经义
拘于鬼神者,不可与言至德;恶于针石者,不可与言至巧。病不许治者,病必不治,治之无功矣。(《素问》)
子之所慎齐战疾。(《论语》)
哲言
人受先人之体,有八尺之躯,而不知医事,所谓游魂耳!虽有忠孝之心,慈惠之性,无以济之。(皇甫谧)
程子云∶病卧于床,委之庸医,比于不孝不慈。事亲者,不可不知医。(《朱子遗书》)
幼幼之心,人所易发;老老之心,人或昧焉。使爱亲如爱子,则人子尽曾参矣。(韩飞霞)
吾有疾病,必尽告医,使其了然于心,然后参以脉。今人以脉试医,犹以身试药也。(苏文忠)
班固曰∶有病不治得中医。倘一药之误,悔将噬脐。古云∶拙医疗病,不如不疗。与此意同。(《医学入门》)
药者,人生之大利大害也。不遇良医,不如不药,不药而误也悔,药而误也亦悔,然不药之悔小,误药之
悔大。○病者所忌,自酒、色、劳役、饮食及一切例禁外,所大忌者有二∶认病为真,终朝 傺,一也;求速效,
而轻用医药,二也。予病中守戒甚严,独此二者,以是久而不痊,慎之哉!(《折肱漫录》)
病有六不治∶骄恣不论于理,一不治也;轻身重财,二不治也;衣食不能适,三不治也;阴阳并脏气不定,
四不治也;形羸不能服药,五不治也;信巫不信医,六不治也。有此一者,则重难治也。(《史记》)
一、广生烦恼,轻身重财;二、饮食无度,不守医戒;三、听信旁言,过求速效;四、但索药方,妄为加
减,药味滥恶,煎丸失法;五、偏听祷赛,杂进医巫,既不识病,又不择医;六、诊视不勤,药不对病,讳病
忌医,攻补错乱;七、任性反复,朝王暮李,试药集医,荡涤肠胃;八、室家聒噪,动成荆棘,及其致败,反
嫁谗说;九、伤生之证,视为平淡,夺命大剂,不敢沾尝;十、不察病本,爱嗜清凉,妄断是非,耽误时日。(罗峰氏)
一俗说∶我是火体,毫不可用补。此说误命最多,只闻风鉴家分金、木、水、火、土之形,未闻服药者
分金、木、水、火、土之体,况又未闻有金体、木体、水体、土体,何得独有火体?人之脏腑,各分发阴阳五
行,又安有专以火为体者?愿病患、医人,细审其理,勿泥俗说,自误误人也。○一俗说∶证虽虚,却补不得。
病患便深信之,抑知其说自相矛盾,可笑也,病不虚则已,既是虚盒饭用补,如何又补不得?如人既已饥寒,
自当予以温饱,
若云饥寒,而又温饱不得,有是理乎?揣其意,以为虚而有火,故谓不可补耳。抑知虚而有火,即是虚火,正
当用补,补则虚回,而火自降。丹溪云∶实火可泻,芩、连之属;虚火可补,参、 之属。愿治病者,先审病,
再用药,审定是虚病,便放心用补。无火固补,有火亦补,只论虚不必论火,补其虚而火自退。奈何医家不审
虚实,但执补不得三字,如莫须有三字一般,便断定虚人罪案,使监守虚牢中,安心待毙而莫之救亦可哀矣。
○一俗说∶孩童纯阳,更不可补。守此俗说,所以杀人无算也。用药只论证。岂论年纪?若实证不当用补,即
八十岁老人亦不可用;若虚证必当用补,即半岁孩童亦当用之。况孩童其质脆嫩,尤易成虚,薛立斋先生云∶
小儿易为虚实。此四字最妙,如食啖稍多即内伤。风寒一触即外感,此易实也;消导稍过脾即弱,表散忽略汗
不止,此易虚也。盖小儿气未盛,血未旺,骨未坚,肉未满,脾胃卑弱,脏腑空虚,如诸果未至成熟之时,其
核尚软,核中之仁,犹是水浆。又如树木老干,虽斧斤不易伤;若初发嫩条,指略攀便折。孰实孰虚,不较然
易辨乎?奈罔顾此脆嫩之质,而任意清之、散之,虚极则发热痰涌,吐泻交作,渐成慢脾,脾气散漫欲绝,仍
以牛黄紫雪之属,通利而镇坠之,其能复有生机乎?○一俗说附子有毒,不可用。抑知凡攻病之药皆有毒,不
独附子为然。《周礼》冬至日采毒药以攻疾。《内经》有大毒治病,常毒治病,小毒治病之论。扁鹊云∶吾以
毒药活人。盖无毒之品,不能攻病,惟有毒性者,乃能有大力,凡沉寒痼冷,及伤寒中阴等证,非附子不能驱
阴回阳,故《本草》称其有斩关夺将之能,追魂夺魄之功。今人但因有毒二字,遂禁锢不用,使阴寒之证,无
由复生。且有病则病受之,亦无余性旁及作毒,即使有毒却能令人生,有毒而生,不胜于无毒而死乎?○一俗
说∶夏月忌用桂、附辛热等药。若是则治病用药,不必论证,只论四时可矣。夏月天炎,便用寒凉药;冬月天
寒,便用温热药;春秋不寒不热,便用平和药。有是理乎?
