大哉!医道之不可不知也;慎哉!医道之不可不知也。人不知医,则养生之道何以
明?良相之心何以济生?知之而不深,其患尤甚。病有虚虚实实之变,法有正治、从
治、标本、攻补先后之宜,识认不清,龙雷者治作实火,中空者治作内余,血虚作楚
治作风邪外束,火冒头痛治作太阳受寒,肾虚作泻治作脾胃内伤,燥涩膈噎治作痰火
郁滞,无根脱气上冲治作有余消导,肾虚奔豚游痛治作血块峻攻,以至脾虚困倦之疟
疾,误为肝强而消伐;劳伤虚袭之微邪,误为伤寒而重疏;困倦内伤之微滞,误为伤
食而重攻。且外微热而里和思食,少少进食何妨?因微热而严禁之,每多饿死之冤;
表气虚而畏寒怕风,微微养卫最宜,疑外感而遽汗之,常有亡阳之叹;罔顾本而徒顾
标,标未尽而本先拔,纵标尽而何功?不切脉而惟问候,候有误而脉无虚,候若异而
何据?守千古以上之成方,奈千古以下之人病情不合;读万载传流之证论,嗟万载传
流以下浓薄迥殊。本浓者,何妨忘本攻邪;本浅者,理宜顾主逐客。凡此种种,察治
稍乖,安危顿异,岂不难哉!况男妇之治不同,少长之候有别。先哲云∶宁治一男子,
莫治一妇人;宁治十妇人,莫治一小儿。盖言其延医之更难也。何则?凡治病有望闻
问切四法,若婴孩,一见生人,定声啼色变。若是则声不得其平,色不得其正,而望
闻之法废矣。饥饱未知,痛痒莫晓,欲问其所苦,询其所由,莫得一二。且脉气未全
未固,嬉戏之余,脉因而动;宁息之际,脉因而静,则问切之法又废矣。四法既废,
察治实难,自非受术精微,阐明至理,视于无形者,安得临症别有一种玄机,深见五
内而极得心应手之乐,口不能言之妙哉?!张自业医以来,日夕兢兢,常思人命最重,
所任匪轻,况寄蜉蝣于六合,得天地好生之德以有生,敢不体天地好生之德以济
人!奈资禀庸拙,不学心聋,徒怀济世之至诚,深愧测海之浅见。然要之见虽浅,而
念则诚,计唯图尽吾心而已。爰是殚心课纂《杂症大小合参痘疹全集》、《内经纂要》、
《药性合参》以及女科、外科、脉诀诸书,计共二十余篇,凡历三十载而始竣目今
圣天子道德性成,万庶均歌尧舜,慈爱念切,群黎遍颂羲皇。奈张衰老生理残障,既不能
少效蚁力,敢不复仰体天心,谨抒野人管龠之见,少左医诀,微尽鄙怀,以证四方,
高明爱我,摘其疵而明教之,幸甚。
康熙岁次甲戌夏六月既望后学冯兆张谨识
医道真是宏大啊!不可不深入知晓;医道真是谨慎啊!不可不深入知晓。人如果不通晓医学,那么养生的道理如何能阐明?良相济世救人的心志如何能实现?如果知晓得不够深刻,其带来的祸患尤其严重。疾病有虚证转实、实证转虚的变化,治法有正治、从治、标本缓急、攻补先后次序的适宜选择。如果辨识不清,就会将龙雷之火(肾中虚火)当作实火来治,将中空之证(正气亏虚)当作内有余邪来治,将血虚引起的疼痛当作风邪外束来治,将火气上冒导致的头痛当作太阳经受寒来治,将肾虚导致的泄泻当作脾胃内伤来治,将燥涩膈噎当作痰火郁滞来治,将无根脱气上冲当作有余之证用消导法治,将肾虚奔豚游走疼痛当作血块用峻猛攻伐法治,以至于将脾虚困倦导致的疟疾,误认为是肝强而用消伐之法;将劳伤虚损感受轻微外邪,误认为是伤寒而用重剂发汗;将困倦内伤导致的轻微积滞,误认为是伤食而用重剂攻下。况且外表微热而里气和顺思食,少量进食有何妨碍?因为微热而严禁饮食,往往造成许多饿死的冤屈;表气虚弱而畏寒怕风,微微养护卫气最为适宜,怀疑是外感而急于发汗,常常导致亡阳的叹息。不顾根本而只顾表象,表象未除而根本先被拔除,即使表象清除又有什么功劳?不切脉而只靠问诊,问诊有误而脉象并无虚象,问诊若与脉象不同依据何在?死守千古以前的成方,无奈千古以后的人病情并不相符;读万卷流传下来的证论,感叹万年流传下来的人体质浓薄截然不同。体质浓厚者,不妨忘掉根本专攻邪气;体质浅薄者,理应顾护主体驱赶客邪。凡此种种,察治稍有偏差,安危立刻迥异,难道不难吗!何况男女的治疗不同,老少诊候有别。先哲说:“宁可治疗一个男子,不要治疗一个妇人;宁可治疗十个妇人,不要治疗一个小儿。”这是说给小儿看病更难。为什么呢?大凡治病有望、闻、问、切四法,如果是婴孩,一见生人,必定哭声改变、脸色变化。如果是这样,声音不得平稳,面色不得正常,望法和闻法就废除了。饥饱不知,痛痒不明,想要询问他的痛苦,询问他发病的原因,无法得知一二。而且小儿脉气未全未固,嬉戏之余,脉象因而跳动;安静休息之际,脉象因而平静,那么问法和切法又废除了。四法既然废除,察治确实困难,如果不是医术精微,阐明至理,视于无形境界的人,怎么能临症时别有一种玄机,深见五脏六腑而极尽得心应手之乐,口不能言说的妙处呢?!我自从事医学以来,日夜兢兢业业,常想人命最重,所承担的责任不轻,何况寄身于天地之间,得天地好生之德而生存,岂敢不体察天地好生之德以救济世人!无奈资质平庸拙劣,学习如心聋一般,徒怀济世的至诚,深深惭愧见识如测海般浅薄。然而总之见解虽浅,但念头真诚,打算只求尽心而已。于是尽心编纂《杂症大小合参痘疹全集》、《内经纂要》、《药性合参》以及女科、外科、脉诀等书,共计二十余篇,历经三十年才完成。当今圣天子道德本性天成,万民皆歌颂尧舜,慈爱之心深切,百姓遍颂羲皇。无奈我衰老生理残障,既不能稍效蚂蚁之力,怎敢不再次仰体天心,恭敬抒发野人管窥之见,略微辅助医诀,稍微表达鄙陋情怀,以印证四方。高明之士爱护我,指出其中的瑕疵并明教,幸甚。
康熙岁次甲戌夏六月既望后学冯兆张谨识
Great indeed is the Way of Medicine, which must be thoroughly understood; cautious indeed is the Way of Medicine, which must be thoroughly understood. If a person does not understand medicine, how can the principles of health preservation (Yang Sheng) be clarified? How can the heart of a good minister to save lives be realized? To know it but not deeply leads to even greater harm. Diseases undergo changes from deficiency to excess and from excess to deficiency. Treatment methods include direct treatment (Zheng Zhi), contrary treatment (Cong