愚按玉机微义曰∶经云∶治病必求其本。本于四时五脏之根也。故洁古张先生云∶五脏
子母
鬼邪微正。若不达其旨意。不易得而入焉。徐用诚先生云∶凡心脏得病必先调其肝肾二脏。
肾者心之鬼。肝气通则心气和。肝气滞则心气乏。此心病先求于肝清其源也。五脏受病必传
其所胜。水能胜火则肾之。受邪必传于心。故先治其肾。逐其邪也。故有退肾邪。益肝气两
方。或诊其脉。肝肾两脏俱和。而心自主疾。然后察其心家虚实治之。张景岳先生曰。本者
原也。始也。世未有无源之流。无根之木。澄其源而流自清。灌其根而枝乃茂。无非求本之
道。今姑举其略曰。死以生为本。欲救其死。勿伤其生。邪以正为本。欲攻其邪。必顾其正
。阴以阳为本。阳存则生。阳尽则死。静以动为本。有动则活。无动则止。血以气为本。气
来
则行。气去则凝。证以脉为本。脉吉则吉。脉凶则凶。先者后之本。从此来者须从此去。急
者缓之本。孰急可忧。孰缓无虑。内者外之本。内实者何伤。中败者堪畏。下者上之本。滋
苗者先固其根。伐下者必枯其上。虚者实之本。有余者拔之何难。不足者攻之何忍。真者假
之本。浅陋者只循像迹。精妙者洞别玄微。至若医家之本在学力。学力不到。安能格物致知
。而
尤忌者不畏难而自足。病家之本在知医。遇士无礼。不可以得贤。而尤忌者好杂用而自专。
凡此者虽未足以尽求本之妙。而一隅三反从可类推。总之求本之。道无他也。求勿伤其生而
已
矣。苏子瞻曰∶夫国之长短。如人之寿夭。人之寿夭在元气。国之长短在风俗。世有 羸而
寿考。亦有壮盛而暴亡。若元气犹存。则 羸而无害。及其已耗。则壮盛而愈危。是以善养
生者慎起居。节饮食。导引关节。吐故纳新。不得已而用药。则择其品之上。性之良。可以
久服而无害者。则五脏和平而寿命长。不善养生者薄节慎之功。迟吐纳之效。厌上药而用下
品。伐真气而用强阳。根本已危。僵仆无日天下之势。与此无异。此坡公借医喻国其理一也
。吁万事有本。何独治病。求本有道。何专药石。故黄帝曰。阴阳者天地之道也。万物之纲
纪变化之父母生杀之本始。神明之府也。则又曰∶治病必求其本。愚以为元气者生身之本也
。病气者元气之贼也。治法者御贼之兵也。药之良毒者攻守之资也。医之贤庸者智愚之将也
。攻必元气病气两实。始可用毒剂。守则为元气既虚。病气独实。虽有可攻之势。必先主守
之方。以待敌忾之衰。益壮我垒之。坚而药之。良者所不敢后即攻亦无多费力也。若其元
气潜
消。根本已摇。攻无可攻。守莫能守。薄节养为迂缓。藐导引非善基。反事搏鸷之雄。妄异
旦夕之效。即纵形盛。何识中亏。其不致偾辙者少矣。再考启玄子释注求属之论有云益火之
源。以消阴翳。壮水之主。以制阳光。又曰脏腑之原。有寒热温凉之主。取心者不必齐以
热取肾者不必齐以寒但益心之阳。寒亦通行。强肾之阴。热之犹可。故或治热以热。治寒以
寒。万举万全。孰知其意。此王氏之心得也。然。求其所谓益与壮者。即温养阳气填补真阴
也。求其所谓源与主者。即所谓求其属也属即本也。根本之谓水火之本。则皆在命门之中耳
。舍命门何处觅寻夫曰本。曰求本。曰必求。又不曰治本。而先曰求本。盖惟求始可得本得
本始可论治吾愿世之学医者。一深长思也。
我考察《玉机微义》中说：医经记载，治病必须探求根本。这个“本”，指的是四时气候与五脏六腑的根本。所以金元时期医家洁古张先生说：五脏之间存在子母相生及克制关系（鬼邪微正指五行生克乘侮的微妙平衡）。如果不能通达其中的旨意，就很难掌握治疗的门径。徐用诚先生说：凡是心脏发生疾病，必须先调理肝肾两脏。肾是心的“鬼”（即水克火，肾水制约心火），肝气通畅则心气和顺，肝气郁滞则心气虚弱。这是治疗心病先从源头（肝）清解的道理。五脏受病必然会传变到它所克制的脏腑。水能胜火，所以肾受邪气必然传于心。因此要先治肾，驱逐邪气。所以有退除肾邪、补益肝气的两个方剂。或者诊察脉象，如果肝肾两脏都调和，而心脏独自患病，然后才审查心脏的虚实进行诊治。张景岳先生说：本，就是原初、开始的意思。世上没有无源头的流水，也没有无根基的树木。澄清源头，水流自然清澈；浇灌根部，枝叶才能茂盛。这都是在阐述探求根本的道理。现在姑且列举其中要点：死以生为根本，想要挽救死亡，就不要伤害生机。邪气以正气为根本，想要攻伐邪气，必须顾护正气。阴以阳为根本，阳气存在则生存，阳气耗尽则死亡。静以动为根本，有运动则生命活跃，无运动则停滞。血以气为根本，气来则血行，气去则血凝。证候以脉象为根本，脉象吉利则预后好，脉象凶险则预后差。先发生的症状是后发症状的根本，由此产生的病症须从根源上去除。急症是缓症的根本，谁急谁令人担忧，谁缓谁无需忧虑。内里是外表的根本，内部充实有什么妨害？内部败坏才值得畏惧。下部是上部的根本，滋润苗株必须先稳固其根，砍伐下部必然导致上部枯死。虚证是实证的根本，有余的病邪拔除它有何困难？不足的虚损攻伐它怎么忍心（此处意指虚证不可妄攻，应补）？真像是假象的根本，浅陋的人只追随表象，精妙的人能洞察玄微。至于医家的根本在于学识能力，学识能力达不到，怎么能通过探究事物原理来获得知识？尤其忌讳的是不畏难而自满。病人的根本在于了解医学，遇到医生无礼，就无法得到贤良医生的帮助，尤其忌讳的是喜欢杂乱用药而独断专行。以上这些虽然不足以穷尽探求根本的奥妙，但可以从一个角落推知其他方面。总之，探求根本的道理没有别的，就是要求不伤害人的生机罢了。苏东坡说：国家的长短，就像人的寿命长短。人的寿命长短取决于元气，国家的长短取决于风俗。世间有瘦弱却长寿的，也有强壮却突然死亡的。如果元气还存在，那么瘦弱也无害；等到元气耗竭，那么强壮也愈发危险。所以善于养生的人谨慎起居，节制饮食，导引关节，吐故纳新。不得已而用药，就选择品质上等、药性温和、可以久服而无害的药物，这样五脏和平而寿命延长。不善于养生的人轻视节制和谨慎的功效，推迟吐纳养生的效果，厌恶上品药而使用下品药，伐伤真气而使用强阳之药。根本已经危险，倒下死亡的日子不远了。天下的局势，与此没有不同。这是苏东坡借医学比喻治国，道理是一样的。唉，万事都有根本，何止治病？探求根本有方法，何止局限于药物？所以黄帝说：阴阳是天地运行的规律，万物的纲纪，变化的父母，生杀的本始，神明的府库。他又说：治病必须探求根本。我认为元气是身体的根本，病气是元气的贼寇。治法是抵御贼寇的军队，药物的良毒是进攻和防守的资本。医生的贤能与平庸是智者和愚者的将领。只有当元气和病气都充实时，才可以开始使用有毒性的猛药；如果是守法，则是元气已虚，只有病气实盛，虽然有可攻之势，但必须先主用守正的方剂，等待敌势衰退，增强我方堡垒的坚固，依靠良药不敢轻易进击，即使进攻也不会花费太多力气。