不利为癃。不约为遗溺。（热实则癃闭。虚寒则遗溺。）胆为怒。（刚决善怒。）是谓五病。五精所并。精气并于心则喜。
并于肺则悲。并于肝则忧。并于脾则畏。并于肾则恐。是谓五并。虚而相并者也。五病所发。阴病发于骨。（骨属少阴。）
阳病发于血。（阳动阴静。阳乘阴。而发于血。）阴病发于肉。（肉属太阴。）阳病发于冬。（阳不能敌阴。）阴病发于夏。
（阴
不能胜阳。）是谓五发。五邪所乱。邪入于阳则狂。（火盛狂癫。）邪入于阴则痹。（痹者。闭也。）搏阳则为巅疾。（头为
六阳之会。邪搏阳分。则为巅顶之疾。）搏阴则为喑。（三阴脉连舌循喉。邪搏之则不能言搏。灵枢俱作转。）阳入之阴则
静。（阳邪传入阴分则静。）阴出之阳则怒。（阴邪传出阳分。则怒。）是谓五乱。五劳所伤。久视伤血。（目得血而能视。）
久卧伤气。久坐伤肉。久立伤骨。久行伤筋。是谓五劳所伤。（宣明五气篇）（灵枢九针论并同）
【素】春善病鼽衄。（春气在头。鼻水曰鼽。鼻血曰衄。）仲夏善病胸胁。长夏善病洞泄寒中。秋善病风疟。冬善病
痹厥。（金匮真言论）
【素】神有余则笑不休。（心藏神。心在声为笑。在志为喜。）神不足则悲。气有余则喘咳上气。（肺藏气。）不足则
息利少气。（灵枢本神篇。作鼻息不利少气。）血有余则怒。（肝藏血。在志为怒。）不足则恐。形有余则腹胀。（脾藏形。）
泾溲不利。（土克水。）不足则四肢不用。（脾主四肢。虚则四肢不随人用。）志有余则腹胀飧泄。（肾藏志。为胃之关。故
或胀或泻。）不足则厥。（厥论。阳气衰于下。则为寒厥。阴气衰于下。则为热厥。）帝曰。余已闻虚实之形。不知其何以
生。曰。气血以并。阴阳相倾。（血为阴。气为阳。）气乱于卫。血逆于经。血气离居。一实一虚。（并则分离。阴阳不交。
血并于阴。气并于阳。故为惊狂。血并于阳。气并于阴。乃为炅中。（热中。）血并于上。气并于下。心烦惋善怒。（马注。
惋当作 。读为闷。）血并于下。气并于上。乱而善忘。（按灵枢大惑论。上气不足。下气有余。肠胃实而心肺虚。虚则
营卫留于下。久之不以时上。故善忘。）血气者。喜温而恶寒。寒则泣。（涩。）不能流。温则消而去之。是故气之所并为
血虚。（有阳无阴。）血之所并为气虚。（有阴无阳。）有者为实。无者为虚。故气并则无血。血并则无气。今血与气相失。
故为虚焉。络之与孙脉。俱输于经。血与气并。则为实焉。血之与气。并走于上。则为大厥。（下不足。故并走于上而厥
逆。）厥则暴死。气复反则生。不反则死。夫邪之生也。或生于阴。或生于阳。其生于阳者。得之风雨。寒暑。（外感阳
受。）其生于阴者。得之饮食居处。阴阳喜怒。（内伤阴受。）风雨之伤人也。先客于皮肤。传入于孙脉。孙脉满则传入于
络脉。络脉满则输于大经脉。（皮部论曰。百病之始生也。必先于皮毛。邪中之则腠理开。开则入客于络脉。络脉满则注
于经脉。经脉满则入舍于脏腑也。）。血气与邪。并客于分腠之间。其脉坚大。故曰实。实者。外坚充满。不可按之。按
之则痛。寒湿之中人也。皮肤不收。（全元起曰。不仁也。甲乙太素无不字。）肌肉坚紧。荣血泣卫气去。故曰虚。虚者
聂辟。（聂皱襞积。）气不足。按之则气足以温之。故快然而不痛。（调经篇）
【灵】风雨寒热。（外感之邪。）不得虚邪。不能独伤人。卒然逢疾风豪雨而不病者。盖无虚。故邪不能独伤人。此
必因虚邪之风。（天有八方虚实之风。实风主长养万物。虚风伤人。主杀主害。）与其身形。（人有身形虚实之别。）两虚
相得。乃客其形。两实相逢。众人肉坚。其中于虚邪也。因于天时。与其身形。参以虚实。大病乃成。气有定舍。因处
为名。（因邪所舍之处。属某经则名为某病。）上下中外。分为三员。（马注。人身自纵言之。则以上中下为三部。自横言
之。则以在表在里在半表半里为三部。故病有中上中下中表中里之异。）是故虚邪之中人也。始于皮肤。（在表。）皮肤缓
则腠理开。开则邪从毛发入。入则抵深。深则毛发立。（竖。）毛发立则淅然。（寒貌。）故皮肤痛。留而不去。则传舍于
络脉。在络之时。痛于肌肉。其痛之时息。大经乃代。（络邪传经。）留而不去。传舍于经。在经之时。洒淅喜惊。（外则
恶寒。内则善惊。）留而不去。传舍于输。（六经之俞穴。）在输之时。六经不通四肢。（邪气间隔。）则肢节痛。腰脊乃强。
留而不去。传舍于伏冲之脉。（岁露篇论疟曰。入脊内。注于伏冲之脉。素问又作伏膂之脉。王注。谓膂筋之间。肾脉之
