麻子仁二升 芍药半筋 枳实一筋 大黄一筋 厚朴一尺 杏仁一升
右六味，末之；炼蜜为丸，梧子大，饮服十丸，日三，以知为度。
@@@
肾着之病，其人身体重，腰中冷，如坐水中，形如水状，反不渴，小便自利，饮食如
故，病属下焦，身劳汗出，衣里冷湿，久久得之，腰以下冷痛，腹重如带五千钱，干
姜苓术汤主之。
【按】
肾缺中风、中寒二条，必是简脱。
【注】
肾着者，谓肾为寒湿所伤，□而不行之为病也。肾受寒湿，故体重腰冷，如坐水中，
虽形如水肿之状。反不渴而小便自利，非水也，乃湿也。饮食如故，以病属下焦肾，
而不属中焦脾故也。询其所以得之之由，身劳汗出，衣里冷湿，久久伤之也，是以腰
下冷痛寒胜也。腹重，湿胜也。如带五千钱，形容重着之甚也。以甘姜苓术汤补土以
制水，散寒以渗湿也。
【集注】
尤怡曰：其病不在肾之中藏，而在肾之外府，故其治不在温肾以散寒，而在燠土以胜
水也。
甘草二两 白术二两 干姜四两 茯苓四两
右四味，以水五升，煮取三升，分温三服，腰中即温。
@@@
肾死藏，浮之坚，按之乱如转丸，益下入尺中者，死。
【注】
肾中风寒之邪，若见浮之极坚，按之乱动有如转丸，及下入尺中，通然乱动，皆肾死
真藏之脉也。
【集注】
程林曰：肾藏死，浮之坚，与『内经』辟辟如弹石曰肾死同意，皆坚之象也。按之则
乱如转丸，下入尺中者，此阴阳离决之状也，故死。以上真藏与『内经』互有异同。
总之脉无胃气，现于三部中，脉象形容不一也。
@@@
问曰：三焦竭部，上焦竭，善噫，何谓也？师曰：上焦受中焦气，未和，不能消谷，
故能噫耳。下焦竭，即遗溺失便，其气不和，不能自禁制，不须治，久则愈。
【注】
三焦竭部者，谓三焦因虚竭而不各归其部，不相为用也。上焦受气于中焦，下焦生气
于中焦，互相为用则为和也。若中焦虚竭，不能消化水谷，谷气不受，则上焦不相为
用而失和也，失和则谷气郁而不宣，故善噫也。下焦虚竭，不能供升生之气于中焦，
则失和也。失和则肾气独沉，自不能禁，故前遗溺而后失便也。不须治，久则愈，在
善噫可也。若遗溺失便，未有不治能愈者，恐是错简。
【集注】
程林曰：竭虚也。『本经』云：三焦不归其部，上焦不归者，噫而酢吞；中焦不归者
，不能消谷引食；下焦不归者，则遗溲。上焦胃上口也，中焦脾也，脾善噫，脾不和
，则食息迫逆于胃口而为噫也。经云，膀胱不约为遗溺，因气不和则溲便不约。故遗
失而不能自禁制也。
@@@
师曰：热在上焦者，因咳为肺痿；热在中焦者，则为坚；热在下焦者，则尿血，亦令
淋秘不通。大肠有寒者，多鹜溏；有热者，便肠垢；小肠有寒者，其人下重便血，有
热者必痔。
【注】
热在上焦者，篇中所谓肺痿吐涎沫也；热在中焦者，篇中所谓腹满坚痛也；热在下焦
者，篇中所谓小便淋沥也。其外大肠有寒者，多清澈鹜溏，即下利溏泻也。有热者，
便稠粘肠垢，即下利脓血也。小肠有寒者，下重便血，即结阴便血也。有热者，热流
于大肠，蓄于肛门必病痔也。
【集注】
徐彬曰：小肠为受盛之官，与心为表里。丙，小肠也。挟火以济阴，而阴不滞，挟气
以化血，而血归经，有寒则气不上通而下重，血无主气而妄行矣。直肠者，大肠之头
也，门为肛，小肠有热，则大肠传导其热，而气结于肛门故痔。痔者，滞其丙小肠之
热于此也。
@@@
问曰：病有积、有聚、有□气，何谓也？师曰：积者，藏病也，终不移。聚者，府病
也，发作有时，展转痛移，为可治。□气者，□下痛，按之则愈，复发为□气。诸积
大法：脉来细而附骨者，乃积也。寸口积在胸中，微出寸口，积在喉中；关上积在脐
傍，上关上，积在心下；微下关，积在少腹。尺中积在气冲，脉出左，积在左；脉出
右，积在右；脉两出，积在中央，各以其部处之。（□作漀解见首篇）
【注】
病有积、有聚、有漀气，当别之也。积者藏病，无时不有，不移其处也。聚者府病，
发作有时，展转痛移也。为可治，谓府病易治也。漀深者，饮积□下痛也，按之则止
，不按复痛。以水气得按暂散，故痛暂止也，此即其证而言之。然诸积大法，尤当以
诊候之也，脉来沉伏附骨而细者，乃诸积之诊也。若见两寸，积在胸中也；微出近鱼
际，积在喉中也；两关，积在脐傍也；上关近寸，积在心下也；微下近尺，积在少腹
也；尺中，积在气冲也；脉出左、积在左，脉出右、积在右；脉两出，谓左右俱见，
积在中央也。各以其部之处，而诊积之所在也。
【集注】
