孤精于内，气耗于外，形不可与衣相保，此四极亟而动中，是气拒于内，而形施于外，治之奈何？
此水气胀满之病，其本不从毫毛生，五脏阳气竭耗，而脉气孤危，故魄独居。此四极亟而
动中，气拒内，形施外，故不与衣相保。
岐伯对曰∶平治于权衡，去宛陈 ，是以微动四极，温衣，缪刺其处，以复其形，开鬼门，
洁净府。
此言量其内外轻重而施治，如水气在内，则用以微动四极，缪剌其处，以复其形，以牵牛、
甘遂之类泻之，去其积，故曰去宛陈 ；水气在表，用苍术、羌活之类汗之，故曰开鬼门；水气
在下，用五苓散之类，以利小水，故曰洁净府。
藏气法时论 曰∶肝病者，两胁下痛引小腹，令人善怒，虚则目KT KT 无所见，耳
无所闻，善恐如人将捕之，取其经厥阴与少阳，气逆则头痛耳聋不聪颊肿。取血者。
此肝经之病，而合于胆。凡经络到处，皆为之病，两胁下痛引小腹，善怒，此为肝经实病。
目KT KT 无见，耳无所闻，善恐，此肝脉系胆脉，风火上攻故也。胁中血满，独异于常，随其
左右而利之也。
心病者，胸中痛，胁支满，胁下痛，膺背肩甲间痛，两臂内痛，虚则胁腹大，胁下与腰相引
而痛，取其经，少阴太阳舌下血者。其变病，剌 中血者。
此心经之病，而合于小肠。舌下，为舌本，心之系。 中，为心脉，在掌后去腕半寸。
脾病者，身重善饥肉痿，足不收行，善 脚下痛，虚则腹满肠鸣，飧泄食不化，取其经，太
阴阳明少阴血者。
此脾经之病，而合于脾者，善行 ，故取足太阴阳明少阴出血也。
肺病者，喘咳逆气，肩背痛，汗出，尻阴股膝髀 足皆痛，虚则少气不能报息，耳聋咽干，
取其经，太阴足太阳之外厥阴内血者。
此肺经之病，实则喘咳逆气，肩背股膝俱痛，虚则少气耳聋，太阳之外，厥阴之内，有血满
异于常者则取之。
肾病者，腹大胫肿，喘咳身重，寝汗出憎风，虚则胸中痛，大腹小腹痛，清厥意不乐。取其
经，少阴太阳血者。
此肾经之病，凡剌虚则补，剌实则泻，不盛不虚以经取之，是谓得道。经络有血，剌而去
之，是谓守法，犹当揣形定气，先取血脉，而后乃调有余不足。
腹中论 帝曰∶夫子数言热中消中，不可服膏粱芳草石药，石药发颠，芳草发狂。夫
热中消中者，皆富贵人也，今禁膏粱，是不合其心，禁芳草石药，是病不愈，愿闻其说。
热中多饮溲数，消中多食数溲，皆脾气上溢，肥甘所致，故禁膏粱石药芳草之浓美也。
岐伯对曰∶夫芳草之气美，石药之气悍，二者其气急疾坚劲，故非缓心和人，不可以服此二
者。曰∶不可以服此者，何以然？曰∶夫热气 悍，（ ，疾也。）药气亦然。二者相遇，恐内
伤脾，脾者土也，而恶木，服此药者，至甲乙日更论。
热气 盛，则木气有余，躁怒伤脾，故至甲乙日，更论脾病之增减。
五常政大论篇 帝曰∶天不足西北，左寒而右凉；地不满东南，右热而左温，其故
何也？岐伯对曰∶阴阳之气，高下之理，大小之异也。东南方，阳也，阳者其精降于下，故右热
而左温。西北方，阴也，阴者其精奉于上，故左寒而右凉。是以地有高下，气有温凉，高者气寒，
下者气热，故适寒凉者胀，之温热者疮。下之则胀已，汗之则疮已。此腠理开闭之常，大小之异
耳。曰∶其于寿夭何如？曰∶阴精所奉其人寿，阳精所降其人夭。
阴精所奉，高之地也。阴方之地，阳不妄泄，寒气外持，邪不数中，而正坚守，故寿延。
阳精所降，地之下也。阳方之地，阳气耗散，发泄无度，风湿数中，真气倾竭，故夭折。即事验
之，今中原之境，西北方人多寿，东南方人多夭，其中各有微甚耳。此方土之异也。
帝曰∶其病治之奈何？曰∶西北之气散而寒之，东南之气收而温之，所谓同病异治也。
西北方皮肤闭腠理密，人皆食热，故宜散宜寒。东南方人腠理疏，冬皆长冷，故宜收宜温
散，不解表。
故曰∶气寒气凉，治以寒凉，行水渍之。气温气热，治以温热，强其内守。必同其气，可使
平也，假者反之。
寒方以寒，热方以热，是正治也。西北方有病冷，假热方以除之；东南方有病热，假凉方
以除之。是则假者，反上之正法以取之。
岐伯曰∶补上下者从之，治上下者逆之。
上者天气，下者地气。不及则顺而和之，太过则逆而治之也。
以所在寒热盛衰而调之，故曰∶上取下取，内取外取，以求其过。能毒者以浓药，不胜毒者
以薄药，此之谓也。
药之浓薄，药之气味浓薄也。上下内外求治其过，当因人之体气浓薄而施，则可以求其过也。
气反者，病在上，取之下；病在下，取之上；病在中，傍取之。
气反者，谓病下而反上，病上而反下。病反在上，而治取于下，病反在下，而治取于上，
病在中，而治取于傍。如寒逆于下，热反攻于上，不利于下，气盈于上，则温下以调之，余仿此。
治热以寒，温而行之；治寒以热，凉而行之；治温以清，冷而行之；治清以温，热而行之。
故消之削之，吐之下之，补之泻之，久新同法。
治法要审轻重刚柔逆顺以施之，新久则皆同一理法也。
曰∶病在中而不实不坚，且聚且散奈何？曰∶无积者求其藏，虚则补之，药以祛之，食以随
之，行水渍之，和其中外，可使必已。曰∶有毒无毒，服有约乎？曰∶病有新久，方有大小，有
毒无毒，固宜常制矣。（有约，常制，即下文云。）大毒治病，十去其六，常毒治病，十去其七，
小毒治病，十去其八，无毒治病，十去其九，谷肉菜果，食养尽之，无使过之，伤其正也。不尽，
行复如法。
约，节约也。假如无毒治病，病已十去其九，须以此为节约，再勿药也。须以谷肉菜果，
随五脏所宜，食之养之，以尽其余病也。若违约节而过用之，必至于伤正气也。
六元正纪论 帝曰∶论言热无犯热，寒无犯寒，予欲不远热，不远寒奈何？
上之寒热二字，所用之寒热也，下之寒热二字，因气之寒热也。远，犹避也。不远寒，不
远热，犹言可以热治热，而寒治寒者也。
岐伯对曰∶发表不远热，攻里不远寒。
出汗宜热药，故不避热。下利宜寒药，故不避寒。如是则夏亦可用寒，皆谓不获已而用之也。
帝曰∶不发不攻而犯寒犯热何如？曰∶寒热内贼，其病益甚。曰∶愿闻无病何如？曰∶无者
生之，有者甚之。
犯寒热者，其病益甚，无病犯禁，犹能生病故曰∶无则生，有则甚。
曰∶生者何如？曰∶不远热则热至，不远寒则寒至。寒至则坚痞腹满，痛急下利之病生矣。
热至则身热，吐下霍乱，痈疽疮疡，瞀（音冒。闷也。）郁注下， 肿胀，呕鼽衄头痛，骨节
变肉痛，血溢血泄，淋闭之病生矣。曰∶治之奈何？曰∶时必顺之，犯者治以胜也。
春宜凉，夏宜寒，秋宜温，冬宜热，此时之宜，不可不顺。犯热治以酸寒，犯寒治以甘热，
犯凉治以苦温，犯温治以辛凉，所谓胜也。
