对于寒热真假之辨，最为紧要。当症状表现似是而非，难以辨认时，应舍症取舌，观舌苔之干燥与否，口渴之喜冷与否。答案肯定，则为热证无疑，虽身兼寒证，是为假寒；若答案是否定的，则为寒证无疑。即如认一个人一样，不论其穿什么衣服，都能够认出来，这就说明已经抓住其本质特征了。诊断疾病也是一样，不能凭其现象的某一点，而是本质上的特点才行。曾治一例浑身大热、大渴患者，看似热证无疑，但细察其舌，见无苔而润，口虽渴但不喜冷饮，当时考虑其热象属假，阳虚内寒是真，遂给予真武之类药品而愈。
寒中包火与火中伏寒
李老以善治夹杂证而见长，特别是善于识别夹杂证中相反证之孰多孰少、孰丰孰客，并能判断出比例，进行量化分析，然后据此对证下药，而一举获效。在寒热夹杂证中，他认为首先应区别寒中包火证与火中伏寒证之不同。寒中包火证。以寒证为主，火证往往不甚显著；火中伏寒之证，以火证为主，而寒证也往往不甚显著。在这种情况下，怎样知道是寒中包火或火中伏寒呢?李老认为，只有根据治疗经过，先行试探性治疗，以药测证，方能辨别清楚。盖寒中包火证，单用温药治疗不但不能取效，反而出现火证的表现；火中伏寒证单用寒凉泻火药治疗，也不能取效，反而出现寒证之表现。至于寒证热证卜分明显的寒热夹杂之证，开始时寒热并用自然可以治愈，无须另立名称，徒乱人意。寒在肺中日久，变从火化，则当以火证治之，无须顾其寒。风寒咳血，多因外感日久，陈寒入肺，因寒动火，损伤血络，而致咳嗽日久不愈，形成寒中包火或火中伏寒之寒热错杂证。医者往往因辨不清以寒证为主之寒中包火证及以热证为主之火中伏寒证而乱投药，将寒热比例颠倒，终因误治酿成痨瘵，慎之慎之!
临床上，李老常以清除郁火之方治疗寒中包火之证，方如小柴胡汤加苏子、款冬花；以搜剔陈寒之方治疗火中伏寒之证，方如《千金》麦门冬汤(麦冬三钱，生地三钱，桔梗二钱，桑皮三钱，半夏二钱，紫菀三钱，竹茹三钱，麻黄一钱，五味子一钱，生姜三片，甘草一钱)。麦门冬汤虽寒热并用，但以清凉泻火为主，因风寒客于肺中而引火生痰，故用桔梗、桑皮、半夏、生姜以祛除痰饮，用生地、紫菀、竹茹、麦冬、五味子以清敛火气。然陈寒不除，则痰火旋去而旋生，故以辛温之麻黄一味，以搜剔陈寒。用甘草以调和诸药．，诸药配伍，清敛之中寓以剔除陈寒，达到火气清而伏寒除、痰火去而不反复的目的。
血证论
我们通常将异常出血统称血证，李老则将血的．切病状统称血证，其中包括血热、血寒、血虚、血瘀、出血及血脱六种。六者皆出现有关血液(包括月经)方面的证候：血热者，为血液热度太过，有了热证症状，必见喜冷怕热，口干舌燥，嗜食冷性饮食；血寒者，血液的热度不足，有了寒证症状，必见喜热恶寒，恶冷性饮食；血虚者，为血中成分不足，亦称贫血，症见面色苍白，经量少色淡，舌淡苔少，脉细；血瘀者，为血中有块，有栓塞或血滞的证候，为血证中的实证，症见各处刺痛，月经有块，皮肤及舌上有瘀点、瘀斑等；出血者，为除了正常月经及伤寒病解之鼻衄外的一切出血；血脱者，为出血过多不止，脉微欲绝，或无脉，或脉大无伦之证。
论瘀血与五脏之关系
“瘀血”为中医特有的一种病理现象，有两层含义。其一，瘀血是多种疾病过程中因不同原因造成的一种病理产物；其二，由于瘀血之存在，影响脏腑功能，又可变牛各种疾病。瘀血的形成不外外伤、气虚、阴虚、血虚、气滞、寒凝、热灼等原因。同时，血液之正常生成循行及瘀血的产生又与五脏有着密切的关系，可以总括为：血液生化于脾，总统于心，贮藏于肝，宣布于肺，施泄于．肾。
1．瘀血与肝的关系
肝乃瘀血形成的关键所在。肝不疏泄，则气血郁遏于内，或横溢于外，所滞之处，皆可成瘀。或肝火炽盛，血被煎熬，也可凝结为瘀。《外科补要论》曰：“跌打损伤之证，恶血留内，则不分十二经络，皆可以肝为主。”临床上瘀血阻于肝，常可见癥积、鼓胀等症。
2．瘀血与心的关系
心与瘀血关系亦大，血之往返循环，皆为心所主宰，而心之能主血，全赖心阳旺盛，心窍通利。倘若心阳不振，则搏动无力，致血行缓滞而积瘀；心窍不通，则血也壅滞为瘀。《灵枢。经脉》曰：“手少阴(心)气绝则脉不通，脉不通则血不流，血不流则发色不泽，故其面黑如漆柴者，血先死。”反之，若心火过旺，营血为之煎熬，则会干结成瘀。瘀血阻于心，临床上常可见胸痹、真心痛、心悸等症。
3．瘀血与脾的关系
脾为生血、统血之脏，与瘀血之消长存亡有着更为密切的关系。唐容川言：“食入于胃，脾经化汁，上奉于心，心火得之，变化而赤，是谓血。故治血者，以治脾为主。”又，血生于心火，而下藏于肝，气生于肾水，而上主于肺，其间运上下者脾也。故脾为气血运行之枢纽，若脾病不能运化水谷精微，上奉心火，则血难以生，血少难以畅行脉间，而成瘀血。脾虚气弱，不能运行上下，灌溉四旁，则阳自升而阴自降，于是清浊相混，隧道壅塞，气留血滞，郁而不行，万病丛生之源也。《素问。太阴阳明论》： “脾不能为胃行其津液，四肢不得禀水谷气，气日以衰，脉道不利。”瘀血阻滞于中焦脾胃，临床常见胃脘痛、腹痛、呕血、便血等症。
