癸巳癸亥岁
王冰曰同岁会
其化上辛凉中咸和下咸寒药食宜也
张介宾曰中运少征得天地之生助故宜咸和上下同骥案元珠密语天运加临纪癸亥岁风疾行于上治之以辛凉用金性金味
以伏风木之胜勿食酸物佐木之胜也元和纪用经上中下并同
帝曰论言热无犯热寒无犯寒余欲不远寒不远热奈何岐伯曰悉乎哉问也发表不远热攻里不远寒
王冰曰汗泄故用热不远热下利故用寒不远寒皆以其不住于中也如是则夏可用热冬可用寒不发不泄而无畏忌是谓妄远
法所禁也皆谓不获已而用之也秋冬亦同新校正云按至真要大论发不远发表不远热也冬月攻里不远寒也发表攻里之品不留
于中而有所宜也马莳曰此言汗下其邪者可以偶犯寒热而无故犯之者非也邪郁于表则用热药以发之热积于里则用寒药以攻
之张介宾曰中于表者多寒邪故发表之治不能远热夏月亦然郁于里者多热邪故攻里之治不能远寒冬月亦然愚按此二句大意
全在发攻二字发者逐之于外也攻者逐之于内也寒邪在表非温热之气不能散故发表者不远热热郁在内非沉寒之物不能除故
攻里者不远寒此必然之理也然亦有用小柴白虎益元冷水之类而取汗愈病者何也此因表里俱热故当凉解非发之之谓也又有
用理中四逆回阳之类而除痛去积者何也此因阴寒留滞故当温中非攻之之谓也所谓发者开其外之固也攻者伐其内之实也今
之昧者但见外感发热等病不能察人伤于寒而传为热者有本寒标热之义辄用芩连等药以清其标焉知邪寒在表药寒在里以寒
得寒气求声应致内外合邪遂不可解此发表用寒之害也其于春秋冬三季及土金水三气治令阴胜阳微之时为尤以火不在里最
忌寒凉此而误入是不知当发者不可远热也又如内伤喘痛胀满等多有三阴亏损今人但见此类不辨虚寒便用硝黄之属且云先
去其邪然后固本若乎近理焉知有假实真虚之病而复伐之则病未去而元气不能支矣此而误入是不知当攻者方不远寒也二者
之害余见之多矣不得不特表出之以为当事者之戒骥案元和纪用经药经五味寒热温凉平性配合五内联应五入五气五宜参配
岁运太过不及处用有殊六气标本治病之枢六气用药寒暑燥湿风火所胜中见五运或逆或从天而逆地或从地而逆天临御之化
阴阳舒卷人事可调用寒远寒 寒无犯寒也用热远热热无犯热也从者养和逆者生病
帝曰不发不攻而犯寒犯热何如岐伯曰寒热内贼其病益甚
王冰曰以水济水以火济火适足以更生病岂唯本病之益甚乎马莳曰若非发表而犯热则热贼内而热反甚非攻里而犯寒则
寒贼内而寒反胜骥案元和纪用经木立之与四时之五气之用饮食衣药温□故以轻犯寒热则同者皆宜避之若
四时同犯以水济水以火助火病必生矣岐伯司气以热用热无犯间
气同其主无犯异其主则小犯之是谓四畏必谨察之天气反时则可根据时反甚为病故也反胜其主则可犯之谓夏寒甚则可以热寒
气不甚则不可犯之以平为期而不可过过而病生与反犯同邪客胜主则不可御要格曰寒盛格阳治热以热慎不可寒格阳而治以
寒外似顺而中气乃逆热盛拒阴治寒以寒慎不可热拒阴而治以热外似顺而中气乃逆因气异形迷乱圣经慎之
帝曰愿闻无病者何如岐伯曰无者生之有者甚之
王冰曰无病者犯禁犹能生病况有病者而求轻减不亦难乎吴昆曰无病而犯寒犯热则生寒生热有病而犯寒犯热则寒甚热
甚马莳曰彼无病而误服者仅足以生病奚止于有病而胜者哉
帝曰生者何如岐伯曰不远热则热至不远寒则寒至寒至则坚否腹满痛急下利之病生矣
王冰曰食已不饥吐利腥秽亦寒疾也马莳曰犯寒则寒至凡为坚否为腹满为痛急为下利之病生矣张介宾曰寒至则阳衰不
