学问之道,必由浅入深,从未有浅近不知而专求怪僻者。况医法一误,必至伤生害命,尤不可不慎也!
夫所谓浅近者,如伤风则防风、荆芥,感寒则苏叶、葱头,咳嗽则苏子、杏仁,伤食则山楂、神曲,伤暑
则香薷、广藿,疟疾则柴胡汤加减,痢疾则黄芩汤加减,妇人则四物汤加减,小儿则异功散加减。此皆历
圣相传之定法,千古不能易也。至于危险疑难之症,则非此等药所能愈,必博考群方,深明经络,实指此
病何名,古人以何方主治而随症加减。今则以古圣之法为卑鄙不足道,又不能指出病名,惟以阳虚、阴虚、
肝气、肾弱等套语概之,专用温补,以致外邪入里。驯至不救;间有稍驯谨之人,起病时仍用切近
之药一二剂,未即有效,即转而改为温补。不思病之中人,愈必有渐,不可因无速效而即换方也。况所服
之方,或未尽善,不思即于前方损益万妥,而遽求变法,又不肯先用轻淡之剂探测病情,专取性雄力浓
之品,大反前辙,必至害不旋踵。总由胸无定见之故。当思人之有病,不外风、寒、暑、湿、燥、火为
外因,喜、怒、忧、思、悲、惊、恐为内因,此十三因,试问何因是当补者?!
大凡人非老死即病死,其无病而虚死者,千不得一,况病去则虚者亦生,病留则实者亦死。若果元气欲
脱,虽浸其身于参、附之中,亦何所用?乃谬举《内经》曰∶“邪之所凑,其气必虚。”气虚固当补矣,所凑
之邪不当去耶?盖邪气补住则永不复出,重则即死,轻则迁延变病;
或有幸而愈者,乃病轻而元气渐复,非药之功也。
余少时见问疾者,闻医家已用补药则相庆病者已愈,今则病势方张,正群然议进参、附、熟地,岂不
可骇!其始也,医者先以虚脱吓人,而后以补药媚人。浙江则六味、八味汤加人参、麦冬等药;江南则理中
汤加附、桂、熟地、鹿茸、脐带等药。于是人人习闻,以为我等不怕病死,只怕虚死。所以补药而死,
犹恨补之不早、补之不重,并自恨服人参无力,以致不救。医者虚脱之言,真有先见之明,毫无疑悔。若
服他药而死,则亲戚朋友,群诟病家之重财不重命,死者亦目不能瞑。医者之罪,竟不胜诛矣!所以病患
向医者述病,必自谓极虚,而傍人代为述病,亦共指为极虚,惟恐医者稍用攻削之剂,以致不起,或有稍
识病之医,即欲对症拟方,迫于此等危言,亦战战兢兢,择至补之药,以顺其意,既可取
容,更可免谤,势使然也。此风之起,不过三十余年,今则更甚,不知何时而可挽回也?!
学问的道理,必须从浅显处入手深入,从来没有不了解浅近知识却专门追求怪异偏僻之法的。况且医学一旦误治,必然导致伤害生命,尤其不可不谨慎啊!
所谓浅近的知识,比如伤风用防风、荆芥,受寒用苏叶、葱头,咳嗽用苏子、杏仁,饮食积滞用山楂、神曲,中暑用香薷、广藿香,疟疾用柴胡汤加减,痢疾用黄芩汤加减,妇科病用四物汤加减,儿科病用异功散加减。这些都是历代圣贤相传的固定法则,千古不能改变。至于危险疑难的病证,就不是这些普通药物所能治愈的,必须广泛考证各方剂,深刻明了经络理论,确切指出此病叫什么名字,古人用什么方剂主治而随症状加减。现在的人却认为古圣人的法则是卑鄙不足道的,又不能指出具体病名,只用阳虚、阴虚、肝气、肾弱等套话概括,专门使用温补疗法,以致外邪侵入体内。逐渐发展到无法救治;偶尔有稍微谨慎的人,在发病初期仍用切近病情的药物一二剂,如果没有立即见效,就转而改为温补。不考虑疾病侵入人体,痊愈必定有一个渐进过程,不能因为没有速效就立即更换方剂。何况所服的方剂,或许并不完美,不想着就在前方基础上增减完善,却急于求变,又不肯先用轻清淡薄的药剂探测病情,专门选取药性猛烈、力量浓厚的药材,完全违背了之前的治疗原则,必然导致危害接踵而至。总归是由于心中没有定见的缘故。应当想到人患病,不外乎风、寒、暑、湿、燥、火为外因,喜、怒、忧、思、悲、惊、恐为内因,这十三种病因,试问哪一种是需要补益的?!
