进退, 以意用之, 久久自得其效.
1.虚损成劳因复感, 阳虚外寒损肺经, 阴虚内热从肾损, 饮食劳倦
自脾成, 肺损皮毛洒寒嗽, 心损血少月经凝, 脾损食少肌消泻, 肝损
胁痛懒于行. 肾损骨痿难久立, 午热夜汗骨蒸蒸, 从下皮聚毛落死,
从上骨痿不起终. 恐惧不解则伤精, 怵惕思虑则伤神, 喜乐无极则伤
魄,悲哀动中则伤魂, 忧愁不巳则伤意, 盛怒不止则伤志, 劳倦过度
则伤气, 气血骨肉筋精极.
【注】虚者, 阴阳, 气血, 荣卫, 精神, 骨髓, 津液不足是也. 损者
,外而皮, 脉, 肉, 筋, 骨, 内而肺, 心, 脾, 肝, 肾消损是也. 成
劳者, 谓虚损日久, 留连不愈, 而成五劳, 七伤, 六极也. 因复感者
,谓不足之人, 阳虚复感外寒, 则损从皮毛肺始; 阴虚更生内热, 则
损从骨髓肾始; 内伤饮食劳倦, 则损从肌肉脾始. 此虚损成劳之因,
然其证有五: 一, 损皮聚毛落, 洒淅恶寒咳嗽, 肺劳也. 二, 损血脉
虚少, 男子面无血色, 女子月经不通, 心劳也. 三, 损饮食减少, 肌
肉消瘦, 大便溏泻, 脾劳也. 四, 损两胁引胸而痛, 筋缓不能行肝劳
也.五, 损骨痿不能久立, 午后发热, 盗汗骨蒸, 肾劳也. 从下肾脏
损起者, 损至皮聚毛落则死也. 从上肺脏损起者, 损至骨痿不能起于
床则终也. 从脾脏损起者, 或至皮聚毛落, 或至骨痿不起皆死也. 虚
损为七伤之证: 一, 恐惧不解则伤精, 精伤则骨酸痿厥, 精时自下,
盖五脏主藏精者也, 不可伤, 伤则失守而阴虚, 阴虚则无气, 无气则
死矣. 二, 怵惕思虑则伤神, 神伤则恐惧自失, 破?? 脱肉, 毛瘁色
夭,死于冬也. 三, 喜乐无极则伤魄, 魄伤则狂, 狂则意不存人, 皮
革焦, 毛瘁色夭, 死于夏也. 四, 悲哀动中则伤魂, 魂伤则狂妄不精
,不精则不正, 阴缩而挛筋, 两胁骨不举, 毛瘁色夭, 死于秋也. 五
,忧愁不巳则伤意, 意伤则悗乱, 四肢不举, 毛瘁色夭, 死于春也.
六,盛怒不止则伤志, 志伤则喜忘其前言, 腰脊不可以俯仰屈伸, 毛
瘁色夭, 死于季夏也. 七, 劳倦过度则伤气, 气伤则火愈壮, 壮火则
食气, 故无气以动, 喘乏汗出, 内外皆越, 则气日耗, 气日耗则死矣
.虚损为六极之证: 一, 数转筋, 十指爪甲痛, 筋极也. 二, 牙齿动
,手足痛, 不能久立, 骨极也. 三, 面无血色, 头发坠落, 血极也.
四,身上往往如鼠走, 削瘦干黑, 肉极也. 五, 气少无力, 身无膏泽
,翕翕羸瘦, 眼无精光, 立不能定, 身体苦痒, 搔之生疮, 精极也.
六,胸胁逆满, 恒欲大怒, 气少不能言, 气极也.
【按】前人分七伤之证. 似多不经. 根据『内经』改之. 庶后学易明也
.
