恶寒喘咳。以脉推之。当浮大而涩。如中湿。乃肾邪乘心也。以液推之。当多汗。以病推之。当
身热而小腹痛。足胫寒逆。以脉推之。沉濡而大。若先有形寒饮冷。伤于肺者。则邪必乘肺矣。
如中风。肝邪乘肺也。以色推之。当白。以病推之。当喘咳。洒淅恶寒而胁痛。以脉推之。当涩
而浮大。如伤暑。心邪乘肺也。以臭推之。当腥臭。以病推之。当咳喘寒热而心烦。以脉推之。
当浮涩而大。如伤饮食劳倦。脾邪乘肺也。以味推之。当辛。以病推之。当洒淅寒热。体重嗜卧。
以脉推之。当涩而缓。如伤寒。肺邪自入肺也。以声推之。当哭。以病推之。当喘咳而恶寒。以脉
推之。当浮而涩。如中湿。肾邪乘肺也。以液推之。当涕。以病推之。当寒热。小腹痛。喘咳。而
足胫寒。以脉推之。当涩而沉。若先有恚怒气逆伤于肝者。则邪必乘肝矣。如中
风。肝邪自入肝也。以色推之。当青。以病推之。当往来寒热。胁下满痛。以脉推之。当弦急而
浮。如伤暑。心邪入肝也。以臭推之。当臊臭。以病推之。当胁下痛而心烦。身热。以脉推之。
当弦细而散。如伤饮食劳倦。脾邪乘肝也。以味推之。当酸。以病推之。当胁痛体重。四肢不收。
以脉推之。当弦而缓。如伤寒。肺邪乘肝也。以声推之。当呼。以病推之。当胁痛。寒热而喘
咳。以脉推之。当涩而弦。如中湿。肾邪乘肝也。以液推之。当泣。以病推之。当胁满痛而足胫
寒逆。以脉推之。当弦濡而沉。若先有饮食劳倦。伤于脾者。则邪必乘脾矣。如中风。肝邪乘脾
也。以色推之。当黄。以病推之。当体重而胁下痛。以脉推之。当缓而弦。如伤暑。心邪乘脾也
。以臭推之。当香臭。以病推之。当体重不收。烦热心痛。以脉推之。当缓而大。如伤饮食劳倦。
脾邪自入脾也。以味推之。当甘。以病推之。当体重嗜卧。四肢不收。以脉推之。当缓而滑。
如伤寒。肺邪乘脾也。以声推之。当歌。以病推之。当体重而洒淅寒热。以脉推之。当缓而涩。
如中湿。肾邪乘脾也。以液推之。当吐涎。以病推之。当体重而足胫寒逆。以脉推之。当缓而沉
濡。若先有久坐湿地。强力入房。伤于肾者。则邪必乘肾矣。如中风。肝邪乘肾也。以色推之。当
黑。以病推之。当小腹痛。足胫寒。胁下满痛。以脉推之。当沉而弦。如伤暑。心邪乘肾也。以臭
推之。当腐。以病推之。当小腹痛。足胫寒而身热。以脉推之。当沉而大。如伤饮食劳倦 。脾邪
乘肾也。以味推之。当咸。以病推之。当足胫寒。小腹痛而体重。以脉推之。当沉而缓。如伤寒
。肺邪乘肾也。以声推之。
当呻。以病推之。当小腹痛。足胫寒而喘咳。以脉推之。当沉而涩。如中湿。肾邪自入肾也。以
液推之。当唾多。以病推之。当小腹痛。足胫寒而逆。以脉推之。当沉而迟。此即五脏类推二十
五证之法也。而五腑之二十五证。当以首章之言脉微脉甚推之可也。至五十难复言虚实贼微正
五邪者。欲审其邪之所来。知其或生或克。可以辨七传间脏之理。而犹恐后人遗其腑。故又以五
十二难之腑病与脏病同法明之。以足首章脏腑十变之意也。至五十三难总结前五章五邪之精义。
而又贯通已病未病。用法施治之周。盖五邪之病。皆发于本原之虚。故其传变莫测。必察其邪之所
由来。而审其七传间脏之病。如间脏之传其所生。易愈而易治也。七传之传其所胜。难愈而难治
也。然治之之法。在兼顾其将传之脏。使其不至于七传而死。此大异于伤寒传经之法。故另列而
不混也。乃见越人立法济世。至深切矣。凡人之心肾二脏。最易受伤。而夏冬二气。又最易感病。
余特表而出之。以俟后之贤者。采择而裁政焉。如忧愁思虑伤于心者。富贵贫贱皆不能免。伤则
心火常动。火动必克于肺金。心不受外感之邪则已。若一受外感之邪。必传其所胜之肺矣。肺又
传于所胜之肝。肝又传于所胜之脾。脾又传于所胜之肾。肾又传于所胜之心。心又传于所胜之肺。
故云七传。然肺不能两次受伤。故死。此即一脏不再伤之义也。若其人平日素伤于心者。适犯暑
邪。必乘虚而入于心。心受邪。而病势必乘虚而入于肺。医能识此。即于清暑之中。兼保其肺。
如东垣之清
暑益气汤。虽治已病之心。而实兼治未病之肺也。孙真人之生脉散。是预防其邪。而专治未病之
剂也。至若暑邪太甚。类于伤寒者。人参败毒散。亦驱邪保正之剂。最宜者也。若专任苦寒。以
为清暑。此即中工之治已病耳。如久坐湿地。强力入房。而伤肾者。理更深微。盖肾有两脏。一水
一火。其伤有别。如久坐湿地而受病者。常人有之。富贵者少。然其所伤在右肾居多。何也。
湿就下而伤右肾之火。右肾之火。乃水中之火也。即坎中之真阳也。伏而不发。受邪则发矣。发
则便为邪火。邪火能撼动心君之火。而心亦受伤矣。故其人平日素伤于湿者。适犯暑邪。必乘虚而
入于右肾。右肾受邪。而病势必乘虚而传于心。其见证也。必现假热之象。或格阳而面赤者有之
。烦躁而舌黑者有之。神昏而目定者有之。医能识此。即于驱邪之中。兼扶其阳。如仲景麻黄
附子细辛汤。附子理中汤。虽治已病之右肾。而实兼扶未病之心阳也。金匮八味丸。是预防其邪
而专治未病之剂也。如强力入房而受病者。常人鲜有之。然其所伤在左肾居多。何也。精气泄而伤
于左肾之水。左肾真阴之脏也。精竭则阴亏。阴亏则血亏。心为离。而离中之真阴。血也。故阴
亏而血必枯。血枯则心亦受伤矣。若其人平日素伤于左肾者。适犯寒邪。必乘其虚而入于左肾。左肾
受邪。而病势必乘虚而传于心。其见证也。必现假寒之象。或格阴而面黑者有之。外寒而内燥者有之
。四逆而目赤者有之。医能识此。即于驱邪之中。兼救其离中之阴。如仲景之通脉四逆汤。犀角地
黄汤。人参白虎。黄
连阿胶汤之类。虽治已病之左肾。而实兼治未病之心也。六味地黄汤丸。龟鹿人参等胶。是预防
其邪。即所谓损其肾者益其精。亦专治未病之剂也。当此真假疑似之际。若非细心求脉。投药
一误。害如反掌。故云凭脉而不证书。可也。又如饮食劳倦伤脾者。饮食之伤。伤于胃而为实。
劳倦之伤。伤于脾而为虚。治实当兼顾膀胱。治虚当兼顾右肾。恚怒气逆伤肝者。治当兼顾其脾
。形寒饮冷伤肺者。治当兼顾其肝。以此研求类推。细心体会。庶不负越人之深意也。至于间脏
而传其子者。盖因所伤未甚。因其未甚。故平日未克其所胜之脏腑。其受邪而病。亦不传其所胜
之脏腑。而传其所生之脏腑也。余故曰。若腑病传其所胜。亦如脏病之难治也。于斯益明矣。
五十四难（误列五十二难）曰。腑脏发病。根本等不。然。不等也。其不等奈何。然。脏病
者。止而不移。其病不离其处。腑病者。仿佛贲响。上下行流。居处无常。故以此知脏腑根本不同也。
此问脏腑发病。根本等否者。乃言发积聚之源。以起下章之意也。根本者。积有根本也。不等者。聚
无根本也。止而不移。不离其处者。言积有根本。故不离而不移也。仿佛贲响。上下行流者。言
聚无根本。故贲响而行流也。
五十五难曰。病有积有聚。何以别之。然。积者阴气也。聚者阳气也。故阴沉而伏。阳浮而
动。气之
所积。名曰积。气之所聚。名曰聚。故积者。五脏所生。聚者。六腑所成。积者。阴气也。其始发有常处
其痛不离其部。上下有所终始。左右有所穷处。谓之积。聚者。阳气也。其始发无根本。上下无
所留止。其痛无常处。谓之聚。故以是别知积聚也。
此章言积聚之源。上下有所终始。左右有所穷处。此发明积有常处也。上下无所留止。其痛
无常处。此发明聚无根本也。经谓气之所积曰积。气之所聚曰聚。愚又补其意曰。兼乎血而阴
气凝积为积。纯乎气而阳气结聚为聚。
（误列十八难末节）人病有沉滞久积聚。可切脉而知之耶
。然。诊病在右胁有积气。得肺脉结脉。结甚则积甚。结微则积微。诊不得肺脉。而右胁有积气
者。何也。然。肺脉虽不见。右手脉沉伏。其外痼疾同法耶。将异也。然。结者。脉来去时一止
。无常数。名曰结也。伏者。脉行筋下也。浮者。脉在肉上行也。左右表里。法皆如此。假令脉
结伏者。内无积聚。脉浮结者。外无痼疾。有积聚。脉不结伏。有痼疾。脉不浮结。为脉不
应病。病不应脉。是为死病也。
此承上文言积聚之脉。如右胁有积聚。应当右寸肺部得结脉。结之微甚。可以推积之微甚也。
肺脉虽不见者。言肺部之结脉虽不见。然肺部必见沉伏之脉也。若外有痼疾。脉必浮结。内有积
聚。脉必伏结。至论积疾五脏俱有。则肝心脾肾之脉。亦此法推之。故曰左右表里法皆如此。至脉不应病。病不
应脉。此脏败而气不应也。所以必死。痼疾者。如瘿瘤疮 皆是也。
五十六难曰。五脏之积。各有名乎。以何月何日得之。然。肝之积。名曰肥气。在左胁下。如覆杯
