『金匮要略』一书,其世远而就阙误也,与『伤寒论』等。如□饦之「□」字,与缓
中补虚用大黄□虫圆主之之类,俱不可以为法。爰加斟酌其改移删补诸式,与夫存疑
之二十八条,悉仿『伤寒论』叙次云。
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师曰:病人语声寂然,喜惊呼者,骨节间病;语声谙谙然,不彻者,心膈间病;语声
啾啾然,细而长者,「腹」〔头〕中病。
【按】
头中病之「头」字,当是「腹」字,经中从无头中病之文,且文义不属,当改之。
师曰:吸而微数,其病在中焦,实也,当下之即愈,虚者不治。在上焦者,其吸「远
」〔促〕;在下焦者,其吸「促」〔远〕,此皆难治。呼吸动摇振振者,不治。
【按】
吸促之「促」字,当是「远」字,吸远之「远」字,当是「促」字;方合病义,当移
之。
问曰:〔寸脉沉大而滑,沉则为实,滑则为气,实气相搏,〕「厥」〔血〕气入藏即
死,入府即愈,此为卒厥,何谓也?师曰:唇口青,身冷,为入藏,即死;如身和,
汗自出,为入府,即愈。
【按】
「寸脉沉大而滑,沉则为实,滑则为气,实气相搏」之十八字,文理不顺,衍文也,
当删之。血气入藏之「血」字,当是「厥」字,始与卒厥相合,当改之。
问曰:阳病十八,何谓也?师曰:头痛,项、腰、脊、臂、脚掣痛。阴病十八,何谓
也?师曰:欬,上气,喘,哕,咽,肠鸣,胀满,心痛,拘急。五藏病各有十八,合
为九十病;人又有六微,微有十八病,合为一百八病。五劳、七伤、六极,妇人三十
六病,不在其中。清邪居上,浊邪居下,大邪中表,小邪中里,「漀」〔□〕饦之邪
,从口入者,宿食也。五邪中人,各有法度,风中于前,寒中于暮,湿伤于下,雾伤
于上,风令脉浮,寒令脉急,雾伤皮腠,湿流关节,食伤脾胃,极寒伤经,极热伤络
。
【按】
字典无「□」字,当是「漀」字,漀音倾,侧水也。后之积聚门,□气之「□」字,
亦误。
问曰:病有急当救里救表者,何谓也?师曰:病,医下之,续得下利清谷不止,身体
疼痛者,急当救里;后身体疼痛,清便自调者,急当救表也。
【按】
此条注,详见『伤寒论·太阴篇』内,故不复释。
夫诸病在藏,欲攻之,当随其所得而攻之,如渴者「小便不利」,与猪苓汤,余皆仿
此。
【按】
如渴者之下,当有「小便不利」四字,必是遗失,当补之。
《金匮要略》这本书,由于年代久远而存在缺漏和错误,与《伤寒论》等书的情况相同。例如“饦”字中的那个缺字(□),以及治疗缓中补虚时使用的“大黄䗪虫丸主之”中的那个缺字(□)之类,都不可以作为定法依据。因此加以斟酌,对其修改、移动、删除和补充的各种形式,以及保留疑问的二十八条内容,全部仿照《伤寒论》的叙述顺序进行整理。
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│补注:正误各条置于引号内者为改正正确者,置于中括弧内者为应删错误原文。│
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老师说:病人说话声音寂静,却喜欢突然惊呼的,是骨节间的病;说话声音低沉含糊(谙谙然),不通畅的,是心膈间的病;说话声音细微悠长(啾啾然),是头部(原书作“腹”,此处存疑)的病。
【按语】
“头中病”的“头”字,应当是“腹”字,医经中从来没有“头中病”的说法,而且文义不通顺,应当改正。
老师说:吸气轻微急促的,病在中焦,属于实证,用泻下法即可痊愈;如果是虚证,则难以治愈。病在上焦的,其吸气表现为短促(原书作“远”,此处存疑);病在下焦的,其吸气表现为深长(原书作“促”,此处存疑),这些都属于难治之症。如果呼吸时身体动摇震颤,则是死证,无法治愈。
【按语】
“吸促”的“促”字,应当是“远”字;“吸远”的“远”字,应当是“促”字;这样才符合病义,应当互换位置。
问:〔寸脉沉大而滑,沉则为实,滑则为气,实气相搏,〕“厥”〔血〕气入脏即死,入腑即愈,这叫做卒厥,是什么意思?老师说:嘴唇口唇发青,身体冰冷,这是邪气入脏,就会死亡;如果身体温和,汗自然流出,这是邪气入腑,就会痊愈。
【按语】
“寸脉沉大而滑,沉则为实,滑则为气,实气相搏”这十八个字,文理不顺,是衍文(多余的文字),应当删除。“血气入脏”的“血”字,应当是“厥”字,这样才能与“卒厥”相吻合,应当改正。
