹加吴萸之类是也。果见阴虚而致者，其人水少火多，饮食易消，精神言语声音必壮，心性多躁暴，肌肤多干粗，吐痰胶粘，喜清凉，脉必细数，恶辛辣热物，方是的候，如鸡子黄连汤、六味地黄之类，皆可服也。尚有一等，久病无神，皮肉如火炙而无润泽，喜热恶冷，此尤属真气衰极，不能薰腾津液而灌溉肌肤，十有九死。更有一等，阳虚阴盛已极，元阳将脱之咳嗽，气喘痰鸣，六脉浮空，或劲如石，唇青爪甲黑，周身大热，自汗，乃脱绝危候，急宜大剂回阳饮治之，十中可救二三。余曾经验多人，但逢此候，务先在药单上拟明。以免庸俗借姜附为口舌。
余又得一奇法。[眉批]非法之奇，乃人之愚者多也，故又借一奇字。以醒人眼目。一人病患咳嗽，发呕欲吐，头眩腹胀，小便不利。
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余意膀胱气机不降而返上，以五苓散倍桂，一剂便通，而诸证立失。由是观之，医贵明理，不可固执，真不谬矣。查目下市习，于咳嗽一证，每每见痰化痰，见咳止咳，所用药品，无非杏仁、贝母、冬花、紫菀、百合、桑皮、化红、苏子、白芥、南星、薄荷、半夏，与夫参苏饮、苏沉九宝、滋阴六味，一味杂投，以为止咳化痰，每每酿成劳证，此岂药之咎哉。由其不知内外各有攸分，阴阳各有实据，药性各有专主，何其相沿不察，贻害无穷也。予故辩而正之。
肺 痿 肺 痈痿症，咳吐浊沫或脓血，口臭不渴，小便利。痈症，咳吐脓血，胸中隐隐作痛，将成时，坐卧不安。
按痈、痿二证，名异而源同。同者，同在肺也。痿虚由肺阳不足，而津液失运。而痈实。由肺阴不足，而燥邪日生蕴酿日久。痿宜温肺，《金匮》之甘草干姜汤是也。姜性辛温，能宣肺中之寒，甘草能缓姜性之散，又能温中补中，又足生气，故见功实速。余曾经验多人。痈宜开壅，《金匮》之皂荚丸是也。皂荚功专开壅去垢，又得蜜，枣以安中，邪去而正气无伤，妙法也。[眉批]辛甘化阳，甘咸养阴，学者功力深到，便识得此义玄妙，医中之能事毕矣。予细维《金匮》治痿证，首列甘草干姜汤，明是辛甘化阳之法，必是肺冷无疑。再以痿字义考之，委者，谢也。[眉批]委谢痈壅，晰义精确，一虚一实，判若列眉。如花木之叶萎，败而无润泽，其源定属坎中真气不上薰蒸。若坎中既有真气上腾，肺何由而得萎也。而治痈以皂荚丸，皂荚辛咸，枣、蜜味甘。明是甘咸养阴之法，必是肺热无疑。更以痈字义考之，痈者，壅也。壅则聚而不通，热伏不溃之象，其源定属水衰火旺。然痈之将成未成，其中尚有许多治法。果系胸中隐痛，脉数滑，口中辟辟燥，唾脓血，卧难安。此际乃痈的候。否则照常治嗽法投之。予意当以肺阳不足而痿证生，肺阴不足而痈证起，以定此二案。[眉批]阴阳案定，人有遵循。后学始有
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把握，庶不致错乱无据也。
胃 病 不 食
按不食一症，有因外邪伏而不宣，逆于胃口者；有因饮食生冷，停滞胃口者；有因七情过度，损伤胃气者；有因阳虚者；有因阴虚者。因外邪所致而不食者，定有发热、头痛、身痛，与夫恶寒、恶风、恶热、口苦、便赤、四肢酸痛等情。按定六气节令，六经提纲病情治之，外邪去而食自进矣。因饮食生冷而致不食者，定见饱闷吞酸，胸膈胀痛等情，照温中行气消导之法治之，生冷去而食其进矣。因七情过度而致不食者，审其所感，或忧思、或悲衰、或恐惧、或用心劳力、或抑郁、或房劳，按其所感所伤而调之，则饮食自进矣。因阳虚者，阳衰则阴盛，阳虚二字，包括七情在内，论阳虚，是总其名也。阴主闭藏，故不食。此等病人，必无外感，饮食病情为难。法宜扶阳，扶阳二字，须按定上中下部位。阳旺阴消，而食自进矣。因阴虚者，阴虚则火旺。阴虚二字，有外感客邪，随阳经而化为热邪伤血，按其所感经络治之，若系真阴虚极，则又非苦寒可用。火伏于中，其人烦热口渴饮冷，甚有呃逆不休，咳嗽不已，反胃而食不下诸症。轻则人参白虎，重则大小承气之类。是泻其亢盛之火邪，以复阴血。若由真阳虚极，不能化生真阴，阴液已枯，其人定然少神气短，肌肤全无润泽。若火炙然，亦常思泊润凉物。病至此际，十少一生。苟欲挽回，只宜大甘大温以复阳，阳回则津液自生。即苦甘化阴，甘淡养阴，皆其次也。昧者不知此中消息，妄以苦[1]寒大凉治之，鲜不速毙。果能投治无差，则阴长阳生，而食自进矣。[眉批]饮食为人之大源，其所以能饮食之故，尤重在精气。不食一证所因最为繁多，无论内外各病，皆能致之。此按扼定病机病情，指出治法。大具手眼，
[1] 苦原本作"若"，据文义改。
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至活至妙。学者苟知精气为饮食之本，从精气上消息不食之故，便合钦安之法，而得不食之源，于治胃病乎何难。
以上内外诸法俱备，学者务要下细理会，不可因其不食，而即以消食、行气、破滞之品杂乱投之，病人莫不阴受其害。查近日市习，一见不食，便以平胃散加丑牛、槟榔、山楂、麦芽、香附、三棱、莪术[1]之类投之。内外莫分，阴阳莫辩，诚可慨也。今特略陈大意，至于变化圆通，存乎其人。[眉批]八字要紧。又安可执一说，而谓尽括无遗。
按呕吐、泄泻一证，有只呕吐而不泄泻者，有只泄泻而不呕吐者，有呕吐、泄泻并行者。
呕吐而不泄泻者，邪乘于上也。上指胃。泄泻而不呕吐者，邪乘于下也。下指脾。呕吐与泄泻并行者，邪隔于中，上下俱病也。中指脾胃交会处也。论外因，则有风、寒、暑、湿、燥、火，与夫痘、麻、癍诊发泄漏之异。论内因，则有饮食停滞、阳虚、阴虚之别。予推究太阴一经，在三阳之底面，外邪初入，必不能致呕吐泄泻。即有吐泻，定是失于表散。邪壅于阳阴，则有干呕之条。邪伏于少阳，则有喜呕之列，不得即直入于内，而至吐泻也。其所以致吐泻者，由其表邪未解，妄行攻下，引邪入内，邪陷于中，方能致此。治法仍宜升举其所陷之邪，如桂枝汤加葛根之法是也。亦有外邪未解，传经而至太阴者。邪至此地，不问何邪传至，但以本经为主，即在本经之标本中三气上求之。湿为太阴之本气，湿为阴邪，一切外邪至此，即从本气而化为病者俱多，亦有不从本气而从中化为病者亦多。中指胃，胃与脾为表里也。亦有不从本中所化，
