十三条 脾中风者。翕翕发热。形如醉人。腹中烦重。皮目 而短气。
足太阴脾经。外走足内 之上侧。故脾从经穴而内中风也。风邪化热。由内而外蒸。故翕翕发热。形如醉人
者。就其面赤。及肢体倦怠而言。盖面为阳明胃腑之应。脾移热于胃。故面赤如醉人。又肢体者。脾阳之所贯
也。脾中真气。受伤于风热。则真阳痿顿。故肢体倦怠如醉人。热伤津液则烦。土气沉困则重。腹中为脾胃之
应。脾热。故液干气滞耳。皮者。周身之皮肉。目、指眼眶而言。经气虚而灌注不匀。则移宫易位而 动。皮目俱
者。脾病而气馁于外也。脾肺同治手足之太阴。而相为呼应。故息道深长。今肺吸而脾中邪实。艰于纳
受。故短气也。细玩全文。自是活症。亦不出方者。岂因风寒论中。已列借主桂枝之例乎。肝肺及心三脏。中
风条后。俱有中寒论。脾脏独不及者。盖因脾中寒之大法。已详腹满中。故不再论。同志者。不得认为漏且缺也。
十四条 脾死脏。浮之大坚。按之如覆杯。洁洁状如摇者死。
脾为黄泉之己土。其一种生物之善气。和柔相杂。不可得而见者也。若其脉中空散漫而大浮土灰尘之象。
真阴之欲绝也。凝冱切责而坚结土沙石之象。真阳之欲绝也。浮之、为在上在外之应。浮之大坚。是阴阳不
能蒸被之诊矣。如覆杯者。即上文大坚。而加以形圆、体空之象。盖形圆。则关下无来踪。关上无去迹。体空。则
底面无根脚。按之如覆杯。是为离绝之土矣。夫离绝而犹见余动者。譬之全蟹已经熟食。而生遗之腿足。其
动机尚在之应。故必死也。洁洁。孤洁无与之貌。摇者。言上下不见来去。底面不见鼓发。但觉从两旁摇动而
已。状之覆杯。不亦宜乎。此句。又仲景自注覆杯之义也。
十五条 趺阳脉浮而涩。浮则胃气强。涩则小便数。浮涩相搏。大便则坚。其脾为约。麻子仁丸主之。
麻子仁丸方 麻子仁（二升） 杏仁（一升） 芍药（半斤） 大黄（一斤） 枳实（一斤） 浓朴（半斤）
上六味。末之。炼蜜和丸如梧子大。饮服十丸。日三。以知为度。
此条见伤寒阳明篇。入此者。从脾病之类也。论条方意。详伤寒中。以脾家治例。不论风寒杂症俱同也。
十六条 肾着之病。其人身体重。腰中冷。如坐水中。形如水状。反不渴。小便自利。饮食如故。病属下焦。
身劳汗出。
衣里冷湿。久久得之。腰以下冷痛。腹重如带五千钱。甘姜苓术汤主之。
甘草干姜茯苓白术汤方（亦名肾着汤。）
甘草（二两） 干姜（四两） 茯苓（四两） 白术（二两）
上四味。以水五升。煮取三升。分温三服。腰中即温。
肾着者。寒湿之邪。着于肾而不去之义。盖肾为水脏。其气多寒。常与寒湿之外邪相召。故入则直着于肾者。
从其类也。肾中之真气。上贯周身。而轻便干健者。以先天之丙火胎于水。而庚金亦伏于水故也。寒湿着之。
寒则阳微。湿则气滞而不上贯。则失其轻便干健之用。故身体重也。腰为肾之府。肾着寒。故腰中冷。湿为水
之渐。肾着湿。故腰以下如坐水中。三句。言病患之自觉者。可从问诊而得之也。阳虚而寒着之。则浮肿如水
状。气虚而湿着之。则黄润如水状。故曰如水。而非真水也。夫如水而知其非水者。盖因不渴。则水之入者既
少。小便自利。则水之出者又多。而中无所蓄矣。三句。言旁人之共见者。又可从望诊而得之也。脏腑之阳虚
者。俱能病积滞痹着等候。身重如水。上焦之肺与膻中。不能呵嘘水道。及中焦之脾胃。不能分理。俱能病此。
而何独知为肾着乎。盖以其人之饮如故。故知非属上焦。食如故。故知非属中焦。而属下焦之肾脏矣。二句。
言辨肾着之确切处。里字。当是裹字之讹。肾为强力之官。所以任劳者也。身劳汗出。则肾虚矣。衣冷裹湿。则
冷湿之邪。乘虚而着之。况担延久久乎。二句。推言肾着之病因也。冷痛者。阴沁切责。冷气逼阳之象。腹重者。
坚癖沉坠。湿气下注之象。如五千钱者。正气不能上提。故着久而愈觉其重耳。二症。就上文之腰中冷。身体
重。而甚言之耳。主本汤者。原为肾中冷湿。而所以温之、燥之者。其用药注意。却又在中焦之脾胃。故君辛热
之干姜。以除冷。淡渗之茯苓、以除湿。而以甘温守中之甘草、白术佐之。盖因暖土。可以祛寒。而燥土。尤能胜
湿故也。观夫阳春回于大地。而幽壑冰消。堤岸固于江乡。而浸淫患息。仲景制方之意。概可知矣。他脏之
例。先言风寒。次及死脏。此独缺之者。以详少阴伤寒之直中也。
十七条 肾死脏。浮之坚。按之乱如转丸。益下入尺中者死。
