伤寒得之为微邪，（心克肺也。）中湿得之为贼邪。（肾克心也。）
五十一难曰∶病有欲得温者，有欲得寒者，有欲得见人者，有不欲得见人者，而各不同，病在何脏腑也?
然∶病欲得寒，
而
欲见人者，病在腑也；病欲得温，而不欲见人者，病在脏也。何以言之？腑者阳也，（《素·金匮真言论》云∶“腑者为阳。”）
阳病欲得寒，又欲见人；（阳病热胜，故喜寒而恶热。阳主动而散，故欲见人。）脏者阴也，《素》∶“脏者为阴。”）阴病欲
得温，又欲闭户独处，恶闻人声。（阴病寒胜，故喜温而恶寒。阴主静而藏，故欲闭户恶人也。）故以别知脏腑之病也。
五十二难曰∶腑脏发病，根本等否？（此指有形质之病，如 瘕之类，故曰根本。）
然∶不等也。其不等奈何？
然∶
脏病者，止而不移，其病不离其处；（脏病，脏体受伤，或脏气受病也。五脏本无出纳，故病亦常居其所不移动也。）腑
病者，仿佛贲响，上下流行，居处无常。（腑病，六腑受病也。仿佛，无形质也。贲响，贲动有声也。忽上忽下，而无定
位，盖六腑泻而不藏，气无常定，故其病体亦如此。）故以此知脏腑根本不同也。
五十三难曰∶经言七传者死，间传者生，何谓也？（七传，根据相克之序历过七脏也。间传，根据相克之序中间间一他
脏也。）
然∶七传者，传其所胜也。（所胜，所克之脏也。）间脏者，传其子也。（子，所生也。）何以言之？假令心病传肺，
肺传肝，肝传脾，脾传肾，肾传心，（以上皆传所胜之脏。）一脏不再伤，故言七传者死也。（再伤，谓肺复受心病之传也。
七传，谓心病复传至心，已历六脏，至肺共七脏也。）间传者，传其所生也。（一本无此二句）假令心病传脾，（心欲传肺，
而脾者肺之母、心之子，中间间此一脏，则不传所克也。）脾传肺，肺传肾，肾传肝，肝传心，是子母相传，（谓母病传
其子也。）周（一作竟）而复始，如环无端，（心又传脾，仍为相生之脏也。）故曰（一作言）生也。
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；腑病易治者，传其子也。与七传、
间脏同法也。
五十五难曰∶病有积、有聚，何以别之？
然∶积者，阴气也；聚者，阳气也。（阴邪积而成积，阳邪聚而成聚也。）
故阴沉而伏，阳浮而动。（此言积聚之象也。沉伏，阴之体。浮动，阳之体。）气之所积名曰积，气之所聚名曰聚。（此明
积聚之所由名也。积者，积渐而成；聚者，凝滞未散。积则有物，聚则无形也。）故积者，五脏所生；聚者，六腑所成也。
（此又明积聚之所由生也。脏属阴，故阴气积于内而成积；腑属阳，故阳气聚于外而成聚，各从其类也。）积者，阴气也，
其始（一本无始字）发有常处，（有定位也。）其痛不离其部，（其部，积所起之地也。）上下有所终始，左右有所穷处；
（言
其形之长短大小可循按也。）聚者，阳气也，其始发无根本，（无定位也。）上下无所留止，（无定形也。）其痛无常处。（其
病亦无定在也。）故以是别知积聚也。
五十六难曰∶五脏之积，各有名乎？以何月、何日得之？
然∶肝之积，名曰肥气，（其气肥盛也。）在左胁下，如覆
杯，（左胁，肝之位。覆杯，本大末小，肝木之象也。）有头足。（头足，一本二末，木形歧出也。）久不愈，令人发咳逆，
疟，（咳逆，肝气上冲于肺，乘所胜也。 疟，间日而发为 ，连日发为疟，肝之病状也。）连岁不已。（言病入深而无
已时也。）以季夏戊己日得之。（季夏时令属土，戊己日干属土也。下仿此。）何以言之？肺病传肝，（所谓脏病传其所胜
也。下仿此。）肝当传脾，脾季夏适王，（脾当时之旺令也。）王者不受邪，（言邪不能伤。）肝复欲还肺，肺不肯受，（肝
木又不能胜肺金也。下仿此。）故留结为积（邪气结聚于肝也。）故知肥气以季夏戊己日得之。心之积，名曰伏梁，（横亘
如屋梁而伏处也。）起脐上，大如臂，上至心下。（脐上至心下，皆心之分也。）久不愈，令人烦心。（烦心，火郁之状也。）
以秋庚辛日得之。何以言之？肾病传心，心当传肺，肺以（一本无以字）秋适王，王者不受邪，心欲复还肾，肾不肯受，
故留结为积，故知伏梁以秋庚辛日得之。
脾之积，名曰痞气，（痞，痞塞不通也。）在胃脘，覆大如盘。（胃脘，中焦之地，脾之分也。）久不愈，令人四肢不
