，足太阳经也，病苦转胞，不得小便，头眩痛烦满，脊背强。（同上）（《千金》并曰∶名曰膀胱实热也。）
夫膀胱者，贮诸脏之津液。若实则生热，热则膀胱急，口舌燥，咽嗌痛，小便不通，尿黄赤色，举体沉重，四肢
气满，面肿目黄，小腹偏痛者，则是膀胱实热之候也。（《圣惠方》）
膀胱实一证，癃闭，属膀胱实热。（《本草经疏》）
膀胱虚 左手关后尺中阳绝者，无膀胱脉也，苦逆冷，妇人月信不调，王月则闭，男子失精，尿有余沥。
（《脉经》）
左手尺中神门以后脉阳虚者，足太阳经也，病苦脚中筋急，腹中痛引腰背，不可屈伸，转筋恶风，偏枯腰痛，外踝
后痛。右手尺中神门以后脉阳虚者，足太阳经也，病苦肌肉振动，脚中筋急，耳聋忽忽不闻，恶风飕飕作声。（同上）
（《千金》并曰∶名曰膀胱虚冷也。）
膀胱气不足，则寒气客之，胞滑，小便数而多也，面色黑，是膀胱气之虚也，则宜补之。（《病源论》）
热入膀胱，则其气急而苦小便黄涩也。膀胱寒，则小便数而清也。（《中藏经》）
膀胱虚三证∶小便不禁，属气血虚；遗尿，属本经气虚（见小肠虚条内，因膀胱虚亦能致遗尿，故复列此）；
膀胱气。（《本草经疏》）
肾膀胱俱实 左手尺中神门以后脉阴阳俱实者，足少阴与太阳经俱实也，病苦脊强反折戴眼，气上抢
心，脊痛不能自反侧。右手尺中神门以后脉阴阳俱实者，足少阴与太阳经俱实也，病苦癫疾，头重与目相引痛，
厥欲起走，反眼大风多汗。（《脉经》）
肾膀胱俱虚 左手尺中神门以后脉阴阳俱虚者，足少阴与太阳经俱虚也，病苦小便利，心痛背寒，时
时少腹满。右手尺中神门以后脉阴阳俱虚者，足少阴与太阳经俱虚也，病苦心痛，若下重不自收，篡反出，时时
苦洞泄、寒中泄，肾心俱痛。一说云∶肾有左右而膀胱无二，今用当以左肾合膀胱，右肾合三焦。（《脉经》）
三焦病证 三焦为水谷之道路，气之所终始也。三焦气盛为有余则胀，气满于皮肤内，轻轻然而不牢，
或小便涩，或大便难，是为三焦之实也，则宜泻之。三焦之气不足，则寒气客之，病遗尿，或泻利，或胸满，或
食不消，是三焦之气虚也，则宜补之。诊其寸口脉迟，上焦有寒。尺脉迟，下焦有寒。尺脉浮者，客阳在下焦。
（《病源论》）（按∶诊其寸口以下，本出《脉经》。）
三焦者，主通阴阳，调虚实。呼吸有病，则苦腹胀气满，小腹坚，溺而不得，便而窘迫也。溢则作水，留则
作胀，足太阳是其经也。又上焦实热，则额汗出而身无汗，能食而气不利，舌干口焦咽闭之类，腹胀时时胁肋
痛也。寒则不入食，
吐酸水，胸背引痛，嗌干津不纳也。实则食已还出，膨膨然不乐。虚则不能制下，遗便溺而头面肿也。中焦实
热，则上下不通，腹胀而喘咳，下气不上，上气不下，关格而不通也。寒则下利不止，食饮不消而中满也。虚则
肠鸣鼓胀也。下焦实热，则小便不通，而大便难，苦重痛也。虚寒则大小便泄下而不止。三焦之气和则内外和，
逆则内外逆，故云三焦者，人之三元之气也，宜修养矣。（《中藏经》）
三焦者，谓上中下也。若上焦有热，则胸膈痞满，口苦咽干，有寒，则吞酢而吐沫。中焦有热，则身重目黄；
有寒，则善胀而食不消。下焦有热，则大便难；有寒，则少腹痛而小便数。三焦之气，主腐熟水谷，分别清浊，
若不调平，则生诸病。（《简要济众方》）
上焦虚，则引气于肺。中焦虚，则生寒，腹痛洞泄，便利霍乱。下焦虚，则大小便不止，津液气绝。寒则
补于肾，然三焦者，水谷之道路，气之所终始也，其处虽异，其原则一，故有俱虚之病。上焦虚寒，则令人精
神不守，引气于肺，咳嗽，语声不出，膈寒之病生焉。上焦有热，则喉舌干燥，口气面赤，胸膈否满之病生焉。
若寒客中焦，则胃中冷，胃中冷则饮食不化，腹痛飧泄，霍乱吐利，治法宜温补之。仲景曰∶热在中焦，则为
坚。故其气实，则闭塞不通，上下隔绝。热则身重目黄，口甘脾瘅之证生焉。下焦其气虚寒，则津液不固，大
小便利不止，小腹痛，不欲闻人语，治宜温之。下焦其气实而有热，则津液内燥，传导不利，由是有气逆便难
胃胀呕哕之证。（《圣济总录》）
三焦虚二证∶腹寒，属中气虚；气短少气，属气虚。（《本草经疏》）
三焦实三证∶喉痹，即缠喉风，属少阳相火、少阴君火；
头面赤热，属上焦火升；赤白游风，属血热，热则生风，故善游走，俗名火丹，小儿多患此，大人亦时有之。
（同上）
五脏病发于外 人身之有形于外者必有诸内，以故五脏之受病于内而发于外者，必见之眼耳鼻舌口牙之
间。心经蕴热，则口舌生疮，唇口裂拆。脾与胃相通，故受热则噎气臭秽。肾受冷则耳不能听，或兼风则牙痛
颔肿。肺受风邪则皮毛瘙痒，积毒则发为痈疽。肝受病，则目不能视。发乃血之余，焦枯者，血不足也。此病皆
在内而应乎外也，凡有其证，必须考其所自来，辨其冷热实虚治之。（《医方大成》）
