上以水三升，煮取一升。去滓，内蜜二升，煎令水气尽，取二升。强人服七合，弱人服五合。不瘥，明日更服，不
可日再服。又方治寒疝，腹中痛，逆冷，手足不仁。若身疼痛，灸刺诸药不能治，用本方以桂枝汤五合，解令少清，初
服二合。不知，即服三合。又不知，复加至五合。其知者如醉状，得吐者为中病。《外台》乌头汤，治寒疝腹中绞痛∶贼
风入攻五脏，拘急不得转侧，发作有时，使人阴缩，手足厥逆，即此合桂枝汤方也。
大黄附子汤 《金匮》治胁下偏痛，发热，其脉紧弦，此寒也，以温药下之。 大黄（二两） 附子（二枚炮）
细辛（二两） 上三味，以水五升，煮取二升，分温三服。若强人煮取二升半，分温三服。服后如人行四五里，进一服。
仲景治伤寒热邪，痞聚心下，而挟阳虚阴盛之证，用附子泻心汤之法矣。其杂证胁下偏痛，发热为阳，其脉弦紧，
为阴寒上逆者，复立此温药下之一法。然仲景谆谆传心，后世领略者鲜。《金匮》又别出一条云∶其脉数而紧乃弦，状如
弓弦，按之不移，数脉弦者，当下其寒。脉紧而迟者，必心下坚。脉大而紧者，阳中有阴，可下之。读者罔识其指，讵
知皆以温药下之之法耶？其曰当下其寒、曰阳中有阴、试一提出，其金针不跃然乎。
赤丸 治寒气厥逆。 茯苓（四两） 乌头（二两炮） 半夏（四两洗一方用桂枝） 细辛（一两《千金》作
人参） 上四味末之，内真朱为色，炼蜜丸，如麻子大。先食，酒饮下三丸，日再服。不知，稍增之，以知为度。
以上十二方，引证《金匮》证治。
论建中之法 伤寒有小建中汤一法，乃桂枝汤加胶饴，共六味，治二三日心悸而烦，欲传不传之邪。以其人中
气馁弱，不能送邪外出，故用胶饴之甘，小小创建中气以祛邪也。《金匮》有黄 建中汤一法，于小建中汤内加黄 ，治
虚劳里急自汗，表虚肺虚诸不足证，而建其中之卫气也。《金匮》复有大建中汤一法，以其人阴气上逆，胸中大寒，呕不
能食，而腹痛至极。用蜀椒、干姜、人参、胶饴，大建其中之阳，以驱逐浊阴也。后人推展其义，曰乐令建中汤，治虚
劳发热，以之并建其中之荣血。曰十四味建中汤，治脏气素虚，以之两建其脾中肾中之阴阳。仲景为祖，后人为孙，一
脉渊源，猗欤盛矣。建中如天子建中和之极，揖逊征诛，皆建中内当然之事。虚羸之体，服建中后，可汗可下，诚足恃
也。至理中则变理之义，治中则分治之义，补中温中，莫非惠先京国之大端矣。缘伤寒外邪，逼处域中，法难尽用。仲
景但于方首以小之一字，示其微意，至《金匮》治杂证，始尽建中之义。后人引伸触类，曲畅建中之旨。学人必于前人
之方，一一会其大意，庶乎心手之间，无入而不自得也。
论东垣升阳益胃汤 黄 补胃汤二方。汇方诸书，采治恶寒之证，其误最大。恶寒一证，大率阳虚所致，有微
甚之不同。微者用桂枝汤加人参、黄 ，甚者并加附子。仲景之法，精且备矣。后世全不究心，但曰外感遵仲景，内伤
法东垣。取东垣升阳益胃、黄 补胃二汤，为表虚恶寒之治，此不可不辨也。盖表为阳，表虚即表之阳虚，故恶寒也。
与升阳益胃之方，迥不相涉。升阳益胃者，因其人阳气遏郁于胃土之中，胃虚不能升举其阳，本内经火郁发之之法，益
其胃以发其火也。升阳方中，半用人参、黄 、白术、甘草益胃，半用独活、羌活、防风、柴胡升阳，复以火本宜降，
虽从其性而升之，不得不用泽泻、黄连之降，以分杀其势，制方之义若此。至黄 补胃汤，则并人参不用，而用白芷、
本、升麻、麻黄、黄柏，大升小降之矣。然阳火郁于胃土之中，其时寒必兼时热，其脉必数实，其证必燥渴。若不辨
而简其方，以治阳虚阴盛，有寒无热，脉微不渴之恶寒，宁不杀人乎？
论扶阳助胃汤 此方乃东垣弟子罗谦甫所制，治虚寒逆上胃痛之证。遵《内经》寒淫于内，治以辛热，佐以苦
温之旨。用附子、干姜之大辛热者，温中散寒。用草豆蔻、益智仁辛甘大热者，驱逐胃寒，同为主治。用甘草之甘温，
白术、陈皮之苦温，温养脾气以佐之。寒水挟木势侮土，故作急痛，用桂以伐肾邪，用芍药以泻肝木，用吴茱萸以泄胸
中厥逆之气。三使分猷而出，井井有条。谦甫师事东垣二十年，尽得东垣之学。观此方以扶阳助其胃为名，明是中寒由
于胃寒，一似韩只和法门，较之升阳益胃，不啻歧途矣。要知东垣治火郁，发其火则烟熄。谦甫治无火，补其土则气温。
用方者可不辨之于早乎？《语》云∶见过于师，方堪传授。见与师齐，减师半德。谦甫真不愧东垣弟子矣。
论附子理中汤 理中汤，古方也。仲景于伤寒证，微示不用之意，故太阳误下协热而利，心下痞硬，表里不解，
用理中汤加桂枝，而更其名曰桂枝人参汤。及治霍乱证，始仍理中之旧，此见理中非解外之具矣。然人身脾胃之地，总
名中土，脾之体阴而用则阳，胃之体阳而用则阴、理中者，兼阴阳体用而理之，升清降浊，两擅其长。若脾肾两脏，阳
虚阴盛，本方加附子，又以理中之法兼理其下。以肾中之阳，较脾中之阳，关系更重也。后人更其名曰附子补中汤，换
一补字，去兼理之义远矣。《宝鉴》复于本方加白芍、白茯、浓朴、草豆蔻、陈皮，名曰附子温中汤，治中寒腹痛自利，
完谷不化，脾胃虚弱，不喜饮食，懒言困倦，嗜卧等证，反重健运之阳，不重蛰藏之阳， 乱成法，无足取也。夫既重
