钱氏曰∶肝脏病见秋,木旺,肝强胜肺也,宜补肺泻肝,轻则肝病退,重者唇白而死。
肺病见春,金旺,肺强胜肝,当泻肺,轻者肺病退,重者目淡青,必发惊,更有赤者,发搐为肝怯,当目淡青也。
心病见冬,火旺,心强胜肾,当补肾泻心,轻者心病退,重者下窜不语,肾气怯也。
肾病见夏,水胜火,肾胜心也,宜泻肾,轻者肾病退,重者悸动当搐也。
脾病见四时,皆仿此治之。顺者易治,逆者难治。脾怯面目赤黄,五脏相反,当随症治之。
一肺病又见肝症,切牙多呵欠者,易治。肝虚不胜肺故也。若目直大叫哭,项急烦闷者,难治。盖肺病久则虚冷,
肝强实而反胜肺,视病之邪久虚实,虚则补母,实则泻子,斯得之矣。
洁古云∶肝胜肺则肝病,身热发搐,又见肺虚喘而气短,病见于申酉戌时,是肝真强也。
《内经》曰∶受所制而不能制,谓之真强,法当补脾肺而泻肝,导赤散、泻黄散主之。
按刘宗浓云∶此皆五脏相胜,病机不离五行生克制化之理。盖小儿初生襁褓,未有七情六欲,只是形体脆弱,血气
未定,脏腑精神未完,所以有脏气虚实胜乘之病,但世俗不审此理,往往遇是即指为外感内伤而用药,致枉死者多矣,
悲夫!然钱氏论之太略,洁古补之,今特参附,以惠无穷云。
〔附方〕
导赤散 见惊风症内,一见五淋症内。
泻黄散 见热症内。
钱乙说:肝脏有病出现在秋季,此时木气旺盛,肝气强盛而克制肺金。治疗应当补益肺气、泻除肝火。病情轻的,肝病会消退;病情重的,会出现嘴唇发白而死。
肺脏有病出现在春季,此时金气旺盛,肺气强盛而克制肝木。治疗应当泻除肺热。病情轻的,肺病会消退;病情重的,眼睛呈现淡青色,必定会发生惊风,如果眼睛发红,则发生抽搐,这是因为肝气怯弱,应当表现为目淡青色的情况。
心脏有病出现在冬季,此时火气旺盛,心气强盛而克制肾水。治疗应当补肾气、泻心火。病情轻的,心病会消退;病情重的,会出现阴囊内缩、不能说话的症状,这是肾气怯弱的表现。
肾脏有病出现在夏季,此时水气胜过火气,肾气强盛而克制心火。治疗应当泻除肾邪。病情轻的,肾病会消退;病情重的,会出现心悸动摇并伴随抽搐。
脾脏有病出现在四季(春、夏、秋、冬),都仿照上述原则治疗。顺应五行生克规律的容易治疗,逆乱的难以治疗。脾气怯弱时,面目呈现赤黄色,这是由于五脏之气相互克制反常所致,应当根据具体症状进行治疗。
如果是肺病又出现肝病的症状,如咬牙、多打哈欠的,属于易治之症。这是因为肝虚不能制约肺金。如果出现两眼直视、大声哭叫、颈项强直、烦躁闷热的,属于难治之症。这是因为肺病日久导致虚冷,而肝气强盛实热反而克制肺金。观察病邪时间的长短以及虚实状况,虚证则补其母脏,实证则泻其子脏,这样就能掌握治疗要领了。
张元素(洁古)说:肝气克制肺金会导致肝病,身体发热并发生抽搐,同时伴有肺虚引起的喘息和气短。病症在申时、酉时、戌时显现,这是肝气真正强盛的表现。
《黄帝内经》说:受到制约而不能制约对方,称为“真强”。治疗方法应当补益脾肺之气而泻除肝火,主方用导赤散和泻黄散。
按语:刘宗浓说:这些都是五脏之间相互克制的病理变化,病机离不开五行相生相克的原理。因为小儿初生尚在襁褓之中,没有七情六欲的干扰,只是形体脆弱,血气未定,脏腑精神尚未完善,所以会有脏气虚实相互胜乘的疾病。但是世俗之人不明了这个道理,往往遇到这些症状就指认为外感或内伤而用药,导致枉死的人很多,可悲啊!然而钱乙的论述过于简略,张元素加以补充,现在我特意参考并附加注解,以造福后世无穷无尽的患者。
Qian Yi stated: When liver disease manifests in autumn, the Wood qi is prosperous. The liver is strong and overacts on the Lung Metal. Treatment should involve tonifying the Lung and draining the Liver. In mild cases, the liver disease will recede; in severe cases, the lips will turn white, leading to death.