万物以阳火为绵软。胶饧糕饼之属于蒸烙。可证也。浮之坚。是水无阳而冰冻之象。按之如转丸者。按处仍
见坚硬。更加无来无去。而形圆体滚。即脾脏如覆杯而微较数小之状。但彼则如两边动摇。故曰摇。此则如
上下圆转。故曰乱、曰转。是水泡上泛。水气底散之象。下入尺中。则其气已尽。不能远出。常有就地涣散之义。
故死。第他脏之死。俱合阴阳而两言之。肾脏独言阳绝者。以肾为水寒之脏。其阳气尤为贵重故也。
十八条 问曰。三焦竭部。上焦竭善噫。何谓也。师曰。上焦受中焦气。未和。不能消谷。故能噫耳。
下焦竭。即遗溺失便。其气不和。不能自禁制。不须治。久则愈。
竭者。非竭尽之谓。盖指一时虚乏而言。观下文未和。及不须治自见。噫。嗳气也。三焦竭部。当是古医经之篇
目。长沙借为问答。以发其奥。曰。三焦竭之篇部中。有云上焦竭则善噫者。夫噫出于脾胃。似在中焦矣。而谓
由于上焦者何也。不知谷食之在中焦。虽由脾胃之运化。而实成于上焦之呵嘘蒸被。二便之在下焦。虽由
脾胃之提挈。而实成于下焦之关键纵送者也。故曰上焦氤氲之气。虽受之于中焦腐化中。而其下炎之用。
复能运饮熟谷。以为中焦之助。譬之太阳。聚万物之晶光。而还以照临万物。譬之人主。总万民之推奉。而还
以君临万民之道也。若此气一时虚乏而未和。则不能助理消谷。而谷停于胃。谷停则败。败气上熏心主。故
能噫耳。三焦竭部之所谓上焦竭而善噫者此也。夫胃腑如沤。化臭腐为神奇之气。从脾历肺而达于胸者。
纯是一种温暖轻灵。虚无恬淡之妙。故上焦喜之。若谷停未化。其直从胃脘而上逆者。惟渣质滞浊之气。为
清宁灵府之所见恶者。此噫而出之之所由来也。答语止此。推之下焦受中焦气。而以禁制助中焦之提挈
者。与上焦同义。倘下焦一时虚乏。则前阴遗溺。后阴失便者。亦非单责之中焦也。当知因下焦之气。不与中
上相和。故不能自禁制耳。禁制合守送两边而言。不禁。如热急后重之类。不制。谓传送不畅快也。不须治两
句。是双承上文。非单指下焦也。盖上焦之气。如遇惊恐嗔怒等类。则一时上虚下乘而不和。下焦之气。如遇
泄泻热淋等类。则一时后坠前结而不和。二者。俱常有之症。久则中气分贯之。而上下之不和者复和矣。故
久则愈也。
十九条 师曰。热在上焦者。因咳为肺痿。热在中焦者。则为坚。热在下焦者。则尿血。亦令淋闭不通。大肠
有寒者多 溏。有热者便肠垢。小肠有寒者。其人下重便血。有热者必痔。篇首至肾死脏。言五脏病。自上条及此。
言六腑病。言六腑而独详三焦者。以三焦虽属六腑之一。而其余五腑。俱丽三焦之部。如上焦如雾。虽单指
心肺夹空之气。而其实膻中一腑。亦属上焦所管。且阳明之脘。少阳之系。其上半截俱穿膈上。而为上焦之
所属也。中焦胃腑之外。下焦膀胱之外。可类推矣。此长沙以三焦该六腑之意乎。下焦独抽言大小肠者。以
四腑之病。散详别见。而大小肠二腑。合伤寒金匮中。未尝论及。故备言之耳。上条以虚竭言三焦之轻病。
此条以寒热言三焦之重病。不言死症者。以诸病入脏者死。入腑者愈也。热在上焦。火气逼清虚之管而
作痒。故咳。咳多则肺劳。劳热相并。故肺气痿顿。热在中焦。则脾胃之液渐干。而糟粕结滞。故肠胃殊觉坚硬。
热在下焦。膀胱之血分受伤。则吸入脬中。而血与尿并见。故尿血。若其气分受伤。自邪热燔炙而论。如煎饧
成质。煮海成盐之象。而为膏砂等淋。自真气不布而论。则传化艰涩。而闭塞不通也。至下焦所属之大肠有
寒。则不能以湿化燥化。收摄渣质中之余水。故粪与清水。两不融和。而便如骛鸭之溏屎。如大肠有热。则燥
化大过。刮下肠中之垢如白脓。其实即大肠所挂之津液也。又下焦所属之小肠有寒。则见下重便血。盖因
人身之大气。逐节相提。故宗气提脾胃。脾胃提小肠。小肠提大肠。而形脏不至沉坠者此也。小肠寒不能提。
而大肠之气陷下。故下重也。气者。血之主令。气不升举。则大肠之血。亦下脱而见于便矣。若小肠有热。除正
传膀胱而为癃闭等症之外。其热气又随渣质而贯注大肠。肛门者。大肠之尽处也。尽则无所传卸。故结为
瘿乳等类之痔矣。六腑之候。其统于三焦者如此。
二十条 问曰。病有积。有聚。有 气。何谓也。师曰。积者。脏病也。终不移。聚者。腑病也。发作有时。
展转痛移。为可治。 气者。胁下痛。按之则愈。复发为 气。诸积大法。脉来细而附骨者。乃积也。寸口。积在胸中。