伏行者也。巢元方作伏冲。谓冲脉之上行者也。）体重身痛。留而不去。传舍于肠胃。（经邪入府。）贲（奔。）响腹胀。
多寒则肠鸣飧泄。食不化。多热则溏出麋。（便溏如麋。）留而不去。传舍于肠胃之外。膜原之间。（皮里膜外。）留着于
脉。稽留而不去。息而成积。邪气淫佚。不可胜论。起居不节。用力过度。则络脉伤。阳络伤（三阳之络。）则血外溢。
血外溢则衄血。（鼻血。衄。女六切。）阴络伤（三阴之络。）则血内溢。血内溢则后血。（便血。）肠胃之络伤。则血溢于
肠外。肠外有寒。汁沫与血相搏。则并合凝聚不得散。而积成矣。（百病始生。）
【素】风者。百病之长也。今风寒客于人。使人毫毛毕直。皮肤闭而为热。当是之时。可汗而发也。或痹不仁肿痛。
（风寒伤形则肿。伤气则痛。）当是之时。可汤熨及火灸刺而去之。（汤药。蒸熨。火灸。针刺四法。）弗治。病入舍于肺。
名曰肺痹。（阳入之阴。则痹。）发咳上气。弗治。肺即传而行之肝。（金克木。）病名曰肝痹。一名曰厥。（王注。肝脉通
胆。善怒气逆。故厥。）胁痛出食。（肝气逆。故食入反出。）当是之时。可按（按摩导引。）若刺耳。弗治。肝传之脾。
（木
克土。）病名曰脾风。（木盛生风。）发瘅（王注。黄瘅。）腹中热。烦心出黄。（便出色黄。）当此之时。可按可药可浴。
弗治。脾传之肾。（土克水。）病名曰疝瘕。少腹冤热而痛。出白。（便出色白。淫浊之类。）一名曰蛊。（如虫侵蚀。）当
此之时。可按可药。弗治。肾传之心。（水克火。）病筋脉相引而急。病名曰螈。（音异。灵枢曰。心脉急甚为螈 。肾水
不生。心虚血燥。不能荣筋也。）当此之时。可灸可药。弗治。满十日。法当死。肾因传之心。心即复反传。而行之肺。
（再传。火又克金。）发寒热。法当三岁死。（此亦言其大较耳。吴鹤皋改三岁作三哕。欠理。）此病之次也。然其卒发者。
不必治于传。（卒暴之病。不必根据传次治。）或其传化有不以次者。忧恐悲喜怒。令不得以其次。（五志之火。时发无常。）
故令人有大病矣。（风寒为外感。五志为内伤。故病加重。）因而喜大虚。则肾气乘矣。（喜为心志。肾因虚而乘之。）怒
则肝气乘矣。（肝乘脾。）悲则肺气乘矣。（肺乘肝。）恐则脾气乘矣。（脾乘肾。）忧则心气乘矣。（心乘肺。）此其道也。
（内
伤不次之道。）（玉机真藏论）
【灵】邪气之中人也。无有常。中于阴则溜（流。）于府。中于阳则溜于经。中于面则下阳明。（手足阳明经。）中于
项则下太阳。（手足太阳经。）中于颊则下少阳。（手足少阳经。）其中于膺背两胁者。亦中其经。（三阳经分。）中于阴者。
常从臂 始。（手经手臂。足经足 。）此故伤其脏乎。曰。身之中于风也。不必动脏。故邪入于阴经。则其脏气实。邪
气入而不能容。故还之于腑。（故中阴溜腑。）愁忧恐惧则伤心。形寒寒饮则伤肺。以其两寒相感。中外皆伤。故气逆而
上行。（形寒伤外。饮寒伤内。素问咳论云。其寒饮食入胃则肺寒。肺寒则外内合邪。与此文义正同。今人惟知形寒为外
伤寒。而不知饮冷为内伤寒。讹为阴症。非也。凡饮冷者。虽无房事。而亦每患伤寒也。若房事饮冷。而患伤寒。亦有
在三阳经者。当从阳症论治。不得便指为阴症也。世医不明。妄以热剂投之。杀人多矣。特揭出以告人。气逆上行。故
有发热头痛诸症。）有所堕坠。恶血留内。若有所大怒。气上而不下。积于胁下则伤肝。（肝藏血。胁为肝经部分。故血
多积于两胁。）有所击仆。若醉入房。汗出当风。则伤脾。有所用力举重。若入房过度。汗出浴水则伤肾。愿闻六腑之病。
曰。面热者足阳明病。（胃脉上面。）鱼络血者手阳明病。（按经脉篇。手大指后肉隆起处名鱼。鱼际。其间穴名。属太阴
肺经。太阳经无鱼络之名。络血亦未详是何病。）两跗之上。脉陷竖者。（足面之脉。或陷或竖。）足阳明病。此胃脉也。
大肠病者。肠中切痛。而鸣濯濯。（肠中水火相激。四时气篇曰。腹中尝鸣。气上冲胸喘。邪在大肠。）冬日重感于寒即
泄。当脐而痛。（大肠部位。当脐。）不能久立。与胃同候。（胃脉入膝膑下足跗。故不能久立。大肠胃同属阳明燥金。）
胃病者。腹 胀。胃脘当心而痛。上肢。（支。）两胁。（胁为肝部。土反侮木。）膈咽不通。食饮不下。（四时气篇曰。膈
塞不通。邪在胃脘。在上脘则刺抑而去之。在下脘则散而去之。）小肠病者。小腹痛腰脊控睾而痛。（四时气篇曰。小肠
