李东垣先生曰。自伏羲神农黄帝而下。名医虽多。所可法者有几人哉。至于华氏之剖腹
。王
氏之针妖。术非不神也。后人安得而仿之。非若岐伯之圣经。雷公之炮炙。伊芳挚之汤液。箕
子之洪范。越人之问难。仲景之伤寒。叔和之脉诀。士安之甲乙。启玄子之传注。钱仲阳之
论议。洁古之方书。皆活法所可学人。岂千方万论。印定后人眼目者所能比哉。其间德高行
远。奇才异士。与夫居缙绅。隐草野者。虽有一节一法之可观。非百代可行之活法。皆所不
取
也。予岂好辨哉。欲使学人观此数圣贤。而知所向慕而已。或有人焉。徒知广览泛诵。自以
为多学。而用无益者。岂其知本欤。
或问丹溪朱彦修先生曰。医之为事。切脉察病用药。先生必以读儒书者能之何也。曰。
非四
书无以穷理尽性。成格物致知之功。非易无以穷阴阳造化功用。消长生成之道。升降浮沉之
理。孙真人曰。不知易者。不足以言太医。
问曰。医书何先。曰必须先读内经。本草。脉经。非内经无以识病。非本草无以识药。
非脉经何以诊候。然后却参诸家之说。
又问仲景伤寒。出证见方。为医学之祖。亦先须看否。答曰。凡先入者为主。内经尽阴
阳之
妙。变化无穷。诸书皆出于此。如越人演八十一难。止得内经中一二。仲景取其伤寒一节。
河间以热论变仲景之法。东垣以饮食劳役立论。恐先仲景书者。以伤寒为主。恐误内伤作外
感。先东垣书者以胃气为主。恐误外感为内伤。先河间书者。以热为主。恐误以寒为热。不
若先主于内经。则自然活泼泼地。
问曰。今之医但看脉诀。以为诊视。越诸方书。便可治病。以为简便。先生之教读内经
。虽
识病无方可据。脉经千条万绪。难以抚寻。曰。正欲如此。人之生命至重。非积岁月之功。
岂可便视人之疾。前人立论制方。有与内经意合者。有穿凿者。有立意偏者。有因病而以病
人之虚实形气脉证而制方者。病之变化无穷。人之形志苦乐不一。地土所宜。证有相似。治
有不同。不读内经。便欲据方施治。若有差误。死不复生。人虽不知。于心安乎。脉理精微
。通阴阳造化之理。千变万化。圣人尚论其端绪。秘其蕴奥。善为脉者。从而推展。岂高阳
生数语之脉诀能尽无穷之病邪。
先生曰。刘张之学。其论脏腑气化有六。而于湿热相火三气致病为甚多。以推陈致新。
泻火
之法疗之。此固高出前代矣。然有阴虚火动。或阴阳两虚。湿热自甚者。又当消息而治之。
东垣之谓饮食劳倦。内伤元气。则胃脘之阳。不能升举。并心肺之气陷入于中焦。而用补中
益气等药治之。此亦前人所无也。然天不足于西北。地不满于东南。天阳而地阴。西北之人
阳气易降。东南之人阴气易升。苟不知此。而徒取其法。则于气之降者。固可以获效。，而
于气之升者。亦从而用之。吾恐反增其病矣。当以三家之论。去其短而取其长。又曰。阴不
足而阳有余。因而思之。故人病气升者多。气降者少。是其验也。补其阴与阳齐等。则水火
自然升降。所谓乾坤定位。而坎离交也。
凡治病用药。以前人方论未可者。切不宜孟浪。须沉潜思绎。千条万绪。必求气之所在
而取之。不过格物致知之功。久久自入穷通变化之妙。
论曰。五运六气。内经备论。诸方所略。其理奥妙。未易造入。愿发明焉。曰。学医之
初。
且须识病机。知变化。论人形而处治。若便工于气运。恐流于马宗素之徒。而云某生人于某
日。病为某经。用某药治之之类也。人之脏腑。外应天地。司气司运。八风动静之变。人气
应焉。岂不切当。苟不知此。为医未造其理。何以调之。杨太受常云。五运六气。须每日候
之。记其风雨冥晦。而有应时作病者。有伏气后时而病者。有故病冲而动者。体认纯熟。久
则自能造其至极。
治病用药犹权衡。不可毫厘轻重也。若以执古方而治今病。更不酌量。吾不知其不能无
少差也。
先生曰。吾每治病。用东垣之药。效仲景处方。庶品味数少。则药力专精也。问曰。读素问
有不晓者奈何。曰。乃上古之书。中间多有阙文讹舛。且通其所可通。缺其所可疑。又王冰
释于强解。及失经意者亦有之。须自要着力熟读玩味。
问曰。素难之外。更看何书为要。曰。外感法重景。内伤法东垣。则仲景治法。更合内
经。然于读书皆须览过。以长识见。
问曰先生治病有证同而异治者。又非地土不同。老幼苦乐之异何也。曰。阴阳气运。参
差不
齐。赋生有浓薄。五气有偏胜。脏腑刚柔不同。用药以抑强扶弱取中而治。岂得而同也。
问曰诸方立论。有多用热者。有多用寒者。时之异耶。地势之然也。曰。看方须要知其
立意。取其所长。去其所短。人性偏执。其通疏者。自古及今。宁几人欤。
问曰一人之证。久伏床枕。处方既定。前后又有加减者何也。曰。内有国中虚实之异。
外
