乡人李信道得疾，六脉沉不见，深按至骨，则若有力。按∶周本“若”字作“弦紧”。
头痛
，身温，烦躁，指末皆冷，中满恶心，两更医矣。医皆不识，止供调气药。予因诊视曰∶此
阴中伏阳也。仲景法中无此证，世人患此者多。若用热药以助之，则为阴邪隔绝，不能导引
真阳，反生客热；若用冷药，则所伏真火，愈见消烁。须用破散阴气，导达真火之药，使火
升水降，然后得汗而解。授破阴丹二百粒，作一服，冷盐汤下。不半时，烦躁狂热，手足躁
扰按∶周本“躁”作“燥”。其家大惊。予曰∶此俗所谓换阳也，无恐。须臾稍定，略睡，
已中汗矣。自昏达旦方止，身凉而病除。硫黄、水银、陈皮、青皮四味，面丸，冷汤下，名
破阴丹。
(篇中所援诸论，并出张石顽《医通》)
《内经》云∶阴盛生内寒，阴虚生内热。其证候不同矣。阴虚之脉，数散而涩；阴盛之
脉，
迟紧而涩。其脉象不同矣。阴虚宜甘润填阴，阴盛宜辛温振阳。其治法更不同矣。况阴盛格
阳于外，与阴虚阳越于外，其机括尤不同也。阴踞于内，升降不调，阳欲内返而不得，此阴
力之能格阳也；阴虚不能维阳，无根之阳不能内返，游弋于外，此微阳之自外越也。而前贤
每以脉浮而大，按之无力，为阴寒内盛之脉；以面热戴阳，烦躁不安，为阴寒内盛之证。喻
嘉言所讥为传派不清者也，殊不知此正阴虚阳越之事。其治宜温润填阴以安阳，无大热温经
以回阳也。至于脉沉细而疾，渴欲饮水，烦躁闷乱，此阴痼于外，阳怫于内之象也，而曰阴
盛格阳，水极似火，不亦误乎?即用热剂，如许氏之破阴，亦彻外阴以透伏阳，岂驱逐伏阴
之谓乎?若夫所谓内外有热，其脉沉伏，不洪不数，但指下沉涩而小急，此为伏热，不可误
认虚寒，以温热治之，是益其热也。此又阴虚而阳气下陷，入于阴中，所谓荣竭卫降者也，
与上文阴盛阳郁之证，又自霄壤。大抵阴盛于内，为内实，其脉象决无按之反芤者，非牢即
坚，即细紧耳!惟阴虚者，精血内空，阳气外迫，其脉则浮大而芤矣。第阴盛之人，有阳虚
，有阳不虚；阴虚之人，有阳盛，有阳不盛。从阴引阳，从阳引阴，喻嘉言有三分七分、昼
服夜服之论矣。此专就虚劳一病言之也。若寻常杂病，只于本病对治剂中，用药略有偏寒偏
热、兼升兼降、重散重敛之不同耳!即如阴盛之人，阳虚者，直用温经回阳矣；阳不虚者，
用温化之药，加以微苦微酸，清肃浮阳，使之内合也。阴虚之人，阳盛者，是内热也，宜甘
润咸润以填阴，佐以参、 、升、柴补气建中之品，提挈阳气出返阳位也；阳不盛者，即浮
阳外越也，宜温润兼补脾肾，酸辛并用可矣。此内伤治法之大略也。总宜审察脉象，以决病
机，无惑于重按全无是为伏阴之说，庶不致寒热攻补之倒施耳!
