负笈行医,周游四方,俗呼为走方。其术肇于扁鹊,华佗继之。故其所传诸法与国医少
异∶治外以针刺蒸灸胜;治内以顶、串、禁、截胜。取其速验,不计万全也。
手所持器以铁为之,形如环盂,虚其中,置铁丸,周转摇之,名曰虎刺。乃始于李次口。
次口,走医也。常行深山,有虎啮刺于口,求李拔之。次口置此器于虎口,为拔其刺。后其
术大行,名闻江湖。祖其术者率持此以为识,即名虎刺云(三才藻异作虎撑)。
手所持药囊曰无且囊,云秦无且所用者。针曰铍针。有小袋曰罗星袋。有小尺曰分脉尺。
有药点之镜曰语魅。有马口铁小筒,用以取牙,曰折脆。所作伪药皆曰何兼。市草药曰夹草。
持竿布,卖膏药,曰货软。作道妆僧服曰游方。用针曰挑红。用刀曰放红。撮痧曰标印。艾
火曰秉离。水调曰填冷。与人治病曰打桩。两人合治曰拢工。共分酬金曰破洞。赚人财帛曰
捞爪。脱险曰出洞。如此之类不能悉载,略举一、二焉。
走医有三字诀∶一曰贱,药物不取贵也;二曰验,以下咽即能去病也;三曰便,山林僻
邑仓卒即有。能守三字之要者,便是此中之杰出者矣。
走医有四验,以坚信流俗∶一取牙;二点痣;三去翳;四捉虫。四者皆凭药力。手法有
四要∶用针要知补泻;推拿要识虚实;揉拉在缓而不痛;钳取在速而不乱。志欲敖,礼欲恭,
语
药上行者曰顶,下行者曰串,故顶药多吐,串药多泻。顶、串而外,则曰截。截,绝也,
使其病截然而止。按此即古汗、吐、下三法也。然有顶中之串,串中之顶,妙用如神,则又
不可以常格论也。
药有常用之品,有常弃之品,走医皆收之。病有常见之症,有罕见之症,走医皆习之。
故有二难,曰∶用药难;识症难。非通乎阴阳,察乎微妙,安能使沉 顿起,名医拱手?谁
谓小道不有可观者欤!然今之煦煦然唯利是求、言伪而辩者,开方则笔似悬槌,临症则目如
枯炭,直谓之医奴可耳,此走医之罪人也。
药有异性,不必医皆知之,而走医不可不知。脉有奇经,不必医尽知之,而走医不可不
知。用奇乘间,一时之快捷方式也;得心应手,平日之功用也。古人出则行道,入则读书。盖医
学通乎性命,知医则知立命。而一切 戾不能中之,可以却病延年。否则己身之厄不能免,
又焉能救人之危耶!
医本期于济世,能治则治之,不必存贪得之心。近率以医为行业,谓求富者莫如医之一
途。于是,朋党角立,趋利若 ,入主出奴,各成门户。在延医者每以病试医,在为医者又
以药试病,彼此茫然,迄无成效。幸而偶中,则伪窃标榜。走医之术类聚既非,乡里论道罕
见精微,惟各挟一长以遨游逐食,忌则相贼,合则相呼,如雀隼之交,欢屈莫定。有如此者,
勿
药有最验者曰丹头,即劫剂是也,病除后必不可再用。走医多挟此以博效,人每诧为神
奇。病后再求余药,则授以丸药,谓可除余疾也。不知此即药肆中所弃之根渣,不论寒、热、
温
医者意也,用药不如用意,治有未效,必以意求。苟意入元微,自理有洞解,然后用药
无不验。今则每恃祖方为长技,用而偶验,则留根不除,俟再发而再获也。用而不验,则率
用猛毒之药以攻之,所谓下杀手也。在实症或间有转机,而虚损之人不且立毙者乎?不知全
在平日用心之讲求也。若终岁群居科诨,入市招摇,贪饕沉凶,不知潜心理道者,勿读吾书。
截法中有点金药、拦江网、八面锋。如鲫鱼霜、中分散、截骨、移毒皆点金药也。黄鹤丹、
青囊丸皆拦江网也。兑金、鲤鲮皆八面锋也。俱不可不知。
走医于内科有变病法,如药脾丸中之用木瓜露以闭溺窍;掩月散中之用鲤脊鳞以遮瞳神;
取贝母中之丹龙睛以弛髓脉;剔刺 中之连环骨以缩骨筋。外科则用白朱砂以种毒,蛇蕈灰
以种疮,即九种十三根之类。更有合扁豆膏以留疟,曼陀酒以留癫,甚则醉兽散之可以病牛
