生气通天论曰∶夫自古通天者生之本,本于阴阳,天地之间,六合之内,其气九州九窍五脏十二节,皆通乎天
气。其生五,其气三,数犯此者,则邪气伤人,此寿命之本也。由此论之,人身元气,与天相通,颐养有道,病何
从生?然则病生有因,其发有原乎,从其原而治之则易疗。阴阳应象大论曰∶天有四时五行,以生长收藏,以生寒
暑燥湿风。人有五脏,化五气,以生喜怒悲忧恐。又曰∶因于露风,乃生寒热,是以春伤于风,邪气留连,乃为洞
泄。夏伤于暑,秋为 疟。秋伤于湿,上逆而咳,发为痰厥。冬伤于寒,春必病温。四时之气,更伤五脏,此四时
四气之病原也。黄帝明以春温根于冬寒,其间气候相近,症恙相同,犹可言者,原未兼及暑也。至汉张长沙仲景着
伤寒书,遂演《内经》之说曰∶其伤于四时之气,皆能为病,以伤为毒者,以其最成杀厉之气,中而即病者,名曰
伤寒。不即病者,寒毒藏于肌肤,至春变为温病,至夏变为暑病。暑病者,热极重于温也。自此论出,而后之业岐
黄术者皆宗之,果尔是专主一寒气。三病分久近,皆寒为根,故后世医家,有四时伤寒之说,甚至通以麻黄桂枝汤
兼治温热症,误人良多。陶节庵诸名家,亦剖三病若列眉,而根始于寒,不免沿而未能脱,又何怪乎碌碌者?愚谓
道以一气生天地,以二气生五行,五气各司其用,而水火为最要,水火能生物,亦能杀物,若仲景之说,是水专擅
其权,而火为虚而无用矣,愚为冬之寒病,专属寒威,此固然不易者,至春时阳气渐舒,孔窍开张,服御单夹,乃天
气变幻,倏暖倏寒,又多荡风,人感寒直入脏腑,故为温病,犹可名曰春寒;已与冬寒不相蒙矣。况夏至后,炎火时
流,蒸郁烁人,得病似伤寒者,皆是暑火所感而成,与冬之寒气,毫不相涉,而亦以为冬寒之积久所发者误矣。即生
气通天论曰∶是故阳因而上卫外者也。因于寒,欲如运枢,起居如惊,神气乃浮。因于暑,汗烦则喘喝,静则多言,体
若燔炭,汗出而散,是寒暑分因,水火别证,明列断案,万世医学之祖也。又何惑乎?然《内经》之温根于寒者何故
?案《山海经》桂,名招摇,叶长二尺,桑名帝女,大围五十尺,桂竹叶大二尺余,高数丈,其草树奇怪类若此。据经
想太古时,洪水横流,怀山襄陵,草木闭塞,天地蒙昧,阴霭拂郁,阳明未舒,以故寒气盛行,元和令少,即当大夏
,亦无烁金之患。后世衣冠文物渐开,五行分布,水火之气,各司其权,若斯争烈者,即今春值淫雨,余寒为厉,甚者如
隆冬,挟纩不能去,试观晋中暑证寥寥,绝无 疟,皆阴胜之左券也,何况古洪荒世乎,此《内经》温根于寒所由发也
。何仲景遂申演其说,并暑而一类乎?是蛇足也。且古人茹毛衣草,简缘淡薄,无助火之具,后世炙 之味适口, 郁
之酒充腹,嗜欲灼精,尘劳食气,皆足以嘘焰而煽炽,宜暑火之乘类而善入也。谓古之寒病多而暑病少,今之寒暑并
重,而暑为尤剧则可,愚故特列论曰∶伤寒者感于冬之严寒,温病者感于春之轻寒,若暑
病则专感于夏之炎热,若冰炭霄泉之不相及,一水一火,各操其令。治法一热剂,一凉剂,各中其窍,而概以为
寒因,不几于执一遗二哉!予俯仰踌躇,万不得已,敢于翻千古之案,以开百世之觉,破迷而拔苦,遂自甘于僭
窃云耳。
霖按∶《素问·生气通天论》言春伤于风,邪气留连,乃为洞泄,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,此四时伏气之机,阴阳互根之理也。春伤于风者阳邪也。留连日久,乃下
为洞泄之阴病。秋伤于湿之阴邪,乃为上逆而咳之阳病。夏伤于暑热之阳邪,至秋发为 疟之阴病。冬伤于寒之
阴邪,至春必发为温热之阳病。是阴阳上下之相乘也。此六淫之邪伤人,由人身之阴阳不固,故金匮真言论曰∶夫
精者身之本也。故藏于精者,春不病温。夏暑汗不出者,秋成风疟,足征人身之气血,皆生于精。冬宜闭藏,则阴
气固密,若纵欲精耗则阴虚,阴虚则阳邪易犯,故多病温。夏宜疏泄,逆之而汗不出,汗不出则暑邪内伏,遇秋风
凄切,寒热相战,则为疟病。阴阳启闭,时气宜然,举冬夏言,其春秋伏气,自可类推。而阴阳应象论,又重复言
四时伏气者,盖六淫之邪,亦由七情不慎,五脏化五气为内贼以伤之,此《内经》反复阐明伏邪之义也。
又按∶《素问·热论》曰∶今夫热病者,皆伤寒之类也。越人五十八难曰∶伤寒有五,有中风,有伤寒,有湿
温,有热病,有温病。其名各不同,是伤寒为古医经之通称可证。仲景太阳篇,首揭发热汗出,恶风脉缓者,名中
风。恶寒发热,体痛呕逆,脉阴阳俱紧者,名伤寒。发热而渴,不恶寒者,为温病。发汗已,身灼热,脉阴阳俱浮