如盛冬伤寒传经阴证,治用石膏、大黄、承气之类,岂以冬月天寒,盒饭忌用寒凉耶?若夏月本属伏阴在内,
而人又多食冷物,或冷水洗浴,或裸体贪凉,故中阴中寒之证,夏月更多,岂以夏月阴寒之证,亦忌用温热,
以视其死耶?夏月疟痢,每多夹阴之证,即当同伤寒阴证治法,非温补不能救,而况乎直中阴经之证,舍桂、
附更将奚恃乎?第人不能辨认,故只知温热当忌耳。岂知寒凉杀人,易如反掌耶?往往见治夹阴疟痢,亦同治
邪疟热痢法,直以芩、连、大黄之类杀之。遇中阴寒证,不曰中暑,便云受热,直用白虎汤、香薷饮之类杀之。
辛热固当忌矣,不知寒凉杀人,亦当忌否?○一俗说∶治重病先须用药探之,方为小胆细心。愚谓此非小胆也,
非细心也,第无目耳。试看门前无目乞儿,以竹棒点地,探途路也,扪墙摸壁,探门户也。纵探得是路,又不
知是坑、是埂,纵探着有门,又不知是庙宇、是住宅。何如有目者,一目了然,既看得清,又毫不费力。故治
病而用探法。再探不着;即探着,亦探不清。况从来重病最易哄人,大实偏似虚,大虚偏似实,大寒偏似热,
大热偏似寒。探着相似处,必与真处相反,再待探着真处,而前之反药,已不可救矣。惟有目医人,一眼觑定
病患之真情,或大泻实,或大补虚,一发中的,使久病立效,危病立安,岂不直捷痛快!何用东掏西摸,作瞎
子行径?若危急之证,能待尔纵容细探乎?○一俗说∶产后服不得人参。此极不通之论,不知出自何书?有何引
据而为此语,以误人命?遂令家喻户晓,见有用人参以救产妇者,必群力阻之,坐视其死而后已。彼谓产后服
不得人参者,恐其补住污血,不得行耳。抑知气行则血行,气滞则血滞,然气之所以滞者,气虚故也;气之所
以行者,气旺故也。故必用人参以补气,气旺则气行,而污血自行,必无补住不行之理。况产后虚证甚多,要
紧处不专在行污,安可单为污血而置性命于不问乎?丹溪云∶产后当以大补气血为主,一切杂证皆从末治之。
彼有杂证者,尚以补气血为主;若无杂证,
而一味是虚,岂反不当用补乎?又《证治准绳·产后门》中,开首一方是独参汤,产后眩晕者主之。奈何今人
恶生好死,一任产妇发寒发热,出汗作泻,神昏气乱,虚证百出,一息奄奄,犹必不肯用人参拯救。最喜专门
女科,动加以产后惊风之名,于益母、泽兰通套药中,加以钩藤、僵蚕、秦艽、天麻之类,使产妇虚而益虚,
虽欲不死,不可得也。○一俗说∶吐血服不得人参。一见血证,便云是火。固不可谓此证必无火,然不可谓此
证必皆是火。如担夫出力之人,纵酒受热之辈,初起自当清之,稍久其血去多,便已成虚,亦不得复谓之火矣。
若富室娇儿,深闺弱质,不待吐血后血枯气竭,然后成虚,即吐血之先,原因虚而后吐。盖气耗则血出,气固
则血止。气虚不能摄血,血乃走漏,冲口而出。气虚不能嘘入经络,血亦渗泄咳咯而出。故不独失血之后,当
补气生血,以复其固有;即血未止之时,急当重固其气,所谓血脱者必先益气。又谓有形之血,不能骤生;无
形之气,所宜急固也。今人治此证,必曰有火。凉之而血不止也,又曰是肺火;润之而血不止也,又曰是阴火;
滋之而血不止也,又曰气逆上行,降之而血不止也,又曰宜去污生新,荡涤之而血不止也,又曰宜保肺清金;
保之、清之而血不止也。更有谓宜急于止血者,止之而血愈不止也;且有用大寒以冰伏之,而元气愈亏,血愈
不止也。何也?总未得补气固血之法也。故人谓吐血不可用参,余谓吐血必须用参。人谓要用参,须待血止;
余谓不用参,血必不止。直待血吐尽,而后议补,用参晚矣。血已竭而难生,气已空而难复,损证成矣,无可
救矣。○一俗说∶某医用药稳妥,某病服药相安。盖用药以中病为贵,服药以得效为凭。若不必求其中病,而
但曰稳妥,则不如饮汤之为更稳妥也。不必求其得效,而但曰相安,则不如饮水之为更相安也。其真稳妥者,
在于轻重得宜,补泻恰当,见之似可畏,服之必奏功,此则真稳妥也。若真相安者,重病服之顿减,轻病服之立
除,安之云者,病却而复于安康无事之谓也,此则
真相安也。今则不然,但见药味则至浮至淡,数则至少至微,举方不令人惊,误服亦无大害,此今之所以稳妥
也。吾恐不痒不疼,养瘿为患,虽不伤人于目前,必贻祸患于异日。人方喜其稳妥,孰知其大不稳妥者,即由
之而伏也。又若病患服药,不增不减,无是无非,到口无臭味之可憎,入腹无功过之可指,此今之所谓相安也。
吾恐因循日久,邪气不退则日进,正气不长则日消。人方幸其相安,孰知其大不相安者,即随之而至也。○一
俗说∶用补药要关住贼邪在内。此一语最易动人,最易害人。如新伤食滞,伤寒阳证,传经热邪,时令邪疟,
结热下痢,如此等证,自无用补之理,亦必无妄补之人。彼所议者,不在此种实邪之证,而在阴盛阳衰,正虚
邪凑,断当用补,断当急补,而不可游移延缓者。如伤寒阴证,阴寒下利,及寒疟、三阴疟,夹阴痢疾,脾虚
成鼓,脏寒胀满,吐泻欲脱等证,俱宜以温补为主,正气旺则邪气自除,阳气回则阴邪自退,皆当急补,惟恐
补之不早。稍一迟延,邪炽正衰,阴凝阳灭,命即危殆。乃亦以关住贼邪为词,眩惑病患。以致倾命。如此俗
说,真是贼邪,愿医家同以慧剑斩之。(《医验录》)
病家误,早失计,初时抱恙不介意,人日虚兮病日增,纵有良工也费气。病家误,不直说,讳病试医工与
拙,所伤所作只君知,纵有名家猜不出。病家误,性躁急,病有回机药须吃,药既相宜病自除,朝夕更医也不
必。病家误,在服药,服药之中有窍妙,或冷或热要分明,食前食后皆有道。病家误,最善怒,气逆冲胸仍不
悟,岂知肝木克脾元,愿君养性须回护。病家误,苦忧思,忧思抑郁欲何之,常将不如己者比,知得雄来且守
雌。病家误,好多言,多言伤气最难痊,劝君默口疑神坐,好将真气养真元。病家误,染风寒,风寒散去又复
还,譬如城郭未完固,那堪盗贼更摧残。病家误,不戒口,口腹伤人处处有,食饮相宜中气和,鼓腹含哺天地
久。病家误,不戒慎,闺房衽席不知命,命至颠危可若何?愿将好色人为镜。(程钟龄)
【经文要义】
拘泥于鬼神迷信的人,不可以与他谈论高深的医德;厌恶针石治疗的人,不可以与他谈论精妙的医术。病人不允许治疗的,病必然治不好,即使治疗也不会见效。(出自《素问》)
孔子所谨慎对待的事情是:斋戒、战争、疾病。(出自《论语》)
【哲理名言】
人承受了祖先赋予的身体,拥有八尺之躯,却不懂得医学知识,这就像是一个游荡的孤魂!虽然有着忠孝之心和慈惠之性,也无法救助自己。(皇甫谧)
程子说:生病卧床,将性命托付给平庸的医生,这等同于不孝和不慈。侍奉双亲的人,不能不懂医学。(出自《朱子遗书》)
爱护幼小的心,人们容易激发;尊敬老人的心,人们有时却会蒙昧。如果像爱护子女一样去爱护父母,那么人人都能成为曾参那样的孝子了。(韩飞霞)
我自己有疾病时,必定把病情全部告诉医生,让医生心里完全清楚,然后再结合脉诊来验证。现在有些人用脉诊来试探医生,这就像是用身体去试药一样危险。(苏东坡)
班固说:有病不去治疗,算是中等水平的处理。如果因为用药失误,后悔就来不及了。古语说:拙劣的医生治病,不如不治疗。这与上面的意思相同。(出自《医学入门》)
药物,对人生来说既是巨大的利益也是巨大的危害。如果没有遇到良医,不如不吃药。不吃药而误事,后悔较小;吃药而误事,后悔很大。○病人所忌讳的,除了酒、色、劳累、饮食以及一切常规的禁忌之外,最大的忌讳有两个:一是把假病当真病,整天惊慌失措,这是其一;二是追求速效,轻易使用药物,这是其二。我在生病期间严守这些戒律,唯独这两点没做到,所以病久不愈,一定要谨慎啊!(出自《折肱漫录》)
疾病有六种情况难以治愈(六不治):傲慢放纵不讲道理,是一不治;轻视身体看重钱财,是二不治;衣食不能适应调节,是三不治;阴阳失调且脏腑之气不稳定,是四不治;形体消瘦无法服药,是五不治;相信巫师不相信医生,是六不治。只要有其中一条,就属于难治的情况。(出自《史记》)
一、产生过多的烦恼,轻视身体看重钱财;二、饮食没有节制,不遵守医生的医嘱;三、听信旁人的闲言碎语,过分追求速效;四、只索要药方,胡乱加减药味,药材质量低劣,煎煮丸剂的方法不当;五、偏听祈祷祭祀的话,混杂使用医生和巫术,既不认识病症,也不选择医生;六、诊察不勤快,药不对症,隐瞒病情忌讳就医,攻补错乱;七、任性反复无常,朝秦暮楚,尝试各种药物以荡涤肠胃;八、家属吵闹不休,动辄成为障碍,等到病情败坏时,反而嫁祸于谗言;九、把危及生命的证候看得很平淡,不敢服用救命的重剂;十、不考察病的根本,喜爱清凉之物,妄断是非,耽误时间。(罗峰氏)
