《素问·生气通天论篇》曰∶春伤于风，邪气留连，乃为洞泻；夏伤于暑，秋为 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，外散于筋脉故痿弱也。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》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，则当发为下痢。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。是以土乘木之分，
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，故水得以乘土之分。土者，坤也，坤在申之分，申为相火。水入
于土，则水火相干；水火相干则阴阳交急，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，水不足也；
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，无以滋生化之源，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？但在轻轻平易说去，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，岂能于未发之前须知其客于何经络、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
悟因病始知其原之理，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、头痛、
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，将发病于后耶？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。
请陈四气所伤所病之义。夫风者，春之令也。春感之，偶不即病而至夏，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，肠胃之职岂能从容
传化泌别而得其常乎？故水谷不及分别而并趋下以泄出也。其为飧泄亦类此义。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。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，出太远而无所归矣。姑摭成无己、王海藏之说，辨其甚者一二。
夫无已谓风淫末疾则当发于四肢，雨淫腹疾则当发为下痢。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，阳受其郁，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。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，安得为春温病欤？其谓大寒之令复行于春，
温病方作，杀是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，其义谓己亢极，则胜己者来制，如
火亢，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，皆是胜己者为承。
今以亢为母，承为子，将求胜于经欤？抑未达欤？又如制物者为所胜，受制者为所不胜，与经所
谓气有余则制己所胜而侮所不胜，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，固不暇悉辨也。
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
而僭逾之罪，固已自知其不得辞矣，但未知观者以为何如。（《溯洄集》）
支秉中曰∶春伤风，夏伤暑，秋伤湿，冬伤寒，此感疾之由也。曰飧泄，曰 疟，曰咳嗽，
曰病温，此已形之症也。盖人感四时之气，待时传变推迁，则所胜侮其所不胜，遂发为前症。如
人之元气本实，亦有过时而不发者矣。辩论已悉，愚不敢赘，但其所谓时伤令、令伤时之说，则
有间然矣。夫春夏秋冬，时也；温热凉寒，令也。如春宜温而寒，夏宜热而凉，秋宜凉而热，冬
宜寒而温，皆反其令之常为气之变也。人，触之，遂能成疾，岂时令有心于伤人哉？若谓时能伤
令，又谓令能伤时，则气相伤而天下之人将同日而俱病矣，有是理乎？
