凡劳心劳力之人,须时时偷闲歇息,以保既耗之元气。盖气根于息,息调则气调,气调则一身之中,无不
流通四达,百脉安和,神情清泰,虽劳不甚苦人矣。调息之法,端默静坐,随境澄心,口目俱闭上,于鼻中徐
呼徐吸,任其自然,勿得作意思维。若着力太重,反使本来不息之真,窒而不利。(此治虚劳之妙法,仿而行
之,无有不验,胜于药饵多矣。)
凡用补药,必先泻邪,邪去则补药得力,譬之涤衣,先除垢腻,而后粉饰可加耳。若专事补,而不知邪气
之当泻,补必为害。(此用药之真诀,凡病皆然,而劳症尤为切要。)
虚劳病未尝非阴血虚也,虽圣人复起,亦未尝不谓阴血虚也,是则生熟地黄、当归、知母、元参、天冬、
麦冬诸药,岂曰无功。举世遵而行之,岂曰不可。但此等之药,既寒凉,又濡润,在脾胃既衰,水谷未减之时,
用此治标则可。若多服久服,未有不使脾胃生化之源,而为却谷减餐者矣。经曰∶血乃水谷之精,生化于脾。
又曰∶脾为至阴。人之阴虚,乃脾虚也。脾土一虚,则生化之源竭,何能营运水谷,而成阴血乎?故进滋补之
药者,当时时以饮食进退为消息,但见饮食减少,咳嗽炽盛,急思调和脾胃,兼行气清金等药。有司命之责者,
岂可专执,而不知变通哉!
有客过而问余曰∶一大病久虚人,容颜黄瘁,饮食减少,两足浮肿,已经年岁,气血下陷无疑矣,速
进补中益气汤,反肋满胸膨,呕秽不能食则奈何?余曰∶据子所言,是诚气虚下陷之病,然古人立教,言有尽
而意无穷,虽不足者补之,而不足之中,未始不兼有余之病,于此而漫补焉,则不足者未补,而有余者必炽矣。
虽然,下陷者清升,而清气下陷者,未必绝无浊气之在上,于此而漫升焉,则清气未升,而浊气已先横矣。子
之所以用升补而反剧者,大率近是。客曰∶何以知其不足中之有余,清气上之浊气乎?曰∶以证知之。夫证之
见于外者,如恶膨满,痰嗽喉痛,腹痛作泻,与饮食有妨之类是也。此即所谓有余之病,兼在上之浊气也,升
补之法,便须酌量而施之。然此乃见症之显者,更有症虽见而实隐,尤为难察。如本不恶心,而胸中则时懊 ;
本不膨胀,而肋间隐刺痛;本不痰嗽喉痛,而偶然似哽似噎;本不作痛作泻,而大便不时至,欲解不解;本不
妨饮食,而亦时有厌饫而难安。如此等症,亦即有余之病,兼在上之浊气也,升补之药,便须酌量而后施。非
用心精,而晰理密者不能也。故用补中益气汤,必审之当,而察之详,始用之无弊矣。
此段审症,最为精细,凡脾胃之症,如此推求,非专为补中益气汤言也。
凡是用心用力的劳心劳力之人,必须时常抽空休息,以保养已经耗损的元气。因为气根源于呼吸,呼吸调顺则气机调顺,气机调顺则全身上下无处不流通通达,百脉安宁调和,精神神情清静安泰,即使劳作也不至于太痛苦了。调息的方法,在于端身正坐、保持沉默、静心打坐,随着环境澄澈心境,口和眼睛都闭上,在鼻中缓慢地呼气、缓慢地吸气,任凭其自然,不要刻意去思维造作。如果用力过重,反而会使本来自然不息的真气,因阻滞而不能通畅。(这是治疗虚劳病的妙法,模仿并实行它,没有不灵验的,比药物疗效好得多。)
凡是使用补药,必须先祛除邪气,邪气去除后补药才能发挥作用,就像洗涤衣服,先除去污垢油腻,然后才能施加粉饰。如果专门从事滋补,而不知道邪气应当祛除,那么滋补必然成为危害。(这是用药的真谛,所有疾病都是如此,而对于虚劳病症尤其关键。)
虚劳病未尝不是因为阴血亏虚,即使是圣人复活,也未曾不认为这是阴血亏虚,那么生地黄、熟地黄、当归、知母、玄参、天冬、麦冬这些药物,难道说没有功效吗?全世界遵循并施行它们,难道说不可以吗?但是这类药物,既寒凉又滋润,在脾胃功能已经衰弱,饮食水谷摄入并未减少的时候,用它们来治标是可以的。如果多服久服,没有不使脾胃生化之源枯竭,从而导致厌食减餐的了。医经说:血是水谷的精微,由脾生化。又说:脾为至阴。人的阴虚,其实是脾虚。脾土一旦虚弱,那么生化之源就枯竭了,怎么能营运水谷,从而生成阴血呢?所以进用滋补药物的人,应当时时根据饮食的增减来斟酌调整,只要见到饮食减少,咳嗽剧烈加重,就要急着调和脾胃,兼用行气、清肺等药物。有治病救人责任的人,怎么可以固执己见,而不知道变通呢!
