肺（为主气之脏。其）中风者。（气不布津而）口燥（气不下行）而喘。（气伤不支。
而）身（如坐舟车之上。而转）运（气伤乏力。）而（身）重。（气伤则清阳不升而
头）冒（气伤则水道不行）而肿胀。（五液在肺为涕。）肺中寒。（则寒气闭于肺窍。而
蓄藏之郁热。则反从口中）吐（出）浊涕。肺（将）死。（而脉见真）脏浮之虚。按之
弱如葱叶。下无根者。（为天水不交。故）死。
此篇于内经不同。所以补内经之未及也。
此节言肺中风寒证脉也。
徐忠可云、按以上证。皆言肺本受病。则所伤在气。而凡身之藉气以为常者。作诸
变证如此。乃详肺中风寒之内象也。若内经所云。肺风之状。多汗恶风。时咳。昼瘥暮
甚。诊在眉上。其色白。此言肺感表邪之外象。
肝（为风木之脏。若）中风者。（以风从风动而上行。则）头目 。（肝脉布胁肋。
风胜而脉急。则）两胁痛。（而）行常伛。（内经云。肝苦急。食甘以缓之。此木胜而
土负。乃求助于其味。故）令人嗜甘。 肝中寒者。（大筋拘急。故）两臂不举。（肝
脉循喉咙之后。肝寒而逼热于上。则）舌本燥。（胆主善太息。肝病则胆郁。郁则）善太
息。（肝脉上行者。挟胃贯膈。寒则）胸中痛。（痛甚则）不得转侧。（挟胃。则胃
受木克。故得）食则吐（贯膈。则心母临子）而（为）汗（自）出也。肝（将）死。
（而脉见真）脏浮之弱。按之如索（弦紧俱见。去而）不来。或（失阴阳往复之道。无胃
气也。或出入勉强。有委而不前。屈曲难伸之状。脉形）曲如蛇行者。（主）死。
此言肝中风寒证脉也。
徐忠可云、以上言风寒所感。肝之阴受伤。则木气不能敷荣。而凡身之藉阴以为养者。
作诸变证如此。乃详肝中风寒之内象也。如内经所云。肝中于风。多汗恶风。善悲。
色苍。嗌干善怒时憎女子。诊在目下。其色青。此言肝受表邪之外象也。
（肝主疏泄。气血滞而不行。如物之粘着。为病名曰）肝着。其人常欲（以手）
蹈其胸上。（藉按摩以通其气也。盖血气之郁滞。遇热略散。苟至大苦时。则病气发而为
热。又非饮热所能胜矣。故必）先（于）未苦时。但欲（求其散而思）饮热。（由此病
证而得其病情以为据。以）旋复花汤主之。
此另言肝着之证治也。但胸者。肺之位也。肝病而气注于肺。所谓横也。（纵横二
字详伤寒论）
徐忠可云、前风寒皆不立方。此独立方。盖肝着为风寒所渐。独异之病。非中风家
正病故也。
旋复花汤方
旋复花（三两即金沸草） 葱（十四茎） 新绛（少许）
上三味。以水三升。煮取一升。顿服。
心（为火脏。乃君主之官。若）中风者。（风为阳邪。并之则）翕翕（然风火并齐而
）发热。（君主病。而百骸皆废。则）不能起。（火乱于中。则）心中（嘈而）饥。（
热格于上。则）食即呕吐。心中寒者。（寒为阴邪。外束之则火内聚。）其人苦病心（中
懊无奈。似痛非痛。其麻辣）如啖蒜状。剧者心痛彻背。背痛彻心。譬如虫（之往来交
）注。其脉浮者。（寒有外出之机。强用吐法则不可。若得机欲向愈而）自吐（病）乃
愈。心伤者。（不关于风寒。而气血不足。为内伤也。）其人（一有）劳倦。即头面赤
而下重。（盖以血虚者。其阳易浮。上盛者。下必无气也。血虚不能养心。则）心中
痛。（火亢）而（成未济。则）自烦发热。（心虚于上。以致肾动于下。则）当脐跳。
（子盗母气。）其脉（则）弦。此为心脏伤所致也。心（将）死。（而脉见真）脏浮之
实如麻豆。按之益躁疾者。（为阴气已绝。主）死。
此言心中风寒之证脉也。又心伤者。风寒外之本病也。以心为十二官之主。故特郑
重言之也。
徐忠可云、生万物者火。杀万物者亦火。火之体在热。而火之用在温。故鼎烹则颐
养。燎原则焦枯。以上证。乃正为邪使。而心火失阳和之用。凡身之藉阳以暖者。其变
证如此。乃详心中风之内象也。若内经云、心中于风。多汗恶风。焦绝善怒吓。病甚则
言不可快。诊在口。其色黑。千金曰、诊在唇。其色赤。此言心中风之外象也。
（至于心伤证。前言犹未尽也。请再申其义。人病如）邪（所凭。而为悲）哭（致
）使魂魄不安者。（虽有六气七情痰火之异。而其源则为）血气少也。（然）血气（之所
以）少者。属于心。（血从气生。言气即可以该血。）心气虚者。其人则畏。合目欲眠。
梦远行。而精神离散。魂魄妄行。（心主失其统御之权。为显为狂。势所必至者。然
颠狂亦有阴阳之分。）阴气衰者为颠。阳气衰者为狂。（其与经文重阴者颠。重阳者狂
之旨。似若未合。然彼以寒热分阴阳。此以气血分阴阳。后之览者。当会通于言外。）
此承上节心伤而申其说也。
脾中风。（则周身）翕翕发热。形如醉人（面红四肢俱软。）腹中（因风动火而）
烦（本气湿生而）重（上下眼胞属脾胃。而名）皮目（风入而主动。则见） 。（脾居
肺肾之中界。一病则懒于承上接下。天水不交）而短气。脾（将）死。（而脉见真）脏
浮之大坚。（全失柔和之胃气。）按之如覆杯。（覆杯何状。即空而无有之）洁洁状（
且燥疾不宁。）如摇者。（主）死。
此言脾中风之证脉也。
按、宋本臣亿等。五脏各有中风中寒。今脾止载中风。肾中风中寒俱不载。古人
简乱极多。去古既远。无文可以补缀也。（沈自南云。脾中寒。予拟伤寒论中太阴自利不
渴而补之。肾中风。予拟少阴黄连阿胶汤证补之。肾中寒。予拟通脉四逆汤证补之。不
识以为何如。）
徐忠可云、金匮缺脾中寒。然不过如自利腹痛。腹胀不食。可类推也。若以上脾中
风诸证。则凡形体之待中土以收冲和之益者。其变证如此。乃详脾中风之内象也。若内
经云。脾中风状。多汗恶风。身体怠惰。四肢不欲动。色薄微黄。不嗜食。诊在鼻上。
其色黄。此言脾中风之外象也。
（今试诊之趺阳。）趺阳（为胃脉。今）脉浮而涩。浮则（为）胃气强。涩则（为
脾阴虚。脾阴虚。不能为胃上输精气。水独下行。故）小便数。浮涩相搏。大便则坚。
其（病因）脾（虚）为（胃所管）约。（以）麻仁丸主之。
