阳旺未有不胜阴者，其阳旺而阴生，必剂中有阴药之为引导。若人参本具生津益气之大
力，
与肉桂、附子纯阳者迥别，其益阴，本不得谓之阳旺之功也。至于真火衰歇，沉阴冱寒，津
气因寒不得敷布，发为烦渴；精血因寒不得充壮，发为枯瘦；渣滓因寒不得运动，发为秘结
，以姜、桂、萸、附补益真阳，遂能蒸动津液，宣化水精，使五脏百脉为之充润也。此阳旺
而阴始化，非阳旺而阴自生也。又有暴病，阴盛格阳，寒结于内，热浮于上，烦躁，狂妄，
谵语，喘促，以桂、附开其下寒，而虚火遂返其宅者，此亦阴化，非阴生也。且皆以其阴盛
，而益阳以胜之，使归于和平，非以阴少，而益阳以助之也。岂真有精枯血燥，虚火亢炎，
而桂，附能以独力致阴消火者乎?必用阴药而资桂、附熏蒸鼓舞之力也。《内经》谓∶辛能
开腠理，通气致津液，其所谓“致”，是自此而之彼，非自无而之有；是熏蒸、鼓舞、宣通
、敷布之谓，非包涵、孕育、滋长、增益之谓也。前人措词过当，每多如此，其病根总由于
语欲惊人也。后人习为常谈，漫不加察，贻误匪浅，故敢正之。
吴又可谓∶黄连性寒不泄，只能制热，不能泄实；若内有实邪，必资大黄以泄之，否则
畏大
黄之峻，而徒以黄连清之，反将热邪遏住，内伏益深，攻治益难。此义甚精。凡治病，总宜
使邪有出路。宜下出者，不泄之不得下也；宜外出者，不散之不得外也。近时于温热证，喜
寒清而畏寒泄；于寒湿证，喜温补而畏温通。曾闻有患痰饮者，久服附子，化为 肿，是不
用茯苓、猪苓之苦降淡渗以导邪，而专益其阳，阳气充旺，遂鼓激痰水四溢矣，即补而不泄
之过也。张子和变化于汗、吐、下之三法，以治百病。盖治病非三法不可也，病去调理，乃
可专补，补非所以治病也。且出路又不可差也。近时治病，好用利水，不拘何病，皆兼利小
便，此误会前人治病以小便通利为快捷方式之说也。尝有患痰饮而 肿者，医以真武、五苓合与
之，不效。余曰∶此因三焦阳气不得宣通于表，表气郁而里气始急也。虽有痰饮，并不胀满
，
宜以温补合辛散，不得合淡渗也。治之果汗出而愈，渗之是益伤其里矣。当时有谓∶须泄虚
其里，使表水退返于里以泄之，而后可愈者，是真杀之也。前人有用此法者，是邪伏里膜，
非在肤表也。虚其肠胃，俟里膜之邪复聚于肠胃，然后从而竭之。如吴又可所谓；俟膜原热
邪复淤到胃，再用下法是也。盖肿，表证也，为风，为寒湿，其证动而后喘，法宜散之；胀
，里证也，为湿热里盛，脾实肝滞，木郁土中，其证不待动而自喘，法宜泄之；肿胀兼有，
散之、泄之。未有肤肿而反泄之，使陷入于里者也。
阳气旺盛，没有不能胜过阴气的。但是，如果要在阳气旺盛的情况下使阴气滋生，方剂中必须有滋阴药物作为引导。人参本来具有生津液、益元气的强大功效，这与肉桂、附子等纯阳之药截然不同。人参的益阴作用，根本不能称为是阳气旺盛的功效。至于真火（肾阳）衰微，沉寒积冷，津液和元气因为寒冷而不能布散，导致烦渴；精血因为寒冷而不能充盈壮大，导致枯瘦；糟粕因为寒冷而不能运动，导致便秘。此时用干姜、肉桂、山茱萸、附子来补益真阳，就能蒸腾动化津液，宣发转化水谷精微，使五脏和全身血脉得到充润。这是阳气旺盛而阴气才开始化生，并非阳气旺盛而阴气自然产生。又有突发疾病，阴气极盛格拒阳气，寒气结聚于体内，热气浮越于上部，出现烦躁、狂妄、胡言乱语、气喘急促等症状。此时用肉桂、附子开通下焦的寒邪，虚火就会返回其本位。这也是阴气的化生，而非阴气的产生。而且这些都是因为阴气过盛，所以通过补益阳气来战胜阴邪，使其恢复平衡，并不是因为阴气不足，才通过补益阳气来助长它。难道真有精血枯竭、血液燥热、虚火亢盛炎上的情况，单靠肉桂、附子就能独自消除阴邪、平息火势的吗？必须使用滋阴药物来资助肉桂、附子的熏蒸鼓舞之力。《黄帝内经》说：辛味能开泄腠理，通畅气机以输送津液。这里所说的“致”，是指津液从此处到达彼处，而不是从无到有；是指熏蒸、鼓舞、宣通、布散的意思，而不是包涵、孕育、滋长、增益的意思。前人措辞过于夸张，大多如此，其病根总在于言语想要惊世骇俗。后人习以为常，不加考察，贻误不浅，所以我敢于纠正这一点。
吴又可曾说：黄连性寒但不具有泻下的作用，只能制约热邪，不能泻除实邪；如果体内有实邪，必须依靠大黄来泻下，否则畏惧大黄的峻猛，而仅仅用黄连清热，反而会将热邪遏制住，使其在体内潜伏得更深，治疗更加困难。这个观点非常精妙。凡是治病，总应该让邪气有出路。应当从大便排出的，如果不泻下就不能排出；应当从体表排出的，如果不发散就不能外出。近来治疗温热病证，喜欢用寒凉清热而畏惧寒凉泻下；治疗寒湿病证，喜欢用温补而畏惧温通。曾听说有患痰饮病的患者，长期服用附子，结果变成了水肿。这是因为没有使用茯苓、猪苓的苦降淡渗之品来引导邪气外出，而专门补益阳气，导致阳气充盛旺盛，于是鼓动激荡痰水四溢，这就是只补不泻的过错。张子和在汗、吐、下三法上有所变化，用来治疗各种疾病。大概治病非用这三法不可，病邪去除后进行调理，才可以专门进补，补益并不是用来治病的方法。而且出路也不能搞错。近来治病，喜欢好用利小便的方法，不管什么病，都兼用利小便，这是对前人治病以小便通利为快捷方式这一说法的误解。曾经有患痰饮并伴有水肿的患者，医生将真武汤和五苓散合在一起给他服用，没有效果。我说：这是因为三焦阳气不能在体表宣通，表气郁滞导致里气紧迫。虽然有痰饮，但并不胀满，应该用温补配合辛散的方法，不能配合淡渗利尿的方法。治疗果然出汗后痊愈，如果用渗利之法，只会进一步损伤里气。当时有人主张：必须泻下以空虚里气，使体表的积水退回体内再行泻下，这样才可以痊愈，这简直是杀人。前人有使用这种方法的情况，是因为邪气潜伏在膜原（半表半里之间），并不在肤表。通过空虚肠胃，等待膜原的邪气重新聚集到肠胃，然后趁机彻底清除。就像吴又可所说的：等到膜原的热邪重新淤积到胃，再用泻下法。大概水肿属于表证，由风邪、寒湿引起，症状表现为活动后气喘，治法宜发散；胀满属于里证，由湿热内盛、脾实肝滞、木郁土中引起，症状表现为不待活动就气喘，治法宜泻下；肿胀同时存在，则发散与泻下并用。从来没有皮肤浮肿却反而用泻下法，使邪气陷入体内的道理。
