黄帝问曰。人病胃脘痈者。诊当何如。（按以下四篇论奇恒之为病。篇名病能者。言奇病之不因于四时六气。而能为
脏腑经脉作病也。疏五过论曰。上经下经。揆度阴阳。奇恒五中。决以明堂。审于终始。可以横行。方盛衰论曰。诊有
大方。坐起有常。出入有行。以转神明。必清必静。上观下观。司八正邪。别五中部。按脉动静。循尺滑涩寒温之意。
视其大小。合之病能。逆从以得。复知病名。诊可十全。盖言本经之上经。论气之通于天。下经言病之变化。临病之士。
审证辨脉。察色观形。分时候气。别正甄邪。再当比类奇恒。合之病能。诊可十全。方为得道。是以本卷一十五篇。自
热病论至厥论。论疾病之变化。而以奇恒四篇。续于其后。谓疾病变化之外。而又有奇恒之病。诊恒病之脉证。又当合
参之于病能。庶不致有五过四失之误。首论胃脘痈者。言荣卫血气。由阳明之所生。血气壅逆。则为痈肿之病。与外感
四时六淫内伤五志七情之不同也。张兆璜曰。病能者。言奇病之形能也。）岐伯对曰。诊此者。当候胃脉。其脉当沉细。
沉细者气逆。逆者人迎甚盛。甚盛则热。（胃脉者。手太阴之右关脉也。人迎者。结喉两旁之动脉也。盖胃气逆。则不能
至于手太阴。而胃脉沉细矣。气逆于胃。则人迎甚盛。人迎甚盛。则热聚于胃矣。）人迎者。胃脉也。逆而盛。则热聚于
胃口而不行。故胃脘为痈也。（人迎者。胃之动脉也。故胃气逆。则人迎脉盛。热聚于胃口而不行。则留滞而为痈矣。）
帝曰。善。人有卧而有所不安者何也。岐伯曰。脏有所伤。及精有所之。寄则安。故人不能悬其病也。（此言胃不和而卧
不安也。夫五脏所以藏精者也。精者胃腑水谷之所生。而分走于五脏。如脏有所伤。乃精有所往而不受。则为卧不安矣。
盖五味入胃。津液各走其道。是胃腑所生之精。能分寄于五脏则安。逆留于胃。即为卧不安之病。上节论胃中气逆。则
为脘痈。此言胃腑精逆。则卧有所不安。是奇恒之道。如璇玑玉衡。神转不回。如回而不转。则失其相生之机。如有所
留阻。则为痈逆之病。故人不能少空悬其病也。张兆璜曰。夫百病之始生。必起于燥湿寒暑风雨。阴阳喜怒。饮食居
处。而又有奇恒之病。故人不能少悬其病。玉师曰。奇恒之病。病经气之厥逆。血气生于胃腑水谷之精。故先论阳明
精气之逆。）帝曰。人之不得偃卧者何也。岐伯曰。肺者。脏之盖也。肺气盛则脉大。脉大则不得偃卧。论在奇恒阴阳
中。（此言肺气逆而为病也。脏真高于肺。为五脏之华盖。朝百脉而输精于脏腑。肺气逆则气盛而脉大。脉大则不得偃卧
矣。偃、仰也。奇恒阴阳中。谓玉机诸论篇中。言行奇恒之法。以太阴始也。张兆璜曰。此处提奇恒二字。）帝曰。
有病厥者。诊右脉沉而紧。左脉浮而迟。不然。病主安在。（此论肾气逆而为病也。夫左脉主血当沉。右脉主气当浮。今
脉不然。其所主之病安在。）岐伯曰。冬诊之。右脉固当沉紧。此应四时。左脉浮而迟。此逆四时。在左当主病在肾。颇
关在肺。当腰痛也（脉合四时。故冬诊之。左右脉皆当沉紧。今左脉反浮而迟。是逆四时之气矣。肾主冬气。而又反浮
在左。故当主病在肾。颇关涉于肺。当为腰痛之病。）帝曰。何以言之。岐伯曰。少阴脉贯肾络肺。今得肺脉。肾为之病。
