(灵枢刺节真邪篇)
黄帝曰∶有一脉生数十病者,或痛、或痈、或热、或寒、或痒、或痹、或不仁,变化无穷,其故何也?岐伯曰∶此
皆邪气之所生也。(一脉,犹言一经也。邪气,即下文之虚风也。虚邪贼风,善行数变,故其为病则变化无穷。)黄帝曰∶
余闻气者,有真气,有正气,有邪气,何谓真气?岐伯曰∶真气者,所受于天,与谷气并而充身也。(真气,即元气也。
气在天者,受于鼻而喉主之;在水谷者,入于口而咽主之。然钟于未生之初者,曰先天之气;成于已生之后者,曰后天
之气。气在阳分即阳气,在阴即阴气,在表曰卫气,在里曰营气,在脾曰充气,在胃曰胃气,在上焦曰宗气,在中焦曰
中气,在下焦曰元阴元阳之气,皆无非其别名耳。)正气者,正风也,从一方来,非实风,又非虚风也。(从一方来,谓
太一所居之方也。风得时之正者,是为正风。然正风实风本同一方,而此曰非实风者,以正风之来徐而和,故又曰正气;
实风之来暴而烈,故与虚风对言也。按岁露论曰∶诸所谓风者,皆发屋折树木扬沙石,此虚风实风之谓也。详运气类三
十五、六。)邪气者,虚风之贼伤人也,其中人也深,不能自去。(从冲后来者为虚风,其中人也甚,故深入不能自去。)
正风者,其中人也浅,合而自去,其气来柔弱,不能胜真气,故自去。(合而自去,谓邪与正合而正胜之,故自去也。)
虚邪之中人也,洒淅动形,起毫毛而发腠理,其入深,内抟于骨则为骨痹,抟于筋则为筋挛,抟于脉中则为血闭不通,
则为痈,抟于肉,与卫气相抟,阳胜者则为热,阴胜者则为寒,寒则真气去,去则虚,虚则寒,抟于皮肤之间。(洒淅,
寒栗也。邪之中人,变不可测,故无分皮肉筋骨,着则为病也。若与卫气相抟,阳胜则热,阴胜则寒,皆邪气也,何独
曰寒则真气去、去则虚?盖气属阳,人以气为主,寒胜则阳虚,所重在气也。阳气既虚,则阴寒抟聚于皮肤之间矣。)其
气所发,腠理开,毫毛摇,气往来行则为痒,留而不去则痹,卫气不行则为不仁。(邪之在表者其气外发,或腠理开则汗
为不敛,或毫毛动摇则毛悴而败,或气往来行则流而为痒,或邪留不去则痛而为痹。若卫气受伤,虚而不行,则不知痛
痒,是为不仁。)虚邪偏容于身半,其入深,内居荣卫,荣卫稍衰则真气去,邪气独留,发为偏枯;其邪气浅者,脉偏痛。
(虚邪若中于半身,其入深而重者,则营卫衰,真气去,乃发为偏枯。若邪之浅者,亦当为半身偏痛也。)虚邪之入于身
也深,寒与热相抟,久留而内着,寒胜其热则骨疼肉枯,热胜其寒则烂肉腐肌为脓,内伤骨,内伤骨为骨蚀。(邪中于外
者必寒,气蓄于内者必热,寒邪深入与热相抟,久留不去,必内有所着,故寒胜则伤阳而为痛为枯,热胜则伤阴而为脓
为腐;其最深者,内伤于骨,是为骨蚀,谓侵蚀及骨也。蚀音食。)有所疾前筋,筋屈不得伸,邪气居其间而不反,发为
筋溜。(有所疾前筋,谓疾有始于筋也。筋之初着于邪,则筋屈不得伸。若久居其间而不退,则发为筋溜。筋溜者,有所
流注而结聚于筋也,即赘瘤之属。下仿此。溜,力救切。)有所结,气归之,卫气留之不得反,津液久留,合而为肠溜。
(邪有所结,气必归之,故致卫气失常,留而不反则搐积于中,流注于肠胃之间,乃结为肠溜。卫气失常为病,详针刺
类二十六。)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,连以聚居为昔瘤。
(其有久者,必数岁而后成也。然其始也,按之虽柔,或上或下,已有所结;及其久也,气渐归之,津液留之,复中邪
气,则易于日甚,乃结为昔瘤。昔瘤者,非一朝夕之谓。瘤音溜。)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。(又有按之而坚者,其深中骨,是气因于骨而然。骨与气并,其结日大,名为附骨疽也。)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。(又有结于肉中者,则宗气归之。宗,大也,以阳明
