说甚善，已得治实之法矣。然痛证亦有虚实，治法亦有补泻，其辨之之法，不可不详。凡痛而胀闭者多实；不胀不闭者
多虚；痛而拒按者为实；可按者为虚；喜寒者多实；爱热者多虚；饱而甚者多实；饥而甚者多虚。脉实气粗者多实；脉
虚气虚者多虚。新病壮年者多实；愈攻愈剧者多虚。痛在经者脉多弦大；痛在藏者脉多沉微，必兼脉证而察之，则虚实
自有明辨，实者可利，虚者亦可利乎。不当利而利之，则为害不浅。故凡治表虚而痛者，阳不足也，非温经不可。里虚
而痛者，阴不足也，非养营不可。上虚而痛者，心脾受伤也，非补中不可。下虚而痛者，脱泄亡阴也，非速救脾胃，温
补命门不可。夫以温补而治痛者，古人非不多也，惟近代薛立斋、汪石山辈尤得之。奈何明似丹溪，而亦曰诸痛不可补
气，局人意见，岂良法哉？
崆峒子云∶脾土上应乎天，亦属湿化，所以水谷津液不行，即停聚而为痰饮也。夫人之病痰火者十之八九，老人不
宜速降其火，虚人不宜尽去其痰，攻之太甚，则病转剧而致危殆，须以固元气为本。凡病推类而行之，亦思过半矣。昌
按药以胜病，乃致脾胃不能胜药，犹不加察，元气一坏，变症多端。如脾虚而气短不能以续，变而似喘促，尚用降气定
喘之药；如脾虚卫气不行，变而为浮肿，尚用耗气利水之药；如脾虚郁滞，变而作寒热，尚谓外感，用发散之药；虚而
益虚，直令气尽身亡，全不悔祸。复以此法施之他人，展转戕生，可胜诛哉！
国小有虚实分治之法，谓疾病之生也，皆因外感内伤，生火生湿，湿热生痰，四者而已。审其少壮新病，是湿则燥
之，是火则泻之。湿而生热，则燥湿而兼清热；火而生痰，则泻火而兼豁痰，无余蕴矣。审其衰老久病，又当攻补兼施。
如气虚而有湿热痰火，则以四君子汤补气，而兼燥湿、清热、豁痰、泻火；如血虚而有痰火湿热，则以四物汤补血，而
兼泻火豁痰、清热、燥湿，如此则攻补合宜，庶乎可也。故曰少壮新病，攻邪可审；老衰久病，补益为先。若夫阴虚火
动，脾胃衰弱，真阴者水也，脾胃者土也，土虽喜燥，然太燥则草木枯槁；水虽喜润，然太润则草木湿烂；是以补脾滋
肾之剂，务在燥湿得宜，随证加减焉耳。
国小有火湿分治之法，谓肥人气虚生寒，寒生湿，湿生痰。瘦人血虚生热，热生火，火生燥。故肥人多寒湿，瘦人
多热燥也。
治病分国中末三法∶初治之道。法当猛峻。缘病得之新暴。当以疾利猛峻之药急去之。不使病邪久居身中为害也。
中治之道，法当宽猛相济。为病得之非新非久，当以缓疾得中，养正去邪，相济而兼治之。末治之道，治当宽缓，广服
平善无毒，用其安中养血气，俾邪自去。
治病有和、取、从、折、属五法∶一治曰和，假令小热之气，当以凉药和之。二治曰取，为热势稍大，当以寒药取
之。三治曰从，为热势既甚，当以温药从之，或寒因热用，或寒以温用，或以汗发之。四治曰折，谓病热极甚，当以逆
制之，或以下夺之，五治曰属，为求其属以衰之。缘热深陷在骨髓，无法可出，针药所不能及，故求其属以衰之。昌按
求属之法，《内经》明谓诸寒之而热者取之阴，热之而寒者取之阳，所谓求其属也。又谓大寒而甚，热之不热，是无火也，
当助其心；大热而甚，寒之不寒，是无水也，当助其肾。又谓取心者不必齐以热，取肾者不必齐以寒，但益心之阳，寒
亦通行。强肾之阴，热之犹可，妙义精切若此。本文插入不通无着之语，火衰于戌，金衰于辰，盲瞽后人，今特正之。
治病有八要，八要不审，病不能去，非病不去，医无可去之术也。故须辨审八要，庶不有误。其一曰虚，五虚是也，
脉细、皮寒、气少、泄泻前后、饮食不进，此为五虚。二曰实，五实是也，脉盛、皮热、腹胀、前后不通、闷瞀，此五
实也。三曰冷，脏腑受其积冷是也。四曰热，脏腑受其积热是也。五曰邪，非脏腑正病也。六曰正，非外邪所中也。七
曰内，病不在外也。八曰外，病不在内也。审此八要，参以脉候病机，乃不至于有误。
学士商辂云∶医者意也，如对敌之将，操舟之工。贵乎临机应变，方固难于尽用，然非方则古人之心弗传，茫如望
洋如捕风，必有率意而失之者矣。方果可以不用乎？虽然方固良矣，然必熟之《素问》，以求其本；熟之本草，以究其用；
熟之诊视；以察其证；熟之治疗，以通其变，始于用方而终至于无俟于方，夫然后医之道成矣。此论学医用方，最为精
切。
《柏斋三书》云∶药之治病，各有所主。主治者君也；辅治者臣也；与君相反而相助者佐也；引经及引治病之药至
