（凡十七条）
夫人禀五常。因风气而生长。风气虽能生万物。亦能害万物。如水能浮舟。亦能覆舟。若五
脏元真通畅。人即安和。客气邪风。中人多死。千般疚难。不越三条。一者经络受邪。入脏腑。为
内所因也。二者四肢九窍。血脉相传。壅塞不通。为外皮肤所中也。三者房室金刃。虫兽所伤。
以此详之。病由都尽。若人能养慎。不令邪风干忤经络。适中经络。未流传脏腑。即医治之。四
肢才觉重滞。即导引、吐纳、针、灸、膏、摩。勿令九窍闭塞。更能无犯王法。禽兽灾伤。房室
勿令竭乏。服食节其冷热。苦酸辛甘。不遣形体有衰。病则无由入其腠理。腠者。是三焦通会元
真之处。为血气所注。理者。是皮肤脏腑之纹理也。（旧本俱列本篇第二条。余玩其文义。确是
开章语气。且有内外因。及不内不外之病由。然后有上工之问。并启色脉诊法。如后文所云。故
特僭移于篇首焉。）
五常。即五行。其名本内经五常政论来。东方生气。动而为风。人禀东方之生气而生。故曰
因风生长。风又为六淫之首。百病之长。故曰亦能害生。生害而广言万物者。见人在万物之中而
不可逃也。观于浮舟覆舟之水。其理益可信矣。元真者。五脏之元阳真气也。此句为养生治病之
要。学人当吃紧着眼。盖元真通畅。卫气自固。经络自不受邪。岂能入脏腑。是无脏腑之内因。
又元真通畅。而神机流贯。四肢九窍。血脉不致壅塞。是
无皮肤之外因。言欲避风气之害。惟有珍重元真。养生者可以保其不病。治病者可以救其已病。
不特为后文二十五篇之纲。亦且为本篇一十七条之大纲也。客气。谓五常政、六微旨中加临之
气。邪风。谓天地虚邪之风也。二句仍合内外因而言。犹言不知珍重元真。则内气不充于外。
外邪深入于内。而必死矣。直者为经。横者为络。经络外通皮毛。内通脏腑。脏腑之元真不充。中
邪。必致入脏。故曰内因。手、足为四肢。耳、目、口、鼻以及二阴、为九窍。俱以元真通
畅。而使血脉相传。倘血脉壅塞。则是外邪中之。遂使元真不贯。故曰皮肤所中。是不言外因。
而实为外因可知。房室、女色也。金刃、非杀戮之谓。如古之宫腐、刖足者是。玩下文病由字自
见。虫兽、指爪牙角毒而言也。言除却脏腑元真之气不充。血脉元真之气不贯。惟有如此。则成
不内不外病由。故曰不越三条也。今就内因而言。上之养元真。慎起卧。使邪不干经络。次之虽
已受邪。预为医治。使之不流脏腑。就外因而言。受邪必由四肢而渐至九窍。才觉重滞。或摇动
为导引。以利其机。或呼吸为吐纳。以清其气。或针以出其血。或灸以壮其火。或膏药以活其凝
聚。或按摩以散其郁结。邪去气行。九窍焉得闭塞哉。治内外因者如此。王法即上文金刃而广之。
如鞭朴笞杖之类。禽兽。即虫兽。如今之云、广。所谓孔雀粪能致瘴者皆是。灾伤、指坠溺种种
也。言不内不外之因。虽曰天数。亦可谨慎。故曰更能。若房室嗜欲之多寡。衣服饮食之冷热。
五味之于形体。虽各有所喜。亦各有所恶。偏好、则偏衰者。理也。并能慎之。则病由安得入其
腠理乎。语气已完。后二句。又就腠理而自释其义耳。皮肉之窈冥虚空为腠。五脏之元真。各自
开门。由其本经而出于皮肉之窈冥虚空。又三焦之阳。亦各从上中下。而氤氲于此。故曰通会之
处。夫气之所注。血即随之。故
为血气之所注也。理者。皮肤之纹。与肉轮并其丝绺相应者。自然皆从本脏腑之形质化出。故曰。
皮肤、脏腑之纹理也。
问曰。上工治未病。何也。师曰。夫治未病者。见肝之病。知肝传脾。当先实脾。四季脾王
不受邪。即勿补之。中工不晓相传。见肝之病。不解实脾。惟治肝也。夫肝之病。补用酸。助用
焦苦。益用甘味之药调之。酸入肝。焦苦入心。甘入脾。脾能伤肾。肾气微弱。则水不行。水不行。
则心火气盛。则伤肺。肺被伤。则金气不行。金气不行。则肝气盛。则肝自愈。此治肝补脾之要
妙也。肝虚则用此法。实则不在用之。经曰。虚虚实实。补不足。损有余。是其义也。余脏仿此。
（旧本属第一条、今交互移于此。）
承上文言内外因。及不内外因之病由。凡后文二十四篇之证。俱宜如此治未病之法也。言一肝。而其余脏
腑之补法可类推矣。故曰余脏仿此。言一补肝。而其余脏腑之泻法。又可反悟矣。故曰补不足。损有余。上工
治未病。上古医经之文。仲景特借为问答以发论耳。见肝之病者。如经所云平旦慧。下晡甚。夜半静。又目
无所见。耳无所闻。善恐。如人将捕之之类。是肝气已虚。势必挟其虚木之气。以凌脾土。将来脾必受病。法
当实脾。以治脾之未病也。土寄王于四时之季月。人之脏气。与天时相应。逢季月。则脾气王而足以自持。故
