黄帝问于岐伯曰。人之血气精神者。所以奉生而周于性命者也。经脉者。所以行血气而荣阴阳。濡筋骨
利关节者也。卫气者。所以温分肉。充皮肤。肥腠理。司开阖者也。志意者。所以御精神。收魂魄。适寒温。
和喜怒者也。是故血和则经脉流行。营覆阴阳。筋骨劲强。关节清利矣。卫气和则分肉解利。皮肤调
柔。腠理致密矣。志意和则精神专直。魂魄不散。悔怒不起。五脏不受邪矣。寒温和则六腑化谷。风痹不作。
经脉通利。肢节得安矣。此人之常平也。五脏者。所以藏精神血气魂魄者也。六腑者。所以化水谷而行津液者
也。此人之所以具受于天也。无愚智贤不肖。无以相倚也。然有其独尽天寿。而无邪僻之病。百年不衰。虽犯
风雨卒寒大暑。犹有弗能害也。有其不离屏蔽室内。无怵惕之恐。然犹不免于病。何也。愿闻其故。岐伯曰。
窘乎哉问也。五脏者。所以参天地。副阴阳。而运四时。化五节者也。五脏者。固有小大高下。坚脆端正偏倾者。
六腑亦有小大长短浓薄结直缓急。凡此二十五者。各不同。或善或恶。或吉或凶。请言其方。
上章论在外之皮肤肌腠。因刚柔浓薄而生病。此章论在内之五脏六腑。有大小高下。偏正浓薄之不同。
亦因形而生病也。夫营卫血气。脏腑之所生也。脉肉筋骨。脏腑之外合也。精神魂魄。五脏之所藏也。
水谷津液。六腑之所化也。是以血气神志和调。则五脏不受邪而形体得安。然又有因于脏腑之形质。而能
长寿不衰。虽犯风雨寒暑。邪勿能害者。有外不离屏蔽室内。内无怵惕之恐。然犹不免于病者。此缘脏腑
在大小浓薄之不同。致有善恶凶吉之变异。盖五脏六腑。本于天地阴阳。四时五行之气而成此形。故宜
中正坚浓。以参副天地阴阳之正气。
心小则安。邪弗能伤。易伤以忧。心大则忧不能伤。易伤于邪。心高则满于肺中。 而善忘。难开
以言。心下则脏外易伤于寒。易恐以言。心坚则脏安守固。心脆则善病消瘅热中。心端正则和利难伤。
心偏倾则操持不一。无守司也。
心小则神气收藏。故邪弗能害。小心故易伤以忧也。心大则神旺而忧不能伤。大则神气外弛。故易伤
于邪也。肺者心之盖。故心高则满于肺中。在心主言。在肺主声。满则心肺之窍闭塞。故闷而善忘。难开
以言也。经云。心部于表。故心下则脏外易伤于寒。心卑下。故易恐以言也。心坚则脏安守固。心脆则
善病消瘅热中。按邪气脏腑篇。五脏脉微小为消瘅。盖五脏主藏精者也。五脏脆弱。则津液微薄。故皆成
消瘅。心正则精神和利。而邪病难伤。心偏倾则操持不一。无守司也。
肺小则少饮。不病喘喝。肺大则多饮。善病胸痹喉痹。逆气。肺高则上气肩息咳。肺下则居贲迫肺。
善胁下痛。肺
坚则不病咳上气。肺脆则苦病消瘅。易伤。肺端正。则和利。难伤。肺偏倾。则胸偏痛也。（贲叶奔）
肺主通调水道。故小则少饮。大则多饮。肺居胸中。开窍于喉。以司呼吸。故小则不病喘喝。大则
善病胸痹喉痹。肺主气。故高则上气息肩而咳也。贲乃胃脘之贲门。在胃之上口。下则肺居贲间而胃脘
迫肺。血脉不通。故胁下痛。胁下乃肺脉所出之云门中府处也。肺坚则气不上逆而咳。肺脆则苦病消
瘅。而肺易伤也。肺藏气。气舍魄。肺端正。则神志和利。邪勿能伤。肺偏倾。则胸偏痛也。
肝小则脏安。无胁下之痛。肝大则逼胃迫咽。迫咽则苦膈中。且胁下痛。肝高则上支贲切。胁 为息
贲。肝下则逼胃。胁下空。胁下空则易受邪。肝坚则脏安难伤。肝脆则善病消瘅。易伤。肝端正则和利。
难伤。肝偏倾。则胁下痛也。
肝居胁下。故小则脏安而无胁下之痛。肝居胃之左。故大则逼胃。而胃脘上迫于咽也。肝在膈之下。
故大则苦于膈中。且胁下痛。肝脉贯膈上注肺。故高则上支贲切。胁 为息贲。肝居胃旁。故下则逼胃而
胁下空。空则易受于邪。盖胁乃邪正出入之枢部也。肝坚则脏安难伤。脆则善病消瘅而易伤也。肝藏血。
血舍魂。端正则神志和利。偏倾则胁痛也。
脾小则脏安。难伤于邪也。脾大则苦凑 而痛。不能疾行。脾高则 引季胁而痛。脾下则下加于大肠。
下加于大肠。则脏苦受邪。脾坚则脏安难伤。脾脆则善病消瘅易伤。脾端正则和利难伤。脾偏倾则善满
善胀也。（ 音秒与杪同）
脾为中土。而主于四旁。故小则脏安而难伤于邪也。脾居于腹。在胁骨之秒。故大则苦凑 而痛。
脾主四肢。故不能疾行也。胁在 之上。故高则 引季胁而痛。下则加于大肠。加于大肠。则脏苦受邪。
盖脏虚其本位也。脾坚则脏安难伤。脾脆则善病消瘅而易伤也。脾藏意。意舍荣。端正则神志和利。偏倾
则善满善胀也。
肾小则脏安难伤。肾大则善病腰痛。不可以俯仰。易伤以邪。肾高则苦背膂痛。不可以俯仰。肾下则
腰尻痛。不可以俯仰。为狐疝。肾坚则不病腰背痛。肾脆则苦病消瘅易伤。肾端正则和利难伤。肾偏倾则
苦腰尻痛也。凡此二十五变者。人之所苦常病也。（尻音敲肫骨也）
夫脏者藏也。故小则脏安难伤。大则善病腰痛。腰乃肾之府也。夫腰脊者。身之大关节也。故腰痛背
膂痛。腰尻痛。皆不可以俯仰。肾附于腰脊间。故病诸痛也。狐疝者。偏有大小。时时上下。狐乃阴兽。善
变化而藏。睾丸上下。如狐之出入无时。此肾脏之疝也。肾坚则不病腰背痛。脆则苦病消瘅而易伤也。肾藏
精。精舍志。脏体端正。则神志和利而难伤。偏倾则苦腰尻痛也。夫身形。五脏之外合也。皮薄理疏。则风
雨寒暑之邪。循毫毛而入腠理以病形。盖六气之客于外也。如在内之藏形。薄脆偏倾。则人之所苦常病。
常病者。五五二十五变病也。
黄帝曰。何以知其然也。岐伯曰。赤色小理者心小。粗理者心大。无 者心高。 小短举者心下。
长者心下坚。 弱小以薄者心脆。 直下不举者心端正。 倚一方者。心偏倾也。（ 音结 音干）
小理者。肌肉之纹理细密。粗理者。肉理粗疏。大肉 脂。五脏之所生也。故候肉理之粗细。即
知脏形之大小。 。胸下蔽骨也。本经曰。膏人纵腹垂腴。肉人者上下客大。盖人之 肉本于脏腑募原之精液以
资生募原者。脏腑之膏肓也。五脏所藏之精液。溢于膏肓而外养于 肉。是以五脏病者。大肉陷下。破 脱肉。
白色小理者肺小。粗理者肺大。巨肩反膺陷喉者肺高。合腋张胁者肺下。好肩背浓者肺坚。肩
背薄者肺脆。背膺浓者肺端正。胁偏疏者。肺偏倾也。
肺居肩膺之内。胁腋之上。故视其肩背膺腋。即知肺之高下坚脆偏倾。倪冲之曰。肺属天而
华盖于上。背为阳。而形身之上也。故肺俞出于肩背。朱永年曰。脉要精微论云。尺内两旁。则
季胁也。尺外以候肾。尺里以候腹中。推而外之。内而不外。有心腹积也。推而内之。外而不内。
身有热也。盖形身之上下。即脏腑所居之外候也。
青色小理者肝小。粗理者肝大。广胸反 者肝高。合胁兔 者肝下。胸胁好者肝坚。胁骨弱者肝
脆。膺腹好相得者肝端正。胁骨偏举者。肝偏倾也。（ 音交）
