半补虚一半清热，终属模糊不得要领。然舍补虚清热外，更无别法，当细辨之。补虚有二法∶一补脾；一补胃。
如疟痢后，脾气衰弱，饮食不能运化，宜补其脾；如伤寒后，胃中津液久耗，新者未生，宜补其胃。二者有霄
壤之殊也。清热亦有二法∶初病之热为实热，宜用苦寒药清之；病后之热为虚热，宜用甘寒药清之。二者亦有
霄壤之殊
也。人身天真之气，全在胃口，津液不足即是虚，生津液即是补虚，故以生津液之药合甘寒泻热之药，而治感
后之虚热，如麦冬、生地、丹皮、人参、梨汁之属，皆为合法。设误投参、 、苓、术补脾之药为补，岂不并
邪热而补之乎？至于饮食之补，但取其气，不取其味。如五谷之气以养之，五菜之气以充之，人皆不知此理，
急于用肥甘之味以补之，不知油腻阻滞经络，邪热不能外出矣。（喻嘉言）
选案
徐五宜先生长君，伤寒危甚，有人来言，病者早起，一晕竟绝。予问∶病来几日？云∶九日矣。胸尚热
否？曰∶但不冷耳。予曰∶可救也。至则僵卧在床，口鼻无气，面青口噤，目闭手撒，唇色紫黑。予笑曰∶此
人不死。阴虚证误服白虎所致耳。切脉，两尺尚在。遂取人参一两，熟地二两，附子、炮姜各五钱，浓煎挖而
灌之。尽剂目开，面色转红，不及一时，大叫冷甚，即发壮热，通身汗下而苏。此晚腹胀不便，予曰∶无忧，
大汗之后，虚不能出耳。再饮药即得解。次日诸证悉除，但多妄言怒骂，如有神灵，复投附子理中、建中而愈。
（《己任编》）
方昱公伤寒九日，头痛脉浮，身如燔炭，发表多剂，终莫得汗。予曰∶伤寒固当发汗，然辛散助热耗阴，
汗为热隔，不能达外，惟有养其津液，使阴阳和而后雨泽降。试之诚然。（程华仲）
一妇患伤寒十余日，手足躁扰，口目 动，面白身冷，谵语发狂。其家以为疯，缚其手足。或以为虚，
或以为寒，或辞不治。切其脉全无，问其证不知，按其身不热。余曰∶此非参、附证即硝、黄证，出此入彼，
死生立判。坐视良久，聆其声重而长，谛思若是虚寒证，到此脉脱之时，气息奄奄，那得有如许气力大呼疾声
耶？即作大承气汤，牙关紧闭，挖灌下咽，黄昏便解黑粪，次早脉出身热，人事亦知。又服小陷胸汤二剂而愈。
○孝廉项恂如患伤寒，服发散药二帖，其病愈甚，昏热脉脱，急用参、 、术各一两，附子三钱，姜、桂二钱，
下午后，脉渐出，随投六、
七剂，其病如故，更加舌肿唇烂，渴饮不绝。余曰∶病是此病，药是此药，服之反甚，得无误乎？细视不瘥，
又进数剂，病复如故，十余日，总不能言。幸其子深信不疑，跪恳救治。余曰∶药已至矣，病终不转，奈何？更
用八味丸料一斤，浓煎六碗，冰冷与饮。日夜服尽，舌消能伸，亦能言语识人。每日用药一剂，粥食数碗，
大便不解，听其自然，至二十八、九日，腹始胀，遂以参、苓、 、术、姜、桂、附子煎汁加大黄二钱，服后，额微汗
出，手足躁扰。此正气虚极。又用大料温补一剂，遂安卧，夜解宿粪半桶。后用温补药百剂而愈。共计用人参
五斤，附子三十枚。稍失调理，便发热脱颏，直至次年始健。（张锡驹）
黄长人犯房劳，病伤寒，守不服药之戒，身热已退十余日外，忽然昏沉战栗，手足如冰，医已合就姜附药
矣。余见而骇之，诊毕再三辟其谬，病家自疑阴证，言之不入，只得与医约曰∶此药入口，生死关系重大，吾
与丈各立担承。医云∶吾治伤寒三十年，不知甚么担承。余笑曰∶有吾明眼在此，不忍见活人就毙。如不担承，
待吾用药。以调胃承气汤，煎成热服半盏，少顷又服半盏，厥回人苏，前药服终，人事大清，浑身壮热，再与