4．瘀血与肺的关系
肺者，司呼吸而主气之脏也，气行则血行，故肺又有行血之功能。 《灵枢·经脉别论》曰：“食入于胃，浊气归心，淫精于脉，脉气流经，经气归于肺，肺朝百脉，输精于皮毛，毛脉合精，气行于腑。”这说明诸经之血，皆通过肺，并在肺气之鼓动下，才能循行机体。若肺气虚弱，或郁遏不宣，则百脉不能朝肺，肺亦不能将血宣布于全身，终致脉道壅塞而为瘀血。
5．瘀血与肾的关系
人每忽视肾与瘀血的关系，孰知祛瘀之关键在一肾乎，盖血之施泄在．肾，司二便者，亦肾也，人有旧血死血，皆通过肾之作用而从经水或二便排出。傅青主说：“夫经本乎肾，而其流五脏六腑之血皆能归之。”以肾能施泄血液，故新血能源源不断而来，旧血滔滔而去，而能环周不息，奉养生身。倘肾失施泄，旧血无路可出，新血不得通行，壅塞于脉络之间而成瘀。且体内有瘀，亦需由肾排除，故古今医家皆以通利大小肠为祛瘀之要务。如张仲景主张用下法逐瘀，谓通利散行，利下及溺水赤勿怪，即瘀血也。沈金鳌曰：“恶血在内，先要清心行血。通利大小肠。”肾阳不足，阴寒内盛，可令血凝为瘀；肾气亏损，肾阴不足，虚火内炽，灼血为瘀。是故瘀血之成，可由于肾，瘀血之去，更赖于肾也。
四肢厥冷有阳虚与失血之别
杂证四肢厥冷，多为脾肾阳虚，阳气不能达于四末所致，方用四逆汤治之。
失血证四肢厥冷，多是热邪内陷之假寒证，其症身冷如冰，目昏神暗，脉伏不见，或冷一阵、热一阵，或厥数日、热数日．厥多热少者，是阳极似阴之证也，厥少热多者，是伏热犹得发泄，热尚浅也。因为厥阴肝经内寄胆火，病则火伏阴中，而为厥，火出阳分而为热。发热固是火甚，发厥则火伏于内而热更盛矣。治则先宜治其伏火，使火得发，转厥为热。方用清化汤合升降散攻其伏热，或当归龙荟丸攻之．，转热后更清其热，其病可愈，方用五蒸丸清之。清后热不退者。再用大补阴丸、地黄汤以滋阴善后，
热入血室论
热入血室一证根据文献记载和实践证明确实是男女都有的证候，但限于有些地区习惯认为血室就是子宫，如果对男子此证也叫热入血室的话，就会造成很大的笑话，因此李老在当时改为“热入膀胱”。这虽然是无关治疗的一件小事，但对于学者来说，也是不可忽略的环节。
《伤寒论》145条云：“妇人伤寒，发热，经水适来，昼日明了，暮则谵语，如见鬼状者，此为热入血室，无犯胃气及上二焦，必自愈。”无犯胃气及上二焦是告诫医者不要将此证误认为上焦的谵语证(即今日所谓“邪入心包”之证)及中焦阳明病的谵语证而用上中二焦的治法，应该按照下焦热入血室治疗，或用竹叶玉女煎以清热，或用加减桃仁承气汤以破结。所渭“必自愈”者，乃言这样治疗就会痊愈，并非不治自愈。李老曾遇一男子用桃仁承气加减治愈。
汗法小议
汗法是指运用辛温或辛凉药物促使人体发汗，使邪气从汗而解，从而解除表证的一种治法，又叫解表法。汗法在临床应用中，要掌握一个“度”的问题，以遍身（执／水）热水微汗者为佳，假使汗出不能遍身，或大汗淋漓，皆非所宜，因为前者汗出不彻，则病邪不解，后者汗出太多，易使正气耗伤，严重的导致亡阳。另外，在汗法的应用中，会碰到．些问题，应该具体问题具体分析。 一、当汗而汗不出是什么缘故 除药不对证当然不能出汗外，凡药已对证而汗不出者其原因有以下几点：
(一)药的质量
1．品种不纯。
2.采集失时：如桂枝是肉桂的嫩枝，应于春季割取，若秋冬采集，则药效大减。
3．炮制失当：如荆芥用于发汗解表宜生用，而制炭后则长于止血。麻黄生用发汗力强，而蜜炙后其发汗力缓而长于润肺平喘。
4．日久变质：包括霉烂虫蛀等而失效。
(二)药的数量
病重药轻。
(三)煎法失当
煎时过久，药性挥发。汗法所用药物性质均较轻灵，久煎则药效减少。
按：现代药理证明，汗法所用药物挥发油含量丰富，不耐高温，久煎则挥发。
(四)服法违反常规
1．药液过冷：汗法所用药液宜温服。
2．服药后未加温覆或临门当风而卧。
3．服药后误服生冷或其他应忌食物，如油腻等物。
(五)对患者具体情况了解不够彻底
1．温病阴分不足(阴虚)，用辛凉解表药发汗则不能得汗。
2．久患疮疡。
二、汗出而表不解是什么缘故
表证是指恶寒发热、头痛身痛等症状，如果汗出后表证解则为寒邪，汗出表不解，非风则湿。 (参见《温病条辨》中焦篇第六十六条。) 三、当汗不汗有什么害处 当汗是指有表证，而此时未用汗法解表，则邪不能去，表不得解。 四、不当汗而汗有什么害处 不当汗有以下几种原因： 1．邪不在表。 2．亡血。 3。疮疡。 4．素体阴虚。 以上情况本身即有阴分受伤，本不应发汗，若汗之，则更伤阴液。
上面谈到汗法是以发汗为手段来达到解除表证的目的，那么有汗、无汗在临床上又有什么意义呢?
