中身者外而胸胁腹背脊脐内而五脏六腑一有所病统属于中原其病之所起必有所因外因者
由于春
之风夏之热暑长夏之湿秋之燥冬之寒也当其时而至则为正气非其时而至或过盛则为淫邪凡此
六淫为病皆属外因亦有因于八风相感如冬至日正北大刚风立春日东北凶风春分日正东婴儿风
立夏日东南弱风夏至日正南大弱风立秋日西南谋风秋分日正西刚风立冬日西北折风应时而至
主生养万物不应时而至主杀害万物若人感受内生重病外生痈疽凡此八风为病亦属外因故曰外
因六淫八风感也内因者起于耳听淫声眼观邪色鼻闻恶臭舌贪滋味心思过度意念妄生皆损人神
凡此六欲为病皆属内因又有喜过伤心怒过伤肝思过伤脾悲过伤肺恐过伤肾忧久则气结卒惊则
气缩凡此七情为病亦属内因故曰内因六欲共七情也不内外因者由于饮食不节起居不慎过饮醇
酒则生火消灼阴液过饮茶水则生湿停饮过食五辛则损气血伤饥失饱则伤脾胃凡此皆饮食之致
病也昼日过劳挑轻负重跌扑闪堕等类损其身形夜不静息强力入房劳伤精气凡此皆起居之致病
也其有起于膏粱浓味者多令人荣卫不从火毒内结起于藜藿薄食者多令人肾气不充气血亏少凡
此亦属不内外因也夫民病百千变化其受病之原皆不出于三因兹集前后证略数则非三因之外别
有致病之由盖以病有类集治有攸分故为辨别科条缕析名目逐症分疏于后俾施治者明于辨症而
无所疑惑焉
一胸为肺分心脾肾肝胆胞络七经之筋脉俱上至胸胸满短气阳实喘促不卧虚满则心下痞而
不痛
胸痛者多属肝之虚痛引胁背肝实不能转侧善太息余经能令胸满短气而亦不痛仲景云胸痹
心下
痞留气结在胸胸满胁下逆抢心非若中满者外有腹胀之形也鸡胸乃属肺病胀满有痰肺热也胀满
无痰肺虚也皆胸膈高起故名鸡胸
一胁痛有左右之分左右者阴阳之道路也左为肝肝主血血留止滞则左痛右为肺肺主气肝邪
入
肺气不流通则右痛然亦有左痛不专主于血右痛不专于气但按之痛不按亦痛者血也膨痛时止
嗳
即宽畅少时复痛者气也若痰食致痛皆在右胁必有痰食之症与气血凝滞不同明者自辨更有房劳
过度肾虚羸怯之人胸胁间多隐隐微痛此肾虚不能纳气气虚不能生血阴阳循行之道有阻滞所以
作痛若不知正本寻源而执一不化则犯虚虚之戒矣
一腹坚硬是由脾阳下陷浊阴之气乘之按之如石亦不痛但苦胀满气结饮食不化小儿多有此
症
大抵寒则收引或因伤食而成若有块硬痛是虫痛也又有冲脉为痛气溢于大肠绕脐而痛有脾伤传
肾少腹冤然而痛故曰绕脐痛大肠病也脐下冷痛者肾病也
一腰背痛经云巨阳虚则头项腰背痛又曰足之三阳从头走足足之三阴从足走腹诸经所过皆
能为
痛有风寒湿热挫闪瘀血气滞痰积由外以致内者标病也若房室劳伤肾虚而痛者本病也腰者肾之
府转摇不能肾将败矣肩背分野属肺喘咳逆气肩背痛肺燥也当肩背一片冷痛此有痰饮气积故也
背心红肿痛者风热也红属火邪肿为风胜经云岁火太过民病肩背热按背心为督脉循行部分督脉
贯脊络肾风气从风府而下积而化热故取肩井肺俞之穴灸而散之又外邪与流行荣卫真气相击搏
则百节酸疼筋骨挛痛下部虚冷三阴不足故腰膝酸痛凡人真气失调少有所亏则五邪六淫皆得乘
间而入所以圣人谆谆告戒令人养摄真元为卫生却病之上妙方也
一虚痨之疾为精血内夺百脉空虚先贤经义条分缕析谆谆垂示后人秦越人发虚损之论谓虚
而
感寒则损其阳阳虚则阴盛损则自上而下一损损于肺皮聚而毛落二损损于心血脉不能荣养脏腑
三损损于胃饮食不为肌肤过于胃则不可治虚而感热则损其阴阴虚则阳盛损则自下而上一损损
于肾骨痿不起于床二损损于肝筋缓不能自收持三损损于脾饮食不能消化过于脾则不可治此秦
越人归重脾胃为治虚劳之妙谛也至汉张仲景明立虚劳门谓五劳虚极羸瘦腹满不能饮食食伤忧
伤饮伤房室伤饥伤劳伤经络荣卫气伤内有干血肌肤甲错两目黯黑缓中补虚大黄 虫丸主之意
以虚劳发热未有不由瘀血者而瘀血未有不由内伤者治病必求其本惟仲景得之矣巢氏病
源谓有虚劳有蒸病有注劳有五劳六极七伤蒸有五蒸二十四蒸注有三十六种九十九种分门异治
后人以岐路之多茫然莫知适从大要无非酒色劳倦七情饮食所致故或先伤其气气伤必及于精或
先伤于精精伤必及于气精虚者阴虚也其病为躁烦头红面赤唇干舌燥咽痛口疮吐血衄血便血尿
血大便燥结小水痛涩等症气虚者阳虚也其病为怯寒憔悴气短神疲头运目眩呕恶食少腹痛飧泄
二便不禁甚至咳嗽吐痰遗精盗汗气喘声喑筋骨疼痛心神恍惚饥肉尽削梦与鬼交妇人月闭等症
久虚不复则为损损极不复则为劳故知劳瘵之候未有不由气血亏损而成气不生血血瘀则营虚营
虚则发热久热则蒸其所瘀之血化而为虫遂成传尸痨症其症令人寒热盗汗梦与鬼交遗精白浊发
干而耸或腹内有块或脑后两边有小结核复连数个或聚或散沉沉默默咳嗽痰涎或咯脓血如肺痿
肺痈状或腹痛下利羸瘦困倦不自胜持积月累年以致于死死复传注亲属乃至灭门符药罔效知此
者惟取膏肓俞四花穴及早灸之可否几半晚亦不济矣凡灸虚劳取其助益阳气若脉洪阳盛者又不
可灸临症审之
一自汗盗汗未有不由心肾而得者也经云汗者心之液又云肾主五液心为阳虚则不能卫
外而为固
则外伤而自汗不分寤寐不因劳动发散溱溱然自出乃阴蒸于阳也肾为阴阴虚不能内营而秘藏
则内伤而盗汗即内经所云寝汗也人寤卫气行于阴则腠理益疏故熟睡汗出醒则渐收乃阳蒸于阴
也凡虚劳发热颊红汗自出津液消涸虚火益炎血气所存者寡矣若伤寒阳明欲作实必自汗邪传少
阳居半表半里之间亦见盗汗此又当别论
一血症有咳呕吐咯唾痰涎带血衄血便血尿血肠风脏毒又有耳目齿牙毛孔诸见血经云
荣者水谷
之精也和调五脏洒陈六腑乃能入于脉也源源而来生化于脾总统于心脏受于肝宣布于肺施泄于
肾灌溉一身故曰血者神气也得之则存失之则亡分而言之咳血出于肺肺又不独咳血而亦唾血盖
肺主气气逆为咳肾主水水化液为唾二脏相关病则俱病若涎唾中有少血散漫者此肾从相火炎上
之血也若血如红缕在痰中咳而出者此肺络受热伤之血也甚至咳白血色浅红似肉似肺死不治咯
血者不嗽而咯出血也咯与唾少异唾出于气上无所阻咯出于痰气郁于喉咙之下滞不得出咯而乃
出求其所属之脏咯唾同出于肾也若上膈壅热紫黑成块则呕而出气虚不摄随气上越则吐而出此
呕吐皆出于胃也经云阳络伤则血外溢血外溢则衄血阴络伤则血内溢血内溢则后血积热于膀胱
则闭癃溺血渗透肠中则为肠风血热上迫则见诸耳目口舌又毛孔出血名曰血汗即肌衄又名脉溢
是为极虚之候故凡血症之治须察阴阳虚实有火无火若脉浮洪数实有火者不可艾灸恐以火济火
而反促其危亡也
一鼓胀病岐伯曰水始起也目窠上微肿其颈脉微动时咳阴股间寒足胫肿腹乃大以手按
