Viscera, meridians and collaterals are the first in disease, pulse and syndrome
1. Ask: if Shanggong (1) is not ill, what is it? The teacher said: if husband is not ill (2), he will see the disease of the liver, know that the liver transmits the spleen, and first strengthen the spleen. The spleen King (3) will not suffer evil in all seasons, that is, he will not mend it. Middle Engineer ④ didn't know about it. He saw the disease of the liver and didn't know how to strengthen the spleen. He only treated the liver.
For the disease of the liver, it can supplement the acid, help to use the scorching and bitter, and benefit to use the sweet medicine. Sour people's liver, scorching people's hearts, sweet people's spleen. If the spleen can hurt the kidney, if the kidney qi is weak, then the water cannot; if the water cannot, then the heart fire Qi will be strong; if the heart fire Qi is strong, then the lung will be hurt, then the gold Qi will not be strong; if the gold Qi is not strong, then the liver Qi will be strong. Therefore, the spleen will heal itself. This treatment of liver and spleen is also wonderful. This method is used for liver deficiency, but it is not used in practice.
The Sutra says, "the deficiency is filled and the excess is damaged", which is also the meaning of the Sutra. This is true for the rest.
[comments] this section discusses the general treatment principles of miscellaneous diseases from a holistic perspective. There are two main points: one is to treat the disease. "Nanjing · 77 Nan" said: "what is the meaning of" the treatment of disease by industry in the past and the treatment of disease by industry in the middle "? However: the so-called treatment of disease without disease, see the disease of liver, then know that the liver should be passed on to the spleen, so first consolidate its temper, without the evil of liver, so it is called treatment of disease without disease. Those who are in the middle of the labor force are not familiar with the disease of the liver, but they are devoted to the treatment of the liver, so they call it the treatment of the disease. " Zhang Zhongjing, on the basis of inheriting the thought of treating diseases before they are cured in the "difficult classics" and according to the theory of restraining the five elements of yin and Yang, expounds that the diseases of viscera include
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① Go to work: refers to a wise doctor.
② To treat the diseased: to treat the diseased viscera.
③ Four seasons King: Wang Tongwang. Spleen prosperity in four seasons refers to the last eighteen days of spring, summer, autumn and winter. When spleen and soil are prosperous, the spleen should not be consolidated if the spleen's temper is not weak.
④ Zhonggong: refers to ordinary doctors.
⑤ Wounded: it means to subdue here.
The law of succession. Compared with the "difficult classics", Zhongjing added "four seasons spleen king is not affected by evil, that is, not to mend it" on the basis of the basic principle of "seeing the disease of liver, knowing the liver and transmitting the spleen, being the first to strengthen the spleen". He emphasized the specific treatment according to the current order and the deficiency and reality of the spleen, which can be said to be the supplement and improvement of the theory of "difficult classics". Second, the treatment of disease should be divided into the virtual and the real, and avoid the virtual and the real. It is a positive rule for the treatment of deficiency and excess diseases.
In view of the liver deficiency syndrome, Zhongjing proposed the method of "the disease of the liver, supplement the acid, help to use the scorching and bitter, and benefit to use the sweet medicine". This method is of great guiding significance in clinical application. Many doctors in the future follow this method to treat liver diseases, such as the liver tonifying formula in Ye Tianshi's "clinical guidance medical case · liver wind gate Cao case", Use the acid of paeony to nourish the liver, stir fry the raw ground into the heart to generate blood, stir fry the chrysanthemum to make charcoal, without the disadvantages of spicy powder; use the second medicine to help the paeony to nourish the liver and rest the wind, and manage the liver, "the liver is bitter and urgent, and the quick food is sweet and slow", use the sweet of roasted licorice, South jujube, and the stomach is slow, and cultivate the soil and rongmu. As for "acid into the liver Many commentators think that it is a mistake for posterity to enter the text, aiming to explain the significance of treating liver deficiency with sour, sweet and bitter.
