内伤饮食付药者受药者皆以为琐末细事是以所当重者为轻利害非细殊不思胃气者营气也
卫气
也谷气也清气也资少阳生发之气也人之真气衰旺皆在饮食入胃胃和则谷气上升谷气者升腾之
气
也乃足手少阳元气始发生长万化之别名也饮食一伤若消导药的对其所伤之物既消则胃气愈旺
五谷之精华上腾乃清气为天者也精气神气皆强盛也七神卫护生气不乏增益大旺气血周流则百
病不能侵虽有大风苛毒弗能害也此一药之用其利博哉易水张先生尝戒不可用峻利食药食药下
咽未至药丸施化其标皮之力始开便言空快也所伤之物已去若更待一两时辰许药尽化开其峻药
必有情性病去之后脾胃安得不损乎脾胃既损是真气元气败坏促人之寿常时用枳术丸一药消化
胃中所伤下胃不能即去须待一两时辰许食则消化是先补而后化其所伤则不峻利矣因用荷叶烧
饭为丸荷叶一物中央空虚象震卦之体震者动也人感之生足少阳甲胆也甲胆者风也生化万物之
根蒂也左传云履端于始序则不愆人之饮食入胃营气上行即少阳甲胆之气也其手少阳三焦经人
之元气也手足经同法便是少阳元气生发也胃气谷气元气甲胆上升之气一也异名虽多止是胃气
上升者也若内伤脾胃以辛热之物酒肉之类自觉不快觅药于医者此风习以为常医者亦不问所伤
付之以集香丸巴豆大热药之类下之大便下则物去遗留食之热性药之热性重伤元气七神不炽经
云热伤气正谓此也其人必无气以动而热困四肢不举传变诸疾不可胜数使人真气自此衰矣若伤
生冷硬物世医或用大黄牵牛二味大寒药投之物随药下所伤去矣遗留食之寒性药之寒性重泻
其
阳阳去则皮肤筋肉血脉无所根据倚便为虚损之证论言及此令人寒心夫辛辣气薄之药无故不可乱
服非止牵牛而已至人要大论云五味入口各先逐其所喜攻攻者克似泻也辛味下咽先攻泻肺之
正气正气者真气元气也其牵牛之辛辣猛烈夺人尤甚饮食所伤脾胃受邪当以苦味泄其肠胃可也
肺与元气何罪之有夫牵牛不可用者有五此其一也况胃主血为物所伤物者有形之物也皆血病血
病泻气此其二也且饮食伤于中焦止合克化消导其食重泻上焦肺中已虚之气此其三也食伤肠胃
当塞因塞用又寒因寒用枳实大黄苦寒之物以治有形是也反以辛辣牵牛散泻真气犯大禁四也殊
不知针经有云外来客邪风寒伤人五脏若误泻胃气必死误补亦死其死也无气以动故静若内伤肠
胃反泻五脏必死误补亦死其死也阴气有余故躁今内伤肠胃是谓六腑不足之病及泻上焦虚无肺
气肺者五脏之一数也为牵牛之类朝损暮损其元气消耗此乃暗折人寿数犯大禁五也良可哀叹又
曰胃恶热而喜清大肠恶清冷而喜热两者不和何以调之岐伯曰调此者饮食衣服亦欲适寒温寒无
凄怆暑无出汗饮食热无灼灼寒无 寒温中适故气将持乃不致邪僻详见本经是必有因用岂可
用俱寒俱热之食药致损者与内经云内伤者其气口脉反大于人迎一倍二倍三倍分经用药又曰上
部有脉下部无脉其人当吐不吐者死如但食不纳恶心欲吐者不问一倍二倍不当正以瓜蒂散吐之
但以指或以物探去之若所伤之物去不尽者更诊其脉问其所伤以食药去之以应塞因塞用又谓之
寒因寒用泄而下降乃应太阴之用其中更加升发之药令其元气上升塞因塞用因曲而为之直何为
曲内伤胃气是也何为直而升发胃气是也因治其饮食之内伤而使生气增益胃气完复此乃因曲而
为之直也若根据分经用药其所伤之物寒热温凉生硬柔软所伤不一难立定法只随所伤之物不同各
立治法临时加减用之其药又当问病患从来禀气盛衰所伤寒物热物是喜食而食之耶不可服破气
