尝见朱丹溪阳常有余、阴常不足论,谓人生之气常有余,血常不足,而专以抑火为言。
且妄引《内经》阳道实,阴道虚,及至阴虚,天气绝,至阳盛,地气不足等文,强以为证。
此诚大倍经旨,大伐生机之谬谈也。何也?盖人得天地之气以有生,而有生之气,即阳气也
,无阳则无生矣。故凡自生而长,自长而壮,无非阳气为之主,而精血皆其化生也。是以阳
盛则精血盛,生气盛也;阳衰则精血衰,生气衰也。故经曰∶中焦受气取汁,变化而赤,是
谓血。是岂非血生于气乎?丹溪但知精血皆属阴,故曰阴常不足,而不知所以生精血者先由
此阳气,倘精血之不足,又安能阳气之有余?由此虑之,何不曰难成易亏之阳气,而反曰难
成易亏之阴气,是何异但知有母而不知有父者乎?故其所立补阴等方,谓其能补阴也,然知
、柏止堪降火,安能补阴?若任用之,则戕伐生气而阴以愈亡,以此补阴,谬亦甚矣。及察
其引证经文,则何其谬诞。若经曰∶阳者,天气也,主外;阴者,地气也,主内,故阳道实
,阴道虚。此“太阴阳明论”言脾之与胃生病有异,以阳明主表,太阴主里。凡犯贼风虚邪
者,阳受之,阳受之则入六腑,而外邪在表,邪必有余,故曰阳道实也。食饮不节,起居不
时者,阴受之,阴受之则入五脏,而内伤脏气,脏必受亏,故曰阴道虚也。此本经以阳主外
阴主内,而言阳病多实、阴病多虚有如此,岂以天地和平之阴阳而谓其阳常有余、阴常不足
乎?勉强引证,此一谬也。又经曰∶至阴虚,天气绝;至阳盛,地气不足。此方盛衰论言阴
阳痞隔之为病。谓阴虚于下则不升,下不升则上亦不降,是至阴虚,天气绝也;阳亢于上则
不降,上不降则下亦不升,是至阳盛,地气不足也。此本以上下不交者为言,亦非阳常有余
、阴常不足之谓也。且下二句犹或似之,而上二句云至阴虚,天气绝,则何以为解?此更谬
也。以丹溪之通博,而胡为妄引若此,抑为偏执所囿而忘其矫强乎?余陋不自觉,而念切在
道,故不能为丹溪讳而摘正于此,犹俟高明之评教。
一、丹溪相火论曰∶五行各一其性,惟火有二∶曰君火,人火也;曰相火,天火也。火
内阴而外阳,主乎动者也。故凡动皆属火。天主生物,故恒于动,人有此生,亦恒于动,其
所以恒于动者,皆相火之所为也。故人自有知之后,五志之火为物所感,不能不动,为之动
者,即《内经》五火也。相火易起,五性厥阳之火相扇而妄动矣。火起于妄,变化莫测,无
时不有,煎熬真阴。阴虚则病,阴绝则死。
据丹溪此论,则无非阐扬火病而崇其补阴之说也。第于此而浅视之,则若或近理,故易
动人;于此而深味之,则意识皆幻,大是误人,余请精绎其义,用解后人之惑何如?盖自一
元初肇,两仪继之,则动静于斯乎见。而阳主动,阴主静也。自两仪奠位,而五行布之,则
气质各有所主,而火主热,水主寒也。此两仪动静,为五行之先天。先天者,性道也;五行
寒热,为两仪之后天。后天者,变体也。先后之理,有可混言者,有不可混言者。其可混者
,如火本属阳,即言火为动,若为不可也。其不可混者,以阳为元气之大主,火为病气之变
见,而动乃阳之性道,安得以性道为病变,而言凡动皆属火也。即自天人论之,则曰天行健
,岂天动即火乎?又曰君子以自强不息,岂人动即火乎?使天无此动则生机息,人无此动则性
命去,又何可以火言动乎?若谓之火,则火必宜去,而性亦可去乎?若谓凡动皆属火,则岂必
其不动而后可乎?夫以阳作火,词若相似,而理则大倍矣。故在丹溪则曰阴虚则病,阴绝则
死;余则曰阳虚则病,阳脱则死,此机微疑似中,有毫厘千里之异,临岐者不可不详察也。
或曰∶子言虽是,第未达丹溪之意耳。如曰五脏各有火,五志激之,其火随起,以致真阴受
伤,阴绝则死者。岂非因动生火乎?予曰∶此或因情欲之思动火者,止有一证,如欲念不遂
,或纵欲太过,致动相火而为劳为瘵者,诚有之也。此外而五志之动皆能生火,则不然也。
夫所谓五志者,喜怒思忧恐也。经曰∶喜伤心,怒伤肝,思伤脾,忧伤肺,恐伤肾。五脏既
受此伤,则五火何由而起?又曰∶喜则气散,怒则气逆,忧则气闭,思则气结,恐则气下。
此五者之性为物所感,不能不动,动则耗伤元气,元气既耗如此,则火又何由而起?故经曰
∶五脏者,主藏精者也。不可伤,伤则失守而阴虚,阴虚则无气,无气则死矣。是可见脏不
可伤,气亦不可伤,未闻伤即为火也。即云为火,必有火证,使无火证,而但以动字敷衍其
说,是何异捉影为形,而天下事又何不可马鹿其间乎。且常见五志所伤之人,伤极必生战栗
。是盖以元阳不固,神气失守而然。倘遇河间为之和,则又必谓战栗皆生于火矣。孰是孰非
,其几如此,能不为生民痛哉!
一、丹溪《局方发挥》曰∶相火之外,又有脏腑厥阳之火,五志之动,各有火起。相火
者,此经所谓一水不胜二火之火,出于天造。厥阳者,此经所谓一水不胜五火之火,出于人
欲。气之升也,随火炎上,升而不降,孰能御之?
原经文五火之说,乃解精微论中言厥病之目无所见也。谓其阳并于上,阴并于下,阴阳
不交,所以为厥。厥者,逆也。由其阳逆于上则火不降,阴逆于下则水不升,水既不升,火
又不降,而目以一阴之微精,不胜五脏之阳逆,此单言厥逆之为病也如此,岂言火有五而水
止一乎?又按二火之说,乃逆调论言∶人有身寒之甚而反不战栗者,名为骨痹。谓其人肾气
素胜,以水为事,则肾脂枯而髓不能满,故寒甚至骨也。又以肝为一阳,心为二阳,二藏皆
有伏火,则一水不胜二火,所以身虽寒而不冻栗,此单言骨痹之为病也如此。又岂阳常有余
之谓乎?若以五火、二火尽可引为火证,则如示从容论中有云二火不胜三水者,又将何以解
之,而何独不引为言耶?试以此问丹溪,其将何以答乎?