问:阳病有十八种,是什么?老师说:头痛,项、腰、脊、臂、脚掣痛。阴病有十八种,是什么?老师说:咳嗽,上气,气喘,呃逆,咽部不适,肠鸣,胀满,心痛,拘急。五脏病各有十八种,合起来为九十种病;人又有六微(六种轻微病变),每种有十八种病,合起来为一百零八种病。五劳、七伤、六极,妇女三十六病,不在其中。清邪居上位,浊邪居下位,大邪侵袭体表,小邪侵入体内,“漀”〔□〕饦之邪,从口进入的,是宿食。五种邪气伤人,各有规律,风邪在前(早晨)伤人,寒邪在傍晚伤人,湿邪损伤下部,雾邪损伤上部,风邪使脉象浮,寒邪使脉象紧急,雾邪损伤皮肤腠理,湿邪流注关节,饮食损伤脾胃,极寒损伤经脉,极热损伤络脉。
【按语】
字典中没有“□”字,应当是“漀”字,漀音倾,意为侧水。后来的积聚门中,“□气”的“□”字,也是错误的。
问:疾病有应当先救里或先救表的,是什么意思?老师说:患病后,医生误用泻下法,接着出现下利清谷不止,身体疼痛的,应当紧急救里;后来身体疼痛,大小便正常的,应当紧急救表。
【按语】
这条内容的注释,详见《伤寒论·太阴篇》内,所以不再解释。
凡是各种病在脏,想要攻逐它,应当随着它所结合的部位来攻逐它,比如口渴且“小便不利”的,给予猪苓汤,其余都仿照这个原则。
【按语】
“如渴者”之下,应当有“小便不利”这四个字,必定是遗失了,应当补上。
The book *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet), due to its great age, has suffered from omissions and errors, similar to those found in *Shanghan Lun* (Treatise on Cold Damage). For instance, the missing character (□) in "Tuō" (a type of food or symptom context), and the missing character (□) in the prescription "Da Huang Zhe Chong Wan" (Cinnabar and Ground Beetle Pill) used for treating "Huan Zhong Bu Xu" (relaxing the middle and tonifying deficiency), cannot be taken as standard methods. Therefore, after careful consideration, the various forms of modification, relocation, deletion, and supplementation have been arranged, along with the twenty-eight items retained for doubt, all following the narrative order of *Shanghan Lun*.
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The Master said: When a patient's voice is silent but they frequently startle with loud cries, the disease is in the joints; when their voice is muffled and indistinct, failing to resonate clearly, the disease is in the heart and diaphragm region; when their voice is fine and prolonged, the disease is in the head [original text says "abdomen", here under suspicion].
[Commentary]
The character "head" in "disease in the head" should be "abdomen". There is no mention of "disease in the head" in the classics, and the meaning does not fit; it should be corrected.
