夫病有虚实寒热之殊，故药有补泻温凉之别。若虚中挟实，实中挟虚，寒因热化，热因
寒化
，上寒下热，上热下寒。其症种种不同，则临证用药之法，不可不知。昔韩懋之嫂口舌唇皆
疮，或至封喉，下部虚脱，白带如注，医或投凉剂解其上，则下部疾愈甚。或投热剂，及以
汤药熏蒸其下，则热晕欲绝。懋曰∶此亡阳症也，以盐煮附子为君，制以薄荷防风，佐以姜
桂芎归，水煎后，入井冰冷与之，未尽剂即少瘥。或问其故曰∶真对真，假对假。上乃假热
，故以假冷之药从之。下乃真寒，故以真热之药反之。斯上下和而病解矣。此治假热真寒之
法也。张锐治蔡鲁公孙妇产后次日大泄，而喉闭不入食，众医曰∶二疾若冰炭，虽司命无如
之何。张曰∶无忧也，取药数十粒使吞之，咽喉即通，下泄亦止。鲁公奇之，张曰∶此于经
无所载特以意处之。向者所用药，乃附子理中丸，裹以紫雪耳。方喉闭不通，非至寒之药不
为用。既下咽，则消释无余。其得至腹中者，附子力也，故一服而两疾愈，此寒热并治之法
也。罗谦甫治一妇肝脾郁结，午前用补中益气汤下六味丸，午后用逍遥散下归脾汤，此气血
并治之法也。谦甫又治一妇，肝脾气滞，与归脾汤下芦荟丸，此补泻兼施之法也。薛新甫治
一妇怒气伤肝，气血俱虚，朝用逍遥散，夕用归脾汤。又治一妇郁怒伤肝脾，朝用归脾汤，
夕用逍遥散。盖一则肝阴大损，故先用逍遥以达木性，次用归脾以补其土，使木不能克制。
一则脾土既为肝木所克，故先用归脾以扶衰敌强，次用逍遥以疏其气，使木性得畅，土不复
克，此治标治本先后次序之法也。李东垣治息贲伏梁诸丸，初令服二丸，一日加一丸，二日
加二丸，加至大便微溏为度。再从二丸加服，周而复始，俟积消大半而止。盖恐病浅药深，
转伤正气，故必逐渐增添，此由少加多之法也。李士材制阴阳二积之剂，补中数日，然后攻
伐，不问积去多少，再与补中，待其神旺，则复攻之，屡攻屡补，以平为期。此攻补迭用之
法也。余本各法以治目疾，应手辄效。尝治沈某目红壅肿，眵泪如脓，口干唇燥，小便赤涩
，此一水不能胜五火也。第降其火，则水不即生，第滋其水，则火不遽息。乃以六味作汤下
青宁丸，火清而水亦壮。又姚某右目为苗叶针伤，白障满泛，疼痛不止，当以活血为本，治
气为标，乃朝用四物汤，加苏木、红花、乳香、没药、 虫，以行其血，夕用沉香越鞠丸，
以通其气。又干某痘后，两睥生癣，此因虚郁热停滞脾胃，当以扶脾为本，清热为标，乃朝
用六君子去甘草，加升麻望月砂杏仁，以健脾润肺，夕用清目散，以泻火。又李某两目赤障
，昼则时痛时止，此阳不和也，乃朝用香砂六君子，以和其阳。然上焦郁气未通，再用搐鼻
碧云散，以达其气。又马某两目赤翳，夜则时痛时止，此阴不和也。余用补肝散合四物汤，
以和其阴。然浮火上升，不可不降，再用熟地附子捣烂，涂涌泉穴，以降其浮游之火。又刘
某两目昏 ，胸膈郁闷，无事生怒，此肾水不能生肝木也，余用左归饮下越鞠丸，则壮水之
中兼解其郁。丹此阴阳互济，气血并调，虚实兼治，诸法不能遍举，略述数条，以待学人隅
反。或曰何不合一汤以治之？余曰不然。用药之法，同于用兵，譬如两枝兵合路而来，则合
师以剿，自可奏功。若东一支兵，西一支兵，分路来犯，若合师以剿，东驰西走，力不能专
，何如分师进取各奏成功。然而奇正相生，各存乎人，总期变通尽利。故兵法曰∶多算胜者
，少算不胜也。
疾病有虚证、实证、寒证、热证的区别，因此药物也有补益、泻下、温性、凉性的不同。如果虚证中夹杂实证，或实证中夹杂虚证，寒证因热而转化，热证因寒而转化，或者上寒下热、上热下寒。这些症状种种不同，那么临证用药的方法，是不可不知道的。
从前韩懋的嫂子口、舌、唇都生疮，甚至堵塞咽喉，下部虚脱，白带如注。医生如果投用凉剂来解除上面的热症，则下部的病会更加严重；如果投用热剂，并用汤药熏蒸下部，则会导致头晕欲绝。韩懋说：“这是亡阳症。”他用盐煮附子作为主药，用薄荷、防风来制约它，用干姜、肉桂、川芎、当归作为佐药，水煎后，放入井水中冷却后给病人服用。药未服完，病情就稍微缓解。有人问他原因，他说：“真对真，假对假。上部是假热，所以用假冷的药顺从它；下部是真寒，所以用真热的药对抗它。”这样上下调和，病就好了。这是治疗假热真寒的方法。
张锐治疗蔡鲁公的孙媳妇，产后第二天出现严重腹泻，且咽喉闭塞无法进食。众医生说：“这两种病像冰和炭一样矛盾，即使是神医也无能为力。”张锐说：“不用担心。”取几十粒药让病人吞服，咽喉随即通畅，腹泻也停止了。鲁公感到惊奇，张锐说：“这在经典中没有记载，我是凭意理解治疗的。之前所用的药，其实是附子理中丸，外面包裹着紫雪罢了。当咽喉闭塞不通时，非至寒之药不能发挥作用。一旦咽下，药力便消散无余。能到达腹中的，是附子的力量，所以一服药后两种病都好了。”这是寒热并治的方法。
罗谦甫治疗一位妇女肝脾郁结，上午服用补中益气汤送服六味地黄丸，下午服用逍遥散送服归脾汤，这是气血并治的方法。罗谦甫又治疗一位妇女，肝脾气滞，给予归脾汤送服芦荟丸，这是补泻兼施的方法。
