一、忌米汤。得谷者昌，百病之生死，判于胃气之存亡，犹之兵家饷道，最为要
事。惟时邪霍乱痧胀，独不然者。以暑湿秽恶之邪，由口鼻吸入肺胃，而阻其气道之流行，
乃痞塞不通之病。故浊不能降而腹痛呕吐，清不能升而泄泻无嚏。或欲吐不吐，欲泻不泻，
而窃踞中枢。苟不亟为展化宣通，邪必由经入络，由腑入脏，而滋蔓难图矣。凡周时内，一口米汤下
咽，即胀逆不可救者，正以谷气入胃，长气于阳。况煮成汤液，尤能闭滞隧络，何异资寇兵
而盗粮哉。惟吐泻已多，邪衰正夺者，犹之寇去民穷，正宜抚恤。须以清米汤温饮之，
以为接续，不可禁之太过，反致胃气难复。知所先后，则近道矣。
物性中和，莫如谷矣。为生人之至宝，乃霍乱痧胀邪热方张之际，不可一试。米汤如是，况
补
必同时而病，病不必皆成霍乱。既同时而病霍乱，岂非外邪为患。而流行渐广，遂成疫疠。
何司命者，尚不识其病情耶。凡一病有一病之宜忌，先议病，后议药，中病即是良药。故投
之而当，硝黄即是补药；投而不当，参术皆为毒药。譬如酒色财气，庸人以之杀生。而英雄
或以之展抱负，礼乐文章，圣人以之经世。而竖儒反以之误苍生。药之于医也，亦然。补偏救弊
，随时而中。病无定情，药无定性。顾可舍病而徒以药之纯驳为良毒哉。
或云∶扶阳抑阴，治世之道，古圣以之立教，景岳以之喻医。今人身不治，病乱于中，竟辟
温补扶阳。惟事清解助阴，毋乃偏任寒凉，将起后人之议乎？余曰∶扶阳抑阴，大易原以喻
君子小人。故章虚谷谓∶但可以论治世，不可以论治病。惜章氏尚一间未达也。夫人身元气
，犹阳也。外来邪气，犹阴也。扶正抑邪，岂必专藉热药哉？如热伤胃液，仲圣谓之无阳矣
。然欲扶其阳，必充其液。欲抑其阴，须撤其热。虽急下曰存阴，而急下者，下邪也。下邪即是
抑阴。存阴者，存正也。存正即是扶阳，苟知此义，则易理医理，原一贯也。设但泥温补为
扶阳之药，而不知阴阳乃邪正之喻。虽满腹经纶，无非是苍生之罗网，治人治世，无二致也
或又曰∶丹溪谓人身阴不足，景岳谓人身阳不足。君以为孰是，余谓人身一小天地，试以天
地之理论之，阴阳本两平，而无偏也。故寒与暑为对待，昼与夜为对待，然雨露之滋，霜雪
之降，皆所以佐阴之不足，而制阳之有余。明乎此，则朱张之是非判矣。或又曰∶子言扶正
即是扶阳，则补阴补阳，皆扶阳也。抑阴即是抑邪，则逐寒逐热，皆抑阴也。顾专事逐邪
，不崇补正，得毋未合扶阳抑阴之旨乎？余因述先慈之训以答，曰∶无论外感，不可妄投温补。
即
思义，则纯虚之证殊少也。徐洄溪亦云∶大凡人非老死即病死，其无病而虚死者，千不得一
。况病去则虚者亦生，病留则实者亦死。故去病正以扶阳也。余尝谓人气以成形耳。法天
行健，原无一息之停。惟五气外侵，或七情内扰，气机愆度，疾病乃生。故虽在极虚之人，既病
即为虚中有实，即酷暑严寒，人所共受，而有病有不病者，不尽关乎老少强弱也。以身中之气，有
愆有不愆也。愆则邪留，着而为病；不愆则气默，运以潜消。调其愆而使之不愆，治外感
内伤诸病，无余蕴矣。霍乱云乎哉。
（不惜倾筐倒箧而出之，嘉惠后学之心至矣。读此而犹不悟，请勿从事于此道也。
随园云∶人之气血，有塞滞之处，则其壮者，为痈疽。而其弱者，为劳瘵。余尝佩服以为名
言。今读此论，与二语正相合，定州杨照藜素园。）
或又曰∶经言邪之所凑，其气必虚，亦不然乎？曰∶人身气血，原有强弱，强者，
未必皆寿。弱者，未必皆夭。正以气血虽强，设为邪凑，而流行愆度，似乎虚矣。不去其邪
，则病愈实而正愈虚，驯致于死，虽强而夭折矣。气血虽弱，不为邪凑，则流行不愆，不觉其
虚，即为邪凑，但去其邪，则病不留，而正自安，虽弱亦得尽其天年矣。使看勇如贲育之人，
身躯不觉其重大者，以正气健行不息也。卒受痧邪，亦遂肢冷脉伏告毙者，以气为邪闭，而
血肉即死也。所谓邪之所凑，其气必虚者，当作如是解。凡治此证者，将急开其闭，以宣通
乎。抑从而下石，更投补塞乎。不但痧证尔也。凡病未去而补之，则病处愈实。未病处必愈虚
，以未病处之气血，皆挹而注于病处也。盖所谓补药者，非能无中生有，以增益人身气血也
。不过具衰多益寡，挹彼注此之能耳。平人服之，尚滋流毙，况病
人乎。故经言不能治其虚，焉
财
为务，有入而无出，甚则坎土穴墙以藏埋之。是故一人小积，则受其贫者百家。一人大积，则
受其贫者万家。虽然吝者之积财，以为久聚而不散矣。祸灾之来，兵寇之攻，取百年之财，
一日而尽之，安见其果不出也。治国者，若以积财为务，必至四海困穷，天禄永终。是天下
之财源，如人身之气血，俾得流通灌注，病自何来？故因论霍乱而并及之。
（吾叔于道光间，辑裕后须知书，以励末俗。因采魏昭伯奢吝说一条，颇招訾议。
讵十余年来，其言辄应，可慨也已。至于治虚，尤独擅一时。忆丁巳春烈年二十七，在上海患
吐血，诸医用清火补阴等药，久治不瘥，势濒于殆。返杭求诊，投大剂参 ，数服而痊。迄
今无恙，且茁实胜于曩时，虽流离播越，尚能胜任也。今读此论，谨书以识感佩之忱。绍武。
（今夏先生来申，适谟患身热便泻口干。幸能纳食，仍强起任事。先生察脉弦大。曰∶此忧