此言脾约之证治也。
麻仁丸方
麻仁（一升） 芍药（半斤） 大黄（去皮一斤） 枳实（半斤） 浓朴（一尺去
皮） 杏仁（一升去皮尖熬别作脂）
上六味。末之。炼蜜和丸桐子大。饮服十丸。日三服。渐加。以知为度。
（肾受冷湿。着而不去。名为肾着。）肾着之病。其人身体（因湿而见）重。腰中
（因寒而畏）冷。如坐水中。（着处）形（微肿）如水（肿之）状。（但湿邪能阻止津而
口渴。今）反不渴。（知其上之无热。）小便自利。（知其下之阳衰。）饮食如故。（知
其）病（不关中焦。而）属下焦。（然肾不劳则不虚。推其致病之由。由于）身劳汗出。
衣里冷湿。久久得（而伤）之。（其证自）腰以下冷痛。（至）腹（皆）重如带五千钱。
（以）甘姜苓术汤主之。
此言肾着之病由于冷湿。不在肾之中脏。而在肾之外腑。以辛温甘淡之药治之也。
徐忠可云、肾脏风寒皆缺。然观千金三黄汤。用独活细辛治中风及肾者。而叙病状
曰。烦热心乱恶寒。终日不欲饮食。又叙肾中风曰。踞坐腰痛。则知金匮所缺肾风内动
之证。相去不远。至寒中肾。即是少
阴标阴之寒证。当不越厥逆下利欲吐不吐诸条。若内经云。肾中风状。多汗恶风。面庞
然如肿。脊痛不能正立。其色 。隐曲不利。诊在肌上。其色黑。盖言风自表入。伤少阴
经气。乃肾中风之外象也。
甘草干姜茯苓白术汤方（一名肾着汤）
甘草 白术（各二两） 干姜 茯苓（各四两）
右四味。以水五升。煮取三升。分温三服。腰中即温。
肾（将）死。（而脉见真）脏浮之坚。（则不沉而外散。阳已离于阴位。）按之乱
如转丸。（是变石之体。而为燥动。真阳将搏跃而出。）益下入尺中者。（应伏而反动。
反其封蛰之常。主）死。
此言肾脏之死脉也。
问曰。三焦（之气虚）竭（而不各归其）部。（固也。但噫为脾病。今云）上焦竭。
善噫。何谓也。师曰。（中气实统乎三焦。）上焦受中焦气（中焦）未和。不能消谷。
（谷气郁而不宣。）故能噫耳。（且中焦不和。而）下焦（亦因而虚）竭。即（见前则
）遗溺（后则）失便。（盖下焦听命于中焦。）其（中焦之）气不和。（下焦无以受
中之荫。则肾气日虚。经云。北方黑色。开窍于二阴。肾虚则前后）不能自禁制。（此下
焦虽病。却）不须治。（止以补脾健胃。治其中焦。）久则（自）愈。
此言三焦虚竭。统以中焦为主治也。
师曰。热在上焦者。（心肺受之。心火盛。肺金愈伤。）因咳为肺痿。热在中焦者。
（脾胃受之。胃热必实而硬。脾热必燥而 。因热而结。）则为坚。热在下焦者。（以
下焦为肝肾膀胱大小肠所居之处。或肝肾热盛。）则尿血。（或膀胱热盛。）亦令淋
不通。（至若）大肠有寒者多 溏。（即下利溏泻也。）有热者便肠垢。（即下利脓血
也。）小肠有寒者。其人下重便血。（即阴结便血也。）有热者（流蓄肛门。）必（病）
痔。
此又分晰三焦各病也。
问曰。病有积有聚。有 气。何谓也。师曰。积者。脏病也。（始）终不移。聚者。
腑病也。发作有时。展转痛移为可治。
气者。（食气也。食积太阴。敦阜之气。抑遏肝气。故）胁下痛。（以手）按（
摩）之。则（食化气行而）愈。（若饮食稍一不节。则）复发（名）为 气。
此言腹中痛病大概有三也。
徐忠可云、此积非 瘕之类。亦未必有形停积。天下之物。皆从无中生有。乃气从
阴结。阴则粘着也。观下文云积在喉中。则结阴可知。不然。则喉中岂能容有形之物耶。
（积病坚久难治。必详之于脉。）诸（凡气血痰食等）积大法。脉来（沉）细而附骨者。
（此）乃（为）积也。（所以然者。以积而不移之处。其气血营卫。不复上行而外达。
则其脉亦沉。而作是象。兹试举其脉出之所以。决其受病之处。若此脉出）寸口。积在
胸中。微出寸口。积在喉中。（出）关上。积在脐旁。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。（若沉细不起之）脉两（手
俱）出。（是中央有积。其气不能分左右也。可断之曰。）积在中央。（凡此者。）各
以其部处之。
此言积脉分上下左右而定之也。
肺（作为主司气机的脏器。）如果感受风邪，（会导致气机不能布散津液而）口干（气机不能下行）并气喘。（气机受损无力支撑，）身体（就像坐在摇晃的车船上一样，感到）眩晕（气虚乏力，并且）沉重。（气机受损则清阳之气不能上升而）头昏（气机受损导致水道运行不畅）并出现肿胀。（五液在肺表现为涕。）肺受寒邪，（寒气闭阻肺窍，使得）郁积的热气反而从口中）吐出浊涕。肺（即将衰竭时，）脉象呈现真脏脉，轻取虚浮，重按软弱如葱叶，下无根底者。（这是水火不交，所以）死亡。
这一篇与《内经》不同，是用来补充《内经》未涉及的内容。
这一节论述肺中风寒证的脉象。
徐忠可说：按照以上证候，都是说肺本身受病，那么所伤的是气，凡是身体依赖气来维持正常的功能，出现各种变证如此，这是详细阐述肺中风寒的内部征象。至于《内经》所说，肺受风邪的症状，多汗恶风，时常咳嗽，白天减轻晚上加重，诊察部位在眉上，面色白，这是说肺感受表邪的外部征象。
肝（是风木之脏，若）感受风邪，（因为风性主动上行，则）头目眩晕。（肝经循行布于胁肋，风邪偏胜导致经脉拘急，则）两胁疼痛。（并且）行走时常弯腰驼背。（《内经》说，肝苦急，吃甘味食物可以缓急，这是木气偏胜而土气受制，于是求助于甘味，所以）使人嗜食甘味。肝受寒邪，（大筋拘急，所以）两臂不能抬起。（肝经循行喉咙之后，肝寒逼迫热气上行，则）舌根干燥。（胆主善太息，肝病导致胆气郁结，郁结则）喜欢叹气。（肝经上行部分，挟胃穿过膈肌，寒邪侵袭则）胸中疼痛。（痛得厉害时）不能翻身侧卧。（挟胃，则胃受到木气的克制，所以进食后）呕吐（穿过膈肌，则心火临于子位，导致）自）出汗。肝（即将衰竭时，）脉象呈现真脏脉，轻取虚弱，重按如绳索般弦紧俱见，去而不来，或者（失去阴阳往复的规律，没有胃气，或者出入勉强，有委顿不前、屈曲难伸的状态，脉形）弯曲如蛇行者。（主）死亡。