有八风之变。四时更易。气运迭迁。七情所动。是以主病之药虽不更。佐使岂无加减也。
问曰何以谓之通疏。曰。无先入之主。能穷变化之神。识时措之宜。致二五之精妙合为
冲和
之气。虚则补之。实则泻之。寒者热之。热者寒之。上者抑之。下者举之。无所偏负。则自
然天地位。而万物育矣。
尝看成无己注伤寒论曰。夫伤寒之病。以阳气为主。只此一句。已见深造圣蕴。盖天之
邪气
感。则伤人气也。饮食起居七情动。则伤人形也。然此其深者。气病形乃应。形气病乃从。治病必求其本。
先生曰。仲景治伤寒以寒字为主。用辛热甘热等药者。主即病而言。河间治热病。以热
字为主。用辛凉等剂者。主不即病。寒毒藏于肌肤。至春变温。至夏变为热病之意也。
问曰。阴阳之体用。先生尝以阴不足。而阳有余。远取诸天地日月为譬其体也。近取呼
吸升
降为喻其用也。则得闻命矣。然阴阳虚实之体虽不同。而其升降之用。所乘之机。既无降杀
。则阴之体本虚。曷用补哉。
先生曰。邵子谓天地自相根据附。天根据形。地附气。其形也有涯。其气也无涯。人之形质
有涯
者也。天癸绝后。形则衰矣。苟不益阴以内守。则阳亦无以发扬为健运之能。是天失所根据也
。而为飘散飞荡如丧家之狗耳。阳既飘散。则地愈失所附也。形气不相根据附则死矣。人其补
养残衰伤朽之质。又何云哉。
先生曰。治病必分血气。如气病补血。虽不中病亦无害也。血病补气。则血愈虚散。散
则气
血俱虚。是谓诛罚无过也。病或昼轻夜重者血病也。昼重夜轻者气病也。盖昼阳夜阴也。
座右铭曰。学问所以别理欲。开昏闭。衣食所以防饥寒。广恩惠。言行要留好样与儿孙
。心术要不得罪于天地。
卫生药室铭曰。治病之方。先顾元气。攻病击邪。斟酌药剂。邪轻剂轻。邪峻剂峻。元
气或
虚。峻剂当慎。必求其本。如流有源。泥标忘本。白首不痊。血病治血。气病治气。脏腑经
络。逐一点视。虚的施补。实的施泻。察色听声。勿差纤芥。属寒治寒。属热治热。属湿燥
火。细心分别。气微则逆。气甚则从。逆为正治。从乃反攻。从少从多。各观其事。其始则
同
。其终则异。必先岁气。毋伐天和。违时伐化。夭殃斯多。寒热温凉。用之远之。升降浮沉
。顺时为宜。厥逆厥顺。道理玄微。或有所假。不必拘之。在表治表。在里治里。汗下之间
。反掌生死。上制以缓。下制以急。缓急不分。无过受击。新病猛除。久病宽治。不久不新
。宽猛相济。求治之诚。必当自宝。毋得苟就。轻此至道。病不可治。必当速已。毋得容情
。启人之毁。凡此数条。圣师至训。洞然于胸。正行无问。
广陵丘克容先生曰。今医之专门于刘张者。率以发汗吐下施治。盖本诸张子和十形三疗
。若
曰风。寒。暑。湿。燥。火。内伤。外伤。内积。外积。视其中人。身之上若下。必三法之
可已。果子和之遗意欤。何其与内经仲景之言大不相似也。内经不曰。邪气盛则实。精气夺
则虚。又曰。虚则补之。实则泻之。邪盛而实当泻。三法或可已也。精夺而虚当补。将无他
治欤。第曰。木郁则达之。火郁则发之。土郁则夺之。金郁则泄之。水郁则折之。是亦发汗
吐下
之别称也。向使此无彼遏。果例用欤。仲景治外感。分六经。别腑脏。亦尝发汗吐下也。而
太阳有解肌。少阳则三禁。并病用刺法。岂无其故欤。子和亦曰。不读本草。焉知药性。又
曰。识病得法。工中之甲。仗三疗疗十形。又何必知药性求得法哉。岂子和真书亡于金源氏
之南迁。此特后人附会其说。而执迷妄意者。遂以卤莽之言为的确之论。甚至认虚为实。假
寒为燠。其于适事为故。与夫各安其气之说。略不加究。志古之士。独无憾焉。
夫医道之有内经以来。历代名医着述之藏有司者。至有元时得一百七十九家。二百九部
。一
千二百五十九卷。不为不多矣。然其要者宁几欤。惟七书而下。所可法者。如有宋成无己伤
寒明理论。金之刘守真原病式。元李明之内外伤辨。医学发明。活法机要。王好古此事难知
。罗谦甫卫生宝鉴。朱彦修局方发挥。及圣朝滑伯仁十四经发挥。徐用诚本草发挥。皆启七
书之精奥。为体用之本领云。
李东垣先生说：“从伏羲、神农、黄帝以来，名医虽然众多，但值得效法的又有几人呢？至于华佗（华氏）的剖腹手术，王叔和（王氏，此处指代某种针法传说或特定人物，原文‘针妖’疑为传抄异文或特指某类高深针法，暂译为‘神奇的针刺技艺’）的针刺技艺，技术并非不神妙，但后人怎能仿效得了呢？这不像岐伯的经典著作，雷公的炮制方法，伊尹（伊芳挚）的汤液方剂，箕子的《洪范》，扁鹊（越人）的问难对答，张仲景的《伤寒论》，王叔和的《脉诀》，皇甫谧（士安）的《甲乙经》，启玄子（王冰）的注释，钱乙（钱仲阳）的议论，洁古（张元素）的方书，这些都是可以让人学习的活法。哪里是那些千篇一律、万种论述，用来固定后人眼光的东西所能相比的呢？其中德行高尚、品行深远、才华奇特的人士，以及那些身居官位或隐居乡野的人，虽然有一节一法值得观赏，但不是百代可行的活法，都不被取用。我难道喜欢争辩吗？只是希望让学医者观看这几位圣贤，从而知道所向往仰慕的对象罢了。如果有人只知道广泛浏览、泛泛诵读，自以为学识渊博，但应用起来却无益处，这难道是懂得根本吗？”
