余奉讳里居。每婴 疾。偶检方书。茫无涯 。因叹前贤如坡公沈存中辈。皆明于
医理。用以济世利物。其不效者。特格物未至耳。吴航陈修园先生。精岐黄术。以名孝
廉宰畿辅。晚归里中。与先大夫结真率会。余尝撰杖侍坐。聆其谈医。洞然有见垣一方
之眼。窃谓近世业医者。无能出其右也。今先生捐馆数年矣。令嗣灵石传其业。世咸推
重焉。先生生前所刊医书若干种。已传海内。今复读其金匮要略浅注一十卷。明显通达
如诸掌。虽王叔和之阐内经。不是过也。灵石又遵庭训为金匮歌括六卷。取韵语之便
于记诵。附以行世。犹先生志也。昔范文正公有言不为良相。则为良医。先生在官在乡。
用其术活人。岁以千百计。况着书以阐前人之旨。为业医者之HT 。其功岂浅鲜哉。灵
石以序见委。余固不知医。然窃愿为医者讲明其理。庶有以济世利物。而勿误人于生死
之交也。是为序。
道光十年岁次庚寅仲春望后愚侄林则徐拜撰
问曰。上工治未病。何也。师曰。（病不外邪正虚实。邪气盛则实。正气夺则虚。
是邪正统于虚实中也。）夫（上工）治未病者。见肝（邪）之（为实）病。知（已病之
）肝（必）传（未病之）脾。当先实脾。（若春之三月。夏之六月。秋之九月。冬之
十二月。）四季脾王。不受邪。即勿补之。（所以然者。脏病惟虚者受之。而实则不受。
脏邪惟实则能传。而虚则不传也。）中工不晓（邪实则）相传。见肝之病。不解（
先）实（未病之）脾。惟治（其）肝（不防其传）也。夫肝（虚）之病。补（其本脏之
体。则）用酸。（经云。木生酸。酸生肝。遂其曲直之性也。补之犹恐不及。则用助。
）助（其阳必）用焦（热之药。使心旺而气感于肝也。助其阴必以）苦（用苦寒之药。
养心液之不足。泄君火之有余。则木得其养矣。助之犹恐不足。则用益。）益用甘味之
药调之。（益稼穑作甘。则用培土升木之法。其法悉备于乌梅丸之中也。若中工不解。
误以）酸入肝。焦苦入心。甘入脾。（三句为克制之治。然则肝虚正治之法。当从于
何处求之。以下十二句。是述中工之误。以为补）脾能伤肾。肾气微弱。则水不行。水
不行则心火气盛。则伤肺。肺被伤。则金气不行。金气不行。则肝气盛。则肝自愈。（
以）此（为）治肝补脾之要妙也。（然则上工治）肝虚（之病）则用此（酸甘焦苦之药。
按调补助益之妙。）法（若治肝）实（之病）则不在（治肝虚之例可）用之。经曰、
（无）虚虚。（无）实实。补不足。损有余。是其义也。余脏准此。（余脏。他脏也。实者
防其传。先治其未病之脏。虚者补其虚。求本脏之体用。遵经旨而治之。则得矣。）
此论五行之理。以次而传。别中上二工之治。学人当审其虚实。而分其治法焉。
按肝阴脏。论标本。挟心包之火。论表里。含少阳之气。故恶燥而复喜暖。治之之
法。补用酸者。肝属木。木生酸。酸生肝。补本脏之体。顺曲直之性也。助用焦苦者。
焦药性温入心。俾心气旺而感于肝也。如木得
阳春之气。则欣欣向荣矣。过暖则为热。如盛夏溽暑薰蒸。枝垂叶萎。故必佐以苦寒之
药。入心以清其火。养液以维其阳。阴长阳潜。木得遂其条达之性矣。肝苦急。与甘味以缓
之。为调肝补土之义也。以下脾能伤肾十二句。是述中工误认克制之说。以为治肝补脾
之要妙。故复申之曰肝虚则用此法。此字指调补助益而言。又曰实则不在用之。言实者
当防其传。不在补虚之例。此仲师虚实并举之旨。以明正治之法也。又引经而证之曰。
虚虚实实。补不足。损有余。是其义也。汉文古奥。注家往往多误。
男（元犀）按、肝
与胆同居。体阴而用阳。藉胆火以为用。故内经不从标本。而从中见。金匮助用焦苦。
俱入心而亦主火为用。其义一也。实者降其火。用其用。虚者补其火。助其用。别其用
之不同也。知肝传脾者。肝属厥阴巽木。脾属太阴坤土。以阴传阴。侮其所胜之义也。
本节先君小注中。突出乌梅丸一句。取厥阴全体之治。于群书无字中会出。是文家化境
也。按厥阴篇。消渴、气上撞心、心中疼热、饥而不欲食、食则吐蛔、下之利不止。以
及便血、吐脓、烦呕、厥热等症。立乌梅丸一方。降逆止利。顺接阴阳法。破阴行阳。
为传转法。借以调肝实脾。以明体用之妙也。夫以体用言之。方用乌梅酸平。入肝纳气补
其体。当归苦温。入肝养血而通经。俾气血调而木得遂矣。人参甘寒。益脾中之阴。干
姜苦温。补脾中之阳。令阴阳和则脾健。而邪不能侵矣。黄连黄柏。苦寒入心降火。降
炎上之火。以温下寒。此为用其用也。蜀椒桂枝。焦辛入心。补阳气。散寒水。令心君
旺而下交于肾。此为助其用也。妙在细辛之辛香交通上下。领诸药环转周身。调气血。
通络脉。以运其枢。附子入肾。镇浮阳。暖水脏。以固其根。味备酸甘焦苦。性兼调补
助益。统厥阴体用而并治之。则土木无忤矣。中工不晓此理。以补土制水。纵火刑金。则是治一
脏而殃及四脏。恶在肝虚之治法哉。
夫人禀五常。（日在五气之中。而实）因风气而生长。（风即气。气即风。所谓人
在风中而不见风是也。）风气虽能生万物。亦能害万物。如水能浮舟。亦能覆舟。若五
脏（得和风。则）元真通畅。（其呼吸出入间。徐疾有度。上下得宜。）人即安和。（
否则一失其和。则为）客气邪风。中人多死。（然风有轻重。病有浅深。虽）千般 难。
（总计）不越三条。一者、（中虚人。）经络受邪入脏腑。为内所因也。二者、中实
人。脏腑不受。惟外体四肢九窍。血脉相传。壅塞不通。为外皮肤所中也。三者、房
室金刃虫兽所伤。（非由中外虚实感召其邪。是为不内外因也。）以此详之。病由（以
此三条而）都尽。若人能养慎。不令邪风干忤经络。适中经络。未流传脏腑。即（以发
汗和解之法）医治之。（则内因之病可免也。）四肢才觉重滞。即导引吐纳。针灸膏
摩。勿令九窍闭塞。（则外因之病可解也。）更能无犯王法禽兽灾伤。房室勿令竭乏。
（此不内外之因可免也。凡）服食节其冷热苦酸辛甘。（各适其宜。）不遣形体有衰。
病则无由入其腠理。腠者。是（一身之空隙。）三焦通会元真之处。理者。是（合）
皮肤脏腑（内外井然不紊）之文理也。
此以风气二字。提出全书之大主脑也。上节论肝病按虚物理用之治法。为开宗第一
义。可知独重者在此。此节即畅发之。风气二字宜串讲。切不可泥旧注以八风六气板之
也。六气之害人。在风尤为亲切。但五气有损无益。风则生长因之。内经云、风生木。
木生肝。又云、神在天为风。又云、大气举之。佛经以风输主持天地。人得风气以生。
日在风中而不见风。鼻息出入。顷刻离风即死。可知人之所以生者。风也。推而言之。
木无风。则无以遂其条达之情。火无风。则无以遂其炎上之性。金无风。则无以成其坚
劲之体。水无风则潮不上。土无风则植不蕃。书中切切以风为训。意者和风一布。到处
皆春矣。所患者。风失其和。即为客气邪风。所以特立三因救治之法。考后贤陈无择三
因方。以六淫邪气所触。病从外来者为外因。五脏情志所感。病从内生者为内因。饮食
房室。跌扑金刃所伤。不从邪气情志所生者。为不内外因。而不知仲景以客气邪风为主。
故不以外感内伤为内外。而以经络脏腑为内外也。
问曰。病患有气色见于面部。愿闻其说。师曰。（鼻者明堂也。明堂光泽则无病。
若）鼻头色青。（为木郁克土。故）腹中痛。（又）苦冷者（为亡阳主）死。鼻头色微
