五脏六腑病形百出。然各有自为之病形。以为证据。如心为噫。非心止有噫之一证。谓无论何证。但见噫气。则知
属于心矣。余仿此。
心为噫。
噫者胸中结气。哽之使出俗说是打格顿非也。打格顿与噫。音义不符。打格顿是气厄于胸而出于口。故名曰呃。二
者均病在胸前。属心之部位。故皆属心经。柿形象心而蒂苦涩。治呃降心气也。胸满噫气。乃是肺胃痰火。仲景旋覆麦
冬治之。而必用赭石破心血镇心气也。久病闻呃为胃绝。则以其火不生土。心气逆也。心病不止一噫。然见噫气。便知
属心。用药乃知方向。
肺为咳。
内经言五脏六腑。皆有咳证。而无不聚于胃关于肺。盖肺主气管。气管中非痰饮。即风寒火燥。令其气逆故咳。有
从皮毛口鼻入气管者。有从肠胃膈膜入气管者。当分头治之。按 咳二证。道路不同。鼻主吸气。 字从鼻。是吸入之
气管不利。此管详膀胱肺肾条。咳字从欠。欠者口气下垂也。口主出气是呼出之气管不利。此管在胸。膈故每咳必胸前。
痒滞。详三焦条。
肝为语。
谵语属阳明燥热。郑声属心神虚恍。而此云肝为语。盖燥热乃木火克土。神恍乃肝魂不清。因而心神扰惑。故皆宜
泻木火安魂也。
脾为吞。
脾主化谷生津。凡口中津液少者。时常作吞。引之状反吞为吐又是水谷不下之故。皆属脾病。可以互勘。
肾为欠为嚏。
欠者阴。引阳入。故呵欠。至而欲寐嚏者。阳引阴出故喷嚏出而人醒。二者皆根于气海。故肾病则见此二证。
胃为气逆。为哕为恐。
阳明主纳。其气以下行为顺。气逆则反其令也。冲脉丽于阳明冲逆亦属阳明胃。哕者。吐秽恶之气也。吞酸嗳腐之
类。皆反其纳物之令也。恐者肾所主。肾水动而胃土不能制之。故恐亦属胃。
大小肠为泄。
泄多是脾胃中焦之证。然总出于肠中。故皆属于大小肠之病。小肠属火以化谷。火虚则谷不化而飧泄。大肠属金以
燥粪燥气不足则粪溏泻。小肠火甚则又胶结为痢。大肠燥粪则又秘结不便。此又为泄之变态矣。
下焦溢为水肿。
三焦乃决渎之官前已详注。此但云下焦者。因上焦连心肺。中焦连脾胃。多兼心肺脾胃之证。尚非三焦专责。惟下
焦当膀胱上口为水入膀胱之路此处不利则水溢于上。达于外而发水肿。下焦属肾属肝治宜疏泄肝肾。又肺居高能御下。
主通调水道。非开利。肺气不能治下焦也。
膀胱不利为癃。不约为遗溺。
膀胱下为溺管。溺管淋涩不通为癃肺主水道。由肺气闭。则宜清利。肝脉绕茎。由肝血滞。则宜滑利。据西医之说。
以为溺管发炎肿塞或砂淋内塞究之。皆肺肝两端所致也。又溺管之后为精窍。精窍有败精死血。亦能挤塞溺管。法当利
肾。夫肺以阴气下达膀胱。通调水道而主制节。使小便有度。不得违碍肝肾以阳气达于膀胱蒸发水气使其上腾。不得直
泻。若阳气不能蒸。发则水无约束。发为遗溺。治宜温胞室。盖膀胱如釜。胞如灶温。胞室者。釜底添薪也。参看十二
官条自见。
胆气郁为怒。
胆者木生之大也。西医论胆专言汁不知有汁即有气。故内经均以气立论。木气条畅。火气宣达。则清和朗润。其人
和平。若木郁生火。火郁暴发则为震怒凡病之易怒者皆责于胆气也。
脏腑之证。不一而足。举此为验。任其证形百变均莫得而遁情矣。
The pathological manifestations of the Zang and Fu organs are myriad, yet each has its specific signs serving as diagnostic evidence. For instance, heart pathology manifests as "Yi" (belching). This does not imply that the heart only presents with belching; rather, it signifies that regardless of other symptoms, if belching is observed, the pathology can be attributed to the Heart channel. The same logic applies to other organs.
Heart governs belching.
Belching refers to Qi stagnating in the chest and being forced out through the throat. It is commonly mistaken for hiccuping (E), which is incorrect. Hiccups and belching differ in sound and meaning. Hiccups occur when Qi is obstructed in the chest and expelled through the mouth, hence named "E". Both conditions occur in the anterior chest region, corresponding to the anatomical area of the Heart, and thus both are attributed to the Heart channel. Persimmons resemble the shape of the heart, and their calyxes are bitter and astringent; they treat hiccups by descending Heart Qi. Chest fullness accompanied by belching is typically caused by Phlegm-Fire in the Lung and Stomach. Zhang Zhongjing treats this with Xuanfu Daiduzhong Decoction (Inula and Ophiopogon Decoction), but must include Hematite (Hematitum) to break Blood stasis and calm Heart Qi. Hiccups appearing in chronic illness indicate the exhaustion of Stomach Qi, resulting from Heart Fire failing to generate Spleen Earth and causing rebellious Heart Qi. Heart disease is not limited to belching, but observing belching indicates Heart involvement, providing direction for treatment.