这说的是肝中风寒证的脉象。
徐忠可说：以上所说的风寒所感，肝之阴受伤，则木气不能敷布荣养，凡是身体依赖阴来滋养的功能，出现各种变证如此，这是详细阐述肝中风寒的内部征象。如《内经》所说，肝中于风，多汗恶风，容易悲伤，面色苍青，咽喉干，容易发怒，有时厌恶女子，诊察部位在目下，面色青，这是说肝受表邪的外部征象。
（肝主疏泄，气血滞涩不行，像物体粘连附着一样，这种病名叫）肝着。患者常常想要（用手）踩踏或捶打胸部。（借助按摩来通利气机。大概血气郁滞，遇到热稍微发散，如果到了非常痛苦的时候，则病气发作产生热，又不是喝热水所能胜任的了，所以必须）先（在）尚未痛苦时，只想要（寻求发散而想）喝热水。（根据这些病证来了解病情作为依据，用）旋复花汤主治。
这里另外讲述肝着的证治。但胸是肺的部位，肝病而气注于肺，这就是所谓的“横”。（纵横二字详见《伤寒论》）
徐忠可说：前面风寒都不立处方，这里单独立方，大概是因为肝着是被风寒逐渐侵袭，是独特的疾病，不是中风家的正病缘故。
旋复花汤方
旋复花（三两即金沸草） 葱（十四茎） 新绛（少许）
以上三味药，用水三升，煮取一升，一次性服用。
心（是火脏，是君主之官，若）感受风邪，（风为阳邪，与之相合则）翕翕（然风火并齐而）发热。（君主之官生病，百骸皆废弛，则）不能起身。（火乱于中，则）心中（嘈杂似）饥。（热气格拒于上，则）进食即呕吐。心中受寒邪，（寒为阴邪，外束则火内聚。）患者苦于心（中懊恼无奈，似痛非痛，那种麻辣）像吃蒜一样的感觉，严重的则心痛彻背，背痛彻心，就像虫子（往来交）注一样，脉象浮者。（说明寒邪有外出的机转，强行用吐法则不可，如果得到机转趋向痊愈而）自吐（出病邪）才能痊愈。心气伤者，（不关乎风寒，而是气血不足，属于内伤。）患者（一旦）劳累疲倦，就头面发红而下肢沉重。（因为血虚者，阳气容易浮越，上部盛实，下部必然无气。血虚不能养心，则）心中痛。（火亢盛）而（形成未济卦象，则）自烦发热。（心虚于上，导致肾动于下，则）肚脐跳动。（子盗母气。）其脉（则）弦，这是心脏受伤所致。心（即将衰竭时，）脉象呈现真脏脉，浮取坚实如麻豆，重按更加躁疾者。（说明阴气已绝，主）死亡。
这说的是心中风寒的证脉。另外心伤者，是风寒外在表现的根本病症。因为心是十二官的主宰，所以特别郑重地论述它。
徐忠可说：生万物者是火，杀万物者也是火。火的体在热，而火用在温。所以鼎烹则颐养，燎原则焦枯。以上证候，正是被邪气驱使，而心火失去了阳和的作用，凡是身体依赖阳来温暖的功能，其变证如此，这是详细阐述心中风的内部征象。若《内经》说，心中于风，多汗恶风，焦绝善怒吓，病重则言语不快，诊察部位在口，面色黑，《千金方》说，诊察部位在唇，面色赤，这是说心中风的外部征象。
（至于心伤证，前文还没说完，请再申述其义。人患病如同）邪（气依附，而导致悲）哭（致使）魂魄不安者。（虽然有六气七情痰火的不同，但其根源则是）血气少也。（然而）血气（之所以）少，归属于心。（血从气生，言气就可以包括血。）心气虚的人，他就害怕，闭眼想睡觉，梦见远行，精神离散，魂魄妄行。（心主失去统御的权力，显现为狂，是势所必至的，然而颠狂也有阴阳之分。）阴气衰者为颠，阳气衰者为狂。（这与经文重阴者颠，重阳者狂的宗旨，似乎不合，然而彼处以寒热分阴阳，此处以气血分阴阳，后来的读者，应当在言外会通理解。）
这是承接上一节心伤而申述其说。
脾感受风邪，（则周身）翕翕发热，形体像醉人（面红四肢俱软。）腹中（因风动火而）烦闷（本气湿生而）沉重（上下眼胞属脾胃，而名）眼皮（风入而主动，则见）眼睑跳动。（脾居肺肾之中界，一病则懒于承上接下，天水不交）而短气。脾（即将衰竭时，）脉象呈现真脏脉，浮取大而坚。（完全失去柔和的胃气。）重按如覆杯。（覆杯什么样子，就是空而无有的）洁洁状（且燥疾不宁。）像摇动的样子。（主）死亡。
这说的是脾中风的证脉。
按：宋本陈臣亿等认为，五脏各有中风中寒，现在脾只载中风，肾中风中寒都不载。古人简略混乱极多，离古代既远，没有文献可以补缀。（沈自南说，脾中寒，我拟用《伤寒论》中太阴自利不渴来补之。肾中风，我拟用少阴黄连阿胶汤证补之。肾中寒，我拟用通脉四逆汤证补之，不知道各位以为如何？）
徐忠可说：《金匮》缺脾中寒，不过像是自利腹痛，腹胀不食，可以类推。若以上脾中风诸证，则凡是形体依赖中土来收冲和益处的，其变证如此，这是详细阐述脾中风的内部征象。若《内经》说，脾中风状，多汗恶风，身体怠惰，四肢不欲动，色薄微黄，不嗜食，诊察部位在鼻上，面色黄，这是说脾中风的外部征象。
（现在试着诊察趺阳脉。）趺阳脉（是胃脉，现在）脉浮而涩，浮则（是）胃气强，涩则（是）脾阴虚，脾阴虚，不能为胃上输精气，水独下行，所以）小便频数。浮涩相搏，大便则坚硬。其（病因）脾（虚）被（胃所管）约束。（用）麻仁丸主治。
这说的是脾约的证治。
麻仁丸方
麻仁（一升） 芍药（半斤） 大黄（去皮一斤） 枳实（半斤） 浓朴（一尺去皮） 杏仁（一升去皮尖熬别作脂）
以上六味药，研末，炼蜜和丸如桐子大，饮水送服十丸，每日三次，逐渐增加，以见效为度。
（肾受冷湿，附着不去，名叫肾着。）肾着病，患者身体（因湿而见）沉重，腰中（因寒而畏）冷，像坐在水中。（着处）形（微肿）像水（肿之）状。（但湿邪能阻碍津液而口渴，现在）反不渴。（知道上部无热。）小便自利。（知道下部阳衰。）饮食如故。（知道）病（不关中焦，而）属下焦。（然而肾不劳则不虚，推究致病的原因，由于）身体劳累汗出，衣里冷湿，久久得（而伤）之。（其证自）腰以下冷痛。（至）腹（皆）重得像带着五千钱。（用）甘姜苓术汤主治。
