皆为虚矣。其六脉紧牢而有力者。皆为实矣。莫以脉经所载濡紧牢。认为其脉焉。即若有力无力字面。然其诊之濡牢。
亦可由此类推出也。言也缓也。皆为内伤之候。其病亦有虚实。岂止虚耳。然此篇概为虚者。凡内伤者。脏病多不足。
其偶有见实。乃皆一时邪之所为。多是假实。而非真实也。入也。不言也。急也。虽皆为外伤之候。然亦有虚实。岂独
实耳。此专为实者。凡外伤者。腑病多有余。其偶见虚。亦是假虚。而非真虚也。方其内攻。虽外伤须挟虚矣。方其外
发。则内伤亦有似实焉。此篇特就其病发见之始而言之。以分其虚实耳。痛为实。快为虚者。是乃扪循切按之候。即诊
尺之义。学人须知古人察脉病外于诊之一事。亦不可忽诸。
（第四十九旧五十一）难曰。病有欲得温者。（饮食衣服居处）有欲得寒者。（同上）有欲得见人者。（恶幽闲）有不
欲得见人者。（好静默）而各不同。病在何脏腑也。然。病欲得寒。而欲见人者。病在腑也。（主阳）病欲得温。而不欲
见人者。病在脏也。（主阴）何以言之。腑者阳也。阳病欲得寒。又欲见人。脏者阴也。阴病欲得温。又欲闭户独处。恶
闻人声。故以别知脏腑之病也。
按此篇专缘其所欲之情。以别脏腑之病。夫冬日饮汤。夏日饮水。常情之所使然。然则病情亦当如是。盖冬则阳伏
而阴旺。故人身外少气而内有余。所谓阳虚则外寒。阴盛则内寒。内外皆寒。故欲饮汤就温。夏则阴沉而阳浮。故外充
而内空。所谓阳盛则外热。阴虚则内热。内外皆热。故欲饮水受冷常情尚且如此况病情乎。且其至于见人之好恶及动静
语默。亦皆阴阳之分。昭然可见矣。虽然。此亦一义例已。至其变化。则知脏病热炽。盒饭欲寒。腑病寒甚。盒饭欲温。
且如素问阳明病恶人。此乃一时热积胸中所致。此难谓恶人者阴病。情之所为。读者察诸。因前篇有三虚三实之候。故
此商病情以辩表里寒热。旧本第九篇。以迟数之脉。分脏腑寒热。与此篇互相发。宜参看。
（第五十旧四十九）难曰。有正经自病。有五邪所伤。何以别之。然。忧愁思虑。（二字灵枢作恐惧）则伤心。形寒
饮冷。（饮冷灵枢作寒饮）则伤肺。恚怒气逆。上而不下。（气积胁下）则伤肝。饮食劳倦。则伤脾。（灵枢作若醉入房汗
出当风则伤脾）久坐湿地。强力（灵枢作有所用力举重）入水。（灵枢作入房过度汗出浴水）则伤肾。是正经之自病也。
按此难所发。即出素问遗篇本病论。但彼阙肺一病。灵枢第四篇。有类此者。而文稍异焉。滑注引之。由不视遗篇
尔。所谓正经自病者。言五脏内虚。而病从内生。东垣所谓内伤是也。盖心肝二病。固为七情偏气之所伤。而其肺脾肾
之病。乃似内伤挟外感者。然既为正经自病。则知非寻常外邪矣。夫忧愁属肺。思虑属脾。共为手足太阴二脏。偏倾而
伤心。怒伤肝。此其本情。无论已。形寒饮冷。虽从外而入。然其人自失节。而所受者。非天时之寒伤之。且其寒与冷。
亦非一朝一夕之感也。久坐湿地者。是亦似外邪。实非天时之湿。居处失宜。下体不温。加之强力入房。汗出入水等事。
以渐发病。亦非一时之水湿也。饮食劳倦。有内外之辨。故在下文。五邪病亦复言之。滑注引谢氏说为是。正经之饮食
伤主。劳倦五邪之劳倦。伤饮食为之主。仍详东垣内外伤辩。宜参考。
何谓五邪。然。有中风。（肝）有伤暑。（心）有饮食劳倦。（脾）有伤寒。（肺）有中湿。（肾）此之谓五邪。假令心
病。何以知中风得之。（虚邪）然。其色当赤。何以言之。肝主（五）色。自入为青。（正）入心为赤。（虚）入脾为黄。
（贼）入肺为白。（微）入肾为黑。（实）肝为心邪。（从后而来）故知当赤色。其病身热。（心）胁下满痛。（肝）其脉浮
大（心）而弦。（肝）何以知伤暑得之。（正邪）然。当恶焦（旧本脱故补）臭。何以言之。心主（五）臭。自入为焦臭。
（正）入脾为香臭。（虚）入肝为臊臭。（实）入肾为腐臭。（微）入肺为腥臭。（贼）故知心病伤暑得之。（自病）当恶焦
臭。其病身热而烦。心痛。（心）其脉浮大而散。（心）何以知饮食劳倦得之。（实邪）然。当喜苦味也。虚为不欲食。实
为欲食。（二句旧注或以为衍然于义无害）何以言之。脾主（五）味。入肝为酸。（微）入心为苦。（实）入肺为辛。（虚）
入肾为咸。（贼）自入为甘。（正）故知脾邪入心。（从前而来）为喜苦味也。其病身热（心）而体重。嗜卧。四肢不收。
（脾）其脉浮大（心）而缓。（脾）何以知伤寒得之。（微邪）然。当谵言妄语。何以言之。肺主（五）声。入肝为呼。（贼）
入心为言。（微）入脾为歌。（实）入肾为呻。（虚）自入为哭。（正）故知肺邪入心。（从所胜而来）为谵言妄语也。其病
身热（心）洒洒恶寒。甚则喘咳。（肺）其脉浮大（心）而涩。（肺）何以知中湿得之。然。当喜汗出不可止。何以言之。
肾主（五）液。（旧本作湿误）入肝为泣。（虚）入心为汗。（贼）入脾为涎。（微）入肺为涕。（实）自入为唾。（正）故
知肾邪入心。（从所不胜而来）为汗出不可止也。其病身热（心）而小腹痛。足胫寒而逆。（肾）其脉沉濡（肾）而大。（心）
此五邪之（诊）法也。
按肝总管五色。心管五臭。脾管五味。肺管五声。肾管五液。液应水。声应金。味应土。臭应火。色应木。是其类
也。凡一脏有五病。五五二十五变。本篇举心为例。余可类推。夫肝之中风。邪入他脏。则见各脏色于面。心之伤暑。
邪入他脏。则恶各脏臭于鼻。脾之饮食。邪入他脏。则喜各脏味于口。肺之伤寒。邪入他经。则发各脏之声。肾之中湿。
邪入他经。则出各脏之液。古者率皆以此。乃知其病之传变焉。难经言此者居多。旧本三十四篇。出声色臭味液。第七
十四篇。言一脏有五病。第十篇有一脉十变。当与此篇参考。
（第五十一旧五十）难曰。病有虚邪。有实邪。有贼邪。有微邪。有正邪。何以别之。然从后来者。（母往临子）为
