或问∶人之病何者为多?予曰∶火热为多。如病机十九条,火居其五,热居其四。凡人
毛窍
三千六百,窍窍通气,气即火也。(《内经》气有余便是火。)若感风寒,毛窍闭塞,气不得
泄,便郁而成火,所谓人伤于寒,则病热也。若感暑感燥,暑即火而兼湿,燥即火在其中,
故人感六淫,皆为热病。更脏腑中各有少火,少火生气为无病。一脏失调,一腑气逆即郁滞
,少火变为壮火,壮火食气则病。故外之六淫,内之脏腑,违之则皆化火而病生矣。岂非
火热为多乎?问∶病既火热为多,何温热之药,补益之方,方书并载,未曾独多寒凉耶?答曰
∶壮火食气,久则为虚为寒。(气少故也。)或过用寒凉,或禀气素弱,或命门火衰,或劳倦
内
伤,或寒邪直犯脏腑。如此等症,自然要用温热补益耳。治火诸法,条述于后。风寒初感,
火未甚郁者用辛散,已愈者用辛凉,半表半里者用和解,表邪未祛而里症又急者用双解。表
邪已尽,惟内有实热者,或清或下。感暑湿者清而利之,暑兼风者散而清之,湿热者苦辛淡
分消之,感燥者清而兼润之。脏腑郁火为病者,心郁则泻之,肝郁则疏之,脾郁则夺之,肺
郁则散之,肾郁则泄之。其六腑郁火,各从其类而治之。
风寒之中人也,始则皮毛,肺应之,为喷嚏恶风,鼻出清涕,肌肤烘热,咳嗽咽痛,甚
则发
疹,继逼腠理。肺与胃应之,为恶寒头痛,身热咳嗽,纳食无味,甚则为斑为疹;渐浸肌肉
,胃应之,为舌黄口渴壮热,口中气秽,不思纳食,形体牵滞,卧不安寐,甚则发斑。及至
半表半里,则为口苦胁痛,往来寒热,心烦喜呕,不欲纳入,甚则壮热谵语。夫风寒之中人
也,由浅而深;其为病也,亦由轻而重,总不外火郁二字。至郁久而为毒,此毒非鸩酒蛇泥
也,乃人自家正气,被外邪所逼,一步退一步,始于皮毛,及至脏腑;始于一星,终于燎原
,荧荧不灭,炎炎奈何?今详述明晓,俾患者早为疗治,咸登寿域焉尔。
有人问:人的疾病中,哪一种最多?我回答说:火热病最多。比如《内经》中的病机十九条,火邪占了五条,热邪占了四条。凡人的毛孔有三千六百个,每个孔窍都通气,气就是火。(《内经》说:气有余便是火。)如果感受风寒,毛孔闭塞,气不能宣泄,就会郁结而变成火,这就是所说的人受寒邪侵袭,就会患热病。如果感受暑邪或燥邪,暑邪就是火兼夹湿邪,燥邪中本身就含有火,所以人感受六淫(风、寒、暑、湿、燥、火六种外感病邪),都会成为热病。再加上脏腑中各有“少火”,少火能化生元气,这是无病的状态。一旦某一脏功能失调,某一腑气机逆乱导致郁滞,少火就会变成“壮火”,壮火会消耗元气,从而产生疾病。所以,外感的六淫和内伤的脏腑,违背了正常规律,都会化火而导致疾病发生。这难道不是火热病居多吗?
又问:既然火热病最多,为什么医书里温热的药物和补益的方剂记载得很多,并没有特别偏重寒凉药呢?回答说:壮火会消耗元气,时间久了就会导致虚证和寒证。(这是因为元气不足的缘故。)或者是因为过度使用寒凉药物,或者因为先天禀赋虚弱,或者因为命门火衰,或者因为劳倦内伤,或者因为寒邪直接侵犯脏腑。像这样的病症,自然需要使用温热补益的药物来治疗。关于治疗火的各种方法,在后面详细叙述。风寒初感,火邪尚未严重郁结的,用辛散法;已经痊愈的(注:此处原文逻辑似有脱漏或指余邪未尽/轻症,依文意译为针对已愈或轻浅者,但结合上下文“已愈者用辛凉”可能指表证已解但余热未清或轻症,按字面直译),用辛凉法;处于半表半里的,用和解法;表邪未除而里证又急迫的,用双解法。表邪已经完全去除,只有内有实热的,或用清热法,或用攻下法。感受暑湿的,用清利法;暑邪兼夹风邪的,用散清法;湿热证的,用苦辛淡味分消法;感受燥邪的,用清润法。脏腑郁火致病的,心经郁火则泻之,肝经郁火则疏之,脾经郁火则夺之(注:夺指祛除、削弱),肺经郁火则散之,肾经郁火则泄之。至于六腑的郁火,各自根据其所属类别进行治疗。
风寒邪气侵入人体,开始是在皮毛,肺与之相应,出现打喷嚏、怕风、流出清鼻涕、肌肤烘热、咳嗽咽痛等症状,严重的甚至出疹子,接着邪气逼迫腠理。肺与胃与之相应,出现怕冷头痛、身体发热咳嗽、进食无味,严重的会出现斑点和疹子;逐渐浸淫到肌肉,胃与之相应,出现舌苔黄、口渴、高热、口中气味秽浊、不想吃东西、身体沉重僵硬、睡眠不安,严重的甚至发斑。等到邪气进入半表半里,就会出现口苦、胁痛、忽冷忽热、心烦喜呕、不想进食,严重的甚至高热说胡话。风寒邪气侵入人体,是由浅入深;它导致的疾病,也是由轻变重,总离不开“火郁”这两个字。至于郁积久了变成毒,这个毒并不是鸩酒蛇泥那样的剧毒,而是人自身的正气,被外邪逼迫,一步步后退,从皮毛开始,直到脏腑;从星星之火开始,最终变成燎原大火,小火不灭,大火奈何?现在详细阐述明白,使患者能够尽早治疗,都能达到长寿健康的境界。
A question was asked: "Among human diseases, which type is the most common?" I replied: "Fire-heat diseases are the most common. For instance, in the Nineteen Pathogenesis Mechanisms (Bing Ji Shi Jiu Tiao) of the *Neijing* (Classic of Internal Medicine), fire accounts for five items, and heat accounts for four. Every person has 3,600 hair follicles (Mao Qiao), each allowing Qi to circulate; Qi is essentially Fire. (*Neijing* states: 'When Qi is in excess, it becomes Fire.') If one contracts Wind-Cold, the hair follicles become closed, preventing Qi from venting, leading to stagnation that transforms into Fire. This is what is meant by 'when humans are injured by Cold, they develop Heat diseases.' If one contracts Summer-heat or Dryness, Summer-heat is Fire combined with Dampness, and Dryness contains Fire within it. Therefore, when humans contract the Six Excesses (Liu Yin, i.e., Wind, Cold, Summer-heat, Dampness, Dryness, and Fire), all result in Heat diseases. Furthermore, each Zang-Fu organ possesses 'Lesser Fire' (Shao Huo); Lesser Fire generates Qi, which indicates a state of health. However, if one Zang becomes dysfunctional or one Fu experiences rebellious Qi causing stagnation, Lesser Fire transforms into 'Greater Fire' (Zhuang Huo). Greater Fire consumes Qi, leading to disease. Thus, both external Six Excesses and internal Zang-Fu disorders, when deviating from normalcy, transform into Fire, giving rise to illness. Is this not proof that Fire-heat diseases are predominant?
