例一、庄某，女，34岁。患眩晕症已数年，虽经多种治疗，眩晕呕恶仍反复发作，特来针灸。诊得脉形沉细，舌苔薄腻，辨证为劳倦所伤，湿痰中阻，为取百会、天柱、大杼、丝竹空，内关、足临泣等穴，用捻旋泻法，以清镇宁神，疏泄肝胆，并加中脘(针后拔火罐)、足三里，亦用捻旋泻法，是用调胃和中之法，以收化湿除痰之功。数诊而眩晕呕吐皆愈，至今已近二十年，未见复发。
例二、姚某，女，64岁。患腰痛不能回顾，甚则悲泣不已，诊为「阳明腰痛」。为针双侧足三里，用捻旋泻法，腰痛顿缓，再取肾俞，气海俞，针后拔火罐，转侧回顾均便，满意而归。
例三、曹某，女，23岁，教师。患肠鸣腹泻已年余，神疲力乏，肌肉瘦削，情绪低沉，思想苦闷。由亲友陪同来诊，诊为「脾虚泄泻」。处单方：炒自扁豆肉、扁豆衣各15克，玫瑰花4朵，日服一剂，煎汤代茶。并嘱其注意饮食有节，起居有常，保暖节劳，怡悦乐观。一周后复诊，肠鸣腹泻均有好转，精神亦见振作，乃处参苓自术散方，加玫瑰花，并倍加炒白扁豆肉、衣煎服。二周后再复诊时，病愈大半，原方续进，服药二月，形体均复，元气充足，即告痊愈。
我认为人身之脾胃，犹汽车之发动机，如发动机受损，则其它配件虽完美无缺，也不能开动。反之，只要发动机正常，零件的维修是较为轻易的。所以在临床上必须重视调理脾胃，扶佐正气。惟元气充足，虽痼疾亦易康复，若脾胃失治，元气大伤，则机体之修复为难矣。正如李东垣所说：「治肝、心、缔、肾，有余不足，或补或泻，惟益脾胃之药为切。∽凋理脾胃方法很多。我在慢性病的用药时，常男加佛手柑、女加玫瑰花，在针灸取穴时，也常男用足兰里、女用三阴交，以健运脾胃，固后天之本，使疾病容易康复。
注重七情致病
喜怒忧思悲恐惊，此七情是人体对外界环境各种条件的刺激而产生的精神话动，正常情况下是在体内各脏腑的调节之下进行。但过甚或过久的情志活动影响脏腑调节，遂至损伤脏腑而致病。在《内经》中即有「怒伤肝，喜伤心，思伤脾，忧伤肺，恐伤肾」的论述，后世医家作为病因学的三因之一。
虽说七情均可致病，但临床上以怒、思、忧致病为多见。怒则气机逆乱，肝气郁滞，可见胸闷、腹胀、两胁疼痛，脉弦。由于「暴怒伤阴」，阴伤则阳失所制，故常伴有肝火上炎之症，如面赤升火，甚则呕血。忧哀太甚，则肺气抑郁，甚则肺阴受伤，以至形瘁气乏。思虑过度，则脾气郁结，以致胸脘痞塞，脾为所伤，则运化无权，而不思饮食。三志伤人致病，均可使正常运行之气机受阻而郁滞，其怒忧二志常伤脏阴，为患尤烈。
关于治疗，《素问·阴阳应像大论》云：「悲胜怒，怒胜思，喜胜忧……」我认为忧、怒、思三志可使气机郁滞，甚则耗气伤阴。惟喜乐能使气机和顺，情志舒畅，营卫通利，正如《索问·举痛论》所说：「喜则气和志达，营卫通利，故气缓矣。」因此可用喜乐之法而统治怒、忧、思三志。
医生之责，在于要千方百计的治好疾病，当医生在为病者诊察之际，治疗即已寓其中。若能针对病因劝导病者，并采用各种方法，使之．心情舒畅，调节好病者的情志活动，常能获事半功倍之效。《灵枢·本神》日：「故智者之养生也，如顺四时而适寒暑，和喜怒而安居处，节阴阳而调刚柔，如是则僻邪不至，长生久视。」昔张子和以戏言狂谑，使病人大笑不忍，而使心下结块于一、二日内皆散。临床上用喜乐之法治疗怒、悲、思所致疾病，从未闻有过甚之例，故不会有「喜伤心」之虞。此外，柴胡疏肝散、逍遥散，是古医家为气郁而设，内关、足三里、中脘等穴，具理气宽中之效，我在临床上亦是经常采用的。
在临床上，待病者的态度应和蔼可亲，诊察上．要详审细致，治疗上要认真负责。遇有七情所伤者，更应循循善诱。记得有一位病者，女性，年四十岁，因家庭不和而争吵，遂使两胁胀痛，胸闷，心悸，已有十余天。由丈夫陪同前来就诊，诊得脉形弦数，面红升火。除用疏肝解郁之剂外，并以婉言劝之、导之。翌日，夫妻双双前来面谢，言归于好，诸症皆消。对情志怫郁而致神经衰弱的患者，更应如此。
因情志违和而致病，用调节情志之法治疗已为医者所重视，其具体方法，可因人、因事、因时而异，但其目的为使病者消除不悦之感，而达情志舒畅，身心健康。在临床上，重视七情致病，善用喜乐之法治之，也是中医传统方法之一。
余生平无他好，惟以治病为已任，急病人之所急，惟病人之乐而乐焉。临诊六十余年，虽无建树，但蕾赜从事，亦无殒越。孙思邈日：「胆欲大而一心欲小，智欲圆而行欲方。」是为余行医之鉴，终身守之而不失，得益非浅。上述点滴体会，甚属肤浅，惟读书临诊，均行之有效，不揣浅陋，冒昧录之，难免贻笑大方，幸同道指正。
(尊依蠢徐明光誊纛盔整理)
祖述宪章发扬光大
南京中医学院教授吴考檗
【作者简介】吴考檗(1903～)，江苏海门人。一九二三年毕业予海门中兴医学校；一九三三至一九五二年问曾任海了保神医学校校长兼教师；现为南京中医学院教授。毕生从事中医教育事业和中医经典著作的研究工作，颇着声誉。著作有《伤寒论百家注》、《金匮要略五十家注》、《本经集义》、《难经集义》、《素灵辑释》、《麻黄汤六十五方释义》等。
我学医时，有两种学法：一是从源到流，即由《素闻》、《难经》、《本草经》、《伤寒论》、《金匮要略》，而后《千金》、《外台》，金元四家，明清各家，以及叶、薛、吴、王温热诸书；一是从流到源。我是接受学校规定的从源到流的途径学习的。
独立思考
我初进学校，老师即说：本校是从源到流授课的。《韩诗外传》说：「源清流清」。唐·魏征《谏太宗十思疏》云：「欲流之远者，必浚其泉源，源不深而欲求流之远，不可得也。」从源到流，很好，这就医学来说，当然即从《素问》、《难经》开始了。但《素问黟、《难经》，也是采取群说的综合著作，如《素问·宣明五气篇》既有「肝藏魂、肺藏魄」之说，「调经论」又有「肺藏气，肝藏血」之语。《难经·六十九难》既有「虚者补其母之盲，「七十五难」又有「母能令子虚。之辞。且《素问)、、《难经》作者，又各有其师承的不同论点。如《素问·宣明五气篇》说「脾脉代」，而《难经·四准》则说「脾脉在中」}《素问·平人气象论》说「厌厌聂聂，如落榆荚日肺平」，而《难经·十五难》为「肝平」；《素问·平人气象论》说「如鸡举足日脾病」，而《难经·十五难》为「心病」。