一、丹溪曰∶气有余便是火。又曰∶五脏各有火,五志激之,其火随起。若诸寒为病,
必须身犯寒气,口得寒物,乃为病寒。非若诸火,病自内作。所以气之病寒者,十无一二。
予味丹溪此言,不能不掩卷叹息。岂必气之病寒者十无一二耶?夫气本属阳,阳实者固
能热,阳虚者独不能寒乎?故经曰∶气实者,热也。气虚者,寒也。又经曰∶血气者,喜温
而恶寒,寒则泣不能流,温则消而去之,则其义有可知矣。且今人之气实与气虚者,孰为多
寡?则寒热又可知矣。然而何以证之?如心气虚则神有不明,肺气虚则治节有不行,脾气虚则
食饮不能健,肝气虚则魂怯而不宁,肾气虚则阳道衰而精少志屈,胃气虚则仓廪匮而并及诸
经,三焦虚则上中下俱失其职,命门虚则精气神总属无根。凡此者,何非气虚之类?气虚即
阳虚,阳虚则五内不暖而无寒生寒,所以多阳衰羸败之病。若必待寒气寒食而始为寒证,则
将置此辈于何地?夫病之所贵于医者,贵其能识生气,是诚医家最大关系,而丹溪全不之察
。故无怪其曰∶气有余便是火。而余反之曰∶气不足便是寒。使其闻余之说,尚不知以为然
否。
一、丹溪《格致余论》曰∶六气之中,湿热为病,十居八九。
据此说,湿热为病十居八九,则无怪乎寒凉之药,亦宜八九矣,此亦大谬之言也。夫阴
阳之道,本若权衡,寒往暑来,无胜不复。若偏热如此,则气候乱而天道乖矣。故轩辕帝曰
∶其德化政令之动静损益皆何如?岐伯曰∶夫德化政令灾变,不能相加也。胜复盛衰,不能
相多也。往来大小,不能相过也。用之升降,不能相无也。各从其动而复之耳。此气交变大
论之文,岂亦其不足信乎?
一、丹溪夏月伏阴论曰∶若于夏月火令之时,妄投温热,宁免实实虚虚之患乎?或曰∶
巳月纯阳,于理或通。五月一阴,六月二阴,非阴冷而何?答曰∶此阴之初动于地下也。四
阳浮于地上,燔灼焚燎,流金烁石,何阴冷之有?
据此一说,则夏月止宜寒凉矣。而何以帝曰∶服寒而反热,服热而反寒,其故何也?岐
伯曰∶治其旺气,是以反也。然则丹溪止知治旺气。而旺气有不可治者,何以不知也?矧春
夏之温热,秋冬有寒凉,此四时之主气也;而风寒暑湿火燥,此六周之客气也。故春夏有阴
寒之令,秋冬有温热之时,所谓主气不足,客气胜也。所谓必先岁气,无伐天和,亦此谓也
。岂丹溪止知有主气,而客气之循环胜复,又何以不知也?然此犹以气令言也。若人之血气
阴阳,本自不同,病之表里寒热,岂皆如一?设以夏月得阴证而忌用温热,冬月得阳证而忌
用寒凉,则其人能生乎?是丹溪止知时热宜凉,而舍时从证。又何以不知也?观其所论,止言
夏月忌温热,不言冬月忌寒凉,何其畏火之见,主火之言,一至于此。
一、丹溪《局方发挥》曰∶经云暴注下迫,皆属于热。又曰∶暴注属于火。又曰∶下痢
清白属于寒。夫热为君火之气,火为相火之气,寒为寒水之气,属火热者二,属水寒者一,
故泻痢一证。似乎属热者多,属寒者少。详玩《局方》专以热涩为用,若用于下痢清白而属
寒者,斯可矣。经所谓下迫者,即里急后重之谓也,其病属火。相火所为,其毒甚于热也,
投以涩热,非杀之而何?
据此说,以二火一水言泻痢之由,殊未当也。夫经言暴注下迫皆属于热者,谓暴泻如注
之下迫,非肠 下痢之谓也。观《太阴阳明论》曰∶阴受之则入五脏,下为飧泄,久为
肠。然肠 言久,岂同暴注而皆为热乎?且《内经》所言泻痢之证,寒者极多。
今于泄泻门详列可考,何丹溪俱不引证,而独引二火之说,亦勉强矣。及遍考《内经》,则
止有暴注下迫皆属于热一句,并无暴注属于火之文,即或以属火之年有言暴注者,然木金土
水之年皆有此证,又何以独言火也?盖其意专在火,故借引经文以证其说,而不知经言二火
者,本言六气之理也,岂以泻痢一证为二火乎?观之经曰∶长夏善病洞泄寒中,何不曰洞泄
热中,其义可知,而丹溪何不察也。夫以泻痢为火者,本出河间,而丹溪宗之,故变为此说
。戴原礼又宗丹溪,故云∶痢虽有赤白二色,终无寒热之分,通作湿热治。自此说相传,遂
致诸家方论,无不皆言湿热,而不知复有寒湿矣,其害孰甚。至若《局方》一书,虽云多用
热涩,然于实热新邪,岂云皆用此法。观其所载太平丸、戊己丸、香连丸、薷苓汤之类,岂
非以寒治热者耶?又若真人养脏汤、大已寒丸、胡椒理中汤之类,皆有可用之法,其中随证
酌宜,顾在用之者何如耳?岂《局方》专以热涩为用,而可斥其非耶。且是书之行,乃宋神
宗诏天下高医各以效方奏进而成者。此其中或过于粉饰者,料不能无,而真效之方必亦不少
。第在丹溪之言火多者,谓热药能杀人,而余察其为寒多者,则但见寒药之杀人耳。明者其
深察之。
一、丹溪曰∶痢赤属血,自小肠来;白属气,自大肠来,皆湿热为本。初得一二日间,
元气未虚,必推荡之,此通因通用之法。大承气汤、调胃承气汤。下后看其气病血病而用药
,气用参、术,血用四物。痢五日后不可下,脾胃气虚故也。壮实者亦可下。
据此说,以赤白言血气,而分属大肠小肠,其于五行之说则然。而于病情之真则凿矣。
盖小肠为心之腑,宜其主血,大肠为肺之腑,宜其主气。然水谷气化于小肠,岂小肠之非气
乎?或于粪前而见血,岂大肠之无血乎?观之经曰∶血者,神气也。此非赤化于气乎?又曰∶
白血出者死。此非白亦为血乎?盖白者赤者,无不关乎血气,但其来浅者白,而来深者则赤
也。故经曰∶阳络伤则血外溢,血外溢则衄血;阴络伤则血内溢,血内溢则后血。此自至理
,何其明显,而顾可以小肠大肠分血气哉!然此犹无碍,亦不必深为之辨也。至若初得一二
日间,元气未虚,必推荡之,为通因通用法,则此说不可概言矣。盖此证有不宜下者,有必
不可下者。岂以一二日间必可推荡耶?若病之可泻者,必其元气本强,积聚多实,则无论寒
邪热邪,但得一推,则邪从泻去,而气本无伤,故可泻也。使无此元气,无此胀实,则无可
言泻者矣。则强盛之人,随食随化,故饮食不易伤,泻痢不易犯,即有所犯,亦无不随病而
随愈也。其有易病者,必其易伤者也。易伤者,必其本弱者也。所以凡患泻痢而有久延难愈
者,必其弱者多,而强者少也。是以治宜推荡者,亦不过数十中之一二耳。且体弱之证,亦
有不同,有微弱者,有次弱者,有大弱者,此其形气脉息,病因证候,是实是虚,自可明辨
。凡见脾肾不足而致泻痢者,则始终皆不可下。若妄用之,则微者必甚,甚者必死,莫可解
救,此推荡之不可轻用也。诚见其致误者不少矣。即在丹溪亦曰∶余近年涉历,亦有大虚大
我曾见到朱丹溪提出的“阳常有余、阴常不足”的论点,他说人生之气常常有余,而血常常不足,因此专门强调抑制火邪。
并且他胡乱引用《内经》中“阳道实,阴道虚”,以及“至阴虚,天气绝;至阳盛,地气不足”等文句,强行作为证据。
这确实是与经典宗旨背道而驰、严重损害生机的大谬论。为什么呢?因为人依靠天地之气而生,而维持生命的元气,就是阳气。没有阳气就没有生命。所以凡是自然生长、由长到壮的过程,无不是阳气在主导,而精和血都是由它化生出来的。因此,阳气旺盛则精血旺盛,这是生气旺盛的表现;阳气衰弱则精血衰弱,这是生气衰弱的表现。所以医经说:“中焦受纳水谷之气,提取其中的汁液,经过变化变成红色,这就叫做血。”这难道不是说明血是由气产生的吗?