药若乘饥困而食之耶当益胃气或为人所勉劝强食之宜损血而益气也诊其脉候伤在何脏方可与
对病之药岂可妄泻天真生气以轻丧身宝乎且如先食热而不伤继之以寒物因后食致前食亦不消
化而伤者当问热食寒食孰多孰少斟酌与药无不当矣喻如伤热物二分寒物一分则当用寒药二
分热药一分相合而与之则荣卫之气必得周流更有或先饮酒而后伤寒冷之食及伤热食冷水与冰
如此不等皆当验其节次所伤之物约量寒热之剂分散各各对证而与之无不取验
内伤饮食后服药,无论是开药者还是服药者,都将其视为琐碎细微的小事,因此本该重视的事情被看得很轻,其危害并非细小。殊不思胃气,就是营气(运行于脉中、具有营养作用的气),卫气(运行于脉外、具有防御作用的气),谷气(由水谷精微化生的气),清气(清阳之气),也是资助少阳生发之气的根本。人体真气的盛衰,全在于饮食入胃后的状态。胃气和顺,则谷气上升;谷气,就是升腾之气,是手足少阳经的元气开始发生、生长,化生万物变化的别名。
如果饮食受伤,使用消导药物针对所伤之物,一旦食物消化,胃气就会更加旺盛。五谷的精华上腾,这就是所谓的“清气为天”。精气、神气都会强盛,七神(指人的精神意识思维活动)卫护,生气不乏且增益大旺,气血周流全身,那么百病不能侵袭,即使有大风苛毒也不能伤害。这一味药的作用,其利益真是广泛啊!
易水张先生(张元素)曾告诫不可使用峻烈通利的食药。食药咽下后,尚未到药丸发挥作用的时候,表皮的力量刚打开,就感觉空快舒适。此时所伤之物已去,如果再等待一两个时辰左右,让药物完全化开,那么峻烈的药物必然损伤性情(脾胃功能)。病去之后,脾胃怎能不受损呢?脾胃既已受损,真气、元气就会败坏,缩短人的寿命。
平常时候用枳术丸一味药来消化胃中所伤。下胃后不能立即去除,须等待一两个时辰左右,食物才能消化。这是先补而后化,对于所伤之物就不算峻烈了。因此用荷叶烧饭为丸。荷叶这一物,中央空虚,象征震卦(八卦之一,代表雷、动)的体象。震者,动也。人感受它,产生足少阳甲胆之气。甲胆者,风也,是生化万物的根蒂。《左传》说:“履端于始,序则不愆。”人的饮食入胃,营气上行,即少阳甲胆之气也。手少阳三焦经,是人体的元气。手足经同理,这便是少阳元气的生发。胃气、谷气、元气、甲胆上升之气,本质上是一回事。异名虽多,只是胃气上升罢了。
如果内伤脾胃,因食用辛热之物如酒肉之类,自觉不快,向医生觅药。这种风气习以为常,医生也不问所伤之物,给予集香丸、巴豆等大热药之类的药物。服用后大便下行,物去矣,但遗留的食物之热性、药物之热性会重伤元气,导致七神不炽。《内经》说:“热伤气”,正是说的这种情况。此人必定无气以动,热困四肢不能举动,传变诸疾不可胜数,使人真气从此衰弱。
如果损伤生冷硬物,世医有时用大黄、牵牛这两味大寒药投服。物随药下,所伤去矣,但遗留的食物之寒性、药物之寒性重泻其阳。阳气离去,则皮肤、筋肉、血脉无所依托,便成为虚损之证。论述到这里,令人寒心。
辛辣气薄的药物,无故不可乱服,不仅限于牵牛子。《至要人大论》说:“五味入口,各先逐其所喜攻。”攻者,克似泻也。辛味下咽,先攻泻肺之正气。正气,就是真气、元气。牵牛的辛辣猛烈,夺人气尤甚。饮食所伤,脾胃受邪,应当以苦味泄其肠胃即可。肺与元气有什么罪过呢?
