八叶也。）主藏魄。肾有两枚，重一斤二两，主藏志。（两枚，即上文所谓左为肾、右为命门者也。）
胆在肝之短叶间，重三两三铢，盛精汁三合。（上言五脏，以下言六腑。）胃重二斤十四两，（一作一两）纾曲屈伸（谓
统计其屈曲处也。）长二尺六寸，大一尺五寸，径五寸。盛（一作容）谷二斗，水一斗五升。小肠重二斤十四两，长三丈
二尺，广二寸半，径八分、分之少半，左 （一作回，下同。）叠积十六曲，盛（一作容）谷二斗四升，水六升三合、合
之大半。大肠重三（一作二）斤十二两，长二丈一尺，广四寸，径一寸，当脐右回叠积十
六曲，盛谷一斗，水七升半。《灵·肠胃篇》云∶“回肠当脐左环回周叶积而下，回运环返十六曲，大四寸，径一寸、寸
之少半”。上三条长短受盛，与经文俱同。膀胱重九两二铢，纵广九寸，（膀胱亦不正圆，故曰纵广。）盛溺九升九合。（水
从大肠渗入膀胱则为溺，不与谷同居，故不曰水而曰溺，此越人精微处也。）口广二寸半，唇至齿长九分，齿已后至会厌
（已后，即以下也，会厌，吸门也。）深三寸半，大容五合。（谓口内可受五合也。）舌重十两，长七寸，广二寸半。咽门
重十二两，（一作十两。《灵·肠胃篇》∶咽门重十两”。）广二寸半，至胃长一尺六寸。（咽门，谓咽物之处，即俗名食脘
者也，下通于胃。）喉咙重十二两，广二寸，长一尺二寸，九节。（喉咙，即出声之处，即俗名喉脘者也，下通于肺。九
节，有薄骨相联系，其节有九也。）肛门重十二两，大八寸，径二寸大半，长二尺八寸，受谷九升三合、八分合之一。”（肛
门，即广肠。此条长短受盛，亦与上同。）
四十三难曰∶人不食饮，七日而死者，何也？
然∶人胃中当有留谷二斗，水一斗五升。（即上条所谓横屈受水谷三斗
五升也。）故平人日再至圊，（圊，厕也。）一行二升半，（行水谷，化糟粕。行，去也。日中五升，日中五升，《灵》作“一
日中五升”，言一日之中共去五升也。）七日五七三斗五升，而水谷尽矣。故平人不食饮七日而死者，水谷津液俱尽，即
死矣。（津液由水谷而生，水谷尽则津液亦亡矣。）
四十四难曰∶七冲门何在？（冲者，冲要之地也。）
然∶唇为飞门，（飞，飞动之。）齿为户门，（齿有关键之象，如
家之有户，物不得径出入也。）会厌为吸门，（会厌，谓物之所会聚，又能掩闭勿使物误入。吸，吸纳处也。）胃为贲门，
（贲，犹奔也。物入于胃，疾奔而下太仓也。）太仓下口为幽门，（《灵·胀论》∶“胃者，太仓也。”以其聚物如仓廪，故
曰太仓。下口，接小肠处也。幽，深晦之地，与上下出入处至远也。）大肠小肠会为阑门，（会者，小肠之下，大肠之上。
小肠为受盛之官，化物出焉，纳滓秽于大肠，泌津液于膀胱，水谷于此而分别焉，故曰阑门，谓阑截分别、不得并出入
也。）下极为魄门，（极，底也。魄门，即肛门也。饮食至此，精华已去，止存形质，故曰魄门，即所谓鬼门也。又肺藏
魄，肛门连大肠，与肺为表里，故曰魄门。《素·五脏别论》云∶“魄门亦为五脏使，水谷不得久藏。”）故曰七冲门也。
四十五难曰∶经言八会者，何也？（会，聚也。气之所聚，共八穴也。）
然∶腑会太仓，（太仓，属任脉，即中脘穴，
在脐上四寸。六腑取禀于胃，故曰腑会。）脏会季胁，（季胁，属足厥阴，即章门穴，在大横外直脐季肋端，脾募也。五
脏皆禀于脾，故为脏会。）筋会阳陵泉，（阳陵泉，属足少阳，足少阳之筋结膝外廉，即此穴。肝主筋而胆其合也，故为
筋会。）髓会绝骨，（绝骨，属足少阳，即悬钟穴，在外踝上四寸。《灵·经脉篇》论足少阳之脉云∶“是主骨”，盖诸髓皆
属于骨，故为髓会。）血会膈俞，（膈俞，属足太阳，在项后第七椎下，去脊旁一寸半，在中焦之分，化精微而为血之地
也，故为血会。）骨会大杼，（大杼，属足太阳，在项后第一椎下，去脊旁一寸半。《灵·海论》云∶“冲脉为十二经之海，
其输在于大杼”；《动输篇》云，冲脉与肾之大络起于肾下，盖肾主骨，膀胱与肾合，故为骨会。）脉会太渊，（太渊，属
手太阴，在掌后陷中，即寸口也。肺朝百脉，故为脉会。义详第一难中。）气会三焦外，一筋直两乳内也。（三焦外，谓
在焦膜之外。两乳内，谓两乳之中，任脉之所过，即膻中穴也。《灵·经脉篇》手少阳之脉“是主气”；又《海论篇》云∶
