仲景论伤寒少阴病利止，息高者死，时眩冒者死。又谓∶霍乱利止者，亡血也，脉不出
者死
。吾诊病虚损者两人，皆上咳下遗，遗止两三月即死。盖遗者，阴阳不相维也，然犹有精，
而气犹足以激出之；止则精神当日旺，病证当日瘳，乃反身日见困，神日见衰，脉形日细，
至数日数，断续不匀，早晚无定，此乃阴阳偏绝，无气以激其离根之元气，仅萦萦于中焦而
未散耳!故咳声日低，呼吸日短，饮食时进时退，渐见稍动即喘，神魂不宁。此时补脾则中
满，补肺则上壅，而补肾与命门真阴真阳，温养摄纳，引气归元，虽为对病之剂，亦是催命
之符。何者?下焦元气空虚无主，五脏营运之气久已不归其根，一旦补药得力，中焦气将下
运，如桶脱底而一去不得返矣。孙一奎治马二尹伤食，误服大黄、芒硝、巴豆重剂，尚未得泻
，以六君子救之，而曰∶虑其得药后，脾阳内动，诸药性发，将大泻不止，如瓶水底漏而不
可禁也，须备人参数斤以预之。其机括正与此同。孔毓礼亦谓∶痢止而手足厥逆，脉反沉细
无神，不能食者，死也。仲景为利止脉不出者，出人参四逆汤，亦不忍坐视，聊尽人事而已
。夫利出浊道，又属暴病，犹且如此，况遗出命根，又在久病之后者乎!
肝之性，喜升而恶降，喜散而恶敛。经曰∶肝苦急，急食辛以散之，以辛补之，以酸泄
之。
肝为将军之官，而胆附之，凡十一脏取决于胆也。东垣曰∶胆木春升，余气从之，故凡脏腑
十二经之气化，皆必藉肝胆之气化以鼓舞之，始能调畅而不病。凡病之气结、血凝、痰饮、
肿、臌胀、痉厥、癫狂、积聚、痞满、眩晕、呕吐、哕呃、咳嗽、哮喘、血痹、虚损，皆
肝气之不能舒畅所致也。或肝虚而力不能舒，或肝郁而力不得舒，日久遂气停血滞，水邪泛
滥，火势内灼而外暴矣。其故由于劳倦太过，致伤中气，以及忧思不节，致伤神化也；内伤
饮食，外感寒湿，脾肺受困，肝必因之。故凡治暴疾、痼疾，皆必以和肝之法参之。和肝者
，伸其郁、开其结也；或化血，或疏痰，兼升兼降，肝和而三焦之气化理矣，百病有不就理
者乎?后世专讲平肝，不拘何病，率入苦凉清降，是伐肝也。殊不知肝气愈郁愈逆，疏泄之
性横逆于中，其实者暴而上冲，其虚者折而下陷，皆有横悍逼迫之势而不可御也，必顺其性
而舒之，自然相化于无有。如东垣重讲脾胃，必远肝木，所指药品，乃防风、羌活、川芎、
白芷诸辛散之品也，即陈皮、浓朴，且屡伸泄气之戒矣。其义不大可思乎?丹溪号善用苦寒
，而意重开郁，常用之药，不外香附、川芎、白芷、半夏也。其义不更可思乎?故知古人平
肝之法，乃芳香鼓舞，舒以平之，非白芍、枳壳寒降以伐之也。然则肝盛者当何如?曰∶肝
盛固当泄也，岂百病皆可泄肝乎?医者善于调肝，乃善治百病。《内经》曰∶升降出入。又
曰∶疏其气而使之调。故东垣之讲胃气，河间之讲玄府，丹溪之讲开郁，天士之讲通络，未
有逾于舒肝之义者也。所谓肝盛者，风火自盛，升散之力太过也。后人每以郁而上冲头痛、
头胀者，为肝阳太旺、更有以遗精、白浊、烦躁、不眠诸下陷之证，指为肝阳太旺者，不亦
戾乎!
