煮药之法,取味者火宜缓,取气者火宜速。若人参虽取气,亦须武火缓煎。
世俗服药之弊有六,不可不知。有食已而即药者,有药已而即恣饮茶汤者;有药食杂进
而恬
不知忌者;有才服此医之药,而旋以彼医之药继之者;有明受此医之药,而阴则服彼医之药
,不肯明言以欺人者;更有苦于服药,所投汤丸,潜倾暗废,中外侍人,又互为之隐,无可
稽穷者。病或偶减,因无论已;设或病增,咎将安责?
一人七月间病热,日夜炎炎不解,医用杏仁、薄荷、芩、连之类,解肌退热,数服不
愈。病
经旬日,其人开张药铺。略知医药,因谓同伴曰∶前所服药,甚为对症而不瘳,我其殆焉哉
!惟心中想冷冻饮料,同伴咸谓闭塞腑气,不与,病者无可如何?又经数日,适无人在侧,因意床
下
藏有雪水一瓮。乃勉力支撑,掀盖连饮数碗,即倒卧床下,汗流遍身;及觉即思粥饮,身凉
脉静矣。其伴询于其人,所患乃燥热之症,治法当用玉女煎加解肌药,早已愈矣。其如芩、
连能清热,不能润燥,兼有杯水车薪之弊,所以似是而实非。其饮雪水而愈者,如热斧沃水
,则气蒸蒸然,燥火之邪,从汗而泄,此必然之势,无足奇者。
凡病难于末治。前人有言,如钱孔中过鼠,全身已出,而尾不能出。要知尾不能出,其
中有
故在,只要细心体定,自然有得,不然则一篑之亏,前功尽弃矣!昔闻一人伤寒愈后,昼能
食,夜能眠,二便如常,可称无患矣。然坐卧一室,窗户紧闭,或启透风,庭除小步,便作
寒
热。近处知名者,药治殆遍,终无一效。后诣吴门薛一瓢延医,曰∶贼去而门未关者,用玉
屏风散而痊。此所谓知其要者一言而终,脱尾而出,究何难哉?人患身热咳嗽,予为延医。
知其暑风,用辛凉无效,因其烦躁不宁,用大黄下之,一服而愈,粥饭兼进。一日忽目赤舌
红,咽痛如刺,服西瓜汁缓痛,弹指顷,诊其脉如平人。因思表邪已散,暑热已清,结食已
消,而见此症何耶?静思一片时,念其痛虽甚,只宜轻清,方为合法,乃用灯心二十茎,竹
卷心二十个,以清心火,大甘草三片,以甘泻之,煎半杯,才服即合眼酣寝。觉而谓人曰∶
前药下咽,即不痛
,是何仙方耶?而不知药不值一文,此亦脱尾之验也。
煮药的方法,想要提取药物的“味”(厚重之质),火候宜缓;想要提取药物的“气”(轻清之性),火候宜速。虽然人参主要取其气,但也需要用武火(大火)缓慢煎煮。
世俗人服药存在六种弊端,不可不知道。有一种是吃完饭后立刻吃药的;有一种是吃完药后立刻大量饮用茶或汤水的;有一种是药和食物混杂服用,且安然不知禁忌的;有一种是刚才服用了这位医生的药,紧接着又服用那位医生的药的;有一种是明面上接受这位医生的药,暗地里却服用那位医生的药,不肯明说以欺骗人的;更有甚者,因为苦于服药,将投下的汤药或丸药偷偷倾倒废弃,身边的侍从又互相隐瞒,无法查究清楚。如果病情偶尔减轻,也就罢了;假如病情加重,责任该归咎于谁呢?
有一人在七月间患热病,日夜发热不退,医生使用杏仁、薄荷、黄芩、黄连之类药物,旨在解肌退热,服用数次后未愈。患病十多天后,此人开了一家药铺,略懂医药,便对同伴说:“之前服用的药,非常对症却没有痊愈,我恐怕要死了吧!”只是心中渴望喝冷冻饮料,同伴们都认为这会闭塞腑气,不给他喝,病人无可奈何。又过了几天,恰好身边无人,他便想起床下藏有一瓮雪水。于是勉强支撑身体,掀开盖子连喝了几碗,随即倒在床下,浑身大汗淋漓;等到醒来时就想喝粥,身体变凉,脉搏平静了。他的同伴询问他,得知他所患乃是燥热之症,治疗方法应当用玉女煎加上解肌药,早就应该痊愈了。像黄芩、黄连能清热,但不能润燥,兼有“杯水车薪”(力量太小,无济于事)的弊端,所以看似正确实则错误。他喝雪水而痊愈,就像用冷水浇烧红的铁斧,热气蒸腾,燥火之邪随汗液排出,这是必然的趋势,没什么奇怪的。
凡是疾病到了后期都难以治疗。前人说过,这就像老鼠从钱孔中钻过,全身已经出来了,但尾巴还卡在孔里。要知道尾巴出不来,其中是有原因的,只要细心体察定夺,自然会有收获,否则就会因一筐土的缺失(功亏一篑),前功尽弃!以前听说有人伤寒病愈后,白天能吃,晚上能睡,大小便正常,可以说是没有隐患了。然而坐在房间里,窗户紧闭,或者稍微透风,在庭院里小走几步,就出现寒热症状。附近的名医,用药治疗几乎遍试,最终都没有效果。后来去苏州找薛一瓢延请医生,医生说:“贼已离去而门未关好”,用玉屏风散而痊愈。这就是所说的懂得关键的人,一句话就能解决问题,脱尾而出,究竟有什么难的呢?有人患身体发热咳嗽,我为他延请医生。知道是暑风,用辛凉法无效,因为他烦躁不安,用大黄攻下,服用一次就好了,还能吃粥吃饭。一天突然眼睛红、舌头红,咽喉痛如针刺,服用西瓜汁缓解疼痛,眨眼之间,诊脉如同正常人。我想表邪已散,暑热已清,积食已消,为什么会出现这些症状呢?静思片刻,想到虽然疼痛厉害,只宜用轻清之法,才是合法度,于是用灯心草二十根,竹卷心二十个,以清心火,大甘草三片,以甘缓泻之,煎成半杯,刚服下就闭眼熟睡。醒来后对人说道:“前面的药咽下去,就不痛了,这是什么仙方呢?”却不知道药不值一文钱,这也是“脱尾”(指治病抓住关键,事半功倍)的验证。
The method of decocting medicine: to extract the "flavor" (heavy substance), the fire should be slow; to extract the "qi" (light nature), the fire should be rapid. Although *Renshen* (Ginseng Radix) is primarily used for its qi, it must also be slowly decocted with vigorous fire (Wu Huo).
