刘河间《原病式》所列病机，原出自《内经·至真要大论》。盖本论详言五运六气盛衰
胜复之理，而以病机一十九条总于篇末，且曰∶有者求之，无者求之，盛者泻之，虚者补之
，令其调达，而致和平。是可见所言病机，亦不过挈运气之大纲，而此中有无之求，虚实之
异，最当深察，总惟以和平为贵也。故《五常政大论》又详言五运三气之辨，则火之平气曰
升明，火之太过曰赫曦，火之不及曰伏明，此虚火实火之辨，则有如冰炭之异，而《内经》
不偏不倚之道，固已详明若是。奈河间不能通察本经全旨，遂单采十九条中一百七十六字，
演为二百七十七字，不辨虚实，不察盛衰，悉以实火言病，着为《原病式》以讫于今。夫实
火为病故为可畏，而虚火之病犹为可畏。实火固宜寒凉，去之本不难也；虚火最忌寒凉，若
妄用之，无不致死。矧今人之虚火者多，实火者少，岂皆属有余之病，顾可概言为火乎？历
观唐宋以前，原未尝偏僻若此，继自《原病式》出，而丹溪得之定城，遂目为至宝。因续着
《局方发挥》，及阳常有余等论，即如东垣之明，亦因之而曰火与元气不两立。此后，如王
节斋、戴原礼辈，则祖述相传，遍及海内。凡今之医流，则无非刘朱之徒，动辄言火，莫可
解救，多致伐人生气，败人元阳，杀人于冥冥之中而莫之觉也。诚可悲矣！即间有一二特达
，明知其非而惜人阳气，则必有引河间之说而群吠之者矣。何从辨哉。矧病机为后学之指南
，既入其门，则如梦不醒，更可畏也。医道之坏，莫此为甚。此误谬之源不可不察，故直笔
于此，并再辨其略于下。
一、河间论吐酸曰∶酸者，肝木之味也，由火盛制金，不能平木，则肝木自甚，故为酸
也。而俗医主于温和脾胃，岂知经言人之伤于寒也，则为病热云云。
宾谓吐酸吞酸等证，总由停积不化而然。而停积不化，又总由脾胃不健而然。脾土既不
能化，非温脾健胃不可也。而尚可认为火盛耶？且妄引经文为证，其谬孰甚。本证别有详辨
，具载吞酸门，所当互阅。
一、河间论泻痢曰∶泻，白为寒，青红黄赤黑皆为热也。大法∶泻利小便。清白不涩为
寒，赤色者为热。又完谷不化而色不变，吐痢腥秽，澄澈清冷，小便清白不涩，身凉不渴，
脉迟细而微者，寒证也；谷虽不化而色变非白，烦渴，小便赤黄而或涩者，热证也。凡谷消
化者，无问色及他证便为热也，寒泻而谷消化者，未之有也。或火主疾速，而热盛则传化失
常，谷不能化而飧泄者，亦有之矣。又曰痢为热，热甚于肠胃，怫热郁结而成，或言下痢白
为寒者，误也。若果为寒，则不能消谷，何由反化为脓也？如世之谷肉果菜，湿热甚则自然
腐烂化为浊水，故食于腹中。感人湿热邪气，则自然溃发，化为脓血也。
据河间此说，似是而非，误人不浅。夫泻白为寒，人皆知也，而青挟肝邪，脾虚者有之
，岂热证乎？红因损脏，阴络伤者有之，岂尽热乎？正黄色浅，食半化者有之，岂热证乎？黑
为水色，元阳衰者有之，岂热证乎？若此者皆谓之热，大不通矣。且凡泻痢者，水走大肠，
小水多涩，水枯液涸，便尿多黄，此黄涩之证未必皆由热也。亡液者渴，亡阴者烦，此烦渴
之证未必尽为热也。至如完谷不化，澄澈清冷，诚大寒矣。然人偶有寒邪伤脏，或偶以生冷
犯脾，稍失温和即病泻痢者，此本受寒，然未必即大寒证也。且凡脾胃初伤，阳气犹在，何
能卒至清冷，遂成完谷不化？若必待清冷不化始云为寒，则阳已大败。又岂无渐寒而遽至若
是哉？夫渐寒者，即寒证也。此等证候，犯者极多。若作热治，必用寒凉。夫既以生冷伤于
前，复以寒凉败于后，乃至冰坚于霜而遭其厄者，皆此论之杀之也。再观其前条，则犹云泻
白为寒也；观其后条，则又云或言下痢白为寒者误也。然则凡治此者，舍清凉之外，则必无寒
证矣，谬甚！谬甚！又若寒则不能消谷，及谷化为脓之说，则尤为不妥。夫饮食有时，本当速
化，此自胃气之常，人皆赖之以为生也。若化觉稍迟，便是阳虚之病，又何待不能消谷而始
为寒乎？矧以所下脓垢，原非谷之所化。盖饮食入胃，凡其神化而归于营卫者，乃为膏血；
其不能化而留于肠胃者，惟糟粕耳。此其为精为秽，本自殊途，是以糟粕不能化脓，从可知
矣。且垢亦非脓，而实肠脏之脂膏也。何以知之？近有偶病而服硝黄等药者，随泻而下，必
有如脓之垢，又或偶患泄泻者，于一二日间，即有此垢，岂热化之脓，其速有如此乎？又如
久痢不已，或经年累月不能痊可，而每日所下皆有脓垢者，岂热化之脓，可以久延如此乎？
此其非脓也，明矣。既知非脓，安得皆云为热？此盖以肠脏受伤，而致膏脂不固，随剥随下
，所以如此。若不为之安养脏气，而再用寒凉以治其热，则未有不藏气日败，而必至于死。
故今之治痢多危者，率受此害，最当察也。
一、河间曰∶假如下痢赤白，俗言寒热相兼。其说尤误。岂知水火阴阳寒热者，犹权衡
也，一高必一下，一盛必一衰。岂能寒热俱甚于肠胃而同为痢乎？如热生疮疡而出白脓者，
岂可以白为寒欤？由其在皮肤之分，属肺金，故色白也。在血脉之分，属心火，故为血疖
也。在肌肉，属脾土，故作黄脓。在筋部，属肝木，故脓色带苍。深至骨，属肾水，故紫
黑血出也。各随五脏之部而见五色，是谓标也。本则一出于热，但分深浅而已。大法下迫窘
痛，后重里急，小便赤涩，皆属燥热，而下痢白者必多有之，然则为热明矣。
据此说，以五色分五脏，其理颇通。若谓本则一出于热，则大不通矣。且五脏之分五色
之证，则犹有精义，余因其说，并为悉之。夫泻出于脏，无不本于脾胃，脾胃之伤，以五气
皆能犯之。故凡其兼赤者，则脾心证也；兼青者，脾肝证也；兼白者，脾肺证也；兼黑者，
脾肾证也；正黄者，本脏证也。若以脾兼心，火乘土也，其土多热，言火可也。以脾兼肝，
土受克也，其土多败，非火也。以脾兼肾，水反克也，其土多寒，非火也。以脾兼肺，母气
泄也，其土多虚，非火也。本脏自病，脾受伤也，其土多湿，非火也。此兼证之盛衰，其逆
顺有如此。且凡脾肾之强者有实热，脾肾之弱者皆虚寒，此脏气之可辨也。矧火本热，而尚
有虚火实火之异；风本阳也，而亦有风热风寒之异；土本乎中气也，而亦有湿热寒湿之异。
至于金之寒，水之冷，同归西北之化，则其寒多热少，理所必致。岂可谓五脏之痢，本则一
出于热乎？因致寒证之衔冤者，此言之不得辞其责也。又赤白义详后丹溪条中。
一、河间曰∶夫治诸痢者，莫若于辛苦寒药治之，或微加辛热佐之则可。盖辛热能发散
开通郁结，苦能燥湿，寒能胜热，使气宣平而已。如钱氏香连丸之类是也。故治诸痢者，黄
连、黄柏为君，以至苦大寒，正主湿热之病。
据河间此说，最为治痢之害。又观其所着药性，则曰诸苦寒药多泄。惟黄连、黄柏，性
冷而燥。故自丹溪而后，相传至今。凡治痢者，举世悉用寒凉，皆此说之误也。毋论其他，
姑以苦能燥湿一言辨之，则河间之见大左矣。夫五味之理，悉出《内经》，《内经》有曰∶
以苦燥之者，盖言苦之燥者也。河间不能详察，便谓是苦皆燥，而不知《内经》之言苦者，
其性有二，其用有六。如曰∶火生苦。曰∶其类火，其味苦。曰∶少阳在泉为苦化，少阴在
泉为苦化。曰∶湿淫于内，治以苦热；燥淫于内，治以苦温。是皆言苦之阳也。曰∶酸苦涌
泄为阴。曰∶湿司于地，热反胜之，治以苦冷。曰∶湿化于天，热反胜之，治以苦寒。是皆
言苦之阴也。此其言性之二也。又曰以苦发之，以苦燥之，以苦温之，以苦坚之，以苦泄之
，以苦下之，此其言用之六也。盖苦之发者，麻黄、白芷、升麻、柴胡之属也。苦之燥者，
苍术、白术、木香、补骨脂之属也。苦之温者，人参、附子、干姜、肉桂、吴茱萸、肉豆蔻
、秦椒之属也。苦之坚者，续断、地榆、五味、诃子之属也。苦之泄者，栀、柏、芩、连、
木通、胆草之属也。苦之下者，大黄、芒硝之属也。夫气化之道，惟阳则燥，惟阴则湿，此