2. My wife has five regular reports. She grows because of the atmosphere. Although the wind can produce all things, it can also harm all things, such as water can float a boat, it can also capsize a boat. If the five zang organs are really smooth, people will be at peace. You're welcome. Many people die. There are three ways to deal with these problems: one is that the meridians and collaterals are affected by evils, and the internal organs of people are also caused by internal factors; the other is that the limbs and nine orifices, blood vessels are passed down, blocked up, and are also caused by external skin; the third is that the room, the golden blade, and the insects and animals are injured. In this way, the disease will be eliminated. If one can be cautious and keep the evil wind away from the meridians and collaterals, the meridians and collaterals should be moderate, and the viscera should not be spread, that is to say, he should be cured. Only when the limbs feel heavy stagnation, that is to say, guidance, Tuina, acupuncture, and plaster, do not block the nine orifices;
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① Wuchang: that is, the five elements of water, fire, gold, wood and earth are transported and changed. The five elements should be the five Qi of heaven, the five flavor of earth, and the viscera of human beings.
② Fashion: there are narrow sense and broad sense. In a narrow sense, it refers to the wind in spring. In a broad sense, climate refers to the climate of nature, which is the latter.
③ Yuanzhen: refers to the vitality and genuine Qi of the five zang organs.
④ Chen lining: disease.
It is better not to violate the king's law. When animals are injured, the room should not be exhausted. If you eat it, you will feel cold, hot, bitter, sour, spicy and sweet. If you have a bad body, you will have no reason to be ill. The "Zhuo" is the true place of Sanjiao to connect with the Yuan Dynasty, which is injected by blood and Qi; the "Li" is the culture and principle of the skin and viscera.
[comments] the whole section should be read in three sections: the first section starts with the sentence and ends with "you can also capsize the boat". It discusses the close relationship between human life, aging and death and whether the natural climate is normal or not from the corresponding point of view of heaven and man. In the preface to treatise on typhoid fever, it is said: "five elements are arranged in heaven to transport all kinds of people. People are endowed with five permanent conditions and five internal organs." The growth and collection of all things depend on the four seasons of climate change. Normal climate change is the reason for all things to grow; abnormal and sudden climate is enough to harm all things. "If the five viscera are really smooth As the second paragraph, it discusses that human health is closely related to the rise and fall of diseases and healthy qi, and sums up the causes of diseases into three. One is that the genuine Qi of the five zang organs cannot be kept internally, and the vital qi of the Zang organs is deficient first, and then the external evils are easy to take advantage of the deficiency and internal disturbance, so it is called "internal cause"; the other is that there is no other disease inside, and the external evils invade the skin, and the blood vessels of the nine orifices of the limbs are blocked, so it is called "external cause"; the third is that the damage caused by the room golden blade insect is neither internal cause nor external polite evil wind, so it is called "internal cause". Chen Yan of Song Dynasty put forward the "three cause theory" on the basis of Zhongjing's etiology, which categorizes the etiology into internal cause, external cause and non internal cause, among which the internal cause is caused by the emotions of the five zang organs, the external cause is caused by the external sense of six evils, and the internal and external cause is caused by the diet, the room, the fall of the servant and the golden blade. It can be seen that there are obvious differences between Chen Yan's theory of three causes and Zhongjing's theory of etiology.
The third paragraph from "if people can care" to the end of the sentence, emphasizing that prevention is more important than treatment and early treatment of disease, that is, prevention before disease, early treatment of disease, and put forward specific methods. This more embodies Zhongjing's principle of "treating diseases before they occur".
3. Ask and say: the patient has complexion, which can be seen in the face, and would like to hear it. The teacher said: blue nose, abdominal pain, bitter cold death; a cloud of abdominal cold, bitter epilepsy death. If the nose is slightly black, there is moisture; if the nose is yellow, there is cold on the chest; if the nose is white, there is blood loss, and if the nose is slightly red, there will be death; if the eyes are round, there will be spasm and no cure. And the color blue is pain, the color black is labor, the color red is wind, the color yellow is difficult, the color bright has retention drink.
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① To take: take, as of clothing. Food refers to food.
