天有四时即有六淫,(风寒暑湿燥火。)人之感也,随其脏腑之虚实而病焉。邪如穿窬,
见人
家墙门不固之处,则乘而入。昔有三人,冒露晓行,后一人无病,一人病,一人死。无病者
先以酒食,胃气充而肌表固也;病者不饮酒而单食,死者空腹而行。可见邪之即凑,其气必
虚。夫春气宜温,万物发陈,其气疏以达。设天寒衣薄,腠理闭塞,阳气不得透泄,诸病生
焉。骤发者其感也轻,更有从冬而受邪者。如王叔和云∶寒邪藏于肌肤,至春变为温病,其
感也深。若贫乏之辈,肌理固密,胃气壮实,更复营作,不时出汗,即有所感,邪从汗而泄
矣。故被体虽薄而不病也。至于寒之初着人也,始则皮毛则肺应之,次则肌肉则胃应之。当
体中稍有不适,即以辛散之剂服之,何至阳气不得泄越,郁而成病?始则身热咳嗽,甚则为
疹
为斑,其总名曰春阳寒郁。更有当春季受邪,阳气不透,其人禀浓,不致骤发,至春杪夏初
,始欲走泄,因病热焉,其邪传心胞及胃者居多,或寒热往来,或单热不休,或疹或斑,或
成温疫,其
名曰春温晚发。夏为火德,万物欣荣。然大江以南,土卑潮汐,当梅雨淋漓,则多湿邪;大
小暑又多酷热,暑伤人气,湿侵肠胃。人当夏令,宜谨起居,薄滋味,为卫生要事。暑邪无
形,从人口鼻吸受;暑先伤气分,故气促脉软,四肢无力;暑伤心,心主液,故心烦少寐汗
出;或久晴土燥,忽大雨下注,热气上蒸,最易受暑。及途行浅舍,劳逸虽殊,其受邪也同
,是为阳暑。更有处于凉亭水榭,爱纳凉,喜冷冻饮料,胃气抑郁,其病恶寒壮热,少汗,脉沉
滞,或吐泻,是为阴暑,不可不知。暑必挟湿挟秽,其病有霍乱者,有四因也∶受暑、受凉
、受湿、伤食。至于赤白二痢,皆由湿热内侵饮食不节,其名曰暑湿交病。秋气宜凉,金令
清肃,则病者少;若秋阳炽骄,人感其气,或贪凉露坐,毛窍为风露所遏,邪不得泄,最易
受病。大抵疟症多从是得。及身热头痛,咳嗽喘促等症,愈晚愈重,其名曰凉风袭暑。冬气
凛冽,万物闭藏。然每有夏秋伏暑在内,至冬至一阳来复,感其气而欲泄,多见形寒肢热,
咳嗽吐血,牙宣鼻衄等症。更有冬气和煦,阳藏不密,冬温症。当冬三月,善卫生者,晨不
冒雾露,闭关独宿,夜卧不致过暖,则为来春发生之本。若空腹晓行,不谨房室,易生寒病
,即病者古名为伤寒,可不慎欤?其名曰冬藏不固,其治法前贤悉备,何待予之赘辞耶。然
未有分四时而立法者,故探讨精微,特出己意,以成一编。俾业斯者,观之了如指掌,熟玩
详求,自能得心应手。至不关乎气感,当另立一门,以见意也。《内经》之四季所感而发病
,未尝不以四气而论,予分四时受病,并出治法者,乃推其本而究其源,与古人立法,原无
大异,惟用主药有别耳。
天有四季,也就有风、寒、暑、湿、燥、火六种外感邪气(六淫)。人感受这些邪气后,会根据其脏腑的虚实状况而发病。邪气就像穿墙越户的小偷,看到人家墙壁门户不坚固的地方,就会趁机侵入。
过去有三个人,在清晨冒着露水赶路,结果一人没病,一人病了,一人死了。没病的人因为先喝了酒吃了饭,胃气充实且肌表固密;生病的人没有喝酒只吃了饭;死的人是空腹行走的。由此可见,邪气之所以容易凑近人体,是因为人体正气必然虚弱。
春季的气候应当温和,万物萌发更新,其气机疏畅通达。如果天气寒冷而衣着单薄,导致腠理(皮肤毛孔)闭塞,阳气不能透发宣泄,各种疾病就会产生。突然发作的,说明感受邪气较轻;还有的是从冬季就已经受了邪气。正如王叔和所说:寒邪潜伏在肌肤之间,到了春天就转变为温病(以发热为主要特征的急性外感热病),这种感受邪气的程度较深。如果是贫苦之人,肌理致密,胃气壮实,再加上从事劳作,不时出汗,即使有所感受,邪气也会随着汗液排出。所以虽然身体单薄但不会生病。
至于寒气初袭人体时,首先皮毛受邪则肺脏应之,其次肌肉受邪则胃脏应之。当身体稍有不适时,立即服用辛散解表的药物,怎么会导致阳气不能宣泄,郁结而成病呢?起初表现为身热咳嗽,严重时出现皮疹或斑疹,总称为“春阳寒郁”。还有在春季感受邪气,阳气不透发,其人禀赋浓厚,不至于立即发作,直到春末夏初,才想要发散宣泄,因而患病发热,这种邪气多传变至心包络及胃,或者寒热往来,或者持续发热不退,或者出疹出斑,或者形成温疫(具有传染性的温热病),称为“春温晚发”。