不用此例。中下之工不知。故知之者为上工也。答语已完。此下十九句。又就实脾而自申其奥耳。肝实、如两
胁下痛引少腹。或满。善怒。及惊。气逆。则头痛员员。耳聋等类。肝虚二句。与四季脾王三句同意。上文言王月
即不可补。此言肝实。断不宜补。否则、违虚虚实实之经旨。而非补不足、损有余之义矣。按素问五味之于
五脏。顺之者为泻。逆之者为补。仲景以酸补肝。以苦助心。以甘益脾。是以顺之者为补。而与经旨相背矣。不
知内经以逆为补。补其脏中之神志。仲景以顺为补。补其脏中之气血也。即以木论。木性之所喜者。阳和雨
露耳。投其所喜。则气畅津荣。然而花叶外蕃。则精华之内蕴者鲜矣。又木之所畏者。阴寒霜雪耳。克以所畏。
则枝柯虽暂为凋谢。而根株之神自全。此大圣大贤之妙用。学人分别遵行可也。
问曰。病有气色见于面部。愿闻其说。师曰。鼻头色青。腹中痛。苦冷者死。鼻头色微黑者。有水气。色黄者。胸
上有寒。色白者。亡血也。设微赤非时者死。其目正圆者 不治。又色青为痛。色黑为劳。色赤为风。色黄者便难。色
鲜明者。有留饮。
此及下五条。俱暗承前条。言欲治未病。何以审知五脏之本病。而且先实其所胜也。是非望色、闻声、切脉、不
可。故又设为问答而言曰。鼻头为面王。于内属中土。望色者最为要紧。色青。是木凌土位。鼻为腹。又下文曰
青为痛。故知其腹中痛也。所赖阳气燠土。生金子以制木鬼。则青色可退。腹痛可愈。若更苦冷。则卫阳衰败。
命门之阳可知不能复温。故主死。黑为北方水色。鼻头微黑。是水反乘土。故主有水气。土气凭肺德而氤氲
于胸中。以为宗气。则脾胃之气舒展。胸上有寒。则阻扼土气。不能上布。而郁于中宫。亦遂于本位上现其本
色。故色黄者。知胸上有寒也。脾胃为后天精悍之原。夭然色白。故知亡血。而生机不荣也。非其时。兼秋冬而
言。微赤为火气。凌金焦土。其死于所不胜之春夏乎。若微赤而且目正圆者。微赤为土无津液。目正圆为肝
肾枯燥。夫精汁短少而得风热者。则病 。 病在经。宜开玄府以发散。在腑。宜驱胃实以攻下。鼻微赤而目
正圆者。两皆不可。故曰不治。痛、则阳气不通。而阴寒切责。故色青应之。劳、则神气虚耗。而精气外薄。故色黑
应之。风为阳邪。气从上炎。且能化热。故于色赤者。知其中风也。脾胃之气不下通。则火土之光外浮。故于色
黄者。知其便难也。此句。与胸上有寒句。同义。盖中焦之气。总以上舒下畅为运化之妙。上不舒。固现黄色。下
不畅。亦现黄色。合而详之。则庶几矣。留饮与水不同。水、为积聚之外水。饮、则膈中之液。或因风寒湿热所成。
而不能流行者。是也。然留饮久必成热。故色则红白鲜明者。水火之兼色耳。以上俱跟鼻头而言。推而广之。
则自庭与阙上。以及阙中下极等处。各可类诊矣。此望而知之之上工也。
师曰。病患语声寂然。喜惊呼者。骨节间病。语声 然。不彻者。心膈间病。语声啾啾然。细而长者。头中病。
成文为语。不成文为声。寂然者。久而不闻也。惊呼。忽然如受惊而呼叫之状。盖骨属少阴肾脏。节者。神气游
行出入之所。少阴性沉。故病则喜寐。语声寂然。喜寐之应。故知其病在骨也。神气者。火也。忽然惊呼者。是游
行出入之火。有以致其忽然疼痛。故知其病在骨之节也。 、不明之象。不彻者。呻吟才出而即回。犹言不
透彻也。夫病患痛楚。声唤以开泄其气者。心为之主令也。今 不彻。是心膈有剥肤之痛。而不暇声唤。故
中道而自废耳。啾啾、尖浮之义。加之声出细长。是从下而上托其疾苦之象。故知其头中痛也。明以寂然之
突呼。言肾家之下部。以 不彻之短声。言心膈之中部。以尖而浮细之长声。言头中之上部。由此推之。夫
亦可从五音之阴阳凌替。而神会其脏腑之玄机矣。此闻而知之之上工也。
师曰。息摇肩者。心中坚。息引胸中上气者。咳。息张口、短气者。肺痿。吐沫。
息、兼呼吸而言。息之吸气。从口鼻而入。先由肺管。而遍历肺叶之小窍。复还胸中。而下历肝肾。以应命门之
伏机。伏机者。真息之吸也。命门之伏机鼓还。则息之吸气。乃应鼓动之机。而送出为呼气。呼气由胸中而历
肺窍者亦如之。命门伏机之鼓还者。真息之呼也。然必胸中之阳气充满。则如晴明太空。高远无暨。而息道
裕如矣。倘胸中之阳气亏损。而下焦肝肾之阴气上乘。则心下痞塞甚而心中遂坚息摇肩者。气道狭而气
机滞。假摇动以行之也。故知之。心中非有形之物可坚。旧注谓邪实。误甚。息引胸中上气。谓气粗而有声也。
肺性喜温喜燥。肝肾中有寒湿之气上冲者。则肺管不清。而气粗有声矣。肺管不清。故知其必咳也。肺为呼
吸之门户。门户坚固。则出入细而长且远矣。今张口短气。是肺无关锁之权。譬之吹竹筒者。窍大则吹短。故