温脾，附子可以不用。既用附子温肾，即不当杂以白芍之酸寒。况完谷不化，亦岂浓朴、陈皮、豆蔻所能胜哉？嗟夫！
釜底有火，乃得腐熟水谷。冷灶无烟，世宁有不炊自熟之水谷耶？后人之不逮古昔远矣。今人竞争补肾不如补脾，不知
此语出自何典，而庸俗方信为实有是说，岂非俚浅易入耶？又三因桂香丸、洁古浆水散，未免太过。仲醇脾肾双补丸，
未免不及。太过则阳亢，不及则阴凝，总不若附子理中之无偏无陂矣。
论增损八味丸 古方崔氏八味丸，用附桂二味阳药，入地黄等六味阴药之中。《金匮》取治香港脚上入，少腹不
仁，其意颇微。盖地气上加于天，则独用姜附之猛以胜之。地气才入少腹，适在至阴之界，无事张皇，所以但用阳药加
于阴药内治之，不必偏于阳也。至肾水泛溢，妇人转胞，小便不利，则变其名为肾气丸，而药仍不变。盖收摄肾气，则
肾水归源，而小便自行，亦无取偏阳为矣。观此则治阳虚阴盛之卒病，其当用纯阳无阴，更复何疑。后人于香港脚入腹，
少腹不仁，而见上气喘急，呕吐自汗，不识其证。地气已加于天，袭用此方不应。乃云此证最急，以肾乘心水克火，死
不旋踵。用本方加附桂各一倍，终是五十步笑百步。不达卒病大关，徒以肾乘心水克火，五脏受克为最急，不知五脏互
相克贼。危则危矣，急未急也。厥后朱奉议治香港脚，变八味丸为八味汤，用附子、干姜、芍药、茯苓、甘草、桂心、人
参、白术，其义颇精。于中芍药、甘草、人参，临证更加裁酌，则益精矣。奈何无识之辈，复以此汤插入己见，去桂心，
加干地黄。以阴易阳，奚啻千里，而方书一概混收，讵识其为奉议之罪人乎？
论《三因》治自汗用 附术附参附三方 黄 一两，附子五钱，名 附汤。白术一两、附子五钱，名术附汤。
人参一两、附子五钱，名参附汤。三方治自汗之证，审其合用何方，煎分三服服之。其卫外之阳不固而自汗，则用欧附。
其脾中之阳遏郁而自汗，则用术附。其肾中之阳浮游而自汗，则用参附。凡属阳虚自汗，不能舍三方为治耳。然三方之
用则大矣， 附可以治虚风；术附可以治寒湿；参附可以壮元神。三者亦交相为用，其所以只用二物，比而成汤，不杂
他味者，用其所当用，功效若神，诚足贵也。年高而多姬外家者，每有所失，随进参附汤一小剂。即优为而不劳，仕宦之
家，弥老而貌若童子，得力于此方者颇众。故治自汗一端，不足以尽三方之长也。以黄 、人参为君，其长驾远驭，附
子固不能以自恣，术虽不足以制附，然遇阳虚阴盛，寒湿沉锢，即生附在所必用，亦何取制伏为耶。《金匮》近效白术附
子汤中，即本方加甘草一味，仲景取之以治痹证，岂非以节制之师，缓图其成乎？急证用其全力，即不可制。缓证用其
半力，即不可不制。至如急中之缓，缓中之急，不制而制，制而不制，妙不容言矣。
论《宝鉴》桂附丸 方用川乌、黑附、干姜、赤石脂、川椒、桂六味为丸。疗风邪冷气，入乘心络，脏腑暴感
风寒，上乘于心，令人卒然心痛。或引背膂，乍间乍甚，经久不瘥。按此方原仿《金匮》九痛丸之例，治久心痛而去暴
感风寒，入乘于心，令人卒然心痛。则是素无其病，卒然而痛矣。卒病宜用汤以温之，岂有用丸？且服至一料之理。千
万方中，获此一方，有合往辙，又不达制方之蕴，学人将何所宗乎？况邪在经络，则治其经络；邪在府，则治其府；邪
在脏，则治其脏。此方即变为汤，但可治脏病，不可治府及经络之病。盖脏为阴，可胜纯阳之药。腑为阳，必加阴药一
二味，以监制其 热。经络之浅，又当加和荣卫，并宣导之药矣，因并及之。
论《得效》荜茇丸 虚寒泄泻，宜从温补，固矣。然久泻不同暴病，且有下多亡阴之戒，方中用附子胜寒，当
兼以参、术，如理中之例可也。乃用干姜，复用良姜；用荜茇，复用胡椒；用丁香、复用豆蔻；惟恐不胜其泻，曾不思
五脏气绝于内，则下利不禁。其敢以一派香燥，坐耗脏气耶？后人复制万补丸，虽附子与人参、当归、白术同用，而仍
蹈前辙。丁、沉、乳、茴、草蔻、肉蔻、姜、桂、荜茇，既无所不有，更加阳起、钟乳、赤脂石性之悍。冀图涩止其泻，
而不知尽劫其阴，徒速人脏气之绝耳，用方者鉴诸。
论《本事》温脾汤 学士许叔微制此方，用浓朴、干姜、甘草、桂心、附子各二两，大黄四钱，煎六合顿服。
治锢冷在肠胃间，泄泻腹痛，宜先取去，然后调治，不可畏虚以养病也。叔微所论，深合仲景以温药下之之法，其大黄
止用四钱，更为有见。夫锢冷在肠胃而滑泄矣，即温药中宁敢多用大黄之猛，重困之乎？减而用其五之一，乃知叔微之
得于仲景者深也。仲景云∶病患旧微溏者，栀子汤不可与服。又云∶太阴病脉弱便利，设当行大黄、芍药者宜减之，以
其人胃气弱，易动故也。即是观之，肠胃锢冷之滑泄，而可恣用大黄耶？不用则温药必不能下，而久留之邪，非攻不去；
多用则温药恐不能制，而洞下之势，或至转增。裁酌用之，真足法矣。《玉机》微义，未知此方之渊源，不为首肯，亦何
贵于论方哉。
论《本事》椒附散 治项筋痛连背体，不可转移。方用大附子一枚，炮去皮脐为末。每服二钱，用川椒二十粒，