故肾为腰痛之病也。（行奇恒之法。以太阴始。五脏相通。移皆有次。是水谷所生之精气。先至于手太阴。太阴肺金。相
生而顺传于肾。肾当复传之于肝。今反见浮迟之肺脉。是肾脏有病。而气反还逆之于母脏。故当主肾病之腰痛。而颇关
涉之于肺也。）帝曰。善。有病颈痈者。或石治之。或针灸治之。而皆已。其真安在。（经曰。肾移寒于肝。痈肿少气。
此言五脏相通。虽顺传有次。然不得相生之正气。而反受母脏之寒邪。则为痈肿之病矣。）岐伯曰。此同名异等者也。（等、
类也。痈虽同名。而为病之因。各有其类。）夫痈气之息者。宜以针开除去之。（灵枢痈疽篇曰。阴阳已张。因息乃行。
又曰。寒邪客于经络之中则血泣。血泣则不通。故痈肿。盖言邪客于脉络之中而为痈肿者。宜用针开除以去之。夫肾脉
上贯肝膈。肾与肝脉。皆循喉咙入颃颡。故痈肿在颈。此病因于肾也。）夫气盛血聚者。宜石而泻之。此所谓同病异治也。
（肝藏之血。行于皮肤气分。如肾藏之寒邪。顺传于肝。肝气盛而血聚于皮肤之间而为痈肿者。宜石而泻之。盖石者。
砭其皮肤出血。针者。刺入经穴之中。故病在脉络者宜针。病在皮肤者宜石。是以同病异治而皆已也。张兆璜曰。陷
下者又宜灸。始言针灸而后只言针石者。盖此篇论五脏之相传。而肾藏之气已传于肝。故只宜针宜石。设或有回陷于肾
者。又当灸之。此虽不明言。盖欲人意会。读者宜潜心参究。不可轻忽一字。）帝曰。有病怒狂者。此病安生。（经曰。
肝移寒于心。狂。膈中。又肝病者善怒。此肝虽顺传于心。而不得相生之正气。反受肝之寒邪。寒凌心火。故为怒狂。）
岐伯曰。生于阳也。帝曰。阳何以使人狂。岐伯曰。阳气者。因暴折而难决。故善怒也。病名曰阳厥。（折、屈逆也。决、
流行也。本经曰。所谓少气善怒者。阳气不治。阳气不治。则阳气不得出。肝气当治而未得。故善怒。善怒者。名曰煎
厥。此言肝气上逆。则阳气暴折而不得出。阳气难于流行。则肝气亦未得而治。故善怒也。）帝曰。何以治之。岐伯曰。
阳明者常动。巨阳少阳不动。不动而动大疾。此其候也。（心为阳中之太阳。巨阳者。心之标阳也。少阳者。肝之表气也。
夫阳明乃胃之悍气。故独动而不休。巨阳少阳不动者也。今不动之气。反动而大疾。故使人怒狂也。）帝曰。治之奈何。
岐伯曰。夺其食即已。夫食入于阴。长气于阳。故夺其食则已。（食气入胃。散精于肝。食气入胃。浊气归心。淫精于脉。
毛脉合精。行气于腑。是食入于阴。而长气于阳也。此言巨阳少阳。受气于心肝二脏之阴。肝心之气上逆。以致巨阳少
阳之动大疾。故夺其食。则阴气衰而阳动息矣。）使之服以生铁落为饮。夫生铁落者。下气疾也。（夫所谓怒狂者。肝
邪上乘于心。铁乃乌金。能伐肝木。故下肝气之疾速也。）帝曰。善。有病身热懈堕。汗出如浴。恶风少气。此为何病。
岐伯曰。病名曰酒风。（此言脾气逆而为病也。夫饮酒数醉。气聚于脾中。热盛于中。故热遍于身。而四肢懈堕也。热盛
则生风。风热相搏。是以汗出如浴。而恶风少气。张兆璜曰。饮酒者。先充络脉。从络脉而反逆于脾中。在心主脉。