Lung governs cough.
The *Neijing* states that all Zang and Fu organs can present with cough, but none do so without gathering at the Stomach and relating to the Lung. The Lung governs the airways; if these contain Phlegm-Fluids or are affected by Wind-Cold, Fire, or Dryness, Qi rebels upward causing cough. Pathogens may enter the airways from the skin and hair or nose/mouth, or from the intestines and diaphragm; these should be treated separately according to their entry points. Analyzing the characters: "Ke" (cough) relates to inhalation via the nose; obstruction here affects the airway detailed in the Bladder, Lung, and Kidney sections. "Sou" (clearing phlegm/coughing sound) relates to exhalation via the mouth; obstruction here affects the thoracic diaphragm, often causing itching and stagnation in the anterior chest during coughing, detailed in the Sanjiao section.
Liver governs speech abnormalities (such as delirium or muttering).
Delirious speech (Zhanyu) belongs to Yangming Dryness-Heat; murmuring speech (Zhengsheng) belongs to Heart Spirit deficiency and confusion. Here, liver governance of speech implies that Dryness-Heat involves Wood-Fire overacting on Earth, while confusion involves unclear Liver Hun (Ethereal Soul), thereby disturbing the Heart Shen (Spirit). Therefore, treatment should focus on draining Wood-Fire and calming the Hun.
Spleen governs swallowing.
The Spleen transforms food and generates fluids. Individuals with insufficient oral fluids often exhibit frequent swallowing motions. Conversely, inability to swallow food and fluid also indicates Spleen pathology. These signs can be cross-referenced.
Kidney governs yawning and sneezing.
Yawning occurs when Yin draws Yang inward, leading to drowsiness. Sneezing occurs when Yang draws Yin outward, waking the person upon expulsion. Both originate from the Qi Sea (Lower Dantian); thus, Kidney pathology presents with these two signs.
Stomach governs rebellious Qi, hiccups (Yue), and fear.
Yangming Stomach receives food, and its Qi should descend smoothly. Rebellious Qi violates this function. The Chong Mai connects to Yangming; rebellious Qi from the Chong Mai also pertains to the Stomach. Yue refers to expelling foul-smelling Qi. Acid regurgitation and belching of rotten food violate the receiving function. Fear is primarily governed by the Kidney, but if Kidney Water moves recklessly and Stomach Earth fails to control it, fear also relates to the Stomach.
Large and Small Intestines govern diarrhea.
Diarrhea is mostly a Middle Jiao disorder involving the Spleen and Stomach, but ultimately originates in the intestines, thus belonging to Large and Small Intestine pathology. The Small Intestine belongs to Fire and transforms food; Fire deficiency leads to undigested food in stool (Sunxie). The Large Intestine belongs to Metal and dries feces; insufficiency of drying Qi leads to loose stools. Excessive Fire in the Small Intestine causes sticky dysentery; dryness in the Large Intestine causes constipation. These are variations of diarrhea.
Excess in the Lower Jiao leads to edema.
The Sanjiao is the official of drainage, as noted previously. Mentioning only the Lower Jiao here is because the Upper Jiao connects to the Heart and Lung, and the Middle Jiao to the Spleen and Stomach, often presenting combined syndromes not solely attributable to the Sanjiao. Only the Lower Jiao, located at the entrance to the Bladder, serves as the pathway for water entry. Obstruction here causes water to overflow upwards and reach the exterior, resulting in edema. The Lower Jiao belongs to the Kidney and Liver; treatment should promote the free flow of Liver and Kidney Qi. Additionally, the Lung resides high and controls the lower regions, governing the regulation of water passages. Without promoting Lung Qi, the Lower Jiao water pathology cannot be resolved.
Bladder dysfunction leads to strangury (Long), and lack of restraint leads to enuresis.
Below the Bladder lies the urethra. Obstruction and painful urination constitute strangury. The Lung governs water passages; closure of Lung Qi requires clearing and promoting. The Liver channel wraps around the penis; blood stasis requires lubricating and unblocking. Western medicine attributes urethral inflammation, swelling, or sand blockage to local issues, but fundamentally, these stem from Lung and Liver dysfunction. Behind the urethra lies the essence aperture; retained semen or dead blood can compress the urethra, requiring treatment to benefit the Kidney. The Lung transmits Yin Qi to the Bladder to regulate water passages and ensure controlled urination, preventing interference from Liver-Kidney Yang. Liver-Kidney Yang reaches the Bladder to evaporate water vapor, preventing direct leakage. If Yang fails to evaporate, water lacks constraint, leading to enuresis. Treatment should warm the "Bao Shi" (Uterus/Lower Jiao furnace). The Bladder is like a pot, and the Bao Shi is like the stove; warming the Bao Shi is akin to adding firewood to the stove. Refer to the Twelve Officials section for details.
Gallbladder Qi stagnation leads to anger.
The Gallbladder is the major organ of Wood generation. Western medicine focuses on bile, ignoring Qi. The *Neijing* discusses Qi. When Wood Qi flows freely and Fire Qi spreads, the body remains clear, harmonious, and peaceful. If Wood stagnates generating Fire, and Fire stagnates erupting violently, it results in rage. All cases of irritability are attributed to Gallbladder Qi.
Syndromes of the Zang and Fu organs are numerous. These examples serve as verification. Regardless of how varied the clinical presentations, they cannot escape these fundamental principles.