于病所者使也。如治寒病用热药，则热药君也，凡温热之药，皆辅君者也，臣也。然或热药之过甚而有害也，须少用寒
凉药以监制之，使热药不至为害，此则所谓佐也。至于五脏六腑及病之所在，各须有引导之药，使药与病相遇，此则所
谓使也。余病推此，按柏斋此论，乃用药之权，最为精切。旧谓一君、二臣、三佐、四使为定法，此未可泥。药性论又
以众药之和浓者定为君，其次为臣为佐，有毒者多为使，此说殊谬。设若削坚破积，大黄、巴豆辈，岂得不为君耶？
晋时才人，欲刊正《周易》及诸药方，先与祖讷共论，讷曰辨释经典，纵有异同，不足以伤风教。至于汤药小小不
达，便致寿夭所由，则后人受弊不少，何可轻以裁断。祖讷之言，可谓仁矣，今天下才士励志医学，正可入理深谭，乃
效齐人惟知管晏，以《陶氏六书》窜入仲景成法，后人受弊，更当何如？
夫医者非仁爱之士不可托也。非聪明达理，不可任也，非廉洁淳良，不可信也。是以古之用医，必选明良，其德能
仁恕博爱，其智能宣畅曲解，能知天地神祗之次，能明性命吉凶之数，处虚实之分，定顺逆之节，原疾病之轻重，而量
药剂之多少，贯微洞幽，不失细少，如此乃谓良医。岂区区俗学能之哉？（《初学记》）
医以活人为务，与吾儒道最切近。自《唐书》列之技艺，而吾儒不屑为之。世之习医者，不过诵一家之成说，守一
定之方，以幸病之偶中，不复深为探索，上求圣贤之意，以明夫阴阳造化之会归，又不能博极群书，采择众议，以资论
治之权变。甚者至于尽弃古方，附会臆见，展转以相迷，而其为患不少矣！是岂圣贤慈惠生民之盛意哉？昌按春秋时，
左氏谭医理甚悉，汉儒已不习医，太史公作仓公等列传，鲜所发明，况其他乎？其后如《华元化传》，寝涉妖妄，医脉
之断，实儒者先断之也。有唐列之方技，无足怪矣。《九灵山房文集》所论医者，当博极群书，求圣贤之意旨，明造化
之会归，其属望顾不大欤？（戴叔明）
医之为道，非精不能明其理，非博不能至其约。是故前人立教，必使之先读儒书，明《易理》、《素》、《难》、《本草》、
《脉经》而不少略者何？盖非四书无以通义理之精微，非《易》无以知阴阳之消长；非《素问》无以识病；非《本草》
无以识药；非《脉经》无从诊候而知寒热虚实之证。圣贤示人，略举其端而已。后学必须会群书之长，参所见而施治之，
然后为可。（《医学集成》）
正五音者，必法师旷之律吕。成方员者，必法公输之规矩。五音方员，特末技耳，尚取精于其事者，况医为人之司
命，不精则杀人。今之患者不达此理，委命于时医，与自暴自弃，甘于沟渎何异？故病有六失∶失于不审、失于不信、
失于过时、失于不择医、失于不知病、失于不知药。又《史记》云∶骄恣不伦于理一不治。轻身重财二不治、衣食不能
适三不治、阴阳并藏气不定四不治、形羸不能服药五不治、信巫不信医六不治，今时病家此其通弊矣。（本集）
世间多有病患亲友故旧交游来问疾，其人曾不经事，未读方书，自骋了了，诈作明能，谭说异端。或言是虚，或道
是实；或云是风，或云是气；纷纷谬说，种种不同；破坏病患心意，不知孰是；迁延未就，时不待人； 然至祸，此段
情态，今时尤甚。（孙思邈）
说得很对，这已经掌握了治疗实证的方法。然而疼痛病症也有虚实之分，治疗方法也有补泻之别，辨别它们的方法，不可不详细考察。凡是疼痛且伴有胀满闭塞的多为实证；不胀不闭塞的多为虚证；疼痛且拒绝按压的为实证；可以按压的为虚证；喜欢寒冷刺激的多为实证；喜爱温热刺激的多为虚证；饱食后疼痛加重的多为实证；饥饿时疼痛加重的多为虚证。脉象实、气息粗壮的多为实证；脉象虚、气息微弱的多为虚证。新近患病且正值壮年的多为实证；越攻伐病情越严重的多为虚证。疼痛在经络的，脉象多弦大；疼痛在脏腑的，脉象多沉微，必须结合脉象和症状来观察，那么虚实自然有明确的辨别，实证可以用通利法，虚证也可以用通利法吗？不当用通利法而用了，那么危害就不浅了。所以凡是治疗表虚而痛的，是阳气不足，不用温经法是不行的。里虚而痛的，是阴血不足，不用滋养营血法是不行的。上虚而痛的，是心脾受损，不用补中益气法是不行的。下虚而痛的，是泄泻亡失阴液，不用迅速救治脾胃、温补命门法是不行的。用温补法治痛，古人并非不多见，只是近代的薛立斋、汪石山等人尤其深得此道。为何明似朱丹溪，却说各种疼痛不可补气，这是拘泥于个人见解，难道是良法吗？
