扁鹊论医病有六不治。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。阴阳并藏气不足。四不治也。形羸不能服药。五不治也。信巫不信医。六不治也。云
林子曰。越人之论。一三四五六是矣。二则于予心有未适然者。何也。轻者彼轻也。重者彼
重也。彼轻而我重之。则彼之生可活矣。不然。彼以一吝而丧生。固病者之不智。子以一吝
而不治。亦医者之不仁。噫。古之神医。于此意犹存。则世医可知矣。
夫药者。天地间之万物也。昔古神农悯苍生之疾苦。格物理之精微。其用心可为仁矣。
故本
草药品虽多。然其味不过五。乃甘辛咸苦酸是也。而其性不过六。温凉补泻升降是也。且甘
辛温补升者阳也。苦咸凉泻降者阴也。淡渗泄而属阳。酸性阳而味阴。故药有纯阳者。有纯
阴者。有阴中之阳。有阳中之阴。有专用其气者。有独用其味者。大抵味之浓者必补。气之
重者必降。味淡则泻。性轻则升。升者治在上在表之病。降者治在下在里之疾。诸寒凉者治
乎血热。诸温热者治乎气郁气虚。润以濡燥。涩以收脱。又甘为诸补之原。苦为诸泻之本。
辛香者亦升泄之类。酸咸者皆补降之属。所谓补者。性味各有所补。而其泻者。亦各有所泻
然补中有泻。而泻中有补。如酸入肝。生津以制燥。至苦入心。滋阴以降火。辛能温肺以
退寒。咸可坚肾以御热。如欲去其邪。在使复其正。泻阳有以补阴。泻阴有以补阳。降则通
其自升。升则欲其自降。惟病有兼成。而法当合用。故方有奇偶。而药有君臣。制之以散者
散也。或成之以锭者镇也。用汤者荡也。取气味荡漾。而无所不至。用丸者缓也。取气味缓
达。而有所及远。汤有生熟。泻则宜生。补则宜熟。丸有大小。病在上者宜小。俱服于
食后。或散末以轻调。或含丸以缓化。病在下者宜大。俱服于食前。或服后以食压。或汤药
以顿服。吞补剂于早于未语之前。服疾药当脱衣临睡之际。郁气妙舐嚼之方。温症利丸散之
功。凡用甘草者。解诸药毒。取甘以缓脾。剂投生姜者。行诸药力。取辛以开胃。故病以脾
胃为主。始得以攻病之力。用酒者欲其上达。用盐者取其下行。丸用蜡者匮其毒。裹用蜡者
藏其气。水丸求其速化以清利。蜜丸取其缓行以滋润。用新者速其功。用陈者远其毒。调脾
胃之药。丸宜五谷。和气血之剂。利用醋酒。炒以缓其性。泡以剖其毒。浸能滋阴。炼可助
阳。但制有太过不及之弊。忌用有相反畏恶之情。有疗之于理者。有疗之以意者。又有不药
之术。出乎才智之巧。如针灸熏熨淋渍之类。治六淫外病之药也。有以人事真伪之机。委曲
旁求之变。动人耳目。移病者之心志。郁者散之。散者郁之。劳者逸之。静者动之。乃治七
情内病之药也。故导引营运。调乎饮食起居。从中正之心。无欺妄之忧者。乃修养之药也。
故药者非徒药物之为药。而人事所宜之门。莫不为之药也。
扁鹊论述治病有六种情况不予治疗。骄傲放纵，不讲道理，这是第一种不治疗的情况。轻视身体而看重钱财，这是第二种不治疗的情况。饮食起居不能适应调节，这是第三种不治疗的情况。阴阳失调且脏腑之气不足，这是第四种不治疗的情况。形体消瘦虚弱，无法承受服药，这是第五种不治疗的情况。信奉巫术而不相信医生，这是第六种不治疗的情况。
云林子说：越人（即扁鹊）的论述中，第一、第三、第四、第五、第六点是对的。但对于第二点，我心里却有些不完全认同。为什么呢？病人认为身体轻贱，是因为他们自己看轻身体；病人认为钱财重要，是因为他们自己看重钱财。如果病人看轻身体，而医生能重视并挽救他们的生命，那么病人的生命就可以存活了。否则，病人因为吝啬钱财而丧命，固然是病人不智慧；但如果医生也因为这点小事（指病人重财轻身）就不去治疗，那也是医生的不仁义。唉，古代的神医，还保留着这种心意，那么当时的世医也就可想而知了。
所谓药物，是天地间的万物。从前神农怜悯百姓的疾苦，探究物理的精微之处，他的用心可以说是仁爱了。所以《本草》中的药品虽然很多，但它们的味不过五种，就是甘、辛、咸、苦、酸这五种。而它们的性不过六种，就是温、凉、补、泻、升、降这六种。而且，甘、辛、温、补、升属于阳；苦、咸、凉、泻、降属于阴。淡味渗泄而属阳，酸性属阳而味属阴。所以药有纯阳的，有纯阴的，有阴中之阳，有阳中之阴。有的专门利用其气，有的单独利用其味。大致来说，味道浓厚的必然具有补益作用，气味厚重的必然具有沉降作用；味道淡则具有泻的作用，性质轻扬则具有升的作用。升提的药治疗在上部、在体表的病；沉降的药治疗在下部、在体内的疾。各种寒凉的药物治疗血热，各种温热的药物治疗气郁和气虚。用滋润的方法濡养燥邪，用收敛的方法固摄脱失。又因为甘味是各种补益的根本，苦味是各种泻下的基础。辛香类药物也属于升散泄浊的一类，酸咸类药物都属于补益沉降的一类。所谓的“补”，性味各有其补益的对象；所谓的“泻”，也各有其泻除的对象。然而补中有泻，泻中有补。例如酸味入肝，生津液以制约燥邪；极苦味入心，滋阴以降火；辛味能温肺以退寒；咸味可坚肾以御热。如果想要去除邪气，关键在于使正气恢复。泻阳可以补阴，泻阴可以补阳。降是为了通导，使其自然上升；升是为了引导，使其自然下降。只有疾病往往是兼夹形成的，所以治疗方法应当配合使用。因此方剂有奇方和偶方，药物有君药和臣药。制成散剂的目的是发散；制成锭剂的是为了镇坠。使用汤剂是为了荡涤，取药气荡漾，无所不到；使用丸剂是为了缓和，取药气缓慢到达，作用深远。汤剂有生用和熟用之分，泻下宜生用，补益宜熟用。