(《素问·评热病论》)
黄帝问曰∶有病温者,汗出辄复热而脉躁疾,不为汗衰,狂言不能食,病名为何?岐伯对曰∶病名阴阳交,交者死
也。(汗者阴之液,身热脉躁者阳之邪,病温汗出之后,则当邪从汗解,热退脉静矣。今其不为汗衰者,乃阳胜之极,阴
气不能复也,故为狂言,为不食。正以阳邪交入阴分,则阴气不守,故曰阴阳交,交者死也。)帝曰∶愿闻其说。岐伯曰∶
人所以汗出者,皆生于谷,谷生于精。(谷气内盛则生精。精气外达则为汗。)今邪气交争于骨肉而得汗者,是邪却而精
胜也,精胜则当能食而不复热。(惟精胜邪,所以能汗。邪从汗散,则当能食,不复热矣。)复热者,邪气也。汗者,精
气也。今汗出而辄复热者,是邪胜也。不能食者,精无俾也。(俾,使也。精,阴气也。五脏所以藏精,藏气虚则不能使
人饮食,故曰精无俾也。俾音比。)病而留者,其寿可立而倾也。(病气留而不退,则元气日败,必致损命矣。)且夫《热
论》曰∶汗出而脉尚躁盛者死。(《热论》指《灵枢·热病篇》也,见针刺类四十。凡汗后脉当迟静,而反躁盛者,直阴
竭而邪独胜也,故病必死。)今脉不与汗相应,此不胜其病也,其死明矣。(精气不胜病气也。)狂言者是失志,失志者死。
(此总五志为言也。志舍于精,精不胜邪,则五脏之志皆失,故致狂言者多死。)今见三死,不见一生,虽愈必死也。(汗
后辄复热不能食者,一死;汗后脉尚躁盛者,二死;汗后反狂言失志者三死。有此三者,则必死之候。)
《素问·评热病论》记载:
黄帝问道:有一种患温病的人,出汗后随即又发热,脉搏躁动疾速,出汗并不能使病情减轻,还出现胡言乱语、不能进食的症状,这种病叫什么名字?岐伯回答说:这种病名叫“阴阳交”,所谓“交”,是指死证。
(汗是阴液,身体发热、脉搏躁动是阳邪的表现。患温病出汗之后,应当邪气随汗而解,热退脉静。现在出汗后病情并不减轻,这是阳邪极盛,阴气无法恢复的缘故,所以出现胡言乱语、不能进食。正是因为阳邪侵入阴分,导致阴气不能固守,所以叫“阴阳交”,“交”意味着死亡。)
黄帝说:我想听听其中的道理。岐伯说:人之所以能出汗,都是因为谷气的作用,谷气又能化生为精气。
(谷气充盛于内则能生成精气。精气向外达表则化为汗液。)现在邪气与正气在骨肉之间交争,能够出汗的,说明邪气被驱除而精气占上风,精气占上风就应当能够进食且不再发热。
(只有精气战胜邪气,才能出汗。邪气随汗发散,就应当能够进食,不再发热。)再次发热的,是因为邪气仍在。汗出,代表精气外泄。现在出汗后随即又发热,说明邪气胜过精气。不能进食,是因为精气得不到补充。
(俾,意为使。精,指阴气。五脏负责藏精,如果脏气虚弱,就不能使人正常饮食,所以说“精无俾”。俾读音同“比”。)疾病迁延不愈,寿命很快就会终结。
(病气滞留不退,元气就会日渐败坏,必然导致丧命。)况且《热论》中说:出汗后脉搏仍然躁动旺盛的,会死亡。
(《热论》指的是《灵枢·热病篇》,见针刺类第四十节。凡是出汗后脉搏应当变得迟缓安静,反而躁动旺盛的,直接表明阴气枯竭而邪气独盛,所以病必死。)现在脉搏与出汗的情况不相适应,这说明正气不能战胜疾病,死亡是显而易见的。
(精气不能战胜病气。)胡言乱语是神志丧失的表现,神志丧失就会死亡。
(这里总括五志而言。志依附于精,如果精不胜邪,那么五脏所藏的志都会丧失,所以出现胡言乱语的往往死亡。)现在看到了三种死亡的征象,却看不到一种生存的生机,即使暂时好转,最终也必定死亡。
(出汗后随即发热、不能进食,这是一死;出汗后脉搏仍然躁动旺盛,这是二死;出汗后反而胡言乱语、神志丧失,这是三死。有这三种情况,就是必死的征候。)
Recorded in *Suwen: Commentary on Heat Diseases* (*Suwen · Ping Re Bing Lun*):
The Yellow Emperor asked, saying: There is a person suffering from a warm disease (Wenbing, febrile diseases caused by warm pathogens). After sweating, the fever returns immediately, and the pulse is rapid and restless. The sweating does not alleviate the condition; instead, the patient speaks deliriously and cannot eat. What is the name of this disease?