一般来说，这两种现象是正常的生理现象，但在某种情况下就成为诊断治疗的依据，因此成为主要的症状。例如：太阳病有汗就用桂枝汤，无汗就用麻黄汤；有汗就叫作中风，无汗就叫作伤寒。又如：阳明经病有汗就宜用白虎汤，无汗就不宜用白虎汤；夏月多汙、冬月无汗都是正常现象，反之就是病象。
滋阴法的禁忌证
滋阴法是利用甘寒滋润的药品滋补津液的方法。因为温为阳邪，最易耗伤津液，故滋阴法在温病治疗中为常用方法，但需要注意的是，在以下四种情况出现时，滋阴法是不宜应用的：
1。湿邪未尽、阴液未伤者不可用，用之则湿邪留恋，病深难解。
2．病在气分，虽高热而津液未伤者不可用，用之则引邪深入营血，而使病情加剧。
3．温邪乍入营分，气分之邪未尽者不可用，因为此时当透营泄热，转出气分而解，早投滋阴反致病邪难透。
4．阳虚病人绝不可用，恐阳气愈虚，阴阳离决，引起脱变也。
补子益母
李翰卿先生认为天王补心丹(人参、当归、炒枣仁、五味子、远志、丹参、茯神、柏子仁、天冬、麦冬、生地、元参、桔梗、朱砂)系补心气、养心血、生津清热、镇心安神之方，主治忧愁思虑伤心及劳心过度，心血不足，神志不宁，健忘怔忡，心跳善惊，虚烦不寐，大便不利，小便短赤，舌千口渴，口舌生疮等。在其加减法一栏之末，李老有一条重要的按语：
“本方在任何情况下都宜加炙草三至五钱以补中，因脾胃为后天之本。又为心之子，补子也可益母也．”
下法在伤寒和温病中的不同应用
下法，是中医治疗八法之一，具有荡涤肠胃的作用，可以使停留于肠胃的宿食、燥屎、冷积、瘀血、结痰、停水等从下窍而出。然而在伤寒和温病中，下法的应用又各具特点，分辨清楚才能应用得当。
伤寒的下法具有以下特点：
]．伤寒下不嫌迟，早下恐表邪内陷，所以有一分表证，仍宜表之，故下不嫌迟。
2．伤寒是下其结滞，故多用枳朴之品(但也有不用者，如调胃承气汤证)．
3．伤寒用下法必待表证全解而后用之．
4。伤寒上焦有邪不可下。
5．伤寒一下即止，需连下者甚少。
6．伤寒为阴邪，未尝传腑化热，最虑邪气下陷，故有早下之戒。
对照而言，温病的下法具有以下特点：
1．温病下不嫌早。
2．温病是下其郁热，故忌用苦燥，如枳朴之类，而用硝黄。(也有兼用者，但比较少些。使用大小承气汤者较少，使用调胃承气汤者较多。)
3．温病不论表邪罢与不罢，但见里证，即可攻下。
4．温病只要具备可下之证，虽上焦有邪也可下。
5．温病往往再三用下，甚者有多至一二十剂者。
对于寒证与热证的真假辨别，是最为紧要的。当症状表现似是而非、难以辨认时，应当舍弃对表面症状的依赖而重点观察舌象，查看舌苔是否干燥，以及口渴时是否喜欢冷饮。如果答案是肯定的，那么就是热证无疑，即使身体兼有寒证的表现，那也是假寒；如果答案是否定的，那么就是寒证无疑。这就好比认识一个人一样，不论他穿什么衣服，都能够认出来，这说明已经抓住了其本质特征。诊断疾病也是一样，不能凭其现象的某一点，而是依据本质上的特点才行。曾治疗一例浑身大热、大渴的患者，看似热证无疑，但仔细察其舌，发现无苔且湿润，口虽渴但不喜欢冷饮，当时考虑其热象属于假象，阳虚内寒才是真象，于是给予真武汤之类的药物而痊愈。
寒中包火与火中伏寒
李老以善于治疗夹杂证而闻名，特别是善于识别夹杂证中相反证候的孰多孰少、孰盛孰衰，并能判断出比例，进行量化分析，然后据此对证下药，从而一举获效。在寒热夹杂证中，他认为首先应区别寒中包火证与火中伏寒证的不同。寒中包火证，以寒证为主，火证往往不甚显著；火中伏寒证，以火证为主，而寒证也往往不甚显著。在这种情况下，怎样知道是寒中包火还是火中伏寒呢？李老认为，只有根据治疗经过，先行试探性治疗，以药测证，方能辨别清楚。所谓寒中包火证，单用温药治疗不但不能取效，反而会出现火证的表现；火中伏寒证单用寒凉泻火药治疗，也不能取效，反而会出现寒证的表现。至于寒证热证十分明显的寒热夹杂之证，开始时寒热并用自然可以治愈，无须另立名称，徒乱人意。寒邪在肺中日久，变从火化，则应当以火证治之，无须顾及其寒邪。风寒咳血，多因外感日久，陈寒入肺，因寒动火，损伤血络，而致咳嗽日久不愈，形成寒中包火或火中伏寒的寒热错杂证。医者往往因辨不清以寒证为主的寒中包火证及以热证为主之火中伏寒证而乱投药，将寒热比例颠倒，终因误治酿成痨瘵（肺结核），慎之又慎！
临床上，李老常以清除郁火之方治疗寒中包火之证，方如小柴胡汤加苏子、款冬花；以搜剔陈寒之方治疗火中伏寒之证，方如《千金》麦门冬汤（麦冬三钱，生地三钱，桔梗二钱，桑皮三钱，半夏二钱，紫菀三钱，竹茹三钱，麻黄一钱，五味子一钱，生姜三片，甘草一钱）。麦门冬汤虽寒热并用，但以清凉泻火为主，因风寒客于肺中而引火生痰，故用桔梗、桑皮、半夏、生姜以祛除痰饮，用生地、紫菀、竹茹、麦冬、五味子以清敛火气。然而陈寒不除，则痰火旋去而旋生，故以辛温之麻黄一味，以搜剔陈寒。用甘草以调和诸药，诸药配伍，清敛之中寓以剔除陈寒，达到火气清而伏寒除、痰火去而不反复的目的。
血证论
我们通常将异常出血统称血证，李老则将血的一切病状统称血证，其中包括血热、血寒、血虚、血瘀、出血及血脱六种。六者皆出现有关血液（包括月经）方面的证候：血热者，为血液热度太过，有了热证症状，必见喜冷怕热，口干舌燥，嗜食冷性饮食；血寒者，血液的热度不足，有了寒证症状，必见喜热恶寒，恶冷性饮食；血虚者，为血中成分不足，亦称贫血，症见面色苍白，经量少色淡，舌淡苔少，脉细；血瘀者，为血中有块，有栓塞或血滞的证候，为血证中的实证，症见各处刺痛，月经有块，皮肤及舌上有瘀点、瘀斑等；出血者，为除了正常月经及伤寒病解之鼻衄外的一切出血；血脱者，为出血过多不止，脉微欲绝，或无脉，或脉大无伦之证。
论瘀血与五脏之关系
“瘀血”为中医特有的一种病理现象，有两层含义。其一，瘀血是多种疾病过程中因不同原因造成的一种病理产物；其二，由于瘀血之存在，影响脏腑功能，又可变成各种疾病。瘀血的形成不外外伤、气虚、阴虚、血虚、气滞、寒凝、热灼等原因。同时，血液之正常生成循行及瘀血的产生又与五脏有着密切的关系，可以总括为：血液生化于脾，总统于心，贮藏于肝，宣布于肺，施泄于肾。
1．瘀血与肝的关系
肝乃瘀血形成的关键所在。肝不疏泄，则气血郁遏于内，或横溢于外，所滞之处，皆可成瘀。或肝火炽盛，血被煎熬，也可凝结为瘀。《外科补要论》曰：“跌打损伤之证，恶血留内，则不分十二经络，皆可以肝为主。”临床上瘀血阻于肝，常可见癥积、鼓胀等症。
2．瘀血与心的关系
心与瘀血关系亦大，血之往返循环，皆为心所主宰，而心之能主血，全赖心阳旺盛，心窍通利。倘若心阳不振，则搏动无力，致血行缓滞而积瘀；心窍不通，则血也壅滞为瘀。《灵枢·经脉》曰：“手少阴（心）气绝则脉不通，脉不通则血不流，血不流则发色不泽，故其面黑如漆柴者，血先死。”反之，若心火过旺，营血为之煎熬，则会干结成瘀。瘀血阻于心，临床上常可见胸痹、真心痛、心悸等症。
3．瘀血与脾的关系
脾为生血、统血之脏，与瘀血之消长存亡有着更为密切的关系。唐容川言：“食入于胃，脾经化汁，上奉于心，心火得之，变化而赤，是谓血。故治血者，以治脾为主。”又，血生于心火，而下藏于肝，气生于肾水，而上主于肺，其间运上下者脾也。故脾为气血运行之枢纽，若脾病不能运化水谷精微，上奉心火，则血难以生，血少难以畅行脉间，而成瘀血。脾虚气弱，不能运行上下，灌溉四旁，则阳自升而阴自降，于是清浊相混，隧道壅塞，气留血滞，郁而不行，万病丛生之源也。《素问·太阴阳明论》：“脾不能为胃行其津液，四肢不得禀水谷气，气日以衰，脉道不利。”瘀血阻滞于中焦脾胃，临床常见胃脘痛、腹痛、呕血、便血等症。
4．瘀血与肺的关系
肺者，司呼吸而主气之脏也，气行则血行，故肺又有行血之功能。《灵枢·经脉别论》曰：“食入于胃，浊气归心，淫精于脉，脉气流经，经气归于肺，肺朝百脉，输精于皮毛，毛脉合精，气行于腑。”这说明诸经之血，皆通过肺，并在肺气之鼓动下，才能循行机体。若肺气虚弱，或郁遏不宣，则百脉不能朝肺，肺亦不能将血宣布于全身，终致脉道壅塞而为瘀血。
