或问部胎产金丹用以调经可乎?曰∶不可。金丹真良方也，然名曰胎产，因胎前、产后
而设
。其方以河车为君，佐以肉桂，取温暖畅达之意。怀孕将至足月，不复宜凉，服金丹一、二
丸，可以易产；产后最忌停瘀，服一、二丸，可以行瘀。予治旗营妇人，怀孕五、六月忽小
产，二胎不下，腹痛异常，以芎归汤下金丹一丸，不过数剂，衣胞下而腹痛止，足见为行血
通瘀之品，胎前、产后实属相宜，至妇人经水不调，岂皆虚寒停瘀所致，如果过期不至，子
宫虚冷，金丹可服，否则经不过期而转频数，金丹岂可服耶?至有善于滑胎，而欲以金丹保
胎者，则保之适以催之，殊可笑也。
病之生也，百出不穷，治法总不外乎阴阳五行四字。天以阴阳五行化生万物，医以阴阳
五行
调治百病。要之，五行之生克，仍不外乎阴阳。阴阳即血气之谓也，气为阳，血为阴也。气
血即水火之谓也，气为火，而血为水也。气无形，而血有形，气附血以行，血无气亦不能自
行。无阴则阳无以生，无阳则阴无以化，阴阳和而万物生焉。人生一小天地，阴阳必得其平
。医者偏于用凉，偏于用温，皆不得其正也。
医有定理，亦有活法。王太仆云∶寒之不寒，是无水也，宜壮水之主，以制阳光；热之
不热
，是无火也，宜益火之原，以消阴翳。此定理也。又有论目云∶能远视不能近视，责其无水
；能近视不能远视，责其无火。夫目乃水精之光，无水则任意滋水可也。而书称目无火不病
，又称眼病无寒，设以不能远视之故而任意补火，能无损目乎?凡人生而近视者甚多，往往
不受热药，此则当参以治法，不可尽责其无火也。
用药之道，惟危急存亡之际，病重药轻，不能挽救，非大其法不可。否则法先宜小，有
效乃
渐加增，不得以古方分量之重为准。况考古方之分量，合之于今，并不甚重。如仲景立方，
动以斤计，或称升合，似甚多也。及其用末药，不过方寸匕；丸药如梧子大，所服不过三十
粒，又似甚少。何丸、散、汤液之相悬如此耶?考《千金》、《本草》，皆以古三两为今之
一两，古三升为今之一升，则所两者，仅得今之三钱耳!且仲景汤液总分三次服，则又止得
三分之一。合而计之，岂非古之一两，仅得今之一钱乎?惟世有古今，地有南北，人有强弱
，药有刚柔，医者知所变通，庶几有得耳!
凡人有病，如锁错 ；医者治病，如以钥开锁。不善开锁，虽极用力而锁不开，甚且将
锁损坏。铜
匠善开锁，只须铜钱一根，轻轻一拨，而锁自开。故不善治病者，虽用重剂，而病不解，甚
且加增；善治病者，只须一药，即可得救。初学治病，当自审其能治则治，否则以待善治者
，不可未识病情，孟浪用药，将人损坏，虽有善者，未如之何!夫锁可损也，人亦可损乎哉?
凡用药调理病患，如浇灌花木，然有宜清水者，有宜肥壮者，既得其宜，而又浇灌适中
，无太过不及之弊，自然发旺异常。调理病患亦然，有宜清养者，有宜峻补者，有宜补气者，有
宜补阴者，必求其当而后有效，不可蒙混施治也，即如有求速效者，以为人参补气，既服人
参，何气尚不足?熟地补阴，既服熟地，何阴尚不足?不知用药培养，亦如浇灌花木之道，浇
灌得宜，则花木借以易长，非所浇灌者，即是花木也。即如芍药最宜稠粪，多以稠粪加之，
岂即变为芍药乎?是故气虚者，宜参，则人之气易生，而人参非即气也；阴虚者，宜地，服
地则人之阴易生，而熟地非即阴也。善调理者，不过用药得宜，能助人生生之气，若以草根
树皮，竟作血气用，极力填补，如花木之浇肥太过，反遏其生机矣。我辈用药，总要轻重得
宜，不可呆泥。况善用补者，补中有开，譬如作文，尽填实字，无一虚字，可能成文乎?总
之，不通儒学，不能通医理也。
药有甚贵，宜于人有益而反有损者，人参是也。据《本草》人参能回元气于无何有之
乡，可
而弱，可以补救；若气至无何有，人参何能为无气之人生出气来耶?然此不过无益而已，而
更有损者，何也?富贵之人，骄奢之性，淫欲不节，自谓体虚，初病即欲服参，庸工无识，
意
进。予至亲丁吴氏，肺热音哑，某医顺病患之意，人参服之数两，而更无音。乃延予诊，嘱
以停参，进泻白散数服而愈。又予至友吴在郊翁，肝火上升，头晕、出汗，其家皆以为虚
，某医亦以为虚，逐日服参，而汗、晕更甚。遂延予诊，欲代平肝，本人深信，而旁言哓哓
，以为如此温补，汗尚不止，况停参服阴药耶?予辨以服参多日，毫未见效，且觉病进，犹
不更法，必欲以参治死老翁耶!予曾代伊芳家排难解纷，素知感激，故能如此争论。而其子以
为知医，最喜用参，某医附和之，究不信予之言，幸老翁深信不疑，自愿服予之方。予总以
平肝养血为主，调理一月而愈，然则服参何益耶?更有目睹者，吾乡富户赵氏，为予近邻。
其父血痢，死于参。其弟疔证，亦死于参。又有吴景贤者，偶感时邪，赵氏因其父之老友，
特送参数钱，景贤并不肯服，奈旁人以为财东所送，何能不服?某医尤加附和，极力劝服，
遂致邪不出而死。此皆人所同知，以益人之药而损人，谁之过欤?予治病四十余年，大抵富
贵者少，中平者多，类多无力用参，而予亦轻易不用；即富贵之人，其病不当用参，予必禁
止不用。如必用参而始能活人，则无力之人能活者有几哉?
