邪在肺。则病皮肤痛。寒热。上气喘。汗出。咳动肩背。取之膺中外俞。背三节五脏之旁。以
手疾按之。快然乃刺之。取之缺盆中以越之。
此承上章复论邪在五脏而病于外也。夫六腑之应于皮肉筋骨者。脏腑雌雄之相合也。五脏之外
应者。阴阳之气。皆有出有入也。肺主皮毛。故邪在肺。则病皮肤痛。寒热者。皮寒热也。盖脏为
阴。皮肤为阳。表里之气。外内相乘。故为寒为热也。上气喘者。肺气逆也。汗出者。毛腠疏也。
咳动肩背者。咳急息肩。肺俞之在肩背也。膺中外俞。肺脉所出之中府云门处。背三节五脏之旁。
乃肺俞旁之魄户也。缺盆中者。手阳明经之扶突。盖从腑以越阴脏之邪。
邪在肝。则两胁中痛。寒中。恶血在内。行善掣节。时脚肿。取之行间。以引胁下。补三里以
温胃中。取血脉以散恶血。取耳间青脉以去其掣。
肝脉循于两胁。故邪在肝。则胁中痛。两阴交尽。是为厥阴。病则不能生阳。故为寒中。盖邪
在肝。胁中痛。乃病经脏之有形。寒中。病厥阴之气也。内、脉内也。行善掣节者。行则掣节而痛。
此恶血留于脉内。脉度循于骨节也。时脚肿者。厥阴之经气下逆也。当取足厥阴肝经之行间。以引
胁下之痛。补足阳明之三里。以温寒中。取血脉以散在内之恶血。耳间青脉。乃少阳之络。循于耳
之前后。入耳中。盖亦从腑阳以去其掣节。
邪在脾胃。则病肌肉痛。阳气有余。阴气不足。则热中善饥。阳气不足。阴气有余。则寒中。
肠鸣腹痛。阴阳俱有余。若俱不足。则有寒有热。皆调于三里。
脾胃主肌肉。故邪在脾胃则肌肉痛。脾乃阴中之至阴。胃为阳热之腑。故阳明从中见太阴之化。
则阴阳和平。雌雄相应。若阳气有余。阴气不足。则热中而消谷善饥。若阳气不足。阴气有余。则
寒中而肠鸣腹痛。阴阳俱有余者。邪病之有余。俱不足者。正气之不足。皆当调之三里而补泻之。
亦从腑而和脏也。
邪在肾。则病骨痛阴痹。阴痹者。按之而不得。腹胀腰痛。大便难。肩背颈项痛。时眩。取之
涌泉昆仑。视有血者尽取之。
在外者。筋骨为阴。病在阴者。名曰痹阴。痹者。病在骨也。按之而不得者。邪在骨髓也。腹
胀者。脏寒生满病也。腰者。肾之府也。肾开窍于二阴。大便难者。肾气不化也。肩背颈项痛。时
眩者。脏病而及于腑也。故当取足少阴之涌泉。足太阳之昆仑。视有血者尽取之。
邪在心。则病心痛喜悲。时眩仆。视有余不足。而调之其输也。
邪在心。邪薄于心之分也。喜为心志。心气病则虚。故喜悲。神气伤。故时眩仆。视有余不足。
而调其输也。按皮脉肉筋骨。五脏之外合也。邪在心而不病脉者。手厥阴心主包络主脉也。邪客篇
曰。心者。五脏六腑之大主也。精神之所舍也。其脏坚固。邪勿能容也。容之则伤心。伤心则神去。
神去则死矣。故诸邪在于心者。皆在于心之包络。包络者。心主之脉也。本输者。皆因其气之虚实
疾徐以取之。故邪在心。邪在于包络。心之分也。视
有余不足而调之者。因心气之虚实。而调之也。此邪薄于心之分。以致心气之有余不足。邪不在心。
故不外应于脉。
沈亮宸曰。邪干脏则死。非独伤于心也。曰邪在肺。邪在肝者。邪薄于五脏之分。病脏气而不伤
其脏真。故首言三节五脏之旁。以手疾按之。快然乃刺之。盖五脏之旁。乃五脏之气舍也。病在气。
当取之气。取之气。故以手按之则快然。曰三节。曰五脏之旁。俱宜体会。
When pathogenic factors invade the Lung, skin pain, aversion to cold with fever, dyspnea and wheezing, sweating, and coughing that pulls on the shoulder and back occur. Treatment should involve needling the acupoints in the middle of the chest exterior (Zhongfu [LU-1] and Yunmen [LU-2]) and the Po Hu (BL-48) located beside the Back-Shu points of the five Zang organs at the level of the third thoracic vertebra. The practitioner should press these points quickly with the hand; only when the patient feels a sense of relief and comfort should needling proceed. Additionally, points in the Supraclavicular Fossa (Quepen) can be selected to vent the Lung Qi and disperse pathogens.