这说的是肾着病由于冷湿，不在肾之中脏，而在肾之外腑，用辛温甘淡的药治疗。
徐忠可说：肾脏风寒都缺，然而看《千金方》三黄汤，用独活细辛治中风及肾者，而叙述病状说：烦热心乱恶寒，终日不欲饮食，又叙述肾中风说：踞坐腰痛，则知《金匮》所缺肾风内动之证，相去不远。至于寒中肾，即是少阴标阴之寒证，当不越厥逆下利欲吐不吐诸条。若《内经》说，肾中风状，多汗恶风，面庞然如肿，脊痛不能正立，其色 ，隐曲不利，诊察部位在肌上，面色黑，大概是说风自表入，伤少阴经气，乃肾中风的外部征象。
甘草干姜茯苓白术汤方（一名肾着汤）
甘草 白术（各二两） 干姜 茯苓（各四两）
右四味药，用水五升，煮取三升，分温三服。腰部就会温暖。
肾（即将衰竭时，）脉象呈现真脏脉，浮取坚。（则不沉而外散，阳已离于阴位。）重按乱如转丸。（是变石之体，而为燥动，真阳将搏跃而出。）益下入尺中者。（应伏而反动，反其封蛰之常，主）死亡。
这说的是肾脏的死脉。
问曰：三焦（之气虚）竭（而不各归其）部。（固然，但噫是脾病，现在说）上焦竭，善噫，是什么意思呢？老师说：（中气实统乎三焦。）上焦受中焦气（中焦）不和，不能消谷，（谷气郁而不宣。）所以能噫耳。（而且中焦不和，而）下焦（亦因而虚）竭，即（见前则）遗溺（后则）失便。（盖下焦听命于中焦。）其（中焦之）气不和，（下焦无以受中之荫，则肾气日虚，经云。北方黑色，开窍于二阴，肾虚则前后）不能自禁制。（此下焦虽病，却）不需要治。（只以补脾健胃，治其中焦。）久则（自）愈。
这说的是三焦虚竭，统以中焦为主治。
老师说：热在上焦者，（心肺受之，心火盛，肺金愈伤。）因咳为肺痿。热在中焦者，（脾胃受之，胃热必实而硬，脾热必燥而 。因热而结。）则为坚。热在下焦者，（以下焦为肝肾膀胱大小肠所居之处，或肝肾热盛。）则尿血。（或膀胱热盛。）亦令淋不通。（至若）大肠有寒者多 溏。（即下利溏泻也。）有热者便肠垢。（即下利脓血也。）小肠有寒者，其人下重便血。（即阴结便血也。）有热者（流蓄肛门。）必（病）痔。
这又分晰三焦各病。
问曰：病有积有聚，有 气，是什么意思呢？老师说：积者，脏病也。（始）终不移。聚者，腑病也，发作有时，展转痛移为可治。
气者，（食气也，食积太阴，敦阜之气，抑遏肝气，所以）胁下痛。（用手）按（摩）之，则（食化气行而）愈。（若饮食稍一不节，则）复发（名）为 气。
这说的是腹中痛病大概有三也。
徐忠可说：此积非 瘕之类，也未必有形停积，天下之物，皆从无中生有，乃气从阴结，阴则粘着也。观下文云积在喉中，则结阴可知，不然，则喉中岂能容有形之物耶。
（积病坚久难治，必详之于脉。）诸（凡气血痰食等）积大法，脉来（沉）细而附骨者，（此）乃（为）积也。（所以然者，以积而不移之处，其气血营卫，不复上行而外达，则其脉亦沉，而作是象，兹试举其脉出之所以，决其受病之处，若此脉出）寸口，积在胸中，微出寸口，积在喉中。（出）关上，积在脐旁，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。（若沉细不起之）脉两（手俱）出，（是中央有积，其气不能分左右也，可断之曰。）积在中央。（凡此者。）各以其部处之。
这说的是积脉分上下左右而定之也。
The Lung (as the zang organ governing Qi) if affected by Wind, (leading to failure of Qi to distribute fluids and resulting in) dry mouth (and failure of Qi to descend causing) wheezing. (Qi damage leads to inability to support,) body (feels like sitting on a rocking boat or carriage, experiencing) dizziness (Qi deficiency causes fatigue,) heaviness. (Qi damage prevents Clear Yang from ascending causing) vertigo (Qi damage obstructs water passages leading to) swelling. (The five fluids manifest as mucus in the Lung.) Cold affecting the Lung, (cold pathogen closes lung orifices, causing) accumulated stagnant heat to instead be expelled from the mouth as) turbid nasal discharge. When the Lung (is about to fail,) the pulse reveals the Zang pulse: floating and empty superficially, weak like a scallion leaf deep down, with no root at the base. (This indicates failure of Heaven and Water to interact, thus leading to) death.
This chapter differs from the *Nei Jing* (Inner Canon), serving to supplement what was not covered there.
