黄之类救之。舌生大红点者，热毒乘心也，导赤、犀角，加黄连、金汁治之，或稍加生大黄
汁利之。舌心绛干，乃胃热上铄心营，宜清心、胃；舌尖绛干，乃心火上炎，宜导赤以泻其
腑；舌绛而光亮，绛而不鲜，甚至干晦枯萎者，或淡而无色如猪腰样者，此胃、肝、肾阴涸
极，而舌无神气者也，急宜加减炙甘草汤，加沙参、玉竹、鸡子黄、生龟板等味，甘平濡润
以救之。黑为肾色，苔黑燥而浓，此胃肠邪结，伤及肾阴，急宜大承气咸苦下之；若黑燥而
不甚浓，调胃承气微和之，或增液承气垫下之；若舌淡黑，如淡墨色，而津不满者，此肾虚
无根之火上炎，急用复脉、生脉、六味辈救之；舌苔灰黑青黯而滑润者，及舌虽无苔不燥，
而有如烟煤隐隐者，无热不渴，或见肢凉，此虚寒证，水来克火之象，急宜理阴煎之类温之
。若舌短缩，为肝、肾气竭，难治。
看舌之后，又须验齿。齿为骨之余，龈为胃之络。燥热最烁胃津，并烁肾液。初起齿光
燥如石者，热烁肾阴也。若无汗、恶寒，乃寒燥之气搏束卫分所致，宜辛凉透汗，勿用滋腻
。初病齿流清血，痛者为胃火冲激，不痛者为龙火内烁，分虚实治之。齿焦而有垢者，胃热
烁肾阴也，当微下之；无下证者，宜玉女煎，清胃救肾。齿上半润、下半燥者，乃水不上承
，心火无济，宜清心滋水，枯处转润乃安。胃、肾二经之血，上走齿龈，病深动血，结瓣于
上，阳血色紫如干漆，阴血色黄如酱豆瓣，阳血滋胃为主，阴血救肾为要。然见豆瓣色者多
险，盖阴下竭，阳上厥也。齿垢如灰糕样者，乃胃气无权，湿浊用事，多死。齿无垢者死，
齿如枯骨者死，肾液涸而色不荣，而齿因无神气矣。切牙，有实有虚。切牙龈者，为湿热化
风。但切牙者，或痰热阻络，或胃腑热极，气走其络，皆欲作痉之象。或切牙而脉证皆衰，
或在下后，此胃虚无谷气以自荣，虚则喜实故也，速宜滋益胃阴。若下后牙关紧闭，为胃气
绝，不治。其有初病舌本不缩而硬，牙关咬定不开者，此痰热阻窍，先用乌梅擦之使开，（酸
能生津，又酸属木，木来泄土，故擦之即开）。再进清热化痰潜肝之剂。
肾开窍于二阴，前阴利水，后阴利谷。燥病溺多清黄，湿病溺多混浊，湿热、温邪，溺
多浑黄浑赤。其有病湿而溺不混浊者，在外感为邪郁气分，气不行水，以致湿热留而不行；
在内伤为气虚不能传化。若论大便，燥邪多硬，湿邪多溏，燥搏气机不能化水，又多窘迫下
利。伤寒化燥伤阴，下之宜猛；湿邪胶粘重浊，粪如败酱，下之宜轻。若春温、温疫、温热
，内有燥粪者，又当急下阳明以存津液。伤寒大便溏为邪已尽，若协热下利，及下利稀水色
纯青者，又当速下存津，不可误认为邪已尽。湿邪大便溏为邪未尽，必屎燥乃为无湿。若大
便尘腐散薄，完谷不化，而无气味，或如屋漏水者，此属败象，不可误认为邪未尽。总之，
经权常变，不可执一，互证旁参，乃有心得。
形窍望后，当审胸腹脏腑部位。胸中为肺之府，膻中为心之府，正在心下，有膈膜，旁
有胁肋，为肝胆之分野，此数者皆清气津液往来之所。其有胸痞者，湿阻气机也；胸痛者，
水结气分也，或肺气壅遏也。正在心下，以及胁肋硬痛者，乃湿热、痰饮、蓄水与气搏结使
然，非渣滓也。胃为中土，西学云∶胃横居膈下偏左，脘大向左，尾小向右（胃气故由右降）
。胃上口名曰贲门，其纹密，故食物易入而难出，非呕吐不开；胃下口名曰幽门，下达小肠
。小肠周回叠积，下抵小腹，小肠下口横接大肠。大肠分上、中、下三回，回长尺许。上回与
小肠横接，名曰阑门，其口如唇，渣滓可入不可出，上回由右胯内旁倒行而上；中回横过胃底
；下回至脾下，从左软胁斜落，下达广肠，以至魄门（魄门即肛门，与肺气贯通）。肝居膈下
，胃上，左右两大叶，左小右大，右大故稍偏膈肉右方，经故曰肝生于左，不曰肝藏于左。（经
曰∶肝生于左，肺藏于右）。凡肝有病，最为要害。肝叶撑张则胀，肝热血燥，经络凝滞不通
，下部回血壅胀，即有水血溢于夹膜之里，渐渍渐深，终成蛊胀，肚大筋青不治。
夫青筋，非筋也，血络也。青者，血燥而结也。此证多由怒郁伤肝所致，盖肝郁则热，
热则燥，燥则血不流通而结，血结则不独血滞于中，即水饮
亦无由吸摄，不能循其常道下输膀胱，故蛊胀多水。医者见水行水，不审水由肝血燥结所致
，所以不效。《易》曰∶山风蛊。艮为山，巽为风，艮上巽下则为蛊。古人取名为蛊，为其
燥木克土，象类山风之义。胆系肝右叶内，胆汁所以润肝而利肠也。肝性易燥，每取润于胆
汁。凡人食后，小肠饱满，肠头上逼胆囊，胆汁渍入肠内，利传渣滓。胆有热，则上呕苦涎
，热迫下行，则下泄青汁；胆受惊，亦泄青汁；肠有寒，渣滓不结，胆汁无所用事，亦致泻
青。胆络凝滞，胆汁入血，又多生黄病。肝胆经脉，由胁肋下抵小腹，绕阴器，故少腹属厥
阴经。肝经凝滞，则经脉结痛成疝；肝经血燥，则抽搐，燥甚则引舌与卵，故舌卷卵缩。脾
附于胃。西学谓脾居胃之左，在第九至十一肋骨之内，脾形如竖掌，与胃相连。胃脘大向左
，故曰脾居胃之左。外丰圆向胁，内深窝向胃，故曰脐以上属太阴经。脾质甚软，可小可大
，其用在集聚往来之血，为动脉宽间之地，经故曰脾统血。脾为胃行其津液，经故曰脾为之
使。人有疟疾，恶寒战栗，血脉不行于外，即缩于内，无所归藏则聚于脾，聚于脾则脾胀大
，脾胀大故人脘胁胀闷，迨疟止血行，其胀自消。久久不已，脾不输精，水与血结，成为疟
母。再久则湿去疟止，血燥成块，结于左肋，在体质壮者，人参鳖甲煎丸，取血肉飞走诸灵
，通和血络；若湿未去而疟未止者，取蒋氏夜光丸，通络燥湿。然此皆利于实而不利于虚也
。吾乡又多有痞块，亦生左肋下，世宗越人“肥气”之说，后人又妄制五积丸药，一派消
削攻下，多致人于死。不知五积与疟母之推移不动者，皆由血络燥结所致，血燥而至于结块，
则营气不得行于其间，故按之坚硬不痛。治法皆以润为主，或温润，或清润，视其人之寒热
用之；再佐咸润以软之，辛润以通之；有湿者，佐苦辛以化之，自无不效之理。又脾络燥结
