素问生气通天论篇曰。春伤于风。邪气留连。乃为洞泄。夏伤于暑。秋为咳疟。秋伤于湿
。
上逆而咳。发为痿厥。冬伤于寒。春必病温。阴阳应象论篇曰。春伤于风。夏生飧泄。夏伤
于暑。秋必 疟。秋伤于湿。冬生咳嗽。冬伤于寒。春必病温。王启玄注云。风中于表。则
内
应于肝。肝气乘脾。故洞泄。或飧泄。夏暑已甚。秋热复收。两热相攻。则为 疟。秋湿既
胜。冬水复旺。水湿相得。肺气又衰。故乘肺而为咳嗽。其发为痿厥者。盖湿气内攻于脏腑
。则咳逆。外散于筋脉。则痿弱也。厥谓逆气也。冬寒且凝。春阳气发。寒不为释。阳怫于
中。寒怫相持。故为温病。伤寒论引素问后篇八句。成无己注云。当春之时。风气大行。春
伤于风。风气通于肝。肝以春适旺。风虽入之。不能即发。至夏肝衰。然后始动。风淫
末疾。则当发于四肢。夏以阳气外盛。风不能外发。故攻内而为飧泄。当秋之时。湿气大
行。秋伤于湿。湿则干于肺。肺以秋适旺。湿虽入之。不能即发。至冬肺衰。然后湿始动
也
。雨淫腹疾。则当发为下利。冬以阳气内固。湿气不能下行。故上逆而为咳嗽。当夏之时。
暑气大行。夏伤于暑。夏以阴为主内。暑虽入之。势未能动。及秋阴出。而阳为内主。然后
暑动搏阴。而为 疟。当冬之时。寒气大行。冬伤于寒。冬以阳为主内。寒虽入之。势未能
动。及春阳出。而阴为内主。然后寒动搏阳。而为温病。王海藏曰。木在时为春。在人为
肝。在天为风。当春之时。发为温令。反为寒折。是三春之月。行三冬之令也。以是知水太
过矣。水既太过。金肃愈严。是所胜者乘之。而妄行也。所胜者乘之。则木虚明矣。木气
既虚。火令不及。是所生者受病也。故所不胜者侮之。是以土来木之分。变而为飧泄也。所
以病发于夏者。以木绝于夏。而土旺于夏。湿本有下行之体
故也。不病于春者。以春时风虽有伤。木实当权故也。
暑季夏也。季夏者。湿土也。君火持权。不与之子
。暑湿之令不行也。湿令不行。则土亏矣。所胜妄行。木气太过。少阳旺也。所生者受病。
则肺金不足。所不胜者侮之故水得以来土之分。土者坤也。坤在申之分。申为相火。水入于
土。则水火相干。水火相干。则阴阳交争。故为寒热。兼木气终见三焦。是少阳相火合也。
少阳在湿土之分。故为寒热。肺金不足。洒淅寒热。此皆往来未定之气也。故为 疟。不发
于夏。而发于秋者。以湿热在酉之分。方得其权故也。秋者清肃之气。收敛下行之体也。为
湿所伤。是长夏之气。不与秋令也。秋令不及。所胜妄行。故火得以炎上而克金。心火既刑
于肺。故肺气逆而为咳。所不胜者侮之。木气上行。与火同德。动而不息者也。所生者受病
。故肾水亏也。长夏已亢。三焦之气盛也。命门者三焦之合也。故迫肾水上行。与脾土湿热
。相合为疾。因咳而动于脾之湿。是以咳嗽有声。有涎。不发于秋。而发于冬者。以其六阴之极
。肃
杀始得其气故也。冬伤于寒者。是冬行春令也。当寒而温。火胜而水亏矣。水既已亏。则所
胜妄行。土有余也。所生受病。木不足也。所不胜者侮之。
火太过也。火土合德。湿热相助。故为温病。不病于冬。而病于春
者。以其寒水居卯之分。方得其权。大寒之令。复行于春。腠理开泄。少阴不藏。房室劳伤
。辛苦之人。阳气泄于外。肾水亏于内。当春之月。时强木长。无以滋生化之原。故为温病
耳。夫春伤于风。夏伤于暑。冬伤于寒。辞理皆顺。时字伤令字也。独秋伤于湿。说作令字
伤时字。读者不可疑也。此四说。皆母所亢。而害其所承之子也。若说秋字伤湿字。其文与
上三句相通。其理与法不得相通矣。大抵理与法通。不必拘于文也。或谓春伤于风。是人为
风所伤。非也。若是。则止当头痛。恶风。自汗。何以言夏为飧泄哉。今言春伤于风。即是
时伤令也明矣。愚按。此四伤诸家注释。皆不得经旨者。盖由推求太过故也。孟子曰。道在
迩。而求诸远。事在易。而求诸难。此之谓欤。但只轻轻平易说
去。则经旨自明。而无穿凿之患矣。何以言之。夫风暑湿寒者。天地之四气也。其
伤于人。人岂能于未发病之前。预知其客于何经络。何脏腑。何部分。而成何病乎。及其既
发病。然后可以诊候。始知其客于某经络。某脏腑。某部分。成某病耳。注释者。苟误因病
始知病原之理。则于此四伤。不劳余力。自迎刃而解矣。夫洞泄也。 疟也。咳与痿厥也。
温病也。皆是因其发动之时。形诊昭着。乃逆推之。而知其昔日致病之原。为伤风。伤暑。
伤湿。伤寒耳。非是初受伤之时。能预定其今日必为此病也。且夫伤于四气。有当时发病者
。有过时发病者。有久而后发病者。有过时之久自消散。而不成病者。何哉。盖由邪气之传
变聚散不常。及正气之虚实不等故也。且以伤风言之。其当时而发则为恶风。发热。头疼。
自汗。咳嗽。喘促等病。其过时与久而发。则为疠风。热中。寒中。偏枯。五脏之风等病
。是则洞泄。飧泄者。乃过时而发之中之一病耳。因洞泄。飧泄之病生。以形诊推之。则知
其为春伤风。藏蓄不散。而致此也。苟洞泄。飧泄之病未生。孰能知其已伤风于前。将发病
于后邪。假如过时之久自消散。而不成病者。人亦能知乎。世有太素脉法。虽或预知死亡之
期。然亦是因诊之昭着。而始能知耳。夏伤暑为 疟。冬伤寒为温病。意亦类此。但秋伤湿。
上逆为咳嗽。为痿厥。其因病知原。则与三者同。
其令行于时。则与三者异。夫春之风。夏之暑。冬之寒。皆是本时之令也。湿乃长夏之令。
何于秋言之。盖春夏冬每一时。各有三月。故其令亦各就其本时而行也。若长夏。则寄旺于
六月之一月耳。秋虽亦有三月。然长夏之湿令。每侵过于秋而行。故曰秋伤于湿。(秋令为
燥
