阳气者。若天与曰。失其所。则折寿而不彰(日不明。则万物不彰。人无阳。则夭折不
寿)故
天运当以曰光明(日即阳也。阳即明也。)是故。阳因而上卫外者也(人以阳为卫)欲如运枢(
昼夜五十度营运于身)起居如惊。神气乃浮(若于起居之时。烦扰如惊则神气浮散而不固○旧
本欲如运枢上。有因于寒三字。今从吴注移在下)因于寒。体若燔炭。汗出而散。(伤于寒则
为病热在表者汗以散之○旧本体若燔炭二句。在静则多言下。今从吴注移此)因于暑汗。烦
则喘喝。静则多言(暑先入心。而热熏肺故多汗。烦则喘。大声呼喝。静者多言而无次)因
于湿。首如裹(昏重也)湿热不攘(除也)大筋 (音软)短。小筋 (弛同)长 短为拘 长为痿
(湿郁而热。大筋连于骨肉。受热则缩而短。故病拘挛。小筋络于骨外。得湿则引而长。故
病痿弱)因于气。为肿(气道壅滞。故为浮肿)四维相代。阳气乃竭(四维。四肢也。相代。更
迭而病也。竭尽也。二句总结上文)阳气者。烦劳则张。精绝。辟积于夏。使人煎厥(烦扰乎
阳。则气张大而火炎。故令精绝。春令邪辟之气积至夏月火旺而精益亏。孤阳厥逆。故日煎
厥○上文言阳气不固。外邪伤之。此下言起居不节。致伤阳气也)目肓不可以视。耳闭不可
以听(肾之精为瞳子。耳为肾窍。精绝于内。故见证若此)溃溃乎若坏都 (音骨)乎不可止
。(都防水堤也)阳气者。大怒则形气绝而血菀(音郁)于上。使人薄厥(阳气贵充和若大怒则
伤形气。气达于旰。故血妄行。而菀积于上焦也相迫曰薄气逆曰厥。气血俱乱。故为薄厥)
有伤于筋。纵其若不容(纵缓不收。若难为容止)汗出偏沮。(湿也)使人偏枯(身常汗出半边
者。气血有所偏沮。久则营气不固。营气失守。故为偏枯。即半身不遂也)汗出见湿乃生痤
痱(音锄沸○汗出则玄府辟若湿留肤腠。甚者为痤。微者为痱。痤小疖也。痱瘾疹也)高梁(
膏粱同)之变足主大丁(疔同)受如持虚(足能也。膏梁美食。内多滞热其变能生大疔。感发最
易。如持空器以受物也)劳汗当风。寒薄为 。(音渣)郁乃痤(形劳汗出。凄风寒气薄之。液
凝于肤腠为 。即粉刺也。若郁而稍重乃或痤)阳气者。精则养神。柔则养筋(内化精微养于
神。外为津液柔于筋)开阖不得。寒气从之。乃生大偻(音吕○开谓皮肤。发泄。阖谓玄府封闭
。若为寒所袭阳气受伤。不能柔筋。形为偻俯矣)陷脉为 (音陋)留连肉腠(寒气自筋络而陷
入脉中。发为疡 。留结腠理)俞气化薄。传为善畏。及为惊骇(寒气流于经俞气化薄于脏腑则
为恐畏惊骇。此阳气被伤不能养神也)营气不从。逆于肉理。乃生痈肿(营行脉中。邪气陷脉
则不顺而逆于肉理。血郁热聚。故为痈肿)魄汗未尽形弱而气荣。穴俞已闭。发为风疟(魄。
阴也。汗由阴液。故曰魄汗。汗出未止。形弱气消风寒。薄之。穴俞随闭。邪留为疟。以所
病在风。故名风疟)故风者。百病之始也。清静则肉腠闭拒。虽有大风苛毒。弗之能害。此
因时之序也(清静之道在因四时之气序。而为调摄)
是以春伤于风邪气留连。乃为洞泄(风摇木胜。即病者为外感。若邪气留连日久。克制
脾土。故为洞泄)夏伤于暑。秋为 疟(暑邪伏而不发。延至秋凉外束。则寒热交争而为 疟)秋
伤于湿。上逆而咳。发为痿厥(湿土用事于长夏之未。故秋伤于湿也。然秋气通于肺。湿郁
成热。则气逆而为咳嗽。湿伤筋。筋弛长则为痿。阳不能胜湿则为厥)冬伤于寒春必温病(冬
伤寒邪不即病者寒毒藏于阴分。至春时阳气上升。则变为温病)四时之气更伤五脏(风暑寒湿
迭相胜负。故四时之气。更伤五脏之和也。然五脏内隐阴气也惟内不守。而后骨邪得以犯之
