积聚腹中有块，无拘左右，痛而始有形，不痛而即无形者，瘕症也（宜活血行气，如当归补血汤，加桂、麦芽）。不痛而亦有形，按之不移者，疒征病也（宜三物厚朴七气汤），有嗳腐，大便极臭，而腹中有块者，宿食积聚也（平胃散加大黄，莪术）。有痰涎不止，腹中累累觉痛，作水声者，痰湿积聚也（宜桂苓术甘汤、理中汤加砂、半）。有小腹硬满，小便不利者，血积聚于下焦也（宜五苓加桃仁、红花）。总之喜揉按者，阴之积聚，由于阳不化阴也（宜温解）。手不可近者，阳之积聚。由于气不活而血壅甚也（宜攻破）。
治积聚亦不出阴、阳两法。
痰饮痰饮者，水湿之别名也。脾无湿不生痰，水道清则饮不作。痰清而不胶者，胃阳不足以行水也（宜温中、理中汤）。痰黄而胶，喜生冷者，火旺而津枯也（宜鸡子黄连汤）。痰白、痰青、痰咸，皆由于阳不足（宜温、宜补）。痰臭、痰吐如丝不断，痰结如砂石者，皆由于阴亏火旺（宜五味子汤养血汤）。《金匮》列五饮之名，亦当熟看。
咳嗽咳而兼发热身疼者，外感也（小青龙、麻黄汤之类）。咳而不发热身痛，饱闷嗳腐臭者，饮食为病也，亦间有发热者（宜平胃散加麦、曲）。咳而身大热，喜极热汤，唇舌青白者，元阳外越，阴气上干清道也（宜吴萸四逆汤）。咳而身如瓮中，欲饮热者，肺为寒痰闭塞也（宜苓桂术甘汤加细辛、干姜、五味子）。咳而口干喜冷饮，二便不利者，肺为火逼也（宜泻白散中加苏叶、桅子）。干咳而无痰者，肺燥血虚也（宜补血汤合黑姜甘草汤，加五味子）。
咳而痰水如泉涌者，脾阳不运也（宜理中加砂、半、吴萸、茯苓）。咳症虽多，总以阴、阳两法辨之即可。
喘喘而发热、身疼者，寒邪闭塞肺窍也（宜麻黄汤倍麻）。喘而不发热、身疼，舌青、二便自利者，元气上腾也（宜潜阳丹）。喘而身大热，面赤如硃，口不渴，唇、舌青、白者，元阳外越也（宜吴萸四逆汤）。
呕吐呕吐水谷，尚欲饮冷者，热隔于中也（宜黄连生姜汤）。呕吐而欲饮极热者，寒隔于中也（宜理中加吴萸）。呕吐身热头痛者，挟外感也（宜桂枝汤倍生姜、加吴萸）。呕吐身大热而无外感，尚欲饮热者，脾阳外越也（宜附子理中加吴萸）。凡吐症发热者多，因吐气机向外，故身亦发热，以身不痛为据。
霍乱腹痛吐、泻交加，而欲饮水者，热隔于中，阻其阴、阳交通之机也（宜五苓加炒枝）。吐、泻交加而欲饮热者，寒隔于中，阻其阴、阳交通之机也（宜理中汤）。
呃逆呃逆来饮水即止者，胃火上冲也（宜大承气汤主之）。呃逆来而欲极热饮者，阴邪上干清道也（宜吴萸四逆汤）。
痢症痢症不拘赤、白，舌黄、脉有神者，燥热为病也（宜大黄木香汤）。
痢症红、白，脉无神而口不渴者，下焦阳衰，不能化下焦之精血也（宜附子理中加小茴、安桂）。痢症红、白，身大热而渴饮极热，或不渴而舌青滑者，元阳外越，而内无阳以化肠胃中之精血也（宜吴萸四逆汤）。若大热、舌黄，饮冷不休，日数十次者，胃热极也（宜白虎汤加柴、葛）。痢疾初起，发热身疼脉浮者，外感也（宜人参败毒散）。
头痛头痛如裂，身无他苦，舌青、不渴，或身大热，或脉劲者，此皆元阳外越，暴脱之候，切忌发散，法宜收纳（宜四逆汤，或潜阳丹）。头痛、身热、颈、背强痛者，风寒袭于太阳也（宜桂枝汤）。六经各有头痛，须按法治之，此不过明其危险者。
耳、目、口、鼻、唇、齿、喉各部肿痛，或发热，或不发热，脉息有神，舌黄、饮冷，二便短赤，精神饮食一切不衰者，气有馀之症也（宜清凉、升解、攻下，如小柴胡、甘桔、白虎、凉膈、导赤之类）。各部肿痛，或发热，或不发热，脉息无神，脉浮大而空，或坚劲如石，唇、口、舌青白，津液满口，喜极热汤，二便自利，间有小便赤者，此皆为气不足之症，虽现肿痛火形，皆为阴盛逼阳之的候。市医往往称为阴虚火旺，而用滋阴降火之药者极多，试问有阴虚火旺，而反见津液满口，唇、舌青滑，脉息无神，二便自利者乎？吾愿天下医生，切切不可见头治头，见肿治肿，凡遇一症，务将阴、阳、虚、实辨清，用药方不错误。
心痛心中气痛，面青、肢冷、舌滑、不渴者，寒邪直犯于心君，由君火衰极也（宜四逆汤）。心中气痛，面赤、舌黄、欲饮冷者，热邪犯于心包也（宜桅子大黄汤）。
胸、腹、胁、背、腰、肘、胯、膝，痛、肿各部肿与痛，而不喜手按者，或发热，或不发热，恶寒喜热，舌黄、便赤、脉息有神，乃为气血壅滞，皆有馀之候（宜活血、行气清凉之品）。各部或肿或痛，而喜手按者，或发热，或不发热，舌青喜热饮，二便清长，脉息无神，人困极者，乃阳衰不能运行，皆为不足之候（宜温中、行气之品）。
二便病二便不利，腹胀、烦躁、舌黄、饮冷，脉息有神者，乃阳邪闭结也（宜清凉分利、攻下之品）。二便不利，腹不满，人安静，口不渴，喜卧，脉息无神，舌青滑者，阴邪闭于下，由阳不足，不能化阴也（宜温补、回阳之品）。
辨认脉法气有馀：所现浮、洪、长、大、实、数、紧之类。（倘病现阴色不合脉，舍脉从病）。
气不足：所现沉、迟、细、微、虚、短、涩之类（倘病现阳色不合脉，舍脉从病）。