劳过甚，元气大亏之证也。投大剂参、术、苓、草、防、芍、橘、斛、木瓜，旬日而痊。即
旋里省亲，逾月抵沪，患寒热。先生视为暑湿类疟，授清化药，四贴霍然。但觉疲惫，仍以参
、、甘、柏等峻补而瘳。治虚独擅一时，岂不信哉？归安陈廷谟半樵。）
二、忌姜糖。徐氏云∶如有暑邪，姜断不可用。虽与芩、连并行，亦不可也。况
独姜汤乎？惟初起挟寒者，或可量证略用些须。糖助湿热而腻滞满中，误用之，反为秽浊之
邪竖帜矣。不但增其呕吐已也，推而至于枣子、龙眼、甘草一切甜腻守滞之药，类可知矣。
三、忌热汤、酒醴、澡浴，此三者，皆驱寒之事也。寒伤形，则客邪在表，饮以热汤酒醴，
或暖房澡浴，皆可使寒邪从汗而解也。故表散寒邪之药，每佐甘草、姜、枣之类。俾助中
气以托邪外出，亦杜外邪而不使内入。若暑湿热疫秽恶诸邪，皆由口鼻吸入，直伤气分，而渐
入营分。亟宜清凉疏沦，俾气展浊行，邪得下走，始有生机。不但辛温甘腻一概忌投，即热
汤酒醴澡浴，皆能助热焰之披猖，不可不严申厉禁也。
四、慎痧丸。痧药方最多，而所主之证不一。有宜于暑热病者，有宜于寒湿病者，岂可随便
轻尝耶？更有不经之方，群集猛厉之品，杂合为剂。妄夸无病不治，而好仁不好学人，广制
遍送，间有服之亦效者。大抵皆强壮之人，风餐露宿为病也。概施于人，多致轻者重，而重
者死矣。故服药难，施药不易。必也择方须良，择药须精。刊列证治，须分寒热，实心实力行
之，斯有功而无弊焉。如酷暑烈日之中，路途卒倒者，虽不可以霍乱痧胀名之，而其病较霍
乱痧胀为尤剧。设以泛泛痧药治之，每致不救。或口鼻出血而死，此为暑邪直入心包络，必以
紫雪灌之始效，然此药贵重难得，有力者能备以济世，必有善报也。凡阴虚内热之人，或新产
血去，阴阳之后，酷热之时，虽不出户庭，亦有患此者，余见屡矣。详三篇《梦影》中。
五、慎延医。医之用药，犹将之用兵。食禄之将，尚鲜其良。谋食之医，宜乎其陋。然十室
之邑，必有忠信如某者矣。语云∶为人子者，不可不知医，要在平时留意，知其有活人之术
，而非道听途说者流，则有病时，方可以性命托之。知其有用兵之才，而非惜死爱钱之辈，
则有寇时，方可以土地民众托之。噫！难矣。
六、慎服药。选医难如选将，选得矣。或徒有虚名而无实学，或饱学而非通才，或通才而
无卓识，或见到而
。然则如何而可服其药耶？但观其临证时，审问精详。心思周到，辨证剀切，方案明通，言
词慷爽近情，举止落落大方者。虽向未谋面之人，亦一见而知为良医矣。其药可服也。
七、宜凉爽。霍乱痧胀，流行成疫，皆热气病气，酝酿使然。故房中人勿太多，门窗勿闭，
得气有所泄也。盖覆勿浓，总以病患不觉冷为度。昧者不知，强加衣被，而致烦躁昏瞀者，
甚多也。如楼居者，必移榻清凉之所。势剧者，宜铺席于阴凉干燥泥地上卧之，热气得土而自消
也。凡见路途卒倒之人，纵无药赠，但能移之阴处，即是一服清凉散也。吐泻秽浊，随时扫
除净尽。毋使熏触病患与旁人，医来时尤宜加意。否则臭难向迩。如何息心静气以辨证耶？
八、宜镇静。凡患急证，病患无不自危，旁人稍露张皇。病者逆谓必死，以致轻者重，而重
者遂吓杀矣。盖人虽寿至百龄，未有不贪生畏死者，此人之情也。故近情之医，虽
临危证，非病患耳聋者，必不当面言凶。亲友切勿交头接耳，以增病患之惧。妇女更勿颦眉
掩泪，以致弄假成真。
九、宜泛爱。凡患急证，生死判乎呼吸，苟不速为救治，病必转入转深。救治而少周详，或
致得而复失，骨肉则痛痒相关，毋庸勉强。最苦者，贫老无根据，经商旅贾，舟行寄庑，举目无
亲。惟望邻友多情，居停尚义，解囊出力，起此危 。
十、保胎孕。凡怀妊于夏月而陡患腹痛者，虽在临贫之际，先须握其手而指尖不冷，抚其额
而身不发热者，方是将娩之痛。否则即是痧患。而痧药类多妨孕，概勿轻试。余每以晚蚕沙
及雪羹治之，无不立效。挟寒者，紫苏、砂仁、香附、橘红之类可用。设患霍乱重证，先取
井底泥，敷心下及丹田，再用卷而未舒之嫩荷叶，焙干五钱，蚌粉减半共研，新汲水入蜜
调服三钱。并涂腹上，名罩胎散。若系寒霍乱，用伏龙肝研末，水和涂脐方寸，干即再涂。服药尤须加慎，一切伤胎之
品，均不可用。回阳膏亦不可贴。
一、忌喝米汤。俗话说“得谷者昌”，百病的生死存亡，取决于胃气的有无，这就像兵家的粮道一样，是最为重要的事。然而对于时行邪气引起的霍乱和痧胀，情况却并非如此。因为暑湿秽恶的邪气，从口鼻吸入肺和胃，阻碍了气道的气机流行，这是一种痞塞不通的病证。所以浊气不能下降导致腹痛呕吐，清气不能上升导致泄泻无喷嚏（或指气机不宣）。或者想吐吐不出，想拉拉不出，邪气窃据在中焦枢纽位置。如果不赶紧进行展化宣通的治疗，邪气必定由经入络，由腑入脏，从而蔓延难治。在发病的一周内，如果有一口米汤咽下，就会导致腹胀气逆不可救治，正是因为谷气进入胃中，助长了阳热之气。况且煮成的米汤，更能闭滞经络隧道，这与资助敌人的兵力和粮食有什么区别呢？只有当吐泻已经很多，邪气衰退而正气耗夺的时候，才像寇盗离去百姓贫困一样，正宜安抚救济。此时可以用清米汤温着饮用，作为接续滋养，但不能禁止得太过头，反而导致胃气难以恢复。懂得先后的次序，就接近医道了。
