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。脉之虚实者。濡者为虚。紧
牢者为实。
丁曰。脉缓软者濡。按之而有力者牢实也。杨曰。按之如切绳之状。谓之紧也。
病之虚实者。出者为虚。入者为实。
丁曰。阴阳者、主其内外也。今阳不足。阴出乘之。在内俱阴。故知出者为虚也。阴不足。阳入乘之。在外俱阳。
故知入者为实也。杨曰。呼多吸少。吸多呼少。
言者为虚。不言者为实。
杨曰。肺主声。入心为言。故知言者为虚。肝主谋虑。故入心即不言。用为实邪。故知不言者为实也。杨曰。脏气
虚。精气脱。故多言语也。脏气实。邪气盛。故不欲言语也。
缓者为虚。急者为实。
丁曰。阳主躁。阴主静。阴即缓。阳即急。故知缓者为虚。急者为实也。杨曰。皮肉宽缓。皮肤满急也。
诊之虚实者。濡者为虚。
杨曰。皮肤濡缓也。
牢者为实。
杨曰。皮肉牢强也。
痒者为虚。
杨曰。身体虚痒也。
痛者为实。
杨曰。身形有痛处皆为实。
外痛内快。为外实内虚。
杨曰。轻手按之则痛。为外实。病浅故也。重手按之则快。为内虚。病深故也。
内痛外快。为内实外虚。
杨曰。重手按之则痛。为内实。病深故也。轻手按之则快。为外虚。病浅故也。凡人病。按之则痛者。皆为实。按
之则快者。皆为虚也。
故曰虚实也。
杨曰。是三虚三实之证也。丁曰。诊按之心腹皮肤内外。其痛按之而止者虚。接之而其痛甚者实。内外同法也。
四十九难曰。有正经自病。有五邪所伤。何以别之。然。经言忧愁思虑则伤心。
丁曰。心主脉。忧愁思虑。即心脉不得宣行。故伤心也。吕曰。心为神。五脏之君。聪明才智。皆由心出。忧劳之
甚。则伤其心。心伤神弱也。虞曰。任治于物清筝栖灵曰心。今忧愁思虑不息。故伤心也。
形寒饮冷则伤肺。
丁曰。肺主皮毛。恶其寒。所以形寒饮寒则令伤其肺也。吕曰。肺主皮毛。形寒者、皮毛寒也。饮冷者、伤肺也。
肺主受水浆。水浆不可冷冻饮料。肺又恶寒。故曰伤也。
恚怒气逆。上而不下。则伤肝。
丁曰。肝主谋虑。胆主勇断。故怒极即伤其肝也。吕曰。肝与胆为脏腑。其气勇。故主怒。怒则伤也。虞曰。素问
云。怒则血菀积于上焦。名曰逆厥。又曰。怒甚呕血。气逆使然。故伤也。
饮食劳倦则伤脾。
丁曰。脾主味。饮食味美。而过食之无度。劳动其力。倦局其足。故伤脾也。吕曰。饮食饱。胃气满。脾络恒急。
或走马跳跃。或以房劳脉络裂。故伤脾也。虞曰。脾为仓廪之官。五味出焉。谓纳其五味。化生五气。以养人身。今饮
食劳倦而致自伤。是故圣人谨和五味。骨正筋柔。谨道如法。长有尺命。安致自伤。养生之道。可不戒哉。
久坐湿地。强力入水。则伤肾。
丁曰。肾主腰。腰者、肾之府。久坐则肾气不得宣行。故损也。肾穴在足心底。名曰涌泉。居处湿地入水。故有损
也。强力者。务快其心。强合阴阳。故伤其肾也。吕曰。久坐湿地。谓遭忧丧。强力者。谓举重引弩。入水者。谓复溺
于水。或妇人经水未过。强合阴阳也。虞曰。土主湿。自然之理也。今久坐湿地。则外湿内感于肾。合之风寒。发为瘴
病。强力过用。必致自饮也。经脉别论曰。持重远行。必伤于肾。生气通天论曰。因而强力。肾气乃伤。高骨乃坏。经
脉别论曰。度水跌仆。喘出于肾与胃也。
是正经之自病也。
丁曰。此五者。皆正经自病。非谓他邪也。吕曰。此皆从其脏内自发病。不从外来也。虞曰。吕氏言其脏内自发其
病。不从外来。其义、非也。只如形寒饮冷伤肺者。谓外寒感于皮毛。内合于肺。此从外来也。又饮冷入口。内伤于肺。
亦从外来也。余悉如此。圣人大意。言正经虚则腠理开。腠理开则外感于内。故曰正经自病也。
何谓五邪。然有中风。
丁曰。中者、伤也。言中风者。调肝应风。主色邪。散于五脏。为之五色也。吕曰。肝主风也。虞曰。东方生风。
风生木。恶风。又巽木为风。
有伤暑。
丁曰。伤暑者。谓心应暑。主臭邪。放于五脏。为之五臭也。吕曰。心主暑也。虞曰。心火主暑。王于夏暑、热也。
素问曰。夏伤于暑。秋必 疟。
有饮食劳倦。
