而衰之也如邪热入胃用咸寒之剂以攻去又如中漏腹胀湿热内甚其人壮气实者则攻下之或势盛不能顿除者则劫夺其势而使
之衰又如湿热为痢非力轻之剂可治者则或攻或劫以致其平凡此之类皆夺之之法也金郁泄之泄者渗泄而利小便也疏通其气
也如肺金为肾水上源金受火烁其令不行原郁而渗道闭矣宜整肃金化滋以利之又如肺气 满以凭仰息非利肺气之剂不足以
疏通之凡此之类皆泄之之法也王氏谓渗泄解表利小便夫渗泄利小便固为泄金郁矣其解表二字得非以人之皮毛属肺其受邪
为金郁而解表为泄之乎窃谓如此则凡筋病便是木郁肉病便是土郁耶此二字未当今刚去且解表间于渗泄利小便之中是渗泄
利小便为三治矣故易之曰渗泄而利小便也水郁折之折者制御也伐而挫之也渐杀其盛也如肿胀之病水气淫溢而渗道以塞夫
水之所不胜者土也今土气衰弱不能制之故反受其侮治当实其脾土资其运化俾可以治水而不敢犯则渗道达而后愈或病势既
旺非上法所能遽制则用泄水之剂伐而挫之或去宛陈 开鬼门洁净府三法备举迭用以渐平之王氏所谓抑之制其冲逆正欲折
挫其泛滥之势也夫实土者守也泄水者攻也兼三治者广略而决胜也守也攻也广略也虽俱为治水之法然不审病之虚实久近浅
深杂焉妄施其不倾踣者寡矣夫五郁之病固有法以治之然邪气久客正气必损今邪气虽去正气岂能遽平哉苟不平调正气使各
安其位复其常于治郁之余则犹未足以尽治法之妙故又曰然调其气苟调之而其气犹或过而未服则当益其所不胜以制之如木
过者当益金金能制木则木斯服矣所不胜者所畏者也故曰过者折之以其畏也夫制物者物之所欲也制于物者物之所不欲也顺
其欲则喜逆其欲则恶今逆之以所恶故曰所谓泻之王氏谓咸泻肾酸泻肝之类未尽厥旨虽然自调其气以下盖经之本旨故余推
其义如此若扩充为应变之用则不必尽然也）帝曰假者何如岐伯曰有假其气则无禁也（假借也正气不足客气胜之故借寒热
温凉以资夫正气即胜气可犯之谓也○王注假寒热温凉以资正气则可以热犯热以寒犯寒以温犯温以凉犯凉也）所谓主气不
足客气胜也（续客气谓六气更临之气主气谓五脏应四时正旺春夏秋冬也并六元正纪论）气味有浓薄性用有躁静治保有多
少力化有浅深（愚谓此指药之气味功用言）○上淫于下所胜平之外淫于内所胜治之（续淫谓行所不胜已者也上淫于下天
之气也外淫于内地之气也随所制胜而以平治之也制胜谓五味寒热温凉随胜用之下文备矣下文云司天之气风淫所胜平以辛
凉佐以苦甘以甘缓之以酸泻之之类诸气在泉风淫于内治以辛凉佐以苦以甘缓之以辛散之之类王注风性喜温而恶清故治之
凉是以胜气治之也佐以苦随其所利也木苦急则以甘缓之若抑则以辛散之新校正云天气主岁虽有淫胜但当平调之故不曰治
而曰平故在泉曰治司天曰平即此义也）谨察阴阳所在而调之以平为期正者正治反者反治（阴病阳不病阳病阴不病正也以
寒治热以热治寒治之正也阳位已见阴脉阴位又见阳脉反也以寒治寒以热治热治之反也）夫气之胜也微者随之甚者制之气
之复也和者平之暴者夺之皆随胜气安其屈伏无问其数以平为期此其道也（续随谓随之制谓制止平谓平调夺谓夺其胜气也
安谓顺胜气以和之也治此者不以数之多少但以气平和为准度尔）高者抑之（制其胜也）下者举之（济其弱也）有余者折
之（屈其锐也）不足者补之（全其气也）佐以所利和以所宜（愚谓如辛利于散酸利于收之类和以所宜如肝宜散肺宜收之
类）必安其主客适其寒温同者逆之异者从之（续虽制胜扶弱而客主须安一气失所则矛盾更作各伺其便内淫外并而危败之
由作矣同谓寒热温清气相比和者异谓金木水火土不比和者气相得者则逆所胜之气以治之不相得者则顺所不胜气以治之）
帝曰气有多少病有盛衰治有缓急方有大小愿闻其约（约度准则也）岐伯曰气有高下病有远近症有中外治有轻重适其至所
为故也（续脏位有高下腑气有远近病症有表里药用有轻重调气多少和其紧慢令药气至病所为故勿太过与不及也）大要曰
君一臣二奇之制也君二臣四偶之制也君二臣三奇之制也君三臣六偶之制也（愚按奇古之单方独用一物是也又有数合阳数
之奇方谓一三五七九皆阳数也以药味之数皆单也君一臣三君三臣五亦合阳数也病在上而近者宜奇方○偶古之复方也有两
味相配之偶方有二方相合之偶方有数合阴数之偶方谓二四六八十皆阴数也以药味之数皆偶也君二臣四君四臣六亦合阴数
也病在下而远者宜偶方制者有因时制宜之义以病有远近治有轻重所宜故云制也）故曰近者奇之远者偶之汗者不以奇下者
不以偶（愚按王注汗药如不以偶则气不足以外发下药如不以奇则药毒攻而致过是奇则单行偶则并行单则力孤而微并则力
齐而大意者下本易行故用单汗或难出故宜并及观仲景之制方桂枝汤汗药也反以三味为奇大承气汤下药也反以四味为偶何
也此又可见古人因时制宜而难以偶奇拘之也）补上治上制以缓补下治下制以急急则气味浓缓则气味薄适其至所此之谓也
（愚按急方有五有急病急攻之急方有汤散荡涤之急方有药性有毒之急方有气味浓药之急方王注治下补下方若缓慢则滋道
