阳虚易于受寒，阴虚易于受热，以身中之不足，感召外邪之有余，此流湿就燥之义，且无以御之之故也。然亦有阴虚中寒，阳虚受热者，其邪盖因虚而招致，不必同类而感召也。治热则恐亡阳，治寒则虑亡阴，最难为矣。
阴虚只当发热，不当恶寒，然亦有恶寒者，热胜反兼胜己之化也。气虚只当恶寒，不当发热，然亦有发热者，火与元气不两立也。
小便黄赤，多主于热。经又云：肺气虚则肩背痛寒，少气不足以息，溺色变。又冬脉不及令人月少清脊痛，溺色变。二者言肺肾虚寒而小便变，何虚实寒热相悬，而其病则同。若此要知肺虚则不能通调水道，肾虚则关门不利，皆能郁而为热，热则溺色变，是热则一第有虚实之不同耳。亦不可不知从治之法也。
张汉瓿曰：小便赤变有中寒，而如是虚人老人恒多。溺色变，热则一，未应说也。
必伏其所主而先其所因
丹毒之与发斑，亦有表里致病之殊。丹毒则系感触时行不正之气，滞于营卫，斑则由阳明瘀热而发于肌肉耳。二者虽宜清热，在丹毒不可不加以解散，在斑又不可不顾其虚，盖斑亦有亡阳于外者，如丹溪所治完颜小将军是也。又丹疹随出随没，系阴虚而虚火游行者。又身痒瘾疹，有因风湿及痰者。
风伤卫，卫伤则不能固卫津液，故令自汗。此说深得用桂枝汤之旨，表实则里虚，此一语人往往潦草看过，而不求其所以然，盖营卫受气于胸中，而脏腑亦受输于营卫，今营卫受邪而实，则失其转输之职，而里为之虚，亦医道之浅而易忽者。
张永孚曰：营卫受邪而实，当言卫受邪而实，则营失其卫而里为之虚，不然表实里虚一语，终欠明耳。
病有大相悬殊，而其理则同者。如肺痿之与痿蹙肺痈之与痹病不同。然一本于阴虚，一本于阳实，其理则同，故学者不可不知比类。
人身中三阳经卫于外，三阴经守于中，原无胜负，第阳气喜舒而恶郁，郁则热生，七情六淫皆能令郁也。又天气作阳，厚味助火，又劳倦则阳和之气动乱为火，如是则火与热搏击于身形之中，未免伤阴，阴伤则阳旺，阳旺阴愈伤，以至偏胜偏虚，故丹溪发阳有余阴不足之论，世人读其言不精求其义，毋怪其有吠声。
太阴厥阴无热而少阴反有热者，缘少阴与太阳为表里，其经亦里之表，又少阴藏真阳，斯二者俱是反有热之故也。观其用麻黄附子细辛汤概可见矣。
胃偏于阳则消谷易饥。又曰：邪热不杀谷。盖消谷是胃阳发露，不杀谷是邪热耳。
《伤寒论》、《金匮要略》岂每证治验，然后笔之于书哉!不过以正气与邪气相搏击在何经，又系何邪见证应作何等立其例，论其理耳。然却非杜撰，后人亦将此等理明白于胸中何难?因此及彼昔贤议论真筌蹄也。又《要略》者，是举其要而言扩而充之，存乎其人。
燥极而口噤，善惊数欠者，以木被金囚而不舒也。妇人藏燥喜悲伤，亦是此意。
寒之而热者取之阴，热之而寒者取之阳，各求其属
当天地不交之时，阳独治于上，无阴以盖覆之。阴独治于下，而填九窍之原明者，当于阳药中加以收敛降下之品，使阳归于阴，阴药中加以升腾生发之味，使阴加于阳。
过用阴精而阴脱于下，暴喜伤阳而阳脱于上，则各补其阴阳。其有亡阴而阳脱于上，亡阳而阴脱于下，则脱阴者当补其阳，脱阳者当补其阴。
阴虚阳亢，法当益水，或加细生甘草以泻火，此先天之阴阳也。阴虚而生湿热，法当滋阴，以泻湿热，如六味丸加黄柏、知母，此后天之阴阳也。阴虚而阳无所附，法当峻补其阴，以摄伏阳；阳虚而无所倚，法当峻补其阳，以承领其阴；阴阳两虚，则平补而各居其位。此后天之阴阳而并通乎先天之阴阳也。
相火有二，在少阴者，元阳也；在少阳者，生发之气也。皆须阴以养之。咳嗽大半是火来克金，谓之贼邪，故难愈。在实火固可泻，若虚火惟有壮水之主，然壮水岂常人之能事?又岂可以岁月程功?况乎阴虚于下则痰气壅于上，养阴之药又皆阻气留痰，亦未易仓卒取效也。
刘澹庵曰：此是内伤阴虚，火来克金之嗽。若风寒外入，肺邪未出失解者。久之，火亦克金，传变生痰，又在体认明白。
人有至冬寒时苦，足冷夜半，阳气渐生，其冷愈甚，此亦质壮秋冬，夺于所用病之轻者也。其人上焦必多热，盖两肾阴阳抱负，损一分之阴，即脱出一分之阳。既强力入房，夺其收藏之用，阴精纵未全亏，阳气亦难全藏，是以上焦每多热，下焦每多寒。至秋冬三阴气多，三阳气少之时，足为之冷矣。昼当阳气旺，或能入于阴，子后初生之阳，其气尚微，遂不能入于阴，而足愈冷也。比之夏至，一阴生而天气反热，冬至一阳生，而天气反寒，其理一也。矧脱出之阳，与上焦初生之阳，至此时，两阳搏击于胸中，未免痰气溷滞，此又阳不能入于阴之一义也。《内经》寒厥论云：春夏则阳气多而阴气少，秋冬则阴气盛而阳气衰。此人质壮以秋冬夺于所用，下气上争不能复，精气溢下，邪气因从之而上也。人知秋冬夺于所用，谓秋冬夺于收藏之用，但不知收藏何物。岂知收藏者，指此阳气而言也。阳气至此时收藏肾中，正当思培养之计，为来岁生长化之用，奈何恃其质壮而以入房，遂夺此收藏之用，于是下焦之阳衰矣。衰则求救于上焦之阳，原赖于下焦之阳为之根，今下焦潜藏之阳既衰，而上焦之阳安能复也?阳不能持其阴精，而精气溢下，上下之阳俱虚，时令之寒挟下焦之寒从之而上，故寒厥耳。后人谓夺于所用是精竭于下，上争而求救于母气，肾所去者太过，肺所生者不及，故不能复，如此言则是阴虚之证不当见为寒厥，与阳气衰于下则为寒厥，及阳气衰不能渗营，其经络之旨大相背戾，此盖随文顺释之弊，后学无可适从耳。
肾虚水泛为痰，谓肾中阳虚也，阳虚故水泛溢。若阴虚则是有升无降，咳唾痰涎，二者相去径庭，治法迥别。
火之所以沉伏者，多本于阴虚，无以堵御。经谓：阴脉不足阳往乘之也。故养得一分之阴，即能托出一分之火。如疟疾邪微，正复将欲愈者，口舌反生疮。又伤寒口渴为欲愈是矣。
丹溪阴不足之论，诚为精确，是则当养阴矣。然道家又言纯阳，又是喜阳而恶阴，不知阴阳不可偏胜，亦不可偏负。其相得无间便是真气元气，即生气也。人生动作不衰，皆赖此阳气，然养此阳气，又全赖此阴气，如鱼之有水。所以阴在内，阳之守也。然阴气匮乏一分，则阳气脱出一分，阴气全绝，则孤阳飞越而去矣。善摄生者，外邪不侵，内情不动，茹淡，远则火不作而阴全，阴全则阳气相抱，四肢百骸皆阳气充乎其间，故曰纯阳。苟不知此理，而一味养阳以求生，经曰：有阳无阴，谓之厥阳。厥阳可生乎?