大柴胡一剂，热退身安。○徐国祯伤寒六、七日，身热目赤，索水到前，复置不饮，异常大躁，门牖洞启，
身卧地上。一医以承气与服。余诊其脉，洪大无伦，重按无力。谓曰∶此参、附、干姜证，奈何认为下证耶？
医曰∶身热、目赤、躁急若此，再服参、附、干姜、逾垣上屋矣。余曰∶阳欲暴脱，外显假热，内有真寒，
姜、附尚恐不胜回阳之任，况敢以纯阴之药重劫其阳乎？观其水不欲咽，情已大露，岂水尚不欲咽，而反可咽
硝、黄乎？天气燠蒸，必有大雨，顷刻一身大汗，不可救矣。惟用姜、附，所谓补中有发，一举两得，何可致
疑？于是以附子、干姜各五钱，人参三钱，甘草二钱，煎成冷服，服后寒战戛齿，以重绵覆之，阳微之象始着。
再剂微汗，热退而安。（喻嘉言）
一味地补虚、一味地清热，终究是模糊不清、不得要领。然而除了补虚和清热之外，也没有其他办法，应当仔细辨别。补虚有两种方法：一是补脾；二是补胃。
例如疟疾或痢疾之后，脾气衰弱，饮食无法运化，适宜补脾；例如伤寒之后，胃中津液长期耗损，新的津液尚未生成，适宜补胃。这两者有着天壤之别。清热也有两种方法：初病时的热为实热，适宜用苦寒药来清泻；病后出现的热为虚热，适宜用甘寒药来清润。这两者也有着天壤之别。人身上的先天真气，全在于胃气（胃口），津液不足就是虚，生津液就是补虚，所以用生津液的药物配合甘寒泻热的药物，来治疗感邪后的虚热，如麦冬、生地、丹皮、人参、梨汁这类药物，都是合法的治法。如果错误地投用参、白术、茯苓、白术等补脾的药物作为补益，岂不是连同邪热一起补了吗？至于饮食的补益，只取其气，不取其味。如五谷之气来滋养它，五菜之气来充实它，人们都不懂这个道理，急于用肥腻甘甜的味道来补益，不知道油腻会阻滞经络，导致邪热不能外出。（喻嘉言）
选案
徐五宜先生的长子，患伤寒病情危重，有人来说，病人早起时突然晕厥昏迷。我问：生病几天了？回答说：九天了。胸口还热吗？回答说：只是不冷罢了。我说：可以救治。到了那里，见病人僵卧在床上，口鼻没有气息，面色青紫，牙关紧闭，眼睛闭合，手松无力，嘴唇颜色紫黑。我笑着说：这个人不会死。这是阴虚证误服白虎汤所致。切脉，两尺脉还在。于是取人参一两，熟地黄二两，附子、炮姜各五钱，浓煎后撬开嘴巴灌下去。喝完一剂药，眼睛睁开，面色转红，不到一个时辰，大叫非常冷，随即发高热，全身大汗而苏醒。这天晚上腹胀不大便，我说：不用担心，大汗之后，正气虚弱不能推动排便罢了。再喝药就能解出。第二天各种症状都消除了，只是多胡言乱语、愤怒骂人，好像有神灵附体，又投用附子理中汤、小建中汤而痊愈。（《己任编》）
方昱公患伤寒九天，头痛脉浮，身体像燃烧的炭一样热，用了许多发汗药，始终没能出汗。我说：伤寒固然应当发汗，然而辛散药物助热耗伤阴液，汗被热邪阻隔，不能达于体表，只有滋养津液，使阴阳调和然后雨水（汗液）才能降下。尝试果然有效。（程华仲）
一位妇女患伤寒十多天，手足躁动不安，口眼歪斜抽动，面色苍白身体发冷，说胡话发狂。她的家人以为是疯病，绑住了她的手脚。有人说这是虚证，有人说这是寒证，有人推辞不治。切她的脉完全摸不到，问她的症状她不知道，按她的身体也不热。我说：这不是人参、附子证就是硝石、大黄证，出此入彼，生死立刻判定。坐着观察了很久，听到她声音沉重而长，仔细思考如果是虚寒证，到了脉脱的时候，气息奄奄，怎么会有这么大的力气大声疾呼呢？于是制作大承气汤，牙关紧闭，撬开灌下去，黄昏时就解出黑粪，次日早晨脉象出现，身体发热，人事也清醒了。又服用小陷胸汤两剂而痊愈。