有人问丹溪朱彦修先生：“医学这件事，切脉、察病、用药，先生为什么一定认为读儒家书籍的人才能做好呢？”回答说：“没有《四书》就无法穷尽事理、尽性至命，完成格物致知的功夫；没有《易经》就无法穷尽阴阳造化的功用，消长生成的道理，升降浮沉的原理。孙思邈说：不懂《易经》的人，不足以称为太医。”
又问：“医书应该先读哪一本？”回答说：“必须先读《内经》、《本草》、《脉经》。不读《内经》就无法认识疾病，不读《本草》就无法认识药物，不读《脉经》如何诊察候脉？然后才参看各家学说。”
又问：“张仲景的《伤寒论》，出示证候并给出方剂，是医学的祖师，是否也需要先看？”回答说：“凡是先入为主的内容往往成为主导。《内经》穷尽了阴阳的奥妙，变化无穷，其他书籍都出于此。如扁鹊演绎的《八十一难经》，只得到了《内经》中的一二成；张仲景选取了《伤寒》这一部分；刘河间（河间）以热论改变了张仲景的方法；李东垣以饮食劳倦立论。如果先读张仲景的书，以伤寒为主，恐怕会把内伤误作外感；先读李东垣的书，以胃气为主，恐怕会把外感误作内伤；先读刘河间的书，以热为主，恐怕会把寒证误作热证。不如先以《内经》为主导，那么自然就能活泼灵动。”
又问：“现在的医生只看《脉诀》，以此作为诊视依据，忽略其他方书，就可以治病，认为这样简便。先生教导读《内经》，虽然能认识疾病但没有现成的方子依据，《脉经》千条万绪，难以查找。”回答说：“正是要像这样。人的生命至关重要，不是积累岁月的功夫，怎么能轻易诊治他人的疾病呢？前人立论制方，有的与《内经》意旨相合，有的穿凿附会，有的立意偏颇，有的因病而根据病人的虚实形气脉证来制方。病的变化无穷无尽，人的形体意志苦乐不一，各地水土适宜不同，证候有相似之处，治疗方法却不同。不读《内经》，就想依据现成方子施治，如果有差错，死了就救不回来了。别人虽然不知道，但自己心里安得下吗？脉理精微，通晓阴阳造化的道理，千变万化。圣人尚且讨论其端绪，秘藏其深奥，善于诊脉的人，顺着推展探究，难道是高阳生那几句简单的《脉诀》能穷尽无穷的疾病吗？”
先生说：“刘完素、张从正之学，他们的脏腑气化理论有六点，而对于湿热、相火三气致病尤为多，用推陈致新、泻火的方法来治疗。这固然高出前代。然而有阴虚火动，或者阴阳两虚，湿热自盛的情况，又应当斟酌情况而治疗。李东垣所说的饮食劳倦，内伤元气，导致胃脘之阳不能升举，心肺之气陷入中焦，而用补中益气等药治疗。这也是前人所没有的。然而天不足于西北，地不满于东南，天属阳地属阴，西北之人阳气易降，东南之人阴气易升。如果不了解这一点，仅仅取其方法，那么对于阳气下降的病，固然可以见效，但对于阳气上升的病，也跟随使用降气之法，我恐怕反而会增加病情。应当综合三家的论述，去掉短处，吸取长处。”又说：“阴不足而阳有余，由此思考，所以人患病时气机上逆的多，气机下降的少，这就是验证。补充阴气使其与阳气相等，那么水火自然升降，这就是所谓的乾坤定位，坎离交济。”
大凡治病用药，对于前人方论中不可行的，切忌鲁莽。必须深沉潜心地思考推绎，千头万绪，必须探求气的所在而取法。不过是格物致知的功夫，时间久了自然能进入穷通变化的妙境。
评论说：“五运六气，《内经》中有详细论述，各方书略而不谈。其理奥妙，不容易深入。希望您能阐明它。”回答说：“初学医的时候，且须认识病机，知道变化，论断人的形体而处理治疗。如果便精通于气运，恐怕会流于马宗素这类人，说什么某人出生在某天，病在某经，用某药治疗之类的话。人的脏腑，外应天地，司掌气运，八风动静之变，人气随之响应。这难道不恰当吗？如果不了解这些，做医生尚未达到其理，凭什么去调治呢？杨太受常说，五运六气，必须每天观察记录风雨晦明，而有按时发作的疾病，有伏气滞后而发病的，有旧病冲动而发作的。体认纯熟，久了自然能达到极致。”
治病用药如同权衡轻重，不可以毫厘之差。如果拿着古方来治今病，不再斟酌度量，我不知道他不会有一点差错。
