火风伤筋。故筋痹。部在胁肋。故胁满。不足是肝脏本虚。故成肝痹。肝痹者。肝气郁而血不荣筋之症也。脉滑为风热
合邪。故病肝风疝。淫气聚筋而寒热往来。抽掣相引者是也。涩则血滞故病积。肝主筋而开窍于目。故筋急目痛。
以上六气犯阴犯阳之痹症也。人身阴阳。外应六气。则六气有时而内淫。亦因脏腑阴阳之有余不足。而外邪得以留
之。此于运气之外。又有所留为阴阳之痹也。脉滑为邪气有余。故留滞为风疝。风谓其动。疝谓其聚也。涩为本气不足。
故不能胜邪而为积。疝与积。概指其聚。而积者非特前阴少腹之病也。
疟 疟疾皆生于风。得之夏。伤于暑。暑气舍于营。令人汗孔疏。腠理开。因得秋气汗出遇风。及得之以浴凄沧水。
寒舍于皮肤之内。与卫气并居。卫气者。昼行阳。夜行阴。此气得阳而外出。得阴而内入。是以日作。作则阴阳上下交
争。虚实相倾。故阳并于阴则阴实而阳虚。阳明虚则寒栗鼓颔。巨阳虚则腰背头项痛。三阳俱虚则阴气胜。阴胜则骨寒
而痛。此寒生于内故中外皆寒。阴气逆极。则后出之阳。并于阳则阳胜。阳盛则外热。阴虚则内热。外内皆热。则喘而
渴。故欲冷冻饮料也。有间日而作者。气之舍深。内薄于阴。阳气独发。阴邪内着。阴与阳争不得出。是以间日。其日晏日
早者。邪客于风府。循膂而下。其卫气一日一夜大会于风府。其明日邪则日下一节故作晏。二十五日下至 骨。二十六
日入于脊。内注于伏膂之下。其气复上行。九日出缺盆之中。其气日高。故作日早也。其间日作者。邪气内薄。五脏横
连募原。道远气深。故其行迟而不得与卫皆出。唯卫气之所在。与邪气相合则病作。故不论日与间日。唯疟气随经络以
内薄。必俟卫气应乃作。是以早晏随之也。其先寒后热者。遇夏气凄怆之水寒。寒者阴气也。秋伤于风。风者阳气也。
先伤于寒而后伤于风。故先寒后热。名曰寒疟。其先热后寒者。先伤于风而后伤于寒。故先热后寒。名曰温疟。有但热
不寒者。阴气先绝。阳气独发。则少气烦冤。手足热而欲呕。名曰瘅疟。其病之发。如火热如风雨不可当也。故经言毋
刺 之热。毋刺浑浑之脉。毋刺漉漉之汗。以其病逆不可治也。唯当其未发阴阳未并。因而调之。真气得安。邪气乃
已。然疟亦有不必应暑者。其病异形反四时也。以秋病者寒甚。以冬病者寒不甚。以春病者恶风。以夏病者多汗。以四
时之气。寒热各有相反。皆能为疟也。
温疟者。得之冬。中于风寒。气藏骨髓之中。至春而阳气大发。邪气不能自出。因遇大暑。腠理发泄。兼有用力。
邪乃与汗皆出。斯时阴虚阳盛。阳盛则热矣。衰则气复反。人入则阳虚。阳虚则寒矣。故温疟先热后寒也。
瘅疟者。肺素有热。气盛于身。厥逆上冲。因有所用力。腠理开。风寒入舍之。阳气盛而不衰。其气不及于阴。故
但热不寒。气内藏于心而外合分肉之间。令人销铄肌肉。故为瘅疟也。
疟之所发。六经皆有见症。足太阳之疟。腰痛头重。寒从背起。先寒后热。 焰然。热止汗出难已。邪在三阳。
盛于表。汗不易收。故曰难也。
足少阳之疟。身体解 。寒不甚。热不甚。恶见人。见人心惕惕然。热多汗出甚。解 。谓倦甚。不耐烦劳。不甚
寒热者。病在半表里也。惕惕邪在胆而怯也。少阳主木火。故并多于寒。且汗出甚。
足阳明之疟。先寒洒淅。寒甚久乃热。热去汗出。喜见日月光火气乃快然。阳明热盛之腑。而寒反胜之。故先寒久乃热。
热去则邪衰。故汗出。喜见日月火者。阳明而受阴邪。故喜暖也。
足太阴之疟。不乐好太息。不嗜食。多寒热汗出。病至则善呕。呕已乃衰。脾喜乐。病则否。上焦痞塞。故好太息
而不嗜食。太阴主里。邪不易解。故多寒热而汗出。脾病及胃。故病至善呕。呕已乃衰。
足少阴之疟。呕吐甚。多寒热。热多寒少。欲闭户牖而处。其病难已。少阴主里。病则阴邪上冲。故呕吐甚。肾病
见阴虚。阴虚则热多寒少。在阴则欲闭户牖而处。肾为至阴之脏。而邪居之。故病难已。
足厥阴之疟。腹痛。少腹满。小便不利如癃状。意恐惧。气不足。腹中悒悒。厥阴环阴器。抵少腹。布胁肋。故为
腰腹小便之病。凡小水不利。为癃如癃状者。病不在水而在邪气之陷。急欲数便也。肝气不足则恐惧。悒悒者。不畅之
貌。
疟邪之深。亦能为五脏疟。肺疟者令人心寒。寒甚热。热间善惊。如有所见。肺为心之盖。邪寒乘所不胜。故令人
心寒。寒甚复热。心气受伤。故善惊而有所见。
心疟者。烦心甚。欲得清水。反寒多不甚热。疟邪在心。故烦心欲得水以解也。心本阳脏。为邪所居。则阳虚阴盛。
故反寒多不甚热。
肝疟者。色苍苍然。善太息。其状若死。苍肝色也。肝郁则气逆。故太息。木病则强。故状若死。
脾疟者。令人寒。腹中痛。热则肠中鸣鸣也。汗出。脾至阴。而疟邪居之。故令人寒而腹痛。寒已而热。则脾气行。
故腹中鸣鸣也。热则阳气外达。故汗出而解也。
肾疟者。洒洒然。腰脊痛。宛转大便难。目 然。手足寒。洒洒。寒栗貌。肾脉背脊开窍于二阴。故腰脊痛而大
便难也。眩眩。视不明貌。水亏也。手足寒。阴之厥也。
胃疟者。善饥而不能食。食而支满腹大。胃为六腑之长。故独言之邪。在阳明则胃痛及脾。故善饥而不能食。支满