。然秋之三月前近于长夏。其不及为湿所胜。其太过则同于火化。其平气则又不伤人。
此经所以于伤人止言风暑湿寒。而不言燥也。或问余曰。五运六气七篇。所叙燥之为病甚多
何哉。余曰。运气七篇。与素问诸篇。自是两书。作于二人之手。其立意各有所主。不可混
言。王冰以为七篇参入素问之中。本非素问元文也。余今所推之义。乃是素问本旨。当自作
一意看。)请陈四气所伤所病之义。夫风者。春之令也。春感之。偶不即发。而至夏。邪既
不散。则必为疾。其所以为洞泄者。风盖天地浩荡之气。飞扬鼓舞。神速不恒。人身有此。
肠胃之职。其能从容传化泌别。而得其常乎。故水谷不及分别。而并 下。以泄出也。其为
飧泄。亦类此义。(说者谓。春伤风为内通肝。洞泄飧泄。为木乘土。又谓。不发于春为邪
避
木旺。发于夏为木衰邪动。窃谓风既通肺。则正当木班之时。木极盛土极衰矣。理宜乘旺而
即发于春。不宜反过时而发于夏也。且夏火司权。母能滋子。何故不发于土衰极之时。而反
发于土受滋之时乎。其说不通。难以凭据。)暑者。夏之令也。夏感之。偶不即发。而至秋
。
又伤于风与寒。故为 疟也。寒者。冬之令也。冬感之。偶不即发。而至春。其身中之阳。
虽始为寒邪所郁。不得顺其渐升之性。然亦必欲应时而出。故发为温病也。若夫秋伤湿。其
令行于时之义。上文已论之矣。前篇所谓上逆而咳。发为痿厥。不言过时。似是当时即发者
。但既与风暑寒三者并言。则此岂得
独为即发者乎。然经无明文。终亦不敢比同后篇。便断然以为冬发病也。虽然。湿本长夏之
令。侵过于秋耳。纵使即发。亦近于过时而发者矣。此当只以秋发病为论。湿从下受。故干
肺为咳。谓之上逆。夫肺为诸气之主。今既有病。则气不外运。又湿滞经络。故四肢痿弱无
力。而或厥冷也。后篇所谓冬生咳嗽。既言过时。则与前篇之义颇不同矣。夫湿气久客不散
。至冬而寒气大行。肺恶寒。而或受伤。故湿气得以乘虚上侵于肺。发为咳嗽也。观者。
以此意求之经旨。其或着乎。或者见素问于病温 疟等。间以必言之。遂视为一定不易之辞
。而曰此必然之道。嗟乎。果可必耶。果不可必耶。素问之或言必。或不言必者。盖不可胶
为一定故也。(往往有泥于必之一字。遂谓冬伤寒。必当得病于春。其冬伤寒而即病者。反
置而不论。若此者。可不谓之弃本逐末乎。)
经中每有似乎一定不易之论。而却不可以为一定不易者。如曰热厥。因醉饱入房。而得热中
消中者。皆富贵人也。新沐中风。则为首风。如此之类。岂一一皆然哉。读者。当活法。勿
拘执也。夫王启玄之注。虽未免泥于必字。及未得经旨。然却不至太远也。若成无己之说。
则似太远矣。然犹未至于甚也。至王海藏立论。则推求过极。欲异于人。殊不知反穿凿缀缉
乖
悖经旨。有不可胜言者。此先儒所谓。如大军游骑。出大远。而无所归矣。姑摭成无己王海
藏之说。辨其甚者一二。夫无己谓风淫末疾。则当发于四肢。雨淫腹疾。则当发为下利。窃
谓则当二字。决然之辞也。春伤风遇夏之阳气外盛。而不能外发。故攻内为飧泄。此或若可
通
矣。经曰。木发无时。倘风不伤于春。而伤于他时。不遇夏之阳气外盛。将外发乎。将内攻
乎。况风属阳。与夏同气。果欲外出。则当随其散越之势而出。安有不能之理乎。且风善行
数变。其为病非一。岂独能为四肢之疾乎。所谓雨淫腹疾之义。其不通亦如此。至若夏伤暑
。秋为 疟者。盖因暑疾藏于皮肤之内。肠胃之外。复秋感风。故疾作耳。观素问疟论可见
。其与夏阴主内。秋阳内主。暑动搏阴。何相干哉。冬伤寒。春为温病者。盖因寒毒中人肌
肤
。阳受所郁。至春天地之阳气外发。其人身受郁之阳。亦不能不出。故病作也。(韩祗和谓
。冬时感寒郁阳至春时。再有感而后发。余谓此止可论温病之有恶寒者耳。其不恶寒者。则
亦不为再感。而后发也。故仲景曰。太阳病不发热而渴。不恶寒者。为温病。)观伤寒论可
见
。其与冬阳主内。春阴内主。寒动搏阳。何相干哉乃若海藏。则又以春伤风。夏伤暑。冬伤
寒。为时伤令。秋伤湿。为令伤时。故于春伤风。谓春行冬令。而温为寒折。于夏伤暑。谓
暑者。季夏。季夏者。湿土。君火持权不与子。而暑湿令不行。于秋伤湿。谓秋为湿所伤。
是长夏之气不与秋令。于冬伤寒。谓冬行春令。火胜水亏。大寒之令。复行于春。阳气外泄
。肾水内亏者病。又谓温病。为湿热相助而成。又谓四时伤。皆母亢而害所承之子。吁。何
支离破碎徒费辞如此乎。夫经中所言伤风。伤暑之类甚多。皆是以人受风暑等所伤为义。未
尝有时伤令。令伤时之意也。若如海藏所言。则疟论所谓夏伤于暑。秋伤于风。与先伤于风
。后伤于寒等语。其时伤令欤。令伤时欤。吾固知其不能不屈于此也。且暑为夏令。孰不知
之。今以暑为季夏。为湿土。得不怪哉。夫冬果行春令。人若感此。则成冬温病矣。安得
为春温病乎。其谓大寒之令。复行于春。温病方作。设使
大寒之令。不复行于春。其温病当作者。遂不作乎。况今之春为温病者。比比皆是。未尝见
其必由大寒。复行于春。而后成也。经曰。亢则害。承乃制。其义谓已亢极。则胜已者来制
。如火亢极。则水来制之。经所谓相火之下。水气承之。水位之下。土气承之。之类。皆是
胜已者为承。今以亢为母。承为子。将求胜于经欤。抑未达欤。又如以制物者为所胜。受制
者为所不胜。与经所谓气有余。则制已所胜。而侮所不胜。及传之于其所胜。死于其所不胜
之旨全反矣。余如因时伤令令伤时之说。委曲衍说者。固不暇患辨也。呜呼。予非好斥前
人之非。盖为其有害大义。晦蚀经旨。以误后人。故不敢谀顺而嘿嘿耳。然而 逾之罪。
固已自知。其不得辞矣。但未知观者。以为何如。