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而从标化为病，标即太阴经也。太阴为阴经，邪从经为病，亦阴也。盖从本化者为湿邪，泄泻居多。从中化者为热邪，皮黄、便赤、呕吐者众。从标化者为阴邪，腹痛不食屡生。如此而求，便得邪之所从所化也。故前贤云：吐泻病，求太阴。是叫人在太阴经之标、本、中三气上求之也。治之之法，湿、热、阴三字定之矣。从队湿者，其人吐泻甚而肢冷唇青，仲景之理中、吴茱萸汤之类是也。从热化者，其人即吐泻而思水饮，如仲景之五苓、四苓、或黄连、吴萸汤之类是也。更有吐泻甚而兼腹痛剧者，前贤称为霍乱，称为发痧。学者不必多求，即在本经之标、本、中三法求之。亦间有卒闭而即四肢冷者，腹痛吐泻甚者，由其内本先虚，外邪卒入，闭其清道，邪正相攻，腹痛吐泻并作，法宜宣之，散之、开之、刺之、刮之等例，亦不可不知。至于饮食停滞而致吐泻者，盖以饮食伤中也，其人多饱闷吞酸嗳臭，治以温中消食便了。[眉批]此证钦安合三证而并论。吐本从阳，泻本从阴，一时吐泻并作，中宫失运，此三证也。吐从阳，宜温降，泻从阴，宜温升。吐泻并作，必兼头痛发热身疼，热多欲饮水者，五苓散主之；寒多不饮水者，理中丸主之。其证小便不利者多，若小便复利而大汗出，脉微者，四逆汤主之。此外，如内因外因，阳虚阴虚，饮安论法大备，学者留心参究，临证自有把握。知非氏曰：定吐泻为脾病，大有妙义。再细论其理，脾与胃为夫妻，同处中州，一脏一腑，合为一家，一阴一阳，共同转运之权，日奉君火之令而行。自能燮理阴阳，分清别浊，何得灾害，并至今令肠中溏泻。以干易湿明，明脾不行水，水不归经，并入肠中，水主润下，焉能久停，故大泻作。又令人吐，亦明明是水不运行，牌阴把持君火之令，火性炎上，令不行之不胃出食管，故大吐作。又把由妻失运化，至令其夫不能正位。又安望其输精皮毛，润溉骨髓，柔及筋膜，将子女臣妾悉受俱害。加以日久浸淫，变证蜂起。若扰及君主，恐更祸生不测者，噫！可畏也。昔贤云：吐泻病，求太阴，允推卓见。但其中至理，不为发明，学者焉能了了，直捣中坚，抑或旁取、逆取、以出奇而制胜。饮安无奈何，又不能直吐心肺，只得多方指陈，旁引曲证，广立法门，亦犹王良之诡遇，以期嬖奚幸而获禽，其心实良苦矣。知非从旁不忿，直抒胞臆，为饮安畅言之，试问吐泻之证，本属脾胃，孰敢定为脾病孚？此有功医林这按，
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学者不宜轻视。
至于痘麻，毒初出时，吐者居多，泄泻者少。诚以痘出于脏，从太阳而发泄于外。外者，皮肤、肌肉之属也。肌肉属阳明，毒邪将出未出之候，从太阳鼓舞，尽壅于阳明，故呕吐者多。要吐则毒气方能发泄得透。医者当迎其机而导之。考古方首用桂枝汤，初发热时也；次用升麻葛根汤，初现点时也；皆是顺其气机以发透为妙也。麻出于腑，感天行者多，当将出未出之际，治法初与痘同。但痘出透时，以养浆结疤，收回阳气为重。麻证出透时，以清解毒尽为先。至于癍疹之邪，由外感不正之时气，伏于肌肉之间，不能深入，当经气旺时，邪不能久藏，随气机而发泄于外，若用苦寒，遇郁其外泄之气机，其客最速。亦多发吐。学者于此数证，先告以服药后，吐亦无妨，切不可妄行温中降逆止呕之法，务要果真胃寒发吐，方可温中。
更有阳虚之人，俨若平常好人，却不能劳心用力多言。但劳神一刻，即有发呕发吐者，稍食猪肉即大泻者，法只宜温中，或补命门相火。亦有阴虚之人，血液枯极，贲门不展，有干呕吐，而食不得下者。更有朝食暮吐，食而即吐，种种情形。治法不必细分，总之，呕吐与反胃、咳嗽、呃逆、吐血诸证，皆是一个逆字，挐定阴阳实据治之，发无不中。要积各经受寒闭塞，皆能致逆。逆则呕吐、泄泻必作。各以受热传变，皆能致逆，逆则呕吐、泄泻亦作，不可不知。
近阅市习，一见呕吐、泄泻，多用藿香正气散、胃苓汤、柴苓、四神、肉蔻散等方，治非不善，总不若辩明阴阳之为当也。
肝 病 筋 挛
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阳虚失血而致者，有阳虚者。
因霍乱吐泻而致者，由其吐泻太甚，伤及中宫，中宫之阴阳两亡，转输失职，不能运当液而交通上下，筋骨失养，故筋挛作。法宜安中，如仲景之吴茱萸汤、理中汤，皆可与也。
因误汗而致者，由其发汗太过，血液骤伤，火动于中，筋脉失养，故筋挛。法宜扶阴，如仲景之芍药甘草汤是也。
因阳虚失血而致者，由阳气衰弱，不能统血，血亡于外，气衰于内，薰蒸失宜，枯槁渐臻，筋脉失养，故筋挛。法宜大辛大甘以扶阳，如仲景之附子甘草汤、甘草干姜汤，皆可服也。
阴虚而致者，由外邪入内，合阳经气化，成为火邪，火甚血伤，筋脉失养，故筋[1]挛。世云火症，便是阴虚的大眼目，无论何经、保脏、何腑有火，俱要养阴，但非真阴虚也。若真阴虚者，其人元气虚极，不能化生阴液，多系久病，方能致此，十中罕有一生。予故曰真阴虚者少。法宜养阴清火，如仲景之鸡子黄连汤，与后贤之六味地黄汤、生地四物汤，皆可与也。
当体内阳气充盈时出现疼痛，常伴有频繁呕吐清冷痰涎，喜欢食用辛辣、胡椒、生姜等热性食物。这是因为肝胆阳气不足，无法固摄水液，导致阴寒之气（龙雷之火指代阴寒之气）挟带水湿上泛，直接侵犯上部清窍所致。这类患者通常表现为腰部和胁肋部胀痛，足膝时常发冷，两颧时而发红，夜间痰和水饮症状加重，咽喉干燥但不想喝水。如果口渴且想喝冷饮，那就是阴虚火旺的表现。以上内外两种治法，不可混淆错乱。
如果是外感风邪侵袭导致的咳嗽，祛除风邪后咳嗽自然停止，例如使用桂枝汤来祛风散寒。如果是寒邪侵袭，发散寒气后咳嗽自然停止，例如使用麻黄汤或小青龙汤。如果是暑邪侵袭，清除暑热后咳嗽自然停止，例如使用益元散或清暑汤。如果是湿邪侵袭，渗利湿气后咳嗽自然停止，例如使用二陈汤或桂苓术甘汤。如果是燥邪侵袭，滋润燥邪后咳嗽自然停止，例如使用甘桔汤或麦冬饮之类。如果是火邪侵袭，疏散火邪、清泻火邪后咳嗽自然停止，例如使用导赤散或葛根芩连汤之类。
如果是内伤导致的心肺阳气衰弱，扶助阳气后咳嗽自然停止，例如使用姜桂茯半汤或温肺饮之类。如果是脾胃阳气衰弱，调理脾胃后咳嗽自然停止，例如使用半夏生姜汤、香砂六君汤或甘草干姜汤之类。如果是肝肾阳气衰弱，导致水邪上泛，温补肾阳后咳嗽自然停止，例如使用真武汤、滋肾丸或潜阳丹加吴茱萸之类。
确实见到因阴虚导致的咳嗽，患者体内阴液少而虚火多，饮食容易消化，精神、言语和声音必然壮实，性格多急躁暴戾，肌肤多干燥粗糙，吐出的痰粘稠，喜欢清凉之物，脉象必定细数，厌恶辛辣热物，这才是确切的证候，此时可以使用鸡子黄连汤、六味地黄丸之类，都可以服用。
还有一种情况，久病导致神气衰败，皮肤肌肉像被火烤一样但没有润泽，喜热恶冷，这尤其属于真气极度衰竭，不能蒸腾津液以灌溉肌肤，十个人中有九个会死亡。又有一种情况，阳气虚弱、阴寒极盛，元气将脱的咳嗽，气喘痰鸣，六脉浮大中空或坚硬如石，嘴唇青紫，指甲发黑，全身大热，自汗出，这是阳气脱绝的危重证候，急需大剂量回阳饮治疗，十个人中可救活两三个。我曾亲自治愈过多人，但遇到这种证候，务必先在药方上写明理由，以免被庸俗之辈借姜、附子作为攻击的口实。
