经义
诸风掉眩，皆属于肝，诸寒收引，皆属于肾，诸气 郁，皆属于肺；诸湿肿满，皆属于脾；诸热瞀 ，
皆属于火；诸痛痒疮，皆属于心；诸厥固泄，皆属于下；诸痿喘呕，皆属于上；诸禁鼓栗，如丧神守，皆属于
火；诸痉项强，皆属于湿；诸逆冲上，皆属于火；诸胀腹大，皆属于热；诸躁狂越，皆属于火；诸暴强直，
皆属于风；诸病有声，鼓之如鼓，皆属于热；诸病 肿，疼酸惊骇，皆属于火；诸转反戾，水液混浊，皆属于
热；诸病水液，澄澈清冷，皆属于寒；诸呕吐酸，暴注下迫，皆属于热。○脉盛，皮热，腹胀，前后不通，闷瞀，
此谓五实；脉细，皮寒，气少，泄利前后，饮食不入，此谓五虚。浆粥入胃，泄注止，则虚者活；身汗，得后
利，则实者活。○神有余则笑不休，不足则悲。○气有余则喘咳上气，不足则息利少气。○血有余则怒，不足
则恐。○形有余则腹胀，泾溲不利，不足则四肢不用。○志有余则腹胀
飧泄，不足则厥。○怒则气上，喜则气缓，悲则气消，恐则气下，寒则气收，炅则气泄，惊则气乱，劳则气耗，
思则气结，九气不同，百病之生。○阳虚则外寒，阴虚则内热，阳盛则外热，阴盛则内寒。（《素问》）
入国问俗，入家问讳，上堂问礼，临病患问所便。○何谓五夺？形肉已夺，是一夺也；大夺血之后，是
二夺也；大汗出之后，是三夺也；大泄之后，是四夺也；新产及大血之后，是五夺也。○何谓五逆？热病脉静，
汗已出，脉盛躁，是一逆也；病泄脉洪大，是二逆也；着痹不移， 破身热，脉偏绝，是三逆也；淫而夺形，
身热，色夭然白，及后下血 ，是四逆也；寒热夺形，脉坚搏，是五逆也。（《灵枢》）
疾医掌养万民之疾病，四时皆有疠疾∶春时有 首疾，夏时有痒疥疾，秋时有疟寒疾，冬时有嗽上气疾。
（《周礼》）
从后来者为虚邪，从前来者为实邪，从所不胜来者为贼邪，从所胜来者为微邪，自病为正邪。（《难经》）
哲言
千般灾难，不越三条∶一者经络受邪，入脏腑，为内因也；二者四肢九窍血脉相传，壅塞不通，为外皮肤
所中也；三者房室金刃虫兽所伤也。○师持脉，病患欠者，无病也；脉之呻者，痛也；言迟者，风也；摇头者，
里痛也；行迟者，表强也；坐而伏者，短气也；坐而下一脚者，腰痛也；里实护腹如怀卵者，心痛也。（张仲景）
医之审病，如吏之审案，望闻即两造具备，察言观色之时，问而笔之，供词也，切则考鞫亲切而论治，
为判断发落矣。（韩飞霞）
疗病先察病机，五脏未虚，六腑未竭，血脉未乱，精神未散，
服药必活。若病已成，可得半愈。病势已剧，命将难存。（《汤液本草》）
极闸人定议病式∶某年、某月、某地、某人。年纪若干，形之肥瘦长短若何？色之黑、白、枯润若何？声
之清浊、长、短若何？人之形志苦乐若何？病始何日？初服何药？次后再服何药？某药稍效？某药不效？时下
昼夜孰重？寒热孰多？饮食喜恶多寡？二便滑涩有无？脉之三部九候，何候独异？二十四脉中，何脉独见？何
脉兼见？其证或内伤，或外感，或兼内外，或不内外，根据经断为何病？其标本先后何在？汗、吐、下、和、寒、
温、补、泻何施？其药宜用七方中何方？十剂中何剂？五气中何气？五味中何味？以何汤名为加减和合？其
效验定于何时？一一详明，务令纤毫不爽，起众信从，允为医门矜式，不必演文可也。（《寓意草》）
一问寒热二问汗，三问头身四问便，五问饮食六问胸，七聋八渴须当辨，九因脉证察阴阳，十从气味神章
见，定见虽然事不难，也须明哲毋招怨。○六变者，表、里、寒、热、虚、实也。明此六者，万病皆指诸掌矣。
以表言之，则风、寒、暑、湿、燥、火感于外者是也；以里言之，则七情、劳欲、饮食伤于内者是也。寒者阴
之类，或为内寒，或为外寒，寒者多虚；热者阳之类，或为内热，或为外热，热者多实。虚者正气不足也，内
出之病多不足；实者邪气有余也，外入之病多有余。○湿从阴者为寒湿，湿从阳者为湿热。燥从阳者因于火，
燥从阴者因于寒。热则伤阴，必连于脏；寒则伤阳，必连于经。（《景岳全书》）
《释经》说∶地、水、火、风和合成人。凡人火气不调，举身蒸热；风气不调，全身强直，诸毛孔闭塞；
水气不调，身体浮肿，气满喘粗；土气不调，四肢不举，言无音声。火去则身冷，风去则气绝，水竭则无血，
土散则身裂。（《千金方》）
病认不真，则静坐思之，总于望、闻、问、切四者中搜求病
机，必有得心之处，胸中了了，用药方灵。若终于疑惑，而勉强投方，窃恐误人性命。○外感、内伤，为证治
两大关键。然去其所本无，复其所固有，两言可尽之也。盖六淫外袭，身中气血，日失和平，一切外感有余之
证，有须汗、吐、下、和之治，皆是去其所本无也。若七情受伤，腑脏有损，身中气血，日就亏耗，一切内伤
不足之证，有须滋填补之治，皆是复其所固有也。（《吴医汇讲》）
内伤发热，时热时止；外感发热，热盛无休。内伤则手心热，外感则手背热。内伤则饮食无味，外感则