《素问·生气通天论篇》说：春季感受风邪，邪气滞留体内，就会发生洞泄（指腹泻如水、完谷不化的严重泄泻）；夏季感受暑邪，到了秋季就会发生咳疟（咳嗽伴发疟疾）；秋季感受湿邪，湿气上逆引起咳嗽，进而发展为痿厥（肢体痿软无力兼四肢逆冷）；冬季感受寒邪，到了春季必然发生温病。
《素问·阴阳应象大论篇》说：春季感受风邪，夏季会发生飧泄（大便中夹杂未消化食物的泄泻）；夏季感受暑邪，秋季必然发生疟疾；秋季感受湿邪，冬季会发生咳嗽；冬季感受寒邪，春季必然发生温病。
王启玄注释说：风邪侵袭体表，内应于肝。肝气乘袭脾土，所以导致洞泄或飧泄。夏季暑热极盛，秋季热气又收敛，两热相争，就形成疟疾。秋季湿气既已胜行，冬季水气又旺，水湿相合，肺气又衰，所以湿气乘肺导致咳嗽。至于发生痿厥，是因为湿气内攻脏腑，则气逆而咳；外散于筋脉，则肢体痿弱。所谓“厥”，是指气机逆乱。冬季寒气凝滞，春季阳气升发，若寒邪未能解散，阳气郁结于中，寒邪与郁阳相互搏持，所以形成温病。
《伤寒论》引用《素问》后一篇的八句话，成无己注释说：在春季之时，风气盛行。春季伤于风，风气通于肝，肝气在春季正当旺盛，风邪虽然侵入，但不能立即发病。等到夏季肝气衰退，然后才开始发动。风邪淫溢会导致四肢疾病，本应在四肢发作。但夏季阳气外盛，风邪不能向外发散，所以向内攻伐导致飧泄。在秋季之时，湿气盛行。秋季伤于湿，湿邪干犯肺脏，肺气在秋季正当旺盛，湿邪虽然侵入，但不能立即发病。等到冬季肺气衰退，然后湿气才开始发动。雨湿淫溢会导致腹部疾病，本应表现为下利。但冬季阳气内固，湿气不能下行，所以上逆导致咳嗽。在夏季之时，暑气盛行。夏季伤于暑，夏季以阴为主在内，暑邪虽然侵入，势力尚不足以发动。等到秋季阴气外出，阳气主内，然后暑邪发动并与阴气搏结，形成疟疾。在冬季之时，寒气盛行。冬季伤于寒，冬季以阳为主在内，寒邪虽然侵入，势力尚不足以发动。等到春季阳气外出，阴气主内，然后寒邪发动并与阳气搏结，形成温病。
王海藏说：木对应的时间是春季，对应的人体脏腑是肝，对应的天象是风。在春季之时，本该发出温暖的时令，反而被寒冷折抑，这是三个月的春季行走了三个月冬季的时令。由此可知水气太过。水气既然太过，金气的肃杀就更严厉，这是所胜者（金克木，此处指金反侮木或金气过亢克制木）乘虚妄行。所胜者妄行，那么木气显然虚弱。木气既已虚弱，火令就不及，这是所生者（木生火）受病。所以所不胜者（水克火，此处指水反侮火或水气过亢）来侮之。因此土气来侵犯木的分野，变化为飧泄。之所以病症在夏季发作，是因为木气绝于夏季，而土气旺于夏季，湿本来具有下行的性质，所以如此。不在春季发病，是因为春季时风虽有伤害，但木气实际上当权得令。
暑属于季夏，季夏属于湿土。君火主持权柄，不给其子（土）以令，暑湿的时令就不能运行。湿令不行，土气就亏损了。所胜者（木克土，此处指木气过亢）妄行，木气太过，少阳相火旺盛。所生者（木生火，此处指火生土，逻辑稍显复杂，原意应为木旺克土致土虚，或火不生土）受病，则肺金不足。所不胜者（土克水，此处指水反侮土）来侮之，所以水得以侵犯土的分野。土属坤，坤位于申之分野，申为相火。水进入土中，水火相干，水火相干则阴阳交争，所以出现寒热往来。兼有木气终见三焦，这是少阳相火的合象。少阳位于湿土的分野，所以出现寒热。肺金不足，出现洒淅恶寒发热，这些都是往来未定的气机，所以形成疟疾。不在夏季发作而在秋季发作，是因为湿热在酉之分野，方才得其权柄。秋季是清肃之气，具有收敛下行的性质。被湿邪所伤，这是长夏之气不与秋令相应。秋令不及，所胜者妄行，所以火得以炎上而克金。心火既刑克肺金，所以肺气上逆而咳嗽。所不胜者来侮之，木气上行，与火同德，动而不息。所生者受病，所以肾水亏损。长夏已经亢盛，三焦之气旺盛。命门是三焦的合象，所以逼迫肾水上行，与脾土的湿热相合成为疾病。因为咳嗽而动摇了脾的湿邪，所以咳嗽有声，有涎沫。不在秋季发作而在冬季发作，是因为六阴至极，肃杀之气始得其位。冬季伤于寒，这是冬季行春季的时令。应当寒冷却温暖，火胜而水亏。水既已亏损，则所胜者妄行，土有余，所生者受病，木不足，所不胜者来侮之，火太过。火土合德，湿热相助，所以形成温病。不在冬季发病而在春季发病，是因为寒水居于卯之分野，方才得其权柄。大寒的时令，重新在春季施行，腠理开泄，少阴不藏，房劳损伤。辛苦之人，阳气泄于外，肾水亏于内。在春季之时，时令强盛的木气生长，无以滋养生化之源，所以形成温病罢了。
大抵春伤于风、夏伤于暑、冬伤于寒，辞理都顺承，是“时伤令”（季节伤了该季节的时令）。唯独秋伤于湿，解释为“令伤时”（时令伤了该季节），读者不要怀疑。这四种说法，都是母气亢盛，而害其所承的子气。如果说“秋字伤湿字”，其文义与上三句相通，但其道理与法则不得相通。大体上道理与法则是通的，不必拘泥于文字。有人说春伤于风，是人被风邪所伤，不对。如果是这样，则只应当头痛、恶风、自汗，为什么说夏季会飧泄呢？现在说春伤于风，就是时伤令，已经很明白了。
