余幼业医,见家伯祖景明公,有《症因脉治》一稿,序原丹溪先生《脉因证治》中来。
时余学浅,未会其趣,后见嘉言先生《寓意草》云∶治症必先识病,然后可以议药。今之
学医者,议药不议病,叹《内经》、《甲乙》无方之书,无人考究。丹溪《脉因证治》,分
析精详,反不见用,而《心法》诸书,群方错杂,则共宗之。余因知景明公《症因脉治》之
作,非无谓也,遂有纂述之志,然慎之未敢为也。后三十年,年至虑深,每思有以成公之集
,而牵于生事,日无宁晷,偶忆袁先生可以济人之语,遂乃屏绝应酬,潜心纂述,症分内外
伤,因分内外因,脉分虚实,治分经络,对症用药,无游移多歧之惑,不十载而就意者,彼
苍好生,或丹溪、景明两公,阴能助余也。书成之明年,余友施君宇瞻仲季见而悦之,因谓
余曰∶是书寿世之宝也。与其宝之一方,不若广之天下;与其利诸目前,不若传之后世。子
为是书以利济一方,余兄弟为是刻以公天下可乎?余与及门皆大欢喜,乃谢施君曰∶是书出
,倘有补于斯世者,惟君之力。
时康熙四十五年岁在丙戌腊月秦之桢字皇士纂
─是书之作,窃比丹溪先生《脉因证治》篇。但先生凭脉寻因,寻症施治,暗中摸索
,后人苦无下手,是以王宇泰先生着《准绳》书,竟取证治立名,则有确据下手矣。然不详
及脉因二条,余又恐其脱略,今更其名曰《症因脉治》,则四科俱备,开卷了然,亦足以为
─凡前贤着书,往往于外感内伤、有余不足,混叙一篇,不分条例。彼以同是症名,
则同一论列,听人自择而已,不知此但可语中人以上者也;设中下之才,因见同在一门,每
每以治虚之法,施之实症之人;内伤之方,用之外感之症。余今于每症中,必以外感内伤,
各着一端,有余不足,各分治法,临症庶无多歧之惑。
─治病先当分别十二经络,灼见何经主病,用药可以不误。故凡一经见症,则以一经
所主之药治之;两经见症,则以两经之药合而治之。如是则孰急孰缓、从少从多,皆有主宰
,有病之经,再无失治,无故之经,不妄诛伐也。
─用药之法,须寻实据之症固已。然有症脉相应,根据脉用方,而为正治者;亦有症象
分明,脉象模糊,难于根据脉立方,而必随症施治者。余于治法中立此两条,则从症从脉,自
有准绳,玄机之士,所当触类而旁通也。
─每症章中,详立外感内伤,诚恐学人混于施治。然亦有外感而兼内伤者,则以外感
方中加内伤药一二味;有内伤则兼外感者,则于内伤方中加外感药一二味;若二症并见者,
则以二症并治。例如仲景治伤寒,若见纯表症者,纯用表药;见纯里症者,纯用里药;表里
兼见者,则以一半发表、一半清里,双解表里之邪。广而推之,伤寒如是,杂症亦无不如是也。
─凡着十二经络症象,不能一条详悉者,必得互相发明,症象始着,故余着水肿症,
已经分别各经络病形。然有言之未尽者,则于后条胀症中重言以申之,以为两相阐发之用。
他如五脏咳嗽、五脏痿痹等症,经络既同,则症象亦无不同,前后合参,彼此互发,相得益
彰,泛视之竟似重复,实反复发明诸经形证。今之治病不明经络者,通忽此法耳。
─病机百出,书不尽言,集中诸病,皆确见于平时临症而不惑者,故敢就正当世。至
如篇中,或因文义拘牵,而病情不无遗漏,或因言此彼明,而辞意概从省释,又或病症中大
关节处,前书未尝明言,后人每多忽略,往往反复告戒,以见郑重其词,安辞烦琐之讥,难
免支离之诮,然而闻一可以知十,知经可以达权,业是道者,或亦鉴此苦心也。
秦皇士识
我自幼学习医学,见到伯祖景明公有一部《症因脉治》的手稿,其内容源自丹溪先生的《脉因证治》。
当时我学识浅薄,未能领会其中的旨趣。后来看到嘉言先生的《寓意草》,书中说:治疗病症必须先识别疾病,然后才能讨论用药。现在的学医者,只议论用药而不辨析疾病,令人叹息《内经》和《甲乙经》这类没有固定方剂的经典著作,无人深入研究。丹溪先生的《脉因证治》分析精详,反而不被采用,而《医宗金鉴·心法要诀》等书籍中各方混杂,大家却共同尊崇。我因此知道景明公撰写《症因脉治》并非无意义之举,于是产生了编纂阐述的志向,但因谨慎而未敢轻易动手。三十年后,年岁渐长思虑加深,常常想着完成景明公的遗著,但被生计琐事牵绊,每日不得安宁。偶然想起袁先生“可以济人”的话语,于是断绝应酬,潜心编纂。病症分为内伤和外感,病因分为内因和外因,脉象分为虚和实,治法分为经络,对症用药,没有犹豫不决、多歧路之惑。不到十年便完成了,我想这是上天好生之德,或是丹溪、景明两位先贤在暗中助我也。书成后的第二年,我的朋友施宇瞻兄弟看到并喜爱此书,便对我说:这本书是造福世人的宝物。与其将其作为一方之宝,不如推广至天下;与其利于眼前,不如流传后世。你写这本书是为了利益救济一方百姓,我们兄弟刻印此书以公之于天下,可以吗?我和门下弟子都非常高兴,于是推辞施君说:这本书问世,如果对社会有所补益,全靠您的力量。
时值康熙四十五年(丙戌年)腊月,秦之桢字皇士编纂
——这部书的创作,私下里比拟丹溪先生的《脉因证治》篇。但丹溪先生凭借脉象寻找病因,寻找症状施治,如同暗中摸索,后人苦于无从下手。因此王宇泰先生编写《准绳》一书,竟然以取证治立名,这样就有确切的依据可以着手了。然而该书未详细涉及脉和因两个方面,我又担心其有遗漏,现在将书名改为《症因脉治》,则病、因、脉、治四科具备,翻开书卷一目了然,也足以……