虚邪。从前来者。（子来乘母）为实邪。从所不胜来者。（夫克妻）为贼邪。从所胜来者。（妻侮夫）为微邪。自病者。（己
自受过）为正邪。何以言之。假令心病中风。得之为虚邪。伤暑得之。为正邪。饮食劳倦得之。为实邪。伤寒得之。为
微邪。中湿得之。为贼邪。
按此承前篇之旨。申明五邪之名义。据气厥论五脏寒热相移等言。则五邪非独有传变。虽正经自病。其至久则亦当
有传焉。下编所谓七传。似言其义。然七传者。唯谓五脏相克为病。而未曾言及一脏病。为彼此相移。故与此所言。义
本自异。不宜为一途看。
（第五十二旧五十三）难曰。经（灵素病传二篇）言七传者死。（相克）间脏者生。（相生）何谓也。然。七传者。
传其所胜也。间脏者。传其子也。何以言之。假令心病（初）传肺。（火克金）肺传肝。（金克木）肝传脾。（木克土）脾
传肾。（土克水）肾传心。（水克火心复传肺乃为再伤）一脏不再伤。（若再伤者死）故言七传者死也。假令心病传脾。（火
生土）脾传肺。（土生金）肺传肾。（金生水）肾传肝。（水生木）肝传心。（木生火）是子母相传。竟而复始。如环无端。
（再伤亦不至死）故曰生也。
按灵素病传二篇。所谓五脏腑相传。以至肠胃。命曰必死。此篇七传。盖本诸此。其实相逆，各传其所胜。故曰死
矣。假令病始于心。相克至肺。则为再伤。始于肺。则至肝为再伤。余脏皆然。灵素举五脏及胃膀胱七者。以论病传。
此篇独谓五脏再伤为七传。而不言及腑。此乃所以与经异者何。观后篇脏腑病有治之难易等说。则其义似不相戾。唯越
人分割脏腑二病。言其义耳。所谓间脏者。五脏母子相传之病。而比诸七传。病势则稍缓。故曰生焉。内经曰。间脏者
刺之。又曰。不间脏者难治。排列相克脏。以一脏间之。则成相生。辟如排列心肺。以脾间之之类。故有间脏之名。吕
氏之说得之。滑注。以素问标本论间甚之间字释其义。非是。所谓间甚。犹言轻重。与间脏之间。不相干涉。间脏字既
出病传二篇。及平人气象论中。学人审诸。
（第五十三旧五十四）难曰。脏病难治。腑病易治。何谓也。然。脏病所以难治者。传其所胜也。（若夫顺传者非难
愈）腑病易治者。传其子也。（若夫逆传者非易治）与七传间脏同法。（可见非由脏腑第由顺逆耳）
按前篇谓七传间脏者。言脏病有死生之分。此篇特举脏腑二病者。以 其难易之治。凡脏病之所以难治。多传其所
胜。若夫母子相传则易愈。腑病之易治者。多传其所生。若夫逆传。虽腑病亦难治焉。故曰。与七传间脏同法。滑注既
得其旨。故不复赘。
（第五十四旧五十二）难曰。腑脏发病根本等不。然。不等也。其不等者（四字因熊氏俗解补之）何。然。脏病者
止（留）而不移。其病不离其处。（有常部分）腑病者。仿佛（转变）贲响。（奔走）上下行流。居处无常。故以此知脏
腑（二病）根本不同也。
按此为后篇论积聚起本。凡百尔病千态万化。于泽如蕉。更仆不尽。然其所适从。唯脏腑为期。舍此无可他求。此
篇旧本在七传前。似隔一顷。故易地云。
（第五十五旧同）难曰。病有（五）积有（六）聚。何以别之。然。积者阴气也。（属脏）聚者阳气也。（属腑）故
阴沉而伏。（兼脉证）阳浮而动。（同上）气之所积。名曰积。（病根于阴）气之所聚。名曰聚。（病本于阳）故积者五脏
所生。（其根深）聚者六腑所成（其本浅）也。积者阴气也。（再说）其始发有常处。其痛不离其部。上下有所终始。左
右有所穷处。（总言五积病）谓之积（三字旧本无因下文本例私补之）聚者阳气也。（再说）其始发无根本。上下无所留
止。其痛无常处。（总言六聚病）谓之聚。故以是别知积聚也。
按此篇所谓积聚。有脏腑之分。盖积者其所从来。以渐而深。累积荏苒成块。原于脏也。聚者所受犹浅。聚散倏忽。
居处无常。本于腑也。积不易位。故后篇审言其病形。聚无定体。临时更改。故此第言其所以然之由。宜与后篇连读。
（第五十六旧同）难曰。五脏之积。各有名乎。（第一问）以何月何日得之。（第二问）然。肝之积。名曰肥气。（盛
满猛烈）在左胁下。（肝部候）如覆杯。（积块）有头足。（形象）久不愈。令人发咳逆（逼所）不胜 疟。（乘所胜或
如疟每发寒热）连岁不已。以季夏戊己日得之。（应第二问）何以言之。肺病传于肝。（金克木）肝当传脾。（木克土）脾
季夏（六月）适王。（旺同下仿此）王者不受邪。（纵下同）肝复欲还肺。（横下同）肺不肯受。（制者强）故留结为积。（受
制者弱）故知肥气为季夏戊己日（土旺时）得之。心之积名曰伏梁。（血根）起齐上。大如臂。（积形）上至心下。（胸博）
久不愈。令人病烦心。（本经自病）以秋庚辛日得之。何以言之。肾病传心。（水克火）心当传肺。（火克金）肺（金）以
秋（七十二日）适王。王者不受邪。心复欲还肾。肾不肯受。（强下同）故留结为积。（弱下同）故知伏梁以秋庚辛日（金
旺）得之。脾之积。名曰痞气。（痞塞上下不通）在胃脘。（腹中央）覆大如盘。（形）久不愈。令人四肢不收。发黄胆。
饮食不为肌肤。（皆属本病）以冬壬癸日得之。何以言之。肝病传脾。（木克土）脾当传肾。（土克水）肾以冬适王。王者
不受邪。脾复欲还肝。肝不肯受。故留结为积。故知痞气以冬壬癸日（水旺）得之。肺之积。名曰息贲。（挟喘息而发）
在右胁下。（肺部位）覆大如杯。（形）久不已。令人洒淅寒热。喘咳发肺壅。（本病）以春甲乙日得之。何以言之。心病
传肺。（火克金）肺当传肝。（金克木）肝以春适王。王者不受邪。肺复欲还心。心不肯受。故留结为积。故知息贲以春
甲乙日（木旺）得之。肾之积。名曰贲豚。（如豚贲突）发于小腹。（肾部位）上至心下。若豚（奔）状。或上或下无时。
（积状）久不已。令人喘逆。（及其所生）骨痿少气。（本经病）以夏丙丁日得之。何以言之。脾病传肾。（土克水）肾当
传心。（水克火）心以夏适王。王者不受邪。肾复欲还脾。脾不肯受。故留结为积。故知贲豚以夏丙丁日（火旺）得之。
