客或难予曰。素问阴阳应象论云。天之邪气。感则害人五脏。水谷之寒热。感则害人六腑。
太阴阳明论云。犯贼风虚邪者。阳受之。食饮不节。起居不时者。阴受之。阳受之则入六腑
。阴受之则入五脏。两说正相反。愿闻其解。余复之曰。此所谓似反。而不反者也。夫感天之
邪气。犯贼风。虚邪。外伤有余之病也。感水谷寒热。食饮不节。内伤不足之病也。二者之
伤。腑脏皆尝受之。但随其所从。所发之处。而为病耳。不可以此两说之异。而致疑。盖并
行
不相悖也。读者当合而观之。其旨斯尽。若曰不然。请以诸处所论证之。金匮真言论曰。风
触五脏邪气发病。八正神明论曰。夫八正之虚邪。以身之虚。而逢天之虚。两虚相感。其气
至骨。入则五脏伤。灵枢经曰。五脏之中风。又曰。东风伤人。内舍于肝。南风伤人。内
舍
于心。西南风伤人。内舍于脾。西风伤人。内舍于肺。北风伤人。内舍于肾。观乎此。则
天
之邪气。固伤五脏矣。灵枢又曰。邪之中人也。无有常。中于阴则溜于腑。又曰。虚邪之中
人也。始从皮肤以入。其传。自络脉而经而输而伏冲之脉。以至于肠胃。又曰东北风伤人。
内
舍于大肠。西北风伤人。内舍于小肠。东南风伤人。内舍于胃。观乎此。则天之邪气。岂不
伤六腑乎。素问曰。饮食自倍。肠胃乃伤。观乎此。则水谷寒热。固伤六腑矣。灵枢又曰。
形寒寒饮则伤肺。难经曰。饮食劳倦则伤脾。观乎此。则水谷寒热。岂不伤五脏乎。至于地之
湿气。亦未必专害皮肉筋脉。而不能害脏腑。邪气水谷。亦未必专害脏腑。而不能害皮肉筋
脉也。但以邪气无形。脏主藏精气。故以类相从。而多伤腑。水谷有形。腑主传化物。故因
其所有。而多伤腑。湿气浸润。其性缓慢。其入人也以渐。其始也自足。故从下而上。从浅
而
深。而多伤于皮肉筋脉耳。孰谓湿气全无及于脏腑之理哉。至若起居不时一语。盖劳役所
伤之病。不系上文。异同之义。故不之及也。
有人诘问我道：《素问·阴阳应象大论》说：“天的邪气，侵入则伤害五脏；水谷的寒热之气，侵入则伤害六腑。”《素问·太阴阳明论》说：“遭受贼风虚邪侵袭的，阳经受之；饮食不节制、起居无规律的，阴经受之。阳经受邪则病入六腑，阴经受邪则病入五脏。”这两种说法正好相反，希望听听您的解释。我回答说：这就是所谓的表面相反，实则并不矛盾。感受天的邪气，遭受贼风、虚邪，属于外伤有余的病证；感受水谷的寒热，饮食不节制，属于内伤不足的病证。这两类损伤，脏腑都曾受到侵害，只是随着邪气所从入的途径、所发作的部位不同而表现为不同的疾病罢了。不能因为这两种说法的差异而产生怀疑，它们实际上是并行不悖的。读者应当综合起来观察，其中的旨意就完全明白了。如果说不是这样，请让我用其他篇章中的论述来证明它。《素问·金匮真言论》说：“风触五脏邪气发病。”《灵枢·八正神明论》说：“八正时的虚邪，趁着人体正气虚弱，又逢天时虚邪，两虚相感，其气深入至骨，进入体内则伤害五脏。”《灵枢经》说：“五脏之中风邪。”又说：“东风伤人，内舍于肝；南风伤人，内舍于心；西南风伤人，内舍于脾；西风伤人，内舍于肺；北风伤人，内舍于肾。”看这些论述，那么天的邪气，确实会伤害五脏了。《灵枢》又说：“邪气中于人，没有固定的部位，中于阴经则流注于腑。”又说：“虚邪中于人，开始从皮肤进入，其传变过程，从络脉到经脉，再到输穴，再到伏冲之脉，以至于肠胃。”又说：“东北风伤人，内舍于大肠；西北风伤人，内舍于小肠；东南风伤人，内舍于胃。”看这些论述，那么天的邪气，难道不会伤害六腑吗？《素问》说：“饮食自倍，肠胃乃伤。”看这些论述，那么水谷的寒热，确实会伤害六腑了。《灵枢》又说：“形寒寒饮则伤肺。”《难经》说：“饮食劳倦则伤脾。”看这些论述，那么水谷的寒热，难道不会伤害五脏吗？至于地的湿气，也未必专门伤害皮肉筋脉，而不能伤害脏腑；邪气与水谷，也未必专门伤害脏腑，而不能伤害皮肉筋脉。只是因为邪气无形，脏主藏精气，所以以类相从，而多伤及腑（此处原文逻辑似有笔误或特指某种语境，通常脏藏精，腑传化，邪气易犯腑，但前文已论证天邪亦伤脏，此处王履意在说明湿气特性）；水谷有形，腑主传化物，所以因其所有，而多伤及腑（同上，意指水谷直接作用于胃肠等腑）。湿气浸润，其性缓慢，它进入人体是逐渐进行的，起初从足部开始，所以从下而上，从浅而深，因而多伤害皮肉筋脉罢了。谁说湿气完全没有涉及脏腑的道理呢？至于“起居不时”这一句话，大概是劳役所伤的病证，不属于上文讨论的天邪与水谷异同的意义范畴，所以不予提及。
A guest challenged me, saying: The *Suwen* (Basic Questions), chapter "Yin-Yang Yingxiang" states: "The pathogenic qi of heaven, when invading, harms the five zang organs; the cold and heat of food and drink, when invading, harms the six fu organs." The chapter "Taiyin Yangming Lun" in the *Suwen* states: "Those who are afflicted by thieving wind and empty pathogens receive them on the yang channels; those whose diet and drinking are irregular and whose daily routine is untimely receive them on the yin channels. Receiving them on the yang channels leads to disease in the six fu organs; receiving them on the yin channels leads to disease in the five zang organs." These two statements are directly contradictory. I wish to hear your explanation.