有头足。久不愈。令人发咳逆 疟。连岁不已。以季夏戊己日得之。何以言之。肺病传肝。肝当
传脾。脾季夏适王。王者不受邪。肝复欲还肺。肺不肯受。故留结为积。故知肥气以季夏戊己
日得之。
此章言五脏积之所起。亦由五邪相传而成也。积有常处。故有定名。聚无常处。故无名可定
也。此言肺病传肝。肝当传脾。脾土适王于季夏之土令。故力能拒而不受。则邪当复返于肺。但
脾土得令而旺。肺金亦得土之生气而亦能拒邪。故曰不肯受也。邪因无道可行。故仍结于肝而成
积矣。越人形容成积之理。可谓曲尽。乃见虚处受邪。旺处不容。今人治积以攻为务。大失经旨
。良可叹也。
心之积。名曰伏梁。起脐上。大如臂。上至心下。久不愈。令人病烦心。以秋庚辛日得之。
何以言之。肾病传心。心当传肺。肺秋适王。王者不受邪。心复欲还肾。肾不肯受。故留结为
积。故知伏梁以秋庚辛日得之。
肺金得秋金之王令。而能拒邪。肾水亦得秋金之生气。而亦能拒也。
脾之积。名曰痞气。在胃脘。覆大如盘。久不愈。令人四肢不收。发黄胆。饮食不为肌肤。以冬壬癸
日得之。何以言之。肝病传脾。脾当传肾。肾以冬适王。王者不受邪。脾复欲还肝。肝不肯受。故
留结为积。故知痞气以冬壬癸日得之。
肾水旺于冬水之令。而能拒邪。肝木亦得水之生气。而亦能拒也。
肺之积。名曰息贲。在右胁下。覆大如杯。久不已。令人洒淅寒热。喘咳。发肺壅。以春甲乙日得
之。何以言之。心病传肺。肺当传肝。肝以春适王。王者不受邪。肺复欲还心。心不肯受。故留结
为积。故知息贲以春甲乙日得之。
肝木旺于春木之令。而能拒邪。心火亦得木之生气。而亦能拒也。
肾之积。名曰贲豚。发于少腹。上至心下。若豚状。或上或下无时。久不已。令人喘逆骨痿少气。以
夏丙丁日得之。何以言之。脾病传肾。肾当传心。心以夏适王。王者不受邪。肾复欲还脾。脾不
肯受。故留结为积。故知贲豚以夏丙丁日得之。
心火旺于夏火之令。而能拒邪。脾土亦得火之生气。而亦能拒也。
此是五积之要法也。
此总结上文推其积之所自。而可以会悟治之之法矣。其法维何。经曰。治病必求于本也。不
列六腑之聚。无定名故也。
五十七难曰。泄凡有几。皆有名不。然。泄凡有五。其名不同。有胃泄。有脾泄。有大肠泄。有小
肠泄。有大瘕泄。名曰后重。
五泄名虽不同。然必由胃及脾。叔和云。湿多成五泄。此之谓也。五泄俱后重。故以名曰后
重该之。下文各具其病状也。
胃泄者。饮食不化。色黄。
胃受邪。则不能运化饮食。黄者胃土之色。邪乃或湿或寒之邪也。
脾泄者。腹胀满。泄注。食即呕吐逆。
凡六腑禀气于胃。五脏禀气于脾。脾胃受邪。则诸气滞而不化。故胀满骤注也。气不化必逆。故
食即呕吐也。
大肠泄者。食已窘迫。大便色白。肠鸣切痛。
肺与大肠为表里。因邪从脾来。脾气不化。则肺与大肠之气亦不化。饮食入腹。迫气下行。故窘
迫也。气不化。则攻冲。故鸣而痛也。白者。肺色也。
小肠泄者。溲而便脓血。少腹痛。
小肠者。泌别清浊之职。因气不化。则清浊不分。欲溲小便而大便必同至。觉少腹窘痛而下脓血
也。
大瘕泄者。里急后重。数至圊而不能便。茎中痛。
瘕。假也。圊。厕也。茎。小便也。此邪传于肾。肾乃开窍于二阴。肾气不化。二便失常。大便欲便
而不得便。似乎假便之状。故曰瘕。因里急则数至圊。因后重则不能便。前阴不利。则必茎中痛
也。
此五泄之要法也。
此总结上文。言当审其在腑在脏。浅深久暴。推源而治。故曰要法也。
五十八难曰。伤寒有几。其脉有变。不。然。伤寒有五。有中风。有伤寒。有湿温。有热病。有
温病，其所苦各不同。
Chills, asthma, and cough. Inferring from the pulse, it should be floating, large, and choppy (Se). If it is dampness striking (Zhong Shi), then the Kidney pathogen is invading the Heart. Inferring from body fluids, there should be excessive sweating. Inferring from symptoms, there should be fever with lower abdominal pain, and coldness with counterflow in the lower legs and shins. Inferring from the pulse, it should be deep (Chen) and soft (Ru) yet large. If previously damaged by cold exposure and cold drinks affecting the Lung, then the pathogen will surely invade the Lung. Like wind-stroke (Zhong Feng), where the Liver pathogen invades the Lung. Inferring from complexion, it should be white. Inferring from symptoms, there should be asthma and cough, chills and shivering (Sa Xi) with aversion to cold, and hypochondriac pain. Inferring from the pulse, it should be choppy (Se) and floating-large. Like heatstroke (Shang Shu), where the Heart pathogen invades the Lung. Inferring from odor, there should be a fishy smell. Inferring from symptoms, there should be coughing, wheezing, alternating cold and heat, and mental restlessness. Inferring from the pulse, it should be floating, choppy (Se), and large. Like injury from diet and overexertion, where the Spleen pathogen invades the Lung. Inferring from taste, it should be pungent (Xin). Inferring from symptoms, there should be chills and shivering with alternating cold and heat, heavy body, and propensity to lie down. Inferring from the pulse, it should be choppy (Se) and slow (Huan). Like cold damage (Shang Han), where the Lung pathogen enters the Lung itself. Inferring from voice, there should be crying. Inferring from symptoms, there should be asthma and cough with aversion to cold. Inferring from the pulse, it should be floating and choppy (Se). Like dampness striking, where the Kidney pathogen invades the Lung. Inferring from body fluids, there should be nasal