路而力又微制急方而气味薄则力与缓等○缓方有五有甘以缓之之缓方有丸以缓之之缓方有品件群众之缓方有无毒治病之
缓方有气味薄药之缓方王注补上治上方若迅急则上不住而迫走于下制缓方而气味原则势与急同适者宜也谓凡制方须宜至
其病所无太过不及也）病所远而中道气味之者食而过之无越其制度也（续假如病在肾而心之气味食而令足仍急过之不饲
以气味肾药凌心心复益衰余上下远近不同）是故平气之道近而奇偶制小其服也远而奇偶制大其服也大有数少小则数多多
则九之少则二之（王注或识见高远权以合宜方奇而分两偶方偶而分两奇如是者近而偶制多数服之远而奇制少数服之○愚
按大方有二有君一臣三佐九之大方有分两大而顿服之大方盖治肾肝及在下而远者宜顿服而数少之大方病有兼症而邪不专
不可以一二味治者宜君一臣三佐九之大方王太仆以人之身三折之近为心肺远为肾肝中为脾胃故肝之三服可并心之七服肾
之二服可并肺之七服也○小方有二有君一臣二之小方有分两微而频服之小方盖治心肺及在上而近者宣分两微少而顿服之
小方徐徐呻之是也病无兼症而邪气专可一二味而治者宜君一臣二之小方故肾之二服可分为肺之九服及肝之三服也）奇之
不去则偶之是谓重方偶之不去则反佐以取之所谓寒热温凉反从其病也（续方与其重也宁轻与其毒也宁善与其大也宁小是
以奇方不去偶方主之偶方病在则反其一佐以同病之气而取之也盖细小寒热可以正治而折消之甚大寒热则必与违性者争雄
与异气者相格是以反其佐以同其气则药可入而病可愈矣所谓始同终异是也○愚谓经云偶是谓重方而七方中又有复方复即
重也岂非偶方者二方相合之谓复方者二方四方相合之方欤一说复字非重复乃反复之复何也既言奇之不去则偶之又云偶之
不去则反佐以取之是反复以取之也故以复为反复亦不远内经之意且复方有分两均齐之复方如胃风汤各等分是也有本方之
外别如余味者为复方如承气汤外参以连翘薄荷黄芩栀子以为凉膈散是也）帝曰五味之用何如岐伯曰辛甘发散为阳酸苦涌
泻为阴咸味涌泄为阴淡味渗泄为阳六者或收或散或缓或急或燥或润或软或坚以所利而行之调其气使其平也（续涌吐也泄
利也渗泄小便也言水液自回肠泌别汁渗入膀胱胞气化之而为溺以出也经曰五味各有所利或散或收或缓或急或坚或软四时
五脏病随五味所宜也）帝曰非调气而得者（不因于气也）治之奈何有毒无毒何先何后愿闻其道（病生之类有四一者始因
气动而内有所成二者因气动而外有所成三者不因气动而病生于内四者不因气动而病生于外夫因气动而内成者谓积聚 瘕
瘤瘿结核癫痫之类外成者谓痈肿疮疡痂疥疽痔掉螈浮肿目赤瘭疹 肿痛痒之类不因气动而病生于内者谓留饮辟食饥饱劳
损宿食霍乱悲恐喜想慕忧结之类生于外者谓瘴气贼魅虫蛇蛊毒飞尸鬼击冲薄坠堕风寒暑湿斫射刺割捶仆之类如是四类有
独治内而愈者有兼治内而愈者有独治外而愈者有兼治外而愈者有先治内而后治外而愈者有先治外而后治内而愈者有须毒
剂而攻击者有须无毒而调引者凡此之类方治所施或重或轻或缓或急或收或散或润或燥或软或坚方土之用见解不同各擅己
心好用非素故复问之）岐伯曰有毒无毒所治为主适大小为制也（续言但能破积愈疾则为良方非必要言以先毒为是后毒为
非无毒为非有毒为是必量病轻重大小制之也）曰请言其制曰君一臣二制之小也君一臣三佐五制之中也君一臣三佐九制之
大也热者寒之寒者热之微者逆之甚者从之（续病之微小者犹人火也遇草而病得木而燔可以湿伏可以水灭故逆其性气以折
之攻之病之大甚者犹龙火也得湿而 遇水而燔不知其性以水湿折之适足以光 诣天物穷方正矣识其性者以火逐之则燔灼
自消燔火扑灭逆之谓以寒攻热以热攻寒从之谓以寒治寒以热治热是以下文曰逆者正治云云）坚者削之客者除之劳者温之
结者散之留者攻之燥者濡之急者缓之散者收之损者益之逸者行之惊者平之（愚谓卒见异物暴闻异声以致惊也须使其习见
异物熟闻异声则平常习熟不以为异而惊去矣故曰平之或谓镇静其心安定其神亦所以平之也）上之下之摩之浴之薄之劫之
开之发之适事为故（续量病症候适事用之）曰何谓逆从曰逆者正治从者反治从少从多观其事也（续逆者正治逆病气而正
治也从者反治须从顺病气乃反治法也从少谓一同而二异从多谓二同而三异言尽同者是奇制也）曰反治何如曰热因寒用寒
因热用塞因塞用通因通用必伏其所主而先其所因其始则同其终则异可使破积可使溃坚可使气和可使必已（夫大寒内结蓄
聚疝瘕以热攻除寒格热反纵反纵之则痛发尤甚攻之则热不得前方以蜜煎乌头佐之以热蜜多其药服已便消此谓热因寒用也
有火气动服冷已过热为寒格而身冷呕哕嗌干口苦恶热好寒众议为热冷治则甚其如之何则热物冷服下嗌之后冷休既消热性
便发由是病气随愈呕哕皆除醇酒冷冻饮料则其类矣此谓热因寒用也又病热者寒攻之则不入以豆豉诸冷药酒渍或温而服之酒热
