（论二首脉证十七条方三首）
肺中风者。口燥而喘。身运而重。冒而肿胀。
〔衍义〕肺者。手太阴燥金。与足太阴同为湿化。内主音声。外合皮毛。属上焦阴部。
行营卫。在五行生克。畏火克木。今为风中之。夫风者。内应肝木之气。得火反侮
所不胜之金。然木之子。火也。火必随木而至。风能胜湿。热能燥液。故为口燥。风
火皆阳。二者合。则摇动不宁。动于肺。则燥其所液之湿。鼓其音声。有出难入。而
作喘鸣。动于荣卫。鼓其脉络肌肉。则身运作肿胀。虽然。此特风中于肺。失其运
用之一证耳。若内经所论肺风者。多汗、恶寒、色白、时咳、昼瘥、暮剧。是又叙其邪
在肺作病状如是。各立一义以为例耳。然后人自此而推。皆可得之。其在脏在
舍在经络。凡所见之病。不患其不备也。余脏皆然。
肺中寒。吐浊涕。
〔衍义〕肺者。阴也。居阳部。故曰阴中之阳。谓之娇脏。恶热复恶寒。过热则伤所禀
之阴。过寒则伤所部之阳。为相传之官。布气化液。行诸内外。阳伤则气耗。阴伤
则液衰。今寒中之。则气液蓄于胸。而成浊饮。唾出于口。蓄于经脉。乃成浊涕。流
出于鼻。以鼻是肺脏呼吸之门也。
肺死脏。浮之虚。按之弱如葱叶。下无根者死。
〔衍义〕肺金主秋。当下四十五日后。阴气微上。阳气微下之时。内经论其平脉曰。
气来轻虚以浮。来急去散。又曰。微毛而有胃气。又曰。厌厌聂聂。如落榆叶状。其
阴阳微上下之象如此。又曰。死脉则为真肺脉至。大而虚。如毛羽中人肤。又曰。
来如物之浮。如风吹毛。又曰。但毛无胃。则是阳气不下。阴气不上。盛阳当变阴
而不变。既不收敛。又不和缓。惟浮。欲死可知已。因火克金而阴亡。内经谓其不
过三日死。正与此同。盖阴者阳之根。浮者有之。沉者亦有之。根壮而后枝叶茂。
叙平脉惟贵轻虚以浮。非全无沉者。但浮沉皆止三菽之重耳。不欲其如石之
沉也。今浮之虚。按之又弱如葱叶。于三菽其有几哉。越人曰。肝与肺有生熟浮
沉之异。生浮则熟沉。生沉则熟浮。盖阳极生阴。阴极生阳。更始体用之气在二
脏。故二脏之形亦如之。缘肺居阳部。故体轻浮。主气以象阳。阳极变阴。故用收
敛以象阴。肝居阴部。故体重沉。藏血以象阴。阴极变阳。故用升发以象阳。浮沉
正此耳。五脏阴阳。各具一体用。不可不察。
肝中风者。头目 。两胁痛。行常伛。令人嗜甘。
〔衍义〕五气在天为风。在地为木。在脏为肝。与筋合。肝之筋与经脉。皆出足大趾
之端。过股内。上循两胁。出胸中。至于巅。今中于风则动摇。上者为头目 。风甚
则亢。亢则害。承乃制。兼金之体。于是血液皆衰。经络尽从收敛而急束。故两胁
痛。不能俯仰。伛而行。经曰。肝苦急。急食甘以缓之。故令嗜甘也。若内经肝风之
状。多汗恶风。善悲。色苍。嗌干。善怒。时憎女子。此又并其脏之体用而言也。
肝中寒者。两臂不举。舌本燥。喜太息。胸中痛。不得转侧。食则吐而汗出也。（千金云时盗汗
出咳食已吐其汁）
〔衍义〕肝者。阴之阳。其气温和。启陈舒荣而魂居之。并神出入。所畏者金也。金性
凉。其气收敛肃杀。故克之。令更中寒。金乃水之母。母必从子而至。以害其木。凝
泣气血。生化失职。不荣于上之筋脉。则两臂不举矣。
肝死脏。浮之弱。按之如索不来。或曲如蛇行者死。
〔补注〕曷言死脏。已无生气也。肝属木应濡。是弱犹为本脉。然但浮之弱。既非长
竿末梢之循矣。及按之曰如索。则弦紧俱见。曰不来。则脉有来去。乃阴阳往复