微出寸口。积在喉中。关上。积在脐旁。上关上。积在心下。微下关。积在少腹。尺中。积在气冲。脉在左。积在左。
脉在右。积在右。脉两出。积在中央。各以其部处之。
积者。久积不行。聚者。暂聚未散之义。二者。皆脏腑之阴液。因阳衰、气寒而不能运动。故沉着于脏腑之内者
也。 气者。谷气也。胃中饱食过度。或久停未化。于是胃实气满。不从下行。而由胃络旁溢者是也。但积聚以
及气。其症俱能作痛。而其名义。颇相似而难辨。故问其所以为积、为聚、为 气之谓也。不知积为脏病。脏
者。收藏之象。其精常住而不散。故积之为病。亦因其脏精之居守。而始终不移。聚为腑病。腑者。府库之象。其
气既入而亦出。故聚之为病。亦因其腑气之流行。而发作有时。展转痛移。夫发作有时。则未发者。为阳气犹
有自振之机。展转痛移。则所聚者。为病邪已见腾挪之渐。投以辛甘。治以攻发。迎而导之。则聚者自散。宁与
脏积之始终不移。正邪相服。而无隙可乘者比哉。故可治也。聚曰可治。则积之不可治者。在言外矣。胃之络
脉通于胁。故实满之 气。溢于胁下。而作如刺如胀之痛也。按则其气复从络而还于胃。故其痛则愈。复发
者。指按起而言。不曰可治不可治者。其意或以减谷则愈者乎。此所谓 气之症也。下文二十一句。就五脏
之积而言其脉。且广言积之在募原内络中者。其诊法亦准脏积之例也。盖谓五脏诸积之大法。俱属有阴
无阳。而其阴液沉着之候。故其脉来必细以应无阳。必沉以应脏。必伏以应阴液沉着。此细而沉伏附骨者。
乃积脉也。若此脉见寸口。积在胸中。胸中者。心肺之所托也。微出寸口。积在喉中。喉中者。心肺上出之络之
所经也。见关上。积在脐旁。脐旁者。肝脾之所托也。上关上。积在心下。心下者。心肺下行之络之所经也。微下
关。积在少腹。少腹者。肝肾之所托也。见尺中。积在气冲。经名气街穴。针灸大成作气冲。在脐下横骨两端毛
际中。动脉应手者是。足阳明脉气之所发也。但于脏无取。未详其义。岂阳明之气。与阴会相合而通于肾脏
者乎。脉与积应。其左右中央。各根据其部者。如寸口左见。则积在心。右见。则积在肺。左右两见。则积在心肺中
央之内络。而穿于前后之募原者是矣。又如关上左见。则积在肝。右见。则积在脾。左右两见。则积在肝脾中
央之内络。而穿于前后之募原者是矣。下焦及寸关尺之微上微下者俱仿此。以五脏之系及络俱能病积。
故曰广言积之在募原内络中者。其诊法俱准脏积之例也。或曰。条端明列三病。仲景独言积脉。而不及
聚与 气者。何也。答曰。 气为一时之轻病。减谷则气消而痛愈。故可不必言其脉也。然愚尝试之。其人尺
寸俱平。关脉实而滑于右。弦而细涩于左者。乃 气之脉也。若夫聚之为脉。已具积脉中。而俟善读者之自
悟久矣。如诸聚大法。脉来细而于不浮不沉中见者。乃聚也。下文十九句。文则易积以聚。意则易脏以腑。而
细按之。则三焦之所属。六腑之所经。左右中央之所寄托。不与积脉同一彰明较着乎哉。
Article 13 When the Spleen is struck by Wind, there is a slight fever, the appearance resembles that of a drunken person (facial flushing and limb fatigue), abdominal discomfort and heaviness, eyelid twitching, and shortness of breath.
The Foot-Taiyin Splein Meridian runs externally along the upper side of the medial malleolus. Thus, the Spleen is invaded by Wind pathogen through its meridian acupoints. The Wind pathogen transforms into Heat and steams from the interior to the exterior, causing slight fever. The description "resembling a drunken person" refers to facial redness and limb fatigue. Since the face reflects the Yangming Stomach organ, when Spleen Heat transfers to the Stomach, the face becomes red like that of a drunkard. Furthermore, the limbs are penetrated by Spleen Yang. When the true Qi within the Spleen is injured by Wind-Heat, the True Yang suddenly weakens, leading to limb fatigue resembling drunkenness. Heat damaging body fluids causes irritability; the sinking and stagnation of Earth Qi causes heaviness. The abdomen reflects the Spleen and Stomach; Spleen Heat leads to dry fluids and stagnant Qi. "Skin" refers to the skin and flesh of the whole body; "eyes" refer to the eye sockets. When meridian Qi is deficient and unevenly distributed, it shifts position, causing twitching of the eyelids and eye sockets. This indicates that Spleen disease causes Lung Qi to weaken at the exterior. The Spleen and Lung belong to the Hand-Taiyin and Foot-Taiyin meridians respectively and respond to each other. Therefore, breathing is deep and long. Now, the Lung inhales while the Spleen is filled with excess pathogens, making reception difficult, resulting in shortness of breath. Careful study of the full text reveals this is an excess syndrome. The reason no formula is provided may be because the *Treatise on Cold Damage* has already listed examples of borrowing Guizhi Tang (Cinnamon Twig Decoction) for Wind-Cold. After the Wind-strike articles for the Liver, Lung, and Heart, there are articles on Cold-strike, but none for the Spleen. This is because the general principles of Cold striking the Spleen were detailed in the article on Abdominal Fullness, so they are not repeated. Colleagues should not consider this an omission or deficiency.