腹大也。
凡治疟先发如食顷。过之则失时也。
痿 痿为五脏皆有之症。热伤血脉。则皆能发为皮毛血脉肌肉骨髓之痿。然其证必以肺为主。肺为一身元气之主。
而职行治节。苟金清而气行。则一身之皮血筋肉骨皆得其宜。何痿之有。唯邪热乘金。肺先受克。则肺热叶焦。征之于
外则为皮毛虚弱急痹而着。是则热邪伤肺。必及于筋脉肉骨而痛生痿 也。而其所以得之者。以肺为脏之长。为心之盖。
凡一应烦劳房室伤精。必至伤气。伤气则唯肺受之。且心火上乘。肺气虚而受乘于火。则金病而发为喘鸣。金失整肃。
火留不去。故肺热叶焦。五脏因肺热自病。而气不得行。故发为痿 也。然痿以肺为主。而经论治痿独取阳明者何也。
盖阳明为肺之母。而为五脏六腑之海。主润宗筋。宗筋主束骨而利机关。又冲脉为十二经之海。主渗灌溪谷。与阳明合
于宗筋。而阳明为之长。皆属于带脉而络于督脉。唯其阳明虚。则宗筋弛。故致足痿不用。是以欲除肺热。必先除阳明
之热。而养其阴。调其虚实。和其逆从。则病自已矣。
五脏痿症。自肺热叶焦皮薄着而下。有脉痿肉痿筋痿骨痿之不一。脉痿者。心气热则脉下厥而上。枢折挈胫纵不任
地。又得之悲哀太甚。阳气内动。则心下崩。数血溲。肉痿者。胃干而渴。肌肉不仁。又渐于湿而有所留。亦痹而不仁。
筋痿者。筋膜干。筋急而挛。又入房太甚。宗筋弛纵。亦发筋痿。及为白淫。骨痿者。肾气热骨枯而髓减。腰脊不举。
及远行劳倦。阳气内伐。则足不任身。此五痿者。必外征之于色。肺热色白而毛败。心热色赤而络脉溢。肝热色苍而爪
枯。脾热色黄而肉蠕动。肾热色黑而齿槁。
咳 咳之一症。内经以皮毛为肺之合。皮毛受邪。入而从其合。又内则寒饮食。入胃从肺。上至于肺则肺寒。肺
寒则内外合邪。因而客之则为咳。然肺为五脏之华盖。五脏各以时受病。虽非肺之所受。而皆能各传以与之。故五脏时
盛于寒。邪气虽微。必传于肺而为咳。咳之则六腑所受之。是以五脏六腑皆有咳。而肺咳乃兼有五脏六腑之证也。
肺咳者。咳而喘息有音。甚则吐血。肺主气而司呼吸。故病则喘息有音。吐血者。随咳而出。其病在肺。呕与血不同。
心咳者。咳则心痛。喉仲介介然如梗状。甚则嗌肿喉痹。本经既病。上挟于咽。故喉中妨碍而梗介。甚则为肿痹也。
肝咳者。咳则两胁下痛。甚则不可以转。转则两 下满。咳在肺而肝部本经之病仍见。故名肝咳。肝脉布胁肋。故胁下
痛不可转。转则气逆而 下满也。
脾咳者。咳则右胁下痛。阴阴引肩背。甚则不可以动。动则咳剧。痛引肩背者。脉从胃别上鬲也。阴土之气应坤而
出于西南。故右胁下痛也。动则咳剧者。脾喜静而不欲动也。
肾咳者。咳则腰背相引而痛。甚则咳涎。腰背相引。肾脉贯脊也。肾主涎而脉循喉咙。故甚则咳涎。
五脏之咳。更能移于六腑。脾咳不已。则胃受之。咳而呕。呕甚则长虫出胃受脾邪而不能客。必气逆作呕。长虫。
也。呕甚则虫随气上也。肝咳不已。则胆受之。咳呕若汁。肺咳不已。则大肠受之。咳而遗矢。心咳不已。则小肠受之。
咳而失气。与咳俱失。肾咳不已。则膀胱受之。咳而遗溺。久咳不已。则三焦受之。咳而腹满不欲饮食。咳而不已。则
上中下三焦俱病。出纳升降。皆失其宜。故腹满不能饮食。此皆聚于胃。关于肺。使人多涕唾而面浮肿气逆也。聚胃关
肺者。胃为五脏六腑之本。肺为皮毛之合。自外自内。皆不能去此二脏也。阳明脉起于鼻。会于面。肺亦开窍于鼻而主
气。故使人多涕吐。而面浮肿。又气逆也。然内经之咳。皆谓风寒伤皮毛。寒饮食伤胃。传肺使肺寒而内外合邪。又五
脏非时受邪。亦能传以与之诸条。皆以外邪伤肺。传肺而咳。则凡五脏内伤。非待之热而火上炎。亦必传于肺无疑矣。
又肾水与肺金为子母。则病每相关为本末。于是有寒热水火两症。如肾火虚。水泛则侮肺溢肺。而为寒痰上壅之咳。肾
水虚。火沸则挟肝刑金。而为肺痿喉 之咳。他若龙火起肝挟心火上逆而咳。脾气不运上焦不通而咳。胃受饮食之火上
通于咽而咳。以火移肺而咳。此又五脏非时之热。能移于肺之咳。其发亦兼五脏之见症。与风邪不殊。不可不察也。治
之之法。自表入者。宜辛温发散。自内传者。其阴已伤。阴虚于下。则阳浮于上。水涸金枯。治宜甘以养阴。润以养肺。
而兼治根本之真阴。则肺自宁矣。然形气病气俱虚者。又当培补其中气。而命门阳虚不能纳气者。则亦当温气以化水。
不然无济也。
火邪与风邪损伤筋脉，因此形成筋痹。病位位于胁肋部，所以出现胁肋胀满的症状。这并非肝脏本体的虚损，而是形成了肝痹。所谓肝痹，是指肝气郁结且血液不能濡养筋脉的病证。脉象滑利表示风热合邪为患，因此疾病表现为肝风疝气，即寒热往来、抽搐牵引的症状。脉象涩滞表示血行瘀滞，因此形成积聚。肝主管筋脉并开窍于目，所以筋脉拘急且眼睛疼痛。以上所述是六淫之气侵犯人体阴阳所致的痹症。人体的阴阳在外对应六淫之气，因此六淫之气有时会在体内侵袭；这也取决于脏腑阴阳的有余或不足，使得外邪得以停留。这在运气学说之外，又有所谓因阴阳失调而形成的痹症。脉滑表示邪气有余，因此邪气留滞形成风疝。“风”指其动，“疝”指其聚。脉涩表示正气不足，因此不能抵御邪气而形成积聚。疝与积聚，概指邪气的聚集，而积聚不仅仅指前阴和少腹部的疾病。