一种世俗的说法:我是“火体”,绝对不能用补药。这种说法害死很多人。只听说过风水先生区分金、木、水、火、土五种形体,没听说过吃药的人区分金、木、水、火、土五种体质,况且也没听说过有金体、木体、水体、土体的人,怎么偏偏独有“火体”?人的脏腑,各自分属阴阳五行,又怎会有专门以火为体质的呢?希望病患和医生仔细审察其中的道理,不要拘泥于世俗的说法,从而误己误人。○另一种世俗说法:证候虽然是虚证,但是不能补。病患便深信不疑,却不知道这种说法自相矛盾,很可笑。病不虚就算了,既然是虚证就应该用补法,怎么又说不能补呢?就像人已经饥寒交迫,自然应当给予温暖和饱食,如果说既饥寒又不能让温饱,哪有这个道理?揣测其本意,认为是虚而有火,所以说不可补。却不知道虚而有火,就是虚火,正当用补法,补则虚损恢复,火气自然下降。丹溪说:实火可以用泻法,如黄芩、黄连之类;虚火可以用补法,如人参、肉桂之类。希望治病的人,先审察病情,再用药,确定是虚病,就放心大胆地用补法。无火固然要补,有火也要补,只论虚实不必论火,补其虚而火自然消退。奈何医生不审察虚实,只执着于“不可补”三个字,就像“莫须有”罪名一样,就断定虚证病人的罪案,让他们在虚证的牢狱中安心等死而不施救,也很可悲啊。○还有一种世俗说法:孩童是纯阳之体,更不可用补药。坚守这种世俗说法,所以杀人无数。用药只论证候,难道还论年纪吗?如果是实证不当用补,即使是八十岁老人也不可用;如果是虚证必须用补,即使是半岁的孩童也应当用。况且孩童体质脆嫩,更容易形成虚证,薛立斋先生说:“小儿易为虚实。”这四个字最妙。比如饮食稍多就会内伤,风寒一触就会外感,这是易实;消导稍过脾就弱,发汗忽略汗不止,这是易虚。大概是因为小儿气未盛,血未旺,骨未坚,肉未满,脾胃卑弱,脏腑空虚,就像各种果实未到成熟之时,果核尚软,核中的仁,还是像水浆一样稀薄。又像树木的老干,虽然斧头不易砍伤;若是刚发出的嫩条,手指稍微攀折就会折断。孰实孰虚,不是很容易分辨吗?无奈不顾及这种脆嫩的体质,而任意用清法、散法,导致虚极则发热痰涌,吐泻交作,逐渐形成慢脾风,脾气散漫欲绝,仍然用牛黄、紫雪之类通利镇坠的药物,还能有生机吗?○又一种世俗说法:附子有毒,不可用。却不知道凡是攻病的药物都有毒,不只是附子如此。《周礼》记载冬至日采集毒药以攻疾。《内经》有大毒治病、常毒治病、小毒治病的论述。扁鹊说:我用毒药救人。大概无毒的物品,不能攻病,只有有毒性的,才能有大力,凡沉寒痼冷,以及伤寒中阴等证候,非附子不能驱除阴寒回阳救逆,所以《本草》称它有斩关夺将的能力,追魂夺魄的功效。现在的人只因有毒二字,就禁锢不用,使阴寒证候的病人无法复生。而且有病则病受之,也没有多余的药性旁及作为毒性,即使有毒却能让人活下来,有毒而生,不是胜过无毒而死吗?○又一种世俗说法:夏季忌讳使用桂枝、附子等辛热药物。如果是这样,治病用药就不必论证候,只论四季就可以了。夏天天气炎热,就用寒凉药;冬天天气寒冷,就用温热药;春秋不寒不热,就用平和药。有这样的道理吗?
如在深冬伤寒传经阴证,治疗用石膏、大黄、承气汤之类,难道因为冬天天气寒冷,就忌讳用寒凉药吗?若夏天本属伏阴在内,而人多食冷物,或冷水洗浴,或裸体贪凉,所以中阴中寒的证候,夏天更多,难道因为夏天阴寒证候,也忌讳用温热药,看着他们死去吗?夏天的疟疾痢疾,很多夹杂阴证,就应当同伤寒阴证的治疗方法,非温补不能挽救,何况是直接中阴经的证候,舍弃桂枝、附子还将依靠什么呢?只是人们不能辨认,所以只知道温热当忌。哪里知道寒凉杀人,易如反掌耶?往往看见治疗夹阴疟痢,也同治疗邪疟热痢的方法,直接用黄芩、黄连、大黄之类杀死病人。遇到中阴寒证,不说中暑,就说受热,直接用白虎汤、香薷饮之类杀死病人。辛热固然应当忌,不知道寒凉杀人,也应当忌吗?○又一种世俗说法:治疗重病必须先用药试探,这才是胆大心细。我认为这不是胆大,也不是细心,只是没有眼睛罢了。试着看看门前没有眼睛的乞丐,用竹棒点地探路,摸墙摸壁探门户。纵然探到了路,又不知道是坑还是埂,纵然探到有门,又不知道是庙宇还是住宅。哪如有眼睛的人,一目了然,既看得清,又毫不费力。所以治病如果用试探法,再探不着;即使探着,也探不清。况且从来重病最容易迷惑人,大实偏似虚,大虚偏似实,大寒偏似热,大热偏似寒。探到相似之处,必然与真相相反,再等待探到真处,之前的反药已经无法挽救了。唯有有眼光的医生,一眼看清病患的真情,或大泻实,或大补虚,一发中的,使久病立即见效,危病立即安定,岂不直捷痛快!何必东掏西摸,做瞎子的行径?若是危急的证候,能等你从容细细试探吗?○又一种世俗说法:产后服不得人参。这是极其不通的言论,不知道出自哪本书?有什么依据而说出这样的话,来误人性命?遂令家喻户晓,见到有人用人参救治产妇,必群起阻挠,坐视其死才罢休。他们说产后服不得人参,是怕补住污血,不得运行。却不知道气行则血行,气滞则血滞,然而气之所以滞,是因为气虚;气之所以行,是因为气旺。所以必须用人参补气,气旺则气行,污血自行,绝无补住不行的道理。况且产后虚证很多,关键之处不仅仅在行污血,怎么能单为污血而置性命于不问呢?丹溪说:产后应当以大补气血为主,一切杂证皆从末治之。那些有杂证的人,尚且以补气血为主;若无杂证,而一味是虚,难道反而不当用补吗?又《证治准绳·产后门》中,开首一方是独参汤,主治产后眩晕。奈何现在的人恶生好死,任凭产妇发寒发热,出汗作泻,神昏气乱,虚证百出,气息奄奄,仍一定不肯用人参拯救。最喜欢专门的女科医生,动不动加上产后惊风之名,在益母草、泽兰等通套药中,加上钩藤、僵蚕、秦艽、天麻之类,使产妇虚而益虚,虽然想不死,也不可能了。○又一种世俗说法:吐血服不得人参。一见血证,便说是火。固然不能说此证必无火,但也不能说此证必皆是火。如挑担出力之人,纵酒受热之辈,初起自然应当清之,稍久其血去多,便已成虚,也不得再谓之火。若是富室娇儿,深闺弱质,不待吐血后血枯气竭,然后成虚,即吐血之前,原因虚而后吐。盖气耗则血出,气固则血止。气虚不能摄血,血乃走漏,冲口而出。气虚不能嘘入经络,血亦渗泄咳咯而出。所以不仅失血之后,当补气生血,以恢复其固有;即血未止之时,急当重固其气,所谓血脱者必先益气。又说有形之血,不能骤生;无形之气,所宜急固也。现在的人治疗此证,必说有火。凉之而血不止也,又说肺火;润之而血不止也,又说阴火;滋之而血不止也,又说气逆上行,降之而血不止也,又说宜去污生新,荡涤之而血不止也,又说宜保肺清金;保之、清之而血不止也。更有谓宜急于止血者,止之而血愈不止也;且有用大寒以冰伏之,而元气愈亏,血愈不止也。为什么呢?总未得补气固血之法也。所以人说吐血不可用参,我说吐血必须用参。人说要用参,须待血止;我说不用参,血必不止。直待血吐尽,而后议补,用参晚矣。血已竭而难生,气已空而难复,损证成矣,无可救矣。○又一种世俗说法:某医用药稳妥,某病服药相安。大概用药以中病为贵,服药以得效为凭。若不必求其中病,而但曰稳妥,则不如饮汤之为更稳妥也。不必求其得效,而但曰相安,则不如饮水之为更相安也。其真稳妥者,在于轻重得宜,补泻恰当,见之似可畏,服之必奏功,此则真稳妥也。若真相安者,重病服之顿减,轻病服之立除,安之云者,病却而复于安康无事之谓也,此则真相安也。今则不然,但见药味则至浮至淡,数则至少至微,举方不令人惊,误服亦无大害,此今之所以稳妥也。吾恐不痒不疼,养瘿为患,虽不伤人于目前,必贻祸患于异日。人方喜其稳妥,孰知其大不稳妥者,即由之而伏也。又若病患服药,不增不减,无是无非,到口无臭味之可憎,入腹无功过之可指,此今之所谓相安也。吾恐因循日久,邪气不退则日进,正气不长则日消。人方幸其相安,孰知其大不相安者,即随之而至也。○又一种世俗说法:用补药要关住贼邪在内。这一句话最容易动人,也最容易害人。如新伤食滞,伤寒阳证,传经热邪,时令邪疟,结热下痢,如此等证,自然无用补之理,也必无妄补之人。彼所议者,不在此种实邪之证,而在阴盛阳衰,正虚邪凑,断当用补,断当急补,而不可游移延缓者。如伤寒阴证,阴寒下利,及寒疟、三阴疟,夹阴痢疾,脾虚成鼓,脏寒胀满,吐泻欲脱等证,俱宜以温补为主,正气旺则邪气自除,阳气回则阴邪自退,皆当急补,惟恐补之不早。稍一迟延,邪炽正衰,阴凝阳灭,命即危殆。乃亦以关住贼邪为词,眩惑病患。以致倾命。如此俗说,真是贼邪,愿医家同以慧剑斩之。(出自《医验录》)