食物的性质中和，没有比谷物更平和的了。它是人类的至宝，但在霍乱、痧胀邪热正盛的时候，不可尝试。米汤尚且如此，何况其他补药呢？病不一定与季节同时发生，发生也不一定都成为霍乱。既然同时发生霍乱，难道不是外邪为患吗？而且流行逐渐广泛，遂成疫疠之症。为什么掌管生死的医生，还不认识这种病情呢？凡是有一种病，就有一种病的适宜与禁忌，先议病，后议药，对症就是良药。所以投药得当，硝石、大黄也是补药；投药不当，人参、白术都是毒药。这就好比酒色财气，庸人用它来杀身，而英雄或许用它来施展抱负；礼乐文章，圣人用它来治理天下，而迂腐的儒生反而用它来误害苍生。药物对于医学来说，也是如此。纠正偏颇，补救弊病，要随时而中肯。病情没有固定的情状，药物也没有固定的定性。怎么能抛开病情，仅仅以药物的纯杂来判断良毒呢？
有人说：扶阳抑阴，是治理世道的道理，古代圣人用它来立教，张景岳用它来比喻医学。现在人身不正，病乱于中，竟然排斥温补扶阳，只从事清热解表、辅助阴液的方法，这未免偏任寒凉，将会引起后人的议论吗？我说：扶阳抑阴，《易经》原本是用来比喻君子与小人的。所以章虚谷说：这只能用来论治理世道，不可以用来论治病。可惜章氏还有一层意思没通达。人体的元气，就像阳；外来邪气，就像阴。扶助正气抑制邪气，难道一定要专门依靠热性药物吗？比如热邪伤了胃液，仲景称之为“无阳”。然而想要扶助其阳，必须充盈其津液。想要抑制其阴，必须撤除其热邪。虽然急下法叫做“存阴”，但急下是为了下邪。下邪就是抑阴。存阴，就是存正。存正就是扶阳。如果懂得这个道理，那么易理和医理，原本就是一贯的。假如只拘泥于温补药是扶阳的药物，而不知道阴阳是邪正的比喻，即使满腹经纶，也不过是苍生的罗网，治人与治世，没有两样。
又有人说：朱丹溪说人身阴不足，张景岳说人身阳不足。你认为谁对？我说：人身是一小天地，试着用天地的理论来分析，阴阳本是平衡的，没有偏颇。所以寒与暑是对立的，昼与夜是对立的，然而雨露的滋润，霜雪的降临，都是为了佐助阴的不足，而制约阳的有余。明白这一点，那么朱丹溪和张景谁的是非就判明了。又有人说：你说扶正即是扶阳，那么补阴补阳，都是扶阳。抑阴即是抑邪，那么逐寒逐热，都是抑阴。但是专门从事驱逐邪气，不推崇补益正气，岂不是不符合扶阳抑阴的宗旨吗？我于是叙述先母的教诲来回答，说：无论外感病，不可妄投温补。即使思考义理，纯虚的证候也很少。徐灵胎也说：大凡人不是老死就是病死，没有生病而因虚死去的，一千个里面得不到一个。况且病去则虚者也能生，病留则实者也会死。所以祛病正是为了扶阳。我曾经说人气形成形体罢了。效法天道运行刚健，原无一息停止。只是五气外侵，或七情内扰，气机失常，疾病才产生。所以即使在极虚的人身上，既病之后就是虚中有实。即使是酷暑严寒，人所共受，而有病和不病的区别，并不完全关乎老少强弱。是因为体内之气，有失常有不失常。失常则邪气停留，附着而为病；不失常则气默运，潜消于无形。调理其失常使之不失常，治疗外感内伤诸病，就没有什么遗漏了。霍乱又算什么呢？
（不惜倾尽所有知识传授出来，嘉惠后学的心意到了极点。读到这里如果还不醒悟，请不要从事这个道业了。）
随园说：人的气血，有堵塞停滞的地方，那么强壮的人，会得痈疽；虚弱的人，会得劳瘵。我曾经佩服这是名言。现在读这篇论述，与这两句话正好相合。（定州杨照藜素园 识）
又有人说：经文说“邪之所凑，其气必虚”，也不是这样吗？我说：人身气血，原有强弱，强的，未必都长寿；弱的，未必都夭折。正因为气血虽强，如果被邪气侵袭，而流行失常，似乎就虚了。不去除邪气，则病愈实而正愈虚，逐渐导致死亡，虽然强也会夭折。气血虽弱，不被邪气侵袭，则流行不失常，不觉其虚，即使被邪气侵袭，只要去除邪气，则病不留，而正气自安，虽然弱也能尽其天年。让看勇士如孟贲、夏育那样的人，身躯不觉其重大，是因为正气健行不息。突然受到痧邪，也就会肢冷脉伏而死，是因为气被邪气闭塞，而血肉即死。所谓“邪之所凑，其气必虚”，应当这样理解。凡是治疗这种证候的，是将急开其闭塞，以宣通气机呢，还是顺水推舟，更投补塞的药呢？不仅仅是痧证如此。凡是病未去而补之，则病处愈实。未病处必愈虚，因为未病处的气血，都被汲取而灌注到病处去了。所谓的补药，并不是能无中生有，以增益人身气血。不过是具有衰多益寡，汲取彼处补充此处的能力罢了。平人服用，尚且滋生流弊，何况病人呢？所以经文说不能治其虚，焉...（此处原文似有缺漏或错字，结合上下文意为：如果只知补虚而不祛邪，就像只积聚财富而不流通，最终会导致困穷甚至死亡）。这是为了务求有入无出，甚则像坎土穴墙以藏埋尸体。所以一个人小积财，则受其贫者百家；一个人大积财，则受其贫者万家。虽然吝啬者的积聚财物，以为长久聚集而不散。祸灾来临，兵寇攻击，取百年之财，一日而尽，怎么见其果不出也。治国者，如果把积聚财富作为任务，必致四海困穷，天禄永终。是天下的财源，如人身的气血，使得流通灌注，病从何而来？所以因论霍乱而一并提及。
