但执持而已。中贵人者,其病暴死,羲无凌犯,故病暴而死也。然邪者,五运六气胜复之受也,有
变则病乘其气之至也。清气大来,燥之胜也,风木受邪,肝病生而流于胆也。热气大来,火之胜
也,燥金受邪,肺病生而流于大肠也。寒气大来,水之胜也,热火受邪,心病生而流于小肠也。
湿气大来,土之胜也,寒水受邪,肾病生而流于膀胱也。风气大来,木之胜也,湿土受邪,脾病
生而流于胃也。所谓感邪而生其病也,外有其气,而内恶之,中外不喜,周而遂病,是谓感也。
乘年之虚,则邪乃甚也,则如年木不足,而外有清邪,至而肝病之类也。
失时之和,亦邪甚也,所谓六气临统,与主气相克,感之而病者也。遇月之空,亦邪甚也,遇月
下弦之后,上弦之前,是谓月空,感于邪,则亦甚也。重感于邪,则病危也,所谓年已不足,邪
气大至,是谓一感,年已不足,天气克之,此时感邪,是谓重感,内气召邪,天气不 ,不危何
哉!则如丁卯、丁酉之岁,外有清邪,至而肝病,己巳、己亥之岁,外有风邪,至而脾病,辛丑、
辛未之岁,外有湿邪,至而肾病。凡言病之吉凶,必明病之腑脏虚实,而与岁中运气胜复之变,
而以加临,可以言也。假令风木之胜,民病脾肺实而肝气虚者,病皆微也。若病脾肺虚而肝气实
者,皆甚也。余皆仿此,推而可知也。
欲知五脏得失间甚之时,死生之期者,必明其脉候,以知何脏也。其病者,愈于子,子不愈,
甚于鬼,鬼不死,持于母。四时日干时辰同法。故经曰夫邪气之客于身也,以胜相加,至其所生
而愈,是谓病藏生之子也,至其所不胜而甚,是谓病藏之鬼也,至于所生而持,是谓病藏之母也,
自得其位而起,是四时五行旺相及日干时辰与病之藏同也。必先定五脏之脉,乃可言间甚之时,
死生之期,此之谓也。
欲知热病间甚大汗之期,取其本脏,遇胜己日甚,己旺日大汗,气逆则胜己日死。故经曰肝
热病者,小便先黄,腹痛,多卧,身热,热争则狂言及惊,胁痛,手足躁,不得安卧。庚辛甚,
甲乙大汗,气逆则庚辛死。心热病者,
先不乐,数日乃热,热争则卒心痛,烦满,喜呕,头痛,面赤,无汗,壬癸甚,丙丁
大汗,气逆则壬癸死。脾热病者,头重,颊痛,烦心,颜青,欲呕,身热,热争则腰痛
不可以俯仰,腹满,溏泄,两颔痛,甲乙甚,戊己大汗,气逆则甲乙死。肺热病者,洒淅然
起毫毛,恶风寒,舌上黄,身热,热争则喘咳,痛走胸膺背,不得太息,头痛不
甚,汗出而寒,丙丁甚,庚辛大汗,气逆则丙丁死。肾热病者,先腰痛 酸,苦渴数饮,
身热,热争则项痛而强, 寒且酸,足下热,不欲言,其逆则项痛员员,澹澹然,戊
己甚,壬癸大汗,气逆则戊己死。及夫肝热病者左颊先赤,心热病者颜先赤,脾热病者鼻
先赤,肺热病者右颊先赤,肾热病者颐先赤,皆所谓病之始也。诸汗者,至其所胜日汗出,
谓气旺日为所胜,则如肝甲乙、心丙丁之类也。汗后脉迟静而愈,脉尚躁盛者死。今不与
诸汗相应,此不胜其病也。狂言失志者,死矣。
然皆圣经之旨也,必凭问望闻切,知其病宗,而与天地时日阴阳相合,推其胜克,而
为法也。审察间甚逆从,而以随证治之,适其治之逆从可否,而以言吉凶,慎不可执其阴
阳而已。然虽阴阳为万物之纲纪,论其吉凶,亦须由其用也。
大抵死因病致,病由邪生,邪因变起,变由不平。平则安而无咎,否则祸患由生。内
则内验,外则外征。外者心行德过,内者腑脏衰兴,大小缓急,无不相应。故经曰∶德者
福之,过者伐之,有德则天降福以应之,有过则天降祸以淫之,则知祸福无门,唯人所召
耳。故曰主明则下安,以此养生则寿,殁世不殆,以为天下则大昌,主不明则
十二官危,使道闭塞而不通,形乃大伤,以此养生则殃,以为天下者,其宗大危,
然则岂不亦由人之所为乎!