黑者。（为脾负而肾气胜之。为）有水气。色黄者。（脾病而生饮。为）胸上有寒。色白者。（
经云。白为寒。又云。血脱者色白。若非寒即为）亡血也。设（色见）微赤。（而）非
（夏月火令。而见秋月金旺之）时者死。（再验之于目。目虽肝之开窍。而实五脏之精
华也。）其目（直视）正圆（不转）者痉。（属阴绝阳强。为）不治。又（目）色青为
（血凝泣而不流。故主）痛。（目）色黑为劳。（劳则伤肾是也。）色赤为风。（风为
阳邪也。目）色黄者便难。（脾病则不运也。目）色鲜明者有留饮。（经云。水病患目下
有卧蚕。面目鲜泽也。）
此言医家之望法也。通面周身。俱有色可察。仲景独取之鼻与目者。示以简要也。
师曰。（闻声之法。内经言之甚详。然握其大要。亦不过上中下三者而已。）病患
（常则）语声寂然。（少阴主静之象也。猝则）喜惊呼者。（厥阴肝木。在志为惊。在
声为呼。病在肝肾。为）骨节间病。（此闻声而知其为下焦病也。声虽有五脏之分。而皆
振响于肺金。而转运于心苗。心苗者舌也。今）语声喑喑然不彻者。（为）心膈间病。
（内经谓中盛脏满。气胜伤恐者。声如从室中言。是中气之湿也。此闻声而知其为中焦
病。）语声啾啾然细而（仍）长者。（为）头中病。（此闻声而知其为上焦病也。）
此言医家闻法也。大要在此。学人由此一隅而三反可矣。
师曰。（闻声辨及呼吸。微矣。然合呼吸而辨之。不如分辨其呼之若此又若彼。吸
之若此又若彼。微而又微矣。兹先就其呼之多而不与吸并言者。征其息。）息（出不顺。
至于）摇肩者。（为）心（胸）中（邪气实）坚。息（出）引胸中上气者。（为肺气
不降而作）咳息。（出时有痰沫阻遏。不容气返之势。而）张口短气者（为）肺痿吐
沫。
此节合下节。言闻法之最细者。先于呼吸出入之气。而辨其病之在上在下。为实为虚也。
徐忠可曰。此节三者全于呼而认其病之在心肺也。然竟不言呼而曰息者。盖出气虽
大。中无小还。不能大呼。故揭出摇肩息引张口六字。而病之在呼者宛然。然不得但言
呼也。
师曰。（再言其吸。若病患）吸（气不得下行。）而（轻）微（急）数。（审其腹
满便硬。阻之于中。其吸气止到中焦而即返。）其病在中焦实也。当下之（令实去气通
）即愈。（若中焦实而元气）虚者（不下之则无以泄其实。而机缄息。竟下之则益以
伐其根。而生气亡。法为）不治。（且可由中焦推之上下。虚）在上焦者。（心肺之阳。
不能下交于阴。心肺道近。故）其吸促。（虚）在下焦者。（肝肾之阴。不能上交于阳。
肝肾道远。故）其吸远。（吸为收摄元气之主。促与远皆元气亏也。）此（虽与中焦实
而元气虚之不治者有间。而究虚在真元。）皆（为）难治。呼吸（之间。周身筋脉）动
摇振振者。（则为形气不能相保。无论上中下虚实。皆）不治。
上节言息。息兼呼吸而言。偏重在呼也。此节不言呼而专言吸。又于吸中而分上中
下虚实之辨。徐忠可谓为闻法之最细。信哉。
师曰。（两手寸关尺。统名寸口。）寸口脉动者。（弦洪毛石缓五脉。）因其（合
于春夏秋冬四季之）王时而动。（其色亦应之。）假令肝王（于春。其脉当弦而）色（
当）青。（推之）四时各随其色。（所谓春脉弦而色青。夏脉洪而色赤。秋脉毛而色白。
冬脉石而色黑。四季脉缓而色黄是也。若）肝（王于春。其）色（当）青而反色白。（
脉当弦而反浮涩。）非其时色脉。皆当病。
此言医道贵因时而察其脉色也。脉色应时为无病。若色反时。病也。脉反时。亦病
也。色反脉。脉反色。亦病也。推而言之。症与脉相合者顺。相生者吉。相反者。治之
无不费力也。
问曰。有（时）未至而（气）至。有（时已）至而（气）不至。有至而不去。有至而太
过。何谓也。师曰。（十一月）冬至之后。（值）甲
子（日）夜半。（为）少阳（所自）起。（至于正月中雨水。为）少阳（方起而出地）
之时。（少）阳（王而万物）始生。天得温和。（此天气之常也。今）以未得甲子。（
而）天（气）因（先）温和。此为（时）未至而（气先）至也。以（已）得甲子。而天
（气犹）未温和。为（时已）至而（气）不至也。以（已）得甲子。而天大寒不解。此
为（时已）至而（应去而）不去也。以（已）得甲子。而天温如盛夏五六月时。此为（
时已）至而（至之）太过也。（由此推之。冬至后值甲子日起。少阳六十日。阳明六十
日。太阳六十日。太阴六十日。少阴六十日。厥阴王各六十日。六六三十六。而岁功成。
人在气交之中。有因时而顺应者。有反时而衰旺者。有即因非时异气而致病者。医者可
不一一而知其由来乎。）
此一节论天气而不及医。然随时制宜之道。在其中也。尤在泾云。上之至。谓时至。
下之至。谓气至。盖时有常数而不移。气无定刻而或迁也。冬至之后甲子。谓冬至后
六十日也。盖古造历者。以十一月甲子朔夜半冬至为历元。根据此推之。则冬至后六十日。
I was residing in my hometown observing mourning for my parents. Frequently plagued by illness, I occasionally consulted medical texts and found them boundless and without limit. Thus, I sighed that former sages such as Su Shi (Su Dongpo) and Shen Kuo (Shen Cunzhong) were all well-versed in medical principles, using them to benefit the world and aid living beings. Those cases where treatment failed were merely due to insufficient investigation into the nature of things. Mr. Chen Xiuyuan from Wuhang mastered the arts of Qi Bo and Huang Di. As a filial and incorruptible scholar-official (Xiaolian), he served in the capital region. In his later years, returning to his hometown, he formed a "Zhenlv Hui" (Sincere Gathering) with my father. I once leaned on a cane and sat in attendance, listening to him discuss medicine. His insights were as clear as seeing the other side of a wall. Privately, I believed that among