（论十三首方一首脉证二条）
问曰。上工治未病。何也。师曰。夫治未病者。见肝之病。知肝传脾。当先实脾。四季脾旺不受邪。
即勿补之。中工不晓相传。见肝之病。不解实脾。惟治肝也。夫肝之病。补用酸。助用焦苦。益用甘味之药调之。
酸入肝。焦苦入心。甘入脾。脾能伤肾。肾气微弱。则水不行。水不行。则心火气盛。心火气盛。则伤肺。
肺被伤。则金气不行。金气不行。则肝气盛。肝气盛。则肝自愈。此治肝补脾之要妙也。肝虚则用此法。实则不可
用之。经曰。虚虚实实。补不足。损有余。是其义也。余脏准此。
〔衍义〕经谓五脏相传者。又是脏气因邪并之。邪正相合。发动则有余。故得传于不胜也。今乃
云肝虚。虚证知其传脾。然肝虚必弱。弱则必为所胜者克。奚能传于不胜也。藏气法时论曰。肝欲
补。急食辛以补之。欲泻。以酸泻之。今云肝虚之病。补用酸。又奚为与内经相反也。试尝思之。
金匮首篇之所叙者。由人禀五行气味以成形。形成则声色渐着。于是四者。日行变化于身形之中。
未尝斯须离也。故列于篇首。以为治病之规范。此条特明于味者耳。夫阴阳者。在天为风、寒、
湿、热、燥、火之气。在地成水、火、金、土、木之形。在人化辛、酸、咸、苦、甘之味。是故人之
五脏。从五行生数。配其奇偶。互成体用。天一生水。在体为精。在气为寒。地二生火。在体为神。在气
为热。精与神配。寒与热配。二者形之始着。自合一奇偶也。天三生木。在体为魂。在气为风。地四生金。
在体为魄。在气为燥。魂与魄合。风与燥配。居形生成之中。亦合奇偶。然生物者气也。成之者味也。
以奇生则成而偶。以偶生则成而奇。寒之气坚。故其味可用咸以 。热之气 。故其味可用苦以坚。
风之气散。故其味可用酸以收。燥之气收。故其味可用辛以散。土兼四时。行无定位。无专性。阴阳
冲气之所生。故其味甘以缓。洪范亦曰。稼穑作甘味之成者
为体。气之成者为用。有诸体而形诸用。故肝木者必收之而后可散。非收则体不立。非散则用不行。
遂致体用之偏之气。皆足以传于不胜也。偏于体不足者必补。酸以收之。偏于用不足者必补。辛以
散之。故补体者必泻其用。补用者即泻其体。因知内经云辛补。为其用也。仲景云酸补。为其体也。
然仲景之言。亦出内经。内经谓风生木。木生酸。酸生肝。岂非酸乃肝之本味。以本味补本体。不待
言而可知。故正言时论补泻其用之行变化者。亦不可以为仲景相反也。又云弱水壮火。使金气不行。
则肝气自愈者。水乃木之母。火乃木之子。此即母能令子虚。子能令母实之义。由子克退鬼贼故也。然不
止一法。又有所谓虚则补其母。实则泻其子。二者之法。常对待而立。为五行逆顺而设。逆行则相胜。
顺行则相生。治相胜者。则当弱水旺火。治相生者。则当益水泻火。水能生木。于木虚者。
盒饭补水。水盛则木得受其所生矣。于木实者。盒饭泻火。火退则金气来制。而木平矣。仲景谓肝虚
用此。实则不用者。意则在是。观夫内经治胜复之气于既复之后。两气皆虚。必补养安全而平定之。使余
之气自归。其所属。少之气自安其所居。初胜之际。其气为实。则泻其有余。由是以言。仲景此条之意。又未必不
似于斯也。
夫人秉五常。因风气而生长。风气虽能生万物。亦能害万物。如水能浮舟。亦能覆舟。若五脏元
真通畅。人即安和。客气邪风。中人多死。千般 难。不越三条。一者经络受邪。入脏腑。为内所
因也。二者四肢九窍。血脉相传。壅塞不通。为皮肤所中也。三者房室金刃虫兽所伤。以此详之。病由
都尽。若人能养慎。不令邪风干忤经络。适中经络。未流传腑脏。即医治之。四肢才觉重滞。即导引吐
纳。针灸膏摩。勿令九窍闭塞。更能无犯王法。禽兽灾伤。房室勿令竭乏。服食节其冷热。苦辛酸
甘。不遣形体有衰。病则无由入其腠理。腠者。是三焦通会元真之处。为血气所注。理者。是皮肤脏
腑之纹理也。
〔衍义〕此条举生身之气而言。所谓五常者。五行经常之气也。上应列宿。在地成
象。名曰刚柔。金、木、水、火、土也。在天无质。名曰阴阳。风寒、湿热、燥火也。人在气交
中。秉地之刚柔。以成五脏百骸之形。秉天地之阴阳。以成六经之气。形气合一。神机发用。驾行谷
