此数药者。赋性咸寒。功能宣利。本草极赞其消瘿散结。疗诸水肿胀之病。愚以为必惟
形气与病气俱实
者。用之得宜。设若稍虚。未有不反增剧也。大都前症多主肝脾两经亏损之故。惟能明于阴
阳水火之微。洞察化源资取之义。斯可以语治道矣。
此数药者。禀质薄劣。取味淡平。具有虚声。渺无实能。鱼鱼鹿鹿。无济缓急。岂国老
之甘草。黄 之绵 君子
之参苓。所能仿佛万一。然只可与共笑谈。不可与同患难也。今之医者。取其平淡无毒。谓
能持王道者
大要莫外此类。吁所协理诸病何病乎。果可以迂缓 茸之流。与商治策乎。予请逐节而详言之。枇杷
叶固云治嗽矣。岂知人之阳常有余。阴常不足。金水二脏。必保养之。始能相生。病则俱病经云诸逆冲
上皆属于火。原病式曰五志色欲之动。皆属相火。水衰而火无所制。得以冲逆于上。其水莫
能救母之鬼贼鬼贼愈盛而受克愈亏矣论治法以苦寒泻火则土藏不堪以辛温补母而子金无济必惟益水滋
肾
以膏润纯甘之品得水少充则火便少熄火熄金复仍尔相生矣而轻飘之枇杷叶。从治肺之标得乎
。石
斛草固云清肺健脾益肾矣。此物果兼温凉两性乎。夫肺待清必属热。脾资健必本弱今母虚
反为泻子
子实而又补母何相混也大凡气之浓者主阳。味之浓者主阴。以轻虚之质。嚼蜡之味。谓能补
肾得乎。扁
豆不过蔬馔中一物。谓曰无伤脾胃可也。乃云能益脾和胃。抑何迂阔。薏苡亦诸谷中一侧谷
耳。昔伏波载归以舟。亦
必经年久服。或少见效。而取以为方药治病得乎。沙参本草谓能补肺之阴。人参益肺之阳试
思肺之阴
何由而虚乎病自有本。金水相生。肺之阴即肾之阴也滋苗者必固其根。岂平淡升浮之沙参果
可益阴
乎。而易老取以代人参。殊不知体质既殊功能亦异。安能代也。惟葛稚川谓沙参主疗卒得
诸疝。小腹及
阴中相引痛如绞盖疝及小腹引痛乃厥阴为患沙参金藏药也得相制耳。予每用此与升麻以疗疝
症。往往奇中。愈信葛言不诬。若夫芡实莲须果可止遗固精乎。汪石山曰经云肾属水。受五
脏六腑
之精而藏之。又曰主蛰封藏之本。肾之处也。又曰阴阳之要阳密乃固。故阳强不能密。阴气
乃绝。阴平阳秘。精神乃治。阴阳离决。精神乃绝。又曰阴阳总宗筋之会。会于气街。
灵枢曰厥气客于阴器。则
梦接内。盖阴器者宗筋之所聚也。而足太阴阳明少阴厥阴之筋。皆结聚于阴器。与冲任督三
脉之所会。
然厥阴主筋。故诸筋皆通于厥阴肾为阴主藏精肝为阳主疏泄阴器乃泄精之窍故肾之阴虚则精
不藏
肝之阳强则气不固若阴客于其窍与所强之阳相感则精脱出而成梦阳强者非藏真之阳强乃肝脏
所寄之相火强耳第病多端。亦有不专在肝肾。而在心肺脾胃之虚火反凌水土不制水金不胜
木者然
必传于肾肝而致精之失也有自然相传之理焉治法从肝肾本脏而得者独治本脏从他脏得者则以
他脏为主。肝肾为标。由阴阳离决。水火不济者则因而和之阳虚补气阴虚补血阳强者泻火阴
实者益火本脏多主有余他脏或兼不足有正治反治从多从少之异何世医不辨阴阳水火。或清之涩之温
之
热之非使真水耗竭则令真阳痿败骨立脂枯。神消气陷。不可复救矣。前药岂能奏效万一哉。灯草木通虽
曰甘淡渗窍。第病邪不一。而传于膀胱成淋者。病自有本。若以前药之属利胞之热未全善也
。夫淋虽由
热生湿。湿生则水液混浊。凝结为患。又有服金丹入房。致败精流于窍中。及饮食失宜。
七情
