凡看病施治，贵乎精一。盖天下之病，变态虽多，其本则一。天下之方，活法虽多，对
证则一。故凡治病之道，必确知为寒，则竟散其寒，确知为热，则竟清其热，一拔其本，诸
证尽除矣。故《内经》曰∶治病必求其本。是以凡诊病者，必须先探病本，然后用药。若见
有未的，宁为少待，再加详察，既得其要，但用一味二味便可拔之，即或深固，则五六味七
八味亦已多矣。然虽用至七八味，亦不过帮助之，导引之，而其意则一也，方为高手。
今之医者，凡遇一证，便若观海望洋，茫无定见，则势有不得不为杂乱而用广络原野之
术。盖其意谓虚而补之，则恐补之为害，而复制之以消；意谓实而消之，又恐消之为害，而
复制之以补。其有最可哂者，则每以不寒不热，兼补兼泻之剂，确然投之，极称稳当，此何
以补其偏而救其弊乎？又有以治风、治火、治痰、治食之剂兼而用之，甚称周备，此何以从
其本而从其标乎？若此者，所谓以药治药尚未遑，又安望其及于病耶？即使偶愈，亦不知其补
之之力，攻之之功也。使其不愈，亦不知其补之为害，消之为害也。是以白头圭匕，而庸庸
没齿者，其咎在于无定见，而用治之不精也。使其病浅，犹无大害，若安危在举动之间，即
用药虽善，若无胆量勇敢而药不及病，亦犹杯水车薪，尚恐弗济，矧可以执两端而药有妄投
者，其害又将何如？耽误民生，皆此辈也，任医者不可不深察焉。
故凡施治之要，必须精一不杂，斯为至善。与其制补以消，孰若少用纯补，以渐而进之
为愈也。与其制攻以补，孰若微用纯攻自一而再之为愈也。故用补之法，贵乎先轻后重，务
在成功；用攻之法，必须先缓后峻，及病则已。若用制不精，则补不可以治虚，攻不可以去
实，鲜有不误人者矣。
余为是言，知必有以为迂阔而讥之者，曰∶古人用药每多至一二十味，何为精一？岂古
人之不尔若耶？是不知相制相使之妙者也，是执一不通而不知东垣之法者也。余曰∶夫相制
者，制其毒也。譬欲用人奇异之才，而又虑其太过之害，故必预有以防其微，总欲得其中而
已。然此特遇不得已之势，间一有之，初未有以显见寻常之法用得其贤，而复又自掣其肘者
也。至若相佐相使，则恐其独力难成，而用以助之者，亦非为欲进退牵制而自相矛盾者也。
观仲景之方，精简不杂，至多不过数味。圣贤之心，自可概见。若必不得已而用行中之补，
补中之行，是亦势所当然。如《伤寒论》之小柴胡汤以人参、柴胡并用，陶氏之黄龙汤以大
黄、人参并用，此正精专妙处，非若今医之混用也。能悟此理，方是真见中活泼工夫。至若
东垣之方，有十余味及二十余味者，此其用多之道，诚自有意。学人欲效其法，必须总会其
一方之味，总计其一方之性。如某者多，某者少，某者为专主，某者为佐使，合其气用，自
成一局之性，使能会其一局之意，斯得东垣之心矣。若欲见头治头，见脚治脚，甚有执其三
四端而一概混用，以冀夫侥幸者，尚敢曰我学东垣者哉。虽然，东垣之法非不善也，然余则
宁师仲景，不敢宗东垣者，正恐未得其清，先得其隘，其失者岂止一方剂也哉，明者宜辨之。
一、《内经》治法。岐伯曰∶高者抑之，下者举之，温者清之，清者温之，散者收之，
抑者散之，燥者润之，急者缓之，坚者软之，脆者坚之，衰者补之，强者泻之，佐以所利，
和以所宜，各安其气，必清必静，则病气衰去，归其所宗，此治之大体。岐伯曰∶寒者热之
，热者寒之，微者逆之，甚者从之，坚者削之，客者除之，劳者温之，结者散之，留者攻之
，燥者濡之，急者缓之，散者收之，损者益之，溢者行之，惊者平之，上之下之，摩之浴之
，薄者劫之，开者发之，适事为故。帝曰∶何谓逆从？岐伯曰∶逆者正治，从者反治，从少
从多，观其事也。帝曰∶反治何谓？岐伯曰∶热因寒用，寒因热用，塞因塞用，通因通用，
必伏其所主，而先其所因，其始则同，其终则异。
岐伯曰∶病生于内者，先治其阴，后治其阳，反者益甚。病生于阳者，先治其外，后治
其内，反者益甚。
一、治病用药，本贵精专，尤宜勇敢。凡久远之病，则当要其终始，治从乎缓，此宜然
也。若新暴之病，虚实既得其真，即当以峻剂直攻其本，拔之甚易。若逗留畏缩，养成深固
之势，则死生系之，谁其罪也。故凡真见里实，则以凉膈、承气；真见里虚，则以理中、十
全。表虚则 、术、建中；表实则麻黄、柴、桂之类。但用一味为君，二三味为佐使，大剂
进之，多多益善。夫用多之道何在？在乎必赖其力而料无害者，即放胆用之。性缓者可用数
两，性急者亦可数钱。若三五七分之说，亦不过点名具数，儿戏而已，解纷治剧之才，举
动固如是乎。
一、治病之则，当知邪正，当权重轻。凡治实者，譬如耘禾，禾中生稗，禾之贼也。有
一去一，有二去二，耘之善者也。若有一去二，伤一禾矣，有二去四，伤二禾矣。若识禾不
