用药如用兵,补泻寒热之间,安危生死之所系也,可不慎与?虽云目病非热不发,非寒
不止,此言夫火之大概耳。内有阴虚、冷泪、昏眇、脱阳等症,岂可独言是火,而用寒凉也
今之庸医,但见目病,不识症之虚实寒热,辨别气血,惟用寒凉治之,殊不知寒药伤胃损
血,是标未退而本先伤,至胃坏而恶心,血败而拘挛。尚不知省,再投再服,遂令元气大伤
而变症日增,必虚寒之症已的,始可投以温和之药,否则有抱薪救火之患。设是火症,投
以热药,其害犹速,不可不慎,大抵燥赤者清凉之,炎秘者寒凉之,阴虚者温补之,脱阳者
温热之,然热药乃回阳之法,寒药乃救火之方,皆非可以常用者。外障者养血去障,内障者
滋胆开郁,故治火虽用芩、连、知、柏之类,制之必以酒炒,庶免寒润泄泻之患,而寒热补
泻之间,又宜谅人禀受之浓薄,年力之盛衰,受病之轻重,年月之远近,毋使太过不及,当
于意中消息,如珠之走盘,如权之走秤,不可拘执,是为良医。
药之生熟,补泻在焉,剂之补泻,利害存焉。盖生者性悍而味重,其攻也急,其性也刚
主乎泻;熟者性淳而味轻,其攻也缓,其性也柔,主乎补。补泻一差,毫厘千里,则药之
利人害人判然明矣。如补药之用制熟者,欲得其醇浓,所以成其资助之功,泻药制熟者,欲
去其悍烈,所以成其攻伐之力。用生用熟,各有其宜。实取其补泻得中,毋损于正气耳。岂
为悦观美听而已哉!何今之庸医,专以生药饵人,夫药宜熟而用生,生则性烈,脏腑清纯中
和之气,服之宁无损伤,故药生则性泻。性泻则耗损正气,宜熟岂可用生,又有以生药为嫌
专尚炮制称奇。夫药宜生而用熟,熟则其性缓,脏腑郁滞不正之邪,服之难以驱逐。故药
熟则性缓,性缓则难攻邪气,宜生岂可用熟。殊不知补汤宜用熟,泻药不嫌生。夫药之用生
犹夫乱世之贼寇,非强兵猛将,何以成摧坚破敌之功。药之用熟,犹夫治世之黎庶,非礼
乐教化,何以成雍熙揖让之风。故天下乱则演武,天下治则修文。医者效此用药,则治病皆
得其宜,庶不至误人之疾也。噫!审诸。
用药如同用兵,在补益与泻下、寒凉与温热之间的运用,关系到患者的安危甚至生死,怎能不谨慎呢?虽然常说眼病非热不能发作,非寒不能停止,这说的是火热之邪的大致情况罢了。体内有阴虚、冷泪、视物昏花、脱阳等症状,难道可以只说是火证,而一味使用寒凉药物吗?
如今的庸医,只要见到眼病,就不辨病症的虚实寒热,不分辨气血状况,只用寒凉药治疗,殊不知寒性药物会损伤脾胃、耗损血液,这是标证未退而本元先伤,导致胃气败坏而恶心,血液败坏而肢体拘挛。如果还不醒悟,继续投药服用,就会使元气大伤,变证日益增多。必须确认为虚寒之证,才可以投用温和的药物,否则会有“抱薪救火”(越救火火势越大)的危害。如果是火证,却投以热药,其危害更快更烈,不可不谨慎。大致来说,干燥发红的用清凉法,炎症便秘的用寒凉法,阴虚的用温补法,脱阳的用温热法。然而,热药是回阳救逆的方法,寒药是清热救火的方剂,都不是可以长期常规使用的。外障眼病要养血去障,内障眼病要滋胆开郁。所以治疗火证虽然常用黄芩、黄连、知母、黄柏之类,但必须经过酒炒炮制,以免产生寒润导致泄泻的弊端。而在寒热补泻的运用之间,又应当估量患者体质的厚薄、年富力力的盛衰、受病的轻重、病程的长短,不要使治疗太过或不及,应当在心中灵活斟酌,像珍珠在盘中滚动一样灵活,像秤砣在秤杆上移动一样精准,不可固执拘泥,这才是良医。
药物的生用与熟用,蕴含着补益与泻下的区别;剂量的补泻,关系着利害的存亡。一般来说,生药性质猛烈且味道厚重,其攻邪作用急迫,性质刚强,主要起泻的作用;熟药性质醇厚且味道轻清,其攻邪作用缓和,性质柔和,主要起补的作用。补泻之间稍有差错,就会失之毫厘谬以千里,那么药物对人有利还是有害就截然分明了。比如补药使用炮制过的熟药,是为了获得其醇厚的药力,从而完成资助正气的功效;泻药使用炮制过的熟药,是为了去除其猛烈之性,从而发挥其攻伐病邪的力量。用生药还是熟药,各有适宜的场合。目的是取其中和的补泻效果,不损伤正气罢了。哪里是为了好看好听呢!为什么现在的庸医,专门用生药给人服用?药物本该熟用却用生药,生药性质猛烈,脏腑中清纯中和之气,服用后难道不会受到损伤吗?所以药生则性质偏泻。性质偏泻就会耗损正气,应该用熟药岂可用生药?又有的人对生药有顾虑,专门崇尚炮制并称奇。药物本该生用却用熟药,熟药性质缓和,脏腑中郁滞不正的病邪,服用后难以驱逐。所以药熟则性质缓和,性质缓和就难以攻逐邪气,应该用生药岂可用熟药。殊不知补益的汤剂宜用熟药,泻下的药物不避讳生药。药物用生药,就像乱世中的盗贼,不是强兵猛将,怎么能成就摧毁坚固、击败敌人的功绩?药物用熟药,就像治世中的百姓,没有礼乐教化,怎么能成就和谐礼让的风气?所以天下动乱就演练武艺,天下太平就修习文教。医生效法这种道理来用药,那么治病都能得其适宜,才不至于误人疾病。唉!请仔细审察。
The use of medicinal substances is like the deployment of troops; the balance between tonification and purgation, cooling and warming, determines safety and danger, life and death. Can one be too cautious? Although it is said that eye diseases do not flare up without heat nor subside without cold, this statement refers only to the general nature of fire pathogens. Conditions such as yin deficiency, cold tears, blurred vision, and yang collapse exist internally; how can one solely attribute them to fire and employ cooling agents?