Yang qi being vigorous has never failed to overcome yin. However, if one wishes for yin to generate under the condition of vigorous yang, the prescription must contain yin-nourishing herbs as guides. Ren Shen (Ginseng Radix) inherently possesses great power to generate body fluids and benefit primordial qi, which is distinctly different from Rou Gui (Cinnamon Twig) and Fu Zi (Aconite Lateralis Radix Praeparata), which are purely yang in nature. Its ability to benefit yin cannot be attributed to the merit of vigorous yang. As for cases where the True Fire (Kidney Yang) is declining and sinking, with deep cold freezing the interior, body fluids and primordial qi fail to distribute due to cold, resulting in irritability and thirst; essence and blood fail to become abundant and strong due to cold, resulting in emaciation and dryness; waste materials fail to move due to cold, resulting in constipation. By using Jiang (Zingiberis Rhizoma), Rou Gui (Cinnamon Twig), Yu Zhu (Corni Fructus), and Fu Zi (Aconite Lateralis Radix Praeparata) to tonify the True Yang, one can vaporize and activate body fluids, disseminate and transform water essences, thereby moistening and nourishing the five zang organs and all vessels. This is yang becoming vigorous so that yin begins to transform, not yang becoming vigorous so that yin generates itself. There are also acute diseases where excessive yin repels yang, with cold knotting internally and heat floating externally, presenting with irritability, madness, delirious speech, and panting. By using Rou Gui (Cinnamon Twig) and Fu Zi (Aconite Lateralis Radix Praeparata) to open the lower cold, the deficient fire returns to its residence. This is also the transformation of yin, not the generation of yin. Moreover, these situations involve benefiting yang to overcome excessive yin, restoring balance, rather than benefiting yang to assist because yin is insufficient. Can it truly be that in cases of exhausted essence and dry blood with hyperactive deficient fire, Rou Gui (Cinnamon Twig) and Fu Zi (Aconite Lateralis Radix Praeparata) alone can eliminate yin and extinguish fire? Yin-nourishing herbs must be used to support the vaporizing and stimulating power of Rou Gui (Cinnamon Twig) and Fu Zi (Aconite Lateralis Radix Praeparata). The *Neijing* states: "Pungent flavors can open the cou li (skin pores and interstices), unblock qi mechanism, and deliver body fluids." The term "deliver" here means moving from here to there, not creating something from nothing; it refers to vaporizing, stimulating, disseminating, and distributing, not encompassing, conceiving, nourishing, or increasing. Predecessors often used exaggerated wording, rooted in a desire to shock people. Successors have taken this as common talk without scrutiny, causing significant harm, so I dare to correct this.
