凡口与鼻气粗。疾出疾入者。为外感邪气有余。口与鼻气微。徐出徐入者。为内伤
正气不足。此辨内外虚实之大法也。若口臭口燥者胃热。口有血腥味者亦胃热。口淡
乏味者。胃伤津液。口腻无味者。胃有湿滞。口干不喜饮者。脾湿内留。口咸吐白沫者
。肾水上泛。口甜者脾瘅。口苦者胆热。口辛者肺热入胃。口酸者肝热犯胃。口干舌燥
者心热。口燥咽痛者肾热。口燥切牙者风痉。口噤难言者风痰。口角流稀涎者脾冷。
口中吐粘涎者脾热。口吐紫血者胃络受伤。口唾淡血者脾不摄血。口张大开者脾绝。口
出鸦声者肺绝。环口黧黑者死。口燥齿枯者死。口如鱼嘴尖起者死。口中气出不返者死
。凡唇焦赤者脾热。唇燥烈者亦脾热。唇焦而红者吉。唇焦而黑者凶。唇干而焦者。脾
受燥热。唇淡而黄者。脾积湿热。唇淡白者血虚。又主吐涎失血。唇红紫者血瘀。又主
虫啮积痛。唇红而吐血者胃热。唇白而吐涎者胃虚。唇红如朱者。血热而心火旺极。唇
白如雪者。血脱而脾阳将绝。唇紫声哑者虫积。唇茧舌裂者毒积。上唇有疮。虫食其
脏者为狐。下疮有疮。虫食其肛者为蜮。唇燥舌干者。心脾热极。唇肿齿焦者。脾肾热
极。唇蹇而缩。不能盖齿者脾绝。唇卷而反。兼连舌短者亦脾绝。唇口颤摇不止者死。
唇吻反青气冷者死。凡病齿燥无津者胃热。齿焦而枯者液涸。切牙 齿者。风动而口筋
牵引。但咬不 者。热甚而牙关紧急。前板齿燥。
脉虚者中暑。下截齿燥。脉芤者便血。上齿龈燥者胃络热极。多吐血。下齿龈燥者肠络热
极。多便红。经行多而齿忽啮人者。冲任涸竭。病必危。虚损久而齿忽啮人者。心肾气
绝。病不治。
【兼勘】叶香岩先生曰。齿为肾之余。龈为胃之络。凡病看舌后。亦须验齿。齿垢
由肾热蒸胃浊所结。其色如糕者。则枯败而津气俱亡。胃肾两竭为无治。齿焦肾水枯
无垢则胃液竭。多死。有垢则火虽盛而液尚未竭。当微下之。齿光燥如石者。胃热甚也
。宜辛凉泄胃。齿如枯骨色者。肾液枯也。宜甘咸救肾。若上半截润。水不上承。心火
炎上也。宜清火救水。热邪耗肾液者。齿色必黄。黄如酱瓣。症多险。宜救肾。热邪耗
胃津者。齿色必紫。紫如干漆。尚可治。宜安胃。齿缝流血而痛者。胃火冲激也。宜清
胃。不痛而出于牙根者。肾火上炎也。宜滋肾。此皆叶先生经验之心得。足补俞氏之未
备。
【荣斋按】本节首段观察吸呼的方法，不完全。尚有最精要、最切合实用的，如∶
气短、气喘、鼻扇、肩息、息高、气息岔涌等六种，均应当深刻了解。而“气粗”“气
微”两种，本节也说得欠详细，兹一并补充之∶
（一）气粗──呼吸有力而不和平，每于阳明热甚时见之，病标在肺，病本在胃；
胃中积热，气不清降，肺被迫而气粗，阳明实症也。（二）气微──呼吸低微，主诸虚
不足，然正气固衰，邪气亦衰了；这常见于热病已愈，正气未复的时候。若在杂病，以
失血症为最显，在伤寒，以两候后为多见。（三）气短──呼吸比平常人短些，也是虚
症。它与气微的差别∶气微的呼吸是静的、是无声的，气短是躁而带粗的；气微是气不
足以息、言不足以听、状态则自然，气短则气若有所窒，语言像不能接续，状态很勉强
。气微者，多属外感病末传，气短者，多属内伤病初起。所以气微为病退之时，气短为
病进之候。（四）气喘──为气急之总名，其原因是体温高涨，其关键在乎胃和肺；
但也有阴不足者；务须注意其兼症。（五）鼻扇──此症是鼻孔弛张不已，可以
一望而知；凡气急非必危症，若兼鼻扇，则多数有危险，大多属于肺脏窒息。（六）肩
息──气管窒塞，体力微弱，吸气时非出全力不可，因而牵动其肩；是谓肩息。病灶在
肺，病源在肾，所谓肾不纳气也，哮喘病剧烈时，往往见之。（七）息高──呼吸及胸
而止，其肺部之起落，仅在胸膈以上。伤寒下后，见之者死，杂病久病衰弱甚者，不在
危殆之例。（八）气息岔涌──此是一种特别急性肺病，其喘息大起大落，胸博腹部皆
膨胀，如抽气的风箱，而鼻孔若感异常狭窄；小儿患此者极危。
凡口鼻呼吸气粗，疾出疾入者，为外感邪气有余。口鼻呼吸气微，徐出徐入者，为内伤正气不足。这是辨别内外虚实的大法。若口臭口燥者，属胃热；口有血腥味者，亦属胃热；口淡乏味者，属胃伤津液；口腻无味者，属胃有湿滞；口干不喜饮者，属脾湿内留；口咸吐白沫者，属肾水上泛；口甜者，属脾瘅（脾热）；口苦者，属胆热；口辛者，属肺热入胃；口酸者，属肝热犯胃；口干舌燥者，属心热；口燥咽痛者，属肾热；口燥切牙者，属风痉（风邪引起的痉挛）；口噤难言者，属风痰；口角流稀涎者，属脾冷；口中吐粘涎者，属脾热；口吐紫血者，属胃络受伤；口唾淡血者，属脾不摄血；口张大开者，属脾绝；口出鸦声者，属肺绝；环口黧黑者死；口燥齿枯者死；口如鱼嘴尖起者死；口中气出不返者死。
