黄帝问曰。太阴阳明为表里。脾胃脉也。生病而异者。何也。（按此篇乃总结三部九候。十二经脉。荣卫血气。皆阳
明胃气之所资生。足太阴之所输转。太阴为之行气于三阴。阳明为之行气于三阳。通于四时。施于四体。是以帝问其病。
而伯答以阴阳顺逆之道焉。）岐伯对曰。阴阳异位。更虚更实。更逆更从。或从内。或从外。所从不同。故病异名也。
（阴阳异位者。谓太阴居上。阳明居下也。更虚更实者。谓阳道实。阴道虚。然阳中有阴。阴中有阳也。更逆者。谓喉
主天气。咽主地气。阴气至头。阳气至足也。更从者。谓天气主外。地气主内。阳受风气。阴受湿气也。或从内者。或
因于饮食不节。起居不时。而为腹满飧泄之病。或从外者。或因于贼风虚邪。而为身热喘呼。故其病异名也。盖言阴阳
二气。总属阳明之所生。一阴一阳。分而为三阴三阳。三阴三阳。分而为十二经脉。三部九候之中。各有天。各有地。
此皆阴阳互交。上下相贯。土生万物。而法天地者也。）帝曰。愿闻其异状也。（状、形象也。谓无形之气象。有形之形
身。）岐伯曰。阳者天气也。主外。阴者地气也。主内。（天包乎地。故阳外而阴内。）故阳道实。阴道虚。（阳刚阴柔。
故阳道常实。阴道常虚。系辞曰。阴阳之义配日月。白虎通曰。日之为言实也。常满有节。月之为言缺也。有满有缺也。
所以有缺何。归功于日也。徐公遐曰。太阴之所以灌溉于脏腑者。着胃土之精也。）故犯贼风虚邪者。阳受之。食饮不节。
起居不时者。阴受之。贼风、贼害之风。虚邪、不正之邪也。阳气主外。故主受风邪。言邪气之在上也。饮食劳倦则伤
脾。故阴受之。言浊气之在中也。）阳受之则入六腑。阴受之则入五脏。（六腑为阳。故阳受之。邪入六腑。五脏为阴。
故阴受之。邪入五脏。各从其类也。）入六腑则身热。不时卧。上为喘呼。（入六腑者。谓阳明为之行气于三阳。阳明病。
则六腑之气皆为之病矣。阳明主肉。故身热。不时卧者。谓不得以时卧也。阳明者。胃脉也。胃者。六腑之海。其气亦
下行。阳明逆。不得从其故道。故不得卧也。下经曰。胃不和则卧不安。此之谓也。阳明气厥。则上为喘呼。）入五脏则
满闭塞。下为飧泄。久为肠 。（ 音嗔。入五脏者。谓太阴为之行气于三阴。太阴病。则五脏之气皆为之病矣。 、
胀也。脾气逆则胀满。太阴为开。开折则仓廪无所输。而为飧泄。久则为肠 矣。）故喉主天气。咽主地气。（故者。承
上文而言。脏腑阴阳之为病者。总属太阴阳明之所主也。喉乃太阴呼吸之门。主气而属天。咽乃阳明水谷之道路。属胃
而主地。所谓阴阳异位是也。公遐曰。阴阳异位之道。可得闻乎。曰。阴阳二气。总属阳明水谷之所生。清中之清者。
上出于喉。以司呼吸。所谓清阳出上窍也。清中之浊者。足太阴为之输禀于四肢。资养于五脏。所谓清阳实四肢。浊阴
走五脏。故经言足太阴独受其浊。阳明者土也。位居中央。故主地。是在脏腑阴阳而言。则太阴为阴。阳明为阳。在天
地阴阳而言。是受清者为天。受浊者为地。是以九候之中。阳明与足太阴主地。手太阴主天。）故阳受风气。阴受湿气。
（手太阴主气而主皮毛。故风气乘之。身半以下。足太阴阳明皆主之。故感地之湿气。）故阴气从足上行至头。而下行
循臂至指端。阳气从手上行至头。而下行至足。（此言土者。生万物而法天地。天气下降。地气上升。是以上下四旁。无
处不到。盖脏腑阴阳。十二经脉之精神气血。皆中土之所生。阴者注阴。阳者注阳。）故曰。阳病者。上行极而下。阴病
者。下行极而上。（此言邪随气转也。人之阴阳出入。随时升降。是以阳病在上者。久而随气下行。阴病在下者。久而随
气上逆。）故伤于风者。上先受之。伤于湿者。下先受之。（上先受之者。言邪气之中人也高。故邪气在上也。下先受之
者。言清湿地气之中人也。必从足始。故清气在下也。）帝曰。脾病而四肢不用何也。岐伯曰。四肢皆禀气于胃。而不
得至经。必因于脾。乃得禀也。（胃为阳土。脾属阴土。畅于四肢。坤之德也。）今脾病不能为胃行其津液。四肢不得禀