之理。今但去。是直上下而无胃气也。否则真气将散。出入勉强。有委而不前。屈
且难伸之状。故曲如蛇行也。呜呼。木之生也。有鼓动条达。发荣柔婉之妙。其死
也。非强直而不复。即矫曲而不遂。木曰曲直。所以始之终之也。
肝着。其人当蹈其胸上。先未苦时。但欲饮热。旋复花汤主之。
旋复花汤方
旋复花（三两） 葱（十四茎） 新绛（少许）
上三味。以水三升。煮取一升。顿服。
〔补注〕肝主疏泄。言其用也。倘郁抑不舒。势必下乘中土。土必弱而时满。气必结
而不开。故喜人之按之揉之也。肝气之弱。言着之心胸之间也。先欲饮热者。木
汲在水。喜其生已。热则能行。乐其散结。以此消息。病情斯得矣。故以旋复为君。
主结气胁下满。消胸上痰。而以葱通阳气也。使徒治肝气而不及血。似与所着
不宣。故取有色无质者。能入藏血之地而不着耳。
心中风者。翕翕发热。不能起。心中饥。食即呕吐。
〔补注〕心为君主。胞络卫焉。邪岂得以干之乎。然则心中风者。殆胞络受邪也。风
为阳邪。善行数变。而所伤在君火之地。两热相合。势必外蒸。伤寒言翕翕为温
热而不至于大热也。夫君火之官受困。则四肢自不能起。而蕴热于内。悬悬如
饥状。乃痰饮蓄聚上脘。初非胃虚也。食又何能下乎。是不至呕吐不止也。
心中寒者。其人苦病心。如啖蒜状。剧者心痛彻背。背痛彻心。譬如蛊注。其脉浮者。自吐乃愈。
〔补注〕心主散。寒入而火郁矣。郁则气既不舒。而津液聚为浊饮。故其苦病如啖
蒜者。正形容心中懊 不得舒坦。若为辛浊所伤也。至甚者。正以阴凝之邪。袭
于阳部。阻其升降。前后不通。亦犹胸痹之痛。彻背彻心。比如虫之蛊注。其状更
有甚于啖蒜者矣。其脉浮者。邪在上也。因高越之。使所结之饮上涌。则所受之
邪亦外出矣。盖吐中自有发散之义也。
心伤者。其人劳倦。即头面赤而下重。心中痛而自烦。发热。当脐跳。其脉弦。此为心脏伤所致也。
〔衍义〕内经曰。心者。君主之官。神明出焉。主明则下安。否则十二官危矣。形乃大
伤。主不明则十二官危。况所安之宅乎。仲景谓心伤者。心之神因七情所伤也。
盖神乃气之主帅。气乃神之从卒。懵乱则神迁。迁则脏真之气应之而乱。久则
衰。衰则心伤矣。心既伤而复加之劳役。脏之真阴不能持守其火。而火乱动。动
则上炎。其头目即发赤。脏真从火炎。不从下行。而阴独在下。故重。心虚则肾水
乘之。内作。心痛而烦。外作。经络之阴不得入与脏通。故发热。心脉络于小肠。火
气不行。伏鼓而动作。故当脐跳。仲景以弦脉为阴为虚。今见于心之阴脏。皆因心伤。所以得是脉也。
心死脏。浮之实如丸豆。按之益躁疾者死。
〔衍义〕内经心脉如钩。但钩无胃曰死。心脉来前曲后居。如操带钩。又云。脉至坚
而搏。如循薏苡子。累累然乃死。心死脉不可一气言。心脏气来。象虽不一。阴阳
之道。未之或异。何也。心脉主夏。阳气盛极于阴始生之时。极而不能生阴者死。
阴极而反胜其阳者死。以阴静。往来候之而已。来者候其阳。去者候其阴。来盛
而去衰如钩。终乏雍容和缓气象。其能久而不死乎。和平之钩者。则前曲后居
之反也。所以如操带钩。无胃气故也。阴阳生化。从守其脏。若薏苡子短数而动。
又能无死乎。动如麻豆。殆与薏苡子象同。盖躁疾者。气脱亡阴也。故主死。
邪哭。使魂魄不安者。血气少也。血气少者属于心。心气虚者。其人则畏合目欲眠。
梦远行而精神离散。魂魄妄行。阴气衰者为癫。阳气衰者为狂。
〔衍义〕神之所任物而不乱者。由气血维持而养之以静也。若气血衰少。则神失