如此等等，不一而足。对此，应视为异苔同岑、异曲同工来理解。「肝藏魂，肺藏魄」，是以神志言；「肺藏气，肝藏血」，是以气血言。两者是一而二，二而一。所以，《灵枢经·本神弹即说；「肝藏血，血台魂，肺藏气，气舍魄」的。「虚者补其母」，是以补虚言，「母能令予虚」，是以玛实言。「脾脉代」是言脉象，「脾脉在中」是言脉位，可以两通。至于「厌厌聂聂」，「如鸡举足」，这些俱是形容语，肺平也好，肝平也好，牌病也好，心病也好，不必在形容语上钻牛角尖。
《素问》是部远年著作，累次传写，错字很多，几乎每篇有之，这确实需要解决。如《素问平人气象论》说：「少阳脉至，乍疏乍数，乍短乍长」。而就在本篇上文则说「乍疏乍数日死」。那么，乍疏乍数是平脉还是死脉呢?考《难经·七难》说：「少阳之至，乍小乍大，乍短乍长。」这就很明显，《素问·平人气象论》上文乍疏乍数是准确的；下文的乍疏乍数，是乍小乍大的错筒了。又《素问·五藏生成篇》说：「诸筋者，皆属于节。」而《太素》卷十七则说：「诸筋者，皆属于肝。」依《素问》下文诸血者皆属于心，诸气者，皆属于肺例之，这又很容易得出「节」是「肝」字之误。而注家随文强解，难以为训。这都应独立思考，自己提出问题，自己解决问题。
融会贯通
(《伤寒论》三百九十七法，一百一十三方，字数不多。我认为最好全部或大部背熟，所谓「熟读唐诗三百首，不会吟诗也会吟」。除熟能生巧外，还应过文字关，如必、不、反、当、虽、者等字，也要留神注意。「必」乃「必然」、「一定」的意思，如必恶寒(3条)(条序依《伤寒论讲义》，上海科学技术出版社，一九矗四年版，下同)，必喘(76条)，必吐下不止(77条)，必恍惚心乱(90条)。「不」乃「勿」的意思，如不呕不渴(61条)，不恶寒(70条)，不大便而呕(233条)，不属阳明也(383条)。「反」乃「不该」的意思，如反与桂枝汤欲攻其表(29条)，反一．三下之(106条)，反以冷水嗅之若灌之(145条)，反发热(30条)。「当」乃「该当」的意思，如当懈之熏之(48条)，当救其里(94条)，当以汤下之(108条)，当先解其外(109条)。「虽」乃「纵然」、「即使」的意思，如虽有阳明证(209条)，虽硬不可攻之(235条)，虽能食(253条)，虽脉浮数者(25g条)。「者」乃别事词，如脉阴阳俱紧者(3条)，汗出恶风者(38条)，病人旧微塘者(83条)，噫气不除者(166条)。一条中有两个或两个以上者字的，是两个或两个以上证的鉴别的意思，如桂枝二麻黄一汤(25条)，是治汗出未彻，与上文汗犬出，一正一反对比鉴别。一是服桂枝汤汗出太过，一是服桂枝汤汗出不及。汗出太过，故日脉洪火；汗出未彻，故日日再发。脉洪大，是表明汗出太过所引起，日再发，是说明汗出未彻所形成。故一日与桂枝汤，一日宜桂枝二麻黄一汤。用两个者字，是表明服桂枝汤后所产生汗出太过和汗出未彻的两个症状。葛根黄芩黄连汤(34条)，是治下后利遂不止、邪已入里的方法，不是治下后利邈不止而表邪末解的方法。故一曰脉促，明其未离太阳；一日喘而汗出，证其邪已入里。是以一日表未解也，一日葛根黄芩黄连汤主之。
表未解也，葛根黄芩黄连汤主之两句，是对比章法。
表未解也，是脉促者之断语；葛根黄芩黄连汤主之，是喘而汗出之方治。这与前桂枝二麻黄一汤同一章法。就是说：脉促者，言脓不言证，是言脉胲证；喘而汗出，言证不言脉，是言证赅脉；表未解也，言位不言方，是言位赅方；葛根黄芩黄连汤，言方不言位，是言方赅位的意思。故与桂枝二麻黄一汤同用两个者字，此是《伤寒论》惯用的方法，亦是古文家常用的章法，只要翻看《伤寒论》前后用及者字的原文一看就清楚的。
此外还有药品的去加，是关及药品的适应不适应，也应密切注意。如胸满去芍药(22条)，渴去半夏(98条)，胁下痞硬去大枣(98条)，小便利去茯苓(316条)，项背强几几加葛根(14条)，喘加厚朴杏子(19条)，渴加瓜蒌根(g8条)，呕加半夏生姜(177条)等。这样将前后上下同类文字对照一下(如23条中就有必、不、反、者四字)，就比较容易理解。因很多条文具有互相联系、相互阐发的意义。如血自下，下者愈(109条)，是宜桃核承气汤下的倒装句。时时恶风(173条)背微恶寒者(174条)，不是表未解，故下文(175条)说无表证者，白虎加人参汤主之。不言脉者，前(26条)已说过，此就可似以证赅脉了。
综合归纳
《金匮要略》二十五篇，一篇一病的有之，一篇二病三病的亦有之。我认为一篇一病，是有独特性的，如奔豚气和其它病很不一样。一篇二病三病，是具有联系性的，如腹满寒疝宿食，都有腹满痛。又趺蹶能前不能却，手指臂肿动，转筋上下行，阴狐疝气时时上下，蜕虫发作有时，其病证表现，一是能前不能后，一是常肿动，一是上下行，一是时时上下，一是发作有时，都有其相对性，所以合为一篇。再是其文与《伤寒论》重复很多，诚如《伤寒论翼·阳明病解》所谓：。见此病、便与此方。」《医学源流论·治病不必分经络脏腑论》所谓「参耆之类，无所不补，通气者无气不通」，也是有其一定道理的。
各篇病证，如「痰饮咳嗽病脉证治」列有痰饮、溢饮、悬饮、支饮、留饮、伏饮多种名称，前后说法略有出入，可以用综合归纳的方法来认识。如上及于目、下至于肠的，为痰饮之所及，咳引胁下痛的，为悬饮之象征，流行遍体四肢的，是溢饮之见汪}上及头目眩冒，证见胸膈支满不得卧的，则为支饮之现象，胸胁及背下至四肢历节痛的，为留饮之病况，平素喘咳，发则影响腰背身目的，为伏饮之症候。其主要区别，素盛今瘐，为痰饮之特点；痛限胁下，为悬饮所独有；身体痛重，属溢饮之范畴；短气不得卧，其形如肿，为支饮之大要}背冷如掌大，为留饮之确证』发则身鹅泣出，为伏饮之真相。这就比较容易辨认，推之其它病证，也可因此隅反之。
病证分析
例一：庄某，女性，34岁。患眩晕症已有数年，虽然经过多种治疗，但眩晕和恶心呕吐仍反复发作，特意前来接受针灸治疗。诊察发现脉象沉细，舌苔薄腻，辨证为因劳累过度导致损伤，湿痰阻滞中焦。选取百会、天柱、大杼、丝竹空、内关、足临泣等穴位，采用捻转旋转泻法，以起到清镇宁神、疏泄肝胆的作用；并加用中脘穴（针刺后拔火罐）和足三里穴，同样使用捻转旋转泻法，这是运用调和胃气、和中焦的方法，以达到化湿除痰的功效。经过数次诊治，眩晕和呕吐症状全部痊愈，至今近二十年，未见复发。
