久行伤筋，劳于肝也。尽力谋虑劳伤乎肝，应筋极也。曲运神机劳伤平脾，应肉极也。意外过思劳伤乎心，应脉极
也。预事而忧劳伤乎肺，应气极也。矜持志节劳伤乎肾，应骨极也。
头者，精神之府。头倾视深，精神将脱也。背者，胸中之府。背屈肩垂，腑将坏也。腰者，肾之府。转摇不动，
肾将惫也。骨者，髓之府。不能久立，则振掉，骨将惫也。膝者，筋之府。屈伸不能行，则偻伛，筋将惫也。
一损损于皮毛，皮聚而毛落也；二损损于血脉，血脉虚少，不能荣于脏腑也；三损损于肌肉，肌肉消瘦，饮食
不能为肌肤也；四损损于筋，筋缓不能自收持也；五损损于骨，骨痿不能起于床也。从上下者，骨痿不能起于床者，
死也；从下上者，皮聚而毛落者，死也。肺主皮毛，损其肺者，益其气也。心主血脉，损其心者，调其荣卫也。脾
主肌肉，损其脾者，调其饮食，适其寒温也。肝主筋，损其筋者，缓其中也。肾主骨，损其骨者，益其精也。忧愁思
虑，则伤心也。形寒饮冷，则伤肺也。恚怒气逆，则伤肝也。饮食劳倦，则伤脾也。坐湿入水，则伤肾也。亢则害，
承乃制也。寒极则生热也。热极则生寒也。木极而似金也。火极而似水也。土极而
似木也。金极而似火也。水极而似土也。
五郁者，泄、折、达、发、夺也。木郁达之谓吐之，令其条达也。火郁发之谓汗之，令其疏散也。土郁夺之
谓下之，令无壅滞也。金郁泄之谓渗泄，解表利小便也。水郁折之谓抑之，制其冲逆也。心下逆满者，下之过也。
气上冲胸，起则眩晕者，吐之过也。肉 筋惕，足蜷恶寒者，汗之过也。
脱阳者见鬼，气不守也；脱阴者目盲，血不荣也。重阳者狂，气并于阳也；重阴者癫，血并于阴也。气留而
不行者，为气先病也；血壅而不濡者，为血后病也。五脏不和，则九窍不通也；六腑不和，则流结为壅也，手屈而
不伸者，病在筋也；手伸而不屈者，病在骨也。螈者，筋脉急而缩也， 者，筋脉缓而伸也。搐搦者，手足牵引，
一伸一缩也。舌吐不收者，阳强也；舌缩不能言者，阴强也。
春伤于风，夏必飧泄也；夏伤于暑，秋必 疟也，秋伤于湿，冬必咳嗽也；冬伤于寒，春必温病也。风者，
百病之长也。风痱者，谓四肢不收也。偏枯者，谓半身不遂也。风懿者，谓奄忽不知人也。风痹者，谓诸痹类风状
也。瘫者，坦也，筋脉弛纵，坦然而不举也。痪者，涣也，血气散满，涣而不用也。
太阳则头痛、身热、脊强也。寒者，天地杀厉之气也。阳明则目痛、鼻干、不眠也。伤风者，身热、有汗、恶
风也，伤寒者，身热、无汗、恶寒也。少阳则耳聋、胁痛、寒热、呕而口苦也。太阴则腹满、自利、尺寸沉而津不
到咽也。少阴则舌干而口燥也。厥阴则烦满而囊拳也。表热者，翕然而热也。里热者，蒸蒸而热也。项背强者，太阳
表邪也，恶风者，见风则怯也。发热恶寒者，发于阳也；无热恶寒者，发于阴也；寒热往来者，阴阳相胜也。烦热
者，热邪传里也。
煎厥者，气热烦劳也。薄厥者，气逆大甚也。解 者，脊脉痛，少气不欲言也。四肢不收者，脾病也。肉痿者，
肌肉不仁也。肉蠕动者，脾热也。
五饮者，支饮、留饮、痰饮、溢饮、气饮也。五泄者，脾泄、胃泄、大肠泄、小肠泄、大瘕泄也。（又有飧
泄、胃泄、洞泄、濡泄、 溏之类。）脾泄者，腹胀呕逆也；胃泄者，饮食不化也；大肠泄者，食已窘迫也；
小肠泄者，泄便脓血也；大瘕泄者，里急后重也。 溏泄者，大肠有寒也。肠垢者，大肠有热也。飧泄者，食不
化，脾病也。脾约者，大便坚而小便利也。五膈者，忧、恚、寒、热、气也。五噎者，忧、思、劳、食、气也。
九气者，喜、怒、忧、思、悲、恐、惊、劳、寒、暑也。五积者，五脏之所生也。六聚者，六腑之所成也。
肝积在左胁，肥气也；肺积在右胁，息奔也；心积在脐上，伏梁也；肾积在脐下，奔豚也；脾积居中，痞气也。五
疸者，黄汗、黄胆、酒疸、谷疸、女劳疸也。五轮者，风、血、肉、气、水也。八廓者，天、地、水、火、风、
云、山、泽也。五瘿者，肉瘿、筋瘿、血瘿、气瘿、石瘿也。六瘤者，骨瘤、脂瘤、肉瘤、脓瘤、血瘤、石瘤也。
九种心痛者，饮、食、风、冷。热、悸、虫、疰、去来痛也。七疝者，寒、水、筋、血、气、狐、 也。三消者
，多属血虚也。上消者，肺也；中消者，胃也；下消者，肾也。五痔者，牝、牡、血、脉、肠痔也。五淋者，气、
砂、血、膏、劳也。五痹者，皮痹、脉痹、肌痹、骨痹、筋痹也。（又有痛痹、着痹、行痹、周痹。）痛痹者，筋
骨掣痛也；着痹者，着而不行也；行痹者，走痛不定也；周痹者，周身疼痛也。