《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，到了秋季就会发生疟疾；秋季感受湿邪，湿气上逆导致咳嗽，进而引发痿厥（肢体痿软无力且手足逆冷）；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（指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，所以出现洞泄或飧泄。夏季暑热极盛，秋季燥热收敛，两热相争就形成疟疾。秋季湿气盛行，冬季水气旺盛，水湿相合，肺气又衰弱，所以湿气乘肺导致咳嗽。之所以发生痿厥，是因为湿气内攻脏腑则引起咳逆，外散于筋脉则导致肢体痿弱。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，阳气郁结于内，寒邪与郁阳相互搏结，所以发生温病。
《伤寒论》引用《素问》后篇的这八句话，成无己注释说：在春季之时，风气盛行。春季感受风邪，风气通于肝，肝气在春季正值旺盛，风邪虽然侵入，但不能立即发病。到了夏季，肝气衰退，风邪才开始发动。风邪淫溢会导致四肢疾病，所以应当在四肢发作。但夏季阳气外盛，风邪不能向外发散，所以向内攻击而发生飧泄。在秋季之时，湿气盛行。秋季感受湿邪，湿气会损伤肺脏。肺脏在秋季正值旺盛，湿邪虽然侵入，但不能立即发病。到了冬季，肺气衰退，湿气才开始发动。雨湿淫溢会导致腹部疾病，所以应当发生下痢。但冬季阳气内固，湿气不能下行，所以上逆而成为咳嗽。在夏季之时，暑气盛行，夏季感受暑邪。夏季以阴为主在内，暑邪虽然侵入，势力尚不足以发动，等到秋季阴气外出而阳气主内时，暑邪才发动并与阴气搏结而形成疟疾。在冬季之时，寒气盛行，冬季感受寒邪。冬季以阳为主在内，寒邪虽然侵入，势力尚不足以发动，等到春季阳气外出而阴气主内时，寒邪才发动并与阳气搏结而形成温病。
王海藏说：木对应季节为春，对应人体为肝，对应天象为风。在春季之时，本应是温暖的时令，反而被寒冷抑制，这是三个月的春天行走了三个月冬天的命令。由此可知水气太过。水气既然太过，金气肃杀更加严厉，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。所胜者乘虚妄行，那么木气显然虚弱。木气既已虚弱，火令不及，这是所生者（木生火）受病，所以所不胜者（水克木，此处指水反侮木或水气过亢）来欺侮它。因此土气乘袭木气的部位，变化为飧泄。之所以病症在夏季发作，是因为木气在夏季绝灭，而土气在夏季旺盛，湿本来具有下行的性质，所以如此。不在春季发病，是因为春季时节风虽有伤，但木气实际当权，所以能抵御。暑对应季夏，季夏对应湿土。君火持有权柄，不给其子（土生金，此处逻辑较复杂，意指火不生土或土不受制），暑湿的命令不能施行，湿令不行则土气亏损。所胜者妄行，木气太过，少阳旺相。所生者受病，则肺金不足。所不胜者欺侮它，所以水得以乘袭土气的部位。土对应坤卦，坤对应申位，申对应相火。水进入土中，则水火相干；水火相干则阴阳交争急迫，所以表现为寒热往来。兼有木气终见三焦，这是少阳相火的合象。少阳位于湿土的部位，所以表现为寒热往来。肺金不足，表现为洒淅恶寒发热，这些都是往来不定的气机，所以称为疟疾。不在夏季发作而在秋季发作，是因为湿热在酉位，方才得其权柄的缘故。秋季是清肃之气，具有收敛下行的性质。被湿邪所伤，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制金。心火既已刑克肺金，所以肺气上逆而咳嗽。所不胜者欺侮它，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，与脾土湿热相合成为疾病，因为咳嗽而动及脾之湿，所以咳嗽有声且有痰涎。不在秋季发作而在冬季发作，是因为六阴至极，肃杀之气始得其势的缘故。冬季感受寒邪，是冬季行春季的命令，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，水不足；所不胜者欺侮它，火太过。火土合德，湿热相助，所以发生温病。不在冬季发病而在春季发病，是因为寒水居于卯位，方才得其权柄，大寒的命令重新在春季施行，腠理开泄，少阴不藏，房劳损伤，辛苦之人阳气泄露于外，肾水亏损于内。在春季月份，时令强盛的木气生长，无法滋养生化之源，所以发生温病。
凡是说“春伤于风”、“夏伤于暑”、“冬伤于寒”，辞理都顺承，这里的“时”字即“令”字。唯独“秋伤于湿”，解释为“令”字伤“时”字，读者不要怀疑。这四种说法都是母气亢盛而伤害其所承继的子气。如果说“秋”字伤“湿”字，其文句与前三句相通，但其道理和法则就不能相通了。大体上道理和法则是相通的，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，那就只应当头痛、恶风、自汗，为什么说夏季会飧泄呢？现在说“春伤于风”，就是时令伤令的意思，已经很明白了。
我按语：对于这四伤，各家的注释都没有领会经典的本意，大概是因为推求太过分的缘故。孟子说：“道在近处却向远处寻求，事在容易却向困难处寻求”，说的就是这个吧？只要用轻浅平易的方式来说明，经典的本意自然明了，而没有穿凿附会的祸患了。为什么这样说？风、暑、湿、寒，是天地四时的气候。它们伤人，难道能在未发病之前就知道客居在哪条经络、哪个脏腑、哪个部分从而形成什么病吗？等到已经发病，然后可以诊察，才知道客居在某经络、某脏腑、某部分，形成某病罢了。注释的人如果领悟了因病才能知道病因的道理，那么对这四种伤害，不用费力就能迎刃而解了。
