術語(yu)來源
“寒熱有(you)常，而(er)虛實(shi)(shi)無常”，是著名經方大家(jia)胡希恕先生率(lv)先提出，原是用于論(lun)述陰陽寒熱虛實(shi)(shi)的(de)關系，重點是概述臨床反應(ying)癥狀的(de)屬性(xing)，是陰證還是陽證。
有(you)關論述記載多(duo)見于(yu)《中(zhong)(zhong)醫辨證(zheng)施治(zhi)概論》一(yi)書中(zhong)(zhong)，該(gai)論著部分內容發表于(yu)1980年第4期的(de)《北(bei)京中(zhong)(zhong)醫學(xue)院學(xue)報(bao)》，題(ti)名為《基于(yu)仲景著作(zuo)的(de)研究試談辨證(zheng)施治(zhi)》。“寒熱有(you)常，而虛實(shi)無常”一(yi)語(yu)出現(xian)于(yu)“論六經與八綱”一(yi)節，胡(hu)希(xi)恕筆記有(you)關原文(wen)節錄如下：
寒(han)(han)和熱(re)(re)(re)：寒(han)(han)指寒(han)(han)性證，熱(re)(re)(re)指熱(re)(re)(re)性證，若(ruo)患病(bing)(bing)機體反映(ying)(ying)為(wei)(wei)寒(han)(han)性的(de)證候(hou)者(zhe)，即稱(cheng)之為(wei)(wei)寒(han)(han)證。若(ruo)患病(bing)(bing)機體反映(ying)(ying)為(wei)(wei)熱(re)(re)(re)性證候(hou)者(zhe)，即稱(cheng)之為(wei)(wei)熱(re)(re)(re)證。基于以(yi)上陰(yin)(yin)(yin)陽(yang)(yang)的(de)說明，則寒(han)(han)為(wei)(wei)不及，當亦陰(yin)(yin)(yin)之屬，故(gu)寒(han)(han)者(zhe)亦必(bi)(bi)陰(yin)(yin)(yin)，則熱(re)(re)(re)為(wei)(wei)太過，當亦陽(yang)(yang)之屬，故(gu)熱(re)(re)(re)者(zhe)亦必(bi)(bi)陽(yang)(yang)。不過寒(han)(han)與熱(re)(re)(re)，是(shi)一具有(you)特性的(de)陰(yin)(yin)(yin)陽(yang)(yang)，若(ruo)泛(fan)言陰(yin)(yin)(yin)，則不定必(bi)(bi)寒(han)(han)，若(ruo)泛(fan)言陽(yang)(yang)，則不定必(bi)(bi)熱(re)(re)(re)，故(gu)病(bing)(bing)有(you)不寒(han)(han)不熱(re)(re)(re)者(zhe)，但絕無不陰(yin)(yin)(yin)不陽(yang)(yang)者(zhe)。
虛(xu)和實：虛(xu)指人(ren)虛(xu)，實指病(bing)實。病(bing)還未解而人(ren)的(de)精力(li)已有所不(bu)支，人(ren)體的(de)反應(ying)顯示出一派(pai)虛(xu)衰的(de)形象(xiang)者(zhe)，即稱之(zhi)為虛(xu)證。病(bing)勢在進而人(ren)的(de)精力(li)并亦不(bu)虛(xu)，人(ren)體的(de)反應(ying)顯示出一派(pai)充實的(de)病(bing)癥(zheng)者(zhe)，即稱之(zhi)為實證。
根據以上說明，可見虛實亦和寒熱一樣，同屬陰陽中的一種特性，不過寒熱有常，而虛實無常。寒熱有常者，即如上述，寒者必陰，熱者必陽，在任何情況下永無變異。但虛實則不然，當其與寒熱交錯互見時，反其陰陽，故謂無常，即如虛而寒者，當然為陰，但虛而熱者，反而為陽。實而熱者，當然為陽，但實而寒者，反而為陰。以是則所謂陽證，可有或熱、或實、或亦熱亦實、或不熱不實或熱而虛者；則所謂陰證，可有或寒、或虛、或亦虛亦寒、或不寒不虛或寒而實者。理解胡希恕這段理論的前提條件是要用經方理論來解讀，因胡希恕這里所講陰陽，與《黃帝內(nei)經》所講陰陽有顯著不同(tong)。
字義(yi)解(jie)讀
“寒(han)熱(re)(re)有常(chang)，而虛實(shi)無常(chang)”，主要(yao)所指是由癥狀的(de)寒(han)熱(re)(re)虛實(shi)辨別陰(yin)陽(yang)的(de)規(gui)律。胡希(xi)恕說“寒(han)者必陰(yin)，熱(re)(re)者必陽(yang)，在任何情況下永無變異(yi)之謂。但虛實(shi)則不(bu)然，當其與(yu)寒(han)熱(re)(re)交錯(cuo)互見(jian)(jian)時，而競(jing)反其陰(yin)陽(yang)”。即是說臨床見(jian)(jian)到寒(han)證(zheng)(zheng)判定為陰(yin)，見(jian)(jian)到熱(re)(re)證(zheng)(zheng)判定為陽(yang)，什么時候(hou)亦(yi)不(bu)會錯(cuo)。但臨床遇(yu)到虛證(zheng)(zheng)和實(shi)證(zheng)(zheng)，則虛者不(bu)一(yi)(yi)定是為陰(yin)證(zheng)(zheng)，實(shi)者亦(yi)不(bu)一(yi)(yi)定是陽(yang)證(zheng)(zheng)。此用于認識《傷(shang)寒(han)論》的(de)六經與(yu)方證(zheng)(zheng)非常(chang)重要(yao)，試從(cong)之三個(ge)病位未來分析：