丹溪只知道精和血都属于阴,所以说“阴常不足”,却不知道产生精血的根源首先在于阳气。如果精血真的不足,又怎么会有阳气的有余呢?由此推想,为什么不说是难以形成容易亏损的阳气,反而说是难以形成容易亏损的阴气呢?这就像只知道有母亲而不知道有父亲一样荒谬。所以他创立的补阴等方剂,声称能补阴,但知母、黄柏只能降火,怎么能补阴呢?如果随意使用它们,就会戕害生机,导致阴更加亡失,用这种方法来补阴,错误实在太大了。等到考察他所引用的经文,又是多么荒诞不经。
比如经文中说:“阳者,天气也,主外;阴者,地气也,主内,所以阳道实,阴道虚。”这是《素问·太阴阳明论》中论述脾与胃生病有所不同,因为阳明胃主表,太阴脾主里。凡是遭受贼风虚邪侵袭的,阳经受之,阳经受邪则病入六腑,而外邪在体表,邪气必然有余,所以说“阳道实”。饮食不节制,起居不规律的,阴经受之,阴经受邪则病入五脏,而内伤脏气,脏气必然受损亏虚,所以说“阴道虚”。这本是经文以阳主外、阴主内,来说明阳病多实证、阴病多虚证的情况,哪里是说天地和平的阴阳是“阳常有余、阴常不足”呢?勉强引用经文,这是第一个谬误。
又比如经文说:“至阴虚,天气绝;至阳盛,地气不足。”这是《素问·方盛衰论》中论述阴阳痞隔造成的疾病。意思是阴虚于下则不能上升,下不升则上也不能下降,这就是所谓的“至阴虚,天气绝”;阳亢于上则不能下降,上不降则下也不能上升,这就是所谓的“至阳盛,地气不足”。这本是以上下不交通来说明的,也不是指“阳常有余、阴常不足”。况且后两句或许还稍微有点相似,而上两句说“至阴虚,天气绝”,又该如何解释呢?这更是谬误了。凭丹溪的博学,为何会如此胡乱引用,恐怕是被偏执的观点所局限而忘记了矫揉造作吧?我学识浅陋却不自知,但念切于大道,所以不能为丹溪避讳,在此摘出并纠正他的错误,还要等待高明之士的批评指教。
一、丹溪在《相火论》中说:“五行各有其本性,只有火有两种:一种是君火,即人火;一种是相火,即天火。火内阴而外阳,主要特征是‘动’。所以凡是动的现象都归属于火。天主宰万物的生成,所以恒常处于运动状态,人有生命,也恒常处于运动状态,之所以恒常运动,都是相火的作用。所以人自从有了知觉之后,五志之火受到外物感应,不能不动,这种发动,就是《内经》所说的五火。相火容易兴起,五性中的厥阳之火相互煽动而妄动。火从妄动而起,变化莫测,无时无刻不存在,煎熬真阴。阴虚就会生病,阴绝就会死亡。”
根据丹溪的这个论点,无非是阐扬火病而推崇他的补阴学说罢了。只是对此看得浅显,似乎有些道理,所以容易打动人心;但如果深入体味,就会发现意识全是虚幻,大大误导后人。我请求仔细推究其中的含义,用来解答后人的疑惑,怎么样呢?大概自从一元之初开始,两仪随之确立,那么动静就在这里显现了。而阳主动,阴主静。自两仪奠定位置,五行分布其中,那么气质各有所主,火主热,水主寒。这两仪的动静,是五行的先天。先天的是性道;五行的寒热,是两仪的后天。后天的是变体。先后的道理,有的可以混着说,有的不可以混着说。那些可以混说的,比如火本属阳,就说火是动的,这还可以。那些不可混说的,是以阳为元气的主要主宰,火为病气的变异表现,而动乃是阳的本性之道,怎么能把本性之道当作病变,而说凡是动都归属于火呢?即使从天人角度论述,也说“天行健”,难道天的运动就是火吗?又说“君子以自强不息”,难道人的运动就是火吗?假如天没有这种运动,生机就停止了;人没有这种运动,性命就丧失了,又怎么能用“火”来谈论“动”呢?如果说那是火,那么火就必须去除,连性命也可以去除了吗?如果说凡是动都归属于火,那岂不是必须不动才可以吗?把阳当作火,言辞似乎相似,但道理相差太大了。所以在丹溪那里说“阴虚则病,阴绝则死”;我说“阳虚则病,阳脱则死”,这在细微疑似之处,有着毫厘千里的差异,面临抉择时不可不详加考察。
有人问:“您说的话虽然对,只是没通达丹溪的意思罢了。比如他说五脏各有火,五志激发它,火随之而起,导致真阴受伤,阴绝而死。这难道不是因动生火吗?”我说:“这或许是因为情欲思虑而动火的情况,只有一种证候,比如欲念不遂,或纵欲太过,导致动相火而为劳损、痨瘵的,确实有这种情况。除此之外,五志的动都能生火,那就不是这样了。所谓五志,就是喜、怒、思、忧、恐。医经说:‘喜伤心,怒伤肝,思伤脾,忧伤肺,恐伤肾。’五脏既然受到这些伤害,那么五火从哪里起来呢?又说:‘喜则气散,怒则气逆,忧则气闭,思则气结,恐则气下。’这五种性情被外物感应,不能不动,动就会耗伤元气,元气既然像这样耗伤,那么火又从哪里起来呢?所以医经说:‘五脏,是主藏精的器官。不可损伤,损伤就会失守而导致阴虚,阴虚就会无气,无气就会死亡。’由此可见,脏不可伤,气也不可伤,没听说过伤了就是火。就算说是火,也必须有火的症状,如果没有火的症状,仅仅用‘动’字来敷衍其说,这和捉影子当形体有什么区别?天下之事又怎么不可以混淆黑白呢?况且常见五志所伤的人,伤到极致必定产生战栗。这是因为元阳不固,神气失守所致。如果遇到刘河间为之调和,又一定会说战栗都是生于火。谁是谁非,关键就在这里,能不让人为百姓痛心吗!
