《中藏经》八卷,少室山邓处中云∶华先生佗游公宜山古洞,值二老人,授以疗病之法,得
石床上书一函,用以施试甚验。按《唐志》有吴普集《华氏药方》,别无中藏之名。普,其弟子,
宜有所集。窃意诸论非普辈不能作,邓氏特附别方而更今名耳。盖其方有用太平钱并山药者,盖
太平乃宋熙宁初年号,薯蓣以避浓陵偏讳而始名山药,其余可以类推。
《圣济经》十卷,宋徽宗所作,大要祖述《内素》而引援六经,旁及老氏之言,以阐轩岐遗
旨。政和间颁是经于两学,辟雍生吴 为之解义,若达道、正纪等篇,皆足以裨益治道,启迪众工者也。(并出《医史》)
学士商辂曰∶医者意也,如对敌之将、操舟之工,贵乎临机应变。方固难于尽用,然非方则
古人之心弗传,茫如望洋,如捕风,必有率意而失之者矣,方果可以弗用乎?虽然,方固良矣,
然必熟之《素问》,以求其本;熟之《本草》,以究其用;熟之诊视,以察其证;熟之治疗,以
通其变。始于用方,而终至于无俟于方,夫然后医之道成矣。昔许胤宗谓我善读仲景书而知其意,
然未尝专用其方,诚名言哉!(《奇效良方·序》)
古医十四科中有脾胃科,而今亡之矣。《道藏经》中颇有是说,自宋元以来止用十三科。考
医政,其一为风科,次伤寒科,次大方脉科,次小方脉科,次妇人胎产科,次针灸科,次眼科,
次咽喉口齿科,次疮疡科,(即今之外科。)次正骨科,次金镞科,次养生科,(即今修养家导引按
摩咽纳是也。)次祝由科。(经曰∶移精变气者,可祝由而已。即今符咒禳祷道教是也。)国朝
亦惟取十三科而已,其脾胃一科终莫之续。元李杲着《脾胃论》,极其精详,但不言十四科之阙
此,不知其得旧本而加己意,抑尽为创着而得上古之同然欤?是诚医道之大幸也。
甫观今世医者,多不工于脾胃,只用反治之法攻击疾病,以治其标,惟知以寒治热,以热治寒,以通治塞,
以塞治通而已。有寒因寒用,热因热用,通因通用,塞因塞用,必伏其所主而先其所因,所谓从
治之法,则漠然无所知也。及致脾胃损伤,犹不加察,元气一坏,变证多端。如脾虚而气短不能
以续,变而似喘促,医尚用降气定喘之药;如脾虚卫气不行,变而为浮肿,医尚用耗气利水之药;
如脾虚郁滞,变而作寒热,医尚谓外感,用发散之药,大段类此。虚而益虚,直以气尽身亡,始
用人参汤、附子汤灌之于殒绝之后,岂有能生之理乎?自今观之,不足者十常八九,况其时势,
竞驰驱于名利之途,劳思伤脾而致病者居其大半。若体实而竟为风寒暑湿之邪袭,则惟攻之而即
愈者亦不多见矣。此故中医治之易成功也。及遇脾胃虚而致风寒暑湿之邪袭,同体实者而施治之,
则大有间然者矣。攻之不已,则曰药不瞑眩,厥疾弗瘳,必大攻之,脾胃益伤而疾愈笃;技穷无
措,则曰难医。时弊如斯,曷可胜纪?要皆不知本之故也。经曰∶得谷者生,失谷者亡。又曰∶
有胃气者生,无胃气者死。然则胃气谷气得非人身之本欤?
