〔《难》〕有正经自病，有五邪所伤，何以别之？经言忧愁思虑则伤心，形寒饮冷则伤肺
，恚怒气逆上而不下则伤肝，饮食劳倦则伤脾，久坐湿地、强力入水则伤肾，是正经自病者
也。何谓五邪？有中风，有伤暑，有饮食劳倦，有伤寒，有中湿，此之谓五邪。假令心病，
何以知中风得之？然，其色当赤。何以言之？肝主色，自入为青，入心为赤，入脾为黄，入肺
为白，入肾为黑。肝为心邪，故知当赤色也。其病身热，胁下满痛，其脉浮大而弦。何以知
伤暑得之？然，当恶臭。何以言之？心主臭，自入为焦臭，入脾为香臭，入肝为臊臭，入肾为
腐臭，入肺为腥臭，故知心病伤暑得之也，当恶臭。其病身热而烦，心痛，其脉浮大而散。
何以知饮食劳倦得之？然，当喜苦味。虚为不欲食，实为欲食，何以言之？脾主味，入肝为酸
，入心为苦，入肺为辛，入肾为咸，自入为甘。故脾邪入心，为喜苦味也。其病身热体重嗜
卧，四肢不收，其脉浮大而缓。何以知伤寒得之？然，当谵言妄语。何以言之？肺主声，入肝
为呼，入心为言，入脾为歌，入肾为呻，自入为哭。故知肺邪入心，为谵言妄语也。其病身
热洒洒恶寒，甚则喘咳，其脉浮大而涩。何以知中湿得之？然，当喜汗出而不可止。何以言
之？肾主湿，入肝为泣，入脾为涎，入肺为涕，自入为唾。故知肾邪入心，为汗出不可止也
。其病身热而小肠痛，足胫寒而逆，其脉沉濡而大。此五邪之法也。（《四十九难》）
肝主色，心主臭，脾主味，肺主声，肾主液。肝色青，其臭臊，其味酸，其声呼，其液
泣。心色赤，其臭焦，其味苦，其声言，其液汗。脾色黄，其臭香，其味甘，其声歌，其液
涎。肺色白，其臭腥，其味辛，其声哭，其液涕。肾色黑，其臭腐，其味咸，其声呻，其液
唾。
病有虚邪，有实邪，有贼邪，有微邪，有正邪，何以别之？从后来者为虚邪，从前来者
为实邪，从所不胜来者为贼邪，从所胜来者为微邪，自病者为正邪。何以言之？假令心病，
中风得之为虚邪，伤暑得之为正邪，饮食劳倦得之为实邪，伤寒得之为微邪，中湿得之为贼
邪。（《五十难》）
一脉为十变者，何谓也？然，五邪刚柔相逢之意也。假令心脉急甚者，肝邪干心也。心
脉微急者，胆邪干小肠也。心脉大甚者，心邪自干心也。心脉微大者，小肠邪自干小肠也。
心脉缓甚者，脾邪干心也。心脉微缓者，胃邪干小肠也。心脉涩甚者，肺邪干心也。心脉微
涩者，大肠邪干小肠也。心脉沉甚者，肾邪干心也。心脉微沉者，膀胱邪干小肠也。五脏各
有刚柔邪，故令一脉辄变为十也。（《十难》）
〔《灵》〕黄帝曰∶请问脉之缓、急、大、小、滑、涩之病形何如？岐伯曰∶臣请言五脏
之病变也。心脉急甚者为螈 ，微急为心痛引背，食不下。（谓色赤脉钩而急也，余缓大小滑
涩五脉仿此）。缓甚为狂笑，微缓为伏梁，在心下上下行，时唾血。大甚为喉 ，微大
为心痹引背，善泪出。小甚为善哕，微小为消瘅。滑甚为善渴，微滑为心疝引脐，小腹鸣。
涩甚为喑，微涩为血溢，维厥，耳鸣，颠疾。
肺脉急甚为癫疾，微急为肺寒热，怠惰，咳唾血，引腰背胸，若鼻 肉不通（谓色白脉
毛而急也，余脉仿此）。缓甚为多汗，微缓为痿 、偏风，头以下汗出不可止。大甚为胫肿
，微大为肺痹引胸背，起恶日光。小甚为泄，微小为消瘅。滑甚为息贲上气，微滑为上下出
血。涩甚为呕血，微涩为鼠 ，在颈肢腋之间，下不胜其上，其应善酸矣。
肝脉急甚者为恶言，微急为肥气在胁下，若覆杯（谓色青脉弦而急也，余脉仿此）。缓甚
为善呕，微缓为水瘕痹也。大甚为内痈，善呕衄，微大为肝痹阴缩，咳引小腹。小甚为多
饮，微小为消瘅。滑甚为 疝，微滑为遗溺。涩甚为溢饮，微涩为 挛筋痹。
脾脉急甚为螈 ，微急为膈中，食饮入而还出，后沃沫。缓甚为痿厥，微缓为风痿，四
肢不用，心慧然若无病。大甚为击仆，微大为疝气，腹里大脓血，在肠胃之外。小甚为寒热
，微小为消瘅。滑甚为 癃，微滑为虫毒 蝎腹热。涩甚为肠 ，微涩为内
，多下脓血。
肾脉急甚为骨癫疾，微急为沉厥奔豚，足不收，不得前后（谓色黑脉石而急也，余脉仿
此）。缓甚为折脊，微缓为洞，洞者食不化，下嗌还出。大甚为阴痿，微大为石水，起脐以
下至小腹HT HT 然，上至胃脘，死不治。小甚为洞泄，微小为消瘅。滑甚为癃
，微滑为骨痿，坐不能起，起则目无所见。涩甚为大痈，微涩为不月，沉痔。黄帝曰∶病之
六变者，刺之奈何？岐伯答曰∶诸急者多寒，缓者多热，大者多气少血，小者血气皆少，滑
者阳气盛微有热，涩者多血少气微有寒。是故刺急者，深内而久留之。刺缓者，浅内而疾发
针，以去其热。刺大者，微泻其气，无出其血。刺滑者，疾发针而浅内之，以泻其阳气而去
其热。刺涩者，必中其脉，随其逆顺而久留之，必先按而循之，已发针，疾按其 ，无
令其血出，以和其脉。诸小者，阴阳形气俱不足。勿取以针，而调以甘药也。（初详滑者阴
气有余，今反言阳气盛，涩者阳气有余，今反言少气多血，恐二脉乃交互间，宜更详之。以
上并见《邪气脏腑病形篇》）
〔垣〕假令肝病实邪，风热相合，风性急，火摇动焰而旋转，其脉弦而紧洪，风热发狂，
宜芎黄汤。
羌活 川芎 大黄（各一两） 甘草（半两）
上 咀。每服半两，水二盏，煎至六分，去渣温服。
虚邪风寒相合，木虑肾恐，拘急自汗，其脉弦紧而沉。仲景云∶风感太阳，移证在少阴
经中，桂枝加附子汤主之。贼邪风燥相合，血虚筋缩，皮肤皴揭，脉弦浮而涩。仲景云∶血
虚筋急，桂枝加栝蒌汤主之。微邪风湿相合，体重节痛，脏腑洞泄，脉弦长而缓。仲景云∶
身体疼痛，下痢清谷，急当救里，四逆汤主之。正邪中风，目眩头重，叫怒不出，脉弦紧而
长。仲景云∶甚则如痫为 ，宜羌活汤。本草云∶羌活主 痫，防风、黄芩为佐。
小儿为痫，大人为 。
假令心病实邪，热湿相合，愦愦心烦，热蒸不眠，脾经络于心，心经起于脾，二经相接
，故为湿热，脉浮大而缓，足太阴寄证在手太阳，宜栀豉汤。若痞，加浓朴、枳实。虚邪热
风相合，妄听妄闻，耳有萧声，胆与三焦之经，同出于耳。铜人云∶刺关冲出血，泻支沟。
脉浮大而弦，初小柴胡汤，后大柴胡汤。此证是太阳与少阳为病，前客后主也。贼邪热寒相
合，胆惕心悬如饥，神怯恐怖，足少阴与手厥阴相接，水中心经，故神怯怖耳。脉大而沉濡
，亦在太阳经中。《内经》曰∶心虚则热收于内，以黄连附子泻心汤主之。治法云∶热多寒
少，以热为佐，如寒多热少，加附子、干姜佐之。微邪热燥相合，过饮歌乐，实为热燥，俗
言畅饮也。病患言快活，快活是有声歌乐也。以意思浆，是无声歌乐也。脉大而洪涩，白虎
汤主之。喘则加人参。正邪热也，脱阳见鬼，躁扰狂越，脉洪实，一呼四至，是八至脉也。
小承气汤主之，谓腹不坚大也。
假令肺病实邪，燥寒相合，毛耸皮凉，溲多而清，其脉短涩而沉。此证如秋冬宜八味丸
，若春夏宜地黄丸。虚邪燥湿相合，微喘而痞，便难而痰，其脉浮涩而缓，枳实理中汤主之
。如喘甚加人参；若便难加木香、槟榔各半钱，为极细末，煎下理中丸。贼邪燥热相合。鼻
窒鼽衄，血溢血泄，其脉涩而浮大，甚者，桃仁承气汤；微者，犀角地黄汤。极者，抵当汤
；微者，抵当丸。微邪燥风相合，皮燥甲枯，血虚气虚，二脏俱虚，先血后气，其脉浮涩而
弦大，养气血药主之。正邪燥自病，其气 郁，皆属于肺，诸燥有声，其脉浮涩而短，
则诸嗽药选而用之。
假令肾病实邪，寒风相合，当藏不藏，故下痢纯清，其脉沉滑而弦。仲景云∶少阴证，
口燥咽干，下痢纯清，大承气汤主之。脉沉弦而迟，四肢逆冷者，宜四逆汤等。虚邪寒清相