Article 14 A dying Pulse of the Spleen is floating, large, and hard; upon pressing, it feels like an inverted cup, clean and rootless, shaking as if unstable, indicating death.
The Spleen belongs to Ji Earth of the Yellow Springs. Its vital Qi that nurtures life is soft and mixed, invisible. If the pulse is hollow, scattered, large, and floating, resembling dust, it indicates the impending exhaustion of True Yin. If it is congealed, harsh, and hard, resembling sand and stones, it indicates the impending exhaustion of True Yang. Floating corresponds to the exterior and upper levels. A floating, large, and hard pulse indicates that Yin and Yang cannot steam and cover. Feeling like an inverted cup means the previously mentioned "large and hard," combined with a round shape and hollow interior. Because it is round, there is no incoming trace below Guan, nor outgoing trace at Guan; because it is hollow, there is no root at the bottom. Pressing like an inverted cup signifies Earth that is severed. Even though severed, if residual movement remains, it is like the legs of a fully cooked crab still moving, indicating lingering vitality, hence death. "Jie Jie" describes a lonely and isolated appearance. "Yao" (shaking) means there is no coming or going up and down, and no pulsation at the bottom, only lateral shaking. Describing it as an inverted cup is appropriate. This sentence is Zhang Zhongjing's own annotation of the meaning of "inverted cup."
Article 15 The Fuyang pulse is floating and choppy. Floating indicates strong Stomach Qi; choppy indicates frequent urination. The interplay of floating and choppy pulses leads to hard stool. This is Spleen Constriction (Pi Yue), treated with Hemp Seed Pill (Maziren Wan).
Hemp Seed Pill Formula:
Hemp Seed (Er Sheng), Apricot Kernel (Yi Sheng), White Peony Root (Ban Jin), Rhubarb (Yi Jin), Immature Bitter Orange (Yi Jin), Magnolia Bark (Ban Jin).
Grind these six herbs into powder, mix with refined honey to make pills the size of mulberry seeds. Take ten pills with water, three times a day, adjusting dosage until effect is achieved.
This article appears in the Yangming Chapter of the *Treatise on Cold Damage*. It is included here as it pertains to Spleen diseases. The discussion of the article and formula details are found in the *Treatise on Cold Damage*; here, only the treatment principles for the Spleen are discussed, applicable to both Wind-Cold and miscellaneous diseases.
Article 16 Kidney Binding Disease (Shen Zhuo): The patient feels heavy throughout the body, cold in the waist, as if sitting in water, appearing watery in form, yet without thirst, with normal urination and appetite. The disease is located in the Lower Jiao, caused by physical exertion and sweating, with cold and dampness penetrating the clothing over time. There is cold pain below the waist and heaviness in the abdomen as if carrying five thousand coins. Treat with Ginger and Licorice Poria and Atractylodes Macrocephala Decoction (Gan Jiang Ling Zhu Tang).
Licorice, Dried Ginger, Poria, and Atractylodes Macrocephala Decoction Formula (also known as Kidney Binding Decoction):
Licorice Root (Liang Liang), Dried Ginger (Si Liang), Poria (Si Liang), Atractylodes Macrocephala Rhizome (Liang Liang).
