(病源形色) 凡一十门
钱乙论五脏所主∶
心主惊,实则叫哭发热,饮水而搐,虚则卧而悸动不安。肝主风,实则目直大叫,呵欠项急顿闷;虚则
切牙多欠,气热则外生,气温则内生。脾主困,实则困睡,身热饮水;虚则吐泻生风。肺主喘,实则闷乱喘
促,有饮水者,有不饮水者;虚则哽气,长出气。肾主虚,无实也。惟疮疹肾实则变黑陷,更当别虚实证。假
如肺病又见肝证,切牙多呵欠者易治,肝虚不能胜肺故也。若目直,大叫哭,项急顿闷者难治。盖肺久病则
虚冷,肝强实而反胜肺也。视病之新久虚实,虚则补其母,实则泻其子。
钱乙论五脏病∶
肝病,哭叫目直,呵欠顿闷项急。心病,多叫哭惊悸,手足动摇,发热饮水。脾病,困睡泄泻,不思饮食。
肺病,闷乱哽气,长出气,气短急喘。肾病,无精光,畏明,体骨重。
钱乙论肝病胜肺∶
肝病秋见(一作日哺。)肝强胜肺,肺怯不能胜肝,当补脾肺治肝。益脾者,母能令子实故也。补脾,益黄散。治
肝,泻青丸主之。(益黄散方见胃气不和门中,泻青丸见惊热门中。)
钱乙论肺病胜肝∶
肺病春见(一作早晨),肺胜肝,当补肾肝治肺脏。肝怯者,受病也。补肝肾,地黄丸。治肺,泻白散
主之。(地黄丸方见虚寒门中,泻白散方见喘咳上气门中。)
钱乙论五脏相胜轻重∶
肝脏病见秋,木旺肝强胜肺也,宜补肺泻肝。轻者肝病退;重者唇白而死。肺脏病见春,金旺肺胜肝,当
泻肺。轻者肺病退;重者目淡青,必发惊。更有赤者当搐,为肝怯。当目淡青色也。心脏病见冬,火旺心强胜
肾,当补肾治心。轻者病退;重者下窜不语。肾怯虚也。肾脏病见夏,水胜火,肾胜心也,当治肾。轻者病退;
重者悸动当搐也。脾脏病见四旁,皆仿此治之。顺者易治;逆者难治。脾怯当面目赤黄。五脏相反,随证治之。
《惠眼观证》论五脏之气各有所主∶
心主于脉,其性动而荣于面,恶于热。因热所伤则脉浊。肺主于皮,其性坚而荣于毛,恶于寒。因寒所伤
则皮涩毛立。脾主于肉,其性浓而荣于唇,恶于湿。因湿所伤则唇枯肉肿。肝主于筋,其性曲直而荣于爪,恶
于风。凡惊风搐搦,本因风气激肝,至令筋动发搐而指爪青黑。此爪者,筋之余气。肾主于骨,其性流润而荣
于发,恶于燥。凡疳劳久泻,下虚上盛,梦中咬齿,须发焦枯。此齿者,骨之余气,而发亦脑之髓海。
《惠眼观证》论五脏受病∶
心之受病,既见于面黄脸赤,而又胸膈烦躁,口鼻干粗及患面疮,或泻、惊、脓,与夫喘息声粗,见水惊
怕。肝之受病,既见于摇头揉眼,而又遍身涩痒,毛焦发立,覆地而卧,及眼生斑疮,或腹中气癖,与夫夜睡
多汗。肺之受病,既见于脸白,喘粗气急,而又憎寒壮热,大肠冷滑,及鼻下常烂,咯唾脓血,与夫咳喘虚胀。
脾之受病,既见于腹上多筋,吃食难化,好吃泥土,粪中虫出,及泻痢频,并多睡,与夫拈眉咬甲。肾之受病,
既见于牙龈患疮,而又胸膈焦渴,小便浊水及下部开张,夜中狂叫,与夫弩咽多黑。
(病因与形色表现) 共分为十个门类
钱乙论述五脏所主:
心主惊,实证表现为叫哭、发热、饮水后出现抽搐;虚证表现为睡眠时悸动不安。肝主风,实证表现为两眼直视、大声呼叫、打哈欠、项部拘急且突然感到烦闷;虚证表现为咬牙、频繁打哈欠,气热则病发于外,气温则病发于内。脾主困倦,实证表现为嗜睡、身体发热、想喝水;虚证表现为呕吐腹泻并引发肝风。肺主喘促,实证表现为胸闷烦躁、呼吸急促,有的想喝水,有的不想喝水;虚证表现为喉间有声的短气、长出气。肾主虚证,没有实证。只有疮疹中肾脏实热才会变为黑陷,此时应当另外辨别虚实证候。假如肺病又出现肝证,如咬牙多、打哈欠的容易治疗,这是因为肝虚不能克制肺的缘故。如果出现两眼直视、大声哭叫、项部拘急突然烦闷的则难治。因为肺久病则虚冷,肝强盛实证反而克制肺。观察疾病的深浅、新旧、虚实,虚证则补其母脏,实证则泻其子脏。