我又发现一种奇特疗法。[眉批]并非方法奇特，而是愚昧的人太多，所以借用一个“奇”字，以唤醒人们的目光。有一人患咳嗽，发作时欲呕欲吐，头晕目眩，腹胀，小便不利。
我认为这是膀胱气化功能不降反而上逆，用五苓散加倍桂枝，一剂药后小便通利，各种症状立刻消失。由此看来，医学贵在明理，不可固执己见，这真是千真万确。查看当下的医疗习俗，对于咳嗽这一病症，往往见到痰就化痰，见到咳就止咳，所使用的药物，无非是杏仁、贝母、款冬花、紫菀、百合、桑白皮、化红（可能指某种药材）、苏子、白芥子、南星、薄荷、半夏，以及参苏饮、苏沉九宝汤、滋阴六味地黄丸等，一味药杂乱投喂，以为能止咳化痰，往往酿成劳损之证，这难道是药物的过错吗？是因为他们不知道外感和内伤各有区分，阴阳各有实证依据，药性各有专主，为何沿袭旧习不加考察，造成无穷危害呢？所以我辨析并纠正这些观点。
肺痿与肺痈
痿症，表现为咳嗽吐出浊沫或脓血，口臭但不渴，小便通畅。痈症，表现为咳嗽吐出脓血，胸中隐隐作痛，即将形成时，坐卧不安。
按：痈和痿两个证候，名称不同但源头相同。相同之处在于病变都在肺。痿证属虚，由肺阳不足，导致津液运行失常；痈证实，由肺阴不足，导致燥邪日益滋生蕴酿日久。痿证宜温肺，《金匮要略》中的甘草干姜汤就是此类。干姜性辛温，能宣散肺中的寒气，甘草能缓和干姜的辛散之性，又能温中补中，还能益气，所以见效迅速。我曾亲自治愈过多人。痈证宜开壅，《金匮要略》中的皂荚丸就是此类。皂荚功效专门在于开壅去垢，再加上蜜、枣来安护中焦，邪气去除而正气不受损伤，这是妙法。[眉批]辛甘可以化生阳气，甘咸可以滋养阴液，学者功力深厚，就能识得此义玄妙，医术中的能事也就完备了。我仔细思考《金匮要略》治疗痿证，首先列出甘草干姜汤，明显是辛甘化阳的方法，必定是肺冷无疑。再从“痿”字的含义考证，“委”者，谢也（推卸、衰退之意）。[眉批]推卸痈壅，解析义理精确，一虚一实，判若分明。就像花木的叶子枯萎，败坏而没有润泽，其根源一定属于肾中（坎中）真气不能向上薰蒸。如果肾中既有真气上腾，肺怎么会发生萎弱呢？而治疗痈用皂荚丸，皂荚辛咸，枣、蜜味甘，明显是甘咸养阴的方法，必定是肺热无疑。再以“痈”字的含义考证，“痈”者，壅也。壅滞则聚而不通，是热伏于内不得溃散的征象，其根源一定属于水衰火旺。然而痈在将成未成之际，其中还有许多治法。如果确实是胸中隐痛，脉数滑，口中辟辟干燥，唾脓血，卧睡难安，这才是痈的确切证候。否则按照常规治嗽法投药即可。我的意见应当以肺阳不足导致痿证产生，肺阴不足导致痈证兴起，来确定这两个案子的性质。[眉批]阴阳案子确定，后人有所遵循。初学者始有把握，才不会致错乱无据。
胃病不食
按：不食这一症状，有因外邪潜伏不能宣发，逆犯胃口的；有因饮食生冷，停滞在胃口的；有因七情过度，损伤胃气的；有因阳虚的；有因阴虚的。因外邪导致的不食，一定有发热、头痛、身痛，以及恶寒、恶风、恶热、口苦、大便赤涩、四肢酸痛等情况。根据六气节令，结合六经提纲病情进行治疗，外邪去除后食欲自然恢复。因饮食生冷导致的不食，一定见饱闷吞酸，胸膈胀痛等情况，照温中行气消导法治之，生冷去除后食欲自然恢复。因七情过度导致的不食，审察其所感受的情志，或是忧思、或是悲哀、或是恐惧、或是用心劳力、或是抑郁、或是房劳，针对所感所伤进行调理，则饮食自然进步。因阳虚者，阳衰则阴盛，“阳虚”二字包括七情在内，论阳虚是总括其名。阴主闭藏，所以不食。这类病人，一定没有外感，饮食病情难以判断。治法宜扶阳，“扶阳”二字，须按定上、中、下部位。阳气旺盛阴气消退，食欲自然恢复。因阴虚者，阴虚则火旺。“阴虚”二字，有外感客邪，随阳经化为热邪伤血，按其所感经络治之，若是真阴虚极，则不能用苦寒药。火伏于中，其人烦热口渴饮冷，甚至有呃逆不休，咳嗽不已，反胃而食不下诸症。轻则用人参白虎汤，重则用大小承气汤之类。这是泻其亢盛之火邪，以恢复阴血。若由真阳虚极，不能化生真阴，阴液已枯，其人定然神气短少，肌肤全无润泽，像火烤一样，也常思吃凉润之物。病到此时，十人中难得一生。想要挽回，只宜大甘大温以复阳，阳回则津液自生。即使是苦甘化阴、甘淡养阴，都是次要的。无知者不知其中的奥妙，妄用苦寒大凉药物治疗，很少有不迅速死亡的。如果能准确投药治疗，则阴长阳生，食欲自然恢复。[眉批]饮食是人的大源泉，之所以能饮食，尤其重在精气。不食一证的原因最为繁多，无论内外各病，都能导致。此处扼定病机病情，指出治法，极具眼光。
[1] “苦”原本作“若”，据文义改。
至活至妙。学者如果知道精气是饮食的根本，从精气上探究不食的原因，就符合钦安（郑钦安）的法则，找到不食的源头，治疗胃病又有什么难的呢？
以上内外诸法都具备了，学者务必要仔细理会，不要因为不食，就用消食、行气、破滞的药物杂乱投喂，病人无不暗中受害。查看近日医疗习俗，一见不食，就用平胃散加牵牛子、槟榔、山楂、麦芽、香附、三棱、莪术之类投喂。内外不分，阴阳不辨，实在令人感慨。现在特略陈大意，至于变化圆通，存乎其人。[眉批]这八个字要紧。又怎么能执守一说，就说尽括无遗。
脾病呕吐泄泻
按：呕吐、泄泻这一证候，有只呕吐而不泄泻的，有只泄泻而不呕吐的，有呕吐、泄泻并行的。
呕吐而不泄泻，是邪气乘于上。上指胃。泄泻而不呕吐，是邪气乘于下。下指脾。呕吐与泄泻并行，是邪气阻隔于中，上下俱病。中指脾胃交会处。论外因，则有风、寒、暑、湿、燥、火，以及痘、麻、斑疹发泄漏的不同。论内因，则有饮食停滞、阳虚、阴虚的区别。我推究太阴一经，位于三阳之底面，外邪初入，必定不能导致呕吐泄泻。即使有吐泻，一定是失于表散。邪气壅于阳明，则有干呕的条文。邪伏于少阳，则有喜呕的类别，不会直接入内而至吐泻。之所以导致吐泻，是因为表邪未解，妄行攻下，引邪入内，邪陷于中，才能导致此症。治法仍宜升举所陷之邪，如桂枝汤加葛根的方法就是如此。也有外邪未解，传经而至太阴的。邪气到了这个地方，不问什么邪气传至，但以本经为主，即在本经的标、本、中三气上求之。湿为太阴的本气，湿为阴邪，一切外邪至此，即从本气而化为病的很多，也有不从本气而从中间化为病的也很多。中指胃，胃与脾为表里。也有不从本中所化，而从标化为病的，标即太阴经。太阴为阴经，邪从经为病，也是阴。大概从本化者为湿邪，泄泻居多。从中化者为热邪，皮黄、便赤、呕吐者众。