连睾。系属于脊。贯肝肺。络心系。气盛则厥逆。上冲肠胃熏肝。散于肓。结于脐。睾音皋。肾丸也。）当耳前热。若寒
甚。（脉上颊。入耳中。故或热或寒。）若独肩上热甚。（脉绕肩胛。交肩上。）三焦病者。腹气满。小腹尤坚。（脉交膻中。
络心包。下膈。属三焦。）不得小便。窘急。（三焦为决渎之官。水道出焉。本输篇曰。三焦并太阳之正。入络膀胱。约
下焦。实则闭癃。虚则遗溺。）溢则水。留即为胀。（外为水肿。内作鼓胀。）膀胱病者。小腹偏肿而痛。以手按之。即欲
小便而不得。（膀胱主小便。）肩上热。（脉循肩膊。）胆病者。善太息。（木气不舒。）口苦。呕宿汁。（四时气篇曰。胆液
泄则口苦。胃气逆则呕苦。）心下澹澹。恐人将捕之。（胆虚。）嗌中 然。（少阳相火。）数唾。（胆病善呕。数唾亦喜
呕之类。胆中有邪故也。）（邪气脏腑病形）
【灵】肺气通于鼻。肺和则鼻能知臭香矣。心气通于舌。（舌为心苗。）心和则舌能知五味矣。肝气通于目。肝和则
目能辨五色矣。脾气通于口。脾和则口能知五谷矣。（口舌虽分。共为一窍。）肾气通于耳。肾和则耳能闻五音矣。五脏
不和。则七窍不通。（一脏各司一窍。）六腑不和。则留为痈。故邪在腑则阳脉不和。阳脉不和则气留之。（腑阳脏阴。气
阳血阴。留滞也。）气留之则阳气盛矣。阳气太盛则阴脉不利。阴脉不利则血留之。血留之则阴气盛矣。阴气太盛则阳气
弗能荣也。故曰关。（马注。关。六阳不得入内。）阳气太盛则阴气弗能荣也。故曰格。（马注。格。六阴不得出外。）阴
阳俱盛。不得相荣。故曰关格。关格者。不得尽期而死也。（马注曰。难经三十七难。误以六阴脉盛为格。六阳脉盛为关。
致后世不曰脉体。而指为膈症。误之误也。昂按。关格二字。字面虽殊。而意义则一。难经虽颠倒。疑无伤也。如素问
脉要精微论。阴阳不相应。病名曰关格。是明以关格属之病矣。又仲景平脉篇。下微本大者。则为关格不通。不得尿。
又曰。趺阳脉伏而涩。伏则吐逆。水谷不化。涩则食不得入。名曰关格。是仲景亦以关格为病症。而二字之义。内经与
仲景均未尝细分也。又难经第三难曰。关之前者。阳之动也。遂上鱼为溢。为外关内格。此阴乘之脉也。关以后者。阴
之动也。遂入尺为覆。为内关外格。此阳乘之脉也。是亦以溢覆言脉。而以关格言病也。今马氏既訾难经。复以仲景东
垣丹溪为非是。而指关格为脉体。不亦并背内经乎。又曰。关为阳不得入。格为阴不得出。是两脉共为一病矣。干义亦
难分也。）（脉度）
【素】气实形实。气虚形虚。此其常也。反此者病。谷盛气盛。谷虚气虚。此其常也。反此者病。脉实血实。脉虚
血虚。此其常也。反此者病。如何而反。气虚身热。此谓反也。（此上缺气盛身寒。此谓反也句。）谷入多而气少。此谓
反也。谷不入而气多。此谓反也。脉盛血少。此谓反也。脉少血多。此谓反也。气盛身寒。得之伤寒。（身寒字。当指初
感之寒言。非谓身体寒冷也。热论曰。人之伤于寒也。则为病热。）气虚身热。得之伤暑。（暑热伤气。）谷入多而气少者。
得之有所脱血。湿居下也。（脱血则阴虚阳盛。故胃燥善消。湿居下则中气不运。故气少。）谷入少而气多者。邪在胃与
肺也。（邪在胃则食少。邪在肺则气多。谓喘壅也。）脉小血多者。饮中热也。（吴注。有痰饮者。脉来弦小。中有热者。
Urination that is obstructed is called Long (stranguria). Urinary incontinence is called Yi Niao (enuresis/involuntary urination). (Heat and excess lead to urinary retention, while deficiency and cold lead to enuresis.) The Gallbladder governs anger. (The Gallbladder's nature is decisive and prone to anger.) This is referred to as the Five Diseases. When the essence of the five Zang organs merges, if essence merges with the Heart, there is excessive laughter.