薛新甫治疗一位妇女，因怒气伤肝，导致气血俱虚，早晨服用逍遥散，晚上服用归脾汤。他又治疗一位妇女，因郁怒伤及肝脾，早晨服用归脾汤，晚上服用逍遥散。这是因为第一种情况肝阴大损，所以先用逍遥散以疏达肝木之性，再用归脾汤以补益脾土，使肝木不能克制脾土。第二种情况脾土已经被肝木所克，所以先用归脾汤扶助衰弱的脾土以对抗强盛的肝木，再用逍遥散疏解气机，使肝木之性得以舒畅，脾土不再受克。这是治标与治本先后次序的方法。
李东垣治疗息贲、伏梁等积聚病症所用的丸药，起初令病人服用两丸，第一天加一丸，第二天加二丸，增加到大便微溏为止。然后再从两丸开始加服，周而复始，等到积滞消除大半时停止。这是担心病轻药重，反而损伤正气，所以必须逐渐增加剂量，这是由少到多的方法。
李士材制定治疗阴阳二积的方剂，先补益数日，然后攻伐，不问积滞去除多少，再给予补益，待病人精神旺盛，再行攻伐，屡攻屡补，以平衡为准则。这是攻补交替使用的方法。
我根据各种方法来治疗眼疾，往往应手见效。曾经治疗沈某眼睛红肿胀痛，眼屎流泪如脓，口干唇燥，小便赤涩，这是肾水不能胜五火（心肝脾肺肾之火）。如果只降火，则水不能立即生成；如果只滋水，则火不能立即熄灭。于是用六味地黄丸作汤剂送服青宁丸，火清而水亦壮盛。
又治疗姚某右目被苗叶针伤，白障满泛，疼痛不止，应当以活血为本，治气为标。于是早晨服用四物汤，加入苏木、红花、乳香、没药、䗪虫，以行其血；晚上服用沉香越鞠丸，以通其气。
又治疗干某痘疹后，两眼睑生癣，这是由于虚郁热停滞在脾胃所致，应当以扶脾为本，清热为标。于是早晨服用六君子汤去甘草，加入升麻、望月砂、杏仁，以健脾润肺；晚上服用清目散，以泻火。
又治疗李某两眼赤障，白天时而疼痛时而停止，这是阳气不和，于是早晨服用香砂六君子汤，以调和其阳。然而上焦郁气未通，再用搐鼻碧云散，以通达其气。
又治疗马某两眼赤翳，夜间时而疼痛时而停止，这是阴气不和。我使用补肝散合四物汤，以调和其阴。然而浮火上升，不可不降，再用熟地黄、附子捣烂，涂于涌泉穴，以降其浮游之火。
又治疗刘某两眼昏花，胸膈郁闷，无故发怒，这是肾水不能生肝木所致，我使用左归饮送服越鞠丸，则在壮水之中兼解其郁结。
以上是阴阳互济，气血并调，虚实兼治，诸法不能一一列举，略述数条，以待学习者举一反三。有人说为什么不合并成一剂汤药来治疗？我说不是这样的。用药的方法，如同用兵打仗。譬如两支军队合路而来，则合并军队剿灭，自然可以成功。如果是东边一支兵，西边一支兵，分路来犯，若合并军队剿灭，则东驰西走，力量不能专注，不如分兵进取，各自取得成功。然而奇正相生，各存乎人，总期变通尽利。所以兵法说：“多算胜者，少算不胜也。”
Diseases differ in deficiency (Xu), excess (Shi), cold (Han), and heat (Re); therefore, medicines differ in tonifying (Bu), purging (Xie), warming (Wen), and cooling (Liang). If a deficiency pattern is complicated by excess, or an excess pattern by deficiency; if cold transforms due to heat, or heat transforms due to cold; or if there is cold above and heat below, or heat above and cold below—the symptoms are various. Thus, the methods of prescribing medication in clinical practice must be understood.
In the past, the sister-in-law of Han Mao suffered from sores on her mouth, tongue, and lips, extending to block the throat, while suffering from lower body deficiency collapse and profuse leukorrhea like a gush. Physicians who administered cooling agents to resolve the upper heat found that the lower pathology worsened. Those who administered heating agents or fumigated the lower body with decoctions caused dizziness and near-syncope. Han Mao stated, "This is Yang exhaustion (Wang Yang)." He used salt-processed Fuzi (Prepared Aconite Root) as the sovereign drug, moderated it with Bohe (Mint) and Fangfeng (Saposhnikovia