东垣治一人脚漆痿弱，下尻臀皆冷，阴汗臊臭，精滑不固，脉沉数有力，是火郁于内，
逼阴
于外也。精不固者，髓中混以湿热也。小柴胡去参，加茯苓、胆草、黄柏苦寒泻之而愈。
节庵治一壮年，夏间劳役后，食冷物，夜卧遗精，遂发热，痞闷。至晚，头额时痛，火
热上
乘也；两足不温，脾气不下也。医谓外感夹阴，以五积散汗之，烦躁，口渴，目赤，便秘。
明
日，以承气下之，但有黄水，身强如痉，烦躁更剧，腹胀喘急，舌苔黄黑，已六七日矣。诊
其脉，六七至而弦劲，急以黄龙汤，下黑物甚多，腹胀顿宽，烦躁顿减，但夜间仍热，舌苔
未尽，更与解毒汤，合生脉散，加地黄，二剂热除，平调月余而安。
同乡人李信道患病，六脉沉伏不见，深按至骨时，感觉脉搏有力。按：周本中“若”字写作“弦紧”。症状表现为头痛，身体温热，烦躁不安，手指末端发冷，胸脘痞满且恶心呕吐，两位医生诊治后均无法确诊，只给予调理气机的药物。我因此诊视后说：这是阴中伏阳证。张仲景的医法中没有记载这种证候，但世人患此病者很多。如果使用热药来助长阳气，会导致阴邪隔绝，不能引导真阳回归，反而产生客热；如果使用冷药，则会使潜伏的真火更加消损耗竭。必须使用能破散阴气、引导通达真火的药物，使火升水降，然后才能通过出汗而痊愈。我传授了二百粒破阴丹，一次性服用，用冷的盐汤送服。不到半小时，患者出现烦躁狂热，手足躁动不安（按：周本中“躁”作“燥”）。他的家人非常惊恐。我说：这就是俗话所说的“换阳”，不要害怕。片刻之后症状稍定，略睡一觉，已经全身出汗了。从黄昏持续到天亮才停止，身体变凉，疾病痊愈。破阴丹由硫黄、水银、陈皮、青皮四味药组成，制成面丸，用冷汤送服。
（篇中所引用的各种论述，都出自张石顽的《医通》）
《内经》说：阴盛产生内寒，阴虚产生内热。它们的证候是不同的。阴虚的脉象，数散而涩；阴盛的脉象，迟紧而涩。它们的脉象特征不同。阴虚适宜用甘润之品填补阴液，阴盛适宜用辛温之品振奋阳气。它们的治疗方法更是不同。况且阴盛格拒阳气于外，与阴虚导致阳气外越于外，其发病机理尤其不同。阴气盘踞在内，升降失调，阳气想要内返却做不到，这是阴气之力能够格拒阳气的原因；阴虚不能维系阳气，无根之阳气不能内返，游荡于体外，这是微弱的阳气自然从外部外越的表现。然而前贤常常将脉浮大而按之无力，当作阴寒内盛的脉象；将面部发热、戴阳、烦躁不安，当作阴寒内盛的证候。这被喻嘉言讥讽为传承派系不清，殊不知这正是阴虚阳越的情况。对此的治疗应当用温润之品填补阴液以安定阳气，而不是用大热的药物温经回阳。至于脉象沉细而快，口渴想喝水，烦躁闷乱，这是阴气固结于外，阳气郁闭于内的征象，却说这是阴盛格阳、水极似火，不也是错误的吗？即使使用热剂，如许叔微的破阴丹，也是彻除外阴以透发伏阳，哪里是驱逐伏阴的意思呢？至于所谓的内外有热，脉象沉伏，不洪大也不数急，只是指下感觉沉涩而小急，这是伏热，不可误认为虚寒，用温热药治疗，这会加重热势。这又是阴虚而阳气下陷，进入阴分，所谓营血枯竭、卫气下降的情况，与上文所述的阴盛阳郁证，又相差甚远。大抵阴盛于内，属于内实，其脉象绝不会按之反见芤象，不是牢脉就是坚脉，或者是细紧脉！只有阴虚的人，精血内部空虚，阳气逼迫向外，其脉象才会浮大而芤。不过，阴盛的人，有的伴有阳虚，有的阳气不虚；阴虚的人，有的伴有阳盛，有的阳气不盛。从阴引阳，从阳引阴，喻嘉言有关于三分七分、昼服夜服的论述，但这专门是针对虚劳这一种病而言的。如果是寻常杂病，只需在本病的对治方剂中，用药略有偏寒偏热、兼升兼降、重散重敛的不同罢了！就像阴盛的人，如果阳气虚，直接温经回阳即可；如果阳气不虚，用温化药物，加上微苦微酸的药物，清肃浮阳，使其内合。阴虚的人，如果阳气盛，这是内热，适宜用甘润咸润之品填补阴液，佐以人参、白术、升麻、柴胡等补气建中的药物，提挈阳气返回阳位；如果阳气不盛，就是浮阳外越，适宜温润兼补脾肾，酸辛并用就可以了。这是内伤治疗方法的概要。总宜审察脉象，以决断病机，不被“重按全无就是伏阴”的说法所迷惑，这样才不会导致寒热攻补的错误施用。
东垣治疗一个人脚膝痿弱，下尻臀部皆冷，阴汗臊臭，精滑不固，脉象沉数有力，这是火郁于内，逼迫阴气外泄所致。精气不固，是因为髓中混杂了湿热。用小柴胡汤去掉人参，加茯苓、龙胆草、黄柏苦寒泻火而痊愈。
节庵治疗一位壮年男子，夏季劳累后，吃了生冷食物，夜间睡觉遗精，随即发热，胸脘痞闷。到了晚上，头额时常疼痛，这是火热上冲；两足不温暖，这是脾气不下降。医生认为是外感夹阴，用五积散发汗，导致烦躁、口渴、目赤、便秘。第二天，用承气汤攻下，只排出黄色水样便，身体僵硬如痉病，烦躁更剧烈，腹胀喘急，舌苔黄黑，已经六七天了。诊察他的脉象，一息六七至且弦劲有力，急忙用黄龙汤攻下，排出黑色粪便很多，腹胀顿时缓解，烦躁顿时减轻，但夜间仍然发热，舌苔未尽，再给解毒汤，合生脉散，加地黄，两剂后热退，平调月余而安。
A fellow townsman, Li Xindao, fell ill. His six pulses were deep and imperceptible; upon pressing deeply to the bone, they felt forceful. Note: In Zhou's edition, the character "ruo" (if/seeming) is written as "xian jin" (wiry and tight). Symptoms included headache, warm body, irritability, cold fingertips, epigastric fullness, and nausea. Two physicians had treated him but failed to identify the condition, prescribing only Qi-regulating herbs. Upon examination, I said: This is a syndrome of Yang hidden within Yin (Yin Zhong Fu Yang). This syndrome is not recorded in Zhang Zhongjing's methods, yet many people suffer from it today. If hot-natured herbs are used to assist Yang, it will cause Yin pathogens to block the pathway, preventing the guidance of True Yang, and instead generating external heat (Ke Re); if cold-natured herbs are used, the hidden True Fire will be further depleted. It is necessary to use herbs that break up Yin Qi and guide/activate True Fire, allowing Fire to rise and Water to descend, so that resolution through sweating can occur. I prescribed two hundred pills of Po Yin Dan (Break Yin Pill), to be taken at once, with cold salt water. Within half an hour, the patient became irritable and feverish, with restless limbs (Note: In Zhou's edition, "zao" [restless] is written as "zao" [dry]). His family was greatly alarmed. I said: This is what laypeople call "changing Yang" (Huan Yang); do not fear. After a short while, symptoms subsided slightly, he slept briefly, and then broke into sweat. This continued from dusk until dawn, after which his body cooled and the illness resolved. Po Yin Dan consists of four ingredients: Huangqi (Sulfur), Shuiyin (Mercury), Chenpi (Tangerine Peel), and Qingpi (Green Tangerine Peel), made into pills with flour, taken with cold water.