从标化者为阴邪，腹痛不食屡生。如此而求，便能得到邪气所从所化的规律。所以前贤说：吐泻病，求太阴。是叫人在太阴经的标、本、中三气上求之。治之之法，湿、热、阴三字定之矣。从湿化者，其人吐泻甚而肢冷唇青，仲景的理中汤、吴茱萸汤之类就是如此。从热化者，其人即吐泻而思水饮，如仲景的五苓散、四苓散、或黄连、吴茱萸汤之类就是如此。更有吐泻甚而兼腹痛剧者，前贤称为霍乱，称为发痧。学者不必多求，即在本经的标、本、中三法求之。也间有卒然闭塞而即四肢冷的，腹痛吐泻甚重的，由其内本先虚，外邪卒入，闭其清道，邪正相攻，腹痛吐泻并作，治法宜宣之、散之、开之、刺之、刮之等例，也不可不知。至于饮食停滞而导致吐泻的，盖因饮食伤中，其人多半饱闷吞酸嗳臭，治以温中消食便了。[眉批]此证钦安合三证而并论。吐本从阳，泻本从阴，一时吐泻并作，中宫失运，此三证也。吐从阳，宜温降，泻从阴，宜温升。吐泻并作，必兼头痛发热身疼，热多欲饮水者，五苓散主之；寒多不饮水者，理中丸主之。其证小便不利者多，若小便复利而大汗出，脉微者，四逆汤主之。此外，如内因外因，阳虚阴虚，饮安论法大备，学者留心参究，临证自有把握。知非氏曰：定吐泻为脾病，大有妙义。再细论其理，脾与胃为夫妻，同处中州，一脏一腑，合为一家，一阴一阳，共同转运之权，日奉君火之令而行。自能燮理阴阳，分清别浊，何得灾害，并至今令肠中溏泻。以干易湿明，明脾不行水，水不归经，并入肠中，水主润下，焉能久停，故大泻作。又令人吐，亦明明是水不运行，脾阴把持君火之令，火性炎上，令不行之不胃出食管，故大吐作。又把由妻失运化，至令其夫不能正位。又安望其输精皮毛，润溉骨髓，柔及筋膜，将子女臣妾悉受俱害。加以日久浸淫，变证蜂起。若扰及君主，恐更祸生不测者，噫！可畏也。昔贤云：吐泻病，求太阴，允推卓见。但其中至理，不为发明，学者焉能了了，直捣中坚，抑或旁取、逆取、以出奇而制胜。饮安无奈何，又不能直吐心肺，只得多方指陈，旁引曲证，广立法门，亦犹王良之诡遇，以期嬖奚幸而获禽，其心实良苦矣。知非从旁不忿，直抒胞臆，为饮安畅言之，试问吐泻之证，本属脾胃，孰敢定为脾病孚？此有功医林这按，学者不宜轻视。
至于痘麻，毒初出时，吐者居多，泄泻者少。诚以痘出于脏，从太阳而发泄于外。外者，皮肤、肌肉之属也。肌肉属阳明，毒邪将出未出之候，从太阳鼓舞，尽壅于阳明，故呕吐者多。要吐则毒气方能发泄得透。医者当迎其机而导之。考古方首用桂枝汤，初发热时也；次用升麻葛根汤，初现点时也；皆是顺其气机以发透为妙也。麻出于腑，感天行者多，当将出未出之际，治法初与痘同。但痘出透时，以养浆结疤，收回阳气为重。麻证出透时，以清解毒尽为先。至于癍疹之邪，由外感不正之时气，伏于肌肉之间，不能深入，当经气旺时，邪不能久藏，随气机而发泄于外，若用苦寒，遇郁其外泄之气机，其客最速。亦多发吐。学者于此数证，先告以服药后，吐亦无妨，切不可妄行温中降逆止呕之法，务要果真胃寒发吐，方可温中。
更有阳虚之人，俨若平常好人，却不能劳心用力多言。但劳神一刻，即有发呕发吐者，稍食猪肉即大泻者，法只宜温中，或补命门相火。亦有阴虚之人，血液枯极，贲门不展，有干呕吐，而食不得下者。更有朝食暮吐，食而即吐，种种情形。治法不必细分，总之，呕吐与反胃、咳嗽、呃逆、吐血诸证，皆是一个逆字，挐定阴阳实据治之，发无不中。要积各经受寒闭塞，皆能致逆。逆则呕吐、泄泻必作。各以受热传变，皆能致逆，逆则呕吐、泄泻亦作，不可不知。
近阅市习，一见呕吐、泄泻，多用藿香正气散、胃苓汤、柴苓、四神、肉蔻散等方，治非不善，总不若辩明阴阳之为当也。
肝病筋挛
按：筋挛这一证候，有因霍乱吐泻而致的，有因误汗而致的，有因阳虚失血而致的，有阳虚的。
因霍乱吐泻而致的，由其吐泻太甚，伤及中宫，中宫的阴阳两亡，转输失职，不能运化津液而交通上下，筋骨失养，故筋挛作。治法宜安中，如仲景的吴茱萸汤、理中汤，皆可与也。
因误汗而致的，由其发汗太过，血液骤伤，火动于中，筋脉失养，故筋挛。治法宜扶阴，如仲景的芍药甘草汤就是如此。
因阳虚失血而致的，由阳气衰弱，不能统血，血亡于外，气衰于内，薰蒸失宜，枯槁渐臻，筋脉失养，故筋挛。治法宜大辛大甘以扶阳，如仲景的附子甘草汤、甘草干姜汤，皆可服也。
阴虚而致的，由外邪入内，合阳经气化，成为火邪，火甚血伤，筋脉失养，故筋挛。世云火症，便是阴虚的大眼目，无论何经、保脏、何腑有火，俱要养阴，但非真阴虚也。若真阴虚者，其人元气虚极，不能化生阴液，多系久病，方能致此，十中罕有一生。予故曰真阴虚者少。治法宜养阴清火，如仲景的鸡子黄连汤，与后贤的六味地黄汤、生地四物汤，皆可与也。
When the body's yang qi is abundant, pain occurs, often accompanied by frequent vomiting of clear, cold phlegm and saliva, with a preference for consuming spicy foods such as pepper, ginger, and other hot-natured substances. This is because the yang qi of the Liver and Gallbladder is insufficient, failing to secure and contain fluids, leading to Yin-cold qi (referred to as "Dragon-Lei fire" indicating Yin-cold) carrying water-dampness upward, directly invading the upper clear orifices. Such patients typically present with distending pain in the waist and hypochondrium, coldness in the feet and knees, occasional redness of the malar regions, worsening of phlegm and fluid retention at night, dry throat without desire to drink. If there is thirst with a desire to drink cold liquids, it indicates Yin deficiency with hyperactive Fire. The aforementioned internal and external treatment methods must not be confused.
