肺中风者，口燥而喘，身运而重，冒而肿胀。
【按】身运而重，当是“头运而身重”，冒而肿胀，当是“冒风而肿胀”，始与文义相合，
此必传写之讹可知。
【注】肺主气，外合皮毛，肺中风邪，风伤气则津结不行，故口燥；风伤肺则气逆上
空，故喘咳。头运而身重者，气伤而力乏也。冒风而肿胀者，皮伤风水也。
【集注】李 曰∶肺主气，风邪中之则气壅而津液不行，故口燥、气逆而呼吸不利，故
气喘也。
肺中寒，吐浊涕。
【注】肺中寒邪，胸中之阳气不治，则津液聚而不行，故吐浊涎如涕也。
【集注】李 曰∶五液入肺为涕，肺合皮毛，开窍于鼻，寒邪从皮毛而入于肺，则肺
窍不利而鼻塞涕唾，浊涎壅遏不通，吐出于口也。
肺死脏，浮之虚，按之弱如葱叶，下无根者，死。
【注】肺中风寒之邪，脉若见浮之极虚，按之弱如葱叶之空，下无根者，乃肺脏之死
脉也。以下五脏俱言浮者，是明外中之邪，应得之脉也。
【集注】程林曰∶真肺脉至，如以毛羽中人肤，非浮之虚乎？葱叶中空，按之弱如葱
叶，下又无根，则浮毛虚弱是无胃气也。此真脏已见，故死。
肝中风者，头目 ，两胁痛，行常伛，令人嗜甘。
【注】肝主风，外合于筋，肝中风邪，风胜则动，故头目 动也。两胁肝之部，肝受
病故两胁痛也。风伤筋，故行常伛偻也。肝苦急欲甘缓之，故令人嗜甘也。
【集注】徐彬曰∶高巅之上，惟风可到，风性动摇，故头目 动。肝脉上贯膈，今胁
肋有邪故痛。肝主筋，风胜则筋急故伛。人以脾胃为主，木邪甚而土负，甘益脾，嗜甘
所以自救也。
肝中寒者，两臂不举，舌本燥，喜太息，胸中痛，不得转侧，食则吐而汗出也。
【按】“两臂不举，舌本燥”二句，“而汗出”三字，文义不属，必是错简，不释。
【注】肝性条达，气行于胸侧，肝中寒邪，故有气抑不伸，喜太息。气滞不行，痛不得
转侧也。食则吐，亦寒邪上逆也。
肝死脏，浮之弱，按之如索不来，或曲如蛇行者，死。
【注】肝中风寒之邪，若脉见浮之极弱，按之不弦，是失其肝之本脉也。今按之如索
不来，曲如蛇行而去，夫索曲蛇行，去而不来，非皆肝脏之死脉乎？
【集注】周扬俊曰∶按之如索，则弦紧俱见，脉有来去，乃阴阳往复之理。今曰∶不
来但去，是无胃气也。否则真气将散，出入强勉，有委而不前，屈且难伸之状，故曲如
蛇行也。
肝着，其人常欲蹈其胸上，先未苦时，但欲饮热，旋复花汤主之。
【按】“旋复花汤主之”六字，与肝着之病不合，当是衍文。
【注】肝着者，为肝气着而不行，致胸痞塞不快也。故其人常欲按摩其胸，以疏通其
气也。其先未曾痞塞苦时，但欲饮热者，乃寒气为病也。
【集注】李 曰∶肝主疏泄，着则气郁不伸，常欲人蹈其胸上，以舒其气，又以寒气
固结于中，欲饮热以胜其寒也。
心中风者，翕翕发热，不能起，心中饥，食即呕吐。
【按】翕翕发热，中风之本证也。不能起，心中饥，食即呕吐，文义不属，必是错简，不
释。
心中寒者，其人苦病心如啖蒜状，剧者心痛彻背，背痛彻心，譬如蛊注，其脉浮者，
自吐乃愈。
【注】其人苦病心如啖蒜状，谓辛辣刺心之状也。剧者心痛彻背，背痛彻心，谓心背
相应而痛也，譬如蛊注，谓似虫之往来不已而痛也。此皆心中寒邪之证。若其脉浮，是
心得本脉，为寒邪上越之候，故自吐则邪去乃愈也。
【集注】徐彬曰∶寒则为阴邪，外束之则火内郁，故如啖蒜状，其似辣而非痛也。剧
则邪盛，故外攻背痛，内攻心痛。彻者相应也。譬如蛊注状，其绵绵不息。若脉浮，是
邪未结，故自吐而愈。
心伤者，其人劳倦，即头面赤而下重，心中痛而自烦，发热，当脐跳，其脉弦，此为
心脏伤所致也。
【按】其脉弦之“弦”字，当是“沉”字。沉为肾脉，文义相属。必是传写之讹。
【注】心伤者，谓心伤病之人也。因其人
劳倦则扰其心，心之阳盛于上，故头面赤也。上盛则下虚，故下重而无力也。心中痛，自
烦发热，当脐跳。其脉沉，肾乘心伤之所致也。
【集注】尤怡曰∶心伤者，其人劳倦，即头面赤而下重。盖心虚者，其阳易浮，上盛
者，其下必虚也。心中痛而自烦发热者，心虚失养而热动于中也。当脐跳者，心虚于上，
而肾动于下也。
邪哭使魂魄不安者，血气少也。血气少者，属于心。心气虚者，其人则畏，合目欲
眠，梦远行而精神离散，魂魄妄行。阴气衰者为癫，阳气衰者为狂。
【按】阴气衰者为癫之“癫”字，当是“狂”字；阳气衰者为狂之“狂”字，当是
“癫”字，《内经》曰∶重阴者癫，重阳者狂。必是传写之讹。
【注】邪哭，谓心伤之人无故而哭也。邪哭则使人魂魄不安，心之血气少也。血气少
而心虚，则令人畏，合目欲眠则梦远行，此是精神离散，魂魄妄行也。心之血阴也，阴
过衰则阳盛，阳盛则为病狂也；心之气阳也，阳过衰则阴盛，阴盛则病癫也。
心死脏，浮之实如丸豆，按之益躁疾者，死。
【注】心中风寒之邪，若脉见浮之极实，如丸豆之状，按之益劲躁疾乱动者，乃心脏
之死脉也。
【集注】李 曰∶《难经》云心脉浮大而散，若浮之实如麻豆，按之益躁疾，则真脏
脉见，胃气全无，故死。《内经》云∶真心脉至坚而搏，如寻薏苡子，累累然即如麻豆。意
可与此同参。
脾中风者，翕翕发热，形如醉人，腹中烦重，皮目 而短气。
【按】脾缺中寒之文，必是简脱。
【注】脾中风邪，翕翕发热，中风之本证也。形如醉人，亦风热攘乱于中，应有之证
也。腹中不快而烦，身体懈惰而重，皮目 ，动而气短，皆脾经证也。
【集注】李 曰∶风属阳邪而气疏泄，形如醉人，言其面赤而四肢软也。风气内扰，故
腹中烦重，皮目，上下眼胞也。
脾死脏，浮之大坚，按之如覆杯，洁洁状如摇者，死。
【注】脾中风寒之邪，若脉见浮之大坚，失其和缓，按之状如覆杯，高章明洁，有力
如摇，乃脾脏之死脉也。
【集注】李 曰∶脉弱以滑，是有胃气，浮之大坚，则胃气绝，真脏脉见矣。覆杯则
内空，洁洁者，空而无有之象也。状如摇者，脉躁疾不宁，气将散也，故死。
跗阳脉浮而涩，浮则胃气强，涩则小便数，浮涩相搏，大便则坚，其脾为约，麻子
仁丸主之。
【按】此条当在《腹满篇》中便难之下，必是错简在此。
【注】跗阳胃脉也，若脉涩而不浮，脾阴虚也，则胃气亦不强，不堪下矣，今脉浮而
涩，胃阳实也，则为胃气强，脾阴亦虚也。脾阴虚不能为胃上输精气，水独下行，故小便
数也；胃气强，约束其脾，不化津液，故大便难也。以麻仁丸主之，养液润燥，清热通
幽。不敢恣行承气者，盖因脉涩终是虚邪也。
【集注】徐彬曰∶脾约病用丸不作汤者，取其缓以开结，不敢骤伤元气也。要知人至
脾约，皆因元气不充，津液不到所致耳！
李 曰∶跗阳胃脉也。胃为水谷之海，浮为阳脉，故胃气强而能食；小便数则津液亡，
故脉涩。盖脾主为胃行津液，此以胃强脾弱，约束津液，不能四布，但输膀胱，致小便数
而大便坚也。麻子仁丸通幽润燥。
麻子仁丸方
麻子仁（二升） 芍药（半斤） 枳实（一斤） 大黄（一斤） 浓朴（一尺） 杏仁（一升）
上六味，末之；炼蜜为丸，梧子大，饮服十丸，日三，以知为度。
肾着之病，其人身体重，腰中冷，如坐水中，形如水状，反不渴，小便自利，饮食