知肺痿而不为息道用也。肺得干温之养。而展布之化始成。然后行其津液于脏腑。今肺痿。故并知其津液
上浮而吐涎沫也。
师曰。吸而微数。其病在中焦。实也。当下之。即愈。虚者不治。在上焦者。其吸促。在下焦者。其吸远。
此皆难治。呼吸动摇振振者。不治。
中焦胃腑。为息道之所经。呼不数。则鼓动之真呼无病。且无摇肩上气等候。则肺与肝肾又无病。而吸独微
数。是吸为中焦所经之胃腑。热入而不容下引之故。故知下之而愈。盖胃实去。而气机相安于下引也。虚者。
即指胃不实而言。吸微数而胃不实。是命门鼓伏之机。伏气偏短。元阴大损之诊。故不治也。上焦吸促。谓呼
长于吸。伏机不能引气归根。下焦吸远。谓吸长于呼。鼓力不能载气报息。挽回上绝下脱之候。十中不得二
三。故曰皆难治。呼吸动摇至振振者。经所谓以肩息者死。喘而其动应衣者死。故不治。此与上条。又合言望
闻二诊。以为上工也。但上条兼言呼吸之病在上焦者皆生。此条单言吸气之病在中焦者易愈。吸气之单
病在上下二焦者多死。呼吸之兼病在上下二焦者。万不得生也。
师曰。寸口脉动者。因其王时而动。假令肝王色青。四时各随其色。肝色青而反色白。非其时色脉。皆当病。
此言色脉之互词也。先言脉以互色。次言色以互脉。故结则合言色脉也。寸口。指手太阴之三部而言。动、非
动摇之谓。指春弦、夏钩、秋浮、冬营、因时而变动之义。寸口脉动。古医经之文。仲景解之曰。寸口脉之变动。各
有其时。上工因其王时。而察其变动之色脉。则病情见矣。夫色与脉之变动相同。言色而脉即可概见。假如
春月。肝木气王。色宜青如翠羽。如苍璧之泽。如以缟裹绛。并其脉之变动。宜应青而弦。弦者。濡弱、轻虚、而滑。
端直、以长也。春肝之色脉如此。推而至于夏月。心火气王。色宜赤如鸡冠。如以缟裹朱。并其脉之变动。宜应
赤而钩。钩者、来盛去衰也。秋月肺金气王。色宜白如豕膏。如鹅羽。如以缟裹红。并其脉之变动。宜应白而浮。
浮者。来急去散也。冬月肾水气王。色宜黑如乌羽。如重漆色。如以缟裹紫。并其脉之变动。宜应黑而营。营者。
沉以搏也。四季之月脾土气王。色宜黄如蟹腹。如罗裹雄黄。如以缟裹栝蒌实。并其脉之变动。和柔相离。如
鸡践地。又难经曰。太阴之至。紧大而长也。此谓四时各随其色脉而无病。若肝色宜青而反白。白、金色也。是
木当王时。而犹受金之克。则木至休囚。而肝必病。甚且至所不胜之时。而必死于秋令矣。三时仿此。但此句、
单言色也。其动脉又可类推矣。比如肝之动宜弦。而反得浮脉。其理一也。非其时色脉句。又合色脉而推展
之。不但春不得青者。为肝病。青不及春者。为脾病。而且不如翠羽苍璧者。为本脏之血病。不如缟裹绛者。为
本脏之气病。甚至青侵他部位者。即以各脏腑之病断之。盖非其地与非其时同诊也。又如濡弱轻虚而滑。
(Seventeen clauses in total)
Humans are endowed with the constant principles of the Five Elements (Wu Xing, Wood, Fire, Earth, Metal, Water), and grow relying on wind and Qi. Although wind and Qi can generate all things, they can also harm all things, just as water can float a boat but also capsize it. If the primal true Qi (Yuan Zhen, the original vital energy) of the five Zang organs is unobstructed, the person will be peaceful and harmonious; if attacked by pathogenic wind (Xie Feng, evil winds from outside), death often ensues. The thousands of diseases and myriad hardships do not exceed three categories: First, when meridians and collaterals receive pathogenic factors which then enter