崆峒子说：脾土上应乎天，也属于湿化，所以水谷津液不能正常运行，就会停滞积聚成为痰饮。人患痰火病的十之八九，老人不宜迅速降火，虚人不宜完全去除痰饮，攻伐太过，则病情反而加重导致危殆，必须以固护元气为根本。凡是疾病推演其理并依此而行，也就明白大半了。我（喻昌）按语：药物是用来战胜疾病的，如果导致脾胃不能承受药力，还不加以考察，一旦元气败坏，变症百出。比如脾虚而气短接续不上，变化得像喘促，还使用降气定喘的药物；比如脾虚卫气不能运行，变化为浮肿，还使用耗气利水的药物；比如脾虚郁滞，变化为寒热往来，还认为是外感，使用发散的药物；使虚者更虚，简直让人气尽身亡，完全不后悔灾祸。再用这种方法施加给别人，辗转残害生命，哪里能杀得完呢！
国小（人名）有虚实分治的方法，说疾病的产生，都是因为外感内伤，生火生湿，湿热生痰，不过是这四种情况罢了。审视其年少强壮新近患病，如果是湿则燥湿，如果是火则泻火。湿而生热，则燥湿兼清热；火而生痰，则泻火兼豁痰，就没有遗漏了。审视其衰老久病，又应当攻补兼施。比如气虚而有湿热痰火，就用四君子汤补气，而兼燥湿、清热、豁痰、泻火；比如血虚而有痰火湿热，就用四物汤补血，而兼泻火豁痰、清热、燥湿，这样攻补合宜，才可以。所以说年少强壮新近患病，攻邪可以审慎；老衰久病，补益为先。至于阴虚火动，脾胃衰弱，真阴是水，脾胃是土，土虽然喜燥，但是太燥则草木枯槁；水虽然喜润，但是太润则草木湿烂；所以补脾滋肾的药剂，务必在燥湿得当，随证加减罢了。
国小有火湿分治的方法，说肥人气虚生寒，寒生湿，湿生痰。瘦人血虚生热，热生火，火生燥。所以肥人多寒湿，瘦人多热燥。
治病分为初、中、末三法：初治之道，方法应当猛峻。因为病是新近突然得的，应当用疾速猛烈之药急去病邪，不让病邪久居体内为害。中治之道，方法应当宽猛相济。因为病来得非新非久，应当以缓急适中，扶正祛邪，相辅相成兼治。末治之道，治疗应当宽缓，广泛服用平和善良无毒的药物，用以安中养血气，让邪气自行离去。
治病有和、取、从、折、属五法：一治叫和，假如是小热之气，应当用凉药调和它。二治叫取，因为热势稍大，应当用寒药攻取它。三治叫从，因为热势已经很甚，应当用温药顺从它，或者寒药热服，或者寒药温服，或者用发汗法。四治叫折，谓病热极甚，应当用逆制法，或者用泻下法。五治叫属，为寻求其所属本源以衰退病势。因为热深陷在骨髓，无法排出，针药所不能及，所以寻求其所属本源以衰退病势。我（喻昌）按语：求属的方法，《内经》明确说诸寒之而热者取之阴，热之而寒者取之阳，这就是所谓的求其属。又说大寒而甚，热之不热，是无火也，应当助其心；大热而甚，寒之不寒，是无水也，应当助其肾。又说取心者不必齐以热，取肾者不必齐以寒，只要益心之阳，寒亦通行。强肾之阴，热之犹可，妙义精切如此。本文插入不通无着之语，火衰于戌，金衰于辰，盲目蒙蔽后人，现在特别纠正它。
治病有八要，八要不审察，病不能去除，不是病不去除，而是医生没有去除病的手段。所以必须辨审八要，才不至于有误。其一曰虚，五虚就是，脉细、皮寒、气少、泄泻前后二便、饮食不进，这叫五虚。二曰实，五实就是，脉盛、皮热、腹胀、前后不通、闷瞀，这叫五实。三曰冷，脏腑受其积冷是也。四曰热，脏腑受其积热是也。五曰邪，非脏腑正病也。六曰正，非外邪所中也。七曰内，病不在外也。八曰外，病不在内也。审察这八要，参以脉候病机，才不至于有误。
学士商辂说：医者意也，就像面对敌人的将领，操纵船只的工匠。贵在临机应变，方剂固然难以穷尽使用，但是没有方剂，古人的心意就无法传承，茫然如望洋兴叹如捕风捉影，必定有随意行事而失误的人。方剂真的可以不用吗？虽然方剂固然好，但是必须熟读《素问》，以求其根本；熟读本草，以探究其用途；熟读诊视，以察其证候；熟读治疗，以通晓其变化，始于用方而最终达到不需要依赖方剂，这样医道才算成就。这个论述学医用方，最为精切。