【病家误】
病家误,早失计,初时抱恙不介意,人日虚兮病日增,纵有良工也费气。
病家误,不直说,讳病试医工与拙,所伤所作只君知,纵有名家猜不出。
病家误,性躁急,病有回机药须吃,药既相宜病自除,朝夕更医也不必。
病家误,在服药,服药之中有窍妙,或冷或热要分明,食前食后皆有道。
病家误,最善怒,气逆冲胸仍不悟,岂知肝木克脾元,愿君养性须回护。
病家误,苦忧思,忧思抑郁欲何之,常将不如己者比,知得雄来且守雌。
病家误,好多言,多言伤气最难痊,劝君默口疑神坐,好将真气养真元。
病家误,染风寒,风寒散去又复还,譬如城郭未完固,那堪盗贼更摧残。
病家误,不戒口,口腹伤人处处有,食饮相宜中气和,鼓腹含哺天地久。
病家误,不戒慎,闺房衽席不知命,命至颠危可若何?愿将好色人为镜。(程钟龄)
[Scriptural Principles]
Those who are constrained by ghosts and spirits cannot be spoken to regarding the highest virtue; those who detest needles and stones cannot be spoken to regarding the highest skill. If a patient does not permit treatment, the illness will certainly not be cured, and any attempt at treatment will yield no merit. (From *Suwen*)
What the Master was cautious about were: fasting, war, and disease. (From *Analects*)
[Philosophical Sayings]
Humans inherit their physical form from their ancestors, possessing an eight-foot body, yet if they do not understand medical affairs, they are merely wandering souls! Although they may have hearts of loyalty and filial piety, and natures of kindness and compassion, they have no means to save themselves. (Huang Fumi)
Master Cheng said: "To lie sick in bed and entrust one's life to mediocre doctors is equivalent to being unfilial and unkind. Those who serve their parents must know medicine." (From *Zhu Xi's Remnant Writings*)
The heart to care for the young is easily aroused by people; the heart to respect the old is sometimes obscured by them. If one loves parents as one loves children, then everyone would be like Zeng Shen (a famous filial son). (Han Feixia)
When I am ill, I must tell the doctor everything, so that he understands clearly in his mind, and then verify with pulse diagnosis. Nowadays, some people use pulse diagnosis to test doctors, which is like testing medicine on one's own body. (Su Dongpo)
Ban Gu said: "Having an illness but not treating it is considered medium-level handling. If a mistake is made with even one herb, regret will come too late. The ancients said: 'A clumsy doctor treating an illness is better than no treatment.' This shares the same meaning." (From *Medical Beginner*)
Medicines are both great benefits and great harms to human life. If one does not encounter a good doctor, it is better not to take medicine. Regret from error without medicine is small; regret from error with medicine is large. ○ What patients should avoid, besides wine, sex, labor, diet, and all routine prohibitions, are two major taboos: first, mistaking false illness for real illness and being anxious all day long; second, seeking quick effects and lightly using medicines. I strictly observed these warnings during my illness, but failed only in these two aspects, which is why my illness lasted long. Be cautious! (From *Records of Broken Arm*)
There are six types of illnesses that are difficult to cure (Six Untreatables): Arrogance and indulgence without regard for reason, this is the first untreatable; Lightly valuing the body and heavily valuing wealth, this is the second; Inability to adapt clothing and food, this is the third; Yin and Yang are disordered and organ Qi is unstable, this is the fourth; The body is emaciated and unable to take medicine, this is the fifth; Believing in shamans but not in doctors, this is the sixth. If any one of these exists, the illness is heavy and difficult to treat. (From *Records of the Grand Historian*)
