太常博士杨日宣病寒郝允诊曰君脉首震而尾息尾震而首息在法为鱼游 戏不可治不数日
死(邵氏见闻录)
真诰有言曰常不能慎事上者自致百 之本而怨咎于神灵乎当风卧湿反责它人于失覆皆痴
人也
夫慎事上者谓举动之事必当慎思若饮食恣情阴阳不节最为百 之本致使虚损内起风湿外侵所
以共成其害如此者岂得关于神明乎惟当动于药术疗理尔
欲疗病先察其源先候其病机五脏未虚六腑未竭血脉未乱精神未散服药必活若病已成可得
半愈病势已过命将难全
夫病之所由来虽多端而皆关于邪邪者不正之因谓非人身之常理风寒暑湿饥饱劳逸皆各是
邪非
独鬼气疫疠者矣人生气中如鱼在水水浊则鱼瘦气昏则人病邪气之伤人最为深重经络既受此气
传入脏腑脏腑随其虚实冷热结以成病病又相生故流遍遂广精神者本宅身以为用身既受邪精神
亦乱神既乱矣则鬼灵斯入鬼力渐强神守稍弱岂得不致于死乎古人譬之植杨斯理当矣但病亦别
有先从鬼神来者则宜以祈祷祛之虽曰可祛犹因药疗致益昔李子豫有赤丸之例是也其药疗无益
者是则不可祛晋景公膏肓之例是也大都鬼神之害则多端疾病之源唯一种盖有轻重者尔(三说
本草)
夫伤寒始自太阳逆传阳明至于厥阴而止六经既别治法不同太阳属膀胱非发汗则不愈必用
麻黄
者以麻黄生于中牟雪积五尺有麻黄处雪则不聚盖此药能通内阳气却外寒也阳明属胃非通泄则
不愈必用大黄芒硝以利之少阳属胆无出入道柴胡与半夏能利能汗佐以子芩非此不解太阴属
脾
中州土也性恶寒湿非干姜白术不能温燥少阴属肾性畏寒燥非附子必不能温厥阴属肝藏血养筋
非温平之药不能润养此经常之道也后学不知伦类妄意进饵遂致错乱诸证蜂起夭伤人命可不究
辩且三阳病汗下和解人必知之至太阴脾经温燥不行亦当温利自阳明出如温脾丸用大黄者是也
少阴肾经虽用附子复使麻黄则知少阴亦自太阳出厥阴用桂自少阳出明矣及其二阳郁闭皆当自
阳明出故三阴皆有下证如少阴口燥咽干下利清水太阴腹满时痛厥阴舌卷肾缩皆当下之学人宜
审详不可率易投也
太常博士杨日宣患寒热病,郝允为他诊脉,说:“您的脉搏起时剧烈而结束时微弱,结束时剧烈而起时微弱,按照医法称为‘鱼游戏’(指脉搏散乱无根,如鱼在水中游动嬉戏,预示病情危重),属于不可治愈的病症。没过几天,他就死了。(出自《邵氏见闻录》)
《真诰》中有这样的话:常常不能谨慎侍奉上天的人,自己招致百病的根本原因,却去怨恨责怪神灵吗?对着风口睡觉、躺在潮湿的地方,反而责怪其他人或事物,这都是痴愚之人啊。
所谓谨慎侍奉上天,是指举手投足之事必须慎重思考。如果饮食放纵情欲、阴阳失去节制,这最是一切疾病的根本,导致虚损从内部产生,风湿从外部侵袭,从而共同造成这种危害。像这样的人,怎么能归咎于神明呢?只应当通过药物医术来进行治疗调理罢了。
想要治疗疾病,先要考察其病因,先观察其病机。如果五脏尚未虚弱,六腑尚未衰竭,血脉尚未紊乱,精神尚未涣散,服药后必定能痊愈;如果疾病已经形成,大概只能好一半;如果病势已经过去,生命将难以保全。
疾病的由来虽然有很多端绪,但都与邪气有关。邪气是不正的原因,指的是不符合人身正常生理规律的因素,风寒暑湿、饥饱劳逸,各自都是邪气,并不仅仅是鬼气疫疠才算是邪气。人的元气在体内,就像鱼在水中一样,水浑浊则鱼瘦弱,元气昏沉则人生病。邪气伤害人体最为深重,经络既然受到这种邪气,就会传入脏腑。脏腑随着其虚实冷热的不同,结聚而形成疾病。疾病又相互滋生,所以流传遍及全身。精神是本来寄托身体以发挥作用的,身体既然受到邪气,精神也会混乱。神既然混乱了,那么鬼灵就会进入,鬼的力量逐渐增强,神的守护稍微减弱,难道不导致死亡吗?古人比喻为种植杨树,这个道理是正确的。但是疾病也有另外一些先从鬼神而来的,就应当用祈祷来驱除它。虽然说可以驱除,还是因为药物治疗而获益,这就是以前李子豫有赤丸的例子。那些药物治疗没有益处的,就是不可驱除的,比如晋景公膏肓的例子。大抵鬼神的害处虽然有很多端绪,但疾病的根源唯有一种,只是有轻重的区别罢了。(出自《三说本草》)
伤寒开始于太阳经,逆传至阳明经,直到厥阴经才停止。六经既然不同,治疗方法也不同。太阳经属于膀胱,如果不发汗就不能痊愈,必须用麻黄,因为麻黄生长在中牟,积雪五尺厚,有麻黄生长的地方雪就不会积聚,大概是因为这种药能通达体内的阳气,抵御外部的寒邪。阳明经属于胃,如果不通泄就不能痊愈,必须用大黄、芒硝来通利它。少阳经属于胆,没有出入之道,柴胡与半夏能够通利和发汗,佐以子芩(黄芩的子根或特定部位,此处指黄芩类清热药),不用这些就不能解除病邪。太阴经属于脾,是中州的土行,性质厌恶寒湿,不用干姜、白术就不能温燥祛湿。少阴经属于肾,性质畏惧寒燥,不用附子一定不能温补。厥阴经属于肝,藏血养筋,不用温平的药就不能润养。这是经常遵循的道理。后学之人不知道伦理类别,随意进服药物,于是导致各种证候错乱蜂起,夭折伤人生命,可不加以研究辨别吗?况且三阳病的汗法、下法、和解法,人们必定知道。到了太阴脾经,温燥之法不行时,也应当温利,从阳明经出来,比如温脾丸使用大黄就是这样。少阴肾经虽然用附子,再配合麻黄,就知道少阴也是从太阳经出来的。厥阴经用桂枝,是从少阳经出来的,这很明显。等到二阳郁闭,都应当从阳明经出来,所以三阴都有下法适用的证候,比如少阴的口燥咽干、下利清水,太阴的腹满时痛,厥阴的舌卷囊缩,都应当用下法。学者应该审慎详细地考察,不可以草率轻易地投药。”
