唐容川曰∶属者统属也。知其所属,则纲领既得,而其条目可例求矣。
经云∶诸风掉眩,皆属于肝。
唐容川曰∶肝为风脏,凡风病皆属于肝。诸风谓中风伤风惊风疠风之类,所赅之症多矣。掉谓转动,凡猝倒惊
痫抽掣摇战之类皆是。肝主筋,此皆筋之为病也。眩是昏晕,凡昏花妄见,头目旋转皆是肝开窍于目。故有此病
也,西医谓目眩惑昏花,痉痫抽掣,皆脑气筋为病。谓目系通脑,故昏眩;脑气用力太过,则肉缩伸抽掣。究问脑
气何故病此,则西医茫然。岂知肝脉通于脑,开窍于目而主筋。凡西医所谓脑气,皆肝脉所司。而脉筋所以致病,
则又肝风所致也。故凡眩掉,皆属于风。而诸风为病,总属之肝。
径云∶诸寒收引,皆属于肾。
唐容川曰∶肾司寒气,故凡寒证,皆属之肾。肾又主骨,肾阳四达,则骨体舒展。举动轻便。若肢骨拘急而收
曲,或 缓而引长,皆骨不为用也。须知拘收引 ,与抽掣缩短者不同,一是寒证,一是风证。
涂蔚生曰∶肾有二枝,生于第十四脊椎下,左右各一枝,中以油膜相连,名曰肾系。肾系穿过之中间脊椎,名曰
命门。蒸发阳气,敷布周身。然此火不自蒸发,必得肾阴之助,而后始能蒸发。盖一阳生于二阴之下,成为坎中满之
象也。亦犹火车之设置汽柜,必先设置火池水锅,而后火煎其水,汽入于柜,能以任重致远也。若吾人之火旺水盛,
则有此健壮水火,即有此强盛之元气,充溢周身,自无寒缩之症。盖其由肾系而生出胁下之板油,
少腹之网油,中焦之膜油,上焦之膈膜,周身之腠理,无不以此水火充足,光辉四映也。常见胖人怕热,以其水足
火旺,元气宽裕,网膜之油汁充足也。又常见瘦人怕冷,以其水亏火耗,真阳化生过少,而网膜之油汁缺欠也。然
过于亏损,又见其孤阳无根据,发生潮热骨蒸等症也。至于肾水充足,肾火衰败,纯属肾阳之虚,而恶寒者,此则不过
十分之一二耳。然任其所好,过食生冷,或曾患热证,过服寒凉,亦足减其真阳之势也。世之所谓小儿为纯阳之体
者,纯属谬误之谈。
经云∶诸气 郁,皆属于肺。
唐容川曰∶五脏六腑之气,无不总统于肺,以肺为气之总管也。故凡治气,皆当治肺。肺主皮毛, 是气之乖
于皮毛者 , 也。《说文》谓形恶,如紫癜班瘤黑痣 鼻之类。西医谓毛孔下有油核,其管直通皮肤。若面生黑
刺,即管塞之故,此即《内经》 之说也。郁是气遏于内,不得舒发也。见病如气逆痰滞血结便闭之类,是气之
乖于腹内者。郁与畅反,肺气不畅,故郁,宜散降之。
经云∶诸湿肿满,皆属于脾。
唐容川曰∶肿在皮肤四肢,满在腹内胀塞,皆湿气壅滞,水下不行,停走于膈膜中也。然湿症尚不止此,故曰
诸湿。或头目昏沉,或疟暑泄痢,或周身痹痛,或痰饮 癖,皆属脾土不制水所致。盖脾生油膜之上,膜是三焦主水
道,油是脾之物,油不沾水;此脾所以利水也。若脾之油失其令,则湿乃得藏匿,故治湿责之于脾。
涂蔚生曰∶查容川之少阴少阳补论,曾言肾合三焦,三焦根于肾系,谓上中下之三焦油膜,全由先天肾脏所司。
至此而容川言膜是三焦主水道,油是脾之物,得勿有相背谬者乎?曰∶人之
未生,是以先天生后天,人之既生,是以后天生先天。脾土生于油膜之上,是火生土,先天生后天之义也。水遇油
而滑利者,是土克水之义也。五行互相为生,亦互相为克,脾土虽生于油膜之上,油膜是肾系所发,而膜之所以能致
有油,油汁充足,光辉明亮者,则由于脾胃健壮,饮食增进。是脾肾二者,得勿二而一,一而二乎。
经云∶诸疮痛痒皆属于心。
唐容川曰∶此言诸疮,或血分凝结,阻滞其气,气与血争则痛。血虚生热,兼动风气,风火相煽则痒。皆属
心经血分为病,治宜和血。又凡病不干血分,皆不发痛,故痞膨肿等,均不痛。凡是腹痛,盖无不关于血分,故
皆属心。
经云∶诸热瞀 ,皆属于心。
唐容川曰∶诸热谓发热恶热瘟暑等症,瞀谓眼目昏花,黑眼见鬼等症, 谓筋不得伸,抽掣等症,皆属于火者。
盖诸热是火伤气分,火克肺金也。瞀是心神扰惑,视物昏乱。火属心,心藏火,扰其神故瞀。 是肝筋为火所灼,无
血养筋,故缩扯。 与 缓不收有异,当辨之。
经云∶诸厥固泻,皆属于下。
唐容川曰∶厥谓四肢逆冷,固谓腹中瘕积,如寒症之类,泻谓下痢不止。皆属于下者,谓属于下焦肾经也。
肾阳不能四达则厥,肾阳不能上升则泻,肾阳不能化气则固结。故皆属于下,宜温之也。
涂蔚生曰∶容川解此节厥固泻三症,谓皆属于下焦肾阳虚寒,是未免得半失半。盖有肾阳不能四达之虚寒厥症,
亦有肾火遏伏内闭之实热厥证也。有肾阳不能化气之虚寒固症,亦有肾火亢烈血结之实热固症也。有肾阳不能上升
之虚寒泻症,亦有肾
火盛旺阴虚之实热泻症也。若遇厥固泻等症,概谓虚寒,一味温补,未免误事不少。
经云∶诸痿喘呕,皆属于上。
唐容川曰∶痿有两症,一是肺痿,肺叶焦举,不能通调津液,则为虚劳咳嗽。一是足痿,胫枯不能行走,则足
痿,然未有足痿而不发于肺者。益肺主津液,由阳明而下润宗筋,足乃能行。肺之津液不行,则宗筋失养。故足