丁曰。脾应湿。主味邪。散入五脏为五味。吕曰。脾主劳倦也。虞曰。正经自病。亦言饮食劳倦。伤脾。今五邪亦
言饮食劳倦。正经病谓正经虚。又伤饮食五邪病。谓食饮伤于脾而致病也。
有伤寒。
丁曰。肺主燥。而其令清切。恶寒。主其声邪散入五脏。为之五声也。吕曰。肺主寒也。虞曰。谓寒感皮毛。故曰
伤寒也。
有中湿。
丁曰。肾应寒。主水邪散入五脏。为之五液也。吕曰。肾主湿也。虞曰。水流湿之义也。
此之谓五邪。
吕曰。此五病。从外来也。虞曰。此五行相胜也。作邪如下说也。
假令心病。何以知中风得之。然。其色当赤。何以言之。肝主色。
虞曰。巽为风。属木。故主中风。木之华萼。敷布五色。作五邪。乃如下说也。
自入为青。
虞曰。木经自病也。
入心为赤。
虞曰。肝邪入心。其色乃赤。
入脾为黄。
虞曰。肝邪入脾。其色黄也。
入肺为白。
虞曰。肝邪入肺。故其色白。
入肝为黑。
虞曰。肝邪在肾。其色黑。
肝为心邪。故知当赤色也。
吕曰。肝主中风。心主伤暑者。今心病中风。故知肝邪往伤心也。
其病身热。胁下满痛。
吕曰。身热者心。满痛者肝。二脏之病证也。虞曰。心主伤暑。病则身热。肝布两胁。故胁满。肝之乘心也。
其脉浮大而弦。
吕曰。浮大者心。弦者肝。二脏脉见应也。
何以知伤暑得之。然。当恶臭。何以言之。心主臭。
虞曰。心火也。火之化物。五臭出焉。
自入为焦臭。
虞曰。火性炎上。则生焦臭。此曰正经自病也。
入脾为香臭。
虞曰。火之化土。其臭乃香。
入肝为臊臭。
虞曰。火之化木。其臭乃臊。
入肾为腐臭。
虞曰。火之化水。其臭乃腐。
入肺为腥臭。
虞曰。火之化金，其臭乃腥。
故知心病伤暑得之也。（按此也字。当在下句之末。别本并脱去。）当恶臭。其病身热而烦。心痛。其脉浮大而散。
吕曰。心主暑。今伤暑。此正经自病。不中他邪。
何以知饮食劳倦得之。然。当喜苦味也。虚为不欲食。实为欲食。何以言之。脾主味。
虞曰。稼穑作甘。礼云。甘受和。故主味也。
入肝为酸。
虞曰。脾主味。为邪乘肝病者。乃喜酸味也。
入心为苦。
虞曰。脾主味。为邪干心病者。乃喜苦味也。
入肺为辛。
虞曰。脾主味。为邪干肺病者。乃喜辛味也。
入肾为咸。
虞曰。脾主味。为邪干肾病者。乃喜咸味也。
自入为甘。
虞曰。土为稼穑。本经自病。乃喜甘味也。
故知脾邪入心。为喜苦味也。
吕曰。心主伤热。脾主劳倦。今心病以饮食劳倦得之。故知脾邪入心也。
其病身热。而体重嗜卧。四肢不收。
吕曰。身热者、心也。体重者、脾也。此二脏病证也。
其脉浮大而缓。
吕曰。浮大者、心脉。缓者、脾脉也。
何以知伤寒得之。然。当谵言妄语。何以言之。肺主声。
虞曰。五金击之有声。故五音出于肺也。
入肝为呼。
虞曰。木之畏金故呼。启玄子云。呼亦当啸。
入心为言。
虞曰。此云言。素问云笑。谓金火相当。夫妇相见。故言笑。
入脾为歌。
虞曰。土母金子。母子相见。故有歌义。
入肾为呻。
虞曰。金母水子。子之见母。发娇呻声也。
自入为哭。
虞曰。肺主于秋。秋者愁也。其音商。商、伤也。故自入为哭也。
故知肺邪入心。为谵言妄语也。
吕曰。心主暑。肺主寒。（按根据前后注例。此下脱今心病以伤寒六字。）得之。故知肺邪入心以为病也。
其病身热。洒洒恶寒。甚则喘咳。
吕曰。身热者心。恶寒者肺。此二脏病证也。
其脉浮大而涩。
吕曰。浮大者心脉。涩者、肺脉也。
何以知中湿得之。然。当喜汗出不可止。何以言之。肾主湿。
丁曰。肾主水。水化五液也。虞曰。肾主水。水流湿。故五湿皆出于肾。
入肝为泣。
虞曰。悲哀动中则伤魂。魂伤则感而泪下。谓肺主悲。悲则金有余。木乃畏之。水者木之母。母忧子。故肝为泣也。
入心为汗。
虞曰。水火交泰。蒸之为汗。
入脾为液。
虞曰。土夫水妻。妻从夫则生涎也。
入肺为涕。
虞曰。北方生寒。寒生肾。今寒感皮毛。内合于肺。肺寒则涕。是知入肺为涕。
自入为唾。
虞曰。肾之脉上络于舌。故生唾也。离中六二爻是也。此则正经自病。
故知肾邪入心。为汗出不可止也。
吕曰。心主暑。肾主湿。今心病以伤湿得知。故知肾邪入心也。
其病身热。而小腹痛。足胫寒而逆。
