《原补》一篇,不当作,由近论补者,与《内经》相违,不得不作耳。夫养生当论
食补,治病当论药攻。然听者皆逆耳,以予言为怪。盖议者尝知补之为利,而不知补之为害也。论补
者盖有六法∶平补,峻补,温补,寒补,筋力之补,房室之补。以人参、黄 之类为平补;
以附子、硫黄之类为峻补;以豆蔻、官桂之类为温补;以天门冬、五加皮之类为寒补;以巴戟
、肉苁蓉之类为筋力之补;以石燕、海马、起石、丹砂之类为房室之补。此六者,近代之所谓补者也。若
施之治病,非徒功效疏阔,至其害不可胜言者。
《难经》言东方实,西方虚,泻南方,补北方。
此言肝木实而肺金虚,泻心火,补肾水也。以此论之,前所谓六补者,了不相涉。试举补之所以
为害者∶如疟,本夏伤于暑,议者以为脾寒而补之,温补之则危,峻补之则死;伤寒热病下之
后,若以温辛之药补之,热当复作,甚则不救,泻血;血止之后,若温补之,血复热,小溲
不利,或变水肿霍乱吐泻;本风湿 合而为之,温补之则危,峻补之则死;小儿疮 之后,有温补之,必发痈肿
痛;妇人大产之后,
心火未降,肾水未升,如黑神散补之,轻则危,甚则死;老人目暗耳聩,肾水衰而心火盛也
,若峻补之,则肾水弥涸,心火弥盛;老人肾虚
,腰脊痛,肾恶燥,腰者肾之府也,峻补之则肾愈虚矣;老人肾虚无力,夜多小溲,肾主足
,肾水虚而火不下,故足痿,心火上乘肺而不入脬囊,故夜多小溲,若峻补之,则火益上行
,脬囊亦寒矣!老人喘嗽,火乘肺也,若温补之则甚,峻补之则危;停饮之人不可补,补则
痞闷转增;脚重之人不可补,补则胫膝转重。
男子二十上下而精不足,女人二十上下而血不
流,皆二阳之病也。时人不识,便作积冷极惫治之,以温平补之。夫积温尚成热,而况燔针
于脐下,火灸手足腕骨。《内经》本无劳证,由此变而为劳,烦渴,咳嗽涎痰,肌瘦,寒热往来,
寝汗不止,日高则颜赤,皆以为传尸劳,不知本无此病,医者妄治而成之耳!夫二阳者,阳
明也,胃之经也。心受之则血不流,脾受之则味不化。故男子少精,女子不月,皆由使内太
过。故隐蔽委屈之事,各不能为也。惟深知涌泻之法者,能治之。又如春三月,风伤于荣,
荣为血,故阴受之。温伤于卫,卫为气,故阳受之。初发之后,多与伤寒相似。头痛身热,
口干潮热,数日不大便,仲景所谓阴阳俱浮,自汗出,身重多眠睡,目不欲开者是也。若以
寒药下之,则伤脏气;若以温药补之,则火助风温,发黄发斑,温毒热增剧矣!风温外甚,
则直视、潮热谵语,寻衣撮空,惊惕而死者,温补之罪也
。《内经》虽言形不足者,温之以气;精不足者,补之以味。气属阳,天食人以五气;
血属阴,地食人以五味者,戒乎偏胜,非便以温为热也。又若《经》云∶损者补之,劳者温之。此温
乃温存之温也,岂以温为热哉?又如“虚则补其母,实则泻其子”者,此欲权衡之得其平也。又
乌在燔针壮火,炼石烧砒,硫、姜、乌、附,然后为补哉?所谓补上欲其缓,补下欲其急者,亦
焉在此等而为急哉?自有酸、苦、甘、辛、咸、淡,寒、凉、温、热、平,更相君、臣、佐、使耳
。所谓平补者,使阴阳两停
,是谓平补。奈时人往往恶寒喜温,甘受酷烈之毒,虽死而不悔也,可胜叹哉?