(用药时)根据病情进退,灵活变通,运用心意,久而久之自然能收到疗效。
1. 虚损发展为劳病,是因为再次感受外邪;阳虚导致外寒侵袭,损伤肺经;阴虚导致内热产生,从肾脏开始损耗;饮食不节和过度劳累,则从脾脏形成病变。肺受损表现为皮毛怕冷、咳嗽;心受损表现为血少、月经凝滞;脾受损表现为食欲减少、肌肉消瘦、腹泻;肝受损表现为胁痛、懒于行动。肾受损表现为骨痿、难以久立,午后发热、夜间盗汗、骨骼蒸热;若病势从下焦(肾脏)发展至皮毛聚落则死亡;若病势从上焦(肺脏)发展至骨痿不起则终结。恐惧不解则损伤精气,惊惧思虑则损伤神志,喜乐无度则损伤魄,悲哀动中则损伤魂,忧愁不已则损伤意,盛怒不止则损伤志,劳倦过度则损伤气,最终导致气血、骨、肉、筋、精的极度亏损。
【注】所谓“虚”,是指阴阳、气血、营卫、精神、骨髓、津液的不足。所谓“损”,是指外在的皮、脉、肉、筋、骨,内在的肺、心、脾、肝、肾的消损。所谓“成劳”,是指虚损日久,迁延不愈,从而形成五劳、七伤、六极。所谓“因复感”,是指身体不足之人,阳虚又感受外寒,则损伤从皮毛、肺脏开始;阴虚又生内热,则损伤从骨髓、肾脏开始;内伤于饮食劳倦,则损伤从肌肉、脾脏开始。这是虚损成劳的原因,然而其证候有五种:第一,损及皮毛聚落,洒淅恶寒咳嗽,是肺劳。第二,损及血脉虚少,男子面无血色,女子月经不通,是心劳。第三,损及饮食减少,肌肉消瘦,大便溏泻,是脾劳。第四,损及两胁牵引胸部疼痛,筋缓不能行走,是肝劳。第五,损及骨痿不能久立,午后发热,盗汗骨蒸,是肾劳。从下焦肾脏损伤起始者,损伤发展到皮毛聚落就会死亡。从上焦肺脏损伤起始者,损伤发展到骨痿不能起床就会终结。从脾脏损伤起始者,或发展到皮毛聚落,或发展到骨痿不起,都会死亡。
虚损属于七伤的证候:第一,恐惧不解则损伤精气,精伤则骨骼酸软、痿厥,精气自行滑泄,因为五脏主藏精,不可损伤,损伤则失守而阴虚,阴虚则无气,无气则死。第二,惊惧思虑则损伤神志,神伤则恐惧自失,眼眶凹陷、肌肉脱削,毛发枯槁、面色夭折,死于冬季。第三,喜乐无度则损伤魄,魄伤则发狂,狂则目中无人,皮肤干枯,毛发枯槁、面色夭折,死于夏季。第四,悲哀动中则损伤魂,魂伤则狂妄不精明,不精明则行为不正,阴器收缩、筋脉拘挛,两胁骨骼不能抬起,毛发枯槁、面色夭折,死于秋季。第五,忧愁不已则损伤意,意伤则烦闷混乱,四肢不能举动,毛发枯槁、面色夭折,死于春季。第六,盛怒不止则损伤志,志伤则喜欢忘记前言,腰脊不能俯仰屈伸,毛发枯槁、面色夭折,死于季夏。第七,劳倦过度则损伤气,气伤则火更壮盛,壮火消耗气,所以没有气来推动,气喘乏力、出汗,内外之气皆耗散,则气日益消耗,气日益消耗就会死亡。
虚损属于六极的证候:第一,频繁转筋,十个脚趾指甲疼痛,是筋极。第二,牙齿松动,手足疼痛,不能久立,是骨极。第三,面无血色,头发脱落,是血极。第四,身上往往感觉像老鼠爬行,消瘦干黑,是肉极。第五,气少无力,身体没有光泽,瘦弱不堪,眼睛没有神采,站立不稳,身体苦痒,搔抓后生疮,是精极。第六,胸胁逆满,经常想发怒,气少不能说话,是气极。
【按语】前人将七伤的证候进行划分,似乎多有不经之谈。现根据《黄帝内经》加以改正,以便后世学者容易明白。
(When using medicine), advance or retreat according to the condition, apply it with intent, and over time, its efficacy will naturally be achieved.
1. Deficiency transforming into consumptive disease is due to secondary pathogenic invasion; Yang deficiency leading to external cold damages the Lung Meridian (Lung Channel); Yin deficiency leading to internal heat begins damage from the Kidney; improper diet and overexertion form pathology starting from the Spleen. Lung damage manifests as aversion to cold in skin and hair, and cough; Heart damage manifests as blood deficiency and stagnation of menstruation; Spleen damage manifests as reduced appetite, emaciation, and diarrhea; Liver damage manifests as hypochondriac pain and reluctance to move. Kidney damage manifests as bone萎 (osteomalacia/weakness) and inability to stand for long periods, afternoon fever, night sweats, and bone-steaming sensation; if the disease progresses from the lower Jiao (Kidney) to the point where hair falls out, death ensues; if it progresses from the upper Jiao (Lung) to the point of bone weakness preventing rising, it ends fatally. Unresolved fear injures Jing (Essence); fright and excessive thinking injure Shen (Spirit); unbounded joy injures Po (Corporeal Soul); sorrow moving within injures Hun (Ethereal Soul); endless worry injures Yi (Intellect); unceasing anger injures Zhi (Will); overexertion injures Qi (Vital Energy), ultimately leading to extreme depletion of Qi, Blood, Bone, Flesh, Sinew, and Essence.
