(《灵枢·五变篇》全。风厥汗出、消瘅、寒热、留痹、积聚。)
黄帝问于少俞曰∶余闻百疾之始期也,必生于风雨寒暑,循毫毛而入腠理,或复还,或留止,或为风肿汗出,或为
消瘅,或为寒热,或为留痹,或为积聚,奇邪淫溢,不可胜数,愿闻其故。夫同时得病,或病此,或病彼,意者天之为
人生风乎?何其异也?(瘅音丹,又上、去二声。)少俞曰∶夫天之生风者,非以私百姓也,其行公平正直,犯者得之,
避者得无殆,非求人而人自犯之。(殆,危也。天非求人而人自犯之,所以有少病多病者,亦在乎人之慎与不慎耳。)黄
帝曰∶一时遇风,同时得病,其病各异,愿闻其故。少俞曰∶善乎哉问!请论以比匠人。匠人磨斧斤砺刀,削斫材木,
木之阴阳尚有坚脆,坚者不入,脆者皮弛,至其交节而缺斤斧焉。夫一木之中,坚脆不同,坚者则刚,脆者易伤,况其
材木之不同,皮之浓薄,汁之多少而各异耶?(此借木之材质以方人之禀赋也。砺音利。斫音卓。脆音翠。弛音矢,解
弛也。)夫木之早花先生叶者,遇春霜烈风,则花落而叶萎。久曝大旱,则脆木薄皮者,枝条汁少而叶萎。久阴淫雨,则
薄皮多汁者,皮溃而漉。卒风暴死,则刚脆之木,枝折杌伤。秋霜疾风,则刚脆之木,根摇而叶落。凡此五者,各有所
伤,况于人乎?(此言木之雕残,各有所因,以方人之疾病,亦无不有所致之也。萎音威,蔫枯也。蔫音烟,物不鲜而
色败也。溃音会,坏烂也。漉音鹿,水湿貌。杌音兀,木之无枝者也。)黄帝曰∶以人应木奈何?少俞答曰∶木之所伤也,
皆伤其枝,枝之刚脆而坚,未成伤也。人之有常病也,亦因其骨节皮肤腠理之不坚固者,邪之所舍也,故常为病也。(木
有坚脆,所以伤有重轻,人有坚脆,所以病有微甚,故虽同时遇风,而有受有不受,此病之所以异也。)
黄帝曰∶人之善病风厥漉汗者,何以候之?(风邪逆于腠理,而汗出漉漉不止者,病名风厥。又详义见本类前三十。)
少俞答曰∶肉不坚,腠理疏,则善病风。黄帝曰∶何以候肉之不坚也?少俞答曰∶ 肉不坚而无分理者粗理,粗理而皮
不致者腠理疏,此言其浑然者。(膝湾曰 ,即足太阳经委中穴也。 中为溪谷之大会,故其理粗而皮不致者,可以验通
身腠理之疏也。 音国。 音致,密也。)
黄帝曰∶人之善病消瘅者,何以候之?少俞答曰∶五脏皆柔弱者,善病消瘅。(消瘅详义见前六十。)黄帝曰∶何以
知五脏之柔弱也?少俞答曰∶夫柔弱者必有刚强,刚强多怒,柔者易伤也。(性气刚暴而肌肉弱者,乃易于伤,故善病消
瘅。)黄帝曰∶何以候柔弱之与刚强?少俞答曰∶此人薄皮肤而目坚固以深者,长冲直扬,其心刚,(皮肤薄者,肌肉必
弱。目坚固而视直扬者,其心必刚。冲者,目光突露之谓。)刚则多怒,怒则气上逆,胸中蓄积,血气逆留, 皮充肌,
血脉不行,转而为热,热则消肌肤,故为消瘅,此言其人暴刚而肌肉弱者也。(怒则气逆,气留则血留,故郁而为热而成
消瘅。 ,宽同。)
黄帝曰∶人之善病寒热者,何以候之?少俞答曰∶小骨弱肉者,善病寒热。(骨属肾,肉属脾,皆至阴之所在也。阴
不足则阳邪易以入之,故善病寒热。)黄帝曰∶何以候骨之小大,肉之坚脆,色之不一也?少俞答曰∶颧骨者骨之本也,
颧大则骨大,颧小则骨小。(目下颊骨曰颧,周身骨胳大小,可验于此也。颧音权。胳音革。)皮肤薄而其肉无 ,其臂
懦懦然,其地色殆然,不与其天同色,污然独异,此其候也。( ,肉之结聚而坚者也。懦懦然,柔弱貌。地气阴浊,天
气清明,质色有余而神色不足,是地不与天同色也,故殆然污然,其状有异。肉有坚脆,色有不同,于此可验强弱也。
,渠允切。懦,儒、糯、软三音。)然后臂薄者其髓不满,故善病寒热也。(髓为骨之充,阴之精也,故髓不满者,当
病寒热。)