discharge. Inferring from symptoms, there should be alternating cold and heat, lower abdominal pain, asthma and cough, and coldness in the lower legs and shins. Inferring from the pulse, it should be choppy (Se) and deep (Chen). If previously injured by anger and qi rebellion affecting the Liver, then the pathogen will surely invade the Liver. Like wind-stroke, where the Liver pathogen enters the Liver itself. Inferring from complexion, it should be green (Qing). Inferring from symptoms, there should be alternating cold and heat, and fullness and pain below the hypochondrium. Inferring from the pulse, it should wiry (Xian) and urgent (Ji) yet floating. Like heatstroke, where the Heart pathogen enters the Liver. Inferring from odor, there should be a foul/musky smell (Sao Chou). Inferring from symptoms, there should be pain below the hypochondrium with mental restlessness and fever. Inferring from the pulse, it should be wiry (Xian), fine (Xi), and scattered (San). Like injury from diet and overexertion, where the Spleen pathogen invades the Liver. Inferring from taste, it should be sour (Suan). Inferring from symptoms, there should be hypochondriac pain, heavy body, and inability to control the four limbs. Inferring from the pulse, it should be wiry (Xian) and slow (Huan). Like cold damage, where the Lung pathogen invades the Liver. Inferring from voice, there should be calling out. Inferring from symptoms, there should be hypochondriac pain, alternating cold and heat, and asthma/cough. Inferring from the pulse, it should be choppy (Se) and wiry (Xian). Like dampness striking, where the Kidney pathogen invades the Liver. Inferring from body fluids, there should be tears. Inferring from symptoms, there should be fullness and pain below the hypochondrium with coldness and counterflow in the lower legs and shins. Inferring from the pulse, it should be wiry (Xian), soft (Ru), and deep (Chen). If previously injured by diet and overexertion affecting the Spleen, then the pathogen will surely invade the Spleen. Like wind-stroke, where the Liver pathogen invades the Spleen. Inferring from complexion, it should be yellow. Inferring from symptoms, there should be heavy body and pain below the hypochondrium. Inferring from the pulse, it should be slow (Huan) and wiry (Xian). Like heatstroke, where the Heart pathogen invades the Spleen. Inferring from odor, there should be a fragrant/foul smell (Xiang Chou). Inferring from symptoms, there should be heavy body with inability to move, mental restlessness, and heart pain. Inferring from the pulse, it should be slow (Huan) and large. Like injury from diet and overexertion, where the Spleen pathogen enters the Spleen itself. Inferring from taste, it should be sweet (Gan). Inferring from symptoms, there should be heavy body with propensity to lie down, and inability to control the four limbs. Inferring from the pulse, it should be slow (Huan) and slippery (Hua). Like cold damage, where the Lung pathogen invades the Spleen. Inferring from voice, there should be singing. Inferring from symptoms, there should be heavy body with chills and shivering and alternating cold and heat. Inferring from the pulse, it should be slow (Huan) and choppy (Se). Like dampness striking, where the Kidney pathogen invades the Spleen. Inferring from body fluids, there should be spitting of saliva. Inferring from symptoms, there should be heavy