“膻中者，为气之海”，故为气会。）热病在内者，取其会之气穴也。（热病在内，则邪气已深，不可浅治，故必从其气
所会聚之处攻取其邪，乃能已疾也。其会，谓各视其病之所在，审取其所当治之会也。）
四十六难曰∶老人卧而不寐；少壮寐而不寤者，何也？（寐，目瞑而神藏也。寤，《说文》云∶“觉而有信”也，盖
寝而心有所忆，不能成寐也。）
然∶经言少壮者，血气盛，肌肉滑，滑，泽也。）气道通，营卫之行不失于常，（《灵·营
卫生会篇》∶营卫行阳二十五度，行阴亦二十五度，平旦而阳受气，日入而阴受气，如是无已。此之谓也。）故昼日精，（精，
精敏不倦也。）夜不寤也。老人血气衰，肌肉不滑，营卫之道涩，（涩，谓不利顺也。）故昼不能精，夜不寐也。故知老人
不得寐也。
四十七难曰∶人面独能耐寒者，何也？
然∶人头者，诸阳之会也。（诸阳，谓六阳经之脉也。）诸阴脉皆至颈、胸中
而还，独诸阳脉皆上至头耳，（《灵·逆顺肥瘦论》云∶“手之三阴，从脏走手；手之三阳，从手走头；足之三阳∶从头走
足；足之三阴，从足走腹。”此之谓也。）故令面耐寒也。
四十八难曰∶人有三虚三实，何谓也？
然∶有脉之虚实，有病之虚实，有诊之虚实也。（诊，候也，证也。）脉之虚
实者，濡者为虚，（濡，柔弱软滞也。《伤塞论》云∶诸濡亡血；又云∶“濡则卫气微”，可见濡为气血两虚之候。）紧牢者
为实。（弦劲曰紧，坚实曰牢。《素·平人气象论》∶脉“盛而紧曰胀”；《伤寒论》云∶“趺阳脉……紧者，脾气强”；又云∶
“寒则坚牢”，可见紧牢为邪气实之候。脉不止此二种，举此以类推也。）病之虚实者，出者为虚，（出，谓精气外耗，
如
汗、吐、泻之类，凡从内出者皆是。）入者为实；（入，谓邪气内结，如能食便闭、感受风寒之类，凡从外入者皆是。）言
者为虚，不言者为实；（言，多言也。病气内乏，神气自清，故惺惺能言也。不言，不能言也，邪气外攻，昏乱神智也。
言、不言，亦即上出入之义。）缓者为虚，急者为实。（缓，病来迟也，正气夺而邪气微，则病渐深，急，病来骤也。正
气未漓而邪气盛，则病疾速也。）诊之虚实者，濡者为虚，牢者为实；痒者为虚，痛者为实；（血气少而肌肉不能充，则
痒。邪气聚而营卫不得和，则痛。）外痛内快，为外实内虚，内痛外快，
为内实外虚。（此则须按而候之也。凡虚者喜按，实者不可着手，故按之而痛处为实，快处为虚也。）故曰虚实也。
四十九难曰∶有正经自病，有五邪所伤，何以别之？（正经，本经也。五邪，谓五脏之邪互相贼也。详下文。）
然∶
忧愁思虑则伤心；（思虑出于心，故过用则受伤。）形寒饮冷则伤肺；（肺脏本寒，故外受风寒，内饮冷水，则受伤也。）
恚怒气逆，上而不下则伤肝；（肝在志为怒，恚怒则木气郁而上冲，故受伤也。）饮食劳倦则伤脾；（脾为仓廪之官，主纳
饮食，四肢皆属于脾，劳倦必由四肢，故过用则脾受伤也。）久坐湿地，强力入水则伤肾。（湿伤于下，故湿先归肾。又
肾为作强之官，水又肾之类，故强力入水则肾受伤。）是正经（一本有之字）自病也。何谓五邪？
然∶有中风，（肝为风
木，故风先入肝。）有伤暑（心为君火，暑，火之气也，故心受之。）有饮食劳倦，（此言脾之受邪也。义见上。）有伤寒，
（此言肺之受邪也。义见上。）有中湿。（此言肾之受邪也。义见上。）此之谓五邪。
假令心病，何以知中风得之？（言心得中风
之病也。下仿此。）
然∶其色当赤。何以言之？肝主色，（见四十难。下同。）自入为青，（自入，肝中风也。《素·阴阳应
象大论》∶肝“在色为苍”。）入心为赤，（心中风也。《素》∶心“在色为赤”。）入脾为黄，（脾中风也。《素》∶脾“在色为
黄。”）入肺为白，（肺中风也。《素》∶肺“在色为白。”）入肾为黑。（肾中风也。《素》肾“在色为黑”。）肝为心邪，（风
入于心而为邪也。）故知当赤色也。（一本无也字）其病身热，（凡外感之邪，先伤营卫，故身皆热。又心属火，热为火邪
之象也。下同。）胁下满痛，（胁下，肝所居之位。）其脉浮大而弦。（浮大，心脉本象。弦则肝脉之象也。）
何以知伤暑得之？
然∶当恶臭。何以言之？心主臭，自入为焦臭，（自
入，心伤暑也。焦，火之气，心属火也。）《素·金匮真言论》∶心“其臭焦”）
