近世医理不明,医学荒杂,治病不辨三因虚实,一概笼统用药,以致虚虚实实,杀人如
麻,
曷胜悼叹!良由不肯留心前人论病论脉论治诸说,遂至越规矩,弃绳墨,师心自用。若欲脱
去陈方旧论,而独辟新奇,殊不知仲景而下,如河间、丹溪、东垣、洁古、海藏诸贤,衡证
衡脉,用药立方,丝丝入扣,不偏不倚,如物之有衡焉。法有定衡,不及于衡者,扩而充之
;太过于衡者,约而敛之,庶可以起沉 而不误人。命余早岁业医,深陋俗习,渴欲抗衡前
人,以为近日医流砥柱,汇采前人论病论脉论治,精确不磨之说,以成上下卷,标其目为医
衡,垂作模楷,则三因辨,虚实分,自无笼统用药之弊,不特后学可为衡鉴。即余之惟日孳
孳,长恐误人者,亦未尝敢越比衡中也,窃愿持衡不失,得进而抗衡前人,斯幸矣!
古吴叶桂天士书
猗欤哉,历代医书之盛,凡三百七十九家,五百九十六部,一万三千一百余卷,反复详
其要主于却病而已。然《内经》有一言而可尽废诸书,则不治已病治未病是也。此说一出,
而后多以修养为言,不知夫修养与保养,原自有异修养则杂于方外元远,而非恒言恒道。保
养则于日用饮食,而为可法可经。如运气之法,运任督者,久则生痈;运脾土者,久则腹胀
;运丹田者,久则尿血运;顶门者,久则脑泄。其余丹砂烹炼之说,遗祸累累。然则修养之
与保养,不大相迳庭哉!请述保养之法。《上古天真论》曰∶饮食有节,起居有常,不妄作
劳,精神内守,病安从来?故形与神居而尽终天年,度百岁乃去,此保养之正宗也。盖有节
有常,则气血从轨,而无事于搬运之烦,精神内守,则身心宁定,而无事于制伏之强,形与
神
居,而神不离形。形不离神,而无损天年之虑。保养既若是之易且显,何今之夭者多而寿者
少欤?盖香醪美酒陈于前,虽病所忌也而弗顾;情况意兴动于中,虽病所禁也而难遏;贪名
竞利之心急,虽劳伤过度而不觉;何况心神百结,斫耗多端。刘孔昭曰∶万人操弧而向一鹄
,鹄能无中乎?万物炫耀以惑一生,生能无伤乎?即有少知收敛精神,安居静养者,又不知百
年机括,希求不死。虽终日闭目,只是一团私意,静亦动也。若识透百年定分,而事事循理
,不贪不躁不妄,可以却未病而尽天年矣。盖主乎私则生死念重,而昏昧错妄,愈求静而不
静。主乎理则人欲消亡,而心清神悦,不求静而自静,此吾所以但言保养,而不言修养也。
然则保养之法,不亦尽废诸书乎。避风寒以保其皮肤六腑,则麻黄、桂枝、温中、四逆之剂
,不必服矣;节劳逸以保其筋骨五脏,则补中益气、劫劳健步之剂,不必服矣;戒色欲以养
精,正思虑以养神,则滋阴降火、养营凝神等汤,又何用哉?薄滋味以养血,寡言语以养气
,则四物、四君、十全、三和等汤,又何用哉?要之血由气生,气由神全,神乎心乎,养心
莫善于寡欲,吾闻是语,未见其人,不得已而仍从一万三千一百余卷中,更觅一治已病之法
也。
近代医学理论不明,医学内容杂乱无章,治病时不辨别三因(内因、外因、不内外因)的虚实情况,一概笼统地用药,导致虚证更虚、实证更实,像割草一样大量杀人,令人不胜悲痛叹息!这主要是因为不肯留心前人关于论病、论脉、论治的各种学说,以至于违背规矩,抛弃法度,主观自用。如果想要摆脱陈旧的方剂和旧有的理论,独自开辟新奇之路,却不知道从张仲景以下,如刘河间、朱丹溪、李东垣、张洁古、王海藏诸位贤人,权衡证候、权衡脉象,用药立方,丝丝入扣,不偏不倚,就像物体有秤砣一样。法度有固定的标准,不及于标准的,就扩大并充实它;过于超过标准的,就约束并收敛它,这样才可以治愈重病而不误人。
命我早年从事医学,深知世俗习气的陋弊,渴望与前人抗衡,成为近日医流的砥柱中流。汇集采择前人关于论病、论脉、论治中精确不可磨灭的说法,编成上下两卷,标目为《医衡》,作为模范楷模。那么三因得以辨别,虚实得以区分,自然就没有笼统用药的弊端,不仅后学者可以作为借鉴,就是我每天孜孜不倦,长恐误人的心情,也未曾敢超越权衡之中,私下希望保持权衡不失,得以进而与前人抗衡,这就是我的幸运了!
