问曰。华佗治伤寒法。与仲景少异何谓。千金方载华佗之言曰。
夫伤寒。始得一日在皮肤。摩膏火灸之则愈。若不解者。二日在肤。
可根据法针。服解肌散发汗。汗出则愈。若不解者。三日在肌。复一发
汗则愈。若不解者。止勿复发汗也。至四日在胸。宜服藜芦丸微吐之
则愈。若病用藜芦丸不能吐者。服小豆瓜蒂散吐之则愈也。视病若
未惺惺者。复一法针之。五日在腹。六日入胃。入胃乃可下也。若热
毒在外。未入于胃而先下之者。其热乘虚入胃。则烂胃也。然热入
胃。要须下去之。不可留于胸中也。雍曰。元化之术。指日期为候。仲
景虽指日。而要在察阴阳六经之证。此其所以若少异也。要之仲景
规矩准绳明备。足为百世之师。元化自得神术。惟可自用。故外台言
元化藜芦丸近用损人。不录。则知后人不能学也。
问曰。仲景元化之术孰优。雍曰。未易优劣。大抵仲景之术。得
于学识。元化之术。得于心悟。心悟则变化无常。自用多奇。而学人
鲜能从。必欲从上圣之精微。为百世之模楷。非仲景而谁欤。故仲景
之于医道。守其常也。元化之医道。从其变也。
问曰。元化临终之日。焚书于狱中。曰。此书可以活人。后世谓
所焚之书为仲景之书。是耶非耶。雍日。非也。仲景之书。出于元化
之后也。曰。异哉。仲景汉人。元化魏人。安得书出其后。曰。仲景元
化同为汉末人。仲景不仕魏。故世称曰汉仲景。元化仕曹氏。故世称
曰魏佗也。考之于史。元化死于吕布陈登之际。计其时在建安之初。
是时佗已百余岁矣。仲景叙论曰。余宗族素多。向余二百。建安纪年
以来。曾未十稔。其死亡者。三分有二。伤寒十居其七。感往昔之沦
丧。伤横夭之莫救。乃勤求古训。博采众方。为伤寒杂病论合十六
卷。则是书作于建安十年之后。故知二公声迹相接。而仲景犹为后
进也。
问曰。世独重仲景之书何也。雍曰。陶隐居、孙真人。可谓古之
名医矣。陶论医方曰。惟张仲景一部。最为众方之祖。孙真人曰。伤
寒热病。自古有之。名医睿哲。多所防御。至于仲景。特有神功。寻思
旨趣。莫测其致。所以医人未能钻仰。以二者之言推之。宜其特重于
世也。文孙真人曰。寻方之大意。不过三种。一则桂枝。二则麻黄。三
则青龙。凡疗伤寒。不出之也。而说者谓如太阳中 。当用白虎。不
可误服桂枝麻黄。此古人所未至。何也。雍曰。伤寒之初。惟有桂枝
麻黄青龙三证。故不出用此三药。若言中 。则中 非伤寒。自是别
病。当用白虎。何缘用此三药。非古人所未至。盖论者误以中 为伤
寒也。
问曰。元化之书有传否。雍曰。未之见也。载于千金者。亦杂以
孙真人之言。近世蕲水庞安常论中所载。其言少异。曰。庞氏所载何
如。曰。庞氏曰。华佗治法云。伤寒病起自风寒。入于腠理。与精气分
争。营卫痞隔。周行不通。病一日至二日。邪气在孔窍皮肤之间。故
病者头疼。恶寒身热。腰脊强直。此邪气在表。随证发汗则愈。病三
日以上。气浮上部。填塞心胸。故头痛胸中满。或多痰涎；当吐之则
愈。病五六日以上。气结在脏腑。故腹满身重。骨节烦疼。当下则愈。
其言与千金又异。
问：华佗治疗伤寒的方法，与张仲景的略有不同，具体是指什么？《千金方》记载了华佗的话说：
大凡伤寒，刚得病第一天，邪气在皮肤表面。用按摩膏药或火灸治疗就能痊愈。如果没好，第二天邪气在肌肤层。可以根据方法针刺，服用解肌散发汗的药。出汗后就能痊愈。如果还没好，第三天邪气在肌肉层。再发一次汗就能痊愈。如果还没好，就不要再发汗了。到了第四天，邪气在胸中。适宜服用藜芦丸轻微催吐，就能痊愈。如果病人用了藜芦丸不能吐出，服用小豆瓜蒂散催吐也能痊愈。观察病情如果病人神志不清醒，再用另一种方法针刺。第五天邪气在腹部。第六天进入胃腑。进入胃腑才可以攻下。如果热毒在体表，还没进入胃腑就先攻下，那么热邪会乘虚进入胃腑，导致胃烂。然而热邪进入胃腑，必须将其攻下排出，不可留在胸中。郭雍说：元化（华佗字）的技术，以日期作为判断病位的依据。张仲景虽然也提及日期，但关键在于诊察阴阳六经的症状表现。这就是他们略有不同的原因。总之，张仲景的规则法度明确完备，足以成为百世的老师。元化自有神奇医术，只适合他自己使用。所以《外台秘要》说元化的藜芦丸近期使用损伤人体，不予收录，这说明后人无法学习。
问：张仲景和华佗的医术谁更优秀？郭雍说：不容易分出高下。大致上，张仲景的医术来源于学识积累，华佗的医术来源于内心领悟。内心领悟则变化无常，自我运用多有奇效，而求学之人很少能跟随。一定要追求上古圣人的精微之处，作为百世的楷模，除了张仲景还有谁呢？所以张仲景对于医道，是坚守常规；华佗的医道，是顺应变化。