气。出入内外。同乎天度。升降浮沉。应夫四时。主宰于身形之中者。谓之元真。其外感者。皆
客气也。主客之气。各有正不正。主气正则不受邪。
不正则邪乘之。客气正则助其生长。不正则害之。主气不正者。由七情动中。服
食不节。房欲过度。金刃虫兽。伤其气血。尽足以虚之。客气之不正者。由气运兴衰。八风不常。尽
足以虚之。客气伤人。或谓风寒湿热燥火。但有德化。政令行于时。和则化。乖则变。变则眚。岂独
风能生能害于物哉。今仲景止言风而不及五气。何也。曰阴阳在天地间。有是气。则有是理。人秉是
气。即以为命。受是理。即以为性。若仁者乃风木之理。风木乃仁之气。先儒且言仁者。天地生物之心。
兼统五常之性。其风木者。亦天地生物号令之首。必兼统五常之气。五气莫不待其
鼓动以行变化。故内经曰。之化之变。风之来也。大抵医之独言风。犹儒之专言
仁也。内经又曰。八风发邪以为经风。触五脏。灵枢曰。虚邪不能独伤人。必因身形之虚而后客之。
又云。风寒伤人。自经络传入经脉肌肉筋骨。内经五内。仲景所谓人能慎养。不令邪中。为内外所因者。
盖取诸此以分表里者也。非后世分三因之内因也。语同而理异。三因之内因。由七情房室。虚其元真。
以致经络脏腑之气。自相克伐者也。
〔补注〕此条首言元真通畅。人即安和。末言病则无由入其腠理。盖重阳气以固其阴也。
问曰。病患有气色见于面部。愿闻其说。师曰。鼻头色青腹中痛。苦冷者死。（一云腹中冷苦痛者死）
鼻头色微黑者。有金气。色黄者。胸上有寒。色白者。亡血也。设微赤非其时者死。其目正圆者。
痉不治。又色青为痛。色黑为劳。色赤为风。色黄者便难。色鲜明者有留饮。
〔衍义〕青者。肝之色。肝苦急。急则痛。苦冷者。是厥阴挟其肾水为寒。寒极则阳亡。
阳亡则死。微黑者肾之色也。肾属水。水停则色微黑而不照。若照者是水胜火而血死。黄者脾之色。脾
主土。输谷气于上焦。以化荣卫。今胸中有寒。谷气不化。郁为胃热。显出其黄色。黄为中焦蓄热。今不
谓中焦热。而为胸中有寒者。乃指其致病之本而言也。白者肺之色。肺主上焦。以行荣卫。荣之色充则面
华。不充则面白。知其亡血也。赤为火色。若非火令之时。加于白色之上。是火重来克金
也。故死。目通于肝。眼皮属之脾。其肺金不能制木。风木得以自盛。反胜脾肺。是故风急则眼皮敛涩。
目为之正圆。甚则筋强肉重而成痉。痉由木贼土败。故亦不治。虽然。色不可一例取。则又云青为痛者。与正文义同。
黑为劳者。房劳也。入
房太盛。竭精无度。情火炽而肾水乏。则又与水气之黑异矣。此属之火也。火之色虽赤。
然是火发于肾水之中。故不赤而反黑。其黑必枯燥。不似水气之黑。黑而光泽者也。赤为风者。由热生风。
子令母实故也。黄为便难者。以中焦热燥其液。肠胃不润。是以便难。然是黄色必枯而不泽。所以又
谓若鲜明者为留饮。留饮以津液不行。滞其谷气。化热致黄也。虽然。同此论也。及考夫内经。其五色又
有从观于面。察于目。谓面黄目青。面黄目赤。面黄目白。面黄目黑。皆不死。又谓青如翠羽。赤如鸡
冠。黄如蟹腹。白如豕膏。黑如乌羽者。是生色也。青如草滋。赤如 血。黄如枳实。黑如 煤。白如枯骨。
是死色也。又有从五脏分部颜颊鼻颐者。如刺热篇谓赤色是也。由是推之。五脏善恶之色。更必有随其气。
显露其色。各于其所司目唇鼻窍之内外者。盖仲景欲明望色知病之道。故举此略耳。
师曰。病患语声寂然。喜惊呼者。骨节间病。语声喑喑然。不彻者。心膈间病。语声啾
啾然。细而长者头中病。
〔衍义〕此条举听五行之病声而言。所谓寂然者。欲语而默默处也。夫阴静而阳
躁。此病在厥阴。故好寂然也。厥阴在志为惊。在声为呼。在体为筋。筋束关节。所
以厥阴之病善惊。在声为呼。则知其病在骨节也。喑喑然不彻者。声出不扬也。盖肺主气。膈乃肺之部。
宗气行呼吸入出升降于是焉。语声之不彻。则知其气不得升。是心膈之有病也。啾啾者。声小啾
唧也。细而长者。其气起自下焦从阴则细。道远则长。盖是巨阳主气。少阴与之为表里。巨阳有邪。
则少阴上从而逆于巅。肾在声为呻。阳主躁。故呻吟之声。从阳变而为啾唧细长也。巨阳脉在头。