Yang Rixuan, a Doctor of Taichang (Grand Secretary of the Court of Imperial Sacrifices), suffered from chills and fever. Hao Yun diagnosed his pulse and said, "Your pulse is vigorous at the beginning and weak at the end, and vigorous at the end and weak at the beginning. According to medical principles, this is called 'Fish Playing' (a metaphor for a scattered, rootless pulse resembling a fish swimming playfully in water, indicating a critical and incurable condition). It is untreatable. A few days later, he died." (From *Shaoshi Jianwen Lu*)
The *Zhen Gao* states: "Those who often fail to be cautious in serving Heaven bring upon themselves the root causes of a hundred diseases, yet they resent and blame the spirits. Sleeping in drafts or lying on dampness, yet blaming others or external factors, are all foolish people."
To serve Heaven cautiously means to think carefully before every action. Indulgence in diet and desires, and lack of moderation in yin and yang, are the primary roots of all diseases. This leads to internal deficiency and damage, while wind-dampness invades from the exterior, jointly causing such harm. How can such cases be attributed to deities? One must rely solely on medicinal arts and therapeutic treatments.
To treat illness, one must first examine its origin and observe its pathogenesis. If the five zang organs are not yet deficient, the six fu organs are not exhausted, the blood vessels are not chaotic, and the spirit is not scattered, medication will surely lead to recovery. If the disease has already formed, half recovery may be expected. If the pathological momentum has passed, life will be difficult to preserve.
