凡物之死生，本由乎阳气。顾今人病阴虚者，十尝八九，不知此“阴”字，正阳气之根也。阴不可无
阳，阳不可无阴。故物之生也，生于阳；而物之成也，成于阴。则补阴者，当先补阳。自河间主火之说行，
而丹溪以苦寒为补阴之神丹，举世宗之。尽以热证明显，人多易见；寒证隐微，人或不知；且虚火、实火
之间，尤为难辨。孰知实热为病者，十不过三四；而虚火为患者，十尝有六也。实热者，邪火也。邪火之
盛，元气本无所伤，故可以苦寒折之，亦不可过剂，过则必伤元气。虚火者，真阴之亏也。真阴不足，岂苦
寒可以填补？人徒知滋阴之可以降火，而不知补阳之可以生水。吾故曰∶使刘、朱之言不息，则轩岐之道不着。
仲景《伤寒论》有曰∶病发于阳而反下之，热入因作结胸；病发于阴而反下之，内虚因作痞气。又
曰∶阳证下之早者，为结胸；阴证下之早者，为痞气。夫结胸、痞气，因下早而成，固人人能明之。独阴
阳二字，未有能确辨之者，不能不致疑其间也。其阴阳，指表里之阴阳言乎？抑指风寒气血之阴阳言乎？
抑指三阳三阴经脏腑之阴阳言乎？其言阳证阴证也，抑以阳邪之热为阳证乎？阴邪之寒为阴证乎？如以阴
阳为表里之阴阳也，以病发于阳为阳证属表之证，不宜下，误下成结胸，固矣。若以病发于阴为阴证属里
之证，正宜下，何云误下反成痞？则知此阴阳，非以表里之阴阳言也。如以阴阳为风寒气血之阴阳也，风
为阳，阳邪伤卫，卫主气，气伤反成结胸；寒为阴，阴邪伤荣，荣主血，血伤反成痞气。夫结胸为实
邪，为证重；痞气为虚邪，为证轻。岂有阳邪伤无形之气，成结胸之实证；阴邪伤有形之血，反成痞满之
虚证乎？则知此阴阳，非以风寒伤气伤血之阴阳言也。如以阳证阴证为三阳三阴经言也，夫三阳经证为
属腑，如太阳、阳明、少阳为病在表，当汗不当下，误下则邪入里而成结胸是矣。但三阴经证则属脏，如
太阴、少阴、厥阴为病在里，正当下，当下而又言误下遂成痞气，则知此阴阳，非以三阴三阳之脏腑言
也。如以阳邪之热证为阳证，而下早成结胸是也，若谓阴寒之阴证下之则死，岂止于痞？则知此阴证，不
可指为中寒之阴证言也。故阳证下早成结胸，此论固无庸辨，独阴证下早成痞一语，不能无疑。仲景亦无
明文，而历代明医，自成无己、许叔微以下，未见有发明。或指阴证之阴，或指阴寒之阴，或指为荣血之
阴，或指为三阴之阴，纷纷拟议，而无定论。予反复思之，而知此阴证之阴，盖以经腑言也。三阳有经有
腑，三阴亦有经有脏。病在经则可汗而不可下，若风寒尚在三阴之经，则邪留肌肉之表，故曰下早则成
痞，是病在经而伤于脏，则邪入而成痞，故邪在三阴之经，则可汗，若入三阴之脏，则可下，其邪在经而
尚未入脏，则不可下，故病发太阴者，尚发于阴之经也，发于阴经而反下之，则作痞矣。虽然此辨是矣，
而所谓三阴者，太阴、少阴、厥阴也，然足厥阴为一阴，足少阴为二阴，足太阴为三阴，概曰三阴，抑太
阴乎？少阴乎？厥阴乎？伤寒之邪，自三阳经足太阳膀胱为始，膀胱为三阳经之首，其邪在三阳经，则可
汗，而反下之，故成结胸。三阴经足太阴脾为始，脾为三阴之首，若邪在三阴足太阴脾之经，则可汗而不
可下，反下之则成痞气，则阴指太阴脾经者也。故王海藏与东垣论痞，谓从血中来，治痞独益中州。中州
者，脾也。脾可补不可泻，当补而泻之，是以成痞。此之谓也。
凡是事物的生死，根本都取决于阳气。然而如今患阴虚病的人，十有八九，却不知道这个“阴”字，正是阳气的根基。阴不能没有阳，阳也不能没有阴。所以万物的生长，源于阳气；而万物的成熟，成于阴精。因此，想要补阴，应当先补阳。自从刘河间主张“火热论”盛行以来，朱丹溪便以苦寒药物作为补阴的神丹妙药，举世之人皆奉为圭臬。人们都知道热证表现明显，容易看见；而寒证隐微，人们往往不了解；况且虚火与实火之间，尤其难以辨别。殊不知因实热致病的人，十人中不过三四；而因虚火致病的人，十人中有六人。所谓实热，是邪火。邪火炽盛时，元气本来并未受伤，所以可以用苦寒药物来折服它，但也不可过量，一旦过量必然会损伤元气。所谓虚火，是真阴的亏损。真阴不足，哪里是苦寒药物所能填补的？世人只知道滋阴可以降火，却不知道补阳可以生水（化生阴液）。所以我常说：如果刘完素、朱震亨的言论不停止，那么黄帝岐伯的医学正道就无法彰显。
张仲景在《伤寒论》中说：疾病发于阳证而误用攻下法，热邪内陷因而形成结胸；疾病发于阴证而误用攻下法，内脏空虚因而形成痞气。又说：阳证过早使用攻下法，会导致结胸；阴证过早使用攻下法，会导致痞气。对于结胸和痞气是因为过早攻下而形成的，这确实是人人都能明白的。唯独对于“阴阳”二字，没有人能够确切分辨，不能不让人对此产生疑问。这里的阴阳，是指表里的阴阳吗？还是指风寒气血的阴阳吗？还是指三阳经和三阴经脏腑的阴阳吗？所说的阳证和阴证，是以阳邪的热表现为阳证呢，还是以阴邪的寒表现为阴证呢？如果把阴阳理解为表里的阴阳，认为病发于阳就是阳证属于表证，不宜攻下，误下导致邪气内陷形成结胸，这是确定的。但如果把病发于阴理解为阴证属于里证，本应该攻下，为什么说误下反而形成了痞气？由此可知，这里的阴阳，不是指表里的阴阳。如果把阴阳理解为风寒气血的阴阳，风为阳，阳邪伤害卫气，卫气主气，气受伤反而形成结胸；寒为阴，阴邪伤害营血，营血主血，血受伤反而形成痞气。但是结胸是实邪，病情重；痞气是虚邪，病情轻。哪有阳邪伤害无形之气，形成结胸这种实证；而阴邪伤害有形之血，反而形成痞满这种虚证的道理呢？由此可知，这里的阴阳，不是指风寒伤气伤血的阴阳。如果把阳证阴证理解为三阳经和三阴经，那么三阳经的病证属于腑，如太阳、阳明、少阳发病在表，应当发汗而不应当攻下，误下则邪气入里形成结胸，这是对的。但是三阴经的病证则属于脏，如太阴、少阴、厥阴发病在里，正当攻下，既然正当攻下却又说误下遂形成痞气，由此可知，这里的阴阳，不是指三阴三阳的脏腑。如果把阳邪的热证称为阳证，过早攻下形成结胸是对的，如果说阴寒的阴证攻下就会死，岂止是形成痞气？由此可知，这个阴证，不可以指为中寒的阴证。所以，“阳证下早成结胸”，这个论述固然无需辩驳，唯独“阴证下早成痞”这一句话，不能不存疑。张仲景也没有明确的文字解释，而历代名医，从成无己、许叔微以下，未见有人阐发发明。