马,金针丸之可以困花木,种种不仁,愈降愈甚,良由操技不精,欲借此遂其罔利之心耳。
此书虽尽删其法,而不能尽绝其传也。故述其大概,使后来者知所免焉。
以上十二条从丁氏八千卷楼所藏抄本补入。所论确有见地,且举其弊而胪列之,足为殷
鉴,
背着书箱行医,周游各地,民间俗称“走方”。这种医术起源于扁鹊,华佗继承并发扬了它。因此,他们流传下来的各种方法与正统中医有所不同:在治疗外部疾病时,以针刺和艾灸见长;在治疗内部疾病时,以顶法、串法、禁法和截法见长。他们追求迅速见效,而不计较是否万无一失。
手中所持的器具是用铁制成的,形状像环形的盂,中间是空的,里面放置铁丸,转动摇晃它,名叫“虎刺”(又称虎撑)。这始于李次口。李次口是一位走方医生。他常年在深山中行走,有一次被老虎咬伤了嘴,请求李次口帮他拔出牙齿上的刺。李次口将这种器具放在老虎嘴里,帮它拔出了刺。后来这项技艺广泛流行,名声传遍江湖。继承这项技艺的人大多持有此物作为标志,所以叫作“虎刺”(《三才藻异》中称为“虎撑”)。
手中所持的药囊叫作“无且囊”,说是秦朝时期无且所使用的。针具叫作“铍针”。有一个小袋子叫作“罗星袋”。有一把小尺子叫作“分脉尺”。有一种用于点药的镜子叫作“语魅”。有一个马口铁制成的小筒,用来拔牙,叫作“折脆”。所制作的假药都叫作“何兼”。在市场上售卖草药叫作“夹草”。拿着竿子铺布卖膏药,叫作“货软”。穿着道士或僧人的服装游走四方,叫作“游方”。使用针具治疗叫作“挑红”。使用刀具治疗叫作“放红”。撮痧疗法叫作“标印”。艾火叫作“秉离”。用水调制药剂叫作“填冷”。给人治病叫作“打桩”。两人合作治疗叫作“拢工”。共同分配酬金叫作“破洞”。骗取钱财叫作“捞爪”。脱离险境叫作“出洞”。像这样的情形不能全部记载,仅列举一二罢了。
走方医生有三字诀:一是“贱”,药物不取昂贵者;二是“验”,服用后能立即去除病痛;三是“便”,在深山僻壤或紧急时刻也能随时获取。能够坚守这三字要领的,就是这一行中的杰出人物了。
走方医生有四种验证疗效的方法,以此让世俗百姓深信不疑:一是拔牙;二是点痣;三是去除眼翳;四是捉虫。这四种方法都凭借药力。手法有四条要点:使用针具要懂得补泻原理;推拿要识别虚实;揉拉动作要缓慢且不引起疼痛;钳取操作要迅速且不混乱。志向要高远,礼节要恭敬。
药力向上的叫作“顶”,向下的叫作“串”,所以顶法药物多引起呕吐,串法药物多引起腹泻。除了顶法和串法之外,还有“截法”。截,意为断绝,使病势戛然而止。按此分类,即古代的发汗、催吐、攻下三法。然而其中有顶法中包含串法,串法中包含顶法,其妙用如神,就不能用常规格局来论断了。
药材有常用的,有常被废弃的,走方医生都收集起来。病症有常见的,有罕见的,走方医生都加以研习。因此有两难之事,曰:用药难;识症难。如果不通晓阴阳,不洞察微妙之处,怎么能让重病之人顿时起身,让名医也拱手佩服呢?谁说小道没有值得观察的地方呢!然而现在的某些医生,只知温良恭俭却唯利是图,言语虚伪而善辩,开方时笔像悬锤一样无力,临症时眼神像枯炭一样无神,简直可以称之为“医奴”,这是走方医生的罪人。
药材有特殊的性质,不一定所有医生都知道,但走方医生不可不知道。脉象中有奇经八脉,不一定所有医生都尽知,但走方医生不可不知道。运用奇特之法乘虚而入,是一时的快捷方式;得心应手,则是平日功夫的体现。古人出门行道,回家读书。因为医学通晓性命之理,懂医学就知道如何确立生命之道。这样一切乖戾之气都不能侵袭身体,可以祛除疾病延长寿命。否则连自身的灾厄都无法避免,又怎么能救助他人的危难呢!
