愚阅张子和书,惟务攻击。其意以为正气不能自病,因为邪所客,所以为病也,邪去正气自安。因病有在上、在中、
在下、深浅之不同,立为汗、吐、下三法以攻之。初看其书,将谓医之法尽于是矣。后因思《内经》有谓之虚者,精气
虚也;谓之实者,邪气实也。夫邪所客,必因正气之虚,然后邪得而客之。苟正气实,邪无自入之理。由是于子和之法,
不能不致疑于其间。又思《内经》有言∶阴平阳秘,精神乃治;阴阳离决,精气乃绝。又思仲景有言∶病当汗解,诊其
尺脉涩,当与黄 建中汤补之,然后汗之。于是以子和之书,非子和之笔也。驰名中土,其法必有过于朋辈者,何其书
之所言,与《内经》、仲景之意,若是之不同也?于是决意于得名师以为之根据归,发其茅塞。遂游江湖,但闻某处有某治
医,便往拜而问之。连经数郡,无一人焉。后到定城,始得《原病式》,东垣方稿,乃大悟子和之孟浪,然终未得的然之
议论,将谓江浙间无可为师者。泰定乙丑夏,始得闻罗太无并陈芝岩之言,遂往拜之。蒙叱骂者五七次,趑趄三阅月,
始得降接。因观罗先生治一病僧,黄瘦倦怠,罗公诊其病,因乃蜀人,出家时其母在堂,及游浙右经七年。忽一日,念
母之心不可遏,欲归无腰缠,徒而朝夕西望而泣,以是得病。时僧二十五岁,罗令其隔壁泊宿,每日以牛肉、猪肚、甘
肥等,煮糜烂与之。凡经半月余,且时以慰谕之言劳之。又曰∶我与钞十锭作路费,我不望报,但欲救汝之死命尔!察
其形稍苏,与桃仁承气,一日三帖下之,皆是血块痰积方止。次日只与熟菜、稀粥,将息又半月,其人遂如故。又半月
余,与钞十锭遂行。因大悟攻击之法,必其人充实,禀质本壮,乃可行也。否则邪去而正气伤,小病必重,重病必死。
罗每日有求医者来,必令其诊视脉状回禀。罗但卧听,口授用某药治某病,以某药监其药,以某药为引经。往来一年半,
并无一定之方。至于一方之中,自有攻补兼用者,亦有先攻后补者,有先补后攻者。又大悟古方治今病焉能吻合?随时
取中,其此之谓乎。是时罗又言用古方治今病,正如拆旧屋凑新屋,其材木非一,不再经匠氏之手,其可用乎?由是又
思许学士释微论曰∶予读仲景书,用仲景之法,然未尝守仲景之方。乃为得仲景之心也。遂取东垣方稿,手自抄录。乃
悟治病患,当如汉高祖纵秦暴,周武王纵商之后,自非发财散粟,与三章之法,其受伤之气, 惫之人何由而平复也。
于是定为阴易乏,阳易亢,攻击宜详审,正气须保护,以《局方》为戒哉!