之气为言。邪留为热,则溃腐肌肉,故为脓。无热则结为粉浆之属,聚而不散,是为肉疽。)凡此数气者,其发无常处,
而有常名也。(虽有常名而发无常处,无常处则形证亦无常矣,此所以变化无常也。)
《灵枢·刺节真邪篇》记载:
黄帝问道:有一条经脉却生出几十种疾病,有的表现为疼痛,有的表现为痈肿,有的表现为发热,有的表现为发冷,有的表现为瘙痒,有的表现为麻木不仁(感觉丧失),有的表现为痹证(气血阻滞不通),变化无穷无尽,这是什么原因呢?岐伯回答说:这都是由邪气所导致的。(这里的“一脉”,就是指一条经脉。所谓的“邪气”,就是下文所说的虚风。虚邪贼风善于游走且变化迅速,所以它引起的疾病也就变化无穷。)
黄帝又问:我听说气有真气、正气、邪气之分,什么是真气呢?岐伯回答说:真气,是禀受于先天之气,并与后天水谷之气相结合从而充养全身的气。(真气,也就是元气。来源于天的气,通过鼻吸入并由喉主管;来源于水谷的气,通过口摄入并由咽主管。然而,在生命形成之前就已存在的,称为先天之气;在生命形成之后生成的,称为后天之气。气存在于阳分就是阳气,存在于阴分就是阴气,存在于体表称为卫气,存在于体内称为营气,存在于脾称为脾气,存在于胃称为胃气,存在于上焦称为宗气,存在于中焦称为中气,存在于下焦称为元阴元阳之气,这些都不过是它的别名罢了。)
正气,就是正风,从单一方向吹来,不是实风,也不是虚风。(从单一方向吹来,是指太一神居住的那个方位的风。顺应时节而来的风,叫做正风。然而正风和实风本属同一类,这里说它不是实风,是因为正风到来时缓慢和缓,所以又称为正气;实风到来时猛烈暴烈,所以与虚风相对而言。按《素问·岁露论》所说:各种所谓的风,都能掀翻房屋、折断树木、扬起沙石,这就是指虚风和实风。详见《运气类》第三十五、三十六节。)
邪气,是指虚风对人体的贼害损伤,它侵入人体很深,不能自行消除。(从冲后方向吹来的是虚风,它侵入人体很严重,所以深入而不能自去。)
正风侵入人体较浅,当它与人体正气相合时就会自行消散,因为它到来的气势柔弱,不能胜过人体的真气,所以会自行消失。(“合而自去”,是指邪气与正气相合,但正气战胜邪气,所以邪气自行消散。)
虚邪侵入人体时,使人感到战栗动摇,毫毛竖起,腠理开泄。如果它深入体内,搏结于骨则成为骨痹,搏结于筋则成为筋挛,搏结于脉中则导致血行闭塞不通,进而形成痈肿;搏结于肌肉之间,与卫气相互搏结,阳气胜则表现为热,阴气胜则表现为寒。寒气盛则真气耗散,真气耗散则导致虚损,虚损则产生寒冷感,寒气最终搏结于皮肤之间。(“洒淅”,形容恶寒战栗的样子。邪气侵入人体,变化不可预测,所以不分皮、肉、筋、骨,只要附着就会致病。如果与卫气相搏结,阳胜则热,阴胜则寒,这都属于邪气,为什么唯独说寒盛则真气去、去则虚呢?这是因为气属于阳,人以气为主,寒邪胜则导致阳虚,重点在于气的损伤。阳气既然虚弱,那么阴寒之气就会搏结聚集在皮肤之间。)
邪气在体表发散时,腠理开泄,毫毛摇动,气机往来流动则产生瘙痒,若停留不去则形成痹证,卫气运行不畅则表现为不仁(感觉迟钝或丧失)。(邪气在体表,其气向外发散,有时腠理开泄导致汗液不收敛,有时毫毛动摇导致毛发憔悴败坏,有时气机往来流动则流注而产生瘙痒,有时邪气停留不去则疼痛而形成痹证。如果卫气受伤,虚弱而不能运行,则不知痛痒,这就叫作不仁。)
虚邪偏侧地侵入身体的一半,如果侵入很深,内居于营卫之中,营卫稍微衰弱则真气离去,邪气独自留存,就会发展为偏枯(半身不遂);如果邪气较浅,则表现为半身疼痛。(虚邪如果侵入半身,侵入深且重的,会导致营卫衰败,真气离去,从而发生偏枯。如果邪气较浅的,也应当表现为半身偏痛。)