鼻塞不通。内伤恶寒，得暖便解；外感恶寒，絮火不除。内伤头痛，乍痛乍歇；外感头痛，连痛无停。内伤恶
风，不恶甚风，反恶隙风；外感恶风，见风便恶。内伤有湿，或不作渴，或心火乘肺，亦作燥渴；外感须二、
三日外，表热传里，口方作渴。内伤则热伤气，四肢沉困无力，倦怠嗜卧；外感则风伤筋，寒伤骨，一身筋骨
疼痛。内伤则短气不足以息，外感则喘壅气盛有余。内伤则气口脉盛，多属不足，宜温、宜补、宜和；外感则
人迎脉盛，多属有余，宜汗、宜吐、宜下。○百病昼则增剧，夜则安静，是阳有余，乃气病而血不病也；夜则增
剧，昼则安静，是阴有余，乃血病而气不病也。昼则发热，夜则安静，是阳气自旺于阳分也；昼则安静，夜则
发热，是阳气下陷入阴中也；昼则发热烦躁，夜亦发热烦躁，是重阳无阴，当亟泻其阳，峻补其阴。夜则恶寒，
昼则安静，是阴血自旺于阴分也；夜则安静，昼则恶寒，是阴气上溢于阳中也；夜则恶寒，昼亦恶寒，是重阴
无阳，当急泻其阴，峻补其阳。昼则恶寒，夜则烦躁，饮食不入，名曰阴阳交错者死。○凡病阴证，则身静重，
语无声，气难布息，目睛不了了，呼吸往来不利，口鼻气息皆冷，水浆不入，二便不禁，面上恶寒有如刀刮；
阳证，则身动轻，语有声，目睛了了，呼吸能往能来，口鼻气息皆热。（李东垣）
凡病开目喜见人者属阳也，闭目不欲见人者属阴也。多睡者阳虚阴盛也，无睡者阴虚阳盛也。喜明者属阳，
元气实也；喜暗者属阴，元气虚也。睡向壁者属阴，元气虚也；睡向外者属阳，元气实也。（《万病回春》）
大寒而甚，热之不热，是无火也；热来复去，昼见夜伏，夜发昼止，时节而动，是无火也。大热而甚，寒
之不寒，是无水也；热动复止， 忽往来，时动时止，是无水也。内格呕逆，食不得入，是有火也；病呕而吐，
食入反出，是无火也。暴注下迫，食不及化，是无水也；溏泄而久，止发无恒，是无火也。故心盛则生热，肾
盛则生寒；肾虚则寒动于中，心虚则热收于内。（王太仆）
既有真阴、真阳，何谓假阴、假阳？如大热发躁，口渴舌燥，非阳证乎？视其人面色浮赤，切其脉尺弱
无力，寸关豁大无伦，此系阴盛于下，逼阳于上，假阳之证也。治以假寒之药，从其性而折之，顷刻平矣。如
恶寒不离复衣，手足厥冷，非阴证乎？视其人面色沉滞，切其脉涩，按之细数有力，此系假寒之证，寒在皮肤，
热在骨髓也。治以辛凉之剂，温而行之，一汗愈矣。凡此皆因真气不固，故假者得以乱其真。假阳者，不足而
示之有余；假阴者，有余而示之不足。既已识其假矣，而无术以投其所欲，彼亦扦格不入。《经》曰∶必伏其
所主，而先其所因，其始则同，其终则异，可使去邪而归于正矣，○东垣以手扪热，有三法∶轻手扪之则热，重
手按之则不热，是热在皮毛血脉也；重按筋骨之间则热，轻手扪之则不热，是热在骨髓也；轻手扪之则不热，
重手按之亦不热，不轻不重按之而热者，是热在筋骨之上皮毛血肉之下，肌肉之间，正内伤劳倦之热也。余于
内伤真阴者，以手扪热，亦有二法，扪之烙手，骨中如炙者，肾中之真阴虚也；扪之烙手，按之筋骨之下，反
觉寒者，肾中之真阳虚也。（赵氏《医贯》）
直中阴证，大势阴盛阳虚；传经阳证，大势阳盛阴虚；疟证，大势阴阳更盛更虚；内伤证，大势阴阳
偏盛偏虚，不可同语。（喻嘉言）
《经》云∶阴虚出盗汗。阴，言手太阴也；虚言肺气虚也。又云∶阴虚发夜热。阴，言足太阴也；虚，
言脾气虚也。同曰阴虚，而其中有手足太阴之分，虽名曰阴虚，而实是脾肺气虚之证。无如历代医师，从未注
明其义，误以脾肺气虚，认为肾水不足，而用滋阴降火之剂，朝夕重阴下逼，逼至土困金败，便溏、声嘶，置
之死地而不悟者，只此两个阴字。拘文牵义，以讹传讹，自古迄今，普天之大，不知日杀凡几，良堪痛哉！（杨乘六）
面赤一证，劳损颧红，发于午后者，阴虚也；格杨浮赤，厥利脉微者，阳虚也。赤色深重，潮热便硬者，
里实也；赤色浅淡，恶寒无汗者，表实也。（《医宗金鉴》）
阴虚足冷，面必燥热，手必蒸烦，脉必涩数，盖火炎于上而不归经故也。若略取一静，火得归经，而即凉
矣。阳虚足冷，虽以烈火御之，犹不止也。火虚之病，身多恶寒，亦有发热者，其热或夜作昼止，或昼热夜无，
时节而动身。然虽发热，而手足必冷，脉必微弱，或沉而无力为别也。（罗赤诚）
凡人素有病，若劳碌动作，反觉精神强健者，此乃阴火沸腾，扶助于内，不觉元气之不足也；若静养调适，
反觉神倦气弱者，此阴火退，阳气复，本相露故也。○内伤清阳下陷，阴火上升，若用寒药，阳愈陷，火愈炽，
火寻窍出。虚者受之，或目痛，或耳聋，或齿痛，从其虚而散也。（周慎斋）
病从孔窍入，亦从孔窍出。汗之，下之，利之，吐之，因其势而导之之法也。其有不从二阴、汗孔及口出
者，或红汗而愈，或喷嚏而愈，或鼻生疮而愈，此邪之从鼻出者也。从目出者，目肿而愈；从耳出者，耳聋而
愈。此邪之自觅门径以退者也。清阳出上窍，浊阴出下窍，得真气为之驱逐，其病退也不难矣。○气血在人身