大凡人不是老死就是病死,没有生病而因虚脱死亡的,千中不得其一,况且病去除了,虚弱的人也能恢复生机,病邪留存,即使体质强壮的人也会死亡。如果真的是元气即将脱失,虽然让人浸泡在人参、附子的药液中,又有什么用处呢?竟然荒谬地引用《黄帝内经》说:“邪气聚集的地方,正气必然虚弱。”气虚固然应当补益,但聚集的邪气难道不应该去除吗?大概邪气被补住后就永远不再复出,重的则立即死亡,轻的则拖延演变出其他病症;或者有幸痊愈的,那是病轻而元气逐渐恢复,并非药物的功效。
我年轻时见到探视病人的人,听说医生已经用了补药就互相庆贺病人已经痊愈,现在却是病势正盛,众人却一起议论进用人参、附子、熟地黄,这难道不令人惊骇吗!起初,医生先用虚脱的症状吓唬人,然后用补药来讨好病人。浙江地区则用六味地黄丸、八味地黄丸加人参、麦冬等药;江南地区则用理中汤加附子、肉桂、熟地黄、鹿茸、脐带等药。于是人人习以为常,认为我们不怕病死,只怕虚死。所以因为服补药而死的人,还怨恨补得不够早、补得不够重,甚至自己恨服用的人参力度不够,以致无法救治。医生关于虚脱的说法,真有先见之明,毫无疑悔。如果服其他药而死,那么亲戚朋友,都会指责病人家属重视钱财不重视生命,死者也闭不上眼睛。医生的罪过,简直不可胜诛!所以病患向医生叙述病情,一定自称极度虚弱,而旁人代为叙述病情,也共同指为极度虚弱,惟恐医生稍用攻伐消削的药剂,以致病情恶化不起。或者有稍微懂病的医生,本想对症开方,迫于这种危言耸听的压力,也战战兢兢,选择最补益的药物,以顺从病人的心意,既可以取悦于人,又可以避免诽谤,这是形势使然啊。这种风气兴起,不过三十多年,现在更加严重,不知道什么时候可以挽回呢?!
The path of learning must proceed from the shallow to the deep; there has never been one who does not understand the basic and proximate knowledge yet specifically seeks strange and eccentric methods. Moreover, if medical treatment is erroneous, it inevitably leads to injury and loss of life, which demands utmost caution!