问：华佗临终那天，在狱中烧毁书籍，说：“这本书可以救人。”后世所说被烧毁的书是张仲景的书，是这样吗还是不是？郭雍说：不是。张仲景的书，是在华佗之后出现的。问：奇怪啊。张仲景是汉代人，华佗是魏国人，怎么书会在华佗之后出现？答：张仲景和华佗同为汉末人。张仲景不做魏国的官，所以世人称他为汉代的张仲景。华佗在曹氏手下做官，所以世人称他为魏国的华佗。考证历史，华佗死于吕布和陈登之间。推算时间在建安初年。这时华佗已经一百多岁了。张仲景在叙论中说：“我的宗族原本很多，过去有二百多人。自建安纪年以来，不到十年，死去的占了三分之二，其中伤寒占十分之七。感念往昔的沦丧，哀叹横死夭折者无人能救，于是勤奋探求古训，广泛采集各方药方，写成《伤寒杂病论》共十六卷。”那么这本书作于建安十年之后。所以知道两位公子的声迹相接，而张仲景算是后辈。
问：世人为什么唯独看重张仲景的书？郭雍说：陶弘景、孙思邈，可以说是古代的名医了。陶弘景论述医方时说：“只有张仲景的一部书，是最为众多方剂的祖师。”孙思邈说：“伤寒热病，自古就有。名医睿智哲人，多有防御之法。至于张仲景，特别有神功。寻思其旨趣，无法测度其深奥。所以医生们未能深入钻研仰慕。”从这两人的话推断，应该被世人特别重视。孙思邈又说：“寻究方剂的大意，不过三种。一种是桂枝汤，一种是麻黄汤，一种是青龙汤。凡是治疗伤寒，不出这三种范围。”而解说的人认为如太阳中暍（中暑），应当用白虎汤，不可误服桂枝汤和麻黄汤。这是古人所未达到的地方，为什么呢？郭雍说：伤寒之初，只有桂枝汤证、麻黄汤证、青龙汤证三种。所以不超出使用这三类药。如果说中暍，那么中暍不是伤寒，自然是别的病。应当用白虎汤，怎么会用这三类药？这不是古人所未达到，大概是解说的人错误地把中暍当作伤寒了。
问：华佗的书有流传下来吗？郭雍说：没见过。《千金方》中记载的，也混杂了孙思邈的话。近代蕲水庞安常（庞安时）论述中所载，说法略有不同。问：庞氏记载的是什么情况？答：庞氏说：华佗治法云：伤寒病起自风寒，侵入腠理，与精气相争，营卫痞塞阻隔，周身运行不通。病一天到两天，邪气在孔窍皮肤之间。所以病人头疼，恶寒身热，腰脊强直。这是邪气在表，随证发汗就能痊愈。病三天以上，气浮于上部，填塞心胸。所以头痛胸中满闷，或多痰涎；应当催吐就能痊愈。病五到六天以上，气结在脏腑。所以腹满身重，骨节烦疼。应当攻下就能痊愈。他的说法与《千金方》又不同。
Question: How does Hua Tuo's method for treating Shanghan (Cold Damage) differ slightly from Zhang Zhongjing's? The *Qianjin Fang* records Hua Tuo's words as follows:
Generally, in the initial stage of Shanghan, on the first day, the pathogen is at the skin level. It can be cured by applying massage ointments or moxibustion. If it does not resolve, on the second day, the pathogen is in the flesh layer. One may needle according to specific methods and administer a diaphoretic formula to release the muscle layer. Sweating will lead to recovery. If it still does not resolve, on the third day, the pathogen is in the muscle layer. Another induction of sweating will cure it. If it remains unresolved, do not induce sweating again. By the fourth day, the pathogen is in the chest. It is appropriate to administer Lili Wan (Veratrum Pill) to induce mild vomiting for recovery. If the patient