表(biao)(biao)(biao)(biao)(biao)(biao)(biao)證(zheng)(zheng)(zheng)：表(biao)(biao)(biao)(biao)(biao)(biao)(biao)證(zheng)(zheng)(zheng)分陰(yin)(yin)陽(yang)(yang)(yang)(yang)，概而述之，陽(yang)(yang)(yang)(yang)實(shi)(shi)(shi)熱(re)(re)者(zhe)為(wei)(wei)(wei)表(biao)(biao)(biao)(biao)(biao)(biao)(biao)陽(yang)(yang)(yang)(yang)證(zheng)(zheng)(zheng)即(ji)太(tai)陽(yang)(yang)(yang)(yang)病(bing)(bing)；陰(yin)(yin)虛(xu)(xu)(xu)寒者(zhe)為(wei)(wei)(wei)表(biao)(biao)(biao)(biao)(biao)(biao)(biao)陰(yin)(yin)證(zheng)(zheng)(zheng)即(ji)少(shao)陰(yin)(yin)病(bing)(bing)；注意(yi)這(zhe)里的(de)(de)(de)(de)(de)陽(yang)(yang)(yang)(yang)實(shi)(shi)(shi)熱(re)(re)和陰(yin)(yin)虛(xu)(xu)(xu)寒是大(da)致的(de)(de)(de)(de)(de)常規，臨(lin)床還常見陽(yang)(yang)(yang)(yang)虛(xu)(xu)(xu)熱(re)(re)和陰(yin)(yin)實(shi)(shi)(shi)寒的(de)(de)(de)(de)(de)表(biao)(biao)(biao)(biao)(biao)(biao)(biao)證(zheng)(zheng)(zheng)。具體來說(shuo)，太(tai)陽(yang)(yang)(yang)(yang)病(bing)(bing)是表(biao)(biao)(biao)(biao)(biao)(biao)(biao)陽(yang)(yang)(yang)(yang)證(zheng)(zheng)(zheng)，但其(qi)中(zhong)又因有(you)(you)汗與(yu)無(wu)汗，分為(wei)(wei)(wei)表(biao)(biao)(biao)(biao)(biao)(biao)(biao)實(shi)(shi)(shi)、表(biao)(biao)(biao)(biao)(biao)(biao)(biao)虛(xu)(xu)(xu)，有(you)(you)汗稱(cheng)為(wei)(wei)(wei)表(biao)(biao)(biao)(biao)(biao)(biao)(biao)虛(xu)(xu)(xu)，無(wu)汗稱(cheng)表(biao)(biao)(biao)(biao)(biao)(biao)(biao)實(shi)(shi)(shi)，兩者(zhe)都(dou)屬(shu)(shu)表(biao)(biao)(biao)(biao)(biao)(biao)(biao)陽(yang)(yang)(yang)(yang)證(zheng)(zheng)(zheng)，即(ji)虛(xu)(xu)(xu)者(zhe)不(bu)(bu)一(yi)定(ding)屬(shu)(shu)陰(yin)(yin)，不(bu)(bu)能(neng)稱(cheng)謂為(wei)(wei)(wei)少(shao)陰(yin)(yin)。而出(chu)現于(yu)太(tai)陽(yang)(yang)(yang)(yang)病(bing)(bing)的(de)(de)(de)(de)(de)方證(zheng)(zheng)(zheng)，有(you)(you)表(biao)(biao)(biao)(biao)(biao)(biao)(biao)實(shi)(shi)(shi)和表(biao)(biao)(biao)(biao)(biao)(biao)(biao)虛(xu)(xu)(xu)之分，有(you)(you)無(wu)汗的(de)(de)(de)(de)(de)麻黃湯(tang)(tang)證(zheng)(zheng)(zheng)和有(you)(you)汗的(de)(de)(de)(de)(de)桂(gui)(gui)枝湯(tang)(tang)證(zheng)(zheng)(zheng)的(de)(de)(de)(de)(de)不(bu)(bu)同，這(zhe)些方證(zheng)(zheng)(zheng)都(dou)屬(shu)(shu)表(biao)(biao)(biao)(biao)(biao)(biao)(biao)陽(yang)(yang)(yang)(yang)證(zheng)(zheng)(zheng)。