body with coldness and counterflow in the lower legs and shins. Inferring from the pulse, it should be slow (Huan), deep (Chen), and soft (Ru). If previously injured by sitting long on damp ground or excessive sexual activity affecting the Kidney, then the pathogen will surely invade the Kidney. Like wind-stroke, where the Liver pathogen invades the Kidney. Inferring from complexion, it should be black. Inferring from symptoms, there should be lower abdominal pain, coldness in the lower legs and shins, and fullness/pain below the hypochondrium. Inferring from the pulse, it should be deep (Chen) and wiry (Xian). Like heatstroke, where the Heart pathogen invades the Kidney. Inferring from odor, there should be a putrid smell (Fu). Inferring from symptoms, there should be lower abdominal pain, coldness in the lower legs and shins, and fever. Inferring from the pulse, it should be deep (Chen) and large. Like injury from diet and overexertion, where the Spleen pathogen invades the Kidney. Inferring from taste, it should be salty (Xian). Inferring from symptoms, there should be coldness in the lower legs and shins, lower abdominal pain, and heavy body. Inferring from the pulse, it should be deep (Chen) and slow (Huan). Like cold damage, where the Lung pathogen invades the Kidney. Inferring from voice, there should be groaning. Inferring from symptoms, there should be lower abdominal pain, coldness in the lower legs and shins, and asthma/cough. Inferring from the pulse, it should be deep (Chen) and choppy (Se). Like dampness striking, where the Kidney pathogen enters the Kidney itself. Inferring from body fluids, there should be excessive saliva. Inferring from symptoms, there should be lower abdominal pain, coldness in the lower legs and shins with counterflow. Inferring from the pulse, it should be deep (Chen) and delayed (Chi). This is the method of inferring twenty-five syndromes for the five Zang organs by analogy. As for the twenty-five syndromes of the five Fu organs, one should infer them based on the discussion of superficial/shallow (Wei) and deep/excessive (Shen) pulses in the first chapter. The Fifty-First Difficulty again discusses the five pathogens of deficiency, excess, theft, minor, and correct types, intending to examine the origin of the pathogen, knowing whether it arises from generation or restriction, thereby distinguishing the principles of seven-transmission (Qi Zhuan) and intervening-Zang (Jian Zang). Fearing that later generations might omit Fu organ diseases, it clarifies in the Fifty-Second Difficulty that Fu organ diseases follow the same methods as Zang organ diseases, aligning with the intent of the ten transformations of Zang and Fu in the first chapter. The Fifty-Third Difficulty summarizes the essence of the five pathogens from the previous five chapters, connecting diseased and undiseased states, making treatment comprehensive. Generally, diseases of the five pathogens all originate from deficiency at the root, so their transmission is unpredictable. One must observe the source of the pathogen and examine the diseases of seven-transmission and intervening-Zang. Intervening-Zang transmission goes to what it generates; it is easy to cure and treat. Seven-transmission goes to what it restricts; it is difficult to cure and treat. However, the treatment method lies in simultaneously attending to the Zang organ about to