吴云。宣。发也。五气。木火土金水也。言五气有入。有病。有并。有恶。有液。有禁。有发。有乱。
有邪。有藏。有主。有伤。有应。是篇皆发明之。
是谓五入 马云。此与灵枢九针论同。但彼多淡入胃一句。简按周礼疾医职云。凡和。春多酸。夏
多苦。秋多辛。冬多咸。调以滑甘。与此同义。
心为噫 马云。口问篇云。噫出于胃。三部九候论与此篇。皆曰。心为噫。考脉解篇。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。经典之旨。
岂非二而一者耶。张云。噫。嗳气也。遍考本经。绝无嗳气一证。而惟言噫者。盖即是也。简按说文。饱食息
也。礼内则。不敢哕噫。是也。（噫。乌界切。音隘。若于希切。音衣。则为痛叹声。与此异义。）嗳。字汇。
于盖切。音嗳。嗳气也。盖嗳。即噫俗字。高云。噫。微嗳也。非。
肝为语 志云。肝气欲达则为语。诊要经终篇曰。春刺冬分。邪气着脏。病不愈。又且欲言语。此言春
令之肝气不舒故也。高云。病气在肝则为语。语。多言也。简按标曰五气所病。则王马吴张之解并误。下文吞同。
脾为吞 志云。脾主为胃行其津液。脾气病而不能灌溉于四脏。则津液反溢于脾窍之口。故为吞咽之
证。简按据志注吞。即吞酸酢吞之谓。（平脉法云。噫而吞酸。食卒不下。又云。上焦不归者。噫而酢吞。）
龚廷贤云。吞酸。与吐酸不同。吞酸。水刺心也。吐酸者。吐出酸水也。是。高云。吞。舌本不和也。未知何据。
肾为欠为嚏 志云。灵枢曰。阳者主上。阴者主下。阳引而上。阴引而下。阴阳相引。故数欠。当
泻足少阴。补足太阳。（口问篇）盖少阴之气在下。病则反逆于上。而欲引于下。欲引于下则欠。反逆于上则
嚏。盖肾络上通于肺也。简按九针论。无为嚏二字。此疑衍文。
为哕为恐 简按为恐。诸注未晰。九针论。无此二字。疑是衍文。
下焦溢为水 高云。下焦病不能决渎。则 溢而为水。简按灵兰秘典论云。三焦者。决渎之官。水
道出焉。此以下焦与胃大肠小肠膀胱胆并称。则下焦。即灵兰秘典论之三焦。（详义。见六节脏象论。）而为
六腑之一。彼此互考。乃知六腑之三焦。专指下焦而言也。
膀胱不利为癃 马云。灵兰秘典论云。膀胱者。州都之官。津液藏焉。气化则能出矣。今曰不利则为
癃。癃者。水道不通之病也。张云。本输篇曰。三焦者。太阳之别也。并太阳之正。入络膀胱。约下焦。实则
闭癃。虚则遗溺。盖三焦为中渎之腑。水道之所由出。故三焦亦属膀胱也。简按三因方云。淋。古谓之癃。名
称不同也。癃者。罢也。淋者。滴也。今名虽俗。于义为得。简按淋为小便病。始见六元正纪大论。癃。乃溺
闭之通称。马注为得。
胆为怒 张云。怒为肝志。而胆亦然者。肝胆相为表里。其气皆刚。而肝取决于胆也。高云。胆病郁
而不舒。则为怒。
是谓五病 志云。谓病五脏五行之气。而六腑亦配合于五行。简按九针论云。五脏气。心主噫。肺主
咳。肝主语。脾主吞。肾主欠。六腑气。胆为怒。胃为气逆哕。大肠小肠为泄。膀胱不约为遗溺。下焦溢为水。
兹举六腑之病。而言五精者。盖以大肠小肠俱为泄欤。
五精所并 吴云。五精。五脏之精气也。并合而入之也。五脏精气。各藏其脏则不病。若合而并于一
脏。则邪气实之。各显其志。张云。并。聚也。高云。脏虚而精气并之也。精者阴精。气者阳气。简按精气。
乃水谷之精气。不必分阴阳矣。
并于肝则忧 马云。阴阳应象大论曰怒。而兹曰忧者。以肺气得以乘之也。高云。肝主怒。今曰忧者。
上文胆为怒。故此肝为忧。怒为有余。忧为不足也。楼云。忧。当作怒。简按九针论。亦作忧。
并于脾则畏 马云。阴阳应象大论曰思。而兹曰畏者。盖思过则反畏也。高云。思虑者。脾之精。
今曰畏者。虑之至也。楼云。畏。当作思。简按九针论亦作畏。甲乙作饥。
（与王注一经同。）
五脏化液 高云。化液者。水谷入口。津液各走其道。五脏受水谷之精。淖注于外窍。而化为五液也。
心为汗 吴云。心主血。汗者血之余。故汗为心液。简按营卫生会篇云。夺血者无汗。夺汗者无血。
三因方。谓伤寒衄者。为红汗。其意同焉。
肺为涕 简按诸字书。以涕为目泣。而医家特为鼻液。考说文。 。又作HT 。鼻液也。盖HT 涕通用。
玉篇。HT 。他计切。鼻HT 。礼内则。不敢唾涕。释文云。本又作 。
脾为涎 吴张并云。涎出于口。脾之窍也。简按证治准绳损伤门云。两脸涎囊。知是涎出于口也。
肾为唾 吴云。唾出于廉泉二窍。二窍挟舌本。少阴肾脉。循喉咙。挟舌本。故唾为肾液。高云。灵
枢根结篇云。少阴根于泉。结涌于廉泉。舌下窍也。是肾为水脏。从下而上。液虽有五。肾实主之。是以五液
皆咸。咸。水味也。
血病无多食咸 张云。血得咸则凝结不流也。五味论曰。血与咸相得则凝。
骨病无多食苦 志云。肾主骨。炎上作苦。苦走骨者。火气下交于肾也。骨病而多食之。则火气反胜
矣。此与并于心则喜。并于肾则恐之义相同。盖心肾水火之气。时相既济。故所走互更。其余三脏。是本脏之
味。而走本脏所主之筋肉也。简按灵五味论曰。酸走筋。多食之令人癃。咸走血。多食之令人渴。辛走气。多
食之令人洞心。苦走骨。多食之令人变呕。甘走肉。多食之令人 心。正与此节同义。九针论曰。苦走血。病
在血无食苦。咸走骨。病在骨无食咸。此以本脏之味而言之。
是谓五禁 九针论。作五裁。五行大义。引黄帝养生经。作五贼。
阴病发于骨 张云。骨属肾。肾者。阴中之阴也。吴马并同。
阳病发于血 张云。血属心。心者。阳中之阳也。
阴病发于肉 张云。肉属脾。脾者。阴中之至阴也。
邪入于阳则狂 马云。生气通天论曰。阴不胜其阳。则脉流薄疾。并乃狂。
邪入于阴则痹 吴云。邪。阴邪也。痹。痹论所谓五脏痹也。阴邪入于阴。是重阴也。则为五脏痹也。
