黄连、黄芩、知母、黄柏,〔治〕病在头面及手梢皮肤者,须酒炒之,借酒力上
升也。咽之下,脐之上〔者〕,〔须〕酒洗之;在下者,生用。凡熟〔升〕生〔降〕
也。大黄须煨,恐寒伤胃气;至于乌头、附子,〔须〕炮去〔其〕毒也。用〔上焦〕
药,〔须〕酒洗曝干。黄柏、〔知母〕等,寒药也,久弱之人,须合〔之
者〕,酒浸曝干,恐寒伤胃气也;熟地黄酒洗,亦然。当归酒浸,助发散之用也。
凡根〔之〕在上者,中半以上,气脉上行,以生苗者为根。中半以下,气脉下
行,入土者为梢。当知病在中焦用身,上焦用根,下焦用梢。经曰∶根升梢降。
肺〔为〕金,肝〔为〕木,肾〔为〕水,心〔为〕火,脾〔为〕土。生我者为父母,我生
者为子孙;克我者为鬼贼,我克者为妻财。相生∶木生火,火生土,土生金,金生
水,水生木。相克∶木克土,〔土克水,水克火,火克金,金克木〕。假令木生火,
木乃火之父母,火乃木之子孙;木克土,木乃土之夫,土乃木之妻。余皆仿此。
夫药有寒、热、温、凉之性,有酸、苦、辛、咸、甘、淡之味,各有所能,不可不
通〔也〕。夫药之气味不必同,同气之物,〔其〕味皆咸,其气皆寒之类是也。凡同
气之物,必有诸味,同味之物,必有诸气,互相气味,各有浓薄,性用不等,制方者,
必须明其用矣。经曰∶味为阴,味浓为纯阴,味薄为阴中之阳;气为阳,气浓为纯阳,
气薄〔为〕阳中之阴。然,味浓则泄,薄则通;气浓则发热,气薄则发泄。又曰∶辛
甘发散为阳,酸苦涌泄为阴,咸味涌泄为阴,淡味渗泄为阳。凡此之味,各有所能。
然,辛能散结润燥,苦能燥湿坚软,咸能软坚,酸能收缓,甘能缓急,淡能利窍。故经
曰∶肝苦急,急食甘以缓之;心苦缓,急食酸以收之;脾苦湿,急食苦以燥之;肺苦气
上逆,急食苦以泄之;肾苦燥,急食辛以润之,〔开腠理〕,致津液通气也。肝欲
散,急食辛以散之,以辛补之,以酸泻之;心欲软,急食咸以软之,以咸补之,以甘泻
之;脾欲缓,急食甘以缓之,以甘补之,以苦泻之;肺欲收,急食酸以收之,以酸补
之,以辛泻之;肾欲坚,急食苦以坚之,以〔苦〕补之,以咸泻之。凡此者,是明其
〔气〕味之用也。若用其味,必明其味之可否;若用其气,必明其气之所宜。识其病之
标本脏腑,寒热虚实,微甚缓急,而用其药之气味,随其证而制其方也,是故方〔有〕
君臣佐使,轻重缓急,大小反正逆从之制也。主病者为君,佐君者为臣,应臣者为使,
此随病之所宜,而又赞成方而用之。君一臣二,奇之制也;君二臣四,耦之制也。
去咽喉〔之病〕,近者奇之;〔治肝肾之病〕,远者耦之。汗者不〔可以〕奇,下者
不〔可以〕耦。补上治上制以缓,缓则气味薄;补下治下制以急,急则气味浓。薄〔者〕
则少服而频服,浓者〔则〕多服而〔顿〕服。又当明五气之郁,木郁达之,谓吐令调达
也;火郁发之,谓汗令其疏散也;土郁夺之,谓下无壅滞也;金郁泄之,谓解表利小便
也;水郁折之,谓〔制〕其〔冲〕逆也。凡此五者,乃治病之〔大〕要〔也〕。
黄连、黄芩、知母、黄柏,治疗病位在头面部及手指梢节皮肤者,必须用酒炒制,借酒的升提之力使药性上行。咽部以下、脐部以上的病位,必须用酒洗;在下部的病位,则生用。凡是熟制则药性上升,生用则药性下降。大黄必须煨制,恐怕其寒凉之性损伤胃气;至于乌头、附子,必须炮制以去除毒性。使用作用于上焦的药物,必须用酒洗后晒干。黄柏、知母等属于寒性药物,对于久病体弱之人,必须配合使用,将药物用酒浸泡后晒干,是担心寒凉之性损伤胃气;熟地黄用酒洗,也是同样的道理。当归用酒浸泡,是为了辅助发散的作用。
凡是植物的根部,在上半部分(中半以上),气脉向上运行,生长出苗的部分称为根。下半部分(中半以下),气脉向下运行,深入泥土的部分称为梢。应当知道:病在中焦使用药物的中段(身),病在上焦使用药物的根,病在下焦使用药物的梢。医经说:根性升,梢性降。
肺属金,肝属木,肾属水,心属火,脾属土。生我者为父母,我生者为子孙;克我者为鬼贼,我克者为妻财。相生关系:木生火,火生土,土生金,金生水,水生木。相克关系:木克土,土克水,水克火,火克金,金克木。假如木生火,木就是火的父母,火就是木的子孙;木克土,木就是土的丈夫,土就是木的妻子。其余类推。