者。胸胁交分之扁骨。内膈前连于胸之鸠尾。旁连于胁。后连于脊之十一椎。肝在膈之下。
故广胸反 者肝高。合胁兔 者肝下。兔者。骨之藏伏也。肝脉下循于腹之章门。上循于膺之期门。在
内者。从肝别贯膈。故膺腹好相得者肝端正。
黄色小理者脾小。粗理者脾大。揭唇者脾高。唇下纵者脾下。唇坚者脾坚。唇大而不坚者脾脆。
唇上下好者脾端正。唇偏举者脾偏倾也。
倪氏曰。唇者脾之候。故视唇之好恶。以知脾脏之吉凶。
黑色小理者肾小。粗理者肾大。高耳者肾高。耳后陷者肾下。耳坚者肾坚。耳薄不坚者肾脆。耳
好前居牙车者肾端正。耳偏高者。肾偏倾也。凡此诸变者。持则安。减则病也。
倪氏曰。耳者肾之候。故视耳之好恶。以知肾脏之高下偏正。凡此诸变者。神志能持则安减则不免于病矣。
帝曰善。然非余之所问也。愿闻人之有不可病者。至尽天寿。虽有深忧大恐怵惕之志。犹不能减
也。甚寒大热。不能伤也。其有不离屏蔽室内。又无怵惕之恐。然不免于病者何也。愿闻其故。岐伯曰。
五脏六腑。邪之舍也。请言其故。五脏皆小者少病。苦焦心。大愁忧。五脏皆大者缓于事。难使以忧。
五脏皆高者好高举措。五脏皆下者好出人下。五脏皆坚者无病。五脏皆脆者不离于病。五脏皆端正者。
和利得人心。五脏皆偏倾者。邪心而善盗。不可以为人平。反复言语也。
倪冲之曰。此总结五脏之形不同。而情志亦有别也。五脏者。所以藏精神血气魂魄志意者也。故小
则血气收藏而少病。小则神志畏怯。故苦焦心。大忧愁也。五脏皆大者。神志充足。故缓于事。难使
以忧五脏皆高者。好高举措。五脏皆下者。好出人下。此皆因形而情志随之也。和于中则着于外。故得
人心。善盗者。贪取之小人。语言反复。不可以为平正人也。
黄帝曰。愿闻六腑之应。岐伯答曰。肺合大肠。大肠者皮其应。心合小肠。小肠者脉其应。肝合胆
。胆者筋其应。脾合胃。胃者肉其应。肾合三焦膀胱。三焦膀胱者。腠理毫毛其应。
倪氏曰。五脏为阴。六腑为阳。脏腑雌雄相合。五脏内合六腑。六腑外应于形身。阴内而阳外也。
故视其外合之皮脉肉筋骨。则知六腑之浓薄长短矣。肾将两脏。一合三焦。一合膀胱。
黄帝曰。应之奈何。岐伯曰。肺应皮。皮浓者。大肠浓。皮薄者。大肠薄。皮缓腹里大者。大肠
大而长。皮急者。大肠急而短。皮滑者。大肠直。皮肉不相离者。大肠结。
倪氏曰。五脏内合六腑。外应于皮脉肉筋骨。是以肺应皮而皮浓者大肠浓。皮薄者大肠薄。脏腑
之形气。外内交相输应者也。
心应脉。皮浓者脉浓。脉浓者小肠浓。皮薄者脉薄。脉薄者小肠薄。皮缓者脉缓。脉缓者小肠大
而长。皮薄而脉波小者。小肠小而短。诸阳经脉皆多纡屈者。小肠结。
邪气脏腑篇曰。脉急者。尺之皮肤亦急。脉缓者。尺之皮肤亦缓。皮脉之相应也。故皮浓者脉浓。
脉浓者小肠浓。皮薄者脉薄。脉薄者小肠薄。
脾应肉。肉 坚大者胃浓。肉 么者胃薄。肉 小而么者胃不坚。肉 不称身者胃下。胃下者下
脘约不利。肉 不坚者胃缓。肉 无小裹累者胃急。肉 多小裹累者胃结。胃结者。上脘约不利也。
（音窘称去声）
倪氏曰。 、肥脂也。么、亦小也。约、约束也。胃有上脘中脘下脘。故胃下则下脘约不利。结
则上脘约不利也。
肝应爪。爪浓色黄者胆浓。爪薄色红者胆薄。爪坚色青者胆急。爪濡色赤者胆缓。爪直色白无约
者胆直。爪恶色黑多纹者胆结也。
朱氏曰。爪者筋之余。故肝应爪。视爪之好恶。以知胆之浓薄缓急也。五脏六腑。皆取决于胆。
故秉五脏五行之气色。莫子瑜曰。胆属甲子。主天干地支之首。故备五行之色。
肾应骨。密理浓皮者。三焦膀胱浓。粗理薄皮者。三焦膀胱薄。疏腠理者。三焦膀胱缓。皮急而
无毫毛者。三焦膀胱急。毫毛美而粗者。三焦膀胱直。稀毫毛者。三焦膀胱结也。
倪氏曰。太阳之气主皮毛。三焦之气通腠理。是以视皮肤腠理之浓薄。则内应于三焦膀胱矣。又
津液随三焦之气以温肌肉。充皮肤。三焦者。少阳之气也。本经云。熏肤充身泽毛是谓气。是以皮毛
皆应于三焦膀胱。朱永年曰。经云 谷属骨。是肌肉之属于骨也。又曰脾生肉。肉生肺。肺生皮毛。是
骨肉皮毛。交相资生者也。故曰肾应骨。密理浓皮者。三焦膀胱浓。
黄帝曰。浓薄美恶皆有形。愿闻其所病。岐伯答曰。视其外应。以知其五内。则知所病矣。
倪氏曰。六腑内合五脏。外应于皮肉筋骨。故视其外应。以知其五内。则知其所病矣。盖六腑之浓
薄缓急大小而为病者。与五脏之相同也。
黄帝向岐伯问道：人的血、气、精神，是用来奉养生命并周流贯彻于性命之中的。经脉，是用来运行血气而营养阴阳，滋润筋骨，滑利关节的。卫气，是用来温煦肌肉，充实皮肤，肥厚腠理，主管汗孔开合的。志意，是用来统御精神，收敛魂魄，适应寒温变化，调和喜怒情绪的。因此，血气和顺则经脉流行，营气覆育阴阳，筋骨强劲有力，关节清滑便利。卫气和顺则肌肉分理舒展滑利，皮肤调和柔润，腠理致密。志意和顺则精神专注正直，魂魄不散乱，悔恨愤怒不起，五脏就不受邪气侵袭。寒温适宜则六腑能消化水谷，风痹不发生，经脉通利，肢节得以安宁。这是人处于常态平衡的状态。
五脏，是用来储藏精神、血气、魂魄的。六腑，是用来消化水谷并传输津液的。这是人与生俱来从先天禀受的特质，无论愚笨还是聪明，贤良还是不肖，都没有谁特别依赖谁的区别。然而，有的人能够享尽天年，没有歪斜不正的疾病，百年不衰，即使遭受风雨、突然的严寒或酷暑，也不能伤害他。有的人虽然不离开遮蔽保护的室内，没有惊恐忧虑，但仍然不免于生病，为什么呢？我希望听您讲讲其中的缘故。
岐伯回答说：您的问问题真是深奥啊！五脏，是参配天地，副合阴阳，运转四时，化生五季（春、夏、长夏、秋、冬）的器官。五脏本来就有大小、高低、坚固、脆弱、端正、偏倾的不同；六腑也有大小、长短、浓薄、结直、缓急的差异。这二十五种情况，各不相同，有的好，有的坏，有的吉，有的凶。请允许我说明其规律。
上一章论述了体表的皮肤肌腠，因为刚柔、浓薄的不同而生病。这一章论述了体内的五脏六腑，有大小、高低、偏正、浓薄的不同，也是因形体差异而导致生病。营卫血气，是由脏腑生成的；脉肉筋骨，是脏腑在外的配合；精神魂魄，是五脏所藏纳的；水谷津液，是六腑所化生的。所以血气神志调和，则五脏不受邪气侵袭而形体得安。然而又有因为脏腑的形质，能够长寿不衰，即使遭受风雨寒暑，邪气不能伤害的；也有虽然外表不离开遮蔽室内，内心没有惊恐忧虑，但仍然不免于生病的。这是因为脏腑在大小、浓薄上的不同，导致了善恶、吉凶的变化。大概五脏六腑，本源于天地阴阳、四时五行之气而形成这种形体，所以应当中正、坚固、浓实，以参配副合天地阴阳的正气。