能运化郁注下眼螈肿脚呕鼽衄头痛骨节变内痛血溢血泄淋 之病生矣
王冰曰暴喑冒昧目不识人躁扰狂越妄见妄闻骂詈惊
痫亦热之病马莳曰犯热则热至凡为身热为吐下为霍乱为痈疽为疮疡为瞀郁为注下为 螈为肿胀为呕为鼽衄为头痛为骨节
变为内痛为血溢为血泄为淋 之病生矣张介宾曰热至则火灼诸经
帝曰治之奈何岐伯曰时必顺之犯者治以胜也
王冰曰春宜凉夏宜寒秋宜温冬宜热此时之宜不可不顺然犯热治以寒犯寒治以热犯春宜用凉犯秋宜用温是以胜也犯热
治以咸凉犯寒治以甘热犯凉治以苦温犯温治以辛凉亦胜之道也吴昆曰时必顺之顺其升降浮沉也犯者治以胜逆其寒热温凉
也故春宜升秋宜降夏宜浮冬宜沉顺四时之谓也温宜凉热宜寒凉宜温寒宜热治以所胜之谓也张志聪曰此言主时之六气亦当
远寒而远热者也按前章之所谓热无犯热寒无犯寒者论司天在泉及加临之六气此章论主时之六气亦有寒热之者太阴之气在
于长夏太阳之气在于冬少阴之气在于夏阳明之气在于秋厥阴之气在于春如冬有热化以征少阴之胜夏有寒化以征太阳之胜
此与春胜长夏长夏胜冬之义相同徐振公曰此即帝所问之有胜有复在六气为胜复在四时为胜化马莳曰治之者春则宜凉夏则
宜寒秋则宜温冬则宜热时所必用不可不顺其有犯而病胜者则犯热治以咸寒犯寒治以甘热犯凉治以苦温犯温治以辛凉治之
以所胜而病可解矣张介宾曰时必顺之治当顺时也若有所误犯则当治之以胜骥案元和纪用经六气为主五味为用司岁备物则
无遗主药当其岁味当其气气味浓薄性用躁静治保多少力化浅深寒热温凉随胜用之岁运所主举抑之制制胜扶弱客主须安一
气失所矛盾交作脏腑淫并危败消亡宝书所载商较服饵药不具五味不备四气而久服之虽且获胜益久流变必致横天寒热温凉
衰之以属随其攸利万举万全卷舒在心去留从意微者逆之甚者从之龙火得湿而焰遇水而燔伏其所主先其所因圣如南阳今古
一人气运用药皆如上例余谓有大暑之候而得寒证大寒之候而得热证证有性偏阴虚虽当隆冬阴粒亏立水不制火阴无所根据外
泄为热或反汗出药宜滋阴若舍证从时误用辛温势必立毙又有性偏阳虚虽当盛夏阳气不足不能卫外洒淅战栗时思热食且御
重裘天令虽热不能敌真阳之虚病属虚寒药宜温补若从时舍证误用苦寒亦必立毙又如春令主升升为春气为风化为木象升有
散之之义也若因饮食劳倦则阳气下陷宜升阳益气泻利不止宜升阳益胃郁火伏内宜升阳散火因湿洞泄宜升阳除湿此证四
时都有夏秋尤多升之之令不独行之于春也又如秋令主降降为秋气为燥化为金象降有敛之之义也若系阴火旺发而炎上咳嗽
多痰吐血鼻衄口苦舌干头疼齿痛骨蒸寒热是谓上热下虚之候宜枇杷叶麦冬贝母白芍牛膝五味之属以降气或用滋水添精之
药以救本此亦四时都有夏冬多见降之之令不专行之于秋也运气用药最宜活看
癸巳年和癸亥年
王冰说:这属于同岁会(岁运不及,地支为阴干之年)。
其气化特点在上部宜用辛凉、中部宜用咸味、下部宜用咸寒的药物和食物。
张介宾说:中运(岁运)属少征(火运不足),得到天地之气的生助,所以适宜用咸味调和;上下部也相同。
我(张骥)按语:《元珠密语》记载天运加临纪年,癸亥年风气盛行于上,治疗应用辛凉之法,利用金的性质和金的味道,来抑制风木的胜气,不要食用酸味食物以辅助木的胜气。《元和纪用经》中上、中、下部的论述与此相同。
黄帝问:医论中说“热无犯热,寒无犯寒”,我想不远离寒药也不远离热药,该怎么办?