同理少(shao)陰(yin)(yin)病(bing)(bing)是表(biao)(biao)(biao)(biao)(biao)(biao)(biao)陰(yin)(yin)證(zheng)(zheng)(zheng)，但其(qi)中(zhong)又因有(you)(you)汗與(yu)無(wu)汗，分為(wei)(wei)(wei)表(biao)(biao)(biao)(biao)(biao)(biao)(biao)實(shi)(shi)(shi)、表(biao)(biao)(biao)(biao)(biao)(biao)(biao)虛(xu)(xu)(xu)，有(you)(you)汗稱(cheng)為(wei)(wei)(wei)表(biao)(biao)(biao)(biao)(biao)(biao)(biao)虛(xu)(xu)(xu)，無(wu)汗稱(cheng)為(wei)(wei)(wei)表(biao)(biao)(biao)(biao)(biao)(biao)(biao)實(shi)(shi)(shi)，兩者(zhe)都(dou)屬(shu)(shu)表(biao)(biao)(biao)(biao)(biao)(biao)(biao)陰(yin)(yin)證(zheng)(zheng)(zheng)，即(ji)實(shi)(shi)(shi)者(zhe)不(bu)(bu)一(yi)定(ding)屬(shu)(shu)陽(yang)(yang)(yang)(yang)，不(bu)(bu)能(neng)稱(cheng)謂為(wei)(wei)(wei)太(tai)陽(yang)(yang)(yang)(yang)病(bing)(bing)。出(chu)現于(yu)少(shao)陰(yin)(yin)病(bing)(bing)的(de)(de)(de)(de)(de)方證(zheng)(zheng)(zheng)，亦有(you)(you)表(biao)(biao)(biao)(biao)(biao)(biao)(biao)實(shi)(shi)(shi)和表(biao)(biao)(biao)(biao)(biao)(biao)(biao)虛(xu)(xu)(xu)之分，即(ji)無(wu)汗表(biao)(biao)(biao)(biao)(biao)(biao)(biao)實(shi)(shi)(shi)的(de)(de)(de)(de)(de)麻黃附(fu)(fu)子(zi)(zi)甘草湯(tang)(tang)證(zheng)(zheng)(zheng)、白(bai)通湯(tang)(tang)證(zheng)(zheng)(zheng)，和有(you)(you)汗表(biao)(biao)(biao)(biao)(biao)(biao)(biao)虛(xu)(xu)(xu)的(de)(de)(de)(de)(de)桂(gui)(gui)枝加附(fu)(fu)子(zi)(zi)湯(tang)(tang)證(zheng)(zheng)(zheng)、烏頭桂(gui)(gui)枝湯(tang)(tang)證(zheng)(zheng)(zheng)，表(biao)(biao)(biao)(biao)(biao)(biao)(biao)實(shi)(shi)(shi)無(wu)汗者(zhe)仍屬(shu)(shu)表(biao)(biao)(biao)(biao)(biao)(biao)(biao)陰(yin)(yin)證(zheng)(zheng)(zheng)，不(bu)(bu)因表(biao)(biao)(biao)(biao)(biao)(biao)(biao)實(shi)(shi)(shi)而稱(cheng)表(biao)(biao)(biao)(biao)(biao)(biao)(biao)陽(yang)(yang)(yang)(yang)證(zheng)(zheng)(zheng)。是說(shuo)判定(ding)表(biao)(biao)(biao)(biao)(biao)(biao)(biao)陽(yang)(yang)(yang)(yang)還是表(biao)(biao)(biao)(biao)(biao)(biao)(biao)陰(yin)(yin)證(zheng)(zheng)(zheng)，寒和熱(re)(re)是固定(ding)的(de)(de)(de)(de)(de)因素(su)，故(gu)《傷寒論》第7條曰：“病(bing)(bing)有(you)(you)發(fa)(fa)熱(re)(re)惡寒者(zhe)，發(fa)(fa)于(yu)陽(yang)(yang)(yang)(yang)也(ye)；無(wu)熱(re)(re)惡寒者(zhe)，發(fa)(fa)于(yu)陰(yin)(yin)也(ye)”，此即(ji)胡希恕所(suo)說(shuo)寒熱(re)(re)有(you)(you)常。而虛(xu)(xu)(xu)實(shi)(shi)(shi)的(de)(de)(de)(de)(de)變(bian)化，有(you)(you)時為(wei)(wei)(wei)陰(yin)(yin)，有(you)(you)時為(wei)(wei)(wei)陽(yang)(yang)(yang)(yang)，此即(ji)胡希恕所(suo)說(shuo)虛(xu)(xu)(xu)實(shi)(shi)(shi)無(wu)常。
