论二首 脉证十七条 方二首（此三字。辑义偶脱。）
肺中风者。（冒而肿胀。辑义。肿。讹作腹。诸本。皆作肿字。）
肺中寒。
按评热病论曰。劳风法在肺下。其为病也。使人强上冥视。唾出若涕。又曰。巨阳引精者三日。中年者五日。
不精者七日。咳出青黄涕。其状如脓。大如弹丸。从口中若鼻中出。咳论久咳下曰。使人多涕唾。先教论曰。古无
痰字。云唾出如涕。谓吐粘痰也。据此。则浊涕。即是粘痰。非鼻涕之谓也。
肺死脏。
先兄曰。此即浮芤之脉。
肝死脏。
先兄曰。此云浮之弱。尤氏以为其劲直则一也。不知何意。
心中风者。
按徐氏曰。饥者。火嘈也。食即呕吐。邪热不杀谷也。尤氏曰。心中饥。食则呕者。火乱于中。而热格于上也。
二说似是。又徐氏翕翕解未确。弟子村田精一曰。文选。张平子思玄赋。温风翕其增热兮。注。良曰。翕。热儿。
衡曰。说文曰。翕。炽也。是翕有热义。此说是。
邪哭使魂魄不安者。（朱氏曰。哭字疑误。阳气衰。阴气衰。衰字。当作病字解。此说谬。）
脾中风者。
按李氏皮目解。系臆说。辑义过存之。当删。
徐氏曰。金匮缺脾中寒。然不过如自利腹痛。腹胀不食。可类推也。
甘草干姜茯苓白术汤方
圣惠。治肾着之为病。身体冷。从腰以下痛重。甘草散方。
于本方。加当归。
三因。苓术汤。治冒暑遭雨。暑湿郁发。四肢不仁。半身不遂。骨节离解。缓弱不收。或入浴晕倒。口眼 斜。
手足 曳。皆湿温类也。
于本方。去甘草。加附子。泽泻桂心。
又苓术汤。治脾胃感风。飧泄注下。肠鸣腹满。四肢重滞。（云云）
于本方。加浓朴。青皮。半夏。草果。
宣明论。肾着汤。治胞痹。小便不利。鼻出清涕者。（即本方）
肾死脏。浮之坚。
徐氏曰。肾脏。风寒皆缺。然观千金三黄汤。用独活细辛。治中风及肾者。而叙病状曰。烦热心乱恶寒。终曰
不欲饮食。又叙肾中风曰。踞坐腰痛。则知金匮所缺。肾风内动之证。相去不远。至寒中肾。即是直中。当不越厥
逆下利。欲吐不吐诸条。
〔余述〕本篇所谓。中风中寒。与伤寒中之中风中寒不同。亦与半身不遂之中风自异。如内经五脏风。稍似相
近。而其证未必契合。则知此别是一义。不宜彼此牵凑。且其于风与寒之旨。注家不敢辨晰。殊无可征验。
姑阙其疑已。徐氏诸辈。于脾肾二脏。补出其遗。又于肝着脾约肾着三方。特论其趣。要皆不免臆度也。
问曰。三焦竭部。
〔赵〕尝考伤寒论。脉法中云。寸口脉微而涩。微者卫气不行。涩者营气不逮。营卫不能相将。三焦无所仰。
不归其部。上焦不归者。噫而吞酢。按平脉法。作酢吞。中焦不归者。不能消谷引食。下焦不归者。则遗溺。正
此之谓。
按魏氏曰。师又言不须治。久则愈者。非听其泄脱。不为援救也。言不须治其下焦。但理其中焦可也。朱氏曰。
便溺虽属下焦。而实中焦气紊所致也。故曰。不须治。久则愈。谓不须治下焦。但调理脾胃。久当自愈耳。二说欠
稳。亦姑存之。
师曰。热在上焦者。因咳为肺痿。
按小肠受胃中水谷。而分利清浊。大肠居小肠之下。主出糟粕。而其下口为肛门。因疑此条大肠小肠。系于传
写互错。盖言小肠有寒。故泌别不职。而水粪杂下。其有热者。肠垢被迫。而下出也。大肠有寒。则阳气下坠。
故下重便血。其有热者。毒结肛门。故为痔也。注家顺文解释。竟不免强凑。今大小易置。其义始了。但脉经