徐彬曰：积者迹也，病气之属阴者也。藏属阴，两阴相得，故不移，不移者，有专痛
之处，而无迁改也。聚则如市井之物，偶聚而已，病气之属阳者也。府属阳，两阳相
比，则非如阴之凝，故寒气感则发，否则已。所谓有时也，既无定□，则痛无常处，
故展转痛移，其根不深，故比积为可治也。
李□曰：积为藏病，深入在里，故脉细而附骨也。寸、关、尺、上下、左右，别积病
之所在，皆指细而附骨之部分，即『内经』前以候前，后以候后，上竟上者，胸喉中
事也；下竟下者，少腹腰股膝胫足中事也。
麻子仁二升，芍药半斤，枳实半斤，大黄半斤，厚朴一尺，杏仁一升。
以上六味药，研成细末；用炼蜜制成丸药，大小如梧桐子，每次用水送服十丸，每日三次，以见效为度。
肾着病，患者身体沉重，腰部发冷，如同坐在水中，外形看似水肿，反而不口渴，小便通畅正常，饮食如常。此病属于下焦，因身体劳累出汗后，衣物里层寒冷潮湿，日久积累而成，表现为腰以下冷痛，腹部沉重如同系着五千枚铜钱，用甘草干姜茯苓白术汤主治。
【按语】
关于肾脏感受风邪、寒邪的两条内容，必定是简册脱漏所致。
【注解】
所谓肾着病，是指肾脏被寒湿所伤，气机阻滞而不运行导致的疾病。肾脏受寒湿侵袭，所以身体沉重、腰部发冷，如同坐在水中，虽然外形像水肿的样子，但反而不渴且小便通利，这不是水饮病，而是湿邪作祟。饮食如常，是因为病位在下焦的肾脏，而不在中焦的脾脏。询问其得病的原因，是因为身体劳累出汗，衣内冷湿，日久损伤所致，因此腰以下冷痛是由于寒邪偏盛。腹部沉重，是由于湿邪偏盛。“如带五千钱”，是形容重着感非常严重。用甘姜苓术汤（即甘草干姜茯苓白术汤）来补益脾土以制约肾水，散除寒邪以渗泄湿邪。
【集注】
尤怡说：此病不在肾脏的内部脏腑，而在肾脏的外在府部（腰部），所以治疗不在于温补肾阳以散寒，而在于温暖脾土以胜水。
甘草二两，白术二两，干姜四两，茯苓四两。
以上四味药，用水五升，煎煮取汁三升，分三次温服，腰部就会感到温暖。
@@@
肾脏的真脏脉若呈现死象，轻取时坚硬，重按时杂乱无章如同转动的丸子，且脉动向下延伸至尺部，这是死证。
【注解】
肾脏感受风寒之邪，如果见到轻取极坚，重按时乱动有如转丸，以及脉气下入尺部，通通乱动，这都是肾脏真脏脉现的死象。
【集注】
程林说：肾脏真脏脉见死候，轻取坚硬，与《内经》中“辟辟如弹石”称为肾死是相同的，都是坚硬的征象。重按时则乱如转丸，脉气下入尺部，这是阴阳离决的状态，所以主死。以上的真脏脉与《内经》互有异同。总之，脉象没有胃气，显现于三部之中，脉象的描述各不相同。
@@@
问：三焦的功能衰竭分部，上焦功能衰竭，容易嗳气，这是什么意思？老师说：上焦接受中焦的气，如果中焦不和，不能消化谷物，所以就会嗳气。下焦功能衰竭，就会出现遗尿和大便失禁，这是因为气机不和，不能自我控制，不需要特别治疗，时间久了自然会痊愈。
【注解】
所谓三焦功能衰竭分部，是指三焦因为虚损衰竭而不能各自归位发挥功用，不相配合。上焦之气来源于中焦，下焦之气也生于中焦，互相配合就是和谐。如果中焦虚损衰竭，不能消化水谷，谷气无法受纳，那么上焦就不能发挥作用而失去和谐，失去和谐则谷气郁结不能宣散，所以容易嗳气。下焦虚损衰竭，不能向上供给生发之气到中焦，也就失去了和谐。失去和谐则肾气独沉，自身不能禁止，所以前边遗尿后边大便失禁。说不需要治疗，时间久了会好，这对于嗳气的情况是可以的。如果是遗尿和大便失禁，没有不治疗就能痊愈的，恐怕是简册错乱。
【集注】
程林说：竭就是虚损。《本经》说：三焦不归其部位，上焦不归者，会嗳气并伴有酸水吞逆；中焦不归者，不能消化谷物引导食物；下焦不归者，则会遗尿失禁。上焦对应胃的上口，中焦对应脾，脾容易嗳气，脾不和，则食息迫逆于胃口而产生嗳气。经文说，膀胱约束无力导致遗尿，因为气机不和则小便大便约束无力。所以遗尿失禁而不能自我控制。
@@@
老师说：热邪在上焦的，因咳嗽导致肺痿；热邪在中焦的，则会导致大便干结坚硬；热邪在下焦的，则会导致尿血，也会引起淋证和小便闭塞不通。大肠有寒邪的，多呈鸭溏样稀便；有热邪的，则排出粘稠的肠垢；小肠有寒邪的，患者会出现肛门坠重并便血，有热邪的必然患痔疮。
【注解】
