医道起于神农之着《本草》,以一药治一病,但一病有数症(统名为病,如疟、痢之类;分名为症,
如疟而呕吐、头疼,痢而寒热、胀痛之类)。后之圣人取药之对症者,合几味而成方,故治病必先有药而
后有方。方成之后,再审其配合之法,与古何方相似,则云以某方加减。并非医者先有一六味、八味、
理中等汤横于胸中,而硬派人服之也。至其辨症用药之法,如有人风、寒、痰、食合而成病,必审其风居
几分?寒居几分?痰、食居几分?而药则随其邪之多寡以为增减,或一方不能兼治,则先治其最急者,所以
无一味虚设之药,无一分不斟酌之分两也。况医之为道,全在自考,如服我之药而病情不减,或反增重,
则必深自痛惩,广求必效之方而后已,则学问自能日进;若不论何病,总以几味温补投之,愈则以为己功,
死则以为病本不治,毫无转计,此则误尽天下而终身不自知也,又其所名陈方者,用柴胡一味即名柴胡
汤,用大黄一味即名承气汤,于古人制方之义全然不知,随其口之所指而已。其医案,则袭几句阴阳虚实、
五行生克笼统套语,以为用温补之地,而文人学士又最易欺,见有阴阳、五行等说,即以为有本之学,深
信不疑。其人亦自诩为得医学之快捷方式,将千古圣人穷思极想,所制对症之方数千首,皆不必问而已称名医
矣!夫医者欲道之行,相习成风,犹无足怪。独是闲居涉猎之人,亦俱蹈袭此等谬说,与医者同声合气,
亲知家有病,即往帮助医者,用危言拿住本家,使之不得不用温补贵重之药,以明关切,因而致死。死则
以为用此等药原未尝云病者服之必效,不过如此门第之家,于理不该服价贱之药耳!若已生疾,又有人亦
以此法毙之,真属可悯!数十年前亦有涉猎医学人,颇能辨别药性,博览经方,今乃相率而入于魔道,其
始起于赵养葵、张景岳辈,全不知古圣制方之义,私心自用,着书成家,彼亦不知流弊至于此极也。我
知天心仁爱,其转移必不久矣。
医学之道起源于神农撰写《本草》,最初是用一种药物治疗一种疾病。但一种疾病往往包含多种症状(统称为“病”,如疟疾、痢疾等;细分称为“症”,例如患疟疾伴有呕吐、头痛,患痢疾伴有寒热、胀痛等情况)。后来的圣人选取针对这些症状的药物,将几味药组合成方剂,所以治病必须先有药物,然后才有方剂。
方剂确立之后,再审视其配伍方法,看它与古代哪个方剂相似,就说是在某个方剂基础上进行加减。这并非医生心中先固定存有六味地黄丸、八味丸、理中汤等现成方子,然后生硬地让人服用。至于辨证用药的方法,比如有人因风、寒、痰、食邪气结合而致病,必须仔细审察:风邪占几分?寒邪占几分?痰和食积各占几分?然后根据邪气的多少来增减药物。如果一方不能兼顾治疗,就先治疗最紧急的症状。因此,没有一味多余的药,也没有一分剂量不是经过斟酌的。
况且医学之道,全在于自我反省。如果服用我的药后病情不减反重,就必须深刻自责,广泛寻求必定有效的方剂,直到找到为止,这样学问自然能日益精进;如果不问是什么病,总是用几味温补药投喂,治好了就认为是自己的功劳,治死了就推说是病根本治不好,毫无反思和改进,这会误导天下人且终身不知悔改。
另外那些所谓的“陈方”(死板的旧方),只用一味柴胡就命名为柴胡汤,只用一味大黄就命名为承气汤,完全不了解古人制定方剂的深意,只是随口所指罢了。他们的医案,则抄袭几句关于阴阳虚实、五行生克的笼统套话,作为使用温补药的借口。文人学士最容易受骗,看到有阴阳、五行等说法,就认为是有根基的学问,深信不疑。这些人也自夸掌握了学医的捷径,把千古圣人穷尽思想所制定的数千首对症方剂都抛在一边不问,就自称名医了!