心小则安定，邪气不能伤害，但容易因忧愁而受伤；心大则忧愁不能伤害，但容易受邪气侵袭；心位置高则压迫肺中，导致健忘，难以用言语开导；心位置低则脏器外露，容易受寒邪侵袭，容易因言语而惊恐；心脏坚实则脏气安定守固；心脏脆弱则容易患消瘅、热中等病；心脏端正则气血和利，难以受伤；心脏偏倾则行为举止不一，缺乏坚守的主宰。
心小则神气收藏，所以邪气不能伤害。因为小心，所以容易因忧愁而受伤。心大则神气旺盛，忧愁不能伤害。因为心大，神气外弛散，所以容易受邪气侵袭。肺是心的覆盖物，所以心位置高则充满于肺中。在心主言语，在肺主声音，充满则心肺的窍道闭塞，所以胸闷且健忘，难以用言语开导。经文说：“心部于表”，所以心位置低则脏器外露，容易受寒邪侵袭。心卑下，所以容易因言语而惊恐。心脏坚实则脏气安定守固。心脏脆弱则容易患消瘅、热中。按《邪气脏腑病形篇》所说，五脏脉微小为消瘅。大概五脏是主藏精的器官，五脏脆弱，则津液微薄，所以都形成消瘅。心脏正则精神和利，邪病难伤。心脏偏倾则行为举止不一，缺乏坚守的主宰。
肺小则饮水少，不患喘喝病；肺大则饮水多，容易患胸痹、喉痹、气逆等病；肺位置高则气上逆，肩息咳嗽；肺位置低则居于贲门之上压迫肺，容易胁下疼痛；肺坚实则不患咳喘气逆病；肺脆弱则苦于消瘅病，容易受伤；肺端正则气血和利，难以受伤；肺偏倾则胸部一侧疼痛。（“贲”音奔）
肺主通调水道，所以肺小则饮水少，肺大则饮水多。肺居胸中，开窍于喉，司呼吸，所以肺小则不患喘喝病，肺大则容易患胸痹、喉痹。肺主气，所以肺高则气上逆，抬肩呼吸而咳嗽。“贲”是胃脘的贲门，位于胃的上口，肺位置低则肺居于贲门之间，胃脘压迫肺，血脉不通，所以胁下疼痛。胁下是肺脉发出的云门、中府穴所在处。肺坚实则气不上逆而咳嗽，肺脆弱则苦于消瘅病，肺容易受伤。肺藏气，气舍魄，肺端正则神志和利，邪气不能伤害，肺偏倾则胸部一侧疼痛。
肝小则脏气安定，无胁下疼痛；肝大则逼迫胃和咽，逼迫咽则苦于膈中不适，且胁下疼痛；肝位置高则向上支撑贲门切压，胁肋胀满如息贲病；肝位置低则逼迫胃，胁下空虚，胁下空虚则容易受邪气侵袭；肝脏坚实则脏气安定，难以受伤；肝脏脆弱则容易患消瘅病，容易受伤；肝脏端正则气血和利，难以受伤；肝脏偏倾则胁下疼痛。
肝居胁下，所以小则脏气安定而无胁下疼痛。肝居胃之左侧，所以大则逼迫胃，胃脘上部压迫于咽。肝在膈之下，所以大则苦于膈中不适，且胁下疼痛。肝脉贯穿膈上注于肺，所以高则向上支撑贲门切压，胁肋胀满如息贲病。肝居胃旁，所以低则逼迫胃而胁下空虚，空虚则容易受邪气侵袭。大概胁部是邪气正气出入的枢纽部位。肝脏坚实则脏气安定，难以受伤；脆弱则容易患消瘅病而易受伤。肝藏血，血舍魂，端正则神志和利，偏倾则胁痛。
脾小则脏气安定，难以受邪气侵袭；脾大则苦于凑聚疼痛，不能快步行走；脾位置高则牵引季胁疼痛；脾位置低则下加于大肠，下加于大肠则脏气苦于受邪；脾坚实则脏气安定，难以受伤；脾脆弱则容易患消瘅病，容易受伤；脾端正则气血和利，难以受伤；脾偏倾则容易腹胀满。（“秒”音秒，与杪同义）
脾属中土，主宰四方，所以小则脏气安定，难以受邪气侵袭。脾居于腹部，在胁骨的末端，所以大则苦于凑聚疼痛。脾主四肢，所以不能快步行走。胁在肋骨之下，所以高则牵引季胁疼痛。低则加于大肠，加于大肠则脏气苦于受邪。大概是因为脏气在其本位虚弱。脾坚实则脏气安定，难以受伤；脾脆弱则容易患消瘅病而易受伤。脾藏意，意舍荣，端正则神志和利，偏倾则容易腹胀满。
肾小则脏气安定，难以受伤；肾大则容易患腰痛，不能俯仰，容易受邪气侵袭；肾位置高则苦于背脊疼痛，不能俯仰；肾位置低则腰尻疼痛，不能俯仰，形成狐疝；肾脏坚实则不患腰背痛；肾脏脆弱则苦于消瘅病，容易受伤；肾脏端正则气血和利，难以受伤；肾脏偏倾则苦于腰尻疼痛。以上这二十五种变化，是人常患的痛苦疾病。（“尻”音敲，指尾骨）
所谓“脏者藏也”，所以小则脏气安定，难以受伤；大则容易患腰痛。腰是肾的府邸。腰脊是人体大关节所在，所以腰痛、背脊痛、腰尻痛，都不能俯仰。肾附于腰脊间，所以患各种疼痛。狐疝，是指睾丸偏有大小，时时上下移动，狐狸是阴兽，善于变化而隐藏，睾丸上下移动，像狐狸出入没有定时，这是肾脏的疝病。肾脏坚实则不患腰背痛，脆弱则苦于消瘅病而易受伤。肾藏精，精舍志，脏体端正则神志和利而难伤，偏倾则苦于腰尻疼痛。身形是五脏的外在配合，皮薄理疏，则风雨寒暑之邪，顺着毫毛进入腠理而损伤形体，这是六气客于体外。如果像内在的藏形，薄脆偏倾，则是人所常患的痛苦疾病。常病，就是五五二十五种变病。
黄帝说：怎么知道是这样的呢？岐伯说：面色赤红且纹理细密的，心小；纹理粗疏的，心大；没有胸骨剑突的，心高；剑突短小上翘的，心下；剑突长而直的，心下坚实；剑突弱小且薄的，心脆；剑突直下不上翘的，心端正；剑突偏向一方的，心偏倾。（“剑突”音结，“剑突”音干）
纹理细密，指肌肉的纹理细密；纹理粗疏，指肌肉纹理粗疏。大肉即脂肪，是五脏所生成的。所以观察肌肉纹理的粗细，即可知道脏腑形体的大小。剑突，即胸下的蔽骨。本经说：“膏人纵腹垂腴，肉人者上下客大。”大概人的肌肉本于脏腑募原的精液来资生，募原是脏腑的膏肓。五脏所藏的精液，溢出到膏肓而外在滋养肌肉。所以五脏有病时，大肉陷下，破䐃脱肉。
面色白且纹理细密的，肺小；纹理粗疏的，肺大；肩膀巨大、胸廓反张、喉头凹陷的，肺高；腋下合拢、胁肋张开的，肺下；肩膀背部丰厚的，肺坚实；肩膀背部薄的，肺脆弱；背部胸廓丰厚的，肺端正；胁肋偏斜疏朗的，肺偏倾。
肺居肩膺之内，胁腋之上，所以观察其肩背膺腋，即可知道肺的高低、坚脆、偏倾。倪冲之说：肺属天，如华盖位于上方，背为阳，是形身的上部，所以肺俞出于肩背。朱永年说：《脉要精微论》云：“尺内两旁，则季胁也。尺外以候肾，尺里以候腹中。推而外之，内而不外，有心腹积也。推而内之，外而不内，身有热也。”大概形身的上下，就是脏腑所处的外在征候。
面色青且纹理细密的，肝小；纹理粗疏的，肝大；胸廓宽阔、反折剑突的，肝高；胁肋合拢、兔骨隐藏的，肝下；胸胁好的，肝坚实；胁骨弱的，肝脆弱；胸腹配合良好的，肝端正；胁骨偏斜上举的，肝偏倾。（“交”音交）
交骨，是胸胁交分的扁骨，内侧膈前连于胸之鸠尾，旁边连于胁，后面连于脊之第十一椎。肝在膈之下，所以胸廓宽阔、反折剑突的，肝高；胁肋合拢、兔骨隐藏的，肝下。“兔”指骨之藏伏。肝脉下行于腹之章门，上行于膺之期门，在内者，从肝别出贯穿膈，所以胸腹配合良好的，肝端正。