热邪在上焦的，即篇中所说的肺痿吐涎沫；热邪在中焦的，即篇中所说的腹部胀满坚硬疼痛；热邪在下焦的，即篇中所说的小便淋漓不畅。此外，大肠有寒邪的，多为清澈的鸭溏，也就是腹泻稀便。有热邪的，排出稠粘的肠垢，也就是痢疾脓血。小肠有寒邪的，肛门坠重便血，也就是结阴便血。有热邪的，热流注于大肠，蓄积于肛门必然发生痔疮。
【集注】
徐彬说：小肠是受盛之官，与心互为表里。丙火对应小肠。小肠挟持火气以济助阴液，使阴液不凝滞；挟持气机以化生血液，使血液回归经脉。有寒邪则气机不能上行通畅而下坠，血液失去主气的统摄而妄行。直肠是大肠的头部，肛门是门户，小肠有热，则大肠传导其热，气结聚于肛门故生痔疮。痔，就是丙火小肠的热邪滞留于此。
@@@
问：疾病有积、有聚、有漀气，是什么意思？老师说：积，是五脏的病，始终位置不移。聚，是六腑的病，发作有定时，疼痛辗转移动，是可以治疗的。漀气，是胁下疼痛，按压后疼痛缓解，复发时又成为漀气。各种积病的诊断大法：脉象来势细小且依附于骨骼的，乃是积病。寸口脉出现积象，积在胸中，微超出寸口，积在喉中；关上脉出现积象，积在脐旁，上至关上，积在心下；微低于关部，积在少腹。尺中脉出现积象，积在气冲穴处，脉象出现在左手，积在左侧；脉象出现在右手，积在右侧；脉象左右都出现，积在中央，分别根据脉出现的部位来判断积的位置。（“□”字作“漀”解，详见首篇）
【注解】
疾病有积、有聚、有漀气，应当加以辨别。积是五脏的病，无时无刻不存在，位置不移动。聚是六腑的病，发作有定时，疼痛辗转移动。说是可治，是指六腑病容易治疗。漀气深在，是水饮积聚在胁下疼痛，按压则停止，不按又痛。因为水气得按压暂时消散，所以疼痛暂时停止，这是从症状而言。然而各种积病的大法，尤其应当通过诊察脉象来确定。脉来沉伏附骨而细的，乃是各种积病的脉象。如果在两寸部见到，积在胸中；微出近鱼际，积在喉中；两关部见到，积在脐旁；上至关部近寸口，积在心下；微下近尺部，积在少腹；尺中部见到，积在气冲穴处；脉象出现在左，积在左边；脉象出现在右，积在右边；脉象左右都出现，谓左右俱见，积在中央。分别根据其所在的部位，来诊察积病所在的地方。
【集注】
徐彬说：积就是痕迹，病气属于阴类。五脏属阴，两阴相合，所以位置不移，不移者，有固定的痛点，而没有迁移改变。聚则像集市上的货物，偶然聚集而已，病气属于阳类。六腑属阳，两阳相比，则不像阴那样凝结，所以感受寒气则发作，否则就停止。所谓发作有时。既然没有固定的形状，则疼痛没有固定处所，所以疼痛辗转移动，其根不深，所以比积病更容易治疗。
李□说：积是五脏的病，深入在体内，所以脉象细而附骨。寸、关、尺、上下、左右，用来辨别积病所在的位置，都是指细而附骨的脉象部分，即《内经》所说的以前候前，以后候后，上竟上者，是胸喉中的事；下竟下者，是少腹腰股膝胫足中的事。
Hemp Seed (Cannabis Fructus) two sheng, White Peony Root (Paeoniae Radix Alba) half jin, Immature Bitter Orange (Aurantii Fructus Immaturus) half jin, Rhubarb (Rhei Radix et Rhizoma) half jin, Magnolia Bark (Magnoliae Officinalis Cortex) one chi, Apricot Seed (Armeniacae Semen) one sheng.
The above six herbs are ground into fine powder; honey is refined to make pills, sized like sophora seeds. Take ten pills with water each time, three times a day, until the desired effect is achieved.