例二：姚某，女性，64岁。患有腰痛，不能回头回顾，严重时悲伤哭泣不止，诊断为“阳明腰痛”。针刺双侧足三里穴，采用捻转旋转泻法，腰痛立刻缓解；再取肾俞、气海俞穴，针后拔火罐，患者转身回顾均感便利，满意而归。
例三：曹某，女性，23岁，教师。患有肠鸣腹泻已一年多，精神疲惫乏力，肌肉消瘦，情绪低沉，思想苦闷。由亲友陪同来就诊，诊断为“脾虚泄泻”。开具单方：炒白扁豆肉、扁豆衣各15克，玫瑰花4朵，每日服用一剂，煎汤代茶饮用。并嘱咐其注意饮食有节制，起居有规律，保暖并节制劳累，保持愉悦乐观的心情。一周后复诊，肠鸣腹泻均有好转，精神也见振作，于是开具参苓白术散方，加入玫瑰花，并加倍使用炒白扁豆肉、扁豆衣煎服。两周后再复诊时，病情痊愈大半，原方继续服用，服药两个月，形体恢复，元气充足，即宣告痊愈。
我认为人体的脾胃，就像汽车的发动机，如果发动机受损，那么其他配件即使完美无缺，也无法启动。反之，只要发动机正常，零件的维修就较为容易。所以在临床上必须重视调理脾胃，扶持正气。只有元气充足，即使是顽固疾病也容易康复；如果脾胃失治，元气大伤，那么机体的修复就困难了。正如李东垣所说：“治疗肝、心、脾、肾，无论有余还是不足，或者补或者泻，只有益脾胃的药物最为切要。”调理脾胃的方法很多。我在治疗慢性病用药时，常给男性加佛手柑，给女性加玫瑰花；在针灸取穴时，也常给男性用足三里，给女性用三阴交，以健运脾胃，巩固后天之本，使疾病容易康复。
注重七情致病
喜、怒、忧、思、悲、恐、惊，这七情是人体对外界环境各种条件刺激而产生的精神活动，正常情况下是在体内各脏腑的调节之下进行的。但是过甚或过久的情志活动会影响脏腑调节，从而导致损伤脏腑而致病。在《内经》中就有“怒伤肝，喜伤心，思伤脾，忧伤肺，恐伤肾”的论述，后世医家将其作为病因学的三因之一。
虽说七情均可致病，但临床上以怒、思、忧致病为多见。怒则气机逆乱，肝气郁滞，可见胸闷、腹胀、两胁疼痛，脉弦。由于“暴怒伤阴”，阴伤则阳失去制约，故常伴有肝火上炎的症状，如面赤升火，甚至呕血。忧哀太甚，则肺气抑郁，甚至肺阴受伤，以至形体憔悴、气力匮乏。思虑过度，则脾气郁结，以致胸脘痞塞，脾被所伤，则运化功能丧失，而不想饮食。这三种情志伤人致病，均可使正常运行之气机受阻而郁滞，其中怒、忧两种情志常伤脏阴，为害尤为剧烈。
关于治疗，《素问·阴阳应象大论》说：“悲胜怒，怒胜思，喜胜忧……”我认为忧、怒、思三种情志可使气机郁滞，甚至耗气伤阴。只有喜乐能使气机和顺，情志舒畅，营卫通利，正如《素问·举痛论》所说：“喜则气和志达，营卫通利，故气缓矣。”因此可用喜乐之法来统摄治疗怒、忧、思三种情志所致疾病。
医生的责任，在于千方百计治好疾病，当医生在为病人诊察之际，治疗即已寓于其中。若能针对病因劝导病人，并采用各种方法，使其心情舒畅，调节好病人的情志活动，常能收到事半功倍的效果。《灵枢·本神》说：“所以智者养生，顺应四时而适应寒暑，调和喜怒而安居处，节制阴阳而调刚柔，这样邪气就不会到来，寿命长久且视力不衰。”昔日张子和用戏言狂谑，使病人大笑不忍，而使心下结块在一两天内消散。临床上用喜乐之法治疗怒、悲、思所致疾病，从未听说过有过分的例子，所以不会有“喜伤心”的担忧。此外，柴胡疏肝散、逍遥散，是古医家为气郁而设，内关、足三里、中脘等穴，具有理气宽中之效，我在临床上也是经常采用的。
在临床上，对待病人的态度应和蔼可亲，诊察上要详审细致，治疗上要认真负责。遇到有七情所伤的，更应循循善诱。记得有一位病人，女性，四十岁，因家庭不和而争吵，致使两胁胀痛，胸闷，心悸，已有十余天。由丈夫陪同前来就诊，诊得脉象弦数，面红升火。除了用疏肝解郁的药剂外，并用婉言劝慰、引导她。第二天，夫妻双双前来面谢，言归于好，诸症皆消。对于因情志怫郁而导致神经衰弱的患者，更应如此。
因情志违和而致病，用调节情志之法治疗已被医者所重视，其具体方法，可因人、因事、因时而异，但其目的是为使病人消除不悦之感，而达到情志舒畅，身心健康。在临床上，重视七情致病，善用喜乐之法治之，也是中医传统方法之一。
我生平没有其他爱好，只把治病当作自己的责任，急病人之所急，以病人的快乐为快乐。临诊六十多年，虽然没有建树，但谨慎从事，也没有失误。孙思邈说：“胆欲大而心欲小，智欲圆而行欲方。”这是我行医的鉴戒，终身遵守而不失，得益非浅。上述点滴体会，实属肤浅，只是读书临诊，行之有效，不揣浅陋，冒昧记录，难免贻笑大方，幸同道指正。
(尊依蠢徐明光誊录整理)
祖述宪章发扬光大
南京中医学院教授吴考槃
【作者简介】吴考槃(1903～)，江苏海门人。一九二三年毕业于海门中兴医学校；一九三三至一九五二年间曾任海门保神医学校校长兼教师；现为南京中医学院教授。毕生从事中医教育事业和中医经典著作的研究工作，颇着声誉。著作有《伤寒论百家注》、《金匮要略五十家注》、《本经集义》、《难经集义》、《素灵辑释》、《麻黄汤六十五方释义》等。
我学医时，有两种学法：一是从源到流，即由《素问》、《难经》、《本草经》、《伤寒论》、《金匮要略》，而后《千金》、《外台》，金元四家，明清各家，以及叶、薛、吴、王温热诸书；一是从流到源。我是接受学校规定的从源到流的途径学习的。
独立思考
我刚进学校，老师说：本校是从源到流授课的。《韩诗外传》说：“源清流清”。唐·魏征《谏太宗十思疏》云：“欲流之远者，必浚其泉源，源不深而欲求流之远，不可得也。”从源到流，很好，这就医学来说，当然即从《素问》、《难经》开始了。但《素问》、《难经》，也是采取群说的综合著作，如《素问·宣明五气篇》既有“肝藏魂、肺藏魄”之说，“调经论”又有“肺藏气，肝藏血”之语。《难经·六十九难》既有“虚者补其母”之言，“七十五难”又有“母能令子虚”之辞。且《素问》、《难经》作者，又各有其师承的不同论点。如《素问·宣明五气篇》说“脾脉代”，而《难经·四难》则说“脾脉在中”；《素问·平人气象论》说“厌厌聂聂，如落榆荚曰肺平”，而《难经·十五难》为“肝平”；《素问·平人气象论》说“如鸡举足曰脾病”，而《难经·十五难》为“心病”。
