详见疟门滞下门
详见本门
东垣曰夫脾胃虚弱遇六七月间河涨霖雨诸物皆润人汗沾衣身重短气甚则四肢痿软行步不
正脚
欹眼黑此肾水与膀胱俱竭之状也当急救之滋肺气以补水之上源又使庚大肠不受邪热不令汗大
泄也汗泄甚则止津液七神无所根据津液相成神乃自生津者庚大肠所主三伏之义庚金受囚木无可
制故风湿相搏骨节烦疼一身尽痛亢则害承乃制是也五月常服五味子是泻丙火补庚大肠益五脏
之元气壬膀胱之寒已绝于己癸肾水已绝于午今更逢湿旺助热为邪西方北方之寒清绝矣圣人立
法夏月宜补者补天元真气非补热火也今人夏食寒是也为热伤元气以人参麦门冬五味子生脉HT
者元气也
谨按王太仆曰苍天布气尚不越于五行人在气中岂不应乎天道然为医者不审阴阳消长升降
浮沉之理将何所据焉故丹溪先生有夏月伏阴在内论深明东垣未悉之旨因附于左宜参考焉
丹溪曰天地以一元之气化生万物根于中者曰神机根于外者曰气立万物天地同此一气人灵
于物
形肖天地参而为三者以其得气之正而通之故天地之气升人之气亦升天地之气浮人之气亦浮降
亦降沉亦沉人与天地同一 也子月一阳生寅月三阳生此气之升也已月六阳生阳尽出地之上
矣此气之浮也人之腹属地气于此时浮于肌表散于皮毛腹中之阳虚矣经曰夏月经满气溢入孙络
受血皮肤充实长夏经络皆盛内HT 嗌肌中又曰夏气在孙络长夏气在肌肉所以表实者里必虚世言夏
月伏阴在内此阴字有虚之义若作阴冷看其误甚矣或曰以手扪腹明知其冷而何前人治暑病有用
玉龙丹大顺散桂苓丸单煮良姜与缩脾饮用草果等皆行温热之剂何吾子不思之甚也子曰经言春
夏养阳王太仆谓春食凉夏食寒所以养阳也其意可见矣若夫凉台水馆大扇风车阴木寒泉水果冰
雪寒凉之伤自内及外不用温热病何由安详玩其意实非为内伏阴冷而用之也前哲又谓升降浮沉
则顺之寒热温凉则逆之若谓夏月火令之时妄投温热宁免实实虚虚之患乎或曰已月纯阳于理或
通五月一阴六月二阴阴气既动岂无阴冷曰此阴之初动于地下也四阳浮于地上燔灼焚炎流金烁
石何冷之有孙真人生脉散令人夏月服之非虚而何
详见本门(指中暑门)。
李东垣说:脾胃虚弱的人,遇到七、八月间河水上涨、连绵阴雨的时候,万物都湿润,人出汗沾湿衣服,身体沉重、气短,严重时四肢痿软无力,行走不正,脚歪斜,眼前发黑。这是肾水和膀胱都枯竭的表现,应当紧急救治。通过滋补肺气来补充水液的上源,又使大肠不受邪热侵袭,不让汗液大量泄出。如果汗出过多,就会停止津液的生成,神志失去依托。津液相互化生,神志自然安定。津液由大肠所主。三伏天时,庚金(大肠)受困,木气无法制约它,所以风湿相搏,骨节烦痛,全身疼痛。这就是“亢则害,承乃制”的道理。五月常服五味子,是为了泻丙火(心火),补庚大肠,益五脏的元气。壬膀胱的寒已绝于己土,癸肾水已绝于午火。现在更逢湿气旺盛,助长热邪为患,西方北方的寒清之气已经断绝了。圣人立法,夏季适宜补的是天元的真气,而不是补热火。现在的人夏天吃寒凉食物,是因为热伤了元气。用人参、麦门冬、五味子组成生脉散,是为了补元气。
谨按:王冰说:苍天布施气化,尚且不超出五行范围,人在气中,岂不应合天道?然而作为医生,如果不审察阴阳消长、升降浮沉的道理,依据什么呢?所以丹溪先生有《夏月伏阴在内论》,深刻阐明了李东垣未完全揭示的宗旨,因此附在这里,供参考。
朱丹溪说:天地以一元之气化生万物,根于体内的叫神机,根于体外的叫气立。万物与天地同此一气,人比万物灵秀,形体像天地,参赞而为三者,是因为得气之正而通达它。所以天地之气上升,人的气也上升;天地之气浮越,人的气也浮越;下降也下降,沉降也沉降。人与天地是同一的。子月一阳生,寅月三阳生,这是气的上升;巳月六阳生,阳气全部出于地上,这是气的浮越。人的腹部属地气,在这个时候,阳气浮于肌表,散于皮毛,腹中的阳气虚了。经书说:夏季经脉满盛,气溢入孙络,受血,皮肤充实。又说:长夏经络皆盛,内嗌,肌中。又说:夏气在孙络,长夏气在肌肉。所以表实者里必虚。世人说夏季伏阴在内,这个“阴”字有虚的含义。如果看作阴冷,那就大错特错了。有人说:用手摸肚子,明明觉得冷,为什么前人治疗暑病有用玉龙丹、大顺散、桂苓丸、单煮良姜、缩脾饮用草果等,都是温热性质的药剂呢?你怎么不想想得很深呢?我说:经书说春夏养阳,王冰说春食凉、夏食寒,以此来养阳,其中的意思可以看到了。至于凉台水馆、大扇风车、阴木寒泉、水果冰雪这些寒凉之物,伤害是从内部到外部的,不用温热药,病怎么能安详平息?玩味其意,实在不是为了内伏阴冷而用的。前哲又说:升降浮沉则顺其性,寒热温凉则逆其性。如果说夏季火令之时,妄投温热,难道能避免实实虚虚的祸患吗?有人说:巳月纯阳,按理或许通融;五月一阴生,六月二阴生,阴气既然发动,难道没有阴冷吗?我说:这是阴气初动于地下。四阳浮于地上,燔灼焚炎,流金烁石,哪里有什么冷呢?孙思邈的生脉散让人在夏季服用,如果不是为了治虚证,又是为了什么?
