治妇人虽有别科，然亦有不能尽圣人之法者。今豪足之家，居奥室之中，处帏幔之内，
复以帛 手臂，既不能行望色之神，又不能殚切脉之巧，四者有二阙焉。黄帝有言曰∶凡治
病，
察其形气色泽，形气相得，谓之可治；色泽以浮，谓之易已；形气相失，谓之难治；色夭不
泽，谓之难已。又曰∶诊病之道，观人勇怯，骨肉皮肤，能知其情，以为诊法。若患人脉病
不相应，既不得见其形，医
人只据脉供药，其可得乎？如此言之，不能尽其术也。此医家之公患，世不能革。医者不免
尽理质问，病家见
所问繁，不为医业不精，往往得药不肯服，似此甚多。扁鹊见齐侯之色，尚不肯信，况其不
得见者乎？呜呼！可谓难也已！
又妇人病温已十二日，诊之，其脉六七至而涩，寸稍大，尺稍小，发寒热，颊赤口干，
不了了，耳聋。问之，病后数日，经水乃行，此属少阳热入血室也。若治不对病，则必死。
乃按
其证，与小柴胡汤服之，二日，又与小柴胡汤加桂枝干姜汤，一日，寒热虽已，又云∶我脐
下急痛，又与抵当丸，微利，脐下痛痊。身渐凉和，脉渐匀，尚不了了，乃复与小柴胡。次
日云∶我但胸中热燥，口鼻干。又少与调胃承气汤，不得利。次日又云∶心下痛。又与大陷
胸丸半服，利三行。而次日虚烦不宁，时妄有所见，时复狂言。虽知其尚有燥屎，以其极虚
，不敢攻之。遂与竹叶汤，去其烦热。其夜大便自通，至晓两次，中有燥屎数枚，而狂言虚
烦尽解。但咳嗽唾沫，此肺虚也。若不治，恐乘虚而成肺痿，遂与小柴胡去人参、大枣、生
姜，加干姜、五味子汤。一日咳减，二日而病悉愈。以上皆用张仲景方。
有妇人病吐逆，大小便不通，烦乱，四肢冷，渐无脉，凡一日半，与大承气汤两剂，至
夜半渐得大便通，脉渐生，翌日乃安。此关格之病，极难治，医者当审谨也。经曰∶关则吐
逆，
格则不得小便。如此亦有不得大便者。
有小儿病虚滑，食略化，大便日十余次，四肢柴瘦，腹大，食讫又饥，此疾正是大肠移
热于胃，善食而瘦，又谓之食 者。时五六月间，脉洪大，按之则绝。今六脉既单洪，则夏
之气
独然，按之绝，则无胃气也。经曰∶夏脉洪，洪多胃气，少曰病，但洪无胃气曰死。夏以胃
气为本，治疗失于过时，后不逾旬，果卒。
有人病久嗽，肺虚生寒热，以款冬花焚三两，俟烟出，以笔管吸其烟，满口则咽之，至
倦则已。凡数日之间五七作，瘥。
有人病疟月余日，又以药吐下之，气遂弱，疾未愈。观其病与脉，乃夏伤暑，秋又伤风，
乃与柴胡汤一剂，安。后，又饮食不节，寒热夏作。此盖前以伤暑，今以饮食不谨，遂致吐
逆
不食，胁下牵急而痛，寒热无时，病名痰疟。以十枣汤一服，下痰水数升，明日又与理中散
二钱，遂愈。
有人苦风痰头痛，颤掉，吐逆，饮食减，医以为伤冷物，遂以药温之，不愈。又以丸药
下之，遂厥。复与金液丹后，谵语，吐逆，颤掉，不省人，狂若见鬼，循衣摸床，手足冷，
脉伏
。此胃中有结热，故昏瞀不省人，以阳气不能布于外，阴气不持于内，即颤掉而厥。遂与大
承气汤，至一剂，乃愈。方见仲景。后服金箔丸，方见《删繁》。
有男子年六十一，脚肿生疮，忽食猪肉不安。医以药利之，稍愈，时出外中风，汗出后，
头面暴肿，起紫黑色，多睡。耳叶上有浮泡小疮，黄汁出。乃与小续命汤中加羌活一倍，服
之
遂愈。
有人年五十四，素羸，多中寒，近服菟丝有效。小年常服生硫黄数斤，脉左上二部，上
下二部，弦紧有力。五七年来，病右手足筋急拘挛，言语稍迟，遂与仲景小续命汤，加薏苡
仁一
两，以治筋急。减黄芩、人参、芍药各半，以避中寒，杏仁只用一百五枚。后云尚觉大冷，
因令尽去人参、芍药、黄芩三物，却加当归一两半，遂安。今人用小续命汤者，比比皆是，
既不能逐证加减，遂至危殆，人亦不知。今小续命汤，世所须也。故举以为例，可不谨哉！
夫八节之正气，生活人者也。八节之虚邪，杀人者也。非正气则为邪，非真实则为虚。所谓
正气者，春温、夏热、秋凉、冬寒，此天之气也。若春在经络，夏在肌肉，秋在皮肤，冬在
骨髓，此人之气也。在处为实，不在处为虚。故曰，若以身之虚，逢时之虚邪不正之气，两
虚相感，始以皮肤经络，次传至脏腑，逮于骨髓，则药力难及矣。如此则医家治病，正宜用
药抵截散补，防其深固而不可救也。又尝须保护胃气。举斯为例，余可仿此。