如故，病属下焦。身劳汗出，衣里冷湿，久久得之。腰以下冷痛，腹重如带五千钱，甘
姜苓术汤主之。
【按】肾缺中风、中寒二条，必是简脱。
【注】肾着者，谓肾为寒湿所伤，着而不行之为病也。肾受寒湿，故体重腰冷，如坐
水中。虽形如水肿之状，反不渴而小便自利，非水也，乃湿也。饮食如故，以病属下焦肾，
而不属中焦脾故也。询其所以得之之由，身劳汗出，衣里冷湿，久久伤之也，是以腰下
冷痛寒胜也。腹重，湿胜也。如带五千钱，形容重着之甚也。以甘姜苓术汤补上以制水，散
寒以渗湿也。
【集注】尤怡曰∶其病不在肾之中脏，而在肾之外府，故其治不在温肾以散寒，而在
燠土以胜水也。
甘草干姜茯苓白术汤方
甘草（二两） 白术（二两） 干姜（四两） 茯苓（四两）
上四味，以水五升，煮取三升，分温三服，腰中即温。
肾死脏，浮之坚，按之乱如转丸，益下入尺中者，死。
【注】肾中风寒之邪，若见浮之极坚，按之乱动有如转丸，及下入尺中，通然乱动，皆
肾死真脏之脉也。
【集注】程林曰∶肾脏死，浮之坚，与《内经》辟辟如弹石曰肾死同意，皆坚之象也。
按之则乱如转九，下入尺中者，此阴阳离决之状也，故死。以上真脏与《内经》互有异
同。总之脉无胃气，现于三部中，脉象形容不一也。
问曰∶三焦竭部，上焦竭，善噫，何谓也？师曰∶上焦受中焦气，未和，不能消谷，
故能噫耳。下焦竭，即遗尿失便，其气不和，不能自禁制，不须治，久则愈。
【注】三焦竭部者，谓三焦因虚竭而不各归其部，不相为用也。上焦受气于中焦，下
焦生气于中焦，互相为用则为和也。若中焦虚竭，不能消化水谷，谷气不受，则上焦不
相为用而失和也，失和则谷气郁而不宣，故善噫也。下焦虚竭，不能供升生之气于中焦，
则失和也。失和则肾气独沉，自不能禁，故前遗尿而后失便也。不须治，久则愈，在善
噫可也。若遗尿失便，未有不治能愈者，恐是错简。
【集注】程林曰∶竭，虚也。本经云∶三焦不归其部，上焦不归者，噫而酢吞；中焦
不归者，不能消谷引食；下焦不归者，则遗溲。上焦胃上口也，中焦脾也，脾善噫，脾
不和，则食息迫逆于胃口而为噫也。经云∶膀胱不约为遗尿，因气不和则溲便不约。故遗
失而不能自禁制也。
师曰∶热在上焦者，因咳为肺痿；热在中焦者，则为坚；热在下焦者，则尿血，亦
令淋秘不通。大肠有寒者，多 溏；有热者，便肠垢。小肠有寒者，其人下重便血；有热
者，必痔。
【注】热在上焦者，篇中所谓肺痿吐涎沫也；热在中焦者，篇中所谓腹满坚痛也；热
在下焦者，篇中所谓小便淋沥也。其外大肠有寒者，多清彻 溏，即下利溏泻也。有热
者，便稠粘肠垢，即下利脓血也。小肠有寒者，下重便血，即结阴便血也。有热者，热
流于大肠，蓄于肛门必病痔也。
【集注】徐彬曰∶小肠为受盛之官，与心为表里。丙，小肠也。挟火以济阴，而阴不
滞，挟气以化血，而血归经，有寒则气不上通而下重，血无主气而妄行矣。直肠者，大
肠之头也，门为肛，小肠有热，则大肠传导其热，而气结于肛门故痔。痔者，滞其丙小
肠之热于此也。
问曰∶病有积、有聚、有 气，何谓也？师曰∶积者，脏病也，终不移。聚者，腑病
也，发作有时，展转痛移，为可治。 气者，胁下痛，按之则愈，复发为 气。诸积大法∶
脉来细而附骨者，乃积也。寸口，积在胸中；微出寸口，积在喉中。关上，积在脐傍；上
关上，积在心下；微下关，积在少腹。尺中，积在气冲；脉出左，积在左；脉出右，积在
右；脉两出，积在中央。各以其部处之。（ 作 解，见首篇。）
【注】病有积、有聚、有 气，当别之也。积者脏病，无时不有，不移其处也。聚者腑
病，发作有时，展转痛移也。为可治，谓腑病易治也。 气者，饮积胁下痛也，按之则
止，不按复痛，以水气得按暂散，故痛暂止止也，此即其证而言之。然诸积大法，尤当
以诊候之也，脉来沉伏附骨而细者，乃诸积之诊也。若见两寸，积在胸中也；微出近鱼
际，积在喉中也。两关，积在脐傍也；上关近寸，积在心下也；微下近尺，积在少腹也。
尺中，积在气冲也；脉出左，积在左；脉出右，积在右；脉两出，谓左右俱见，积在中
央也。各以其部之处，而诊积之所在也。
【集注】徐彬曰∶积者迹也，病气之属阴者也。脏属阴，两阴相得，故不移。不移者，
有专痛之处，而无迁改也。聚则如市井之物，偶聚而已，病气之属阳者也。腑属阳，两阳
相比，则非如阴之凝，故寒气感则发，否则已。所谓有时也，既无定着，则痛无常处，故
展转痛移，其根不深，故比积为可治也。
李 曰∶积为脏病，深入在里，故脉细而附骨也。寸、关、尺，上下、左右，别积
病之所在，皆指细而附骨之部分，即《内经》前以候前，后以候后。上竟上者，胸喉
中事也；下竟下者，少腹腰股膝胫足中事也。
肺经受风邪侵袭，会出现口干舌燥且气喘，头晕目眩而身体沉重，头昏蒙并伴有肿胀。
【按语】“身体沉重而头晕”应当是“头晕而身体沉重”，“头昏蒙并因风而肿胀”应当是“受风邪而肿胀”，这样才与文义相符，这显然是传抄过程中的错误。
【注解】肺主气，外合皮毛，肺受风邪侵袭，风伤气则津液凝结不行，所以口干；风伤肺则气逆向上，所以气喘咳嗽。头晕而身体沉重，是因为气受伤而力气匮乏。受风邪而肿胀，是因为皮肉受伤导致风水相搏。
【集注】李 说：肺主气，风邪侵入则气机壅滞而津液不行，所以口干；气逆而呼吸不利，所以气喘。
肺经中寒邪，会吐出浑浊的鼻涕。
【注解】肺受寒邪，胸中的阳气不能宣通，则津液聚积而不行，所以吐出像鼻涕一样的浊涎。
【集注】李 说：五液入肺化为涕，肺合皮毛，开窍于鼻，寒邪从皮毛进入肺，则肺窍不利而鼻塞流涕唾，浊涎壅塞不通，吐出于口。
肺的死脉，轻取虚浮，重按软弱像葱叶一样中空，下部无根，这是死证。
【注解】肺受风寒之邪，脉象若见轻取极虚，重按软弱像葱叶中空，下部无根，这是肺脏的死脉。以下五脏都提到“浮”，是为了说明外感之邪应有的脉象。
【集注】程林说：真肺脉到来，像羽毛中人皮肤，难道不是轻取虚浮吗？葱叶中空，重按软弱像葱叶，下部又没有根，那么浮毛虚弱就是没有胃气。这是真脏脉已现，所以死。
肝经受风邪侵袭，出现头目跳动，两胁疼痛，行走时常弯腰曲背，使人喜欢吃甘甜的食物。
【注解】肝主风，外合于筋，肝受风邪，风胜则动，所以头目跳动。两胁是肝的部位，肝受病所以两胁痛。风伤筋，所以行走常弯腰曲背。肝苦急，欲用甘味缓之，所以使人喜欢吃甘甜的食物。
【集注】徐彬说：高巅之上，只有风能到达，风性动摇，所以头目跳动。肝脉上贯膈，现在胁肋有邪气所以痛。肝主筋，风胜则筋急所以弯腰。人以脾胃为主，木邪盛而土受损，甘味益脾，嗜甘是为了自救。
肝经中寒邪，两臂不能举起，舌根干燥，喜欢叹气，胸部疼痛，不能翻身侧卧，进食则呕吐并出汗。
【按语】“两臂不能举起，舌根干燥”两句，“以及出汗”三字，文义不连贯，必定是错简，不予解释。
