木郁达之谓吐越。火郁发之乃汗泄。夺土下利令无壅。金泄渗利解表同。水郁折其充逆
尔。治之大体须明此。
法无定体。应变而施。药不执方。合宜而用。备三法焉。国中与末。乃更变权。初治之
道。
猛峻可先。缘病新感。大剂急蠲。中治之道。宽猛济兼。缘病少久。得中药然。去邪养正。
罔或不痊。未治之道。药必宽缓。性味平善。广服必安。此其大法。所用之体。制君臣佐。
各使其宜。主病为君。佐君为臣。应臣为使。适大小制。各安其气。寒者热之。热者寒之。
微者逆之。甚者从之。坚者削之。客者除之。劳者温之。结者散之。留者行之。燥者润之。
急者缓之。散者收之。损者温之。逸者行之。惊者平之。上者下之。摩之浴之。薄者劫之。
开之发之。适事为故。逆者正治。从者反治。反治之谓。热因寒用。寒因热用。塞因塞用。
通因通用。伏其所主。先其所因。其始则同。其终则异。可使破积。可使溃坚。可使气和。
可使必已。其病之气。惟标与本。先受为本。次者为标。或为兼证。知逆与从。正行无问。
知标本者。万举万全。不知标本。是谓妄行。六气为本。三阴三阳。经病为标。病气为本。
受病经络。脏腑为标。急则治标。缓则治本。治之要极。无失色脉。用之不惑。治之大则。
逆从倒行。标本不得。神亡命失。
木郁(肝气郁结)应当用吐法或发散法来疏通。火郁(心火内郁)应当用汗法或泄法来发越。土郁(脾胃壅滞)应当用攻下法通利大便,以消除壅塞。金郁(肺气郁闭)应当用渗湿利水法,与解表法配合使用。水郁(肾水泛滥)应当用折抑其充盛逆乱之气的方法。治疗的大体原则必须明白这些。
治疗方法没有固定的模式,应当根据病情变化而施治。用药不拘泥于固定方剂,应当合乎适宜的情况而使用。具备这三种方法(指针对三焦或上中下三部的治法,或泛指多种治法)。对于国内(指病在里、在脏腑)和末梢(指病在表、在经络)的情况,需要更加灵活变通。初起治疗之道,可以先用猛烈峻急的药物。因为疾病是新近感受的邪气,需要用大剂量药物迅速祛除病邪。中期治疗之道,宽缓与猛烈兼用。因为疾病已经持续了一段时间,得到中等强度的药物即可痊愈。去除病邪,扶助正气,没有不治愈的。后期(或未病先防/病后调理,此处语境偏向病久或善后)治疗之道,药物必须宽缓平和。药性气味平正善良。长期服用必然安宁。这是大概的原则。所采用的方体结构,要制定君臣佐使的关系,各自使其适宜。主治疾病的药物为君药,辅助君药的为臣药,顺应臣药作用的为使药。适应大小的制方规格,各自安顿其气机。寒证用热药治疗,热证用寒药治疗。病情轻微的,采用逆其病势的正治法;病情严重的,采用顺其病势的反治法。坚硬的积块,用削伐法;外来的客邪,用祛除法;虚劳之证,用温补法;结聚之证,用消散法;留滞之证,用行散法;干燥之证,用滋润法;拘急之证,用缓急法;涣散之证,用收敛法;亏损之证,用温养法;安逸停滞之证,用行气活血法;惊恐之证,用镇静安神法;气机上逆之证,用降逆法;按摩洗浴;浅薄的病邪,用劫夺法;开通发泄。以适合病情为准则。逆其病势的是正治,顺其病势的是反治。所谓反治,就是:热因寒用(真寒假热,用热药但佐以寒凉或冷服),寒因热用(真热假寒,用寒药但佐以温热或热服),塞因塞用(真虚假实,用补益法治闭塞症状),通因通用(真实假虚,用通利法治通泄症状)。伏藏其所主的主病,先探求其病因。开始用药时性质可能相同,但最终效果不同。可以破除积滞,可以溃散坚结,可以使气机调和,可以使疾病必愈。疾病的病气,只有标和本的区别。先受邪的为本,后出现的为标。或者作为兼证。知道逆治和从治,正行其道无需疑问。知道标本关系的,万举万全;不知道标本关系的,称为妄行。六气为本,三阴三阳经病为标。病气为本,受病的经络脏腑为标。急则治标,缓则治本。治疗的极致关键,不能失去对色脉的观察。运用它而不迷惑,是治疗的大法则。如果逆从颠倒,标本不分,就会神亡命失。
Wood depression (Liver Qi stagnation) should be treated by vomiting or dispersing methods to unblock it. Fire depression (Heart Fire internal stagnation) should be treated by sweating or purging methods to vent it. Earth depression (Spleen-Stomach congestion) should be treated by downward purging to relieve diarrhea and eliminate obstruction. Metal depression (Lung Qi closure) should be treated by diuresis, combined with exterior-releasing methods. Water depression (Kidney Water flooding) should be treated by restraining its excessive and rebellious qi. The general principles of treatment must understand these.
