典藏书目

Panting (from *Suwen: Ni Diao Lun*)

The five zang and six fu organs can all cause cough; it is not solely the lung. The manifestation of lung cough includes coughing with wheezing and audible sounds, and in severe cases, expectoration of blood. The manifestation of heart cough includes coughing accompanied by heart pain, a sensation of obstruction in the throat as if something were stuck, and in severe cases, swelling of the throat and throat bi syndrome. The manifestation of liver cough includes pain in the hypochondrium on both sides upon coughing, inability to turn the body in severe cases, and fullness in the hypochondrium upon turning. The manifestation of spleen cough includes coughing with pain in the right hypochondrium, dull pain radiating to the shoulder and back, inability to move in severe cases, and exacerbation of cough upon movement. The manifestation of kidney cough includes pulling pain between the waist and back upon coughing, and expectoration of saliva in severe cases (from *Suwen: Ke Lun*).

This is not empty talk. Examining the *Lingshu: Jing Mai* chapter, the collateral vessels of the liver connect to the lung, the meridians of the kidney enter the lung, and the meridians of the heart connect to the lung. Besides diseases originating from the meridians themselves, there are many cases where yin deficiency of these three organs fails to absorb yang qi, causing deficient yang to flare up into the lung and induce cough. Careful examination of pulse and symptoms will naturally distinguish between water distension (*Shui Zhang*), skin distension (*Fu Zhang*), drum distension (*Gu Zhang*), intestinal polyps (*Chang Tan*), stone fibroma (*Shi Xia*), and stone water (*Shi Shui*).

When water disease first begins, the upper eyelids swell slightly, resembling the appearance after waking up. The neck pulse beats, there is frequent coughing, coldness in the inner thighs, and swelling of the lower legs. The abdomen then enlarges, indicating that water has formed. Pressing the abdomen with the hand causes it to rise immediately, resembling a bag wrapped around water; this is its sign.

Skin distension (*Fu Zhang*) occurs when cold qi lodges between the skin. It feels hollow and not firm, the abdomen is large, the whole body is swollen, the skin is thick, pressing the abdomen leaves an indentation that does not rise, and the abdominal color remains unchanged; this is its sign.

Drum distension (*Gu Zhang*) involves abdominal distension and whole-body swelling, similar to skin distension, but the complexion is pale yellow, and the abdominal veins are prominent; this is its sign.

Intestinal polyps (*Chang Tan*) occur when cold qi lodges outside the intestines and struggles with defensive qi (*Wei Qi*). Qi cannot circulate, and due to adhesion, masses form internally. Evil qi arises, and flesh growths develop. Initially, they are the size of a chicken egg, gradually enlarging until resembling pregnancy. After more than a year, pressing them makes them hard, and pushing them moves them. Menstruation still arrives on time.

Stone fibroma (*Shi Xia*) originates in the uterus. Cold qi lodges at the opening of the uterus (*Zi Men*), blocking it so qi cannot pass. Evil blood should be discharged but remains stagnant, enlarging daily, resembling pregnancy. Menstruation does not arrive on time. These conditions occur only in women and can be treated by guiding the pathogenic factors downward (from *Lingshu: Shui Zhang*).

The Yellow Emperor asked: What about conditions that do not originate from the hair pores but result from the exhaustion of yang qi of the five zang organs? Fluids fill the chest cavity, the ethereal soul (*Po*) resides alone inside, essence is isolated inside, qi dissipates outside, and the form cannot maintain warmth with clothing. The four extremities are urgent and disturb the interior. This indicates qi rejecting within and form manifesting externally. How should it be treated?

Qibo replied: Balance and weigh the yin and yang. Remove accumulated stale pathogens. Slightly move the four extremities. Wear warm clothes. Use counter-point needling (*Miu Ci*) to restore the form. Open the sweat gates (*Gui Men*, i.e., pores). Cleanse the bladder (*Jing Jing Fu*). Let essence recover regularly. When the five yang energies are distributed, dredge the five zang organs. Thus, essence generates spontaneously, form becomes robust, bones and flesh protect each other, and great qi becomes balanced (from *Suwen: Tang Ye Lao Li*).

The kidney is the gate of the stomach. If the gate is not functional, water accumulates following its kind. The root of the disease lies in the kidney, and the branch lies in the lung; both involve water accumulation (from *Suwen: Shui Re Xue*).

Facial swelling is called wind-water. Swelling of the lower legs is called water disease. Yellow eyes indicate jaundice (*Huang Dan*). Feeling hungry after eating indicates stomach jaundice (*Wei Dan*) (from *Suwen: Ping Ren Qi Xiang*).

