(《素问·气厥论》全)
黄帝问曰∶五脏六腑寒热相移者何?(相移者,以此病而移于彼也。)岐伯曰∶肾移寒于脾,痈肿少气。(肾中寒气
移于脾者,乃为痈肿。凡痈毒之病,寒热皆能为之,热者为阳毒,寒者为阴毒。盖脾主肌肉,得寒则气聚而坚,坚而不
散,则为肿为痈也。一曰∶痈者壅也,肾以寒水之气,反传所胜,侵侮脾土,故壅为浮肿。其义尤通。少气者,寒盛则
阳虚于下,阳虚则无以化气也。脾字王注作肝。误也。按全元起及《甲乙经》俱作脾者是,今改从之。)脾移寒于肝,痈
肿筋挛。(脾中寒胜,则反传于肝。脾寒则肉寒,故为痈肿。肝寒则筋寒,故为拘挛。)肝移寒于心,狂,隔中。(肝移寒
于心,传其所生也。心主火,其藏神,受肝邪之寒逆,故神乱而为狂。心脉出属心系下隔,阳为阴抑,则气有不行,故
隔塞不通也。)心移寒于肺,肺消。肺消者,饮一溲二,死不治。(心与肺,二阳脏也。心移寒于肺者,君火之衰耳。心
火不足则不能温养肺金,肺气不温则不能行化津液,故饮虽一而溲则倍之。夫肺者水之母也,水去多则肺气从而索矣,
故曰肺消。门户失守,本元日竭,故死不能治。按王氏注曰∶心受诸寒,寒气不消,乃移于肺,寒随心火,内烁金精,
金受火邪,故中消也。愚谓火烁于内者,又安得饮一而溲二?此注似为未妥。)肺移寒于肾,为涌水。涌水者,按腹不坚,
水气客于大肠,疾行则鸣濯濯,如囊裹浆水之病也。(涌水者,水自下而上,如泉之涌也。水者阴气也,其本在肾,其末
在肺。肺移寒于肾,则阳气不化于下,阳气不化,则水泛为邪而客于大肠,以大肠为肺之合也。但按腹不坚,而肠中濯
濯有声者,即是其候。涌, 同。)
脾移热于肝,则为惊衄。(上文言移寒,此下言移热也。脾移热于肝者,反传所胜,热之甚也。肝藏血,病主惊骇,
邪热薄之,则风火交作,故为惊,为鼻中出血也。衄,女六切。)肝移热于心,则死。(心木属火,而肝以风热移之,木
火相燔,犯及君主,故当死也。)心移热于肺,传为膈消。(肺属金,其化本燥,心复以热移之,则燥愈甚而传为膈消。
膈消者,膈上焦烦,饮水多而善消也。按∶上文言肺消者因于寒,此言膈消者因于热,可见消有阴阳二证,不可不辨。)
肺移热于肾,传为柔 。(柔,筋软无力也。 ,骨强直也。肺主气,肾主骨,肺肾皆热,则真阴日消,故传为柔 。按
《伤寒论》曰∶太阳病发热无汗,反恶寒者,名曰刚 ;太阳病发热汗出,不恶寒者,名曰柔 。此又以无汗有汗分刚
柔,但皆兼强直为言也。 音翅。)肾移热于脾,传为虚,肠 ,死不可治。(肾移热于脾者,阴火上炎也。邪热在下,
真阴必亏,故传为虚损。肾本水脏而挟热侮脾,故为肠 。下利脓血,阴虚反克,则水土俱败,故死不治也。 音僻。)
胞移热于膀胱,则癃,溺血,(胞,子宫也,在男则为精室,在女则为血室。膀胱,津液之府也,俗名谓之溲胞。命门火
盛。则胞宫移热于膀胱,故小便不利为癃,甚则为溺血。常见相火妄动,逆而不通,多患此者,即其证也。胞,包、脬
二音,在胞胎之胞则音包,在溲胞之胞则音脬,义详气味类三。癃,良中切。溺,娘料切。)膀胱移热于小肠,膈肠不便,
上为口糜。(膀胱之热上行,则移于小肠。小肠之脉循咽下膈抵胃,其支者循颈上颊,故受热为膈肠之病则痞塞不便,受
热于咽颊之间则上为口糜。糜,苗肌切,烂也。)小肠移热于大肠,为 瘕,为沉。(小肠之热下行,则移于大肠。热结
不散,则或气或血,留聚于曲折之处,是为 瘕。 瘕者,谓其隐伏秘匿,深沉不易取也。 ,伏同。瘕,加、驾二音。)
大肠移热于胃,善食而瘦,又谓之食亦。(大肠移热于胃,燥热之气上行也,故善于消谷。阳明主肌肉而热烁之,则虽食
亦病而瘦,所以谓之食亦。)胃移热于胆,亦曰食亦。(阳明胃热而移于胆,则木火合邪,不生脾土,故亦当善食而瘦。)
胆移热于脑,则辛 鼻渊。鼻渊者,浊涕下不止也。(胆经之脉起于目锐 ,上抵头角,下耳后,曲折布于脑后,故胆移
热于脑,则为辛 鼻渊之病。辛,酸辛也。 音遏,鼻茎也。)传为衄 瞑目。(脑热不已,则传为此证。衄 皆为鼻血,
但甚者为衄,微者为蔑。热伤阴血,则目无所养,故令瞑目,以羞明不能开也。衄,女六切。蔑音灭。)故得之气厥也。
(厥者,气逆也。此总结一篇之义,皆由气逆所致。)
(《素问·气厥论》全文)
黄帝问道:五脏六腑之间的寒热邪气相互传移,是怎么回事?(所谓“相移”,是指此处的病邪转移到了彼处。)岐伯回答说:肾中的寒邪转移至脾脏,会导致痈肿和少气。(肾中寒气转移到脾,就会形成痈肿。大凡痈毒这类疾病,寒邪和热邪都能引起,热邪引起的称为阳毒,寒邪引起的称为阴毒。因为脾主肌肉,遇到寒邪则气机凝聚而坚硬,坚硬而不消散,就形成了肿胀和痈块。另一种说法是:“痈”意为壅塞,肾以寒水之气反传给它所克制的脏腑,侵犯并欺凌脾土,所以壅滞形成浮肿。这种解释更为通达。“少气”,是因为寒盛导致下焦阳气虚衰,阳气虚衰就无法化生元气。王冰注中将“脾”字写作“肝”,是错误的。按全元起本及《甲乙经》都作“脾”字是正确的,现在改正依从它。)脾中的寒邪转移至肝脏,会导致痈肿和筋脉拘挛。(脾中寒邪偏胜,则反过来传传给肝。脾寒则肌肉寒冷,所以形成痈肿;肝寒则筋脉寒冷,所以发生拘挛。)肝中的寒邪转移至心脏,会导致发狂和膈中阻塞不通。(肝寒邪气转移给心,是传给了它所生的脏腑。心属火,藏神,受到肝邪传来的逆乱寒气的侵袭,所以神志错乱而发狂。