岐伯说:问得详尽啊!
发表(解表发汗)不远离热药,攻里(泻下通便)不远离寒药。
王冰说:因为要发汗泄邪,所以用热药而不远离热性;因为要泻下利积,所以用寒药而不远离寒性。都是因为药物不住留在体内(即中病即止)。像这样,夏天可以用热药,冬天可以用寒药,只要不发汗、不泻下就没有禁忌,这叫作妄图远离法度,是治法所禁止的。这都是指不得已而用的情况,秋冬季节也是如此。
新校正云:按《至真要大论》所说,“发表不远热,攻里不远寒”。冬月攻里不远离寒药,是因为发表攻里的药物不留滞在体内,而是有所适宜的。
马莳说:这是说汗法和下法祛除邪气时,可以偶尔触犯寒热,但不能无故去触犯,这种说法是不对的。邪气郁结在表,就用热药来发散它;热邪积聚在里,就用寒药来攻逐它。
张介宾说:邪气中于表的多为寒邪,所以发表的治疗不能远离热药,夏季也是这样;邪气郁于里的多为热邪,所以攻里的治疗不能远离寒药,冬季也是这样。
我(张骥)按语:这两句话的大意全在于“发”和“攻”两个字。“发”是将邪气驱逐到体外;“攻”是将邪气驱逐到体内排出。寒邪在表,非温热之气不能散开,所以发表者不远离热药;热邪郁结在内,非沉寒之物不能清除,所以攻里者不远离寒药。这是必然的道理。
然而也有用小柴胡汤、白虎汤、益元散、冷水之类而取汗治愈疾病的,为什么呢?这是因为表里俱热,所以应当用凉法解表,这不是“发汗”的意思。又有用理中汤、四逆汤回阳救逆之类而消除疼痛、去除积滞的,为什么呢?这是因为阴寒留滞,所以应当温中,这不是“攻下”的意思。所谓“发”,是打开体表的固闭;所谓“攻”,是伐除体内的实邪。
现在的庸医,只见到外感发热等病,不能察知人伤于寒邪而传变为热证,其中含有本寒标热的意义,就随意使用黄芩、黄连等药物来清解表面的热象,哪里知道邪寒在表,若用寒药在里,以寒引寒气,寻求声应,导致内外合邪,于是就无法解除了。这是发表时用寒药的害处。这种情况在春、秋、冬三季以及土、金、水三气主令、阴胜阳微的时候尤为忌讳。火不在里,最忌寒凉,如果误用寒凉,就是不知道当发汗时不可远离热药。
又如内伤引起的喘促、疼痛、胀满等多有三阴亏损的情况,现在的人只见到这类病症,不辨别虚寒,就使用芒硝、大黄之类的药物,并且说先去除邪气然后固护根本,似乎很合乎道理。哪里知道有假实真虚的病证,如果再攻伐它,那么病邪未去而元气已经不能支撑了。如果误入此途,就是不知道当攻下时方不远离寒药。这两种害处,我见到的很多,不得不特别指出,作为处理此类疾病者的警戒。
我(张骥)按语:《元和纪用经》记载,药物依据五味(酸苦甘辛咸)、寒热温凉平性的配合,与五脏相应,关联五种气味、五种适宜,参配岁运太过不及之处,用法有所不同。六气的标本是治病的枢纽,六气用药涉及寒暑燥湿风火,以及所胜之气和中见之气。五运或逆或顺从天道而逆地道,或顺地道而逆天道的临御变化,阴阳舒展卷缩,人事可调。用寒远寒(寒冷季节慎用寒药),寒无犯寒(避免触犯寒邪);用热远热(炎热季节慎用热药),热无犯热(避免触犯热邪)。顺从者养护和谐,逆反者产生疾病。
黄帝问:如果不发汗、不攻下却触犯寒热,会怎样?
岐伯说:寒热成为内部的贼邪,疾病会更加严重。
王冰说:用水去济助水,用火去济助火,只足以使人生更多的病,岂止是本病更加严重呢?
