左升太过，右降不及，何经之病？曰右肺，左肝，肺肝同病，自然升降失常。然肺为五脏
华盖，肝脉布于两胁，此左升仅属肝，右降反属肺矣。何也？盖肝体在旁，肺体在上，只就
位置而言。若论其作用，内经又曰∶肝居人左，肺居人右，右之不降，正失其清肃之用也，左
之过升，肝反多所生逆之用也。横逆之邪，加于清肃之所，木寡于畏，反侮于金，无怪乎半
身以左之气旋于右，既不能透澈于上，亦不能归缩于下，有时邪之相争，盘旋胁部，直宜待
得矢气，则快然。如衰者，木究不能上克于金，而仍下制于土地也。夫土曰稼穑，作甘者也；
木曰曲直，作酸者也。口甘带酸，痰唾亦然何？莫非土受木乘之过，木亦太刚矣哉？谁能柔
之，惟有左金一方，以为克木之制，则木正其体，金得其用，可患升降之不得其常耶？
左金丸
接续手札，荷蒙锦念。谢谢！细绎病源，所云气火益炽等症，即古语云气有余便是火。
气从左边起者肝火也，左金丸主之，当归龙荟丸亦主之。然左金一丸，如水投石于前自宜，
以当归龙荟丸继之于后，未常不可为法也。设使以当归龙荟丸即日为之，聊应台命宜矣，无
如我先生有“为痈为血不可不预防也”一语，断非无稽之谈，出而高明者，弟始而骇然，继
而茫然，自亦不知其笔从何处着也。然在望一方者如饥如渴，以速为贵。而弟亦刻无宁晷，
不过夜以继日，有者求之，无者求之，必得左宜之右无不宜之要法，然覆书非敢缓也，盖有
待也。端午日，下问者少，小徒聚在一堂，讲论百病皆生于气，遂有九气不同之说。气本一
也，因所触而为九，怒与思为九气中之二焉。思则气结，《内经》自为注脚之。思则心有所
存，神有所归，正气留而不行，故气结矣。先生有之不必言矣。至于怒则气上，甚则呕血，恐
则气逆筋缓，发于外为痈疽。古人亦载气门，以昭邪郁必变，久病入络，非无意也。先生博
学而预料之，小徒强志而问及之。弟即从此而
领悟∶怒有形于外者，亦有不形于外者。形于外者每出于暴怒，暴怒伤阴；不形于外者，名
曰郁怒，郁怒伤肝。然视履考详，而阴伤于暴怒者，未必有之；言辞安定，而肝伤于郁怒者，
岂曰无之。惟其郁也，木即不能畅茂条达，反来横逆，则气郁于中者，势必火炎于上，金受
火刑，有升无降。痰血热辨，一病于肺；痞满闷塞，再病于脾。脾肺同病，则胃家之痰食无力
消，胆经之水火从而和之，将来血溢于痈，痈肿于经络，增出一番新病。诚不能不未雨而绸
缪者也。然为痈为血之枝叶，仍不外乎气郁之火为根，治病必求其本。因思“气从左边起
者”条内，有“久患气结诸药不效者，先服沉香化气丸以开其结”之文，不独将来之变病可以
预防，即现下之气火升腾亦为要着。而况右脉弦强则土郁夺之之法，本来郑重者乎，但沉香
化气丸重剂也，权宜也，元虚久病之体不能不用，不可多用。清晨只服八分，晚服逍遥六君
辈调之，以为实必顾虚之计，未知是否？
朝服沉香化气丸，晚服逍遥散、六君汤（北沙参、半夏易川贝）。
左升太过，右降不及，是哪条经络的病证？回答说：右侧属肺，左侧属肝，肺与肝同病，自然导致升降功能失常。然而肺是五脏的华盖（覆盖于其他脏腑之上的保护器官），肝经循行布散于两侧胁肋，这从左侧仅属于肝、右侧反而属于肺的角度来看是这样。为什么呢？大概是因为肝的位置在旁侧，肺的位置在上部，这只是从解剖位置而言。如果论述其生理作用，《黄帝内经》又说：肝位于人体左侧，肺位于人体右侧。右侧之气不下降，正是失去了肺清肃的功能；左侧之气过上升，肝反而产生了过多的生逆作用。横逆的邪气，侵袭了清肃之所，肝木缺乏对金的畏惧，反而反侮肺金，难怪半身左侧的气旋转向右侧，既不能透达于上，也不能归缩于下，有时因邪气相互争斗，盘旋于胁部，直到排出矢气（放屁），才感到舒畅。如果是体虚之人，木终究不能向上克制金，而仍然向下制约脾土。土的特性是稼穑（种植与收获），产生甘味；木的特性是曲直（弯曲与伸直），产生酸味。口中有甜味带酸味，痰唾也是如此，这是为什么呢？莫非是脾土受肝木乘克的过错，肝木也太刚强了吧？谁能柔缓它呢，只有用左金丸一方，作为克制肝木的制约方法，那么肝就能端正其体性，肺就能发挥其功用，还担心升降不能恢复常态吗？
接着上一封书信，承蒙您深厚的挂念。非常感谢！仔细推究病源，所说的“气火日益炽盛”等症状，就是古语说的“气有余便是火”。气从左边发起的，是肝火，应当用左金丸主治，当归龙荟丸也可以主治。然而左金丸一剂，如同水投石上，在前面自当适宜，如果用当归龙荟丸继之于后，未尝不可以成为法则。假如用当归龙荟丸当天就服用，勉强应付您的命令是可以的，无奈我先生有“对于痈疽和出血不可不预防”这句话，绝非没有根据的言论，出来见到高明的人，我起初感到惊骇，继而感到茫然，自己也不知道笔触该从哪里着手。然而在远方诊视一方的医生如饥似渴，以迅速为贵。而我也是时刻没有安宁的时刻，不过夜以继日，有的寻求，没有的也寻求，必定得到左宜右无不宜的要法，然而回信不敢迟缓，是因为有所等待。端午节那天，来询问的人少，小徒弟们聚集在一堂，讲论百病皆生于气，于是有了九气不同的说法。气本是一样，因为所触动的情志不同而分为九种，怒与思是九气中的两种。思虑则气结，《黄帝内经》自己为此作了注脚。思虑则心有所存留，神有所归着，正气停留而不运行，所以气结了。先生有这个病症不必说了。至于怒则气上，严重时呕血，恐则气逆筋缓，发于外部则为痈疽。古人也记载气门，以表明邪气郁结必然变化，久病入络，不是没有意义的。先生博学并预料到这一点，小徒弟强记而问及这一点。我即从此领悟：怒有形表现于外部的，也有不形表现于外部的。表现于外部的每出于暴怒，暴怒伤阴；不表现于外部的，名叫郁怒，郁怒伤肝。然而观察行为考察详情，阴伤于暴怒的，未必有之；言辞安定，而肝伤于郁怒的，难道说没有吗？正因为郁结，木就不能畅茂条达，反而来横逆，那么气郁于中者，势必火炎于上，肺金受火刑，有升无降。痰血热辨析，一病在肺；痞满闷塞，再病在脾。脾肺同病，则胃中的痰食无力消化，胆经的水火从而调和它，将来血溢于痈，痈肿于经络，增出一番新病。确实不能不未雨绸缪啊。然而为痈为血的枝叶，仍不外乎气郁之火为根，治病必求其本。因此想到“气从左边起者”条内，有“久患气结诸药不效者，先服沉香化气丸以开其结”的文字，不仅将来的变病可以预防，即现在的气火升腾也是关键措施。况且右脉弦强则用土郁夺之的方法，本来就是郑重的，但沉香化气丸是重剂，是权宜之计，元气虚弱久病之体不能不用，也不可多用。清晨只服八分，晚上服逍遥散、六君子汤等调理，作为实症必须顾护虚损的计策，不知道是否合适？