the Zang organs, this is considered an internal cause. Second, when the four limbs and nine orifices undergo transmission through blood vessels, leading to obstruction and blockage, this is caused by external pathogens attacking the skin. Third, injuries caused by sexual excess, metal blades, insect bites, or animal attacks. By examining these in detail, the origins of disease are fully understood. If one can cultivate caution, preventing pathogenic wind from interfering with the meridians, and immediately treats the condition when pathogens have just entered the meridians but have not yet spread to the Zang organs; if the four limbs feel heavy and stagnant, one should employ Daoyin (qigong exercises), Tunai (breathing techniques), acupuncture, moxibustion, herbal plasters, and massage, ensuring the nine orifices do not become blocked. Furthermore, one must avoid violating laws, prevent disasters from beasts, ensure sexual activity does not lead to exhaustion, regulate diet regarding temperature and the five flavors (Bitter, Sour, Pungent, Sweet), and prevent physical decline, so that pathogens cannot enter the Couli (interstitial spaces between skin and flesh). Couli refers to the places where the San Jiao (Triple Burner) connects and distributes the primal true Qi, where blood and Qi are infused. Li refers to the textures of the skin and Zang organs. (In older editions, this passage was listed as the second clause of this chapter. After studying its meaning, I find it clearly serves as an introductory tone, discussing internal, external, and neither-internal-nor-external causes, followed by the inquiry into the "Superior Physician treating disease before it arises," and initiating methods of inspection and pulse diagnosis as mentioned later. Therefore, I have presumptuously moved it to the beginning of the chapter.)