心脉出属于心系向下经过膈膜,阳气被阴寒抑制,导致气机运行不畅,所以出现膈部堵塞不通的现象。)心中的寒邪转移至肺脏,会导致肺消症。肺消症的症状是喝一份水却排出两份尿,这是死证,无法治疗。(心和肺,都是阳脏。心将寒邪转移给肺,是因为君火衰弱。心火不足就不能温养肺金,肺气不温暖就不能运化津液,所以虽然喝水一份,排尿却加倍。肺是水液代谢的源头,水分流失过多则肺气随之枯竭,所以称为肺消。门户失守,根本元气日益耗尽,所以死亡且无法治疗。按王冰注解说:心受各种寒邪,寒气不能消除,于是转移给肺,寒气随着心火,在内灼烧金的精气,金受到火邪侵害,所以是中消。我认为如果火在内部灼烧,怎么会出现喝一份尿两份的情况呢?这个注释似乎不太妥当。)肺中的寒邪转移至肾脏,会导致涌水。涌水的症状是按压腹部并不坚硬,水气客居在大肠,快速走动时肠中发出濯濯的声音,就像囊袋包裹着浆水一样的病症。(涌水,是指水自下而上涌出,像泉水喷涌一样。水是阴气,其根源在肾,末梢在肺。肺将寒邪转移给肾,则阳气不能在下方气化,阳气不能气化,则水液泛滥成为邪气而客居于大肠,因为大肠与肺相表里。只要按压腹部不坚硬,而肠中有濯濯声响的,就是它的征候。“涌”通“踊”。)
脾中的热邪转移至肝脏,就会导致惊骇和鼻出血。(上文讲的是转移寒邪,下文讲转移热邪。脾的热邪转移给肝,是反传给它所克制的脏腑,说明热势很盛。肝藏血,病变主要表现为主惊骇,邪热逼迫肝血,则风火交加发作,所以出现惊骇和鼻出血的症状。衄,音女六切。)肝中的热邪转移至心脏,会导致死亡。(心属火,肝属木,肝的风热转移给心,木火互相焚烧,侵犯了君主之官,所以应当死亡。)心中的热邪转移至肺脏,传变为膈消症。(肺属金,其本性燥,心又将热邪转移给它,则燥热更加严重,从而传变为膈消。膈消症的症状是膈上部焦躁烦闷,喝水多且容易消化饥饿。按:上文说肺消是由于寒邪引起,这里说膈消是由于热邪引起,可见消渴病有阴阳两种证型,不可不加以辨别。)肺中的热邪转移至肾脏,传变为柔痉。(柔,指筋软无力。痉,指骨节强直。肺主气,肾主骨,肺肾都有热邪,则真阴日渐消耗,所以传变为柔痉。按《伤寒论》说:太阳病发热无汗,反而恶寒的,名叫刚痉;太阳病发热汗出,不恶寒的,名叫柔痉。这里又是通过有无汗来区分刚柔,但都兼有强直的表现。痉,音翅。)肾中的热邪转移至脾脏,传变为虚损和肠澼,这是死证,无法治疗。(肾热转移给脾,是阴火上炎。邪热在下焦,真阴必然亏损,所以传变为虚损。肾本是水脏却挟带热邪欺凌脾土,所以形成肠澼。下利脓血,阴虚反而克制脾土,则水土两败,所以死亡且无法治疗。澼,音僻。)
胞宫(子宫)中的热邪转移至膀胱,会导致小便不利(癃)和尿血。(胞,即子宫,在男性称为精室,在女性称为血室。膀胱是津液汇聚的府库,俗称溲胞。命门火旺盛,则胞宫的热邪转移给膀胱,所以小便不利称为癃,严重时则出现尿血。常见相火妄动,逆行而不通畅,多患此病,就是这个证候。“胞”字有包、脬两个读音,在胞胎的“胞”读包,在溲胞的“胞”读脬,意义详见气味类第三部分。癃,音良中切。溺,音娘料切。)膀胱中的热邪转移至小肠,会导致膈部和大肠痞塞不便,向上发展为口舌糜烂。(膀胱的热邪上行,则转移给小肠。小肠的经脉沿着咽喉向下穿过膈膜到达胃部,其分支沿着颈部上达面颊,所以受热导致膈部和肠道痞塞不便,在咽颊之间受热则向上形成口糜。糜,音苗肌切,意为腐烂。)小肠中的热邪转移至大肠,会导致伏瘕和沉疝。(小肠的热邪下行,则转移给大肠。热邪结聚不散,则或气或血,留聚在曲折之处,这就是伏瘕。伏瘕,是说它隐伏秘匿,深沉不易发现。“伏”同“伏”。瘕,有加、驾两个读音。)大肠中的热邪转移至胃,表现为食欲旺盛但身体消瘦,又叫做食亦。(大肠的热邪转移给胃,是燥热之气上行,所以善于消化谷物。阳明胃主肌肉,热邪灼烧它,则虽然进食也会生病而消瘦,所以称为食亦。)胃中的热邪转移至胆,也叫做食亦。(阳明胃热转移给胆,则木火合而为邪,不生脾土,所以也应该出现食欲旺盛但身体消瘦的症状。)胆中的热邪转移至脑,会导致鼻辛和鼻渊。鼻渊的症状是浊涕不断流出。(胆经的经脉起于目外眦,向上到达头角,向下经过耳后,曲折分布于脑后,所以胆的热邪转移给脑,就会形成鼻辛和鼻渊的病证。辛,指酸辛感。 ,音遏,指鼻茎。)病情进一步发展会转为鼻衄和瞑目。(脑热不止,则会传变为此种证候。衄和蔑都是指出血,但严重的叫衄,轻微的叫蔑。热邪损伤阴血,则眼睛失去滋养,所以导致闭目不敢睁眼,因为羞明不能睁开。衄,音女六切。蔑,音灭。)所以说,这些都是由于气机逆乱造成的。(厥,就是气逆。这是对整篇文章意义的总结,都是因为气逆所致。)
(Full text of "Qi Jue Lun" from *Suwen*)