合，咳唾多呻，洒淅寒清无寐，经言燥化清，其脉沉实而涩，酸枣仁汤主之。贼邪寒湿相合
，肾为胃关，关闭水溢，关闭不利，水在胃为肿，在肺为喘，及变诸证，其脉沉缓而大。仲
景云∶大病瘥后，腰下有水气者，牡蛎泽泻汤主之。微邪寒热相合，膀胱热郁，津液枯少，
其脉沉濡而大。《内经》曰∶水少干涸是也，猪苓汤主之。正邪寒自病，为寒忿用藏，黑痹
经沉，其脉沉濡而滑，宜黑痹天麻丸。如证同脉异，微者腑病也，甚者脏病也。
假令脾病实邪，湿燥相合，胃中燥屎，腹满坚痛，其脉缓而长涩，正阳阳明证也，调胃
承气汤主之。虚邪湿热相合，热陷胃中，肠 下血，脉缓而大，黄连解毒汤主之。贼邪湿风
相合，呕逆胁痛，往来寒热，脉缓而弦长，小柴胡汤主之。微邪湿寒相合，寒来求湿，身黄
而不热，体重而不渴，谓之寒湿。其脉缓沉而滑，术附汤主之。如小便不利者，加茯苓。正
邪湿自病，腹满时痛，手足自温，其脉沉涩而长。虚痛，桂枝加芍药汤；实痛，桂枝加大黄
汤主之。
胃为十二经之海，十二经皆禀血气滋养于身，脾受胃之禀行其血气也。脾胃既虚，十二
经之邪不一而出。假令不能食而肌肉削，乃本病也。其右关脉缓而弱，本部脉也。本部本证
脉中，兼见弦脉，或见四肢满闭，淋溲便难转筋一二证，此肝之脾胃病也，当于本经药中加
风药以泻之。本部本证脉中，兼见洪大，或见肌热烦面赤，而不能食，肌肉消一二证，此心
之脾胃病也，当于本经药中加泻火之药。本部本证脉中，兼见浮涩，或见气短气上喘咳，痰
盛皮涩一二证，此肺之脾胃病也，当于本经药中兼泻肺之邪，及补气之药。本部本证脉中，
兼见沉细，或见善恐数欠之证，此肾之脾胃病也，当于本经药中加泻肾水之浮，及泻阴火伏
炽之药。
弦脉（风邪所伤，甘草芍药黄 建中汤之类，或甘酸之剂皆可用之）
洪脉（热邪所伤，三黄丸泻黄散、调胃承气汤，或甘寒之剂皆可用之）
脾胃右关其脉缓，如得∶缓脉。（本经太过，湿邪所伤，平胃散加白术、茯苓，五苓散
，或除湿之剂皆可用之）
涩脉（燥邪所伤，异功散加当归，四君子汤加熟地黄，或甘温甘润之剂皆可用之）
沉细脉（寒邪所伤，益黄散、养脾丸、理中汤，如寒甚则加附子甘热之剂，皆可用之）
前项所定方药乃常道也，如变则更之。
脾胃不足，不同余脏，无定体故也。其治肝心肺肾，有余不足，或补或泻，惟益脾胃之
药为切。经言至而不至，是为不及，所胜妄行，所生受病，所不胜乘之也。至而不至者，谓
从后来者为虚邪，心与小肠来乘脾胃也。脾胃脉中见浮大而弦，其病或烦躁闷乱，或四肢发
热，或口苦舌干咽干。盖心主火，小肠主热，火热来乘土位，乃湿热相合，故烦躁闷乱也。
四肢者，脾胃也，火乘之，故四肢发热也。饮食不节，劳役所伤，以致脾胃虚弱，乃血所生
病，主口中津液不行，故口咽干也。病患自以为渴，医者治以五苓散，谓止渴燥而反加渴燥
，乃重竭津液，以至危亡也。经云∶虚则补其母。当于心与小肠中以补脾胃之根蒂，以甘温
之药为之主，以苦寒之药为之使，以酸味为之臣佐。以心苦缓，急食酸以收之，心火旺则肺
金受邪，金虚则以酸补之。次以甘温及甘寒之剂，于脾胃中泻心火之亢盛，是治其本也。所
胜妄行者，谓心火旺能令母实。母者，肝木也。肝木旺则挟火之势，无所畏惧而妄行也，故
脾胃先受之。或身体沉重，走注疼痛，盖热湿相搏，风热郁而不得伸，附丽于有形也。或多
怒者，风热下陷于地中也。或目病而生内障者，脾裹血，胃主血，心主脉，脉者血之府也。
或云心主血，又云肝主血，肝之窍开于目也。或妄见妄闻，起妄心，夜梦亡人，四肢满闷转
筋，皆肝木火盛而为邪也。或生痿，或生痹，或生厥，或中风，或生恶疮，作肾痿，或上热
下寒，为邪不一，皆风热不得生长，而木火遏于有形中也。所生受病者，言肺受土火木之邪
，而清肃之气伤。或胸满少气短气者，肺主诸气，五脏之气皆不足，而阳道不行也。或咳嗽
寒热者，湿热乘其内也。所不胜乘之者，水乘木之妄行，而反来侮土，故肾火下亢，致督任
冲三脉盛，火旺煎熬，令水沸腾。而乘脾肺，故痰涎唾出于口也。下行为阴汗，为外肾冷，
为足不任身，为脚下隐痛，或水附木势而上，为眼涩，为眵，为冷泪。此皆由肺金之虚，而
寡于畏也。夫脾胃不足，是火不能生土，而反抗拒。此至而不至，是为不及也。
白术（君） 人参（臣） 甘草（佐） 芍药（佐） 黄连（使） 黄 （臣） 桑白皮（佐）
诸风药皆是风能胜湿也，诸甘温药亦可。
心火亢盛，乘于脾胃之位，亦至而不至，是为不及也。
【《难经》】有正经自病，有五邪所伤，如何区别它们？经文说：忧愁思虑则损伤心脏，形体受寒、饮食生冷则损伤肺脏，愤怒气逆上冲而不能下行则损伤肝脏，饮食不节且过度劳累则损伤脾脏，久坐湿地或强力涉水则损伤肾脏，这就是正经自病的情况。什么是五邪呢？有中风，有伤暑，有饮食劳倦，有伤寒，有中湿，这就叫做五邪。假如是心脏患病，如何知道是由中风引起的呢？回答说，其面色应当发红。为什么这样说呢？肝主五色，本色入肝为青色，入心为赤色，入脾为黄色，入肺为白色，入肾为黑色。肝作为心的“邪”（此处指五行中木生火，肝木为心火之母，母病及子或母气过盛影响子脏），所以知道面色应当发红。其病症表现为身体发热，胁下胀满疼痛，脉象浮大而弦。如何知道是由伤暑引起的呢？回答说，应当厌恶异味。为什么这样说呢？心主五臭，本色入心为焦臭味，入脾为香味，入肝为臊臭味，入肾为腐臭味，入肺为腥臭味，所以知道心病由伤暑引起时，应当厌恶异味。其病症表现为身体发热且心烦，心痛，脉象浮大而散。如何知道是由饮食劳倦引起的呢？回答说，应当喜欢苦味。虚证则不想进食，实证则想进食，为什么这样说呢？脾主五味，入肝为酸味，入心为苦味，入肺为辛味，入肾为咸味，本色入脾为甘味。所以脾的邪气传入心脏，表现为喜欢苦味。其病症表现为身体发热、身体沉重、嗜睡，四肢无力下垂，脉象浮大而缓。如何知道是由伤寒引起的呢？回答说，应当出现胡言乱语。为什么这样说呢？肺主五声，本色入肺为哭声，入肝为呼号声，入心为言语声，入脾为歌声，入肾为呻吟声。所以肺的邪气传入心脏，表现为胡言乱语。其病症表现为身体发热、怕冷战栗，严重时气喘咳嗽，脉象浮大而涩。如何知道是由中湿引起的呢？回答说，应当喜欢出汗且汗出无法停止。为什么这样说呢？肾主五液，本色入肾为唾液，入肝为泪，入脾为涎，入肺为鼻涕。所以肾的邪气传入心脏，表现为汗出无法停止。其病症表现为身体发热且小肠疼痛，足胫寒冷且逆冷，脉象沉濡而大。这就是辨别五邪的方法。（出自《难经·第四十九难》）
肝主五色，心主五臭，脾主五味，肺主五声，肾主五液。肝的本色是青，本臭是臊，本味是酸，本声是呼，本液是泪。心的本色是赤，本臭是焦，本味是苦，本声是言，本液是汗。脾的本色是黄，本臭是香，本味是甘，本声是歌，本液是涎。肺的本色是白，本臭是腥，本味是辛，本声是哭，本液是涕。肾的本色是黑，本臭是腐，本味是咸，本声是呻，本液是唾。
疾病有虚邪，有实邪，有贼邪，有微邪，有正邪，如何区别它们？从母脏传来的称为虚邪，从子脏传来的称为实邪，从克我之脏传来的称为贼邪，从我克之脏传来的称为微邪，本脏自病的称为正邪。为什么这样说呢？假如是心脏患病，中风（木生火，母来乘子）得之为虚邪，伤暑（本气自病）得之为正邪，饮食劳倦（火生土，子来乘母）得之为实邪，伤寒（水克火，克我来犯）得之为微邪，中湿（土克水，此处原文逻辑似有误，按五行火生土，土为火之子，若湿属土，应为实邪；但原文归类为中湿为贼邪，可能基于其他理论或特定语境，此处依原文翻译）得之为贼邪。（出自《难经·第五十难》）
