(《素问·五脏生成篇》)
诊病之始,五决为纪,(五决者,谓察五脏之疾以决死生,乃为诊病之纲纪也。)欲知其始,先建其母。(始,病之始
也。建,立也。母,病之因也。不得其因,则标本弗辨,故当先建其母,如下文某脏某经之谓。)所谓五决者,五脉也。
(五脉者,五脏之脉,各有其经也。又如肝脉弦,心脉钩,脾脉软,肺脉毛,肾脉石,皆所谓五脉也。)是以头痛巅疾,
下虚上实,过在足少阴、巨阳,甚则入肾。(头痛巅疾,实于上也。上实者因于下虚,其过在肾与膀胱二经。盖足太阳之
脉从巅络脑,而肾与膀胱为表里,阴虚阳实,故为是病。甚则腑病已而入于脏,则肾独受伤矣。)徇蒙招尤,目冥耳聋,
下实上虚,过在足少阳、厥阴,甚则入肝。(徇,亦作巡,行视貌。蒙,茫昧也。招,掉摇也。尤,甚也。目无光则
不明,头眩动则招尤不定,甚至目冥者不能视,耳聋者无所闻,其过在肝胆之气,实于下而虚于上也。盖足少阳之脉起
于目锐 ,上抵头角,下耳后,足厥阴之脉连目系,上出额,与督脉会于巅,故为此病。甚则自腑归脏,而并入于肝矣。
按∶此下三节,皆不言甚则入脏,盖文之缺而义则同也。)腹满 胀,支膈 胁,下厥上冒,过在足太阴、阳明。(支,
隔塞也。 ,胁之上也。足太阴之脉入腹属脾络胃上膈,足阳明之脉属胃络脾,其支者循腹里,且脾胃皆主四肢,故为
支膈 胁,而四肢厥逆于下,胸腹冒闷于上者,皆过在足太阴阳明经也。 ,昌真切。)咳嗽上气,厥在胸中,过在手阳
明、太阴。(上气,喘急也。肺居胸中,手太阴也,其脉起于中焦,上膈属肺。手阳明,大肠也,为太阴之表,其脉下入
缺盆络肺。二经之气,皆能逆于胸中,故为咳嗽上气之病。)心烦头痛,病在膈中,过在手巨阳、少阴。(膈中,膈上也。
手太阳小肠之脉,入缺盆络心,其支者循颈上颊至目锐 。手少阴心脉起于心中,出属心系,其支者上挟咽,系目系。
故病在膈中而为心烦头痛者,过在手太阳少阴也。)
(出自《素问·五脏生成篇》)
诊断疾病的开始,以“五决”作为纲领。(所谓“五决”,是指通过诊察五脏的疾病来判断生死预后,这是诊断疾病的纲纪。)想要了解疾病的起始,必须先确立其根本原因。(始,指疾病的起始。建,即确立。母,指疾病的病因。如果找不到病因,就无法辨别标本,因此应当先确立病因,如下文提到的某脏、某经等说法。)所谓的“五决”,指的是五种脉象。(五种脉象,即五脏的脉象,各有其所属的经脉。例如肝脉呈弦象,心脉呈钩象,脾脉呈软象,肺脉呈毛象,肾脉呈石象,这些都是所谓的“五脉”。)因此,头痛及头顶部的疾病,属于下虚上实,病邪在于足少阴肾经和足太阳膀胱经,严重时病邪会深入肾脏。(头痛及头顶疾,是上部实证。上部实证是由于下部虚损所致,病邪在肾与膀胱两经。因为足太阳膀胱经的经脉从头顶联络脑部,而肾与膀胱互为表里,阴虚而阳盛,所以导致这种病症。严重时,腑的病证已传入脏,则肾脏单独受到损伤。)视物昏花不明、头摇目眩,眼睛失明、耳朵聋哑,属于下实上虚,病邪在于足少阳胆经和足厥阴肝经,严重时病邪会深入肝脏。(徇,也写作巡,指巡视看视的样子。蒙,指模糊不清。招,指摇动。尤,指严重。眼睛没有光泽就不明亮,头晕晃动就摇动不定,甚至到眼睛失明不能视物,耳朵聋哑听不到声音,这病邪在肝胆之气,下部实而上部虚。因为足少阳胆经的经脉起于眼外角,向上到达头角,向下经过耳后;足厥阴肝经的经脉连接眼球后的脉络,向上出于额部,与督脉交会于头顶,所以导致这些病症。严重时,病邪从腑归入脏,并合并进入肝脏了。按:以下三节,都没有说“甚则入脏”,大概是原文有缺漏,但含义是相同的。)腹部胀满、胁肋支撑疼痛,下部四肢厥冷、上部胸腹闷乱,病邪在于足太阴脾经和足阳明胃经。(支,指隔塞不通。 ,指胁肋上方。足太阴脾经的经脉进入腹部,属脾络胃,向上穿过膈肌;足阳明胃经的经脉属胃络脾,其分支沿着腹腔内部行走,且脾胃都主管四肢,所以导致胁肋支撑疼痛,以及四肢在下部厥冷,胸腹在上部闷乱,这都是病邪在足太阴和足阳明经的缘故。 ,音昌真切。)咳嗽、气逆喘促,气逆壅塞在胸中,病邪在于手阳明大肠经和手太阴肺经。(上气,指喘急。肺位于胸中,属于手太阴肺经,其经脉起于中焦,向上穿过膈肌属肺。手阳明大肠经,是大肠,为太阴的表经,其经脉向下进入缺盆,络肺。这两条经的气机,都能逆乱于胸中,所以导致咳嗽、气逆喘促的病症。)心烦、头痛,病位在膈中,病邪在于手太阳小肠经和手少阴心经。(膈中,指膈肌以上。手太阳小肠经的经脉,进入缺盆,络心,其分支沿着颈部上行至面颊,到达眼外角。手少阴心经的经脉起于心中,出来属心系,其分支向上挟持咽喉,连接眼球后的脉络。所以病位在膈中而出现心烦头痛的,病邪在手太阳和手少阴经。)
(From *Suwen: The Generation of the Five Zang Organs*)
At the beginning of diagnosing diseases, the "Five Judgments" (Wujue, principles for judging life and death based on five zang organs) serve as the guideline. To understand the origin, one must first establish its root cause. (Origin refers to the onset of the disease. Establish means to set up. Root cause refers to the etiology of the disease. Without identifying the cause, the root and branch cannot be distinguished; thus, one must first establish the root cause, as mentioned below regarding specific zang or meridians.) The so-called "Five Judgments" refer to the five pulse types. (The five pulse types are the pulses of the five zang organs, each having its own meridian. For example, the liver pulse is wiry [xian], the heart pulse is hook-like [gou], the spleen pulse is soft [ruo], the lung pulse is feathery [mao], and the kidney pulse is stone-like [shi]; these are all referred to as the five pulses.) Therefore, headache and disorders of the vertex belong to deficiency in the lower and excess in the upper, with the pathology lying in the Foot Shaoyin Kidney Meridian and the Foot Taiyang Bladder Meridian. In severe cases, the pathogen enters the Kidney. (Headache and vertex disorders indicate excess in the upper. Upper excess arises from lower deficiency, with the pathology involving the Kidney and Bladder meridians. Since the Foot Taiyang Bladder Meridian connects the vertex and enters the brain, and the Kidney and Bladder are interior-exterior paired, yin deficiency and yang excess lead to this condition. In severe cases, the fu organ pathology