阴阳应象论云水谷之寒热感则害人六腑痹论云阴气者静则神藏躁则消亡饮食自倍肠胃
乃伤此乃混言之也分之为二饮也食也饮者水也无形之气也因而大饮则气逆形寒饮冷则伤肺病
则为喘咳为肿满为水泻轻则当发汗利小便使上下分消其湿解酲汤五苓散生姜半夏枳实白术之
类
是也如重而蓄积为满者芫花大戟甘遂牵牛之属利下之此其治也食者物也有形之血也如生气通
天论云因而饱食筋脉横解肠 为痔又云食伤太阴厥阴寸口大于人迎两倍三倍者或呕吐或痞满
或下痢肠 当分寒热轻重而治之轻则内消重则除下如伤寒物者半夏神曲干姜三棱广术巴豆之
类主之如伤热物者枳实白术青皮陈皮麦 黄连大黄之类主之亦有宜吐者阴阳应象论云在上者
因而越之瓜蒂散之属主之然而不可过剂过剂则反伤肠胃盖先因饮食自伤又加之以药过故肠胃
复伤而气不能化食愈难消矣渐至羸困故五常政大论云大毒治病十去其六小毒治病十去其七凡
毒治病不可过之此圣人之深戒也
调经篇云阴虚生内热岐伯曰有所劳倦形气衰少谷气不盛上焦不行下脘不通而胃气热热气
熏胸
中故内热举痛论云劳则气耗劳则喘且汗出内外皆越故气耗矣夫喜怒不节起居不时有所劳伤皆
损
其气气衰则火旺火旺则乘其脾土脾主四肢故困热无气以动懒于语言动作喘乏表热自汗心烦不
安当病之时宜安心静坐以养其气以甘寒泻其热火以酸味收其散气以甘温补其中气经言劳者温
之损者温之者是也金匮要略云平人脉大为劳脉极虚亦为劳矣夫劳之为病其脉浮大手足烦热春
夏剧秋冬瘥脉大者热邪也极热者气损也春夏剧者时助邪也秋冬瘥者时胜邪也以黄 建中汤治
之此亦温之之意也夫上古圣人饮食有节起居有常不妄作劳形与神俱百岁乃去此谓治未病也今
时
之人去圣人久远则不然饮食失节起居失宜妄作劳役形气俱伤故病而后药之是治其已病也推
其
百病之源皆因饮食劳倦而胃气元气散解不能滋荣百脉灌溉脏腑卫护周身之所致也故苍天之气
贵清静阳气恶烦劳噫饮食喜怒之间寒暑起居之际可不慎欤
《阴阳应象大论》说:“水谷的寒热之气,感受了就会伤害六腑。”《痹论》说:“阴气主静,静则神气内藏;若躁动不安,神气就会消亡。”饮食过量,肠胃就会受伤。这是笼统的说法,细分为两类:饮和食。
“饮”指的是水,属于无形的气。如果大量饮水,会导致气机逆乱。形体受寒、饮用冷水会损伤肺脏,病症表现为气喘咳嗽、肿胀胀满或水样腹泻。轻症应当通过发汗、利小便的方法,使湿气从上、下两路分消。解酲汤、五苓散以及生姜、半夏、枳实、白术之类的药物就是用于此目的。如果病情严重,湿邪蓄积导致腹部胀满,则需用芫花、大戟、甘遂、牵牛子等药物攻下逐水。这就是对“饮”的治疗原则。
“食”指的是食物,属于有形的血类物质。《生气通天论》说:“如果饱食过度,筋脉松弛弛缓,肠道受损就会形成痔疮。”又说:“饮食损伤太阴、厥阴经,寸口脉比人迎脉大两倍或三倍时,会出现呕吐、痞满或痢疾、肠澼等症状。”治疗时应区分寒热和病情的轻重。轻症宜用内消法,重症宜用攻下法。如果是伤于寒性食物,可用半夏、神曲、干姜、三棱、莪术、巴豆等药物治疗;如果是伤于热性食物,可用枳实、白术、青皮、陈皮、麦冬、黄连、大黄等药物治疗。也有适宜用催吐法的,《阴阳应象大论》说:“病邪在上部的,因而用涌吐法使其排出。”瓜蒂散之类的主治此类病症。然而不可用药过量,过量反而会损伤肠胃。因为原本就因饮食自伤,又加上药物过量,导致肠胃再次受伤,气机不能运化食物,消化更加困难,逐渐导致身体消瘦困顿。所以《五常政大论》说:“用大毒药物治疗疾病,病去十分之六即止;用小毒药物治疗疾病,病去十分之七即止。凡是用有毒性的药物治疗疾病,不可过度。”这是圣人的深刻告诫。
《调经论》说:“阴虚产生内热。”岐伯说:“由于劳倦,形体和气都衰弱,谷气不旺盛,上焦不通畅,下脘不流通,导致胃气生热,热气熏蒸胸中,所以产生内热。”《举痛论》说:“劳倦耗气。劳倦则喘息且出汗,内外之气都外越,所以气被耗损。”如果喜怒没有节制,起居没有规律,有所劳伤,都会损伤气机。气衰则火旺,火旺则乘袭脾土。脾主四肢,所以感到困倦发热,没有力气活动,懒于说话,动作气喘乏力,体表发热,自汗,心烦不安。在患病期间,应当安心静坐以养气,用甘寒的药物清泻火热,用酸味的药物收敛耗散之气,用甘温的药物补益中气。《内经》说:“劳者温之,损者温之”,说的就是这个道理。《金匮要略》说:“平人脉象大为劳证,脉象极虚也是劳证。”劳倦病的脉象浮大,手足烦热,春夏季节加重,秋冬季节缓解。脉大代表热邪,极虚代表气损。春夏加重是因为时令助长邪气,秋冬缓解是因为时令克制邪气。用黄芪建中汤治疗,这也是“温之”的意思。