be transmitted to, preventing death from seven-transmission. This differs greatly from the meridian transmission method of Cold Damage, so it is listed separately without confusion. This shows Yuèrén's legislative intent to save the world was extremely profound. In ordinary people, the Heart and Kidney are most easily injured, and summer and winter Qi are most likely to cause disease. I specifically highlight this for future sages to adopt and govern. For those injured in the Heart by worry and overthinking, rich or poor cannot avoid it. Once injured, Heart Fire moves constantly; moving Fire must restrict Lung Metal. If the Heart does not receive external pathogenic factors, it is fine; but once it receives external pathogens, it will surely transmit to its restricted organ, the Lung. The Lung transmits to its restricted organ, the Liver; the Liver to its restricted organ, the Spleen; the Spleen to its restricted organ, the Kidney; the Kidney to its restricted organ, the Heart; the Heart to its restricted organ, the Lung. Hence called seven-transmission. However, the Lung cannot be injured twice, hence death. This is the meaning of "one Zang is not injured twice." If a person is chronically injured in the Heart and encounters Summer Heat pathogen, it will enter the Heart via deficiency. Once the Heart is invaded, the disease force will enter the Lung via deficiency. If the physician recognizes this, they should protect the Lung while clearing Summer Heat. For example, Li Dongyuan's Qing Shu Yi Qi Tang (Clear Summer Heat and Boost Qi Decoction) treats the diseased Heart but actually also treats the undiseased Lung. Sun Simiao's Sheng Mai San (Generate Pulse Powder) prevents pathogens and specifically treats the undiseased state. If Summer Heat is too severe, resembling Cold Damage, Ren Shen Bai Du San (Ginseng Detoxifying Powder) is also a formula to expel pathogens and preserve righteousness, most suitable. Using only bitter-cold herbs to clear Summer Heat is merely the treatment of diseased states by average physicians. For those injured in the Kidney by sitting long on damp ground or excessive sexual activity, the principle is deeper. The Kidney has two aspects: Water and Fire, with different injuries. Sitting long on damp ground causes disease commonly in ordinary people, less in the wealthy. The injury is mostly in the Right Kidney. Why? Dampness descends and injures the Fire of the Right Kidney. The Fire of the Right Kidney is Fire within Water, i.e., True Yang in Kan. It lies dormant; when injured, it flares up, becoming evil fire. Evil fire can shake the Fire of the Heart Monarch, injuring the Heart. Thus, if chronically injured by dampness and encountering Summer Heat, it enters the Right Kidney via deficiency. Once the Right Kidney is invaded, the disease force transmits to the Heart via deficiency. Manifestations show false heat signs: some have face redness due to floating Yang (Ge Yang); some have irritability with black tongue; some have coma with fixed eyes. If the physician recognizes this, they should support Yang while expelling pathogens. For example, Zhang Zhongjing's Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) and Fu Zi Li Zhong Tang (Aconite and Ginger Decoction) treat the diseased Right Kidney but actually support the undiseased Heart Yang. Jin Gui Ba Wei Wan (Eight-Ingredient Pill from the Golden Cabinet) prevents