一脉变为十种变化，是什么意思呢？这是五邪刚柔相逢的意思。假如心脉急甚，是肝邪侵犯心脏。心脉微急，是胆邪侵犯小肠。心脉大甚，是心邪自犯心脏。心脉微大，是小肠邪自犯小肠。心脉缓甚，是脾邪侵犯心脏。心脉微缓，是胃邪侵犯小肠。心脉涩甚，是肺邪侵犯心脏。心脉微涩，是大肠邪侵犯小肠。心脉沉甚，是肾邪侵犯心脏。心脉微沉，是膀胱邪侵犯小肠。五脏各有刚柔之邪，所以使得一脉辄变为十种变化。（出自《难经·第十难》）
【《灵枢》】黄帝说：请问脉象的缓、急、大、小、滑、涩的病状表现是怎样的？岐伯说：请允许我讲述五脏病变的情况。心脉急甚者为抽搐，微急为心痛牵引背部，饮食不下。（这里指面色赤、脉钩而急的情况，其余缓、大、小、滑、涩五种脉象仿照此例推断）。心脉缓甚者为狂笑，微缓为伏梁病，在心下上下移动，时常唾血。心脉大甚者为喉痹，微大为心痹牵引背部，容易流泪。心脉小甚者为频繁呃逆，微小为消瘅病。心脉滑甚者为口渴，微滑为心疝牵引脐部，小腹鸣响。心脉涩甚者为失音，微涩为血液溢出，四肢厥逆，耳鸣，癫疾。
肺脉急甚者为癫疾，微急为肺脏寒热，倦怠乏力，咳嗽唾血，牵引腰背胸部，以及鼻息肉不通。（这里指面色白、脉毛而急的情况，其余脉象仿照此例推断）。肺脉缓甚者为多汗，微缓为痿躄、偏风，头部以下汗出无法停止。肺脉大甚者为小腿肿胀，微大为肺痹牵引胸背，起病时害怕阳光。肺脉小甚者为泄泻，微小为消瘅病。肺脉滑甚者为气逆喘促，微滑为上下出血。肺脉涩甚者为呕血，微涩为鼠瘘，位于颈部腋下之间，下肢无力支撑上身，其反应应当感到酸痛。
肝脉急甚者为恶言骂詈，微急为肥气病在胁下，形状像倒扣的杯子。（这里指面色青、脉弦而急的情况，其余脉象仿照此例推断）。肝脉缓甚者为频繁呕吐，微缓为水瘕痹病。肝脉大甚者为内痈，频繁呕吐和鼻衄，微大为肝痹，阴器收缩，咳嗽牵引小腹。肝脉小甚者为多饮，微小为消瘅病。肝脉滑甚者为疝气，微滑为遗尿。肝脉涩甚者为溢饮，微涩为筋痹挛缩。
脾脉急甚者为抽搐，微急为膈中病，饮食入口即吐出，大便排出泡沫。脾脉缓甚者为痿厥，微缓为风痿，四肢不能活动，心中清醒好像没有病一样。脾脉大甚者为被打倒仆地，微大为疝气，腹内有大量脓血，位于肠胃之外。脾脉小甚者为寒热往来，微小为消瘅病。脾脉滑甚者为小便不利，微滑为虫毒蝎螫腹部发热。脾脉涩甚者为肠澼，微涩为内痈，多排出脓血。
肾脉急甚者为骨癫疾，微急为沉厥奔豚，足部不能收持，大小便不通。（这里指面色黑、脉石而急的情况，其余脉象仿照此例推断）。肾脉缓甚者为脊柱折断感，微缓为洞泄，洞泄是指食物不消化，咽下后又吐出来。肾脉大甚者为阳痿，微大为石水，肿胀从脐下至小腹膨隆然，向上延伸至胃脘，死亡无法治疗。肾脉小甚者为洞泄，微小为消瘅病。肾脉滑甚者为小便不利，微滑为骨痿，坐起困难，站起后眼睛看不见东西。肾脉涩甚者为大痈，微涩为月经不来，沉痔。黄帝说：疾病的六种变化，针刺治疗该怎么办？岐伯回答说：凡是脉急的多为寒证，脉缓的多为热证，脉大的多为气多血少，脉小的多为气血皆少，脉滑的为阳气盛微有热，脉涩的多血少气微有寒。因此，刺脉急者，要深刺并长时间留针。刺脉缓者，浅刺并快速出针，以去除热邪。刺脉大者，轻微泻其气，不要放出血液。刺脉滑者，快速出针并浅刺，以泻去阳气和热邪。刺脉涩者，必须准确刺中血脉，顺着经脉的逆顺方向长时间留针，必须先按压循摸经脉，出针后迅速按压针孔，不让血液流出，以调和血脉。凡是脉小的，阴阳形气都不足。不要用针刺，而要用甘药调理。（起初详细分析滑脉认为是阴气有余，现在反而说阳气盛；涩脉认为是阳气有余，现在反而说少气多血，恐怕这两条脉象存在交互关系，应该再仔细详查。以上均见于《灵枢·邪气脏腑病形篇》）
【李东垣】假如肝病属实邪，风热相合，风性急迫，火性摇动火焰而旋转，其脉象弦而紧洪，风热导致发狂，适宜用芎黄汤。
羌活 川芎 大黄（各一两） 甘草（半两）
切碎。每次服用半两，用水二盏，煎煮至六分，去渣温服。
虚邪风寒相合，木气忧虑肾气恐惧，拘急自汗，其脉象弦紧而沉。张仲景说：风邪感受太阳经，传变证候在少阴经中，用桂枝加附子汤主治。贼邪风燥相合，血虚筋脉收缩，皮肤皱裂，脉象弦浮而涩。张仲景说：血虚筋急，用桂枝加栝蒌汤主治。微邪风湿相合，身体沉重关节疼痛，脏腑洞泄，脉象弦长而缓。张仲景说：身体疼痛，下利清谷，急需救里，用四逆汤主治。正邪中风，目眩头重，叫喊愤怒不出，脉象弦紧而长。张仲景说：严重时像癫痫发作，适宜用羌活汤。本草记载：羌活主治痫证，防风、黄芩作为佐药。
小儿患痫证，大人患痉证。
假如心病属实邪，热湿相合，烦闷心烦，热气蒸腾不眠，脾经络于心，心经起于脾，两经相接，所以为湿热，脉象浮大而缓，足太阴脾经的寄证出现在手太阳小肠经，适宜用栀豉汤。如果有痞满，加厚朴、枳实。虚邪热风相合，妄听妄闻，耳中有风声，胆经与三焦经同出于耳。铜人针灸经说：刺关冲穴出血，泻支沟穴。脉象浮大而弦，初用小柴胡汤，后用大柴胡汤。此证是太阳与少阳同病，前客后主。贼邪热寒相合，胆怯心悸如饥，神气怯弱恐怖，足少阴肾经与手厥阴心包经相接，水克心火，所以神气怯弱恐怖。脉象大而沉濡，也在太阳经中。《内经》说：心虚则热收于内，用黄连附子泻心汤主治。治法说：热多寒少，以热药为佐使；如果寒多热少，加附子、干姜作为佐使。微邪热燥相合，过度饮酒歌唱娱乐，实为热燥，俗语称为畅饮。病人说快活，快活是有声的歌唱娱乐。以意思浆，是无声的歌唱娱乐。脉象大而洪涩，用白虎汤主治。气喘则加人参。正邪热也，脱阳见鬼，躁扰狂越，脉象洪实，一呼四至，这是八至脉。用小承气汤主治，谓腹部不坚硬肿大。
假如肺病属实邪，燥寒相合，毫毛耸立皮肤凉，小便多而清，脉象短涩而沉。此证如秋冬季节适宜用八味丸，如果春夏季节适宜用地黄丸。虚邪燥湿相合，微喘且痞满，大便难且痰多，脉象浮涩而缓，用枳实理中汤主治。如果喘甚加人参；如果大便难加木香、槟榔各半钱，研成极细末，煎服理中丸。贼邪燥热相合。鼻塞鼻渊鼻衄，血液溢出泄漏，脉象涩而浮大，严重的用桃仁承气汤；轻微的用犀角地黄汤。极重的用抵当汤；轻微的用抵当丸。微邪燥风相合，皮肤干燥指甲枯槁，血虚气虚，两脏俱虚，先补血后补气，脉象浮涩而弦大，用补养气血的药物主治。正邪燥自病，其气郁结，皆属于肺，各种燥症有声，脉象浮涩而短，则选择各种止咳药物使用。
假如肾病属实邪，寒风相合，应当封藏而不封藏，所以腹泻纯清水，脉象沉滑而弦。张仲景说：少阴证，口燥咽干，腹泻纯清水，用大承气汤主治。脉沉弦而迟，四肢逆冷的，适宜用四逆汤等。虚邪寒清相合，咳嗽唾沫多呻吟，洒淅恶寒清冷无睡眠，经文说燥化清，脉象沉实而涩，用酸枣仁汤主治。贼邪寒湿相合，肾为胃之关，关闭水液溢出，关闭不利，水在胃则为水肿，在肺则为气喘，以及变成各种证候，脉象沉缓而大。张仲景说：大病痊愈后，腰部以下有水气的，用牡蛎泽泻汤主治。微邪寒热相合，膀胱热郁，津液枯少，脉象沉濡而大。《内经》说：水少干涸就是这种情况，用猪苓汤主治。正邪寒自病，为寒忿用藏，黑痹经沉，脉象沉濡而滑，适宜用黑痹天麻丸。如果证候相同而脉象不同，轻微的为腑病，严重的为脏病。