，即有血水渗泄于下，蛊胀之源，间发于此。此由思虑伤脾所致，思则气结，气结则血亦结
，结则血、水不循常道，而蛊成焉。蛊胀总不外肝、脾二经血络燥结所致。观此而蛊取山风
之义，更可知矣。蛊胀末路，肌肉消瘦，皮肤干黑，青络暴露，皆燥象也，非有目所共睹者
哉！肾居脊骨第十四节陷中（从上数下在十四节；从下数上，在第七节。经曰∶七节之傍，中
有小心是也）。与精液总管相通，经故曰肾藏精。三焦经在右肾傍，化水而通水道，经故曰
肾主水，肾开窍于二阴。肾与天枢穴通，故曰当脐属少阴经。膀胱在前阴交骨之里。西学谓
膀胱内有精囊，有精、溺两管，内底有两小窍，斜与肾通。按∶男子精、溺管，至前阴会而
为
，津液藏焉，气化则能出矣。夫所谓津者，溺是也；液者，日生之精是也。气化者，三焦之
气化也。彼西学之说，尚与经义不悖。脏腑部位体用如此，知此则知病之所在矣。
然病有诸内，必形诸外，更当即着于外者言之。燥病或肌肤刺痛，手不可扪；或项背强
痛，甚痛筋挛发痉，手足牵引，口噤，头摇，面黑，毛焦，唇反，眼戴，舌卷，囊缩；又有
肠拘似块，伛偻难伸，及骨痿、偏枯等证。凡物干则必缩，干则必硬，干则必动，干则必痿
，理固然也，在人亦然。湿病则头目昏重，肢体困倦、酸疼，嗜卧懒动，甚则神智昏沉，如
痴如醉。凡物滥则必重，滥则必软，滥则必混浊而不清明，理固然也，在人亦然。燥热必烦
而动，身热，口渴，揭去衣被，扬手掷足，寻衣摸席，撮空理线（此条非大实，即大虚，总
以苔、脉、神色为凭）；脉来沉实有力，舌苔黄浓，阳也，热也，实也。寒湿必倦而静，无
热，不渴，欲得衣被；或身重，足冷，蜷卧，恶寒；或好向壁卧，闭目不欲见光明，懒
与人言，脉来软滥无力，舌苔色白，阴也，寒也，虚也。然则燥湿、寒热、虚实，不皆即外
可知其内乎？
而犹不止此，盖人身之所守，莫重于五脏，而身之所主，尤莫重于一心。心也者，神气
之所由生者也，顾不重哉？试以燥湿言之。燥属天气，天气为清邪，清邪不昏人神智，故风
燥、寒燥、暑燥初起，令人心知所苦，如头痛、寒热，皆自知之。惟邪来迅速，直传心包者
，乃有内闭神昏之候；或邪传胃腑，与浊滞相合，又令谵语、神昏。湿属地气，地气为浊邪
，浊邪最昏人神智，往往温病初起，即令人神气异常，昏糊烦躁，不知所苦；间有神清而能
自主者，梦寐亦多不安，闭目即有所见，有所见即谵妄之根原；又有病初起时，神智惊惶，
目光外浮，反自云无病，病深时犹能行走，而身体强直（脉病患不病，谓之行尸，不治），此真
阴涸极，病陷于中，神浮于外，最深最重者也，多属不治。
然此就心之一脏言之也，试再言五脏。经曰∶五脏者，身之强也。头者精明之府，头倾
视深，精神将夺矣。背者胸中之府，背曲肩随，府将坏矣。腰者肾之府，转摇不能，肾将惫
矣。膝者筋之府，屈伸不能，行则偻俯，筋将惫矣。骨者髓之府，不能久立，行则振掉，骨
将惫矣。得强者生，失强者死。又曰∶手太阴气绝则皮毛焦，太阴者行气温于皮毛者也，气
不荣则皮毛焦，皮毛焦则津液去皮节，津液去皮节则爪枯毛折，毛折者毛先死，丙笃，丁死
，火胜金也。手少阴气绝则脉不通，脉不通则血不流，血不流则毛色不泽，故其面黑如漆柴
者血先死，壬笃，癸死，水胜火也。足太阴气绝则脉不荣肌肉，唇舌者肌肉之本也，脉不荣
则肌肉软，肌肉软则舌萎、人中满，人中满则唇反，唇反者肉先死，甲笃，乙死，木胜土也
。足少阴气绝则骨枯，少阴者冬脉也，伏行而濡骨髓者也，骨不濡则肉不能着，骨肉不相亲
则肉软却，肉软却故齿长而垢、发无泽，发无泽者骨先死，戊笃，己死，土胜水也。足厥阴
气绝则筋绝，厥阴者肝脉也，肝者筋之合也，筋聚于阴器，而脉络于舌本，脉不荣则筋急，
筋急则引舌与卵，故唇青、舌卷、卵缩，则筋先死，庚笃，辛死，金胜木也。五阴气俱绝则
目系转，转则目运（五脏之精华，皆上聚于目）。目运者志先死，志先死则远一日半死矣。六
阳气绝则阴与阳相离，离则腠理发泄，绝汗乃出（如珠不流），故旦占夕死，夕占旦死。又曰
∶太阳之脉其终也，戴眼（上视），反折（身反向后），螈 （手足抽掣），其色白，绝汗乃出，
出则死矣。少阳终者，耳聋，百节皆纵（缓纵不收，筋痿故也），目环（目运转），绝系，绝系
一日半死，色先青，白乃死矣（金胜木）。阳明终者，口目动作，善惊，妄言，色黄，其上下
经盛，不仁（肉绝），则终矣。少阴终者，面黑，齿长（牙龈宣露）而垢，腹胀闭，上下不通而
终矣（肾开窍于二阴）。太阴终者，腹胀闭，不得息，善呕，呕则逆，逆则面赤，不逆则上下
不通，不通则面黑、皮毛焦而终矣。厥阴终者，中热，嗌干，善溺，心烦，甚则舌卷、卵缩
而终矣。又曰∶大骨枯槁（肾衰），大肉陷下（脾衰），胸中气满，喘息不便，其气动形（肺衰）
，其六月死，真脏脉见，乃与之期日。凡若此者，皆阴液绝于内，而神气夺于外者也。其论
少阴、太阴上下不通两条，乃邪实正虚，正不胜邪，阴液涸极之故。故经又有五实死、五虚
死之说。曰∶脉盛（心实），皮热（肺实），腹胀（脾实），前后不通（肾实），闷瞀（肝实），此谓
五实；脉细（心虚），皮寒（肺虚），气少（肝虚），泄利前后（肾虚），饮食不入（脾虚），此谓五
虚。浆粥入胃，泄注止，则虚者活；身汗得后利（表里皆解），则实者活。是虚者，以脾、肾
为主；实者，以表里得解，邪有出路为主。此诊外感、内伤之大法也。
别有急虚身中卒至（急邪乘虚卒中身内），五脏绝闭，脉道不通，气不往来，譬于堕溺，
不可为期。此不可责之于望也，外此皆可望而知之者也，故曰望而知之之谓神。