② Complexion: the essence of the viscera, the interior is the Qi, and the exterior is the color.
[comment] this section and the next five sections suggest that the diagnosis of diseases should start with the observation, smell, inquiry and incisive examination. The face is the epitome of the body. It is said by the Sutra that "those who are smart in five colors will also have the power of Qi." There must be diseased color when there is diseased Qi, and the diseased color must be revealed on the facial features. By observing the change of the patient's facial color, the position and nature of the disease can be determined.
4. The teacher said: the patient's voice is silent: he who likes to scream, has a disease between the joints; he who does not understand, has a disease between the heart and diaphragm; he who chirps, has a disease in the head. A pain.
[comment] in the difficult Scripture, it is said that "the one who hears and knows is called the God". In this section, we can understand the changes of the patient's spirit and Qi from the different voice of the patient, so as to judge the different diseases and explain the delicacy of Zhang Zhongjing's hearing and diagnosis. As for the interpretation of this section, the synopsis of the Golden Chamber states: "people who are not ill speak as usual, though they are different from each other, there is no difference. Cold and dampness in the bone, hair for the pain, so lazy in the voice and the voice is silent, turn side is sharp pain, so happy exclamation. Between the heart and diaphragm is the lung, and the wet phlegm is blocked in the lung orifices, so the voice is not clear. Headache, say big brain pain want to crack, so the voice chirp ran thin and long, dare not speak loudly also. "
5. The teacher said: those who shake their shoulders at rest, are firm in their hearts; those who draw Qi from their chest, cough; those who open their mouths short, are impotent and spiteful.
6. The teacher said: if you inhale it and count it slightly, the disease will be in the middle of the focus. If it is real, it will be cured immediately. If it is empty, it will not be cured. It is difficult to treat those who are in the upper coke, those who are in the lower coke, and those who are far away from the upper coke. If the breath shakes and vibrates, it will not be cured.
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① Silence: it means silence, or the voice is low and inaudible.
② "Ji" is a kind of small and long murmur.
③ "Yin" means that the voice is not loud and clear.
④ Breath shake shoulder: breath, refers to breathing. Shake, rising meaning, extended to "lift". Shake the shoulder, that is, lift the shoulder. The shoulder shaking refers to the state of difficulty in breathing and shrugging of shoulders.
[comment] in the first two sections, the disease location was determined by the combination of the two diagnosis methods of looking at the shape and smelling and breathing, and the auspiciousness and badness of the prognosis were identified.
7. Division Day: the pulse of Cunkou moves because of its king. If the liver is green, it will follow its color in four seasons. The liver is blue and white. It's not the time of color pulse. It's all disease.
[comment] in response to heaven and man, the color of human body should conform to the four seasons, such as the vigorous liver qi in spring, the slight green color, and the stringy pulse; the vigorous heart qi in summer, the slight red color, and the abundant pulse; the vigorous lung qi in autumn, the slight white color, and the floating pulse; the vigorous kidney qi in winter, the slight black color, and the heavy pulse. "Each of the four seasons follows its own color", which is a disease-free color pulse. This comes from the theory of "Su Wen, Yi Jing Bian Qi" that "the change of Fu and se is based on the pulse of four seasons". The color changes that do not conform to the four seasons belong to the image of disease.
8. The teacher said: after the winter solstice, when the sun rises in the middle of the night, when the sun rises in the middle of the night, the sun begins to grow, and the sky is gentle. If you don't get a Jiazi, the heaven will come because it's gentle. If you get a Jiazi, the heaven will not go because it's not gentle. If you get a Jiazi, the sky will be cold and confused. If you get a Jiazi, it's too warm.
[comments] this section points out that the climate should be adapted to the solar term. The first, the last, the last, the last and the last are all abnormal climates, which will affect the Qi and blood of the human body and cause diseases. Therefore, the normal and abnormal climate can be used as a reference to predict the epidemic of seasonal diseases.