阳气,就像天空中的太阳。如果太阳失去了它正常的运行规律,就会折损人的寿命,使其不能彰显(太阳不明亮,万物就不能显明;人如果没有阳气,就会夭折短寿)。因此,天体的运转应当依靠太阳的光明(太阳就是阳,阳就是光明)。所以,阳气位于人体的上部,起着卫护体表的作用(人以阳气作为卫外屏障)。阳气应当像门轴一样运转自如(昼夜在体内运行五十周次),起居作息如果受到惊扰,神气就会浮散不固。(旧本中“欲如运枢”之上有三字“因于寒”,现根据吴崑的注解移至下文)
如果感受了寒邪,身体发热像燃烧的炭火一样,通过发汗可以使病邪消散。(受寒则生病表现为热证,在表层的用发汗法来解散它。)(旧本中“体若燔炭”两句在“静则多言”之下,现根据吴崑的注解移至此句之后)
如果感受了暑邪而多汗,心烦意乱时会气喘吁喝,安静时则会多言且语无伦次(暑邪先入心,热气熏蒸肺脏,所以多汗;心烦则喘,大声呼喝;安静时多言但缺乏条理)。
如果感受了湿邪,头部感觉像被包裹住一样沉重昏蒙(昏重也)。湿热如果不加清除(除也),大筋会收缩变短,小筋会松弛变长。大筋变短会导致拘挛,小筋变长会导致痿弱(湿气郁结而生热,大筋连接骨肉,受热则收缩变短,所以病发为拘挛;小筋络于骨外,得湿则牵引变长,所以病发为痿弱)。
如果感受了气机逆乱,会导致浮肿(气道壅滞,所以发生浮肿)。四肢交替发病,阳气就会衰竭(四维指四肢,相代指交替患病,竭尽指阳气耗尽。这两句总结上文内容)。
阳气的人,如果过度烦劳,阳气就会亢盛外张,导致阴精枯竭。这种偏邪之气积累到夏季,会使人气血上逆而发为煎厥(烦扰阳气,则气张大而火炎,所以令阴精枯竭。春令的邪僻之气积累至夏月火旺之时,阴精更加亏损,孤阳厥逆,所以叫煎厥。)(上文讲阳气不固,被外邪伤害;下文讲起居不节制,导致损伤阳气)。
眼睛看不见东西,耳朵听不见声音(肾的精气化为瞳孔,耳是肾的窍道。阴精在内枯竭,所以出现这些症状)。病情溃败,就像堤坝崩塌一样不可收拾(都指防水堤坝)。
阳气的人,如果大怒,会导致形体与气机隔绝,血液郁积在上部,使人发生薄厥(阳气贵在充盛平和,如果大怒则损伤形气,气上达于肝,所以血液妄行,郁积在上焦。相互迫近叫薄,气逆叫厥。气血俱乱,所以称为薄厥)。
如果伤了筋脉,筋脉纵缓不收,好像无法控制肢体(纵缓不收,好像难以维持正常的姿态)。
出汗半身有阻(沮通阻,指阻滞不通)。这会导致半身不遂(身体经常只有一半出汗,说明气血有所偏阻,久了营气不固,营气失守,所以成为偏枯,即半身不遂)。
出汗后遇到湿气,就会生痤痱(音锄沸○出汗时毛孔张开,如果湿气停留在皮肤腠理,严重的生痤,轻微的生痱。痤是小疖子,痱是瘾疹)。
膏粱厚味的变化,足以导致大的疔疮(高梁同膏粱。足能也。膏粱美食,内部多有滞热,其变化能生大疔,感发最容易,就像拿着空容器接受物体一样容易)。
劳作出汗后当风,寒气逼迫津液形成渣滓样的粉刺(音渣),郁结严重则变成痤疮(形体劳累出汗,凄冷的风寒之气逼迫它,津液凝结在皮肤腠理形成粉刺,即粉刺。如果郁结稍重则成为痤疮)。
阳气,精微部分用来养神,柔和部分用来养筋(内在化生精微滋养神志,外在化为津液柔润筋脉)。
开阖功能失常,寒气随之侵入,就会发生严重的驼背(开指皮肤发泄,阖指玄府封闭。如果被寒气袭击,阳气受伤,不能柔润筋脉,形体就变为佝偻俯身了)。
寒气陷入脉中,留连在肌肉腠理之间,发为疡漏(音陋)(寒气从筋络陷入脉中,发为疡漏,留结在腠理)。
