反,津液久留,合而为肠溜,久者,数岁乃成,以手按之柔;已有所结,气归之,津液留之,邪气中之,凝结
日以易甚,速以聚居,为昔瘤,以手按之坚;有所结,深中骨,气因于骨,骨与气并,日以益大,则为骨疽;
有所结,中于肉,宗气归之,邪留而不去,有热则化而为脓,无热则为肉疽。凡此数气者,其发无常处,而有
常名也。
此言人身阴阳气血而中贼风,日久深沉,寒热相结,在阴则寒胜,在阳则热胜,寒胜则骨疼肉枯,热胜则
烂肉腐肌而为脓,内伤于骨,则骨损如虫蚀也。上言邪搏于筋而筋挛,即屈不能伸,邪居其间,则发为筋溜,同
瘤也;邪气内结,卫气留滞,津液不输,与邪合而结成肠瘤,久者,数岁乃成;初起按之尚柔,已有所结,则
气日以归,而津液留之,邪气中之,故凝结日易而成昔瘤,谓由宿昔渐结,故云数岁乃成,于是按之坚矣;如邪
深中于骨,气因循骨而行者,与邪并结,日以益大,则为骨疽也;
宗气本温分肉者也,邪中于肉,则宗气归之,邪留不去,有热则肉化成脓,无热则结为肉疽,故有热为痈,无
热为疽,疽为阴证,痈为阳证也。凡此邪气中人发病,无一定之常处,及其成病,则有一定之常名,因名以辨
阴阳、表里、寒热而治之也。
《灵枢·论勇篇》帝曰∶有人于此,并行并立,其年之少长等也,衣之浓薄均也,卒然遇烈风豪雨,或
病,或不病,或皆病,或皆不病,其故何也?少俞曰∶春青风,夏阳风,秋凉风,冬寒风,凡此四时之风者,
其所病各不同形。黄色薄皮弱肉者,不胜春之虚风;白色薄皮弱肉者,不胜夏之虚风;青色薄皮弱肉者,不胜
秋之虚风;赤色薄皮弱肉者,不胜冬之虚风也。帝曰∶黑色不病乎?少俞曰∶黑色而皮浓肉坚固,不伤于四时
之风。其皮薄而肉不坚,色不一者,长夏而有虚风者,病矣;其皮浓而肌肉坚者,长夏而有虚风,不病也。其
皮浓而肌肉坚者,必重感于寒,外内皆然,乃病。
此言四时之风,本于五行之气,而人禀阴阳五行以生,其气质各有强弱之异,而五行有生克,故气质有胜
负。假如黄色,土质也,土畏木,故不胜春之虚风;白色,金质也,金畏火,故不胜夏之虚风;青色,木质也,
木畏金,故不胜秋之虚风;赤色,火质也,火畏水,故不胜冬之虚风。此皆言虚风者,即虚风贼邪也。惟黑色
为水质,水畏土,长夏未月,土旺主令,而有虚风,其皮薄肉弱,而色不一定常黑者,方中其邪;若色黑而皮
浓肉坚者,其阴阳皆充实,故长夏虚风,亦不能伤之,无论四时之风也。必其重感寒邪,内外俱伤,乃病,即
所谓两感者也。故如黄白青赤之人,亦皆言皮薄肉弱,而不胜四时之风,如其皮浓肉坚,亦未必皆病。以此推
之,可概见矣。
《灵枢·贼风篇》帝曰∶夫子言贼风邪气之伤人,令人病焉。今有其不离屏蔽,不出室穴之中,卒然
病者,非不离贼风邪气,其故何也?岐伯曰∶此皆尝有所伤于湿气,藏于血脉之中,分肉之间,久留而不去;
若有所堕坠,恶血在内而不去;卒然喜怒不节,饮食不适,寒温不时,腠理闭而不通,其开而遇风寒,则血气
凝结,与故邪相袭,则为寒痹;其有热则汗出,汗出则受风,虽不遇贼风邪气,必有因加而发焉。
此言不感虚风贼邪,而卒然病者,以平日尝伤湿气,藏于血脉分肉之间,久留不去,而不自觉;又若有所
堕坠,恶血在内不去;或卒然喜怒不节,饮食不适,寒温不时,其腠理闭不通,及开而遇风寒,血气凝结,新
故之邪相袭而成痹;或有因热汗出而受风,如此虽不遇贼风邪气,必有因故邪加重,而卒然发病焉。盖上言正