This passage continues from the previous chapter, further discussing how pathogenic factors invading the five Zang organs manifest as external symptoms. The correspondence between the six Fu organs and the skin, flesh, sinews, and bones reflects the yin-yang pairing of zang-fu organs. The external manifestations of the five Zang organs demonstrate the entering and exiting of yin and yang qi. The Lung governs the skin and hair; therefore, when pathogens are in the Lung, skin pain occurs. Aversion to cold with fever represents "skin cold and heat." Since the Zang organs belong to yin and the skin belongs to yang, the interaction between interior and exterior qi leads to cold and heat sensations. Dyspnea and wheezing result from rebellious Lung Qi. Sweating occurs due to open pores and lax interstices. Coughing pulling on the shoulder and back happens because severe coughing causes rapid breathing requiring shoulder shrugging, and the Lung Shu points are located in the shoulder and back region. "Ying Zhong Wai Yu" refers to the origin points of the Lung Meridian, namely Zhongfu (LU-1) and Yunmen (LU-2). The area beside the Back-Shu points of the five Zang organs at the third thoracic vertebra is Po Hu (BL-48). The Supraclavicular Fossa corresponds to Futu (LI-18) of the Hand-Yangming Large Intestine Meridian. This illustrates the method of using Yang meridians (Fu organs) to vent pathogens from Yin Zang organs (Lung).
When pathogenic factors invade the Liver, pain in both hypochondriac regions, internal cold, retention of evil blood within, joint traction pain during movement, and occasional edema of the feet occur. Treatment involves selecting Xingjian (LR-2) of the Foot-Jueyin Liver Meridian to guide qi from the hypochondrium; tonifying Zusanli (ST-36) of the Foot-Yangming Stomach Meridian to warm the stomach interior; puncturing collateral vessels to dissipate evil blood; and selecting the blue veins behind the ear to relieve joint traction pain.
The Liver Meridian courses through the hypochondriac region; thus, when pathogens are in the Liver, hypochondriac pain occurs. The convergence of two yin meridians constitutes Jueyin. When diseased, it fails to generate yang qi, leading to internal cold. Hypochondriac pain caused by pathogens in the Liver represents pathological changes in the form of meridians and zang-fu organs, while internal cold relates to the qi aspect of Jueyin. "Nei" refers to inside the vessels. Joint traction pain during movement indicates that evil blood is retained within the vessels, which follow the bone joints according to vessel dimensions. Occasional foot edema results from the downward rebellion of Jueyin meridian qi. One should select Xingjian (LR-2) of the Foot-Jueyin Liver Meridian to drain pain in the hypochondrium; tonify Zusanli (ST-36) of the Foot-Yangming Stomach Meridian to warm internal cold; and puncture blood vessels to dissipate retained evil blood. The blue veins behind the ear belong to the Luo-connecting vessels of the Shaoyang Gallbladder Meridian, which course around the ear and enter it. This also demonstrates using Yang meridians (Fu organs) to remove joint traction pain.
When pathogenic factors invade the Spleen and Stomach, muscle pain occurs. If yang qi is excessive and yin qi is deficient, epigastric heat and frequent hunger arise. If yang qi is deficient and yin qi is excessive, internal cold, borborygmus, and abdominal pain occur. If both yin and yang are excessive, or if both are deficient, there will be both cold and heat syndromes. All these conditions should be regulated via Zusanli (ST-36).