Boil these four herbs in five sheng of water to obtain three sheng. Divide into three warm doses. The waist will feel warm.
Kidney Binding refers to Cold-Damp pathogens adhering to the Kidney and not departing. The Kidney is a Water organ with inherently Cold Qi, often attracting external Cold-Damp pathogens due to similarity. Thus, pathogens directly adhere to the Kidney. The True Qi of the Kidney penetrates the whole body, keeping it light and agile, due to Congenital Bing Fire gestating in Water and Geng Metal hiding in Water. Cold-Damp adherence causes Yang to weaken and Qi to stagnate, losing its light and agile function, resulting in body heaviness. The waist is the mansion of the Kidney; Kidney Cold causes coldness in the waist. Dampness is the gradual state of Water; Kidney Dampness makes the area below the waist feel like sitting in water. These three sentences describe the patient's subjective symptoms, obtainable via inquiry. Yang deficiency with Cold adherence causes edema resembling water; Qi deficiency with Damp adherence causes yellowish moisture resembling water. Hence "like water," but not actual water. We know it is not water because there is no thirst (low intake) and urination is free (high output), with no accumulation internally. These three sentences describe objective signs visible to others, obtainable via observation. Organ Yang deficiency can lead to stagnation and binding syndromes. Body heaviness like water can result from Upper Jiao Lung and Qimotore failing to regulate water passages, or Middle Jiao Spleen and Stomach failing to separate clear and turbid. Why specifically identify it as Kidney Binding? Because drinking habits are normal, ruling out Upper Jiao; eating habits are normal, ruling out Middle Jiao; thus it belongs to the Lower Jiao Kidney. These two sentences are key to differentiating Kidney Binding. The character "Li" (inside) is likely a typo for "Guo" (wrap). The Kidney is the official of strength, enduring labor. Physical exertion and sweating deplete Kidney Qi; cold and damp clothing allow pathogens to adhere to the deficiency. Prolonged duration exacerbates this. These two sentences deduce the etiology. Cold pain indicates Yin infiltration forcing out Yang; abdominal heaviness indicates solid stagnation and downward pouring of Dampness. "Like five thousand coins" indicates failure of healthy Qi to ascend, feeling heavier over time. These symptoms intensify the previous "cold waist" and "heavy body." The decoction warms and dries Cold-Damp in the Kidney, but focuses on the Middle Jiao Spleen and Stomach. Dried Ginger (acrid-hot) removes cold; Poria (bland-leaching) removes dampness; Licorice and Atractylodes (sweet-warm) support the center. Warming Earth dispels Cold; drying Earth overcomes Dampness. Just as spring warmth melts ice in valleys and strengthens riverbanks to stop erosion, so too does Zhang Zhongjing's formula work. Other organs discuss Wind-Cold then dying pulses; this section omits them because Cold striking the Shaoyin directly was detailed elsewhere.
Article 17 A dying Pulse of the Kidney is hard on light palpation; on deep palpation, it feels chaotic like a rolling pill, descending into the Chi position, indicating death.
All things become soft with Yang fire, as seen in steamed pastes and cakes. Hardness on light palpation indicates Water frozen without Yang. Chaos like a rolling pill on deep palpation indicates hardness remaining, with no coming or going, round and rolling shape, similar to the Spleen's inverted cup but smaller. Unlike the Spleen which shakes laterally ("Yao"), this rolls vertically ("Luan", "Zhuan"). This indicates water bubbles rising and water Qi scattering at the base. Descending into Chi means Qi is exhausted and cannot extend far, having a tendency to dissipate locally, hence death. Dying pulses of other organs discuss both Yin and Yang; the Kidney discusses only Yang exhaustion because the Kidney is a Cold-Water organ where Yang Qi is particularly precious.