丸剂有大小的区别，病在上部的宜用小丸，都在饭后服用；或者用散末轻轻调服，或者含化丸剂以缓慢溶解。病在下部的宜用大丸，都在饭前服用；或者饭后用食物压住药力，或者用汤药一次性顿服。早晨未说话之前吞服补剂，临睡前脱衣之际服用治病的药。对于郁结之气，妙在咀嚼吞咽的方法；对于温热病症，利于丸散的功效。凡是使用甘草的，是为了消除各种药物的毒性，取甘味来缓和脾气。投用生姜的，是为了推行各种药物的力量，取辛味来开胃。所以治病以脾胃为主，才能发挥攻治病邪的力量。使用酒，是想让药力上达；使用盐，是取其下行。丸药用蜡包裹，是为了遏制毒性；裹药用蜡，是为了藏纳药气。水泛丸求其快速化开以清利，蜜丸取其缓慢行散以滋润。用新药材是为了加速功效，用陈药材是为了远离毒性。调理脾胃的药物，丸剂宜用五谷制作；调和气血的药剂，利用醋和酒。炒制可以缓和药性，浸泡可以剖析毒性。浸渍能滋阴，炼制可助阳。但是炮制有过度和不及的弊端，禁忌用药有相反、相畏、相恶的情况。有的疗法从道理上讲得通，有的疗法从意念上起作用。还有不用药物的方法，出自才智的巧妙运用，如针灸、熏蒸、熨帖、淋洗、渍泡之类，这是治疗六淫外感疾病的药物。有的通过人事真伪的变化，曲折旁求的变通，打动人的耳目，转移患者的意志。郁结的使之发散，散乱的使之郁结（注：此处原文逻辑较深，意指调节情志平衡），劳累的使之安逸，静止的使之运动，这是治疗七情内伤疾病的药物。所以导引运功，调节饮食起居，保持中正之心，没有欺诈妄念的忧虑，这就是修养的药物。所以说，药物不仅仅是草木金石等实物为药，人事所适宜的一切，无不都可以作为药。
Bian Que discussed six conditions under which diseases are not to be treated. First, arrogance and willfulness without regard for reason; this is the first condition of non-treatment. Second, regarding the body as light (insignificant) but wealth as heavy (important); this is the second condition of non-treatment. Third, inability to adapt diet and clothing to seasonal changes; this is the third condition of non-treatment. Fourth, imbalance of Yin and Yang with insufficiency of Zang-fu Qi; this is the fourth condition of non-treatment. Fifth, emaciation and weakness such that the patient cannot tolerate medication; this is the fifth condition of non-treatment. Sixth, believing in witchcraft rather than medicine; this is the sixth condition of non-treatment.
Yun Linzi said: Regarding Yue Ren’s (i.e., Bian Que’s) discussion, points one, three, four, five, and six are correct. However, I am somewhat dissatisfied with point two. Why? The patient considers their body insignificant because they themselves devalue it; the patient values wealth highly because they themselves prioritize it. If the patient devalues their body, yet the physician values it and acts to preserve life, then the patient’s life can be saved. Otherwise, if the patient loses their life due to stinginess, it is indeed the fault of the patient’s lack of wisdom. But if the physician refuses treatment due to this same stinginess, it is also a failure of the physician’s benevolence. Alas, ancient divine physicians retained this mindset, so one can infer the state of contemporary physicians at that time.