以白面填满，水一盏，生姜七片，同煎至七分，去椒入盐，空心服。叔微云∶予昔亲患此，服诸药无效，尝忆千金髓，
有肾气攻背强一证，处此方与之，一服瘥。观此而昌阴病论中，所谓地气从背而上入者，项之颈筋粗大，头项若冰，非
臆说矣。夫肾藏真阳，阳盛则百骸温暖，阳衰则一身 寒。至阳微则地气上逆者，其冷若冰，势所必至。此但项筋痛连
背髀，殊非暴证，且独用附子为治，则暴病必借附子全力，大剂服之，不待言矣。少陵诗云∶“奇文共欣赏，疑义相与析。”
安得起宋代之叔微，剧谈阴病乎？
上方用水三升，煮取一升。滤去药渣，加入蜂蜜二升，煎至水气完全蒸发，取得药液二升。体质强壮者服用七合，体质虚弱者服用五合。若病未愈，次日再服，但不可一天内两次服用。另一方治疗寒疝（因寒邪引起的腹部绞痛），症见腹中疼痛、四肢逆冷、手足麻木不仁。如果伴有身体疼痛，且灸法、针刺及其他药物均无效时，使用本方：取桂枝汤（Cinnamon Twig Decoction）五合，稀释使其稍清，初次服用二合。若无知觉反应，则服用三合；仍无反应，再加量至五合。服药后如有醉意般的感觉，或者出现呕吐，说明药已中病（击中病灶）。《外台秘要》中的乌头汤（Aconite Decoction），治疗寒疝腹中绞痛：贼风侵入攻冲五脏，导致拘急不能转侧，发作有定时，使人阴器收缩，手足厥冷，此方即合用桂枝汤方。
大黄附子汤 《金匮要略》治疗胁下偏侧疼痛，发热，脉象紧弦，这是寒证，应用温性药物进行攻下。大黄（二两）、附子（二枚，炮制）、细辛（二两）。以上三味药，用水五升，煮取二升，分三次温服。若体质强壮者，煮取二升半，分三次温服。服药后如人行走四五里的时间间隔，进服一次。
仲景治疗伤寒热邪痞聚于心下，同时夹杂阳气虚衰、阴寒内盛的证候，使用了附子泻心汤的方法。而对于杂病中的胁下偏痛、发热为阳，脉象弦紧为阴寒上逆的情况，又确立了这种“以温药下之”的方法。然而仲景谆谆教导，后世能领会的人很少。《金匮要略》又另有一条说：脉数而紧即为弦，形状像弓弦，按之不移，脉数而弦者，应当攻下其寒。脉紧而迟者，必然心下坚硬。脉大而紧者，阳中有阴，可以攻下。读者如果不理解其旨意，怎么知道这都是关于“以温药下之”的方法呢？所谓“当下其寒”、“阳中有阴”，一经提出，其中的关键要领不就跃然纸上吗？
赤丸 治疗寒气导致的厥逆。茯苓（四两）、乌头（二两，炮制）、半夏（四两，洗，一方用桂枝）、细辛（一两，《千金方》作人参）。以上四味药研成末，加入真朱砂调色，炼蜜为丸，如麻子大。饭前，用酒送服三丸，每日两次。若无效果，适当增加剂量，以见效为度。
以上十二首方剂，引用《金匮要略》的证治内容。
论建中法 伤寒有小建中汤一种方法，即在桂枝汤中加入胶饴（麦芽糖），共六味药，治疗发病二三日心中悸动而烦乱，邪气欲传而未传的证候。因为患者中气气馁弱，不能将邪气送出体外，所以用胶饴的甘味，小小地建立中气以祛除邪气。《金匮要略》有黄芪建中汤一种方法，在小建中汤中加入黄芪，治疗虚劳里急、自汗、表虚肺虚等诸不足证，从而建立其中的卫气。《金匮要略》又有大建中汤一种方法，因为患者阴气上逆，胸中大寒，呕吐不能进食，腹痛至极。使用蜀椒、干姜、人参、胶饴，大力建立其中的阳气，以驱逐浊阴。后人推展其义，称为乐令建中汤，治疗虚劳发热，以此并建其中的营血。称为十四味建中汤，治疗脏气素来虚弱，以此同时建立脾中和肾中的阴阳。仲景为祖，后人为孙，一脉相承，渊源深厚，真是盛大啊。建中如同天子建立中和的极致，揖逊征伐，都是建中内部理所当然的事。虚羸的身体，服用建中汤后，可汗可下，确实足以依靠。至于理中，则是变通“理”的含义；治中，则是分别治疗的含义；补中、温中，无非是惠及先王京国的大端。因为伤寒外邪，逼迫处于体内，治法难以全部适用。仲景仅在方名中以“小”字，示其微意，直到《金匮要略》治疗杂病，才尽建中之义。后人引申触类，曲畅建中之旨。学人必须对前人的方剂，一一领会其大意，这样在心手之间，才能无入而不自得。
论东垣升阳益胃汤、黄芪补胃汤二方。汇方诸书，采集治疗恶寒的证候，其中错误最大。恶寒一证，大率由阳虚所致，有轻微和严重之分。轻微的用桂枝汤加人参、黄芪，严重的并加附子。仲景之法，精备矣。后世完全不究心，只说外感遵仲景，内伤法东垣。取东垣的升阳益胃汤、黄芪补胃汤二方，作为表虚恶寒的治疗，这是不可不辨别的。盖表为阳，表虚即表之阳虚，所以恶寒。这与升阳益胃的方剂，迥不相涉。升阳益胃，是因为患者阳气遏郁于胃土之中，胃虚不能升举其阳，本于内经“火郁发之”的方法，益其胃以发其火也。升阳方中，一半用人参、黄芪、白术、甘草益胃，一半用独活、羌活、防风、柴胡升阳，又因为火本宜降，虽然顺从其性而升之，不得不使用泽泻、黄连之降，以分杀其势，制方的意义如此。至于黄芪补胃汤，则连人参都不用，而用白芷、藁本、升麻、麻黄、黄柏，是大升小降。然而阳火郁于胃土之中，此时寒必兼时热，脉必数实，证必燥渴。若不辨别而简选其方，用来治疗阳虚阴盛、有寒无热、脉微不渴的恶寒，难道不是杀人吗？
