松香久炼。以苦涩味尽。入熟地乌梅为延年圣药。余曾用之。果亦有功。但内乌梅本草
谓久服能蚀脾
胃。似非纯补之物。易以石枣。或五味。则全璧耳。曩水西林旗峰太守公服之寿逾百。后子
孙修饵不绝。咸跻期颐。脍炙人口久矣。愚以为不尽然也。三山阅阀高第。以世德承家。称水西林公之门为
最。惟其积善。自膺天眷。恐非炉鼎。可致修龄。夫岂无凉行之子勤饵仙剂。而仍促算乎。若自其变者言
之。至夭回寿 。此又理数之不
可晓也。
前药利水宣湿。称有功。亦惟手足太阳二经。病积热壅滞经络。或兼痰湿水邪。用之相
宜。若真藏为患。精
血已亏。神力日耗。虚火燎原。假热混真者纵悉纯补。尚嫌不济。倘加渗利。愈竭真阴矣。
按本草有谓久服
泽泻。令人目盲。有谓苓不水澄而令眼障。有谓苓泻兼用。而令真水暴竭。即立斋亦极言泽
泻久服导损
真阴。令人无子。虽先生固常用八味。六味亦必斟酌于多寡之间每见圆机绝识之士不泥古人
之方亦未始不用古人之方之意也。
之数药者。禀性毒烈。敷功峻悍。诸家每矜其能奏效俄顷。又云必惟大积大聚用之相宜
。嗟乎此说误
世不小。若积与聚。何以大称。夫人元气壮盛脾气得运。饮食入胃。随纳随化。何有停留作
祟乎。及其渐衰也。脾失
转输。物入为患。伤于五脏。则有伏梁息贲痞满肥气奔豚之积。妨于七情。则有虚肿实胀噎
鬲反胃 瘕之病故元气微虚则积为微积元气大虚则积为大积是积聚之大小由乎气虚之微甚也治法断须养
正
缓图则可全生。每有轻用前药而速其死者比比也。虽舟车丸罗破饮万应丸诸方。固宜于西北
形气壮实
之人。愚以为形气既云壮实。何以有此病恙。况风气日漓。赋禀渐薄。恐今之西北。非昔之
西北也。亦须斟
酌耳。试举一二以证其谬。岁甲申冬里人曾云宇继室年逾四旬。素郁怒。 居十载。神思为
病。忽一日因
行经暴怒。血上溢。兼致鼓胀。初延一老医投散气药。不瘥。且渐笃。再延余治。余曰此乃
脏病。得之数年。今
始显发。丹溪鼓胀论可鉴也。脉已洪短与病相逆矣。须峻补脾原。功以渐致。不半载不瘥。
议用六君加姜桂。倍入参术。彼惧增胀。死不敢服。因改投金匮肾气丸。服一月。血逆已止
。胀虽如故。
未见增剧。为药力未
到。须宁耐耳。不信。别请一医。恃有神丹谓旦夕可愈果投一药。下咽半晌而即胀消。便泄
进食。静睡。精神
快爽。举家钦以为神。愿掷百金奉寿。而尤刺余之迂缓鲜识也。及察前剂。乃阿魏姜黄甘遂
葶苈穿山
甲牵牛玄胡之属。过数日。症仍作。仍投前药。亦仍随手而愈。独气困怠耳。不三朝夕。喘
满不堪。再投而漫不应日甚一日。未及旬而殁。又余从舅曾六海长子亦原素郁患前症余曰此
病治本称难。但
广费珍药。又非舌耕清儒所能辨。当奈何。未几有进以草药者。彼悦捷法。信而服之。饭许
。大号数声而死。呜呼病从何生。药从何治。如此盲妄。矜功顷刻。杀人转盼。谁之咎也。
松香经过长时间炼制,直到苦涩味道完全消失,再与熟地黄、乌梅一起使用,便成为延年益寿的圣药。我曾经试用过,确实也有效。但是《本草》记载乌梅长期服用会腐蚀脾胃,这似乎不是纯粹的补益药物。如果将其替换为石枣或五味子,那就完美无缺了。过去水西林旗峰太守公服用此药,寿命超过百岁,他的子孙后代持续服用,都活到了百岁高龄(期颐之年),这件事早已脍炙人口。但我认为事情并不全是这样。三山阅阀高第家族,凭借世代积累的德行继承家业,以水西林公的门第最为显赫,这都是因为他们积善行德,自然得到上天的眷顾,恐怕并不是靠炼丹炉鼎就能达到长寿的。难道没有那些凉行之子勤奋服用仙丹妙药,却依然短命夭折的吗?如果从变化的角度来看,有人早夭而有人长寿,这也是理数和命运中不可知晓的因素。
前面的药物(赤苓猪苓泽泻木通等)具有利水宣湿的功效,称其有功,但也仅适用于手足太阳二经的病证,即体内积热壅滞经络,或者兼有痰湿水邪的情况,使用这些药物才适宜。如果是五脏真元受损,精血已经亏损,神力日渐消耗,虚火燎原,假热混淆真热的情况,即使全部使用纯补的药物,还嫌不够效力;如果再加以渗利之药,只会更加耗竭真阴。
据《本草》记载,有人说长期服用泽泻会导致目盲;有人说茯苓如果不经过水澄处理会导致眼障;有人说茯苓和泽泻同时使用,会导致真水突然枯竭。即使是薛立斋也极力强调泽泻长期服用会导引损伤真阴,导致人无法生育。虽然先生您固然常用八味丸、六味丸,但也必然在剂量多寡之间进行斟酌。我常见那些思维灵活、见识卓越的人,不拘泥于古人的方剂,但也不是不使用古人方剂的本意。