收，（脾主四肢，不收，邪气聚而正气不运也。）发黄胆，（黄胆，皮肤、爪、目皆黄色，湿热病也。脾有积滞，则色征于
外也。《素·平人气象论》∶“溺黄赤，安卧者曰黄胆。”又曰∶“目黄者曰黄胆。”）饮食不为肌肤。（脾主肌肉，不能布其
津液，则不为肌肤也。）以冬壬癸日得之。何以言之？肝病传脾。脾当传肾，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得之，肺之积，名曰息贲，（息贲，气息奔迫也。）在右胁下，（肺之位也。）
覆大如杯。久不已，令人洒淅寒热，（肺主皮毛，故皮肤洒淅寒热也。）喘咳，（肺之病。）发肺壅。（壅，臃肿胀闷，肺主
气故也。）以春甲乙日得之。何以言之？心病传肺，肺当传肝，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得之。
肾之积，名曰贲豚，（其状如豚之奔突也。）发于少腹，上至心下，（少腹，肾之分。至心下，言上则至心而止，非谓
其大至心也。下文自明。）若豚状，（言其躁动如豚也。）或上或下无时，久不已，令人喘逆，（肾气上冲也。《素·逆调论》∶
肾“主卧与喘”。）骨痿少气，（肾主骨，故骨痿。下焦不能纳气，故少气。）以夏丙丁日得之。何以言之？脾病传肾，肾
当传心，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得之。此五积之要法也。
五十七难曰∶泄凡有几？皆有名不？
然∶泄凡有五，其名不同。有胃泄，有脾泄，有大肠泄，有小肠泄，有大瘕泄，
（此五者之名也。）名曰后重。（此专指大瘕泄而言，盖肾邪下结，气坠不升故也。）胃泄者，饮食不化，色黄。（胃主纳
饮食，气虚不能运则泄。黄，胃土之正色也。）脾泄者，腹胀满，泄注，（脾主磨化饮食。不能化。则胀满泄注也。）食即
呕吐逆。（脾弱不能消谷，则反出也。）大肠泄者，食已窘迫，（肠虚气不能摄，故胃气方实，即迫注于下，窘迫不及少待
也。）大便色白，（大肠属金，故色白。）肠鸣切痛。（气不和顺，故鸣而痛。）小肠泄者，溲而便脓血，（每遇小便，则大
便脓血亦随而下，盖其气不相摄而直达于下，故前后相连属，小便甚利而大便亦不禁也。又小肠属火，与心为表里，心
主血，故血亦受病而为脓血也。）少腹痛。（小肠之气下达膀胱，膀胱近少腹，故少腹痛也。）大瘕泄者，（大瘕，邪气结
于下，成 瘕而不散也。）里急后重，（肠气急迫，肛门重坠。）数至圊而不能便，（惟里急，故数至厕；惟后重，故不能
便，皆瘕结不散之故也。）茎中痛。（大便气不能达，则邪气移于小便，故茎中痛。）此五泄之要法也。
五十八难曰∶伤寒有几？其脉有变不？（一作否）
然∶伤寒有五，有中风，有伤寒，有湿温，有热病，有温病，其
所苦各不同。（伤寒，统名也。下五者，伤寒之分证也。）
中风之脉，阳浮而滑，阴濡而弱；（阳，阳经之脉。阴，阴经之脉。浮滑，阳脉之象，风为阳邪，故浮滑在阳经也。
《伤寒论》云∶“太阳之为病脉浮。”又云∶“浮则为风”《灵·邪气脏腑病形篇》云∶“滑者阳气盛，微有热。”又《素·平
人气象论》云∶“脉滑曰病风。”阳盛则阴虚，故阴脉濡而弱也。）湿温之脉，阳濡而弱，阴小而急；（湿热伤阴，故阳脉
则无气而濡弱，阴脉则邪盛而小急也。）伤寒之脉，阴阳俱盛而紧涩；（寒邪中人，营
卫皆伤，故阴阳俱盛紧者，阴脉之象。《伤寒论》云∶“脉阴阳俱紧者，名曰伤寒。”又云∶诸紧为寒。涩者，血气为寒所
凝，不和利也。《灵·邪气脏腑病形篇》∶“涩者多血少气，微有寒。”）热病之脉，阴阳俱浮，（阳气盛，故脉俱浮。《金匮
要略》云∶“浮脉则热”。浮之而滑，沉之散涩；（浮之，谓浮取之；沉之；谓沉取之也。滑则阳盛于外，散涩则阴衰于内
也。）温病之脉，行在诸经，不知何经之动也，各随其经所在而取之。（言温病所中之经不一，病在何经，则脉亦见于所
中之经也。）伤寒有汗出而愈，（汗出，谓发其汗
也。）下之而死者；有汗出而死，下之而愈者，何也？
然∶阳虚阴盛，汗出而愈，下之即死；（滑氏《本义》引《外台》
语“谓表病里和”为阳虚阴盛，邪在表宜发汗，若反下之，引邪入里，诛伐无过，故死。）阳盛阴虚，汗出而死，下之而