contemporary practitioners, none could surpass him. Now, several years have passed since Mr. Chen passed away. His son, Linshi, has inherited his profession, and the world highly respects him. Several medical books published by Mr. Chen during his lifetime have already circulated throughout the land. Now, reading his *Jinkui Yaolue Qianzhu* (Light Commentary on the Essential Prescriptions of the Golden Cabinet), ten volumes, it is clear, accessible, and understandable as if looking at one's own palm. Even Wang Shuhe's elucidation of the *Neijing* (Inner Canon) does not exceed this. Linshi, following his father's teachings, compiled the *Jinkui Gekuo* (Song Rhymes of the Golden Cabinet), six volumes, utilizing rhymed verses for easier memorization, which will be published alongside the text, fulfilling Mr. Chen's wishes. Formerly, Fan Zhongyan said, "If one cannot be a good prime minister, one should be a good doctor." Whether in office or in the countryside, Mr. Chen used his skills to save people, numbering in the thousands each year. Moreover, by writing books to elucidate the intentions of predecessors and serving as a guide for practitioners, how insignificant could his merits be? Linshi entrusted me with writing this preface. Although I do not understand medicine, I privately hope to clarify its principles for practitioners, so that they may benefit the world and aid living beings, and not mislead people at the critical juncture of life and death. This is the preface.
Written in bowing respect by your humble nephew, Lin Zexu, after the full moon of the second month in the Gengyin year of the Daoguang era (1830).
Question: Why does an expert physician treat disease before it arises? The Master said: (Diseases are not outside the realms of pathogenic factors, healthy qi, deficiency, and excess. When pathogenic factors are abundant, it is excess; when healthy qi is depleted, it is deficiency. This is how pathogenic factors and healthy qi govern deficiency and excess.) What is meant by an expert physician treating disease before it arises is that upon seeing liver pathology caused by pathogenic factors manifesting as excess, one knows that the liver disease will inevitably transmit to the spleen. Therefore, one should first strengthen the spleen. (In the third month of spring, sixth month of summer, ninth month of autumn, and twelfth month of winter,) when spleen earth is prosperous in the four seasons and does not accept pathogenic factors, supplementation is unnecessary. (The reason for this is that zang organs only accept pathogenic factors when deficient, not when excess; zang pathogens can only transmit when excess, not when deficient.) An average physician does not understand the transmission of (pathogenic excess). Seeing liver disease, they do not understand to (first) strengthen (the uninvolved) spleen, but only treat (the) liver (without preventing transmission). Regarding liver (deficiency) disease, to tonify (the substance of the original organ), sour substances are used. (The Classics state: Wood generates sourness, sourness generates the liver, complying with its bending and straightening nature. Tonifying it may still be insufficient, so assistance is employed.) To assist (its yang), scorched (hot-natured medicines) are used, causing heart qi to flourish and resonate with the liver. To assist its yin, bitter substances must be used (employing bitter-cold medicines to nourish the insufficiency of heart fluids and drain the surplus of sovereign fire, thereby allowing wood to receive nourishment. If assistance is still insufficient, then enhancement is employed.) Enhancement uses sweet-flavored medicines to regulate. (Enhancing agriculture and harvest involves sweetness, thus employing the method of cultivating earth to raise wood. This method is fully contained within Wumei Wan (Mume Pill). If an average physician does not understand, mistakenly believing that) sour enters the liver, scorched-bitter enters the heart, and sweet enters the spleen. (These three phrases describe a treatment of restriction. However, where should the correct treatment method for liver deficiency be sought? The following twelve sentences describe the errors of average physicians, who mistakenly believe that strengthening the spleen can damage the kidney. Kidney qi becomes weak, water fails to circulate. When water fails to circulate, heart fire qi becomes abundant, damaging the lung. When the lung is damaged, metal qi fails to circulate. When metal qi fails to circulate, liver qi becomes abundant, and the liver disease heals itself. (They regard) this (as) the subtle essence of treating liver disease by strengthening the spleen. (However, for an expert physician treating) liver deficiency (disease), this method (of sour, sweet, scorched, and bitter medicines, adjusted according to the subtleties of regulation, assistance, and enhancement) is applied. (If treating liver) excess (disease), it is not applicable (to the example of treating liver deficiency). The Classics say: (Do not make) deficiency more deficient, (do not make) excess more excess. Tonify insufficiency, reduce surplus. This is the meaning. Other organs follow this principle. (Other organs refer to other zang organs. For excess conditions, prevent transmission by treating the uninvolved organ first; for deficiency conditions, tonify the deficiency and seek the substance and function of the original organ. Following the Classic principles for treatment achieves success.) This section discusses the principles of the Five Elements, transmitting sequentially, distinguishing the treatments of average and expert physicians. Learners should examine deficiency and excess and differentiate their treatment methods accordingly.
