前人皆谓∶富贵之病利用补，贫贱之人利用攻。初未临诊之时，亦深以此语为数，乃至
今而
觉其非也。富贵之人，安居浓奉，脏腑经络，莫不痰涎胶固，气机凝滞，不能流通，故邪气
据之而不得去者，非正气之不足，乃正气之不运也。治之宜重用攻散，且气血充裕，能任攻
散者，正此辈也；若重之以补，是益之滞矣。贫贱之人，藜藿不充，败絮不暖，四时力作，
汗液常泄，荣虚卫散，经脉枯槁。及至有病，初起隐忍，劳役不辍，势至重困，乃始求医，
故其邪气之不去者，非正气之不运，实正气之不足也。治之须助正气，正气一充，其气机之
流利，自能鼓舞驱邪，非似富贵安逸者之气滞，必待重施攻散也。吾每诊贫贱力食之人，病
脉或粗大挺硬，或短弱细微，起伏总是无力，应指总是少神，求似富贵之脉之洪滑搏结者，
殊
不多觏也。盖富病属气血之郁滞，贫病属气血之匮乏。若谓筋骨柔脆与坚强之不同也，此在
无病时则然耳!每治贫病，佐以参、术、归、地，其效甚捷。此无他故也，地瘠者易为溉，
气滑者易为滋也。《内经》曰∶形苦志乐，病生于筋，治之以熨引。是温助其气而运之，形
已苦者，不得复开泄也。形乐志乐，病生于肉，治之以针石；形乐志苦，病生于脉，治之以
灸刺。是形乐者，皆有血实决之之义也。若攻苦之士，家徒四壁，谋道谋食，百计经营，此
又不得与膏粱酣豢者同论矣。故形苦志苦，病生于困竭，治之以甘药，谓表里荣卫俱不足也
。形苦宜补，形乐宜泻，不校然可睹耶!
前人皆认为：富贵之人的疾病适宜用补法，贫贱之人的疾病适宜用攻法。在未亲自临诊之前，我也常常将此话挂在嘴边，但直到今天才发觉这种说法是错误的。
富贵之人，生活安逸，饮食肥甘厚味，其脏腑经络中，无不有痰涎胶结固着，气机凝滞不通，无法流通。因此，邪气盘踞其中而不得去除，并非正气虚弱，而是正气运行不畅所致。治疗时应当重用攻散之法，而且他们气血充裕，能够承受攻散之法，正是这类人；如果反而加重补益，则是使他们的病情更加壅滞了。
贫贱之人，饮食粗劣不足，衣着破烂不暖，四季辛勤劳作，汗液经常外泄，导致营血虚少，卫气涣散，经脉枯槁。等到生病时，起初隐忍痛苦，不停止劳役，直到病情严重困顿，才开始求医。所以他们邪气不去除，并非正气运行不畅，实在是正气不足所致。治疗时必须扶助正气，正气一旦充盈，其气机的流利，自然能鼓舞身体驱除邪气，不像富贵安逸者那样气机阻滞，必须等待重施攻散之法。
我每次诊治贫贱体力劳动者，发现他们的病脉或粗大挺硬，或短弱细微，起伏总是无力，按指之下总是缺乏神气，想要找到类似富贵之人那种洪大滑利搏结的脉象，是非常少见的。大概富人之病属于气血的郁滞，贫贱人之病属于气血的匮乏。如果说筋骨柔脆与坚强不同，这只是在没有生病的时候罢了！
每次治疗贫贱病人的疾病，辅以人参、白术、当归、地黄，疗效非常迅速。这没有其他原因，是因为土地贫瘠容易灌溉，气机滑利容易滋养。《内经》说：形体劳苦而精神快乐，病生于筋，用熨法和导引法治疗。这是温助其气并推动它运行，形体已经劳苦的，不能再开泄发散。形体安乐而精神快乐，病生于肉，用针石治疗；形体安乐而精神苦恼，病生于脉，用灸刺治疗。这是形体安乐的人，都有血实宜决（泻）的含义。如果是攻苦之士，家徒四壁，谋求生计，百计经营，这又不能与吃膏粱厚味酣畅豢养的人同论了。所以形体劳苦且精神也劳苦，病生于困竭，用甘药治疗，这是因为表里荣卫都不足。形体劳苦适宜补益，形体安乐适宜泻法，这不明显可见吗！
Predecessors all held that: diseases of the rich and noble are suitable for tonification, while diseases of the poor and lowly are suitable for purgation. Before personally attending to clinical cases, I also often cited this saying as a rule, but only now do I realize it is incorrect.