Zhi), addressing the root and branch (Biao Ben), and the appropriate sequence of attacking and tonifying. If recognition is unclear, one might treat Dragon and Thunder Fire (Long Lei Huo, referring to deficient fire in the Kidney) as excess fire; treat hollow syndromes (Zhong Kong, referring to deficiency of healthy Qi) as internal excess; treat pain caused by blood deficiency as external constraint by wind pathogens; treat headache caused by flaming-up of fire as Cold invading the Taiyang channel; treat diarrhea caused by Kidney deficiency as internal injury of the Spleen and Stomach; treat dryness, obstruction, and dysphagia as stagnation of Phlegm-Fire; treat upward rushing of rootless and depleted Qi as an excess syndrome treated with digestion-promoting methods; treat running piglet (Ben Tun) and wandering pain caused by Kidney deficiency as blood stasis treated with severe purgation; treat malaria causing fatigue due to Spleen deficiency as Liver excess treated with draining methods; treat slight pathogenic factors invading due to labor injury and deficiency as Cold Damage (Shang Han) treated with heavy sweating; treat slight stagnation causing fatigue due to internal injury as food retention treated with heavy purgation. Furthermore, if there is slight external heat but the interior is harmonious and there is appetite, what harm is there in eating a little? Strictly prohibiting food due to slight heat often leads to unjust deaths from starvation. If exterior Qi is deficient and there is aversion to cold and wind, gently nourishing the Defensive Qi (Wei Qi) is most appropriate; suspecting an external contraction and hastily inducing sweat often leads to sighs of Yang collapse (Wang Yang). Ignoring the root while only attending to the branch results in the root being uprooted before the branch is cleared; even if the branch is cleared, what merit is there? Not taking the pulse but relying solely on inquiry leads to errors in inquiry while the pulse shows no deficiency; if inquiry differs from the pulse, what is the basis? Adhering rigidly to established prescriptions from millennia ago ignores that patients today differ from those of the past; reading diagnostic theories passed down for ten thousand years laments that people's constitutions have changed drastically over time. For those with robust constitutions, it may be acceptable to ignore the root and attack the pathogen; for those with fragile constitutions, it is proper to protect the host and expel the guest. All these cases show that slight deviations in observation and treatment lead to immediate differences between safety and danger. Is this not difficult! Moreover, treatments for men and women differ, and signs vary between the young and old. Ancients