三尸九虫,与人俱生,无所假也。外此必有所假而生,如 瘕门之鳖症、蛇瘕、鸡雏,
及诸
门之蜣螂、蚍蜉、蝼蚁等名,皆因饮食而假外之虫气以生。其结于肠胃之募原为 瘕,散
于经络为 也。至若五脏之劳,有五脏之虫,五色之风,有五色之虫,则并不假于外之虫气
以生。若曰人身血肉可化异类,毋乃诞乎!此必假内之虫气以生也。内之虫气,三尸九虫是
也。大抵邪入而与三尸九虫相感,则孕而生虫,犹之六淫之感人,本以人五脏所禀五行气应
之也,夫何足怪!《病源》卷二十三去∶尸虫常接引外邪,为人患害。又阴尸者,初着之状
,起于皮肤,内卒有物,状如蛤蟆,经宿与身内尸虫相搏,如杯大,动摇掣痛不可忍者,多
因天雨得之。此外邪与尸虫相感之证,风劳生虫,亦犹是也。知此,始可与论尸注、疳蒸诸
大症。若仅执热极风生之说,犹知其当然,不知其所以然也。又况以隋唐言虫诸论,为不经
而弃之哉!
寒与热为定名,温与疫为虚位。伤寒例虽以温兼正气,疫贴时气,其实温者蕴也。疫者
役也
。苟有蕴蓄在内,而其病如相役使者,不论寒热,皆得称为温疫例,据时称以示别,不必泥
看。能知此义,而后百家之言温疫者,可一一以意逆之也。夫温与疫既为虚位,则其为病不
一。但因于寒暑,而又有四时不正之气挟之,则为天行温疫,属伤寒;若因于寒暑,而又
有山川林谷及天地雾雾之气抑之,则为瘴疫温瘴,亦通称为温疫;因于寒暑,而又有鬼神之
气乘之,则为疠疫,亦称温疫,属杂病;苦因于寒暑,而又有饮食之气间之,则发为杂病,
如霍乱、疟、疸之类,皆不称为温疫,属杂病。条分缕析,而后温疫诸杂出之论,不至目炫
。此温疫数者中,惟鬼神一因与因于寒暑者,言多相混,近世不能分别,须细参《病源》卷
十疠疫、瘴气两候及《千金》卷九辟温篇自明。《病源》疠瘴不与温病同篇,而另列为一卷
,《千金》以两温分居二篇首尾,岂无意哉?而鬼神之不兼温疫者,自属中恶,与伤寒法无
涉。犹瘴不兼温疫,但为之瘴;饮食不兼温疫,但谓之伤饮食而已。
三尸九虫,与人俱生,无所假也。
三尸和九虫是与人生来就有的,并非借助外物而产生。
外此必有所假而生,如瘕门之鳖症、蛇瘕、鸡雏,及诸门之蜣螂、蚍蜉、蝼蚁等名,皆因饮食而假外之虫气以生。
除此之外,必定是借助外物而产生的,比如《瘕聚》篇中提到的鳖瘕、蛇瘕、鸡雏,以及其他篇章中提到的蜣螂、蚂蚁、蝼蛄等名称,都是因为饮食不当,借取了外界虫类的“气”而生成。
其结于肠胃之募原为瘕,散于经络为疰。
如果这些虫气凝结在肠胃的募原(脏腑之间筋膜组织),就会形成瘕聚;如果散布在经络之中,就会形成疰病(具有传染性或迁延性的疾病)。
至若五脏之劳,有五脏之虫,五色之风,有五色之虫,则并不假于外之虫气以生。
至于五脏虚劳产生的病症,会有五脏对应的虫;五色对应的气候异常(风邪),也会有五色对应的虫,这些并不是借助外界的虫气生成的。
若曰人身血肉可化异类,毋乃诞乎!
如果说人的血肉可以转化为其他种类的生物,这岂不是荒谬吗!