我按语：这四种伤害，各家的注释，都没有得到经旨的要领，大概是由于推求太过分的缘故。孟子说：“道在近处，却向远处寻求；事在容易处，却向难处寻求。”说的就是这个吧。只要轻轻平易地说去，经旨自然明了，而没有穿凿附会的祸患了。为什么这样说？风、暑、湿、寒，是天地四气。它们伤人，人难道能在未发病之前，预先知道它客居在哪条经络、哪个脏腑、哪个部位，并构成什么病吗？等到已经发病，然后可以诊候，才知道它客居在某经络、某脏腑、某部分，构成某病罢了。注释者如果错误地认为因病才能知道病原的道理，那么对这四种伤害，不需费尽力气，自然迎刃而解。所谓的洞泄、疟疾、咳嗽与痿厥、温病，都是因为在其发作之时，症状明显，于是逆推回去，知道其昔日致病的根源，是伤风、伤暑、伤湿、伤寒罢了。并不是在最初受伤的时候，就能预定今天必定为此病。况且伤于四气，有当时发病的，有过时发病的，有久后才发病的，有过时之后自行消散而不成为疾病的，为什么呢？这是因为邪气的传变聚散无常，以及正气的虚实不等所致。且以伤风为例，其当时发作则为恶风、发热、头疼、自汗、咳嗽、喘促等疾病。其过时与久后发作，则为疠风、热中、寒中、偏枯、五脏之风等疾病。那么洞泄、飧泄，不过是过时发作中的一种疾病罢了。因为洞泄、飧泄的病产生，根据症状推断，就知道它是春季伤风，邪气藏蓄不散，而导致此病。假如洞泄、飧泄的病未产生，谁能知道此前已伤风，将要在后发病呢？假如过时很久自行消散而不成为疾病，人也能知道吗？世间有太素脉法，虽然或许能预知死亡的日期，但这也是因为诊断的症状明显，然后才能知道。夏伤暑为疟疾，冬伤寒为温病，意思也类似。只是秋伤湿，上逆为咳嗽、为痿厥，其因病知原，则与三者相同。其时令运行于时节，则与三者不同。春季的风、夏季的暑、冬季的寒，都是本时的时令。湿却是长夏的时令，为何在秋季言说？大概春夏冬每一时各有三个月，所以其时令也都各自在本时运行。若长夏，则寄旺于六月这一个月而已。秋季虽也有三个月，但长夏的湿令，常常侵越到秋季而行，所以说秋伤于湿。（秋令为燥，然而秋季的前三个月靠近长夏，其不及则被湿所胜，其太过则同于火化，其平气则又不伤人。这部经典之所以在谈伤人时只说风暑湿寒，而不说燥，原因就在这里。）
有人问我：五运六气七篇中，叙述燥邪致病的情况很多，为什么呢？我说：运气七篇与《素问》其他篇章，本是两本书，由两个人所作，其立意各有所主，不可混为一谈。王冰认为七篇参入《素问》之中，本非《素问》原文。我现在所推演的意义，乃是《素问》的本旨，应当当作一个独立的意旨来看待。
请陈述四气所伤致病的意义。风，是春季的时令。春季感受它，偶然没有立即发作，到了夏季，邪气既然不散，就必定成为疾病。之所以成为洞泄，是因为风大概是天地浩荡之气，飞扬鼓舞，神速不定。人身如果有此风邪，肠胃的职责，还能从容传化泌别，而得其常度吗？所以水谷来不及分别，一并而下，从而泄出。其成为飧泄，也是类似的道理。（解说的人说，春伤风内通于肝，洞泄飧泄是木乘土。又说，不在春季发病是因为邪气避开木旺之时，在夏季发病是因为木衰邪动。我认为风既通肺，则正当木旺之时，木极盛土极衰，理应乘旺而在春季即发，不宜反而过时而在夏季发作。况且夏季火司权，母能滋子，为何不在土衰极之时发作，反而在土受滋之时发作呢？这种说法不通，难以凭据。）
暑，是夏季的时令。夏季感受它，偶然没有立即发作，到了秋季，又伤于风与寒，所以形成疟疾。寒，是冬季的时令。冬季感受它，偶然没有立即发作，到了春季，人体中的阳气，虽然开始被寒邪郁遏，不能顺应其渐升的性质，但也一定要应时而出，所以发为温病。至于秋伤湿，其时令运行于时节的意义，上文已经论述过了。前篇所谓上逆而咳，发为痿厥，没有说过时，似乎是当时即发的。但既然与风、暑、寒三者并列言说，那么这难道能独自认为是即发的吗？然而经文没有明文，终究也不敢比同后篇，便断然认为是在冬季发病。虽然如此，湿本是长夏的时令，侵越到秋季罢了。即使即时发作，也接近于过时发作了。这里应当只以秋季发病来论述。湿从下部受邪，所以干犯肺脏而为咳，称为上逆。肺为诸气之主，现在既有病，则气不外运，加上湿滞经络，所以四肢痿弱无力，或者厥冷。后篇所谓冬生咳嗽，既然说过时，则与前篇的意义颇不相同。湿气久留不散，到了冬季寒气大行，肺恶寒，或者受伤，所以湿气得以乘虚上侵于肺，发为咳嗽。观察者，以此意探求经旨，或许能着落吧。
有的人见到《素问》在谈论温病、疟疾等病时，偶尔用“必”字，于是视为一定不易之辞，说这是必然之道。唉！果真可必吗？果真不可必吗？《素问》有时说“必”，有时不说“必”，大概是不愿固执为一定之故。（往往有人拘泥于“必”字，就说冬伤寒，必定在春季得病。那些冬伤寒而即病的，反而置之不论。像这样的人，能不说是弃本逐末吗？）
经文中每有似乎一定不易的言论，却不可以作为一定不易的。比如曰：热厥，因醉饱入房，而得热中消中者，都是富贵人。刚洗完头中风，就成为首风。像这样的例子，难道一一都是这样吗？读者，应当灵活掌握，不要拘执。王启玄的注释，虽然未免拘泥于“必”字，且未得经旨，然而却不至于太远。至于成无己的说法，则似乎太远了，然而还不至于过分。到了王海藏立论，则推求过极，想要与众不同，殊不知反而穿凿附会，违背经旨，有不可胜言的地方。这就是先儒所说的，如同大军游骑，出得太远，而无所归依。姑且摘录成无己、王海藏的说法，辨析其中严重的个别之处。
成无己说风淫末疾，则当发于四肢；雨淫腹疾，则当发为下利。我认为“则当”二字，是决然之辞。春季伤风遇到夏季阳气外盛，而不能外发，所以攻内为飧泄，这或许还可以通融。经文说：木发无时。倘若风不伤于春季，而伤于其他时候，不遇夏季阳气外盛，是将要外发呢？还是要内攻呢？况且风属阳，与夏同气，果欲外出，则应当随着其散越之势而出，哪有不能的道理呢？而且风善行数变，其为病不止一种，岂独能为四肢的疾病呢？所谓雨淫腹疾的意义，其不通也是如此。至于夏伤暑，秋为疟疾，大概是因为暑邪藏于皮肤之内，肠胃之外，又感秋风的邪气，所以疾病发作。看《素问·疟论》可见。这与夏季阴主内、秋季阳内主、暑动搏阴，有什么相干呢？