凡是唇焦赤者，属脾热；唇燥烈者，亦属脾热；唇焦而红者吉；唇焦而黑者凶；唇干而焦者，属脾受燥热；唇淡而黄者，属脾积湿热；唇淡白者，属血虚，又主吐涎失血；唇红紫者，属血瘀，又主虫啮积痛；唇红而吐血者，属胃热；唇白而吐涎者，属胃虚；唇红如朱者，属血热而心火旺极；唇白如雪者，属血脱而脾阳将绝；唇紫声哑者，属虫积；唇茧舌裂者，属毒积；上唇有疮，虫食其脏者为狐（狐惑病）；下阴有疮，虫食其肛者为蜮（狐惑病）。唇燥舌干者，属心脾热极；唇肿齿焦者，属脾肾热极；唇蹇而缩，不能盖齿者，属脾绝；唇卷而反，兼连舌短者，亦属脾绝；唇口颤摇不止者死；唇吻反青气冷者死。
凡是病见齿燥无津者，属胃热；齿焦而枯者，属液涸；切牙者，属风动而口筋牵引；但咬不齘（磨牙）者，属热甚而牙关紧急。前板齿燥，脉虚者，属中暑；下截齿燥，脉芤者，属便血；上齿龈燥者，属胃络热极，多吐血；下齿龈燥者，属肠络热极，多便红。经行多而齿忽啮人者，属冲任涸竭，病必危；虚损久而齿忽啮人者，属心肾气绝，病不治。
【兼勘】叶香岩先生曰：齿为肾之余，龈为胃之络。凡病看舌后，亦须验齿。齿垢由肾热蒸胃浊所结，其色如糕者，则枯败而津气俱亡，胃肾两竭为无治。齿焦肾水枯无垢则胃液竭，多死。有垢则火虽盛而液尚未竭，当微下之。齿光燥如石者，胃热甚也，宜辛凉泄胃。齿如枯骨色者，肾液枯也，宜甘咸救肾。若上半截润，水不上承，心火炎上也，宜清火救水。热邪耗肾液者，齿色必黄，黄如酱瓣，症多险，宜救肾。热邪耗胃津者，齿色必紫，紫如干漆，尚可治，宜安胃。齿缝流血而痛者，胃火冲激也，宜清胃。不痛而出于牙根者，肾火上炎也，宜滋肾。此皆叶先生经验之心得，足补俞氏之未备。
【荣斋按】本节首段观察吸呼的方法，不完全。尚有最精要、最切合实用的，如：气短、气喘、鼻扇、肩息、息高、气息岔涌等六种，均应当深刻了解。而“气粗”“气微”两种，本节也说得欠详细，兹一并补充之：
（一）气粗──呼吸有力而不和平，每于阳明热甚时见之，病标在肺，病本在胃；胃中积热，气不清降，肺被迫而气粗，阳明实症也。
（二）气微──呼吸低微，主诸虚不足，然正气固衰，邪气亦衰了；这常见于热病已愈，正气未复的时候。若在杂病，以失血症为最显，在伤寒，以两候后为多见。
（三）气短──呼吸比平常人短些，也是虚症。它与气微的差别：气微的呼吸是静的、是无声的，气短是躁而带粗的；气微是气不足以息、言不足以听、状态则自然，气短则气若有所窒，语言像不能接续，状态很勉强。气微者，多属外感病末传，气短者，多属内伤病初起。所以气微为病退之时，气短为病进之候。
（四）气喘──为气急之总名，其原因是体温高涨，其关键在乎胃和肺；但也有阴不足者；务须注意其兼症。
（五）鼻扇──此症是鼻孔弛张不已，可以一望而知；凡气急非必危症，若兼鼻扇，则多数有危险，大多属于肺脏窒息。
（六）肩息──气管窒塞，体力微弱，吸气时非出全力不可，因而牵动其肩；是谓肩息。病灶在肺，病源在肾，所谓肾不纳气也，哮喘病剧烈时，往往见之。
（七）息高──呼吸及胸而止，其肺部之起落，仅在胸膈以上。伤寒下后，见之者死，杂病久病衰弱甚者，不在危殆之例。
（八）气息岔涌──此是一种特别急性肺病，其喘息大起大落，胸博腹部皆膨胀，如抽气的风箱，而鼻孔若感异常狭窄；小儿患此者极危。
Whenever the breath from the mouth and nose is coarse, exiting and entering rapidly, it indicates an excess of external pathogenic factors. Whenever the breath from the mouth and nose is faint, exiting and entering slowly, it indicates a deficiency of internal healthy Qi (vital energy). This is the