我阅读张子和的著作,发现他一味强调攻邪。他的观点认为,正气本身不会致病,而是因为邪气侵袭人体,所以才生病;只要邪气去除,正气自然安宁。因为疾病有在上、在中、在下以及深浅程度的不同,所以他创立了汗、吐、下三种方法来攻逐病邪。初看他的书时,我曾以为医学的方法都包含在这其中了。后来思考《内经》中提到:所谓“虚”,是指精气虚弱;所谓“实”,是指邪气盛实。邪气之所以能侵袭人体,必定是因为正气先有虚弱,然后邪气才得以客居体内。如果正气充实,邪气就没有进入的道理。因此,我对张子和的方法不能不产生怀疑。
我又想到《内经》中说:“阴平阳秘,精神乃治;阴阳离决,精气乃绝。”我还想到张仲景曾说:“病应当通过发汗来解除,但如果诊察到尺脉涩滞,应当给予黄耆建中汤进行补益,然后再发汗。”由此看来,张子和的书并非出自张子和之手(意指其思想与经典不符)。他在中原地区享有盛名,其方法必然超过同辈,为什么他的书中言论与《内经》及张仲景的本意如此不同呢?于是我决心寻找名师作为依靠,以开启我的蒙昧。于是游历江湖,只听说某处有擅长治疗的医生,便前往拜见请教。接连经过几个郡县,却没有找到一个人。后来到了定城,才得到《原病式》和东垣的方稿,这才大悟张子和的轻率鲁莽,但最终仍未得到确切的议论,曾以为江浙一带没有可以拜师的人了。
泰定乙丑年夏天,我才听到罗太无和陈芝岩的名字,于是前往拜见。我被他们斥责辱骂了五六次,犹豫徘徊了三个月,才得到他们的接见。我观察罗先生治疗一位患病僧人,该僧面色萎黄消瘦,疲倦无力。罗公诊断后得知,他是蜀地人,出家时母亲尚在堂上,后来游历浙右已七年。忽然有一天,思念母亲的心情无法抑制,想回家却没有路费,只能徒步早晚向西眺望哭泣,因此得了病。当时僧人二十五岁,罗先生让他住在隔壁房间,每天用牛肉、猪肚、甘甜肥腻的食物,煮得烂熟给他吃。总共经过半个多月,并且时常以安慰劝导的话语慰劳他。罗先生又说:“我给你十锭钱作为路费,我不求回报,只想救你的性命罢了!”观察到他的形体稍微恢复生机后,给予桃仁承气汤,一天服用三帖,直到排出血块和痰积为止。第二天只给熟菜和稀粥,调养又过了半个月,那人便恢复了正常。又过了半个多月,罗先生又给他十锭钱,他便上路了。
由此我大悟:攻击疗法,必须患者体质充实,禀赋原本强壮,才可以施行。否则,邪气虽去而正气受伤,小病必加重,重病必致死。罗先生每天有求医者上门,必定让他们诊视脉象回来禀报。罗先生只是躺着听,口头指示用某种药治疗某种病,用某种药监制其他药物,用某种药作为引经药。往来一年半,并没有固定的方剂。至于在一个方剂之中,自有攻补兼用的,也有先攻后补的,有先补后攻的。我又大悟:古方的治疗方法怎么能完全契合今人的病情呢?随时取其中道,说的就是这个道理吧。这时罗先生又说,用古方治疗今病,就像拆旧屋搭建新屋,木材来源不一,如果不经过工匠之手重新加工,能用吗?由此我又想起许学士在《释微论》中说:“我读张仲景的书,使用张仲景的方法,但从未拘守张仲景的方剂。这才是真正领悟了张仲景的心意。”于是我便取来东垣的方稿,亲手抄录。
我领悟到治疗病患,应当像汉高祖废除秦朝暴政、周武王放纵商朝遗民一样,如果不是发放财物粮食,实行宽简的法度,那些受损的气机和疲惫的人身体如何能平复呢?于是确定原则为:阴易匮乏,阳易亢盛,攻邪之法宜详细审慎,正气必须加以保护,以《局方》为戒!
I read Zhang Zihe's books and found that he was solely concerned with attacking pathogens. His view was that healthy Qi (Vital Energy) cannot cause disease on its own; rather, disease occurs because pathogenic factors invade the body. Once the pathogens are eliminated, the healthy Qi naturally becomes tranquil. Because diseases vary in location—upper, middle, or lower—and in depth, he established three methods: sweating (Diaphoresis), vomiting (Emesis), and purging (Purgation)—to attack them. At first glance, I thought all medical methods were contained within his work. Later, reflecting on the *Neijing* (Classic of Internal Medicine), which states that "deficiency" refers to the deficiency of essence and Qi, while "excess" refers to the excess of pathogenic factors, I realized that pathogens can only invade when healthy Qi is deficient. If healthy Qi were robust, there would be no way for pathogens to enter. Thus, I could not help but doubt Zhang Zihe's methods.