是头中病。亦仲景特发听声察病之一法耳。若更推而广之。则五音之宫、商、角
征、羽。五声之歌、哭、笑、呻、吟之变。皆可求五脏表里虚实之病。五气之邪。尤医者之当要也。
师曰。息摇肩者。心中坚。息引胸中。上气者咳。息张口短气者。肺痿唾沫。
〔衍义〕息者。呼气出粗。类微喘而有声也。呼出心与肺。今火乘肺。故呼气奔促而为息也。摇
肩者。肩随息气摇动。以火主动故也。其心之经脉掣引也。因心中有坚实之邪。不得和于经脉。故经脉
抽掣摇动。息引胸中上气咳者。胸中。脉所主也。宗气之所在。火炎于肺。则肺收降之令不行。反
就燥而为固涩坚劲。气道不利。所以上气出于胸中者则咳也。息张口短气。肺痿唾沫。此又火炎于肺之甚
者。收降清肃之气亡。惟从火出。故张口不合也。宗气亦衰而息短矣。津液不布。从火而为沫唾矣。
此仲景因呼息以为察病之法。与后条吸对言以举端耳。然息病属于内外者。岂止此而已。动摇与息
相应者。又宁独在肩而已。岂无阴虚以火动者焉。如内经谓乳子中风热。喘鸣息肩者。脉实大也。缓则生。
急则死。是又在脉别者也。
师曰。吸而微数。其病在中焦。实也。当下之即愈。虚者不治。在上焦者其吸促。在下
焦者其吸远。此皆难治。呼吸动摇振振者不治。
〔衍义〕谷之精气。乃分三隧。清者化荣。浊者化卫。其一为宗气。留胸中以行呼吸
焉。呼吸固资于宗气。然必自阴阳合辟而为之机。于是呼出者。心肺主之。吸入者。肾肝主之。
心肺阳也。肾肝阴也。若中焦有邪实。则阻其升降。宗气因之不盛于上。吸气因之不达于下。中
道即还。宗气不盛则吸微。中道即还则往来速。速则数。故吸而微数。泻中焦实。则升降行而吸即平矣。
不因中焦实。即是肾肝之阴虚。根本不固。其气轻浮上走。脱阴之阳。宗气亦衰。若此者死日有期。尚可治
乎。然则上焦固是主乎呼。下焦固是主乎吸。若阴阳之配合。则又未始有相离
者。故上焦亦得而候其吸焉。而心肺之道近。其真阴之虚者。则从阳火而升不入乎下。故吸促。肝肾之道
远。其元阳之衰者。则因于阴邪所伏。卒难升上。故其吸远。此属真阴元阳之病。皆难以治。若夫人身
之筋骨血肉脉络。皆藉阴气之所成。生气无所克。然后得以镇静而为化生之宇。今阴气惫矣。生气索矣。器宇
亦空矣。惟呼吸之气往来于其中。故振振动摇不自禁也。若此者。即内经所谓
出入废则神机化灭是也。故针药无及矣。
师曰。寸口脉动者。因其旺时而动。假令肝旺色青。四时各随其色。肝色青而反色
白。非其时色脉皆当病。
〔衍义〕内经有谓五脏之脉。春弦夏钩。秋毛冬石。强则为太过。弱则为不足。四时
皆以胃气为本。有胃气曰平。胃少曰病。无胃曰死。有胃而反见所胜之脏脉。甚者今病。微者至其所胜之时
病。又谓五脏之色。在旺时见者。春苍。夏赤。长夏黄。秋白。冬黑。所主外荣之常者。白当肺当皮。赤当
心当脉。黄当脾当肉。青当肝当筋。黑当肾当骨。五色微诊。可以目察。能合脉色。可以万全。其内经
之言如此。斯论殆将本于是之节文也。
问曰。有未至而至。有至而不至。有至而不去。有至而太过。何谓也。师曰。冬至之后。
甲子夜半少阳起。少阳之时阳始生。天得温和。以未得甲子。天因温和。此为未至
而至也。以得甲子而天未温和。此谓至而不至也。以得甲子而天大寒不解。此谓
至而不去也。以得甲子而天温如盛夏五六月时。此谓至而太过也。
〔衍义〕夫斗建子月中辰。即冬至节也。节阳至。一之气即至。故律管飞灰。候于是
日。今仲景乃云。冬至后甲子夜半候以至未至者。何欤。殆以天干地支所合节
至之日。便名甲子。非直待其真甲子日至以候气也。不然。假如乙丑丙寅日冬至。两月后方是甲子。
其时始候之乎。考之内经。候气至不至。有谓四时者。有谓五运者。有谓六气者。发明详矣。至四时。
(Thirteen discussions, one formula, two pulse and symptom clauses)
Question: What is meant by the statement that a superior physician treats disease before it arises?