帝曰∶妇人重身，毒之何如？岐伯曰∶有故无殒，亦无殒也。曰∶愿闻其故何谓也？岐伯曰∶
大积大聚，其可犯也，衰其大半而止，过者死。帝曰∶善。
重身，谓怀妊也。毒之，谓有毒病用毒药以攻之。有大积大聚之故，治其大半则止，过之
者死。非重身者，大毒治病，十去其六而止，当有约也。况重身者，岂无约乎？
曰∶郁之甚者，治之奈何？曰∶木郁达之，火郁发之，土郁夺之，金郁泄之，水郁折之，然
调其气，过者折之，以其畏也，所谓泻之。
郁，郁滞也。达发夺泄折五者，欲其通达之意也。王注以达为吐，以发为汗，以夺为下，
以泄为利小水，皆非也。如气凄清之甚，则肺金太过，而木郁之病生焉。治以轻扬味薄之剂散之，
使之郁气解，而肝木之气伸矣。治郁之余，仍以辛热之味，以泻肺气，畏其热则气斯服。肝肺之
气，各得其平，无获郁滞之患，故曰∶过者折之，以其畏也。余皆仿此。王安道曰∶此段十三句，
通为一章，当分三节。自帝曰至水郁折之九句为一节，治郁法之问答也，然调其气一句为一节，
治郁之余法也。过者折之，以其畏也，所谓泻之三句为一节，调气之余法也。过病之起，多由乎
郁，郁者，滞而不通之义。或因所乘而为郁；或不因所乘而本气自郁，皆郁也。岂惟五运之变，
能使然哉？郁既非五运之变可拘，则达之、发之、夺之、泻之、折之之法，固可扩而充之矣。可
扩而充，其应变不穷之理也。且夫达者，通畅之也，如肝性急怒，气逆 胁，或胀大时上炎，
治以苦寒辛散而不愈者，则用升发之药，加以厥阴报使，而从治之。又如久风入中为飧泄，及不因外
风之入而清气在下为飧泄，则以轻扬之剂举而散之。凡此之类皆达之之法也。王氏以吐训达，以
汗为发，不能使人无疑。以为肺金盛，而抑制肝木欤？则泻肺气，举肝气可矣，不必吐也；以为
脾胃浊气下流，而少阳清气不升欤？则益胃升阳可矣，不必吐也。虽然，木郁固有吐之之理，今
以吐宇总该达字，则凡木郁皆当用吐矣，其可乎哉？
帝曰∶假者何如？岐伯曰∶有假其气，则无禁也。所谓主气不足，客气胜也。
假，借也。主气不足，客气胜之，故假借寒热暖凉，以资夫正气，则客可犯之谓也。主气
谓五脏应四时春夏秋冬也。客气谓六气加临之气。
至真要大论 曰∶上淫乎下，所胜平之，外淫乎内，所胜治之。
上淫乎下，天之气也，所谓司天之气。风淫所胜，平以辛凉，佐以苦甘，以甘缓之，以酸
泻之之类是也。外淫乎内，地之气也，所谓在泉之气。风淫于内，治以辛凉，佐以苦甘，以甘缓
之，以辛散之是也，皆随所制胜以平之也。司天之气曰平，在泉之气曰治，此其义见矣。
谨察阴阳所在而调之，以平为期，正者正治，反者反治。
阴病阳不病，阳病阴不病，正也。以寒治热，以热治寒，正治也。阴位以见阳脉，阳位以
见阴脉，反也。以寒治寒，以热治热，反治也。
夫气之胜也，微者随之，甚者制之，气之复也，和者平之，暴者夺之，皆随胜气，安其屈伏，
无问其数，以平为期，此其道也。
随制平夺，皆不以数之多少，以气和平为度。
帝曰∶气有多少，病有盛衰，治有缓急，方有大小，愿闻其约。岐伯对曰∶气有高下，病有
远近，证有中外，治有轻重，适其至所为故也。
脏腑有高下远近，证候有表里，药治有轻重。调其多少，和其紧慢，令药气之病所为故，
勿令太过与不及也。
《大要》曰∶君一臣二，奇之制也；君二臣四，偶之制也；君二臣三，奇之制也；君三臣六，偶之制也。
古之单方，独用一物曰奇。病在上而近者，宜奇方。古之复方曰偶，有二味相配之偶，有
二方相合之偶。病在下而远者，宜偶方。制者，谓因时制宜之义，以病有远近，治有轻重所宜，
故云制也。若以君臣药味数之，阴阳奇偶则亦然也。
故曰∶近者奇之，远者偶之，汗者不可以奇，下者不可以偶。
奇者单行而力微，故近者奇之可也；偶者并行而力大，故远者必以偶也。汗不可以奇，盖谓
汗难出，故以偶；下不以偶，谓下易行，故以奇。及观仲景制方，桂枝汤汗药也，亦以三味为奇。
大承气汤下药也，亦以四味为偶。此见方因时制宜，不必拘泥奇偶，而失其治之大体。
补上治上制以缓，补下治下制以急。急则气味浓，缓则气味薄，适其所至，此之谓也。
王注谓补上治上之方，若迅急则上不住而反迫于下，所以宜制气味之薄方，欲其升浮而使之
至于病所，而后可以疗其病也。补下治下之方，若慢缓则滋道路而力微，所以宜制气味之浓方，
欲其降沉急而至于病所，而后可以疗其病也。适，宜也。凡制方须宜至其病所，而无太过不及之谓也。
病所远而中道气味之者，食而过之，无越其制度也。
又有病在于下焦，其势不容于遽急而用和缓之气味者，虑其中道而止也，宜于药后，以食
送之至病所，要亦无违上下之制。是故平气之道，近而奇偶，制小其服也；远而奇偶，制大其服
也。大则数少，小则数多。多则九之，少则二之。
大方有二∶有药味数少专攻之大方；有君一臣二佐九之大方。凡治肝肾及在下而远者，宜服
数少之大方。病有兼证而邪不专，不可以一二味治者，宜服君一臣二佐九之大方，故肾之二服，
可分作肺之九服、肝之三服也。
奇之不去则偶之，是谓重方。偶之不去，则反佐以取之，所谓寒热温凉反从其病也。
重方则复方也。奇偶不去则反复以取之，所谓寒热温凉反从其病。如黄连治口疮，佐以干姜
而速之类是也，故曰∶反佐取之。
帝曰∶五味之用何如？岐伯对曰∶辛甘发散为阳，酸苦涌泄为阴，咸味涌泄为阴，淡味渗泄
为阳。六者或收或散，或缓或急，或燥或润，或 或坚，以所利而行之，调其气使其平也。
孤阴精血枯竭于体内，阳气耗散于体表，形体消瘦以至于衣服都显得宽大不合身。这是四肢极度消瘦而内脏动摇不安的表现，说明气机郁结在体内，而形体衰败于体外，应当如何治疗呢？
这是水气胀满的病证，其病根并非从皮毛感受外邪开始，而是由于五脏的阳气衰竭耗损，导致脉气孤立危殆，所以出现“魄独居”（指阴精独存而阳气消亡）的现象。这就是四肢极度消瘦而内脏动摇，气机郁结在内，形体衰败在外，所以身体消瘦到连衣服都保不住的状态。
岐伯回答说：治疗时要权衡病情轻重，去除体内久积的陈腐之物。可以通过轻微活动四肢、穿暖衣服，并用缪刺法（交叉针刺法）刺激相应部位，以恢复形体；通过发汗（开鬼门）和利小便（洁净府）来治疗。
这段话的意思是衡量内外病情的轻重来施治。如果水气积聚在体内，就用轻微活动四肢、缪刺等方法来恢复形体，并用牵牛子、甘遂这类药物泻下，去除积滞，所以叫“去宛陈莝”；如果水气在肌表，就用苍术、羌活这类药物发汗，所以叫“开鬼门”；如果水气在下焦，就用五苓散这类药物，通过利小便来排水，所以叫“洁净府”。