夏季属火德,万物欣欣向荣。然而长江以南地区,地势低洼受潮汐影响,在梅雨连绵时节,多有湿邪;大暑小暑时节又多酷热,暑邪损伤人气,湿邪侵犯肠胃。人在夏季,应当谨慎起居,饮食清淡,这是养生的重要事务。暑邪无形,从人口鼻吸入;暑邪先伤气分,所以出现气短脉软、四肢无力;暑邪伤心,心主津液,所以出现心烦失眠、出汗;或者久晴土地干燥,忽然大雨倾盆,热气上蒸,最容易感受暑邪。以及在途中行走或在简陋房舍休息,虽然劳逸不同,但感受邪气的情况相同,这称为“阳暑”。还有处于凉亭水榭,喜爱纳凉,喜欢喝冷冻饮料,导致胃气抑郁,病症表现为怕冷高热、汗少、脉沉滞,或者呕吐腹泻,这称为“阴暑”,不可不知道。暑邪必定挟带湿邪和秽浊之气,有的病证表现为霍乱(上吐下泻的急性胃肠病),其原因有四种:受暑、受凉、受湿、伤食。至于赤白痢疾,都是由湿热内侵、饮食不节引起的,称为“暑湿交病”。
秋季气候应当凉爽,金气清肃,所以患病者少;如果秋阳炽热骄横,人感受其气,或者贪凉露天而坐,毛孔被风露所遏制,邪气不得宣泄,最容易生病。大抵疟疾(一种寒热往来的寄生虫病)多由此得病。以及身热头痛、咳嗽喘促等症状,时间越晚病情越重,称为“凉风袭暑”。
冬季气候凛冽,万物闭藏。然而常有夏秋季节伏藏的暑邪在内,到了冬至一阳来复之时,感受其气而欲发散,多见形寒肢热、咳嗽吐血、牙龈出血、鼻衄(流鼻血)等症状。还有冬季气候和煦,阳气潜藏不严密,形成冬温症。在冬季三个月中,善于养生的人,早晨不冒雾露出行,闭门独宿,夜间睡觉不过于温暖,这就是来年春季生机勃发的根本。如果空腹晨行,不节制房事,容易产生寒病,即古人所说的伤寒(广义的外感热病总称),能不谨慎吗?这种情况名为“冬藏不固”,其治疗方法前代贤人已完备,何必等我再多言呢?
然而前人未有专门按四季分别立法的,所以我探讨精微之处,特别提出自己的见解,编成这一篇。使从事医学的人,看了能了如指掌,熟读详求,自然能得心应手。至于与气候感受无关的病证,应当另立一门,以体现我的意图。《内经》中关于四季感受邪气而发病的内容,未尝不是以四气来论述的,我将四季受病分开并给出治法,是推究其本源而研究其根源,与前人立法原本没有太大差异,只是所用主药有所不同罢了。
Heaven has four seasons, and thus there are the Six Excesses (Liu Yin, i.e., Wind, Cold, Summerheat, Dampness, Dryness, and Fire). When humans are affected by these pathogens, disease arises according to the deficiency or excess of their Zang-Fu organs. Pathogens are like thieves breaking into a house; they take advantage of places where walls and doors are not secure to enter.
In the past, three people traveled at dawn in the dew. One remained healthy, one fell ill, and one died. The healthy person had consumed alcohol and food first, resulting in robust Stomach Qi and a solid exterior; the sick person ate but did not drink alcohol; the deceased person walked on an empty stomach. This demonstrates that when pathogens approach, it is because the body's Qi is necessarily deficient.