的，俱认为稗，而计图尽之，则无禾矣。此用攻之法，贵乎察得其真，不可过也。凡治虚者
，譬之给饷，一人一升，十人一斗，日饷足矣。若百人一斗，千人一斛，而三军之众，又岂
担石之粮所能活哉？一饷不继，将并前饷而弃之。而况于从中克减乎。此用补之法，贵乎轻
重有度，难从简也。
一、虚实之治，大抵实能受寒，虚能受热，所以补必兼温，泻必兼凉者，盖凉为秋气，
阴主杀也。万物逢之，便无生长，欲补元气，故非所宜。凉且不利于补，寒者益可知矣。即
有火盛气虚，宜补以凉者，亦不过因火暂用，火去即止，终非治虚之法也。又或有以苦寒之
物谓其能补阴者，则《内经》有曰∶形不足者，温之以气，精不足者补之以味。夫气味之相
宜于人者，谓之曰补可也。未闻以味苦气劣而不相宜于人者，亦可谓之补也。虽《内经》有
曰∶水位之主，其泻以咸，其补以苦等论。然此特以五行岁气之味据理而言耳。矧其又云麦
、羊肉、杏、薤皆苦之类，是则苦而补者也。岂若大黄、黄柏之类，气味苦劣若此，而谓之
能补，无是理也。尝闻之王应震曰∶一点真阳寄坎宫，固根须用味甘温。甘温有益寒无补，
堪笑庸医错用功。此一言蔽之也，不可不察。
一、补泻之法，补亦治病，泻亦治病，但当知其要也。如以新暴之病而少壮者，乃可攻
之泻之。攻但可用于暂，未有衰久之病，而屡攻可以无害者，故攻不可以收缓功。延久之病
而虚弱者，理宜温之补之。补乃可用于常，未有根本既伤，而舍补可以复元者，故补不可以
求速效。然犹有其要，则凡临证治病，不必论其有虚证无虚证，但无实证可据而为病者，便
当兼补，以调营卫精血之气；亦不必论其有火证无火证，但无热证可据而为病者，盒饭兼温
，以培命门脾胃之气。此吞泻之要领，苟不知此，未有不至决裂败事者。
一、治法有逆从，以寒热有假真也，此《内经》之旨也。经曰∶逆者正治，从者反治。
夫以寒治热，以热治寒，此正治也，正即逆也。以热治热，以寒治寒，此反治也，反即从也
。如以热药治寒病而寒不去者，是无火也，当治命门，以参、熟、桂、附之类，此王太仆所
谓益火之源以消阴翳，是亦正治之法也。又如热药治寒病而寒不退，反用寒凉而愈者，此正
假寒之病，以寒从治之法也。又如以寒药治热病而热不除者，是无水也，治当在肾，以六味
丸之类，此王太仆所谓壮水之主以镇阳光，是亦正治之法也。又有寒药治热病而热不愈，反
用参、姜、桂、附、八味丸之属而愈者，此即假热之病，以热从治之法也，亦所谓甘温除大
热也。第今人之虚者多，实者少，故真寒假热之病为极多，而真热假寒之病则仅见耳。
一、探病之法，不可不知。如当局临证，或虚实有难明，寒热有难辨，病在疑似之间，
补泻之意未定者，即当先用此法。若疑其为虚，意欲用补而未决，则以轻浅消导之剂，纯用
数味，先以探之，消而不投，即知为真虚矣。疑其为实，意欲用攻而未决，则以甘温纯补之
剂，轻用数味，先以探之，补而觉滞，即知有实邪也。假寒者，略温之必见躁烦；假热者，
略寒之必加呕恶，探得其情，意自定矣。经曰∶有者求之，无者求之。又曰∶假者反之，此
之谓也。但用探之法，极宜精简，不可杂乱。精简则真伪立辨，杂乱则是非难凭。此疑似中
之活法，必有不得已而用之可也。
一、《医诊》治法有曰∶见痰休治痰，见血休治血，无汗不发汗，有热莫攻热，喘生休
耗气，精遗不涩泄，明得个中趣，方是医中杰。行医不识气，治病从何据？堪笑道中人，未
到知音处。观其诗意，皆言不治之治，正《内经》求本之理耳，诚格言也。至于“行医不识
气，治病从何据”一联，亦甚有理。夫天地之道，阳主气，先天也；阴成形，后天也。故凡
上下之升降，寒热之往来，晦明之变易，风水之留行，无不因气以为动静，而人之于气，亦
由是也。凡有余之病，由气之实，不足之病，因气之虚。如风寒积滞，痰饮瘀血之属，气不
行则邪不除，此气之实也。虚劳遗漏，亡阳失血之属，气不固则元不复，此气之虚也。虽曰
泻火，实所以降气也。虽曰补阴，实所以生气也。气聚则生，气散则死，此之谓也。所以病
之生也，不离乎气，而医之治病也，亦不离乎气，但所贵者，在知气之虚实，及气所从生耳
。近见有浅辈者，凡一临证，不曰内伤外感，则曰痰逆气滞。呵！呵！此医家八字诀也。有此
八字，何必八阵？又何必端本澄源以求迂阔哉？第人受其害，恐不无可畏也。
凡看病施治，贵在精准专一。因为天下的疾病，变化虽然繁多，但其根本原因只有一个。天下的方剂，灵活变化的方法虽然很多，但针对证候治疗的原则只有一个。所以凡是治病的方法，必须确切知道是寒证，就彻底散其寒邪；确切知道是热证，就彻底清其热邪，一旦拔除病根，各种症状就会全部消除。因此《黄帝内经》说：治病必须探求根本。所以凡是诊察疾病的人，必须先探明疾病的本源，然后才用药。如果观察还不够确切，宁可稍作等待，再加详细观察，既然抓住了关键，只用一两味药就可以拔除病根；即使病情深固复杂，用五六味或七八味药也已经算多了。然而即使用到七八味药，也不过是辅助引导罢了，而治疗的主旨意图仍然是一致的，这才是高明的医生。
