夫前阴者。宗筋之所聚。太阴阳明之所合也。其精窍通于肾。溺窍通于脬。阴器属于肝。督脉络之。带脉束
之。冲任渗灌之。阳明主润而为之长。动乎情。宰乎心。而其病则生于房室。诊之之法。如经言宗筋纵者。阳
明虚。宗筋痿者。肝气弱。纵挺不收者。足厥阴之经伤于热。缩入不用者。足厥阴之经伤于寒。阳强则有肾
热强中之证。阴痿则有魂伤骨极之因。阴气不起者。伤于内。囊茎肿胀者。属于疝。阴囊及茎俱肿者。水病
之死证。阴囊及卵俱缩者。肝经之绝候。疳疮者。淫秽之毒。肿痛者。湿热之征。凡此诸候。当参四诊。辨其寒
热虚实。察其轻重浅深。庶可识常通变矣。至于儿生阴物不起。亦为死证者。岂以赋禀不足。形体未备欤。
特察小儿。宜从望诊。故并述之。
尝思汗液之有无。由于腠理之开阖。而腠理之开阖。则因卫气之虚实。故经云。阳气有余。为身热无汗。阴
气有余。为多汗身寒。阴阳俱有余。则无汗而寒。夫汗者。心之液。在营则为血。在卫则为汗者也。若因而诊
之。有部位之分。有形色之辨。部位者何。在阳经之部者属乎阳。在阴经之部者属乎阴。头额汗出者。病在
诸阳。手足汗出者。病在于胃。心窝汗出者。心脏亏虚。阴下汗出者。下焦湿热。汗出偏沮者。使人偏枯之先
兆。汗不至足者。热病咳衄之危证。此皆部位之分也。形色者何。三阳实。三阴虚者。汗不出。三阴实。三阳虚
者。汗不止。有汗身热者。阳邪在营。无汗身热者。阴邪在卫。汗出少者为自和。汗出多者为太过。风湿发汗。
微微似欲汗出者。风湿俱去。 如水流漓者。病必不除。黄汗者。湿热之证。白汗者。厥气之征。红汗者。气
虚之候。小儿初生。汗出如血者。多夭寿。小儿初生。汗出不流者。不成人。汗出如浴者。酒风之候。汗出如油
者。命绝之容。汗出如流珠。脉浮者。卫气衰。汗大如贯珠不流者。元气绝。 然汗出者。表将解。 然汗
出者。里未和。汗出不止者。阳亡于外。夺血无汗者。阴虚于内。此皆形色之分也。若夫时有寒暑。衣有冷暖。
形有动静。腠理因之而开阖。汗液因之而有无。非病也。常也。其或饮食饱甚。汗出于胃。惊而夺精。汗出于
心。持重行远。汗出于肾。疾走恐惧。汗出于肝。摇体劳苦。汗出于脾。是皆人事之异。非病候之殊也。故善诊
汗者。必视寒暑。观冷暖。察动静。知其汗之常。以审其汗之变。夫而后可按部位。辨形色。以分其表里。而判
其虚实焉。他如热汗为阳。冷汗为阴。宜合体之冷热而分之。合病之阴阳而辨之。则其诊益备。其用益明矣。
The anterior yin (anterior genital region) is the gathering place of the zong jin (tendons), and the convergence of the Taiyin (Spleen/Lung meridians) and Yangming (Stomach/Large Intestine meridians). Its essence orifice connects with the Kidney, and its urine orifice connects with the Bladder. The sexual organs belong to the Liver, are linked by the Du vessel (Governing Vessel), bound by the Dai vessel (Girdle Vessel), and irrigated by the Chong vessel (Penetrating Vessel) and Ren vessel (Conception Vessel). The Yangming meridian governs moistening and acts as their leader. Movement arises from emotional desire, governed by the Heart, but its diseases arise from sexual excess. The method of diagnosis, as stated in the classics: when the zong jin is flaccid and hanging loose, it indicates deficiency of the Yangming; when the zong jin is atrophic and impotent, it indicates weakness of the Liver qi. When the penis is erect and cannot retract, it indicates that the Foot Jueyin (Liver) meridian has been injured by heat. When the penis retracts and is unusable, it indicates that the Foot Jueyin meridian has been injured by cold. Persistent erection without relief involves a syndrome of strong middle (Qiang Zhong) due to Kidney heat. Impotence involves causes such as soul injury and bone exhaustion. Failure of yang energy to rise results from internal injury. Swelling of the scrotum and penis belongs to hernia (Shan). Swelling of both the scrotum and testicles is a fatal sign of water disease (Edema). Retraction of both the scrotum and testicles is an terminal sign of the Liver meridian. Chancre sores result from toxic filth. Pain and swelling are signs of damp-heat. All these manifestations should be assessed through the four diagnostic methods to distinguish cold, heat, deficiency, and excess, and to observe severity and depth, thereby understanding normal patterns and adapting to changes. As for infants whose genitals do not erect at birth, this is also a fatal sign; is it merely due to insufficient endowment and incomplete physical development? Special examination of children should prioritize inspection (Wang Zhen), hence it is included here.