The Yellow Emperor asked: What is the mechanism by which cold and heat pathogens shift between the five zang organs and six fu organs? (The term "shifting" refers to the pathogenic factors moving from one location to another.) Qibo replied: When cold qi shifts from the Kidney to the Spleen, it results in carbuncles and swelling, and shortness of breath. (When cold qi from the Kidney shifts to the Spleen, carbuncles and swelling form. Generally, for diseases of carbuncles and sores, both cold and heat can cause them; those caused by heat are called Yang Du [Yang Toxin], and those caused by cold are called Yin Du [Yin Toxin]. Since the Spleen governs the muscles, when it encounters cold, the Qi gathers and becomes hard; if it remains hard and does not dissipate, it forms swelling and carbuncles. Another interpretation states: "Yong" [Carbuncle] means obstruction. The Kidney, with its cold water qi, reversely transmits to what it overcomes, invading and bullying the Earth element of the Spleen, thus causing obstruction and edema. This explanation is particularly coherent. "Shortness of breath" occurs because excessive cold leads to deficiency of Yang Qi below; when Yang Qi is deficient, it cannot transform into Qi. Wang Bing's commentary writes "Liver" instead of "Spleen," which is an error. According to Quan Yuanqi and the *Jia Yi Jing*, it is written as "Spleen," which is correct; we now amend it accordingly.) When cold qi shifts from the Spleen to the Liver, it results in carbuncles and swelling, and tendon spasms. (When cold excess in the Spleen shifts to the Liver, it violates the order of generation. Cold in the Spleen causes muscle coldness, leading to carbuncles and swelling; cold in the Liver causes tendon coldness, leading to contracture.) When cold qi shifts from the Liver to the Heart, it results in mania and obstruction in the epigastrium/chest. (Cold qi from the Liver shifts to the Heart, transmitting to what it generates. The Heart governs Fire and houses the Spirit; upon receiving the rebellious cold pathogen from the Liver, the Spirit becomes disordered, resulting in mania. The Heart meridian emerges from the Heart system and passes down through the diaphragm; when Yang is suppressed by Yin, Qi fails to circulate, resulting in obstruction and blockage in the chest/diaphragm area.) When cold qi shifts from the Heart to the Lungs, it results in Lung Xiao [Lung