病机云∶诸气 郁,皆属于肺;诸痿喘呕,皆属于上,二条明指燥病言矣。生气通天论谓∶秋伤于燥
,上逆而咳,发为痿厥。燥病之要,一言而终,与病机二条适相吻合。只以误传伤燥为伤湿,解者竟指燥
为湿,遂至经旨不明。今一论之。
其左 胁痛,不能转侧,嗌干面尘,身无膏泽,足外反热,腰痛惊骇,筋挛,丈夫 疝,妇人小腹痛
,目昧 疮,则燥病之本于肝,
而散见不一者也。又痹论云∶阴气者,静则神藏,躁则消亡。其所以致燥而令阴气消亡之故,引而未发。
又因《内经》脱遗燥症,后虽以东垣之大贤,其治燥诸方,但养营血,及补肾肝亏损,二便秘结而已,初
不论及于肺也。
夫诸气 郁之属于肺者,属于肺之燥,非属于肺之湿也。苟肺气不燥,则诸气禀清肃之令,而周身
四达,亦胡 郁耶?诸痿喘呕之属于上,上亦指肺,不指心也。若统上焦心肺并言,则心病不主痿喘
及呕也。惟肺燥甚,则肺叶痿而不用,肺
气逆而喘鸣,食难过膈而呕出,三者皆燥证之极者也,经文原有逆秋气则太阴不收,肺气焦满,其
可称为湿病乎?
《内经》云∶心移热于肺,传为膈消。肺燥之由来远矣。苟其人肾水足以上升而交于心,则心火下
降而交于肾,不传于肺矣。心火不传于肺,曾何伤燥之虞哉?即肾水或见不足,其肠胃津液足以协济上
供,肺亦不致过伤也。若夫中下之泽尽竭,而高源之水犹得措于不倾,则必无之事矣。所以经文
又云∶二阳结,谓之消。手阳明大肠热结而津不润,足阳明胃热结而血不荣,证成消渴,舌上赤裂,大渴
引饮,与心移热于肺,传为膈消,文虽异而义则一也。治膈消者,用白虎加人参汤专救其肺。以施诸气
郁,诸痿喘呕,罔不合矣。
缪仲淳治病,喜用润剂,于以治燥,似乎独开生面。然亦未有发明,偶因世之患燥病者多,聪明偶
合。然可以治内伤之燥,不可以治外感之燥,节取其长可矣。
《阴阳别论》云∶二阳之病发心脾,有不得隐曲,男子少精,女子不月,其传为风消,其传为息贲,
死不治。此亦肺燥所由来,而未经揭出者。夫燥而令男子津液衰少,女子精血枯闭,亦云极矣。然其始但不
利于隐曲之事耳,其继则胃之燥传入于脾,而为风消。风消者,风热炽而肌肉消削也。大肠之燥传入于肺,
而为息贲。息贲者,息有音而上奔不下也。是则肠胃合心脾,以其成肺金之燥。三脏二腑,阴气消亡殆
尽,可救疗乎?夫由心之肺,已为死阴之属,然脾气散二阳之精,上输于肺,犹得少苏涸鲋。今以燥之为害
,令生我者尽转而浚我之生,故直断为死不治也。从前愦之,特绎明之。
《素问·至真要大论》的病机十九条中说:“诸气膹郁,皆属于肺;诸痿喘呕,皆属于上。”这两条明确是指燥病而言的。《生气通天论》说:“秋伤于燥,上逆而咳,发为痿厥。”燥病的要点,用一句话就能概括,与病机十九条中的这两条恰好相吻合。只是因为误传将“伤燥”当作“伤湿”,解释的人竟然把燥病指认为湿病,导致经典旨意不明。现在对此进行论述。
如果左侧胁肋疼痛,不能翻身侧卧,咽喉干燥,面色如蒙尘垢,身体没有光泽,足外侧反觉发热,腰痛并伴有惊骇感,筋脉拘挛,男子患疝气,妇人小腹痛,视物模糊且生疮疡,这些都是燥病根源在肝的表现,散见于不同症状之中。又《素问·痹论》说:“阴气者,静则神藏,躁则消亡。”其中导致燥病并使阴气消亡的原因,原文引用了但未深入阐发。再加上《内经》中脱漏遗失了关于燥症的记载,后来即使是像李东垣这样的大贤人,他治疗燥病的各种方剂,也只是滋养营血,以及补肾肝亏损、通治二便便秘罢了,起初并不涉及对肺的治疗。
那些气机膹郁归属于肺的,是归属于肺的燥,而不是归属于肺的湿。假如肺气不燥,那么诸气就会禀受清肃的政令,周身通达,怎么会郁结呢?那些痿证、喘证、呕吐归属于上的,“上”也是指肺,不是指心。如果笼统地说上焦的心和肺,那么心病并不主司痿证、喘证及呕吐。只有当肺燥非常严重时,肺叶枯萎而不能使用,肺气上逆而喘息有声,食物难以下咽通过横膈而呕吐出来,这三者都是燥证的极致表现。经文原有“逆秋气则太阴不收,肺气焦满”的说法,这怎么能称为湿病呢?
