仲景论中。虽云不避晨夜。即宜便治。医者亦须顾其表里。待其时日。若不循次第。虽临时得安。损亏五脏。
以促寿期。何足尚也。昔范云为梁武帝属官。得时疫热疾。召徐文伯诊视。是时武帝有九锡之命。期在旦
夕。云欲预盛礼。谓文伯曰。可便得愈乎。文伯曰。便瘥甚易。政恐二年外不复起尔。云曰。朝闻道夕死可矣。
况二年乎。文伯于是先以火 地。布桃柏叶。布席。置云其上。顷刻汗出。以温粉 之。翌日遂愈。云甚喜。
文伯曰。不足喜。后二年果卒。夫取汗先期。尚促寿限。况罔顾表里。不待时日。便欲速愈者耶。今病家不耐病。
才病三四日。昼夜督汗。医者随情顺意。鲜不致毙。故予感此。而以为龟鉴也。
仲景云。卫气和名曰缓。荣气和名曰迟。缓迟相搏。名曰沉。注云缓者四肢不收。迟者身体俱重。沉者腰中
直。腹内急痛。若然则三者皆病脉也。安得谓之和。注者乃以脉诀中沉缓迟论之。不知仲景伤寒脉。与杂
病脉异。何以言之。上文云卫荣盛为高、章、纲。卫荣弱为 、卑、损。至此三脉谓之和。则不盛不弱。乃平和脉。
盖伤寒之脉。高、章、纲者阳证类。 、卑、损者阴证类。即是而言。则缓、迟、沉者阴阳向安之脉也。
不特此尔。下文二寸口脉缓而迟。缓则阳气长。迟则阴气盛。阴阳相抱。荣卫俱行。刚柔相得。非安平而何。
张仲景在论述中提到,虽然治疗不应拘泥于早晚,发现病情就应立即施治,但医生也必须顾及其表里状况,等待适宜的时机。如果不遵循治疗的次第(步骤),即使当时暂时获得安宁,也会损伤五脏,缩短寿命,这哪里值得推崇呢?
从前范云担任梁武帝的属官时,染上了时行疫热病。他召徐文伯来诊视。当时梁武帝已下达九锡的任命,期限就在早晚之间。范云想预先参与盛大的礼仪,便对徐文伯说:“可以立刻痊愈吗?”徐文伯说:“立刻痊愈很容易,只是恐怕两年后您就不能再起来了。”范云说:“早上听闻大道,晚上死去也可以,何况是两年呢?”徐文伯于是先用火加热地面,铺上桃叶和柏叶,再铺上席子,让范云躺在上面。片刻之后,范云出汗,徐文伯用温粉为他擦拭。第二天范云就痊愈了。范云非常高兴。徐文伯说:“不值得高兴,两年后果然去世了。”这种提前取汗的方法,尚且缩短了寿命,更何况那些不顾表里、不等待时日,就想快速痊愈的情况呢?现在的病人不能忍受病痛,才生病三四天,就日夜催促发汗。医生顺从病人的心意,很少有不导致死亡的。所以我对此有所感触,将其作为借鉴。
张仲景说:卫气调和称为“缓”,营气调和称为“迟”。缓与迟相互搏结,称为“沉”。注解说:缓表现为四肢无力收持,迟表现为身体沉重,沉表现为腰部挺直、腹内急痛。如果这样,那么这三种都是病脉,怎么能说是“和”(平和)呢?注解者是用《脉诀》中的沉、缓、迟来解释的,不知道张仲景论述伤寒的脉象,与杂病的脉象是不同的。为什么这样说?上文说卫气和营气旺盛分别称为高、章、纲;卫气和营气虚弱分别称为 、卑、损。到这里提到这三种脉象称为“和”,说明它们既不盛也不弱,乃是平和的脉象。大概伤寒的脉象中,高、章、纲属于阳证类, 、卑、损属于阴证类。由此而言,缓、迟、沉则是阴阳趋向安定的脉象。不仅如此,下文说寸口脉缓而迟,缓则阳气生长,迟则阴气旺盛,阴阳相抱,营卫共同运行,刚柔相得,这不是平安健康又是什么呢?
In his treatises, Zhang Zhongjing stated that although treatment should not be avoided regardless of morning or night and should be administered as soon as the condition is identified, physicians must also consider the exterior and interior states and wait for the appropriate timing. If one does not follow the proper sequence (steps) of treatment, even if temporary relief is achieved at the moment, it will damage the Zang-Fu organs and shorten life expectancy. How could such a practice be worthy of endorsement?
In the past, Fan Yun, an official under Emperor Wu of Liang, contracted an epidemic febrile disease. He summoned Xu Wenbo for diagnosis. At that time, Emperor Wu had issued the appointment of the Nine Bestowals (Nine Gifts), with the ceremony scheduled for imminent days. Fan Yun wished to participate in the grand ceremony in advance, so he asked Xu Wenbo, "Can I recover immediately?" Xu Wenbo replied, "Recovering immediately is very easy, but I fear you will not rise again after two years." Fan Yun said, "If one hears the Dao in the morning, one can die contentedly in the evening; how much more so for two years?" Xu Wenbo then heated the ground with fire, spread peach leaves and cypress leaves upon it, laid down a mat, and placed Fan Yun on top. Within moments, Fan Yun perspired. Xu Wenbo wiped him with warm powder. The next day, Fan Yun recovered. Fan Yun was extremely pleased. Xu Wenbo said, "There is no need to be pleased; indeed, he died two years later." That taking sweat prematurely still shortened the lifespan, let alone those who disregard the exterior and interior, do not wait for the proper time, and desire rapid recovery. Nowadays, patients cannot endure their illness; only three or four days into the sickness, they urge sweating day and night. Physicians, complying with their wishes, rarely fail to cause death. Therefore, I am moved by this and regard it as a mirror for reflection.
Zhang Zhongjing said: When Wei Qi (Defensive Qi) is harmonious, it is called Huan (Slow/Relaxed); when Ying Qi (Nutritive Qi) is harmonious, it is called Chi (Slow). When Huan and Chi interact, it is called Chen (Deep). The commentary notes that Huan manifests as inability to control the limbs, Chi as heaviness of the body, and Chen as a straight waist and acute pain in the abdomen. If this were the case, then all three would be pathological pulses, how could they be described as "He" (Harmonious)? The commentator interpreted these using the pulses of Chen, Huan, and Chi from the Mai Jue (Pulse Classic), unaware that Zhang Zhongjing's pulse descriptions for Shanghan (Cold Damage) differ from those for miscellaneous diseases. Why is this so? The preceding text states that flourishing Wei and Ying Qi are termed Gao (High), Zhang (Chapter), and Gang (Gang); weak Wei and Ying Qi are termed , Bei (Low), and Sun (Damage). Here, mentioning these three pulses as "He" implies they are neither flourishing nor weak, representing a healthy pulse. Generally, in Shanghan pulses, Gao, Zhang, and Gang belong to the Yang syndrome category, while , Bei, and Sun belong to the Yin syndrome category. From this perspective, Huan, Chi, and Chen are pulses where Yin and Yang tend toward stability. Moreover, the following text states that the Cun Kou (Radial Pulse) is both Huan and Chi; Huan indicates the growth of Yang Qi, and Chi indicates the abundance of Yin Qi. Yin and Yang embrace each other, Ying and Wei circulate together, and Gang and Rou (Hardness and Softness) complement each other. Is this not peace and health?