Master said: The so-called treatment of disease before it arises refers to seeing liver disease, knowing that liver disease will transmit to the spleen, and therefore first strengthening the spleen. If in the four seasons the spleen qi is prosperous and not invaded by pathogenic factors, there is no need to specifically tonify the spleen. Physicians of average understanding do not comprehend the transmission between zang organs; upon seeing liver disease, they fail to strengthen the spleen and only treat the liver. For liver disease, sour herbs are used to tonify, scorched bitter herbs to assist, and sweet herbs to harmonize. Sour enters the liver, scorched bitter enters the heart, and sweet enters the spleen. The spleen can restrain the kidney, making kidney qi weak, so water fluids do not flow recklessly. When water does not flow recklessly, heart fire qi becomes prosperous. When heart fire is prosperous, it damages lung metal. When lung is damaged, metal qi cannot circulate. When metal qi does not circulate, liver qi becomes prosperous. When liver qi is prosperous, liver disease heals itself. This is the subtlety of treating liver disease by tonifying the spleen. This method applies to liver deficiency patterns, but should not be used for excess patterns. The Classic says: "Do not make the deficient more deficient or the excess more excess; tonify insufficiency and reduce surplus." This is the meaning. The same principle applies to other zang organs.
[Extended Meaning] The Classic states that transmission among the five zang organs occurs when organ qi combines with pathogenic factors. When pathogenic and righteous qi combine and activate, they manifest as excess, thus transmitting to the organ that cannot overcome it. Now it is said that liver deficiency knows it will transmit to the spleen. However, liver deficiency implies weakness, and weakness implies being overcome by the organ it controls (the one it overcomes in normal physiology), so how can it transmit to the organ it cannot overcome? The *Treatise on Organ Qi and Seasons* states: "The liver desires tonification; urgently eat pungent substances to tonify it. The liver desires purgation; use sour substances to purge it." Now it is said that for liver deficiency, sour is used to tonify. How does this contradict the *Inner Classic*? Consider this: The content narrated in the first chapter of *Jin Gui* describes how humans inherit the qi and flavors of the Five Elements to form their bodies. Once formed, characteristics such as sound, color, and flavor gradually appear. These four aspects undergo daily changes within the body without ever departing. Therefore, they are placed at the beginning of the chapter as standards for treatment. This clause specifically clarifies the principles regarding "flavor." Yin and Yang, in heaven, are the qi of wind, cold, dampness, heat, dryness, and fire; on earth, they form the shapes of water, fire, metal, earth, and wood; in humans, they transform into the flavors of pungent, sour, salty, bitter, and sweet. Thus, the five zang organs of humans follow the generative numbers of the Five Elements, matching odd and even numbers, mutually forming substance and function. Heaven generates one water; in the body it is essence, in qi it is cold. Earth generates two fire; in the body it is spirit, in qi it is heat. Essence and spirit match; cold and heat match. These are the initial manifestations of form, naturally combining odd and even. Heaven generates three wood; in the body it is soul, in qi it is wind. Earth generates four metal; in the body it is corporeal soul, in qi it is dryness. Soul and corporeal soul combine; wind and dryness match. Existing within the formation of form, they also conform to odd and even. However, what generates living things is qi, and what forms them is flavor. Generated by odd, it becomes even; generated by even, it becomes odd. Cold qi is firm, so its flavor can be softened with salty. Heat qi disperses, so its flavor can be consolidated with bitter. Wind qi disperses, so its flavor can be astringed with sour. Dryness qi gathers, so its flavor can be dispersed with pungent. Earth encompasses the four seasons, has no fixed position, no specific nature, and is generated by the harmonious qi of yin and yang, so its flavor is sweet and relaxing. The *Hong Fan* also states: "Sowing and reaping produce sweetness." Flavor formation serves to constitute substance, while qi formation serves to exert function. Having substance manifests function. Therefore, liver wood must first be astringed before it can disperse. Without astringing, substance cannot stand; without dispersing, function cannot operate. This leads to qi of biased substance and function, which is sufficient to transmit to the organ it cannot overcome. Those biased towards insufficient substance must be tonified, using sour to astringe them; those biased towards insufficient function must be tonified, using pungent to disperse them. Thus, tonifying substance requires purging function, and tonifying function requires purging substance. From this, we know that when the *Inner Classic* says pungent tonifies, it refers to tonifying function; when Zhang Zhongjing says sour tonifies, it refers to tonifying substance. However, Zhang Zhongjing's words also originate from the *Inner Classic*. The *Inner Classic* says wind generates wood, wood generates sour, sour generates liver. Is sour not the original flavor of the liver? Using the original flavor to tonify the original substance is self-evident. Therefore, the *Treatise on Organ Qi and Seasons* discusses tonifying and purging the movement and transformation of function, and this cannot be considered contradictory to Zhang Zhongjing. It also