辨认诸症法气有馀：所现脉息、声音、面色、饮食、起居，一切有神。
气不足：所现脉息、声音、面色、饮食、起居，一切无神。
辨认疮法气有馀：所现红肿、高凸、痛甚、烦躁，人有神者，痈也。
辨认痘法气有馀：所现痘色紫红，或夹斑疹，顶焦、唇红、便闭之类。
辨认目疾法气有馀：所现红肿、痛胀、眵翳、障雾、赤脉、泪多、烦躁之类。
气不足：所现痛胀不甚，翳雾障膜虽多，不觉大苦之类。
辨色法气有馀：所现色紫红，口唇如硃，烦躁不宁。色不合病，舍色从病。
气不足：所现色滞暗，青白无神，唇口嘿青。病不合色，卒闭须知。
辨舌法气有馀：所现舌黄、干白、紫红、黑黄、纯干黑，烦躁，饮冷。
气不足：所现舌青滑，润黄、黑润、干黑色、或青中带黄，或黄中带白，黑而润，津液满口，其人安静，而喜热饮之类。
辨二便气有馀：所现尿短赤、黄、红、粪鞕、羊矢、极臭、极黄之类。
钦安用药金针
余考究多年，用药有一点真机，与众不同。无论一切上、中、下部诸病，不问男、妇、老、幼，但见舌青，满口津液，脉息无神，其人安静，唇口淡白，口不渴，即渴而喜热饮，二便自利者，即外现大热、身疼、头痛、目肿、口疮，一切诸症，一概不究，用药专在这先天立极真种子上治之，百发百中。若见舌苔干黄，津液枯搞，口渴饮冷，脉息有神，其人烦躁，即身冷如冰，一概不究，专在这先天立极之元阴上求之，百发百中。后列二图，学者细心参究。
寒邪外入图
寒邪外入图说今以一圈白色，喻人身一团正气，黑色喻外入之寒邪。邪犯皮肤第一层，乃太阳所主，病现头项腰背疼痛，发热恶寒，邪既入于皮肤，如盗贼之入墙垣也。看其何处空虚有隙，便得而乘之，故不必拘定一日二日之说，或入于手足之阳明，或入于手足之少阳，或入于手足之太阴，或入于手足之少阴，或入于手足之厥阴。仲景以太阳一经，包括三百九十七法，一百一十三方，论传经，是六步流行之定理，论圆通，是六步之化机，仲景恐人不知贼之去向，故标出六经提纲病情，与夫误汗、误吐、误下、当汗不汗、当下不下、当吐不吐、用药失宜、变逆匡救之道，俱在一百一十三方之中，学者务宜留心，不必执定伤寒邪入如是，须知六客亦如是也。更要明得外邪入内，闭束皮毛气机，遏郁而为身热疼痛，故发汗散邪，为治外邪初入第一要着。苟外邪从阳经而入内，寒邪亦化为热邪，热甚则伤阴，轻浅者，仲景有人参白虎、小柴胡之类以存阴，最重者，仲景有大、小承气之类以救阴。苟外邪从阴经而入内，阴寒混为一家，阴盛则阳衰，轻浅者，仲景有大、小建中、理中之类以扶阳，最重者，仲景有四逆、白通之类以回阳。余谓此即仲景治外邪入内之子午针也。
寒邪内生图
寒邪内生图说今以一圈白色，喻人身一团正气。正气旺者，外寒不入，内寒不生。夫内寒之生，由于内之正气不足，正气不足一分，身内之阴寒便生一分。故经云：气不足便是寒。究不足之原，因房劳过度者，则损肾阳；因饮食不节者，则损脾阳；因用心过度者，则损心阳。阳者气也，阳气损于何处，阴寒便生于何处，积阴日久，元阳便为阴所灭也。
在上者，仲景用桂枝以扶心阳；在中者，仲景用建中、理中以扶脾阳；在下者，仲景用四逆、白通以救肾阳。阳虚日久，不能化生真阴，阴液日亏，积之久久，血枯而虚阳又炽，反为客邪，此真可谓阴虚也，法宜甘寒养阴，切切不可妄用苦寒，故仲景有炙甘草汤、桂枝龙骨牡蛎汤、甘草黑姜汤之法，从阳以引阴，滋阴、化阴。余谓此即仲景治内伤之子午针也。诸书称痨字从火，皆是从损阳一语悟出也，惜乎解理未畅，后学无从下手，遂使由痨症而毙者多多矣。学者务要明得损阳而阴象症形足征者，照上卷阳虚门法治之。损阳不能化阴，阴液枯竭，肌肤枯搞，神气短少，吐痰胶粘，有火形可验者，照仲景炙甘草、龙骨黑姜汤之法治之，阴虚门方，亦可择取。又要识得外邪从阳经入内，以致热伤血者，亦可谓阴虚，若此而论者，是谓之真阴虚。从外而致者，苦寒、清凉、升解俱可治之，若此论者，只宜甘温微寒，从阳养阴以调之，内外之法，至此详矣。余于上卷将阳虚阴虚症形实据列出，乃辨症认症之子午针也；辛甘化阳，苦甘化阴，乃用药之子午针也；气有余便是火，气不足便是寒，乃犹是一元中之子午针也。学者务宜潜心默会，期于明白了然，幸甚幸甚。
附：禳久病不愈，一切怪症奇疮善法小神作祟亦同
凡人家中，最难免者疾病，感之轻浅，医药可愈。设或感之太重，三年两载，医药无功，此等疾病，非前世罪孽冤缠，即今生不知检束，积罪累愆之所致也。为人父，为人子，为人弟，为人兄，为人夫者，急宜反身修德，多行善功，或终身戒食牛犬，或全家斋敬九皇，或买鱼物而放生，或施棺木而修路，方便时行，阴功广积，斋诚涤滤，虔具悔罪祈恩，解厄消灾疏文，先申中宫，次申城隍，次申东岳，当空焚之，或可转危为安。余常以此法教人，应验屡屡，亦可以补医药之不逮处。
