医门治例,幼科最难。肠胃脆而多伤乳食,筋骨嫩而易感风
寒。易虚易实兮,变如反掌;或补或泄兮,贵若转丸。咸多泄
肾,酸甚扶肝。苦入心而寒凉损胃,辛走肺而燥热伤元。欲求中
正。无过平甘。或病须于(1)瞑眩兮,勿犯其毒;且从治于权宜兮,
但取其能。中病即已,救本为先。茍误投于汤药,即便致于损
残。此上工誓于活人,而良医验于折耾(2)!
尝闻法无一定,但占症候;医不三世,勿服汤丸。病者详于
择术,医者务于救痊。视疾若己,见利勿贪。先察运气兮,阳明
妙契;次观形色兮,顺逆了然。春夏阳而苦寒可用,在夫人之勇
健;秋冬阴而辛温可参,相其人之劳疳。既温反补,以寒再宣,
七神离散,五脏亏崩。虽留心于方脉兮,何补于世;反致人于伤
夭兮,获罪于天。是故胎疾兮急于解毒,食积兮利在消疳。治分
二法,效可十全。襁褓未宁,但调其母;匍匐不快,当固其元。
悲夫,肠胃中和,岂堪药石;微乎,气血稚弱,以渐发生。治非
得已。病有卒然。如护风烛,心常凛凛;若惜掌珠,意惟拳拳。
医可补乎司命,应无忝于家传。
且如病则热起,热则惊生。或治热以热,或攻热以寒。热在
表而柴葛解肌可饮,热在里而芩连消毒急煎。积热无如集圣;虚
热妙以调元。要在识夫脉色,不可妄投汤丸,贻终身之痼疾,促
婴儿之寿元(3)。轻以变重,功不补患。徒委命于气数,不详审乎
简编。前车既覆,后辙犹然。魂魄游于郊野,哭声达于洲泉。识
此之故,是谁之衍?磋夫!渡蚁驾桥,放雀解樊。况伊万物之灵,
匪值一虫之贱,不知谨密,遽尔轻捐(4)。推恻隐之良心,如见入
井;考圣贤之遗训,如弗及泉。居易虚险,因蹶知便。证随百
出,治无一偏。调变(5)造化,保养真元。善攻不如善守,宜急不
若宜缓。种杏成林,踵当年之董奉;植橘名井,见今日之苏耽。
奈何泻久变痢,积久成疳,疟久生癖,惊久成痈。未至留连兮。
攻之宜速;已见沉苛兮,治之且缓。肠胃闭塞兮,急泄而已;气
血虚赢兮,急补而安。外毒急攻,毌令入腹;表邪急解,毌令再
传。余则缓而调理,常恐急而生变;若药下咽,犹防其过,治或
中病,勿张其能(6)。知者常虑一失,死者不可复全。与其悔于已
误,孰若谨于未然。欲求鱼兔,当守蹄筌(7)。茍多方而治病。宜
三复于斯言!
(1)须于:校注者注,应为"须臾"。
(2)拆纮:山东泰安州李雨沾方悦父发梓版为:"拆纮"。。
(3)寿元:山东泰安州李雨沾方悦父发梓版为"寿年"。
(4)轻捐:山东泰安州李雨沾方悦父发梓版为"轻泛"。
(5)调变:山东泰安州李雨沾方悦父发梓版为"变调"。
(6)勿张其能:有的手抄本作"勿强其能"。
(7)蹄筌:汉阳鹤湄张伯琮校定版为"蹄笙"。
医家治疗的常规法则中,儿科是最难处理的。因为小儿肠胃娇嫩,容易因乳食不当而受伤;筋骨柔弱,容易感受风寒邪气。小儿病情容易转化为虚证或实证,变化极快,如同翻手之间;治疗时或补或泻,需要灵活变通,如同转丸般迅速适应。药物味咸多会耗伤肾气,味酸过甚则有助于肝气升发。苦味入心但性寒凉易损伤胃气,辛味走肺但性燥热易损伤元气。想要寻求中正平和的治疗之道,没有比使用平性甘味的药物更好的了。如果病情危急需要服用可能引起瞑眩反应的药物,不要担心其毒性;若采用权宜的从治法,只要取其疗效即可。药物见效即止,以挽救根本为优先。如果误投汤药,立刻会导致身体受损残废。这是高明医生誓愿救死扶伤、良医通过实践验证医术的道理!