只是固执地拘泥于这些原则罢了。中贵人(古代对权贵或宦官的尊称)这类人,其发病往往突然死亡,这是因为他们的体质没有受到外界邪气的直接侵犯(指正气尚存但易受内伤或突发因素),所以病情暴烈而致死。然而所谓的“邪”,是指五运六气胜复变化所导致的异常气候影响,当气候发生变异时,病邪就会乘虚侵袭人体之气。
如果清气(燥气)大盛,这是燥金之气偏胜,风木之气受邪,导致肝病产生并波及胆腑。
如果热气大盛,这是火气偏胜,燥金之气受邪,导致肺病产生并波及大肠腑。
如果寒气大盛,这是水气偏胜,热火之气受邪,导致心病产生并波及小肠腑。
如果湿气大盛,这是土气偏胜,寒水之气受邪,导致肾病产生并波及膀胱腑。
如果风气大盛,这是木气偏胜,湿土之气受邪,导致脾病产生并波及胃腑。
这就是所谓感受邪气而生病的情况:外部有异常的气候存在,而内部脏腑厌恶这种气候,内外不相协调,循环往复最终致病,这就叫作“感”。
如果遇到年份运气虚弱(如岁运不及),那么邪气就会更加严重,例如逢木运不足的年份,外部又有清冷之邪侵袭,就会导致肝病等类似情况。
如果违背了时令的和顺之气,邪气也会加重,这就是所谓六气加临之时,与主时之气相克,感受这种邪气而致病。
如果遇到月亮亏空之时(月空),邪气也会加重,即在农历每月下半月弦之后、上半月弦之前这段时间,称为月空,此时感受邪气,病情也会加重。
再次感受邪气,病情就会危重,这就是所谓年份运气已经不足,邪气又大举入侵,这叫第一次感受;如果年份运气已不足,天气又克制它,此时再感受邪气,这叫再次感受,体内正气召唤邪气,天时的保护机制失效,不危险又能怎样呢!例如丁卯年、丁酉年,外部有清冷之邪,至则引发肝病;己巳年、己亥年,外部有风邪,至则引发脾病;辛丑年、辛未年,外部有湿邪,至则引发肾病。
凡是谈论疾病的吉凶,必须明确病变脏腑的虚实状况,并结合当年岁运胜复的变化,以及客气加临的情况,才能进行判断。假如风木之气偏胜,民众出现脾肺实证而肝气虚证,病情都较轻微。如果是脾肺虚证而肝气实证,病情都会很严重。其余情况都可以仿照此理,推演可知。
想要知道五脏疾病轻重变化及生死期限,必须明确脉象候诊,以判断是哪一脏患病。对于患病之脏,若在子日(生我之日)痊愈,若子日不愈,则在鬼日(克我之日)加重,若鬼日不死,则在母日(生我之母)维持稳定。四时、日干、时辰的判断方法与此相同。所以《内经》说:邪气客居身体,是以五行相克的关系相加,到达能生我的日子(病藏之子)则痊愈,到达被克的日子(病藏之鬼)则加重,到达生我的日子(病藏之母)则持稳,到达本气旺盛的日子则起发。这对应四时五行旺相及日干时辰与病脏相同的情况。必须先确定五脏的脉象,然后才能谈论病情轻重的时间及生死期限,说的就是这个道理。
想要知道热病轻重变化及大汗出期的时间,要取本脏对应的日期,遇到克我之日病情加重,遇到我旺之日大汗出,若气逆则克我之日死亡。所以《内经》说:肝热病患者,小便先变黄,腹痛,嗜睡,身热,正邪交争则胡言乱语及惊厥,胁痛,手足躁动,不能安卧。在庚辛日(金日,克木)病情加重,在甲乙日(木日,本气旺)大汗出,若气逆则在庚辛日死亡。心热病患者,先心情不悦,数日后发热,正邪交争则突然心痛,烦闷,喜欢呕吐,头痛,面赤,无汗,在壬癸日(水日,克火)病情加重,在丙丁日(火日,本气旺)大汗出,若气逆则在壬癸日死亡。脾热病患者,头重,脸颊痛,心烦,面色发青,想呕吐,身热,正邪交争则腰痛不能俯仰,腹部胀满,大便溏泄,两侧下颌痛,在甲乙日(木日,克土)病情加重,在戊己日(土日,本气旺)大汗出,若气逆则在甲乙日死亡。肺热病患者,洒淅恶寒,毫毛竖起,怕风寒,舌苔黄,身热,正邪交争则喘咳,疼痛游走于胸膺背部,不能深呼吸,头痛不甚,出汗后怕冷,在丙丁日(火日,克金)病情加重,在庚辛日(金日,本气旺)大汗出,若气逆则在丙丁日死亡。肾热病患者,先腰痛且酸软,口苦口渴多饮,身热,正邪交争则项痛且僵硬,恶寒且酸软,足下发热,不想说话,若气逆则项痛头晕目眩,心动悸,在戊己日(土日,克水)病情加重,在壬癸日(水日,本气旺)大汗出,若气逆则在戊己日死亡。至于肝热病患者左颊先红,心热病患者颜面先红,脾热病患者鼻部先红,肺热病患者右颊先红,肾热病患者下巴先红,这都是所谓疾病初起的征兆。各种出汗的情况,是到了其所胜之日(即本气旺盛之日,如肝属木应甲乙日,心属火应丙丁日等)出汗。汗出后脉象迟缓安静者痊愈,脉象仍然躁动旺盛者死亡。现在若不出汗或不与上述规律相应,这是不胜任治疗该病。胡言乱语、神志丧失的,预后不良,会死亡。