疟疾皆由风邪引起，夏季感受暑邪。暑气潜伏在营分，使人汗孔疏松、腠理开泄，因此在秋季出汗时遇到风邪，或者洗冷水澡受寒，寒气便潜伏在皮肤之内，与卫气共同居住。卫气白天运行于阳分，夜晚运行于阴分。此邪气随卫气出于阳分则外出，进入阴分则内入，因此每日发作。发作时，阴阳上下交争，虚实相互倾移，所以阳气并入阴分则阴实而阳虚。阳明经虚则出现寒战鼓颔（下巴颤抖）；太阳经虚则出现腰背头项疼痛；三阳经俱虚则阴气胜，阴气胜则骨骼寒冷而痛。这是因为寒气生于内部，所以内外皆寒。当阴气逆乱至极，随后出来的阳气并入阳分则阳气胜。阳气盛则体表发热，阴气虚则体内发热。内外皆热，则气喘且口渴，因此想要喝冷冻饮料。
有隔日发作的，是因为邪气潜伏较深，内迫于阴分，阳气单独发越，阴邪内着，阴与阳相争不得出，因此隔日发作。发作时间早晚不一，是因为邪气客居在风府穴，沿着脊骨向下移动。卫气一日一夜在风府穴大会一次。第二天邪气就下行一节，所以发作时间推迟。二十五天后下行至骶骨，二十六天进入脊柱内部，注入伏膂之下。然后邪气重新上行，第九天出现在缺盆之中。邪气位置日益升高，所以发作时间提前。至于隔日发作的，是因为邪气内迫，横连五脏及募原，道路遥远且邪气深重，所以运行迟缓而不能与卫气同时外出。只有当卫气到达邪气所在之处，与邪气相合时才发病。因此不论是一日一发还是隔日一发，都是疟气随着经络向内逼迫，必须等待卫气相应时才发作，所以发作时间的早晚随之变化。
先寒后热的，是因为遇到了夏季凄冷的水寒之气。寒属于阴气，秋季伤于风邪，风属于阳气。先伤于寒而后伤于风，所以先寒后热，名为寒疟。先热后寒的，是先伤于风而后伤于寒，所以先热后寒，名为温疟。有只发热不恶寒的，是因为阴气先绝，阳气独发，导致少气烦闷冤屈，手足发热且想呕吐，名为瘅疟。这种病发作时，如火热如风雨般猛烈，不可抵挡。所以经文说不要针刺高热之时，不要针刺混乱的脉象，不要针刺淋漓大汗之时，因为此时病势逆乱，难以治疗。只有在未发作、阴阳尚未合并时进行调理，使真气安定，邪气才能消除。然而疟疾也有不一定应合暑气的，其病情形态反而违背四季规律。在秋季发病的，寒气很重；在冬季发病的，寒气不重；在春季发病的，怕风；在夏季发病的，多汗。以四时的气候来看，寒热各有相反的情况，都能导致疟疾。
温疟，是在冬季感受风寒，邪气藏匿于骨髓之中，到了春天阳气大发，邪气不能自行排出，恰逢大暑天气，腠理开泄，加上用力劳作，邪气便随着汗液一起排出。此时阴虚阳盛，阳盛则发热；衰落后气机回复，人入于阴分则阳虚，阳虚则发冷。所以温疟是先热后寒。
瘅疟，是因为肺素来有热，气盛于身体，厥逆之气上冲，又因用力劳作，腠理开泄，风寒侵入潜伏。阳气盛而不衰，其气不及于阴分，所以只发热不恶寒。气内藏于心，外合于分肉之间，使人肌肉消瘦，所以称为瘅疟。
疟疾的发作，六经都有相应的症状表现。足太阳经疟疾，腰痛头重，寒气从背部升起，先寒后热，火焰般炽热，热退后汗出难止。邪气在三阳经，盛于体表，汗不易收敛，所以说“难”。
足少阳经疟疾，身体懈怠松弛，寒不甚，热不甚，害怕见人，见到人就心中惊恐不安，热多汗出很多。“解㑊”指疲倦得很，不耐烦劳。“不甚寒热”指病在半表半里。“惕惕”指邪在胆而胆怯。少阳主木火，所以往往多于寒象，且汗出很多。
足阳明经疟疾，先寒战洒淅，寒甚持续很久才发热，热退后汗出，喜欢见到日光月光或火气才觉得舒服。阳明是热盛的腑，但寒反胜之，所以先寒久后才热。热退则邪气衰退，所以汗出。喜欢见日月火光，是因为阳明经受阴邪侵袭，所以喜暖。
足太阴经疟疾，心情不乐，喜欢长叹气，不想吃东西，多寒热汗出。病发时容易呕吐，吐完病情才减轻。脾喜乐，生病时就不快乐。上焦痞塞，所以喜欢长叹气而不想进食。太阴主里，邪气不易解除，所以多寒热汗出。脾病波及胃，所以病发时容易呕吐，吐完才减轻。
足少阴经疟疾，呕吐严重，多寒热，热多寒少，想关上门窗独处。这种病难以治愈。少阴主里，生病则阴邪上冲，所以呕吐严重。肾病见阴虚，阴虚则热多寒少。在阴分则想关门窗独处。肾为至阴之脏，邪气居于其中，所以病难愈。
足厥阴经疟疾，腹痛，少腹胀满，小便不利像癃闭的样子，心里恐惧，气不足，腹部郁闷不畅。厥阴经脉环绕阴器，抵少腹，布胁肋，所以出现腰腹和小便方面的病症。凡是小便不利，像癃闭样子的，病不在水液而在邪气下陷，急切想多次小便。肝气不足则恐惧。“悒悒”是不畅的样子。
疟邪深入，也能造成五脏疟。肺疟使人心中寒冷，寒甚发热，热间歇时容易惊骇，好像看到了什么。肺为心之盖，邪寒乘其所不胜（火克金，此处指寒邪伤肺进而影响心），所以使人心中寒冷。寒甚复热，心气受伤，所以容易惊骇且产生幻觉。
心疟，心烦很厉害，想要喝清水，反而寒多热少。疟邪在心，所以心烦想喝水以缓解。心本是阳脏，被邪气占据，则阳虚阴盛，所以反而寒多热少。