医学本意在于救济世人,能治的就治,不必存有贪得之心。近来大多把医学当作行业,认为求富没有比学医更好的途径了。于是,朋党对立,追逐利益如同追逐猎物,排斥异己,各自形成门户。在请医生看病的人往往拿病情试探医生,而在行医的人又拿药物试探病情,彼此茫然,最终没有成效。幸好偶尔奏效,就伪窃名声自我标榜。走方医生的技艺类聚既非正宗,乡里间谈论医道很少见到精微之处,只是各自挟带一技之长四处游荡寻找食物,嫉妒时就互相伤害,合作时就互相呼叫,像雀鸟和猛禽之间的交往,欢乐与屈辱不定。有这样的人存在,不要用药。
药效最显著的叫作“丹头”,也就是劫剂,病除后绝不能再继续使用。走方医生多挟带此药以博取效果,人们常常惊讶为神奇。病后再求剩余的药物,他们就给予丸药,说可以去除残余的疾病。却不知道这就是药铺中丢弃的药根药渣,不论寒热温凉,一概混用。
医者靠的是心意,用药不如用心意,治疗如果没有效果,必须从心意上寻求原因。如果心意深入细微之处,自然对医理有透彻的理解,然后用药没有不灵验的。现在的人往往倚仗祖传秘方作为特长,使用偶有灵验,就留下病根不除,等待复发时再获利。使用而不灵验,就随意使用猛烈有毒的药物去攻击,所谓“下杀手”。在实证中或许偶尔有转机,但对于虚损之人岂不是立刻致死吗?不知道全在于平日用心的探究。如果整年群居在一起开玩笑,入市招摇撞骗,贪婪凶狠,不知潜心研究医道的人,不要读我的书。
截法中有“点金药”、“拦江网”、“八面锋”。如鲫鱼霜、中分散、截骨、移毒都属于点金药。黄鹤丹、青囊丸都属于拦江网。兑金、鲤鲮都属于八面锋。这些都不可以不知道。
走方医生在内科方面有变病之法,如在药脾丸中使用木瓜露来闭塞溺窍;在掩月散中使用鲤鱼脊鳞来遮蔽瞳神;在取贝母中使用丹龙睛来松弛髓脉;在剔刺中使用连环骨来收缩骨筋。外科则使用白朱砂来种毒,蛇蕈灰来种疮,即九种十三根之类。更有甚者,合扁豆膏来留住疟疾,曼陀酒来留住癫狂,甚至醉兽散可以用来使牛马生病,金针丸可以用来困住花木,种种不仁之举,越来越严重,实在是因为技术不精湛,想借此实现其牟利的心理罢了。
这本书虽然删去了这些方法,但不能完全断绝其流传。所以陈述其大概情况,使后来者知道如何避免。
以上十二条是从丁氏八千卷楼所藏的抄本中补入的。所论述的观点确有见地,并且列举了其弊端并详细罗列出来,足以成为深刻的借鉴。
Carrying a satchel to practice medicine and traveling everywhere, commonly referred to in folk parlance as "Zoufang" (Wandering Physicians). This art originated with Bian Que and was continued by Hua Tuo. Therefore, the various methods they transmitted differed somewhat from those of orthodox national medicine: for treating external conditions, they excelled in acupuncture and moxibustion; for treating internal conditions, they excelled in Ding (Topical/Emetic), Chuan (Cathartic/Draining), Jin (Spell-binding/Suppression), and Jie (Intercepting/Cutting off) methods. They sought rapid efficacy without worrying about absolute perfection.
