三阴结。谓之水。三阴为六经之主。三阴邪结。是坤土不能运精矣。土不运精。则二阴之水气益甚。势必反来侮土。
且水气盛则阳不得入。阳不得入则肺气不得通调。斯寒水不行而为壅。故为水也。盖中州结则气壅而关门不利。不利则
聚水而从其类。类者。本在肾。末在肺也。
一阴一阳结。谓之喉痹。厥阴。少阳。一主风木。一主相火。胆肝心胞三焦皆所共也。均为热化而风煽之。四结之
脉。皆络于喉。风火逆上而不得发。必于喉乎结之。是成喉痹也。
有并病者。凡人之阴阳内外雌雄。必相输应。是以阴阳相致。得其和平。若既两病。则各经之阴阳。必错迕违逆。
相遇则搏而败。必并于胜。故不谓之合病。而谓之并病。并者有所归也。
二阳一阴。阳明主病。不胜一阴。脉 而动。九窍皆沉。阳明全有谷神营卫之盛气。厥阴则任独使而布行之。合两
家同病。而中州气馁。是阳明主病矣。乃中州气馁。而风木失和。将厥阴之戾。反克于中州。嗣此阳明之脉不复搏大而
见。气不昌而内郁见动。则所以宣之九窍无俾也。故皆沉。此则阳明之病甚矣。是谓并病也。
三阳一阴。太阳脉胜。一阴不能止。内乱五脏。外为惊骇。一阴主筋膜之气。又主三阴之阖。能为太阳之守。莫一
阴若也。乃三阳一阴俱病。而太阳之脉且胜。夫太阳之病。在脉浮。病而脉胜。则浮大中空。无阴可知。无阴则太阳之
上下无常方。风雨并至而为病。而岂无气之一阴能止之乎。于是内气不守。则内乱五脏。本脏神怯。则外为惊骇也。
二阴二阳。病在肺。少阴脉沉。胜肺伤脾。外伤四肢。二阴主里而藏精。病则真精内虚。二阳起谷神而朝津液。病则津
液枯竭。于是气逆火盛。必伤于肺。故曰病在肺。若见少阴脉沉者。是谓肾气不衡。而无根之浮火逆而上乘。则上胜于
肺。中州不能遏其逆。则热燥伤脾脾病则不能授气于四关。故并外伤四肢也。
二阴二阳皆交至。病在肾。骂詈妄行。颠疾为狂。前证明阳气虚内热。肾气不衡。故有胜肺伤脾之见。今内伤之气
皆交至。而定为病在肾者。此系肾家水空火不守。而上发与阳明热邪相并。使心无所主。故神惑志失。而骂詈妄行。太
阳无内。故颠疾。神明内乱。故为病狂。此症之见。似宜皆在阳明。然实肾精不守。不能主里。使心火自焚。与阳明并
也。
二阴一阳。病出于肾。阴气客游于心脘下。空窍堤闭不通。四肢别离。一阳连肾。上至肺。外连脾胃。然其根本出
于二阴。今二阴肾家寒虚。少阳不足。故病出于肾。肾与胆气皆寒虚。是以阴气客游于心脘下。阴气既盛于中脘。则所
以行津液出营卫以灌溉四末者。皆空窍堤闭不通矣。不通者。无阳则不通也。不通则四肢乃别离矣。此证近于单腹胀。
而四肢如削者也。一阴一阳。代绝。此阴气至心上下无常。出入不知。喉咽干燥。病在脾土。一阴之阴。为作朔之阴。
一阳之阳。为生生之阳。二脉皆代绝。是阴不为阳根。阳不为阴生矣。两俱失职。则所以为游部。为独使者。皆无根之
阴气也。心之下。自膻中至三焦。皆少阳生发游行上下之位。二部之生气既已无根。故阴气至心而上下无常。出入不知
也。咽喉胆之使也。故干。脾土之冲和。亦赖胆肝之舒达。若脉皆代绝。是以死气乘脾矣。其为中气不续。中土衰败可
知。
二阳三阴。至阴皆病。阴不过阳。阳气不能止阴。阴阳并绝。沉为血瘕。浮为脓 。二阳三阴。本脾胃也。而后云
至阴者。以明此三阴属于太阴肺。故分别言之。夫阳明居二阳中州气盛。太阴脾常为之行气于三阴。而阳明亦自能达气
于三阳。则手太阴肺常能为治节于其间。是以阴阳和同。阳倡阴随。阴守阳中。阳指阴使。今二阳三阴至阴皆病。其病
气皆见于其脉。则其象为阳浮而不能沉。阴沉而不能浮。是以阴不过阳。阳亦不能止阴。是阴阳离绝也。如是则沉伏于
内者。有阴寒之病。血聚为瘕。浮显于外者。有阳毒之病。壅盛脓 。旧文作沉为脓 。浮为血瘕。有吴鹤皋正之。
按内经无并病之文。然阴阳不和。两戾相遇。势必相战。战有胜负。则其病更有所归。或归胜。或归负。必有为之主者。
终非合病之条也。故另出言之。乃内经举一隅耳。此阴阳之错迕。脏腑之乘除。可不辨明乎。
When the Three Yin meridians are knotted, it is called Water Disease. The Three Yin meridians are the masters of the Six Meridians. When the Three Yin meridians are knotted by pathogenic factors, it means that Kun Earth (Spleen/Stomach) fails to transport and transform essential substances. If Earth fails to transport essentials, then the Water Qi of the Two Yin (Shao Yin and Jue Yin) becomes even more excessive, inevitably coming to insult Earth in return.