——以前贤人著书,往往将外感和内伤、有余和不足混叙在一篇文章中,不分条例。他们因为症状名称相同,就同一论述排列,听凭读者自行选择罢了,不知道这只能对中等以上资质的人讲;假设是中等以下资质的人,因为看到症状同属一门,常常用治疗虚证的方法,施加给实证患者;用治疗内伤的方剂,用于外感病症。我现在对于每种病症,必定将外感和内伤各列一端,有余和不足,各自区分治法,临症时或许就没有多歧路的困惑了。
——治病首先应当分辨十二经络,确切看清是哪条经络主病,用药就不会出错。所以凡是某一经出现症状,就用该经所主的药物治疗;两经出现症状,就用这两经的药物合起来治疗。像这样,那么孰急孰缓、从少还是从多,都有主宰,有病的那条经络,不会再失治,没有病的那条经络,不会妄加攻伐。
——用药的方法,必须寻找确实的症状依据固然已经如此。但也有症与脉相应,根据脉象使用方剂,作为正治的;也有症状形象分明,脉象模糊,难以根据脉象确立方剂,而必须随症状施治的。我在治法中设立这两条规则,那么从症或从脉,自然有准则,精通玄理的人士,应当触类旁通。
——每章病症中,详细设立外感和内伤,实在害怕学医者混淆施治。但也有外感兼内伤的,就在外感方中加入内伤药一二味;有内伤兼外感的,就在内伤方中加入外感药一二味;如果两种症状同时出现,就两种症状一起治疗。例如张仲景治疗伤寒,如果见到纯表证的,纯用解表药;见到纯里证的,纯用治里药;表里症状同时出现的,就用一半发表、一半清里的方法,双解表里之邪。推广开来,伤寒是这样,杂病也没有不是这样的。
——凡是记载十二经络症状,不能一条一条详尽说明的,必须互相发明,症状才显著,所以我写水肿症,已经分别各经络的病形。但有话说未尽的,就在后面的胀症条目中重申以申述它,作为两者互相阐发的作用。其他如五脏咳嗽、五脏痿痹等症状,经络既然相同,那么症状表现也就没有不同,前后合参,彼此互相启发,相得益彰,泛看似乎重复,实际上是反复阐明诸经的形证。现在的治病者不明白经络,都忽略这种方法罢了。
——病机百出,书本不能完全表达言语,集中的各种病症,都是平时临症时确实见到且不迷惑的,所以敢于呈现在当世。至于篇中,或因文义拘泥牵强,而病情不无遗漏,或因言此彼明,而辞意一概从简省略,又或病症中大关节处,前书未曾明确说明,后人往往多忽略,常常反复告诫,以显示郑重其词,难免遭受繁琐的讥讽,难以避免支离的嘲笑,然而闻一知十,知经达权,从事这一道的人,或许也能体察这份苦心吧。
秦皇士识
I studied medicine from a young age and saw my great-uncle, Jingming Gong, who had a manuscript titled *Zheng Yin Mai Zhi* (Disease Manifestation, Etiology, Pulse, and Treatment), which originated from Danxi Xiansheng's *Mai Yin Zheng Zhi* (Pulse, Etiology, Manifestation, and Treatment).
At that time, my learning was shallow, and I did not understand its purport. Later, I read Jia Yan Xiansheng's *Yu Yi Cao* (Grass of Inspired Meaning), which stated: To treat a condition, one must first identify the disease, then one can discuss medication. Modern practitioners of medicine discuss medication without discussing the disease, which is lamentable; no one studies classics like *Nei Jing* (Inner Canon) and *Jia Yi Jing* (A-B Classic of Acupuncture and Moxibustion), which are books without fixed formulas. Danxi Xiansheng's *Mai Yin Zheng Zhi* offers precise and detailed analysis, yet it is not used, whereas books like *Xin Fa* (Core Principles) contain a jumble of various formulas, which everyone reveres. Therefore, I came to know that Jingming Gong's composition of *Zheng Yin Mai Zhi* was not meaningless, and thus I harbored the ambition to compile and elaborate on it, but I was cautious and dared not act. Thirty years later, as I grew older and my thoughts deepened, I often thought of completing Gong's