药有宣通补泻轻重滑涩燥湿十种者,是药之大纲大法,而治疗无出于此。体认十种之用,兼
之寒热温三法,足可配《孙子兵法》十三篇,能法十三法者,战无不克,医无不效,其异事而同
神欤?《本经》未言之,后人未深述之,故调制汤丸多昧于此。今表而出之,从事于医者当体其
所属而法其施,悉尽治疗之道云。
有云∶古方不可以治今病。噫!亦过也。予谓《和剂局方》,丹溪发挥于前,戴元礼祖述于
后,古方之用,亦何负于人哉?盖用之者不得其宜也。虽然,证与方合,其间未必尽然,当因其
证之旁出,而增损其药味之宜,此善之善者也。古方胡为不可用而遽必为拒绝乎?噫!亦过也。
故云∶执古方以为治谓之泥,舍古方以为治谓之凿。泥也,凿也,皆非也。而惟随宜活泼增减用
之,所谓变而裁之,存乎通焉。
震泽王文恪公云∶今之医者祖述李明之、朱彦修,其处方不出参术之类,所谓医之王道,信
之本者矣。然病出于变,非术参辈所能效者,则药亦不得不变。可变而不知变,则坐以待亡;变
而失之毫厘,则反促其死,均之为不可也。故曰∶可与立未可与权。药而能权,可谓妙矣。明之、
彦修未尝废权也,世医师其常而不师其
变,非用权之难乎?(《震泽文集》)
药物具有宣、通、补、泻、轻、重、滑、涩、燥、湿这十种特性,这是用药的总纲和基本原则,而治疗手段也不出这个范围。深入理解这十种药性的运用,再结合寒、热、温三种治法,足以与《孙子兵法》的十三篇相媲美。能够掌握这十三种法则的人,打仗没有不胜利的,治病没有不有效的,这难道不是事情不同但神理相通吗?《神农本草经》中没有详细论述这一点,后人也没有深入阐述,所以在配制汤剂和丸剂时大多对此感到困惑。现在将其揭示出来,从事医疗工作的人应当体会其所属类别并效法其施用方法,从而穷尽治疗的道理。
有人说:“古方不能用来治疗今天的疾病。”唉!这也太过分了。我认为《太平惠民和剂局方》,朱丹溪在前面加以发挥,戴元礼在后面继承阐述,古方的使用,对人们又有什么辜负呢?大概是使用者没有得当罢了。虽然如此,证候与方剂相合的情况,其中未必完全如此,应当根据证候的衍生变化,适当增减药物的配伍,这才是最好的做法。为什么一定要拒绝使用古方呢?唉!这也太过分了。所以说:拘泥于古方来治疗叫做固执不通,舍弃古方来治疗叫做穿凿附会。固执和穿凿都是不对的。只有随着适宜情况灵活增减使用,这就是所说的“变而裁之”,关键在于通达。
震泽王文恪公说:“现在的医生都尊崇李明之(李杲)、朱彦修(朱震亨),他们开出的处方不出人参、白术之类,这可以说是医学的王道,确实是根本所在。然而病情出于变化,不是人参、白术这类药物所能奏效的,那么药物也就不得不改变。可以改变却不知道改变,那就是坐以待毙;改变了却失之毫厘,反而会加速死亡,这两种情况都是不可取的。所以说:可以与之确立原则,但不能与之权变。药物如果能懂得权变,可以说是妙极了。李杲、朱震亨并没有废弃权变之道,只是世间的医生只遵循常规而不学习变化,这难道不是难以运用权变吗?”(出自《震泽文集》)
Medicines possess ten characteristics: dispersing (Xuan), unblocking (Tong), tonifying (Bu), purging (Xie), lightening (Qing), heavy/sedating (Zhong), slipping/lubricating (Hua), astringent (Se), drying (Zao), and moistening (Shi). These constitute the general principles and major laws of materia medica, and therapeutic interventions do not extend beyond this scope. Comprehending the application of these ten properties, combined with the three methods of cold, heat, and warmth, is sufficient to rival the thirteen chapters of *The Art of War* by Sun Tzu. One who can master these thirteen methods will win every battle and achieve efficacy in every cure; is it not that while the affairs differ, the underlying spirit is the same? This was not elaborated upon in the *Shennong Bencao Jing* (Divine Farmer's Materia Medica), nor deeply expounded by later generations; therefore, many are confused regarding the compounding of decoctions and pills. Now that I have brought this to light, those engaged in medicine should understand its categorization and emulate its application, thereby fully exhausting the way of treatment.
It is said: "Ancient formulas cannot treat modern diseases." Alas! This is an exaggeration. I maintain that the *Tai Ping Hui Min He Ji Ju Fang* (Imperial Bureau of Medicine Formulary), with Zhu Danxi expounding upon it earlier and Dai Yuanli succeeding him later, has done no disservice to people through the use of ancient formulas. The issue lies merely in the practitioner's failure to apply them appropriately. Although there may be cases where the syndrome does not perfectly match the formula, the wise approach is to adjust the dosage and ingredients based on the variations of the syndrome; this is the best of the best. Why must one abruptly reject ancient formulas? Alas! This is also an exaggeration. Thus it is said: Clinging to ancient formulas for treatment is called being rigid/stuck (Ni); abandoning ancient formulas for treatment is called being arbitrary/forced (Zao). Both rigidity and arbitrariness are incorrect. Only by flexibly adding or subtracting according to suitability—what is termed "transforming and adjusting"—can one achieve adaptability (Tong).
Wenke Gong of Zhenze stated: "Contemporary physicians revere Li Dongyuan (Li Mingzhi) and Zhu Zhenheng (Zhu Yanxiu). Their prescriptions rarely go beyond herbs like Ginseng (Renshen) and Atractylodes Macrocephala (Baizhu). This can be considered the 'Kingly Way' of medicine, truly rooted in fundamental principles. However, since diseases arise from changes, herbs such as Ginseng and Atractylodes may not always be effective; thus, medicinal strategies must also change. If one knows that change is possible but fails to change, one sits waiting for demise; if one changes but errs by a hair's breadth, one may hasten death. Both scenarios are unacceptable. Hence it is said: 'One can establish principles with another, but one cannot necessarily engage in discretionary adaptation (Quan).' If a physician can exercise discretion in prescribing, this can be called profound. Li Dongyuan and Zhu Zhenheng did not abandon discretion; rather, contemporary physicians follow routine without learning adaptation. Is it not difficult to employ discretion?" (From *Zhenze Wenji*)