This section discusses the pulses for Wind and Cold syndromes of the Lung.
Xu Zhongke states: According to the above syndromes, it is stated that the Lung itself is diseased, meaning the Qi is injured. All bodily functions relying on Qi exhibit these various altered syndromes; this details the internal manifestations of Wind and Cold in the Lung. As stated in the *Nei Jing*: symptoms of Wind affecting the Lung include excessive sweating, aversion to wind, intermittent coughing, improving during the day and worsening at night; diagnosis is made at the area above the eyebrows where the complexion is white. This describes the external manifestations of the Lung contracting exterior pathogens.
The Liver (is the Wood organ associated with Wind; if) affected by Wind, (since Wind moves upward due to its nature,) head and eyes feel dizzy. (The Liver meridian distributes along the hypochondrium; excess Wind causes meridional tension, leading to) pain in both hypochondria. (And) walking often involves stooping. (*Nei Jing* states: "The Liver suffers from urgency; sweet flavors relieve it." Here, Wood excess overcomes Earth, seeking relief through flavor, thus) making one crave sweet foods. Cold affecting the Liver, (causing great tendons to spasm, therefore) both arms cannot be raised. (The Liver meridian circulates behind the throat; Liver cold forces heat upward, causing) dryness at the root of the tongue. (The Gallbladder governs frequent sighing; Liver disease causes Gallbladder stagnation, leading to) frequent sighing. (The ascending part of the Liver meridian flanks the stomach and pierces the diaphragm; cold invasion causes) pain in the chest. (When pain is severe,) turning sideways becomes impossible. (Flanking the stomach means the Stomach is controlled by Wood, so after eating,) vomiting occurs (piercing the diaphragm means Heart Fire influences the Child element, causing) spontaneous sweating. When the Liver (is about to fail,) the pulse reveals the Zang pulse: floating and weak superficially, pressing feels like a cord (string-tight and wiry appearing together, departing without returning), or (losing the way of Yin-Yang reciprocity, lacking Stomach Qi, or showing forced entry/exit with a state of reluctance to advance and difficulty extending, the pulse shape) curves like a snake moving. (Indicates) death.