1. Generating excessive worries, lightly valuing the body and heavily valuing wealth; 2. Indulging in diet, not observing medical advice; 3. Listening to gossip, excessively seeking quick effects; 4. Only demanding prescriptions, arbitrarily adding or subtracting herbs, using poor quality herbs, and incorrect methods for decocting or making pills; 5. Relying solely on prayers and sacrifices, mixing doctors and shamans, failing to recognize the illness and failing to choose a doctor; 6. Negligent diagnosis, medication not matching the illness, concealing illness and avoiding doctors, confusing tonification and purgation; 7. Capricious and inconsistent, changing doctors frequently, experimenting with drugs to cleanse the intestines and stomach; 8. Family members creating noise and obstacles, and when the condition deteriorates, blaming others with slander; 9. Treating life-threatening conditions as trivial, daring not to consume heavy doses that could save lives; 10. Failing to investigate the root of the illness, loving cooling substances, making arbitrary judgments, and delaying time. (Luo Fengshi)
One common saying: "I have a 'Fire Constitution' and absolutely cannot use tonics." This saying has caused many deaths. One has only heard of Feng Shui masters distinguishing forms of Metal, Wood, Water, Fire, and Earth, but never heard of patients distinguishing constitutions of Metal, Wood, Water, Fire, and Earth. Moreover, there is no mention of people having Metal, Wood, Water, or Earth constitutions; how can there be exclusively a "Fire Constitution"? The organs in the human body each correspond to Yin-Yang and the Five Elements. How can there be a constitution dedicated solely to Fire? I hope patients and doctors carefully examine the logic and do not stick to vulgar sayings, thereby harming themselves and others. ○ Another vulgar saying: "Although the syndrome is deficiency, it cannot be tonified." Patients believe this deeply, unaware that the statement is self-contradictory and ridiculous. If the illness is not deficiency, fine; since it is deficiency, it should be tonified. How can it be said that it cannot be tonified? It is like someone suffering from hunger and cold; naturally, warmth and food should be provided. To say one is hungry and cold but cannot be warmed or fed—does such logic exist? Presumably, the intent is that deficiency accompanied by fire means tonification is forbidden. However, deficiency with fire is indeed deficient fire, and tonification is precisely indicated. Tonifying restores deficiency, and the fire naturally subsides. Danxi said: "Excess fire can be drained, using herbs like Scutellariae Radix (Huangqin) and Coptidis Rhizoma (Huanglian); deficient fire can be tonified, using herbs like Ginseng Radix et Rhizoma (Renshen) and Cinnamomi Ramulus (Guizhi)." I hope physicians first examine the illness, then prescribe medication. Once confirmed as a deficiency illness, they should confidently use tonification. Whether there is fire or not, tonification is required; one only discusses deficiency, not fire. Tonifying the deficiency causes the fire to recede. Why do doctors fail to examine deficiency