said: "Better to treat one man than one woman; better to treat ten women than one child." This refers to the difficulty of diagnosing children. Why? The four diagnostic methods are inspection (Wang), auscultation and olfaction (Wen), inquiry (Wen), and palpation (Qie). For infants, seeing a stranger causes crying and facial changes. Thus, the voice is not calm, and the complexion is not normal, rendering inspection and auscultation useless. They cannot indicate hunger or fullness, nor explain pain or itching. Asking about their suffering and cause yields little information. Their pulse Qi is not yet complete or stable; playing makes the pulse move, while resting makes it still, rendering inquiry and palpation useless. With the four methods abolished, diagnosis and treatment are truly difficult. Only those with profound medical skills who elucidate ultimate truths and perceive the formless can possess a unique mystery in clinical practice, deeply seeing the five zang organs, experiencing the joy of perfect coordination between mind and hand, and achieving ineffable subtleties. Since I began practicing medicine, I have been diligent day and night, constantly reflecting that human life is paramount and my responsibility is heavy. Entrusted with life within the six directions, endowed with the Heaven and Earth's virtue of loving life, how dare I not embody this virtue to help others? Alas, my natural endowment is mediocre and clumsy, my learning like deafness, harboring only sincere intentions to save the world but deeply ashamed of my shallow insight like measuring the sea. Nevertheless, although my insight is shallow, my intention is sincere; I plan only to do my best. Therefore, I have devoted myself to compiling the *Complete Collection of Mixed Syndromes Compared Large and Small including Smallpox*, *Essentials of the Inner Canon*, *Comprehensive Analysis of Drug Properties*, as well as books on Gynecology, Surgery, and Pulse Diagnosis, totaling over twenty volumes, completed after thirty years. Now, the Holy Son of Heaven has innate moral character, all people sing praises of Yao and Shun, his compassionate love is deep, and the common people praise Fuxi. However, I am aged and physically impaired, unable to contribute even the strength of an ant. How dare I not again look up to the will of Heaven, respectfully express the limited view of a rustic person, slightly assist medical prescriptions, and briefly express my humble feelings to verify with the world. You, the enlightened ones, who love me, please point out its flaws and instruct me clearly. This would be great fortune.
Inscribed by the junior learner Feng Zhaozhang, after the full moon in the sixth month of summer, in the year Ji Xu of the Kangxi reign.