所养而不宁。并神出入者谓之魂。守神之舍者谓之魄。神不宁则悲。悲则魂魄
不安矣。心与目内外相关。目开则神存于中而应事。目合则神散于外而妄行。
故畏合目。经云。阳盛则梦飞。阴盛则梦坠。今以虚不以盛。故梦远而不飞坠耳。
所言癫狂。非阴阳上下相并之病。乃独持心脏。分气血。阴阳相倾也。盖阴在内。
为阳之守。阳在外。为阴之卫。若阴气衰。阳气并于内。神亦入于阴。故癫。癫病者。
神与声皆闭藏而不发。若阳气衰。阴气并于外。神亦出于阳。故狂。狂病者。神与声皆散乱而妄动也。
脾中风者。翕翕发热。形如醉人。腹中烦重。皮目 而短气。
〔衍义〕风阳邪也。内应肝。在心脏者。尚有翕翕发热。况属脾土。是贼邪乎。故外掣
其皮。目 。内乱其意。如醉人。而腹中烦也。脾受贼邪。气力散解。故重而短气。
且内经脾风者。身体怠惰。四肢不欲动。当不止腹中烦重而已。
脾死脏。浮之大坚。按之如覆杯。洁洁状如摇者死。
〔衍义〕内经死脾脉至。脉来坚锐。如雀之啄。如鸟之距。状其独阴独阳而不柔和
也。如屋之漏状。其动止之不常也。如水之流。状其去之无节也。如弱而乍数乍
疏。状其进退无度也。今浮之大坚。非类鸟啄乎。按之如覆杯。非类鸟距乎。洁洁如摇者。非类屋漏与乍数乍疏乎。
趺阳脉浮而涩。浮则胃气强。涩则小便数。浮涩相搏。大便则坚。其脾为约。麻子仁丸主之。
麻子仁丸方
麻仁（二升） 芍药（半斤） 枳实（半斤） 大黄（一斤）
浓朴（一尺） 杏仁（一升去皮尖）
上末之。炼蜜丸。如梧子大。饮服十丸。日三。以知为度。
〔补注〕趺阳脉。土也。浮为阳。涩为阴。故浮之见阳。沉之见阴也。夫阳有余。则胃气
强。阴不足。则太阴不固。故小便数。然则脾正为胃行津液者也。脏涩而不能约
束水津。则留于胃者甚少。而胃自失所润。然则胃之不润。脾为之也。故曰为约
于是以大黄、枳实去实。先以麻仁润燥。芍药养阴。且用浓朴佐杏仁以利肺气。兼补益阴气之用。斯得之矣。
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。甘姜苓术汤主之。
甘姜苓术汤方
白术（二两） 甘草（二两） 干姜（四两） 茯苓（四两）
上四味。以水五升。煮三升。去滓。分温三服。腰即温。
〔补注〕肾为水脏。而真阳伏焉。肾着之病。肾气本衰。故水火俱虚。而后湿气得以
着之。何也。水与水为类。故易召也。其人身重。湿也。腰如坐冷水。有水状。湿气胜
也。不渴者。阳明未尝热也。小便利。膀胱未尝病也。饮食如故。中焦亦不病也。故
曰病在下焦。而又申明所致病之由。言身劳则阳气张而汗出。湿入则阴气久
而不散。以致冷痛腹重有如彼也。然论病固下焦症也。而立方皆中焦药。岂无
故哉。人之阳气。原于下而盛于中。今因中州无恙之时。再一浓培脾土。使土旺
可以制湿。阳壮足以发越。故取干姜之辛热。茯苓之淡渗。加于补中味内。三服
可令腰温。全不及下焦药者。恐补肾则反助水益火。无由去湿也。仲景明言下
焦。药反出中焦者。不令人想见微旨耶。
肾死脏。浮之坚按之乱如转丸。益下入尺中者死。
〔衍义〕内经死肾脉来。发如夺索。辟辟如弹石。又谓搏而绝。如指弹石。辟辟然。是
皆无胃气而天真之阳已亡。惟真脏之残阴。随呼吸而动。单见本脏之象耳。浮
以候外。外阳也。坚者。犹弹石夺索。乃真阴出于阳也。按以候里。里、阴也。动则为