Although the origins of disease are manifold, they all relate to pathogenic factors (xie qi). Pathogens are irregular causes, referring to factors that do not conform to normal physiological laws. Wind, cold, summer-heat, dampness, hunger, fullness, labor, and rest are each considered pathogens; it is not only ghostly qi and epidemics that constitute pathogens. Human vital energy resides within like a fish in water; when the water is turbid, the fish becomes emaciated; when vital energy is dimmed, the person falls ill. Pathogenic factors harming humans are particularly severe. Once the meridians are affected by such qi, it transmits to the zang-fu organs. The zang-fu organs form diseases based on their deficiency/excess and cold/heat conditions. Diseases generate each other, spreading widely throughout the body. Spirit (shen) originally resides in the body to function; once the body is invaded by pathogens, the spirit becomes chaotic. When the spirit is chaotic, spiritual entities enter; as ghostly power strengthens and divine guardianship weakens, death inevitably follows. The ancients compared this to planting poplar trees, which is an apt analogy. However, some diseases originate from ghosts/spirits and should be dispelled through prayer. Although said to be dispellable, benefit still comes from medicinal treatment, as seen in the case of Li Ziyu using Red Pills. In cases where medicinal treatment yields no benefit, expulsion is impossible, as exemplified by Jin Jinggong's disease in the gaohuang region. Generally, while the harms of ghosts/spirits are manifold, the source of disease is singular, differing only in severity. (From *Sanshuo Bencao*)
Cold damage (Shanghan) begins in the Taiyang channel, reversely transmits to the Yangming channel, and stops at the Jueyin channel. Since the Six Channels differ, so do the treatment methods. The Taiyang channel belongs to the Bladder; without inducing sweating, it cannot heal. Ephedrae Herba (Mahuang, 麻黄) must be used because Ephedra grows in Zhongmu where snow accumulates five chi deep; where Ephedra grows, snow does not accumulate. This is likely because this herb can unblock internal yang qi and repel external cold. The Yangming channel belongs to the Stomach; without purging and draining, it cannot heal. Rhizoma et Radix Rhei (Dahuang, 大黄) and Natrii Sulfas (Mangxiao, 芒硝) must be used to promote drainage. The Shaoyang channel belongs to the Gallbladder; lacking a direct exit or entry pathway, Bupleuri Radix (Chaihu, 柴胡) and Pinelliae Rhizoma (Banxia, 半夏) can promote drainage and induce sweating, assisted by Scutellariae Radix (Huangqin, 黄芩); without these, the pathogen cannot be resolved. The Taiyin channel belongs to the Spleen, which is Earth of the Central Region; its nature dislikes cold and dampness. Without Dried Ginger (Ganjiang, 干姜) and Atractylodis Macrocephalae Rhizoma (Baizhu, 白术), warmth and dryness cannot be achieved. The Shaoyin channel belongs to the Kidney; its nature fears cold and dryness. Without Prepared Aconiti Lateralis Radix (Fuzi, 附子), warming cannot occur. The Jueyin channel belongs to the Liver, which stores blood and nourishes sinews; without warm and neutral herbs, moistening and nourishing cannot take place. This is the constant principle. Later learners, unaware of these categories, arbitrarily administer drugs, leading to chaotic symptoms and premature death. Must one not investigate and distinguish these matters? Regarding the three Yang channels, one must know the methods of sweating, purging, and harmonizing. For the Taiyin Spleen channel, if warming and drying methods fail, one should use warming and draining methods, emerging from the Yangming channel, as seen in Wenyi Wan using Rhizoma et Radix Rhei. For the Shaoyin Kidney channel, although Fuzi is used, combining it with Mahuang shows that Shaoyin also originates from Taiyang. Using Cinnamon Twig (Guizhi, 桂枝) for Jueyin indicates it emerges from Shaoyang. When the two Yang channels are constrained, they should emerge from Yangming; thus, the three Yin channels have indications for purging. Examples include Shaoyin with dry mouth and throat, and watery diarrhea; Taiyin with abdominal fullness and intermittent pain; Jueyin with curled tongue and retracted testicles—all require purging. Scholars should examine these details carefully and not prescribe rashly.