药物有寒、热、温、凉四种性质,有酸、苦、辛、咸、甘、淡六种味道,各自有不同的功效,不可不通晓。药物的气味不一定相同,同一种气味的药物,其味道可能都咸,其气性都寒,这类情况就是如此。凡是气性相同的药物,必然具备各种味道;味道相同的药物,必然具备各种气性。气味相互交错,各有浓淡厚薄之分,药性和作用也不相等,制定方剂的人,必须明确其用途。医经说:味道属阴,味浓为纯阴,味薄为阴中之阳;气性属阳,气浓为纯阳,气薄为阳中之阴。然而,味浓则能泄下,味薄则能通利;气浓则能发热,气薄则能发汗解表。又说:辛味和甘味具有发散作用,属阳;酸味和苦味具有涌吐和泄下的作用,属阴;咸味具有涌吐和泄下的作用,属阴;淡味具有渗湿和泄下的作用,属阳。所有这些味道,各自有其特定的功能。然而,辛味能散结润燥,苦味能燥湿坚阴,咸味能软坚散结,酸味能收敛缓急,甘味能缓解急迫,淡味能通利窍道。所以医经说:肝苦于拘急,急需食用甘味药来缓和它;心苦于涣散,急需食用酸味药来收敛它;脾苦于湿困,急需食用苦味药来燥湿它;肺苦于气机上逆,急需食用苦味药来泄降它;肾苦于干燥,急需食用辛味药来滋润它,开发腠理,促使津液流通和气机通畅。肝喜疏散,急需食用辛味药来疏散它,用辛味补益它,用酸味泻除它;心喜柔软,急需食用咸味药来软化它,用咸味补益它,用甘味泻除它;脾喜缓和,急需食用甘味药来缓和它,用甘味补益它,用苦味泻除它;肺喜收敛,急需食用酸味药来收敛它,用酸味补益它,用辛味泻除它;肾喜坚固,急需食用苦味药来坚固它,用苦味补益它,用咸味泻除它。凡此种种,是阐明药物气味的作用。如果使用药物的味道,必须明辨该味道是否适宜;如果使用药物的气性,必须明辨该气性是否合适。认清疾病的标本、所属脏腑、寒热虚实以及病情的轻重缓急,从而选用相应气味属性的药物,根据证候来制定方剂,因此方剂中有君臣佐使的配合,有轻重缓急、大小反正逆从的法则。主治疾病的药物为君药,辅助君药的药物为臣药,配合臣药的药物为使药,这是顺应病情所需,并协助完成方剂的治疗作用。君药一味、臣药两味,是奇方的体制;君药两味、臣药四味,是偶方的体制。治疗咽喉部位的疾病,病位较近的用奇方;治疗肝肾部位的疾病,病位较远的用偶方。发汗法不可以用奇方,攻下法不可以用偶方。补益上部或治疗上部疾病,制方宜用缓剂,缓剂则气味轻薄;补益下部或治疗下部疾病,制方宜用急剂,急剂则气味浓厚。气味轻薄的药物,应少量多次服用;气味浓厚的药物,应多量一次性服用。还应当明辨五气之郁滞:木郁滞则通达之,指通过催吐使气机调达;火郁滞则发散之,指通过发汗使其疏散;土郁滞则夺之,指通过攻下消除壅滞;金郁滞则泄之,指通过解表和利小便来宣泄;水郁滞则折之,指制约其冲逆之势。这五点,乃是治病的纲要。
Coptidis Rhizoma (Huanglian), Scutellariae Radix (Huangqin), Anemarrhenae Rhizoma (Zhimu), and Phellodendri Cortex (Huangbai), when treating diseases located in the head, face, and skin of the fingertips, must be stir-fried with wine to borrow the ascending power of wine to lift the medicinal properties upward. For diseases below the throat and above the umbilicus, they must be washed with wine; for diseases in the lower part, they should be used raw. Generally, processed (cooked) herbs ascend, while raw herbs descend. Rhei Radix et Rhizoma (Dahuang) must be baked (roasted) to prevent its cold nature from damaging Stomach Qi (Stomach energy). As for Aconiti Lateralis Radix Praeparata (Wutou) and Aconiti Radix Praeparata (Fuzi), they must be processed to remove their toxicity. When using drugs that act on the Upper Jiao (Upper Burner), they must be washed with wine and