The Foot-Taiyang Bladder Meridian, when diseased, suffers from *Zhuanbao* (a condition characterized by urinary retention and acute pain below the umbilicus), inability to urinate, accompanied by dizziness, headache, irritability, chest fullness, and stiffness of the spine and back. (Ibid.) *Qianjin Fang* also states: this is named Bladder Excess-Heat syndrome.
The Bladder stores the fluids of all zang-fu organs. If excess occurs, heat is generated; heat causes bladder urgency, dry mouth and tongue, sore throat, urinary obstruction, yellow-red urine, heaviness of the whole body, qi stagnation and fullness in the four limbs, facial edema, yellow eyes, and pain on one side of the lower abdomen. These are signs of Bladder Excess-Heat syndrome. (*Huifang*)
Regarding Bladder Excess syndrome, *Longbi* (difficulty or impossibility of urination) belongs to Bladder Excess-Heat. (*Bencao Jingshu*)
Bladder Deficiency Syndrome: When the pulse at the Chi position behind Guan on the left hand shows Yang extinction, there is no Bladder pulse. The patient suffers from cold sensations rising upward, irregular menstruation in women (amenorrhea during menstrual periods), seminal emission in men, and dribbling after urination. (*Maijing*)
When the pulse at the Chi position behind Shenmen on the left hand shows Yang deficiency, it indicates a disease of the Foot-Taiyang Bladder Meridian. The patient suffers from spasms of tendons in the feet, abdominal pain radiating to the lower back, inability to bend or stretch, muscle cramps with aversion to wind, hemiplegia with lower back pain, and pain behind the lateral malleolus. When the pulse at the Chi position behind Shenmen on the right hand shows Yang deficiency, it indicates a disease of the Foot-Taiyang Bladder Meridian. The patient suffers from muscle twitching, spasms of tendons in the feet, sudden deafness, aversion to wind with whistling sounds. (Ibid.) *Qianjin Fang* also states: this is named Bladder Deficiency-Cold syndrome.