pathogens and specifically treats the undiseased state. Injury from excessive sexual activity is rare in ordinary people, but the injury is mostly in the Left Kidney. Why? Essence leakage injures the Water of the Left Kidney. The Left Kidney is the organ of True Yin. Exhaustion of essence leads to Yin deficiency; Yin deficiency leads to Blood deficiency. The Heart is Li; True Yin in Li is Blood. So Yin deficiency leads to Blood dryness; Blood dryness injures the Heart. If chronically injured in the Left Kidney and encountering Cold pathogen, it enters the Left Kidney via deficiency. Once the Left Kidney is invaded, the disease force transmits to the Heart via deficiency. Manifestations show false cold signs: some have face blackness due to floating Yin (Ge Yin); some have external cold with internal dryness; some have cold extremities with red eyes. If the physician recognizes this, they should rescue Yin in Li while expelling pathogens. For example, Zhang Zhongjing's Tong Mai Si Ni Tang (Pulse-Unblocking Four Reversals Decoction), Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction), Ren Shen Bai Hu Tang (Ginseng and White Tiger Decoction), and Huang Lian E Jiao Tang (Coptis and Donkey-Hide Gelatin Decoction) treat the diseased Left Kidney but actually treat the undiseased Heart. Liu Wei Di Huang Wan/San (Six-Ingredient Rehmannia Pill/Powder) and Glue made from Gui Lu Ren Shen (Tortoise Shell, Deer Antler, and Ginseng) prevent pathogens, embodying "nourish the Kidney by benefiting Essence," and are formulas specifically treating the undiseased state. At such times of true/false similarity, unless one carefully seeks the pulse, a single medication error causes harm instantly. Hence, relying on pulse rather than just symptoms is acceptable. Similarly, for Spleen injury from diet and overexertion: dietary injury affects the Stomach causing Excess; overexertion injury affects the Spleen causing Deficiency. Treating Excess should attend to the Bladder; treating Deficiency should attend to the Right Kidney. For Liver injury from anger and qi rebellion, treatment should attend to the Spleen. For Lung injury from cold exposure and cold drinks, treatment should attend to the Liver. Research and infer by analogy, experiencing carefully, to honor Yuèrén's deep intent. Regarding intervening-Zang transmission to its child Zang: because the injury is slight, it does not restrict its controlled Zang normally. When injured and diseased, it does not transmit to its controlled Zang but to its generated Zang. Hence I say: if Fu organ disease transmits to its controlled organ, it is also difficult to treat like Zang disease, which becomes clearer here.
The Fifty-Fifth Difficulty (mislisted as Fifty-Second) says: Do Zang and Fu organ diseases have equal roots? Answer: No. How are they unequal? Answer: Zang diseases are stationary and do not move; the pathology stays in its location. Fu organ diseases seem to rumble and flow up and down, with no fixed location. Thus we know the roots of Zang and Fu differ. This question about equal roots refers to the source of accumulation (Ji) and gathering (Ju), leading to the next chapter. "Root" means Ji has a root; "unequal" means Ju has no root. "Stationary and not moving, staying in place" means Ji has a root, thus not moving. "Rumbling and flowing up and down" means Ju has no root, thus rumbling and flowing.