Medicinals are all things within Heaven and Earth. In ancient times, Shennong pitied the suffering of the common people and investigated the subtleties of natural principles; his intention could be described as Ren (benevolence). Therefore, although there are many drugs in the Bencao Materia Medica, their flavors do not exceed five: namely, Sweet (Gan), Pungent (Xin), Salty (Xian), Bitter (Ku), and Sour (Suan). Their properties do not exceed six: namely, Warm, Cool, Tonifying, Draining, Ascending, and Descending. Furthermore, Sweet, Pungent, Warm, Tonifying, and Ascending belong to Yang; Bitter, Salty, Cool, Draining, and Descending belong to Yin. Acrid and leaching flavors belong to Yang; Sour is Yang in nature but Yin in flavor. Thus, drugs may be purely Yang, purely Yin, Yang within Yin, or Yin within Yang. Some utilize only their Qi (energy/vapor), while others utilize only their Flavor. Generally, strong flavors must have tonifying effects, while heavy aromas must have descending effects. Light flavors drain, and light properties ascend. Ascending drugs treat diseases located above or on the exterior; descending drugs treat diseases located below or in the interior. All cooling drugs treat Blood Heat; all warming drugs treat Qi Stagnation and Qi Deficiency. Moistening agents nourish Dryness; astringents secure against collapse. Sweet is the origin of all tonics; Bitter is the root of all draining agents. Pungent and aromatic substances belong to ascending and dispersing categories; Sour and salty substances belong to tonifying and descending categories. What is called "tonification" has specific targets for each property and flavor; what is called "draining" also has specific targets. However, tonification contains draining, and draining contains tonification. For example, Sour enters the Liver, generates fluids to control Dryness; extreme Bitter enters the Heart, nourishes Yin to descend Fire; Pungent warms the Lung to dispel Cold; Salty firms the Kidney to resist Heat. To eliminate pathogens, the key is to restore Zheng Qi (Upright Qi). Draining Yang can tonify Yin; draining Yin can tonify Yang. Descending facilitates natural ascending; ascending facilitates natural descending. Since diseases often occur in combination, therapeutic methods must be combined accordingly. Thus, formulas are classified as Odd (Qi) or Even (Ou), and drugs are categorized into Jun (Monarch), Chen (Minister), etc. Formulas made into San (Powders) aim to disperse; those made into Ding (Tablets/Pills) aim to suppress. Decoctions (Tang) aim to sweep away, utilizing the undulating nature of Qi and Flavor to reach everywhere. Pills (Wan) aim to act slowly, allowing the Qi and Flavor to penetrate deeply over time. Decoctions can be used raw or cooked; raw is suitable for draining, cooked for tonifying. Pills vary in size; small pills are suitable for diseases above, taken after meals. Alternatively, powders are taken lightly, or pills are held in the mouth to dissolve slowly. Large pills are suitable for diseases below, taken before meals. After taking them, food may be used to press down the medicinal force, or decoctions are taken in one dose. Tonics are swallowed in the morning before speaking; disease-curing medicines are taken just before sleep when undressing. For Qi Stagnation, the妙 (wonderful) method is chewing and swallowing; for Warm diseases, the efficacy of pills and powders is beneficial. Whenever Gancao (Licorice Root) is used, it is to resolve the toxicity of other drugs, taking advantage of its Sweet flavor to harmonize the Spleen. When Shengjiang (Fresh Ginger) is administered, it is to promote the power of other drugs, taking advantage of its Pungent flavor to open the Stomach. Therefore, treating disease focuses on the Spleen and Stomach to enable the strength to attack the pathogen. Using Jiu (Alcohol/Wine) aims to direct the action upward; using Yan (Salt) aims to direct the action downward. Wax-coated pills contain toxicity; wax-wrapped herbs store their Qi. Water-hulled pills seek rapid dissolution for clearing and promoting urination; honey-pilled ones seek slow movement for moistening. New materials accelerate efficacy; aged materials reduce toxicity. Drugs for regulating the Spleen and Stomach should use grains for pills; agents for harmonizing Qi and Blood benefit from vinegar and wine. Stir-frying moderates properties; soaking resolves toxicity. Soaking nourishes Yin; refining assists Yang. However, processing may have excess or deficiency defects, and contraindications involve mutual incompatibility, aversion, or hostility. Some treatments are justified by principle, others by intent. There are also techniques of non-medication, derived from clever ingenuity, such as acupuncture, moxibustion/fumigation, hot compresses, washing, and soaking—these are drugs for treating external diseases caused by the Six Excesses (Liu Yin). Others rely on the complexities of human affairs, subtle manipulations that move the senses and shift the patient’s mindset. Dispersing stagnation, consolidating dispersion, resting the fatigued, activating the sedentary—these are drugs for treating internal diseases caused by the Seven Emotions (Qi Qing). Therefore, Daoyin (guiding and pulling exercises), regulating diet and daily routine, maintaining a central and upright mind, free from deceit and worry—these are the drugs of self-cultivation. Thus, "drug" does not merely refer to herbal or mineral substances; everything appropriate in human affairs can serve as a drug.