马云。成 痹也。张云。寿夭刚柔篇曰。病在阴。命曰痹。九针论曰。邪入于阴。则为血痹。
搏阳则为巅疾 张云。搏。击也。巅。癫也。邪搏于阳。则阳气受伤。故为癫疾。上文言邪入于阳则
狂者。邪助其阳。阳之实也。此言搏阳则为巅疾者。邪伐其阳。阳之虚也。故有为狂为癫之异也。九针论曰。
邪入于阳。转则为癫疾。言转入阴分。故为癫也。简按搏。薄同。迫也。马吴注。以巅疾为巅顶之疾。并非。
徐氏经络全书云。搏。当作传。不可从。（下文搏阴同）癫狂判然两疾。而后世混称难辨。因举数说而昭之。
五十九难云。狂癫之病。何以别之。然狂疾之始发。少卧而不饥。自高贤也。自辨知也。自倨贵也。妄笑好歌
乐。妄行不休。是也。癫疾始发。意不乐。僵仆直视。是也。杨玄操云。狂病之候。不爱眠卧。不肯饮食。自
言贤智。歌乐行走。此是阳气盛之所成。故经言重阳者狂。今世以此为癫病。谬矣。癫。颠也。发即僵仆倒地。
故有癫蹶之言。阴气大盛。故不得行立而倒也。今世以为痫病者。误矣。陈氏雪潭居医约云。狂。谓妄言妄走
也。癫。谓僵仆不省也。各自
一症。然经有狂癫疾者。（按厥论。阳明之厥。则癫疾欲走呼。此癫似言狂。）有言狂互引癫者。又言癫疾为
狂者。（按见阴阳类论）此则又皆狂癫兼病。今病有狂言狂走。顷时前后僵仆之类。有僵仆后妄见鬼神。半日
方已之类。是以狂癫兼病者也。欲独闭户牖而处。阴不胜其阳。则脉流薄疾并。此乃独狂症也。陈此说。证之
经文。验之病者。颇为明晰。
搏阴则为喑 张云。邪搏于阴。则阴气受伤。故声为喑哑。阴者。五脏之阴也。盖心主舌。而手少阴
心脉。上走喉咙。系舌本。手太阴肺脉。循喉咙。足太阴脾脉。上行结于咽。连舌本。散舌下。足厥阴肝脉。
循喉咙之后。上入颃颡。而筋脉络于舌本。足少阴肾脉。循喉咙。系舌本。故皆主病喑也。九针论曰。邪入于
阴。转则为喑。言转入阳分则气病。故为喑也。楼氏纲目云。喑者。邪入阴部也。经云。邪搏阴则为喑。又云。
邪入于阴。搏则为喑。然有二症。一曰舌喑。乃中风舌不转运之类。是也。一曰喉喑。乃劳嗽失音之类。是也。
盖舌喑。但舌本不能转运言语。而喉咽音声。则如故也。喉喑。但喉中声嘶。而舌本则能转运言语也。唐慧琳
藏经音义云。喑者。寂然而无声。哑者。有声而无说。舌不转也。简按吴云。喑。哑也。张云。为喑哑。知是
楼氏所谓舌喑。琳音所谓哑也。
阳入之阴则静 简按孙奕示儿编云。之字训变。左传。遇观之否。言观变为否也。盖阳病在外则躁。
若入而变阴则静。下文出之阳意同。王训之为往。似未妥。
是谓五乱 志云。谓邪气乱于五脏之阴阳。简按曰狂。曰痹。曰癫。曰喑。曰静。曰怒。皆乱气所致。
宜曰六乱。然此篇专主五脏而立言。故曰五乱。
皆同命死不治 吴本无命字。马云。是谓五邪。皆同名
曰死不治耳。高本同。下句注云。是谓五邪。皆同言五脏受邪。同于木受金刑之义。命死不治。志本亦同。注
云。命者。谓计其余命生死之期。期以月节克之。不即死。简按从马注为是。
肾藏志 九针论。志。作精。难经同。
久视伤血 简按五脏生成篇云。诸脉者。皆属于目。久视伤血者。伤血脉也。
久卧伤气 张云。久卧则阳气不伸。故伤气。
久坐伤肉 张云。久坐则血脉滞于四体。故伤肉。
久立伤骨 志云。久立则伤腰肾膝胫。故伤骨。
久行伤筋 志云。行走罢极则伤筋。
五劳所伤 志云。劳。谓太过也。上古之民。形劳而不倦。简按劳。说文。剧也。从力荧省。荧。火
烧。 。用力者劳。鲁刀切。尔雅释诂。劳。勤也。
吴云：宣，意为发散。五气，指木、火、土、金、水五行之气。本文阐述五气有入犯、致病、相并、厌恶、化液、禁忌、引发、紊乱、邪客、内藏、主司、损伤、应合等关系，本篇皆对此进行阐发。
这就是所谓的“五入”。马云：这与《灵枢·九针论》相同，只是《灵枢》多了一句“淡味入胃”。丹波简按：《周礼·疾医职》记载：“凡调和饮食，春季多酸，夏季多苦，秋季多辛，冬季多咸，用滑润甘味来调和。”与此义相同。
心对应噫（嗳气）。马云：《灵枢·口问篇》说：“噫出于胃。”《三部九候论》与本篇都说：“心为噫。”考察《脉解篇》，所谓“上走心为噫”，是因为阴气盛而上行于阳明经，阳明经络属于心，所以说上行至心表现为噫。经典的本旨，难道不是二而一吗？张云：噫，就是嗳气。遍查本经，绝无单独列出“嗳气”这一证候，而只说“噫”的，大概就是指这个。丹波简按：《说文解字》解释噫为饱食后的叹息声。《礼记·内则》说：“不敢哕噫”，就是这个意思。（噫，乌界切，音隘；若读于希切，音衣，则为痛叹之声，与此义不同。）嗳，《字汇》注：于盖切，音嗳，即嗳气。大概“嗳”是“噫”的俗字。高云：噫是轻微的嗳气。不对。
肝对应语（多言）。志云：肝气欲通达则表现为多言。《诊要经终篇》说：“春季针刺冬季分肉部位，邪气留着于脏，病不愈，且想要说话。”这是说春令肝气不舒展的缘故。高云：病气在肝则表现为多言，语即多言。丹波简按：既然标题叫“五气所病”，那么王冰、马云、吴崑、张景岳的解释都错了。下文关于“吞”的解释同理。
脾对应吞（吞咽/吞酸）。志云：脾主为胃传输津液，脾气患病不能灌溉四脏，则津液反溢于脾窍之口，所以出现吞咽（或吞酸）的症状。丹波简按：根据志注，“吞”即指吞酸、吞醋。（《平脉法》说：“噫而吞酸，食物突然下不去。”又说：“上焦不归者，噫而酢吞。”）龚廷贤说：吞酸与吐酸不同。吞酸，是水气刺心；吐酸，是吐出酸水。这是对的。高云：吞，指舌根不和。不知依据何在。
肾对应欠（呵欠）和嚏（喷嚏）。志云：《灵枢》说：“阳主升，阴主降。阳引而上，阴引而下，阴阳相互牵引，所以频频呵欠。”应当泻足少阴经，补足太阳经。（见《口问篇》）大概少阴之气在下，生病则反而逆乱于上，而欲引向下，欲引向下则呵欠；逆乱于上则喷嚏。大概肾络上通于肺。丹波简按：《九针论》没有“嚏”二字，此处疑为衍文。