此必假内之虫气以生也。内之虫气,三尸九虫是也。
这一定是借助体内固有的虫气生成的。体内的虫气,指的就是三尸和九虫。
大抵邪入而与三尸九虫相感,则孕而生虫,犹之六淫之感人,本以人五脏所禀五行气应之也,夫何足怪!
大体上,外邪侵入人体后与体内的三尸九虫相互感应,从而孕育生出虫子,这就好比六淫(风、寒、暑、湿、燥、火六种外感病邪)侵犯人体,本来就是因为人体五脏所禀受的五行之气与之相应,这有什么值得奇怪的呢!
《病源》卷二十三去∶尸虫常接引外邪,为人患害。
《诸病源候论》卷二十三记载:尸虫常常引导外邪进入人体,给人带来祸害。
又阴尸者,初着之状,起于皮肤,内卒有物,状如蛤蟆,经宿与身内尸虫相搏,如杯大,动摇掣痛不可忍者,多因天雨得之。
另外,阴尸病的初期症状,发作始于皮肤,体内突然感到有异物,形状像蛤蟆,经过一夜后与体内的尸虫相互搏斗,肿块大小如杯子,摇动时牵引疼痛,难以忍受,这大多是因为下雨天感受湿气而得的。
此外邪与尸虫相感之证,风劳生虫,亦犹是也。
这是外邪与尸虫相互感应的病症,由风邪导致的虚劳生虫,也是同样的道理。
知此,始可与论尸注、疳蒸诸大症。
了解了这个道理,才可以讨论尸注(一种慢性消耗性传染病)、疳蒸(小儿疳积发热)等重大病症。
若仅执热极风生之说,犹知其当然,不知其所以然也。
如果只是固执于“热极生风”的说法,虽然知道现象是这样,却不知道其背后的原理。
又况以隋唐言虫诸论,为不经而弃之哉!
更何况把隋唐时期关于虫证的论述视为不正规而抛弃呢!
寒与热为定名,温与疫为虚位。
“寒”与“热”是确定的性质名称,“温”与“疫”则是相对的概念位置(虚位,指代一类性质而非单一固定病因)。
伤寒例虽以温兼正气,疫贴时气,其实温者蕴也。疫者役也。
《伤寒例》虽然将“温”与正气相关联,将“疫”与时气相关联,但实际上,“温”意味着蕴蓄,“疫”意味着役使(传染流行)。
苟有蕴蓄在内,而其病如相役使者,不论寒热,皆得称为温疫例,据时称以示别,不必泥看。
只要体内有蕴蓄的病邪,且病情表现如同被役使般传染流行,无论表现为寒证还是热证,都可以称为温疫病范畴,根据季节时令称呼以示区别,不必拘泥于字面意思。
能知此义,而后百家之言温疫者,可一一以意逆之也。
能够理解这一层含义,那么对于各家关于温疫的言论,就可以逐一通过推究其意旨来理解了。
夫温与疫既为虚位,则其为病不一。
既然“温”和“疫”是虚位概念,那么它们所导致的疾病就不止一种。
但因于寒暑,而又有四时不正之气挟之,则为天行温疫,属伤寒;
如果是由于寒暑侵袭,又有四季不正之气夹杂其中,这就称为天行温疫(流行性温热病),归属于伤寒范畴;
若因于寒暑,而又山川林谷及天地雾雾之气抑之,则为瘴疫温瘴,亦通称为温疫;
如果是由于寒暑侵袭,又被山川林谷以及天地间雾气瘴气所压抑,这就称为瘴疫或温瘴,也统称为温疫;
因于寒暑,而又有鬼神之气乘之,则为疠疫,亦称温疫,属杂病;
如果是由于寒暑侵袭,又有鬼神之气(指代强烈的致病因子或精神因素)趁虚而入,这就称为疠疫,也称温疫,归属于杂病范畴;
苦因于寒暑,而又有饮食之气间之,则发为杂病,如霍乱、疟、疸之类,皆不称为温疫,属杂病。
如果是由于寒暑侵袭,同时又有饮食不节之气干扰,则发为杂病,如霍乱、疟疾、黄疸之类,都不称为温疫,归属于杂病。
条分缕析,而后温疫诸杂出之论,不至目炫。
这样条理清晰地分析,那么面对温疫各种繁杂的论述,就不会眼花缭乱。
此温疫数者中,惟鬼神一因与因于寒暑者,言多相混,近世不能分别,须细参《病源》卷十疠疫、瘴气两候及《千金》卷九辟温篇自明。
在这几种温疫成因中,只有“鬼神”这一成因与“寒暑”成因的论述经常混淆,近代医家不能分辨,必须仔细参考《诸病源候论》卷十的疠疫、瘴气两个条目,以及《千金要方》卷九的辟温篇,自然就能明白。
《病源》疠瘴不与温病同篇,而另列为一卷,《千金》以两温分居二篇首尾,岂无意哉?