面色黄且纹理细密的，脾小；纹理粗疏的，脾大；嘴唇掀起的，脾高；嘴唇下垂的，脾下；嘴唇坚实的，脾坚实；嘴唇大但不坚实的，脾脆弱；嘴唇上下配合良好的，脾端正；嘴唇偏斜上举的，脾偏倾。
倪氏说：唇是脾的征候，所以观察唇的好恶，可以知道脾脏的吉凶。
面色黑且纹理细密的，肾小；纹理粗疏的，肾大；耳朵高的，肾高；耳后凹陷的，肾下；耳朵坚实的，肾坚实；耳朵薄且不坚实的，肾脆弱；耳朵好且向前位于牙车处的，肾端正；耳朵偏高的，肾偏倾。以上这些变化，若能持守则安，若减弱则病。
倪氏说：耳是肾的征候，所以观察耳的好恶，可以知道肾脏的高低偏正。以上这些变化，神志若能持守则安，若减弱则不免于病。
黄帝说：好。但这不是我之前问的。我希望听说那些不可能生病的人，直到享尽天年，虽然有深深的忧愁、大大的恐惧惊惕的心志，仍然不能减损他的健康；极寒极热，不能伤害他。而那些不离开遮蔽室内，又没有惊恐忧虑，但仍然不免于生病的人，为什么呢？我希望听您讲讲缘故。
岐伯说：五脏六腑，是邪气寄居的地方。请让我说明缘故。五脏都小的，很少生病，但苦于心焦、大愁忧；五脏都大的，对事情迟缓，难以用忧愁使其困扰；五脏都高的，喜好高举措；五脏都低的，喜好出人之下；五脏都坚实的，没有病；五脏都脆弱的，不离于病；五脏都端正的，和利得人心；五脏都偏倾的，有邪心且善于盗窃，不可以为人公平，言语反复无常。
倪冲之说：这是总结五脏形体不同，而情志也有区别。五脏，是用来储藏精神、血气、魂魄、志意的。所以小则血气收藏而少病，小则神志畏怯，所以苦于心焦、大忧愁。五脏都大的，神志充足，所以对事情迟缓，难以用忧愁使其困扰。五脏都高的，喜好高举措；五脏都低的，喜好出人之下。这都是因形体不同而情志随之变化。和于中则着于外，所以得人心。善盗者，是贪取的小人，言语反复，不可以做平正之人。
黄帝说：希望听说六腑的对应关系。岐伯回答说：肺合大肠，大肠应于皮；心合小肠，小肠应于脉；肝合胆，胆应于筋；脾合胃，胃应于肉；肾合三焦膀胱，三焦膀胱应于腠理毫毛。
倪氏说：五脏为阴，六腑为阳，脏腑雌雄相合，五脏内合六腑，六腑外应于形身，阴内而阳外。所以观察其外合的皮、脉、肉、筋、骨，就可以知道六腑的浓薄、长短。肾将两脏，一合三焦，一合膀胱。
黄帝说：对应的情况是怎样的？岐伯说：肺应于皮，皮厚的，大肠厚；皮薄的，大肠薄；皮松弛、腹里宽大的，大肠大而长；皮紧张的，大肠急而短；皮光滑的，大肠直；皮肉不相离的，大肠结。
倪氏说：五脏内合六腑，外应于皮脉肉筋骨，所以肺应于皮，皮厚的则大肠厚，皮薄的则大肠薄。脏腑的形气，内外交相输应。
心应于脉，皮厚的脉厚，脉厚的小肠厚；皮薄的脉薄，脉薄的小肠薄；皮松弛的脉缓，脉缓的小肠大而长；皮薄而脉波小的，小肠小而短；诸阳经脉皆多纡屈的，小肠结。
《邪气脏腑病形篇》说：脉急的，尺部的皮肤也急；脉缓的，尺部的皮肤也缓。这是皮脉相应的道理。所以皮厚的脉厚，脉厚的小肠厚；皮薄的脉薄，脉薄的小肠薄。
脾应于肉，肌肉坚实丰大的，胃厚；肌肉细小的，胃薄；肌肉细小且软的，胃不坚实；肌肉与身体不相称的，胃下。胃下则下脘约束不利；肌肉不坚实的，胃缓；肌肉没有小结节的，胃急；肌肉多有小结节的，胃结。胃结则上脘约束不利。（“称”音窘，去声）
倪氏说：“䐃”、“肥脂”也。“么”亦小也。“约”即约束。胃有上脘、中脘、下脘，所以胃下则下脘约束不利，结则上脘约束不利。
肝应于爪，爪厚色黄的，胆厚；爪薄色红的，胆薄；爪坚硬色青的，胆急；爪濡软色赤的，胆缓；爪直色白无约束的，胆直；爪恶劣色黑多纹的，胆结。
朱氏说：爪是筋之余，所以肝应于爪。观察爪的好恶，可以知道胆的浓薄缓急。五脏六腑，皆取决于胆。所以具备五脏五行之气的颜色。莫子瑜说：胆属甲子，主天干地支之首，所以备五行之色。
肾应于骨，纹理细密、皮厚的，三焦膀胱厚；纹理粗疏、皮薄的，三焦膀胱薄；腠理疏松的，三焦膀胱缓；皮紧张而没有毫毛的，三焦膀胱急；毫毛美而粗的，三焦膀胱直；毫毛稀少的，三焦膀胱结。
倪氏说：太阳之气主皮毛，三焦之气通腠理，所以观察皮肤腠理的浓薄，则内应于三焦膀胱。又津液随三焦之气以温肌肉，充皮肤。三焦是少阳之气。本经说：“熏肤充身泽毛是谓气”，所以皮毛皆应于三焦膀胱。朱永年说：经文说“谷属骨”，是肌肉属于骨。又说“脾生肉，肉生肺，肺生皮毛”，是骨肉皮毛交相资生的。所以说肾应于骨，纹理细密、皮厚的，三焦膀胱厚。
黄帝说：浓薄美恶都有外形表现，希望听说它们所导致的疾病。岐伯回答说：观察其外在反应，就可以知道内脏的情况，从而知道所患的疾病。
倪氏说：六腑内合五脏，外应于皮肉筋骨，所以观察其外在反应，就可以知道内脏，从而知道其所患的疾病。大概六腑的浓薄缓急大小导致疾病，与五脏相同。
Huangdi asked Qibo: The blood, qi, and spirit of a person are what nourish life and circulate throughout the constitution. The meridians (Jingmai) are what transport blood and qi to nourish Yin and Yang, moisten sinews and bones, and facilitate joint movement. The Wei Qi (Defensive Qi) is what warms the muscle tissue, fills the skin, thickens the interstices (Couli), and controls the opening and closing of pores. The Zhi Yi (Will and Intention) is what governs the spirit, gathers the Hun and Po, adapts to cold and heat, and harmonizes joy and anger. Therefore, when blood and qi are harmonious, the meridians flow smoothly, Ying Qi (Nutritive Qi) nourishes Yin and Yang, sinews and bones are strong, and joints are clear and unobstructed. When Wei Qi is