冬伤寒，春为温病，大概是因为寒毒中人肌肤，阳受所郁，到了春季天地之阳气外发，其人身受郁之阳，也不能不出，所以疾病发作。（韩祗和说：冬季感寒郁阳，至春季时，再有感而后发。我认为这只可论述温病中有恶寒症状的。那些不恶寒的，则也不是再感而后发。所以张仲景说：太阳病不发热而渴，不恶寒者，为温病。）看《伤寒论》可见。这与冬季阳主内、春季阴内主、寒动搏阳，有什么相干呢？
至于王海藏，又以春伤风、夏伤暑、冬伤寒为时伤令，秋伤湿为令伤时。所以在春伤风时，谓春行冬令，而温病为寒邪折抑；在夏伤暑时，谓暑属于季夏，季夏属于湿土，君火持权不给其子，而暑湿令不行；在秋伤湿时，谓秋季被湿所伤，这是长夏之气不与秋令相应；在冬伤寒时，谓冬季行春季时令，火胜水亏，大寒的时令，重新在春季施行，阳气外泄，肾水内亏而致病。又谓温病，是湿热相助而成。又谓四时伤害，都是母亢而害所承之子。唉！为何支离破碎、徒费言辞到如此地步呢？
经中所言伤风、伤暑之类很多，都是以人受风暑等邪气所伤为意义，未曾有“时伤令”、“令伤时”的意思。如果像王海藏所说，那么《疟论》所谓“夏伤于暑，秋伤于风”，与“先伤于风，后伤于寒”等语句，是时伤令呢？还是令伤时呢？我固然知道他们不能不屈服于此。况且暑为夏令，谁不知道呢？现在把暑当作季夏，当作湿土，能不奇怪吗？如果冬季真的行春季时令，人若感受此邪，则成为冬温病了，怎能成为春温病呢？其谓大寒的时令，重新在春季施行，温病才发作。假设大寒的时令，不在春季重新施行，其应当发作的温病，就不发作了吗？况且现在的春季患温病的，比比皆是，未曾见其必定是由大寒重新在春季施行，而后形成的。
经文说：亢则害，承乃制。其意义是说已经亢极，则胜己者来制约。如火亢极，则水来制之。经文所谓相火之下，水气承之；水位之下，土气承之之类，都是胜己者为承。现在把亢当作母，承当作子，是将要求胜于经文呢？还是没通达呢？又如把制物者当作所胜，受制者当作所不胜，与经文所谓“气有余，则制已所胜，而侮所不胜”及“传之于其所胜，死于其所不胜”的宗旨完全相反。我对于那种因时伤令、令伤时的说法，委曲衍说的人，本来无暇辩驳。呜呼！我并非喜欢斥责前人的错误，而是因为他们的学说有害大义，晦蚀经旨，以误导后人，所以不敢阿谀顺从而沉默不语。然而逾越礼法的罪过，自己心里已经知道，是不能推辞的了。只是不知道观看的人，认为怎么样。
The *Suwen* (Basic Questions), chapter "Tian Sheng Tong Lun" (Discussion on the Connection between Heaven and Humanity in Generating Qi), states: If one is injured by wind in spring, the pathogenic factor lingers, leading to dongxie (profuse diarrhea with undigested food). If one is injured by summerheat in summer, cough and malaria will occur in autumn. If one is injured by dampness in autumn, it moves upward causing cough, developing into weijue (flaccidity and cold extremities). If one is injured by cold in winter, one will inevitably suffer from wenbing (warm disease) in spring.
The *Suwen*, chapter "Yin Yang Ying Xiang Lun" (Discussion on the Correspondence of Yin and Yang), states: If one is injured by wind in spring, sunxi (diarrhea with undigested food) will occur in summer. If one is injured by summerheat in summer, nujie (malaria) will inevitably occur in autumn. If one is injured by dampness in autumn, cough will occur in winter. If one is injured by cold in winter, wenbing (warm disease) will inevitably occur in spring.