Treatment methods have no fixed form; they should be applied according to changes in the condition. Medicines do not adhere to fixed prescriptions; they should be used when appropriate. Three methods are prepared. For conditions inside (in the interior/organs) and outside (in the extremities/meridians), flexibility and adaptation are required. In the initial stage of treatment, fierce and harsh methods may be used first. Because the disease is newly contracted, large doses are needed to quickly eliminate the pathogen. In the middle stage of treatment, mild and harsh methods are combined. Because the disease has persisted for some time, moderate medicines will suffice. Eliminating pathogens and nourishing healthy qi ensures recovery without exception. In the later stage (or post-treatment care), medicines must be mild and slow-acting. Their nature and flavor should be平和 (peaceful/gentle). Long-term use will ensure peace. These are the general principles. The structure of the prescribed formulas should establish the relationships of Sovereign (Jun), Minister (Chen), Assistant (Zuo), and Envoy (Shi), each suited to its role. The herb that treats the main disease is the Sovereign; assisting the Sovereign is the Minister; responding to the Minister is the Envoy. Adapt to the size of the prescription, settling their qi appropriately. Cold conditions are treated with heat; hot conditions are treated with cold. Minor conditions are treated oppositely (Zheng Zhi); severe conditions are treated similarly (Fan Zhi). Hardness is reduced; external pathogens are expelled. Debility is warmed; accumulation is dispersed. Stagnation is moved; dryness is moistened. Urgency is relieved; scattering is gathered. Deficiency is warmed; inactivity is activated. Fright is calmed; upward rebellion is lowered. Massage and bathing; superficial pathogens are劫 (seized/eliminated); opening and venting. Suitability to the matter is the goal. Opposing the pathogen is Zheng Zhi (Orthodox Treatment); following the pathogen is Fan Zhi (Reverse Treatment). Reverse treatment includes: treating heat with cold usage (treating true cold with false heat signs using hot drugs but administered cold or with cold adjuvants); treating cold with heat usage (treating true heat with false cold signs using cold drugs but administered hot or with hot adjuvants); treating obstruction with obstruction (treating deficiency-type blockage with tonification); treating leakage with leakage (treating excess-type discharge with purgation). Subdue the dominant factor, address the cause first. Initially, the approach may seem similar, but the outcome differs. One can break accumulations, dissolve hardness, harmonize qi, and ensure cure. Regarding the qi of the disease, there are only Biao (Branch/Symptom) and Ben (Root/Cause). What was affected first is Ben; what follows is Biao. Or it may be a concurrent syndrome. Knowing opposition and compliance, proceed correctly without doubt. Knowing Ben and Biao leads to success in every attempt; ignoring them constitutes reckless action. The Six Qi are Ben; the diseases of the Three Yin and Three Yang meridians are Biao. The disease qi is Ben; the affected meridians and organs are Biao. In acute cases, treat Biao; in chronic cases, treat Ben. The ultimate key to treatment lies not losing sight of complexion and pulse. Using this without confusion is the great principle of treatment. If one reverses the orthodox and reverse approaches, and fails to distinguish Ben and Biao, spirit perishes and life is lost.