者,为风温。辨论寒温形证,朗若列眉,治 三法,尤有深义。奈书经兵火散佚,虽高平王叔和编次,仅存伤寒治
法,而温暑亡失益多,不得拉杂叔和序例中语,妄议仲景寒温莫辨也。《内经》温根于寒,谓严寒遏热,乃习坎之
义,亦不须远引洪荒,曲为解说,温病固非春日之轻寒,暑病亦非专感夏日之炎热,欲明温暑伏气之义,当细参
《内经》,庶不为群言所惑。
《素问·生气通天论》说:自古以来,人与天相通是生命的根本,而根本在于阴阳。天地之间,六合之内,人体的九州(指体内脏腑分布区域)、九窍、五脏和十二关节,都与天气相通。生命活动分为五类(五行),气机变化分为三类(三阴三阳)。如果多次触犯这些规律,邪气就会伤害人体,这是决定寿命长短的根本。由此看来,人身元气与天相通,只要调养得当,病从何而生?然而疾病产生有原因,发作有根源吗?顺着根源治疗就容易治愈。
《素问·阴阳应象大论》说:天有四时和五行,用来生长、繁荣、收敛、收藏,从而产生寒、暑、燥、湿、风五种气候。人有五脏,化生五气,从而产生喜、怒、悲、忧、恐五种情志。又说:因受露水和风邪侵袭,就会产生寒热病。所以春天伤于风邪,邪气滞留不去,就会发生洞泄(严重腹泻);夏天伤于暑邪,秋天就会发生疟疾;秋天伤于湿邪,气机上逆而咳嗽,发为痰厥;冬天伤于寒邪,春天必定发生温病。四时的风气交替伤害五脏,这就是四时四气的病因。黄帝明确说明春温的根源在于冬寒,其间气候相近,症状相同,还可以解释,但原本并未兼及暑病。到了汉代张仲景撰写《伤寒论》,于是发挥《内经》的说法说:人受到四时之气伤害,都能致病,其中伤害最重的是杀厉之气,中邪后立即发病的,名叫伤寒。不立即发病的,寒毒潜伏在肌肤,到春天变为温病,到夏天变为暑病。暑病的热度比温病更重。自从这个理论出现后,后世从事岐黄医术的人都尊崇它。果真如此,就是专门主张寒气致病。这三种病分久近,都以寒为根,所以后世医家有“四时伤寒”的说法,甚至通用地用麻黄汤、桂枝汤来兼治温热症,误人良多。陶节庵等名家,虽然将三种病剖析得清清楚楚,但根源仍归于寒,不免沿袭旧说而不能摆脱,又怎能责怪那些平庸的医生呢?我认为道由一气生成天地,由二气生成五行,五气各司其职,而水火最为重要。水火能生物,也能杀物。如果像仲景所说,就是水专擅其权,而火变得虚无无用。我认为冬天的寒病,专属寒威,这固然是不易改变的。至于春天阳气逐渐舒展,毛孔张开,穿着单夹衣物,这是天气变幻,忽暖忽冷,又多刮大风,人感受寒气直入脏腑,所以发生温病,还可以命名为春寒;这已经与冬天的寒不相干了。何况夏至以后,炎火时常流动,蒸郁灼人,得的病看似伤寒,都是暑火所感而成,与冬天的寒气毫不相涉,却认为它是冬天寒气积久所发,这就错了。
再看《生气通天论》说:因此阳气位于上部以卫护体表。因为受寒,阳气应当像门枢一样运转自如,如果起居惊扰不安,神气就会浮越。因为受暑,出汗、烦躁则喘息有声,安静时则多言,身体像燃烧的炭火一样热,出汗后热散而愈。这说明寒和暑病因不同,水和火的证候有别,明确列出断案,是万世医学的祖师。又有什么疑惑呢?然而《内经》说温病根源于寒是什么缘故?查考《山海经》,桂树名叫招摇,叶子长二尺,桑树名叫帝女,树干周长五十尺,桂竹叶大二尺多,高数丈,那里的草木奇怪类若此。根据经典想象太古时代,洪水横流,包围山岭,草木闭塞,天地蒙昧,阴霾郁结,阳明之气未舒,所以寒气盛行,元气稀少,即使是大夏天,也没有熔化金属的酷热。后世衣冠文物逐渐开启,五行分布,水火之气各司其权,像这样争烈的情形,就像现在春天遇到淫雨,余寒厉害,严重的像隆冬,裹着棉絮也不能去除。试看晋朝中暑证寥寥,绝无疟疾,这都是阴胜的证据,何况是上古洪荒时代呢?这就是《内经》说温病根源于寒的原因。为什么仲景于是申演这个说法,并把暑病归为一类呢?这是画蛇添足。而且古人吃生肉穿草衣,饮食简朴淡薄,没有助火的器具,后世烤肉的味道适口,郁热的酒充满腹部,嗜欲烧灼精气,尘世劳累耗损元气,都足以煽动火焰而炽盛,适宜暑火乘虚而入。说古时候寒病多而暑病少,现在寒暑并重,而暑病尤其剧烈是可以的,所以我特别立论说:伤寒是感受冬天的严寒,温病是感受春天的轻寒,至于暑病则是专门感受夏天的炎热,如同冰炭、霄泉互不相干,一水一火,各掌其令。治疗方法一个用热剂,一个用凉剂,各中其窍,如果一概认为是寒邪所致,岂不是固执一端而遗漏了另一端吗!我俯仰沉思,万不得已,敢于推翻千古成案,以开启百世的觉悟,破除迷障而拔除痛苦,于是自甘于僭越窃取之名罢了。