collection, but I was hindered by livelihood matters, having no peaceful moments day or night. Accidentally recalling Mr. Yuan's words about "being able to benefit humanity," I then cut off social engagements and devoted myself to compilation. Diseases were divided into internal injury (*Nei Shang*) and external contraction (*Wai Gan*), etiology into internal and external causes, pulses into deficiency (*Xu*) and excess (*Shi*), and treatments into meridians. Medication was applied according to symptoms, eliminating hesitation and confusion of divergent paths. It took less than ten years to complete; I believe this is due to Heaven's benevolence, or perhaps the secret assistance of both Danxi and Jingming Gongs. The year after the book was completed, my friend Shi Yuzhan and his younger brother saw it and liked it, saying to me: This book is a treasure for benefiting the world. Rather than keeping it as a treasure for one region, it is better to spread it to the world; rather than benefiting the present, it is better to transmit it to future generations. You wrote this book to benefit and relieve one region; would it be acceptable if my brothers and I engraved and printed it to make it public to the world? My disciples and I were greatly delighted, and we declined Mr. Shi, saying: If this book, upon publication, contributes to this world, it is solely due to your power.
Compiled in the twelfth month of Bing Xu year (1706 AD) during the reign of Kangxi, by Qin Zhizhen, courtesy name Huangshi.
—The creation of this book is privately compared to Danxi Xiansheng's chapter in *Mai Yin Zheng Zhi*. However, Danxi Xiansheng sought etiology through pulse and treatment through manifestation, akin to groping in the dark, causing later generations to suffer from not knowing where to start. Therefore, Wang Yutai Xiansheng wrote the *Zhun Sheng* (Standard Rules) series, naming it based on obtaining evidence for treatment, thus providing definite grounds to begin. Yet it does not detail the aspects of pulse and etiology. Fearing omissions, I now rename it *Zheng Yin Mai Zhi*, so that the four categories—manifestation, etiology, pulse, and treatment—are all complete, clear at a glance upon opening the book, which is sufficient...