余用补法
则不然。取其气之偏胜者,其不胜者自平矣。医之道,损有余,乃所以补其不足也。余尝曰
∶吐中自有汗,下中自有补,岂不信然!余尝用补法,必观病患之可补者,然后补之。昔维
阳府判赵显之,病虚羸,泄泻褐色,乃洞泄寒中证也。每闻大黄气味即注泄。余诊之,两手
脉沉而软,令灸水分穴一百余壮,次服桂苓甘露散、胃风汤、白术丸等药,不数月而愈。又
息城酒监赵进道,病腰痛,岁余不愈。诊其两手脉,沉实有力,以通经散下五、七行;次以杜仲
去粗皮细切,炒断丝为细末,每服三钱;猪腰子一枚,薄批五、七片,先以椒盐淹去腥水,掺药在
内,裹以荷叶,外以湿纸数重封,以文武火烧熟,临卧细嚼,以温酒送下;每旦以无比山药
丸一服,数日而愈。又相台监酒岳成之,病虚滑泄,日夜不止,肠鸣而口疮,俗呼为心劳口
疮,三年不愈。予以长流水,同姜枣煎五苓散五、七钱,空心使服之,以治其下;以宣黄连
与白茯苓去皮,二味各等分为末,以白面糊为丸,食后温水下三、五十丸,以治其上,百日
而愈。又汝南节度副使完颜君宝,病脏毒,下 血发渴
,寒热往来,延及六载,日渐瘦弱无力,面黄如染。余诊其两手脉沉,而身凉。《内经》
寒以为荣气在,故生,可治。先以七宣丸下五、七行;次以黄连解毒汤加当归赤芍药,与地
榆散同煎服之,一月而愈。
若此数证,余虽用补,未尝不以攻药居其先,何也?盖邪未去而不可言补,补之则适
足资寇。故病蠲之后,莫若以五谷养之,五果助之,五畜益之,五菜充之,相五脏所宜,毋
使偏倾可也。凡药皆毒也,非止大毒、小毒谓之毒,虽甘草苦参,不可不谓之毒,久服必有偏
胜。气增而久,夭之由也。是以君子贵流不贵滞,贵平不贵强。卢氏云∶强中生百病,其知
言哉!人惟恃强,房劳之病作矣,何贵于补哉?以太宗宪宗高明之资,犹陷于流俗之蔽,为
方士燥药所误;以韩昌黎元微之犹死于小溲不通、水肿。有服丹置数外家,而死于暴脱;有服草
乌头、如圣丸,而死于须疮;有服乳石、硫黄,小溲不通;有习气求嗣,而死于精血;有嗜
酒,而死于发狂见鬼;有好茶而为癖。乃知诸药皆不可久服,但可攻邪,邪去则已。近年运使张伯
英病宿伤,服硫黄、姜、附数月,一日丧明;监察陈威卿病嗽,服钟乳粉数年,呕血而殒。
呜呼!后之谈补者,尚监兹哉!
《原补》这一篇,本不该写,因为近世讨论补法的人,与《内经》的原则相违背,我不得不写这篇文章。养生应当论述饮食滋补,治病应当论述药物攻邪。然而听者都觉得逆耳,认为我的话奇怪。大概议论的人只知道补法的益处,却不知道补法的危害。论述补法大致有六种方法:平补、峻补、温补、寒补、筋力之补、房室之补。以人参、黄芪之类作为平补;以附子、硫黄之类作为峻补;以豆蔻、官桂之类作为温补;以天门冬、五加皮之类作为寒补;以巴戟天、肉苁蓉之类作为筋力之补;以石燕、海马、起石、丹砂之类作为房室之补。这六类,是近代所谓的补法。如果用来治病,不仅功效疏漏宽泛,其带来的害处更是不可胜数。
