今人以古人气体充实,故方剂分两甚重,此无稽之说也。自三代至汉、晋,升斗权衡,
异同,以今较之,不过十分之二。(余亲见汉时,有六升铜量,容今之一升二合。)如桂枝汤
,伤寒大大剂也。桂枝、芍药各三两,甘草二两,共八两为一剂。在今只一两六钱,又分三
服,则一服不过五钱三仞零。他方有药品多者,亦不过倍之而已。况古时之药,医者自备,
俱用鲜者,分两以鲜者为准,干则折算。如半夏、麦冬之类,皆生大而干小。至附子,则野
生者甚小,后人种之乃肥大,皆有确证。今人每方必十余味每味三四钱,则一剂重一三两矣
。更有熟地用至四两一剂者,尤属可怪。古丸药如乌梅丸,每服如桐子大十丸,今秤不过二
三分,今则用三四钱至七八钱矣。古末药用方寸经匕,不过今之六七分,今服三四钱矣。古
人用药,分两未尝从重。(《周礼·遗人》凡万民之食,食者人四 ,六斗四升曰 ,四 共
二石五斗六升,为人一月之食,则每日食八升有余矣。盖一升只二合也。)二十年来,时医误
阅古方,增重分两,此风日炽。即使对病,无气不胜药力,亦必有害,况更与病相反,害不
尤速乎?既不考古,又无师授,无怪乎其动成笑柄也。
古人治法,无一方不对病,无一药不对病。如是而病犹不愈,此乃病本不可愈,非医之咎也
。后世医失其传,病之名亦不能知,宜其胸中毫无所主也。凡一病有一病之名,如中风,总
名也。其类有偏枯、痿痹、风痱、历节之殊,而诸症之中,又各有数症,各有定名,各有主
方。又如水肿,总名也。其类有皮水、正水、石水、风水之殊,而诸症又各有数症,各有定
名,各有主方。凡病尽然。医者必能实指其何名,遵古人所主何方,加减何药,自有法度可
循。乃不论何病,总以阴虚阳虚等笼之谈概之,而试以笼统不切之药。然亦竟有愈者。或其病
本轻,适欲自愈。或偶有一二对症之药,亦奏小效。皆属误治。其得免于杀人之名者,何也
?盖杀人之药,必大毒,如砒鸠之类,或大热大寒,峻厉之品。又适与病相反,服后立见其
危。若寻常之品,不过不能愈病,或反增他病耳,不即死也,久而病气自退,正气自复,无
不愈者。间有迁延日久,或隐受其害而死。更或屡换庸医,遍试诸药,久而病气益深,元
气竭亦死。又有初因误治,变成他病,展转而死。又有始服有小效,久服太过,反增他病而
死。盖日日诊视,小效则以为可愈,小剧又以为难治,并无误治之形,确有误治之实。病家
以为病久不痊,自然不起,非医之咎,因其不即死,而不之罪。其实则真杀之而不觉也。若
夫误投峻厉相反之药,服后显然为害,此其杀人,人人能知之矣;惟误服参附峻厉之药,而
即死者,则病家之所甘心,必不归咎于医。故医者虽自知其误,必不以此为戒,而易其术也
。
Modern people believe that ancient individuals had robust constitutions, therefore the dosages in ancient prescriptions were very heavy. This is an unfounded assertion. From the Three Dynasties (Xia, Shang, Zhou) to the Han and Jin dynasties, although units of volume (Sheng, Dou) and weight standards differed, compared to modern times, they amounted to only two-tenths of the current standard. (I have personally seen a bronze measuring vessel from the Han dynasty marked as "six Sheng," which holds the equivalent of one Sheng and two Ge in modern measurement.) For instance, Guizhi Tang (Cinnamon Twig Decoction), a large-dose prescription for treating Cold Damage (Shanghan), contains Guizhi (Cinnamon Twig) and Shaoyao (Peony Root) each at three Liang, and Gancao (Licorice Root) at two Liang, totaling eight Liang per dose. Converted to modern units, this is only one Liang and six Qian, divided into three doses, meaning each dose amounts to merely five Qian and three Fen. Other prescriptions with more ingredients do not exceed double this amount. Moreover, in ancient times, physicians prepared their own medicines, using fresh herbs whenever possible; dosages were based on fresh weight, with dried herbs being converted accordingly. For example, Banxia (Pinelliae Rhizoma) and Maidong (Ophiopogonis Radix) are larger when fresh and shrink significantly when dried. As for Fuzi (Aconiti Lateralis Radix Praeparata), wild specimens were very small, while cultivated ones became much larger later on, which is supported by solid evidence. Today, practitioners often use over ten herbs per prescription, with each herb weighing three to four Qian, resulting in a total dose weight of one Liang and three Qian. Even more strangely, some use up to four Liang of Shudi (Rehmanniae Radix) per dose. Ancient pills, such as Wumei Wan (Mume Pill), were taken as ten pills the size of tung tree seeds, weighing no more than two or three Qian today, whereas now doses range from three to seven or eight Qian. Ancient powders measured with a Fangcunbi (square-inch spoon) amounted to only six or seven Fen today, but now patients take three to four Qian. Ancient physicians never used heavy dosages. (The *Rites of Zhou* (*Zhou Li*) records under "Yiren": For the sustenance of the common people, each person consumes four Sheng daily; six Dou and four Sheng constitute a unit called "Si"; four "Si" equal two Shi and five Dou and six Sheng, which is one month's ration for one person. Thus, daily consumption exceeds eight Sheng. Essentially, one ancient Sheng equals only two modern Ge.) Over the past twenty years, contemporary physicians have erroneously interpreted ancient prescriptions by increasing dosages, a trend that has intensified daily. Even if the prescription matches the disease, if the patient's healthy Qi cannot withstand the medicinal force, harm will inevitably occur; how much more so if the medicine contradicts the disease, accelerating harm? Since they neither research antiquity nor receive proper transmission from masters, it is no wonder they frequently become objects of ridicule.
