夫附子,味辛而甘,气温大热,有大毒。制法∶以童便煮而浸之,再用文武火
以烈其毒,且可助下行之力,入盐尤捷,此佐使之药,通行诸经,其性善走而不守,浮
中沉无所不致,阳中之阳,故行而不止。用之得宜,有夺旗斩将之功,用之不宜,有
杀身殒命之祸。每人参一钱为君,止可下附子一二分为使,再加甘草以解其毒,内
外之证,遇严寒时候,疮口沉塌,四肢厥冷,寒湿疼痛,痿 拘挛,膝痛不能行步,
腰脊风寒,伏阴伤寒,方可下附子,不审阴阳虚实,一概用之,使人服后,火郁中
焦,气郁下焦,咆哮喘急,顷刻而毙。凡用附子者,岂可不细审之乎。
又曰∶解附子毒,令多吸新水,连饮数碗,遂大呕泄,方解其毒,此又不可不知也。
薛立斋曰∶经云∶诸痛痒疮疡,皆属心火。若肿赤烦躁,发热饮冷,便秘作渴,
脉洪数实,是其常也,虽在严寒之时,必用大苦寒之剂,以泻热者。若脉细皮寒,泻
利肠鸣,饮食不入,呕吐无时,手足逆冷,是变常也,虽在盛暑之时,必用辛温之剂,
以助阳气。《内经》云∶用寒远寒,用热远热,有假者反之,虽违其时,必从其证。
王肯堂曰∶如肿赤烦躁,发热引冷,便秘作渴,脉洪数实,是为五实,虽在严寒
之时,必用大苦寒之剂,泻其阳以救其阴。若脉细皮寒,泻利肠鸣,饮食不入,呕吐
无时,手足逆冷,是为五虚,虽在盛暑之时,必用大辛热之剂,散其阴以回其阳。若
执泥常法,则误矣。(《准绳》)
张景岳曰∶愚意罗先生以舍时从证之法,垂训后人,诚百世不磨之要道也。但
时之迁变,本所难知,而证之幽显,尤不易识,何也?盖常人之所谓时者,春夏秋
冬之时也,岁岁时常之主气也。谁不得而知之。而不知五六周环,则长夏有寒淫之
令,三冬有炎暑之权,此则虽若舍时,而实以从时,昧者固能知此乎!又如察证之
法,则凡脉细皮寒,泄泻厥冷之类,是皆
已见之寒证也,又谁不得而知之。不知其来有源,有甚有渐,即诸证未见之前,而
本来已具,此际便难错认,使必待焦头烂额,而后曲突徙薪,则已晚矣。此罗先生
之所以明已,然则余更为虑未然,盖恐人之见之,迟而无及于事也。虽然余常见今
人之于已然者尚不能见,而复欲其见未然,诚哉过矣!然余慨然之念,则不能不道其
详,而深望于知音者。
附子,味道辛甘,药性大热,有大毒。炮制方法:用童子小便煮并浸泡它,再用文火和武火交替加热以烈化其毒性,并且可以辅助其下行的力量,加入盐效果尤其迅速。这是作为佐使药使用,通行十二经脉,它的性质善于走窜而不固守,浮、中、沉三脉无所不到,属于阳中之阳,所以运行不止。使用得当,有夺旗斩将的功效;使用不当,则有丧命之祸。每用人参一钱作为君药,只可下附子一二分作为使药,再加甘草来解其毒性。对于内外病症,遇到严寒时候,疮口塌陷,四肢厥冷,寒湿疼痛,痿软拘挛,膝盖疼痛不能行走,腰脊受风寒侵袭,伏阴伤寒,才可以服用附子。如果不审察阴阳虚实,一概使用,使人服药后,火郁结在中焦,气郁结在下焦,咆哮哮喘急促,顷刻间死亡。凡是使用附子的,难道可以不仔细审察吗?
又说:解除附子毒的方法,让患者多吸入新鲜空气(或饮新水),连续喝几碗,于是剧烈呕吐腹泻,才能解除其毒性,这又是不可不知道的知识。
薛立斋说:《内经》说:各种痛痒疮疡,都归属于心火。如果红肿赤痛、烦躁、发热、想喝冷饮、便秘口渴,脉象洪数有力,这是正常情况,即使在严寒之时,也必须用大苦寒的药剂,来泻热。如果脉细、皮肤寒冷、腹泻肠鸣、饮食不进、呕吐无常、手足逆冷,这是变常情况,即使在盛夏之时,也必须用辛温的药剂,来助长阳气。《内经》说:用寒药要避开寒时,用热药要避开热时,如果有假象则相反,虽然违背了时令,但必须顺从证候。
王肯堂说:如红肿赤痛、烦躁、发热喜冷、便秘口渴,脉象洪数有力,这叫五实,即使在严寒之时,也必须用大苦寒的药剂,泻其阳热以救其阴液。如果脉细、皮肤寒冷、腹泻肠鸣、饮食不进、呕吐无常、手足逆冷,这叫五虚,即使在盛夏之时,也必须用大辛热的药剂,散其阴寒以回其阳气。如果固执于常规法则,那就错了。(出自《医学准绳六要》)
张景岳说:我认为罗先生以“舍时从证”的方法,教导后人,确实是百世不磨的重要道理。但是时令的变化,本来难以知晓,而证候的隐显,尤其不容易识别,为什么呢?大概常人所说的时令,是指春夏秋冬的时令,是每年四季的主气。谁不知道呢?却不知道五六周环(指运气学说中的主客加临等复杂变化),则长夏有寒淫的命令,三冬有炎暑的权变,这虽然是看似舍弃时令,实际上却是顺从时令,愚昧的人固然能知道这一点吗!又如诊察证候的方法,那么凡是脉细、皮肤寒冷、泄泻厥冷之类的,都是已经显现的寒证,又有谁不知道呢?不知道其来有源头,有的严重有的渐进,就在诸证尚未显现之前,原本就已经具备,这个时候便很难错认,如果一定要等到焦头烂额之后,才去曲突徙薪(比喻事先采取措施防止灾祸),那就太晚了。这就是罗先生之所以阐明已发生的情况的原因,然而我更为担忧未发生的情况,大概是担心人们看得太迟而无济于事。虽然如此,我常见今人对于已经发生的情况尚且不能看见,反而想让他们看见未发生的情况,确实是大错啊!然而我感慨的念头,却不能不详细道来,深深期望那些知音者。
Aconite (Fuzi, 附子) tastes pungent and sweet, possesses a great heat nature, and has significant toxicity. Processing method: It is boiled and soaked in the urine of a healthy young boy, then subjected to alternating mild (Wenhuo, 文火) and strong (Wuhuo, 武火) fire to reduce its toxicity and enhance its descending action; adding salt makes this effect particularly rapid. As an assistant or guide herb (Zuoshi Yao, 佐使之药), it circulates through all meridians. Its nature is agile and mobile rather than static, reaching the superficial, middle, and deep pulse levels without exception. It is "Yang within Yang," thus its movement is unceasing. When used appropriately, it achieves the merit of capturing flags and slaying generals; when used inappropriately, it brings the disaster of death. For every qian (approx. 3-5g) of Ginseng (Renshen, 人参) used as the sovereign herb, only 1-2 fen (approx. 0.3-0.6g) of Aconite should be used as the assistant herb, supplemented by Licorice Root (Gancao, 甘草) to resolve its toxicity. In cases of internal or external disorders, during severe cold weather, if there is a sunken ulcer, cold limbs, pain from cold-dampness, flaccidity with spasms, knee pain preventing walking, wind-cold affecting the waist and spine, latent yin cold damage, or cold damage with latent yin, then Aconite may be administered. If one fails to examine yin and yang deficiency and excess, and uses it indiscriminately, the patient may suffer from fire stagnating in the Middle Jiao (Zhongjiao, 中焦) and qi stagnating in the Lower Jiao (Xiajiao, 下焦), leading to roaring asthma and urgency, resulting in death within moments. Is it not essential to carefully examine before using Aconite?