气同固无违忤酒热既尽寒药已行从其服食热便随散此则寒因热用也或以诸冷物热剂和之如热食猪肉及粉葵乳以椒姜橘热
剂和之是亦寒因热用也又热在下焦治亦然假如下气虚乏中焦气壅 胁满甚食已转增今欲散满则恐虚其下补下则满甚于中
或谓不救其虚且攻其满药入则减药过依然故中满下虚其病常在乃不知疏启其中峻补于下少服则资壅多服则宣通由是而疗
中满自除下虚斯实此则塞因塞用也又大热内结注泄不止热宜寒疗结复不除以寒下之结散利止此则通因通用也又大寒凝内
久利溏泄愈而复作绵历数年以热下之寒去利止亦其类也投寒以热凉而行之投热以寒温而行之始同终异斯之谓也经云治热
以寒温而行之治寒以热凉而行之亦热因寒用寒因热用之义也）曰气调而得者何如（因于气也）曰逆之从之逆而从之从而
逆之疏气令调则其道也（续逆谓逆病气以正治从谓从病气以反治逆其气以正治使其从顺从其气以反取令彼和调故曰逆从
也不疏其气令道路开通则气感寒热而为变始生化多端也）曰病之中外何如曰从内之外者调其内从外之内者治其外（各绝
其源）从内之外而盛于外者先调其内而后治其外从外之内而盛于内者先治其外而后调其内（续皆谓先除其根后削其枝条）
中外不相及则治其主病（中外不相及自各一病也）曰论言治寒以热治热以寒而方士不能废绳墨而更其道也有病热者寒之
而热有病寒者热之而寒二者皆在新病复起奈何治（续谓治之而病不衰退反回药寒热而随生寒热病之新者也）曰诸寒之而
热者取之阴（壮水之主以制阳光）热之而寒者取之阳（益火之源以消阴翳）所谓求其属也（续粗工以热攻寒以寒疗热治
热未已而冷疾已生攻寒日深而热病更起愚谓此即上文新病复起也热起而中寒尚在寒生而外热不除愚谓此即上文二者皆在
也欲攻寒则惧热不前欲疗热则思寒又止岂知脏腑之源有寒热温凉之主哉夫取心者不必齐以热取肾者不必齐以寒但益心之
阳寒亦通行强肾之阴热之犹可观斯之故或治热以热治寒以寒万举万全孰知其意）曰服寒而反热服热而反寒其故何也曰治
其王气是以反也（当其王时须是甚则从之之法也○王注春以清治肝而反温夏以冷治心而反热秋以温治肺而反清冬以热治
肾而反寒盖由补益王气太甚也补王太甚则脏之寒热而气自多矣）曰不治王而然者何也曰不味王味属也（愚谓上味字谓深
味下味字谓食味犹云不深味食味各有所属也）夫五味入胃各归所喜攻酸先入肝苦先入心甘先入脾辛先入肺咸先入肾久而
增气物化之常也气增而久夭之由也（物盛则衰理当然也○王注入肝为温入心为热入肺为清入肾为寒入脾为至阴而四气兼
邪气衰退的方法，就像邪热进入胃腑，使用咸寒性质的方剂来攻逐清除；又比如中焦虚损导致腹胀，湿热内盛，如果患者正气壮实，就用攻下法治疗；或者病势强盛不能一次性去除的，就用劫夺其势的方法使其衰退。又比如湿热导致的痢疾，不是药力轻薄的方剂可以治疗的，就采用攻下或劫夺的方法以消除病邪。像这一类，都是“夺”的治疗方法。
金郁（肺气郁闭）用泄法。“泄”，是指渗湿利水而通利小便，疏通气机。比如肺金为肾水的上源，肺金被火邪灼烧，其宣降功能不行，源头郁滞而水道闭塞，应当整肃金气，滋助化源以利水道。又比如肺气胀满，呼吸急促，非利肺气的方剂不足以疏通。像这一类，都是“泄”的治疗方法。王冰说：“渗泄、解表、利小便。”渗泄和利小便固然属于泄金郁，但“解表”二字，难道是因为人的皮毛属于肺，受邪即为金郁，所以解表就是泄之吗？我认为如果这样理解，那么凡是筋病就是木郁，肉病就是土郁了吗？这“解表”二字不妥，应当去掉。暂且将“解表”置于“渗泄利小便”之中，这样就变成了三种治法了。所以我改为“渗泄而利小便”。
水郁用折法。“折”，是控制、抑制的意思，伐除并挫败它，逐渐削弱其盛势。比如肿胀病，水气淫溢而水道堵塞。水所不胜的是土，现在土气衰弱不能制约水，反而受水之侮。治疗应当充实脾土，资助运化，使脾能治水而不被侵犯，则水道通达而后痊愈。或者病势已经旺盛，上述方法不能立即控制，则使用泻水方剂伐除挫败它；或者运用“去宛陈莝”、“开鬼门”、“洁净府”三法，交替使用以逐渐平复。王冰所说的“抑之制其冲逆”，正是想要挫败其泛滥之势。充实脾土是守正，泻水是攻邪，兼用三法是广略结合以求决胜。守、攻、广略，虽然都是治水的方法，但如果不明辨病证的虚实、久近、浅深，妄加施治，不跌倒死亡的很少了。
五郁之病虽然有固定的治疗方法，但是邪气久留，正气必然受损。如今邪气虽去，正气岂能立刻平和？如果不调和正气，使其各安其位，恢复常态，那么在治郁之余，还不足以尽治法之妙。所以说：“调和气机。”如果调气后，气仍然有余而未服（指未平复），就应当补益其所不胜之气以制约它。比如木气过盛，当补金，金能制木，则木气自平。所不胜，就是所畏惧的。所以说：“过盛的，用其所畏惧的来折服它。”克制事物的，是事物所喜欢的；被事物克制的，是事物所不喜欢的。顺从其喜好则喜，违背其喜好则恶。现在用其所厌恶的来克制，所以说这叫“泻”。王冰说咸味泻肾、酸味泻肝等，没有完全领会其中的旨意。虽然如此，从“调和气机”以下，大概是经文的本旨，所以我推演其义如此。若扩充用于应变，则不必完全拘泥于此。