痿虽见于下,而亦属之上焦也。喘属肺之呼不利,呕属胃之饮食,气逆肺胃,均属上焦。上焦属阳,多病火逆,
宜清之也。
涂蔚生曰∶容川之痿发论,分脉痿津痿治之。而此处解痿,只有肺痿足痿二者,似相歧异。然查其痿之所成,
不外于津液干枯。药之所治,不离乎滋阴潜阳。是二而一也。至其所谓喘属肺之呼不利,则未免失于精当。盖喘有
虚实二者。虚者由于下元亏损,化生之气短少,而肺无所充裕也。治之之法,宜补其气以定喘。经曰∶损其肺者益
其气,即此义也。实者化气太甚,而肺部壅塞也。治之之法,宜降其气以定喘。经曰∶高者抑之,即此义也。若夫
虚实之夹寒夹热,则又在乎医者随症以为加减也。至其所谓呕属胃之饮食,亦是一间未妥。盖呕亦有虚实二种,
其虚而夹热者,则由于膈气空虚,热欲侵入胃阳也,治宜清补。其实而夹寒者,则由膈气滞塞,寒欲侵入胃中也,
治宜温暖。如欲尽治喘呕之能事,宜参观后之喘呕条。
经云∶诸禁鼓栗,如丧神守,皆属于火。
唐容川曰∶禁谓口齿禁切,噤口痢、痉病口噤之类。鼓栗谓鼓战栗,如疟疾手足摇战之类。如丧神守,谓谵语、
百合病、恍惚不安之类。盖热极反寒之象,火扰心神之征,皆宜治其火也。
经云∶诸痉项强,皆属于湿。
唐容川曰∶寒湿则筋脉凝,热湿则筋脉胀,故皆能发痉与项强之症。
经云∶诸逆冲上,皆属于火。
唐容川曰∶诸逆谓吐咳呛呕等症。凡是冲脉气逆,头目咽喉胸中受病,均系心肝之火,挟冲脉上逆也,宜抑之。
涂蔚生曰∶此证务宜查其形色,热确与否。因咳吐呛呕等症,尚有虚寒之一种症治也。富家之儿,以其溺爱
过甚,衣被过浓,每易发生此症。而即得此症之后,复自信参 可以治吐咳,姜夏可以治呛呕。冒然与之,卒至愈
治愈剧,死于非命,是何愚之甚也。
经云∶诸胀腹大,皆属于火。
唐容川曰∶诸胀谓腹内胀满,腹大谓单腹胀。此证是肝不疏泻,则小便不利,水停为胀。脾不运化,则单腹胀。
皆属于热者,属于肝木乘脾也。然此与上节火字有别。火属血分,热属气分,热则气分之水多壅,故主胀大。
经云∶诸躁狂越,皆属于火。
唐容川曰∶躁谓烦躁,狂谓颠狂,越谓升高逾垣。凡此皆三焦与胃火太盛,而血气勃发也。
经云∶诸暴强直,皆属于风。
唐容川曰∶强直僵仆倒地,暴者猝然发作。风性迅速,故能暴发。凡风均属之肝。肝属筋脉,风中筋脉,不能引
动,则强直矣。风者阳动而阴应之矣,故风具阴阳两性。中风之阴,则为寒风;中风之阳,则为热风。无论寒热,
均有强直之证,宜细辨之。
经云∶诸病有声,按之如鼓,皆属于热。
唐容川曰∶此与肠鸣不同。肠鸣则转气功痛下泄,属水渍入肠,发为洞泻,是寒非热也。此有声乃在人皮黑膜内,
连网油膜之中。凡人身连网油膜,均是三焦,乃相火之府,行水之道路
也。水火相激,往往发声,但其声绵绵,与雷鸣切痛者有异。按之亦能作声,又拒手,如按鼓皮。以其在皮膜间,
故按之如鼓。是三焦之火,与水为仇,故曰皆属于热。盖三焦为行气之府,气多则能鼓吹其膜中之管,使之有
声。如西洋象皮人,搦之则出声是矣。
经云∶诸病跗肿,疼酸惊骇,皆属于火。
唐容川曰∶跗,足背。凡足肿皆发于厥阴阳明两经。阳明之脉,行足背;厥阴之脉、起足大指丛毛内踝。肝
木生热,壅阻胃经之湿,则循经下注,而发足肿,极酸痛也。酸字颇有实义。西医云,凡香港脚必胃中先酿酸水,
继而尿中有蛋白形,尿亦发酸,乃发香港脚肿病。但西医未言所以致酸,与因酸致肿之故。惟《内经》理可互证。经
云∶肝木在味为酸。盖木能生火,木能克土,土不化水,火又蒸之,则变酸味,是酸者湿与热合化之味也。羹汤
夏月过夜则酸,湿遇热也,冬月则否,有湿则无热也。知酸所以致疼肿,而香港脚可治也。又凡乍惊乍骇,皆是肝经
木郁火发,魂不藏之故,是以属于火。
经云∶诸转反戾、水液混浊,皆属于热。
唐容川曰∶转者左右扭掉也。反者角弓反张也。戾如犬出户下,其身曲戾,即阳明痉病,头曲至膝也。水液浑
浊,小便不清也。转在侧、属少阳经。反在后,属太阳经。戾在前,属阳明经。水道在膜膈中,属三焦经。皆属于
热。是水液混浊,固属三焦之热,而诸转反戾,亦多同属三焦矣。三焦网膜,西人谓之连网,由内连外,包裹赤肉,
两头生筋,以贯赤肉,筋连于骨节,故利曲伸。观此则知转反戾,是筋所牵引,实则网膜伸缩使然,故《内经》与
水液同论,以见皆属三焦网膜中之热也。西医乃谓抽掣痉等,发于脑筋,不免求深反浅,故西人无治之之术也。
涂蔚生曰∶三焦网膜之热,固能使筋所牵引,以致诸转反戾。然养筋者血也,使血不致为热所灼而干枯,则热
又何至烁筋而牵引。是治此病之初,只宜清热。而见有外症者,亦须解外。迨至三五日后,宜兼养血,以顾其本。
小儿此症颇多,最宜审慎。切不可以其反戾诸状,疑为俗谓天吊诸惊,乱投惊风之药,以致夭札。
经云∶诸病水液,澄澈清冷,皆属于寒。
唐容川曰∶下为小便,上为涎唾,其道路总在三焦膈膜之中。无论何证,但据水液有澄澈清冷之状,即是三焦
火虚之候,故曰皆属于寒。