无处不到，然其常流走者，惟经络 谷皆浸灌而盈者也。流走者，邪不能侵，侵则实时驱逐，易病而易愈也；
浸灌之处，邪气能伏，非积久莫能为害，非为害亦莫能自觉，故其驱逐也较难。若疫邪之伏于膜
原，疟邪之中于风府，痈疽之逆于肉理，其类不一，非溃堤决防，莫之能出，何从得其未病而治之乎？其他痼
疾沉 ，指不胜屈，非发时莫之能治，治亦未必能断根，医者当识。○人身筋骨肌肉空处，无往而非血气。行则
血走其空，故筋骨实而肌肉荣，经络相为流通，血气各得其平， 谷自无所欠缺；血一留滞，则中有瘀处，上流
阻而下流虚，内伤诸证，由此生焉。丹溪以为百病本于痰，因此省悟其源自瘀血起也。予故谓内伤之病，皆由
于瘀血。○大病瘥后，肌肉浮肿，无他痛楚，谓之气复，乃气到血不到，阳速而阴迟故也。不必施治，俟血渐
生，而肿自已。非有喘咳、腹满、尿涩诸证，未可妄作水治。○病盛脉盛者，可攻而愈；病衰脉衰者，可调而愈；
病衰脉盛者，可养而愈；病盛脉衰者，治亦难愈。○死于实，由闭塞；死于虚，由亏损。营卫不行，九窍不通者，闭
塞死也。皮、肉、脉、筋、骨皆无所伤，惟是气血郁结焉。汗不出，则腠理闭塞；二便阻，则水谷闭塞；息不
利，则清窍闭塞。汗之、下之、吐之，皆所以通闭塞也。大骨枯槁，大肉陷下者，亏损死也。皮、肉、脉、筋、
骨皆已受伤，渐至气血竭尽则死矣。○实死急，虚死缓，实死之状恶，虚死之状善；实死者形不脱，虚死者形脱；
实死者多由医误，虚死者多由自戕。知其所以死之故，则知所以起死之诀也。（《医参》）
《经》曰∶五实死，五虚死。夫五实谓五脏俱太过，五虚谓五脏俱不及。言此二证皆死，非谓必死也，
谓不救则死，救之不得其道亦死也。其下复言∶浆粥入胃，则虚者活；身汗后利，则实者活。此两条是前二证
之治法，后人不知，只作辨验生死之断句，直谓病患有此则生，无此则死，虚者听其浆粥自入，实者听其自汗
自利，委之死地，岂不谬哉！夫浆粥入胃而不注泄，则胃气和，胃气和则五虚皆实，是以生也；汗以泄其表，
利以泄其里，并泄则上下通，上下通则五实皆启，是以生也。（《儒门事亲》）
《经》曰∶邪之所凑，其气必虚。又曰∶不治其虚，安问其
[Original Scriptural Meaning]
Various wind diseases causing tremors and dizziness all belong to the Liver; various cold pathogens causing contraction and pulling of tendons all belong to the Kidney; various Qi stagnations and depressions all belong to the Lung; various dampness pathogens causing edema and abdominal fullness all belong to the Spleen; various heat diseases causing mental confusion all belong to Fire (one of the Six Excesses, referring to pathogenic Heat); various pains, itching, and sores all belong to the Heart; various Jue (reversal) conditions, constipation or incontinence all belong to the Lower Jiao (Kidneys, Bladder, etc.); various Wei (wasting) syndromes, asthma, and vomiting all belong to the Upper Jiao (Heart, Lungs, etc.); various cases of mouth closure, chattering teeth, and shivering, as if losing spiritual control, all belong to Fire; various spasms and neck stiffness all belong to Dampness; various rebellious Qi rushing upward all belong to Fire; various abdominal distensions and enlargements all belong to Heat; various restlessness, mania, and