马莳说:如果不是发表而触犯热邪,则热邪贼害内部,热反而更甚;如果不是攻里而触犯寒邪,则寒邪贼害内部,寒反而更盛。
我(张骥)按语:《元和纪用经》记载,木立之与四时的五气之用,饮食衣药温凉……所以以轻犯寒热,则同类皆宜避之。如果四时共同触犯,以水济水,以火助火,病必定产生。
岐伯说:司天之气为热,用热药无犯司天之气;间气与主气相同则无犯,与主气不同则可小犯。这叫作四畏,必须谨慎观察。天气反常之时,则可根据时令调整,反常严重致病,所以反胜主气时可以触犯。谓如夏季寒气甚重,则可以用热药;寒气不重则不可触犯。以平和为期,不可过度,过度则生病,与反犯相同。邪客胜主则不可抵御。《要格》说:寒盛格阳(真寒假热),治热以热,慎不可用寒;格阳而治以寒,外似顺而中气乃逆。热盛拒阴(真热假寒),治寒以寒,慎不可用热;拒阴而治以热,外似顺而中气乃逆。因气异形迷乱圣经,务必谨慎。
黄帝问:我希望了解没有病的人怎么样?
岐伯说:无病者触犯禁忌会产生疾病,有病者触犯禁忌会使病情加重。
王冰说:无病的人触犯禁忌尚且能生病,何况有病的人想要减轻病情,不也很难吗?
吴昆说:无病而触犯寒热,则产生寒热病;有病而触犯寒热,则寒热更甚。
马莳说:那些无病而误服的人,仅足以生病,何止是有病而受邪胜的人呢?
黄帝问:产生疾病和加重病情是怎样的?
岐伯说:不远离热药则热邪至,不远离寒药则寒邪至。寒邪至则产生坚硬痞塞、腹部胀满、疼痛急迫、下利等疾病。
王冰说:食后不饥,吐利腥秽,也是寒疾。
马莳说:触犯寒邪则寒邪至,凡是产生坚硬痞塞、腹部胀满、疼痛急迫、下利的疾病都产生了。
张介宾说:寒邪至则阳气衰败,不能运化,郁注下行,出现眼睑跳动、抽搐、浮肿、脚肿、呕吐、鼻塞、鼻衄、头痛、骨节变形、内痛、血溢、血泄、淋证等疾病。
王冰说:突然失音、神志昏迷、眼睛看不见人、烦躁扰乱、狂越、妄见妄闻、骂詈、惊痫,也是热病。
马莳说:触犯热邪则热邪至,凡是产生身热、吐下、霍乱、痈疽、疮疡、昏闷郁结、注下、抽搐、肿胀、呕吐、鼻塞、鼻衄、头痛、骨节变形、内痛、血溢、血泄、淋证等疾病都产生了。
张介宾说:热邪至则火热灼烧各条经脉。
黄帝问:治疗怎么办?
岐伯说:时机必须顺应它,触犯者用克制它的法治。
王冰说:春季适宜凉,夏季适宜寒,秋季适宜温,冬季适宜热,这是时令的适宜,不可不顺从。然而触犯热邪用寒法治,触犯寒邪用热法治,触犯春(凉)用凉法治,触犯秋(温)用温法治,是以胜克的方式治疗。触犯热邪治以咸凉,触犯寒邪治以甘热,触犯凉邪治以苦温,触犯温邪治以辛凉,这也是以胜克之道。
吴昆说:时必顺之,是顺从其升降浮沉;犯者治以胜,是逆其寒热温凉。所以春季宜升,秋季宜降,夏季宜浮,冬季宜沉,这是顺四时。温宜凉,热宜寒,凉宜温,寒宜热,是用所胜之气治疗,这叫作治以所胜。
张志聪说:这是说主时的六气也应当远寒而远热。按前章所说的“热无犯热,寒无犯寒”,是论述司天在泉及加临的六气;此章论述主时的六气,也有寒热之分。太阴之气在于长夏,太阳之气在于冬,少阴之气在于夏,阳明之气在于秋,厥阴之气在于春。如冬季有热化,以征少阴之胜;夏季有寒化,以征太阳之胜。这与春胜长夏、长夏胜冬的意义相同。
徐振公说:这就是黄帝所问的有胜有复,在六气为胜复,在四时为胜化。
马莳说:治疗方面,春季宜凉,夏季宜寒,秋季宜温,冬季宜热,这是时令必须使用的,不可不顺从。如果有误犯而导致病胜者,则犯热治以咸寒,犯寒治以甘热,犯凉治以苦温,犯温治以辛凉,用所胜之气治疗,病就可以解除了。
张介宾说:时必顺之,治疗应当顺应时令。如果有所误犯,则应当用胜克之法治疗。
我(张骥)按语:《元和纪用经》记载,六气为主,五味为用,司岁备物则无遗漏。主药当其岁,味当其气,气味浓薄,性用躁静,治保多少,力化浅深,寒热温凉随胜用之。岁运所主,举抑之制,制胜扶弱,客主须安。一气失所,矛盾交作,脏腑淫并,危败消亡。宝书所载,商较服饵,药不具五味,不备四气,而久服之,虽且获胜,益久流变,必致横天。寒热温凉,衰之以属,随其攸利,万举万全。卷舒在心,去留从意。微者逆之,甚者从之。龙火得湿而焰,遇水而燔。伏其所主,先其所因。圣如南阳,今古一人。气运用药皆如上例。