黄帝问：假证是怎么回事？岐伯答：有假借之象，就没有禁忌。（假借，指正气不足，客气胜之，故借用寒热温凉之药以资助正气，即胜气可犯之谓。）王冰注：假借寒热温凉以资助正气，就可以用热治热、寒治寒、温治温、凉治凉。所谓主气不足，客气胜之。（续注：客气指六气更临之气，主气指五脏应四时正旺春夏秋冬之气，参见《六元正纪大论》。）
药物的气味有浓薄之分，性用有躁静之别，治疗保全有多寡之差，力化有浅深之异。（我认为这是指药物的气味功用而言。）外邪从上侵入下部，用所胜之气平之；外邪从外侵入内部，用所胜之气治之。（续注：淫指行于所不胜之地。上淫于下是天之气，外淫于内是地之气。随所胜之气而以平治之。制胜指五味寒热温凉，随胜气之用，下文备矣。下文云：司天之气风淫所胜，平以辛凉，佐以苦甘，以甘缓之，以酸泻之之类。诸气在泉，风淫于内，治以辛凉，佐以苦，以甘缓之，以辛散之之类。王冰注：风性喜温而恶清，故治之以凉，是以胜气治之。佐以苦，随其所利也。木苦急，则以甘缓之，若抑之，则以辛散之。新校正云：天气主岁虽有淫胜，但当平调之，故不曰治而曰平。故在泉曰治，司天曰平，即此义也。）
谨慎察视阴阳所在之处而调治之，以平和为期。正治是针对病情性质与药物性质相反的情况（如阴病阳不病，阳病阴不病，以寒治热，以热治寒，此为正的治法）。反治是针对病情出现假象的情况（如阳位已见阴脉，阴位又见阳脉，以寒治寒，以热治寒，此为反的治法）。
气之胜，微者随之，甚者制之。气之复，和者平之，暴者夺之。皆随胜气，安其屈伏，不问其数，以平为期，这就是其道。（续注：随谓随之，制谓制止，平谓平调，夺谓夺其胜气也。安谓顺胜气以和之也。治此者不以数之多少，但以气平和为准度尔。）高者抑之（制约其胜），下者举之（济助其弱），有余者折之（屈折其锐），不足者补之（保全其气）。佐以所利，和以所宜。（我认为如辛利于散，酸利于收之类。和以所宜，如肝宜散，肺宜收之类。）必须安顿好主客之气，适应寒温。同者逆之，异者从之。（续注：虽制胜扶弱，而客主须安。一气失所，则矛盾更作，各伺其便，内淫外并，而危败之由作矣。同谓寒热温清气相比和者；异谓金木水火土不比和者。气相得者，则逆所胜之气以治之；不相得者，则顺所不胜之气以治之。）
黄帝问：气有多少，病有盛衰，治有缓急，方有大小，愿闻其要诀。（约度准则也。）岐伯答：气有高下，病有远近，症有中外，治有轻重，适其至所为故也。（续注：脏位有高下，腑气有远近，病症有表里，药用有轻重。调气多少，和其紧慢，令药气至病所为故，勿太过与不及也。）
大要说：君一臣二，是奇方的制度；君二臣四，是偶方的制度；君二臣三，是奇方的制度；君三臣六，是偶方的制度。（我按：奇，古之单方独用一物是也。又有数合阳数之奇方，谓一三五七九皆阳数也，以药味之数皆单也。君一臣三，君三臣五，亦合阳数也。病在上而近者宜奇方。○偶，古之复方也。有两味相配之偶方，有二方相合之偶方，有数合阴数之偶方，谓二四六八十皆阴数也，以药味之数皆偶也。君二臣四，君四臣六，亦合阴数也。病在下而远者宜偶方。制者有因时制宜之义，以病有远近，治有轻重所宜，故云制也。）所以说：近者用奇方，远者用偶方。发汗不用奇方，攻下不用偶方。（我按：王注认为汗药如不以偶，则气不足以外发；下药如不以奇，则药毒攻而致过。是奇则单行，偶则并行。单则力孤而微，并则力齐而大。意者下本易行，故用单；汗或难出，故宜并。及观仲景之制方，桂枝汤汗药也，反以三味为奇；大承气汤下药也，反以四味为偶。何也？此又可见古人因时制宜，而难以偶奇拘之也。）
补上治上，制以缓方；补下治下，制以急方。急则气味浓，缓则气味薄，适其至所，此之谓也。（我按：急方有五：有急病急攻之急方，有汤散荡涤之急方，有药性有毒之急方，有气味浓药之急方。王注：治下补下方，若缓慢则滋道路而力又微，制急方而气味薄，则力与缓等。○缓方有五：有甘以缓之之缓方，有丸以缓之之缓方，有品件群众之缓方，有无毒治病之缓方，有气味薄药之缓方。王注：补上治上方，若迅急则上不住而迫走于下，制缓方而气味原则势与急同。适者宜也，谓凡制方须宜至其病所，无太过不及也。）病所远而中道气味之者，食而过之，无越其制度也。（续注：假如病在肾而心之气味，食而令足，仍急过之，不饲以气味，肾药凌心，心复益衰。余上下远近不同。）