有的人指出阴证之阴是指阴寒之阴，有的人指出是指荣血之阴，有的人指出是指三阴之阴，纷纷议论，却没有定论。我反复思考后知道，这个阴证之阴，大概是指经络而言。三阳经有经有腑，三阴经也有经有脏。病在经则可以发汗而不可攻下，如果风寒还在三阴经的层面，那么邪气停留在肌肉之表，所以说过早攻下会形成痞气，这是病在经而伤及脏，邪气内陷而形成痞气。所以邪气在三阴经，可以发汗；如果进入三阴之脏，可以攻下；其邪气在经而尚未入脏，则不可攻下。所以病发于太阴者，还是发于阴之经，发于阴经而反用攻下法，就会形成痞气。虽然这个辨析是正确的，但所谓的三阴，包括太阴、少阴、厥阴。然而足厥阴为一阴，足少阴为二阴，足太阴为三阴，概称为三阴，究竟是指太阴呢？少阴呢？还是厥阴呢？伤寒的邪气，从三阳经的足太阳膀胱经开始，膀胱是三阳经之首，邪气在三阳经，可以发汗，却反用攻下法，所以形成结胸。三阴经从足太阴脾经开始，脾是三阴经之首，如果邪气在三阴经的足太阴脾经，可以发汗而不可攻下，反用攻下法则形成痞气，那么这个阴指的就是太阴脾经。所以王海藏与李东垣讨论痞气，说痞气是从血中来的，治疗痞气专门补益中州（脾胃）。中州，就是脾。脾可补不可泻，本该补益却用了泻法，因此形成痞气。说的就是这个道理。
The life and death of all things fundamentally depend on Yang Qi (Yang Energy). However, nowadays, eight or nine out of ten patients suffering from Yin Deficiency (Yin Xu) do not realize that this "Yin" is precisely the root of Yang Qi. Yin cannot exist without Yang, nor can Yang exist without Yin. Therefore, the growth of things arises from Yang; while their maturation is accomplished by Yin. Thus, to tonify Yin, one should first tonify Yang. Since Liu Hejian's theory of Fire-Heat gained prominence, Zhu Danxi advocated using bitter-cold herbs as a divine elixir for tonifying Yin, a view universally adopted. People easily observe obvious Heat Syndromes (Re Zheng), but often fail to recognize subtle Cold Syndromes (Han Zheng); furthermore, distinguishing between Deficient Fire (Xu Huo) and Excess Fire (Shi Huo) is particularly difficult. Little do they know that among those ill due to Excess Heat, only three or four out of ten are affected, whereas six out of ten suffer from Deficient Fire. Excess Heat is pathogenic fire. When pathogenic fire is rampant, Yuan Qi (Primal Qi) is essentially unharmed, so it can be subdued with bitter-cold herbs; however, excessive dosage will inevitably damage Yuan Qi. Deficient Fire is the depletion of True Yin (Zhen Yin). How can bitter-cold herbs replenish insufficient True Yin? People only know that nourishing Yin can descend fire, but do not understand that tonifying Yang can generate Water (metaphorically generating Yin fluids). Hence I say: If the words of Liu [Wansu] and Zhu [Zhenheng] do not cease, the Way of Huangdi and Qibo will remain obscure.
Zhang Zhongjing stated in *Shanghan Lun* (Treatise on Cold Damage Diseases): "When a disease originates from Yang and purgation is wrongly applied, heat enters and forms Jie Xiong (Chest Binding); when a disease originates from Yin and purgation is wrongly applied, internal deficiency leads to Pi Qi (Stagnant Qi)." He further said: "Early purgation in Yang Syndromes results in Jie Xiong; early purgation in Yin Syndromes results