《难经》说:“东方实,西方虚,泻南方,补北方。”这是说肝木实证而肺金虚证,泻心火,补肾水。以此理论来看,前面所说的六种补法,完全不相干。试列举补法之所以为害的例子:如疟疾,本是夏季感受暑邪,议论者认为是脾寒而用补法,用温补则危险,用峻补则致死;伤寒热病经过攻下之后,如果用温辛的药物补益,热邪会再次发作,严重则无法救治,导致便血;便血停止之后,如果用温补,血液再次发热,小便不利,或者变成水肿、霍乱、吐泻;原本是风湿合邪致病,用温补则危险,用峻补则致死;小儿疮疡之后,如果用温补,必定引发痈肿疼痛;妇女大生产之后,心火未降,肾水未升,如果用黑神散补益,轻则危险,重则致死;老人目暗耳聋,是肾水衰而心火盛,如果用峻补,则肾水更加枯竭,心火更加旺盛;老人肾虚,腰脊痛,肾恶燥,腰是肾的府邸,用峻补则肾更虚;老人肾虚无力,夜间多尿,肾主足部,肾水虚而火不下行,所以足痿软,心火上乘于肺而不入膀胱,所以夜间多尿,如果用峻补,则火气更加上行,膀胱也会变冷!老人喘咳,是火邪乘肺,如果用温补则病情加重,用峻补则危险;停饮之人不可补,补则痞闷加重;脚重之人不可补,补则小腿膝盖更加沉重。
男子二十岁左右精气不足,女子二十岁左右经血不通,都是阳明经的病。时人不懂,就当作积冷极惫来治,用温平的方法补益。积聚温热尚且能化热,何况在脐下用燔针,在手足腕骨处用火灸?《内经》本来没有“劳证”这个病名,由此演变出劳证,出现烦渴、咳嗽涎痰、肌肉消瘦、寒热往来、盗汗不止、太阳升高时面色发红,都以为是传尸劳,不知道本来没有这个病,是医生误治造成的!所谓二阳,就是阳明,是胃的经脉。心受病则血不流通,脾受病则五味不能运化。所以男子精少,女子月经不行,都是因为房事过度。因此隐蔽委屈之事,各人都做不了。只有深知涌吐、泻下之法的人,才能治疗这些病。又如春三月,风邪伤及营分,营属于血,所以阴分受邪。温邪伤及卫分,卫属于气,所以阳分受邪。初发之后,大多与伤寒相似。头痛身热,口干潮热,几天不大便,这就是仲景所说的阴阳俱浮,自汗出,身体沉重多睡,眼睛不想睁开的情况。如果用寒药攻下,就会损伤脏气;如果用温药补益,就会火助风温,导致发黄发斑,温毒热势加剧!风温外盛,就会导致直视、潮热谵语、寻衣撮空、惊惕而死,这是温补的罪过。《内经》虽然说过形气不足的,用气来温养;精不足的,用味来补益。气属阳,天给人提供五气;血属阴,地给人提供五味,这是告诫不要偏胜,并不是就说用温就是热。又像《经》云:“损者补之,劳者温之。”这个温是温存的意思,哪里是用温当作热呢?又比如“虚则补其母,实则泻其子”,这是想要权衡得失达到平衡。又哪里需要燔针壮火,炼石烧砒,硫磺、干姜、乌头、附子,然后才叫补呢?所谓补上欲其缓,补下欲其急,又怎么在这些猛烈药物中体现急呢?自有酸、苦、甘、辛、咸、淡,寒、凉、温、热、平,互相作为君臣佐使罢了。所谓平补,是使阴阳两者持平,这叫平补。无奈时人往往厌恶寒冷喜欢温热,甘愿承受酷烈的毒性,即使死了也不后悔,真是令人叹息啊!