肝疟，面色苍苍，喜欢长叹气，状态像死了一样。苍是肝的颜色。肝郁则气逆，所以长叹气。木病则强直，所以状态像死一样。
脾疟，使人发冷，腹中痛，发热时肠鸣咕咕作响，汗出。脾为至阴，疟邪居于其中，所以使人发冷且腹痛。寒退后发热，脾气运行，所以腹中咕咕作响。发热则阳气外达，所以汗出而解。
肾疟，洒洒然畏寒，腰脊痛，翻身困难，大便难，视物昏花，手足寒冷。“洒洒”是寒战的样子。肾脉贯背脊，开窍于二阴，所以腰脊痛且大便难。“眩眩”是视物不明貌，是水亏所致。手足寒，是阴厥的表现。
胃疟，容易饥饿但不能进食，吃了东西就支撑胀满，腹部膨大。胃为六腑之长，所以单独论述它。邪在阳明，胃痛波及脾，所以容易饥饿但不能进食，出现支撑胀满和腹部膨大。
凡治疗疟疾，要在发作前大约一顿饭的时间进行干预，过了这个时间就失去了时机。
痿证是五脏都有的症状。热邪损伤血脉，都能引发皮毛、血脉、肌肉、骨髓的痿证。然而其证候必定以肺为主。肺是一身元气的主宰，行使治节职能。如果肺气清肃且气机通畅，那么全身的皮、血、筋、肉、骨都能得到适宜，怎么会发生痿证呢？只有邪热乘袭肺金，肺先受克制，导致肺热叶焦，反映在外面就是皮毛虚弱、急痹且附着不去。这是热邪伤肺，必然波及筋脉肉骨而产生疼痛和痿证。而其得病的原因，是因为肺为脏之长，为心之盖，凡是烦劳房室耗伤精血，必会伤气。伤气则唯独肺受累。而且心火上乘，肺气虚而受火邪乘袭，则金病而发为喘鸣。金失整肃，火留不去，所以肺热叶焦。五脏因肺热而自病，气机不得运行，所以发为痿证。然而痿证以肺为主，而经文论述治疗痿证唯独取阳明经，为什么呢？因为阳明是肺之母，也是五脏六腑的海，主要滋润宗筋。宗筋主束骨而利关节。另外冲脉为十二经的海，主要渗灌溪谷，与阳明经会合于宗筋，而阳明经为其统领，都归属于带脉并联络督脉。正因为阳明虚，则宗筋弛缓，所以导致足痿不能使用。因此要想清除肺热，必须先清除阳明之热，并滋养阴液，调节虚实，调和逆从，那么病自然痊愈。
五脏痿证，从肺热叶焦、皮毛薄弱附着开始，向下发展，有脉痿、肉痿、筋痿、骨痿等不同。脉痿，心气热则脉气下厥而上逆，枢折提挈不起，胫部纵缓不能站立。又因悲哀太过，阳气内动，导致心下崩漏，数日尿血。肉痿，胃干而渴，肌肉麻木不仁。又渐受湿邪而留滞，也表现为痹而不仁。筋痿，筋膜干燥，筋脉拘急挛缩。又因房事过度，宗筋弛纵，也发为筋痿，以及白淫。骨痿，肾气热则骨枯髓减，腰脊不能挺举。又因远行劳倦，阳气内伐，则足不能支撑身体。这五种痿证，必定在外征见于面色：肺热色白而毛发败坏；心热色赤而络脉溢露；肝热色苍而指甲枯槁；脾热色黄而肌肉蠕动；肾热色黑而牙齿枯槁。
咳嗽这一症状，《内经》认为皮毛是肺的外合，皮毛受邪，内传而从其合；另外内则因寒凉饮食，入胃后循经上归于肺，上至于肺则肺寒。肺寒则内外合邪，因而客居于肺则为咳。然而肺为五脏之华盖，五脏各依时令受病，虽然病非肺直接所受，但都能各自传变给肺。所以五脏时常盛于寒邪，邪气即使轻微，也必传于肺而为咳。咳不仅涉及肺，六腑所受之邪也能传至肺，因此五脏六腑都有咳，而肺咳乃兼有五脏六腑的症状。
肺咳，咳嗽伴有喘息且有声音，严重时吐血。肺主气而司呼吸，所以生病则喘息有声。吐血是随咳嗽而出，病位在肺。呕与血不同。
心咳，咳嗽时心痛，喉咙中有介介然如梗状异物感，严重时咽喉肿痛喉痹。本经既已生病，向上挟持于咽，所以喉咙妨碍而有梗塞感，严重时则为肿痹。
肝咳，咳嗽时两胁下疼痛，严重时不能转身，转身则两胁下胀满。咳在肺而肝部本经的病仍见，所以名叫肝咳。肝脉布胁肋，所以胁下痛不可转，转身则气逆而胁下胀满。
脾咳，咳嗽时右胁下疼痛，隐隐牵引肩背，严重时不能活动，活动则咳嗽加剧。痛引肩背，是因为经脉从胃别出上膈。阴土之气应坤卦而出于西南，所以右胁下痛。活动则咳嗽加剧，是因为脾喜静而不欲动。
肾咳，咳嗽时腰背互相牵引而痛，严重时咳出涎沫。腰背互相牵引，是因为肾脉贯脊。肾主涎且脉循喉咙，所以严重时咳出涎沫。
五脏的咳，更能移传于六腑。脾咳不已，则胃受之，咳嗽伴呕吐，呕吐严重时蛔虫吐出。胃受脾邪而不能容纳，必气逆作呕。长虫即蛔虫，呕吐严重时虫随气上逆而出。肝咳不已，则胆受之，咳嗽呕吐苦汁。肺咳不已，则大肠受之，咳嗽伴大便失禁。心咳不已，则小肠受之，咳嗽伴放屁，与咳嗽同时失气。肾咳不已，则膀胱受之，咳嗽伴遗尿。久咳不已，则三焦受之，咳嗽伴腹部胀满不想饮食。咳不已，则上中下三焦俱病，出纳升降都失去适宜，所以腹部胀满不能饮食。这些病都聚于胃，关乎肺，使人多涕唾且面部浮肿气逆。聚胃关肺，是因为胃为五脏六腑之本，肺为皮毛之合，自外自内，都不能脱离这两脏。阳明脉起于鼻，会于面，肺也开窍于鼻而主气，所以使人多涕唾且面部浮肿气逆。然而《内经》中的咳，都说风寒伤皮毛，寒饮食伤胃，传肺使肺寒而内外合邪，又五脏非时受邪，也能传变与之。诸条皆以外邪伤肺，传肺而咳，那么凡五脏内伤，如果不是热邪火上炎，也必传于肺无疑。