transgression of normal behavior all belong to Fire; various sudden occurrences of rigidity and straightening all belong to Wind; various internal sounds, where percussion of the abdomen produces a drum-like sound, all belong to Heat; various swellings, painful soreness, and fright/allure all belong to Fire; various body twisting and turning, with turbid urine, all belong to Heat; various excretions that are clear, transparent, and cold all belong to Cold; various vomiting of sour fluid, sudden violent diarrhea with tenesmus, all belong to Heat.
○ A surging pulse, hot skin, abdominal fullness, obstruction of urination and defecation, and mental oppression/confusion constitute the "Five Excess" (Wu Shi) syndrome; a fine/thin pulse, cold skin, shortness of breath, incontinence of urine and stool, and inability to eat constitute the "Five Deficiency" (Wu Xu) syndrome. If gruel enters the stomach and diarrhea stops, the deficiency patient may survive; if the body sweats and urination/defecation become unobstructed, the excess patient may survive.
○ Excess of Shen (Spirit) leads to incessant laughter; deficiency of Shen leads to sorrow.
○ Excess of Lung Qi leads to asthma, cough, and rebellious Qi; deficiency of Lung Qi leads to free breathing but weak Qi.
○ Excess of Liver Blood leads to anger; deficiency of Liver Blood leads to fear.
○ Excess of Form (Spleen/Stomach) leads to abdominal fullness and difficult urination/defecation; deficiency of Form leads to inability to use the four limbs.
○ Excess of Zhi (Will/Kidney) leads to abdominal fullness and undigested diarrhea; deficiency of Zhi leads to cold extremities.
○ Anger causes Qi to move upward; Joy causes Qi to relax; Grief causes Qi to dissipate; Fear causes Qi to sink; Cold causes Qi to contract; Heat causes Qi to leak; Fright causes Qi to become chaotic; Labor causes Qi to be consumed; Thought causes Qi to knot. These nine variations of Qi differ, yet they are the origins of hundred diseases.
