五脏各有所主，至其病证莫不随所主而见焉。面赤喜笑，舌破口干，烦躁掌热，心痛而
哕，脐上有动气者，心家病也。面青多怒，胁下痛硬，咳逆目眩，肢节挛急，转筋溲难，脐
左有动气者，肝家病也。（肝乘脾挟水气，故咳逆。足厥阴下终于阴器，故溲难。）面黑而恐，
呵欠呻吟，齿痛骨痿，耳鸣精泄，足胫寒，腰脊痛，小腹急疼，瘕泄而里急后重，脐下有动
气者，肾家病也。面白善嚏，忧愁欲哭，喘嗽气逆，咽喉不利，洒淅恶寒，时作寒热，脐右
有动气者，肺家病也。面黄、善思、善噫、善嗜，中脘胀满，饮食不消，身体肿重，肢节酸
疼
肾受病则耳不能听，脾受病则口不能食，心受病则舌不能举。五脏病证，以此观之，不待智
者而后知矣。然而，心之恶热者何？热则脉溃浊也。肝之恶风者何？风则筋燥急也。肾何以
恶燥？燥则精涸竭也。肺何以恶寒？寒则气留滞也。脾何以恶湿？湿伤肌肉，肉伤则痿肿也。
五脏之病，推原及本，安有不从所受中来哉？是以脏气有余谓之实，脏气不足谓之虚。心实
之候∶口干，喜笑，身热，汗血，痛满乎胛胁膺背之间。肝实之候∶目赤，多怒，头眩，耳
聋，痛引乎两胁小腹之下。肾实之候∶腹膨，体肿，少气不言，骨痛，飧泄而小便黄。肺实
之候∶喘促咳嗽，上气鼻张，胫股肩疼而胸中满。脾气一实，必至肢体重着而不举，腹胀，
尿秘而苦饥。故曰脏气有余谓之实者，此也。心虚则恍惚，多惊，忧烦，少色，咳唾，舌强
，腰背酸疼。肝虚则眼昏，胸痛，筋胁拘挛，恐惧面青，如人将捕。肾虚则心悬如饥，胸痛
引脊，厥逆，溲变， 冷，耳鸣。肺虚则呼吸少气，鼻涕，嗌干，肺中声鸣，喘之咳血。（
唾中有红缕者，此肺损，为热气所伤也。若胁下痛而唾鲜血者，此热气伤肝也。）其或吐逆
泄利，饮食不消，腹胀肠鸣，四肢无力，则脾虚之证生焉。故曰脏气不足谓之虚者，此也。
大抵实者泻之，虚者补之，无过不及，以平为期。否则实实虚虚，损不足而益有余。如东坡
先生所谓至虚有盛势，大实有羸状。差之毫厘，疑似之间，便有死生祸福之畏。吁！何畏哉？
至若心病而直视，面黧，肝病而舌卷、囊缩，肾病而腰折、骨枯，肺病而毛焦、气出，脾病
而脐突、唇反，此则五脏之气绝也。绝者无复生之理，脱遇岐、扁亦未如之何。虽然，病亦
有虚实之证不同耳。邪气盛则实，精气夺则虚。脉盛、皮热、腹胀、前后不通曰五实；脉细、
皮寒、气少、前后泄利、饮食不进曰五虚。诸病出者为虚，入者为实；（阴出乘阳，阳入乘
阴。）言者为虚，不言者为实；缓者为虚，急者为实；（阴主静则缓，阳主躁则急。）濡者为
虚，坚者为实；痒者为虚，痛者为实。外痛内快者，外实内虚；外快内痛者，外虚内实。其
有心腹、皮肤内外俱痛，则按之而止者虚也，按之而痛者实也。经所谓∶皮虚则热，脉虚则
惊，肉虚则重，筋虚则急，骨虚则痛，髓虚则堕，肠虚则溏泄。三阳实三阴虚，汗不出；三
阴实三阳虚，汗不止。与夫脉浮而缓，自汗恶风，法当解肌；脉浮而紧，无汗恶寒，法当发
汗，此表病之一虚一实。脉伏而牢，腹痛秘结，法当下之；脉沉而弱，厥冷自利，法当温之
，此里病之一实一虚。内实之证，心下牢强，腹中痛满，前后不通，干呕而无物出者，死。
内虚之证，厥逆烦躁而吐，利不止者，亡。是又不可不知也。故并及之。
五脏各自有所主，至于它们的病证，无不随着所主的脏腑而显现。面色红赤、喜欢笑、舌体破损、口干、烦躁、手掌发热、心痛并伴有呃逆、脐上有搏动感的人，是心脏的疾病。面色青紫、易怒、胁下疼痛且硬满、咳嗽气逆、头晕目眩、四肢关节拘挛抽搐、转筋、小便困难、脐左侧有搏动感的人，是肝脏的疾病。（肝木乘克脾土兼挟水气，所以出现咳嗽气逆。足厥阴肝经下行终止于阴器，所以出现小便困难。）面色黑、恐惧、呵欠呻吟、牙齿疼痛、骨骼痿弱、耳鸣、精液外泄、足胫寒冷、腰脊疼痛、小腹部急痛、瘕积泄泻且伴有里急后重感、脐下有搏动感的人，是肾脏的疾病。面色白、容易打喷嚏、忧愁想哭、气喘咳嗽气逆、咽喉不利、洒淅恶寒、时而发作寒热、脐右侧有搏动感的人，是肺脏的疾病。面色黄、多思虑、多嗳气、嗜睡、中脘部胀满、饮食不消化、身体浮肿沉重、四肢关节酸痛。
肾脏受病则耳朵不能听，脾脏受病则口不能进食，心脏受病则舌头不能灵活转动。通过观察上述五脏的病证，不需要智者也能明白。然而，心脏为什么厌恶热邪呢？因为热邪会使血脉溃乱浑浊。肝脏为什么厌恶风邪呢？因为风邪会使筋脉干燥紧急。肾脏为什么厌恶燥邪呢？因为燥邪会使精气枯竭。肺脏为什么厌恶寒邪呢？因为寒邪会使气机留滞。脾脏为什么厌恶湿邪呢？因为湿邪损伤肌肉，肌肉受损就会痿软肿胀。推究五脏疾病的本源，难道不是从所受邪气的性质中来的吗？因此，脏气有余称为实，脏气不足称为虚。
心脏实的表现：口干，喜笑，身热，汗血，胸膺背部及两胁之间感到疼痛胀满。肝脏实的表现：眼睛红赤，多怒，头晕，耳聋，疼痛牵引至两胁和小腹之下。肾脏实的表现：腹部膨隆，身体浮肿，少气懒言，骨骼疼痛，完谷不化的泄泻且小便黄。肺脏实的表现：喘促咳嗽，气逆鼻张，小腿大腿及肩部疼痛且胸中满闷。脾气实，必然导致肢体沉重难以抬起，腹胀，尿闭且苦于饥饿（似饥非饥）。所以说脏气有余称为实，就是这种情况。