张仲景在论述伤寒少阴病时提到，如果腹泻停止但出现呼吸浅促（息高），是死证；如果发生眩晕昏冒，也是死证。他又说：霍乱病患者如果腹泻停止，是因为阴血枯竭，如果脉搏摸不到，也是死证。我诊治过两位虚损病人，都是上面咳嗽、下面遗精滑泄，当遗精滑泄停止两三个月后，他们就去世了。这是因为遗精滑泄意味着阴阳失去了维系，虽然体内还有精微物质，但气还能勉强将其激发排出；如果停止了，按理说精神应当日渐旺盛，病症应当日渐好转，然而反而身体日益困顿，神气日益衰弱，脉象日益细弱，至数日益急促，且断续不均匀，早晚没有定数，这是阴阳偏废隔绝，没有气去激发那已经离根脱底的元气，仅在中焦微弱地萦绕而未完全消散罢了！所以咳嗽声日益低沉，呼吸日益短促，饮食有时进食有时减退，逐渐出现稍微活动就气喘，神魂不安宁。这个时候补脾会导致中焦胀满，补肺会导致上焦壅塞，而补肾与命门的真阴真阳，进行温养摄纳，引气归元，虽然是对症的方剂，却也是催命的符咒。为什么呢？因为下焦元气空虚没有主宰，五脏营运的气长久以来已不归其根本，一旦补药生效，中焦之气将向下运行，就像桶底脱落一样一去不复返了。孙一奎治疗马二尹因伤食误服大黄、芒硝、巴豆等重剂，尚未泻下，用六君子汤来救治，并说：担心他服药后，脾阳内动，各种药性发作，将会导致大泻不止，像瓶底漏水一样无法控制，必须准备几斤人参以预先防备。其中的机理正是与此相同。孔毓礼也说：痢疾停止但手足厥冷，脉象反而沉细无神，不能进食的，是死证。张仲景对于利止脉不出者，开出人参四逆汤，也是不忍心坐视不管，姑且尽力而为罢了。况且排泄物从浊道而出，又属于暴病，尚且如此，何况遗精是从生命之根流出，又在久病之后呢！
肝的生理特性，喜欢升发而厌恶沉降，喜欢疏散而厌恶收敛。《内经》说：肝苦急，应当吃辛味食物来疏散它，用辛味来补益它，用酸味来泄导它。肝被称为将军之官，胆附于肝，凡是十一脏的功能都取决于胆。李东垣说：胆木随春气升发，其余脏腑之气随之而动，所以凡是脏腑十二经的气化功能，都必须借助肝胆的气化功能来鼓舞，才能调畅而不生病。凡是疾病中的气结、血凝、痰饮、肿胀、鼓胀、痉厥、癫狂、积聚、痞满、眩晕、呕吐、呃逆、咳嗽、哮喘、血痹、虚损，都是由于肝气不能舒畅所致。或者是肝虚而力量不足以舒展，或者是肝郁而力量不得舒展，日久便导致气停血滞，水邪泛滥，火势内灼而外暴。其原因在于劳倦过度，损伤了中气，以及忧思不节制，损伤了神化功能；内伤饮食，外感寒湿，脾肺受困，肝必然受到牵连。所以凡是治疗暴病、痼疾，都必须参用和肝的方法。所谓和肝，就是舒展其郁结、开通其结滞；或者化瘀血，或者疏化痰饮，兼施升法与降法，肝气调和了，三焦的气化功能也就理顺了，百病有不随之而愈的吗？后世专门讲究平肝，不论什么病，都一律加入苦凉清降的药物，这是伐肝啊。殊不知肝气越郁结越逆乱，疏泄的本性横逆于中，实证则暴烈而上冲，虚证则折损而下陷，都有横悍逼迫之势而不可抵御，必须顺应其本性而舒散它，自然就会在无形中转化调和。如李东垣非常重视脾胃，必定远离肝木，他所指的药品，乃是防风、羌活、川芎、白芷等辛散的药物，即使是陈皮、厚朴，也多次强调要宣泄气机。这个意义难道不值得深思吗？朱丹溪号称善于使用苦寒药物，但意重在开郁，常用的药物，不外乎香附、川芎、白芷、半夏。这个意义难道更不值得深思吗？所以知道古人平肝的方法，是用芳香鼓舞，舒散以使之平和，而不是用白芍、枳壳等寒降药物来伐肝。那么肝盛的情况应当怎么办呢？回答说：肝盛固然应当泄导，难道百病都可以泄肝吗？医生善于调理肝脏，才是善于治疗百病。《内经》说：升降出入。又说：疏通其气使之调和。所以李东垣讲胃气，刘河间讲玄府，朱丹溪讲开郁，叶天士讲通络，都没有超出舒肝这一义理。所谓肝盛，是指风火自盛，升散的力量太过。后人常常把因郁结而上冲导致的头痛、头胀，认为是肝阳太旺；更有把遗精、白浊、烦躁、失眠等下陷的证候，指为肝阳太旺的，这不是很荒谬吗！
Zhang Zhongjing, in his discussion of Shaoyin disease in Shanghan Lun (Treatise on Cold Damage), states that if diarrhea stops but shallow breathing (Xi Gao) occurs, it is a death sign; if dizziness and vertigo occur, it is also a death sign. He further stated: In Huoluan (Cholera-like disorder), if diarrhea stops due to the exhaustion of blood (Wang Xue), and if the pulse cannot be felt, it is a death sign. I diagnosed two patients with Xu Sun (Deficiency Consumption). Both presented with coughing above and seminal emission below. After their seminal emissions stopped for two or three months, they died. This is because seminal emission indicates that Yin and Yang are failing to sustain each other. Although there is still essence present, Qi is still sufficient to stimulate its expulsion. If it stops, logically, spirit should become vigorous day by day, and symptoms should