里(li)(li)(li)(li)(li)(li)證(zheng)(zheng)(zheng)：里(li)(li)(li)(li)(li)(li)證(zheng)(zheng)(zheng)分陰(yin)(yin)(yin)(yin)陽(yang)，概而(er)(er)(er)(er)述之(zhi)(zhi)，陽(yang)實熱者為(wei)(wei)(wei)里(li)(li)(li)(li)(li)(li)陽(yang)證(zheng)(zheng)(zheng)即陽(yang)明(ming)病(bing)；陰(yin)(yin)(yin)(yin)虛(xu)(xu)寒(han)(han)(han)者為(wei)(wei)(wei)里(li)(li)(li)(li)(li)(li)陰(yin)(yin)(yin)(yin)證(zheng)(zheng)(zheng)即太(tai)(tai)陰(yin)(yin)(yin)(yin)病(bing)。注(zhu)意(yi)(yi)，這(zhe)里(li)(li)(li)(li)(li)(li)的(de)(de)陽(yang)實熱和陰(yin)(yin)(yin)(yin)虛(xu)(xu)寒(han)(han)(han)是(shi)(shi)一般常規(gui)所見(jian)，而(er)(er)(er)(er)臨床還(huan)常見(jian)陽(yang)虛(xu)(xu)熱的(de)(de)陽(yang)明(ming)病(bing)，亦(yi)常見(jian)陰(yin)(yin)(yin)(yin)實寒(han)(han)(han)的(de)(de)太(tai)(tai)陰(yin)(yin)(yin)(yin)病(bing)。例如(ru)，《傷(shang)寒(han)(han)(han)論(lun)》第(di)(di)76條(tiao)的(de)(de)梔子(zi)豉湯(tang)(tang)證(zheng)(zheng)(zheng)的(de)(de)“虛(xu)(xu)煩(fan)不(bu)(bu)(bu)(bu)(bu)得眠”、第(di)(di)397條(tiao)的(de)(de)竹(zhu)葉(xie)石膏湯(tang)(tang)證(zheng)(zheng)(zheng)的(de)(de)“虛(xu)(xu)羸少氣”等證(zheng)(zheng)(zheng)，都是(shi)(shi)里(li)(li)(li)(li)(li)(li)虛(xu)(xu)、津虛(xu)(xu)而(er)(er)(er)(er)有熱，而(er)(er)(er)(er)皆屬(shu)(shu)陽(yang)明(ming)病(bing)里(li)(li)(li)(li)(li)(li)陽(yang)證(zheng)(zheng)(zheng)。又如(ru)，《傷(shang)寒(han)(han)(han)論(lun)》第(di)(di)141條(tiao)桔梗(geng)白(bai)散證(zheng)(zheng)(zheng)的(de)(de)“寒(han)(han)(han)實結胸無熱證(zheng)(zheng)(zheng)者”、《金(jin)匱要略·腹滿寒(han)(han)(han)疝宿(su)食(shi)病(bing)》附(fu)方：《外臺(tai)走馬(ma)湯(tang)(tang)》證(zheng)(zheng)(zheng)的(de)(de)“腹脹大(da)(da)便不(bu)(bu)(bu)(bu)(bu)通(tong)”等證(zheng)(zheng)(zheng)，都是(shi)(shi)里(li)(li)(li)(li)(li)(li)實而(er)(er)(er)(er)寒(han)(han)(han)，而(er)(er)(er)(er)皆屬(shu)(shu)太(tai)(tai)陰(yin)(yin)(yin)(yin)病(bing)里(li)(li)(li)(li)(li)(li)陰(yin)(yin)(yin)(yin)證(zheng)(zheng)(zheng)，不(bu)(bu)(bu)(bu)(bu)能因(yin)(yin)里(li)(li)(li)(li)(li)(li)實而(er)(er)(er)(er)稱里(li)(li)(li)(li)(li)(li)陽(yang)證(zheng)(zheng)(zheng)。這(zhe)里(li)(li)(li)(li)(li)(li)特別(bie)注(zhu)意(yi)(yi)，陽(yang)明(ming)病(bing)的(de)(de)提綱(gang)是(shi)(shi)：“陽(yang)明(ming)之(zhi)(zhi)為(wei)(wei)(wei)病(bing)，胃家實是(shi)(shi)也”，有人理(li)解為(wei)(wei)(wei)，凡里(li)(li)(li)(li)(li)(li)實者即為(wei)(wei)(wei)陽(yang)明(ming)病(bing)。這(zhe)是(shi)(shi)錯(cuo)誤的(de)(de)，因(yin)(yin)為(wei)(wei)(wei)不(bu)(bu)(bu)(bu)(bu)論(lun)是(shi)(shi)從(cong)《傷(shang)寒(han)(han)(han)論(lun)》的(de)(de)記載(zai)，還(huan)是(shi)(shi)從(cong)臨床所見(jian)，里(li)(li)(li)(li)(li)(li)虛(xu)(xu)而(er)(er)(er)(er)熱的(de)(de)陽(yang)明(ming)病(bing)是(shi)(shi)多見(jian)的(de)(de)，如(ru)《傷(shang)寒(han)(han)(han)論(lun)》第(di)(di)221條(tiao)的(de)(de)梔子(zi)豉湯(tang)(tang)證(zheng)(zheng)(zheng)“胃中(zhong)空(kong)虛(xu)(xu)，客氣動膈，心(xin)中(zhong)懊惱(nao)”、第(di)(di)154條(tiao)大(da)(da)黃黃連瀉心(xin)湯(tang)(tang)證(zheng)(zheng)(zheng)“心(xin)下(xia)(xia)痞，按之(zhi)(zhi)濡”、《金(jin)匱要略·婦人產后(hou)病(bing)》白(bai)頭翁加(jia)甘草(cao)阿膠(jiao)湯(tang)(tang)證(zheng)(zheng)(zheng)“產后(hou)下(xia)(xia)利(li)虛(xu)(xu)極”。