如果元气暗中消耗，根本已经动摇，无可攻之处，也无法坚守，轻视调养认为是迂腐迟缓，蔑视导引不是好的基础，反而从事凶猛激烈的治疗，妄想追求朝夕之间的疗效，即使形体看似壮盛，哪里知道内部亏损？不导致失败翻车的很少了。再考察启玄子（王冰）对“求其属”的注释论述说：补益火的源头，以消除阴寒的遮蔽；壮大水的主体，以制约阳热的亢盛。又说：脏腑的原气，有寒热温凉的主治原则。治疗心脏不必一律用热药，治疗肾脏不必一律用寒药。只要补益心的阳气，即使是寒药也能通行；强健肾的阴气，即使是热药也可以。所以有的用热药治热病，用寒药治寒病，万次行动万次周全，谁能理解其中的深意？这是王氏的心得体会。然而，探求所谓的“益”和“壮”，就是温养阳气、填补真阴。探求所谓的“源”和“主”，就是所说的“求其属”。属就是本，也就是根本。水火这两个根本，都在命门之中。舍去了命门，到哪里去寻找所谓“本”呢？说“本”，说“求本”，说“必求”，而不说“治本”，而是先说“求本”，大概因为只有探求才能得到本，得到本之后才可以谈论治疗。我希望世上的学医者，深深地思考这个问题。
I have examined the *Yuji Wei Yi* (Subtle Meanings of the Jade Machine), which states: The medical classics record that in treating disease, one must seek the root. This "root" refers to the foundation of the Four Seasons and the Five Zang Organs. Therefore, Master Jiegu (Zhang Congzheng) said: There are generative (mother-son) and controlling relationships among the Five Zang Organs, involving subtle balances of excess and deficiency (Gui Xie Wei Zheng). If one does not comprehend these principles, it is difficult to enter the realm of effective treatment. Master Xu Yongcheng said: Whenever a disease arises in the Heart, one must first regulate the Liver and Kidney organs. The Kidney is the "Ghost" (controlling element) of the Heart; when Liver Qi flows freely, Heart Qi harmonizes; when Liver Qi stagnates, Heart Qi becomes deficient. This illustrates the principle of clearing the source (Liver) when treating Heart diseases. When any Zang organ is diseased, it inevitably transmits to the organ it controls. Water overcomes Fire; thus, if the Kidney is affected by pathogenic factors, it transmits to the Heart. Therefore, one should first treat the Kidney to expel the pathogen. Hence, there are formulas for retreating Kidney pathogens and benefiting Liver Qi. Alternatively, upon pulse diagnosis, if both the Liver and Kidney are harmonious but the Heart alone is diseased, then one examines the Deficiency or Excess of the Heart to treat it. Master Zhang Jingyue stated: The "Root" (Ben) is the origin and beginning. There is no flowing water without a source, nor a tree without roots. Clearing the source makes the flow naturally pure; watering the root causes the branches to flourish. All of this elucidates the Way of seeking the root. Now, I shall briefly list some points: Death takes Life as its root; to save from death, do not injure Life. Pathogens take Righteous Qi (Zheng Qi) as their root; to attack pathogens, one must protect Righteous Qi. Yin takes Yang as its root; where Yang exists, there is life; where Yang is exhausted, there is death. Stillness takes Movement as its root; with movement, there is vitality; without movement, there is stagnation. Blood takes Qi as its root; where Qi comes, Blood moves; where Qi leaves, Blood coagulates. Clinical manifestations take