曾经听说治疗方法没有固定模式,关键在于把握症候;如果不是三世行医之家,不要轻易给病人服用汤药丸剂。病人应详细选择医术精湛的医生,医生务必致力于治愈疾病。看待病人的痛苦要像对待自己一样,见到利益不要贪婪。先观察运气(五运六气)的变化,阳明经的病机要巧妙契合;其次观察面色和形体,顺逆之势了然于心。春夏季节阳气盛,可以使用苦寒药物,这取决于人的体质是否强健;秋冬季节阴气盛,可以参用辛温药物,要根据人的劳累和疳积情况而定。如果该温补反而用了寒凉,该宣散反而用了温补,会导致七神离散,五脏亏空崩塌。虽然留心于方脉研究,但对世道人心有何补益?反而导致人早夭,这是获罪于天的行为。因此,胎毒引发的疾病急于解毒,食积引起的疾病利于消除疳积。治疗分为这两种方法,效果可以十全十美。婴儿尚在襁褓之中未安宁,应当调理母亲的身体;幼儿学步不快,应当固护其元气。
可悲啊,小儿肠胃中和之气尚未稳固,哪里经得起药物的攻伐;微妙啊,小儿气血稚嫩虚弱,需要慢慢滋养才能生长发育。治疗并非出于无奈,而是疾病突然发生。就像保护风中残烛一样,心中常常保持敬畏;如同珍惜掌上明珠一样,心意始终诚恳专注。医生可以弥补司命神的不足,应该不辱没家传医术。
况且如生病则热气升起,热气上升则惊风产生。有的用热药治热病,有的用寒药攻热邪。热邪在表,可以饮用柴葛解肌汤;热邪在里,急煎芩连消毒汤。积热无过于集圣丸;虚热妙用调元汤。关键在于识别脉象和面色,不可妄投汤药丸剂,以免留下终身痼疾,缩短婴儿寿命。轻症变为重症,功劳抵不过祸患。只是把命运交给气数,不详细审阅医书典籍。前车之鉴已经倾覆,后车依然重蹈覆辙。魂魄游荡在郊野,哭声直达洲泉。知道这个缘故,是谁的过失?唉!渡蚂蚁架桥,放麻雀出笼。何况他们是万物之灵,不比一条虫子的生命低贱,如果不谨慎严密,就轻易地牺牲了他们。推究恻隐的良心,就像看到有人掉进井里;考察圣贤的遗训,就像怕来不及救人出井。处于安逸就要想到危险,因为跌倒才知道如何避免不便。证候随病情百出,治疗不能偏执一端。调和变幻造化,保养真元。善于进攻不如善于防守,适宜紧急不如适宜缓和。种植杏树成林,追随当年董奉的美德;种植橘子命名井,看见今日苏耽的事迹。
奈何腹泻久了变成痢疾,积滞久了形成疳积,疟疾久了生出癖块,惊风久了形成痈肿。病势未到缠绵阶段,攻伐应当迅速;已经见到沉疴重病,治疗暂且缓和。肠胃闭塞,急需泄下;气血虚弱羸瘦,急需补益以安定。外毒急攻,不要让毒素进入腹部;表邪急解,不要让邪气再次传变。其余情况则缓慢调理,常恐急躁而生变故;如果药已下咽,还要防止过量,治疗如果中病,不要夸大其能。智者常虑及一失,死者不可复生。与其事后后悔已经误治,不如事前谨慎预防。想要得到鱼兔,应当守住蹄和筌(工具)。如果多方治病,应当反复思考这些话!
In the medical field, pediatric treatment is the most difficult. The intestines and stomach are fragile and prone to injury from milk and food; the bones and tendons are tender and easily affected by wind and cold. Prone to deficiency or excess, changes occur as quickly as flipping a hand; whether tonifying or purging, flexibility is crucial, like turning a pill. Salty flavors often deplete Kidney Qi, while excessive sour flavors support Liver Qi. Bitter flavors enter the Heart but their cold nature damages the Stomach; pungent flavors travel to the Lung but their dryness and heat damage Yuan Qi. To seek a balanced approach, nothing surpasses flat-natured sweet herbs. If the condition requires sudden dizziness (mingxuan) from potent drugs, do not fear their toxicity; if adopting temporary symptomatic treatment, only seek efficacy. Stop medication once it hits the disease, prioritizing the rescue of the root. Misprescribing decoctions immediately leads to damage and disability. This is the oath of superior physicians to save lives, and the verification of good doctors through practice!
