亡之道,用之以卜筮,毫发无差。虽然,全贤谆谆教诲,必使尽人事以副天意,则凶者化吉,亡者得存,未尝令人委之
于天命也。传曰∶修身以俟命而已矣。是故医者可以通神明而权造化,能使夭者寿而寿者仙,医道其可废乎。
或问∶先哲谓诸痛为实,诸痒为虚。丹溪亦曰∶诸痛不可用参 ,盖补其气,气旺不通而痛愈甚。然则凡病痛者,
例不可用参 等药乎?曰;以上所论诸痛,特指其气实者为言耳,如暴伤风寒,在表作痛,或因七情九气怫郁不得宣通
而作痛者,固不可用补气药也。若夫劳役伤形,致身体解 而作痛者,或大便后及大泻痢后气血虚弱,身体疼痛及四肢
麻痹而痛,或妇人产后气血俱虚,致身体百节疼痛等病,其可不用参 等补气药乎,学人毋执一也。
或问∶寸、关、尺三脉部位,既得闻命矣。外有人迎、气口、神门三脉,其位安在?请明以告我。曰∶按《活人书》
谓左手关前一分,人迎是也。右手关前一分,气口是也。又按经脉谓左手人迎以前寸口脉,即知人迎在病患左手关前寸
后之位,诊者右手食指与中指两岐之间是也。又谓右手气口以前寸口脉,即知气口在病患右手关前寸后之位,诊者左手
食指与中指两岐之间是也。经又曰∶两手神门以后尺中脉,即知神门各在病患两手关后寸前之位,诊者中指与无名指两
岐之间是也。今人多不识此,或指人迎于左关,或指人迎于左寸,或指气口于右关,或指气口于右寸,或指神门于两
关相对者,皆非也,学人可不审乎。
或问∶药性有相畏相恶相反,而古方多有同为一剂而用者,其理何如?曰∶若夫彼畏我者,我必恶之,我所恶者,
彼必畏我,盖我能制其毒而不得以自纵也。且如一剂之中,彼虽畏我,而主治之能在彼,故其分两,当彼重我轻,略将
以杀其毒耳;设我重彼轻,制之太过,则尽夺其权而治病之功劣矣。然药性各有能毒,其所畏者畏其能,所恶者恶其毒
耳。如仲景制小柴胡汤,用半夏、黄芩、生姜三物同剂,其半夏、黄芩畏生姜,而生姜恶黄芩、半夏,因其分两适中,
故但制其 悍之毒,而不减其退寒热之能也。其为性相反者,各怀酷毒,如两军相敌,决不与之同队也。虽然,外有大
毒之疾,必用大毒之药以攻之,又不可以常理论也。如古方感应丸用巴豆、牵牛同剂,以为攻坚积药。四物汤加人参、
五灵脂辈,以治血块。丹溪治尸瘵二十四味莲心散,以甘草芫花同剂,而谓妙处在此。是盖贤者真知灼见方可用之,昧
者固不可妄试以杀人也。夫用药如用兵,善用者置之死地而后存,若韩信行背水阵也,不善者徒取灭亡之祸耳,可不慎
哉!