Article 18 Question: In the chapter on Exhaustion of the Three Jiaos, why does Upper Jiao exhaustion lead to belching? Master says: The Upper Jiao receives Qi from the Middle Jiao. If unharmonized, it cannot digest grains, leading to belching. Lower Jiao exhaustion leads to urinary incontinence or fecal loss. Due to Qi disharmony, self-control is lost. No treatment is needed; it will heal after time.
"Exhaustion" (Jie) does not mean complete depletion, but temporary deficiency. This is evident from "unharmonized" and "no treatment needed." Belching (Yi) is eructation. The chapter title "Exhaustion of the Three Jiaos" is likely from ancient medical classics, used by Changsha (Zhang Zhongjing) for dialogue to reveal profound truths. Belching originates from Spleen and Stomach (Middle Jiao), yet is attributed to Upper Jiao. Although digestion occurs in the Middle Jiao via Spleen-Stomach transformation, it is completed by the steaming and covering action of the Upper Jiao. Defecation/urination in the Lower Jiao relies on Spleen-Stomach lifting, but is finalized by the opening and closing mechanisms of the Lower Jiao. Thus, the misty Qi of the Upper Jiao, though derived from Middle Jiao transformation, aids digestion by descending heat. Like the sun gathering light to illuminate all, or a ruler governing subjects. If this Qi is temporarily deficient and unharmonized, it fails to assist digestion, causing grain stagnation in the Stomach. Stagnant grain rots, generating foul Qi that harasses the Heart Master, causing belching. The Stomach ferments food into pure, warm, light Qi, which ascends via Spleen and Lung to the chest, pleasing the Upper Jiao. If grain stagnates and fails to transform, turbid Qi rises directly from the stomach, offending the pure mind, causing belching. Regarding the Lower Jiao receiving Middle Jiao Qi to assist lifting, the principle is the same. Temporary Lower Jiao deficiency causes incontinence. This is not solely blamed on the Middle Jiao but on the lack of harmony between Lower and Middle/Upper Jiao Qi. "Control" involves holding and releasing. Failure to hold resembles urgent tenesmus; failure to release implies poor transmission. "No treatment needed" applies to both Upper and Lower Jiao. Upper Jiao disharmony arises from fright or anger; Lower Jiao disharmony from diarrhea or hot strangury. Both are common; over time, Middle Jiao Qi distributes, restoring harmony. Hence, it heals spontaneously.
Article 19 Master says: Heat in the Upper Jiao causes cough leading to Lung萎 (Fei Wei / Lung Flaccidity). Heat in the Middle Jiao causes hard stool. Heat in the Lower Jiao causes hematuria and strangury/obstruction. Cold in the Large Intestine causes loose stools; Heat causes intestinal mucus. Cold in the Small Intestine causes bearing-down sensation and bloody stool; Heat causes hemorrhoids. From the beginning to the dying pulse of the Kidney, Five Zang diseases are discussed. From the previous article to this, Six Fu diseases are discussed. Discussing Six Fu highlights the Three Jiaos because although the Three Jiaos is one of the Six Fu, the other five are subordinate to it. Upper Jiao like mist refers to Qi between Heart/Lung and diaphragm, including the Qimotore. Yangming Stomach and Shaoyang Gallbladder upper parts pierce the diaphragm into the Upper Jiao. Similarly for Middle and Lower Jiao. This illustrates using Three Jiaos to encompass Six Fu. Only Large and Small Intestines are singled out in Lower Jiao because their diseases were discussed elsewhere in *Cold Damage* and *Essential Prescriptions*, so they are detailed here. The previous article discussed mild Three Jiao exhaustion; this one discusses severe Three Jiao Cold-Heat. No dying pulses are mentioned because diseases entering Zang die, while those entering Fu recover. Heat in Upper Jiao irritates clear vessels, causing cough; chronic cough leads to Lung Flaccidity. Heat in Middle Jiao dries Spleen-Stomach fluids, causing constipation. Heat in Lower Jiao damages Bladder blood, mixing with urine (hematuria); if Qi is damaged, heat cooks fluids into gravel-like strangury or blocks flow completely. Cold in Large Intestine prevents drying of waste, causing watery diarrhea (duck-like stool). Heat causes excessive drying, scraping intestinal mucus (white pus-like substance). Cold in Small Intestine causes bearing-down and bloody stool because healthy Qi lifts sequentially (Zong Qi lifts Spleen/Stomach, which lifts Small Intestine, which lifts Large Intestine). Small Intestine Cold fails to lift, causing Large Intestine Qi to sink. Qi commands Blood; without ascent, Blood descends. Heat in Small Intestine can cause strangury or transmit heat to Large Intestine, forming hemorrhoids at the anus (end of Large Intestine). Thus, Six Fu manifestations are unified under the Three Jiaos.