不易之理也。岂以沉阴下降有如黄连、黄柏之属者，以至苦大寒之性而犹谓其能燥，有是理
乎？是但知苦燥之一言，而不察苦发、苦温、苦坚、苦泄、苦下之五者，抑又何也？凡医中之
讹，每有云其然而不知其所以然者，类如此。因致后人治痢，多不分寒热虚实，动以河间之
法，及其将危，犹云血色如此，何敢用温？腹痛如此，何敢用补？死而无悟，深可哀也。谁之
咎与？谁之咎与？
一、河间肿胀条云∶肿胀者，热胜则 肿。如六月湿热太甚而庶物隆盛，则水肿之
义明可见矣。
据此说，岂其然乎？夫肿胀之病，因热者固有之，而因寒者尤不少。盖因热者，以湿热
之壅，而阴道有不利也；因寒者，以寒湿之滞，而阳气有不化也。故经曰∶脏寒生满病。又
曰∶胃中寒则胀满。是皆轩岐之言也。由此观之，岂胀皆热病耶？且庶物隆盛，乃太和之阳
化，以此拟形质之强壮则可，以此拟 肿之病象，拟亦下矣。
一、河间曰∶战栗动摇，火之象也。栗，寒栗也。或言寒战为脾寒者，未明变化之道也
。此由心火热甚，亢极而战，反兼水化制之，故寒栗也。然寒栗者，由火甚似水，实非兼以
寒气也。
据此说，则凡见寒战皆为火证，而何以经曰阴胜则为寒。又曰阳虚畏外寒。又曰阳虚而
阴盛，外无气，故先寒栗也。又曰阳明虚则寒栗鼓颔也？凡此者皆属经言，而河间悉言为火
，其然否可知也。
一、河间曰∶惊者，心卒动而不宁也。所谓恐则喜惊者，恐则伤肾而水衰，心火自甚，
故喜惊也。
据此所云∶恐则喜惊，恐则伤肾。然经曰∶肝气虚则恐，又曰∶恐则气下，惊则气乱。
夫肝气既虚，肾气既伤，而复见气下气乱，无非阳气受伤之病。阳气既伤，则何由心火遽甚
而惊则皆由火也。即曰恐则伤肾，不能滋养肝木，而肝虚则惊，又何不可？且肾水独衰者有
之，岂必水衰即火盛也？今常见惊恐之人，必阳痿遗溺，其虚可知。然因火入心而惊者，固
亦有之，未有因恐而惊者，皆可指为火证，则倍理甚矣。
一、河间曰∶虚妄者，以心火热甚，则肾水衰而志不精一，故神志失常，如见鬼神。或
以鬼神为阴，而见之则为阴极脱阳而无阳气者，此妄意之言也。
据此一说，则凡以神魂失守而妄见妄言者，俱是火证，亦不然也。夫邪火盛而阳狂见鬼
者，固然有之。又岂无阳气太虚而阴邪为鬼者乎？《难经》曰∶脱阴者，目盲。脱阳者，见
鬼。华元化曰∶得其阳者生，得其阴者死。岂皆妄意之言乎？何自信之如此也。
【背景信息】
书名：景岳全书 作者：张介宾 朝代：明 章节：辨河间（二十八，共九条） 类别：综合
刘河间的《原病式》中所列的病机，原本出自《黄帝内经·素问·至真要大论》。因为该篇详细论述了五运六气盛衰、胜复的道理，并在篇末用十九条病机进行总结，而且说：“有者求之，无者求之，盛者泻之，虚者补之，令其调达，而致和平。”由此可见，所说的病机，也不过是提纲挈领地概括运气的大纲，而其中有无的探求、虚实的差异，最应当深入考察，总之以平和为贵。所以《黄帝内经·素问·五常政大论》又详细论述了五运三气的辨别，那么火的平气叫做升明，火的太过叫做赫曦，火的不及叫做伏明，这虚实火的辨别，就像冰炭那样不同，而《黄帝内经》不偏不倚的道理，确实已经如此详明了。无奈河间不能通晓考察本经的全旨，于是单独采摘十九条中的一百七十六个字，演绎成二百七十七个字，不辨别虚实，不考察盛衰，全部把病归结为实火，著成《原病式》流传至今。实火致病固然可怕，而虚火致病更加可怕。实火固然适宜用寒凉药，去除病根并不难；虚火最忌讳寒凉药，如果妄加使用，没有不导致死亡的。况且现在人患虚火的很多，患实火的很少，难道都是有余的病吗？怎么能一概说是火呢？纵观唐宋以前，医学从未如此偏颇，自从《原病式》出现后，朱丹溪在定城得到它，便视其为至宝。于是接着撰写《局方发挥》，以及阳常有余等理论，就连李东垣那样高明的人，也因此说火与元气不两立。此后，如王节斋、戴原礼等人，便祖述相传，遍及海内。凡是现在的医流，无非是刘河间、朱丹溪的门徒，动不动就谈火，没有人能解救，大多导致损伤人的生气，败坏人的元阳，在不知不觉中杀人，人们却并不察觉。真是可悲啊！即使偶尔有一两个杰出的人，明知其错误而爱惜人的阳气，也必定会有引用河间之说而群起攻击他们的人。从哪里去辨别呢？况且病机是后学的指南，既然进入这个门，就像做梦醒不来，更令人畏惧。医道的败坏，没有比这更严重的了。这种错误的根源不可不考察，所以直笔写在这里，并在下面再次简要辨析。
一、河间论述吐酸说：“酸，是肝木的味道，由于火盛克制金，不能平抑木，则肝木自盛，所以表现为酸。”而世俗医生主张温和脾胃，哪里知道经文说人受寒邪侵袭，就会得热病等等。
我认为吐酸、吞酸等证候，总归是由于停积不化造成的。而停积不化，又总归是由于脾胃不健造成的。脾土既然不能运化，不用温脾健胃的方法不行。这还可以认为是火盛吗？况且妄引经文作为证据，其谬误还有比这更大的吗？本证另有详细辨析，记载在吞酸门中，应当互相参考阅读。
一、河间论述泻痢说：“泄泻，白色属寒，青色、红色、黄色、赤色、黑色都属于热。大法则是利小便。清白且不涩滞的是寒证，赤色的是热证。又有完谷不化且颜色不变，呕吐下痢腥秽，清澈清冷，小便清白不涩，身体凉爽不口渴，脉象迟细而微的，是寒证；谷物虽然不化但颜色不是白色，烦躁口渴，小便赤黄且或涩滞的，是热证。凡是谷物消化的，不论颜色和别的证候都算是热证，寒性泄泻而谷物消化的，是没有过的。或者火主疾速，而热盛则传化失常，谷物不能消化而变成飧泄的，也有这种情况。”又说：“痢疾属于热，热在肠胃，郁结而成，如果说下痢白色属寒，是错误的。如果果真是寒，就不能消化谷物，怎么反而化为脓呢？比如世上的谷物肉菜，湿热严重时自然腐烂化为浊水，所以食物在腹中感染湿热邪气，自然溃发，化为脓血。”
根据河间这种说法，似是而非，误导人不浅。夫泄泻白色属寒，人人都知道，而青色夹杂肝邪，脾虚的人有的，难道是热证吗？红色因损伤脏腑，阴络受伤的人有的，难道全是热吗？正黄色浅淡，食物半消化的有的，难道是热证吗？黑色是水色，元阳衰弱的人有的，难道是热证吗？像这些全都称为热，太不通达了。况且凡是泻痢，水走大肠，小水多涩滞，水枯液涸，便尿多黄，这种黄涩的证候未必全由热引起。亡津液者渴，亡阴者烦，这种烦渴的证候未必全是热。至于完谷不化，清澈清冷，确实是很大的寒证。然而人偶然受寒邪伤脏，或偶然吃生冷伤脾，稍微失去温和就生病泻痢的，这是本受寒，然而未必就是大寒证。况且凡是脾胃初伤，阳气还在，怎么能突然变得清冷，从而形成完谷不化？如果一定要等到清冷不化才说是寒，那么阳气已经大败。又难道没有逐渐变寒而突然到这种地步的吗？所谓逐渐变寒，就是寒证。这种证候，患病的人极多。如果当作热治，必然用寒凉药。既然前面因生冷受伤，后面又因寒凉败坏，以至于像冰霜一样坚硬而遭受厄运的，都是这个理论害死的。再看他前面的条文，还说泄泻白色属寒；看后面的条文，又说有人说下痢白色属寒是错误的。那么凡是治疗这个病的，除了清凉之外，就一定没有寒证了，谬误极大！谬误极大！又如寒则不能消谷，及谷物化为脓的说法，则更为不妥。饮食有时，本来应当快速消化，这是胃气的常态，人都依赖它来生存。如果消化觉得稍慢，就是阳虚的病，又何必要等到不能消谷才开始说是寒呢？况且所下的脓垢，原本就不是谷物所化的。大概饮食入胃，凡其神化而归于营卫的，才是膏血；那些不能消化而留在肠胃的，只是糟粕罢了。这成为精微还是秽物，本自不同的途径，所以糟粕不能化为脓，由此可知。况且垢也不是脓，而是肠脏的脂膏。怎么知道的呢？近来有人偶然生病服用硝黄等药的，随泻而下，必然有像脓一样的垢，又或者偶然患泄泻的，在一两天内，就有这种垢，难道是热化成的脓，速度有这么快吗？又如久痢不止，或经年累月不能痊愈，而每天所下的都有脓垢的，难道是热化成的脓，可以长久延续成这样吗？这显然不是脓，很明白了。既然知道不是脓，怎么能都说它是热？这大概是因肠脏受伤，导致膏脂不固，随着剥落而下，所以如此。如果不为之安养脏气，而再用寒凉药去治它的热，那么没有不脏气日益败坏，而必然至于死亡的。所以现在治疗痢疾多危重的，大都受此害，最应当考察。