Root), assisted by Jiang (Dried Ginger), Rougui (Cinnamon Bark), Chuanxiong (Ligusticum Rhizome), and Danggui (Angelica Sinensis Decoction). The decoction was cooled in well water before administration. Before the dose was finished, the condition improved slightly. When asked for the rationale, he replied: "True addresses true, false addresses false. The upper part presents false heat, so false-cold medicines are used to follow it. The lower part presents true cold, so true-hot medicines are used to counteract it." Thus, the upper and lower harmonized, and the disease resolved. This is the method for treating false heat and true cold.
Zhang Rui treated the granddaughter-in-law of Cai Lugong, who, the day after childbirth, suffered severe diarrhea and throat closure preventing food intake. Other physicians said, "These two ailments are like ice and charcoal; even a life-saving deity could do nothing." Zhang Rui said, "Do not worry." He took dozens of pills for her to swallow; immediately, her throat opened, and the diarrhea stopped. Mr. Cai was amazed. Zhang Rui explained, "This is not recorded in the classics; I treated it based on my understanding. The medicine previously used was actually Fuzi Lizhong Wan (Aconite Pill to Regulate the Middle), wrapped in Zixue (Purple Snow). When the throat was closed, only extreme cold medicines would be effective. Once swallowed, the effect dissipated completely. What reached the abdomen was the power of Fuzi, so one dose cured both ailments." This is the method of treating cold and heat simultaneously.
Luo Qianfu treated a woman with Liver-Spleen Qi stagnation and depression. In the morning, he prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) followed by Liuwei Wan (Six-Ingredient Pill with Rehmannia); in the afternoon, Xiaoyao San (Free and Easy Wanderer Powder) followed by Guipi Tang (Restore the Spleen Decoction). This is the method of treating Qi and Blood simultaneously. Luo Qianfu also treated another woman with Liver-Spleen Qi stagnation, administering Guipi Tang followed by Lushui Wan (Aloe Pill). This is the method of combining tonification and purgation.
