圣人治病,循法守度,援物比类,从容中道,帝以此理,示诸雷公,故曰示从容。
黄帝燕坐;召雷公而问之曰∶汝受术诵书者,若能览观杂学,
及于比类,通合道理,为余言子所长。五脏六腑,胆胃大小肠,脾胞膀胱,脑髓涕唾,哭泣
悲哀,水所从行,此皆人之所生,治之过失,子务明之,可以十全。即不能知,为世所怨。
上为去声。上编雷公曰∶请受道,讽诵用解,故帝燕坐,召雷公而问,谓汝受术诵书者,若能于诵书
之外,览观杂学,触类引伸,而及于比类,贯通会悟,而通合道理。能如是,为余言子所长,凡五脏六腑,胆
胃大小肠,脾胞膀胱,六腑秉气于坤土,故言六腑而及于脾。肾主脑髓,肺主涕唾,肝主哭泣,心主悲哀,脑
髓涕唾,哭泣悲哀,而合于脾,是为五脏,五脏主藏精者也。故曰水所从行。此五脏六腑,皆人之所以生,
治不合道,则治之过失,务明其道,可以十全;即不能知,为世所怨。是受术诵书,尤贵比类而通合也。
雷公曰∶臣请诵《脉经·上下编》,甚众多矣。别异比类,犹未能以十全,又安足以明之。
别,音逼,下同。脉经即《灵枢经》。诵脉经上下编,其言甚众多矣。异者,别之,类者,比
之,别异比类,犹未能以十全,又安足以明之,明言不知,欲帝言之。
帝曰∶子别试通五脏之过,六腑之所不和,针石之败,毒药所
宜,汤液滋味,具言其状,悉言以对,请问不知。
既诵《脉经》,当于《脉经》辨别而试通之。《脉经》具言五脏之过,六腑之所不和,针石之败乱,及治
以毒药之所宜,治以汤液之滋味,皆必辨别试通,具言其状,悉言以对,其中或有不知,然后请问不知可也。
雷公曰∶肝虚肾虚脾虚,皆令人体重烦冤。当投毒药,刺灸砭石汤液,或已或不已,愿闻其解。
此承帝言,而复问也。肝虚肾虚脾虚,乃五脏之过,皆令人体重烦冤,乃六腑之不和,毒药所宜,则当
投毒药,针石之败,汤液滋味,则有刺灸砭石汤液之治。举帝言而复问如是以治,或已或不已,愿闻其解。
帝曰∶公何年之长而问之少,余真问以自谬也。吾问子窈冥,
子言上下编以对,何也?夫脾虚浮似肺,肾小浮似脾,肝急沉散似
肾,此皆工之所时乱也,然从容得之。若夫三脏,土木水参居,此童子之所知,问之何也?
长,上声,少去声,下年长少同。帝问公,公复问帝,故曰∶公何年之长而问之少,问而无答,余真问以
自谬也。吾问子杂学比类,通合道理,可以十全者,乃问子窈冥之道。子言诵《脉经·上下编》以对,则何
也?继问五脏之过,六腑之所不和,子则言肝虚肾虚脾虚,夫脾脏之脉,虚而浮,则似肺病。肾脏之脉,小
而浮,则似脾病,肝脏之脉,急而沉散,则似肾病。此皆工之所时乱,而治之过失也,然比类相似,必
别其真,欲别其真,从容得之。若夫肝肾脾三脏之虚,皆令人体重烦冤,是脾土肝木肾水,三阴参居,此童子
之所知,子问之何也?