我(张骥)认为:有大暑之候而得寒证,大寒之候而得热证。证有性偏阴虚,虽当隆冬,阴精亏立,水不制火,阴无所根据,外泄为热,或反汗出,药宜滋阴。若舍证从时,误用辛温,势必立毙。又有性偏阳虚,虽当盛夏,阳气不足,不能卫外,洒淅战栗,时思热食,且御重裘,天令虽热,不能敌真阳之虚,病属虚寒,药宜温补。若从时舍证,误用苦寒,亦必立毙。
又如春令主升,升为春气,为风化为木象,升有散之义。若因饮食劳倦则阳气下陷,宜升阳益气;泻利不止,宜升阳益胃;郁火伏内,宜升阳散火;因湿洞泄,宜升阳除湿。此证四时都有,夏秋尤多,升之之令不独行之于春也。
又如秋令主降,降为秋气,为燥化为金象,降有敛之义。若系阴火旺发而炎上,咳嗽多痰,吐血鼻衄,口苦舌干,头疼齿痛,骨蒸寒热,是谓上热下虚之候,宜枇杷叶、麦冬、贝母、白芍、牛膝、五味子之属以降气,或用滋水添精之药以救本。此亦四时都有,夏冬多见,降之之令不专行之于秋也。
运气用药最宜活看。
Year of Gui-Si and Gui-Hai
Wang Bing stated: These belong to the category of "Tong Sui Hui" (Same Year Meeting).
The transformation at the upper level should utilize acrid-cool substances; at the middle level, salty harmonizing substances; and at the lower level, salty-cold medicinal and dietary substances. These are appropriate.
Zhang Jiebin stated: The Central Movement (Da Yun) is Shao Zheng (Deficient Fire), receiving generation and assistance from Heaven and Earth Qi, thus it is appropriate to use salty flavor to harmonize; the Upper (Si Tian) and Lower (Zai Quan) levels are identical. Ji's commentary: According to *Yuan Zhu Mi Yu*, regarding the celestial movement superimposition chronology, in the year of Gui-Hai, wind disease prevails above; treatment utilizes acrid-cool medicines, employing the nature and flavor of Metal to subdue the excess of Wind-Wood. One should not consume sour foods to assist the Wood excess. In *He Yuan Ji Yong Jing*, the discussions for the upper, middle, and lower sections are all consistent.
The Yellow Emperor asked: Medical theories state "Do not offend heat with heat, do not offend cold with cold." I wish to neither stay far from cold medicines nor stay far from hot medicines. How should this be handled?
Qi Bo replied: Your question is thorough! For releasing the exterior (Jie Biao Fa Han), one does not stay far from hot medicines; for attacking the interior (Gong Li Xie Xia), one does not stay far from cold medicines.
