疏五过论云。尝贵后贱。虽不中邪。病从内生。名曰脱营。镇阳有一士人。躯干魁梧而意气雄
豪。喜交游而有四方之志。年逾三旬。已入任至五品。出入从骑塞途。姬侍满前。饮食起居。无不
如意。不三年。以事罢去。心思郁结。忧虑不已。以致饮食无味。精神日减。肌肤渐至瘦弱。无如
之何。遂耽嗜于酒。久而中满。始求医。医不审得病之情。辄以丸药五粒。温水送之。下二十余
行。时值初秋。暑热犹盛。因而烦渴。饮冷过多。遂成肠鸣腹痛而为痢疾。有如鱼脑。以至困笃。
命予治之。诊其脉乍大乍小。其证反复闷乱。兀兀欲吐。叹息不绝。予料曰。此病难治。启玄子云
。神屈故也。以其贵之尊荣。贱之屈辱。心怀慕眷。志结忧惶。虽不中邪、病从内生。血脉虚减。
名曰脱营。或曰。愿闻其理。黄帝针经有曰。宗气之道。纳谷为宝、谷入于胃。乃传之脉。流溢
于中。布散于外。精专者行于经隧。终而复始。常营无已。是为天地之纪。故气始从手太阴起。注
于阳明。传流而终于足厥阴。循腹里。入缺盆。下注肺中。于是复注手太阴。此营气之所行也。故
日夜气行五十营。漏水下百刻。凡一万三千五百息。所谓变通者并行一数也。故五十营备。得尽天
地之寿矣。今病者始乐后
苦。皆伤精气。精气竭绝。形体毁阻。暴喜伤阳。暴怒伤阴。喜怒不能自节。盖心为君主。神明出
焉。肺为相辅。主行荣卫。制节由之。主贪人欲。天理不明。则十二官相使。各失所司。使道闭塞
而不通。由是则经营之气脱去。不能灌溉周身。百脉失其天度。形乃大伤。以此养生则殃。何疑之
有焉。
《素问·疏五过论》中说：“曾经显贵后来地位低下，虽然未受外邪侵袭，但病从内生，名叫脱营。”镇阳有一位读书人，身材魁梧，意气风发，喜欢交游且胸怀四方大志。年过三十，已担任官职至五品，出门时随从骑兵马蹄塞满道路，姬妾侍奉在侧，饮食起居，无不如意。不到三年，因事被罢免。心中思绪郁结，忧虑不止，导致饮食无味，精神日渐减退，肌肤逐渐瘦弱，无可奈何。于是沉迷于饮酒，久而久之导致中焦胀满，才开始求医。医生不审察得病的实情，就随意用五粒丸药，温水送服，导致腹泻二十多次。当时正值初秋，暑热依然旺盛，因此出现烦渴，因饮用冷饮过多，遂形成肠鸣腹痛并患上痢疾，大便状如鱼脑，以至于病情危重，性命垂危，请求我诊治。诊察其脉象忽大忽小，症状反复出现胸闷烦乱，头晕恶心欲吐，叹息声不绝于耳。我推测说：“此病难治。”启玄子（王冰）说：“这是神气受损的缘故。”因为他曾享有尊贵荣耀，后遭受屈辱，心中眷恋旧日荣华，志向受阻，忧愁惶恐。虽然未受外邪侵袭，但病从内生，血脉虚弱减少，名叫脱营。有人问：“愿听其道理。”《黄帝针经》中说：“宗气的运行之道，以水谷精微为宝贵。食物进入胃中，然后传注于脉，流溢于体内，布散于体外。其中精纯专一的部分行于经脉隧道，循环往复，常营无休，这就是天地运行的纲纪。所以气开始从手太阴肺经起，注入阳明经，流传终于足厥阴肝经，循行腹部内侧，进入缺盆，向下注入肺中，于是又回流注入手太阴肺经。这就是营气运行的路径。所以日夜之间气行五十周，漏壶滴水一百刻，共一万三千五百息。所谓变通者，是并行于一数之中。所以五十周营气完备，就能享尽天年的寿命了。”现在的病人起初快乐后来痛苦，都损伤精气。精气枯竭断绝，形体毁坏阻滞。暴喜损伤阳气，暴怒损伤阴气，喜怒不能自我节制。心为君主之官，神明由此而出；肺为相傅之官，主行营卫之气，制约节度由它决定。如果贪恋人欲，天理不明，则十二脏腑相互使令，各自失去职能，使得气道闭塞不通。因此经营之气脱失，不能灌溉周身，百脉失去正常的规律，形体受到严重伤害。用这种状态来养生，必然招致灾祸，有什么可怀疑的呢？
The *Suwen: Treatise on the Five Negligences* states: "One who was once noble but later became lowly, although not struck by external pathogens, develops disease from within, named *Tuoying* (Depletion of Ying Qi)." In Zhenyang, there was a scholar. He had a robust physique and heroic spirit, enjoyed socializing, and harbored ambitions for the four corners of the world. Over thirty years old, he held an official rank of the fifth grade. When going out or coming in, his retinue filled the road; concubines attended to him before and after. His diet and daily life were entirely satisfactory. Within less than three years, he was dismissed due to some matter. His thoughts became depressed and knotted, with endless worry and anxiety. This led to a loss of taste in food, a daily decline in spirit, and gradually emaciated skin and muscles. Having no way to remedy this, he indulged in alcohol. After a long time, he developed abdominal fullness in the middle jiao, at which point he sought medical treatment. The physician did not carefully ascertain the condition of the illness and arbitrarily administered five pills, taken with warm water, resulting in more than twenty episodes of diarrhea. At that time, it was early autumn, and summer heat was still prevalent. Consequently, he experienced irritability and thirst. Drinking excessive amounts of cold liquids, he subsequently developed borborygmus (intestinal