水谷气。气日以衰。脉道不利。筋骨肌肉。皆无气以生。故不用焉。（四肢者。五脏六腑之经俞也。经云。人之所受气者
谷也。谷之所注者胃也。胃者。水谷之海也。海之所行云气者天下也。胃之所出血气者经隧也。经隧者。五脏六腑之大
络也。盖四肢受水谷之气者。由脾脏之转输。脾之转输。各因其脏腑之经隧。而受气于阳明。是以脉道不利。则筋骨肌
肉。皆无气以生养矣。）帝曰。脾不主时何也。岐伯曰。脾者土也。治中央。常以四时长四脏。各十八日寄治。不得独
主于时也。（春夏秋冬。肝心肺肾之所主也。土位中央。灌溉于四脏。是以四季月中。各王十八日。是四时之中。皆有土
气。而不独主于时也。五脏之气。各主七十二日。以成一岁。）脾脏者。常着胃土之精也。土者。生万物而法天地。故上
下至头足。不得主时也。（此言脾之所以长旺于四脏者。得胃土之精也。阴阳并交。雌雄输应。故能生万物而法则天地。
交会于上下。分王于四时。）帝曰。脾与胃以膜相连耳。而能为之行其津液。何也。（膜、募原也。言有形之津液。不
能以膜相通。）岐伯曰。足太阴者。三阴也。其脉贯胃属脾络嗌。故太阴为之行气于三阴。（伯言太阴之为胃行其津液者。
由经脉之相通也。太阴者。三阴也。三阴者。至阴也。以其阴之至。故能行气于三阴也。其脉贯胃属脾。上膈络嗌。脏
腑之经络相通。故能为胃行其津液。）阳明者表也。五脏六腑之海也。亦为之行气于三阳。（阳明者。表阳也。为五脏六
腑之海。亦为之行气于三阳。如海之行云气于天下也。）脏腑各因其经而受气于阳明。故为胃行其津液。四肢不得禀水谷
气。日以益衰。阴道不利。筋骨肌肉无气以生。故不用焉。（此复言三阴三阳。所以受气于太阴阳明者。气也。如脏腑四
肢。受水谷之津液者。各因其经脉而通于太阴阳明也。故反复以申明之。朱卫公曰。曰脏腑。曰四肢。盖四肢之荣俞。
脏腑之经络也。）
Huangdi asked: The Taiyin and Yangming meridians are exterior and interior to each other, corresponding to the pulses of the Spleen and Stomach. Why do diseases arising from them present with different symptoms? (Note: This chapter summarizes the Three Regions and Nine Pulses, the Twelve Meridians, as well as Ying-Wei (Nutritive and Defensive) Qi and Blood. All these are generated by the nourishment of the Stomach Qi of Yangming and transported by the Foot-Taiyin Spleen meridian. Taiyin distributes Qi to the Three Yin meridians, while Yangming distributes Qi to the Three Yang meridians. They connect with the Four Seasons and extend to the four limbs. Therefore, the Emperor inquired about diseases, and Bo Gao answered with the principles of the smoothness and reversal of Yin and Yang.)