The "Five Constants" refer to the Five Elements, a term originating from the *Nei Jing* (Inner Canon), specifically the chapter "Wu Chang Zheng Da Lun." The East governs the generating Qi, moving as wind. Humans are born receiving the generating Qi of the East, hence it is said "growing due to wind." Wind is also the head of the Six Excesses (Liu Yin, pathogenic factors) and the leader of a hundred diseases, hence it is said "it can also harm life." The broad discussion of generation and harm regarding all things is because humans are among all things and cannot escape this law. Observing water floating and capsizing boats makes this principle even more credible. Yuan Zhen refers to the primal Yang true Qi of the five Zang organs. This sentence is the key to health preservation and disease treatment; students should pay close attention. Because Yuan Zhen is unobstructed, Wei Qi (Defensive Qi) naturally consolidates, and meridians naturally resist pathogens, so how can pathogens enter the Zang organs? This means there is no internal cause within the Zang organs. Additionally, if Yuan Zhen is unobstructed and Shen Ji (Spiritual Mechanism) flows throughout, the blood vessels of the four limbs and nine orifices will not become obstructed, meaning there is no external cause on the skin. To avoid the harm of wind, one must only value Yuan Zhen. Those preserving health can use this to remain disease-free, and those treating disease can use it to cure existing illness. This serves not only as the outline for the subsequent twenty-five chapters but also as the main outline for the seventeen clauses of this chapter. Ke Qi (Guest Qi) refers to the transient Qi described in "Wu Chang Zheng Da Lun" and "Liu Wei Zhi Da Lun." Xie Feng (Pathogenic Wind) refers to the empty and evil winds of heaven and earth. These two sentences still combine internal and external causes. It means if one does not value Yuan Zhen, internal Qi will not fill the exterior, and external pathogens will penetrate deeply inward, inevitably leading to death. Straight channels are Jing Meridians, horizontal ones are Luo Collaterals. Meridians and collaterals connect externally to the skin and hair follicles and internally to the Zang organs. If the Yuan Zhen of the Zang organs is insufficient and one is struck by pathogens, it will inevitably lead to pathogens entering the Zang, hence called an internal cause. Hands and feet are the four limbs; ears, eyes, mouth, nose, and the two lower orifices are the nine orifices. All rely on the unobstruction of Yuan Zhen to allow blood vessels to transmit. If blood vessels become obstructed, it is due to external pathogens striking, causing Yuan Zhen to fail to circulate. Hence, it is said to be struck by the skin. Although it does not explicitly say "external cause," it is indeed an external cause, as can be known. Fang Shi (House and Chamber) refers to sexual intercourse; Jin Ren (Metal and Blade) does not refer to killing but rather to ancient punishments like castration or amputation; observing the phrase "origin of disease" in the following text makes this clear. Chong Shou (Insects and Beasts) refers to venom from claws, teeth, and horns. It means except for the insufficiency of Yuan Zhen Qi in the Zang organs and the lack of circulation in the blood vessel Yuan Zhen Qi, there are only these situations, forming causes that are neither internal nor external, hence "not exceeding three categories." Now, considering the internal cause: above, one must nourish Yuan Zhen and be cautious with sleep and waking so that pathogens do not interfere with the meridians; next, even if already affected by pathogens, treat them in advance so they do not flow into the Zang organs. Considering the external cause: contracting pathogens must start from the four limbs and gradually reach the nine orifices. Once feeling heavy and stagnant, or shaking, one performs Daoyin to facilitate joint movement; or adjusts breathing for Tunai to clear Qi; or uses acupuncture to expel blood stasis; or moxibustion to strengthen fire/Yang; or herbal plasters to activate凝固 (coagulation/stagnation); or massage to dissipate depression. Once pathogens are removed and Qi moves, how could the nine orifices be blocked? Treating internal and external causes is done thus. Wang Fa (Royal Law) expands upon the aforementioned metal blades, such as whipping and beating; Qin Shou (Birds and Beasts) refers to insects and beasts, such as peacock feces causing miasma today; Zai Shang (Disaster Injury) refers to falling, drowning, etc. Regarding causes that are neither internal nor external, although they may be fate, one can still be cautious, hence "furthermore." As for the quantity of sexual desires and the temperature of clothes and food, the five flavors have preferences and aversions for the body; preference leads to partial deficiency, which is natural. If one is cautious about all these, how can pathogens enter the Couli? The tone here concludes, and the last two sentences explain the meaning of Couli itself. The deep hollow spaces between skin and flesh are Couli. The Yuan Zhen of the five Zang organs opens its own doors, emerging from their respective meridians into the deep hollow spaces of the skin and flesh. Additionally, the Yang of the San Jiao also yun-chen (condenses and spreads) here from the Upper, Middle, and Lower Burners, hence it is called the place of connection and distribution. Where Qi is infused, Blood follows, hence it is called the place where Blood and Qi are infused. Li refers to the patterns of the skin, corresponding to the contours of the muscle and their fibers, naturally transforming from the substance of the respective Zang organs, hence it is said: "The texture of the skin and Zang organs."
Question: What does it mean for a superior physician to treat disease before it arises?