一、丹溪在《局方发挥》中说:“相火之外,又有脏腑厥阳之火,五志的动,各有火起。相火,就是医经所说的‘一水不胜二火’的火,出于天然造化。厥阳,就是医经所说的‘一水不胜五火’的火,出于人欲。气的上升,随着火炎上,升而不降,谁能抵御它?”
追溯原文中“五火”的说法,是解释《素问·解精微论》中关于厥病目中无所见的情况。说的是阳气并于上,阴气并于下,阴阳不交,所以成为厥证。厥,就是逆乱。由于阳气逆于上则火不降,阴气逆于下则水不升,水既不升,火又不降,而以单一阴的微细精气,不能胜过五脏之阳的逆乱,这只是单言厥逆这种病的情况,哪里是说火有五而水只有一呢?另外考察“二火”的说法,出自《素问·逆调论》,说:“人有身体寒冷得很却反而不战栗的,名叫骨痹。”说的是这个人肾气素来强胜,从事涉水劳作,则肾脂枯涸而髓不能充盈,所以寒冷甚至达到骨头。又以肝为一阳,心为二阳,这两个脏器都有伏火,则一水不胜二火,所以身体虽冷却不冻得战栗,这只是单言骨痹这种病的情况。这又哪里是“阳常有余”的意思呢?如果把五火、二火都拿来作为火证的证据,那么在《素问·示从容论》中有“二火不胜三水”的说法,又将如何解释呢?为什么唯独不引用这个说法呢?试着以此问丹溪,他将如何回答呢?
一、丹溪说:“气有余便是火。”又说:“五脏各有火,五志激发它,火随之而起。如果是各种寒性病,必须身体遭受寒气,口吃寒凉食物,才是寒病。不像各种火病,病是从内部产生的。所以气患寒病的,十无一二。”
我品味丹溪这番话,忍不住掩卷叹息。难道气患寒病的真是十无一二吗?气本属阳,阳气实的固然能发热,阳气虚的难道就不能发冷吗?所以医经说:“气实的就是热,气虚的就是寒。”又说:“血气,喜欢温暖而厌恶寒冷,寒冷则凝涩不能流通,温暖则消散而去之。”其中的道理就可以知道了。况且现在人的气实和气虚,哪个多哪个少呢?那么寒热的情况也就可知了。然而用什么来证明呢?比如心气虚则神志不明,肺气虚则治节不行,脾气虚则饮食不能健运,肝气虚则魂怯而不安宁,肾气虚则性功能衰退而精少志屈,胃气虚则仓廪匮乏而波及诸经,三焦虚则上中下都失职,命门虚则精气神总属无根。所有这些,哪一点不是气虚的类型?气虚就是阳虚,阳虚则五脏不暖而无寒生寒,所以多是阳气衰败羸弱的病。如果一定要等到遭受寒气和寒食才算是寒证,那将把这类病人置于何地?治病贵在医生能识别生气,这确实是医家最大的关系,而丹溪完全没察觉。所以难怪他说:“气有余便是火。”而我反过来却说:“气不足便是寒。”如果他听到我的说法,还不知道是否认为正确。
一、丹溪在《格致余论》中说:“六气之中,湿热致病,占十之八九。”
根据这个说法,湿热致病占十之八九,那么寒凉药物也应当用十之八九了,这也是极大的谬论。阴阳之道,本来像秤锤和秤杆一样平衡,寒往暑来,没有偏胜不复的现象。如果偏热到如此程度,那么气候就会混乱,天道就会乖违。所以黄帝说:“德化政令的动静损益都是怎样的?”岐伯说:“德化政令灾变,不能互相叠加。胜复盛衰,不能互相增多。往来大小,不能超过限度。使用的升降,不能互相缺失。各自跟随其运动而恢复而已。”这是《素问·气交变大论》的文句,难道也不足信吗?
一、丹溪在夏月伏阴论中说:“如果在夏季火令之时,妄投温热药,怎能避免实实虚虚的祸患呢?”有人说:“巳月纯阳,从道理上讲或许通顺。五月一阴,六月二阴,不是阴冷是什么?”回答说:“这是阴气开始在地下萌动。四阳浮于地上,燃烧灼烧,流金烁石,哪里有阴冷呢?”
根据这一说法,那么夏季只适宜寒凉了。但为什么黄帝说:“服寒药反而发热,服热药反而发冷,这是什么缘故?”岐伯说:“治疗其旺气,所以反而出现这种情况。”既然如此,丹溪只知道治疗旺气。而旺气有不可治疗的,为什么不知道呢?况且春夏的温热,秋冬的寒凉,这是四时的主气;而风寒暑湿火燥,这是六周的客气。所以春夏有阴寒的时令,秋冬有温热的时候,这叫主气不足,客气胜。这叫“必先岁气,无伐天和”,也是这个意思。难道丹溪只知道有主气,而不知道客气的循环胜复吗?然而这还是从气令方面说的。至于人的血气阴阳,本来各不相同,病的表里寒热,难道都一样吗?假设夏季得了阴证而忌讳用温热药,冬季得了阳证而忌讳用寒凉药,那人还能活吗?这说明丹溪只知道时令热宜凉,而不知道舍时从证。他又怎么不知道呢?看他的论述,只说夏季忌讳温热,不说冬季忌讳寒凉,他对火的畏惧,对主火的言论,竟然到了这种地步。
一、丹溪在《局方发挥》中说:“医经说暴注下迫,皆属于热。又说暴注属于火。又说下痢清白属于寒。热是君火之气,火是相火之气,寒是寒水之气,属于火热的一共两个,属于水寒的一个,所以泻痢这一证,似乎属热的多,属寒的少。详细研读《局方》专门以热涩为功用,如果用于下痢清白而属寒的,就可以了。医经所说的下迫,就是里急后重的意思,这种病属火。是相火所为,其毒比热更甚,投以涩热药,不是杀它是什么呢?”
