东垣曰经云阴虚生内热(云云见热门)又云劳则气耗劳则喘且汗出内外皆越故气耗矣夫喜
怒不
节起居不时有所劳伤皆损其气气衰则火旺火旺则乘其脾土脾主四肢故困热无气以动懒于言语
动作喘之表热自汗心烦不安当病之时宜安心静坐以养其气以甘寒泻其火热以酸味收其散气
以
甘温补其中气经言劳者温之损者温之者是也要略云平人脉大为劳以黄 建中汤治之之意也
谨按丹溪先生曰治病之方先顾原气盖谓诸病多因虚致故也是以劳倦之证其因甚多东垣丹
溪论
治详矣然比之虚损证不同有因病致虚者如伤寒暑饮食后或久病所致之类是也因虚致损者如病
后形瘁痿弱劳瘵之类是也此则虚损皆与劳倦不同大抵因病致虚则为轻盖病势尚浅原气未虚也
至病初愈而复劳或复饮食劳倦或房劳七情六欲阳瘁阴弱加至羸损此因虚致损则为重病势已过
原气已索故也愚谓此当分治如因病致虚及劳倦不足与以下诸证兼虚者宜从东垣丹溪之论治之
因虚致损者又当于东垣丹溪论治而推充行之可也
详见痿门
详见热门
详见寒门
详见滞下门
详见中风门
详见各门
丹溪曰血气者身之神也神既衰乏邪因而入理或有之若夫血气俱亏痰客中焦妨碍升降不得
运用以致十二宫各失其职视听言动皆有虚妄以邪治之焉能愈病宪幕傅兄之子年十七暑月因劳而渴恣饮梅浆又
连得大惊三四次妄言妄见病似邪鬼两脉皆虚弦而沉数予曰数为有热虚弦是大惊又
酸浆停于中脘补虚清热导去痰滞病乃可安与参术陈皮茯苓芩连等浓作汤入竹沥姜汁与浃旬未
效众皆尤药之未对予知其虚之未回痰之未导仍与前药加荆沥又旬余而安外弟一日醉饱后乱言
妄见且言伊芳兄生前事甚的乃叔叱之曰食鱼肉与酒大过痰所为耳灌盐汤一大碗吐痰一升许汗因
大作困睡一宵而安又金氏妇壮年暑月赴筵回乃姑询其座次失序自愧因成病言语失伦其中又时
间一句曰奴奴不是两脉皆弦而数予曰非鬼神乃病也但与补脾导痰清热数日自安其弟不信以数
巫者喷水而咒之旬余而死或曰病无鬼以邪治之何至于死曰暑月赴筵外境蒸热辛辣适口内境郁
热而况旧有积痰加之愧闷其痰与热何可云喻今乃惊以法尺是惊其神而血不宁也喷以法水是冷
密其肌汗不得泄也汗不得泄则热内燔血不得宁则阴消而阳不能独立也不死何俟或曰外台秘要
有禁咒一科庸可废乎予曰移精变气乃小术耳可治小病若内有虚邪外有实邪自有定法符何能也
惟符水可治膈上热痰一呷凉冷岂不清快若内伤而虚与冬令严寒符水入口必冰胃而死斯言也可
与识者道
李东垣说:《内经》记载:“阴虚生内热”(详细内容见“热门”章节),又说:“劳则气耗”,劳累会导致气喘且出汗,体内外的气机都向外发散,因此导致气耗损。如果喜怒情绪没有节制,起居作息不规律,加上有所劳伤,都会损伤人体的气。气衰败了,相火就会亢盛;相火亢盛会乘袭脾土。脾主四肢,所以人会感到困倦发热、无力活动、懒于言语动作、体表发热、自汗、心烦不安。在患病期间,应当安心静坐以养护正气,用甘寒的药物来清泻火热,用酸味的药物来收敛散失的气机,用甘温的药物来补益中焦之气。《内经》说:“劳者温之,损者温之。”《金匮要略》说:平人脉象大而无力是劳损的表现,主张用黄芪建中汤治疗,就是这个意思。
我谨按:朱丹溪先生说:治病的方法首先要顾护元气,大概是因为各种疾病多因虚损而引发。因此,劳倦这类病症,其成因很多,李东垣和朱丹溪关于治疗的论述已经很详细了。然而,这与虚损证有所不同:有因病致虚的情况,如伤寒、暑病、饮食不当后或久病所导致的此类情况;也有因虚致损的情况,如病后形体憔悴痿弱、劳瘵等。这些虚损都与劳倦不同。大抵因病致虚,病情较轻,因为病势尚浅,元气尚未虚损。至于病初愈后又过度劳累,或再次饮食不节、劳倦过度,或房事过度、七情六欲失调,导致阳气衰竭、阴精虚弱,进而加重为羸弱损耗,这种因虚致损属于重病,因为病势已过,元气已极度亏虚。我认为这应当分别治疗:如因病致虚及劳倦不足,以及下面诸证兼有虚损的,宜遵循李东垣、朱丹溪的理论进行治疗;因虚致损的,又应当在李东垣、朱丹溪论治的基础上推演扩充施行即可。
详见“痿门”章节。
详见“热门”章节。
详见“寒门”章节。
详见“滞下门”章节。
详见“中风门”章节。
详见各相关门类。
朱丹溪说:血气是身体的神明所在,神明既然衰乏,邪气便乘虚而入。如果有这种情况,那是由于血气俱亏,痰浊客居在中焦,妨碍了气机的升降运行,导致无法正常使用,致使十二脏腑(十二宫)各自失去其职司,视听言动都有虚妄表现。如果用攻邪的方法来治疗,怎么能治愈疾病呢?宪幕傅兄的儿子,十七岁,夏季因劳累而口渴,恣意饮用梅浆,又接连受到三四次大惊吓,出现胡言乱语、幻视,病症看起来像被邪鬼附身,两手脉象都呈现虚弦而沉数的特点。我说:脉数是有热,虚弦是大惊所致,又有酸浆停滞在中脘。需要补虚、清热、导去痰滞,病才能安宁。给予人参、白术、陈皮、茯苓、黄芩、黄连等药浓煎成汤剂,加入竹沥、姜汁服用。过了十天没有见效,众人都责怪药不对症。我知道他的虚损尚未恢复,痰浊尚未导去,仍然给前药加入荆沥。又过了十多天,病人终于安康。