【注解】肝性喜条达，气行于胸侧，肝受寒邪，所以气机压抑不能舒展，喜欢叹气。气滞不行，疼痛不能翻身侧卧。进食则呕吐，也是寒邪上逆所致。
肝的死脉，轻取软弱，重按像绳索一样不来，或者弯曲像蛇行一样，这是死证。
【注解】肝受风寒之邪，若脉象见轻取极弱，重按不弦，这是失去了肝的本脉。现在重按像绳索一样不来，弯曲像蛇行而去，那绳索弯曲蛇行，去而不来，不都是肝脏的死脉吗？
【集注】周扬俊说：重按像绳索，则弦紧俱见，脉有来去，这是阴阳往复的道理。现在说：不来只去，是没有胃气。否则真气将散，出入勉强，有委顿不前，屈曲难伸的样子，所以弯曲像蛇行。
肝着病，病人常常想要别人踩踏他的胸部，起初未痛苦时，只想喝热饮，用旋复花汤主治。
【按语】“旋复花汤主治”六字，与肝着病不合，应当是衍文。
【注解】肝着病，是因为肝气郁结不行，导致胸痞塞不快。所以病人常常想要按摩胸部，以疏通其气。起初未曾痞塞痛苦时，只想喝热饮，这是寒气致病。
【集注】李 说：肝主疏泄，郁结则气郁不伸，常想要人踩踏胸部，以舒其气，又因为寒气固结于中，想喝热饮以胜其寒。
心中风邪，翕翕发热，不能起身，心中饥饿，进食即呕吐。
【按语】翕翕发热，是中风的本证。不能起身，心中饥饿，进食即呕吐，文义不连贯，必定是错简，不予解释。
心中寒邪，病人痛苦得像吃蒜一样辛辣刺心，严重时心痛彻背，背痛彻心，像蛊注一样，脉浮的，自吐后痊愈。
【注解】病人痛苦得像吃蒜一样辛辣刺心，是指辛辣刺心的感觉。严重时心痛彻背，背痛彻心，是指心背相应而痛，像蛊注，是指像虫子往来不已而痛。这都是心中寒邪的证候。如果脉浮，是心得本脉，为寒邪上越的征候，所以自吐则邪去痊愈。
【集注】徐彬说：寒则为阴邪，外束则火内郁，所以像吃蒜一样，似辣而非痛。严重时邪盛，所以外攻背痛，内攻心痛。彻是相应。像蛊注状，绵绵不息。如果脉浮，是邪未结，所以自吐而愈。
心脏受伤的人，劳累疲倦时，就头面发红而下肢沉重，心中痛且自烦，发热，肚脐跳动，脉弦，这是心脏受伤所致。
【按语】脉弦的“弦”字，应当是“沉”字。沉为肾脉，文义相属。必定是传抄错误。
【注解】心脏受伤，是指心伤病之人。因为劳累疲倦则扰动其心，心之阳盛于上，所以头面红。上盛则下虚，所以下肢沉重无力。心中痛，自烦发热，肚脐跳动，脉沉，是肾乘心伤所致。
【集注】尤怡说：心脏受伤，劳累疲倦时，就头面红而下肢沉重。大概心虚者，其阳易浮，上盛者，其下必虚也。心中痛且自烦发热，是心虚失养而热动于中。肚脐跳动，是心虚于上，而肾动于下。
无故哭泣使魂魄不安的，是血气少。血气少，属于心。心气虚的人，则畏惧，闭眼想睡，梦远行而精神离散，魂魄妄行。阴气衰的是癫，阳气衰的是狂。
【按语】阴气衰的是癫的“癫”字，应当是“狂”字；阳气衰的是狂的“狂”字，应当是“癫”字，《内经》说：重阴者癫，重阳者狂。必定是传抄错误。
【注解】邪哭，是指心伤之人无故而哭。邪哭则使人魂魄不安，是心之血气少。血气少而心虚，则令人畏惧，闭眼想睡则梦远行，这是精神离散，魂魄妄行。心之血是阴，阴过衰则阳盛，阳盛则为病狂；心之气是阳，阳过衰则阴盛，阴盛则病癫。
心的死脉，轻取坚实像丸豆，重按更加躁疾乱动的，是死证。
【注解】心受风寒之邪，若脉象见轻取极实，像丸豆的形状，重按更加劲躁疾乱动，这是心脏的死脉。
【集注】李 说：《难经》说心脉浮大而散，如果轻取实像麻豆，重按更加躁疾，则真脏脉见，胃气全无，所以死。《内经》说：真心脉至坚而搏，像寻薏苡子，累累然即如麻豆。意思可以与此参考。
脾经受风邪侵袭，翕翕发热，形体像醉人，腹中烦重，眼皮跳动而短气。
【按语】脾缺少中寒的条文，必定是简脱。
【注解】脾受风邪，翕翕发热，是中风的本证。形体像醉人，也是风热扰乱于中，应有的证候。腹中不快而烦，身体懈惰而重，眼皮跳动，动而气短，都是脾经证候。
【集注】李 说：风属阳邪而气疏泄，形体像醉人，是说其面赤而四肢软。风气内扰，所以腹中烦重，眼皮跳动，指上下眼睑。
脾的死脉，轻取大坚，重按像倒扣的杯子，光洁洁净像摇动一样，是死证。
【注解】脾受风寒之邪，若脉象见轻取大坚，失去和缓，重按状如倒扣的杯子，高章明洁，有力如摇，这是脾脏的死脉。
【集注】李 说：脉弱以滑，是有胃气，浮之大坚，则胃气绝，真脏脉见了。倒扣的杯子则内空，洁洁，是空而无有的样子。状如摇动，是脉躁疾不宁，气将散，所以死。
跗阳脉浮而涩，浮则胃气强，涩则小便数，浮涩相搏，大便则坚，其脾为约，用麻子仁丸主治。
【按语】此条应当在《腹满篇》中便难的下面，必定是错简在此。
【注解】跗阳是胃脉，如果脉涩而不浮，是脾阴虚，则胃气也不强，不堪攻下，现在脉浮而涩，是胃阳实，则为胃气强，脾阴也虚。脾阴虚不能为胃上输精气，水独下行，所以小便数；胃气强，约束其脾，不化津液，所以大便难。用麻仁丸主治，养液润燥，清热通幽。不敢恣意使用承气汤，是因为脉涩终归是虚邪。
【集注】徐彬说：脾约病用丸不作汤，是取其缓以开结，不敢骤伤元气。要知道人到脾约，都是因为元气不充，津液不到所致！
李 说：跗阳是胃脉。胃为水谷之海，浮为阳脉，所以胃气强而能食；小便数则津液亡，所以脉涩。大概脾主为胃行津液，这里因为胃强脾弱，约束津液，不能四布，但输膀胱，致小便数而大便坚。麻子仁丸通幽润燥。
麻子仁丸方
麻子仁（二升） 芍药（半斤） 枳实（一斤） 大黄（一斤） 浓朴（一尺） 杏仁（一升）
以上六味，研末；炼蜜为丸，梧子大，饮水送服十丸，每日三次，以见效为度。
肾着病，病人身体沉重，腰部冷，像坐在水中，形体像水肿，反而不渴，小便自利，饮食如故，病属下焦。身体劳累汗出，衣服里冷湿，久久得之。腰以下冷痛，腹部重得像带着五千钱，用甘草干姜茯苓白术汤主治。
【按语】肾缺少中风、中寒两条，必定是简脱。
【注解】肾着，是指肾被寒湿所伤，附着而不行之为病。肾受寒湿，所以体重腰冷，像坐在水中。虽然形如水肿之状，反而不渴而小便自利，不是水，是湿。饮食如故，因为病属下焦肾，而不属中焦脾。询问其得病的原因，身体劳累汗出，衣服里冷湿，久久伤之，是以腰下冷痛寒胜。腹重，是湿胜。像带五千钱，形容重着之甚。用甘姜苓术汤补上以制水，散寒以渗湿。
【集注】尤怡说：其病不在肾之中脏，而在肾之外府，所以治疗不在温肾以散寒，而在燠土以胜水。
甘草干姜茯苓白术汤方
甘草（二两） 白术（二两） 干姜（四两） 茯苓（四两）
以上四味，用水五升，煮取三升，分温三服，腰部即温。
肾的死脉，轻取坚硬，重按乱动像转丸，更向下入尺中者，是死证。
【注解】肾受风寒之邪，若见轻取极坚，重按乱动有如转丸，及下入尺中，通然乱动，都是肾死真脏之脉。
【集注】程林说：肾脏死，轻取坚，与《内经》辟辟如弹石曰肾死同意，都是坚的象。重按则乱如转九，下入尺中，这是阴阳离决的状态，所以死。以上真脏与《内经》互有异同。总之脉无胃气，现于三部中，脉象形容不一。