《内经》说:“心移热于肺,传为膈消。”肺燥的由来已经很久了。假如此人肾水充足能够上承而与心相交,那么心火就会下降而与肾相交,就不会传变到肺了。心火不传于肺,哪里还有损伤致燥的担忧呢?即使肾水稍微不足,肠胃的津液也足以协助供给上部,肺也不会受到过度损伤。如果中下焦的水泽完全枯竭,而高源之水还能保持不倾覆,那一定是绝对不可能的事情。所以经文又说:“二阳结,谓之消。”手阳明大肠热结而津液不滋润,足阳明胃热结而血液不荣养,病症形成消渴,舌面赤裂,极度口渴想喝水,这与“心移热于肺,传为膈消”,文字虽然不同,但义理是一致的。治疗膈消,使用白虎加人参汤专门救肺。将此法应用于诸气膹郁、诸痿喘呕,没有不契合的。
缪仲淳治病,喜欢使用润剂,用来治疗燥病,似乎独辟蹊径。然而也没有发明新的理论,只是偶然因为世上患燥病的人多,他的聪明才智偶尔与之相合。这种方法可以治疗内伤引起的燥,不可以治疗外感引起的燥,只取其长处就可以了。
《素问·阴阳别论》说:“二阳之病发心脾,有不得隐曲,男子少精,女子不月,其传为风消,其传为息贲,死不治。”这也是肺燥的来源,但未被揭示出来。燥病使得男子津液衰少,女子精血枯闭,可以说是极度的严重了。然而起初只是不利于房事而已,接着胃的燥传入脾,形成风消。所谓风消,是指风热炽盛而肌肉消瘦。大肠的燥传入肺,形成息贲。所谓息贲,是指呼吸有声而上奔不下。这样看来,肠胃合于心脾,因为它们形成了肺金的燥。三脏二腑,阴气消亡殆尽,还能救治吗?由心传到肺,已经属于死阴的范畴,然而脾气散布二阳的精微,上输于肺,还能够使干涸的鱼得到少许复苏。现在因为燥的危害,使得生我的(脾土)转而汲尽我的生机,所以直接断定为死不治。从前对此感到困惑,现在特意阐明它。
The pathogenesis section of the *Suwen* (Plain Questions) states: "All Qi stagnation and fullness belong to the Lung; all flaccidity syndromes, panting, and vomiting belong to the Upper." These two clauses explicitly refer to Dryness diseases. The *Shengqi Tongtian Lun* (Treatise on the Connection between Vital Energy and Heaven) states: "In autumn, injury by Dryness causes Qi to rebel upward leading to cough, resulting in flaccidity syndromes and cold extremities." The essence of Dryness disease can be summarized in one phrase, which perfectly aligns with these two clauses from the pathogenesis section. However, due to a misinterpretation that confused "injury by Dryness" with "injury by Dampness," commentators mistakenly identified Dryness as Dampness, causing the original meaning of the classics to become unclear. This text aims to clarify this issue.
If there is pain in the left hypochondrium, inability to turn the body, dry throat, a dusty complexion, lack of luster in the skin, heat sensation on the outer aspect of the feet, lower back pain accompanied by fright, tendon contraction, hernia in men, and lower abdominal pain in women, blurred vision, and sores, these are manifestations of the Liver being the root of Dryness, appearing scattered across various symptoms. Furthermore, the *Bi Lun* (Treatise on Bi Syndromes) states: "Yin Qi, when still, preserves the Spirit; when agitated, it dissipates and perishes." The reason why Dryness leads to the dissipation of Yin Qi is cited but not fully elaborated. Additionally, because records of Dryness syndromes were lost in the *Neijing*, later masters, even great sages like Li Dongyuan, treated Dryness primarily by nourishing Ying and Blood, tonifying Liver and Kidney deficiencies, and treating constipation of the bowels, initially neglecting the treatment of the Lung.