一、河间说：“假如下痢赤白，俗话说是寒热相兼。这种说法尤其错误。哪里知道水火阴阳寒热，就像权衡一样，一高必一下，一盛必一衰。怎么可能寒热都在肠胃同时严重而共同导致痢疾呢？比如热生疮疡而出白脓的，难道可以把白色当作寒吗？因为它在皮肤之分，属肺金，所以色白。在血脉之分，属心火，所以是血疖。在肌肉，属脾土，所以作黄脓。在筋部，属肝木，所以脓色带苍。深至骨，属肾水，所以紫黑血出。各随五脏的部位而见五色，这叫标。本则一出于热，只是分深浅而已。大法下迫窘痛，后重里急，小便赤涩，都属于燥热，而下痢白色的必定多有，然而为热是很明显的。”
根据这种说法，用五色分五脏，其理颇为通达。如果说本则一出于热，则太不通达了。况且五脏之分五色之证，则还有精义，我顺着他的说法，一并详细说明。夫泻出于脏，无不本于脾胃，脾胃受伤，五气都能侵犯它。所以凡是兼红色的，是脾心证；兼青色的，是脾肝证；兼白色的，是脾肺证；兼黑色的，是脾肾证；正黄色的，是本脏证。如果以脾兼心，火乘土，其土多热，可以说火。以脾兼肝，土受克，其土多败，不是火。以脾兼肾，水反克，其土多寒，不是火。以脾兼肺，母气泄，其土多虚，不是火。本脏自病，脾受伤，其土多湿，不是火。这些兼证的盛衰，其逆顺有如此。况且凡是脾肾强的有实热，脾肾弱的皆虚寒，这是脏气可以辨别的。况且火本是热，而还有虚火实火的区别；风本是阳，而也有风热风寒的区别；土本乎中气，而也有湿热寒湿的区别。至于金的寒，水的冷，同归西北之化，则其寒多热少，是理所必致的。怎么能说五脏的痢，本则一出于热呢？因而导致寒证蒙冤的，这话不得不承担责任。另外赤白的含义详见后文丹溪条中。
一、河间说：“治疗各种痢疾，不如用辛苦寒药治疗，或者微微加辛热药佐使就可以了。大概辛热能发散开通郁结，苦能燥湿，寒能胜热，使气宣平罢了。比如钱乙香连丸之类的。所以治疗各种痢疾，黄连、黄柏为君药，以至苦大寒，正主治湿热之病。”
根据河间这种说法，对治疗痢疾危害最大。又看他所著的药性，说诸苦寒药多泄。只有黄连、黄柏，性冷而燥。所以自丹溪之后，相传至今。凡是治疗痢疾的，举世都用寒凉药，都是这个说法的错误。不用说其他的，姑且以“苦能燥湿”一句话来辨析，那么河间的见解就大错特错了。夫五味的道理，都出自《黄帝内经》，《黄帝内经》说：“以苦燥之”，是说苦的燥性。河间不能详细考察，便认为只要是苦就能燥，而不知道《黄帝内经》说苦，其性有二，其用有六。比如说：“火生苦。”说：“其类火，其味苦。”说：“少阳在泉为苦化，少阴在泉为苦化。”说：“湿淫于内，治以苦热；燥淫于内，治以苦温。”这些都是说苦的阳。说：“酸苦涌泄为阴。”说：“湿司于地，热反胜之，治以苦冷。”说：“湿化于天，热反胜之，治以苦寒。”这些都是说苦的阴。这是说性的二。又说：“以苦发之，以苦燥之，以苦温之，以苦坚之，以苦泄之，以苦下之”，这是说用的六。大概苦的发的，是麻黄、白芷、升麻、柴胡之类。苦的燥的，是苍术、白术、木香、补骨脂之类。苦的温的，是人参、附子、干姜、肉桂、吴茱萸、肉豆蔻、秦椒之类。苦的坚的，是续断、地榆、五味子、诃子之类。苦的泄的，是栀子、黄柏、黄芩、黄连、木通、胆草之类。苦的下（攻下）的，是大黄、芒硝之类。气化之道，只有阳则燥，只有阴则湿，这是不易的道理。难道像黄连、黄柏这样沉阴下降的，以至苦大寒的性质，还说它能燥，有这样的道理吗？这只是知道苦燥的一句话，而不考察苦发、苦温、苦坚、苦泄、苦下这五种，又是为什么呢？凡是医中的讹误，常有说是这样却不知道为什么会这样的，大抵像这样。因而导致后人治痢，多不分寒热虚实，动不动就用河间的方法，等到将死，还说什么血色如此，怎么敢用温药？腹痛如此，怎么敢用补药？死了也不醒悟，深深可哀啊。这是谁的过错呢？这是谁的过错呢？
一、河间肿胀条说：“肿胀，热胜则肿。比如六月湿热太甚而万物隆盛，那么水肿的意义明显可见了。”
根据这种说法，难道是这样吗？夫肿胀的病，因热的固然有，但因寒的也不少。大概因热的，是因为湿热壅滞，而阴道不利；因寒的，是因为寒湿停滞，而阳气不化。所以经文说：“脏寒生满病。”又说：“胃中寒则胀满。”这都是轩辕岐伯的话。由此看来，难道胀都是热病吗？况且万物隆盛，是太和的阳化，以此比拟形质的强壮则可以，以此比拟肿胀的病象，比拟也太低下粗浅了。
一、河间说：“战栗动摇，是火的征象。栗，是寒栗。有人说寒战是脾寒，是不明白变化的道理。这是由于心火热甚，亢极而战，反兼水化制之，所以寒栗。然而寒栗，是由火甚似水，实际上并不是兼有寒气。”
根据这种说法，那么凡是见到寒战都是火证，而为什么经文说阴胜则为寒。又说阳虚畏外寒。又说阳虚而阴盛，外无气，所以先寒栗。又说阳明虚则寒栗鼓颔？所有这些都属于经文所说，而河间全说是火，其是否正确可想而知。
一、河间说：“惊，是心卒动而不宁。所谓恐则喜惊，是恐则伤肾而水衰，心火自甚，所以喜惊。”
根据所说的：“恐则喜惊，恐则伤肾。”然而经文说：“肝气虚则恐”，又说：“恐则气下，惊则气乱。”夫肝气既虚，肾气既伤，而又见气下气乱，无非是阳气受伤的病。阳气既伤，那么心火怎么会突然旺盛而惊都是由火引起的呢？即使说恐则伤肾，不能滋养肝木，而肝虚则惊，又有什么不可以？况且肾水独衰的有，难道一定水衰即火盛吗？现在常见惊恐的人，必然阳痿遗溺，其虚可知。然而因火入心而惊的，固然也有，没有因恐而惊的，都可以指为火证，则违背事理太甚了。
一、河间说：“虚妄，是以心火热甚，则肾水衰而志不精一，所以神志失常，如见鬼神。或者以鬼神为阴，而见之则为阴极脱阳而无阳气者，这是妄意之言。”
根据这一种说法，那么凡是神魂失守而妄见妄言的，全是火证，也不然。夫邪火盛而阳狂见鬼的，固然有。又难道没有阳气太虚而阴邪为鬼的吗？《难经》说：“脱阴者，目盲。脱阳者，见鬼。”华元化说：“得其阳者生，得其阴者死。”难道都是妄意之言吗？为何如此自信呢？
[Background Information]
Book: Jingyue Quanshu (Complete Works of Zhang Jingyue) | Author: Zhang Jiebin (Zhang Jingyue) | Dynasty: Ming | Chapter: Bian Hejian (Differentiating He Jian, Item 28 of 9) | Category: Comprehensive