What is meant by "basic and proximate" knowledge is as follows: for Wind-Cold (Wind Strike), use Fangfeng (Saposhnikovia Root) and Jingjie (Schizonepeta Spike); for Cold invasion, use Ziyeh (Perilla Leaf) and Congtou (Scallion White); for Cough, use Suzi (Perilla Seed) and Xingren (Apricot Kernel); for Food Stagnation, use Shanzha (Hawthorn Fruit) and Shenqu (Medicated Leaven); for Summerheat, use Xiangru (Elsholtzia Herb) and Guanghuoxiang (Patchouli Herb); for Malaria, modify Chaihu Tang (Bupleurum Decoction); for Dysentery, modify Huangqin Tang (Scutellaria Decoction); for Gynecological disorders, modify Siwu Tang (Four Substances Decoction); for Pediatric disorders, modify Yigong San (Yi Gong Powder). These are all fixed laws passed down through sages of past ages, unchangeable for millennia. As for dangerous and difficult cases, these ordinary herbs cannot cure them; one must extensively examine various prescriptions, deeply understand the Meridians, accurately identify the name of the disease, determine which ancient prescription was primarily used for it, and then modify it according to symptoms. Nowadays, people consider the methods of ancient sages to be base and unworthy of mention, fail to point out specific disease names, and instead use clichés such as Yang Deficiency, Yin Deficiency, Liver Qi Stagnation, or Kidney Weakness to generalize, exclusively employing Warm Tonification therapies. This causes external pathogens to penetrate inward, gradually leading to incurable conditions. Occasionally, some slightly cautious individuals use appropriate herbs for one or two doses at the onset of illness; when no immediate effect is seen, they switch to warm tonification. They fail to realize that recovery from an invading pathogen is necessarily gradual, and one should not change prescriptions merely due to the lack of rapid efficacy. Furthermore, the prescribed formulas may not be perfect; instead of refining the current formula by adding or subtracting ingredients, they hastily seek new methods, refusing to first use light and bland agents to probe the condition. Instead, they exclusively select potent and strong substances, completely reversing previous strategies, inevitably leading to imminent harm. This stems entirely from a lack of firm principles in their minds. One should consider that human diseases arise from External Causes: Wind, Cold, Summerheat, Dampness, Dryness, and Fire; and Internal Causes: Joy, Anger, Worry, Thought, Sorrow, Fright, and Fear. Of these thirteen causes, ask yourself: which one requires tonification?!
Generally, people either die of old age or disease. Those who die of deficiency without having been ill account for less than one in a thousand. Moreover, once the pathogen is eliminated, even a deficient person can recover; if the pathogen remains, even a robust person will perish. If Yuan Qi (Original Qi) is truly about to collapse, even immersing oneself in Ren Shen (Ginseng Root) and Fu Zi (Aconite Lateral Root) would be useless. Yet, absurdly citing the *Neijing* (Inner Canon of the Yellow Emperor): "Where evil gathers, Qi must be deficient," they argue that since Qi is deficient, it must be tonified, ignoring whether the gathered evil should be expelled. If evil is retained by tonification, it will never leave; severe cases result in immediate death, while mild cases lead to prolonged complications. Or, if recovery occurs by chance, it is because the illness was mild and Yuan Qi gradually recovered, not due to the efficacy of the medicine.
In my youth, I saw visitors to sickbeds rejoicing upon hearing that doctors had administered tonics, believing the patient was cured. Now, however, when the disease trend is surging, people collectively discuss administering Ren Shen (Ginseng Root), Fu Zi (Aconite Lateral Root), and Shudi (Prepared Rehmannia Root). Is this not shocking? Initially, doctors frighten patients with talk of collapse, then flatter them with tonics. In Zhejiang, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) and Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill) are modified with Ren Shen (Ginseng Root) and Maidong (Ophiopogon Tuber); in Jiangnan, Lizhong Tang (Regulate the Middle Decoction) is modified with Fu Zi (Aconite Lateral Root), Rougui (Cinnamon Bark), Shudi (Prepared Rehmannia Root), Lurong (Deer Antler Velvet), and Qidai (Umbilical Cord). Thus, everyone becomes accustomed to the belief that we fear deficiency death more than disease death. Consequently, those who die from taking tonics regret only that tonification was not started early enough or was not heavy enough, and even blame themselves for not taking enough Ren Shen (Ginseng Root) to save them. Doctors' warnings of collapse seem prophetic, leaving no room for doubt or regret. If one dies from other medicines, relatives and friends accuse the family of valuing wealth over life, and the deceased cannot rest peacefully. The doctor's sin is unpardonable! Therefore, when patients describe their condition to doctors, they invariably claim extreme deficiency, and bystanders echoing this description also insist on extreme deficiency, fearing that doctors might use attacking or reducing agents, leading to deterioration. Even doctors who somewhat understand the disease, pressured by such alarmist rhetoric, act cautiously, choosing the most tonifying herbs to please the patient, thereby gaining favor and avoiding criticism. This is forced by circumstances. This trend arose only thirty years ago but has intensified since; I do not know when it can be reversed?!