这些都是经典医籍的宗旨,必须凭借问、望、闻、切四诊,了解疾病的根本,并与天地时日阴阳相结合,推演五行胜克关系,从而确立治法。审察病情的轻重、顺逆,并根据证候进行治疗,根据治疗的顺逆和可行性来预测吉凶,千万不要仅仅拘泥于阴阳理论而已。虽然阴阳是万物的纲纪,但在论述吉凶时,也必须依据其实际应用。
大体上,死亡是由疾病导致的,疾病由邪气产生,邪气由变化引起,变化由不平衡所致。平衡则平安而无灾祸,否则祸患由此产生。向内可以验证内脏状态,向外可以观察体表征象。外在表现反映心神德行有过失与否,内在表现反映脏腑兴衰,无论大小缓急,无不相互对应。所以《内经》说:有德则得福,有过则遭伐,有德则天降福以回应,有过则天降祸以侵扰,由此可知祸福没有定门,全由人所招致。所以说君主(心)清明则下属安宁,以此养生则长寿,终身无危险,以此治理天下则大昌盛;君主不明则十二官(脏腑)危殆,使通道闭塞不通,形体遭受重大损伤,以此养生则遭殃,以此治理天下,宗庙社稷将大危,这难道不是由人的行为造成的吗!
merely adhering rigidly to these principles. For "Zhong Guiren" (a term of respect for nobles or eunuchs in ancient times), their illness often leads to sudden death because their constitution has not been directly invaded by external pathogenic factors (indicating that while righteous qi remains, it is susceptible to internal injury or sudden factors), resulting in a violent onset and death. However, what is referred to as "pathogen" here denotes the impact of abnormal climates caused by the winning and reversing changes of the Five Movements and Six Qi. When climate undergoes variation, pathogenic factors invade the body's qi opportunistically.
If clear qi (dryness) becomes predominant, this indicates an excess of Dryness-Metal; Wind-Wood is affected by pathogens, leading to Liver disease which then spreads to the Gallbladder.
If hot qi becomes predominant, this indicates an excess of Fire; Dryness-Metal is affected by pathogens, leading to Lung disease which then spreads to the Large Intestine.
If cold qi becomes predominant, this indicates an excess of Water; Hot-Fire is affected by pathogens, leading to Heart disease which then spreads to the Small Intestine.
