予幼岁留心于医,而未尝见其达者。贞 间
,自沃来河之南,至顿丘而从游张君仲杰之县舍,得遇太医张子和先生,诲仲杰以医,而及
于游公君宝及不肖。猗欤大哉,先生之学!明妙道之渊源、造化之根本,讲五运之抑郁发越
、六气之胜复淫郁,定以所制之法,配以所宜之方。准绳既陈,曲直自正;规矩既设,方圆
自成。先生之学,其学人之准绳规矩欤!虽为人,天师可也。望而知之,以尽其神;闻而知
之,以尽其圣;问而知之,以尽其工;切而知之,以尽其巧。何假饮上池之水,而照见人五脏乎
?一目而无余矣!
至约之法,其治有三;所用之药,其品有六;其治三,则汗下吐;其品六
,则辛、甘、酸、苦、咸、淡也。虽不云补,理实具焉。予恐人之惑于补而莫之解,故续
补说于先生汗、下、吐三论之后。我辈所当闻,医流所当观,而人之所当共知也。
予考诸经,检诸方,试为
天下好补者言之。夫人之好补,则有无病而补者,有有病而补者。无病而补者谁与?上而缙绅之
流,次而豪富之子。有金玉以荣其身,刍豢以悦其口;寒则衣裘,暑则台榭;动则车马,
止则 褥;味则五辛,饮则长夜。醉饱之余,无所用心,
而因致力于床第,以欲竭其精,以耗散其真,故年半百而衰也。然则奈何?以药为之补矣!
或咨诸庸医,或问诸游客。庸医以要用相求,故所论者轻,轻之则草木而已,草木则苁蓉、
牛膝、巴戟天、菟丝之类;游客以好名自高,故所论者重,重之则金石而已,金石则丹砂、
起石、硫磺之类。吾不知此为补也,而补何脏乎?
以为补心耶?而心为丁火,其经则手少阴,热则疮
疡之类生矣!
以为补肝耶?肝为乙木,其经则足厥阴,热则掉眩之类生矣!
脾为己土,而经则足太阴,以热补之,则病肿满。
肺为辛金,而经则手太阴,以热补之,则病愤郁。
心不可补,肝不可补,脾不可补,肺不可补,莫非为补肾乎?人皆知肾为癸水,而不知经则子午
君火焉。补肾之火,火得热而益炽;补肾之水,水得热而益涸。既炽其火,又涸其水,上
接于心之丁火,火独用事,肝不得以制脾土,肺金不得以制肝木。五脏之极,传而之六腑;
六腑之极,遍而之三焦,则百病交起,万疾俱生。小不足言,大则可惧。不疽则中,不中则
暴喑而死矣。以为无病而补之者所得也。
且如有病而补之者谁欤?上而仕宦豪富之家,微而
农商市庶之辈。呕而补,吐而补,泄而补,痢而补,疟而补,咳而补,劳而补,产而补。呕
吐则和胃丸、丁沉煎;泻痢,豆蔻丸、御米壳散;咳不五味,则宁神散,劳,不桂附,则山药;产,
不乌金,则黑神,吾不知此为补,果何意耶?殊不知呕得热而愈酸,吐得热而愈暴,泄得热而清浊不分
,痢得热而休息继至,疟得热而进不能退,咳得热而湿不能除,劳得热而火益烦,产得热而
血愈崩。盖如是而死者八、九,生者一、二。死者枉,生者幸。幸而一生,憔悴之态,人之
所不堪也,视其寒,用热以补之矣。若言其补则前所补者,此病何如?
予请为言补之法。大抵
有余者损之,不足者补之,是则补之义也。阳有余而阴不足,则当损阳而补阴;阴有余而阳
不足,则当损阴而补阳。热则芒硝、大黄,损阳而补阴也;寒则干姜、附子,损阴而补阳也
。岂可以热药而云补乎哉?而寒药亦有补之义也。《经》曰∶“因其盛而减之,因其衰而彰之。
此之谓也。或曰∶形不足者,温之以气;精不足者,补之以味。执此温补二字,便为温补之法,惟
用温补之药。且温补二字,特为形精不足而设,岂为病不病而设哉?虽曰温之,止言其气;
虽曰补之,止言其味。曷尝言热药哉?至于天之邪气,感则害人,五脏实而不满,可下而已
;水谷之寒热,感则害人,六腑满而不实,可吐而已;地之湿气,感则害人,皮肉筋脉,邪
从外入,可汗而已。然发表不远热,而无补之意。
人之所禀,有强有弱。强而病,病而愈,
愈而后必能复其旧矣;弱而病,病而愈,愈而后不必复其旧矣。是以有保养之说。然有是说
,热药亦安所用哉?慎言语,节饮食是矣。以日用饮食言之,则黍稷禾麦之余,食粳者有几?