假如脾病属实邪，湿燥相合，胃中燥屎，腹部胀满坚硬疼痛，脉象缓而长涩，这是正阳阳明证，用调胃承气汤主治。虚邪湿热相合，热陷胃中，肠道下血，脉象缓而大，用黄连解毒汤主治。贼邪湿风相合，呕吐逆气胁痛，往来寒热，脉象缓而弦长，用小柴胡汤主治。微邪湿寒相合，寒来求湿，身体发黄但不发热，身体沉重但不口渴，这叫做寒湿。脉象缓沉而滑，用术附汤主治。如果小便不利的，加茯苓。正邪湿自病，腹部胀满时而疼痛，手足自然温暖，脉象沉涩而长。虚痛，用桂枝加芍药汤；实痛，用桂枝加大黄汤主治。
胃是十二经的海，十二经都禀受血气滋养身体，脾接受胃的禀受运行其血气。脾胃既已虚弱，十二经的邪气不一而出。假如不能进食且肌肉消瘦，这是本病。其右关脉缓而弱，是本部的脉。在本部本证的脉中，兼见弦脉，或者见到四肢胀满闭塞、淋沥小便困难、转筋一二个证候，这是肝之脾胃病，应当在本部药物中加入风药以泻之。在本部本证的脉中，兼见洪大，或者见到肌热烦渴面赤，而不能进食，肌肉消瘦一二个证候，这是心之脾胃病，应当在本部药物中加入泻火的药物。在本部本证的脉中，兼见浮涩，或者见到气短气上喘咳，痰盛皮肤干燥一二个证候，这是肺之脾胃病，应当在本部药物中兼泻肺之邪，以及补气的药物。在本部本证的脉中，兼见沉细，或者见到易惊恐数呵欠的证候，这是肾之脾胃病，应当在本部药物中加入泻肾水之浮，以及泻阴火伏炽的药物。
弦脉（风邪所伤，甘草芍药黄芪建中汤之类，或者甘酸之剂都可以使用）
洪脉（热邪所伤，三黄丸泻黄散、调胃承气汤，或者甘寒之剂都可以使用）
脾胃右关其脉缓，如果得到：缓脉。（本经太过，湿邪所伤，平胃散加白术、茯苓，五苓散，或者除湿之剂都可以使用）
涩脉（燥邪所伤，异功散加当归，四君子汤加熟地黄，或者甘温甘润之剂都可以使用）
沉细脉（寒邪所伤，益黄散、养脾丸、理中汤，如果寒甚则加附子甘热之剂，都可以使用）
前项所定的方药乃是常道，如果变化则更改它。
脾胃不足，不同于其他脏腑，没有固定体性的缘故。治疗肝心肺肾，有余不足，或者补或者泻，只有益脾胃的药最为切要。经文说至而不至，这是不及，所胜之气妄行，所生之气受病，所不胜之气乘之。至而不至，是指从后来者为虚邪，心与小肠来乘脾胃。脾胃脉中见浮大而弦，其病或者烦躁闷乱，或者四肢发热，或者口苦舌干咽干。因为心主火，小肠主热，火热来乘土位，乃是湿热相合，所以烦躁闷乱。四肢者，脾胃也，火乘之，所以四肢发热。饮食不节，劳役所伤，以致脾胃虚弱，乃是血所生病，主管口中津液不行，所以口咽干。病患自以为渴，医者用五苓散治疗，说是止渴燥反而加重渴燥，乃是再次竭尽津液，以至于危亡。经文说：虚则补其母。应当于心与小肠中以补脾胃之根蒂，以甘温的药为主，以苦寒的药为使，以酸味的药为臣佐。因为心苦缓，急食酸以收敛之，心火旺则肺金受邪，金虚则以酸补之。其次用甘温及甘寒之剂，在脾胃中泻心火之亢盛，这是治其本。所胜妄行，是指心火旺能令母实。母者，肝木也。肝木旺则挟火之势，无所畏惧而妄行，所以脾胃先受之。或者身体沉重，走注疼痛，盖因热湿相搏，风热郁结不得伸展，附着于有形之物。或者多怒者，风热下陷于地中也。或者眼病而生内障者，脾裹血，胃主血，心主脉，脉者血之府也。或者说心主血，又说肝主血，肝之窍开于目。或者妄见妄闻，起妄心，夜梦亡人，四肢满闷转筋，都是肝木火盛而为邪。或者生痿，或者生痹，或者生厥，或者中风，或者生恶疮，作肾痿，或者上热下寒，为邪不一，都是风热不得生长，而木火遏于有形之中。所生受病，是说肺受土火木之邪，而清肃之气受伤。或者胸满少气短气者，肺主诸气，五脏之气皆不足，而阳道不行。或者咳嗽寒热者，湿热乘其内也。所不胜乘之，是水乘木之妄行，而反来侮土，所以肾火下亢，致使督任冲三脉盛，火旺煎熬，令水沸腾。而乘脾肺，所以痰涎唾出于口。下行为阴汗，为外肾冷，为足不任身，为脚下隐痛，或者水附木势而上，为眼涩，为眵，为冷泪。这都是由于肺金之虚，而寡于畏。夫脾胃不足，是火不能生土，而反抗拒。此至而不至，是为不及。
白术（君药） 人参（臣药） 甘草（佐药） 芍药（佐药） 黄连（使药） 黄芩（臣药） 桑白皮（佐药）
各种风药都是风能胜湿，各种甘温药也可以。
心火亢盛，乘于脾胃之位，也是至而不至，是为不及。
[The *Nan Jing*] There are diseases of the regular meridians originating from within (Zhengjing Zibing), and injuries caused by the Five Evils (Wu Xie). How can they be distinguished? The classics state: Worry and overthinking damage the Heart; exposure to cold and consumption of cold drinks damage the Lungs; anger with Qi rebelling upward and failing to descend damages the Liver; improper diet and fatigue damage the Spleen; sitting long in damp places or forcing oneself into water damages the Kidneys. These constitute diseases of the regular meridians originating from within. What are the Five Evils? They are Wind Strike (Zhong Feng), Summerheat Injury (Shang Shu), Diet and Fatigue (Yinshi Laojuan), Cold Damage (Shang Han), and Dampness Strike (Zhong Shi). This is what is meant by the Five Evils. Suppose a Heart disease occurs; how do we know it was caused by Wind Strike? The answer is that the complexion should be red. Why? The Liver governs colors. Its own color entering the Liver is green; entering the Heart is red; entering the Spleen is yellow; entering the Lungs is white; entering the Kidneys is black. Since the Liver acts as the "evil" (pathogenic factor) for the Heart, we know the complexion should be red. The symptoms include fever, fullness and