虚邪侵入人体很深,寒与热相互搏结,长久停留并内着于脏腑组织,寒胜热则骨头疼痛、肌肉枯瘦,热胜寒则烂肉腐肌化为脓液,向内损伤骨骼,损伤骨骼严重时称为骨蚀。(邪气从外部侵入必然带有寒性,气蓄积于内部必然产生热性,寒邪深入与热邪相搏结,长久停留不去,必定在内有所附着,所以寒胜则损伤阳气而导致疼痛和枯瘦,热胜则损伤阴液而导致化脓和腐烂;最深层次的,向内损伤骨骼,这叫作骨蚀,意思是侵蚀波及到骨骼。蚀音同食。)
如果有病变起始于筋,筋屈曲不能伸展,邪气停留在其间而不返回,就会发展为筋溜(筋部赘瘤)。(“有所疾前筋”,是指疾病起始于筋。筋最初遭受邪气侵袭,就会屈曲不能伸展。如果长久停留在其间而不消退,就会发展为筋溜。筋溜,是指邪气流注并结聚于筋部,即类似于赘瘤的东西。下文仿照此意。溜,读音为力救切。)
如果有邪气结聚,气归向那里,卫气留滞不能返回,津液长久停留,结合而成肠溜。(邪气有所结聚,气必然归向那里,从而导致卫气失常,留滞而不能返回,则积聚于中,流注于肠胃之间,于是结为肠溜。卫气失常导致的病症,详见《针刺类》第二十六节。)病程长的要经过数年才能形成,用手按压感觉柔软,因为已经有所结聚;气归向那里,津液停留,邪气侵入其中,凝结程度日益加重,连接聚居在一起就形成了昔瘤(陈旧性肿瘤)。(那些病程长的,必定经过数年才能形成。然而开始时,虽然按压感觉柔软,无论上下,都已经有所结聚;等到日久天长,气逐渐归向那里,津液停留,又受到邪气侵袭,就容易日益加重,于是结为昔瘤。昔瘤,不是说一朝夕就能形成的。瘤,读音同溜。)
用手按压感觉坚硬,有所结聚,深入骨骼,气依附于骨,骨与气并结,日渐增大,就称为骨疽。(又有按压感觉坚硬的,说明邪气深入骨骼,这是气依附于骨所致。骨与气并结,肿块日渐变大,名叫附骨疽。)
如果有结聚,位于肌肉之中,宗气归向那里,邪气停留不去,有热则化而为脓,无热则称为肉疽。(又有结聚在肌肉中的,则宗气归向那里。宗,意为大,这里指阳明之气。邪气停留化热,则溃烂腐蚀肌肉,所以化为脓液。如果没有热,则结聚成类似粉浆的东西,聚集而不消散,这就叫作肉疽。)
凡是上述几种邪气,它们的发作没有固定的部位,但有固定的名称。(虽然有固定的名称,但发作没有固定部位,没有固定部位意味着形体和证候也没有固定规律,这就是之所以变化无常的原因。)
[Lingshu: Ci Jie Zhen Xie Chapter]
Huangdi asked: If one meridian gives rise to dozens of diseases, manifesting as pain, carbuncles (sores), heat, cold, itching, bi-syndrome (obstruction and pain due to wind-cold-dampness), or numbness (loss of sensation), with changes that are infinite, what is the reason? Qibo replied: These are all generated by pathogenic factors. ("One meridian" refers to a single meridian. "Pathogenic factors" here refers to the deficient winds mentioned below. Deficient evils and thieving winds change rapidly and move swiftly, hence their diseases are infinitely variable.)