Kidney Fixation Disease: The patient's body feels heavy, the waist is cold, as if sitting in water. The appearance resembles edema, yet there is no thirst, urination is normal and free, and appetite remains unchanged. This disease belongs to the Lower Jiao. It arises from physical exertion causing sweating, followed by cold and dampness penetrating the inner layer of clothing over a long period. Symptoms include cold pain below the waist and abdominal heaviness as if bound with five thousand coins. Gan Jiang Ling Zhu Tang (Licorice, Dried Ginger, Poria, and Atractylodes Macrocephala Decoction) is the primary treatment.
[Note]
The two clauses regarding Kidney contracting Wind and Cold must be omissions due to bamboo slip damage.
[Annotation]
"Kidney Fixation" refers to an illness caused by the Kidney being injured by Cold-Dampness, leading to stagnation and failure of Qi movement. Because the Kidney is affected by Cold-Dampness, the body feels heavy and the waist is cold, resembling sitting in water. Although it looks like edema, the absence of thirst and normal urination indicate this is not Water retention but Dampness. Appetite remains normal because the pathology is in the Lower Jiao (Kidney) rather than the Middle Jiao (Spleen). Regarding the cause: physical exertion leads to sweating, allowing cold and dampness from clothing to penetrate over time, resulting in cold pain below the waist due to excess Cold. Abdominal heaviness is due to excess Dampness. "As if bound with five thousand coins" describes the severe sensation of heaviness. Gan Jiang Ling Zhu Tang tonifies Earth (Spleen) to control Water (Kidney) and disperses Cold to leach out Dampness.
[Collected Notes]
You Yi stated: The disease is not in the internal organs of the Kidney itself, but in its external mansion (the lower back). Therefore, treatment does not focus on warming the Kidney to disperse Cold, but on warming Earth (Spleen) to overcome Water.