（我的叔父在道光年间，编辑《裕后须知》一书，以激励末俗。因此采录魏昭伯奢吝说一条，颇招非议。岂料十余年来，他的话应验了，可叹啊。至于治疗虚证，尤其独擅一时。记得丁巳年春天，我二十七岁，在上海患吐血，众医用清火补阴等药，久治不愈，势濒于危殆。返回杭州求诊，投以大剂人参，数服而痊愈。至今无恙，且身体壮实胜过从前，虽然流离播迁，尚能胜任工作。今读此论，谨书以记录感激佩之情。（绍武 识）
（今年夏天先生来到上海，适逢谟患身热便泻口干。幸能纳食，仍强起工作。先生察脉弦大。说：这是忧劳过甚，元气大亏的证候。投以大剂人参、白术、茯苓、甘草、防风、芍药、橘皮、石斛、木瓜，旬日而痊愈。随即回乡省亲，逾月抵沪，患寒热。先生视为暑湿类疟，授以清化药，四贴霍然。但觉疲惫，仍以人参、...、甘草、柏子仁等峻补而愈。治疗虚证独擅一时，岂能不信呢？（归安陈廷谟半樵 识））
二、忌姜糖。徐氏说：如有暑邪，姜断不可用。即使与黄芩、黄连并行，也不可用。何况单独喝姜汤呢？只有初起挟寒者，或许可以量证略用少许。糖助湿热而腻滞满中，误用之，反为秽浊之邪竖帜了。不但增加其呕吐而已，推而至于枣子、龙眼、甘草一切甜腻守滞之药，类可知矣。
三、忌热汤、酒醴、澡浴，这三者，都是驱寒的方法。寒伤形，则客邪在表，饮以热汤酒醴，或暖房澡浴，皆可使寒邪从汗而解也。所以表散寒邪之药，每佐甘草、姜、枣之类。俾助中气以托邪外出，亦杜外邪而不使内入。若暑湿热疫秽恶诸邪，皆由口鼻吸入，直伤气分，而渐入营分。亟宜清凉疏沦，俾气展浊行，邪得下走，始有生机。不但辛温甘腻一概忌投，即热汤酒醴澡浴，皆能助热焰之披猖，不可不严申厉禁也。
四、慎痧丸。痧药方最多，而所主之证不一。有宜于暑热病者，有宜于寒湿病者，岂可随便轻尝耶？更有不经之方，群集猛厉之品，杂合为剂。妄夸无病不治，而好仁不好学人，广制遍送，间有服之亦效者。大抵皆强壮之人，风餐露宿为病也。概施于人，多致轻者重，而重者死矣。故服药难，施药不易。必也择方须良，择药须精。刊列证治，须分寒热，实心实力行之，斯有功而无弊焉。如酷暑烈日之中，路途卒倒者，虽不可以霍乱痧胀名之，而其病较霍乱痧胀为尤剧。设以泛泛痧药治之，每致不救。或口鼻出血而死，此为暑邪直入心包络，必以紫雪灌之始效，然此药贵重难得，有力者能备以济世，必有善报也。凡阴虚内热之人，或新产血去，阴阳之后，酷热之时，虽不出户庭，亦有患此者，余见屡矣。详三篇《梦影》中。
五、慎延医。医之用药，犹将之用兵。食禄之将，尚鲜其良。谋食之医，宜乎其陋。然十室之邑，必有忠信如某者矣。语云：为人子者，不可不知医，要在平时留意，知其有活人之术，而非道听途说者流，则有病时，方可以性命托之。知其有用兵之才，而非惜死爱钱之辈，则有寇时，方可以土地民众托之。噫！难矣。
六、慎服药。选医难如选将，选得矣。或徒有虚名而无实学，或饱学而非通才，或通才而无卓识，或见到而...（原文此处似有缺漏，推测为“或见到而不能决”之类）。然则如何而可服其药耶？但观其临证时，审问精详。心思周到，辨证剀切，方案明通，言辞慷爽近情，举止落落大方者。虽向未谋面之人，亦一见而知为良医矣。其药可服也。
七、宜凉爽。霍乱痧胀，流行成疫，皆热气病气，酝酿使然。故房中人勿太多，门窗勿闭，得气有所泄也。盖覆勿浓，总以病患不觉冷为度。昧者不知，强加衣被，而致烦躁昏瞀者，甚多也。如楼居者，必移榻清凉之所。势剧者，宜铺席于阴凉干燥泥地上卧之，热气得土而自消也。凡见路途卒倒之人，纵无药赠，但能移之阴处，即是一服清凉散也。吐泻秽浊，随时扫除净尽。毋使熏触病患与旁人，医来时尤宜加意。否则臭难向迩。如何息心静气以辨证耶？
八、宜镇静。凡患急证，病患无不自危，旁人稍露张皇。病者逆谓必死，以致轻者重，而重者遂吓杀矣。盖人虽寿至百龄，未有不贪生畏死者，此人之情也。故近情之医，虽临危证，非病患耳聋者，必不当面言凶。亲友切勿交头接耳，以增病患之惧。妇女更勿颦眉掩泪，以致弄假成真。
九、宜泛爱。凡患急证，生死判乎呼吸，苟不速为救治，病必转入转深。救治而少周详，或致得而复失，骨肉则痛痒相关，毋庸勉强。最苦者，贫老无根据，经商旅贾，舟行寄庑，举目无亲。惟望邻友多情，居停尚义，解囊出力，起此危...（原文此处似有缺漏，推测为“起此危难”）。
十、保胎孕。凡怀妊于夏月而陡患腹痛者，虽在临贫之际（此处“临贫”疑为“临盆”之误），先须握其手而指尖不冷，抚其额而身不发热者，方是将娩之痛。否则即是痧患。而痧药类多妨孕，概勿轻试。余每以晚蚕沙及雪羹治之，无不立效。挟寒者，紫苏、砂仁、香附、橘红之类可用。设患霍乱重证，先取井底泥，敷心下及丹田，再用卷而未舒之嫩荷叶，焙干五钱，蚌粉减半共研，新汲水入蜜调服三钱。并涂腹上，名罩胎散。若系寒霍乱，用伏龙肝研末，水和涂脐方寸，干即再涂。服药尤须加慎，一切伤胎之品，均不可用。回阳膏亦不可贴。
