夫百病之生也，皆生于风、寒、暑、湿、燥、火，以之化之变也。（气之正者为化，气之邪者为变，
故曰“之化之变”也。）盛者泻之，虚者补之，审察病机，无失气宜。（病随气动，必察其机，治
之得要，是无失也。）诸风掉眩，皆属于肝；（风类不一，故曰“诸风”。掉，摇也。眩，运也。风主动摇，
木之化也，故属于肝。其虚其实，皆能致此。如发生之纪，其动掉眩巅疾；厥阴之复，筋骨掉眩之类者，肝
之实也。又如阳明司天，掉振鼓栗，筋痿不能久立者，燥金之盛，肝受邪也；太阴之复，头顶痛重而掉螈
尤甚者，木不制土，湿气反胜，皆肝之虚也。下虚则厥，上虚则眩，实者宜凉宜泻，虚则宜补宜温。反
而为之，祸不旋踵矣。余治仿此。掉，提料切。）诸寒收引，皆属于肾；（收，敛也。引，急也。肾属水，
其化寒。凡阳气不达则荣卫凝聚，形体拘挛，皆收引之谓。如太阳之胜为筋肉拘苛，血脉凝泣。岁水太过为
阴厥，为上下中寒。水之实也；岁水不及为足痿清厥，涸流之纪，其病癃闭，水之虚也。水
之虚实，皆本于肾。）诸气 郁，皆属于肺；（ ，喘急也。郁，痞闷也。肺属金，其化燥。燥金盛则清邪
在肺而肺病有余，如岁金太过，甚则喘咳逆气之类是也；金气衰则火邪胜之而肺病不足，如从革之纪，其发喘
咳之类是也。肺主气，故诸气 郁者，其虚其实，皆属于肺。 ，音愤。）诸湿肿满，皆属于脾；（脾属土，
其化湿，土气实则湿邪盛行，如岁土
太过，则饮发中满食减，四肢不举之类是也。土气虚则风木乘之，寒水侮之∶如岁木太过，脾土受邪，民病
肠鸣，腹支满，卑监之纪，其病留满痞塞；岁水太过，甚则腹大胫肿之类是也。脾主肌肉，故诸湿肿满等症，
虚实皆属于脾。）诸热瞀螈，皆属于火；（瞀，昏闷也，螈，抽掣也。邪热伤神则瞀，亢阳伤血则螈，故皆
属于火，然岁火不及，则民病两臂内痛，郁冒蒙昧；岁火太过则民病身热、烦心、躁悸、渴而妄冒，此又火
之所以有虚实也。）诸痛痒疮，皆属于心；（热甚则痛，热微则痒。心属火。其化热，故疮疡皆属于心也。
然赫曦之纪，其病疮疡，心邪盛也；太阳司天，亦发为痈疡，寒水胜也。火盛则心实，水胜则心虚，于此
可见。）诸厥固泄，皆属于下；（厥，逆也。厥有阴阳二证∶阳衰于下，则为寒厥；阴衰于下，则为热厥。
固，前后不通也。阴虚则无气，无气则清浊不化，寒闭也；火盛则水亏，水亏则精液干涸，热结也，泄，二阴
不固也。命门火衰，则阳虚失禁，寒泄也；命门水衰，则火迫注遗，热泄也。下，肾也。盖肾居五脏之下，
为水火阴阳之宅，开窍于二阴，故诸厥固泄，皆属于下。）诸痿喘呕，皆属于上；（痿有筋痿、脉痿、骨痿、
肉痿之辨，故曰“诸痿”。凡肢体痿弱，多在下部，而曰“属于上”者，如五脏使人痿者，因肺热叶焦，发
为痿 也。肺居上焦，故属于上。气急曰喘，病在肺也。吐而有物有声曰“呕”，病在胃口也。逆而不降，
是皆上焦之病。）诸禁鼓栗，如丧神守，皆属于火；（禁，噤也。寒厥切牙曰“禁”，鼓，鼓颔
也。栗，战也。凡病寒战，而精神不能主持，如丧失神守者，皆火之病也。然火有虚实之辨，若表里热甚而
外生寒栗者，所谓热极生寒，重阳必阴也。心火热甚，亢极而战，反兼水化制之，故为寒栗者，皆言火之实也。
若阴盛阳虚而生寒栗者，阳虚畏外寒，阴胜则为寒，寒则真气去，去则虚，虚则寒搏于皮肤之间，皆言火
之虚也，有伤寒将解而为战汗者，其人本虚，是以作战。有 疟之为寒栗者，疟之发也，始则阳并于阴，既
则阳复阴仇，并于阳则阳胜，并于阴则阴胜，阴胜则寒，阳胜则热，更寒更热，
更实更虚也。由此观之，可见诸禁鼓栗，虽皆属火，必有虚实之分耳。）诸痉项强，皆属于湿；（痉，风强病
也。项为足之太阳，湿兼风化，而侵寒水之经，湿之极也，然太阳所至，为屈伸不利；太阳之复，为腰 反
痛，屈伸不便者，是又为寒水反胜之虚邪矣。痉，音敬。）诸逆冲上，皆属于火；（火性炎上，故诸逆冲
上者，皆属于火。然诸脏诸经，皆有逆气，则其阴阳虚实有不同矣，其在心、脾、胃者，太阴所谓“上走
心为噫”者。阴盛而上走于阳明，阳明络属心，故曰“上走心为噫”也。有在肺者，肺苦气上逆也；有在
脾者，足太阴厥气上逆，则霍乱也；有在肝者，肝脉若搏，令人喘逆也；有在肾者，少阴所谓“呕咳上气喘
者，阴气在下，阳气在上，诸阳气浮，无所根据从”也；有在奇经者，如冲脉为病，逆气里急，督脉生病，
从少腹上冲心而痛，不得前后为冲疝也。凡此者，皆诸逆冲上之病，虽诸冲上皆属于火，但阳盛者火之实，
阳衰者火之虚，治分补泻，于此详之。）诸胀腹大，皆属于热；（热气内盛者，在肺则胀于上，在脾