是从心气之传于脾也。）帝曰。治之奈何。岐伯曰。以泽泻术各十分。麋衔五分。合以三指撮。为后饭。（酒气聚于脾。
则不能上输于肺。而下输膀胱矣。易曰。山泽通气。泽泻服之。能行水上。如泽气之上升为云。而复下泻为雨也。术乃
山之精。得山土之气。能通散脾气于四旁。麋衔草。有风不偃。无风独摇。能去风除湿者也。合三指撮者。三乃木之生
数。取制化土气之义。后饭者。复以谷气助脾也。夫奇恒之病。行所不胜曰逆。逆则死。今论胃腑所生之精气。以太阴
始。而顺传于肾。肾传之肝。肝传之心。心传之脾。是五脏相通。移皆有次。而又有不得偃卧腰痛颈痈诸病。是四时六
淫。七情五志之外。而有奇恒之逆传。奇恒之中。而又有顺传之奇病。故人不能虚悬其病也。按本经八十一篇。内论疾
病者。只二十有奇。而论奇恒者有十篇。当知人之生病也。多起于厥逆。）所谓深之细者。其中手如针也。摩之切之。
聚者坚也。搏者大也。（此论切求奇恒之脉法也。夫胃腑五脏之病能者。其气逆者。其脉沉细。故所谓沉之而细者。其应
手如针之细而沉也。再按而摩之。切而求之。如胃精之聚于胃。脾气之聚于脾者。其脉坚牢而不鼓也。又如肺气之盛。
肾气之上搏于肝。肝气之上搏于心者。其脉应指而大也。）上经者。言气之通天也。下经者。言病之变化也。金匮者。决
死生也。（上经者。谓上古天真。生气通天。至六节藏象藏气法时诸篇。论人之脏腑阴阳。地之九州九野。其气皆通于天
气。下经者。谓通评虚实以下。至于脉解诸篇。论疾病之变化。金匮者。如金匮真言。脉要精微、平人气象诸篇。论脉
理之要妙。以决死生之分。藏之金匮。非其人勿教。非其真勿授。故曰。金匮者。所以决死生也。按本经以七七四十九
篇。为上下经。后附论刺论穴。论五运六气。五过四失。如易之以八八六十四卦。分上下经。而后附系辞说卦诸篇之义。
张兆璜曰。按新校正云。晋皇甫士安序甲乙经云。素问亦有亡失。隋人全元起注本。亦无第七卷。唐时王冰。以天元纪
大论、五营运论、六微旨论、气交变论、五常政论、六元政纪论、至真要论七篇。乃阴阳大论之文。取以补所亡之卷。
是以上经下经之说。不合八十一篇之平分也。）揆度者。切度之也。奇恒者。言奇病也。（揆度者。切度奇恒之脉病。奇
恒者。言奇病之异于恒常也。）所谓奇者。使奇病不得以四时死也。恒者。得以四时死也。（所谓奇者。病五脏之厥逆。
不得以四时之气应之。所谓恒者。奇恒之势。乃六十首。亦得以四时之气。而为死生之期。）所谓揆者。方切求之也。言
切求其脉理也。度者。得其病处。以四时度之也。（揆度奇恒。所指不同。故当切求其脉理。而复度其病处。如本篇论五
脏之病能。当摩之切之。以脉求之。如太阳之肿腰椎。少阳之心胁痛。阳明之振寒。太阴之病胀。又当得其病处。而以
四时度之。）
Huangdi asked: When a person suffers from Wei-wan Yong (abscess of the stomach region), how should the diagnosis be conducted?