The Fifty-Fifth Difficulty says: Diseases include Ji (accumulation) and Ju (gathering). How to distinguish? Answer: Ji is Yin Qi; Ju is Yang Qi. Thus Yin sinks and hides; Yang floats and moves. Where Qi accumulates, it is called Ji; where Qi gathers, it is called Ju. Thus Ji is produced by the five Zang organs; Ju is formed by the six Fu organs. Ji is Yin Qi; its onset has a constant place; its pain does not leave its region, having upper/lower beginnings/endings and left/right limits. This is called Ji. Ju is Yang Qi; its onset has no root, no upper/lower stopping point; its pain has no constant place. This is called Ju. Thus we distinguish Ji and Ju.
This chapter explains the source of Ji and Ju. "Upper/lower beginnings/endings, left/right limits" illustrates Ji has a constant place. "No upper/lower stopping point, pain has no constant place" illustrates Ju has no root. The Classic says Qi accumulation is Ji, Qi gathering is Ju. I add: Ji involves blood coagulation with Yin Qi; Ju involves pure Qi knotting with Yang Qi.
(Mislabeled at end of Eighteenth Difficulty) Can chronic Ji and Ju be known by pulse diagnosis? Answer: Diagnosing disease with Qi accumulation in the right hypochondrium, obtaining a Choppy (Jie) Lung pulse. Severe Jie means severe Ji; mild Jie means mild Ji. If Lung pulse is not obtained but right hypochondrium has Qi accumulation, why? Answer: Although Lung pulse is absent, the right hand pulse is Deep (Fu). Is the external chronic disease the same method? Or different? Answer: Jie pulse stops occasionally during arrival/departure without fixed frequency. Fu pulse runs under tendons. Floating pulse runs above flesh. Left/right interior/exterior follow this law. If pulse is Jie/Fu, there is no internal Ji; if pulse is Floating/Jie, there is no external chronic disease. If there is Ji but pulse is not Jie/Fu; if there is chronic disease but pulse is not Floating/Jie, this is pulse not matching disease, disease not matching pulse, indicating a fatal condition.
This continues discussing Ji pulses. Right hypochondrium Ji should show Jie pulse in right Cun Lung position. Degree of Jie infers degree of Ji. Even if Lung Jie pulse is absent, Lung position must show Deep pulse. External chronic disease implies Floating/Jie pulse; internal Ji implies Deep/Jie pulse. Since Ji exists in all five Zang, Liver/Heart/Spleen/Kidney pulses follow this method. Hence left/right interior/exterior laws apply. Pulse/disease mismatch indicates Zang failure and Qi non-response, hence fatal. Chronic disease includes goiter, tumors, sores, etc.
The Fifty-Sixth Difficulty says: Do the five Zang accumulations have names? Obtained in which month/day? Answer: Liver accumulation is named Fei Qi (Fat Qi), located under left hypochondrium, like an inverted cup with head and feet. Long-term unresolved causes cough, asthma, malaria, continuing for years. Obtained on Wu/Ji days of late summer. Why? Lung disease transmits to Liver; Liver should transmit to Spleen. Spleen is prosperous in late summer; the prosperous does not accept pathogen. Liver tries to return to Lung; Lung refuses. Thus stagnation forms accumulation. Hence Fei Qi is obtained on Wu/Ji days of late summer.
This chapter explains origins of five Zang accumulations, formed by five-pathogen transmission. Ji has constant place, hence fixed name; Ju has no constant place, hence no name. Lung transmits to Liver; Liver should transmit to Spleen. Spleen Earth is prosperous in late summer Earth command, rejecting pathogen. Pathogen returns to Lung. But Spleen Earth is prosperous, and Lung Metal receives Earth's generating Qi to also reject pathogen. Hence Lung refuses. Pathogen has no way to go, remains in Liver forming Ji. Yuèrén describes accumulation mechanism thoroughly, showing deficiency accepts pathogen, prosperity rejects it. Modern treatment focuses on attack, missing the Classic's intent.
Heart accumulation is named Fu Liang (Hidden Beam), starting above navel, arm-sized, extending to below heart. Long-term unresolved causes vexation. Obtained on Geng/Xin days of autumn. Why? Kidney disease transmits to Heart; Heart should transmit to Lung. Lung is prosperous in autumn; prosperous does not accept pathogen. Heart tries to return to Kidney; Kidney refuses. Thus stagnation forms accumulation. Hence Fu Liang is obtained on Geng/Xin days of autumn.
Lung Metal receives autumn Gold command, rejecting pathogen. Kidney Water receives autumn Gold generating Qi, also rejecting.