此五积之要法也。
按此篇详言五积名形。与所以得病之由。而其名与病形。义无容疑。至其谓得病之由。则未尝不使后人起惑焉。夫
五积之所由生。固执月日。则虽难经。其说或涉怪诞。何者。其所谓肝曰季夏戊己。心曰秋庚辛。脾曰冬壬癸。肺曰春
甲乙。肾曰夏丙丁。岂有如是拘拘时日哉。果若其说。则凡五积之病。方其时发者。皆能推算月日知之乎。盖积之为病。
They are all deficiency syndromes. If the six pulses (Cun, Guan, Chi on both left and right hands) are tight, firm, and forceful, they are all excess syndromes. Do not simply assume that the pulse names recorded in *Mai Jing* (Classic of Pulse Diagnosis), such as Ru (Soft/Deficient), Jin (Tight), and Lao (Firm), imply specific qualities of forcefulness or weakness based solely on their literal meanings. However, by examining the Ru and Lao pulses, one can infer others by analogy. "Yan" (Speech) and "Huan" (Slowness/Laxity) are signs of internal injury; their diseases may present with either excess or deficiency, not merely deficiency. However, this chapter primarily discusses deficiency syndromes. Generally, for internal injuries, Zang organ diseases manifest as insufficiency. Occasional manifestations of excess are due to temporary pathogenic factors, representing false excess rather than true excess. "Ru" (Entering) and "Ji" (Urgency/Rapidness) are signs of external injury, yet they also encompass both excess and deficiency, not just excess. This chapter specifically addresses excess syndromes. Generally, for external injuries, Fu organ diseases manifest as surplus. Occasional manifestations of deficiency are false deficiency, not true deficiency. When pathogens attack inward, even external injuries must involve deficiency; when pathogens radiate outward, internal injuries may mimic excess. This chapter specifically refers to the initial manifestation of the disease to distinguish between excess and deficiency. Pain indicates excess, while a feeling of comfort indicates deficiency; these refer to the sensations during palpation and pressing, which is the meaning of diagnosing the Chi skin area. Learners must understand that besides observing the pulse to diagnose disease, the aspect of physical examination cannot be neglected.