入脾为香臭，（脾伤暑也。香，土之气。《素》∶脾“其臭香”。）入肝为臊臭，（肝伤暑也。臊，木之气。《素》∶肝“其臭
臊”。）入肾为腐臭，（肾伤暑也。腐，水之气。《素》∶肾“其臭腐”。）入肺为腥臭。（肺伤暑也。腥，金之气。《素》∶肺
其臭腥。）故知心病伤暑得之，当恶臭。其病身热而烦，（烦，烦躁也，火郁而瞀乱也。）心痛，（邪在心则痛。）其脉浮大
而散。（浮大，心之本脉。散则浮大而空虚无神，心之病脉也。）何以知饮食劳倦得之？
然∶当喜味苦也。虚为不欲食，
实为欲食。（虚则脾气不能化谷，实则尚能化谷，故有能食、不能食之分。盖风、寒、暑、湿，其气不殊，故无虚实之辨，
若饮食劳倦，病因各殊，故越人着此二语，义最精细。）何以言之？脾主味，入肝为酸，（肝受饮食劳倦之病也。《素·阴
阳应象大论》∶肝“在味为酸”。）入心为苦，（心受饮食劳倦之病也。《素》∶心“在味为苦”。）入肺为辛，（肺受饮食劳倦
之病也，《素》∶肺“在味为辛”。入肾为咸，（肾受饮食劳倦之病也。《素》∶肾“在味为咸”。）自入为甘。（脾受饮食劳倦
之病也。《素》∶脾“在味为甘。）故知脾邪入心，为喜味苦也。其病身热而体重，嗜卧，四肢不收”，（嗜卧，倦卧也。脾
主肌肉及四肢故也。）其脉浮大而缓。（浮大，心之本脉。缓，脾之脉象也。）何以知伤寒得之？
然∶当谵言妄语。（谵，
狂悖多言也。）何以言之？肺主声，入肝为呼，（肝伤寒也。《素·阴阳应象大论》∶肝“在声为呼”。）入心为言，（心伤寒
也。）
入肾为呻，（肾伤寒也。《素》∶肾“在声为呻”。）自入为哭。（肺伤寒也。《素》肺“在声为哭”。）故知肺邪入心，为
谵言
妄语也。其病身热，洒洒恶寒。（肺本寒脏，又伤寒则恶寒也。）甚则喘咳，（肺气上逆，则喘而咳。又《灵·九针篇》云∶
“肺主咳”。）其脉浮大而涩。（浮大，心之本脉。涩，肺脉之象也。）何以知中湿得之？然，当喜汗出不可止。何以言之？
肾主湿。
入肝为泣，肝中湿也。《灵·九
针论》云∶“肝主泣。”）入心为汗，（心中湿也。《灵》∶“心主汗。”）入脾为涎，（脾中湿也。《灵》∶“脾主涎”。入肺为涕，
（肺中湿也。《灵》∶肺主涕。）自入为唾。（肾中湿也。《灵》∶“肾主唾。”）故知肾邪入心，为汗出不可止也。（汗者，人
所常有，惟不可止，乃为肾邪入心也。）其病身热，小腹痛，（小腹，肾之位。）足胫寒而逆，（足胫，肾经所过之地，故
畏寒而逆冷，湿性亦近寒也。）其脉沉濡而大。（沉，肾脉之象。濡，湿气之候。大则心脉本象也。独不言浮者。盖沉则
不浮也。）此五邪之法也。（大指谓∶肝病见于色，心病见于臭，脾病见于味，肺病见于声，肾病见于液。其脉以本脏之
脉为主，而兼受邪之脉，以此类推可也。）
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∶从后来者为虚邪，（此亦以五行之义推之
也。后，谓生我者也。邪挟生气而来，则虽进而易退，故为虚邪。）从前来者为实邪，（前，我生者也。受我之气者，其
力方旺，还而相克，其势必甚，故为实邪。）从所不胜来者为贼邪，（所不胜，克我者也。脏气本已相制，而邪气挟其力
而来，残削必甚，故为贼邪。）从所胜来者为微邪，（所胜，我所克也。脏气既受制于我，则邪气亦不能深入，故为微邪。）
自病为正邪。（自病，本脏自感之邪也。）何以言之？假令心病，中风得之为虚邪，（中风，肝邪也。得之，谓因中风而心
得病也。肝生心，所谓从后来者是也。下仿此。）伤暑得之为正邪，（伤暑，自病也。）饮食劳倦得之为实邪，（心生脾也。）
(The lungs have eight lobes.) They store the Po (Corporeal Soul). The kidneys are two in number, weighing one jin and two liang, and they store the Zhi (Will). (Two in number refers to what was mentioned above: the left is the kidney, and the right is the Mingmen [Gate of Life].)