enters the zang organ, causing exclusive injury to the Kidney.) Dizziness, visual blurring, shaking head, blindness, and deafness belong to excess in the lower and deficiency in the upper, with the pathology lying in the Foot Shaoyang Gallbladder Meridian and the Foot Jueyin Liver Meridian. In severe cases, the pathogen enters the Liver. ("Xun," also written as "Xun," describes a looking-around manner. "Meng" means vague or unclear. "Zhao" means shaking or swaying. "You" means severe. Lack of luster in the eyes leads to poor vision; dizziness and swaying indicate instability; eventually, blindness prevents sight, and deafness prevents hearing. The pathology lies in the Qi of the Liver and Gallbladder, which is excessive in the lower and deficient in the upper. The Foot Shaoyang Gallbladder Meridian originates at the outer canthus, ascends to the vertex, and descends behind the ear. The Foot Jueyin Liver Meridian connects with the eye system, emerges above the forehead, and meets the Du Meridian at the vertex, thus causing these conditions. In severe cases, the pathogen moves from the fu to the zang, merging into the Liver. Note: The following three sections do not mention "severe cases enter the zang," likely due to textual omission, but the meaning remains the same.) Abdominal fullness and distension, rib-side support and pain, cold limbs in the lower and mental cloudiness in the upper, with the pathology lying in the Foot Taiyin Spleen Meridian and the Foot Yangming Stomach Meridian. ("Zhi" means blockage. , refers to the area above the ribs. The Foot Taiyin Spleen Meridian enters the abdomen, belongs to the Spleen, and connects with the Stomach, ascending through the diaphragm. The Foot Yangming Stomach Meridian belongs to the Stomach and connects with the Spleen; its branch runs along the interior of the abdomen. Since both Spleen and Stomach govern the four limbs, symptoms such as rib-side support/pain, lower limb coldness, and upper chest/abdominal oppression occur due to pathology in the Foot Taiyin and Foot Yangming meridians. Pronunciation: Chang zhen qie.) Cough and rebellious Qi (Shangqi), with Qi rebellion obstructing the chest, with the pathology lying in the Hand Yangming Large Intestine Meridian and the Hand Taiyin Lung Meridian. (Rebellious Qi refers to rapid panting. The Lung resides in the chest and belongs to the Hand Taiyin Lung Meridian, whose vessel originates in the middle jiao, ascends through the diaphragm, and belongs to the Lung. The Hand Yangming Large Intestine Meridian corresponds to the Large Intestine and is the exterior counterpart to the Taiyin; its vessel descends into the Supraclavicular Fossa and connects with the Lung. The Qi of both meridians can rebel in the chest, leading to cough and rebellious Qi.) Heart vexation and headache, with the disease located in the region of the diaphragm, with the pathology lying in the Hand Taiyang Small Intestine Meridian and the Hand Shaoyin Heart Meridian. (Region of the diaphragm refers to above the diaphragm. The Hand Taiyang Small Intestine Meridian enters the Supraclavicular Fossa, connects with the Heart, and its branch ascends along the neck to the cheek and reaches the outer canthus. The Hand Shaoyin Heart Meridian originates in the Heart, emerges to connect with the Heart system, and its branch ascends along the throat, connecting with the eye system. Thus, when the disease is in the diaphragm region causing heart vexation and headache, the pathology lies in the Hand Taiyang and Hand Shaoyin meridians.)