痰之为病,仲景论四领六证,无择叙内外三因,俱为切当。盖四领则叙因痰而显诸证者
,三
因则论因有所伤而成痰者也。惟王隐君论人之诸疾悉出于痰,此发前人所未论,可谓深识痰
之情状而得其奥者矣。制滚痰丸一方,总治斯盛,固为简便。较之仲景无择,有表里内外而
分汗下温利之法,则疏阔矣,况又有虚实寒热之不同哉。夫痰之为病,有因热而生痰者,热
则熏蒸津液而成痰;亦有因痰而生热者,痰则阻碍气道而生热;有因风寒火热而得者,有因
惊而得者;有因气而得者;有因饮酒而得者;有因食积而得者;有脾虚不能运化而生者;有
肾虚水泛为痰者。风痰多成中风瘫痪奇证,寒痰多成冷痹骨痛,
火痰多成烦热喘嗽,湿痰多成倦怠嗜卧,惊痰
多成心痛癫痫,气痰多成胸
腹膨胀,酒痰多成呕吐泄泻。痰饮多成胁满胸臂痛,食积痰多成癖块痞满。脾虚之痰,因
劳倦伤脾,痰清食少,肾虚之痰,因房劳伤肾,痿冷昏晕。然亦有痰冷而属热者,其为病状
,种种难名,王隐君论中颇为详尽。学人当察其病形脉证,则知所挟之邪,随其表里上下虚
实治之可也。大凡病久淹留,卒不致死者,多因食积痰饮所致。此何以故? 盖胃气亦
赖痰积所养,饮食虽少,胃虚猝不便虚故也。亦有治痰用峻利药过多,则脾气愈虚,津液不
运,痰反生而愈甚,法当补胃清中气,则痰自然运下,此法之本也。
痰这种病证,张仲景论述了四种纲领和六种证候,无择(宋代医家)叙述了内、外、不内外三因,都分析得非常恰当。所谓“四领”,是叙述由痰引起的各种表现症状;“三因”则是论述因各种损伤而形成痰的病因。只有王隐君论述人的各种疾病都源于痰,这是阐发了前人未曾论及的内容,可以说是深刻认识了痰的性状并掌握了其奥秘。他创制了滚痰丸这一方剂,总治这类盛实的痰证,确实简便。但与张仲景和无择相比,他们根据表里内外分别采用发汗、攻下、温法、利法等治疗手段,相比之下就显得疏漏宽泛了,更何况还有虚实寒热的不同呢。
痰这种病证,有因热而生痰的,热邪熏蒸津液从而形成痰;也有因痰而生热的,痰阻碍气道从而产生热;有的因风寒火热而得,有的因惊吓而得;有的因气滞而得;有的因饮酒而得;有的因食积而得;有的因脾虚不能运化水湿而生;有的因肾虚水液泛滥而成痰。风痰多导致中风瘫痪等奇异病症,寒痰多导致冷痹骨痛,火痰多导致烦热喘咳,湿痰多导致倦怠嗜卧,惊痰多导致心痛癫痫,气痰多导致胸腹膨胀,酒痰多导致呕吐泄泻。痰饮多导致胁肋胀满、胸臂疼痛,食积痰多导致癖块痞满。脾虚之痰,因劳倦伤脾,表现为痰清稀、食欲少;肾虚之痰,因房劳伤肾,表现为痿软寒冷、昏晕。然而也有痰虽属寒象但本质为热的情况,其病症表现种种难以名状,王隐君的论述中颇为详尽。学习中医的人应当观察病人的形态、脉象和证候,从而知道所夹杂的病邪,根据其表里上下、虚实情况进行治疗即可。
大凡疾病久延不愈,最终没有致死的,多因食积痰饮所致。这是什么原因呢?大概胃气也依赖痰积来滋养,虽然饮食很少,但因为胃气被痰所养,所以不会突然陷入极度虚弱状态。也有治疗痰证时使用了过多峻猛通利的药物,导致脾气更加虚弱,津液无法运化,痰反而生成更多且病情加重,此时治疗方法应当补益胃气、清理中焦之气,那么痰自然就会运化下行,这才是治法的根本。
The pathology of Phlegm (Tan, 痰) was discussed by Zhang Zhongjing with four leading principles and six syndromes, while Wu Ze narrated the three categories of causes (internal, external, and neither internal nor external), both being quite appropriate. The "four leading principles" describe various symptoms manifesting due to Phlegm, whereas the "three categories of causes" discuss how injuries lead to the formation of Phlegm. Only Wang Yinjun argued that all diseases in humans originate from Phlegm; this elucidates what predecessors had not discussed, demonstrating a profound understanding of the nature and essence of Phlegm. He formulated the Gun Tan Wan (Rolling Phlegm Pill), which generally treats excessive Phlegm syndromes, indeed offering simplicity. However, compared to Zhang Zhongjing and Wu Ze, who differentiated treatments such as sweating (Han, 汗), purging (Xia, 下), warming (Wen, 温), and draining (Li, 利) based on exterior-interior and internal-external distinctions, Wang's approach appears less comprehensive, especially considering the variations of deficiency-excess and cold-heat.
Phlegm pathology includes cases where heat generates Phlegm: heat steams body fluids into Phlegm; or cases where Phlegm generates heat: Phlegm obstructs airways causing heat. Etiologies include wind-cold, fire-heat, fright, Qi stagnation, alcohol consumption, and food retention. It also arises from Spleen deficiency failing to transform and transport, or Kidney deficiency allowing water to overflow into Phlegm. Wind-Phlegm often leads to stroke and paralysis; Cold-Phlegm leads to cold Bi-syndrome and bone pain; Fire-Phlegm leads to irritability, fever, wheezing, and coughing; Damp-Phlegm leads to fatigue and desire to lie down; Fright-Phlegm leads to heart pain and epilepsy; Qi-Phlegm leads to chest and abdominal distension; Alcohol-Phlegm leads to vomiting and diarrhea. Phlegm-fluids (Tan Yin, 痰饮) lead to hypochondriac fullness and chest/arm pain; Food-retention Phlegm leads to masses and stuffiness. Spleen-deficiency Phlegm, caused by overwork injuring the Spleen, presents with clear Phlegm and poor appetite. Kidney-deficiency Phlegm, caused by sexual exhaustion injuring the Kidney, presents with flaccidity, coldness, dizziness, and fainting. However, some Phlegm may appear cold but belong to heat pathologically, presenting complex symptoms difficult to name, as detailed in Wang Yinjun's treatise. Practitioners should observe the patient's form, pulse, and signs to identify the accompanying pathogens and treat according to their location (exterior-interior, upper-lower) and nature (deficiency-excess).
Generally, chronic lingering diseases that do not result in death are often caused by food retention and Phlegm-fluids. Why? Because Stomach Qi relies on Phlegm accumulation for nourishment; although dietary intake is low, the Stomach does not suddenly become critically deficient due to this support. Conversely, if too many harsh and draining medicines are used to treat Phlegm, Spleen Qi becomes more deficient, body fluids fail to circulate, and Phlegm generation worsens. In such cases, the method should be to tonify Stomach Qi and clear the Middle Jiao, allowing Phlegm to naturally descend and transform; this is the fundamental principle of treatment.