and excess, clinging to the three words "cannot be tonified," much like the fabricated charge of "perhaps there is," thus convicting deficiency patients and letting them die in prison without rescue? This is truly pitiable. ○ Yet another vulgar saying: "Children possess pure Yang and must not be tonified." Adhering to this vulgar saying has killed countless people. Medication should be based on syndromes, not age. If excess syndromes do not require tonification, even an eighty-year-old should not receive it; if deficiency syndromes require tonification, even a half-year-old infant should receive it. Furthermore, infants have fragile constitutions and easily become deficient. Mr. Xue Lizhai said: "Infants are prone to both deficiency and excess." These four words are excellent. For example, slightly overeating leads to internal injury, and touching wind-cold leads to external contraction; this is prone to excess. Slightly overusing digestive herbs weakens the Spleen, and neglecting sweating leads to incessant perspiration; this is prone to deficiency. Generally, infants' Qi is not full, Blood is not vigorous, bones are not solid, and flesh is not filled. Their Spleen and Stomach are weak, and Zang-Fu organs are empty. It is like fruits before maturity: the pits are soft, and the kernels inside are like liquid. Or like an old tree trunk, which is hard to damage with an axe; but a new tender branch breaks easily with a slight touch. Who is excess and who is deficiency is clearly distinguishable. Alas, ignoring this fragility and arbitrarily using clearing or dispersing methods leads to extreme deficiency, causing fever, phlegm surging, vomiting, and diarrhea, gradually forming Slow Spleen Wind. With Spleen Qi scattering and nearly extinguished, using herbs like Calculus Bovis (Niuhuang) and Zi Xue San to drain and suppress—can there still be vitality? ○ Another vulgar saying: "Fuzi (Aconiti Lateralis Radix Praeparata) is toxic and cannot be used." Do you not know that all attacking medicines are toxic, not just Fuzi. *Zhou Li* records collecting toxic medicines on the Winter Solstice to attack diseases. *Neijing* discusses treating diseases with great toxicity, common toxicity, and slight toxicity. Bian Que said: "I save people with toxic medicines." Essentially, non-toxic items cannot attack diseases; only those with toxicity possess great power. For deep-seated cold and chronic cold, or Taiyang Cold Damage involving Yin syndromes, only Fuzi can drive out Yin and restore Yang. Thus, *Bencao* praises its ability to break through gates and capture generals, and its merit of retrieving the soul. Today, people forbid its use simply because of the word "toxic," leaving patients with Yin-cold syndromes without hope for recovery. Moreover, when ill, the disease absorbs the medicine, and there is no surplus property to act as poison elsewhere. Even if toxic, it allows life; is it not better to live with toxicity than to die without it? ○ Another vulgar saying: "In summer, one must avoid Gui Zhi (Cinnamomi Ramulus), Fu Zi (Aconiti Lateralis Radix Praeparata), and other acrid-hot medicines." If this were true, treating illness would not require examining syndromes, only the seasons. In summer heat, use cold-cool medicines; in winter cold, use warm-hot medicines; in spring and autumn, use neutral medicines. Is this logical?