The Spleen and Stomach govern the muscles; thus, pathogens in the Spleen and Stomach cause muscle pain. The Spleen is the ultimate yin within yin, and the Stomach is a yang-heat fu organ. Therefore, the Yangming Stomach Meridian transforms according to the Taiyin Spleen's transforming qi, achieving yin-yang balance and harmonious zang-fu pairing. If yang qi is excessive and yin qi is deficient, it leads to epigastric heat and rapid digestion with frequent hunger. If yang qi is deficient and yin qi is excessive, it leads to internal cold, borborygmus, and abdominal pain. "Excessive yin and yang" refers to excess pathogens; "deficient yin and yang" refers to deficiency of healthy qi. These should all be treated with supplementation and reduction techniques at Zusanli (ST-36). This is also a method of harmonizing zang qi by regulating fu qi.
When pathogenic factors invade the Kidney, bone pain and yin-bi syndrome occur. Yin-bi is characterized by an inability to locate tenderness upon pressure, abdominal distension, lower back pain, difficulty defecating, pain in the shoulder, back, neck, and nape, and occasional dizziness. Treatment involves selecting Yongquan (KI-1) and Kunlun (BL-60), and if blood stasis is visible, all such vessels should be punctured.
In the exterior, sinews and bones belong to yin. Disease in the yin aspect is called yin-bi. Bi syndrome implies pathology in the bone. Inability to locate tenderness upon pressure indicates pathogens have penetrated into the bone marrow. Abdominal distension results from cold in the zang organs causing fullness. The lower back is the mansion of the Kidney. The Kidney opens into the two orifices; difficulty defecating arises from impaired Kidney qi transformation. Pain in the shoulder, back, neck, and nape, along with occasional dizziness, indicates zang disease affecting the fu organs. Therefore, one should select Yongquan (KI-1) of the Foot-Shaoyin Kidney Meridian and Kunlun (BL-60) of the Foot-Taiyang Bladder Meridian, and if blood stasis is present, puncture all such vessels.
When pathogenic factors invade the Heart, heart pain, a tendency toward sadness, occasional dizziness, and fainting occur. Treatment depends on whether the condition is excess or deficiency, regulating the Shu-stream points accordingly.
Pathogens invading the Heart represent pathogens encroaching upon the Heart's domain. Sadness is the emotion associated with the Heart. When Heart qi becomes diseased and deficient, there is a tendency toward sadness. Injury to the spirit qi causes occasional dizziness and fainting. Regulation of the Shu-stream points should be based on excess or deficiency. The skin, vessels, flesh, sinews, and bones correspond externally to the five Zang organs. Pathogens in the Heart do not primarily manifest in the vessels because the Pericardium (Hand-Jueyin) governs the vessels. As stated in the *Xie Ke* chapter: "The Heart is the great master of the five zang and six fu organs, the residence of the spirit. Its organ is solid, so pathogens cannot reside within it. If they reside, they injure the Heart. If the Heart is injured, the spirit departs; if the spirit departs, death ensues." Therefore, whenever pathogens affect the Heart, they actually affect the Pericardium. The Pericardium is the meridian of the Heart Master. The treatment of the Original Source points (*Ben Shu*) selects points based on the excess or deficiency and speed of qi. Thus, pathogens in the Heart are actually in the Pericardium and the Heart's domain. Regulating based on excess or deficiency means adjusting according to the deficiency or excess of Heart qi. This is because pathogens encroach upon the Heart's domain, causing Heart qi to become either excessive or deficient. Since the pathogens are not directly in the Heart, they do not externally manifest in the pulse.
Shen Liangchen stated: Pathogens interfering with zang qi lead to death, not only in the case of the Heart. When the text says "pathogens in the Lung" or "pathogens in the Liver," it actually means pathogens encroaching upon the domains of the five Zang organs, affecting zang qi without damaging the true essence of the zang. Hence, it begins by mentioning the area beside the Back-Shu points of the five Zang organs at the third thoracic vertebra, where pressing with the hand brings relief before needling. This is because the areas beside the Zang organs are the abodes of zang qi. When disease is in the qi aspect, one selects points in the qi aspect. Selecting qi points explains why pressing brings relief. The terms "third vertebra" and "beside the five Zang organs" require careful contemplation.