现在的医生，凡是遇到一个证候，就像面对大海望洋兴叹一样，茫然没有确定的见解，那么形势上就不得不采用杂乱无章、广撒网式的用药方法。大概他们的意思是：认为虚证需要补益，又怕单纯补益会产生危害，所以又配合使用消导药；认为实证需要攻逐，又怕攻逐会产生危害，所以又配合使用补益药。其中最可笑的是，常常使用不寒不热、兼有补益和泻下作用的药剂，坚定地投予患者，极口称赞这样很稳妥，这怎么能通过纠正偏颇来挽救弊端呢？又有将治疗风邪、火邪、痰饮、食积的方剂混合使用的，甚至称这样考虑周全，这怎么能说是顺从病本还是顺从病标呢？像这样的情况，所谓连药物之间的相互制约都来不及处理，又怎么指望能治愈疾病呢？即使偶然痊愈了，也不知道是补益的力量起作用，还是攻伐的功效起作用。如果不愈，也不知道是补益造成了危害，还是消导造成了危害。因此那些平庸无能、碌碌无为直到老死的医生，他们的过错在于没有确定的见解，以及用药不够精当。如果病情轻浅，还没有大害；如果关系到生死安危就在举动之间，即使用药很好，如果没有胆量和勇气使药力直达病所，也如同杯水车薪，恐怕还不足以解决问题，何况拿着折中的态度妄加用药，其危害又将如何呢？耽误百姓生命，都是这一类人，担任医者不可不深刻考察这一点。
所以凡是施治的关键，必须精准专一不杂乱，这才是最好的。与其在补益中掺杂消导药，不如少用纯补益药，逐渐进补更为有益。与其在攻逐中掺杂补益药，不如微用纯攻逐药，由轻到重逐步进行更为有益。所以使用补益的方法，贵在先轻后重，务必取得成功；使用攻逐的方法，必须先缓后峻，达到治疗效果即可停止。如果使用方制不精当，那么补益不能治疗虚证，攻逐不能去除实证，很少有不误人的了。
我讲这些话，知道必定有人认为是迂腐空泛而讥笑我的，说：古人用药每多至一二十味，为什么说要精准专一？难道古人不这样做吗？这是不懂得药物相互制约和相互促进的奥妙，是拘泥固执不通晓李东垣（李杲）法度的人。我说：所谓的相互制约，是制约药物的毒性。比如想要任用奇特的人才，又担心他过于激进产生危害，所以预先有所防备以遏制其细微之处，总归是想得到适中而已。然而这只是遇到不得已的情况，偶尔有之，起初并没有看到常规方法中已经选用了贤良的药物，却又自己牵制自己的手臂（指自相矛盾）。至于相互佐助和相互使令，是担心单一力量难以成功，而用来帮助它的，也不是为了进退牵制而自相矛盾。看张仲景的方剂，精简不杂乱，最多不过几味药。圣贤的心思，自然可以概见。如果不得已而使用行气中的补益药，或补益中的行气药，这也是形势所必然。如《伤寒论》中的小柴胡汤用人参、柴胡并用，陶华（陶节庵）的黄龙汤用大黄、人参并用，这正是精准专妙的地方，不像现在医生那样混用。能领悟这个道理，才是真正见识中活泼的功夫。至于李东垣的方剂，有十余味及二十余味的，这是他多用药物之道，确实自有用意。学习者想要效法他的方法，必须总括一方中的所有药味，总计一方中的所有药性。如某药多，某药少，某药为主药，某药为佐使，合其气机作用，自然形成一种格局的性质，如果能领会这一局的意思，就得到了李东垣的心法了。如果想见头治头，见脚治脚，甚至有执着于其中三四端而一概混用，以希望侥幸成功的，还敢说我是学习李东垣的人吗？虽然如此，李东垣的方法并非不好，但我宁愿师法张仲景，不敢尊崇李东垣，正是担心未得其清朗，先得其狭隘，其失误岂止是一个方剂的问题呢，明智的人应该辨别它。
一、《黄帝内经》的治法。岐伯说：病势高的要抑制它，病势下的要提升它，温热的要清凉它，寒凉的要温暖它，耗散的要收敛它，郁结的要疏散它，干燥的要滋润它，急迫的要缓和它，坚硬的要软化它，脆弱的要坚固它，衰弱的要补益它，强盛的要泻除它，用有利于病情的药物作为辅助，用适宜的药物调和，使各脏腑之气安宁，必须清净宁静，那么病气就会衰退离去，回归其所归属的本位，这是治疗的总体原则。岐伯说：寒证用热药治疗，热证用寒药治疗，病轻微的逆其病性治疗，病严重的顺其病性治疗，坚硬的要削去它，外来的邪气要清除它，劳倦的要温养它，结聚的要消散它，留滞的要攻逐它，干燥的要濡润它，急迫的要缓和它，耗散的要收敛它，亏损的要增益它，溢满的要通利它，惊悸的要平复它，在上部的要吐下，在下部的要攻下，按摩洗浴，薄弱的要劫夺它，闭塞的要发散它，以适合事情为原则。黄帝问：什么叫逆治和从治？岐伯说：逆治是正治，从治是反治，从少或从多，要看具体情况。黄帝问：什么叫反治？岐伯说：热因寒用，寒因热用，塞因塞用，通因通用，必须制服其主要病邪，而先探求其病因，开始用药性质相同，最终效果不同。