肾移寒于肝，则痈肿少气也；脾移寒于肝，则痈肿筋挛也。肝移寒于心，则狂、隔中也。心移寒于肺，则肺消。肺
消者，饮一溲二也，死不治。肺移寒于肾，为涌水。涌水者，按腹不坚，水气客于大肠，疾行则鸣濯濯，如囊裹
浆，水之病也。脾移热于肝，则为惊衄也。肝移热于心，则死也。心移热于肺，传为隔消也。肺移热于肾，传为
柔也。肾移热于脾，传为虚肠癖，死不可治也。胞移热于膀胱，则癃，溺血也。膀胱移热于小肠，膈肠不便，上
为口糜也。小肠移热于大肠，为虚瘕，为沉也。大肠移热于胃，善食而瘦，谓之食 。胃移热于胆，亦曰食 。
胆移热于脑，则辛 鼻渊。鼻渊者，浊涕下不止也。
五味者，辛，甘、苦、酸、咸也。多食辛，则筋急而爪枯也。多食甘，则骨痛而发落也。多食苦，则皮槁而
发拔也。多食酸，则肉胝 而唇揭也。多食咸，则脉凝注而变色也。酒者，气浓上升，阳也。肉者，味浓下降，阴
也。味之薄者，为阴中之阳。味薄则通，酸、苦、平、咸是也。味之浓者，为阴中之阴。味浓则泄，酸、苦、咸，
寒是也。气之薄者，为阳中之阴。气薄则发泄，辛、甘、淡、平、寒、凉是也。气之浓者，为阳中之阳。气浓则发
热，辛、甘、温、热是也。轻清成象，（味薄茶之类，）本乎天者，亲上也。重浊成形，（味浓大黄之类，）本乎地
者，亲下也。（各从其类。）气味辛甘发散为阳也；气味酸苦涌泄为阴也。清阳发腠理，清之清者也。（清肺以助
天真。）清阳实四肢，清之浊者也。（荣华腠理。）浊阴归六腑，浊之浊者也。（坚强骨髓。）浊阴走五脏，浊之清
者也。（荣养于神。）
七方者，大、小、缓、急、奇、偶、复也。大者，君一臣三佐九，制之大也。（远而奇偶，制其大服也。大则
数少，少则二之。肾肝位远，服汤散不厌频而多。）小者，君一臣二，制之小也。（近而奇偶，制小其服也。小则
数多，多则九之。心肺位近，服汤散不厌频而少。）缓者补上、治上制以缓，缓则气味薄也。（治三以缓，缓则治
其本。）急者
补下、治下制以急，急则气味浓也。（治三以急，急则治其标。）奇者，君一臣二，奇之制也；君一臣三，奇之
制也。（阳数奇。）偶者，君二臣四，偶之制也∶君二臣六，偶之制也。（阴数偶。）复者，奇之不去则偶之，
是为重方也。
十剂者，宣、通、补、泻、轻、重、滑、涩、燥、湿、寒、热也。宣可以去壅，姜、橘之属是也。通可以去
滞，木通、防己之属是也。补可以去弱，人参、羊肉之属是也。泻可以去闭，葶苈、大黄之属是也。轻可以去
实，麻黄、葛根之属是也。重可以去怯，磁石、铁浆之属是也。滑可以去着，冬葵子、榆白皮之属是也。涩可以
去脱，牡蛎、龙骨之属是也。燥可以去湿，桑白皮、赤小豆之属是也。湿可以去枯，白石英、紫石英之属是也。
寒可以去热，大黄、朴硝之属是也。热可以去寒，附子、官桂之属是也。
百病昼则增剧，夜则安静，是阳病有余，乃气病而血不病也；夜则增剧，昼则安静，是阴病有余，乃血病而
气不病也；昼则发热，夜则安静，是阳气自旺于阳分也；昼则安静，夜则发热、烦躁，是阳气下陷入阴中也；（名
曰热入血室。）昼则发热、烦躁，夜亦发热、烦躁，是重阳无阴也；（当亟泻其阳，峻补其阴。）夜则恶寒，昼
则安静，是阴血自旺于阴分也；夜则安静，昼则恶寒，是阴气上溢于阳中也；夜则恶寒，昼亦恶寒，是重阴无阳，
当亟泻其阴，峻补其阳也；昼则恶寒，夜则烦躁，饮食不入，名曰阴阳交错者，死也。
火多水少，为阳实阴虚，其病为热也；水多火少，为阴实阳虚，其病为寒也。白者肺气虚，黑者肾气足也。肥
人湿多。瘦人火多也。
在表者，汗而发之也；在里者，下而夺之也；在高者，因而越之也；（谓可吐也。）剽悍者，下而收之也。
脏寒虚脱者，
治以灸 也。脉病挛痹者，治以针刺也。血室蓄结肿热者，治以砭石也。气滞痿厥寒热者，治以导引也。经络不
通、病生于不仁者，治以醪醴也。血气凝注、病生筋脉者，治以熨药也。
人能健步，以髓会绝骨也。肩能任重，以骨会大杼也。少壮寐而不寤者，此血有余气不足也。老人寤而不寐
者，此气有余而血不足也。前贫后富，喜伤心也；前富后贫，多郁火也。开鬼门者，谓发其汗也。洁净府者，谓
利小便也。老衰久病者，补虚为先也；少壮新病者，攻邪为主也。节戒饮食者，却病之良方也。调理脾胃者，医中
之王道也。
望而知之者，谓之神，望其五色，以知其病也。闻而知之者，谓之圣，闻其五音，以识其病也。问而知之者，