states that weakening water and strengthening fire causes metal qi to cease, allowing liver qi to heal itself. Water is the mother of wood, and fire is the child of wood. This is the meaning of "the mother can cause the child to be deficient, and the child can cause the mother to be substantial." It is due to the child overcoming and retreating the "ghost thief" (pathogen). However, there is not just one method; there is also the method of "tonify the mother when deficient, purge the child when excess." These two methods are often established in opposition, designed for the reverse and forward sequences of the Five Elements. Reverse sequence involves overcoming; forward sequence involves generating. To treat an overcoming relationship, one should weaken water and strengthen fire; to treat a generating relationship, one should benefit water and purge fire. Water generates wood; for wood deficiency, one should tonify water. When water is abundant, wood receives its generation. For wood excess, one should purge fire. When fire retreats, metal qi comes to control it, and wood qi becomes balanced. Zhang Zhongjing says this method is used for liver deficiency but not for excess; the intent lies here. Observing the *Inner Classic*, after the treatment of winning and losing qi when both are exhausted, one must nourish and stabilize them, allowing residual qi to return to its belonging and deficient qi to settle in its residence. At the initial stage of winning, the qi is excess, so one purges the surplus. From this perspective, the intent of this clause by Zhang Zhongjing may well be similar to this.
Humans inherit the Five Constants (the constant principles of the Five Elements) and grow due to wind and qi. Although wind and qi can generate all things, they can also harm all things, just as water can float a boat but also capsize it. If the primordial true qi of the five zang organs flows smoothly, the person remains peaceful and harmonious. Hostile qi and evil wind invading people often lead to death. The myriad difficulties and diseases do not exceed three categories: First, meridians and collaterals receive pathogenic factors, which enter the zang-fu organs, constituting the internal cause. Second, the four limbs and nine orifices have blood and vessels transmitting pathogens, causing blockage, constituting invasion through the skin. Third, injuries from sexual activity, metal blades, insects, and beasts. Examining these carefully, the causes of disease are fully covered. If a person practices health preservation and caution, preventing evil wind from interfering with meridians and collaterals, and if pathogens hit the meridians but have not yet spread to the zang-fu organs, they should be treated immediately. If the four limbs feel heavy and stagnant, methods such as Daoyin (guiding and pulling), Tunai (breathing exercises), acupuncture, moxibustion, and massage with ointments should be used, preventing the closure of the nine orifices. Furthermore, one should avoid violating laws, suffering disasters from animals, and excessive sexual activity leading to exhaustion. Diet should regulate cold, heat, bitterness, pungency, sourness, and sweetness, ensuring the physical form does not decline. In this way, disease has no opportunity to enter the Couli (interstices). Couli are the places where the Sanjiao connects and the primordial true qi meets, where blood and qi pour in. Li are the textures of the skin and zang-fu organs.
[Extended Meaning] This clause discusses the qi of bodily generation. The so-called Five Constants refer to the constant qi of the Five Elements. Above, they correspond to constellations; below, they form images, named Gang-Rou (Hard and Soft), namely Metal, Wood, Water, Fire, and Earth. In heaven, they have no form, named Yin and Yang, namely Wind, Cold, Dampness, Heat, Dryness, and Fire. Humans exist in the intersection of qi, inheriting the Gang-Rou of the earth to form the shape of the five zang organs and hundred bones, and inheriting the Yin-Yang of heaven and earth to form the qi of the six channels. Form and qi unite, Shen-Ji (spirit mechanism) activates, driving Gu-Qi (grain qi), entering and exiting internally and externally, aligning with celestial measures, rising and sinking, floating and descending, responding to the four seasons. That which governs the human body is called Yuan-Zhen (Primordial True Qi). External invasions are all Ke-Qi (Guest Qi). Master and Guest Qi each have correct and incorrect states. If Master Qi is correct, it does not accept pathogens; if incorrect, pathogens take advantage. If Guest Qi is correct, it aids growth; if incorrect, it causes harm. Incorrect Master Qi results from emotional disturbances, irregular diet, excessive sexual desire, metal blade or insect/beast injuries damaging blood and qi, all sufficient to cause deficiency. Incorrect Guest Qi results from fluctuations in Qi-Yun (qi movements) and irregular Eight Winds, all sufficient to cause deficiency. When Guest Qi harms humans, some say Wind, Cold, Dampness, Heat, Dryness, and Fire. Only when there is virtue and transformation, and policies are executed in season, does harmony lead to transformation; deviation leads to change, and change leads to disaster. Is it only Wind that can generate and harm things? Now Zhang Zhongjing mentions only Wind and not the Five Qi. Why? I reply: Yin and Yang exist in heaven and earth; where there is qi, there is principle. Humans inherit this qi and regard it as life; receiving this principle, they regard it as nature. Benevolence is the principle of Wind-Wood; Wind-Wood is the qi of Benevolence. Ancient Confucians stated that Benevolence is the mind of heaven and earth generating life, encompassing the