in Pi Qi." While everyone understands that Jie Xiong and Pi Qi result from premature purgation, few can accurately distinguish the terms "Yin" and "Yang," leading to doubt. Does "Yin-Yang" here refer to the Yin-Yang of Exterior-Interior (Biao-Li)? Or does it refer to the Yin-Yang of Wind-Cold and Qi-Blood? Or does it refer to the Yin-Yang of the Zang-Fu organs of the Three Yang and Three Yin meridians? Regarding "Yang Syndromes" and "Yin Syndromes," does it mean Yang pathogens' heat constitutes Yang Syndromes, and Yin pathogens' cold constitutes Yin Syndromes? If Yin-Yang refers to Exterior-Interior, then disease originating from Yang implies a Yang Syndrome belonging to the Exterior, which should not be purged; erroneous purgation leads to Jie Xiong, which is clear. But if disease originating from Yin implies a Yin Syndrome belonging to the Interior, which properly requires purgation, why does erroneous purgation lead to Pi Qi instead? This indicates that the Yin-Yang mentioned here does not refer to Exterior-Interior. If Yin-Yang refers to Wind-Cold and Qi-Blood, Wind is Yang; Yang pathogens injure Wei Qi (Defensive Qi), which governs Qi; injuring Qi leads to Jie Xiong. Cold is Yin; Yin pathogens injing Ying Blood (Nutritive Blood), which governs Blood; injuring Blood leads to Pi Qi. However, Jie Xiong is an Excess Pathogen with severe symptoms, while Pi Qi is a Deficient Pathogen with mild symptoms. How could Yang pathogens injuring formless Qi result in the Excess syndrome of Jie Xiong, while Yin pathogens injuring tangible Blood result in the Deficiency syndrome of Pi Qi? This indicates that the Yin-Yang mentioned here does not refer to Wind-Cold injuring Qi or Blood. If Yang/Yin Syndromes refer to the Three Yang/Three Yin meridians, diseases of the Three Yang meridians belong to the Fu organs. For example, Taiyang, Yangming, and Shaoyang diseases are in the Exterior, requiring sweating rather than purgation; erroneous purgation causes pathogenic factors to enter the Interior, forming Jie Xiong, which is correct. But diseases of the Three Yin meridians belong to the Zang organs. For instance, Taiyin, Shaoyin, and Jueyin diseases are in the Interior, where purgation is appropriate. Yet, if purgation is deemed appropriate, why does erroneous purgation lead to Pi Qi? This indicates that the Yin-Yang mentioned here does not refer to the Zang-Fu of the Three Yin and Three Yang. If Yang Syndromes refer to Heat caused by Yang pathogens, early purgation causing Jie Xiong is correct. But if Yin Cold Syndromes