愈。（滑氏谓“里病表和”为阳盛阴虚，邪入里宜急下，若反汗之，兼虚其表，故死。）
寒热之病，候之如何也？（寒热，指忽寒忽热者言。候之，言候其病在何处也。）
然∶皮寒热者，（寒热在皮。邪之
中人最浅者也。）皮不可近席，（邪气在皮，不能着物也。）毛发焦，鼻 ，（一作槁，下同。）不得汗；（肺主皮毛，开窍
于鼻，故皮有邪，则毛发焦干而鼻枯槁不泽也。不得汗，营卫不和也。）肌寒热者，（皮之内则肌肉也。）皮肤痛，（肌肉
之邪由皮肤而入故痛。）唇舌 ，无汗；（脾主肌肉，开窍于口，故肌有邪，则唇舌皆受病也。）骨寒热者，病无所安，（骨
受邪，则病最深，故一身之中，无所得安也。）汗注不休，齿本 痛。（肾主骨，又主液，齿为骨之余，故骨病则肾液泄
而为汗，齿枯槁而痛也。）
五十九难曰∶狂癫之病，何以别之？
然∶狂疾（一本无疾字）之始发，（始发，未成之时也。）少卧而不饥，（狂属阳，
阳气盛，不入于阴，故少卧。阳气并于上，故不饥。）自高贤也，自辨智也，自倨贵（一本作贵倨）也，（三者皆狂之意
也。）妄笑好歌乐，妄行不休是也。（三者狂之态也。狂属阳，阳性动散而常有余，故其状如此。）癫疾（一作病）始发，
意不乐，（癫之意也。）僵仆直视。（一本作直视僵仆。癫之态也。癫属阴，阴性静结而常不足，故其状如此。）其脉三部
阴阳俱盛是也。（此总上二者而言，狂则三部阳脉皆盛，癫则三部阴脉皆盛也。）
六十难曰∶头心之病，有厥痛，有真痛，（厥，逆也，气逆而痛也。厥痛，厥头痛、厥心痛也。真痛，真头痛、真心
痛也。）何谓也？
然∶手三阳之脉，受风寒，伏留而不去者，则名厥头痛；（手三阳，小肠、大肠、三焦也。《素》∶“手之
三阳，从手走头”，故风寒留滞，则头痛也。）入连在脑者，名真头痛。（入连在脑，邪进入于脑也。不在经而在脑，故曰
真。）其五脏气相干，（相干，谓脏有偏胜，邪乘于心也。）名厥心痛；其痛甚，但在心，（但在心，言无别脏相干也。）手
足青者，（手足青，寒邪犯君火之位，血色变也。）即名真心痛。其真心痛者，（滑氏《本义》谓真字下当欠一“头”字）
旦发夕死，夕发旦死。（心为君主之官，故邪犯之即不治也。《灵·邪客篇》∶“心者，五脏六腑之大主也，精神之所舍也，
其脏坚固，邪弗能容，容之则心伤，心伤则神去，神去则死矣。”即此义也。）
六十一难曰∶经言望而知之谓之神，（望，谓望病患之五色而知其病之所在，如《素·五脏生成篇》、《灵·五色篇》
所云是也。神，圣而不可知之谓。）闻而知之谓之圣，（闻，谓闻病患之声也。如《灵·九针篇》“心主噫，肺主咳”；《素·阴
阳应象大论》肝“在声为呼”，心“在声为笑”，及下文五音之类是也。圣，谓艺之至于至极者也。）问而知之谓之工，（问，
谓问病患之所患及其爱憎喜怒也。如《灵·九针篇》∶“肝恶风，心恶热”，“气并肝则忧，并心则喜”之类是也。工，专
精之谓。）切脉而知之谓之巧，（切脉之法，详《灵》、《素》及前诸难中。巧，心智灵变也。）何谓也？
然∶望而知之者，望见其五色，以知其病。（五色，五脏所现之色。）闻而知之者，闻其五音，以别其病。（五音，五
脏所发之音也。又五脏之音属宫、商、角、征、羽，详《灵·五音五味篇》。）问而知之者，问其所欲五味，以知其病所
起所在也。（一本无也字。五味，五脏所喜之味。《灵·师传篇》∶“临病患问所便。”所起，病之所由生；所在，病之所留
处也。）切脉而知之者，诊其寸口，视其虚实，以知其病在何脏腑也，（别其何脏腑之脉象，则知其病在何脏腑也。）经言
以外知之曰圣，以内知之曰神，此之谓也。（外，视色、闻声也。内，问欲、切脉也。）
Shaoyang disease (disease of the Shaoyang channel) as an evil pathogen is mild, (because Heart Fire overcomes Lung Metal.) Dampness disease as an evil pathogen is a thief evil. (because Kidney Water overcomes Heart Fire.)