《素问·藏气法时论》说：肝病的人，两侧胁肋下疼痛牵引小腹，使人容易发怒；虚证则两眼昏花看不清东西，耳朵听不见声音，容易恐惧，好像有人要抓捕他一样。治疗应取足厥阴肝经和足少阳胆经的穴位，如果是气逆导致的头痛、耳聋、听力减退、面颊肿胀，应取血络放血。
这是肝经的疾病，与胆经相表里。凡是经络循行经过的地方，都会发生病变。两胁下疼痛牵引小腹，容易发怒，这是肝经的实证。两眼昏花看不见，耳朵听不见，容易恐惧，这是因为肝脉连接胆脉，风火之气上攻所致。胁中血气壅盛，异于常态，应根据病位在左或在右，采用利泄的方法治疗。
心病的人，胸部疼痛，胁肋支撑胀满，胁下疼痛，胸前区、背部及肩胛间疼痛，双臂内侧疼痛；虚证则胁腹部胀大，胁下与腰部相互牵引而痛。治疗应取手少阴心经和手太阳小肠经的穴位，以及舌下的血络放血。如果有变证，应针刺中指端的血络放血。
这是心经的疾病，与小肠经相表里。舌下为舌本，是心的系属所在。“中”指神门穴，位于手掌后腕横纹上半寸处，是心经的原穴。
脾病的人，身体沉重，容易饥饿但肌肉痿软无力，双脚不能收持行走，脚底疼痛；虚证则腹部胀满，肠鸣，完谷不化的腹泻，食物不消化。治疗应取足太阴脾经、足阳明胃经和足少阴肾经的血络放血。
这是脾经的疾病，与脾胃功能相关，脾气虚弱则运化失职，所以取足太阴、阳明、少阴经出血来治疗。
肺病的人，气喘咳嗽，气机上逆，肩背疼痛，出汗，臀部、阴部、大腿、膝盖、小腿及足部都疼痛；虚证则气短，呼吸浅促，耳聋，咽干。治疗应取手太阴肺经、足太阳膀胱经外侧和足厥阴肝经内侧的血络放血。
这是肺经的疾病，实证表现为气喘咳嗽气逆，肩背股膝俱痛；虚证表现为气短、耳聋。在足太阳经外侧和足厥阴经内侧，如果有血气壅盛异于常态的，就取之放血。
肾病的人，腹部肿大，小腿浮肿，气喘咳嗽，身体沉重，睡中出汗，怕风；虚证则胸部疼痛，大腹和小腹疼痛，手足厥冷，心情抑郁不乐。治疗应取足少阴肾经和足太阳膀胱经的血络放血。
这是肾经的疾病。凡针刺虚证用补法，实证用泻法，不虚不实则取本经治疗，这就叫做得道。经络中有瘀血的，针刺去除它，这就叫做守法。还应当诊察形体定夺气机，先取血脉放血，然后调理有余和不足。
《素问·腹中论》黄帝说：先生多次提到热中、消中病，不可以服用膏粱厚味、芳草和石药。石药容易引起癫狂，芳草容易引起发狂。热中、消中病患者，都是富贵之人，现在禁止他们吃膏粱厚味，不符合他们的饮食习惯；禁止使用芳草石药，病又治不好，希望听听您的解释。
热中病表现为多饮、小便频数；消中病表现为多食、小便频数。这都是因为脾气上溢，由肥甘厚味引起的，所以要禁止食用膏粱厚味以及气味浓烈的芳草石药。
岐伯回答说：芳草的气味芳香美好，石药的气性猛烈悍急，这两者的药气都急疾坚劲，所以如果不是性情平和的人，不可以服用这两种药。黄帝问：不可以服用这两种药，是什么原因呢？岐伯说：体内的热气悍急，药物的气性也是如此。两者相遇，恐怕会内伤脾脏。脾脏属土，而恶木气，服用这些药物的人，到了甲乙日（木旺之日），需要重新讨论脾病的增减变化。
热气亢盛，则木气有余，躁怒伤脾，所以到了甲乙日，需要重新论述脾病的增减情况。
《素问·五常政大论》黄帝说：天的西北方不足，左边寒冷右边凉爽；地的东南方不满，右边炎热左边温暖，这是什么原因呢？岐伯回答说：这是阴阳之气、高下地理、大小差异的道理。东南方属阳，阳气精华下降于下，所以右边热左边温。西北方属阴，阴气精华奉升于上，所以左边寒右边凉。因此地面有高下之分，气候有温凉之别，高处气寒，低处气热，所以去寒凉之地容易生胀满，去温热之地容易生疮疡。用泻下法可以消除胀满，用发汗法可以治愈疮疡。这是腠理开闭的正常规律，只是程度大小不同罢了。黄帝问：这对寿命长短有什么影响？岐伯说：阴精奉养于上的地方人长寿，阳气精华下降于下的地方人短命。
阴精奉养于上，是指高地。阴方之地，阳气不妄自泄散，寒气在外固持，邪气不易频繁侵袭，正气坚守，所以寿命延长。
阳气精华下降于下，是指低地。阳方之地，阳气耗散，发泄无度，风湿之邪频繁侵袭，真气倾竭，所以早夭。以此事验证，如今中原地区，西北方人多长寿，东南方人多短命，其中各有细微差别罢了。这是地域环境的差异。
黄帝问：这些疾病如何治疗？岐伯说：西北方的病，宜发散并兼用寒凉药；东南方的病，宜收敛并兼用温散药，如果不解表则无效。这叫做同病异治。
西北方皮肤致密，腠理紧闭，人们都吃热性食物，所以适宜发散和寒凉。东南方人腠理疏松，冬天都穿着厚重的保暖衣物，所以适宜收敛和温散，不解表则病难愈。
所以说：气候寒冷凉爽，治疗用寒凉药，配合药液浸渍；气候温暖炎热，治疗用温热药，加强内部守御。必须顺应当地的气候特点，可以使人体平衡，如果是假象则相反。
寒凉之地用寒凉药，温热之地用温热药，这是正治法。西北方有病属寒，若见假热，则用寒凉方除去；东南方有病属热，若见假凉，则用温热方除去。这就是对假象，反用上述正治法来取效。
岐伯说：病在上下的，顺从其势而治；病在上下相反的，逆其势而治。
上部指天气，下部指地气。不及则顺其势调和，太过则逆其势治疗。
根据所在部位的寒热盛衰来调理，所以说：上取下取，内取外取，以求纠正偏差。能耐受药力的人用浓药，不能耐受药力的人用薄药，说的就是这个道理。
药的浓薄，指药气味的浓烈与淡薄。上下内外求治其偏颇，应当根据人的体质强弱浓薄来施用，才可以纠正偏差。
气机逆反的，病在上，取之下部治疗；病在下，取之上部治疗；病在中，取周围治疗。
气机逆反，是指病在下而表现向上，病在上而表现向下。病反见于上，而治疗取之于下；病反见于下，而治疗取之于上；病在中，而治疗取之于旁侧。如寒气逆于下，热气反攻于上，不利于下部，气盈于上，则温下以调之，其余仿此。
治疗热病用寒药，但要温服；治疗寒病用热药，但要凉服；治疗温病用清药，但要冷服；治疗凉病用温药，但要热服。
所以消导、削积、催吐、泻下、补益、泻实，无论新病久病，道理相同。
治法务必审察轻重的刚柔逆顺来施用，新病久病则都遵循同一理法。
问：病在中焦而不实不坚，且聚散无常，怎么办？答：没有积滞的，探求脏腑虚实，虚则补之，用药祛除病邪，饮食辅助调理，配合药液浸渍，调和内外，可以使病痊愈。问：有毒无毒的药，服用有限制吗？答：病有新久，方有大小的区别，有毒无毒，本来就有常规制度。（所谓“约”，即常规制度，就是下文所说的。）大毒的药物治病，病去十分之六就停药；常毒的药物治病，病去十分之七就停药；小毒的药物治病，病去十分之八就停药；无毒的药物治病，病去十分之九就停药。剩下的用五谷、肉类、蔬菜、水果等食物调养来清除余邪，不要过度，以免损伤正气。如果病没好尽，再按此法进行。