The instrument held in hand is made of iron, shaped like a ringed bowl, hollow in the middle, containing an iron ball that rotates when shaken, named "Huci" (Tiger Pierce/Tiger Support). It originated with Li Cikou. Cikou was a wandering physician. He often traveled in deep mountains, where once a tiger bit his mouth, asking Li to remove a thorn stuck there. Li placed this instrument in the tiger's mouth and extracted the thorn. Later, this technique became widely popular, and his name spread throughout the rivers and lakes (the medical community). Those who inherited this technique generally carried this object as a symbol, hence the name "Huci" (referred to as "Hucheng" or Tiger Support in *Sancai Zaoyi*).
The medicine pouch held in hand is called "Wuqie Nang" (Wuqie Pouch), said to be used by Wuqie of the Qin Dynasty. The needle is called "Pizhen" (Chisel Needle). A small bag is called "Luoxing Dai" (Luo Star Bag). A small ruler is called "Fenmai Chi" (Pulse-Dividing Ruler). A mirror used for applying medicated points is called "Yumei". A small tube made of sheet iron, used for extracting teeth, is called "Zhecui". All counterfeit medicines produced are called "Hejian". Selling herbal medicines in the market is called "Jiacao". Holding a pole and spreading cloth to sell plasters is called "Huoruan". Wearing Taoist or monk robes while wandering is called "Youfang". Using needles for treatment is called "Tiaohong". Using knives for treatment is called "Fanghong". Scraping therapy (Gua Sha) is called "Biaoyin". Moxa fire is called "Bingli". Mixing with water is called "Tianleng". Treating others' illnesses is called "Dazhuang". Two people treating together is called "Longgong". Sharing remuneration is called "Podong". Earning people's wealth through deceit is called "Laozhua". Escaping danger is called "Chudong". Such examples cannot all be recorded; only one or two are briefly mentioned.
Wandering physicians have a three-character mantra: First is "Jian" (Cheap), meaning drugs are not expensive; Second is "Yan" (Effective), meaning diseases can be cured immediately upon ingestion; Third is "Bian" (Convenient), meaning supplies are available even in remote mountainous areas or sudden emergencies. Those who can adhere to the essence of these three characters are the outstanding figures in this field.
Wandering physicians have four verification methods to firmly convince the vulgar public: First, extracting teeth; Second, removing moles; Third, clearing eye cataracts/opacities; Fourth, catching parasites. All four rely on medicinal power. There are four essentials in manual techniques: When using needles, one must understand tonification and sedation; when performing tuina (massage), one must distinguish deficiency and excess; rubbing and pulling should be slow and painless; clamping and extracting should be fast and orderly. One's ambition should be lofty, and etiquette respectful.
Medicines acting upward are called "Ding" (Top), and those acting downward are called "Chuan" (String/Drain); thus, Ding medicines mostly induce vomiting, and Chuan medicines mostly induce purging. Besides Ding and Chuan, there is "Jie" (Intercept). Jie means to cut off, making the disease stop abruptly. According to this classification, it corresponds to the ancient methods of sweating, vomiting, and purging. However, there are cases where Ding contains Chuan, and Chuan contains Ding, with miraculous applications that cannot be judged by conventional standards.
Herbs include commonly used items and commonly discarded items, all of which wandering physicians collect. Diseases include common symptoms and rare symptoms, all of which wandering physicians study. Thus, there are two difficulties: prescribing medication is difficult; identifying symptoms is difficult. Without understanding Yin and Yang and observing subtleties, how can one make severe patients recover instantly and make famous doctors yield? Who says that minor arts do not have their merits! However, current practitioners who are merely superficially benevolent yet seek only profit, whose words are hypocritical but eloquent, hold their pens like hanging hammers when prescribing, and look like dried charcoal when diagnosing; they can simply be called "medical slaves," and are the criminals of the wandering physicians.