If Bladder qi is insufficient, cold qi invades, causing the bladder to become slippery, leading to frequent and copious urination, and dark complexion. This is a sign of Bladder qi deficiency, which should be treated with tonification. (*Bingyuan Lun*)
If heat enters the Bladder, its qi becomes urgent, suffering from yellow and scanty/difficult urination. If the Bladder is cold, urination is frequent and clear. (*Zhongzang Jing*)
There are three types of Bladder Deficiency syndromes: Incontinence of urine belongs to Qi and Blood deficiency; Enuresis belongs to deficiency of the meridian's own qi (see Small Intestine Deficiency section, as Bladder deficiency can also cause enuresis, hence listed again); Bladder qi deficiency. (*Bencao Jingshu*)
Kidney and Bladder Both Excess Syndrome: When the pulse at the Chi position behind Shenmen on the left hand shows both Yin and Yang excess, it indicates that both the Foot-Shaoyin Kidney Meridian and Foot-Taiyang Bladder Meridian are in excess state. The patient suffers from stiff spine, opisthotonos, fixed upward gaze (*Daiyan*), qi rushing up to the heart, and severe back pain preventing turning over. When the pulse at the Chi position behind Shenmen on the right hand shows both Yin and Yang excess, it indicates that both the Foot-Shaoyin Kidney Meridian and Foot-Taiyang Bladder Meridian are in excess state. The patient suffers from manic-depressive illness, heavy head with pulling pain in the eyes,厥逆 (cold extremities/jue syndrome) with desire to walk, reversed eyes, excessive sweating due to wind. (*Maijing*)
Kidney and Bladder Both Deficiency Syndrome: When the pulse at the Chi position behind Shenmen on the left hand shows both Yin and Yang deficiency, it indicates that both the Foot-Shaoyin Kidney Meridian and Foot-Taiyang Bladder Meridian are in deficiency state. The patient suffers from frequent clear urination, heart pain with cold back, and occasional lower abdominal fullness. When the pulse at the Chi position behind Shenmen on the right hand shows both Yin and Yang deficiency, it indicates that both the Foot-Shaoyin Kidney Meridian and Foot-Taiyang Bladder Meridian are in deficiency state. The patient suffers from heart pain, sensation of heaviness downward unable to retract, prolapse of the anus, frequent watery diarrhea, cold middle diarrhea, and simultaneous pain in Kidney and Heart. Another theory states: The Kidneys are left and right, but the Bladder is single; therefore, in application, the Left Kidney should correspond to the Bladder, and the Right Kidney to the Sanjiao. (*Maijing*)
Sanjiao Disease Syndromes: The Sanjiao is the pathway for food and fluids, and the beginning and end of qi. If Sanjiao qi is excessive (repletion), distension occurs; qi fills inside the skin, feeling light but not firm, possibly with difficult urination or difficult defecation. This is Sanjiao Excess syndrome, requiring purgation. If Sanjiao qi is deficient, cold qi invades, causing enuresis, diarrhea, chest fullness, or indigestion. This is Sanjiao Qi Deficiency syndrome, requiring tonification. Palpating the Cun Kou pulse, if slow, indicates Cold in the Upper Jiao. If Chi pulse is slow, it indicates Cold in the Lower Jiao. If Chi pulse is floating, it indicates invading Yang in the Lower Jiao. (*Bingyuan Lun*) (Note: Diagnosis below Cun Kou originally comes from *Maijing*.)