《诸病源候论》将疠气和瘴气不与温病放在同一篇,而是单独列为一卷;《千金要方》将两种温病分别置于两篇的首尾,难道没有深意吗?
而鬼神之不兼温疫者,自属中恶,与伤寒法无涉。
至于鬼神之气如果不兼夹温疫性质的,自然属于中恶(急性中毒或突发性昏厥),与伤寒的治疗法则无关。
犹瘴不兼温疫,但为之瘴;饮食不兼温疫,但谓之伤饮食而已。
就像瘴气如果不兼夹温疫性质,只称为瘴;饮食不兼夹温疫性质,只称为伤食罢了。
San Shi (Three Corpses) and Jiu Chong (Nine Parasites) are born with humans, not relying on external borrowing.
San Shi (Three Corpses: spiritual parasites residing in the human body) and Jiu Chong (Nine Parasites: various internal worms/parasites) exist from birth; they do not originate from external sources.
Others must be generated through external borrowing, such as the鳖 Zhen (Turtle Mass), Snake Zhen, and Chicken Chick mentioned in the Zhen Men (Chapter on Masses), as well as names like Dung Beetle, Ant, and Mole Cricket in other chapters; all these arise because of improper diet, borrowing the "Qi" (vital energy/presence) of external insects.
Other than these innate ones, conditions must arise through external acquisition. For instance, the Turtle Mass (a type of abdominal mass resembling a turtle), Snake Mass, and Chicken Chick described in the chapter on Abdominal Masses, along with references to dung beetles, ants, and mole crickets in other sections, all result from dietary indiscretion where one absorbs the pathogenic influence of external insects.
When these condense at the Mu Yuan (origin of fu-organs located between the skin and internal organs) of the intestines and stomach, they form Zhen (abdominal masses); when scattered in the meridians and collaterals, they form Zhu (infectious or lingering diseases).
If this pathogenic influence aggregates at the Mu Yuan (the interstitial spaces connecting the zang and fu organs), it forms Zhen (masses); if it disperses into the meridians and collaterals, it manifests as Zhu disease (characterized by transmission and chronicity).
Regarding the exhaustion of the five zang organs, there are worms corresponding to the five zang; regarding the winds of five colors, there are worms corresponding to the five colors; these do not rely on external insect Qi for their generation.
As for disorders stemming from the depletion of the Five Zang organs, there are specific worms associated with each organ; similarly, wind pathogens associated with the Five Colors have corresponding worms. These are not derived from external insect influences.
To claim that human flesh and blood can transform into different species is absurd!
The assertion that human tissues can metamorphose into entirely different biological species is baseless and absurd.
This must be generated by borrowing the internal insect Qi. The internal insect Qi refers to San Shi and Jiu Chong.
Such phenomena must arise from the activation of internal parasitic Qi. This internal Qi corresponds to the San Shi (Three Corpses) and Jiu Chong (Nine Parasites).
Generally, when external pathogens enter and interact with San Shi and Jiu Chong, they gestate and produce worms, just as the Six Excesses (Liu Yin) affect humans because the Qi of the Five Elements inherent in the Five Zang organs resonates with them; what is strange about this?