钱乙论述五脏病:
肝病,表现为哭叫、两眼直视、打哈欠、项部拘急突然烦闷。心病,表现为多叫哭、惊悸、手足动摇、发热、想喝水。脾病,表现为嗜睡、泄泻、不思饮食。肺病,表现为胸闷烦躁、喉间短气、长出气、气短急促喘息。肾病,表现为眼神无光彩、畏光、身体骨骼沉重。
钱乙论述肝病胜肺:
肝病在秋季出现(一说为日哺时分),肝强盛克制肺,肺气怯弱不能克制肝,应当补脾肺而治肝。益脾的原因,是母脏能令子脏充实的缘故。补脾用益黄散。治肝用泻青丸为主。(益黄散的方剂见胃气不和门中,泻青丸见惊热门中。)
钱乙论述肺病胜肝:
肺病在春季出现(一说为早晨),肺强盛克制肝,应当补肾肝而治肺脏。肝怯弱是因为受了病邪。补肝肾用地黄丸。治肺用泻白散为主。(地黄丸的方剂见虚寒门中,泻白散的方剂见喘咳上气门中。)
钱乙论述五脏相胜轻重:
肝脏病在秋季出现,木旺肝强盛克制肺,宜补肺泻肝。轻者肝病消退;重者嘴唇发白而死。肺脏病在春季出现,金旺肺强盛克制肝,当泻肺。轻者肺病消退;重者眼睛淡青色,必定发生惊风。更有面色赤红的应当抽搐,这是肝气怯弱的表现。应当注意眼睛呈淡青色时的情形。心脏病在冬季出现,火旺心强盛克制肾,当补肾治心。轻者病退;重者向下窜动、不语。这是肾气怯弱虚损的表现。肾脏病在夏季出现,水克火,肾强盛克制心,当治肾。轻者病退;重者悸动并应当抽搐。脾脏病出现在四季之末(四旁),都仿照此法治疗。顺证的容易治疗;逆证的难治。脾怯弱时应当面目赤黄。五脏相反的情况,随证治疗。
《惠眼观证》论述五脏之气各有所主:
心主脉,其性质躁动而荣华于面部,厌恶热邪。因热邪所伤则脉象浑浊。肺主皮,其性质坚硬而荣华于毫毛,厌恶寒邪。因寒邪所伤则皮肤涩滞、毫毛竖立。脾主肉,其性质浓浊而荣华于口唇,厌恶湿邪。因湿邪所伤则口唇枯槁、肌肉肿胀。肝主筋,其性质曲直而荣华于爪甲,厌恶风邪。凡是惊风抽搐,本因风气激惹肝脏,致使筋脉跳动引发抽搐而手指爪甲青黑。这爪甲,是筋之余气。肾主骨,其性质流润而荣华于头发,厌恶燥邪。凡是疳积劳热久泻,下虚上盛,梦中咬齿,须发焦枯。这牙齿,是骨之余气,而头发也是脑之髓海的外荣。
《惠眼观证》论述五脏受病:
心的受病,既见于面色黄而脸红,而又胸膈烦躁、口鼻干燥粗糙及患面部疮疡,或者腹泻、惊风、脓血便,以及喘息声粗大、见水惊吓害怕。肝的受病,既见于摇头揉眼,而又遍身涩痒、毛发焦枯竖立、趴伏在地而卧,以及眼生斑疮,或者腹中有气癖块,以及夜间睡觉多汗。肺的受病,既见于脸色苍白、喘息粗重气急,而又憎恶寒冷壮热、大肠冷滑,以及鼻下经常溃烂、咯唾脓血,以及咳嗽喘息虚胀。脾的受病,既见于腹部多筋、进食难消化、喜欢吃泥土、粪便中有虫出,以及腹泻痢疾频繁、并且多睡,以及皱眉咬指甲。肾的受病,既见于牙龈患疮,而又胸膈焦渴、小便浑浊如水及下部开张、夜间狂叫,以及咽喉弩张多黑色。
(Pathogenesis and Manifestations of Form and Color) Divided into ten categories in total.