Left ascent is excessive, right descent is insufficient; which meridian's disease is this? It is said: The right belongs to the Lung (Fei, 肺), the left to the Liver (Gan, 肝). When the Lung and Liver are diseased together, natural ascent and descent become disordered. However, the Lung is the canopy of the five zang organs (Huagai, 华盖), and the Liver meridian spreads over both hypochondriac regions. Thus, from the perspective of location, the left ascent belongs only to the Liver, while the right descent belongs to the Lung. Why is this? Generally, the substance of the Liver is on the side, and the substance of the Lung is above; this refers only to anatomical position. If discussing their physiological functions, the *Neijing* (Yellow Emperor's Inner Canon) states: The Liver resides on the left of the human body, and the Lung on the right. The failure of the right to descend precisely indicates a loss of the Lung's clear and purifying function (Qing Su, 清肃); the excessive ascent on the left indicates that the Liver generates excessive rebellious qi (Ni Qi, 逆气). The rebellious pathogenic factor attacks the seat of purity and clarity. Wood lacks fear of Metal and counter-attacks it (Wood insulting Metal, 木侮金). No wonder the qi on the left half of the body rotates to the right; it cannot penetrate upwards nor contract downwards. Sometimes, due to the struggle between pathogens, it swirls in the hypochondriac region, and only after passing flatus (Shi Qi, 矢气) does one feel relieved. In cases of deficiency, Wood ultimately cannot overcome Metal upwards but still controls Earth downwards. Earth is characterized by sowing and reaping (Jia Se, 稼穑) and produces sweetness; Wood is characterized by bending and straightening (Qu Zhi, 曲直) and produces sourness. Why is there a sweet taste with sourness in the mouth, and similarly in phlegm and saliva? Is it not the fault of Earth being overwhelmed by Wood, and Wood being too rigid? Who can soften it? Only the formula Zuojin Wan (Left Golden Pill) can serve as a method to control Wood. Then Wood will correct its nature, and Metal will utilize its function. Would one still worry about ascent and descent failing to return to normal?