cannot vomit after taking Lili Wan, administering Xiaodou Gaidi San (Adzuki Bean and Melon Seed Powder) to induce vomiting will also work. Observe if the patient is not lucid; if so, apply another needling method. On the fifth day, the pathogen is in the abdomen. On the sixth day, it enters the Stomach. Only when it has entered the Stomach should purgation be used. If heat-toxin is on the exterior and has not yet entered the Stomach, but purgation is applied prematurely, the heat will enter the Stomach vacuously, causing gastric erosion. However, once heat enters the Stomach, it must be purged downward and cannot be allowed to remain in the chest. Guo Yong stated: Yuanhua’s (Hua Tuo's courtesy name) technique uses days as indicators for pathogen location. Although Zhang Zhongjing also references days, his key lies in examining the syndromes of Yin-Yang and the Six Channels. This is why their approaches differ slightly. In essence, Zhang Zhongjing’s rules and standards are clear and complete, sufficient to serve as a model for generations. Yuanhua possessed miraculous skills suited only for his own use. Thus, the *Waitai Miyao* states that Yuanhua’s Lili Wan causes harm if used recently and is therefore excluded, indicating that later practitioners could not learn from it.
Question: Whose medical skill is superior, Zhang Zhongjing’s or Hua Tuo’s? Guo Yong replied: It is difficult to judge superiority. Generally speaking, Zhang Zhongjing’s skill derives from scholarly learning, whereas Hua Tuo’s skill derives from intuitive insight. Intuitive insight leads to unpredictable changes and unique applications, which few students can follow. To pursue the subtleties of ancient sages and become a model for all generations, who else but Zhang Zhongjing? Therefore, regarding the medical way, Zhang Zhongjing adhered to constancy, while Hua Tuo followed variability.