其腹随手
而起如裹水之状此其候也肤胀者寒气客于皮肤腹大身尽肿按其腹空而不起鼓胀者身腹大与肤
胀同色苍黄腹筋起肠覃者寒气客于肠外与卫气相搏因有所系癖而内着恶气乃起 肉乃生始大
如鸡卵稍以益大至其成如怀子之状按之则坚推之则移月事以时下石瘕生于胞中寒气客于子门
子门闭塞气不得通恶血当泻不泻 以留止日以益大状如怀子月事不以时下皆生于女子可导而
下仲景云风水其脉自浮骨节疼痛恶风皮水其脉亦浮 肿按之没指不恶风正水其脉沉迟外症自
喘石水其脉自沉腹满不喘黄汗其脉沉迟身发热胸满四肢头面肿久不愈必至痈肿内经云阴气在
上则生 胀夫阴气者地气也宜在于下今反腾于上如云雾浓布将天之阳光蒙翳一片阴晦之象结
而不开必将大作雷电继以风雨然后雾收云散离照光天悟此可得内经治胀之法矣古人论治有五
脏之分有阴阳之别与夫风湿寒郁积滞血蛊饮食劳倦之不一其因审证明晰然后按法施治庶无虚
虚实实之误
一积聚痞块无形而虚为痞有形而实为块东垣云夫痞者心下满而不痛是也太阴者湿也
主壅塞乃
土乘心下为痞满也积者推而不移病在五脏聚者推而移动病在六腑肝积在左胁之下名为肥气肺
积在右胁之下名为息贲心积起脐上上入心下大如臂名为伏梁脾积在胃脘大如盘名曰痞气肾积
在脐下上冲心而痛名曰奔豚又有寒热酒食水气血蛊之积其症不同其治亦异经云察其邪气所在
而调治之正谓此也
一心腹痛胀内经所谓九种心痛者五脏胃脘与痰虫食积为九也又谓胃脘当心而痛后人
因此一语
遂将二者混为一例不知心为君主之官神灵之舍不能受邪其受者乃手心主包络也如包络引邪直
犯心之正经而痛者则谓之真心痛必死不可治凡脏腑经脉挟其淫气自支脉乘于心而为痛者必有
各腑脏病形与之相应如灵枢谓厥心痛与背相控善 如从后触其心伛偻者肾心痛也厥心痛腹胀
胸满心尤痛甚胃心痛也厥心痛如以锥针刺其心心痛甚者脾心痛也厥心痛色苍苍如死状终
日不
得太息肝心痛也厥心痛卧若徙居动作痛益甚色不变肺心痛也故心痛各有病状不得与胃脘痛混
一而论也盖胃为水谷之海三阳之总司五脏六腑十二经脉皆受气于此初病在经久病入络其或满
或胀或食不下或呕或吞酸或大便难或泻利面色浮而黄者皆胃之本病也其有淫邪相乘于胃病状
虽与心痛相类但其间必有胃之本病参杂而见之于外也东垣云夫心胃痛及腹中诸痛皆因劳力过
甚饮食失节中气不足寒气乘虚而入客之故卒然而作大痛然腹痛有部分脏腑有高下如中脘痛者
太阴也脐腹痛者少阴也少腹痛者厥阴也审其有形无形在脏在腑随其高下而治之更循各藏部分
穴而灸之则又在人之有确见也
一膈噎症非由外邪所致乃忧思劳欲七情郁结而成张鸡峰所谓神思间病若不垂帘返照
内观静养
一切排遣物过不留则五火丛生气逆梗塞血液日枯而清浊相干乱于胸中饮食不得下矣夫咽嗌梗
塞气不顺利水饮不行食物难入其槁在吸门名曰膈其或食下则胃脘作痛烦闷不安须臾吐出食而
安其槁在贲门名曰噎二者皆属上焦东垣云阳气不得上出者曰塞五脏之所生阴也血也阴气不得
下降者曰噎六腑之所生阳也气也阳气结于上阴液衰于下因成此膈噎之症经云三阳结谓之膈三
阳大小肠膀胱也三阳热结津液不能上供肺用故吸门塞而食不入治者当先识此
一反胃症食虽可下良久复出其槁在幽门乃中焦病或朝食暮吐暮食朝吐完谷不化小便
赤大便难
或如羊矢其槁在阑门病属下焦伤寒注以晨食入胃胃虚不能克化至暮胃气行里与邪相搏则食反
出也王太仆注内经谓食不得入是有火也食入反出是无火也巢氏亦云脏冷则脾不磨而宿食不化
其气逆而成反胃此皆主于胃气虚寒用辛香大热之剂若脉数火气炎上多升少降邪热不杀谷或伤
食伤饮者又不可执为虚寒而不知通变也
一霍乱者由阴阳清浊二气相干乱于肠胃心腹卒痛呕吐下利憎寒壮热头痛肿晕先心痛
则先吐先
腹痛则先利心腹俱痛吐利并作甚至转筋入腹则毙矣此症多发于夏末秋初四时间或有之实因残
暑新凉并时行不正之气干犯胃阳陡然上吐下泻汤药有所不及惟灸法取效如神又有干霍乱症上
不得吐下不得泻腹中痛甚俗名绞肠纱急以盐汤灌之令其大吐庶有可生切莫与谷食虽米饮一呷
入口即死必吐泻过二三时直至饥甚方与稀粥从缓调理可也
一呕吐者东垣云皆属于胃然亦有分别如呕者阳明也阳明多血多气故有声有物气血俱
病也吐者
太阳也太阳多血少气故有物无声乃血病也干呕者少阳也少阳多气少血故有声无物乃气病也究
三者之源皆因脾气虚弱或因寒气客胃加之饮食所伤而致也又有因上焦伤风开其腠理经气失
道邪气内着身背皆热肘臂牵痛其气不续膈间厌闷食入即先呕而后下名曰漏气有下焦实大小便
不通气逆不续呕逆不禁名曰走哺有吐食者气热上冲食已暴吐有恶心者胸中似喘不喘似呕不呕
似哕不哕心中愤愤然无奈者有呕苦者邪在胆逆在胃胆液泄则口苦胃气逆则呕苦有吐酸者吐出
酸水如醋平时津液随上升之气郁而成积久则生热从木化而作酸故内经训以为热有吞酸者因郁
积之久不能自涌而出伏于肺胃之间咯不得上咽不得下肌表得风寒则内热愈郁而酸味刺心必须
温暖解肌忌用寒药故东垣又以为寒若吐清水则为寒湿吐痰涎则为水饮呕家虽呕痈脓不可治呕
脓尽自愈更有吐蛔者仲景以为胃中冷也
一咳嗽须分六气五脏之殊而其要皆主于肺内经金匮言之详矣后贤推衍其义各抒己见
而鲜有会
归至喻氏嘉言始发内经秋伤于湿冬生咳嗽句有脱文之论乃正之曰夏伤于暑长夏伤于湿秋必
疟秋伤于燥冬为咳嗽六气配四时之理灿然明矣言六气主病风火热湿燥寒皆能乘肺皆足致咳
其湿咳即分属于风火热燥寒五气中也风乘肺咳汗出头痛痰涎不利火乘肺咳喘急壅逆涕唾见
血热乘肺咳喘急面赤潮热甚者热盛于中四末反寒热
移于下便泄无度燥乘肺咳皮毛干槁细疮湿痒痰胶便闭寒乘肺咳恶寒无汗鼻塞身疼发热燥烦至
中身，指身体中部。外部包括胸、胁、腹、背、脊、脐，内部包括五脏和六腑。只要其中任何一处发生病变，都归属于中身范畴。其发病的原因必然有所依据：外因是由于春季的风、夏季的热与暑气、长夏的湿、秋季的燥、冬季的寒。当这些气候在其应有的季节到来时，称为正气；若不在其应有的季节到来，或者过于强盛，则成为淫邪。凡是这六种淫邪（风、寒、暑、湿、燥、火）导致的疾病，都属于外因。也有因感受八种风向之风而致病的情况，例如：冬至日正北来的刚风、立春日东北来的凶风、春分日正东来的婴儿风、立夏日东南来的弱风、夏至日正南来的大弱风、立秋日西南来的谋风、秋分日正西来的刚风、立冬日西北来的折风。这些风若在应时的季节到来，主生养万物；若不应时而至，主杀害万物。如果人感受了这些风，内生重病，外生痈疽，凡此八风导致的疾病也属于外因。所以说，外因是六淫和八风的感受。