过度。虚实不调。藏气不和。致肾虚而膀胱受热。又有肺痿而上源失通调之令。有液枯而水
道干涩不润。又有膏石血气沙劳冷七种之别。又有小肠移热而应于心者。又有痰积而渗入胞
者又有小便不通与溺数而短。及溺血溲血淋血或失气化之常。或病脾而九窍不通。仲景亦谓
胃气行
则小便宣通。而淋亦有因脾虚如太阴初作之气病中热胀而成者大抵病固多端。不外虚实寒热
。溯其源而治之。斯中病情矣。如浮小麦麻黄根气味索然。果可以疗汗脱之重症乎。即有他药
佐使。亦属赘庞耳。夫人阴阳相维。营卫营运。无失常度。血气得灌溉护卫之用汗为心之
液。主于气阳密乃固。则气不外泄。卫气虚为自汗。阴
气虚为盗汗。伤寒盗汗。责在胆热。初症伤风而汗。有伤湿伤暑劳役柔 而汗者。有阳虚冷
汗者。虽有阴阳寒热之殊。究竟皆元气之脱越。或虚惫不升耳。当从此根蒂处察虚实治之倘
未得其窍即参 术苓亦难为用矧兹二物乎。
这几味药,禀赋性质咸寒,功能在于宣通利泄。本草书籍极力称赞它们能消除瘿瘤、散开结块,治疗各种水肿胀满的病证。我认为,只有当病人的形体体质与病邪之气都表现为实证时,使用这些药物才恰当。如果病人稍有虚象,没有不反而使病情加重恶化的。大抵上述前文提到的那些病症,多是由于肝脾两经亏损的缘故。只有能够明了阴阳水火细微变化的道理,洞察化生之源及资取之义的人,才可以与他谈论治病之道了。
这几味药,禀受质地薄弱低劣,摄取味道淡平。具有虚假的名声,缺乏实际的效能。像鱼群鹿群一样杂乱无章,在紧急关头毫无帮助。哪里比得上国老甘草、黄耆绵芪君子人参茯苓那样,能达到它们万分之一的功效呢?然而,只可以与它们一起谈笑风生,不可与它们共同承担患难重任。现在的医生,喜欢它们平淡无毒,认为能够秉持“王道”治法的大要,不外乎这类药物。唉!所协调治疗的各类疾病是什么病呢?果真可以用这种迂腐迟缓的平庸之辈,来商讨治疗策略吗?我请求逐节详细论述。
枇杷叶固然说能治疗咳嗽,但岂知人的阳气常有余,阴气常不足。肺金与肾水两脏,必须加以保养,才能相生互济。生病则两脏俱病。《内经》说:“各种逆气冲上的病证,都属于火。”《原病式》说:“五志和色欲的发动,都归属于相火。”肾水衰少而火无所制约,得以冲逆于上。此时肾水不能救助作为母脏的肺金(注:此处原文逻辑似有倒置或特定语境,通常金生水,水为金之子,若按五行相生,肺为肾之母;若按“鬼贼”克伐关系,水克火,火旺反侮水。原文意指水衰不能制火,火盛反克金/水,导致金水受损)。鬼贼之火愈盛,受克的脏腑愈亏。论治法,如果用苦寒药泻火,则脾土藏纳不堪承受;如果用辛温药补母(肺),则子脏(肾)金亦无济于事。必须唯有益水滋肾,用膏润纯甘的药物,使肾水稍微充盈,则火势便稍息;火熄后肺金恢复,自然又能相生。而轻飘上浮的枇杷叶,只能从治肺之标症,能得到根本吗?
石斛草固然说能清肺健脾益肾,但这物果然兼具温凉两性吗?肺待清必属热证,脾资健必本虚弱。今母脏(脾)虚,反成为泻子脏(胃/大肠等,此处指代不清,通常脾为肺之母,若脾虚则肺气亦虚,所谓“母虚子盗”或“母病及子”,原文“母虚反为泻子”可能指误用清热药更伤脾胃,或指病理上的相互影响混乱)。子实而又补母,何相混也?大凡气浓者主阳,味浓者主阴。以轻虚之质,嚼蜡之味,谓能补肾得乎?