(Chapter 49, formerly Chapter 51) Question: In diseases, some patients desire warmth, (in terms of diet, clothing, and dwelling) some desire cold, (same as above) some desire to see people, (disliking seclusion and quietude) and some do not desire to see people, (preferring silence and stillness), and these differ from each other. Which Zang or Fu organ is affected? Answer: Diseases where the patient desires cold and wishes to see people affect the Fu organs. (Fu belongs to Yang) Diseases where the patient desires warmth and does not wish to see people affect the Zang organs. (Zang belongs to Yin) Why is this so? Fu organs belong to Yang; Yang diseases desire cold and wish to see people. Zang organs belong to Yin; Yin diseases desire warmth and prefer closing doors to stay alone, disliking the sound of voices. Thus, one can distinguish Zang and Fu diseases by this method.
Commentary: This chapter specifically uses the patient's desires and dispositions to differentiate Zang and Fu diseases. Drinking hot soup in winter and water in summer is driven by common human nature. Similarly, disease conditions should follow this pattern. In winter, Yang Qi is hidden and Yin Qi is prosperous, so the exterior of the body lacks Qi while the interior is abundant. As stated, "Yang deficiency leads to exterior cold, Yin excess leads to interior cold." With cold inside and out, one desires hot drinks and warmth. In summer, Yin sinks and Yang floats, so the exterior is full while the interior is empty. As stated, "Yang excess leads to exterior heat, Yin deficiency leads to interior heat." With heat inside and out, one desires cold drinks and coolness. If common nature is thus, how much more so for disease states? Furthermore, preferences regarding seeing people and attitudes toward movement, speech, and silence are clearly distinctions of Yin and Yang. Although this is but one principle, regarding variations: if a Zang disease has intense heat, the patient will desire cold; if a Fu disease has severe cold, the patient will desire warmth. For instance, in *Su Wen*, Yangming disease involves aversion to people, caused by temporary heat accumulation in the chest. Here, aversion to people is attributed to Yin disease and emotional disposition; readers should examine this carefully. Since the previous chapter discussed three types of deficiency and excess signs, this chapter discusses disease conditions to differentiate exterior-interior and cold-heat. The old version of Chapter 9 differentiates Zang-Fu cold-heat using slow and rapid pulses, complementing this chapter; they should be consulted together.