雷公曰∶于此有人,头痛筋挛。骨重,怯然少气,哕噫腹满时
惊,不嗜卧,此何脏之发也?脉浮而弦,切之石坚,不知其解,复问所以三脏者,以知其比类也。
头痛筋挛,肝病也;骨重怯然少气,肾病也;哕噫腹满,脾病也;时惊不嗜卧,胃病也。于此有人,诸
病齐作,此何脏之发也?浮,开脉也;弦,枢脉也;石坚,阖脉也。于此有人,脉浮而弦,切之石坚,如是
之脉,不知其解。初承帝问,复问肝虚肾虚脾虚,所以问此三脏者,正以欲知其比类也。
帝曰,夫从容之谓也。
比类者,同类相比,辨别其真,必从容而得之。故曰∶夫从容之谓也。
夫年长,则求之于腑;年少,则求之于经,年壮,则求之于脏。今子所言,皆失八风菀热,
五脏消烁,传邪相受。夫浮而弦者,是肾不足也;沉而石者,是肾气内着也;怯然少气者,是水道
不行,形气消索也;咳嗽烦冤者,是肾气之逆也。一人之气,病在一脏也,若言三脏俱行,不在法也。
长,犹老也。年老,则脏衰。于此有病,则求之于腑,而从容比类可也。少,犹幼也,年幼,则腑脏
未充,于此有病,则求之于经,而从容比类可也。年壮,则经脉有余,脏腑皆盛,于此有病,则求之于脏,而
从容比类可也。八风,四方四偶之风也。八风合于五行,通于五脏,八风菀热,则五脏消烁,传为邪病,而
相受于人身。今子所言何脏之发,但求其脏,皆失其八风菀热,致五脏消烁,及传邪相受之理。凡病在脏,论
其脉证,当约归一脏,不可多求。子言脉浮而弦,切之石坚,夫浮而弦者,是肾气之不足也。沉而石者,是
肾气之内着也。子然怯然少气者,是肾之水道不行,而形气消索也。若怯然少气,不能上交于心肺,肺咳嗽而
心烦冤者,亦是肾气之下逆也。凡生阳之气,起于肾脏,故一人之气,病在一
脏也。若言三脏俱行而比类之,不在从容之法也。
雷公曰∶于此有人,四肢解堕,喘咳血泄,而愚诊之,以为伤
肺,切脉浮大而紧,愚不敢治。粗工用砭石,病愈,多出血,血止身轻,此何物也?
承病在一脏之义而复问也。四懈堕,脾病也。喘咳,肺病也。血泄,肝病也。诊之而以为伤肺,亦以
一人之气,病在一脏也。切脉浮大,伤肺无疑。浮大而紧,则阴阳内乱。故不敢治。粗工不知经
脉,妄治出血而愈,此何故也?
帝曰∶子所能治,知亦众多,与此病失矣。譬以鸿飞,亦冲于
天。夫圣人之治病,循法守度,援物比类,化之冥冥,循上及下,何必守经?
治病固有经常之道,而神化无方,不必守经也。子所能治之病,亦众且多,要知与此病不相合而相失
矣。粗工妄治而愈,是千虑一得。譬以鸿飞,亦冲于天。若夫圣人之治病,必循法守度,更援物比类,然其
中神化之冥冥。循上可以及下,不拘常度,又何必守经,而不知权变耶?
今夫脉浮大虚者,是脾气之外绝,去胃,外归阳明也。夫二火
不胜三水,是以脉乱而无常也。四肢懈堕,此脾精之不行也。喘咳
者,是水气并阳明也。血泄者,脉急,血无所行也。若夫以为伤肺
者,由失以狂也。不引比类,是知不明也。夫伤肺者,脾气不守,
胃气不清,经气不为使,真脏坏决,经脉旁绝,五脏漏泄,不衄则
呕,此二者,不相类也。譬如天之无形,地之无里,白与黑相去远
矣。是失吾过矣。以子知之,故不告子,明引比类从容,是以名曰诊轻。是谓至道也。
使,去声。脉浮大,为虚,脉紧,为乱而无常。子言脉浮大而紧,故不敢治。今夫脉浮大而虚者,是太
阴脾气之外绝。太阴主开,内合胃土。今脉浮大,不合于胃,是去胃土之有形,而外归阳明之热气