It needs to be pointed out that Shaoyang in the text is a seasonal name, which is based on the saying of "seven difficulties in dysmenorrhea": "after the winter solstice, you get the king of Jiazi Shaoyang, the king of Jiazi Yangming, the king of Jiazi Taiyin, the king of Jiazi Shaoyin and the king of Jiazi Jueyin". Sixty days for each king, six, three hundred and sixty days for one year. Three yang and three yin
The king's time is important. "
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① Unexpected arrival: the season has not arrived, and the climate has arrived. The former "to" refers to the season, and the latter "to" refers to the climate.
② Jiazi: refers to the first Jiazi day after the winter solstice. On Jiazi day, it's the time of rain. It's the time when ice and snow break up to form rain. It's the beginning of mild weather.
③ At the time of Shaoyang, each of the three yin and three Yang flourished for 60 days, a total of 360 days. After the winter solstice, it is the time of Shaoyang.
9. The teacher said: the patient's pulse floats in the front ①, and his disease is on the surface; the patient floats in the back ②, and his disease is on the inside, and the back pain is strong and can't be done, so he must be short of breath and extreme.
10. Jingyun: jueyang ③ walking alone, what is it? The teacher said: This is jueyang, so it's called jueyang.
[comments] in this section, it is specially proposed that the Yin and Yang of the human body must be harmonious. According to the theory of "plain question, Qi is connected with heaven", it is said that "Yin is peaceful and Yang is secret, spirit is governance, yin and yang are separated, and essence and Qi are separated." If there is Yang and there is no Yin, then jueyang goes against it, which is called jueyang. Clinical symptoms such as liver and kidney Yin failure in high age, solitary yang hyperactivity, postpartum sweating of yin deficiency and Yang excess, and wind movement of yin deficiency with heat entering lower Jiao in the later stage of febrile disease, all belong to the category of jueyang.
11. Ask: Inch pulse is big and slippery, sinking is solid, slippery is Qi, and solid Qi fight with each other @. Blood and Qi are dead when people's viscera are over, which is Jue ⑤. What's that? Teacher said: lips are blue, body is cold, people's viscera are dead when they are over; if body and sweat come out, people's viscera are over.
[comment] this section takes "apoplexy" as an example to elaborate the law of disease transmission and change, and to judge the method of disease progression and regression. Apoplexy refers to the stagnation and reversal of blood Qi, and apoplexy. Disease is in up and down maladjustment, and prognosis judgment, depends on the viscera into the Fu. Evil Qi enters the internal organs and blocks the blood Qi. The magic machine can't enter and leave. If you see the lips and mouth are green and the body is cold, you will be in danger. If the evil spirit enters the viscera, it can overcome the evil. The disease has the opportunity to go out. The body is mild, sweat comes out, and the prognosis is good.
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① Front: refers to the inch pulse before closing.
② Posterior: refers to the posterior ulnar vein.
③ Jueyang: Jue, zhujias often explain the word "Jin", "inverse" or "Ji". Jueyang is the extreme point where Yang Qi is more abundant, and the lone Yang goes up against it.
④ Real Qi phase beat: real blood solid, gas solid. Real Qi fight, that is, evil Qi is real in Qi and blood. In the 28th year of the volume of "preparing a thousand gold prescriptions for emergencies", it is said that "sinking is blood, sliding is Qi, blood and Qi fight each other, and people will die if they are dirty."
⑤ Jue: Jue, with the sudden, sudden meaning. A stroke is a condition of sudden fainting.
12. Ask: when the pulse falls off, one's internal organs die, and one's internal organs heal. What is that? The teacher said: all diseases are not one disease. For example, if the ulcer of immersion (2) flows from the mouth to the limbs, it can be cured; if the population flows from the limbs, it cannot be cured. Those who are ill outside can be cured; those who are in die.
[comment] the syndromes of apoplexy and devascularization are all the diseases of apoplexy. Although the causes of the diseases are different, the pathogenesis of "entering the viscera is death, entering the viscera is healing" is the same. Therefore, Zhongjing proposed that "all diseases are not one disease". This is consistent with the spirit of "Jue rebellious, connected with viscera, then death, connected with meridians, then life" in "Suwen Yangming pulse solution" and "difficult meridians, 54 difficulties" in "viscera disease is difficult to treat, viscera disease is easy to treat".