另外肾水与肺金为子母关系，则病每每相关为本末，于是有寒热水火两种症状。如肾火虚，水泛则侮肺溢肺，而为寒痰上壅之咳。肾水虚，火沸则挟肝刑金，而为肺痿喉痹之咳。其他若龙火起于肝挟心火上逆而咳，脾气不运上焦不通而咳，胃受饮食之火上通于咽而咳，以火移肺而咳。这又是五脏非时之热能移于肺的咳。其发作也兼有五脏的见证，与风邪无异，不可不察。治疗的方法，自表入者，宜用辛温发散；自内传者，其阴已伤，阴虚于下，则阳浮于上，水涸金枯，治疗宜用甘味以养阴，润味以养肺，并兼治根本的真阴，则肺自然安宁。然而形气病气都虚的，又应当培补其中气，而命门阳虚不能纳气的，则也应当温气以化水，否则无济于事。
Fire and wind pathogens damage the sinews, thus forming Sinew Bi (Bi Syndrome of the Sinews). The disease location is in the hypochondrium and ribs, hence there is a sensation of fullness in the hypochondrium. This is not due to the intrinsic deficiency of the Liver organ, but rather constitutes Liver Bi (Bi Syndrome of the Liver). Liver Bi refers to a syndrome where Liver Qi is stagnant and blood fails to nourish the sinews. A slippery pulse indicates the combination of wind-heat pathogens, thus the disease manifests as Liver Wind Hernia (Gan Feng Shan), characterized by alternating chills and fever, and twitching with traction. A choppy pulse indicates blood stasis, thus leading to the formation of Accumulations (Ji). The Liver governs the sinews and opens into the eyes; therefore, there is stiffness of the sinews and eye pain. The above describes Bi syndromes caused by the six climatic factors invading Yin and Yang. Human Yin and Yang correspond externally to the six climatic factors; thus, these factors may invade internally at certain times. This also depends on the excess or deficiency of Yin and Yang within the Zang-Fu organs, allowing external pathogens to remain. Beyond the theory of Six Qi (Yunqi), there are Bi syndromes formed due to Yin-Yang imbalance. A slippery pulse indicates an excess of pathogenic factors, so the pathogens remain stagnant forming Wind Hernia. "Wind" denotes movement, and "Hernia" denotes accumulation. A choppy pulse indicates a deficiency of healthy Qi, so it cannot overcome the pathogens, leading to Accumulations. Hernia and Accumulations generally refer to the gathering of pathogens, and Accumulations are not limited to diseases of the anterior yin and lower abdomen.