For instance, in deep winter, if Cold Damage transmits to Yin syndromes, treatment uses Shigypsum (Shigypsum), Dahuang (Rhei Radix et Rhizoma), and Chengqi Tang. Would one avoid cold-cool medicines just because it is winter? Summer inherently contains hidden Yin within, and people often eat cold foods, bathe in cold water, or expose themselves to coolness to seek relief. Therefore, Yin-cold syndromes are more common in summer. Should we avoid warm-hot medicines for summer Yin-cold syndromes and watch them die? Summer malaria and dysentery often involve mixed Yin syndromes, requiring the same treatment as Cold Damage Yin syndromes; only warm-tonification can save them. How much more so for direct invasion of the Yin meridians? Without Gui Zhi and Fu Zi, what else can be relied upon? People simply cannot distinguish, so they only know to avoid warm-hot medicines. They do not realize that cold-cool medicines kill as easily as turning a hand. Often, treating mixed Yin malaria/dysentery follows the method for pathogenic malaria/hot dysentery, directly killing the patient with Huangqin, Huanglian, and Dahuang. Encountering central Yin-cold syndromes, instead of recognizing summerheat, they claim heat reception, directly killing with Baihu Tang or Xiangru Yin. Acrid-hot medicines should indeed be avoided, but should cold-cool medicines also be avoided since they kill? ○ Another vulgar saying: "Treating severe illness requires probing with medicine first, showing boldness and carefulness." I argue this is neither bold nor careful, but blind. Consider a blind beggar tapping the ground with a bamboo stick to find the path, or feeling walls to find doors. Even if they find the path, they don't know if it's a pit or a ridge; even if they find a door, they don't know if it's a temple or a house. How does this compare to someone with eyesight, who sees clearly at a glance without effort? Therefore, using a probing method for illness: if probing fails, fine; if it succeeds, it is still unclear. Moreover, severe illnesses are always deceptive: great excess resembles deficiency, great deficiency resembles excess, great cold resembles heat, great heat resembles cold. Probing similarities leads to opposites of truth. Waiting to probe the truth, the previous counter-medicines are already irrecoverable. Only a physician with insight can see the patient's true condition at a glance, either purging excess greatly or tonifying deficiency greatly, hitting the target immediately, bringing immediate effect to chronic illness and immediate peace to critical illness. Is this not straightforward and satisfying? Why grope around like a blind person? Can critical conditions wait for your leisurely probing? ○ Another vulgar saying: "After childbirth, Ren Shen (Ginseng Radix et Rhizoma) cannot be taken." This is extremely illogical. From which book does it come? What evidence supports this error that misleads people? It has become common knowledge. Seeing anyone use Ren Shen to save a postpartum woman, crowds oppose it, watching her die until the end. They say Ren Shen cannot be taken postpartum because it might tonify and trap lochia, preventing its discharge. Do they not know that when Qi moves, Blood moves; when Qi stagnates, Blood stagnates. The reason for Qi stagnation is Qi deficiency; the reason for Qi movement is Qi prosperity. Therefore, Ren Shen must be used to tonify Qi. When Qi is prosperous, Qi moves, and lochia flows naturally. There is no logic that it will be trapped. Moreover, postpartum deficiency syndromes are numerous. The key point is not solely moving lochia; how can one ignore life for the sake of lochia? Danxi said: "Postpartum should focus primarily on greatly tonifying Qi and Blood; all miscellaneous syndromes are treated as secondary." If those with miscellaneous syndromes prioritize tonifying Qi and Blood, how much more so those with pure deficiency? Also, in *Zhengzhi Zhunsheng · Postpartum Section*, the first prescription is Danshen Tang (Single Ginseng Decoction), indicated for postpartum dizziness. Why do modern people prefer death over life, allowing postpartum women to suffer chills, fever, sweating, diarrhea, confusion, chaotic Qi, and myriad deficiency symptoms, gasping for breath, yet refusing to use Ren Shen for rescue? They favor specialized gynecologists who diagnose "Postpartum Convulsions," adding Gouteng (Uncariae Ramulus cum Uncis), Jiangcan (Bombyx Batryticatus), Qinjiao (Gentianae Macrophyllae Radix), and Tianma (Gastrodiae Rhizoma) to standard herbs like Yimucao (Leonuri Fructus) and Zelan (Lycopus Herba), making the postpartum woman more deficient. Though she wishes not to die, it is impossible. ○ Another vulgar saying: "In hematemesis, Ren Shen cannot be taken." Upon seeing blood syndromes, one immediately claims it is Fire. While one cannot say this syndrome definitely lacks Fire, one also cannot say it is entirely Fire. For laborers or those indulging in alcohol and heat, initially clearing is appropriate. After a while, with significant blood loss, deficiency arises, and it can no longer be called Fire. For delicate children of wealthy families or frail women in inner chambers, deficiency exists even before hematemesis, leading to bleeding due to deficiency. When Qi dissipates, Blood exits; when Qi is secured, Blood stops. Qi deficiency fails to control Blood, causing leakage and spurting from the mouth. Qi deficiency fails to guide Blood into collaterals, causing seepage and coughing up of blood. Therefore, not only after blood loss should one tonify Qi to generate Blood and restore what is inherent; even while blood has not stopped, one must urgently secure Qi. As stated, "In blood collapse, one must