Xue Xinpu treated a woman whose anger injured the Liver, resulting in simultaneous deficiency of Qi and Blood. He prescribed Xiaoyao San in the morning and Guipi Tang in the evening. He also treated another woman whose depression and anger injured the Liver and Spleen, prescribing Guipi Tang in the morning and Xiaoyao San in the evening. In the first case, Liver Yin was severely damaged, so Xiaoyao San was used first to soothe the Liver Wood, followed by Guipi Tang to tonify Spleen Earth, preventing Wood from overacting on Earth. In the second case, Spleen Earth was already controlled by Liver Wood, so Guipi Tang was used first to strengthen the deficient Spleen against the strong Liver, followed by Xiaoyao San to soothe Qi, allowing Liver Wood to flow freely without suppressing Earth. This is the method of addressing symptoms and root causes in a specific sequence.
Li Dongyuan treated accumulations such as Xiben and Fuliang using pills. Initially, patients took two pills, increasing by one pill on the first day and two on the second, until stools became slightly loose. Then, they restarted from two pills, cycling repeatedly, stopping when the accumulation had reduced by more than half. This prevents heavy medication from damaging healthy Qi in mild cases, employing the method of gradual increase.
Li Shicai formulated agents for Yin and Yang accumulations. He would tonify for several days, then attack the accumulation. Regardless of how much was removed, he would resume tonification until the patient's spirit recovered, then attack again. This repeated cycle of attacking and tonifying continues until balance is achieved. This is the method of alternating attack and tonification.
I applied these methods to treat eye diseases with immediate efficacy. For example, Shen suffered from red, swollen eyes with purulent discharge, dry mouth and lips, and dark, scanty urine—a case where Kidney Water cannot control the Five Fires. Merely clearing fire does not generate water quickly; merely nourishing water does not extinguish fire abruptly. Therefore, I used Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) to administer Qingning Wan (Green Peace Pill), clearing fire while strengthening water.
Another case involved Yao, whose right eye was injured by a plant thorn, causing white opacities and unceasing pain. Treatment should focus on invigorating blood as the root and regulating Qi as the branch. I prescribed Siwu Tang (Four Substance Decoction) with Sumu (Calamus Wood), Honghua (Carthamus Flower), Ruxiang (Frankincense), Moyao (Myrrh), and E chong (Ground Beetle) in the morning to move blood, and Chenxiang Yueju Wan (Agarwood Free and Unstuck Pill) in the evening to regulate Qi.
Gan suffered from eyelid eczema after smallpox, caused by deficiency, stagnation, and heat lingering in the Spleen and Stomach. The root is supporting the Spleen; the branch is clearing heat. I prescribed Liujunzi Tang (Six Gentlemen Decoction) minus Gancao (Licorice), plus Shengma (Cimicifuga Rhizome), Wangyuesha (Hare Feces), and Xingren (Apricot Seed) in the morning to strengthen the Spleen and moisten the Lungs, and Qingmu San (Clear Eye Powder) in the evening to drain fire.
Li suffered from red opacities in both eyes, with intermittent pain during the day, indicating disharmony of Yang. I prescribed Xiangsha Liujunzi Tang (Atractylodes and Amomum Six Gentlemen Decoction) in the morning to harmonize Yang. However, since Upper Jiao Qi stagnation remained unresolved, I also used Biyun San (Blue Cloud Powder) insufflated into the nose to diffuse Qi.
Ma suffered from red pterygium in both eyes, with intermittent pain at night, indicating disharmony of Yin. I used Bugan San (Tonify Liver Powder) combined with Siwu Tang to harmonize Yin. However, floating Fire ascends and must be descended, so I applied cooked Shudi (Prepared Rehmannia Root) and Fuzi (Prepared Aconite Root) mashed together to the Yongquan acupoint (KI1) to descend floating Fire.
Liu suffered from blurred vision, chest oppression, and irritability, caused by Kidney Water failing to nourish Liver Wood. I used Zuogui Yin (Left Restoring Decoction) administered with Yueju Wan to strengthen Water while resolving stagnation.
These examples illustrate mutual assistance between Yin and Yang, simultaneous regulation of Qi and Blood, and combined treatment of deficiency and excess. Not all methods can be listed here; I have briefly described a few to help students infer others from one instance. Some ask, "Why not combine everything into one decoction?" I reply: Prescribing is like military strategy. If two armies approach along the same path, merging forces to attack ensures success. But if enemies attack from east and west separately, merging forces leads to scattered efforts and lack of focus. It is better to divide forces to achieve victory in each theater. Yet, orthodox and unorthodox tactics vary by individual, aiming for maximum flexibility. As the Art of War states: "He who calculates more wins; he who calculates less loses."