内因，起于耳朵听淫靡之声、眼睛看邪僻之色、鼻子闻恶臭之气、舌头贪恋美味、心思过度、意念妄生，这些都损伤人的精神。凡此六种欲望导致的疾病，都属于内因。又有喜悦过度伤心、愤怒过度伤肝、思虑过度伤脾、悲伤过度伤肺、恐惧过度伤肾、忧愁日久导致气机郁结、突然受惊导致气机收敛。凡此七情（喜、怒、忧、思、悲、恐、惊）导致的疾病也属于内因。所以说，内因是六欲加上七情。
不内外因，是由于饮食不节制、起居不慎。过量饮用美酒则生火，消灼阴液；过量饮茶则生湿，停聚水饮；过量食用五辛（葱、蒜、韭、薤、兴渠）则损伤气血；饥饱失常则损伤脾胃。凡此皆由饮食导致的疾病。白天过度劳累，挑轻物或负重物，跌倒扑打、闪挫坠落等，损伤身形；夜晚不能安静休息，强行行房事，劳伤精气。凡此皆由起居导致的疾病。那些起因于膏粱厚味（油腻精细食物）的人，多使人营卫不和，火毒内结；起因于藜藿薄食（粗劣食物）的人，多使人肾气不充，气血亏少。凡此也属于不内外因。百姓的疾病千变万化，但其受病的根源都不出这三种病因。这里收集前后的证候略述数条，并非在三因之外另有致病原因，而是因为疾病有类似聚集的情况，治疗各有侧重，所以辨别科条，条理分明，列举名目，逐症分析，以便施治者明确辨证，没有疑惑。
其一，胸部为肺所主，心、脾、肾、肝、胆、胞络七经的筋脉都上达于胸。胸满、短气、阳实证见喘促不能卧；虚证见胸满则心下痞塞但不痛。胸痛多属肝虚，疼痛牵引胁背；肝实则不能转侧，喜欢叹气。其他经脉能引起胸满短气，但也不痛。张仲景说：“胸痹，心下痞塞，留气结在胸，胸满，胁下之气逆抢心。”这不是像中满那样外部有腹胀形态的病。鸡胸属于肺病，胀满有痰的是肺热，胀满无痰的是肺虚，都因为胸膈高高隆起，所以叫鸡胸。
其二，胁痛有左右之分。左右是阴阳的道路。左边属肝，肝主血，血停留阻滞则左边痛；右边属肺，肺主气，肝邪入肺，肺气不流通则右边痛。然而也有左痛不专主于血，右痛不专主于气的情况。如果是按压才痛，不按也痛的，是血瘀；如果是胀痛，时好时坏，打嗝后暂时宽畅，过会儿又痛的，是气滞。若是痰食导致的疼痛，都在右胁，必有痰食的病症，与气血凝滞不同，明眼人自然能辨别。还有房事过度、肾虚体弱的人，胸胁间多隐隐微痛，这是肾虚不能纳气，气虚不能生血，阴阳循行的道路有阻滞，所以作痛。如果不知道正本清源，固执一端不知变通，就会犯“虚虚”（使虚者更虚）的戒律。
其三，腹部坚硬是由脾阳下陷，浊阴之气乘虚而入，按之如石头，也不痛，只是苦于胀满，气结，饮食不化。小儿多有此症。大抵寒性收引，或因伤食而成。如果有块状、硬痛，是虫痛。又有冲脉为病，气溢于大肠，绕脐而痛；有脾伤传肾，少腹冤然而痛，所以说绕脐痛是大肠病。脐下冷痛，是肾病。
其四，腰背痛，《针经》说巨阳（太阳经）虚则头项腰背痛。又说足之三阳经从头走足，足之三阴经从足走腹，诸经经过的地方都能引起疼痛。有风寒湿热、挫闪、瘀血、气滞、痰积，由外致内的，是标病。若是房室劳伤、肾虚而痛的，是本病。腰是肾的府邸，转动困难说明肾将败亡。肩背分野属肺，喘咳逆气，肩背痛是肺燥。当肩背一片冷痛，这是有痰饮气积。背心红肿痛，是风热。红属火邪，肿为风胜。《内经》说岁火太过，民病肩背热。按背心为督脉循行部分，督脉贯脊络肾，风气从风府穴而下，积聚化热，所以取肩井、肺俞穴灸治以散之。另外，外邪与流行营卫真气相搏击，则百节酸疼，筋骨挛痛。下部虚冷，三阴不足，所以腰膝酸痛。凡人真气失调，稍有亏损，则五邪六淫都能乘隙而入。所以圣人谆谆告诫，让人养护摄持真元，这是卫生却病的上妙方法。
其五，虚劳之疾，是精血内夺，百脉空虚。先贤经义条分缕析，谆谆垂示后人。秦越人（扁鹊）发虚损之论，谓虚而感寒则损其阳，阳虚则阴盛，损则自上而下：一损损于肺，皮聚而毛落；二损损于心，血脉不能荣养脏腑；三损损于胃，饮食不为肌肤，过于胃则不可治。虚而感热则损其阴，阴虚则阳盛，损则自下而上：一损损于肾，骨痿不起于床；二损损于肝，筋缓不能自收持；三损损于脾，饮食不能消化，过于脾则不可治。这是秦越人归重脾胃为治疗虚劳的妙谛。到了汉代，张仲景明立虚劳门，谓五劳虚极羸瘦，腹满，不能饮食，食伤、忧伤、饮伤、房室伤、饥伤、劳伤、经络营卫气伤，内有干血，肌肤甲错，两目黯黑，用大黄䗪虫丸主之。意思是虚劳发热，未有不由瘀血引起的，而瘀血未有不由内伤引起的，治病必求其本，只有张仲景做到了。巢元方《诸病源候论》谓有虚劳、有蒸病、有注劳，有五劳六极七伤。蒸有五蒸、二十四蒸；注有三十六种、九十九种，分门别类治疗。后人因为岐路太多，茫然不知适从。大要无非酒色、劳倦、七情、饮食所致。所以有的先伤其气，气伤必及于精；有的先伤于精，精伤必及于气。精虚者是阴虚，其病为躁烦、头红面赤、唇干舌燥、咽痛、口疮、吐血、衄血、便血、尿血、大便燥结、小水痛涩等症状。气虚者是阳虚，其病为怯寒、憔悴、气短、神疲、头晕目眩、呕恶、食少、腹痛、飧泄、二便不禁，甚至咳嗽吐痰、遗精盗汗、气喘声喑、筋骨疼痛、心神恍惚、肌肉尽削、梦与鬼交、妇人月闭等症状。久虚不复则为损，损极不复则为劳。所以知道劳瘵之候，未有不由气血亏损而成。气不生血，血瘀则营虚，营虚则发热，久热则蒸，其所瘀之血化而为虫，遂成传尸痨症。其症令人寒热盗汗、梦与鬼交、遗精白浊、发干而耸，或腹内有块，或脑后两边有小结核复连数个，或聚或散，沉沉默默，咳嗽痰涎，或咯脓血如肺痿肺痈状，或腹痛下利，羸瘦困倦不自胜持，积月累年以致于死，死复传注亲属，乃至灭门，符药罔效。知此者，惟取膏肓俞、四花穴及早灸之，尚可救半晚亦不济矣。凡灸虚劳取其助益阳气，若脉洪阳盛者又不可灸，临症审之。
其六，自汗盗汗，未有不由心肾而得的。《内经》说汗者心之液，又说肾主五液。心为阳，阳虚则不能卫外而为固，则外伤而自汗，不分醒睡，不因劳动，溱溱然自出，乃阴蒸于阳也。肾为阴，阴虚不能内营而秘藏，则内伤而盗汗，即《内经》所云寝汗也。人醒时卫气行于阴，则腠理益疏，故熟睡汗出，醒则渐收，乃阳蒸于阴也。凡虚劳发热，颊红汗自出，津液消涸，虚火益炎，血气所存者寡矣。若伤寒阳明欲作实，必自汗；邪传少阳，居半表半里之间，亦见盗汗，此又当别论。