Typically, when external pathogenic factors invade and resonate with the internal San Shi and Jiu Chong, they foster the development of parasites. This is analogous to how the Six Excesses (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) affect the body: it is fundamentally due to the resonance between the external pathogens and the Five Elements Qi inherent in the Five Zang organs. There is nothing surprising about this.
The *Bing Yuan* (Source of Diseases), Volume 23 states: "Shi Chong (Corpse Worms) often guide external evils to cause harm to humans."
The *Zhu Bing Yuan Hou Lun* (Catalogue of the Causes and Symptoms of All Diseases), Vol. 23, states: "The Corpse Worms frequently attract external pathogens, causing harm to the person."
Furthermore, Yin Shi (Yin Corpse Disease): its initial manifestation begins in the skin, suddenly an object appears internally, shaped like a toad; after overnight, it struggles with the internal Shi Chong, becoming cup-sized, shaking and causing pulling pain that is unbearable; this is mostly contracted due to rainy weather.
Additionally, regarding Yin Shi (Yin Corpse Syndrome): the initial symptoms manifest on the skin, followed by a sudden sensation of an internal mass resembling a toad. After remaining overnight, it contends with the internal Corpse Worms, growing to the size of a cup, causing throbbing and pulling pain that is intolerable. This condition is often acquired during rainy seasons due to dampness.
These are syndromes where external evils resonate with Shi Chong; worms generated by Wind Lao (Wind Exhaustion) are also of this nature.
These represent cases where external pathogens resonate with the Corpse Worms. Similarly, worms arising from Wind-induced consumption (Lao) follow this same mechanism.
Understanding this allows one to discuss major syndromes such as Shi Zhu (Corpse Transmission) and Gan Zheng (Childhood Malnutrition with Fever).
Only by grasping this principle can one properly discuss severe conditions such as Shi Zhu (a contagious wasting disease) and Gan Zheng (pediatric malnutrition syndrome with steaming fever).
If one merely adheres to the theory that 'extreme heat generates wind,' one knows the phenomenon but not the reason why.
Merely clinging to the doctrine that "extreme heat generates wind" reveals an understanding of the surface phenomenon but fails to comprehend the underlying etiology.
How much more so to discard the discussions on worms from the Sui and Tang dynasties as unorthodox!
It is even more unreasonable to dismiss the worm-related theories from the Sui and Tang dynasties as heterodox and reject them.
Cold and Heat are fixed names; Warmth and Epidemic are virtual positions (conceptual categories).
"Cold" and "Heat" are definitive pathological natures, whereas "Warmth" (Wen) and "Epidemic" (Yi) are conceptual categories rather than fixed etiologies.
Although the *Shanghan Li* (Example of Cold Damage) associates Warmth with righteous Qi and Epidemic with seasonal Qi, actually, Warmth implies accumulation; Epidemic implies service/transmission.
Although the *Shanghan Li* links "Warmth" with the body's righteous Qi and "Epidemic" with seasonal Qi, essentially, "Warmth" denotes internal accumulation, while "Epidemic" denotes transmissive or epidemic spread.
If there is accumulation within, and the disease acts like a transmissive force, regardless of cold or heat, it can be called the Warmth-Epidemic category; naming it according to the season distinguishes it, without needing rigid literal interpretation.
If there is internal accumulation and the disease exhibits transmissive characteristics, whether presenting as cold or heat, it falls under the category of Warmth-Epidemic. It should be named according to the season for distinction, without rigid adherence to literal definitions.
Understanding this meaning allows one to interpret the various schools' statements on Warmth-Epidemic by inferring their intent.
Once this concept is understood, one can analyze and interpret the diverse theories on Warmth-Epidemic put forward by various medical schools by deducing their underlying intent.
Since Warmth and Epidemic are virtual positions, the diseases they cause are not uniform.
Since "Warmth" and "Epidemic" are conceptual categories, the diseases they encompass are not uniform.