先生说：“我每次治病，用药效法李东垣，处方效法张仲景，大概因为药味数量少，则药力专精。”问：“读《素问》有不明白的地方怎么办？”回答说：“那是上古的书，中间多有缺文讹误。姑且通晓那些可以通晓的，保留那些可疑的缺失。而且王冰的解释有时强解，也有失掉经文原意的地方。必须自己要着力熟读玩味。”
问：“在《素问》、《难经》之外，再看什么书为重要？”回答说：“外感病效法张仲景，内伤病效法李东垣，那么张仲景的治法，更契合《内经》。然而在读书上都须浏览过，以增加见识。”
问：“先生治病有证候相同而治疗方法不同的，又不是因为地域不同，老幼苦乐各异，为什么呢？”回答说：“阴阳气运参差不齐，禀赋有厚薄，五气有偏胜，脏腑刚柔不同。用药以抑制强盛、扶助虚弱，取其中道而治，怎么可能相同呢？”
问：“各方立论，有多用热药的，有多用寒药的，是时令不同呢，还是地势使然？”回答说：“看方须要知道其立意，取其长处，去掉短处。人性偏执，通达疏朗的，从古至今，能有几个人呢？”
问：“一个人的证候，久卧床榻，处方既定，前后又有加减，为什么呢？”回答说：“内有国家（此处指人体内部环境或社会背景影响，结合语境多指体内环境）虚实之异，外有八风之变，四时更易，气运迭迁，七情所动。所以主病之药虽然不改变，佐使药岂能没有加减呢？”
问：“什么叫通疏？”回答说：“没有先入为主的成见，能穷尽变化的神妙，识得时宜措施，致使二五之精妙合冲和之气。虚则补之，实则泻之，寒者热之，热者寒之，上者抑之，下者举之，无所偏负，那么自然天地定位，万物化育。”
曾经看成无己注解的《伤寒论》说：“夫伤寒之病，以阳气为主。”只这一句，已见其深造圣人之蕴奥。盖天之邪气感受，则伤人气也；饮食起居七情触动，则伤人形也。然而这是深层的道理，气病则形乃应，形气病乃从。治病必求其本。
先生说：“张仲景治伤寒以‘寒’字为主，用辛热甘热等药，是针对即病而言；刘河间治热病以‘热’字为主，用辛凉等剂，是针对不即病，寒毒藏于肌肤，至春变为温病，至夏变为热病之意。”
问：“阴阳的体用，先生曾以阴不足而阳有余，远取诸天地日月为譬喻其体，近取呼吸升降为比喻其用，则得以听闻教诲了。然而阴阳虚实的体虽不同，而其升降之用，所乘之机，既然没有降杀（减退），那么阴之体本虚，为何要用补法呢？”
先生说：“邵雍说天地互相依附，天根据形，地附气。其形有边界，其气无边界。人的形质是有边界的。天癸绝后，形就衰败了。如果不益阴以内守，则阳也无法发扬为健运的功能。是天失去了所根据，而飘散飞荡如丧家之狗。阳既飘散，则地愈失去所依附。形气不相依附则死矣。人还要补养残衰伤朽的体质，又说什么呢？”
先生说：“治病必须分清血气。如气病补血，虽然不对症也没有害处。血病补气，则血更虚散，散则气血俱虚，这叫诛罚无罪之人。病或昼轻夜重的是血病，昼重夜轻的是气病。因为昼属阳夜属阴。”
座右铭说：“学问用来辨别理欲，开启昏闭；衣食用来防备饥寒，广施恩惠。言行要留下好榜样给儿孙，心术不得罪于天地。”
卫生药室铭说：“治病的方子，先顾护元气。攻病击邪，斟酌药剂。邪气轻则药力轻，邪气峻则药力峻。元气若虚，峻剂当谨慎。必须求其本源，如水流有源头。泥标忘本，白首不愈。血病治血，气病治气。脏腑经络，逐一点视。虚的施补，实的施泻。察色听声，勿差纤芥。属寒治寒，属热治热。属湿燥火，细心分别。气微则逆，气甚则从。逆为正治，从乃反攻。从少从多，各观其事。其始则同，其终则异。必先岁气，毋伐天和。违时伐化，夭殃斯多。寒热温凉，用之远之。升降浮沉，顺时为宜。厥逆厥顺，道理玄微。或有所假，不必拘之。在表治表，在里治里。汗下之间，反掌生死。上制以缓，下制以急。缓急不分，无过受击。新病猛除，久病宽治。不久不新，宽猛相济。求治之诚，必当自宝。毋得苟就，轻此至道。病不可治，必当速已。毋得容情，启人之毁。凡此数条，圣师至训。洞然于胸，正行无问。”
广陵丘克容先生说：“现在专门研究刘完素、张从正的医生，大都以发汗、吐、下三法施治。大概基于张子和的十形三疗。如果说风、寒、暑、湿、燥、火，内伤、外伤，内积、外积，视其中于人身的上下部位，必定用这三法才可治愈。果真是张子和的遗意吗？为什么与《内经》、张仲景的话大不相同呢？《内经》不是说：邪气盛则实，精气夺则虚。又说：虚则补之，实则泻之。邪盛而实当泻，三法或许可以治愈。精气夺而虚当补，难道没有其他治法吗？只是说：木郁则达之，火郁则发之，土郁则夺之，金郁则泄之，水郁则折之。这也是发汗、吐、下的别称吗？假如这里没有那种遏制，果真一概使用吗？张仲景治外感，分六经，别腑脏，也曾用过发汗、吐、下。而太阳病有解肌法，少阳病有三禁，并病用刺法，难道没有缘故吗？张子和也说：不读本草，焉知药性。又说：识病得法，工中之甲。仗三疗疗十形，又何必知药性求得法呢？莫非张子和的真书亡于金源氏南迁，这只是后人附会其说，而执迷妄意者，遂以卤莽之言为的确之论。甚至认虚为实，假寒为暖。对于适事为故，与各安其气的说法，略不加考究。志古之士，独无遗憾吗？”