这几味药(甘遂大戟巴豆牵牛芫花葶苈阿魏商陆姜黄郁金等),禀性毒烈,功效峻猛强悍。各家医书往往夸耀它们能迅速奏效,又说只有在大积大聚的情况下使用才适宜。唉,这种说法误导世人不少。所谓的“积”与“聚”,为什么要用“大”来称呼呢?当人的元气壮盛,脾气运化正常时,饮食进入胃中,随吃随化,哪里有停留作祟的道理呢?等到元气逐渐衰退,脾失转输功能,食物进入身体反而成为祸患。伤及五脏,就会产生伏梁、息贲、痞满、肥气、奔豚等积病;妨碍七情调畅,就会产生虚肿、实胀、噎膈、反胃、瘕疝等疾病。所以元气轻微虚弱则产生轻微的积,元气大虚则产生大的积。积聚的大小取决于气虚的轻重程度。治疗方法必须通过扶正固本、缓慢图谋,才能保全生命。经常见到轻率使用前文提到的峻猛药物而导致病人迅速死亡的例子,比比皆是。虽然像舟车丸、罗摩饮、万应丸等方剂,本来适宜于西北地域形体气质壮实的人使用,但我认为既然形体气质已经壮实,为什么还会得这样的病呢?况且风气日益浇薄,天赋禀赋逐渐薄弱,恐怕现在的西北地区,已经不是以前的西北地区了。这也需要斟酌对待。
试举一两个例子来证明上述观点的错误。岁甲申年冬天,同乡曾云宇的继室,年龄超过四十岁,平时性格忧郁易怒,独居十年,神思受损患病。忽然有一天因为月经期间暴怒,导致血液上溢,并引发鼓胀病。起初请一位老医生投用散气药,病情没有好转,反而逐渐加重。再次请我诊治,我说这是脏病,已经得了几年,现在才开始显现发作。可以参考朱丹溪关于鼓胀的论述。脉象洪大而短,与病症相逆,必须峻补脾原,功效需逐渐取得,不到半年不会痊愈。建议用六君子汤加干姜、肉桂,加倍人参和白术。她害怕增加胀满感,因恐惧不敢服用。于是改投金匮肾气丸,服用一个月后,血逆症状已止住,胀满虽然依旧,但没有加剧,认为是药力未到,必须忍耐等待。但她不信,另外请了一位医生,倚仗有神丹妙药说早晚可以治愈。果然投下一服药,咽下不久胀消,大便泄出,进食,安静睡觉,精神爽快,全家钦佩视为神医,愿意赠送百金祝寿,并且嘲笑我迂缓无知。等到检查之前的药剂,原来是阿魏、姜黄、甘遂、葶苈子、穿山甲、牵牛子、玄胡索之类的药物。过了几天,症状仍然发作,再次投用前药,也是随手见效。只是气息困倦怠惰而已。不到三个早晨和晚上,喘满不堪忍受,再次投药却漫无反应,病情一天比一天严重,不到十天就去世了。又比如我的表舅曾六海的长子,原本也忧郁患有前症,我说这个病治疗根本很难,而且广费珍贵药材,又不是靠教书的清儒所能辨别的,该怎么办呢?没过多久有人进献草药,他喜欢快捷的方法,相信并服用了。只吃了一顿饭的时间,大叫几声就死了。唉!病从何而生?药从何而治?如此盲目狂妄,夸耀片刻之功,杀人只在转眼之间,这是谁的过错呢?
Cinnamomi Cortex (Songxiang) is refined for a long time until its bitter and astringent taste completely disappears. When combined with prepared Rehmanniae Radix (Shudi) and processed Mume Fructus (Wumei), it becomes a holy medicine for longevity. I have tried it myself, and indeed, it has efficacy. However, the Materia Medica states that long-term consumption of Wumei can erode the Spleen and Stomach, suggesting it is not purely a tonic. If replaced with Shizao or Schisandrae Fructus (Wuweizi), it would be perfect. In the past, Governor Gong of Qifeng, Xilin Water, took this medicine and lived beyond one hundred years. His descendants continued to take it without interruption, all reaching the age of one hundred (Qiyi). This story has been widely praised for a long time. But I do not think it is entirely so. The Gaodi family of Sanshan Yuefa inherited their family status through generations of virtue, and the lineage of Gong Xilin Water was considered