（肾）还对应哕（呃逆）和恐。丹波简按：“为恐”一词，各家注释未阐明。《九针论》无此二字，疑是衍文。
下焦溢出化为水。高云：下焦患病不能疏通水道，则水液溢出而为水肿。丹波简按：《灵兰秘典论》说：“三焦者，决渎之官，水道出焉。”此处将下焦与胃、大肠、小肠、膀胱、胆并称，则下焦即《灵兰秘典论》中的三焦。（详细含义见《六节脏象论》。）它作为六腑之一，彼此互考，才知道六腑中的三焦专指下焦而言。
膀胱不利（不通畅）导致癃（小便不通）。马云：《灵兰秘典论》说：“膀胱者，州都之官，津液藏焉，气化则能出矣。”现在说不利则导致癃，癃就是水道不通的病。张云：《本输篇》说：“三焦者，太阳之别也，并太阳之正，入络膀胱，约下焦，实则闭癃，虚则遗溺。”大概三焦是中渎之腑，水道由此而出，所以三焦也归属于膀胱。丹波简按：《三因方》说：“淋，古时候称为癃，名称不同罢了。”癃，意为罢废；淋，意为点滴。现在虽称淋，但在意义上更确切。丹波简按：淋作为小便病，始见于《六元正纪大论》。癃，乃是溺闭的通称。马注是正确的。
胆对应怒。张云：怒是肝的情志，但胆也是如此，因为肝胆互为表里，其气皆刚强，而肝的功能取决于胆。高云：胆病郁结而不舒展，则表现为怒。
这就是所谓的“五病”。志云：指五脏五行之气发病，而六腑也配合于五行。丹波简按：《九针论》说：“五脏气，心主噫，肺主咳，肝主语，脾主吞，肾主欠。六腑气，胆为怒，胃为气逆哕，大肠小肠为泄，膀胱不约为遗溺，下焦溢为水。”这里列举六腑的病，却讲五精（五脏精气），大概是因为大肠和小肠都表现为泄泻吧。
五精所并。吴云：五精，指五脏的精气。并合而入于某脏。五脏精气各藏于本脏则不病，如果合并入于一脏，则邪气充实其中，各自显现其情志。张云：并，即聚积。高云：脏虚而精气并入。精者指阴精，气者指阳气。丹波简按：精气乃水谷之精气，不必分为阴阳。
精气并于肝则忧。马云：《阴阳应象大论》说肝主怒，而这里说忧，是因为肺气得以乘袭肝木。高云：肝主怒，这里说忧，是因为上文已说胆为怒，所以肝为忧。怒为有余，忧为不足。楼云：忧，当作怒。丹波简按：《九针论》也作忧。
精气并于脾则畏。马云：《阴阳应象大论》说脾主思，而这里说畏，大概是思虑过度反而产生畏惧。高云：思虑是脾的精气，这里说畏，是思虑至极的表现。楼云：畏，当作思。丹波简按：《九针论》也作畏，《甲乙经》作饥。（与王冰注一致。）
五脏化液。高云：化液，指水谷入口后，津液各行其道，五脏受纳水谷之精，渗注于外窍，而化为五液。
心对应汗。吴云：心主血，汗是血的余气，所以汗为心液。丹波简按：《营卫生会篇》说：“夺血者无汗，夺汗者无血。”《三因方》认为伤寒衄血者为红汗，其意相同。
肺对应涕。丹波简按：各种字书以涕为目泪，而医家特指鼻液。考《说文解字》，涕即鼻液。大概“涕”与“涕”通用。《玉篇》注：涕，他计切，鼻中液体。《礼记·内则》说：“不敢唾涕。”释文说：原本又写作“涕”。
脾对应涎。吴崑、张景岳并云：涎出于口，口为脾之窍。丹波简按：《证治准绳·损伤门》说：“两颊有涎囊”，可知涎出于口。
肾对应唾。吴云：唾出于廉泉二窍，二窍挟持舌本，足少阴肾脉循喉咙，挟舌本，所以唾为肾液。高云：《灵枢·根结篇》说：“少阴根于涌泉，结于廉泉”，舌下窍也。肾为水脏，从下而上，液虽有五种，肾实为主宰，所以五液皆咸，咸是水之味。
血病患者不要多吃咸味。张云：血得咸则凝结不流动。《五味论》说：“血与咸相得则凝。”
骨病患者不要多吃苦味。志云：肾主骨，火炎上作苦，苦走骨，是火气下交于肾。骨病而多吃苦味，则火气反而胜克肾水。这与“并于心则喜，并于肾则恐”的意义相同。大概心肾水火之气，时常相互既济，所以味道所走之处互相转换。其余三脏，是本脏之味，而走本脏所主的筋肉。丹波简按：《灵枢·五味论》说：“酸走筋，多食之令人癃；咸走血，多食之令人渴；辛走气，多食之令人洞心；苦走骨，多食之令人变呕；甘走肉，多食之令人悗心。”正与此节同义。《九针论》说：“苦走血，病在血无食苦；咸走骨，病在骨无食咸。”这是从本脏之味来说的。
这就是所谓的“五禁”。《九针论》作“五裁”，《五行大义》引《黄帝养生经》作“五贼”。
阴病发于骨。张云：骨属肾，肾者是阴中之阴。吴崑、马云观点相同。
邪气入于阳则发狂。马云：《生气通天论》说：“阴不胜其阳，则脉流薄疾，并乃狂。”
邪气入于阴则成痹。吴云：邪，指阴邪。痹，指《痹论》所说的五脏痹。阴邪入于阴，是重阴，则成为五脏痹。马云：成为痹证。张云：《寿夭刚柔篇》说：“病在阴，命曰痹。”《九针论》说：“邪入于阴，则为血痹。”
邪气搏结于阳则发巅疾（癫疾）。张云：搏，击也。巅，通癫。邪气搏结于阳，则阳气受伤，所以发癫疾。上文说邪入于阳则狂，是邪助其阳，阳之实证。这里说搏阳则为巅疾，是邪伐其阳，阳之虚证。所以有狂和癫的区别。《九针论》说：“邪入于阳，转则为癫疾。”意思是转入阴分，所以为癫。丹波简按：搏，通“薄”，迫也。马、吴注以巅疾为头顶之疾，并不正确。徐氏《经络全书》说：搏，当作传，不可从。（下文“搏阴”同理。）癫和狂是两种截然不同的疾病，而后世混称难以辨别，因此列举几种说法以昭示清楚。《五十九难》问：狂癫之病，如何区别？回答说：狂疾刚开始发作时，睡眠少且不饥饿，自认为高明贤能，自认为辩才无碍，自认为尊贵，妄笑好歌乐，妄行不休，这就是狂。癫疾刚开始发作时，心情不乐，僵仆倒地，两眼直视。杨玄操说：狂病的症状，不爱眠卧，不肯饮食，自称贤智，歌乐行走，这是阳气盛所造成，所以经文说“重阳者狂”。现在世人把这称为癫病，是错误的。癫，即颠，发作时僵仆倒地，所以有“癫蹶”的说法。阴气大盛，所以不能行走站立而倒下。现在世人把它称为痫病，也是错误的。陈氏《雪潭居医约》说：狂，指胡言乱语、乱跑；癫，指僵仆不省人事。各自是一症。然而经文中有“狂癫疾”的说法。（按《厥论》，阳明之厥，则癫疾欲走呼，这里的癫似乎指狂。）有说“狂互引癫”的，又有说“癫疾为狂”的。（按见《阴阳类论》）这又是狂癫兼病。现在的病有狂言狂走，片刻前后僵仆之类的；有僵仆后妄见鬼神，半天才停止之类的。这是狂癫兼病。如果想独自关窗闭门独处，阴不胜其阳，则脉流薄疾并，这是独狂症。陈述这些说法，验证经文，验之于病人，颇为清晰。