霖按:《素问·生气通天论》说春天伤于风,邪气留连,就发生洞泄;夏天伤于暑,秋天发生疟疾;秋天伤于湿,气上逆而咳,发为痿厥;冬天伤于寒,春天必病温。这是四时伏气的机理,也是阴阳互根的道理。春天伤于风,是阳邪。留连日久,就下行为洞泄这种阴病。秋天伤于湿,是阴邪,就上逆为咳这种阳病。夏天伤于暑热,是阳邪,到秋天发为疟疾这种阴病。冬天伤于寒,是阴邪,到春天必发为温热这种阳病。这是阴阳上下相互乘侮。这种六淫邪气伤人,是因为人身阴阳不固密,所以《金匮真言论》说:精是身体的根本。所以藏精的人,春天不病温。夏天暑天汗不出的人,秋天会形成风疟,足见人身的气血都生于精。冬天宜闭藏,则阴气固密,如果纵欲导致精耗则阴虚,阴虚则阳邪容易侵犯,所以多病温。夏天宜疏泄,违背它则汗不出,汗不出则暑邪内伏,遇到秋风凄切,寒热相战,就形成疟病。阴阳开闭,时令之气本该如此,举冬天夏天为例,春秋的伏气自然可以类推。而《阴阳应象大论》又重复讲四时伏气,大概六淫之邪,也由于七情不慎,五脏化生的五气成为内贼来伤害身体,这是《内经》反复阐明伏邪的意义。
又按:《素问·热论》说:现在的热病,都属于伤寒之类。扁鹊(越人)《难经·五十八难》说:伤寒有五,有中风,有伤寒,有湿温,有热病,有温病。它们的名称各不相同,这证明伤寒是古代医经的通称。张仲景《伤寒论》太阳篇,首先揭示发热汗出、恶风脉缓的,名叫中风。恶寒发热、体痛呕逆、脉阴阳俱紧的,名叫伤寒。发热而渴、不恶寒的,为温病。发汗后,身体灼热,脉阴阳俱浮的,为风温。辨析论述寒温的症状,清晰如列眉,治疗三种病的法则,尤其有深意。无奈书籍经过兵火散佚,虽然高平人王叔和编次,仅存伤寒治法,而温暑亡失更多,不能把王叔和序例中的杂乱话语拉杂在一起,妄议仲景寒温不分。《内经》说温病根源于寒,意思是严寒遏制热气,这是习坎卦的含义,也不须远引洪荒时代,曲折解说。温病固然不是春天的轻寒,暑病也并非专门感受夏天的炎热。想要明白温暑伏气的意义,应当仔细参究《内经》,才不被各种言论所迷惑。
According to the *Suwen: Shengqi Tongtian Lun* (Treatise on the Connection between Human Life and Heaven in the Basic Questions), it is said: Since ancient times, the connection between humans and heaven has been the root of life, which lies in Yin and Yang. Within the universe and the six directions, the Qi of the nine regions (referring to internal organ distributions), nine orifices, five Zang organs, and twelve joints are all connected with Heavenly Qi. Life activities are categorized into five (Five Elements), and Qi dynamics are divided into three (Three Yin and Three Yang). If one frequently violates these principles, pathogenic factors will harm the body; this is the foundation of longevity. From this discussion, we see that human Yuan Qi (Original Qi) connects with heaven; if nurtured properly, how can disease arise? However, diseases have causes and origins. Treating according to the origin makes healing easier.