general method for distinguishing between interior/exterior and deficiency/excess patterns. If there is bad breath and dryness in the mouth, it is due to Stomach Heat. If there is a metallic/bloody taste in the mouth, it is also due to Stomach Heat. If the taste is bland and lacking flavor, it is due to injury of Stomach fluids. If the mouth feels sticky and tasteless, it is due to dampness stagnation in the Stomach. If the mouth is dry but there is no desire to drink, it is due to Spleen dampness retained internally. If the mouth tastes salty with foamy saliva, it is due to Kidney water floating upward. If the mouth tastes sweet, it is Pi Dan (Spleen Heat/Damp-Heat). If the mouth tastes bitter, it is Gallbladder Heat. If the mouth tastes pungent/spicy, it is Lung Heat invading the Stomach. If the mouth tastes sour, it is Liver Heat invading the Stomach. If the mouth and tongue are dry, it is Heart Heat. If the mouth is dry with a sore throat, it is Kidney Heat. If the mouth is dry with teeth grinding/clenching, it is Feng Jing (Wind-induced spasms). If the jaw is locked making speech difficult, it is Wind-Phlegm. If thin saliva flows from the corners of the mouth, it is Spleen Cold. If sticky saliva is spat from the mouth, it is Spleen Heat. If purple blood is vomited, it is injury to the Stomach collaterals. If pale blood is spat in saliva, it is the Spleen failing to control the blood. If the mouth opens wide and cannot close, it indicates Spleen exhaustion. If sounds like a crow come from the mouth, it indicates Lung exhaustion. Blackening around the mouth signifies death. Dry mouth with withered teeth signifies death. Mouth resembling the pointed lips of a fish signifies death. Breath escaping from the mouth without returning signifies death.