药有极贱，似于人无益而大有益者，黑芝麻 是也。予尝治肝气胀痛异常，气逆呕吐，
前医
用二陈、香附、木香，顺气不效，加用破气，如枳壳、腹皮、乌药、沉香之类，更不效。予
思肝气横逆，固非顺气不可，但肝为刚脏，治之宜柔，前医所用皆有刚意，故肝不受。治宜
甘以缓之，兼养阴以平肝，然非兼通气之品，亦难速效，惟通气之药，难免刚燥之意。偶思
及芝麻 ，外直内通，其色黑可径达肾，其性微凉，毫无刚意，遂用一支，助以金橘饼三钱
，一服而效，数服全愈矣。每遇举发，即用是方，无不速愈。嗣后予治肝气必用之，无不应
手，所谓软通于肝最宜。因思凡人脏腑之气，无不贵通，《内经》通则不痛，痛则不通，固
已。而推展其意，通则不胀，胀则不通；通则不逆，逆则不通。凡治气病，无不宜通，不独
肝经也。兼治哮症多年，肾气上逆，予用六味地黄加减为丸，每服五钱，以芝麻 一支，煎
汤下，竟能渐愈，久不发矣。又治肝气犯胃，饮食阻滞，欲成膈症，予以滋润平肝、青金畅
胃
之品，加芝麻 、金橘饼，十数服而愈。又遇胀症，几有单腹之象，予用甘麦大枣汤加芝麻
、金橘饼，连服月余而愈。其它诸气为病，服之得效者，不可数计。今诸亲友，凡有气症
，延予延医，必嘱以芝麻 为家藏。若夫财翁，惟知爱参，此种贱药之妙，彼固不知，且不
信也。此药各家本草所不载，予偶得之，十年于兹，始以治肝气，渐则可治之病甚多，虽蛊
胀单腹，亦所能治。予不肯以为独得之奇也，特表而出之，以公诸世。
予尝以所阅医书，配以儒书。如《内经》，儒书之五经也；仲景《伤寒论》、《金匮玉
函
》，儒书之四书也。汉以后医书虽多，皆不甚醇正，惟喻嘉言发挥仲景之书，精微博大，奥
义毕宣，儒书中之朱注也。虽有柯氏出其后，意欲抹煞喻氏以炫其书，亦如朱注之后，有吹
毛求疵，妄肆讥评者，究何能灭朱文正而行其说耶?予所以心悦诚服于喻氏也，惟其书独详
于《伤寒》、《金匮》，欲为仲景后之一人。其《医门法律》于杂症颇略，幸有《冯氏锦囊
》，书称美备，议论深醇，且其书于幼科尤为精细，为钱仲阳所不能及，即如痘症一门，予
尝本之以治家中痘症，皆万全无弊，时下幼科所未尝见也。予故于喻氏外，又推重冯氏，而
欲后人学之也。
予不习外科，而治杨梅疮十数人，果未吃捺药，无不应手而愈者，盖推冯氏治痘之法而
用之
也。今外科治杨梅，总不离乎下法。不知此毒必须升透，即如治天花，果能升透如花之发旺
，自然上浆结痂，无不顺吉。升透之法，必善内托，保元汤∶人参、黄 、官桂、糯米、紫
草、甘草，所以为主方也。若肆用大黄，气血下虚，痘必内陷，毒何能透?命何能保耶?夫天
花先天之毒也，杨梅后天之毒也。先天之毒欲透发之，犹必内托，不可伤其气血；后天之毒
欲透发之，可不内托，而惟以大下伤其气血乎?盖气血旺，则毒易托出而易尽，无后患也；
气血弱，则毒难托出而难尽，遗祸无穷∶是故切不可伤其气血也。天花、杨梅，竟属一理，
予比而同之，闻者得毋惊而至于惑乎!然予天花虽少，而无不愈，治杨梅较多，而亦无不愈
，取《锦囊》治痘之意而贯通之，屡获大效。吾家后学，或不治杨梅，而家中生育甚多，幼
子童孙难免痘症，能讲求于冯氏之书，庶几有得，而不至受时下幼科之害也。
今将治杨梅之法，姑述大略。杨梅初起，火毒甚重，大便必难，不得不先通之，龙胆泻
肝汤
加大黄，三两剂，大便已通则止。此等毒由肝肾受者居多，故先用此汤。或已现于面，毒已
由脏及腑，面部多属阳明，阳明主肌肉，则用河间防风通圣散，内有发散、攻下、清凉解毒
诸药，且有兼顾气血之品，可服三、四剂，亦大便通即止。二方皆以土茯苓二两，煎汤煎药
。戒吃茶叶，恐解药性。嗣则看其人之本体，如气分不足，则以四君加败毒之品 ，银花、
槐蕊之类；如血分不足，则以四物加败毒之品，银花、槐蕊可以多加，更加养血凉血之品。
亦以土茯苓煎汤煎药，另合五宝丹∶朱砂五分，琥珀五分，滴乳石五分，珍珠五分，研极细
，入冰片二分五厘，牛黄五分，再同研，加飞罗面二两和匀，瓷瓶收贮。每服五分，土茯苓
汤下。逐日必戒茶饮，恐解性，可以土茯苓汤代之。如此医治，轻者丹服一料即愈，重者不
过二料，无不愈者。予屡见有过服下药，致饮食不进，而其疮臭不可近，予用归脾汤合加味
五宝丹，不过三服，其臭遂止，十日后而其疮愈矣。其一为巫某，其一为老友柏邃庵，今邃
庵八十有四犹健，可问而知也。
最可笑者，吾乡之小儿科，自不知书，毫无学问，不过其师传以发散、消导数方，如张
子和
三子养亲汤∶苏子、白芥子、莱菔子，在所必传，加以羌、防、柴、葛、枳壳、腹皮、山楂
、浓朴消导药十数味，再传以脉案，曰∶受凉停滞。食乳相裹，防变防惊数语，遂即悬壶
行道矣。每遇临症，即将师传数语立方，叮嘱人家症重不可吃乳，米饮亦不可吃，日以发散
、消导与服，数日不退热，不易原方，虽十数日不退热，
仍用原法，略为加减耳!其家少进米饮，则曰吃坏了。因燥药吃多，血分大亏，不能
荣筋，以致抽搐，则曰此急惊也，吾早言之矣。多日不吃饱乳，且服发散，治得气微欲绝，
则曰此慢惊也，吾早言之矣。直至于死，医者不悟，而受害者亦不悟，犹以为先生甚灵，彼
早言
矣。尤可恨者，有拂惊之妇人，毫无传授，妄行作孽，其儿并无惊，实因误药，气血已虚，
往往一拂而死。夫喜、怒、忧、思、悲、恐、惊，惊乃七情之病，必因惊吓而后起，岂有因
外感而成惊者乎?我辈方脉，不看幼科，然因方脉而救小儿者不少。如曹耕之之孙女，某幼
科治之将死，遂请拂惊老妇，余再三劝止，嘱令止药，吃乳食粥，数日全愈。韦廷璋次子，
甫生八月，偶因外感发热不退，某医肆用发散，不许吃乳以及米饮，延至多日，看看待毙
，乃回绝不治。适予至伊芳家有事，廷璋各予求救。予以手指探其口，尚裹予指，知将饿死，
乃伪曰我有妙方，能救此儿，但先须吃乳。其家谓已将断气，何能吃乳?予断以必能吃乳，
但须其母上床以乳就之耳!其母依言，以乳就之，果然能吃，且吃不少，乳后安睡。予告以
今夜且不必服药，明早我来进药可也。次早往视，儿夜间吃乳不少，且得安眠，似已全愈。
伊芳家问药，笑应之曰∶予有何药，仍吃乳耳!此儿有病多日，过服发散、消导，有何外感?有
何停滞?又不许吃乳，直饿死耳!而不死者，殆与我前世有缘也。其家感激，强将其子寄我名