improve day by day. However, the body becomes increasingly debilitated, spirit increasingly declines, the pulse shape becomes increasingly thready, the rate becomes increasingly rapid, irregular and uneven, with no fixed pattern between morning and evening. This signifies the severance of Yin and Yang, where there is no Qi to stimulate the Yuan Qi (Original Qi) that has detached from its root, lingering weakly in the Middle Jiao without dissipating completely! Consequently, the cough sound becomes lower daily, respiration shorter daily, food intake fluctuates, and gradually, panting occurs upon slight movement, with unsettled spirit and mind. At this stage, tonifying Spleen causes fullness in the Middle Jiao, tonifying Lung causes congestion in the Upper Jiao. Tonifying Kidney and Mingmen (Gate of Life) with True Yin and True Yang, employing warming, nourishing, grasping, and receiving methods to guide Qi back to its origin, although these are appropriate formulas for the disease, they act as tokens of death. Why? Because the Yuan Qi in the Lower Jiao is empty and lacks a master, and the Qi operating within the five Zang organs has long failed to return to its root. Once the tonic medicine takes effect, the Qi in the Middle Jiao will descend, like the bottom falling out of a bucket, gone forever. Sun Yikui treated Ma Eryin, who suffered from food stagnation and mistakenly took heavy doses of Dahuang (Rhubarb Rhizome et Caudex), Mangxiao (Natrii Sulfas), and Badou (Crotonis Fructus). Before purgation occurred, he used Liujunzi Tang (Six Gentlemen Decoction) to rescue him, stating: "I fear that after taking the medicine, Spleen Yang will move internally, causing the properties of all medicines to activate, leading to uncontrollable severe diarrhea, like water leaking from the bottom of a bottle. One must prepare several jin of Renshen (Ginseng Radix et Rhizoma) in advance." The mechanism here is exactly the same. Kong Yuli also stated: "If dysentery stops but hands and feet are cold, the pulse becomes deep, thready, and devoid of spirit, and the patient cannot eat, it is a death sign." Zhang Zhongjing, for cases where diarrhea stops and the pulse is absent, prescribed Renshen Sini Tang (Ginseng and Aconite Decoction), not out of willingness to sit idle, but merely to do what one can. Since excretion comes from the turbid pathway and belongs to acute diseases, it is so dire; how much more so when seminal emission comes from the root of life, following chronic illness!