Master said: Treating disease before it arises means seeing liver disease, knowing that liver disease transmits to the spleen, and therefore first strengthening the spleen. When the spleen is prosperous in the four seasons and does not accept pathogens, do not tonify it. Average physicians do not understand this transmission; seeing liver disease, they do not know to strengthen the spleen and only treat the liver. In treating liver disease, tonification uses sour herbs, assistance uses scorched bitter herbs, and benefit uses sweet herbs to regulate. Sour enters the liver, scorched bitter enters the heart, and sweet enters the spleen. The spleen can control the kidney. If kidney Qi is weak, water does not move. If water does not move, heart fire becomes abundant. If heart fire is abundant, it damages the lung. If the lung is damaged, metal Qi does not move. If metal Qi does not move, liver Qi becomes abundant, and the liver heals itself. This is the subtlety of treating liver disease by tonifying the spleen. This method is used for liver deficiency, not for liver excess. The Classic says: "Do not make deficiency more deficient or excess more excess"; tonify what is insufficient, reduce what is excessive. This is the meaning. Other organs follow this example.
Continuing from the previous text regarding internal, external, and neither-internal-nor-external causes, the syndromes in the subsequent twenty-four chapters should all be treated using this method of "treating disease before it arises." Mentioning one liver allows the tonification methods for other Zang organs to be inferred, hence "other organs follow this example." Mentioning one tonification of the liver allows the purgation methods for other Zang organs to be deduced inversely, hence "tonify the insufficient, reduce the excessive." "Treating disease before it arises" is a phrase from ancient medical classics; Zhang Zhongjing borrowed it for dialogue to initiate his discussion. Seeing liver disease, as the Classic states, "clear at dawn, severe in late afternoon, quiet at midnight," and "eyes see nothing, ears hear nothing, prone to fear, as if being hunted," indicates liver Qi is already deficient. It will inevitably carry its deficient Wood Qi to bully Spleen Earth, and the spleen will surely become diseased. The method should be to strengthen the spleen to treat the spleen's pre-disease state. Earth prospers in the seasonal months of the four seasons; human organ Qi corresponds to heavenly timing. During seasonal months, spleen Qi is prosperous and self-sufficient, so this rule does not apply. Average and inferior physicians do not know this, so those who know are called superior physicians. The answer is complete. The following nineteen sentences further elaborate on the profundity of strengthening the spleen. Liver excess includes pain in the hypochondrium radiating to the lower abdomen, fullness, irritability,惊 (fright), Qi rebellion causing dizziness, deafness, etc. The two sentences on liver deficiency agree with the three sentences on spleen prosperity in the four seasons. The previous text said not to tonify during prosperous months; here it says liver excess definitely should not be tonified, otherwise violating the classic principle of "making deficiency more deficient," failing the meaning of "tonifying the insufficient, reducing the excessive." According to *Su Wen*, regarding the five flavors and five Zang organs, following nature is purgation, opposing nature is tonification. Zhang Zhongjing considers sour tonifying the liver, bitter assisting the heart, and sweet benefiting the spleen, taking "following nature" as tonification, which contradicts the classic. However, the *Nei Jing* takes opposing nature as tonification, tonifying the spirit/mind of the Zang; Zhang Zhongjing takes following nature as tonification, tonifying the Qi and Blood of the Zang. Taking Wood as an example, Wood likes warm rain and dew. Giving it what it likes makes Qi smooth and fluids abundant, but flowers and leaves flourish externally while essence remains internally scarce. Wood fears cold frost and snow. Using what it fears to control it causes branches to wither temporarily but preserves the spirit of the roots. This is the profound application of sages; students should distinguish and practice accordingly.
Question: Pathological colors appear on the face; I wish to hear your explanation.
Master said: If the tip of the nose is blue/green, there is abdominal pain; if accompanied by aversion to cold, it is fatal. If the tip of the nose is slightly black, there is fluid retention (Shui Qi). If yellow, there is cold in the chest. If white, there is loss of blood. If slightly red and out of season, it is fatal. If the eyes are fixed straight open, it is untreatable. Also, green color indicates pain, black indicates劳 (consumption/overwork), red indicates wind, yellow indicates difficulty defecating, and bright/shiny color indicates retained fluid (Liu Yin).