Licorice Root (Glycyrrhizae Radix et Rhizoma) two liang, Atractylodes Macrocephala Rhizome (Atractylodis Macrocephalae Rhizoma) two liang, Dried Ginger (Zingiberis Rhizoma) four liang, Poria (Poria) four liang.
The above four herbs are boiled in five sheng of water to obtain three sheng of decoction. Divide into three warm doses. The waist will feel warm.
@@@
If the Kidney's True Organ Pulse exhibits death signs, light pressure reveals hardness, while heavy pressure feels chaotic like rolling balls, extending downward into the Chi position, this indicates a fatal prognosis.
[Annotation]
When the Kidney is invaded by Wind-Cold pathogens, if the pulse is extremely hard upon light pressure, chaotic and rolling-like upon heavy pressure, and extends chaotically into the Chi position, these are all signs of the Kidney's True Organ Pulse appearing, indicating death.
[Collected Notes]
Cheng Lin stated: The death sign of the Kidney's True Organ pulse, being hard upon light pressure, agrees with the *Nei Jing* description of "pi pi like striking stones," both indicating hardness. Chaotic rolling upon heavy pressure and extension into the Chi position represent the separation of Yin and Yang, hence death. The True Organ pulses described here differ slightly from those in the *Nei Jing*. In summary, the absence of Stomach Qi manifested in the three positions results in varied descriptions of pulse images.
@@@
Question: What does it mean when the functional zones of the San Jiao fail? If the Upper Jiao fails, frequent belching occurs. Why? Master said: The Upper Jiao receives Qi from the Middle Jiao. If the Middle Jiao is disharmonious and cannot digest grains, belching ensues. If the Lower Jiao fails, urinary incontinence and fecal incontinence occur because the Qi is disharmonious and cannot self-regulate. No specific treatment is needed; it will heal after a long time.
[Annotation]
"San Jiao functional zone failure" means that due to deficiency and exhaustion, the San Jiao cannot return to its respective zones to function, failing to support each other. The Upper Jiao receives Qi from the Middle Jiao, and the Lower Jiao generates Qi from the Middle Jiao; mutual support constitutes harmony. If the Middle Jiao is deficient and exhausted, unable to digest food and fluids, Grain Qi is not received. Consequently, the Upper Jiao cannot function properly and becomes disharmonious. Disharmony causes Grain Qi to stagnate and fail to diffuse, leading to frequent belching. If the Lower Jiao is deficient and exhausted, it cannot supply ascending and generating Qi to the Middle Jiao, leading to disharmony. Disharmony causes Kidney Qi to sink exclusively, losing self-control, resulting in anterior urinary incontinence and posterior fecal incontinence. Saying "no treatment needed, heals over time" applies to belching. However, for urinary and fecal incontinence, healing without treatment is unlikely; this may be a textual error.
[Collected Notes]
Cheng Lin stated: "Jie" means deficiency. The *Ben Jing* states: When the San Jiao does not return to its parts, if the Upper Jiao does not return, there is belching and acid regurgitation; if the Middle Jiao does not return, digestion and food intake are impaired; if the Lower Jiao does not return, there is urinary incontinence. The Upper Jiao corresponds to the upper orifice of the Stomach, the Middle Jiao to the Spleen. The Spleen tends to belch; when the Spleen is disharmonious, food and breath rush backward to the stomach orifice, causing belching. The classic states that bladder lack of constraint causes urinary incontinence; due to Qi disharmony, urine and stool lack constraint. Thus, incontinence occurs without self-control.
@@@
Master said: Heat in the Upper Jiao causes Lung萎 (Lung Atrophy) via coughing; Heat in the Middle Jiao leads to firmness (constipation); Heat in the Lower Jiao causes hematuria and also induces strangury and urinary obstruction. Cold in the Large Intestine results in many duck-dung-like loose stools; Heat in the Large Intestine results in sticky intestinal mucus. Cold in the Small Intestine causes bearing-down sensation and bloody stools; Heat in the Small Intestine inevitably leads to hemorrhoids.