Zuojin Wan (Left Golden Pill)
Continuing from the previous letter, I am deeply grateful for your kind concern. Thank you! Carefully analyzing the source of the disease, the symptoms described as "qi and fire becoming increasingly fierce" correspond to the ancient saying: "Excess qi becomes fire." Qi arising from the left side is Liver Fire (Gan Huo, 肝火), which should be treated primarily with Zuojin Wan (Left Golden Pill); Danggui Longhui Wan (Angelica Sinensis and Picrorhiza Pill) is also applicable. However, Zuojin Wan alone is like water thrown on stone, suitable initially. Using Danggui Longhui Wan subsequently is also a valid method. If one were to use Danggui Longhui Wan immediately to merely comply with your request, it would be acceptable. Yet, you mentioned, "One must prevent abscesses (Yong Ju, 痈疽) and bleeding," which is certainly not baseless talk. Upon encountering experts, I was initially startled, then bewildered, not knowing where to begin writing. However, physicians diagnosing from afar are eager and value speed. I, too, have no leisure, working day and night, seeking what exists and creating what does not, striving for a crucial method that suits both left and right. My reply is not delayed intentionally but awaits the right moment. On the Dragon Boat Festival, few visitors came, and my junior disciples gathered to discuss that all diseases arise from qi, leading to the theory of nine different types of qi. Qi is originally one, but divided into nine based on emotional triggers. Anger and contemplation are two of these nine. Contemplation causes qi stagnation (Qi Jie, 气结), as annotated in the *Neijing*: Contemplation fixes the mind and spirit, causing righteous qi to remain stagnant and not flow, thus resulting in qi stagnation. You already suffer from this. As for anger, it causes qi to ascend; severely, it leads to vomiting blood. Fear causes qi to rebel and tendons to relax; externally manifesting as abscesses. Ancient texts record "qi gates" to show that pathogenic stagnation inevitably transforms, and chronic illness enters the collaterals (Luo Mai, 络脉); this is not without significance. Your erudition anticipated this, and my disciples asked out of strong memory. From this, I realized: Anger may manifest externally or internally. External manifestation often stems from violent anger (Bao Nu, 暴怒), which injures Yin (Shang Yin, 伤阴). Internal manifestation is called depressed anger (Yu Nu, 郁怒), which injures the Liver. Observing behavior carefully, injury to Yin from violent anger may not exist; however, injury to the Liver from depressed anger, despite calm speech, surely exists. Due to depression, Wood cannot flourish and spread freely, instead rebelling horizontally. Thus, qi stagnating internally inevitably causes fire blazing upward. Metal suffers from fire punishment, having ascent but no descent. Phlegm, blood, and heat differentiation shows one disease in the Lung; distension, fullness, and blockage shows a second disease in the Spleen. With Spleen and Lung diseased together, the Stomach lacks strength to digest phlegm and food, and the Gallbladder's water and fire harmonize accordingly. Future blood extravasation into abscesses and swelling in collaterals will create new diseases. Indeed, one must prepare for rain before it falls (Wei Yu Chou Mou, 未雨绸缪). However, the branches of abscesses and bleeding still stem from fire rooted in qi depression. Treating disease requires addressing the root. Therefore, recalling the section on "qi arising from the left," there is text stating: "For chronic qi stagnation unresponsive to various medicines, first take Chenxiang Huaqi Wan (Aucklandia Qi-Transforming Pill) to open the stagnation." This not only prevents future complications but also addresses current rising qi and fire. Moreover, a wiry and strong right pulse indicates using the method of "draining earth stagnation" (Tu Yu Duo Zhi, 土郁夺之), which is indeed prudent. But Chenxiang Huaqi Wan is a heavy dose and a temporary measure; it cannot be used excessively for patients with primordial deficiency and chronic illness. Take only 0.8 fen in the morning, and regulate with Xiaoyao San (Free and Easy Wanderer Powder) and Liujun Zi Tang (Six Gentlemen Decoction) at night, as a strategy to protect deficiency amidst excess. I wonder if this is correct?
Take Chenxiang Huaqi Wan (Aucklandia Qi-Transforming Pill) in the morning, and Xiaoyao San (Free and Easy Wanderer Powder) and Liujun Zi Tang (Six Gentlemen Decoction) [with Radix Glehniae (Beishashen, 北沙参) and Rhizoma Pinelliae (Banxia, 半夏) replacing Radix Nardostachyos (Chuanbeimu, 川贝)] in the evening.