還(huan)應該特別(bie)注(zhu)意(yi)(yi)，有人記住了(le)太(tai)(tai)陰(yin)(yin)(yin)(yin)病(bing)提綱(gang)“太(tai)(tai)陰(yin)(yin)(yin)(yin)之(zhi)(zhi)為(wei)(wei)(wei)病(bing)，腹滿而(er)(er)(er)(er)吐，食(shi)不(bu)(bu)(bu)(bu)(bu)下(xia)(xia)，自(zi)(zi)利(li)益(yi)甚，時腹自(zi)(zi)痛。若下(xia)(xia)之(zhi)(zhi)，必胸下(xia)(xia)結硬(ying)(ying)(ying)。”誤認(ren)為(wei)(wei)(wei)凡下(xia)(xia)利(li)屬(shu)(shu)太(tai)(tai)陰(yin)(yin)(yin)(yin)，凡大(da)(da)便硬(ying)(ying)(ying)屬(shu)(shu)陽(yang)明(ming)，這(zhe)明(ming)顯(xian)不(bu)(bu)(bu)(bu)(bu)符合張仲景書中(zhong)記載(zai)，如(ru)《傷(shang)寒(han)(han)(han)論(lun)》第(di)(di)174條(tiao)“傷(shang)寒(han)(han)(han)八九日，風濕相搏，身體疼煩(fan)、不(bu)(bu)(bu)(bu)(bu)能自(zi)(zi)轉側(ce)、不(bu)(bu)(bu)(bu)(bu)嘔、不(bu)(bu)(bu)(bu)(bu)渴、脈浮虛(xu)(xu)而(er)(er)(er)(er)澀者，桂枝附(fu)子(zi)湯(tang)(tang)主(zhu)之(zhi)(zhi)；若其人大(da)(da)便硬(ying)(ying)(ying)、小(xiao)便自(zi)(zi)利(li)者，去桂加(jia)白(bai)術湯(tang)(tang)主(zhu)之(zhi)(zhi)”。這(zhe)里(li)(li)(li)(li)(li)(li)的(de)(de)大(da)(da)便硬(ying)(ying)(ying)與走馬(ma)湯(tang)(tang)證(zheng)(zheng)(zheng)的(de)(de)大(da)(da)便不(bu)(bu)(bu)(bu)(bu)通(tong)一樣，屬(shu)(shu)太(tai)(tai)陰(yin)(yin)(yin)(yin)而(er)(er)(er)(er)不(bu)(bu)(bu)(bu)(bu)屬(shu)(shu)陽(yang)明(ming)。亦(yi)是(shi)(shi)說，判(pan)定里(li)(li)(li)(li)(li)(li)陽(yang)證(zheng)(zheng)(zheng)還(huan)是(shi)(shi)里(li)(li)(li)(li)(li)(li)陰(yin)(yin)(yin)(yin)證(zheng)(zheng)(zheng)的(de)(de)主(zhu)要看(kan)寒(han)(han)(han)熱，是(shi)(shi)因(yin)(yin)寒(han)(han)(han)熱有常。
半(ban)(ban)(ban)(ban)(ban)(ban)(ban)表(biao)半(ban)(ban)(ban)(ban)(ban)(ban)(ban)里(li)(li)(li)(li)證(zheng)：半(ban)(ban)(ban)(ban)(ban)(ban)(ban)表(biao)半(ban)(ban)(ban)(ban)(ban)(ban)(ban)里(li)(li)(li)(li)分(fen)陰(yin)(yin)(yin)陽(yang)，概而述之(zhi)，應(ying)是(shi)(shi)(shi)半(ban)(ban)(ban)(ban)(ban)(ban)(ban)表(biao)半(ban)(ban)(ban)(ban)(ban)(ban)(ban)里(li)(li)(li)(li)陽(yang)實熱(re)(re)(re)(re)者(zhe)為(wei)少陽(yang)病(bing)(bing)(bing)(bing)(bing)；半(ban)(ban)(ban)(ban)(ban)(ban)(ban)表(biao)半(ban)(ban)(ban)(ban)(ban)(ban)(ban)里(li)(li)(li)(li)陰(yin)(yin)(yin)虛寒(han)(han)(han)者(zhe)為(wei)厥(jue)陰(yin)(yin)(yin)病(bing)(bing)(bing)(bing)(bing)。