《柏斋三书》说：药物治病，各有所主。主治的是君药；辅助治疗的是臣药；与君药相反但相助的是佐药；引导药物到达病所的是使药。比如治寒病用热药，那么热药是君药，凡是温热之药，都是辅佐君药的，是臣药。然而如果热药过甚而有害，须少量用寒凉药以监制它，使热药不至为害，这就是所谓的佐药。至于五脏六腑及病之所在，各需要有引导之药，使药与病相遇，这就是所谓的使药。其余病症类推。按照柏斋的这个论述，乃是用药的权衡，最为精切。旧说一君、二臣、三佐、四使为定法，这个不可拘泥。药性论又以众药之和浓者定为君，其次为臣为佐，有毒者多为使，这种说法很荒谬。假设若是削坚破积，大黄、巴豆之类，难道得不为君药吗？
晋朝才子，想要刊正《周易》及诸药方，先与祖讷共同讨论，祖讦说：辨释经典，纵有异同，不足以伤风教。至于汤药小小不达，便致寿夭所由，则后人受弊不少，何可轻以裁断。祖讷的话，可谓仁爱了，如今天下才士立志医学，正可深入道理谈论，却效仿齐国人只知道管仲晏婴，把《陶氏六书》窜入张仲景成法，后人受弊，更是如何呢？
大夫不是仁爱之士不可以托付，不是聪明达理的不可以任用，不是廉洁淳良的不可以信任。所以古代用医，必选明良，其德能仁恕博爱，其智能宣畅曲解，能知天地神祗之次，能明性命吉凶之数，处虚实之分，定顺逆之节，原疾病之轻重，而量药剂之多少，贯微洞幽，不失细少，这样才叫良医。岂是区区俗学能做到的呢？（《初学记》）
医以活人为务，与吾儒道最切近。自《唐书》列之技艺，而吾儒不屑为之。世之习医者，不过诵一家之成说，守一定之方，以幸病之偶中，不复深为探索，上求圣贤之意，以明夫阴阳造化之会归，又不能博极群书，采择众议，以资论治之权变。甚者至于尽弃古方，附会臆见，展转以相迷，而其为患不少矣！这难道是圣贤慈惠生民的盛意吗？我（喻昌）按语：春秋时，左氏谭医理甚悉，汉儒已不习医，太史公作仓公等列传，鲜所发明，况其他乎？其后如《华元化传》，寝涉妖妄，医脉之断，实儒者先断之也。有唐列之方技，无足怪矣。《九灵山房文集》所论医者，当博极群书，求圣贤之意旨，明造化之会归，其属望顾不大欤？（戴叔明）
医之为道，非精不能明其理，非博不能至其约。所以前人立教，必使之先读儒书，明《易理》、《素》、《难》、《本草》、《脉经》而不少略者何？盖非四书无以通义理之精微，非《易》无以知阴阳之消长；非《素问》无以识病；非《本草》无以识药；非《脉经》无从诊候而知寒热虚实之证。圣贤示人，略举其端而已。后学必须会群书之长，参所见而施治之，然后为可。（《医学集成》）
正五音者，必法师旷之律吕。成方员者，必法公输之规矩。五音方员，特末技耳，尚取精于其事者，况医为人之司命，不精则杀人。今之患者不达此理，委命于时医，与自暴自弃，甘于沟渎何异？故病有六失：失于不审、失于不信、失于过时、失于不择医、失于不知病、失于不知药。又《史记》云：骄恣不伦于理一不治。轻身重财二不治、衣食不能适三不治、阴阳并藏气不定四不治、形羸不能服药五不治、信巫不信医六不治，今时病家此其通弊矣。（本集）
世间多有病患亲友故旧交游来问疾，其人曾不经事，未读方书，自骋了了，诈作明能，谭说异端。或言是虚，或道是实；或云是风，或云是气；纷纷谬说，种种不同；破坏病患心意，不知孰是；迁延未就，时不待人； 然至祸，这段情态，今时尤甚。（孙思邈）
It is well said; the method for treating excess patterns has been grasped. However, pain syndromes also have deficiency and excess distinctions, and treatment methods include tonification and purgation. The methods for differentiation must be examined in detail. Generally, pain accompanied by distension and obstruction indicates excess; pain without distension or obstruction indicates deficiency. Pain that refuses pressure indicates excess; pain that can be pressed indicates deficiency. Preference for cold indicates