胃乃受纳之腑,脾为转运之官,故水谷入胃,得脾气之转输,而后能充实于四肢,资养于肌肉。胃为
阳,脾为阴,脾与胃以膜相连,阴阳相交。如能食而瘦者,阳与阴绝也。夫阳明不从标本,从太阴中见之
化。阳明乃燥热之腑,不得太阴之湿化,则悍热之气更盛;脾不得禀水谷之气,则太阴之气愈虚。是以胃中热
则消谷善饥,脾气虚则肌肉日瘦,盛者愈盛而虚者愈虚,渐至五有余而二不足,则死不治矣。夫人参、甘
草、半夏、橘皮、生姜之类,乃助胃之品也;白术、苍术、山药、黄 、浓朴、茯苓、干姜、大枣之类,乃
助脾之品也;枳实、黄连、大黄、石膏、麻仁、芍药之类,乃抑胃之药也。经言强者抑之,弱者扶之。不
知药性之所主,不分强弱之资抑,是以强者仍强,而弱者仍弱矣。《阳明篇》曰∶胃气生热,其阳则绝。又
曰∶浮则胃气强,其脾为约,麻仁丸主之。此阳与阴
绝,而用抑强之法也。
张开之曰∶此外因之新病,故止用抑强之法。如病久而肌肉消瘦者,当以助脾之药为君,宜胃之药为
臣,使胃气与脾气相通,泻胃之药为佐,斯为正治之法。
夫病之生于内伤外感,人所共知,而奇恒之病,知之者鲜矣!所谓奇恒者,异于恒常也。乃阴阳偏胜,五
行逆传,审证辩脉,大有径庭。《内经》之论疾病者,不及二十余篇,论奇恒之章有八。学人当用心参究,庶
免五过之责。
胃是负责受纳饮食的脏腑,脾是负责转运水谷精微的官职(功能),所以水谷进入胃中,得到脾气的转输作用后,才能充实四肢,滋养肌肉。胃属阳,脾属阴,脾与胃通过膜相连,阴阳相互交济。如果能进食但身体消瘦,这是阳气与阴气隔绝的表现。阳明经不遵循标本关系,而是顺从太阴经的中见之气而化生。阳明是燥热之腑,如果得不到太阴经湿气的化解,那么刚烈燥热之气就会更加旺盛;脾脏如果不能禀受水谷的精气,那么太阴经的气机就会更加虚弱。因此,胃中有热就会消化食物快、容易饥饿,脾气虚弱就会导致肌肉日渐消瘦,亢盛的更加亢盛,虚弱的更加虚弱,逐渐发展到“五有余”而“二不足”的程度,就会死亡且无法治疗了。像人参、甘草、半夏、橘皮、生姜这类药物,是辅助胃气的;白术、苍术、山药、黄芩、厚朴、茯苓、干姜、大枣这类药物,是辅助脾气的;枳实、黄连、大黄、石膏、火麻仁、芍药这类药物,是抑制胃气的。经文说:亢盛的要抑制它,虚弱的要扶持它。如果不了解药性的主治方向,不区分强弱来运用抑制或扶持的方法,结果就是亢盛的依然亢盛,虚弱的依然虚弱。《伤寒论·阳明篇》说:“胃气产生内热,其阳气就会隔绝。”又说:“脉浮说明胃气强盛,其脾脏被约束(津液不足),用麻子仁丸主治。”这就是阳气与阴气隔绝,而采用抑制亢盛一方的治疗方法。
张开之说:这是外邪引起的急性新病,所以只使用抑制亢盛的方法。如果是患病日久导致肌肉消瘦的,应当以辅助脾气的药物作为君药,以辅助胃气的药物作为臣药,使胃气与脾气相通,以泻除胃热的药物作为佐药,这才是正确的治疗方法。
疾病由内伤或外感引起,人们都知道,但对于“奇恒”类疾病,知道的人很少!所谓“奇恒”,就是异于平常的意思。这是由于阴阳偏胜,五行逆传,审察证候辨析脉象,与常规疾病大有不同。《黄帝内经》中论述疾病的篇章不到二十篇,但专门论述奇恒疾病的章节就有八篇。学习中医的人应当用心参悟探究,这样才能免除因误诊而导致的“五过”之责。
The Stomach is the fu-organ responsible for receiving and storing, while the Spleen is the official responsible for transportation and transformation. Therefore, when food and drink enter the Stomach, they rely on the Spleen Qi's (Spleen Qi) transformative and transporting function to subsequently nourish the four limbs and sustain the muscles. The Stomach belongs to Yang, and the Spleen belongs to Yin; the Spleen and Stomach are connected by membranes, allowing Yin and Yang to interact. If a person can eat but remains emaciated, it indicates an isolation between Yang and Yin. The Yangming channel does not follow its biao-biao relationship but transforms according to the zhongjian qi (middle-view qi) of the Taiyin channel. Yangming is a fu-organ of dryness and heat; if it does not receive the dampening transformation of Taiyin, the fierce heat qi will become even more vigorous. If the Spleen cannot receive the essence from food and drink, the qi of Taiyin will become increasingly deficient. Thus, heat in the Stomach leads to rapid digestion and easy hunger, while deficiency of Spleen Qi leads to daily emaciation of the muscles. The excessive becomes more excessive, and the deficient becomes more