胃则胀于中，在肝肾则胀于下。此以火邪所至，乃为烦满，故曰“诸胀腹大，皆属于热”。如岁火太过，民
病胁支满；少阴司天，肺 ，腹大满，膨膨而喘咳；少阳司天，身面 肿，腹满仰息之类，皆实热也。然岁
水太过，民病腹大胫肿；岁火不及，民病胁支满，胸腹大，流衍之纪，其病胀。水郁之发，善厥逆，痞坚
腹胀。太阳之胜，腹满食减；阳明之复，为腹胀而泄。又如适寒凉者胀，脏寒生满病，胃中寒则胀满，是皆言
热不足，寒有余也。腹满不减，减不足言，须当下之，宜与大承气汤，言实胀也；腹胀时减，复如故，此为
寒，当与温药，言虚胀也，治此者，不可不察也。）诸躁狂越，皆属于火；（躁，烦躁不宁也。狂，狂乱也，越，
失常度也。热盛于外，则肢体躁扰；热盛于内，则神志燥烦。盖火入于肺则烦，火入于肾则躁。烦为热之轻，
躁为热之甚耳。如少阴之胜，心下热，呕逆躁烦；少阳之复，心热躁烦；便数憎风之类，是皆火胜之躁也，然
有所谓阴躁者，如岁水太过，寒气流行，邪害心火，民病心热、烦心、躁悸、阴厥、
谵妄之类，阴之胜也，是为阴盛发躁，名曰“阴躁”。凡内热而躁者，有邪之热也，病多属火；外热而躁者，
无根之火也，病多属寒，此所以热躁宜寒，阴躁宜热也。狂，阳病也。邪入于阳则狂，重阳者狂，如赫曦之纪，
血流狂妄之类，阳狂也。然复有虚狂者，如悲哀动中则伤魂，魂伤则狂妄不精；喜乐无极则伤魄，魄伤则狂。
狂者意不存人，阳重脱者阳狂，石之则阳气虚，虚则狂，是狂亦有虚实，补泻不可误用也。）诸暴强直，皆属
于风；（暴，猝也。强直，筋病，强劲不柔和也，肝主筋，其化风。风气有余，如木郁之发，善暴僵仆之类，
肝邪实也；风气不足，如委和之纪，其动 戾拘缓之类，肝气虚也。此皆肝木本气之化，故曰“属风”，非外来
虚风、八风之谓，凡诸病风而筋为强急者，正以风位之下，金气乘之，燥随风生，其燥益甚，治宜补阴以制阳，
养营以润燥，故曰∶“治风先治血，血行风自灭。”此最善之法也。设误认为外感之邪，而用疏风愈风等剂，
则益燥其燥，非惟不能去风，而适所以致风矣。）诸病有声，鼓之如鼓，皆属于热；（鼓之如鼓，胀而有声也。
为阳气所逆，故属于热。然胃中寒则腹胀，肠中寒则肠鸣飧泄，中气不足，肠为之苦鸣，此又皆寒胀之有声
者也。）诸病 肿，疼酸惊骇，皆属于火；（ 肿，浮肿也。 肿疼酸者，阳实于外，火在经也。惊骇不
宁者，热乘阴分，火在脏也。故如少阴、少阳司天，皆为疮疡、 肿之类，是火之实也。然伏明之纪，其
发痛；太阳司天为 肿，身后痈；太阴所至为重 肿；太阳在泉，寒复内余则腰尻、股胫、足膝中痛之类，
皆以寒湿之胜，而为肿为痛，是又火之不足也。至于惊骇，虚实亦然，如少阴所至为惊骇，君火盛也；若委和
之纪，其发惊骇；阳明之复，亦为惊骇，此又以木衰金胜，肝胆受伤，火无生气，阳虚所致，当知也。）
诸转反戾，水液混浊，皆属于热；（诸转反戾，转筋拘挛也。水液，小便也。热气燥烁于筋，则挛螈为痛，火
主燔灼，燥动故也。小便混浊者，天气热则水混浊，寒则清洁，水体清而火体浊故也；
又如清水为汤，则自然浊也，此所谓“皆属于热”，宜从寒者是也。然其中
亦各有虚实之不同者，如伤暑霍乱而为转筋之类，宜用甘凉调和等剂清其亢烈之火者，热之属也；如感冒非
时风寒，或因豪雨之后湿毒中脏而为转筋霍乱，宜用辛温等剂理中气以逐阴邪者，寒之属也。大抵热胜者必多
烦躁焦渴，寒胜者必多厥逆畏寒。故太阳之至为痉；太阳之复为腰 反痛，屈伸不便，水郁之发为大关节不利。
是皆阳衰阴胜之病也。水液之浊，虽为属火，然思虑伤心，劳倦伤脾，色欲伤肾，三阴损亏者多有是病，又
中气不足，溲便为之变，则阴阳盛衰，又未可尽为实热。）诸病水液，澄澈清冷，皆属于寒；（水液者，
上下所出皆是也。水体清，其气寒，故凡或吐或利，水谷不化而澄澈清冷者，皆得寒水之化，如秋冬寒冷，水必
澄清也。）诸呕吐酸，暴注下迫，皆属于热。（胃膈热甚则为呕，火气炎上之象也，酸者，肝木之味也，由火
盛制金，不能平木，则肝木自甚，故为酸也。暴注，卒暴注泄也。肠胃热甚而传化失常，火性疾速，故如是
也。下迫，后重里急。迫，痛也。火性急速而能燥物故也。是皆就热为言，亦属暴病故耳。或有属虚，属寒，
属湿，又当久病，宜临病而察之，不可扪 以为日也。）谨守病机，各司其属。有者求之，无者求之，
盛者责之，虚者责之。必先五胜，疏其血气，令其调达而致和平。（上文一十九条，即病机也。机者，要也，
变也，病变所由出也。凡或有或无，皆谓之机。有者言其实，无者言其虚，求之者，求有无之本
也。夫大寒而甚，热之不热，是无火也，当助其心。大热而甚，寒之不寒，是无水也；热动复止，倏忽往来，
时动时止，是无水也，当助其肾。内格呕逆，食不得入，是有火也；病呕而吐，食入反出，是无火也。暴速
注下，食不及化，是无水也；溏泄而久，止发无恒，是无水也。故心盛则生热，肾盛则生寒。肾虚则寒动于
中，心虚则热收于内。又热不得寒，是无水也；寒不得热，是无火也。夫寒之不寒，责其无水；热之不热，
责其无火。热之不久，责心之虚；寒之不久，责肾之少。有者泻之，无者补之，虚者
补之，盛者泻之，适其中外。疏其雍塞，令上下无碍，气血通调，则寒热
自和，阴阳调达矣。是以方有治热以寒，寒之而火食不入；攻寒以热，热之而昏躁以生。此则气不疏通，雍而
为是也，纪于水火，余气可知，故曰∶“有者求之，无者求之，盛者责之，虚者责之。”令气通调，妙之道
也。五胜，谓五行更胜也。先以五行，寒暑温凉湿、酸咸甘辛苦相胜为法也。）
各种疾病的发生，都源于风、寒、暑、湿、燥、火六气，这是由气的正常变化（化）和异常变化（变）所导致的。（气的正常状态称为“化”，气的邪僻状态称为“变”，所以说是“之化之变”。）实证用泻法，虚证用补法，审察病机，不要违背气化的规律。（疾病随着气机运动而变化，必须考察其机理，治疗抓住关键，才不会失误。）
凡是风类引起的肢体摇动、头晕目眩，都属于肝；（风邪种类不一，所以说“诸风”。掉，指摇动。眩，指眩晕。风性主动摇，对应木的生化特性，所以归属于肝。无论是肝虚还是肝实，都能导致这种情况。例如在发生之纪，其病变表现为摇动、眩晕和头部疾病；厥阴复气时，出现筋骨摇动眩晕等，属于肝实。又如阳明司天时，出现颤抖鼓栗、筋痿不能久立，是燥金过盛，肝受邪气侵犯；太阴复气时，头顶沉重疼痛且摇动抽搐特别严重，是木不制土，湿气反胜，都属于肝虚。下焦虚则发生厥逆，上焦虚则发生眩晕，实证宜凉宜泻，虚证宜补宜温。如果相反处理，灾祸立刻就会降临。其他病症的治疗可参照此理。掉，读音为提料切。）
凡是寒类引起的身体收缩牵引，都属于肾；（收，指收敛。引，指拘急。肾属水，其气化表现为寒。凡是阳气不能通达，导致营卫气血凝聚，形体拘挛，都叫作收引。例如太阳之气偏胜，会导致筋肉拘谨苛刻，血脉凝滞不通。岁运水太过，会导致阴厥，上下中寒，这是水的实证；岁运水不及，会导致足部痿软清冷厥逆，涸流之纪，其病表现为小便闭塞不通，这是水的虚证。水的虚实，根本都在于肾。）
凡是气机喘急痞闷，都属于肺；（ ，指喘急。郁，指痞闷。肺属金，其气化表现为燥。燥金过盛，则清邪在肺，导致肺病有余，如岁运金太过，严重时出现喘咳逆气等情况；金气衰弱，则火邪胜之，导致肺病不足，如从革之纪，出现喘咳等情况。肺主气，所以各种气机喘急痞闷，无论虚实，都属于肺。 ，读音为愤。）
凡是湿类引起的浮肿胀满，都属于脾；（脾属土，其气化表现为湿。土气实则湿邪盛行，如岁运土太过，则出现饮水发于中焦、腹部胀满、食欲减退、四肢不能举动等情况。土气虚则风木乘虚侵袭，寒水侮犯：如岁运木太过，脾土受邪，百姓患病肠鸣，腹部支撑胀满；卑监之纪，其病表现为留滞胀满痞塞；岁运水太过，严重时出现腹部肿大、小腿肿胀等情况。脾主肌肉，所以各种湿肿胀满等症状，无论虚实，都属于脾。）
凡是热类引起的昏闷抽搐，都属于火；（瞀，指昏闷。螈，指抽掣。邪热损伤神志则昏闷，亢阳损伤血液则抽搐，所以都属于火。然而岁运火不及，百姓患病两臂内侧疼痛，郁闷冒昧蒙蔽；岁运火太过，百姓患病身体发热、心烦、躁动心悸、口渴而狂妄冒昧，这又是火有虚实的原因。）
凡是痛痒疮疡，都属于心；（热甚则痛，热微则痒。心属火，其气化表现为热，所以疮疡都属于心。然而赫曦之纪，其病为疮疡，是心邪过盛；太阳司天，也发生痈疡，是寒水胜克所致。火盛则心实，水胜则心虚，由此可以看见。）
凡是厥逆、二便不通或失禁，都属于下焦；（厥，指逆乱。厥有阴阳两种证候：阳气衰于下，则为寒厥；阴气衰于下，则为热厥。固，指前后二阴不通。阴虚则无气，无气则清浊不化，导致寒闭；火盛则水亏，水亏则精液干涸，导致热结。泄，指二阴不固。命门火衰，则阳虚失禁，为寒泄；命门水衰，则火迫注遗，为热泄。下，指肾。因为肾位于五脏之下，是水火阴阳的宅舍，开窍于二阴，所以各种厥逆、二便不通或失禁，都属于下焦。）
凡是痿证、喘证、呕证，都属于上焦；（痿有筋痿、脉痿、骨痿、肉痿的区别，所以说“诸痿”。凡是肢体痿弱，多在下部，但说“属于上”的，如五脏使人患痿证，是因为肺热叶焦，发为痿躄。肺居上焦，所以属于上。气急叫作喘，病在肺。吐而有物有声叫作“呕”，病在胃口。气逆而不降，这些都是上焦的病。）
凡是口噤、鼓颔战栗，如同丧失神志主宰，都属于火；（禁，指口噤。寒厥咬紧牙关叫“禁”，鼓，指鼓颔。栗，指战栗。凡是患寒战，而精神不能主持，如同丧失神志主宰的，都是火的病证。然而火有虚实之分，若表里热甚而外生寒栗的，所谓热极生寒，重阳必阴。心火热甚，亢极而战，反兼水化制约，所以出现寒栗的，都说是火的实证。若阴盛阳虚而生寒栗的，阳虚畏外寒，阴胜则为寒，寒则真气离去，离去则虚，虚则寒搏于皮肤之间，都说是火的虚证。有伤寒将解而出现战汗的，其人本虚，所以作战。有疟疾出现寒栗的，疟疾发作时，开始阳气并入阴分，随后阳气复返与阴相争，并入阳则阳胜，并入阴则阴胜，阴胜则寒，阳胜则热，更寒更热，更实更虚。由此看来，可见各种口噤鼓栗，虽然都属于火，但必须有虚实的区分罢了。）
凡是痉挛项强，都属于湿；（痉，指风强病。项部是足太阳经所过，湿兼风化，侵入寒水之经，是湿之极。然而太阳所至，表现为屈伸不利；太阳之复，表现为腰部反折疼痛，屈伸不便的，这又是寒水反胜的虚邪了。痉，读音为敬。）
凡是气逆冲上，都属于火；（火性炎上，所以各种气逆冲上的，都属于火。然而各脏各经，都有逆气，则其阴阳虚实有所不同。在心、脾、胃者，太阴所谓“上走心为噫”的。阴盛而上走于阳明，阳明络属心，所以说“上走心为噫”。有的在肺，肺苦气上逆；有的在脾，足太阴厥气上逆，则霍乱；有的在肝，肝脉若搏动有力，令人喘逆；有的在肾，少阴所谓“呕咳上气喘者，阴气在下，阳气在上，诸阳气浮，无所根据从”；有的在奇经，如冲脉为病，逆气里急，督脉生病，从少腹上冲心而痛，不得大小便为冲疝。凡这些，都是各种气逆冲上的病，虽然各种冲上都属于火，但阳盛者是火的实证，阳衰者是火的虚证，治疗分为补泻，在此详细论述。）
凡是胀满腹大，都属于热；（热气内盛者，在肺则胀于上，在脾胃则胀于中，在肝肾则胀于下。这是因为火邪所致，乃为烦满，所以说“诸胀腹大，皆属于热”。如岁运火太过，百姓患病胁肋支撑胀满；少阴司天，肺气壅滞，腹部胀满膨隆而喘咳；少阳司天，身面浮肿，腹部胀满仰息等情况，都是实热。然而岁运水太过，百姓患病腹部肿大、小腿肿胀；岁运火不及，百姓患病胁肋支撑胀满，胸腹大，流衍之纪，其病为胀。水郁之发，善发厥逆，痞坚腹胀。太阳之胜，腹满食减；阳明之复，为腹胀而泄。又如适逢寒凉则胀，脏寒生满病，胃中寒则胀满，这都是说热不足，寒有余。腹满不减，减不足言，须当下之，宜与大承气汤，说的是实胀；腹胀时减，复如故，此为寒，当与温药，说的是虚胀，治疗这些，不可不考察。）
凡是躁动狂乱失常，都属于火；（躁，指烦躁不宁。狂，指狂乱。越，指失常度。热盛于外，则肢体躁扰；热盛于内，则神志燥烦。盖火入于肺则烦，火入于肾则躁。烦为热之轻，躁为热之甚。如少阴之胜，心下热，呕逆躁烦；少阳之复，心热躁烦；便数憎风等情况，都是火胜之躁。然而有所谓阴躁的，如岁运水太过，寒气流行，邪害心火，百姓患病心热、心烦、躁悸、阴厥、谵妄等情况，阴之胜也，是为阴盛发躁，名叫“阴躁”。凡内热而躁的，有邪之热也，病多属火；外热而躁的，无根之火也，病多属寒，这就是为什么热躁宜寒，阴躁宜热。狂，是阳病。邪入于阳则狂，重阳者狂，如赫曦之纪，血流狂妄等情况，是阳狂。然而又有虚狂的，如悲哀动中则伤魂，魂伤则狂妄不精；喜乐无极则伤魄，魄伤则狂。狂者意不存人，阳重脱者阳狂，石之则阳气虚，虚则狂，是狂也有虚实，补泻不可误用。）
凡是突然发生的强直，都属于风；（暴，指猝然。强直，是筋病，强劲不柔和，肝主筋，其气化表现为风。风气有余，如木郁之发，善发暴僵仆等情况，是肝邪实；风气不足，如委和之纪，其动表现为戾气拘缓等情况，是肝气虚。这都是肝木本气之化，所以说“属风”，不是外来虚风、八风的说法。凡诸病风而筋为强急的，正因为风位之下，金气乘之，燥随风生，其燥益甚，治疗宜补阴以制阳，养营以润燥，所以说：“治风先治血，血行风自灭。”这是最好的方法。假如误认为是外感之邪，而用疏风愈风等药剂，则会更加燥其燥，不仅不能去风，反而致风。）
凡是病有声响，叩击如鼓声，都属于热；（鼓之如鼓，指胀而有声。为阳气所逆，所以属于热。然而胃中寒则腹胀，肠中寒则肠鸣飧泄，中气不足，肠为之苦鸣，这又都是寒胀的有声者。）
凡是病见浮肿，疼酸惊骇，都属于火；（ 肿，指浮肿。 肿疼酸，是阳实于外，火在经。惊骇不宁，是热乘阴分，火在脏。所以如少阴、少阳司天，都为疮疡、 肿等情况，是火的实证。然而伏明之纪，其发痛；太阳司天为 肿，身后痈；太阴所至为重 肿；太阳在泉，寒复内余则腰尻、股胫、足膝中痛等情况，都是以寒湿之胜，而为肿为痛，这又是火的不足。至于惊骇，虚实亦然，如少阴所至为惊骇，君火盛；若委和之纪，其发惊骇；阳明之复，亦为惊骇，这又以木衰金胜，肝胆受伤，火无生气，阳虚所致，应当知道。）
凡是转筋反折，水液混浊，都属于热；（诸转反戾，指转筋拘挛。水液，指小便。热气燥烁于筋，则挛螈为痛，火主燔灼，燥动故也。小便混浊，是天气热则水混浊，寒则清洁，水体清而火体浊故也；又如清水为汤，则自然浊也，这叫作“皆属于热”，宜从寒治。然而其中也各有虚实不同，如伤暑霍乱而为转筋等，宜用甘凉调和等剂清其亢烈之火的，是热之属；如感冒非时风寒，或因豪雨之后湿毒中脏而为转筋霍乱，宜用辛温等剂理中气以逐阴邪的，是寒之属。大抵热胜者必多烦躁焦渴，寒胜者必多厥逆畏寒。所以太阳之至为痉；太阳之复为腰部反折疼痛，屈伸不便，水郁之发为大关节不利。这些都是阳衰阴胜的病。水液之浊，虽为属火，然而思虑伤心，劳倦伤脾，色欲伤肾，三阴损亏者多有是病，又中气不足，溲便为之变，则阴阳盛衰，又未可尽为实热。）
凡是病见水液，澄澈清冷，都属于寒；（水液，指上下所出皆是。水体清，其气寒，所以凡或吐或利，水谷不化而澄澈清冷的，都得寒水之化，如秋冬寒冷，水必澄清也。）
凡是呕吐酸水，卒暴泄泻，肛门重坠，都属于热。（胃膈热甚则为呕，是火气炎上之象。酸，是肝木之味，由火盛制金，不能平木，则肝木自甚，所以为酸。暴注，指卒暴注泄。肠胃热甚而传化失常，火性疾速，所以如此。下迫，指后重里急。迫，痛也。火性急速而能燥物故也。这些都是就热而言，也是暴病缘故。或有属虚，属寒，属湿，又当久病，宜临病而察之，不可固执以为日也。）
谨慎坚守病机，各自分析其所属。有的求其因，无的求其源，盛的责其因，虚的责其因。必须先明五行胜复，疏通其血气，使其调达而达到和平。（上文一十九条，就是病机。机，是要领，是变化，是病变所由出的原因。凡或有或无，都叫作机。有是说其实，无是说其虚，求之，是求有无的根本。夫大寒而甚，热之不热，是无火也，当助其心。大热而甚，寒之不寒，是无水也；热动复止，倏忽往来，时动时止，是无水也，当助其肾。内格呕逆，食不得入，是有火也；病呕而吐，食入反出，是无火也。暴速注下，食不及化，是无水也；溏泄而久，止发无恒，是无水也。所以心盛则生热，肾盛则生寒。肾虚则寒动于中，心虚则热收于内。又热不得寒，是无水也；寒不得热，是无火也。夫寒之不寒，责其无水；热之不热，责其无火。热之不久，责心之虚；寒之不久，责肾之少。有者泻之，无者补之，虚者补之，盛者泻之，适其中外。疏通其雍塞，令上下无碍，气血通调，则寒热自和，阴阳调达矣。是以方有治热以寒，寒之而火食不入；攻寒以热，热之而昏躁以生。这是因为气不疏通，雍而为是也，纪于水火，余气可知，所以说：“有者求之，无者求之，盛者责之，虚者责之。”令气通调，妙之道也。五胜，谓五行更胜也。先以五行，寒暑温凉湿、酸咸甘辛苦相胜为法也。）
The generation of all diseases arises from Wind, Cold, Summer-heat, Dampness, Dryness, and Fire (Six Qi), resulting from their normal transformation (Hua) and abnormal changes (Bian). (The normal state of Qi is called Hua, while the pathological state is called Bian; hence the term "Zhi Hua Zhi Bian".) For excess conditions, use draining methods; for deficiency conditions, use tonifying methods. Examine the pathogenesis carefully and do not deviate from the appropriateness of Qi dynamics. (Diseases follow the movement of Qi; one must investigate its mechanism to grasp the key to treatment and avoid errors.)
All wind-related tremors and dizziness belong to the Liver. (Wind varies in type, thus referred to as "all winds." 'Diao' means trembling; 'Xuan' means vertigo. Wind has a moving quality, corresponding to the transformation of Wood, hence it belongs to the Liver. Both Liver deficiency and excess can cause this. For instance, during the Ji of Generation, manifestations include tremors, vertigo, and head disorders; during the reversal of Jueyin, symptoms like tendon and bone tremors indicate Liver excess. Conversely, when Yangming governs the year, shaking, shivering, tendon flaccidity, and inability to stand long result from excessive Dry Metal attacking the Liver; during the reversal of Taiyin, severe headache with heavy sensation and pronounced tremors/spasms indicate Liver deficiency due to Wood failing to control Earth and Dampness prevailing. Deficiency in the lower Jiao leads to Jue (reversal cold/heat); deficiency in the upper Jiao leads to vertigo. Excess requires cooling and draining; deficiency requires tonifying and warming. Reversing this approach leads to immediate disaster. Other treatments follow this principle. 'Diao' is pronounced 'ti liao qie'.)
All cold-related contraction and pulling belong to the Kidney. ('Shou' means contraction/restriction; 'Yin' means urgency/tightness. The Kidney belongs to Water, whose transformation is Cold. When Yang Qi fails to penetrate, Ying and Wei Qi stagnate, causing body cramping, known as contraction. For example, excess Taiyang causes muscle stiffness and blood stasis. Excessive Water year运 leads to Yin Jue and internal cold (Water excess); deficient Water year运 leads to foot flaccidity and cold Jue, or urinary retention in the Ji of Drying Up (Water deficiency). Both Water excess and deficiency originate in the Kidney.)
All Qi-related asthma and stifling belong to the Lung. (' ,' refers to rapid breathing/asthma; 'Yu' means stifling/fullness. The Lung belongs to Metal, whose transformation is Dryness. Excessive Dry Metal brings clear pathogens to the Lung, causing Lung excess, such as wheezing and coughing with rebellious Qi in years of excessive Metal; if Metal Qi declines, Fire pathogens prevail, causing Lung deficiency, such as wheezing in the Ji of Transformation. The Lung governs Qi; thus, all Qi-related asthma and stifling, whether deficiency or excess, belong to the Lung. ' ,' is pronounced 'fen'.)
All dampness-related edema and fullness belong to the Spleen. (The Spleen belongs to Earth, whose transformation is Dampness. Earth excess leads to prevalent Dampness, such as fluid retention, abdominal fullness, reduced appetite, and limb immobility in years of excessive Earth. Earth deficiency allows Wind-Wood to invade and Cold-Water to insult: e.g., excessive Wood year affects Spleen Earth causing bowel sounds and abdominal distension; in the Ji of Low Supervision, disease involves stagnation and blockage; excessive Water year causes abdominal swelling and leg edema. The Spleen governs muscles; thus, all dampness-related edema and fullness, regardless of deficiency or excess, belong to the Spleen.)
All heat-related stupor and spasms belong to Fire. ('Mao' means stupor/confusion; 'Yuan' means convulsion/spasm. Pathogenic Heat damages Spirit causing stupor; hyperactive Yang damages Blood causing spasms, hence both belong to Fire. However, deficient Fire year causes pain in inner arms and mental cloudiness; excessive Fire year causes fever, vexation, palpitations, thirst, and delirium, illustrating Fire's deficiency and excess.)
All pain, itching, and sores belong to the Heart. (Intense Heat causes pain; mild Heat causes itching. The Heart belongs to Fire, whose transformation is Heat, so sores belong to the Heart. In the Ji of Blazing Sun, sores indicate Heart pathogen excess; during Taiyang governance, carbuncles may arise due to Cold-Water overcoming Fire. Fire excess indicates Heart excess; Water overcoming Fire indicates Heart deficiency.)
All Jue (reversal) and solid/loose excretions belong to the Lower Jiao. ('Jue' means reversal. There are two types: Yang deficiency below causes Cold Jue; Yin deficiency below causes Heat Jue. 'Gu' refers to obstruction of urination and defecation. Yin deficiency leads to lack of Qi, failure to transform clear and turbid, causing cold closure; Fire excess depletes Water, drying fluids and causing heat binding. 'Xie' refers to incontinence. Mingmen Fire deficiency causes Yang deficiency incontinence (cold diarrhea); Mingmen Water deficiency causes Fire forcing leakage (heat diarrhea). The Lower Jiao refers to the Kidney. Located below the five Zang organs, it is the residence of Water and Fire, Yin and Yang, opening into the two yin orifices. Thus, all Jue and excretory disorders belong to the Lower Jiao.)
All Wei (flaccidity), panting, and vomiting belong to the Upper Jiao. (Wei includes tendon, vessel, bone, and muscle flaccidity. Although limbs often weaken in the lower body, it is said to "belong to the Upper" because organ-induced Wei stems from Lung Heat scorching leaves. The Lung resides in the Upper Jiao. Panting indicates Lung pathology. Vomiting with sound and matter originates at the stomach gate. Rebellious Qi failing to descend characterizes Upper Jiao diseases.)
All locked jaws, chattering teeth, and shivering, resembling loss of spiritual control, belong to Fire. ('Jin' means locked jaw; 'Gu' means chattering teeth; 'Li' means shivering. Diseases with chills where spirit cannot maintain control are Fire diseases. Fire has deficiency and excess. External chills with internal intense heat represent extreme Heat generating Cold (Yang transforming to Yin). Extreme Heart Fire causing shivering via Water counter-reaction indicates Fire excess. Chills due to Yin excess and Yang deficiency indicate Fire deficiency. Shaking sweat during resolving Cold Damage indicates underlying deficiency. Malaria chills involve alternating Yin/Yang excess/deficiency. Thus, while these symptoms belong to Fire, one must distinguish deficiency from excess.)
All spasms and neck stiffness belong to Dampness. (Spasm is a wind-strong disease. The neck is traversed by the Foot-Taiyang channel. Dampness combined with Wind invades the Cold-Water channel, representing extreme Dampness. Taiyang excess causes limited flexion/extension; Taiyang reversal causes back arching pain and difficulty moving, indicating deficiency evil from Cold-Water counter-attack. 'Jing' is pronounced 'jing'.)
All rebellious Qi rushing upward belong to Fire. (Fire nature is flaming upward, so rebellious Qi belongs to Fire. However, various organs/channels have rebellious Qi differing in Yin/Yang and deficiency/excess. In Heart/Spleen/Stomach, Taiyin describes "rising to Heart as belching" due to Yin excess rising to Yangming, which connects to Heart. In Lung, Qi rebels upward. In Spleen, Jue Qi rebellion causes Huoluan. In Liver, pulsating pulse causes panting/rebellion. In Kidney, Shaoyin describes vomiting/coughing/panting due to floating Yang lacking root. In extraordinary vessels, Chong Mai disease causes rebellious Qi and urgency; Du Mai disease causes Qi rushing from lower abdomen to heart with pain and obstruction (Chong Hernia). All these rebellious upward conditions belong to Fire, but Yang excess indicates Fire excess, while Yang deficiency indicates Fire deficiency. Treatment distinguishes tonification and draining.)
All distension and abdominal enlargement belong to Heat. (Internal Heat excess causes distension in Upper Jiao (Lung), Middle Jiao (Spleen/Stomach), or Lower Jiao (Liver/Kidney). Caused by Fire pathogen leading to vexation/fullness, it is attributed to Heat. Examples include胁肋 fullness in excessive Fire years, lung congestion/abdominal distension/panting in Shaoyin governance, and facial/body swelling/abdominal fullness in Shaoyang governance (all excess heat). However, excessive Water years cause abdominal/leg swelling; deficient Fire years cause chest/abdominal distension; Ji of Overflowing Waters causes distension. Water depression causes厥逆/bloating. Taiyang excess causes abdominal fullness/reduced appetite; Yangming reversal causes abdominal distension/diarrhea. Exposure to cold causes distension; visceral cold causes fullness; stomach cold causes bloating (indicating insufficient Heat/excess Cold). Unrelenting abdominal fullness requires purgation (Da Cheng Qi Tang) for excess distension; intermittent fullness returning to normal indicates cold, requiring warming herbs for deficiency distension. Careful examination is essential.)
All restlessness, mania, and deviation from normal behavior belong to Fire. ('Zao' is restless agitation; 'Kuang' is madness; 'Yue' is deviation. External Heat excess causes limb agitation; internal Heat excess causes mental vexation. Fire entering Lung causes vexation; Fire entering Kidney causes restlessness. Vexation is mild Heat; restlessness is severe Heat. Shaoyang excess causes heart heat/vomiting/restlessness. However, "Yin Restlessness" occurs in excessive Water years where Cold harms Heart Fire, causing heart heat/vexation/palpitations/Yin Jue/delirium. Internal heat with restlessness usually indicates Fire pathogen; external heat with restlessness indicates rootless Fire (often Cold). Mania is a Yang disease. Evil entering Yang causes mania (e.g., blood flow madness in Blazing Sun year). Deficient mania exists: grief injuring Hun causes madness; excessive joy injuring Po causes madness. Yang depletion causes Yang mania. Stone therapy depletes Yang, leading to deficiency mania. Mania has deficiency/excess; tonification/draining must not be misapplied.)