牵牛子不可用的原因有五条,这是其一。况且胃主血,为物所伤者,物是有形之物,皆属血病。血病而泻气,此为其二。且饮食伤于中焦,只合克化消导其食,重泻上焦肺中已虚之气,此为其三。食伤肠胃,当“塞因塞用”、“寒因寒用”,如枳实、大黄等苦寒之物以治有形之积,这是正确的。反以辛辣牵牛散泻真气,犯大禁四也。
殊不知《针经》有云:“外来客邪风寒伤人五脏,若误泻胃气必死,误补亦死,其死也无气以动故静。若内伤肠胃,反泻五脏必死,误补亦死,其死也阴气有余故躁。”今内伤肠胃,是谓六腑不足之病。及泻上焦虚无肺气,肺者,五脏之一数也。为牵牛之类朝损暮损,其元气消耗,此乃暗折人寿数,犯大禁五也。良可哀叹。
又说:胃恶热而喜清,大肠恶清冷而喜热,两者不和,何以调之?岐伯曰:“调此者,饮食衣服亦欲适寒温。寒无凄怆,暑无出汗。饮食热无灼灼,寒无 寒温中适,故气将持,乃不致邪僻。”详见本经。是必有因,岂可用俱寒俱热的食药致损者与?
《内经》云:“内伤者,其气口脉反大于人迎一倍、二倍、三倍。”分经用药。又曰:“上部有脉,下部无脉,其人当吐,不吐者死。如但食不纳,恶心欲吐者,不问一倍二倍,不当正以瓜蒂散吐之,但以指或以物探去之。若所伤之物去不尽者,更诊其脉,问其所伤,以食药去之,以应‘塞因塞用’,又谓之‘寒因寒用’。泄而下降,乃应太阴之用。其中更加升发之药,令其元气上升。‘塞因塞用’,‘因曲而为之直’。何为曲?内伤胃气是也。何为直而升发胃气是也。因治其饮食之内伤而使生气增益,胃气完复,此乃因曲而为之直也。”
若根据分经用药,其所伤之物寒热温凉、生硬柔软,所伤不一,难立定法,只随所伤之物不同,各立治法,临时加减用之。其药又当问病患从来禀气盛衰,所伤寒物热物,是喜食而食之耶?不可服破气药。若乘饥困而食之耶?当益胃气。或为人所勉劝强食之,宜损血而益气也。诊其脉候,伤在何脏,方可与对病之药。岂可妄泻天真生气,以轻丧身宝乎?
且如先食热而不伤,继之以寒物,因后食致前食亦不消化而伤者,当问热食寒食孰多孰少,斟酌与药,无不当矣。喻如伤热物二分,寒物一分,则当用寒药二分,热药一分,相合而与之,则荣卫之气必得周流。更有或先饮酒而后伤寒冷之食,及伤热食冷水与冰,如此不等,皆当验其节次所伤之物,约量寒热之剂分散,各各对证而与之,无不取验。
When taking medicine for internal injury caused by diet, both the prescriber and the patient regard it as a trivial matter. Consequently, what should be taken seriously is treated lightly, and the harm is not minor. One fails to realize that *Wei Qi* (Stomach Qi) is *Ying Qi* (Nutritive Qi), *Wei Qi* (Defensive Qi), *Gu Qi* (Grain Qi), *Qing Qi* (Clear Yang Qi), and also the foundation that nourishes the generating and ascending Qi of Shaoyang. The prosperity or decline of the body's True Qi depends entirely on the state after food enters the stomach. When Stomach Qi is harmonious, Grain Qi ascends. Grain Qi is the ascending energy; it is the beginning of the generation and growth of the Yuan Qi (Original Qi) of the Foot and Hand Shaoyang meridians, and the alias for the transformation and generation of all things.
If dietary injury occurs, using resolving and guiding medicines against the injured food, once the food is digested, Stomach Qi becomes even more vigorous. The essence of the five grains ascends, which is referred to as "Clear Qi becoming Heaven." Jing Qi (Essence Qi), Shen Qi (Spirit Qi) will all become strong. The Seven Spirits (referring to mental activities) will guard, Sheng Qi (Vital Qi) will be abundant and greatly increased, Qi and Blood will circulate throughout the body, so that hundred diseases cannot invade, and even severe wind or toxic pathogens cannot harm. The utility of this single medicine is indeed extensive!