The gallbladder is located between the short lobes of the liver, weighing three liang and three zhu, and holds three he of jingzhi (essence juice). (The preceding text discussed the five zang organs; the following discusses the six fu organs.) The stomach weighs two jin and fourteen liang (another version says one liang), with a tortuous and extended shape (referring to the measurement of its curves). It is two chi six cun long, one chi five cun wide, and five cun in diameter. It can hold two dou of grain and one dou five sheng of water. The small intestine weighs two jin and fourteen liang, is three zhang two chi long, two cun half wide, and eight fen plus one-third fen in diameter. Its left side is folded into sixteen curves, holding two dou four sheng of grain and six sheng three he plus two-thirds he of water. The large intestine weighs three jin twelve liang (another version says two jin), is two zhang one chi long, four cun wide, and one cun in diameter. Located at the navel on the right, it is folded into sixteen curves, holding one dou of grain and seven sheng half of water. The *Ling Shu · Chang Wei Chapter* states: "The huichang [returning intestine] loops around to the left of the navel, accumulating in leaf-like folds downwards, rotating back and forth in sixteen curves, four cun wide, and one cun plus one-third cun in diameter." The descriptions of length and capacity for these three organs are identical to the classic text. The bladder weighs nine liang two zhu, is nine cun in both longitudinal and transverse dimensions (the bladder is not perfectly round, hence described by length and width), and holds nine sheng nine he of urine. (Water seeping from the large intestine into the bladder becomes urine; since it does not coexist with grain, it is called 'ni' [urine] rather than 'shui' [water], which reflects Bian Que's profound understanding.) The mouth opening is two cun half wide, the lips to teeth distance is nine fen, and from the teeth to the huiyan (epiglottis, also known as the Xi Men [Inhaling Gate]) is three cun half deep, with a capacity of five he (meaning the oral cavity can hold five he). The tongue weighs ten liang, is seven cun long and two cun half wide. The yanmen (swallowing gate) weighs twelve liang (another version says ten liang; *Ling Shu · Chang Wei Chapter*: "Yanmen weighs ten liang"), is two cun half wide, and extends one chi six cun to the stomach. (Yanmen refers to the place where food is swallowed, commonly known as the esophagus, connecting downwards to the stomach.) The houlong (throat) weighs twelve liang, is two cun wide, one chi two cun long, and has nine segments. (Houlong is the place of sound production, commonly known as the larynx/trachea, connecting downwards to the lungs. Nine segments refer to the cartilaginous connections, totaling nine joints.) The gangmen (anus) weighs twelve liang, has an opening of eight cun, a diameter of two cun plus two-thirds cun, is two chi eight cun long, and holds nine sheng three he plus one-eighth he of grain. (Gangmen refers to the guochang [large intestine]. This description of length and capacity is also consistent with the previous ones.)
Difficulty 43 states: If a person does not eat or drink and dies after seven days, what is the reason?
Reply: The human stomach should contain two dou of retained grain and one dou five sheng of water. (This refers to the thirty-five sheng of water and grain retained in the tortuous sections mentioned in the previous difficulty.) Therefore, a healthy person defecates twice a day. (Qing means toilet.) Each time, two sheng five hun are expelled. (Expelling water and grain, transforming them into dregs. 'Xing' means to go/expel. Five sheng during the day, written as "five sheng per day" in *Ling Shu*, meaning a total of five sheng expelled in a day.) Over seven days, this amounts to five times seven, i.e., three dou five sheng, exhausting all water and grain. Thus, if a healthy person does not eat or drink for seven days, they die because the water, grain, and jinye (body fluids) are completely exhausted. (Jinye is generated from water and grain; when water and grain are exhausted, jinye also perishes.)
Difficulty 44 asks: Where are the Seven Chong Gates? (Chong means critical or important places.)