These five clauses and the following ones implicitly continue the previous point: to treat disease before it arises, one must ascertain the root disease of the five Zang organs and first strengthen the controlling organ. This requires inspection, listening/smelling, and palpation, so a Q&A format is used. The nose tip is the "King of the Face," corresponding internally to Central Earth; inspection of color is crucial. Green color indicates Wood bullying Earth. The nose corresponds to the abdomen, and the text below says green indicates pain, so abdominal pain is known. Relying on Yang Qi to warm Earth and generate Metal to control Wood Ghost, the green color recedes and abdominal pain heals. If accompanied by aversion to cold, Wei Yang has collapsed, and Ming Men (Gate of Life) Yang cannot recover, hence fatal. Black is the color of Northern Water. Slightly black nose tip indicates Water counter-attacking Earth, hence fluid retention. Earth Qi relies on Lung Virtue to condense in the chest as Zong Qi (Gathering Qi), allowing Spleen/Stomach Qi to expand. Cold in the chest obstructs Earth Qi, preventing upward distribution, causing stagnation in the Center Palace, revealing its true color. Thus, yellow color indicates cold in the chest. Spleen/Stomach is the source of post-heaven refined Qi, naturally white; thus, white indicates loss of blood and lack of vitality. "Out of season" refers to autumn/winter. Slight red indicates Fire Qi bullying Metal and scorching Earth; death occurs in the season where it is overcome (Spring/Summer). If slight red and eyes fixed straight, slight red indicates Earth lacks fluids, and fixed eyes indicate Liver/Kidney dryness. Essence is scanty with wind-heat: if in meridians, open pores to disperse; if in fu organs, purge stomach excess. Nose slightly red with fixed eyes allows neither, hence untreatable. Pain blocks Yang Qi, Yin-Cold presses, so green corresponds. Consumption depletes Spirit/Qi, essence leaks outward, so black corresponds. Wind is Yang pathogen, Qi rises, generates heat, so red indicates wind strike. Spleen/Stomach Qi fails to descend, Fire/Earth light floats outward, so yellow indicates difficult defecation. This sentence shares meaning with "cold in the chest." Middle Jiao Qi operates best with upper expansion and lower smoothness. Upper stagnation shows yellow; lower blockage shows yellow. Combining them provides clarity. Retained fluid differs from water; water is accumulated external fluid, while retained fluid is liquid in the diaphragm, formed by wind-cold-damp-heat, unable to circulate. Long-standing retained fluid generates heat, so bright red-white color indicates mixed water-fire signs. All above relate to the nose tip; extending this, one can diagnose areas like Ting (forehead), Que Shang, Que Zhong, Xia Ji, etc. This is the superior physician who knows by inspection.
Master said: If a patient's voice is silent but suddenly cries out in fright, the disease is in the bone joints. If the voice is hoarse and not clear, the disease is in the heart and diaphragm. If the voice is chirping-like, thin and long, the disease is in the head.
Formed words are Yu, unformed sounds are Sheng. Silent means long-unheard. Sudden cry is like being startled. Bones belong to Shaoyin Kidney; joints are places where Shen Qi travels in and out. Shaoyin nature is sinking, so disease causes drowsiness; silent voice is the sign of drowsiness, indicating bone disease. Shen Qi is Fire. Sudden crying indicates traveling Fire causing sudden pain, indicating joint disease. Hoarse is unclear. Not clear means groaning stops quickly, i.e., not thorough. Patient pain calls out to vent Qi, governed by Heart. Hoarse/not clear means Heart/Diaphragm has severe pain, too exhausted to call out, stopping midway. Chirping implies sharp and floating. Thin and long sound lifts suffering from below, indicating head disease. Clearly, silent sudden cry indicates lower Kidney area; hoarse short sound indicates middle Heart/Diaphragm area; sharp floating long sound indicates upper Head area. From this, one can comprehend Zang-Fu mysteries through the yin-yang alternation of the five tones. This is the superior physician who knows by listening.
Master said: Breathing with shoulder movement indicates fullness in the chest. Breathing drawing Qi up to the chest indicates cough. Breathing with open mouth and shortness of breath indicates Lung萎 (Flaccidity), with spitting saliva.
Xi (Breath) includes both inhalation and exhalation. Inhalation enters via nose/mouth, passes through lung tubes, traverses lung alveoli, returns to chest, descends to Liver/Kidney, responding to the hidden mechanism of Ming Men. Hidden mechanism refers to true inhalation. Ming Men's hidden mechanism drives return, so inhalation responds to this driving force and sends out exhalation. Exhalation goes from chest through lung pores similarly. Ming Men's driving return is true exhalation. Chest Yang Qi must be full, like clear sky, high and boundless, making airways ample. If Chest Yang is deficient and Lower Jiao Liver/Kidney Yin ascends, Heart area becomes blocked and firm. Shoulder movement during breathing means airway is narrow and Qi mechanism stagnant, using movement to facilitate flow, hence known. "Heart" here does not mean a solid object; old notes saying "pathogenic excess" are very wrong. Drawing Qi up means rough breathing with sound. Lung likes warmth and dryness; if Cold-Damp from Liver/Kidney rushes up, lung tubes become unclear, causing rough breathing, hence cough. Lung is the portal of respiration; if firm, entry/exit is fine, long, and far. Open mouth/short breath means Lung lacks locking power; like blowing a bamboo tube, large hole means short blow, hence Lung Flaccidity and failure of airway function. Lung needs dry-warm nourishment to spread transformations and distribute fluids to Zang-Fu. Lung Flaccidity means fluids float up and spit saliva.