natures of the Five Constants. Wind-Wood is also the head of heaven and earth's biological commands, necessarily encompassing the qi of the Five Constants. The Five Qi wait for its stirring to undergo transformation and change. Thus the *Inner Classic* says: Transformation and change come with Wind. Generally, physicians speak only of Wind, just as Confucians speak exclusively of Benevolence. The *Inner Classic* also says: Eight Winds emit pathogens to become Jing-Feng (Meridian Wind), touching the five zang. The *Ling Shu* says: Deficient pathogens cannot injure alone; they must encounter bodily deficiency to invade. It also says: Wind and cold injuring humans enter from meridians into channels, muscles, and sinews/bones. The *Inner Classic*'s internal organs, and Zhang Zhongjing's statement that humans can practice caution and not let pathogens invade, referring to internal and external causes, essentially takes from this to distinguish exterior and interior. It is not the Internal Cause of the later Three Causes theory. The words are the same, but the logic differs. The Internal Cause of the Three Causes theory results from seven emotions and sexual activity depleting Yuan-Zhen, causing the qi of meridians and zang-fu organs to attack each other.
[Supplementary Note] This clause begins by stating that when Yuan-Zhen flows smoothly, the person is peaceful and harmonious, and ends by saying that if disease does not enter the Couli, it is primarily about valuing Yang Qi to secure Yin.
Question: Patients show complexion changes on the face. I wish to hear your explanation.
Master said: A bluish nose tip indicates abdominal pain; if accompanied by aversion to cold, it is fatal. (Another version says: abdominal cold and severe pain is fatal.) A slightly black nose tip indicates water retention. Yellow color indicates cold above the chest. White color indicates loss of blood. If slightly red and not during the appropriate season, it is fatal. Eyes staring straight ahead indicate untreatable Spasm (Jing). Additionally, blue color indicates pain, black indicates劳 (exhaustion/strain), red indicates Wind, yellow indicates difficult defecation, and bright/lustrous color indicates retained fluid (Liu-Yin).
[Extended Meaning] Blue is the color of the Liver. The Liver suffers from urgency, and urgency causes pain. "Bitter cold" indicates Jueyin combining with Kidney Water to create cold. Extreme cold leads to Yang collapse, and Yang collapse leads to death. Slightly black is the color of the Kidney. Kidney belongs to Water; water stagnation causes a slightly black color lacking luster. If it shines, it means Water overcomes Fire and blood dies. Yellow is the color of the Spleen. Spleen governs Earth, transporting grain qi to the Upper Jiao to transform Ying and Wei. Currently, there is cold in the chest, grain qi fails to transform, stagnates into Stomach heat, revealing yellow. Yellow indicates heat accumulation in the Middle Jiao. Now it is not called Middle Jiao heat, but cold in the chest, referring to the root cause of the disease. White is the color of the Lung. Lung governs the Upper Jiao, circulating Ying and Wei. When Ying color is full, the face is radiant; when not full, the face is white, indicating blood loss. Red is the color of Fire. If not during the Fire season, appearing over white, it means Fire returns to overcome Metal, hence fatal. Eyes connect to the Liver; eyelids belong to the Spleen. If Lung Metal cannot control Wood, Wind-Wood becomes excessive, counter-overcoming Spleen and Lung. Thus, urgent Wind causes eyelids to contract and stiffen, eyes becoming round. Severe cases lead to strong sinews and heavy flesh, resulting in Spasm. Spasm results from Wood attacking Earth and Earth failing, hence also untreatable. Nevertheless, colors cannot be judged uniformly. Saying blue indicates pain aligns with the main text. Black indicates 劳 (sexual exhaustion). Excessive sexual activity depletes essence without limit, passion fire blazes while Kidney Water lacks, differing from the black of water qi. This belongs to Fire. Although Fire's color is red, since this fire originates within Kidney Water, it is not red but black. Its blackness must be dry and rough, unlike the glossy black of water qi. Red indicates Wind because heat generates Wind, and the child makes the mother substantial. Yellow indicates difficult defecation because Middle Jiao heat dries fluids, intestines and stomach lack moisture, leading to difficulty. However, this yellow must be dull and un-lustrous. Hence, it is said that if bright and lustrous, it indicates retained fluid. Retained fluid occurs because Jin-Ye (body fluids) do not flow, stagnating grain qi, transforming into heat causing yellow. Although discussing the same topic, examining the *Inner Classic*, the five colors also include observing the face and eyes: yellow face with blue eyes, yellow face with red eyes, yellow face with white eyes, yellow face with black eyes—all are not fatal. It also states: Blue like kingfisher feathers, red like chicken combs, yellow like crab abdomen, white like pig fat, black like crow feathers—are vibrant colors (Sheng-Se). Blue like grass stains, red like clotted blood, yellow like buckthorn fruit, black like soot, white like dead bones—are dying colors (Si-Se). There are also distributions according to five zang on the cheeks, nose, and chin, such as the *Ci Re Pian* mentioning red color. From this, it can be deduced that the good and evil colors of the five zang must also reveal their colors according to their qi, each in their respective domains of the eyes, lips, nose, and orifices. Zhang Zhongjing likely mentioned this briefly to clarify the method of diagnosing disease by observing color.