所谓的洞泄、疟疾、咳嗽与痿厥、温病，都是因为在其发作的时候，症状表现明显，于是逆向追溯才知道昔日的致病原因是伤风、伤暑、伤湿、伤寒而已，并不是在最初受伤的时候就能预定今天一定会得这种病。况且感受四时之气，有当时就发病的，有过时后才发病的，有过了很久才发病的，也有过时很久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不固定，以及正气的虚实不等的缘故。就拿伤风来说，当时发作，就会出现恶风、发热、头痛、自汗、咳嗽、喘促等疾病；过时或很久后发作，就会出现疠风、热中、寒中、偏枯、五脏之风等疾病。那么洞泄、飧泄，只是过时发作中的一种疾病罢了。因为产生了洞泄、飧泄的病，根据症状表现推断，就知道是因为春季伤风，邪气藏蓄不散而导致此病。如果洞泄、飧泄的病没有产生，谁能知道之前已经伤风，将要发病在后头呢？假如过时很久，自行消散而不成为疾病，人们又能知道吗？世上有太素脉法，虽然或许能预知死亡的时间，但这也是因为诊断征象明显之后才能知道的。夏季伤暑导致疟疾，冬季伤寒导致温病，意思也与此类似。但是秋季伤湿导致上逆咳嗽、痿厥，其因病知原的道理，与上述三者相同；但其令行于时的情况，则与三者不同。春天的风、夏天的暑、冬天的寒，都是本时令的气候。湿却是长夏时令的气候，为什么要在秋天谈论呢？大概春夏冬每一个季节各有三个月，所以它们的命令也都各自在本时令运行，而长夏则寄旺在六月这一个月里。秋天虽然也有三个月，但长夏的湿令常常侵犯超过秋天而运行，所以说“秋伤于湿”。
请陈述四气所伤致病的意义。风，是春季的命令。春季感受它，偶然没有立即生病而到了夏季，邪气既然没有消散，就必然成为疾病。之所以成为洞泄，是因为风大概是天地间浩荡的气，飞扬鼓舞，神速不定。人身如果有这种气，肠胃的职责怎么能从容地传导、化泌、分别而保持常态呢？所以水谷来不及分别而一起趋向下方排出体外。飧泄也是类似的道理。暑，是夏季的命令。夏季感受它，偶然没有立即发作而到了秋季，又受到风和寒的伤害，所以成为疟疾。寒，是冬季的命令。冬季感受它，偶然没有立即发作而到了春季，身体中的阳气，虽然开始被寒邪郁遏，不能顺应其逐渐升发的本性，但也一定要应时而出，所以发生温病。至于秋季伤湿，其令行于时的意义，上文已经讨论过了。前篇所说的“上逆而咳，发为痿厥”，没有说过时，似乎是当时就发作的，但既然与风、暑、寒三者并列言说，那么这难道能单独认为是即时发作的吗？然而经文没有明文，终究不敢等同于后篇，便断然认为是在冬季发病。虽然如此，湿本是长夏的命令，只是侵犯超过了秋天罢了。即使是即时发作，也接近于过时发作的情况了。这里应当只以秋季发病来论述。湿从下部受邪，所以干扰肺脏导致咳嗽，称为上逆。肺是各种气的主宰，现在既有病，气就不能向外运化，加上湿气阻滞经络，所以四肢痿弱无力，或者厥冷。后篇所说的“冬季生咳嗽”，既然说过时，那么与前篇的意义颇不相同了。湿气长久客居不散，到了冬季寒气大行，肺恶寒而可能受伤，所以湿气得以乘虚上侵于肺，发生咳嗽。读者用这个意思去探求，经典的本意或许就明确了。
有人见到《素问》在论述温病、疟疾等病时，偶尔用“必”字，于是视为一定不变的言辞，说：“这是必然的道理。”唉！果真必然吗？果真不必然吗？《素问》有时说“必”，有时不说“必”，大概是不愿固执地定为一定不变的原因。经文中常有似乎一定不变的言论，却不可以作为一定不变来看待。比如说道：热厥是因为醉饱后入房得到的，热中、消中患者，都是富贵人，刚洗完头中风就会成为首风。像这样的例子，难道每一样都是这样吗？读者应当灵活理解，不要拘泥固执。
王启玄的注释，虽然不免拘泥于“必”字且未完全领会经旨，但还不算太远。至于成无己的说法，似乎就太远了，但还没有到极点。至于王海藏立论，则推求过分极端，想要与众不同，殊不知反而穿凿附会，违背经旨，有不可胜言的错误。这就是先儒所说的像大军派出游骑兵，出去太远而没有归宿。姑且摘录成无己、王海藏的说法，辨析其中严重的几点。
成无己认为风淫末疾则应当发作于四肢。我认为“则当”二字，是决然的语气。春季伤风，遇到夏季阳气外盛，而不能向外发散，所以向内攻击成为飧泄。这或许还可以讲通。经文说：木气发作没有固定时间。倘若风不是在春季受伤而是在其他时间受伤，没有遇到夏季阳气外盛，是将向外发散呢？还是向内攻击呢？况且风属阳，与夏季同气，如果真的想要外出，就应当随着其散越的趋势而出，哪里有不能的道理呢？而且风善行数变，其导致的疾病不止一种，难道仅仅只能导致四肢的疾病吗？所谓“雨淫腹疾”的意义，其不通畅也是如此。至于夏季伤暑，秋季成为疟疾，大概是因为暑邪潜伏在皮肤之内、肠胃之外，又感受秋季的风邪，所以疾病发作。看《素问·疟论》就可以明白。这与夏季阴主内、秋季阳主内、暑邪动而搏阴有什么关系呢？冬季伤寒，春季成为温病，大概是因为寒毒侵入人的肌肤，阳气受到郁遏，到了春季，天地的阳气向外发散，人体受郁的阳气也不能不出去，所以疾病发作。看《伤寒论》就可以明白。这与冬季阳主内、春季阴主内、寒邪动而搏阳有什么关系呢？