If cough is caused by invasion of exogenous Wind pathogen, removing the Wind will naturally stop the cough, such as using Guizhi Tang (Cinnamon Twig Decoction) to dispel Wind and scatter Cold. If caused by Cold pathogen, dispersing Cold will naturally stop the cough, such as using Mahuang Tang (Ephedra Decoction) or Xiao Qinglong Tang (Minor Blue Dragon Decoction). If caused by Summerheat pathogen, clearing Summerheat will naturally stop the cough, such as using Yiyuan San (Benefit Primordial Powder) or Qingshu Tang (Clear Summerheat Decoction). If caused by Dampness pathogen, leaching out Dampness will naturally stop the cough, such as using Erchen Tang (Two-Aged Phlegm Decoction) or Guiling Zhugan Tang (Cinnamon Twig, Poria, Atractylodes Macrocephala, and Licorice Decoction). If caused by Dryness pathogen, moistening Dryness will naturally stop the cough, such as using Ganjie Tang (Licorice and Catalpa Seed Decoction) or Maidong Yin (Ophiopogon Decoction). If caused by Fire pathogen, dispersing and clearing Fire will naturally stop the cough, such as using Daochi San (Guide Out Redness Powder) or Gegen Qinlian Tang (Kudzu Root and Scutellaria Baicalensis Decoction).
If cough is due to internal injury causing decline of Heart and Lung Yang, tonifying Yang will naturally stop the cough, such as using Jianggui Fuban Tang (Ginger, Cinnamon Twig, Poria, and Pinellia Decoction) or Wenfei Yin (Warm Lung Drink). If due to decline of Spleen and Stomach Yang, regulating the Spleen and Stomach will naturally stop the cough, such as using Banxia Shengjiang Tang (Pinellia and Fresh Ginger Decoction), Xiangsha Liujun Tang (Aucklandia and Amomum Six-Gentlemen Decoction), or Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction). If due to decline of Liver and Kidney Yang causing flooding of Water pathogen upward, warming the Kidney Yang will naturally stop the cough, such as using Zhenwu Tang (True Warrior Decoction), Zishen Wan (Nourish Kidney Pill), or Qianyang Dan (Submerge Yang Powder) added with Wuzhuyu (Evodia Fruit).
For cases truly caused by Yin deficiency, the patient has little Yin and much deficient Fire, food digests easily, spirit, speech, and voice are robust, temperament is often irritable and violent, skin and muscles are dry and rough, expectorated phlegm is sticky, prefers cool substances, pulse is thready and rapid, and dislikes spicy hot foods. Only then is this the accurate syndrome pattern; Jizi Huanglian Tang (Chicken Egg and Coptis Decoction) and Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) can be taken.