[Note] "Deficiency" refers to the insufficiency of Yin-Yang, Qi-Blood, Ying-Wei (Nutritive and Defensive Qi), Spirit, Marrow, and Body Fluids. "Damage" refers to the wasting of the outer Five Tissues (Skin, Vessels, Flesh, Sinews, Bones) and the inner Five Zang Organs (Lung, Heart, Spleen, Liver, Kidney). "Becoming Consumptive Disease" means that prolonged deficiency and damage, lingering without cure, result in the Five Consumptions, Seven Injuries, and Six Extremes. "Secondary Invasion" means that in a person with insufficiency, if Yang deficiency is compounded by external cold, damage starts from the Skin and Lung; if Yin deficiency generates internal heat, damage starts from the Marrow and Kidney; if internal injury results from diet and overexertion, damage starts from the Muscle and Spleen. These are the causes of deficiency becoming consumptive disease. However, there are five types of syndromes: First, damage to skin causing hair loss, chills, and cough is Lung Consumption. Second, damage to vessels causing blood deficiency, pallor in men, and amenorrhea in women is Heart Consumption. Third, damage causing reduced intake, emaciation, and loose stools is Spleen Consumption. Fourth, damage causing hypochondriac pain radiating to the chest, flaccid sinews, and inability to walk is Liver Consumption. Fifth, damage causing bone weakness, inability to stand long, afternoon fever, night sweats, and bone-steaming is Kidney Consumption. If damage originates from the lower Kidney and progresses to hair loss, death occurs. If damage originates from the upper Lung and progresses to bone weakness preventing getting out of bed, it ends fatally. If damage originates from the Spleen, whether progressing to hair loss or bone weakness preventing rising, both lead to death.
Deficiency constitutes the Seven Injuries: First, unresolved fear injures Essence; Essence injury leads to sore and weak bones, cold extremities, and spontaneous seminal emission. Since the Five Zang store Essence, they must not be injured; injury leads to loss of control and Yin deficiency, Yin deficiency leads to Qi deficiency, and Qi deficiency leads to death. Second, fright and thinking injure Spirit; Spirit injury leads to fear and self-loss, sunken eyes, muscle wasting, brittle hair, and sallow complexion, dying in Winter. Third, unbounded joy injures Po; Po injury leads to mania, disregard for others, dry skin, brittle hair, and sallow complexion, dying in Summer. Fourth, sorrow injuring the interior injures Hun; Hun injury leads to madness and lack of clarity, moral deviation, retraction of genitals, contracted sinews, immobility of the hypochondriac bones, brittle hair, and sallow complexion, dying in Autumn. Fifth, endless worry injures Yi; Yi injury leads to confusion, immobility of the four limbs, brittle hair, and sallow complexion, dying in Spring. Sixth, unceasing anger injures Zhi; Zhi injury leads to forgetfulness, inability to bend or extend the waist and spine, brittle hair, and sallow complexion, dying in Late Summer. Seventh, overexertion injures Qi; Qi injury leads to hyperactive Fire; Strong Fire consumes Qi, resulting in lack of movement energy, panting, fatigue, sweating, and leakage of Qi internally and externally, leading to daily consumption of Qi and eventual death.
Deficiency constitutes the Six Extremes: First, frequent muscle cramps and pain in the fingernails and toenails is Extreme Sinew. Second, loose teeth, pain in hands and feet, and inability to stand long is Extreme Bone. Third, pallor and hair loss is Extreme Blood. Fourth, sensation of insects crawling on the body, emaciation, and dark dryness is Extreme Flesh. Fifth, shortness of breath, weakness, lack of luster, severe thinness, dull eyes, instability when standing, itching, and sores upon scratching is Extreme Essence. Sixth, distension and fullness in the chest and hypochondrium, frequent desire to rage, shortness of breath, and inability to speak is Extreme Qi.
[Commentary] Previous authors' classification of the Seven Injuries seems somewhat arbitrary. This has been corrected based on the Huangdi Neijing (The Yellow Emperor's Inner Canon) to facilitate understanding for future students.