论扶阳助胃汤 此方乃东垣弟子罗谦甫所制，治疗虚寒逆上胃痛之证。遵循《内经》“寒淫于内，治以辛热，佐以苦温”的宗旨。用附子、干姜之大辛热者，温中散寒。用草豆蔻、益智仁辛甘大热者，驱逐胃寒，同为主治。用甘草之甘温，白术、陈皮之苦温，温养脾气以佐之。寒水挟木势侮土，故作急痛，用桂以伐肾邪，用芍药以泻肝木，用吴茱萸以泄胸中厥逆之气。三使分猷而出，井井有条。谦甫师事东垣二十年，尽得东垣之学。观此方以扶阳助其胃为名，明是中寒由于胃寒，一似韩愈只讲调和法门，较之升阳益胃，不啻歧途矣。要知道东垣治火郁，发其火则烟熄。谦甫治无火，补其土则气温。用方者可不早辨别吗？《论语》云：“见过于师，方堪传授。见与师齐，减师半德。”谦甫真不愧东垣弟子矣。
论附子理中汤 理中汤，古方也。仲景在伤寒证中，微示不用之意，故太阳误下协热而利，心下痞硬，表里不解，用理中汤加桂枝，而更其名曰桂枝人参汤。及治霍乱证，始仍理中之旧，这说明理中非解外之具。然而人身脾胃之地，总名中土，脾之体阴而用则阳，胃之体阳而用则阴，理中者，兼阴阳体用而理之，升清降浊，两擅其长。若脾肾两脏，阳虚阴盛，本方加附子，又以理中之法兼理其下。以肾中之阳，较脾中之阳，关系更重也。后人更其名曰附子补中汤，换一个“补”字，去兼理之义远矣。《宝鉴》复于本方加白芍、白茯、浓朴、草豆蔻、陈皮，名曰附子温中汤，治中寒腹痛自利，完谷不化，脾胃虚弱，不喜饮食，懒言困倦，嗜卧等证，反重健运之阳，不重蛰藏之阳，扰乱成法，无足取也。夫既重温脾，附子可以不用。既用附子温肾，即不当杂以白芍之酸寒。况完谷不化，亦岂浓朴、陈皮、豆蔻所能胜哉？嗟夫！釜底有火，乃得腐熟水谷。冷灶无烟，世宁有不炊自熟之水谷耶？后人之不逮古昔远矣。今人竞争补肾不如补脾，不知此语出自何典，而庸俗方信为实有是说，岂非俚浅易入耶？又三因桂香丸、洁古浆水散，未免太过。仲醇脾肾双补丸，未免不及。太过则阳亢，不及则阴凝，总不若附子理中之无偏无陂矣。
论增损八味丸 古方崔氏八味丸，用附桂二味阳药，入地黄等六味阴药之中。《金匮要略》取治香港脚上入，少腹不仁，其意颇微。盖地气上加于天，则独用姜附之猛以胜之。地气才入少腹，适在至阴之界，无事张皇，所以但用阳药加于阴药内治之，不必偏于阳也。至肾水泛溢，妇人转胞，小便不利，则变其名为肾气丸，而药仍不变。盖收摄肾气，则肾水归源，而小便自行，亦无取偏阳为矣。观此则治阳虚阴盛之卒病，其当用纯阳无阴，更复何疑。后人于香港脚入腹，少腹不仁，而见上气喘急，呕吐自汗，不识其证。地气已加于天，袭用此方不应。乃云此证最急，以肾乘心水克火，死不旋踵。用本方加附桂各一倍，终是五十步笑百步。不达卒病大关，徒以肾乘心心水克火，五脏受克为最急，不知五脏互相克贼。危则危矣，急未急也。厥后朱奉议治香港脚，变八味丸为八味汤，用附子、干姜、芍药、茯苓、甘草、桂心、人参、白术，其义颇精。于中芍药、甘草、人参，临证更加裁酌，则益精矣。奈何无识之辈，复以此汤插入己见，去桂心，加干地黄。以阴易阳，奚啻千里，而方书一概混收，讵识其为奉议之罪人乎？
论《三因》治自汗用芪附、术附、参附三方 黄芪一两，附子五钱，名芪附汤。白术一两、附子五钱，名术附汤。人参一两、附子五钱，名参附汤。三方治自汗之证，审其合用何方，煎分三服服之。其卫外之阳不固而自汗，则用芪附。其脾中之阳遏郁而自汗，则用术附。其肾中之阳浮游而自汗，则用参附。凡属阳虚自汗，不能舍三方为治耳。然三方之用则大矣，芪附可以治虚风；术附可以治寒湿；参附可以壮元神。三者亦交相为用，其所以只用二物，比而成汤，不杂他味者，用其所当用，功效若神，诚足贵也。年高而多姬妾外家者，每有所失，随进参附汤一小剂。即优为而不劳，仕宦之家，弥老而貌若童子，得力于此方者颇众。故治自汗一端，不足以尽三方之长也。以黄芪、人参为君，其长驾远驭，附子固不能以自恣，术虽不足以制附，然遇阳虚阴盛，寒湿沉锢，即生附在所必用，亦何取制伏为耶。《金匮》近效白术附子汤中，即本方加甘草一味，仲景取之以治痹证，岂非以节制之师，缓图其成乎？急证用其全力，即不可制。缓证用其半力，即不可不制。至如急中之缓，缓中之急，不制而制，制而不制，妙不容言矣。
论《宝鉴》桂附丸 方用川乌、黑附、干姜、赤石脂、川椒、桂六味为丸。疗风邪冷气，入乘心络，脏腑暴感风寒，上乘于心，令人卒然心痛。或引背膂，乍间乍甚，经久不瘥。按此方原仿《金匮》九痛丸之例，治久心痛而去暴感风寒，入乘于心，令人卒然心痛。则是素无其病，卒然而痛矣。卒病宜用汤以温之，岂有用丸？且服至一料之理。千万方中，获此一方，有合往辙，又不达制方之蕴，学人将何所宗乎？况邪在经络，则治其经络；邪在府，则治其府；邪在脏，则治其脏。此方即变为汤，但可治脏病，不可治府及经络之病。盖脏为阴，可胜纯阳之药。腑为阳，必加阴药一二味，以监制其燥热。经络之浅，又当加和荣卫，并宣导之药矣，因并及之。