至于王海藏又以春季伤风、夏季伤暑、冬季伤寒为“时伤令”，秋季伤湿为“令伤时”。所以对于春季伤风，说是春季行冬季的命令，而温病被寒邪抑制。对于夏季伤暑，说是暑对应季夏，季夏对应湿土，君火持有权柄不给其子，所以暑湿的命令不能施行。对于秋季伤湿，说是秋季被湿邪所伤，是长夏之气不与秋令相应。对于冬季伤寒，说是冬季行春季的命令，火胜水亏，大寒的命令重新在春季施行，阳气外泄，肾水内亏而致病。又说温病是湿热相助而成，又说四季伤害都是母气亢盛而伤害所承继的子气。唉！多么支离破碎，徒费口舌如此！经书中所说的伤风、伤暑之类很多，都是以人感受风暑等邪气所伤为意义，从未有过时伤令、令伤时的意思。如果像王海藏所说，那么《疟论》所说的“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。况且暑是夏季的命令，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的命令，人如果感受这个，就成为冬温病了，怎么能成为春温病呢？他说大寒的命令重新在春季施行，温病才发作，那岂不是大寒的命令如果不重新在春季施行，温病本该发作的就不发作了吗？况且现在的春季患温病的比比皆是，未曾见到一定是由大寒重新在春季施行后才形成的。经文说：亢则害，承乃制，其意义是己气亢极，则胜己者来制约，如火亢，则水来制约。经文所说的相火之下，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，是想追求胜过经文呢？还是没有通达呢？又如制约物者为所胜，受制者为所不胜，与经文所说的气有余则制约自己所胜者而欺侮所不胜者，以及传变到自己所能胜者，死在自己所不胜者的旨意完全相反了。我对于因时伤令、令伤时之说委曲衍伸的解释，本来就没有空闲一一辨析。
唉！我并非喜欢指责前人的错误，而是因为他们的观点有害大义，遮蔽经典本意从而误导后人，所以不敢阿谀顺从而沉默不语。然而僭越冒犯的罪责，我自知无法推脱，只是不知道读者认为如何。（出自《溯洄集》）
支秉中说：春伤风，夏伤暑，秋伤湿，冬伤寒，这是感疾的原因。曰飧泄，曰疟疾，曰咳嗽，曰病温，这是已经显现的症状。大概人感受四时之气，等待时机传变推移，则所胜者欺侮其所不胜者，于是发作前述症状。如人的元气原本充实，也有过时而不发病的了。辩论已经详尽，我不敢多言，但他所说的时伤令、令伤时的说法，则有值得商榷之处。春夏秋冬，是时令；温热凉寒，是气候。如春季应当温暖却寒冷，夏季应当炎热却凉爽，秋季应当凉爽却炎热，冬季应当寒冷却温暖，都是违反常令的气候变异。人，触犯了这些，遂能成疾，难道是时令有心伤人吗？如果说时令能伤气候，又说气候能伤时令，那么气互相伤害，天下的人将同一天全部生病，有这样的道理吗？
The *Suwen* (Basic Questions), "Shengqi Tongtian Lun" chapter, states: If one is injured by wind in spring, the pathogenic factor lingers and leads to **dongxie** (severe diarrhea with undigested food); if injured by summerheat in summer, **maji** (malaria) will occur in autumn; if injured by dampness in autumn, it causes upward reversal leading to coughing and develops into **weijue** (flaccidity and cold extremities); if injured by cold in winter, **wenbing** (warm disease) will inevitably occur in spring.
The *Suwen*, "Yinyang Yingxiang Lun" chapter, states: If injured by wind in spring, **sunxie** (diarrhea with undigested food) occurs in summer; if injured by summerheat in summer, **maji** (malaria) inevitably occurs in autumn; if injured by dampness in autumn, coughing occurs in winter; if injured by cold in winter, **wenbing** (warm disease) inevitably occurs in spring.