5．瘀血与肾的关系
人每忽视肾与瘀血的关系，孰知祛瘀之关键在一肾乎，盖血之施泄在肾，司二便者，亦肾也，人有旧血死血，皆通过肾之作用而从经水或二便排出。傅青主说：“夫经本乎肾，而其流五脏六腑之血皆能归之。”以肾能施泄血液，故新血能源源不断而来，旧血滔滔而去，而能环周不息，奉养生身。倘肾失施泄，旧血无路可出，新血不得通行，壅塞于脉络之间而成瘀。且体内有瘀，亦需由肾排除，故古今医家皆以通利大小肠为祛瘀之要务。如张仲景主张用下法逐瘀，谓通利散行，利下及溺水赤勿怪，即瘀血也。沈金鳌曰：“恶血在内，先要清心行血。通利大小肠。”肾阳不足，阴寒内盛，可令血凝为瘀；肾气亏损，肾阴不足，虚火内炽，灼血为瘀。是故瘀血之成，可由于肾，瘀血之去，更赖于肾也。
四肢厥冷有阳虚与失血之别
杂证四肢厥冷，多为脾肾阳虚，阳气不能达于四末所致，方用四逆汤治之。
失血证四肢厥冷，多是热邪内陷之假寒证，其症身冷如冰，目昏神暗，脉伏不见，或冷一阵、热一阵，或厥数日、热数日，厥多热少者，是阳极似阴之证也，厥少热多者，是伏热犹得发泄，热尚浅也。因为厥阴肝经内寄胆火，病则火伏阴中，而为厥，火出阳分而为热。发热固是火甚，发厥则火伏于内而热更盛矣。治则先宜治其伏火，使火得发，转厥为热。方用清化汤合升降散攻其伏热，或当归龙荟丸攻之，转热后更清其热，其病可愈，方用五蒸丸清之。清后热不退者，再用大补阴丸、地黄汤以滋阴善后。
热入血室论
热入血室一证根据文献记载和实践证明确实是男女都有的证候，但限于有些地区习惯认为血室就是子宫，如果对男子此证也叫热入血室的话，就会造成很大的笑话，因此李老在当时改为“热入膀胱”。这虽然是无关治疗的一件小事，但对于学者来说，也是不可忽略的环节。
《伤寒论》145条云：“妇人伤寒，发热，经水适来，昼日明了，暮则谵语，如见鬼状者，此为热入血室，无犯胃气及上二焦，必自愈。”无犯胃气及上二焦是告诫医者不要将此证误认为上焦的谵语证（即今日所谓“邪入心包”之证）及中焦阳明病的谵语证而用上中二焦的治法，应该按照下焦热入血室治疗，或用竹叶玉女煎以清热，或用加减桃仁承气汤以破结。所谓“必自愈”者，乃言这样治疗就会痊愈，并非不治自愈。李老曾遇一男子用桃仁承气加减治愈。
汗法小议
汗法是指运用辛温或辛凉药物促使人体发汗，使邪气从汗而解，从而解除表证的一种治法，又叫解表法。汗法在临床应用中，要掌握一个“度”的问题，以遍身漐漐（zhé zhé，微汗貌）如水湿微汗者为佳，假使汗出不能遍身，或大汗淋漓，皆非所宜，因为前者汗出不彻，则病邪不解，后者汗出太多，易使正气耗伤，严重的导致亡阳。另外，在汗法的应用中，会碰到一些问题，应该具体问题具体分析。 一、当汗而汗不出是什么缘故 除药不对证当然不能出汗外，凡药已对证而汗不出者其原因有以下几点：
(一)药的质量
1．品种不纯。
2.采集失时：如桂枝是肉桂的嫩枝，应于春季割取，若秋冬采集，则药效大减。
3．炮制失当：如荆芥用于发汗解表宜生用，而制炭后则长于止血。麻黄生用发汗力强，而蜜炙后其发汗力缓而长于润肺平喘。
4．日久变质：包括霉烂虫蛀等而失效。
(二)药的数量
病重药轻。
(三)煎法失当
煎时过久，药性挥发。汗法所用药物性质均较轻灵，久煎则药效减少。
按：现代药理证明，汗法所用药物挥发油含量丰富，不耐高温，久煎则挥发。
(四)服法违反常规
1．药液过冷：汗法所用药液宜温服。
2．服药后未加温覆或临门当风而卧。
3．服药后误服生冷或其他应忌食物，如油腻等物。
(五)对患者具体情况了解不够彻底
1．温病阴分不足（阴虚），用辛凉解表药发汗则不能得汗。
2．久患疮疡。
二、汗出而表不解是什么缘故
表证是指恶寒发热、头痛身痛等症状，如果汗出后表证解则为寒邪，汗出表不解，非风则湿。（参见《温病条辨》中焦篇第六十六条。） 三、当汗不汗有什么害处 当汗是指有表证，而此时未用汗法解表，则邪不能去，表不得解。 四、不当汗而汗有什么害处 不当汗有以下几种原因： 1．邪不在表。 2．亡血。 3．疮疡。 4．素体阴虚。 以上情况本身即有阴分受伤，本不应发汗，若汗之，则更伤阴液。
上面谈到汗法是以发汗为手段来达到解除表证的目的，那么有汗、无汗在临床上又有什么意义呢？
一般来说，这两种现象是正常的生理现象，但在某种情况下就成为诊断治疗的依据，因此成为主要的症状。例如：太阳病有汗就用桂枝汤，无汗就用麻黄汤；有汗就叫作中风，无汗就叫作伤寒。又如：阳明经病有汗就宜用白虎汤，无汗就不宜用白虎汤；夏月多汗、冬月无汗都是正常现象，反之就是病象。
滋阴法的禁忌证
滋阴法是利用甘寒滋润的药品滋补津液的方法。因为温为阳邪，最易耗伤津液，故滋阴法在温病治疗中为常用方法，但需要注意的是，在以下四种情况出现时，滋阴法是不宜应用的：
1．湿邪未尽、阴液未伤者不可用，用之则湿邪留恋，病深难解。
2．病在气分，虽高热而津液未伤者不可用，用之则引邪深入营血，而使病情加剧。
3．温邪乍入营分，气分之邪未尽者不可用，因为此时当透营泄热，转出气分而解，早投滋阴反致病邪难透。
4．阳虚病人绝不可用，恐阳气愈虚，阴阳离决，引起脱变也。
补子益母
李翰卿先生认为天王补心丹（人参、当归、炒枣仁、五味子、远志、丹参、茯神、柏子仁、天冬、麦冬、生地、元参、桔梗、朱砂）系补心气、养心血、生津清热、镇心安神之方，主治忧愁思虑伤心及劳心过度，心血不足，神志不宁，健忘怔忡，心跳善惊，虚烦不寐，大便不利，小便短赤，舌干口渴，口舌生疮等。在其加减法一栏之末，李老有一条重要的按语：
“本方在任何情况下都宜加炙草三至五钱以补中，因脾胃为后天之本。又为心之子，补子也可益母也。”
下法在伤寒和温病中的不同应用
下法，是中医治疗八法之一，具有荡涤肠胃的作用，可以使停留于肠胃的宿食、燥屎、冷积、瘀血、结痰、停水等从下窍而出。然而在伤寒和温病中，下法的应用又各具特点，分辨清楚才能应用得当。
伤寒的下法具有以下特点：
1．伤寒下不嫌迟，早下恐表邪内陷，所以有一分表证，仍宜表之，故下不嫌迟。
2．伤寒是下其结滞，故多用枳朴之品（但也有不用者，如调胃承气汤证）。
3．伤寒用下法必待表证全解而后用之。
4．伤寒上焦有邪不可下。
5．伤寒一下即止，需连下者甚少。
6．伤寒为阴邪，未尝传腑化热，最虑邪气下陷，故有早下之戒。
对照而言，温病的下法具有以下特点：
1．温病下不嫌早。
2．温病是下其郁热，故忌用苦燥，如枳朴之类，而用硝黄。（也有兼用者，但比较少些。使用大小承气汤者较少，使用调胃承气汤者较多。）
3．温病不论表邪罢与不罢，但见里证，即可攻下。
4．温病只要具备可下之证，虽上焦有邪也可下。
5．温病往往再三用下，甚者有多至一二十剂者。