经俞之气化薄于脏腑,传变为易恐惧以及惊骇的症状(寒气流于经俞,气化薄于脏腑,则产生恐畏惊骇,这是阳气被伤不能养神的结果)。
营气不顺,逆乱于肌肉纹理之间,就会发生痈肿(营气行于脉中,邪气陷入脉中则不顺而逆乱于肌肉纹理,血郁热聚,所以成为痈肿)。
魄汗未止,形体虚弱而气虚,穴俞已闭,发为风疟(魄属阴,汗由阴液所化,所以叫魄汗。汗出未止,形体虚弱气消,风寒薄之,穴俞随即关闭,邪气停留成为疟疾,因为病因在风,所以名叫风疟)。
所以风邪,是百病的开端。清静无为就能使肉腠闭合拒邪,即使有大风苛毒,也不能伤害人体,这是因为顺应了四时的次序(清静之道在于顺应四时之气序,来进行调摄)。
因此,春季伤于风邪,邪气留连不去,就会发生洞泄(风摇木胜,即病者为外感,如果邪气留连日久,克制脾土,所以发生洞泄)。
夏季伤于暑邪,秋季就会发生疟疾(暑邪潜伏不发,延至秋凉外束,则寒热交争而发生疟疾)。
秋季伤于湿邪,气机上逆而咳嗽,发为痿厥(湿土主事于长夏之末,所以秋季伤于湿。然而秋气通于肺,湿郁成热,则气逆而为咳嗽。湿伤筋,筋弛长则为痿,阳不能胜湿则为厥)。
冬季伤于寒邪,春天必定发生温病(冬季伤寒邪不立即发病者,寒毒藏于阴分,至春季阳气上升,则变为温病)。
四时的气候更替伤害五脏(风、暑、寒、湿交替胜负,所以四时之气更伤五脏的和顺状态。然而五脏内隐阴气,只有内部不守正,而后外邪才得以侵犯)。
Yang Qi is like the sun in the sky. If it loses its proper function, it will shorten life and prevent it from flourishing (If the sun is not bright, all things cannot be manifest; if a person lacks Yang Qi, they will suffer premature death and short life). Therefore, the movement of heaven relies on the brightness of the sun (The sun is Yang, and Yang is brightness). Thus, Yang Qi resides in the upper part of the body and serves to defend the exterior (Humans rely on Yang Qi as a defensive barrier). Yang Qi should operate freely like a door pivot (circulating fifty times throughout the body day and night); if daily activities are disturbed or startled, Shen Qi (Spiritual Energy) will float and become unconsolidated. (In older editions, the three characters "Yin Yu Han" [Due to Cold] appeared above "Yu Ru Yun Shu"; this is now moved below according to Wu Kun's commentary.)