Malaria (Nue) arises from wind pathogens. It is contracted in summer from heat pathogens. Heat pathogens lodge in the Ying (Nutritive) level, causing the pores to be loose and the interstices (Cou Li) to open. Consequently, when sweating in autumn, one encounters wind, or after bathing in cold water, cold pathogens lodge inside the skin and reside together with Wei (Defensive) Qi. Wei Qi circulates in the Yang levels during the day and in the Yin levels at night. This pathogen moves outward with Wei Qi when it enters Yang, and inward when it enters Yin, hence the daily occurrence. During an attack, Yin and Yang contend above and below, with deficiency and excess shifting against each other. Thus, when Yang merges into Yin, Yin becomes excessive and Yang deficient. Deficiency of the Yangming channel leads to chills with trembling of the jaw; deficiency of the Jueyin (Taiyang) channel leads to pain in the waist, back, head, and neck; deficiency of all three Yang channels allows Yin to prevail. When Yin prevails, the bones become cold and painful. Since the cold originates internally, both interior and exterior feel cold. When Yin Qi reverses to an extreme, the subsequently emerging Yang merges into Yang, making Yang excessive. Yang excess causes external heat, while Yin deficiency causes internal heat. With both internal and external heat, there is panting and thirst, hence the desire for cold drinks.
In cases occurring every other day, the pathogen lodges deeply, pressing inward on Yin. Yang Qi erupts alone, while Yin pathogens remain fixed internally. Yin and Yang contend but cannot exit, hence the interval. Variations in the timing of attacks (early or late) occur because the pathogen resides in the Fengfu point and moves down along the Du vessel. Wei Qi gathers at Fengfu once every day and night. The next day, the pathogen descends one vertebral segment, delaying the attack. After twenty-five days, it reaches the sacrum; on the twenty-sixth day, it enters the spine and injects into the Fu Lu beneath. Then the pathogen ascends again, appearing in the Quepen area on the ninth day. As the pathogen's position rises daily, the attack occurs earlier. In intermittent cases, the pathogen presses inward, connecting horizontally through the five Zang organs and the Mu Yuan (Source). The path is long and the pathogen is deep, so its movement is slow and it cannot exit simultaneously with Wei Qi. Disease occurs only when Wei Qi arrives at the pathogen's location and combines with it. Therefore, whether daily or intermittent, the Malaria pathogen follows the meridians inward, waiting for Wei Qi to respond before attacking, causing the variation in timing.
Attacks starting with chills followed by heat result from encountering cold water in summer. Cold is Yin Qi; wind in autumn is Yang Qi. Injury by cold first, then wind, results in chills followed by heat, named Cold Malaria (Han Nue). Attacks starting with heat followed by chills result from injury by wind first, then cold, named Warm Malaria (Wen Nue). Cases with heat only and no chills occur when Yin Qi is exhausted first, and Yang Qi erupts alone, causing shortness of breath, vexation, hot hands and feet, and nausea, named Dan Malaria (Dan Nue). The onset is fierce like fire and wind, unstoppable. Hence, the Classic states: do not needle during high fever, do not needle chaotic pulses, and do not needle during profuse sweating, as the pathology is reversed and difficult to treat. Treatment should be administered before the onset, when Yin and Yang have not yet merged, to calm the True Qi and eliminate the pathogen. However, malaria does not always correspond to summer heat; its presentation may contradict the seasons. Autumn-onset malaria has severe cold; winter-onset has mild cold; spring-onset features aversion to wind; summer-onset features profuse sweating. Any seasonal climate can cause malaria if it opposes the normal pattern.
Warm Malaria (Wen Nue) is contracted in winter from wind-cold. The pathogen hides in the bone marrow. In spring, Yang Qi expands greatly, but the pathogen cannot exit spontaneously. Encountering intense summer heat, the interstices open, combined with physical exertion, the pathogen exits with sweat. At this time, Yin is deficient and Yang is excessive, causing heat. When the pathogen declines, Qi returns; entering Yin makes Yang deficient, causing cold. Thus, Warm Malaria presents with heat first, then chills.
Dan Malaria (Dan Nue) occurs when the Lung has pre-existing heat, and Qi is abundant in the body, with rebellious Qi rushing upward. Due to exertion, the interstices open, and wind-cold enters. Yang Qi remains excessive and does not decline, failing to reach the Yin level, resulting in heat without chills. The pathogen lodges internally in the Heart and externally between the muscle intervals, wasting the muscles, hence named Dan Malaria.