Regarding the differentiation between true and false cold and heat syndromes, this is of utmost importance. When symptoms are ambiguous and difficult to distinguish, one should discard reliance on surface symptoms and focus on observing the tongue: check whether the tongue coating is dry or moist, and whether thirst is accompanied by a preference for cold drinks. If the answer is affirmative, it is undoubtedly a Heat Syndrome (Re syndrome), even if there are concurrent cold manifestations, which would be considered False Cold (Jia Han); if the answer is negative, it is undoubtedly a Cold Syndrome (Han syndrome). This is akin to recognizing a person regardless of their clothing; it indicates that the essential characteristics have been grasped. Diagnosing diseases is similar; one cannot rely on a single superficial phenomenon but must identify the essential features. For instance, I once treated a patient with severe whole-body heat and intense thirst, who appeared to have an undeniable Heat Syndrome. However, upon careful examination of the tongue, no coating was found, and it was moist; although thirsty, the patient did not prefer cold drinks. At that time, I considered the heat manifestation to be false, while Yang Deficiency with internal Cold (Yang Xu Nei Han) was the truth. Consequently, I administered a formula similar to Zhenwu Tang (True Warrior Decoction), and the patient recovered.
Cold Enveloping Fire and Fire Concealing Cold
Old Li was renowned for his expertise in treating mixed syndromes, particularly in identifying the predominance of opposing syndromes within a mixed pattern, assessing their proportions through quantitative analysis, and prescribing medication accordingly to achieve immediate efficacy. In cases of mixed Cold and Heat syndromes, he believed that the first step is to distinguish between "Cold Enveloping Fire" (Han Zhong Bao Huo) and "Fire Concealing Cold" (Huo Zhong Fu Han). In Cold Enveloping Fire, the Cold Syndrome is predominant, and the Fire manifestation is often insignificant; in Fire Concealing Cold, the Fire Syndrome is predominant, and the Cold manifestation is often insignificant. How, then, can one determine whether it is Cold Enveloping Fire or Fire Concealing Cold? Old Li believed that only by reviewing the treatment history and conducting exploratory treatment—using medication to test the syndrome—can the distinction be made clear. In Cold Enveloping Fire, using warming herbs alone will not only fail to produce results but may also exacerbate Fire manifestations; in Fire Concealing Cold, using cooling and purgative herbs alone will also fail, potentially revealing Cold manifestations. For mixed Cold and Heat syndromes where Cold and Heat are clearly distinct, simultaneous use of Cold and Heat-resolving methods at the onset naturally leads to cure, so there is no need to create new terminology that might confuse practitioners. If Cold lingers in the Lung for a long time and transforms into Fire, it should be treated as a Fire Syndrome, without needing to address the residual Cold. Wind-Cold hemoptysis is often caused by prolonged external contraction, allowing old Cold to enter the Lung, triggering Fire due to Cold, damaging blood collaterals, and resulting in chronic cough, forming a mixed Cold-Heat syndrome of either Cold Enveloping Fire or Fire Concealing Cold. Physicians often misprescribe because they cannot distinguish between Cold-dominant Cold Enveloping Fire and Heat-dominant Fire Concealing Cold, reversing the ratio of Cold and Heat, ultimately leading to consumptive disease (Lao Zhai, e.g., tuberculosis) due to misdiagnosis. Caution is advised!