Wasting-Thirst]. Lung Xiao is characterized by drinking one portion of fluid but urinating two portions; this is a fatal condition that cannot be treated. (The Heart and Lungs are both Yang organs. When the Heart transfers cold to the Lungs, it indicates a decline of Sovereign Fire. Insufficient Heart Fire fails to warm and nourish Lung Metal; without warmth, Lung Qi cannot transport and transform body fluids. Thus, although only one portion is drunk, two portions are excreted. The Lung is the mother of Water; excessive loss of water depletes Lung Qi, hence the name Lung Xiao. With the gates failing to hold and the root Yuan Qi daily exhausted, death ensues and treatment is impossible. Note: Wang Bing commented that the Heart receives various cold pathogens, which fail to dissipate and shift to the Lungs; the cold follows Heart Fire to internally scorch the essence of Metal. Affected by Fire evil, Metal suffers, resulting in Middle Xiao [Middle Wasting-Thirst]. I argue that if Fire were scorching internally, how could there be drinking one part and urinating two parts? This commentary seems inappropriate.) When cold qi shifts from the Lungs to the Kidneys, it results in Yong Shui [Surging Water]. Yong Shui is characterized by a soft abdomen upon palpation; water qi resides in the Large Intestine, producing a gurgling sound ("zhuo zhuo") when moving quickly, resembling a bag containing watery fluid. (Yong Shui refers to water surging upward like a spring. Water is Yin Qi; its root is in the Kidney, and its branch is in the Lungs. When Lung cold shifts to the Kidney, Yang Qi fails to transform below. Without Yang transformation, water floods and becomes pathogenic, residing in the Large Intestine, which is exteriorly-interiorly related to the Lung. If the abdomen is soft to touch but produces gurgling sounds in the intestines, this is the sign. "Yong" is synonymous with "Yong" [surge/jump].)