风之气柔弱,不能胜真气,则自去而不为病,此因先有所伤之邪,与外风相袭,则加重而病发,不必虚风贼邪
方病。以余观之,平时此等病证为多,而虚风贼邪所伤者少也。
帝曰∶夫子之所言者,皆病患之所自知也。其毋所遇邪气,又无怵惕之所志,卒然而病者,何也?惟有因
鬼神之事乎?岐伯曰∶此亦由故邪留而未发,因而志有所恶,及有所慕,血气内乱,两气相搏。其所从来者
微,视之不见,听而不闻,故似鬼神。帝曰∶其祝而已者何也?岐伯曰∶先巫者,因知百病之胜,先知其病之
所从来,可祝而已也。
此言初无外感、内伤之因,而有卒然病发,心昏语乱,似为
鬼神所凭者,以其有故邪内伏,而不自觉,适因所恶所慕之情感触,气血内乱,其情志与故邪两气相搏而病发。
其所从来,由微而渐,故视之不见,听而不闻,卒然发作,似乎鬼神所凭。其有祝之而已者,先巫知百病相
胜之理,如恐胜喜、怒胜思之类,审其病之所生,即以其情志之相胜者祝之,使情志平调,则气血和而病自愈。
昔有一女子,许字未嫁,其夫外出,多年无信,因而结思成病。朱丹溪治之,用激怒之法,遂大哭,呕吐痰涎,
惭以夫有信至将归,遂调理而愈,旋即其夫果归矣。可知情志之病,由渐而成,其卒发者,必有故邪相触,
而亦真有鬼神所凭者,必由其内气先病,乘虚而入也。盖人鬼乃阴阳之分,鬼之侮人,人之阳亏,或心不正直
故也。
(接上文)如果津液长期停留,与邪气结合就会形成“肠溜”;病程较长的,经过数年才形成,用手按压感觉柔软;如果已经形成了结聚,气机汇聚于此,津液留滞其中,邪气侵入并占据,凝结程度每天加重,病邪迅速聚集,形成“昔瘤”,用手按压感觉坚硬;如果结聚位置深达骨骼,气机依附于骨,骨与邪气相并,体积每天增大,就形成“骨疽”;如果结聚在肌肉中,宗气汇聚于此,邪气停留不去,如果有热象,就会化脓,如果没有热象,就形成“肉疽”。以上几种邪气致病,发病部位没有固定之处,但疾病名称却有固定的规律。
这段文字论述的是人身阴阳气血受到贼风侵袭,日久深入,寒热相互搏结。病在阴分则寒邪胜,病在阳分则热邪胜。寒邪胜则导致骨痛、肌肉枯槁;热邪胜则导致肌肉腐烂化为脓液,内伤骨骼,使骨质受损如同虫蚀一般。上文提到邪气搏结于筋脉导致筋挛,即关节屈伸不利,邪气居于其间,就会发为“筋溜”,这与肿瘤类似;邪气在内结聚,卫气留滞,津液不能输布,与邪气结合结成“肠瘤”,病程长的,经过数年才形成;初起时按压尚且柔软,一旦形成结聚,气机每天汇聚,津液留滞,邪气侵入,所以凝结程度日益加重而形成“昔瘤”,意思是随着时间推移逐渐结聚,所以说数年才形成,此时按压感觉坚硬了;如果邪气深深侵入骨骼,气机沿着骨骼运行,与邪气并结,体积每天增大,就形成“骨疽”;
宗气原本是用来温煦分肉(肌肉间隙)的,邪气侵入肌肉,宗气就会汇聚去抵御,邪气停留不去,如果有热象,肌肉就会化成脓液,如果没有热象,就会结聚成“肉疽”,所以有热象的叫“痈”,无热象的叫“疽”,疽属于阴证,痈属于阳证。凡是这些邪气中人发病,没有一定固定的发病部位,但等到疾病形成后,就有固定不变的名称,因此可以通过名称来辨别阴阳、表里、寒热,从而进行治疗。