Malaria manifestations appear in all six meridians. Taiyang Malaria involves lower back pain, heavy head, cold rising from the back, chills followed by heat, intense burning sensation, and difficult-to-stop sweating after heat subsides. The pathogen is in the Three Yang, prevailing in the exterior, making sweat hard to retain, hence "difficult." Shaoyang Malaria involves flaccidity of the body, mild chills and heat, aversion to people, palpitations upon seeing others, much heat and sweating. "Flaccidity" means extreme fatigue and intolerance to labor. Mild chills and heat indicate the disease is in the half-exterior/half-interior. Palpitations indicate fear due to pathogen in the Gallbladder. Shaoyang governs Wood and Fire, often presenting with more chills and profuse sweating. Yangming Malaria involves initial shivering chills, prolonged severe cold before heat, and sweating after heat subsides. The patient feels better in sunlight or near fire. Yangming is a heat-predominant Fu organ, but cold prevails initially, causing prolonged chills before heat. Heat subsiding means pathogen declines, leading to sweating. Preference for warmth indicates Yangming suffering from Yin pathogen. Taiyin Malaria involves depression, frequent sighing, anorexia, alternating chills/fever, and sweating. Nausea occurs at onset and subsides after vomiting. Spleen likes joy; illness brings sorrow. Upper Jiao obstruction causes sighing and anorexia. Taiyin governs the interior; pathogens are hard to resolve, causing alternating chills/fever and sweating. Spleen disease affects Stomach, causing nausea which subsides after vomiting. Shaoyin Malaria involves severe vomiting, alternating chills/fever (more heat than chills), desire to close doors and windows. The disease is hard to cure. Shaoyin governs the interior; illness causes Yin pathogen to rush upward, causing severe vomiting. Kidney disease shows Yin deficiency, leading to more heat than chills. Being in Yin causes desire for seclusion. Kidney is the organ of Extreme Yin; pathogen residing here makes it hard to cure. Jueyin Malaria involves abdominal pain, lower abdominal fullness, difficulty urinating resembling strangury, fear, Qi deficiency, and abdominal oppression. Jueyin meridian circles the genitalia, reaches the lower abdomen, and spreads to the hypochondrium, causing these symptoms. Difficulty urinating resembling strangury is due to pathogen sinking, not water retention, causing urgency. Liver Qi deficiency causes fear. "Oppression" describes stagnation.
Deep-seated Malaria pathogens can affect the Five Zang organs. Lung Malaria causes heart coldness, severe chills followed by heat, and fright/hallucinations during remission. Lung is the canopy of the Heart; cold pathogen overcomes what it does not conquer (Metal controls Wood, but here Cold/Water overcomes Fire/Heart indirectly via Lung), causing heart cold. Chills followed by heat injure Heart Qi, causing fright and hallucinations. Heart Malaria involves severe mental restlessness, desire for clear water, but more chills and less heat. Pathogen in Heart causes restlessness and desire for water. Heart is a Yang organ; pathogen occupation leads to Yang deficiency and Yin excess, hence more chills. Liver Malaria presents with pale/greenish complexion, frequent sighing, and a state resembling death. Green is the Liver color. Liver stagnation causes Qi rebellion and sighing. Wood disease causes rigidity, resembling death. Spleen Malaria causes chills, abdominal pain, and borborygmi during heat, with sweating. Spleen is Extreme Yin; pathogen residence causes chills and pain. After chills, heat arises, Spleen Qi moves, causing borborygmi. Heat allows Yang Qi to reach the exterior, causing sweating and resolution. Kidney Malaria presents with shivering, lower back/spine pain, difficulty turning and defecating, blurred vision, and cold extremities. Shivering is chills. Kidney meridian passes through the spine and opens into the two orifices, causing back pain and constipation. Blurred vision indicates Water deficiency. Cold extremities indicate Yin reversal. Stomach Malaria involves hunger but inability to eat, distension, and abdominal enlargement after eating. Stomach is the leader of the Six Fu organs. Pathogen in Yangming causes Stomach pain affecting Spleen, leading to hunger without appetite and distension.
Treatment of malaria should begin about the time it takes to eat a meal; otherwise, the opportunity is missed.
Wei (Atrophy) syndrome occurs in all five Zang organs. Heat damaging blood vessels can cause atrophy of skin, vessels, muscles, and bones. However, the syndrome is primarily governed by the Lung. The Lung is the master of primal Qi and governs regulation. If Lung Metal is clear and Qi flows, the skin, blood, sinews, flesh, and bones are properly nourished, preventing atrophy. Only when evil heat attacks Lung Metal, causing Lung heat and scorched leaves, does it manifest externally as weak, tight, and bi-fixed skin and hair. Heat damaging the Lung inevitably affects sinews, vessels, flesh, and bones, causing pain and atrophy. The etiology lies in the Lung being the chief of Zang organs and canopy of the Heart. Excessive mental labor or sexual indulgence damages Essence and Qi. Damaging Qi specifically harms the Lung. Furthermore, Heart Fire attacks upward; Lung Qi deficiency allows Fire to oppress, causing asthma and wheezing. Loss of Lung's regulating function and lingering Fire lead to scorched Lung leaves. The Five Zang become diseased due to Lung heat, Qi fails to move, and atrophy ensues. Although atrophy is governed by the Lung, why does the Classic state that treatment of atrophy focuses solely on the Yangming? Because Yangming is the mother of Lung and the sea of the Five Zang and Six Fu organs. It moistens the Zong Jin (Major Sinews), which bind bones and facilitate joint movement. The Chong Mai (Penetrating Vessel) is the sea of the Twelve Meridians, moistening the Xi Gu (Valleys), combining with Yangming at the Zong Jin, with Yangming as the leader. All belong to the Dai Mai (Belt Vessel) and connect to the Du Mai. Yangming deficiency leads to flaccid Zong Jin, causing leg atrophy. Thus, to clear Lung heat, one must first clear Yangming heat, nourish Yin, regulate deficiency/excess, and harmonize rebellion/compliance, curing the disease.