以来诸书。皆与今本同。则姑记所疑。以俟有道论定已。
李中梓病机沙篆曰。仲景云。小肠有寒。其人下重便血。以干姜。烧黑存性。磁碗合放冷地上。为末。每服一
钱。
米饮调下。神效。
问曰。病有积。有聚。有HT 气。何谓也。（脉经。HT 气。并作系气。为谷气下。有夫病已愈。不得复发。今病
复发。即为系气也。十七字。乃积也下。有细一作结注文。朱氏。亦以诸积以下为别条。）
〔朱〕凡阴寒凝结。由渐而成者。俱谓之积。故曰诸积。非有一例之证象也。但有一定沉细之脉象。故知其为
积也。病气深沉。不可不分上中下三焦以处之。脉亦必从寸关尺三部以候之。如寸口主上焦。脉细而附骨。知其积
在胸中。如胸痹之类是也。出寸口。上竟上也。主积在喉中。如痰气相搏。咽中如有炙脔等是也。关上主中焦。关
脉细沉。主积在脐旁。（按原文。作关部主中焦。而关有三候。关中主积在脐旁。云云。殊属无稽。今按经文改订。）
如选脐腹痛之类是也。微上关上。积在心下。如胃寒脘痛之类是也。微下关。积在少腹。如少腹寒痛之类是也。尺
候下焦。尺脉细沉。积在气冲。如阴寒疝症之类是也。
按聚者为可治。则积之为难治。可推可知。至HT 气。则固属易治。然恐不得不治自愈矣。
又按十八难。有寸关尺。主胸以上。膈以下。齐以下之言。又载诊积聚法。并与本条相发。宜参。又脉经。载诊五
脏积条。及诊法七条。今录其诊法于左。以备对考。
寸口脉沉而横者。胁下及腹中有横积痛。（按此素平人气象论文。）其脉弦。腹中急痛。（按此据小建中汤条。）腰背
痛相引。腹中有寒疝瘕。脉弦紧而微细者。 也。夫寒痹 瘕积聚之脉。皆弦紧。若在心下。即寸弦紧。在胃管。即关
弦紧。在脐下。即尺弦紧。（一曰关脉弦长。有积在脐左右上下也。）
又脉 法。左手脉横。 在左。右手脉横。 在右。脉头大者在上。头小者在下。
又法。横脉见左。积在左。见右积在右。偏得洪实而滑。亦为积。弦紧亦为积。为寒痹。为疝痛。内有积不见脉。
难治。见一脉（一作胁）相应。为易治。诸不相应。为不治。
左手脉大。右手脉小。上病在左胁。下病在左足。右手脉大。左手脉小。上病在右胁。下病在右足。
脉弦而伏者。腹中有 。不可转也。必死不治。
脉来细而沉。时直者。身有痈肿。若腹中有伏梁。
脉来小沉而实者。胃中有积聚。不下食。食即吐。
Two Treatises, Seventeen Pulse and Symptom Sections, Two Prescriptions (The three characters "this" are occasionally omitted in the *Jiyi*.)
When the Lung is affected by Wind: (The patient experiences dizziness and swelling. The *Jiyi* notes that the character "swelling" [Zhong] was erroneously written as "abdomen" [Fu]. All versions read "swelling".)