鸡豚牛羊之余,食血者有几?桃杏李梅之余,食梨者有几?葱韭薤蒜之余,食葵者有几?
其助则姜桂椒莳,其和则盐油醯酱,常而粥羹,别而焦炒,异而烧炙,甚则以五辣生
。而荐酒之肴,以姜醋羹羊,而按酒之病,大而富贵,
此尤甚,小而市庶,亦得以享,此吾不知何者为寒?何物为冷?而以热药为补哉?日用饮食之
间,已为太过矣!尝闻人之所欲者生,所恶者死,今反忘其寒之生,甘于热之死,则何如
?由其不明《素问》造化之理,《本草》药性之源,一切委之于庸医之手。医者曰∶寒凉之
药,虽可去疾,奈何腑脏不可使之久冷,脾胃不可使之久寒,保养则固可温补之是宜。斯言方脱
诸口,已深信于心矣。如金石之不可变,山岳之不可移,以至于杀身而心无少悔。呜呼!医
者之罪,固不容诛;而用之者,亦当分受其责也。病者之不诲,不足怪也。而家家若是,何
难见而难察耶?人惟不学故耳!
亦有达者之论,以《素问》为规矩准绳,以《本草》为斤斧法
则矣。其药则寒凉,其剂则两,其丸则百。人之闻者,如享美馔,而见蛆蝇,惟恐去之不亟也,何
哉?而所见者丘垤,及见谈泰山则必骇,不取唾而远则幸矣,尚敢冀其言之能从乎?兹正之所以难立,
而邪之所以易行也。吾实忧之。且天下之不知,过不在天下而已。在医流尚不知,何责于
天下哉?噫!春秋之法,责贤不责愚。所谓我辈者,犹且弃道学之本源而拘言语之末节,
以文章自富,以谈辨自强,坐而昂昂,立而行行,阔其步,翼其手,自以为高人而出尘表,
以天下聪明莫己若也,一旦疾之临身, 然无所知。茫
若抟风之不可得,迷若捕影之不可获。至于不得已,则听庸医之裁判。疾之愈则以为得人,
不愈则以为疾之既极,无可奈何,委之于
命而甘于泉下矣!呜呼!实与愚夫殆不相远,此吾所以言之喋喋也。然而未敢必其听之何如
耳!虽然,吾之说,非止欲我辈共知,欲医流共知,欲天下共知也。我辈共知,医流共知,
天下共知,惬吾之意,满吾所望矣!
I paid attention to medicine since childhood, but I had never seen anyone who truly mastered it. During the Zhenyou era, I came from Wo to the south of the Yellow River and went to Dunqiu County to study under Mr. Zhang Zhongjie. There, I met the Imperial Physician Mr. Zhang Zihe (Zhang Congzheng). He taught medicine to Zhongjie, and his influence extended to you Gong Junbao and myself. Oh, how great is Mr. Zhang's learning! He elucidated the origins of the profound Dao and the fundamentals of creation, discussed the stagnation and release of the Five Movements (Wu Yun), and analyzed the excess, deficiency, and oppression of the Six Qi (Liu Qi). He established methods he formulated and paired them with appropriate prescriptions. Once the standards are set, crookedness and straightness naturally become correct; once the compass and square are established, circles and squares naturally form. Is not Mr. Zhang's learning the standard and compass for learners? Even as a human, he could be considered a Heavenly Master. Through observation (Wang Zhen), he exhausts the spirit; through listening and smelling (Wen Zhen), he exhausts sagacity; through inquiry (Wen Zhen), he exhausts skill; through palpation (Qie Zhen), he exhausts dexterity. Why would he need to drink water from the upper pool to see through the five Zang organs? One glance reveals everything without omission!
The most concise treatment methods consist of three; the categories of medicines used consist of six. The three treatments are sweating (Han), purging (Xia), and vomiting (Tu); the six medicinal properties are pungent (Xin), sweet (Gan), sour (Suan), bitter (Ku), salty (Xian), and bland (Dan). Although "tonification" (Bu) is not explicitly mentioned, the principle is inherently included. Fearing that people would be confused by tonification and unable to resolve their misconceptions, I have appended this treatise on tonification after Mr. Zhang's discussions on sweating, purging, and vomiting. This is what our generation should hear, what the medical community should observe, and what people should collectively know.