用甘缓的药物来救治它。舌面上出现大红点的，是热毒侵犯心经，可用导赤散、犀角（现多用水牛角代替），加入黄连、金汁治疗，或者稍加生大黄汁以通利大便。舌中心绛红且干燥的，是胃热上灼心营，应当清泄心和胃的热邪；舌尖绛红且干燥的，是心火上炎，宜用导赤散清泻小肠腑热；舌色绛红而光亮，或绛红但不鲜亮，甚至干枯晦暗枯萎的，或者颜色淡而无血色像猪腰子一样的，这是胃、肝、肾阴液枯竭到了极点，舌象失去神气的表现，急需使用加减炙甘草汤，加入沙参、玉竹、鸡蛋黄、生龟板等药物，用甘平濡润的方法急救。黑色对应肾脏的颜色，舌苔黑而干燥浓厚，这是胃肠邪气结聚，损伤了肾阴，急需大承气汤咸苦攻下；如果黑燥但不是很浓厚，用调胃承气汤轻微调和，或者用增液承气汤垫底攻下；如果舌色淡黑，像淡墨色，且津液不足的，这是肾虚导致无根之火上浮，急需复脉汤、生脉散、六味地黄丸之类救治；舌苔灰黑青暗且滑润的，以及舌面虽然无苔但不干燥，而有像烟煤一样隐隐出现的，没有热象也不口渴，或者见到四肢发凉，这是虚寒证，是水气克制火气的征象，急需理阴煎之类的温补。如果舌头短缩，是肝、肾气竭的表现，难以治疗。
看舌之后，又必须检查牙齿。齿为骨之余，龈为胃之络。燥热最容易灼伤胃津，并灼伤肾液。初起时牙齿光亮干燥如石头般的，是热邪灼伤肾阴。如果没有汗、恶寒，是寒燥之气束缚卫分所致，宜用辛凉透汗的方法，不要用滋腻的药物。初病时牙齿流出清血，疼痛的是胃火冲激，不疼痛的是龙雷之火内烁，需分辨虚实进行治疗。牙齿焦黑且有垢秽的，是胃热灼伤肾阴，应当轻微攻下；没有可下之证的，宜用玉女煎，清胃救肾。牙齿上半部分湿润、下半部分干燥的，是水气不能上承，心火无法济助，宜清心滋水，待枯处转润才安稳。胃、肾二经的血，上行至齿龈，病深动血，凝结成瓣在上部，阳血色紫如干漆，阴血色黄如酱豆瓣，治阳血以滋养胃为主，治阴血以救肾为要。然而见到豆瓣色的大多危险，这是因为阴精在下枯竭，阳气在上厥逆。齿垢像灰糕样的，是胃气无权，湿浊盛行，多致死。齿无垢的死亡，齿像枯骨的死亡，肾液枯竭而色泽不荣，牙齿因此失去神气。咬牙，有实有虚。咬牙龈的，是湿热化风。只是咬牙的，或是痰热阻滞经络，或是胃腑热极，气走其络，都是将要发生痉病的征象。或者咬牙而脉证都衰弱的，或者在攻下之后，这是胃虚无谷气以自养，虚则喜实的原因，速宜滋益胃阴。如果在攻下后牙关紧闭，是胃气绝，不可治。那些初病舌本不短缩而僵硬，牙关咬定不开的，这是痰热阻窍，先用乌梅擦拭使其张开，（酸能生津，又酸属木，木来泄土，所以擦拭即开）。再进清热化痰潜肝的药物。
肾开窍于前后二阴，前阴主利水，后阴主利谷。燥病小便多清黄，湿病小便多混浊，湿热、温邪，小便多浑黄浑赤。有的患湿病而小便不混浊的，在外感是因为邪气郁结气分，气不行水，以致湿热停留而不行；在内伤是因为气虚不能传化。若论大便，燥邪多硬，湿邪多溏，燥邪搏结气机不能化水，又多窘迫下利。伤寒化燥伤阴，攻下宜猛；湿邪胶粘重浊，粪便如败酱，攻下宜轻。如果是春温、温疫、温热，内有燥粪的，又当急下阳明以保存津液。伤寒大便溏说明邪气已尽，如果是协热下利，以及下利稀水色纯青的，又当速下存津，不可误认为邪已尽。湿邪大便溏说明邪气未尽，必须等到屎燥才表示无湿。如果大便像尘腐散薄，完谷不化，而没有气味，或者像屋漏水的，这属于败象，不可误认为邪气未尽。总之，经权常变，不可执一，互证旁参，乃有心得。
观察形体和孔窍之后，应当审查胸腹脏腑部位。胸中是肺的府舍，膻中是心的府舍，正在心下，有膈膜，旁边有胁肋，是肝胆的分野，这些部位都是清气津液往来的地方。如果有胸痞的，是湿阻气机；胸痛的是水结气分，或者是肺气壅遏。正在心下，以及胁肋硬痛的，是湿热、痰饮、蓄水与气搏结使然，不是渣滓。胃为中土，西学说：胃横居膈下偏左，脘大向左，尾小向右（胃气故由右降）。胃上口名叫贲门，其纹密，所以食物易入而难出，非呕吐不开；胃下口名叫幽门，下达小肠。小肠周回叠积，下抵小腹，小肠下口横接大肠。大肠分上、中、下三回，回长尺许。上回与小肠横接，名叫阑门，其口如唇，渣滓可入不可出，上回由右胯内旁倒行而上；中回横过胃底；下回至脾下，从左软胁斜落，下达广肠，以至魄门（魄门即肛门，与肺气贯通）。肝居膈下，胃上，左右两大叶，左小右大，右大故稍偏膈肉右方，经书所以说肝生于左，不说肝藏于左。（经书说：肝生于左，肺藏于右）。凡是肝有病，最为要害。肝叶撑张则胀，肝热血燥，经络凝滞不通，下部回血壅胀，就有水血溢于夹膜之里，渐渍渐深，终成蛊胀，肚大筋青不治。
所谓青筋，不是筋，是血络。青者，是血燥而结。此证多由怒郁伤肝所致，盖肝郁则热，热则燥，燥则血不流通而结，血结则不独血滞于中，即水饮也无由吸摄，不能循其常道下输膀胱，所以蛊胀多水。医者见水行水，不审水由肝血燥结所致，所以不效。《易经》说：山风蛊。艮为山，巽为风，艮上巽下则为蛊。古人取名为蛊，因为其燥木克土，象类山风之义。胆系在肝右叶内，胆汁所以润肝而利肠也。肝性易燥，每取润于胆汁。凡人食后，小肠饱满，肠头上逼胆囊，胆汁渍入肠内，利传渣滓。胆有热，则上呕苦涎，热迫下行，则下泄青汁；胆受惊，亦泄青汁；肠有寒，渣滓不结，胆汁无所用事，亦致泻青。胆络凝滞，胆汁入血，又多生黄病。肝胆经脉，由胁肋下抵小腹，绕阴器，所以少腹属厥阴经。肝经凝滞，则经脉结痛成疝；肝经血燥，则抽搐，燥甚则引舌与卵，所以舌卷卵缩。脾附于胃。西学谓脾居胃之左，在第九至十一肋骨之内，脾形如竖掌，与胃相连。胃脘大向左，所以说脾居胃之左。外丰圆向胁，内深窝向胃，所以说脐以上属太阴经。脾质甚软，可小可大，其用在集聚往来之血，为动脉宽间之地，经书所以说脾统血。脾为胃行其津液，经书所以说脾为之使。人有疟疾，恶寒战栗，血脉不行于外，即缩于内，无所归藏则聚于脾，聚于脾则脾胀大，脾胀大人就脘胁胀闷，等到疟止血行，其胀自消。久久不已，脾不输精，水与血结，成为疟母。再久则湿去疟止，血燥成块，结于左肋，在体质壮者，用人参鳖甲煎丸，取血肉飞走诸灵，通和血络；如果湿未去而疟未止者，取蒋氏夜光丸，通络燥湿。然而这些都利于实而不利于虚。我家乡又多有痞块，也生左肋下，世宗越人“肥气”之说，后人又妄制五积丸药，一派消削攻下，多致人于死。不知道五积与疟母之推移不动者，皆由血络燥结所致，血燥而至于结块，则营气不得行于其间，所以按之坚硬不痛。治法皆以润为主，或温润，或清润，视其人之寒热用之；再佐咸润以软之，辛润以通之；有湿者，佐苦辛以化之，自无不效之理。又脾络燥结，就有血水渗泄于下，蛊胀之源，间发于此。这是由思虑伤脾所致，思则气结，气结则血亦结，结则血、水不循常道，而蛊成焉。蛊胀总不外肝、脾二经血络燥结所致。观此而蛊取山风之义，更可知矣。蛊胀末路，肌肉消瘦，皮肤干黑，青络暴露，皆燥象也，非有目所共睹者哉！