Wang Qixuan commented: Wind attacks the exterior and corresponds internally to the Liver (*Gan*). Liver Qi overacts on the Spleen (*Pi*), hence **dongxie** or **sunxie**. Summer heat is extreme, and autumn dryness/heat contracts; the conflict of two heats results in **maji** (malaria). Autumn dampness prevails, and winter water qi flourishes; water and dampness combine, Lung (*Fei*) qi declines, so dampness attacks the Lung causing coughing. The development of **weijue** occurs because dampness attacks the Zang-Fu internally causing reverse coughing, and scatters externally into the sinews causing flaccidity. "Jue" refers to reversed Qi. Winter cold condenses, and spring Yang Qi emerges; if cold is not resolved, Yang becomes stifled internally. Cold and stifled Yang contend, resulting in **wenbing** (warm disease).
Cheng Wuji, commenting on these eight sentences from the *Suwen* quoted in the *Shanghan Lun* (Treatise on Cold Damage), stated: In spring, wind qi is prevalent. Spring injury by wind connects to the Liver. Liver Qi is prosperous in spring; although wind enters, it does not manifest immediately. By summer, Liver Qi declines, and the wind begins to move. 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 **sunxie**. In autumn, dampness is prevalent. Autumn injury by dampness dries/injures the Lung. Lung Qi is prosperous in autumn; although dampness enters, it does not manifest immediately. By winter, Lung Qi declines, and dampness begins to move. Rain/dampness excess causes abdominal diseases, so it should cause dysentery. However, in winter, Yang Qi is secured internally, preventing dampness from descending, so it reverses upward causing coughing. In summer, summerheat is prevalent. Summer injury by summerheat: Summer is Yin-dominated internally; although summerheat enters, its force cannot move. When autumn arrives, Yin moves out and Yang dominates internally, then summerheat moves and contends with Yin, causing **maji**. In winter, cold is prevalent. Winter injury by cold: Winter is Yang-dominated internally; although cold enters, its force cannot move. When spring arrives, Yang moves out and Yin dominates internally, then cold moves and contends with Yang, causing **wenbing**.