《灵枢·论勇篇》黄帝说:这里有个人,和大家同时行走站立,年龄大小相等,衣服厚薄也相同,突然遇到狂风暴雨,有的人生病,有的人不生病,有的都生病,有的都不生病,这是什么原因?少俞回答说:春天的青风,夏天的阳风,秋天的凉风,冬天的寒风,这四季的风邪,所导致的病症形态各不相同。肤色黄、皮肤薄、肌肉弱的人,承受不住春天的虚风;肤色白、皮肤薄、肌肉弱的人,承受不住夏天的虚风;肤色青、皮肤薄、肌肉弱的人,承受不住秋天的虚风;肤色赤、皮肤薄、肌肉弱的人,承受不住冬天的虚风。黄帝问:黑色皮肤的人就不生病吗?少俞说:肤色黑且皮肤厚实、肌肉坚固的人,不会被四季的虚风所伤。如果皮肤薄而肌肉不坚实,面色不均匀的人,在长夏季节遇到虚风,就会生病;如果皮肤厚实而肌肉坚固的人,在长夏季节遇到虚风,就不会生病。只有那些皮肤厚实、肌肉坚固的人,如果再次感受寒邪,内外皆受寒,才会生病。
这段文字论述四季之风,本源于五行之气,而人禀受阴阳五行而生,其体质各有强弱差异,而五行之间存在生克关系,所以体质也有胜负之分。假如黄色属土,土畏惧木,所以承受不住春天的虚风;白色属金,金畏惧火,所以承受不住夏天的虚风;青色属木,木畏惧金,所以承受不住秋天的虚风;赤色属火,火畏惧水,所以承受不住冬天的虚风。这里所说的都是虚风,也就是虚风贼邪。只有黑色属水,水畏惧土,长夏六月,土旺当令,如果遇到虚风,且其人皮肤薄、肌肉弱,面色不一定常黑的人,才会中邪;如果面色黑且皮肤厚实、肌肉坚固的人,其阴阳之气都充实,所以长夏的虚风也不能伤害他,无论四季之风都一样。只有当再次感受寒邪,内外俱伤,才会生病,这就是所谓的“两感”病。所以像黄、白、青、赤肤色的人,也都说皮肤薄、肌肉弱,承受不住四季之风,但如果他们皮肤厚实、肌肉坚固,也未必都会生病。由此类推,可以概见一斑。
《灵枢·贼风篇》黄帝说:先生您说贼风邪气伤人,使人患病。现在有人从不离开遮蔽物,不出居室之中,却突然生病,这并不是因为接触了贼风邪气,这是什么原因?岐伯回答说:这都是因为曾经被湿气所伤,湿气藏伏在血脉之中、分肉之间,长久停留而不消散;或者曾经跌坠损伤,恶血留在体内而不消散;或者突然喜怒不节制,饮食不当,寒温失调,腠理闭塞不通,当腠理开放时又遇到风寒,就会导致血气凝结,与新近感受的邪气相合,就形成寒痹;如果有热象则会出汗,出汗后容易受风,即使没有遇到贼风邪气,也必定是因为旧邪未去,新邪相加而发作。
这段文字论述的是没有感受虚风贼邪,却突然生病的情况,这是因为平日曾经受伤于湿气,湿气藏伏在血脉和分肉之间,长久停留而不消散,患者自己并不察觉;又或者曾经跌坠,恶血留在体内不去除;或者突然喜怒不节制,饮食不适,寒温不调,导致腠理闭塞不通,等到腠理开泄时遇到风寒,血气凝结,新的邪气与旧的邪气相互侵犯,从而形成痹症;或者有因发热出汗而受风的情况,像这样即使没有遇到贼风邪气,也必定是因为旧邪加重而突然发病。上文提到正风之气柔弱,不能胜过人体的真气,就会自行散去而不致病,这里是因为有先前受伤的邪气,与外来的风邪相合,从而加重并发病,不一定是虚风贼邪才会致病。依我看来,平时这类病症很多,而真正由虚风贼邪所伤的较少。
黄帝说:先生所说的,都是病人自己所知道的病因。对于那些没有遭遇邪气,又没有惊恐忧虑等情志刺激,却突然生病的人,是什么原因呢?难道是因为鬼神作祟吗?岐伯回答说:这也是因为旧邪留滞而未发作,恰好因为心中有所厌恶或有所贪慕,导致血气内部紊乱,新旧两种气机相互搏结。这种邪气来源细微,看它看不见,听它听不到,所以看起来像是鬼神作祟。黄帝问:对于用祝由法就能治愈的病是怎么回事?岐伯说:以前的巫医,知道百病相克的道理,预先知道疾病的由来,可以用祝由法来治愈。