這(zhe)里(li)(li)(li)(li)要特(te)別注意，半(ban)(ban)(ban)(ban)(ban)(ban)(ban)表(biao)半(ban)(ban)(ban)(ban)(ban)(ban)(ban)里(li)(li)(li)(li)證(zheng)病(bing)(bing)(bing)(bing)(bing)因病(bing)(bing)(bing)(bing)(bing)機的特(te)殊性(xing)。胡(hu)希恕先(xian)生指出(chu)“由于半(ban)(ban)(ban)(ban)(ban)(ban)(ban)表(biao)半(ban)(ban)(ban)(ban)(ban)(ban)(ban)里(li)(li)(li)(li)為(wei)諸臟器所(suo)在，病(bing)(bing)(bing)(bing)(bing)邪郁集此體(ti)部則(ze)往往影(ying)響某一(yi)臟器或某些臟器出(chu)現(xian)癥狀反應(ying)，以是(shi)(shi)(shi)證(zheng)情復雜(za)多變，不(bu)(bu)(bu)似表(biao)里(li)(li)(li)(li)的為(wei)證(zheng)單純(chun)，較易提(ti)出(chu)簡明的概括(kuo)特(te)征(zheng)。”即(ji)半(ban)(ban)(ban)(ban)(ban)(ban)(ban)表(biao)半(ban)(ban)(ban)(ban)(ban)(ban)(ban)里(li)(li)(li)(li)證(zheng)是(shi)(shi)(shi)胸腹兩大(da)腔間之(zhi)證(zheng)，邪無(wu)直(zhi)接出(chu)路(lu)，很(hen)易寒(han)(han)(han)郁化熱(re)(re)(re)(re)，熱(re)(re)(re)(re)走于上(shang)(shang)(shang)，呈現(xian)上(shang)(shang)(shang)熱(re)(re)(re)(re)下(xia)寒(han)(han)(han)，故少陽(yang)病(bing)(bing)(bing)(bing)(bing)亦具上(shang)(shang)(shang)熱(re)(re)(re)(re)下(xia)寒(han)(han)(han)，厥(jue)陰(yin)(yin)(yin)病(bing)(bing)(bing)(bing)(bing)亦呈上(shang)(shang)(shang)熱(re)(re)(re)(re)下(xia)寒(han)(han)(han)，不(bu)(bu)(bu)過厥(jue)陰(yin)(yin)(yin)病(bing)(bing)(bing)(bing)(bing)的下(xia)寒(han)(han)(han)更(geng)明顯(xian)(xian)是(shi)(shi)(shi)主要區別。這(zhe)樣少陽(yang)，雖有(you)(you)(you)(you)下(xia)寒(han)(han)(han)，但(dan)大(da)致符(fu)合(he)半(ban)(ban)(ban)(ban)(ban)(ban)(ban)表(biao)半(ban)(ban)(ban)(ban)(ban)(ban)(ban)里(li)(li)(li)(li)陽(yang)實熱(re)(re)(re)(re)。而厥(jue)陰(yin)(yin)(yin)病(bing)(bing)(bing)(bing)(bing)，上(shang)(shang)(shang)熱(re)(re)(re)(re)下(xia)寒(han)(han)(han)明顯(xian)(xian)，很(hen)顯(xian)(xian)然不(bu)(bu)(bu)符(fu)合(he)半(ban)(ban)(ban)(ban)(ban)(ban)(ban)表(biao)半(ban)(ban)(ban)(ban)(ban)(ban)(ban)里(li)(li)(li)(li)陰(yin)(yin)(yin)虛寒(han)(han)(han)的規律(lv)(lv)，即(ji)仲景(jing)(jing)書(shu)(shu)所(suo)載(zai)，厥(jue)陰(yin)(yin)(yin)病(bing)(bing)(bing)(bing)(bing)有(you)(you)(you)(you)明顯(xian)(xian)上(shang)(shang)(shang)熱(re)(re)(re)(re)。按八綱規律(lv)(lv)，陰(yin)(yin)(yin)不(bu)(bu)(bu)得有(you)(you)(you)(you)熱(re)(re)(re)(re)，少陰(yin)(yin)(yin)、太陰(yin)(yin)(yin)不(bu)(bu)(bu)見熱(re)(re)(re)(re)，而厥(jue)陰(yin)(yin)(yin)是(shi)(shi)(shi)半(ban)(ban)(ban)(ban)(ban)(ban)(ban)表(biao)半(ban)(ban)(ban)(ban)(ban)(ban)(ban)里(li)(li)(li)(li)陰(yin)(yin)(yin)證(zheng)亦不(bu)(bu)(bu)應(ying)有(you)(you)(you)(you)熱(re)(re)(re)(re)，但(dan)從仲景(jing)(jing)書(shu)(shu)記載(zai)看，不(bu)(bu)(bu)論(lun)是(shi)(shi)(shi)厥(jue)陰(yin)(yin)(yin)病(bing)(bing)(bing)(bing)(bing)提(ti)綱，還是(shi)(shi)(shi)有(you)(you)(you)(you)關條(tiao)文，厥(jue)陰(yin)(yin)(yin)病(bing)(bing)(bing)(bing)(bing)呈上(shang)(shang)(shang)熱(re)(re)(re)(re)下(xia)寒(han)(han)(han)多見。