rumbling) and abdominal pain, leading to dysentery. His stool resembled fish brains. His condition became critical and severe, prompting him to request my treatment. Upon palpating his pulse, it was intermittently large and small. His symptoms included recurrent chest oppression, mental confusion, persistent dizziness and nausea, and unceasing sighing. I deduced: "This disease is difficult to treat." Qixuanzi (Wang Bing) stated: "It is due to the depletion of Shen (Spirit)." Because he had enjoyed high status and honor, but later suffered humiliation, his heart remained attached to past glory, his will was constrained, and he was filled with sorrow and fear. Although not struck by external pathogens, the disease arose from within, causing blood vessels to become deficient and reduced, named *Tuoying* (Depletion of Ying Qi). Someone asked: "I wish to hear the reasoning behind this." The *Huangdi Zhenjing* (Yellow Emperor's Classic of Acupuncture) states: "The pathway of Zong Qi (Gathering Qi) treasures grain as its essence. Grain enters the stomach, then transmits to the vessels, overflowing internally and spreading externally. The pure and specialized portion travels through the meridians and collaterals, completing cycles endlessly, constantly nourishing without rest. This is the principle of Heaven and Earth. Thus, Qi begins at the Hand-Taiyin Lung Meridian, flows into the Yangming, circulates and terminates at the Foot-Jueyin Liver Meridian, follows the interior of the abdomen, enters the supraclavicular fossa (Quepen), descends into the lungs, and then re-enters the Hand-Taiyin Lung Meridian. This is the pathway of Ying Qi (Nutritive Qi). Therefore, Qi circulates fifty times during day and night, corresponding to one hundred ke (water clock units) and 13,500 breaths. The so-called variations and adaptations operate within this single numerical system. When the fifty circuits of Ying Qi are complete, one can attain the natural lifespan." Now, this patient transitioned from joy to suffering, both damaging Jing Qi (Essence-Qi). When Jing Qi is exhausted and severed, the physical form is damaged and obstructed. Sudden joy damages Yang Qi; sudden anger damages Yin Qi. If one cannot regulate joy and anger, it leads to imbalance. The Heart is the Sovereign Monarch, from whom Shen (Spirit) emerges. The Lungs are the Minister and Assistant, governing the circulation of Ying and Wei (Defensive) Qi, providing regulation and restraint. If one indulges in human desires while neglecting Heavenly Principles, the twelve organs lose their respective functions. The pathways of Qi become blocked and obstructed. Consequently, the circulating and managing Qi departs, unable to irrigate the entire body. The hundred vessels lose their natural rhythm, and the physical form suffers severe injury. To maintain health under such conditions inevitably leads to disaster. What doubt could there be?