Wang Bing explained: Because sweating is required to vent pathogens, hot medicines are used without staying far from heat; because purgation is required for diarrhea/constipation, cold medicines are used without staying far from cold. This is because these medicines do not remain stagnant within the body. If this were the case, hot medicines could be used in summer and cold medicines in winter; as long as there is no sweating or purging, there would be no taboos. This is called recklessly ignoring the methodological prohibitions, which is forbidden by therapeutic laws. It is stated that these are only used when unavoidable. The same applies to autumn and winter. The New Correction notes: According to *Zhi Zhen Yao Da Lun*, releasing the exterior does not stay far from heat, and attacking the interior does not stay far from cold. In winter, attacking the interior does not stay far from cold. Exterior-releasing and interior-attacking medicines do not remain in the middle but have specific appropriateness. Ma Shi stated: This passage refers to sweating and purging methods; pathogens can occasionally be confronted with heat or cold, but one should not offend them without cause. This statement is incorrect. When pathogens are constrained in the exterior, hot medicines are used to disperse them; when heat accumulates in the interior, cold medicines are used to attack them. Zhang Jiebin stated: Pathogens in the exterior are mostly cold pathogens, so exterior-releasing treatments cannot stay far from heat, even in summer. Pathogens constrained in the interior are mostly heat pathogens, so interior-attacking treatments cannot stay far from cold, even in winter. My analysis: The main idea of these two sentences lies entirely in the characters "Fa" (Disperse/Release) and "Gong" (Attack/Purge). "Fa" means driving pathogens outward; "Gong" means driving pathogens inward. Cold pathogens in the exterior cannot be dispersed without warm-hot qi; therefore, those releasing the exterior do not stay far from heat. Heat constrained in the interior cannot be eliminated without heavy-cold substances; therefore, those attacking the interior do not stay far from cold. This is an inevitable principle. However, there are cases where Xiao Chai Hu Tang (Minor Bupleurum Decoction), Bai Hu Tang (White Tiger Decoction), Yi Yuan San, or cold water are used to induce sweating and cure disease. Why? This is because both exterior and interior are hot, so cool resolution is indicated; this is not "releasing" in the sense of dispersing cold. There are also cases where Li Zhong Tang (Regulate the Middle Decoction) and Si Ni Tang (Frigid Extremities Decoction) for restoring Yang are used to eliminate pain and remove accumulation. Why? This is because yin-cold is stagnating, so warming the middle is indicated; this is not "attacking" in the sense of purging excess. "Fa" refers to opening the external constriction; "Gong" refers to destroying internal excess. Modern ignorant practitioners, seeing only external contraction fever, fail to perceive that injury by cold transforms into heat, possessing the meaning of original cold and manifest heat. They arbitrarily use Huang Qin (Scutellariae Radix) and Lian Zi (Nelumbinis Semen) to clear superficial heat. Do they not know that cold pathogens are in the exterior while cold medicines act in the interior? Using cold to attract cold qi creates resonance, leading to combined exterior-interior pathogens, making them incurable. This is the harm of using cold medicines for exterior release. During the spring, autumn, and winter seasons, and during periods governed by Earth, Metal, and Water where yin prevails and yang is weak, this is especially contraindicated. Fire not being in the interior makes cold-cool substances most taboo; misusing them here shows ignorance that exterior release requires not staying far from heat. Similarly, for internal injuries causing panting, pain, and distension, often involving deficiency of the Three Yin, modern practitioners see such conditions, fail to distinguish deficiency-cold, and use Xiao (Nitratum) and Huang Bo (Phellodendri Cortex) or similar purgatives, claiming to first remove pathogens then tonify the root. This seems plausible, but do they not know diseases of false excess and true deficiency? Further attacking such conditions leaves the pathogen unremoved while vital Qi collapses. Misusing this method shows ignorance that interior attacking requires not staying far from cold. I have seen these two harms frequently and must highlight them as a warning to practitioners. Ji's commentary: *He Yuan Ji Yong Jing* discusses how the five flavors' cold, hot, warm, cool, and neutral natures coordinate with the Five Zang organs, linking to Five Elements, entering Five Qi, and having Five Appropriatenesses. Usage varies according to the excess or deficiency of annual movements. The six Qi's root and branch are the pivot of treatment. Medicines for the six Qi involve cold, heat, dryness, dampness, wind, and fire. The overcoming Qi and Intermediate Seeing Qi determine usage. Five Movements may be contrary or follow Heaven, opposing Earth, or follow Earth, opposing Heaven. The transformations of imperial control involve the expansion and contraction of Yin and Yang. Human affairs can be regulated. Use cold avoiding cold; do not offend cold with cold. Use heat avoiding heat; do not offend heat with heat. Following nourishes harmony; opposing causes illness.
The Yellow Emperor asked: What happens if one offends heat and cold without releasing the exterior or attacking the interior?
Qi Bo replied: If heat and cold become internal thieves, the disease will worsen.