The pathogenesis listed in Liu Wansu's (He Jian) *Yuan Bing Shi* (Original Treatise on Disease Mechanisms) originally comes from the *Suwen: Zhi Zhen Yao Da Lun* chapter of the *Huangdi Neijing* (Yellow Emperor's Inner Canon). This chapter details the principles of the rise and fall, overcoming and retaliation of the Five Movements (Wu Yun) and Six Qi (Liu Qi), and summarizes the nineteen pathogenetic mechanisms at the end. It states: "For those that exist, investigate them; for those that do not exist, investigate them; excess should be drained, deficiency should be tonified, allowing harmony and smoothness to achieve peace." Thus, the discussed pathogenesis merely outlines the general principles of the movements and qi. The investigation of existence versus non-existence, and the differences between deficiency and excess, must be deeply examined, with peace being the ultimate goal. Therefore, the *Chang Wu Zheng Da Lun* chapter further elaborates on the differentiation of the Five Movements and Three Qi. The normal state of Fire is called *Sheng Ming* (Ascending Brightness); excessive Fire is called *He Xi* (Blazing Heat); deficient Fire is called *Fu Ming* (Hidden Brightness). The distinction between deficiency-fire and excess-fire is as different as ice and charcoal. The impartial way of the *Neijing* is indeed explained so clearly. However, He Jian failed to thoroughly understand the complete intent of this classic. He selectively extracted one hundred and seventy-six characters from the nineteen mechanisms, expanded them into two hundred and seventy-seven characters, failed to distinguish between deficiency and excess or examine rise and fall, and attributed all diseases to excess-fire, writing the *Yuan Bing Shi* which has been passed down to this day. While diseases caused by excess-fire are indeed fearful, diseases caused by deficiency-fire are even more so. Excess-fire is indeed suitable for cold-cooling treatments, and removing its root is not difficult; however, deficiency-fire strictly forbids cold-cooling treatments. If used recklessly, death is inevitable. Moreover, nowadays, people suffering from deficiency-fire are many, while those with excess-fire are few. Can they all be considered diseases of excess? How can one generally attribute them to fire? Looking back before the Tang and Song dynasties, medicine was never so biased. Since the emergence of the *Yuan Bing Shi*, Zhu Danxi obtained it in Dingcheng and regarded it as a supreme treasure. He subsequently wrote *Ju Fang Fa Hui* (Exposition of the Formulary) and theories such as "Yang is often in excess." Even Li Dongyuan, despite his brilliance, adopted the view that "fire and vital qi cannot coexist." Later, figures like Wang Jiezhai and Dai Yuanli followed this tradition, spreading it throughout the land. All current medical practitioners are essentially disciples of Liu Wansu and Zhu Danxi; they constantly talk about fire, unable to provide relief, often damaging patients' vital qi and destroying their primordial yang, killing people in the dark without anyone realizing it. Truly pitiable! Even if there are rare outstanding individuals who know it is wrong and cherish patients' yang qi, they will inevitably be attacked by those citing He Jian's theories. How can one distinguish right from wrong? Furthermore, pathogenesis serves as a guide for students; once they enter this school, they are like dreamers who cannot wake up, which is even more terrifying. No harm to the medical arts is greater than this. The source of this error must be investigated; therefore, I write this frankly and briefly differentiate it below.