Qian Yi discusses the governance of the Five Zang Organs:
The Heart governs fright (Jing). Excess patterns manifest as crying and shouting, fever, and convulsions after drinking water; deficiency patterns manifest as palpitations and restlessness during sleep. The Liver governs wind (Feng). Excess patterns manifest as staring straight ahead, loud screaming, yawning, neck stiffness, and sudden oppression; deficiency patterns manifest as teeth grinding and frequent yawning. Heat in Qi causes external manifestation, while warmth in Qi causes internal manifestation. The Spleen governs lethargy. Excess patterns manifest as drowsiness, body heat, and thirst; deficiency patterns manifest as vomiting, diarrhea, and the generation of wind. The Lungs govern panting. Excess patterns manifest as chest stuffiness, agitation, and rapid breathing; some patients desire water, others do not; deficiency patterns manifest as sighing (Geng Qi) and long exhalations. The Kidneys govern deficiency; there is no excess pattern. Only in cases of smallpox and chickenpox does an excess condition of the Kidney result in blackening and sinking, which requires separate differentiation of excess and deficiency syndromes. For instance, if a Lung disease presents with Liver symptoms such as teeth grinding and frequent yawning, it is easy to treat because Liver deficiency fails to overcome the Lung. If symptoms include staring straight ahead, loud crying, neck stiffness, and sudden oppression, it is difficult to treat. This is because chronic Lung disease leads to deficiency and cold, while strong Liver excess overcomes the Lung. Observe the newness or chronicity, and excess or deficiency of the disease: for deficiency, tonify its mother organ; for excess, drain its child organ.
Qian Yi discusses diseases of the Five Zang Organs:
Liver disease manifests as crying, shouting, staring straight ahead, yawning, neck stiffness, and sudden oppression. Heart disease manifests as frequent crying and shouting, fright and palpitations, shaking of hands and feet, fever, and thirst. Spleen disease manifests as drowsiness, diarrhea, and lack of appetite. Lung disease manifests as chest stuffiness, sighing, long exhalations, shortness of breath, and rapid panting. Kidney disease manifests as dull eyes lacking luster, photophobia, and heaviness of the body and bones.
Qian Yi discusses Liver overcoming the Lungs:
When Liver disease appears in autumn (or alternatively at dusk), the Liver is strong and overcomes the Lung, while the Lung is timid and cannot overcome the Liver. One should tonify the Spleen and Lungs and treat the Liver. Tonifying the Spleen works because the mother organ can make the child organ solid. Use Yihuang San (Benefit the Yellow Powder) to tonify the Spleen. Use Xieqing Wan (Drain the Green Pill) to treat the Liver. (See Yihuang San formula under the section on Disharmony of Stomach Qi; see Xieqing Wan under the section on Fright Heat.)
