一气之块然乎太虚之间也。氤氲摩荡,以
生生万物。而其禀之驳者,为禽兽,为草木;粹者为人。而其粹者,亦有浓薄强弱之不同
,加之六气 乎外,七情侵乎内,而诸疾生焉。有寒有热,有表有里,千状
万证,不可俱述。而要之不过虚实两者之间焉。故经曰∶虚则补,实则泻。呜呼!虚实者
,诊病之标的,而补泻者,施治之大要也哉!长沙以还,明哲辈出,家擅专门,人立异见。诸说旁舞
,
于泻,而立斋偏于补。既有所偏,则不能无弊。苟不能无弊,则又不可无辨焉!予窃为二君之
术,一补一泻,虽有不同,而各极其至,庶乎圣之功,亦莫以加焉。然天下之病,未必尽实
,则其偏于泻也,吾恐虚者之反受其害也;未必尽虚,则其偏于补也,吾恐实者之亦反受其
害也。一得一失,明于此而暗于彼,此岂斯道之大成哉!若长沙则不然,可以补则补,而不
偏于补;可以泻则泻,而不偏于泻。虚实随证,补泻应机,呜呼!亦可谓大成矣。拟诸古之
圣贤,二君之于长沙,犹夷惠之于孔子也。盖补泻之不可偏废,犹裘葛之不可一施也。而今
不核虚与实,而致补泻之各偏,犹不审冬夏之异候,而欲偏裘葛之御也,岂其理也哉。故曰
∶少阴病下利清谷,里寒外热者,通脉四逆汤主之。又曰∶少阴病,自利清水,色纯青者
,宜大承气汤。补泻不可偏废也,可见矣。方今之世,好补而恶泻,喜温而畏寒,大黄芒硝
,视如蛇蝎;干姜附子,甘如饴蜜。遇硝黄奏效,则曰∶此惟取一时之快,后必致寒中之患
。姜附错投,则曰∶姜附犹不验,归之于命。盖亦不思之甚也。故凡治疗之书,偏于补者,
盛行于世,而梨枣日广,至于戴人此书,传诵甚罕,予窃童蒙学医者,
哗偏补之书,而不讲泻实之方,则虚虚实实,其弊将有不可胜言者。
鸠工寿梓,以广其传。惟冀此书,与立斋之书,并行于世,可以泻则师戴人,可以补则师立斋
,无致补泻之偏胜,使斯民同跻于仁寿之域矣!
正德辛卯八月望日渡边荣元安甫书于洛阳松下睡鹤轩
天地之间,只是一团浑然之气。这气在太虚之中氤氲交融、相互激荡,从而化生万物。其中禀受驳杂之气者,成为禽兽草木;禀受纯粹之气者,成为人类。然而即使是禀受纯粹之气的人,也有浓厚与稀薄、强壮与虚弱的不同。再加上外界六气的侵袭,内部七情的侵扰,各种疾病便由此产生。疾病有寒热之分,有表里之别,症状千姿百态,无法一一陈述。但归根结底,不过是在“虚”和“实”两者之间罢了。所以医经说:“虚证则用补法,实证则用泻法。”唉!虚实是诊断疾病的标尺,而补泻则是施治的关键所在啊!
自从汉代长沙太守张仲景以来,明智贤哲辈出,各家擅长专门之学,各人树立不同的见解。各种学说纷繁杂陈,有的偏重于泻法(如戴人),有的偏重于补法(如立斋)。既然有所偏颇,就必然会产生弊端。既然有弊端,就不能不进行辨析!我私下认为,这两位君子的医术,一补一泻,虽然有所不同,但都达到了极高的境界,对于圣人的功绩来说,也没有比这更高的了。然而天下的疾病,未必全是实证,那么那些偏重于泻法的人,我担心虚证患者反而会受害;未必全是虚证,那么那些偏重于补法的人,我担心实证患者也会反过来受害。一种方法得此失彼,明白这一面却暗于另一面,这难道是医学大道的圆满大成吗?
像张仲景就不是这样,可以补的时候就补,但不偏执于补;可以泻的时候就泻,但不偏执于泻。根据虚实随证变化,补泻顺应时机,唉!这才可以称为大成啊。如果拿古代的圣贤来比拟,戴人和立斋对于张仲景,就像伯夷、柳下惠对于孔子一样(意指虽高但未至圣人全备之境)。补法和泻法不可偏废,就像皮衣和葛衣不能只在同一个季节穿一样。而现在如果不核实虚与实,而导致补泻各自偏颇,就像不审视冬夏气候的不同,却想只靠皮衣或葛衣来御寒避暑,这符合道理吗?
所以说:“少阴病,下利清谷(拉出未消化的食物),里有寒外有热的,用通脉四逆汤主治。”又说:“少阴病,自动腹泻清水,颜色纯青的,宜用大承气汤。”由此可见,补泻是不可偏废的。当今之世,喜好补法而厌恶泻法,喜欢温补而畏惧寒凉,把大黄、芒硝看作蛇蝎一样可怕;把干姜、附子看得像饴糖一样甜美。遇到使用硝石、大黄奏效时,就说:“这只是图一时的痛快,以后必定导致中寒的祸患。”误用姜、附后无效时,就说:“连姜附都不见效,只能归咎于命运。”这也太不思量了。所以凡是治疗方面的书籍,偏重于补法的,在世间盛行,刻印日益广泛。至于戴人的这本书,流传诵读非常稀少。我私下担忧,童蒙学习医学的人,喧哗推崇偏补的书籍,而不研习泻实的方剂,那么就会导致“虚者更虚,实者更实”的弊病,其后果将不堪言说。
于是聘请工匠雕刻书版,以扩大其传播。只希望这本书能与立斋的书并行于世,可以泻的时候师法戴人,可以补的时候师法立斋,不要导致补泻的偏胜,使百姓共同达到仁爱的长寿境界!