excess; preference for heat indicates deficiency. Aggravation after fullness indicates excess; aggravation on an empty stomach indicates deficiency. A surging pulse with coarse breathing indicates excess; a deficient pulse with weak breathing indicates deficiency. Recent onset in young adults indicates excess; worsening with aggressive treatment indicates deficiency. Pain in the meridians often presents with wiry and large pulses; pain in the zang-organs often presents with deep and faint pulses. One must observe both pulse and symptoms to clearly distinguish between deficiency and excess. Can excess conditions be treated with draining methods? Can deficiency conditions also be treated with draining methods? If draining is used when inappropriate, the harm will be profound. Therefore, for exterior deficiency causing pain, it is due to insufficient Yang Qi (Yang energy); warming the meridians is indispensable. For interior deficiency causing pain, it is due to insufficient Yin Blood (Yin fluid); nourishing the Ying (Nutritive) level is indispensable. For upper deficiency causing pain, it is injury to the Heart and Spleen; tonifying the Middle Jiao (Middle Burner) is indispensable. For lower deficiency causing pain, it is loss of Yin fluids through diarrhea or leakage; rapidly rescuing the Spleen and Stomach and warming the Mingmen (Gate of Life) is indispensable. Using warming and tonifying methods to treat pain was not uncommon among ancient physicians, but figures like Xue Lizhai and Wang Shishan in recent times particularly mastered this approach. Why did Zhu Danxi, who seemed enlightened, state that "all pains should not be treated with Qi-tonifying herbs"? This is merely adhering to personal opinion; is it truly a good method?