1. Avoid rice soup. As the saying goes, "He who obtains grain prospers." The life and death of all diseases depend on the existence or extinction of Stomach Qi (Stomach Energy), just as the supply line is the most critical matter for a military campaign. However, this does not apply to epidemic pathogens causing Huoluan (Cholera-like disease) and Shazhang (Sha distension). This is because the pathogenic factors of summer-heat, dampness, filth, and malodor are inhaled through the mouth and nose into the Lung and Stomach, obstructing the free flow of Qi in the air passages. It is a condition of blockage and obstruction. Therefore, turbid Qi cannot descend, leading to abdominal pain and vomiting; clear Qi cannot ascend, leading to diarrhea without sneezing (or indicating lack of Qi dissemination). Or there may be an urge to vomit but inability to do so, an urge to defecate but inability to do so, with the pathogen occupying the central pivot. If immediate measures to resolve transformation and promote circulation are not taken, the pathogen will enter the collaterals from the meridians, and the fu organs from the zang organs, becoming difficult to manage due to its spread. Within the first week of illness, if even a single mouthful of rice soup is swallowed, it leads to unbearable abdominal distension and rebellious Qi. This is precisely because grain Qi entering the Stomach generates Yang heat. Moreover, cooked liquid can further obstruct the channels and collaterals. What is the difference between this and supplying weapons and food to the enemy? Only when vomiting and diarrhea have been excessive, the pathogen has declined, and the healthy Qi has been depleted, resembling a situation where bandits have left and the people are impoverished, should one provide relief. At this stage, clear rice soup can be drunk warm to provide continuity of nourishment. One must not prohibit it too strictly, lest the Stomach Qi become difficult to restore. Understanding the sequence of priorities brings one close to the Dao of medicine.