吕曰。身热者心。小腹痛者肾。肾邪干心。此二脏病证也。
其脉沉濡而大。
吕曰。大者、心脉。沉濡者、肾脉也。
此五邪之法也。
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。
丁曰。假令心病得肝脉来乘。是为虚邪。肝是母。心是子。子能令母虚。故云从后来者为虚邪。吕曰。心王之时。
脉当洪大而长。反得弦小而急。是肝王毕木传于心。夺心之王。是肝往乘心。故言从后来也。肝为心之母。母之乘子。
是为虚邪也。
从前来者为实邪。
丁曰。脾脉来乘。是为实邪。心是母。脾是子。而母能令子实。故云从前来者为实邪也。吕曰。谓心王得脾脉。心
王毕。当传脾。今心王未毕。是脾来逆夺其王。故言从前来也。脾者心之子。子之乘母。是为实邪。
从所不胜来者为贼邪。
丁曰。火所不胜于水。心病肾脉来乘。故为贼邪。吕曰。心王得肾脉。水胜火。故是为贼邪也。
从所胜来者为微邪。
丁曰。火所胜于金。心病肺脉来乘。故云微邪。吕曰。心王反得肺脉。火胜金。故为微邪也。
自病者为正邪。
丁曰。无他邪相乘。则为正邪。吕曰。心王之时。脉实强太过。反得虚微。为正邪也。
何以言之。假令心病。中风得之为虚邪。伤暑得之为正邪。
吕曰。心主暑。今心自病伤暑。故为正邪也。
饮食劳倦得之为实邪。
吕曰。从前来者。脾乘心也。脾主劳倦。故为实邪。
伤寒得之为微邪。
吕曰。从所胜来者。肺乘心也。肺主寒。又畏心。故为微邪。
中湿得之为贼邪。
吕曰。从所不胜来者。肾乘心也。肾主湿。水克火。故为贼邪也。丁曰。夫在天之寒。在地为水。在人为肾。肾主
水与寒。在天之风。在地为木。在人为肝。肝主风。在天之暄暑。在地为火。在人为心。心主暑。在天之燥。在地为金。
在人为肺。肺主燥。在天之湿。在地为土。在人为脾。脾主湿。此是天地人三才相通也。今经以寒合肺。以湿合肾。以
饮食劳倦合脾。此三者。义理稍差。未详其旨。
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。病欲得温而不欲得见人者。病在脏也。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。
丁曰。手三阴三阳应天。主暄暑燥病。即欲得寒也。然阳者、明也。是以欲得见人。阳为腑。故言病在腑也。足三
阴三阳应地。主风寒湿。故病即欲得温。阴主脏。故不欲见人也。诸浮躁者。病在手。诸静不躁者。病在足。
五十二难曰。腑脏发病。根本等不。然。不等也。其不等奈何。然。脏病者。止而不移其病。不离其处。
丁曰。脏病为阴。阴主静。故止而不移。吕曰。脏者阴。决于地。（按决字疑当作法。）故不移动也。
腑病者。仿佛贲向。上下行流。居处无常。
丁曰。腑病为阳。主动。故上下行流。居处无常。吕曰。腑、阳也。阳者法天。天有回旋不休。故病流转。居无常
处也。
故以此知脏腑根本不同也。
Chapter 48 states: Humans have three types of deficiency syndromes (Xu Zheng) and three types of excess syndromes (Shi Zheng). What does this mean? The response is: There are pulse deficiencies and excesses, disease deficiencies and excesses, and diagnostic (palpation) deficiencies and excesses.
Regarding pulse deficiencies and excesses: A soft and floating pulse indicates a deficiency syndrome; a tight or deep-firm pulse indicates an excess syndrome.