“医道自从有《内经》以来，历代名医著述收藏在官府中的，到了元代得到一百七十九家，二百九部，一千二百五十九卷，不算不多啊。然而其中重要的能有几部呢？只有以下七本书，值得效法的，如有宋代的成无己《伤寒明理论》，金代的刘守真《原病式》，元代的李明之《内外伤辨》、《医学发明》、《活法机要》，王好古《此事难知》，罗谦甫《卫生宝鉴》，朱彦修《局方发挥》，以及本朝的滑伯仁《十四经发挥》，徐用诚《本草发挥》，都开启了七书的精奥，作为体用的本领。”
Mr. Li Dongyuan said, "From Fuxi, Shennong, and the Yellow Emperor onwards, although there have been many famous physicians, how many are truly worthy of emulation? As for Hua Tuo's (Hua Shi) abdominal surgery or Wang's (Wang Shi) miraculous acupuncture techniques, while their skills were indeed profound, how could later generations hope to replicate them? This is not comparable to the classic works of Qibo, the processing methods of Leigong, the decoctions of Yi Yin (Yi Fangzhi), the *Hongfan* of Jizi, the dialogues of Bian Que (Yueren), Zhang Zhongjing's *Treatise on Cold Damage*, Wang Shuhe's *Pulse Classic*, Huangfu Mi's (Shi'an) *Jia Yi Jing*, Wang Bing's (Qixuanzi) commentaries, Qian Yi's (Qian Zhongyang) discussions, Zhang Yuansu's (Jiegou) formularies, and others. These are all living methods that can be learned by people. How can they be compared to those myriad formulas and theories that merely fix the eyesight and thinking of later generations? Among them, those with high virtue and far-reaching conduct, extraordinary talents, whether holding official positions or hiding in the wilderness, may have certain merits worth observing. However, if they do not represent living methods applicable for a hundred generations, they are not adopted. Do I enjoy debating? No, I simply wish for students to observe these sages and know whom to admire. If someone merely reads widely and recites generally, considering themselves well-learned, yet finds no utility in practice, do they truly understand the root?"