Qibo replied: In diagnosing this condition, one should observe the Stomach pulse. The pulse should appear deep and fine. A deep and fine pulse indicates Qi rebellion; in cases of Qi rebellion, the Renying pulse (artery at the side of the larynx) becomes very full. A very full Renying pulse indicates heat. (The Stomach pulse is located at the right Guan position of the Hand-Taiyin Lung channel. The Renying point is the arterial pulse on both sides of the larynx. Because Stomach Qi rebels upward, it cannot descend to the Hand-Taiyin Lung channel, resulting in a deep and fine Stomach pulse. Qi rebelling in the Stomach causes the Renying pulse to become very full; when the Renying pulse is very full, heat accumulates in the Stomach.) The Renying pulse reflects Stomach Qi. If the pulse Qi rebels and becomes full, heat accumulates at the gastric orifice and fails to circulate, thereby causing an abscess in the Wei-wan (stomach region). (Renying is the arterial pulse of the Stomach. When Stomach Qi rebels, the Renying pulse becomes full. Heat accumulating at the gastric orifice and failing to circulate stagnates and forms an abscess.)
Huangdi said: Excellent. Why do some people feel restless while lying down?
Qibo said: When the Zang organs are injured, or when Jing-Essence gathers and lodges abnormally, restlessness during sleep occurs. Therefore, one cannot view such illness as merely suspended or isolated. (This discusses how disharmony of the Stomach leads to restless sleep. The Five Zang organs store Essence. Essence is produced by the Stomach and Intestines digesting food and water, then distributed to the Five Zang. If the Zang organs are injured, Essence travels there but is not accepted, leading to restless sleep. After the five flavors enter the Stomach, fluids follow their respective pathways. If the Essence produced by the Stomach can be distributed to the Five Zang, the person remains peaceful; if Essence rebels and stagnates in the Stomach, it becomes the disease of restless sleep. The previous section discussed how Qi rebellion in the Stomach causes Wei-wan abscess; this section discusses how Essence rebellion in the Stomach causes restless sleep. This is the principle of Qi-Heng (extraordinary) diseases. Like the Xuanji Yuheng, the Shen-spirit turns without stopping; if it turns back without advancing, the mechanism of mutual generation is lost; if there is obstruction, it becomes an abscess or rebellion disease. Thus, one must not lightly overlook such illnesses.)
Huangdi said: Why can some people not lie on their backs?
Qibo said: The Lung is the canopy of the Zang organs. When Lung Qi is excessive, the pulse becomes large; a large pulse makes it impossible to lie on the back. This is discussed in the Qi-Heng Yin-Yang chapter. (This discusses pathology caused by rebellious Lung Qi. The True Qi of the Zang organs resides highest in the Lung, which serves as the Hu-Gai (canopy) of the Five Zang, receiving all pulses and distributing essence to the organs. Rebellious Lung Qi leads to excess Qi and a large pulse; a large pulse prevents lying on the back. Yan means to lie on the back. "Qi-Heng Yin-Yang" refers to chapters like Yu-Ji Zhen-Zang Lun, which explain the method of Qi-Heng, starting with Taiyin.)
Huangdi said: In cases of Jue-ni (reversal cold/heat) disease, the right pulse is deep and tight, and the left pulse is floating and slow. If not so, where is the disease primarily located?
Qibo said: If diagnosed in winter, the right pulse should naturally be deep and tight, conforming to the seasons; the left pulse being floating and slow violates the seasonal pattern. An abnormality in the left pulse indicates the disease is primarily in the Kidney, but also involves the Lung, manifesting as lower back pain. (Pulses conform to the seasons, hence the diagnosis in winter. Both left and right pulses should be deep and tight. Now the left pulse is floating and slow, reversing the Qi of the seasons. The Kidney governs winter Qi, and the left pulse showing a floating sign indicates disease in the Kidney, involving the Lung, thus lower back pain.)