[Annotation]
Heat in the Upper Jiao refers to Lung Atrophy with salivary foam mentioned earlier; Heat in the Middle Jiao refers to abdominal fullness, firmness, and pain; Heat in the Lower Jiao refers to dribbling urination. Externally, Cold in the Large Intestine causes clear, duck-dung-like loose stools (diarrhea). Heat causes sticky, viscous intestinal mucus (dysentery with pus and blood). Cold in the Small Intestine causes bearing-down and bloody stools (Yin-binding bloody stools). Heat flowing into the Large Intestine and accumulating in the anus inevitably causes hemorrhoids.
[Collected Notes]
Xu Bin stated: The Small Intestine is the Official of Reception and Transformation, interior-exterior related to the Heart. Bing Fire corresponds to the Small Intestine. It carries Fire to nourish Yin, preventing Yin stagnation; it carries Qi to transform Blood, ensuring Blood returns to its vessels. Cold prevents Qi from ascending smoothly, causing bearing-down; without Qi mastery, Blood wanders recklessly. The rectum is the head of the Large Intestine, and the anus is the gate. Heat in the Small Intestine is transmitted by the Large Intestine, causing Qi to knot at the anus, thus forming hemorrhoids. Hemorrhoids are the stagnation of Bing Small Intestine Heat in this location.
@@@
Question: Diseases include Ji (Accumulation), Ju (Aggregate), and Qi (Qi Distension). What do these mean? Master said: Ji is a Zang organ disease, fixed in place and unchanging. Ju is a Fu organ disease, occurring at intervals, with pain shifting around; it is treatable. Qi Distension involves pain under the hypochondrium, which relieves upon pressure but recurs; this is Qi Distension. The general principle for diagnosing Ji: A pulse that is thin and adheres closely to the bone indicates Ji. If the pulse appears at the Cun position, the accumulation is in the chest; slightly beyond Cun, in the throat; at the Guan position, beside the umbilicus; slightly above Guan, in the epigastrium; slightly below Guan, in the lower abdomen. At the Chi position, the accumulation is at the Qichong point. If the pulse appears on the left, the accumulation is on the left; if on the right, on the right; if on both sides, in the center. Diagnose the location of the accumulation according to the pulse position. (The character "□" is interpreted as "Qi", see the first chapter).
[Annotation]
Diseases include Ji, Ju, and Qi; they must be distinguished. Ji is a Zang disease, always present, without positional change. Ju is a Fu disease, occurring intermittently, with migrating pain. "Treatable" means Fu diseases are easier to treat. Deep Qi involves fluid accumulation causing pain under the hypochondrium; pressing stops the pain, releasing brings it back. Fluid Qi dissipates temporarily upon pressure, so pain stops temporarily; this describes the symptoms. However, the general principle for Ji relies heavily on pulse diagnosis. A pulse that is deep, hidden, adheres to the bone, and is thin indicates various accumulations. If seen at both Cun positions, accumulation is in the chest; slightly beyond near the radial styloid process, in the throat; at both Guan positions, beside the umbilicus; slightly above Guan near Cun, in the epigastrium; slightly below near Chi, in the lower abdomen; at the Chi position, at the Qichong point. Pulse on the left indicates accumulation on the left; pulse on the right indicates accumulation on the right; pulse on both sides indicates accumulation in the center. One diagnoses the location of the accumulation based on these positions.
[Collected Notes]
Xu Bin stated: Ji implies traces; pathogenic Qi belongs to Yin. Zang organs belong to Yin; two Yins combine, hence immobility. Immobile means there is a specific painful spot without migration. Ju is like goods in a market, gathering occasionally; pathogenic Qi belongs to Yang. Fu organs belong to Yang; two Yangs compare, unlike Yin's coagulation. Thus, Cold sensation triggers onset, otherwise cessation. Hence "occasional." Without fixed shape, pain has no fixed location, hence migrating pain. Its root is shallow, making it more treatable than Ji.
Li [Name Missing] stated: Ji is a Zang disease, deep inside, hence the pulse is thin and adheres to the bone. Cun, Guan, Chi, up, down, left, right distinguish the location of Ji. All refer to the specific parts where the thin, bone-adhering pulse is felt, consistent with the *Nei Jing*: "Front to front, back to back; top to top concerns chest and throat; bottom to bottom concerns lower abdomen, waist, thighs, knees, shins, and feet."