庚辰冬。于鼎翁公祖园中。识先生半面。窃见身体重着。履步艰难。面色滞晦。语言迟缓。以为有虚风
卒中之候也。因为过虑。辛巳秋召诊间。细察脾脉。缓急不调。肺脉劲大。然肝木尚平。阳气尚旺。是八风之
邪。未可易中。而筋脉掣痛。不能安寝者。大率风而加之以湿。交煽其虐所致。以斯知尚可引年而施
治也。何也。风者肝之病。天之气也。湿者脾之病。地之气也。天气迅疾。故发之暴。益以地气之迂缓。反
有所牵制而不能暴矣。然气别则病殊。而气交则病合。有不可不明辨者。病殊者。在天
气则风为百病之长。其来微。则随相克为传次。必遍五脏而始烈。其来甚。则不繇传次而直中。唯体虚之人。
患始不测焉。在地气则湿为下体之患。其来微。则足跗肿大。然得所胜亦旋消。其来甚。则害及皮肉筋脉。
以渐而上攻。亦唯阳虚之人。势始腾越焉。两者一本之天。一本之地。病各悬殊。治亦异法者也。病
合者。天之气入于筋脉。地之气亦入于筋脉。时乎天气胜。则筋脉张而劲焉。时乎地气胜。则筋脉 而缓焉。
两者其源虽异。其流则同。交相蕴结。蔓而难图者也。先生房中之风。始虽不可知。然而所感则微也。至若
湿之一字。既以醇酒浓味而酿之于内。又为炎蒸岚瘴而袭之于外。是以足患日炽。虽周身筋脉舒
展。亦不自如。究竟不若足间昼夜掣痛。疮疡肿溃。浸淫无已也。夫春时之风也。夏时之湿与热也。秋时之燥
也。三时之气。皆为先生一身之患者也。而一身之患。又唯一隅独当之。亦良苦矣。设内之风湿热燥不攘。足
患其有宁宇乎。所可嘉者。惟冬月寒水司令。势稍末减。而医者不识此意。每投壮筋骨之药酒。
以驱其湿。不知此乃治寒湿之法。惟冬月病增者方宜。岂以风湿热湿。而倒行逆施。宁不重其困耶。况乎先生
肺脉劲大。三四日始一大便。虽冬月亦喜形寒饮冷。而不欲近火。何所见其为寒湿也哉。所以孙真人大小竹沥
等方。风湿热燥寒五治之药俱备。笼统庞杂。后人全不知用。若识此义为去取。则神而明之之
事矣。然则不辨证而用方者。几何而不误耶。
胡卣臣先生曰。辨证纵横无碍。剑光烨烨逼人。
In the winter of the Gengchen year, in the garden of Grandfather Dingweng, I met Mr. Jiang and saw only half his face. Privately observing him, I noticed his body felt heavy, his steps were difficult, his complexion was dull and stagnant, and his speech was slow. I considered this a sign of "deficient wind" (Xu Feng, sudden attack by pathogenic wind due to deficiency) striking the person. Thus, I worried excessively. In the autumn of the Xinsi year, he summoned me for consultation in his study. Upon carefully palpating his Spleen pulse (Pishi Mai), it appeared irregular with alternating slackness and tension; his Lung pulse (Fei Mai) was forceful and large. However, the Liver Wood Qi was still balanced, and Yang Qi was still vigorous. This indicated that the pathogens of the Eight Winds (Ba Feng, eight directional winds acting as pathogenic factors) could not easily invade. The symptoms of tendon and vessel spasmodic pain and inability to sleep were largely caused by Wind combined with Dampness, mutually inciting their cruelty. From this, I knew that longevity could be extended and treatment applied. Why? Wind is the disease of the Liver, belonging to the Qi of Heaven; Dampness is the disease of the Spleen, belonging to the Qi of Earth. Heavenly Qi is swift, so its onset is violent; added to the sluggishness of Earthly Qi, it is actually restrained and cannot be overly violent. However, different Qi leads to different diseases, and intersecting Qi leads to combined diseases, which must be clearly distinguished.
When diseases are distinct: Regarding Heavenly Qi, Wind is the chief of all diseases. If the pathogen is slight, it transmits according to the cycle of mutual restriction (Xiang Ke), spreading through all five Zang organs before becoming fierce. If the pathogen is severe, it strikes directly without transmission, affecting only those with weak constitutions, making the illness unpredictable. Regarding Earthly Qi, Dampness affects the lower body. If slight, it causes swelling of the dorsum of the foot, but if countered by the restricting element, it subsides quickly. If severe, it harms skin, flesh, tendons, and vessels, gradually attacking upward, affecting only those with deficient Yang, where the condition escalates. These two have different origins (Heaven vs. Earth), distinct pathologies, and thus require different treatments.
When diseases combine: Heavenly Qi enters the tendons and vessels, and Earthly Qi also enters them. When Heavenly Qi prevails, the tendons and vessels become tense and rigid; when Earthly Qi prevails, they become relaxed and slow. Although their sources differ, their manifestations converge, intertwining and spreading, making them difficult to resolve. The origin of Wind in Mr. Jiang's residence was unknown initially, but the contracted Wind was likely slight. As for Dampness, it was brewed internally by rich wine and heavy flavors, and attacked externally by hot vapors and miasmas. Thus, the foot affliction intensified daily. Although the tendons and vessels throughout the body were uncomfortable, the worst symptoms were the day-and-night spasmodic pain in the feet, with sores swelling, ulcerating, and oozing incessantly. The Wind of Spring, the Dampness and Heat of Summer, and the Dryness of Autumn—all these seasonal Qi became ailments for Mr. Jiang's whole body. Yet, the ailment of the whole body was borne solely by one corner (the foot), which was indeed bitter. If the internal Wind-Damp-Heat-Dryness were not expelled, how could the foot affliction ever find peace? Fortunately, only in winter, when Cold Water rules, did the condition slightly subside. However, physicians failed to understand this, often prescribing medicinal wines to strengthen bones and tendons to dispel dampness. They did not realize this is a method for Cold-Damp, suitable only when conditions worsen in winter. How can one use such methods inversely for Wind-Damp-Heat? Would this not exacerbate his distress? Moreover, Mr. Jiang’s Lung pulse was forceful, he had bowel movements only every three to four days, and even in winter, he preferred feeling cold and drinking cold liquids, avoiding fire. How could one judge this as Cold-Damp?
Therefore, Sun Simiao’s formulas such as Da Zhu Li Tang (Large Bamboo Juice Decoction) and Xiao Zhu Li Tang (Small Bamboo Juice Decoction) contain herbs for treating Wind, Damp, Heat, Dryness, and Cold. They are comprehensive yet complex, and later generations did not know how to use them. If one understands the principles to select and discard appropriately, it would be a divine and illuminating matter. Conversely, using formulas without syndrome differentiation leads to errors.
Mr. Hu Youchen said, "His syndrome differentiation is free and unimpeded; his sword-like insight shines brightly, intimidating others."