13. Ask: Yang disease ③ 18, what is it? Teacher: headache, neck, waist, spine, arm and foot pain. Yin disease ④ eighteen, what is also: teacher said: cough, upper Qi, asthma, cough, pharynx ⑤, bowel sounds, fullness, heartache, and anxiety. Each of the five viscera diseases has 18, which is 90; the others have 6 micro 6, which is 18, which is one hundred and eight. Five labors, seven wounds, six poles and thirty-six diseases of women are not among them. In the house of evil in the Qing Dynasty, in the house of turbid evil, in the house of great evil, in the house of small evil, the evil of cooking, from the mouth to the mouth, the food and shelter. Each of the five evils has its own law. Wind in the front, cold in the evening, dampness in the bottom, fog in the top, wind makes the pulse floating, cold makes the pulse urgent, fog injures the skin, wet flow joints, food injures the spleen and stomach, extremely cold injures the meridians, extremely hot injures the collaterals.
[comment] Based on the theory of Zang Fu meridians and the theory of six pathogenic factors, this section discusses the classification method of disease syndromes and the general law of people in five pathogenic factors. As for the specific meanings of "Yang disease 18", "yin disease 18", "five viscera disease 18", "slight disease 18" and "woman 36 disease" in the articles, there are different opinions of doctors in the past dynasties, which can be used for mutual reference and no strong explanation here.
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① Maituo: refers to the disease syndrome that the pulse can not be seen at a time. It is mostly caused by the obstruction of evil Qi and the blockage of Qi and blood in the pulse.
② Immersion sore: it is one of the skin diseases, which can spread from the local to the whole body.
③ Yang disease: You Yi said "in addition to the drive shell", that is, the external meridians disease.
④ Yin disease: You Yi said "in the body", that is, the internal organs of the disease.
⑤ Pharynx: that is, choking, refers to the infarction in the pharynx.
⑥ Six micro: refers to the six Fu organs. Six evils invade people's six viscera, which is a disease, lighter than people's five viscera.
14. Ask: what is the meaning of those who are in urgent need of rescuing the watch when they are ill? The teacher said: if they are ill and are cured, they will continue to be able to get benefit and clear the valley. If they are in pain, they will be in urgent need of rescuing the watch. If they are in pain, they will adjust themselves. If they are in pain, they will be in urgent need of rescuing the watch.
[comment] this section is to discuss the priority and urgency of treatment of the same disease. In the treatment of the same disease, it is advisable to treat it first from the exterior to the interior, or first from the interior to the exterior, according to the priority. There are three kinds of treatment methods: first, the first is to understand the exterior and then to treat the interior, which is suitable for the exterior evil to spread in at the beginning, and the evil has the potential to reach the exterior. When the situation is favorable, the evil can be dispelled and go out. The other is to treat both exterior and interior, such as Guizhi ginseng decoction. The third is to treat the internal symptoms first and then to solve the external symptoms, which is shown in this section. Although the external symptoms and internal symptoms are the same, the following methods are misused, resulting in the damage of the spleen and stomach Yang, the internal symptoms are urgent, and the internal symptoms are not only urgent, but also suitable for the internal symptoms and the internal symptoms and external symptoms are still acute, and the external symptoms and external symptoms can be adjusted after the Qing Dynasty.
15. The chronic diseases of the husband should be treated first, then the chronic diseases.
[comment] You Yi said: a stroke is easy to remove, so it should be treated first; a chronic disease is hard to get rid of, so it should be eased, and the disease should not be allowed to help the old disease. At the time of clinical treatment, when encountering the situation of "treating chronic diseases with stroke", we can not only follow this principle, but also adopt the method of treating both old and new diseases as appropriate. For example, Li Jinyong, a national medical master, said that people who have been suffering from gonorrhea for a long time feel the evil spirit of exogenous diseases. If they only treat exogenous diseases first and sweat, and forget the prohibition of "no sweating in the Lin family", it will cause the change of blood in the stool.