The Sanjiao governs the communication of Yin and Yang, adjusting repletion and deficiency. Diseases of respiration cause abdominal distension and fullness, hard lower abdomen, inability to urinate, and straining during defecation. Overflow leads to water retention (edema); stasis leads to distension. The Foot-Taiyang meridian is its channel. Furthermore, Upper Jiao Excess-Heat causes sweat on the forehead but no body sweat, ability to eat but poor qi movement, dry tongue, scorched mouth, closed throat, abdominal distension with occasional hypochondriac pain. Cold prevents eating, causes vomiting of sour fluid, pulling pain in chest and back, dry throat with inability to swallow saliva. Excess causes food to come back up immediately after eating, feeling bloated and unhappy. Deficiency fails to control the lower part, causing incontinence of urine and feces, and edema of head and face. Middle Jiao Excess-Heat causes blockage of upper and lower, abdominal distension with wheezing and coughing, failure of descending qi and ascending qi, resulting in Guan Ge (obstruction) without passage. Cold causes persistent diarrhea, indigestion, and middle jiao fullness. Deficiency causes borborygmus and drum-like distension. Lower Jiao Excess-Heat causes urinary obstruction and difficult defecation, suffering from heaviness and pain. Deficiency-Cold causes continuous leakage of urine and feces. When Sanjiao qi is harmonious, interior and exterior are harmonious; when rebellious, interior and exterior are rebellious. Thus, Sanjiao is called the Yuanqi of the three origins, and should be cultivated. (*Zhongzang Jing*)
Sanjiao refers to Upper, Middle, and Lower. If Upper Jiao has Heat, there is chest and diaphragm stuffiness, bitter taste, and dry throat; if Cold, there is acid regurgitation and spitting of foam. If Middle Jiao has Heat, the body feels heavy and eyes turn yellow; if Cold, there is prone distension and indigestion. If Lower Jiao has Heat, defecation is difficult; if Cold, there is lower abdominal pain and frequent urination. Sanjiao qi primarily rots and ripens food and fluids, separating clear from turbid. If not balanced, various diseases arise. (*Jianyao Jizhong Fang*)
Upper Jiao Deficiency draws qi to the Lung. Middle Jiao Deficiency generates Cold, causing abdominal pain, watery diarrhea, and cholera-like symptoms. Lower Jiao Deficiency causes unceasing urination and defecation, exhaustion of fluids and qi. For Cold, tonify the Kidney. However, Sanjiao is the pathway for food and fluids, the start and end of qi; although locations differ, the principle is one, so there are diseases of simultaneous deficiency. Upper Jiao Deficiency-Cold causes loss of spirit, drawing qi to the Lung, coughing, inability to speak, generating Diaphragm Cold disease. Upper Jiao Heat causes dry throat and tongue, red face and bad breath, generating Chest-Diaphragm Stagnation disease. If Cold invades Middle Jiao, the Stomach becomes cold; cold Stomach fails to digest food, causing abdominal pain, undigested stool diarrhea, cholera with vomiting and diarrhea; treatment should be warming and tonifying. Zhang Zhongjing said: Heat in Middle Jiao becomes solid. Thus, if qi is excess, it blocks and does not pass, isolating upper and lower. Heat causes heavy body, yellow eyes, sweet taste in mouth, and Spleen Damp-Heat syndromes. Lower Jiao Deficiency-Cold fails to secure fluids, causing unceasing urination and defecation, lower abdominal pain, aversion to hearing voices; treatment should be warming. Lower Jiao Excess-Heat causes internal dryness of fluids, poor transportation, leading to rebellious qi, difficult defecation, stomach distension, vomiting, and belching. (*Shengji Zonglu*)
Two types of Sanjiao Deficiency syndromes: Abdominal cold belongs to Middle Qi deficiency; Shortness of breath and weak qi belong to Qi deficiency. (*Bencao Jingshu*)
Three types of Sanjiao Excess syndromes: Throat Bi (obstruction), i.e., Chantoufeng (wrapping throat wind), belongs to Shaoyang Minister Fire and Shaoyin Sovereign Fire; Red and hot head and face belong to Rising Fire of Upper Jiao; Red and white wandering wind rash belongs to Blood Heat. Heat generates Wind, hence it wanders easily; commonly known as Huodan (fire mole), often seen in children, occasionally in adults. (Ibid.)
Diseases of the Five Zang Organs Manifesting Externally: Whatever is formed externally in the human body must have an internal basis. Therefore, diseases of the five zang organs originating internally and manifesting externally will necessarily appear between the eyes, ears, nose, tongue, mouth, and teeth. Heat accumulating in the Heart Meridian causes sores in the mouth and tongue, and cracking of lips and corners of the mouth. The Spleen and Stomach are connected; thus, when affected by Heat, there is stifling sensation with foul odor. Cold affecting the Kidney causes deafness, or combined with Wind, toothache and swelling of the jaw. Wind pathogen affecting the Lung causes itching of skin and hair; accumulated toxins cause carbuncles and ulcers. Disease affecting the Liver causes blindness. Hair is the surplus of blood; brittle and dry hair indicates Blood deficiency. All these diseases originate internally and respond externally. Whenever such syndromes exist, one must investigate their origin, differentiate Cold, Heat, Excess, and Deficiency, and treat accordingly. (*Yifang Dacheng*)