岐伯说：病生于内部的，先治其阴分，后治其阳分，反之则病情加重。病生于外部的，先治其体表，后治其内部，反之则病情加重。
一、治病用药，本来贵在精准专一，尤其宜勇敢果断。凡是久远的疾病，应当探究其始终，治疗应从缓图，这是理所当然的。如果是新近暴发的疾病，虚实既然探明了真相，就应当用峻猛的药剂直接攻逐病根，拔除它很容易。如果逗留畏缩，养成深固的局势，那么生死就系于此，谁之罪过呢？所以凡是真见到里实证的，就用凉膈散、承气汤；真见到里虚证的，就用理中汤、十全大补汤。表虚的用白术、黄芪、建中汤；表实的用麻黄、柴胡、桂枝之类。只用一味药为君药，二三味药为佐使药，大剂量进服，多多益善。使用多药道的道理在哪里？在于必须依赖其药力且料定无害者，就放手大胆使用。药性缓和的可用数两，药性急猛的也可用数钱。如果只有三五七分这样的说法，也不过是点名凑数，如同儿戏罢了，解纷治剧的人才，举动难道是這樣的吗？
一、治病的准则，应当知晓邪正，应当权衡轻重。凡是治疗实证，譬如除草，禾苗中生的稗草，是禾苗的贼害。有一株稗草去掉一株，有两株去掉两株，是除草善于的人。如果有一株稗草却伤了一株禾苗，有两株稗草却伤了二株禾苗。如果不能识别禾苗，都认为是稗草，而企图全部铲除，那么就没有禾苗了。这是使用攻逐的方法，贵在察觉得真实，不可过度。凡是治疗虚证，譬如发放军饷，一人一升，十人一斗，每日供给足够就可以了。如果百人只给一斗，千人只给一斛，而三军的众人，又岂是靠担石之粮所能养活的呢？一旦饷银不继，将领就会抛弃前面的饷银。更何况从中克扣减损呢。这是使用补益的方法，贵在轻重有度，难以从简。
一、虚实的治疗，大体上实证能承受寒凉，虚证能承受温热，所以补益必兼温性，泻下必兼凉性的原因，是因为凉气属秋气，阴主杀伐。万物逢之，便无生长，想要补益元气，所以不适合。凉尚且不利于补益，寒就更不用说了。即使有火盛气虚，适宜用凉药补益的，也不过是因火邪暂时使用，火去即止，终究不是治疗虚证的方法。又或者有人认为苦寒之物能补阴，那么《黄帝内经》说：形体不足的，用气来温养；精气不足的，用味来补益。气味适宜于人的，叫做补是可以的。没听说过味道苦劣、气味不佳而不适宜于人的，也可以叫做补。虽然《黄帝内经》有说：水运之主，其泻用咸，其补用苦等论述。但这只是根据五行岁气的味道据理而言罢了。况且他又说小麦、羊肉、杏、薤都属于苦味之类，这是苦而能补的。哪里像大黄、黄柏之类，气味苦劣到这种程度，而说它们能补益，是没有道理的。曾听王应震说：一点真阳寄居在坎宫，巩固根基须用味甘温。甘温有益寒无补，可笑庸医错用功。这一句话概括了它，不可不考察。
一、补泻的方法，补也是治病，泻也是治病，但应当知道关键所在。如对新近暴发疾病且身体强壮的人，才可以攻之泻之。攻法只能用于暂时，未有衰弱已久的疾病，而屡次攻逐可以无害的，所以攻法不可以收缓功。拖延已久的疾病且虚弱的人，按理应当温之补之。补法可以用于常态，未有根本既已损伤，而舍弃补益可以恢复元气的，所以补法不可以求速效。然而还有其关键，那么凡是临证治病，不必论其有虚证无虚证，只要没有实证可依据而致病者，就应当兼用补益，以调营卫精血之气；也不必论其有火证无火证，只要没有热证可依据而致病者，就应当兼用温法，以培命门脾胃之气。这是补泻的要领，如果不知道这个，没有不到处决裂败事的。
一、治法有逆治和从治，是因为寒热有假象和真象，这是《黄帝内经》的宗旨。经书说：逆治是正治，从治是反治。用寒药治热病，用热药治寒病，这是正治，正即逆。用热药治热病，用寒药治寒病，这是反治，反即从。如用热药治寒病而寒不去者，是无火也，应当治命门，用人参、熟地、肉桂、附子之类，这是王冰所谓益火之源以消阴翳，也是正治之法。又如用热药治寒病而寒不退，反而用寒凉药而痊愈者，这是真正的假寒病，用寒药从治的方法。又如用寒药治热病而热不除者，是无水也，治疗应当在肾，用六味丸之类，这是王冰所谓壮水之主以镇阳光，也是正治之法。又有用寒药治热病而热不愈，反而用人参、干姜、肉桂、附子、八味丸之类的而痊愈者，这就是假热病，用热药从治的方法，也就是所谓甘温除大热。只是现在人的虚证多，实证少，所以真寒假热的病极为多见，而真热假寒的病则仅见而已。