经云∶诸呕吐酸,暴注下迫,皆属于热。
唐容川曰∶呕谓干呕,是火逆也。吐有寒症,吐酸则无寒症。暴注下迫,里急后重,逼塞不得畅,俗名痢症,
皆属于热者,属于肝经之热也。肝火上逆,则呕吐酸;肝火下注,则痢下迫。因肝欲疏泄,肺欲收敛,金木不和,
故欲泄不得。且痢多发于秋,金克木也。
涂蔚生曰∶暴注下迫,似宜分作两条。暴注者便系溏稀之物,勃然下泻,热甚汹猛,毫无艰难阻止之状也。
下迫者便系脓血之物,情急欲出,至下而滞,壅遏塞止之状也。一则由肝火之发,一则由于金性之收。然非内有积热,
皆不至此。不过暴注之色,多系深黄黑色,或者一种赤血水耳。
唐容川曰∶病机百出,未能尽录。但举其凡,以例其余。
唐容川说:“属”意为统属、归属。明白了疾病的所属类别,就掌握了纲领,那么具体的条目就可以类推求得了。
《内经》说:“各种风病引起的肢体摇动、头晕目眩,都归属于肝。”
唐容川说:肝是主风的脏腑,凡是风病都归属于肝。“诸风”包括中风、伤风、惊风、疠风等,所涵盖的症状非常多。“掉”指转动,凡是突然昏倒、惊痫、抽搐、摇颤等都算作此类。肝主管筋脉,这些都是筋脉的病变。“眩”指昏晕,凡是视物模糊、出现幻觉、头目旋转都属于肝开窍于目的功能异常。西医认为目眩、视物模糊、痉挛癫痫、抽搐等都是脑神经的疾病。他们认为目系连接大脑,所以会出现昏眩;脑神经用力过度,则肌肉收缩、伸展时发生抽搐。但如果追问脑神经为何会患此病,西医则感到茫然。哪里知道肝脉通达于脑,开窍于目并主管筋脉。凡西医所说的脑神经疾病,其实都由肝脉所管辖。而脉和筋之所以致病,又是由于肝风所致。所以凡是眩晕、摇动,都归属于风。而各种风病,总归属于肝。
《内经》说:“各种寒证引起的筋脉收缩牵引,都归属于肾。”
唐容川说:肾主管寒气,所以凡是寒证,都归属于肾。肾又主管骨骼,肾阳通达全身,则骨骼舒展,举动轻便。如果肢体骨骼拘急弯曲,或者松弛而伸长,都是骨骼不能正常发挥作用的表现。需要知道的是,拘挛收缩牵引与抽搐缩短是不同的,前者是寒证,后者是风证。
涂蔚生说:肾有两枝,生于第十四脊椎下方,左右各一枝,中间由油膜相连,称为“肾系”。肾系穿过的中间脊椎,称为“命门”,负责蒸发阳气,敷布全身。然而这火不能自行蒸发,必须得到肾阴的帮助,然后才能蒸发。这就好比一阳生于二阴之下,形成坎卦中满的形象。也就像火车设置汽柜,必须先设置火池和水锅,然后火煎水,蒸汽进入柜子,才能承载重物、行远路。如果人的火旺水盛,就有这种健壮的水火,也就有强盛的元气,充溢全身,自然没有寒冷收缩的症状。大概因为从肾系生出胁下的板油、少腹的网油、中焦的膜油、上焦的膈膜以及全身的腠理,无不因为水火充足,光辉四映。常见胖人怕热,是因为他们水足火旺,元气宽裕,网膜中的油汁充足。又常见瘦人怕冷,是因为他们水亏火耗,真阳化生过少,而网膜中的油汁缺乏。然而如果亏损过于严重,又会见到孤阳无根,发生潮热、骨蒸等症状。至于肾水充足但肾火衰败,纯属肾阳虚,表现为恶寒的,这种情况只占十分之一二。但是,如果任由喜好,过食生冷,或者曾经患过热证,过服寒凉药物,也足以削弱真阳的气势。世上所谓小儿是“纯阳之体”的说法,纯属谬误之谈。
《内经》说:“各种气机郁滞,都归属于肺。”
唐容川说:五脏六腑的气,无不由肺统领,因为肺是气的总管。所以凡是治疗气病,都应该治肺。肺主管皮毛,“皶”是指面部皮肤粗糙、色泽恶浊,如紫癜、斑痕、黑痣、酒渣鼻等。西医认为毛孔下有油核,其管道直通皮肤。如果脸上长黑头粉刺,就是管道堵塞的缘故,这就是《内经》中关于“皶”的说法。“郁”是指气被遏制在体内,不得舒展发散。表现为气逆、痰滞、血结、便秘等症状,这是气在腹部内的异常。郁与畅相反,肺气不畅,所以称为郁,宜用散法或降法治疗。
《内经》说:“各种湿邪引起的肿胀、胀满,都归属于脾。”
唐容川说:肿在皮肤四肢,满在腹内胀塞,都是湿气壅滞,水液下行不利,停聚在膈膜中间。然而湿症还不止于此,所以说“诸湿”。有的头目昏沉,有的疟疾暑天泄痢,有的周身痹痛,有的痰饮癖积,都属于脾土不能制水所致。大概脾生长在油膜之上,膜是三焦主司水道,油是脾的物质,油不沾水,这就是脾利水的原因。如果脾的油失去其功能,湿气就能藏匿,所以治疗湿病要责之于脾。
涂蔚生说:查阅唐容川关于少阴、少阳补论的文章,他曾说肾合三焦,三焦根于肾系,谓上、中、下三焦的油膜,全由先天肾脏所管辖。到这里唐容川又说膜是三焦主司水道,油是脾的物质,这不是相互矛盾吗?回答说:人未出生时,是以先天生后天;人出生后,是以后天生先天。脾土生于油膜之上,这是火生土、先天生后天的道理。水遇到油变得滑利,这是土克水的道理。五行互相为生,也互相为克。脾土虽然生于油膜之上,油膜是肾系所发,但膜之所以能产生油,油汁充足、光辉明亮,则是由于脾胃健壮,饮食增进。这样看来,脾和肾二者,是不是既二又一、既一又二呢?