The *Suwen: Yinyang Yingxiang Dalun* (Great Treatise on the Correspondence between Yin-Yang and Phenomena) states: Heaven has four seasons and Five Elements, which govern growth, flourishing, gathering, and storage, thereby generating Cold, Heat, Dryness, Dampness, and Wind. Humans have five Zang organs that transform into five Qi, generating Joy, Anger, Sorrow, Grief, and Fear. It also says: Exposure to dew and wind leads to cold and heat disorders. Thus, injury by wind in spring, with lingering pathogenic factors, results in severe diarrhea (Dongxie); injury by summerheat in summer leads to malaria (Nüe) in autumn; injury by dampness in autumn causes upward counterflow coughing, developing into Phlegm-Jue (Tan-Jue); injury by cold in winter leads to Warm diseases (Wenbing) in spring. The Qi of the four seasons alternately harms the five Zang organs; this is the etiology of the four seasonal Qi.
Yellow Emperor clearly explained that Spring-Warmth originates from Winter-Cold. Although the climate and symptoms are similar, the original text did not include Summerheat. When Zhang Zhongjing of the Han Dynasty wrote the *Shanghan Lun* (Treatise on Cold Damage Disorders), he expanded on the *Neijing* theory: Injury by the Qi of the four seasons can cause disease. Among them, the most lethal is the killing Qi. Immediate onset after injury is called Shanghan (Cold Damage). Non-immediate onset involves Cold toxicity hiding in the skin and muscles, transforming into Wenbing in spring and Shubing (Summerheat Disease) in summer. Shubing is more intense in heat than Wenbing. Since this theory emerged, later practitioners of Qihuang medicine have revered it. If true, this implies a sole focus on Cold as the pathogen. These three diseases differ in duration but share Cold as the root. Hence, later physicians proposed "Four-Season Shanghan," even using Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction) to treat Warm-Heat syndromes, causing much harm. Experts like Tao Jian'an analyzed the three diseases clearly but remained rooted in Cold, failing to break free from tradition. How can one blame mediocre doctors?
I argue that Dao generates heaven and earth through one Qi, and the Five Elements through two Qi. The five Qi have their functions, with Water and Fire being paramount. Water and Fire can generate and destroy. If Zhongjing’s view holds, Water monopolizes power while Fire becomes void and useless. I believe winter cold diseases are exclusively due to Cold dominance, which is unchangeable. In spring, Yang Qi gradually expands, pores open, and clothing changes. Weather fluctuates between warm and cold, with frequent winds. Humans contracting cold directly into the zang-fu organs develop Warm diseases, which could be named "Spring Cold." This is distinct from Winter Cold. Moreover, after the Summer Solstice, blazing fire flows, steaming and scorching people. Diseases resembling Shanghan are caused by Summerheat-Fire, unrelated to Winter Cold. Attributing them to accumulated Winter Cold is erroneous.
Revisiting the *Shengqi Tongtian Lun*: "Therefore, Yang Qi resides above to defend the exterior. Due to Cold, it should move like a door pivot; if daily life is disturbing, Shen Qi (Spirit Qi) floats." Due to Summerheat, sweating occurs; restlessness leads to panting and loud breathing; stillness leads to excessive talking; the body feels like burning charcoal, resolving when sweat appears. This clearly distinguishes Cold and Summerheat etiologies and Water and Fire syndromes, serving as an eternal medical ancestor. What confusion remains?