一、探病的方法，不可不知。如当局临证，或者虚实难以明辨，寒热难以分辨，病在疑似之间，补泻之意未定的时候，就应当先用这种方法。如果怀疑它是虚证，想要用补益而未决断，就用轻浅的消导药剂，纯用几味药，先用来试探，消导后若不舒适，就知道是真虚了。怀疑它是实证，想要用攻逐而未决断，就用甘温纯补的药剂，轻用几味药，先用来试探，补益后觉得阻滞，就知道有实邪了。假寒病，略用温药必然出现烦躁；假热病，略用寒药必然加重呕吐恶心，探得真情，意念自然安定。经书说：有的求其所以然，无的求其所以不然。又说：假象的反向推求，说的就是这个意思。但使用探病的方法，极宜精简，不可杂乱。精简则真伪立辨，杂乱则是非难凭。这是疑似中的活法，必须有不得已的情况下才可使用。
一、《医诊》治法中有说：见痰不要只治痰，见血不要只治血，无汗不要发汗，有热不要攻热，喘生不要耗气，精遗不要涩泄，明白其中的趣味，才是医中豪杰。行医不认识气，治病从何依据？可笑道中人，未到知音处。看他的诗意，都说是不治之治，正是《黄帝内经》求本的道理，确实是格言。至于“行医不识气，治病从何据”这一联，也很有道理。天地的道理，阳主气，是先天；阴成形，是后天。所以凡是上下升降，寒热往来，晦明变易，风水留行，无不因气而产生动静，而人对于气，也是如此。凡是有余的病，由气之实；不足的病，因气之虚。如风寒积滞，痰饮瘀血之类，气不行则邪不除，这是气之实。虚劳遗漏，亡阳失血之类，气不固则元不复，这是气之虚。虽然说泻火，实际是降气。虽然说补阴，实际是生气。气聚则生，气散则死，说的就是这个道理。所以病的产生，不离乎气，而医的治病，也不离乎气，但可贵的是，在于知道气的虚实，以及气所从生的根源。近来见到浅薄之辈，凡是临证，不说内伤外感，就说痰逆气滞。呵！呵！这是医家的八字诀。有了这八字，何必用八阵？又何必端正根本澄清源头以求迂阔呢？只是人受到其害，恐怕不可不畏惧啊。
In treating diseases and administering therapy, precision and singularity are paramount. Although the manifestations of diseases under heaven are numerous, their root cause is singular. Although the methods for formulating prescriptions are flexible and varied, the principle of targeting the syndrome remains singular. Therefore, in the treatment of disease, one must accurately determine if it is cold, then thoroughly disperse the cold; if accurately determined to be heat, then thoroughly clear the heat. Once the root is extracted, all symptoms will be eliminated. Thus, the *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "Treating disease requires seeking its root." Hence, when diagnosing, one must first explore the root of the disease before administering medication. If the observation is not yet definitive, it is better to wait a short while and examine more carefully. Once the key is grasped, using only one or two herbs can extract the root; even if the condition is deep-seated, five or six, or seven or eight herbs are already excessive. However, even if seven or eight herbs are used, they merely serve as assistance and guidance, while the therapeutic intent remains singular; this constitutes a master physician.