Wang Bing (Wang Qixuan) commented: Wind attacks the exterior, corresponding internally to the Liver. Liver Qi overacts on the Spleen, thus causing dongxie or sunxi. Summer heat is extreme, and autumn heat gathers; the two heats attack each other, forming nujie (malaria). Autumn dampness prevails, and winter water qi flourishes; water and dampness combine, Lung Qi declines, so dampness attacks the Lung causing cough. As for weijue, dampness attacks the zang-fu internally causing rebellious Qi and cough, and disperses externally into the sinews and vessels causing flaccidity. Jue refers to rebellious Qi. Winter cold condenses, and spring Yang Qi emerges; if cold is not released, Yang becomes blocked within. Cold and blocked Yang contend, thus forming wenbing.
The *Shanghan Lun* (Treatise on Cold Damage) cites the eight sentences from the latter chapter of *Suwen*. Cheng Wuji commented: In spring, wind qi is prevalent. Spring injury by wind means wind Qi connects with the Liver. The Liver is prosperous in spring; although wind enters, it does not manifest immediately. By summer, Liver Qi declines, and then it moves. Wind excess causes diseases of the extremities, so it should manifest in the four limbs. However, in summer, Yang Qi is abundant externally, preventing wind from dispersing outward, so it attacks inward causing sunxi. In autumn, dampness qi is prevalent. Autumn injury by dampness means dampness affects the Lung. The Lung is prosperous in autumn; although dampness enters, it does not manifest immediately. By winter, Lung Qi declines, and then dampness moves. Rain/dampness excess causes abdominal diseases, manifesting as lower purging. However, in winter, Yang Qi is secured internally, preventing dampness from descending, so it moves upward causing cough. In summer, summerheat qi is prevalent. Summer injury by summerheat: summer is dominated by Yin internally. Although summerheat enters, its force is insufficient to move. When autumn arrives, Yin exits and Yang dominates internally, then summerheat moves and contends with Yin, forming nujie. In winter, cold qi is prevalent. Winter injury by cold: winter is dominated by Yang internally. Although cold enters, its force is insufficient to move. When spring arrives, Yang exits and Yin dominates internally, then cold moves and contends with Yang, forming wenbing.
