《素问·奇病论》帝曰∶人有重身,九月而喑,此为何也?岐伯曰∶胞之络脉绝也。帝曰∶何以言之?
岐伯曰∶胞络者,系于肾,少阴之脉,贯肾系舌本,故
不能言。帝曰∶治之奈何?岐伯曰∶无治也,当十月复。《刺法》曰∶无损不足,益有余,以成其疹,然后
调之。所谓无损不足者,身羸瘦,无用 石也;无益其有余者,腹中有形而泄之,泄之则精去,而病独擅
中,故曰成疹也。
身重者,孕妇也;喑者,失音也;胞之络脉绝者,言脉气阻绝不通,非断绝之绝。此因胎大压其胞脉,致
少阴肾经之气,不得上贯于舌而喑也。俟十月产后,脉通气复自愈,无用治也。若强治之,反损其正之不足,
而益其病之有余,以成其疹,疹者,痼疾难愈也。然其由胎大之故,则亦无法可治之矣。
《素问·咳论》帝曰∶肺之令人咳,何也?岐伯曰∶五脏六腑皆令人咳,非独肺也。皮毛者,肺之合也,
皮毛先受邪气,邪气以从其合也。其寒饮食入胃,从肺脉上至于肺,则肺寒,肺寒则外内合邪,因而客之,则
为肺咳。五脏各以其时受病,非其时各传以与之。人与天地相参,故五脏各以治时,感于寒则受病,微则为咳,
甚则为泄为痛。乘秋则肺先受邪,乘春则肝先受之,乘夏则心先受之,乘至阴则脾先受之,乘冬则肾先受之。
肺为华盖而朝百脉,主一身之气,故各脏腑之气,皆由经脉汇于肺,而行周身。五脏六腑皆令人咳者,以所受之邪,随
气而归于肺也。皮毛为肺之合,皮毛先受邪,则邪
气以从其合,必入于肺。其寒饮食入胃,亦从经脉上达于肺,则肺寒,而与外邪相合客之,则为肺咳也。人生
天地气交之中,故与天地相参,五脏禀五行之气,以治五时,各以其时而受外邪。若非肺脏主令之时,而各脏
所受之邪,皆随气而传于肺。假如感寒而微,则为咳,甚则为泄泻、为腹痛也。肺金主秋,肝木主春,心火主
夏,脾土为至阴,而主长夏未月,肾水主冬,皆各以其时而先受邪,邪之变化多端,皆能传肺而致咳。故治咳
者,其邪有寒热,气有虚实,必审其所因。下文即明其病状也。
黄帝问道:怀孕的人到了第九个月出现声音嘶哑甚至失音,这是什么原因呢?岐伯回答说:这是因为胞宫的络脉气血阻滞不通。黄帝问:为什么这样说呢?
岐伯说:胞宫的络脉与肾相连,足少阴肾经贯穿肾脏并联系舌根,所以会导致不能说话。黄帝问:该怎么治疗呢?岐伯说:不需要治疗,等到第十个月分娩后自然会恢复。《刺法》中说:不要损伤正气不足的人,也不要补益邪气有余的人,否则会导致病情加重形成痼疾,然后再进行调理。所谓不要损伤正气不足,是指身体消瘦虚弱的人,不要用砭石等攻伐疗法;不要补益邪气有余,是指腹中有形积滞而误用泻法,泻法则精气耗散,病邪独留于体内,所以说会形成痼疾。
身重,指的是孕妇;喑,指的是失音;胞之络脉绝,是指脉气阻滞不通,并非断绝之意。这是因为胎儿过大压迫了胞宫脉络,导致足少阴肾经之气无法上达舌根而致失音。等到十月产后,脉气通畅即可自愈,无需治疗。如果强行治疗,反而损伤本已不足的正气,助长病邪的有余,从而形成痼疾,痼疾即指顽固难愈的疾病。然而由于这是由胎大引起的,也就没有特殊的治法了。
黄帝问道:肺脏使人咳嗽,是什么原因呢?岐伯回答说:五脏六腑都能使人咳嗽,不仅仅是肺脏。皮毛是肺的外合,皮毛先受邪气侵袭,邪气便顺着经络内传于肺。如果寒凉饮食进入胃中,寒气会沿着肺脉上行至肺,导致肺寒,肺寒则外感风寒与内伤生冷相互结合,邪气客居其中,就会形成肺咳。五脏各自在其所主的季节感受病邪,如果不是其主令的季节,其他脏腑的病邪也会随气机传变给肺。人与天地相应,所以五脏各自在其所主的时节,感受寒邪则发病,轻微的就表现为咳嗽,严重的则表现为泄泻或疼痛。
秋季肺气当令,故肺先受邪;春季肝气当令,故肝先受邪;夏季心气当令,故心先受邪;长夏脾气当令,故脾先受邪;冬季肾气当令,故肾先受邪。肺为华盖,朝会百脉,主管一身之气,因此各脏腑的气血都通过经脉汇聚于肺,然后运行周身。五脏六腑都能使人咳嗽,是因为它们所受的邪气,随着气机的运行归于肺脏。皮毛是肺之外合,皮毛先受邪气,邪气便顺着外合而入肺。寒凉饮食入胃,也通过经脉上达于肺,导致肺寒,与外邪相结合客居于肺,就形成肺咳。人生于天地气交之中,故与天地相应,五脏禀受五行之气以应五时,各自在其所主的时节感受外邪。如果不是肺脏主令的时节,其他脏腑所受的邪气,都会随着气机传变于肺。假如感受寒邪较轻,就表现为咳嗽;严重的话,则表现为泄泻、腹痛。肺属金主秋,肝属木主春,心属火主夏,脾属土为至阴主长夏六月,肾属水主冬,各自在其所主的时节先受邪气,邪气的变化多端,都能传变至肺而导致咳嗽。所以治疗咳嗽,必须审察邪气有寒热之分,气机有虚实之别,务必查明病因。下文将具体说明各种咳嗽的症状。
The Yellow Emperor asked: Why does a woman who is pregnant lose her voice in the ninth month? Qibo replied: This is because the collateral vessels of the uterus are obstructed. The Yellow Emperor asked: Why do you say so?