When the Lung is affected by Cold:
According to the *Ping Re Bing Lun* (Treatise on Evaluating Heat Diseases): The disease of Lao Feng typically resides below the Lung. Its symptoms include: stiffness of the neck and blurred vision, expectoration of viscous fluid resembling mucus. It further states: those with abundant essence recover in three days, middle-aged individuals in five days, and those lacking essence in seven days; they cough up greenish-yellow purulent sputum, resembling pus, sized like a pellet, expelled from the mouth or nose. The *Ke Lun* (Treatise on Cough) and its section on chronic cough state: causing excessive phlegm and saliva. The *Qi Bing Lun* (Treatise on Rare Diseases) states: in ancient times, there was no character for "phlegm"; it was described as "expectorating things like mucus," meaning the expulsion of sticky phlegm. Based on this, turbid nasal discharge refers to sticky phlegm, not merely nasal mucus.
The pulse of a dying Lung (Si Zang Mai):
My elder brother stated: This is the Floating-Kou pulse.
The pulse of a dying Liver (Si Zang Mai):
My elder brother stated: This is a Floating-Weak pulse. You Shi believed their stiff and straight quality was identical, but the meaning remains unclear.
When the Heart is affected by Wind:
According to Xu Shi: The sensation of hunger is "fire-related gastric discomfort" (Huo Cao); vomiting immediately after eating indicates pathogenic heat failing to rot and ripen food. You Shi stated: Hunger in the heart and vomiting after eating result from fire disturbing the interior and heat blocking the superior aspect. These explanations seem plausible. Regarding Xu Shi's interpretation of "Xi Xi," it was inaccurate. Disciple Murata Seichi cited Zhang Pingzi's *Sixuan Fu* in the *Wenxuan*: "Warm winds Xi increase the heat." The commentary by Liang states: "Xi means hot." Heng stated: The *Shuowen Jiezi* defines "Xi" as blazing/intense. Thus, "Xi" carries the meaning of heat. This interpretation is correct.
Crying caused by pathogenic factors, leading to unrest of the Hun and Po spirits: (Zhu Shi suggested the character "cry" [Ku] might be an error, proposing that "decline" [Shuai] should be interpreted as "disease." This view is incorrect.)
When the Spleen is affected by Wind:
Regarding Li Shi's explanation of "Pi Mu," it is speculative. The *Jiyi* retained it excessively; it should be deleted.
Xu Shi stated: The *Jin Gui Yao Lue* lacks a section on Cold affecting the Spleen. However, this can be inferred to resemble spontaneous diarrhea, abdominal pain, abdominal distension, and loss of appetite.
Gancao Ganjiang Fuling Baizhu Tang Prescription
The *Shenghui Fang* treats Shen Zhuo (Kidney Fixation): coldness of the body, pain and heaviness from the waist downward. Gancao San Prescription.
To this prescription, add Danggui.
The *San Yin Ji Yi Bing Zheng Fang Lun* Lingzhu Tang treats conditions arising from exposure to summer heat and rain, where summer-heat and dampness stagnate and manifest: numbness of the four limbs, hemiplegia, laxity of joints, weakness and inability to hold posture, or fainting during bathing, deviation of the mouth and eyes, and traction of hands and feet. These are all classified under Damp-Warmth diseases.
To this prescription, remove Gancao, and add Fuzi, Zexie, and Guixin.
Another version of Lingzhu Tang treats Spleen and Stomach affected by Wind: undigested diarrhea, borborygmus, abdominal fullness, and heavy, sluggish limbs. (Etc.)
To this prescription, add Houpo, Qingpi, Banxia, and Caoguo.
The *Xuanming Lun Fang* Shen Zhuo Tang treats Bao Bi (Bladder Obstruction): difficult urination and clear nasal discharge. (This is the same prescription.)
The pulse of a dying Kidney (Si Zang Mai): Hard upon light palpation.
Xu Shi stated: The Wind and Cold syndromes of the Kidney are missing. However, observing the Sanhuang Tang in the *Qianjin Fang*, which uses Duohuo and Xixin to treat Wind-stroke and Kidney diseases, the described symptoms include: vexation, heat, mental confusion, aversion to cold, and total lack of appetite throughout the day. Describing Wind affecting the Kidney, it mentions squatting due to lower back pain. From this, we know that the missing syndrome of internal stirring of Wind in the Kidney in the *Jin Gui* is not far removed. As for Cold directly invading the Kidney (Zhi Zhong), it would not exceed symptoms such as Jue Ni (cold extremities), diarrhea, and the urge to vomit without success.