黄帝曰∶何以候人之善病痹者?少俞答曰∶粗理而肉不坚者,善病痹。(肉不坚,则风寒湿邪易以入也。)黄帝曰∶
痹之高下有处乎?少俞答曰∶欲知其高下者,各视其部。(人之上下左右,虚实自有不同,故当各视其部。)
黄帝曰∶人之善病肠中积聚者,何以候之?少俞答曰∶皮肤薄而不泽,肉不坚而淖泽,如此则肠胃恶,恶则邪气留
止,积聚乃伤。脾胃之间,寒温不次,邪气稍至, 积留止,大聚乃起。(皮肤薄者,肉不坚也。不润泽者,血不足也。
淖泽者,湿滞多也。此其肠胃薄恶,气禀之有亏也。故或中外邪,留而不去,或肠胃寒温,有不以次,皆足致邪而大聚
起矣。义详《百病始生篇》,见本类前二。淖音闹。 ,蓄同。)
黄帝曰∶余闻病形,已知之矣,愿闻其时。(此总结五变而问其凶吉之期也。)少俞答曰∶先立其年,以知其时,时
高则起,时下则殆。(先立其年,则五运六气各有所主,故知其时。凡病遇生王,则时之高也,故可以起,起言愈也。如
逢衰克,则时之下也,病当危殆矣。《六元正纪大论》亦曰∶先立其年,以明其气。详运气类十七。)虽不陷下,当年有
冲通,其病必起,是谓因形而生病,五变之纪也。(虽非衰克陷下之时,而年有所冲,则气有所通,其病亦因而起,此非
上节之所谓起也。如水火相冲,火当畏水,金木相冲,木当畏金;然火胜则水亦病,木胜则金亦病。故有以金形之人,
而反病于丁壬年者,有以木形之人,而反病于甲己年者,是谓因形生病,五变之纪也。)
(《灵枢·五变篇》全文。涉及风厥汗出、消瘅、寒热、留痹、积聚等病症。)
黄帝向少俞问道:我听说各种疾病的发生,必定始于风雨寒暑的侵袭,邪气顺着毫毛进入腠理(皮肤纹理及肌肉间隙),有的又返回体外,有的则停留体内;有的表现为风肿汗出,有的发展为消瘅(以多饮、多食、消瘦为特征的病证),有的表现为寒热往来,有的形成留痹(风寒湿邪滞留经络关节所致的痹证),有的造成积聚(腹内结块,或痛或胀的病证)。奇邪淫溢泛滥,多得数不清,我希望了解其中的原因。为什么同时遭受外邪致病,有的人患这种病,有的人患那种病?难道是天故意让人生风吗?为何差异如此之大呢?(“瘅”音丹,又有上声、去声两种读音。)
少俞回答说:上天产生风,并不是为了偏私百姓,它的运行公平正直,触犯它的人就会生病,躲避它的人就不会有危险,这不是天在找人麻烦,而是人自己触犯了它。(“殆”,意为危险。天并非主动害人而人自取其祸,所以有人少病有人多病,也在于人的谨慎与不谨慎罢了。)
黄帝说:在同一时间遇到风邪,同时得病,但病情各异,我想听听其中的缘故。
少俞说:问得好!请让我用匠人来打比方。匠人磨快斧头刀刃,砍削木材,木材的阴阳属性中还有坚硬与脆嫩的区别,坚硬的木材斧斤难入,脆嫩的木材表皮松弛,到了节疤处,斧斤反而容易缺损。同一棵树中,坚硬与脆嫩不同,坚硬的则刚强,脆嫩的易受损伤,更何况不同的木材,树皮厚薄、汁液多少各不相同呢?(这是借用木材的材质来比喻人的先天禀赋。“砺”音利。“斫”音卓。“脆”音翠。“弛”音矢,意为松懈。)
那些早春开花先长叶子的树木,遇到春霜和猛烈大风,花朵就会凋落,叶子就会枯萎。长期暴晒和大旱,脆嫩且皮薄的树木,枝条汁液减少,叶子枯萎。长期阴雨连绵,皮薄多汁的树木,表皮溃烂渗水。突然遭遇暴风骤雨,刚硬与脆嫩的树木,树枝折断,树干受损。秋霜和疾风,刚硬与脆嫩的树木,根部动摇,叶子脱落。这五种情况,各自受到不同的伤害,何况是人呢?(这说明树木的凋零残败各有原因,以此比喻人的疾病,也无不有所导致的原因。“萎”音威,意为蔫枯。“蔫”音烟,指物体不新鲜而颜色败坏。“溃”音会,意为腐烂。“漉”音鹿,形容水湿的样子。“杌”音兀,指没有枝干的木头。)
黄帝说:用人来对应树木的道理是怎样的?