谓之工，问其所欲五味，以审其病也。切而知之者，谓之巧，切其脉，以察其病也。
外感法张仲景也；内伤法李东垣也；热病用刘河间也；杂病用朱丹溪也。识感、中、伤三者，标本之微甚也。
明内、外、不内外，均表里之虚实也。必先岁气，勿伐天和也。能合色脉，可以万全也。天地有南北之不同也，人
身有虚实之各异也。化而裁之，存乎变也；神而明之，在乎人也。医演岐黄，神圣之术也，学推孔孟，仁义之心也。
此前圣之确论，为医家之所宗也。诚后学之阶梯，乃云林之所述也。
长时间行走会损伤筋脉，这是因劳倦伤及肝脏所致。竭尽精力进行谋虑会损伤肝脏，表现为筋脉极度疲惫（应筋极）。过度运用心神思考会损伤脾脏，表现为肌肉极度疲惫（应肉极）。意料之外的过度思虑会损伤心脏，表现为脉象极度疲惫（应脉极）。对未发生之事预先担忧劳碌会损伤肺脏，表现为气机极度疲惫（应气极）。刻意坚守志节、克制欲望会损伤肾脏，表现为骨骼极度疲惫（应骨极）。
头部是精神汇聚之所。如果头低垂、眼神深陷，说明精神即将耗脱。背部是胸中脏腑的外府。如果背弯曲、肩膀下垂，说明内脏功能即将败坏。腰部是肾脏的外府。如果腰部转动困难，说明肾脏功能即将衰竭。骨骼是骨髓汇聚之所。如果不能久站，身体震颤摇摆，说明骨骼功能即将衰竭。膝盖是筋脉汇聚之所。如果屈伸不利、行走跛行驼背，说明筋脉功能即将衰竭。
第一层损耗损伤皮毛，表现为皮肤聚缩、毛发脱落；第二层损耗损伤血脉，表现为血脉虚少，不能滋养脏腑；第三层损耗损伤肌肉，表现为肌肉消瘦，饮食无法转化为肌肤营养；第四层损耗损伤筋脉，表现为筋脉松弛，无法自主收持；第五层损耗损伤骨骼，表现为骨痿无力，不能起床。如果是从上往下发展的损耗，出现骨痿不能起床的，预后不良，主死；如果是从下往上发展的损耗，出现皮聚毛落的，预后不良，主死。肺主管皮毛，损伤肺脏的，应当补益肺气。心主管血脉，损伤心脏的，应当调和营卫。脾主管肌肉，损伤脾脏的，应当调节饮食，适应寒温变化。肝主管筋脉，损伤筋脉的，应当舒缓其情志。肾主管骨骼，损伤骨骼的，应当填补肾精。忧愁思虑，会损伤心脏。形体受寒、饮用冷物，会损伤肺脏。愤怒气逆，会损伤肝脏。饮食不节、劳倦过度，会损伤脾脏。久坐湿地、涉水，会损伤肾脏。亢盛则有害，有制约才能平衡。寒极则生热。热极则生寒。木气极盛而似金性。火气极盛而似水性。土气极盛而似木性。金气极盛而似火性。水气极盛而似土性。
五郁的治疗方法，分别是泄、折、达、发、夺。木郁用“达”法，即吐法，使其条达舒畅。火郁用“发”法，即汗法，使其疏散。土郁用“夺”法，即下法，使其无壅滞。金郁用“泄”法，即渗利小便、解表，使邪气排出。水郁用“折”法，即抑制法，制约其冲逆之气。心下逆满，是误用下法造成的。气上冲胸，起身眩晕，是误用吐法造成的。肌肉跳动、筋惕肉瞤，足部蜷缩恶寒，是误用汗法造成的。
阳气外脱的人会出现幻觉见鬼，这是气不能固守；阴血外脱的人会双目失明，这是血不能荣养。重阳之人发狂，是气并聚于阳分；重阴之人发癫，是血并聚于阴分。气停留而不运行，是先病在气；血壅滞而不濡润，是后病在血。五脏不和，九窍就不通利；六腑不和，津液流结成为壅滞。手能屈而不能伸，病在筋；手能伸而不能屈，病在骨。抽搐者，是筋脉拘急收缩；弛纵者，是筋脉松弛伸展。搐搦者，是手足牵引，一伸一缩交替。舌吐不收，是阳强；舌缩不能言语，是阴强。
春天感受风邪，夏天必定发生完谷不化的泄泻；夏天感受暑邪，秋天必定发生疟疾；秋天感受湿邪，冬天必定发生咳嗽；冬天感受寒邪，春天必定发生温病。风邪是百病的先导。风痱，是指四肢不能收引。偏枯，是指半身不遂。风懿，是指突然昏迷不知人。风痹，是指各种痹证类似风邪致病的特点。瘫，意为坦荡，指筋脉弛缓纵容，平坦而不能举起。痪，意为涣散，指气血散漫，涣散而不能使用。
太阳经病变，表现为头痛、身热、脊柱强直。寒邪，是天地间肃杀厉烈之气。阳明经病变，表现为目痛、鼻干、失眠。伤风，表现为身热、有汗、怕风。伤寒，表现为身热、无汗、怕冷。少阳经病变，表现为耳聋、胁痛、寒热往来、呕吐且口苦。太阴经病变，表现为腹满、自发性腹泻、寸关尺脉沉且津液不到咽喉。少阴经病变，表现为舌干口燥。厥阴经病变，表现为烦闷且阴囊收缩。表热，是翕翕发热（如羽毛覆盖般的温热）。里热，是蒸蒸发热（如蒸笼般的热）。项背强直，是太阳表邪。怕风，是见到风就胆怯。发热恶寒，是病发于阳。无热恶寒，是病发于阴。寒热往来，是阴阳相互胜负。烦热，是热邪传入里部。