harmonious, muscle tissue is relaxed and smooth, skin is supple and soft, and interstices are dense. When Will and Intention are harmonious, the spirit is focused and upright, Hun and Po do not scatter, regret and anger do not arise, and the Five Zang Organs are not invaded by pathogenic factors. When cold and heat are moderate, the Six Fu Organs digest food and water, wind-bi does not occur, meridians are unobstructed, and limbs and joints are at peace. This is the state of normal balance in humans.
The Five Zang Organs store spirit, blood, qi, Hun, and Po. The Six Fu Organs transform food and water and transport body fluids. These are endowments received from Heaven at birth; whether one is foolish or wise, virtuous or unworthy, there is no special dependence on others. However, some people enjoy their full natural lifespan without deviant diseases, remaining vigorous for a hundred years; even if they encounter wind, rain, sudden cold, or intense heat, these cannot harm them. Others, though staying indoors away from drafts and free from fear and anxiety, still fall ill. Why is this? I wish to hear the reason.
Qibo replied: Your question is profound! The Five Zang Organs correspond to Heaven and Earth, match Yin and Yang, regulate the Four Seasons, and transform the Five Periods. The Zang Organs naturally vary in size, height, firmness, fragility, uprightness, and deviation; the Fu Organs also vary in size, length, thickness, knotting, straightness, and tension. These twenty-five variations differ from each other, being either good or bad, auspicious or inauspicious. Let me explain the principles.
The previous chapter discussed how external skin and interstices become diseased due to differences in rigidity and thickness. This chapter discusses how internal Zang and Fu Organs become diseased due to differences in size, height, deviation, and thickness. Ying and Wei Qi, blood and qi are generated by the Zang and Fu Organs; vessels, muscles, sinews, and bones are their external manifestations; spirit, Hun, and Po are stored within the Zang Organs; food, water, and body fluids are transformed by the Fu Organs. Thus, when blood, qi, and spirit are harmonious, the Zang Organs are not invaded by pathogens, and the physical form remains secure. Yet, some, due to the physical constitution of their Zang and Fu Organs, enjoy longevity and remain vigorous despite wind, rain, cold, and heat, as pathogens cannot harm them. Others, though staying indoors and free from internal fear, still fall ill. This is because differences in the size and thickness of Zang and Fu Organs lead to variations in health and disease. Generally, the Five Zang and Six Fu Organs are formed based on the Qi of Heaven, Earth, Yin, Yang, Four Seasons, and Five Phases; thus, they should be upright, firm, and substantial to correspond with the righteous Qi of Heaven and Earth.
