谓寒（伤形）热伤气。形气能自伤也。此云不足者皆太过也。以其
太过。则自伤。自伤则不足矣。
\r图\ps11a7.bmp\r
金匮真言云。冬。按跷四时各有病者何。盖五脏之阳气。皆伏于肾中。动有深浅随行动
而病。故于四时而各异也。
诸痛为实。痛随利减。世皆以利为下之者。非也。假令痛在表者实也。痛在里者实也。
痛在
血气者亦实也。在表者汗之。则痛愈。在里者下之。则痛愈。在血气者散之行之。则痛愈。岂
可以利字。只作下之乎。但将利字训作通字。或训作导字。则可矣。是以诸痛为实。痛随利
减。汗而通导之利也。下而通导之亦利也。散气行血。皆通导而利之也。故经曰。诸痛为实
。痛随利减。又曰。通则不痛。痛则不通。此之谓也。
假令高者抑之。非高者固当抑也。以其本下。而失之太高。故抑之而使下。若本高何抑
之有。
假令下者举之。非下者固当举也。以其本高而失之大下。故举之而使高。若本下何举之
有。
假令水在木之分。是从后来从后来者为虚邪。虽在水为虚邪。则木本虚矣。
假令火在水之分。是从前来。从前来者为实邪。虽在火为实邪。则木本实矣。经曰。子
能令母实。
假令两手脉中弦无表证。乃东方实也。是西方肺气大不足也。缘
母虚所致也。当大补其脾。微补其肺。大泄其火。微泄其水。杂证诸论云。先调其气。次论
诸疾况。此乃本经不足之证也。难经云。东方实。是西方虚也。又云欲泄其邪。先补其虚。
此之谓也。如是之证。当以温药补脾。以气药燥剂为用。如正气已胜。当以泄火泄风之药。
清高凉上。勿令入胃中。此为全治。益黄白术半夏茯苓甘草。酒病得之。加泽泻。手足阳明
二燥用益黄者。燥湿而补其气也。实泄黄也。泄火木泄青之类。羌活防风生地黄黄连等分。
黄芩倍之。凡用药补。即用各方之生数。（理中丸）（建中汤）是也。泻即用各方之成数。（七
宣丸）（七圣丸）是也。
所谓寒邪损伤形体，热邪损伤气机。形与气能够自我损伤。这里所说的“不足”，实际上都是由于“太过”造成的。因为太过，所以导致自我损伤；自我损伤后，就表现为不足了。
《金匮真言论》说：冬季……按摩导引（按跷）在四季中各有不同的病症，为什么呢？大概是因为五脏的阳气，都潜藏于肾中，其活动的深浅随着动作的变化而不同，从而引发疾病，所以在四季中表现各异。
各种疼痛属于实证，疼痛会随着通畅而减轻。世人通常将“利”理解为泻下法，这是错误的。假如疼痛在表，属于实证；疼痛在里，也属于实证；疼痛涉及血气，同样属于实证。在表的，通过发汗治疗，疼痛就会痊愈；在里的，通过泻下治疗，疼痛就会痊愈；涉及血气的，通过疏散行气活血治疗，疼痛就会痊愈。怎么能把“利”字仅仅当作泻下呢？只要将“利”字解释为“通”，或者解释为“引导”，就可以了。因此，“诸痛为实，痛随利减”，这里的“利”是指通过发汗达到通畅引导的效果；通过泻下达到通畅引导也是“利”；疏散气机、运行血液，也都是通过通畅引导来达到“利”的效果。所以经文说：“诸痛为实，痛随利减。”又说：“通则不痛，痛则不通。”说的就是这个道理。
假如说“高者抑之”，并不是说凡是高的就一定需要抑制。而是因为原本位置偏低，却失误地升提得太高，所以要抑制它使其下降。如果原本就是高的，为什么要抑制它呢？
假如说“下者举之”，并不是说凡是低的一定需要举升。而是因为原本位置偏高，却失误地攻下得太厉害，所以要举升它使其恢复高位。如果原本就是低的，为什么要举升它呢？
假如水邪停留在肝木的分野，这是从母脏传来的病邪，即“从后来者”，属于虚邪。虽然对于水（肾）来说是虚邪，但对于木（肝）来说，本气已经虚弱了。
假如火邪停留在肾水的分野，这是从子脏传来的病邪，即“从前来者”，属于实邪。虽然对于火（心）来说是实邪，但对于木（肝）来说，本气已经充实了。经文说：“子能令母实。”
假如两手脉象都呈现弦脉，且没有表证，这是东方（肝）实证的表现。这是因为西方（肺）肺气严重不足所致，是由于母脏（脾/肺，此处语境指五行相生关系中的母或制约关系，结合下文补脾肺，主要指土生金或金克木失衡导致的连锁反应，原文逻辑稍显复杂，依文直译即可）虚弱引起的。应当大补脾气，微补肺气，大泄心火，微泄肾水。杂病各论中说：“先调畅气机，再论述其他疾病的情况。”这属于本经不足的证候。《难经》说：“东方实，是西方虚。”又说：“想要泻除邪气，先补其虚。”说的就是这个意思。像这样的证候，应当用温性药物补脾，以具有燥湿作用的补气药为主方。如益黄散加白术、半夏、茯苓、甘草。如果是酒病导致的，加入泽泻。手足阳明二经干燥的，使用益黄散，是为了燥湿并补益气机。这是为了实土泄木。泄火方面，可用青皮之类泄肝木；羌活、防风、生地黄、黄连等分，黄芩加倍用量。凡是用药物进行补益时，就采用各方剂的“生数”（如理中丸、建中汤）。泻下时，就采用各方剂的“成数”（如七宣丸、七圣丸）。
It is said that cold pathogens damage the *xing* (form/body structure), while heat pathogens damage *qi* (vital energy). Both form and qi can be self-damaged. The "deficiency" mentioned here actually stems from "excess." Because of this excess, self-injury occurs; once self-injured, it manifests as deficiency.