Current physicians, upon encountering a syndrome, often feel overwhelmed like gazing at the ocean, lacking definite views, thus inevitably resorting to chaotic, wide-spread prescribing strategies. Their reasoning is: believing deficiency requires tonification, yet fearing that tonification alone may cause harm, so they add resolving agents; believing excess requires purging, yet fearing that purging alone may cause harm, so they add tonifying agents. The most laughable cases involve firmly administering formulas that are neither cold nor hot, combining tonification and purgation, claiming such approaches are extremely safe. How does this correct bias and remedy defects? Others combine formulas for treating wind, fire, phlegm, and food stagnation, claiming thoroughness. How does this follow the root or the branch? In such cases, managing drug interactions is insufficient, let alone curing the disease. Even if recovery occurs by chance, one cannot know if it was due to tonification or purgation. If recovery fails, one cannot know if tonification or resolving caused harm. Thus, mediocre physicians who remain incompetent until death err due to lack of definite views and imprecise prescribing. If the disease is superficial, there is little harm; but if life and death hang in the balance, even good medicine without courage to reach the disease site is like a cup of water on a cartload of burning wood—likely insufficient. How much worse is it to hold a middle ground and prescribe recklessly? These individuals delay people's lives; physicians must deeply reflect on this.
Therefore, the essence of therapy must be precise, singular, and unadulterated, which is the highest perfection. Rather than mixing resolving agents with tonics, it is better to use pure tonics sparingly and advance gradually. Rather than mixing tonics with purgatives, it is better to use pure purgatives mildly and advance from light to heavy. Thus, tonification should start light and become heavy, aiming for success; purgation should start mild and become harsh, stopping once the disease is addressed. If prescription composition is imprecise, tonification cannot treat deficiency, and purgation cannot remove excess, leading almost inevitably to error.
I speak these words knowing some will ridicule them as pedantic, asking: "Ancients often used ten to twenty herbs; why emphasize precision? Were ancients less capable?" This shows ignorance of the subtleties of mutual restraint and mutual enhancement, and a failure to understand Li Dongyuan’s (Li Gao’s) methods. I say: Mutual restraint refers to controlling toxicity. Just as one might employ extraordinary talent but fear excessive harm, one must prepare safeguards to prevent minor issues, aiming for moderation. This applies only to unavoidable situations, rarely occurring. It is uncommon to see standard methods employing effective herbs only to self-sabotage. Mutual assistance and facilitation are used because single strength may be insufficient, not to create internal contradiction. Observing Zhang Zhongjing’s formulas, they are concise and uncluttered, rarely exceeding a few herbs. The mindset of sages is evident here. If unavoidable, using qi-moving within tonics or tonifying within qi-movers is natural. For example, Xiao Chai Hu Tang (Minor Bupleurum Decoction) in the *Shanghan Lun* (Treatise on Cold Damage) uses both Renshen (Ginseng Radix et Rhizoma) and Chaihu (Bupleuri Radix); Tao Hua’s Huanglong Tang (Yellow Dragon Decoction) uses both Dahuang (Rhei Radix et Rhizoma) and Renshen. This is precise and subtle, unlike modern mixed prescribing. Understanding this principle reflects true clinical flexibility. Regarding Li Dongyuan’s formulas with over ten or twenty herbs, his extensive use has specific intent. Learners emulating him must summarize all herbs and properties in a formula. Identifying dominant vs. auxiliary herbs, and their combined energetic effects, creates a unified character. Grasping this holistic intent captures Li Dongyuan’s spirit. Treating head for head and foot for foot, or blindly mixing based on partial understanding, hoping for luck, cannot claim to follow Li Dongyuan. Although Li Dongyuan’s methods are not bad, I prefer following Zhang Zhongjing rather than venerating Li Dongyuan, fearing that failing to grasp clarity leads to narrowness. The errors extend beyond single formulas; wise practitioners should distinguish this.
