经谓∶春伤于风者,乃即病之新感也,即二卷中伤风冒风之证;今谓春伤于风,夏生飧泄者,此不即
病之伏气也。盖风木之气,内通乎肝,肝木乘脾,脾气下陷,日久而成泄泻。经又云∶邪气留连,乃为洞泄。
此亦言伏气为病。可见飧泄洞泄,皆由伏气使然。然有寒泻、火泻、暑泻、湿泻、痰泻、食泻,虽不
因乎伏气,又不得不并详之。盖飧泄则完谷不化,洞泄则直倾于下;寒泻则脉迟溺白,腹中绵痛;火泻则脉
数溺赤,痛一阵,泻一阵;又有烦渴面垢为暑泻;胸痞不渴为湿泻;或时泻,或时不泻为痰泻;嗳气作酸,
泻下腐臭为食泻。泄泻之病,尽于斯矣。《灵枢》又云∶春伤于风,夏生后泄肠 。肠 者,古之痢
名也。痢有风、寒、热、湿、噤口、水谷、休息、五色之分,均宜辨治。风痢者,似肠风下血而有痛坠;
寒痢者,下稀水而清腥,腹中痛甚;热痢者,如鱼脑而稠粘,窘迫而痛;湿痢者,色如豆汁,
胸闷腹疼;又有下痢不食,或呕不能食,名噤口痢;糟粕脓血杂下者,名水谷痢;时发时止者,名休息痢;
五色脓血相混而下,名五色痢。痢证多端,治宜分别。复揣夏生后泄肠 之训,是独指风痢而言,其余之痢,
在夏为少,在秋为多,而吾医者,又弗可胶于句下耳。
《内经》所说“春伤于风”,是指感邪后立即发病的新感病,即本书第二卷中所述的伤风、冒风之证;如今所说的“春伤于风,夏生飧泄”,这是指感邪后不立即发病的伏气温病。因为风木之气内通于肝,肝木克制脾土,导致脾气下陷,日久便形成泄泻。《内经》又说:“邪气留连不去,就会成为洞泄。”这也是在论述伏气致病。由此可见,飧泄和洞泄,都是由伏气引起的。然而,还有寒泻、火泻、暑泻、湿泻、痰泻、食泻,虽然它们并非由伏气引起,但也不得不详细加以说明。飧泄的特点是完谷不化(大便中含有未消化的食物),洞泄的特点是粪便直倾而下;寒泻的特点是脉象迟缓、小便清白、腹部绵绵作痛;火泻的特点是脉象数急、小便赤红、腹痛一阵、腹泻一阵;又有烦渴、面色垢浊的是暑泻;胸脘痞闷、口不渴的是湿泻;有时腹泻、有时不腹泻的是痰泻;嗳气泛酸、泻下物腐臭的是食泻。泄泻这类疾病,其要点都包含在这里了。《灵枢》又说:“春伤于风,夏生后泄肠澼。”肠澼,是古代对痢疾的称呼。痢疾有风痢、寒痢、热痢、湿痢、噤口痢、水谷痢、休息痢、五色痢之分,都应当辨证治疗。风痢的症状,类似肠风下血且伴有疼痛坠胀感;寒痢的症状,排出稀水样便且气味清腥,腹部疼痛剧烈;热痢的症状,大便如鱼脑般稠粘,里急后重且疼痛;湿痢的症状,颜色像豆汁一样,胸闷腹痛;又有下痢不能进食,或者呕吐无法进食的,称为噤口痢;糟粕与脓血混杂而下的,称为水谷痢;时发时止的,称为休息痢;五色脓血混杂而下的,称为五色痢。痢疾证候繁多,治疗应当分别对待。再推究“夏生后泄肠澼”这句经文的意思,它是专指风痢而言,其余种类的痢疾,在夏季较少见,在秋季较多见,而我们医者,又不应当拘泥于字句表面意思。
The *Classic of Internal Medicine* states that "wind injury in spring" refers to a new contraction where illness occurs immediately, which corresponds to the conditions of wind strike and wind exposure described in Volume Two of this book. The current statement "wind injury in spring leads to undigested stool diarrhea in summer" refers to latent pathogenic qi (latent pathogenic factor) that does not cause immediate illness. This is because the wind-wood qi internally connects with the Liver; when Liver wood overacts on Spleen earth, Spleen qi sinks downward, eventually resulting in diarrhea after prolonged duration. The *Classic* further states: "When pathogenic qi lingers, it becomes severe watery diarrhea." This also discusses illness caused by latent pathogenic qi. Thus, both undigested stool diarrhea (*Sunxie*) and severe watery diarrhea (*Dongxie*) are caused by latent pathogenic qi. However, there are also cold diarrhea, fire diarrhea, summerheat diarrhea, dampness diarrhea, phlegm diarrhea, and food stagnation diarrhea. Although these are not caused by latent pathogenic qi, they must be detailed as well. Undigested stool diarrhea is characterized by undigested food in the stool; severe watery diarrhea is characterized by direct profuse discharge below; cold diarrhea is characterized by a slow pulse, clear urine, and lingering abdominal pain; fire diarrhea is characterized by a rapid pulse, red urine, pain followed by diarrhea episodes; summerheat diarrhea presents with irritability, thirst, and a greasy complexion; dampness diarrhea presents with chest fullness and absence of thirst; phlegm diarrhea presents with intermittent episodes of diarrhea and non-diarrhea; food stagnation diarrhea presents with belching, sour regurgitation, and foul-smelling stools. The essence of diarrhea diseases is covered here. The *Ling Shu* further states: "Wind injury in spring leads to post-diarrhea and *Changpi* in summer." *Changpi* is the ancient name for dysentery. Dysentery is divided into wind dysentery, cold dysentery, heat dysentery, dampness dysentery, closed-mouth dysentery, grain-and-blood dysentery, remittent dysentery, and five-color dysentery, all of which require differentiation and treatment. Wind dysentery resembles intestinal wind bleeding accompanied by pain and bearing-down sensation; cold dysentery presents with thin watery stools that are clear and fishy-smelling, with severe abdominal pain; heat dysentery presents with thick, sticky stools resembling fish brains, with tenesmus and pain; dampness dysentery presents with stools colored like bean dregs, chest tightness, and abdominal pain; dysentery accompanied by inability to eat or vomiting preventing intake is called closed-mouth dysentery; dysentery where feces mix with pus and blood is called grain-and-blood dysentery; dysentery that comes and goes intermittently is called remittent dysentery; dysentery where pus and blood of five colors mix and descend is called five-color dysentery. There are many types of dysentery, and treatment should be differentiated. Re-examining the instruction "summer leads to post-diarrhea and *Changpi*," it specifically refers to wind dysentery. Other types of dysentery are less common in summer and more common in autumn. Therefore, physicians should not rigidly adhere to the literal meaning of the text.