诸虚先要辨阴阳血阴而气阳也。有暴虚而无伤损者易复。有虚而亏损者亦可补益。惟久
虚
。气口脉弱则死。强则生。女人久病。人迎脉强则生。弱则死。虚症必食少神昏。遗精潮汗。
痰嗽腰背胸胁筋骨痛。但见一二症。便是阳损。自上而下。一损于肺。则皮聚而毛落。二损
于心。则血脉虚少。不能荣于脏腑。妇人月水不通。三损于胃。则饮食不能消克。不为肌肤
治。宜辛甘。若淡于胃。则不可治矣。阴损自下而上。一损于肾。则骨痿不能起于床。二损
于肝。则筋缓不能自收持。三损于脾则饮食不能消克。不为肌肤治宜酸苦。若咸过脾则不可
治矣。大要心肺损而色惫。汗多者为阳虚。肝肾损而形瘁。汗多者为阴虚。经云。损其肺者
。
益其气。损其心者。补其荣血。损其脾者。调其饮食。适其寒温。损其肝者。缓其中。损其
肾者。益其精。古庵云肺。脾主气。肺恶寒。而脾恶湿。则温寒燥湿之药。是补肺脾。而泻
心肾也。心肾主血。心恶热而肾恶燥。则清热润燥之药。是补心肾。而泻肺脾也。要之阴阳
损伤。皆水火不济。火降则血脉和畅。水升则精神充满。或心肾俱虚。或心脾俱虚。或肺肾
俱虚。或五脏俱虚。但以补和心肾为主。兼养脾胃。则饮食进。而精神气血生矣。
治疗各种虚证,首先要辨别阴阳。阴对应血,阳对应气。如果是突然发生的虚损而没有造成实质损伤的,容易恢复。如果是已经造成亏损的虚证,也可以通过补益来治疗。只有长期虚弱且脉象呈现特定危象时才危险:如果气口脉(寸口脉)微弱则预后不良,强盛则有生机;女性久病,如果人迎脉强盛则有生机,微弱则预后不良。虚证必然伴随食欲减退、神志昏沉、遗精、潮热盗汗等症状,以及痰嗽、腰背胸胁筋骨疼痛等表现。只要见到其中一两个症状,就是阳气受损。
阳气受损自上而下发展:第一损及肺,表现为皮毛枯槁脱落;第二损及心,表现为血脉虚少,不能滋养脏腑,女性会出现月经不通;第三损及胃,表现为饮食无法消化运化,身体消瘦。治疗应当使用辛甘味的药物。如果口味变得淡薄无味,则难以治愈。
阴损自下而上发展:第一损及肾,表现为骨痿无力,不能起床;第二损及肝,表现为筋脉弛缓,不能自主收持;第三损及脾,表现为饮食无法消化运化,身体消瘦。治疗应当使用酸苦味的药物。如果口味过咸伤及脾脏,则难以治愈。
大要而言:心肺受损而面色疲惫、多汗的是阳虚;肝肾受损而形体憔悴、多汗的是阴虚。《内经》说:损伤肺的,要益其气;损伤心的,要补其营血;损伤脾的,要调理饮食,适应寒温变化;损伤肝的,要舒缓其情志/中焦;损伤肾的,要益其精。古庵说:肺和脾主气,肺恶寒,脾恶湿,所以用温寒燥湿的药物,是补肺脾而泻心肾。心和肾主血,心恶热,肾恶燥,所以用清热润燥的药物,是补心肾而泻肺脾。总之,阴阳损伤,都是水火不济。火降则血脉和畅,水升则精神充满。无论是心肾俱虚,还是心脾俱虚,或肺肾俱虚,或五脏俱虚,都以补和心肾为主,兼养脾胃,这样饮食就能增进,精神气血也就生发了。
In treating various deficiency syndromes, one must first distinguish between Yin and Yang. Yin corresponds to Blood, and Yang corresponds to Qi. If the deficiency is sudden without causing structural damage, it is easy to recover. If there is existing depletion, it can also be treated with tonification. However, in cases of chronic deficiency, if the Qikou pulse (Cunkou pulse) is weak, the prognosis is poor; if strong, life is preserved. In women with chronic illness, if the Renying pulse is strong, life is preserved; if weak, the prognosis is poor. Deficiency syndromes inevitably present with symptoms such as poor appetite, mental confusion, spermatorrhea, tidal fever, and night sweats, as well as phlegm-cough, pain in the lower back, back, chest, hypochondrium, bones, and joints. The appearance of even one or two of these symptoms indicates damage to Yang.
Yang damage progresses from top to bottom: First damage affects the Lung, manifesting as withered skin and falling hair; second damage affects the Heart, manifesting as deficient and scanty blood vessels unable to nourish the Zang-Fu organs, leading to amenorrhea in women; third damage affects the Stomach, manifesting as inability to digest and transform food, resulting in emaciation. Treatment should employ Pungent and Sweet herbs. If the taste becomes bland, it is difficult to treat.
Yin damage progresses from bottom to top: First damage affects the Kidney, manifesting as bone atrophy and inability to rise from bed; second damage affects the Liver, manifesting as flaccid sinews unable to maintain posture; third damage affects the Spleen, manifesting as inability to digest and transform food, resulting in emaciation. Treatment should employ Sour and Bitter herbs. If Salty flavor excessively damages the Spleen, it is difficult to treat.
Generally speaking: Damage to the Heart and Lung with weary complexion and profuse sweating indicates Yang deficiency. Damage to the Liver and Kidney with emaciated form and profuse sweating indicates Yin deficiency. The Classic states: For damage to the Lung, benefit its Qi; for damage to the Heart, tonify its Ying-Blood; for damage to the Spleen, regulate diet and adapt to cold and warmth; for damage to the Liver, soothe its interior/middle; for damage to the Kidney, benefit its Essence. Gu An stated: The Lung and Spleen govern Qi. The Lung dislikes Cold, and the Spleen dislikes Dampness. Therefore, using herbs that warm Cold and dry Dampness tonifies the Lung and Spleen while draining the Heart and Kidney. The Heart and Kidney govern Blood. The Heart dislikes Heat, and the Kidney dislikes Dryness. Therefore, using herbs that clear Heat and moisten Dryness tonifies the Heart and Kidney while draining the Lung and Spleen. In essence, Yin-Yang damage results from the failure of Water and Fire to interact. When Fire descends, blood vessels become harmonious and smooth; when Water ascends, spirit and vitality are filled. Whether it is simultaneous deficiency of the Heart and Kidney, Heart and Spleen, Lung and Kidney, or all five Zang organs, the primary treatment is to tonify and harmonize the Heart and Kidney, while concurrently nourishing the Spleen and Stomach. This will promote appetite and generate spirit, Qi, and Blood.