邪气搏结于阴则失音（喑）。张云：邪气搏结于阴，则阴气受伤，所以声音变为喑哑。阴，指五脏之阴。大概心主舌，手少阴心脉上行至喉咙，系舌本；手太阴肺脉循喉咙；足太阴脾脉上行结于咽，连舌本，散舌下；足厥阴肝脉循喉咙之后，上入颃颡，而筋脉络于舌本；足少阴肾脉循喉咙，系舌本。所以这些都主司喑病。《九针论》说：“邪入于阴，转则为喑。”意思是转入阳分则气病，所以为喑。楼氏《纲目》说：喑，是邪入阴部。经文说：“邪搏阴则为喑”，又说“邪入于阴，搏则为喑”。然而有两种症状：一是舌喑，即中风舌不能转动言语之类；二是喉喑，即劳嗽失音之类。大概舌喑，只是舌本不能转动言语，而咽喉音声如故；喉喑，只是喉中声嘶，而舌本能转动言语。唐慧琳《藏经音义》说：喑，寂然而无声；哑，有声而无说，舌不转。丹波简按：吴云：喑，哑也。张云：为喑哑。可知是楼氏所说的舌喑，琳音所说的哑。
阳气入于阴则安静。丹波简按：孙奕《示儿编》说：之字训为变。《左传》“遇观之否”，意思是观变为否。大概阳病在外则躁动，如果入里变为阴则安静。下文“出之阳”意同。王冰训“之”为往，似乎不妥。
这就是所谓的“五乱”。志云：指邪气扰乱五脏之阴阳。丹波简按：说狂、说痹、说癫、说喑、说静、说怒，都是乱气所致，应该说六乱。然而本篇专主五脏而立言，所以说五乱。
（以上五邪）都同名死不治。吴本无“命”字。马云：这叫五邪，都同样被称为死不治。高本相同。下句注云：这叫五邪，都同样说五脏受邪，同于木受金刑的意义。命死不治，志本也相同。注云：命，谓计算其剩余寿命生死之期，期限以月节克之，不立即死。丹波简按：依马注为是。
久视伤血。丹波简按：《五脏生成篇》说：“诸脉者，皆属于目。”久视伤血，即伤血脉。
五劳所伤。志云：劳，谓太过。上古之人，形劳而不倦。丹波简按：劳，《说文》解释为剧也。从力荧省，荧，火烧……用力者劳，鲁刀切。《尔雅·释诂》：劳，勤也。
Wu Yun: "Xuan" (宣) means to disperse. The "Five Qi" (五气) refer to the five phases of Wood, Fire, Earth, Metal, and Water. This text expounds on the relationships of the Five Qi regarding invasion, disease causation, aggregation, aversion, fluid transformation, contraindications, induction, disorder, pathogenic invasion, internal storage, governance, injury, and correspondence. This chapter elucidates all these aspects.
This is referred to as the "Five Entries" (五入). Ma Yun: This is identical to the *Ling Shu: Nine Needles Treatise*, except that the latter includes an additional phrase "Salty taste enters the Stomach." Danbo Jian'an: The *Rites of Zhou: Office of Disease Physicians* states: "In general harmonization, spring favors sour, summer favors bitter, autumn favors pungent, winter favors salty, adjusted with slippery and sweet tastes." This shares the same meaning.
The Heart corresponds to Yi (噫, belching). Ma Yun: The *Ling Shu: Mouth Inquiry Chapter* states: "Yi originates from the Stomach." Both the *San Bu Jiu Hou Treatise* and this chapter state: "The Heart governs Yi." Examining the *Mai Jie Chapter*, what is meant by "ascending to the Heart manifests as Yi" is that when Yin is excessive and ascends to the Yangming channel, and since the Yangming channels