其七，血症有咳血、呕血、咯血、唾痰涎带血、衄血、便血、尿血、肠风、脏毒，又有耳目齿牙毛孔诸见血。《内经》说：荣者，水谷之精也，和调五脏，洒陈六腑，乃能入于脉也。源源而来，生化于脾，总统于心，藏受于肝，宣布于肺，施泄于肾，灌溉一身，故曰血者神气也，得之则存，失之则亡。分而言之，咳血出于肺，肺又不独咳血而亦唾血，盖肺主气，气逆为咳；肾主水，水化液为唾。二脏相关，病则俱病。若涎唾中有少血散漫者，此肾从相火炎上之血也。若血如红缕在痰中咳而出者，此肺络受热伤之血也。甚至咳白血，色浅红似肉似肺，死不治。咯血者，不嗽而咯出血也。咯与唾少异，唾出于气，上无所阻；咯出于痰，气郁于喉咙之下，滞不得出，咯而乃出。求其所属之脏，咯唾同出于肾也。若上膈壅热，紫黑成块，则呕而出；气虚不摄，随气上越，则吐而出。此呕吐皆出于胃也。《内经》说：阳络伤则血外溢，血外溢则衄血；阴络伤则血内溢，血内溢则后血。积热于膀胱则闭癃溺血，渗透肠中则为肠风，血热上迫则见诸耳目口舌。又毛孔出血名曰血汗，即肌衄，又名脉溢，是为极虚之候。故凡血症之治，须察阴阳虚实，有火无火。若脉浮洪数实有火者，不可艾灸，恐以火济火而反促其危亡也。
其八，鼓胀病。岐伯说：水始起也，目窠上微肿，其颈脉微动，时咳，阴股间寒，足胫肿，腹乃大。以手按其腹，随手而起，如裹水之状，此其候也。肤胀者，寒气客于皮肤，腹大身尽肿，按其腹空而不起。鼓胀者，身腹大，与肤胀同，色苍黄，腹筋起。肠覃者，寒气客于肠外，与卫气相搏，因有所系，癖而内着，恶气乃起，息肉乃生，始大如鸡卵，稍以益大，至其成如怀子之状，按之则坚，推之则移，月事以时下。石瘕生于胞中，寒气客于子门，子门闭塞，气不得通，恶血当泻不泻，衃以留止，日以益大，状如怀子，月事不以时下，皆生于女子，可导而下。张仲景说：风水，其脉自浮，骨节疼痛，恶风；皮水，其脉亦浮，肿，按之没指，不恶风；正水，其脉沉迟，外症自喘；石水，其脉自沉，腹满不喘；黄汗，其脉沉迟，身发热，胸满，四肢头面肿，久不愈，必至痈肿。《内经》说：阴气在上则生贲豚胀（此处原文可能有误，通常指胀满之类）。夫阴气者，地气也，宜在于下，今反腾于上，如云雾浓布，将天之阳光蒙翳，一片阴晦之象，结而不开，必将大作雷电，继以风雨，然后雾收云散，离照光天。悟此可得《内经》治胀之法矣。古人论治，有五脏之分，有阴阳之别，与夫风湿寒郁、积滞血蛊、饮食劳倦之不一其因。审证明晰，然后按法施治，庶无虚虚实实之误。
其九，积聚痞块。无形而虚为痞，有形而实为块。李东垣说：夫痞者，心下满而不痛是也。太阴者湿也，主壅塞，乃土乘心下为痞满也。积者，推而不移，病在五脏；聚者，推而移动，病在六腑。肝积在左胁之下，名为肥气；肺积在右胁之下，名为息贲；心积起脐上，上入心下，大如臂，名为伏梁；脾积在胃脘，大如盘，名曰痞气；肾积在脐下，上冲心而痛，名曰奔豚。又有寒热、酒食、水、气、血、蛊之积，其症不同，其治亦异。《内经》说：察其邪气所在而调治之，正谓此也。
其十，心腹痛胀。《内经》所谓九种心痛者，五脏、胃脘与痰、虫、食积为九也。又谓胃脘当心而痛，后人因此一语，遂将二者混为一例。不知心为君主之官，神灵之舍，不能受邪，其受者乃手心主包络也。如包络引邪直犯心之正经而痛者，则谓之真心痛，必死不可治。凡脏腑经脉挟其淫气，自支脉乘于心而为痛者，必有各脏腑病形与之相应。如《灵枢》谓厥心痛与背相控，善伛偻，如从后触其心，伛偻者，肾心痛也；厥心痛腹胀胸满，心尤痛甚，胃心痛也；厥心痛如以锥针刺其心，心痛甚者，脾心痛也；厥心痛色苍苍如死状，终日不得太息，肝心痛也；厥心痛卧若徙居，动作痛益甚，色不变，肺心痛也。故心痛各有病状，不得与胃脘痛混一而论也。盖胃为水谷之海，三阳之总司，五脏六腑十二经脉皆受气于此。初病在经，久病入络。其或满或胀，或食不下，或呕，或吞酸，或大便难，或泻利，面色浮而黄者，皆胃之本病也。其有淫邪相乘于胃病，状虽与心痛相类，但其间必有胃之本病参杂而见之于外也。李东垣说：夫心胃痛及腹中诸痛，皆因劳力过甚，饮食失节，中气不足，寒气乘虚而入客之，故卒然而作大痛。然腹痛有部分，脏腑有高下，如中脘痛者，太阴也；脐腹痛者，少阴也；少腹痛者，厥阴也。审其有形无形，在脏在腑，随其高下而治之，更循各藏部分穴而灸之，则又在人之有确见也。
其十一，膈噎症。非由外邪所致，乃忧思劳欲，七情郁结而成。张鸡峰所谓神思间病，若不垂帘返照，内观静养，一切排遣，物过不留，则五火丛生，气逆梗塞，血液日枯，而清浊相干，乱于胸中，饮食不得下矣。夫咽嗌梗塞，气不顺利，水饮不行，食物难入，其槁在吸门，名曰膈。其或食下则胃脘作痛，烦闷不安，须臾吐出，食而安，其槁在贲门，名曰噎。二者皆属上焦。李东垣说：阳气不得上出者曰塞，五脏之所生，阴也，血也；阴气不得下降者曰噎，六腑之所生，阳也，气也。阳气结于上，阴液衰于下，因成此膈噎之症。《内经》说：三阳结谓之膈。三阳，大小肠膀胱也。三阳热结，津液不能上供肺用，故吸门塞而食不入。治者当先识此。
其十二，反胃症。食虽可下，良久复出，其槁在幽门，乃中焦病。或朝食暮吐，暮食朝吐，完谷不化，小便赤，大便难，或如羊矢，其槁在阑门，病属下焦。《伤寒论》注以晨食入胃，胃虚不能克化，至暮胃气行里，与邪相搏，则食反出也。王冰注《内经》谓食不得入，是有火也；食入反出，是无火也。巢氏亦云：脏冷则脾不磨，而宿食不化，其气逆而成反胃。此皆主于胃气虚寒，用辛香大热之剂。若脉数，火气炎上，多升少降，邪热不杀谷，或伤食伤饮者，又不可执为虚寒而不知通变也。
其十三，霍乱者，由阴阳清浊二气相干，乱于肠胃，心腹卒痛，呕吐下利，憎寒壮热，头痛肿晕。先心痛则先吐，先腹痛则先利，心腹俱痛，吐利并作，甚至转筋入腹则毙矣。此症多发于夏末秋初四时间或有之，实因残暑新凉并时行不正之气干犯胃阳，陡然上吐下泻，汤药有所不及，惟灸法取效如神。又有干霍乱症，上不得吐，下不得泻，腹中痛甚，俗名绞肠纱，急以盐汤灌之，令其大吐，庶有可生。切莫与谷食，虽米饮一呷，入口即死。必吐泻过二三时，直至饥甚，方与稀粥，从缓调理可也。