《内经》说:“各种疮疡疼痛、瘙痒,都归属于心。”
唐容川说:这里说的各种疮疡,如果是血分凝结,阻滞了气机,气与血相争就会疼痛。血虚生热,兼动风气,风火相煽就会瘙痒。这些都归属于心经血分的病变,治疗宜调和血液。另外,凡是病不涉及血分,都不会发生疼痛,所以痞块、膨胀、肿胀等都不痛。凡是腹痛,无不关系到血分,所以都归属于心。
《内经》说:“各种热病引起的神志昏乱、视物不清,都归属于心。”
唐容川说:“诸热”指发热、恶热、瘟疫、暑病等症状;“瞀”指眼目昏花、眼前发黑见鬼等症状;“瘛”指筋脉不能伸展、抽搐等症状,这些都归属于火。大概诸热是火损伤气分,火克肺金。瞀是心神被扰乱迷惑,视物昏乱。火属于心,心藏火,火扰动了心神所以出现瞀。瘛是肝筋被火灼烧,没有血液滋养筋脉,所以收缩牵扯。瘛与弛缓不收不同,应当辨别清楚。
《内经》说:“各种厥逆、闭塞、泄泻,都归属于下焦。”
唐容川说:厥指四肢逆冷,固指腹中积聚,如寒证之类,泻指下痢不止。都归属于下,是指归属于下焦肾经。肾阳不能通达全身则发生厥逆,肾阳不能上升则发生泄泻,肾阳不能化气则发生固结闭塞。所以都归属于下,治疗宜温补。
涂蔚生说:唐容川解释这一节的厥、固、泻三种症状,都说归属于下焦肾阳虚寒,未免得失参半。因为有肾阳不能通达的虚寒厥症,也有肾火遏伏内闭的实热厥证。有肾阳不能化气的虚寒固症,也有肾火亢烈血结的实热固症。有肾阳不能上升的虚寒泻症,也有肾火盛旺阴虚的实热泻症。如果遇到厥、固、泻等症状,一概说是虚寒,一味温补,难免误事不少。
《内经》说:“各种痿证、喘证、呕吐,都归属于上焦。”
唐容川说:痿有两种症状,一是肺痿,肺叶焦枯,不能通调津液,则为虚劳咳嗽。一是足痿,小腿枯瘦不能行走,即为足痿,但没有足痿不是由肺引起的。因为肺主津液,通过阳明经向下滋润宗筋,脚才能行走。肺的津液不行,则宗筋失养。所以足痿虽然表现在下部,但也归属于上焦。喘属于肺的呼气不利,呕属于胃的饮食停滞,气逆犯肺胃,都属于上焦。上焦属阳,多病火逆,治疗宜清解。
涂蔚生说:唐容川关于痿证的论述,分为脉痿、津痿来治疗。而此处解释痿证,只有肺痿和足痿两种,似乎有些歧异。然而查考痿证的形成,不外乎津液干枯。药物治疗,不离乎滋阴潜阳。这其实是二而一的道理。至于他说喘属于肺的呼气不利,未免不够精当。因为喘有虚实两种。虚者由于下元亏损,化生的气短少,而肺无所充裕。治疗之法,宜补气以定喘。《内经》说:“损其肺者益其气”,就是这个意思。实者化气太甚,肺部壅塞。治疗之法,宜降气以定喘。《内经》说:“高者抑之”,就是这个意思。至于虚实夹杂寒热,则在于医生随症加减。至于他说呕属于胃的饮食停滞,也有一点不妥。因为呕也有虚实两种,虚而夹热的,是由于膈气空虚,热欲侵入胃阳,治疗宜清补。实而夹寒的,是由于膈气滞塞,寒欲侵入胃中,治疗宜温暖。如果想彻底治好喘呕,宜参考后面的喘呕条文。
《内经》说:“各种口噤、鼓颔战栗,如同丧失神志主宰,都归属于火。”
唐容川说:禁指口齿紧闭,如噤口痢、痉病口噤等。鼓栗指鼓颔战栗,如疟疾手足摇颤等。如丧神守,指谵语、百合病、恍惚不安等。这是热极反寒的现象,火扰心神的征象,都宜治疗其火。
《内经》说:“各种痉挛、项背强直,都归属于湿。”
唐容川说:寒湿则筋脉凝滞,热湿则筋脉胀大,所以都能引发痉挛和项背强直的症状。
《内经》说:“各种气逆冲上,都归属于火。”
唐容川说:诸逆指吐、咳、呛、呕等症状。凡是冲脉气逆,头目咽喉胸中受病,都是心肝之火,挟冲脉上逆,治疗宜抑制。
涂蔚生说:此证务必查看患者的形色,确定是否有热。因为咳、吐、呛、呕等症状,还有一种虚寒证治。富贵人家的孩子,因为溺爱过甚,衣被过厚,容易发生此症。而在得了此症之后,又自信人参可以治吐咳,姜半夏可以治呛呕。贸然给予,最终导致越治越重,死于非命,这是多么愚蠢啊!