下，予亦听之。又在蒋姓家诊病，其家顺以小儿药方请教。予看脉案，痰喘声如拉锯，药甚
厉害。 予问小儿何在?奶妈现抱在予旁，并无拉锯之声，惟神气甚弱耳!予稍为诊脉，曰∶
此
发散、消导太过，想必又不许吃乳，乃虚痰耳!速宜进乳，不必服药。其家依言，数日全愈
矣。幼科之误人也，予姑略述二、三，类此者甚
多，不能尽举。我后人学方脉，于幼科亦须留意。
凡名家医书，皆有幼科，固宜善看，而《冯氏锦囊》，由小儿始，以痘科终，尤不可忽
。果能遍看方脉，小儿无不兼备。家中生育颇多，庶不至受幼科之误也。
【背景信息】
书名：知医必辨 作者：李冠仙 朝代：清 章节：附论胎产金丹 / 杂论(十一条) 类别：医论
有人问：用“胎产金丹”来调理月经可以吗？回答说：不可以。“胎产金丹”确实是良方，但既然名字叫“胎产”，是因为它是为产前、产后设立的。这个方子以紫河车（胎盘）为君药，辅以肉桂，取温暖畅达之意。怀孕临近足月时，不再适宜用凉药，服用一、二丸“胎产金丹”，可以顺利生产；产后最忌讳瘀血停滞，服用一、二丸，可以行散瘀血。我治疗过旗营的一位妇人，怀孕五、六个月时突然小产，二胎未下，腹痛异常，我用芎归汤送服一丸“胎产金丹”，不过几剂药，衣胞（胎盘）排出且腹痛停止，足见它是活血通瘀的药物，对于产前、产后确实适宜。至于妇女月经不调，难道都是虚寒瘀滞导致的吗？如果月经过期不来，是子宫虚冷所致，那么“胎产金丹”可以服用；否则，月经不过期反而变得频繁，“胎产金丹”怎么可以服用呢？至于那些善于导致滑胎（习惯性流产），却想用“胎产金丹”来保胎的人，这所谓的保胎，实际上是在催产，真是可笑。
疾病的产生，层出不穷，治疗方法总离不开阴阳五行这四个字。天依靠阴阳五行化生万物，医生依靠阴阳五行调治百病。总之，五行的生克关系，仍不超出阴阳的范围。阴阳就是指气血，气属于阳，血属于阴。气血就是指水火，气属于火，血属于水。气是无形的，血是有形的，气依附于血而运行，血没有气也不能自行运行。没有阴，阳就无法生成；没有阳，阴就无法化生，阴阳调和则万物生长。人身体就是一个小天地，阴阳必须保持平衡。医生用药偏重于凉性，或偏重于温性，都不符合正道。
医学有固定的法则，也有灵活的方法。王太仆说：“寒证用寒药而不退热，这是肾水不足，应当壮水之主（滋补肾阴），以抑制阳光（虚火）；热证用热药而不退寒，这是命门火衰，应当益火之原（温补命门之火），以消除阴翳（阴寒）。这是固定法则。”又有论述眼睛的篇章说：“能看远不能看近，责在无水（肾阴亏）；能看近不能看远，责在无火（心阳/命门火衰）。”眼睛是水精之光，没有水就任意滋补水液即可。但书中说眼睛没有火不会生病，又说眼病没有寒证，假设因为不能看远就任意补火，能不损伤眼睛吗？凡是人生来近视的人很多，往往受不了热药，这应当参考治疗方法，不能全责怪无火。
用药的道理，只有在危急存亡之际，病情重而药力轻，无法挽救时，才不得不加大法度（增加药量或改变策略）。否则，法度起初应该小，有效后再逐渐增加，不能以古方分量重为标准。况且考证古方的分量，合于今制，并不很重。如张仲景创立方剂，动不动就用斤计算，或者称升合，似乎很多。等到他用末药（粉末），不过一方寸匕；丸药像梧桐子大，服用的不过三十粒，又似乎很少。为什么丸药、散剂、汤液相差如此之大呢？考证《千金方》、《本草》，都是以古三两作为今之一两，古三升作为今之一升，那么所谓的“两”，仅得到现在的三钱罢了！而且张仲景的汤药总分三次服用，那就只剩下三分之一了。合计起来，难道不是古之一两，仅得现在的一钱吗？世上有古今之分，地有南北之别，人有强弱不同，药有刚柔差异，医生懂得变通，才会有所收获！
凡人有病，就像锁扣错住；医生治病，就像用钥匙开锁。不善于开锁的人，虽然极用力也开不开，甚至把锁损坏。铜匠善于开锁，只需要一根铜钱串成的线，轻轻一拨，锁自然就开了。所以不善于治病的人，虽然用重剂，病也不解，甚至加重；善于治病的人，只需要一味药，就可以救活。初学治病的人，应当审视自己能否治好，如果不能，就等待善于治病的人，不可在未认清病情时，鲁莽用药，把人治坏，即使有高手，也无能为力！锁可以损坏，人也可以损坏吗？
凡是用药调理病患，就像浇灌花木，有的适宜清水，有的适宜施肥。既得其宜，而又浇灌适中，没有太过或不及的弊端，自然长得茂盛。调理病患也是这样，有的适宜清养，有的适宜峻补，有的适宜补气，有的适宜补阴，必须求得当而后有效，不可蒙混施治。就像有人追求速效，认为人参补气，既然服了人参，为什么气还不足？熟地补阴，既然服了熟地，为什么阴还不足？不知道用药培养，也像浇灌花木的道理，浇灌得宜，花木借以容易生长，被浇灌的东西，并不是花木本身。就像芍药最适宜浓粪，多加浓粪，难道芍药就变成了浓粪吗？所以气虚者，适宜用人参，那么人的气就容易生成，而人参并不是气本身；阴虚者，适宜用地黄，服用地黄那么人的阴就容易生成，而熟地黄并不是阴本身。善于调理的人，不过是用药得宜，能帮助人生生不息之气，如果把草根树皮，竟然当作血气来用，极力填补，就像花木浇肥太多，反而遏制了生机啊。我们用药，总要轻重得宜，不可拘泥死板。况且善于使用补药的人，补中有通，譬如写文章，全是实字，没有一个虚字，可能成文吗？总之，不通儒学，就不能通晓医理。
药有非常贵重的，适宜于人有益反而有害的，就是人参。据《本草》记载，人参能在元气将绝之时挽回元气，可以弱转强，可以补救；但如果气已经到“无何有之乡”（极度虚弱近乎无的状态），人参怎么能给无气之人生出气来呢？然而这不过是无益而已，更有损害的，为什么呢？富贵之人，骄奢的性格，淫欲不节制，自认为体虚，初病就想服人参，庸医无知，顺从意进。我的至亲丁吴氏，肺热音哑，某医顺从病患的意思，让人参服了几两，结果更不出声了。于是请我诊治，嘱咐停用人参，进服泻白散几服就好了。又我的挚友吴在郊老翁，肝火上升，头晕、出汗，他的家人都认为是虚证，某医也认为是虚证，每天服人参，结果汗出、头晕更严重。于是请我诊治，我想平抑肝火，本人深信，但旁人议论纷纷，认为这样温补，汗尚且不止，何况停参服阴药呢？我辩解说服参多日，毫无见效，且觉得病势进展，如果不换方法，一定要用人参治死老翁吗？我曾替他家排难解纷，素知感激，所以能如此争论。而他的儿子自以为懂医，最喜欢用人参，某医附和他，终究不信我的话，幸好老翁深信不疑，自愿服我的方子。我总以平肝养血为主，调理一个月而愈，那么服参有什么益处呢？更有亲眼目睹的，我乡富户赵氏，是我的近邻。他的父亲患血痢，死于人参。他的弟弟患疔疮，也死于人参。又有吴景贤者，偶然感受时邪，赵氏因其父的老朋友，特意送参数钱，景贤不肯服，无奈旁人认为财东送的，怎么能不服？某医尤其附和，极力劝服，致使邪气不得外泄而死。这都是众人所知道的，以益人之药而损人，是谁的过错呢？我治病四十多年，大体上富贵者少，中等人家多，大多无力用人参，而我也轻易不用；即使是富贵之人，其病不适宜用人参，我必定禁止不用。如果必须用人参才能救人，那么无力之人能救活的有几个呢？