Kongtongzi stated: The Earth element of the Spleen corresponds to Heaven above and belongs to the transformation of Dampness. Thus, if the fluids from food and water fail to circulate, they stagnate and accumulate to form Phlegm-Fluids (Tan-Yin). Eight or nine out of ten patients suffer from Phlegm-Fire. Elderly people should not have their Fire rapidly reduced, and deficient individuals should not have their Phlegm completely eliminated. Over-aggressive attack will worsen the condition and lead to danger; one must take consolidating Yuan Qi (Original Energy) as the foundation. By applying this reasoning to diseases, one understands more than half. I (Yu Chang) note: Medicines are meant to overcome disease, but if they overwhelm the Spleen and Stomach's capacity to bear them, and this is not observed, once Yuan Qi is damaged, myriad complications arise. For example, if Spleen deficiency causes shortness of breath that cannot continue, transforming into apparent panting, yet one still uses Qi-descending and pantling-stopping herbs; if Spleen deficiency prevents Wei (Defensive) Qi from circulating, transforming into edema, yet one still uses Qi-consuming and diuretic herbs; if Spleen deficiency causes stagnation, transforming into alternating chills and fever, yet one assumes external invasion and uses dispersing herbs—this makes the deficient even more deficient, leading to exhaustion of Qi and death, with no remorse for the disaster. Applying such methods to others results in endless killing, which is unpardonable!
Guo Xiao proposed a method of differentiating deficiency and excess in treatment. He stated that diseases arise from external invasions and internal injuries, generating Fire and Dampness; Dampness and Heat generate Phlegm. These four factors suffice. For young, strong individuals with recent illness: if it is Dampness, dry it; if it is Fire, purge it. If Dampness generates Heat, dry Dampness and clear Heat simultaneously; if Fire generates Phlegm, purge Fire and resolve Phlegm simultaneously, leaving nothing unaddressed. For elderly individuals with chronic illness, one must combine attacking and tonifying. For instance, if Qi deficiency exists alongside Damp-Heat, Phlegm, and Fire, use Si Jun Zi Tang (Four Gentlemen Decoction) to tonify Qi, while simultaneously drying Dampness, clearing Heat, resolving Phlegm, and purging Fire. If Blood deficiency exists alongside Phlegm-Fire, Damp-Heat, use Si Wu Tang (Four Substances Decoction) to tonify Blood, while simultaneously purging Fire, resolving Phlegm, clearing Heat, and drying Dampness. In this way, attacking and tonifying are appropriate. Thus, it is said: for young, strong individuals with recent illness, attacking pathogens can be assessed carefully; for the elderly and those with chronic illness, tonification comes first. Regarding Yin deficiency with Fire hyperactivity and Spleen-Stomach weakness: True Yin is Water, and Spleen-Stomach is Earth. Although Earth prefers dryness, excessive dryness causes vegetation to wither; although Water prefers moisture, excessive moisture causes vegetation to rot. Therefore, formulas for tonifying Spleen and nourishing Kidney must ensure proper balance of dryness and moisture, adjusted according to symptoms.
Guo Xiao also proposed a method of differentiating Fire and Dampness. He stated that obese individuals have Qi deficiency generating Cold, Cold generating Dampness, and Dampness generating Phlegm. Emaciated individuals have Blood deficiency generating Heat, Heat generating Fire, and Fire generating Dryness. Thus, obese people mostly suffer from Cold-Dampness, while emaciated people mostly suffer from Heat-Dryness.