疟之寒热，当知三者之别，一因有形之积留于中焦。夫中焦之气主行营卫者也，为有形所阻，则营卫不能受气而虚，卫虚则恶寒，营虚则发热也。再则因暑邪为阴寒所束，在半表半里之间，一旦发动，薄阴则阴实而阳虐，薄阳则阳实而阴虚，阴虚则发热，阳虚则恶寒也。其三则因气血两靡，气虚则恶寒，血虚则发热也。凡病见寒热，总不越此三者。
张汉瓿曰；气血虚恶寒发热说，在疟之寒热条下宜分别。气不足则中焦之气断续而不行，凝结而为胀满痞塞。血不足则不能吸阳气于下，中焦之气亦断续而不行，凝结而为胀满痞塞于此。但当诊其脉症，察阴虚阳虚而补益之，一切破气消导之药不可用也。夫四肢百骸皆受气于胸中，气血虚则周身浮肿，亦如中焦之气断续不行，留结而为胀满痞塞也。于此亦当审其气虚血虚而补益之，浮肿自消，一切消肿利水之药不可用也。
明知逆顺正行无间
呕衄血不止有当下之者，人皆知血出下窍为顺，故其法应施于妄逆之际也。不知血之妄逆皆因于火，治火必用苦寒，苦寒之药能令血凝不流，血不流则气逆呕逆岂能止乎？纵使得药而止，瘀血之患作矣。所以用苦寒下之，俾火降而瘀血不留，斯一举而两得也。
刘澹庵曰：呕衄用苦寒下之，是逐瘀血也。然不若慎用苦寒，无使血瘀不愈于下之乎？
推本阴阳
表之阳附于津液，大汗亡津液，故曰亡阳。里之阳附于肾水，房劳损阴精，故曰脱阳，不然，津液与精皆阴类，何以阳名？
温疟、风温，悉是冬不藏精之人，其寒直中少阴，至春因温而发病。虽有轻重之不同，而致病之由则一也。《内经》、仲景未详其治而但有其论，后人因其论而仿佛其治，总不外甘寒以救肾，辛凉以祛温，独不思肾虚者，肾中之元阴元阳虚也。此法施之于阴虚之人则可，施之于阳虚之人其可乎？不但知冬不藏精，谓之阴虚，不思阴既虚矣，阳岂能安其位乎？况两肾之中，一点真阳，每曰守邪之神，风寒真中少阴，多由神不能守，此等又可以前法治乎？安得起仲景于九原而细商至当不易之理也？
老人阴虚者，十常八九，阳虚者，百无一二，天地古今之理亦然。试观古人敦厚和平，阴之体也，今人尖锐躁急，阳之体也，世道渐漓，亦指此敦厚和平之阴气渐漓耳。审此则古方治今病断有不可执者，至论进阳退阴，进君子退小人，若《易》之喜复而恶剥，此阳盖指生发之气，阳指肃杀之气，又非谓人身日用消长之阴阳也。
刘澹庵曰：老人阴虚者固有，阴虚者更多，有服参芪附桂，而人不容已，始长年而安保者，则何故耶？是说当论活些，勿执。
寒热，人身中之阴阳耳，治则为阴阳，乖则为寒热。
卫属阳，其气慓悍，故行速；营属阴，其气静翕，故行迟。疟邪之间一日及连二日发者，邪之着于营也，人周天之数，日行过之，月行不及，亦是阴阳迟速之分耳。
生我者非他，五运之气也；死我者非他，亦五运之气也。故有五脏即具五行，及邪之所凑，或真气本虚，或他脏薄乘，则各呈其象而为病，以脉言之，如真脏脉见，即与之决死期。
烧针益阳损阴，今时阴气渐漓，尽从火化，故烧针一法，多不效。非无其传也，时世异也。即岐伯生于今之时，亦当舍烧针而从事汤液矣。治病有失之浅者，见病治病是也。有生之深者，诛伐无过是也。推本阴阳，万举为当。
食养尽之，毋使过之，伤其正也
弦数者，风发也。以饮食消息止之，深得勿药之理。
神气相得，则生化之机不息。故养生家不能无为，而又不可使之有为，此便是天地无心而成化，圣人有心而无为之理。昧者为情欲所牵制而疾病生，所谓吉凶悔吝生乎动也。此岂可以针砭药饵治哉!反观自养可耳。
要知邪气，即吾身中之正气，治则为正气，不治则为邪气，方知养正积自除之说不谬。
不澄其源而欲其流之清，不去其薪而欲其汤之不沸，不断厚味而欲其积之可消，此不可得之数也。
病之始起也，可刺而已。其盛可待衰而已。望其文而不知其义，知其义而不详其法，皆不之以言治。请试论之。病之始起不过由于真气失守，邪气乘之。邪气者，内伤外感是矣。其初只是客病，不妨攻之使去，故曰可刺而已。久则正虚而生邪热，既不能补，复不可攻，慑生者，此时当使之慎起居，俾阴精日生，热退则余邪自退，此不治之治，故曰可待衰而已。示病者医者不识待之理与待衰之法，一则躁急以求治，一则杂药以妄投，不死于病而死于医者，踵相接也。
贫瘘之人得剧病，多有不服药而自愈者，以其无服药之力，且无治邪之味也。医家以兵法治病，文清野千里，是广服大药。予谓不然。贵在断厚味，使邪无所助而自退，又不战而屈人兵之法也。
丹溪茹淡论最得调摄之法，然阴之所生，本在五味，一味茹淡，亦恐阴气不生。予谓甘肥之味，要在淡煮，使不生痰助火，至于蔬菜，不妨加以盐豉，益其味也。
张汉瓿曰：精不足者，补之以味。断厚味在看何病宜，何当忌则是。如肿胀食盐助邪，可类推矣。若一意教人淡食，则恐胃气日惫，精神顿消，而不可回者矣。若肥昧淡煮，可谓得情。
微妙在脉不可不察
《内经》曰：血虚脉大。然气虚亦有脉大者。盖血虚气无所附故脉大；气虚则邪火甚，故脉亦大，此种经旨皆有，但未尝明白指示，此道之所以常不明耳。
脉细小之类，为正气不足，洪大之类，为邪气有余。正气不足而见细小之脉，可补而愈也，邪气有余而见洪大之脉，可泻而愈也。唯是正气不足而脉反洪大，邪气有余而脉反细小，一则正虚邪胜一则邪胜正虚，故皆不治。诊者先知此种大意，则不难迎刃而解。问病然后察脉，以病合脉，其脉得，其病亦得。若以脉求病，则二十四脉每部各有寒热虚实证候纷纠，何能一按了然?譬如浮脉，浮而有力为风；浮而无力为虚似矣，然中风脉浮而缓，缓之与无力相去几何?譬之沉脉，沉而有力为实，沉而无力为虚似矣，然中寒脉沉而微细，微细之与无力相去几何?又如弦脉，邪在少阳则脉弦，血虚脉弦，风家脉弦，支饮脉弦，苟不问其人之壮怯，及表里阴阳，有何痛苦，所谓猝持寸口，何病能中?况噤之以声息，蔽之以帷幄，此非窘医，实自贻其咎耳。脉如车盖，如羹上浮．是阳气将绝也。如屋漏，如泻漆，是阴气将绝也。亦自本乎天者亲上，本乎地者亲下之义。
阳虚体质的人容易感受寒邪，阴虚体质的人容易感受热邪。这是因为体内正气不足，感召了外界邪气的有余，这符合“水流向潮湿处，火趋向干燥处”的道理，也是因为缺乏抵御外邪的能力。然而，也有阴虚而患寒证、阳虚而患热证的情况，这种邪气是因为正气虚弱而招致的，并不一定是同类的邪气才会相互感召。治疗热证时担心耗伤阳气，治疗寒证时忧虑耗伤阴液，这是最难处理的。