Yang qi guides upward and defends the exterior. Due to cold, one wishes to move like a door pivot; startle during daily activities causes spirit qi to float. Due to summer heat, sweating occurs; irritability leads to panting with loud sounds, while quietness leads to excessive talking. The body feels like burning charcoal; sweating disperses the condition. Due to dampness, the head feels wrapped. If damp-heat is not resolved, large tendons contract and shorten, while small tendons relax and lengthen. Shortening causes spasms (*Ju*), and relaxation causes flaccidity (*Wei*). Due to qi dysfunction, swelling occurs. When the four dimensions alternate in failure, yang qi is exhausted.

Yang qi, when subjected to excessive fatigue, expands and dissipates, leading to essence depletion. Accumulating this in summer causes "burning厥" (*Jian Jue*), resulting in blindness and deafness. It collapses like a breached dam, unstoppable. Injury to tendons causes flaccidity, as if unable to lift. Hemihidrosis (sweating on one side) leads to hemiplegia (*Pian Gu*). Sweating exposed to dampness generates acne and prickly heat (*Cuo Fei*). Changes from rich foods lead to large carbuncles on the feet. Pathogens enter like holding an empty vessel. Labor and sweat exposed to wind-cold transform into cold stagnation, generating acne. Yang qi nourishes the spirit when refined and softens tendons when gentle. If opening and closing fail, cold qi enters, causing severe stooping (*Da Lou*). Depressed vessels retain pathogens, affecting muscle interstices. Acupoint qi transforms thinly, transmitting fear and fright. Ying qi does not follow, reversing into muscle texture, generating abscesses. Unfinished魄 sweat, weak form, and depleted qi close acupoints, triggering wind malaria. Thus, wind is the beginning of all diseases. Purity closes muscle interstices and repels pathogens; even strong winds and toxins cannot harm. This follows the sequence of seasons.

Yin stores essence and rises urgently (two characters suspected erroneous). Yang defends the exterior and maintains solidity. If yin cannot overcome yang, pulses flow rapidly and merge, leading to mania. If yang cannot overcome yin, the five zang qi struggle, and nine orifices become blocked. Wind guests invade qi, essence is lost, and evil harms the liver. Overeating causes tendons and vessels to loosen, leading to hemorrhoids. Excessive drinking causes qi reversal. Excessive sexual activity injures kidney qi and damages high bones. The key to yin and yang is that yang must be dense to maintain solidity. If yang is strong but not dense, yin qi is exhausted. When yin is level and yang is secret, spirit and vitality are governed. If yin and yang separate, essence and qi are exhausted (from *Suwen: Sheng Qi Tong Tian*).

Diseases of the two yang (Yangming) originate in the heart and spleen, causing hidden difficulties (referring to private matters or emotional constraints) and amenorrhea in women. Transmission leads to "wind consumption" (*Feng Xiao*) or "breath accumulation" (*Xi Ben*), which is fatal and untreatable. Diseases of the three yang (Taiyang) present with chills and fever, lower body carbuncles, and flaccidity/feverish limbs. Transmission leads to dry skin (*Suo Ze*) or scrotal hernia (*Tui Shan*). Disease of the one yang (Shaoyang) presents with shortness of breath, frequent cough, and diarrhea. Transmission leads to heart palpitations (*Xin Che*) or diaphragm obstruction (*Ge*). Disease of two yang and one yin (Jueyin) presents with fright, back pain, belching, and yawning, named "wind jue". Disease of two yin (Shaoyin) and one yang presents with distension, chest fullness, and sighing. Disease of three yang and three yin (Taiyin) presents with hemiplegia, flaccidity, and immobility of the four limbs (from *Suwen: Yin Yang Bie Lun*).

(Shen Youpeng) Note: "Two yang" refers to the Yangming meridian, not the zang-fu organs. Diseases of Yangming originating in the heart and spleen: Yangming is a meridian abundant in blood, and blood is the essence of food and drink, refined by heart fire. Worry and anxiety damage the heart, affecting its son (spleen), leading to poor appetite. Without food intake, blood cannot be generated, causing Yangming disease. The anterior orifice is the convergence of all sinews, meeting at the Qichong point, with Yangming as the leader. Thus, Yangming disease causes impotence and inability to resolve private issues. Taichong is the sea of blood, running alongside the Yangming meridian. Thus, Yangming disease causes Chong meridian deficiency and amenorrhea in women.

Heart transferring cold to the lung causes "lung consumption" (*Fei Xiao*). In lung consumption, drinking one part results in urinating two parts; this is fatal and untreatable. Lung transferring cold to the kidney causes "surging water" (*Yong Shui*). Surging water feels non-firm upon pressure, gurgles when walking quickly, like a bag wrapping slurry, with water qi lodging in the large intestine. Heart transferring heat to the lung transmits to "diaphragm consumption" (*Ge Xiao*). Bladder transferring heat to the pericardium causes strangury and bloody urine. Bladder transferring heat to the small intestine causes intestinal obstruction and mouth ulcers. Large intestine transferring heat to the stomach causes polyphagia with emaciation, called "food also" (*Shi Yi*). Stomach transferring heat to the gallbladder is also called "food also". Gallbladder transferring heat to the brain causes nasal sinusitis (*Bi Yuan*), characterized by continuous discharge of turbid mucus. Transmission leads to epistaxis, blurred vision, and eye closure (from *Suwen: Qi Jue Lun*).