上古圣人饮食有节制,起居有规律,不妄加劳役,形与神俱备,能活到百岁才去世,这叫做“治未病”。现在的人远离圣人时代,就不这样了,饮食失节,起居不适,妄加劳役,形体和气都受伤,所以先生病然后用药治疗,这是“治已病”。推究百病的根源,都是因为饮食劳倦导致胃气和元气散失,不能滋养荣润百脉,灌溉脏腑,卫护周身所致。所以苍天之气贵在清静,阳气厌恶烦劳。唉!在饮食、喜怒之间,寒暑、起居之际,能不谨慎吗?
The *Da Yi Ying Xiang Lun* (Great Treatise on the Correspondence of Yin and Yang) states: "The cold and hot nature of food and drink, when perceived, harms the Six Fu Organs." The *Bi Lun* (Treatise on Bi Syndrome) states: "Yin Qi is quiet; in quietness, the Spirit is stored. If restless, the Spirit dissipates." Excessive intake of food and drink injures the Intestines and Stomach. This is a general statement; specifically divided into two categories: Drinks (Yin) and Food (Shi).
"Drinks" refer to water, which belongs to formless Qi. Drinking excessively causes Qi rebellion. Cold exposure and drinking cold liquids injure the Lungs, resulting in symptoms such as panting and coughing, swelling and fullness, or watery diarrhea. For mild cases, sweating and promoting urination should be employed to disperse dampness from above and below. *Jie Cheng Tang* (Dreg-Resolving Decoction), *Wu Ling San* (Five-Ingredient Powder with Poria), and herbs such as *Sheng Jiang* (Zingiberis Rhizoma Recens), *Ban Xia* (Pinelliae Rhizoma), *Zhi Shi* (Aurantii Fructus Immaturus), and *Bai Zhu* (Atractylodis Macrocephalae Rhizoma) are indicated. For severe cases where dampness accumulates causing abdominal fullness, drugs such as *Yuan Hua* (Genkwa Flos), *Da Ji* (Euphorbiae Pekinensis Radix), *Gan Sui* (Kansui Radix), and *Qian Niu* (Pharbitidis Semen) should be used to purge downwards. This constitutes the treatment for "Drinks."