阴虚通常只表现为发热，不应有恶寒，但有时也会出现恶寒，这是因为热势亢盛，反而兼有了克制它的那一行的气化特点（即热极似寒）。气虚通常只表现为恶寒，不应有发热，但有时也会出现发热，这是因为火邪与元气不能共存（火旺则元气衰）。
小便黄赤，多主热证。医经又说：肺气虚则肩背疼痛怕冷，气短不足以呼吸，尿液颜色改变。还有冬季脉象不及（弱），使人腰部清冷脊痛，尿液颜色改变。这两条经文讲的是肺肾虚寒导致小便颜色改变，为什么虚实寒热相差悬殊，但病症却相同呢？对此必须明白，肺虚则不能通调水道，肾虚则关门不利，都能郁结而生热，热则导致尿液颜色改变，所以虽然都表现为小便变色，但有虚实之分。这也是不可不知的“从治”方法（顺从病性而治的方法）。
张汉瓿说：小便赤变中有因中寒引起的，这种情况在虚损体质的老人中很常见。关于溺色变，热证是一般的解释，这里不再赘述。
必须潜伏其主导的病机，并先探究其病因。
丹毒和发斑，致病原因有表里之不同。丹毒是由于感触了时行不正之气，滞留在营卫之间；发斑则是由于阳明经瘀热发于肌肉。两者虽然都适宜清热，但在治疗丹毒时不可不加用解散之法，在治疗发斑时又不可不顾及患者的正气虚弱，因为发斑也有导致亡阳于外的情况，如朱丹溪所治疗的完颜小将军就是例子。另外，丹疹随出随没，属于阴虚而虚火游走所致。还有身体瘙痒出现瘾疹，有的因风湿引起，有的因痰湿引起。
风邪伤害卫气，卫气受伤则不能固护津液，所以导致自汗。这种说法深得使用桂枝汤的要旨。表实则里虚，这一句话人们往往潦草地看过，而不求其所以然。其实营卫之气受气于胸中，脏腑也依赖营卫的输布。现在营卫受邪而实证，就失去了转输的功能，从而导致里虚。这也是医道中浅显而容易被忽视的地方。
张永孚说：营卫受邪而实，应当说是卫受邪而实，这样营气失去卫气的保护而导致里虚。否则，“表实里虚”这句话终究不够明确。
病情有大相径庭，但其道理相同的。例如肺痿与痿蹙、肺痈与痹病，病名不同。但它们一个基于阴虚，一个基于阳实，其道理是相同的，所以学者不可不知道类比推理。
人体中三阳经护卫于外，三阴经守持于内，原本没有胜负之分。只是阳气喜欢舒展而厌恶郁结，郁结则生热，七情六淫都能导致郁结。另外，天气化生阳气，厚味助长火气，劳倦使阳和之气动荡化为火，这样火与热在身体中搏击，难免损伤阴液。阴伤则阳旺，阳旺则阴更伤，以至偏胜偏虚。所以朱丹溪提出“阳常有余，阴常不足”的理论，世人读他的话不精求其义，难怪会有盲目附和之声。
太阴、厥阴无热而少阴反有热的原因，是因为少阴与太阳互为表里，少阴经也是里中之表，加上少阴藏真阳，这两个因素共同导致了少阴反有热的情况。看麻黄附子细辛汤的运用就可以概见一斑。
胃偏于阳则消谷善饥。又说：邪热不杀谷。所谓消谷是胃阳外露的表现，不杀谷则是邪热所致。
《伤寒论》、《金匮要略》难道每证都经过验证后才写进书里吗？不过是根据正气与邪气相搏击在哪一经，又是哪种邪气见证，从而确立法则，论述道理罢了。但这并非杜撰，后人若能将这些道理明白于心，有何困难？由此及彼，前贤的议论真是得鱼忘筌的工具啊。另外，《要略》是举其要点而言，扩充在于个人。
燥气至极而出现口噤、易惊、频繁呵欠，是因为木气被金气囚困而不能舒展。妇人脏躁喜欢悲伤，也是这个意思。
寒之而热者取之阴，热之而寒者取之阳，各求其根本所属。
当天地阴阳不交之时，阳气独治于上，没有阴气来覆盖它；阴气独治于下，填补九窍之源。此时应当在阳药中加入收敛降下的药物，使阳气归于阴；在阴药中加入升腾生发的药物，使阴气加于阳。
过用阴精导致阴脱于下，暴喜损伤阳气导致阳脱于上，则分别补益其阴阳。如果有亡阴而阳脱于上，亡阳而阴脱于下，则脱阴者应当补其阳，脱阳者应当补其阴。
阴虚阳亢，治法应当益水，或加细生甘草以泻火，这是先天之阴阳。阴虚而生湿热，治法应当滋阴以泻湿热，如六味丸加黄柏、知母，这是后天之阴阳。阴虚而阳无所依附，治法应当峻补其阴以摄伏阳；阳虚而无所倚靠，治法应当峻补其阳以承领其阴；阴阳两虚，则平补而各居其位。这是后天之阴阳而贯通先天之阴阳。
相火有两种，在少阴的是元阳，在少阳的是生发之气。都需要阴来滋养。咳嗽大半是火来克金，称为贼邪，所以难愈。对于实火固然可以泻，若为虚火只有壮水之主（滋补肾阴），然而壮水难道是普通人能轻易做到的事吗？又岂能以岁月来计算功效？况且阴虚于下则痰气壅塞于上，养阴的药物又都阻碍气机留滞痰湿，也不容易仓促见效。
刘澹庵说：这是内伤阴虚，火来克金的咳嗽。若是风寒外入，肺邪未出失解者，久之火亦克金，传变生痰，又需要在体认上明白。
有人到了冬天寒冷时感到痛苦，足冷夜半，阳气渐生，其冷愈甚，这也是体质强壮者在秋冬季节过度使用精力导致的轻症。这种人上焦必多热，盖因两肾阴阳抱负，损一分之阴，即脱出一分之阳。既然强力入房，夺其收藏之用，阴精纵然未全亏，阳气也难全藏，所以上焦每多热，下焦每多寒。至秋冬三阴气多，三阳气少之时，足为之冷矣。昼当阳气旺，或能入于阴，子后初生之阳，其气尚微，遂不能入于阴，而足愈冷也。比之夏至，一阴生而天气反热，冬至一阳生，而天气反寒，其理一也。矧脱出之阳，与上焦初生之阳，至此时，两阳搏击于胸中，未免痰气溷滞，此又阳不能入于阴之一义也。《内经》寒厥论云：春夏则阳气多而阴气少，秋冬则阴气盛而阳气衰。此人质壮以秋冬夺于所用，下气上争不能复，精气溢下，邪气因从之而上也。人知秋冬夺于所用，谓秋冬夺于收藏之用，但不知收藏何物。岂知收藏者，指此阳气而言也。阳气至此时收藏肾中，正当思培养之计，为来岁生长化之用，奈何恃其质壮而以入房，遂夺此收藏之用，于是下焦之阳衰矣。衰则求救于上焦之阳，原赖于下焦之阳为之根，今下焦潜藏之阳既衰，而上焦之阳安能复也?阳不能持其阴精，而精气溢下，上下之阳俱虚，时令之寒挟下焦之寒从之而上，故寒厥耳。后人谓夺于所用是精竭于下，上争而求救于母气，肾所去者太过，肺所生者不及，故不能复，如此言则是阴虚之证不当见为寒厥，与阳气衰于下则为寒厥，及阳气衰不能渗营，其经络之旨大相背戾，此盖随文顺释之弊，后学无可适从耳。