○孝廉项恂如患伤寒，服用发散药两帖，病情反而加重，昏热脉微欲绝，急忙用人参、白术、茯苓各一两，附子三钱，干姜、肉桂各二钱，下午后，脉象渐渐出现，随后投用六、七剂，病情依旧，更加舌肿唇烂，口渴饮水不止。我说：病是这个病，药是这个药，服用后反而加重，难道有误吗？仔细看没有好转，又进服几剂，病情依旧，十多天，始终不能说话。幸好他儿子深信不疑，跪求救治。我说：药已经用到了，病情始终不转变，怎么办？改用八味丸料一斤，浓煎成六碗，冰冷着给他喝。日夜服完，舌头消肿能伸出，也能言语识人。每天用药一剂，吃粥几碗，大便不解，听其自然，到二十八、九天，腹部才胀，于是用人参、茯苓、白芍、白术、干姜、肉桂、附子煎汁加大黄二钱，服用后，额头微微出汗，手足躁动不安。这是正气极度虚弱。又用大剂量温补药一剂，于是安静躺卧，夜里解出宿粪半桶。后来用温补药一百剂而痊愈。共计用人参五斤，附子三十枚。稍微失去调理，就会发热脱颏（下巴脱臼状），直到次年才健康。（张锡驹）
黄长人犯房劳，患伤寒，遵守不服药的戒律，身体发热已经退了十多天外，忽然昏沉战栗，手脚像冰一样，医生已经配好姜附药了。我看见很震惊，诊脉完毕再三驳斥其谬误，病家自己怀疑是阴证，我的话听不进去，只得与医生约定说：这药入口，生死关系重大，我和您各自承担责任。医生说：我治伤寒三十年，不知道什么担承。我笑着说：有我明眼人在这里，不忍心看着活人被治死。如果不担承，等我用药。用调胃承气汤，煎成后热服半盏，一会儿又服半盏，四肢回暖人苏醒，前面的药服完，人事完全清醒，浑身壮热，再给大柴胡汤一剂，热退身安。
○徐国祯患伤寒六、七天，身体发热眼睛红，要水送到面前，又放下不喝，异常烦躁，门窗大开，身体躺在地上。一个医生用承气汤给他服用。我诊他的脉，洪大无比，重按无力。对他说：这是人参、附子、干姜证，为什么认为是下法证呢？医生说：身体热、眼睛红、烦躁如此严重，再服人参、附子、干姜，就要跳墙爬屋了。我说：阳气将要暴脱，外显假热，内有真寒，姜、附尚且恐怕不能胜任回阳的任务，哪里敢用纯阴的药物重重劫夺他的阳气呢？看他水不想咽，情况已经大露破绽，难道水尚且不想咽，反而可以咽下硝石、大黄吗？天气闷热蒸腾，必有大雨，顷刻间一身大汗，就无法救治了。只有用姜、附，所谓补中有发，一举两得，有什么可怀疑的？于是用附子、干姜各五钱，人参三钱，甘草二钱，煎成后冷服，服用后寒战咬牙，用厚绵覆盖，阳微的征象才明显。再服两剂，微微出汗，热退而安。（喻嘉言）
To merely tonify deficiency and to merely clear heat is ultimately vague and misses the key point. However, apart from tonifying deficiency and clearing heat, there are no other methods; one must distinguish them carefully. There are two methods of tonifying deficiency: one is tonifying the Spleen; the other is tonifying the Stomach.