○ Yang deficiency leads to external cold; Yin deficiency leads to internal heat; Yang excess leads to external heat; Yin excess leads to internal cold. (From *Su Wen*)
When entering a country, ask about its customs; when entering a home, ask about its taboos; when ascending the hall, ask about its etiquette; when facing a patient, ask about their comfort/preferences.
○ What are the "Five Deprivations" (Wu Duo - five states of extreme depletion)? When flesh and muscle are already depleted, this is the first deprivation; after massive blood loss, this is the second; after profuse sweating, this is the third; after severe diarrhea, this is the fourth; after recent childbirth or massive hemorrhage, this is the fifth.
○ What are the "Five Rebellions" (Wu Ni - five critical signs indicating poor prognosis)? In a heat disease, a quiet pulse indicates the first rebellion; after sweating, a surging and restless pulse indicates the second rebellion; in Bi syndrome (painful obstruction) that is fixed, with ulcerated skin, fever, and an absent pulse on one side, this is the third rebellion; due to excessive sexual activity leading to emaciation, with fever, sallow complexion, and hematochezia, this is the fourth rebellion; in alternating cold and heat leading to emaciation, with a firm and pounding pulse, this is the fifth rebellion. (From *Ling Shu*)
Physicians of Disease manage the illnesses of the people; there are pestilential diseases in all four seasons: head/facial diseases in Spring, itchy scabies in Summer, malaria/cold-heat alternation in Autumn, and cough/rebellious Qi diseases in Winter. (From *Zhou Li*)
Coming from what does not overcome me is False Evil (Xu Xie); coming from what I overcome is Minor Evil (Wei Xie); self-disease is True Evil (Zheng Xie); coming from what overcomes me is Thief Evil (Ze Xie); coming from what I generate is Empty Evil (Shi Xie). (From *Nan Jing*)
[Philosophical Sayings]
A thousand disasters do not exceed three categories: First, meridians receive evil, which enters the Zang-Fu organs, constituting an internal cause; Second, limbs and nine orifices transmit evil through blood vessels, causing blockage, constituting an external attack on the skin; Third, injuries from intercourse, metal/blades, insects, or beasts. (Zhang Zhongjing)
A physician examining a disease is like an official examining a case. Observation and listening prepare the evidence (plaintiff and defendant); questioning and recording constitute the confession; palpation is the intimate interrogation and treatment discussion, leading to judgment and execution. (Han Feixia)
Treating disease requires first examining the pathogenesis. If the Five Zang are not deficient, the Six Fu are not exhausted, blood vessels are not chaotic, and spirit has not scattered, medication will surely cure. If the disease has already formed, half recovery is possible. If the disease momentum is severe, life will be hard to preserve. (*Tang Ye Ben Cao*)
Jizha Ren established a format for discussing illness: Year, month, place, person. Age? Body fat/thin/long/short? Complexion dark/light/dry/moist? Voice clear/turbid/long/short? Physical and mental suffering/joy? Onset date? Initial medication? Subsequent medications? Which medication had slight effect? Which had no effect? Which time of day/night is worse? More cold or heat? Dietary preferences and quantity? Slippery/roughness of urination/defecation? Pulse at Three Parts and Nine Positions, which position is unique? Among twenty-four pulses, which appears alone? Which appears combined? Is the syndrome internal injury, external contraction, both, or neither? Based on classics, what is the disease? Where are the root and branch, priority and sequence? Which method applies: sweating, vomiting, purging, harmonizing, cooling, warming, tonifying, draining? Which of the Seven Formulas? Which of the Ten Categories? Which of the Five Qi? Which of the Five Flavors? Which decoction name for modification? When will efficacy be determined? Detail everything clearly, ensuring no error, to gain public trust, serving as a model for physicians, without need for literary flourish. (*Yu Yi Cao*)