《内经》说:“各种腹胀、腹大,都归属于火(热)。”
唐容川说:诸胀指腹内胀满,腹大指单腹胀。此证是肝不疏泄,则小便不利,水停为胀。脾不运化,则单腹胀。都归属于热,是肝木乘脾所致。然而这与上一节的“火”字有别。火属血分,热属气分,热则气分的水多壅滞,所以主胀大。
《内经》说:“各种烦躁、狂乱、超越常态,都归属于火。”
唐容川说:躁指烦躁,狂指颠狂,越指登高逾墙。凡此皆因三焦与胃火太盛,而血气勃发所致。
《内经》说:“各种突然发生的强直,都归属于风。”
唐容川说:强直僵仆倒地,暴指猝然发作。风性迅速,故能暴发。凡风都归属于肝。肝属筋脉,风中筋脉,不能引动,则强直。风是阳动而阴应之,所以风具有阴阳两性。中风之阴,则为寒风;中风之阳,则为热风。无论寒热,均有强直的证候,宜仔细辨别。
《内经》说:“各种病伴有声响,按压如鼓,都归属于热。”
唐容川说:这与肠鸣不同。肠鸣则转气攻痛下泄,属水渍入肠,发为洞泻,是寒非热。此有声乃在人皮黑膜内,连网油膜之中。凡人身连网油膜,均是三焦,是相火的府库,是水液运行的道路。水火相激,往往发声,但其声绵绵,与雷鸣切痛者不同。按压也能作声,且拒按,如按鼓皮。因为其位于皮膜间,所以按之如鼓。这是三焦之火与水为仇,所以说都归属于热。大概三焦是行气的府库,气多则能鼓吹其膜中之管,使之有声。就像西洋的象皮人,捏之则出声一样。
《内经》说:“各种病跗肿、疼酸、惊骇,都归属于火。”
唐容川说:跗,指足背。凡足肿都发于厥阴、阳明两经。阳明之脉,行于足背;厥阴之脉,起于足大趾丛毛内踝。肝木生热,壅阻胃经之湿,则循经下注,而发足肿,极度酸痛。“酸”字颇有实义。西医说,凡香港脚必胃中先酿酸水,继而尿中有蛋白形,尿亦发酸,乃发香港脚肿病。但西医未言所以致酸,与因酸致肿的缘故。惟《内经》的道理可与之互证。《内经》说:肝木在味为酸。大概木能生火,木能克土,土不化水,火又蒸之,则变酸味,是酸为湿与热合化之味。羹汤夏月过夜则酸,是湿遇热也;冬月则否,有湿则无热也。知道酸所以致疼肿,而香港脚可治。另外,凡是乍惊乍骇,都是肝经木郁火发,魂不藏的缘故,所以归属于火。
《内经》说:“各种扭转、角弓反张、身体曲戾、水液混浊,都归属于热。”
唐容川说:转指左右扭动。反指角弓反张。戾如犬出户下,其身曲戾,即阳明痉病,头曲至膝。水液浑浊,指小便不清。转在侧,属少阳经。反在后,属太阳经。戾在前,属阳明经。水道在膜膈中,属三焦经。都归属于热。是水液浑浊,固属三焦之热,而诸转反戾,也多同属三焦。三焦网膜,西人谓之连网,由内连外,包裹赤肉,两头生筋,以贯赤肉,筋连于骨节,故利曲伸。观此则知转反戾,是筋所牵引,实则网膜伸缩使然,所以《内经》与水液同论,以见皆属三焦网膜中之热。西医乃谓抽掣痉等,发于脑筋,不免求深反浅,所以西人无治之之术。
涂蔚生说:三焦网膜之热,固能使筋所牵引,以致诸转反戾。然而养筋者是血,使血不致为热所灼而干枯,则热又何至烁筋而牵引。所以治疗此病之初,只宜清热。而见有外症者,亦须解表。等到三五日后,宜兼养血,以顾其本。小儿此症颇多,最宜审慎。切不可因其反戾诸状,疑为俗谓天吊诸惊,乱投惊风之药,以致夭折。
《内经》说:“各种病水液,澄澈清冷,都归属于寒。”
唐容川说:下为小便,上为涎唾,其道路总在三焦膈膜之中。无论何证,只要根据水液有澄澈清冷之状,即是三焦火虚之候,所以说都归属于寒。
《内经》说:“各种呕吐酸水、急迫腹泻、里急后重,都归属于热。”
唐容川说:呕指干呕,是火逆。吐有寒症,吐酸则无寒症。暴注下迫,指里急后重,逼塞不得畅,俗名痢症,都归属于热,是归属于肝经之热。肝火上逆,则呕吐酸;肝火下注,则痢下迫。因为肝欲疏泄,肺欲收敛,金木不和,故欲泄不得。且痢多发于秋,金克木也。
涂蔚生说:暴注下迫,似宜分作两条。暴注者便系溏稀之物,勃然下泻,热甚汹猛,毫无艰难阻止之状。下迫者便系脓血之物,情急欲出,至下而滞,壅遏塞止之状。一则由肝火之发,一则由于金性之收。然而非内有积热,皆不至此。不过暴注之色,多系深黄黑色,或者一种赤血水耳。
唐容川说:病机百出,未能尽录。但举其凡,以例其余。
Tang Rongchuan stated: "Shu" (belong to) implies subordination and attribution. By understanding the attribution of diseases, one grasps the general principles, and specific details can then be deduced by analogy.
The Classic states: "All wind disorders characterized by tremors and dizziness belong to the Liver."
Tang Rongchuan explained: The Liver is the zang organ governing wind; therefore, all wind disorders belong to the Liver. "Zhu Feng" (various winds) includes conditions such as Zhong Feng (wind stroke), Shang Feng (wind injury), Jing Feng (convulsive disorder in children), and Li Feng (leprosy-like diseases), encompassing a vast array of symptoms. "Diao" refers to rotation or shaking, including sudden collapse, convulsions, spasms, and trembling. The Liver governs the sinews (tendons); thus, these are pathologies of the sinews. "Xuan" refers to vertigo or dizziness, including blurred vision, visual hallucinations, and spinning sensations, which arise because the Liver opens into the eyes. Western medicine attributes vertigo, blurred vision, spasms, and convulsions to disorders of the cerebral nerves (brain qi-jin). They posit that the optic nerve connects to the brain, causing dizziness; excessive strain on the cerebral nerves leads to muscle contraction and spasms during extension. However, when asked why the cerebral nerves suffer these ailments, Western medicine remains at a loss. One should know that the Liver meridian connects to the brain, opens into the eyes, and governs the sinews. What Western medicine calls cerebral nerve diseases are actually governed by the Liver meridian. The pathology of the meridians and sinews is caused by Liver Wind. Therefore, all vertigo and tremors belong to Wind, and all wind disorders ultimately belong to the Liver.