If it merges with the Lung, there is sorrow. If it merges with the Liver, there is worry. If it merges with the Spleen, there is fear. If it merges with the Kidney, there is terror. This is referred to as the Five Merges. This occurs when deficiency allows pathogenic factors to merge. The sites of onset for the five diseases: Yin diseases manifest in the bones. (Bones belong to the Shaoyin channel.)
Yang diseases manifest in the blood. (Yang is active, Yin is static; Yang pathogens invade the Yin aspect, thus manifesting in the blood.) Yin diseases manifest in the flesh/muscles. (Flesh belongs to the Taiyin channel.) Yang diseases manifest in winter. (Yang Qi cannot resist Yin cold.) Yin diseases manifest in summer.
(Yin Qi cannot overcome Yang heat.) This is referred to as the Five Manifestations. The disturbances caused by the five evils: When evil enters the Yang aspect, mania ensues. (Excess fire leads to mania and epilepsy.) When evil enters the Yin aspect, Bi syndrome (obstruction) ensues. (Bi means obstruction.) When evil contends with the Yang aspect, disease of the vertex (top of the head) occurs. (The head is the convergence of the six Yang channels; evil contending in the Yang aspect causes disease at the vertex.) When evil contends with the Yin aspect, aphonia (loss of voice) occurs. (The three Yin meridians connect to the root of the tongue and circulate along the throat; evil contending here prevents speech. In *Ling Shu*, this is written as "Zhuan".) When Yang evil transmits into the Yin aspect, quietness results. (When Yang evil transmits into the Yin aspect, there is stillness.) When Yin evil transmits out to the Yang aspect, anger ensues. (When Yin evil transmits out to the Yang aspect, anger occurs.) This is referred to as the Five Disorders. The injuries caused by the five types of overexertion: Prolonged viewing damages the blood. (The eyes rely on blood nourishment to see.)
Prolonged lying down damages Qi. Prolonged sitting damages muscles. Prolonged standing damages bones. Prolonged walking damages sinews/tendons. This is referred to as the injuries caused by the five labors. (From the *Xuan Ming Wu Qi* chapter, identical to *Ling Shu: Jiu Zhen Lun*.)
*[Su Wen]* In spring, one is prone to rhinitis and epistaxis. (Spring Qi is in the head; nasal discharge is Qiu, nasal bleeding is Nu.) In mid-summer, one is prone to chest and hypochondriac disorders. In late summer, one is prone to severe diarrhea with cold in the middle. In autumn, one is prone to wind-malaria. In winter, one is prone to Bi syndrome and jue (cold extremities/reversal). (From the *Jin Gui Zhen Yan Lun* chapter.)
*[Su Wen]* Excess Shen (Spirit) leads to incessant laughter. (The Heart stores Shen; the Heart's sound is laughter, its emotion is joy.) Deficiency of Shen leads to sadness. Excess Qi leads to wheezing, coughing, and rebellious Qi. (The Lung stores Qi.) Deficiency leads to clear breathing but shortness of breath. (*Ling Shu: Ben Shen* chapter writes "difficult nasal breathing and shortness of breath"). Excess Blood leads to anger. (The Liver stores Blood; its emotion is anger.) Deficiency leads to fear. Excess Xing (Form/Body) leads to abdominal distension. (The Spleen stores Form.) Difficulty in urination and defecation. (Earth controls Water.) Deficiency leads to inability to use the four limbs. (The Spleen governs the four limbs; deficiency leads to limbs not responding to will.) Excess Zhi (Willpower) leads to abdominal distension and undigested food diarrhea. (The Kidney stores Zhi; it acts as the gate of the Stomach, hence either distension or diarrhea.) Deficiency leads to jue (reversal/cold extremities). (*Jue Lun*: Decline of Yang Qi below leads to cold jue; decline of Yin Qi below leads to hot jue.) The Yellow Emperor said: I have heard of the forms of deficiency and excess, but do not know how they arise. Qi Bo said: Qi and Blood merge, and Yin and Yang tilt against each other. (Blood is Yin, Qi is Yang.) Qi becomes chaotic in the Wei (Defensive) level, and Blood rebels in the Jing (Main) vessels. Blood and Qi separate from their proper locations, resulting in one excess and one deficiency. (Merging leads to separation, and Yin-Yang do not interact. If Blood merges into Yin and Qi merges into Yang,惊狂 (fright and mania) occur. If Blood merges into Yang and Qi merges into Yin, Re Zhong (Heat in the Middle) occurs. If Blood merges upward and Qi merges downward, heart vexation, stifling sensation, and irritability occur. (Ma Shi's annotation: 'Wan' should be read as 'Men' [stifling].) If Blood merges downward and Qi merges upward, confusion and forgetfulness occur. (According to *Ling Shu: Da Huo Lun*: Insufficiency of upper Qi, excess of lower Qi, fullness of intestines/stomach, and deficiency of Heart/Lung cause Ying and Wei to remain below, failing to ascend in time, leading to forgetfulness.) Blood and Qi prefer warmth and dislike cold. Cold causes stagnation (Qi). (Seepage/Stagnation.) preventing