心脏虚的表现：神志恍惚，易惊，忧烦，面色无华，咳唾，舌体僵硬，腰背酸痛。肝脏虚的表现：眼昏花，胸痛，筋脉和胁部拘挛，恐惧面色青，感觉像被人追捕一样。肾脏虚的表现：心中空虚如饥，胸痛牵引至脊柱，四肢厥冷，小便异常，耳鸣。肺脏虚的表现：呼吸短气，流鼻涕，咽喉干燥，肺中有鸣响，喘息咳血。（唾液中带有血丝的，这是肺脏受损，被热邪所伤。如果胁下疼痛且吐出鲜血的，这是热邪伤了肝脏。）如果出现呕吐逆气、泄利、饮食不消化、腹胀肠鸣、四肢无力，则是脾脏虚的症状。所以说脏气不足称为虚，就是这种情况。
大抵实证用泻法，虚证用补法，不要过度也不要不及，以平衡为准则。否则就会导致实者更实、虚者更虚，损害不足的正气而增加有余的邪气。正如苏东坡先生所说：“至虚有盛势，大实有羸状。”在毫厘之差、疑似之间，便涉及生死祸福的畏惧。唉！多么令人畏惧啊！
至于心脏疾病出现两眼直视、面色黧黑；肝脏疾病出现舌卷缩、睾丸上缩；肾脏疾病出现腰部折断感、骨骼枯槁；肺脏疾病出现毛发焦枯、气息外脱；脾脏疾病出现肚脐突出、嘴唇反翻，这些都是五脏之气绝灭的表现。气绝就没有再生的道理，即使遇到扁鹊这样的神医也无能为力。虽然如此，疾病也有虚实证候的不同。邪气盛实称为实，精气耗夺称为虚。脉象盛大、皮肤发热、腹部胀满、大小便不通称为五实；脉象细弱、皮肤发冷、气短、大小便泄利、饮食不进称为五虚。诸病由内出外的为虚，由外入内的为实；（阴气外出乘袭阳气，阳气内入乘袭阴气。）能言语的为虚，不能言语的为实；脉势缓的为虚，脉势急的为实；（阴主静故脉缓，阳主动故脉急。）脉濡软的为虚，脉坚硬的为实；瘙痒的为虚，疼痛的为实。外部疼痛内部舒适的，是外实内虚；外部舒适内部疼痛的，是外虚内实。如果心腹、皮肤内外都疼痛，按压后疼痛停止的是虚证，按压后疼痛加剧的是实证。经文说：皮虚则热，脉虚则惊，肉虚则重，筋虚则急，骨虚则痛，髓虚则堕，肠虚则溏泄。三阳经实而三阴经虚，则无汗；三阴经实而三阳经虚，则汗出不止。以及脉浮而缓，自汗恶风，治法应当解肌；脉浮而紧，无汗恶寒，治法应当发汗，这是表证的一虚一实。脉伏而牢，腹痛便秘，治法应当攻下；脉沉而弱，四肢厥冷自利，治法应当温补，这是里证的一实一虚。内实的证候，心下坚硬强痛，腹中疼痛胀满，大小便不通，干呕却无物吐出，预后不良（死）。内虚的证候，四肢厥冷烦躁且呕吐，泄利不止，预后极差（亡）。这些又是不可不知晓的。所以一并论述。
Each of the Five Zang organs has its specific dominion, and their pathological manifestations invariably appear according to the affected organ. Red complexion, excessive laughter, cracked tongue, dry mouth, irritability, heat in the palms, heart pain accompanied by hiccups, and pulsation above the umbilicus indicate a disease of the Heart (Xin). Cyan complexion, frequent anger, painful hardness in the hypochondrium, cough with rebellious Qi, dizziness, spasms and cramps of the limbs and joints, difficult urination, and pulsation to the left of the umbilicus indicate a disease of the Liver (Gan). (Liver Wood overacting on Spleen Earth with retained fluid causes cough and rebellious Qi. The Foot Jueyin Liver meridian terminates at the genitalia, causing difficult urination.) Black complexion, fearfulness, yawning and groaning, toothache, bone weakness, tinnitus, seminal emission, coldness of the lower legs, pain in the waist and spine, acute pain in the lower abdomen, abdominal masses with diarrhea and tenesmus, and pulsation below the umbilicus indicate a disease of the Kidney (Shen). White complexion, frequent sneezing, sorrow and desire to cry, asthma and cough with rebellious Qi, throat obstruction, aversion to wind and cold, alternating chills and fever, and pulsation to the right of the umbilicus indicate a disease of the Lung (Fei). Yellow complexion, excessive thinking, frequent belching, somnolence, fullness in the epigastrium, indigestion, generalized edema and heaviness, and soreness and pain in the limbs and joints.