I replied: This is what is meant by appearing contradictory but not actually being so. Contracting the pathogenic qi of heaven, or being afflicted by thieving wind and empty pathogens, constitutes a disease of external injury with excess characteristics. Contracting the cold and heat of food and drink, or having irregular diet, constitutes a disease of internal injury with deficiency characteristics. Both types of injury can affect both the fu and zang organs; it merely depends on the pathway from which the pathogen enters and the location where the disease manifests. One should not doubt this due to the apparent difference between these two statements, as they run parallel without contradiction. Readers should observe them comprehensively, and the essence will be fully understood. If you say otherwise, let me prove it using arguments from other sections.
The *Jingui Zhenyan Lun* (Golden Cabinet True Discussions) in the *Suwen* states: "Wind touching the five zang organs causes disease due to pathogenic qi." The *Bazheng Shenming Lun* (Discussion on the Eight Norms and Divine Clarity) states: "The empty pathogens of the eight seasonal norms, encountering the body's deficiency and meeting the heaven's emptiness, cause the two deficiencies to interact. Their qi reaches the bone, and upon entering, it injures the five zang organs." The *Lingshu Jing* (Spiritual Pivot) states: "The five zang organs can be affected by wind." It also says: "East wind harms people, lodging internally in the Liver; South wind harms people, lodging internally in the Heart; Southwest wind harms people, lodging internally in the Spleen; West wind harms people, lodging internally in the Lung; North wind harms people, lodging internally in the Kidney." Observing this, it is clear that the pathogenic qi of heaven indeed injures the five zang organs.
The *Lingshu* further states: "When pathogenic qi strikes humans, there is no fixed pattern; if it strikes the yin channels, it flows into the fu organs." It also says: "When empty pathogens strike humans, they begin at the skin and enter. Their transmission proceeds from the collaterals to the main channels, then to the shu points, then to the Fu-chong vessels, and finally to the intestines and stomach." It also states: "Northeast wind harms people, lodging internally in the Large Intestine; Northwest wind harms people, lodging internally in the Small Intestine; Southeast wind harms people, lodging internally in the Stomach." Observing this, does the pathogenic qi of heaven not injure the six fu organs?
The *Suwen* states: "If food and drink intake doubles, the intestines and stomach are injured." Observing this, do the cold and heat of food and drink not indeed injure the six fu organs? The *Lingshu* also states: "Cold form and cold drinks injure the Lung." The *Nanjing* (Classic of Difficult Issues) states: "Irregular diet and fatigue injure the Spleen." Observing this, do the cold and heat of food and drink not indeed injure the five zang organs?
As for the dampness of the earth, it is not necessarily true that it exclusively harms the skin, flesh, sinews, and vessels while failing to harm the zang and fu organs. Similarly, pathogenic qi and food/drink do not exclusively harm the zang and fu organs while failing to harm the skin, flesh, sinews, and vessels. It is simply that pathogenic qi is formless, and since the zang organs store essence and qi, things of similar nature attract each other, leading to frequent injury of the fu organs (Note: The original text logic here contrasts formless vs. formed, though traditionally formless qi often affects zang, Wang Lu argues based on specific mechanistic interactions). Food and drink have form, and since the fu organs transmit and transform substances, they are frequently injured due to their nature. Dampness infiltrates, its nature is slow, and its entry into the human body is gradual. It begins at the feet, thus moving from below to above, from shallow to deep, and therefore mostly injures the skin, flesh, sinews, and vessels. Who would say that dampness has absolutely no effect on the zang and fu organs?
Regarding the phrase "untimely daily routine," it generally refers to diseases caused by labor and overexertion, which do not belong to the discussion of similarities and differences between heavenly pathogens and food/drink mentioned earlier, so it is not addressed here.