肾居脊骨第十四节陷中（从上数下在十四节；从下数上，在第七节。经书说：七节之傍，中有小心是也）。与精液总管相通，经书所以说肾藏精。三焦经在右肾傍，化水而通水道，经书所以说肾主水，肾开窍于二阴。肾与天枢穴通，所以说当脐属少阴经。膀胱在前阴交骨之里。西学谓膀胱内有精囊，有精、溺两管，内底有两小窍，斜与肾通。按：男子精、溺管，至前阴会而为，津液藏焉，气化则能出矣。夫所谓津者，溺是也；液者，日生之精是也。气化者，三焦之气化也。彼西学之说，尚与经义不悖。脏腑部位体用如此，知此则知病之所在矣。
然而病有诸内，必形诸外，更当即着于外者言之。燥病或肌肤刺痛，手不可扪；或项背强痛，甚痛筋挛发痉，手足牵引，口噤，头摇，面黑，毛焦，唇反，眼戴，舌卷，囊缩；又有肠拘似块，伛偻难伸，及骨痿、偏枯等证。凡物干则必缩，干则必硬，干则必动，干则必痿，理固然也，在人亦然。湿病则头目昏重，肢体困倦、酸疼，嗜卧懒动，甚则神智昏沉，如痴如醉。凡物滥则必重，滥则必软，滥则必混浊而不清明，理固然也，在人亦然。燥热必烦而动，身热，口渴，揭去衣被，扬手掷足，寻衣摸席，撮空理线（此条非大实，即大虚，总以苔、脉、神色为凭）；脉来沉实有力，舌苔黄浓，阳也，热也，实也。寒湿必倦而静，无热，不渴，欲得衣被；或身重，足冷，蜷卧，恶寒；或好向壁卧，闭目不欲见光明，懒与人言，脉来软滥无力，舌苔色白，阴也，寒也，虚也。那么燥湿、寒热、虚实，不皆即外可知其内乎？
而且不止于此，盖人身之所守，莫重于五脏，而身之所主，尤莫重于一心。心也者，神气之所由生者也，顾不重哉？试以燥湿言之。燥属天气，天气为清邪，清邪不昏人神智，所以风燥、寒燥、暑燥初起，令人心知所苦，如头痛、寒热，皆自知之。惟邪来迅速，直传心包者，乃有内闭神昏之候；或邪传胃腑，与浊滞相合，又令谵语、神昏。湿属地气，地气为浊邪，浊邪最昏人神智，往往温病初起，即令人神气异常，昏糊烦躁，不知所苦；间有神清而能自主者，梦寐亦多不安，闭目即有所见，有所见即谵妄之根原；又有病初起时，神智惊惶，目光外浮，反自云无病，病深时犹能行走，而身体强直（脉病患不病，谓之行尸，不治），此真阴涸极，病陷于中，神浮于外，最深最重者也，多属不治。
然而此就心之一脏言之也，试再言五脏。经书说：五脏者，身之强也。头者精明之府，头倾视深，精神将夺矣。背者胸中之府，背曲肩随，府将坏矣。腰者肾之府，转摇不能，肾将惫矣。膝者筋之府，屈伸不能，行则偻俯，筋将惫矣。骨者髓之府，不能久立，行则振掉，骨将惫矣。得强者生，失强者死。又说：手太阴气绝则皮毛焦，太阴者行气温于皮毛者也，气不荣则皮毛焦，皮毛焦则津液去皮节，津液去皮节则爪枯毛折，毛折者毛先死，丙笃，丁死，火胜金也。手少阴气绝则脉不通，脉不通则血不流，血不流则毛色不泽，故其面黑如漆柴者血先死，壬笃，癸死，水胜火也。足太阴气绝则脉不荣肌肉，唇舌者肌肉之本也，脉不荣则肌肉软，肌肉软则舌萎、人中满，人中满则唇反，唇反者肉先死，甲笃，乙死，木胜土也。足少阴气绝则骨枯，少阴者冬脉也，伏行而濡骨髓者也，骨不濡则肉不能着，骨肉不相亲则肉软却，肉软却故齿长而垢、发无泽，发无泽者骨先死，戊笃，己死，土胜水也。足厥阴气绝则筋绝，厥阴者肝脉也，肝者筋之合也，筋聚于阴器，而脉络于舌本，脉不荣则筋急，筋急则引舌与卵，故唇青、舌卷、卵缩，则筋先死，庚笃，辛死，金胜木也。五阴气俱绝则目系转，转则目运（五脏之精华，皆上聚于目）。目运者志先死，志先死则远一日半死矣。六阳气绝则阴与阳相离，离则腠理发泄，绝汗乃出（如珠不流），故旦占夕死，夕占旦死。又说：太阳之脉其终也，戴眼（上视），反折（身反向后），螈 （手足抽掣），其色白，绝汗乃出，出则死矣。少阳终者，耳聋，百节皆纵（缓纵不收，筋痿故也），目环（目运转），绝系，绝系一日半死，色先青，白乃死矣（金胜木）。阳明终者，口目动作，善惊，妄言，色黄，其上下经盛，不仁（肉绝），则终矣。少阴终者，面黑，齿长（牙龈宣露）而垢，腹胀闭，上下不通而终矣（肾开窍于二阴）。太阴终者，腹胀闭，不得息，善呕，呕则逆，逆则面赤，不逆则上下不通，不通则面黑、皮毛焦而终矣。厥阴终者，中热，嗌干，善溺，心烦，甚则舌卷、卵缩而终矣。又说：大骨枯槁（肾衰），大肉陷下（脾衰），胸中气满，喘息不便，其气动形（肺衰），其六月死，真脏脉见，乃与之期日。凡若此者，皆阴液绝于内，而神气夺于外者也。其论少阴、太阴上下不通两条，乃邪实正虚，正不胜邪，阴液涸极之故。故经又有五实死、五虚死之说。曰：脉盛（心实），皮热（肺实），腹胀（脾实），前后不通（肾实），闷瞀（肝实），此谓五实；脉细（心虚），皮寒（肺虚），气少（肝虚），泄利前后（肾虚），饮食不入（脾虚），此谓五虚。浆粥入胃，泄注止，则虚者活；身汗得后利（表里皆解），则实者活。是虚者，以脾、肾为主；实者，以表里得解，邪有出路为主。此诊外感、内伤之大法也。
别有急虚身中卒至（急邪乘虚卒中身内），五脏绝闭，脉道不通，气不往来，譬于堕溺，不可为期。此不可责之于望也，外此皆可望而知之者也，所以说望而知之之谓神。