肾虚水泛为痰，是指肾中阳虚，阳虚故水泛溢。若阴虚则是有升无降，咳唾痰涎，二者相去径庭，治法迥别。
火之所以沉伏者，多本于阴虚，无以堵御。经谓：阴脉不足阳往乘之也。故养得一分之阴，即能托出一分之火。如疟疾邪微，正复将欲愈者，口舌反生疮。又伤寒口渴为欲愈是矣。
丹溪阴不足之论，诚为精确，是则当养阴矣。然道家又言纯阳，又是喜阳而恶阴，不知阴阳不可偏胜，亦不可偏负。其相得无间便是真气元气，即生气也。人生动作不衰，皆赖此阳气，然养此阳气，又全赖此阴气，如鱼之有水。所以阴在内，阳之守也。然阴气匮乏一分，则阳气脱出一分，阴气全绝，则孤阳飞越而去矣。善摄生者，外邪不侵，内情不动，茹淡，远则火不作而阴全，阴全则阳气相抱，四肢百骸皆阳气充乎其间，故曰纯阳。苟不知此理，而一味养阳以求生，经曰：有阳无阴，谓之厥阳。厥阳可生乎?
疟之寒热，当知三者之别，一因有形之积留于中焦。夫中焦之气主行营卫者也，为有形所阻，则营卫不能受气而虚，卫虚则恶寒，营虚则发热也。再则因暑邪为阴寒所束，在半表半里之间，一旦发动，薄阴则阴实而阳虐，薄阳则阳实而阴虚，阴虚则发热，阳虚则恶寒也。其三则因气血两靡，气虚则恶寒，血虚则发热也。凡病见寒热，总不越此三者。
张汉瓿曰；气血虚恶寒发热说，在疟之寒热条下宜分别。气不足则中焦之气断续而不行，凝结而为胀满痞塞。血不足则不能吸阳气于下，中焦之气亦断续而不行，凝结而为胀满痞塞于此。但当诊其脉症，察阴虚阳虚而补益之，一切破气消导之药不可用也。夫四肢百骸皆受气于胸中，气血虚则周身浮肿，亦如中焦之气断续不行，留结而为胀满痞塞也。于此亦当审其气虚血虚而补益之，浮肿自消，一切消肿利水之药不可用也。
明知逆顺正行无间
呕衄血不止有当下之者，人皆知血出下窍为顺，故其法应施于妄逆之际也。不知血之妄逆皆因于火，治火必用苦寒，苦寒之药能令血凝不流，血不流则气逆呕逆岂能止乎？纵使得药而止，瘀血之患作矣。所以用苦寒下之，俾火降而瘀血不留，斯一举而两得也。
刘澹庵曰：呕衄用苦寒下之，是逐瘀血也。然不若慎用苦寒，无使血瘀不愈于下之乎？
推本阴阳
表之阳附于津液，大汗亡津液，故曰亡阳。里之阳附于肾水，房劳损阴精，故曰脱阳，不然，津液与精皆阴类，何以阳名？
温疟、风温，悉是冬不藏精之人，其寒直中少阴，至春因温而发病。虽有轻重之不同，而致病之由则一也。《内经》、仲景未详其治而但有其论，后人因其论而仿佛其治，总不外甘寒以救肾，辛凉以祛温，独不思肾虚者，肾中之元阴元阳虚也。此法施之于阴虚之人则可，施之于阳虚之人其可乎？不但知冬不藏精，谓之阴虚，不思阴既虚矣，阳岂能安其位乎？况两肾之中，一点真阳，每曰守邪之神，风寒真中少阴，多由神不能守，此等又可以前法治乎？安得起仲景于九原而细商至当不易之理也？
老人阴虚者，十常八九，阳虚者，百无一二，天地古今之理亦然。试观古人敦厚和平，阴之体也，今人尖锐躁急，阳之体也，世道渐漓，亦指此敦厚和平之阴气渐漓耳。审此则古方治今病断有不可执者，至论进阳退阴，进君子退小人，若《易》之喜复而恶剥，此阳盖指生发之气，阳指肃杀之气，又非谓人身日用消长之阴阳也。
刘澹庵曰：老人阴虚者固有，阴虚者更多，有服参芪附桂，而人不容已，始长年而安保者，则何故耶？是说当论活些，勿执。
寒热，人身中之阴阳耳，治则为阴阳，乖则为寒热。
卫属阳，其气慓悍，故行速；营属阴，其气静翕，故行迟。疟邪之间一日及连二日发者，邪之着于营也，人周天之数，日行过之，月行不及，亦是阴阳迟速之分耳。
生我者非他，五运之气也；死我者非他，亦五运之气也。故有五脏即具五行，及邪之所凑，或真气本虚，或他脏薄乘，则各呈其象而为病，以脉言之，如真脏脉见，即与之决死期。
烧针益阳损阴，今时阴气渐漓，尽从火化，故烧针一法，多不效。非无其传也，时世异也。即岐伯生于今之时，亦当舍烧针而从事汤液矣。治病有失之浅者，见病治病是也。有生之深者，诛伐无过是也。推本阴阳，万举为当。
食养尽之，毋使过之，伤其正也
弦数者，风发也。以饮食消息止之，深得勿药之理。
神气相得，则生化之机不息。故养生家不能无为，而又不可使之有为，此便是天地无心而成化，圣人有心而无为之理。昧者为情欲所牵制而疾病生，所谓吉凶悔吝生乎动也。此岂可以针砭药饵治哉!反观自养可耳。
要知邪气，即吾身中之正气，治则为正气，不治则为邪气，方知养正积自除之说不谬。
不澄其源而欲其流之清，不去其薪而欲其汤之不沸，不断厚味而欲其积之可消，此不可得之数也。
病之始起也，可刺而已。其盛可待衰而已。望其文而不知其义，知其义而不详其法，皆不之以言治。请试论之。病之始起不过由于真气失守，邪气乘之。邪气者，内伤外感是矣。其初只是客病，不妨攻之使去，故曰可刺而已。久则正虚而生邪热，既不能补，复不可攻，慑生者，此时当使之慎起居，俾阴精日生，热退则余邪自退，此不治之治，故曰可待衰而已。示病者医者不识待之理与待衰之法，一则躁急以求治，一则杂药以妄投，不死于病而死于医者，踵相接也。
贫瘘之人得剧病，多有不服药而自愈者，以其无服药之力，且无治邪之味也。医家以兵法治病，文清野千里，是广服大药。予谓不然。贵在断厚味，使邪无所助而自退，又不战而屈人兵之法也。
丹溪茹淡论最得调摄之法，然阴之所生，本在五味，一味茹淡，亦恐阴气不生。予谓甘肥之味，要在淡煮，使不生痰助火，至于蔬菜，不妨加以盐豉，益其味也。
张汉瓿曰：精不足者，补之以味。断厚味在看何病宜，何当忌则是。如肿胀食盐助邪，可类推矣。若一意教人淡食，则恐胃气日惫，精神顿消，而不可回者矣。若肥昧淡煮，可谓得情。
微妙在脉不可不察
《内经》曰：血虚脉大。然气虚亦有脉大者。盖血虚气无所附故脉大；气虚则邪火甚，故脉亦大，此种经旨皆有，但未尝明白指示，此道之所以常不明耳。