煎厥，是因气热烦劳所致。薄厥，是因气逆严重所致。解㑊，是脊脉疼痛，气短不想说话。四肢不能收引，是脾病。肉痿，是肌肉麻木不仁。肌肉蠕动，是脾热。
五饮，包括支饮、留饮、痰饮、溢饮、气饮。五泄，包括脾泄、胃泄、大肠泄、小肠泄、大瘕泄。（还有飧泄、洞泄、濡泄、溏泄之类。）脾泄，表现为腹胀呕吐；胃泄，表现为饮食不消化；大肠泄，表现为进食后立即窘迫欲便；小肠泄，表现为排泄脓血；大瘕泄，表现为里急后重。溏泄，是大肠有寒。肠垢，是大肠有热。飧泄，是食物不消化，属脾病。脾约，是大便坚硬而小便频数。五膈，包括忧、恚、寒、热、气五种病因。五噎，包括忧、思、劳、食、气五种病因。九气，包括喜、怒、忧、思、悲、恐、惊、劳、寒、暑（注：原文列举了十种，通常九气指七情加劳、寒/热等，此处依原文提取）。五积，是五脏所生的积病。六聚，是六腑所成的聚病。
肝积在左胁，名为肥气；肺积在右胁，名为息贲；心积在脐上，名为伏梁；肾积在脐下，名为奔豚；脾积居中，名为痞气。五疸，包括黄汗、黄胆、酒疸、谷疸、女劳疸。五轮，包括风、血、肉、气、水。八廓，包括天、地、水、火、风、云、山、泽。五瘿，包括肉瘿、筋瘿、血瘿、气瘿、石瘿。六瘤，包括骨瘤、脂瘤、肉瘤、脓瘤、血瘤、石瘤。九种心痛，包括饮、食、风、冷、热、悸、虫、疰、去来痛。七疝，包括寒、水、筋、血、气、狐、㿗。三消，多属于血虚。上消，病在肺；中消，病在胃；下消，病在肾。五痔，包括牝痔、牡痔、血痔、脉痔、肠痔。五淋，包括气淋、砂淋、血淋、膏淋、劳淋。五痹，包括皮痹、脉痹、肌痹、骨痹、筋痹。（还有痛痹、着痹、行痹、周痹。）痛痹，是筋骨掣痛；着痹，是固定不移；行痹，是游走不定；周痹，是周身疼痛。
肾将寒邪移于肝，则发生痈肿、气短；脾将寒邪移于肝，则发生痈肿、筋挛。肝将寒邪移于心，则发狂、膈中阻塞。心将寒邪移于肺，则发生肺消。肺消，表现为喝一份尿两份，预后不良，难以治愈。肺将寒邪移于肾，称为涌水。涌水，按腹部不坚硬，水气客居大肠，快跑时肠鸣濯濯，像囊袋裹着浆液，这是水的病证。脾将热邪移于肝，则发生惊悸和衄血。肝将热邪移于心，则死亡。心将热邪移于肺，传变为膈消。肺将热邪移于肾，传变为柔痉。肾将热邪移于脾，传变为虚损肠癖，死亡不可治愈。胞宫将热邪移于膀胱，则发生癃闭、尿血。膀胱将热邪移于小肠，导致肠道隔塞不便，上行则口腔糜烂。小肠将热邪移于大肠，形成虚瘕、沉疝。大肠将热邪移于胃，表现为善饥但消瘦，称为食亦。胃将热邪移于胆，也称为食亦。胆将热邪移于脑，则鼻辛、鼻渊。鼻渊，表现为浊涕不止。
五味，包括辛、甘、苦、酸、咸。多食辛味，则筋脉拘急、指甲枯槁。多食甘味，则骨痛、头发脱落。多食苦味，则皮肤干枯、毫毛脱落。多食酸味，则皮肤角质增厚、嘴唇揭裂。多食咸味，则血脉凝滞、面色改变。酒，气味浓烈上升，属阳。肉类，味道浓厚下降，属阴。味道薄的，属于阴中之阳。味薄则通利，酸、苦、平、咸属于此类。味道浓厚的，属于阴中之阴。味浓则泄下，酸、苦、咸、寒属于此类。气味薄的，属于阳中之阴。气薄则发泄，辛、甘、淡、平、寒、凉属于此类。气味浓厚的，属于阳中之阳。气浓则发热，辛、甘、温、热属于此类。轻清成象（如味薄的茶之类），本乎天，亲上。重浊成形（如味厚的大黄之类），本乎地，亲下。（各从其类。）气味辛甘发散为阳；气味酸苦涌泄为阴。清阳发腠理，是清中之清（清肺以助天真）。清阳实四肢，是清中之浊（荣华腠理）。浊阴归六腑，是浊中之浊（坚强骨髓）。浊阴走五脏，是浊中之清（荣养神气）。
七方，包括大、小、缓、急、奇、偶、复。大方，君药一，臣药三，佐药九，制方较大。（远而奇偶，制其大服也。大则数少，少则二之。肾肝位远，服汤散不厌频而多。）小方，君药一，臣药二，制方较小。（近而奇偶，制小其服也。小则数多，多则九之。心肺位近，服汤散不厌频而少。）缓方，补上、治上，制方以缓，缓则气味薄。（治三以缓，缓则治其本。）急方，补下、治下，制方以急，急则气味浓。（治三以急，急则治其标。）奇方，君药一臣药二，或君一臣三，是奇数的制方。（阳数奇。）偶方，君药二臣药四，或君二臣六，是偶数的制方。（阴数偶。）复方，奇方无效则用偶方，这叫重方。