Master Ding says: A pulse that is slow and soft is called "Ru" (Soft); one that is forceful upon heavy pressure is called "Lao" (Deep-firm). Master Yang says: When pressed, it feels like cutting a rope, which is called "Jin" (Tight).
Regarding disease deficiencies and excesses: Pathogens moving from the interior to the exterior indicate deficiency; pathogens moving from the exterior to the interior indicate excess.
Master Ding says: Yin and Yang govern the interior and exterior respectively. If Yang Qi is insufficient and Yin Qi moves outward to invade, the interior becomes purely Yin, thus "moving out" signifies deficiency. If Yin Qi is insufficient and Yang Qi enters to invade, the exterior becomes purely Yang, thus "moving in" signifies excess. Master Yang adds: Excessive exhalation with insufficient inhalation, or excessive inhalation with insufficient exhalation, are signs of deficiency and excess.
Regarding speech: Excessive talking indicates deficiency; silence indicates excess.
Master Yang says: The Lung governs sound, and sound entering the Heart transforms into speech; thus, excessive talking indicates deficiency. The Liver governs planning and deliberation; if pathogenic factors enter the Heart causing Liver Qi stagnation, one remains silent, which is an excess syndrome. Therefore, silence indicates excess. Master Yang further states: When Zang Qi is deficient and Essence-Qi is depleted, there is excessive talking; when Zang Qi is solid and pathogenic factors are abundant, there is no desire to speak.
Regarding pulse momentum: A slow/weak pulse momentum indicates deficiency; a rapid/tense pulse momentum indicates excess.
Master Ding says: Yang governs agitation/movement, while Yin governs stillness/slowness. Yin abundance leads to a slow pulse, Yang abundance leads to a tense pulse; thus, slow indicates deficiency and tense indicates excess. Master Yang says: Loose skin and flesh indicate deficiency; tight skin indicates excess.
Regarding diagnostic (palpation) deficiencies and excesses: Soft and flaccid skin indicates deficiency.
Master Yang says: The skin is soft and relaxed.
Firm and rigid skin and flesh indicate excess.
Master Yang says: The skin and flesh are firm and strong.
Itching indicates deficiency.
Master Yang says: The body itches due to deficiency.
Pain indicates excess.
Master Yang says: Any painful area on the body belongs to excess.
Pain on the exterior but comfort on the interior indicates Exterior Excess and Interior Deficiency.
Master Yang says: Pain upon light pressure indicates Exterior Excess because the disease is superficial. Comfort upon heavy pressure indicates Interior Deficiency because the disease is deep.
Pain on the interior but comfort on the exterior indicates Interior Excess and Exterior Deficiency.
Master Yang says: Pain upon heavy pressure indicates Interior Excess because the disease is deep. Comfort upon light pressure indicates Exterior Deficiency because the disease is superficial. Generally, for any patient, pain upon palpation indicates excess; comfort upon palpation indicates deficiency.
Thus, these are the manifestations of deficiency and excess.
Master Yang says: These are the aforementioned three deficiencies and three excesses. Master Ding says: During diagnosis, by examining the heart, abdomen, and skin internally and externally, if pain stops upon pressing, it is deficiency; if pain worsens upon pressing, it is excess. The principle is the same for internal and external conditions.
Chapter 49 states: There are diseases originating from the regular meridians themselves (Zheng Jing Zi Bing) and injuries caused by the Five Pathogenic Factors (Wu Xie). How can they be distinguished? The response is: The Classics state that worry and overthinking damage the Heart.
Master Ding says: The Heart governs the vessels. Worry and overthinking cause the Heart vessels to fail to circulate freely, thereby damaging the Heart. Master Lu says: The Heart houses the Spirit (Shen) and is the ruler of the five Zang organs; wisdom and intelligence all originate from the Heart. Extreme worry and fatigue damage the Heart, leading to weak Spirit. Master Yu says: The Heart governs clarity in handling matters. Since worry and overthinking ceaselessly continue, the Heart is damaged.
Physical cold exposure and drinking cold beverages damage the Lungs.
Master Ding says: The Lungs govern the skin and hair and dislike cold. Therefore, physical cold and cold drinks injure the Lungs. Master Lu says: The Lungs govern the skin and hair; physical cold means the skin and hair are cold; drinking cold damages the Lungs. The Lungs receive fluids, but fluids should not be frozen/cold, and the Lungs dislike cold, hence injury occurs.
Anger and rebellious Qi rising upward without descending damage the Liver.
Master Ding says: The Liver governs planning, and the Gallbladder governs courage and decision-making. Thus, extreme anger damages the Liver. Master Lu says: The Liver and Gallbladder are interior-exterior pairs with courageous Qi, governing anger; anger causes injury. Master Yu says: *Su Wen* states: Anger causes blood to stagnate in the upper Jiao, named Ni Jue (Rebellious Cold); it also states that extreme anger causes vomiting of blood, resulting from rebellious Qi, hence injury.