connect to the Heart, it is said to ascend to the Heart manifesting as Yi. Is not the purport of the classics essentially one and the same? Zhang Jingyue: Yi refers to belching. Scanning the entire classic, there is no separate syndrome listed solely as "belching," but only "Yi," which presumably refers to this. Danbo Jian'an: The *Shuo Wen Jie Zi* defines Yi as a sigh after a full meal. The *Book of Rites: Inner Rules* says: "Do not belch or retch," which refers to this. (Yi, pronounced 'ai' in the Wu jie rhyme; if pronounced 'yi' in the Yu Xi rhyme, it denotes a cry of pain, which differs in meaning.) Ai (嗳), according to the *Zi Hui*, is pronounced 'ai' and means belching. Essentially, "Ai" is the colloquial character for "Yi." Gao Shi: Yi is slight belching. Incorrect.
The Liver corresponds to Yu (语, excessive speech). Zhi: When Liver Qi desires to flow freely, it manifests as excessive speech. The *Zhen Yao Jing Zhong Chapter* states: "If needling is performed in the winter areas during spring, pathogenic factors adhere to the Zang organs, the illness does not resolve, and the patient desires to speak." This indicates that the Liver Qi of spring fails to unblock. Gao Shi: When pathogenic Qi is in the Liver, it manifests as excessive speech; Yu means talking much. Danbo Jian'an: Since the heading is "Diseases Caused by the Five Qi," the interpretations of Wang Bing, Ma Yun, Wu Kun, and Zhang Jingyue are all incorrect. The explanation for "Tun" below follows the same logic.
The Spleen corresponds to Tun (吞, swallowing/swallowing acid). Zhi: The Spleen is responsible for transporting fluids for the Stomach. If Spleen Qi is diseased and cannot irrigate the four Zang organs, fluids overflow into the opening of the Spleen, the mouth, resulting in symptoms of swallowing (or swallowing acid). Danbo Jian'an: According to Zhi's annotation, "Tun" refers to swallowing acid/vinegar. The *Ping Mai Fa* states: "Belching accompanied by swallowing acid, food suddenly cannot go down." It also states: "If the Upper Jiao does not return, belching accompanies acidic swallowing." Gong Tingxian stated: Swallowing acid differs from vomiting acid. Swallowing acid is water piercing the Heart; vomiting acid is spitting out acidic water. This is correct. Gao Shi: Tun refers to disharmony of the tongue root. Unknown basis.
