至元己巳上都住。夏月。太保刘仲晦使引进史柔明来曰。近一两月。作伴数人。皆有淋疾。是
气运使然。是水土耶。予思之。此间别无所患。此疾独公所有之。殆非运气水土使然。继问柔明近
来公多食甚物。曰。宣使赐木瓜百余对。遂多蜜煎之。每客至以此待食。日三五次,予曰。淋由此
也。内经曰。酸多食之令人癃。可与太保言之。夺饮则已。一日。太保见予问曰。酸味致淋。其理
安在。予曰。小便主气。针经云。酸入于胃。其气涩以收。上之两焦。弗能出入也。不出则留胃中
。胃中和温则下注膀胱之胞。胞薄以懦。得酸则缩绻。约而不通。水道不行。故癃而涩。乃作淋也
。又曰。阴之所生。本在五味。阴之五宫。伤在五味。五味口嗜而欲食之。必自裁制。勿使过焉。
五味过则皆能伤其正。岂止酸味耶。太保欢曰。凡为人子不可不知医。信哉。
刑部侍郎王立甫之婿。发二十五岁。至元丁卯十一月间。困劳役忧思烦恼。饮食失节而病。时
发躁热。肢体困倦。盗汗湿透其衾。不思饮食。气不足一息。面色青黄不泽。请予治之。具说前证。
诊其脉。浮数而短涩。两寸极小。予告曰。此危证也。治虽粗安。至春必死。当令亲家知之。夫
人不以为然。遂易医。至正月躁热而
卒。异日。立甫同外郎张介夫来谓予曰。吾婿果如君言。愿闻其理。予曰。此非难知也。内经曰。
主胜逆。客胜从。天之道也。盖时令为客。人身为主。冬三月人皆惧寒。独渠躁热盗汗。是令不固
其阳。时不胜其热。天地时令。尚不能制。药何能为。冬乃闭藏之月。阳气当伏于九泉之下。至春
发为雷。动为风。鼓坼万物。此奉生之道也。如冬藏不固。则春生不茂。又有疫疠之灾。且人身阳
气。亦当伏潜于内。不敢妄扰。无泄皮肤。使气亟夺。此冬藏之应也。令婿汗出于闭藏之月。肾水
已涸。至春何以生木。阳气内绝。无所滋荣。不死何待。二君乃叹息而去。
至元己巳年,我居住在上都。夏季,太保刘仲晦派遣引进官史柔明前来对我说:“最近一两个月,与我结伴的几个人都患上了淋病(小便频数短涩、滴沥刺痛、欲出未尽的病证)。这是气候运气导致的吗?还是水土的原因呢?”我思考后认为,这里并没有其他特别的病患,唯独这位公侯患有此疾,恐怕不是气候运气或水土造成的。接着我问史柔明,近来太保多吃了什么食物?史柔明回答说:“宣使赐给了太保一百多对木瓜,于是用蜂蜜煎制保存。每当有客人到来,就用这来招待食用,每天吃三到五次。”我说:“淋病就是由此引起的。《内经》说:‘酸味吃得过多会使人发生癃闭(小便不通)’。您可以把这个道理告诉太保,只要停止饮用蜜渍木瓜即可。”
有一天,太保见到我问:“酸味导致淋病,其中的原理是什么?”我回答说:“小便的通利依赖于气的运行。《针经》说:‘酸味进入胃中,其气性涩且具有收敛作用,向上到达上焦和中焦,无法自由出入。’如果不出入流通,就会滞留于胃中。胃中的温和之气将其向下输送到膀胱的胞宫(此处指膀胱及其功能系统)。膀胱壁薄而柔弱,遇到酸味就会收缩卷曲,约束而不通畅,水道因此不能通行,所以发生癃闭且伴有涩痛,这就形成了淋病。”我又说:“阴精的生成,根本在于五味;五脏(阴之五宫)的伤害,也在于五味。虽然口中嗜好某种味道想要食用,但必须自我节制,不要过量。五味如果过量,都会损伤人体的正气,难道仅仅是酸味吗?”太保高兴地说:“作为人子不可不懂医学,这话真是可信啊。”
刑部侍郎王立甫的女婿,当时二十五岁。在至元丁卯年十一月期间,因劳累役使、忧思烦恼,加上饮食不节而生病。时常发作躁热,肢体困倦乏力,盗汗湿透被褥,不想吃东西,气息微弱,不足一息即停,面色青黄无光泽。请我诊治。详细陈述了上述症状。诊察他的脉象,浮取数急而短促涩滞,两寸脉极小。我对他说:“这是危重的证候。即使治疗暂时稍有好转,到了春天必定死亡。应当让亲家知道这件事。”他的妻子不以为然,于是更换了医生。到了正月,患者因躁热而去世。
过了几天,王立甫同外郎张介夫来对我说:“我的女婿果然像您说的那样,希望能听听其中的道理。”我回答说:“这并不难理解。《内经》说:‘主胜为逆,客胜为从,这是天道的规律。’时令属于‘客’,人身属于‘主’。冬三个月人们都害怕寒冷,唯独他出现躁热和盗汗,这是因为不能固护体内的阳气,时令的寒邪不能胜过体内的热邪。连天地时令都不能制约这种状态,药物又能起什么作用呢?冬季是闭藏的季节,阳气应当潜伏在九泉之下,等到春天才发出来变成雷,动起来变成风,鼓动万物破裂生长,这是顺应生发的道理。如果冬天不能固藏,那么春天的生发就不会茂盛。此外还有疫疠灾害的可能。况且人身体的阳气,也应当潜伏在内,不敢妄自扰动,不要通过皮肤泄汗,使气机频繁耗夺,这才是顺应冬季闭藏的法则。现在您的女婿在闭藏的月份出汗,肾水已经枯竭,到了春天靠什么来生发肝木(水生木)呢?阳气在内已经断绝,没有滋生的荣养,不死还等待什么呢?”两位先生于是叹息着离开了。
In the year Jisi of the Zhiyuan era, I resided in Shangdu. During the summer, Liu Zhonghui, the Taibao (Grand Protector), sent Shi Rouding, an introduction official, to come and tell me: "For the past one or two months, several companions have all suffered from Lin disease (a syndrome characterized by frequent, short, scanty, painful, and incomplete urination). Is this caused by the climatic fortune (Yunqi) or the local water and soil conditions?" I pondered this and thought that there were no other special illnesses here, yet only this nobleman suffered from this malady; it was likely not due to climatic fortune or water and soil. I then asked Shi Rouding what the Taibao had been eating excessively lately. He replied: "The Xuan Shi (Envoy) bestowed over a hundred pairs of papayas upon the Taibao, which were then preserved by candying them with honey. Whenever guests arrived, this was served as a treat, consumed three to five times daily." I said: "The Lin disease arises from this. The *Neijing* states: 'Excessive consumption of sour flavors leads to Long Bi (urinary retention/obstruction).' You may convey this reasoning to the Taibao; the condition will cease if he stops consuming the honey-candied papaya."
