外有风寒暑湿,内有饥饱劳逸。劳逸,非奔逸之逸,乃逸豫怠惰而生病也,
与劳相反。故经曰∶劳者温之,逸者行之。使气血营运也。西山记曰∶久劳则安
闲以保其极力之处,久逸则导引以宣其积滞之气。或作役者误也。
一者,因气变动而内成积聚、 瘕、癫狂、惊痫之类也。
(音贞,坚积。)瘕(音假,血气聚也。)多喜曰癫。多怒曰狂。
二者,因气变动而外成痈肿、疮疡、痂疥、疽痔、掉眩、浮肿、目赤、 胗、 肿、痛痒之类也。
不因一时所伤而病,乃久以渐积脏腑变动兴衰而病者,是曰因气变动也;脏
腑和平,卒然而即成病者,是曰不因气之变动也。浅而大曰痈,深而恶曰疽。
掉,动摇也。 (音漂,赤丹留毒,火 也。)
三者,不因气之变动而病生于内,则留饮、僻食、饥饱、劳损、宿食、霍乱、悲恐、想慕、忧结之类也。
僻(邪也。)霍乱(上吐而下泻也。)
四者,不因气之变动,而病生于外,则瘴气、鬼魅、虫蛇、蛊毒、蜚尸、鬼
击、冲薄、坠堕、斫射、刺割、捶扑、打探、HT 拉、触抹、风、寒、暑、湿之类也。
蜚(去声,兽也。通言兽所伤人。)
怒则气上,喜则气缓,悲则气消,恐则气下,寒则气收,炅则气泄,惊则气乱,劳则气耗,思则气结。
炅(音桂,热也,旧音耿,非。)人怒则气逆,甚则呕血及飧泄,故气上也。人喜则气
和而志达,荣卫通利,故气缓。缓犹和也,故令人气散也。悲则心系急,肺布叶举,而上焦不通,荣卫
不散,热气在中,故令人气消也。恐则气却,却则上焦闭,闭则气还,还则下焦胀,故气下也。寒则
腠理闭而气不行,故气收也。炅者,热也,热则腠理开,而荣卫通,汗大泄,故气泄也。惊则心无所倚,
神无所归,虑无所定,故气乱也。劳则喘且汗出,内外皆越,故气耗也。越,散越也。
思则心有所存,神有所归,正气留而不行,故气结也。结者,滞而不通也。
外感病邪有风、寒、暑、湿,内伤病因有饥饿与饱食、过度劳累与安逸。这里的“逸”,不是指奔跑奔驰的“逸”,而是指安逸享乐、怠惰懒散从而引发疾病,这与“劳”是相反的。所以医经中说:“对于虚损劳伤者用温补法治疗,对于安逸停滞者用行气导滞法治疗。”目的是使气血运行通畅。西山先生记载说:“长期劳累后,应通过安闲静养来保护那些因用力过度而受损的地方;长期安逸后,应通过导引吐纳来宣通体内积聚阻滞的气机。”有些人误以为“逸”是指从事役使劳作,这是错误的。
第一类,是因为气机变动而在体内形成积聚、瘕(zhǎ,坚硬的积块)、癫狂、惊痫等病症。
(“瘕”音同“假”,指血气聚结而成的包块。)多表现为喜笑无常的是癫证,多表现为发怒暴躁的是狂证。
第二类,是因为气机变动而在体表形成痈肿、疮疡、结痂疥癣、疽、痔疮、震颤眩晕、浮肿、目赤、疹子、肿胀、疼痛瘙痒等病症。
如果不是因为一时受邪致病,而是由于日久逐渐积累,导致脏腑功能变动、兴衰失常而发病的,这叫做“因气变动”;如果脏腑功能平和,突然之间就发病的,这叫做“不因气之变动”。病位浅表且范围大的叫“痈”,病位深在且性质凶险的叫“疽”。
“掉”,指动摇不定。“丹”(音piāo,指赤色丹毒留滞之毒,属火邪)。
第三类,是不因气机变动而病生于体内的,包括留饮(水饮停留)、僻食(饮食偏嗜或腐败食物)、饥饱失调、劳损、宿食、霍乱、悲伤恐惧、思慕过度、忧闷郁结等病症。
“僻”,指邪僻不正。“霍乱”,指上吐下泻的病症。
第四类,是不因气机变动而病生于体外的,包括瘴气、鬼魅(迷信说法,指不明原因的怪病)、虫蛇咬伤、蛊毒、飞尸(一种突发性急症)、鬼击(突然遭受外力打击般的症状)、冲薄(撞击挤压)、坠堕、砍射、刺割、捶打扑击、殴打探击、拉扯、触碰摩擦、风、寒、暑、湿等病症。
“蜚”,去声,指野兽。泛指野兽所伤之人。
愤怒会导致气机上逆,喜悦会导致气机舒缓,悲伤会导致气机消沉,恐惧会导致气机下陷,寒冷会导致气机收敛,炎热会导致气机泄越,惊吓会导致气机紊乱,劳累会导致气机耗散,思虑会导致气机郁结。
“炅”(音guì,热也,旧读gěng是错误的)。人发怒时气机逆乱,严重时会出现呕血和完谷不化的腹泻,所以说是气机上逆。人喜悦时气机和顺、神志通达,营卫之气通行流利,所以气机舒缓。舒缓即和顺,因此使人气机发散。悲伤时心系拘急,肺叶张举,导致上焦不通畅,营卫之气不能布散,热气郁结在中焦,所以使人气机消沉。恐惧时气机退缩,气机退缩则上焦闭塞,闭塞则气机返还,返还则下焦胀满,所以说是气机下陷。寒冷时腠理闭塞,气机运行受阻,所以气机收敛。炅就是热,热则腠理开泄,营卫之气通行,大汗淋漓,所以气机泄越。惊吓时心神无所依托,精神无处归依,思虑没有定准,所以气机紊乱。劳累时喘息且出汗,内外之气都向外散越,所以气机耗散。“越”,指散失。思虑时心思有所专注,精神有所归着,正气停留而不运行,所以气机郁结。“结”,指停滞不通。
External pathogenic factors include Wind, Cold, Summerheat, and Dampness; internal causes include hunger and fullness, as well as overexertion and inactivity. Here, "inactivity" (Yi) does not refer to running or galloping, but rather to a state of ease, pleasure-seeking, laziness, and indolence that leads to disease, which is the opposite of "overexertion" (Lao). Therefore, the classics state: "For conditions of deficiency and exhaustion, use warming methods; for conditions of stagnation due to inactivity, use methods to promote movement." This ensures the smooth circulation of Qi and Blood. Mr. Xishan recorded: "After prolonged exertion, one should preserve strength through rest and tranquility at the sites of excessive effort; after prolonged inactivity, one should use Daoyin (guiding and pulling exercises) to circulate and disperse accumulated stagnant Qi." Some mistakenly interpret "Yi" as engaging in labor or service, which is incorrect.
The first category involves the formation of accumulations (Ji), masses (Jia), mania (Diankuang), epilepsy, and fright-epilepsy within the body due to alterations in Qi dynamics.
(Jia [zhǎ] refers to hard, fixed masses.) Excessive laughter characterizes Dian (mania-like depression), while excessive anger characterizes Kuang (mania).