或问∶当归一物,雷公谓头破血,身和血,尾止血。东垣又云头止血,身养血,尾破血。二说不同,岂无归一之论
乎?请明以告我。曰∶东垣曰∶当归者,使气血各有所归之功之号也。盖其能逐瘀血,生新血,使血脉通畅,与气并行,
周流不息,故云然。又曰∶中半以上,气脉上行,天气主之,中半以下,气脉下行,地气主之,身则独守乎中而不行也,
故人身之法象亦犹是焉。予谓瘀血在上焦与上焦之血少,则用去芦上截;瘀血在下焦与下焦之血虚,则用下截之尾;若
欲行中焦之瘀与补中焦之血,则用中一段之身。非独当归,他如黄芩,用上截之虚者以降肺火,用下截之实者以泻大肠
之火,防风、桔梗之类亦然,此千古不易之定论也,学人详之。
或问∶黄柏、地黄之类,俱忌铁器蒸捣,何欤?曰∶夫地黄、黄柏之类,皆肾经药也。钱仲阳谓肾有补而无泻。又
曰虚者补其母,实者泻其子。盖肾乃阴中之少阴,为涵养真元之水脏,其所以忌铁器者,防其伐木泻肝,恐子能令母虚
也。竟无他说。
或问∶本草所载竹茹、竹叶及烹竹沥,皆云用淡竹。夫竹类颇多,未审何竹名为淡竹耶?曰∶东坡苏公之方有云∶
淡竹者,对苦竹为文,除苦竹之外,皆淡竹也。我丹溪先生常用早 ,俗名雷竹,此淡中之淡者也。此竹又名甜竹,以
其笋之味甜也。别有一种水竹,其笋味纯淡。故以上二竹皆可入药用,缘二笋俱无 辣之味,故知其无毒故也。如无二
竹,晚 竹亦可代用,余竹皆不可用也。
或问∶岭表烟瘴之地,其俗平居无病之人,朝夕常噬槟榔,云可辟除山岚瘴气之疾。吾儒有仕于彼地者,亦随其俗
而噬之,果有益乎?否乎?曰∶按本草槟榔味辛气温,为纯阳之物,善驱逐滞气,散邪气,泄胸中至高之气,除痰癖下
行,以治后重脱 之证。如果有以上诸疾,用之以佐木香、芩、术等药,无不应验。若无病冲和之胃气,而无故朝夕常
噬,吾恐反泄真气,非徒无益而又害之是也。呜呼!因习之弊,死而无悔者焉。罗谦甫曰∶无病服药,如壁里添柱。诚
哉是言也。尝闻用药如用兵,朝廷不得已而行之,以御寇耳;若无寇可平而无故发兵,不惟空废粮饷,抑且害及于无辜
之
良民也,戒之戒之!
或问∶妇人产后诸疾,古方多用四物汤加减调治。我丹溪先生独谓芍药酸寒,能伐发生之气,禁而不用,何欤?曰∶
新产之妇,血气俱虚之甚,如天地不交之否,有降无升,但存秋冬肃杀之令,而春夏生发之气未复,故产后诸证,多不
利乎寒凉之药,大宜温热之剂,以助其资始资生之化源也。盖先哲制四物汤方,以川芎、当归之温,佐以芍药地黄之寒,
是以寒温适中,为妇人诸疾之妙剂也。若或用于产后,必取白芍药以酒重复制炒,去其酸寒之毒,但存生血活血之能,
胡为其不可也。后人传写既久,脱去制炒注文,丹溪虑夫俗医卤莽,不制而用之,特举其为害之由以戒之耳。若能根据法
制炒为用,何害之有哉,学人其可不知此乎。
The path to ruin, if applied to divination and fortune-telling, can be executed with not a hair's breadth of error. Nevertheless, the sages earnestly teach that one must exhaust human effort to align with Heaven's will, so that misfortune transforms into auspiciousness, and the dying are preserved; they never advocate leaving everything to fate. The classics say: "Cultivate oneself and await destiny." Therefore, physicians can communicate with the divine and manipulate creation, enabling those destined for premature death to live long, and the long-lived to attain immortality. How could the Way of Medicine be abolished?
A question was raised: Ancient philosophers stated that all pain belongs to Excess (Shi), while all itching belongs to Deficiency (Xu). Zhu Danxi also said: "All pain should not be treated with Ginseng," because tonifying Qi causes it to become vigorous but stagnant, thereby worsening the pain. Then, is it true that for all painful conditions, Ginseng and similar herbs must generally be avoided? The answer is: The aforementioned discussion on various pains specifically refers to cases where Qi is Excess. For instance, sudden invasion of Wind-Cold causing pain in the exterior, or pain arising from the stagnation of the Seven Emotions and Nine Qi which fails to circulate freely, certainly cannot be treated with Qi-tonifying herbs. However, regarding conditions such as body ache due to overexertion damaging the form, or body pain following defecation or severe dysentery due to Qi and Blood deficiency, or limb numbness and pain, or postpartum general joint pain due to dual deficiency of Qi and Blood in women—can these possibly be treated without Ginseng and other Qi-tonifying herbs? Students must not adhere rigidly to a single viewpoint.