(Chapter 50, formerly Chapter 49) Question: There are diseases originating from the regular meridians themselves (Zheng Jing Zi Bing) and those injured by the Five Evils (Wu Xie). How can they be distinguished? Answer: Worry and overthinking (fear in *Ling Shu*) injure the Heart; exposure to cold and drinking cold beverages (cold drinks in *Ling Shu*) injure the Lung; anger with rebellious Qi rising upward without descending (Qi accumulating under the hypochondrium) injures the Liver; improper diet and fatigue injure the Spleen (*Ling Shu* adds: entering the room drunk with sweat exposed to wind injures the Spleen); sitting long in damp places, exerting great strength (lifting heavy weights in *Ling Shu*), or entering water (excessive intercourse with sweat followed by bathing in water in *Ling Shu*) injures the Kidney. These are diseases of the regular meridians originating internally.
Commentary: This question originates from the lost chapter *Ben Bing Lun* of *Su Wen*, which lacks the Lung disease. *Ling Shu* Chapter 4 has similar content but with slightly different wording. Hua Su cited it because he had not seen the lost chapter. "Regular meridian self-disease" means internal deficiency of the five Zang organs leading to disease arising from within, what Li Dongyuan called internal injury. Diseases of the Heart and Liver are indeed caused by the biased Qi of the Seven Emotions. Diseases of the Lung, Spleen, and Kidney seem like internal injury complicated by external contraction. However, since they are regular meridian self-diseases, they are not ordinary external pathogens. Worry belongs to the Lung, overthinking to the Spleen, both Hand-Taiyin organs, yet they bias and injure the Heart. Anger injures the Liver; this is the natural emotion. Exposure to cold and drinking cold, although entering from outside, results from the patient's lack of moderation; the cause is not seasonal cold, nor is the cold sensation instantaneous. Sitting long in damp places seems like an external pathogen but is actually not seasonal dampness; it is improper living conditions causing lower body chill, combined with excessive strain or intercourse with sweat entering water, developing gradually, not instantaneous wetness. Diet and fatigue have internal and external distinctions, discussed later regarding the Five Evils. Hua Su cites Xie Shi's view as correct: Regular meridian diet injury is primary; fatigue is the fatigue evil among the Five Evils, with diet as the primary factor. Refer to Li Dongyuan's *Differentiation of Internal and External Injury*.
What are the Five Evils? Answer: Wind-stroke (injuring Liver), Summerheat (injuring Heart), Diet and Fatigue (injuring Spleen), Cold damage (injuring Lung), Damp-wetness (injuring Kidney). These are the Five Evils. Suppose Heart disease: How do we know it is caused by Wind-stroke? (Deficient Evil/Xu Xie) Answer: The complexion should be red. Why? The Liver governs the Five Colors. Entering itself is Green (Correct/Zheng), entering Heart is Red (Deficient/Xu), entering Spleen is Yellow (Thieving/Ze), entering Lung is White (Slight/Wei), entering Kidney is Black (Excess/Shi). The Liver is the evil of the Heart (coming from behind, i.e., Mother affecting Child), so the color should be red. Symptoms: Body heat (Heart), fullness and pain in the hypochondrium (Liver), pulse floating and large (Heart) and wiry (Liver). How do we know it is caused by Summerheat? (Correct Evil/Zheng Xie) Answer: There should be aversion to burnt odor. Why? The Heart governs the Five Odors. Entering itself is Burnt (Correct/Zheng), entering Spleen is Fragrant (Deficient/Xu), entering Liver is Pungent/Fishy (Excess/Shi), entering Kidney is Rotten (Slight/Wei), entering Lung is Fishy (Thieving/Ze). Thus, Heart disease from Summerheat causes aversion to burnt odor. Symptoms: Body heat and irritability, Heart pain (Heart), pulse floating, large, and scattered (Heart). How do we know it is caused by Diet and Fatigue? (Excess Evil/Shi Xie) Answer: There should be a preference for bitter taste. Deficiency