Learning the Essentials of the Golden Chamber 01

• Post By: 汉青
• Date: 2020-08-21
• Category: Clinical Reflections

Original text
The question is: If the patient is cured before he is ill, why? The teacher said: When treating a person who is not sick, but sees a liver disease and knows that the liver transmits to the spleen, the spleen should be strengthened first. If the spleen is strong in all seasons and free from evil, do not supplement it. It is said that Zhong Gong didn’t know that when he saw liver diseases, he didn’t know how to strengthen the spleen, but only treated the liver.
For liver diseases, use acid supplements to help relieve the bitterness of the scorched liver, and use sweet-flavored medicine to relieve the pain. Sourness enters the liver, burnt bitterness enters the heart, and sweetness enters the spleen. The spleen can damage the kidneys. If the kidney qi is weak, the water will not work; if the water does not work, the heart fire qi will be strong, which will damage the lungs; if the lungs are hurt, the metal qi will not work; if the metal qi is not good, the liver qi will be strong. Therefore, if the spleen is strengthened, the liver will heal itself. This is a wonderful way to treat the liver and nourish the spleen. Use this method if you have liver deficiency, but don’t use it if it’s not. The Sutra says: Deficit and excess, deficiency and deficiency, excess of damage, this is its meaning. Yu Zang is right about this.
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This paragraph has always been considered to be Zhongjing’s treatment principle for viscera syndrome differentiation. The theoretical source is the Huangdi Neijing. It discusses the transmission and treatment rules of diseases based on the five elements.
Personally, I think this paragraph may be a paraphrase with little significance. The clinical application value of the current mainstream discussion has not been fully reflected, which shows that people do not pay much attention to treating diseases before they occur. On the other hand, the restraint of the Five Elements is not very systematic in many aspects. It is interconnected and can be explained in any way. When it comes to liver disease, it can treat the spleen or the kidney. This leaves a lot of room for improvement, which is a great test of the doctor’s understanding. This is also the biggest difference between Jingui and typhoid fever.

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原文

问曰：上工治未病，何也？师曰：夫治未病者，见肝之病，知肝传脾，当先实脾，四季脾旺不受邪，即勿补之。中工不晓相传，见肝之病，不解实脾，惟治肝也。

夫肝之病，补用酸，助用焦苦，益用甘味之药调之。酸入肝，焦苦入心，甘入脾。脾能伤肾，肾气微弱，则水不行；水不行，则心火气盛，则伤肺；肺被伤，则金气不行；金气不行，则肝气盛。故实脾，则肝自愈。此治肝补脾之要妙也。肝虚则用此法，实则不在用之。经曰：虚虚实实，补不足，损有余，是其义也。余藏准此。

学习

此段历来认为是仲景脏腑辨证的治疗原则，理论来源为黄帝内经，以五行制化为基础，论述了疾病的传变和治疗规律。

个人认为此段可能为衍文，意义不大，当前主流论述的临床应用价值没有得到充分体现，可见人们十分不重视治未病。另一方面，五行生克制化在许多方面并不是很系统，环环相扣，怎么解释都可以，见肝之病，可以治脾，也可以治肾，如此一来余地甚多，十分考验医者悟性，这也是金匮与伤寒最大不同之处。