这段文字论述的是起初没有外感、内伤的明显原因,却突然发病,出现心神昏乱、言语错乱,似乎被鬼神附身的情况,这是因为有旧邪潜伏在内,患者自己并不察觉,恰好因为厌恶或贪慕的情感触动,导致气血内部紊乱,情志之气与旧邪之气相互搏结而发病。这种病的由来,是由微渐著,所以看它看不见,听它听不到,突然发作,似乎被鬼神附身。对于那种仅用祝由法就能治愈的,是因为先代的巫医懂得百病相胜的道理,比如恐胜喜、怒胜思等,审察疾病产生的根源,就用相应的情志相克之法进行祝由,使情志平调,那么气血调和,疾病自然痊愈。
过去有一个女子,许配人家但未出嫁,丈夫外出多年没有音信,因而忧思成病。朱丹溪治疗她,采用激怒的方法,她于是大哭一场,呕吐出痰涎,羞愧地认为丈夫有信来即将归来,随后调理身体而痊愈,不久她的丈夫果然回来了。由此可见,情志类的疾病,是逐渐形成的,其突然发作,必定是有旧邪被触动,而真正所谓鬼神附身的,必定是由于人体内部正气先已虚弱,邪气乘虚而入。大概人与鬼属于阴阳的不同范畴,鬼魅侵扰人,是因为人的阳气亏损,或者心术不正的缘故。
(Continuing from the previous text) If body fluids remain stagnant for a long time and combine with pathogenic factors, they form "Changliu" (Intestinal Slough); if the course is prolonged, it takes several years to develop, and palpation feels soft; if a knot has already formed, Qi converges there, body fluids remain, and pathogenic factors invade and occupy it, causing condensation that worsens daily. Pathogens rapidly gather to form "Xiliu" (Ancient Tumor), which feels hard upon palpation; if the knot is deep within the bone, Qi adheres to the bone, and the bone combines with the pathogen, enlarging daily, forming "Guju" (Bone Abscess/Gangrene); if the knot is in the flesh, Zongqi (Pectoral Qi) converges there, the pathogen remains without departing, heat transforms it into pus, and absence of heat forms "Rouju" (Flesh Abscess/Gangrene). Regarding these various pathogens, their onset has no fixed location, but their disease names are consistent.