Master said: Patients who are silent in speech but prone to sudden cries have disease in the joints. Patients whose speech is hoarse and indistinct have disease in the Heart and Diaphragm. Patients whose speech is quiet, thin, and long have disease in the head.
[Extended Meaning] This clause discusses listening to the sounds of diseases related to the Five Elements. "Silent" means wanting to speak but remaining mute. Yin is quiet, Yang is restless. This disease is in Jueyin, hence preferring silence. Jueyin corresponds to fear in emotion, crying in sound, and sinews in the body. Sinews bind the joints, so Jueyin disease is prone to fright and crying in sound, indicating disease in the joints. Hoarse and indistinct means sound does not project clearly. Lung governs Qi, and the Diaphragm is the region of the Lung. Zong-Qi (Gathering Qi) moves respiration in and out, rising and falling here. Indistinct speech indicates Qi cannot rise, implying disease in the Heart and Diaphragm. "Jiu-Jiu" means small chirping sounds. Thin and long: Qi originating from the Lower Jiao following Yin is thin; the path is long, so it is long. JuYang (Greater Yang) governs Qi, and ShaoYin is its exterior-interior pair. When JuYang has pathogens, ShaoYin follows upward and rebels to the vertex. Kidney corresponds to groaning in sound. Yang governs restlessness, so groaning sounds transform from Yang into quiet, thin, and long chirps. JuYang pulses are in the head, indicating disease in the head. This is another special method of Zhang Zhongjing for diagnosing disease by listening. If extended further, the five tones Gong, Shang, Jue, Zhi, Yu, and the five sounds Song, Cry, Laugh, Groan, Moan, along with their variations, can all be used to seek disease in the interior-exterior, excess-deficiency of the five zang. Pathogens of the five qi are especially important for physicians.
Master said: Breathing accompanied by shoulder movement indicates hardness in the Heart. Breathing drawing Qi upward from the chest indicates cough. Breathing with open mouth and shortness of breath indicates Lung萎 (Flaccidity) with saliva foam.
[Extended Meaning] Xi (Breath/Sigh) refers to coarse exhalation, resembling mild wheezing with sound. Exhalation is governed by Heart and Lung. Now Fire attacks Lung, causing rapid exhalation and sighing. Shoulder shaking means shoulders move with breathing due to Fire's active nature. It pulls the Heart meridians. Because there is solid pathogenic factor in the Heart, unable to harmonize with meridians, the meridians spasm and shake. Drawing Qi upward from the chest with cough: The chest is governed by meridians and is the location of Zong-Qi. Fire blazing in Lung prevents Lung's descending function, turning instead to dryness, becoming rigid and obstructive, airway not smooth, thus Qi rising from chest causes cough. Open-mouth breathing and shortness of breath with Lung Flaccidity and saliva foam: This is severe Fire blazing in Lung. Descending and clearing Qi is lost, only following Fire out, hence mouth opens and cannot close. Zong-Qi declines, breath is short. Fluids do not distribute, turning to foam/saliva via Fire. This is Zhang Zhongjing's method of diagnosing disease via respiration, contrasting with inhalation in subsequent clauses to provide an example. However, respiratory diseases belonging to interior/exterior are not limited to this. Movements corresponding to breath are not limited to shoulders. Could there not be Yin deficiency moving by Fire? As the *Inner Classic* states: Infants contracting Wind-Heat, wheezing and sighing with shoulder movement, pulse is substantial and large. Slow pulse indicates survival, rapid pulse indicates death. This depends on pulse differentiation.
Master said: Inhalation that is slightly rapid indicates disease in the Middle Jiao, which is excess. Purging will cure it. Deficiency is untreatable. In the Upper Jiao, inhalation is short and急促 (rapid); in the Lower Jiao, inhalation is deep and distant. All these are difficult to treat. Respiration accompanied by whole-body trembling and shaking is untreatable.