1. He Jian discusses retching acid saying: "Acidity is the flavor of Liver Wood. It arises because excessive Fire controls Metal, failing to restrain Wood, causing Liver Wood to become excessive, thus manifesting as acidity." Yet common physicians advocate warming and harmonizing the Spleen and Stomach. Do they not know the classic states that when humans are injured by Cold pathogens, they develop heat diseases, etc.?
I believe that symptoms like retching acid and swallowing acid are entirely due to stagnation and failure to transform. And this stagnation and failure to transform is entirely due to Spleen-Stomach weakness. Since the Spleen Earth fails to transform, warming the Spleen and strengthening the Stomach is indispensable. How can this be considered excessive Fire? To recklessly cite classics as evidence, what error could be greater? This syndrome is detailed elsewhere in the section on Swallowing Acid; readers should cross-reference.
2. He Jian discusses diarrhea and dysentery saying: "Diarrhea with white discharge indicates Cold; green, red, yellow, crimson, and black indicate Heat. The general principle is to promote urination. Clear and white without astringency indicates Cold; red indicates Heat. Also, undigested food with unchanged color, vomit and stool that are fishy and offensive, clear and cold urine without astringency, cool body without thirst, and slow, fine, and faint pulse indicate Cold syndrome; undigested food but color changes from white, irritability and thirst, red-yellow and possibly astringent urine indicate Heat syndrome. Whenever food is digested, regardless of color or other symptoms, it is Heat. There has never been a case of Cold diarrhea where food is digested. Or perhaps Fire governs speed, and when Heat is excessive, transportation and transformation become abnormal, leading to undigested food in diarrhea (Sun Xie), which is possible." He also said: "Dysentery is Heat. Heat accumulates in the intestines and stomach, stagnating and knotting to form. Those who say white dysentery indicates Cold are mistaken. If it were truly Cold, it could not digest food, how could it turn into pus? Just as grains, meats, fruits, and vegetables rot and turn into turbid water under severe Damp-Heat, so too does food in the abdomen, infected by Damp-Heat pathogens, naturally ulcerate and turn into pus and blood."
