一人见予所着医案中，有开手即补者，有邪未尽去而间用补者，有邪才去而用峻补者，
乃讶
之。予告之曰∶古来名医，莫如仲景，病邪之甚，莫若伤寒。仲景立一百一十三方，七十余
方皆用人参，谓邪之所凑，其气必虚，故于表散中用人参，清疏中用人参，温剂中用人参。
予之邪未尽而间用补者，是法仲景也。后世名医，如金之东垣，明之介宾，亦为表表者。东
垣补中益气等汤，治劳倦内伤，其效如神；介宾八阵方中一阴煎至四阴煎等汤，治血虚发热
，其效亦如神。予之开手即补，乃法东垣、介宾也。至于邪已去而用补者，庸人之技耳，何
待辨哉？盖予之为治，贫乏居多，其患每由劳倦而得。《脾胃论》言之甚详，姑再述其要者
，以见意焉。开手即补，其要端有三∶先视其色，面无黑滞油气，再问明身热恶寒，若卧于
被中，则体不寒，或自汗不思纳，纳亦无味，肢软气弱，舌上微胎不渴，脉浮大而软，小便
微赤而长，正属劳倦内伤，合补中益气。若其人身热不恶寒，盗汗舌绛少胎，喜饮而不消水
，面带微红，脉细数无力，此为阴亏发热，合四物四阴煎等汤。或有劳倦兼血虚者，以上之
症，间而有之，合八物或补中益气，加生地、归身、麦冬之类。至若久病，或疗治未痊，正
气已虚，留邪未尽，理应清疏中佐补，补剂中佐彻邪，辨症稍涉疑似。不但用补药误人，清
疏
温泻，何一不误人。况予之虚心，君不得而知也。每遇用或攻或补或寒或热之剂，常另立一
簿，录出方案。若复诊，必悉其情；如不复诊，必再四探听，服剂已痊，中心始安。医案所
述，尽如此也。客闻之，唯唯而退。
有一位客人看到我编写的医案中，有的治疗一开始就使用补法，有的在病邪尚未完全清除时偶尔使用补药，还有的在病邪刚刚去除时就使用峻猛的补药，对此感到惊讶。我告诉他说：自古以来著名的医生，没有比得上张仲景的；而病邪之严重，没有超过伤寒病的。张仲景创立了一百一十三首方剂，其中七十多首方剂都使用了人参，这是因为“邪气聚集的地方，正气必然虚弱”，所以在解表散邪的药中加入人参，在清热疏利的药中加入人参，在温里药中也加入人参。我所说的在病邪未尽时偶尔使用补药，是效法张仲景的方法。后世的著名医生，如金代的李东垣、明代的赵献可（号介宾），也是其中的佼佼者。李东垣的补中益气汤等方剂，治疗劳倦内伤，效果神奇；赵献可在《医贯》八阵方中的从一阴煎到四阴煎等方剂，治疗血虚发热，效果也同样神奇。我所说的治疗一开始就使用补法，是效法李东垣和赵献可的方法。至于病邪已经去除才使用补药，那是平庸医生的技艺罢了，哪里值得辩驳呢？大概我的治疗方法中，针对贫乏之人居多，他们的患病往往是由于劳倦引起的。《脾胃论》对此论述得非常详细，姑且再简述其要点，以表明我的心意。
治疗一开始就使用补法，其关键要点有三条：首先观察面色，如果面部没有黑滞油腻的光泽；其次询问清楚是否有身热恶寒的症状，如果躺在被子里身体不觉得冷，或者自汗不想进食，即使进食也觉得无味，肢体软弱、气息微弱，舌苔微厚但不口渴，脉象浮大而柔软，小便微红且长，这正属于劳倦内伤，适合使用补中益气汤。如果病人身热但不恶寒，盗汗，舌质红绛少苔，喜欢喝水但不能化水，面带微红，脉象细数无力，这是阴虚发热，适合使用四物汤合四阴煎等方剂。如果有的人劳倦兼有血虚，上述症状间或出现，适合使用八物汤或补中益气汤，加生地、当归身、麦冬之类的药物。至于久病，或者治疗未痊愈，正气已经虚弱，留存的病邪尚未清除，理应在使用清热疏利药时辅助使用补药，在使用补药时辅助清除病邪，辨证时稍微涉及疑似难辨的情况。不仅是用补药会误人，清热、疏利、温里、泻下，哪一种不会误人呢？况且我虚心谨慎的态度，您是无法完全了解的。每次遇到使用攻伐或补益、寒凉或温热性质的方剂时，我常常另外设立一个簿子，记录下治疗方案。如果是复诊，一定要了解全部病情；如果不进行复诊，一定要反复打听，直到服药后痊愈，心里才安心。医案中所记载的，都是这样的过程。客人听了之后，连连称是便退下了。
A guest was surprised to see that in the medical cases I compiled, some treatments began immediately with tonification, some occasionally used tonics while pathogenic factors were not yet fully eliminated, and others used potent tonics as soon as the pathogenic factors had just been cleared. I told him: Among famous physicians throughout history, none surpasses Zhang Zhongjing; and among diseases, none involves more severe pathogenic factors than Cold Damage (Shanghan). Zhang Zhongjing established 113 formulas, more than 70 of which employ Ren Shen (Ginseng Radix et Rhizoma). This is because "where pathogenic factors gather, Qi must be deficient." Therefore, he included Ren Shen in exterior-releasing formulas, in heat-clearing and draining formulas, and in warming formulas. My practice of occasionally using tonics when pathogenic factors are not yet fully eliminated follows the method of Zhang Zhongjing. Among later famous physicians, Li Dongyuan of the Jin Dynasty and Zhao Xianke (courtesy name Jiebin) of the Ming Dynasty are also outstanding figures. Li Dongyuan's formulas such as Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) treat fatigue-induced internal injury with miraculous efficacy; Zhao Xianke's formulas from Yi Guan (The Canon of Medicine), specifically Cong Yi Yin Jian (One-Yin Decoction) to Si Yin Jian (Four-Yin Decoction), treat blood-deficiency fever with equally miraculous