胃风之状,颈多汗,恶风,饮食不下,膈塞不通,腹善满,失衣则 胀,食寒则泄,诊形瘦而腹大。
颈两旁人迎,胃脉也,故汗偏多于颈;风邪阻胃,故食饮不下,膈塞腹满也;失衣则又加外寒,故 胀;
食寒则又加内寒,故泄泻;正伤肉消,故形瘦;邪壅于中,故腹大也。
首风之状,头面多汗恶风,当先风一日则病甚,头
痛不可以出内,至其风日,则病少愈。漏风之状,或多汗,常不可单衣,食则汗出,甚则身汗,喘息恶风,衣
常濡,口干善渴,不能劳事。泄风之状,多汗,汗出泄衣上,口中干,上渍其风,不能劳事,体尽痛,则寒。
此申上文首风、漏风、泄风之状也。首风因新沐而邪中之,不及他处,头应天气,天将起风,而人应之,
故先一日头痛恶风,甚不可以出内,至发风日,其气外泄,则少愈也。漏风者,腠理疏漏,风邪易入难去,
表虚,故不可单衣,食则气泄汗出,甚则身常多汗,喘息恶风,肺气虚也,汗多津耗,故口干善渴,气伤,故
不能劳事也。漏风由饮酒而得,泄风因表虚而得,表虚,故劳则体尽痛而汗出,汗出则阳泄,故寒,余同漏
风也。
《灵枢·五变篇》帝曰∶人之善病风厥漉汗者,何以候之?少俞曰∶肉不坚,腠理疏,则善病风。帝曰∶
何以候肉之不坚也?少俞曰∶ 肉不坚而无分理者,粗理而皮不致者,腠理疏。此言其浑然者。
肉不坚而腠理疏,风邪易入,故善病风而汗多如水漉,名漉汗。膝后曲处为 , 肉不坚而无分理,或
理粗,则其皮不致密而腠理疏矣。浑然者,即无分理之谓也。
《素问·评热病论》帝曰∶有病身热汗出烦满,烦满不为汗解,此为何病?岐伯曰∶汗出而身热者,风
也;汗出而烦满不解者,厥也,病名曰风厥。帝曰∶愿卒闻之。岐伯曰∶巨阳主气,故先受邪,少阴与其为表
里也,得热则上从之,从之则厥也。帝曰∶治之奈何?岐伯曰∶表里刺之,饮之服汤。
此即仲景所云风伤卫之病也。风为阳邪,性疏泄,故自汗,而烦满不为汗解者,以太阳名巨阳,统营卫而
主一身之表,其经内通少阴,故为表里,因太阳风邪化热,而少阴之气上从,上从者,上逆也,上逆而阴并于
阳,则上实下虚,上实则烦满不解,下虚则足冷而厥,因风邪所致,故名风厥。是当表里兼治,既刺以解表,
服汤以和里也。
胃受风邪的症状,表现为颈部多汗,怕风,饮食难以下咽,胸膈阻塞不通畅,腹部容易胀满,受凉后腹胀加重,吃冷食则导致腹泻,诊察时可见形体消瘦而腹部膨大。
颈旁的人迎穴处是胃经脉气所在之处,所以汗液偏多于颈部;风邪阻滞胃腑,所以饮食难以下咽,出现胸膈阻塞和腹部胀满;若未添衣保暖则外寒侵袭,所以腹胀加剧;若进食寒凉食物则内寒增加,所以发生泄泻;正气受损肌肉消减,所以形体消瘦;邪气壅滞于中焦,所以腹部膨大。
首风的症状,表现为头面部多汗且怕风,往往在起风的前一天病情加重,头痛剧烈以至于不能外出或进入室内,到了起风的日子,病情会稍微减轻。漏风的症状,表现为多汗,经常不能穿单衣,吃饭时出汗,严重时全身出汗,气喘怕风,衣服常常被汗水浸湿,口干喜欢喝水,不能从事体力劳动。泄风的症状,表现为多汗,汗水流出浸湿衣服,口中干燥,风邪浸渍体表,不能从事体力劳动,全身疼痛,伴有恶寒感。
以上是对前文所述首风、漏风、泄风症状的总结。首风是因为刚洗头后风邪乘虚而入,病位局限于头部,因为头为诸阳之会应合天气,当天气将要起风时,人体与之相应,所以在起风前一天出现头痛怕风,严重到不能外出或入内,等到真正起风的日子,邪气随汗外泄,病情就会稍有好转。漏风是由于腠理疏松如漏洞,风邪容易侵入却难以排出,表虚,所以不能穿单衣,进食时气机外泄导致出汗,严重时身体常多汗,气喘怕风,这是肺气虚的表现,汗多耗伤津液,所以口干喜饮,气机受损,所以不能从事体力劳动。漏风多由饮酒引起,泄风因表虚所致,表虚则劳作时全身疼痛并出汗,出汗则阳气外泄,所以感到寒冷,其余症状与漏风相同。
《灵枢·五变篇》黄帝问:人容易患风厥和漉汗病的,如何诊断?少俞回答说:肌肉不坚实,腠理疏松,就容易患风病。黄帝问:如何判断肌肉不坚实呢?少俞回答说:肌肉不坚实且没有纹理分界的,纹理粗糙且皮肤不致密的,就是腠理疏松。这里说的是浑然一体的情况。
肌肉不坚实且腠理疏松,风邪容易侵入,所以容易患风病且汗出如水渗下,称为漉汗。膝后的弯曲处(腘窝)肌肉不坚实且没有纹理分界,或者纹理粗糙,那么皮肤就不致密而腠理疏松。所谓“浑然”,就是指没有纹理分界的意思。
《素问·评热病论》黄帝问:有一种病,身体发热,出汗后烦闷胀满,但出汗后烦闷胀满并不缓解,这是什么病?岐伯回答说:出汗而身体发热的,是风邪致病;出汗后烦闷胀满不缓解的,是厥逆,这种病名叫风厥。黄帝说:我想详细听听其中的道理。岐伯回答说:太阳经主司一身之气,所以首先受到邪气侵袭,少阴经与太阳经互为表里,感受热邪后,少阴之气向上顺从太阳,顺从太过则发生厥逆。黄帝问:怎么治疗?岐伯回答说:对表里两经进行针刺,并服用汤药。