Wang Haizang said: Wood corresponds to Spring in time, Liver in humanity, and Wind in heaven. In spring, the warm command should prevail, but it is suppressed by cold; this means the three months of spring execute the commands of the three months of winter. Thus, Water Qi is excessive. Since Water is excessive, Metal's肃杀 (astringent/killing) nature is severe; the overcoming element acts recklessly. When the overcoming element acts recklessly, Wood Qi is clearly deficient. Since Wood is deficient, Fire command is insufficient; the generated element suffers disease, so the overcoming element (Water) insults it. Thus, Earth overacts on Wood's domain, transforming into **sunxie**. The disease manifests in summer because Wood perishes in summer while Earth flourishes; dampness naturally tends downward. It does not manifest in spring because although wind injures, Wood actually holds power. Summerheat corresponds to Late Summer, which corresponds to Damp Earth. Ruler Fire holds power and does not give to its son; the summer-damp command does not execute. If damp command does not execute, Earth is deficient. The overcoming element acts recklessly, Wood Qi is excessive, Shaoyang is prosperous. The generated element suffers disease, so Lung Metal is insufficient. The overcoming element insults it, so Water overacts on Earth's domain. Earth corresponds to Kun, Kun corresponds to Shen, Shen corresponds to Ministerial Fire. Water entering Earth causes Water-Fire conflict; Water-Fire conflict causes urgent Yin-Yang interaction, resulting in alternating chills and fever. Combined with Wood Qi ending in Sanjiao, this is the combination of Shaoyang Ministerial Fire. Shaoyang is in the Damp Earth domain, hence alternating chills and fever. Insufficient Lung Metal causes shivering chills and fever; these are all unsettled Qi, hence **maji**. It manifests in autumn rather than summer because damp-heat gains power in You. Autumn is clear and austere Qi, with a contracting and descending nature. Injury by dampness means Long Summer Qi does not accord with Autumn Command. Autumn Command is insufficient, the overcoming element acts recklessly, so Fire flares upward to overcome Metal. Heart Fire punishes Lung, so Lung Qi reverses causing cough. The overcoming element insults it, Wood Qi ascends, aligning with Fire, moving ceaselessly. The generated element suffers disease, so Kidney Water is deficient. Long Summer is excessive, Sanjiao Qi is prosperous. Mingmen is the convergence of Sanjiao, forcing Kidney Water upward to combine with Spleen-Damp-Heat, causing disease. Cough moves Spleen-Damp, hence cough with sound and phlegm. It manifests in winter rather than autumn because the extreme of Six Yin allows killing Qi to gain power. Winter injury by cold means Winter executes Spring Command; it should be cold but is warm, Fire wins and Water is deficient. Water deficient, the overcoming element acts recklessly, Earth is surplus; the generated element suffers disease, Water is insufficient; the overcoming element insults it, Fire is excessive. Fire and Earth combine virtue, damp-heat assist each other, causing **wenbing**. It manifests in spring rather than winter because Cold-Water occupies Mao, gaining power; the great cold command re-executes in spring, pores open, Shaoyin fails to store, sexual fatigue injures, hardworking people leak Yang externally, Kidney Water deficiency internally. In spring months, strong Wood grows, unable to nourish the source of generation, hence **wenbing**.
