损分五脏,而五脏所藏,则无非精与气耳。夫精为阴,人之水也;气为阳,人之火也。水火得其正,
则为精为气;水火失其和,则为热为寒。此因偏损,所以致有偏胜。故水中不可无火,无火则阴胜而寒
病生;火中不可无水,无水则阳胜而热病起。但当详辨阴阳,则虚损之治无余义矣。如水亏者,阴虚也,
只宜大补真阴,切不可再伐阳气;火虚者,阳虚也,只宜大补元阳,切不可再伤阳气。此因阳气不足而复
伐其阴,阴亦损矣;阴已不足而再伤其阳,阳又亡矣。夫治虚治实,本是不同。实者阴阳固有余,但去其
余,则得其平;虚者阴阳有不足,再去所有,则两者俱败,其能生乎?故治虚之要,凡阴虚多热者,最嫌
辛燥,恐助阳邪也。尤忌苦寒,恐伐生气也。惟喜纯甘壮水之剂,补阴以配阳,则刚为柔制,虚火自降,
而阳归乎阴矣。阳虚多寒者,最嫌凉润,恐助阴邪也,尤忌辛散,恐伤阴气也。只宜甘温益火之品,补阳以
配阴,则不得其主,阴寒自敛,而阴从乎阳矣。是以气虚者宜补其上,精虚者宜补其下,阳虚者宜补而兼暖
,阴虚者宜补而兼清,此固阴阳之治辨也。其有气因精而虚者,自当补精以化气;精因气而虚者;自当补气以
生精。又如阳失阴而离者,非补阴何以收散亡之气;水失火而败者,非补火何以苏垂绝之阴。此又阴阳相济
之妙用也。故善补阳者,必于阴中求阳,则阳得阴助而生化无穷;善补阴者,必于阳中求阴,则阴得阳升而
泉源不竭,故以精气分阴阳,则阴阳不可离;以寒热分阴阳,则阴阳不可混。此又阴阳邪正之离合也。知阴
阳邪正之治,则阴阳和而生道得矣。
人知阴虚唯一,而不知阴虚有二。如阴中之水虚,则病在精血;阴中之火虚,则病在神气。
盖阳衰则气去,故神志为之昏乱,非火虚乎?阴亏则形坏,故肢体为之废弛,非水虚乎?今以神离形坏
之证,乃不求水火之原,而犹以风治,鲜不危矣。试以天道言之,其象显然,旱则多燥,燥则多风,是
风木之化从乎燥,燥则阴虚之候也。故凡治类风者,专宜培补真阴,以救根本,使阴气复则风燥自除。然外
感者,非曰绝无虚症,气虚则虚也;内伤者非曰必无实症,有滞则实也。治虚者,察其在阴在阳而直补之;
治实者,察其因痰因气而暂开之。此内伤外感及虚实攻补之间,最当察其有无微甚而酌其治也。甚至有元气
素亏,猝然倒扑,上无痰,下失禁,瞑目昏沉,此厥竭之证,尤与风邪无涉。使非大剂参附,或七年之艾,
破格挽回,又安望其复真气于将绝之顷哉。倘不能察其表里,又不能辨其虚实,但以风之为名,多用风药,
不知风药皆燥,燥复伤阴,风药皆散,散复伤气,以内伤作外感,以不足为有余,是促人之死也。
虚损分为五脏,而五脏所藏的精气,无非就是精和气罢了。精属于阴,是人的“水”;气属于阳,是人的“火”。水火运行正常,就能化为精和气;水火失去和谐,就会产生热证或寒证。这是因为偏颇的损伤,导致了偏胜的病机。所以水中不可没有火,没有火则阴气偏胜而寒病产生;火中不可没有水,没有水则阳气偏胜而热病发生。只要详细辨别阴阳,那么治疗虚损的道理就没有遗漏了。比如肾水亏损,属于阴虚,只应当大补真阴,切不可再攻伐阳气;命门火衰,属于阳虚,只应当大补元阳,切不可再损伤阳气。这是因为如果阳气已经不足,再去攻伐其阴,阴也会受损;如果阴已经不足,再去损伤其阳,阳就会消亡。治疗虚证和实证,本来是不同的。实证是阴阳都固盛有余,只需去除多余的部分,就能恢复平衡;虚证是阴阳有不足,如果再把原本就有的正气去掉,那么两者都会败坏,怎么能生存呢?所以治疗虚证的关键在于:凡是阴虚且多热的,最忌讳辛温燥烈之药,恐怕助长阳邪;尤其忌讳苦寒之药,恐怕伐伤生机。只喜欢纯甘味以壮水滋阴的药物,通过补阴来配平阳气,使刚强的阳气被柔弱的阴气制约,虚火自然下降,阳气回归于阴。凡是阳虚且多寒的,最忌讳凉润之药,恐怕助长阴邪;尤其忌讳辛散之药,恐怕损伤阴气(此处指耗散阳气)。只适宜用甘温益火的药物,通过补阳来配平阴气,使阴寒之气因失去主导而自然收敛,阴气顺从于阳气。因此,气虚的人适合补上焦,精虚的人适合补下焦,阳虚的人适合补益兼以温暖,阴虚的人适合补益兼以清润,这确实是辨别阴阳治疗的要点。如果有因为精亏而导致气虚的,自然应当补精以化生为气;有因为气虚而导致精亏的,自然应当补气以滋生精。又比如阳气失却阴液依附而离散者,不补阴用什么来收摄散亡之气?肾水失却命火温煦而败坏者,不补火用什么来唤醒垂绝之阴?这又是阴阳相互济助的妙用。所以善于补阳的人,必定在补阴中求取阳气,这样阳气得到阴液的资助而生化无穷;善于补阴的人,必定在补阳中求取阴液,这样阴液得到阳气的升发而泉源不竭。因此,以精气来分阴阳,则阴阳不可分离;以寒热来分阴阳,则阴阳不可混淆。这又是阴阳邪正离合的道理。懂得阴阳邪正的治疗原则,就能使阴阳调和而获得养生之道。
人们只知道阴虚是一种情况,却不知道阴虚有两种情况。比如阴中的“水”虚,则病变在精血;阴中的“火”虚,则病变在神气。大概阳气衰微则气去,所以神志为之昏乱,这不是火虚吗?阴液亏损则形体败坏,所以肢体为之废弛无力,这不是水虚吗?现在面对神离形坏的证候,如果不探究水火之源,仍然按照风证来治疗,很少有不危险的。试从天道来比喻,现象很明显:干旱则多燥,燥则多风,这是风木的变化顺应了燥气,燥是阴虚的表现。所以凡是治疗类似风证的,专门应当培补真阴,以挽救根本,使阴气恢复则风燥自然消除。然而外感病,并非绝对没有虚证,气虚就是虚证;内伤病,并非绝对没有实证,有积滞就是实证。治疗虚证,要观察是在阴还是在阳而直接补益;治疗实证,要观察是因痰还是因气而暂时开泄。这在内伤外感以及虚实攻补之间,最应当考察其有无、轻重而斟酌治疗方法。甚至有元气素来亏虚,突然跌倒昏迷,上部无痰,下部失禁,闭目昏沉,这是厥脱竭绝的证候,尤其与风邪无关。如果不是用大剂量的参附汤,或者陈年的艾叶,打破常规全力挽回,又怎么指望在真气即将断绝之时恢复真气呢?如果不能察辨表里,又不能辨别虚实,仅仅以“风”为名,多用风药,不知道风药都是燥烈的,燥烈又会损伤阴液;风药都是发散耗散的,发散又会损伤正气。把内伤病当作外感病治,把不足当作有余治,这是加速人的死亡啊。
Deficiency injuries are divided among the five Zang organs, and what is stored within these five Zang organs is nothing other than Essence (Jing) and Qi. Essence belongs to Yin and is the "Water" of the human body; Qi belongs to Yang and is the "Fire" of the human body. When Water and Fire function correctly, they transform into Essence and Qi; when Water and Fire lose harmony, Heat or Cold syndromes arise. This occurs because partial damage leads to partial excess. Therefore, Fire