When Shaoyin qi arrives, teeth gnawing occurs. When Shaoyang qi arrives, cheek gnawing occurs. When Yangming qi arrives, lip gnawing and diarrhea occur. There are five types: Stomach diarrhea involves undigested food and yellow stool (Food enters the stomach, moves to the small intestine for gradual transformation. If excreted before transformation, the disease is in the stomach. The stomach is the mansion of the spleen, belonging to Earth, hence yellow stool). Spleen diarrhea involves abdominal fullness, watery diarrhea, and vomiting after eating (This is Taiyin disease. The text states: Taiyin disease presents with abdominal fullness, vomiting, inability to eat, worsening spontaneous diarrhea, and periodic abdominal pain). Large intestine diarrhea involves urgency after eating, white stool, and cutting intestinal pain (The large intestine is the mansion of the lung, belonging to Metal, hence white stool). Small intestine diarrhea involves dysuria with pus and blood in stool and lower abdominal pain (The lower abdomen is the mansion of the heart, belonging to Fire, hence pus and blood. Dysuria here refers to incomplete urination). Major mass diarrhea involves tenesmus, frequent attempts to defecate without success, and penile pain, named "post-heaviness" (Mass refers to concretion. Mentioning only post-heaviness implies small intestine diarrhea lacks this symptom. *Nan Jing 57*).

The onset of mania (*Kuang Ji*) involves little sleep, lack of hunger, feeling superior and wise, claiming intelligence, arrogance, delusional laughter, singing, and ceaseless erratic behavior. The onset of epilepsy (*Dian Ji*) involves unhappiness, sudden collapse, and staring straight ahead. The pulse shows excess in all three positions and yin/yang aspects (from *Nan Jing 59*).

All wind-related tremors and vertigo belong to the liver. All cold-related contraction and drawing-in belong to the kidney. All qi-related fullness and depression belong to the lung. All dampness-related swelling and fullness belong to the spleen. All heat-related confusion and convulsions belong to fire. All pain, itching, and sores belong to the heart. All jue and retention/diarrhea belong to the lower jiao. All flaccidity, panting, and vomiting belong to the upper jiao. All inhibition, shivering, and loss of spiritual control belong to fire. All spasms and stiff neck belong to dampness. All rebellious qi rushing upward belong to fire. All abdominal distension and enlargement belong to heat. All restlessness, mania, and overaction belong to fire. All sudden stiffness belong to wind. All conditions with sounds, drum-like upon percussion, belong to heat. All swelling, pain, soreness, fright, and terror belong to fire. All twisting and turning with turbid fluids belong to heat. All clear and cold fluids belong to cold. All vomiting, acid regurgitation, acute diarrhea, and tenesmus belong to heat (from *Suwen: Zhi Zhen Yao Da Lun*).

These nineteen clauses are shortcuts for medical practice. Past famous physicians have all memorized and cited them. Liu Wansu of Hejian especially revered them as treasures and wrote commentaries. (Shen Youpeng) I secretly doubt this. Why? Although diseases may be similar, their deficiency/excess and cold/heat nature are not entirely identical. Therefore, inspection, listening/smelling, and inquiry must not be neglected. Upon observing one symptom, one must combine it with other current symptoms for comprehensive analysis to grasp the true nature of the disease. If summarized merely by "all belong to," establishing nineteen prescriptions would suffice. Pulse diagnosis and syndrome differentiation would be useless. Is treating disease really that easy?

For example, "abdominal distension and enlargement": excess belongs to Yangming and heat, while deficiency belongs to Taiyin and cold. How can it be said to all belong to fire? "Swelling": early-stage water disease belongs to kidney deficiency and cold; additionally, qi deficiency sinking and external damp invasion exist. How can it be said to all belong to fire? "Conditions with sounds, drum-like": if all belonged to fire, why did Zhang Zhongjing use Ginger and Heart-warming Decoction (*Sheng Jiang Xie Xin Tang*) for rumbling diarrhea, combining cold and heat herbs? "Clear and cold fluids": if all belonged to cold, why did Zhang Zhongjing use Great Chengqi Decoction (*Da Cheng Qi Tang*) for urgent purgation in cases of clear watery diarrhea, pure green stool, dry mouth, and dry tongue? Regarding "vomiting and acid regurgitation," Danxi advocated fire, while Dongyuan advocated cold. Both have been effective in clinical practice. Thus, the theory that "all belong to heat" is certainly not a fixed conclusion. Such one-sided views likely originated from crude practitioners fabricating theories. (Shen Youpeng) carefully extracts these points for discussion with knowledgeable scholars.