根据这个说法,用二火一水来解释泻痢的原因,非常不当。医经说暴注下迫皆属于热,是指暴泻如注伴有下迫感,不是指肠澼下痢。看《素问·太阴阳明论》说:“阴受之则入五脏,下为飧泄,久为肠澼。”而且肠澼说是日久形成的,难道同暴注一样都是热证吗?况且《内经》所言泻痢之证,寒证极多。如今在泄泻门类中详细列出可供考证的,为什么丹溪都不引用,而单独引用二火的说法,也是勉强的。及至遍考《内经》,只有“暴注下迫皆属于热”一句,并没有“暴注属于火”的文字,即使或以属火之年有说暴注的,然而木、金、土、水之年都有此证,又为什么独独说火呢?大概他的意图专在火,所以借引经文来证明他的说法,而不知道医经说二火,本是讲六气的道理,哪里是把泻痢这一证归为二火呢?看医经说:“长夏善病洞泄寒中”,为什么不说是洞泄热中,其中的道理就知道了,而丹溪为什么不考察呢?把泻痢归为火,本出自刘河间,而丹溪宗法他,所以变为这种说法。戴原礼又宗法丹溪,所以说:“痢虽有赤白二色,终无寒热之分,通作湿热治。”从此说法相传,致使各家方论,无不都说湿热,而不知道还有寒湿,其危害孰大至甚。至于《局方》一书,虽说多用热涩,但对于实热新邪,难道都说都用此法吗?看其所载太平丸、戊己丸、香连丸、薷苓汤之类,难道不是以寒治热的吗?又如真人养脏汤、大已寒丸、胡椒理中汤之类,都是有可用之法,其中随证斟酌适宜,只看使用者如何罢了?难道《局方》专门以热涩为功用,就可以斥责它不对吗?且这本书的流传,是宋神宗诏令天下高医各以效方奏进而成的。这其中或许有过于粉饰的,料想不能没有,但真正有效的方子也一定不少。只是在丹溪看来,说他多说火,谓热药能杀人;而我考察他认为寒多,则只见寒药杀人罢了。明智的人请深加考察。
一、丹溪说:“痢疾见赤色属血,来自小肠;白色属气,来自大肠,都以湿热为本。初得一二日间,元气未虚,必须推荡攻下,这是通因通用的方法。用大承气汤、调胃承气汤。下后看是气病还是血病再用药,气病用人参、白术,血病用四物汤。痢疾五日后不可下,因为脾胃气虚的缘故。体质壮实者也可下。”
根据这个说法,用赤白来区分血气,分别归属大肠小肠,这在五行学说上或许成立。但在病情的真实情况上就牵强附会了。盖小肠为心之腑,理应主血,大肠为肺之腑,理应主气。然而水谷气化于小肠,难道小肠就没有气吗?或者在粪便前见血,难道大肠就没有血吗?看医经说:“血者,神气也。”这难道不是赤色由气化成的吗?又说:“白血出者死。”这难道不是白色也是血吗?盖白色和赤色,无不关乎血气,只是来得浅的呈白色,来得深的呈赤色。所以医经说:“阳络伤则血外溢,血外溢则衄血;阴络伤则血内溢,血内溢则便血。”这是至理,何其明显,却顾惜用小肠大肠来分血气吗!然而这还不碍事,也不必深辩。至于说初得一二日间,元气未虚,必须推荡攻下,作为通因通用法,那么这个说法就不能一概而论了。盖此证有不宜下的,有必不可下的。难道以为一二日间就一定可推荡吗?若病可泻者,必是其元气本强,积聚多实,那么无论寒邪热邪,只要得一推荡,则邪从泻去,而气本无伤,故可泻。假使没有这种元气,没有这种胀实,就无可言泻的了。那么强壮之人,随食随化,所以饮食不易伤,泻痢不易犯,即使有所犯,也无不是随病而随愈。那些易患病的人,一定是易受伤的人。易受伤的,一定是本源虚弱的人。所以凡患泻痢而有久延难愈的,一定是弱者多,而强者少。因此治疗适宜推荡的,也不过数十人中之一二罢了。况且体弱之证,也有不同,有微弱的,有次弱的,有大弱的,其形气脉息,病因证候,是实是虚,自然可以明辨。凡见脾肾不足而致泻痢的,则始终都不可下。若妄用之,则轻者必重,重者必死,无可解救,这就是推荡不可轻用的原因。诚然见到因误治而致误的不少了。即使在丹溪那里也说:“我近年阅历,也有大虚大……”
I have observed Zhu Danxi's theory of "Yang is often in excess, Yin is often insufficient," which states that the Qi (vital energy) of human life is often in excess, while Blood is often insufficient, and therefore he specifically emphasizes suppressing Fire.
Furthermore, he recklessly cites passages from the *Neijing* (Inner Canon), such as "The pathway of Yang is solid/excess, the pathway of Yin is hollow/deficient," and "When Yin is extremely deficient, Heavenly Qi ceases; when Yang is extremely excessive, Earthly Qi is insufficient," forcing them as evidence.
This is indeed a fallacious discourse that greatly contradicts the purport of the classics and severely damages the vital potential. Why? Because humans acquire Qi from Heaven and Earth to generate life, and this life-generating Qi is precisely Yang Qi. Without Yang, there is no life. Therefore, all processes of natural growth, from growing to becoming strong, are dominated by Yang Qi, and Essence (Jing) and Blood are transformed and generated by it. Thus, when Yang is abundant, Essence and Blood are abundant, indicating vigorous life force; when Yang is declining, Essence and Blood decline, indicating waning life force. Hence, the Classics state: "The Middle Jiao receives Qi, extracts its essence, transforms it, and turns it red; this is called Blood." Does this not prove that Blood is born from Qi?
Danxi only knows that Essence and Blood belong to Yin, thus saying "Yin is often insufficient," but does not understand that the source generating Essence and Blood lies first in this Yang Qi. If Essence and Blood are truly insufficient, how can there be an excess of Yang? Considering this, why not say that Yang Qi is difficult to form and easy to lose, rather than Yin Qi? This is akin to knowing only the mother and ignoring the father. Therefore, his formulas for tonifying Yin, such as those containing Zhi Mu (Anemarrhenae Rhizoma) and Bai Pi (Phellodendri Cortex), claim to tonify Yin, yet Zhi Mu and Bai Pi are merely capable of descending Fire; how can they tonify Yin? If used indiscriminately, they will damage the life-generating Qi, causing Yin to perish even more. To use this method to tonify Yin is a grave error. Upon examining the classical texts he cites, how absurd they are.