The nature of Liver prefers ascending and dislikes descending, prefers dispersing and dislikes constraining. The Classics state: "When Liver suffers from urgency, use pungent flavors to disperse it, use pungent flavors to tonify it, and use sour flavors to drain it." Liver is called the General, with Gallbladder attached to it; the functions of all eleven Zang-Fu organs depend on Gallbladder. Li Dongyuan said: "Wood of Gallbladder ascends with Spring Qi, and the Qi of other organs follows. Therefore, the Qi transformation of all twelve meridians of the Zang-Fu organs must rely on the Qi transformation of Liver and Gallbladder to be encouraged, so that they may flow smoothly and remain free from disease." All conditions involving Qi stagnation, Blood stasis, Phlegm-fluid retention, swelling, abdominal distension, spasms and convulsions, epilepsy and mania, accumulations and masses, epigastric fullness, dizziness, vomiting, hiccups, cough, asthma, Blood Bi syndrome, and deficiency consumption are caused by the inability of Liver Qi to flow freely. Whether due to Liver deficiency lacking strength to expand, or Liver constraint lacking ability to unblock, over time this leads to stagnant Qi and sluggish Blood, overflowing Water pathogens, and internal burning and external flaring of Fire. The cause lies in excessive labor and fatigue damaging Middle Qi, and unregulated worry and thought damaging Spirit transformation; internal injury from diet and external contraction of cold-dampness confine Spleen and Lung, inevitably affecting Liver. Thus, whether treating acute or chronic diseases, one must always incorporate methods to harmonize Liver. Harmonizing Liver means extending its depression and opening its knots; resolving Blood stasis or dispersing Phlegm, combining ascending and descending actions. When Liver is harmonized, the Qi transformation of Sanjiao (Triple Burner) is regulated, and all diseases will surely resolve. Later generations focused solely on "calming Liver," indiscriminately adding bitter-cool descending herbs to any disease, which is actually attacking Liver. Little do they know that the more constrained Liver Qi becomes, the more rebellious it grows; its nature of dispersion and drainage turns horizontal and violent in the center. Excess patterns surge violently upward; deficiency patterns collapse downward. Both possess a fierce, coercive momentum that cannot be resisted. One must follow its nature and soothe it, allowing natural transformation into nothingness. For instance, Li Dongyuan emphasized Spleen and Stomach, deliberately avoiding Wood of Liver. His chosen herbs were pungent-dispersing agents like Fangfeng (Saposhnikoviae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), and Baizhi (Angelicae Dahuricae Radix). Even Chenpi (Citri Reticulatae Pericarpium) and Houpo (Magnoliae Officinalis Cortex) were frequently cautioned against for their qi-draining properties. Is this meaning not worthy of deep reflection? Zhu Danxi was renowned for using bitter-cold herbs, yet his focus was on opening depression. His commonly used herbs were not beyond Xiangfu (Cyperi Rhizoma), Chuanxiong, Baizhi, and Banxia (Pinelliae Rhizoma). Is this meaning not even more worthy of reflection? Thus, we understand that the ancients' method of calming Liver involved aromatic encouragement and soothing to bring peace, not using Sour-descending herbs like Baishao (Paeoniae Radix Alba) and Zhike (Aurantii Fructus Immaturus) to attack it. So, what should be done for Liver Excess? It is said: Liver excess indeed requires draining, but can all diseases be treated by draining Liver? A physician skilled in regulating Liver is skilled in treating all diseases. The Neijing states: "Ascending, descending, exiting, entering." And again: "Unclog its Qi to make it harmonious." Therefore, Li Dongyuan's discussion of Stomach Qi, Liu Wansu's discussion of Xuanfu (Mysterious Gates), Zhu Danxi's discussion of opening depression, and Ye Tianshi's discussion of unblocking collaterals, none exceed the principle of soothing Liver. What is meant by Liver Excess is that Wind and Fire flourish naturally, and the power of ascending and dispersing is excessive. Later practitioners often mistake headache and head distension caused by constraint and upward surging as Hyperactive Liver Yang. Moreover, pointing to sinking syndromes such as seminal emission, leukorrhea, irritability, and insomnia as Hyperactive Liver Yang is indeed absurd!