问：三焦竭部，上焦竭，善噫，是什么意思？老师说：上焦受中焦气，未和，不能消谷，所以能噫。下焦竭，即遗尿失便，其气不和，不能自禁制，不需要治，久了则愈。
【注解】三焦竭部，是指三焦因虚竭而不各归其部，不相为用。上焦受气于中焦，下焦生气于中焦，互相为用则为和。如果中焦虚竭，不能消化水谷，谷气不受，则上焦不相为用而失和，失和则谷气郁而不宣，所以善噫。下焦虚竭，不能供升生之气于中焦，则失和。失和则肾气独沉，自不能禁，所以前遗尿而后失便。不需要治，久了则愈，对于善噫是可以的。如果遗尿失便，没有不治能愈的，恐怕是错简。
【集注】程林说：竭，虚也。本经说：三焦不归其部，上焦不归者，噫而酢吞；中焦不归者，不能消谷引食；下焦不归者，则遗溲。上焦胃上口也，中焦脾也，脾善噫，脾不和，则食息迫逆于胃口而为噫。经说：膀胱不约为遗尿，因气不和则溲便不约。所以遗失而不能自禁制。
老师说：热在上焦的，因咳成为肺痿；热在中焦的，则为坚；热在下焦的，则尿血，也令淋秘不通。大肠有寒的，多溏；有热的，便肠垢。小肠有寒的，其人下重便血；有热的，必痔。
【注解】热在上焦的，篇中所谓肺痿吐涎沫；热在中焦的，篇中所谓腹满坚痛；热在下焦的，篇中所谓小便淋沥。其外大肠有寒的，多清彻溏，即下利溏泻。有热的，便稠粘肠垢，即下利脓血。小肠有寒的，下重便血，即结阴便血。有热的，热流于大肠，蓄于肛门必病痔。
【集注】徐彬说：小肠为受盛之官，与心为表里。丙，小肠也。挟火以济阴，而阴不滞，挟气以化血，而血归经，有寒则气不上通而下重，血无主气而妄行矣。直肠者，大肠之头也，门为肛，小肠有热，则大肠传导其热，而气结于肛门故痔。痔者，滞其丙小肠之热于此也。
问：病有积、有聚、有奔气，是什么？老师说：积者，脏病也，终不移。聚者，腑病也，发作有时，展转痛移，为可治。奔气者，胁下痛，按之则愈，复发为奔气。诸积大法：脉来细而附骨者，乃积也。寸口，积在胸中；微出寸口，积在喉中。关上，积在脐傍；上关上，积在心下；微下关，积在少腹。尺中，积在气冲；脉出左，积在左；脉出右，积在右；脉两出，积在中央。各以其部处之。（奔作奔解，见首篇。）
【注解】病有积、有聚、有奔气，应当辨别。积者脏病，无时不有，不移其处。聚者腑病，发作有时，展转痛移。为可治，谓腑病易治。奔气者，饮积胁下痛，按之则止，不按复痛，以水气得按暂散，故痛暂止，此即其证而言之。然诸积大法，尤当以诊候之，脉来沉伏附骨而细者，乃诸积之诊。若见两寸，积在胸中也；微出近鱼际，积在喉中也。两关，积在脐傍也；上关近寸，积在心下也；微下近尺，积在少腹也。尺中，积在气冲也；脉出左，积在左；脉出右，积在右；脉两出，谓左右俱见，积在中央也。各以其部之处，而诊积之所在。
【集注】徐彬说：积者迹也，病气之属阴者也。脏属阴，两阴相得，故不移。不移者，有专痛之处，而无迁改也。聚则如市井之物，偶聚而已，病气之属阳者也。腑属阳，两阳相比，则非如阴之凝，故寒气感则发，否则已。所谓有时也，既无定着，则痛无常处，故展转痛移，其根不深，故比积为可治。
李 说：积为脏病，深入在里，故脉细而附骨。寸、关、尺，上下、左右，别积病之所在，皆指细而附骨之部分，即《内经》前以候前，后以候后。上竟上者，胸喉中事也；下竟下者，少腹腰股膝胫足中事也。
When the Lung is invaded by Wind pathogen, there is dryness of the mouth and panting, dizziness with heaviness of the body, a sensation of being stunned (Mao) accompanied by swelling.
[Note] "Heaviness of the body with dizziness" should be "dizziness with heaviness of the body"; "Stunned due to Wind and swelling" should be "swelling due to Wind pathogen," which aligns with the textual meaning. This is evidently a transcription error.
[Annotation] The Lung governs Qi and corresponds externally to the skin and hair. When Wind pathogen invades the Lung, Wind damages Qi, causing Jin-Ye (Body Fluids) to coagulate and fail to circulate, resulting in dryness of the mouth; Wind damages the Lung, causing Qi to rebel upward, resulting in panting and coughing. Dizziness and heaviness of the body occur because Qi is damaged and strength is lacking. Swelling due to Wind occurs because the skin and flesh are injured, leading to a struggle between Wind and Water.
[Collected Notes] Li said: The Lung governs Qi. When Wind pathogen invades, Qi becomes obstructed and Jin-Ye fails to circulate, causing dryness of the mouth; Qi rebels and breathing is difficult, causing panting.
When Cold pathogen invades the Lung, turbid mucus is expectorated.
[Annotation] When Cold pathogen invades the Lung, the Yang Qi in the chest cannot be regulated, causing Jin-Ye to accumulate and fail to circulate, resulting in the expectoration of turbid saliva resembling mucus.
