夏天气上行。秋天气下行。治者当顺天道谓如先寒后热。
太阳阳明病。白虎加桂也。此天气上行宜用之若天气下行。则不宜泻肺。宜泻相火命门则可
矣。亦有内伤冷物而作者。当先调中。后定疟形。治随应见乃得康宁。亦有久而不瘥者。当
求虚实。以脉为期虚补实泻。可使却疾。此之谓也。
\r候汤液之图\ps11a13.bmp\r
答曰。素问者。从天之六气言也难经者。从地之血脉言也。铜人者。从经言人也从天而
言先
气而后血从地而言。亦先气而后血从天而言在天地之间从地之病而言。即地中之气病。故血
从而病也。从天而言。先是动后所生从地而言。亦先是动而所生之病后也。
启玄子云。热不得寒是无水也。寒不得热是无火也寒之不寒责其无水。热之不热责其无
火经云。滋其化源。源既已绝药之假不能滋其真水火也。
或始不早治。日数久淹。或困乃求医。法不及用。病势已盈。岂为天命。
（仲景平脉法第二）
及诊得脉形证相应。因与服汤。食顷变大吐下腹痛。是为变怪。或有旧时服药。今乃作
发。是亦谓之灾怪耳。
华佗云。盛而为喘。减而为枯。故活人亦云。发喘者。气有余也。凡看文本。
须得会得本意。盛而为喘者。非肺气盛也。喘为肺气有余者。亦非气有余也气盛当认作气衰
有余当认作不足。肺气果盛又为有余则当清肃下行而不喘以其火入于肺衰与不足而为喘焉。
故言盛者。非言肺气盛也言肺中之火盛也。言有余者。非言肺气有余也。言肺中之火有余也
。故泻肺以苦寒之剂。非泻肺也。泻肺中之火实。补肺气也。用者不可不知。
夏天的气机向上运行，秋天的气机向下运行。治疗者应当顺应天道。比如先出现寒象后出现热象的情况。
如果是太阳病与阳明病并见，可以使用白虎加桂枝汤（Baihu Jia Guizhi Tang）。这是因为天气上行时适宜使用此方；如果天气下行（指秋令或气机下陷），则不适宜泻肺，而应该泻相火和命门之火。也有因为内伤冷物而导致喘息的，应当先调理中焦脾胃，然后再确定疟疾的证型进行治疗。治疗要随证应变，这样才能恢复健康安宁。也有病程迁延不愈的，应当辨别虚实，以脉象为依据，虚证用补法，实证用泻法，可以使疾病痊愈。说的就是这个道理。
关于汤液煎煮方法的图示。
回答说：《素问》是从天之六气的角度来论述的，《难经》是从地之血脉的角度来论述的，《铜人腧穴针灸图经》则是从人的经络角度来论述的。从天而言，先论气而后论血；从地而言，也是先论气而后论血。从天而言，是在天地之间；从地之病而言，即是地中之气病，所以血随之而病。从天而言，先是动而后所生；从地而言，也是先是动而后所生之病。
启玄子（王冰）说：热证得不到寒凉药的治疗，是因为无水（肾阴不足）；寒证得不到温热药的治疗，是因为无火（肾阳不足）。用寒凉药治不好寒证，责任在于无水；用温热药治不好热证，责任在于无火。经文说：滋养其化源。既然源头已经枯竭，药物的假借之力也不能滋养其真元，这里指的是水火（阴阳/肾阴肾阳）。
或者开始没有及早治疗，日子久了拖延病情；或者等到困顿不堪时才求医，治疗方法来不及施展，病势已经充盈盛大，这难道是天命吗？
等到诊察到脉象与症状相应，于是给予服用汤药。过了一会儿，出现剧烈呕吐、腹泻、腹痛等变化，这称为“变怪”。或者有旧时服用的药物，现在才发作反应，这也称为“灾怪”。
华佗说：气盛则表现为喘息，气减则表现为枯槁。所以《活人书》也说：发喘的人，是气有余。凡是阅读文本，必须领会其本意。“盛而为喘”，并不是指肺气盛；说喘是肺气有余，也不是指气有余。气盛应当理解为气衰，有余应当理解为不足。如果肺气真的盛且有余，就应当清肃下行而不发生喘息，因为火入于肺导致肺衰与不足而发生喘息。所以说“盛”，不是指肺气盛，而是指肺中的火盛；说“有余”，不是指肺气有余，而是指肺中的火有余。因此，用苦寒剂泻肺，并不是泻肺气，而是泻肺中的火实，从而补益肺气。使用者不可不知道这一点。
The Qi of summer moves upward. The Qi of autumn moves downward. Practitioners should conform to the Way of Heaven. For instance, in cases where cold precedes heat.