Based on He Jian's theory, it is plausible yet incorrect, misleading people significantly. Everyone knows that white diarrhea indicates Cold. Green discharge involves Liver pathogenic factors; some cases arise from Spleen deficiency, are these Heat syndromes? Red discharge results from organ damage; some cases involve injury to Yin collaterals, are they all Heat? Pale yellow discharge with semi-digested food exists, is this Heat? Black is the color of Water; cases of Primordial Yang deficiency exist, are these Heat? To call all these Heat is extremely unreasonable. Moreover, in diarrhea and dysentery, water flows into the Large Intestine, urine becomes scanty and astringent, fluids dry up, and urine/stool become yellow. Such yellow and astringent symptoms do not necessarily stem from Heat. Loss of fluids causes thirst; loss of Yin causes irritability. Such irritability and thirst are not always Heat. As for undigested food, clear and cold, this is indeed severe Cold. However, if a person is occasionally injured by Cold pathogens or eats raw/cold foods harming the Spleen, developing diarrhea/dysentery upon slight loss of warmth, this originates from Cold but may not be a severe Cold syndrome. If Spleen-Stomach is initially injured but Yang Qi remains, how can it suddenly become clear and cold, forming undigested food? If one waits until clear and cold undigested food appears to diagnose Cold, then Yang Qi is already severely defeated. Are there no cases of gradual Cold progressing rapidly to this state? Gradual Cold is simply a Cold syndrome. Many suffer from such conditions. If treated as Heat using cold-cooling herbs, after being injured by raw/cold foods previously, one is then ruined by cold-cooling herbs afterwards, suffering like ice enduring frost. These deaths are caused by this theory. Looking at his earlier statement, he said white diarrhea is Cold; looking at later statements, he said claiming white dysentery is Cold is an error. Thus, for treating this, apart from cooling, there are no Cold syndromes left. How erroneous! How erroneous! Furthermore, the ideas that Cold prevents digestion and that food turns into pus are particularly inappropriate. Food should digest quickly according to timing; this is the normal function of Stomach Qi, upon which life depends. If digestion seems slightly slow, it is a disease of Yang deficiency. Why wait until digestion fails to label it Cold? Moreover, the pus-like discharge is not derived from food. When food enters the Stomach, what transforms and nourishes Ying and Wei becomes essence and blood; what fails to transform and remains in the intestines/stomach is merely dregs. Essence and waste follow different paths; thus, dregs cannot turn into pus, as can be seen. Also, this discharge is not pus but the fat/grease of the intestines and organs. How do we know? Recently, someone taking minerals like Niter and Mirabilite had discharge resembling pus. Or someone with acute diarrhea developed this discharge within one or two days. Could heat-transformed pus appear so quickly? For chronic dysentery lasting years with daily pus-like discharge, could heat-transformed pus persist so long? Clearly, this is not pus. Knowing it is not pus, how can it all be called Heat? This is likely due to intestinal/organ injury causing grease to loosen and fall off. If one does not nourish the organ Qi but uses cold-cooling herbs to treat 'Heat', organ Qi will deteriorate daily, leading to death. Most critical dysentery cases today suffer from this harm; this must be carefully observed.