This discusses the pulses for Wind and Cold syndromes of the Liver.
Xu Zhongke states: The above discusses Wind and Cold injuring Liver Yin, preventing Wood Qi from nourishing. All bodily functions relying on Yin exhibit these various altered syndromes; this details the internal manifestations of Wind and Cold in the Liver. As in the *Nei Jing*: Liver affected by Wind presents with excessive sweating, aversion to wind, sadness, cyanotic complexion, dry throat, irritability, occasional aversion to women; diagnosis is at the area below the eyes where the complexion is green. This describes the external manifestations of the Liver contracting exterior pathogens.
(Liver governs free flow; when Qi and Blood stagnate and do not move, adhering like sticky objects, this disease is named) Gan Zhuo (Liver Fixation). The patient constantly desires (to use hands to) tread upon their chest. (Relying on massage to unblock Qi. Generally, stagnant Qi and Blood disperse slightly with heat; however, when suffering greatly, pathological Qi generates heat, which hot drinks cannot overcome. Thus, one must) first (before) feeling distress, only desire (seeking dispersion and thinking to) drink hot liquids. (Using these symptoms to understand the condition as basis, treat with) Xuan Fu Hua Tang (Inula Flower Decoction).
This separately discusses the syndrome and treatment of Gan Zhuo. However, the chest is the domain of the Lung; Liver disease causing Qi to focus on the Lung is called "Horizontal" (Heng). (See *Shang Han Lun* for details on Horizontal and Vertical).
Xu Zhongke states: Previous Wind and Cold sections did not prescribe formulas; this independently prescribes one. Likely because Gan Zhuo is gradually caused by Wind and Cold, a unique disease, not the primary illness of Wind families.
Xuan Fu Hua Tang Formula
Xuan Fu Hua (Inulae Flos, 3 liang, also known as Jin Fei Cao) Cong Bai (Allii Cepae Bulbus, 14 stems) Xin Jiang (Safflower Red, a small amount)
These three ingredients, boil in 3 sheng of water, reduce to 1 sheng, take in one dose.
The Heart (is the Fire organ, the Sovereign Official; if) affected by Wind, (Wind is a Yang pathogen; combining with it causes) feverish heat (with Wind and Fire merging). (If the Sovereign is ill, all limbs become useless, leading to) inability to rise. (Fire chaos within causes) heartburn-like hunger. (Heat blockage above causes) immediate vomiting after eating. Cold affecting the Heart interior, (Cold is a Yin pathogen; exterior constriction causes Fire to gather internally.) The patient suffers from cardiac discomfort (restlessness and helplessness, painful yet not painful, feeling spicy-hot) as if eating garlic. Severe cases involve heart pain penetrating to the back, and back pain penetrating to the heart, like insects (crawling back and forth). If the pulse is floating, (it indicates Cold has an opportunity to exit; forcing emesis is inadvisable. If the mechanism favors recovery and) spontaneous vomiting occurs, the disease resolves. Heart Qi injury, (unrelated to Wind/Cold, but due to Qi and Blood deficiency, constituting internal injury.) The patient, upon any) labor or fatigue, experiences redness of the head and face with heaviness in the lower body. (Since Blood deficiency allows Yang to float easily; upper excess implies lower deficiency. Blood deficiency fails to nourish the Heart, causing) heart pain. (Fire hyperactivity) leads to (creating a We Ji hexagram state, causing) spontaneous vexation and fever. (Heart deficiency above causes Kidney movement below, leading to) pulsation at the navel. (Child stealing Mother's Qi.) The pulse is (then) wiry. This is caused by Heart injury. When the Heart (is about to fail,) the pulse reveals the Zang pulse: floating and solid like hemp seeds, pressing makes it more restless. (Indicates Yin Qi is exhausted, leading to) death.
This discusses the syndromes and pulses of Cold/Wind in the Heart. Additionally, Heart Qi injury is the fundamental pathology underlying exterior Wind/Cold manifestations. Since the Heart is the master of the twelve officials, it is discussed particularly solemnly.
Xu Zhongke states: Fire generates all things, yet Fire also destroys all things. The substance of Fire is heat, while its function is warmth. Thus, cooking pot nourishes, while wildfire scorches. The above syndromes are driven by evil, causing Heart Fire to lose its harmonious Yang function. All bodily functions relying on Yang for warmth exhibit these altered syndromes; this details the internal manifestations of Wind in the Heart. As the *Nei Jing* says: Heart affected by Wind presents with excessive sweating, aversion to wind, extreme anger/fright, severe cases involve slow speech; diagnosis is at the mouth where the complexion is black. *Qian Jin Fang* says diagnosis is at the lips where the complexion is red. This describes the external manifestations of Wind in the Heart.