Wang Bing explained: Adding water to water and fire to fire only serves to generate more illness, let alone worsening the original disease. Ma Shi stated: If one offends heat without releasing the exterior, heat becomes an internal thief and intensifies; if one offends cold without attacking the interior, cold becomes an internal thief and prevails. Ji's commentary: *He Yuan Ji Yong Jing* states that Wood stands in relation to the five Qi of the four seasons, affecting diet, clothing, and medicine warmth. Thus, lightly offending heat and cold implies avoiding similarities. If the four seasons are commonly offended, adding water to water and fire to fire will inevitably cause disease. Qi Bo stated: When the controlling Qi is heat, use heat without offending the intercalary Qi. If the intercalary Qi matches the principal Qi, do not offend it; if it differs, a slight offense is permissible. This is called the "Four Feared Things," requiring careful observation. When heavenly weather is contrary to the season, one may adjust according to the time; if contrary phenomena are severe, they cause disease. If the controlling Qi is overcome, it may be offended. For example, if cold is severe in summer, heat may be used; if cold is not severe, it should not be offended. The goal is balance; exceeding it causes disease, similar to counter-offending. When pathogens overcome the principal Qi, they cannot be resisted. *Yao Ge* states: Severe cold repelling Yang (Ge Yang) treats heat with heat; never use cold to treat Ge Yang. Severe heat rejecting Yin (Ju Yin) treats cold with cold; never use heat to treat Ju Yin. Externally appearing compliant but internally reversing Qi. Due to differing Qi forms causing confusion of the Classics, caution is essential.
The Yellow Emperor asked: I wish to hear about those without disease.
Qi Bo replied: Those without disease who violate taboos will get sick; those with disease who violate taboos will suffer exacerbation.
Wang Bing explained: Even those without disease who violate taboos can fall ill; how much harder is it for those with disease to seek relief through violation? Wu Kun stated: Without disease, offending heat and cold generates cold and heat illnesses; with disease, offending heat and cold makes cold and heat more severe. Ma Shi stated: Those without disease who mistakenly take medicines only suffice to cause illness, let alone those with disease whose condition worsens.
The Yellow Emperor asked: How does illness arise?
Qi Bo replied: Not staying far from heat leads to heat arrival; not staying far from cold leads to cold arrival. Cold arrival causes hardness, obstruction, abdominal fullness, painful urgency, and diarrhea.
Wang Bing explained: Eating without hunger, vomiting and diarrhea with foul odors, are also cold diseases. Ma Shi stated: Offending cold leads to cold arrival, causing diseases such as hardness, obstruction, abdominal fullness, painful urgency, and diarrhea. Zhang Jiebin stated: Cold arrival causes Yang decline, inability to transport and transform, depression, downward flow, twitching eyelids, convulsions, edema, foot swelling, vomiting, nasal congestion, epistaxis, headache, bone joint deformation, internal pain, blood extravasation, bloody stool, and strangury.
Wang Bing explained: Sudden aphonia, dizziness, blindness, restlessness, mania, delusions, hallucinations, cursing, fright, and epilepsy are also heat diseases. Ma Shi stated: Offending heat leads to heat arrival, causing diseases such as body heat, vomiting and diarrhea, cholera-like syndrome, carbuncles, sores, mental clouding, depression, downward flow, convulsions, swelling, vomiting, nasal congestion, epistaxis, headache, bone joint deformation, internal pain, blood extravasation, bloody stool, and strangury. Zhang Jiebin stated: Heat arrival causes fire to scorch the meridians.
The Yellow Emperor asked: How to treat them?
Qi Bo replied: One must conform to the season; offenders are treated with what overcomes them.