The *Jinkui Zhenyan* (True Words of the Golden Coffer) states: In winter... *Anqiao* (massage and stretching exercises) present different diseases in each season. Why? This is because the *yang qi* (positive energy) of the five zang organs are all latent within the kidneys. Their activity depth varies with movement, leading to disease, thus presenting differently across the four seasons.
All pain belongs to *shi* (excess syndrome); pain diminishes with *li* (free flow/unblocking). The world generally interprets "li" as purgation (downward draining), which is incorrect. For instance, if pain is at the exterior (*biao*), it is excess; if pain is at the interior (*li*), it is also excess; if pain involves blood and qi, it is likewise excess. If at the exterior, sweating releases it, and pain subsides. If at the interior, purgation drains it, and pain subsides. If involving blood and qi, dispersing and moving it resolves the pain. How can the character "li" be interpreted solely as purgation? One should interpret "li" as "tong" (unblocking/free flow) or "dao" (guiding). Thus, "all pain is excess, pain diminishes with free flow": sweating achieves unblocking and guiding, which is "li"; purgation achieves unblocking and guiding, which is also "li"; dispersing qi and moving blood are all methods of unblocking and guiding to achieve "li." Hence, the classic says: "All pain is excess, pain diminishes with free flow." It also says: "When there is free flow, there is no pain; when there is pain, there is no free flow." This is what is meant.
Regarding "those that are high, suppress them," it does not mean that everything high must be suppressed. It is because the original position was low, but due to error, it was raised too high; therefore, it must be suppressed to lower it. If it were originally high, why suppress it?
Regarding "those that are low, elevate them," it does not mean that everything low must be elevated. It is because the original position was high, but due to error, it was drained down too much; therefore, it must be elevated to raise it back. If it were originally low, why elevate it?
If water pathogen resides in the domain of Wood (Liver), this comes from the mother organ ("following from behind"), constituting a *xu xie* (deficiency pathogen). Although it is a deficiency pathogen for Water (Kidney), the Wood (Liver) itself has become deficient.
If fire pathogen resides in the domain of Water (Kidney), this comes from the child organ ("following from ahead"), constituting a *shi xie* (excess pathogen). Although it is an excess pathogen for Fire (Heart), the Wood (Liver) itself has become excessive. The classic states: "The child can make the mother excessive."
If both wrists show a *xian* (wiry) pulse without exterior symptoms, this indicates East (Liver) excess. This is caused by a significant deficiency of West (Lung) qi, resulting from the deficiency of the mother organ. One should strongly tonify Spleen qi, mildly tonify Lung qi, strongly drain Heart fire, and mildly drain Kidney water. Discussions on miscellaneous diseases state: "First regulate qi, then discuss other conditions." This is a condition of deficiency in the primary meridian. The *Nanjing* (Classic of Difficult Issues) states: "East is excess, meaning West is deficient." It also says: "To drain the pathogen, first tonify the deficiency." This refers to such cases. For such conditions, warm medicines should be used to tonify the Spleen, employing drying agents that tonify qi, such as *Yihuang San* (Yellow-Protecting Powder) combined with Baizhu (Atractylodis Macrocephalae Rhizoma), Banxia (Pinelliae Rhizoma), Fuling (Poria), and Gancao (Glycyrrhizae Radix et Rhizoma). If caused by alcohol consumption, add Ze Xie (Alismatis Rhizoma). For dryness in the Hand-Foot Yangming meridians, *Yihuang San* is used to dry dampness and tonify qi, thereby strengthening Earth to drain Wood. To drain fire, Qingpi (Citri Reticulatae Pericarpium Viride) may be used to drain Liver wood; Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Shengdihuang (Rehmanniae Radix), and Huanglian (Coptidis Rhizoma) in equal parts, with Huangqin (Scutellariae Radix) doubled. Whenever using medicine for tonification, one employs the "Sheng shu" (generative numbers) of various formulas, such as Lizhong Wan (Regulate the Middle Pill) and Jianzhong Tang (Establish the Middle Decoction). When using purgation, one employs the "Cheng shu" (completed numbers) of various formulas, such as Qixuan Wan (Seven Unblocking Pills) and Qisheng Wan (Seven Sages Pills).