There are six common faults in taking medicine among the secular world, which one must not ignore. Some take medicine immediately after eating; some drink tea or soup excessively immediately after taking medicine; some mix food and medicine together while remaining unaware of dietary taboos; some just finished taking medicine from one physician and immediately follow it with medicine from another; some openly accept medicine from one physician but secretly take medicine from another, refusing to speak the truth to deceive others; furthermore, some, suffering from the bitterness of taking medicine, secretly discard the decoctions or pills they have taken, while attendants conceal this fact from each other, making it impossible to trace. If the illness happens to subside slightly, let it pass; but if the illness worsens, who shall be held responsible?
An individual suffered from a heat disease in July, with fever burning day and night without relief. Physicians prescribed herbs such as *Xingren* (Apricot Seed), *Bohe* (Mint), *Qinhua* (Scutellariae Radix), and *Lianhua* (Lotus Plumule) to release the muscle layer and reduce fever. After several doses, there was no improvement. After more than ten days, this person, who ran a pharmacy and had slight knowledge of medicine, said to his companions, "The previous medicine was very appropriate for the condition but did not cure me; I fear I am doomed!" He craved cold drinks. His companions argued that this would block the fu-organ qi and refused him. Helpless, he waited a few more days. When no one was around, he remembered a jar of snow water hidden under the bed. He forced himself up, opened the lid, and drank several bowls. He then collapsed under the bed, sweating profusely all over his body. Upon waking, he desired porridge; his body was cool, and his pulse was calm. His companions later learned that his condition was dryness-heat. The correct treatment should have been *Yunü Jian* (Jade Woman Decoction) combined with muscle-releasing herbs, which would have cured him long ago. Herbs like *Qinhua* and *Lianhua* can clear heat but cannot moisten dryness; using them here is like "a cup of water on a cartload of firewood" (ineffective against overwhelming heat). Thus, the prescription seemed correct but was actually wrong. His recovery by drinking snow water was like pouring water on a red-hot axe: steam rises, and the dryness-fire pathogen exits through sweat. This is an inevitable trend and nothing strange.
Generally, treating diseases in their late stages is difficult. Ancients said it is like a mouse passing through a coin hole: the whole body has emerged, but the tail remains stuck. One must realize that the reason the tail cannot exit lies within specific causes; careful contemplation will yield insights. Otherwise, failing at the last moment (like dropping one basket of earth before completing a mound) renders all previous efforts useless. I once heard of someone who recovered from *Shanghan* (Cold Damage). During the day he could eat, at night he could sleep, and his excretions were normal—seemingly free of danger. However, sitting in a room with closed windows, or even slight drafts, or walking a few steps in the courtyard, triggered chills and fever. Famous local physicians tried almost every prescription without effect. Later, he sought treatment from Xue Yipiao in Suzhou. Xue said, "The thief has left, but the door is not closed," and prescribed *Yupingfeng San* (Jade Windscreen Powder), resulting in a cure. This illustrates that those who grasp the essence can resolve matters with a single word. It is easy to emerge from the "tail" (the lingering complication). Another case: a patient suffered from fever and cough. I consulted a physician. Knowing it was summer-wind, we used acrid-cool methods without success. Due to restlessness and irritability, we used *Dahuang* (Rhubarb Root and Rhizome) to purge. One dose cured him, and he resumed eating porridge and meals. Suddenly, his eyes turned red, tongue red, and throat painful as if pierced. Drinking watermelon juice relieved the pain momentarily, and his pulse returned to normal. I reasoned that exterior pathogens had dispersed, summer-heat cleared, and food stagnation resolved. Why these symptoms? After quiet reflection, I concluded that despite severe pain, only light and clearing methods were appropriate. Thus, I prescribed 20 stems of *Dengxincao* (Juncus Medulla), 20 pieces of *Zhuanjuanxin* (Bamboo Leaf Heart), to clear heart-fire, and 3 slices of *Dagancao* (Licorice Root) to sweetly drain it. Decocted into half a cup, he fell into deep sleep immediately after ingestion. Waking up, he asked, "After swallowing the previous medicine, the pain ceased instantly. What immortal prescription is this?" Unaware that the medicine was worth less than a penny, this too serves as proof of mastering the "tail" (key point) of treatment.