Reply: The lips are the Fei Men (Flying Gate), (Fei refers to movement.) The teeth are the Hu Men (Door Gate), (Teeth resemble keys/doors, preventing items from entering or exiting freely.) The huiyan (epiglottis) is the Xi Men (Inhaling Gate), (Huiyan is where food gathers and closes to prevent misdirection. Xi refers to inhalation/absorption.) The stomach entrance is the Ben Men (Rushing Gate), (Ben sounds like ben [run]. Food enters the stomach and rushes swiftly to the Tai Cang [Grand Granary].) The lower outlet of the Tai Cang is the You Men (Secluded Gate), (*Ling Shu · Zhang Lun*: "The stomach is the Tai Cang." Because it stores food like a granary, it is called Tai Cang. The lower outlet connects to the small intestine. You means deep and obscure, far from the upper and lower openings.) The junction of the large and small intestines is the Lan Men (Screen/Gate Gate), (Junction refers to below the small intestine and above the large intestine. The small intestine is the official of reception and transformation, excreting residue into the large intestine and secreting fluids into the bladder, separating water and grain here. Hence Lan Men, meaning to intercept and separate, preventing simultaneous entry and exit.) The lower extremity is the Po Men (Corporeal Gate), (Ji means bottom. Po Men is the anus. By the time food reaches here, the essence has been removed, leaving only form/quality, hence Po Men, also called Gui Men [Ghost Gate]. Additionally, the Lung stores Po, the anus connects to the Large Intestine, and they are exterior-interior pairs, hence Po Men. *Su Wen · Wu Zang Bie Lun* states: "Po Men also serves the five zang organs; water and grain cannot be stored there for long.") Thus, they are called the Seven Chong Gates.
Difficulty 45 asks: What are the Eight Hui (Assemblage) Points mentioned in the classics? (Hui means gathering. Qi gathers here, totaling eight acupoints.)
Reply: The Hui Point of the Fu organs is Tai Cang, (Tai Cang belongs to the Ren Mai [Conception Vessel], which is Zhongwan [CV12], four cun above the umbilicus. The six fu organs derive their qi from the stomach, hence it is the Hui Point of Fu.) The Hui Point of the Zang organs is Ji Xie (Costal Margin), (Ji Xie belongs to the Foot Jueyin Liver Meridian, specifically Zhangmen [LR13], outside Daheng, aligned with the costal margin at the navel level, and is the Mu-Point of the Spleen. All five zang organs derive from the spleen, hence it is the Hui Point of Zang.) The Hui Point of the tendons is Yanglingquan (GB34), (Yanglingquan belongs to the Foot Shaoyang Gallbladder Meridian. The tendons of the Foot Shaoyang knot at the lateral knee, which is this point. The Liver governs tendons and the Gallbladder is its paired organ, hence it is the Hui Point of Tendons.) The Hui Point of the marrow is Juegu, (Juegu belongs to the Foot Shaoyang Meridian, specifically Xuanzhong [GB39], four cun above the lateral malleolus. *Ling Shu · Jing Mai Chapter* discusses the Foot Shaoyang meridian saying: "It governs the bones," since all marrow belongs to the bones, hence it is the Hui Point of Marrow.) The Hui Point of blood is Ge Shu (BL17), (Ge Shu belongs to the Foot Taiyang Bladder Meridian, below the seventh thoracic vertebra, one and a half cun lateral to the spine, in the region of the Middle Jiao, where essence and microcosm are transformed into blood, hence it is the Hui Point of Blood.) The Hui Point of the bones is Dashu (BL11), (Dashu belongs to the Foot Taiyang Meridian, below the first thoracic vertebra, one and a half cun lateral to the spine. *Ling Shu · Hai Lun* states: "The Chong Mai is the sea of the twelve meridians, its transport point is at Dashu"; *Dong Shu Chapter* states that the Chong Mai and the great collateral of the Kidney originate below the kidney. Since the Kidney governs bones and the Bladder is exterior-interior with the Kidney, hence it is the Hui Point of Bones.) The Hui Point of the vessels is Taiyuan (LU9), (Taiyuan belongs to the Hand Taiyin Lung Meridian, in the depression behind the wrist, which is the Cunkou [inch position]. The Lung directs all vessels, hence it is the Hui Point of Vessels. Detailed explanation is in Difficulty 1.) The Hui Point of Qi is outside the Sanjiao, directly between the two breasts. (Outside the Sanjiao refers to outside the jiaomo [membrane of the triple burner]. Between the two breasts refers to the center between the nipples, where the Ren Mai passes, which is Danzhong [CV17]. *Ling Shu · Jing Mai Chapter* states the Hand Shaoyang meridian "governs Qi"; *Hai Lun* states: "Danzhong is the Sea of Qi," hence it is the Hui Point of Qi.) For heat diseases located internally, treat using the Qi points of the Hui Assemblages. (When heat disease is internal, the pathogenic factor is deep-seated and cannot be treated superficially; thus, one must attack and extract the pathogen from where its associated Qi gathers to cure the disease. The 'Hui' refers to selecting the appropriate Hui point based on the location of the pathology.)