However, if caused by cold and summer-heat, accompanied by the irregular Qi of the four seasons, it is Tian Xing Wen Yi (Heavenly Transmission Warmth-Epidemic), belonging to Shanghan;
For example, if caused by cold and summer-heat, compounded by the irregular Qi of the four seasons, it is termed Tian Xing Wen Yi (Heavenly Transmission Warmth-Epidemic), which belongs to the Shanghan (Cold Damage) category;
If caused by cold and summer-heat, but suppressed by the misty Qi of mountains, forests, valleys, and heaven and earth, it is Zhang Yi Wen Zhang (Miasma Epidemic Warmth-Miasma), also generally called Wen Yi;
If caused by cold and summer-heat, yet constrained by the miasmic Qi of mountains, forests, valleys, and atmospheric vapors, it is termed Zhang Yi Wen Zhang (Miasma Epidemic/Warmth-Miasma), also broadly classified as Wen Yi;
If caused by cold and summer-heat, with the Qi of ghosts and gods taking advantage, it is Li Yi (Plague Epidemic), also called Wen Yi, belonging to Zabing (Miscellaneous Diseases);
If caused by cold and summer-heat, with the pathogenic influence of "ghosts and gods" (metaphor for intense or obscure pathogenic factors) exploiting the weakness, it is Li Yi (Plague Epidemic), also referred to as Wen Yi, falling under Zabing (Miscellaneous Diseases);
If caused by cold and summer-heat, interrupted by dietary Qi, it develops into miscellaneous diseases, such as Huoluan (Cholera-like disorder), Nue (Malaria), and Dan (Jaundice); these are not called Wen Yi, but belong to Zabing.
If caused by cold and summer-heat, but complicated by dietary pathogenic factors, it manifests as miscellaneous diseases, such as Huoluan (acute vomiting and diarrhea), Nue (malaria), and Dan (jaundice). These are not classified as Wen Yi but belong to Zabing.
Analyzing them in detail prevents confusion regarding the various mixed theories on Warmth-Epidemic.
By analyzing these distinctions clearly, one avoids being bewildered by the myriad conflicting theories on Warmth-Epidemic.
Among these types of Warmth-Epidemic, only the causes involving "ghosts and gods" and those involving "cold and summer-heat" are often confused in discourse; modern practitioners fail to distinguish them, requiring careful reference to *Bing Yuan* Vol. 10 on Li Yi and Zhang Qi, and *Qianjin* Vol. 9 on Pi Wen, to clarify.
Among these categories, the descriptions of causes related to "ghosts and gods" and those related to "cold and summer-heat" are frequently conflated. Contemporary physicians often fail to differentiate them; one must carefully consult Vol. 10 of the *Bing Yuan* (sections on Plague Epidemic and Miasma Qi) and Vol. 9 of the *Qianjin Yaofang* (section on Preventing Warmth) to achieve clarity.
The *Bing Yuan* does not place Li and Zhang in the same chapter as Wen Bing, but lists them in a separate volume; *Qianjin* places two types of Wen at the beginning and end of two chapters; could this be without significance?
The *Bing Yuan* separates Li (Plague) and Zhang (Miasma) from the chapter on Wen Bing (Warmth Diseases), placing them in a distinct volume. The *Qianjin Yaofang* positions two types of Wen at the beginning and end of separate chapters. Is this arrangement without deeper meaning?
Those cases involving ghosts and gods that do not combine with Warmth-Epidemic naturally belong to Zhong E (Sudden Evil Attack), having no relation to Shanghan methods.
Cases involving "ghosts and gods" that do not overlap with Warmth-Epidemic characteristics naturally fall under Zhong E (Sudden Attack by Evil), which is unrelated to the treatment principles of Shanghan.
Just as Zhang (Miasma) not combining with Wen Yi is simply called Zhang; dietary issues not combining with Wen Yi are simply called Injury by Diet.
Similarly, if Miasma does not combine with Warmth-Epidemic features, it is simply termed Zhang; if dietary injury does not combine with Warmth-Epidemic features, it is simply termed Dietary Injury.