其十四，呕吐者。李东垣说：皆属于胃，然亦有分别。如呕者，阳明也，阳明多血多气，故有声有物，气血俱病也；吐者，太阳也，太阳多血少气，故有物无声，乃血病也；干呕者，少阳也，少阳多气少血，故有声无物，乃气病也。究三者之源，皆因脾气虚弱，或因寒气客胃，加之饮食所伤而致也。又有因上焦伤风，开其腠理，经气失道，邪气内着，身背皆热，肘臂牵痛，其气不续，膈间厌闷，食入即先呕而后下，名曰漏气。有下焦实，大小便不通，气逆不续，呕逆不禁，名曰走哺。有吐食者，气热上冲，食已暴吐。有恶心者，胸中似喘不喘，似呕不呕，似哕不哕，心中愤愤然无奈者。有呕苦者，邪在胆，逆在胃，胆液泄则口苦，胃气逆则呕苦。有吐酸者，吐出酸水如醋，平时津液随上升之气，郁而成积，久则生热，从木化而作酸，故《内经》训以为热。有吞酸者，因郁积之久，不能自涌而出，伏于肺胃之间，咯不得上，咽不得下，肌表得风寒则内热愈郁，而酸味刺心，必须温暖解肌，忌用寒药，故李东垣又以为寒。若吐清水则为寒湿，吐痰涎则为水饮。呕家虽呕痈脓，不可治，呕脓尽自愈。更有吐蛔者，张仲景以为胃中冷也。
其十五，咳嗽须分六气五脏之殊，而其要皆主于肺。《内经》、《金匮》言之详矣。后贤推衍其义，各抒己见，而鲜有会归。至喻氏嘉言始发《内经》“秋伤于湿，冬生咳嗽”句有脱文之论，乃正之曰：“夏伤于暑，长夏伤于湿，秋必疟，秋伤于燥，冬为咳嗽。”六气配四时之理，灿然明矣。言六气主病，风、火、热、湿、燥、寒皆能乘肺，皆足致咳。其湿咳即分属于风、火、热、燥、寒五气中也。风乘肺咳，汗出头痛，痰涎不利；火乘肺咳，喘急壅逆，涕唾见血；热乘肺咳，喘急面赤，潮热，甚者热盛于中，四末反寒，热移于下，便泄无度；燥乘肺咳，皮毛干槁，细疮湿痒，痰胶便闭；寒乘肺咳，恶寒无汗，鼻塞身疼，发热燥烦。至
The middle body refers to the central part of the human body. Externally, it includes the chest, hypochondrium, abdomen, back, spine, and umbilicus; internally, it encompasses the Zang organs (solid organs) and Fu organs (hollow organs). Any disease occurring in these areas belongs to the category of the middle body. The origin of such diseases must have a cause: External causes arise from wind in spring, heat and summerheat in summer, dampness in late summer, dryness in autumn, and cold in winter. When these climatic factors arrive in their proper seasons, they are considered normal Qi (vital energy); if they arrive out of season or are excessively strong, they become pathogenic influences (Evil Qi). Diseases caused by these six pathogenic influences (wind, cold, summerheat, dampness, dryness, fire) all belong to external causes. There are also diseases caused by the influence of eight directional winds, such as: Gangfeng (Rigid Wind) from due north on the day of Winter Solstice, Xiongfeng (Auspicious Wind) from northeast on the day of Start of Spring, Ying'erfeng (Infant Wind) from due east on the day of Spring Equinox, Ruofeng (Weak Wind) from southeast on the day of Start of Summer, Daruofeng (Great Weak Wind) from due south on the day of Summer Solstice, Mofeng (Strategizing Wind) from southwest on the day of Start of Autumn, Gangfeng (Rigid Wind) from due west on the day of Autumn Equinox, and Zhefeng (Folding Wind) from northwest on the day of Start of Winter. If these winds arrive in their proper seasons, they nourish all things; if they arrive out of season, they harm all things. If a person contracts these winds, leading to internal severe diseases or external carbuncles and sores, such diseases caused by the eight winds also belong to external causes. Thus, external causes refer to the contraction of the six pathogenic influences and the eight winds.