Spring Qi should be warm, allowing all things to sprout and renew, with its energy being open and unobstructed. If the weather is cold and clothing is thin, causing the Cou Li (pores and interstices) to close, Yang Qi cannot penetrate and vent, leading to various diseases. Sudden onset indicates a light pathogenic invasion; however, some cases involve pathogens acquired from winter. As Wang Shuhe stated: Cold pathogens hide in the skin and muscles, transforming into Warm Diseases (Wen Bing, acute febrile diseases characterized by fever) in spring; such invasions are deep. For poor individuals with dense muscle texture and strong Stomach Qi, who engage in labor and sweat occasionally, even if invaded, the pathogens are expelled through sweat. Thus, although their bodies may be frail, they do not fall ill.
When Cold initially attacks the human body, the skin and hair are affected first, corresponding to the Lung; subsequently, the muscles are affected, corresponding to the Stomach. If one takes acrid-dispersing formulas upon feeling slight discomfort, how could Yang Qi fail to vent and become stagnant to cause disease? Initially, there is body heat and cough; severely, rashes or macules appear. This is collectively named "Spring Yang Cold Stagnation." There are also cases where pathogens are acquired in spring, Yang Qi fails to penetrate, and due to the individual's strong constitution, symptoms do not appear immediately. Instead, as late spring approaches early summer, the desire to vent arises, leading to febrile illness. These pathogens mostly transmit to the Pericardium and Stomach, presenting as alternating chills and fever, persistent fever, rashes, macules, or epidemic warm diseases (Wen Yi, warm diseases with contagious nature), named "Late-Onset Spring Warmth."
Summer corresponds to the virtue of Fire, and all things flourish. However, south of the Yangtze River, the land is low and influenced by tides. During the continuous plum rains, Dampness pathogens are prevalent; during Major and Minor Heat periods, intense heat prevails. Summerheat damages Human Qi, and Dampness invades the intestines and stomach. In summer, one should be cautious in daily routine and consume bland flavors, which are essential for health preservation. Summerheat is formless and enters through the mouth and nose; it first injures the Qi level, causing shortness of breath, soft pulse, and limb weakness. Summerheat injures the Heart; since the Heart governs fluids, it causes mental restlessness, insomnia, and sweating. Alternatively, after long sunny days making the soil dry, sudden heavy rain causes heat vapor to rise, making one susceptible to Summerheat. Whether traveling or resting in simple shelters, despite differences in labor and rest, the susceptibility to pathogens is the same; this is called "Yang Summerheat." Conversely, residing in cool pavilions or water terraces, loving cooling, and preferring frozen beverages depresses Stomach Qi, causing aversion to cold, high fever, scanty sweat, sluggish deep pulse, vomiting, or diarrhea; this is called "Yin Summerheat," which must be understood. Summerheat invariably carries Dampness and filth. Some diseases manifest as Cholera (Huo Luan, acute gastroenteritis with vomiting and diarrhea), having four causes: contracting Summerheat, catching Cold, contracting Dampness, and dietary injury. Red and white dysentery results from internal invasion of Damp-Heat and irregular diet, named "Simultaneous Disease of Summerheat and Dampness."
Autumn Qi should be cool, and Metal Qi is clear and肃 (solemn/clear), so fewer people fall ill. If autumn sun is scorching, humans contract its Qi, or if they sit outdoors seeking coolness, pores are obstructed by wind and dew, preventing pathogen expulsion, making them highly susceptible to disease. Malaria (Nue Zheng, a parasitic disease with alternating chills and fever) largely originates here. Symptoms include body heat, headache, cough, and wheezing; the later the onset, the heavier the condition, named "Cool Wind Attacking Summerheat."
Winter Qi is biting, and all things hibernate. However, latent Summerheat from summer and autumn remains inside. At Winter Solstice, when Yang Qi begins to recover, sensing this Qi leads to venting, often presenting as aversion to cold with hot limbs, cough, hemoptysis, bleeding gums, and epistaxis. Additionally, mild winter weather with insufficient concealment of Yang Qi leads to Winter Warmth (Dong Wen) syndrome. During the three winter months, those skilled in health preservation avoid fog and dew in the morning, stay indoors alone, and sleep without excessive warmth, establishing the root for spring vitality. Walking on an empty stomach at dawn and failing to regulate sexual activity easily generates Cold diseases, historically named Shang Han (Cold Damage, a general term for exogenous febrile diseases). Can one not be cautious? This is named "Failure of Winter Storage." The treatment methods were fully prepared by former sages; why add my words? However, no one had established laws specifically divided by four seasons. Therefore, I explored the subtleties and presented my own views to compile this section. May practitioners understand it clearly; by studying it thoroughly, they will naturally achieve mastery. Conditions unrelated to atmospheric influence should be classified separately to show my intent. The *Nei Jing* discusses seasonal pathogenic influences based on the Four Qi; my division of seasonal illnesses and treatments traces the root and source. It differs little from ancient legislation, except for the different primary herbs used.