If the Heart is small, it is stable, and pathogens cannot harm it, but it is easily injured by sorrow. If the Heart is large, sorrow cannot harm it, but it is easily injured by pathogens. If the Heart is high, it presses against the Lungs, causing forgetfulness and difficulty in verbal expression. If the Heart is low, the organ is exposed externally and easily injured by cold, leading to fear triggered by speech. If the Heart is firm, the organ is stable and secure. If the Heart is fragile, it is prone to Xiao Shan (wasting-thirst) and Re Zhong (internal heat). If the Heart is upright, its functions are smooth and difficult to injure. If the Heart is deviated, behavior is inconsistent, lacking a governing principle.
A small Heart stores Shen Qi (Spirit Qi), so pathogens cannot harm it. Because it is cautious, it is easily injured by sorrow. A large Heart has vigorous Shen Qi, so sorrow cannot harm it. Because it is large, Shen Qi dissipates outward, making it easily injured by pathogens. The Lung covers the Heart; thus, a high Heart fills the Lung area. In the Heart, it governs speech; in the Lung, it governs sound. Fullness blocks the orifices of the Heart and Lung, causing chest stuffiness and forgetfulness, making verbal communication difficult. The Classic states: "The Heart distributes to the exterior." Thus, a low Heart exposes the organ, making it easily injured by cold. A humble Heart is easily frightened by speech. A firm Heart ensures stability. A fragile Heart leads to Xiao Shan and internal heat. According to the *Chapter on Pathogenic Factors and Zang-Fu Diseases*, minute and small pulses in the Zang Organs indicate Xiao Shan. Since the Zang Organs store essence, fragility leads to scanty body fluids, resulting in Xiao Shan. An upright Heart ensures smooth spirit and resistance to disease. A deviated Heart lacks consistency and governance.
A small Lung drinks little and does not suffer from asthma or panting. A large Lung drinks much and is prone to Xiong Bi (chest bi), Hou Bi (throat bi), and rebellious Qi. A high Lung causes upper Qi rebellion, shoulder breathing, and cough. A low Lung sits below the Bei Men (cardia), pressing on the Lung, causing pain under the ribs. A firm Lung does not suffer from cough or rebellious Qi. A fragile Lung suffers from Xiao Shan and is easily injured. An upright Lung ensures smooth function and resistance to injury. A deviated Lung causes unilateral chest pain. ("Bei" sounds like Ben.)