Difficulty 46 asks: Why do elderly people lie down but cannot sleep, while young and strong people sleep without waking? (Mei refers to closing eyes and storing spirit. Wu, according to *Shuo Wen Jie Zi*, means "awakening with certainty," implying sleeping with thoughts in mind, preventing deep sleep.)
Reply: The classics state that young and strong people have abundant blood and qi, smooth muscles (smooth means glossy/lubricated), unobstructed air pathways, and normal circulation of Ying and Wei (nutritive and defensive) qi. (*Ling Shu · Ying Wei Sheng Hui Chapter*: Ying and Wei circulate twenty-five cycles in Yang and twenty-five cycles in Yin. At dawn, Yang receives Qi; at sunset, Yin receives Qi, continuing endlessly. This is what is meant.) Therefore, they are energetic during the day (Jing means sharp, agile, and tireless) and sleep soundly at night. Elderly people have declining blood and qi, non-smooth muscles, and obstructed Ying and Wei pathways (Se means unfavorable or sluggish). Therefore, they lack energy during the day and cannot sleep at night. Thus, we know elderly people suffer from insomnia.
Difficulty 47 asks: Why is the human face uniquely able to resist cold?
Reply: The human head is the convergence of all Yang meridians. (All Yang refers to the six Yang meridians.) All Yin meridians reach the neck and chest and then return, whereas only the Yang meridians ascend to the head and ears. (*Ling Shu · Ni Shun Fei Shou Lun* states: "Hand Three Yin travel from zang to hand; Hand Three Yang travel from hand to head; Foot Three Yang travel from head to foot; Foot Three Yin travel from foot to abdomen." This is what is meant.) Hence, the face is able to resist cold.
Difficulty 48 asks: Humans have three types of Deficiency (Xu) and three types of Excess (Shi). What are they?
Reply: There is pulse Xu/Shi, disease Xu/Shi, and diagnostic Xu/Shi. (Zhen refers to observing and verifying.) Regarding pulse Xu/Shi: Ru (soft/soggy) indicates Deficiency. (Ru means soft, weak, and sluggish. *Shang Han Lun* states: All Ru pulses indicate loss of blood; also: "Ru indicates微弱 Wei Qi," showing Ru is a sign of dual deficiency of Qi and Blood.) Jin (tight) and Lao (firm/deep) indicate Excess. (Xian/jing denotes Jin; solid/firm denotes Lao. *Su Wen · Ping Ren Qi Xiang Lun*: Pulse "excessive and tight indicates distension"; *Shang Han Lun* states: "Fuyang pulse... tight indicates strong Spleen Qi"; also: "Cold leads to firmness," showing Jin/Lao are signs of pathogenic Excess. Pulses are not limited to these two; these are cited to infer others.) Regarding disease Xu/Shi: Exit indicates Deficiency. (Exit refers to external consumption of essence/Qi, such as sweating, vomiting, diarrhea—anything exiting from inside.) Entry indicates Excess. (Entry refers to internal accumulation of pathogens, such as good appetite with constipation or contracting wind-cold—anything entering from outside.) Speaking indicates Deficiency, silence indicates Excess. (Speaking means talking excessively. Internal deficiency of pathogenic Qi leaves Shen [spirit] clear, so one is alert and talkative. Silence means inability to speak; external attacking pathogens confuse the Shen. Speaking/Silence corresponds to the previous Exit/Entry meanings.) Slow progression indicates Deficiency, rapid progression indicates Excess. (Slow means the disease develops gradually; Zheng Qi is depleted while pathogen is weak, leading to gradual deepening. Rapid means sudden onset; Zheng Qi is intact but pathogen is strong, leading to rapid development.) Regarding diagnostic Xu/Shi: Ru pulse indicates Deficiency, Lao pulse indicates Excess. Itching indicates Deficiency, pain indicates Excess. (Less blood/qi fails to nourish muscles, causing itching. Pathogen accumulation disrupts Ying/Wei harmony, causing pain.) Pain externally with comfort internally indicates External Excess and Internal Deficiency; pain internally with comfort externally indicates Internal Excess and External Deficiency. (This requires palpation. Deficient conditions welcome pressure; excess conditions do not tolerate touch. Thus, tender areas upon pressing are Excess, and comfortable areas are Deficiency.) Hence, these are called Xu and Shi.
Difficulty 49 asks: There is direct disease of the regular meridians and injury by the Five Evils. How to distinguish them? (Regular meridians refer to the primary meridians. Five Evils refer to mutual overacting among the five zang organs. See below.)