这就是张仲景所说的风伤卫气的病证。风为阳邪,性质疏泄,所以自汗,而烦闷胀满不因出汗而缓解的原因,是因为太阳经名为巨阳,统摄营卫并主管一身之表,其经脉内部连通少阴,所以互为表里。由于太阳风邪化热,导致少阴之气上逆,所谓上逆,就是向上冲逆,阴气并入阳气,则上部实而下部虚,上部实则烦闷胀满不缓解,下部虚则脚冷而发生厥逆,因风邪所致,所以名叫风厥。此时应当表里兼治,既通过针刺解表,又通过服汤药调和里气。
The manifestations of Wind affecting the Stomach include excessive sweating on the neck, aversion to wind, difficulty in swallowing food and drink, obstruction and blockage in the chest and diaphragm, frequent abdominal distension, worsening of distension when exposed to cold without adequate clothing, diarrhea after consuming cold food, and upon examination, a thin body with a distended abdomen.
The Yingjing (ST9) acupoint on both sides of the neck is where the Stomach meridian qi resides; therefore, sweat tends to be more abundant on the neck. When Wind pathogen obstructs the Stomach, food and drink cannot pass down, leading to chest/diaphragmatic obstruction and abdominal fullness. Exposure to cold due to inadequate clothing adds external Cold, causing increased distension. Consuming cold food adds internal Cold, resulting in diarrhea. Damage to righteous Qi leads to muscle wasting, hence the thin body; pathogenic stagnation in the middle jiao causes the distended abdomen.
The manifestations of Shou Feng (Head Wind) include excessive sweating on the head and face with aversion to wind. The condition typically worsens one day before the wind arises, with severe headache preventing going out or entering indoors. On the day the wind actually blows, the condition improves slightly. The manifestations of Lou Feng (Leaking Wind) include excessive sweating, inability to wear single-layer clothes normally, sweating during meals, and in severe cases, whole-body sweating, panting, aversion to wind, constantly damp clothes, dry mouth with frequent thirst, and inability to perform physical labor. The manifestations of Xie Feng (Draining Wind) include excessive sweating that soaks the clothes, dry mouth, wind pathogen infiltrating the surface, inability to perform physical labor, generalized body pain, and aversion to cold.