See the sections on Malaria (Nüe) and Dysentery (Zhixia).
See the section on this disease.
Li Dongyuan said: When the Spleen and Stomach are weak, during the seventh and eighth months when rivers flood and rain persists, all things become moist. People sweat until their clothes are damp, feel heavy in the body, suffer from shortness of breath, and in severe cases, experience flaccidity and weakness in the four limbs, unsteady gait, foot deviation, and blurred vision. This is a state where Kidney Water and Bladder Qi are exhausted. Immediate rescue is required. One should nourish Lung Qi to replenish the upper source of fluids, prevent the Large Intestine from being invaded by pathogenic heat, and avoid excessive sweating. If sweating is excessive, fluid production ceases, and Shen (Spirit) loses its foundation. Fluids mutually generate, and Shen stabilizes itself. Fluids are governed by the Large Intestine (Geng Metal). During the Sanfu days, Geng Metal is confined, and Wood cannot control it; thus, Wind-Dampness combats each other, causing joint pain and whole-body ache. This illustrates the principle that "excess leads to harm, and restraint brings regulation." Taking Wuweizi (Schisandra Chinensis Fruit) regularly in the fifth month helps to drain Bing Fire (Heart Fire), tonify Geng Large Intestine, and benefit the Yuan Qi of the Five Zang Organs. The cold of Ren Bladder is exhausted by Ji Earth, and Gui Kidney Water is exhausted by Wu Fire. Now, with abundant Dampness assisting Heat as a pathogen, the cold and clear Qi of the West and North have ceased. The Sages established the method that in summer, one should tonify the Tianyuan True Qi, not tonify Hot Fire. Nowadays, people eat cold foods in summer because Heat has injured their Yuan Qi. Shengmai San (Pulse-Generating Powder), composed of Renshen (Ginseng Radix et Rhizoma), Maidong (Ophiopogonis Tuber), and Wuweizi (Schisandrae Fructus), is used to tonify Yuan Qi.
Commentary: Wang Bing stated: Heaven distributes Qi, which does not exceed the Five Elements. Humans exist within Qi; how could they not correspond to the Way of Heaven? However, if physicians do not examine the principles of Yin-Yang waxing and waning, ascending and descending, floating and sinking, what basis do they have? Therefore, Mr. Danxi wrote "On Hidden Yin Inside During Summer," profoundly elucidating points not fully addressed by Dongyuan. It is attached here for reference.
Zhu Danxi said: Heaven and Earth transform and generate all things through the Qi of One Origin. Those rooted inside are called Shenji (Spirit Mechanism); those rooted outside are called Qili (Qi Establishment). All things share this single Qi with Heaven and Earth. Humans are more spiritual than other beings, their forms resembling Heaven and Earth, participating as three because they obtain the upright Qi and connect with it. Thus, when Heaven and Earth's Qi ascends, human Qi also ascends; when it floats, human Qi floats; when it descends, human Qi descends; when it sinks, human Qi sinks. Humans and Heaven and Earth are identical. In Zi Month, one Yang arises; in Yin Month, three Yangs arise; this is the rising of Qi. In Si Month, six Yangs arise, and Yang Qi emerges completely above ground; this is the floating of Qi. The human abdomen corresponds to Earthly Qi. At this time, Yang Qi floats on the muscle surface and disperses into the skin and hair, leaving the internal Yang deficient. The Classics state: In summer, meridians are full, Qi overflows into Sunluo (Sun Collaterals), blood is received, and skin becomes firm. It also states: In Changxia (Late Summer), meridians are prosperous, Qi enters the throat and muscles. Furthermore: Summer Qi resides in Sunluo; Changxia Qi resides in muscles. Therefore, when the exterior is excess, the interior must be deficient. The saying "Hidden Yin inside during summer" implies that "Yin" refers to deficiency. Interpreting it as coldness is a serious error. Some ask: Touching the abdomen clearly feels cold. Why did predecessors use warm and hot agents like Yulong Dan, Dashun San, Guiling Wan, boiled Liangjiang (Galangal Rhizome), or Suopi Yin with Caoguo (Tsaoko Fructus) to treat Summerheat diseases? Have you not considered this deeply? I say: The Classics state "Nourish Yang in Spring and Summer." Wang Bing said eating cool in spring and cold in summer nourishes Yang. This intent is visible. Regarding cool pavilions, water halls, large fans, wind wheels, shady woods, cold springs, fruits, ice, and snow—these cold injuries affect from inside out. Without warm agents, how can the illness resolve peacefully? Examining the meaning, these were not used for hidden internal cold. Former sages also said: For ascending, descending, floating, and sinking, follow their nature; for cold, heat, warm, and cool, oppose their nature. If one recklessly administers warm and hot agents during the Fire Command of summer, will one not incur the disaster of reinforcing excess and depleting deficiency? Some argue: Si Month is pure Yang, so perhaps it allows flexibility; May sees one Yin arising, June sees two Yin arising. Since Yin Qi moves, is there no cold? I say: This is the initial movement of Yin underground. Four Yangs float on the ground, blazing and burning, melting metals and cracking stones. Where is the cold? Sun Simiao's Shengmai San is taken in summer; if not for deficiency, for what else?