脉细小之类，为正气不足，洪大之类，为邪气有余。正气不足而见细小之脉，可补而愈也，邪气有余而见洪大之脉，可泻而愈也。唯是正气不足而脉反洪大，邪气有余而脉反细小，一则正虚邪胜一则邪胜正虚，故皆不治。诊者先知此种大意，则不难迎刃而解。问病然后察脉，以病合脉，其脉得，其病亦得。若以脉求病，则二十四脉每部各有寒热虚实证候纷纠，何能一按了然?譬如浮脉，浮而有力为风；浮而无力为虚似矣，然中风脉浮而缓，缓之与无力相去几何?譬之沉脉，沉而有力为实，沉而无力为虚似矣，然中寒脉沉而微细，微细之与无力相去几何?又如弦脉，邪在少阳则脉弦，血虚脉弦，风家脉弦，支饮脉弦，苟不问其人之壮怯，及表里阴阳，有何痛苦，所谓猝持寸口，何病能中?况噤之以声息，蔽之以帷幄，此非窘医，实自贻其咎耳。脉如车盖，如羹上浮．是阳气将绝也。如屋漏，如泻漆，是阴气将绝也。亦自本乎天者亲上，本乎地者亲下之义。
Yang deficiency makes one susceptible to cold pathogens, while yin deficiency makes one susceptible to heat pathogens. This is because the insufficiency within the body attracts the excess of external pathogens, which follows the principle that "water flows to dampness and fire tends to dryness," and also due to the lack of ability to resist external pathogens. However, there are cases where yin deficiency presents with cold syndromes and yang deficiency presents with heat syndromes; these pathogens are attracted due to weakness and do not necessarily need to be of the same nature to interact. Treating heat requires caution against damaging yang, and treating cold requires worry about damaging yin, making it the most difficult to manage.
Yin deficiency typically manifests only as fever, without aversion to cold, but sometimes aversion to cold occurs; this is because excessive heat may assume the transformation characteristics of the element that controls it (i.e., extreme heat mimicking cold). Qi deficiency typically manifests only as aversion to cold, without fever, but sometimes fever occurs; this is because fire and primordial qi cannot coexist (when fire is strong, primordial qi declines).
Yellow or reddish urine mostly indicates heat syndromes. The classics also state: "When lung qi is deficient, there is pain in the shoulder and back with cold sensation, shortness of breath, and a change in urine color." Also, when the winter pulse is insufficient (weak), it causes coldness in the lower back and spine, and a change in urine color. These two passages discuss how kidney and lung deficiency-cold lead to changes in urine color. Why do deficiency-excess and cold-heat differ so greatly, yet the symptoms are similar? One must understand that lung deficiency fails to regulate water passages, and kidney deficiency fails to control the opening and closing of the gates, both leading to stagnation and generating heat. Heat causes changes in urine color. Thus, although both present with changed urine color, there are differences between deficiency and excess. This is also a method of "following treatment" (treating according to the nature of the disease) that must be known.