积聚是指腹中有肿块，无论位于左侧还是右侧，疼痛时肿块显现，不痛时肿块消失的，称为瘕症（适宜活血行气，如使用当归补血汤，加入桂枝、麦芽）。不痛但仍有肿块，按压时位置不移的，称为疝病（适宜使用三物厚朴七气汤）。伴有嗳气有腐臭味，大便极臭，且腹中有肿块的，是宿食积聚（适宜平胃散加大黄、莪术）。痰涎不止，腹部累累作痛，发出水声的，是痰湿积聚（适宜桂苓术甘汤、理中汤加砂仁、半夏）。小腹硬满，小便不利的，是血积聚在下焦（适宜五苓散加桃仁、红花）。总之，喜欢揉按的，属于阴之积聚，是由于阳气不能化生阴邪所致（适宜温散解结）。手不可触碰的，属于阳之积聚，是由于气机不畅导致血瘀严重所致（适宜攻破消散）。
痰饮：痰饮是水湿的别名。脾脏没有湿气就不会生痰，水道清澈则不会形成饮邪。痰液清稀而不黏稠的，是胃阳不足以运化水液所致（适宜温中，用理中汤）。痰液黄而黏稠，喜欢生冷食物的，是火旺而津液枯竭所致（适宜鸡子黄连汤）。痰白、痰青、痰咸，都是由于阳气不足所致（适宜温补）。痰臭、痰吐如丝不断、痰结如砂石般的，都是由于阴亏火旺所致（适宜五味子汤养血汤）。《金匮要略》列出了五饮的名称，应当熟读。
咳嗽：咳嗽兼有发热、身体疼痛的，是外感所致（用小青龙汤、麻黄汤之类）。咳嗽而不发热身痛，饱闷嗳气有腐臭味的，是饮食致病，也有发热的（适宜平胃散加麦冬、神曲）。咳嗽而身体大热，喜欢喝极热的汤，嘴唇舌头青白的，是元阳外越，阴气上犯清道所致（适宜吴茱萸四逆汤）。咳嗽而身体感觉像被瓮盖住一样，想喝热饮的，是肺被寒痰闭塞所致（适宜苓桂术甘汤加细辛、干姜、五味子）。咳嗽而口干喜欢冷饮，大小便不利的，是肺被火逼迫所致（适宜泻白散中加苏叶、栀子）。干咳而无痰的，是肺燥血虚所致（适宜补血汤合黑姜甘草汤，加五味子）。
咳嗽而痰水像泉水涌出般的，是脾阳不运所致（适宜理中汤加砂仁、半夏、吴茱萸、茯苓）。咳嗽症状虽然多，总以阴阳两法来辨别即可。
喘：气喘而发热、身体疼痛的，是寒邪闭塞肺窍所致（适宜麻黄汤倍用麻黄）。气喘而不发热、身体疼痛，舌色青、大小便自利的，是元气上腾所致（适宜潜阳丹）。气喘而身体大热，面赤如朱砂，口不渴，嘴唇、舌头青白的，是元阳外越所致（适宜吴茱萸四逆汤）。
呕吐：呕吐水谷，还想喝冷水的，是热隔于中焦所致（适宜黄连生姜汤）。呕吐而想喝极热饮品的，是寒隔于中焦所致（适宜理中汤加吴茱萸）。呕吐伴身热头痛的，是挟带外感所致（适宜桂枝汤倍用生姜、加吴茱萸）。呕吐而身体大热却没有外感，还想喝热饮的，是脾阳外越所致（适宜附子理中汤加吴茱萸）。凡是呕吐病症发热的较多，因为呕吐使气机向外，所以身体也发热，以身无疼痛为判断依据。
霍乱：腹痛，吐泻交加，想喝水的，是热隔于中焦，阻碍了阴阳交通的机制（适宜五苓散加炒枝）。吐泻交加而想喝热饮的，是寒隔于中焦，阻碍了阴阳交通的机制（适宜理中汤）。
呃逆：呃逆发作时饮水即停止的，是胃火上冲所致（适宜大承气汤主治）。呃逆发作而想喝极热饮品的，是阴邪上犯清道所致（适宜吴茱萸四逆汤）。
痢症：痢症不拘泥于赤白，舌苔黄、脉象有神气的，是燥热致病（适宜大黄木香汤）。痢症红白相间，脉象无神气而口不渴的，是下焦阳气衰微，不能化生下焦的精血所致（适宜附子理中汤加小茴香、安桂）。痢症红白相间，身体大热而渴饮极热，或者不渴而舌苔青滑的，是元阳外越，而内部没有阳气来化肠胃中的精血所致（适宜吴茱萸四逆汤）。如果大热、舌苔黄，不停饮用冷水，一天几十次的，是胃热极盛（适宜白虎汤加柴胡、葛根）。痢疾初起，发热身痛脉浮的，是外感所致（适宜人参败毒散）。
头痛：头痛如裂，身体没有其他痛苦，舌色青、不渴，或者身体大热，或者脉象劲急的，这都是元阳外越，暴脱的征候，切忌发散，治法宜收纳（适宜四逆汤，或潜阳丹）。头痛、身热、颈背强痛的，是风寒侵袭太阳经所致（适宜桂枝汤）。六经各有头痛，须按法治之，这里只是阐明那些危险的证候。
耳、目、口、鼻、唇、齿、喉各部肿痛，或者发热，或者不发热，脉息有神气，舌苔黄、喜冷饮，大小便短赤，精神饮食一切不衰的，是气有余的病症（适宜清凉、升解、攻下，如小柴胡汤、甘桔汤、白虎汤、凉膈散、导赤散之类）。各部肿痛，或者发热，或者不发热，脉息无神气，脉浮大而空，或者坚劲如石，嘴唇、口、舌青白，津液满口，喜极热汤，大小便自利，间有小便赤的，这些都是气不足的病症，虽然现出肿痛火形的表现，都是阴盛逼阳的确切征候。市井医生往往称为阴虚火旺，而使用滋阴降火的药物的人极多，试问有阴虚火旺，反而见到津液满口，唇舌青滑，脉息无神，大小便自利的吗？我希望天下的医生，切切不可见头治头，见肿治肿，凡遇到一个病症，务必将阴阳、虚实辨清，用药才不会错误。
心痛：心中气痛，面色青、四肢冷、舌滑、不渴的，是寒邪直犯心君，由君火衰极所致（适宜四逆汤）。心中气痛，面色赤、舌苔黄、想喝冷水的，是热邪犯于心包所致（适宜栀子大黄汤）。