The Kidney corresponds to Qian (欠, yawning) and Ti (嚏, sneezing). Zhi: The *Ling Shu* states: "Yang governs ascending, Yin governs descending. Yang draws upward, Yin draws downward; mutual attraction causes frequent yawning." One should drain the Foot Shaoyin and tonify the Foot Taiyang. (See *Kou Wen Chapter*). Generally, Shaoyin Qi resides below; when diseased, it rebels upward and seeks to draw downward. Seeking to draw downward causes yawning; rebelling upward causes sneezing. Generally, Kidney collaterals connect upwards to the Lung. Danbo Jian'an: The *Jiu Zhen Lun* lacks the word "Ti"; this is suspected to be a later addition.
(It also corresponds to Yue 哕, hiccup, and Kong 恐, fear.) Danbo Jian'an: The phrase "manifests as fear" is unclear in various annotations. The *Jiu Zhen Lun* lacks these two words; suspected to be a later addition.
Excess fluid in the Lower Jiao transforms into edema. Gao Shi: When the Lower Jiao is diseased and cannot dredge, fluid overflows causing edema. Danbo Jian'an: The *Ling Lan Mi Dian Lun* states: "The San Jiao is the official of dredging, through which water passages exit." Here, the Lower Jiao is listed alongside the Stomach, Large Intestine, Small Intestine, Bladder, and Gallbladder. Thus, the Lower Jiao refers to the San Jiao mentioned in the *Ling Lan Mi Dian Lun*. (For detailed meaning, see *Liu Jie Zang Xiang Lun*.) As one of the Six Fu organs, cross-referencing reveals that the San Jiao among the Six Fu organs specifically refers to the Lower Jiao.
Bladder dysfunction leads to Long (癃, urinary retention). Ma Yun: The *Ling Lan Mi Dian Lun* states: "The Bladder is the official of the city depot, storing fluids; upon Qi transformation, they can exit." Now it says dysfunction leads to Long; Long is a disease of blocked water passages. Zhang Jingyue: The *Ben Shu Chapter* states: "The San Jiao is a branch of the Taiyang, merging with the main Taiyang, entering and connecting to the Bladder, regulating the Lower Jiao. Excess leads to closure and Long; deficiency leads to enuresis." Generally, the San Jiao is the central dredging organ, the source of water passages, so the San Jiao is also attributed to the Bladder. Danbo Jian'an: The *San Yin Fang* states: "Lin (strangury) was called Long in ancient times; names differ." Long implies exhaustion/blockage; Lin implies dripping. Although the modern name is common, it fits the meaning better. Danbo Jian'an: Lin as a urination disease first appears in the *Liu Yuan Zheng Ji Da Lun*. Long is the general term for urinary obstruction. Ma's annotation is correct.
The Gallbladder corresponds to Nu (怒, anger). Zhang Jingyue: Anger is the emotion of the Liver, but the Gallbladder is the same, as the Liver and Gallbladder are exterior-interior pairs, both possessing rigid Qi, and Liver function depends on the Gallbladder. Gao Shi: When Gallbladder disease stagnates and fails to soothe, it manifests as anger.
This is referred to as the "Five Diseases" (五病). Zhi: Refers to diseases of the Five Zang Five Phase Qi, while the Six Fu organs also correspond to the Five Phases. Danbo Jian'an: The *Jiu Zhen Lun* states: "Qi of the Five Zang: Heart governs Yi, Lung governs cough, Liver governs speech, Spleen governs swallowing, Kidney governs yawning. Qi of the Six Fu: Gallbladder manifests as anger, Stomach as rebellious Qi and hiccup, Large and Small Intestines as diarrhea, Bladder lack of control as enuresis, Lower Jiao excess fluid as edema." Here, Six Fu diseases are listed, yet it speaks of Five Jing (Essence). Perhaps because both Large and Small Intestines manifest as diarrhea.
Aggregation of the Five Jing (Essences). Wu Yun: The Five Jing refer to the essential Qi of the Five Zang. Aggregation implies entering. If the essential Qi of the Five Zang remains in its own organ, there is no disease. If it aggregates into one organ, pathogenic factors fill it, manifesting respective emotions. Zhang Jingyue: Bing (并) means gathering. Gao Shi: Organ deficiency allows essence and Qi to aggregate. Jing refers to Yin Essence, Qi refers to Yang Qi. Danbo Jian'an: Essence and Qi are the essential Qi from grain and water; there is no need to divide them into Yin and Yang.
Aggregation into the Liver manifests as You (忧, sorrow/worry). Ma Yun: The *Yin Yang Ying Xiang Da Lun* states the Liver governs anger, but here it says sorrow, because Lung Qi can overcome it. Gao Shi: The Liver governs anger; here it says sorrow because the previous section stated the Gallbladder governs anger, so the Liver governs sorrow. Anger indicates excess; sorrow indicates deficiency. Lou: You should be Nu (anger). Danbo Jian'an: The *Jiu Zhen Lun* also writes You.
Aggregation into the Spleen manifests as Wei (畏, fear). Ma Yun: The *Yin Yang Ying Xiang Da Lun* states the Spleen governs Si (thought), but here it says fear, perhaps excessive thought turns into fear. Gao Shi: Thought is the essence of the Spleen; here it says fear, indicating extreme deliberation. Lou: Wei should be Si (thought). Danbo Jian'an: The *Jiu Zhen Lun* also writes Wei; *Jia Yi Jing* writes Ji (hunger). (Consistent with Wang Bing's note.)
Transformation of Fluids by the Five Zang. Gao Shi: Transformation of fluids refers to food and drink entering, where fluids follow their respective paths. The Five Zang receive the essence of grain and water,渗注 (seeping) to external orifices, transforming into Five Fluids.
The Heart corresponds to Sweat. Wu Yun: The Heart governs Blood; sweat is the surplus of blood, thus sweat is the fluid of the Heart. Danbo Jian'an: The *Ying Wei Sheng Hui Chapter* states: "Those who lose blood have no sweat; those who lose sweat have no blood." The *San Yin Fang* considers nasal bleeding in cold damage as "red sweat," sharing the same intent.