This passage discusses how Yin and Yang, Qi, and Blood in the human body are invaded by treacherous winds. Over time, the invasion becomes deep, and cold and heat bind together. In the Yin aspect, cold prevails; in the Yang aspect, heat prevails. When cold prevails, it causes bone pain and muscle wasting; when heat prevails, it causes tissue rotting and pus formation, damaging bones internally as if eaten by worms. The earlier text mentioned pathogens clashing with tendons causing spasms and inability to flex or extend; when pathogens reside between them, "Jinliu" (Tendon Slough) develops, similar to tumors. Internal binding of pathogens, stagnation of Wei Qi (Defensive Qi), failure of fluid distribution, and combination with pathogens form "Changliu" (Intestinal Slough), taking years to mature. Initially soft to touch, once knotted, Qi gathers daily, fluids remain, pathogens invade, leading to progressive condensation into "Xiliu" (Ancient Tumor), implying gradual accumulation over years, becoming hard upon palpation. If pathogens deeply enter bones, Qi follows the bones, binding with pathogens and enlarging daily, forming "Guju" (Bone Abscess/Gangrene).
Zongqi (Pectoral Qi) originally warms the fenrou (muscle intervals). When pathogens invade the flesh, Zongqi converges to resist. If pathogens remain, heat transforms flesh into pus; absence of heat forms "Rouju" (Flesh Abscess/Gangrene). Thus, heat indicates "Yong" (Carbuncle/Abscess - Yang syndrome), while absence of heat indicates "Ju" (Deep-seated Abscess/Gangrene - Yin syndrome). For diseases caused by these pathogens, there is no fixed site of onset, but once established, there are fixed names. Therefore, one can distinguish Yin/Yang, Exterior/Interior, Cold/Heat based on the name to guide treatment.
In *Ling Shu: Lun Yong* (Discussion on Courage), the Emperor asked: "Here is a person walking and standing with others, of equal age, wearing clothes of equal thickness. Suddenly encountering fierce wind and heavy rain, some get sick, some do not; all get sick, or none get sick. What is the reason?" Shaoyu replied: "Spring's green wind, summer's yang wind, autumn's cool wind, and winter's cold wind—these four seasonal winds cause different pathological manifestations. Those with yellow complexion, thin skin, and weak flesh cannot withstand spring's deficient wind; those with white complexion, thin skin, and weak flesh cannot withstand summer's deficient wind; those with green complexion, thin skin, and weak flesh cannot withstand autumn's deficient wind; those with red complexion, thin skin, and weak flesh cannot withstand winter's deficient wind." The Emperor asked: "Do black-complexioned people not get sick?" Shaoyu said: "Those with black complexion, thick skin, and firm flesh are not injured by the four seasons' deficient winds. Those with thin skin, unfirm flesh, and uneven color will get sick if exposed to deficient wind during late summer; those with thick skin and firm flesh will not get sick even if exposed to deficient wind during late summer. Only if those with thick skin and firm flesh suffer repeated cold exposure, affecting both exterior and interior, will they become ill."
This passage explains that the winds of the four seasons originate from the Five Elements (Wu Xing) Qi. Humans are born endowing Yin-Yang and Five Elements, resulting in varying constitutional strengths. Since Five Elements have generating and overcoming relationships, constitutions have superiority and inferiority. Yellow corresponds to Earth, which fears Wood, hence unable to withstand spring's deficient wind; White corresponds to Metal, which fears Fire, hence unable to withstand summer's deficient wind; Green corresponds to Wood, which fears Metal, hence unable to withstand autumn's deficient wind; Red corresponds to Fire, which fears Water, hence unable to withstand winter's deficient wind. These refer to deficient winds, i.e., treacherous pathogens. Only Black corresponds to Water, which fears Earth. During late summer (the sixth month), Earth is prosperous and commands. If deficient wind occurs, only those with thin skin, weak flesh, and variable (not consistently black) color will be affected. Those with black color, thick skin, and firm flesh have sufficient Yin and Yang, so late summer deficient winds cannot harm them, regardless of the season. Illness occurs only upon repeated cold injury, affecting both interior and exterior, known as "Lianggan" (Double Invasion). Thus, for yellow, white, green, and red complexions, thin skin and weak flesh make one susceptible to seasonal winds; however, if skin is thick and flesh firm, illness is not inevitable. This logic applies generally.