must not be absent from Water; without Fire, Yin will prevail and Cold diseases will arise. Water must not be absent from Fire; without Water, Yang will prevail and Heat diseases will arise. As long as Yin and Yang are carefully distinguished, there will be no omission in the treatment of deficiency injuries. For instance, if Kidney Water is deficient, this is Yin deficiency; one should only greatly tonify True Yin and absolutely must not further attack Yang Qi. If Mingmen Fire is deficient, this is Yang deficiency; one should only greatly tonify Original Yang and absolutely must not further injure Yang Qi. This is because if Yang Qi is already insufficient and one attacks its Yin, Yin will also be damaged; if Yin is already insufficient and one further injures its Yang, Yang will perish. The treatment of deficiency and excess syndromes is fundamentally different. In excess syndromes, Yin and Yang are solidly abundant; removing the excess restores balance. In deficiency syndromes, Yin and Yang are insufficient; removing what remains causes both to fail, how can life be sustained? Therefore, the key to treating deficiency is: for those with Yin deficiency and much Heat, pungent-drying herbs are most disliked, lest they assist Yang pathogenic factors; bitter-cold herbs are especially contraindicated, lest they destroy vital energy. One prefers purely sweet herbs that strengthen Water, tonifying Yin to harmonize Yang, so that rigid Yang is controlled by soft Yin, defying fire naturally descends, and Yang returns to Yin. For those with Yang deficiency and much Cold, cooling-moistening herbs are most disliked, lest they assist Yin pathogenic factors; pungent-dispersing herbs are especially contraindicated, lest they injure Yin Qi (here referring to dissipating Yang Qi). One should only use sweet-warm herbs that benefit Fire, tonifying Yang to harmonize Yin, so that Yin-Cold naturally contracts due to lack of a master, and Yin follows Yang. Thus, for Qi deficiency, supplementation should focus on the Upper Jiao; for Essence deficiency, supplementation should focus on the Lower Jiao; for Yang deficiency, supplementation should include warming; for Yin deficiency, supplementation should include clearing. This is indeed the distinction in treating Yin and Yang. If Qi is deficient due to Essence deficiency, one should naturally tonify Essence to generate Qi; if Essence is deficient due to Qi deficiency, one should naturally tonify Qi to generate Essence. Furthermore, if Yang has lost Yin as its anchor and dispersed, how else but by tonifying Yin can scattered Qi be gathered? If Water has failed due to loss of Fire's warmth, how else but by tonifying Fire can dying Yin be revived? This is the subtle application of mutual assistance between Yin and Yang. Therefore, those skilled in tonifying Yang must seek Yang within Yin, so that Yang receives assistance from Yin and its generation is endless; those skilled in tonifying Yin must seek