When Taiyang (Greater Yang) and Yangming (Yang Brightness) diseases occur together, Baihu Jia Guizhi Tang (White Tiger plus Cinnamon Twig Decoction) may be used. This is appropriate when the Heavenly Qi moves upward; if the Heavenly Qi moves downward, it is not suitable to drain the Lung, but rather one should drain the Ministerial Fire (Xiang Huo) and Mingmen (Gate of Life). There are also cases caused by internal injury from consuming cold substances; in such instances, one should first regulate the Middle Jiao (Middle Burner), and then determine the pattern of malaria for treatment. Treatment must follow the changing manifestations to achieve health and peace. In cases that persist without recovery, one must seek the deficiency or excess, using the pulse as the guide: tonify deficiency and drain excess, which can drive away the disease. This is what is meant.
[Image: Diagram of decoction preparation]
Answered: *Suwen* (Basic Questions) discusses from the perspective of the Six Qi (Six Atmospheric Factors) of Heaven; *Nanjing* (Classic of Difficult Issues) discusses from the perspective of the blood vessels of Earth; *Tongren* (Bronze Man) discusses from the perspective of human meridians. Speaking from Heaven, Qi is discussed before Blood; speaking from Earth, Qi is also discussed before Blood. Speaking from Heaven, it is within the space between Heaven and Earth; speaking from the diseases of Earth, it refers to the Qi disease within the Earth, thus Blood becomes diseased following it. Speaking from Heaven, movement comes first, followed by generation; speaking from Earth, movement also comes first, followed by the generated disease.
Qixuanzi (Wang Bing) said: Heat cannot be treated with cold because there is no Water (Kidney Yin); Cold cannot be treated with heat because there is no Fire (Kidney Yang). If cold cannot be resolved with cold agents, the responsibility lies in the lack of Water; if heat cannot be resolved with heat agents, the responsibility lies in the lack of Fire. The Classic states: Nourish its source. Once the source is exhausted, the borrowed power of medicine cannot nourish the true essence; this refers to Water and Fire (Yin and Yang / Kidney Yin and Kidney Yang).
If early treatment is not sought, days pass and the condition lingers; or if one seeks medical help only when exhausted, the methods may not be applied in time, and the pathological momentum has already become full and vigorous. Is this due to the Mandate of Heaven?
(Zhongjing's Method of Examining Pulses Second)
When the pulse shape and symptoms correspond, one then administers the decoction. After a short while, severe vomiting, diarrhea, and abdominal pain occur; this is called "bian guai" (abnormal transformation). Or perhaps medications taken previously are now manifesting effects; this is also referred to as "zai guai" (disaster-like anomaly).
Hua Tuo said: When excessive, it manifests as wheezing; when deficient, it manifests as emaciation. Therefore, *Huoren Shu* (Book of Living People) also states: Those who wheeze have an excess of Qi. Whenever reading texts, one must grasp the original intent. "Excessive leads to wheezing" does not mean Lung Qi is excessive. Saying wheezing indicates Lung Qi excess does not mean Qi itself is excessive. Excess of Qi should be recognized as deficiency of Qi; apparent excess should be recognized as insufficiency. If Lung Qi were truly excessive and abundant, it would descend clearly and turbidly without wheezing. Instead, because Fire enters the Lung causing Lung deficiency and insufficiency, wheezing occurs. Therefore, saying "excessive" does not refer to Lung Qi being excessive, but to Fire in the Lung being excessive. Saying "redundant/excess" does not refer to Lung Qi being redundant, but to Fire in the Lung being redundant. Thus, using bitter-cold agents to drain the Lung is not draining Lung Qi, but draining the excess Fire in the Lung, thereby tonifying Lung Qi. Users must understand this.