Improper diet and overwork damage the Spleen.
Master Ding says: The Spleen governs the five flavors. Delicious food eaten excessively without restraint, along with physical labor and limb fatigue, damages the Spleen. Master Lu says: Overeating fills the Stomach Qi, keeping the Spleen collaterals constantly tense; or riding horses/jumping, or sexual exhaustion causing collateral rupture, damages the Spleen. Master Yu says: The Spleen is the official of granaries, from which the five flavors emerge. It takes the five flavors, transforms them into five Qi, and nourishes the body. Now, self-injury due to diet and overwork occurs; therefore, sages carefully harmonize the five flavors, ensuring straight bones and flexible tendons, following the Way, to achieve longevity. How could one self-injure? One must beware of the way of health preservation.
Sitting long in damp places and forcing entry into water damages the Kidneys.
Master Ding says: The Kidneys govern the waist, which is the mansion of the Kidneys. Long sitting prevents Kidney Qi from circulating freely, causing damage. The Kidney acupoint at the sole of the foot is named Yongquan (Bubble Spring). Dwelling in damp places or wading into water causes damage. "Forcing strength" refers to seeking pleasure through forced intercourse, damaging the Kidneys. Master Lu says: Sitting long in damp places metaphorically refers to encountering mourning/grief; "forcing strength" refers to lifting weights or drawing bows; "entering water" refers to drowning again, or forced intercourse during menstruation. Master Yu says: Earth governs dampness, which is natural law. Sitting long in damp places allows external dampness to invade the Kidneys internally, combining with wind-cold to manifest as miasma disease. Overuse of strength inevitably leads to self-injury. *Jing Mai Bie Lun* states: Carrying heavy loads and traveling far will surely injure the Kidneys. *Sheng Qi Tong Tian Lun* states: Due to forced strength, Kidney Qi is injured, and the high bones (spine) are destroyed. *Jing Mai Bie Lun* states: Wading water and falling results in panting originating from the Kidneys and Stomach.
This constitutes the self-disease of the regular meridians.
Master Ding says: These five cases are all self-diseases of the regular meridians, not caused by other pathogens. Master Lu says: These all arise spontaneously from within the Zang organs, not invading from outside. Master Yu says: Master Lu's view that the disease originates internally and not externally is incorrect. For example, physical cold and cold drinks damaging the Lungs implies external cold affecting the skin/hair and merging internally with the Lungs; this comes from outside. Also, cold drinks entering the mouth and injuring the Lungs internally also come from outside. The rest are similar. The sage's main point is that when the regular meridians are deficient, the Cou Li (interstices) open; when Cou Li open, external pathogens easily invade internally, hence it is called "self-disease of the regular meridians."
What are the Five Pathogenic Factors? The response is: There is Wind Strike (Zhong Feng).
Master Ding says: "Zhong" means injury. Speaking of Wind Strike, the Liver corresponds to Wind, governs color pathogens, scatters into the five Zang organs, manifesting as five colors. Master Lu says: The Liver governs Wind. Master Yu says: The East generates Wind; Wind generates Wood; one dislikes wind; the Xun trigram belongs to Wood and represents Wind.
There is Heatstroke Injury (Shang Shu).
Master Ding says: Heatstroke injury means the Heart corresponds to Summerheat, governs odor pathogens, scatters into the five Zang organs, manifesting as five odors. Master Lu says: The Heart governs Summerheat. Master Yu says: Heart Fire governs Summerheat, flourishing in summer; Summerheat is heat. *Su Wen* states: Injuring oneself to Summerheat in summer leads to Malaria in autumn.
There is Diet and Overwork.
Master Ding says: The Spleen corresponds to Dampness, governs flavor pathogens, scatters into the five Zang organs manifesting as five flavors. Master Lu says: The Spleen governs overwork. Master Yu says: Self-disease of regular meridians also mentions diet and overwork damaging the Spleen. Now, the Five Pathogenic Factors also mention diet and overwork. Regular meridian disease refers to regular meridian deficiency, while the disease of injuring diet via the Five Pathogens refers to food/drink injuring the Spleen and causing illness.
There is Cold Damage (Shang Han).
Master Ding says: The Lungs govern Dryness, their command is clear and cutting, they dislike cold, and govern sound pathogens, scattering into the five Zang organs manifesting as five sounds. Master Lu says: The Lungs govern Cold. Master Yu says: Cold pathogens affect the skin/hair, hence it is called Cold Damage.
There is Dampness Strike (Zhong Shi).
Master Ding says: The Kidneys correspond to Cold, govern Water pathogens, scatter into the five Zang organs manifesting as five fluids. Master Lu says: The Kidneys govern Dampness. Master Yu says: It is the meaning of water flowing toward dampness.
These are called the Five Pathogenic Factors.