药有极其便宜的，似乎于人无益而大有益的，就是黑芝麻。我曾经治疗肝气胀痛异常，气逆呕吐，前医用二陈汤、香附、木香，顺气无效，加用破气药，如枳壳、腹皮、乌药、沉香之类，更无效。我思考肝气横逆，固然非顺气不可，但肝为刚脏，治之宜柔，前医所用都有刚意，所以肝不接受。治宜甘以缓之，兼养阴以平肝，然而非兼通气之品，也难速效，只是通气之药，难免有刚燥之意。偶然想到芝麻，外直内通，其色黑可直达肾脏，其性微凉，毫无刚意，遂用一支，助以金橘饼三钱，一服而效，数服全愈了。每次遇到发作，就用这个方子，无不速愈。此后我治肝气必用此药，无不应手，所谓软通于肝最适宜。因此思考凡人脏腑之气，无不贵在通畅，《内经》说通则不痛，痛则不通，固然是这样。而推展其意，通则不胀，胀则不通；通则不逆，逆则不通。凡治气病，无不适宜通，不独肝经。兼治哮症多年，肾气上逆，我用六味地黄丸加减为丸，每服五钱，以芝麻一支，煎汤送下，竟能渐愈，久不复发。又治疗肝气犯胃，饮食阻滞，欲成膈症，我以滋润平肝、青金畅胃之品，加芝麻、金橘饼，十数服而愈。又遇到胀症，几乎有单腹胀的迹象，我用甘麦大枣汤加芝麻、金橘饼，连服月余而愈。其他诸气为病，服之得效的，不可胜数。如今亲友，凡有气症，延请我诊治，必嘱咐以芝麻为家藏。至于财主老爷，只知道爱人参，这种贱药的妙处，他们根本不知道，也不相信。此药各家本草所不载，我偶然得到它，十年于此，开始用来治肝气，渐渐发现可治的病甚多，虽蛊胀单腹，也能治疗。我不肯以为独得之奇，特地表而出之，以公诸于世。
我曾经把我阅读的医书，配以儒书。如《内经》，是儒书中的五经；张仲景《伤寒论》、《金匮玉函》，是儒书中的四书。汉以后的医书虽多，皆不甚醇正，只有喻嘉言发挥张仲景的书，精微博大，奥义毕宣，是儒书中的朱熹注疏。虽然有柯琴出其后，意欲抹杀喻昌以炫耀自己的书，也如同朱注之后，有吹毛求疵、妄肆讥评的人，究竟怎能灭掉朱文的正统而行其说呢？我之所以心悦诚服于喻氏，只因为他的书详细于《伤寒》、《金匮》，想成为张仲景之后的第一人。他的《医门法律》对于杂症颇略，幸好有《冯氏锦囊》，书称美备，议论深醇，且他的书对于儿科尤为精细，为钱乙所不能及，就像痘症一门，我曾经依据它来治疗家中的痘症，皆万全无弊，时下儿科所未曾见过的。所以我除了推崇喻氏之外，又推重冯氏，而想让后人学习它。
我不擅长外科，而治疗杨梅疮十多人，果然不吃捺药（外用腐蚀药），无不应手而愈的，大概是推演冯氏治痘的方法而应用的。现在外科治疗杨梅疮，总不离乎下法（泻下法）。不知道此毒必须升透，就像治疗天花，果能升透如花之发旺，自然上浆结痂，无不顺吉。升透之法，必善内托，保元汤：人参、黄芪、官桂、糯米、紫草、甘草，所以为主方也。若肆意使用大黄，气血下虚，痘必内陷，毒怎么能透发？命怎么能保住呢？夫天花是先天之毒，杨梅疮是后天之毒。先天之毒想要透发，犹必内托，不可伤其气血；后天之毒想要透发，可不内托，而惟以大下伤其气血吗？盖气血旺，则毒易托出而易尽，无后患也；气血弱，则毒难托出而难尽，遗祸无穷：是故切不可伤其气血也。天花、杨梅疮，竟属一理，我把它们等同起来，听到的人会不会惊讶以至于困惑呢？然而我治天花虽少，而无不一愈，治杨梅疮较多，也无不一愈，取《锦囊》治痘之意而贯通之，屡获大效。我家后学，或许不治杨梅疮，而家中生育甚多，幼子童孙难免痘症，能讲求于冯氏之书，庶几有得，而不至受时下儿科之害。
现在将治杨梅疮的方法，姑且陈述大概。杨梅疮初起，火毒甚重，大便必难，不得不先通之，龙胆泻肝汤加大黄，三两剂，大便已通则止。此等毒由肝肾受者居多，故先用此汤。或已现于面，毒已由脏及腑，面部多属阳明，阳明主肌肉，则用河间防风通圣散，内有发散、攻下、清凉解毒诸药，且有兼顾气血之品，可服三、四剂，亦大便通即止。二方皆以土茯苓二两，煎汤煎药。戒吃茶叶，恐解药性。嗣则看其人之本体，如气分不足，则以四君子汤加败毒之品，银花、槐蕊之类；如血分不足，则以四物汤加败毒之品，银花、槐蕊可以多加，更加养血凉血之品。亦以土茯苓煎汤煎药，另合五宝丹：朱砂五分，琥珀五分，滴乳石五分，珍珠五分，研极细，入冰片二分五厘，牛黄五分，再同研，加飞罗面二两和匀，瓷瓶收贮。每服五分，土茯苓汤下。逐日必戒茶饮，恐解性，可以用土茯苓汤代之。如此医治，轻者服一料即愈，重者不过二料，无不愈者。我屡见过服下药，致饮食不进，而其疮臭不可近，我用归脾汤合加味五宝丹，不过三服，其臭遂止，十日后而其疮愈矣。其一为巫某，其一为老友柏邃庵，今邃庵八十有四犹健，可问而知也。