1. Treatment methods of the *Neijing*. Qibo stated: Suppress what is high, elevate what is low, cool what is warm, warm what is cool, consolidate what is scattered, dissipate what is constrained, moisten what is dry, relax what is tense, soften what is hard, strengthen what is brittle, tonify what is deficient, purge what is excess, assist with beneficial agents, harmonize with suitable agents, calm each qi, ensuring clarity and stillness, so pathogenic qi declines and returns to its origin. This is the general framework. Qibo also said: Treat cold with heat, heat with cold; reverse-treat mild cases, follow-treat severe cases; reduce hardness, eliminate invaders, warm labor-induced conditions, dissipate knots, attack retention, moisten dryness, relax tension, consolidate scattering, benefit loss, promote overflow, calm fright, induce vomiting for upper pathogens, purgation for lower pathogens, massage and bathe,劫夺 (rob/attack) weak conditions, open blockages, adapting to the situation. The Yellow Emperor asked: What are reverse and follow treatments? Qibo replied: Reverse is regular treatment (Zheng Zhi), follow is counter-treatment (Fan Zhi). Follow lightly or heavily depending on the case. The Emperor asked: What is counter-treatment? Qibo said: Heat treated with cold agents, cold treated with heat agents, obstruction treated with obstructive agents, diarrhea treated with purgative agents. One must subdue the main factor and address the cause initially; though starting similarly, the outcome differs. Qibo added: Diseases originating internally should first treat Yin, then Yang; reversing this worsens the condition. Diseases originating externally should first treat the exterior, then interior; reversing this worsens the condition.
2. Medicinal treatment values precision and bravery. For chronic diseases, investigate the beginning and end, treating slowly is appropriate. For acute diseases, once deficiency/excess is confirmed, use harsh agents to attack the root directly; extraction is easy. Hesitation allows deep-seated conditions to form, determining life or death—who bears the blame? True interior excess warrants Liang Ge San (Cooling the Diaphragm Powder) or Cheng Qi Tang (Order the Qi Decoction); true interior deficiency warrants Li Zhong Tang (Regulate the Middle Decoction) or Shi Quan Da Bu Tang (Complete Ten Tonifying Decoction). Exterior deficiency calls for Baizhu (Atractylodis Macrocephalae Rhizoma), Huangqi (Astragali Radix), and Jian Zhong Tang (Establish the Middle Decoction); exterior excess calls for Mahuang (Ephedrae Herba), Chaihu (Bupleuri Radix), Guizhi (Cinnamomi Ramulus), etc. Use one herb as Sovereign, two or three as Ministers/Assistants/Guides, in large doses. Using many herbs relies on their power and safety assurance. Mild herbs may use several taels; potent herbs several qian. Dosages of 3-5-7 fen are mere counting exercises, childish playfitting for resolving crises?
3. Treatment principles require knowing evil vs. righteous qi and weighing importance. Treating excess is like weeding rice fields; barnyard grass (weeds) harms rice. Removing one weed for one weed, or two for two, is skilled weeding. Removing one weed but damaging two rice plants, or two weeds damaging four plants, is poor skill. Mistaking rice for weeds and removing all results in no rice. Thus, purgation requires accurate identification and avoiding excess. Treating deficiency is like distributing rations: one person gets one sheng, ten get one dou; daily supply suffices. Giving one dou to a hundred, one hu to a thousand, cannot sustain an army; if supplies fail, soldiers abandon previous rations. Deductions make it worse. Thus, tonification requires measured weight and difficulty in simplification.
4. Deficiency/excess treatment generally holds that excess tolerates cold, deficiency tolerates heat. Hence, tonification includes warmth, purgation includes coolness. Coolness corresponds to autumn qi, Yin governs killing. All things meeting it cease growing; thus, it is unsuitable for tonifying Yuan Qi. If coolness is unsuitable for tonification, cold is even more so. Even in fire-excess/qi-deficiency cases where cool tonification seems indicated, it is temporary for fire; once fire clears, stop. It is not a method for treating deficiency. Some claim bitter-cold herbs tonify Yin. The *Neijing* states: "Deficient form is warmed by Qi; deficient essence is tonified by Flavor." Agents suitable to humans are called tonics. Unheard of is calling bitter-flavored, inferior-smelling, unsuitable agents tonics. Although the *Neijing* mentions Water phase masters use salty for purgation and bitter for tonification, this refers to Five Phases annual qi flavors. Moreover, wheat, mutton, apricot, leek are bitter-tonic examples. How can Dahuang (Rhei Radix et Rhizoma) and Huangbai (Phellodendri Cortex), with bitter-inferior qualities, be called tonics? This is illogical. Wang Yingzhen said: "A spark of True Yang resides in Kan Palace; solidify roots with sweet-warm agents. Sweet-warm benefits, cold does not tonify; laughable are mediocre doctors wasting effort." This summarizes the point; observe carefully.