如此等等，不一而足。对此，应视为异曲同工来理解。“肝藏魂，肺藏魄”，是以神志言；“肺藏气，肝藏血”，是以气血言。两者是一而二，二而一。所以，《灵枢经·本神》即说：“肝藏血，血舍魂，肺藏气，气舍魄”的。“虚者补其母”，是以补虚言，“母能令子虚”，是以泻实言。“脾脉代”是言脉象，“脾脉在中”是言脉位，可以两通。至于“厌厌聂聂”，“如鸡举足”，这些俱是形容语，肺平也好，肝平也好，脾病也好，心病也好，不必在形容语上钻牛角尖。
《素问》是部远古著作，累次传写，错字很多，几乎每篇有之，这确实需要解决。如《素问·平人气象论》说：“少阳脉至，乍疏乍数，乍短乍长”。而就在本篇上文则说“乍疏乍数曰死”。那么，乍疏乍数是平脉还是死脉呢？考《难经·七难》说：“少阳之至，乍小乍大，乍短乍长。”这就很明显，《素问·平人气象论》上文乍疏乍数是准确的；下文的乍疏乍数，是乍小乍大的错简了。又《素问·五脏生成篇》说：“诸筋者，皆属于节。”而《太素》卷十七则说：“诸筋者，皆属于肝。”依《素问》下文诸血者皆属于心，诸气者，皆属于肺例之，这又很容易得出“节”是“肝”字之误。而注家随文强解，难以为训。这都应独立思考，自己提出问题，自己解决问题。
融会贯通
《伤寒论》三百九十七法，一百一十三方，字数不多。我认为最好全部或大部背熟，所谓“熟读唐诗三百首，不会吟诗也会吟”。除熟能生巧外，还应过文字关，如必、不、反、当、虽、者等字，也要留神注意。“必”乃“必然”、“一定”的意思，如必恶寒(3条)(条序依《伤寒论讲义》，上海科学技术出版社，一九八四年版，下同)，必喘(76条)，必吐下不止(77条)，必恍惚心乱(90条)。“不”乃“勿”的意思，如不呕不渴(61条)，不恶寒(70条)，不大便而呕(233条)，不属阳明也(383条)。“反”乃“不该”的意思，如反与桂枝汤欲攻其表(29条)，反一二下之(106条)，反以冷水噀之若灌之(145条)，反发热(30条)。“当”乃“该当”的意思，如当解之熏之(48条)，当救其里(94条)，当以汤下之(108条)，当先解其外(109条)。“虽”乃“纵然”、“即使”的意思，如虽有阳明证(209条)，虽硬不可攻之(235条)，虽能食(253条)，虽脉浮数者(258条)。“者”乃别事词，如脉阴阳俱紧者(3条)，汗出恶风者(38条)，病人旧微溏者(83条)，噫气不除者(166条)。一条中有两个或两个以上者字的，是两个或两个以上证的鉴别的意思，如桂枝二麻黄一汤(25条)，是治汗出未彻，与上文汗大出，一正一反对比鉴别。一是服桂枝汤汗出太过，一是服桂枝汤汗出不及。汗出太过，故曰脉洪大；汗出未彻，故曰日再发。脉洪大，是表明汗出太过所引起，日再发，是说明汗出未彻所形成。故一曰与桂枝汤，一曰宜桂枝二麻黄一汤。用两个者字，是表明服桂枝汤后所产生汗出太过和汗出未彻的两个症状。葛根黄芩黄连汤(34条)，是治下后利遂不止、邪已入里的方法，不是治下后利遂不止而表邪未解的方法。故一曰脉促，明其未离太阳；一曰喘而汗出，证其邪已入里。是以一曰表未解也，一曰葛根黄芩黄连汤主之。
表未解也，葛根黄芩黄连汤主之两句，是对比章法。
表未解也，是脉促者之断语；葛根黄芩黄连汤主之，是喘而汗出之方治。这与前桂枝二麻黄一汤同一章法。就是说：脉促者，言脉不言证，是言脉赅证；喘而汗出，言证不言脉，是言证赅脉；表未解也，言位不言方，是言位赅方；葛根黄芩黄连汤，言方不言位，是言方赅位的意思。故与桂枝二麻黄一汤同用两个者字，此是《伤寒论》惯用的方法，亦是古文家常用的章法，只要翻看《伤寒论》前后用及者字的原文一看就清楚的。
此外还有药品的去加，是关及药品的适应不适应，也应密切注意。如胸满去芍药(22条)，渴去半夏(98条)，胁下痞硬去大枣(98条)，小便利去茯苓(316条)，项背强几几加葛根(14条)，喘加厚朴杏子(19条)，渴加瓜蒌根(98条)，呕加半夏生姜(177条)等。这样将前后上下同类文字对照一下(如23条中就有必、不、反、者四字)，就比较容易理解。因很多条文具有互相联系、相互阐发的意义。如血自下，下者愈(109条)，是宜桃核承气汤下的倒装句。时时恶风(173条)背微恶寒者(174条)，不是表未解，故下文(175条)说无表证者，白虎加人参汤主之。不言脉者，前(26条)已说过，此就可以以证赅脉了。
综合归纳
《金匮要略》二十五篇，一篇一病的有之，一篇二病三病的亦有之。我认为一篇一病，是有独特性的，如奔豚气和其它病很不一样。一篇二病三病，是具有联系性的，如腹满寒疝宿食，都有腹满痛。又趺蹶能前不能却，手指臂肿动，转筋上下行，阴狐疝气时时上下，蛔虫发作有时，其病证表现，一是能前不能后，一是常肿动，一是上下行，一是时时上下，一是发作有时，都有其相对性，所以合为一篇。再是其文与《伤寒论》重复很多，诚如《伤寒论翼·阳明病解》所谓：“见此病、便与此方。”《医学源流论·治病不必分经络脏腑论》所谓“参耆之类，无所不补，通气者无气不通”，也是有其一定道理的。
各篇病证，如“痰饮咳嗽病脉证治”列有痰饮、溢饮、悬饮、支饮、留饮、伏饮多种名称，前后说法略有出入，可以用综合归纳的方法来认识。如上及于目、下至于肠的，为痰饮之所及，咳引胁下痛的，为悬饮之象征，流行遍体四肢的，是溢饮之见证；上及头目眩冒，证见胸膈支满不得卧的，则为支饮之现象，胸胁及背下至四肢历节痛的，为留饮之病况，平素喘咳，发则影响腰背身目的，为伏饮之症候。其主要区别，素盛今羸，为痰饮之特点；痛限胁下，为悬饮所独有；身体痛重，属溢饮之范畴；短气不得卧，其形如肿，为支饮之大要；背冷如掌大，为留饮之确证；发则身瞤泣出，为伏饮之真相。这就比较容易辨认，推之其它病证，也可因此隅反之。
病证分析
