邪气各有所属也,当穷其要于前;治法各有所归也,当防其差于后。盖治病之要,以穷其所
属为先。苟不知法之所归,未免于无差尔。是故疾病之生,不胜其众,要其所属,不出乎五运六
气而已。诚能于此审察而得其机要,然后为之治,又必使之各应于运气之宜,而不至有一毫差误
之失。若然,则治病求属之道,庶乎其无愧矣。至真要大论曰∶审察病机,无失气宜。意蕴诸此。
尝谓医道有一言可以尽其要者,运气是也。天为阳,地为阴。阴阳二气,各分三品,谓之三
阴三阳。然天非纯阳,而亦有三阴;地非纯阴,而亦有三阳。故天地上下,各有风热火湿燥寒之
六气。其斡旋运动乎两间者,而又有木火土金水之五运。人生其中,脏腑气穴亦与天地相为流通。
是知众疾之作,而所属之机无出乎是也。然而医之为治,当何如哉?惟当察乎此,使勿失其宜而后可。
若夫诸风掉眩,皆属肝木;诸痛疮痒,皆属心火;诸湿肿满,皆属脾土;诸气 郁,皆属肺
金;诸寒收引,皆属肾水。此病机属于五运者也。诸暴强直,皆属于风;诸呕吐酸,皆属于热;
诸躁扰狂越,皆属于火;诸 强直,皆属于湿;诸涩枯涸,皆属于燥;诸病水液,皆属于寒。此
病机属于六气者也。
夫惟病机之察,虽曰既审;而治病之施,亦不可不详。故必别阴阳于疑似之间,辨标本于隐
微之际。有无
之殊者,求之于有无之所以殊;虚实之异者,责其虚实之所以异。为汗吐下,投其所当投;寒热
温凉,用其所当用;或逆之以制其微,或从之以导其甚;上焉以远司气之犯,中焉以辨岁运之化,
下焉以审南北之宜。使大小适中,先后合度,以是为治,又岂有差殊乖乱之失邪?
又考之《内经》曰∶治病必求其本。《本草》曰∶欲疗者,先察病机。此审病机之意也。六
元正纪大论曰∶无失天信,无逆气宜。五常政大论曰∶必先岁气,无伐天和。此皆无失气宜之意
也。故《素问》《灵枢》之经未尝不以气运为言,既曰先立其言,以明其气,复有以戒之曰∶治
病者必明天道地理,阴阳更胜。既曰不知年之所加,气之盛衰,虚实之所起,不可以为工矣。谆
谆然若有不能自已者,是岂圣人私忧过计哉?以医道之要悉在乎此也。观乎《原病式》一书,比
类物象,深明乎气运造化之妙,其于病机气宜之理,不可以有加矣。
邪气各有其所属的范畴,应当在治疗前深入探究其关键;治法各有其归属的原则,应当在实施后防止出现偏差。大抵治病的关键,在于首先探明疾病所属的范畴。如果不知道治法的归属原则,难免会出现差错。因此,疾病的产生,不胜枚举,但追究其所属范畴,不出乎五运六气的规律之外。如果能在此仔细审察并掌握其机要,然后进行治疗,又必须使治疗方法各顺应运气之适宜,从而不至于有一毫一厘的差错失误。如果是这样,那么治病求属的道理,大概就可以无愧于心了。《素问·至真要大论》说:“审察病机,无失气宜。”其中的意蕴就在于此。
我曾经认为,医道中有一句话可以概括其要领,那就是“运气”。天属于阳,地属于阴。阴阳二气,各自分为三类,称为三阴三阳。然而天并非纯阳,其中也包含三阴;地并非纯阴,其中也包含三阳。所以天地上下,各有风、热、火、湿、燥、寒这六气。在天地之间运转运动的,又有木、火、土、金、水这五运。人生活在天地之中,脏腑之气与穴位也与天地相互流通。因此知道各种疾病的发生,其所属的机理没有超出这些范围。然而医生进行治疗,应当怎么做呢?只应当审察这些规律,使其不失去适宜性才可以。
至于那些各种风邪引起的动摇眩晕,都归属于肝木;各种疼痛疮疡瘙痒,都归属于心火;各种湿邪引起的肿胀胀满,都归属于脾土;各种气机郁滞,都归属于肺金;各种寒邪引起的收缩牵引,都归属于肾水。这是病机归属于五运的情况。各种突然发生的强直拘急,都归属于风;各种呕吐酸水,都归属于热;各种烦躁扰乱狂乱越常,都归属于火;各种肢体强直(注:原文此处有缺字,据《内经》补为“诸痉项强”或类似含义,此处依文意译为肢体强直),都归属于湿;各种干涩枯涸,都归属于燥;各种水液代谢异常的疾病,都归属于寒。这是病机归属于六气的情况。
只有对病机的审察,虽然说是已经详尽;但在施治时,也不可不详细斟酌。所以在疑似之间辨别阴阳,在隐微之际分辨标本。对于有无不同的情况,探究其之所以不同的原因;对于虚实不同的情况,追究其实虚之所以不同的原因。该用汗法、吐法、下法的,就投用相应的治法;该用寒、热、温、凉性质的药物,就使用相应的药性;或者逆其病势以制约轻微的邪气,或者顺其病势以引导严重的病邪;在上者以远离司天之气的侵犯,在中者以辨别岁运的变化,在下者以审察南北地域的适宜。使得用药大小适中,先后合乎法度,以此作为治疗,难道还会有差错混乱的失误吗?
