古之医者,所用之药皆自备之。《内经》云∶司气备物,则无遗主矣。当时韩康卖药,
非卖
药也,即治病也。韩语公《进学解》云∶牛溲、马渤、败鼓之皮,俱收并蓄,特用无遗,医
师之良也。今北方人称医者为卖药先生,则医者之自备药可知。自宋以后,渐有写方不备药
之医,其药皆取之肆中,今则举世皆然。夫卖药者不知医,犹之可也。乃行医者竟不知药,
则药之是非真伪,全然不同,医者与药不相谋,方即不误,而药之误多矣。又古圣人之治病
,惟感冒之疾,则以煎剂为主,余者皆用丸散为多。其丸散,有非一时所能合者。倘有急迫
之疾,必须丸散,俟丸散合就,而人已死矣。又有一病只须一丸而愈,合药不可只合一丸。
若使病家为一人而合一料,则一丸之外,皆为无用。惟医家合之,留待当用者用之,不终弃
也。又有不常用,不易得之药,储之数年,难遇一用,药肆之中,因无人问,则亦不备。惟
医者自蓄之,乃可待不时之需耳。至于外科所用之煎方,不过通散营卫耳。若护心托毒,全
赖各种丸散之力,其药皆贵重难得。及锻炼之物,修合非一二日之功,而所费又大,亦不得
为一人只合一二丸。若外治之围药、涂药、升药、降药,护肌腐肉,止血行瘀,定痛煞痒,
提脓呼毒,生肉生皮,续筋连骨;又有薰蒸烙灸,吊洗点 等药,种种各异,更复每症不同
,皆非一时所得备,尤必须平时预合。乃今之医者,既不知其方,亦不讲其法;又资本以蓄
药料,偶遇一大症,内科则一煎方之外,更无别方;外科则膏药之外,更无余药。即有之,
亦惟取极贱极易得之一二味,以为应酬之具,则安能使极危、极险、极奇、极恶之症,令
起死回生乎?故药者,医家不可不全备者也。
古代的医生,所用的药物都是自己准备的。《黄帝内经》说:“主管气象(或指顺应天时)并准备好相应的物品,就不会有遗漏的主治对象。”当时的韩康卖药,并不是单纯地卖药,而是直接治病。韩愈在《进学解》中说:“牛溲(车前草)、马勃、破鼓皮,都收集保存起来,使用时无一浪费,这才是良医。”如今北方人称医生为“卖药先生”,由此可知古代医生自备药物的情况。自从宋代以后,逐渐出现了只开方子却不备药的医生,他们的药物都从药店购买,现在全社会都是这样。卖药的人不懂医术,这还可以理解;但行医的人竟然不懂药理,那么药物的优劣真伪就完全搞不清楚了,医生与药物不能相互配合,即使处方没有错误,因药物问题导致的失误也太多了。
另外,古代圣人治病,只有感冒这类疾病以汤剂为主,其余大多使用丸剂和散剂。那些丸剂和散剂,不是一时半会儿就能配制好的。如果有紧急的疾病,必须用丸散,等到丸散配制完成,病人已经死了。又有一种病只需要吃一丸就能痊愈,但配药不可能只配一丸。如果让病家为了一个人而配制一整料药材,那么除了那一丸之外,剩下的都成了无用之物。只有由医生来配制,留待需要使用时再取用,才不会最终被废弃。
还有一些不常用、不易获得的药物,储存几年也难以遇到一次使用的机会,药店中因为无人问津,所以也不准备。只有医生自己储备这些药物,才能应对不时之需。至于外科所用的汤剂,不过是为了疏通营卫之气罢了。若要护心托毒,全赖各种丸散的力量,其中的药物大多贵重难得,且经过锻炼加工,不是两三天能完成的功夫,花费又大,也不能只为一个人配制一两丸。至于外治用的围药、涂药、升药、降药,用于保护肌肉、去除腐肉、止血化瘀、止痛止痒、提脓排毒、生肌长皮、续筋接骨;还有熏蒸、烙灸、吊洗、点药等药物,种类繁多,每种病症用药也不同,都不是一时能准备好的,尤其必须平时预先配制好。
然而现在的医生,既不知道这些方剂,也不研究这些方法;又没有资金去储备药材,偶尔遇到重症,内科除了一个汤剂方子外,再无其他方药;外科除了膏药外,再无其他药物。即使有,也只是选取极其便宜且容易得到的少数几味药,作为应付场面之用,这样怎么能使得极危重、极险恶、极奇特、极恶劣的病症起死回生呢?所以,药物是医生不可不全盘准备的。
Ancient physicians prepared their own medicines. The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "When one manages the qi and prepares the necessary substances, there will be no omission in treating the primary conditions." In those days, when Han Kang sold medicine, he was not merely selling drugs but directly treating diseases. Han Yu, in his *Jinxue Jie* (Explanation of Advancing Learning), said: "Niu Sou (Plantago Seed/Herba Plantaginis), Ma Bo (Lycoperdon/Bovista), and broken drum skin are all collected and stored; used without waste—this is the virtue of a good physician." Today, people in northern China refer to doctors as "Mr. Selling Medicine," which indicates that ancient physicians prepared their own medicines. Since the Song Dynasty, there gradually emerged physicians who only prescribed formulas without stocking medicines, sourcing them from pharmacies instead; this practice has become universal today. It is understandable if those selling medicine do not understand medical theory; however, it is unacceptable if practicing physicians do not understand materia medica. Consequently, the quality, authenticity, and properties of medicines are often misunderstood. When physicians and medicines do not coordinate, even if the prescription is correct, errors arising from the medicines themselves are frequent.
Furthermore, ancient sages treated diseases primarily with decoctions only for conditions like common colds (Ganmao); for others, pills (Wan) and powders (San) were predominantly used. These pills and powders could not be compounded instantly. If an urgent condition required pills or powders, waiting for their preparation might result in the patient's death before they could be administered. Additionally, some conditions require only a single pill for recovery, yet compounding cannot be done for just one pill. If patients were to compound a full batch for a single individual, everything except that one pill would be useless. Only when physicians compound these remedies can they store them for future use, preventing waste. Moreover, some rarely used or hard-to-obtain herbs may remain unused for years; pharmacies, lacking demand, do not stock them. Only physicians storing these themselves can meet unexpected needs.
Regarding external surgery, decoctions are used merely to unblock and circulate Ying (Nutritive Qi) and Wei (Defensive Qi). To protect the heart and expel toxins, reliance is entirely placed on various pills and powders. These ingredients are often precious and rare, requiring complex processing that takes more than a day or two and incurs high costs; thus, they cannot be compounded for just one or two pills for a single patient. External treatments include encircling pastes (Wei Yao), topical applications (Tu Yao), ascending agents (Sheng Yao), and descending agents (Jiang Yao), used to protect muscle tissue, remove necrotic flesh, stop bleeding, invigorate blood circulation, relieve pain and itching, promote pus discharge, draw out toxins, regenerate flesh and skin, and reconnect tendons and bones. There are also fumigation, moxibustion/cauterization, hanging washes, and point-application medicines. These vary greatly by condition and cannot be prepared on the spot; they must be pre-compounded during times of peace.
However, contemporary physicians neither know these formulas nor study their methods. Lacking capital to stock medicinal materials, when encountering severe cases, internal medicine physicians rely solely on a single decoction formula with no alternatives; surgical physicians have nothing beyond plasters. Even when other options exist, they select only the cheapest and most easily obtained herbs as mere formalities. How can such practices enable the revival of extremely critical, dangerous, bizarre, or malignant conditions? Therefore, comprehensive preparation of medicines is indispensable for physicians.