The Master said: If inspiration is slightly rapid, the disease is in the Middle Jiao (Middle Burner), which is an Excess pattern; purgation will lead to recovery. If it is a Deficiency pattern, it is difficult to treat. If the disease is in the Upper Jiao (Upper Burner), inspiration is [original text says "prolonged/deep", here under suspicion]; if the disease is in the Lower Jiao (Lower Burner), inspiration is [original text says "rapid/shallow", here under suspicion]. These are all difficult to treat. If there is trembling and shaking during respiration, it is a death sign and untreatable.
[Commentary]
The character "rapid" in "rapid inspiration" should be "prolonged/deep"; the character "prolonged/deep" in "prolonged inspiration" should be "rapid". This aligns with the pathological meaning and should be swapped.
Question: [If the Cun position pulse is deep, large, and slippery, deep indicates Excess, slippery indicates Qi stagnation, and Excess and Qi struggle together,] "Jue" [Blood] Qi entering the Zang organs leads to death, while entering the Fu organs leads to recovery. This is called "Cu Jue" (Sudden Jue), what does this mean? The Master said: Blue lips and mouth, cold body, indicate entry into the Zang organs, leading to death; if the body is warm and sweat comes out spontaneously, it indicates entry into the Fu organs, leading to recovery.
[Commentary]
The eighteen characters "Cun pulse deep, large, and slippery, deep indicates Excess, slippery indicates Qi, Excess and Qi struggle together" do not flow logically and are superfluous text (derivative error); they should be deleted. The character "blood" in "Blood Qi entering Zang" should be "Jue" (Cold/Reversal). Only then does it correspond to "Su Jue" (Sudden Jue/Cold Reversal); it should be corrected.
Question: What are the Eighteen Yang Diseases? The Master said: Headache, stiffness/pain in the neck, waist, spine, arms, and pulling pain in the legs. What are the Eighteen Yin Diseases? The Master said: Cough, rebellious Qi, wheezing, hiccups, throat discomfort, borborygmus (intestinal rumbling), distension and fullness, heart pain, and spasm/tightness. Each of the Five Zang organs has eighteen diseases, totaling ninety diseases. Humans also have Six Micro (minor) conditions, each having eighteen diseases, totaling one hundred and eight diseases. The Five Labors, Seven Injuries, Six Extremes, and Thirty-Six Women's Diseases are not included within these counts. Clear pathogens reside in the upper part, turbid pathogens reside in the lower part, major pathogens strike the exterior, minor pathogens strike the interior. Pathogens of "Qi Tuō" [□] entering through the mouth are retained food (undigested food). The five types of pathogens attacking humans follow specific laws: Wind attacks in the morning (front), Cold attacks in the evening, Dampness injures the lower part, Fog injures the upper part. Wind causes the pulse to be floating, Cold causes the pulse to be tight. Fog injures the skin and interstices, Dampness flows into the joints. Food damages the Spleen and Stomach, extreme Cold damages the meridians, extreme Heat damages the collaterals.
[Commentary]
The dictionary does not contain the character "□"; it should be "Qi" (漀), pronounced "qing," meaning water flowing sideways. In the later section on Accumulation and Gathering, the character "□" in "□ Qi" is also an error.
Question: In diseases, when should one urgently rescue the Interior or the Exterior? What does this mean? The Master said: If a patient was treated by a physician with purgatives, and subsequently suffers from continuous diarrhea with undigested food, accompanied by body pain, one must urgently rescue the Interior. Later, if the body pain persists but bowel movements and urination are normal, one must urgently rescue the Exterior.
[Commentary]
For the commentary on this item, see *Shanghan Lun*, Taoin Chapter, so it is not explained again here.
For any disease located in the Zang organs, if one wishes to attack it, one should follow where the pathogen has gathered to attack it. For example, for thirst with "difficulty in urination," administer Zhu Ling Tang (Polyporus Decoction); apply this principle to others.
[Commentary]
After "for thirst," the four characters "difficulty in urination" should exist; they were likely lost and should be supplemented.