Among foods, none is more neutral in nature than grains. They are the supreme treasure of human life, yet during the peak of pathogenic heat in Huoluan and Sha distension, they must not be tried. If rice soup is contraindicated, how much more so are tonics? Illness does not necessarily occur simultaneously with seasons, nor does every seasonal illness become Huoluan. Since Huoluan occurs simultaneously and spreads widely, forming epidemics, why do physicians fail to recognize the nature of this disease? Every disease has its specific indications and contraindications. One must discuss the disease before discussing the prescription; if the medication matches the disease, it is good medicine. Therefore, if administered correctly, Nuxiao (Mirabilite) and Huanglian (Coptis Rhizome - *Note: Text says Xiaoshi/Dahuang contextually implies purgatives like Mirabilite and Rhubarb*) act as tonics; if administered incorrectly, Renshen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome) act as poisons. Consider alcohol, lust, wealth, and anger: mediocre people use them to kill themselves, while heroes may use them to realize their ambitions. Rituals, music, literature, and essays allow sages to govern the world, but pedantic scholars misuse them to harm the common people. Medicines function similarly in medicine. Correcting deviations and remedying defects requires appropriateness to the time. Disease conditions are not fixed, nor are drug properties fixed. How can one discard the disease condition and judge drugs solely by their purity or impurity?
Some say: "Supporting Yang and suppressing Yin" is the way to govern the world, used by ancient sages to establish teachings, and Zhang Jingyue used it to metaphorize medicine. Now, with the body's imbalance and internal chaos, we reject warming and tonifying methods that support Yang, focusing only on clearing heat and assisting Yin. Is this not overly biased towards cold and cool herbs, inviting criticism from later generations? I reply: Supporting Yang and suppressing Yin in the *I Ching* (Book of Changes) was originally used to metaphorize gentlemen versus petty men. Thus, Zhang Xugu stated: "This can be used to discuss governing the world, but not to discuss treating disease." Unfortunately, Master Zhang did not fully grasp this point. Human Yuan Qi (Primal Qi) is like Yang; external pathogenic Qi is like Yin. To support healthy Qi and suppress pathogenic Qi, must one rely exclusively on hot herbs? For instance, when heat damages Stomach fluids, Zhongjing refers to this as "absence of Yang." However, to support its Yang, one must replenish its fluids. To suppress its Yin, one must eliminate its heat. Although urgent purgation is called "preserving Yin," urgent purgation targets the pathogen. Eliminating the pathogen is suppressing Yin. Preserving Yin is preserving Healthy Qi. Preserving Healthy Qi is supporting Yang. If one understands this principle, then the principles of the *I Ching* and medicine are consistent. If one merely sticks to warming and tonifying herbs as means to support Yang, without understanding that Yin and Yang are metaphors for Pathogen and Healthy Qi, then despite having extensive knowledge, one creates a trap for the people. Treating humans and governing the world follow the same logic.
Another asks: Zhu Danxi said the human body suffers from Yin deficiency; Zhang Jingyue said it suffers from Yang deficiency. Who is correct? I say: The human body is a small universe. Let us analyze it using the theory of heaven and earth. Yin and Yang are inherently balanced, without bias. Cold and summer-heat are opposites; day and night are opposites. Yet, the nourishment of rain and dew, and the descent of frost and snow, all serve to assist the insufficiency of Yin and restrain the excess of Yang. Understanding this clarifies the correctness or incorrectness of Zhu and Zhang. Another asks: You say supporting Healthy Qi is supporting Yang, so tonifying Yin and tonifying Yang are both supporting Yang. Suppressing Yin is suppressing the pathogen, so expelling cold and expelling heat are both suppressing Yin. But if one focuses solely on expelling the pathogen and does not advocate tonifying Healthy Qi, does this not contradict the principle of supporting Yang and suppressing Yin? I respond with my late mother's teaching: Regardless of external contraction, one must not recklessly administer warming and tonifying herbs. Even considering the principle, purely deficient syndromes are rare. Xu Lingtai also said: Generally, people die of old age or disease; those who die of deficiency without illness are less than one in a thousand. Moreover, when the disease leaves, the deficient person recovers; when the disease remains, the excess person dies. Therefore, removing the disease is precisely how one supports Yang. I once said that human Qi forms the body. Following the vigorous movement of Heaven, there is no moment of cessation. Only when the Five Qi invade externally, or Seven Emotions disturb internally, causing Qi mechanisms to deviate, do diseases arise. Thus, even in extremely deficient individuals, once ill, there is excess within deficiency. Whether enduring extreme heat or cold, everyone is exposed, yet some get sick and others do not; this depends not entirely on age or strength, but on whether the Qi within the body is in deviation or not. Deviation allows pathogen retention, attaching to cause disease; non-deviation allows Qi to operate silently, dissolving issues secretly. Regulating deviation to prevent it achieves the treatment of external and internal diseases without omission. What about Huoluan?
(Sharing all knowledge without reservation shows great benevolence towards future learners. If one reads this and still does not understand, do not engage in this profession.)