For example, after malaria or dysentery, if Spleen Qi is weak and food cannot be transformed and transported, it is appropriate to tonify the Spleen; for instance, after a Shanghan (Cold Damage) disease, if Stomach fluids have been consumed for a long time and new fluids have not yet generated, it is appropriate to tonify the Stomach. The difference between the two is as vast as heaven and earth. There are also two methods of clearing heat: heat at the onset of illness is Excess Heat, which should be cleared with Bitter-Cold herbs; heat appearing after the illness is Deficiency Heat, which should be cleared with Sweet-Cold herbs. The difference between these two is also as vast as heaven and earth. The innate vital Qi of the human body resides entirely in the Stomach Qi (appetite/digestive function). Insufficiency of fluids constitutes deficiency; generating fluids constitutes tonifying deficiency. Therefore, combining herbs that generate fluids with those that clear heat using Sweet-Cold properties to treat post-infection deficiency heat, such as Ophiopogonis Radix (Maidong), Rehmanniae Radix Preparata (Shudihuang), Moutan Cortex (Danpi), Ginseng Radix et Rhizoma (Renshen), and Pear Juice, are all lawful treatments. If one mistakenly administers herbs like Ginseng Radix et Rhizoma (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu), Poria (Fuling), and Atractylodis Rhizoma (Baizhu) for tonifying the Spleen as a form of tonification, would this not amount to tonifying both the pathogenic heat and the deficiency? As for dietary tonification, one should only utilize its Qi (energetic quality), not its Flavor (taste/substance). For example, nourish it with the Qi of the five grains, and fill it with the Qi of the five vegetables. People generally do not understand this principle; they are eager to use rich, greasy, and sweet flavors to tonify, unaware that grease and oil obstruct the meridians, preventing pathogenic heat from exiting outward. (Yu Jiayan)
Selected Cases
The eldest son of Mr. Xu Wuyi suffered from severe Shanghan (Cold Damage). Someone reported that the patient fainted and fell into unconsciousness early in the morning upon rising. I asked, "How many days has he been ill?" He replied, "Nine days." I asked, "Is his chest still warm?" He answered, "It is just not cold." I said, "He can be saved." Upon arrival, I found him lying stiffly in bed, without breath at the mouth and nose, with a cyan face, clenched jaw, closed eyes, and relaxed hands. His lips were purple-black. I smiled and said, "This person will not die. This is due to the mistaken administration of Baihu Tang (White Tiger Decoction) in a Yin-Deficiency pattern." I palpated the pulse; the Chi (Cun-Kou) pulses at both wrists were still present. I then took one liang of Ginseng Radix et Rhizoma (Renshen) and two liang of Rehmanniae Radix Preparata (Shudihuang), along with three qian each of Aconiti Lateralis Radix Preparata (Fuzi) and Zingiberis Radix Preparata (Paojiang), decocted them strongly, pried open his mouth, and administered the liquid. After finishing the dose, his eyes opened, his complexion turned red, and within less than an hour, he cried out loudly about feeling extremely cold, followed by a high fever. He sweated profusely over his entire body and regained consciousness. That evening, his abdomen was distended and he had no bowel movement. I said, "Do not worry; after profuse sweating, the deficient Zheng Qi (Upright Qi) lacks the strength to expel stool. Drinking more medicine will facilitate passage." The next day, all symptoms disappeared, except for delirious speech and angry cursing, as if possessed by spirits. He was treated with Fuzi Lizhong Wan (Aconite and Ginger Regulate the Middle Pill) and Xiaojianzhong Tang (Minor Construct the Middle Decoction) until he recovered. (from *Jiren Bian*)