the Pulse as their root; an auspicious pulse indicates a good prognosis, while an inauspicious pulse indicates a poor one. What occurs first is the root of what occurs later; conditions arising from a source must be resolved at that source. Acute conditions are the root of chronic ones; who is urgent causes worry, who is slow allows peace. The Interior is the root of the Exterior; internal fullness is no harm, but internal collapse is terrifying. The Lower is the root of the Upper; to nourish the sprout, one must first secure the root; cutting the lower causes the upper to wither. Deficiency is the root of Excess; it is easy to remove excess, but how can one bear to attack deficiency? (Note: Context implies deficiency requires tonification, not attack). Truth is the root of falsehood; the shallow follow appearances, while the profound discern subtleties. As for physicians, their root lies in scholarly ability; without sufficient learning, how can one investigate things to extend knowledge? Especially to be avoided is being unwilling to face difficulties yet becoming self-satisfied. For patients, their root lies in understanding medicine; being rude to practitioners prevents obtaining wise help, especially to be avoided is indiscriminate medication and self-will. Although these points may not exhaust the subtleties of seeking the root, one can infer the whole from a part. In short, the Way of seeking the root is nothing other than ensuring no injury to one's vital life force. Su Dongpo said: The longevity of a nation is like the lifespan of a person. A person's lifespan depends on Yuan Qi (Original Qi); a nation's longevity depends on customs. In the world, there are those who are frail yet live long, and those who are robust yet die suddenly. If Yuan Qi remains, frailty is harmless; once Yuan Qi is depleted, even robustness becomes perilous. Thus, those skilled in nurturing life are cautious in daily routine, moderate in diet, practice Daoyin (guiding and pulling) for joints, exhale the old and inhale the new. If medication is unavoidable, they choose high-quality, mild-natured drugs safe for long-term use, thereby maintaining harmony among the Five Zang Organs and prolonging life. Those unskilled in nurturing life neglect moderation and caution, delay the effects of breathing exercises, despise superior medicines in favor of inferior ones, deplete True Qi by using strong yang agents. With the foundation already precarious, collapse is imminent. The state of the world is no different from this. This is how Su Po used medicine to metaphorize governance; the principle is the same. Alas, all matters have a root, why only disease? Seeking the root has methods, why restrict oneself to herbs? Thus, the Yellow