Treating disease involves three stages: Initial, Middle, and Terminal. The Initial stage requires fierce and drastic methods because the disease is new and sudden; one must urgently remove pathogens with rapid, potent medicines to prevent them from lingering and harming the body. The Middle stage requires a balance of leniency and severity. Since the disease is neither new nor long-standing, one must act with moderate speed, nurturing righteousness (Zheng Qi) while removing pathogens, combining both approaches. The Terminal stage requires lenient and slow methods; one should widely administer mild, safe, non-toxic medicines to stabilize the Middle Jiao and nourish Qi and Blood, allowing pathogens to depart naturally.
There are five methods for treating disease: Harmonizing (He), Taking/Attacking (Qu), Following (Cong), Breaking/Restraining (Zhe), and Seeking the Root/Category (Shu).
1. Harmonizing: For mild heat, use cool medicines to harmonize.
2. Taking: For slightly intense heat, use cold medicines to attack/purge.
3. Following: For severe heat, use warm medicines to follow/comply, or administer cold medicine hot, or cold medicine warm, or induce sweating.
4. Breaking: For extreme heat, use counteracting methods, such as purgation.
5. Seeking the Root: When heat sinks deeply into the marrow and cannot be expelled by needles or medicines, seek its root category to diminish it.
I (Yu Chang) note: The method of "seeking the root" is explicitly stated in the *Neijing* (Inner Canon): "For those who become hotter despite cold treatment, treat the Yin; for those who become colder despite heat treatment, treat the Yang." This is seeking the root. It also states: "If great cold persists and heating fails to warm, there is no Fire; assist the Heart." "If great heat persists and cooling fails to cool, there is no Water; assist the Kidney." Furthermore, "Assisting the Heart does not require uniform heat; assisting the Kidney does not require uniform cold." Simply benefiting Heart Yang allows cold to circulate; strengthening Kidney Yin allows heat to dissipate. The meaning is subtle and precise. The text inserts nonsensical phrases about Fire declining at Xu hour and Metal declining at Chen hour, blinding future generations; I correct this here.
There are eight essentials in treating disease. If these eight are not examined, the disease cannot be removed—not because the disease won't go, but because the physician lacks the means. One must discern these eight essentials to avoid error.
1. Deficiency: The Five Deficiencies—fine pulse, cold skin, shortness of breath, diarrhea/incontinence, inability to eat.
2. Excess: The Five Excesses—surging pulse, hot skin, abdominal distension, blockage of bowels/bladder, oppression/dizziness.
3. Cold: Accumulated cold in Zang-Fu organs.
4. Heat: Accumulated heat in Zang-Fu organs.
5. Pathogen: Disease not originating from Zang-Fu organs themselves.
6. Righteousness (Zheng): Not invaded by external pathogens.
7. Interior: Disease not located externally.
8. Exterior: Disease not located internally. Examining these eight essentials, combined with pulse diagnosis and pathogenesis analysis, prevents error.
Scholar Shang Lu said: Medicine relies on intuition, like a general facing an enemy or a boatman navigating waters. It values adapting to circumstances. Formulas are hard to apply exhaustively, but without them, the wisdom of ancients is lost, leaving one茫然 like gazing at the ocean or catching wind, inevitably leading to arbitrary errors. Can formulas be unused? Although formulas are good, one must master the *Suwen* (Basic Questions) to find the root; master Materia Medica to understand usage; master diagnosis to observe symptoms; master treatment to understand variations. Starting with using formulas and ending with needing no formulas—that is the completion of medical Dao. This discussion on learning and using formulas is most precise.
The *Bai Zhai San Shu* states: Each medicine has its specific function. The primary agent is the Sovereign (Jun) herb; assistants are Ministers (Chen) herbs; those contrary to the Sovereign but aiding it are Assistant (Zuo) herbs; those guiding other herbs to the lesion are Envoy (Shi) herbs. For example, treating Cold with Hot herbs makes the Hot herb the Sovereign; all warming herbs serve as Ministers. However, if Hot herbs are too strong and harmful, a small amount of Cold/Cool herbs is added to control them, preventing harm—this is the Assistant role. For each Zang-Fu organ and lesion site, guiding herbs are needed to bring the medicine to the disease—this is the Envoy role. Other diseases follow this logic. Bai Zhai's theory on medication weighting is precise. The old rule of "One Sovereign, Two Ministers, Three Assistants, Four Envoys" should not be rigidly applied. The *Materia Medica Theory* claims the herb with the strongest flavor is Sovereign, followed by Minister/Assistant, and toxic herbs are Envoys; this is absurd. If breaking hardness and eliminating accumulations, how could Da Huang (Rhubarb) or Ba Dou (Croton Seed) not be Sovereign?