Generally, "Spring injury by wind," "Summer injury by summerheat," and "Winter injury by cold" follow smooth logic; here "time" (Shi) equals "command" (Ling). Only "Autumn injury by dampness" is interpreted as "Command injuring Time"; readers should not doubt this. These four theories all describe Mother Qi being excessive and harming the Son Qi it bears. If "Autumn" injures "Dampness," 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 rigid about the text. Some say "Spring injury by wind" means humans are injured by wind, which is incorrect. If so, there would only be headache, aversion to wind, and spontaneous sweating; why mention summer **sunxie**? Now saying "Spring injury by wind" clearly means Time injuring Command.
My commentary: Various annotations 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. If explained simply and plainly, the classic's intent becomes clear without forced interpretation. Why? Wind, summerheat, dampness, and cold are the four Qi of heaven and earth. When they injure humans, can one know before manifestation which meridian, Zang-Fu, or part is affected and what disease forms? Only after manifestation can diagnosis reveal which meridian, Zang-Fu, or part is affected and what disease forms. If annotators understand that disease reveals the origin, these four injuries resolve easily.
**Dongxie**, **maji**, cough and **weijue**, and **wenbing** are all traced back to their origins (wind, summerheat, dampness, cold injury) based on obvious symptoms at onset; it is not that the initial injury predetermined the current disease. Injuries by the four Qi may manifest immediately, after a delay, or long after; some dissipate without disease. This is due to variable pathogenic transmission and varying Zheng Qi (Upright Qi) strength. Taking wind injury: immediate manifestation causes aversion to wind, fever, headache, sweating, cough, panting; delayed manifestation causes leprosy-like conditions, internal heat/cold, hemiplegia, wind of five Zang. Thus, **dongxie**/**sunxie** is just one type of delayed manifestation. From these diseases, we infer spring wind injury stored within. If these diseases did not arise, who could know prior wind injury? If delayed injury dissipates, who knows? Even Taisu pulse methods, predicting death, rely on obvious signs. Summer heat causing **maji** and winter cold causing **wenbing** follow similar logic. However, autumn dampness causing cough and **weijue** shares the "disease reveals origin" logic but differs in "command timing." Spring wind, summer heat, winter cold are native season commands. Dampness is Long Summer's command; why mention autumn? Spring, summer, winter have three months each, their commands run in their seasons. Long Summer parasitizes June. Autumn has three months, but Long Summer dampness often invades autumn, hence "Autumn injury by dampness."
Let us explain the meaning of four Qi injuries. Wind is Spring's command. Spring infection, if not immediate, persists to summer, becoming disease. **Dongxie** occurs because wind is vast, flying, and rapid; human intestines/stomach cannot process food normally, leading to simultaneous discharge of fluids and grains. **Sunxie** is similar. Summerheat is Summer's command. Summer infection, if not immediate, persists to autumn, combined with wind/cold, causing **maji**. Cold is Winter's command. Winter infection, if not immediate, persists to spring. Body Yang is stifled by cold, unable to rise gradually, but must emerge timely, causing **wenbing**. Autumn dampness's command timing was discussed earlier. The previous chapter's "upward reversal cough and **weijue**" implies immediate manifestation, but listed with wind/summerheat/cold, it likely isn't immediate. Without explicit text, I dare not equate it to winter onset. Although damp is Long Summer's command invading autumn, even if immediate, it resembles delayed onset. We discuss autumn onset. Damp enters from below, disturbs Lung causing cough (upward reversal). Lung governs Qi; disease prevents external movement; damp blocks meridians, causing limb flaccidity and cold. The later chapter's "winter cough" mentions delay, differing from the former. Damp lingers until winter cold prevails; Lung fears cold and is injured; damp exploits deficiency to invade Lung, causing cough. Readers should seek this intent to understand the classic.
Some see "inevitably" (bi) in *Suwen* regarding **wenbing** and **maji** and treat them as absolute laws. Alas! Is it truly inevitable? *Suwen* uses "inevitably" sometimes and not others, refusing rigidity. Classics have seemingly absolute statements that are not absolute. E.g., Heat Jue from drunken sex; Heat/Sweet Middle from the rich; Head Wind after washing hair. Are these universal? Readers should be flexible, not rigid.