Wang Haizang said: Wood corresponds to spring in time, Liver in humanity, and wind in heaven. In spring, the warming command should issue, but it is restrained by cold. This is three months of spring executing the commands of three months of winter. Thus, Water Qi is excessive. Since Water is excessive, Metal's肃杀 (astringing and killing) nature is stricter; this is the conquered element overacting and acting recklessly. When the conquered element overacts, Wood Qi is clearly deficient. Since Wood is deficient, Fire command is inadequate; this is the generated element suffering disease. Thus, the unconquered element insults it. Therefore, Earth Qi invades Wood's domain, transforming into sunxi. The reason symptoms appear in summer is that Wood ends in summer, while Earth flourishes in summer. Dampness naturally has a downward nature. It does not appear in spring because, although wind injures, Wood actually holds power.
Summerheat belongs to late summer, which is damp-earth. Sovereign Fire holds authority and does not grant command to its child (Earth), so the summerheat-dampness command does not run. If dampness command does not run, Earth is deficient. The conquered element (Wood) overacts, Wood Qi is excessive, Shaoyang Minister Fire is prosperous. The generated element suffers, so Lung Metal is insufficient. The unconquered element (Water) insults it, so Water invades Earth's domain. Earth is Kun, located in the Shen sector, where Shen is Minister Fire. Water entering Earth causes water-fire interference, yin-yang contention, thus alternating chills and fever. Combined with Wood Qi ending in Sanjiao, this is Shaoyang Minister Fire combination. Shaoyang is in the damp-earth domain, hence alternating chills and fever. Insufficient Lung Metal causes shaxi (shivering) chills and fever. These are all unsettled Qi, hence nujie. It does not appear in summer but in autumn because damp-heat gains authority in the You sector. Autumn is clear and austere Qi, with a converging and descending nature. Injury by dampness means Changxia (late summer) Qi does not accord with Autumn command. Autumn command is inadequate, so the conquered element overacts; Fire flares up to insult Metal. Heart Fire insults Lung, so Lung Qi rebels causing cough. The unconquered element insults, Wood Qi moves upward, aligning with Fire, moving ceaselessly. The generated element suffers, so Kidney Water is deficient. Changxia is hyperactive, Sanjiao Qi is prosperous. Mingmen is the convergence of Sanjiao, forcing Kidney Water upward to combine with Spleen damp-heat, forming disease. Cough disturbs Spleen dampness, hence cough with sound and phlegm. It does not appear in autumn but in winter because six Yin extremes, austere-killing Qi gains position. Winter injury by cold is winter executing spring command. It should be cold but is warm; Fire prevails, Water is deficient. Since Water is deficient, the conquered element overacts, Earth is surplus, the generated element suffers, Wood is deficient, the unconquered element insults, Fire is excessive. Fire and Earth combine virtue, damp-heat assists, thus wenbing. It does not appear in winter but in spring because Cold Water occupies the Mao sector, gaining authority. Great cold command re-executes in spring, pores open, Shaoyin fails to store, sexual exhaustion. Hardworking people, Yang leaks externally, Kidney Water deficient internally. In spring, strong Wood grows, lacking source for nourishment and generation, thus wenbing.
Generally, spring injury by wind, summer injury by summerheat, winter injury by cold follow logical sequence; "shi" (time/season) injures "ling" (command/climate). Only autumn injury by dampness is interpreted as "ling" (dampness command) injuring "shi" (autumn season). Readers should not doubt. These four theories all involve mother Qi hyperactivity harming the son Qi it bears. If read as "Autumn word injures Dampness word," the text connects with the previous three sentences, but the principle and method do not connect. Generally, principle and method connect; one need not be bound by text. Some say spring injury by wind means humans are injured by wind, which is incorrect. If so, it would only cause headache, aversion to wind, spontaneous sweating. Why mention summer sunxi? Now saying spring injury by wind clearly means season injures climate.
My analysis: Annotations by various scholars on these four injuries fail to grasp the classic's intent, likely due to over-speculation. Mencius said, "The Way is near, yet sought far; matters are easy, yet sought difficult." This applies here. Simply explaining plainly reveals the classic's intent without forced interpretation. Why? Wind, summerheat, dampness, cold are the four Qi of heaven and earth. When they injure humans, can one predict before onset which meridian, zang-fu, or part is affected and what disease forms? Only after onset can diagnosis reveal the location and disease. Annotators mistakenly assume knowing disease implies knowing etiology. For these four injuries, understanding this saves effort. Dongxie, nujie, cough/weijue, wenbing are identified by their obvious manifestations at onset, tracing back to prior injury by wind, summerheat, dampness, or cold. One cannot predict specific future disease at the moment of initial injury. Moreover, injury by four Qi may manifest immediately, later, or after a long time, or dissipate without disease, due to variable pathogen transmission and varying Zheng Qi (Upright Qi) strength. Taking wind injury: immediate manifestation includes aversion to wind, fever, headache, sweating, cough, panting. Later manifestation includes leprosy, heat center, cold center, hemiplegia, five viscera wind. Thus, dongxie/sunxi are just types of delayed onset. From these symptoms, we infer prior spring wind injury retained inside. Without these symptoms, who could know prior wind injury? If it dissipates, who knows? Even Taisu pulse methods predicting death rely on obvious signs. Summer heat injury causing nujie, winter cold injury causing wenbing follow similar logic. Autumn dampness causing cough/weijue identifies origin via disease, same as others. But its timing differs. Spring wind, summer heat, winter cold are native seasonal commands. Dampness is Changxia's command, why mentioned in autumn? Spring, summer, winter have three months each, their commands run in their seasons. Changxia resides in the sixth month. Autumn has three months, but Changxia dampness often encroaches on autumn, hence "autumn injury by dampness." (Autumn command is dryness. Early autumn approaches Changxia; deficiency allows dampness to prevail, excess matches fire transformation, balanced state does not injure. Hence the classic mentions wind, heat, damp, cold, not dryness.)