Emperor said: Yin and Yang are the Way of Heaven and Earth, the netting of all things, the parents of change, the beginning of birth and death, the mansion of spirit and enlightenment. He also said: In treating disease, one must seek the root. I believe Yuan Qi is the root of the body, while Pathogenic Qi is the thief of Yuan Qi. Treatment methods are the army defending against thieves; the efficacy and toxicity of drugs are the resources for offense and defense. The virtue or mediocrity of a physician is like the wisdom or folly of a general. Only when both Yuan Qi and Pathogenic Qi are substantial can toxic/potent agents be used. For defensive strategies, when Yuan Qi is deficient and only Pathogenic Qi is excessive, although there is a situation amenable to attack, one must first employ defensive formulas to wait for the enemy's strength to wane, strengthen one's own defenses, and rely on good medicine to avoid rash attacks; even if attacking, little effort will be required. However, if Yuan Qi secretly dissipates and the foundation shakes, there is nothing to attack and nothing to defend. Disregarding nourishment as too slow, and despising Daoyin as ineffective, one instead resorts to fierce treatments, falsely hoping for immediate results. Even if the form appears robust, how can one recognize internal depletion? Few escape failure in such cases. Furthermore, examining Qixuanzi's (Wang Bing's) commentary on "seeking its category/affinity," he wrote: Benefit the source of Fire to eliminate Yin shadows; strengthen the master of Water to control Yang brilliance. He also stated: The origins of the Zang-Fu organs have governing principles of cold, heat, warmth, and coolness. Treating the Heart need not uniformly use hot herbs; treating the Kidney need not uniformly use cold herbs. By benefiting Heart Yang, even cold herbs can circulate; by strengthening Kidney Yin, even hot herbs are permissible. Thus, sometimes heat is treated with heat, and cold with cold, achieving success every time. Who understands this intent? This is Wang's personal insight. However, seeking what is meant by "benefiting" and "strengthening" refers to warming and nourishing Yang Qi and filling True Yin. Seeking what is meant by "source" and "master" refers to "seeking its affinity." Affinity is the Root. The Roots of Water and Fire reside within the Mingmen (Gate of Life). Apart from the Mingmen, where else can one find the so-called "Root"? It says "Root," "Seek the Root," "Must Seek the Root," but not "Treat the Root," but rather "Seek the Root" first. This is likely because only by seeking can one obtain the Root, and only by obtaining the Root can one discuss treatment. I wish physicians of the world would ponder this deeply.