Another question arose: "Since Fire-heat diseases are so common, why do medical texts record numerous warm-natured herbs and tonifying formulas, without specifically emphasizing cold-natured ones?" The answer is: "Greater Fire consumes Qi; prolonged exposure leads to Deficiency and Cold conditions (due to insufficient Qi). Additionally, excessive use of cold-natured medicines, innate constitutional weakness, decline of Mingmen Fire (Gate of Life Fire), internal injury from overwork and fatigue, or direct invasion of Cold pathogens into the Zang-Fu organs can occur. In such cases, warm-natured and tonifying treatments are naturally required. Various methods for treating Fire are detailed below. For initial contraction of Wind-Cold where Fire is not severely stagnant, acrid-dispersing methods are used; for those already recovered (or mild residual cases), acrid-cooling methods are used; for conditions at the Shaoyang level (Half-Exterior Half-Interior), harmonizing methods are used; for cases where exterior pathogens remain but interior symptoms are urgent, dual-release methods are used. Once exterior pathogens are completely expelled and only interior Excess-Heat remains, clearing or purging methods are employed. For Summer-heat and Dampness, clearing and draining methods are used; for Summer-heat combined with Wind, dispersing and clearing methods are used; for Damp-Heat, bitter, acrid, and bland methods are used to separate and eliminate it; for Dryness, clearing and moistening methods are used. For diseases caused by stagnant Fire in the Zang organs: Heart stagnant Fire is drained, Liver stagnant Fire is dispersed, Spleen stagnant Fire is subdued/removed, Lung stagnant Fire is scattered, and Kidney stagnant Fire is excreted. For stagnant Fire in the Fu organs, treatment follows their respective categories.
When Wind-Cold invades the human body, it first affects the skin and hair, corresponding to the Lungs. Symptoms include sneezing, aversion to wind, clear nasal discharge, burning sensation on the skin, cough, and sore throat; severe cases may present with rashes. Subsequently, the pathogen forces its way into the Cou Li (interstices). The Lungs and Stomach respond, presenting with aversion to cold, headache, fever, cough, loss of taste, and in severe cases, macules and rashes. As it gradually infiltrates the muscles, the Stomach responds, presenting with yellow tongue coating, thirst, high fever, foul breath, anorexia, bodily heaviness and stiffness, insomnia, and in severe cases, macules. When the pathogen reaches the Half-Exterior Half-Interior stage, symptoms include bitter taste, hypochondriac pain, alternating chills and fever, irritability, frequent vomiting, reluctance to eat, and in severe cases, high fever with delirium. The invasion of Wind-Cold proceeds from shallow to deep; the resulting diseases progress from mild to severe. Ultimately, it does not exceed the concept of 'Fire Stagnation.' If stagnation persists for a long time, it turns into 'Toxin.' This toxin is not like poisonous wine or snake venom; rather, it is the body's own Righteous Qi (Zheng Qi) being forced back by external pathogens, retreating step by step. It starts at the skin and hair, progressing to the Zang-Fu organs; starting as a spark, ending as a prairie fire. If the small fire is not extinguished, how can the great fire be managed? Now, I explain this in detail so that patients may seek treatment early and attain longevity and health."