“约”，即节约限制。假如用无毒药物治疗，病已去十分之九，必须以此为界限，不要再用药了。需要用五谷、肉类、蔬菜、水果，根据五脏所宜，饮食调养，以清除剩余的病邪。如果违背这个节制而过量用药，必然会损伤正气。
《素问·六元正纪大论》黄帝说：医论说热天不要用热药，寒天不要用寒药，我想不避热天用热药，不避寒天用寒药，可以吗？
上面的“寒热”二字，指的是药物的寒热属性；下面的“寒热”二字，指的是气候的寒热。远，就是避开的意思。不远寒、不远热，犹言可以用热药治热病，用寒药治寒病。
发汗适宜用热药，所以不避热天。泻下适宜用寒药，所以不避寒天。像这样，夏天也可以用寒药，都是指不得已而用的情况。
黄帝问：不解表也不攻里，却违反禁忌使用寒热药怎么样？答：寒热之邪内侵，病情会更加严重。问：如果没有病的人用了会怎样？答：没病的人用了会生病，有病的人用了病情会加重。
违反寒热禁忌，病情会加重；没病的人违反禁忌，尚且能生病，所以说：无病者生（病），有病者甚（重）。
问：生了病会怎样？答：不避热天则热邪至，不避寒天则寒邪至。寒邪至则出现坚硬痞块、腹胀满、腹痛急迫、下利等症状。热邪至则出现身体发热、呕吐、腹泻、霍乱、痈疽疮疡、头目昏闷、气机郁滞、注下（痢疾）、肿胀、呕吐、鼻塞、鼻衄、头痛、骨节变形肌肉疼痛、各种出血、淋证闭尿等症状。问：如何治疗？答：必须顺应时令，犯禁者用克制它的药物治疗。
春季适宜凉，夏季适宜寒，秋季适宜温，冬季适宜热，这是时令的适宜，不可不顺从。犯热用酸寒药，犯寒用甘热药，犯凉用苦温药，犯温用辛凉药，这叫作“胜”（克制）。
黄帝问：孕妇患病，用毒药治疗怎么样？岐伯说：有病故而无损伤，胎儿也无损伤。问：希望听听其中的道理是什么？岐伯说：有大积大聚的病症，可以使用毒药攻伐，但病势消退大半就要停止，超过限度会导致死亡。黄帝说：好。
“重身”指怀孕。“毒之”指有实邪重病时用毒药攻伐。有大积大聚的病故，治疗到大半就停止，过度的话会导致死亡。非孕妇者，大毒治病去六分即止，应当有节制。何况孕妇，难道没有节制吗？
问：郁滞严重的，怎么治疗？答：木郁滞则疏通它，火郁滞则发散它，土郁滞则攻夺它，金郁滞则宣泄它，水郁滞则制约它，然而要调畅气机，过盛的予以折损，利用其畏惧的特性，这就叫作泻法。
“郁”，即郁滞。“达、发、夺、泄、折”五种方法，意在使其通达。王冰注解说“达”是吐法，“发”是汗法，“夺”是下法，“泄”是利小便，都不正确。如气候凄清严重，则肺金太过，而肝木郁滞的病产生。治疗用轻扬味薄的药剂疏散它，使郁气解除，肝木之气舒展。治疗郁滞之余，仍用辛热的味道，以泻肺气，因其畏惧热则气机顺服。肝肺之气，各得其平，没有郁滞的祸患，所以说：过盛的予以折损，利用其畏惧的特性。其余仿此。王安道说：这段十三句话，通为一章，应当分三节。从“帝曰”到“水郁折之”九句为一节，是治疗郁法的问答；然而“然调其气”一句为一节，是治疗郁后的余法；“过者折之，以其畏也，所谓泻之”三句为一节，是调气的余法。郁病的起因，多由于郁滞，郁，就是滞而不通的意思。或者因受乘侮而为郁；或者不因受乘侮而本气自郁，都是郁。岂止五运的变化能使这样呢？郁既然不是五运的变化所能拘泥，那么达之、发之、夺之、泄之、折之的方法，固然可以扩充充实了。可以扩充充实，这是应变无穷的道理。况且“达”，就是通畅的意思，如肝性急躁易怒，气逆胁痛，或胀大时常上炎，治疗用苦寒辛散而不愈的，则用升发之药，加以厥阴引经药，而从治之。又如久风入中导致完谷不化的泄泻，以及不因外风入侵而清气在下导致的完谷不化泄泻，则以轻扬之剂举而散之。凡此类都是“达”的方法。王氏将“吐”解释为“达”，将“汗”解释为“发”，不能不让人怀疑。认为是肺金盛而抑制肝木吗？则泻肺气、举肝气就可以了，不必用吐法；认为是脾胃浊气下流，而少阳清气不升吗？则补胃升阳就可以了，不必用吐法。虽然，木郁固有吐之的道理，但现在用“吐”字总括“达”字，则凡是木郁都应当用吐法了，这可以吗？
黄帝问：假象是怎么回事？岐伯说：有借假气（假象）的情况，就没有禁忌了。所谓主气不足，客气胜之。
“假”，借也。主气不足，客气胜之，所以借用寒热暖凉（假象），以资助正气，则客气可犯，这就叫作假。主气指五脏对应四季春夏秋冬之气。客气指六气加临之气。
《素问·至真要大论》说：上淫于下（司天之气侵犯人体下部），用所胜之气平之；外淫于内（在泉之气侵犯人体内部），用所胜之气治之。
上淫于下，是天之气，所谓司天之气。风淫所胜，用辛凉平之，佐以苦甘，以甘缓之，以酸泻之之类。外淫于内，是地之气，所谓在泉之气。风淫于内，用辛凉治之，佐以苦甘，以甘缓之，以辛散之是也，都是随着所胜之气来平复它。司天之气叫“平”，在泉之气叫“治”，这里的含义就显现了。
谨慎地考察阴阳所在的部位并调理它，以平衡为准则。正病用正治法，反病用反治法。
阴病阳不病，阳病阴不病，这是正。用寒治热，用热治寒，这是正治。阴位见到阳脉，阳位见到阴脉，这是反。用寒治寒，用热治热，这是反治。
气有余，轻微的顺随它，严重的制约它；气来复，平和的平复它，暴烈的剥夺它，都随着胜气，安抚其屈伏，不问次数多少，以平衡为准则，这就是其道。
随、制、平、夺，都不以数量多少为标准，以气机平和为限度。
黄帝说：气有多少，病有盛衰，治有缓急，方有大小，希望听听其中的概要。岐伯回答说：气有高下，病有远近，证有中外，治有轻重，适宜到达病所才是根本。
脏腑有高下远近，证候有表里，药治有轻重。调节多少，调和紧慢，令药气到达病所，不要太过与不及。
《大要》说：君药一臣药二，是奇方制；君药二臣药四，是偶方制；君药二臣药三，是奇方制；君药三臣药六，是偶方制。
古代的单方，独用一味药叫奇。病在上部且近的，宜用奇方。古代的复方叫偶，有两味药相配的偶，有两方相合的偶。病在下部且远的，宜用偶方。制，指因时制宜的意思，因为病有远近，治有轻重适宜，所以叫制。如果用君臣药味数量来说，阴阳奇偶也是一样的。
所以说：近的用奇方，远的用偶方。发汗的不可以用奇方，泻下的不可以用偶方。