Regarding Qi stagnation belonging to the Lung, it belongs to the Dryness of the Lung, not the Dampness of the Lung. If Lung Qi is not dry, then all Qi would follow the clear and descending command, circulating freely throughout the body, and how could they stagnate? Regarding flaccidity, panting, and vomiting belonging to the "Upper," "Upper" refers to the Lung, not the Heart. If one were to speak generally of both the Heart and Lung in the Upper Jiao, heart disease does not primarily govern flaccidity, panting, or vomiting. Only when Lung Dryness is severe do the lung lobes become flaccid and non-functional, Lung Qi rebels causing wheezing, and food fails to pass through the diaphragm, leading to vomiting. These three are extreme manifestations of Dryness syndromes. The classic text originally stated: "Violating the Qi of Autumn, the Taiyin fails to receive, causing Lung Qi to become scorched and distended." How can this be called a Dampness disease?
The *Neijing* states: "Heart transfers Heat to the Lung, transmitting it as Diaphragmatic Xiao (Wasting-Thirst)." The origin of Lung Dryness is ancient. If a person's Kidney Water is sufficient to ascend and interact with the Heart, then Heart Fire descends to interact with the Kidney, and does not transmit to the Lung. If Heart Fire does not transmit to the Lung, what danger of injury by Dryness exists? Even if Kidney Water is slightly deficient, the fluids of the intestines and stomach are sufficient to assist in supplying the upper body, preventing excessive damage to the Lung. However, if the waters of the Middle and Lower Jiao are completely exhausted, it is impossible for the water at the high source to remain stable without tilting. Therefore, the classic text also states: "Jie (binding/accumulation) of the Two Yangs is called Xiao." When Hand Yangming Large Intestine Heat binds and fluids do not moisten, and Foot Yangming Stomach Heat binds and blood does not nourish, Wasting-Thirst syndrome forms, characterized by a cracked red tongue and extreme thirst desiring drinking. Although the wording differs from "Heart transfers Heat to the Lung, transmitting it as Diaphragmatic Xiao," the underlying principle is identical. To treat Diaphragmatic Xiao, use Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) to specifically rescue the Lung. Applying this to Qi stagnation, flaccidity, panting, and vomiting fits perfectly.
Miu Zhongchun, in treating diseases, liked to use moistening agents to treat Dryness, seemingly opening a new path. However, he did not elucidate the theory deeply; his success was merely coincidental due to the prevalence of Dryness diseases at the time. While this approach can treat internal injury-induced Dryness, it cannot treat external contraction-induced Dryness. One should only adopt its strengths.
The *Yinyang Bie Lun* (Treatise on Differences between Yin and Yang) states: "Diseases of the Two Yangs originate in the Heart and Spleen, involving difficulties in intimate relations, scanty essence in men, and amenorrhea in women. It transmits as Fengxiao (Wind-Wasting), and further as Xiben (Panting Accumulation), which is incurable and fatal." This is also an origin of Lung Dryness that had not been revealed. Dryness causing depletion of fluids in men and exhaustion of essence and blood in women is indeed extreme. Initially, it only affects intimate relations; subsequently, Stomach Dryness transmits to the Spleen, forming Fengxiao. Fengxiao refers to intense Wind-Heat causing muscle wasting. Large Intestine Dryness transmits to the Lung, forming Xiben. Xiben refers to breathing with sound that rushes upward without descending. Thus, the intestines and stomach combine with the Heart and Spleen to create Dryness in Metal (Lung). With the Three Zang organs and Two Fu organs having nearly exhausted their Yin Qi, can it be cured? Transmission from the Heart to the Lung already belongs to the category of Dead Yin. Although the Spleen scatters the essence of the Two Yangs to transport upwards to the Lung, allowing for slight recovery of the dried fish, now due to the harm of Dryness, the organ that generates me (Spleen) turns to drain my life force. Therefore, it is directly judged as incurable and fatal. Previously, I was confused; now I clarify it.