胸、腹、胁、背、腰、肘、胯、膝，各部的肿与痛，不喜欢手按的，或者发热，或者不发热，恶寒喜热，舌苔黄、便赤、脉息有神气，乃是气血壅滞，都是有剩余的征候（适宜活血、行气清凉之品）。各部或者肿或者痛，而喜欢手按的，或者发热，或者不发热，舌色青喜热饮，大小便清长，脉息无神气，人极度困倦的，乃是阳衰不能运行，都是不足的征候（适宜温中、行气之品）。
二便病：二便不利，腹胀、烦躁、舌苔黄、饮冷，脉息有神气的，乃是阳邪闭结所致（适宜清凉分利、攻下之品）。二便不利，腹部不满，人安静，口不渴，喜欢躺卧，脉息无神气，舌苔青滑的，是阴邪闭于下焦，由阳气不足，不能化阴所致（适宜温补、回阳之品）。
辨认脉法：气有余：所呈现浮、洪、长、大、实、数、紧之类的脉象。（倘若病症呈现阴色但与脉象不合，应舍脉从病）。
气不足：所呈现沉、迟、细、微、虚、短、涩之类的脉象（倘若病症呈现阳色但与脉象不合，应舍脉从病）。
辨认诸症法：气有余：所呈现的脉息、声音、面色、饮食、起居，一切都有神气。
气不足：所呈现的脉息、声音、面色、饮食、起居，一切都没有神气。
辨认疮法：气有余：所呈现红肿、高凸、痛甚、烦躁，人有神气的，是痈。
辨认痘法：气有余：所呈现痘色紫红，或者夹杂斑疹，顶焦、唇红、便闭之类的。
气不足：所呈现痘疮灰暗、凹陷、平塌、寒战、唇口青白、便利之类的。
辨认目疾法：气有余：所呈现红肿、痛胀、眵翳、障雾、赤脉、泪多、烦躁之类的。
气不足：所呈现痛胀不甚，翳雾障膜虽多，不觉大苦之类的。
辨色法：气有余：所呈现色紫红，口唇如朱砂，烦躁不宁。色不合病，舍色从病。
气不足：所呈现色滞暗，青白无神，唇口默青。病不合色，卒闭须知。
辨舌法：气有余：所呈现舌苔黄、干白、紫红、黑黄、纯干黑，烦躁，饮冷。
气不足：所呈现舌苔青滑，润黄、黑润、干黑色、或者青中带黄，或者黄中带白，黑而润，津液满口，其人安静，而喜热饮之类的。
辨口流涎水：气有余：所呈现流涎不止，口热，思水饮的，是胃火。
辨二便：气有余：所呈现尿短赤、黄、红、粪硬、羊矢状、极臭、极黄之类的。
辨皮毛肌肤：气有余：所呈现皮干枯、皮粗、毛干枯、肌肤燥痒之类的。
辨起居性情：气有余：所呈现身轻，喜动游，怒骂，喜笑、狂叫之类的。
钦安用药金针
我考究多年，用药有一点真机，与众不同。无论上部、中部、下部各种疾病，不问男女老幼，只要见到舌色青，满口津液，脉息无神气，其人安静，嘴唇口淡白，口不渴，即使口渴也喜欢热饮，大小便自利的，即使外表现出大热、身痛、头痛、目肿、口疮，一切诸症，一概不究，用药专门在这先天立极的真种子上治疗，百发百中。如果见到舌苔干黄，津液枯搞，口渴饮冷，脉息有神气，其人烦躁，即使身体冷如冰，一概不究，专门在这先天立极的元阴上求治，百发百中。后列二图，学者细心参究。
寒邪外入图
寒邪外入图说：现在用一个白色圆圈，比喻人身一团正气，黑色比喻外入的寒邪。邪气侵犯皮肤第一层，乃太阳经所主，病症现头项腰背疼痛，发热恶寒，邪气既然进入皮肤，就像盗贼进入墙垣一样。看其何处空虚有隙，便得以乘虚而入，所以不必拘泥于一日二日的说法，或者进入手足阳明经，或者进入手足少阳经，或者进入手足太阴经，或者进入手足少阴经，或者进入手足厥阴经。张仲景以太阳一经，包括三百九十七法，一百一十三方，论述传经，是六步流行的定理，论述圆通，是六步的化机，张仲景恐怕人们不知道贼的去向，所以标出六经提纲病情，以及误汗、误吐、误下、当汗不汗、当下不下、当吐不吐、用药失宜、变逆匡救之道，都在一百一十三方之中，学者务必留心，不必执着认为伤寒邪入就是这样，须知六客也是如此。更要明白外邪入内，闭束皮毛气机，遏郁而为身热疼痛，所以发汗散邪，是治疗外邪初入的第一要着。倘若外邪从阳经而入内，寒邪也化为热邪，热甚则伤阴，轻浅者，张仲景有人参白虎汤、小柴胡汤之类以存阴，最重者，张仲景有大、小承气汤之类以救阴。倘若外邪从阴经而入内，阴寒混为一家，阴盛则阳衰，轻浅者，张仲景有大、小建中汤、理中汤之类以扶阳，最重者，张仲景有四逆汤、白通汤之类以回阳。我认为这就是张仲景治疗外邪入内的子午针。
寒邪内生图
寒邪内生图说：现在用一个白色圆圈，比喻人身一团正气。正气旺盛者，外寒不入，内寒不生。内寒的产生，是由于内部的正气不足，正气不足一分，身内的阴寒便生一分。所以经文说：气不足便是寒。探究不足的原因，因房劳过度者，则损肾阳；因饮食不节者，则损脾阳；因用心过度者，则损心阳。阳就是气，阳气损于何处，阴寒便生于何处，积阴日久，元阳便为阴所灭也。