最可笑的是，我乡的儿科，自不知书，毫无学问，不过其师传以发散、消导数方，如张子和三子养亲汤：苏子、白芥子、莱菔子，在所必传，加以羌活、防风、柴胡、葛根、枳壳、腹皮、山楂、厚朴消导药十数味，再传以脉案，曰：受凉停滞。食乳相裹，防变防惊数语，遂即悬壶行道矣。每遇临症，即将师传数语立方，叮嘱人家症重不可吃乳，米饮亦不可吃，日以发散、消导与服，数日不退热，不易原方，虽十数日不退热，仍用原法，略为加减耳！其家少进米饮，则曰吃坏了。因燥药吃多，血分大亏，不能荣筋，以致抽搐，则曰此急惊也，吾早言之矣。多日不吃饱乳，且服发散，治得气微欲绝，则曰此慢惊也，吾早言之矣。直至于死，医者不悟，而受害者亦不悟，犹以为先生甚灵，彼早言矣。尤可恨者，有拂惊之妇人，毫无传授，妄行作孽，其儿并无惊，实因误药，气血已虚，往往一拂而死。夫喜、怒、忧、思、悲、恐、惊，惊乃七情之病，必因惊吓而后起，岂有因外感而成惊者乎？我辈方脉，不看幼科，然因方脉而救小儿者不少。如曹耕之之孙女，某儿科治之将死，遂请拂惊老妇，余再三劝止，嘱令止药，吃乳食粥，数日全愈。韦廷璋次子，甫生八月，偶因外感发热不退，某医肆用发散，不许吃乳以及米饮，延至多日，看看待毙，乃回绝不治。适予至伊芳家有事，廷璋各予求救。予以手指探其口，尚裹予指，知将饿死，乃伪曰我有妙方，能救此儿，但先须吃乳。其家谓已将断气，何能吃乳？予断以必能吃乳，但须其母上床以乳就之耳！其母依言，以乳就之，果然能吃，且吃不少，乳后安睡。予告以今夜且不必服药，明早我来进药可也。次早往视，儿夜间吃乳不少，且得安眠，似已全愈。伊芳家问药，笑应之曰：予有何药，仍吃乳耳！此儿有病多日，过服发散、消导，有何外感？有何停滞？又不许吃乳，直饿死耳！而不死者，殆与我前世有缘也。其家感激，强将其子寄我名下，予亦听之。又在蒋姓家诊病，其家顺以小儿药方请教。予看脉案，痰喘声如拉锯，药甚厉害。予问小儿何在？奶妈现抱在予旁，并无拉锯之声，惟神气甚弱耳！予稍为诊脉，曰：此发散、消导太过，想必又不许吃乳，乃虚痰耳！速宜进乳，不必服药。其家依言，数日全愈矣。幼科之误人也，予姑略述二、三，类此者甚多，不能尽举。我后人学方脉，于幼科亦须留意。
凡名家医书，皆有幼科，固宜善看，而《冯氏锦囊》，由小儿始，以痘科终，尤不可忽。果能遍看方脉，小儿无不兼备。家中生育颇多，庶不至受幼科之误也。
[Background Information]
Book: Zhi Yi Bi Bian (Must-Distinguish Medical Knowledge)
Author: Li Guanxian
Dynasty: Qing
Chapter: Appendix on Taichan Jindan / Miscellaneous Discussions (11 items)
Category: Medical Discourse
Someone asked: Is it appropriate to use "Taichan Jindan" (Fetal and Postpartum Golden Pill) to regulate menstruation? The answer is: No. "Taichan Jindan" is indeed a good prescription, but since its name implies fetal and postpartum use, it was established for the periods before and after childbirth. The formula uses Placenta Hominis (Ziheche, Human Placenta) as the sovereign drug, assisted by Cinnamon Twig (Rougui), taking the meaning of warming and promoting free flow. When pregnancy approaches full term, cooling drugs are no longer suitable; taking one or two pills of "Taichan Jindan" can facilitate delivery; after childbirth, blood stasis is most taboo; taking one or two pills can dispel stasis. I treated a woman in the Banner Camp who suffered a miscarriage at five or six months of pregnancy, with the second fetus not expelled and severe abdominal pain. I administered one pill of "Taichan Jindan" with Xionggui Tang (Safflower and Angelica Decoction). After only a few doses, the placenta was expelled and the abdominal pain stopped. This shows it is a blood-activating and stasis-resolving agent, truly suitable for pre- and postpartum conditions. As for women with irregular menstruation, are all cases caused by deficiency-cold and stasis? If menstruation is overdue due to uterine deficiency-cold, then "Taichan Jindan" can be taken; otherwise, if menstruation is not overdue but becomes frequent, how can "Taichan Jindan" be taken? As for those prone to habitual abortion (slippery fetus) who wish to use "Taichan Jindan" to secure the fetus, this so-called securing is actually inducing labor, which is truly laughable.