Master Lu says: These five diseases come from outside. Master Yu says: This is the mutual overcoming of the Five Phases, acting as pathogens as described below.
Suppose there is Heart disease. How do we know it was caused by Wind Strike? The response is: The complexion should be red. Why say so? The Liver governs colors.
Master Yu says: The Xun trigram is Wind, belonging to Wood, thus governing Wind Strike. The essence of Wood spreads five colors, forming the five pathogens as follows.
Self-disease of Wood manifests as Green/Cyan.
Master Yu says: This is the self-disease of the Wood Meridian.
Entering the Heart manifests as Red.
Master Yu says: Liver pathogen entering the Heart makes the complexion red.
Entering the Spleen manifests as Yellow.
Master Yu says: Liver pathogen entering the Spleen makes the complexion yellow.
Entering the Lungs manifests as White.
Master Yu says: Liver pathogen entering the Lungs makes the complexion white.
Entering the Kidneys manifests as Black.
Master Yu says: Liver pathogen entering the Kidneys makes the complexion black.
The Liver becomes the pathogen of the Heart, so the complexion is known to be red.
Master Lu says: The Liver governs Wind Strike, and the Heart governs Heatstroke Injury. Now, Heart disease is caused by Wind Strike, so we know it is Liver pathogen invading the Heart.
Symptoms include body heat, fullness and pain under the ribs.
Master Lu says: Body heat is a Heart symptom; fullness and pain are Liver symptoms. These are the syndromes of the two Zang organs. Master Yu says: The Heart governs Heatstroke Injury; illness brings body heat. The Liver distributes across the hypochondrium, hence rib fullness; this is Liver overacting on the Heart.
The pulse is Floating, Large, and Wiry.
Master Lu says: Floating and Large is the Heart pulse; Wiry is the Liver pulse. This is the corresponding pulse manifestation of the two Zang organs.
How do we know it was caused by Heatstroke Injury? The response is: One should dislike foul odors. Why say so? The Heart governs smell.
Master Yu says: The Heart is Fire; Fire transforms things, producing five odors.
Self-disease of Fire manifests as Scorched Odor.
Master Yu says: Fire nature flares upward, producing scorched odor. This is called self-disease of the regular meridian.
Entering the Spleen manifests as Fragrant Odor.
Master Yu says: Fire transforms into Earth, the odor is fragrant.
Entering the Liver manifests as Pungent/Fishy Odor (Sao).
Master Yu says: Fire transforms into Wood, the odor is pungent/fishy.
Entering the Kidneys manifests as Putrid Odor.
Master Yu says: Fire transforms into Water, the odor is putrid.
Entering the Lungs manifests as Raw/Fishy Odor (Xing).
Master Yu says: Fire transforms into Metal, the odor is raw/fishy.
Thus, we know Heart disease is caused by Heatstroke Injury. (Note: The character "ye" here should be at the end of the next sentence; other versions omit it.) One should dislike foul odors. Symptoms include body heat with vexation, Heart pain, and a Floating, Large, and Scattered pulse.
Master Lu says: The Heart governs Summerheat. Now, injuring oneself to Summerheat is self-disease of the regular meridian, not struck by other pathogens.
How do we know it was caused by Diet and Overwork? The response is: One should desire bitter taste. Deficiency means no desire to eat; Excess means desire to eat. Why say so? The Spleen governs flavors.
Master Yu says: Sowing and reaping produce Sweetness. The Book of Rites states sweetness accepts harmony, thus the Spleen governs flavor.
Entering the Liver manifests as Sour Taste.
Master Yu says: The Spleen governs flavor. If pathogen invades Liver disease, one desires sour taste.
Entering the Heart manifests as Bitter Taste.
Master Yu says: The Spleen governs flavor. If pathogen invades Heart disease, one desires bitter taste.
Entering the Lungs manifests as Acrid/Pungent Taste.
Master Yu says: The Spleen governs flavor. If pathogen invades Lung disease, one desires acrid taste.
Entering the Kidneys manifests as Salty Taste.
Master Yu says: The Spleen governs flavor. If pathogen invades Kidney disease, one desires salty taste.
Self-disease manifests as Sweet Taste.
Master Yu says: Earth governs sowing and reaping; self-disease of the original meridian makes one desire sweet taste.
Thus, we know Spleen pathogen entering the Heart manifests as desiring bitter taste.
Master Lu says: The Heart governs Heat/Injury, and the Spleen governs overwork. Now, Heart disease is caused by diet and overwork, so we know it is Spleen pathogen entering the Heart.
Symptoms include body heat, heavy body, drowsiness, and inability to gather/strengthen the four limbs.
Master Lu says: Body heat is a Heart symptom; heavy body is a Spleen symptom. These are the syndromes of the two Zang organs.