Suiyuan said: Where human Qi and Blood stagnate, the strong develop abscesses and ulcers, while the weak develop consumption and tuberculosis. I have always admired this as a profound statement. Reading this treatise aligns perfectly with these two sentences. (Yang Zhaoli, courtesy name Sulian, from Dingzhou)
Another asks: The classic states, "Where the pathogen gathers, the Qi must be deficient." Is this not true? I say: Human Qi and Blood naturally vary in strength. The strong are not necessarily long-lived; the weak are not necessarily short-lived. Precisely because even strong Qi, if invaded by pathogens, becomes deviated in flow, appearing deficient. If the pathogen is not removed, the disease becomes more excess and the Healthy Qi more deficient, eventually leading to death, causing premature demise despite initial strength. If Qi and Blood are weak but not invaded by pathogens, their flow is not deviated, and deficiency is not felt. Even if invaded, removing the pathogen ensures the disease does not linger, allowing Healthy Qi to remain at peace, enabling the weak to live out their natural lifespan. Consider brave warriors like Meng Ben and Xia Yu; their bodies do not feel heavy because Healthy Qi moves vigorously without stopping. Suddenly struck by Sha pathogen, they may die with cold limbs and hidden pulse because Qi is closed by the pathogen, causing flesh and blood to perish. Thus, "Where the pathogen gathers, the Qi must be deficient" should be interpreted this way. When treating such cases, should one urgently open the closure to promote circulation, or push the patient down further by administering blocking tonics? This applies not only to Sha syndromes. Whenever tonification is given while the disease remains, the diseased area becomes more excess, and unaffected areas become more deficient, as Qi and Blood from unaffected areas are drawn to the diseased site. Tonics do not create Qi and Blood from nothing; they merely redistribute, taking from the abundant to supplement the scarce. In healthy people, this causes problems; how much worse for patients? Thus, the classic warns against failing to treat deficiency properly... [Text fragment] ...leading to accumulation without expenditure, akin to burying oneself in a pit. A small hoarder impoverishes hundreds; a large hoarder impoverishes thousands. Though the miser believes wealth accumulates permanently, disaster and war can wipe out a century's wealth in a day. Does it truly stay? A ruler who focuses on hoarding wealth leads to universal poverty and the end of heavenly mandate. Just as national resources are like human Qi and Blood, allowing free circulation prevents disease. Hence, I mention this while discussing Huoluan.
(My uncle compiled the book *Yuhou Xuzhi* during the Daoguang era to encourage proper conduct among the lower classes. He included a passage on Wei Zhaobo's views on stinginess, which attracted criticism. Yet, over ten years later, his words proved prophetic, which is lamentable. Regarding the treatment of deficiency, he was uniquely skilled. I recall in the spring of the Dingsi year, at age twenty-seven, I suffered from hematemesis in Shanghai. Physicians used cooling fire and yin-tonifying herbs for a long time without success, and my condition became critical. Returning to Hangzhou for consultation, I was prescribed a large dose of Renshen (Ginseng Root). After several doses, I recovered. I remain healthy today, stronger than before, able to work despite displacement. Reading this treatise, I record this to express my gratitude. (Shao Wu))
(This summer, Mr. came to Shanghai. Mo happened to suffer from fever, diarrhea, and dry mouth. Fortunately, he could eat and continued working. The physician observed a wiry and large pulse, stating: "This is a syndrome of severe worry and fatigue, with major depletion of Yuan Qi." He prescribed a large dose of Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Fuling (Poria), Gancao (Licorice Root), Fangfeng (Saposhnikovia Root), Shaoyao (Peony Root), Juhong (Tangerine Peel), Shihu (Dendrobium Stem), and Mugua (Chaenomeles Fruit). Within ten days, he recovered. He then returned home to visit relatives, arrived in Shanghai after a month, and suffered from chills and fever. The physician diagnosed it as summer-dampness resembling malaria and prescribed clearing and transforming herbs. After four doses, he recovered completely. Feeling fatigued, he was treated with strong tonics including Renshen (Ginseng Root)... Gancao (Licorice Root), and Baiziren (Baiji Seed), and healed. His unique skill in treating deficiency is indeed credible. (Chen Tingmo, courtesy name Banqiao, from Gui'an))
2. Avoid ginger and sugar. Mr. Xu said: If there is summer-heat pathogen, ginger must absolutely not be used. Even if used concurrently with Huangqin (Scutellaria Root) and Lianzi (Lotus Plumule), it is inadvisable. How much more so is ginger soup alone? Only in early stages complicated by cold might a small amount be considered based on the syndrome. Sugar promotes damp-heat and causes greasy stagnation in the middle jiao. Misuse gives rise to filth and turbidity. It not only increases vomiting but also extends to dates, longan, licorice, and all sweet, greasy, and stagnant drugs, which can be inferred similarly.
3. Avoid hot soups, wine, and bathing. These three are methods to dispel cold. When cold injures the form, the guest pathogen is in the exterior. Drinking hot soups and wine, or bathing in a warm room, can allow the cold pathogen to resolve through sweating. Therefore, herbs that release the exterior to dispel cold are often assisted by Gancao (Licorice Root), ginger, and dates. This aids Middle Qi to push the pathogen outward and prevents external pathogens from entering inward. However, summer-heat, dampness, heat, epidemic, filth, and malodor pathogens are all inhaled through the mouth and nose, directly injuring the Qi level and gradually entering the Ying (Nutritive) level. Immediate cooling and draining are required to allow Qi to expand and turbidity to move, enabling the pathogen to exit downward, which provides a chance for survival. Not only must pungent-warm and sweet-greasy herbs be avoided, but hot soups, wine, and bathing must also be strictly prohibited as they fuel the rampant heat.