means no appetite, Excess means desire to eat. Why? The Spleen governs the Five Tastes. Entering Liver is Sour (Slight/Wei), entering Heart is Bitter (Excess/Shi), entering Lung is Pungent (Deficient/Xu), entering Kidney is Salty (Thieving/Ze). Entering itself is Sweet (Correct/Zheng). Thus, Spleen evil entering Heart (from front, i.e., Child affecting Mother) causes preference for bitter taste. Symptoms: Body heat (Heart), heavy body, drowsiness, limbs unable to move (Spleen), pulse floating, large (Heart) and slow (Spleen). How do we know it is caused by Cold damage? (Slight Evil/Wei Xie) Answer: There should be delirious speech. Why? The Lung governs the Five Sounds. Entering Liver is Shouting (Thieving/Ze), entering Heart is Speaking (Slight/Wei), entering Spleen is Singing (Excess/Shi), entering Kidney is Moaning (Deficient/Xu). Entering itself is Crying (Correct/Zheng). Thus, Lung evil entering Heart (from the conquered, i.e., Conqueror's child) causes delirious speech. Symptoms: Body heat (Heart), chills, severe coughing and panting (Lung), pulse floating, large (Heart) and choppy (Lung). How do we know it is caused by Damp-wetness? Answer: There should be profuse, unstoppable sweating. Why? The Kidney governs the Five Fluids (Old text says Wetness, error). Entering Liver is Tears (Deficient/Xu), entering Heart is Sweat (Thieving/Ze), entering Spleen is Saliva (Slight/Wei), entering Lung is Mucus (Excess/Shi). Entering itself is Spittle (Correct/Zheng). Thus, Kidney evil entering Heart (from the unconquered, i.e., Unconqueror's child) causes unstoppable sweating. Symptoms: Body heat (Heart), lower abdominal pain, cold feet and legs (Kidney), pulse deep and soft (Kidney) and large (Heart). This is the diagnostic method for the Five Evils.
Commentary: The Liver governs the Five Colors, Heart the Five Odors, Spleen the Five Tastes, Lung the Five Sounds, Kidney the Five Fluids. Fluids correspond to Water, Sounds to Metal, Tastes to Earth, Odors to Fire, Colors to Wood. Each Zang has five diseases, totaling twenty-five variations. This chapter uses Heart disease as an example; others can be inferred. In Liver Wind-stroke, if evil enters other Zang, respective colors appear on the face. In Heart Summerheat, if evil enters other Zang, respective odors are disliked in the nose. In Spleen Diet, if evil enters other Zang, respective tastes are liked in the mouth. In Lung Cold damage, if evil enters other meridians, respective sounds emerge. In Kidney Damp-wetness, if evil enters other meridians, respective fluids discharge. Ancients used these to know disease transmission. *Nan Jing* mentions this often. Old Chapter 34 discusses Sound, Color, Odor, Taste, Fluids; Chapter 74 discusses one Zang having five diseases; Chapter 10 discusses one pulse transforming ten times; these should be referenced with this chapter.
(Chapter 51, formerly Chapter 50) Question: Diseases include Deficient Evil (Xu Xie), Excess Evil (Shi Xie), Thieving Evil (Ze Xie), Slight Evil (Wei Xie), and Correct Evil (Zheng Xie). How are they distinguished? Answer: Coming from behind (Mother affecting Child) is Deficient Evil. Coming from front (Child affecting Mother) is Excess Evil. Coming from the unconquered (Conqueror affecting Conquered) is Thieving Evil. Coming from the conquered (Conquered affecting Conqueror) is Slight Evil. Self-disease (Self-inflicted) is Correct Evil. Why? Suppose Heart disease: Wind-stroke is Deficient Evil; Summerheat is Correct Evil; Diet and Fatigue is Excess Evil; Cold damage is Slight Evil; Damp-wetness is Thieving Evil.
Commentary: This follows the previous chapter's intent, clarifying the names of the Five Evils. According to *Qi Jue Lun* on the transfer of cold and heat among Zang, the Five Evils involve not only transmission but also long-term self-diseases transferring. The lower section's "Seven Transmissions" seems to address this. However, Seven Transmissions refers only to Zang overcoming Zang, not mutual transfer between any two Zang, so the meaning differs from this chapter and should not be conflated.