十剂，包括宣、通、补、泻、轻、重、滑、涩、燥、湿、寒、热。宣可以去壅滞，如姜、橘之类。通可以去滞涩，如木通、防己之类。补可以去虚弱，如人参、羊肉之类。泻可以去闭塞，如葶苈、大黄之类。轻可以去实证，如麻黄、葛根之类。重可以去怯弱，如磁石、铁浆之类。滑可以去着留，如冬葵子、榆白皮之类。涩可以去脱失，如牡蛎、龙骨之类。燥可以去湿，如桑白皮、赤小豆之类。润可以去枯焦，如白石英、紫石英之类。寒可以去热，如大黄、朴硝之类。热可以去寒，如附子、官桂之类。
百病白天加重、夜间安静，是阳病有余，乃气病而血不病；夜间加重、白天安静，是阴病有余，乃血病而气不病；白天发热、夜间安静，是阳气自旺于阳分；白天安静、夜间发热烦躁，是阳气下陷入阴中（名叫热入血室）；白天发热烦躁、夜间也发热烦躁，是重阳无阴（应当紧急泻其阳，峻补其阴）；夜间恶寒、白天安静，是阴血自旺于阴分；夜间安静、白天恶寒，是阴气上溢于阳中；夜间恶寒、白天也恶寒，是重阴无阳，应当紧急泻其阴，峻补其阳；白天恶寒、夜间烦躁、饮食不入，名叫阴阳交错，预后不良，主死。
火多水少，为阳实阴虚，其病为热；水多火少，为阴实阳虚，其病为寒。面色白是肺气虚，面色黑是肾气足。肥胖人多湿。瘦人多火。
病在表的，用汗法发散；病在里的，用下法攻夺；病在上的，因势利导使之越出（谓可吐）；病势剽悍急骤的，用下法收敛。脏寒虚脱的，用灸法治之。脉病挛痹的，用针刺法治之。血室蓄结肿热的，用砭石法治之。气滞痿厥寒热的，用导引法治之。经络不通、病生于麻木不仁的，用醪醴法治之。血气凝注、病生筋脉的，用熨药法治之。
人能健步，是因为髓会绝骨穴。肩能负重，是因为骨会大杼穴。年少壮年睡眠深沉不易醒，这是因为血有余而气不足。老人易醒难睡，这是因为气有余而血不足。以前贫穷后来富有，喜悦过度会伤心；以前富有后来贫穷，多生郁火。开鬼门，就是发汗。洁净府，就是利小便。老衰久病的人，以补虚为先；年少壮年新病的人，以攻邪为主。节制饮食，是祛病的良方。调理脾胃，是医中的王道。
望而知之者，称为神，通过观察五色来知道病情。闻而知之者，称为圣，通过听五音来识别病情。问而知之者，称为工，询问其对五味的喜好来审察病情。切而知之者，称为巧，切脉来察知病情。
外感病效法张仲景；内伤病效法李东垣；热病使用刘河间的理论；杂病使用朱丹溪的理论。识感、中、伤三者，是辨别标本的轻重。明内、外、不内外，均涉及表里的虚实。必须首先考虑岁气，不要侵犯天和。能结合色脉诊断，可以万全。天地有南北的不同，人身有虚实的差异。化裁运用，在于变化；神明其道，在于人为。医学源于岐黄，是神圣的技术；学问推崇孔孟，是仁义的心肠。这是前代圣贤的确切论述，被医家所尊崇。确实是后学的阶梯，这是云林（龚廷贤号云林）所述的内容。
Prolonged walking damages the sinews (sinews), which is due to labor injuring the Liver. Exhausting one's strength in planning and worrying injures the Liver, manifesting as extreme fatigue of the sinews (Ying Jin Ji). Overusing the spirit for mental calculation injures the Spleen, manifesting as extreme fatigue of the flesh (Ying Rou Ji). Unexpected excessive worry injures the Heart, manifesting as extreme fatigue of the vessels (Ying Mai Ji). Preoccupation with future events causes labor that injures the Lungs, manifesting as extreme fatigue of Qi (Ying Qi Ji). Striving to maintain moral integrity and restraining desires injures the Kidneys, manifesting as extreme fatigue of the bones (Ying Gu Ji).