5. Tonification and purgation both treat disease, but know the essentials. Acute disease in robust individuals can be purged. Purgation is temporary; chronic weakness cannot withstand repeated purgation without harm; thus, purgation yields slow results. Chronic weakness should be warmed and tonified. Tonification is for routine use; once the root is damaged, abandoning tonification prevents recovery; thus, tonification seeks no quick effect. However, the key is: when treating, regardless of apparent deficiency, if no excess evidence exists, combine tonification to regulate Ying-Wei, Jing-Blood Qi. Regardless of apparent fire, if no heat evidence exists, combine warming to cultivate Mingmen and Spleen/Stomach Qi. This is the essence of tonification/purgation; ignoring this leads to disaster.
6. Treatment involves reverse/follow methods due to false/true cold/heat, per the *Neijing*. "Reverse is regular, follow is counter." Treating heat with cold, cold with heat is regular/reverse. Treating heat with heat, cold with cold is counter/follow. Treating cold disease with heat agents without relief indicates lack of Fire; treat Mingmen with Renshen (Ginseng Radix et Rhizoma), Shudi (Rehmanniae Radix Preparata), Rougui (Cinnamomi Cortex), Fuzi (Aconiti Lateralis Radix Preparata). This is Wang Bing’s "Enrich the source of Fire to dissipate Yin shadows," a regular method. Treating cold disease with heat agents without relief, cured by cold agents, indicates false cold; treat with cold following method. Treating heat disease with cold agents without relief indicates lack of Water; treat Kidney with Liu Wei Wan (Six-Ingredient Pill with Rehmannia). This is Wang Bing’s "Strengthen the master of Water to suppress Yang brilliance," a regular method. Treating heat disease with cold agents without relief, cured by Renshen, Ganjiang (Zingiberis Rhizoma), Rougui, Fuzi, Ba Wei Wan (Eight-Ingredient Pill), indicates false heat; treat with heat following method, known as "Sweet-warm removes great heat." Currently, deficiency is common, excess rare; thus, true-cold/false-heat is frequent, true-heat/false-cold is rare.
7. Probing disease methods are essential. When deficiency/excess or cold/heat is unclear, or treatment intent is undecided, use probing. Suspecting deficiency but undecided on tonification: use light resolving agents, few herbs, probe first. If discomfort ensues after resolving, it is true deficiency. Suspecting excess but undecided on purgation: use sweet-warm pure tonics, few herbs, probe first. If stagnation ensues after tonification, there is excess pathogen. False cold: slight warming causes irritability. False heat: slight cooling causes nausea/vomiting. Probing reveals truth, stabilizing intent. The *Neijing* says: "Seek the existent, seek the non-existent." And: "For false signs, reverse approach." This is the meaning. Probing must be concise, not chaotic. Conciseness distinguishes true/false; chaos confuses right/wrong. This is a flexible method for ambiguous cases, used only when necessary.
8. *Yizhen* treatment methods state: Seeing phlegm, do not just treat phlegm; seeing blood, do not just treat blood; no sweat, do not induce sweating; having heat, do not attack heat; wheezing arises, do not deplete Qi; sperm leakage, do not astringe. Understanding this essence makes a medical hero. Practicing medicine without understanding Qi, how to base treatment? Laughable are those in the Dao who have not reached understanding. The poem speaks of "treating by not treating," aligning with the *Neijing*'s principle of seeking the root, a true maxim. "Practicing medicine without understanding Qi, how to base treatment" is also reasonable. Heaven and Earth: Yang governs Qi (Pre-heaven); Yin forms shape (Post-heaven). Ascending/descending, cold/heat, dark/light, wind/water movement all depend on Qi for motion. Human Qi follows suit. Excess disease stems from Qi excess; deficiency disease from Qi deficiency. Wind-cold, stagnation, phlegm-fluid, blood stasis: if Qi does not move, pathogens remain (Qi excess). Consumption, leakage, Yang collapse, blood loss: if Qi does not secure, Yuan Qi does not recover (Qi deficiency). Saying "purge fire" actually means descend Qi. Saying "tonify Yin" actually means generate Qi. Qi gathering brings life; Qi scattering brings death. Disease arises from Qi; treatment relies on Qi. The value lies in knowing Qi’s excess/deficiency and its origin. Recently, shallow practitioners, upon examining patients, always cite "internal injury/external contraction" or "phlegm reversal/Qi stagnation." Ha! Ha! These are the "Eight-Character Mantra" of physicians. With these eight characters, why need Eight Arrays? Why seek root sources and appear pedantic? People suffer; this is terrifying.