《中藏经》共八卷,少室山邓处中说道:华佗先生游历公宜山的古洞时,遇到两位老人,传授给他治疗疾病的方法,并得到石床上的一函书,用来施治验证非常灵验。查阅《唐志》(唐代书目)中有吴普编纂的《华氏药方》,但没有《中藏经》的名字。吴普是华佗的弟子,应该有所收集。我推测这些论述不是吴普这类人所能创作的,邓氏只是特别附上其他方剂而改换了现在的名字罢了。大概其中有用到太平钱和山药的方子,因为“太平”是宋神宗熙宁初年的年号,“薯蓣”是为了避讳宋英宗赵曙的名讳才改名为山药,其余的可以据此类推。
《圣济经》共十卷,由宋徽宗所作,大体上遵循《内经》(包括《素问》和《灵枢》)的宗旨并引用六经理论,旁及老子的言论,以阐发黄帝、岐伯遗留下来的旨意。政和年间将此经颁行于太学和地方学校,辟雍生吴芾为之解释义理,像《达道》、《正纪》等篇章,都足以有益于治国之道,启迪众医家。(均出自《医史》)
学士商辂说:医生的工作在于意念与判断,就像面对敌人的将领、驾船的技术工人一样,贵在随机应变。方剂固然难以全部使用,但如果没有方剂,古人的心法就无法传承,医生会感到茫然如望洋兴叹、捕风捉影,必然会有随意行事而失误的人,难道方剂真的可以不用吗?虽然如此,方剂固然好,但必须熟读《素问》,以求得疾病的根本;熟读《本草》,以探究药物的作用;熟习诊视,以察看病证;熟习治疗,以通晓变化。从开始使用方剂,最终达到不需要依赖方剂的地步,这样医术才算大成。从前许胤宗说我善于阅读张仲景的书从而理解其意旨,然而从未专门套用他的方剂,这确实是至理名言啊!(出自《奇效良方·序》)
古代医学分为十四科,其中有脾胃科,如今已经失传了。《道藏经》中颇有这方面的说法,自宋元以来只沿用十三科。考证医政制度,第一是风科,第二是伤寒科,第三是大方脉科,第四是小方脉科,第五是妇人胎产科,第六是针灸科,第七是眼科,第八是咽喉口齿科,第九是疮疡科(即现在的外科),第十是正骨科,第十一是金镞科(箭伤科),第十二是养生科(即现在修养家的导引按摩咽纳等功法),第十三是祝由科(经文说:转移精神、改变气机,可以通过祝由疗法来解决。即现在的符咒禳祷道教仪式)。本朝也只取十三科而已,那个脾胃科始终没有恢复。元代李杲撰写了《脾胃论》,极其精详,但他没有提到十四科中缺失这一科,不知他是得到了旧本而加入了自己的见解,还是完全创新著述从而获得了上古医学的共同真理呢?这确实是医道的大幸事。
我看当今世上的医生,大多不擅长调理脾胃,只用反治法攻击疾病,来治疗其表象,只知道用寒凉药治热病,用温热药治寒病,用通利药治闭塞,用收敛药治通泄罢了。对于有寒因寒用、热因热用、通因通用、塞因塞用的治法,必须潜伏其主要病邪而先解决其病因,所谓的从治之法,则茫然无知。等到导致脾胃损伤,还不去仔细考察,元气一旦败坏,变证繁多。比如脾虚导致气短不能接续,变化得像喘促,医生还用降气定喘的药;比如脾虚导致卫气不行,变化为浮肿,医生还用耗气利水的药;比如脾虚郁滞,变化出寒热症状,医生还认为是外感,用发散的药物,大致类似这种情况。虚证更虚,简直导致气尽身亡,才开始用人参汤、附子汤在人已濒死时灌服,哪里还有能救活的道理呢?从现在的情况看,不足症的患者十有八九,况且当时的社会风气,竞相奔走于名利之途,劳思伤脾而致病者占了一半以上。如果体质结实竟然被风寒暑湿之邪侵袭,那么只有攻邪就能痊愈的也不多见。这是因为中医治疗容易成功。如果遇到脾胃虚弱而导致风寒暑湿之邪侵袭,却像对待体质结实的人那样施治,那就有很大的问题了。攻伐不止,就说“药不瞑眩,厥疾弗瘳”(药物不起剧烈反应,重病就不能治愈),一定要大力攻伐,脾胃更加受伤而疾病更加严重;技艺穷尽无计可施,就说“难医”。时弊如此,怎么数得完?都是不知道根本的缘故。经文说:能进食的就生存,不能进食的就死亡。又说:有胃气的就生存,无胃气的就死亡。那么胃气和谷气难道不是人身体的根本吗?
*Zangjing* (Classic of the Inner Viscera), eight volumes, states Deng Chuzhong of Shaoshi Mountain: "Master Hua Tuo (Hua Tuo) traveled to the ancient cave of Gongyi Mountain and encountered two elderly men who taught him methods for treating diseases. He received a box of writings from a stone bed, which proved very effective when applied in practice. According to the *Tang Zhi* (Tang Dynasty Bibliography), there is a work called *Huashi Yaofang* (Hu Family Prescriptions) compiled by Wu Pu, but no mention of *Zangjing*. Wu Pu was a disciple of Hua Tuo and likely did some compiling. I speculate that these discussions could not have been authored by people like Wu Pu; it seems Deng merely appended other prescriptions and changed the name to what it is known as today. Notably, some prescriptions use 'Taiping coins' and 'Shanyao' (Dioscorea Opposita Rhizome). 'Taiping' refers to the era name early in the Xining period of Emperor Shenzong of Song. 'Shuyu' (Dioscorea Opposita) was renamed 'Shanyao' to avoid the naming taboo of Emperor Yingzong of Song (Zhao Shu). The rest can be inferred similarly.