flow; warmth causes dispersion and elimination. Therefore, where Qi merges, Blood is deficient. (Presence of Yang, absence of Yin.) Where Blood merges, Qi is deficient. (Presence of Yin, absence of Yang.) Presence constitutes Excess, absence constitutes Deficiency. Thus, Qi merging means absence of Blood; Blood merging means absence of Qi. Now that Blood and Qi have lost each other, it manifests as deficiency. Luo (Collateral) and Sun (Sun) vessels all transport to the Jing (Main) vessels. When Blood and Qi merge, it manifests as Excess. When Blood and Qi move together upward, it results in Da Jue (Great Reversal). (Insufficiency below causes them to rush upward, leading to reversal.) Jue leads to sudden death; if Qi returns, life is preserved; if it does not return, death ensues. The generation of evil may originate from Yin or from Yang. Those originating from Yang are acquired from wind, rain, cold, and heat. (External pathogens affect Yang channels.) Those originating from Yin are acquired from diet, living conditions, and emotions like joy and anger. (Internal injuries affect Yin channels.) Wind and rain injuring humans first lodge in the skin, then transmit to Sun vessels; when Sun vessels are full, they transmit to Luo vessels; when Luo vessels are full, they transport to the large Jing vessels. (*Pi Bu Lun* states: All diseases begin in the hair and skin; when evil strikes, pores open, allowing entry into Luo vessels; when Luo vessels are full, they enter Jing vessels; when Jing vessels are full, they lodge in Zang-Fu organs.) Blood and Qi, along with evil, jointly lodge between the fenli (muscle intervals). The pulse is firm and large, hence called Excess. Excess means external firmness and fullness, untouchable; touching causes pain. Cold-damp injuring humans causes skin laxity. (Quan Yuanqi says: numbness. *Jia Yi Jing* and *Tai Su* lack the character 'bu'.) Muscles become firm and tight, Ying Blood stagnates, and Wei Qi departs, hence called Deficiency. Deficiency means skin wrinkling and accumulation. (Nie is synonymous with wrinkling/accumulation.) Qi is insufficient; pressing provides Qi to warm, bringing comfort and no pain. (From *Tiao Jing Pian*)
*[Ling Shu]* Wind, rain, cold, and heat. (External pathogens.) Without xu evil (deficient pathogens), they cannot injure alone. One who suddenly encounters fierce wind and heavy rain without getting sick does so because there is no internal deficiency, so evil cannot injure alone. This must be due to xu evil wind. (Heaven has eight directions of shi [solid] and xu [deficient] winds. Shi wind nurtures all things; xu wind injures humans, causing killing and harm.) Combined with the body's constitution. (Humans have differences in body constitution regarding deficiency/excess.) When two xus meet, evil lodges in the form. When two shis meet, the masses have firm flesh. Injury from xu evil depends on heavenly timing and human constitution, combined with deficiency/excess, leading to major disease. Qi has fixed abodes, named according to location. (Depending on where evil lodges, belonging to a certain channel, it is named after that disease.) Upper, lower, interior, and exterior are divided into three zones. (Ma Shi's annotation: Vertically, these are upper, middle, and lower sections; horizontally, these are exterior, interior, and half-exterior/half-interior. Hence diseases vary among upper/middle/lower and exterior/interior.) Thus, when xu evil injures humans, it begins in the skin. (At the exterior.) If skin is lax, pores open; opening allows evil to enter via hair follicles; entering leads to depth; depth causes hair to stand erect. (Erect.) Hair standing erect causes chills (Xi Ran). (Appearance of cold.) Hence skin pain. If lingering and not expelled, it transits to Luo vessels. During this stage, pain is felt in muscles; the pain comes and goes, and the large Jing vessels take over. (Luo evil transmits to Jing.) If lingering and not expelled, it transits to Jing vessels. During this stage, there is shivering aversion to cold and fright. (Externally aversion to cold, internally prone to fright.) If lingering and not expelled, it transits to Shu (Transport) points. (Shu points of the six channels.) During this stage, the six channels are blocked in the four limbs. (Evil qi blocks.) Hence joint pain, and stiffness of the waist and spine. If lingering and not expelled, it transits to the Fu Chong (Hidden Surge) vessel. (*Sui Lu* chapter on malaria states: Enters inside the spine, notes into the Fu Chong vessel. *Su Wen* also writes Fu Lv vessel. Wang Bing's annotation: Between the lv tendons, the hidden path of the Kidney channel. Chao Yuanfang writes Fu Chong, referring to the ascending path of the Chong vessel.) Body weight and pain. If lingering and not expelled, it transits to the intestines and stomach. (Jing evil enters Fu organs.) Rushing sounds and abdominal distension. More cold leads to borborygmus and undigested food diarrhea, with