The Classic states: "All cold syndromes characterized by contraction and pulling belong to the Kidney."
Tang Rongchuan explained: The Kidney governs cold qi; thus, all cold syndromes belong to the Kidney. The Kidney also governs the bones. When Kidney Yang spreads throughout the body, the skeletal structure is flexible and movement is light. If the limbs and bones are cramped, contracted, or relaxed and elongated, it indicates the bones are not functioning properly. It must be understood that cramping and contraction differ from twitching and shortening; the former is a Cold syndrome, while the latter is a Wind syndrome.
Tu Weisheng explained: The Kidneys have two branches originating below the 14th thoracic vertebra, one on each side, connected centrally by an oily membrane, called the "Kidney System" (Shen Xi). The vertebra through which the Kidney System passes is called the Gate of Life (Ming Men), responsible for evaporating Yang Qi and distributing it throughout the body. However, this fire cannot evaporate on its own; it requires the assistance of Kidney Yin to do so. This resembles the image of Kan (☵), where one Yang line lies between two Yin lines. It is like setting up a steam engine: one must first establish a fire pit and water boiler. Fire boils the water, steam enters the cylinder, enabling it to carry heavy loads over long distances. If a person has abundant fire and water, they possess robust vital energy (Yuan Qi) filling the body, naturally avoiding symptoms of cold contraction. Specifically, the plate fat under the hypochondrium, the omental fat in the lower abdomen, the membranous fat in the middle jiao, the diaphragm in the upper jiao, and the interstices throughout the body are all illuminated by sufficient water and fire. Fat people often fear heat because their water and fire are abundant, their Yuan Qi is ample, and their omental oil is plentiful. Thin people often fear cold because their water is deficient and fire is consumed, resulting in insufficient production of True Yang and a lack of omental oil. However, if deficiency is severe, solitary Yang lacks a root, leading to tidal fever and bone-steaming sensations. Cases where Kidney Water is sufficient but Kidney Fire is weak, manifesting purely as Kidney Yang deficiency with aversion to cold, account for only ten to twenty percent. Nevertheless, indulging in preferences, consuming excessive raw or cold foods, or taking too many cold-natured herbs after a febrile disease can sufficiently diminish the momentum of True Yang. The worldly notion that children are bodies of "pure Yang" is entirely erroneous.
The Classic states: "All qi stagnation belongs to the Lung."
Tang Rongchuan explained: The qi of the five zang and six fu organs is universally directed by the Lung, as the Lung is the master manager of qi. Therefore, treating qi disorders always involves treating the Lung. The Lung governs the skin and hair. "Za" refers to rough, discolored skin, such as purpura, spots, black moles, and rhinophyma. Western medicine posits that there are oily nodules beneath the pores, with ducts extending directly to the skin surface. Blackheads on the face result from blocked ducts, which corresponds to the concept of "Za" in the *Nei Jing*. "Yu" (depression/stagnation) means qi is constrained internally and cannot diffuse. Symptoms include qi rebellion, phlegm retention, blood stasis, and constipation, indicating qi abnormalities within the abdomen. Yu is the opposite of smooth flow; since Lung qi is not smooth, it is termed Yu, and treatment should involve dispersing or descending methods.
The Classic states: "All dampness-induced swelling and fullness belong to the Spleen."
Tang Rongchuan explained: Swelling in the skin and limbs, and fullness/distension in the abdomen, are caused by dampness obstruction and failure of water to descend, leading to accumulation in the diaphragmatic region. However, dampness disorders are not limited to this, hence "all dampness." Symptoms may include heavy head and eyes, malaria, summerheat diarrhea, generalized bi-syndrome pain, or phlegm-fluid accumulations. All are caused by Spleen Earth failing to control Water. The Spleen sits atop the oily membranes. These membranes are governed by the San Jiao (Triple Burner) as the pathways for water, while the oil itself belongs to the Spleen. Since oil repels water, this is how the Spleen promotes water metabolism. If the Spleen's oil loses its function, dampness can hide, so treating dampness requires addressing the Spleen.
Tu Weisheng commented: In Tang Rongchuan’s discussion on supplementing Shaoyin and Shaoyang, he stated that the Kidney combines with the San Jiao, and the San Jiao roots in the Kidney System, meaning the oily membranes of the Upper, Middle, and Lower San Jiao are entirely governed by the congenital Kidneys. Here, however, Tang says the membranes are governed by the San Jiao for water pathways, while the oil belongs to the Spleen. Is this contradictory? The answer is: Before birth, congenital nature generates postnatal nature; after birth, postnatal nature nourishes congenital nature. Spleen Earth grows upon the oily membranes, illustrating Fire generating Earth and congenital generating postnatal. Water becomes slippery upon encountering oil, illustrating Earth controlling Water. The Five Elements mutually generate and mutually overcome. Although Spleen Earth grows on the membranes generated by the Kidney System, the reason the membranes produce oil, and why the oil is abundant and bright, is due to strong Spleen and Stomach function and increased dietary intake. Thus, the Spleen and Kidney are both two-in-one and one-in-two.
The Classic states: "All sores, pain, and itching belong to the Heart."
Tang Rongchuan explained: Regarding various sores, if blood coagulation obstructs qi, the struggle between qi and blood causes pain. Blood deficiency generates heat, stirring wind; wind and fire fanning each other cause itching. These are all pathologies of the Heart Meridian blood aspect, and treatment should harmonize the blood. Furthermore, any disease not involving the blood aspect does not cause pain; thus, masses, distension, and swelling are generally painless. All abdominal pain relates to the blood aspect, so it belongs to the Heart.
The Classic states: "All heat-induced mental confusion and visual obscuration belong to the Heart."