奇方单行而力微，所以近的可以用奇方；偶方并行而力大，所以远的必用偶方。发汗不可以用奇方，是说发汗难出，所以用偶方；泻下不可以用偶方，是说泻下易行，所以用奇方。但看张仲景制方，桂枝汤是发汗药，也是三味药为奇。大承气汤是泻下药，也是四味药为偶。这说明方剂因时制宜，不必拘泥于奇偶，而失去治疗的大体原则。
补上治上，制方宜缓；补下治下，制方宜急。急则药气味浓厚，缓则药气味淡薄，适宜到达病所，说的就是这个道理。
王冰注解说，补上治上的方子，如果迅急则药气在上停留不住反而迫于下，所以适宜制作气味薄的方子，想要其升浮而到达病所，然后才能治疗疾病。补下治下的方子，如果慢缓则滋长道路而力微，所以适宜制作气味浓厚的方子，想要其降沉急而到达病所，然后才能治疗疾病。适，适宜。凡是制方都必须适宜到达病所，而没有太过不及，就叫适。
病所遥远而在中途被药气阻隔的，饭后服药送之，不要超越这个制度。
又有病在下焦，其势不容许遽急而用和缓气味的，担心药在中途停止，适宜在药后，以食物送之至病所，这也未违背上下之制。所以平气之道，近而奇偶，制小其服；远而奇偶，制大其服。大方则药味少，小方则药味多。多则九味，少则二味。
大方有两种：有药味数少专攻的大方；有君一臣二佐九的大方。凡是治肝肾及在下而远的，宜服药味少的大方。病有兼证而邪不专，不可以一二味治疗的，宜服君一臣二佐九的大方，所以肾的二服，可分作肺的九服、肝的三服。
奇方不去病则用偶方，这叫重方。偶方不去病，则反佐以取之，所谓寒热温凉反从其病。
重方就是复方。奇偶不去则反复以取之，所谓寒热温凉反从其病。如黄连治口疮，佐以干姜而速效之类，所以说：反佐取之。
黄帝问：五味的运用怎么样？岐伯说：辛甘发散为阳，酸苦涌泄为阴，咸味涌泄为阴，淡味渗泄为阳。这六种味道或收或散，或缓或急，或燥或润，或软或坚，顺着有利的方向而行，调畅气机使其平衡。
Isolated yin essence depletes internally, while qi dissipates externally; the emaciated body cannot fill the clothes. This indicates extreme emaciation of the four limbs and internal instability, signifying that qi is obstructed internally while the form deteriorates externally. How should this be treated?
This is a disease of water qi distension and fullness. Its root does not originate from the hair follicles (exterior), but stems from the exhaustion of yang qi in the five zang organs, leading to isolated and precarious pulse qi, hence "Po resides alone" (yin essence remains while yang qi vanishes). This condition of extreme limb emaciation and internal unrest, with qi obstructed inside and form decaying outside, results in the body becoming so thin that it no longer fills the garments.
Qibo replied: "Balance the treatment according to the scale of severity; remove the accumulated stagnation (Qu Wan Chen Cuo). Facilitate slight movement of the four limbs, keep warm with clothing, apply Miu Ci (cross-point needling) at corresponding locations to restore the form, open the 'ghost gates' (sweat pores via diaphoresis), and purify the 'clean mansion' (bladder via diuresis)."
This passage explains treating based on the severity of interior and exterior conditions. If water qi accumulates internally, use slight limb movement and Miu Ci to restore form, and employ herbs like Qian Niu Zi (Pharbitis Seed) or Gan Sui (Kansui Root) to purge accumulation; thus it is called "removing accumulated stagnation." If water qi is at the exterior, use herbs like Cang Zhu (Atractylodes Rhizome) or Qiang Huo (Notopterygium Rhizome) to induce sweating; thus it is called "opening the ghost gates." If water qi is in the lower jiao, use formulas like Wu Ling San (Five-Ingredient Powder with Poria) to promote urination; thus it is called "purifying the clean mansion."
The *Su Wen: Zang Qi Fa Shi Lun* states: "In liver diseases, pain radiates from the hypochondrium to the lower abdomen, causing irritability. In deficiency patterns, vision blurs, hearing diminishes, and there is excessive fear, as if being hunted. Treat by selecting points from the Jueyin (Liver) and Shaoyang (Gallbladder) meridians. For qi rebellion causing headache, deafness, tinnitus, and facial swelling, select blood vessels for bleeding."
This is a disease of the Liver Meridian, harmonizing with the Gallbladder. Pathology occurs along the meridian pathways. Hypochondriac pain radiating to the lower abdomen and irritability indicate Liver Meridian excess. Blurred vision, hearing loss, and fear result from wind-fire attacking upward due to the connection between Liver and Gallbladder meridians. When blood stagnates in the hypochondrium, deviating from normal, treat by draining according to the side (left or right).
In heart diseases, there is chest pain, distending fullness in the hypochondrium, pain under the ribs, pain in the precordium, back, and scapula, and pain in the inner aspect of both arms. In deficiency patterns, the hypochondrium and abdomen become distended, with pulling pain between the hypochondrium and waist. Treat by selecting points from the Shaoyin (Heart) and Taiyang (Small Intestine) meridians, and bleed the sublingual vessels. For altered patterns, needle the blood vessels at the center of the palm (Shenmen point).
This is a disease of the Heart Meridian, harmonizing with the Small Intestine. The sublingual area is the root of the tongue, the connection of the Heart. "Zhong" refers to Shenmen, located half a cun proximal to the wrist crease on the radial side, the Yuan-Source point of the Heart Meridian.
In spleen diseases, the body feels heavy, there is hunger with muscle flaccidity, inability to hold the feet or walk properly, and pain in the soles. In deficiency patterns, there is abdominal fullness, borborygmus, undigested stool diarrhea, and food intolerance. Treat by selecting blood vessels from the Taiyin (Spleen), Yangming (Stomach), and Shaoyin (Kidney) meridians.
This is a disease of the Spleen Meridian, relating to Spleen function. Spleen deficiency leads to impaired transport, so bleeding from the Foot-Taiyin, Yangming, and Shaoyin meridians is indicated.
In lung diseases, there is wheezing, coughing, rebellious qi, shoulder and back pain, sweating, and pain in the sacrum, genitals, thighs, knees, calves, and feet. In deficiency patterns, there is shortness of breath, inability to complete inhalation, deafness, and dry throat. Treat by selecting blood vessels from the Taiyin (Lung), the lateral aspect of the Taiyang (Bladder), and the medial aspect of the Jueyin (Liver) meridians.
This is a disease of the Lung Meridian. Excess presents as wheezing, coughing, rebellious qi, and pain in shoulders, back, thighs, and knees. Deficiency presents as shortness of breath and deafness. At the lateral aspect of the Taiyang and medial aspect of the Jueyin meridians, if blood stagnation deviates from normal, select these sites for bleeding.
In kidney diseases, there is abdominal distension, calf edema, wheezing, coughing, heavy body, night sweats, and aversion to wind. In deficiency patterns, there is chest pain, lower abdominal pain, cold extremities, and depression. Treat by selecting blood vessels from the Shaoyin (Kidney) and Taiyang (Bladder) meridians.
This is a disease of the Kidney Meridian. Generally, tonify deficiency and drain excess; for neither excess nor deficiency, treat the affected meridian directly—this is the correct method. If blood stasis exists in the meridians, needle to remove it—this is observing the rules. One must assess the form and determine qi status, first removing blood stasis, then regulating excess and deficiency.
The *Su Wen: Fu Zhong Lun* states: The Emperor said, "You often mention that Re Zhong (Heat Center) and Xiao Zhong (Consumption Center) patients should not consume Gao Liang (rich/fatty foods), Fang Cao (aromatic herbs), or Shi Yao (mineral drugs). Mineral drugs cause Dian (mania/epilepsy), and aromatic herbs cause Kuang (madness). Re Zhong and Xiao Zhong patients are usually wealthy. Prohibiting rich foods goes against their habits; prohibiting mineral/aromatic herbs leaves the disease uncured. I wish to hear your explanation."
Re Zhong involves polydipsia and polyuria; Xiao Zhong involves polyphagia and polyuria. Both result from Spleen Qi overflowing upward due to sweet and fatty foods; thus, rich foods and potent mineral/aromatic herbs are prohibited.
Qibo replied: "The qi of aromatic herbs is beautiful, and the qi of mineral drugs is fierce. Both have urgent, firm, and strong properties. Therefore, unless one has a calm and gentle disposition, they should not take these two types of drugs." The Emperor asked, "Why can they not be taken?" Qibo answered, "Internal heat is fierce, and drug qi is similar. Their meeting may injure the Spleen internally. The Spleen belongs to Earth and dislikes Wood. Patients taking these drugs will see changes in Spleen pathology on Jia-Yi days (Wood days)."
When heat qi is excessive, Wood qi becomes surplus, leading to irritability that injures the Spleen. Thus, on Jia-Yi days, the fluctuation of Spleen disease must be reassessed.
The *Su Wen: Wu Chang Zheng Da Lun* states: The Emperor said, "Heaven is deficient in the northwest, where the left is cold and the right cool; Earth is incomplete in the southeast, where the right is hot and the left warm. What is the reason?" Qibo replied, "It is the principle of Yin-Yang qi, high-low geography, and size differences. The southeast is Yang; Yang essence descends, making the right hot and left warm. The northwest is Yin; Yin essence ascends, making the left cold and right cool. Thus, ground has height and depth, climate has warmth and cold. High places are cold, low places are hot. Going to cold/cold climates causes distension; going to warm/hot climates causes sores. Purging resolves distension; sweating resolves sores. This is the normal opening and closing of Cou Li (pores), differing only in degree." The Emperor asked, "How does this affect longevity?" Qibo replied, "Where Yin essence is nourished, people live long; where Yang essence descends, people die young."
Yin essence nourishment occurs in high lands. In Yin regions, Yang does not leak recklessly, cold holds the exterior, pathogens rarely strike, and Zheng Qi (Upright Qi) remains firm, extending life.
Yang essence descent occurs in low lands. In Yang regions, Yang Qi dissipates, excretion is uncontrolled, wind-damp strikes frequently, and True Qi exhausts, leading to premature death. Verifying this, in central China, people in the northwest live longer, while those in the southeast have shorter lifespans, with minor variations. This is due to geographical differences.
The Emperor asked, "How should these diseases be treated?" Qibo replied, "Qi in the northwest should be dispersed and cooled; Qi in the southeast should be gathered and warmed. This is called 'Same Disease, Different Treatment.'"
In the northwest, skin is dense and Cou Li tight, and people eat hot foods; thus, dispersal and cooling are suitable. In the southeast, Cou Li is loose, and people wear heavy winter clothes; thus, gathering and warming dispersion are suitable. Without resolving the exterior, the disease will not clear.
Therefore: In cold/cold climates, treat with cold/cool methods, using herbal baths. In warm/hot climates, treat with warm/hot methods, strengthening internal retention. One must align with local Qi to achieve balance; for false patterns, do the opposite.
Cold regions use cold treatments, hot regions use hot treatments—this is Zheng Zhi (Direct Treatment). Northwest diseases presenting with cold but false heat are treated with cold formulas; southeast diseases presenting with heat but false cold are treated with warm formulas. This applies reverse direct treatment to false patterns.
Qibo said: "For disorders above and below, follow the trend; for disorders involving reversal, oppose the trend."
Above refers to Heaven Qi, below to Earth Qi. If deficient, harmonize following the trend; if excessive, treat opposing the trend.
Regulate based on the abundance and deficiency of cold and heat in the affected area. Thus, "treat above by accessing below, treat below by accessing above, treat interior by accessing exterior," seeking the deviation. Those who can tolerate toxicity receive strong medicines; those who cannot tolerate toxicity receive weak medicines.
"Strong" and "weak" refer to the potency of drug flavors. Treating deviations above, below, interior, and exterior requires adjusting dosage strength according to the patient's constitution.
In cases of Qi Reversal (Qi Fan): Disease above, treat below; disease below, treat above; disease in the middle, treat laterally.
Qi Reversal means disease originating below manifests above, or vice versa. If disease manifests above but originates below, treat below; if manifesting below but originating above, treat above; if in the middle, treat the periphery. For example, if Cold rebels below and Heat attacks above, with Qi surging upward, warm the lower part to regulate it. Similar logic applies elsewhere.
Treat Heat with Cold, but administer warm; treat Cold with Heat, but administer cool; treat Warmth with Clearing, but administer cold; treat Coolness with Warming, but administer hot.
Thus, reducing,削 (cutting away), vomiting, purging, tonifying, and draining follow the same principles for new and old diseases.
Treatment must assess light/heavy, rigid/flexible, and reverse/conforming patterns. New and old diseases share the same underlying logic.
Question: What if disease is in the middle, neither solid nor hard, and gathers and scatters intermittently? Answer: If there is no accumulation, investigate the Zang organs. Tonify deficiency. Use medicine to expel pathogens, food to support recovery, and herbal baths to harmonize interior and exterior. The disease can be cured. Question: Is there a limit to taking toxic or non-toxic drugs? Answer: Diseases vary in newness/oldness, and formulas vary in size. There are standard protocols for toxic and non-toxic drugs. (The "limit" refers to the following protocol.) For highly toxic drugs, stop when 60% of the disease is resolved; for moderately toxic drugs, stop at 70%; for slightly toxic drugs, stop at 80%; for non-toxic drugs, stop at 90%. Use grains, meats, vegetables, and fruits to complete the recovery through dietary therapy. Do not overdo it, lest you injure Zheng Qi. If unresolved, repeat the process.
"Limit" means restraint. If non-toxic drugs resolve 90% of the disease, one must stop here. Use grains, meats, vegetables, and fruits suited to the Five Zang to nourish and clear residual pathogenic factors. Violating this restraint and overusing drugs will inevitably injure Zheng Qi.
The *Su Wen: Liu Yuan Zheng Ji Da Lun* states: The Emperor said, "Discussions say 'Do not violate heat with heat, do not violate cold with cold.' I wish to know why I should not avoid heat when using heat, nor avoid cold when using cold."
The first "heat/cold" refers to drug properties; the second refers to climatic conditions. "Avoid" means to shun. Not avoiding heat/cold implies using heat to treat heat, and cold to treat cold.
Qibo replied: "When releasing the exterior, do not avoid heat; when attacking the interior, do not avoid cold."
Diaphoresis suits hot drugs, so heat is not avoided. Purgatives suit cold drugs, so cold is not avoided. Thus, cold drugs can be used in summer, provided they are necessary.
The Emperor asked, "What if one violates cold/heat without releasing the exterior or attacking the interior?" Qibo replied, "Cold and heat become internal thieves, worsening the disease." The Emperor asked, "What about healthy individuals?" Qibo replied, "For those without disease, it generates illness; for those with disease, it worsens it."
Violating cold/heat禁忌 worsens disease. Even healthy people violating prohibitions can fall ill; hence, "no disease becomes sick, existing disease becomes severe."
The Emperor asked, "How does illness arise?" Qibo replied, "Not avoiding heat brings heat; not avoiding cold brings cold. Cold arrival causes hardness,痞 (masses), abdominal fullness, acute pain, and diarrhea. Heat arrival causes fever, vomiting, diarrhea, Huo Luan (cholera-like syndrome), abscesses, sores, mental confusion, stagnation, dysentery, swelling, vomiting, nasal congestion, epistaxis, headache, bone joint deformation, muscle pain, hemorrhage, strangury, and urinary retention." The Emperor asked, "How to treat?" Qibo replied, "Comply with the seasons. For violations, treat with the controlling element."
Spring suits coolness, Summer suits cold, Autumn suits warmth, Winter suits heat. Seasonal compliance is essential. For heat violation, use sour-cold; for cold violation, use sweet-hot; for cool violation, use bitter-warm; for warm violation, use pungent-cool. This is called "controlling."
The Emperor asked, "How to treat pregnant women with toxic drugs?" Qibo replied, "If there is a pathological cause, there is no injury [to the mother], and no injury [to the fetus]." The Emperor asked, "What is the reason?" Qibo replied, "For large accumulations and masses, toxic drugs may be used, but stop when more than half the disease is resolved. Exceeding this limit causes death." The Emperor said, "Excellent."
"Chong Shen" means pregnancy. "Du Zhi" means using toxic drugs for serious pathological conditions. For large accumulations, stop after resolving more than half. Exceeding this causes death. For non-pregnant patients, stop highly toxic drugs at 60% resolution, observing limits. How much more should pregnant women observe limits?
The Emperor asked, "How to treat severe stagnation?" Qibo replied, "For Wood stagnation, facilitate flow; for Fire stagnation, vent; for Earth stagnation, purge; for Metal stagnation, drain; for Water stagnation, restrain. However, regulate Qi. For excess, restrain using what it fears; this is called draining."
"Yu" means stagnation. "Da, Fa, Duo, Xie, Zhe" aim to promote flow. Wang Bing interpreted "Da" as vomiting, "Fa" as sweating, "Duo" as purging, and "Xie" as diuresis, which is incorrect. For example, if cold climate is severe, Metal (Lung) is excessive, causing Wood (Liver) stagnation. Treat with light, thin-flavored herbs to disperse, resolving stagnation and allowing Liver Qi to extend. After treating stagnation, use pungent-hot flavors to drain Lung Qi; since Lung fears heat, Qi becomes compliant. Liver and Lung Qi achieve balance, preventing stagnation. Thus, "excess is restrained by its fear." Apply similarly to others. Wang Andao stated: This section comprises thirteen sentences, divided into three parts. From "Emperor said" to "Water Yu Zhe Zhi" (nine sentences) is the Q&A on treating Yu. "Ran Tiao Qi" (one sentence) is the supplementary method. "Guo Zhe Zhe Zhi..." (three sentences) is the supplementary method for regulating Qi. Yu arises from blockage, either from being overcome or inherent Qi stagnation. It is not limited to the Five Movements. Thus, methods of Da, Fa, Duo, Xie, Zhe can be expanded. "Da" means smooth flow. For Liver anger and Qi rebellion, if bitter-cold/pungent-dispersing fails, use ascending herbs with Jueyin guiding agents. For chronic wind entering the middle causing undigested stool diarrhea, or clear Qi sinking causing similar diarrhea, use light herbs to lift and disperse. These are methods of "Da." Wang’s interpretation of "Tu" as "Da" is questionable. If Lung Metal suppresses Liver Wood, draining Lung and lifting Liver suffices without vomiting. If Spleen/Stomach turbid Qi sinks and Shaoyang clear Qi fails to rise, tonifying Stomach and raising Yang suffices without vomiting. Although vomiting has merit for Wood Yu, equating all Wood Yu with vomiting is unreasonable.
The Emperor asked, "What about false patterns?" Qibo replied, "When Qi borrows a false nature, there are no prohibitions. This is when Host Qi is deficient and Guest Qi prevails."
"Jia" means borrowing. When Host Qi (Zang organs corresponding to seasons) is deficient and Guest Qi (Six Qi additions) prevails, borrow cold/hot/warm/cool properties to support Zheng Qi, allowing Guest Qi to be addressed.
The *Su Wen: Zhi Zhen Yao Da Lun* states: "Upper invasion affecting the lower (Si Tian Qi), pacify with the controlling element. External invasion affecting the interior (Zai Quan Qi), treat with the controlling element."
Upper invasion refers to Si Tian Qi. For Wind excess, pacify with pungent-cool, assist with bitter-sweet, ease with sweet, drain with sour. External invasion refers to Zai Quan Qi. For Wind within, treat with pungent-cool, assist with bitter-sweet, ease with sweet, disperse with pungent. All follow the controlling element to pacify. Si Tian uses "Pacify"; Zai Quan uses "Treat."
Carefully observe Yin-Yang locations and regulate them, aiming for balance. Correct patterns use Zheng Zhi (Direct Treatment); reversed patterns use Fan Zhi (Reverse Treatment).
Yin disease without Yang involvement, or Yang without Yin, is correct. Treating Heat with Cold, Cold with Heat, is Zheng Zhi. Yin location showing Yang pulse, or Yang location showing Yin pulse, is reversed. Treating Cold with Cold, Heat with Heat, is Fan Zhi.
For Qi excess: mild cases follow the trend, severe cases control it. For Qi recovery: peaceful cases pacify, violent cases deprive. Follow the prevailing Qi, soothe the suppressed, regardless of frequency, aiming for balance. This is the Dao.
Following, controlling, pacifying, and depriving depend not on quantity but on achieving Qi harmony.
The Emperor asked, "Qi varies in amount, disease in prosperity/decline, treatment in urgency, formulas in size. What is the summary?" Qibo replied, "Qi has high/low positions, disease has near/far locations, symptoms have exterior/interior, treatment has light/heavy intensity. Suit the treatment to reach the disease site."
Zang-Fu have high/low/near/far distances; symptoms have exterior/interior; treatments have light/heavy intensities. Regulate amounts, harmonize tension/speed, ensuring drug Qi reaches the target without excess or deficiency.
The *Da Yao* states: "One Sovereign, two Ministers, is a Qi (Odd) formula; Two Sovereigns, four Ministers, is an Ou (Even) formula; Two Sovereigns, three Ministers, is a Qi formula; Three Sovereigns, six Ministers, is an Ou formula."
Ancient single-herb formulas are Qi. Diseases above and near suit Qi formulas. Compound formulas are Ou. Diseases below and far suit Ou formulas. "Zhi" means adapting to time, as disease location and treatment intensity vary. Using sovereign/minister herb counts, Yin-Yang odd/even principles apply similarly.
Thus: Near diseases use Qi formulas; far diseases use Ou formulas. Diaphoretics should not use Qi; purgatives should not use Ou.
Qi formulas act singly with mild force, suitable for near diseases. Ou formulas act jointly with strong force, suitable for far diseases. Diaphoresis is difficult, so Ou (stronger) is used. Purging is easy, so Qi (milder/direct) is used. However, Zhang Zhongjing’s Guizhi Tang (Cinnamon Twig Decoction) for sweating has three ingredients (Qi). Dachengqi Tang (Major Order the Qi Decoction) for purging has four ingredients (Ou). This shows formulas adapt to time, not rigidly adhering to odd/even, preserving the general principle.
Tonifying/treating above requires slow-acting formulas; tonifying/treating below requires fast-acting formulas. Fast-acting formulas have strong flavors; slow-acting have weak flavors. Suiting the destination is key.
Wang Bing noted: Formulas for above must not be too rapid, or they pass through to below. Weak flavors allow floating/rising to the target. Formulas for below must not be too slow, or they lose strength en route. Strong flavors allow sinking/descending to the target. "Shi" means suitability. Formulas must reach the target without excess or deficiency.
For distant diseases where drug Qi is blocked mid-way, take medicine after meals to guide it to the target, without violating regulations.
For lower Jiao diseases requiring gradual action, fear of mid-way cessation suggests taking medicine followed by food to guide it to the target, respecting upper/lower regulations. Thus, for balancing Qi: near diseases use small doses (odd/even); far diseases use large doses (odd/even). Large formulas have few ingredients; small formulas have many. Many up to nine; few down to two.
Large formulas come in two types: few ingredients for specific attack; or One Sovereign, Two Ministers, Nine Assistants. For Liver/Kidney or distant lower diseases, use few-ingredient large formulas. For combined syndromes with diffuse pathogens, use One Sovereign, Two Ministers, Nine Assistants formulas. Thus, two doses for Kidney can be divided into nine for Lung or three for Liver.
If Qi formulas fail, use Ou formulas; this is Chong Fang (Repeated Formula). If Ou formulas fail, use Fan Zuo (Counter-Assistance), where cold/hot/warm/cool follows the disease nature.
Chong Fang is compound. If Qi/Ou fail, repeat treatment. Counter-assistance follows disease nature, e.g., Huang Lian (Coptis Rhizome) for mouth ulcers assisted by Gan Jiang (Dried Ginger) for speed. This is "counter-assistance."
The Emperor asked, "How are the Five Flavors used?" Qibo replied, "Pungent and Sweet disperse and ascend (Yang); Sour and Bitter induce vomiting and drain (Yin); Salty induces vomiting and drains (Yin); Bland渗泄 (percolates and drains) (Yang). These six flavors either gather or disperse, relax or tense, dry or moisten, soften or harden. Act according to benefit, regulate Qi to achieve balance."