the most prominent. This was due to their accumulation of good deeds, which naturally received Heaven's favor. It is unlikely that longevity could be achieved solely through alchemical furnaces. Were there no sons of the Liangzhi family who diligently took immortal elixirs but still died young? If we speak from the perspective of change, some die young while others live long; this is also a matter of principle and fate that cannot be fully understood.
The aforementioned medicines (Chiling, Zhuling, Ze Xie, Mutong) promote urination and dispel dampness, and are credited with merit. However, they are only suitable for diseases of the Hand and Foot Taiyang meridians, where accumulated heat obstructs the collaterals, or when accompanied by phlegm-dampness and water pathogens. In such cases, their use is appropriate. If the Zang organs themselves are affected, with essence and blood already depleted, divine power daily consumed, and deficient fire raging like a prairie fire, where false heat confuses true heat, even if pure tonics are used exclusively, they may still be insufficient. If diuretic and draining herbs are added, it will further deplete the True Yin.
According to the Materia Medica, some say that long-term consumption of Alismatis Rhizoma (Zexie) causes blindness; some say that Poria Cocos (Fuling) causes eye obstruction if not washed in water; some say that using Fuling and Zexie together causes a sudden depletion of True Water. Even Xue Lizhai strongly emphasized that long-term consumption of Zexie guides and damages True Yin, leading to infertility. Although Mr. [the author being discussed] certainly often uses Ba Wei Wan (Eight-Ingredient Pill) and Liu Wei Wan (Six-Ingredient Pill), he must carefully consider the dosage ratios. I often see those with flexible minds and extraordinary insight who do not rigidly adhere to ancient prescriptions, yet they do not fail to utilize the intent behind ancient formulas.