The Lung corresponds to Nasal Discharge (Ti 涕). Danbo Jian'an: Various dictionaries define Ti as eye tears, but medical texts specifically refer to nasal discharge. Examining the *Shuo Wen Jie Zi*, Ti is nasal discharge. Generally, Ti and Ti are interchangeable. The *Yu Pian* notes: Ti, pronounced 'ji', is nasal fluid. The *Book of Rites: Inner Rules* states: "Do not spit or blow nose." The commentary states: Originally written as Ti.
The Spleen corresponds to Saliva (Xian 涎). Wu Kun and Zhang Jingyue both state: Saliva exits from the mouth, which is the orifice of the Spleen. Danbo Jian'an: The *Zheng Zhi Zhun Sheng: Injury Section* states: "There are salivary sacs in both cheeks," confirming saliva exits from the mouth.
The Kidney corresponds to Spittle (Tuo 唾). Wu Yun: Spittle exits from the Lianquan orifices, which flank the root of the tongue. The Foot Shaoyin Kidney meridian follows the throat and flanks the tongue root, thus spittle is the fluid of the Kidney. Gao Shi: The *Ling Shu: Gen Jie Chapter* states: "Shaoyin roots at Yongquan and knots at Lianquan," the sublingual orifice. The Kidney is the Water organ, rising from below. Although there are five fluids, the Kidney governs them all; hence all five fluids are salty, and salt is the taste of water.
Patients with Blood diseases should not consume excessive salty taste. Zhang Jingyue: Blood coagulates and stops flowing when it encounters salt. The *Wu Wei Lun* states: "When blood meets salt, it coagulates."
Patients with Bone diseases should not consume excessive bitter taste. Zhi: The Kidney governs bones. Fire flares up making things bitter; bitter travels to bones, representing Fire Qi interacting downward with the Kidney. In bone disease, consuming excessive bitter taste causes Fire Qi to overpower. This is consistent with the meaning of "aggregation into the Heart manifests as joy, aggregation into the Kidney manifests as fear." Generally, the Water-Fire Qi of Heart and Kidney constantly interact and balance, so the tastes they govern interchange. For the other three Zang organs, it is the taste of the organ itself, traveling to the sinews/muscles governed by that organ. Danbo Jian'an: The *Ling Shu: Wu Wei Lun* states: "Sour travels to sinews, excessive consumption causes strangury; Salt travels to blood, excessive consumption causes thirst; Pungent travels to Qi, excessive consumption causes hollow heart pain; Bitter travels to bones, excessive consumption causes vomiting; Sweet travels to flesh, excessive consumption causes muggy heart." This aligns perfectly with this section. The *Jiu Zhen Lun* states: "Bitter travels to blood, do not eat bitter if disease is in blood; Salt travels to bones, do not eat salt if disease is in bones." This discusses from the perspective of the taste of the specific organ.
This is referred to as the "Five Contraindications" (五禁). The *Jiu Zhen Lun* writes "Five Cuts" (五裁); the *Wu Xing Da Yi* citing the *Huang Di Yang Sheng Jing* writes "Five Thieves" (五贼).
Yin diseases originate in the bones. Zhang Jingyue: Bones belong to the Kidney; the Kidney is Yin within Yin. Wu Kun and Ma Yun agree.
Yang diseases originate in the blood. Zhang Jingyue: Blood belongs to the Heart; the Heart is Yang within Yang.
Yin diseases originate in the flesh/muscles. Zhang Jingyue: Flesh belongs to the Spleen; the Spleen is Yin within Supreme Yin.
Pathogenic factors entering Yang cause mania (Kuang 狂). Ma Yun: The *Sheng Qi Tong Tian Lun* states: "If Yin cannot overcome Yang, pulses flow rapidly and forcefully, leading to mania."
Pathogenic factors entering Yin cause Bi syndrome (Bi 痹). Wu Yun: Pathogen refers to Yin pathogen. Bi refers to the Five Zang Bi described in the *Bi Lun*. Yin pathogen entering Yin is double Yin, resulting in Five Zang Bi. Ma Yun: Becomes Bi syndrome. Zhang Jingyue: The *Shou Yao Gang Rou Chapter* states: "Disease in Yin is named Bi." The *Jiu Zhen Lun* states: "Pathogen entering Yin becomes Blood Bi."
Pathogenic factors clashing with Yang cause Dian disease (巅疾, epilepsy/manic disorder). Zhang Jingyue: Bo (搏) means strike. Dian (巅) is synonymous with Dian (癫, epilepsy). Pathogen clashing with Yang injures Yang Qi, thus causing epileptic/manic disorders. The previous text stated pathogen entering Yang causes Kuang (mania), which is pathogen assisting Yang, an excess condition of Yang. Here, clashing with Yang causes Dian disease, which is pathogen attacking Yang, a deficiency condition of Yang. Hence the difference between Kuang and Dian. The *Jiu Zhen Lun* states: "Pathogen entering Yang, turning leads to Dian disease." Meaning it turns into the Yin aspect, thus becoming Dian. Danbo Jian'an: Bo is synonymous with Bo (薄), meaning pressure. Ma and Wu interpret Dian disease as disease of the vertex, which is incorrect. Xu's *Jing Luo Quan Shu* states: Bo should be Chuan (transmit), do not follow. (Same for "Bo Yin" below.) Dian and Kuang are distinctly different diseases, but later generations confused them. Therefore, several explanations are cited to clarify. The *Nan Jing: Fifty-Ninth Difficulty* asks: How to distinguish Kuang and Dian? Answer: Kuang begins with little sleep, no hunger, considering oneself wise and noble, speaking arrogantly, laughing excessively, singing, walking aimlessly without rest. Dian begins with unhappiness, sudden collapse, staring straight. Yang Xuancuo states: Symptoms of Kuang include unwillingness to sleep or eat, claiming wisdom, singing and walking; this is caused by excessive Yang Qi, hence the classic says "Double Yang is Kuang." Modern people call this Dian disease, which is wrong. Dian means toppling; onset involves collapsing to the ground, hence "Dian Jue." Excessive Yin Qi prevents standing/walking, causing collapse. Modern people call this Epilepsy (Xian), which is also wrong. Chen's *Xue Tan Ju Yi Yue* states: Kuang refers to nonsense and running; Dian refers to collapse and unconsciousness. They are separate syndromes. However, the classics mention "Kuang Dian Ji" (see *Jue Lun*: Yangming Jue leads to Dian disease wanting to run and shout, where Dian seems to imply Kuang); mentions "Kuang interweaves with Dian"; and mentions "Dian disease is Kuang" (see *Yin Yang Lei Lun*). These refer to combined Kuang-Dian diseases. Current diseases include cases of Kuang speech/walking followed by collapse; or collapse followed by hallucinations resolving after half a day. These are combined Kuang-Dian. Those who wish to stay alone behind closed doors, where Yin cannot overcome Yang, pulses flow rapidly and forcefully, represent isolated Kuang syndrome. Presenting these theories, verifying against the classics and patients, provides clarity.