It has been heard that methods are not fixed, but depend on symptoms; if one is not a physician from three generations, do not administer decoctions or pills. Patients should carefully select skilled practitioners, and physicians must strive for cure. View illness as if it were one's own, and do not be greedy for profit. First observe the influence of climate (Yunqi), skillfully aligning with Yangming mechanisms; then observe complexion and physique, clearly understanding favorable and unfavorable trends. In spring and summer, when Yang is abundant, bitter-cold herbs can be used, depending on the patient's robustness; in autumn and winter, when Yin is abundant, pungent-warm herbs can be considered, based on the patient's fatigue and gan syndrome. If warming is needed but cold is used, or if dispersal is needed but warmth is applied, the Seven Spirits will scatter, and the Five Zang organs will collapse. Although paying attention to pulse and prescription studies, what benefit does it bring to the world? Instead causing premature death, this incurs heavenly retribution. Therefore, for congenital diseases, urgent detoxification is required; for food stagnation, eliminating gan syndrome is beneficial. Treatment divides into two methods, achieving perfect efficacy. For infants still unsettled in swaddling clothes, regulate the mother; for toddlers walking unsteadily, consolidate their Yuan Qi.
Alas, the harmonious center of the intestines and stomach cannot withstand medicinal attacks; subtle is the weak and immature Qi and Blood, which develop gradually. Treatment is not out of desperation, but because diseases strike suddenly. Like protecting a candle in the wind, the heart remains vigilant; like cherishing a pearl in the palm, the intention is sincere. Physicians can supplement the Lord of Life, without disgracing family traditions.
For instance, when illness arises, heat emerges; when heat rises, fright occurs. Some treat heat with heat, others attack heat with cold. If heat is in the exterior, Chai Ge Jie Ji Tang (Bupleurum and Pueraria Muscle-Releasing Decoction) can be drunk; if heat is in the interior, Qin Lian Xiao Du Tang (Scutellaria and Coptis Detoxifying Decoction) should be boiled urgently. For accumulated heat, Ji Sheng Wan (Ji Sheng Pill) is unparalleled; for deficient heat, Tiao Yuan Tang (Regulating Yuan Decoction) is excellent. The key lies in recognizing pulses and colors, not recklessly administering decoctions or pills, lest leaving lifelong chronic diseases or shortening the infant's lifespan. Mild conditions becoming severe, the merit does not offset the harm. Merely entrusting fate to destiny, without carefully studying classics. The previous cart overturned, yet the tracks remain the same. Souls wander in the suburbs, cries reach the rivers. Knowing this cause, whose fault is it? Alas! Building bridges for ants, freeing sparrows from cages. How much more so for spirits among all things, not worth less than a worm, if not cautious and meticulous, they are lightly sacrificed. Extending compassionate conscience, as if seeing someone fall into a well; examining sages' teachings, as if fearing failure to save them. Living in ease implies danger, knowing falls teaches caution. Symptoms emerge in hundreds of ways, treatments avoid bias. Harmonize and transform creation, preserve true Yuan. Good offense is inferior to good defense, urgency is preferable to slowness. Planting apricots to form a forest, following Dong Feng of old; planting oranges naming a well, seeing Su Dan of today.
Why does prolonged diarrhea become dysentery, prolonged stagnation become gan syndrome, prolonged malaria produce masses, prolonged fright turn into abscesses? Before lingering sets in, attack should be swift; once severe illness appears, treatment should be gentle. Intestines and stomach blocked, urgently purge; Qi and Blood deficient and emaciated, urgently tonify to stabilize. External toxins attacked urgently, preventing entry into the abdomen; exterior pathogens resolved urgently, preventing further transmission. Others are regulated slowly, fearing rapid changes; once medicine is swallowed, prevent overdose; if treatment hits the disease, do not exaggerate ability. The wise often worry about one mistake, the dead cannot be restored. Better to be cautious before error than regret after misjudgment. To seek fish and rabbits, hold onto the trap and basket. If treating diseases with multiple methods, repeat these words thrice!