Tang Rongchuan explained: "Zhu Re" (various heats) refers to fever, aversion to heat, plague, and summerheat syndromes. "Mao" refers to blurred vision, seeing ghosts, or darkening of vision. "Chi" refers to inability of sinews to extend, twitching, etc. All belong to Fire. Heat damages the qi aspect (Fire overcoming Metal/Lung). Mao results from the Heart Spirit being disturbed, causing visual confusion. Fire belongs to the Heart, which stores Fire; disturbance of the Spirit causes Mao. Chi occurs when Liver sinews are scorched by Fire and lack blood nourishment, leading to contraction. Chi differs from flaccidity and relaxation, and must be distinguished.
The Classic states: "All jue (cold extremities), obstruction, and diarrhea belong to the Lower [Jiao]."
Tang Rongchuan explained: Jue refers to cold extremities. Gu (obstruction/retention) refers to abdominal masses, such as in cold syndromes. Xie refers to persistent dysentery/diarrhea. "Belonging to the Lower" means belonging to the Lower Jiao and Kidney Meridian. If Kidney Yang cannot spread, jue occurs. If Kidney Yang cannot ascend, diarrhea occurs. If Kidney Yang cannot transform qi, obstruction occurs. Thus, they all belong to the Lower, and treatment should be warming.
Tu Weisheng commented: Tang’s interpretation that jue, gu, and xie all belong to Lower Jiao Kidney Yang deficiency and cold is half-right and half-wrong. There are xu-cold jue syndromes due to Kidney Yang failure to spread, and shi-re jie syndromes due to Kidney Fire suppression and internal closure. There are xu-cold gu syndromes due to Kidney Yang failure to transform qi, and shi-re gu syndromes due to excessive Kidney Fire and blood coagulation. There are xu-cold xie syndromes due to Kidney Yang failure to ascend, and shi-re xie syndromes due to excessive Kidney Fire and Yin deficiency. If one assumes all jue, gu, and xie are xu-cold and treats them solely with warming tonification, many errors will occur.
The Classic states: "All wei (flaccidity), panting, and vomiting belong to the Upper [Jiao]."
Tang Rongchuan explained: Wei has two types: Fei Wei (Lung flaccidity), where lung lobes are dry and unable to regulate fluids, leading to consumptive cough; and Zu Wei (foot flaccidity), where calves waste away and walking is impossible. No foot flaccidity arises without Lung involvement. The Lung governs fluids, which descend via the Yangming Meridian to moisten the Zong Jin (general tendons), allowing leg movement. If Lung fluids fail to reach the Zong Jin, the tendons lose nourishment. Thus, although foot flaccidity appears in the lower body, it belongs to the Upper Jiao. Panting is due to impaired Lung exhalation; vomiting is due to food retention in the Stomach with qi rebelling against the Lung and Stomach. Both belong to the Upper Jiao. The Upper Jiao belongs to Yang and is prone to Fire rebellion, so treatment should clear heat.
Tu Weisheng commented: Tang’s discussion on Wei distinguishes Mai Wei (pulse/flaccidity) and Jin Wei (fluid/flaccidity) treatments. Here, he only mentions Fei Wei and Zu Wei, which seems inconsistent. However, the formation of Wei invariably involves fluid dryness, and treatment focuses on nourishing Yin and subduing Yang, making them essentially one. His statement that panting is merely impaired Lung exhalation is imprecise. Panting has xu and shi types. Xu panting stems from Lower Yuan deficiency and insufficient qi generation, leaving the Lung unfulfilled; treatment supplements qi to calm panting (*Nei Jing*: "Damage to the Lung benefits its qi"). Shi panting results from excessive qi generation and Lung congestion; treatment descends qi to calm panting (*Nei Jing*: "What is high suppress it"). Mixed xu/shi with cold/heat requires physician discretion. His statement that vomiting is merely food retention in the Stomach is also incomplete. Vomiting has xu and shi types. Xu with heat arises from empty Diaphragm qi allowing heat to invade Stomach Yang; treat with clearing and tonifying. Shi with cold arises from stagnant Diaphragm qi allowing cold to invade the Stomach; treat with warming. For comprehensive treatment of panting and vomiting, refer to subsequent sections.
The Classic states: "All mouth locking, chattering, and trembling, resembling loss of spiritual control, belong to Fire."
Tang Rongchuan explained: "Jin" refers to locked jaws, such as in Jin Kou Li (lockjaw dysentery) or Jing Bing (spasm disorder). "Gu Li" refers to chattering and trembling, such as in malaria with limb shaking. "Ru Sang Shen Shou" (like losing spiritual control) refers to delirium, Bai He Bing (Lily Disease), and mental instability. These are signs of extreme heat turning to cold and Fire disturbing the Heart Spirit, requiring treatment of the Fire.
The Classic states: "All spasms and neck stiffness belong to Dampness."
Tang Rongchuan explained: Cold-Damp causes sinew constriction; Heat-Damp causes sinew swelling. Both can induce spasms and neck stiffness.
The Classic states: "All rebellious qi rushing upward belong to Fire."
Tang Rongchuan explained: "Ni" (rebellion) refers to vomiting, coughing, choking, etc. Any Chong Mai qi rebellion affecting the head, eyes, throat, or chest is due to Heart and Liver Fire carrying the Chong Mai qi upward. Treatment should suppress it.
Tu Weisheng commented: This condition requires careful observation of complexion to determine heat presence. Cough, vomiting, choking, and retching can also stem from xu-cold. Children of wealthy families, often over-dressed and over-loved, are prone to this. After contracting it, parents mistakenly believe Ginseng treats cough/vomiting and Ginger-Pinellia treats choking/retching. Administering these rashly worsens the condition, potentially leading to death. How foolish!
The Classic states: "All distension and abdominal enlargement belong to Fire (Heat)."
Tang Rongchuan explained: "Zhu Zhang" refers to abdominal fullness; "Fu Da" refers to monastic abdominal distension (ascites). This condition arises when the Liver fails to disperse, causing urinary difficulty and water retention leading to distension. If the Spleen fails to transport and transform, monastic abdominal distension occurs. These belong to Heat, specifically Liver Wood overacting on Spleen Earth. However, this "Fire" differs from the previous section. Fire belongs to the Blood aspect; Heat belongs to the Qi aspect. Heat causes excessive stagnation of water in the Qi aspect, leading to distension.