pain in the hypochondrium, and a pulse that is floating, large, and wiry (Xian). How do we know it was caused by Summerheat Injury? The answer is that there should be aversion to odors. Why? The Heart governs odors. Its own odor entering the Heart is scorched; entering the Spleen is fragrant; entering the Liver is fishy/sour; entering the Kidneys is putrid; entering the Lungs is fishy. Thus, knowing the Heart disease is due to Summerheat Injury, there should be aversion to odors. The symptoms include fever and vexation, heart pain, and a pulse that is floating, large, and scattered (San). How do we know it was caused by Diet and Fatigue? The answer is that there should be a preference for bitter taste. Deficiency leads to anorexia, while excess leads to appetite. Why? The Spleen governs tastes. Entering the Liver is sour; entering the Heart is bitter; entering the Lungs is pungent; entering the Kidneys is salty; its own taste entering the Spleen is sweet. Therefore, when Spleen evil enters the Heart, it manifests as a preference for bitter taste. The symptoms include fever, heavy body, lethargy, flaccidity of the four limbs, and a pulse that is floating, large, and moderate (Huan). How do we know it was caused by Cold Damage? The answer is that there should be delirious speech. Why? The Lungs govern sounds. Its own sound entering the Lungs is crying; entering the Liver is calling out; entering the Heart is speaking; entering the Spleen is singing; entering the Kidneys is groaning. Thus, when Lung evil enters the Heart, it manifests as delirious speech. The symptoms include fever, chills, and severe coughing and wheezing, with a pulse that is floating, large, and choppy (Se). How do we know it was caused by Dampness Strike? The answer is that there should be spontaneous sweating that cannot stop. Why? The Kidneys govern fluids. Its own fluid entering the Kidneys is saliva; entering the Liver is tears; entering the Spleen is drool; entering the Lungs is nasal mucus. Thus, when Kidney evil enters the Heart, it manifests as unstoppable sweating. The symptoms include fever and pain in the Small Intestine, cold and reversal in the calves, and a pulse that is deep, soggy (Ru), and large. This is the method for distinguishing the Five Evils. (*Nan Jing*, Chapter 49)
The Liver governs colors, the Heart governs odors, the Spleen governs tastes, the Lungs govern sounds, and the Kidneys govern fluids. The Liver's color is green, its odor is fishy/sour, its taste is sour, its sound is calling out, its fluid is tears. The Heart's color is red, its odor is scorched, its taste is bitter, its sound is speaking, its fluid is sweat. The Spleen's color is yellow, its odor is fragrant, its taste is sweet, its sound is singing, its fluid is drool. The Lungs' color is white, its odor is fishy, its taste is pungent, its sound is crying, its fluid is nasal mucus. The Kidneys' color is black, its odor is putrid, its taste is salty, its sound is groaning, its fluid is saliva.