在上部者，张仲景用桂枝以扶心阳；在中部者，张仲景用建中汤、理中汤以扶脾阳；在下部者，张仲景用四逆汤、白通汤以救肾阳。阳虚日久，不能化生真阴，阴液日亏，积之久久，血枯而虚阳又炽，反为客邪，这真可谓阴虚也，治法宜甘寒养阴，切切不可妄用苦寒，所以张仲景有炙甘草汤、桂枝龙骨牡蛎汤、甘草黑姜汤之法，从阳以引阴，滋阴、化阴。我认为这就是张仲景治疗内伤的子午针。诸书称“痨”字从火，都是从损阳一语悟出的，可惜解释道理未通畅，后学无从下手，遂使得由痨症而死的人很多。学者务要明白损阳而阴象症形足征者，照上卷阳虚门法治之。损阳不能化阴，阴液枯竭，肌肤枯搞，神气短少，吐痰胶粘，有火形可验者，照张仲景炙甘草汤、龙骨黑姜汤之法治之，阴虚门方，亦可择取。又要识得外邪从阳经入内，以致热伤血者，也可谓阴虚，若此而论者，是谓之真阴虚。从外而致者，苦寒、清凉、升解俱可治之，若此论者，只宜甘温微寒，从阳养阴以调之，内外之法，至此详矣。我在上卷将阳虚阴虚症形实据列出，乃是辨症认症之子午针也；辛甘化阳，苦甘化阴，乃是用药之子午针也；气有余便是火，气不足便是寒，乃是犹是一元中之子午针也。学者务宜潜心默会，期于明白了然，幸甚幸甚。
附：禳久病不愈，一切怪症奇疮善法小神作祟亦同
凡人家中，最难免的是疾病，感受轻浅，医药可愈。假如感受太重，三年两载，医药无功，这种等疾病，不是前世罪孽冤缠，就是今生不知检束，积罪累愆所致。为人父，为人子，为人弟，为人兄，为人夫者，急宜反身修德，多行善功，或者终身戒食牛犬，或者全家斋敬九皇，或者买鱼物而放生，或者施棺木而修路，方便时行，阴功广积，斋诚涤滤，虔具悔罪祈恩，解厄消灾疏文，先申中宫，次申城隍，次申东岳，当空焚之，或许可以转危为安。我常用此法教人，应验屡屡，也可以弥补医药的不逮之处。
Accumulation and Mass: When there is a mass in the abdomen, regardless of whether it is on the left or right side, appearing when painful and disappearing when painless, it is called Jia syndrome (瘕症) (suitable for invigorating blood and moving qi, such as Danggui Buxue Tang [Angelica Sinensis and Astragalus Decoction] with added Guizhi [Cinnamon Twig] and Maiya [Malt]). When there is a mass that is not painful but remains fixed upon palpation, it is called Shan disease (疝病) (suitable for Sanwu Houpo Qiqi Tang). Accompanied by belching with a putrid odor, extremely foul stools, and a mass in the abdomen, it is food retention accumulation (suitable for Pingwei San with Dahuang [Rhubarb] and Ezhu [Curcuma]). With incessant phlegm-saliva, successive pain in the abdomen, and sounds of water, it is phlegm-dampness accumulation (suitable for Guiling Zhugan Tang or Lizhong Tang with Sharen [Amomum] and Banxia [Pinellia]). With hardness and fullness in the lower abdomen and difficulty urinating, it is blood accumulation in the Lower Jiao (suitable for Wuling San with Taoren [Peach Kernel] and Honghua [Safflower]). In general, masses that prefer rubbing and pressing are Yin accumulations, caused by Yang failing to transform Yin (suitable for warming and resolving). Masses that cannot be touched by hand are Yang accumulations, caused by stagnant Qi leading to severe blood stasis (suitable for attacking and breaking up).