治疗妇人疾病虽然有其他专科方法，但有时也无法完全遵循圣人的诊疗法则。如今富贵人家，居住在深宅大院中，身处帷幔之内，又用丝绸遮盖手臂，既不能通过观察气色来施展望诊的神妙，也不能通过切脉来发挥诊脉的灵巧，这四种诊法（望、闻、问、切）中有两项缺失了。黄帝曾说：大凡治病，要观察病人的形体、气息、色泽。如果形体与气息相协调，称为可治；如果面色光泽浮露，称为容易痊愈；如果形体与气息不相协调，称为难治；如果面色枯槁无光泽，称为难以痊愈。又说：诊断疾病的道理，在于观察人的勇敢或怯懦，以及骨骼、肌肉、皮肤的状态，从而了解病情，以此作为诊断方法。如果患病者的脉象与病症不相符合，医生既然无法看到病人的形体，仅凭脉象提供药物，这行得通吗？这样说起来，就无法穷尽医术的全部奥妙了。这是医家的普遍弊病，世俗难以改变。医者不免会详尽地询问以探究真理，病人家属看到问题繁多，不认为医生医术不精，往往拿到药也不肯服用，类似情况非常多。扁鹊观察齐侯的气色，尚且不被相信，何况是那些根本见不到病人的医生呢？唉！这真是很难啊！
又有妇人患温病已经十二天，诊察时，脉搏一息六到七次且涩滞，寸脉稍大，尺脉稍小，出现寒热往来，脸颊发红，口干，神志不清，耳聋。询问得知，病后几天，月经才来潮，这属于少阳病热邪陷入血室的情况。如果治疗不对症，必然死亡。于是根据证候，给予小柴胡汤服用。两天后，又给予小柴胡汤加桂枝干姜汤。一天后，寒热症状虽然消失，病人又说脐下急痛，又给予抵当丸，轻微通便后，脐下疼痛痊愈。身体逐渐凉爽平和，脉象逐渐均匀，但仍感神志不清，于是再次给予小柴胡汤。第二天病人说：我只觉得胸中燥热，口鼻干燥。又少量给予调胃承气汤，未能通便。第二天又说心下疼痛。又给予大陷胸丸半剂，排便三次。到了第二天，出现虚烦不安，时而胡言乱语，时而发狂。虽然知道体内还有燥屎，但因为病人极度虚弱，不敢使用攻下法。于是给予竹叶汤，去除其烦热。当天夜里大便自然通畅，直到天亮共两次，排出几枚燥屎，于是狂言和虚烦全部解除。只剩下咳嗽吐泡沫痰，这是肺虚的表现。如果不治疗，恐怕会乘虚导致肺痿，于是给予小柴胡汤去掉人参、大枣、生姜，加入干姜、五味子的方子。一天后咳嗽减轻，两天后病全愈。以上都使用了张仲景的方剂。
有一位妇人患呕吐逆气，大小便不通，心烦意乱，四肢冰冷，逐渐摸不到脉搏，持续了一天半，给予大承气汤两剂，到半夜逐渐大便通畅，脉搏逐渐恢复，第二天才安定下来。这是关格病，极难治疗，医者应当审慎。经书说：关则呕吐逆气，格则小便不通。像这样也有大便不通的。
有一个小儿患虚滑泄泻，食物略能消化，每天大便十几次，四肢消瘦，腹部胀大，吃完饭后又感到饥饿，这个疾病正是大肠的热邪移注于胃，善于进食却身体消瘦，又称为食疳病。当时正值五六月间，脉象洪大，重按则感觉绝迹。现在六脉都呈现单洪之象，说明夏季的邪气独盛，重按绝迹，说明没有胃气了。经书说：夏脉洪大，洪大而有胃气是正常的，胃气少为病，只有洪大而无胃气为死证。夏季以胃气为本，治疗失当错过时机，后来不超过十天，果然突然死亡。
有人患长期咳嗽，肺虚产生寒热，取款冬花三两焚烧，待烟冒出，用笔管吸入烟雾，满口后咽下，感到疲倦就停止。在几天内发作五六次，病愈。
有人患疟疾一个多月，又用药物催吐和泻下，气力随即虚弱，疾病未愈。观察其病症和脉象，乃是夏季感受暑邪，秋季又感受风邪，于是给予柴胡汤一剂，病安。后来，又因饮食不节制，寒热在夏季发作。这大概是先前因伤暑，现在因饮食不慎，导致呕吐逆气、不能进食，胁下牵引急痛，寒热无常，病名痰疟。给予十枣汤一服，吐出痰水数升，第二天又给予理中散二钱，于是痊愈。
有人苦于风痰引起的头痛，颤抖动摇，呕吐逆气，饮食减少，医生认为是受冷物所致，于是用药物温补，未愈。又用丸药泻下，导致厥逆。随后服用金液丹后，出现谵语，呕吐逆气，颤抖动摇，不省人事，疯狂如见鬼状，循衣摸床，手足冰冷，脉伏匿。这是胃中有结聚的热邪，所以昏沉不省人事，因为阳气不能布达于外，阴气不能固持于内，即出现颤抖动摇和厥逆。于是给予大承气汤，服用一剂后，病愈。方剂见张仲景著作。后来服用金箔丸，方剂见《删繁》一书。
有一位六十一岁的男子，脚部肿胀生疮，忽然吃猪肉后不适。医生用药利导，稍微好转，偶尔外出中风，出汗后，头面部突然肿胀，呈紫黑色，嗜睡。耳叶上有浮泡小疮，流出黄色汁液。于是给予小续命汤中加倍羌活，服用后遂愈。
有人五十四岁，素体瘦弱，多受寒邪，最近服用菟丝子有效。年轻时常服用生硫黄数斤，脉象左手上部、下部，右手上部、下部，弦紧有力。五七年来，患右手足筋脉拘急挛缩，言语稍显迟缓，于是给予张仲景的小续命汤，加入薏苡仁一两，以治疗筋急。减去黄芩、人参、芍药各一半，以避免加重中寒，杏仁只用一百五十枚。后来还说觉得非常冷，因此令其完全去掉人参、芍药、黄芩三味药，反而加入当归一两半，于是安定。现在人们使用小续命汤的比比皆是，既然不能根据证候加减，遂至危险境地，人们也不知道。现在小续命汤是世所必需的。所以举此为例，能不谨慎吗！