Case 1: Zhu, female, 34 years old. Suffering from vertigo for several years, despite various treatments, the vertigo and nausea/vomiting continued to recur. She specifically came for acupuncture treatment. The pulse was found to be deep and fine (Chen Xi), and the tongue coating was thin and greasy (Bo Ni). The syndrome differentiation indicated injury due to overexertion, with damp-phlegm obstructing the middle jiao. Acupoints selected included Baihui (DU20), Tianzhu (BL10), Dazhu (BL11), Sizhukong (TE23), Neiguan (PC6), and Zulinqi (GB41). A twisting and rotating reducing method (Nian Xuan Xie Fa) was applied to clear, calm, and nourish the spirit, and to soothe the liver and gallbladder. Zhongwan (CV12) (cupping after needle insertion) and Zusanli (ST36) were added, also using the twisting and rotating reducing method. This employs the method of harmonizing the stomach and regulating the middle jiao to achieve the effect of resolving dampness and eliminating phlegm. After several sessions, both vertigo and vomiting were cured. Nearly twenty years have passed since then, with no recurrence.
Case 2: Yao, female, 64 years old. Suffering from lower back pain preventing her from turning her head; at times, she would cry uncontrollably. Diagnosed as "Yangming Lower Back Pain." Bilateral Zusanli (ST36) were needled using the twisting and rotating reducing method, providing immediate relief from the lower back pain. Shenshu (BL23) and Qihai Shu (BL24) were then needled, followed by cupping. The patient could turn and look around comfortably and left satisfied.
Case 3: Cao, female, 23 years old, a teacher. Suffering from borborygmus and diarrhea for over a year, accompanied by mental fatigue, emaciation, low mood, and depression. Accompanied by relatives and friends, she was diagnosed with "Spleen Deficiency Diarrhea." A single prescription was given: Stir-fried White Coix Seed Flesh and Coix Seed Husk, 15g each, and 4 Rose Buds, taken as one dose daily, decocted in water to replace tea. She was advised to maintain regular diet and lifestyle, keep warm, avoid overexertion, and maintain a joyful and optimistic attitude. Upon follow-up after one week, borborygmus and diarrhea had improved, and her spirit had lifted. Shenling Baizhu San (Ginseng and Poria Powder) was prescribed with added Rose Buds, and the dosage of stir-fried White Coix Seed Flesh and Husk was doubled. Two weeks later, upon further follow-up, the illness was mostly cured. The original formula was continued. After two months of medication, her physique recovered, and her Yuan Qi (Primordial Qi) was sufficient, marking full recovery.