Note: The liver is a yin organ. Discussing root and branch, it harbors the fire of the pericardium; discussing interior and exterior, it contains the qi of Shaoyang (Lesser Yang). Therefore, it dislikes dryness and prefers warmth. The treatment method: Tonification uses sour flavors because the liver belongs to wood, wood generates sourness, and sourness generates the liver, tonifying the substance of the original organ and complying with its bending and straightening nature. Assistance uses scorched-bitter flavors. Scorched medicines are warm and enter the heart, causing heart qi to flourish and resonate with the liver. Just as wood receives the qi of early spring and thrives. Excessive warmth leads to heat, like the humid heat of midsummer steaming, causing branches to droop and leaves to wither. Therefore, bitter-cold medicines must be added to enter the heart and clear its fire, nourishing fluids to maintain its yang. As yin grows and yang submerges, wood can achieve its free-flowing nature. The liver suffers from urgency; sweet flavors are given to relieve it, embodying the meaning of regulating the liver and supplementing earth. The following twelve sentences ("spleen can damage kidney...") describe the average physician's error in recognizing the theory of restriction, mistaking it for the subtle essence of treating liver disease by strengthening the spleen. Thus, it is reiterated: Liver deficiency applies this method. This character refers to regulation, assistance, and enhancement. It also states that excess does not apply this, meaning excess conditions should prevent transmission and do not fall under the category of tonifying deficiency. This is Master Zhang's intention of presenting both deficiency and excess to clarify the correct treatment method. He further cites the Classics to prove: "Make deficiency more deficient, make excess more excess" is incorrect; tonify insufficiency, reduce surplus. This is the meaning. Han dynasty texts are archaic, and commentators often make mistakes.
My son (Yuanxi) notes: The liver and gallbladder reside together; the substance is yin while the function is yang, relying on gallbladder fire for its function. Thus, the *Neijing* does not focus on root and branch but on the intermediate manifestation. *Jinkui* advocates using scorched-bitter substances, all entering the heart and primarily using fire for function; the meaning is consistent. For excess, lower its fire and utilize its function; for deficiency, tonify its fire and assist its function. Distinguish the differences in function. Knowing that the liver transmits to the spleen: The liver belongs to Jueyin (Terminal Yin) Xun Wood, and the spleen belongs to Taiyin (Greater Yin) Kun Earth. Transmission from yin to yin follows the principle of insulting what it overcomes. In the minor commentary of my father in this section, the mention of Wumei Wan (Mume Pill) stands out, taking the comprehensive treatment of Jueyin, emerging from words among books, representing the transformative realm of literary composition. According to the Jueyin chapter, symptoms such as thirst, qi rushing up to the heart, pain and heat in the heart, hunger without desire to eat, vomiting roundworms after eating, diarrhea after purgation, blood in stool, pus in vomit, irritability and vomiting, cold and heat alternations, etc., led to the establishment of the Wumei Wan formula. It descends rebellion and stops diarrhea, smoothly connecting yin and yang, breaking yin to move yang, serving as a transmission method, borrowing it to regulate the liver and strengthen the spleen, illustrating the subtleties of substance and function. Speaking of substance and function: The formula uses Mume Fructus (Wumei), sour and neutral, entering the liver to gather qi and tonify its substance; Angelicae Sinensis Radix (Danggui), bitter and warm, entering the liver to nourish blood and unblock collaterals, allowing qi and blood to harmonize and wood to thrive. Ginseng Radix et Rhizoma (Renshen), sweet and cold, benefits yin in the spleen; Zingiberis Rhizoma (Ganjiang), bitter and warm, tonifies yang in the spleen, making yin and yang harmonious so the spleen is strong and pathogens cannot invade. Coptidis Rhizoma (Huanglian) and Phellodendri Cortex (Huangbai), bitter and cold, enter the heart to descend fire, lowering upward-rising fire to warm lower cold; this is utilizing its function. Schisandrae Fructus (Wuweizi - *Note: Text says Shuzhao/Guizhi context implies warming/dispersing, specifically listed as Shuzhao Guizhi here*), Sichuan Pepper (Shuzhao) and Cinnamon Twig (Guizhi), scorched and acrid, enter the heart, tonify yang qi, disperse cold water, causing the Heart Sovereign to flourish and descend to communicate with the kidney; this is assisting its function. The brilliance lies in Asari Radix et Rhizoma (Xixin)'s acrid fragrance communicating above and below, leading the various medicines to circulate throughout the body, regulating qi and blood, unblocking collaterals, and operating the pivot. Aconiti Lateralis Radix Praeparata (Fuzi) enters the kidney, anchoring floating yang, warming the water organ, and solidifying the root. The flavors include sour, sweet, scorched, and bitter; the properties include regulation, tonification, assistance, and enhancement. Treating the substance and function of Jueyin together ensures wood and earth do not conflict. Average physicians do not understand this principle. Using earth to control water and fire to punish metal means treating one organ while endangering four others. How can this be the treatment method for liver deficiency?