sun-dried. Huangbai and Zhimu are cold-natured drugs; for people who are chronically weak, they must be combined with processing: soaked in wine and sun-dried, fearing that the cold nature will damage Stomach Qi; Rehmanniae Radix Praeparata (Shudihuang) is also washed with wine for the same reason. Angelicae Sinensis Radix (Danggui) is soaked in wine to assist its dispersing action.
Generally, for plant roots, the upper half (above the middle) has qi and blood vessels flowing upward, and the part that sprouts is called the root. The lower half (below the middle) has qi and blood vessels flowing downward, and the part entering the soil is called the tip (or end). One should know: for diseases in the Middle Jiao (Middle Burner), use the body (middle section) of the herb; for diseases in the Upper Jiao, use the root; for diseases in the Lower Jiao, use the tip. The classics state: Roots ascend, tips descend.
The Lung belongs to Metal, the Liver to Wood, the Kidney to Water, the Heart to Fire, and the Spleen to Earth. Those that generate me are Parents; those that I generate are Offspring; those that control me are Ghosts/Thieves; those that I control are Wife/Wealth. Generating cycle: Wood generates Fire, Fire generates Earth, Earth generates Metal, Metal generates Water, Water generates Wood. Controlling cycle: Wood controls Earth, Earth controls Water, Water controls Fire, Fire controls Metal, Metal controls Wood. For example, if Wood generates Fire, Wood is the Parent of Fire, and Fire is the Offspring of Wood; if Wood controls Earth, Wood is the Husband of Earth, and Earth is the Wife of Wood. The rest follow this pattern.
The Heart stores Shen (Spirit), the Lung stores Po (Corporeal Soul), the Liver stores Hun (Ethereal Soul), the Spleen stores Yi (Intellect) and Zhi (Will/Intention), and the Kidney stores Jing (Essence) and Zhi (Will/Fear).