Qibo replied: Yin and Yang occupy different positions; they alternate between deficiency and excess, and between reversal and compliance. Some pathogens originate internally, while others invade externally. Since their origins differ, the names of the diseases also differ. ("Yin and Yang occupy different positions" refers to Taiyin residing in the upper Jiao and Yangming in the lower Jiao. "Alternating deficiency and excess" refers to the principle that the Path of Yang is often full/excess, while the Path of Yin is often empty/deficient, yet Yang contains Yin and Yin contains Yang. "Reversal" refers to the throat governing Heavenly Qi and the pharynx governing Earthly Qi, with Yin Qi ascending to the head and Yang Qi descending to the feet. "Compliance" refers to Heavenly Qi governing the exterior and Earthly Qi governing the interior, where Yang meridians receive Wind Qi and Yin meridians receive Dampness Qi. Diseases originating internally result from irregular diet and lifestyle, leading to abdominal fullness and diarrhea with undigested food. Diseases originating externally result from invasion by treacherous winds and deficient evils, leading to fever and wheezing. Thus, their disease names differ. Essentially, Yin and Yang Qi are all generated by Yangming. One Yin and one Yang divide into the Three Yin and Three Yang, which further divide into the Twelve Meridians. Within the Three Regions and Nine Pulses, there are Heaven and Earth in each, representing the interplay of Yin and Yang, the connection of upper and lower, and the generation of all things by Earth (Spleen/Stomach) following the patterns of Heaven and Earth.)
Huangdi said: I wish to hear about their specific manifestations. ("Zhuang" refers to image or form, encompassing both formless Qi phenomena and physical bodies.)
Qibo said: Yang corresponds to Heavenly Qi and governs the exterior; Yin corresponds to Earthly Qi and governs the interior. (Heaven envelops Earth, so Yang is external and Yin is internal.) Therefore, the Path of Yang is often full/excess, and the Path of Yin is often empty/deficient. (Yang is firm and Yin is soft, hence the Path of Yang is often full and the Path of Yin often deficiant. The *Xi Ci* states: The meaning of Yin and Yang is matched with the Sun and Moon. The *Baihu Tongyi* states: The character for Sun implies "fullness," always complete and rhythmic; the character for Moon implies "lack," having both fullness and lack. Why is there lack? Because it attributes completion to the Sun. Xu Gongxia stated: The reason Taiyin irrigates the Zang-Fu organs is due to the essence of Stomach Earth.)
Therefore, those afflicted by treacherous winds and deficient evils receive them first in Yang; those with irregular diet and lifestyle receive them first in Yin. Treacherous wind refers to harmful winds; deficient evil refers to incorrect pathogens. Yang Qi governs the exterior, thus primarily receiving Wind Evil, indicating that pathogens affect the upper part. Diet and fatigue injure the Spleen, thus Yin receives them, indicating that turbid Qi resides in the middle.)
When Yang receives pathogens, they enter the Six Fu Organs; when Yin receives pathogens, they enter the Five Zang Organs. (The Six Fu Organs are Yang, so Yang receives them; pathogens enter the Six Fu Organs. The Five Zang Organs are Yin, so Yin receives them; pathogens enter the Five Zang Organs. Each follows its corresponding category.)
Pathogens entering the Six Fu Organs cause body heat, inability to sleep at regular times, and upward progression to wheezing and calling out. (Entering the Six Fu Organs means Yangming distributes Qi to the Three Yang meridians; if Yangming is diseased, the Qi of all Six Fu Organs becomes diseased. Yangming governs flesh/muscle, hence body heat. "Inability to sleep at regular times" means one cannot sleep when one should. Yangming is the Stomach meridian; the Stomach is the Sea of the Six Fu Organs, and its Qi also descends. If Yangming Qi rebels and does not follow its proper path, one cannot sleep. The *Xia Jing* states: When the Stomach is disharmonious, sleep is uneasy; this is what is meant. Yangming Qi rebellion manifests upward as wheezing and calling out.)