If damp qi becomes predominant, this indicates an excess of Earth; Cold-Water is affected by pathogens, leading to Kidney disease which then spreads to the Bladder.
If wind qi becomes predominant, this indicates an excess of Wood; Damp-Earth is affected by pathogens, leading to Spleen disease which then spreads to the Stomach.
This is what is meant by contracting illness through pathogenic influence: there is an abnormal climate externally, while the internal organs dislike this climate; the internal and external are not harmonious, and through cyclic interaction, illness ensues. This is called "contracting."
If one encounters a year with deficient movement-qi (e.g., insufficient annual luck), the pathogenic factor will be more severe. For example, in years where Wood movement is deficient, if external cold-dry pathogens arrive, Liver disease and similar conditions may occur.
If the harmony of the season is violated, the pathogenic factor also intensifies. This refers to the situation where the Six Qi superimposed upon the time clash with the Principal Qi; contracting such pathogens leads to illness.
Encountering the "Moon Void" (period of lunar waning) also exacerbates the pathogenic effect. Specifically, after the lower half-moon phase and before the upper half-moon phase, this period is termed Moon Void. Contracting pathogens during this time results in aggravated illness.
Repeated exposure to pathogens leads to critical illness. This means that when the annual luck is already deficient and pathogenic qi arrives in force, it is termed the first contraction. If the annual luck is deficient and the heavenly weather overcomes it, and one contracts pathogens at this moment, it is termed repeated contraction. The internal qi summons the pathogen, and the protective mechanism of heaven fails; how could it not be dangerous? For instance, in Ding-Mao and Ding-You years, external cold-dry pathogens arrive causing Liver disease; in Ji-Si and Ji-Hai years, external wind pathogens arrive causing Spleen disease; in Xin-Chou and Xin-Wei years, external damp pathogens arrive causing Kidney disease.
Whenever discussing the prognosis of illness, one must clarify the deficiency or excess of the affected Zang-Fu organs, combine this with the variations of winning and reversing movements of the year, and consider the superimposition of Guest Qi to make judgments. Suppose Wind-Wood is excessive, and the people present with Excess patterns in the Spleen and Lung but Deficiency patterns in the Liver; the illness will be mild. Conversely, if there are Deficiency patterns in the Spleen and Lung but Excess patterns in the Liver, the illness will be severe. All other cases can be deduced similarly.
To understand the timing of severity fluctuations and life-death periods for diseases of the Five Zang organs, one must clearly examine the pulse conditions to identify the affected organ. For a diseased organ, recovery occurs on the Zi day (the day that generates the organ); if not recovered on Zi day, severity increases on the Gui (Ghost) day (the day that controls the organ); if death does not occur on the Ghost day, the condition stabilizes on the Mother day (the day generated by the organ). The methods for determining seasons, Heavenly Stems, and earthly branches follow the same principle. Thus, the Classics state: When pathogenic qi invades the body, it acts according to the five-element controlling relationship. Recovery occurs when reaching the day that generates the diseased organ (Son of the diseased Zang); severity increases when reaching the day that controls the diseased organ (Ghost of the diseased Zang); stability is maintained when reaching the day generated by the diseased organ (Mother of the diseased Zang); and onset occurs when reaching its own position of prosperity. This corresponds to the flourishing phases of the four seasons and five elements, as well as the alignment of Heavenly Stems and time segments with the diseased Zang. One must first determine the pulses of the five Zang organs before discussing the timing of severity fluctuations and life-death periods; this is what is meant.