也。阳明为二阳,二阳,犹二火也。太阴为三阴,三阴,犹三水也。脾气外归阳明,是二火不胜三水。是以
脉浮大而紧,紧则乱而无常也。子言四肢懈堕,喘咳血泄,诊之以为伤肺。夫四肢懈堕者,此脾精之不行于
四肢也。喘咳者,是膀胱之水气,上并于阳明,土虚水汛而喘咳也。血泄者,心包主脉,脉急则血无所行而下
泄也。凡此皆非肺病。若夫以为伤肺者,由于审证未确,忽略从事,失以狂也。失以狂,则不能引伸比类,
是知子之不明也。夫伤肺者,土不生金,必脾气不守,脾气不守,则胃气不清矣。伤肺者,气不荣经,必经
气不为使。经气不为使,则真脏坏绝矣。经气不使,必至经脉旁绝。脾气不守,必至五脏漏泄。经脉旁绝,
五脏漏泄,其病不衄则呕。由此言之,则绝脾伤肺,二者不相类也。不相类而妄类之,譬如天之无形而求
以形,地之无里而求以里。无形求形,无里求里,不相类而妄类之,是白与黑,相去远矣。相去既远,
非子之过,是失吾过矣。以子知化之冥冥,循上及下之道,故不告子,明乎引伸比类从容,则神化无方,不
拘拘于诊,是以名曰诊轻,犹言从容中道;至于神化,则诊可轻,必如是,始谓从容之至道也。
圣人治疗疾病,遵循法度,运用类比推理,从容不迫地把握中道。黄帝将这一道理展示给雷公,所以这篇名为《示从容》。
黄帝闲坐,召见雷公并问他:“你学习医术、诵读医书,如果能博览杂学,善于类比,贯通事理,请告诉我你的专长所在。五脏六腑,包括胆、胃、大小肠、脾、胞、膀胱,以及脑髓、涕唾、哭泣、悲哀等,还有水液运行的规律,这些都是人体生命活动的基础。如果治疗出现过失,你一定要阐明其中的道理,这样才可以做到十全十美。如果连这些都不知道,就会遭到世人的埋怨。”
雷公回答说:“请允许我接受教导,通过讽诵来理解。所以您闲坐召见我,说我是学习医术诵读医书的人,如果我能在诵读之外,博览杂学,触类旁通,达到类比推理的境界,贯通领悟事理,能像这样,请告诉我您的专长。凡是五脏六腑,胆、胃、大小肠、脾、胞、膀胱,六腑禀受坤土之气,所以说六腑时涉及到了脾。肾主脑髓,肺主涕唾,肝主哭泣,心主悲哀,脑髓、涕唾、哭泣、悲哀与脾相合,这就构成了五脏,五脏是贮藏精气的器官。所以说这是水液运行的途径。这五脏六腑,都是人赖以生存的根本,如果治疗不合乎道,那就是治疗的过失,务必阐明这个道理,才可以做到十全十美;如果不知道,就会被世人埋怨。所以学习医术诵读医书,尤其贵在类比推理和贯通事理。”
雷公说:“臣请求背诵《脉经·上下编》,内容非常多。但在辨别异同、进行类比方面,我还不能做到十全十美,又怎么足以阐明呢?”
黄帝说:“你试着分别阐述五脏的过错,六腑的不和,针刺砭石的失误,以及药物汤液的适宜之处,详细陈述其状况,全部回答我的问题,如果有不知道的,再请问。”
雷公说:“肝虚、肾虚、脾虚,都让人身体沉重、心中烦闷冤屈。应当投用毒药,或者使用刺灸、砭石、汤液治疗,有的好了,有的没好,希望听听您的解释。”
黄帝说:“雷公啊,你年纪多大却问出这么幼稚的问题,我真正的提问反而让你自己弄错了。我问你的是深奥微妙的道理,你却拿《脉经·上下编》的内容来回答,为什么呢?脾脏虚弱浮取似肺脉,肾脏虚弱浮取似脾脉,肝脏虚弱沉取散乱似肾脉,这些都是医生时常混淆的地方,然而从容观察就能分辨清楚。至于这三脏(肝、脾、肾),木、土、水三者参居其中,这是小孩子都知道的,你还问什么呢?”