Mr. Zhang from Yishui (Zhang Yuansu) once warned against using harsh and purgative foods and medicines. After swallowing such medicine, before the pill has time to act, the power at the skin level just begins to open, and one feels empty and comfortable. At this point, the injured food has already gone. If one waits another hour or two for the medicine to fully dissolve, the harsh medicine will inevitably damage the nature/function of the Spleen and Stomach. After the pathogen is eliminated, how can the Spleen and Stomach not be damaged? Once the Spleen and Stomach are damaged, True Qi and Yuan Qi will be ruined, shortening life expectancy.
Usually, Zhi Zhu Wan (Immature Bitter Orange and Atractylodes Macrocephala Pill) is used to digest injuries in the stomach. After entering the stomach, it cannot remove the food immediately; one must wait an hour or two for digestion. This method first tonifies and then resolves, making it not harsh for the injured food. Therefore, lotus leaves are used with cooked rice to form pills. The lotus leaf is hollow in the center, symbolizing the structure of the Zhen Trigram (Thunder/Movement). Zhen represents movement. Human perception of it generates the Qi of the Foot Shaoyang Jia Gallbladder. The Jia Gallbladder corresponds to Wind, which is the root of generating and transforming all things. As stated in the *Zuo Zhuan*: "Begin at the proper starting point, and the order will not err." When human food enters the stomach, Ying Qi ascends, which is the Qi of the Foot Shaoyang Jia Gallbladder. The Hand Shaoyang Sanjiao Meridian is the body's Yuan Qi. The principles of the hand and foot meridians are the same; this is the generation of Shaoyang Yuan Qi. Stomach Qi, Grain Qi, Yuan Qi, and the ascending Qi of the Jia Gallbladder are essentially one. Although there are many different names, they all refer to the ascending of Stomach Qi.
If there is internal injury to the Spleen and Stomach due to consuming pungent and hot substances like alcohol and meat, feeling uncomfortable, and seeking medicine from a doctor, this custom is common. Doctors often do not inquire about the specific injury but prescribe Ji Xiang Wan (Agarwood and Amber Pill) or Ba Dou (Croton Seed), a very hot drug. After administration, bowel movements occur, and the food is expelled. However, the residual heat nature of the food and the heat nature of the medicine severely damage the Yuan Qi, causing the Seven Spirits to lose vigor. The *Classic* states: "Heat damages Qi," which refers to this situation. Such a person will certainly lack Qi to move, have heat trapping the limbs preventing them from rising, and undergo numerous transformations into other diseases, causing True Qi to decline from this point onward.
If injured by cold, raw, or hard foods, physicians sometimes administer Da Huang (Rhubarb Root) and Qian Niu (Morning Glory Seed), two very cold drugs. The food is expelled with the medicine, and the injury is removed. However, the residual cold nature of the food and the cold nature of the medicine heavily purge Yang Qi. With Yang Qi departing, the skin, muscles, tendons, and blood vessels lose their support, resulting in deficiency and damage syndromes. Discussing this makes one shudder.
Pungent and thin-qi medicines should not be taken indiscriminately without cause, and this applies not only to Qian Niu. The *Treatise on the Great Importance of Human Life* states: "The five flavors enter the mouth, each first attacking what it likes." Attacking implies overcoming, similar to purging. Upon swallowing pungent flavors, they first attack and purge the Zheng Qi (Upright Qi) of the Lung. Zheng Qi is True Qi and Yuan Qi. The pungency and ferocity of Qian Niu are particularly damaging to Qi. For dietary injury where the Spleen and Stomach are affected by pathogens, one should use bitter flavors to drain the intestines and stomach. What crime have the Lungs and Yuan Qi committed?