There is another condition: chronic illness leading to loss of Shen (Spirit), skin and flesh feel like being roasted by fire but lack moisture, preference for heat and aversion to cold. This particularly belongs to extreme depletion of True Qi, unable to vaporize Jin-Ye (Body Fluids) to irrigate the skin and muscles; nine out of ten cases result in death. Another condition involves extreme Yang deficiency and Yin excess, where Yuan Yang (Original Yang) is about to collapse, presenting with cough, asthma, rattling phlegm, floating and empty six pulses, or hard as stone, cyan lips and black nails, generalized intense heat, spontaneous sweating. This is a critical sign of Yang collapse; urgently treat with large doses of Huiyang Yin (Return Yang Drink); two or three out of ten may be saved. I have personally treated many such cases, but upon encountering this syndrome, one must clearly state the rationale on the prescription to avoid criticism from mediocre practitioners who use Ginger and Aconite as excuses for attack.
I have also discovered a unique method. [Marginal Note] It is not that the method is unique, but rather that there are too many ignorant people, so I borrow the word "unique" to awaken people's eyes. A patient suffered from cough, episodes of retching, dizziness, abdominal distension, and difficulty urinating.
I surmised that the Qi mechanism of the Bladder was not descending but reversing upward. Using Wuling San (Five-Ling Powder) with doubled Guizhi (Cinnamon Twig), after one dose, urination became smooth, and all symptoms disappeared immediately. From this, we see that medicine values understanding principles and forbids stubbornness; this is indeed true. Examining current medical practices, for the symptom of cough, physicians often see phlegm and resolve phlegm, see cough and stop cough. The medicines used are nothing but Xingren (Apricot Seed), Beimu (Fritillaria Bulb), Donghua (Kalanchoe Flower), Ziwan (Aster Root), Baihe (Lily Bulb), Sangpi (Mulberry Bark), Huahong (likely a specific herb), Su Zi (Perilla Seed), Baijiezi (White Mustard Seed), Nanting (Pinellia Tuber), Bohe (Mint), Banxia (Pinellia Rhizome), along with Rensu Yin (Ginseng and Perilla Drink), Suchen Jiubao (Perilla and Amber Nine-Treasures), and Ziyin Liuwei (Nourishing Yin Six-Ingredient). They indiscriminately mix these, believing they can stop cough and resolve phlegm, often酿成 (brewing into) consumptive diseases. Is this the fault of the drugs? No, it is because they do not know that exogenous and endogenous causes have their distinct divisions, Yin and Yang have their substantial evidence, and drug properties have their specific dominances. Why do they follow old habits without examination, causing infinite harm? Therefore, I distinguish and correct them.
**Lung Atrophy (Fei Wei) and Lung Abscess (Fei Yong)**
Atrophy syndrome presents with coughing up turbid foam or pus-blood, foul breath without thirst, and free urination. Abscess syndrome presents with coughing up pus-blood, dull pain in the chest, and restlessness when approaching formation.
Analysis: The syndromes of Yong (Abscess) and Wei (Atrophy) differ in name but share the same source: both reside in the Lung. Wei (Atrophy) is deficiency, caused by insufficiency of Lung Yang, leading to failure of Jin-Ye (Body Fluids) transport. Yong (Abscess) is excess, caused by insufficiency of Lung Yin, allowing Dryness pathogen to generate and accumulate over time. Wei should be treated by warming the Lung, such as Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) from *Jinkui Yaolue*. Ginger is pungent and warm, able to disperse Cold in the Lung; Licorice moderates the dispersing nature of Ginger, warms and tonifies the Middle, and generates Qi, thus achieving rapid results. I have personally treated many such cases. Yong should be treated by opening obstruction, such as Zaoying Wan (Soap Pod Pill) from *Jinkui Yaolue*. Soap pod specializes in opening obstruction and removing filth; combined with Honey and Jujube to calm the Middle, the pathogen is removed while Zheng Qi (Upright Qi) remains unharmed; this is a wonderful method. [Marginal Note] Pungent and Sweet transform into Yang; Sweet and Salty nourish Yin. When scholars' proficiency reaches a deep level, they recognize the profound mystery of this meaning, completing the capabilities of medicine. I carefully consider that *Jinkui Yaolue* lists Gancao Ganjiang Tang first for treating Wei syndrome, clearly indicating the method of Pungent-Sweet transforming Yang, undoubtedly pointing to Lung Cold. Examining the character "Wei" (萎), "Wei" means to decline or shed. [Marginal Note] Shedding Yong obstruction, the analysis is precise; one is deficiency, one is excess, clearly distinguished. Like tree leaves wilting, becoming ruined and lacking moisture, the source must belong to the True Qi of Kan (Kidney/Water) failing to steam upward. If Kan had True Qi rising, how could the Lung atrophy? Treating Yong with Zaoying Wan, Soap pod is Pungent-Salty, Jujube and Honey are Sweet. Clearly, this is the method of Sweet-Salty nourishing Yin, undoubtedly pointing to Lung Heat. Examining the character "Yong" (痈), "Yong" means obstruction. Obstruction implies accumulation without flow, a sign of latent Heat unable to suppurate; the source must belong to Water deficiency and Fire hyperactivity. However, before Yong fully forms, there are many treatments. If there is indeed dull chest pain, rapid slippery pulse, dry mouth ("pipi" dryness), spitting pus-blood, and inability to sleep comfortably, this is the accurate syndrome of Yong. Otherwise, treat according to standard cough methods. My opinion is to determine these two cases based on Lung Yang insufficiency causing Wei syndrome and Lung Yin insufficiency causing Yong syndrome. [Marginal Note] Determining Yin and Yang cases gives followers a reference. Beginners gain confidence, avoiding confusion and lack of basis.