Q: Why do the Five Movements and Six Qi seven chapters describe many dryness diseases? A: These chapters differ from other Suwen parts, authored by different people with distinct intents. Wang Bing noted they were inserted into Suwen, not original. My deduction follows Suwen's original intent.
Explain the meaning of four Qi injuries. Wind is spring's command. Spring infection, if not immediate, persists to summer, causing disease. Dongxie occurs because wind is vast, flying, rapid Qi. Human body with such Qi disrupts intestinal functions, unable to separate fluids and grains properly, leading to diarrhea. Sunxi is similar. (Scholars claim spring wind connects to Liver, wood overacting on earth. They argue non-manifestation in spring avoids strong Wood, manifestation in summer exploits weak Wood. I argue wind connects to Lung; when Wood is peak and Earth weak, it should manifest in spring, not summer. Summer Fire governs, nourishing Earth; why manifest when Earth is nourished rather than weakened? This logic fails.)
Summerheat is summer's command. Summer infection, if not immediate, persists to autumn, combined with wind/cold, causing nujie. Cold is winter's command. Winter infection, if not immediate, persists to spring. Body Yang is initially constrained by cold, unable to rise gradually, but must emerge with the season, causing wenbing. Regarding autumn dampness timing, discussed above. Previous chapter mentions cough/weijue without "delayed," seeming immediate. But listed with wind/heat/cold, it cannot be solely immediate. Lacking explicit text, I dare not equate it to winter onset. Although dampness is Changxia's command, encroaching on autumn, even immediate onset is close to delayed. We discuss autumn onset. Dampness enters from below, affecting Lung causing cough (upward rebellion). Lung governs Qi; disease prevents Qi distribution. Dampness stagnates in collaterals, causing limb flaccidity/cold. Later chapter mentions winter cough, explicitly delayed, differing from previous. Dampness lingers, winter cold arrives. Lung dislikes cold and gets injured; dampness invades vacuity, causing cough. Seek this intent to understand.
Some see "bi" (must) in Suwen regarding wenbing/nujie and treat it as absolute law. Alas! Is it truly absolute? Suwen uses "bi" sometimes, not others, avoiding rigidity. (Those sticking to "bi" insist winter cold causes spring disease, ignoring immediate cases, losing essence for details.) Classics often seem absolute but aren't. E.g., hot jue from drunkenness/sex leads to heat center/xiao zhong in rich people; headwind after washing causes shoufeng. Are these universal? Readers must be flexible, not rigid. Wang Bing's notes, though rigid on "bi" and missing intent, are not too far. Cheng Wuji is farther but acceptable. Wang Haizang goes too far, seeking novelty, resulting in forced interpretations contradicting the classic, like "scouts wandering far without return."
Critiquing Cheng Wuji: He says wind excess causes extremity diseases, rain excess causes diarrhea. "Should" implies certainty. Spring wind + summer Yang prevents outward release, attacking inward causing sunxi. Plausible. But classics say "Wood moves anytime." If wind injures other seasons without summer Yang, will it move out or in? Wind is Yang, same as summer; if moving out, it follows dispersion. Why not? Wind changes rapidly; diseases vary, not just limbs. Rain excess causing diarrhea is equally flawed. Nujie from summer heat/autumn wind: heat hides in skin/intestines, autumn wind triggers it. See *Nu Jie Lun*. Irrelevant to summer Yin/autumn Yang dynamics. Wenbing from winter cold/spring: cold toxin traps Yang in skin. Spring Yang releases trapped Yang, causing disease. (Han Zhihe says winter cold traps Yang, spring re-injury triggers it. I say this only fits wenbing with aversion to cold. Zhang Zhongjing: Taiyang disease without fever/thirst/aversion is wenbing.) See *Shanghan Lun*. Irrelevant to winter Yang/spring Yin dynamics.
Wang Haizang claims spring/summer/winter injuries are "season injures command," autumn dampness is "command injures season." He argues spring executes winter command (cold restrains warmth); summer heat is late summer damp-earth, Sovereign Fire denies child, stopping damp-heat; autumn dampness is Changxia invading autumn; winter executes spring command (Fire wins/Water loses, great cold returns to spring, Yang leaks/Kidney Water deficits). He claims wenbing is damp-heat cooperation and all four injuries involve mother hyperactivity harming son. How fragmented and verbose! Classics speak of wind/summerheat injury as humans being injured, never "season/command" inversion. If Wang's view held, how to interpret *Nu Jie Lun*'s "summer heat, autumn wind"? Would they fit his theory? Summerheat is summer command; calling it late summer damp-earth is bizarre. If winter executed spring command, it would be winter-wenbing, not spring-wenbing. If great cold didn't return to spring, would spring-wenbing not occur? Spring-wenbing is common, not always preceded by great cold.
Classic says: "Hyperactivity causes harm, succession brings control." Meaning: extreme hyperactivity invites the conquering element to control. Fire extreme invites Water. "Below Minister Fire is Water succession; below Water level is Earth succession." Conqueror is successor. Wang makes hyperactivity Mother, succession Son. Does he seek to surpass the classic or fail to understand? He calls controller "conquered" and controlled "unconquered," reversing the classic's "excess controls conquered, insults unconquered; transmits to conquered, dies by unconquered." I ignore his convoluted "season/command" theories. I criticize predecessors not for love of debate, but to prevent harm to great principles and misleading future generations. I accept blame for overstepping, awaiting readers' judgment.