[Extended Meaning] Essence of grain divides into three tunnels: clear transforms into Ying, turbid into Wei, and one becomes Zong-Qi, remaining in the chest to govern respiration. Respiration relies on Zong-Qi, but must originate from the opening and closing of Yin and Yang. Thus, exhalation is governed by Heart and Lung; inhalation by Kidney and Liver. Heart and Lung are Yang; Kidney and Liver are Yin. If there is pathogenic excess in the Middle Jiao, it blocks ascending and descending. Zong-Qi consequently fails to prosper upwards, and inhalation fails to reach downwards, returning midway. Zong-Qi not prospering makes inhalation slight; returning midway makes movement fast, hence rapid. Thus, slight and rapid inhalation. Purging Middle Jiao excess allows ascending/descending to proceed, and inhalation levels out. If not due to Middle Jiao excess, it is Kidney/Liver Yin deficiency, root instability, Qi floating upward, Yang escaping Yin, Zong-Qi declining. Such cases have a set date for death, how can they be treated? Although Upper Jiao governs exhalation and Lower Jiao governs inhalation, Yin-Yang pairing never separates, so Upper Jiao can also be observed via inhalation. Heart/Lung pathways are close; true Yin deficiency rises with Yang Fire and does not enter Lower Jiao, hence rapid inhalation. Kidney/Liver pathways are distant; Yuan Yang deficiency lies hidden under Yin pathogens, hard to ascend, hence distant/deep inhalation. These are diseases of True Yin and Yuan Yang, all difficult to treat. Human sinews, bones, flesh, blood, and vessels rely on Yin Qi for formation. When Sheng-Qi (Vital Qi) has nothing to overcome, it can remain calm and serve as the space for generation. Now Yin Qi is exhausted, Vital Qi is depleted, the vessel is empty. Only respiratory Qi moves within, causing trembling and uncontrollable shaking. Such cases are what the *Inner Classic* calls "When exit and entry cease, the Shen-Ji perishes." Thus, acupuncture and medicine are useless.
Master said: Cun-Kou (Inch Position) pulse movement occurs due to its prosperous time. For example, Liver prosperity brings blue color. The four seasons each follow their respective colors. If Liver color is blue but turns white, and it is not the appropriate season, both color and pulse indicate disease.
[Extended Meaning] The *Inner Classic* states the pulses of the five zang: Spring Wiry, Summer Hook, Autumn Floating, Winter Sinking. Strong is excess, weak is insufficiency. The four seasons all take Stomach Qi as the root. Having Stomach Qi is peace, little Stomach Qi is disease, no Stomach Qi is death. With Stomach Qi but showing the pulse of the overcoming organ, severe cases mean current disease, mild cases mean disease when reaching the overcoming time. It also states the colors of the five zang seen in prosperous times: Spring Azure, Summer Red, Late Summer Yellow, Autumn White, Winter Black. The normal external manifestation governed by them: White corresponds to Lung and Skin, Red to Heart and Vessels, Yellow to Spleen and Flesh, Blue to Liver and Sinews, Black to Kidney and Bone. Subtle diagnosis of five colors can be observed by eye; combining pulse and color ensures perfection. The words of the *Inner Classic* are thus. This discussion likely derives from these excerpts.
Question: What is meant by "not arrived but arrived," "arrived but not arrived," "arrived but not departed," and "arrived but excessive"?
Master said: After Winter Solstice, at midnight of the Jia-Zi day, ShaoYang rises. When ShaoYang arrives, Yang begins to generate, and the weather becomes warm. If the weather is warm before the Jia-Zi day arrives, this is "not arrived but arrived." If the Jia-Zi day arrives but the weather is not yet warm, this is "arrived but not arrived." If the Jia-Zi day arrives but severe cold persists, this is "arrived but not departed." If the Jia-Zi day arrives and the weather is warm like midsummer (May/June), this is "arrived but excessive."
[Extended Meaning] The Dipper points to Zi month and Chen hour, which is the Winter Solstice solar term. Yang arrives, the first Qi arrives, hence the tuning pipes fly ash on this day. Now Zhang Zhongjing says to observe arrival/non-arrival after Winter Solstice at midnight of Jia-Zi. Why? Likely because the day the Heavenly Stems and Earthly Branches combine with the solar term is named Jia-Zi, not waiting strictly for the true Jia-Zi day to observe Qi. Otherwise, if Winter Solstice falls on Yi-Chou or Bing-Yin days, Jia-Zi would be two months later; would observation start then? Examining the *Inner Classic*, observing Qi arrival/non-arrival mentions Four Seasons, Five Yun, and Six Qi, explained in detail. Regarding Four Seasons,