少俞回答说:树木受到的伤害,都伤及其枝条,枝条的刚脆与坚硬,尚未构成严重损伤。人之所以常有疾病,也是因其骨节、皮肤、腠理不够坚固,成为邪气栖留的地方,所以常患病。(树木有坚脆之分,所以受伤有轻重;人有强弱之别,所以病情有轻有重,因此虽然同时遇风,有的受病,有的不受病,这就是疾病差异的原因。)
黄帝说:人容易患风厥、漉汗(汗出如水流不止)的病,如何从体征上判断?(风邪逆乱于腠理,导致汗出漉漉不止,病名叫风厥。详细含义见本类前三十篇。)
少俞回答说:肌肉不坚实且没有清晰纹理的是粗理,纹理粗糙且皮肤不致密的就是腠理疏松,这是指整体而言的情况。(膝弯处称为腘,即足太阳膀胱经的委中穴。腘中是溪谷之大会,所以如果此处纹理粗糙且皮肤不致密,可以推断全身腠理都是疏松的。“腘”音国。“致”音致,意为密实。)
少俞回答说:五脏都柔弱的人,容易患消瘅病。(消瘅的详细含义见前六十篇。)
少俞回答说:柔弱的人必然伴随刚强的性格,刚强的人容易发怒,柔弱体质的人容易受伤。(性情刚暴而肌肉薄弱的人,容易受伤,所以善于患消瘅病。)
少俞回答说:这种人皮肤薄,眼睛深邃且目光坚定直视,眉毛长而冲直上扬,内心刚强。(皮肤薄的人,肌肉必然薄弱。眼睛深邃且目光直视上扬的人,内心一定刚强。“冲”,指目光突露的样子。)刚强就容易发怒,发怒则气机上逆,胸中蓄积,血气逆乱停滞,皮肤充塞肌肉,血脉不通,转而化热,热邪消耗肌肤,所以形成消瘅,这是说那种外表暴戾刚强而肌肉虚弱的人。(发怒则气逆,气滞则血滞,所以郁结而为热,形成消瘅。“ ”,同“宽”。)
少俞回答说:骨骼细小、肌肉软弱的人,容易患寒热病。(骨属肾,肉属脾,都是至阴所在。阴气不足,阳邪就容易侵入,所以容易患寒热病。)
少俞回答说:颧骨是骨的根本,颧骨大则骨骼大,颧骨小则骨骼小。(眼下脸颊部的骨头叫颧,周身骨骼的大小,可以通过这里来验证。“颧”音权。“胳”音革。)皮肤薄且肌肉没有结节坚实感,手臂柔弱无力,面色晦暗,不与天色(正常光泽)相同,显得污浊独异,这就是其征候。(“ ”,指肌肉结聚而坚实的部分。“懦懦然”,柔弱貌。“地气”阴浊,“天气”清明,体质色泽有余而神色不足,是地气不与天气同色,所以显得晦暗污浊,状态有异。肌肉有坚脆,面色有不同,由此可验证体质的强弱。“ ”,音渠允切。“懦”,音儒、糯、软三音。)然后,手臂瘦薄的人,其骨髓不满,所以容易患寒热病。(髓是骨的充盈物,是阴精,所以骨髓不满的人,应当患寒热病。)
少俞回答说:纹理粗糙且肌肉不坚实的人,容易患痹病。(肌肉不坚实,风寒湿邪就容易侵入。)
少俞回答说:想知道高下部位,分别观察其身体各部位即可。(人体上下左右,虚实自然不同,所以应当分别观察各部位。)
少俞回答说:皮肤薄而无光泽,肌肉不坚实而湿润,像这样肠胃功能就恶劣,功能恶劣则邪气停留,积聚便形成并损伤身体。脾胃之间,寒温失调,邪气稍至,就会蓄积停留,大的积聚便会兴起。(皮肤薄,说明肌肉不坚实。不润泽,说明血不足。淖泽,说明湿滞多。这是肠胃薄弱恶劣,禀气有亏损。所以无论是内外邪气停留不去,还是肠胃寒温不按次序,都足以招致邪气并形成大积聚。义理详见《百病始生篇》,见本类前两篇。“淖”音闹。“ ”,同“蓄”。)
黄帝说:我已经知道了疾病的形态,希望了解发病的时间。(这是总结五变并询问吉凶发作的时间。)
少俞回答说:先确立当年的岁运,以知晓发病时机,时运旺盛则病起(痊愈),时运衰退则病危。(先确立当年岁运,则五运六气各有主司,所以能知晓时机。凡是遇到相生旺盛之时,就是时运之高,所以可以痊愈,“起”指痊愈。如果遇到相克衰退之时,就是时运之下,病当危殆。《六元正纪大论》也说:先立其年,以明其气。详见运气类十七篇。)即使没有陷入衰退,当年如果有冲通之气,病也一定会发作,这叫作因形体特质而生病,这是五变的规律。(虽然不是相克衰退陷下之时,但年份有冲撞,则气机有通达,病也会因此发作,这不是上一节所说的“起”(痊愈)。如水火相冲,火本该畏水,金木相冲,木本该畏金;然而火胜则水也病,木胜则金也病。所以有金形之人,反而在丁壬年发病的,有木形之人,反而在甲己年发病的,这叫作因形体特质而生病,是五变的规律。)
(The full text of *Ling Shu: Wu Bian Pian*. Involving conditions such as Feng Jue with sweating, Xiao Dan, Cold and Heat, Liu Bi, and Ji Ju.)