Fang Yugong suffered from Shanghan (Cold Damage) for nine days, presenting with headache, floating pulse, and a body hot as burning charcoal. Many diaphoretic prescriptions were given, but sweat never occurred. I said, "Although Shanghan (Cold Damage) should indeed be treated with diaphoresis, acrid-dispersing herbs assist heat and consume Yin. When sweat is blocked by heat, it cannot reach the exterior. One must nourish the fluids so that Yin and Yang harmonize, allowing rain (sweat) to descend." The trial proved correct. (Cheng Huazhong)
A woman suffered from Shanghan (Cold Damage) for more than ten days, exhibiting restless limbs, twitching of the mouth and eyes, pale complexion, cold body, delirium, and mania. Her family thought it was madness and bound her limbs. Some considered it a Deficiency syndrome, others a Cold syndrome, and some refused treatment. Her pulse was imperceptible; she did not respond to questions regarding her symptoms; her body was not hot to touch. I said, "This is either a Renshen-Fuzi (Ginseng-Aconite) case or a Xiaoshi-Dahuang (Niter-Rhubarb) case. Choosing one way or the other determines life or death immediately." I sat observing for a long time, hearing her voice was heavy and long. Reflecting carefully, if this were a Deficiency-Cold syndrome, at the stage of pulse collapse, with faint breathing, how could she have enough strength to shout loudly? I therefore prepared Dachengqi Tang (Major Order the Yellow Decoction). With her jaw tightly clenched, I pried it open and forced the decoction down. At dusk, she passed black stool. By early morning, her pulse returned, she had a fever, and her mental state clarified. She took two doses of XiaoXiantong Tang (Small Trap-Piercing Decoction) and recovered.
○ Xiang Xunru, a Licentiatus, suffered from Shanghan (Cold Damage). After taking two doses of diaphoretic herbs, his condition worsened significantly: he became comatose with fever, and his pulse became faint and nearly absent. Urgently, I prescribed one liang each of Ginseng Radix et Rhizoma (Renshen), Atractylodis Rhizoma (Baizhu), and Poria (Fuling), three qian of Aconiti Lateralis Radix Preparata (Fuzi), and two qian each of Zingiberis Rhizoma (Shengjiang) and Cinnamomi Ramulus (Guizhi). In the afternoon, his pulse gradually emerged. Subsequently, six to seven doses were administered, but the condition remained unchanged, worsening with swollen tongue, ulcerated lips, and incessant thirst requiring drinking. I said, "The disease is this disease, the medicine is this medicine; taking it makes things worse. Could there be an error?" Observing no improvement, I advanced several more doses, but the condition persisted. For over ten days, he could not speak. Fortunately, his son believed firmly and knelt begging for rescue. I said, "The medication has reached the limit, yet the disease does not transform. What shall we do?" I switched to Ba Wei Wan (Eight-Ingredient Pill) formula, one jin, decocted strongly into six bowls, and gave it to him cold. He finished it day and night. His tongue reduced in swelling, could extend, and he could speak and recognize people. He took one dose daily and ate several bowls of porridge. Bowel movements did not occur, so I left nature to take its course. On the 28th or 29th day, his abdomen finally distended. I then used a decoction of Ginseng Radix et Rhizoma (Renshen), Poria (Fuling), Paeoniae Radix Alba (Baishao), Atractylodis Rhizoma (Baizhu), Zingiberis Rhizoma (Shengjiang), Cinnamomi Ramulus (Guizhi), and Aconiti Lateralis Radix Preparata (Fuzi), adding two qian of Rheum Palmatum (Dahuang). After ingestion, slight sweat appeared on his forehead, and his limbs became restless. This indicated extreme deficiency of Zheng Qi (Upright Qi). I then administered a large-dose warming-tonic prescription, after which he lay quietly and passed half a bucket of old stool during the night. He later took one hundred doses of warming-tonic medicines and recovered. In total, five jin of Ginseng Radix et Rhizoma (Renshen) and thirty pieces of Aconiti Lateralis Radix Preparata (Fuzi) were used. Any slight lapse in regulation led to fever and mandibular dislocation-like symptoms, until he recovered healthily the following year. (Zhang Xiju)