Diseases arise endlessly, but treatment methods always revolve around the four characters: Yin-Yang and Five Elements. Heaven generates all things through Yin-Yang and Five Elements; physicians treat all diseases through Yin-Yang and Five Elements. In essence, the generation and restriction of the Five Elements do not exceed Yin-Yang. Yin-Yang refers to Qi and Blood; Qi is Yang, and Blood is Yin. Qi and Blood refer to Water and Fire; Qi is Fire, and Blood is Water. Qi is formless, while Blood has form. Qi moves attached to Blood, and Blood cannot move independently without Qi. Without Yin, Yang cannot generate; without Yang, Yin cannot transform. When Yin and Yang are harmonious, all things are born. The human body is a small universe where Yin and Yang must be balanced. Physicians who bias towards cooling drugs or bias towards warming drugs are not adhering to the correct path.
Medicine has fixed principles and flexible methods. Wang Taipou said: "When cold is not resolved by cold drugs, it indicates a lack of Water (Kidney Yin); one should strengthen the master of Water to control the sunlight (deficient fire). When heat is not resolved by hot drugs, it indicates a lack of Fire (Mingmen Fire); one should benefit the source of Fire to eliminate the yin shadow (cold pathogen). This is a fixed principle." Another discussion on the eyes states: "Ability to see far but not near is blamed on lack of Water; ability to see near but not far is blamed on lack of Fire." The eyes are the light of Water Essence; lacking water, one may nourish water arbitrarily. However, texts state that eyes do not get sick without fire, and eye diseases have no cold pattern. Assuming one supplements fire arbitrarily because of inability to see far, would it not damage the eyes? Many people are nearsighted from birth and often cannot tolerate hot drugs. This situation requires referring to treatment methods and not solely blaming a lack of fire.
The way of using medicine applies primarily when life is in danger. When the disease is severe and the medication is too weak to save the patient, it is necessary to increase the method (dosage or strategy). Otherwise, the method should initially be mild, gradually increasing if effective. One should not take the heavy dosages of ancient formulas as the standard. Moreover, examining ancient dosages compared to modern ones, they are not particularly heavy. For example, Zhang Zhongjing's formulas often used jin (catties) or sheng/he (volume measures), seeming large. However, when he used powder, it was merely a fangcunbi (a square-inch scoop); pills were sized like wutong seeds, with only thirty pills taken, seeming very small. Why such a discrepancy between pills, powders, and decoctions? Examining *Qianjin Fang* and *Bencao*, three ancient liang are equivalent to one modern liang, and three ancient sheng to one modern sheng. Thus, the "liang" amounts to only three qian today! Furthermore, Zhang Zhongjing's decoctions were divided into three doses, leaving only one-third. Calculated together, does one ancient liang equal only one modern qian? There are differences between ancient and modern times, north and south regions, strong and weak constitutions, and rigid and soft drugs. Physicians who know how to adapt will surely gain something.
When a person is ill, it is like a locked mechanism; treating a disease is like unlocking it with a key. An incompetent locksmith, even with great effort, cannot open the lock and may even break it. A skilled locksmith needs only a copper wire to gently flick the lock open. Similarly, an incompetent physician, even with heavy medications, cannot resolve the disease and may worsen it; a competent physician can save the patient with just one herb. Beginners in medicine should assess their capability; if unable, they should wait for a skilled physician. They must not rashly prescribe without understanding the condition, damaging the patient. Even if experts exist later, they may be powerless. A lock can be damaged, but can a person be damaged?
Using medicine to regulate patients is like watering flowers. Some need clear water, some need fertilizer. Once the right method is chosen and watering is moderate, without excess or deficiency, the plants will flourish naturally. Regulating patients is the same. Some need clearing and nourishing, some need vigorous tonification, some need Qi tonification, some need Yin tonification. One must seek appropriateness to be effective, not to treat vaguely. Some seek quick results, thinking Ginseng tonifies Qi, so why is Qi still deficient after taking Ginseng? Rehmannia tonifies Yin, so why is Yin still deficient after taking Rehmannia? They do not understand that medicinal cultivation is like watering flowers; proper watering helps growth, but the water itself is not the plant. For instance, Peony prefers thick manure; adding manure does not turn the Peony into manure. Therefore, for Qi deficiency, Ginseng is suitable, helping Qi generate, but Ginseng is not Qi itself; for Yin deficiency, Rehmannia is suitable, helping Yin generate, but Rehmannia is not Yin itself. Skilled regulators use appropriate medicines to assist the vital energy of life. If one treats herbal roots and barks as direct substitutes for Qi and Blood, filling excessively, it is like over-fertilizing flowers, suppressing their vitality. Our use of medicine must be moderate and not rigid. Those skilled in tonification include unblocking within tonification, like writing articles filled only with substantive words without functional words—can it form a coherent text? In short, without understanding Confucian studies, one cannot understand medical principles.
