夫治病有八要八要不审病不能去非病不去无可去之术也故须审辩八要庶不违误其一曰虚
五虚
是也脉细皮寒气少泄利前后饮食不进此为五虚二曰实五实是也脉盛皮热腹胀前后不通闷瞀此
五实也三曰冷脏腑受其积冷是也四曰热脏腑受其积热是也五曰邪非脏腑正病也六曰正非外邪
所中也七曰内病不在外也八曰外病不在内也既先审此八要参之六脉审度所起之源继以望闻问
切加诸病者于(于与乌同)有不可治之疾也(本草衍义)
夫不可治者有六失失于不审失于不信失于过时失于不择医失于不识病失于不知药六失之
中有
一于此即为难治非止医家之罪亦病家之罪也矧又医不慈仁病者猜鄙二理交驰于病何益由是言
之医者不可不慈仁不慈仁则招祸病者不可猜鄙猜鄙则招祸惟贤者动达物情各就安乐亦治病之
一说耳(同上)
治妇人虽有别科然亦有不能尽圣人之法者今豪足之家居奥室之中处帷幔之内复以帛 手
臂既
不能行望色之神又不能殚切脉之巧四者有二阙焉黄帝有言曰凡治病察其形气色泽形气相得谓
之可治色泽以浮谓之易已形气相失谓之难治色夭不泽谓之难已又曰诊病之道观人勇怯骨肉皮
肤能知其情以为诊法若患人脉病不相应既不得见其形医人止据脉供药其可得乎如此言之乌能
尽其术也此医家之公患世不能革医者不免尽理质问病家见所问繁还为医业不精往往得药不肯
服似此甚多扁鹊见齐侯之色尚不肯信况其不得见者乎呜呼可谓难也已(同上)
Treating diseases involves eight essentials. If these eight essentials are not carefully examined, the disease cannot be eliminated; if it is not a disease, there is no method to eliminate it. Therefore, one must carefully examine and distinguish the eight essentials to avoid errors.
The first is "Deficiency" (Xu), specifically the Five Deficiencies. These are: fine pulse, cold skin, shortness of breath, diarrhea and urinary incontinence, and inability to eat or drink. This constitutes the Five Deficiencies.
The second is "Excess" (Shi), specifically the Five Excesses. These are: surging pulse, hot skin, abdominal distension, obstruction of urination and defecation, and mental confusion with oppression. This constitutes the Five Excesses.
The third is "Cold", where the Zang-Fu organs have accumulated cold.
The fourth is "Heat", where the Zang-Fu organs have accumulated heat.
The fifth is "Pathogenic Factor" (Xie), which is not a primary disease of the Zang-Fu organs.
The sixth is "Upright Qi" (Zheng), which is not invaded by external pathogenic factors.
The seventh is that internal diseases do not manifest externally.
The eighth is that external diseases do not reside internally.
Having first examined these eight essentials, one should consult the six pulses, determine the source of origin, and then apply observation, auscultation/olfaction, inquiry, and palpation. With this approach, among all patients, are there any incurable diseases? (From *Bencao Yan Yi*)
Those deemed incurable often result from six failures: failure to examine carefully, failure to trust, delay in timing, failure to select a qualified physician, failure to recognize the disease, and failure to understand the medicinal properties. If even one of these six failures occurs, treatment becomes difficult. This is not solely the fault of the physician but also that of the patient's family. Moreover, if the physician lacks compassion and benevolence, and the patient harbors suspicion and disdain, these two attitudes conflict detrimentally to the illness, yielding no benefit. Thus, physicians must be compassionate and benevolent; lacking this invites disaster. Patients must not be suspicious and disdainful; doing so invites disaster. Only the wise can understand human nature and circumstances, allowing both parties to attain peace and comfort. This is merely one perspective on treating diseases. (Ibid.)
Although there are specialized departments for treating women, there are instances where the methods of the Sages cannot be fully applied. Today, wealthy families live in deep inner chambers, behind curtains, and cover their arms and hands with silk. Consequently, the physician cannot perform the divine art of observing complexion, nor can they fully utilize the skill of pulse diagnosis. Of the four diagnostic methods, two are missing. The Yellow Emperor stated: "In treating diseases, observe the form, qi, color, and luster. When form and qi are harmonious, it is treatable; when color and luster are bright and floating, recovery is easy; when form and qi are discordant, it is difficult to treat; when color is dull and lacks luster, recovery is difficult." He also said: "The way to diagnose diseases is to observe a person's courage or timidity, bones, muscles, skin, and flesh, which reveals their condition and forms the basis of diagnostic methods." If a patient's pulse does not correspond to the disease, and since the physician cannot see their physical appearance, relying solely on the pulse to prescribe medicine—is this feasible? In such cases, how can the full extent of medical skill be utilized? This is a common dilemma for physicians that society has failed to rectify. Physicians are compelled to ask detailed questions, but patients, perceiving excessive questioning as a sign of incompetence, often refuse to take the prescribed medicine. There are many such cases. Even Bian Que, who could diagnose by observing the complexion of the Duke of Qi, was not trusted; how much less so for those whose appearances cannot be seen? Alas! This is indeed difficult. (Ibid.)