啊,历代医书兴盛,共有三百七十九家,五百九十六部,一万三千一百多卷,反复详究其要点,主要在于祛除疾病罢了。然而《内经》有一句话可以废掉所有其他书籍,那就是“不治已病治未病”。这个说法一出之后,后人多以修养为言,不知道修养与保养,原本就有差异。修养则夹杂在方外玄远之中,并非恒常之言和恒常之道。保养则在日常饮食起居中,是可以效法和遵循的。比如运气的方法,运转任督二脉的,久了会生痈疽;运转脾土的,久了会腹胀;运转丹田的,久了会尿血;运转顶门的,久了会脑泄。其余丹砂烹炼的说法,遗留祸患累累。那么修养与保养,不是大相径庭吗!请陈述保养的方法。《上古天真论》说:饮食有节制,起居有规律,不妄自劳累,精神内守,病从哪里来呢?所以形体与精神共存而终尽天年,度过百岁才离去,这是保养的正宗。大概因为有节有常,气血就遵循轨道,而无须搬运之烦劳;精神内守,身心就安宁定静,而无须强行制伏之苦;形体与精神共存,神不离形,形不离神,而无损天年的忧虑。保养既然如此容易且明显,为什么现在夭折的人多而长寿的人少呢?大概因为香醇美酒陈列在前,虽然是病症所忌,却视而不见;情欲意兴动于心中,虽然是病症所禁,却难以遏制;贪求名利之心急切,虽然劳伤过度却不觉得;何况心神百结,斫耗多方面。刘孔昭说:万人拉弓射向一个靶心,靶心能不中箭吗?万物炫耀以迷惑一生,生命能不受伤吗?即使有少许知道收敛精神,安居静养的人,又不知道百年的机关枢纽,希求不死。虽然整天闭目,只是一团私意,静也是动。如果识透百年定分,而事事循理,不贪不躁不妄,就可以预防未病而终尽天年了。大概主乎私则生死念头重,而昏昧错妄,愈求静而不静。主乎理则人欲消亡,而心清神悦,不求静而自静,这就是我之所以只谈保养,而不谈修养的原因。
那么保养的方法,不是几乎废掉所有书籍了吗?避风寒以保护皮肤六腑,那么麻黄、桂枝、温中、四逆的药剂,就不必服用了;节劳逸以保护筋骨五脏,那么补中益气、劫劳健步的药剂,就不必服用了;戒色欲以养精,正思虑以养神,那么滋阴降火、养营凝神等汤剂,又何用呢?薄滋味以养血,寡言语以养气,那么四物、四君、十全、三和等汤剂,又何用呢?总之血由气生,气由神全,神在心吗?养心没有比寡欲更好的了,我听过这句话,却没见到这样的人,不得已而从一万三千一百多卷中,再寻找一种治疗已病的方法。
In recent times, medical theories have been unclear, and medical practice has become chaotic. Physicians treat diseases without distinguishing the deficiency or excess of the Three Causes (Internal, External, and Neither Internal nor External), indiscriminately administering medications. This results in exacerbating deficiencies with tonics and excesses with purgatives, killing people as if cutting grass, which is deeply lamentable! This is primarily due to a failure to pay attention to previous scholars' discussions on disease patterns, pulse diagnosis, and treatment methods, leading to a disregard for rules and standards, and reliance on subjective judgment. If one seeks to break away from old prescriptions and theories to forge new paths, they fail to realize that since Zhang Zhongjing, sages such as Liu Wansu, Zhu Danxi, Li Dongyuan, Zhang Congzheng, and Wang Haogu carefully weighed symptoms and pulses, and formulated medications with precision and balance, much like an object balanced on a scale. There are fixed standards for these methods: those falling short should be expanded and supplemented; those exceeding them should be restrained and condensed. Only then can severe illnesses be cured without harming patients.