Wu Youke stated: Huang Lian (Coptidis Rhizoma) is cold but does not purge; it can only restrain heat but cannot drain excess. If there is excess pathogen inside, Da Huang (Rhei Radix et Rhizoma) must be relied upon to purge it; otherwise, fearing the harshness of Da Huang (Rhei Radix et Rhizoma) and merely using Huang Lian (Coptidis Rhizoma) to clear heat will instead suppress the heat pathogen, causing it to hide deeper within, making treatment more difficult. This insight is profound. In treating any disease, one should always provide an exit for the pathogen. What should exit via defecation cannot be discharged without purging; what should exit via sweating cannot be released without dispersing. Recently, in treating warm-heat syndromes, physicians prefer cold clearing but fear cold purging; in treating cold-damp syndromes, they prefer warm tonification but fear warm unblocking. I once heard of a patient with Tan Yin (Phlegm-Rheum) who took Fu Zi (Aconite Lateralis Radix Praeparata) for a long time and developed edema. This was because Ku Jiang Dan Shen (Pinelliae Rhizoma Preparatum) and Zhu Ling (Polyporus) were not used for their bitter descending and bland leaching properties to guide the pathogen out, but rather yang was solely tonified. The resulting vigorous yang qi stirred up phlegm-fluids, causing them to overflow. This is the fault of tonifying without draining. Zhang Hezi varied the three methods of sweating, vomiting, and purging to treat hundred diseases. Treating diseases essentially requires these three methods; only after the pathogen is removed can one focus on tonification for recovery. Tonification is not the method for eliminating disease. Furthermore, the exit route must not be mistaken. Recently, physicians love using diuretics indiscriminately for any disease, misunderstanding the predecessors' saying that free urination is a shortcut to curing disease. I once treated a patient with Tan Yin (Phlegm-Rheum) and edema. A physician prescribed Zhen Wu Tang (True Warrior Decoction) combined with Wu Ling San (Five-Ingredient Powder with Poria), but it was ineffective. I said: This is because the yang qi of the San Jiao (Triple Burner) cannot be disseminated to the exterior, leading to exterior qi stagnation and subsequent interior urgency. Although there is phlegm-rheum, there is no distension. One should use warm tonification combined with pungent dispersion, not bland leaching. The treatment indeed resulted in sweating and cure. Using leaching would further damage the interior. At that time, someone suggested: "One must purge to empty the interior, allowing exterior water to retreat into the interior for purging, before recovery is possible." This is truly killing the patient. Predecessors used this method when the pathogen was latent in the Mo Yuan (Membrane Source), not on the skin surface. By emptying the stomach and intestines, one waits for the pathogen in the membrane source to gather again in the stomach and intestines, then exhausts it. This is like Wu Youke's statement: Wait until the heat pathogen in the membrane source accumulates in the stomach, then use purging. Edema is an exterior syndrome caused by wind, cold, or dampness; symptoms include panting after movement, and the method should be dispersing. Distension is an interior syndrome caused by excess damp-heat, spleen excess, liver stagnation, and wood depressing earth; symptoms include panting without movement, and the method should be purging. When both swelling and distension exist, disperse and purge together. It is unheard of to have skin edema and yet use purging, causing the pathogen to sink inward.