Treatment of accumulation does not go beyond the two methods of Yin and Yang.
Phlegm-Fluids: Phlegm-fluids are another name for water-dampness. The Spleen produces phlegm only when dampness is present; if the water passages are clear, fluids do not form. Clear and non-viscid phlegm indicates insufficient Stomach Yang to transport water (suitable for warming the Middle, using Lizhong Tang). Yellow and viscid phlegm, preferring cold foods, indicates excessive Fire and dried-up Jin-Ye (suitable for Jizi Huanglian Tang). White, green, or salty phlegm all result from insufficient Yang (suitable for warming and tonifying). Foul-smelling phlegm, phlegm spitting like unbroken threads, or phlegm clumping like sand/stone all result from Yin deficiency with hyperactive Fire (suitable for Wuweizi Tang and Yangxue Tang). The *Jingui Yaolue* lists five types of fluids; one should study them thoroughly.
Cough: Cough accompanied by fever and body ache is due to external contraction (suitable for Xiao Qinglong Tang or Mahuang Tang). Cough without fever or body ache, with fullness, belching, and putrid odor, is caused by dietary issues, though fever may occasionally occur (suitable for Pingwei San with Maidong [Ophiopogon] and Shenqu [Medicated Leaven]). Cough with high fever, preference for very hot drinks, and blue-white lips/tongue indicates Yuan Yang floating outward and Yin Qi invading the clear pathways (suitable for Wuyu Sini Tang). Cough with a sensation of being covered by a pot, desiring hot drinks, indicates Lung obstruction by cold-phlegm (suitable for Linggui Zhugan Tang with Xixin [Asarum], Ganjiang [Dried Ginger], and Wuweizi [Schisandra]). Cough with dry mouth, preference for cold drinks, and difficulty in urination/defecation indicates Lung forced by Fire (suitable for Xiebai San with Suzye [Perilla Leaf] and Zhizi [Gardenia]). Dry cough without phlegm indicates Lung dryness and Blood deficiency (suitable for Buxue Tang combined with Heijiang Gancao Tang with Wuweizi).
Cough with phlegm-water gushing like a spring indicates Spleen Yang failure to transport (suitable for Lizhong Tang with Sharen, Banxia, Wuyu, and Fuling). Although cough symptoms are numerous, they can always be differentiated by the two methods of Yin and Yang.
Wheezing: Wheezing with fever and body ache indicates Cold pathogen obstructing the Lung orifices (suitable for Mahuang Tang with increased Mahuang). Wheezing without fever or body ache, with a blue tongue and normal urination/defecation, indicates Yuan Qi rising upward (suitable for Qianyang Dan). Wheezing with high fever, red face like cinnabar, no thirst, and blue-white lips/tongue indicates Yuan Yang floating outward (suitable for Wuyu Sini Tang).
Vomiting: Vomiting food/water yet desiring cold drinks indicates Heat blocking the Middle Jiao (suitable for Huanglian Shengjiang Tang). Vomiting yet desiring very hot drinks indicates Cold blocking the Middle Jiao (suitable for Lizhong Tang with Wuyu). Vomiting with fever and headache indicates concurrent external contraction (suitable for Guizhi Tang with increased Shengjiang and added Wuyu). Vomiting with high fever but no external contraction, yet desiring hot drinks, indicates Spleen Yang floating outward (suitable for Fuzi Lizhong Tang with Wuyu). Most vomiting cases involve fever because the Qi mechanism moves outward during vomiting; absence of body pain is the key indicator.
Huo Luan (Cholera-like): Abdominal pain with simultaneous vomiting and diarrhea, desiring water, indicates Heat blocking the Middle Jiao, obstructing the communication between Yin and Yang (suitable for Wuling San with fried Zhi). Simultaneous vomiting and diarrhea desiring hot drinks indicates Cold blocking the Middle Jiao, obstructing Yin-Yang communication (suitable for Lizhong Tang).
Hiccups: Hiccups that stop upon drinking water indicate Stomach Fire rushing upward (suitable for Dachengqi Tang). Hiccups desiring very hot drinks indicate Yin pathogen invading the clear pathways (suitable for Wuyu Sini Tang).
Dysentery: Dysentery, regardless of red or white discharge, with yellow tongue coating and spirited pulse, is caused by dry-Heat (suitable for Dahuang Muxiang Tang). Red and white dysentery with an unspirited pulse and no thirst indicates Lower Jiao Yang decline, unable to transform essence/blood of the Lower Jiao (suitable for Fuzi Lizhong Tang with Xiaohui and Angui). Red and white dysentery with high fever and desire for very hot drinks, or no thirst with a slippery blue tongue, indicates Yuan Yang floating outward with internal lack of Yang to transform intestinal essence/blood (suitable for Wuyu Sini Tang). High fever, yellow tongue, incessant cold drink consumption, and dozens of bowel movements daily indicate extreme Stomach Heat (suitable for Baihu Tang with Chaihu and Gegen). Early-stage dysentery with fever, body ache, and floating pulse indicates external contraction (suitable for Renshen Baidu San).
Headache: Headache like splitting, with no other discomfort, blue tongue, no thirst, or high fever, or forceful pulse, indicates Yuan Yang floating outward and sudden collapse; dispersing methods are strictly contraindicated, treatment should focus on gathering/receiving (suitable for Sini Tang or Qianyang Dan). Headache, fever, and stiffness in neck/back indicate Wind-Cold attacking the Taiyang channel (suitable for Guizhi Tang). Each of the Six Channels has its own headache patterns; this text clarifies dangerous ones.