3. He Jian said: "Suppose dysentery with red and white discharge; laypeople say this is mixed Cold and Heat. This view is especially wrong. Do they not know that Water/Fire, Yin/Yang, Cold/Heat are like a balance beam; high implies low, excess implies deficiency. How can Cold and Heat both be excessive in the intestines/stomach simultaneously causing dysentery? For example, heat-generated sores producing white pus—can white be considered Cold? Because it is in the skin layer, belonging to Lung Metal, hence white. In blood vessels, belonging to Heart Fire, hence blood boils. In muscles, belonging to Spleen Earth, hence yellow pus. In tendons, belonging to Liver Wood, hence greenish pus. Deep in bones, belonging to Kidney Water, hence purple-black blood. Each follows the Five Zang locations showing five colors; this is the branch (Biao). The root (Ben) is solely Heat, differing only in depth. General principles: tenesmus, urgency, pain, red/astringent urine all belong to Dryness-Heat. White dysentery is very common, yet it is clearly Heat."
According to this, differentiating five colors by five Zang organs has some logic. But claiming the root is solely Heat is highly unreasonable. Regarding the five colors corresponding to five Zang organs, there is profound meaning; I will elaborate following his theory. Diarrhea originates from Zang organs, fundamentally rooted in Spleen-Stomach. Spleen-Stomach injury can be caused by any of the Five Qi. Thus, red involvement indicates Spleen-Heart syndrome; green indicates Spleen-Liver; white indicates Spleen-Lung; black indicates Spleen-Kidney; pure yellow indicates the Spleen itself. If Spleen involves Heart, Fire attacks Earth, Earth is hot, so calling it Fire is acceptable. If Spleen involves Liver, Earth is controlled, Earth is damaged, not Fire. If Spleen involves Kidney, Water counter-controls, Earth is cold, not Fire. If Spleen involves Lung, Mother Qi leaks, Earth is deficient, not Fire. Spleen self-disease, Spleen injured, Earth is damp, not Fire. The rise and fall of these combined syndromes have such reversals. Moreover, strong Spleen-Kidney have Excess Heat; weak Spleen-Kidney have Deficiency Cold; this distinguishes Organ Qi. Fire is inherently Hot, yet differs in Deficiency vs Excess Fire; Wind is inherently Yang, yet differs in Wind-Heat vs Wind-Cold; Earth is Central Qi, yet differs in Damp-Heat vs Damp-Cold. Metal's Cold and Water's Cold return to Northwest transformation, implying more Cold than Heat, which is logical. How can one say all five-Zang dysenteries originate solely from Heat? This causes Cold syndromes to suffer injustice; this statement bears responsibility. The meaning of red and white is detailed in the subsequent Danxi section.
4. He Jian said: "To treat various dysenteries, nothing is better than bitter-pungent-cold herbs, or slightly adding pungent-hot auxiliaries. Pungent-hot disperses and opens stagnation; Bitter dries Dampness; Cold overcomes Heat, making Qi smooth and peaceful. Examples include Qian Yi's Xiang Lian Wan. Thus, for dysentery, Huang Lian (Coptis Rhizome) and Huang Bo (Phellodendron Bark) are sovereign herbs, extremely bitter and cold, primarily treating Damp-Heat diseases."