The Lung regulates water passages; thus, a small Lung drinks little, and a large Lung drinks much. Located in the chest, opening to the throat and governing respiration, a small Lung avoids asthma, while a large Lung is prone to chest and throat bi. Governing Qi, a high Lung causes Qi rebellion, shoulder breathing, and cough. "Bei" refers to the cardia of the stomach, located at the upper opening. A low Lung sits between the cardia and stomach, where gastric pressure obstructs blood vessels, causing rib pain. The area under the ribs is where the Lung meridian emerges, at Yunmen and Zhongfu points. A firm Lung prevents Qi rebellion and cough; a fragile Lung suffers from Xiao Shan and is easily injured. The Lung stores Qi, and Qi houses the Po. An upright Lung ensures smooth spirit and resistance to pathogens; a deviated Lung causes unilateral chest pain.
A small Liver ensures organ stability and absence of rib pain. A large Liver compresses the Stomach and pharynx, causing discomfort in the diaphragm and rib pain. A high Liver pushes up against the cardia, causing rib distension resembling Xi Ben disease. A low Liver compresses the Stomach, leaving the rib area empty and susceptible to pathogens. A firm Liver ensures stability and resistance to injury. A fragile Liver is prone to Xiao Shan and easy injury. An upright Liver ensures smooth function and resistance to injury. A deviated Liver causes rib pain.
Located under the ribs, a small Liver ensures stability. Located to the left of the Stomach, a large Liver compresses the Stomach and pharynx. Below the diaphragm, a large Liver causes diaphragmatic discomfort and rib pain. The Liver meridian passes through the diaphragm to the Lung; thus, a high Liver pushes against the cardia. Located beside the Stomach, a low Liver compresses it, leaving the rib area empty and vulnerable. The rib area is the pivot for pathogenic and righteous Qi. A firm Liver is stable; a fragile Liver suffers from Xiao Shan. The Liver stores Blood, and Blood houses the Hun. Uprightness ensures smooth spirit; deviation causes pain.
A small Spleen ensures stability and resistance to pathogens. A large Spleen causes gathering pain and inability to walk quickly. A high Spleen pulls on the hypochondrium, causing pain. A low Spleen adds weight to the Large Intestine, making the organ susceptible to pathogens. A firm Spleen ensures stability. A fragile Spleen is prone to Xiao Shan. An upright Spleen ensures smooth function. A deviated Spleen causes fullness and distension. ("Miao" sounds like Miao/Shaft.)
As the Central Earth governing the four directions, a small Spleen is stable. Located in the abdomen at the tip of the ribs, a large Spleen causes gathering pain. Governing the four limbs, it affects walking speed. Above the ribs, a high Spleen pulls the hypochondrium. Below, it affects the Large Intestine, weakening the organ's position. A firm Spleen is stable; a fragile one suffers from Xiao Shan. The Spleen stores Yi (Intellect), which houses Ying. Uprightness ensures smooth spirit; deviation causes distension.
A small Kidney ensures stability. A large Kidney is prone to lower back pain, limiting flexion and extension, and susceptibility to pathogens. A high Kidney causes back and spine pain. A low Kidney causes lumbosacral pain and Hu Dan (fox hernia). A firm Kidney prevents back pain. A fragile Kidney suffers from Xiao Shan. An upright Kidney ensures smooth function. A deviated Kidney causes lumbosacral pain. These twenty-five variations are common chronic ailments. ("Kao" sounds like Qiao, referring to the coccyx.)
Since "Zang" means storage, a small Kidney is stable. The waist is the mansion of the Kidney. The waist and spine are major joints; thus, pain limits movement. The Kidney attaches to the spine, causing various pains. Hu Dan involves asymmetrical testicles moving up and down, resembling a fox hiding and emerging unpredictably, indicating a Kidney hernia. A firm Kidney prevents pain; a fragile one suffers from Xiao Shan. The Kidney stores Jing (Essence), and Jing houses Zhi (Will). Uprightness ensures smooth spirit; deviation causes pain. The physical form is the external manifestation of the Zang Organs. Thin skin and loose interstices allow wind, cold, heat, and summer-heat pathogens to enter via hair follicles into the interstices, damaging the form. Internal fragility and deviation lead to common chronic diseases, specifically the twenty-five variations.
Huangdi asked: How do we know this? Qibo replied: Red complexion with fine texture indicates a small Heart; coarse texture indicates a large Heart. Absence of the xiphoid process indicates a high Heart; short and raised xiphoid indicates a low Heart; long and straight xiphoid indicates a firm lower Heart; weak and thin xiphoid indicates a fragile Heart; straight and non-raised xiphoid indicates an upright Heart; deviated xiphoid indicates a deviated Heart. ("Xian" sounds like Jie; "Jian" sounds like Gan.)
Fine texture means dense muscle fibers; coarse texture means sparse fibers. Muscle mass is generated by the Zang Organs. Observing muscle texture reveals organ size. The xiphoid process is the breastbone. The Classic states: "Gao people have hanging bellies; Rou people have large upper and lower bodies." Muscle is nourished by essence from the Mu Yuan (origin) of the Zang Organs. Disease manifests as sunken muscle mass.
White complexion with fine texture indicates a small Lung; coarse texture indicates a large Lung. Large shoulders, reversed chest, and depressed throat indicate a high Lung. Closed armpits and spread ribs indicate a low Lung. Thick shoulders and back indicate a firm Lung; thin shoulders and back indicate a fragile Lung. Thick back and chest indicate an upright Lung; deviated and sparse ribs indicate a deviated Lung.
Located in the chest and above the ribs, observing the shoulders and back reveals Lung position and quality. Ni Chongzhi said: The Lung belongs to Heaven, covering upwards like a canopy. The back is Yang, the upper part of the body, so Lung Shu points emerge from the back. Zhu Yongnian cited the *Classic of Pulse Essentials*: "The sides of the Chi position correspond to the hypochondrium... Pushing outwards... inward without outward suggests abdominal masses; pushing inwards... outward without inward suggests fever." The upper and lower body reflect the location of the Zang and Fu Organs.