Huangdi said: Why do you say so?
Qibo said: The Shaoyin Kidney channel penetrates the Kidney and connects to the Lung. The appearance of a Lung pulse (floating and slow) indicates that Kidney disease affects the Lung; thus, the Kidney is the root of the lower back pain. (Applying the Qi-Heng method, starting with Taiyin. The Five Zang organs are interconnected, and transmission follows a sequence. Essence generated from food and water first reaches the Hand-Taiyin Lung. Lung Metal generates and transmits smoothly to the Kidney, which then transmits to the Liver. Seeing a floating and slow Lung pulse instead indicates Kidney disease, with Qi reversing back to the mother organ (Lung); thus, it primarily manifests as Kidney-related lower back pain, involving the Lung.)
Huangdi said: Excellent. Some patients with neck abscesses are cured by using Bian-shi (stone knives), while others are cured by acupuncture and moxibustion. What is the underlying principle?
Qibo said: These share the same name but differ in etiology categories. (Deng means category. Although called abscess, the causes belong to different categories.) For abscesses caused by stagnant Qi, acupuncture should be used to open and remove the stagnation. (The Ling-Shu chapter on Abscesses and Ulcers states: When Yin and Yang Qi expand, stagnation allows pathogenic factors to act. It also states: When cold pathogens lodge in the collaterals, blood coagulates and flow stops, causing abscesses. This means for abscesses caused by pathogens lodging in the collaterals, needles should be used to open and expel them. The Kidney channel passes through the liver and diaphragm; both Kidney and Liver channels circle the throat and enter the pharynx. Thus, neck abscesses originate from the Kidney.) For conditions with excessive Qi and accumulated Blood, Bian-shi (stone knives) should be used to drain the blood. This is what is meant by treating the same disease differently. (Blood stored in the Liver circulates in the skin and Qi levels. If cold pathogens stored in the Kidney transmit smoothly to the Liver, causing Liver Qi excess and blood accumulation in the skin forming an abscess, stone knives should be used to drain. Stone knives pierce the skin to bleed; needles penetrate the meridian points. Thus, diseases in the collaterals suit needles, while diseases in the skin suit stone knives. Hence, the same disease can be cured by different treatments.)
Huangdi said: Excellent. How does anger-manic disease arise?
Qibo said: It arises from Yang channels.
Huangdi said: How does Yang Qi cause mania?
Qibo said: Yang Qi, due to sudden frustration and difficulty in unblocking, leads to irritability. This disease is named Yang-Jue (Yang Reversal). (Zhe means reversal/frustration; Jue means circulation. The Classic states: Shortness of breath and irritability occur because Yang Qi is disordered. Disordered Yang Qi cannot exit; Liver Qi desires regulation but fails, causing irritability. Irritability is named Jian-Jue. Here, Liver Qi rebelling upward causes sudden Yang frustration and inability to exit; difficult Yang circulation prevents Liver Qi regulation, causing irritability.)
Huangdi said: How should it be treated?
Qibo said: Restricting food intake will cure it. Food enters the Yin and nourishes Yang. Therefore, restricting food cures it. (Food Qi enters the Stomach, dispersing essence to the Liver; turbid Qi returns to the Heart, flooding the pulses. Hair and pulse essence combine, circulating Qi in the Fu organs. This is food entering Yin and nourishing Yang. Here, Ju-Yang and Shao-Yang receive Qi from the Yin of the Heart and Liver. Rebellious Qi of Heart and Liver causes Ju-Yang and Shao-Yang to beat rapidly. Restricting food reduces Yin, calming Yang movement.) Administer Sheng-Tie-Luo Yin (Raw Iron Filings Decoction). Raw iron filings have a rapid Qi-descending effect. (Anger-mania is Liver pathogen attacking the Heart. Iron is black metal, capable of subduing Liver Wood, thus rapidly descending Liver Qi.)