有位客人来访问我:一个大病之后长期虚弱的人,容颜黄瘦憔悴,饮食减少,两脚浮肿,已经一年多了,气血下陷是毫无疑问的,快速进服补中益气汤,反而出现胁肋胀满、胸部膨隆、呕吐秽物不能进食的情况,该怎么办?我说:根据你的描述,这确实是气虚下陷的病证,然而古人设立教法,言语有尽而意蕴无穷,虽然不足的要补益,但在不足之中,未尝不兼夹有余(实邪)的病证,在这里盲目进补,那么不足的地方没补上,而有余的实邪必定炽盛。虽然如此,下陷的清阳之气需要升提,但清气下陷的人,未必完全没有浊气在上焦,在这里盲目升提,那么清气还没升上来,浊气就已经横逆于上了。你之所以使用升提补益的药物反而病情加重,大体上接近这个原因。客人问:怎么知道是不足之中的有余,以及清气之上的浊气呢?我说:通过症状来判断。那些表现于外的症状,比如厌恶胀满、痰嗽喉痛、腹痛腹泻,以及妨碍饮食之类的,这就是所谓的有余之病,兼夹在上焦的浊气,升补的方法,就必须斟酌衡量后施用。然而这只是明显的症状,更有症状虽然存在但实际上隐蔽的,尤为难以察觉。比如本来不恶心,但胸中时常烦闷懊恼;本来不腹胀,但肋间隐隐刺痛;本来不痰嗽喉痛,但偶尔感觉像哽住像噎住;本来不疼痛腹泻,但大便不时到来,想解却解不出;本来不妨碍饮食,但也时常感到饱腻而难以安适。像这样的症状,也是有余之病,兼夹在上焦的浊气,升补的药物,就必须斟酌衡量后才施用。不是用心精细、辨析道理严密的人是不能做到的。所以使用补中益气汤,必须审察得当,观察详细,才开始使用而没有弊端。
For those who engage in mental or physical labor, it is essential to take frequent breaks and rest to preserve the already depleted Yuan Qi (Original Qi). This is because Qi is rooted in respiration; when respiration is regulated, Qi becomes harmonious. When Qi is harmonious, it flows freely throughout the body, ensuring the peace and harmony of all meridians, resulting in a clear and tranquil spirit and mind. Even under labor, one will not suffer excessively. The method for regulating respiration involves sitting upright in silence and stillness, clearing the mind according to the environment, keeping both mouth and eyes closed, and breathing slowly in and out through the nose, allowing nature to take its course without deliberate cognitive effort. If excessive force is applied, it may instead obstruct the natural, unceasing True Qi, causing stagnation and blockage. (This is a subtle method for treating Consumption Disease [Xu Lao]; imitating and practicing it yields reliable results, surpassing the efficacy of herbal medicines.)