Use sweet and緩 (Gān Huǎn, sweet and relaxing) herbs to rescue it. If there are large red spots on the tongue, it indicates heat-toxin invading the Heart meridian; treat with Dao Chi San (Coptis Decoction), Xi Jiao (Rhinoceros Horn, now often substituted with Shui Niu Jiao/Buffalo Horn), add Huang Lian (Coptis Rhizome) and Jin Zhi (Gold Juice), or slightly add Sheng Da Huang Zhi (Raw Rheum Juice) to promote bowel movement. If the center of the tongue is crimson and dry, it signifies Stomach heat scorching the Ying level of the Heart; clear the heat of the Heart and Stomach. If the tip of the tongue is crimson and dry, it indicates Heart fire flaming upward; use Dao Chi San to drain the Fu organ (Small Intestine). If the tongue is crimson and glossy, or crimson but not fresh, even dry, dull, and withered, or pale without color resembling a pig's kidney, this represents extreme depletion of Yin in the Stomach, Liver, and Kidney, and the tongue has lost its Shen Qi (Spiritual Energy); urgently use Jia Jian Zhi Gan Cao Tang (Modified Licorice Decoction), adding Sha Shen (Glehnia Root), Yu Zhu (Polygonatum Odoratum Rhizome), Ji Zi Huang (Egg Yolk), and Sheng Gui Ban (Tortoise Plastron), using sweet, neutral, and moistening methods to rescue. Black corresponds to the Kidney color. If the coating is black, dry, and thick, it indicates pathogenic accumulation in the intestines and stomach damaging Kidney Yin; urgently use Da Cheng Qi Tang (Major Order the Qi Decoction) with salty and bitter purgatives. If black and dry but not very thick, use Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction) to gently harmonize, or Zeng Ye Cheng Qi Tang (Increase Fluids Order the Qi Decoction) as a base for purging. If the tongue is pale black like light ink and lacks fluids, it indicates floating of rootless fire due to Kidney deficiency; urgently use Mai Mai Tang (Pulse Restoring Decoction), Sheng Mai San (Generate the Pulse Powder), Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia), etc. If the coating is gray-black, dark green, and slippery/moist, or if there is no coating but it is not dry, showing a faint smoke-like coal pattern, with no heat sensation or thirst, or cold limbs, this is a deficiency-cold syndrome, a sign of Water overcoming Fire; urgently warm with Li Yin Jian (Decocting Yin Decoction). If the tongue is short and retracted, it indicates exhaustion of Qi in the Liver and Kidney, which is difficult to treat.