I believe that the spleen and stomach in the human body are like the engine of a car. If the engine is damaged, other parts, even if perfect, cannot function. Conversely, as long as the engine is normal, repairing other parts is relatively easy. Therefore, in clinical practice, we must emphasize regulating the spleen and stomach and supporting Zheng Qi (Upright Qi). Only when Yuan Qi is sufficient can stubborn diseases be easily cured; if the spleen and stomach are neglected and Yuan Qi is severely damaged, the body's repair becomes difficult. As Li Dongyuan said: "In treating the liver, heart, spleen, and kidney, whether there is excess or deficiency, whether tonifying or reducing, only herbs that benefit the spleen and stomach are most pertinent." There are many methods to regulate the spleen and stomach. In my use of herbs for chronic diseases, I often add Bergamia Fructus (Foshougan) for men and Rosa Rugosa (Meiguihua) for women. In acupuncture point selection, I often use Zusanli (ST36) for men and Sanyinjiao (SP6) for women, to strengthen the transportation and transformation of the spleen and stomach, consolidate the foundation of acquired constitution, and facilitate disease recovery.
Emphasis on Disease Caused by Seven Emotions
Joy, anger, worry, thought, sadness, fear, and fright—these seven emotions are mental activities generated by the human body in response to stimuli from various external environmental conditions. Under normal circumstances, they are regulated by the internal organs. However, excessive or prolonged emotional activities affect this regulation, leading to organ damage and disease. The *Neijing* states: "Anger injures the Liver, Joy injures the Heart, Thought injures the Spleen, Sadness injures the Lung, Fear injures the Kidney." Later physicians considered this one of the three categories of etiology.
Although all seven emotions can cause disease, clinically, anger, thought, and worry are the most common. Anger causes qi mechanism reversal and stagnation of Liver Qi, manifesting as chest tightness, abdominal distension, hypochondriac pain, and a wiry pulse. Due to "violent anger injuring Yin," Yin deficiency leads to uncontrolled Yang, often accompanied by symptoms of Liver Fire flaring up, such as facial flushing and rising heat, or even hematemesis. Excessive sorrow depresses Lung Qi and may injure Lung Yin, leading to physical exhaustion and lack of energy. Overthinking causes Spleen Qi stagnation, resulting in chest and epigastric fullness. When the Spleen is injured, its transportation and transformation functions fail, leading to loss of appetite. These three emotions obstruct the normal flow of qi, causing stagnation. Among them, anger and worry often injure Zang Yin, causing particularly severe harm.
Regarding treatment, the *Suwen·Yin Yang Yingxiang Dalun* states: "Sorrow overcomes Anger, Anger overcomes Thought, Joy overcomes Worry..." I believe that worry, anger, and thought can cause qi stagnation and even consume qi and injure Yin. Only joy can make qi smooth, emotions relaxed, and Ying and Wei (Nutritive and Defensive Qi) flow freely. As stated in the *Suwen·Jutong Lun*: "Joy makes qi harmonious and will directed, Ying and Wei flow freely, thus qi relaxes." Therefore, the method of inducing joy can be used to treat diseases caused by anger, worry, and thought.
The doctor's responsibility is to cure the disease by every means possible. Treatment is inherent in the process of diagnosis. By counseling patients based on the etiology and employing various methods to make them feel comfortable and regulate their emotional activities, one can often achieve twice the result with half the effort. The *Lingshu·Benshen* states: "Therefore, the wise person nurtures life by following the four seasons and adapting to cold and heat, harmonizing joy and anger and living peacefully, regulating yin and yang and adjusting hardness and softness. In this way, pathogenic factors do not arrive, and life is prolonged and vision remains clear." In the past, Zhang Zihe used jokes and playful behavior to make patients laugh uncontrollably, causing submental masses to dissipate within one or two days. In clinical practice, using the method of joy to treat diseases caused by anger, sadness, and thought has never been reported to cause excess, so there is no fear of "Joy injuring the Heart." Additionally, Chaihu Shugan San (Bupleurum Powder to Soothe the Liver) and Xiaoyao San (Free and Easy Wanderer Powder) were designed by ancient physicians for qi stagnation. Acupoints such as Neiguan (PC6), Zusanli (ST36), and Zhongwan (CV12) have the effect of regulating qi and widening the middle jiao, which I frequently use in clinical practice.
In clinical practice, our attitude towards patients should be amiable. Diagnosis should be detailed and meticulous, and treatment should be serious and responsible. For those injured by the seven emotions, we should guide them patiently. I recall a female patient, forty years old, who suffered from hypochondriac distending pain, chest tightness, and palpitations for over ten days due to family discord and arguments. Accompanied by her husband, her pulse was wiry and rapid, and her face was red with rising heat. Besides prescribing herbs to soothe the Liver and resolve stagnation, I gently persuaded and guided her. The next day, the couple returned together to express their gratitude, having reconciled, with all symptoms disappearing. This approach is especially important for patients with neurasthenia caused by emotional depression.
Diseases caused by emotional disharmony treated by regulating emotions have gained attention among physicians. Specific methods vary according to the individual, situation, and time, but the goal is always to eliminate the patient's displeasure and achieve emotional comfort and physical and mental health. In clinical practice, emphasizing diseases caused by the seven emotions and skillfully using the method of joy is also one of the traditional methods of Traditional Chinese Medicine.
Throughout my life, I have had no other hobbies but treating diseases as my duty, sharing the anxieties of my patients and finding joy in their happiness. Having practiced for over sixty years, although I have achieved little, I have proceeded cautiously without error. Sun Simiao said: "Courage should be great, but the mind cautious; wisdom should be round, but conduct square." This serves as my motto for medical practice, which I have adhered to throughout my life, gaining much benefit. The above reflections are superficial, but they have proven effective in reading and clinical practice. Presuming my shallowness, I dare to record them, hoping for correction from colleagues.