Huang Changren engaged in sexual activity while suffering from Shanghan (Cold Damage). Adhering to the taboo against taking medicine, his body heat had subsided for over ten days when suddenly he became lethargic and shivering, with icy hands and feet. A physician had already compounded a Shengjiang-Fuzi (Fresh Ginger-Aconite) prescription. Seeing this, I was shocked. After diagnosis, I repeatedly refuted the error. The family suspected a Yin syndrome and would not listen to me. I made an agreement with the physician: "Once this medicine enters the mouth, life and death hang in the balance. You and I will each bear responsibility." The physician said, "I have treated Shanghan (Cold Damage) for thirty years; I know nothing of 'bearing responsibility'." I laughed and said, "With my clear vision here, I cannot bear to see a living person die. If you will not accept responsibility, let me use my medication." I prepared Tiaowei Chengqi Tang (Regulate the Stomach Order the Yellow Decoction), heated it, and administered half a cup. Shortly after, another half cup was given. His extremities warmed, and he regained consciousness. After finishing the previous medicine, his mental state cleared completely, but he developed intense whole-body heat. I then gave one dose of Da Chaihu Tang (Major Bupleurum Decoction), after which the heat subsided and he felt comfortable.
○ Xu Guozhen suffered from Shanghan (Cold Damage) for six or seven days, presenting with body heat, red eyes, desire for water but refusing to drink when brought, extreme restlessness, opening doors and windows wide, and lying on the ground. A physician administered a Chengqi Tang (Order the Yellow Decoction) variant. I palpated his pulse: it was surging and large beyond measure, but empty upon deep pressure. I told him, "This is a Renshen-Fuzi-Ganjiang (Ginseng-Aconite-Dried Ginger) case. Why do you consider it a purgation case?" The physician said, "With body heat, red eyes, and such extreme agitation, administering Renshen, Fuzi, and Ganjiang would make him jump walls and climb roofs." I said, "Yang Qi is about to violently collapse; false heat appears externally while true cold exists internally. Even Jiang (Ginger) and Fu (Aconite) may barely suffice to restore Yang; how dare one use purely Yin-cold herbs to heavily plunder his Yang? Observe that he does not wish to swallow water; the truth is revealed. If he does not even wish to swallow water, how could he swallow Niter (Xiaoshi) and Rhubarb (Dahuang)? When the weather is sultry and steaming, heavy rain must follow. Suddenly, profuse sweating over the entire body will occur, and it will be incurable. Only by using Jiang and Fu, which embody 'tonification with dispersion,' can one achieve two goals with one stroke. Why doubt this?" Thus, I prescribed five qian each of Aconiti Lateralis Radix Preparata (Fuzi) and Zingiberis Rhizoma (Ganjiang), three qian of Ginseng Radix et Rhizoma (Renshen), and two qian of Glycyrrhizae Radix et Rhizoma (Gancao). The decoction was cooled before administration. After ingestion, he experienced chills and teeth chattering. Covering him with thick cotton, the signs of Yang deficiency became apparent. After two doses, slight sweat occurred, heat subsided, and he stabilized. (Yu Jiayan)