—Previous sages writing books often mixed external contraction and internal injury, excess and deficiency in one article, without separating them into regulations. Because the symptom names were the same, they listed them together, leaving readers to choose freely, unaware that this could only be discussed with those of above-average aptitude; for those of average or below aptitude, seeing symptoms in the same category, they often applied methods for treating deficiency to patients with excess conditions, or formulas for internal injury to symptoms of external contraction. Now, for each symptom, I definitely separate external contraction and internal injury, and distinguish treatment methods for excess and deficiency separately, so that in clinical practice, there will hopefully be no confusion of divergent paths.
—Treating disease requires first distinguishing the twelve meridians (*Shi Er Jing Luo*), clearly seeing which meridian is primarily diseased, so that medication will not be mistaken. Thus, whenever symptoms appear in one meridian, treat them with medications governing that meridian; when symptoms appear in two meridians, combine medications from both meridians to treat. In this way, urgency and slowness, following fewer or more, all have a master; the diseased meridian will not be mistreated, and the healthy meridian will not be wantonly attacked.
—The method of using medication must indeed seek solid symptomatic evidence. However, there are cases where symptoms and pulse correspond, and one follows the pulse to prescribe a formula as standard treatment; there are also cases where symptoms are distinct but the pulse is vague, making it difficult to establish a formula based on the pulse, requiring treatment to follow symptoms. By establishing these two rules in treatment methods, whether following symptoms or pulse, there will naturally be a standard. Those versed in profound principles should be able to extend knowledge by analogy.
—In each chapter of symptoms, external contraction and internal injury are detailed, truly fearing that learners might confuse their treatment. However, there are cases of external contraction complicated by internal injury, in which case add one or two herbs for internal injury to the external contraction formula; there are cases of internal injury complicated by external contraction, in which case add one or two herbs for external contraction to the internal injury formula; if both symptoms appear simultaneously, treat both. For example, Zhang Zhongjing treated *Shang Han* (Cold Damage); if pure exterior symptoms were seen, pure exterior-releasing drugs were used; if pure interior symptoms were seen, pure interior-treating drugs were used; if exterior and interior symptoms appeared together, half was used to release the exterior and half to clear the interior, simultaneously resolving exterior and interior pathogens. Extending this principle, *Shang Han* is like this, and miscellaneous diseases are no different.
—Regarding the manifestations of the twelve meridians, if one cannot detail every single item, mutual explanation is necessary for symptoms to become clear. Thus, when I wrote about edema (*Shui Zhong*), I already distinguished the pathological forms of each meridian. However, for points not fully explained, I reiterate them in the subsequent entry on distension (*Zhang Zheng*) to serve as mutual elaboration. Similarly, for symptoms such as coughs of the five zang organs (*Wu Zang Ke Sou*) and flaccidity/obstruction of the five zang organs (*Wu Zang Wei Bi*), since the meridians are the same, the symptoms are also largely the same. Comparing front and back, mutually inspiring each other, they enhance each other. Superficially appearing repetitive, they actually repeatedly clarify the manifestations of various meridians. Modern practitioners who do not understand meridians tend to ignore this method.
—Pathogenic mechanisms are myriad, and books cannot fully express speech. The various diseases collected here are those I have genuinely encountered and understood without confusion in clinical practice, so I dare to present them to the contemporary world. As for the text, due to linguistic constraints, some disease conditions may be omitted; due to explaining one thing to clarify another, language and meaning are generally simplified; or regarding major junctures in diseases, previous books did not explicitly state them, leading later generations to often overlook them. I frequently repeat warnings to show seriousness, avoiding ridicule of verbosity and criticism of fragmentation. However, hearing one allows knowing ten; understanding the constant allows adapting to change. Practitioners of this path may also appreciate this painstaking effort.
Recorded by Qin Huangshi.