uncooked food. More heat leads to loose stool like paste. (Loose stool like mud.) If lingering and not expelled, it transits outside the intestines and stomach, between the mo yuan (membrane origins). (Between skin and fascia.) Lodging in the vessels, lingering and not expelling, gradually forms accumulations. Evil qi spreads excessively, beyond discussion. Irregular daily routine and excessive effort damage Luo vessels. Damage to Yang Luo (collaterals of the three Yang channels) leads to external bleeding; external bleeding leads to epistaxis. (Nasal bleeding. Nu, pronounced nü liu.) Damage to Yin Luo (collaterals of the three Yin channels) leads to internal bleeding; internal bleeding leads to hematochezia (blood in stool). Damage to the Luo vessels of the intestines and stomach leads to blood overflowing outside the intestines. If there is cold outside the intestines, juices and blood contend, coagulating and unable to disperse, forming an accumulation. (From *Bai Bing Shi Sheng*)
*[Su Wen]* Wind is the chief of a hundred diseases. Now, when wind-cold lodges in humans, it causes all fine hairs to stand erect, and skin pores close, generating heat. At this time, sweating can induce release. Or Bi syndrome with numbness, swelling, and pain. (Wind-cold damaging form causes swelling; damaging Qi causes pain.) At this time, herbal decoctions, hot compresses, moxibustion, and acupuncture can remove it. (Four methods: herbal medicine, steaming/compresses, fire moxibustion, needle insertion.) If untreated, the disease enters the Lung, named Fei Bi (Lung Bi). (Yang entering Yin leads to Bi.) Coughing and rebellious Qi arise. If untreated, the Lung transmits to the Liver. (Metal controls Wood.) The disease is named Gan Bi (Liver Bi). Also known as Jue. (Wang Bing's annotation: Liver channel connects to Gallbladder, prone to anger and rebellious Qi, hence Jue.) Hypochondriac pain and vomiting food. (Liver Qi rebellious, hence food vomited upon entry.) At this time, massage (Tuina and Dao Yin) or ear acupuncture can be used. If untreated, the Liver transmits to the Spleen. (Wood controls Earth.) The disease is named Pi Feng (Spleen Wind). (Excess Wood generates Wind.) Jaundice (Wang Bing's annotation: Yellow jaundice) arises, with heat in the abdomen, vexation, and yellow urine. (Stool colored yellow.) At this time, massage, herbs, and baths can be used. If untreated, the Spleen transmits to the Kidney. (Earth controls Water.) The disease is named Shan Jia (Hernia/Mass). Heat and pain in the lower abdomen, with white discharge. (Stool/discharge colored white, similar to leukorrhea.) Also known as Gu (Gu worm). (Like erosion by insects.) At this time, massage and herbs can be used. If untreated, the Kidney transmits to the Heart. (Water controls Fire.) Sinews and vessels contract and spasm. The disease is named Yu (convulsion/spasm). (Pronunciation yi. *Ling Shu* states: Extreme urgency of Heart pulse leads to Yu. Kidney water fails to generate, Heart blood becomes dry, failing to nourish sinews.) At this time, moxibustion and herbs can be used. If untreated, after ten days, death is expected. The Kidney transmitting to the Heart causes the Heart to reverse-transmit to the Lung. (Second transmission, Fire again controls Metal.) Fever and chills arise; death is expected within three years. (This speaks generally. Wu Hegao changed "three years" to "three hiccups," which is unreasonable.) This is the sequence of disease transmission. However, acute onset does not necessarily follow transmission treatment. (Acute/sudden diseases need not be treated according to transmission sequence.) Or transmission may not follow the sequence due to emotions like worry, terror, grief, joy, and anger, preventing sequential progression. (Fire of the five emotions arises irregularly.) Thus causing major disease. (Wind-cold is external invasion; five emotions are internal injury, hence disease worsens.) Excessive joy leads to great deficiency, allowing Kidney Qi to invade. (Joy is the emotion of the Heart; Kidney invades due to deficiency.) Anger allows Liver Qi to invade. (Liver invades Spleen.) Grief allows Lung Qi to invade. (Lung invades Liver.) Fear allows Spleen Qi to invade. (Spleen invades Kidney.) Worry allows Heart Qi to invade. (Heart invades Lung.) This is the principle. (Principle of non-sequential internal injury.) (From *Yu Ji Zhen Zang Lun*)