Wang Qixuan's annotation, though rigid on "inevitably" and missing full intent, is not too far off. Cheng Wuji's view is further off but not extreme. Wang Haizang's theory is overly speculative, trying to be unique, but ends up forced and contradictory. As ancient scholars said: like scouts going too far without return. I will critique Cheng and Wang.
Cheng Wuji says wind excess causes extremity diseases, thus limbs. I say "should" is absolute. Spring wind + Summer Yang abundance = inward attack (**sunxie**). Plausible? Classic says: Wood movement has no fixed time. If wind injury is not in spring, or without Summer Yang, does it go out or in? Wind is Yang, same as Summer; if outgoing, it follows dispersion. Why not? Wind changes rapidly; diseases vary, not just limbs. "Rain excess causes abdominal disease" is equally flawed. Summer heat causing autumn **maji**: heat hides between skin and stomach/intestines; autumn wind triggers it. See *Suwen·Maji Lun*. What does this have to do with Summer Yin internal/Autumn Yang internal/heat contending with Yin? Winter cold causing spring **wenbing**: cold toxin enters skin/muscle, stifles Yang; spring Yang emerges, body's stifled Yang exits, disease starts. See *Shanghan Lun*. What does this have to do with Winter Yang internal/Spring Yin internal/cold contending with Yang?
Wang Haizang calls spring/summer/winter injuries "Time injuring Command" and autumn dampness "Command injuring Time." He claims spring executes winter command (cold suppresses warmth); summer heat is Late Summer/Damp Earth, Ruler Fire doesn't generate son, damp command fails; autumn injured by damp means Long Summer Qi doesn't match Autumn; winter executes spring command (Fire wins/Water loses, cold returns to spring, Yang leaks/Kidney Water deficient). He says **wenbing** is damp-heat assistance and all four injuries are Mother excessive harming Son. How fragmented and verbose! Classics mean humans are injured by wind/heat, not Time/Command mutual injury. If Wang were right, how to interpret "Summer injury by heat, Autumn injury by wind" in *Maji Lun*? Time injuring Command or Command injuring Time? Who doesn't know heat is Summer's command? Calling it Late Summer/Damp Earth is strange. If winter executes spring command, it causes Winter Warm Disease, not Spring Warm Disease. If great cold returns to spring for **wenbing**, does absence of great cold prevent **wenbing**? Spring **wenbing** is common, not always due to great cold. Classic says: Excess harms, bearing controls. Excess invites control (e.g., Fire excess invites Water). "Ministerial Fire borne by Water," "Water position borne by Earth" means the overcoming element bears. Wang calls Excess Mother, Bearing Son; does he surpass the classic or fail to understand? Restraint vs. Overcoming: Restraint is Sheng Suo (Overcome), Being Restraint is Bu Sheng Suo (Not Overcome). Classic: Excess Qi restrains what it overcomes and insults what does not overcome it. Wang's view contradicts this. I won't bother refuting every derivative point of his Time/Command theory.
Alas! I criticize predecessors not for pleasure, but to protect the Great Meaning and prevent misleading future generations. I accept the charge of presumption.
Zhi Bingzhong said: Spring wind, summer heat, autumn damp, winter cold are causes; **sunxie**, **maji**, cough, **wenbing** are symptoms. Humans feel four Qi; waiting for transmission/change, the overcoming element insults the non-overcoming, causing symptoms. If Yuan Qi is solid, delayed manifestation may not occur. Debate is complete; I add nothing. But his "Time injuring Command/Command injuring Time" theory is questionable. Spring/Summer/Autumn/Winter are Times; Warm/Hot/Cool/Cold are Commands. Spring should be warm but is cold; Summer hot but cool; Autumn cool but hot; Winter cold but warm. These are abnormal Qi variations. Humans touching them get sick; does Time intend to harm? If Time injures Command and Command injures Time, Qi mutually harms, and everyone gets sick simultaneously. Is this logical?