Swelling/Pain in Ear, Eye, Mouth, Nose, Lips, Teeth, Throat: Swelling/pain with or without fever, spirited pulse, yellow tongue, desire for cold drinks, short/red urine/stool, and undiminished spirit/appetite indicates Excess Qi (suitable for cooling, ascending/resolving, purging formulas like Xiaochaihu Tang, Ganjie Tang, Baihu Tang, Liangge San, Daochi San). Swelling/pain with or without fever, unspirited pulse, large/empty or stone-hard pulse, blue-white lips/tongue, full mouth saliva, desire for very hot drinks, normal urination/defecation (occasional red urine) indicates Deficient Qi. Despite appearing as swelling/fire, these are signs of Yin excess forcing Yang out. Physicians often misdiagnose this as Yin deficiency with hyperactive Fire and use yin-nourishing/fire-clearing herbs; however, true Yin deficiency does not present with full mouth saliva, blue/slipping tongue, unspirited pulse, or normal bowels. Physicians must distinguish Yin/Yang and Deficiency/Excess clearly to avoid error.
Heart Pain: Qi-pain in the heart, blue face, cold limbs, slippery tongue, no thirst indicates Cold pathogen directly attacking the Heart Monarch due to extreme decline of Ministerial Fire (suitable for Sini Tang). Qi-pain in the heart, red face, yellow tongue, desire for cold drinks indicates Heat pathogen attacking the Pericardium (suitable for Zhizi Dahuang Tang).
Swelling/Pain in Chest, Abdomen, Flank, Back, Waist, Elbow, Hip, Knee: Swelling/pain disliking pressure, with or without fever, aversion to cold/preference for heat, yellow tongue, red stool, spirited pulse indicates Qi/Blood stagnation and Excess (suitable for blood-invigorating, qi-moving, cooling herbs). Swelling/pain liking pressure, with or without fever, blue tongue, preference for hot drinks, clear/long urination/defecation, unspirited pulse, extreme fatigue indicates Yang decline failing to circulate, and Deficiency (suitable for warming-middle, qi-moving herbs).
Urination/Defecation Disorders: Difficulty urinating/defecating, abdominal distension, irritability, yellow tongue, desire for cold drinks, spirited pulse indicates Yang pathogen closure (suitable for cooling/drainage, purging herbs). Difficulty urinating/defecating, non-distended abdomen, quiet patient, no thirst, preference for lying down, unspirited pulse, slippery blue tongue indicates Yin pathogen closing below due to Yang insufficiency failing to transform Yin (suitable for warming/tonifying, restoring Yang herbs).
Differentiating Pulse Methods: Qi Excess: Floating, surging, long, large, solid, rapid, tight pulses. (If disease signs are Yin but pulse is Yang, discard pulse and follow disease). Qi Deficiency: Deep, slow, fine, minute, empty, short, choppy pulses. (If disease signs are Yang but pulse is Yin, discard pulse and follow disease).
Differentiating Symptoms: Qi Excess: Spirited pulse, voice, complexion, diet, activity. Qi Deficiency: Unspirited pulse, voice, complexion, diet, activity.
Differentiating Sores: Qi Excess: Red/swollen, elevated, severe pain, irritability, spirited person = Carbuncle (Yong). Qi Defusion: Normal skin color/spreading swelling, no pain, unspirited person = Ulcer (Ju).
Differentiating Smallpox: Qi Excess: Purple-red spots, possibly with macules/papules, scorched apex, red lips, constipation. Qi Deficiency: Gray/sunken/flat sores, chills, blue-white lips/mouth, loose stools.
Differentiating Eye Diseases: Qi Excess: Red/swollen, painful/distended, discharge/cataracts, misty vision, red vessels, tearing, irritability. Qi Deficiency: Mild pain/distension, many cataracts/mists but no great suffering.
Differentiating Color: Qi Excess: Purple-red, lips like cinnabar, irritability. If color doesn't match disease, discard color and follow disease. Qi Deficiency: Dull/dark, blue-white unspirited, dark blue lips/mouth. If disease doesn't match color, note sudden closure.
Differentiating Tongue: Qi Excess: Yellow, dry-white, purple-red, black-yellow, pure dry-black, irritability, cold drink desire. Qi Deficiency: Blue-slipping, moist-yellow, moist-black, dry-black, or blue-with-yellow, yellow-with-white, black-moist, full mouth saliva, quiet person, hot drink desire.
Differentiating Breath: Qi Excess: Rough breath, warm exhalation, loud speech. Qi Deficiency: Weak breath, shortness, cold exhalation, faint speech.
Differentiating Saliva: Qi Excess: Incessant saliva, hot mouth, desire for water = Stomach Fire. Qi Deficiency: Incessant saliva, cold mouth, desire for hot soup = Stomach Cold.
Differentiating Urine/Stool: Qi Excess: Short/red/yellow urine, hard/sheep-dung-like/foul/yellow stool. Qi Deficiency: Clear/long urine (occasionally yellow), loose/white/green stool.
Differentiating Skin/Hair: Qi Excess: Dry/coarse skin/hair, dry/itchy skin. Qi Deficiency: Smooth/lustrous skin/hair, thin but non-itchy skin.
Differentiating Diet: Qi Excess: Large appetite, easy digestion, hunger, desire for soups/water. Qi Deficiency: Poor appetite, hard digestion, feeling full after little, preference for hard foods.