One day, the Taibao came to ask me: "What is the rationale behind sour flavors causing Lin disease?" I answered: "The patency of urination depends on the movement of Qi. The *Zhenjing* (Needle Classic) says: 'When sour flavor enters the stomach, its Qi is astringent and contracting, reaching the Upper and Middle Jiao, where it cannot freely enter or exit.' If it does not circulate, it remains stagnant in the stomach. The warm Qi of the stomach directs it downward into the bladder's Bao (bladder/cyst). The wall of the Bao is thin and fragile; upon encountering sourness, it contracts and curls, becoming constricted and obstructed, causing the water passages to fail to flow. Thus, Long Bi occurs accompanied by astringency and pain, forming Lin disease." I further stated: "The generation of Yin essence fundamentally lies in the Five Flavors; the injury to the Five Zang Organs (the palaces of Yin) also stems from the Five Flavors. Although the mouth craves and desires to eat certain flavors, one must exercise self-restraint and avoid excess. If any of the Five Flavors are taken in excess, they can all damage the body's Righteous Qi (Zheng Qi); why should it be limited only to sour flavors?" The Taibao rejoiced and said: "It is indispensable for a son to understand medicine. This is truly credible."
The son-in-law of Wang Lifu, Vice Minister of the Ministry of Justice, was twenty-five years old. In November of the Dingmao year of the Zhiyuan era, he fell ill due to physical exhaustion from labor, worry, anxiety, and irregular diet. He frequently experienced irritability and heat, limb fatigue and lassitude, night sweats soaking his bedding, loss of appetite, and breath so weak that less than one breath sufficed. His complexion was greenish-yellow and lusterless. He requested my treatment. After detailing the aforementioned symptoms, I palpated his pulse: it was floating, rapid, short, and choppy, with the pulses at both Cun (inch) positions being extremely minute. I told him: "This is a critical syndrome. Even if treatment brings temporary relief, he will certainly die by spring. You should inform your relatives accordingly." His wife did not accept this view and changed physicians. By the first lunar month, the patient died due to irritability and heat.
Some days later, Wang Lifu and Zhang Jiefu, Wailang (External Director), came to me and said: "My son-in-law indeed passed away as you predicted. We wish to hear the reasoning." I replied: "This is not difficult to comprehend. The *Neijing* states: 'If the Host prevails, it is contrary (Ni); if the Guest prevails, it follows (Cong). This is the Way of Heaven.' Seasonal timing acts as the 'Guest,' while the human body acts as the 'Host.' During the three winter months, people generally fear cold; however, he alone exhibited irritability and night sweats. This indicates an inability to secure the Yang Qi within, such that the seasonal cold could not overcome the internal heat. Even the heaven-earth seasonal timing could not control this state, so how could medicine be effective? Winter is the season of closure and storage; Yang Qi should lie dormant deep underground, emerging in spring as thunder, moving as wind, stimulating the cracking open and growth of all things. This is the Dao of nourishing life. If winter storage is not secured, spring growth will not flourish. Furthermore, there may be disasters of epidemic pathogens. Moreover, the body's Yang Qi should also lie latent within, avoiding reckless disturbance, preventing sweat leakage through the skin which would cause frequent depletion of Qi. This is the correspondence to winter storage. Now, your son-in-law sweated during the month of storage, indicating that Kidney Water has already dried up. How can Liver Wood (Water generates Wood) be generated in spring? With internal Yang Qi severed and lacking nourishment, death is inevitable." The two gentlemen sighed and departed.