Zhang Hanbu said: Among cases of red urine, some are caused by middle-jiao cold, which is common in elderly patients with deficiency constitutions. Regarding changes in urine color, the heat explanation is general and will not be elaborated here.
One must subdue the dominant pathogenic factor and address its cause first.
Erysipelas (Dan Du) and macules (Ban) have different etiologies involving exterior and interior. Erysipelas results from contracting epidemic abnormal qi, which stagnates in the Ying and Wei levels. Macules arise from stasis-heat in the Yangming channel manifesting in the muscles. Although both are suitable for clearing heat, treating erysipelas requires dispersing methods, while treating macules requires considering the patient's deficiency. Macules can also lead to loss of yang on the exterior, as seen in the case treated by Zhu Danxi involving General Wanyan. Additionally, papules that appear and disappear quickly belong to yin deficiency with wandering deficient fire. Itching and hives (Yin Zhen) may be caused by wind-dampness or phlegm.
Wind damages the Wei (Defensive) qi. When Wei qi is damaged, it cannot secure body fluids, leading to spontaneous sweating. This understanding deeply grasps the essence of using Guizhi Tang (Cinnamon Twig Decoction). "Exterior excess leads to interior deficiency" is a phrase often skimmed over without seeking its rationale. Ying and Wei qi derive their energy from the chest, and the zang-fu organs rely on the transport functions of Ying and Wei. Now, if Ying and Wei are affected by pathogens and become excess, they lose their transport function, leading to interior deficiency. This is a shallow aspect of medical theory easily overlooked.
Zhang Yongfu said: "Ying and Wei affected by pathogens and becoming excess" should be stated as "Wei affected by pathogens and becoming excess." In this way, Ying loses the protection of Wei, leading to interior deficiency. Otherwise, the phrase "exterior excess, interior deficiency" remains unclear.
Diseases may seem vastly different but share the same underlying principles. For example, Lung Flaccidity (Fei Wei) differs from Limb Atrophy (Wai Qu), and Lung Abscess (Fei Yong) differs from Bi Syndrome (Bi Bing). However, one is based on yin deficiency and the other on yang excess; their principles are the same. Therefore, scholars must know how to use analogical reasoning.
The three Yang channels guard the exterior, and the three Yin channels guard the interior; originally, there is no superiority or inferiority. However, yang qi likes expansion and dislikes stagnation. Stagnation generates heat, and the seven emotions and six exogenous factors can all cause stagnation. Furthermore, weather generates yang, rich foods assist fire, and fatigue disturbs the harmonious movement of yang, transforming into fire. Thus, fire and heat battle within the body, inevitably injuring yin. When yin is injured, yang becomes hyperactive; when yang is hyperactive, yin is further injured, leading to imbalance and deficiency. Hence, Zhu Danxi proposed the theory of "Yang is often in excess, Yin is often deficient." People who read his words without seeking their true meaning deserve criticism for blind following.
Taiyin and Jueyin channels typically do not present with heat, whereas Shaoyin does. This is because Shaoyin is paired with Taiyang as exterior-interior, and Shaoyin is the "exterior of the interior." Additionally, Shaoyin stores True Yang. These two factors contribute to Shaoyin presenting with heat. This can be inferred from the use of Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction).
Stomach bias towards yang leads to easy digestion and frequent hunger. It is also said: "Pathogenic heat fails to digest food." Digestion refers to the exposure of stomach yang, while failure to digest refers to pathogenic heat.
Did *Shanghan Lun* (Treatise on Cold Damage) and *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) record every verified case? No, they merely established principles based on where righteous qi battles pathogenic qi, which channel is involved, and what the manifestations are, discussing the rationale. This is not fabrication. If later generations understand these principles clearly, it is not difficult. These discussions by sages are tools to grasp the essence. *Yaolue* highlights key points; expanding upon them depends on the individual.
Extreme dryness causes lockjaw, fright, and frequent yawning because Wood is imprisoned by Metal and cannot expand. Uterine dryness in women causing sadness shares this meaning.
If cooling measures fail to resolve heat, treat the yin; if warming measures fail to resolve cold, treat the yang. Seek the root affiliation.
When heaven and earth do not interact, yang dominates above without yin to cover it; yin dominates below, filling the origins of the nine orifices. In this case, add astringent and descending agents to yang herbs to return yang to yin, and add ascending and generating agents to yin herbs to allow yin to join yang.
Overuse of yin essences leads to yin collapse below; sudden joy damages yang, leading to yang collapse above. In such cases, tonify yin and yang respectively. If there is loss of yin with yang collapsing above, or loss of yang with yin collapsing below, then for yin collapse, tonify yang; for yang collapse, tonify yin.
For yin deficiency with yang hyperactivity, the method is to nourish water (kidney yin), possibly adding raw Gancao (Licorice Root) to clear fire. This concerns congenital yin and yang. For yin deficiency generating damp-heat, the method is to nourish yin to drain damp-heat, such as Liuwei Wan (Six-Ingredient Pill) plus Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome). This concerns acquired yin and yang. For yin deficiency with yang having no attachment, severely tonify yin to anchor yang; for yang deficiency with no support, severely tonify yang to guide yin; for dual yin-yang deficiency, gently tonify both to restore their positions. This integrates acquired yin-yang with congenital yin-yang.
Xianghuo (Ministerial Fire) has two types: in Shaoyin, it is Yuan Yang (Primordial Yang); in Shaoyang, it is Shengfa Qi (Generating Qi). Both require yin to nourish them. Most coughs are caused by fire overcoming metal, called "robber pathogen," making them hard to cure. While excess fire can be drained, deficient fire requires strengthening the master of water (nourishing kidney yin). However, is strengthening water an easy task for ordinary people? Can it be achieved quickly? Moreover, yin deficiency below leads to phlegm-qiu stagnation above, and yin-nourishing drugs often obstruct qi and retain phlegm, making rapid effects difficult.
Liu Dan'an said: This is a cough due to internal injury yin deficiency, where fire overcomes metal. If wind-cold enters externally and lung pathogens are not resolved, over time fire also overcomes metal, transmitting and generating phlegm. This requires clear recognition.