是故平气之道，近而奇偶，制小其服也；远而奇偶，制大其服也。大有数少，小则数多，多则九之，少则二之。（王注：或识见高远，权以合宜，方奇而分两偶，方偶而分两奇。如是者，近而偶制多数服之，远而奇制少数服之。○我按：大方有二：有君一臣三佐九之大方，有分两大而顿服之大方。盖治肾肝及在下而远者，宜顿服而数少之大方。病有兼症而邪不专，不可以一二味治者，宜君一臣三佐九之大方。王太仆以人之身三折之，近为心肺，远为肾肝，中为脾胃。故肝之三服可并心之七服，肾之二服可并肺之七服也。○小方有二：有君一臣二之小方，有分两微而频服之小方。盖治心肺及在上而近者，宜分两微少而顿服之小方，徐徐呻之是也。病无兼症而邪气专，可一二味而治者，宜君一臣二之小方。故肾之二服可分为肺之九服及肝之三服也。）
奇之不去，则偶之，是谓重方。偶之不去，则反佐以取之，所谓寒热温凉，反从其病也。（续注：方与其重也宁轻，与其毒也宁善，与其大也宁小。是以奇方不去，偶方主之。偶方病在，则反其一，佐以同病之气而取之也。盖细小寒热可以正治而折消之，甚大寒热则必与违性者争雄，与异气者相格，是以反其佐以同其气，则药可入而病可愈矣。所谓始同终异是也。○我谓经云“偶是谓重方”，而七方中又有复方，复即重也。岂非偶方者二方相合之谓，复方者二方四方相合之方欤？一说复字非重复，乃反复之复，何也？既言奇之不去则偶之，又云偶之不去则反佐以取之，是反复以取之也。故以复为反复，亦不远内经之意。且复方有分两均齐之复方，如胃风汤各等分是也；有本方之外别如余味者为复方，如承气汤外参以连翘薄荷黄芩栀子以为凉膈散是也。）
黄帝问：五味之用如何？岐伯答：辛甘发散为阳，酸苦涌泻为阴，咸味涌泄为阴，淡味渗泄为阳。六者或收或散，或缓或急，或燥或润，或软或坚，以所利而行之，调其气使其平也。（续注：涌吐也，泄利也，渗泄小便也。言水液自回肠泌别汁渗入膀胱胞，气化之而为溺以出也。经曰：五味各有所利，或散或收，或缓或急，或坚或软。四时五脏病，随五味所宜也。）
黄帝问：非调气而得者（不因于气也），治之奈何？有毒无毒，何先何后？愿闻其道。（病生之类有四：一者始因气动而内有所成，二者因气动而外有所成，三者不因气动而病生于内，四者不因气动而病生于外。夫因气动而内成者，谓积聚、瘕瘤、瘿结核、癫痫之类。外成者，谓痈肿疮疡、痂疥疽痔、掉螈浮肿、目赤瘭疹、肿痛痒之类。不因气动而病生于内者，谓留饮、辟食、饥饱劳损、宿食、霍乱、悲恐喜想慕忧结之类。生于外者，谓瘴气、贼魅、虫蛇蛊毒、飞尸鬼击、冲薄坠堕、风寒暑湿、斫射刺割、捶仆之类。如是四类，有独治内而愈者，有兼治内而愈者，有独治外而愈者，有兼治外而愈者，有先治内而后治外而愈者，有先治外而后治内而愈者，有须毒剂而攻击者，有须无毒而调引者。凡此之类，方治所施，或重或轻，或缓或急，或收或散，或润或燥，或软或坚。方土之用，见解不同，各擅己心，好用非素，故复问之。）
岐伯答：有毒无毒，所治为主，适大小为制也。（续注：言但能破积愈疾则为良方，非必要言以先毒为是，后毒为非，无毒为非，有毒为是。必量病轻重大小制之也。）曰：请言其制。曰：君一臣二，制之小也；君一臣三佐五，制之中也；君一臣三佐九，制之大也。热者寒之，寒者热之，微者逆之，甚者从之。（续注：病之微小者，犹人火也，遇草而病，得木而燔，可以湿伏，可以水灭，故逆其性气以折之攻之。病之大甚者，犹龙火也，得湿而焰，遇水而燔，不知其性，以水湿折之，适足以光耀诣天，物穷方正矣。识其性者，以火逐之，则燔灼自消，燔火扑灭。逆之，谓以寒攻热，以热攻寒。从之，谓以寒治寒，以热治热。是以下文曰：逆者正治，云云。）
坚者削之，客者除之，劳者温之，结者散之，留者攻之，燥者濡之，急者缓之，散者收之，损者益之，逸者行之，惊者平之。（我谓：卒见异物，暴闻异声，以致惊也。须使其习见异物，熟闻异声，则平常习熟，不以为异，而惊去矣。故曰平之。或谓镇静其心，安定其神，亦所以平之也。）上之下之，摩之浴之，薄之劫之，开之发之，适事为故。（续注：量病症候，适事用之。）
曰：何谓逆从？曰：逆者正治，从者反治。从少从多，观其事也。（续注：逆者正治，逆病气而正治也。从者反治，须从顺病气乃反治法也。从少谓一同而二异，从多谓二同而三异。言尽同者是奇制也。）曰：反治何如？曰：热因寒用，寒因热用，塞因塞用，通因通用。必伏其所主，而先其所因。其始则同，其终则异。可使破积，可使溃坚，可使气和，可使必已。（夫大寒内结，蓄聚疝瘕，以热攻除，寒格热反纵，反纵之则痛发尤甚。攻之则热不得前，方以蜜煎乌头，佐之以热蜜，多其药服，已便消，此谓热因寒用也。有火气动，服冷已过热，为寒格而身冷呕哕，嗌干口苦，恶热好寒，众议为热冷治则甚，其如之何？则热物冷服，下嗌之后，冷休既消，热性便发，由是病气随愈，呕哕皆除。