When heat qi shifts from the Spleen to the Liver, it results in fright and nosebleeds. (The above discussed shifting of cold; hereinafter discusses shifting of heat. Heat shifting from Spleen to Liver violates the overcoming cycle, indicating severe heat. The Liver stores Blood, and disease manifests primarily as fright; when evil heat presses upon it, Wind and Fire interact, causing fright and epistaxis. "Nu" [nosebleed] is pronounced 'nǚ liù'.) When heat qi shifts from the Liver to the Heart, it results in death. (Heart belongs to Fire, Liver to Wood. When Liver wind-heat shifts to the Heart, Wood and Fire burn each other, attacking the Monarch organ, thus leading to death.) When heat qi shifts from the Heart to the Lungs, it transmits as Ge Xiao [Diaphragm Wasting-Thirst]. (The Lung belongs to Metal, whose nature is originally dry. When Heart heat shifts to it, dryness and heat intensify, transmitting as Ge Xiao. Ge Xiao is characterized by irritability and vexation above the diaphragm, increased thirst, and rapid digestion. Note: Above, Lung Xiao was attributed to cold; here, Ge Xiao is attributed to heat. This shows that Xiao diseases have Yin and Yang syndromes, which must be distinguished.) When heat qi shifts from the Lungs to the Kidneys, it transmits as Rou Jing [Soft Spasm]. (Rou [Soft] refers to weak tendons; Jing [Spasm] refers to stiff bones. The Lung governs Qi, the Kidney governs bones. Heat in both Lung and Kidney causes daily depletion of True Yin, transmitting as Rou Jing. Note: The *Shanghan Lun* states: In Taiyang disease, fever without sweat and aversion to cold is named Gang Jing [Hard Spasm]; fever with sweating and no aversion to cold is named Rou Jing. Here, hard and soft are distinguished by the presence or absence of sweat, but both involve stiffness. "Jing" is pronounced 'chì'.) When heat qi shifts from the Kidneys to the Spleen, it transmits as Xu Sun [Deficiency Damage] and Chang Pi [Intestinal Dysentery]; this is a fatal condition that cannot be treated. (Kidney heat shifting to the Spleen is due to Minister Fire flaring upward. Evil heat below causes deficiency of True Yin, transmitting as deficiency damage. The Kidney is originally a Water organ but carries heat to bully the Spleen, causing Chang Pi. Bloody purulent diarrhea indicates Yin deficiency counter-attacking Earth, leading to the failure of both Water and Earth, thus death ensues and treatment is impossible. "Pi" is pronounced 'pì'.)