雷公说:“这里有人,头痛、筋脉拘挛、骨头沉重、怯弱少气、呃逆嗳气、腹部胀满、时常惊恐、不喜欢睡觉,这是什么脏腑发病呢?脉象浮而弦,重按如石般坚硬,我不知道如何解释,再次询问关于这三脏的道理,是想通过类比来明白它。”
黄帝说:“年长的人,病多求之于腑;年少的人,病多求之于经;年壮的人,病多求之于脏。如今你所讲的,都忽略了八风郁热导致五脏消烁,邪气传变相互影响的道理。脉浮而弦,是肾气不足;脉沉而石坚,是肾气内结;怯弱少气,是水液通道不行,形体之气消损;咳嗽烦闷,是肾气上逆。一个人的气,病在一脏,如果说三脏同时发病,就不符合法度了。”
雷公说:“这里有人,四肢懈怠无力,喘咳、便血,我诊断认为是伤肺,切脉浮大而紧,我不敢治疗。粗疏的医生用砭石放血,病好了,出血很多,血止后身体轻快,这是什么原因呢?”
黄帝说:“你能治疗的病,知道也很多,但与此病不符。就像大雁飞翔,也会冲撞天空。圣人治病,遵循法度,运用类比,神妙变化于无形之中,由上及下,何必死守常经?”
黄帝说:“如今脉浮大虚,这是脾气外绝,离开胃土,向外归于阳明。二火不胜三水,所以脉象紊乱无常。四肢懈怠,这是脾精不能运行。喘咳,是水气并犯阳明。便血,是因为脉急,血无所行而下泄。如果认为这是伤肺,那是由于判断失误而狂妄。不引伸类比,说明认识不明。所谓伤肺,是脾气不守,胃气不清,经气不为使,真脏败坏决裂,经脉旁绝,五脏漏泄,不出血就呕吐,这两种情况是不相似的。就像天没有形状,地没有里层,白与黑相差很远啊。这是我的过失。因为你知道这些,所以不告诉你,明确引伸类比、从容不迫,所以命名为‘诊轻’。这就是至高无道的医学原理。”
When the Sages treat diseases, they follow laws and standards, draw analogies from things, and act with composure to adhere to the Mean. The Yellow Emperor demonstrated this principle to Lei Gong, hence the chapter is titled "Demonstrating Composure" (Shi Cong Rong).
The Yellow Emperor sat in leisure and summoned Lei Gong, asking him: "You who have received medical arts and recited books, if you can browse diverse studies, master analogy, and comprehend principles, tell me your strengths. Regarding the five zang organs and six fu organs, including the gallbladder, stomach, large and small intestines, spleen, bladder, brain marrow, nasal discharge and saliva, weeping and sorrow, and the pathways of water metabolism—all these are fundamental to human life. If treatment errors occur, you must clarify them, so that you may achieve perfect success (ten out of ten cases). If you cannot know them, you will be blamed by the world."
Lei Gong replied: "Please allow me to receive the Way. I recite and understand through chanting. Thus, You sat in leisure and summoned me, saying I am one who receives arts and recites books. If I can, beyond recitation, browse diverse studies, extend by touching upon categories, reach analogy, penetrate and realize principles, and thus comprehend the Way—if I can do so, please tell me Your strengths. All five zang organs and six fu organs, the gallbladder, stomach, large and small intestines, spleen, bladder—the six fu organs derive their qi from Kun Earth, hence mentioning six fu organs involves the spleen. The Kidney governs brain marrow; the Lung governs nasal discharge and saliva; the Liver governs weeping; the Heart governs sorrow. Brain marrow, nasal discharge and saliva, weeping and sorrow, combined with the Spleen, constitute the five zang organs. The five zang organs store essence. Hence it is said 'the pathway of water.' These five zang and six fu organs are what humans rely on for life. If treatment does not accord with the Dao, it is a treatment error. One must clarify the Dao to achieve perfection; if one does not know, one will be blamed by the world. Therefore, receiving arts and reciting books especially values analogy and comprehension."