The head is the mansion of the spirit. If the head droops and the eyes are sunken, the spirit is about to escape. The back is the mansion of the chest organs. If the back is curved and the shoulders hang low, the internal organs are about to deteriorate. The waist is the mansion of the Kidneys. If turning and shaking is difficult, the Kidneys are about to be exhausted. The bones are the mansion of the marrow. If one cannot stand for long and trembles, the bones are about to be exhausted. The knees are the mansion of the sinews. If flexion and extension are impossible and walking results in stooping, the sinews are about to be exhausted.
First-degree damage affects the skin and hair: the skin gathers and hair falls out. Second-degree damage affects the blood vessels: the vessels become deficient and small, unable to nourish the internal organs. Third-degree damage affects the muscles: the muscles emaciate, and food cannot transform into flesh. Fourth-degree damage affects the sinews: the sinews relax and cannot hold themselves. Fifth-degree damage affects the bones: bone weakness prevents rising from bed. If the damage progresses from top to bottom, resulting in bone weakness preventing rising from bed, it is fatal. If the damage progresses from bottom to top, resulting in gathered skin and fallen hair, it is fatal. The Lungs govern the skin and hair; for Lung damage, tonify Qi. The Heart governs the blood vessels; for Heart damage, regulate Ying and Wei (nutritive and defensive Qi). The Spleen governs the muscles; for Spleen damage, regulate diet and adapt to cold and warmth. The Liver governs the sinews; for sinew damage, soothe the interior (emotions). The Kidneys govern the bones; for bone damage, benefit the essence. Worry and thought injure the Heart. Cold form and cold drinks injure the Lungs. Anger and reversed Qi injure the Liver. Improper diet and labor fatigue injure the Spleen. Sitting in dampness or entering water injures the Kidneys. Excess leads to harm; control brings balance. Extreme cold generates heat. Extreme heat generates cold. Extreme Wood resembles Metal. Extreme Fire resembles Water. Extreme Earth resembles Wood. Extreme Metal resembles Fire. Extreme Water resembles Earth.
The five depressions (Wu Yu) are treated by draining, breaking, reaching, dispersing, and seizing. "Reaching" for Wood depression means vomiting to allow free flow. "Dispersing" for Fire depression means sweating to allow dispersion. "Seizing" for Earth depression means purging to remove stagnation. "Draining" for Metal depression means渗利 (promoting urination) and releasing the exterior. "Breaking" for Water depression means suppressing to control rebellious Qi. Fullness and rebellion below the heart result from improper purging. Qi rushing to the chest and dizziness upon standing result from improper vomiting. Muscle twitching, fear of cold, and curled feet result from improper sweating.
Loss of Yang leads to seeing ghosts, as Qi fails to guard. Loss of Yin leads to blindness, as Blood fails to nourish. Excess Yang leads to mania, as Qi merges with Yang. Excess Yin leads to epilepsy, as Blood merges with Yin. Stagnant Qi that does not move indicates primary Qi disease. Obstructed Blood that does not moisten indicates secondary Blood disease. Disharmony of the Five Zang organs leads to blockage of the nine orifices. Disharmony of the Six Fu organs leads to fluid accumulation and obstruction. Hands that can flex but not extend indicate sinew disease. Hands that can extend but not flex indicate bone disease. Convulsions indicate tense and contracted sinews. Flaccidity indicates relaxed and extended sinews. Twitching involves alternating extension and contraction of limbs. Tongue protrusion without retraction indicates excess Yang. Tongue retraction and inability to speak indicate excess Yin.
Wind injury in spring leads to undigested diarrhea in summer. Summerheat injury in summer leads to malaria in autumn. Dampness injury in autumn leads to cough in winter. Cold injury in winter leads to warm diseases in spring. Wind is the leader of a hundred diseases. Feng Fei refers to inability to control the four limbs. Pian Ku refers to hemiplegia. Feng Yi refers to sudden unconsciousness. Feng Bi refers to bi-syndromes resembling wind patterns. Tan refers to flaccid paralysis where sinews are loose and cannot lift. Huan refers to涣散 (scattering) where Qi and Blood are dispersed and useless.
Taiyang disease presents with headache, fever, and stiff spine. Cold is the killing energy of heaven and earth. Yangming disease presents with eye pain, dry nose, and insomnia. Wind injury presents with fever, sweating, and aversion to wind. Cold injury presents with fever, no sweating, and aversion to cold. Shaoyang disease presents with deafness, hypochondriac pain, alternating chills and fever, vomiting, and bitter taste. Taiyin disease presents with abdominal fullness, spontaneous diarrhea, deep pulse at cun/guan/chest, and lack of fluids reaching the throat. Shaoyin disease presents with dry tongue and mouth. Jueyin disease presents with irritability, fullness, and contracted scrotum. Exterior heat feels like light covering (xi ran). Interior heat feels like steaming (zheng zheng). Stiff neck and back indicate Taiyang exterior pathogen. Aversion to wind indicates fear of wind. Fever with chills indicates onset in Yang. No fever with chills indicates onset in Yin. Alternating chills and fever indicates winning and losing between Yin and Yang. Irritable heat indicates heat transmitting to the interior.