我使用补法却不是这样。选取气偏胜的一方,那不胜的一方自然平和了。医道,减去有余的,就是补充不足的。我曾经说:吐法中自有发汗的作用,下法中自有补益的作用,难道不是这样吗!我曾用补法,一定观察病人可以补的地方,然后才补。过去维阳府判赵显之,病体虚弱消瘦,泄泻褐色,这是洞泄寒中证。每次闻到大黄的气味就注泄不止。我诊察他的两手脉沉而软,让他灸水分穴一百多壮,接着服用桂苓甘露散、胃风汤、白术丸等药,不到几个月就好了。又息城酒监赵进道,病腰痛,一年多不好。诊察他的两手脉,沉实有力,用通经散攻下五六次;接着用杜仲去掉粗皮细切,炒断丝为细末,每服三钱;猪腰子一枚,薄批五六片,先用椒盐淹去腥水,将药掺在里面,用荷叶包裹,外面用湿纸几层封好,用文武火烧熟,临睡前细细咀嚼,用温酒送下;每天早上服无比山药丸一服,几天就好了。又相台监酒岳成之,病虚滑泄,日夜不停,肠鸣且口疮,俗呼为心劳口疮,三年不好。我用长流水,同姜枣煎煮五苓散五七钱,空腹让他服用,以治其下部;用宣黄连与白茯苓去皮,两味各等分为末,用白面糊做成丸,饭后温水送下三五十丸,以治其上焦,一百天就好了。又汝南节度副使完颜君宝,病脏毒,便血口渴,寒热往来,延续六年,日渐瘦弱无力,面色黄如染色。我诊察他的两手脉沉,而身体凉。《内经》说寒以为荣气在,故生,可治。先用七宣丸攻下五六次;接着用黄连解毒汤加当归赤芍药,与地榆散同煎服之,一个月就好了。
像这几个病例,我虽然用了补法,但未尝不以攻药居先,为什么呢?因为邪气未去而不可言补,补之则正好资助寇贼。所以病邪消除之后,不如用五谷滋养它,五果帮助它,五畜增益它,五菜充实它,顺应五脏所宜,不要使其偏倾就可以了。凡药都有毒,不只是大毒、小毒叫做毒,即使是甘草、苦参,也不能不叫做毒,久服必然有偏胜。气增而久,是夭折的原因。所以君子贵在流通而不在停滞,贵在平和而不在强盛。卢氏说:强盛中生百病,这话真知灼见啊!人只依仗强盛,房劳的病就产生了,何必贵于补呢?以太宗宪宗高明的资质,还陷入流俗的蔽障,被方士的燥药所误;以韩昌黎、元微之,还死于小便不通、水肿。有服丹置数外家,而死于暴脱;有服草乌头、如圣丸,而死于须疮;有服乳石、硫黄,小便不通;有习气求嗣,而死于精血;有嗜酒,而死于发狂见鬼;有好茶而为癖。于是知道诸药都不可久服,只能攻邪,邪去则已。近年运使张伯英病宿伤,服硫黄、姜、附数月,一天失明;监察陈威卿病嗽,服钟乳粉数年,呕血而死。呜呼!后之谈补者,尚且以此为鉴吧!
The chapter "On the Origin of Tonification" should not have been written, as contemporary discussions on tonification contradict the *Neijing* (Classic of Internal Medicine). I was compelled to write it. For health preservation, one should discuss dietary tonification; for treating disease, one should discuss pharmacological attack/expulsion. However, listeners find these words disagreeable and consider my statements strange. Generally, critics know the benefits of tonification but ignore its harms. There are six methods of discussing tonification: mild tonification (Ping Bu), severe/strong tonification (Jun Bu), warm tonification (Wen Bu), cold tonification (Han Bu), tonification for sinews and strength (Jin Li Zhi Bu), and tonification for sexual intercourse (Fang Shi Zhi Bu). Ginseng (Renshen) and Astragalus (Huangqi) are used for mild tonification; Aconite (Fuzi) and Sulfur (Liuhuang) for severe tonification; Cardamom (Doukou) and Cinnamon Bark (Guigui) for warm tonification; Asparagus Root (Tianmendong) and Dogwood Bark (Wujiapi) for cold tonification; Morinda Root (Bajitian) and Cistanche (Roucongrong) for tonification of sinews and strength; Stone Swallow (Shiyan), Seahorse (Haima), Arsenic Trioxide (Qishi), and Cinnabar (Dansha) for tonification of sexual function. These six constitute what modern times call tonification. If applied to treating disease, not only are their effects sparse and broad, but their harms are countless.