又考证《内经》说:“治病必求其本。”《本草》说:“想要疗疾的人,先要审察病机。”这就是审察病机的意思。《素问·六元正纪大论》说:“不要违背天的信期,不要逆反气之适宜。”《素问·五常政大论》说:“必须先了解当年的岁气,不要损伤天和之气。”这都是不失去气之适宜的意思。所以《素问》和《灵枢》的经典未曾不以气运来谈论,既然确立了这些言论以阐明气之规律,又反复告诫说:“治病的人必须明白天道地理,阴阳的更替胜负。”既然又说:“不知道年份所加临的气运,气的盛衰,虚实产生的原因,就不能成为合格的医生。”语重心长,好像不能自已,这难道是圣人私下担忧、考虑过分吗?因为医道的要领全在于此啊。观看刘完素的《原病式》一书,通过比类物象,深刻明白了气运造化的奥妙,其在病机气宜的道理上,可以说是无以复加了。
Pathogenic factors each have their specific affiliations; one must thoroughly investigate their essentials beforehand. Therapeutic methods each have their respective归 (principles/affiliations); one must guard against errors afterwards. The crux of treating diseases lies in prioritizing the investigation of their affiliations. If one does not understand the principles to which therapeutic methods belong, errors are inevitable. Therefore, although diseases arise in countless forms, their affiliations ultimately fall within the scope of the Five Movements and Six Qi (Wuyun Liuqi, the theory of cosmic cycles influencing health). If one can carefully examine these and grasp their key mechanisms, and then proceed with treatment, ensuring that each method corresponds appropriately to the favorable conditions of the movements and qi, there will be no slightest error. In this way, the principle of seeking the affiliation in disease treatment would be without reproach. The *Suwen* (Basic Questions), Chapter "Zhizhen Yao Da Lun" (Great Discussion on the Most Essential Principles), states: "Examine the pathogenesis carefully, do not neglect the appropriateness of the qi." This is the meaning implied here.
I have often said that there is one phrase in medicine that can summarize its essence: it is the Theory of Movements and Qi (Yunqi). Heaven is Yang, Earth is Yin. The Qi of Yin and Yang are each divided into three categories, known as the Three Yin and Three Yang (Sanyin Sanyang). However, Heaven is not purely Yang, but also contains Three Yin; Earth is not purely Yin, but also contains Three Yang. Thus, above and below heaven and earth, there exist the Six Qi (Liuqi, six climatic factors: Wind, Heat/Fire, Dampness, Dryness, Cold) of Wind, Heat, Fire, Dampness, Dryness, and Cold. Rotating and moving between heaven and earth are the Five Movements (Wuyun, five phases/cycles: Wood, Fire, Earth, Metal, Water). Humans live within this system, and the Qi of their Zang-Fu organs and acupoints circulates and interacts with heaven and earth. Hence, we know that the mechanism behind the occurrence of various diseases does not exceed these factors. So, how should a physician treat? One must observe these laws, ensuring they do not deviate from what is appropriate.
Regarding various wind-induced tremors and vertigo, all belong to Liver Wood; various pains, sores, and itching all belong to Heart Fire; various dampness-induced swellings and fullness all belong to Spleen Earth; various Qi stagnations all belong to Lung Metal; various cold-induced contraction and pulling all belong to Kidney Water. These are pathogeneses belonging to the Five Movements. Various sudden stiffness and rigidity all belong to Wind; various vomiting and acid regurgitation all belong to Heat; various restlessness, agitation, mania, and deviation all belong to Fire; various stiffness and rigidity all belong to Dampness; various dryness and withering all belong to Dryness; various disorders involving body fluids all belong to Cold. These are pathogeneses belonging to the Six Qi.
Although the examination of pathogenesis may be deemed thorough, the application of treatment must also be detailed. One must distinguish Yin and Yang amidst ambiguity, and differentiate Root (Ben) and Branch (Biao) in subtle matters. For differences in existence or non-existence, seek the reason for such difference; for differences in deficiency or excess, investigate the cause of such disparity. Employ sweating, vomiting, or purging methods where appropriate; use Cold, Hot, Warm, or Cool properties where suitable. Sometimes counteract the pathogen to control mild symptoms, sometimes follow the pathogen to guide severe ones. Above, distance oneself from the invasion of the ruling Qi (Siqi); in the middle, discern the transformation of the annual movement; below, assess the suitability of North and South regions. Ensure the dosage is moderate and the sequence is proper. With such treatment, how could there be errors or chaos?
Furthermore, the *Neijing* (Inner Canon) states: "In treating diseases, one must seek the Root." The *Bencao* (Materia Medica) states: "To heal, one must first examine the pathogenesis." This is the intent of examining pathogenesis. The *Liuyuan Zhengji Dalun* (Great Discussion on the Six Primary Ordinances) states: "Do not lose faith in Heaven's timing, do not go against the appropriateness of the Qi." The *Wuchang Zheng Dalun* (Great Discussion on the Five Constant Policies) states: "First ascertain the annual Qi, do not damage the Harmony of Heaven." All these emphasize not losing the appropriateness of the Qi. Thus, the classics *Suwen* and *Lingshu* always speak of Movements and Qi. Having established these words to clarify the Qi, they further warn: "Those who treat diseases must understand Heavenly Dao and Earthly Geography, and the alternating superiority of Yin and Yang." It is stated again: "If one does not know the addition of the year, the flourishing and declining state of Qi, and the origin of deficiency and excess, one cannot be a skilled practitioner." Their earnest admonition seems uncontrollable. Is this the private worry and over-caution of sages? No, because the essence of medical practice lies entirely herein. Observing the book *Yuanbing Shi* (Original Treatise on Disease Causes), by comparing and categorizing phenomena, one deeply understands the wonders of Qi and Movement creation. Regarding the principles of pathogenesis and Qi appropriateness, nothing could be added.