[Collected Notes] Li said: The five fluids transform into mucus when entering the Lung. The Lung corresponds to the skin and hair and opens into the nose. When Cold pathogen enters the Lung from the skin and hair, the nasal orifice becomes obstructed, causing nasal congestion and flow of mucus and saliva. Turbid saliva becomes blocked and cannot circulate, thus being expectorated from the mouth.
The pulse of a dying Lung is floating and empty on light pressure, weak and hollow like a scallion leaf on heavy pressure, with no root below. This indicates death.
[Annotation] When the Lung is invaded by Wind-Cold pathogen, if the pulse is extremely empty on light pressure and weak and hollow like a scallion leaf on heavy pressure, with no root below, this is the pulse of a dying Lung organ. The mention of "floating" for the following five Zang organs clarifies the pulse corresponding to external invading pathogens.
[Collected Notes] Cheng Lin said: The true Lung pulse arrives as if feathers touch the skin; is this not floating and empty? A scallion leaf is hollow inside; feeling weak like a scallion leaf on heavy pressure with no root below means the floating and fine weakness indicates the absence of Stomach Qi. Since the True Zang pulse has appeared, death ensues.
When the Liver is invaded by Wind pathogen, there is twitching of the head and eyes, pain in both hypochondria, a habitual stooping posture while walking, and a craving for sweet flavors.
[Annotation] The Liver governs Wind and corresponds externally to the sinews. When Wind pathogen invades the Liver, excessive Wind causes movement, resulting in twitching of the head and eyes. The hypochondria are the region of the Liver; disease of the Liver causes pain in both hypochondria. Wind damages the sinews, causing a habitual stooping posture. The Liver suffers from tension and desires Sweet flavor to relax it, hence the craving for sweets.
[Collected Notes] Xu Bin said: Above the high summit, only Wind can reach. The nature of Wind is shaking, causing twitching of the head and eyes. The Liver meridian passes through the diaphragm; now there is pathogen in the costal region, causing pain. The Liver governs the sinews; excessive Wind causes sinew tension, leading to stooping. Humans rely on the Spleen and Stomach as the foundation; when Wood pathogen is excessive and Earth suffers, Sweet flavor benefits the Spleen, and craving for sweets is a form of self-rescue.
When Cold pathogen invades the Liver, the arms cannot be raised, the root of the tongue is dry, there is frequent sighing, chest pain, inability to turn over, vomiting upon eating, and sweating.
[Note] The phrases "arms cannot be raised" and "root of the tongue is dry," along with "and sweating," do not fit the context logically and are likely misplaced text (Cuo Jian); therefore, they are not explained.