醇酒冷冻饮料，则其类矣，此谓热因寒用也。又病热者，寒攻之则不入，以豆豉诸冷药酒渍，或温而服之，酒热气同，固无违忤，酒热既尽，寒药已行，从其服食，热便随散，此则寒因热用也。或以诸冷物热剂和之，如热食猪肉及粉葵乳，以椒姜橘热剂和之，是亦寒因热用也。又热在下焦，治亦然。假如下气虚乏，中焦气壅，胁满甚，食已转增。今欲散满，则恐虚其下；补下，则满甚于中。或谓不救其虚，且攻其满。药入则减，药过依然，故中满下虚，其病常在。乃不知疏启其中，峻补于下。少服则资壅，多服则宣通。由是而疗，中满自除，下虚斯实，此则塞因塞用也。又大热内结，注泄不止，热宜寒疗，结复不除，以寒下之，结散利止，此则通因通用也。又大寒凝内，久利溏泄，愈而复作，绵历数年，以热下之，寒去利止，亦其类也。投寒以热，凉而行之；投热以寒，温而行之。始同终异，斯之谓也。经云：治热以寒，温而行之；治寒以热，凉而行之。亦热因寒用，寒因热用之义也。）
曰：气调而得者何如？（因于气也。）曰：逆之从之，逆而从之，从而逆之，疏气令调，则其道也。（续注：逆谓逆病气以正治，从谓从病气以反治。逆其气以正治，使其从顺；从其气以反取，令彼和调。故曰逆从也。不疏其气，令道路开通，则气感寒热而为变，始生化多端也。）
曰：病之中外何如？曰：从内之外者，调其内；从外之内者，治其外。（各绝其源。）从内之外而盛于外者，先调其内而后治其外；从外之内而盛于内者，先治其外而后调其内。（续注：皆谓先除其根，后削其枝条。）中外不相及，则治其主病。（中外不相及，自各一病也。）
曰：论言治寒以热，治热以寒，而方士不能废绳墨而更其道也。有病热者寒之而热，有病寒者热之而寒，二者皆在新病复起，奈何治？（续注：谓治之而病不衰退，反回药寒热而随生寒热，病之新者也。）曰：诸寒之而热者，取之阴（壮水之主，以制阳光）；热之而寒者，取之阳（益火之源，以消阴翳）。所谓求其属也。（续注：粗工以热攻寒，以寒疗热。治热未已，而冷疾已生；攻寒日深，而热病更起。愚谓此即上文新病复起也。热起而中寒尚在，寒生而外热不除。愚谓此即上文二者皆在也。欲攻寒则惧热不前，欲疗热则思寒又止。岂知脏腑之源有寒热温凉之主哉？夫取心者不必齐以热，取肾者不必齐以寒。但益心之阳，寒亦通行；强肾之阴，热之犹可观。斯之故，或治热以热，治寒以寒，万举万全，孰知其意？）
曰：服寒而反热，服热而反寒，其故何也？曰：治其王气，是以反也。（当其王时，须是甚则从之之法也。○王注：春以清治肝而反温，夏以冷治心而反热，秋以温治肺而反清，冬以热治肾而反寒。盖由补益王气太甚也。补王太甚，则脏之寒热而气自多矣。）曰：不治王而然者何也？曰：不味王味属也。（我谓：上味字谓深味，下味字谓食味。犹云不深味食味，各有所属也。）
夫五味入胃，各归所喜。攻酸先入肝，苦先入心，甘先入脾，辛先入肺，咸先入肾。久而增气，物化之常也。气增而久，夭之由也。（物盛则衰，理当然也。○王注：入肝为温，入心为热，入肺为清，入肾为寒，入脾为至阴而四气兼……）
The method of reducing pathogenic factors is like when pathogenic heat enters the stomach; one uses a salty and cold formula to attack and eliminate it. For example, if there is central deficiency leading to abdominal distension with severe internal damp-heat, and the person has strong qi and substantial constitution, then one attacks and purges it. Or if the pathogenic factor is too vigorous to be removed all at once, one uses a method to seize and reduce its momentum so that it declines. For instance, dysentery caused by damp-heat cannot be treated with mild formulas; one may use attacking or seizing methods to eliminate the pathogen. These are all methods of "reduction" (Duo).
