尝思观形容者。非但欲诊之于行。抑且欲诊之于坐。苟能心领神会。虽一动一静。莫不有昭着者焉。间尝
验之于病。见有坐而仰者。坐而伏者。坐而叉手冒心者。坐而以手护腹者。以及坐而下一脚。坐而掉两手。
或坐而不得眠。或眠而不得坐者。由是稽之于古。则谓坐而仰者肺实。实则胸盈仰息。坐而伏者肺虚。虚
则伏而短气。叉手冒心者。汗后血虚。以手护腹者。里实心痛。其坐而下一脚者。腰痛之貌。坐而掉两手者。
烦躁之容。但坐不得眠。眠则气逆者。咳嗽肺胀。但眠不耐坐。坐则昏沉者。血夺气虚。其他坐不能起者。阴
经之证。立不能坐者。阳病之征。坐而欲起者。阴气实。坐不欲起者。阳气虚。转侧不能者。痿痹之状。坐卧不
定者。烦躁之形。是皆显而易见者也。然合五官而察之。合五体而辨之。其坐卧之间。形容之变。竟有难于
言传者矣。是篇举其一隅。导夫先路。至若听声写形。尚有待于来者。
在昔圣贤之于望也。不惟欲观其行止。抑且欲省其衷怀。故虽寤寐之间。鉴察之下。亦有诊法存焉。盖尝
以是论之。卧之状。有多睡者。无睡者。但欲寐者。不得眠者。转侧不能者。起卧不安者。其形又有仰伏舒卷
之殊。内外左右之异。稽之于古。以为多睡者脾虚。无睡者胃实。但欲寐者。少阴之证。不得眠者。阳明之征。
转侧不能者。风湿相搏。起卧不安者。腹满心烦。卧不得安者。胃中不和。坐不得卧者。肺中气逆。其睡而仰
者属乎阳。睡而伏者属乎阴。不得正偃者。胃不和而肺气实。但欲伏眠者。腹中痛而肝气虚。仰而舒足者。
小肠之证。仰而卷足者。肾脏之征。舒为阳。卷为阴。舒而不欲卷者。阳经实热。卷而不欲舒者。阴经虚寒。睡
向内者属阴。是热已去而正虚。睡向外者属阳。是热未去而邪实。腰痛左卧。卷左足而痛减者。病在左肾。
右卧。卷右足而痛减者。病在右肾。痛在肝者。属左胁。故左着床则更痛。痛在脾者。属右 。故右着床则更
痛。病在肺之左者。宜于左。病在肺之右者。宜于右。其肺痈生于左者。右卧则更痛。生于右者。左卧则更痛。
其水病。左半着床。则左半身愈肿。右半着床。则右半身愈肿。此皆卧诊之大略也。合形状而观之。不有可
见者乎。若夫因脉证而异。因气色而异。又当参之四诊。辨其三因。庶乎标本明而虚实判。不至以不平平之矣。
I have pondered that observing the patient's posture and appearance is not only for diagnosis during walking but also during sitting. If one can grasp the essence mentally, then every movement and stillness of the patient will reveal distinct characteristics.
I have verified this in patients, observing those who sit leaning backward, those who sit leaning forward, those who sit with hands crossed over the chest, those who sit protecting their abdomen with hands, as well as those who sit with one leg dangling, those who sit shaking both hands, or those who cannot sleep while sitting, or cannot sit after sleeping. Consulting ancient texts: Sitting leaning backward indicates Lung Excess Syndrome (Lung Shi); excess leads to chest fullness and仰息 (仰息 - breathing with head tilted back). Sitting leaning forward indicates Lung Deficiency Syndrome (Lung Xu); deficiency leads to a forward-leaning posture and shortness of breath. Hands crossed over the heart indicate Blood Deficiency following sweating. Protecting the abdomen with hands indicates Heart Pain due to Interior Excess. Sitting with one leg dangling is the appearance of Lower Back Pain. Shaking both hands while sitting is the expression of Irritability (Fan Zao). Inability to sleep when sitting, but Qi rebellion upon lying down, indicates Cough and Lung Distension. Inability to endure sitting when lying down, leading to dizziness and heaviness upon sitting, indicates Blood Depletion and Qi Deficiency. Others who cannot rise from sitting belong to Yin Meridian syndromes; those who cannot sit from standing belong to Yang disease signs. Those who wish to rise while sitting indicate Yin Qi Excess; those who do not wish to rise indicate Yang Qi Deficiency. Inability to turn or roll indicates Wei Bi (Atrophy and Obstruction) conditions. Restlessness in sitting and lying indicates the form of Irritability. These are all obvious. However, combining observation of the five sense organs and differentiation of the five body tissues, the changes in posture between sitting and lying are often difficult to describe fully in words. This chapter presents a corner of this knowledge to pave the way; as for diagnosing by listening to sounds and describing forms, it awaits future scholars.
In ancient times, sages in inspection did not only observe movements but also examined the inner mind. Thus, even between wakefulness and sleep, diagnostic methods exist within careful observation. I argue thus: Postures in lying include sleeping much, sleeping little, merely desiring to sleep, inability to sleep, inability to turn or roll, and restlessness in rising and lying. Forms vary between supine and prone, extended and curled, inward and outward, left and right. Consulting ancient texts: Sleeping much indicates Spleen Deficiency; sleeping little indicates Stomach Excess. Merely desiring to sleep indicates Shaoyin Syndrome; inability to sleep indicates Yangming Syndrome. Inability to turn or roll indicates Wind-Dampness attacking together; restlessness in rising and lying indicates Abdominal Fullness and Heart Restlessness. Lying without peace indicates Disharmony in the Stomach; inability to lie down while sitting indicates Qi Rebellion in the Lungs. Sleeping in a supine position belongs to Yang; sleeping in a prone position belongs to Yin. Inability to lie flat on the back indicates Stomach Disharmony and Lung Excess. Desiring only to sleep in a prone position indicates Abdominal Pain and Liver Qi Deficiency. Supine with legs extended indicates Small Intestine syndrome; supine with legs curled indicates Kidney signs. Extension is Yang; curling is Yin. Extending without desire to curl indicates Yang Meridian Excess-Heat; curling without desire to extend indicates Yin Meridian Deficiency-Cold. Sleeping facing inward (towards the bed center) belongs to Yin, indicating Heat has gone and Zheng Qi is deficient; sleeping facing outward (away from the bed center) belongs to Yang, indicating Heat remains and Pathogenic factors are excess. For lower back pain, lying on the left side with curled left leg reducing pain indicates disease in the Left Kidney; lying on the right side with curled right leg reducing pain indicates disease in the Right Kidney. Pain in the Liver is located in the Left Hypochondrium, so lying on the left side exacerbates pain. Pain in the Spleen is located in the Right [Hypochondrium/Abdomen], so lying on the right side exacerbates pain. Disease in the Left Lung favors left lateral recumbency; disease in the Right Lung favors right lateral recumbency. Lung Abscess arising on the left causes more pain when lying on the right; arising on the right causes more pain when lying on the left. In Water Disease (Edema), lying on the left side makes the left half of the body more swollen; lying on the right side makes the right half more swollen. These are the general principles of lying diagnosis. Observing shapes, are there not visible signs? As for variations due to pulse and symptoms, or complexion, one must combine the Four Diagnostic Methods and differentiate the Three Causes, so that root and branch become clear, and excess and deficiency are judged, avoiding the use of improper methods for proper treatment.