I have pondered that the presence or absence of sweat depends on the opening and closing of the cou li (pores/skin texture), which in turn depends on the deficiency or excess of Wei Qi (Defensive Qi). Thus, the classics state: Excess of Yang qi manifests as body heat and no sweat; excess of Yin qi manifests as profuse sweating and cold body; excess of both Yin and Yang manifests as no sweat and coldness. Sweat is the fluid of the Heart; within Ying (Nutritive) level it becomes blood, within Wei (Defensive) level it becomes sweat. Diagnosis based on this involves distinctions of location and appearance/color. What are locations? Sweating in Yang meridian areas belongs to Yang; sweating in Yin meridian areas belongs to Yin. Sweating on the forehead indicates disease in the various Yang meridians. Sweating on hands and feet indicates disease in the Stomach. Sweating in the epigastrium indicates Heart deficiency. Sweating in the perineal/genital area indicates damp-heat in the Lower Jiao. Hemihidrosis (sweating on only one side) is a precursor to hemiplegia. Absence of sweat reaching the feet is a critical sign of severe heat disease with cough and nasal bleeding. These are distinctions of location. What are appearances/colors? Excess in San Yang (Taiyang, Yangming, Shaoyang) and deficiency in San Yin (Taiyin, Shaoyin, Jueyin) results in no sweat; excess in San Yin and deficiency in San Yang results in continuous sweating. Sweating with body heat indicates Yang pathogen in Ying; no sweating with body heat indicates Yin pathogen in Wei. Scant sweating indicates self-harmonization; profuse sweating indicates excess. For wind-dampness, slight perspiration suggests the removal of wind-damp pathogens; profuse sweating like flowing water indicates the disease will not be resolved. Yellow sweat indicates damp-heat syndrome. White sweat indicates Jue Qi (rebellious/cold qi). Red sweat indicates Qi deficiency. In newborns, sweat resembling blood often leads to premature death. In newborns, sweat that does not flow indicates failure to thrive. Sweat resembling bathing indicates Jiu Feng (Alcohol Wind) syndrome. Sweat resembling oil indicates impending death. Sweat resembling beads with a floating pulse indicates decline of Wei Qi. Large drops of sweat that do not flow indicate exhaustion of Yuan Qi (Original Qi). However, mild continuous sweating indicates the exterior pattern is resolving; persistent sweating indicates interior disharmony. Unremitting sweating indicates loss of Yang on the exterior. Blood loss precludes sweating, indicating interior Yin deficiency. These are distinctions of appearance. Regarding seasonal cold/heat, clothing warmth/cold, and physical activity/rest, the cou li opens/closes accordingly, and sweat appears/disappears; this is not disease, but normalcy. Alternatively, excessive fullness from food causes sweat from the Stomach; fright causing essence depletion causes sweat from the Heart; carrying heavy loads over long distances causes sweat from the Kidney; running fast and fear causes sweat from the Liver; bodily exertion causes sweat from the Spleen. These are variations due to human activities, not differences in pathological signs. Therefore, a skilled practitioner diagnosing sweat must observe climate, check clothing, examine activity levels, know the norm of sweating, and thereby assess deviations. Only then can one analyze locations, distinguish appearances, differentiate exterior/interior, and judge deficiency/excess. Furthermore, hot sweat is Yang, cold sweat is Yin; one must combine body temperature and disease yin/yang differentiation for comprehensive diagnosis and clear application.