For instance, the Classics state: "Yang is Heavenly Qi, governing the exterior; Yin is Earthly Qi, governing the interior. Therefore, the pathway of Yang is solid/excess, and the pathway of Yin is hollow/deficient." This passage from the *Taiyin Yangming Lun* (Treatise on Taiyin and Yangming) discusses how Spleen and Stomach diseases differ because Yangming (Stomach) governs the exterior and Taiyin (Spleen) governs the interior. When attacked by treacherous winds and empty evils, the Yang channels receive them; receiving them leads to disease entering the Six Fu organs, where external pathogens remain at the exterior, so the pathogen is necessarily in excess; hence, "the pathway of Yang is solid/excess." When diet is irregular and daily routine is untimely, the Yin channels receive them; receiving them leads to disease entering the Five Zang organs, damaging internal organ Qi, which inevitably becomes deficient; hence, "the pathway of Yin is hollow/deficient." This text uses Yang governing the exterior and Yin governing the interior to explain that Yang diseases are mostly excess patterns and Yin diseases are mostly deficiency patterns. How could it mean that the harmonious Yin and Yang of Heaven and Earth are "Yang often in excess, Yin often insufficient"? Forcing these citations constitutes the first fallacy.
Again, the Classics state: "When Yin is extremely deficient, Heavenly Qi ceases; when Yang is extremely excessive, Earthly Qi is insufficient." This is from the *Fang Sheng Shuai Lun* (Treatise on Approaching Abundance and Decline), discussing illnesses caused by the blockage of Yin and Yang. It means that if Yin is deficient below, it cannot ascend; if it does not ascend below, it cannot descend above; this is what is meant by "When Yin is extremely deficient, Heavenly Qi ceases." If Yang is hyperactive above, it cannot descend; if it does not descend above, it cannot ascend below; this is what is meant by "When Yang is extremely excessive, Earthly Qi is insufficient." This explains the lack of communication between upper and lower, and does not refer to "Yang often in excess, Yin often insufficient." Moreover, while the latter two phrases might seem somewhat similar, how should one interpret the former two phrases, "When Yin is extremely deficient, Heavenly Qi ceases"? This is another fallacy. Given Danxi's erudition, why would he cite recklessly like this? Perhaps he was confined by his bias and forgot his own forced reasoning. I am ignorant yet concerned with the Dao, so I cannot shield Danxi from criticism and hereby point out his errors, awaiting the commentary of the wise.
1. In his *Xiang Huo Lun* (Treatise on Ministerial Fire), Danxi states: "Each of the Five Elements has its own nature, but Fire has two types: Jun Huo (Monarch Fire), which is Human Fire; and Xiang Huo (Ministerial Fire), which is Heavenly Fire. Fire is Yin inside and Yang outside, and it is characterized by movement. Therefore, all movements belong to Fire. Heaven governs the generation of things, so it is constantly in motion. Humans have life, so they are also constantly in motion. The reason for this constant motion is the action of Ministerial Fire. Since humans gained consciousness, the Fire of the Five Emotions is stimulated by external objects and cannot help but move. This movement is what the *Neijing* calls the Five Fires. Ministerial Fire rises easily; the Jue Yang Fire of the Five Natures fans each other into reckless movement. Fire arises from recklessness, changes unpredictably, exists at all times, and boils down True Yin. Yin deficiency leads to disease; Yin exhaustion leads to death."
Based on this argument of Danxi, he is merely expounding on Fire diseases and promoting his theory of tonifying Yin. Viewing this superficially, it seems reasonable and thus easily persuasive; but delving deeply into it reveals that the concepts are illusory and greatly mislead people. I request to carefully analyze its meaning to resolve the doubts of later generations, how about that? Generally, since the beginning of the One Primeval Qi, the Two Modes followed, and thus movement and stillness were manifested. Yang governs movement, and Yin governs stillness. Once the Two Modes established their positions, the Five Elements were distributed, and each temperament had its specific governance: Fire governs heat, and Water governs cold. The movement and stillness of the Two Modes are the Pre-Heaven of the Five Elements. The Pre-Heaven refers to Nature and Dao; the heat and cold of the Five Elements are the Post-Heaven of the Two Modes. The Post-Heaven refers to the changing forms. The principles of Pre- and Post-Heaven can sometimes be discussed together, but sometimes they cannot. What can be mixed includes: Fire belongs to Yang, so saying Fire is moving is acceptable. What cannot be mixed is: Yang is the great master of Original Qi, while Fire is a pathological manifestation of Qi. Movement is the nature and Dao of Yang; how can one equate Nature and Dao with pathological changes and say that all movement belongs to Fire? Even discussing from the perspective of Heaven and Humanity: "Heaven moves vigorously," does Heaven's movement mean it is Fire? "The gentleman strives unceasingly," does human movement mean it is Fire? If Heaven did not have this movement, the vital potential would cease; if humans did not have this movement, life and destiny would depart. How can one speak of movement using Fire? If it is said to be Fire, then Fire must be removed, and can life and destiny also be removed? If all movement belongs to Fire, does one have to be immobile to avoid it? Equating Yang with Fire makes the words sound similar, but the principles differ vastly. Thus, Danxi says "Yin deficiency leads to disease, Yin exhaustion leads to death"; I say "Yang deficiency leads to disease, Yang collapse leads to death." In these subtle and doubtful mechanisms, there is a difference of a hair's breadth leading to a thousand miles' deviation. One must examine carefully when facing choices.
Someone might ask: "Your words are correct, but you fail to understand Danxi's intent. He says each of the Five Zang organs has Fire, and when stirred by the Five Emotions, Fire rises accordingly, injuring True Yin until Yin exhaustion causes death. Is this not Fire generated by movement?" I reply: "This may apply to cases where emotional desires stir Fire, which is only one type of syndrome, such as unfulfilled desires or excessive indulgence, causing Ministerial Fire to move and resulting in consumption diseases. Such cases do exist. However, outside of this, claiming that the movement of the Five Emotions all generates Fire is incorrect. The so-called Five Emotions are Joy, Anger, Worry, Thought, and Fear. The Classics state: 'Joy injures the Heart, Anger injures the Liver, Thought injures the Spleen, Worry injures the Lungs, Fear injures the Kidneys.' Since the Five Zang organs are injured by these, from where do the Five Fires arise? It also states: 'Joy disperses Qi, Anger reverses Qi, Worry closes Qi, Thought knots Qi, Fear sinks Qi.' These five natures are stimulated by external objects and cannot help but move. Movement consumes and injures Original Qi. Since Original Qi is consumed like this, from where does Fire arise? Therefore, the Classics state: 'The Five Zang organs are the masters of storing Essence. They must not be injured; injury leads to loss of control and Yin deficiency. Yin deficiency leads to lack of Qi; lack of Qi leads to death.' This shows that Zang organs must not be injured, and Qi must not be injured. I have never heard that injury equals Fire. Even if it is Fire, there must be symptoms of Fire. If there are no Fire symptoms, but one merely uses the word 'movement' to pad the argument, what is the difference between catching a shadow and treating it as a form? How can worldly affairs not be confused within this logic? Furthermore, I often see that people injured by the Five Emotions, when injured to the extreme, inevitably experience shivering. This is due to insecure Yuan Yang and loss of Shen Qi. If Liu Hejian were to treat them, he would surely say shivering is generated by Fire. Who is right and who is wrong? The key lies here. Can one not feel pain for the people?