I was appointed to practice medicine at a young age, deeply despising vulgar habits, and eager to rival past masters to become a pillar of contemporary medicine. I compiled precise and enduring insights from predecessors regarding disease, pulse, and treatment into two volumes, titled *Yi Heng* (Medical Balance), to serve as a model. Thus, the Three Causes can be distinguished, deficiency and excess clarified, eliminating the弊端 of indiscriminate medication. Not only will future students have a standard to follow, but my own diligent efforts, constantly fearing error, will also remain within the bounds of balance. I secretly hope to maintain this balance and advance to rival the ancients, which would be my greatest fortune!
Alas, the prosperity of medical books through the ages is immense, comprising 379 authors, 596 works, and over 13,100 volumes. Their core purpose, repeatedly emphasized, is disease prevention. However, the *Neijing* contains a single statement that renders all other books superfluous: "Treat disease before it arises." Once this principle emerged, many focused on "cultivation" (Xiuyang). Yet, cultivation differs fundamentally from "preservation" (Baoyang). Cultivation involves esoteric, transcendent practices not suited for daily life. Preservation, however, applies to daily diet and lifestyle and is practical and sustainable. For instance, long-term manipulation of Ren and Du meridians may cause carbuncles; manipulating Spleen Earth may cause abdominal distension; manipulating the Dantian may cause hematuria; manipulating the crown may cause cerebral leakage. Other alchemical practices involving cinnabar have caused numerous disasters. Thus, cultivation and preservation are vastly different. Let us discuss preservation. The *Shanggu Tianzhen Lun* states: "Eat with moderation, live with regularity, avoid excessive labor, and keep the spirit inward. How can disease arise?" Thus, when form and spirit coexist, one fulfills their natural lifespan, living beyond a hundred years. This is the orthodox path of preservation. With moderation and regularity, Qi and Blood follow their proper courses, avoiding the burden of forced circulation. With the spirit kept inward, body and mind remain tranquil, avoiding the strain of suppression. Form and spirit support each other, ensuring no threat to one's natural lifespan. Since preservation is so simple and evident, why do many die young while few live long? It is because fragrant wines are displayed before them; though contraindicated for illness, they are ignored. Desires stir within; though forbidden by illness, they are hard to suppress. The eagerness for fame and profit leads to unnoticed overexertion. Moreover, tangled thoughts and diverse consumptive habits prevail. Liu Kongzhao said: "If ten thousand men shoot arrows at one target, will the target not be hit? If myriad dazzling things confuse a life, will the life not be harmed?" Even those who slightly know how to conserve spirit and rest quietly often misunderstand the mechanisms of longevity, seeking immortality. Though they close their eyes all day, they are filled with selfish desires; stillness is actually movement. If one understands their destined lifespan and acts according to reason—without greed, impatience, or recklessness—they can prevent disease and fulfill their natural years. Selfishness intensifies fear of death, leading to confusion and failed attempts at stillness. Reason eliminates desires, bringing mental clarity and joy, achieving stillness naturally. This is why I speak only of preservation, not cultivation.
Doesn't this method of preservation render most books unnecessary? Avoiding wind and cold protects the skin and Six Fu Organs, making *Mahuang Tang*, *Guizhi Tang*, warming middle, and *Sini Tang* unnecessary. Regulating work and rest protects sinews, bones, and Five Zang Organs, making *Buzhong Yiqi Tang* and *Jielao Jianbu* preparations unnecessary. Abstaining from sexual desire nourishes Essence, and correcting thoughts nourishes Spirit, making *Ziyin Jianghuo* and *Yangying Ningshen* decoctions unnecessary. Eating bland flavors nourishes Blood, and speaking sparingly nourishes Qi, making *Siwu Tang*, *Sijunzi Tang*, *Shiquan Dabu Tang*, and *Sanhe Tang* unnecessary. Ultimately, Blood is generated by Qi, and Qi is perfected by Spirit. Is Spirit in the Heart? To nourish the Heart, nothing is better than reducing desires. I have heard this saying but seen no one who truly embodies it. Reluctantly, I must still seek a method for treating existing disease among those thirteen thousand volumes.