When the Kidney is diseased, hearing is impaired; when the Spleen is diseased, eating is impaired; when the Heart is diseased, tongue movement is impaired. Observing the pathological manifestations of the Five Zang organs as described above, one does not need wisdom to understand them. However, why does the Heart dislike Heat? Because Heat causes blood vessels to become disordered and turbid. Why does the Liver dislike Wind? Because Wind causes tendons to become dry and tense. Why does the Kidney dislike Dryness? Because Dryness causes essence to be depleted. Why does the Lung dislike Cold? Because Cold causes Qi stagnation. Why does the Spleen dislike Dampness? Because Dampness damages muscles; damaged muscles lead to flaccidity and swelling. Tracing the origin of diseases of the Five Zang organs, do they not all arise from the nature of the pathogenic factors received? Therefore, excess of Zang Qi is termed Excess (Shi), and deficiency of Zang Qi is termed Deficiency (Xu).
Manifestations of Heart Excess: dry mouth, excessive laughter, body heat, hematuria or bleeding from sweat, pain and fullness in the chest, epigastrium, back, and between the ribs. Manifestations of Liver Excess: red eyes, irritability, dizziness, deafness, pain radiating to both hypochondria and lower abdomen. Manifestations of Kidney Excess: abdominal distension, bodily swelling, shortness of breath and reluctance to speak, bone pain, undigested stool in diarrhea, and yellow urine. Manifestations of Lung Excess: rapid breathing and cough, rebellious Qi with nasal flaring, pain in calves, thighs, and shoulders, and fullness in the chest. When Spleen Qi is in Excess, it inevitably leads to heavy limbs that are difficult to lift, abdominal distension, urinary retention, and a sensation of hunger that is distressing. Thus, "excess of Zang Qi is termed Excess" refers to this.