Internal causes originate from hearing obscene sounds with the ears, viewing lewd sights with the eyes, smelling foul odors with the nose, craving delicious flavors with the tongue, excessive mental activity, and妄生 (wildly generating) thoughts, all of which damage the Shen (Spirit). Diseases caused by these six desires all belong to internal causes. Additionally, excessive joy damages the Heart, excessive anger damages the Liver, excessive thought damages the Spleen, excessive grief damages the Lungs, and excessive fear damages the Kidneys. Prolonged worry leads to Qi stagnation, and sudden fright leads to Qi collapse. Diseases caused by these seven emotions (joy, anger, worry, thought, grief, fear, fright) also belong to internal causes. Thus, internal causes refer to the six desires combined with the seven emotions.
Neither-internal-nor-external causes arise from irregular diet and careless living habits. Excessive consumption of rich wine generates fire, consuming Yin fluids; excessive tea drinking generates dampness and retains fluid; excessive consumption of the "Five Pungents" (garlic, chives, leeks, scallions, and asafoetida) damages Qi and Blood; irregular meals (starvation or overeating) damage the Spleen and Stomach. All these are diseases caused by diet. Daytime overexertion, carrying light loads or heavy burdens, falling, striking, spraining, or dislocating, damages the physical form. Nighttime lack of rest and forced sexual intercourse injure Jing (Essence) and Qi. All these are diseases caused by lifestyle. Those who consume rich and greasy foods often suffer from disharmony of Ying (Nutritive) and Wei (Defensive) Qi, with internal accumulation of Fire-Toxin. Those who consume coarse and meager food often suffer from insufficient Kidney Qi and deficiency of Qi and Blood. These also belong to neither-internal-nor-external causes. Although people's diseases vary in thousands of ways, their origins do not go beyond these three categories. The following case summaries are collected here not to suggest causes outside the Three Categories, but because diseases may present similarly while treatments differ. Therefore, distinctions are made, principles are clarified, names are listed, and symptoms are analyzed one by one, so that practitioners can clearly differentiate syndromes without doubt.
First, the chest is governed by the Lung. The sinews and vessels of the Heart, Spleen, Kidney, Liver, Gallbladder, and Pericardium meridians all ascend to the chest. Chest fullness, shortness of breath, and excess Yang presenting with panting and inability to lie down indicate excess syndrome; chest fullness with epigastric stuffiness but no pain indicates deficiency syndrome. Chest pain mostly belongs to Liver deficiency, with pain radiating to the hypochondrium and back; Liver excess prevents turning and twisting, accompanied by frequent sighing. Other meridians can cause chest fullness and shortness of breath but not pain. Zhang Zhongjing stated: "Chest Bi (obstruction), epigastric stuffiness, trapped Qi knotting in the chest, chest fullness, and rebellious Qi rushing up from the hypochondrium to the heart." This is different from "Zhongman" (central fullness), which presents with external abdominal distension. "Chicken breast" belongs to Lung disease; distension with phlegm indicates Lung Heat, while distension without phlegm indicates Lung deficiency. Both are named "chicken breast" because the chest and diaphragm protrude high.
Second, hypochondriac pain differs between left and right. The left and right are pathways of Yin and Yang. The left belongs to the Liver, which governs Blood; stagnation of Blood causes left-sided pain. The right belongs to the Lung, which governs Qi; when Liver evil invades the Lung, obstructing Qi flow, it causes right-sided pain. However, left pain is not exclusively Blood-related, nor is right pain exclusively Qi-related. Pain that persists even without pressure indicates Blood stasis; distending pain that comes and goes, relieved temporarily by belching but returning later, indicates Qi stagnation. Pain caused by Phlegm-Food retention occurs mainly in the right hypochondrium and must be accompanied by signs of Phlegm-Food, differing from Qi-Blood stagnation, which astute observers can distinguish. In cases of excessive sexual activity and Kidney deficiency with emaciation, there is often dull, slight pain in the chest and hypochondrium. This is because Kidney deficiency fails to grasp Qi, and Qi deficiency fails to generate Blood, causing obstruction in the pathways of Yin-Yang circulation. Failing to seek the root cause and adhering rigidly to one view violates the prohibition against "making deficiency more deficient."
Third, abdominal hardness results from sinking of Spleen Yang, allowing turbid Yin Qi to invade. It feels hard like stone upon pressure and is painless, but painful due to fullness, Qi knotting, and undigested food. This is common in children. Generally, Cold causes contraction, or it results from Food injury. Hard masses with pain indicate Worm pain. Pain encircling the navel caused by Chong Mai (Penetrating Vessel) pathology, where Qi overflows into the Large Intestine, is attributed to Large Intestine disease. Lower abdominal pain radiating upward due to Spleen injury transmitting to the Kidney is also noted. Cold pain below the navel indicates Kidney disease.
Fourth, lower back and back pain: The *Zhenjing* states that deficiency of Juyang (Taiyang/Bladder Meridian) causes head, neck, waist, and back pain. It also states that the three Yang meridities of the foot descend from head to foot, while the three Yin meridities of the foot ascend from foot to abdomen; pain can occur along any meridian pathway. External pathogens (Wind, Cold, Damp, Heat), trauma, Blood stasis, Qi stagnation, and Phlegm accumulation causing internal issues are branch (Biao) diseases. Pain due to sexual exhaustion and Kidney deficiency is a root (Ben) disease. The waist is the mansion of the Kidney; inability to turn indicates impending Kidney failure. The shoulder and back region belongs to the Lung; panting, coughing, and rebellious Qi causing shoulder and back pain indicate Lung Dryness. A band of cold pain across the shoulder and back indicates Phlegm-Fluid and Qi accumulation. Redness, swelling, and pain on the upper back indicate Wind-Heat. Redness belongs to Fire Evil, swelling to Wind excess. The *Neijing* states that excessive Fire in the year causes shoulder and back heat. The upper back is traversed by the Du Mai (Governing Vessel), which connects to the Kidneys. Wind Qi descends from Fengfu (DU16) and accumulates to transform into Heat; thus, Jianding (GB21) and Feishu (BL13) are moxa-ed to dissipate it. Furthermore, when external pathogens clash with circulating Ying and Wei Qi, hundred joints ache, and sinews and bones spasm. Lower body deficiency and cold, with insufficiency of the three Yin meridians, cause soreness and pain in the waist and knees. Whenever True Qi is失调 (disharmonious) or slightly deficient, Five Evils and Six Pathogens can enter through gaps. Therefore, sages earnestly advise nurturing and preserving True Qi as the supreme method for health and disease prevention.