Wang Bing explained: Spring suits coolness, summer suits cold, autumn suits warmth, winter suits heat. This seasonal appropriateness must not be disobeyed. However, if heat is offended, treat with cold; if cold is offended, treat with heat. If spring is offended, use cool; if autumn is offended, use warm. This is treating with overcoming. If heat is offended, treat with salty-cool; if cold is offended, treat with sweet-hot; if cool is offended, treat with bitter-warm; if warm is offended, treat with acrid-cool. This is also the way of overcoming. Wu Kun explained: Conforming to the season means following its ascending, descending, floating, and sinking. Treating offenders with what overcomes them means opposing their cold, heat, warmth, and coolness. Thus, spring suits ascending, autumn suits descending, summer suits floating, winter suits sinking—this is conforming to the four seasons. Warm suits cool, heat suits cold, cool suits warm, cold suits heat—treating with what overcomes is called treating by superiority. Zhang Zhicong stated: This refers to the Six Qi governing the season, which should also avoid cold and heat. The previous chapter's "Do not offend heat with heat, do not offend cold with cold" discussed Si Tian and Zai Quan plus superimposed Six Qi. This chapter discusses the Six Qi governing the season, which also has distinctions of cold and heat. Tai Yin Qi is in late summer, Tai Yang Qi in winter, Shao Yin Qi in summer, Yang Ming Qi in autumn, Jue Yin Qi in spring. If winter has heat transformation, it indicates Shao Yin excess; if summer has cold transformation, it indicates Tai Yang excess. This is consistent with the meaning of Spring overcoming Late Summer and Late Summer overcoming Winter. Xu Zhengong stated: This is exactly what the Emperor asked about: victory and retaliation. In Six Qi, it is victory and retaliation; in Four Seasons, it is victory and transformation. Ma Shi stated: Treatment: Spring suits cool, summer suits cold, autumn suits warm, winter suits heat. This is necessary for the season and must not be disobeyed. If there is an offense and disease dominance occurs, then: offend heat with salty-cold, offend cold with sweet-hot, offend cool with bitter-warm, offend warm with acrid-cool. Treat with what overcomes, and the disease can be resolved. Zhang Jiebin stated: Conform to the season; treatment should accord with the season. If mistakenly offended, treat with what overcomes. Ji's commentary: *He Yuan Ji Yong Jing* states Six Qi are primary, Five Flavors are functional. Prepare medicines according to the year to avoid omission. Main drugs correspond to the year, flavors correspond to Qi. Density and thinness of Qi and flavor, active and static nature, treatment preservation quantity, power and transformation depth, cold, heat, warmth, and coolness are used according to what overcomes. Annual movement governance involves suppression and support systems, overcoming victory and supporting weakness. Guest and Principal must be peaceful. If one Qi loses its place, contradictions arise. Zang-Fu excess leads to danger and collapse. Precious books discuss medication preparation. Medicines lacking complete Five Flavors and Four Qi, taken long-term, may initially win benefits but eventually lead to premature death due to changes. Cold, heat, warmth, and coolness are diminished by their attributes, benefiting wherever applicable. Ten thousand attempts, ten thousand completions. Expansion and contraction depend on the mind; departure and retention follow intent. Minor cases oppose them; major cases follow them. Dragon fire flares with moisture and burns upon water. Subdue the principal, address the cause. Sage like Nanyang [Zhang Zhongjing], unique in past and present. Qi movement medicine usage follows the above examples. I believe that during great heat, one may obtain cold syndromes; during great cold, one may obtain heat syndromes. Syndromes have tendencies. Yin deficiency, even in deep winter, with depleted Yin essence, Water fails to control Fire, Yin has no basis, escapes outward as heat, or manifests as sweating. Medicine should nourish Yin. If abandoning syndrome for season, mistakenly using acrid-warm, death will be immediate. Also, Yang deficiency, even in midsummer, with insufficient Yang failing to protect the exterior, shivering and trembling, desiring hot food, wearing heavy furs, heavenly heat cannot counteract true Yang deficiency. Disease belongs to deficiency-cold; medicine should warm and tonify. If following season abandoning syndrome, mistakenly using bitter-cold, death will be immediate. Furthermore, Spring governs ascending. Ascending is Spring Qi, Wind transformation, Wood image. Ascending has the meaning of dispersing. If due to diet and fatigue, Yang Qi sinks, one should ascend Yang and benefit Qi; if diarrhea persists, ascend Yang and benefit Stomach; if depressed fire hides inside, ascend Yang and scatter fire; if dampness causes profuse diarrhea, ascend Yang and remove dampness. These conditions occur in all four seasons, especially summer and autumn. The command to ascend is not exclusive to Spring. Autumn governs descending. Descending is Autumn Qi, Dryness transformation, Metal image. Descending has the meaning of gathering. If Yin fire flares upward, causing cough with phlegm, hematemesis, epistaxis, bitter taste, dry tongue, headache, toothache, bone-steaming fever and chills, this is Upper Heat and Lower Deficiency syndrome. One should use Pi Pa Ye (Loquat Leaf), Mai Dong (Ophiopogonis Radix), Bei Mu (Fritillariae Bulbus), Bai Shao (Paeoniae Radix Alba), Niu Xi (Achyranthis Bidentatae Radix), Wu Wei Zi (Schisandrae Fructus) to descend Qi, or use Kidney-Nourishing and Essence-Replenishing medicines to save the root. This also occurs in all four seasons, common in summer and winter. The command to descend is not exclusive to Autumn. Qi movement medicine usage must be viewed flexibly.