Someone asked Mr. Zhu Danxi (Zhu Yanxiu): "Regarding medicine—taking pulses, examining diseases, and prescribing herbs—why do you insist that only those who study Confucian classics can excel?" He replied: "Without the *Four Books*, one cannot exhaust principles and fully realize human nature, achieving the merit of investigating things to extend knowledge. Without the *I Ching* (*Book of Changes*), one cannot exhaust the functions of yin-yang creation and transformation, the laws of waxing and waning, generation and destruction, and the principles of ascending and descending, floating and sinking. Sun Simiao said: 'One who does not know the *I Ching* is unfit to be called a Grand Physician.'"
Another asked: "Which medical books should be read first?" The reply was: "One must first read the *Neijing* (*Inner Canon*), *Bencao* (*Materia Medica*), and *Maijing* (*Pulse Classic*). Without the *Neijing*, one cannot recognize diseases; without *Bencao*, one cannot recognize herbs; without *Maijing*, how can one diagnose via pulse? Only then should one consult the theories of various schools."
Yet another asked: "Zhang Zhongjing's *Treatise on Cold Damage* presents symptoms and corresponding formulas, serving as the ancestor of medicine. Should it also be read first?" The answer was: "What enters the mind first often becomes dominant. The *Neijing* exhausts the wonders of yin and yang, with infinite variations; all other books derive from it. For instance, Bian Que's *Eighty-One Difficulties* captures only a fraction of the *Neijing*. Zhang Zhongjing selected the aspect of cold damage; Liu Wansu (Hejian) altered Zhang's methods focusing on heat; Li Dongyuan established his theory based on dietary irregularities and overwork. If one prioritizes Zhang Zhongjing's book, focusing on cold damage, one might mistake internal injury for external contraction. If one prioritizes Li Dongyuan's book, focusing on stomach qi, one might mistake external contraction for internal injury. If one prioritizes Liu Wensu's book, focusing on heat, one might mistake cold for heat. It is better to prioritize the *Neijing*, so that one's understanding naturally becomes flexible and dynamic."
Another asked: "Current physicians merely look at the *Pulse Jue* (*Pulse Aphorisms*) for diagnosis, ignoring other formularies, believing this is simple and effective. Your teaching emphasizes reading the *Neijing*. Although it helps recognize disease, it lacks specific formulas, and the *Maijing* has thousands of threads, making it hard to search." The reply was: "Precisely so. Human life is extremely precious. Without accumulating years of effort, how can one lightly treat others' illnesses? Predecessors' theories and formulas either align with the *Neijing*, are forced interpretations, have biased intentions, or are formulated based on the patient's deficiency/excess, form, spirit, suffering/joy, pulse, and symptoms. Disease changes infinitely; people's constitutions and emotional states vary; suitable treatments differ by region. Even with similar symptoms, treatments differ. Without reading the *Neijing*, relying solely on existing formulas leads to errors; if mistakes occur, death is irreversible. Others may not know, but can one rest easy in conscience? Pulse theory is subtle, connecting to the principles of yin-yang creation. Sages discussed its beginnings and kept its depths secret. A skilled pulse-taker deduces from these clues. Can Gao Yangsheng's few lines in the *Pulse Jue* cover infinite diseases?"
Mr. Zhu said: "The learning of Liu Wansu and Zhang Congzheng discusses six aspects of zang-fu qi transformation, particularly emphasizing pathogenic factors of dampness-heat and ministerial fire. They treat these by pushing out the old and bringing in the new, and purging fire. This certainly surpasses previous generations. However, in cases of yin deficiency with fire hyperactivity, or dual deficiency of yin and yang, or self-generated dampness-heat, treatment must be carefully considered. Li Dongyuan stated that dietary irregularities and fatigue injure primordial qi, preventing the yang of the epigastrium from ascending, causing qi of the heart and lungs to sink into the middle jiao. He treated this with herbs like Buzhong Yiqi Tang. This was also unprecedented. However, heaven is deficient in the northwest, earth is incomplete in the southeast. Heaven is yang, earth is yin. People in the northwest have qi that descends easily; people in the southeast have yin qi that ascends easily. Ignoring this and merely copying methods means that while descending qi disorders may respond, applying descending methods to ascending qi disorders will likely worsen the condition. One should synthesize the three schools, discarding flaws and adopting strengths." He added: "Considering yin deficiency and yang excess, people suffer more from ascending qi and less from descending qi. Supplementing yin to balance yang allows water and fire to ascend and descend naturally, known as the positioning of Qian and Kun, and the interaction of Kan and Li."