[Additional Remarks] The Wind and Cold mentioned in this chapter differ from the Wind and Cold in the *Shang Han Lun*, and also differ from the Wind-stroke causing hemiplegia. Although somewhat similar to the Five Zang Winds in the *Nei Jing*, the symptoms do not necessarily align. Thus, this represents a distinct concept and should not be forced into alignment with others. Furthermore, commentators have dared not clarify the principles of Wind and Cold, leaving little verifiable evidence. We shall tentatively leave these doubts unresolved. Scholars like Xu Shi supplemented the missing aspects of the Spleen and Kidney and specifically discussed the prescriptions for Ganshuo, Piyue, and Shenzhuo, yet these efforts inevitably involve speculation.
Question: When the San Jiao functions fail, how are the regions affected?
Zhao: I have examined the Pulse Methods in the *Shang Han Lun*, which states: If the Cun Kou pulse is Micro and Choppy, Micro indicates Wei Qi does not flow, and Choppy indicates Ying Qi does not reach. When Ying and Wei cannot coordinate, the San Jiao has no support and fails to return to its proper region. If the Upper Jiao does not return, there is belching and acid regurgitation; according to the *Ping Mai Fa*, this is "swallowing acid." If the Middle Jiao does not return, there is an inability to digest grains and a reduced desire for food. If the Lower Jiao does not return, there is urinary incontinence. This is exactly what is meant.
Wei Shi noted: The Master said, "No treatment is needed; it will heal itself over time." This does not mean allowing leakage without rescue. It implies that treating the Lower Jiao is unnecessary; rather, one should regulate the Middle Jiao. Zhu Shi stated: Although urination and defecation belong to the Lower Jiao, they are actually caused by disorder in the Middle Jiao Qi. Therefore, saying "no treatment is needed; it will heal itself" means no treatment of the Lower Jiao is required; regulating the Spleen and Stomach will lead to self-healing over time. Both explanations are unstable, so they are retained tentatively.
The Master said: When Heat is in the Upper Jiao, it leads to Fei Wei (Lung Withered Root) due to coughing.
The Small Intestine receives water and grain from the Stomach and separates the clear from the turbid. The Large Intestine lies below the Small Intestine and is responsible for expelling waste, ending at the anus. Therefore, I suspect that in this passage, "Large Intestine" and "Small Intestine" were transposed during copying. The likely meaning is: Cold in the Small Intestine causes failure in separation, leading to watery stool mixed with feces; if there is Heat, intestinal debris is forced downward. Cold in the Large Intestine causes Yang Qi to sink, leading to tenesmus and bloody stool; if there is Heat, toxins accumulate in the anus, causing hemorrhoids. Commentators explaining the text literally failed to resolve the contradiction. Swapping the positions clarifies the meaning. However, since texts from the *Mai Jing* onwards match the current version, I record my doubt here for future scholars to determine.
Li Zhongzi in *Bingji Shazhuan* states: Zhang Zhongjing said that for Cold in the Small Intestine causing tenesmus and bloody stool, use Ganjiang charred to retain its properties, placed in a porcelain bowl cooled on the ground, powdered. Take one qian per dose, mixed with rice water. It is miraculous.
Question: Diseases include Ji (Accumulation), Ju (Gathering), and HT Qi (Binding Qi). What does this mean? (In the *Mai Jing*, HT Qi is written as "Xi Qi," implying grain Qi descending. The seventeen characters "If a disease has healed and does not recur, but now recurs, it is called Xi Qi" are annotations under "Ji," with one variant reading "Jie." Zhu Shi also treated the sections following various accumulations as separate entries.)