Manifestations of Heart Deficiency: mental confusion, frequent fright, anxiety and vexation, lack of luster in the complexion, coughing and spitting, stiff tongue, and soreness and pain in the waist and back. Manifestations of Liver Deficiency: blurred vision, chest pain, stiffness and spasms of tendons and hypochondrium, fearfulness with cyan complexion, feeling as if being hunted. Manifestations of Kidney Deficiency: sensation of emptiness in the heart like hunger, chest pain radiating to the spine, cold extremities, abnormal urination, and tinnitus. Manifestations of Lung Deficiency: shortness of breath, runny nose, dry throat, wheezing sounds in the lungs, asthma, and hemoptysis. (Red threads in sputum indicate lung damage due to Heat injuring the tissue. If there is pain under the hypochondrium and expectoration of fresh blood, this indicates Heat injuring the Liver.) If vomiting, diarrhea, indigestion, abdominal distension with borborygmus, and weakness of the four limbs occur, these are manifestations of Spleen Deficiency. Thus, "deficiency of Zang Qi is termed Deficiency" refers to this.
Generally, Excess conditions are treated with draining methods, and Deficiency conditions with tonifying methods. One must avoid excess and insufficiency, aiming for balance. Otherwise, one may cause the Excess to become more Excess and the Deficiency to become more Deficient, damaging what is insufficient and augmenting what is already excessive. As Mr. Su Dongpo stated, "Extreme Deficiency may present with vigorous symptoms, and extreme Excess may present with emaciated signs." A difference of a hair's breadth, amidst seemingly similar conditions, can determine life or death, fortune or disaster. Alas! How fearful this is!
Regarding Heart disease presenting with fixed staring and darkened complexion; Liver disease with curled tongue and retracted testicles; Kidney disease with sensation of broken waist and withered bones; Lung disease with withered hair and escaping Qi; Spleen disease with protruding umbilicus and inverted lips—these represent the exhaustion of the Qi of the Five Zang organs. Exhaustion implies no possibility of recovery; even if met with masters like Qibo or Bian Que, nothing can be done. Nevertheless, diseases also differ in their Excess and Deficiency patterns. Abundant pathogenic Qi constitutes Excess; depleted vital Essence constitutes Deficiency. Pulse surging, skin hot, abdomen full, and blockage of anterior and posterior orifices constitute the Five Excesses; pulse fine, skin cold, shortness of breath, diarrhea of anterior and posterior orifices, and inability to eat constitute the Five Deficiencies. Diseases emerging from within are Deficiency; entering from without are Excess. (Yin exiting to attack Yang, Yang entering to attack Yin.) Ability to speak is Deficiency; inability to speak is Excess. Slow pulse is Deficiency; rapid/tense pulse is Excess. (Yin is quiet thus slow; Yang is active thus tense.) Soft pulse is Deficiency; firm pulse is Excess. Itching is Deficiency; pain is Excess. Pain externally but comfort internally indicates External Excess and Internal Deficiency; comfort externally but pain internally indicates External Deficiency and Internal Excess. If there is pain inside and out in the heart/abdomen and skin, relief upon pressure indicates Deficiency; increased pain upon pressure indicates Excess. The Classics state: Skin Deficiency leads to heat; Pulse Deficiency leads to fright; Muscle Deficiency leads to heaviness; Tendon Deficiency leads to spasms; Bone Deficiency leads to pain; Marrow Deficiency leads to collapse; Intestine Deficiency leads to loose stools. Three Yang Excess and Three Yin Deficiency result in no sweating; Three Yin Excess and Three Yang Deficiency result in incessant sweating. Furthermore, floating and slow pulse with spontaneous sweating and aversion to wind requires muscle-releasing methods; floating and tight pulse with no sweating and aversion to cold requires diaphoretic methods. This represents the Excess and Deficiency of Exterior diseases. Deep and firm pulse with abdominal pain and constipation requires purgative methods; deep and weak pulse with cold extremities and spontaneous diarrhea requires warming methods. This represents the Excess and Deficiency of Interior diseases. In cases of Internal Excess, hardness and strength below the heart, abdominal pain and fullness, blockage of anterior and posterior orifices, and dry heaving without expulsion indicate a fatal prognosis. In cases of Internal Deficiency, cold extremities, restlessness, vomiting, and unceasing diarrhea indicate demise. These are also matters that must not be ignored. Hence, they are discussed together.