(The various arguments cited in this chapter are all derived from Zhang Shiwan's *Yi Tong*.)
The *Neijing* states: Excess Yin generates internal cold; Yin deficiency generates internal heat. Their clinical manifestations differ. The pulse of Yin deficiency is rapid, scattered, and choppy; the pulse of Yin excess is slow, wiry/tight, and choppy. Their pulse characteristics differ. Yin deficiency should be treated with sweet and moistening herbs to tonify Yin; Yin excess should be treated with pungent and warm herbs to invigorate Yang. Their treatment methods are even more distinct. Moreover, the mechanism of Yin excess repelling Yang to the exterior differs significantly from Yin deficiency causing Yang to float outward. When Yin occupies the interior, disrupting ascending and descending functions, Yang desires to return inward but cannot; this is the power of Yin to repel Yang. When Yin is deficient and cannot sustain Yang, rootless Yang cannot return inward and wanders outside; this is the natural floating outward of weak Yang. However, former experts often regarded a floating and large pulse that feels empty upon pressure as indicative of severe internal Yin-cold; and facial flushing, Dai Yang (floating Yang), and irritability as signs of severe internal Yin-cold. Yu Jiayan criticized this view as unclear lineage transmission, unaware that this is precisely the case of Yin deficiency with floating Yang. The appropriate treatment is to use warm and moistening herbs to fill Yin and calm Yang, rather than using intensely hot herbs to warm meridians and restore Yang. As for cases where the pulse is deep, fine, and rapid, accompanied by thirst, irritability, and confusion, these are signs of Yin stagnating externally and Yang being constrained internally. To label this as Yin excess repelling Yang or "water extreme resembling fire" is erroneous. Even when using hot formulas, such as Xu's Po Yin Dan, the intent is to clear external Yin to reveal hidden Yang, not to expel hidden Yin. Regarding cases described as having internal and external heat, with a deep and hidden pulse that is neither surging nor rapid, but feels deep, choppy, small, and urgent upon palpation, this is hidden heat. It must not be mistaken for deficiency-cold and treated with warm-hot herbs, as this would exacerbate the heat. This scenario involves Yin deficiency with sinking Yang entering the Yin level, known as exhaustion of Ying (Nutritive Qi) and descent of Wei (Defensive Qi). This is worlds apart from the Yin-excess Yang-constraint syndrome mentioned above. Generally, Yin excess in the interior constitutes internal excess; its pulse will never feel hollow (Kou) upon pressure, but will be firm (Lao), hard (Jian), or fine and wiry (Xi Jin). Only in Yin deficiency, where essence and blood are empty internally and Yang is forced outward, does the pulse become floating, large, and hollow. Furthermore, among those with Yin excess, some have Yang deficiency, while others do not; among