**Stomach Disease: Anorexia (Bu Shi)**
Analysis: Anorexia can be caused by exogenous pathogens lurking and failing to diffuse, rebelling against the stomach gate; by consumption of raw/cold food stagnating in the stomach; by excessive Seven Emotions damaging Stomach Qi; by Yang deficiency; or by Yin deficiency. For anorexia caused by exogenous pathogens, there must be fever, headache, body ache, aversion to cold/wind/heat, bitter taste, dark urine, and sore limbs. Treat according to the Six Qi seasons and Six Meridian outline syndromes; once exogenous pathogens are removed, appetite returns. For anorexia caused by raw/cold food, there must be fullness, acid regurgitation, and chest/diaphragm distending pain; treat with warming, moving Qi, and digesting methods; once raw/cold food is removed, appetite returns. For anorexia caused by excessive Seven Emotions, examine the specific emotion felt—worry/thought, sorrow/grief, fear, mental labor, depression, or sexual exhaustion—and regulate according to the cause; then diet naturally improves. For Yang deficiency, Yang decline leads to Yin excess; "Yang deficiency" includes the Seven Emotions; discussing Yang deficiency is a general term. Yin governs closure/storage, hence anorexia. These patients definitely have no exogenous infection, making dietary symptoms difficult to judge. The method should be to support Yang; "supporting Yang" must be determined by Upper, Middle, and Lower locations. When Yang is vigorous and Yin declines, appetite returns. For Yin deficiency, Yin deficiency leads to Fire hyperactivity. "Yin deficiency" includes exogenous pathogens transforming into Heat pathogens injuring Blood along Yang meridians, treated according to the affected meridian; if it is extreme True Yin deficiency, Bitter-Cold herbs cannot be used. Fire lurks inside; the patient has vexation, heat, thirst, desire for cold drinks, possibly incessant hiccups, continuous cough, reverse flow (regurgitation) with inability to eat. Mild cases use Renshen Baihu Tang (Ginseng and White Tiger Decoction); severe cases use Da Chengqi Tang or Xiao Chengqi Tang. This drains excessive Fire pathogen to restore Yin-Blood. If caused by extreme True Yang deficiency failing to generate True Yin, with dried-up Yin fluids, the patient definitely has shortness of Qi, lack of spirit, and skin/flesh completely lacking moisture, feeling like being roasted, yet desiring cool/moist foods. At this stage, one in ten survives. To reverse this, only Great Sweet and Great Warm herbs to restore Yang should be used; when Yang returns, Jin-Ye generates spontaneously. Even Bitter-Sweet transforming Yin or Sweet-Damp nourishing Yin are secondary. Ignorant people, unaware of this mechanism, recklessly use Bitter-Cold and Great Cool herbs, rarely failing to cause rapid death. If treatment is accurate, Yin grows and Yang generates, and appetite returns. [Marginal Note] Diet is the great source of humans; the reason for being able to eat depends especially on Jing-Qi (Essence-Qi). The causes of anorexia are numerous; whether exogenous or endogenous, all diseases can cause it. Here, grasping the disease mechanism and symptoms points out treatment methods, demonstrating great insight.
[1] "Bitter" originally read "Ruo", corrected according to context.
To be alive and subtle. If scholars know that Jing-Qi is the root of diet, and explore the cause of anorexia from Jing-Qi, they align with Qin'an's (Zheng Qin'an) method, finding the source of anorexia, making the treatment of Stomach diseases easy.
The above internal and external methods are complete. Scholars must study them carefully. Do not, simply because of anorexia, indiscriminately administer digestive, Qi-moving, or stasis-breaking drugs, as patients will secretly suffer. Examining recent medical customs, upon seeing anorexia, physicians often use Pingwei San (Pingwei Powder) added with Qiuniu (Morning Glory Seed), Binglang (Areca Nut), Shanzha (Hawthorn), Maiya (Barley Sprout), Xiangfu (Cyperus Rhizome), Sanleng (Sparganium Rhizome), Ezhu (Curcuma Rhizome). Internal and external are not distinguished, Yin and Yang are not differentiated; this is truly lamentable. Now I briefly state the main idea; changes and flexibility depend on the individual. [Marginal Note] These eight characters are crucial. How can one stick to one theory and claim it covers everything?
**Spleen Disease: Vomiting and Diarrhea**
Analysis: Vomiting and diarrhea syndromes include those with only vomiting, only diarrhea, or both simultaneously.
Vomiting without diarrhea indicates pathogen attacking the Upper (Stomach). Diarrhea without vomiting indicates pathogen attacking the Lower (Spleen). Simultaneous vomiting and diarrhea indicate pathogen blocking the Middle, affecting both Upper and Lower. The Middle refers to the junction of Spleen and Stomach. Regarding exogenous causes, there are Wind, Cold, Summerheat, Dampness, Dryness, Fire, and differences in eruption of Smallpox, Measles, and Macules. Regarding endogenous causes, there are food stagnation, Yang deficiency, and Yin deficiency. I deduce that Taiyin (Spleen) is at the bottom of the Three Yang meridians; initial exogenous invasion cannot cause vomiting/diarrhea. If vomiting/diarrhea occur, it is due to failure to release via the exterior. Pathogen obstructing Yangming causes dry heaving; pathogen hiding in Shaoyang causes desire to vomit; it does not enter internally directly to cause vomiting/diarrhea. The reason for vomiting/diarrhea is that exogenous pathogen was not resolved, and purgatives were wrongly used, drawing pathogen inward, trapping it in the Middle. Treatment should still lift the trapped pathogen, such as Guizhi Tang added with Gegen (Kudzu Root). There are also cases where exogenous pathogen resolves externally but transmits to Taiyin. Upon reaching this location, regardless of the transmitting pathogen, focus on the primary meridian, seeking within the Biao (Branch), Ben (Root), and Zhong (Middle) Qi of this meridian. Dampness is the Ben Qi (Root Qi) of Taiyin; Dampness is Yin pathogen. Most exogenous pathogens here transform into disease according to Ben Qi, but many also transform according to Zhong Qi. Zhong refers to Stomach, which is exterior-interior with Spleen. Some transform according to Biao Qi (Branch Qi), which is the Taiyin Meridian itself. Taiyin is a Yin meridian; pathogen entering via meridian is also Yin. Generally, transformation according to Ben yields Dampness pathogen, mostly diarrhea. Transformation according to Zhong yields Heat pathogen, mostly yellow skin, dark urine, vomiting. Transformation according to Biao yields Yin pathogen, mostly abdominal pain and anorexia. Seeking this way reveals the origin and transformation of the pathogen. Hence, ancient sages said: For vomiting/diarrhea, seek Taiyin. This instructs seeking within the Biao, Ben, and Zhong Qi of Taiyin. Treatment is determined by Damp, Heat, and Yin. Cases transforming from Damp present with severe vomiting/diarrhea, cold limbs, and cyan lips; Lizhong Tang (Regulate Middle Decoction) or Wuzhuyu Tang (Evodia Decoction) from Zhang Zhongjing are appropriate. Cases transforming from Heat present with vomiting/diarrhea and desire for water; Wuling San (Five-Ling Powder), Siling San (Four-Ling Powder), or Huanglian Wuzhuyu Tang (Coptis and Evodia Decoction) are appropriate. More severely, with intense abdominal pain, ancient sages call this Huoluan (Cholera-like disorder) or Fasha (Sha Syndrome). Scholars need not seek far; apply Biao, Ben, Zhong methods of this meridian. Occasionally, sudden closure with cold limbs and severe abdominal pain/vomiting/diarrhea occurs due to prior internal deficiency and sudden exogenous invasion closing clear pathways, with pathogen and righteous Qi clashing. Treatment