The pulse is Floating, Large, and Slow.
Master Lu says: Floating and Large is the Heart pulse; Slow is the Spleen pulse.
How do we know it was caused by Cold Damage? The response is: One should talk deliriously and妄语 (nonsense). Why say so? The Lungs govern sound.
Master Yu says: Metal striking produces sound, thus the five tones originate from the Lungs.
Entering the Liver manifests as Calling Out (Hu).
Master Yu says: Wood fears Metal, thus calling out. Qixuanzi says: Calling out can also be whistling.
Entering the Heart manifests as Speech (Yan).
Master Yu says: Here "speech," *Su Wen* says "laughter." It means Metal and Fire are balanced, like husband and wife meeting, hence speech and laughter.
Entering the Spleen manifests as Singing (Ge).
Master Yu says: Earth is the mother of Metal; mother and son meet, hence the meaning of singing.
Entering the Kidneys manifests as Moaning (Shen).
Master Yu says: Metal is the mother of Water; child sees mother, emitting delicate moaning sounds.
Self-disease manifests as Crying (Ku).
Master Yu says: The Lungs govern Autumn; Autumn is sorrow. Its tone is Shang, Shang means injury. Thus, self-disease manifests as crying.
Thus, we know Lung pathogen entering the Heart manifests as delirious speech.
Master Lu says: The Heart governs Summerheat, and the Lungs govern Cold. (Note: Based on preceding commentary style, six characters "now Heart disease due to Cold Damage" are missing here.) Causing it, we know Lung pathogen entering the Heart becomes illness.
Symptoms include body heat, shivering aversion to cold, and severe panting/coughing.
Master Lu says: Body heat is a Heart symptom; aversion to cold is a Lung symptom. These are the syndromes of the two Zang organs.
The pulse is Floating, Large, and Choppy.
Master Lu says: Floating and Large is the Heart pulse; Choppy is the Lung pulse.
How do we know it was caused by Dampness Strike? The response is: One should desire unstoppable sweating. Why say so? The Kidneys govern dampness.
Master Ding says: The Kidneys govern Water; Water transforms into five fluids. Master Yu says: The Kidneys govern Water; water flows to dampness, thus all five dampnesses originate from the Kidneys.
Entering the Liver manifests as Weeping/Tears (Qi).
Master Yu says: Sorrow moving internally injures Hun (Ethereal Soul). When Hun is injured, sensation causes tears to fall. The Lungs govern sorrow; sorrow means Metal is excessive, Wood fears it. Water is the mother of Wood; the mother worries about the child, thus the Liver manifests as weeping.
Entering the Heart manifests as Sweat (Han).
Master Yu says: Water and Fire interact and transform, steaming into sweat.
Entering the Spleen manifests as Fluid/Saliva (Ye).
Master Yu says: Earth is husband, Water is wife; wife follows husband, generating saliva.
Entering the Lungs manifests as Nasal Discharge (Ti).
Master Yu says: North generates Cold; Cold generates Kidneys. Now cold affects skin/hair, merging internally with Lungs. Lung cold causes nasal discharge, thus entering Lungs manifests as nasal discharge.
Self-disease manifests as Spittle (Tuo).
Master Yu says: The Kidney meridian connects to the tongue, thus generating spittle. This corresponds to the Six-Two line of the Li Trigram. This is self-disease of the regular meridian.
Thus, we know Kidney pathogen entering the Heart manifests as unstoppable sweating.
Master Lu says: The Heart governs Summerheat, and the Kidneys govern Dampness. Now, Heart disease is known from injuring dampness, so we know it is Kidney pathogen entering the Heart.
Symptoms include body heat, lower abdominal pain, and cold/reversal in the calves and feet.
Master Lu says: Body heat is a Heart symptom; lower abdominal pain is a Kidney symptom. Kidney pathogen interfering with the Heart; these are the syndromes of the two Zang organs.
The pulse is Deep, Soft, and Large.
Master Lu says: Large is the Heart pulse; Deep and Soft is the Kidney pulse.
This is the method of the Five Pathogenic Factors.
Chapter 51 states: Diseases include Deficient Pathogen (Xu Xie), Excess Pathogen (Shi Xie), Robber Pathogen (Ze Xie), Minor Pathogen (Wei Xie), and Correct Pathogen (Zheng Xie). How to distinguish them? The response is: Coming from the later stage is Deficient Pathogen.
Master Ding says: Suppose Heart disease receives Liver pulse invasion; this is Deficient Pathogen. Liver is Mother, Heart is Child. The child can make the mother deficient, hence "coming from the later" is Deficient Pathogen. Master Lu says: When the Heart is King (dominant), the pulse should be Hong Da Chang (Vast, Large, Long). Instead, getting Xian Xiao Ji (Wiry, Small, Rapid) means Liver dominance has ended, Wood transmits to Heart, seizing Heart's dominance. This is Liver invading Heart, hence "coming from the later." Liver is Heart's Mother; Mother invading Child is Deficient Pathogen.