This summarizes the symptoms of Shou Feng, Lou Feng, and Xie Feng mentioned earlier. Shou Feng occurs when Wind pathogen invades shortly after bathing, affecting only the head. Since the head corresponds to Heaven's Qi, when weather is about to become windy, the human body responds accordingly. Thus, headache and aversion to wind occur one day prior, severe enough to prevent going out or in. On the day the wind rises, the pathogenic Qi escapes outward through sweat, leading to slight improvement. Lou Feng results from loose and leaky couli (pores/skin texture), allowing Wind pathogen to enter easily but exit with difficulty. Due to exterior deficiency, single-layer clothes are not tolerated. Eating causes Qi leakage and sweating; severely, the body sweats excessively, accompanied by panting and aversion to wind, indicating Lung Qi deficiency. Excessive sweating consumes fluids, causing dry mouth and thirst. Qi damage prevents physical labor. Lou Feng is often caused by drinking alcohol. Xie Feng arises from exterior deficiency. With exterior deficiency, labor causes generalized pain and sweating; sweating leads to Yang leakage, causing cold sensations. Other symptoms resemble those of Lou Feng.
In *Ling Shu: Wu Bian Pian* (Five Changes Chapter of the Spirit Pivot), the Yellow Emperor asked: How can we diagnose those prone to Feng Jue (Wind Jue) and Lu Han (Dripping Sweat)? Shao Yu replied: Those whose muscles are not firm and whose couli are loose are prone to Wind diseases. The Yellow Emperor asked: How can we identify non-firm muscles? Shao Yu replied: Non-firm muscles without distinct tissue lines indicate coarse texture and loose skin, meaning loose couli. This refers to a homogeneous appearance. Non-firm muscles and loose couli allow Wind pathogen to invade easily, causing susceptibility to Wind disease and profuse sweating like dripping water, termed Lu Han. The area behind the knee (popliteal fossa) should have firm muscles. If muscles there are non-firm without tissue lines, or if the texture is coarse, the skin is not dense and couli are loose. "Homogeneous" here means lacking distinct tissue lines.
In *Su Wen: Ping Re Bing Lun* (Discussion on Evaluating Heat Diseases Chapter of the Basic Questions), the Yellow Emperor asked: There is a disease characterized by fever, sweating, irritability, and fullness, where sweating does not relieve the irritability and fullness. What is this disease? Qi Bo replied: Fever with sweating indicates Wind. Irritability and fullness persisting despite sweating indicate Jue (reversal). This disease is named Feng Jue. The Yellow Emperor requested further explanation. Qi Bo replied: The Taiyang (Greater Yang) meridian governs the body's Qi and is thus the first to receive pathogenic invasion. Shaoyin (Lesser Yin) is its interior-exterior pair. When heat is received, Shaoyin Qi follows upward; following too much leads to Jue. The Yellow Emperor asked: How should it be treated? Qi Bo replied: Needle both the exterior and interior meridians, and administer herbal decoctions.
This corresponds to Zhang Zhongjing's description of Wind damaging Wei Qi. Wind is a Yang pathogen with a dispersing nature, causing spontaneous sweating. The reason irritability and fullness do not resolve with sweating is that Taiyang, also called Ju Yang (Giant Yang), controls Ying and Wei Qi and governs the exterior of the body. Its meridian internally connects with Shaoyin, forming an interior-exterior relationship. Because Wind pathogen in Taiyang transforms into Heat, Shaoyin Qi follows upward. "Following upward" means counter-flowing upward. Yin merges with Yang, resulting in excess above and deficiency below. Excess above causes persistent irritability and fullness; deficiency below causes cold feet and Jue. Caused by Wind pathogen, it is named Feng Jue. Treatment requires addressing both exterior and interior: needling to release the exterior and taking decoctions to harmonize the interior.