After observing the tongue, one must examine the teeth. Teeth are the surplus of bone, and gums are the network vessels of the Stomach. Dryness-heat easily scorches Stomach fluids and Kidney fluids. Initially, if teeth are shiny and dry like stone, it is heat scorching Kidney Yin. If there is no sweat and aversion to cold, it is caused by cold-dryness binding the Wei Defense level; use acrid-cool methods to induce sweating, do not use cloying/nourishing herbs. In early disease, if clear blood flows from teeth, pain indicates Stomach fire rushing up; lack of pain indicates Dragon Fire (Ministerial Fire) scorching internally; treat according to excess and deficiency. If teeth are scorched black with debris, it is Stomach heat scorching Kidney Yin; mildly purge if indicated; if no purge indication exists, use Yu Nu Jian (Jade Woman Decoction) to clear Stomach heat and rescue Kidney Yin. If the upper half of the teeth is moist and the lower half is dry, it signifies Water failing to ascend and Heart fire failing to assist; clear the Heart and nourish Water until the dry areas become moist for safety. Blood from the Stomach and Kidney meridians ascends to the gums. Deep disease moving blood forms clots on the upper part: Yang blood is purple like dried lacquer, Yin blood is yellow like soybean paste. Treating Yang blood focuses on nourishing the Stomach; treating Yin blood focuses on rescuing the Kidney. However, seeing soybean-paste color is often dangerous, indicating exhaustion of Yin below and rebellion of Yang above. Debris on teeth resembling gray cake indicates Stomach Qi lacking authority and damp-turbidity prevailing, often fatal. No debris indicates death; teeth like dead bone indicate death; Kidney fluid exhaustion leads to lack of luster, and the teeth lose their Shen Qi. Clenching teeth can be excess or deficiency. Clenching the gums indicates damp-heat transforming into wind. Only clenching teeth may indicate phlegm-heat blocking collaterals or extreme Stomach heat causing Qi to move through collaterals, all signs of impending spasms. If clenching occurs with weak pulse and symptoms, or after purgation, it is because Stomach deficiency lacks grain Qi to nourish itself; deficiency tends to seek excess, so quickly nourish Stomach Yin. If jaw locks after purgation, it indicates Stomach Qi exhaustion, untreatable. If initially the tongue root is stiff but not short, and the jaw is locked shut, this is phlegm-heat blocking orifices; first wipe with Mei Gu (Mume Fruit) to open it (Sour generates fluids, and sour belongs to Wood, Wood drains Earth, so wiping opens it). Then administer clearing heat, resolving phlegm, and subduing Liver herbs.
The Kidney opens into the two yin passages (anterior and posterior). The anterior passage governs water excretion, and the posterior passage governs food residue. In dryness diseases, urine is often clear-yellow; in dampness diseases, urine is often turbid; in damp-heat or warm pathogens, urine is often turbid yellow or red. Some dampness diseases have non-turbid urine; in external contraction, this is due to pathogen stagnating in the Qi level, preventing Qi from moving water, causing damp-heat to linger; in internal injury, it is due to Qi deficiency failing to transform. Regarding stool, dryness pathogens cause hardness, dampness pathogens cause looseness. Dryness binding Qi mechanism fails to transform water, often causing urgent diarrhea. In Shang Han (Cold Damage) transforming into dryness and damaging Yin, purgation should be vigorous. Dampness pathogens are sticky, heavy, and turbid, with stool like spoiled sauce; purgation should be mild. For Chun Wen (Spring Warmth), Wen Yi (Warm Pestilence), or Wen Re (Warm Heat), if there is dry feces inside, urgently purge the Yangming to preserve fluids. In Shang Han, loose stool means pathogens are exhausted; however, if there is diarrhea with fever or watery stool pure green, urgently purge to preserve fluids, do not mistake this for pathogens being exhausted. Loose stool in dampness diseases means pathogens are not exhausted; only when stool becomes dry is dampness gone. If stool is like dust/rot, thin, undigested, odorless, or like roof leak water, this is a collapse sign, do not mistake it for pathogens remaining. In summary, principles and adaptations vary; do not adhere rigidly, cross-reference and compare to gain insight.