Master said: Slight and rapid inhalation indicates disease in Middle Jiao, excess pattern, requiring purgation for cure. Deficiency pattern is untreatable. In Upper Jiao, inhalation is hurried; in Lower Jiao, inhalation is distant/deep. All are difficult to treat. Body trembling during breathing is untreatable.
Middle Jiao Stomach is the pathway of breath. Normal exhalation means no disease in true exhalation, no shoulder movement or Qi rising, so Lung/Liver/Kidney are fine. Only slight rapid inhalation indicates heat entering the Stomach (pathway of inhalation), preventing downward guidance, hence purgation cures. Removing Stomach excess allows Qi mechanism to settle downward. Deficiency means Stomach is not excess. Slight rapid inhalation with non-excess Stomach indicates Ming Men's hidden mechanism is weak, Fu Qi is short, and Primordial Yin is greatly damaged, hence untreatable. Upper Jiao hurried inhalation means exhalation is longer than inhalation; hidden mechanism cannot guide Qi back to root. Lower Jiao distant inhalation means inhalation is longer than exhalation; driving force cannot carry Qi to return breath, reversing upper severance and lower collapse. Few survive, hence difficult. Trembling during breathing matches the Classic: "dying with shoulder breathing," "panting with clothes moving," hence untreatable. This combines with the previous clause on inspection/listening for superior physicians. Previous clause said respiratory disease in Upper Jiao lives; this clause says isolated inhalation disease in Middle Jiao is easy to cure. Isolated inhalation disease in Upper/Lower Jiao mostly dies. Combined respiratory disease in Upper/Lower Jiao rarely survives.
Master said: Cun Kou (Radial artery) pulsation moves according to its prosperous season. For example, Liver prosperous, color green; four seasons each follow their color. Liver color green but appearing white is color/pulse out of season, all indicating disease.
This discusses the mutual reference of color and pulse. Pulse referenced to color, then color to pulse, finally combined. Cun Kou refers to the three positions of Hand Taiyin. Movement here means seasonal variation: Spring String (Xian), Summer Hook (Gou), Autumn Float (Fu), Winter Sink (Ying). Ancient classics state Cun Kou pulsation varies by season; Zhang Zhongjing explains: Superior physicians observe color/pulse changes during prosperous seasons to see disease. Color and pulse changes correspond. Spring, Liver Wood prosperous, color should be green like kingfisher feathers, dark jade luster, wrapped silk over crimson. Pulse should be Green and String-like (soft, weak, light, void, slippery, straight, long). Summer, Heart Fire prosperous, color red like chicken comb, wrapped silk over vermilion. Pulse Red and Hook-like (strong arrival, weak departure). Autumn, Lung Metal prosperous, color white like pig fat, goose feather, wrapped silk over red. Pulse White and Floating-like (urgent arrival, scattered departure). Winter, Kidney Water prosperous, color black like crow feather, heavy lacquer, wrapped silk over purple. Pulse Black and Sink-like (deep and firm). Seasonal months, Spleen Earth prosperous, color yellow like crab belly, wrapped silk over realgar, wrapped silk over trichosanthes fruit. Pulse soft and distinct, like chicken walking on ground. *Nan Jing* says: Taiyin arrival is tight, large, and long. This describes four seasons' color/pulse without disease. If Liver color should be green but appears white (Metal color), Wood is prosperous but controlled by Metal, Wood becomes weak, Liver diseased, potentially dying in Autumn (Metal season). Other seasons similar. This sentence focuses on color; pulse movement can be inferred. E.g., Liver pulse should be String-like but appears Floating, same logic. "Color/pulse out of season" expands on both. Not green in Spring is Liver disease; green lacking Spring quality is Spleen disease. Not like kingfisher/jade is Blood disease of the organ; not like wrapped silk is Qi disease of the organ. Green invading other areas diagnoses respective Zang-Fu diseases. Diagnosing wrong place/time is similar. Like soft, weak, light, void, slippery...