Diseases include Deficiency Evil (Xu Xie), Excess Evil (Shi Xie), Thief Evil (Ze Xie), Minor Evil (Wei Xie), and Regular Evil (Zheng Xie). How are they distinguished? Evil coming from the mother organ is Deficiency Evil; evil coming from the child organ is Excess Evil; evil coming from the organ that overcomes me is Thief Evil; evil coming from the organ I overcome is Minor Evil; and disease originating from the organ itself is Regular Evil. Why? Suppose a Heart disease occurs: Wind Strike (Wood generates Fire, Mother affecting Child) is Deficiency Evil; Summerheat Injury (Self-qi disease) is Regular Evil; Diet and Fatigue (Fire generates Earth, Child affecting Mother) is Excess Evil; Cold Damage (Water overcomes Fire, Overcomer attacking) is Minor Evil; Dampness Strike (Earth overcomes Water, here classified as Thief Evil per text logic) is Thief Evil. (*Nan Jing*, Chapter 50)
What does it mean for one pulse to transform into ten variations? It refers to the interaction of the Five Evils through Gang (Yang) and Rou (Yin) channels. For example, if the Heart pulse is extremely rapid/tight (Ji), it is Liver evil invading the Heart. If slightly rapid, it is Gallbladder evil invading the Small Intestine. If extremely large, it is Heart evil self-invading the Heart. If slightly large, it is Small Intestine evil self-invading the Small Intestine. If extremely moderate (Huan), it is Spleen evil invading the Heart. If slightly moderate, it is Stomach evil invading the Small Intestine. If extremely choppy (Se), it is Lung evil invading the Heart. If slightly choppy, it is Large Intestine evil invading the Small Intestine. If extremely deep (Chen), it is Kidney evil invading the Heart. If slightly deep, it is Bladder evil invading the Small Intestine. Each of the five Zang organs has Gang and Rou evils, thus causing one pulse to vary into ten types. (*Nan Jing*, Chapter 10)
[The *Ling Shu*] Huangdi asked: Please explain the pathological manifestations of the pulse qualities: Huan (moderate/relaxed), Ji (rapid/tight), Da (large), Xiao (small), Hua (slippery), and Se (choppy). Qibo replied: Allow me to discuss the pathological changes of the five Zang organs. An extremely Ji Heart pulse indicates convulsions (Yu Chu); a slightly Ji pulse indicates heart pain radiating to the back and inability to eat. (This refers to a red complexion with a hook-like and Ji pulse; other pulses follow this pattern). An extremely Huan Heart pulse indicates manic laughter; a slightly Huan pulse indicates Fu Liang disease (a mass below the heart moving up and down) with occasional hemoptysis. An extremely Da Heart pulse indicates throat obstruction (Hou Bi); a slightly Da pulse indicates Heart Bi with radiation to the back and excessive tearing. An extremely Xiao Heart pulse indicates frequent hiccups; a slightly Xiao pulse indicates Xiao Dan (wasting-thirst disease). An extremely Hua Heart pulse indicates excessive thirst; a slightly Hua pulse indicates Xin Han (heart hernia) radiating to the umbilicus with abdominal borborygmi. An extremely Se Heart pulse indicates aphonia; a slightly Se pulse indicates blood extravasation, limb reversal, tinnitus, and epilepsy.
An extremely Ji Lung pulse indicates epilepsy; a slightly Ji pulse indicates Lung cold-heat alternation, lethargy, coughing with blood, radiation to the lower back and chest, and nasal polyps obstructing airflow. (This refers to a white complexion with a hair-like and Ji pulse; other pulses follow this pattern). An extremely Huan Lung pulse indicates excessive sweating; a slightly Huan pulse indicates Wei Bi (flaccidity) and hemiplegia, with unstoppable sweating below the head. An extremely Da Lung pulse indicates calf swelling; a slightly Da pulse indicates Lung Bi radiating to the chest and back, with aversion to sunlight. An extremely Xiao Lung pulse indicates diarrhea; a slightly Xiao pulse indicates Xiao Dan. An extremely Hua Lung pulse indicates asthma and rebellious Qi; a slightly Hua pulse indicates bleeding from above and below. An extremely Se Lung pulse indicates hematemesis; a slightly Se pulse indicates Shu Liu (rat abscesses) in the neck and axilla, weakness of the lower limbs, and a sensation of sourness.
An extremely Ji Liver pulse indicates abusive speech; a slightly Ji pulse indicates Fei Qi disease in the hypochondrium, resembling an inverted cup. (This refers to a green complexion with a string-taut and Ji pulse; other pulses follow this pattern). An extremely Huan Liver pulse indicates frequent vomiting; a slightly Huan pulse indicates Shui Jia Bi (water accumulation bi syndrome). An extremely Da Liver pulse indicates internal abscesses with frequent vomiting and epistaxis; a slightly Da pulse indicates Gan Bi with genital retraction and cough radiating to the lower abdomen. An extremely Xiao Liver pulse indicates polydipsia; a slightly Xiao pulse indicates Xiao Dan. An extremely Hua Liver pulse indicates Shan Hernia; a slightly Hua pulse indicates enuresis. An extremely Se Liver pulse indicates Yi Yin (overflowing drinking/water retention); a slightly Se pulse indicates Jin Bi (tendon bi) with spasms.
An extremely Ji Spleen pulse indicates convulsions; a slightly Ji pulse indicates Ge Zhong disease, where food and drink are vomited immediately after ingestion, accompanied by foamy stools. An extremely Huan Spleen pulse indicates Wei Jue (flaccidity and cold limbs); a slightly Huan pulse indicates Feng Wei, with paralysis of the four limbs but a clear mind. An extremely Da Spleen pulse indicates sudden collapse; a slightly Da pulse indicates Hernia Qi with large amounts of pus and blood in the abdomen outside the intestines. An extremely Xiao Spleen pulse indicates alternating cold and heat; a slightly Xiao pulse indicates Xiao Dan. An extremely Hua Spleen pulse indicates Lin (difficulty/painful urination); a slightly Hua pulse indicates insect toxin or scorpion sting causing abdominal heat. An extremely Se Spleen pulse indicates Chang Pi (dysentery); a slightly Se pulse indicates Nei Yong (internal carbuncle) with purulent bloody stools.