Pathogens entering the Five Zang Organs cause abdominal fullness and obstruction, downward progression to diarrhea with undigested food, and over time, development of Changpi (intestinal dysentery/bloating). (Entering the Five Zang Organs means Taiyin distributes Qi to the Three Yin meridians; if Taiyin is diseased, the Qi of all Five Zang Organs becomes diseased. Pi here refers to bloating. Spleen Qi rebellion causes bloating. Taiyin governs opening; if opening fails, the granaries cannot transport nutrients, leading to diarrhea with undigested food, which over time becomes Changpi.)
Therefore, the throat governs Heavenly Qi, and the pharynx governs Earthly Qi. ("Gu" connects to the previous text. Diseases of the Zang-Fu and Yin-Yang are generally governed by Taiyin and Yangming. The throat is the gate of respiration for Taiyin, governing Qi and belonging to Heaven; the pharynx is the pathway for water and food for Yangming, belonging to the Stomach and governing Earth. This is what is meant by "Yin and Yang occupy different positions." Gongxia asked: May I hear the principle of Yin and Yang occupying different positions? Answer: Yin and Yang Qi are all generated by Yangming water and food. The purest clear portion ascends through the throat to govern respiration, known as "Clear Yang exits through the upper orifices." The turbid clear portion is distributed by the Foot-Taiyin to the four limbs and nourishes the Five Zang Organs, known as "Clear Yang fills the four limbs, Turbid Yin travels to the Five Zang Organs." Hence, the classic states that Foot-Taiyin alone receives its turbidity. Yangming belongs to Earth, positioned centrally, thus governing Earth. In terms of Zang-Fu Yin-Yang, Taiyin is Yin and Yangming is Yang; in terms of Heaven-Earth Yin-Yang, receiving Clear Qi is Heaven, receiving Turbid Qi is Earth. Therefore, in the Nine Pulses, Yangming and Foot-Taiyin govern Earth, while Hand-Taiyin governs Heaven.)
Thus, Yang receives Wind Qi, and Yin receives Dampness Qi. (Hand-Taiyin Lung meridian governs Qi and skin/hair, so Wind Qi easily attacks it. The lower half of the body is governed by Foot-Taiyin and Foot-Yangming, so it easily feels the Dampness of Earth.)
Yin Qi ascends from the feet to the head, then descends along the arms to the fingertips; Yang Qi ascends from the hands to the head, then descends to the feet. (This describes how Earth generates all things following Heaven and Earth. Heavenly Qi descends, Earthly Qi ascends, so there is no place not reached above, below, or to the sides. The spirit, Qi, and blood of the Zang-Fu Yin-Yang and Twelve Meridians are all generated by Central Earth. Yin flows to Yin, Yang flows to Yang.)
Therefore it is said: Yang diseases, after reaching their peak upward, reverse downward; Yin diseases, after reaching their peak downward, reverse upward. (This describes pathogens transforming with Qi movement. Human Yin-Yang enters and exits, rising and falling with time. Thus, Yang diseases located upward will eventually descend with Qi movement; Yin diseases located downward will eventually rebel upward with Qi movement.)
Therefore, those injured by Wind Qi suffer first in the upper part; those injured by Dampness Qi suffer first in the lower part. ("Suffering first in the upper part" means pathogens enter humans at a high level, so pathogens are in the upper part. "Suffering first in the lower part" means cold and damp Earth Qi enters humans, starting from the feet, so Clear Qi is in the lower part.)
Huangdi asked: Why does Spleen disease lead to the inability to use the four limbs?
Qibo said: The four limbs all receive Qi from the Stomach, but cannot reach the meridians directly; they must rely on the Spleen's transport to receive Qi. (The Stomach is Yang Earth, the Spleen is Yin Earth, extending to the four limbs, possessing the virtue of Kun/Earth.)