Zhu: Any condition formed gradually by the congealing of Yin-Cold is called Ji (Accumulation), hence "various accumulations." There is no fixed symptom pattern, only a specific Chen-Xi (Deep-Fine) pulse, which identifies it as Ji. The pathology is deep-seated and must be managed by distinguishing the Upper, Middle, and Lower Jiao. The pulse must be assessed via the Cun, Guan, and Chi positions. For example, Cun governs the Upper Jiao; a Fine pulse pressing to the bone indicates accumulation in the chest, such as Xiong Bi. A pulse extending beyond the Cun to the tip of the thumb indicates accumulation in the throat, such as Phlegm-Qi binding with a sensation of a roasted meat lump in the throat. Guan governs the Middle Jiao; a Fine-Chen Guan pulse indicates accumulation near the navel, such as peri-umbilical abdominal pain. A pulse slightly above the Guan indicates accumulation in the epigastrium, such as Stomach Cold causing upper abdominal pain. A pulse slightly below the Guan indicates accumulation in the hypogastrium, such as cold pain in the lower abdomen. Chi assesses the Lower Jiao; a Fine-Chen Chi pulse indicates accumulation near the Qichong point, such as Yin-Cold hernia.
Note: Since Ju (Gathering) is treatable, the difficulty of treating Ji (Accumulation) can be inferred. As for HT Qi, although easily treated, it may require treatment to resolve spontaneously.
Furthermore, the *Nan Jing* Chapter 18 states that Cun, Guan, and Chi correspond to above the diaphragm, between the diaphragm and the umbilicus, and below the umbilicus, respectively. It also details methods for diagnosing Accumulation and Gathering, which complement this section. The *Mai Jing* contains sections on diagnosing Five Zang Accumulations and seven diagnostic methods. These are recorded below for comparison.
A Chen-Heng (Deep-Transverse) pulse at Cun Kou indicates transverse accumulation and pain in the hypochondrium and abdomen. (This is from the *Su Wen* Ping Ren Qi Xiang Lun.) A Xian (Wiry) pulse with acute abdominal pain indicates... (This is based on the Xiao Jianzhong Tang section). Pain radiating between the waist and back, with cold hernia masses in the abdomen, corresponds to a Xian-Jin (Wiry-Tight) and slightly Fine pulse, indicating entrenched disease. The pulses for Cold Bi, Zheng Jia, and Ji Ju are all Xian-Jin. If located in the epigastrium, the Cun is Xian-Jin; in the stomach tube, the Guan is Xian-Jin; below the umbilicus, the Chi is Xian-Jin. (Alternatively, a long Xian Guan pulse indicates accumulation around the navel.)
According to another Pulse Method: A transverse pulse on the Left Hand indicates accumulation on the left; on the Right Hand, on the right. A pulse head larger than the root indicates pathology above; smaller indicates pathology below.
Another method: Transverse pulse on the left indicates accumulation on the left; on the right, on the right. A pulse that is predominantly Hong-Shi-Hua (Surging-Solid-Slippery) also indicates accumulation. Xian-Jin also indicates accumulation, Cold Bi, or hernia pain. Internal accumulation without corresponding pulse signs is difficult to treat. One corresponding pulse sign indicates easy treatment. No corresponding signs indicate untreatable conditions.
A large pulse on the Left Hand and small on the Right indicates upper pathology in the left hypochondrium and lower pathology in the left foot. A large pulse on the Right Hand and small on the Left indicates upper pathology in the right hypochondrium and lower pathology in the right foot.
A Xian-Fu (Wiry-Deep/Hidden) pulse indicates abdominal accumulation that cannot be moved; this is fatal and untreatable.
A pulse that is Fine, Deep, and occasionally Straight indicates abscesses in the body or Fuliang (Hidden Beam) accumulation in the abdomen.
A Small, Deep, and Solid pulse indicates Stomach accumulation: inability to eat, and vomiting immediately after eating.