Some suffer from cold feet at midnight during winter. As yang qi begins to generate, the cold feels worse. This is a mild illness in robust individuals who overexert themselves in autumn and winter. Such people usually have much heat in the upper jiao. Because the two kidneys embrace yin and yang, losing one part of yin releases one part of yang. After strenuous sexual activity, depleting the storage function, even if yin essence is not fully depleted, yang qi cannot be fully stored. Thus, the upper jiao often has heat, and the lower jiao often has cold. During autumn and winter, when yin qi is abundant and yang qi is scarce, the feet become cold. During the day, when yang qi is strong, it may enter yin. But after midnight, the newly generated yang qi is weak and cannot enter yin, making the feet colder. This is similar to summer solstice, where one yin is born but the weather is hot, and winter solstice, where one yang is born but the weather is cold; the principle is the same. Furthermore, the released yang and the newly generated yang in the upper jiao battle in the chest, causing phlegm and qi stagnation. This is another meaning of "yang failing to enter yin." The *Neijing* states in the Cold Jue chapter: "In spring and summer, yang qi is abundant and yin qi is scarce; in autumn and winter, yin qi is prosperous and yang qi declines." This person is robust but overexerts in autumn and winter. Lower qi struggles upward and cannot recover; essence overflows downward, and pathogenic qi follows upward. People know that overexertion in autumn and winter depletes the storage function, but do not know what is being stored. Storage refers to this yang qi. When yang qi reaches this time, it stores in the kidney, and one should plan for cultivation for next year's growth. How can one rely on robust constitution and engage in sex, thereby depleting this storage function? Thus, lower jiao yang declines. Declining, it seeks help from upper jiao yang. Originally relying on lower jiao yang as its root, now that hidden lower jiao yang is weak, how can upper jiao yang recover? Yang cannot hold yin essence, causing essence to overflow downward. Upper and lower yang are both deficient. Seasonal cold combines with lower jiao cold and rises upward, causing Cold Jue. Later commentators say "overexertion" means essence depletion below, with upper struggle seeking help from mother qi, kidney loss too great, lung generation insufficient, hence inability to recover. Such statements imply that yin deficiency syndromes should not present as Cold Jue, contradicting the principle that yang decline below causes Cold Jue and yang decline failing to nourish meridians. This error stems from literal interpretation, leaving students confused.
Kidney deficiency leading to water overflowing as phlegm refers to kidney yang deficiency; thus, water overflows. If yin deficiency, there is rising without descending, causing coughing up of saliva and phlegm. These two are vastly different, with distinct treatments.
Fire sinking and hiding mostly stems from yin deficiency, lacking the ability to contain it. The classics state: "When yin pulses are insufficient, yang attacks." Thus, nourishing one part of yin can expel one part of fire. For example, in malaria with weak pathogens and recovering righteousness, ulcers may appear on the mouth and tongue. Similarly, thirst in cold damage indicates recovery.
Zhu Danxi's theory of yin insufficiency is precise, implying yin should be nourished. However, Daoism speaks of pure yang, preferring yang and disliking yin. One must know that yin and yang cannot dominate excessively nor be neglected. Their seamless interaction is True Qi (Primordial Qi), i.e., Life Qi. Human movement and vitality rely on this yang qi, but nourishing it relies entirely on yin qi, like fish needing water. Thus, "yin inside is the guardian of yang." If yin qi lacks one part, yang qi escapes one part. If yin qi is completely exhausted, lone yang flies away. Those good at self-care avoid external pathogens and internal emotional disturbance, eat blandly, keep fire distant so yin remains complete. With complete yin, yang embraces it, filling limbs and bones with yang qi, hence called "pure yang." Ignoring this and solely nourishing yang for longevity contradicts the classic: "Having yang without yin is called Jue Yang." Can Jue Yang survive?
Regarding malaria chills and fever, distinguish three causes: 1. Accumulation of tangible matter in the middle jiao. Middle jiao qi governs Ying and Wei circulation. Obstruction by tangible matter causes Ying and Wei to lack qi and become deficient. Wei deficiency causes aversion to cold; Ying deficiency causes fever. 2. Summerheat pathogen constrained by yin-cold between exterior and interior. Upon activation, attacking yin makes yin excess and yang tyrannical; attacking yang makes yang excess and yin deficient. YIN deficiency causes fever; yang deficiency causes aversion to cold. 3. Exhaustion of both qi and blood. Qi deficiency causes aversion to cold; blood deficiency causes fever. All chills and fevers fall into these three categories.
Zhang Hanbu said: The explanation of qi and blood deficiency causing chills and fever in malaria should be distinguished. Qi insufficiency causes middle jiao qi to intermittently stop flowing, condensing into distension and fullness. Blood insufficiency fails to absorb yang qi from below, causing middle jiao qi to intermittently stop flowing, condensing into distension and fullness. One should diagnose pulse and symptoms, observe yin/yang deficiency, and tonify accordingly. All qi-breaking and digestion-promoting drugs are contraindicated. Limbs and bones receive qi from the chest. Qi and blood deficiency causes generalized edema, similar to middle jiao qi stagnation causing distension. Here, assess qi/blood deficiency and tonify; edema will subside. All diuretic and swelling-reducing drugs are contraindicated.
Clearly knowing reversal and normalcy allows uninterrupted practice.
Persistent vomiting and epistaxis may require purgation. People know bleeding from lower orifices is favorable, so this method applies to rebellious bleeding. However, rebellious bleeding is caused by fire. Treating fire requires bitter-cold herbs, which congeal blood. Congealed blood stops flowing, preventing qi rebellion and stopping vomiting. Even if bleeding stops, blood stasis complications arise. Thus, using bitter-cold purgatives lowers fire and prevents stasis, achieving two goals at once.
Liu Dan'an said: Using bitter-cold purgatives for vomiting/epistaxis removes blood stasis. However, it is better to use bitter-cold cautiously to avoid blood stasis rather than purging.
Tracing back to yin and yang.
Exterior yang attaches to body fluids. Profuse sweating loses fluids, hence called "loss of yang." Interior yang attaches to kidney water. Sexual exhaustion damages yin essence, hence called "collapse of yang." Otherwise, since fluids and essence are yin categories, why name them yang?
Warm Malaria and Wind-Warmth all occur in people who did not store essence in winter. Cold directly strikes Shaoyin, and in spring, warmth triggers disease. Though severity varies, the cause is the same. *Neijing* and Zhang Zhongjing did not detail treatments, only theories. Later generations approximated treatments based on theory, generally using sweet-cold to save kidney and acrid-cool to dispel warmth. Did they not consider that kidney deficiency involves both yuan yin and yuan yang deficiency? This method works for yin deficiency but not yang deficiency. Knowing winter non-storage is yin deficiency, one must ask: if yin is deficient, can yang remain stable? Moreover, the single True Yang in the kidneys is the "God guarding against pathogens." True wind-cold striking Shaoyin often occurs because this God fails to guard. Can such cases be treated with previous methods? How can we revive Zhang Zhongjing to discuss the ultimate truth?