*[Ling Shu]* Evil qi invading humans has no constant pattern. Invading Yin flows to Fu organs; invading Yang flows to Jing channels. Invading the face descends to the Yangming channels. (Hand and Foot Yangming channels.) Invading the nape descends to the Taiyang channels. (Hand and Foot Taiyang channels.) Invading the cheek descends to the Shaoyang channels. (Hand and Foot Shaoyang channels.) Invading the chest, back, or flanks also affects their respective channels. (Division of three Yang channels.) Invading Yin usually starts from the arms/legs. (Hand channels affect arms, foot channels affect legs.) Does this injure the Zang organs? It is said: Invasion by wind does not necessarily disturb the Zang. Thus, when evil enters Yin channels, if the Zang Qi is solid, evil cannot reside, so it returns to the Fu organs. (Hence, invading Yin flows to Fu.) Sorrow, worry, and fear injure the Heart. External cold and cold drinks injure the Lung. Because these two colds interact, both interior and exterior are injured, causing Qi to rebel and ascend. (External cold damages the exterior; cold drinks damage the interior. *Su Wen: Ke Lun* states: Cold food entering the stomach causes Lung cold; Lung cold leads to external and internal combined evil, consistent with this text. Modern people only know external cold as exogenous cold, not knowing cold drinks as endogenous cold, mistakenly calling it Yin syndrome, which is incorrect. Those drinking cold liquids, even without sexual activity, often suffer from cold damage. If sexual activity and cold drinks combine to cause cold damage, it may also involve the three Yang channels and should be treated as Yang syndrome, not immediately labeled Yin syndrome. Unaware physicians recklessly administer hot agents, killing many. This is highlighted to inform others. Qi rebelling upward causes fever, headache, etc.) Falling or bruising leaves bad blood inside. Great anger causes Qi to rise but not descend, accumulating under the hypochondrium, injuring the Liver. (Liver stores Blood; hypochondrium is part of the Liver channel, hence blood accumulates in the flanks.) Blows or falls, drunken intercourse, sweating exposed to wind, injure the Spleen. Heavy lifting, excessive intercourse, sweating followed by bathing in water, injure the Kidney. You wish to hear about diseases of the six Fu organs. It is said: Heat on the face indicates Foot Yangming disease. (Stomach channel passes above the face.) Blood in the fish-line collateral indicates Hand Yangming disease. (According to *Jing Mai Pian*, the fleshy prominence behind the thumb is called Fish, specifically Yu Ji acupoint, belonging to the Taiyin Lung channel. Taiyang channel has no name for fish-line collateral, and the pathology of collateral blood is unclear.) Depression or protrusion of pulses on the dorsum of both feet. (Pulses on the top of the foot, either depressed or prominent.) Indicates Foot Yangming disease, which is the Stomach channel. Disease of the Large Intestine involves cutting pain in the intestines and gurgling sounds. (Water and fire clash in intestines. *Si Shi Qi Pian* states: Frequent abdominal rumbling, Qi rushing to chest and panting, evil in Large Intestine.) Heavy cold exposure in winter leads to diarrhea, pain at the umbilicus. (Large Intestine region is at the umbilicus.) Inability to stand for long periods, sharing prognosis with Stomach. (Stomach channel enters knee, patella, and dorsum of foot, hence inability to stand long. Large Intestine and Stomach both belong to Yangming Dry Metal.) Disease of the Stomach involves abdominal distension, pain in the epigastrium corresponding to the heart, radiating to... (Radiating.) Both hypochondria. (Hypochondrium is Liver area, Earth insulting Wood.) Obstruction in diaphragm and throat, inability to eat or drink. (*Si Shi Qi Pian* states: Diaphragmatic obstruction, evil in epigastrium; if in upper epigastrium, needle to suppress and remove; if in lower epigastrium, scatter and remove.) Disease of the Small Intestine involves lower abdominal pain, pain controlling to testicles from waist and spine. (*Si Shi Qi Pian* states: Small Intestine connects to testicles, attached to spine, penetrates Liver and Lung, connects to Heart system, Qi excess leads to rebellion, rushing up to intestines/stomach, steaming Liver, dispersing to Huang, knotting at umbilicus. Gao is pronunciation for testicle.) Heat or severe cold before the ears. (Channel ascends to cheek, enters ear, hence heat or cold.) If only shoulder heat is severe. (Channel wraps scapula, crosses shoulders.) Disease of the San Jiao (Triple Burner) involves abdominal fullness, especially hardness in the lower abdomen. (Channel intersects Dan Zhong, connects to Pericardium, descends through diaphragm, belongs to San Jiao.) Inability to urinate, urgency. (San Jiao is official of sluices, waterways emerge from it. *Ben Shu Pian* states: San Jiao joins Taiyang true path, enters and connects to Bladder, regulates lower Jiao; excess leads to stranguria, deficiency leads to enuresis.) Overflow leads to edema; retention leads to distension. (External edema, internal drum-like distension.) Disease of the Bladder involves unilateral lower abdominal swelling and pain; pressing makes one desire to urinate but unable. (Bladder governs urination.) Heat on shoulders. (Channel follows shoulder blades.) Disease of the Gallbladder involves frequent sighing. (Wood Qi not free-flowing.) Bitter taste in mouth, vomiting old bile. (*Si Shi Qi Pian* states: Leakage of Gallbladder juice causes bitter taste; rebellious Stomach Qi causes vomiting bitterness.) Palpitations, fear of being caught. (Gallbladder deficiency.) Sensation of obstruction in throat. (Shaoyang Ministerial Fire.) Frequent spitting. (Gallbladder disease prone to vomiting; frequent spitting is similar, due to evil in Gallbladder.) (From *Xie Qi Zang Fu Bing Xing*)