医生想要医术之道推行,相互习染成风,本来还不算奇怪。唯独那些闲居无事、浅尝辄止的人,也全都沿袭这种谬论,与庸医同声相应。亲戚朋友家中有病人,他们就前去“帮助”医生,用危言耸听的话控制住家属,迫使家属不得不使用昂贵温补的药物,以显示关心,结果导致病人死亡。死后还说,使用这类药原本就没说过吃了必定有效,只不过像这种门第人家,按理说不该服用廉价药物罢了!如果已经生病,又有人也用这种方法害死病人,真是令人怜悯!
几十年前也有涉猎医学的人,颇能辨别药性,博览经典方剂,如今却相继陷入魔道。这起初源于赵养葵、张景岳等人,他们完全不知道古代圣人制定方剂的义理,凭私心自用,著书立说自成一家,他们也不知道流弊会发展到如此极端的地步。我知道上天心存仁爱,局势的转变应该不会太久了。
The Way of Medicine originated with Shennong’s compilation of the *Bencao* (Compendium of Materia Medica), where one drug was used to treat one disease. However, a single disease often presents with multiple symptoms (collectively termed "Bing" [Disease], such as malaria or dysentery; specifically termed "Zheng" [Symptom/Manifestation], such as vomiting and headache accompanying malaria, or chills, fever, distension, and pain accompanying dysentery). Later sages selected drugs that corresponded to these symptoms, combining several herbs into prescriptions. Thus, in treating diseases, one must first have the drugs before forming the prescription.
Once a prescription is established, its method of combination is examined to see which ancient prescription it resembles, leading to statements like "additions and subtractions based on [Specific Prescription]." This does not mean the physician has fixed formulas such as Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), Bawei Wan (Eight-Ingredient Pill), or Lizhong Tang (Regulate the Middle Decoction) rigidly in mind to force upon patients. Regarding the method of syndrome differentiation and medication: if a patient falls ill due to a combination of Wind, Cold, Phlegm, and Food Stagnation, one must carefully assess: what proportion is Wind? What proportion is Cold? What proportions are Phlegm and Food Stagnation? The dosage of herbs is then increased or decreased according to the magnitude of these pathogenic factors. If a single prescription cannot address all aspects, the most urgent condition is treated first. Consequently, there is no superfluous herb, nor any dosage unit that has not been carefully deliberated.
Moreover, the practice of medicine relies entirely on self-reflection. If a patient’s condition fails to improve or worsens after taking my prescription, I must deeply reproach myself, extensively seeking effective prescriptions until success is achieved; through this, medical knowledge naturally advances daily. Conversely, if one ignores the specific disease and indiscriminately administers warming and tonifying herbs, claiming credit for recovery and blaming the incurable nature of the disease for death, without any reflection or adjustment, this misleads the world while the practitioner remains unaware of their error throughout their life.
Furthermore, those who rely on "stale formulas" merely name a prescription "Chaihu Tang (Bupleurum Decoction)" because it contains Chaihu (Bupleuri Radix), or "Chengqi Tang (Order the Qi Decoction)" because it contains Dahuang (Rhei Radix et Rhizoma). They completely ignore the profound meaning behind ancient formula formulation, acting only on casual suggestions. Their medical records plagiarize vague clichés regarding Yin-Yang, Deficiency-Excess, and the generation and restriction cycles of the Five Elements to justify the use of warming and tonifying therapies. Literati and scholars are easily deceived by this; upon seeing references to Yin-Yang and Five Elements, they assume it is a scholarly discipline with deep roots and believe it without doubt. These practitioners boast of having found a shortcut to medicine, disregarding the thousands of symptomatic prescriptions formulated by ancient sages through exhaustive thought, yet still calling themselves famous physicians.
It is not surprising that physicians propagate these practices among themselves, creating a prevailing trend. However, it is disturbing that idle amateurs also follow these fallacies, echoing quacks. When relatives or acquaintances fall ill, these amateurs intervene to "assist" the physician, using alarmist language to coerce families into purchasing expensive warming and tonifying drugs to demonstrate concern, thereby causing death. After death, they rationalize that such drugs were never guaranteed to be effective, arguing simply that families of certain social standing ought not consume cheap medicines. If another person dies from the same illness due to similar methods, it is truly pitiable.
Decades ago, some amateurs could distinguish drug properties and studied classical prescriptions extensively. Now, however, they have collectively fallen into heresy. This began with figures such as Zhao Yangkui and Zhang Jingyue, who ignored the principles of ancient formula formulation, acted on personal bias, wrote books, and established schools of thought, unaware that their errors would lead to such extreme consequences. I believe Heaven’s benevolence will bring about change soon.