Ancient therapeutic methods ensured that every prescription corresponded precisely to the disease, and every herb matched the pathology. If the illness still did not resolve under such conditions, it was because the disease itself was incurable, not due to the physician's fault. Later generations lost this transmission; physicians could not even identify disease names, leading to a complete lack of internal guidance. Every disease has its specific name. For example, Zhongfeng (Wind Stroke) is a general term. Its subtypes include Pianku (Hemiplegia), Weibi (Flaccid Paralysis), Fengfei (Wind Flaccidity), and Lijie (Bi Syndrome affecting joints). Within these categories, there are further specific symptoms, each with defined names and primary formulas. Similarly, Shuizhong (Edema/Water Swelling) is a general term, encompassing Pishui (Skin Water), Zhengshui (True Water), Shishui (Stone Water), and Fengshui (Wind Water). Each subtype presents distinct symptoms, possesses specific names, and has corresponding main formulas. This applies to all diseases. A physician must be able to accurately identify the specific diagnosis, adhere to the primary formula prescribed by ancients, and adjust herbs according to established principles. However, nowadays, regardless of the disease, physicians generalize everything under vague concepts like Yin Deficiency or Yang Deficiency, and apply indiscriminate, imprecise medications. Yet, some cases do recover. This may be because the disease was mild and naturally resolving, or coincidentally, one or two herbs happened to match the pathology, yielding minor effects. These are all instances of mismanagement. Why do these physicians escape the label of "murderers"? Because truly lethal drugs are highly toxic, such as Pishuang (Arsenic Trioxide) or Zhenwu (Ibis poison), or extremely hot/cold and harsh substances. When administered against the disease nature, danger manifests immediately. Ordinary herbs, however, merely fail to cure the disease or may exacerbate other conditions, but do not cause immediate death. Given time, pathogenic factors recede, and Healthy Qi recovers, leading to recovery. Occasionally, prolonged illness leads to hidden damage and death. Or, frequent changes of incompetent doctors and trial-and-error with various drugs deepen the pathogen and deplete Yuan Qi (Original Qi), causing death. Some cases transform into different diseases due to initial misdiagnosis, leading to death through complications. Others show initial minor improvement, but long-term excessive use causes new ailments and death. Physicians visit daily; seeing minor improvement, they assume curability; seeing slight worsening, they deem it difficult to treat. There is no visible sign of mismanagement, yet the reality is clear. Patients' families attribute the prolonged non-recovery to the natural course of the disease, not blaming the doctor because death does not occur immediately. In truth, the patient is killed without awareness. If harsh, contradictory drugs are mistakenly administered, causing obvious harm, everyone recognizes this as murder. However, when patients die quickly after taking harsh tonics like Renshen (Ginseng Radix) and Fuzi (Prepared Aconite Root), families accept it willingly and do not blame the physician. Consequently, even if physicians know their mistake, they do not take it as a warning nor change their methods.