Qibo replied: This disease is named "Yin-Yang Jiao" (Intertwining of Yin and Yang). "Jiao" indicates a fatal outcome.
(Note: Sweat is the fluid of Yin. Body heat and a restless pulse are manifestations of Yang pathogenic factors. After sweating in a warm disease, the pathogen should resolve with the sweat, and the heat and pulse should subside and calm down. Now that the condition does not improve after sweating, it signifies extreme excess of Yang, and Yin Qi cannot recover. Hence, delirium and anorexia occur. Precisely because Yang pathogens intertwine into the Yin aspect, causing Yin Qi to lose its hold, it is called "Yin-Yang Jiao," where "Jiao" implies death.)
The Yellow Emperor said: I wish to hear the explanation.
Qibo said: The reason humans produce sweat lies in Gu Qi (Grain Qi/Nutritive Qi derived from food), which generates Jing Qi (Essence Qi).
(Gu Qi abundant internally generates Jing Qi. When Jing Qi reaches the exterior, it transforms into sweat.)
Now, when pathogenic factors contend with healthy Qi in the muscles and bones, resulting in sweating, it means the pathogen is retreating and Jing Qi is prevailing. If Jing Qi prevails, the patient should be able to eat and not have recurrent fever.
(Only when Jing Qi defeats the pathogen can sweat be produced. As the pathogen disperses with the sweat, the patient should be able to eat and no longer experience fever.) Recurrent fever indicates the presence of pathogenic factors. Sweat represents the leakage of Jing Qi. Now, sweating followed immediately by recurrent fever indicates that the pathogen is prevailing over the Jing Qi. Inability to eat means that Jing Qi lacks support/nourishment.
(Bi means to enable or assist. Jing refers to Yin Qi. The Zang organs store Jing Qi. If the Qi of the Zang organs is deficient, they cannot facilitate digestion and intake, hence it is said "Jing has no Bi." Bi is pronounced like "Bi".) If the disease lingers, life expectancy will end abruptly.
(If pathogenic Qi remains without receding, Yuan Qi (Original Qi) will deteriorate daily, inevitably leading to death.) Furthermore, *Re Lun* (Treatise on Heat) states: Those who sweat but whose pulses remain rapid and vigorous will die.
(*Re Lun* refers to the chapter "Heat Diseases" in *Lingshu*, see Acupuncture Category 40. Generally, after sweating, the pulse should become slow and quiet. If it remains rapid and vigorous, it directly indicates exhaustion of Yin and exclusive dominance of the pathogen, so the disease is fatal.) Now, the pulse does not correspond with the sweating, indicating that healthy Qi cannot overcome the disease; death is evident.
(Jing Qi fails to overcome pathogenic Qi.) Delirious speech indicates loss of Zhi (Will/Spirit). Loss of Zhi leads to death.
(This generally refers to the Five Zhi associated with the Five Zang organs. Zhi resides in Jing. If Jing cannot resist the pathogen, the Zhi of all five Zang organs will be lost, leading to delirium and often death.) Now, three signs of death are observed, while no sign of life is seen. Even if there is temporary improvement, death is inevitable.
(Sweating followed by immediate fever and inability to eat is the first sign of death; sweating followed by a still rapid and vigorous pulse is the second sign of death; sweating followed by delirium and loss of Zhi is the third sign of death. With these three conditions present, they are indicators of certain death.)