扁豆不过是蔬馔中的一物,说它无伤脾胃是可以的,乃说它能益脾和胃,抑又何其迂阔。薏苡也是诸谷中一种侧谷罢了。昔日伏波将军马援载回以舟,也是经过多年久服,才稍见效验,而把它当作方药治病,能得到效果吗?沙参,本草说能补肺之阴,人参益肺之阳。试思肺之阴何由而虚乎?病自有本源,金水相生,肺之阴即肾之阴也。滋苗者必固其根,岂是平淡升浮的沙参果可益阴乎?而易老(李东垣?)取它以代替人参,殊不知体质既然不同,功能亦异,安能替代呢?只有葛稚川说沙参主治突然得的各类疝气,小腹及阴中牵引疼痛如绞。盖疝及小腹引痛乃是厥阴肝经为患,沙参为金藏之药,得相制耳。我每用此药配合升麻来疗疝症,往往奇效,更加相信葛洪之言不诬。
至于芡实莲须,果真可以止遗精固精气吗?汪石山说:《内经》云肾属水,受五脏六腑之精而藏之。又说:肾主蛰封藏之本,肾之处也。又说:阴阳之要,阳密乃固。故阳强不能密,阴气乃绝。阴平阳秘,精神乃治。阴阳离决,精神乃绝。又说:阴阳总宗筋之会,会于气街。《灵枢》曰:厥气客于阴器,则梦接内。盖阴器者宗筋之所聚也。而足太阴、阳明、少阴、厥阴之筋,皆结聚于阴器,与冲任督三脉之所会。然厥阴主筋,故诸筋皆通于厥阴。肾为阴主藏精,肝为阳主疏泄,阴器乃泄精之窍。故肾之阴虚则精不藏,肝之阳强则气不固。若阴客于其窍,与所强之阳相感,则精脱出而成梦。阳强者,非藏真之阳强,乃肝脏所寄之相火强耳。第病多端,亦有不专在肝肾,而在心肺脾胃之虚火反凌水土,不制水,金不胜木者。然必传于肾肝而致精之失也,有自然相传之理焉。治法从肝肾本脏而得者,独治本脏;从他脏得者,则以他脏为主,肝肾为标。由阴阳离决,水火不济者,则因而和之。阳虚补气,阴虚补血,阳强者泻火,阴实者益火。本脏多主有余,他脏或兼不足,有正治反治、从多从少之异。何世医不辨阴阳水火,或清之、涩之、温之、热之?非使真水耗竭,则令真阳痿败,骨立脂枯,神消气陷,不可复救矣。前药岂能奏效万一哉。
灯心草、木通虽曰甘淡渗窍,第病邪不一,而传于膀胱成淋者,病自有本。若以前药之属利胞之热未全善也。夫淋虽由热生湿,湿生则水液混浊,凝结为患。又有服金丹入房,致败精流于窍中,及饮食失宜,七情过度,虚实不调,藏气不和,致肾虚而膀胱受热。又有肺痿而上源失通调之令,有液枯而水道干涩不润。又有膏、石、血、气、劳、冷七种之别。又有小肠移热而应于心者。又有痰积而渗入胞者。又有小便不通与溺数而短,及溺血、溲血、淋血,或失气化之常,或病脾而九窍不通。仲景亦谓胃气行则小便宣通。而淋亦有因脾虚如太阴初作之气病中热胀而成者。大抵病固多端,不外虚实寒热。溯其源而治之,斯中病情矣。
如浮小麦、麻黄根气味索然,果可以疗汗脱之重症乎?即有他药佐使,亦属赘庞耳。夫人阴阳相维,营卫营运,无失常度,血气得灌溉护卫之用。汗为心之液,主于气。阳密乃固,则气不外泄。卫气虚为自汗,阴气虚为盗汗。伤寒盗汗,责在胆热。初症伤风而汗,有伤湿、伤暑、劳役、柔痉而汗者,有阳虚冷汗者。虽有阴阳寒热之殊,究竟皆元气之脱越,或虚惫不升耳。当从此根蒂处察虚实治之。倘未得其窍,即参术苓亦难为用,矧兹二物乎。
These few herbs possess a salty and cold nature, with functions of diffusing and promoting drainage. Materia Medica highly praises their ability to eliminate goiter (thyroid enlargement) and dissipate nodules, treating various diseases of edema and distension. I believe that they are appropriate only when both the patient's physical constitution and the pathogenic qi are in a state of excess. If there is even slight deficiency, the condition will inevitably worsen. Generally, the aforementioned conditions are mostly due to deficiency of the Liver and Spleen meridians. Only those who can clearly understand the subtleties of Yin-Yang and Water-Fire, and penetrate the meaning of the source of transformation and acquisition, can be spoken to regarding therapeutic principles.