Reply: Worry and overthinking injure the Heart; (Thinking originates in the Heart, so overuse causes injury.) Cold exposure and drinking cold liquids injure the Lungs; (The Lung is naturally cold, so external wind-cold and internal cold drinks cause injury.) Anger with rebellious Qi rising upward injures the Liver; (Liver emotion is anger; anger causes Wood Qi to stagnate and rush upward, causing injury.) Diet and fatigue injure the Spleen; (Spleen is the official of the granary, governing food intake; limbs belong to the Spleen, and fatigue arises from limbs, so overuse injures the Spleen.) Sitting long in damp places or forcing oneself into water injures the Kidneys. (Dampness injures the lower body, so dampness first returns to the Kidney. Also, Kidney is the official of strength, and water is akin to Kidney, so forcing into water injures the Kidney.) This is direct disease of the regular meridians. What are the Five Evils?
Reply: There is Wind Strike, (Liver is Wind-Wood, so Wind enters Liver first.) Summerheat Injury, (Heart is Sovereign Fire, Summerheat is Fire Qi, so Heart receives it.) Diet and Fatigue, (This refers to Spleen receiving evil. Meaning seen above.) Cold Damage, (This refers to Lung receiving evil. Meaning seen above.) Dampness Strike. (This refers to Kidney receiving evil. Meaning seen above.) These are called the Five Evils.
Suppose Heart disease; how do we know it is caused by Wind Strike? (Meaning: Heart contracting Wind Strike disease. Subsequent examples follow this pattern.)
Reply: The complexion should be red. Why? Liver governs colors. (See Difficulty 40. Same below.) Self-injury manifests as green/cyan, (Self-injury means Liver Wind Strike. *Su Wen · Yin Yang Ying Xiang Da Lun*: Liver "color is cyan".) Entering Heart manifests as red, (Heart Wind Strike. *Su Wen*: Heart "color is red".) Entering Spleen manifests as yellow, (Spleen Wind Strike. *Su Wen*: Spleen "color is yellow.") Entering Lung manifests as white, (Lung Wind Strike. *Su Wen*: Lung "color is white".) Entering Kidney manifests as black. (Kidney Wind Strike. *Su Wen*: Kidney "color is black".) Liver becomes the evil of Heart (Wind enters Heart becoming evil), hence the color should be red. (One version lacks the character 'ye'.) Symptoms include body heat, (External pathogens first injure Ying/Wei, so body heats up. Also, Heart belongs to Fire, and heat is the image of Fire evil. Same below.), fullness and pain in the hypochondrium, (Hypochondrium is the location of the Liver.) Pulse is floating, large, and wiry. (Floating and large are the original images of Heart pulse. Wiry is the image of Liver pulse.)
How do we know it is caused by Summerheat Injury?
Reply: One should dislike foul odors. Why? Heart governs odors. Self-injury manifests as burnt odor, (Self-injury means Heart Summerheat. Burnt is Fire Qi, Heart belongs to Fire. *Su Wen · Jin Gui Zhen Yan Lun*: Heart "odor is burnt".) Entering Spleen manifests as fragrant odor, (Spleen Summerheat. Fragrant is Earth Qi. *Su Wen*: Spleen "odor is fragrant".) Entering Liver manifests as musky odor, (Liver Summerheat. Musky is Wood Qi. *Su Wen*: Liver "odor is musky".) Entering Kidney manifests as putrid odor, (Kidney Summerheat. Putrid is Water Qi. *Su Wen*: Kidney "odor is putrid".) Entering Lung manifests as fishy odor. (Lung Summerheat. Fishy is Metal Qi. *Su Wen*: Lung "odor is fishy".) Hence, Heart disease from Summerheat manifests as aversion to odors. Symptoms include body heat and vexation, (Vexation means irritability, confusion due to Fire stagnation.), heart pain, (Pathogen in Heart causes pain.) Pulse is floating, large, and scattered. (Floating and large are the original Heart pulse. Scattered means floating, large, empty, and lacking spirit, which is the pathological Heart pulse.)
How do we know it is caused by Diet and Fatigue?
Reply: One should crave bitter taste. Deficiency manifests as lack of appetite, Excess manifests as desire to eat. (Deficiency means Spleen Qi cannot transform grain; Excess means it still can, hence the difference between ability and inability to eat. Generally, Wind, Cold, Summerheat, and Dampness have similar Qi, so no distinction of Xu/Shi is made. However, Diet and Fatigue have distinct etiologies, so Bian Que added these two phrases, reflecting exquisite reasoning.) Why? Spleen governs tastes. Entering Liver manifests as sour, (Liver receives Diet/Fatigue disease. *Su Wen · Yin Yang Ying Xiang Da Lun*: Liver "taste is sour".) Entering Heart manifests as bitter, (Heart receives Diet/Fatigue disease. *Su Wen*: Heart "taste is bitter".) Entering Lung manifests as pungent, (Lung receives Diet/Fatigue disease. *Su Wen*: Lung "taste is pungent".) Entering Kidney manifests as salty, (Kidney receives Diet/Fatigue disease. *Su Wen*: Kidney "taste is salty".) Self-injury manifests as sweet. (Spleen receives Diet/Fatigue disease. *Su Wen*: Spleen "taste is sweet.") Hence, Spleen evil entering Heart manifests as craving bitter taste. Symptoms include body heat and heavy body, lethargy, and inability to control the limbs, (Lethargy means weary lying down. Because Spleen governs muscles and limbs.) Pulse is floating, large, and slow. (Floating and large are the original Heart pulse. Slow is the Spleen pulse image.)
