王海藏云世之治伤寒有法疗杂病有方是则是矣然犹未也吾谓治杂病亦有法疗伤寒亦有方
方即
法也法即方也岂有异乎要当全识部分经络表里脏腑岂有二哉以其后世才智之不及古也所以分
伤寒杂病为二门故有长于此而短于彼者亦有长于彼而短于此者逮夫国家取士分科为七宜乎愈
学而愈陋愈专而愈粗也试以伤寒杂病二科论之伤寒从外而之内者法当先治外而后治内杂病从
内而之外者法当先治内而后治外至于中外不相及则治主病其方法一也亦何必分之为二哉大抵
杂病之外不离乎表伤寒之内不离乎里表则汗里则下中则和不易之法也剂之寒热温凉在其中矣
余风产二条目疾疮肿小儿等科各自专门无怪其工之陋且粗也是以知证不知脉知药不知源是岂
真知而全识哉耳熟目厌习坏多经涉久误合则病愈不契则疾甚所尝见所尝闻者粗有晓会其所未
尝见未尝闻者则有所不知也此继述而不及创物者远矣呜呼天之所锡其智识有限量故耶哀哉庸
夫以衣食迫以口舌争视学业如仇雠专妒忌为能干误人性命恬不知恤甘为忍人罔顾阴理其教之
有所失耶时世之有所俾然耶抑疾者之不幸而有所自致耶
谨按汉张仲景推充内经伤寒脉证论例立法虽因证传变而不离即病之伤寒也至宋之李有托
时世
之异乃别立方用参苏藿香正气之类而遗即病之伤寒使世俗因之往往失仲景意况与杂病分二科
专伤寒者尚不能备晓其通变主杂病者而不能遍识其仿佛宜乎其教之乖误为疾之不幸使人不能
无憾恨也噫仲景推充内经大法可谓无穷之惠人犹不知其例三百余法备即病伤寒之传变宋医所
论为时气变法非真伤寒也故其方不多且病从外而之内者不离乎风寒暑湿其间传变者余伤寒皆
轻从内而之外者不离乎内伤七情其间坏异者非
伤寒之重故有轻重不同因分二科大抵学人要于诊候之际辨内外之感伤寒表里之轻重杂病伤寒
脉证所异伤寒杂病治法不殊不殊者杂病之外不离乎表伤寒之内不离乎里所异者伤寒从外而之
内杂病从内而之外外感法仲景内伤法东垣六气推充乎剂张杂病融会乎诸氏万法归吾一心一心
贯乎万法不致得此而失彼为二科之分遗乎世之识诮也
王海藏说:“当今治疗伤寒有固定的法则,治疗杂病有现成的方剂,这虽然是对的,但还不够。我认为,治疗杂病也有法则,治疗伤寒也有方剂。方就是法,法就是方,难道有什么两样吗?关键在于要全面认识经络、表里、脏腑的归属,哪里会有两种截然不同的体系呢?只是因为后世人的才智不如古人,所以将伤寒和杂病分为两个门类。因此有人擅长于此而短于彼,也有人擅长于彼而短于此。等到国家选拔人才时分为七个科室,这就使得学问越专越浅陋,技术越专精越粗糙。
试着以伤寒和杂病这两科来论述:伤寒是从外部侵入内部的疾病,治法应当先治外邪,后治内症;杂病是从内部产生并表现于外部的疾病,治法应当先治内因,后治外候。至于内外病症互不相关的,则只治疗主要病症。其治疗方法本质上是一样的,又何必将其分为两类呢?大体上,杂病的病变范围离不开体表(表证),伤寒的病变范围离不开体内(里证)。在表则用发汗法,在里则用攻下法,在中焦则用和解法,这是不易的原则。药物的寒、热、温、凉属性也就包含在这些方法之中了。
至于风病、产科、疮疡、肿毒、小儿等科室,各自成为专门领域,难怪医术显得浅陋粗糙。那些只知道症状而不知脉象,只知道药物而不知病因本源的人,这难道是真正的知识和全面的认识吗?耳朵听熟了,眼睛看厌了,习惯性地沿袭错误的经方,时间久了就会造成误诊。遇到相合的情况病就好了,遇到不相符的情况病就加重了。对于曾经见过、听过的病症,稍微有些了解;对于未曾见过、未曾听过的,则一无所知。这种继承前人成果而缺乏创新的做法,与古圣先贤相比相差甚远了。
唉!上天赋予人的智识是有限的吗?真是可悲啊!平庸的医生被衣食所迫,为口舌之争忙碌,视学业如仇敌,把嫉妒忌刻当作能干,误人性命却安然不觉,毫不怜悯,甘愿做残忍之人,不顾及阴德天理。这是教育有所缺失呢?还是时代风气使然呢?或者是患者不幸导致的结果呢?