Moreover, when Water Qi is abundant, Yang cannot enter. If Yang cannot enter, the Lung's function of diffusing and descending cannot be regulated. Thus, Cold Water stagnates and becomes obstructed, resulting in Water Disease. Generally, when the Middle Jiao is knotted, Qi becomes congested and the "gates" (excretory orifices or lower jiao water passages) fail to open properly. When they fail to open, water accumulates and follows its kind. The "kind" refers to the root being in the Kidney and the branch being in the Lung.
When One Yin (Jue Yin) and One Yang (Shao Yang) are knotted, it is called Throat Bi (Obstruction). Jue Yin and Shao Yang, one governs Wind-Wood and the other governs Ministerial Fire. The Gallbladder, Liver, Pericardium, and San Jiao all share these attributes. Both tend toward Heat transformation, with Wind fanning the flames. The four meridians involved all connect to the throat. When Wind and Fire rebel upward and cannot disperse, they must knot at the throat, thereby forming Throat Bi.
There is a condition known as Bing Bing (Concurrent Disease). In humans, Yin and Yang, interior and exterior, male and female principles must correspond and interact. Therefore, when Yin and Yang converge harmoniously, peace is achieved. If two diseases occur simultaneously, the Yin and Yang of each meridian will inevitably clash and contradict. Upon meeting, they contend and deteriorate, ultimately merging into the side that prevails. Hence, it is not called He Bing (Combined Disease), but Bing Bing (Concurrent Disease). "Bing" implies a tendency toward a specific outcome.
In the case of Two Yang (Yang Ming) and One Yin (Jue Yin) concurrent disease, Yang Ming is primarily affected because it cannot overcome One Yin. The pulse is restless, and all nine orifices appear sunken. Yang Ming originally possesses the robust Qi of Grain Essence, Shen Spirit, Ying, and Wei. Jue Yin acts independently to distribute and circulate. When both meridians are diseased, the Qi of the Middle Jiao weakens, making Yang Ming the primary site of pathology. Since the Middle Jiao Qi is weak and Wind-Wood loses harmony, the rebellious nature of Jue Yin counter-attacks the Middle Jiao. Consequently, the Yang Ming pulse no longer appears forceful and large; instead, due to deficient and internally constrained Qi, restlessness manifests. This lack of strength prevents the proper dissemination to the nine orifices, causing them to sink. This indicates severe Yang Ming disease, termed Concurrent Disease.
In the case of Three Yang (Tai Yang) and One Yin (Jue Yin) concurrent disease, the Tai Yang pulse is dominant, and One Yin cannot restrain it. Internally, it disrupts the Five Zang organs; externally, it causes fright and palpitations. One Yin governs the Qi of the sinews and membranes and controls the closing function of the Three Yin meridians, serving as the guard for Tai Yang, with no better candidate than One Yin. However, when both Three Yang and One Yin are diseased, and the Tai Yang pulse is still dominant: Tai Yang disease typically presents with a floating pulse. A dominant pulse in this context suggests a floating, large, and hollow quality, indicating a lack of Yin. Without Yin, Tai Yang lacks stability, allowing Wind and Rain pathogens to strike simultaneously. Can such a weak One Yin restrain this? Internal Qi fails to hold fast, disrupting the Five Zang organs. Due to weakness of the organ's Shen spirit, external manifestations include fright and palpitations.
In the case of Two Yin (Shao Yin, Jue Yin) and Two Yang (Yang Ming, Tai Yin) concurrent disease, the pathology lies in the Lung. The Shao Yin pulse is deep. This represents an excess condition injuring the Lung and Spleen, with external injury to the four limbs. Two Yin govern the interior and store essence; disease here implies internal deficiency of true essence. Two Yang (primarily Yang Ming) generates Shen Qi from Grain Essence and gathers body fluids; disease here implies depletion of body fluids. Thus, rebellious Qi and flourishing Fire inevitably damage the Lung, hence "pathology lies in the Lung." If the Shao Yin pulse is seen as deep, it signifies unbalanced Kidney Qi, with rootless floating Fire rebelling upward and overwhelming the Lung. The Middle Jiao cannot curb this rebellion, so heat and dryness injure the Spleen. Spleen disease prevents the transmission of Qi to the four joints, resulting in external injury to the limbs.