Coming from the earlier stage is Excess Pathogen.
Master Ding says: Spleen pulse invasion is Excess Pathogen. Heart is Mother, Spleen is Child. The mother can make the child excess, hence "coming from the earlier" is Excess Pathogen. Master Lu says: When Heart is King, receiving Spleen pulse. Heart dominance ends, should transmit to Spleen. Now Heart dominance hasn't ended, Spleen comes to reverse-seize its dominance, hence "coming from the earlier." Spleen is Heart's Child; Child invading Mother is Excess Pathogen.
Coming from the non-conquering direction is Robber Pathogen.
Master Ding says: Fire is not conquered by Water. Heart disease receiving Kidney pulse invasion is Robber Pathogen. Master Lu says: Heart King receiving Kidney pulse; Water conquers Fire, hence Robber Pathogen.
Coming from the conquering direction is Minor Pathogen.
Master Ding says: Fire conquers Metal. Heart disease receiving Lung pulse invasion is Minor Pathogen. Master Lu says: Heart King contrary-receiving Lung pulse; Fire conquers Metal, hence Minor Pathogen.
Self-disease is Correct Pathogen.
Master Ding says: Without other pathogens invading, it is Correct Pathogen. Master Lu says: When Heart is King, pulse is overly solid/strong, suddenly becoming deficient/weak, this is Correct Pathogen.
Why say so? Suppose Heart disease: Wind Strike makes it Deficient Pathogen; Heatstroke Injury makes it Correct Pathogen.
Master Lu says: The Heart governs Summerheat. Now Heart self-disease from Summerheat is Correct Pathogen.
Diet and Overwork make it Excess Pathogen.
Master Lu says: Coming from the earlier stage is Spleen invading Heart. Spleen governs overwork, hence Excess Pathogen.
Cold Damage makes it Minor Pathogen.
Master Lu says: Coming from the conquering direction is Lung invading Heart. Lung governs Cold, and fears Heart, hence Minor Pathogen.
Dampness Strike makes it Robber Pathogen.
Master Lu says: Coming from the non-conquering direction is Kidney invading Heart. Kidney governs Dampness; Water conquers Fire, hence Robber Pathogen. Master Ding says: Cold in Heaven is Water on Earth, Kidney in Man; Kidney governs Water and Cold. Wind in Heaven is Wood on Earth, Liver in Man; Liver governs Wind. Summerheat in Heaven is Fire on Earth, Heart in Man; Heart governs Summerheat. Dryness in Heaven is Metal on Earth, Lung in Man; Lung governs Dryness. Dampness in Heaven is Earth on Earth, Spleen in Man; Spleen governs Dampness. This is the connection of Heaven, Earth, and Man. Now the Classic matches Cold with Lung, Dampness with Kidney, and Diet/Overwork with Spleen. These three have slight discrepancies in principle, and their intent is unclear.
Chapter 51 states: Some patients desire warmth, some desire cold, some desire to see people, some do not desire to see people, each different. Which Zang or Fu organ is diseased? The response is: Disease desiring cold and wanting to see people is in the Fu organs. Disease desiring warmth and not wanting to see people is in the Zang organs. Why say so? Fu organs are Yang. Yang diseases desire cold and want to see people. Zang organs are Yin. Yin diseases desire warmth and want to close doors and stay alone, disliking human voices. Thus, we distinguish Zang and Fu diseases.
Master Ding says: Hand Three Yin and Three Yang correspond to Heaven, governing warm/summer/dry diseases, thus desiring cold. However, Yang is brightness, thus wanting to see people. Yang is Fu, hence disease in Fu. Foot Three Yin and Three Yang correspond to Earth, governing wind/cold/damp, thus desiring warmth. Yin governs Zang, thus not wanting to see people. Agitated/restless diseases are in Hand meridians; quiet/non-agitated diseases are in Foot meridians.
Chapter 52 states: Do Zang and Fu diseases have the same root? The response is: They are not equal. How are they unequal? The response is: Zang diseases are static and do not move; the disease does not leave its location.
Master Ding says: Zang diseases are Yin; Yin governs stillness, thus static and unmoving. Master Lu says: Zang is Yin, determined by Earth (Note: "Jue" likely a typo for "Fa" - method/law), thus not moving.
Fu diseases are like running forward, flowing up and down, having no fixed residence.
Master Ding says: Fu diseases are Yang; Yang governs movement, thus flowing up and down, having no fixed residence. Master Lu says: Fu is Yang; Yang follows Heaven. Heaven rotates incessantly, thus disease flows and has no fixed residence.
Thus, we know the roots of Zang and Fu are different.