Medicines have four natures: Cold, Hot, Warm, and Cool; and six flavors: Sour, Bitter, Pungent, Salty, Sweet, and Bland. Each has specific capabilities and must be understood thoroughly. The qi and flavor of medicines do not necessarily correspond; for instance, substances with the same qi may all have a salty flavor and cold nature. Generally, substances with the same qi possess various flavors, and substances with the same flavor possess various qis. Due to the interplay of qi and flavor, there are differences in density and thickness, leading to unequal properties and uses. Formulators must clearly understand these applications. The classics state: Flavor is Yin; dense flavor is Pure Yin, thin flavor is Yang within Yin; Qi is Yang; dense qi is Pure Yang, thin qi is Yin within Yang. However, dense flavor causes purging/descending, while thin flavor promotes unblocking/flowing; dense qi causes heat generation, while thin qi induces sweating/release. It is also said: Pungent and Sweet flavors disperse and belong to Yang; Sour and Bitter flavors induce vomiting and purging and belong to Yin; Salty flavor induces vomiting and purging and belongs to Yin; Bland flavor promotes渗泄 (percolation and draining) and belongs to Yang. All these flavors have specific functions. Specifically, Pungent can dissipate nodules and moisten dryness; Bitter can dry dampness and firm softness; Salty can soften hardness; Sour can astringe and relax tension; Sweet can relieve urgency; Bland can open orifices and promote diuresis. Thus, the classics state: If the Liver suffers from tension/urgency, urgently consume Sweet flavors to relax it; if the Heart suffers from flaccidity/scattering, urgently consume Sour flavors to astringe it; if the Spleen suffers from dampness, urgently consume Bitter flavors to dry it; if the Lung suffers from rebellious Qi, urgently consume Bitter flavors to drain it; if the Kidney suffers from dryness, urgently consume Pungent flavors to moisten it, opening the cutaneous pores, promoting fluid distribution, and facilitating Qi flow. The Liver desires dispersion, so urgently consume Pungent flavors to disperse it; use Pungent to tonify it, and Sour to drain it. The Heart desires softening, so urgently consume Salty flavors to soften it; use Salty to tonify it, and Sweet to drain it. The Spleen desires relaxation, so urgently consume Sweet flavors to relax it; use Sweet to tonify it, and Bitter to drain it. The Lung desires astringency, so urgently consume Sour flavors to astringe it; use Sour to tonify it, and Pungent to drain it. The Kidney desires firmness, so urgently consume Bitter flavors to firm it; use Bitter to tonify it, and Salty to drain it. These clarify the uses of Qi and Flavor. If using flavor, one must determine its appropriateness; if using Qi, one must determine its suitability. By identifying the root and branch of the disease, the affected Zang-Fu organs, the Cold/Heat and Deficiency/Excess patterns, and the severity and urgency, one selects medicines based on their Qi and Flavor, formulating prescriptions according to the syndrome. Therefore, prescriptions contain the hierarchy of Jun (Monarch), Chen (Minister), Zuo (Assistant), and Shi (Envoy), as well as principles of weight, urgency, size, reversal, and conformity. The drug that treats the main disease is the Monarch; the drug assisting the Monarch is the Minister; the drug responding to the Minister is the Envoy. This follows the needs of the disease and assists in completing the prescription's function. A prescription with one Monarch and two Ministers is an Odd (Qi) formula; one with two Monarchs and four Ministers is an Even (Ou) formula. For diseases of the throat, which are near, use Odd formulas; for diseases of the Liver and Kidney, which are far, use Even formulas. Sweating methods should not use Odd formulas; purging methods should not use Even formulas. Tonifying the upper or treating upper diseases requires slow-acting formulations, which have thin Qi and Flavor; tonifying the lower or treating lower diseases requires rapid-acting formulations, which have dense Qi and Flavor. Thin substances are taken in small doses frequently; dense substances are taken in larger doses at once. One must also understand the five types of Qi stagnation: Wood stagnation is resolved by venting (using emesis to regulate and smooth); Fire stagnation is resolved by dispersing (using sweating to scatter); Earth stagnation is resolved by seizing/purging (using purgatives to remove obstruction); Metal stagnation is resolved by draining (using exterior-releasing and promoting urination); Water stagnation is resolved by restraining (controlling its rushing rebellion). These five points are the major essentials of treating diseases.