"Food" refers to solid matter, belonging to the category of有形之血 (formative blood/substance). The *Sheng Qi Tong Tian Lun* (Treatise on Vital Energy Communicating with Heaven) states: "Excessive satiety leads to flaccidity of sinews and vessels, and intestinal damage results in hemorrhoids." It further states: "Injury to the Tai Yin and Jue Yin meridians by food results in the Cun Kou pulse being two or three times larger than the Ren Ying pulse, accompanied by vomiting, epigastric fullness, or dysentery and intestinal disorders." Treatment must distinguish between cold and heat, and severity. Mild cases are treated by internal resolution; severe cases by purgation. For injury caused by cold-natured foods, *Ban Xia*, *Shen Qu*, *Gan Jiang*, *San Leng*, *E Zhu*, and *Ba Dou* are indicated. For injury caused by hot-natured foods, *Zhi Shi*, *Bai Zhu*, *Qing Pi*, *Chen Pi*, *Mai Dong*, *Huang Lian*, and *Da Huang* are indicated. Emetic therapy is also suitable in some cases. The *Da Yi Ying Xiang Lun* states: "For pathogens located above, induce vomiting to expel them." *Gua Di San* (Melon Seed Powder) is indicated for such conditions. However, dosage must not be excessive, as it will re-injure the intestines and stomach. Since the patient has already self-injured via diet, adding excessive medication further damages the gastrointestinal Qi, impairing digestion and leading to emaciation and debility. Thus, the *Wu Chang Zheng Da Lun* (Great Treatise on the Five Constant Policies) states: "When treating disease with highly toxic substances, stop when six-tenths of the disease is removed; when using slightly toxic substances, stop when seven-tenths is removed. One must never overuse toxic drugs." This is a profound warning from the Sages.
The *Tiao Jing Lun* (Treatise on Regulating the Channels) states: "Yin deficiency generates internal heat." Qi Bo said: "Due to fatigue and overexertion, the physical form and Qi decline, and Gu Qi (Grain Qi) becomes insufficient. The Upper Jiao fails to circulate, and the Lower Wan fails to transmit, causing Stomach Qi to generate heat. This heat steams the chest, resulting in internal heat." The *Ju Tong Lun* (Treatise on Painful Conditions) states: "Fatigue consumes Qi. Fatigue leads to panting and sweating, causing both interior and exterior Qi to escape, thus depleting Qi." Unregulated emotions and irregular daily routines cause injury to Qi. When Qi declines, Fire flares up, attacking the Spleen Earth. Since the Spleen governs the four limbs, the patient feels fatigued and feverish, lacks strength for movement, is reluctant to speak, experiences panting and weakness during activity, has surface heat, spontaneous sweating, and restlessness. During illness, one should sit quietly to nourish Qi, use Sweet-Cold herbs to clear Heat, use Sour herbs to astringe escaping Qi, and use Sweet-Warm herbs to tonify Middle Qi. The Classics state: "Tonify fatigue with warmth, tonify deficiency with warmth," which refers to this principle. The *Jin Gui Yao Lue* states: "A large pulse indicates labor syndrome; an extremely deficient pulse also indicates labor syndrome." In labor syndrome, the pulse is floating and large, with vexing heat in the hands and feet, worsening in Spring and Summer, and improving in Autumn and Winter. A large pulse indicates Heat pathogen; extreme deficiency indicates Qi damage. Worsening in Spring/Summer is due to seasonal support of the pathogen; improvement in Autumn/Winter is due to seasonal suppression of the pathogen. *Huang Qi Jian Zhong Tang* (Astragalus Decoction to Establish the Middle) is used for treatment, embodying the principle of "warming."
The Ancient Sages regulated their diet, maintained regular routines, avoided excessive exertion, and preserved both Form and Spirit, living to a hundred years. This is called "treating disease before it arises." People today, far removed from the Sages' era, do not act thus. They have irregular diets, improper routines, and engage in reckless labor, injuring both Form and Qi. Consequently, they fall ill and then take medicine, which is "treating disease after it has arisen." Tracing the origin of all diseases reveals that dietary indiscretion and fatigue cause the dispersion of Wei Qi (Stomach Qi) and Yuan Qi (Original Qi), preventing them from nourishing the collaterals, irrigating the Zang-Fu organs, and protecting the body. Therefore, the Qi of Heaven values clarity and stillness, while Yang Qi dislikes vexation and labor. Alas! Must one not be cautious regarding diet, emotions, climate, and daily routine?