When the pathogenic factors of Two Yin and Two Yang intersect and arrive together, the pathology lies in the Kidney. Symptoms include cursing, erratic behavior, mania arising from epilepsy. Previous texts established that Yang Qi deficiency leads to internal heat and unbalanced Kidney Qi, causing injuries to the Lung and Spleen. Now, with internal injured Qi intersecting, the pathology is defined as lying in the Kidney. This is because Kidney Water is empty and Fire does not stay put, rising to merge with Yang Ming Heat Pathogens. This leaves the Heart without a master, causing confusion of Shen and loss of Zhi, leading to cursing and erratic behavior. With Tai Yang lacking internal support, mania ensues. Internal disorder of Shen results in Kuang (madness). Although these symptoms seem related to Yang Ming, the root is actually Kidney Essence failing to secure the interior, allowing Heart Fire to burn itself out and merge with Yang Ming.
In the case of Two Yin and One Yang concurrent disease, the pathology originates from the Kidney. Yin Qi wanders below the heart and epigastrium, blocking the orifices and barriers, causing the limbs to waste away. One Yang (Shao Yang) connects to the Kidney, ascends to the Lung, and extends externally to the Spleen and Stomach. However, its root lies in Two Yin. Currently, the Kidney family of Two Yin is cold and deficient, and Shao Yang is insufficient, so the pathology originates from the Kidney. Both Kidney and Gallbladder Qi are cold and deficient, allowing Yin Qi to wander below the heart and epigastrium. Once Yin Qi is abundant in the middle epigastrium, the channels responsible for distributing fluids, generating Ying and Wei, and irrigating the four extremities become blocked by closed orifices and barriers. Blockage occurs due to the absence of Yang. Blockage leads to the wasting of the limbs. This condition resembles single-abdominal distension with emaciated limbs.
When One Yin and One Yang pulses show Dai Jue (intermittent cessation), Yin Qi reaches the Heart, moving up and down irregularly, entering and exiting unknowingly, accompanied by dryness of the throat and tongue. The pathology lies in Spleen Earth. The Yin of One Yin is the Yin of the new moon (beginning of Yin generation); the Yang of One Yang is the Yang of continuous generation. If both pulses show Dai Jue, it means Yin is not the root of Yang, and Yang is not generated by Yin. Both have failed in their duties. The wandering parts and independent messengers become rootless Yin Qi. Below the Heart, from Dan Zhong to San Jiao, are the positions where Shao Yang generates, rises, and circulates. Since the Sheng Qi of these two regions has lost its root, Yin Qi reaches the Heart with irregular movement and unknown entry/exit. The throat is the envoy of the Gallbladder, hence dryness. The harmonious nature of Spleen Earth also relies on the soothing and dispersing actions of the Gallbladder and Liver. If the pulses both show Dai Jue, it indicates that Dead Qi invades the Spleen. It can be known that the Middle Qi is discontinuous and the Central Earth is declining.
In the case of Two Yang and Three Yin concurrent disease, the Zhi Yin (Tai Yin) is diseased. Yin cannot exceed Yang, and Yang cannot restrain Yin. If Yin and Yang pulses both cease, a deep pulse indicates Blood Xi (abdominal mass), while a floating pulse indicates Nong Chuang (abscess). Two Yang and Three Yin originally refer to the Spleen and Stomach. However, mentioning "Zhi Yin" clarifies that these Three Yin belong to the Tai Yin Lung, hence they are discussed separately. Yang Ming resides within Two Yang, possessing strong Middle Jiao Qi. Tai Yin Spleen often transports Qi among the Three Yin, while Yang Ming can naturally reach Qi to the Three Yang. Thus, Hand Tai Yin Lung often regulates the balance between them. Therefore, Yin and Yang are harmonious: Yang initiates and Yin follows; Yin guards within Yang; Yang directs and Yin serves. Now, if Two Yang and the Zhi Yin of Three Yin are all diseased, their pathological Qi manifests in the pulses. The image is Yang floating but unable to sink, and Yin sinking but unable to float. Thus, Yin cannot exceed Yang, nor can Yang restrain Yin. This is the separation and extinction of Yin and Yang. In such cases, what sinks internally involves Yin-Cold pathology, with blood coagulating to form Xi masses. What floats externally involves Yang-Toxin pathology, with congestion and swelling forming abscesses. Old texts read "deep indicates abscess, floating indicates blood mass," which was corrected by Wu Hegao.
Note: The Nei Jing does not explicitly use the term "Bing Bing" (Concurrent Disease). However, when Yin and Yang are disharmonious and conflicting forces meet, they inevitably battle. Victory or defeat determines where the pathology settles—either归于 the victor or the vanquished. There must be a dominant factor. It is fundamentally different from He Bing (Combined Disease). Thus, it is mentioned separately. This is an example of the Nei Jing using one instance to illustrate others. Such contradictions of Yin and Yang, and the mutual overcoming of Zang-Fu organs, must be clearly distinguished.