Jian Jue is caused by hot Qi and overexertion. Bo Jue is caused by severe Qi rebellion. Xie Jie involves spinal pain, shortness of breath, and reluctance to speak. Inability to control limbs indicates Spleen disease. Rou Wei indicates numb muscles. Muscle writhing indicates Spleen heat.
The five drinks include Zhi Yin, Liu Yin, Tan Yin, Yi Yin, and Qi Yin. The five diarrheas include Pi Xie, Wei Xie, Da Chang Xie, Xiao Chang Xie, and Da Xia Xie. (Also includes Sun Xie, Dong Xie, Ru Xie, Tang Xie.) Pi Xie presents with abdominal distension and vomiting. Wei Xie presents with undigested food. Da Chang Xie presents with urgency after eating. Xiao Chang Xie presents with pus and blood in stool. Da Xia Xie presents with tenesmus. Tang Xie indicates Cold in the Large Intestine. Chang Gou indicates Heat in the Large Intestine. Sun Xie indicates undigested food due to Spleen disease. Pi Yue indicates hard stool and frequent urination. The five Ge include You, Hui, Han, Re, and Qi. The five Ye include You, Si, Lao, Shi, and Qi. The nine Qi include Xi, Nu, You, Si, Bei, Kong, Jing, Lao, Han, Shu. The five Ji are generated by the Five Zang. The six Ju are formed by the Six Fu.
Liver Ji is in the left hypochondrium, named Fei Qi. Lung Ji is in the right hypochondrium, named Xi Ben. Heart Ji is above the umbilicus, named Fu Liang. Kidney Ji is below the umbilicus, named Ben Tun. Spleen Ji is central, named Pi Qi. The five Dan include Huang Han, Huang Dan, Jiu Dan, Gu Dan, and Nv Lao Dan. The five Lun include Feng, Xue, Rou, Qi, and Shui. The eight Kuo include Tian, Di, Shui, Huo, Feng, Yun, Shan, Ze. The five Ying include Rou Ying, Jin Ying, Xue Ying, Qi Ying, and Shi Ying. The six Liu include Gu Liu, Zhi Liu, Rou Liu, Nong Liu, Xue Liu, and Shi Liu. The nine types of heart pain include Yin, Shi, Feng, Leng, Re, Ji, Chong, Zhu, and Qu Lai Tong. The seven Shan include Han, Shui, Jin, Xue, Qi, Hu, and Chuang. San Xiao mostly belongs to Blood deficiency. Shang Xiao is in the Lungs. Zhong Xiao is in the Stomach. Xia Xiao is in the Kidneys. The five Zhi include Pin, Mu, Xue, Mai, and Chang Zhi. The five Lin include Qi, Sha, Xue, Gao, and Lao. The five Bi include Pi Bi, Mai Bi, Ji Bi, Gu Bi, and Jin Bi. (Also include Tong Bi, Zhuo Bi, Xing Bi, Zhou Bi.) Tong Bi involves pulling pain in sinews and bones. Zhuo Bi is fixed and immobile. Xing Bi moves unpredictably. Zhou Bi involves whole-body pain.
Kidney transferring Cold to Liver causes abscesses and shortness of breath. Spleen transferring Cold to Liver causes abscesses and sinew spasms. Liver transferring Cold to Heart causes mania and chest obstruction. Heart transferring Cold to Lungs causes Lung Xiao. Lung Xiao involves drinking one part and urinating two parts; it is fatal and untreatable. Lung transferring Cold to Kidneys causes Yong Shui. Yong Shui presents with soft abdomen when pressed; water Qi resides in the Large Intestine, making gurgling sounds when walking fast, like a bag wrapping paste. This is a water disease. Spleen transferring Heat to Liver causes fright and epistaxis. Liver transferring Heat to Heart is fatal. Heart transferring Heat to Lungs transmits to Ge Xiao. Lung transferring Heat to Kidneys transmits to Rou Jing. Kidney transferring Heat to Spleen transmits to Xu Chang Pi, which is fatal and untreatable. Bladder transferring Heat to the Uterus causes Long and bloody urine. Bladder transferring Heat to the Small Intestine causes intestinal blockage and upper mouth ulcers. Small Intestine transferring Heat to the Large Intestine causes Xu Jia and Chen Shi. Large Intestine transferring Heat to the Stomach causes hunger with emaciation, called Shi Yi. Stomach transferring Heat to the Gallbladder is also called Shi Yi. Gallbladder transferring Heat to the Brain causes nasal pungency and Bi Yuan. Bi Yuan presents with continuous turbid discharge.
The five flavors are Xin, Gan, Ku, Suan, and Xian. Excessive Xin causes tight sinews and withered nails. Excessive Gan causes bone pain and hair loss. Excessive Ku causes withered skin and falling hairs. Excessive Suan causes calloused skin and peeling lips. Excessive Xian causes coagulated vessels and changed complexion. Wine has strong ascending Qi and is Yang. Meat has thick descending flavor and is Yin. Thin flavors are Yin within Yang. Thin flavors promote circulation; Suan, Ku, Ping, Xian belong here. Thick flavors are Yin within Yin. Thick flavors promote purging; Suan, Ku, Xian, Han belong here. Thin Qi is Yang within Yin. Thin Qi promotes excretion; Xin, Gan, Dan, Ping, Han, Liang belong here. Thick Qi is Yang within Yang. Thick Qi generates heat; Xin, Gan, Wen, Re belong here. Light and clear form images (like thin-flavored tea), originating from Heaven,亲近 superior. Heavy and turbid form shapes (like thick-flavored Rhubarb), originating from Earth,亲近 inferior. (Each follows its kind.) Xin and Gan flavors disperse and are Yang. Suan and Ku flavors induce vomiting and purging and are Yin. Clear Yang opens the Cou Li (clearest of clear). Clear Yang fills the four limbs (turbid among clear). Turbid Yin returns to the Six Fu (turbid among turbid). Turbid Yin travels to the Five Zang (clear among turbid).