should involve venting, dispersing, opening, acupuncture, scraping, etc., which must be known. For vomiting/diarrhea caused by food stagnation, due to food injuring the Middle, patients usually have fullness, acid regurgitation, and foul belching; treat with warming Middle and digesting food. [Marginal Note] Qin'an discusses these three syndromes together. Vomiting originates from Yang, Diarrhea from Yin. Simultaneous occurrence indicates Middle Palace failure to transport. Vomiting from Yang requires warming and descending; Diarrhea from Yin requires warming and ascending. With simultaneous vomiting/diarrhea, plus headache, fever, body ache, and desire for water due to Heat, Wuling San governs; if Cold predominates with no desire for water, Lizhong Wan governs. If urination is difficult, common; if urination becomes free with profuse sweating and faint pulse, Sini Tang (Reverse the Extremities Decoction) governs. Additionally, regarding endogenous/exogenous causes, Yang/Yin deficiency, Yin'an's discussion is comprehensive; scholars should study carefully to gain confidence in clinical practice. Zhifei says: Defining vomiting/diarrhea as Spleen disease has profound meaning. Further reasoning: Spleen and Stomach are like husband and wife, residing in the Central Region, one Zang one Fu, forming one family, one Yin one Yang, sharing transport authority, daily obeying Jun Fire command. Naturally, they balance Yin-Yang, separate clear/turbid. How can disaster occur, leading to loose stools? Clearly, Spleen fails to move Water; Water does not return to its channels, merging into intestines. Water governs moistening downward; how can it stay long? Thus, massive diarrhea occurs. Also causing vomiting: clearly, Water fails to circulate; Spleen Yin holds the Jun Fire command; Fire nature flares upward, forcing non-circulating Stomach contents up the esophagus, thus massive vomiting occurs. Because the wife fails to transport, the husband cannot maintain his proper position. How can one expect him to deliver essence to skin/hair, irrigate marrow, soften tendons/sinews, benefiting children/ministers? Over time, complications arise like bees swarming. If disturbing the Monarch (Heart), unpredictable disasters may follow. Alas! Fearful. Ancient sages said: For vomiting/diarrhea, seek Taiyin; truly outstanding insight. But the profound principles therein were not elucidated; how can scholars understand clearly, strike the core, or use indirect/reverse methods to win? Yin'an, having no choice, could not directly address Heart/Lung, so he pointed out various aspects, cited examples, established many gates, like Wang Liang's unconventional hunting, hoping for lucky catches; his heart was truly sincere and arduous. Zhifei, indignant from the side, speaks directly from his own mind, speaking freely for Yin'an. Ask: Vomiting/diarrhea fundamentally belongs to Spleen/Stomach; who dares definitively say it is only Spleen disease? This contribution to the medical forest is significant; scholars should not underestimate it.
Regarding Smallpox and Measles, when toxins first emerge, vomiting is common, diarrhea rare. Indeed, Smallpox originates from Zang, emerging from Taiyang to the exterior. Exterior refers to skin and muscle. Muscle belongs to Yangming. When toxin is about to emerge, Taiyang stimulates, accumulating entirely in Yangming, hence frequent vomiting. Vomiting allows toxin to vent thoroughly. Physicians should guide according to this opportunity. Ancient formulas first use Guizhi Tang at initial fever; then Shengma Gegen Tang (Cimicifuga and Kudzu Root Decoction) at initial spots; all follow Qi mechanism to vent thoroughly, which is wondrous. Measles originate from Fu, often contracted from Heaven's travel. When about to emerge, initial treatment is same as Smallpox. But when Smallpox vents, nourishing pulp and forming scabs to recover Yang Qi is key. When Measles vent, clearing and resolving toxin completely is priority. Regarding Macule/Rash pathogen, caused by improper seasonal Qi lurking between muscles, unable to penetrate deeply. When meridian Qi is vigorous, pathogen cannot hide long, venting outward with Qi mechanism. If Bitter-Cold is used, it suppresses outward-venting Qi mechanism, causing rapid relapse. Also frequently causes vomiting. For these syndromes, scholars should inform patients that vomiting after taking medicine is acceptable; absolutely do not recklessly use warming Middle, descending Rebellious Qi, or stopping vomiting methods. Only if truly Stomach Cold causes vomiting, should one warm the Middle.
Furthermore, Yang-deficient persons appear normal but cannot endure mental labor, physical effort, or excessive talking. Mental exertion for a moment causes retching/vomiting; eating pork causes severe diarrhea. Method should only warm Middle or supplement Mingmen Minister Fire. Yin-deficient persons have extremely dried blood,贲门 (cardia) does not open, causing dry heaving and inability to swallow food. Also morning food evening vomiting, or immediate vomiting after eating, various situations. Treatment need not be overly detailed; essentially, vomiting, reverse flow, cough, hiccup, and hematemesis all share the character "Ni" (Rebellion/Counterflow). Grasping substantial Yin-Yang evidence for treatment ensures accuracy. Accumulated Cold blocking various meridians can cause Ni; Ni causes vomiting/diarrhea. Heat transmission can also cause Ni; Ni causes vomiting/diarrhea. This must be known.
Examining recent medical customs, upon seeing vomiting/diarrhea, physicians often use Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi), Weiling Tang (Stomach and Five-Ling Decoction), Chailing (Bupleurum and Five-Ling), Sishen (Four-Essence), Roukou San (Nutmeg Powder). Treatment is not bad, but total differentiation of Yin-Yang is more appropriate.
**Liver Disease: Tendon Cramping (Jin Luan)**
Analysis: Tendon cramping can be caused by Huoluan vomiting/diarrhea, by mistaken sweating, by Yang deficiency with blood loss, or by Yang deficiency alone.
Caused by Huoluan vomiting/diarrhea: Excessive vomiting/diarrhea injures the Middle Palace, causing dual loss of Yin-Yang in Middle Palace, failure of transport, inability to transform Jin-Ye and connect Upper/Lower, leading to malnourishment of sinews/bones, thus tendon cramping. Method should calm the Middle, such as Wuzhuyu Tang or Lizhong Tang from Zhang Zhongjing.
Caused by mistaken sweating: Excessive sweating suddenly injures Blood, Fire moves internally, sinews/malnutrition lead to cramping. Method should support Yin, such as Shaoyao Gancao Tang (Peony and Licorice Decoction) from Zhang Zhongjing.
Caused by Yang deficiency with blood loss: Yang Qi weak, failing to control Blood; Blood lost externally, Qi衰 internally, steaming malfunction, gradual withering, sinew malnutrition leads to cramping. Method should use Great Pungent and Great Sweet to support Yang, such as Fuzi Gancao Tang (Aconite and Licorice Decoction) or Gancao Ganjiang Tang from Zhang Zhongjing.
Caused by Yin deficiency: Exogenous pathogen enters interior, combines with Yang meridian Qi transformation, becoming Fire pathogen; Fire severe, Blood injured, sinew malnutrition leads to cramping. Worldly saying: Fire syndrome is the major indicator of Yin deficiency. Regardless of which meridian, Zang, or Fu has Fire, one must nourish Yin, but this is not True Yin deficiency. True Yin deficiency involves extreme Yuan Qi deficiency, unable to generate Yin fluids, usually from chronic illness, rarely saving one in ten. Hence I say True Yin deficiency is rare. Method should nourish Yin and clear Fire, such as Jizi Huanglian Tang from Zhang Zhongjing, or Houxian's Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) and Shengdi Siwu Tang (Rehmannia Four-Substance Decoction).