Fifth, Xu Lao (Deficiency Consumption) involves internal depletion of Essence and Blood, leaving all vessels empty. Ancient sages analyzed this in detail. Qin Yueren (Bian Que) discussed deficiency and damage: Deficiency contracting Cold damages Yang; Yang deficiency leads to Yin excess. Damage proceeds top-down: First damage to Lung (skin gathers, hair falls); second to Heart (blood vessels fail to nourish organs); third to Stomach (food fails to nourish flesh); beyond the third stage, it is incurable. Deficiency contracting Heat damages Yin; Yin deficiency leads to Yang excess. Damage proceeds bottom-up: First damage to Kidney (bone atrophy, inability to rise from bed); second to Liver (sinews relax, inability to hold); third to Spleen (food fails to digest); beyond the third stage, it is incurable. Qin Yueren emphasized the Spleen and Stomach as key to treating Xu Lao. Later, Zhang Zhongjing established the Xu Lao chapter, describing five labors leading to extreme deficiency, emaciation, abdominal fullness, anorexia, and internal dried Blood manifesting as rough skin and dark eyes, treated with Dahuang Zhechong Wan. He understood that fever in Xu Lao stems from Blood stasis caused by internal injury, seeking the root cause. Chao Yuanfang's *Zhubing Yuanhou Lun* categorized Xu Lao, Zheng Bing (Steaming Disease), and Zhu Lao (Infectious Consumption) into various subtypes. Modern practitioners were confused by these many paths. Ultimately, these result from alcohol, sex, fatigue, emotions, and diet. Qi injury affects Jing; Jing injury affects Qi. Jing deficiency is Yin deficiency, manifesting as irritability, red face/head, dry lips/tongue, sore throat, mouth ulcers, hematemesis, epistaxis, hematochezia, hematuria, constipation, and dysuria. Qi deficiency is Yang deficiency, manifesting as aversion to cold, emaciation, shortness of breath, fatigue, dizziness, nausea, anorexia, abdominal pain, diarrhea, incontinence, cough, expectoration, nocturnal emission, night sweats, asthma, hoarseness, bone/joint pain, mental confusion, severe muscle wasting, dreams of sexual intercourse, and amenorrhea. Prolonged deficiency becomes Sun (Damage); extreme non-recovery becomes Lao (Consumption). Thus, Lao Zhai arises from Qi and Blood deficiency. Qi fails to generate Blood; Blood stasis leads to Ying deficiency, causing fever. Prolonged fever steams the stagnant Blood, transforming it into worms, leading to Chuanshi (Transmitting Corpse) Lao. Symptoms include alternating chills and fever, night sweats, dreams of sexual intercourse, nocturnal emission, white turbidity, dry erect hair, abdominal masses, small nodules behind the ears, chronic cough with sputum, hemoptysis resembling Fei Wei (Lung Atrophy) or Fei Yong (Lung Abscess), abdominal pain, diarrhea, emaciation, and weakness. Over months and years, it leads to death and transmission to relatives, causing family extinction, unresponsive to charms or medicines. Knowing this, one should apply moxibustion early to Gaohuangshu (BL43) and Sihua acupoints. Delay renders treatment futile. Moxibustion for Xu Lao aids Yang Qi; however, it is contraindicated if the pulse is flooding and Yang is excessive. Clinical judgment is essential.
Sixth, spontaneous sweating and night sweating stem from Heart and Kidney dysfunction. Sweat is the fluid of the Heart; the Kidneys govern the five fluids. Heart Yang deficiency fails to secure the exterior, leading to spontaneous sweating regardless of wakefulness or labor, profusely oozing, caused by Yin steaming Yang. Kidney Yin deficiency fails to nourish internally and store, leading to night sweating (sleep sweat) when Wei Qi enters Yin during sleep, opening pores; sweating stops upon waking, caused by Yang steaming Yin. In Xu Lao fever, flushed cheeks, spontaneous sweating, depleted fluids, and flaring deficient fire leave little Qi and Blood. Spontaneous sweating also occurs in Yangming syndrome approaching excess; night sweating occurs in Shaoyang syndrome at the half-exterior/half-interior level. These require separate discussion.
Seventh, Blood disorders include hemoptysis, hematemesis, spitting blood in saliva, epistaxis, hematochezia, hematuria, Changfeng (Intestinal Wind), Zangdu (Visceral Toxin), and bleeding from ears, eyes, teeth, gums, and pores. Ying Qi, refined from grain and water, harmonizes the Zang organs, spreads to the Fu organs, and enters the vessels. Generated by the Spleen, commanded by the Heart, stored in the Liver, distributed by the Lungs, and excreted by the Kidneys, it irrigates the body. Blood is Shen Qi; possessing it means life, losing it means death. Hemoptysis originates in the Lung; the Lung also governs saliva. Lung governs Qi (rebellion causes cough); Kidney governs Water (transformation creates saliva). Disease in one affects both. Scattered blood in saliva indicates Kidney Fire flaming upward; thread-like blood in sputum indicates Lung collateral heat injury. Coughing up pale, meat-like blood is fatal. Geketsu (spitting blood without coughing) differs from Tuosuo (saliva/spittle); saliva rises freely, while phlegm-bound blood gets stuck in the throat. Both relate to the Kidney. Purple-black clots vomited from upper burner heat originate in the Stomach; Qi deficiency failing to control blood leads to vomiting. Epistaxis results from damaged Yang collaterals; hematochezia from damaged Yin collaterals. Heat in the Bladder causes urinary retention and hematuria; heat penetrating intestines causes Changfeng; heat forcing upward causes bleeding in ears, eyes, mouth, and tongue. Bleeding from pores is called Xuehan (Blood Sweat) or Jinü (Muscle Ecchymosis), indicating extreme deficiency. Treatment requires distinguishing Yin/Yang and excess/deficiency, presence/absence of Fire. If the pulse is floating, flooding, rapid, and full with Fire, moxibustion is contraindicated to avoid adding Fire to Fire.
Eighth, Gu Zhang (Drum Distension): Qibo stated that early edema shows swollen eye sockets, pulsating neck veins, occasional cough, cold inner thighs, swollen calves, and abdominal enlargement. Pressing the abdomen leaves an indentation that rebounds slowly, like a water-filled bag. Fuzhang (Skin Distension) involves Cold invading skin, causing general swelling and abdominal distension, but pressing leaves no indentation. Guzhang involves abdominal distension similar to Fuzhang but with yellowish-green skin and visible abdominal veins. Changtan (Intestinal Tumor) involves Cold invading outside the intestines, interacting with Wei Qi, forming a mass starting size of a chicken egg, growing large like pregnancy, hard to press but movable, with regular menstruation. Shixia (Stone Fibroma) forms in the uterus due to Cold blocking the Zi Men (Cervical Os), trapping bad blood, causing menstrual irregularity; treatable by guiding downward. Zhang Zhongjing described Fengshui (Wind Edema) with floating pulse, joint pain, aversion to wind; Shuishui (Water Edema) with floating pulse, pitting edema, no aversion to wind; Zhengshui (True Water) with deep-slow pulse, wheezing; Shuishui (Stone Water) with deep pulse, abdominal fullness, no wheezing; Huanghan (Yellow Sweat) with deep-slow pulse, fever, chest fullness, swelling of limbs/face, potentially leading to abscesses. The *Neijing* states that Yin Qi ascending causes distension. Yin Qi (Earth Qi) should be below; if it ascends like clouds obscuring sunlight, it creates darkness. Only after thunder, rain, and clearing can light return. Understanding this reveals the *Neijing*'s method for treating distension. Ancient treatments distinguish five Zang organs, Yin/Yang, and causes like Wind-Damp-Cold-Stagnation, Blood-Toxins, Diet, and Fatigue. Clear diagnosis prevents errors of reinforcing excess or draining deficiency.