The teacher said: each of the five viscera diseases has its own gains. The more the others have, the more the five viscera diseases have their own evils.
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① "Qing" is the same as "sex". Guangya: "sex, toilet also". It's used as a verb here. The defecation is normal.
② Chronic disease: refers to an old disease or chronic disease.
③ Stroke: refers to a new or urgent disease.
④ Get: "get", make "close" solution. This refers to the food and living place suitable for patients.
⑤ Abomination: refers to the abomination of the patient.
[comment] it is very important for diagnosis, treatment and nursing to ask patients about their likes and dislikes. "Difficult classics 61 difficult" said: "ask and know, ask the five taste, in order to know where the disease also The nature of the disease is different, so there are differences in the diet and habitation. The patient's gains, evils and dislikes will vary according to the nature of the disease.
It is of great value to the clinical practice that "every one of the five viscera diseases has its own benefits". Pu Fuzhou paid special attention to diet therapy in disease conditioning, and used tea to treat the elderly patients with heat injury. The patient suffered from sores after fever and took medicine for a long time, but the heat was slightly reduced, but the patient was restless, insomnia, did not think of food, defecated for seven days, and then vomited, ate and vomited, drank water and water, and took medicine and vomited. The patient is a senior with a long history of illness. His children think that they have no hope. They ask if he can be saved with a tentative mood. After asking about his illness, he specifically asks what the patient wants to eat. When he learns that the patient only wants to drink tea, he takes 6g of "Longjing tea". He asks the patient to put tea in two minutes after boiling water and boil it twice, that is, drink less with the patient. He especially emphasizes "less" Two words. The next day, the patient's surprise came and said: "as soon as the tea was cooked, my mother began to drink it after smelling the fragrance of the tea. After a few sips of it, she felt comfortable. Then her stomach rumbled, two farts were released, and two dry feces were removed. She could go to sleep that night. When she woke up in the morning, she was hungry and asked for food. What else could she use?" Pu laoyun said: "people who have been sick for a long time, take too much medicine, and their stomach qi is greatly damaged. At the beginning of this period, their stomach qi is souped and cut No more medicine stone can be used. If there is a slight deviation in the medication, the stomach qi will be destroyed and the consequences will be unimaginable. I would like to use very thin rice porridge to nourish stomach yin and stomach qi. " After a month of such diet, people in danger should recover. Pu Lao recalled: "although there is empty heat after healing, you can't pass through bitter cold, or your stomach will be exhausted.". Therefore, with the tea of slight bitterness, slight sweetness and slight cold, the fragrance is pungent to open without hurting Yin, bitter to fall without hurting Yang, bitter and sweet, it can awaken the stomach and delight the spleen. After tea, it can get the arrow Qi and relieve the dry feces. It is the hinge of the spleen and stomach lifting that has been operated. Being able to fall asleep and ask for food after waking up is a clear proof of the harmony of yin and Yang, and "less and less" is the key to medication. If you are greedy and aggressive, it will be destroyed. " (editorial office of Journal of Shandong University of traditional Chinese medicine, famous for the road of traditional Chinese medicine (Volume 3). Jinan: Shandong science and Technology Press, 1985:186)
17. If you want to attack the diseases in your internal organs, you should attack them according to what you get. If you are thirsty, you can imitate Zhuling decoction.
[comment] this section proposes that we should master the principle of "follow what we get" in the treatment of miscellaneous diseases, and emphasize the treatment of the causes of trial. If you want to get rid of the evil, you must first seek the cause. You Yi cloud: invisible evil into the knot in the dirty, there must be evidence, water, blood, phlegm and food, are evil serval also. If thirsty, water and heat get and heat knot in the water, so with Zhuling soup benefit its water and heat is also removed. If there is food and heat, and heat knot in the food, it is appropriate to Chengqi soup under its food, and heat also go. If there is no gain, the invisible evil will not attack the Dharma.
① Gain: refers to the evil spirit.