Clinically, Old Li often used formulas to clear Depressed Fire to treat Cold Enveloping Fire, such as Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with Su Zi (Perilla Fruit) and Kuan Dong Hua (Coltsfoot Flower); and used formulas to search out and eliminate old Cold to treat Fire Concealing Cold, such as Qianjin Mai Men Dong Tang (Millennium Ophiopogon Decoction from *Qian Jin Fang*) [Ophiopogonis Radix (Maidong) 3 qian, Rehmanniae Radix (Shengdi) 3 qian, Platycodonis Radix (Jiegeng) 2 qian, Morus Cortex (Sangpi) 3 qian, Pinelliae Rhizoma Preparatum (Banxia) 2 qian, Asteris Radix (Ziwan) 3 qian, Bamboo Shavings (Zhuru) 3 qian, Ephedrae Herba (Mahuang) 1 qian, Schisandrae Fructus (Wuweizi) 1 qian, Zingiberis Rhizoma Recens (Shengjiang) 3 slices, Glycyrrhizae Radix et Rhizoma (Gancao) 1 qian]. Although Qianjin Mai Men Dong Tang uses both Cold and Heat herbs, its primary action is clearing and purging Fire. Since Wind-Cold lodged in the Lung triggers Fire to generate Phlegm, Jiegeng, Sangpi, Banxia, and Shengjiang are used to dispel Phlegm-fluids, while Shengdi, Ziwan, Zhuru, Maidong, and Wuweizi are used to clear and astringe Fire. However, if old Cold is not removed, Phlegm-Fire will reappear immediately after being cleared. Therefore, a single dose of辛温 (acrid-warm) Mahuang is used to search out and eliminate old Cold. Gancao is used to harmonize the various herbs. The combination of these herbs achieves the goal of eliminating old Cold within the process of clearing and astringing, ensuring that Fire is cleared, concealed Cold is removed, and Phlegm-Fire does not recur.
Discussion on Blood Syndromes
We usually refer to abnormal bleeding collectively as Blood Syndromes (Xue Zheng). Old Li, however, referred to all pathological conditions related to blood as Blood Syndromes, including six categories: Blood Heat, Blood Cold, Blood Deficiency, Blood Stasis, Bleeding, and Blood Collapse. All six present with syndromes related to blood (including menstruation): Blood Heat refers to excessive heat in the blood, presenting with Heat Syndrome symptoms such as preference for cold and aversion to heat, dry mouth and tongue, and craving for cold foods; Blood Cold refers to insufficient heat in the blood, presenting with Cold Syndrome symptoms such as preference for heat and aversion to cold, and aversion to cold foods; Blood Deficiency refers to a lack of blood components, also known as anemia, presenting with pale complexion, scanty and pale menstrual flow, pale tongue with little coating, and fine pulse; Blood Stasis refers to the presence of clots, embolisms, or blood stagnation in the blood, representing an Excess Syndrome in Blood Syndromes, presenting with stabbing pain in various areas, menstrual clots, petechiae, and ecchymoses on the skin and tongue; Bleeding refers to all bleeding except for normal menstruation and epistaxis occurring during the resolution of Taiyang Disease; Blood Collapse refers to excessive, uncontrolled bleeding, presenting with a faint pulse nearing extinction, absent pulse, or a large and chaotic pulse.
On the Relationship Between Blood Stasis and the Five Zang Organs
"Blood Stasis" (Yu Xue) is a pathological phenomenon unique to Traditional Chinese Medicine, carrying two meanings. First, Blood Stasis is a pathological product formed due to various causes during the course of multiple diseases; second, due to its existence, it affects Zang-Fu organ functions and can give rise to various other diseases. The formation of Blood Stasis stems from trauma, Qi Deficiency, Yin Deficiency, Blood Deficiency, Qi Stagnation, Cold Coagulation, Heat Scorching, etc. Simultaneously, the normal generation and circulation of blood, as well as the production of Blood Stasis, are closely related to the Five Zang Organs, summarized as: Blood is generated by the Spleen, governed by the Heart, stored in the Liver, distributed by the Lungs, and discharged by the Kidneys.
1. Relationship between Blood Stasis and the Liver
The Liver is the key to the formation of Blood Stasis. If the Liver fails to ensure the free flow of Qi, Qi and Blood become stagnant internally or overflow externally; wherever stagnation occurs, Blood Stasis can form. Alternatively, if Liver Fire is blazing, blood is scorched and can coagulate into stasis. *Waike Buyao Lun* states: "In cases of traumatic injury, if evil blood remains inside, regardless of the twelve meridians, the Liver takes the primary role." Clinically, Blood Stasis obstructing the Liver often presents with masses (Zheng Ji) and abdominal distension (Gu Zhang).
2. Relationship between Blood Stasis and the Heart
The relationship between the Heart and Blood Stasis is also significant. The circulation of blood is governed by the Heart, and the Heart's ability to govern blood relies entirely on vigorous Heart Yang and unobstructed Heart orifices. If Heart Yang is weak, cardiac pulsation is powerless, causing slow blood flow and accumulation of stasis; if Heart orifices are blocked, blood becomes congested and forms stasis. *Ling Shu: Jing Mai* states: "When Qi of the Hand-Shaoyin (Heart) ceases, vessels do not flow; when vessels do not flow, blood does not circulate; when blood does not circulate, hair loses luster. Thus, those whose faces are black like lacquered firewood have experienced prior death of blood." Conversely, if Heart Fire is excessive, Ying-Blood is scorched and dries into stasis. Clinically, Blood Stasis obstructing the Heart often presents with Chest Bi (Xiong Bi), True Heart Pain (Zhen Xin Tong), and palpitations.
3. Relationship between Blood Stasis and the Spleen
The Spleen is the organ that generates and controls blood, having a closer relationship with the waxing and waning of Blood Stasis. Tang Rongchuan said: "Food enters the Stomach, the Spleen channel transforms juices, sends them up to the Heart, Heart Fire receives them, changes them into red, this is called blood. Therefore, in treating blood disorders, one should primarily treat the Spleen." Furthermore, blood is born from Heart Fire and stored in the Liver below; Qi is born from Kidney Water and governed by the Lungs above; the Spleen transports between upper and lower. Thus, the Spleen is the pivot of Qi and Blood circulation. If Spleen disease fails to transform and transport essence from food and water to send up to Heart Fire, blood is difficult to generate; with insufficient blood, it is hard to circulate freely in vessels, leading to Blood Stasis. With Spleen Qi deficiency and weakness, unable to transport up and down and irrigate the four peripheries, Yang rises spontaneously and Yin descends spontaneously, causing turbidity and clarity to mix, tunnels to become blocked, Qi to remain and Blood to stagnate,郁而不行 (stagnant and unable to move), becoming the source of myriad diseases. *Su Wen: Tai Yang Yang Ming Lun* states: "If the Spleen cannot transport fluids for the Stomach, the four limbs cannot receive Qi from water and grain, Qi declines daily, and vessel channels become unfavorable." Blood Stasis obstructing the Middle Jiao Spleen and Stomach commonly presents clinically with epigastric pain, abdominal pain, hematemesis, and melena.