Chapter 51 states: Some patients desire warmth, some desire coolness, some wish to see people, and some do not wish to see people, with varying conditions. In which Zang or Fu organs are these diseases located?
The answer is: Patients who desire coolness and wish to see people have diseases in the Fu organs; patients who desire warmth and do not wish to see people have diseases in the Zang organs. Why is this said? The Fu organs belong to Yang. (As stated in *Suwen: Jin Gui Zhen Yan Lun*: "The Fu organs belong to Yang.") Yang diseases prefer coolness and wish to see people; (Yang diseases involve excess heat, thus preferring coolness and disliking heat. Yang is active and dispersing, hence the desire to see people.) The Zang organs belong to Yin. (*Suwen* states: "The Zang organs belong to Yin.") Yin diseases prefer warmth and wish to stay indoors alone, disliking the sound of voices. (Yin diseases involve excess cold, thus preferring warmth and disliking cold. Yin is quiet and storing, hence the desire to close doors and stay alone, disliking contact with others.) Therefore, one can distinguish between Zang and Fu diseases by these signs.
Chapter 52 asks: Are the fundamental conditions of onset for Zang and Fu diseases the same? (This refers to diseases with tangible substance, such as Jia masses, hence the term "fundamental".)
The answer is: They are not the same. How are they different?
The answer is: Zang diseases are stationary and do not move; the pain does not leave its original location. (Zang diseases involve injury to the Zang body or dysfunction of Zang Qi. Since the Five Zang organs do not have functions of intake and discharge, their diseases also remain in place without moving.) Fu diseases present with vague rumbling sounds, flowing up and down, with no fixed location. (Fu diseases involve pathology of the Six Fu organs. "Fufu" implies formlessness. "Benxiang" refers to qi movement with sound. Moving up and down without a fixed position occurs because the Six Fu organs excrete without storing, and qi has no constant fixation, so their pathological manifestations are similar.) Thus, one knows that the fundamentals of Zang and Fu are different.
Chapter 53 asks: The classics state that "transmission through seven stages leads to death, while transmission skipping organs leads to survival." What does this mean? (Seven-stage transmission follows the order of mutual overcoming across seven organs. Skipping-organ transmission follows the order of mutual overcoming but skips one intervening organ.)
The answer is: Seven-stage transmission refers to transmission to the organ it overcomes. (The "sheng" organ is the one overcome.) Skipping-organ transmission refers to transmission to the organ it generates. ("Zi" refers to the generated organ.) Why is this said? For example, if Heart disease transmits to Lung, Lung to Liver, Liver to Spleen, Spleen to Kidney, and Kidney back to Heart, (all above are transmissions to the overcome organ.) Since an organ is not injured twice, it is said that seven-stage transmission leads to death. (Double injury means Lung receiving transmission from Heart again. Seven-stage transmission means Heart disease transmitting back to Heart, having passed through six other organs, totaling seven organs including Lung.) Skipping-organ transmission refers to transmission to the generated organ. (Some versions omit these two sentences.) For example, if Heart disease transmits to Spleen, (Heart intended to transmit to Lung, but Spleen is the mother of Lung and the child of Heart, intervening this organ prevents transmission to the overcome organ.) Spleen transmits to Lung, Lung to Kidney, Kidney to Liver, Liver to Heart. This is mother-child transmission, (meaning mother disease transmitting to its child.) It cycles endlessly like a ring without beginning or end, (Heart transmits to Spleen again, remaining within the generating relationship.) Hence it is said to lead to survival.
Chapter 54 asks: Zang diseases are difficult to treat, while Fu diseases are easy to treat. What does this mean?
The answer is: Zang diseases are difficult to treat because they transmit to the organ they overcome; Fu diseases are easy to treat because they transmit to the organ they generate. This follows the same logic as seven-stage and skipping-organ transmission.
Chapter 55 asks: Diseases include Ji (accumulation) and Ju (gathering). How to distinguish them?