Generally, when treating diseases and prescribing herbs, one should not act rashly regarding predecessors' unverified formulas. One must deeply ponder and analyze, seeking the source of qi amidst countless complexities. This is the work of investigating things to extend knowledge; over time, one will enter the wonder of infinite changes.
Commentary: "The Five Movements and Six Qi are thoroughly discussed in the *Neijing* but neglected in other texts. Their principles are profound and difficult to grasp. Please elucidate them." The reply was: "At the beginning of studying medicine, one must understand pathogenesis and changes, assess the person's constitution before treating. If one focuses too early on qi movements, one risks falling into the trap of Ma Zongsu, claiming 'a person born on such-and-such day suffers from such-and-such meridian disease and should be treated with such-and-such herb.' Human organs correspond externally to heaven and earth, governing qi and movements, responding to the eight winds. Is this not appropriate? Without knowing this, a physician has not grasped the principle and cannot regulate. Yang Taishou often said: 'Five Movements and Six Qi must be observed daily, recording wind, rain, and darkness. Some diseases arise on schedule, some lie dormant and appear later, some are triggered by chronic conditions.' With thorough experience, one eventually reaches the pinnacle."
Treating disease and prescribing herbs is like using a balance scale; not a hair's breadth of error is allowed. Using ancient formulas for modern diseases without adjustment guarantees some degree of error.
Mr. Zhu said: "When I treat diseases, I use herbs following Li Dongyuan's principles and prescribe formulas following Zhang Zhongjing's style. Fewer ingredients mean more concentrated medicinal power." Asked: "What if one does not understand parts of the *Suwen*?" The reply was: "It is an ancient text with many missing characters and errors. Understand what can be understood, leave doubts aside. Wang Bing's annotations sometimes force interpretations or miss the original meaning. One must strive to read and savor it repeatedly."
Asked: "Beyond the *Suwen* and *Nanjing*, which books are essential?" The reply was: "For external contractions, follow Zhang Zhongjing; for internal injuries, follow Li Dongyuan. Zhang's methods align closely with the *Neijing*. However, one should browse all books to broaden knowledge."
Asked: "You treat patients with identical symptoms differently, not due to regional differences or age/lifestyle variations. Why?" The reply was: "Yin-yang qi movements are uneven. Endowment varies in thickness; the five qi have excesses; zang-fu organs differ in hardness and softness. Medication suppresses strength and supports weakness to achieve balance. How can treatment be uniform?"
Asked: "Some formularies emphasize hot herbs, others cold herbs. Is this due to season or geography?" The reply was: "When analyzing formulas, one must know the intent, adopt strengths, and discard weaknesses. Human nature tends to be biased; those who are open-minded are rare. Since ancient times, how many have there been?"
Asked: "A patient lies bedridden for a long time. After the main prescription is set, why are there additions and subtractions later?" The reply was: "Internally, there are differences in national (internal environment) deficiency and excess; externally, there are changes in the eight winds, seasons, qi movements, and emotions. Thus, while the main medicinal herbs remain unchanged, the assistant and guide herbs must be adjusted."
Asked: "What is meant by 'open-minded'?" The reply was: "Having no preconceived notions, one can exhaust the subtleties of change, recognize timely measures, and combine the essence of two and five to create harmonious qi. Deficiency is tonified, excess is purged, cold is heated, heat is cooled, rising is suppressed, sinking is lifted. With no bias, heaven and earth find their place, and all things flourish."
Reflecting on Cheng Wuji's commentary on the *Treatise on Cold Damage*: "Cold damage disease is primarily about yang qi." In these words alone, one sees deep attainment of sage wisdom. Heavenly pathogenic qi damages human qi; diet,起居, and seven emotions damage human form. Deep down, qi disease manifests in form; form and qi disease follow each other. Treating disease requires seeking the root.
Mr. Zhu said: "Zhang Zhongjing treats cold damage focusing on 'cold,' using acrid-hot and sweet-hot herbs, addressing immediate illness. Liu Wansu treats heat disease focusing on 'heat,' using acrid-cool agents, addressing latent illness where cold toxin hides in skin and muscles, transforming into warm disease in spring and heat disease in summer."
Asked: "Regarding the substance and function of yin-yang, you previously used heaven and earth/sun/moon as metaphors for substance (yin deficiency, yang excess), and breathing/ascending-descending for function. I have heard this. Although the substance of yin-yang deficiency/excess differs, their function of ascending/descending shares mechanisms. Since there is no reduction, and yin substance is originally deficient, why use tonification?"
Mr. Zhu said: "Shao Yong said heaven and earth rely on each other; heaven relies on form, earth relies on qi. Form has boundaries; qi does not. Human form is bounded. After Tian Gui ceases, form declines. If one does not benefit yin to guard internally, yang cannot exert its vigorous movement. Heaven loses its foundation, becoming scattered like a stray dog. Yang scatters, earth loses attachment. Form and qi detaching leads to death. One must nourish the damaged and decaying constitution."