[Annotation] The Liver's nature is to be smooth and unobstructed, with Qi circulating in the chest and sides. When Cold pathogen invades the Liver, Qi is suppressed and cannot extend, leading to frequent sighing. Qi stagnation and failure to move cause pain preventing turning over. Vomiting upon eating is also due to Cold pathogen rebelling upward.
The pulse of a dying Liver is weak on light pressure, and on heavy pressure feels like a cord that does not return, or curved like a snake moving away. This indicates death.
[Annotation] When the Liver is invaded by Wind-Cold pathogen, if the pulse is extremely weak on light pressure and does not feel wiry on heavy pressure, it has lost its fundamental Liver pulse. Now, feeling like a cord that does not return on heavy pressure, or curving like a snake moving away—such cords curving and snakes moving, going without returning—are these not all pulses of a dying Liver organ?
[Collected Notes] Zhou Yangjun said: Feeling like a cord on heavy pressure shows both Wiry and Tight qualities. A pulse with arrival and departure follows the principle of Yin-Yang reciprocation. Now, saying "no arrival, only departure" indicates the absence of Stomach Qi. Otherwise, the True Qi is scattering, with forced entry and exit, showing a state of reluctance to advance and difficulty bending and extending, hence curving like a snake.
In Gan Zhuo (Liver Fixation), the patient often desires someone to tread on their chest. Initially, before suffering, they only desire hot drinks. Xuan Fu Hua Tang (Inula Flower Decoction) is indicated.
[Note] The six characters "Xuan Fu Hua Tang is indicated" do not match the pathology of Gan Zhuo and are likely superfluous text (Yan Wen).
[Annotation] Gan Zhuo refers to Liver Qi becoming fixed and failing to circulate, leading to chest fullness and discomfort. Thus, the patient often desires massage of the chest to unblock the Qi. When initially not suffering from fullness, desiring only hot drinks indicates that Cold pathogen is the disease.
[Collected Notes] Li said: The Liver governs free flow. Fixation leads to Qi depression and lack of extension. The patient often desires someone to tread on the chest to soothe the Qi. Additionally, because Cold pathogen is firmly bound within, they desire hot drinks to overcome the Cold.
When Wind pathogen invades the Heart, there is mild fever (Xi Xi Fa Re), inability to rise, a sensation of hunger in the heart/chest, and vomiting immediately after eating.
[Note] Mild fever is the primary symptom of Wind invasion. Inability to rise, hunger in the chest, and vomiting after eating do not fit the context logically and are likely misplaced text; therefore, they are not explained.
When Cold pathogen invades the Heart, the patient suffers as if eating garlic, with a pungent sensation piercing the heart. In severe cases, heart pain radiates to the back, and back pain radiates to the heart, resembling Gu Zhu (worm-like transmission). If the pulse is Floating, spontaneous vomiting will lead to recovery.
[Annotation] Suffering as if eating garlic refers to the pungent, piercing sensation of the heart. Severe heart pain radiating to the back and back pain radiating to the heart means the heart and back correspond in pain. Resembling Gu Zhu means the pain comes and goes incessantly like a worm. These are all symptoms of Cold pathogen in the Heart. If the pulse is Floating, it indicates the Heart has its fundamental pulse, representing an indication of Cold pathogen moving upward; thus, spontaneous vomiting expels the pathogen, leading to recovery.
[Collected Notes] Xu Bin said: Cold is a Yin pathogen. Externally constrained, Fire is internally depressed, hence the sensation like eating garlic, which is spicy but not painful. In severity, the pathogen is strong, attacking outward to cause back pain and inward to cause heart pain. "Che" (penetrating/radiating) means correspondence. Resembling Gu Zhu, it is continuous. If the pulse is Floating, the pathogen is not yet knotted, so spontaneous vomiting leads to recovery.
If the Heart organ is injured, upon fatigue and exhaustion, the head and face become red while the lower body feels heavy. There is heart pain, internal restlessness, fever, pulsation at the umbilicus, and the pulse is Wiry. This is caused by injury to the Heart organ.
[Note] The character "Wiry" (Xian) in "pulse is Wiry" should be "Deep" (Chen). Deep is the Kidney pulse, which fits the context. This is evidently a transcription error.
[Annotation] Injury to the Heart refers to patients with Heart organ disease. Fatigue and exhaustion disturb the Heart. Heart Yang is abundant above, causing redness of the head and face. Abundance above leads to deficiency below, causing heaviness and weakness in the lower body. Heart pain, internal restlessness, fever, and pulsation at the umbilicus with a Deep pulse indicate that the Kidney is overcoming the injured Heart.
[Collected Notes] You Yi said: In injury to the Heart, upon fatigue, the head and face become red while the lower body feels heavy. Generally, when the Heart is deficient, its Yang floats easily; when abundance is above, deficiency must be below. Heart pain and internal restlessness with fever indicate Heart deficiency failing to nourish, with Heat stirring within. Pulsation at the umbilicus indicates Heart deficiency above and Kidney activity below.
Abnormal crying causing insecurity of the Hun and Po is due to scarcity of Blood and Qi. Scarcity of Blood and Qi belongs to the Heart. When Heart Qi is deficient, the person fears, closes their eyes desiring sleep, dreams of traveling far, and their Spirit scatters while Hun and Po wander recklessly. Deficiency of Yin leads to Dian (catatonic schizophrenia); deficiency of Yang leads to Kuang (manic psychosis).
[Note] The character "Dian" in "Deficiency of Yin leads to Dian" should be "Kuang"; the character "Kuang" in "Deficiency of Yang leads to Kuang" should be "Dian." The Nei Jing states: Heavy Yin leads to Dian, Heavy Yang leads to Kuang. This is evidently a transcription error.
[Annotation] Abnormal crying refers to a person with Heart injury crying without cause. Abnormal crying causes insecurity of Hun and Po due to scarcity of Heart Blood and Qi. Scarcity of Blood and Qi leads to Heart deficiency, causing fear. Closing eyes desiring sleep and dreaming of traveling far indicates scattered Spirit and reckless wandering of Hun and Po. Heart Blood is Yin; excessive deficiency of Yin leads to excess Yang, resulting in Kuang (mania). Heart Qi is Yang; excessive deficiency of Yang leads to excess Yin, resulting in Dian (catatonia).
The pulse of a dying Heart is solid like pills or beans on light pressure, and becomes increasingly restless and rapid on heavy pressure. This indicates death.
[Annotation] When the Heart is invaded by Wind-Cold pathogen, if the pulse is extremely solid on light pressure, like pills or beans, and becomes increasingly vigorous, restless, rapid, and chaotic on heavy pressure, this is the pulse of a dying Heart organ.
[Collected Notes] Li said: The Nan Jing states the Heart pulse is Floating, Large, and Scattered. If it is solid like hemp beans on light pressure and increasingly restless on heavy pressure, the True Zang pulse appears, and Stomach Qi is completely absent, hence death. The Nei Jing states: The True Heart pulse is firm and beating, like searching for Coix seeds, accumulating like hemp beans. The meaning can be cross-referenced here.