Elderly people are yin deficient 80-90% of the time, and yang deficient only 1-2%. This aligns with natural laws. Ancients were honest and peaceful (yin nature); modern people are sharp and irritable (yang nature). The decline of society reflects the decline of this honest, peaceful yin qi. Understanding this, ancient formulas may not fit modern diseases. Discussions on advancing yang/retracting yin or advancing gentlemen/retracting villains, like the I Ching favoring Fu (Return) and disliking Bo (Peeling), refer to generating vs. destructive qi, not daily physiological yin-yang fluctuation.
Liu Dan'an said: Elderly people are indeed yin deficient, but more so. Some take Ginseng, Astragalus, Aconite, and Cinnamon but cannot endure them, only surviving long-term by doing so. Why? This view should be flexible, not rigid.
Chills and fever are simply yin and yang in the body. Harmonized, they are yin and yang; discordant, they are chills and fever.
Wei belongs to yang; its qi is fierce, so it moves fast. Ying belongs to yin; its qi is quiet, so it moves slow. Malaria pathogens affecting Ying cause intermittent or consecutive day发作. The pathogen adheres to Ying. In a celestial cycle, the sun passes it, the moon falls behind. This is also a division of yin-yang speed.
What generates me is the Five Movements Qi; what destroys me is also the Five Movements Qi. Thus, the five zang organs embody the five elements. When pathogens gather, whether due to original qi deficiency or attack from other zang organs, each presents its image as disease. In terms of pulse, if true zang pulses appear, death can be predicted.
Moxibustion on needles benefits yang but damages yin. Currently, yin qi is declining, transforming into fire. Thus, needle moxibustion is often ineffective. Not because the transmission is lost, but because times have changed. Even if Qibo were born today, he would abandon needle moxibustion for herbal decoctions. Treating disease superficially is treating symptoms only. Treating deeply is punishing the innocent (pathogens without addressing root). Tracing back to yin and yang ensures success.
Dietary care completes treatment; do not exceed limits, lest it damage righteous qi.
Wiry and rapid pulses indicate wind onset. Using dietary adjustments to stop it deeply understands the principle of avoiding medication.
When spirit and qi are harmonious, the mechanism of life continues. Thus, health cultivators cannot be inactive but must not force action. This is the principle of heaven and earth forming transformations without intent, and sages acting with intent but without forcing. Ignorant people are controlled by desires, causing disease. Good fortune, misfortune, regret, and shame arise from movement. How can this be treated with acupuncture or herbs? Self-reflection and nurturing are sufficient.
Know that pathogenic qi is essentially righteous qi within us. Treated, it becomes righteous qi; untreated, it becomes pathogenic qi. Only then do we understand that "nourishing righteousness eliminates accumulation" is not false.
Not clarifying the source but wanting clear flow, removing fuel but wanting boiling to stop, cutting rich food but expecting accumulation to dissolve—these are impossible.
At the beginning of disease, acupuncture suffices. When severe, wait for decline. Reading text without understanding meaning, or knowing meaning without detailed methods, leads to failed treatment. Let us discuss. Disease begins with loss of true qi defense, allowing pathogens to invade. Pathogens include internal injury and external contraction. Initially, it is a guest disease; attacking it to remove it is fine, hence "acupuncture suffices." Over time, righteous qi becomes deficient, generating pathogenic heat. Neither tonification nor attack is suitable. Prudent practitioners should advise careful living to increase yin essence daily. As heat retreats, residual pathogens fade. This is "non-treatment as treatment," hence "wait for decline." Showing patients and doctors the principle and method of waiting is crucial. Impatience leads to seeking quick cures; random medication leads to death not from disease but from doctors.
Poor people with severe illnesses often heal without medicine because they lack the strength to take medicine and the taste to treat pathogens. Doctors treat disease like war, clearing fields for miles, taking large doses of medicine. I disagree. The key is cutting rich food, depriving pathogens of support so they retreat naturally. This is the method of defeating enemies without fighting.
Danxi's theory of eating blandly best fits regulation. However, yin is generated from the five flavors. Eating only blandly may prevent yin generation. I suggest sweet and fatty foods should be boiled blandly to prevent phlegm and fire. Vegetables can have salt and fermented bean added to enhance flavor.
Zhang Hanbu said: "For insufficiency of essence, tonify with flavor." Cutting rich food depends on the disease and contraindications. For example, edema worsens with salt. Teaching everyone to eat blandly may exhaust stomach qi and spirit irrecoverably. Boiling rich foods blandly is appropriate.
Subtlety lies in the pulse; it must not be ignored.
*Neijing* states: "Blood deficiency leads to large pulse." However, qi deficiency can also lead to large pulse. Blood deficiency leaves qi unattached, causing large pulse; qi deficiency allows pathogenic fire to flourish, also causing large pulse. These principles exist in classics but are not explicitly pointed out, leading to confusion in this field.
Small and thin pulses indicate righteous qi deficiency; surging and large pulses indicate pathogenic qi excess. Righteous qi deficiency with small/thin pulse can be cured by tonification; pathogenic qi excess with surging/large pulse can be cured by draining. However, righteous qi deficiency with surging/large pulse, or pathogenic qi excess with small/thin pulse, indicate either righteous deficiency with pathogenic victory or pathogenic victory with righteous deficiency, both untreatable. Diagnosticians must know this general idea to solve problems easily. Ask about disease then examine pulse; match disease with pulse. If pulse matches, disease is identified. If seeking disease from pulse alone, the twenty-four pulses each have complex cold/heat/deficiency/excess patterns, making it impossible to clarify with one touch. For example, floating pulse: floating with force indicates wind; floating without force seems like deficiency. But wind-stroke pulse is floating and slow. What is the difference between slow and without force? Sunken pulse: sunken with force indicates excess; sunken without force seems like deficiency. But cold invasion pulse is sunken, minute, and thin. What is the difference between minute/thin and without force? Wiry pulse: Shaoyang pathogen causes wiry pulse; blood deficiency causes wiry pulse; wind patients have wiry pulse; fluid retention causes wiry pulse. Without asking about robustness, exterior-interior, yin-yang, and suffering, how can holding the cun-kou pulse identify disease? Moreover, silencing breathing and hiding behind curtains distresses the doctor and invites blame. Pulses like a chariot canopy or fat floating on soup indicate impending yang collapse. Pulses like a leaking roof or dripping paint indicate impending yin collapse. This follows the principle that things originating from heaven tend upward, and things from earth tend downward.