*[Ling Shu]* Lung Qi connects to the nose; when Lung is harmonious, the nose perceives odors. Heart Qi connects to the tongue. (Tongue is the sprout of the Heart.) When Heart is harmonious, the tongue perceives flavors. Liver Qi connects to the eyes; when Liver is harmonious, the eyes distinguish colors. Spleen Qi connects to the mouth; when Spleen is harmonious, the mouth tastes grains. (Mouth and tongue are distinct but share one orifice.) Kidney Qi connects to the ears; when Kidney is harmonious, the ears hear sounds. Disharmony of the five Zang organs leads to blockage of the seven orifices. (Each Zang governs one orifice.) Disharmony of the six Fu organs leads to retention forming abscesses. Thus, evil in Fu organs causes disharmony of Yang pulses; disharmony of Yang pulses causes Qi stagnation. (Fu are Yang, Zang are Yin; Qi is Yang, Blood is Yin; stagnation.) Stagnation of Qi leads to excess Yang Qi. Excess Yang Qi makes Yin pulses unfavorable; unfavorable Yin pulses cause Blood stagnation. Stagnation of Blood leads to excess Yin Qi. Excess Yin Qi prevents Yang Qi from nourishing. Hence called Guan (Obstruction). (Ma Shi's annotation: Guan, six Yang cannot enter inward.) Excess Yang Qi prevents Yin Qi from nourishing. Hence called Ge (Rebellion). (Ma Shi's annotation: Ge, six Yin cannot exit outward.) Both Yin and Yang are excessive, unable to nourish each other, hence called Guan Ge. Guan Ge leads to death before the natural lifespan ends. (Ma Shi says: *Nan Jing* Chapter 37 mistakenly identifies excess of six Yin pulses as Ge and excess of six Yang pulses as Guan, leading later generations to refer to pulse characteristics as Ge Syndrome, a double error. Ang notes: Although the characters Guan and Ge differ, their meaning is one. Even if *Nan Jing* reverses them, it likely causes no harm. As *Su Wen: Mai Yao Jing Wei Lun* states: Yin and Yang not corresponding, disease named Guan Ge, clearly attributing Guan Ge to disease. Also Zhang Zhongjing's *Ping Mai Pian*: Lower subtle, root large, leads to Guan Ge blockage, inability to urinate. Also: Dubo pulse hidden and choppy, hidden leads to vomiting/regurgitation, undigested food; choppy leads to inability to eat, named Guan Ge. Thus Zhongjing also viewed Guan Ge as a disease, and neither *Nei Jing* nor Zhongjing strictly distinguished the two characters. Also *Nan Jing* Chapter 3 states: Before the Guan position, Yang movement rises to the fish line, called Yi, external Guan internal Ge, this is Yin multiplying pulse. After the Guan position, Yin movement enters the Chi position, called Fu, internal Guan external Ge, this is Yang multiplying pulse. Thus speaking of Yi/Fu regarding pulses, and Guan/Ge regarding disease. Now Ma criticizes *Nan Jing*, yet considers Zhongjing, Dongyuan, and Danxi incorrect, pointing to Guan Ge as pulse characteristic, contradicting *Nei Jing*. Also states: Guan is Yang unable to enter, Ge is Yin unable to exit, implying two pulses constitute one disease. The meaning is hard to distinguish.) (From *Mai Du*)
*[Su Wen]* Qi excess corresponds to Form excess; Qi deficiency corresponds to Form deficiency. This is normal. Opposite indicates disease. Grain abundance corresponds to Qi abundance; grain scarcity corresponds to Qi deficiency. This is normal. Opposite indicates disease. Pulse excess corresponds to Blood excess; pulse deficiency corresponds to Blood deficiency. This is normal. Opposite indicates disease. How does the opposite occur? Qi deficiency with body heat is called opposite. (Missing above: "Qi excess with body cold is called opposite.") Abundant intake but little Qi is called opposite. Little intake but much Qi is called opposite. Full pulse with little Blood is called opposite. Weak pulse with much Blood is called opposite. Qi excess with body cold is acquired from cold damage. (The word 'cold' refers to initial cold sensation, not necessarily feeling cold. *Re Lun* states: Injury by cold leads to heat disease.) Qi deficiency with body heat is acquired from summerheat damage. (Summerheat damages Qi.) Abundant intake but little Qi is acquired from blood loss, with dampness residing below. (Blood loss leads to Yin deficiency and Yang excess, hence stomach dryness and consumption; dampness below leads to middle Qi stagnation, hence little Qi.) Little intake but much Qi is due to evil in Stomach and Lung. (Evil in Stomach reduces food intake; evil in Lung increases Qi, meaning wheezing/congestion.) Small pulse with much Blood indicates heat within fluid retention. (Wu's annotation: Those with phlegm-fluid retention have wiry-small pulses; those with internal heat have...)