我的外弟有一天醉饱之后,胡言乱语、幻视,而且说他哥哥生前的事非常确切。他的叔父斥责他说:“吃鱼肉和酒太多,是痰作祟罢了。”灌下一大碗盐汤,吐出一升多痰,随后大汗大作,昏睡了一夜而痊愈。
还有金氏妇人,壮年时夏季赴宴回来,婆婆询问她的座次安排失序,她因羞愧而生病,言语错乱无序,其中偶尔夹杂一句说:“奴家并非有意。”两手脉象都弦而数。我说:“这不是鬼神作怪,而是病。”只要补脾、导痰、清热,几天自然能安。她的弟弟不信,请了几个巫师喷水念咒。过了十多天,病人死了。有人说:“病本来没有鬼,用邪法治疗,怎么会致死?”我说:“夏季赴宴,外界环境蒸热,辛辣食物适口,内部郁热更甚,何况旧有积痰,加之羞愧郁闷,那痰与热的状况怎么可以用言语形容?现在竟然用法尺惊吓他,这是惊吓了他的神志,使血气不宁;喷法水,这是寒冷闭塞肌表,使汗液不得排泄。汗不得排泄,则热在内焚烧;血不得安宁,则阴精消亡,阳气不能独立存在。不死还等什么?有人说:《外台秘要》中有禁咒这一科,难道可以废弃吗?我说:移精变气只是小术,只能治小病。如果内有虚邪,外有实邪,自有定法,符咒有什么用呢?只有符水可以治疗膈上的热痰,喝一口凉冷的,岂不清快?如果是内伤虚损,或者在冬季严寒之时,符水入口必然冰伏胃气而死。这话只可与懂行的人说。”
Li Dongyuan stated: The *Neijing* records, "Yin deficiency generates internal heat" (see details in the "Hot Disease" section), and also states, "Labor exhausts Qi." Labor leads to panting and sweating, causing both internal and external Qi to dissipate outwardly, thereby resulting in Qi exhaustion. If emotions such as joy and anger are not regulated, daily routines are irregular, and there is physical strain, all these damage the body's Qi. When Qi declines, ministerial fire becomes hyperactive; when ministerial fire is hyperactive, it overacts upon Spleen Earth. Since the Spleen governs the four limbs, the patient feels fatigued, hot, lacking energy for movement, reluctant to speak or act, experiencing surface heat, spontaneous sweating, and mental restlessness. During the illness, one should sit quietly with a calm mind to nourish Qi, use sweet-cold herbs to clear and drain fire-heat, use sour-flavored herbs to astringe dissipated Qi, and use sweet-warm herbs to tonify Middle-Jiao Qi. The *Neijing* states, "For labor, warm it; for loss, warm it." The *Jingui Yaolue* states that a large but empty pulse in a healthy person indicates labor, and recommends treating it with Huangqi Jianzhong Tang (Astragalus Decoction to Build the Middle). This is the intended meaning.