If the lips are scorched and red, it is Spleen Heat. If the lips are dry and cracked, it is also Spleen Heat. Scorched lips that are red indicate a favorable prognosis. Scorched lips that are black indicate an unfavorable prognosis. Dry and scorched lips indicate the Spleen suffering from dryness-heat. Pale and yellow lips indicate accumulated damp-heat in the Spleen. Pale white lips indicate Blood deficiency, and may also manifest as vomiting saliva or loss of blood. Red-purple lips indicate Blood stasis, and may also be caused by parasites causing accumulation pain. Red lips with hematemesis indicate Stomach Heat. White lips with vomiting of saliva indicate Stomach deficiency. Lips red as vermilion indicate extreme Blood heat and hyperactive Heart Fire. Lips white as snow indicate Blood depletion and impending extinction of Spleen Yang. Purple lips with hoarseness indicate parasite accumulation. Calloused lips and fissured tongue indicate toxin accumulation. Sores on the upper lip where parasites eat the viscera constitute Hu (Fox disease, likely referring to Erythema Multiforme/Behcet's-like syndrome). Sores on the lower genitalia/anus where parasites eat the anus constitute Yu (also part of Hu-Yu syndrome). Dry lips and dry tongue indicate extreme Heat in the Heart and Spleen. Swollen lips and scorched teeth indicate extreme Heat in the Spleen and Kidney. Lips that are stiff and retracted, unable to cover the teeth, indicate Spleen exhaustion. Lips that curl inward and backward, accompanied by a short frenulum, also indicate Spleen exhaustion. Lips and mouth trembling continuously signify death. Lips turning blue-green with cold breath signify death.
Regarding teeth: Teeth dry without fluid indicate Stomach Heat. Scorched and withered teeth indicate exhaustion of body fluids. Teeth clenching/grinding indicates Wind stirring and traction of oral tendons. Teeth grinding without clenching indicates severe Heat causing stiffness of the jaw. Dryness of the anterior plate teeth with a deficient pulse indicates Summerheat. Dryness of the lower teeth with a knotted (Kou) pulse indicates blood in the stool. Dryness of the upper gingiva indicates extreme Heat in the Stomach collaterals, often leading to hematemesis. Dryness of the lower gingiva indicates extreme Heat in the intestinal collaterals, often leading to hematochezia. Excessive menstruation followed by sudden tooth-clenching indicates exhaustion of the Chong and Ren vessels, indicating a critical condition. Long-term deficiency consumption followed by sudden tooth-clenching indicates exhaustion of Heart and Kidney Qi, indicating an untreatable condition.
[Supplementary Verification] Mr. Ye Tianshi stated: Teeth are the surplus of the Kidney; gums are the collaterals of the Stomach. After examining the tongue in any disease, one must also examine the teeth. Dental plaque is formed by Kidney Heat steaming Stomach turbidity. If its color resembles cake, it indicates decay with exhaustion of both fluids and Qi, and exhaustion of both Stomach and Kidney, which is untreatable. Scorched teeth with dry Kidney water and no plaque indicate exhaustion of Stomach fluids, often fatal. If there is plaque, although Fire is strong, fluids have not yet been exhausted, and mild purgation should be used. Teeth that are shiny and dry like stone indicate severe Stomach Heat; acrid-cool herbs to drain Stomach Heat should be used. Teeth that look like withered bone indicate exhaustion of Kidney fluids; sweet-salty herbs to rescue the Kidney should be used. If the upper half is moist, Water fails to ascend, and Heart Fire flares upward; clear Fire and rescue Water should be used. When Heat pathogens consume Kidney fluids, the teeth turn yellow, like soybean paste; the condition is dangerous, rescue the Kidney. When Heat pathogens consume Stomach fluids, the teeth turn purple, like dried lacquer; the condition is treatable, stabilize the Stomach. Bleeding from gum margins with pain indicates Stomach Fire rushing and striking; clear the Stomach. Bleeding from the gum roots without pain indicates Kidney Fire flaming upward; nourish the Kidney. These are all insights from Mr. Ye’s experience, sufficient to supplement the omissions in Mr. Yu’s work.