1. In *Ju Fang Fa Hui* (Exposition of the Formulas Bureau), Danxi states: "Besides Ministerial Fire, there is also the Jue Yang Fire of the Zang and Fu organs. The movement of the Five Emotions each gives rise to Fire. Ministerial Fire is the 'One Water unable to overcome Two Fires' mentioned in the Classics, originating from natural creation. Jue Yang is the 'One Water unable to overcome Five Fires' mentioned in the Classics, originating from human desires. As Qi ascends, it follows the fire flaming upward. Ascending without descending, who can resist it?"
Tracing the original text, the concept of "Five Fires" explains the section in *Jie Jing Wei Lun* (Treatise on Explaining the Profound Secrets of Essence) regarding the symptom of blindness in Jue diseases. It states that Yang merges above and Yin merges below, and because Yin and Yang do not communicate, Jue results. Jue means reversal. Because Yang reverses upward, Fire does not descend; because Yin reverses downward, Water does not ascend. Since Water does not ascend and Fire does not descend, the subtle essence of a single Yin cannot overcome the reversal of Yang of the Five Zang. This solely discusses the pathology of Jue reversal, not that there are Five Fires and only one Water. Regarding the "Two Fires" theory, it comes from *Ni Diao Lun* (Treatise on Reversed Regulation), which says: "There are people whose bodies are extremely cold yet do not shiver, named Gu Bi (Bone Bi)." It explains that this person's Kidney Qi is naturally strong, engaging in water-related labor, causing Kidney fat to dry up and Marrow to fail to fill, so cold reaches the bones. It further states that the Liver is One Yang and the Heart is Two Yang; both organs have latent Fire, so One Water cannot overcome Two Fires, hence the body is cold but does not freeze-shiver. This solely discusses the pathology of Bone Bi, not "Yang often in excess." If one were to cite Five Fires and Two Fires as evidence of Fire syndromes, then in *Shi Cong Rong Lun* (Treatise on Showing Ease and Composure), there is a statement about "Two Fires unable to overcome Three Waters." How would one explain that? Why is it not cited? Try asking Danxi this; how would he answer?
1. Danxi states: "Excess Qi is simply Fire." He also says: "Each of the Five Zang organs has Fire; when stirred by the Five Emotions, Fire rises accordingly. If suffering from various Cold diseases, one must have been exposed to Cold Qi or ingested Cold substances to become ill with Cold. Unlike various Fire diseases, which originate internally. Therefore, among Qi diseases, only one or two out of ten are Cold."
Tasting Danxi's words, I cannot help but close the book and sigh. Are Qi diseases really only one or two out of ten being Cold? Qi inherently belongs to Yang. Those with Excess Yang certainly can generate Heat, but do those with Deficient Yang not generate Cold? Therefore, the Classics state: "Excess Qi is Heat; Deficient Qi is Cold." It also states: "Blood and Qi prefer warmth and dislike cold. Cold causes stagnation and inability to flow; warmth causes dissolution and removal." The meaning is clear. Moreover, among modern people, which is more common, Excess Qi or Deficient Qi? Then Heat and Cold conditions can be known. How to prove this? For example, Heart Qi deficiency leads to unclear spirit; Lung Qi deficiency leads to impaired regulation; Spleen Qi deficiency leads to poor digestion; Liver Qi deficiency leads to fearful and restless soul; Kidney Qi deficiency leads to declined sexual function, scanty essence, and frustrated will; Stomach Qi deficiency leads to depleted granaries affecting other meridians; Sanjiao deficiency leads to failure of upper, middle, and lower functions; Mingmen deficiency leads to Essence, Qi, and Spirit lacking roots. Are all these not types of Qi deficiency? Qi deficiency is Yang deficiency. Yang deficiency means the Five Internal Organs are not warm, leading to internal Cold generation, resulting in many diseases of Yang decline, emaciation, and decay. If one must wait for exposure to Cold Qi and ingestion of Cold food to diagnose a Cold syndrome, where would these patients be placed? The value of a physician lies in recognizing the Life-Generating Qi. This is indeed the greatest concern for physicians, yet Danxi completely overlooked it. No wonder he said, "Excess Qi is simply Fire." I counter with: "Deficient Qi is simply Cold." If he heard my view, he might not know whether to agree or not.
1. In *Ge Zhi Yu Lun* (Remnants of Ge Zhi Studies), Danxi states: "Among the Six Qi, diseases caused by Damp-Heat account for eight or nine out of ten."
According to this statement, if Damp-Heat diseases account for 80-90%, then cool/cold medicines should also be used 80-90%. This is a major fallacy. The Way of Yin and Yang is like a balance scale; Cold goes, Summer comes, without permanent dominance or non-recovery. If it were biased toward Heat to this extent, climate would be chaotic and the Way of Heaven distorted. Thus, the Yellow Emperor asked: "How are the dynamics and损益 (benefits and losses) of virtue, transformation, administration, and order?" Qibo replied: "Virtue, transformation, administration, disaster, and change cannot add to each other. Dominance and recovery, abundance and decline, cannot increase each other. Incoming and outgoing, large and small, cannot exceed limits. Use of ascending and descending cannot lack each other. Each returns following its movement." This is from the *Qi Jiao Bian Da Lun* (Great Treatise on Changes in Qi Intersection). Is this not credible?
1. In his discussion on Hidden Yin in Summer, Danxi states: "If during the Summer Fire command period, one recklessly administers Warm-Hot medicines, how can one avoid the dangers of reinforcing excess and depleting deficiency?" Some say: "The month of Si is pure Yang, which might make sense theoretically. But May has One Yin, June has Two Yin; isn't that Cold?" The response is: "This is Yin initially stirring underground. Four Yang float on the ground, burning and scorching, melting metal and stone. Where is the Cold?"
Based on this view, Summer should only use Cool/Cold medicines. But why did the Emperor say: "Taking Cold medicines results in Heat; taking Hot medicines results in Cold. What is the reason?" Qibo answered: "Treating the Prosperous Qi causes the reverse reaction." Thus, Danxi only knows to treat Prosperous Qi. But there are Prosperous Qis that cannot be treated; why doesn't he know this? Moreover, the Warmth of Spring and Summer, and the Cold of Autumn and Winter, are the Principal Qi of the four seasons; Wind, Cold, Summer-Heat, Dampness, Fire, and Dryness are the Guest Qi of the six cycles. Therefore, Spring and Summer have periods of Yin Cold, and Autumn and Winter have periods of Warmth. This is called "Principal Qi insufficient, Guest Qi victorious." This is what is meant by "First ascertain the Yearly Qi, do not violate the Harmony of Heaven." Did Danxi only know of Principal Qi and ignore the cyclical dominance and recovery of Guest Qi? However, this speaks of climatic commands. As for human Blood, Qi, Yin, and Yang, they are inherently different. Do diseases of interior/exterior and Cold/Heat always remain uniform? Suppose one contracts a Yin syndrome in Summer and avoids Warm-Hot medicines, or contracts a Yang syndrome in Winter and avoids Cool-Cold medicines; can such a person survive? This shows Danxi only knew that seasonal heat requires cooling, but did not know to abandon the season in favor of the syndrome. How could he not know this? His discussion only mentions avoiding Warm-Hot in Summer, not avoiding Cool-Cold in Winter. His fear of Fire and advocacy for Fire reached such extremes.