Herbs have unique properties that not all doctors need to know, but wandering physicians must know. Pulse diagnoses involving the Eight Extraordinary Vessels may not be known by all doctors, but wandering physicians must know them. Using extraordinary methods to take advantage of opportunities is a temporary shortcut; being proficient and responsive is the result of daily practice. In ancient times, scholars went out to practice their profession and came home to read. Medicine connects to life and nature; knowing medicine means knowing how to establish one's life. In this way, all adverse influences cannot penetrate, allowing one to eliminate disease and prolong life. Otherwise, one cannot even avoid personal misfortune, let alone rescue others from danger!
Medicine originally aimed to save the world; if one can treat, one treats, without harboring greed. Recently, many treat medicine as a trade, believing that no path leads to wealth like medicine. Consequently, factions stand opposed, chasing profits like prey, excluding others, and forming separate schools. Patients often test doctors with their conditions, while doctors test diseases with their medicines, leaving both parties confused with no results. Fortunately, if it works by chance, they falsely claim credit and boast. Wandering physicians' skills are neither orthodox nor refined; discussions in villages rarely touch on subtle principles. They merely wander seeking food with their specialized skills, harming each other when jealous, calling each other when cooperating, like the interaction between sparrows and falcons, with uncertain joy and humiliation. For such people, do not use medicine.
The most effective medicines are called "Dantou" (Dan Head), which are also known as Jieji (Robbing Agents/Purgatives); they must absolutely not be used again after the disease is cured. Wandering physicians often carry these to gain reputation, and people are often amazed by their perceived magic. After the illness, if patients ask for remaining medicines, they are given pills, claiming they can remove residual ailments. Little do they know that these are merely the root dregs discarded by pharmacies, mixed indiscriminately regardless of cold, heat, or warmth.
A doctor relies on intention; using medicine is less important than using intention. If treatment is ineffective, one must seek reasons in intention. If intention penetrates the profound and subtle, one will naturally have a clear understanding of the principles, and then every prescription will be effective. Nowadays, people often rely on ancestral formulas as their specialty. If it works occasionally, they leave the root cause untreated, waiting for recurrence to profit again. If it does not work, they arbitrarily use fierce and toxic drugs to attack, so-called "killing blows." In excess patterns, there might be occasional turnaround, but for deficient and damaged individuals, would this not lead to immediate death? One does not realize that everything depends on careful study in daily life. Those who spend the whole year joking in groups, swaggering in markets, greedy and ferocious, and unaware of studying medical principles, should not read my book.
In the Jie method, there are "Dianjin Yao" (Gold-Pointing Medicines), "Lanjiang Wang" (River-Blocking Nets), and "Bamian Feng" (Eight-Faced Blades). Examples of Dianjin Yao include Jiyu Shuang, Zhongfen San, Jiegu, and Yidu. Examples of Lanjiang Wang include Huanghe Dan and Qingnang Wan. Examples of Bamian Feng include Duijin and Liling. These must all be known.
Wandering physicians have methods for altering diseases in internal medicine, such as using Papaya Dew in Yaopi Wan to close the urinary orifice; using Carp Spine Scales inianyue San to cover the pupil; using Dan Longjing in Qu Beimu to relax the marrow vessels; using Lianhuan Gu in Ti Ci to shrink bone tendons. In surgery, they use White Cinnabar to implant toxins, and Snake Mushroom Ash to implant sores, such as the Nine Types and Thirteen Roots categories. Even worse, they combine Doubean Plaster to retain malaria, and Datura Wine to retain epilepsy; some go so far as Zuishou San to make cattle and horses sick, and Jinzhen Wan to stunt plants and trees. Such inhumane acts become increasingly severe, primarily because their technical skills are not refined, and they wish to exploit this to achieve their profit-driven intentions.
Although this book deletes these methods, it cannot completely cut off their transmission. Therefore, I state the general outline so that later generations know what to avoid.
The above twelve items were added from the manuscript copy collected in the Ding Family's Eight Thousand Scrolls Pavilion. The discussions indeed have insights, and listing their drawbacks serves as a sufficient warning.