After observing form and orifices, examine the chest, abdomen, and zang-fu locations. The chest is the mansion of the Lung; Dan Zhong (Conception Vessel 17) is the mansion of the Heart; directly below the heart, separated by the diaphragm, with hypochondriac regions on sides, these are the domains of the Liver and Gallbladder. These areas are where clear Qi and body fluids circulate. Chest fullness indicates dampness blocking Qi mechanism; chest pain indicates water accumulation in the Qi level or Lung Qi congestion. Hardness and pain directly below the heart and in the hypochondrium result from damp-heat, phlegm-fluid, water retention, and Qi knotting, not from solid waste. The Stomach is Central Earth. Western medicine states the Stomach lies horizontally below the diaphragm, slightly left, with the greater curvature to the left and lesser to the right (Stomach Qi descends from the right). The upper opening is called the Cardia, with tight folds, allowing food entry but making exit difficult unless vomiting; the lower opening is the Pylorus, leading to the Small Intestine. The Small Intestine loops and piles, reaching the lower abdomen, connecting transversely to the Large Intestine at its lower end. The Large Intestine has three turns, each about a chi long. The upper turn connects transversely to the Small Intestine at the Lan Men (Gate of Iris), whose mouth is lip-like, allowing waste in but not out; the upper turn runs up beside the right hip. The middle turn crosses over the stomach bottom. The lower turn goes under the Spleen, slopes down from the soft left hypochondrium, reaches the Chang Chang (Large Intestine terminal), and finally to the Po Men (Anus, connected to Lung Qi). The Liver sits below the diaphragm and above the Stomach, with two large lobes, left small and right large; the right lobe is slightly to the right of the diaphragm muscle, hence the Classic says "Liver arises on the left," not "stored on the left" (Classic: "Liver arises on the left, Lung stores on the right"). Liver disease is critical. Liver lobe distension causes bloating; Liver heat and blood dryness cause collateral stasis, lower return blood congestion, leading to water/blood overflowing into the peritoneal cavity, gradually deepening into Gu Zhang (Ascites/Tympanites), with large belly and visible veins, untreatable.
Qing Jin (Green Veins) are not sinews but blood collaterals. Green indicates blood dryness and knotting. This condition often results from anger/stagnation injuring the Liver. Liver stagnation causes heat, heat causes dryness, dryness causes blood stasis and knotting. When blood knots, not only does blood stagnate internally, but also water drinks cannot be absorbed and transported normally to the Bladder, hence Gu Zhang often involves water. Physicians who see water and treat water, without recognizing it stems from Liver blood dryness/knotting, fail. The I Ching says: Mountain Wind Gu. Gen is Mountain, Xun is Wind; Gen above, Xun below is Gu. Named Gu because dry Wood overcomes Earth, resembling mountain wind. The Gallbladder system is within the right liver lobe; bile moistens the Liver and benefits the Intestines. Liver nature easily dries, relying on bile for moisture. After eating, the Small Intestine fills, pressing the Gallbladder head, soaking bile into the intestine to transport waste. Gallbladder heat causes bitter saliva vomiting or downward pressure causing green juice diarrhea; Gallbladder fright also causes green juice diarrhea; Intestine cold prevents waste coagulation, bile is unused, also causing green diarrhea. Gallbladder collateral stasis allows bile into blood, often causing Jaundice. Liver/Gallbladder meridians run from hypochondrium to lower abdomen, winding around genitalia, so lower abdomen belongs to Jueyin Meridian. Liver meridian stasis causes hernia pain; Liver blood dryness causes spasms; extreme dryness pulls tongue and testicles, causing tongue retraction and testicular shrinkage. The Spleen attaches to the Stomach. Western medicine places Spleen left of Stomach, within 9th-11th ribs, shaped like an upright palm, connected to Stomach. Stomach curvature left implies Spleen is left of Stomach. Outer round toward hypochondrium, inner hollow toward Stomach, so umbilicus-above belongs to Taiyin Meridian. Spleen tissue is soft, variable size, function gathers circulating blood, acting as reservoir for arteries, hence Classic says "Spleen controls blood." Spleen transports fluids for Stomach, hence "Spleen is its envoy." Malaria patients with chills/shivering have blood retreating inward, gathering in Spleen, causing Spleen enlargement, epigastric/hypochondriac fullness; once malaria stops and blood flows, swelling subsides. Chronic cases, Spleen fails to transport essence, water/blood knot, forming Nu Mu (Malaria Mass). Later, dampness clears, malaria stops, blood dries into mass, knotting in left hypochondrium. In robust constitutions, use Ren Shen Bie Jia Jian Wan (Ginseng and Turtle Shell Decoction) using animal substances to unblock collaterals; if dampness remains and malaria persists, use Jiang Shi Ye Guang Wan (Jiang Family Night-Shining Pill) to unblock collaterals and dry dampness. These suit excess, not deficiency. My hometown has many masses in left hypochondrium, referencing Bo Zu's "Fei Qi"; later generations wrongly made Wu Ji Wan (Five Accumulations Pill), using draining/purgative herbs, often fatal. They do not know Wu Ji and immovable Nu Mu stem from blood collateral dryness/knotting; blood dryness forming masses blocks Ying Qi circulation, feeling hard and painless. Treatment focuses on moistening, either warm-moistening or cool-moistening based on cold/heat; assist with salty-moistening to soften, acrid-moistening to unblock; if dampness, assist with bitter-acrid to transform, always effective. Spleen collateral dryness/knotting causes blood/water leakage downward, source of Gu Zhang, sometimes originating here. Caused by overthinking injuring Spleen; thinking knots Qi, Qi knotting knots Blood, Blood/Water fail normal paths, forming Gu. Gu Zhang ultimately stems from Liver/Spleen blood collateral dryness/knotting. Observing this, the Gu meaning of Mountain Wind is clearer. Terminal Gu Zhang shows emaciation, dry black skin, exposed blue veins, all dryness signs, obvious to eyes.
Kidney sits in depression of 14th thoracic vertebra (counting down 14, up 7). Connected to Essence总管, hence "Kidney stores Essence." Sanjiao Meridian is beside right Kidney, transforms water and opens waterways, hence "Kidney governs water, opens to two yin." Kidney connects to Tian Shu point, so umbilicus belongs to Shaoyin Meridian. Bladder is inside pubic symphysis anteriorly. Western medicine says bladder has seminal vesicles, sperm/urine tubes, two small apertures at base obliquely connecting to Kidney. Note: Male sperm/urine tubes meet at anterior yin, storing fluids, transformed by Qi to exit. Jin (thin fluids) is urine; Ye (thick fluids) is daily generated essence. Qi transformation is Sanjiao Qi transformation. Western view aligns with Classic. Knowing zang-fu structure/function locates disease.