4. Relationship between Blood Stasis and the Lungs
The Lung is the organ that governs respiration and Qi, and since Qi movement drives Blood movement, the Lung also has the function of moving blood. *Ling Shu: Jing Mai Bie Lun* states: "Food enters the Stomach, turbid Qi returns to the Heart, nourishes the vessels, vessel Qi flows through meridians, Meridian Qi returns to the Lungs, the Lungs face all vessels, distribute essence to skin and hair, hair and vessel essences combine, Qi moves through the fu organs." This explains that blood from all meridians passes through the Lungs and, driven by Lung Qi, can circulate throughout the body. If Lung Qi is weak or constrained and not diffused, hundred vessels cannot face the Lungs, and the Lungs cannot distribute blood to the whole body, eventually causing vessel blockage and forming Blood Stasis.
5. Relationship between Blood Stasis and the Kidneys
People often overlook the relationship between the Kidneys and Blood Stasis, not knowing that the key to removing stasis lies in the Kidney. The discharge of blood depends on the Kidneys, which also control urination and defecation. Old and dead blood in humans are expelled through the Kidney's action via menstruation or urine/stool. Fu Qingzhu said: "Menstruation originates from the Kidney, and its flow allows blood from the five Zang and six Fu organs to return to it." Because the Kidney can discharge blood, new blood comes continuously, old blood goes away profusely, enabling continuous circulation to nourish the body. If the Kidney loses its discharging function, old blood has no way out, new blood cannot circulate, congestion occurs between collaterals, forming stasis. Moreover, stasis in the body also needs to be eliminated by the Kidneys, so physicians throughout history have regarded promoting urination and defecation as a crucial task for removing stasis. For example, Zhang Zhongjing advocated using purgation methods to drive out stasis, stating that promoting flow disperses and moves; if stool is dark or urine is bloody, do not be surprised, this is Blood Stasis. Shen Jin'ao said: "If evil blood is inside, one must first clear the Heart and move blood, promoting urination and defecation." Insufficient Kidney Yang and abundant internal Yin-Cold can cause blood to coagulate into stasis; Kidney Qi deficiency and insufficient Kidney Yin, with empty Fire blazing internally, scorch blood into stasis. Thus, the formation of Blood Stasis can stem from the Kidney, and its removal relies even more on the Kidney.
Distinction between Yang Deficiency and Blood Loss in Limb Coldness
Miscellaneous syndromes involving coldness of the four limbs are mostly caused by Spleen-Kidney Yang Deficiency, where Yang Qi cannot reach the extremities, treated with Si Ni Tang (Frigid Extremities Decoction).
For Blood Loss syndromes involving limb coldness, it is mostly a False Cold Syndrome caused by Heat Evil sinking inward. Symptoms include body cold as ice, dim vision and dull spirit, hidden pulse not visible, alternating episodes of cold and heat, or several days of cold followed by several days of heat. If cold exceeds heat, it is a syndrome of Extreme Yang resembling Yin; if heat exceeds cold, latent Heat is still able to vent, indicating shallow Heat. Because the Jueyin Liver meridian harbors Gallbladder Fire internally, when diseased, Fire hides in Yin causing coldness (Jue), and Fire emerges in Yang causing heat. Fever certainly indicates strong Fire, but coldness indicates Fire hidden inside with even stronger Heat. The treatment principle should first address the hidden Fire, allowing Fire to vent, transforming coldness into heat. Use Qing Hua Tang combined with Sheng Jiang San (Ascending and Descending Powder) to attack latent Heat, or Dang Gui Long Hui Wan (Angelica Dragon Bile Pill) to attack it. After heat returns, clear the remaining Heat with Wu Zheng Wan (Five Steaming Pills). If heat persists after clearing, use Da Bu Yin Wan (Major Nourishing Yin Pill) and Di Huang Tang (Rehmannia Decoction) to nourish Yin for recovery.
Discussion on Heat Entering the Blood Chamber
The syndrome of Heat Entering the Blood Chamber (Re Ru Xue Shi), according to literature and practice, indeed occurs in both men and women. However, limited by regional habits considering the Blood Chamber solely as the uterus, calling this syndrome in men "Heat Entering the Blood Chamber" would cause great ridicule. Therefore, Old Li changed it to "Heat Entering the Bladder" at that time. Although this is a minor matter unrelated to treatment, it is an indispensable link for scholars.
Article 145 of *Shang Han Lun* states: "In women with Shang Han, fever, and menstruation just beginning, clear during the day but delirious at night, seeing ghosts, this is Heat Entering the Blood Chamber. Do not violate Stomach Qi and the Upper and Middle Jiao; it will heal itself." "Do not violate Stomach Qi and the Upper and Middle Jiao" warns physicians not to mistake this syndrome for Upper Jiao delirium (today known as "Evil entering the Pericardium") or Middle Jiao Yangming Disease delirium, and thus not to use Upper/Middle Jiao treatments. One should treat it as Lower Jiao Heat Entering the Blood Chamber, using Zhu Ye Yu Nu Jian (Bamboo Leaf Jade Maiden Decoction) to clear Heat, or Jia Jian Tao Ren Cheng Qi Tang (Modified Peach Kernel Cathartic Decoction) to break accumulations. The phrase "will heal itself" means that with such treatment, it will heal; it does not mean healing without treatment. Old Li once encountered a male patient cured by modified Tao Ren Cheng Qi Tang.
Brief Discussion on Sweating Method
The Sweating Method (Han Fa) refers to using acrid-warm or acrid-cool herbs to induce sweating, allowing pathogenic factors to exit via sweat, thereby resolving Exterior Syndromes (Biao Zheng). It is also called Exterior-Resolving Method. In clinical application, the Sweating Method requires mastering the "degree"; mild sweating covering the whole body is ideal. If sweating does not cover the whole body, or if there is profuse sweating, neither is appropriate. The former means incomplete sweating, so pathogens are not resolved; the latter means excessive sweating, easily consuming Healthy Qi, and severely leading to Yang Collapse (Wang Yang). Additionally, problems may arise in applying the Sweating Method, requiring specific analysis for specific issues.
I. Reasons for inability to sweat when sweating is indicated:
Apart from incorrect prescription, reasons for failure to sweat despite correct prescription include:
(1) Drug Quality
1. Impure variety.
2. Improper harvesting time: e.g., Guizhi (Cinnamon Twig) is the tender branch of Rougui (Cinnamon Bark), should be harvested in spring; if harvested in autumn/winter, efficacy greatly decreases.
3. Improper processing: e.g., Jingjie (Schizonepeta) should be used raw for inducing sweating and resolving exterior; charred, it is better for stopping bleeding. Mahuang (Ephedra) used raw has strong sweating power; honey-fried, its sweating power is milder but better for moistening lungs and calming wheezing.
4. Deterioration over time: Including mold and insect damage leading to loss of efficacy.
(2) Drug Quantity
Disease is heavy, drug dosage is light.
(3) Improper Decoction Method
Decocting too long causes volatilization of medicinal properties. Herbs used in Sweating Method are generally light and agile; long decoction reduces efficacy.
Note: Modern pharmacology proves that herbs used in Sweating Method are rich in volatile oils, intolerant to high temperatures, and volatilize with long decoction.