(Chapter 52, formerly Chapter 53) Question: The Classics say Seven Transmissions result in death (Overcoming), Interspersed Zang results in life (Generating). What does this mean? Answer: Seven Transmissions transmits to what it conquers. Interspersed Zang transmits to its Child. Why? Suppose Heart disease transmits to Lung (Fire conquers Metal), Lung to Liver (Metal conquers Wood), Liver to Spleen (Wood conquers Earth), Spleen to Kidney (Earth conquers Water), Kidney to Heart (Water conquers Fire, Heart transmitting back to Lung is second injury). One Zang is not injured twice (if injured twice, death occurs), hence Seven Transmissions means death. Suppose Heart disease transmits to Spleen (Fire generates Earth), Spleen to Lung (Earth generates Metal), Lung to Kidney (Metal generates Water), Kidney to Liver (Water generates Wood), Liver to Heart (Wood generates Fire). This is Mother-Child transmission, ending and restarting like a circle without beginning or end (second injury does not lead to death), hence life.
Commentary: *Ling Shu* and *Su Wen* Disease Transmission chapters state that transmission among Zang and Fu, reaching Stomach and Intestines, is fatal. This chapter's Seven Transmissions is based on this. It is contrary, transmitting to what it conquers, hence death. If disease starts in Heart, overcoming reaches Lung, it is a second injury; starting in Lung, overcoming reaches Liver, it is a second injury; same for others. *Ling Su* lists five Zang plus Stomach and Bladder (seven) to discuss transmission. This chapter defines Seven Transmissions as five Zang being injured twice, excluding Fu organs, differing from the Classics. Later chapters discuss ease/difficulty of treating Zang/Fu diseases, suggesting consistency. Yue Ren (Bian Que) separates Zang and Fu diseases to explain the principle. Interspersed Zang refers to Mother-Child transmission among five Zang; compared to Seven Transmissions, the disease progression is slower, hence life. *Nei Jing* says: Interspersed Zang can be acupunctured. Also: Non-interspersed Zang is difficult to treat. Arranging overcoming Zang and interspersing one creates generating sequence, e.g., arranging Heart-Lung and interspersing Spleen. Hence the name Interspersed Zang. Lu's view is correct. Hua Su interprets "Jian" in *Su Wen* Bian Ben Lun as intensity/severity, which is incorrect. Jian-Shen means light/heavy, unrelated to Jian-Zang. Jian-Zang appears in *Disease Transmission* and *Ping Ren Qi Xiang Lun*; learners should examine carefully.
(Chapter 53, formerly Chapter 54) Question: Zang diseases are difficult to treat, Fu diseases are easy to treat. Why? Answer: Zang diseases are difficult because they transmit to what they conquer. (If transmitted smoothly, not difficult to cure) Fu diseases are easy because they transmit to their Child. (If transmitted inversely, not easy to cure) This follows the same logic as Seven Transmissions and Interspersed Zang. (Shows it depends on smooth/inverse transmission, not just Zang/Fu status)
Commentary: The previous chapter on Seven Transmissions and Interspersed Zang distinguishes life and death in Zang diseases. This chapter highlights Zang and Fu diseases regarding treatment difficulty. Zang diseases are difficult mainly due to transmission to what they conquer; Mother-Child transmission is easier to cure. Fu diseases are easy mainly due to transmission to what they generate; inverse transmission makes Fu diseases difficult too. Hence, "Same method as Seven Transmissions and Interspersed Zang." Hua Su grasps this point, so no further elaboration is needed.
(Chapter 54, formerly Chapter 52) Question: Are the origins of Zang and Fu diseases equal? Answer: They are not equal. Why? Zang diseases remain stationary and do not move; the pathology stays in its location (fixed part). Fu diseases resemble rushing sounds, moving up and down, with no fixed location. Thus, we know the fundamental difference between Zang and Fu diseases.
Commentary: This leads to the discussion of Accumulation and Aggregation in later chapters. All diseases are myriad and complex, but ultimately relate to Zang and Fu. Without this, there is no other basis. This chapter was originally before Seven Transmissions in old texts, seemingly disconnected, so moved here.
(Chapter 55, formerly same) Question: Diseases include Accumulation (Ji) and Aggregation (Ju). How are they distinguished? Answer: Accumulation is Yin Qi (belongs to Zang); Aggregation is Yang Qi (belongs to Fu). Therefore, Accumulation is deep and latent (including pulse/symptoms); Aggregation is floating and active (same). Qi accumulation is named Accumulation (rooted in Yin); Qi aggregation is named Aggregation (rooted in Yang). Therefore, Accumulation arises from five Zang (deep root); Aggregation is formed by six Fu (shallow root). Accumulation is Yin Qi (reiterated): Its onset has a fixed place; pain does not leave its region; up and down have limits; left and right have boundaries (General description of five Ji diseases). Named Accumulation (Three characters missing in old text, added for consistency). Aggregation is Yang Qi (reiterated): Its onset has no root; up and down have no retention; pain has no fixed place (General description of six Ju diseases). Named Aggregation. Thus, we distinguish Accumulation and Aggregation.