There are five reasons why Qian Niu should not be used; this is the first. Moreover, the Stomach governs Blood. Injury by objects involves有形 (form/material) objects, which belong to Blood disorders. Purging Qi when there is a Blood disorder is the second reason. Furthermore, dietary injury affects the Middle Jiao; one should only resolve and guide the food. Heavily purging the already deficient Qi of the Upper Jiao Lungs is the third reason. Food injury to the intestines and stomach should be treated with "treating obstruction with obstruction" (Sa Yin Sai Yong) and "treating cold with cold" (Han Yin Han Yong), such as using bitter-cold substances like Zhi Shi (Immature Bitter Orange) and Da Huang to treat solid accumulations. Conversely, using pungent-hot Qian Niu to scatter and purge True Qi violates the major prohibition (fourth).
One fails to realize that the *Needle Classic* states: "When external guest pathogens like wind and cold injure the five Zang organs, mistakenly purging Stomach Qi leads to death, and mistakenly tonifying also leads to death. Death occurs because there is no Qi to move, hence stillness. If internal injury affects the intestines and stomach, mistakenly purging the five Zang organs leads to death, and mistakenly tonifying also leads to death. Death occurs because Yin Qi is excessive, hence restlessness." Now, internal injury to the intestines and stomach is a disease of insufficiency of the six Fu organs. Purging the empty Qi of the Upper Jiao Lungs—the Lungs being one of the five Zang organs—causes daily loss of Yuan Qi through the use of Qian Niu-like substances. This secretly reduces lifespan and violates the fifth major prohibition. It is truly lamentable.
It is also said: The Stomach dislikes heat and prefers clarity; the Large Intestine dislikes cold and prefers heat. How to harmonize these two when they are discordant? Qibo said: "To regulate this, diet and clothing should also suit the cold and heat. In cold, avoid shivering; in heat, avoid sweating. Food should not be scorching hot, nor freezing cold. Warmth and coolness should be moderate, so that Qi is maintained and deviations do not occur." See the Basic Classic for details. There must be a reason; how can one use uniformly cold or uniformly hot foods and medicines causing damage?
The *Inner Canon* states: "In internal injury, the Qi Kou pulse is reversely larger than the Ren Ying pulse by one, two, or three times." Medicines should be prescribed according to the meridian. It also says: "If there is a pulse in the upper part but none in the lower part, the person should vomit; if they do not vomit, they will die. If they eat but cannot retain it, feel nauseous, and want to vomit, regardless of whether the pulse difference is one, two, or three times, one should not strictly use Gua Di San (Melon Sprout Powder) to induce vomiting, but rather use fingers or objects to probe and remove it. If the injured food is not completely removed, re-examine the pulse, ask about the injury, and use food or medicine to remove it, responding to 'treating obstruction with obstruction' and 'treating cold with cold.' Draining and descending responds to the function of the Taiyin. Add generating medicines within to allow Yuan Qi to ascend. 'Treating obstruction with obstruction' and 'making straight by bending.' What is bending? Internal injury to Stomach Qi. What is straightening and ascending Stomach Qi? By treating the internal injury of diet to increase Sheng Qi and restore Stomach Qi completely, this is making straight by bending."
If prescribing according to meridians, the injured substances vary in cold, heat, warmth, coolness, hardness, and softness, making it difficult to establish fixed methods. One should establish treatment methods based on the specific injured substance and adjust temporarily. When prescribing, one must ask about the patient's innate constitution strength or weakness, whether the cold or hot food was consumed out of preference, in which case breaking-Qi medicines should not be used. Or was it eaten while hungry and fatigued, in which case Stomach Qi should be supplemented. Or was it forced eating due to persuasion, in which case Blood should be reduced and Qi supplemented. Examine the pulse to determine which Zang organ is injured before prescribing targeted medicine. How can one recklessly purge the innocent Sheng Qi and lightly lose the treasure of the body?
For example, if one eats hot food without injury, followed by cold food, causing the previous food to fail to digest due to the latter, one should ask which was more abundant, hot or cold food, and prescribe accordingly without error. For instance, if injured by two parts hot food and one part cold food, use two parts cold medicine and one part hot medicine, combined and administered, so that Ying and Wei Qi will surely circulate. Similarly, if one drinks alcohol first and then injures themselves with cold food, or eats hot food with cold water or ice, etc., one must verify the sequence of injuries, estimate the cold and heat agents, disperse them, and prescribe each according to the syndrome. There will be no failure in efficacy.