[Rongzhai’s Note] The method of observing respiration in the first paragraph of this section is incomplete. There are other most essential and practical methods, such as: Shortness of breath (Qi Duan), Panting/Asthma (Qi Chuan), Flaring of nostrils (Bi Shan), Shoulder breathing (Jian Xi), High-pitched breathing (Xi Gao), and Surging irregular breathing (Qi Xi Cha Yong), six types in total, which should be deeply understood. Furthermore, the descriptions of "Coarse breath" and "Faint breath" in this section are insufficiently detailed; here they are supplemented together:
(1) Coarse breath (Qi Cu) – Breathing is forceful but not peaceful/harmonious, often seen when Yangming Heat is severe. The manifestation is in the Lung, but the root is in the Stomach; accumulated Heat in the Stomach prevents Qi from descending clearly, forcing the Lung into coarse breathing. This is a Yangming Excess pattern.
(2) Faint breath (Qi Wei) – Breathing is low and faint, indicating various deficiencies. However, while Healthy Qi is indeed declining, Pathogenic Factors are also declining; this is commonly seen when a febrile disease has resolved but Healthy Qi has not yet recovered. In miscellaneous diseases, it is most prominent in hemorrhagic conditions; in Shanghan (Cold Damage), it is common after two stages (approx. 10 days).
(3) Shortness of breath (Qi Duan) – Breathing is shorter than normal, also a deficiency pattern. The difference between Qi Duan and Qi Wei: Qi Wei breathing is quiet and silent; Qi Duan is restless and somewhat coarse. Qi Wei indicates insufficient Qi for respiration and speech, with a natural state; Qi Duan feels obstructed, speech seems discontinuous, and the state is strained. Qi Wei mostly belongs to the late transmission of external contraction diseases; Qi Duan mostly belongs to the initial onset of internal injury diseases. Therefore, Qi Wei is a sign of disease receding, while Qi Duan is a sign of disease progressing.
(4) Panting/Asthma (Qi Chuan) – A general term for urgent breathing. Its cause is high body temperature, and its key lies in the Stomach and Lung; however, there are cases of Yin deficiency; one must pay attention to accompanying symptoms.
(5) Flaring of nostrils (Bi Shan) – This symptom involves continuous dilation of the nostrils, visible at a glance. While urgent breathing is not necessarily critical, if accompanied by flaring nostrils, it is usually dangerous, mostly belonging to lung suffocation.
(6) Shoulder breathing (Jian Xi) – Tracheal obstruction, weak physical strength, requiring full effort to inhale, thereby pulling the shoulders; this is called Shoulder breathing. The lesion is in the Lung, the source is in the Kidney, known as "Kidney failing to grasp Qi." It is often seen during severe asthma attacks.
(7) High-pitched breathing (Xi Gao) – Respiration stops at the chest, with lung movement only above the diaphragm. In Shanghan, seeing this after purgation indicates death. In miscellaneous diseases, long-term severe weakness does not fall into the critical category.
(8) Surging irregular breathing (Qi Xi Cha Yong) – This is a special acute pulmonary disease. Its panting rises and falls drastically, the chest and abdomen are both distended, like an air pump, and the nostrils feel abnormally narrow; infants suffering from this are extremely critical.