八节的气候正气，是养育生命的。八节的气候虚邪，是杀人的。不是正气就是邪气，不是真实就是虚弱。所谓正气，是指春温、夏热、秋凉、冬寒，这是天的气候。如果在经络，在肌肉，在皮肤，在骨髓，这是人的气机分布。处在实处为实，不在处为虚。所以说，如果用身体的虚弱，遇到时令的虚邪不正之气，两虚相互感应，起初在皮肤经络，其次传至脏腑，等到深入骨髓，那么药力就难以到达了。像这样，医家治病，正宜用药抵挡截断、消散补益，防止病邪深入牢固而不可救治。又常常需要保护胃气。举此为例，其余可仿照此类。
Although the treatment of women's diseases has other specialized methods, sometimes it is impossible to fully follow the diagnostic and therapeutic principles of the Sages. Nowadays, wealthy families reside in deep courtyards, within curtains, and cover their arms with silk. Consequently, physicians cannot employ the divine skill of observing complexion (Wang Zhen) nor fully utilize the dexterity of pulse diagnosis (Qie Mai). Among the four diagnostic methods (Wang, Wen, Wen, Qie), two are missing. The Yellow Emperor stated: In treating diseases, one must observe the patient's form, Qi, and complexion. If form and Qi are harmonious, it is termed treatable; if the complexion is bright and floating, it is termed easily curable; if form and Qi are discordant, it is termed difficult to treat; if the complexion is dull and lacks luster, it is termed difficult to cure. He also said: The way to diagnose disease lies in observing a person's courage or timidity, as well as their bones, muscles, and skin, to understand the condition and establish diagnostic methods. If the pulse does not correspond to the disease, and since the physician cannot see the patient's form, relying solely on the pulse to prescribe medicine—would this work? Thus, one cannot exhaust the entirety of medical art. This is a common flaw among physicians, which society finds hard to rectify. Physicians inevitably ask detailed questions to explore the truth thoroughly. Patients' families, seeing many questions, do not attribute them to lack of skill but often refuse to take the prescribed medicine. Such cases are numerous. Even Bian Que was not believed when he observed the complexion of the Duke of Qi, let alone physicians who cannot see the patients at all. Alas! This is indeed difficult!