Huangdi asked Shaoyu: I have heard that the onset of various diseases must originate from the invasion of wind, rain, cold, and heat. The pathogenic factors enter the Couli (skin texture and muscle interstices) via the fine hairs; some return to the exterior, while others remain inside. Some manifest as wind-induced swelling and sweating, some develop into Xiao Dan (a condition characterized by polydipsia, polyphagia, and emaciation), some present as alternating chills and fever, some form Liu Bi (bi-syndrome caused by the stagnation of wind-cold-damp pathogens in meridians and joints), and some result in Ji Ju (abdominal masses causing pain or distension). The overflow of strange pathogens is countless. I wish to understand the reasons behind this. Why do people exposed to the same external pathogens at the same time suffer from different diseases? Is it that Heaven intentionally generates wind to make people sick? Why are there such differences? ("Dan" is pronounced "dan", and also has rising and departing tones.)
Shaoyu replied: Heaven's generation of wind is not for the sake of favoring any particular person; its movement is fair and upright. Those who encounter it get sick, and those who avoid it remain safe. It is not that Heaven seeks out people to harm them, but rather that people inadvertently encounter it. ("Dai" means danger. Heaven does not actively seek to harm people, yet people suffer from it; thus, some have few illnesses and many have many, depending on whether one is cautious or careless.)
Huangdi said: Encountering wind at the same time and getting sick simultaneously, yet having different diseases, I wish to hear the reason.
Shaoyu said: Excellent question! Let me use a carpenter as an analogy. A carpenter sharpens axes and knives to chop wood. Within the wood, there are differences between hard and brittle textures. Hard wood resists the axe, while brittle wood has loose skin. At the knots, the axe may even break. Even within a single tree, hardness and brittleness differ; hard wood is tough, while brittle wood is easily damaged. How much more so for different types of wood, which vary in bark thickness and sap content? (This borrows the material properties of wood to compare with human innate constitution. "Li" is pronounced "li". "Zhuo" is pronounced "zhuo". "Cui" is pronounced "cui". "Chi" is pronounced "shi", meaning loose.)