又從厥(jue)陰(yin)(yin)(yin)病(bing)(bing)(bing)(bing)(bing)的諸多方證(zheng)來看，如(ru)烏梅丸(wan)證(zheng)、柴胡(hu)桂枝(zhi)干姜(jiang)湯(tang)證(zheng)、干姜(jiang)黃芩黃連人參湯(tang)證(zheng)、半(ban)(ban)(ban)(ban)(ban)(ban)(ban)夏(xia)瀉心湯(tang)證(zheng)等，都見上(shang)(shang)(shang)熱(re)(re)(re)(re)下(xia)寒(han)(han)(han)，不(bu)(bu)(bu)符(fu)合(he)陰(yin)(yin)(yin)虛寒(han)(han)(han)的規律(lv)(lv)，但(dan)仲景(jing)(jing)書(shu)(shu)判定厥(jue)陰(yin)(yin)(yin)病(bing)(bing)(bing)(bing)(bing)為(wei)半(ban)(ban)(ban)(ban)(ban)(ban)(ban)表(biao)半(ban)(ban)(ban)(ban)(ban)(ban)(ban)里(li)(li)(li)(li)陰(yin)(yin)(yin)證(zheng)，這(zhe)里(li)(li)(li)(li)提(ti)示我們(men)，出(chu)現(xian)了(le)寒(han)(han)(han)熱(re)(re)(re)(re)亦無(wu)常(chang)了(le)？因此，寒(han)(han)(han)熱(re)(re)(re)(re)有(you)(you)(you)(you)常(chang)，而虛實無(wu)常(chang)，這(zhe)一(yi)辨證(zheng)規律(lv)(lv)，適(shi)用(yong)于仲景(jing)(jing)書(shu)(shu)的表(biao)證(zheng)和里(li)(li)(li)(li)證(zheng)之(zhi)辨，而不(bu)(bu)(bu)適(shi)用(yong)于半(ban)(ban)(ban)(ban)(ban)(ban)(ban)表(biao)半(ban)(ban)(ban)(ban)(ban)(ban)(ban)里(li)(li)(li)(li)之(zhi)辨，半(ban)(ban)(ban)(ban)(ban)(ban)(ban)表(biao)半(ban)(ban)(ban)(ban)(ban)(ban)(ban)里(li)(li)(li)(li)之(zhi)辨證(zheng)規律(lv)(lv)，應(ying)是(shi)(shi)(shi)虛實無(wu)常(chang)，寒(han)(han)(han)熱(re)(re)(re)(re)亦無(wu)常(chang)。是(shi)(shi)(shi)否如(ru)此，望同道商討。
學術意義
胡希恕先生提出“寒(han)熱有(you)常，而虛實(shi)無常”說，是讀(du)(du)《傷(shang)寒(han)論(lun)》全文(wen)時總結出的學術用語，是臨(lin)證辨證的規律總結。適(shi)用于解讀(du)(du)《傷(shang)寒(han)論(lun)》全文(wen)、分辨六經及方證，亦適(shi)用于臨(lin)床。
有一(yi)(yi)同道(dao)提出(chu)“虛(xu)(xu)(xu)(xu)實(shi)是(shi)分辨太(tai)(tai)(tai)陽(yang)(yang)少(shao)(shao)陰(yin)(yin)(yin)(yin)的(de)(de)(de)唯(wei)一(yi)(yi)標(biao)準”“從虛(xu)(xu)(xu)(xu)實(shi)著眼是(shi)劃(hua)分太(tai)(tai)(tai)陽(yang)(yang)病(bing)(bing)(bing)(bing)與少(shao)(shao)陰(yin)(yin)(yin)(yin)病(bing)(bing)(bing)(bing)的(de)(de)(de)可靠路徑”。其(qi)理由是(shi)“表(biao)證(zheng)(zheng)(zheng)(zheng)系寒(han)(han)邪(xie)侵襲肌表(biao)，衛陽(yang)(yang)被束，氣血津液郁滯所致，性(xing)質(zhi)屬(shu)寒(han)(han)，無表(biao)熱(re)存在，所以判(pan)斷表(biao)陽(yang)(yang)表(biao)陰(yin)(yin)(yin)(yin)的(de)(de)(de)標(biao)準也就只有虛(xu)(xu)(xu)(xu)實(shi)，或(huo)者(zhe)說虛(xu)(xu)(xu)(xu)實(shi)是(shi)分辨太(tai)(tai)(tai)陽(yang)(yang)少(shao)(shao)陰(yin)(yin)(yin)(yin)的(de)(de)(de)唯(wei)一(yi)(yi)標(biao)準。”