The answer is: Ji is formed by Yin Qi; Ju is formed by Yang Qi. (Yin pathogens accumulate to form Ji; Yang pathogens gather to form Ju.)
Thus, Yin is deep and latent, while Yang is floating and active. (This describes the phenomena of accumulation and gathering. Deep and latent are characteristics of Yin constitution. Floating and active are characteristics of Yang constitution.) Where Qi accumulates, it is called Ji; where Qi gathers, it is called Ju. (This explains the origin of the names. Ji forms gradually; Ju is stagnation that has not dispersed. Ji has form; Ju is formless.) Therefore, Ji arises from the Five Zang organs; Ju is formed by the Six Fu organs. (This further clarifies the origin of Ji and Ju. Zang belongs to Yin, so Yin Qi accumulates internally to form Ji; Fu belongs to Yang, so Yang Qi gathers externally to form Ju, each following its own kind.) Ji, being Yin Qi, starts at a fixed location, (has a definite position.) the pain does not leave that area, (that area is where the Ji originated.) it has upper and lower limits, and left and right boundaries; (describing that its shape, length, and size can be palpated.) Ju, being Yang Qi, starts without a root, (no fixed position.) it has no stopping point up or down, (no fixed form.) the pain has no fixed location. (Its pathology also has no fixed site.) Thus, one distinguishes Ji and Ju by these features.
Chapter 56 asks: Do the five Zang accumulations have specific names? On which month and day are they acquired?
The answer is: The accumulation of the Liver is named Feiqi (Fat Qi), (because its qi is abundant and flourishing.) located under the left hypochondrium, shaped like an inverted cup, (the left hypochondrium is the seat of the Liver. An inverted cup, broad at the base and narrow at the top, represents the image of Wood.) with heads and feet. (Heads and feet, in some versions referred to as two ends, represent the branching nature of Wood.) If untreated for a long time, it causes coughing and counterflow qi, malaria, (coughing and counterflow qi result from Liver qi rushing upward to the Lung, invading the overcome organ. Malaria, occurring every other day as Jie, or daily as Nue, are symptoms of Liver disease.) persisting year after year. (Meaning the disease goes deep and has no end.) It is acquired on Wu and Ji days in late summer. (Late summer corresponds to Earth element; Wu and Ji heavenly stems also correspond to Earth. The following examples follow this pattern.) Why is this said? Lung disease transmits to Liver. (This is the transmission of Zang disease to the overcome organ. The following examples follow this pattern.) Liver should transmit to Spleen, but Spleen is prosperous in late summer. (Spleen is in its peak season during this time.) The prosperous organ does not accept evil, (meaning evil cannot injure it.) Liver then tries to transmit back to Lung, but Lung refuses to accept it, (Liver Wood cannot overcome Lung Metal. The following examples follow this pattern.) so the evil stays and knots to form an accumulation (evil qi knots in the Liver.) Thus, we know Feiqi is acquired on Wu and Ji days in late summer. The accumulation of the Heart is named Fuliang (Hidden Beam), (lying horizontally like a roof beam.) starting above the umbilicus, as large as an arm, extending up to below the heart. (From above the umbilicus to below the heart is the domain of the Heart.) If untreated for a long time, it causes vexation and heart pain. (Vexation is a sign of fire stagnation.) It is acquired on Geng and Xin days in autumn. Why is this said? Kidney disease transmits to Heart. Heart should transmit to Lung, but Lung is prosperous in autumn, and the prosperous organ does not accept evil. Heart tries to transmit back to Kidney, but Kidney refuses to accept it, so it stays and knots to form an accumulation. Thus, we know Fuliang is acquired on Geng and Xin days in autumn.
The accumulation of the Spleen is named Piqi (Pi Qi), (Pi means obstruction and blockage.) located in the epigastrium, covering an area as large as a plate. (The epigastrium is the middle jiao, the domain of the Spleen.) If untreated for a long time, it causes weakness and inability to control the limbs, (Spleen governs the limbs; inability to control indicates evil accumulation and failure of righteous qi to circulate.) jaundice, (Jaundice involves yellowing of skin, nails, and eyes, a damp-heat disease. With Spleen accumulation, color manifests externally. *Suwen: Ping Ren Qi Xiang Lun* states: "Yellow urine and excessive sleeping indicate jaundice." Also: "Yellow eyes indicate jaundice.") and food failing to nourish the muscles. (Spleen governs muscles; inability to distribute fluids fails to nourish the muscles.) It is acquired on Ren and Gui days in winter. Why is this said? Liver disease transmits to Spleen. Spleen should transmit to Kidney, but Kidney is prosperous in winter, and the prosperous organ does not accept evil. Spleen tries to transmit back to Liver, but Liver refuses to accept it, so it stays and knots to form an accumulation. Thus, we know Piqi is acquired on Ren and Gui days in winter. The accumulation of the Lung is named Xiben (Xibin), (Xiben means breath rushing and forcing.) located under the right hypochondrium, (the seat of the Lung.) covering an area as large as a cup. If untreated, it causes chills and fever with shivering, (Lung governs skin and hair, hence the shivering sensation on the skin.) wheezing and coughing, (diseases of the Lung,) leading to Lung congestion. (Congestion refers to swelling and oppression; Lung governs qi.) It is acquired on Jia and Yi days in spring. Why is this said? Heart disease transmits to Lung. Lung should transmit to Liver, but Liver is prosperous in spring, and the prosperous organ does not accept evil. Lung tries to transmit back to Heart, but Heart refuses to accept it, so it stays and knots to form an accumulation. Thus, we know Xiben is acquired on Jia and Yi days in spring.