The Classic states: "All restlessness, mania, and transgression of norms belong to Fire."
Tang Rongchuan explained: "Zao" is irritability/restlessness; "Kuang" is mania; "Yue" is climbing over walls or exceeding normal limits. All result from excessive Fire in the San Jiao and Stomach, causing vigorous eruption of blood and qi.
The Classic states: "All sudden rigidity belong to Wind."
Tang Rongchuan explained: Rigidity and falling are sudden. Wind is swift, hence sudden onset. All wind belongs to the Liver. The Liver governs sinews; wind invading sinews prevents movement, causing rigidity. Wind is Yang-moving responding to Yin, possessing both Yin and Yang natures. Yin Wind is cold wind; Yang Wind is hot wind. Both cold and hot winds cause rigidity, requiring careful differentiation.
The Classic states: "All diseases with sounds, pressing like a drum, belong to Heat."
Tang Rongchuan explained: This differs from intestinal borborygmus. Intestinal borborygmus involves gas moving, pain, and diarrhea due to water soaking the intestines, causing watery diarrhea (Cold, not Heat). This sound occurs within the skin and black membranes, connected to the omental network. The entire omental network constitutes the San Jiao, the residence of Ministerial Fire and pathway for water. Water and Fire agitating each other produce sound, but it is continuous, unlike thunderous pain. Pressing produces sound and is tender/rejecting, like pressing a drumhead. Because it is between membranes, pressing feels like a drum. This is San Jiao Fire opposing Water, hence belonging to Heat. The San Jiao is the residence of Qi circulation; excess Qi blows through tubes in the membranes, creating sound, similar to a rubber man squeaking when squeezed.
The Classic states: "All diseases with dorsum pedis swelling, soreness, acidity, fright, and alarm belong to Fire."
Tang Rongchuan explained: "Fu" is the dorsum of the foot. Foot swelling originates in the Jueyin and Yangming meridians. The Yangming meridian runs along the dorsum; the Jueyin meridian starts at the big toe and medial malleolus. Liver Wood generating heat obstructs Stomach channel dampness, which sinks downward along the channels, causing foot swelling and extreme soreness/acidity. "Suan" (sour/aching) has substantial meaning. Western medicine states that gout (Hong Kong Foot) begins with sour fluid fermentation in the Stomach, followed by protein in urine and acidic urine, causing swelling. Western medicine does not explain the cause of acidity or how acidity causes swelling. The *Nei Jing* theory corroborates this: Liver Wood tastes sour. Wood generates Fire and controls Earth. If Earth fails to transform Water and Fire steams it, the taste becomes sour. Sourness is the flavor of combined Dampness and Heat. Soup turns sour overnight in summer (Damp meeting Heat) but not in winter (Damp without Heat). Understanding that acidity causes pain and swelling allows treatment of gout. Additionally, sudden fright and alarm result from Liver Wood stagnation and Fire eruption, with Hun (Ethereal Soul) failing to reside, hence belonging to Fire.
The Classic states: "All twisting, opisthotonos, body curvature, and turbid fluids belong to Heat."
Tang Rongchuan explained: "Zhuan" is lateral twisting. "Fan" is opisthotonos. "Li" is body curvature, like a dog emerging from under a door, or Yangming spasm with head bent to knees. Turbid fluids refer to cloudy urine. Twisting laterally belongs to Shaoyang; opisthotonos posteriorly belongs to Taiyang; curvature anteriorly belongs to Yangming. Water pathways in the diaphragmatic membranes belong to the San Jiao. All belong to Heat. Turbid fluids indicate San Jiao Heat; twisting and curvature also largely involve the San Jiao. The San Jiao network (omentum), called "lian wang" by Westerners, extends internally and externally, wrapping red flesh, with tendons connecting to bones for flexion/extension. Thus, twisting and curvature are tendon pullings caused by omental contraction/expansion. The *Nei Jing* links them to fluids to show they all involve Heat in the San Jiao omentum. Western medicine attributes spasms to brain nerves, seeking depth but finding shallowness, hence lacking effective treatment.
Tu Weisheng commented: San Jiao omental heat indeed causes tendon pulling and twisting. However, blood nourishes tendons; if blood is not scorched dry by heat, heat would not scorch tendons. Initial treatment should clear heat. If exterior symptoms exist, resolve the exterior. After three to five days, nourish blood to support the root. This is common in children and requires caution. Do not mistake opisthotonos for "heaven-hanging" convulsions and indiscriminately administer wind-dispelling drugs, causing premature death.
The Classic states: "All diseases with clear, cold fluids belong to Cold."
Tang Rongchuan explained: Downward, this is urine; upward, this is saliva/phlegm. The pathway is always within the San Jiao diaphragmatic membranes. Regardless of the syndrome, if fluids are clear and cold, it indicates deficiency of San Jiao Fire, hence belonging to Cold.
The Classic states: "All vomiting of acid, sudden diarrhea, and tenesmus belong to Heat."
Tang Rongchuan explained: Ou (dry heaving) is Fire rebellion. Vomiting can be Cold, but vomiting acid is never Cold. Bao Zhu Xia Po (sudden diarrhea with tenesmus) involves urgency and heaviness, commonly known as dysentery. This belongs to Heat, specifically Liver Meridian Heat. Liver Fire rebelling upward causes vomiting of acid; Liver Fire sinking downward causes dysenteric tenesmus. The Liver desires dispersion, the Lung desires convergence. Metal-Wood disharmony prevents proper discharge. Dysentery often occurs in Autumn, when Metal controls Wood.
Tu Weisheng commented: "Bao Zhu Xia Po" should be split. "Bao Zhu" is loose stool erupting suddenly, with fierce heat and no obstruction. "Xia Po" is pus/blood stool, urgent desire to defecate but stagnation and blockage upon expulsion. One stems from Liver Fire eruption; the other from Metal’s constrictive nature. Neither occurs without internal accumulated heat. Bao Zhu stool is usually dark yellow/black or bloody water.
Tang Rongchuan concluded: Pathogenic mechanisms are countless and cannot be fully recorded. I have listed the general principles to illustrate the rest.