Differentiating Activity/Temperament: Qi Excess: Light body, active, angry/scolding, laughing/raving. Qi Deficiency: Heavy body, lethargic, silent, worried/sorrowful.
Qin'an's Golden Needle for Medication Use
After years of study, I have found a true principle in medication use, distinct from others. Regardless of upper, middle, or lower body diseases, and regardless of gender or age, if one sees a blue tongue, full mouth saliva, unspirited pulse, quiet demeanor, pale lips/mouth, no thirst (or thirst preferring hot drinks), and normal urination/defecation, even if external signs show high fever, body ache, headache, eye swelling, or mouth ulcers, ignore all these symptoms. Treat solely based on the primordial root of congenital establishment. This yields 100% success. Conversely, if one sees a dry-yellow tongue coating, dried-up saliva, thirst for cold drinks, spirited pulse, irritability, even if the body is cold as ice, ignore these. Seek treatment in the primordial Yin of congenital establishment. This also yields 100% success. Two diagrams follow for careful study.
Diagram of External Cold Pathogen Entering
Explanation: A white circle represents the body's righteous Qi; black represents external Cold pathogen. Invasion of the first skin layer is governed by the Taiyang channel, presenting with head/neck/back pain, fever, and aversion to cold. Like thieves entering a wall, the pathogen exploits voids. Thus, one need not adhere strictly to day-count theories. It may enter Yangming, Shaoyang, Taiyin, Shaoyin, or Jueyin channels of the hands/feet. Zhang Zhongjing used the Taiyang channel to encompass 397 methods and 113 prescriptions. Discussing transmission follows the law of Six Steps' circulation; discussing versatility follows their transformation mechanism. To prevent confusion about the pathogen's direction, he outlined the six channel提纲 (outline) conditions and errors (mis-sweating, mis-vomiting, mis-purging, etc.) within the 113 prescriptions. Students must pay attention. Note that "Six Guests" (pathogens) act similarly. Crucially, external pathogens close skin pores, trapping Qi and causing fever/pain. Sweating to scatter pathogens is the primary method for initial external invasion. If pathogens enter via Yang channels, Cold transforms to Heat, damaging Yin. Mild cases use Renshen Baihu Tang or Xiaochaihu Tang to preserve Yin; severe cases use Da/Xiao Chengqi Tang to save Yin. If pathogens enter via Yin channels, Yin/Cold merge, leading to Yang decline. Mild cases use Da/Xiao Jianzhong Tang or Lizhong Tang to support Yang; severe cases use Sini Tang or Baitong Tang to restore Yang. This is Zhang Zhongjing's "Midnight-Noon Needle" for external pathogens.
Diagram of Internal Cold Pathogen Generation
Explanation: A white circle represents righteous Qi. Strong righteous Qi prevents external Cold entry and internal Cold generation. Internal Cold arises from deficient righteous Qi; for every unit of Qi deficiency, a unit of internal Cold generates. As the classics state: "Qi deficiency is Cold." Causes of deficiency: excessive sexual activity damages Kidney Yang; irregular diet damages Spleen Yang; overthinking damages Heart Yang. Where Yang/Qi is damaged, Cold generates. Prolonged Yin accumulation extinguishes Yuan Yang. For Upper Jiao, Zhang uses Guizhi to support Heart Yang; for Middle Jiao, Jianzhong/Lizhong to support Spleen Yang; for Lower Jiao, Sini/Baitong to rescue Kidney Yang. Long-term Yang deficiency fails to generate True Yin, leading to Yin fluid depletion. Eventually, Blood dries and Empty Fire flares, becoming a guest pathogen—this is true Yin deficiency. Treatment requires Sweet-Cold to nourish Yin; never recklessly use Bitter-Cold. Hence, Zhang uses Zhigancao Tang, Guizhi Longgu Muli Tang, or Gancao Heijiang Tang to guide Yin from Yang, nourishing and transforming Yin. This is Zhang's "Midnight-Noon Needle" for internal injury. Books link "Lao" (consumption) to Fire, derived from "damaging Yang," but explanations are unclear, leading to many deaths. Students must recognize Yang damage with Yin manifestations and treat per the Yang Deficiency section above. If Yang damage fails to transform Yin, leading to fluid exhaustion, dry skin, short spirit, sticky phlegm, and fire signs, treat per Zhigancao or Longgu Heijiang Tang methods, selecting from Yin Deficiency formulas. Also, recognize that external pathogens entering Yang channels causing Heat-blood damage can be called Yin deficiency (True Yin Deficiency). Caused externally, Bitter-Cold/Cooling/Ascending methods work. Caused internally, only Sweet-Warm/Slightly-Cold methods guiding Yang to nourish Yin work. Internal/external methods are detailed here. In Volume 1, I listed actual signs of Yang/Yin deficiency as the diagnostic needle; Sweet-Acrid transforms Yang, Bitter-Sweet transforms Yin as the medication needle; "Qi excess is Fire, Qi deficiency is Cold" as the One-Yuan needle. Students must ponder deeply for clarity.
Appendix: Rituals for Chronic Illnesses, Strange Symptoms, and Miraculous Sores (Also applies to malevolent spirits)
Illnesses are unavoidable. Mild cases respond to medicine. Severe cases lasting years with no medical effect stem from past-life karma or present-life moral failings. Fathers, sons, brothers, husbands should cultivate virtue, perform good deeds, abstain from beef/dog meat, worship the Nine Emperors, release fish, donate coffins, or repair roads. Accumulate hidden merit, purify with fasting/piety, and submit repentance/prayer petitions to the Central Palace, City God, and Dongyue, burning them in the air. This may turn danger to safety. I teach this method frequently with success, supplementing medicine where it falls short.