The *Nan Jing* (Classic of Difficult Issues) states: "East is excess, West is deficiency; drain the South, tonify the North." This refers to Liver Wood excess and Lung Metal deficiency; draining Heart Fire and tonifying Kidney Water. By this logic, the aforementioned six types of tonification are irrelevant. Let us cite examples of how tonification causes harm: Malaria (Nué) originates from summer heat injury. Critics attribute it to Spleen Cold and apply tonification; warm tonification leads to danger, strong tonification to death. After purgation in Cold Damage (Shanghan) or febrile diseases, if warm-acrid herbs are used for tonification, heat will recur, potentially leading to fatal hemorrhage (Xie Xue); after bleeding stops, warm tonification may cause blood heat, dysuria, or transform into edema (Shuizhong), Huoluan (cholera-like vomiting and diarrhea). If originally caused by Wind-Dampness, warm tonification is dangerous, strong tonification fatal. After pediatric sores, warm tonification can trigger carbuncles and swelling. Postpartum women often have un-descended Heart Fire and un-ascended Kidney Water; using Heishen San (Black Divine Powder) for tonification can lead to danger or death. Elderly people with dim vision and deafness suffer from declining Kidney Water and flourishing Heart Fire; strong tonification dries Kidney Water further and exacerbates Heart Fire. Elderly people with Kidney deficiency causing lumbar pain: the Kidney dislikes dryness, and the waist is the mansion of the Kidney; strong tonification worsens Kidney deficiency. Elderly people with Kidney deficiency, weakness, and nocturia: the Kidney governs the feet; deficient Kidney Water fails to descend fire, causing foot flaccidity; Heart Fire attacks the Lungs instead of entering the Bladder, causing nocturia; strong tonification drives fire upward and chills the Bladder! Elderly people with wheezing and coughing due to Fire attacking the Lungs: warm tonification aggravates the condition, strong tonification endangers life. Patients with retained fluid cannot be tonified, as it increases stagnation and fullness. Patients with heavy legs cannot be tonified, as it weighs down the calves and knees.
Men around twenty with insufficient essence, and women around twenty with stagnant blood, both suffer from Yangming disease. Laypeople fail to recognize this, treating it as accumulated cold and extreme exhaustion with mild-warm tonification. Accumulated warmth generates heat; how much more so when burning needles are applied below the navel or moxibustion is used on the wrist and ankle bones? The *Neijing* originally had no concept of "Consumption Disease" (Lao Zheng). From this misinterpretation arises Consumption, characterized by irritability, thirst, coughing with phlegm, emaciation, alternating chills and fever, night sweats, and facial redness at noon. These are mistaken for "Transmitting Corpse Consumption" (Chuanshi Lao), a disease that does not exist naturally but is created by medical error. "Two Yang" refers to Yangming, the Stomach meridian. If the Heart is affected, blood does not flow; if the Spleen is affected, flavors are not transformed. Thus, scanty semen in men and amenorrhea in women result from excessive sexual activity ("making use of the interior"). Consequently, intimate acts become impossible. Only those who deeply understand the methods of inducing vomiting (Yong) and purging (Xie) can treat this. Similarly, in the spring months, wind injures the Ying (Nutrient) level; Ying belongs to Blood, so Yin is affected. Warmth injures the Wei (Defensive) level; Wei belongs to Qi, so Yang is affected. Initially, symptoms resemble Cold Damage: headache, fever, dry mouth, tidal fever, constipation for several days. This matches Zhang Zhongjing's description of "both Yin and Yang pulses floating, spontaneous sweating, body heaviness, excessive sleepiness, and unwillingness to open the eyes." If treated with cold purgatives, Zang organs are damaged; if treated with warm tonics, fire aids wind-warmth, leading to jaundice, macules, and intensified warm-toxic heat. Severe external wind-warmth causes staring eyes, tidal fever, delirium, picking at empty air, fright, and death—this is the fault of warm tonification. Although the *Neijing* states that for form/Qi deficiency, one warms with Qi; for essence deficiency, one tonifies with flavor, and that Qi is Yang (nourished by Heaven's five qi) while Blood is Yin (nourished by Earth's five flavors), this warns against imbalance, not that "warm" equals "hot." Furthermore, "Deficiency is tonified, Labor is warmed"—here "warm" means gentle care, not heat. "Tonify the Mother when deficient, Drain the Child when excess" aims for balance. Why must one use burning needles, intense fire, refined stones, arsenic, sulfur, ginger, aconite, etc., to call it tonification? "Tonifying the upper requires slowness, tonifying the lower requires speed"—where is this speed in such harsh substances? One relies on sour, bitter, sweet, acrid, salty, and bland flavors, and cold, cool, warm, hot, and neutral properties, acting as Sovereign, Minister, Assistant, and Courier. "Mild tonification" means balancing Yin and Yang equally. Yet people hate cold and love warmth, willingly accepting toxic harshness even unto death. Alas!