When the Spleen is invaded by Wind pathogen, there is mild fever, the appearance resembles that of a drunk person, abdominal烦重 (fullness and heaviness), eyelid twitching, and shortness of breath.
[Note] The section on Spleen invaded by Cold pathogen is missing, likely due to lost bamboo slips.
[Annotation] When Wind pathogen invades the Spleen, mild fever is the primary symptom of Wind invasion. The appearance resembling a drunk person is also a symptom expected from Wind-Heat disturbing internally. Abdominal discomfort and vexation, physical lassitude and heaviness, eyelid twitching, and shortness of breath are all Spleen meridian symptoms.
[Collected Notes] Li said: Wind is a Yang pathogen that causes dispersion. Appearance resembling a drunk person refers to a red face and soft limbs. Internal disturbance by Wind causes abdominal fullness and heaviness. Eyelid twitching refers to the upper and lower eyelids.
The pulse of a dying Spleen is large and hard on light pressure, and on heavy pressure feels like an inverted cup, clean and empty, appearing to shake. This indicates death.
[Annotation] When the Spleen is invaded by Wind-Cold pathogen, if the pulse is large and hard on light pressure, losing its harmonious and slow quality, and on heavy pressure feels like an inverted cup, high and clear, forceful and shaking, this is the pulse of a dying Spleen organ.
[Collected Notes] Li said: A pulse that is weak and slippery indicates the presence of Stomach Qi. Floating, large, and hard indicates the extinction of Stomach Qi and the appearance of the True Zang pulse. An inverted cup is empty inside. "Jie Jie" describes an empty and void appearance. Appearing to shake indicates a restless and agitated pulse, suggesting Qi is scattering, hence death.
The Fu Yang pulse is Floating and Choppy. Floating indicates strong Stomach Qi; Choppy indicates frequent urination. The interaction of Floating and Choppy results in hard stools. The Spleen is constrained (Yue). Ma Zi Ren Wan (Hemp Seed Pill) is indicated.
[Note] This passage should belong under "Difficult Urination" in the "Abdominal Fullness Chapter" and is likely misplaced here.
[Annotation] Fu Yang is the Stomach pulse. If the pulse were Choppy without Floating, it would indicate Spleen Yin deficiency, and Stomach Qi would not be strong, making purgation inadvisable. Now, the pulse is Floating and Choppy, indicating strong Stomach Yang (strong Stomach Qi) and Spleen Yin deficiency. Spleen Yin deficiency cannot transport essence and Qi to the Stomach; water descends alone, causing frequent urination. Strong Stomach Qi constrains the Spleen, preventing the transformation of Jin-Ye, resulting in hard stools. Ma Zi Ren Wan is used to nourish fluids, moisten dryness, clear heat, and unblock the interior. One dares not freely use Cheng Qi Tang because the Choppy pulse ultimately indicates a deficiency pathogen.
[Collected Notes] Xu Bin said: Using a pill instead of a decoction for Spleen Constraint aims to slowly resolve the knot without abruptly damaging Yuan Qi. It must be known that Spleen Constraint arises because Yuan Qi is insufficient and Jin-Ye does not reach.
Li said: Fu Yang is the Stomach pulse. The Stomach is the sea of water and grain. Floating is a Yang pulse, so Stomach Qi is strong and appetite is good. Frequent urination depletes Jin-Ye, hence the Choppy pulse. Generally, the Spleen governs transporting Jin-Ye for the Stomach. Here, due to strong Stomach and weak Spleen, Jin-Ye is constrained, unable to distribute widely, but only transported to the Bladder, causing frequent urination and hard stools. Ma Zi Ren Wan unblocks the interior and moistens dryness.
Ma Zi Ren Wan Formula
Hemp Seed (2 Sheng)
Peony Root (0.5 Jin)
Immature Bitter Orange (1 Jin)
Rhubarb (1 Jin)
Magnolia Bark (1 Chi)
Apricot Seed (1 Sheng)
Grind the above six herbs into powder; mix with refined honey to make pills the size of walnut seeds. Take 10 pills with water, three times daily, adjusting dosage until effect is achieved.
In Shen Zhuo (Kidney Fixation), the patient has a heavy body, coldness in the waist, a sensation of sitting in water, and an appearance resembling edema, yet there is no thirst, urination is normal, and diet remains unchanged. The disease is located in the Lower Jiao. It is caused by long-term exposure to cold dampness due to sweating from labor while wearing cold, wet clothes. There is cold pain below the waist, and heaviness in the abdomen as if carrying five thousand coins. Gan Jiang Ling Zhu Tang (Ginger, Gastrodia, Poria, and Atractylodes Macrocephala Decoction) is indicated.
[Note] The sections on Kidney invaded by Wind and Cold are missing, likely due to lost bamboo slips.
[Annotation] Shen Zhuo refers to the Kidney being injured by Cold-Dampness, which adheres and fails to move. The Kidney receiving Cold-Dampness causes body heaviness and waist coldness, like sitting in water. Although resembling edema, the absence of thirst and normal urination indicate it is not Water retention but Dampness. Diet remains unchanged because the disease is in the Lower Jiao (Kidney) and not the Middle Jiao (Spleen). Asking about the cause, labor-induced sweating with cold, wet clothes for a long time injures the body, causing cold pain below the waist due to Cold dominance. Abdominal heaviness is due to Dampness dominance. "Carrying five thousand coins" describes the extreme heaviness. Gan Jiang Ling Zhu Tang tonifies the Upper to control Water, disperses Cold, and leaches out Dampness.
[Collected Notes] You Yi said: The disease is not in the inner Zang of the Kidney but in the outer mansion of the Kidney. Therefore, treatment does not focus on warming the Kidney to disperse Cold, but on warming the Earth (Spleen) to overcome Water.
Gan Jiang Ling Zhu Tang Formula
Licorice Root (2 Liang)
Atractylodes Macrocephala Rhizome (2 Liang)
Dried Ginger (4 Liang)
Poria Cocos (4 Liang)
Boil the above four herbs in 5 Sheng of water to obtain 3 Sheng. Divide into three warm doses. The waist will become warm.
The pulse of a dying Kidney is hard on light pressure, and on heavy pressure moves chaotically like a rolling ball, extending downward into the Chi position. This indicates death.
[Annotation] When the Kidney is invaded by Wind-Cold pathogen, if the pulse is extremely hard on light pressure, moves chaotically on heavy pressure like a rolling ball, and extends downward into the Chi position with chaotic movement throughout, these are all pulses of a dying Kidney True Zang.
[Collected Notes] Cheng Lin said: The dying Kidney pulse, hard on light pressure, agrees with the Nei Jing's description of "Pi Pi like striking stone" for dying Kidney, both indicating hardness. On heavy pressure, it moves chaotically like a rolling ball, extending into the Chi position; this is a state of separation of Yin and Yang, hence death. The True Zang pulses above differ slightly from the Nei Jing. In summary, the pulse lacks Stomach Qi, appearing in the three positions, with various descriptive images.