论《得效》荜茇丸 虚寒泄泻，宜从温补，固矣。然久泻不同暴病，且有下多亡阴之戒，方中用附子胜寒，当兼以参、术，如理中之例可也。乃用干姜，复用良姜；用荜茇，复用胡椒；用丁香、复用豆蔻；惟恐不胜其泻，曾不思五脏气绝于内，则下利不禁。其敢以一派香燥，坐耗脏气耶？后人复制万补丸，虽附子与人参、当归、白术同用，而仍蹈前辙。丁、沉、乳、茴、草蔻、肉蔻、姜、桂、荜茇，既无所不有，更加阳起、钟乳、赤脂石性之悍。冀图涩止其泻，而不知尽劫其阴，徒速人脏气之绝耳，用方者鉴诸。
论《本事》温脾汤 学士许叔微制此方，用浓朴、干姜、甘草、桂心、附子各二两，大黄四钱，煎六合顿服。治锢冷在肠胃间，泄泻腹痛，宜先取去，然后调治，不可畏虚以养病也。叔微所论，深合仲景以温药下之之法，其大黄止用四钱，更为有见。夫锢冷在肠胃而滑泄矣，即温药中宁敢多用大黄之猛，重困之乎？减而用其五之一，乃知叔微之得于仲景者深也。仲景云：“病患旧微溏者，栀子汤不可与服。”又云：“太阴病脉弱便利，设当行大黄、芍药者宜减之，以其人胃气弱，易动故也。”即是观之，肠胃锢冷之滑泄，而可恣用大黄耶？不用则温药必不能下，而久留之邪，非攻不去；多用则温药恐不能制，而洞下之势，或至转增。裁酌用之，真足法矣。《玉机》微义，未知此方之渊源，不为首肯，亦何贵于论方哉。
论《本事》椒附散 治疗项筋痛连背体，不可转移。方用大附子一枚，炮去皮脐为末。每服二钱，用川椒二十粒，以白面填满，水一盏，生姜七片，同煎至七分，去椒入盐，空心服。叔微云：“予昔亲患此，服诸药无效，尝忆千金髓，有肾气攻背强一证，处此方与之，一服瘥。”观此而昌阴病论中，所谓地气从背而上入者，项之颈筋粗大，头项若冰，非臆说矣。夫肾藏真阳，阳盛则百骸温暖，阳衰则一身寒。至阳微则地气上逆者，其冷若冰，势所必至。此但项筋痛连背髀，殊非暴证，且独用附子为治，则暴病必借附子全力，大剂服之，不待言矣。少陵诗云：“奇文共欣赏，疑义相与析。”安得起宋代之叔微，剧谈阴病乎？
The above prescription uses three sheng of water, boiled down to one sheng. Strain the dregs, add two sheng of honey, and simmer until all moisture evaporates, yielding two sheng of liquid. Robust individuals take seven he; frail individuals take five he. If the condition does not improve, administer again the next day, but do not exceed twice a day. Another prescription treats cold hernia (abdominal colic caused by cold pathogen), characterized by abdominal pain, cold limbs, and numbness in hands and feet. If accompanied by body pain, and moxibustion, acupuncture, and other medications fail, use this formula: take five he of Guizhi Tang (Cinnamon Twig Decoction), dilute it slightly for clarity, and initially administer two he. If there is no response, administer three he; if still no response, increase to five he. A sensation akin to drunkenness indicates the medicine has taken effect; vomiting signifies the disease is struck. The Wutou Tang (Aconite Decoction) from *Waitai Mi Yao* treats cold hernia with severe abdominal cramping: when treacherous wind invades and attacks the five zang organs, causing stiffness and inability to turn, occurring at specific times, leading to retraction of the genitals and cold extremities, this formula combines with Guizhi Tang.