Article 20 Question: What are Accumulation (Ji), Gathering (Ju), and Ben Qi (Rushing Qi)? Master says: Accumulation is a Zang disease, fixed and immovable. Gathering is a Fu disease, intermittent with migrating pain, treatable. Ben Qi causes hypochondriac pain relieved by pressure, recurring later. General rule for Accumulation: Pulse is fine and adherent to bone. At Cun Kou, accumulation is in the chest; slightly above Cun Kou, in the throat; at Guan, beside the umbilicus; above Guan, below the heart; slightly below Guan, in the lower abdomen; at Chi, at Qichong. Left pulse indicates left accumulation; right pulse indicates right accumulation; bilateral pulse indicates central accumulation. Diagnose based on location.
Accumulation implies long-standing stagnation; Gathering implies temporary aggregation. Both result from Yin fluids settling in Zang-Fu due to Yang deficiency and Cold Qi preventing movement. Ben Qi is Grain Qi from overeating or undigested food causing Stomach fullness, overflowing via Stomach collaterals to the hypochondrium. All three cause pain and are similar but distinct. Accumulation is Zang disease; Zangs store essence permanently, so Accumulations are fixed. Gathering is Fu disease; Fus store and release Qi, so Gatherings are intermittent and migratory. Intermittency suggests Yang can still rise; migration suggests pathogen shifting. Treating with acrid-sweet and attacking methods can disperse Gatherings. Unlike Accumulations where pathogen and healthy Qi struggle without gap, Gatherings are treatable. Implied: Accumulations are untreatable. Stomach collaterals connect to hypochondrium; Ben Qi overflow causes stabbing/distending pain. Pressure returns Qi to Stomach, relieving pain. Recurrence happens after pressure stops. Untreated because reducing food resolves it. Article 21 discusses pulses for Five Zang Accumulations and Accumulations in Mu-Yuan and internal collaterals. All Accumulations are Yin-dominant/Yang-absent, with sinking Yin fluids. Pulses are fine (no Yang), deep (Zang), and hidden (sinking Yin). Fine/deep/adherent-to-bone pulse indicates Accumulation. Cun Kou: Chest (Heart/Lung). Above Cun Kou: Throat (collaterals). Guan: Beside umbilicus (Liver/Spleen). Above Guan: Below heart (collaterals). Below Guan: Lower abdomen (Liver/Kidney). Chi: Qichong (Stomach Meridian, near pubic hairline). Left pulse: Left accumulation; Right pulse: Right accumulation. Bilateral: Central collateral/Mu-Yuan. Same logic applies to Guan and Chi variations. Since Zang systems and collaterals can harbor Accumulations, diagnosis follows Zang Accumulation rules. Some ask why only Accumulation pulse is given, not Gathering or Ben Qi. Ben Qi is mild, resolving with diet change, so no pulse needed. I have observed Ben Qi pulse: Ping at Cun/Chi, Shi-Hua at Guan (Right), Xian-Xi-Se at Guan (Left). Gathering pulse is implied within Accumulation pulse; discerning readers will realize it. General rule for Gathering: Fine pulse, neither floating nor deep. The following nineteen sentences replace Accumulation with Gathering and Zang with Fu, showing Three Jiao locations and Fu pathways mirror Accumulation patterns clearly.