The accumulation of the Kidney is named Benteng (Benteng), (its appearance is like a pig running and leaping.) originating in the lower abdomen, extending up to below the heart, (the lower abdomen is the domain of the Kidney. Extending to below the heart means it stops at the heart, not that it reaches the heart itself. The following text clarifies this.) resembling a pig, (describing its restlessness like a pig.) moving up or down without fixed timing. If untreated, it causes wheezing and counterflow qi, (Kidney qi rushing upward. *Suwen: Ni Tiao Lun* states: Kidney "governs bedrest and wheezing".) bone萎 (bone atrophy/weakness) and shortness of breath, (Kidney governs bones, hence bone weakness. Lower jiao fails to grasp qi, hence shortness of breath.) It is acquired on Bing and Ding days in summer. Why is this said? Spleen disease transmits to Kidney. Kidney should transmit to Heart, but Heart is prosperous in summer, and the prosperous organ does not accept evil. Kidney tries to transmit back to Spleen, but Spleen refuses to accept it, so it stays and knots to form an accumulation. Thus, we know Benteng is acquired on Bing and Ding days in summer. These are the essential methods for the five accumulations.
Chapter 57 asks: How many types of Xie (diarrhea/loose stools) are there? Do they all have names?
The answer is: There are five types of Xie, with different names. There is Wei Xie (Stomach Xie), Pi Xie (Spleen Xie), Dachang Xie (Large Intestine Xie), Xiaochang Xie (Small Intestine Xie), and Da Jia Xie (Great Jia Xie), (these five are their names.) Da Jia Xie is also named Houzhong (Tenesmus). (This specifically refers to Da Jia Xie, likely due to Kidney evil knotting downward, causing qi to sink and fail to rise.) Wei Xie presents with undigested food and yellow stool. (Stomach receives food and drink; qi deficiency fails to transport, leading to diarrhea. Yellow is the proper color of Stomach Earth.) Pi Xie presents with abdominal fullness and watery diarrhea, (Spleen grinds and digests food. Failure to digest leads to fullness and watery diarrhea.) and vomiting/regurgitation immediately after eating. (Spleen weakness fails to process grain, causing food to come back up.) Dachang Xie presents with urgency after eating, (Intestinal deficiency and qi failure to hold cause stomach qi to press downward immediately upon filling, leaving no time to wait.) white stool, (Large Intestine belongs to Metal, hence white color.) and loud borborygmus with severe pain. (Qi is not harmonious, hence rumbling and pain.) Xiaochang Xie presents with pus and blood in stool accompanying urination, (Whenever urination occurs, pus and blood in stool also pass down, likely because qi fails to hold and goes directly downward, linking front and back. Urination is profuse, and stool is incontinent. Additionally, Small Intestine belongs to Fire, exterior-interior related to Heart; Heart governs blood, so blood is affected and becomes pus and blood.) and lower abdominal pain. (Small Intestine qi descends to Bladder; Bladder is near the lower abdomen, hence lower abdominal pain.) Da Jia Xie, (Da Jia refers to evil knotting in the lower part, forming a mass that does not disperse.) tenesmus, (intestinal urgency and anal heaviness.) frequent trips to the toilet with inability to defecate, (Due to urgency, one goes frequently; due to heaviness, one cannot defecate, both caused by the knotting mass.) and pain in the urethra. (Qi from stool cannot reach, so evil shifts to urine, causing urethral pain.) These are the essential methods for the five types of Xie.
Chapter 58 asks: How many types of Shanghan (Cold Damage) are there? Do their pulses change? (Some versions read "not".)
The answer is: There are five types of Shanghan: Zhongfeng (Wind Strike), Shanghan (Cold Damage), Shiwen (Damp-Warmth), Rebing (Heat Disease), and Wenbing (Warm Disease). Their suffering symptoms differ. (Shanghan is the general term. The following five are subtypes of Shanghan.)
