《西遊記》醫案故事：本草「以毒攻毒」藥理醫道的人文哲思

Medical Record of Journey to the West: Humanistic Philosophy of Medical Treatment “To Cure Ills with Poison” by Herbal Medicine

在《西遊記》第68回到第71回，提到診脈開方的醫治故事，選巴豆具有毒性之藥，運用君臣佐使的調配，在身體羸弱沉痾之際，以毒性之藥作為醫治。本草用藥進入身體的行速、攻役、戰果，具有攻克的本事，有如將軍的攻役，特別是所選毒性之藥，能長驅的直搗，藥效峻利猛烈，具有破敵攻克的卓越功績，能發揮迅捷醫治的良好效果。歷代重要藥書皆貫上「本草」的命名，採取博物志的記述，「毒」在這樣的基礎，開發為藥之運用，可作為主藥的重要地位，發揮醫治的迅捷功效，成為治病救命之方。中醫藥理發展出「以毒攻毒」（以邪治邪）的治療思路，此是「邪」亦是「正」，所謂「正／邪」辨證，以二元的形式，卻不局限於其中，能含融二者而有超越對立的深蘊。傳統中醫對本草用藥不是理論性的技術施治，其內涵用藥之道的人文哲思。以文學探討中醫，選以《西遊記》入手，中醫提出「以毒攻毒」模式，《西遊記》提出「以邪治邪」方式。中醫從「毒」著眼，《西遊記》從「邪」著眼，這二者可看到相通模式的運作。本草具有毒性，能作為應天順人的將軍；妖魔也可以將功贖罪，助成取經能成羅漢成聖成佛。本草用藥進入身體的行效戰役，西遊歷難的「正／邪」攻防，這之間有著共通淵源的承傳演繹。《西遊記》以「物活」視角，將本草以故事化的生命敘述，透過文學的途徑，對本草的用藥之道，探討背後的宇宙觀和生命觀，及所運用「君臣佐使」配伍，「以齊其不齊，而成其所以齊」的調和之道。本草之毒雖列為下品藥，卻能為方劑結構的「君位」，能達至「破邪歸正」之功。所謂藥理之道，用藥進藥吃藥，治病養性養命，有著通向天人之道，在這裡文學內涵是如此，中醫藥理醫道亦如是。

The 68th to 71st chapters of Journey to the West mention a medical story of checking the pulse and prescribing. It adopts the “monarch, minister, assistant, and envoy” principle and selects croton, a poisonous medicine, to treat weak bodies. When herbal medicine enters the body, it advances fast, attacks, and achieves victory. Its ability to attack and conquer can be likened to a general’s attack. The selected poisonous medicine is particularly strong and effective. In the history of important medical books, the term “herbal medicine” was always dubbed in the title. Meanwhile, natural history tradition describes “poison” as a medicine that can be adopted as an effective principal drug. Furthermore, the poison in herbal medicine can cure rather than harm the body. Hence, the concept, “to cure ills with poison” which developed in the pharmacology of Chinese medicine. While poison in herbal medicine is “evil”, it is also “positive/healthy” when used in treatments. This ideology is not limited to the duality of “evil” and “positive/healthy”, but rather combines and transcends both. Herbal medicine in traditional Chinese medicine is not mere technical prescriptions and principles. Instead, it reveals profound medical wisdom. Research on Chinese medicine can be done through literature, in this case based on Journey to the West. Chinese medicine proposes “to cure ills with poison”, and in Journey to the West this idea is modified as “to treat evil by evil”. In particular, Chinese medicine focuses on “poison”, whereas Journey to the West emphasizes “evil”. The similarity in their principles is apparent. With its poisonous characteristic, Chinese Materia Medica can also be likened to a general who attacks evils in the human body. The evils in Journey to the West can also be atoned and become arhats, saints, or Buddha at the end of the novel. The physical efficacy of herbal medicine shares the same origin such as that of the battles between “righteousness and evil”. Journey to the West depicts the stories of herbal medicine from the perspective of “living objects”. It also explores the underlying views of the universe and life by its prescription of herbal medicine. The “monarch, minister, assistant, and envoy” principle harmonizes the four types of medicine by complementing each other to complete the treatment. Although poisons in herbal medicine are classified as medicines in the lowest grade, they serve as “monarchs” and can effectively support the prescription. The principle of pharmacology, prescriptions, medicine taking, curing disease, nurturing minds and sustaining life, exemplifies the unity between heaven and man, which is valid in literature as well as in Chinese medicine.