Question: On his deathbed, Hua Tuo burned books in prison, saying, "This book can save lives." Is it true that the books burned were those of Zhang Zhongjing? Guo Yong said: No. Zhang Zhongjing’s book was produced after Hua Tuo. Questioner: Strange indeed. Zhang Zhongjing was a Han person, and Hua Tuo was a Wei person. How could the book appear after him? Reply: Both Zhang Zhongjing and Hua Tuo lived in the late Han dynasty. Zhang Zhongjing did not serve the Wei regime, hence he is called Zhang Zhongjing of Han. Hua Tuo served under the Cao clan, hence he is called Hua Tuo of Wei. Historical records show Hua Tuo died during the conflict involving Lü Bu and Chen Deng. Calculating the time, this was early Jian’an era. At that time, Hua Tuo was already over one hundred years old. Zhang Zhongjing wrote in his preface: "My clan was originally large, numbering nearly two hundred. Since the beginning of the Jian’an era, within ten years, two-thirds have perished, with seven out of ten cases being Shanghan. Mourning the past losses and the untimely deaths that could not be saved, I diligently sought ancient teachings and collected various prescriptions, compiling the *Shanghan Zabing Lun* (Treatise on Cold Damage and Miscellaneous Diseases) into sixteen volumes." Thus, the book was written after the tenth year of Jian’an. Hence, we know the two figures’ timelines overlapped, and Zhang Zhongjing was the junior.
Question: Why does the world value Zhang Zhongjing’s book above all others? Guo Yong said: Tao Hongjing and Sun Simiao can be considered famous ancient physicians. Tao Hongjing discussed medical formulas, stating: "Among all works, only Zhang Zhongjing’s volume is the ancestor of all formulas." Sun Simiao said: "Shanghan and febrile diseases have existed since antiquity. Famous doctors and wise men have had many preventive measures. Regarding Zhang Zhongjing, he possesses miraculous efficacy. Pondering his purport, its depth is unfathomable. Therefore, physicians have failed to delve deeply into it." Inferring from these statements, it is understandable why it is particularly valued. Sun Simiao further stated: "The general intent of prescriptions falls into three categories: one is Guizhi Tang (Cinnamon Twig Decoction), two is Mahuang Tang (Ephedra Decoction), and three is Qinglong Tang (Azure Dragon Decoction). In treating Shanghan, nothing goes beyond these." However, commentators argue that for Taiyang Zhongshu (Heatstroke in the Taiyang channel), Baihu Tang (White Tiger Decoction) should be used, and Guizhi Tang and Mahuang Tang must not be mistakenly administered. This point was not reached by ancients. Why? Guo Yong said: In the early stage of Shanghan, there are only three syndromes corresponding to Guizhi Tang, Mahuang Tang, and Qinglong Tang. Hence, treatment does not exceed these three. If discussing Zhongshu (Heatstroke), Zhongshu is not Shanghan but a distinct disease. Baihu Tang should be used; why would these three decoctions be used? This is not because ancients failed to reach this understanding, but likely because commentators mistakenly classified Zhongshu as Shanghan.
Question: Are Hua Tuo’s books transmitted? Guo Yong said: I have not seen them. What is recorded in the *Qianjin Fang* also mixes in words from Sun Simiao. In recent times, Pang Anchang (Pang Anshi) of Qishui included discussions where the wording differs slightly. Questioner: What does Pang record? Reply: Pang states: Hua Tuo’s treatment method says: Shanghan originates from Wind-Cold, entering the Couli (pores and interstices), contending with vital Qi, causing stagnation and obstruction between Ying and Wei, blocking circulation throughout the body. From one to two days, the pathogen is between the orifices and skin. Thus, the patient suffers headache, aversion to cold, fever, and stiffness of the waist and spine. This indicates the pathogen is at the exterior; inducing sweating according to the syndrome will cure it. After three days, Qi floats to the upper part, filling and obstructing the chest and heart. Thus, headache, chest fullness, or excessive phlegm-saliva occur; inducing vomiting will cure it. After five to six days, Qi knots in the Zang-Fu organs. Thus, abdominal distension, heaviness of the body, and painful joints occur; purging will cure it. His account differs again from the *Qianjin Fang*.