Furthermore, recalling the *Neijing*: "When Yin is balanced and Yang is secure, spirit and vitality are regulated; when Yin and Yang separate, essence and vital energy perish." I also recalled Zhang Zhongjing's statement: "When a disease should be resolved through sweating, if the Chi pulse at the wrist is choppy, one should administer Huangqi Jianzhong Tang (Astragalus Decoction to Build the Middle) to tonify before inducing sweating." Consequently, I concluded that Zhang Zihe's book did not truly reflect his own笔 (writing/thoughts) in alignment with classics. Although he was famous in China and his methods surpassed his peers, why did his teachings differ so greatly from the intentions of the *Neijing* and Zhang Zhongjing? Therefore, I resolved to find a master teacher as my guide to clear my confusion. I traveled through rivers and lakes, seeking out renowned physicians wherever I heard of them. After passing through several commanderies, I found no one suitable. Finally, arriving in Dingcheng, I obtained the *Yuanbing Shi* (Original Treatise on Disease Causes) and Dongyuan's manuscript drafts. Only then did I realize the rashness of Zhang Zihe's approach, yet I still lacked definitive theoretical understanding, believing there were no masters worth following in the Jiangzhe region.
In the summer of Yichou year of the Taiding era, I finally heard of Luo Taiwu and Chen Zhiyan, so I went to pay them respects. I was scolded and rebuked five or six times and hesitated for three months before being received. I observed Master Luo treating a sick monk who was sallow, emaciated, and fatigued. Upon diagnosis, Master Luo learned the monk was from Shu. When he became a monk, his mother was still alive, but after traveling in western Zhejiang for seven years, he suddenly felt an overwhelming urge to return home. Lacking funds for travel, he walked daily, facing west and weeping, which caused his illness. The monk was twenty-five years old. Master Luo had him stay in the adjacent room and provided him with beef, pork stomach, and other rich, fatty foods, cooked until very soft. This continued for over half a month, accompanied by comforting words. Master Luo added, "I will give you ten ingots of silver for your travel expenses. I ask for nothing in return; I simply wish to save your life!" Once the monk's condition showed slight improvement, Master Luo administered Tao Ren Chengqi Tang (Peach Kernel Decoction to Direct the Qi downward). He took three doses daily until blood clots and phlegm accumulations were expelled. The next day, he was given only cooked vegetables and thin porridge, resting for another half month until he fully recovered. Over half a month later, Master Luo gave him another ten ingots, and he departed.
From this, I greatly realized that attacking methods must only be used on patients who are physically robust and have strong constitutions. Otherwise, eliminating pathogens damages healthy Qi; minor illnesses become severe, and severe illnesses become fatal. Every day, patients came to Master Luo. He would have them examine their pulses and report back. Master Luo would lie down and listen, orally prescribing specific herbs for specific conditions, using certain herbs to moderate others, and using specific herbs as guiding agents. Over a year and a half, there was never a fixed formula. Within a single formula, there were combinations of attacking and tonifying, sequences of attacking then tonifying, or tonifying then attacking. I further realized that ancient formulas cannot perfectly match modern diseases. One must adapt to the situation to find the mean, which is what this implies. Master Luo also said that using ancient formulas for modern diseases is like dismantling an old house to build a new one; the materials are not uniform, and without the craftsman's hand to rework them, they cannot be used.
Reflecting again on Scholar Xu's *Shiwei Lun*: "I read Zhang Zhongjing's books and use his methods, but I never rigidly adhere to his formulas. This is truly grasping Zhang Zhongjing's intent." I thus took Dongyuan's manuscript drafts and copied them by hand. I understood that treating patients is like Emperor Gaozu of Han abolishing Qin tyranny or King Wu of Zhou allowing Shang remnants to live freely. Without distributing wealth and grain, and implementing lenient laws, how could injured Qi and exhausted bodies recover? Thus, I established the principle: Yin tends toward deficiency, Yang tends toward hyperactivity. Attacking methods require careful deliberation, and healthy Qi must be protected. Let the *Jufang* (Formulary of the Imperial Pharmacy) serve as a warning!