(Regarding Heart Qi injury, the previous text was incomplete; let us reiterate. When a person is possessed by) evil spirits, leading to crying (causing) soul and spirit unrest. (Although sources vary among Six Qi, Seven Emotions, Phlegm, and Fire, the root is) deficiency of Qi and Blood. (However, the reason for Qi and Blood) deficiency lies with the Heart. (Blood is generated from Qi; speaking of Qi encompasses Blood.) Heart Qi deficiency causes fear, desire to sleep with eyes closed, dreaming of long journeys, scattered spirit and soul, wandering妄行. (Loss of Heart Master's control inevitably leads to mania, though Mania/Dian has Yin/Yang distinctions.) Yin deficiency leads to Dian (depression/lethargy); Yang deficiency leads to Kuang (mania/excitement). (This seems inconsistent with the classic saying "Excess Yin leads to Dian, Excess Yang leads to Kuang," but that classification uses Cold/Heat for Yin/Yang, whereas this uses Qi/Blood. Readers should understand this beyond the words.)
This continues the discussion on Heart Qi injury.
Spleen affected by Wind, (causes whole-body) feverish heat, appearance like a drunkard (red face, soft limbs). Abdominal (heat stirred by Wind causes) vexation (original Dampness generates) heaviness. (Upper and lower eyelids belong to Spleen/Stomach, named) eyelids (Wind entering causes movement, leading to) twitching. (Spleen sits between Lung and Kidney; when diseased, it neglects connecting up and down, failing Heaven-Water interaction causing) shortness of breath. When the Spleen (is about to fail,) the pulse reveals the Zang pulse: floating, large, and hard. (Completely losing the soft Stomach Qi.) Pressing feels like an overturned cup. (What does an overturned cup look like? Empty and void) clean and empty state (restless and agitated.) Shaking appearance. (Indicates) death.
This discusses the syndrome and pulse of Wind in the Spleen.
Note: Song edition editors Chen Yiren etc. state each Zang organ has Wind and Cold syndromes; now Spleen only records Wind, Kidney neither Wind nor Cold. Ancients were extremely concise and chaotic; far from antiquity, no texts remain to patch gaps. (Shen Zinan says: For Spleen Cold, I propose supplementing with Taiyin spontaneous diarrhea without thirst from *Shang Han Lun*. For Kidney Wind, I propose supplementing with Shaoyin Huanglian Ejiao Tang syndrome. For Kidney Cold, I propose supplementing with Tongmai Sini Tang syndrome. What do you think?)
Xu Zhongke states: *Jin Gui* lacks Spleen Cold, but it can be inferred as spontaneous diarrhea, abdominal pain, bloating, anorexia. Regarding the above Spleen Wind syndromes, all physical forms relying on Central Earth for harmony exhibit these altered syndromes; this details the internal manifestations of Wind in the Spleen. As *Nei Jing* says: Spleen Wind presents with excessive sweating, aversion to wind, bodily laziness, limbs unwilling to move, pale yellow complexion, anorexia; diagnosis is on the nose where the complexion is yellow. This describes the external manifestations of Wind in the Spleen.
(Now attempting to diagnose the Fuyang pulse.) Fuyang (is the Stomach pulse; now the) pulse is floating and choppy. Floating indicates) strong Stomach Qi; choppy indicates) Spleen Yin deficiency. Spleen Yin deficiency cannot transport essence/Qi to the Stomach; water descends alone, thus) frequent urination. Floating and choppy interact, causing stool to become hard. The (cause) Spleen (deficiency) is constrained by (the Stomach.) Treat with) Mahuang Wan (Hemp Seed Pill).
This discusses the syndrome and treatment of Spleen Constraint.
Mahuang Wan Formula
Huo Ma Ren (Cannabis Fructus, 1 sheng) Shao Yao (Paeoniae Radix Alba, half jin) Da Huang (Rhei Radix et Rhizoma, peeled, 1 jin) Zhi Shi (Aurantii Fructus Immaturus, half jin) Hou Po (Magnoliae Cortex, one chi, peeled) Xing Ren (Armeniacae Semen, peeled tip, roasted separately into paste)
These six ingredients, grind into powder, mix with refined honey into pills the size of tung seeds. Take ten pills with water, three times daily, gradually increase until effective.
(Kidney exposed to cold dampness, adhering and not leaving, is named Shen Zhuo.) Disease of Shen Zhuo, the patient's body feels (due to dampness) heavy, waist (due to cold) feels cold, as if sitting in water. (At the site of adherence,) form (slightly swollen) looks like water (edema). (But dampness obstructs fluids causing thirst; now) conversely no thirst. (Knowing no heat above.) Urination is normal/free. (Knowing Yang deficiency below.) Diet remains normal. (Knowing) disease (does not involve Middle Jiao, but) belongs to Lower Jiao. (However, Kidney is not deficient unless labored; tracing the cause, due to) body labor and sweating, clothes inside cold and damp, over time contracted (and injured). (Symptoms naturally) cold pain below the waist. (To) abdomen (all) heavy as if carrying five thousand coins. (Treat with) Gan Jiang Ling Zhu Tang (Licorice, Dried Ginger, Poria, Atractylodes Decoction).
This discusses Shen Zhuo disease caused by cold dampness, located not in the Kidney Zang proper, but in the Kidney exterior fascia, treated with acrid-warm, sweet-pale herbs.