If affected by Cold, the body becomes hot like burning charcoal, and sweating will disperse the pathogen. (When injured by Cold, illness manifests as heat; for pathogens at the exterior, sweating is used to disperse them.) (In older editions, the two lines "Ti Ruo Fan Tan" [Body like burning charcoal] were placed under "Jing Ze Duo Yan" [Quiet but talkative]; this is now moved here according to Wu Kun's commentary.)
If affected by Summerheat with excessive sweating, mental restlessness leads to panting and loud breathing, while quietness leads to excessive, incoherent speech (Summerheat first enters the Heart, and heat steams the Lung, causing excessive sweating; restlessness causes panting and loud exhalations; quietness results in talking without order).
If affected by Dampness, the head feels heavy as if wrapped (heavy and dull). If Damp-Heat is not cleared (removed), the large tendons contract and shorten, while the small tendons relax and lengthen. Shortening of large tendons causes spasms (Ju Luan), and lengthening of small tendons causes flaccidity (Wei Ruo) (Dampness stagnates and generates Heat; large tendons connect bone and flesh, contracting when heated, thus causing spasms; small tendons network outside bones, stretching when wet, thus causing flaccidity).
If affected by Qi disorder, edema occurs (Qi mechanism is obstructed, leading to swelling). When the four limbs alternate in suffering, Yang Qi will be exhausted (Si Wei refers to the four limbs; Xiang Dai means alternating illness; Jie Jin means exhaustion. These two sentences summarize the preceding text).
In persons with Yang Qi, excessive mental labor causes Yang Qi to expand and flare outward, leading to the depletion of Essence (Jing). This accumulation of pathological Qi into summer, when Fire is prosperous, causes Yin Essence to further decline, resulting in solitary Yang reversing upward, known as Jian Jue (Frying Reversal) (Disturbing Yang causes Qi to expand and Fire to blaze, thus depleting Essence. The pathological Qi accumulated during spring reaches its peak in summer when Fire is strong, causing Yin Essence to亏 (decline) further, leading to solitary Yang reversal, hence called Jian Jue.) (The previous text discussed Yang Qi being insecure and injured by external pathogens; the following text discusses how irregular lifestyle injures Yang Qi.)
The eyes cannot see, and the ears cannot hear (The Essence of the Kidney forms the pupils, and the ears are the orifices of the Kidney. With Essence depleted internally, these symptoms appear). The condition deteriorates like a breached dam, irrecoverable (Du refers to a flood embankment).
In persons with Yang Qi, extreme anger causes the separation of Form and Qi, with Blood stagnating in the upper part, leading to Bo Jue (Thin Reversal) (Yang Qi values fullness and harmony; extreme anger damages Form and Qi, driving Qi to the Liver, causing Blood to flow recklessly and stagnate in the Upper Jiao. Mutual pressure is called Bo, Qi reversal is called Jue. With both Qi and Blood chaotic, it is termed Bo Jue).
If tendons are injured, they become flaccid and uncontrolled, as if unable to maintain posture (Flaccid and unretracted, as if difficult to control movements).
Sweating occurs only on one side (Ju implies obstruction/blockage). This leads to hemiplegia (Pian Ku) (If half the body sweats constantly, it indicates biased obstruction of Qi and Blood; over time, Ying Qi (Nutritive Energy) becomes insecure and lost, resulting in Pian Ku, i.e., hemiplegia).
Sweating followed by exposure to Dampness generates Acne (Cuo) and Prickly Heat (Fei) (When sweating, pores open; if Dampness remains in the skin and interstices, severe cases develop Cuo [small boils], mild cases develop Fei [urticaria-like rash]).