I have examined the classics and inspected various formulas to speak to those in the world who favor tonification. People who favor tonification do so either when healthy or when ill. Who tonifies when healthy? They are, at the top, the scholar-officials, and below them, the sons of the wealthy. They adorn their bodies with gold and jade, delight their mouths with beef, mutton, pork, and dog meat; they wear furs when cold and dwell in pavilions when hot; they ride carriages and horses when moving, and sleep on soft mats when resting; they prefer the five pungent spices and drink wine until late night. After getting drunk and full, having nothing else to occupy their minds, they devote themselves to sexual intercourse, exhausting their essence through desire and dissipating their true Qi. Thus, before reaching fifty, their bodies decline. So, what do they do? They use medicine to tonify!
They consult quack doctors or ask wandering physicians. Quacks, seeking to please those who want tonification, discuss only light substances—herbal plants such as Cistanche Herba (Rongshou), Achyranthes Bidentatae Radix (Niuxi), Morinda Officinalis Radix (Bajitian), and Cuscutae Semen (Tusizi). Wandering physicians, seeking fame and elevating themselves, discuss only heavy substances—minerals and stones such as Cinnabar (Dansha), Quartz (Qishi), and Sulfur (Liuhuang). I do not know if this constitutes tonification. If so, which Zang organ is being tonified?
If one claims to tonify the Heart: The Heart belongs to Ding Fire, its meridian is the Hand-Shaoyin Heart Meridian. Using heat to tonify it will generate conditions like sores and ulcers.
If one claims to tonify the Liver: The Liver belongs to Yi Wood, its meridian is the Foot-Jueyin Liver Meridian. Using heat to tonify it will generate conditions like tremors and vertigo.
The Spleen belongs to Ji Earth, its meridian is the Foot-Taiyin Spleen Meridian. Using heat to tonify it will cause swelling and distension.
The Lung belongs to Xin Metal, its meridian is the Hand-Taiyin Lung Meridian. Using heat to tonify it will cause resentment and depression.
The Heart cannot be tonified, the Liver cannot be tonified, the Spleen cannot be tonified, the Lung cannot be tonified. Is it all about tonifying the Kidney? Everyone knows the Kidney belongs to Gui Water, but few know its meridian connects to the Zi-Wu Ministerial Fire. Tonifying the fire of the Kidney makes the fire blaze hotter due to heat; tonifying the water of the Kidney dries up the water due to heat. With the fire blazing and the water dried up, the excessive fire connects upward to the Heart's Ding Fire, allowing fire to dominate unchecked. The Liver Wood fails to control the Spleen Earth, and the Lung Metal fails to control the Liver Wood. When the pathology of the five Zang reaches its extreme, it transmits to the six Fu organs; when the pathology of the six Fu reaches its extreme, it spreads throughout the Sanjiao. Then, hundreds of diseases arise simultaneously, and ten thousand ailments are born. Minor issues are negligible, but major ones are terrifying. One may suffer from carbuncles or stroke, or suddenly lose voice and die. This is the result of tonifying when healthy.
And who tonifies when ill? At the top, officials and the wealthy; at the bottom, farmers, merchants, and commoners. They tonify for vomiting, for diarrhea, for dysentery, for malaria, for coughing, for consumptive fever, and for postpartum conditions. For vomiting, they use Hewei Wan and Dingchen Jian; for diarrhea and dysentery, they use Doukou Wan and Yumiqiao San; for coughing, instead of Schisandra Fructus (Wuweizi), they use Ningshen San; for consumptive fever, instead of Cinnamon Twig (Guizhi) and Aconite Root (Fuzi), they use Dioscorea Rhizome (Shanyao); for postpartum conditions, instead of Wujin Wan, they use Heishen San. I do not know what intent this tonification has. Little do they know that vomiting aggravated by heat becomes more acidic and violent; diarrhea aggravated by heat leads to indistinguishable clear and turbid discharges; dysentery aggravated by heat results in recurrent bouts; malaria aggravated by heat becomes frequent and hard to subside; coughing aggravated by heat prevents the removal of dampness; consumptive fever aggravated by heat increases vexatious fire; postpartum conditions aggravated by heat lead to severe uterine bleeding. Nine out of ten die from such errors, while only one or two survive. The dead die unjustly, the living survive by luck. Those who survive are left in a wretched state, unbearable to behold. Seeing cold syndromes, they use heat to tonify. If this is called tonification, then what good was the previous tonification for such illnesses?