Dahuang Fuzi Tang (*Rhubarb and Aconite Decoction*) from *Jingui Yaolue* treats unilateral hypochondriac pain and fever with a tight, string-taut pulse, indicating a cold syndrome; treat with warming purgatives. Dahuang (Rhei Radix et Rhizoma, 2 liang), Fuzii Praeparata (Prepared Aconiti Lateralis Radix, 2 pieces, processed), Xixin (Asari Radix et Rhizoma, 2 liang). Boil these three ingredients in five sheng of water to obtain two sheng, divide into three warm doses. For robust individuals, boil to obtain two and a half sheng, divided into three warm doses. Administer one dose after the time it takes a person to walk four or five li.
Zhongjing treated exterior heat pathogens stagnating in the epigastrium combined with deficiency of yang and excess of yin using the method of Fuzi Xiexin Tang (Aconite Drain the Epigastrium Decoction). For miscellaneous diseases involving unilateral hypochondriac pain and fever (yang aspect) with a string-taut, tight pulse (yin-cold rising), he established the method of "using warming agents to purge." However, few later generations grasped his earnest teachings. *Jingui Yaolue* states: a pulse that is rapid yet tight is string-taut, feeling like a bowstring, unyielding to pressure; rapid and string-taut pulses require purging the cold. A tight and slow pulse indicates hardness in the epigastrium. A large and tight pulse indicates yang containing yin, which can be purged. Readers who fail to understand the intent miss that these all refer to the method of "warming purgation." Mentioning "purge the cold" and "yang contains yin" reveals the golden needle clearly.
Chi Wan (Red Pill) treats cold-induced jue-ni (cold reversal). Fuling (Poria, 4 liang), Wutou (Aconiti Radix, 2 liang, processed), Banxia (Pinelliae Rhizoma, 4 liang, washed; one formula uses Guizhi), Xixin (Asari Radix et Rhizoma, 1 liang; *Qianjin Fang* uses Renshen). Powder the four ingredients, mix with real cinnabar for color, refine honey to make pills the size of hemp seeds. Take three pills before meals with wine, twice daily. Increase dosage gradually until effective.
The above twelve formulas cite syndromes and treatments from *Jingui Yaolue*.
On the Method of Jianzhong (Establishing the Middle): In shaoyang disorders, Xiaojianzhong Tang (Minor Construct the Middle Decoction) adds Jiaoyi (Maltose) to Guizhi Tang, totaling six ingredients, treating palpitations and irritability after two to three days, where the pathogen desires to transmit but has not. Because the patient's middle qi is weak and cannot expel the pathogen, the sweetness of Jiaoyi is used to slightly establish middle qi to dispel the pathogen. *Jingui Yaolue* presents Huangqi Jianzhong Tang (Astragalus Construct the Middle Decoction), adding Huangqi (Astragali Radix) to Xiaojianzhong Tang, treating deficiency consumptive disease with interior urgency, spontaneous sweating, exterior deficiency, lung deficiency, and various insufficiencies, thereby establishing the defensive qi within. *Jingui Yaolue* also presents Dajianzhong Tang (Major Construct the Middle Decoction) for patients with reversing yin qi, severe cold in the chest, vomiting, inability to eat, and extreme abdominal pain. Using Shujiao (Sichuan Pepper), Ganjiang (Zingiberis Rhizoma), Renshen (Ginseng Radix et Rhizoma), and Jiaoyi, it greatly establishes middle yang to drive out turbid yin. Later scholars expanded this meaning: Le Ling Jianzhong Tang treats deficiency consumptive fever by constructing both Ying blood; Shisiwei Jianzhong Tang treats inherent organ weakness by simultaneously constructing spleen and kidney yin-yang. Zhongjing is the ancestor, later scholars are descendants; the lineage is profound and magnificent. Jianzhong is like the Son of Heaven establishing the ultimate harmony; all actions follow naturally. For emaciated bodies, after taking Jianzhong, sweating or purging can be safely employed. Lizhong involves varying the meaning of "regulating"; Zhizhong implies separate treatment; Buzhong and Wenzhong are major benefits to the state. Since exterior pathogens in shaoyang disorders press inward, methods cannot be fully applied. Zhongjing used the character "small" to indicate subtle intent; only in *Jingui Yaolue* treating miscellaneous diseases was the full meaning of Jianzhong realized. Later scholars extended this, allowing learners to master the general principles of predecessors' formulas, achieving effortless mastery.