Trees that flower early and grow leaves first, when encountering spring frost and fierce winds, will have their flowers fall and leaves wither. Under long exposure to sun and drought, brittle trees with thin bark will have reduced sap in branches and withered leaves. During prolonged heavy rain, trees with thin bark and abundant sap will have their bark rot and ooze water. When suddenly struck by violent storms, both hard and brittle trees will have broken branches and damaged trunks. With autumn frost and gale-force winds, hard and brittle trees will have shaken roots and falling leaves. These five situations each cause specific damage; how much more so for humans? (This states that the decay of trees has various causes, analogous to human diseases, which also have specific etiologies. "Wei" is pronounced "wei", meaning withered. "Nian" is pronounced "yan", referring to objects losing freshness and color. "Kui" is pronounced "hui", meaning rotten. "Lu" is pronounced "lu", describing a wet appearance. "Wu" is pronounced "wu", referring to a tree without branches.)
Huangdi said: How does the comparison between humans and trees apply?
Shaoyu answered: Damage to trees affects their branches; the hardness or brittleness of branches does not constitute severe injury initially. Humans often suffer from chronic diseases because their bones, joints, skin, and Couli are not firm enough, providing a residence for pathogenic factors, hence they frequently fall ill. (Wood has hard and brittle parts, leading to varying degrees of injury; humans have strong and weak constitutions, leading to varying severity of illness. Thus, even when exposed to wind simultaneously, some get sick and others do not, which explains the difference in diseases.)
Huangdi said: How can one identify those prone to Feng Jue and profuse sweating (sweating like flowing water)? (When wind pathogen reverses in the Couli, causing continuous profuse sweating, the disease is named Feng Jue. See detailed meaning in the previous 30 articles of this category.)
Shaoyu answered: Those with unfirm muscles and loose Couli are prone to wind diseases.
Huangdi said: How can one identify unfirm muscles?
Shaoyu answered: Those with unfirm muscles and unclear tissue lines have coarse texture; those with coarse texture and non-tight skin have loose Couli. This refers to the general state. (The popliteal fossa is called Guo, which is the Weizhong acupoint of the Foot-Taiyang Bladder Meridian. Guo is the major confluence of Xi-Gu (valleys); thus, if the texture here is coarse and skin is not tight, it indicates that the Couli throughout the body are loose. "Guo" is pronounced "guo". "Zhi" is pronounced "zhi", meaning dense.)
Huangdi said: How can one identify those prone to Xiao Dan?
Shaoyu answered: Those whose Five Zang organs are all weak are prone to Xiao Dan. (See detailed meaning of Xiao Dan in the previous 60 articles.)
Huangdi said: How can one know the weakness of the Five Zang organs?
Shaoyu answered: Weakness is necessarily accompanied by rigidity; those who are rigid tend to be angry, and those with weak constitutions are easily injured. (Those with a harsh temperament and weak muscles are prone to injury and thus susceptible to Xiao Dan.)
Huangdi said: How can one distinguish between weak and rigid constitutions?
Shaoyu answered: Such individuals have thin skin, deep-set eyes with a firm, direct gaze, long eyebrows that rise straight up, and a rigid heart/mind. (Thin skin implies weak muscles. Deep-set eyes with a direct, upward gaze imply a rigid mind. "Chong" refers to the protruding nature of the gaze.) Rigidity leads to anger; anger causes Qi to reverse upwards, accumulating in the chest, causing blood and Qi to stagnate and reverse. The skin becomes congested, muscles tense, and blood vessels fail to circulate properly. This transforms into heat, which consumes the flesh and skin, resulting in Xiao Dan. This describes individuals who are outwardly aggressive and rigid but have weak muscles. (Anger causes Qi reversal; Qi stagnation leads to blood stagnation,郁结 generating heat and forming Xiao Dan. " ", same as "kuan".)
Huangdi said: How can one identify those prone to Cold and Heat diseases?