These few herbs have thin and inferior qualities, with light and neutral flavors. They have false reputations but lack substantial efficacy. Like schools of fish and herds of deer, they are chaotic and useless in emergencies. How can they compare to Guolao (Licorice Root), Huangqi (Astragalus Root), or Junzi Renshen Fuling (Ginseng and Poria)? Their efficacy cannot reach one ten-thousandth of these superior herbs. However, they can only be used for idle talk, not for sharing hardships. Current physicians favor them for being mild and non-toxic, believing that the essence of "Kingly Way" treatment lies in such herbs. Alas! What are the various diseases to be coordinated? Can one really discuss therapeutic strategies with such mediocre and slow-acting agents? I request to explain each point in detail.
Pipaye (Loquat Leaf) is indeed said to treat coughs. But does it know that human Yang is often in excess while Yin is often deficient? The Lung Metal and Kidney Water organs must be nourished to maintain mutual generation. When diseased, both are affected. The Classic states: "All rebellious Qi rushing upward belongs to Fire." Yuan Bing Shi states: "Movements of the Five Emotions and sexual desires all belong to Minister Fire." When Kidney Water declines and Fire is uncontrolled, it rushes upward. At this time, Water cannot rescue the Mother organ (Lung). The destructive Fire becomes stronger, and the afflicted organs become more depleted. Regarding treatment methods, using bitter-cold herbs to drain Fire burdens the Earth organ (Spleen); using acrid-warm herbs to tonify the Mother (Lung) does not help the Child (Kidney/Lung metal aspect). One must benefit Water and nourish the Kidney using moistening, purely sweet substances. When Kidney Water is slightly replenished, Fire subsides; when Fire extinguishes, Lung Metal recovers, and mutual generation resumes. Can light and floating Pipaye (Loquat Leaf), which only treats the branch symptoms of the Lung, address the root?
Shihu Cao (Dendrobium Stem) is said to clear the Lung, strengthen the Spleen, and benefit the Kidney. Does this herb truly possess both warm and cool properties? The Lung requires clearing if it is hot; the Spleen requires strengthening if it is weak. If the Mother organ is deficient, it inadvertently drains the Child. If the Child is excess and the Mother is tonified, how can this be mixed up? Generally, strong Qi governs Yang, and strong Flavor governs Yin. With light and void quality and tasteless flavor, how can it tonify the Kidney?
Bian Dou (Adzuki Bean) is merely a food item. Saying it harms neither the Spleen nor Stomach is acceptable, but claiming it benefits the Spleen and harmonizes the Stomach is overly pedantic. Yiyi Ren (Coix Seed) is just one of the grains. Historically, General Ma Yuan brought it back by boat, taking years of long-term use before seeing slight effects. Can it be used as a prescription to cure diseases effectively? Shashen (Adenophora Root) is said in Materia Medica to tonify Lung Yin, while Renshen (Ginseng Root) tonifies Lung Yang. Consider how Lung Yin becomes deficient. Disease has its origin; Metal and Water generate each other; Lung Yin is essentially Kidney Yin. To nourish the sprout, one must solidify the root. Can plain and ascending Shashen truly nourish Yin? Yi Lao (Li Dongyuan?) used it to replace Renshen, unaware that since constitutions differ, functions differ, so how can it substitute? Only Ge Zhichuan (Ge Hong) stated that Shashen treats sudden onset of various hernias, with pain in the lower abdomen and genitals radiating like twisting. Hernia and lower abdominal radiating pain are disorders of the Jueyin Liver Meridian. Shashen, a Metal-natured herb, exerts a controlling effect on Wood. I often use this herb combined with Shengma (Cimicifuga Rhizome) to treat hernia, achieving miraculous results, confirming Ge's words are not false.