efficacy. My practice of beginning treatment immediately with tonification follows the methods of Li Dongyuan and Zhao Xianke. As for using tonics only after pathogenic factors have been completely eliminated, that is merely the skill of mediocre physicians, hardly worth debating. Generally, my treatments often address patients who are impoverished, whose illnesses frequently arise from fatigue and overwork. The Pi Wei Lun (Treatise on the Spleen and Stomach) discusses this in great detail. I shall briefly restate the essentials here to clarify my intent.
The key points for beginning treatment immediately with tonification are threefold: First, observe the complexion; if there is no dark, stagnant, or oily luster on the face. Second, inquire carefully about symptoms of fever and aversion to cold; if the patient feels no coldness while lying under blankets, or experiences spontaneous sweating without desire to eat, and even if they do eat, it tastes bland, accompanied by soft limbs and weak Qi, a slightly thick tongue coating without thirst, a floating, large, and soft pulse, and slightly red but long urine, this precisely constitutes fatigue-induced internal injury, suitable for Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If the patient has fever without aversion to cold, night sweats, a crimson tongue with scant coating, a preference for drinking water but inability to transform fluids, a slightly reddish facial hue, and a fine, rapid, and forceless pulse, this indicates Yin deficiency causing fever, suitable for Si Wu Tang (Four-Substance Decoction) combined with Si Yin Jian (Four-Yin Decoction) or similar formulas. For those with both fatigue and blood deficiency, where the above symptoms appear intermittently, Ba Wu Tang (Eight-Ingredient Decoction) or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) can be used, adding Sheng Di Huang (Rehmanniae Radix), Dang Gui (Angelicae Sinensis Radix), and Mai Dong (Ophiopogonis Radix). Regarding chronic illnesses or cases where treatment has not yet achieved full recovery, if Zheng Qi (Righteous Qi) is already deficient and residual pathogenic factors remain, one should assist with tonification while using heat-clearing and draining methods, or assist with eliminating pathogens while using tonic formulas. When differentiation is slightly ambiguous, not only can improper use of tonics harm people, but so too can inappropriate use of heat-clearing, draining, warming, or purging methods. Moreover, my attitude of humility and caution is something you cannot fully perceive. Whenever I prescribe attacking or tonifying, cooling or warming agents, I maintain a separate ledger recording the treatment plans. If there is a follow-up visit, I must ascertain the entire situation; if there is no follow-up, I must repeatedly inquire until the patient recovers after taking the medicine, at which point my heart finds peace. The medical cases recorded are all like this. Upon hearing this, the guest nodded in agreement and withdrew.