The rich and noble live in comfort and consume rich foods; their Zang-Fu organs and meridians invariably have phlegm-fluids (Tan-Yan) firmly adhering and stagnating, causing Qi mechanism (Qi-Ji) to be blocked and unable to circulate freely. Therefore, when pathogenic factors (Xie-Qi) occupy these areas and cannot be expelled, it is not due to a deficiency of Zheng-Qi (Upright Qi), but rather due to the failure of Zheng-Qi to move. Treatment should heavily employ dispersing and attacking methods. Moreover, since their Qi and Blood are abundant, they can tolerate such aggressive treatments; this group precisely fits this description. If one were to add heavy tonification instead, it would only increase their stagnation.
The poor and lowly suffer from inadequate coarse food and insufficient warm clothing. They engage in strenuous labor throughout the four seasons, with sweat frequently escaping, leading to a deficiency of Ying-Blood (Nutritive Blood) and dispersion of Wei-Qi (Defensive Qi), resulting in withered meridians. When illness strikes, they initially endure it silently without ceasing work, seeking medical help only when the condition becomes critically severe. Thus, the reason their pathogenic factors remain is not because Zheng-Qi fails to move, but truly because Zheng-Qi is deficient. Treatment must assist Zheng-Qi; once Zheng-Qi is replenished, the smooth flow of Qi mechanism will naturally inspire the body to drive out pathogens, unlike the Qi stagnation seen in those living in luxury who require heavy dispersing and attacking therapies.
Whenever I diagnose the pulse of the poor engaged in physical labor, the disease pulse may be coarse, large, and rigid, or short, weak, and minute; its rising and falling is always powerless, and upon palpation, it always lacks Shen-Spirit (Vitality). It is extremely rare to encounter pulses resembling those of the rich—large, slippery, and knotted. Generally, diseases of the rich belong to Qi and Blood stagnation, while diseases of the poor belong to Qi and Blood insufficiency. The argument that bones and sinews differ in fragility versus strength applies only when one is free of disease!
When treating illnesses among the poor, I supplement with Ren-Shen (Ginseng Root), Bai-Zhu (Atractylodes Rhizome), Dang-Gui (Angelica Sinensis Root), and Di-Huang (Rehmannia Root). The efficacy is very rapid. There is no other reason than this: barren land is easy to irrigate, and slippery Qi is easy to nourish. The *Nei Jing* (Inner Canon) states: "When the form is bitter [hardworking] and the mind is happy, disease arises in the sinews; treat with warming compresses and guiding exercises." This warms and assists Qi to promote its movement. For those whose form is already bitter [hardworking], one must not again use opening and draining methods. "When the form is comfortable and the mind is happy, disease arises in the flesh; treat with needles and stones [acupuncture]. When the form is comfortable and the mind is bitter [stressed], disease arises in the vessels; treat with moxibustion and acupuncture." This implies that those whose form is comfortable have blood excess requiring drainage. However, scholars who endure hardship, with empty homes, striving for both the Way and sustenance through myriad efforts, cannot be discussed on the same level as those indulging in rich meats and grains. Therefore, when both form and mind are bitter [hardworking/stressed], disease arises from exhaustion; treat with sweet medicines, indicating that the exterior and interior, Ying and Wei are all deficient. Form that is bitter requires tonification; form that is comfortable requires purgation. Is this not clearly observable?