First ask about cold and heat, second about sweating, third about head and body, fourth about urination and defecation, fifth about diet, sixth about chest, seventh about deafness, eighth about thirst—these must be distinguished. Ninth, observe Yin and Yang via pulse and symptoms; Tenth, discern spirit via smell and taste. Although clear judgment makes matters easy, one must be wise to avoid resentment. ○ The Six Changes are Exterior, Interior, Cold, Heat, Deficiency, and Excess. Understanding these six places all diseases in the palm. From the Exterior perspective, it is Wind, Cold, Summerheat, Dampness, Dryness, and Fire affecting the outside; from the Interior perspective, it is Seven Emotions, labor/desire, and diet damaging the inside. Cold belongs to Yin, either internal or external, mostly Deficiency; Heat belongs to Yang, either internal or external, mostly Excess. Deficiency is lack of Righteous Qi, diseases arising internally are mostly deficiency; Excess is surplus of Pathogenic Qi, diseases entering externally are mostly excess. ○ Dampness following Yin becomes Cold-Damp; Dampness following Yang becomes Damp-Heat. Dryness following Yang is due to Fire; Dryness following Yin is due to Cold. Heat injures Yin, connecting to Zang organs; Cold injures Yang, connecting to Meridians. (*Jing Yue Quan Shu*)
*Shi Jing* states: Earth, Water, Fire, and Wind combine to form humans. If Fire Qi is disordered, the whole body steams with heat; if Wind Qi is disordered, the whole body becomes rigid with closed pores; if Water Qi is disordered, the body swells with fullness and rough breathing; if Earth Qi is disordered, the four limbs cannot move and speech is lost. Loss of Fire leads to cold body; loss of Wind leads to cessation of Qi; exhaustion of Water leads to lack of Blood; scattering of Earth leads to cracking of the body. (*Qian Jin Fang*)
If the disease is not recognized accurately, sit quietly and reflect, searching for the pathogenesis among Observation, Listening/Smelling, Inquiry, and Palpation. There must be a point of understanding; only when the mind is clear can medication be effective. If doubt persists and prescription is forced, it may cost lives. ○ External contraction and Internal injury are the two key aspects of syndrome differentiation and treatment. However, removing what is originally absent (pathogen) and restoring what is originally present (Righteous Qi) can summarize them. When Six Excesses invade externally, the body's Qi and Blood lose peace daily; all external excess syndromes require sweating, vomiting, purging, or harmonizing methods, which remove what is originally absent. If Seven Emotions injure, Zang-Fu are damaged, and Qi/Blood deplete daily; all internal deficiency syndromes require nourishing and filling treatments, which restore what is originally present. (*Wu Yi Hui Jiang*)
Internal injury fever comes and goes; external contraction fever is intense and continuous. Internal injury causes hot palms; external contraction causes hot backs of hands. Internal injury causes loss of taste; external contraction causes nasal congestion. Internal injury aversion to cold resolves with warmth; external contraction aversion to cold persists despite fire. Internal injury headache is intermittent; external contraction headache is continuous. Internal injury aversion to wind is mild, fearing drafts; external contraction aversion to wind is severe, fearing any wind. Internal injury with dampness may have no thirst, or heart-fire attacking lungs causes dry thirst; external contraction requires 2-3 days for exterior heat to transmit inward before thirst occurs. Internal injury damages Qi, causing heavy/weak limbs and lethargy; external contraction damages sinews/bones with wind/cold, causing whole-body pain. Internal injury causes shortness of breath; external contraction causes asthmatic fullness and abundant Qi. Internal injury shows surging Qi Kou pulse, mostly deficiency, suitable for warming/tonifying/harmonizing; external contraction shows surging Ren Ying pulse, mostly excess, suitable for sweating/vomiting/purging. ○ Hundred diseases worsening by day and quiet by night indicate Yang excess, Qi disease not Blood; worsening by night and quiet by day indicate Yin excess, Blood disease not Qi. Fever by day, quiet by night indicates Yang flourishing in Yang divisions; quiet by day, fever by night indicates Yang sinking into Yin; fever/restlessness by day and night indicates Double Yang without Yin, requiring urgent draining of Yang and strong tonification of Yin. Chills by night, quiet by day indicates Yin-Blood flourishing in Yin divisions; quiet by night, chills by day indicates Yin Qi overflowing to Yang; chills by day and night indicate Double Yin without Yang, requiring urgent draining of Yin and strong tonification of Yang. Chills by day, restlessness by night, inability to eat is named "Yin-Yang Intercourse," fatal. ○ Yin syndromes feature still/heavy body, silent speech, difficult breathing, unclear vision, irregular respiration, cold breath/nose, inability to drink/eat, incontinence, and facial chills like knife scraping; Yang syndromes feature active/light body, audible speech, clear vision, regular respiration, and hot breath/nose. (Li Dongyuan)