When heat qi shifts from the Bao Gong [Uterus/Womb] to the Bladder, it results in Long [Dysuria] and blood in urine. (Bao refers to the uterus; in males, it is the Essence Chamber; in females, the Blood Chamber. The Bladder is the mansion of body fluids, commonly known as the Urinary Bladder. Excessive Mingmen Fire causes Bao Gong heat to shift to the Bladder, resulting in difficult urination termed Long; severely, it causes hematuria. Commonly, reckless movement of Minister Fire causing rebellion and blockage often leads to this condition. "Bao" has pronunciations 'bāo' and 'pāo'; in Bao Tai [embryo], it is 'bāo'; in Sou Bao [urinary bladder], it is 'pāo'. Meaning detailed in Aroma and Flavor Category III. "Long" is pronounced 'liáng zhōng'. "Niao" [urine/void] is pronounced 'niáng liào'.) When heat qi shifts from the Bladder to the Small Intestine, it results in obstruction and constipation in the diaphragm and intestines, and upward progression to mouth ulcers. (Heat from the Bladder moves upward to the Small Intestine. The Small Intestine meridian follows the throat, descends through the diaphragm to the Stomach, and its branch ascends along the neck to the cheek. Heat causes obstruction and difficulty in defecation in the diaphragm/intestines; heat in the throat and cheeks causes mouth ulcers. "Mi" [ulcer/rotten] is pronounced 'miáo jī', meaning rotten.) When heat qi shifts from the Small Intestine to the Large Intestine, it results in Fu Jia [Hidden Mass] and Chen Hong [Deep Hernia]. (Heat from the Small Intestine moves downward to the Large Intestine. Heat accumulation that does not dissipate causes Qi or Blood to stagnate in tortuous areas, forming Fu Jia. Fu Jia implies hidden, deep, and difficult-to-detect masses. "Fu" is identical to "Fu". "Jia" has pronunciations 'jiā' and 'jià'.) When heat qi shifts from the Large Intestine to the Stomach, it results in polyphagia with emaciation, also called Shi Yi [Eating Similarly]. (Large Intestine heat shifting to the Stomach is dry-heat qi moving upward, enhancing grain digestion. The Yangming Stomach governs muscles; heat scorches them, so even with eating, the body wastes away, hence called Shi Yi.) When heat qi shifts from the Stomach to the Gallbladder, it is also called Shi Yi. (Yangming Stomach heat shifting to the Gallbladder combines Wood and Fire evils, failing to generate Spleen Earth, thus also causing polyphagia with emaciation.) When heat qi shifts from the Gallbladder to the Brain, it results in Xin Bi [Acrid Nose] and Bi Yuan [Nasal Sinusitis]. Bi Yuan is characterized by continuous discharge of turbid mucus. (The Gallbladder meridian originates at the outer canthus, ascends to the vertex, descends behind the ear, and winds around the back of the head. Thus, Gallbladder heat shifting to the Brain causes Xin Bi and Bi Yuan. "Xin" refers to acridity. "Bi" [nasal septum/stem] is pronounced 'è', referring to the nasal stem.) Progression leads to Nu Mie [Nosebleed] and Ming Mu [Closed Eyes]. (Unceasing brain heat transmits to this syndrome. Nu and Mie both refer to bleeding; severe cases are Nu, mild cases are Mie. Heat damages Yin Blood, depriving the eyes of nourishment, causing closed eyes due to photophobia. "Nu" is pronounced 'nǚ liù'. "Mie" is pronounced 'miè'.) Therefore, these conditions arise from Qi Jue [Qi Reversal]. (Jue means Qi rebellion. This summarizes the main point of the chapter: all result from Qi rebellion.)