Huangdi said: Excellent. A patient has fever, flaccidity, sweating profusely as if bathing, aversion to wind, and shortness of breath. What disease is this?
Qibo said: This disease is named Jiu-Feng (Wind-Damp from Alcohol). (This discusses Spleen Qi rebellion. Frequent drunkenness causes Qi to gather in the Spleen, with intense heat within. Thus, heat pervades the body, causing limb flaccidity. Intense heat generates wind; wind-heat struggle causes profuse sweating, aversion to wind, and shortness of breath.)
Huangdi said: How should it be treated?
Qibo said: Use Ze-Xie (Alisma Rhizome) and Bai-Zhu (Atractylodes Macrocephala Rhizome) in equal parts (10 units each), and Mi-Xian (Elsholtzia splendens) in 5 parts. Mix and take three finger-pinches after meals. (Alcohol Qi gathers in the Spleen, preventing transport to the Lungs and Bladder. The I-Ching says: Mountain and Lake communicate. Ze-Xie promotes water movement, rising like clouds and falling like rain. Bai-Zhu is the essence of mountains, obtaining Earth Qi, spreading Spleen Qi to all directions. Mi-Xian grass stands firm in wind and sways alone without wind, dispelling wind and dampness. Using three finger-pinches, three is the generating number of Wood, controlling Earth Qi. Taking after meals uses grain Qi to assist the Spleen.)
Regarding the deep and fine pulse: pressing deeply feels fine like a needle tip. Palpating and pressing, gathered pulses are firm, and beating pulses are large. (This discusses pulse methods for Qi-Heng diseases. For Zang organ diseases with rebellious Qi, the pulse is deep and fine. Thus, pressing deeply yields a fine pulse like a needle. Further palpation reveals that if Stomach Essence gathers in the Stomach or Spleen Qi gathers in the Spleen, the pulse is firm and non-pulsatile. Conversely, if Lung Qi is excessive, or Kidney Qi beats up to the Liver, or Liver Qi beats up to the Heart, the pulse feels large upon contact.)
Shang-Jing (Upper Classic) discusses Qi connecting with Heaven. Xia-Jing (Lower Classic) discusses changes in diseases. Jin-Gui (Golden Cabinet) determines life and death. (Shang-Jing refers to chapters like Shanggu Tianzhen Lun, Shengqi Tongtian Lun, Liu-Jie Zangxiang Lun, etc., discussing human Zang-Yang and Earth's regions, whose Qi connects with Heavenly Qi. Xia-Jing refers to chapters from Tongping Xu-Shi Lun to Maijie Lun, discussing disease changes. Jin-Gui refers to chapters like Jin-Gui Zhenyan Lun, Maiyao Jingwei Lun, Pingren Qixiang Lun, discussing pulse principles to determine life and death boundaries. Stored in the Golden Cabinet, taught only to worthy disciples, hence determining life and death.)
Kui-Duo means measuring pulses and diseases. Qi-Heng refers to extraordinary diseases. (Kui-Duo measures Qi-Heng pulses and diseases. Qi-Heng describes diseases differing from the constant.)
"Qi" (Extraordinary) means extraordinary diseases do not die according to the four seasons. "Heng" (Constant) means constant diseases may die according to the four seasons. ("Qi" refers to Zang organ reversals not responding to seasonal Qi. "Heng" refers to the sixty patterns, which can also use seasonal Qi to determine life and death timing.)
"Kui" means precisely seeking the pulse principle. "Duo" means locating the disease site and evaluating it by the seasons. (Kui-Duo differs in application; one must seek pulse principles and evaluate disease sites. As discussed in this chapter regarding Five Zang diseases, one must palpate and seek via pulses. For example, Taiyin lumbar swelling, Shaoyang chest-hypochondriac pain, Yangming chills, Taiyin abdominal distension—locate the disease site and evaluate by seasons.)