Five Zang atrophies progress from Lung heat/scorched leaves downward, manifesting as Mai Wei (Vessel Atrophy), Rou Wei (Flesh Atrophy), Jin Wei (Sinew Atrophy), and Gu Wei (Bone Atrophy). Mai Wei: Heart heat causes Qi to reverse downward and upward; the pivot breaks, the tibia hangs limp, unable to stand. Also caused by excessive grief moving Yang Qi inward, causing Heart collapse and frequent hematuria. Rou Wei: Dry stomach with thirst, insensible muscles. Also caused by dampness lingering, leading to bi-insensitivity. Jin Wei: Dry fascia, stiff and contracted sinews. Also caused by excessive intercourse flaccidifying Zong Jin, leading to sinew atrophy and white discharge. Gu Wei: Kidney heat causes dry bones and reduced marrow, inability to raise waist/spine. Also caused by long walking/fatigue damaging Yang Qi inward, making legs unable to support the body. These five atrophies manifest in color: Lung heat-white/bald hair; Heart heat-red/visible collaterals; Liver heat-green/dry nails; Spleen heat-yellow/twitching muscles; Kidney heat-black/dry teeth.
Cough: The Classic states skin/hair is the exterior of the Lung. Skin/hair pathogens enter via their connection. Internally, cold food enters the Stomach and travels to the Lung, cooling the Lung. Lung cold combines with external pathogens, causing cough. The Lung is the floral canopy of the Zang organs. Each Zang suffers according to its season. Even if not directly affected, they transmit to the Lung. Thus, when Zang organs suffer cold, even slight pathogens transmit to the Lung, causing cough. Cough involves the Six Fu organs; therefore, all Zang and Fu can cause cough, with Lung cough including symptoms of all Zang and Fu.
Lung Cough: Cough with wheezing and sound; severe cases involve hemoptysis. Lung governs Qi and respiration, causing wheezing. Blood follows cough out; the disease is in the Lung. Vomiting differs from bleeding. Heart Cough: Cough with heart pain, throat feeling obstructed like a foreign body; severe cases involve sore throat and Bi. The meridian affects the pharynx, causing obstruction and swelling. Liver Cough: Cough with pain under both hypochondria; severe cases prevent turning. Turning causes fullness under the hypochondria. Liver meridian spreads to hypochondria, causing pain and Qi rebellion/fullness. Spleen Cough: Cough with pain under the right hypochondrium radiating to the shoulder/back; severe cases prevent movement, worsening cough. Pain radiates because the meridian branches from the Stomach up through the diaphragm. Earth corresponds to Kun (Southwest), hence right-sided pain. Movement worsens cough because Spleen prefers stillness. Kidney Cough: Cough with牵引 (traction/pain) between waist and back; severe cases produce saliva. Kidney meridian passes through the spine. Kidney governs saliva and meridian follows the throat, hence salivation.
Zang coughs transfer to Fu organs. Persistent Spleen cough transfers to Stomach, causing vomiting and expulsion of roundworms. Stomach rejects Spleen pathogen, causing Qi rebellion. Persistent Liver cough transfers to Gallbladder, causing bitter vomiting. Persistent Lung cough transfers to Large Intestine, causing fecal incontinence. Persistent Heart cough transfers to Small Intestine, causing flatus with cough. Persistent Kidney cough transfers to Bladder, causing urinary incontinence. Persistent cough transfers to San Jiao, causing abdominal fullness and anorexia. All three Jiaos are diseased, disrupting ascent/descent and intake/excretion, causing fullness and anorexia. These gather in the Stomach and concern the Lung, causing excessive phlegm/saliva and facial edema with Qi rebellion. Stomach is the root of Zang/Fu; Lung is the exterior of skin/hair. External and internal pathogens cannot escape these two. Yangming meridian starts at the nose and meets on the face; Lung opens at the nose and governs Qi, causing phlegm, facial edema, and Qi rebellion. The Classic attributes cough to wind-cold damaging skin/hair and cold food damaging the Stomach, transmitting to cool the Lung. Non-seasonal Zang pathogens also transmit to the Lung. Internal injuries from Zang organs, unless heat/fire flares up, will definitely transmit to the Lung.
Kidney Water and Lung Metal are mother-son. Diseases relate as root and branch. Cold/Heat patterns arise. Kidney Fire deficiency causes Water flooding to insult/flood the Lung, causing cold-phlegm cough. Kidney Water deficiency causes Fire boiling to attack Metal via Liver, causing Lung atrophy/pharyngeal Bi cough. Other cases: Dragon Fire from Liver combining with Heart Fire rising causes cough; Spleen Qi stagnation blocking Upper Jiao causes cough; Stomach food-fire ascending to the pharynx causes cough; Fire transferring to Lung causes cough. These are non-seasonal Zang heat transferring to Lung, presenting with Zang symptoms similar to wind pathogens. Treatment: For exterior-originating cough, use acrid-warm dispersants. For interior-transmitted cough, Yin is damaged; deficiency below causes floating Yang above, drying Water and Withering Metal. Treatment should use sweet to nourish Yin, moisten to nourish Lung, and treat the fundamental True Yin, calming the Lung. For concurrent Form and Qi deficiency, tonify Middle Qi. For Mingmen Yang deficiency failing to grasp Qi, warm Qi to transform Water; otherwise, treatment fails.