Contemporary mediocre physicians, upon seeing any eye disease, fail to distinguish the deficiency or excess, cold or heat of the syndrome, nor do they differentiate qi and blood. They indiscriminately apply cooling treatments. Little do they know that cold medicines damage the Stomach (Wei) and deplete blood. The branch symptoms remain unresolved while the root is injured first, leading to stomach failure with nausea, and blood deterioration with spasms. If they do not reflect and cease, continuing to administer these drugs will severely injure Yuan Qi (Primordial Qi), causing complications to increase daily. Only when a deficiency-cold syndrome is definitively diagnosed should mild and warm medicines be administered; otherwise, there is the risk of "adding fuel to the fire." Conversely, if a fire syndrome exists but hot medicines are administered, the harm is even more rapid. One must be extremely cautious. Generally, dryness and redness require cooling; inflammation and constipation require cold clearing; yin deficiency requires warm tonification; and yang collapse requires warm heating. However, hot medicines are methods to restore Yang, and cold medicines are prescriptions to save from fire; neither should be used routinely. For exterior obstructions (Wai Zhang), nourish blood and remove obstructions; for interior obstructions (Nei Zhang), nourish the Gallbladder (Dan) and resolve stagnation. Thus, although treating fire syndromes involves herbs like Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhimu (Anemarrhenae Rhizoma), and Huangbai (Phellodendri Cortex), they must be processed with wine stir-frying to avoid side effects of cold-induced diarrhea. In the application of cold/heat and tonification/purgation, one must assess the patient's constitutional strength, age and vitality, severity of illness, and duration of disease. Avoid excess or insufficiency; adjust flexibly in mind, like a pearl rolling on a plate or a weight moving on a scale. Do not be rigid; this constitutes a good physician.
The raw or cooked state of medicines embodies the principles of tonification and purgation; the dosage determines benefit or harm. Raw medicines have fierce properties and heavy flavors; their attack is urgent, their nature is rigid, primarily serving purgation. Cooked medicines have mellow properties and light flavors; their attack is slow, their nature is soft, primarily serving tonification. A slight error in tonification versus purgation leads to a discrepancy of a thousand miles; thus, whether a medicine benefits or harms is clearly distinguished. For tonifying medicines, using processed (cooked) forms seeks their mellow richness to achieve the function of supporting assistance. For purging medicines, using processed forms seeks to remove their fierceness to achieve the power of attacking and eliminating. The choice between raw and cooked has its appropriateness. The goal is to achieve balanced tonification and purgation without damaging righteous Qi. Is it merely for aesthetic appeal? Why do contemporary mediocre physicians exclusively feed patients raw medicines? Medicines should be cooked; using raw ones implies fierce properties. Will the pure and harmonious Qi of the Zang-Fu organs not be damaged by ingestion? Therefore, raw medicines have a purging nature. A purging nature consumes righteous Qi; thus, cooked is appropriate, not raw. Conversely, some fear raw medicines and exclusively advocate processing. Medicines should be raw; using cooked ones implies slow properties. Will the stagnant and abnormal pathogens within the Zang-Fu organs be difficult to expel after ingestion? Therefore, cooked medicines have a slow nature. A slow nature makes it hard to attack pathogens; thus, raw is appropriate, not cooked. It is unknown that tonifying decoctions should use cooked medicines, while purging medicines need not shy away from raw ones. Using medicines in their raw state is like bandits in chaotic times; without strong soldiers and fierce generals, how can one achieve the merit of breaking fortifications and defeating enemies? Using medicines in their cooked state is like the common people in peaceful times; without rites and music education, how can one achieve an atmosphere of harmony and courtesy? Therefore, when the world is in chaos, martial arts are practiced; when the world is governed, culture is cultivated. Physicians who emulate this principle in medication will treat diseases appropriately and avoid harming patients. Alas! Reflect upon this carefully.