To know the timing of severity fluctuations and profuse sweating in Heat diseases, one must refer to the days corresponding to the root organ. Severity increases on days that control the organ; profuse sweating occurs on days when the organ is prosperous; if qi rebels, death occurs on the controlling days. Thus, the Classics state: In Liver Heat disease, urine turns yellow first, accompanied by abdominal pain, somnolence, and fever. During the struggle between heat and pathogen, there is delirium and惊厥 (convulsions), hypochondriac pain, restlessness of hands and feet, and inability to lie down peacefully. Severity increases on Geng-Xin days (Metal days, controlling Wood); profuse sweating occurs on Jia-Yi days (Wood days, organ's own prosperity); if qi rebels, death occurs on Geng-Xin days. In Heart Heat disease, there is initial displeasure, followed by fever after several days. During the struggle, sudden heart pain, irritability, fullness, frequent vomiting, headache, flushed face, and absence of sweat occur. Severity increases on Ren-Gui days (Water days, controlling Fire); profuse sweating occurs on Bing-Ding days (Fire days, organ's own prosperity); if qi rebels, death occurs on Ren-Gui days. In Spleen Heat disease, there is heavy head, cheek pain, mental distress, bluish complexion, desire to vomit, and fever. During the struggle, lower back pain preventing bending or twisting, abdominal fullness, loose stools, and pain in both mandibles occur. Severity increases on Jia-Yi days (Wood days, controlling Earth); profuse sweating occurs on Wu-Ji days (Earth days, organ's own prosperity); if qi rebels, death occurs on Jia-Yi days. In Lung Heat disease, there is chills, gooseflesh, aversion to wind-cold, yellow tongue coating, and fever. During the struggle, wheezing and coughing occur, pain radiating to the chest, epigastrium, and back, difficulty taking deep breaths, mild headache, sweating followed by coldness. Severity increases on Bing-Ding days (Fire days, controlling Metal); profuse sweating occurs on Geng-Xin days (Metal days, organ's own prosperity); if qi rebels, death occurs on Bing-Ding days. In Kidney Heat disease, there is initial lower back pain and soreness, bitter taste, thirst with frequent drinking, and fever. During the struggle, neck pain and stiffness, aversion to cold with soreness, heat in the soles of the feet, and reluctance to speak occur. If qi rebels, there is dizzy neck pain and palpitations. Severity increases on Wu-Ji days (Earth days, controlling Water); profuse sweating occurs on Ren-Gui days (Water days, organ's own prosperity); if qi rebels, death occurs on Wu-Ji days. Regarding facial coloration at the onset: redness on the left cheek indicates Liver Heat; redness on the forehead indicates Heart Heat; redness on the nose indicates Spleen Heat; redness on the right cheek indicates Lung Heat; redness on the chin indicates Kidney Heat. These are all signs of the beginning of the disease. Regarding sweating: it occurs on the days when the organ's qi is victorious (i.e., prosperous days, such as Jia-Yi for Liver/Wood, Bing-Ding for Heart/Fire, etc.). After sweating, if the pulse is slow and calm, recovery ensues; if the pulse remains rapid and vigorous, death follows. If sweating does not correspond to these patterns, it indicates the treatment cannot overcome the disease. Delirium and loss of consciousness indicate death.
These are all the principles of the sacred classics. One must rely on inquiry, observation, auscultation/olfaction, and palpation to ascertain the root of the disease, align it with heaven, earth, time, and yin-yang, deduce the winning and controlling relationships, and establish treatment methods. By examining the severity and compliance/non-compliance of symptoms and treating accordingly based on the syndrome, and judging the feasibility of the treatment's compliance or opposition, one can predict auspiciousness or inauspiciousness. One must not merely adhere to yin-yang theory. Although yin-yang is the guideline for all things, when discussing fortune and misfortune, one must also rely on its practical application.
Generally speaking, death is caused by disease, disease arises from pathogens, pathogens arise from changes, and changes arise from imbalance. Balance brings peace without blame; otherwise, disaster arises. Internally, one verifies the state of the viscera; externally, one observes physical signs. External manifestations reflect the virtue or faults of the mind-heart; internal manifestations reflect the rise and decline of the zang-fu organs. Whether large or small, slow or urgent, everything corresponds. Thus, the Classics state: Virtue brings blessing, fault brings punishment. With virtue, heaven descends blessings to respond; with fault, heaven descends disasters to afflict. From this, we know that doors to disaster and fortune are not fixed; they are summoned by human actions. Therefore, it is said: If the ruler (Heart) is clear, the subordinates are peaceful. Using this for health preservation leads to longevity and safety throughout life; using this to govern the world leads to great prosperity. If the ruler is unclear, the twelve officials (organs) are endangered, the pathways become blocked and uncommunicative, and the form suffers greatly. Using this for health preservation leads to calamity; using this to govern the world leads to great danger for the lineage. Is this not due to human conduct!