There was a woman suffering from Warm Disease (Wen Bing) for twelve days. Upon diagnosis, her pulse beat six to seven times per respiration and was choppy (Se). The Cun position was slightly large, and the Chi position was slightly small. She presented with alternating chills and fever, red cheeks, dry mouth, mental confusion, and deafness. Inquiry revealed that her menstruation started several days after the onset of illness. This belongs to Shaoyang Heat entering the Blood Chamber (Xue Shi). If treated incorrectly, death would ensue. Based on the syndrome, Xiao Chai Hu Tang (Minor Bupleurum Decoction) was administered. After two days, Xiao Chai Hu Tang plus Guizhi Tang (Cinnamon Twig Decoction) and Ganjiang Tang (Dried Ginger Decoction) were given. One day later, although the chills and fever subsided, she complained of urgency and pain below the umbilicus. Didang Wan (Di Dang Pill) was then administered. After mild purgation, the pain below the umbilicus resolved. Her body gradually became cool and peaceful, and her pulse became even, yet mental confusion persisted. Xiao Chai Hu Tang was administered again. The next day, she reported heat and dryness in the chest, and dryness in the mouth and nose. A small dose of Tiaowei Chengqi Tang (Regulate the Stomach and Purge Yang Decoction) was given, but no bowel movement occurred. The next day, she reported pain in the epigastrium. Half a dose of Daxiexiong Wan (Major Arming Pill) was given, resulting in three bowel movements. On the following day, she suffered from deficiency-induced restlessness, occasional delirium, and manic speech. Although dry feces were suspected, due to her extreme deficiency, aggressive purging was avoided. Zhuye Tang (Bamboo Leaf Decoction) was given to clear deficiency heat. That night, her bowels moved naturally twice until dawn, passing several pieces of dry feces. Her delirium and restlessness completely resolved. Only coughing with frothy sputum remained, indicating Lung Deficiency. Without treatment, this might lead to Lung萎 (Fei Wei/Lung Atrophy) due to deficiency. Thus, Xiao Chai Hu Tang was modified by removing Renshen (Ginseng Radix), Dazao (Jujubae Fructus), and Shengjiang (Zingiberis Rhizoma Recens), and adding Ganjiang (Zingiberis Rhizoma) and Wuweizi (Schisandrae Fructus). Cough decreased after one day, and the disease was cured after two days. All above prescriptions were from Zhang Zhongjing.
A woman suffered from vomiting and regurgitation, obstruction of both urination and defecation, mental agitation, cold limbs, and a gradually imperceptible pulse. This lasted for a day and a half. Two doses of Dachengqi Tang (Major Order the Yang Decoction) were administered. By midnight, bowel movement gradually resumed, the pulse returned, and she stabilized the next day. This is Guan Ge Syndrome (Obstruction and Rejection Syndrome), which is extremely difficult to treat; physicians must be cautious. The Classics state: Guan involves vomiting and regurgitation; Ge involves inability to urinate. In such cases, inability to defecate may also occur.
A child suffered from deficiency-type loose stools, slight digestion of food, more than ten bowel movements daily, emaciated limbs, abdominal distension, and hunger shortly after eating. This disease is precisely "Large Intestine Heat transferring to the Stomach," characterized by good appetite but emaciation, also known as Shi Ji (Food Accumulation Disorder). It was May or June; the pulse was洪大 (Hong Da/Vigorous and Large), but vanished upon heavy pressure. With all six pulses showing only Vigor and Large qualities, it indicated that Summer pathogenic factors were dominant. The absence of pulse upon pressure indicated the absence of Stomach Qi. The Classics state: Summer pulse is Vigorous and Large. If accompanied by Stomach Qi, it is normal; if Stomach Qi is scant, it is pathological; if Vigorous and Large without Stomach Qi, it indicates death. Summer relies on Stomach Qi as the root. Due to mistimed treatment, the child died suddenly within ten days.