Why does the *Neijing* state that Warmth roots in Cold? According to the *Shanhai Jing*, the Gui tree (Cassia) is called Zhaoyao, with leaves two chi long; the Sang tree (Mulberry) is called Divinü, with a trunk circumference of fifty chi. Ancient times saw floods overflowing mountains, vegetation blocked, and heaven and earth shrouded in gloom. Yangming Qi was unexpanded, so Cold prevailed, and Yuan Qi was scarce. Even in midsummer, there was no metal-melting heat. Later, with the development of civilization and distribution of Five Elements, Water and Fire powers balanced. Today, spring rains bring lingering cold, severe enough to require fur clothing. In Jin dynasty records, Summerheat cases were rare, and malaria was absent, proving Yin dominance. How much more so in prehistoric times? This explains why the *Neijing* links Warmth to Cold. Why did Zhongjing extend this to include Summerheat? This is superfluous. Ancients ate raw meat and wore grass, with simple diets and no heating tools. Later generations enjoyed roasted meats and fermented wines, indulging in desires and labor, which ignite flames and favor Summerheat invasion. It is plausible that ancient times had more Cold diseases and fewer Summerheat diseases, whereas today both are heavy, with Summerheat being more severe. Therefore, I specifically propose: Shanghan is contracted from Winter's severe cold; Wenbing from Spring's mild cold; Shubing exclusively from Summer's intense heat. They are as incompatible as ice and charcoal, or sky and spring water; Water and Fire each hold their command. Treatment requires hot decoctions for one and cool decoctions for the other, targeting specific pathways. To attribute all to Cold is to cling to one aspect while ignoring another. After deep reflection, compelled to act, I dare to overturn ancient precedents to awaken future generations, dispelling delusion and suffering, accepting the charge of overstepping.
Lin notes: The *Suwen: Shengqi Tongtian Lun* mentions spring wind injury leading to diarrhea, summer heat injury leading to autumn malaria, autumn dampness injury leading to cough and Wei-Jue (Flaccidity-Jue), and winter cold injury leading to spring warmth. This illustrates the mechanism of latent Qi across seasons and the mutual root of Yin and Yang. Spring wind is Yang pathogen; lingering leads to Yin-type diarrhea. Autumn dampness is Yin pathogen; counterflow leads to Yang-type cough. Summer heat is Yang pathogen; manifesting in autumn as Yin-type malaria. Winter cold is Yin pathogen; manifesting in spring as Yang-type warmth. This shows Yin-Yang mutual overcoming. Six Excess pathogens harm the body due to insecure Yin-Yang. The *Jinkui Zhenyan Lun* states: Essence is the root of the body. Those who conserve essence do not get Warm diseases in spring. Those who do not sweat in summer heat will develop wind-malaria in autumn. This proves Qi and Blood originate from Essence. Winter favors storage and solid Yin; desire depletes Essence, causing Yin deficiency and Yang pathogen invasion (Warm diseases). Summer favors dispersion; inhibiting sweating traps Summerheat, which clashes with autumn wind to cause malaria. Yin-Yang opening/closing follows seasonal norms. Extending from winter/summer, spring/autumn latent Qi can be inferred. The *Yinyang Yingxiang Lun* repeats latent Qi because Six Excess pathogens also stem from emotional imbalance, where Zang-transformed Qi become internal thieves. This clarifies the meaning of latent pathogens.
Furthermore, the *Suwen: Relun* states: All current heat diseases belong to the category of Shanghan. Bian Que (Yueren) in *Nanjing Chapter 58* says: Shanghan includes five types: Zhongfeng (Wind Strike), Shanghan, Shiwen (Damp-Warmth), Rebing (Heat Disease), and Wenbing. Their names differ, proving Shanghan is a general term in ancient classics. In the *Taiyang Pian* of Zhang Zhongjing’s work, fever with sweating, aversion to wind, and slow pulse is Zhongfeng. Aversion to cold, fever, body pain, vomiting, and tight pulses are Shanghan. Fever with thirst and no aversion to cold is Wenbing. Post-sweating burning heat and floating pulses are Fengwen (Wind-Warmth). The differentiation of Cold and Warm symptoms is clear. The treatment principles have profound meaning. Unfortunately, books were lost in wars. Wang Shuhe edited them, preserving only Shanghan treatments, while Warm and Summerheat texts were largely lost. One cannot use Wang’s preface to claim Zhongjing confused Cold and Warm. The *Neijing*’s link of Warmth to Cold means Cold suppresses Heat (Kan trigram meaning). One need not invoke prehistory. Wenbing is not merely spring cold; Shubing is not solely summer heat. To understand latent Warm/Summerheat, one must study the *Neijing* carefully to avoid confusion.