When using tonifying herbs, one must first eliminate pathogenic factors. Only after the pathogens are removed can the tonics take effect. This is akin to washing clothes: one must first remove dirt and grease before applying any polish. If one focuses solely on tonification without recognizing the need to purge pathogens, tonification will inevitably cause harm. (This is the true principle of medication application, applicable to all diseases, but particularly critical for Consumption Disease.)
Consumption Disease [Xu Lao] is indeed often due to Yin Blood deficiency. Even if the sages were to rise again, they would acknowledge this as Yin Blood deficiency. Therefore, do herbs such as Sheng Di Huang (Raw Rehmannia Root), Shu Di Huang (Prepared Rehmannia Root), Dang Gui (Angelica Sinensis), Zhi Mu (Anemarrhena Rhizome), Xuan Shen (Scrophularia Root), Tian Dong (Asparagus Tuber), and Mai Dong (Ophiopogon Tuber) lack efficacy? Is it wrong for the world to follow and practice them? However, these herbs are both cold-cooling and moistening. When the Spleen and Stomach function is already weakened and food intake has not decreased, using them to treat superficial symptoms is acceptable. But if taken in large amounts or over a long period, they will inevitably deplete the source of transformation and production in the Spleen and Stomach, leading to anorexia and reduced food intake. The Classics state: "Blood is the essence of water and grain, transformed by the Spleen." It also states: "The Spleen is the Ultimate Yin." Human Yin deficiency is essentially Spleen deficiency. Once the Earth element of the Spleen is deficient, the source of transformation and production is exhausted; how can it transport and transform water and grain to generate Yin Blood? Therefore, those administering tonic medicines must constantly adjust based on changes in diet. Whenever dietary intake decreases and coughing intensifies, one should urgently harmonize the Spleen and Stomach and use herbs that promote Qi circulation and clear the Lungs. Physicians with the responsibility of saving lives cannot be rigid and fail to adapt!
A guest visited me and asked: "A patient suffering from a severe illness and long-term deficiency presents with a sallow and emaciated complexion, reduced appetite, and edema in both feet, persisting for over a year. There is no doubt that Qi and Blood have sunk. Should we quickly administer Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)? Instead, the patient developed hypochondriac fullness, abdominal distension, vomiting of foul matter, and inability to eat. What should be done?" I replied: "Based on your description, this is indeed a case of Qi deficiency with sinking. However, the teachings of the ancients imply more than their words suggest. While deficiency requires tonification, within deficiency there is often co-existing excess (pathogenic retention). Blindly tonifying here means the deficiency remains unaddressed while the excess becomes rampant. Furthermore, although sinking Clear Qi needs to be raised, a patient with sinking Clear Qi likely also has Turbid Qi stagnant in the upper jiao. Blindly raising Qi here means the Clear Qi fails to ascend while the Turbid Qi becomes entrenched. Your worsening condition after using ascending and tonifying methods is largely due to this reason." The guest asked: "How do you know there is excess within the deficiency and Turbid Qi above?" I said: "By observing the symptoms. External manifestations such as aversion to distension, phlegm-cough, sore throat, abdominal pain with diarrhea, and interference with eating are what we call 'excess' conditions combined with Turbid Qi in the upper jiao. In such cases, ascending and tonifying methods must be carefully weighed. However, these are obvious symptoms. More difficult to detect are symptoms that appear present but are actually hidden. For example, no nausea but occasional chest oppression and restlessness; no abdominal distension but dull stabbing pain in the intercostal region; no phlegm-cough or sore throat but occasional sensations of globus hystericus or choking; no pain or diarrhea but irregular bowel movements with incomplete evacuation; no dietary intolerance but occasional satiety and discomfort. These symptoms also indicate excess conditions combined with Turbid Qi in the upper jiao. Ascending and tonifying drugs must be used only after careful consideration. This requires meticulous attention and precise reasoning. Therefore, when using Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), one must examine appropriately and observe in detail to avoid adverse effects."
This segment of symptom examination is extremely refined. Such analysis applies to all Spleen and Stomach disorders, not just those treated with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction).