土受木邪，则 而兼动也。九窍之气，皆阳明所及，阳明病则胃气不行，故九窍皆为沉滞不通利矣。）三阳
一阴，太阳脉胜，一阴不能止，内乱五内，外为惊骇；（三阳一阴，膀胱与肝合病也。肝木生火，而膀胱以寒
水侮之，故太阳脉胜，一阴肝气虽强，不能禁止，由是而风寒相挟，内乱五脏，肝气受伤，故发为惊骇之病。）
二阴二阳，病在肺，少阴脉沉，胜肺伤脾，外伤四肢；（二阴，手少阴也。二阳，足阳明也。少
阴为心火之脏，火邪则伤金，故病在肺。阳明为胃土之府，土邪必伤水，故足少阴之脉沉，沉者，气衰不振之
谓。然胃为脾腑，脾主四肢，火既胜肺，胃复连脾，脾病则四肢亦病矣。）二阴二阳皆交至，病在肾，骂
詈妄行，巅疾为狂；（二阴之至，邪在肾也。二阳之至，邪在胃也。水土之邪交至，则土胜水亏，水亏则
阴不胜阳，故病在肾；土胜则阳明邪实，故骂詈妄行，巅疾为狂。）二阴一阳，病出于肾，阴气客游于心
脘，下空窍堤，闭塞不通，四肢别离；（二阴，肾也。一阳，三焦
也。肾与三焦合病，则相火受水之制，故病出于肾。肾脉之支者，从肺出络心，注胸中，故阴气盛则客游于
心脘也。阴邪自下而上，阳气不能下行，故下焦空窍，若有堤障而闭塞不通。清阳实四肢，阳虚则四肢不为
用，状若别离于身者矣。）一阴一阳代绝，此阴气至心，上下无常，出入不知，喉咽干燥，病在土脾；（一阴、
足厥阴肝也。一阳，足少阳胆也。代绝者，二脏气伤，脉来变乱也。肝胆皆木，本生心火，病以阳
衰，则阴气至心矣。然木病从风，善行数变，故或上或下，无有常处，或出或入，不知由然。其为咽喉干燥
者，盖咽为肝胆之使，又脾脉结于咽也，故病在土脾，正以风木之邪必克土耳。）二阳三阴至阴皆在，
阴不通阳，阳气不能止阴，阴阳并绝，浮为血瘕，沉为脓 ，阴阳皆壮，下至阴阳。（二阳，胃也。三阴，
肺也。至阴，脾也。皆在，皆病也。脾胃相为表里，病则仓廪不化，肺布气于脏腑，病则治节
不行，故致阴不通阳，则阴自为阴，不通入于阳分也，阳气不能止阴，则阳自为阳，不留止于阴分也。
若是者，无复交通，阴阳并绝矣。故脉浮者，病当在外而为血瘕，脉沉者，病当在内而为脓 。正以阴阳表里
不相交通，故脉证之反若此。至若阴阳皆壮，则亢而为害，或以孤阴，或以孤阳，病之所及，下至阴阳，盖
男为阳道，女为阴器，隐曲不调，俱成大病也。）上合昭昭，不合冥冥，诊决死生之期，遂至岁首。（
昭昭可见，冥冥可测，有阴阳之道在也。故欲决死生之期者，必当求至岁首，如甲、己之年，丙寅作首，则
二月丁卯，三月戊辰；子、午之年，君火司天，则初气太阳，二气厥阴之类。以次求之，则五行衰王，可得
其逆顺之期矣。）
阴阳表里，上下雌雄相输应也。如三阳独至者，是三阳并至。并至如风雨，上为巅疾，下为漏病。（
三阳独至，虽兼手、足太阳而言，而尤以足太阳为之主，故曰“独至”。盖足太阳为三阳之纲
领，故凡太阳之邪独至者，则三阳气会，皆得随而并至也。阳邪之至，疾
速无期，故如风雨，且足太阳之脉上从巅入络脑，下络肾，属膀胱，手太阳之脉上循颈颊，下抵胃，属小肠，
故上为顶巅之疾，下为漏病。漏病者，二阴不禁，凡水谷精血之类皆是也。）外无期，内无正，不中经
纪，诊无上下。（三阳并至，倏如风雨，故外无证据可期，内无名目可正。病变之至，不中于经常纲纪，故
其证也。亦无上下一定之法。）盖三阳者，至阳也。积并则为惊，病起疾风，至如 砺，九窍皆
塞，阳气滂溢，干嗌喉塞。（太阳为至盛之阳，故曰“至阳”。若诸阳更为积并，则阳盛之极，心伤阴气。手
太阳之阴，心也；足太阳之阴，肾也。心伤其神，肾伤其志，则为惊骇、疾风、 砺，皆速暴之谓，其为九
窍嗌喉之干塞者，以手太阳、手足少阴之脉皆循咽喉也。）并于阴则上下无常，薄为肠 。（阴，脏也。阳
邪自表入脏，并聚于阴，则或上或下，亦无定诊。若留薄下焦，则为肠 而下痢。）此谓三阳直心，坐不
得起卧者，便身全三阳之病。（直心，谓邪气直冲心膈也。手太阳之脉，循臂外廉，出绕肩胛、交肩上，入
缺盆，络心；足太阳之脉，挟脊贯臀，入 中，其别者散之肾，循膂，当心入散，故凡病邪气直心，及坐
不得起，起不得卧者，便身全三阳之病也。按，三阳之邪多自外入，故伤寒家多有直心、不得起卧之证，
凡诊外感者不可不察也。）病伤五脏，筋骨以消。（邪并于阳则阳病，并于阴则阴病。阴阳俱病，故伤五脏。
脏伤于内，则筋骨消于外也。）肾且绝，惋惋日暮，从容不出，人事不殷。（肾与足太阳为表里，至阴之脏也。
如三阳并至而病伤五脏，则精虚气竭，筋骨以消矣。且太阳传里，必至少阴，是以肾气受伤，真阴且绝，故
惋惋不已，忧疑终日，宜其窘窘乎从容之不出，岌岌乎人事之不殷也。然则阳邪之至，害必归阴，五脏之伤，
穷必及肾，此所谓阴阳、表里、上下、雌雄相输应也。）
脾虚浮似肺，肾小浮似脾，肝急沉散似肾，此皆工之所时乱也。（脾本微 ，病而虚浮，则似肺矣；
肾本微沉，病而小浮，则似
脾矣；肝本微弦，病而急沉散，则似肾矣。脉有相关，不能辨之，则以此作彼，所以时多惑乱也。浮而缓
曰脾，浮而短曰肺，小浮而滑曰心，急紧而散曰肝，搏沉而滑曰肾，五脏脉体，不可不明也。）于此有人焉
头痛，筋挛骨重，怯然少气，哕噫，腹满，时惊，不嗜卧，脉浮而弦，切之石坚。欲知其解，年长则求之于
腑，年少则求之于经，年壮则求之于脏。（言肾病之疑似也。脉浮类肺，脉弦类肝，脉石
坚类肾，当比异别类也。夫年长者每多口味，六腑所以受物，故当求之于腑，以察其过；年少者每多风寒劳
倦，所受在经，故当求之于经，以察其伤；年壮者多纵房欲，五脏所以积精，故当求之于脏，以察其虚实。）
夫浮而弦者，是肾不足也。（肾脉宜沉，浮则阴虚，水以生木，弦则气泄，故为肾之不足。）沉而石者，
是肾气内着也。（沉而石，沉甚而坚也。阴中无阳，则肾气不达，故内着不行也。）怯然少气者，是水道
不行，形气消索也。（精所以成形，所以化气，水道不行则形气消索，故怯然少气也。）咳嗽烦冤者，是肾气
之逆也。（水脏空虚则上窍母气，故令人咳嗽烦冤，是肾气之上逆也。）一人之气，病在一脏也。
（此一人之气，病在肾之一脏耳。即如头痛者，以水亏火炎也；筋挛者，肾水不能养筋也；骨重者，肾主
骨也；哕噫者，肾气上贯肝膈，阴气逆也；腹满者，水邪侮土也；时惊者，肾藏志，志失则惊也；不嗜卧者，
阴虚目不瞑也。病皆本于肾也。）于此有人焉，四肢解堕，喘咳血泄，诊之以为伤肺，切脉浮大而紧，粗工
砭石病愈，多出血，血止身轻。欲知其解，脉浮大虚者，是脾气之外绝去胃，外归阳明也。（此言脾病之疑
似也。夫脾属阴，为胃之里；胃属阳，为脾之表。今脉来浮大而虚，则外有余，内不足，是脾气之外绝于
胃也。脾已去胃，故气归阳明而脉见如此。阳明常多气多血，粗工砭石而愈者，正所以泄阳明之邪实耳。）
夫二火不胜三水，是以脉乱而无常也。（二火，谓二阳脏，心、肺居于膈上也。三水，谓三阴脏，肝、脾、
肾居于膈下也。此
五脏之象，阴多于阳，故曰∶“二火不胜三水”。是以脾为阴土，须赖火生，今之脾气去胃，外绝阳明，故
脉乱无常者，以脾中无胃气也。）四肢解堕，此脾精之不行也。（脾主四肢也。）喘咳者，是水气并阳明
也。（脾病不能制水，则水邪泛溢，并于胃腑，气道不利，故为喘为咳。盖五脏六腑，皆能令人咳也。）
血泄者脉急，血无所行也。（经脉者，所以行血气而营阴阳也。脉之急疾，由于气乱，气乱则血乱，故注泄
于便，无所正行矣。血不守中，主在脾也。）若以为伤肺者，由失以狂也。不引比类，是知不明也。（狂，妄
也。不引比类，故因喘咳为伤肺，是知之不明也。若参合脉证而求之，则病在脾而不在肺，可类察之矣。）
夫伤肺者，脾气不守，胃气不清，经气不为使，真脏坏决，经脉旁绝，五脏漏泄，不衄则呕，此二者不相类
也。（此明伤肺之候也。肺金受伤，窃其母气，故脾不能守。人受气于谷，谷入于胃，以传于肺，肺病则谷气
无以行，故胃不能清。肺者，所以行营卫，通阴阳，肺伤则营卫俱病，故经气不为使。真脏，言肺脏也。肺
脏损坏则治节不通，以致经脉有所偏绝而五脏之气皆失其守，因为漏泄，故不衄血于鼻则呕血于
口，此其在脾在肺，所本不同，故二者不相类也。按心、肺、肝、脾、肾皆为阴也，发明三阴为病之义不
及心、肝二脏者，盖心为君主，邪不可伤，伤则死矣；肝为将军之官，本气多强，亦不详言其病也。惟肾
为藏精之本，肺为藏气之本，脾为水谷之本，水病则及肺，金病则及脾，盗母气也；土病则败及诸脏，失
化生之原也。凡犯三阴亏损者，皆在此“三本”耳。三本俱伤。鲜能免矣。）明引比类，从容以诊，
是谓道也。（明引形证，皆量异同，以法诊之，是得之也。）
土受木邪，则脉急而兼动也。九窍之气，皆由阳明经所主管，若阳明经受病，则胃气运行受阻，因此九窍都会出现沉滞、不通利的症状。）三阳与一阴同病，太阳脉象亢盛，一阴（肝）不能制约，导致内部五脏紊乱，外部表现为惊恐骇怕；（三阳一阴同病，指膀胱经与肝经合病。肝木生心火，而膀胱寒水反侮肝木，故太阳脉象亢盛，虽然一阴肝气尚强，却无法禁止这种病理变化，由此风寒相挟，内乱五脏，肝气受伤，所以发生惊恐骇怕的疾病。）二阴与二阳同病，病变在肺，少阴脉象沉，胜伤肺脏并损伤脾脏，外部影响四肢；（二阴，指手少阴心经。二阳，指足阳明胃经。少阴是心火之脏，火邪会伤金（肺），所以病变在肺。阳明是胃土之府，土邪必伤水（肾），所以足少阴脉象沉，所谓“沉”，是指气衰不振的意思。然而胃为脾之腑，脾主四肢，火既胜肺，胃又连及脾，脾病则四肢也会生病。）二阴二阳同时交至，病变在肾，骂人胡言乱语、行为妄动，头部疾病发为狂症；（二阴之至，邪气在肾。二阳之至，邪气在胃。水土之邪交至，则土胜水亏，水亏则阴不能制阳，所以病变在肾；土胜则阳明邪实，所以骂人胡言乱语、行为妄动，头部疾病发为狂症。）二阴一阳同病，病出于肾，阴气客居于心脘部位，下焦空窍如堤坝阻塞，闭塞不通，四肢感觉分离；（二阴，指肾。一阳，指三焦。肾与三焦合病，则相火受水之制约，所以病出于肾。肾脉的支脉，从肺出络心，注入胸中，所以阴气盛则客居于心脘。阴邪自下而上，阳气不能下行，所以下焦空窍，若有堤障而闭塞不通。清阳充实四肢，阳虚则四肢不能运用，状若四肢别离于身体一样。）一阴一阳代绝，这是阴气至心，上下无常，出入不知，咽喉干燥，病变在土脾；（一阴，指足厥阴肝经。一阳，指足少阳胆经。代绝者，指肝胆二脏气伤，脉来变乱。肝胆皆属木，本生心火，病因为阳衰，则阴气至心。然而木病从风，善行数变，所以或上或下，没有常处，或出或入，不知原因。其为咽喉干燥者，盖咽为肝胆之使，且脾脉结于咽部，所以病变在土脾，正是由于风木之邪必克脾土的缘故。）二阳三阴至阴皆在，阴不通阳，阳气不能止阴，阴阳并绝，浮脉为血瘕，沉脉为脓疡，阴阳皆壮，下至阴阳。（二阳，指胃。三阴，指肺。至阴，指脾。皆在，指都发病。脾胃相为表里，病则仓廪不化，肺布气于脏腑，病则治节不行，所以致阴不通阳，则阴自为阴，不通入于阳分；阳气不能止阴，则阳自为阳，不留止于阴分。若是这样，无复交通，阴阳并绝了。所以脉浮者，病当在外而为血瘕，脉沉者，病当在内而为脓疡。正因为阴阳表里不相交通，所以脉证之反若此。至于阴阳皆壮，则亢而为害，或以孤阴，或以孤阳，病之所及，下至男女生殖器，盖男为阳道，女为阴器，隐曲不调，俱成大病也。）上合昭昭，不合冥冥，诊决死生之期，遂至岁首。（昭昭可见，冥冥可测，有阴阳之道在也。所以欲决死生之期者，必当求至岁首，如甲、己之年，丙寅作首，则二月丁卯，三月戊辰；子、午之年，君火司天，则初气太阳，二气厥阴之类。以次求之，则五行衰王，可得其逆顺之期矣。）
阴阳表里，上下雌雄相输应也。如三阳独至者，是三阳并至。并至如风雨，上为巅疾，下为漏病。（三阳独至，虽兼手、足太阳而言，而尤以足太阳为之主，故曰“独至”。盖足太阳为三阳之纲领，故凡太阳之邪独至者，则三阳气会，皆得随而并至也。阳邪之至，疾速无期，故如风雨，且足太阳之脉上从巅入络脑，下络肾，属膀胱，手太阳之脉上循颈颊，下抵胃，属小肠，故上为顶巅之疾，下为漏病。漏病者，二阴不禁，凡水谷精血之类皆是也。）外无期，内无正，不中经纪，诊无上下。（三阳并至，倏如风雨，故外无证据可期，内无名目可正。病变之至，不中于经常纲纪，故其证也。亦无上下一定之法。）盖三阳者，至阳也。积并则为惊，病起疾风，至如 砺，九窍皆塞，阳气滂溢，干嗌喉塞。（太阳为至盛之阳，故曰“至阳”。若诸阳更为积并，则阳盛之极，心伤阴气。手太阳之阴，心也；足太阳之阴，肾也。心伤其神，肾伤其志，则为惊骇、疾风、 砺，皆速暴之谓，其为九窍嗌喉之干塞者，以手太阳、手足少阴之脉皆循咽喉也。）并于阴则上下无常，薄为肠 （阴，脏也。阳邪自表入脏，并聚于阴，则或上或下，亦无定诊。若留薄下焦，则为肠 而下痢。）此谓三阳直心，坐不 得起卧者，便身全三阳之病。（直心，谓邪气直冲心膈也。手太阳之脉，循臂外廉，出绕肩胛、交肩上，入缺盆，络心；足太阳之脉，挟脊贯臀，入 中，其别者散之肾，循膂，当心入散，故凡病邪气直心，及坐不得起，起不得卧者，便身全三阳之病也。按，三阳之邪多自外入，故伤寒家多有直心、不得起卧之证，凡诊外感者不可不察也。）病伤五脏，筋骨以消。（邪并于阳则阳病，并于阴则阴病。阴阳俱病，故伤五脏。脏伤于内，则筋骨消于外也。）肾且绝，惋惋日暮，从容不出，人事不殷。（肾与足太阳为表里，至阴之脏也。如三阳并至而病伤五脏，则精虚气竭，筋骨以消矣。且太阳传里，必至少阴，是以肾气受伤，真阴且绝，故惋惋不已，忧疑终日，宜其窘窘乎从容之不出，岌岌乎人事之不殷也。然则阳邪之至，害必归阴，五脏之伤，穷必及肾，此所谓阴阳、表里、上下、雌雄相输应也。）
脾虚浮似肺，肾小浮似脾，肝急沉散似肾，此皆工之所时乱也。（脾本微 ，病而虚浮，则似肺矣；肾本微沉，病而小浮，则似脾矣；肝本微弦，病而急沉散，则似肾矣。脉有相关，不能辨之，则以此作彼，所以时多惑乱也。浮而缓曰脾，浮而短曰肺，小浮而滑曰心，急紧而散曰肝，搏沉而滑曰肾，五脏脉体，不可不明也。）于此有人焉头痛，筋挛骨重，怯然少气，哕噫，腹满，时惊，不嗜卧，脉浮而弦，切之石坚。欲知其解，年长则求之于腑，年少则求之于经，年壮则求之于脏。（言肾病之疑似也。脉浮类肺，脉弦类肝，脉石坚类肾，当比异别类也。夫年长者每多口味，六腑所以受物，故当求之于腑，以察其过；年少者每多风寒劳倦，所受在经，故当求之于经，以察其伤；年壮者多纵房欲，五脏所以积精，故当求之于脏，以察其虚实。）夫浮而弦者，是肾不足也。（肾脉宜沉，浮则阴虚，水以生木，弦则气泄，故为肾之不足。）沉而石者，是肾气内着也。（沉而石，沉甚而坚也。阴中无阳，则肾气不达，故内着不行也。）怯然少气者，是水道不行，形气消索也。（精所以成形，所以化气，水道不行则形气消索，故怯然少气也。）咳嗽烦冤者，是肾气之逆也。（水脏空虚则上窍母气，故令人咳嗽烦冤，是肾气之上逆也。）一人之气，病在一脏也。（此一人之气，病在肾之一脏耳。即如头痛者，以水亏火炎也；筋挛者，肾水不能养筋也；骨重者，肾主骨也；哕噫者，肾气上贯肝膈，阴气逆也；腹满者，水邪侮土也；时惊者，肾藏志，志失则惊也；不嗜卧者，阴虚目不瞑也。病皆本于肾也。）于此有人焉，四肢解堕，喘咳血泄，诊之以为伤肺，切脉浮大而紧，粗工砭石病愈，多出血，血止身轻。欲知其解，脉浮大虚者，是脾气之外绝去胃，外归阳明也。（此言脾病之疑似也。夫脾属阴，为胃之里；胃属阳，为脾之表。今脉来浮大而虚，则外有余，内不足，是脾气之外绝于胃也。脾已去胃，故气归阳明而脉见如此。阳明常多气多血，粗工砭石而愈者，正所以泄阳明之邪实耳。）夫二火不胜三水，是以脉乱而无常也。（二火，谓二阳脏，心、肺居于膈上也。三水，谓三阴脏，肝、脾、肾居于膈下也。此五脏之象，阴多于阳，故曰∶“二火不胜三水”。是以脾为阴土，须赖火生，今之脾气去胃，外绝阳明，故脉乱无常者，以脾中无胃气也。）四肢解堕，此脾精之不行也。（脾主四肢也。）喘咳者，是水气并阳明也。（脾病不能制水，则水邪泛溢，并于胃腑，气道不利，故为喘为咳。盖五脏六腑，皆能令人咳也。）血泄者脉急，血无所行也。（经脉者，所以行血气而营阴阳也。脉之急疾，由于气乱，气乱则血乱，故注泄于便，无所正行矣。血不守中，主在脾也。）若以为伤肺者，由失以狂也。不引比类，是知不明也。（狂，妄也。不引比类，故因喘咳为伤肺，是知之不明也。若参合脉证而求之，则病在脾而不在肺，可类察之矣。）夫伤肺者，脾气不守，胃气不清，经气不为使，真脏坏决，经脉旁绝，五脏漏泄，不衄则呕，此二者不相类也。（此明伤肺之候也。肺金受伤，窃其母气，故脾不能守。人受气于谷，谷入于胃，以传于肺，肺病则谷气无以行，故胃不能清。肺者，所以行营卫，通阴阳，肺伤则营卫俱病，故经气不为使。真脏，言肺脏也。肺脏损坏则治节不通，以致经脉有所偏绝而五脏之气皆失其守，因为漏泄，故不衄血于鼻则呕血于口，此其在脾在肺，所本不同，故二者不相类也。按心、肺、肝、脾、肾皆为阴也，发明三阴为病之义不及心、肝二脏者，盖心为君主，邪不可伤，伤则死矣；肝为将军之官，本气多强，亦不详言其病也。惟肾为藏精之本，肺为藏气之本，脾为水谷之本，水病则及肺，金病则及脾，盗母气也；土病则败及诸脏，失化生之原也。凡犯三阴亏损者，皆在此“三本”耳。三本俱伤。鲜能免矣。）明引比类，从容以诊，是谓道也。（明引形证，皆量异同，以法诊之，是得之也。）
When Earth is affected by Wood pathogen, the pulse becomes tense and dynamic. The Qi of the nine orifices is governed by the Yangming channel; if Yangming disease occurs, Stomach Qi fails to circulate, causing stagnation and obstruction in all nine orifices.) When Three Yang and One Yin are involved simultaneously, the Taiyang pulse prevails, and One Yin (Liver) cannot restrain it, leading to internal chaos of the five Zang organs and external manifestations of fright and alarm; (Simultaneous involvement of Three Yang and One Yin refers to the combined disease of the Bladder and Liver channels. Liver Wood generates Heart Fire, but Bladder Cold Water insults Liver Wood, causing the Taiyang pulse to prevail. Although One Yin Liver Qi is strong, it cannot prevent this pathological change; thus, Wind-Cold combine to disrupt the five Zang internally and injure Liver Qi, resulting in diseases of fright and alarm.) When Two Yin and Two Yang are involved simultaneously, the disease is in the Lung, the Shaoyin pulse is deep, prevailing over and injuring the Lung and Spleen, affecting the limbs externally; (Two Yin refers to the Hand-Shaoyin Heart channel. Two Yang refers to the Foot-Yangming Stomach channel. Shaoyin is the organ of Heart Fire; Fire pathogen injures Metal (Lung), so the disease is in the Lung. Yangming is the mansion of Stomach Earth; Earth pathogen inevitably injures Water (Kidney), so the Foot-Shaoyin pulse is deep. "Deep" signifies weak and unvigorous Qi. However, the Stomach is the Fu organ of the Spleen, and the Spleen governs the limbs. Since Fire prevails over the Lung and the Stomach affects the Spleen, Spleen disease leads to limb disease.) When Two Yin and Two Yang arrive together, the disease is in the Kidney, characterized by cursing, erratic behavior, and mania arising from head disorders; (Arrival of Two Yin indicates pathogen in the Kidney. Arrival of Two Yang indicates pathogen in the Stomach. When Water and Earth pathogens combine, Earth prevails and Water declines. Water decline means Yin cannot control Yang, so the disease is in the Kidney; Earth prevalence means Yangming pathogen is excess, causing cursing, erratic behavior, and mania from head disorders.) When Two Yin and One Yin are involved simultaneously, the disease originates from the Kidney. Yin Qi lodges in the cardiac epigastrium, obstructing the lower orifices like a dam, causing blockage, and a sensation of separation in the limbs; (Two Yin refers to the Kidney. One Yang refers to the Sanjiao. Combined disease of Kidney and Sanjiao causes Ministerial Fire to be controlled by Water, so the disease originates from the Kidney. A branch of the Kidney meridian emerges from the Lung, connects with the Heart, and enters the chest; thus, when Yin Qi is excessive, it lodges in the cardiac epigastrium. Yin pathogen rises from below while Yang Qi fails to descend, causing the lower orifices to be blocked as if by a dam. Clear Yang nourishes the limbs; Yang deficiency renders the limbs useless, creating a sensation as if they are separated from the body.) When One Yin and One Yang show intermittent interruption, this indicates Yin Qi reaching the Heart, with irregular movement up and down and unknown entry and exit, dry throat and pharynx, with the disease located in the Earth-Spleen; (One Yin refers to the Foot-Jueyin Liver channel. One Yang refers to the Foot-Shaoyang Gallbladder channel. Intermittent interruption signifies injury to the Qi of these two organs, causing chaotic pulses. Both Liver and Gallbladder belong to Wood, which naturally generates Heart Fire. Due to Yang deficiency, Yin Qi reaches the Heart. However, Wood diseases follow Wind, moving swiftly and changing frequently, hence appearing up or down without fixed location, entering or exiting without clear cause. The dry throat and pharynx occur because the pharynx is the envoy of Liver and Gallbladder, and the Spleen meridian knots at the pharynx; thus, the disease is in the Earth-Spleen, precisely because Wind-Wood pathogen must overcome Earth.) When Two Yang, Three Yin, and Zhiyin (Spleen) are all present, Yin does not communicate with Yang, Yang cannot restrain Yin, both Yin and Yang are severed, floating pulse indicates blood mass, deep pulse indicates abscess, and if both Yin and Yang are hyperactive, the disease extends to the genitalia. (Two Yang refers to the Stomach. Three Yin refers to the Lung. Zhiyin refers to the Spleen. "All present" means all are diseased. Spleen and Stomach are exterior-interior pairs; disease here impairs digestion. Lung distributes Qi to the Zang-Fu; disease here impairs regulatory function. Thus, Yin fails to communicate with Yang, remaining solely Yin and not entering Yang aspects; Yang fails to restrain Yin, remaining solely Yang and not staying in Yin aspects. In such cases, there is no further communication, and both Yin and Yang are severed. Therefore, a floating pulse indicates an external disease manifesting as a blood mass, while a deep pulse indicates an internal disease manifesting as an abscess. This reversal of pulse and symptoms occurs because Yin-Yang and exterior-interior do not communicate. If both Yin and Yang are hyperactive, they become harmful due to excess, either as isolated Yin or isolated Yang. The disease extends to the genitalia: men have Yang pathways, women have Yin organs; dysfunction in these hidden areas constitutes major illness.) Aligning with the obvious, failing to grasp the obscure, diagnosing the timing of life and death leads to the beginning of the year. (The obvious is visible, the obscure is measurable, governed by the Way of Yin and Yang. To determine the timing of life and death, one must seek the beginning of the year. For example, in Jia and Ji years, Bing-Yin marks the start, followed by Ding-Mao in the second month, Wu-Chen in the third; in Zi and Wu years, with Sovereign Fire presiding, the first Qi is Taiyang, the second Qi is Jueyin, etc. Calculating sequentially allows one to determine the periods of waxing and waning of the Five Phases and their favorable or unfavorable timing.)
Yin-Yang, exterior-interior, above-below, male-female correspond and transmit to each other. If Three Yang arrive alone, it means the Three Yang converge. Their convergence is like wind and rain, causing head disorders above and leakage diseases below. (Three Yang arriving alone refers primarily to the Foot-Taiyang, though it includes Hand-Taiyang. Foot-Taiyang is the leader of the Three Yang; thus, when Taiyang pathogen arrives alone, the Qi of all Three Yang converges and follows. Yang pathogen arrives swiftly and unpredictably, like wind and rain. Foot-Taiyang meridian ascends to the vertex, enters the brain, descends to connect with the Kidney, and belongs to the Bladder. Hand-Taiyang meridian ascends along the neck and cheek, descends to the Stomach, and belongs to the Small Intestine. Hence, it causes vertex disorders above and leakage diseases below. Leakage diseases refer to the inability of the Two Yin to restrain, encompassing water, grain essence, and blood.) There are no external signs to anticipate, no internal names to define, deviating from standard meridians, diagnosis lacks upper-lower distinction. (With the sudden convergence of Three Yang like wind and rain, there are no external evidence to predict nor internal names to define. The progression of disease deviates from standard principles, so its manifestations lack fixed upper-lower rules.) Three Yang represents Extreme Yang. Accumulation and convergence cause fright; the disease arises like a sudden gale, becoming severe like whetstones, blocking all nine orifices, with Yang Qi overflowing, drying the throat and causing obstruction. (Taiyang is the most vigorous Yang, hence called "Extreme Yang." If various Yang energies accumulate and converge, Yang excess reaches its peak, injuring the Yin Qi of the Heart. The Yin of Hand-Taiyang is the Heart; the Yin of Foot-Taiyang is the Kidney. Injury to Heart Spirit and Kidney Will results in fright, sudden gales, and severity like whetstones—all denoting rapid violence. The dryness and obstruction of the nine orifices and throat occur because the meridians of Hand-Taiyang and Hand/Foot-Shaoyin all traverse the throat.) When merging with Yin, movements become irregular, and thinning leads to intestinal [dysentery]. (Yin refers to the Zang organs. When Yang pathogen enters from the exterior into the Zang and gathers in Yin, it moves up or down without fixed diagnosis. If it lingers and thins in the Lower Jiao, it causes intestinal dysentery.) This is referred to as Three Yang directly striking the Heart; those who cannot sit up or lie down fully exhibit Three Yang disease. (Directly striking the Heart means pathogen rushes straight to the heart diaphragm. Hand-Taiyang meridian runs along the outer arm, winds around the scapula, crosses the shoulder, enters the supraclavicular fossa, and connects with the Heart. Foot-Taiyang meridian flanks the spine, passes through the buttocks, enters the popliteal fossa; its branches scatter to the Kidney, run along the back muscles, and enter the center corresponding to the Heart. Thus, any disease where pathogen strikes the Heart directly, or where one cannot rise from sitting or lie down from rising, involves the full spectrum of Three Yang disease. Note that Three Yang pathogens mostly enter from outside; thus, Shanghan practitioners often see direct Heart strikes and inability to sit/lie. Physicians diagnosing external contractions must observe this carefully.) Disease injures the five Zang, causing bones and sinews to waste away. (Pathogen merging with Yang causes Yang disease; merging with Yin causes Yin disease. With both Yin and Yang diseased, the five Zang are injured. Internal Zang injury leads to external wasting of bones and sinews.) Kidney Qi approaches exhaustion; sorrowful until dusk, unable to move calmly, human affairs become neglected. (Kidney and Foot-Taiyang are exterior-interior, belonging to the extreme Yin organ. If Three Yang converge and injure the five Zang, essence becomes deficient and Qi exhausted, leading to wasting of bones and sinews. Furthermore, Taiyang transmitting inward must reach Shaoyin, injuring Kidney Qi and depleting True Yin. Thus, one feels perpetual sorrow and worry throughout the day, appropriately unable to move calmly and neglecting daily affairs. Therefore, when Yang pathogen arrives, harm inevitably returns to Yin; when five Zang are severely injured, it ultimately reaches the Kidney. This is what is meant by the correspondence between Yin-Yang, exterior-interior, above-below, and male-female.)
Spleen deficiency presents as floating resembling Lung; Kidney slight floating resembles Spleen; Liver tension with deep scattered pulse resembles Kidney. These are often confused by physicians. (Spleen normally has a slightly soft pulse; when diseased and deficient-floating, it resembles Lung. Kidney normally has a slightly deep pulse; when diseased and slightly floating, it resembles Spleen. Liver normally has a slightly wiry pulse; when diseased with tense, deep, and scattered qualities, it resembles Kidney. Pulses are interrelated; inability to distinguish them leads to confusion, mistaking one for another. Floating and slow indicates Spleen; floating and short indicates Lung; slightly floating and slippery indicates Heart; tense, tight, and scattered indicates Liver; forceful, deep, and slippery indicates Kidney. The pulse characteristics of the five Zang must be clearly understood.) Here is a person with headache, tendon cramping, heavy bones, timidity with shortness of breath, hiccups and belching, abdominal fullness, occasional fright, insomnia, with a floating and wiry pulse that feels hard like stone upon palpation. To understand this, for the elderly, seek the Fu organs; for the young, seek the meridians; for the vigorous adult, seek the Zang organs. (This describes the ambiguity of Kidney disease. Floating pulse resembles Lung, wiry pulse resembles Liver, stone-hard pulse resembles Kidney; differentiation is required. Elderly people often have dietary indiscretions; since the Six Fu organs receive substances, investigate the Fu organs to check for faults. Young people often suffer from Wind-Cold and fatigue; since injuries affect the meridians, investigate the meridians to check for damage. Vigorous adults often indulge in sexual desires; since the five Zang store essence, investigate the Zang organs to check for deficiency or excess.) A floating and wiry pulse indicates Kidney insufficiency. (Kidney pulse should be deep; floating indicates Yin deficiency. Water generates Wood; wiry indicates Qi leakage, hence Kidney insufficiency.) A deep and stone-like pulse indicates Kidney Qi stagnating internally. (Deep and stone-like means extremely deep and hard. Without Yang within Yin, Kidney Qi cannot penetrate, thus stagnating internally.) Timidity and shortness of breath indicate failure of water pathways and consumption of form and Qi. (Essence forms the body and transforms into Qi. Failure of water pathways leads to consumption of form and Qi, causing timidity and shortness of breath.) Coughing and distress indicate rebellious Kidney Qi. (Empty Water organ fails to nourish the mother organ of the upper orifices, causing cough and distress, indicating rebellious Kidney Qi ascending.) The Qi of one person is diseased in one Zang organ. (In this case, the disease is in the single Kidney Zang. For instance, headache is due to Water deficiency and Fire flaming; tendon cramping is because Kidney Water cannot nourish sinews; heavy bones are because Kidney governs bones; hiccups and belching are due to Kidney Qi penetrating upward through Liver diaphragm with rebellious Yin Qi; abdominal fullness is due to Water pathogen insulting Earth; occasional fright is because Kidney stores Will, and loss of Will causes fright; insomnia is due to Yin deficiency preventing eye closure. All diseases originate from the Kidney.) Here is a person with flaccid limbs, wheezing cough, and bloody discharge. Diagnosis considers Lung injury. Palpation reveals a large, floating, and tight pulse. An incompetent physician using acupuncture and stone therapy cures the disease, causing significant bleeding; once bleeding stops, the body feels light. To understand this, a large and floating-deficient pulse indicates Spleen Qi severing externally from the Stomach and returning outward to Yangming. (This describes the ambiguity of Spleen disease. Spleen is Yin, interior to Stomach; Stomach is Yang, exterior to Spleen. A large, floating, and deficient pulse indicates excess externally and deficiency internally, meaning Spleen Qi is severed externally from the Stomach. Having left the Stomach, Qi returns to Yangming, producing such a pulse. Yangming typically has abundant Qi and Blood; curing via acupuncture by an incompetent physician works precisely by draining the excess pathogen in Yangming.) When Two Fires cannot overcome Three Waters, the pulse becomes chaotic and irregular. (Two Fires refer to the Two Yang Zang organs, Heart and Lung, located above the diaphragm. Three Waters refer to the Three Yin Zang organs, Liver, Spleen, and Kidney, located below the diaphragm. This image of the five Zang shows Yin exceeding Yang, hence "Two Fires cannot overcome Three Waters." Since Spleen is Yin Earth, it relies on Fire for generation. Now, Spleen Qi leaves the Stomach and severs externally from Yangming; thus, the chaotic and irregular pulse is due to the absence of Stomach Qi in the Spleen.) Flaccid limbs indicate the failure of Spleen Essence to circulate. (Spleen governs the limbs.) Wheezing and coughing indicate Water Qi merging with Yangming. (Spleen disease fails to control Water; Water pathogen overflows and merges with the Stomach Fu, obstructing the airway, causing wheezing and coughing. Indeed, all six Fu and five Zang can cause cough.) Bloody discharge with a tense pulse indicates blood having nowhere to flow. (Meridians transport Qi and Blood to nourish Yin and Yang. Rapid pulse results from Qi chaos; Qi chaos leads to Blood chaos, causing leakage into bowels with no proper circulation. Blood failing to stay central is governed by the Spleen.) If considered Lung injury, it is due to error and madness. Failing to draw analogies indicates unclear understanding. (Madness implies absurdity. Failing to draw analogies, attributing wheezing and cough to Lung injury reflects unclear understanding. If pulse and symptoms are integrated and investigated, the disease is in the Spleen, not the Lung, which can be discerned by analogy.) Regarding Lung injury: Spleen Qi fails to guard, Stomach Qi fails to clear, Meridian Qi fails to serve, True Zang is damaged and ruptured, meridians are abandoned peripherally, five Zang leak, resulting in either nasal hemorrhage or vomiting. These two conditions are not similar. (This clarifies the presentation of Lung injury. Lung Metal injury steals its Mother's Qi, so Spleen cannot guard. Humans receive Qi from grain; grain enters the Stomach and transmits to the Lung. Lung disease prevents grain Qi from circulating, so Stomach cannot clear. Lung transports Ying and Wei, connecting Yin and Yang; Lung injury causes both Ying and Wei diseases, so Meridian Qi fails to serve. "True Zang" refers to the Lung. Damage to the Lung impedes regulatory function, causing meridians to be abandoned peripherally and the Qi of all five Zang to lose their guard, leading to leakage. Thus, either nasal hemorrhage or vomiting occurs. Since the root in Spleen differs from the root in Lung, these two are not similar. Note that Heart, Lung, Liver, Spleen, and Kidney are all Yin. The explanation of Three Yin disease omits Heart and Liver because Heart is the Monarch, invulnerable to pathogen (injury means death); Liver is the General, inherently strong, so its disease is not detailed. Only Kidney is the root of storing essence, Lung the root of storing Qi, Spleen the root of grain and water. Water disease affects Lung, Metal disease affects Spleen, stealing Mother Qi; Earth disease ruins all Zang, losing the source of transformation. Any violation involving Three Yin deficiency falls under these "Three Roots." If all three roots are injured, few can escape.) Clearly drawing analogies and calmly diagnosing is called the Way. (Clearly citing symptoms and signs, measuring similarities and differences, and diagnosing according to method achieves this.)