(Transcribed and organized by Xu Mingguang)
Ancestral Tradition and Great Development
Professor Wu Kaobi, Nanjing University of Chinese Medicine
[Author Profile] Wu Kaobi (1903–), from Haimen, Jiangsu. Graduated from Haimen Zhongxing Medical School in 1923; served as principal and teacher at Haimen Baoshen Medical School from 1933 to 1952; currently a professor at Nanjing University of Chinese Medicine. He devoted his life to TCM education and research on classic TCM texts, achieving considerable reputation. His works include *Shanghan Lun Baijia Zhu*, *Jinkui Yaolue Wushijia Zhu*, *Benjing Jiyi*, *Nanjing Jiyi*, *Suling Jishi*, and *Mahuang Tang Liushiwu Fang Shiyi*.
When I studied medicine, there were two approaches: one from source to stream, i.e., starting from *Suwen*, *Nanjing*, *Bencao Jing*, *Shanghan Lun*, *Jinkui Yaolue*, and then moving to *Qianjin*, *Waitai*, the Four Masters of Jin and Yuan, Ming and Qing schools, and the Warm Heat books by Ye, Xue, Wu, and Wang; the other from stream to source. I accepted the school-regulated path of learning from source to stream.
Independent Thinking
When I first entered the school, the teacher said: Our school teaches from source to stream. *Han Shi Waizhuan* says: "Clear source, clear stream." Wei Zheng of the Tang Dynasty in his *Memorial on Ten Thoughts to Emperor Taizong* stated: "To seek a distant stream, one must dredge its source; if the source is not deep, seeking a distant stream is impossible." Learning from source to stream is good. In terms of medicine, this naturally begins with *Suwen* and *Nanjing*. However, *Suwen* and *Nanjing* are comprehensive works compiling various theories. For example, *Suwen·Xuanming Wuqi Pian* states "Liver stores Hun, Lung stores Po," while *Tiaojing Lun* states "Lung stores Qi, Liver stores Blood." *Nanjing·Diagnosis 69* states "Deficient syndromes are treated by tonifying the mother," while *Diagnosis 75* states "The mother can make the child deficient." Furthermore, the authors of *Suwen* and *Nanjing* had different lineages and viewpoints. For instance, *Suwen·Xuanming Wuqi Pian* says "Spleen pulse is Dai (alternating)," while *Nanjing·Diagnosis 4* says "Spleen pulse is in the center"; *Suwen·Pingren Qixiang Lun* says "Yanyan Nie Nie, like falling elm seeds, indicates healthy Lung," while *Nanjing·Diagnosis 15* refers to healthy Liver; *Suwen·Pingren Qixiang Lun* says "Like a chicken lifting its foot indicates Spleen disease," while *Nanjing·Diagnosis 15* refers to Heart disease.
And so on, too numerous to list. These should be understood as different melodies achieving the same effect. "Liver stores Hun, Lung stores Po" refers to spiritual consciousness; "Lung stores Qi, Liver stores Blood" refers to Qi and Blood. They are two aspects of one reality. Thus, *Lingshu·Benshen* states: "Liver stores Blood, Blood houses Hun; Lung stores Qi, Qi houses Po." "Deficient syndromes are treated by tonifying the mother" refers to tonifying deficiency, while "The mother can make the child deficient" refers to draining excess. "Spleen pulse is Dai" refers to pulse quality, while "Spleen pulse is in the center" refers to pulse position; both can be valid. As for "Yanyan Nie Nie" and "like a chicken lifting its foot," these are descriptive terms. Whether it describes healthy Lung, healthy Liver, Spleen disease, or Heart disease, one should not get bogged down in the descriptive language.
*Suwen* is an ancient work subject to repeated copying, containing many errors in almost every chapter, which indeed needs resolution. For example, *Suwen·Pingren Qixiang Lun* states: "Shaoyang pulse arrives, sometimes sparse, sometimes rapid, sometimes short, sometimes long." But earlier in the same chapter, it says "Sparse and rapid indicates death." So, is sparse and rapid a healthy pulse or a fatal one? Consulting *Nanjing·Diagnosis 7*, it says: "Shaoyang arrival, sometimes small, sometimes large, sometimes short, sometimes long." It is clear that the earlier mention of sparse and rapid in *Suwen·Pingren Qixiang Lun* is accurate; the later mention of sparse and rapid is a textual error for small and large. Also, *Suwen·Wuzang Shengcheng Pian* states: "All sinews belong to the joints." While *Tai Su* Vol. 17 states: "All sinews belong to the Liver." Based on the subsequent text in *Suwen* stating "All blood belongs to the Heart, all Qi belongs to the Lung," it is easy to deduce that "joint" is a typo for "Liver." Commentators forcing interpretations based on the text are difficult to accept. One must think independently, raise questions, and solve them oneself.