Opening eyes and preferring to see people indicates Yang; closing eyes and avoiding people indicates Yin. Sleeping much indicates Yang deficiency and Yin excess; sleeping little indicates Yin deficiency and Yang excess. Preferring light indicates Yang and solid Yuan Qi; preferring darkness indicates Yin and deficient Yuan Qi. Sleeping facing the wall indicates Yin and deficient Yuan Qi; sleeping facing outward indicates Yang and solid Yuan Qi. (*Wan Bing Hui Chun*)
Severe cold unresponsive to heat therapy indicates No Fire (Mingmen Fire Decline); heat coming and going, appearing by day/sleeping by night, occurring seasonally, indicates No Fire. Severe heat unresponsive to cold therapy indicates No Water (Kidney Yin Deficiency); heat moving and stopping, fluctuating, indicates No Water. Internal rejection with vomiting/inability to eat indicates Fire; vomiting/spitting up food after eating indicates No Fire. Sudden violent diarrhea with undigested food indicates No Water; chronic loose stools with irregular onset/cessation indicates No Fire. Thus, Heart excess generates heat; Kidney excess generates cold; Kidney deficiency causes internal cold movement; Heart deficiency causes internal heat retention. (Wang Bing)
Since there are True Yin and True Yang, why are there Fake Yin and Fake Yang? For example, severe heat, agitation, thirst, and dry tongue seem like Yang syndrome? But if the face is floating red, and the Chi pulse is weak/powerless while Cun/Guan are vast/rare, this is Yin excess below forcing Yang above, a Fake Yang syndrome. Treat with fake-cold medicine, following its nature to subdue it, and it calms instantly. For example, aversion to cold requiring layers of clothing, cold extremities seems like Yin syndrome? But if the face is dull/stagnant, pulse is choppy, and pressing reveals fine/rapid/forceful qualities, this is a Fake Cold syndrome, cold in skin, heat in marrow. Treat with acrid-cool agents, warming and administering, and one sweat cures it. All these occur because True Qi is not secure, allowing falsity to confuse truth. Fake Yang shows excess where there is deficiency; Fake Yin shows deficiency where there is excess. Once falsity is identified, but the treatment does not match its desire, resistance occurs. *Classic* says: Subdue the master, address the cause first; initially same, finally different, thus expelling evil and returning to righteousness. ○ Dongyuan used hand palpation for heat in three ways: Light touch yields heat, heavy press yields no heat → heat in skin/blood vessels; Heavy press between sinew/bone yields heat, light touch yields no heat → heat in marrow; Light touch yields no heat, heavy press yields no heat, medium touch yields heat → heat in muscles between sinew/bone and skin/flesh, precisely internal injury/labor fatigue heat. Regarding internal injury True Yin, I use two methods: Touch burns hand, bone feels roasted → True Yin deficiency in Kidney; Touch burns hand, pressing below sinew/bone feels cold → True Yang deficiency in Kidney. (Zhao Xianke *Yi Guan*)
Direct entry into Yin syndrome features Yin excess/Yang deficiency; transmitted Yang syndrome features Yang excess/Yin deficiency; Malaria features alternating Yin/Yang excess/deficiency; Internal injury features biased Yin/Yang excess/deficiency; they cannot be discussed together. (Yu Jiayan)
*Classic* says: Yin deficiency causes night sweating. "Yin" refers to Hand Taiyin; "Deficiency" refers to Lung Qi deficiency. Also: Yin deficiency causes night fever. "Yin" refers to Foot Taiyin; "Deficiency" refers to Spleen Qi deficiency. Both called Yin deficiency, but distinguish Hand/Foot Taiyin. Though named Yin deficiency, it is actually Spleen/Lung Qi deficiency. Yet历代 physicians never clarified this, mistakenly treating Spleen/Lung Qi deficiency as Kidney Water insufficiency, using Yin-nourishing/Fire-descending formulas. Day and night heavy Yin presses down, until Earth is trapped and Metal fails, causing loose stools and hoarseness, placing them in death without realization. Only these two characters "Yin" cause this. Rigid interpretation spreads error; since ancient times, countless die daily. Truly painful! (Yang Chengliu)
Red face: Labored damage malar flush appearing after noon is Yin deficiency; Floating red face with Jue/cold limbs and faint pulse is Yang deficiency. Deep red color with tidal fever and hard stool is Interior Excess; Pale red color with aversion to cold and no sweat is Exterior Excess. (*Yi Zong Jin Jian*)
Yin deficiency with cold feet必然 presents with dry/hot face, steaming/annoyed hands, and choppy/rapid pulse, because Fire flares upward and does not return to its channel. If slightly calm, Fire returns to channel and cools immediately. Yang deficiency with cold feet remains cold even against fierce fire. Fire deficiency disease features mostly aversion to cold, sometimes fever; fever may occur at night/stop by day, or day/night, occurring seasonally. Though feverish, hands/feet are cold, pulse is weak/faint or deep/powerless for distinction. (Luo Chicheng)