Shaoyu answered: Those with small bones and weak muscles are prone to Cold and Heat diseases. (Bones belong to the Kidney, and muscles belong to the Spleen; both are locations of extreme Yin. Insufficiency of Yin allows Yang pathogens to easily invade, hence susceptibility to Cold and Heat diseases.)
Huangdi said: How can one assess bone size, muscle firmness, and complexion variations?
Shaoyu answered: The zygomatic bone (Quan) is the root of the bones; large Quan indicates large bones, and small Quan indicates small bones. (The cheekbone below the eye is called Quan; the size of the entire skeletal structure can be verified here. "Quan" is pronounced "quan". "Ge" is pronounced "ge".) Thin skin, lack of firm muscle nodules, soft arms, and a dull complexion that differs from the natural brightness (Heavenly Qi), appearing murky and distinct, are these signs. (" ", refers to firm, aggregated muscle tissue. "Nuonuo ran" means soft/weak. "Di Qi" (Earthly Qi) is turbid and Yin, while "Tian Qi" (Heavenly Qi) is clear and Yang. If physical color is excessive but spiritual luster is lacking, Earth does not match Heaven, hence appearing dull and murky. Variations in muscle firmness and complexion allow one to verify strength and weakness. " ", pronounced quyun qie. "Nuo", pronounced ru, nuo, ruan.) Furthermore, those with thin arms have insufficient marrow, making them prone to Cold and Heat diseases. (Marrow fills the bones and is the essence of Yin; thus, insufficient marrow predisposes one to Cold and Heat diseases.)
Huangdi said: How can one identify those prone to Bi syndrome?
Shaoyu answered: Those with coarse texture and unfirm muscles are prone to Bi syndrome. (Unfirm muscles allow wind-cold-damp pathogens to easily invade.)
Huangdi said: Does Bi syndrome have fixed locations of high and low?
Shaoyu answered: To know the location, observe each part of the body separately. (The upper/lower and left/right aspects of the human body naturally differ in deficiency and excess, so each part should be observed individually.)
Huangdi said: How can one identify those prone to intestinal Ji Ju?
Shaoyu answered: Thin skin without luster, and unfirm yet moist muscles indicate poor gastrointestinal function. Poor function allows pathogenic factors to linger, leading to the formation of Ji Ju and bodily injury. Between the Spleen and Stomach, if cold and warmth are disordered, even slight pathogenic invasion causes accumulation and stagnation, leading to large accumulations. (Thin skin implies unfirm muscles. Lack of luster implies blood insufficiency. Moisture implies damp stagnation. This indicates weak and poor gastrointestinal constitution and deficient innate Qi. Thus, whether internal or external pathogens linger, or if gastrointestinal cold/warmth is disordered, all can attract pathogens and initiate large accumulations. For detailed meaning, see *Bai Bing Shi Sheng Pian*, previous two articles of this category. "Nao" is pronounced "nao". " ", same as "xu".)
Huangdi said: I have known the forms of the diseases; I wish to know the timing. (This summarizes the five changes and asks about the timing of auspicious or inauspicious occurrences.)
Shaoyu answered: First establish the annual cycle to know the timing. When the timing is high (prosperous), the disease arises (recovers); when the timing is low (declining), the disease becomes critical. (Establishing the annual cycle reveals the dominance of the Five Movements and Six Qi, allowing one to know the timing. Whenever one encounters a generating/prosperous phase, it is "high," hence recovery is possible; "qi" means recovery. If one encounters a overcoming/declining phase, it is "low," and the disease becomes critical. *Liu Yuan Zheng Ji Da Lun* also states: Establish the year first to clarify the Qi. See detailed discussion in the Luck/Qi category, article 17.) Even if not in a declining phase, if there is a clash-through in the current year, the disease will definitely arise. This is called becoming ill due to physical constitution, which is the principle of the Five Changes. (Even if not in a overcoming/declining phase, a yearly clash allows Qi to connect, and the disease arises accordingly. This is not the "arise" (recovery) mentioned in the previous section. For example, Water and Fire clash; Fire fears Water. Metal and Wood clash; Wood fears Metal. However, if Fire prevails, Water also suffers; if Wood prevails, Metal also suffers. Thus, a Metal-type person may fall ill in Ding-Ren years, and a Wood-type person may fall ill in Jia-Ji years. This is called becoming ill due to constitution, which is the principle of the Five Changes.)