Xu Zhongke states: Kidney Wind and Cold are missing, yet observing *Qian Jin San Huang Tang* using Du Huo and Xi Xin for Wind/Kidney, describing symptoms as: vexation, heart chaos, aversion to cold, total lack of appetite; and describing Kidney Wind as: squatting with low back pain, then knowing *Jin Gui*'s missing internal Kidney Wind syndromes are not far off. As for Cold entering Kidney, it is Shaoyin marked Yin Cold syndrome, not exceeding items like cold extremities, diarrhea, desire to vomit but unable. As *Nei Jing* says: Kidney Wind presents with excessive sweating, aversion to wind, puffy face like edema, back pain unable to stand straight, complexion , difficulty in private matters; diagnosis is on muscle where complexion is black. This likely means Wind enters from exterior, injuring Shaoyin meridian Qi, being the external manifestation of Wind in Kidney.
Gan Jiang Ling Zhu Tang Formula (also named Shen Zhuo Tang)
Gan Cao (Radix Glycyrrhizae) Bai Zhu (Rhizoma Atractodis Macrocephalae) (each 2 liang) Gan Jiang (Rhizoma Zingiberis Recens) Fu Ling (Sclerotium Poriae) (each 4 liang)
Right four ingredients, boil in 5 sheng of water, extract 3 sheng, divide into three warm doses. Waist will become warm.
Kidney (about to fail,) pulse reveals Zang pulse: floating and hard. (Not sinking but dispersing outward, Yang has separated from Yin position.) Pressing feels chaotic like rolling balls. (Changing stone body into dry agitation, True Yang about to leap out.) Extending downward into Chi position. (Should be hidden but reacts violently, reversing hibernation norm, indicating) death.
This discusses the death pulse of the Kidney.
Question: Three Burners' (Qi deficiency) exhaustion (not returning to their respective departments) (is true, but belching is Spleen disease; now saying) Upper Jiao exhaustion causes frequent belching, what does this mean? Master says: (Middle Qi reality governs Three Burners.) Upper Jiao receives Middle Jiao Qi (Middle Jiao) unharmonized, cannot digest grains, (Grain Qi stagnates and does not diffuse.) thus causing belching. (Moreover, Middle Jiao disharmony causes) Lower Jiao (also consequently deficient) exhaustion, resulting in (previously) enuresis (later) fecal incontinence. (Lower Jiao obeys Middle Jiao.) Its (Middle Jiao's) Qi unharmonized, (Lower Jiao receives no protection, causing Kidney Qi daily deficiency; Classic says: North is Black, opens to two yins; Kidney deficiency causes anterior and posterior) inability to self-control. (Although this Lower Jiao is diseased, it does) not require treatment. (Only tonify Spleen and strengthen Stomach, treating Middle Jiao.) Over time (it will spontaneously) heal.
This discusses Three Burner deficiency exhaustion, governed primarily by treating Middle Jiao.
Master says: Heat in Upper Jiao affects (Lung and Heart; Heart Fire excess injures Lung Metal further.) leading to cough becoming Lung萎 (Lung Flaccidity). Heat in Middle Jiao affects (Spleen and Stomach; Stomach heat becomes solid and hard, Spleen heat becomes dry and constipated. Due to heat binding.) results in hardness. Heat in Lower Jiao affects (Lower Jiao houses Liver, Kidney, Bladder, Large and Small Intestines; if Liver/Kidney heat excess.) causes hematuria. (Or Bladder heat excess.) also causes strangury with obstruction. (As for) Large Intestine having Cold causes mostly loose stools. (i.e., diarrhea with loose stools.) Having Heat causes passage of intestinal mucus/pus-blood. (i.e., dysentery with pus and blood.) Small Intestine having Cold causes heaviness below and bloody stools. (i.e., Yin constipation with bloody stools.) Having Heat (accumulates in anus.) necessarily causes hemorrhoids.
This further analyzes diseases of each Jiao.
Question: Diseases include Ji (Accumulation), Ju (Gathering), and [Food] Qi, what does this mean? Master says: Ji is Zang disease. (Beginning to end) does not move. Ju is Fu disease, attacks occur at times, shifting pain location indicates treatability.
[Food] Qi disease (is Food Qi; food accumulation in Taiyin, abundant Qi suppresses Liver Qi, thus) pain under hypochondrium. (With hand) press (massage) it, then (food digests, Qi moves and) heals. (If diet is slightly irregular, it) recurs (named) [Food] Qi.
This generally discusses abdominal pain diseases having three types.
Xu Zhongke states: This Ji is not like mass-type accumulations, nor necessarily有形 (有形 material accumulation). All things in the world arise from nothing; it is Qi binding with Yin, Yin adheres. Observing later text saying Ji in throat proves Yin binding; otherwise, how could throat contain material objects?
(Ji disease is hard and chronic, difficult to treat; must detail via pulse.) General principles for all (Qi, Blood, Phlegm, Food etc.) Ji: pulse comes (deep) thin and attached to bone. (This) is (a) Ji. (Reason: At sites of immobile Ji, Qi, Blood, Ying, Wei no longer ascend and reach exterior, so pulse is also deep, presenting this image. Now trying to举 pulse emergence to determine disease site: if this pulse emerges) at Cun Kou, Ji is in chest; slightly emerging from Cun Kou, Ji is in throat. (Emerging) at Guan, Ji is beside umbilicus; above Guan, Ji is below heart; slightly below Guan, Ji is in lower abdomen; Chi position, Ji is at Qichong. Pulse emerges left, Ji is left; pulse emerges right, Ji is right. (If deep thin pulse does not rise) pulse both (hands simultaneously) emerge, (is Central Ji, Qi cannot distinguish left/right, can conclude:) Ji is in Center. (All these.) Each according to their location.
This discusses determining Ji pulse by upper/lower/left/right positions.