Yin within Yang, so that Yin receives elevation from Yang and its source is inexhaustible. Thus, dividing Yin and Yang by Essence and Qi means Yin and Yang cannot be separated; dividing Yin and Yang by Cold and Heat means Yin and Yang cannot be confused. This is the separation and union of Yin-Yang, pathogenic and righteous factors. Understanding the treatment of Yin-Yang, pathogenic and righteous factors allows Yin and Yang to harmonize and the Way of Life to be attained.
People know there is only one type of Yin deficiency, but do not know there are two types. If the "Water" within Yin is deficient, the disease lies in Essence and Blood; if the "Fire" within Yin is deficient, the disease lies in Spirit and Qi. Generally, when Yang declines, Qi departs, causing confusion of spirit and consciousness—is this not Fire deficiency? When Yin declines, the form deteriorates, causing flaccidity of limbs—is this not Water deficiency? Now, facing symptoms of spirit departing and form deteriorating, if one does not investigate the root of Water and Fire but still treats it as Wind, danger is inevitable. Consider the analogy of Heaven's Dao: the phenomenon is obvious. Drought brings dryness; dryness brings Wind. This is the transformation of Wood-Wind following Dryness; Dryness is a sign of Yin deficiency. Therefore, in treating conditions resembling Wind, one should specifically cultivate and tonify True Yin to save the root; once Yin Qi recovers, Wind and Dryness will naturally disappear. However, external contraction does not absolutely exclude deficiency syndromes; Qi deficiency constitutes a deficiency syndrome. Internal injury does not absolutely exclude excess syndromes; stagnation constitutes an excess syndrome. To treat deficiency, observe whether it is in Yin or Yang and directly tonify it; to treat excess, observe whether it is due to Phlegm or Qi and temporarily open it up. Between internal injury and external contraction, and between deficiency/excess and attacking/tonifying, one must most carefully examine presence/absence and severity to adjust treatment. There are even cases where Original Qi is chronically deficient, leading to sudden collapse, with no Phlegm above, incontinence below, eyes closed, and deep coma. This is a syndrome of Jue-Jie (collapse and exhaustion), which has nothing to do with Wind pathogenic factors. Unless large doses of Shenfu Decoction (Ginseng and Aconite Decoction) or seven-year-old Moxa are used to break conventions and reverse the condition, how can one hope to restore True Qi at the moment it is about to vanish? If one cannot distinguish exterior-interior, nor differentiate deficiency-excess, but merely names it "Wind" and uses many Wind herbs, one fails to realize that Wind herbs are all drying, and drying further injures Yin; Wind herbs are all dispersing, and dispersing further injures Qi. Treating internal injury as external contraction, and insufficiency as excess, is hastening death.