*Shengji Jing* (Holy Relief Classic), ten volumes, was composed by Emperor Huizong of Song. It generally follows the principles of *Neijing* (Inner Canon, comprising *Suwen* and *Lingshu*) and draws upon the Six Channels theory, while also incorporating the words of Laozi to elucidate the legacy of Huangdi (Yellow Emperor) and Qibo. During the Zhenghe era, this classic was distributed to the Imperial Academy and local schools. Wu Fei, a student of the Bixiong Academy, provided an interpretation of its meaning. Chapters such as *Dadao* (Reaching the Way) and *Zhengji* (Correcting the Record) are sufficient to benefit governance and enlighten practitioners. (Both cited from *Yishi* [History of Medicine])
Academician Shang Lu stated: "Medicine relies on mental discernment, akin to a general facing an enemy or a boatman navigating waters; one must excel in adapting to changing circumstances. While formulas cannot be used in every case, without them, the wisdom of the ancients would not be transmitted, leaving physicians茫然 (at a loss) like gazing at the ocean or trying to catch the wind, inevitably leading to arbitrary errors. Can formulas truly be discarded? Although formulas are excellent, one must thoroughly study *Suwen* to grasp the root of disease; thoroughly study *Bencao* (Materia Medica) to investigate drug properties; master diagnostic observation to identify syndromes; and master treatment strategies to understand variations. One begins by using formulas and ultimately reaches a state where reliance on formulas is unnecessary. Only then is the Way of Medicine perfected. In the past, Xu Yinzong said, 'I am good at reading Zhang Zhongjing’s books to understand his intent,' yet he never exclusively applied his formulas. This is indeed a profound truth!" (From the Preface to *Qixiao Liangfang* [Excellent Effective Good Prescriptions])
In ancient medicine, there were fourteen specialties, including the Spleen and Stomach specialty, which has now disappeared. There are many references to this in the *Daozang Jing* (Daoist Canon). Since the Song and Yuan dynasties, only thirteen specialties have been used. Examining the medical administration system: the first is Wind Specialty, second is Cold Damage Specialty, third is Large Internal Medicine Specialty, fourth is Small Internal Medicine Specialty, fifth is Women’s Obstetrics and Gynecology Specialty, sixth is Acupuncture and Moxibustion Specialty, seventh is Ophthalmology Specialty, eighth is Throat and Dental Specialty, ninth is Sores and Ulcers Specialty (i.e., modern Surgery), tenth is Orthopedics Specialty, eleventh is Arrow Wound Specialty, twelfth is Health Preservation Specialty (i.e., modern Daoist exercises involving guidance, massage, swallowing, and breathing techniques), and thirteenth is Zhuyou Specialty (The classic states: 'Those whose spirit can be shifted and qi transformed can be treated through Zhuyou.' This refers to modern Taoist rituals involving talismans and prayers). Our dynasty also adopts only the thirteen specialties; the Spleen and Stomach specialty remains unreinstated. Li Gao of the Yuan Dynasty wrote *Piwei Lun* (Treatise on Spleen and Stomach), which is extremely precise and detailed, yet he did not mention the absence of this specialty among the fourteen. Did he obtain an old text and add his own ideas, or did he create it entirely, thereby recovering the common truth of ancient times? This is truly a great fortune for the Way of Medicine.
Observing physicians in the current world, most are not skilled in treating the Spleen and Stomach. They only use contrary treatment methods to attack diseases, addressing symptoms rather than the root. They only know to treat heat with cold, cold with heat, obstruction with purgation, and patency with astringents. Regarding the methods of "treating cold with cold," "treating heat with heat," "treating unblocking with unblocking," and "treating obstruction with obstruction"—which require suppressing the primary pathogen and addressing the cause first, known as following-treatment—they remain completely ignorant. By the time Spleen and Stomach damage occurs, they fail to examine it carefully. Once the Primordial Qi (Yuan Qi) is damaged, numerous complications arise. For instance, if Spleen deficiency causes shortness of breath that cannot continue, manifesting as apparent asthma, doctors still use herbs to descend Qi and calm asthma. If Spleen deficiency leads to failure of Defensive Qi (Wei Qi) circulation, resulting in edema, doctors still use herbs that consume Qi and promote urination. If Spleen deficiency causes stagnation leading to alternating chills and fever, doctors still attribute it to external contraction and use dispersing herbs. Such cases are common. Deficiency leads to further deficiency, eventually causing death due to exhaustion of Qi. Only then do they administer Renshen Tang (Ginseng Decoction) or Fuzi Tang (Aconite Decoction) after the patient is near death. How could there be any chance of survival? From current observations, deficiency patterns account for eight or nine out of ten cases. Moreover, given the social climate where people compete for fame and profit, those suffering from Spleen injury due to overthinking constitute more than half. Even if constitutionally strong individuals are attacked by Wind, Cold, Summer-heat, or Dampness pathogens, cures achieved solely through attacking the pathogen are rare. This is because Traditional Chinese Medicine treatments succeed easily when the root is addressed. However, when Spleen and Stomach deficiency allows Wind, Cold, Summer-heat, or Dampness pathogens to invade, treating them as if the patient were constitutionally strong leads to significant problems. Continuous attacking worsens the condition, with excuses like "if the medicine does not cause dizziness/nausea, the severe disease will not heal," leading to aggressive treatments that further injure the Spleen and Stomach and intensify the illness. When skills are exhausted, they claim the disease is "difficult to treat." These malpractices are countless. All stem from ignorance of the root. The classic states: "Those who can eat grain live; those who lose the ability to eat die." It also states: "Those with Stomach Qi live; those without Stomach Qi die." Are Stomach Qi and Grain Qi not the foundation of the human body?