Qian Yi discusses Lung overcoming the Liver:
When Lung disease appears in spring (or alternatively in the morning), the Lung overcomes the Liver. One should tonify the Liver and Kidneys and treat the Lung organ. The timidity of the Liver indicates it has received pathogenic factors. Use Dihuang Wan (Rehmannia Pill) to tonify the Liver and Kidneys. Use Xiebai San (Drain the White Powder) to treat the Lungs. (See Dihuang Wan formula under the section on Deficiency Cold; see Xiebai San formula under the section on Panting, Cough, and Upper Qi Disorders.)
Qian Yi discusses the mutual overcoming and severity of the Five Zang Organs:
When Liver disease appears in autumn, Wood is prosperous, the Liver is strong and overcomes the Lung. It is appropriate to tonify the Lung and drain the Liver. In mild cases, the Liver disease recedes; in severe cases, the lips turn white and death ensues. When Lung disease appears in spring, Metal is prosperous, the Lung overcomes the Liver. One should drain the Lung. In mild cases, the Lung disease recedes; in severe cases, the eyes appear pale green, and fright will definitely occur. If the face is redder, convulsions should occur, indicating Liver timidity. Note the situation when the eyes are pale green. When Heart disease appears in winter, Fire is prosperous, the Heart is strong and overcomes the Kidney. One should tonify the Kidney and treat the Heart. In mild cases, the disease recedes; in severe cases, the patient crouches downward and becomes mute. This indicates Kidney timidity and deficiency. When Kidney disease appears in summer, Water overcomes Fire, and the Kidney overcomes the Heart. One should treat the Kidney. In mild cases, the disease recedes; in severe cases, there is palpitation and convulsions. When Spleen disease appears in the four seasons' transitions, treatment follows this pattern. Smooth progression is easy to treat; reverse progression is difficult to treat. Spleen timidity manifests as red and yellow complexion. Treat according to symptoms when the Five Zang organs oppose each other.
"Huiyan Guanzheng" (Observation of Syndromes through the Wise Eye) discusses that the Qi of each Zang organ has specific governance:
The Heart governs the vessels (Mai). Its nature is active and flourishes in the face; it dislikes heat. Injury by heat causes turbid vessels. The Lungs govern the skin. Their nature is firm and flourishes in the hair; they dislike cold. Injury by cold causes rough skin and erect hair. The Spleen governs the muscles. Its nature is dense and flourishes in the lips; it dislikes dampness. Injury by dampness causes dry lips and swollen flesh. The Liver governs the sinews. Its nature is curved and straight and flourishes in the nails; it dislikes wind. All cases of fright wind and convulsions originate from wind qi stimulating the Liver, causing sinew movement and convulsions, resulting in blue-black fingers and nails. These nails are the surplus Qi of the sinews. The Kidneys govern the bones. Their nature is flowing and moist and flourishes in the hair; they dislike dryness. All cases of malnutrition, consumption, and chronic diarrhea involve lower deficiency and upper excess, teeth grinding in dreams, and scorched, dry hair and beard. These teeth are the surplus Qi of the bones, and the hair also reflects the sea of marrow of the brain.
"Huiyan Guanzheng" discusses diseases received by the Five Zang organs:
Diseases received by the Heart manifest as yellowish face with red cheeks, chest and diaphragm irritability, dry and coarse mouth and nose, facial sores, or diarrhea, fright, and purulent stools, as well as coarse breathing sounds and fear of water. Diseases received by the Liver manifest as head shaking and eye rubbing, generalized rough itching, scorched hair and erect hair, lying prone on the ground, spots and sores on the eyes, abdominal gas masses, and night sweats. Diseases received by the Lungs manifest as pale face, coarse and rapid breathing, aversion to cold with high fever, cold and slippery large intestines, constant ulceration under the nose, coughing up pus and blood, and coughing, panting, and distension. Diseases received by the Spleen manifest as visible tendons on the abdomen, difficulty digesting food, craving for eating dirt, worms in feces, frequent diarrhea and dysentery, excessive sleep, eyebrow knitting, and nail biting. Diseases received by the Kidneys manifest as gum sores, chest and diaphragm scorching thirst, turbid urine resembling water, opening of the lower orifices, nighttime wild screaming, and dark discoloration of the throat.