Some expensive medicines, seemingly beneficial, can actually be harmful; Ginseng is one such example. According to *Bencao*, Ginseng can restore Yuan Qi in the realm of nothingness, turning weakness into strength and providing rescue. But if Qi has reached the "realm of nothingness," how can Ginseng generate Qi for someone with no Qi? However, this is merely ineffectual; there are more harmful cases. Why? Wealthy people, with arrogant and luxurious habits and unrestrained lust, consider themselves weak and want to take Ginseng at the first sign of illness. Incompetent doctors, ignorant of this, comply. My close relative, Mrs. Ding Wu, had lung heat causing hoarseness. A doctor, catering to the patient's wishes, prescribed several liang of Ginseng, resulting in complete loss of voice. I was called to treat her, advised stopping Ginseng, and prescribing Xiebai San (White Flower Decoction) for a few doses, leading to recovery. My close friend, Old Man Wu Zaixiao, had rising Liver Fire causing dizziness and sweating. His family and another doctor considered it deficiency and prescribed daily Ginseng, worsening the sweating and dizziness. I was called to treat him, intending to calm the Liver. Although he trusted me, others argued against stopping Ginseng for Yin-nourishing drugs. I reasoned that days of Ginseng showed no effect and the disease progressed; continuing would kill him. Having previously helped his family, I could argue firmly. His son, claiming medical knowledge, loved Ginseng, and the other doctor agreed. Fortunately, the old man trusted me completely and took my prescription. I focused on calming the Liver and nourishing Blood, regulating for a month until recovery. What benefit did Ginseng provide? I witnessed others: Mr. Zhao, a wealthy neighbor. His father died of bloody dysentery due to Ginseng; his brother died of carbuncles due to Ginseng. Wu Jingxian caught a seasonal pathogen. Mr. Zhao, a friend of Wu's father, sent Ginseng. Wu refused, but others insisted on accepting it from the benefactor. The doctor encouraged it, leading to death from trapped pathogen. Everyone knows these cases. Who is at fault for harming people with supposed beneficial drugs? I have practiced for forty years. Mostly middle-class patients, few wealthy ones, mostly unable to afford Ginseng, which I rarely use. Even for the wealthy, if the condition does not suit Ginseng, I forbid it. If Ginseng were essential for survival, how many poor people would survive?
Some extremely cheap medicines, seemingly useless, are highly beneficial; Black Sesame Seed is one. I once treated abnormal Liver Qi distension and pain with rebellious Qi vomiting. Previous doctors used Erchen Tang, Cyperi Rhizoma, and Aucklandiae Radix to smooth Qi without effect. Adding Qi-breaking drugs like Aurantii Fructus, Trogopterori Faeces, Linderace Cortex, and Aquilariae Lignum added no effect. I reasoned that although Liver Qi rebellion requires smoothing, the Liver is a rigid organ, best treated with softness. Previous drugs were too rigid. Treatment should use sweet to relax and nourish Yin to calm the Liver. However, without Qi-moving herbs, quick effect is hard. Qi-moving herbs tend to be dry and warm. I thought of Sesamum Indicum (Black Sesame): straight outside, connecting inside; black color reaches Kidney directly; slightly cool nature, no rigidity. I used one branch, aided by three qian of Citrus Reticulata 'Chachi' (Jinju Bing). One dose brought effect, several doses cured it. Whenever it recurred, this formula worked quickly. Since then, I always use it for Liver Qi issues, achieving success. It is said that softening and unblocking suits the Liver best. I realized that the Qi of all organs values unblocking. *Neijing* says: "Unblocking means no pain, pain means unblocking." Extending this meaning: unblocking means no distension, distension means unblocking; unblocking means no rebellion, rebellion means unblocking. Treating Qi diseases generally benefits from unblocking, not just the Liver channel. I treated asthma for years, caused by rebellious Kidney Qi. I used Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) modified, five qian per dose, taken with decoction of Black Sesame. It gradually improved and did not recur. I also treated Liver Qi invading Stomach, causing food stagnation threatening to become Ge Syndrome (dysphagia). Using moistening Liver-calming and Stomach-unblocking herbs, plus Black Sesame and Jinju Bing, cured it in ten doses. I encountered bloating resembling single-abdominal distension. Using Ganmai Dazao Tang (Licorice, Wheat, and Jujube Decoction) plus Black Sesame and Jinju Bing, cured it after a month. Countless other Qi disorders responded. Relatives now advise keeping Black Sesame at home for Qi symptoms. Wealthy lords love Ginseng and ignore this cheap herb's wonder. Not recorded in Bencao, I discovered it ten years ago. Initially for Liver Qi, I found it treats many diseases, even ascites. I do not claim unique discovery but publish it for public benefit.
I compare medical books to Confucian classics. *Neijing* is the Wujing (Five Classics); Zhang Zhongjing's *Shanghan Lun* and *Jingui Yaolue* are the Sishu (Four Books). Post-Han medical books are numerous but not pure. Only Yu Jiayan's expansion of Zhang Zhongjing's work is profound and broad, revealing hidden meanings, akin to Zhu Xi's annotations in Confucianism. Although Ke Qin came later, trying to overshadow Yu to promote his own work, like critics after Zhu Xi, he could not extinguish Zhu's orthodoxy. I admire Yu because his book details *Shanghan* and *Jingui*, aiming to be the successor to Zhang Zhongjing. His *Yi Men Falü* is brief on miscellaneous diseases. Fortunately, *Feng Shi Jin Nang* is excellent, with deep discussions, especially detailed in pediatrics, surpassing Qian Yiyi. For example, in smallpox, I used it to treat family cases successfully, unseen in current pediatrics. Thus, besides Yu, I revere Feng and encourage future study of his work.