In *Ling Shu: Zei Feng* (Treacherous Wind), the Emperor asked: "You say treacherous wind and pathogens injure humans and cause disease. Now, someone who never leaves shelter or exits their room suddenly falls ill. This is not due to contact with treacherous wind or pathogens. What is the reason?" Qibo replied: "This is because they were previously injured by dampness, which hid in the blood vessels and between muscle layers, remaining for a long time without dispersing; or they had a fall, leaving bad blood inside that did not disperse; or sudden emotional excesses, improper diet, or mismatched cold/warmth caused the couli (pores/skin texture) to close and block. When the couli open and encounter wind-cold, Qi and blood condense, combining with old pathogens to form Hanbi (Cold Bi Syndrome); if there is heat, sweating occurs, and sweat makes one susceptible to wind. Even without encountering treacherous wind, illness must arise from the addition of new pathogens to old ones."
This passage discusses sudden illness without exposure to deficient or treacherous winds. It is because dampness was previously injured and hidden in blood vessels and muscle layers, lingering unnoticed. Or, retained bad blood from trauma remains. Or, sudden emotional imbalance, poor diet, or temperature dysregulation blocks the couli. Upon opening and encountering wind-cold, Qi and blood condense, and new and old pathogens attack each other, forming Bi Syndrome. Or, heat-induced sweating leads to wind susceptibility. Even without treacherous wind, illness arises from the aggravation of old pathogens. Earlier, it was stated that normal winds are gentle and cannot overcome true Qi, thus dissipating without causing disease. Here, pre-existing pathogens combine with external wind, worsening the condition. Disease does not require treacherous winds specifically. In my observation, such cases are common, while injuries from deficient/treacherous winds are rare.
The Emperor asked: "What you described involves causes known to patients. For those who encountered no pathogens and had no fright or anxiety, yet suddenly fell ill, what is the reason? Is it due to ghosts and spirits?" Qibo replied: "This is also due to old pathogens remaining latent. Triggered by aversion or longing, internal Qi and blood become chaotic, and two types of Qi clash. The origin is subtle, invisible and inaudible, thus seeming like ghost possession." The Emperor asked: "Why are some cured by Zhu You (incantation therapy)?" Qibo said: "Ancient shamans knew the mutual overcoming of diseases. Knowing the origin of the disease, they could cure it via Zhu You."
This passage discusses sudden illness without obvious exterior or interior causes, presenting with mental confusion and erratic speech, resembling ghost possession. This is due to latent old pathogens. Emotional triggers (aversion/longing) cause Qi and blood chaos, where emotional Qi clashes with old pathogens. The origin is subtle, imperceptible, appearing sudden and supernatural. For those cured by incantation, ancient shamans understood the principle of mutual overcoming of diseases (e.g., fear overcoming joy, anger overcoming worry). By diagnosing the root and applying corresponding emotional countermeasures through incantation, emotions are balanced, Qi and blood harmonize, and the disease resolves spontaneously.
In the past, a woman engaged but unmarried fell ill from worry after her husband left for years without news. Zhu Danxi treated her using provocation of anger. She cried loudly and vomited phlegm-saliva. Feeling ashamed that her husband might return soon, she recovered after regulation, and indeed, her husband returned shortly after. This shows that emotional diseases develop gradually. Sudden onset implies triggering of old pathogens. True "ghost possession" occurs only when internal Qi is first deficient, allowing pathogens to enter vacuously. Generally, humans and ghosts belong to different Yin-Yang categories. Ghosts harassing humans occur due to human Yang deficiency or moral corruption.