Excessive consumption of rich food and wine (Gao Liang) can lead to severe Ding Sores (High Liang is synonymous with Gao Liang; Zu Neng means sufficient/able to cause. Rich foods create internal stagnant heat; their transformation easily generates large Ding sores, triggering easily, like holding an empty vessel to receive objects).
Sweating from exertion exposed to wind, where Cold forces the fluid to congeal into comedones (Zha), which, if stagnated severely, become acne (Physical labor causes sweating; cold wind attacks it, condensing fluids in the skin and interstices into Zha [comedones]. If stagnation worsens, it becomes Cuo [acne]).
Yang Qi, in its refined aspect, nourishes Shen (Spirit); in its soft aspect, it nourishes the tendons (Internally transforming fine essences to nourish Spirit; externally becoming fluids to soften tendons).
If opening and closing functions fail, Cold Qi follows and invades, leading to severe kyphosis (Kai refers to skin excretion; He refers to closure of Xuan Fu [pores]. If attacked by Cold, Yang Qi is injured and cannot soften tendons, resulting in a hunched posture).
Cold Qi sinking into vessels lingers in muscle interstices, causing ulcers (Lou) (Cold Qi sinks from tendons into vessels, causing ulcers, lingering in the interstices).
Qi transformation at Shu points invading organs transmits as fear and fright (Cold Qi flows through meridian Shu points and invades organs via Qi transformation, causing fear and fright; this is because injured Yang Qi cannot nourish Shen).
Ying Qi (Nutritive Qi) does not follow its course, reversing in muscle tissue, leading to carbuncles and swellings (Ying Qi moves within vessels; when pathogens sink into vessels, it becomes irregular and reverses in muscle tissue, causing blood stagnation and heat accumulation, thus forming carbuncles).
Unfinished Po Sweat (sweat derived from Yin fluids, hence Po Sweat), with weak form and dissipating Qi, closed Shu points, develops into Wind Malaria (Po is Yin; sweat comes from Yin fluids, thus Po Sweat. If sweat has not stopped, form is weak and Qi is consumed; Cold and Wind attack, Shu points close, pathogen stays causing Malaria; since the pathology involves Wind, it is named Wind Malaria).
Therefore, Wind is the beginning of all diseases. Clarity and stillness allow muscle interstices to close and resist; even with great wind and harsh toxins, harm cannot occur, due to following the sequence of seasons (The way of clarity and stillness lies in following the sequence of Four Seasons' Qi for regulation).
Thus, injury by Wind in Spring, with pathogen lingering, leads to Profuse Diarrhea (Dong Xie) (Wind shakes Wood and prevails; acute illness is external contraction, but if pathogen lingers long, it suppresses Spleen Earth, causing Dong Xie).
Injury by Summerheat in Summer leads to Nu Malaria in Autumn (Summerheat pathogen lies dormant; extending to autumn coolness which binds externally, Cold and Heat contend, causing Nu Malaria).
Injury by Dampness in Autumn leads to rebellious cough and Wei Jue (Flaccidity and Reversal) (Damp Earth governs late Chang Xia, so Autumn injury is by Dampness. However, Autumn Qi connects to Lung; Damp stagnates into Heat, causing Qi rebellion and cough. Damp injures tendons, relaxation causes Flaccidity; Yang cannot overcome Damp, causing Reversal/Jue).
Injury by Cold in Winter leads to Warm Disease in Spring (Winter Cold pathogen does not immediately manifest; Cold toxin hides in Yin divisions. When Spring arrives and Yang Qi rises, it transforms into Warm Disease).
The Qi of the Four Seasons alternately injures the Five Zang Organs (Wind, Summerheat, Cold, and Damp alternate in victory and defeat, so the Qi of the Four Seasons alternately injures the harmony of the Five Zang. However, the Five Zang hide Yin Qi internally; only when internal defense fails can external pathogens invade.)