This view is most harmful to dysentery treatment. In his materia medica notes, he says most bitter-cold herbs drain. Only Huang Lian and Huang Bo are cold and drying. Since Danxi, this has been transmitted. Worldwide, dysentery is treated with cold-cooling herbs due to this error. Let us analyze just the phrase "Bitter dries Dampness," revealing He Jian's major error. The theory of five flavors comes from the *Neijing*. The *Neijing* says: "Use Bitter to dry," referring to the drying nature of Bitter. He Jian failed to investigate thoroughly, assuming all Bitter dries, unaware that the *Neijing* describes two natures and six functions of Bitter. E.g., "Fire generates Bitter," "Its category is Fire, its flavor is Bitter," "Shaoyang in泉 transforms as Bitter, Shaoyin in泉 transforms as Bitter," "Dampness invading interior, treat with Bitter-Hot; Dryness invading interior, treat with Bitter-Warm." These refer to the Yang aspect of Bitter. "Sour and Bitter induce vomiting/draining are Yin," "Dampness governs Earth, Heat counter-wins, treat with Bitter-Cold," "Dampness transforms from Heaven, Heat counter-wins, treat with Bitter-Cold." These refer to the Yin aspect. These are the two natures. Also: "Use Bitter to vent, Bitter to dry, Bitter to warm, Bitter to firm, Bitter to drain, Bitter to purge." These are the six functions. Bitter-venting includes Ma Huang (Ephedra Herba), Bai Zhi (Angelicae Dahuricae Radix), Sheng Ma (Cimicifugae Rhizoma), Chai Hu (Bupleuri Radix). Bitter-drying includes Cang Zhu (Atractylodis Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Mu Xiang (Aucklandiae Radix), Bu Gu Zhi (Psoraleae Fructus). Bitter-warming includes Ren Shen (Ginseng Radix), Fu Zi (Aconiti Lateralis Radix Preparata), Gan Jiang (Zingiberis Rhizoma), Rou Gui (Cinnamomi Cortex), Wu Zhu Yu (Evodiae Fructus), Dou Kou (Myristicae Semen), Qin Jiao (Gentianae Macrophyllae Radix). Bitter-firming includes Xu Duan (Dipsaci Radix), Di Yu (Sanguisorbae Radix), Wu Wei Zi (Schisandrae Fructus), He Zi (Terminalia Chebulae Fructus). Bitter-draining includes Zhi Zi (Gardeniae Fructus), Bo (Phellodendri Cortex), Qin (Scutellariae Radix), Lian (Coptidis Rhizoma), Mu Tong (Akebiae Caulis), Dan Cao (Gentianae Radix). Bitter-purging includes Da Huang (Rhei Radix et Rhizoma), Mang Xiao (Natrii Sulfas). The way of Qi transformation: only Yang dries, only Yin moistens; this is immutable. How can sinking, Yin-descending herbs like Huang Lian and Huang Bo, being extremely bitter and cold, still be said to dry? This only knows "Bitter dries" but ignores Bitter-vent, Bitter-warm, Bitter-firm, Bitter-drain, Bitter-purge. Medical errors often claim something is so without knowing why, similar to this. Consequently, later doctors treating dysentery often fail to distinguish Cold/Heat/Deficiency/Excess, blindly applying He Jian's methods. Near death, they say, "Blood color is like this, how dare I use Warmth?" "Abdominal pain is like this, how dare I use Tonification?" They die unawakened, deeply lamentable. Whose fault is it? Whose fault is it?
5. He Jian's swelling section says: "Swelling: Excessive Heat causes swelling. Like June when Damp-Heat is extreme and all things flourish, the meaning of edema is clearly visible."
Is this true? Swelling diseases caused by Heat exist, but those caused by Cold are no less frequent. Heat-induced swelling is due to Damp-Heat obstruction blocking Yin pathways; Cold-induced swelling is due to Cold-Damp stagnation preventing Yang transformation. Hence the classic says: "Cold in Zang generates fullness diseases." And: "Cold in Stomach causes distension." These are words of Yellow Emperor and Qi Bo. Thus, is all distension a Heat disease? Comparing flourishing things to robust physique is okay, but comparing it to swelling pathology is crude.
6. He Jian said: "Trembling and shaking are images of Fire. 'Li' refers to shivering from cold. Some say cold chills are Spleen Cold, misunderstanding transformation. This is due to excessive Heart Fire, hyperactive trembling, counter-assimilating Water transformation to control it, hence cold shivering. However, cold shivering arises from Fire appearing like Water; it is not actually accompanied by Cold pathogen."
If so, all cold chills are Fire syndromes. Yet the classic says: "Yin excess leads to Cold." "Yang deficiency fears external Cold." "Yang deficiency and Yin excess, lack of external Qi, hence first cold shivering." "Yangming deficiency leads to cold shivering and jaw quivering." All these are classic statements, yet He Jian attributes them all to Fire. Whether correct is evident.
7. He Jian said: "Jing (Fright) is sudden heart movement and unrest. 'Fear leads to fright': Fear injures Kidney, Water declines, Heart Fire becomes excessive, hence prone to fright."
Regarding "Fear leads to fright, Fear injures Kidney": The classic says: "Liver Qi deficiency leads to fear," and "Fear causes Qi to sink, Fright causes Qi to scatter." If Liver Qi is deficient and Kidney Qi injured, resulting in sinking and scattering Qi, these are injuries to Yang Qi. With injured Yang Qi, how can Heart Fire suddenly become excessive and all fright be attributed to Fire? Even if Fear injures Kidney, failing to nourish Liver Wood, leading to Liver deficiency and fright, is this not valid? Cases of isolated Kidney Water decline exist; does Water decline always mean Fire excess? Often, frightened people show impotence and enuresis, indicating deficiency. While Fire entering Heart causing fright exists, attributing all fright from fear to Fire contradicts reason greatly.
8. He Jian said: "Delusion: Excessive Heart Fire causes Kidney Water decline and unfocused Will (Zhi), leading to abnormal spirit/mind, seeing ghosts/spirits. Some say ghosts are Yin, seeing them means Extreme Yin releasing Yang and lacking Yang Qi; this is speculative nonsense."
If so, all delusions from lost spirit/mind are Fire syndromes, which is incorrect. Excessive evil fire causing mania and seeing ghosts exists. But do cases of extreme Yang deficiency with Yin pathogens manifesting as ghosts not exist? The *Nan Jing* says: "Loss of Yin causes blindness. Loss of Yang causes seeing ghosts." Hua Yuanyou said: "Gain Yang to live, gain Yin to die." Are these all speculative nonsense? Why such arrogance?