A person suffered from chronic cough, with Lung Deficiency generating cold and heat. Three liang of Kuandonghua (Flos Farfarae) were burned. When smoke emerged, it was inhaled through a brush tube until the mouth was full, then swallowed. This was done five or six times over several days until recovery.
A person suffered from Malaria (Nüe) for over a month. Subsequent use of emetics and purgatives weakened their Qi, and the disease persisted. Observation of symptoms and pulse indicated Summer Heat injury followed by Wind injury in Autumn. One dose of Chaihu Tang (Bupleurum Decoction) was administered, leading to stability. Later, due to irregular diet, chills and fever recurred in summer. This was caused by prior Summer Heat injury and subsequent dietary indiscretion, leading to vomiting, anorexia, pulling pain in the hypochondrium, and irregular chills and fever. The disease name was Tan Nüe (Phlegm Malaria). One dose of Shizao Tang (Ten Jujube Decoction) expelled several sheng of phlegm-water. The next day, Lizhong San (Regulate the Middle Powder) was administered, leading to recovery.
A person suffered from headache due to Wind-Phlegm, tremors, vomiting, and reduced appetite. The physician attributed it to cold-damage and used warming medicines without success. Pill-based purgatives induced Jue (Syncope/Cold Extremities). Subsequent administration of Jin Ye Dan (Golden Liquid Pill) led to delirium, vomiting, tremors, unconsciousness, manic behavior resembling ghost-visitation, grasping at clothes and bedrails, cold extremities, and a hidden pulse. This indicated accumulated heat in the Stomach causing coma, as Yang Qi could not distribute outward and Yin Qi failed to hold inward, resulting in tremors and Jue. Dachengqi Tang (Major Order the Yang Decoction) was administered. One dose resulted in recovery. See Zhang Zhongjing for the formula. Later, Jinbo Wan (Gold Foil Pill) was taken, see *Shanfan* for the formula.
A sixty-one-year-old man had swollen feet with sores. After eating pork, he felt unwell. Medicines promoting drainage provided slight relief. Upon going outside, he contracted Wind, and after sweating, his head and face swelled suddenly, turning purple-black, with excessive sleepiness. Small blisters with yellow discharge appeared on the earlobes. Xiao Xuming Tang (Minor Continuation of Life Decoction) with double the amount of Qianghuo (Notopterygii Rhizoma et Radix) was administered, leading to recovery.
A fifty-four-year-old man was constitutionally weak and prone to Cold invasion. Recently, Tusizi (Cuscutae Semen) proved effective. In his youth, he consumed several jin of raw Liuhuang (Sulfur). His pulses at the left and right upper and lower positions were Xian Jin (String-tight and Forceful). For five to seven years, he suffered from spastic contraction of tendons in the right hand and foot, and slightly delayed speech. Zhang Zhongjing's Xiao Xuming Tang was prescribed, with Yiyiren (Coicis Semen) added in one liang to treat tendon spasm. Huangqin (Scutellariae Radix), Renshen (Ginseng Radix), and Shaoyao (Paeoniae Radix) were each reduced by half to avoid aggravating internal Cold. Xingren (Armeniacae Semen Amarum) was limited to 150 grains. He later reported feeling very cold. Therefore, Renshen, Shaoyao, and Huangqin were removed entirely, and Danggui (Angelicae Sinensis Radix) was added in one and a half liang, leading to stabilization. Many people currently use Xiao Xuming Tang. Without modifying according to syndromes, they reach critical conditions unknowingly. Since Xiao Xuming Tang is widely needed today, this case is cited as an example. Can one not be cautious?
The righteous Qi of the eight solar terms sustains life. The deficient evil of the eight solar terms kills. What is not righteous Qi becomes evil; what is not substantial becomes deficiency. Righteous Qi refers to Spring Warmth, Summer Heat, Autumn Coolness, and Winter Cold—this is Heaven's Qi. In humans, it resides in the meridians in Spring, muscles in Summer, skin in Autumn, and marrow in Winter. Presence constitutes Excess; absence constitutes Deficiency. Thus, using the body's deficiency to encounter the seasonal deficient evil and unrighteous Qi, when two deficiencies interact, the pathogen first enters the skin and meridians, then transmits to the Zang-Fu organs, and finally reaches the marrow. At this stage, medicinal power can hardly reach it. Therefore, physicians should use medicines to block, scatter, and tonify, preventing the pathogen from becoming deep-seated and incurable. Furthermore, protecting Stomach Qi is essential. Taking this as an example, others can be inferred similarly.