(4) Violation of Administration Conventions
1. Liquid too cold: Liquids for Sweating Method should be taken warm.
2. Not covering with warmth after taking medicine or lying near a drafty door/window.
3. Accidentally consuming raw/cold or forbidden foods after taking medicine, such as greasy foods.
(5) Inadequate understanding of patient's specific condition
1. In Warm Diseases, if Yin aspect is deficient (Yin Deficiency), using acrid-cool exterior-resolving herbs will not induce sweating.
2. Chronic sores and ulcers.
II. Reasons for sweating but unresolved Exterior Syndrome
Exterior Syndrome refers to symptoms like aversion to cold, fever, headache, and body ache. If sweating resolves these symptoms, it is Cold Evil; if sweating does not resolve the Exterior, it is either Wind or Dampness. (See *Wen Bing Tiao Bian*, Middle Jiao Chapter, Article 66.)
III. Harm of failing to sweat when indicated
"When to sweat" means having an Exterior Syndrome. If Sweating Method is not used to resolve the exterior, pathogens cannot be removed, and the Exterior cannot be resolved.
IV. Harm of sweating when not indicated
Reasons for "not sweating when not indicated" include:
1. Pathogen is not in the Exterior.
2. Blood loss.
3. Sores and ulcers.
4. Constitutionally Yin Deficient.
These conditions already involve injury to the Yin aspect; sweating should not be induced. If sweated, Yin fluids are further damaged.
Above, we discussed that the Sweating Method uses sweating as a means to resolve Exterior Syndromes. What is the significance of having sweat vs. no sweat clinically?
Generally, these two phenomena are normal physiological states, but under certain circumstances, they become basis for diagnosis and treatment, thus becoming main symptoms. For example: In Taiyang Disease, if there is sweat, use Guizhi Tang (Cinnamon Twig Decoction); if no sweat, use Mahuang Tang (Ephedra Decoction). If there is sweat, it is called Wind Strike (Zhong Feng); if no sweat, it is called Cold Damage (Shang Han). Again: In Yangming Channel Disease, if there is sweat, Bai Hu Tang (White Tiger Decoction) is suitable; if no sweat, Bai Hu Tang is not suitable. Summer sweating is normal; winter no-sweat is normal; conversely, these are pathological signs.
Contraindications for Nourishing Yin Method
Nourishing Yin Method utilizes sweet-cold and moistening drugs to tonify Body Fluids. Since Warmth is a Yang Evil that easily consumes Body Fluids, Nourishing Yin Method is commonly used in Warm Disease treatment. However, note that Nourishing Yin Method is inappropriate in the following four situations:
1. If Damp Evil is not exhausted and Yin Fluids are not injured, do not use; using it causes Damp Evil to linger, making deep disease difficult to resolve.
2. If disease is in Qi Level, even with high fever, if Body Fluids are not injured, do not use; using it draws Evil deep into Ying-Blood level, worsening the condition.
3. If Warm Evil has just entered Ying Level and Qi Level Evil is not exhausted, do not use; at this time, one should vent Ying and drain Heat, turning out to Qi Level to resolve. Early administration of Nourishing Yin hinders pathogen penetration.
4. Absolutely do not use in Yang Deficient patients, fearing further Yang deficiency, separation of Yin and Yang, and collapse transformation.
Tonifying the Son to Benefit the Mother
Mr. Li Hanqing believed that Tian Wang Bu Xin Dan (Heavenly Emperor Heart-Nourishing Pill) [Ren Shen (Ginseng), Dang Gui (Angelica Sinensis), Chao Zao Ren (Stir-fried Sour Jujube Seed), Wu Wei Zi (Schisandra), Yuan Zhi (Polygala), Dan Shen (Salvia), Fu Shen (Poria with Hostwood), Bai Zi Ren (Biota Seed), Tian Dong (Asparagus Root), Mai Dong (Ophiopogon), Sheng Di (Rehmannia), Yuan Shen (Scrophularia), Jie Geng (Platycodon), Zhu Sha (Cinnabar)] is a formula that tonifies Heart Qi, nourishes Heart Blood, generates fluids, clears Heat, calms the Spirit, and anchors the Mind. It treats heart injury from worry and overthinking, excessive mental labor, Heart Blood Deficiency, restless spirit, forgetfulness, palpitations, fear of startling, empty vexation and insomnia, difficulty in defecation, short dark urine, dry tongue with thirst, and mouth/tongue ulcers. At the end of its modification section, Old Li added an important annotation:
"This formula should always be added with 3 to 5 qian of Zhi Cao (Honey-fried Licorice) to tonify the Middle, because the Spleen and Stomach are the foundation of Post-Heaven existence. They are also the 'Son' of the Heart; tonifying the Son can benefit the Mother."
Different Applications of Purging Method in Shang Han and Wen Bing
The Purging Method (Xia Fa) is one of the Eight Methods of TCM treatment, possessing the function of cleansing the intestines and stomach, allowing retained food residues, dry feces, cold accumulations, Blood Stasis, congealed phlegm, and stagnant water in the intestines and stomach to exit through the lower orifices. However, the application of the Purging Method differs in Shang Han (Cold Damage) and Wen Bing (Warm Diseases); distinguishing these clearly is necessary for proper application.
Characteristics of the Purging Method in Shang Han:
1. In Shang Han, purging is not disliked to be late; early purging fears interior invasion of Exterior Evil, so if any Exterior Syndrome exists, exterior resolution is still preferred, hence purging is not disliked to be late.
2. Shang Han purges stagnation, thus often using Zhi (Aurantii Fructus) and Po (Magnoliae Officinalis Cortex) products (though some cases do not use them, e.g., Tiao Wei Cheng Qi Tang syndrome).
3. In Shang Han, the Purging Method must wait until the Exterior Syndrome is completely resolved before use.
4. In Shang Han, if Evil is in the Upper Jiao, purging is contraindicated.
5. In Shang Han, purging stops after one use; consecutive purging is rare.
6. Shang Han is caused by Yin Evil, rarely transmitting to Fu organs to transform into Heat; greatest concern is Evil sinking downward, hence warning against early purging.
In contrast, characteristics of the Purging Method in Wen Bing:
1. In Wen Bing, purging is not disliked to be early.
2. Wen Bing purges Depressed Heat, thus avoiding bitter-dry herbs like Zhi and Po, instead using Xiao (Natrii Sulfas) and Huang (Rhei Radix et Rhizoma). (Some combinations exist but are less common. Use of Da/Xiao Cheng Qi Tang is less frequent; use of Tiao Wei Cheng Qi Tang is more frequent.)
3. In Wen Bing, regardless of whether Exterior Evil has ceased or not, if Interior Syndrome is seen, purging can be applied.
4. In Wen Bing, as long as indications for purging are present, purging can be used even if Evil is in the Upper Jiao.
5. In Wen Bing, purging is often repeated several times, sometimes up to ten or twenty doses.