Metal depression (Lung Qi stagnation) is treated with dispersion ("Xie"). "Dispersion" refers to promoting diuresis and benefiting urination to unblock the Qi mechanism. For example, the Lung Metal is the source of Kidney Water. If Lung Metal is scorched by Fire, its regulatory function fails, causing stagnation at the source and closure of the fluid pathways. One should regulate the Metal transformation and nourish the source to benefit the flow. Again, if Lung Qi is full and breathing is labored, only a formula that benefits Lung Qi can sufficiently unblock it. These are all methods of "dispersion". Wang Bing said: "Promote diuresis, release the exterior, benefit urination." Promoting diuresis and benefiting urination certainly belong to dispersing Metal depression, but what about the term "release the exterior"? Is it because the skin and hair belong to the Lung, and when affected by pathogens it constitutes Metal depression, so releasing the exterior is a form of dispersion? I argue that if this were the case, then any tendon disease would be Wood depression, and any flesh disease would be Earth depression. The term "release the exterior" is inappropriate here and should be omitted. Temporarily placing "release the exterior" among "promote diuresis and benefit urination" would result in three treatments. Therefore, I change it to "promote diuresis and benefit urination".
Water depression is treated with restraint ("Zhe"). "Restraint" means controlling, suppressing, attacking, and defeating it, gradually killing its excess. For example, in edema diseases, water qi overflows and blocks the fluid pathways. What water cannot overcome is Earth. Now, if Earth qi is weak and cannot control water, it suffers from water's insult. Treatment should strengthen Spleen Earth and support its transportation and transformation, enabling it to control water so it dares not invade, after which the fluid pathways open and recovery occurs. Or if the disease momentum is already vigorous and the above methods cannot immediately control it, one uses water-draining formulas to attack and defeat it; or employs the three methods of "removing accumulated stasis", "opening the ghost gate" (sweating), and "cleaning the fu organs" (diuresis), alternating them to gradually calm the condition. Wang Bing's statement "suppress it to control its rushing rebellion" precisely aims to curb its flooding momentum. Strengthening Earth is defense (Shou); draining water is attack (Gong); combining the three methods is a comprehensive strategy to win decisively. Defense, attack, and comprehensive strategies are all methods for treating water disorders. However, if one does not carefully examine the deficiency/excess, chronicity, and depth of the disease and applies treatment recklessly, few will avoid collapse or death.
Although there are fixed methods for treating the five depressions, prolonged pathogenic invasion inevitably damages righteous qi. Even if the pathogen is gone, how can righteous qi recover immediately? If one does not harmonize the righteous qi to restore its proper position and normal state, the subtlety of treatment is not fully exhausted even after treating the depression. Hence it says: "Harmonize the Qi." If harmonizing the Qi still leaves it excessive and unrested, one should tonify its unconquered element to restrain it. For example, if Wood is excessive, one should tonify Metal, as Metal controls Wood, thus calming Wood. The unconquered element is that which is feared. Hence it says: "Excess is restrained by what it fears." That which controls things is what things desire; that which is controlled by things is what things do not desire. Following desires brings joy; opposing desires brings aversion. Now, using what is dreaded to control implies "draining" (Xie). Wang Bing stated that salty flavor drains the Kidney and sour flavor drains the Liver, but he did not fully grasp the essence. Nevertheless, from "harmonizing the Qi" onwards seems to be the original intent of the Classic, so I deduce its meaning as such. If expanded for flexible application, it need not be rigidly adhered to.
The Yellow Emperor asked: What about false conditions? The Yellow Emperor asked: What about false conditions? Qibo answered: When there is a false appearance, there are no prohibitions. (False appearance refers to righteous qi being deficient and pathogenic qi being dominant, so one borrows cold, hot, warm, or cool properties to supplement the righteous qi, meaning the dominant pathogen can be attacked.) Wang Bing's commentary: Borrowing cold, hot, warm, or cool to supplement righteous qi allows treating heat with heat, cold with cold, etc. This refers to main qi being deficient and guest qi being dominant. (Guest qi refers to the six climatic influences succeeding each other; main qi refers to the five zang organs corresponding to the four seasons' peak times.)
Medicinal flavors have density and thinness; their natures have agitation and tranquility; their therapeutic preservation has more and less; their power and transformation have depth and shallowness. (I interpret this as referring to the medicinal flavors and functions.) External pathogens invading from above downwards are balanced by the conquering element; external pathogens invading from outside inwards are treated by the conquering element. (Continued: Yin refers to movement into the unconquered territory. Invading from above downwards is heavenly qi; invading from outside inwards is earthly qi. Balance and treat according to the conquering element. Conquering refers to the five flavors and four temperatures, used according to the prevailing pathogen, as detailed below. E.g., for Wind excess under Heaven's influence, balance with pungent-cool, assist with bitter-sweet, soothe with sweet, drain with sour. For Wind excess under Earth's influence, treat with pungent-cool, assist with bitter, soothe with sweet, disperse with pungent. Wang Bing notes: Wind likes warmth and dislikes coolness, so cooling treats it by overcoming it. Bitter assists according to benefit. Wood hates urgency, so sweet soothes it; if suppressing, pungent disperses it. New corrections note: Heavenly influence governs the year; although there is excess, one should only balance, hence "balance" is used instead of "treat". Thus, Earth's influence uses "treat", Heaven's uses "balance".)