Another question: I have heard of the positions of the Cun, Guan, and Chi pulse locations. Additionally, there are three pulse sites: Renying, Qikou, and Shenmen. Where are their positions? Please inform me clearly. The answer is: According to the *Huoren Shu* (Book of Living People), the Renying pulse is located at the one-fen position anterior to the Guan on the left wrist. The Qikou pulse is located at the one-fen position anterior to the Guan on the right wrist. Furthermore, according to the Meridian theory, the Cun Kou pulse anterior to the Renying on the left hand indicates that Renying is situated between the Guan and Cun on the patient's left wrist, corresponding to the bifurcation between the index and middle fingers of the examiner's right hand. Similarly, the Cun Kou pulse anterior to the Qikou on the right hand indicates that Qikou is situated between the Guan and Cun on the patient's right wrist, corresponding to the bifurcation between the index and middle fingers of the examiner's left hand. The classics further state: The Chi pulse posterior to the Shenmen on both hands indicates that Shenmen is located between the Guan and Cun on both wrists of the patient, corresponding to the bifurcation between the middle and ring fingers of the examiner. Nowadays, many people do not recognize these positions. Some locate Renying at the Left Guan, others at the Left Cun; some locate Qikou at the Right Guan, others at the Right Cun; some locate Shenmen opposite the two Guans. All these are incorrect. Can students fail to examine this carefully?
Another question: Drug properties include Mutual Fear (Xiangwei), Mutual Aversion (Xiang'e), and Mutual Opposition (Xiangfan). Yet ancient prescriptions often combine such drugs in a single formula. What is the rationale? The answer is: If Drug B fears Drug A, then Drug A avers Drug B; what Drug A avers, Drug B fears. This is because Drug A can control the toxicity of Drug B, preventing it from acting recklessly. Moreover, within a single prescription, although Drug B may fear Drug A, its therapeutic efficacy is primary. Therefore, the dosage should be heavier for Drug B and lighter for Drug A, merely to mitigate its toxicity. If Drug A were heavier and Drug B lighter, the control would be excessive, completely stripping Drug B of its authority and diminishing its therapeutic effect. However, each drug has its own potency and toxicity. The "fear" relates to controlling the opponent's potency, while "aversion" relates to countering its toxicity. For example, Zhang Zhongjing's Xiao Chai Hu Tang (Minor Bupleurum Decoction) combines Banxia (Pinelliae Rhizoma), Huangqin (Scutellariae Radix), and Shengjiang (Zingiberis Rhizoma Recens). Banxia and Huangqin fear Shengjiang, while Shengjiang avers Huangqin and Banxia. Because the dosages are balanced, Shengjiang only restrains the harsh toxicity of the others without reducing their ability to resolve alternating chills and fever. As for drugs with Mutual Opposition, each harbors severe toxicity, like two armies facing each other; they absolutely do not share the same formation. Nevertheless, for external diseases caused by great toxins, great toxic drugs must be used to attack them; this cannot be judged by ordinary rules. For instance, the ancient Ganying Wan uses Badou (Crotonis Fructus) and Qianniuzi (Pharbitidis Semen) together to break down accumulations. Si Wu Tang (Four Substance Decoction) combined with Renshen (Ginseng Radix et Rhizoma) and Wulingzhi (Trogopterori Faeces) treats blood masses. Zhu Danxi's Ershisi Wei Lianxin San for Corpse Consumption (Lao/Consumption disease) combines Gancao (Glycyrrhizae Radix et Rhizoma) and Yuanhua (Genkwa Flos), claiming the brilliance lies here. Only sages with true insight can use such combinations; fools must not rashly try them, lest they kill. Using medicine is like using troops: the skilled place themselves in desperate situations to survive, like Han Xin's Back-to-the-River formation; the unskilled invite only destruction. Must one not be cautious!
Another question: Regarding Danggui (Angelicae Sinensis Radix), Lei Gong stated that the head breaks blood, the body harmonizes blood, and the tail stops bleeding. Li Dongyuan stated that the head stops bleeding, the body nourishes blood, and the tail breaks blood. These two theories differ. Is there no unified conclusion? Please clarify. The answer is: Li Dongyuan said: "Danggui" signifies the merit of making Qi and Blood return to their proper places. It can expel stasis and generate new blood, ensuring smooth meridians, allowing Qi and Blood to move together continuously. He further explained: The upper half of the root corresponds to ascending Qi governed by Heaven; the lower half corresponds to descending Qi governed by Earth; the middle part remains central. Thus, the analogy to the human body holds. I propose: For stasis in the Upper Jiao or deficiency of blood in the Upper Jiao, use the upper section (head); for stasis in the Lower Jiao or deficiency of blood in the Lower Jiao, use the lower section (tail); for stasis or deficiency in the Middle Jiao, use the middle section (body). This applies to other herbs as well: for Huangqin (Scutellariae Radix), use the upper section for empty heat to descend Lung fire, and the lower section for excess heat to drain Large Intestine fire. Fangfeng (Saposhnikoviae Radix) and Jiegeng (Platycodonis Radix) follow similar principles. This is an unchangeable principle since antiquity; students should study it carefully.