A Jin dynasty scholar wished to correct the *I Ching* and various medical formulas, discussing this with Zu Ne. Zu Ne said: Correcting classics, even with differences, does not harm moral teachings. But slight errors in decoctions determine life and death, causing much harm to later generations; one should not lightly judge them. Zu Ne's words were benevolent. Today, talented scholars aspiring to medicine should delve into deep principles, yet they imitate Qi people knowing only Guan Zhong and Yan Ying, inserting *Tao Shi Liu Shu* into Zhang Zhongjing's established methods, causing even greater harm to later generations.
A physician must be entrusted only to those with Ren (Benevolence); appointed only to those intelligent and logical; trusted only to those honest and pure. Ancient selection of physicians required virtue of benevolence and broad love, intelligence for clear understanding, knowledge of heaven and earth, understanding of life/death and fortune/misfortune, distinguishing deficiency/excess, determining favorable/unfavorable trends, assessing disease severity, and dosing accurately. Only such profound insight qualifies as a good physician. How can superficial scholarship achieve this? (*Chuxue Ji*)
Medicine aims to save lives, closely aligning with Confucian Dao. Since the *Book of Tang* listed it as a skill, Confucians disdained it. Practitioners today merely recite one school's theories, stick to fixed formulas, hoping for accidental success, without exploring deeper to understand the integration of Yin-Yang and creation, nor reading broadly to adapt treatments. Worse, they abandon ancient formulas, attach to subjective views, confusing each other, causing much harm. Is this the sincere intent of sages to benefit people? I (Yu Chang) note: During the Spring and Autumn period, Zuo Qiuming discussed medical principles thoroughly; Han Confucians neglected medicine; Sima Qian's biography of Cang Gong rarely elaborated; what of others? Later, biographies like Hua Tuo's became mythical. The break in medical lineage was actually initiated by Confucians. Thus, listing medicine as a technical skill in Tang is not surprising. The *Jiu Lingshan Fang Wenji* argues physicians must read broadly, seek sage wisdom, and understand creation's integration—isn't this expectation grand? (Dai Shuming)
The Dao of medicine requires precision to understand principles and breadth to reach simplicity. Hence, predecessors insisted students first read Confucian classics, mastering *Yi Li*, *Suwen*, *Nanjing*, *Bencao*, and *Maichuang*. Why? Without the Four Books, one cannot grasp subtle principles; without *I Ching*, one cannot know Yin-Yang waxing/waning; without *Suwen*, one cannot recognize disease; without *Bencao*, one cannot recognize herbs; without *Maichuang*, one cannot diagnose cold/heat/deficiency/excess. Sages briefly outlined the beginning. Students must synthesize strengths of many books, combine insights, and treat accordingly. (*Yixue Jicheng*)
To tune pentatonic notes, one must follow Shi Kuang's pitch pipes. To make squares/circles, one must follow Gongshu Ban's compass/square. Musical and geometric skills are minor arts, yet experts are sought; how much more so for medicine, which holds life and death? Imprecision kills. Patients today do not understand this, entrusting fate to contemporary doctors, equivalent to self-abandonment. Thus, six failures in illness: failure to examine carefully, failure to believe, delay, failure to choose doctor wisely, ignorance of disease, ignorance of medicine. Also, *Shiji* lists six untreatable cases: arrogant/illogical, valuing wealth over health, improper clothing/diet, chaotic Yin-Yang/Zang-Qi, emaciation unable to take medicine, believing in witchcraft over medicine. These are common faults of modern patients. (From this collection)
Many relatives/friends ask about illnesses, having no experience or reading formulas, pretending to be knowledgeable, spreading heretical theories. Some say deficiency, some excess; some wind, some Qi; conflicting false statements confuse patients, delaying treatment until disaster strikes. This situation is especially prevalent today. (Sun Simiao)