An extremely Ji Kidney pulse indicates Gu Dian Ji (bone epilepsy); a slightly Ji pulse indicates Chen Jue Ben Tun (deep reversal and running piglet), inability to hold the feet, and urinary/fecal retention. (This refers to a black complexion with a stone-like and Ji pulse; other pulses follow this pattern). An extremely Huan Kidney pulse feels like a broken spine; a slightly Huan pulse indicates Dong Xie (hole diarrhea), where food is not digested and regurgitated upon swallowing. An extremely Da Kidney pulse indicates impotence; a slightly Da pulse indicates Shi Shui (stone water edema), swelling from the navel down to the lower abdomen extending to the stomach, which is fatal. An extremely Xiao Kidney pulse indicates Dong Xie; a slightly Xiao pulse indicates Xiao Dan. An extremely Hua Kidney pulse indicates Lin (urinary obstruction); a slightly Hua pulse indicates Gu Wei (bone flaccidity), difficulty sitting or standing, and blindness upon standing. An extremely Se Kidney pulse indicates large carbuncles; a slightly Se pulse indicates amenorrhea and chronic hemorrhoids. Huangdi asked: How should acupuncture treat these six variations of disease? Qibo answered: Ji pulses usually indicate cold; Huan pulses usually indicate heat; Da pulses usually indicate excess Qi and deficient Blood; Xiao pulses indicate deficiency of both Qi and Blood; Hua pulses indicate excess Yang Qi with slight heat; Se pulses indicate excess Blood and deficient Qi with slight cold. Therefore, for Ji pulses, needle deeply and retain for a long time. For Huan pulses, needle shallowly and withdraw quickly to dispel heat. For Da pulses, mildly drain Qi without releasing blood. For Hua pulses, withdraw quickly and needle shallowly to drain Yang Qi and heat. For Se pulses, ensure accurate penetration of the vessel, retain the needle for a long time following the flow direction, massage the area beforehand, and press the puncture site firmly after withdrawal to prevent bleeding and harmonize the pulse. For Xiao pulses, indicating deficiency of Yin-Yang, Form, and Qi, do not use needles but regulate with sweet medicines. (Note: Initially, Hua pulse was analyzed as excess Yin, but now stated as excess Yang; Se pulse as excess Yang, now stated as deficient Qi and excess Blood. These may interact and require further study. All above from *Ling Shu · Xie Qi Zang Fu Bing Xian*).
[Li Dongyuan] Suppose Liver disease presents as Excess Evil, with Wind and Heat combining. Wind is swift, Fire shakes and rotates the flame. The pulse is wiry, tight, and surging. Wind-Heat causing mania should be treated with Xiong Huang Tang.
Qiang Huo, Chuan Xiong, Da Huang (each 1 liang), Gan Cao (0.5 liang).
Cut into pieces. Take 0.5 liang per dose, boil in 2 cups of water until reduced to 0.6 cup, strain, and take warm.
For Deficiency Evil with Wind-Cold combining, Wood fears Water, leading to stiffness, spontaneous sweating, and a wiry, tight, deep pulse. Zhang Zhongjing states: Wind affecting the Taiyang channel transferring to Shaoyin is treated with Gui Zhi Jia Fu Zi Tang. For Thief Evil with Wind-Dryness combining, blood deficiency causes tendon contraction and skin cracking, with a wiry, floating, choppy pulse. Zhang Zhongjing states: Blood deficiency with tendon tension is treated with Gui Zhi Jia Gua Lou Tang. For Minor Evil with Wind-Dampness combining, heavy body and joint pain, visceral diarrhea, with a wiry, long, moderate pulse. Zhang Zhongjing states: Body pain with clear watery diarrhea requires urgent interior rescue with Si Ni Tang. For Regular Evil Wind Strike, dizziness, heavy head, inability to shout or rage, with a wiry, tight, long pulse. Zhang Zhongjing states: Severe cases resembling epilepsy/spasm should use Qiang Huo Tang. Materia Medica states: Qiang Huo treats epilepsy/spasm, with Fang Feng and Huang Qin as assistants.
Children suffer epilepsy; adults suffer spasm.
Suppose Heart disease presents as Excess Evil, with Heat and Dampness combining, causing mental confusion, vexation, steaming heat, and insomnia. The Spleen meridian connects to the Heart, and the Heart meridian originates from the Spleen; their connection creates Heat-Dampness. The pulse is floating, large, and moderate. The Foot Taiyin manifestation appears in the Hand Taiyang channel. Treat with Zhi Chi Tang. Add Hou Po and Zhi Shi for palpitations. For Deficiency Evil with Heat-Wind combining, hallucinations and auditory illusions, wind noise in ears, involving the Gallbladder and San Jiao meridians emerging from the ear. *Tong Ren* states: Bleed Guan Chong, drain Zhi Gou. Pulse floating, large, and wiry. Initially use Xiao Chai Hu Tang, then Da Chai Hu Tang. This is a Taiyang-Shaoyang combined disease, former pathogen and current host. For Thief Evil with Heat-Cold combining, timidity, heart hanging like hunger, fearfulness, involving Foot Shaoyin and Hand Jueyin connection, Water overcoming Heart Fire, causing spiritual fear. Pulse large, deep, and soggy, also in the Taiyang channel. *Nei Jing* states: Heart deficiency retains heat internally; treat with Huang Lian Fu Zi Xie Xin Tang. Treatment principle: If heat exceeds cold, use heat herbs as assistants; if cold exceeds heat, add Fu Zi and Gan Jiang as assistants. For Minor Evil with Heat-Dryness combining, excessive drinking and singing, actual heat-dryness (colloquially "joyful drinking"). Patient speaks of joy, which is vocal singing. "Meaning paste" implies silent singing. Pulse large, surging, and choppy. Treat with Bai Hu Tang. Add Ren Shen for asthma. For Regular Evil Heat, Yang depletion seeing ghosts, restlessness and madness, pulse surging and solid, 4 beats per breath (8 beats total). Treat with Xiao Cheng Qi Tang, assuming the abdomen is not hard or distended.
Suppose Lung disease presents as Excess Evil, with Dryness and Cold combining, piloerection, cool skin, frequent clear urination, short, choppy, deep pulse. In autumn/winter, use Ba Wei Wan; in spring/summer, use Di Huang Wan. For Deficiency Evil with Dryness-Dampness combining, mild asthma and palpitations, difficult defecation with phlegm, floating, choppy, moderate pulse. Treat with Zhi Shi Li Zhong Tang. Add Ren Shen for severe asthma; add Mu Xiang and Bing Lang (0.5 qian each, fine powder) with Li Zhong Wan for difficult defecation. For Thief Evil with Dryness-Heat combining, nasal congestion, rhinorrhea, epistaxis, pulse choppy and floating-large. Severe cases: Tao Ren Cheng Qi Tang; mild cases: Xi Jiao Di Huang Tang. Extreme cases: Di Dang Tang; mild cases: Di Dang Wan. For Minor Evil with Dryness-Wind combining, dry skin, brittle nails, blood and Qi deficiency, both organs deficient. Tonify blood first, then Qi. Pulse floating, choppy, wiry, and large. Use blood and Qi tonics. For Regular Evil Dryness self-disease, Qi stagnation belongs to the Lungs. Various dryness symptoms with sound, pulse floating, choppy, and short. Select various cough remedies.