The pulse of Zhongfeng is floating and slippery on the Yang position, and soggy and weak on the Yin position. (Yang refers to the pulse of Yang channels. Yin refers to the pulse of Yin channels. Floating and slippery are images of Yang pulses; Wind is a Yang pathogen, hence floating and slippery appear on Yang channels. *Shanghan Lun* states: "Taiyang disease presents with a floating pulse." Also: "Floating indicates Wind." *Lingshu: Xieqi Zangfu Bingxian Pian* states: "Slippery indicates excess Yang qi and slight heat." Also *Suwen: Ping Ren Qi Xiang Lun* states: "Slippery pulse indicates Wind disease." Yang excess leads to Yin deficiency, hence the Yin pulse is soggy and weak.) The pulse of Shiwen is soggy and weak on the Yang position, and small and rapid on the Yin position. (Damp-heat injures Yin, hence the Yang pulse lacks qi and is soggy/weak, while the Yin pulse shows excess evil and is small/rapid.) The pulse of Shanghan is excess and tight/choppy in both Yin and Yang positions. (Cold evil invades the person, injuring Ying and Wei, hence both Yin and Yang pulses are excess. Tightness is an image of Yin pulse. *Shanghan Lun* states: "Pulse excess and tight in both Yin and Yang is named Shanghan." Also: All tight pulses indicate Cold. Choppy indicates blood and qi congealed by Cold, lacking smoothness. *Lingshu: Xieqi Zangfu Bingxian Pian* states: "Choppy indicates much blood and little qi, with slight cold.") The pulse of Rebing is floating in both Yin and Yang positions. (Yang qi is excess, hence pulses float. *Jingui Yaolue* states: "Floating pulse indicates heat.") Floating extraction is slippery, sinking extraction is scattered/choppy. (Floating extraction means superficial palpation; sinking extraction means deep palpation. Slippery indicates Yang excess externally; scattered/choppy indicates Yin deficiency internally.) The pulse of Wenbing flows through various channels, unknown which channel is activated; one must palpate according to the location of the affected channel. (Meaning Wenbing affects various channels; wherever the disease is, the pulse appears in that channel.) In Shanghan, some recover with sweating, (sweating refers to inducing diaphoresis,) while some die from it; some die from sweating, while some recover with purgation. Why?
The answer is: In Yang deficiency and Yin excess, sweating leads to recovery, while purgation leads to death. (Master Hua cites *Waitai Miyao*, stating "Wei bing li he" [exterior disease, interior harmony] as Yang deficiency and Yin excess. Evil is on the exterior, suitable for sweating; if purged instead, evil enters the interior, attacking the innocent, hence death.) In Yang excess and Yin deficiency, sweating leads to death, while purgation leads to recovery. (Master Hua considers "li bing biao he" [interior disease, exterior harmony] as Yang excess and Yin deficiency. Evil has entered the interior, requiring urgent purgation; if sweated instead, the exterior is further depleted, hence death.)
How to diagnose Hanre (cold-heat alternating) diseases? (Hanre refers to alternating chills and fever. Hou zhi means diagnosing the location of the disease.)
The answer is: Pi Hanre (Skin Cold-Heat), (cold-heat at the skin level. The shallowest invasion of evil.) the skin cannot tolerate lying on mats, (evil at the skin prevents contact with objects.) hair becomes brittle, nose dries, (some versions read 'gao', same below.) and sweating is absent; (Lung governs skin and hair, opens into the nose; thus, evil at the skin causes brittle hair and dry nose. Absence of sweating indicates disharmony of Ying and Wei.) Ji Hanre (Muscle Cold-Heat), (inside the skin lies muscle.) skin pain, (evil in muscle enters via skin, causing pain.) lips and tongue dry, no sweat; (Spleen governs muscle, opens into the mouth; thus, evil in muscle affects lips and tongue.) Gu Hanre (Bone Cold-Heat), the patient finds no comfort, (evil in bone means deepest disease, hence no comfort anywhere in the body.) sweating pours continuously, teeth roots hurt. (Kidney governs bone and fluids; teeth are surplus of bone. Thus, bone disease causes Kidney fluid to leak as sweat, and teeth become brittle and painful.)
Chapter 59 asks: How to distinguish Kuang (mania) and Dian (epilepsy/melancholia)?