Diseases within manifest externally. Dryness disease: skin prickling pain, unbearable to touch; neck/back stiffness/pain, severe spasms, limb traction, lockjaw, head shaking, black face, dry hair, inverted lips, staring eyes, rolled tongue, contracted scrotum; intestinal cramping like mass, stooping difficulty, bone weakness, hemiplegia. Dry things contract, harden, move, wither; same for humans. Dampness disease: heavy head/eyes, tired/sore limbs, lethargy, severe mental confusion like drunkenness. Wet things are heavy, soft, turbid; same for humans. Dry-heat causes restlessness/movement, fever, thirst, removing clothes, flailing arms/legs, picking at air/bedsheets (indicates extreme excess or deficiency, judge by tongue/pulse/color): pulse deep/excess/powerful, yellow thick coating, Yang/Heat/Excess. Cold-damp causes fatigue/stillness, no fever/thirst, desire for clothes; or heavy body/cold feet, curled sleeping, aversion to cold; or preferring wall-facing, closed eyes avoiding light, reluctant to speak: pulse soft/weak, white coating, Yin/Cold/Deficiency. Thus, dry/damp, cold/heat, excess/deficiency are known externally.
Moreover, Five Zang are vital guards, Heart is paramount master. Heart generates Shen Qi. Consider dry/damp. Dryness is Heaven Qi, clear pathogen, does not confuse Shen, so initial Wind/Cold/Summerheat dryness allows knowing suffering (headache, fever/chills). Rapid pathogens transmitting directly to Pericardium cause internal closure/Shen confusion; or transmitting to Stomach combining with turbidity causes delirium/confusion. Dampness is Earth Qi, turbid pathogen, confuses Shen most. Early warm disease often causes abnormal Shen, confusion/restlessness, unknown suffering; some clear-headed but restless sleep, closed-eye visions lead to delirium; some initial panic, floating gaze, claiming no illness, walking while stiff in deep disease (pulse sick, person healthy = Walking Corpse, untreatable), this is extreme True Yin exhaustion, disease sinking, Shen floating, deepest/heaviest, often untreatable.
Speaking of Heart, consider Five Zang. Classic: Five Zang are strength of body. Head is mansion of clarity; head drooping/deep eyes, Spirit will be taken. Back is mansion of chest; curved back/drooping shoulders, mansion will fail. Waist is mansion of Kidney; unable to twist/turn, Kidney will be exhausted. Knees are mansion of sinews; unable to bend/extend, stooping when walking, sinews will be exhausted. Bones are mansion of marrow; unable to stand long, trembling when walking, bones will be exhausted. Strength brings life, loss brings death. Hand-Taiyin Qi exhaustion: skin/hair dry. Taiyin warms skin; Qi failing nourishes skin drying, fluids leaving joints, nails withering/hair breaking; hair dies first, Bing day severe, Ding day dead, Fire overcomes Metal. Hand-Shaoyin Qi exhaustion: vessels blocked, blood not flowing, hair/luster lost, face black like lacquered wood; blood dies first, Ren day severe, Gui day dead, Water overcomes Fire. Foot-Taiyin Qi exhaustion: vessels not nourishing muscle, lips/tongue root of muscle; vessels failing, muscle soft, tongue atrophy/glabella full, glabella full, lips inverted; meat dies first, Jia day severe, Yi day dead, Wood overcomes Earth. Foot-Shaoyin Qi exhaustion: bones withered. Shaoyin is Winter pulse, hidden nourishing marrow; bones not nourished, flesh not attaching, flesh soft/receding, teeth long/filthy, hair lusterless; bone dies first, Wu day severe, Ji day dead, Earth overcomes Water. Foot-Jueyin Qi exhaustion: sinews severed. Jueyin is Liver pulse, Liver combines sinews, sinews gather at genitalia, connect to tongue root; vessels failing, sinews tense, pulling tongue/testicles, cyan lips/rolled tongue/testicular shrinkage; sinews die first, Geng day severe, Xin day dead, Metal overcomes Wood. All five Yin Qi exhausted: eye axis turns, vision spins (essence gathers in eyes). Vision spinning, Zhi (Will) dies first, dies in 1.5 days. Six Yang Qi exhausted: Yin/Yang separate, pores open, absolute sweat (beads not flowing), morning diagnosed evening dies, evening diagnosed morning dies. Taiyang meridian end: staring up, opisthotonos, convulsions, white color, absolute sweat, death. Shaoyang end: deafness, all joints lax, rolling eyes, severed connection, dies in 1.5 days, color first green then white (Metal overcomes Wood). Yangming end: mouth/eye twitching, fear, delirium, yellow color, upper/lower vessels full, insensible (flesh exhausted), death. Shaoyin end: black face, long filthy teeth, abdominal fullness/blockage, upper/lower blockage, death. Taiyin end: abdominal fullness/blockage, breathing difficulty, frequent vomiting, reverse flow, red face, or blockage, black face/dry skin, death. Jueyin end: internal heat, dry throat, frequent urination, irritability, severe tongue retraction/testicular shrinkage, death. Great bones withered (Kidney failure), great muscles sunken (Spleen failure), chest full, breathing difficult, Qi moves form (Lung failure), dies in six months, true Zang pulse appears, predict date. All these: Yin fluid exhausted internally, Shen Qi seized externally. Shaoyin/Taiyin blockage lines indicate pathogen excess/deficiency weak, Yin fluid exhausted. Classic mentions Five Excess Death/Five Deficiency Death. Pulse strong (Heart excess), skin hot (Lung excess), abdomen full (Spleen excess), front/back blocked (Kidney excess), oppression/dizziness (Liver excess) = Five Excess. Pulse fine (Heart def), skin cold (Lung def), Qi few (Liver def), diarrhea/front/back (Kidney def), no food intake (Spleen def) = Five Deficiency. Porridge enters stomach, diarrhea stops, deficient live; Sweat obtained, bowels free (exterior/interior resolved), excess live. Deficiency focuses on Spleen/Kidney; Excess focuses on exterior/interior resolution/pathogen exit. This is major method for external/internal diagnosis.
Sudden acute deficiency struck internally, Five Zang closed, vessels blocked, Qi not circulating, like falling/drowning, cannot predict. This cannot be judged by observation; others can be observed, hence "Observing knows is called Divine."