These few herbs (Gansui, Daye, Baidu, Qianniu, Yuanhua, Tingli, Awei, Shanglu, Jianghuang, Yujin) possess toxic and fierce natures, and their effects are severe and harsh. Various schools often boast of their ability to produce rapid results, claiming they are only suitable for large accumulations and masses. Alas, this saying has misled the world significantly. Why are "accumulation" (Ji) and "mass" (Ju) called "large"? When a person's Yuan Qi is robust and the Spleen's transportation function operates normally, food entering the Stomach is digested immediately upon intake. How can there be stagnation causing harm? As vitality gradually declines, the Spleen loses its transportive function, and ingested substances become harmful. Injury to the Five Zang organs leads to accumulations such as Fuliang, Xiben, Piman, Feiqi, and Bentun. Obstruction of the Seven Emotions leads to conditions such as Xu Zhong, Shi Zhang, Yige, Fanwei, and Jia. Therefore, slight deficiency of Yuan Qi leads to slight accumulation, while major deficiency of Yuan Qi leads to large accumulation. The size of the accumulation depends on the severity of the Qi deficiency. The treatment method must rely on nourishing righteousness (Zheng Qi) and planning slowly to preserve life. There are countless cases where people were killed quickly by the light-handed use of the aforementioned harsh medicines. Although formulas such as Zhou Che Wan, Luo Po Yin, and Wan Ying Wan are originally suitable for people in the Northwest region with robust physical constitutions, I argue that if the constitution is truly robust, why would such diseases arise? Moreover, as social morals decline and innate endowment weakens, the Northwest of today is likely not the Northwest of the past. Careful consideration is necessary.
Let me cite one or two examples to prove the fallacy of these views. In the winter of the Jiashen year, the second wife of my fellow townsman Zeng Yunyu, aged over forty, who was usually prone to depression and anger, had lived alone for ten years and suffered from mental disorders. Suddenly, due to extreme anger during menstruation, blood regurgitated upwards, accompanied by distension (Gu Zhang). Initially, an old doctor prescribed Qi-dispersing herbs, but the condition did not improve and worsened. I was then consulted. I said this is a Zang disease that has existed for several years and is now manifesting. One can refer to Zhu Danxi's discussion on Gu Zhang. The pulse is surging and short, contrary to the disease. Severe tonification of the Spleen source is required, and efficacy will come gradually. It will not heal in less than half a year. I proposed using Liu Jun Zi Tang (Six Gentlemen Decoction) with dried Ginger (Jiang) and Cinnamon Twig (Guizhi), doubling the dosage of Ginseng Radix (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu). She feared increased distension and refused to take it out of fear. Thus, Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet) was administered instead. After one month, the upward rebellion of blood stopped. Although distension remained unchanged, it did not worsen. I attributed this to the medicinal force not yet taking full effect and advised patience. She did not believe this and consulted another doctor, who relied on a "divine pill" claiming cure within days. Indeed, after taking one dose, the distension subsided, defecation occurred, appetite returned, she slept quietly, and felt refreshed. The whole family admired him as a god, offered a hundred gold pieces for his longevity, and mocked my approach as slow and ignorant. Upon examining the previous prescription, it consisted of herbs such as Awei, Jianghuang, Gansui, Tingli, Manis Squama (Shan Jianjia), Semen Persicae (Qianniu), and Corydalis Rhizoma (Yanhusuo). A few days later, symptoms recurred. The same herbs were administered again, and symptoms resolved instantly. However, the patient only experienced fatigue and weakness. Within three days, she suffered from unbearable panting and fullness. Another dose was given, but there was no response, and the condition worsened daily. She died within ten days.
Another example: the eldest son of my maternal uncle Zeng Liu Hai, who was also prone to depression and suffered from similar symptoms, I stated that treating the root of this disease is difficult. Furthermore, spending heavily on precious medicines is beyond the capability of scholars who earn a living by teaching. What should be done? Soon, someone introduced herbal remedies. He preferred quick methods, believed them, and took them. After just one meal's worth, he shouted several times and died. Alas! From where does the disease arise? From where is the treatment derived? Such blind arrogance, boasting of momentary merit, killing within a glance—whose fault is it?