How do we know it is caused by Cold Damage?
Reply: One should speak deliriously. (Chan means mad and talkative.) Why? Lung governs voice. Entering Liver manifests as shouting, (Liver Cold Damage. *Su Wen · Yin Yang Ying Xiang Da Lun*: Liver "sound is shout".) Entering Heart manifests as speaking, (Heart Cold Damage.) Entering Kidney manifests as groaning, (Kidney Cold Damage. *Su Wen*: Kidney "sound is groan".) Self-injury manifests as crying. (Lung Cold Damage. *Su Wen*: Lung "sound is cry".) Hence, Lung evil entering Heart manifests as delirious speech. Symptoms include body heat and shivering aversion to cold. (Lung is naturally a cold organ, and Cold Damage causes aversion to cold.) Severe cases involve wheezing and coughing, (Lung Qi rebels upward, causing wheezing and coughing. Also *Ling Shu · Jiu Zhen Chapter* states: "Lung governs cough".) Pulse is floating, large, and choppy. (Floating and large are the original Heart pulse. Choppy is the Lung pulse image.)
How do we know it is caused by Dampness Strike? Reply: One should sweat excessively and uncontrollably. Why?
Kidney governs dampness. Entering Liver manifests as tears, Liver Dampness. *Ling Shu · Jiu Zhen Lun* states: "Liver governs tears".) Entering Heart manifests as sweat, (Heart Dampness. *Ling Shu*: "Heart governs sweat".) Entering Spleen manifests as saliva, (Spleen Dampness. *Ling Shu*: "Spleen governs saliva".) Entering Lung manifests as nasal discharge, (Lung Dampness. *Ling Shu*: Lung governs nasal discharge.) Self-injury manifests as spit. (Kidney Dampness. *Ling Shu*: "Kidney governs spit".) Hence, Kidney evil entering Heart manifests as uncontrollable sweating. (Sweat is common in humans; only when it cannot stop is it Kidney evil entering Heart.) Symptoms include body heat, lower abdominal pain, (Lower abdomen is the location of the Kidney.), cold and reversal in the calves, (Calves are the pathway of the Kidney meridian, hence fear of cold and reversal cold; Dampness nature is also near cold.) Pulse is deep, soft, and large. (Deep is Kidney pulse image. Soft is Dampness sign. Large is original Heart pulse image. Floating is not mentioned because Deep implies not Floating.) This is the method of the Five Evils. (General principle: Liver disease manifests in color, Heart disease in odor, Spleen disease in taste, Lung disease in sound, Kidney disease in fluid. The pulse is primarily the original zang pulse, combined with the pulse of the invading evil, allowing inference by analogy.)
Difficulty 50 asks: Diseases include Xu Evil, Shi Evil, Zei Evil, Wei Evil, and Zheng Evil. How to distinguish them?
Reply: Evil coming from behind is Xu Evil, (This is deduced from Five Elements theory. Behind refers to the element that generates me. Evil carrying generating Qi comes, so although it advances, it retreats easily, hence Xu Evil.) Evil coming from ahead is Shi Evil, (Ahead refers to the element I generate. The one receiving my Qi has vigorous power; returning to overcome me, its force is severe, hence Shi Evil.) Evil coming from what I cannot overcome is Zei Evil, (What I cannot overcome refers to the element overcoming me. Zang Qi is already constrained, and evil brings its force to come, causing severe depletion, hence Zei Evil.) Evil coming from what I overcome is Wei Evil, (What I overcome is what I control. Zang Qi is controlled by me, so evil cannot penetrate deeply, hence Wei Evil.) Self-disease is Zheng Evil. (Self-disease refers to pathogen contracted by the zang itself.) Why? Suppose Heart disease: Wind Strike makes it Xu Evil, (Wind Strike is Liver evil. Contracting it means Heart disease due to Wind Strike. Liver generates Heart, which is 'coming from behind'. Subsequent examples follow this pattern.) Summerheat Injury makes it Zheng Evil, (Summerheat Injury is self-disease.) Diet and Fatigue make it Shi Evil, (Heart generates Spleen.)