Spleen accumulation is named Pi Qi (Stagnant Qi), in epigastrium, plate-sized. Long-term unresolved causes limb weakness, jaundice, emaciation despite eating. Obtained on Ren/Gui days of winter. Why? Liver disease transmits to Spleen; Spleen should transmit to Kidney. Kidney is prosperous in winter; prosperous does not accept pathogen. Spleen tries to return to Liver; Liver refuses. Thus stagnation forms accumulation. Hence Pi Qi is obtained on Ren/Gui days of winter.
Kidney Water is prosperous in winter Water command, rejecting pathogen. Liver Wood receives Water generating Qi, also rejecting.
Lung accumulation is named Xi Ben (Breath Burping), under right hypochondrium, cup-sized. Long-term unresolved causes chills/fever, asthma/cough, lung obstruction. Obtained on Jia/Yi days of spring. Why? Heart disease transmits to Lung; Lung should transmit to Liver. Liver is prosperous in spring; prosperous does not accept pathogen. Lung tries to return to Heart; Heart refuses. Thus stagnation forms accumulation. Hence Xi Ben is obtained on Jia/Yi days of spring.
Liver Wood is prosperous in spring Wood command, rejecting pathogen. Heart Fire receives Wood generating Qi, also rejecting.
Kidney accumulation is named Ben Tun (Running Piglet), starting in lower abdomen, extending to below heart, pig-like, moving up/down unpredictably. Long-term unresolved causes asthma/wheezing, bone萎 (atrophy), shortness of breath. Obtained on Bing/Ding days of summer. Why? Spleen disease transmits to Kidney; Kidney should transmit to Heart. Heart is prosperous in summer; prosperous does not accept pathogen. Kidney tries to return to Spleen; Spleen refuses. Thus stagnation forms accumulation. Hence Ben Tun is obtained on Bing/Ding days of summer.
Heart Fire is prosperous in summer Fire command, rejecting pathogen. Spleen Earth receives Fire generating Qi, also rejecting.
This is the essential method for five accumulations.
Summarizing previous text to infer accumulation origin and understand treatment. Method? Classic says: Treat disease seeking the root. Six Fu Ju are not listed due to lack of fixed names.
The Fifty-Seventh Difficulty says: How many types of diarrhea (Xie)? Do they have names? Answer: Five types: Wei Xie (Stomach Diarrhea), Pi Xie (Spleen Diarrhea), Da Chang Xie (Large Intestine Diarrhea), Xiao Chang Xie (Small Intestine Diarrhea), Da Xia Xie (Great Mass Diarrhea), named Hou Zhong (Tenesmus).
Though names differ, all stem from Stomach to Spleen. Wang Shuhe said: Dampness causes five diarrheas. All five have tenesmus, hence summarized as Hou Zhong. Below are specific symptoms.
Wei Xie: Undigested food, yellow stool. Stomach receiving pathogen cannot transform food. Yellow is Spleen/Stomach Earth color; pathogen is damp or cold.
Pi Xie: Abdominal fullness, projectile diarrhea, vomiting after eating. Fu organs derive Qi from Stomach; Zang organs derive Qi from Spleen. Spleen/Stomach pathogen causes Qi stagnation, leading to fullness and sudden diarrhea. Qi stagnation causes rebellion, leading to vomiting.
Da Chang Xie: Urgency after eating, white stool, loud bowel sounds and cutting pain. Lung/Large Intestine are exterior-interior. Pathogen comes from Spleen; Spleen Qi fails, so Lung/Large Intestine Qi fails. Food entering gut forces Qi downward, causing urgency. Qi failure causes rushing, hence sound and pain. White is Lung color.
Xiao Chang Xie: Urination with pus/blood in stool, lower abdominal pain. Small Intestine separates clear/turbid. Qi failure causes mixing of clear/turbid. Desire to urinate brings stool simultaneously, causing lower abdominal urgency/pain and pus/blood discharge.
Da Xia Xie: Internal urgency, tenesmus, frequent trips to toilet without passage, penile pain. Xia means fake. Qing means toilet. Jing means penis. Pathogen transmits to Kidney; Kidney opens to two yin orifices. Kidney Qi failure causes abnormal urination/defecation. Desire to defecate but unable, appearing fake, hence Xia. Internal urgency causes frequent trips; tenesmus prevents passage. Anterior orifice blockage causes penile pain.
This is the essential method for five diarrheas. Summarizing, one must examine Fu/Zang involvement, depth/duration, and treat by tracing source.
The Fifty-Eighth Difficulty says: How many types of Shang Han? Are there pulse changes? Answer: Shang Han has five types: Zhong Feng (Wind Strike), Shang Han (Cold Damage), Shi Wen (Damp-Warmth), Re Bing (Heat Disease), Wen Bing (Warm Disease). Their sufferings differ.