1. In *Ju Fang Fa Hui*, Danxi states: "The Classics say: Acute diarrhea with urgency and tenesmus all belong to Heat. Also: Acute diarrhea belongs to Fire. Also: Dysentery with clear and white discharge belongs to Cold. Heat is the Qi of Monarch Fire; Fire is the Qi of Ministerial Fire; Cold is the Qi of Cold Water. Two belong to Fire/Heat, one belongs to Water/Cold. Therefore, in dysentery and diarrhea, it seems Heat is common and Cold is rare. Studying *Ju Fang* closely, it specializes in using Astringent-Hot methods. If applied to clear/white dysentery belonging to Cold, that would be appropriate. The 'urgency and tenesmus' mentioned in the Classics refers to tenesmus; this disease belongs to Fire. Caused by Ministerial Fire, its toxicity is greater than Heat. Administering Astringent-Hot medicines is essentially killing the pathogen."
Based on this, explaining dysentery via Two Fires and One Water is inappropriate. The Classics stating "Acute diarrhea with urgency and tenesmus all belong to Heat" refers to acute watery diarrhea with urgency, not intestinal dysentery. Looking at the *Taiyin Yangming Lun*: "Yin receives it and enters the Five Zang, manifesting below as undigested stool diarrhea; prolonged, it becomes intestinal dysentery." Intestinal dysentery implies a chronic condition; how can it be the same as acute diarrhea and all be Heat? Moreover, the *Neijing* mentions many Cold cases of diarrhea and dysentery. Why does Danxi not cite the detailed records in the Diarrhea category but instead forces the Two Fire theory? Examining the *Neijing*, only "Acute diarrhea with urgency and tenesmus all belong to Heat" exists; there is no text saying "Acute diarrhea belongs to Fire." Even if some years attributed to Fire mention acute diarrhea, Wood, Metal, Earth, and Water years also have this syndrome; why single out Fire? His intent is focused on Fire, so he borrows classical text to prove his point, not realizing the Classics discuss Two Fires in the context of Six Qi, not specifically for dysentery. The Classics state: "Late Summer is prone to severe diarrhea and Cold in the Middle." Why not say "Severe diarrhea and Heat in the Middle"? The meaning is clear, yet Danxi failed to observe. Attributing dysentery to Fire originated from Liu Hejian, whom Danxi followed, hence this theory. Dai Yuanli followed Danxi, stating: "Although dysentery has red and white colors, there is ultimately no distinction between Cold and Heat; treat all as Damp-Heat." This theory spread, causing all subsequent medical discussions to mention only Damp-Heat, forgetting Cold-Damp, causing great harm. Regarding *Ju Fang*, although it uses many Astringent-Hot methods, does it apply them to all Excess Heat and new pathogens? Look at Taiping Wan, Wuji Wan, Xianglian Wan, and Ruling Tang; are these not using Cold to treat Heat? Also, Zhenren Yangzang Tang, Da Yi Han Wan, and Hu Jiao Lizhong Tang are all applicable methods. Their use depends on the practitioner's judgment based on the syndrome. Can *Ju Fang* be criticized solely for using Astringent-Hot methods? This book was compiled under Emperor Shenzong of Song, ordering high physicians to submit effective formulas. While some may be embellished, true effective formulas must be numerous. Danxi claims hot medicines kill people because he focuses on Fire; I observe that cold medicines kill people because he focuses on Cold. Wise ones should investigate deeply.
1. Danxi states: "Red dysentery belongs to Blood, coming from the Small Intestine; White dysentery belongs to Qi, coming from the Large Intestine; both take Damp-Heat as the root. In the first one or two days, when Original Qi is not yet deficient, one must purge it. This is the method of 'treating obstruction with unblocking' (Tong Yin Yong Tong). Use Dachengqi Tang or Tiaowei Chengqi Tang. After purging, treat based on Qi or Blood syndrome: use Renshen and Baizhu for Qi, Siwu Tang for Blood. After five days of dysentery, do not purge, as Spleen and Stomach Qi is deficient. Robust individuals may also be purged."
Based on this, distinguishing Blood and Qi by red and white, assigning them to Large and Small Intestines, aligns with Five Element theory but is flawed regarding the true nature of the disease. The Small Intestine is the Fu organ of the Heart, governing Blood; the Large Intestine is the Fu organ of the Lungs, governing Qi. However, water and grain transform in the Small Intestine; does it lack Qi? Or if blood appears before stool, does the Large Intestine lack Blood? The Classics state: "Blood is Shen Qi." Does this not mean red is transformed from Qi? It also states: "White blood exiting indicates death." Does this not mean white is also Blood? Both white and red relate to Blood and Qi; shallow involvement yields white, deep involvement yields red. The Classics state: "Injury to Yang collaterals causes external bleeding (epistaxis); injury to Yin collaterals causes internal bleeding (hematochezia)." This is obvious truth; why distinguish Blood and Qi by Small and Large Intestines? This part is harmless and need not be debated deeply. However, the claim that in the first one or two days, when Original Qi is not deficient, one must purge using "treating obstruction with unblocking" cannot be generalized. There are cases unsuitable for purging and cases absolutely contraindicated for purging. Must one purge in one or two days? If a disease can be purged, the patient must have strong Original Qi and substantial accumulation. Whether Cold or Heat pathogen, one purge removes the pathogen without injuring Qi, so purging is possible. Without such Qi or fullness, purging is impossible. Robust individuals digest quickly, so food rarely injures them, and they rarely contract diarrhea/dysentery; if they do, they recover quickly. Those prone to illness are those prone to injury. Those prone to injury are those with weak constitutions. Therefore, chronic diarrhea/dysentery cases are mostly weak, few are strong. Thus, only one or two in a hundred require purging. Weak constitutions vary: slight weakness, moderate weakness, severe weakness. Their form, Qi, pulse, etiology, and syndrome clearly indicate excess or deficiency. For dysentery caused by Spleen and Kidney deficiency, purging is contraindicated throughout. Reckless purging will worsen mild cases and kill severe ones, with no rescue possible. This is why purging must not be used lightly. I have seen many errors caused by this. Even Danxi admitted: "In my recent experiences, there are cases of severe deficiency..."