谨按:汉代张仲景推演扩充《内经》中关于伤寒脉证的理论,确立法则,虽然根据证候传变而有所不同,但不离即病之伤寒的根本。到了宋代,李东垣等人认为时代不同,于是另立方剂,使用参苏饮、藿香正气散之类的药物,而忽略了即病之伤寒的本意,致使世俗之人因此往往误解了张仲景的原意。况且将伤寒与杂病分为两科,专攻伤寒者尚不能全面通晓其变化规律,主攻杂病者也不能遍识其大概,这使得他们的教学出现偏差错误,给患者带来不幸,使人难免遗憾怨恨。
唉!张仲景推演扩充《内经》的大法,可以说是无穷无尽的恩惠,但人们还不知道其中的例法。三百多种法则备齐,涵盖了即病伤寒的传变过程。宋代医家所论述的是“时气”变法,并非真正的伤寒,所以他们的方剂不多。而且,病从外部侵入内部的,离不开风寒暑湿,其中传变的,余下的伤寒病情都较轻;病从内部产生并向外的,离不开内伤七情,其中发生坏变的,不是严重的伤寒,所以有轻重不同,因而分为两类。
大体上,学习中医的人关键要在诊候之际,辨别是外感还是内伤,分辨伤寒表里的轻重,明了伤寒与杂病脉证的差异。伤寒与杂病的治疗法则并无不同。所谓“无不同”,是指杂病的病变不离乎表,伤寒的病变不离乎里。所谓“差异”,是指伤寒是从外部侵入内部,杂病是从内部产生向外表现。治疗外感遵循张仲景的方法,治疗内伤遵循李东垣的方法,六气理论充实于方剂之中,杂病融会贯通于各家学说。万法归于吾心,一心贯通万法,不至于得到此而失彼,避免因为分为两科而被世人讥笑见识浅薄。
Wang Haicang stated: "Currently, there are established principles for treating *Shanghan* (Cold Damage) and ready-made prescriptions for treating *Zabing* (Miscellaneous Diseases). While this is correct, it is incomplete. I argue that treating *Zabing* also requires principles, and treating *Shanghan* also utilizes prescriptions. A prescription is a principle; a principle is a prescription. Is there any difference? The key lies in fully comprehending the domains of meridians, exterior-interior relationships, and zang-fu organs. How could there be two distinct systems? It is merely because the intellectual capacity of later generations fell short of the ancients that *Shanghan* and *Zabing* were divided into two categories. Consequently, some excel in one but lack in the other, while others excel in the latter but lack in the former. When the state selected officials by dividing them into seven departments, scholarship became increasingly superficial with specialization, and technique became increasingly crude with narrow focus.
Let us discuss these two departments. *Shanghan*, entering from the exterior to the interior, should be treated by addressing the exterior first and the interior subsequently. *Zabing*, originating from the interior and manifesting externally, should be treated by addressing the internal cause first and the external manifestation subsequently. If the interior and exterior conditions are unrelated, only the primary disease should be treated. The method remains essentially the same; why must they be divided into two? Generally, the pathology of *Zabing* does not depart from the Exterior (*Biao*), while the pathology of *Shanghan* does not depart from the Interior (*Li*). For conditions at the Exterior, sweating methods are used; for conditions at the Interior, purgative methods are used; for conditions in the Middle, harmonizing methods are used. This is an unchangeable principle. The cold, heat, warm, and cool properties of medicines are contained within these methods.
As for departments such as Wind diseases, Obstetrics, Sores and Ulcers, Swellings, and Pediatrics, each has become a specialized field, which explains why their medical skills appear shallow and crude. Those who know symptoms but not pulse diagnosis, or know herbs but not the source of disease, do not possess true knowledge or comprehensive understanding. Familiarity through hearing and seeing leads to habitual adherence to flawed classics, resulting in long-term errors. When treatment coincides with the condition, the illness resolves; when it does not coincide, the illness worsens. One may have a slight understanding of what has been seen and heard, but knows nothing of what has not. This approach of inheriting without innovating falls far short of the ancient sages. Alas! Is human intellectual endowment limited by Heaven? Truly pitiable! Mediocre practitioners, driven by livelihood and verbal disputes, view study as an enemy, regard jealousy as capability, ruin lives without remorse, act cruelly ignoring moral retribution, and neglect heavenly principles. Is this due to educational failure, the influence of the times, or the misfortune of patients themselves?
According to records: Zhang Zhongjing of the Han Dynasty expanded upon the *Neijing* (Inner Canon) regarding *Shanghan* pulse and syndrome theories, establishing laws. Although based on syndrome transmission, it remained rooted in immediate-onset *Shanghan*. In the Song Dynasty, Li Donggan argued that times had changed and established new prescriptions using formulas like *Shensu Yin* (Ginseng and Ephedra Decoction) and *Huoxiang Zhengqi San* (Agastache Powder for Regulating Qi), thereby neglecting immediate-onset *Shanghan*. This caused common people to often misunderstand Zhang Zhongjing’s intent. Furthermore, dividing *Shanghan* and *Zabing* into two categories means that those specializing in *Shanghan* cannot fully grasp its variations, and those specializing in *Zabing* cannot broadly recognize its patterns. This leads to erroneous teaching and patient misfortune, causing regret.
Alas! Zhang Zhongjing’s expansion of the *Neijing*’s great methods was an infinite benefit, yet people failed to understand its examples. Three hundred methods were prepared to cover the transmission of immediate-onset *Shanghan*. The Song physicians discussed 'Seasonal Qi' variations, which were not true *Shanghan*; thus, their prescriptions were few. Diseases entering from the exterior involve Wind, Cold, Summerheat, and Dampness; among these, transmitted cases are generally mild *Shanghan*. Diseases originating from the interior involve Seven Emotions; among these, deteriorated cases are not severe *Shanghan*. Hence, distinctions in severity led to division.
Generally, students must distinguish between external invasion and internal injury during diagnosis, assess the severity of Exterior-Interior in *Shanghan*, and identify differences in pulses and syndromes between *Shanghan* and *Zabing*. The treatment principles for *Shanghan* and *Zabing* are not different. They are 'not different' because *Zabing* stays at the Exterior and *Shanghan* stays at the Interior. They differ in that *Shanghan* moves from Exterior to Interior, while *Zabing* moves from Interior to Exterior. Treat external invasions following Zhang Zhongjing’s methods; treat internal injuries following Li Dongyuan’s methods. Expand Six Qi theory into prescriptions; integrate *Zabing* through various schools. Ten thousand methods return to one mind; one mind penetrates ten thousand methods. Avoid gaining one aspect while losing another, preventing criticism from the world for splitting disciplines and lacking broad insight.