Carefully observe the location of Yin and Yang and harmonize them, aiming for balance. Correct treatment (Zheng Zhi) addresses the true nature of the disease (e.g., Yin disease without Yang involvement, treating heat with cold). Reverse treatment (Fan Zhi) addresses false symptoms (e.g., Yang location showing Yin pulse, treating cold with cold).
For mild pathogenic excess, follow it; for severe excess, control it. For pathogenic rebound, if mild, balance it; if violent, reduce it. All follow the prevailing pathogen, pacify the suppressed aspect, regardless of number, aiming for balance. This is the Way. High aspects are suppressed; low aspects are lifted; excess is reduced; deficiency is tonified. Assist with what is beneficial, harmonize with what is appropriate. Must stabilize the host and guest Qi, adapt to cold and heat. Similar conditions are treated oppositely (Ni); different conditions are treated similarly (Cong).
The Yellow Emperor asked: Qi varies in quantity, diseases vary in severity, treatments vary in speed, and formulas vary in size. I wish to hear the principles. Qibo answered: Qi has high and low positions; diseases have distant and near locations; symptoms have internal and external sites; treatments have heavy and light applications. Adapt to the target site. Generally: Jun 1, Chen 2 is an Odd (Qi) system; Jun 2, Chen 4 is an Even (Ou) system; Jun 2, Chen 3 is an Odd system; Jun 3, Chen 6 is an Even system. (Odd formulas historically refer to single herbs or combinations summing to odd numbers, suitable for upper/near diseases. Even formulas refer to combinations summing to even numbers, suitable for lower/far diseases.) Thus: Near diseases use Odd formulas; far diseases use Even formulas. Sweating does not use Odd formulas exclusively; purging does not use Even formulas exclusively. (Wang Bing notes: Sweating requires combination to generate enough Qi to reach the exterior; purging requires single action to avoid toxicity. Zhang Zhongjing's Guizhi Tang has 3 ingredients (Odd) for sweating; Dachengqi Tang has 4 ingredients (Even) for purging, showing flexibility based on timing.)
Tonifying upper/upper treatments use slow formulas; tonifying lower/lower treatments use rapid formulas. Rapid formulas have dense flavors; slow formulas have thin flavors, reaching the target appropriately. If the disease is far, use larger doses; if near, use smaller doses. Large formulas have fewer doses; small formulas have more doses (up to 9 or down to 2). If Odd formulas fail, use Even formulas (Chong Fang). If Even formulas fail, use reverse assistance (Fan Zuo), matching the disease's nature (cold/hot/warm/cool) to allow entry.
The Yellow Emperor asked: How are the five flavors used? Qibo answered: Pungent and sweet disperse and are Yang; sour and bitter induce vomiting/purging and are Yin; salty induces vomiting/drainage and is Yin; bland promotes diuresis and is Yang. These six actions (astringing, dispersing, slowing, urgent, drying, moistening, softening, hardening) are applied according to benefit to harmonize Qi and achieve balance.
The Yellow Emperor asked: For conditions not arising from Qi disturbance, how to treat? Which toxic/non-toxic herbs to use first? Qibo answered: Toxicity depends on the disease treated, sized appropriately. Heat is treated with cold; cold with heat. Mild cases oppose the nature (Ni); severe cases follow the nature (Cong). Hardness is削 (scraped/reduced); guests are removed; labor is warmed; knots are scattered; retention is attacked; dryness is moistened; urgency is slowed; scattering is gathered; deficiency is benefited; inactivity is moved; shock is calmed. Upper/lower, rubbing/bathing, pressing/seizing, opening/dispersing—adapt to the situation.
Reverse (Ni) is correct treatment; Cong is reverse treatment. Observe the case to determine degree. Reverse treatment includes: Heat used with cold administration; Cold used with heat administration; Blockage treated with blockage (for deficiency blockage); Flow treated with flow (for excess flow). Conceal the main cause and address the root. Initially similar, finally different. Can break accumulations, dissolve hardness, harmonize Qi, ensure cure. (Examples provided for heat/cold reversal techniques.)
For conditions arising from Qi disturbance: Oppose or follow, reverse or comply, unblock Qi to harmonize. Internal-originating diseases affecting external: treat internal first. External-originating diseases affecting internal: treat external first. If internal affects external strongly, treat internal then external. If external affects internal strongly, treat external then internal. If internal and external are unrelated, treat the primary disease.
Regarding treating cold with heat and heat with cold: If heat treated with cold remains hot, or cold treated with heat remains cold, due to new complications, how to treat? For heat persisting despite cold treatment, tonify Yin (strengthen Water to control Fire). For cold persisting despite heat treatment, tonify Yang (strengthen Fire to dispel Yin). Seek the affiliation. Taking heart herbs need not always be hot; taking kidney herbs need not always be cold. Benefit Heart Yang to circulate cold; strengthen Kidney Yin to manage heat.
Taking cold causes heat; taking heat causes cold. Why? Treating the Wang (Prosperous) Qi leads to reversal. If not treating Wang Qi, why? Because flavors belong to specific elements. Five flavors enter the stomach and go to their preferred organs: Sour to Liver, Bitter to Heart, Sweet to Spleen, Pungent to Lungs, Salty to Kidneys. Long-term use increases Qi, which is normal transformation. But long-term increase leads to premature death.