Mr. Zhu said: "Treating disease requires distinguishing blood and qi. If qi disease is treated by tonifying blood, it may not hit the target but causes no harm. If blood disease is treated by tonifying qi, blood becomes more deficient and scattered, leading to dual deficiency of qi and blood. This is punishing the innocent. Diseases lighter by day and heavier by night indicate blood disease; heavier by day and lighter by night indicate qi disease, because day is yang and night is yin."
Inscription on the Desk: "Learning distinguishes principle from desire and opens ignorance. Food and clothing prevent hunger and cold and spread kindness. Words and deeds should leave good examples for descendants. Intentions should not offend heaven and earth."
Inscription on the Health Preservation Medicine Room: "Prescriptions for treating disease must first protect primordial qi. When attacking pathogens, adjust dosage carefully. Mild pathogens require mild doses; severe pathogens require strong doses. If primordial qi is deficient, be cautious with strong doses. Seek the root, like a stream has a source. Focusing on branches and forgetting the root leads to untreatable white-haired elders. Blood disease treats blood; qi disease treats qi. Examine zang-fu and meridians point by point. Tonify deficiency, purge excess. Observe color and listen to voice without slight error. Cold treated with cold, heat with heat. Distinguish dampness, dryness, and fire carefully. Weak qi opposes, strong qi follows. Opposition is direct treatment; following is reverse treatment. Adjust based on circumstances. Start same, end different. First consider annual qi, do not harm heavenly harmony. Violating seasons and transformations brings disaster. Use cold, heat, warm, cool appropriately. Ascend, descend, float, sink according to season. Reversal and compliance involve subtle principles. Exceptions exist, do not be rigid. Exterior diseases treat exterior; interior diseases treat interior. Between sweating and purging, life and death turn in a moment. Upper regulation uses slow methods; lower regulation uses rapid methods. Confusing slow and rapid invites blame. Acute diseases remove vigorously; chronic diseases treat gently. Balance gentleness and vigor. Sincerity in seeking cure must be cherished. Do not settle casually or轻视 this supreme dao. Untreatable diseases must cease quickly. Do not show leniency to invite criticism. These points are teachings from sage masters. Keep them clear in mind, walk correctly without doubt."
Mr. Qiu Kerong of Guangling said: "Physicians specializing in Liu and Zhang mostly use sweating, vomiting, and purging methods, based on Zhang Hezi's ten forms and three therapies. Whether wind, cold, summer-heat, dampness, dryness, fire, internal/external injury, or accumulation, regardless of location in the body, they believe these three methods suffice. Is this truly Zhang Hezi's legacy? Why does it differ greatly from the *Neijing* and Zhang Zhongjing? The *Neijing* says: 'Exuberant pathogenic qi indicates excess; depleted vital essence indicates deficiency.' And: 'Tonify deficiency, purge excess.' If pathogenic excess requires purging, the three methods might work. But if essence depletion requires tonification, are there no other treatments? They cite: 'Wood stagnation reaches release, fire stagnation emits, earth stagnation夺 (purges), metal stagnation drains, water stagnation bends.' Are these just aliases for sweating, vomiting, and purging? If there were no obstruction, would one blindly apply them? Zhang Zhongjing treated external contractions by dividing six meridians and distinguishing fu-zang organs, also using sweating, vomiting, and purging. Yet Taiyang has muscle-relaxing methods, Shaoyang has three prohibitions, and combined diseases use acupuncture. Surely there is reason? Zhang Hezi also said: 'Without reading Bencao, how can one know herb properties?' And: 'Recognizing disease and finding method makes one the best among workers.' Relying on three therapies for ten forms, why need to know herb properties? Perhaps Zhang Hezi's true works were lost during the Jin dynasty's southward migration, and this is a later fabrication. Obsessed followers turned reckless statements into absolute truths, mistaking deficiency for excess and fake cold for warmth. They ignore 'acting according to circumstances' and 'letting qi rest.' Scholars of antiquity, do you feel no regret?"
"Since the *Neijing*,历代名医 writings stored in government archives reached 179 authors, 209 volumes, and 1,259 scrolls by the Yuan dynasty—a large number. Yet how many are truly essential? Among them, the following seven books are worthy of emulation: Song Dynasty Cheng Wuji's *Clarifying Theory on Cold Damage*, Jin Dynasty Liu Shouzhen's *Original Causes Formula*, Yuan Dynasty Li Mingzhi's *Differentiation of Internal and External Injury*, *Medical Invention*, *Essentials of Living Methods*, Wang Haogu's *This Matter is Hard to Know*, Luo Qianfu's *Health Precious Mirror*, Zhu Yanxiu's *Analysis of the Formulary*, and our dynasty's Hua Borren's *Elucidation of the Fourteen Meridians*, Xu Yongcheng's *Analysis of Materia Medica*. These unlock the profundity of the Seven Classics and serve as the fundamental principles of substance and function."