Question: What does it mean when the San Jiao departments are exhausted, specifically the Upper Jiao exhaustion causing frequent belching?
Master said: The Upper Jiao receives Qi from the Middle Jiao. If they are not harmonized, digestion of grain fails, hence belching occurs. Exhaustion of the Lower Jiao leads to urinary incontinence and fecal loss. Due to disharmony of Qi, self-control is lost. No treatment is needed; it will heal itself over time.
[Annotation] Exhaustion of San Jiao departments means the San Jiao, due to deficiency and exhaustion, does not return to its respective department and fails to function mutually. The Upper Jiao receives Qi from the Middle Jiao, and the Lower Jiao generates Qi from the Middle Jiao; mutual functioning constitutes harmony. If the Middle Jiao is exhausted and cannot digest food and water, Grain Qi is not received, causing the Upper Jiao to fail in mutual function and become disharmonious. Disharmony causes Grain Qi to stagnate and fail to diffuse, hence frequent belching. Lower Jiao exhaustion fails to provide ascending and generating Qi to the Middle Jiao, causing disharmony. Disharmony causes Kidney Qi to sink alone, losing self-control, hence urinary incontinence and fecal loss. No treatment is needed for healing over time applies to belching. However, for urinary incontinence and fecal loss, healing without treatment is unlikely; this may be misplaced text.
[Collected Notes] Cheng Lin said: "Jie" means deficiency. The Classic states: When San Jiao does not return to its department, Upper Jiao not returning causes belching and acid regurgitation; Middle Jiao not returning causes inability to digest grain and induce eating; Lower Jiao not returning causes urinary incontinence. The Upper Jiao is the stomach opening; the Middle Jiao is the Spleen. The Spleen is prone to belching; Spleen disharmony causes food and breath to reverse against the stomach opening, causing belching. The Classic states: Bladder failing to constrain causes urinary incontinence; Qi disharmony causes urine and stool to be unconstrained. Hence, loss and inability to self-control.
Master said: Heat in the Upper Jiao leads to Lung Wei (Lung Withering) due to coughing. Heat in the Middle Jiao leads to hardness. Heat in the Lower Jiao leads to hematuria and also causes strangury and retention of urine. Cold in the Large Intestine causes frequent loose stools; Heat in the Large Intestine causes passage of intestinal mucus. Cold in the Small Intestine causes tenesmus and bloody stools; Heat in the Small Intestine必然 leads to hemorrhoids.
[Annotation] Heat in the Upper Jiao refers to Lung Wei with expectoration of saliva and foam mentioned in this chapter. Heat in the Middle Jiao refers to abdominal fullness, hardness, and pain. Heat in the Lower Jiao refers to dribbling urination mentioned in this chapter. Externally, Cold in the Large Intestine causes clear and thin loose stools (diarrhea with loose stools). Heat causes thick and sticky intestinal mucus (dysentery with pus and blood). Cold in the Small Intestine causes tenesmus and bloody stools (Jie Yin bloody stools). Heat flows into the Large Intestine and accumulates in the anus, inevitably causing hemorrhoids.
[Collected Notes] Xu Bin said: The Small Intestine is the official of reception and transformation, exterior-interior related to the Heart. Bing represents the Small Intestine. It carries Fire to nourish Yin, preventing Yin stagnation; it carries Qi to transform Blood, ensuring Blood returns to the vessels. Cold prevents Qi from ascending, causing lower heaviness; Blood lacks Qi mastery and flows recklessly. The rectum is the head of the Large Intestine; the anus is the gate. Heat in the Small Intestine transmits heat to the Large Intestine, causing Qi to knot in the anus, hence hemorrhoids. Hemorrhoids represent the stagnation of Bing (Small Intestine) Heat in this location.
Question: Diseases include Ji (Accumulation), Ju (Gathering), and Ben Qi (Rushing Qi). What are they?
Master said: Ji is a Zang disease, finally immobile. Ju is a Fu disease, occurring at times, with shifting pain migration, and is treatable. Ben Qi is pain under the hypochondria, relieved by pressure, recurring as Ben Qi. The general principle for all Accumulations: A pulse that is fine and adheres to the bone indicates Accumulation. At Cun Kou (Inch position), Accumulation is in the chest; slightly beyond Cun Kou, Accumulation is in the throat. At Guan (Bar position), Accumulation is beside the navel; above Guan, Accumulation is below the heart; slightly below Guan, Accumulation is in the lower abdomen. At Chi (Cubit position), Accumulation is at Qi Chong; if the pulse emerges on the Left, Accumulation is on the Left; if on the Right, Accumulation is on the Right; if emerging on both, Accumulation is in the center. Diagnose the location of Accumulation according to each position. (Ben is interpreted as Rushing, see first chapter.)
[Annotation] Diseases include Ji, Ju, and Ben Qi, which must be distinguished. Ji is a Zang disease, present at all times, immobile in location. Ju is a Fu disease, occurring at times, with shifting pain. "Treatable" means Fu diseases are easier to treat. Ben Qi involves fluid accumulation causing hypochondriac pain, relieved by pressure, recurring without pressure, as Water Qi temporarily disperses with pressure, hence pain temporarily stops. This describes the symptoms. However, the general principle for Accumulations emphasizes diagnosis via pulse. A pulse that is deep,伏 (hidden), adheres to the bone, and is fine is the diagnostic sign for all Accumulations. If seen at both Cun positions, Accumulation is in the chest; slightly beyond near Yu Ji, Accumulation is in the throat. At both Guan positions, Accumulation is beside the navel; Guan near Cun, Accumulation is below the heart; slightly below near Chi, Accumulation is in the lower abdomen. At Chi, Accumulation is at Qi Chong; pulse emerging on Left, Accumulation is on Left; on Right, Accumulation is on Right; pulse emerging on both means seen on left and right, Accumulation is in the center. Diagnose the location of Accumulation according to each position.
[Collected Notes] Xu Bin said: Ji means trace; it is a pathogenic Qi belonging to Yin. Zang belongs to Yin; two Yins combine, hence immobility. Immobility means there is a specific painful area without migration. Ju is like market goods, gathering occasionally; pathogenic Qi belongs to Yang. Fu belongs to Yang; two Yangs compare, unlike Yin congealing, so Cold Qi manifests when encountered, otherwise ceases. This is "occurring at times." Having no fixed location, pain has no constant place, hence shifting pain migration. Its root is shallow, hence more treatable than Ji.
Li said: Ji is a Zang disease, deeply rooted internally, hence the pulse is fine and adheres to the bone. Cun, Guan, Chi, up/down, left/right distinguish the location of Ji disease, all pointing to the fine and bone-adhering pulse parts, consistent with Nei Jing: front to examine front, back to examine back. "Shang Jing Shang" concerns the chest and throat; "Xia Jing Xia" concerns the lower abdomen, waist, thighs, knees, shins, and feet.