first tonify Qi." It is also said: "Formative Blood cannot be generated suddenly; Formless Qi should be urgently secured." Modern physicians treating this always claim "there is Fire." Cooling fails to stop bleeding, so they claim Lung Fire; moistening fails, so they claim Deficient Fire; nourishing fails, so they claim Qi rebellion; descending fails, so they claim removing stasis and generating new; cleansing fails, so they claim protecting the Lung and clearing Metal; protecting and clearing fail. Some claim urgent hemostasis is needed, but stopping fails and bleeding worsens. Some use great cold to ice it down, further depleting Yuan Qi and worsening bleeding. Why? Because they never obtain the method of tonifying Qi and securing Blood. Thus, people say Ren Shen cannot be used for hematemesis; I say Ren Shen must be used. People say Ren Shen should be used only after bleeding stops; I say without Ren Shen, bleeding will never stop. Waiting until bleeding ceases to discuss tonification is too late. Blood is exhausted and hard to regenerate; Qi is empty and hard to recover. Consumption syndromes form, and there is no rescue. ○ Another vulgar saying: "So-and-so's medication is stable/safe, so-and-so's illness takes medicine peacefully." Generally, medication values hitting the target, and taking medicine values efficacy. If one does not seek hitting the target but only calls it "stable," drinking soup is more stable. If one does not seek efficacy but only calls it "peaceful," drinking water is more peaceful. True stability lies in appropriate weightiness, correct tonification and purgation, appearing formidable but achieving results upon ingestion. This is true stability. True peace means severe illness reduces instantly, mild illness disappears immediately. "Peace" means the illness retreats and returns to health. This is true peace. Now it is not so. Medicines are floating and light, dosages minimal, prescriptions unstartling, and accidental ingestion harmless. This is modern "stability." I fear that nurturing goiters without itching or pain, though not harming now, will bring disaster later. People rejoice in this stability, unaware that the greatest instability lies dormant within it. Similarly, patients taking medicine experience no increase or decrease, no right or wrong, no offensive taste, no merit or fault in the abdomen. This is modern "peace." I fear that prolonged inertia allows pathogenic Qi to advance daily if not retreated, and Healthy Qi to diminish daily if not grown. People rejoice in this peace, unaware that the greatest unrest follows. ○ Another vulgar saying: "When using tonics, one must keep the thief-pathogen inside." This phrase is most persuasive and most harmful. For fresh food stagnation, Yang syndromes of Cold Damage, transmitted heat pathogens, seasonal malaria, or heat-binding dysentery, there is naturally no reason to tonify, nor will anyone recklessly tonify. The discussion here concerns not these excess pathogen syndromes, but rather Yin-excess/Yang-deficiency, Healthy-deficiency/Pathogen-encroachment, where tonification is definitely required and urgently required, without hesitation or delay. For Yin syndromes of Cold Damage, Yin-cold diarrhea, cold malaria, Three-Yin malaria, mixed-Yin dysentery, Spleen-deficiency distension, Organ-cold fullness, vomiting/diarrhea with collapse, etc., warm-tonification should be primary. When Healthy Qi is prosperous, Pathogenic Qi removes itself; when Yang Qi returns, Yin Pathogens recede. All require urgent tonification, fearing only that tonification is not early enough. A slight delay allows Pathogens to flourish and Healthy Qi to decline, Yin to congeal and Yang to extinguish, endangering life. Yet, using "keeping the thief-pathogen inside" as an excuse confuses patients, leading to death. Such vulgar sayings are truly thief-pathogens; I wish physicians would cut them with the sword of wisdom. (From *Medical Verification Records*)
[Mistakes of the Patient]
Patient mistakes: Premature planning. Initially dismissing illness, the person grows weaker daily while the illness grows stronger. Even a skilled doctor finds it exhausting.
Patient mistakes: Not speaking frankly. Concealing illness to test the doctor's skill. Only the patient knows the harm done; even famous doctors cannot guess.
Patient mistakes: Impatience. When the illness has a chance to recover, medicine must be taken. If the medicine suits, the illness clears. Changing doctors morning and night is unnecessary.
Patient mistakes: Taking medicine incorrectly. There are subtleties in taking medicine. Temperature (cold/hot) must be clear, and timing (before/after meals) has its way.
Patient mistakes: Anger. Qi rebels and rushes to the chest, yet still does not realize. Does one not know Liver Wood overacts on Spleen Earth? I wish you to nurture your nature and protect yourself.
Patient mistakes: Worry and thought. Where does depression lead? Often compare oneself to those worse off. Knowing strength, yet choosing to remain yielding.
Patient mistakes: Excessive talking. Talking damages Qi, making recovery hardest. I advise silence and sitting like a deity, preserving True Qi and nourishing True Yuan.
Patient mistakes: Contracting Wind-Cold. Wind-Cold scatters and returns. Like an incomplete city wall, how can it withstand further destruction by thieves?
Patient mistakes: Not guarding the mouth. The mouth and belly harm people everywhere. Suitable food and drink harmonize Middle Qi, allowing one to enjoy longevity like Heaven and Earth.
Patient mistakes: Lack of caution. Ignoring life in the bedroom. When life reaches peril, what can be done? Let lustful men be your mirror. (Cheng Zhongling)