As for Qianshi (Euryale Seed) and Lianxu (Lotus Stamen), can they truly stop seminal emission and consolidate essence? Wang Shishan said: The Classic states the Kidney belongs to Water, receiving and storing essence from the Five Zang and Six Fu organs. It also states the Kidney is the root of hibernation and sealing/storage. It states: The key to Yin-Yang is that when Yang is dense, it secures. Thus, if Yang is excessive and cannot secure, Yin Qi perishes. When Yin is peaceful and Yang is secret, Spirit thrives. When Yin-Yang separate, Spirit perishes. It also states: Yin-Yang converge at the Sinew Master, meeting at the Qichong point. Ling Shu says: When Juevi Qi invades the genitalia, dreams of intercourse occur. The genitalia are where the Sinew Master gathers. The sinews of Foot Taiyin, Yangming, Shaoyin, and Jueyin all gather at the genitalia, converging with the Chong, Ren, and Du vessels. Jueyin governs sinews, so all sinews connect to Jueyin. The Kidney, governing Yin, stores essence; the Liver, governing Yang, controls free flow. The genitalia are the orifice for semen discharge. Thus, Kidney Yin deficiency leads to insecure essence; Liver Yang excess leads to insecure Qi. If Yin pathogens invade the orifice and interact with excessive Yang, essence escapes, causing nocturnal emissions. Excessive Yang here refers not to true stored Yang, but to Minister Fire residing in the Liver. Diseases are manifold; some do not focus solely on Liver-Kidney but involve deficiency fire of Heart-Lung-Spleen-Stomach overacting on Earth-Water, failing to control Water, or Metal failing to control Wood. However, it must transmit to Liver-Kidney causing loss of essence, following natural transmission laws. Treatment derived from Liver-Kidney primary organs focuses solely on the primary organ; if derived from other organs, focus on the other organ as primary, Liver-Kidney as secondary. For cases of Yin-Yang separation and Water-Fire non-interaction, harmonize accordingly. Tonify Qi for Yang deficiency, tonify Blood for Yin deficiency, drain Fire for Yang excess, benefit Fire for Yin excess. Primary organs often show excess; other organs may have concurrent deficiency. There are differences in direct vs. reverse treatment, focusing on majority vs. minority. Why do physicians fail to distinguish Yin-Yang and Water-Fire, using clearing, astringing, warming, or heating methods? This either exhausts True Water or causes True Yang impotence, emaciation, fat depletion, spirit fading, Qi sinking, irrecoverable damage. How could the previous herbs achieve even one ten-thousandth of efficacy?
Dengxin Cao (Juncus Effusus) and Mutong (Akebia Caulis) are said to be sweet, bland, and draining through orifices. However, pathogens vary, and transmission to the Bladder causing Lin syndrome (dysuria) has its own origin. Using these herbs to clear heat in the bladder is not entirely sound. Although Lin arises from Heat generating Dampness, leading to turbid fluids and凝結 (coagulation) issues, there are also cases caused by taking Golden Elixir pills and sexual activity, leading to degenerate essence flowing into orifices, improper diet, excessive Seven Emotions, imbalance of deficiency-excess, and disharmony of Zang-Qi, resulting in Kidney deficiency and Bladder heat. There are cases of Lung萎 (withering) where the upper source loses regulating commands, or fluid exhaustion causing dry and rough water pathways. There are seven types: Gao, Shi, Xue, Qi, Lao, Leng. There is Heat transferring from Small Intestine affecting the Heart. There is Phlegm accumulation penetrating the bladder. There is urinary retention, frequent short urination, hematuria, or loss of Qi transformation norms, or Spleen disease causing nine orifices blockage. Zhang Zhongjing also stated that when Stomach Qi moves, urination is unobstructed. Lin can also arise from Spleen deficiency, such as early Taiyin Qi disease with internal heat and distension. Generally, diseases are manifold but do not exceed Deficiency-Excess and Cold-Heat. Tracing the source and treating it hits the mark.
Fuxiao Mai (Floating Wheat) and Mahuang Gen (Ephedra Root) have insipid tastes. Can they truly treat severe sweating collapse? Even with other herbs as assistants, they are superfluous. Human Yin-Yang support each other, Ying-Wei circulate without deviating from norms, providing irrigation and protection for Blood-Qi. Sweat is the fluid of the Heart, governed by Qi. When Yang is dense and secure, Qi does not leak. Wei-Qi deficiency causes spontaneous sweating; Yin-Qi deficiency causes night sweating. In Shanghan, night sweating is blamed on Gallbladder Heat. Initial Wind-strike sweating, or sweating from Dampness, Summerheat, labor, or soft spasm, or Yang-deficiency cold sweat. Despite differences in Yin-Yang and Cold-Heat, ultimately all represent escape of Yuan-Qi or failure of rising due to exhaustion. One must examine deficiency-excess from this root. If the key is not grasped, even Renshen Baizhu Fuling are hard to utilize, let alone these two herbs.