Let me explain the true method of tonification. Generally, excess is reduced, and deficiency is supplemented; this is the meaning of tonification. If Yang is in excess and Yin is deficient, one should reduce Yang and tonify Yin; if Yin is in excess and Yang is deficient, one should reduce Yin and tonify Yang. For heat syndromes, using Mirabilite (Mangxiao) and Rhubarb (Dahuang) reduces Yang and tonifies Yin; for cold syndromes, using Dried Ginger (Ganjiang) and Prepared Aconite Root (Fuzi) reduces Yin and tonifies Yang. How can one claim that heat medicines constitute tonification? Moreover, cold medicines also possess the meaning of tonification. The Classic states: "Reduce what is excessive, and manifest what is deficient." This refers to this principle. Some say: "For deficiency of form, warm with Qi; for deficiency of essence, tonify with flavor." Clinging to the words "warm" and "tonify," they believe this is the method of warming and tonifying, using only warming and tonifying drugs. However, the terms "warm" and "tonify" were specifically established for deficiencies of form and essence, not for treating illness per se. Although it says "warm," it refers only to the Qi; although it says "tonify," it refers only to the flavor. It never mentions using heat-producing drugs. Regarding pathogenic Qi from heaven, upon infection, it harms humans; the five Zang become solid but not full, and can be treated with purgation. Regarding cold and heat from food and drink, upon infection, they harm humans; the six Fu become full but not solid, and can be treated with emesis. Regarding dampness from earth, upon infection, it harms humans; pathogens enter from outside into skin, flesh, sinews, and vessels, and can be treated with sweating. However, releasing the exterior does not avoid heat, and there is no intention of tonification here.
Human endowment varies between strong and weak. If one is strong and falls ill, recovers, and returns to health, they will likely regain their former strength. If one is weak and falls ill, recovers, and returns to health, they may not necessarily regain their former strength. Hence, the concept of maintenance exists. But even with this concept, where is there any use for heat medicines? One should merely guard speech and regulate diet. Speaking of daily diet, how many eat the remnants of millet and wheat? How many eat the remnants of chicken, pig, cow, and sheep? How many eat the remnants of peaches, apricots, plums, and plums? How many eat the remnants of green onions, leeks, wild garlic, and garlic? Condiments include ginger, cinnamon, pepper, and dill; seasonings include salt, oil, vinegar, and soy sauce; staples are porridge and soup; preparations include frying and roasting; exotic foods include grilling; some even eat the five pungent spices raw. Accompaniments for wine include ginger, vinegar, mutton soup, and mutton dishes. The wealthy enjoy these excessively, and even commoners partake. I do not know what is cold? What food is cold? Yet they consider heat medicines as tonics! In daily diet, one already consumes too much. I have heard that people desire life and abhor death. Now, they forget that cold promotes life and willingly accept heat leading to death. Why? Because they do not understand the principles of creation in *Suwen* (Basic Questions) and the sources of drug properties in *Bencao* (Materia Medica), entrusting everything to quack doctors. Doctors say: "Cold and cool medicines can remove disease, but why should the Zang-Fu not be kept warm, and the Spleen-Stomach not be kept free of cold? For maintenance, it is appropriate to warm and tonify." As soon as these words leave their mouths, they are deeply believed. Like unchangeable metal and stone, or immovable mountains, they persist until death, with no regret. Alas! The doctor's sin is indeed unpardonable; yet the user also shares the responsibility. It is not surprising that patients lack knowledge. But why is it that every household is like this, making it easy to see but hard to rectify? It is simply because people do not study.
There are also enlightened theories, taking *Suwen* as the standard and *Bencao* as the rule. Their medicines are cold and cool, dosages are measured in liang, and pills contain a hundred grains. When people hear this, it is like seeing maggots in delicious food, wishing to flee quickly. Why? Because what they see is merely a small mound; when Mount Tai is discussed, they are terrified. Not spitting and staying away is already lucky; how could they expect to follow such words? This is precisely why the orthodox path is hard to establish and heretical paths easy to spread. I am truly worried. Moreover, the ignorance of the world is not solely the fault of the world. If the medical community itself does not know, how can we blame the world? Ah! The *Spring and Autumn Annals* style dictates blaming the virtuous rather than the foolish. Our own generation, despite claiming to uphold the Dao, abandons the source of learning and clings to trivial verbalities. We boast of literary skills and rhetorical strength, sitting with heads high and walking with swagger, striding broadly and waving hands, considering ourselves superior and transcendent, believing no one in the world matches our wisdom. Yet, when disease strikes, we are茫然 (at a loss). Confused like trying to catch the wind, lost like trying to catch a shadow. Forced to rely on quack doctors' judgments. If cured, we think we found a sage; if not cured, we think the disease is terminal, helpless, resigning ourselves to fate and death. Alas! We are hardly different from ignorant fools. This is why I speak incessantly. However, I dare not assume they will listen. Nevertheless, my theory is not just for our generation to know, nor just for the medical community, but for the whole world to know. If our generation knows, the medical community knows, and the world knows, my wishes will be fulfilled.