I respectfully note: Mr. Zhu Danxi said, "The prescription for treating disease must first attend to the Yuan Qi (Original Qi)." This is because most diseases arise from deficiency. Therefore, regarding fatigue and exhaustion syndromes, which have many causes, the discussions on treatment by Li Dongyuan and Zhu Danxi are quite detailed. However, this differs from Xu Sun (Deficiency Damage) syndromes. There are cases where illness leads to deficiency, such as those caused by Shanghan (Cold Damage), Summerheat, improper diet, or chronic illness. There are also cases where deficiency leads to damage, such as emaciation and flaccidity after illness, or consumptive diseases. These Xu Sun conditions differ significantly from simple fatigue. Generally, illness leading to deficiency is milder because the pathogenic factor is shallow and the Yuan Qi is not yet exhausted. Conversely, if one labors excessively shortly after recovering from an illness, or indulges in improper diet, physical fatigue, sexual excess, or emotional disturbances, leading to Yang exhaustion and Yin weakness, worsening into severe emaciation, this "deficiency leading to damage" constitutes a serious condition because the pathological process has progressed and the Yuan Qi is depleted. I believe these should be treated differently: For illness-induced deficiency, fatigue insufficiency, and other syndromes accompanied by deficiency, one should follow the theories of Li Dongyuan and Zhu Danxi. For deficiency-induced damage, one should expand upon and apply the treatments proposed by Li Dongyuan and Zhu Danxi.
See the "Wei Men" (Flaccidity Section) for details.
See the "Re Men" (Heat Section) for details.
See the "Han Men" (Cold Section) for details.
See the "Zhi Xia Men" (Dysentery Section) for details.
See the "Zhong Feng Men" (Wind Stroke Section) for details.
See various sections for details.
Zhu Danxi said: Blood and Qi are the spirit of the body. If the spirit is depleted, pathogens enter easily. In cases where both Blood and Qi are deficient, phlegm lodges in the Middle Jiao, obstructing the ascending and descending mechanisms, preventing normal function, causing the twelve organs (Twelve Palaces) to lose their respective duties, resulting in delirious vision, hearing, speech, and movement. How can using methods to attack pathogens cure the disease?
The son of my colleague Fu Xianmu, aged seventeen, became thirsty due to labor in summer and drank plum juice excessively. He then suffered three or four sudden frights, leading to delirious speech and hallucinations, resembling possession by evil spirits. His pulses were both deficient, wiry, deep, and rapid. I said, "Rapid pulse indicates heat; deficient and wiry pulse indicates great fright. Additionally, sour juice stagnates in the Zhongwan (CV12). Treatment requires tonifying deficiency, clearing heat, and guiding out phlegm stagnation for the disease to settle." I prescribed a concentrated decoction of Renshen (Ginseng Radix), Baizhu (Atractylodis Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Fuling (Poria), Huangqin (Scutellariae Radix), and Huanglian (Coptidis Rhizoma), adding Zhuli (Bambusa Textilis Caulis Juice) and Jiangzhi (Zingiberis Recensis Juice). After ten days, there was no improvement, and everyone blamed the medicine. I realized his deficiency had not recovered and phlegm had not been guided out, so I continued the previous formula adding Jingli (Bambusa Textilis Caulis Juice). After another ten-plus days, he recovered.
My maternal cousin, after becoming drunk and overeating one day, spoke deliriously and saw visions, accurately recounting events from his deceased elder brother's life. His uncle scolded him, saying, "You ate too much fish, meat, and wine; this is caused by phlegm." He was given a large bowl of salt water to induce vomiting, expelling more than a liter of phlegm. He then sweated profusely, slept deeply for one night, and recovered.
Furthermore, Mrs. Jin, in her prime, fell ill after returning from a summer banquet. Her mother-in-law questioned why she had arranged the seating improperly. Feeling ashamed, she developed a condition characterized by disordered speech, occasionally interjecting, "This servant did not mean to [be improper]." Her pulses were wiry and rapid. I said, "This is not ghosts or gods, but a disease. Tonify the Spleen, guide out phlegm, and clear heat; she will recover in a few days." Her younger brother did not believe me and consulted several shamans who sprayed water and chanted spells. After more than ten days, she died. Someone asked, "Illness does not involve ghosts; how could treating it with 'evil' methods lead to death?" I replied, "In summer, attending a banquet involves external steaming heat and spicy foods that suit the palate, creating internal stagnant heat. Moreover, with pre-existing accumulated phlegm, compounded by shame and depression, the interaction of phlegm and heat is indescribable. Now, using a magic ruler to startle him startles his Shen (Spirit), causing Blood to become restless. Spraying magic water colds and closes the skin pores, preventing sweat from venting. If sweat cannot vent, heat burns internally. If Blood is not peaceful, Yin is consumed, and Yang cannot stand alone. Why would he not die? Some say the *Waitai Miyao* includes a section on exorcism and incantations; can this be discarded? I say, shifting Jing (Vitality) and changing Qi is a minor art, suitable only for minor illnesses. If there is internal deficiency-pathogen and external excess-pathogen, there are established methods; what use are talismans? Only talisman water can treat upper Jiao heat-phlegm; drinking a sip of cool liquid clears and refreshes. But if applied to internal injury with deficiency, or during winter severe cold, talisman water entering the stomach will freeze the Stomach Qi and cause death. This statement can only be shared with those who understand."