Humans inherit the Five Constants. (Sun is within the five qi, and actually) grows due to wind qi. (Wind is qi, qi is wind, so-called being in the wind without seeing the wind.) Wind qi can generate all things, but it can also harm all things, just as water can float a boat but also capsize it. If the five zang organs (receive gentle wind, then) Yuanzhen (Original True Qi) flows freely. (Between inhalation and exhalation, speed is measured, upper and lower are appropriate.) Humans are peaceful and harmonious. (Otherwise, losing harmony results in) guest pathogenic wind invading most people, causing death. (However, wind has severity, and diseases have depth. Although there are thousands of difficulties,) (in total) they do not exceed three categories. First, (for those with middle deficiency,) pathogenic factors enter the meridians and reach the zang-fu organs, constituting the internal cause. Second, for those with middle excess, the zang-fu organs do not accept pathogens; only the external body, limbs, nine orifices, and blood vessels transmit pathogens, becoming obstructed and blocked, constituting invasion by external skin. Third, injuries from sexual activity, metal blades, insects, and beasts. (Not caused by internal/external deficiency/excess attracting pathogens, this is the neither-internal-nor-external cause.) Analyzing this carefully, diseases are completely covered by (these three categories). If humans can cultivate caution, preventing pathogenic wind from interfering with meridians, and if pathogens hit the meridians but have not yet spread to the zang-fu organs, they should be treated (with sweating and harmonizing methods). (Then internal cause diseases can be avoided.) When limbs feel heavy and stagnant, employ Dao Yin (guiding and pulling), Tu Na (breathing exercises), acupuncture, moxibustion, and plaster massage, preventing obstruction of the nine orifices. (Then external cause diseases can be resolved.) Furthermore, avoid violating laws, animal disasters, and injuries; ensure sexual activity does not lead to exhaustion. (This avoids the neither-internal-nor-external causes. Generally,) regulate food and drink regarding cold, hot, bitter, sour, acrid, and sweet. (Each suits its appropriateness.) Do not let the physical form decline, and diseases will have no way to enter the Couli (pores/skin texture). Couli refers to (the spaces of the whole body,) where Sanjiao (Triple Burner) connects and Yuanzhen gathers. Li refers to (combining) the textures of skin and zang-fu organs (internally and externally orderly).
This section raises "wind qi" as the main theme of the entire book. The previous section discussed the treatment method for liver disease based on deficiency, principle, substance, and function, which is the first principle of opening the chapter, showing that emphasis lies here. This section elaborates on it. "Wind qi" should be read continuously; one must not rigidly stick to old commentaries regarding Eight Winds and Six Qi. Among the Six Qi harming humans, wind is particularly intimate. But the five qi only harm, they do not benefit; wind is the cause of growth. The *Neijing* says: Wind generates wood, wood generates liver. It also says: Spirit in heaven is wind. And: Great air lifts it. Buddhist scriptures state that wind transport governs heaven and earth; humans derive life from wind qi. Sun is in the wind but invisible; nasal breathing enters and exits, leaving wind for an instant leads to death. Thus, we know that what gives humans life is wind. Extending this, without wind, wood cannot achieve its free-flowing emotion; without wind, fire cannot achieve its flaming-upward nature; without wind, metal cannot form its firm and tough body; without wind, water tides do not rise; without wind, plants do not flourish. The book earnestly instructs regarding wind, implying that when gentle wind spreads, spring arrives everywhere. The concern is wind losing harmony, becoming guest pathogenic wind. Therefore, specific rescue methods for the Three Causes are established. Examining the *San Yin Fang* (Three Causes Formula) by later scholar Chen Wuye: Pathogens touched by the six excesses, coming from outside, are external causes; emotions felt by the five zang, arising from inside, are internal causes; diet, sexual activity, falls, metal, and blade injuries, not generated by pathogenic qi or emotions, are neither-internal-nor-external causes. However, Master Zhang regards guest pathogenic wind as primary, thus not classifying external/internal invasions as external/internal, but rather meridians/zang-fu as external/internal.