Commentary: This chapter distinguishes Accumulation and Aggregation by Zang and Fu. Accumulation develops gradually, becoming deep and forming masses, originating from Zang. Aggregation is shallow, gathering and dispersing suddenly, with no fixed location, originating from Fu. Accumulation does not change position, so later chapters detail its form. Aggregation has no fixed shape, changing temporarily, so this chapter explains the reason. Read with subsequent chapters.
(Chapter 56, formerly same) Question: Do the five Zang accumulations have names? (First question) On what month and day are they acquired? (Second question) Answer: Liver accumulation is named Fei Qi (Fullness/Vigor), located under the left hypochondrium (Liver area), like an inverted cup, with head and feet (shape). If untreated, it causes coughing, asthma, and malaria-like symptoms (overcoming conquered or alternating chills/fever) year after year. Acquired on Wu-Ji days of late summer (corresponding to second question). Why? Lung disease transmits to Liver (Metal conquers Wood); Liver should transmit to Spleen (Wood conquers Earth). Spleen is prosperous in late summer (June); prosperous organs do not accept evil. Liver tries to return to Lung, but Lung refuses (Conqueror is strong). Thus, it remains and forms accumulation (Conquered is weak). Hence, Fei Qi is acquired on Wu-Ji days (Earth prosperous time). Heart accumulation is named Fu Liang (Hidden Beam/Blood Root), starting above the navel, arm-sized (mass shape), extending to below the heart. If untreated, it causes irritability. Acquired on Geng-Xin days of autumn. Why? Kidney disease transmits to Heart (Water conquers Fire); Heart should transmit to Lung (Fire conquers Metal). Lung (Metal) is prosperous in autumn (72 days); prosperous organs do not accept evil. Heart tries to return to Kidney, but Kidney refuses (Strong). Thus, it remains and forms accumulation (Weak). Hence, Fu Liang is acquired on Geng-Xin days (Metal prosperous). Spleen accumulation is named Pi Qi (Stagnation/Qi Blockage), in the epigastrium (center of abdomen), large like a plate. If untreated, it causes limb weakness, jaundice, and poor nutrition from food. Acquired on Ren-Gui days of winter. Why? Liver disease transmits to Spleen (Wood conquers Earth); Spleen should transmit to Kidney (Earth conquers Water). Kidney is prosperous in winter; prosperous organs do not accept evil. Spleen tries to return to Liver, but Liver refuses. Thus, it remains and forms accumulation. Hence, Pi Qi is acquired on Ren-Gui days (Water prosperous). Lung accumulation is named Xi Ben (Panting/Breath Rush), in the right hypochondrium (Lung area), large like a cup. If untreated, it causes chills, fever, coughing, and lung congestion. Acquired on Jia-Yi days of spring. Why? Heart disease transmits to Lung (Fire conquers Metal); Lung should transmit to Liver (Metal conquers Wood). Liver is prosperous in spring; prosperous organs do not accept evil. Lung tries to return to Heart, but Heart refuses. Thus, it remains and forms accumulation. Hence, Xi Ben is acquired on Jia-Yi days (Wood prosperous). Kidney accumulation is named Ben Tun (Racing Pig/Turbid Qi), starting in lower abdomen (Kidney area), rising to below the heart, resembling a pig running, moving up and down unpredictably. If untreated, it causes asthma, bone萎 (withering), and shortness of breath. Acquired on Bing-Ding days of summer. Why? Spleen disease transmits to Kidney (Earth conquers Water); Kidney should transmit to Heart (Water conquers Fire). Heart is prosperous in summer; prosperous organs do not accept evil. Kidney tries to return to Spleen, but Spleen refuses. Thus, it remains and forms accumulation. Hence, Ben Tun is acquired on Bing-Ding days (Fire prosperous). This is the essential method for the five accumulations.
Commentary: This chapter details the names and forms of the five accumulations and their causes. The names and forms are unquestionable. However, the explanation of acquisition causes may confuse later generations. Fixing the generation of five accumulations to specific months and days, even in *Nan Jing*, seems bizarre. Liver in late summer Wu-Ji, Heart in autumn Geng-Xin, Spleen in winter Ren-Gui, Lung in spring Jia-Yi, Kidney in summer Bing-Ding. Can such rigid timing apply? If so, could all five accumulation cases be calculated by month and day at onset? Actually, accumulation diseases...