All sudden rigidity belong to Wind. ('Bao' means sudden. Rigidity is a tendon disease, stiff and unyielding. Liver governs tendons, transforming into Wind. Excess Wind, like Wood depression eruption, causes sudden collapse (Liver excess). Deficient Wind, like Ji of Gentle Harmony, causes deformity/limpness (Liver deficiency). This reflects Liver Wood's intrinsic transformation, termed "belonging to Wind," distinct from external wind. For wind diseases with tendon rigidity, Metal conquers below Wind, generating Dryness. Treatment should nourish Yin to control Yang and nourish Ying to moisten Dryness: "Treat wind by treating blood first; when blood moves, wind extinguishes." Misdiagnosing as external pathogen and using dispersing wind formulas exacerbates Dryness and generates wind.)
All diseases with sounds, drum-like upon percussion, belong to Heat. (Drum-like sound indicates distension with noise caused by rebellious Yang, hence Heat. However, stomach cold causes abdominal distension; intestinal cold causes borborygmus/sundew diarrhea; middle Qi deficiency causes painful bowel sounds (cold distension with sound).)
All diseases with edema, pain/aching, and fright belong to Fire. ('Zhong' swelling is edema. Pain/aching in swelling indicates Yang excess externally, Fire in channels. Fright/restlessness indicates Heat invading Yin divisions, Fire in organs. Shaoyin/Shaoyang governance causes sores/edema (Fire excess). However, Ji of Hidden Brightness causes pain; Taiyang governance causes posterior carbuncles; Taiyin causes heavy edema; Taiyin in泉 with residual Cold causes waist/thigh/knee pain (Cold-Damp excess, Fire deficiency). Fright also varies: Shaoyin causes fright (Minister Fire excess); Ji of Gentle Harmony/Yangming reversal cause fright (Wood deficiency/Metal excess damaging Liver/Gallbladder, Fire lacking life force, Yang deficiency).)
All twisting, arching, and turbid fluids belong to Heat. (Twisting/arching refers to tendon spasms. Fluids refer to urine. Heat drying tendons causes spasms/pain (Fire burns, Dryness moves). Turbid urine resembles hot water becoming cloudy (Fire is turbid, Water is clear). Treatment should cool. However, deficiency/excess varies. Summerheat Huoluan with spasms requires sweet-cool harmonizing agents (Heat). Non-seasonal Cold/Wind or post-rain damp-toxin Huoluan requires pungent-warm agents to regulate middle Qi and expel Yin evil (Cold). Heat excess causes vexation/thirst; Cold excess causes Jue/cold aversion. Taiyang arrival causes spasm; Taiyang reversal causes back pain/stiffness; Water depression causes joint stiffness (Yang deficiency/Yin excess). Turbid urine, though Fire-related, also arises from Heart/Spleen/Kidney damage from worry/fatigue/excess sex, or middle Qi deficiency affecting urination. Yin/Yang balance must be considered, not just excess Heat.)
All diseases with clear, cold fluids belong to Cold. (Fluids refer to all discharges. Water is clear and cold. Vomiting/diarrhea of undigested food that is clear and cold reflects Cold-Water transformation, like clear water in autumn/winter.)
All vomiting of acid, sudden profuse diarrhea, and tenesmus belong to Heat. (Stomach/esophagus Heat causes vomiting (Fire flaming up). Sour taste is Liver Wood flavor; Fire excess controls Metal, failing to subdue Wood, causing Wood excess and sourness. Sudden profuse diarrhea results from intestinal/stomach Heat disrupting transmission (Fire is swift). Tenesmus (heavy feeling/urgency) is due to Fire's speed and drying nature. These describe acute Heat diseases. However, some cases are deficiency, cold, or damp, especially chronic ones. Clinical observation is necessary; do not rigidly apply rules.)
Closely observe the pathogenesis and determine its affiliation. Investigate what is present and what is absent. Address excess and deficiency accordingly. First understand the Five Phases' mutual overcoming, then unblock Qi and Blood to restore harmony. (The previous nineteen clauses constitute the pathogenesis. 'Ji' means essence and change, the source of disease variation. Presence indicates excess; absence indicates deficiency. Investigation seeks the root. Severe cold unresponsive to heat indicates lack of Fire; tonify Heart. Severe heat unresponsive to cold indicates lack of Water; tonify Kidney. Intermittent heat indicates Water deficiency. Internal rejection/vomiting preventing intake indicates Fire presence. Vomiting after eating indicates Fire absence. Sudden watery diarrhea indicates Water deficiency. Chronic loose stools indicate Water deficiency. Heart excess generates Heat; Kidney excess generates Cold. Kidney deficiency causes internal cold; Heart deficiency causes internal heat retention. Cold unresponsive to heating indicates Water deficiency; Heat unresponsive to cooling indicates Fire deficiency. Brief response to heat indicates Heart deficiency; brief response to cold indicates Kidney deficiency. Drain excess, tonify deficiency. Unblock obstructions to allow free flow of Qi and Blood, harmonizing Cold/Heat and Yin/Yang. If cooling fails and food is rejected, or heating fails and causes confusion/agitation, it is due to blocked Qi. Understanding Water/Fire applies to other Qi. Hence: "Investigate presence/absence, address excess/deficiency." Unblocking Qi is the subtle way. 'Wu Sheng' refers to the mutual overcoming of Five Phases, using Cold/Hot/Warm/Cool/Damp and Sour/Bitter/Sweet/Pungent/Salty as methods.)