The answer is: When Kuang disease first begins, (first onset, before becoming established.) sleep is scant and appetite is absent, (Kuang belongs to Yang; Yang qi is excess, entering not into Yin, hence scant sleep. Yang qi merges upward, hence no appetite.) self-regarding as wise and virtuous, self-regarding as intelligent, self-regarding as arrogant and noble (some versions read 'gui ju'), (these three are aspects of Kuang.) laughing foolishly, liking to sing and rejoice, walking aimlessly without cease, (these three are states of Kuang. Kuang belongs to Yang; Yang nature is active and dispersing, always in excess, hence such symptoms.) Dian disease first begins with unhappiness, (emotion of Dian.) stiff falling and staring straight ahead. (Some versions read 'staring straight ahead then falling'. State of Dian. Dian belongs to Yin; Yin nature is quiet and knotted, always deficient, hence such symptoms.) Their pulses show excess in all three positions of Yin and Yang. (This summarizes the above two: Kuang shows excess Yang pulses in all three positions; Dian shows excess Yin pulses in all three positions.)
Chapter 60 asks: Head and Heart diseases include Jue Tong (Reversal Pain) and Zhen Tong (True Pain). (Jue means reversal, pain from reversed qi. Jue Tong refers to Jue Tou Tong and Jue Xin Tong. Zhen Tong refers to Zhen Tou Tong and Zhen Xin Tong.) What does this mean?
The answer is: When the Three Hand-Yang meridians are invaded by Wind-Cold, which lingers and does not depart, it is named Jue Tou Tong; (Three Hand-Yang refer to Small Intestine, Large Intestine, and Sanjiao. *Suwen* states: "Three Hand-Yang go from hand to head," hence lingering Wind-Cold causes headache.) if it penetrates and connects to the brain, it is named Zhen Tou Tong. (Penetrating to the brain means evil enters the brain. Not in the meridians but in the brain, hence called True.) If the Qi of the Five Zang organs interferes with each other, (interference means Zang imbalance, evil attacking Heart,) it is named Jue Xin Tong; if the pain is severe but confined only to the Heart, (confined to Heart means no other Zang interference,) and hands and feet turn blue, (hands and feet blue indicate cold evil invading the position of Sovereign Fire, changing blood color,) it is named Zhen Xin Tong. As for Zhen Xin Tong, (Master Hua's *Benyi* suggests a character "Head" might be missing after "Zhen") morning onset leads to evening death, evening onset leads to morning death. (Heart is the Sovereign Official; thus, evil invading it is untreatable. *Lingshu: Xieke Pian* states: "Heart is the great master of the Five Zang and Six Fu, the residence of Spirit. Its organ is solid, evil cannot reside; if it resides, Heart is injured, Spirit leaves, and death ensues." This is the meaning.)
Chapter 61 asks: The classics say "Knowing by observation is called Shen (Divine)," (Observation means observing the Five Colors of the patient to know the disease location, as described in *Suwen: Wuzang Shengcheng Pian* and *Lingshu: Wuse Pian*. Shen refers to the sacred and unknowable.) "Knowing by listening/smelling is called Sheng (Sage)," (Listening means hearing the patient's voice. As in *Lingshu: Jiuzhen Pian* "Heart sighs, Lung coughs"; *Suwen: Yinyang Yingxiang Dalun* Liver "sound is call", Heart "sound is laugh", and the following five tones. Sheng refers to art reaching perfection.) "Knowing by questioning is called Gong (Artisan)," (Questioning means asking about the patient's suffering and preferences/dislikes. As in *Lingshu: Jiuzhen Pian*: "Liver dislikes wind, Heart dislikes heat", "Qi merging with Liver causes sorrow, merging with Heart causes joy". Gong refers to specialization.) "Knowing by palpation is called Qiao (Skillful)." (Palpation methods are detailed in *Lingshu*, *Suwen*, and previous Nan Jing chapters. Qiao refers to mental agility.) What does this mean?
The answer is: One who knows by observation sees the Five Colors and thereby knows the disease. (Five Colors are colors manifested by the Five Zang organs.) One who knows by listening hears the Five Tones and thereby distinguishes the disease. (Five Tones are sounds emitted by the Five Zang organs. Furthermore, Five Zang tones correspond to Gong, Shang, Jue, Zhi, Yu, detailed in *Lingshu: Wuyin Wuwei Pian*.) One who knows by questioning asks about desired flavors to know the origin and location of the disease. (Some versions omit "ye". Five Flavors are tastes preferred by the Five Zang organs. *Lingshu: Shichuan Pian* states: "When attending patients, ask what is convenient." Origin is the cause of disease; location is where the disease resides.) One who knows by palpation diagnoses the Cunkou (Radial Pulse), observes deficiency and excess, and thereby knows which Zang or Fu organ is diseased. (By distinguishing the pulse image of which Zang or Fu, one knows the disease location.) The classics say knowing from the outside is Sheng, knowing from the inside is Shen. This is what is meant. (Outside refers to observing color and hearing sound. Inside refers to asking desires and palpating pulse.)