正德辛卯年八月十五日,渡边荣元安甫,写于洛阳松下睡鹤轩。
Between the Great Void, there is but a single, undifferentiated mass of Qi. Through its swirling interaction and mutual agitation within the Great Void, all things are generated. Those who receive mixed Qi become beasts and plants; those who receive pure Qi become humans. However, even among those with pure Qi, there are differences in density (thickness/thinness) and strength. Furthermore, when invaded by the Six Qi (Six Climatic Factors: Wind, Cold, Summer Heat, Dampness, Dryness, Fire) externally and assaulted by the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright) internally, various diseases arise. Diseases manifest as cold or heat, exterior or interior, with thousands of symptoms and signs that cannot be fully enumerated. Ultimately, they fall only between "Deficiency" (Xu) and "Excess" (Shi). Thus, the Classics state: "For deficiency, tonify; for excess, drain." Alas! Deficiency and Excess are the standards for diagnosing disease, while Tonification and Draining are the major principles of treatment!
Since Zhang Zhongjing (the Prefect of Changsha), wise sages have emerged in succession, each specializing in specific schools and establishing divergent views. Various theories dance around; some lean towards draining (e.g., Dai Ren/Zhang Congzheng), while others lean towards tonifying (e.g., Li Zhihe/Li Shizhen's predecessor in this context, likely referring to Li Dongyuan or similar figures depending on interpretation, but here explicitly named "Lizhai"). Since there is bias, there must be drawbacks. Since there are drawbacks, differentiation is necessary! I privately believe that the techniques of these two gentlemen, one tonifying and one draining, though different, both reach their utmost perfection. In terms of the merit of the Sages, nothing could add to it. However, diseases in the world are not necessarily all Excess; thus, regarding those biased towards draining, I fear that patients with Deficiency will suffer harm. They are not necessarily all Deficiency; thus, regarding those biased towards tonifying, I fear that patients with Excess will also suffer harm. Gaining one aspect while losing another, being clear on one side but obscure on the other—is this truly the great completion of the Dao of medicine?
Zhang Changsha (Zhang Zhongjing) was not like this. When tonification is appropriate, he tonifies without bias towards tonification; when draining is appropriate, he drains without bias towards draining. He follows the syndrome regarding Deficiency and Excess, and applies tonification and draining according to the timing/opportunity. Alas! This can truly be called the Great Completion. Comparing them to ancient sages, Dai Ren and Lizhai, in relation to Zhang Changsha, are like Boyi and Liuxia Hui in relation to Confucius. The necessity of not neglecting either tonification or draining is like the impossibility of wearing only fur coats or only hemp clothes regardless of the season. Yet now, without examining Deficiency and Excess, people cause tonification and draining to be biased separately. This is like failing to examine the different climates of winter and summer yet wanting to rely solely on fur or hemp for protection. Is this logical?
Therefore, it is said: "In Shaoyin disease, if there is diarrhea with undigested food, indicating interior cold and exterior heat, Tongmai Sini Tang (Pulse-Reviving Four Reversals Decoction) should be used." It is also said: "In Shaoyin disease, if there is spontaneous diarrhea of clear water, purely green in color, Da Chengqi Tang (Major Order the Qi Decoction) is suitable." From this, it is evident that tonification and draining cannot be neglected. In today's world, people favor tonification and dislike draining, prefer warmth, and fear cold. They view Radix Astragali Preparata (Huangqi, 黄芪) [Note: Text says Dahuang/Mangxiao as snake/scorpion, implying harsh purgatives]... wait, text says "Dahuang Mangxiao, viewed as snakes and scorpions". So: They view Rhubarb (Da Huang) and Mirabilite (Mang Xiao) as terrifying as snakes and scorpions; they view Dried Ginger (Gan Jiang) and Aconite Root (Fu Zi) as sweet as maltose syrup. When Mirabilite and Rhubarb achieve efficacy, they say: "This only seeks temporary relief, and will inevitably lead to middle-jiao cold disorders later." If Ginger and Aconite are misapplied and fail, they say: "Even Ginger and Aconite do not work, so we attribute it to fate." This is extremely thoughtless. Therefore, all medical books that lean towards tonification are prevalent in the world, with printing blocks expanding daily. As for Dai Ren's book, it is rarely circulated or recited. I privately worry that students learning medicine will clamor for these biased tonification books and neglect formulas for draining excess. Consequently, "deficient patients become more deficient, and excess patients become more excessive," and the resulting drawbacks will be beyond description.
I have commissioned artisans to carve the woodblocks to spread its transmission. I only hope that this book will circulate alongside Lizhai's book. When draining is appropriate, learn from Dai Ren; when tonification is appropriate, learn from Lizhai. Do not allow an imbalance of tonification and draining, so that the common people may jointly ascend to the realm of benevolence and longevity!
Written by Watanabe Eigan Anpu at the Sleep Crane Pavilion under the Pine Tree in Luoyang, on the Full Moon Day of the Eighth Month in the Xinmao Year of Zhengde.