Ninth, Ji Ju (Accumulation and Gathering) and Pi Kuai (Pi Masses). Formless and deficient is Pi; formed and solid is Kuai. Li Dongyuan stated Pi is epigastric fullness without pain. Taiyin is Dampness, causing obstruction; Earth overacting on the Heart causes Pi Man (Pi Fullness). Ji (Accumulation) is fixed and immovable, located in Zang organs; Ju (Gathering) is movable, located in Fu organs. Liver Ji is Feiqi under left hypochondrium; Lung Ji is Xiben under right hypochondrium; Heart Ji is Fuliang above navel entering heart; Spleen Ji is Piqi in stomach; Kidney Ji is Bentun below navel rushing to heart. Other accumulations involve Cold-Heat, Wine-Food, Water, Qi, Blood, and Toxins, with different treatments based on pathogen location.
Tenth, Xin Tong (Heart Pain) and Abdominal Pain. The "Nine Types of Heart Pain" include five Zang pains, Stomach pain, and Phlegm/Worm/Food accumulation pains. Historically, epigastric pain was confused with heart pain. The Heart, as Sovereign, cannot be invaded; the Pericardium receives evil. Direct invasion causing true heart pain is Zhenxin Tong (True Heart Pain), fatal. Organ meridians carrying evil to the heart cause Jue Xin Tong (Rebellious Heart Pain), corresponding to specific organ symptoms: Kidney pain controls back and stooping; Stomach pain has abdominal/chest fullness; Spleen pain feels like needle刺; Liver pain has cyanotic face and sighing; Lung pain worsens with movement. Stomach pain, originating from the Sea of Grain and Water, can mimic heart pain but always includes stomach symptoms (fullness, bloating, anorexia, vomiting, acid regurgitation, bowel changes, yellow complexion). Li Dongyuan attributed heart/stomach/abdominal pain to excessive labor, irregular diet, Middle Qi deficiency, and Cold invasion. Abdominal pain locations correspond to meridians: Zhongwan (CV12) is Taiyin; Umbilical is Shaoyin; Lower abdomen is Jueyin. Treatment depends on formlessness/form, Zang/Fu, and height, using acupuncture/moxibustion points accordingly.
Eleventh, Ge Ye (Diaphragmatic Dysphagia) is not caused by external pathogens but by emotional depression (worry, thought, fatigue, desire). As Zhang Jifeng noted, if one does not cultivate stillness and clear thoughts, Five Fires arise, Qi rebels, fluids dry, and clear/turbid mix in the chest, preventing swallowing. Obstruction at Xi Men (Admission Gate) is Ge; obstruction at Ben Men (Rebelling Gate) with delayed vomiting is Ye. Both are Upper Burner issues. Li Dongyuan stated: Sai (Obstruction) is Yang Qi failing to ascend (Yin/Blood from Zang); Ye (Dysphagia) is Yin Qi failing to descend (Yang/Qi from Fu). Yang knotting above and Yin deficiency below cause this. The *Neijing* says "Three Yang knotting causes Ge." Three Yang (Large Intestine, Small Intestine, Bladder) heat knots, preventing fluids from nourishing the Lung, closing Xi Men.
Twelfth, Fan Wei (Regurgitation): Food enters but returns later, obstruction at You Men (Pylorus), Middle Burner disease. Morning food evening vomit, evening food morning vomit, undigested food, red urine, hard stools like sheep dung, obstruction at Lan Men (Valve Gate), Lower Burner disease. *Shanghan Lun* notes stomach deficiency failing to digest, with evening Qi clashing with evil causing regurgitation. Wang Bing noted: inability to eat indicates Fire; eating then vomiting indicates No Fire. Chao Yuanfang said cold spleen fails to grind food, causing Qi rebellion. Treat with pungent-hot herbs for Stomach Cold-Qi Deficiency. However, rapid pulse indicates Fire flaming upward; heat failing to digest food or food/drink injury requires differentiation, not just assuming cold-deficiency.
Thirteenth, Huo Luan (Colic Vomiting and Diarrhea): Conflict of Yin/Yang and Clear/Turbid Qi in intestines/stomach causes sudden abdominal pain, vomiting, diarrhea, aversion to cold, high fever, headache, dizziness. Heart pain precedes vomiting; abdominal pain precedes diarrhea. Simultaneous pain causes simultaneous vomiting/diarrhea. Muscle spasms entering abdomen are fatal. Common in late summer/early autumn due to residual summerheat, new coolness, and epidemic Qi invading Stomach Yang. Moxibustion is effective where herbs fail. Gan Huo Luan (Dry Huo Luan) involves inability to vomit or defecate, severe abdominal pain ("Intestinal Twisting"). Immediately administer salt water to induce vomiting for survival. Avoid food/drink until vomiting/diarrhea cease for 2-3 hours, then introduce thin porridge gradually.
Fourteenth, Ou Tu (Vomiting): Li Dongyuan stated all belong to Stomach but differ. Ou (Vomiting with sound and matter) is Yangming (many blood/qi, Qi-Blood disease). Tu (Vomiting with matter only) is Taiyang (many blood, less qi, Blood disease). Gan Ou (Dry Vomiting with sound only) is Shaoyang (many qi, less blood, Qi disease). Root causes include Spleen Qi deficiency, Cold invading Stomach, and dietary injury. Upper Jiao Wind opens pores, disrupting Qi, causing back/arm heat and pain, leading to Lou Qi (Leaking Qi) where food vomits then passes down. Lower Jiao excess causes Zou Bu (Walking Nourishment) with urinary/fecal retention and uncontrollable vomiting. Heat rushing up causes violent vomiting. Chest oppression resembles panting/vomiting/hiccupping. Bitter vomiting indicates Gallbladder evil invading Stomach. Sour vomiting (Tu Suan) is heat from Wood transformation of stagnant fluids. Swallowing sourness (Tun Suan) is stagnant heat in Lung/Stomach aggravated by Cold; treat with warming, avoid cold herbs. Clear water vomiting is Cold-Damp; phlegm vomiting is Fluid retention. Vomiting pus from abscesses resolves spontaneously. Vomiting worms indicates Stomach Cold (Zhang Zhongjing).
Fifteenth, Ke Sou (Cough) must distinguish Six Qi and Five Zang, primarily involving the Lung. *Neijing* and *Jinkui* detailed this. Yu Juyan corrected "Autumn injury by Dampness, Winter produces Cough" to "Summer injury by Summerheat, Late Summer injury by Dampness, Autumn malaria, Autumn injury by Dryness, Winter Cough," aligning Six Qi with Four Seasons. Wind, Fire, Heat, Damp, Dryness, and Cold all invade Lung causing cough. Wind-Lung cough: sweating, headache, difficult phlegm. Fire-Lung cough: panting, obstruction, bloody sputum. Heat-Lung cough: panting, red face, tidal fever, cold extremities if heat is central, diarrhea if heat moves down. Dryness-Lung cough: dry skin, fine eczema, sticky phlegm, constipation. Cold-Lung cough: aversion to cold, no sweat, nasal congestion, body ache, fever, irritability. To...