On Dongyuan's Shengyang Yiwetang (Raise Yang and Benefit Stomach Decoction) and Huangqi Buweitang (Astragalus Tonify Stomach Decoction): Compilations collecting prescriptions for aversion to cold contain significant errors. Aversion to cold is generally due to yang deficiency, varying in severity. Mild cases use Guizhi Tang plus Renshen and Huangqi; severe cases add Fuzi. Zhongjing's methods are precise and complete. Later generations neglect this, claiming exterior disorders follow Zhongjing and interior disorders follow Dongyuan. Using Dongyuan's Shengyang Yiwetang and Huangqi Buweitang for exterior deficiency aversion to cold is incorrect. Exterior is yang; exterior deficiency is exterior yang deficiency, causing aversion to cold. This differs entirely from Shengyang Yiwetang. Shengyang Yiwetang addresses yang suppression within stomach earth due to stomach deficiency failing to raise yang, following the *Neijing* principle of "venting fire stagnation," benefiting the stomach to vent fire. Half the formula uses Renshen, Huangqi, Baizhu, and Gancao to benefit the stomach; half uses Duduo, Qianghuo, Fangfeng, and Chaihu to raise yang. Since fire should descend, Zexie and Huanglian are added to descend and counterbalance the ascending nature. Huangqi Buweitang excludes Renshen, using Baizhi, Gaoben, Shengma, Mahuang, and Huangbai for strong ascending and mild descending. However, if yang fire is suppressed in stomach earth, there must be alternating cold and heat, a rapid and solid pulse, and dry thirst. Using this for yang deficiency with excess yin, cold without heat, faint pulse, and no thirst would be fatal.
On Fuyang Zhuwetang: Formulated by Luo Qianfu, disciple of Dongyuan, for deficiency-cold with rebellious qi causing stomach pain. Following *Neijing*: "Cold invading internally, treat with pungent-hot, assist with bitter-warm." Uses Fuzi and Ganjiang (pungent-hot) to warm middle and scatter cold; Caodoukou and Yizhiren (pungent-sweet-hot) to drive out stomach cold as main treatments. Gancao (sweet-warm), Baizhu, and Chenpi (bitter-warm) nourish spleen qi as assistants. When cold water joins wood to insult earth causing acute pain, Guizhi attacks kidney evil, Shaoyao drains liver wood, and Wuzhuyu vents jue-ni qi in the chest. The three ministers act in order. Luo studied under Dongyuan for twenty years, mastering his learning. Naming this formula "Support Yang and Assist Stomach" clarifies that middle cold stems from stomach cold, resembling Han Yu's harmonizing approach, differing from Shengyang Yiwetang. Dongyuan treats fire stagnation by venting fire to extinguish smoke; Qianfu treats lack of fire by tonifying earth to warm qi. Physicians must distinguish early. As the *Analects* says: "Insight surpassing the teacher allows transmission; insight equal to the teacher reduces virtue by half." Qianfu truly deserves to be Dongyuan's disciple.
On Fuzi Lizhong Tang: Lizhong Tang is an ancient formula. Zhongjing hinted against its use in shaoyang disorders; thus, for taiyang misdirected downward causing協熱利 (coordinated heat diarrhea), epigastric fullness, and unresolved exterior-interior, he added Guizhi to Lizhong Tang, renaming it Guizhi Renshen Tang. Only in treating Huoluan (cholera-like disorder) did he revert to Lizhong, showing it is not for resolving the exterior. The spleen and stomach constitute the central earth. Spleen substance is yin, function is yang; stomach substance is yang, function is yin. Lizhong regulates both substance and function, ascending clear and descending turbid. For spleen-kidney dual yang deficiency with yin excess, adding Fuzi applies Lizhong method to the lower jiao. Kidney yang is more critical than spleen yang. Later scholars renamed it Fuzi Buzhong Tang; changing "Li" (regulate) to "Bu" (tonify) loses the nuance of simultaneous regulation. *Baojian* added Shaoyao, Baifu, Houpo, Caodoukou, and Chenpi to create Fuzi Wenzhong Tang for middle cold, abdominal pain, diarrhea with undigested food, spleen-stomach weakness, poor appetite, lethargy, and desire to lie down. This overemphasizes transportive yang while neglecting storing yang, disrupting established laws. If focusing on warming spleen, Fuzi is unnecessary; if using Fuzi to warm kidney, mixing sour-cold Shaoyao is inappropriate. Undigested food cannot be handled by Houpo, Chenpi, or Doukou alone. Without fire under the pot, grains do not cook spontaneously. Later generations fall far short of antiquity. The claim "tonifying spleen is better than tonifying kidney" lacks canonical basis and is merely vulgar slang. San Yin Guixiang Wan and Jiegu Jiangshui San are excessive; Zhongchun Pishen Shuangbu Wan is insufficient. Excess causes yang hyperactivity; insufficiency causes yin coagulation. None match the balance of Fuzi Lizhong Tang.
On Zengsun Bawei Wan: Ancient Cui Shi Bawei Wan uses Fuzi and Guizhi (yang herbs) among Dihuang and others (yin herbs). *Jingui Yaolue* uses it for Hongjiao (podagra) ascending with insensitivity in the lower abdomen. The intent is subtle: when earth qi ascends to heaven, use potent Ginger and Aconite to overcome it. When earth qi enters the lower abdomen (boundary of extreme yin), avoid alarmism; simply add yang herbs to yin herbs internally without bias toward yang. For kidney water flooding, female urinary retention, use Shenqi Wan (Kidney Qi Pill) with unchanged ingredients. Collecting kidney qi returns water to source, allowing urination, without needing yang bias. Thus, for sudden illness of yang deficiency and yin excess, pure yang formulas are indicated. Later generations mistook Hongjiao entering the abdomen with asthma, vomiting, and sweating as the same syndrome. Earth qi had already reached heaven; repeating this formula fails. Claiming this is most urgent due to kidney attacking heart (water overcoming fire) is wrong. Adding double Fuzi and Guizhi is merely comparing fifty steps to a hundred. Not understanding sudden illness, they focus on five zang mutual overcoming as urgent, missing that danger exists but urgency does not. Later, Zhu Fengyi treated Hongjiao by changing Bawei Wan to Bawei Tang, using Fuzi, Ganjiang, Shaoyao, Fuling, Gancao, Guixin, Renshen, and Baizhu, refining the meaning. Adjusting Shaoyao, Gancao, and Renshen clinically improves precision. Ignorant people altered this by removing Guixin and adding Dihuang, replacing yang with yin, a thousand-mile error, yet recorded indiscriminately in formularies, making them sinners against Fengyi.