those with Yin deficiency, some have Yang excess, while others do not. Yu Jiayan proposed theories on drawing Yang from Yin and Yin from Yang, including proportions and timing of administration, but these specifically apply to consumptive diseases (Xu Lao). For ordinary miscellaneous diseases, one merely adjusts the primary formula with slight biases toward cold/hot, ascending/descending, dispersing/astringing, etc. For instance, in Yin excess patients with Yang deficiency, direct warming of meridians and restoration of Yang is used; if Yang is not deficient, warming-transforming herbs are combined with slightly bitter and sour herbs to clear and settle floating Yang, guiding it inward. In Yin deficiency patients with Yang excess, this indicates internal heat, treated with sweet/moist and salty/moist herbs to fill Yin, assisted by Ginseng, Atractylodes, Bupleurum, and Cimicifuga to tonify Qi and build the center, lifting Yang back to its proper position. If Yang is not excessive, it represents floating Yang escaping outward, treated with warm-moistening herbs that tonify Spleen and Kidney, combining sour and pungent flavors. These are the general principles for treating internal injury. One must carefully examine the pulse to determine the pathogenesis, avoiding confusion caused by the notion that "a pulse disappearing completely upon heavy pressure indicates hidden Yin," thereby preventing the misapplication of cold/hot or attacking/tonifying therapies.
Dong Yuan treated a patient with flaccidity of the legs and knees, coldness in the lower buttocks, foul-smelling genital sweating, and seminal emission without retention. The pulse was deep, rapid, and forceful. This indicated Fire constrained internally, forcing Yin outward. The seminal instability was due to damp-heat mixing in the marrow. He treated this with Xiao Chai Hu Tang (Minor Bupleurum Decoction), removing Ren Shen (Ginseng), adding Fu Ling (Poria), Long Dan Cao (Gentian Root), and Huang Bai (Phellodendron Bark) to drain with bitter-cold herbs, resulting in recovery.
Jie An treated a young man who, after summer labor and consuming cold food, experienced nocturnal emission followed by fever and chest/epigastric stuffiness. By evening, he suffered intermittent frontal headaches, indicating Fire rising upward; his feet were cold, indicating Spleen Qi failing to descend. Physicians diagnosed external contraction complicated by Yin involvement and administered Wu Ji San (Five Accumulations Powder) to induce sweating, leading to irritability, thirst, red eyes, and constipation. The next day, Cheng Qi Tang (Order the Qi Decoction) was used to purge, yielding only yellow fluid. The patient developed rigidity resembling spasm, worsened irritability, abdominal distension, wheezing, and yellow-black tongue coating, persisting for six or seven days. Palpation revealed a pulse rate of 6-7 beats per breath, wiry and forceful. Urgently, Huang Long Tang (Yellow Dragon Decoction) was administered, evacuating much black stool. Abdominal distension immediately eased, and irritability decreased. However, fever persisted at night, and the tongue coating remained. Jie An then prescribed Jie Du Tang (Detoxification Decoction) combined with Sheng Mai San (Generate the Pulse Powder), adding Di Huang (Rehmannia Root). After two doses, the fever subsided. The patient recovered after a month of balanced regulation.