The second category involves the formation of carbuncles (Yong), sores, scabies with crusts, gangrene (Ju), hemorrhoids, tremors and vertigo, edema, red eyes, rashes (Zhen), swelling, pain, and itching on the exterior due to alterations in Qi dynamics.
If the disease arises not from an acute injury but from gradual accumulation over time, leading to changes in the rise and fall of Zang-Fu organ functions, it is termed "due to alteration of Qi dynamics"; if the Zang-Fu organs are harmonious and the disease strikes suddenly, it is termed "not due to alteration of Qi dynamics." A superficial and large lesion is called Yong (carbuncle); a deep and malignant lesion is called Ju (gangrene).
"Diao" refers to trembling or shaking. Dan (piāo) refers to erysipelas or red toxic heat retained in the skin, associated with Fire.
The third category includes diseases arising internally not due to Qi dynamic alterations, such as retained fluids (Liuyin), dietary irregularities (Pishi), hunger and fullness imbalances, physical damage from overwork, retained food, cholera-like syndrome (Huoluan), grief, fear, obsessive longing, and melancholic constriction.
"Pi" refers to abnormality or deviation. Huoluan refers to vomiting and diarrhea.
The fourth category includes diseases arising externally not due to Qi dynamic alterations, such as miasma (Zhangqi), demonic influences (Guimei), insect and snake bites, gu poison, flying corpse syndrome (Feishi), ghost strike (Guiji), impact and compression, falls, cuts and stabs, blows and bruises, beating and probing, pulling, touching and rubbing, as well as Wind, Cold, Summerheat, and Dampness.
"Fei" (fourth tone) refers to wild beasts; generally, it denotes injuries caused by animals.
Anger causes Qi to ascend; joy causes Qi to slacken; grief causes Qi to dissipate; fear causes Qi to sink; cold causes Qi to contract; heat causes Qi to leak; fright causes Qi to become chaotic; exertion causes Qi to be consumed; thought causes Qi to knot.
Jiong (guì) means heat (the old pronunciation gěng is incorrect). When people are angry, Qi becomes rebellious; severely, this leads to hematemesis and undigested stool diarrhea, hence it is said that Qi ascends. When people are joyful, Qi is harmonious and the spirit is unblocked, allowing Ying and Wei (Nutritive and Defensive Qi) to flow freely, hence Qi slackens. Slackening implies harmony, thus causing Qi to scatter. Grief causes the Heart system to tighten and the Lung leaves to elevate, obstructing the Upper Jiao, preventing Ying and Wei from dispersing, and trapping hot Qi in the center, thus causing Qi to dissipate. Fear causes Qi to retreat; when Qi retreats, the Upper Jiao closes; when closed, Qi returns; when returned, the Lower Jiao becomes distended, hence Qi sinks. Cold causes the pores (Couli) to close and Qi to fail to move, hence Qi contracts. Jiong is heat; heat causes pores to open and Ying and Wei to flow, resulting in profuse sweating, hence Qi leaks. Fright causes the Heart to have no support, the Spirit to have no refuge, and thoughts to lack direction, hence Qi becomes chaotic. Exertion causes panting and sweating, with internal and external Qi scattering outward, hence Qi is consumed. "Scatter" means to dissipate. Thought causes the mind to focus and the Spirit to reside, causing Zheng Qi (Upright Qi) to remain stagnant and not move, hence Qi knots. "Knot" means stagnation and obstruction.