Although I am not skilled in surgery, I treated over ten cases of Syphilis (Yangmei Chuang) without external cauterizing drugs, all cured promptly, applying Feng's smallpox methods. Current surgeons treat Syphilis mainly with purgatives. This toxin must be raised and transmitted outward. Like smallpox, if raised and transmitted like flourishing flowers, it naturally forms pustules and scabs, proceeding smoothly. Raising and transmitting requires internal support. Baoyuan Tang: Ginseng, Astragali Radix, Cinnamon Twig, Glutinous Rice, Lithospermi Semen, Glycyrrhizae Radix, serves as the main formula. If Da Huang (Rhubarb) is used recklessly, Qi and Blood descend and weaken, causing smallpox to collapse inward. How can the toxin transmit? How can life be saved? Smallpox is congenital toxin; Syphilis is acquired toxin. Congenital toxin requires transmission with internal support, not damaging Qi and Blood. Acquired toxin requires transmission; can we damage Qi and Blood with purgatives without internal support? Abundant Qi and Blood help push out toxins easily without sequelae; weak Qi and Blood make it hard to expel toxins, causing endless trouble. Thus, never damage Qi and Blood. Smallpox and Syphilis share the same principle. I equate them; listeners may be confused. I treated few smallpox cases, all cured; more Syphilis cases, all cured. Applying *Jin Nang* principles yielded great results. Future generations, though perhaps not treating Syphilis, may have many children susceptible to smallpox. Studying Feng's book will prevent harm from current pediatricians.
Briefly describing Syphilis treatment: Early stage, fire-toxin is heavy, stool is difficult. Must first unblock. Longdan Xiegan Tang (Gardenia and Gentian Decoction) plus Da Huang for three doses. Stop when stool flows. This toxin mostly affects Liver and Kidney, hence this formula first. If appearing on the face, toxin moved from zang to fu. Face belongs to Yangming, which governs muscles. Use Hejian Fangfeng Tongsheng San (Saposhnikovia and Mint Powder). Contains dispersing, purging, cooling, and detoxifying herbs, plus Qi and Blood balancing agents. Take three to four doses. Stop when stool flows. Both formulas use two liang of Smilax Glabra Rhizome (Tufuling) decocted to cook the medicine. Avoid tea, fearing it dissolves drug properties. Then examine constitution. If Qi deficiency, use Sijunzi Tang (Four Gentlemen Decoction) plus anti-toxin herbs like Honeysuckle Flower and Sophora Flower. If Blood deficiency, use Siwu Tang (Four Substances Decoction) plus anti-toxin herbs, increasing Honeysuckle and Sophora, plus Blood-nourishing and cooling herbs. Also decoct Tufuling. Prepare Wubao Dan (Five-Treasure Pill): Cinnabar 5 fen, Succinum 5 fen, Murrayae Semen 5 fen, Margarita 5 fen, ground fine. Add Borneolum Syntheticum 2.5 fen, Bovis Calculus 5 fen, grind again. Mix with 2 liang of refined flour. Store in porcelain bottle. Take 5 fen with Tufuling decoction. Daily avoid tea, replacing with Tufuling decoction. With this treatment, mild cases cure in one course, severe in two. I saw cases of excessive purging leading to loss of appetite and foul-smelling sores. I used Guipi Tang (Restore the Spleen Decoction) combined with modified Wubao Dan. Three doses stopped the odor; sores healed in ten days. One case was Mr. Wu, another old friend Bai Suian, now 84 and healthy. Ask him to verify.
Most laughable is local pediatrics. Practitioners are uneducated, taught only dispersing and digesting formulas like Zhang Zihe's Sanshengyangqin Tang: Perillae Fructus, White Mustard Seed, Raphani Semen. Plus Qianghuo, Saposhnikovia, Bupleuri Radix, Puerariae Radix, Aurantii Fructus, Trogopterori Faeces, Crataegi Fructus, Magnoliae Officinalis Cortex, etc. Ten-plus digestive herbs. Taught pulse records saying: "Caught cold, stagnation. Milk and food mixed, fear transformation into convulsions." They immediately practice medicine. Every case, they use these phrases to prescribe, warning parents not to feed milk or rice drink due to severity. Daily dispersing and digesting. If fever persists for days, they do not change the original formula. Even after ten days, slight modifications only. If parents give rice drink, they blame it. Due to dry drugs, Blood is depleted, failing to nourish sinews, causing convulsions. They say: "Acute convulsion, I warned you." Days without full milk and dispersing drugs lead to faint Qi. They say: "Chronic convulsion, I warned you." Until death, neither doctor nor victim realizes, thinking the doctor was prescient. Most hateful are "convulsion-soothing" women with no training, committing atrocities. Children have no convulsion, but due to wrong drugs, Qi and Blood are weak, often dying from a single soothing stroke. Joy, anger, worry, thought, sorrow, fear, and fright are Seven Emotions. Fright arises from shock. Can fright come from exterior contraction? We internal medicine doctors do not treat pediatrics, but save many children via internal medicine. Cao Gengzhi's granddaughter was dying under pediatric care. A convulsion-soothing woman was hired. I advised stopping drugs, feeding milk and porridge. She recovered in days. Wei Tingzhang's second son, eight months old, had persistent fever from exterior contraction. A doctor used excessive dispersing, forbidding milk and rice drink. Days passed, near death, doctor refused treatment. I visited, Wei begged for help. I probed his mouth; he gripped my finger, indicating hunger. I pretended to have a miracle cure requiring milk first. Family doubted he could swallow. I insisted, suggesting mother lie down to nurse. Mother complied, baby drank well and slept peacefully. I told them no medicine tonight, I would return tomorrow. Next morning, baby had eaten much and slept well, seeming cured. Family asked for medicine. I laughed, saying: "What medicine? Just milk!" The child had been over-treated with dispersing and digesting drugs. What exterior contraction? What stagnation? Starved to death! Survival was fate. Family grateful, named child after me. At Jiang's house, I diagnosed illness. They asked for pediatric advice. Pulse record showed phlegm-wheeze like sawing wood, harsh drugs. I asked where the child was. Nurse held baby nearby, no sawing sound, only weak spirit. I palpated pulse, said: "Excessive dispersing and digesting, likely forbidden milk, causing deficiency phlegm. Feed milk immediately, no medicine needed." Family followed, cured in days. Pediatric errors are many. I listed a few. Future internal medicine students must pay attention to pediatrics.
All famous medical books include pediatrics, which should be studied well. *Feng Shi Jin Nang*, starting from infants and ending with smallpox, is especially important. If one studies internal medicine thoroughly, pediatrics will be covered. Families with many children will avoid pediatric errors.