My use of tonification is different. I address the excess aspect of Qi, allowing the deficient aspect to normalize naturally. The medical way is to reduce excess, thereby supplementing deficiency. I once said: Vomiting contains sweating; purging contains tonification. Is this not true? When I use tonification, I first observe where the patient can be tonified. Formerly, Zhao Xianzhi, Prefect Judge of Weiyang, suffered from emaciation and brown diarrhea, a case of Dongxie (profuse watery diarrhea) due to Cold-Stagnation. He reacted violently to the smell of Rhubarb (Dahuang). His pulses were deep and soft. I ordered over 100 moxa cones on Shuifen (CV9), followed by Guiling Ganlu San, Weifeng Tang, and Baizhu Wan. He recovered in months. Zhao Jindao, Wine Supervisor of Xicheng, suffered from low back pain for over a year. His pulses were deep, solid, and forceful. I purged him 5-7 times with Tongjing San. Then, I prepared Du Zhong (Eucommia Bark) finely chopped and stir-fried until silk threads break, powdered. Each dose: 3 qian. One pig kidney, sliced thinly, soaked in pepper salt to remove fishiness, stuffed with the powder, wrapped in lotus leaf, sealed with wet paper, and cooked slowly. Chewed well before bed, taken with warm wine. Additionally, Wubi Shanyao Wan was taken every morning. He recovered in days. Yue Chengzhi, Wine Inspector of Xiangtai, suffered from weak slippery diarrhea day and night, with intestinal borborygmus and mouth ulcers (folk name: Heart-Labor Mouth Ulcer), lasting three years. I decocted Wuling San (Five-Ingredient Powder with Poria) with ginger and jujube in long-flowing water, taken on an empty stomach to treat the lower burner. I mixed Huanglian (Coptis Rhizome) and Fuling (Poria) in equal parts, made pills with wheat paste, taken after meals with warm water to treat the upper burner. He recovered in 100 days. Wanyan Junbao, Vice Commander of Runan, suffered from Zangdu (visceral toxin), bloody stools, thirst, alternating chills and fever, lasting six years, becoming progressively emaciated and yellow-faced. His pulses were deep, and his body was cool. The *Neijing* says cold indicates Ying Qi remains, thus survival is possible; it is treatable. I purged him 5-7 times with Qixuan Wan. Then, I administered Huanglian Jiedu Tang (Coptis Decoction to Relieve Toxicity) with Dang Gui (Angelica Sinensis) and Chishao (Red Peony Root), decocted with Diyü (Sanguisorba Root). He recovered in one month.
In these cases, although I used tonification, I always preceded it with attack/purgative drugs. Why? Because if pathogenic factors remain, one cannot speak of tonification; tonifying then only aids the enemy. Once pathogens are eliminated, one should nourish with grains, assist with fruits, benefit with meats, and fill with vegetables, adapting to the needs of the Five Zang organs without causing imbalance. All medicines are toxic. Not just major or minor toxins are called toxic; even Licorice (Gancao) and Sophora (Kushen) are toxic. Long-term use inevitably causes imbalance. Prolonged increase of one Qi leads to premature death. Therefore, gentlemen value flow over stagnation, and balance over strength. Lu Shi said: "Strength breeds all diseases." How insightful! Relying on strength invites diseases from sexual fatigue; why value tonification? Even Emperor Taizong and Xianzong, with their high intelligence, fell victim to vulgar prejudices and were misled by alchemists' drying drugs. Han Yu and Yuan Zhen died of urinary retention and edema. Some died of sudden collapse after taking Dan (elixirs); some died of beard sores after taking Caowutou (Aconitum carmichaelii) or Rusheng Wan; some suffered urinary retention from Milkstone (Rushi) and Sulfur; some died of depleted essence/blood seeking heirs; some died of madness and hallucinations from alcoholism; some developed tea addiction. Thus, we know medicines should not be taken long-term; they are only for expelling pathogens. Once pathogens are gone, stop. Recently, Transport Commissioner Zhang Boying took Sulfur, Ginger, and Aconite for months for chronic injury and lost his sight in a day. Censor Chen Weiqing took Zhuru (Stalactite) powder for years for cough and died of hematemesis. Alas! Those who discuss tonification in later generations should take this as a warning!