Huangdi asked again: I have heard that qi is divided into True Qi (Zhen Qi), Correct Qi (Zheng Qi), and Pathogenic Qi (Xie Qi). What is True Qi? Qibo answered: True Qi is derived from Heaven (innate constitution) and combines with Grain Qi (nutritive energy from food) to nourish the whole body. (True Qi is also known as Yuan Qi. The qi derived from Heaven enters through the nose and is governed by the throat; the qi from water and grain enters through the mouth and is governed by the pharynx. However, that which exists before birth is called Innate Qi (Xian Tian Zhi Qi); that which forms after birth is called Acquired Qi (Hou Tian Zhi Qi). When qi exists in the Yang aspect, it is Yang Qi; in the Yin aspect, it is Yin Qi; on the exterior, it is Wei Qi (Defensive Qi); within, it is Ying Qi (Nutritive Qi); in the Spleen, it is Pi Qi (Spleen Qi); in the Stomach, it is Wei Qi (Stomach Qi); in the Upper Jiao, it is Zong Qi (Gathering Qi); in the Middle Jiao, it is Zhong Qi (Middle Qi); and in the Lower Jiao, it is Yuan Yin and Yuan Yang Qi. All these are merely alternative names.)
Correct Qi refers to Correct Wind (Zheng Feng), which comes from a single direction; it is neither Excess Wind (Shi Feng) nor Deficient Wind (Xu Feng). (Coming from a single direction refers to the direction where Tai Yi resides. Wind that conforms to the season is called Correct Wind. Although Correct Wind and Excess Wind originate from the same source, this text states it is not Excess Wind because Correct Wind arrives slowly and gently, thus also called Correct Qi; Excess Wind arrives violently and fiercely, hence contrasted with Deficient Wind. According to the Suwen chapter "Sui Lu Lun": Winds described as capable of destroying houses, breaking trees, and raising sand refer to Deficient and Excess Winds. See detailed discussion in Yunqi Category, chapters 35-36.)
Pathogenic Qi refers to the damaging effect of Deficient Wind on humans. It penetrates deeply and cannot eliminate itself. (Deficient Wind comes from the Chong Hou direction; its invasion is severe, so it penetrates deeply and remains.)
Correct Wind invades superficially. When it combines with the body's Correct Qi, it dissipates spontaneously. Its arrival is gentle and weak, unable to overcome the body's True Qi, so it disappears on its own. ("Combining and disappearing spontaneously" means the pathogen combines with Correct Qi, but Correct Qi prevails, causing the pathogen to dissipate.)
When Deficient Evil invades, it causes shivering and trembling, raises the hair follicles, and opens the Cou Li (pores/skin texture). If it penetrates deeply and binds to the bones, it becomes Bone Bi (Bone Obstruction); if it binds to the tendons, it becomes Tendon Spasm; if it binds within the vessels, it causes blood closure and obstruction, leading to Carbuncles; if it binds in the flesh and struggles with Wei Qi (Defensive Qi), Yang excess results in Heat, while Yin excess results in Cold. Cold depletes True Qi; depletion leads to Deficiency; deficiency manifests as Cold, with the pathogen binding between the skin layers. ("Shaxi" describes chills and trembling. Pathogens invade unpredictably, affecting skin, flesh, tendons, or bones, causing disease wherever they attach. If struggling with Wei Qi, Yang excess causes Heat, Yin excess causes Cold—both are pathogens. Why specifically mention Cold depleting True Qi? Because Qi belongs to Yang, and humans rely on Qi as their master. Cold excess damages Yang, emphasizing the injury to Qi. Once Yang Qi is deficient, Yin-Cold accumulates in the skin layers.)