The Seven Forms are Da, Xiao, Huan, Ji, Qi, Ou, and Fu. Da Form: One Sovereign, Three Ministers, Nine Assistants, large regulation. Xiao Form: One Sovereign, Two Ministers, small regulation. Huan Form: Tonifies upper/treats upper with slow action, thin flavor. Ji Form: Tonifies lower/treats lower with urgent action, thick flavor. Qi Form: Odd numbers (1 Sovereign 2 Ministers, etc.). Ou Form: Even numbers (2 Sovereigns 4 Ministers, etc.). Fu Form: If Qi form fails, use Ou form; this is a compound formula.
The Ten Agents include Xuan, Tong, Bu, Xie, Qing, Zhong, Hua, Se, Zao, Shi, Han, Re. Xuan removes stagnation (Ginger, Tangerine Peel). Tong removes obstruction (Akebia, Stephania). Bu removes weakness (Ginseng, Mutton). Xie removes closure (Descurainia, Rhubarb). Qing removes excess (Ephedra, Kudzu). Zhong removes timidity (Magnetite, Iron Slag). Hua removes adherence (Oriental Ladybell Seed, Elm Bark). Se removes leakage (Oyster Shell, Dragon Bone). Zao removes dampness (Mulberry Bark, Adzuki Bean). Shi (Moistening) removes dryness (White Quartz, Purple Quartz). Han removes heat (Rhubarb, Mirabilite). Re removes cold (Aconite, Cinnamon).
Diseases worsening by day and quiet by night indicate excess Yang, Qi disease only. Worsening by night and quiet by day indicate excess Yin, Blood disease only. Fever by day, quiet by night indicates Yang flourishing in Yang division. Quiet by day, fever/restlessness by night indicates Yang sinking into Yin (Re Ru Xue Shi). Fever/restlessness day and night indicates Re Yang without Yin (drain Yang, tonify Yin urgently). Chills by night, quiet by day indicates Yin/Blood flourishing in Yin division. Quiet by night, chills by day indicates Yin overflowing into Yang. Chills day and night indicates Re Yin without Yang (drain Yin, tonify Yang urgently). Chills by day, restlessness by night, inability to eat indicates Yin-Yang confusion, which is fatal.
Fire excess/Water deficiency is Yang excess/Yin deficiency, causing heat. Water excess/Fire deficiency is Yin excess/Yang deficiency, causing cold. White complexion indicates Lung Qi deficiency. Black complexion indicates Kidney Qi sufficiency. Fat people have much dampness. Thin people have much fire.
Exterior pathogens: release via sweating. Interior pathogens: purge via downward movement. High pathogens: induce vomiting. Fierce pathogens: gather via downward movement. Cold deficiency collapse of Zang: treat with moxibustion. Pulse-related spasm/bi: treat with acupuncture. Blood stasis/swelling/heat: treat with Bian stones. Qi stagnation/paralysis/cold-heat: treat with Dao Yin. Meridian blockage/numbness: treat with medicinal wine. Blood/Qi coagulation/sinew disease: treat with warming compresses.
Good walking relies on Marrow meeting Juegu. Bearing weight relies on Bones meeting Dazhu. Young adults sleeping deeply have excess Blood and deficient Qi. Elderly waking easily have excess Qi and deficient Blood. Poverty to wealth hurts the Heart with joy. Wealth to poverty creates stagnant fire. Kai Gui Men means sweating. Jing Jing Fu means promoting urination. For elderly/prolonged illness, tonify deficiency first. For young/new illness, attack pathogen primarily. Regulating diet is a good prescription for curing disease. Regulating Spleen and Stomach is the royal way of medicine.
Diagnosis by observation is Shen (Divine): observing five colors. Diagnosis by listening/smelling is Sheng (Sage): hearing five tones. Diagnosis by questioning is Gong (Worker): asking preferences for five flavors. Diagnosis by palpation is Qiao (Skillful): feeling pulses.
External contraction follows Zhang Zhongjing. Internal injury follows Li Dongyuan. Heat diseases follow Liu Hejian. Miscellaneous diseases follow Zhu Danxi. Understanding Gan, Zhong, Shang distinguishes root and branch severity. Clarifying Internal, External, Non-internal/external addresses Deficiency/Excess of Interior/Exterior. Respect seasonal Qi, do not violate Heavenly Harmony. Combining color and pulse ensures perfection. Heaven and Earth differ North/South; bodies differ Deficiency/Excess. Adaptation lies in change; enlightenment lies in the person. Medicine originates from Qi and Huang, a sacred art. Learning follows Confucius and Mencius, a benevolent heart. These are the firm words of sages, revered by physicians. They are the ladder for students, as described by Yunlin.