People with chronic illness who feel energetic after labor/exertion experience boiling Yin Fire assisting internally, unaware of Yuan Qi deficiency; those resting/calming feel tired/weak because Yin Fire retreats, Yang Qi recovers, revealing true state. ○ Internal injury with sinking of Clear Yang and rising of Yin Fire: if cold herbs are used, Yang sinks further, Fire blazes, seeking orifices to exit. Deficient areas receive it, causing eye pain, deafness, or toothache, dispersing according to deficiency. (Zhou Shenzhai)
Disease enters through orifices and exits through orifices. Sweating, purging, promoting urination, vomiting are methods guiding according to momentum. Some do not exit via lower orifices, sweat pores, or mouth; some recover via red sweat, sneezing, or nasal sores (evil exiting nose); some via swollen eyes or deaf ears (evil exiting eyes/ears). This is evil seeking its own path to retreat. Clear Yang exits upper orifices, Turbid Yin exits lower orifices; driven by True Qi, disease retreatal is not difficult. ○ Qi and Blood reach everywhere, but normally flow through meridians and溪谷 (valleys/grooves), irrigating and filling them. Flowing parts: evil cannot invade; if invaded, expelled immediately, easy to get sick and recover. Irrigated parts: evil can hide, causing harm only after accumulation, often unnoticed, making expulsion harder. If epidemic evil hides in Mo Yuan, Malaria evil strikes Fengfu, Carbuncles/ulcers reverse in flesh texture, types vary. Without breaking dams, they cannot exit; how to treat before sickness? Other chronic/deep diseases are numerous, untreatable except during flare-ups, and未必 curative. Physicians must know. ○ Hollows of sinew/bone/muscle are filled with Qi/Blood. Movement allows blood to flow through hollows, making sinew/bone solid and muscle lush, meridians circulating, Qi/Blood balanced,溪谷 sufficient. If blood stagnates, stasis forms, upper flow blocked, lower flow empty, generating internal injury syndromes. Danxi believed hundred diseases originate from Phlegm; I realize origin is Blood Stasis. Thus I say internal injury diseases all stem from Blood Stasis. ○ After major illness remission, muscle edema without other pain is called Qi Recovery, meaning Qi arrives but Blood lags, Yang fast/Yin slow. No treatment needed; wait for Blood generation, swelling subsides. Unless asthma/cough, abdominal fullness, or dysuria exist, do not wrongly treat as water retention. ○ Disease surging with surging pulse: attackable to cure; Disease fading with fading pulse: adjustable to cure; Disease fading with surging pulse: nourishable to cure; Disease surging with fading pulse: hard to cure. ○ Death from Excess is due to blockage; death from Deficiency is due to depletion. Non-functioning Ying/Wei, blocked nine orifices is blockage death. Skin/flesh/vessel/sinew/bone uninjured, only Qi/Blood knotted. No sweat → pore blockage; blocked urination/defecation → grain/water blockage; irregular breathing → clear orifice blockage. Sweating/purging/vomiting all open blockages. Withered big bones, sunken big flesh is depletion death. Skin/flesh/vessel/sinew/bone injured, gradually exhausting Qi/Blood leads to death. ○ Excess death is rapid, appearance ugly, body intact; Deficiency death is slow, appearance peaceful, body wasted. Excess death often due to medical error; Deficiency death often due to self-harm. Knowing the cause of death reveals the secret to reviving the dead. (*Yi Can*)
*Classic* says: Five Excess dies, Five Deficiency dies. Five Excess means Five Zang all excessive; Five Deficiency means Five Zang all deficient. Saying these two syndromes die does not mean inevitable death, but death if not saved, or saved incorrectly. Below it says: Gruel enters stomach → deficiency lives; Sweat then unobstructed defecation → excess lives. These two lines are treatments for previous syndromes. Later generations didn't know, treating them as diagnostic sentences for life/death, saying patients live if they have these, die if not, letting deficiency patients eat freely and excess patients sweat/poop freely, abandoning them to death. How absurd! If gruel enters stomach without diarrhea, Stomach Qi harmonizes; harmonized Stomach Qi makes Five Deficiencies Excess, thus living. Sweating drains Exterior, unblocking drains Interior; simultaneous drainage opens Upper/Lower; opened Upper/Lower啟 Five Excesses, thus living. (*Ru Men Shi Qin*)
*Classic* says: Where evil gathers, Qi must be deficient. Also: If not treating deficiency, how can one ask about...