It is also said: To resolve Aconite toxicity, allow the patient to inhale fresh air freely and drink several bowls of new water, inducing severe vomiting and diarrhea, which resolves the toxicity. This is another point that must be known.
Xue Lizhai stated: The Classics say: All pain, itching, sores, and ulcers belong to Heart Fire. If there is swelling, redness, irritability, fever, desire for cold drinks, constipation, thirst, and a surging, rapid, and full pulse, this is the normal presentation. Even in severe cold, large bitter-cold formulas must be used to drain heat. If the pulse is fine, skin is cold, there is diarrhea with borborygmus, inability to eat, frequent vomiting, and inverted cold of the hands and feet, this is an abnormal presentation. Even in peak summer, acrid-warm formulas must be used to assist Yang Qi. The *Neijing* states: Use cold remedies avoiding cold times, use hot remedies avoiding hot times; however, if there are false manifestations, reverse this rule. Although violating the season, one must follow the syndrome.
Wang Kentang stated: Swelling, redness, irritability, fever with preference for cold, constipation, thirst, and a surging, rapid, and full pulse constitute the "Five Excesses" (Wushi, 五实). Even in severe cold, large bitter-cold formulas must be used to drain Yang heat to save Yin fluids. Fine pulse, cold skin, diarrhea with borborygmus, inability to eat, frequent vomiting, and inverted cold of the hands and feet constitute the "Five Deficiencies" (Wuxu, 五虚). Even in peak summer, large acrid-hot formulas must be used to disperse Yin cold to restore Yang Qi. Adhering rigidly to standard methods leads to error. (*Yixue Zhunsheng*, Medical Standard)
Zhang Jingyue stated: I believe Mr. Luo's method of "abandoning the season to follow the syndrome" serves as an eternal teaching for future generations, truly an indispensable principle. However, changes in seasons are inherently difficult to know, and the subtle or obvious nature of syndromes is even harder to recognize. Why? Because what ordinary people call "seasons" refers merely to Spring, Summer, Autumn, and Winter, the dominant Qi of each year. Who does not know this? Yet they do not realize that through the cycles of the Five Movements and Six Qi, Long Summer may have commands of Cold Tyranny, and the Three Winters may have the authority of Heat and Summer. This appears to abandon the season but actually follows it. Can the ignorant understand this? Regarding syndrome examination, symptoms like fine pulse, cold skin, diarrhea, and cold limbs are already manifest cold syndromes; who does not know them? But one must not ignore their origin, severity, or gradual progression. Before these symptoms appear, the underlying condition may already exist, making it hard to misrecognize at that stage. If one waits until the head is scorched and forehead broken before taking preventive measures (Qu Tu Xi Xin, 曲突徙薪 - bending the chimney and moving the firewood), it is too late. This is why Mr. Luo clarified existing conditions. However, I worry more about non-existent conditions, fearing people will perceive them too late to be effective. Although I often see that modern physicians cannot even perceive existing conditions, let alone non-existent ones, which is indeed a grave error! Nevertheless, my sighing thoughts compel me to explain in detail, deeply hoping for those who understand.