Pathogenic factors clashing with Yin cause Aphonia (Yin 喑). Zhang Jingyue: Pathogen clashing with Yin injures Yin Qi, thus voice becomes aphonic. Yin refers to the Yin of the Five Zang. Generally, the Heart governs the tongue; the Hand Shaoyin Heart meridian ascends to the throat and ties to the tongue root; the Hand Taiyin Lung meridian follows the throat; the Foot Taiyin Spleen meridian ascends to knot at the pharynx, connects to the tongue root, and spreads under the tongue; the Foot Jueyin Liver meridian follows the throat posteriorly, enters the epiglottis, and sinew collaterals tie to the tongue root; the Foot Shaoyin Kidney meridian follows the throat and ties to the tongue root. Thus, all these govern aphonia. The *Jiu Zhen Lun* states: "Pathogen entering Yin, turning leads to aphonia." Meaning turning to the Yang aspect causes Qi disease, thus aphonia. Lou's *Gang Mu* states: Yin is pathogen entering the Yin region. The classic states: "Pathogen clashing with Yin leads to aphonia," and "Pathogen entering Yin, clashing leads to aphonia." There are two types: one is She Yin (tongue aphonia), such as stroke where the tongue cannot move for speech; the other is Hou Yin (throat aphonia), such as loss of voice from chronic cough. Generally, She Yin means the tongue root cannot move for speech, but throat sounds remain normal; Hou Yin means hoarseness in the throat, but the tongue root can still move for speech. Tang Huilin's *Cang Jing Yi Yi* states: Yin is silent and soundless; Ya (mute) has sound but no speech due to immovable tongue. Danbo Jian'an: Wu Yun states: Yin means mute. Zhang Jingyue states: Manifests as aphonia. This indicates Lou's She Yin and Lin Yin's Ya.
Yang entering Yin leads to tranquility. Danbo Jian'an: Sun Yi's *Shi Er Bian* states: The character "Zhi" (之) means change. The *Zuo Zhuan* "Encountering Guan changing to Pi" means Guan changes to Pi. Generally, Yang disease outside causes agitation; if it enters and changes to Yin, it becomes tranquil. The following text "Exiting to Yang" has the same meaning. Wang Bing interprets "Zhi" as going, which seems inappropriate.
This is referred to as the "Five Disorders" (五乱). Zhi: Refers to pathogenic factors disrupting the Yin-Yang of the Five Zang. Danbo Jian'an: Mentioning Kuang, Bi, Dian, Yin, Jing (tranquility), and Nu (anger) are all caused by disordered Qi; it should be called Six Disorders. However, this chapter focuses on the Five Zang, hence it is called Five Disorders.
(All five pathogens) share the same name: death untreatable. The Wu edition lacks the character "Ming" (命). Ma Yun: This is called the Five Pathogens, all similarly termed death untreatable. Gao edition agrees. Note below states: This is called the Five Pathogens, all similarly stating the Five Zang receive pathogens, similar to Wood receiving Metal punishment. Ming death untreatable, Zhi edition also agrees. Note states: Ming means calculating the remaining lifespan and time of death; the period is determined by monthly/seasonal overcoming; death does not occur immediately. Danbo Jian'an: Following Ma's annotation is correct.
The Kidney stores Zhi (Will). The *Jiu Zhen Lun* writes Jing (Essence) instead of Zhi; the *Nan Jing* agrees.
Prolonged viewing injures Blood. Danbo Jian'an: The *Wu Zang Sheng Cheng Chapter* states: "All vessels belong to the eyes." Prolonged viewing injuring Blood means injuring the blood vessels.
Prolonged lying down injures Qi. Zhang Jingyue: Prolonged lying down prevents Yang Qi from extending, thus injuring Qi.
Prolonged sitting injures Flesh/Muscles. Zhang Jingyue: Prolonged sitting causes blood vessels to stagnate in the four limbs, thus injuring flesh.
Prolonged standing injures Bones. Zhi: Prolonged standing injures the waist, kidneys, knees, and shins, thus injuring bones.
Prolonged walking injures Sinews. Zhi: Walking to exhaustion injures sinews.
The Five Labors Cause Injury. Zhi: Lao (Labor/Exertion) means excess. Ancients were physically active but not exhausted. Danbo Jian'an: Lao, according to *Shuo Wen*, means severe/intense. From Li (power) with省略 (provisional) Ying (fire burning)... exerting force is Lao, pronounced 'lu dao'. The *Er Ya: Shi Gu* states: Lao means diligence/toil.