When lung disease manifests in spring, the Metal qi is prosperous. The lung is strong and overacts on the Liver Wood. Treatment should involve draining the Lung. In mild cases, the lung disease will recede; in severe cases, the eyes will appear pale cyan, inevitably leading to *Jing Feng* (Wind Stirring / Convulsive Disorder). If the eyes are red, convulsions (*Chou*) will occur due to liver deficiency; this condition should present with pale cyan eyes.
When heart disease manifests in winter, the Fire qi is prosperous. The heart is strong and overacts on the Kidney Water. Treatment should involve tonifying the Kidney and draining the Heart. In mild cases, the heart disease will recede; in severe cases, the patient will exhibit retraction of the genitals and inability to speak, indicating weakness of Kidney Qi.
When kidney disease manifests in summer, Water overcomes Fire. The kidney overacts on the Heart. Treatment should involve draining the Kidney. In mild cases, the kidney disease will recede; in severe cases, palpitations and tremors accompanied by convulsions will occur.
Spleen disease occurring in any of the four seasons should be treated following these principles. Cases following the generative cycle are easy to treat; those violating it are difficult. Spleen deficiency presents with red and yellow complexion. When the five Zang organs act against each other abnormally, treatment must be tailored to the specific symptoms.
If lung disease presents with liver symptoms, such as teeth grinding and frequent yawning, it is easy to treat. This is because the Liver is deficient and cannot control the Lung. However, if the eyes are fixed, there is loud crying, neck stiffness, and irritability, it is difficult to treat. This is because prolonged lung disease leads to deficiency-cold, while the Liver becomes strong and excess, thereby counter-acting the Lung. By observing the duration of the pathogen and the deficiency or excess nature, one should tonify the Mother organ in deficiency cases and drain the Child organ in excess cases; thus, the correct approach is achieved.
Zhang Yuansu (Jiegu) stated: When Liver overacts on Lung, liver disease occurs, characterized by body heat and convulsions, along with lung deficiency manifesting as wheezing and shortness of breath. The pathology appears during the Shen, You, and Xu hours, indicating true strength of the Liver.
The *Huangdi Neijing* states: "Being controlled but unable to control others is called 'True Strength'." The method should be to tonify the Spleen and Lung and drain the Liver, primarily using *Daochi San* (Guiding Out Red Powder) and *Xiehuang San* (Draining Yellow Powder).
Commentary: Liu Zongnong stated: These are all diseases of the five Zang organs overcoming each other; the pathogenesis does not depart from the principles of the mutual generation and restriction of the Five Elements. Since infants are still in swaddling clothes, devoid of the seven emotions and six desires, their physical form is fragile, blood and qi are undetermined, and the zang-fu spirit and essence are incomplete. Therefore, diseases arise from the deficiency and excess of zang qi leading to overcoming and multiplying. However, laypeople do not understand this principle and often misidentify these conditions as external contraction or internal injury, administering medication accordingly, resulting in many wrongful deaths. How tragic! Qian Yi's discussion was too brief, and Zhang Yuansu supplemented it. I now specially reference and add annotations to benefit future generations.
[Attached Formulas]
*Daochi San* (Guiding Out Red Powder): See under Convulsive Disorder and Five Types of Lin Syndrome.
*Xiehuang San* (Draining Yellow Powder): See under Heat Syndrome.