On *San Yin* Treating Spontaneous Sweating with Qifu, Shufu, and Shenfu Three Formulas: Huangqi (1 liang) + Fuzi (5 qian) = Qifu Tang. Baizhu (1 liang) + Fuzi (5 qian) = Shufu Tang. Renshen (1 liang) + Fuzi (5 qian) = Shenfu Tang. These three treat spontaneous sweating based on selection. For defensive yang insecurity causing sweating, use Qifu Tang. For spleen yang suppression causing sweating, use Shufu Tang. For kidney yang floating causing sweating, use Shenfu Tang. All yang-deficiency sweating requires these three. Their uses are vast: Qifu treats deficient wind; Shufu treats cold-dampness; Shenfu strengthens primordial spirit. They complement each other. Using only two ingredients creates potent efficacy. Elderly men with many concubines often take small doses of Shenfu Tang after depletion, maintaining vitality. Officials remain youthful using this formula. Thus, treating sweating does not exhaust their potential. With Huangqi and Renshen as sovereigns, Fuzi cannot act arbitrarily. Although Baizhu cannot restrain Fuzi, in cases of yang deficiency, yin excess, and deep cold-dampness, raw Fuzi is essential, requiring no restraint. *Jingui*'s Jin Xiao Baizhu Fuzi Tang adds Gancao to this base, used by Zhongjing for bi-syndrome, acting like a disciplined army achieving results slowly. Acute cases use full force without restraint; chronic cases use half force requiring restraint. The subtleties of acute-chronic interplay are indescribable.
On *Baojian* Guifu Wan: Uses Chuanwu, Heifu, Ganjiang, Chishizhi, Chuanjiao, and Rougui as pills. Treats wind-cold invading heart collaterals, sudden cold-wind affecting viscera ascending to heart, causing sudden heart pain, radiating to back, fluctuating severity, persisting long. This imitates *Jingui* Jiutong Wan but removes sudden cold-wind, treating sudden heart pain in previously healthy individuals. Sudden illness requires decoctions, not pills, especially not a full course. Finding such a formula aligns with past patterns but misunderstands formulation principles. Pathogens in collaterals treat collaterals; in fu organs, treat fu organs; in zang organs, treat zang organs. Even as a decoction, this treats only zang diseases, not fu or collaterals. Zang is yin, tolerating pure yang; fu is yang, requiring yin herbs to moderate heat. Superficial collaterals need harmonizing Ying-Wei and guiding herbs.
On *Defxiao* Bibie Wan: Deficiency-cold diarrhea requires warming tonification. However, chronic diarrhea differs from acute illness; excessive purging harms yin. While Fuzi counters cold, it should combine with Renshen and Baizhu, like Lizhong. Using Ganjiang, Liangjiang, Bibie, Hujiao, Dingxiang, and Doukou fears diarrhea inadequacy, ignoring that internal organ qi exhaustion leads to uncontrollable diarrhea. Using aromatic-dry herbs consumes organ qi. Later Wanbu Wan repeats this, combining Fuzi with Renshen, Danggui, and Baizhu but retaining Dingchen, Rushan, Huixiang, Cao Kou, Rou Kou, Jiang, Gui, and Bibie, plus harsh Yangqi, Zhongru, and Chizhishi. Seeking to stop diarrhea by astringency destroys yin and accelerates organ qi exhaustion. Physicians beware.
On *Benshi* Wenpi Tang: Scholar Xu Shumi formulated this using Houpo, Ganjiang, Gancao, Guixin, and Fuzi (2 liang each), Dahuang (4 qian), boiled to 6 he, taken once. Treats entrenched cold in intestines/stomach causing diarrhea and abdominal pain; purge first, then regulate, fearing deficiency is not an excuse to nurture disease. Xu's discussion aligns deeply with Zhongjing's "warming purgation." Using only 4 qian of Dahuang shows insight. With entrenched cold and slippery diarrhea, daring to use much Dahuang in warming agents would further weaken the patient. Reducing to one-fifth shows Xu's deep understanding of Zhongjing. Zhongjing stated: patients with chronic loose stools cannot take Zhizi Tang; Taiyin disease with weak pulse and free stool requires reducing Dahuang/Shaoyao due to weak stomach qi. Thus, for intestinal cold with slippery diarrhea, arbitrary Dahuuse is wrong. Without it, warming agents cannot purge lingering pathogens; too much overwhelms warming agents, increasing diarrhea. Careful dosing is exemplary. *Yuji* micro-meanings may not recognize this formula's origin, questioning the value of discussing formulas without understanding.
On *Benshi* Jiaofu San: Treats neck tendon pain radiating to back, immobility. Formula: Da Fuzi (1 piece, processed, skin/umbilicus removed, powdered). Take 2 qian, fill 20 Chuanjiao grains with white flour, boil with 1 cup water and 7 slices Shengjiang to 0.7 portion, remove pepper, add salt, take fasting. Xu Shumi said: "I suffered this, other medicines failed. Recalling *Qianjin Sui*, kidney qi attacking back stiffness, I prescribed this, cured in one dose." This confirms Chang's Yin Disease Theory: earth qi ascending from back causes thick neck tendons and ice-cold head/neck. Kidney stores true yang; abundance warms body, deficiency causes cold. Extreme yang weakness leads to earth qi reversal and ice-cold sensation. Neck/back pain is not acute; using Fuzi alone suffices. Acute illness requires full-dose Fuzi. Du Fu's poem: "Appreciate wonderful texts together, analyze doubts together." How to revive Song dynasty Shumi to discuss yin diseases vigorously?