When the pathogen manifests at the surface, Cou Li open, and hair follicles tremble. If Qi flows back and forth, it causes itching; if it stays and does not leave, it causes Bi-syndrome; if Wei Qi fails to circulate, it causes Numbness (lack of sensation). (Surface pathogens emit outward. Sometimes Cou Li opening prevents sweat retention; sometimes hair trembling indicates deterioration; sometimes flowing Qi causes itching; sometimes lingering pathogens cause pain and Bi-syndrome. If Wei Qi is injured, becoming deficient and stagnant, one loses sensation of pain and itch, termed Numbness.)
If Deficient Evil invades half the body deeply, residing within Ying and Wei Qi, slight decline in Ying and Wei leads to departure of True Qi, leaving only Pathogenic Qi, resulting in Hemiplegia (Pian Ku); if the pathogen is shallow, it causes unilateral pain. (Deep and heavy invasion of Deficient Evil into half the body causes Ying/Wei decline and True Qi departure, leading to Hemiplegia. Shallow invasion causes unilateral pain.)
Deficient Evil invading deeply causes Cold and Heat to struggle. Long-term retention leads to internal fixation. Cold exceeding Heat causes bone pain and muscle emaciation; Heat exceeding Cold causes rotting flesh and muscle, forming pus, and internally injuring bones, termed Bone Erosion (Gu Shi). (External pathogens bring Cold; internal accumulation brings Heat. Deep Cold struggling with Heat, lingering internally, attaches to tissues. Cold excess injures Yang, causing pain and emaciation; Heat excess injures Yin, causing pus and rot. Deepest injury reaches bones, termed Bone Erosion, meaning erosion extends to bone. 'Shi' sounds like 'shi'.)
If a disease originates in the tendons, causing flexion inability, and Pathogenic Qi lodges there without retreating, it develops into Tendon Liuliu (Tendon Lipoma/Nodule). ("You suo ji qian jin" means disease starting in tendons. Initial pathogen attachment causes tendon flexion inability. Prolonged lodging without retreat develops into Tendon Liuliu. Liuliu refers to fluid accumulation and nodulation in tendons, similar to lipomas. 'Liu' is pronounced 'liu jiu'.)
If there is nodulation, Qi converges there. Wei Qi stagnates and cannot return; fluids remain long-term, combining to form Intestinal Liuliu. (Pathogenic nodulation attracts Qi, causing Wei Qi dysfunction. Stagnation leads to accumulation in the middle, flowing into intestines/stomach, forming Intestinal Liuliu. See Zhenji Category 26 for Wei Qi disorders.) Long-standing cases take years to form. Palpation feels soft because nodulation has occurred. As Qi converges and fluids remain, combined with pathogenic invasion, condensation worsens daily. Clustering together forms Xi Liu (Old Tumor). (Long-standing cases take years. Initially soft upon palpation, nodulation exists. Over time, Qi converges, fluids remain, and pathogens invade, worsening daily, forming Xi Liu. 'Xi Liu' implies formation over time, not overnight. 'Liu' sounds like 'liu'.)
Palpation feels hard. Nodulation is deep in the bone. Qi adheres to bone; bone and Qi combine, enlarging daily, forming Bone Ju (Bone Abscess/Gangrene). (Hard palpation indicates deep bone invasion, where Qi adheres to bone. Bone-Qi combination enlargs the mass, named Fugu Ju.)
Nodulation in the flesh attracts Zong Qi (Gathering Qi). Pathogenic retention with Heat transforms into pus; without Heat, it forms Flesh Ju (Flesh Abscess/Gangrene). (Nodulation in flesh attracts Zong Qi. 'Zong' means great, referring to Yangming Qi. Retained pathogen generating heat ulcerates muscle, forming pus. Without heat, it forms paste-like clusters,不散 (not dispersing), termed Flesh Ju.)
These various pathogenic factors have no fixed site of manifestation but have fixed names. (Although names are fixed, sites vary. Variable sites mean variable signs and symptoms, hence the infinite variability.)