Question: Patients have complexions visible on the face; I wish to hear the explanation. The Master said: (The nose is the Ming Tang (Bright Hall); if the Ming Tang is lustrous, there is no disease. If) the tip of the nose is blue-green. (Due to wood stagnation overcoming earth, therefore) abdominal pain. (Also) suffering from cold indicates (yang depletion and is) fatal. If the tip of the nose is slightly black. (Indicates spleen defeat and kidney qi overcoming it, indicating) fluid retention. Yellow color. (Spleen disease generating phlegm-fluid, indicating) cold above the chest. White color. (The Classics say: White indicates cold. Also: Blood loss results in white complexion. If not cold, it is) blood loss. Suppose (color appears) slightly red. (But) not (during summer fire command, but appearing during autumn metal prosperity) time, death. (Further verify with the eyes; although the eyes are the opening of the liver, they are truly the essence of the five zang.) Eyes that are (staring straight) perfectly round (and do not turn) indicate Jing (spasm). (Belongs to yin exhaustion and yang strength, indicating) incurable. Also, eye (color) blue-green indicates (blood coagulation and stasis, thus governing) pain. Eye (color) black indicates Lao (consumption). (Consumption damages the kidney.) Red color indicates Feng (wind). (Wind is a yang pathogen.) Eye (color) yellow indicates difficult defecation. (Spleen disease fails to transport.) Eye (color) bright and clear indicates retained fluid. (The Classics say: Water patients have silkworm-like swelling under the eyes, and face and eyes are fresh and lustrous.)
This describes the inspection method of physicians. The entire face and body have colors to observe; Zhang Zhongjing uniquely selects the nose and eyes to show brevity.
The Master said: (The method of hearing sounds is detailed in the *Neijing*, but grasping the essentials involves only upper, middle, and lower categories.) Patients (normally) speak quietly. (Image of Shaoyin governing stillness. Suddenly) liking to shout loudly. (Jueyin liver wood, emotion is fear/startle, sound is shout, disease in liver and kidneys, indicates) disease between bone joints. (This hears sound to know it is lower jiao disease. Although sounds divide among five zang, they all resonate in lung metal and transfer to the heart sprout; the heart sprout is the tongue. Now) speech that is hoarse and not penetrating. (Indicates) disease in the heart-diaphragm area. (*Neijing* states: When middle is full and organs are distended, qi overwhelms and injures fear, sound is like speaking from a room; this is dampness in middle qi. This hears sound to know it is middle jiao disease.) Speech that is chirping, fine, and (still) long. (Indicates) disease in the head. (This hears sound to know it is upper jiao disease.)
This describes the auscultation method of physicians. The essentials are here. Learners can infer the rest from this corner.
The Master said: (Distinguishing sounds and respiration is subtle. However, combining respiration to distinguish is less effective than distinguishing whether exhalation is like this or that, and inhalation is like this or that, subtly and very subtly. Here, focusing on exhalation much more than inhalation, we investigate breath.) Breath (not smooth, until) shoulder shaking. (Indicates) hardness in the heart (chest) (due to pathogenic excess). Breath (exhalation) drawing upward qi from the chest. (Indicates cough due to lung qi failing to descend). (Exhalation has phlegm foam blocking, no momentum for air to return, and) mouth-opening shortness of breath. (Indicates) Fei Wei (Lung Atrophy) with spitting foam.
This section combined with the next discusses the most subtle aspects of auscultation. First, distinguishing disease location (upper/lower) and nature (excess/deficiency) through inhalation and exhalation. Xu Zhongke said: These three points in this section are entirely recognized through exhalation as disease in heart and lungs. Yet it does not explicitly say exhalation but says breath, because although exhaled air is large, there is no small return in the middle, so one cannot shout loudly. Thus, highlighting the six characters "shoulder-shaking, drawing-breath, mouth-opening," the disease in exhalation is clear. However, one cannot only speak of exhalation.