Now, if the Spleen is diseased and cannot transport fluids for the Stomach, the four limbs do not receive Water-Guo (food and drink) Qi. Qi declines daily, meridians become obstructed, and sinews, bones, muscles, and flesh have no Qi to generate, hence they cannot function. (The four limbs are the acupoints where the meridians of the Five Zang and Six Fu Organs converge. The Classic states: The Qi humans receive comes from grain; grain is injected into the Stomach. The Stomach is the Sea of Water and Grain; the clouds and Qi circulating in the sea are like the atmosphere of the world. The Qi and Blood output by the Stomach are transmitted via the Jing-Sui (Meridian Tunnels). The Jing-Sui are the great collaterals of the Five Zang and Six Fu Organs. Generally, the four limbs receive Water-Guo Qi through the transport of the Spleen organ. The Spleen's transport follows the meridians of each Zang-Fu organ, receiving Qi from Yangming. Therefore, if meridians are obstructed, sinews, bones, muscles, and flesh have no Qi to nourish.)
Huangdi asked: Why does the Spleen not govern a specific season?
Qibo said: The Spleen belongs to Earth, governs the Center, and constantly nourishes the Four Zang Organs throughout the four seasons. It rules for eighteen days at the end of each season,寄治 (residing in rule), and does not solely govern one season. (Spring, Summer, Autumn, and Winter are governed by the Liver, Heart, Lungs, and Kidneys respectively. Earth is positioned in the Center, irrigating the Four Zang Organs. Thus, it rules for eighteen days at the end of each month/season. This means Earth Qi exists in all four seasons, not governing just one. The Qi of each Zang organ governs seventy-two days, completing one year.)
The Spleen organ constantly adheres to the essence of Stomach Earth. Earth generates all things following Heaven and Earth, so from top to bottom, head to feet, it does not solely govern a specific time. (This explains why the Spleen thrives among the Four Zang Organs: it obtains the essence of Stomach Earth. Yin and Yang intersect, male and female correspond, thus generating all things and following the laws of Heaven and Earth, intersecting above and below, ruling separately during the four seasons.)
Huangdi asked: The Spleen and Stomach are connected only by membranes, yet they can transport fluids to each other. Why? ("Mo" refers to Mu Yuan (origin of募), implying that有形 (physical) fluids cannot be connected merely by membranes.)
Qibo said: The Foot-Taiyin Spleen meridian is one of the Three Yin meridians. Its vessel penetrates the Stomach, attaches to the Spleen, and connects to the pharynx. Therefore, Taiyin distributes Qi to the Three Yin meridians. (Bo Gao stated that Taiyin transports fluids for the Stomach because of the connectivity of the meridians. Taiyin is the Three Yin, and Three Yin is the Ultimate Yin. Because its Yin is ultimate, it can distribute Qi to the Three Yin meridians. Its vessel penetrates the Stomach, attaches to the Spleen, ascends through the diaphragm, and connects to the pharynx. The Zang-Fu meridians are connected, thus it can transport fluids for the Stomach.)
Yangming is the exterior, the Sea of the Five Zang and Six Fu Organs, and it also distributes Qi to the Three Yang meridians. (Yangming is Exterior Yang, serving as the Sea of the Five Zang and Six Fu Organs, distributing Qi to the Three Yang meridians, just as the sea distributes clouds and Qi to the world.)
The Zang-Fu organs each receive Qi from Yangming according to their meridians; therefore, (the Spleen) can transport fluids for the Stomach. If the four limbs do not receive Water-Guo Qi, they decline day by day, the Yin pathways become obstructed, and sinews, bones, muscles, and flesh have no Qi to generate, hence they cannot function. (This reiterates why the Three Yin and Three Yang receive Qi from Taiyin and Yangming: it is due to Qi, similar to how Zang-Fu and four limbs receive Water-Guo fluids, each connecting to Taiyin and Yangming through their meridians. Thus, it is repeated to clarify. Zhuweigong stated: Mentioning Zang-Fu and four limbs, generally the Ying-Shu points of the four limbs are the meridians of the Zang-Fu organs.)