Blue complexion with fine texture indicates a small Liver; coarse texture indicates a large Liver. Broad chest and reversed xiphoid indicate a high Liver. Closed ribs and hidden rabbit bone indicate a low Liver. Good chest and ribs indicate a firm Liver; weak ribs indicate a fragile Liver. Harmonious chest and abdomen indicate an upright Liver; deviated ribs indicate a deviated Liver. ("Jiao" sounds like Jiao.)
The Jiao Gu (crossing bone) connects the sternum, ribs, and spine. The Liver is below the diaphragm; thus, broad chest and reversed xiphoid indicate a high Liver. Closed ribs and hidden bone indicate a low Liver. The Liver meridian runs through Zhangmen and Qimen; harmony indicates an upright Liver.
Yellow complexion with fine texture indicates a small Spleen; coarse texture indicates a large Liver. Raised lips indicate a high Spleen; drooping lips indicate a low Spleen. Firm lips indicate a firm Spleen; large but soft lips indicate a fragile Spleen. Harmonious lips indicate an upright Spleen; deviated lips indicate a deviated Spleen.
Ni said: Lips are the manifestation of the Spleen; observing them reveals Spleen health.
Black complexion with fine texture indicates a small Kidney; coarse texture indicates a large Kidney. High ears indicate a high Kidney; depressed ear lobes indicate a low Kidney. Firm ears indicate a firm Kidney; thin and soft ears indicate a fragile Kidney. Ears forward aligned with the jaw indicate an upright Kidney; high ears indicate a deviated Kidney. Maintaining these traits ensures health; diminishing them leads to disease.
Ni said: Ears are the manifestation of the Kidney; observing them reveals Kidney position. Maintaining spirit ensures health.
Huangdi said: Excellent, but this is not my original question. I wish to know about those who cannot be sick, enjoying full lifespan despite deep sorrow or fear, and resisting extreme cold and heat. Conversely, why do those staying indoors without fear still fall ill?
Qibo replied: The Zang and Fu Organs are the abodes of pathogens. Small Zang Organs rarely get sick but suffer from heart anxiety and sorrow. Large Zang Organs are slow to act and hard to worry. High Zang Organs aspire to heights. Low Zang Organs submit to others. Firm Zang Organs are disease-free. Fragile Zang Organs are perpetually ill. Upright Zang Organs gain popularity. Deviated Zang Organs harbor evil thoughts, steal, and speak inconsistently.
Ni said: This summarizes how physical form influences emotion. Small organs store Qi and resist disease but cause timidity and sorrow. Large organs have abundant spirit, causing slowness. High and low positions influence ambition. Harmony attracts people; theft and inconsistency stem from deviation.
Huangdi asked about the Six Fu Organs. Qibo replied: The Lung combines with the Large Intestine, corresponding to the skin. The Heart combines with the Small Intestine, corresponding to the vessels. The Liver combines with the Gallbladder, corresponding to the sinews. The Spleen combines with the Stomach, corresponding to the flesh. The Kidney combines with the Sanjiao and Bladder, corresponding to the interstices and hair.
Ni said: Zang are Yin, Fu are Yang. They pair internally and externally. Observing skin, vessels, flesh, sinews, and bones reveals Fu organ qualities. The Kidney pairs with two organs: Sanjiao and Bladder.
Huangdi asked how they correspond. Qibo replied: Lung corresponds to skin. Thick skin means thick Large Intestine; thin skin means thin Large Intestine. Loose skin with wide abdomen means large and long Large Intestine. Tight skin means tight and short Large Intestine. Smooth skin means straight Large Intestine. Skin adhering to flesh means knotted Large Intestine.
Ni said: Internal Zang and external Fu correspond. Thick skin correlates with thick Large Intestine.
Heart corresponds to vessels. Thick skin means thick vessels, meaning thick Small Intestine. Thin skin means thin vessels, meaning thin Small Intestine. Loose skin means loose vessels, meaning large and long Small Intestine. Thin skin with small pulses means small and short Small Intestine. Twisted Yang meridians mean knotted Small Intestine.
The *Chapter on Pathogenic Factors* states that pulse urgency matches skin urgency.
Spleen corresponds to flesh. Firm and large flesh means thick Stomach; small flesh means thin Stomach. Small and soft flesh means unstable Stomach. Flesh disproportionate to body means low Stomach, causing lower Orifice dysfunction. Soft flesh means lax Stomach. Flesh without nodules means urgent Stomach. Flesh with many nodules means knotted Stomach, causing upper Orifice dysfunction.
Ni said: "Pan" refers to fat. "Me" means small. "Yue" means constraint. Low Stomach affects the lower Orifice; knotted Stomach affects the upper Orifice.
Liver corresponds to nails. Thick yellow nails mean thick Gallbladder. Thin red nails mean thin Gallbladder. Hard green nails mean urgent Gallbladder. Soft red nails mean lax Gallbladder. Straight white nails without constraint mean straight Gallbladder. Bad black nails with many lines mean knotted Gallbladder.
Zhu said: Nails are the surplus of sinews; observing them reveals Gallbladder quality. All Zang and Fu depend on the Gallbladder. Mo Ziyu said: Gallbladder belongs to Jia Zi, leading the Heavenly Stems and Earthly Branches, embodying all Five Phase colors.
Kidney corresponds to bones. Dense skin and thick texture mean thick Sanjiao and Bladder. Coarse skin and thin texture mean thin Sanjiao and Bladder. Loose interstices mean lax Sanjiao and Bladder. Tight skin without hair means urgent Sanjiao and Bladder. Beautiful coarse hair means straight Sanjiao and Bladder. Sparse hair means knotted Sanjiao and Bladder.
Ni said: Tai Yang Qi governs skin and hair; Sanjiao Qi connects interstices. Observing skin reveals Sanjiao and Bladder quality. Body fluids warm muscles via Sanjiao Qi. The Classic states: "Warming skin, filling body, moistening hair is called Qi." Thus, skin and hair correspond to Sanjiao and Bladder. Zhu Yongnian cited: "Grain belongs to bone," showing muscle-bone connection, and "Spleen generates flesh, flesh generates Lung, Lung generates skin/hair," showing mutual generation. Hence, Kidney corresponds to bones; dense skin/thick texture means thick Sanjiao and Bladder.
Huangdi asked about diseases arising from these forms. Qibo replied: Observe external signs to know internal conditions and diseases.
Ni said: External signs reveal internal Zang and Fu states, indicating disease, similar to Zang organ variations.