Qibo said: The collateral vessels of the uterus are connected to the Kidney. The Foot-Shaoyin Kidney Meridian passes through the Kidney and connects with the root of the tongue; therefore, it results in the inability to speak. The Yellow Emperor asked: How should this be treated? Qibo said: No treatment is needed; it will recover naturally after the tenth month (delivery). The *Ci Fa* (Methods of Acupuncture) states: Do not damage what is insufficient, nor benefit what is excessive, lest you create a chronic disease (*zhen*), and only then attempt to regulate it. To "not damage what is insufficient" means that for those who are emaciated and weak, one should not use stone lancets or other aggressive therapies; to "not benefit what is excessive" means that if there is a palpable mass in the abdomen and one mistakenly uses purgation, purgation will deplete the essence, leaving the pathogen dominant within, thus creating a chronic disease.
"Heaviness of the body" refers to pregnancy; "yin" refers to loss of voice; "obstruction of the collateral vessels of the uterus" means that the qi and blood flow in the vessels are blocked, not severed. This occurs because the large fetus compresses the uterine collaterals, preventing the qi of the Foot-Shaoyin Kidney Meridian from ascending to the tongue, resulting in aphonia. After delivery in the tenth month, when the vessel qi becomes unblocked, it will heal spontaneously without treatment. If forced treatment is applied, it will instead damage the already insufficient healthy qi and exacerbate the excess pathogenic factor, thereby forming a chronic disease. A chronic disease (*zhen*) refers to an entrenched illness that is difficult to cure. However, since this condition is caused by the size of the fetus, there is no specific treatment required.
The Yellow Emperor asked: Why does the Lung cause coughing? Qibo replied: All five zang organs and six fu organs can cause coughing, not just the Lung. The skin and hair are the exterior correspondence of the Lung. When the skin and hair are first attacked by pathogenic factors, the pathogens follow the correspondence to enter the Lung. If cold food and drink enter the Stomach, the cold travels up along the Lung meridian to the Lung, causing Lung cold. When the Lung is cold, external and internal pathogens combine and lodge within, resulting in Lung cough. Each of the five zang organs contracts disease in its respective season; if it is not their season, pathogens from other organs may transmit to the Lung. Humans correspond to Heaven and Earth; thus, each zang organ contracts disease in its governing season upon exposure to cold. Mild cases manifest as cough, while severe cases manifest as diarrhea or pain.
In Autumn, the Lung is first to contract the pathogen; in Spring, the Liver; in Summer, the Heart; during the late summer (the earth element), the Spleen; and in Winter, the Kidney. The Lung acts as the canopy, receiving all meridians, and governs the qi of the whole body. Therefore, the qi of all zang and fu organs converges in the Lung via the meridians and circulates throughout the body. The reason why all five zang and six fu organs can cause coughing is that the pathogens they contract follow the qi mechanism and return to the Lung. Since the skin and hair are the exterior correspondence of the Lung, pathogens attacking them first enter the Lung. Cold food entering the Stomach also reaches the Lung via the meridians, causing Lung cold. Combined with external pathogens lodging in the Lung, this results in Lung cough. Humans live within the intersection of heaven and earth qi, corresponding to nature. The five zang organs inherit the qi of the Five Phases to govern the five seasons, contracting external pathogens in their respective seasons. Even if it is not the season governed by the Lung, pathogens contracted by other organs will transmit to the Lung following the qi movement. For example, mild cold contraction leads to cough, while severe cases lead to diarrhea and abdominal pain. Metal of the Lung governs Autumn, Wood of the Liver governs Spring, Fire of the Heart governs Summer, Earth of the Spleen is the ultimate yin governing the sixth month of late summer, and Water of the Kidney governs Winter. Each contracts pathogens first in its season. Pathogens change in myriad ways but can all transmit to the Lung causing cough. Therefore, treating cough requires examining whether the pathogen is cold or hot, and whether the qi is deficient or excess, strictly determining the etiology. The following text clarifies the symptoms of these conditions.