医道肇于轩岐,而着书立言以发明之者,莫如张、刘、李、朱为最,以至陶、王、陈、薛,各有阐
述,然亦有不能无弊者。如一言之谬戾,每遗祸于后人,是不得不取而辨论之,以正其失,非敢妄訾乎
前贤也。将以为质疑之一助云尔!
伤寒千态万状,只虚实二字尽之。一实一虚,则邪正相为胜负,正胜则愈,邪胜则死。若正气实者,
即感大邪,其病亦轻;正气虚者,即感微邪,其病亦甚。故凡气实而病者,但去其邪,攻之无难,所可虑
者,惟伤寒挟虚为难耳!最可恨者,有曰“伤寒无补法”,惑乱人心,莫此为甚。独不观仲景立三百九十
七法,脉症之虚寒者一百有余;定一百十三方,用参者三十,用桂、附者五十余。孰谓伤寒无补法耶?矧
今人患挟虚伤寒者,十尝六七,传诵“伤寒无补法”者,十之八九,虚而不补,且复攻之,不可胜纪。故
力辨之,欲以救时弊,非好补也。即如表邪不解,屡散之而汗不出者,中虚无力,阴气不能达也。不知汗
生于阴,补阴最能发汗。又如身热不退,屡清之而热犹炽者,阴不足也。人知惟寒可以去热,不知滋阴
方能降火也。又如正气不足,邪气有余,正不胜邪,病必不解,但实中气,使正气内强,逼邪外出,荣
卫渐平。此不散表而表自解,不攻邪而邪自退。今人不识虚实,见发热胸闷不退,动手便攻,邪气未
去,而正气因攻先败。此皆守“伤寒无补法”一言误之也。
医学之道起源于黄帝与岐伯,而著书立说以阐发其义理的,莫过于张仲景、刘完素、李东垣、朱丹溪最为突出,至于陶华、王履、陈实功、薛己等人,也各有阐述。然而其中也不能没有弊端。例如一句话的错误,往往给后人留下祸患,因此不得不选取这些内容进行辨析讨论,以纠正其中的失误,这并不是敢妄加指责前贤,只是作为提出疑问的辅助罢了!
伤寒病千姿百态,用“虚”和“实”两个字就能概括它。一虚一实,就是邪气与正气相互胜负,正气胜则病愈,邪气胜则死亡。如果正气充实,即使感受了大邪气,病情也会较轻;如果正气虚弱,即使感受了轻微邪气,病情也会很重。所以凡是气实而患病的人,只要去除邪气,攻伐并不困难,所令人担忧的,只有伤寒夹杂虚证难以处理罢了!最令人痛恨的是,有人说“治疗伤寒没有补法”,这种说法迷惑人心,没有比这更严重的了。难道没看到张仲景确立了三百九十七种治法,其中脉象症状属于虚寒的一百多种;制定了第一百一十三首方剂,使用人参的有三十首,使用桂枝、附子的有五十多首。谁说治疗伤寒没有补法呢?况且现在人患有夹杂虚证的伤寒,十人中常有六七人,而传诵“伤寒无补法”的,十人有八九人,对于虚证不采用补法,反而再次攻伐,这种情况多得数不胜数。所以我极力辩驳它,想要挽救当时的弊病,并不是喜好补益。就像表邪不解,多次发散却不出汗的,是因为中气虚弱无力,阴气不能通达。不知道汗液生于阴精,补阴最能发汗。又如身体发热不退,多次清热而热势依然炽盛的,是阴液不足。人们只知道只有寒凉药可以去热,却不知道滋阴才能降火。又如正气不足,邪气有余,正气不能战胜邪气,病必然不能解除,只要充实中气,使正气在内变强,逼迫邪气外出,营卫逐渐平和。这样不散表而表邪自然解除,不攻邪而邪气自然退去。现在的人不认识虚实,见到发热胸闷不退,动手就攻伐,邪气还没去除,而正气因为攻伐先败坏了。这都是坚守“伤寒无补法”这一句话造成的误判啊。
The Way of Medicine originated from Huangdi (Yellow Emperor) and Qibo, and those who wrote books to elucidate it were none other than Zhang Zhongjing, Liu Wansu, Li Dongyuan, and Zhu Danxi, who were the most prominent. Later figures such as Tao Hua, Wang Lv, Chen Shigong, and Xue Ji also provided their own interpretations. However, there are inevitably flaws in these works. For instance, a single erroneous statement can often bring disaster to later generations; therefore, it is necessary to select and debate these points to correct their mistakes. This is not to dare to recklessly criticize former sages, but merely to assist in raising questions!
Shanghan (Cold Damage Disease) presents in thousands of forms, which can be summarized by the two concepts of Xu (Deficiency) and Shi (Excess). The interplay between pathogenic factors (Xieqi) and healthy Qi (Zhengqi) determines the outcome: if Zhengqi prevails, recovery occurs; if Xieqi prevails, death ensues. If Zhengqi is substantial, even severe pathogenic invasion results in mild disease; if Zhengqi is deficient, even minor pathogenic invasion results in severe disease. Thus, for those with excess conditions due to substantial Qi, removing the pathogen through purgation or attack is straightforward. The difficulty lies only in Shanghan complicated by deficiency! Most hateful is the assertion that "there is no tonification method for Shanghan," which confuses people more than any other doctrine. Have they not observed that Zhang Zhongjing established 397 treatment methods, over 100 of which involved pulse and symptom patterns of deficiency and cold? He formulated 113 prescriptions, using Renshen (Ginseng Root) in 30, and Guizhi (Cinnamon Twig) and Fuzi (Aconite Lateralis Preparata) in over 50. Who says there is no tonification method for Shanghan? Moreover, among contemporary patients suffering from Shanghan complicated by deficiency, six or seven out of ten fall into this category, while eight or nine out of ten recite the dogma of "no tonification for Shanghan." Treating deficiency without tonifying, and instead attacking again, is countless. Therefore, I strongly refute this view to save the current medical malpractice, not because I favor tonification. Consider cases where exterior pathogens remain unresolved and repeated diaphoresis fails to produce sweat; this is due to middle Jiao (Middle Burner) deficiency and weakness, preventing Yin fluids from reaching the surface. One must know that sweat is generated from Yin; tonifying Yin is the best way to induce sweating. Similarly, when body heat persists despite repeated clearing of heat, it indicates Yin insufficiency. People know that cold-natured herbs can reduce heat, but they do not realize that nourishing Yin can subdue fire. Furthermore, when Zhengqi is insufficient and Xieqi is excessive, Zhengqi cannot overcome Xieqi, and the disease will not resolve. By strengthening the Middle Jiao and making Zhengqi internally robust, one can force the pathogen outward, allowing Ying (Nutritive) and Wei (Defensive) Qi to gradually harmonize. In this manner, the exterior resolves without dispersing, and the pathogen retreats without direct attack. Today's physicians, failing to distinguish between deficiency and excess, see persistent fever and chest fullness and immediately resort to attack. Before the pathogen is removed, Zhengqi collapses due to the attack. All these errors stem from adhering to the single phrase "there is no tonification method for Shanghan."