Integration and Mastery
*Shanghan Lun* contains 397 methods and 113 formulas, with relatively few words. I believe it is best to memorize all or most of it, as the saying goes: "Read three hundred poems of Tang, and you can compose poetry even if you don't know how." Besides proficiency leading to skill, one must pass the test of language. Words like bi (must), bu (not), fan (contrary), dang (should), sui (although), zhe (particle indicating condition) require careful attention. "Bi" means "necessarily" or "certainly," e.g., Bi E Han (must feel aversion to cold, Clause 3), Bi Chuan (must wheeze, Clause 76), Bi Tu Xia Bu Zhi (must have incessant vomiting and diarrhea, Clause 77), Bi Huang Hu Xin Luan (must have mental confusion, Clause 90). "Bu" means "do not," e.g., Bu Ou Bu Ke (no vomiting, no thirst, Clause 61), Bu E Han (no aversion to cold, Clause 70), Bu Da Bian Er Ou (no bowel movement but vomiting, Clause 233), Bu Shu Yang Ming Ye (does not belong to Yangming, Clause 383). "Fan" means "should not," e.g., Fan Yu Guizhi Tang Yu Gong Qi Biao (contrarily giving Cinnamon Twig Decoction to attack the exterior, Clause 29), Fan Yi Er San Xia Zhi (contrarily purging two or three times, Clause 106), Fan Yi Leng Shui Xun Zhi Ruo Guan Zhi (contrarily spraying or pouring cold water, Clause 145), Fan Fa Re (contrarily having fever, Clause 30). "Dang" means "ought to," e.g., Dang Jie Zhi Xun Zhi (should resolve via fumigation, Clause 48), Dang Jiu Qi Li (should rescue the interior, Clause 94), Dang Yi Tang Xia Zhi (should purge via decoction, Clause 108), Dang Xian Jie Qi Wai (should first resolve the exterior, Clause 109). "Sui" means "even if," e.g., Sui You Yang Ming Zheng (even if there are Yangming signs, Clause 209), Sui Ying Bu Ke Gong Zhi (even if hard, cannot purge, Clause 235), Sui Neng Shi (even if able to eat, Clause 253), Sui Mai Fu Shu Zhe (even if the pulse is floating and rapid, Clause 258). "Zhe" is a particle indicating a specific condition, e.g., Mai Yin Yang Ju Jin Zhe (pulse Yin and Yang both tight, Clause 3), Han Chu E Feng Zhe (sweating and aversion to wind, Clause 38), Bing Ren Jiu Wei Tang Zhe (patient previously had loose stools, Clause 83), Yi Qi Bu Chu Zhe (belching not relieved, Clause 166). When a clause has two or more "zhe," it implies a differential diagnosis between two or more conditions. For example, Guizhi Er Mahuang Yi Tang (Clause 25) treats incomplete sweating, contrasting with the previous clause on profuse sweating. One case is excessive sweating after taking Guizhi Tang, the other is insufficient sweating. Excessive sweating leads to a洪大 (surging-large) pulse; incomplete sweating leads to recurrence daily. A surging-large pulse indicates excessive sweating; daily recurrence indicates incomplete sweating. Hence, one clause advises Guizhi Tang, the other Guizhi Er Mahuang Yi Tang. Using two "zhe" indicates the two symptoms produced after taking Guizhi Tang: excessive sweating and incomplete sweating. Gegen Huangqin Huanglian Tang (Clause 34) treats persistent diarrhea after purging where pathogens have entered the interior, not where the exterior pathogen remains unresolved. Hence, one clause mentions Cu (rapid) pulse, indicating retention in Taiyang; another clause mentions Chuan Er Han Chu (wheezing and sweating), proving pathogens have entered the interior. Thus, one clause states "Exterior unresolved," the other "Gegen Huangqin Huanglian Tang governs."
"Exterior unresolved, Gegen Huangqin Huanglian Tang governs" uses a comparative structure.
"Exterior unresolved" is the conclusion for the Cu pulse case; "Gegen Huangqin Huanglian Tang governs" is the treatment for the wheezing and sweating case. This matches the structure of Guizhi Er Mahuang Yi Tang. That is: Cu pulse discusses pulse without explicitly stating syndrome (pulse encompasses syndrome); wheezing and sweating discusses syndrome without explicitly stating pulse (syndrome encompasses pulse); "Exterior unresolved" discusses location without formula (location encompasses formula); "Gegen Huangqin Huanglian Tang" discusses formula without location (formula encompasses location). Thus, using two "zhe" here is a habitual method in *Shanghan Lun* and a common rhetorical device in classical prose.
Additionally, the addition or removal of herbs relates to their appropriateness and requires close attention. E.g., remove Shaoyao for chest fullness (Clause 22), remove Banxia for thirst (Clause 98), remove Dazao for hypochondriac hardness (Clause 98), remove Fuling for frequent urination (Clause 316), add Gegen for stiffness of neck and back (Clause 14), add Houpo and Xingren for wheezing (Clause 19), add Gualougen for thirst (Clause 98), add Banxia and Shengjiang for vomiting (Clause 177). Comparing similar texts before and after (e.g., Clause 23 contains bi, bu, fan, zhe) makes understanding easier because many clauses are interconnected and mutually explanatory. For example, "Blood flows out spontaneously, spontaneous flow indicates healing" (Clause 109) is an inverted sentence meaning Taohe Chengqi Tang should be used. "Constantly feeling aversion to wind" (Clause 173) and "slight aversion to cold on the back" (Clause 174) do not indicate unresolved exterior; hence, the following clause (175) states that for those without exterior signs, Baihu Jia Renshen Tang governs. Not mentioning pulse is because it was mentioned earlier (Clause 26); here, syndrome encompasses pulse.
Comprehensive Synthesis
*Jinkui Yaolue* has twenty-five chapters. Some chapters discuss one disease, others two or three. I believe a chapter discussing one disease highlights its uniqueness, such as Benteng Qi being very different from other diseases. Chapters discussing two or three diseases highlight their connections, such as Fuman, Hanshan, and Sushí all presenting with abdominal fullness and pain. Also, Diejue (ability to move forward but not backward), Finger and Arm Swelling and Tremors, Convulsions moving up and down, Yinhu Hernia moving up and down intermittently, and Huichong (roundworm) attacks occurring at intervals—all have relative characteristics (forward but not backward, constant swelling/tremor, moving up/down, intermittent movement, periodic attacks), so they are combined into one chapter. Furthermore, the text overlaps significantly with *Shanghan Lun*, as noted in *Shanghan Lun Yi·Yangming Bingjie*: "Seeing this disease, give this formula." And as stated in *Yixue Yuanliu Lun·Zhibing Bubi Fen Jingluo Zangfu Lun*: "Herbs like Ginseng and Astragalus tonify everything; Qi-moving herbs unblock all Qi." This has some validity.
For diseases in each chapter, such as "Tan Yin Cough Disease Pulse Syndrome Treatment" listing Tan Yin, Yi Yin, Xuan Yin, Zhi Yin, Liu Yin, and Fu Yin, with slight variations in descriptions, a comprehensive synthesis method can be used. Tan Yin affects areas from eyes to intestines; cough pulling hypochondriac pain symbolizes Xuan Yin; spreading throughout limbs and body is Yi Yin; affecting head/eyes with dizziness and chest/diaphragm fullness preventing lying down is Zhi Yin; pain in chest/hypochondrium/back extending to limbs/joints is Liu Yin; chronic wheezing/cough affecting waist/back/head/eyes during attacks is Fu Yin. Key distinctions: formerly robust now emaciated is characteristic of Tan Yin; pain limited to hypochondrium is unique to Xuan Yin; heavy body pain falls under Yi Yin; shortness of breath preventing lying down with swollen appearance is key to Zhi Yin; back coldness the size of a palm is definitive for Liu Yin; attacks with body tremors and tearing are true signs of Fu Yin. This makes identification easier, and by analogy, other diseases can be understood similarly.
Disease Analysis