Lei Gong said: "Your subject requests to recite the *Classic of Pulse Diagnosis · Upper and Lower Chapters*. There is much content. In distinguishing differences and making comparisons, I still cannot achieve perfection, let alone clarify them."
The Yellow Emperor said: "Try to distinguish and comprehend the faults of the five zang organs, the disharmony of the six fu organs, the failures of needle and stone therapy, the suitability of toxic drugs, and the flavors of decoctions. State their conditions fully and answer completely. If there is anything unknown, then ask about the unknown."
Lei Gong said: "Liver deficiency, Kidney deficiency, and Spleen deficiency all cause the body to feel heavy and the mind to feel vexed and wronged. One should administer toxic drugs, or use needling, moxibustion, bian stones, and decoctions. Some recover, some do not. I wish to hear the explanation."
The Yellow Emperor said: "Lei Gong, how old are you to ask such immature questions? My true question has led you to err yourself. I asked you about profound and subtle matters, yet you answered with the Upper and Lower Chapters of the *Classic of Pulse Diagnosis*. Why? When the Spleen is deficient and floating, it resembles the Lung pulse; when the Kidney is deficient and slightly floating, it resembles the Spleen pulse; when the Liver is deficient, rapid, deep, and scattered, it resembles the Kidney pulse. These are often confused by skilled physicians, but composure allows one to discern them. As for these three organs—Liver Wood, Spleen Earth, and Kidney Water coexisting—this is knowledge possessed by children. Why do you ask?"
Lei Gong said: "Here is a person with headache, tendon cramping, heavy bones, timidity and shortness of breath, hiccups and belching, abdominal fullness, frequent fright, and aversion to lying down. Which organ's disease is this? The pulse is floating and wiry, and firm like stone upon deep pressure. I do not understand. I again ask about the three organs to know their analogy."
The Yellow Emperor said: "This is what is meant by 'composure'."
The Yellow Emperor said: "For the elderly, seek disease in the fu organs; for the young, seek disease in the meridians; for the vigorous, seek disease in the zang organs. What you described ignores the pathogenic wind from eight directions stagnating into heat, causing the five zang organs to consume and wither, and transmitting evil qi mutually. A floating and wiry pulse indicates Kidney insufficiency; a deep and stone-like pulse indicates Kidney qi adhering internally; timidity and shortness of breath indicate failure of water pathways and consumption of form and qi; coughing and vexation indicate rebellious Kidney qi. Qi in one person is diseased in one zang organ. To say three zang organs act together violates the method."
Lei Gong said: "Here is a person with flaccid limbs, wheezing and coughing, and bloody stool. I diagnosed it as Lung injury. The pulse was floating, large, and tight, so I dared not treat. An unskilled physician used bian stones, the illness resolved, bleeding was profuse, and after bleeding stopped, the body felt light. What is this?"
The Yellow Emperor said: "The diseases you can treat are numerous, but they do not match this case. It is like a wild goose flying, which may also strike the sky. When the Sages treat disease, they follow laws and standards, draw analogies, and transform mysteriously within the unseen, following from above to below. Why must one stick to fixed classics?"
The Yellow Emperor said: "Now, a floating, large, and empty pulse indicates the external severance of Spleen qi, leaving Stomach earth and returning externally to Yangming. Two Fires cannot overcome Three Waters, hence the pulse is chaotic and irregular. Flaccid limbs indicate Spleen essence failing to circulate. Wheezing and coughing indicate Water qi merging with Yangming. Bloody stool indicates rapid pulses where blood has nowhere to go and leaks downward. To consider this Lung injury is due to madness from diagnostic error. Not drawing analogies shows unclear understanding. True Lung injury involves Spleen qi failing to guard, Stomach qi failing to clear, Meridian qi failing to serve, Zang organs decaying, meridians perishing laterally, and five zang leakage resulting in epistaxis or vomiting. These two scenarios are not similar. It is like seeking form in the formless Heaven or lining in the boundless Earth; White and Black are far apart. This is my fault. Since you know this, I did not tell you. Clearly drawing analogies with composure is named 'Light Diagnosis' (Zhen Qing). This is the Supreme Dao."