經方、仲景(jing)書辨證(zheng)(zheng)(zheng)(zheng)論(lun)治(zhi)主要依據癥狀(zhuang)反(fan)應，是(shi)論(lun)其(qi)證(zheng)(zheng)(zheng)(zheng)候屬(shu)性(xing)，不(bu)是(shi)論(lun)其(qi)病(bing)(bing)(bing)(bing)因(yin)(yin)屬(shu)性(xing)。不(bu)論(lun)感受是(shi)寒(han)(han)邪(xie)還是(shi)熱(re)邪(xie)，不(bu)論(lun)感受六淫之中(zhong)哪一(yi)(yi)邪(xie)，正邪(xie)相爭(zheng)，癥狀(zhuang)反(fan)應是(shi)陽(yang)(yang)實(shi)熱(re)者(zhe)，為(wei)(wei)太(tai)(tai)(tai)陽(yang)(yang)；癥狀(zhuang)反(fan)應是(shi)陰(yin)(yin)(yin)(yin)虛(xu)(xu)(xu)(xu)寒(han)(han)者(zhe)，為(wei)(wei)少(shao)(shao)陰(yin)(yin)(yin)(yin)。以上觀點，一(yi)(yi)是(shi)混淆了病(bing)(bing)(bing)(bing)因(yin)(yin)和證(zheng)(zheng)(zheng)(zheng)候的(de)(de)(de)屬(shu)性(xing)，即(ji)用醫(yi)經的(de)(de)(de)病(bing)(bing)(bing)(bing)因(yin)(yin)辨證(zheng)(zheng)(zheng)(zheng)，誤認為(wei)(wei)太(tai)(tai)(tai)陽(yang)(yang)病(bing)(bing)(bing)(bing)是(shi)表(biao)受寒(han)(han)邪(xie)則為(wei)(wei)寒(han)(han)證(zheng)(zheng)(zheng)(zheng)。而(er)經方是(shi)據癥狀(zhuang)反(fan)應，太(tai)(tai)(tai)陽(yang)(yang)病(bing)(bing)(bing)(bing)辨證(zheng)(zheng)(zheng)(zheng)為(wei)(wei)表(biao)實(shi)熱(re)證(zheng)(zheng)(zheng)(zheng)。二是(shi)未理解(jie)“寒(han)(han)熱(re)有常，虛(xu)(xu)(xu)(xu)實(shi)無常”。即(ji)太(tai)(tai)(tai)陽(yang)(yang)病(bing)(bing)(bing)(bing)表(biao)陽(yang)(yang)證(zheng)(zheng)(zheng)(zheng)，是(shi)表(biao)陽(yang)(yang)實(shi)熱(re)，少(shao)(shao)陰(yin)(yin)(yin)(yin)病(bing)(bing)(bing)(bing)是(shi)表(biao)陰(yin)(yin)(yin)(yin)證(zheng)(zheng)(zheng)(zheng)，是(shi)表(biao)陰(yin)(yin)(yin)(yin)虛(xu)(xu)(xu)(xu)寒(han)(han)證(zheng)(zheng)(zheng)(zheng)。
太(tai)陽(yang)(yang)病(bing)又(you)有(you)無(wu)汗(han)的(de)(de)表(biao)實(shi)(shi)(shi)證(zheng)(zheng)和(he)有(you)汗(han)的(de)(de)表(biao)虛(xu)證(zheng)(zheng)。少陰病(bing)亦(yi)有(you)無(wu)汗(han)的(de)(de)表(biao)實(shi)(shi)(shi)陰證(zheng)(zheng)和(he)有(you)汗(han)的(de)(de)表(biao)虛(xu)陰證(zheng)(zheng)，即(ji)太(tai)陽(yang)(yang)病(bing)和(he)少陰病(bing)都有(you)虛(xu)實(shi)(shi)(shi)之(zhi)證(zheng)(zheng)，故(gu)不(bu)能(neng)用虛(xu)實(shi)(shi)(shi)分辨太(tai)陽(yang)(yang)和(he)少陰。而辨別(bie)太(tai)陽(yang)(yang)和(he)少陰的(de)(de)屬(shu)性，決定于寒和(he)熱(re)，即(ji)《傷寒論》第7條“病(bing)有(you)發熱(re)惡寒者，發于陽(yang)(yang)也；無(wu)熱(re)惡寒者，發于陰也”。即(ji)表(biao)證(zheng)(zheng)見發熱(re)者屬(shu)太(tai)陽(yang)(yang)，無(wu)熱(re)惡寒者屬(shu)少陰。
總(zong)之，理解“寒熱有常(chang)，而虛實無常(chang)”，對讀《傷寒論》，認識辨六經(jing)及方證(zheng)有指導意義。
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