The Master said: (Speaking again of inhalation, if patients) inhale (qi cannot descend.) lightly, finely, rapidly, and frequently. (Examining abdominal fullness and hard stool, obstructed in the middle, inhalation stops at the middle jiao and returns immediately.) Disease is excess in the middle jiao. It should be purged (to remove excess and unblock qi) to heal. (If middle jiao excess but yuan qi is) deficient (not purging cannot drain excess, and mechanism rests; purging directly will further attack the root and destroy vital qi, method is) incurable. (Furthermore, deduce from middle jiao to upper and lower. Deficiency) in upper jiao. (Heart-lung yang cannot descend to communicate with yin; heart-lung pathway is close, therefore) inhalation is rapid. (Deficiency) in lower jiao. (Kidney-liver yin cannot ascend to communicate with yang; kidney-liver pathway is distant, therefore) inhalation is distant/deep. (Inhalation is the master of gathering yuan qi; rapid and distant both indicate yuan qi deficit.) This (although distinct from the incurable case of middle jiao excess with yuan qi deficiency, ultimately the deficiency is in true yuan.) All (are) difficult to treat. During respiration (between, whole body tendons and pulses) trembling and shaking. (Indicates form and qi cannot protect each other; regardless of upper/middle/lower deficiency/excess, all are) incurable.
Previous section discussed breath, breath includes respiration, focusing on exhalation. This section does not discuss exhalation but focuses solely on inhalation, further dividing upper/middle/lower deficiency/excess within inhalation. Xu Zhongke considers this the most subtle aspect of auscultation, truly so.
The Master said: (Cun, Guan, Chi on both wrists are collectively named Cun Kou/Pulse Gate.) Cun Kou pulse movement. (String, Flood, Hair, Stone, Slow five pulses.) Due to (coinciding with the prosperous times of Spring, Summer, Autumn, Winter four seasons) moving. (Its color also responds.) Suppose liver is prosperous (in Spring, its pulse should be String-like and) color (should be) Green. (Deducing) four seasons each follow their color. (So-called Spring pulse String-like and color Green, Summer pulse Flood-like and color Red, Autumn pulse Hair-like and color White, Winter pulse Stone-like and color Black, Four Seasons pulse Slow-like and color Yellow is so. If) liver (prosperous in Spring, its) color (should be) Green but instead White. (Pulse should be String-like but instead Floating and Choppy.) Colors and pulses not corresponding to the season all indicate disease.
This discusses that medical practice values observing pulse and color according to the season. Pulse and color responding to season means no disease; if color opposes season, disease exists. If pulse opposes season, disease exists. If color opposes pulse, pulse opposes color, disease exists. Extending this, symptoms matching pulse are favorable, generating each other is auspicious, opposing each other makes treatment laborious.
Question: There is (time) not arrived but (qi) arrived, (time) arrived but (qi) not arrived, arrived but not gone, arrived but excessive. What does this mean? The Master said: (November) after Winter Solstice. (Value) Jiazi (day) midnight. (For) Shaoyang (self) rising. (Until mid-month Rain Water, for) Shaoyang (just rising and exiting earth) time. (Lesser) Yang (prosperous and all things) begin to grow, heaven obtains mild warmth. (This is normal heavenly qi. Now) having not obtained Jiazi. (And) heaven (qi) because (first) mild warmth, this is (time) not arrived but (qi first) arrived. Having (already) obtained Jiazi, and heaven (qi still) not mild warmth, is (time already) arrived but (qi) not arrived. Having (already) obtained Jiazi, and heaven great cold does not resolve, this is (time already) arrived but (should go but) not gone. Having (already) obtained Jiazi, and heaven warmth like midsummer fifth and sixth months, this is (time already) arrived but (arrival of) excessive. (Deducing from this, after Winter Solstice value Jiazi day rising, Shaoyang sixty days, Yangming sixty days, Taiyang sixty days, Taiyin sixty days, Shaoyin sixty days, Jueyin prosperous each sixty days, six-six thirty-six, and yearly work completes. Humans in qi intersection, some conform to time and adapt, some oppose time and decline/prosper, some immediately due to non-time abnormal qi cause disease, can physicians not know their origins one by one?)
This section discusses heavenly qi and not medicine, but the way of adapting to time is within it. You Zaijing said: Upper arrival refers to time arriving. Lower arrival refers to qi arriving. Time has constant measure and does not shift; qi has no fixed moment and may migrate. After Winter Solstice Jiazi refers to sixty days after Winter Solstice. Ancient calendar makers used November Jiazi new moon midnight Winter Solstice as calendar origin; deducing from this, then sixty days after Winter Solstice.