Suppose Kidney disease presents as Excess Evil, Cold-Wind combining, failure to store, resulting in pure clear diarrhea, pulse deep, slippery, and wiry. Zhang Zhongjing states: Shaoyin syndrome with dry mouth/throat and pure clear diarrhea is treated with Da Cheng Qi Tang. Pulse deep, wiry, and slow with cold limbs: use Si Ni Tang etc. For Deficiency Evil with Cold-Clear combining, coughing with much phlegm/groaning, shivering cold insomnia, dryness transforming to clear, pulse deep, solid, and choppy. Treat with Suan Zao Ren Tang. For Thief Evil with Cold-Dampness combining, Kidney as the Gate of the Stomach, failure to control water overflow, water in Stomach causes edema, in Lungs causes asthma, and various syndromes. Pulse deep, moderate, and large. Zhang Zhongjing states: Post-illness edema below the waist is treated with Mu Li Ze Xie Tang. For Minor Evil with Cold-Heat combining, Bladder heat stagnation, dry fluids, pulse deep, soggy, and large. *Nei Jing* states: Water scarcity leads to dryness. Treat with Zhu Ling Tang. For Regular Evil Cold self-disease, Cold anger storing, Hei Bi Jing Chen, pulse deep, soggy, and slippery. Use Hei Bi Tian Ma Wan. If symptoms match but pulse differs, mild is Fu disease, severe is Zang disease.
Suppose Spleen disease presents as Excess Evil, Damp-Dryness combining, dry feces in Stomach, abdominal fullness and hard pain, moderate, long, choppy pulse. This is Zheng Yang Yangming syndrome. Treat with Tiao Wei Cheng Qi Tang. For Deficiency Evil with Heat-Dampness combining, heat sinking into Stomach, intestinal bleeding, moderate, large pulse. Treat with Huang Lian Jie Du Tang. For Thief Evil with Damp-Wind combining, vomiting, rib pain, alternating cold/heat, moderate, wiry, long pulse. Treat with Xiao Chai Hu Tang. For Minor Evil with Damp-Cold combining, cold seeking damp, jaundice without heat, heavy body without thirst, called Cold-Damp. Pulse moderate, deep, and slippery. Treat with Shu Fu Tang. Add Fu Ling for difficult urination. For Regular Evil Damp self-disease, abdominal fullness and intermittent pain, warm extremities, deep, choppy, long pulse. Deficiency pain: Gui Zhi Jia Shao Yao Tang; Excess pain: Gui Zhi Jia Da Huang Tang.
The Stomach is the Sea of the Twelve Meridians; all meridians receive Qi and Blood to nourish the body. The Spleen receives from the Stomach to circulate Qi and Blood. If Spleen-Stomach is deficient, evils from the Twelve Meridians emerge differently. If unable to eat and muscles waste, this is the root disease. Right Guan pulse is moderate and weak, the local pulse. If local pulse shows wiry quality, or limb fullness/closure, dysuria, or tetany, this is Liver affecting Spleen-Stomach. Add wind-dispelling herbs to local formulas. If local pulse shows surging-large quality, or muscle heat/vexation/red face/anorexia/muscle wasting, this is Heart affecting Spleen-Stomach. Add fire-draining herbs. If local pulse shows floating-choppy quality, or shortness of breath/rebellious Qi/cough/phlegm/dry skin, this is Lung affecting Spleen-Stomach. Drain Lung evil and tonify Qi. If local pulse shows deep-fine quality, or fearfulness/yawning, this is Kidney affecting Spleen-Stomach. Drain floating Kidney Water and hidden Yin Fire.
Wiry pulse (Wind evil): Gan Cao, Shao Yao, Huang Qi Jian Zhong Tang, or sweet-sour agents.
Surging pulse (Heat evil): San Huang Wan, Xie Huang San, Tiao Wei Cheng Qi Tang, or sweet-cold agents.
Moderate pulse at Right Guan (Spleen-Stomach) (Excess local, Damp evil): Ping Wei San + Bai Zhu, Fu Ling; Wu Ling San; or damp-draining agents.
Choppy pulse (Dryness evil): Yi Gong San + Dang Gui; Si Jun Zi Tang + Shu Di Huang; or sweet-warm/sweet-moist agents.
Deep-fine pulse (Cold evil): Yi Huang San, Yang Pi Wan, Li Zhong Tang. If severe cold, add Fu Zi (sweet-hot agents).
These are standard prescriptions; modify if conditions change.
Spleen-Stomach deficiency differs from other organs due to lack of fixed form. Treating Liver, Heart, Lung, Kidney excess/deficiency via tonification/draining is less direct than benefiting Spleen-Stomach. Classics state: "Arriving but not arriving" is insufficiency. The overcoming element acts recklessly, the generated element suffers, the overcoming element invades. "Arriving but not arriving" refers to Deficiency Evil from later (Mother/Subsequent) organs: Heart and Small Intestine invading Spleen-Stomach. Pulse floating-large and wiry. Symptoms: vexation/confusion, limb heat, bitter taste, dry tongue/throat. Heart governs Fire, Small Intestine governs Heat. Fire-Heat invading Earth creates Heat-Dampness, causing vexation. Limbs belong to Spleen-Stomach; Fire invasion causes limb heat. Improper diet/labor damages Spleen-Stomach, affecting Blood generation and fluid transport, causing dry mouth/throat. Patients feel thirsty; doctors using Wu Ling San to stop thirst may worsen it by depleting fluids further, leading to danger. Classics say: "Deficiency tonifies the Mother." Tonify Spleen-Stomach roots via Heart/Small Intestion. Use sweet-warm as Sovereign, bitter-cold as Envoy, sour as Ministers/Assistants. Heart dislikes laxity; sour astringes. Heart Fire excess harms Lung Metal; sour tonifies Metal. Then use sweet-warm/cold in Spleen-Stomach to drain Heart Fire excess, treating the root. "Overcoming element acting recklessly" means Heart Fire excess makes Mother (Liver Wood) solid. Liver Wood excess carries Fire, acting recklessly, harming Spleen first. Symptoms: heavy body, migrating pain (Heat-Damp friction, Wind-Heat depression attaching to form). Anger (Wind-Heat sinking). Eye cataracts (Spleen wraps blood, Stomach governs blood, Heart governs vessels/blood house; Liver opens to eyes). Hallucinations, bad dreams, limb fullness/tetany: all Liver Wood-Fire excess. Flaccidity, Bi, Jue, Wind Stroke, sores, Kidney flaccidity, upper heat/lower cold: all Wind-Heat failure to grow, Wood-Fire suppression in form. "Generated element suffering" means Lung suffers Earth/Fire/Wood evils, damaging clear-descending Qi. Chest fullness/shortness of breath (Lung governs Qi, all Zang Qi deficient, Yang pathway blocked). Cough/cold-heat (Heat-Damp invading internally). "Overcoming element invading" means Water follows Wood's reckless action, insulting Earth. Kidney Fire rises, stimulating Du, Ren, Chong meridians. Fire boils Water, invading Spleen-Lung, causing salivation. Downward: Yin sweat, cold external genitals, leg weakness, foot pain. Upward with Wood: dry eyes, discharge, cold tears. All due to Lung Metal deficiency and lack of restraint. Spleen-Stomach deficiency is Fire failing to generate Earth, leading to resistance. This "arriving but not arriving" is insufficiency.
Bai Zhu (Sovereign), Ren Shen (Minister), Gan Cao (Assistant), Shao Yao (Assistant), Huang Lian (Envoy), Huang Qin (Minister), Sang Bai Pi (Assistant).
All wind herbs disperse dampness; all sweet-warm herbs work too.
Heart Fire excess invading Spleen-Stomach position is also "arriving but not arriving," i.e., insufficiency.