4. Be cautious with Sha pills. There are many formulas for Sha medicines, addressing different syndromes. Some suit summer-heat diseases, others suit cold-damp diseases. How can one casually experiment? There are also unorthodox formulas gathering fierce and potent ingredients mixed together. They falsely claim to cure all diseases. Benevolent but unlearned people produce and distribute them widely. Occasionally, they are effective, mostly in robust individuals suffering from exposure to wind and dew. General application often results in mild cases becoming severe and severe cases resulting in death. Therefore, taking medicine is difficult, and dispensing medicine is harder. One must select good formulas and fine herbs. Published treatments must distinguish between cold and heat, practiced sincerely and effectively, to achieve merit without弊端. For example, someone collapsing suddenly on the road under scorching sun, though not named Huoluan or Sha distension, suffers a more severe condition. Using generic Sha medicines often fails to save them. Death may result from bleeding from mouth and nose, indicating summer-heat pathogen directly entering the Pericardium Collateral. Only Zixue Powder (Purple Snow Powder)灌 (irrigated/administered) will be effective. However, this medicine is expensive and rare. Those with means who prepare it to help the world will surely receive good karma. Individuals with Yin deficiency and internal heat, or women after childbirth with blood loss, or during sexual activity, or in extreme heat, may suffer this even staying indoors. I have seen this frequently. See detailed accounts in the third chapter *Mengying*.
5. Be cautious in selecting a physician. A physician's use of medicine is like a general's use of troops. Generals paid by the state are rarely excellent. Physicians seeking livelihood are likely to be inferior. Yet, in a town of ten households, there must be someone loyal and trustworthy. The saying goes: "One who is a son must know medicine." Pay attention normally, knowing he has the art of saving lives, and is not a rumor-monger. Then, when ill, you can entrust your life to him. Knowing he has the talent of warfare, and is not a cowardly or money-loving person, you can entrust your land and people to him when attacked. Alas! It is difficult.
6. Be cautious in taking medicine. Selecting a physician is as hard as selecting a general. Once selected, he may have fame but no real learning, or be learned but not versatile, or versatile but lacking insight, or see clearly but... [Text fragment]. So how can one take his medicine? Observe his clinical practice: careful questioning, thorough thinking, precise differentiation, clear prescriptions, frank and reasonable speech, and dignified demeanor. Even if never met before, one can recognize a good physician at first sight. His medicine can be taken.
7. Prefer coolness. Huoluan and Sha distension, spreading as epidemics, are caused by the fermentation of hot and pathological qi. Therefore, rooms should not be crowded, doors and windows should not be closed, allowing air to vent. Bedding should not be thick; the degree is when the patient does not feel cold. Ignorant people force extra clothing and blankets, causing irritability and confusion, which is common. Those living upstairs must move beds to cool places. In severe cases, lie on mats placed on cool, dry mud ground, as heat dissipates into the soil. Seeing someone collapsed on the road, even without medicine, moving them to a shady spot is like giving a dose of Cooling Powder. Vomit and feces should be cleaned up immediately. Do not let odors affect the patient and others, especially when the doctor arrives. Otherwise, the smell is unbearable. How can one calm the mind to differentiate the syndrome?
8. Prefer tranquility. Patients with acute syndromes naturally fear for their lives. If bystanders show panic, the patient anticipates death, turning mild cases severe and killing severe ones with fright. Although people live to a hundred, none do not love life and fear death; this is human nature. Therefore, empathetic physicians, even facing critical conditions, must not speak of doom to hearing patients. Relatives must not whisper to increase fear. Women must not frown or cry, turning false alarms into reality.
9. Prefer universal love. In acute syndromes, life and death depend on breath. Without rapid rescue, the disease deepens. Rescue without detail may lead to relapse. Family members feel each other's pain and need not hesitate. The most bitter are the poor and elderly without support, traveling merchants, or those lodging on boats, with no relatives nearby. They rely on neighbors' kindness and landlords' righteousness to open their purses and exert effort to save this crisis... [Text fragment].
10. Protect pregnancy. If a pregnant woman in summer suddenly suffers abdominal pain, even near term, first hold her hand to check if fingertips are cold, and touch her forehead to check for fever. If not cold and not feverish, it is labor pain. Otherwise, it is Sha pathology. Most Sha medicines hinder pregnancy and should not be tried lightly. I usually treat it with Late Silkworm Sand (Can Sha) and Xue Geng (Snow Soup), achieving immediate effect. If complicated by cold, Zi Su (Perilla Leaf), Sharen (Amomum Fruit), Xiangfu (Cyperus Rhizome), and Juhong (Tangerine Peel) can be used. If suffering severe Huoluan, first apply well-bottom mud to the epigastrium and Dantian. Then, take five qian of dried, unbloomed tender lotus leaves, half that amount of clam powder, grind together, mix with fresh water and honey, take three qian orally, and apply the residue to the abdomen. This is called Zaotai San (Fetal-Covering Powder). If cold Huoluan, use Fulonggan (Dragon's Liver/Calcined House-hold Earth) ground to powder, mixed with water, applied to the navel square inch, reapplying when dry. Medication must be extremely cautious; all items harmful to the fetus are forbidden. Huiyang Gao (Return-Yang Plaster) must not be applied.