are purged, death would ensue, not merely Pi Qi. Thus, this "Yin Syndrome" cannot refer to Middle-Jiao Cold Yin Syndromes. Therefore, "Early purgation in Yang Syndromes causes Jie Xiong" needs no debate, but "Early purgation in Yin Syndromes causes Pi Qi" remains doubtful. Zhang Zhongjing provided no explicit text, and famous physicians since Cheng Wuji and Xu Shuwei have failed to elucidate this. Some interpret the "Yin" in Yin Syndrome as Yin Cold, others as Ying Blood, others as the Three Yin meridians; discussions abound without a definitive conclusion. After repeated reflection, I conclude that the "Yin" in this Yin Syndrome refers to the Meridians. The Three Yang meridians have both Meridian and Fu aspects; the Three Yin meridians have both Meridian and Zang aspects. Disease in the Meridian allows for sweating but forbids purgation. If Wind-Cold remains in the Three Yin Meridians, the pathogen stays at the surface of the muscles; thus, early purgation causes Pi Qi. This means disease in the Meridian injures the Zang, causing the pathogen to enter and form Pi Qi. Therefore, if the pathogen is in the Three Yin Meridians, sweating is allowed; if it enters the Three Yin Zang organs, purgation is allowed; if it is in the Meridian but has not entered the Zang, purgation is forbidden. Thus, disease originating in Taiyin is still originating from the Yin Meridian; erroneously purging the Yin Meridian causes Pi Qi. Although this distinction is correct, regarding the "Three Yin," which includes Taiyin, Shaoyin, and Jueyin: Foot Jueyin is First Yin, Foot Shaoyin is Second Yin, and Foot Taiyin is Third Yin. When generally referred to as "Three Yin," does it mean Taiyin, Shaoyin, or Jueyin? Cold damage pathogens begin with the Foot Taiyang Bladder Meridian of the Three Yang; the Bladder is the head of the Three Yang. If the pathogen is in the Three Yang meridians, sweating is indicated, but erroneous purgation causes Jie Xiong. The Three Yin meridians begin with the Foot Taiyin Spleen Meridian; the Spleen is the head of the Three Yin. If the pathogen is in the Foot Taiyin Spleen Meridian, sweating is indicated and purgation is forbidden; erroneous purgation causes Pi Qi. Thus, "Yin" here refers to the Taiyin Spleen Meridian. Wang Haizang discussed Pi Qi with Li Dongyuan, stating it arises from blood and should be treated by benefiting the Central Region (Zhong Zhou). The Central Region is the Spleen. The Spleen can be tonified but not purged; tonifying when purgation was needed leads to Pi Qi. This is what is meant.