deficient, gradually progressing to a state of "five excesses" and "two deficiencies," which results in death that is untreatable. Substances such as Renshen (Ginseng Radix), Gancao (Licorice Root), Banxia (Pinellia Tuber), Jupi (Tangerine Peel), and Shengjiang (Fresh Ginger) are substances that assist Stomach Qi. Baizhu (Atractylodis Macrocephalae Rhizoma), Cangzhu (Atractylodis Rhizoma), Shanyao (Dioscoreae Rhizoma), Huangqin (Scutellariae Radix), Houpo (Magnoliae Officinalis Cortex), Fuling (Poria), Ganjiang (Zingiberis Rhizoma), and Dazao (Jujubae Fructus) are substances that assist Spleen Qi. Zhishi (Aurantii Fructus Immaturus), Huanglian (Coptidis Rhizoma), Dahuang (Rhei Radix et Rhizoma), Shigao (Gypsum Fibrosum), Huren (Cannabis Semen), and Shaoyao (Paeoniae Radix) are medicines that suppress Stomach Qi. The Classics state: "Suppress what is excessive, support what is deficient." If one does not understand the primary functions of medicinal properties and fails to distinguish between strength and weakness when applying suppression or support, the result is that the excessive remains excessive, and the deficient remains deficient. The Yangming Chapter states: "Stomach Qi generates heat, and its Yang becomes isolated." It also says: "Floating pulse indicates strong Stomach Qi, and the Spleen is constrained; Maren Wan (Hemp Seed Pill) is the main treatment." This represents the isolation of Yang and Yin, treated by suppressing the excessive aspect.
Zhang Kaizhi said: "This is a new disease caused by external pathogens, so only the method of suppressing the excessive should be used. If the disease has persisted for a long time leading to muscle emaciation, one should use spleen-assisting medicines as the sovereign drug, stomach-assisting medicines as the minister drug, to allow Stomach Qi and Spleen Qi to communicate, and stomach-draining medicines as the assistant drug. This is the correct treatment method."
It is well known that diseases arise from internal injury or external contraction, but few know about "Qiheng" (strange and constant/unusual) diseases! What is meant by "Qiheng" is that which differs from the ordinary. It involves Yin-Yang bias and excess, reverse transmission of the Five Elements, where examining syndromes and differentiating pulses differs greatly from the norm. In the *Neijing* (Inner Canon), there are fewer than twenty chapters discussing diseases, yet eight chapters specifically discuss Qiheng diseases. Students of medicine must study these with care to avoid the responsibility of the "Five Errors."