Another question: The Materia Medica states that Zhuru (Bambusa Textilis Caulis), Zhuye (Bambusa Leaf), and Zhuli (Bambusa Sap) must avoid iron vessels during steaming and pounding. Why? The answer is: Dihuang (Rehmanniae Radix Praeparata) and Huangbai (Phellodendri Cortex) are Kidney channel herbs. Qian Zhongyang stated: "The Kidney has tonification but no purgation." He also said: "Tonify the Mother for Deficiency, Purge the Child for Excess." The Kidney is the Shaoyin of Yin, the water organ that nurtures True Yuan. The reason for avoiding iron is to prevent the depletion of Wood (Liver) via Metal (Iron), fearing that the Child (Water/Kidney) being drained might cause the Mother (Wood/Liver) to become deficient. There is no other explanation.
Another question: The Materia Medica specifies using Danshu (Light Bamboo) for Zhuru, Zhuye, and Zhuli. There are many bamboo species. Which one is called Danshu? The answer is: Su Dongpo's formulas state: "Danshu" is defined in contrast to Kushu (Bitter Bamboo); except for Kushu, all others are Danshu. My master, Mr. Danxi, often used early-shoot bamboo, commonly known as Leizhu (Thunder Bamboo), which is the lightest of the light. This bamboo is also called Tiantu (Sweet Bamboo) because its shoots are sweet. Another variety, Shuishu (Water Bamboo), has shoots with a pure mild taste. Therefore, these two bamboos can be used medicinally because their shoots lack pungent/spicy flavors, indicating non-toxicity. If these two are unavailable, Wanzhu (Late Bamboo) can substitute; other bamboos are unusable.
Another question: In the miasma-prone regions of Lingnan, locals who are otherwise healthy chew Binglang (Arecae Semen) morning and night, claiming it wards off mountain miasma diseases. Confucian scholars serving there adopt this custom. Is it beneficial or harmful? The answer is: According to the Materia Medica, Binglang is Pungent and Warm, a Pure Yang substance. It effectively disperses stagnant Qi, scatters pathogenic Qi, descends excessive Qi in the chest, moves phlegm downwards, and treats tenesmus and rectal prolapse. If such symptoms exist, combining it with Muxiang (Aucklandiae Radix), Huangqin, and Baizhu yields effective results. However, if one has a harmonious Stomach Qi and is healthy, chewing it daily out of habit likely leaks True Qi, doing more harm than good. Alas! The弊端 (drawback) of habit leads to regret even unto death. Luo Qianfu said: "Taking medicine when healthy is like adding pillars inside a wall." This is truly correct. I have heard that using medicine is like deploying troops; the court does so reluctantly to repel invaders. If there are no invaders yet troops are sent, grain is wasted, and innocent civilians are harmed. Beware! Beware!
Another question: Ancient formulas for postpartum disorders often use Si Wu Tang (Four Substance Decoction) with modifications. However, my master Danxi exclusively prohibited Shaoyao (Paeoniae Radix Alba) because its Sour and Cold nature damages the generating Qi. Why? The answer is: Women after childbirth suffer extreme Qi and Blood deficiency, akin to the hexagram Pi (Standstill), where descent occurs without ascent. Only the austere energy of Autumn/Winter exists, while the generating energy of Spring/Summer has not returned. Therefore, postpartum conditions generally contraindicate Cold/Cooling herbs and strongly favor Warm/Hot agents to support the source of generation. The ancients formulated Si Wu Tang using the Warmth of Chuanxiong (Chuanxiong Rhizoma) and Danggui to balance the Coldness of Shaoyao and Dihuang, making it an excellent formula for gynecological disorders. If used postpartum, one must take Baishaoyao (White Peony Root), repeatedly stir-fry it with wine to remove its Sour/Cold toxicity, retaining only its blood-generating and blood-invigorating properties. Why would this be unacceptable? Later copies omitted the processing instructions. Danxi feared ignorant doctors would use it raw and thus warned of the dangers. If processed correctly according to method, what harm is there? Should students not know this?