阳。乱动如转丸。乃真阳将脱。动无伦序。不能去来。惟系息于其中。若益入尺。是
阴阳离决。死兆彰彰矣。
问曰。三焦竭者。上焦竭。善噫。何也。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。
〔衍义〕竭者涸也。上焦属心肺。一阴一阳之部。肺主气。心主血。以行荣卫。为气为
血。有一衰弱。则荣卫不能相持而行。上焦之化政竭矣。虽中焦受谷气。亦不消
散。而聚于胸中。必待噫而出之。下焦属肝肾。亦是一阴一阳之部。肾主闭藏。肝
主疏泄。其气不和。则荣不能内守。卫亦不能外固。下焦如渎。气化之政竭矣。故
小便不禁而遗溺也。久而荣卫和。则自愈。尝考伤寒论脉法中云。寸口脉微而
涩。微者卫气不行。涩者荣气不逮。荣卫不能相将。三焦无所仰。不归其部。上焦
不归者。噫而吞酸。中焦不归者。不能消谷引食。下焦不归者。则遗溺。正此之谓。
出于上焦。而中焦亦噫也。内经以督脉所生病为遗溺。灵枢以肝所生病为遗溺。则遗溺亦不惟此已。
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
闭不通。大肠有寒者。多 溏。有热者。便肠垢。小肠有寒者。其人下重便血。有热者必痔。
〔衍义〕热在上焦为肺痿。义同肺痿条。然中焦为坚满。亦与脾约同义。热在下焦
尿血及淋闭者。三焦下输。入络膀胱。即与内经胞移热于膀胱为癃溺意同。盖
膀胱为州都之官。气化而溺出焉。热在血。则血渗入膀胱。尿而出之。热在气。气
郁成燥。水液因凝。故小便赤而淋闭不通。虽淋闭属气郁。亦有属血者。气病溺
色白。血病溺色赤。为热在下焦。下焦固不独膀胱。若肾若肝若小肠。皆居下焦。
（本篇论述共有二条总纲，十七条脉证，三个方剂）
肺脏受风邪侵袭。表现为口干舌燥且气喘。身体感觉昏眩沉重。头目昏蒙并伴有肿胀。
〔衍义〕肺属手太阴燥金之气，与足太阴脾土同主湿化。内主管声音，外合于皮毛。位于上焦阴部。
运行营卫之气。在五行生克关系中，肺畏火克、木侮。如今被风邪所中。风对应肝木之气，得火气则反侮其所不胜的金气。然而木之子为火，火必随木而至。风能胜湿，热能燥液。所以出现口干。风和火皆属阳，二者结合，则导致摇动不宁。风动于肺，则燥其津液之湿，鼓动其音声，导致气出难入，从而产生喘鸣。风动于营卫，鼓动其脉络肌肉，则导致身体昏眩、运作失常及肿胀。虽然如此，这仅是风邪中于肺，使其功能失常的一种证候罢了。若《内经》所论述的肺风，表现为多汗、恶寒、面色白、时时咳嗽、白天减轻、傍晚加重。这是叙述邪气在肺作病的症状表现。各自确立一种意义作为范例。后人由此推演，皆可得知。其在脏、在舍、在经络，凡所见到的病证，不用担心不全面。其余脏腑也是如此。
肺脏受寒邪侵袭。吐出浑浊的鼻涕。
〔衍义〕肺属阴，居于阳部，所以说它是“阴中之阳”。称为娇脏，既怕热又怕冷。过热则损伤其所禀受的阴气，过寒则损伤其所管辖的阳气。肺为相傅之官，布散气化津液，行于内外。阳气受损则气耗散，阴气受损则津液衰少。如今寒邪中于肺，则气液蓄积于胸中，形成浊饮。唾出于口，蓄积于经脉，便成为浊涕，流出于鼻。因为鼻是肺脏呼吸的门户。
肺脏败绝的死脉。轻取虚浮，重按软弱如葱叶，下部无根者死。
〔衍义〕肺金主秋令，应在立秋四十五日后，阴气微升、阳气微降之时。《内经》论述其平脉说：脉气来轻虚而浮，来势急而去势散。又说：微带毛象而有胃气。又说：脉象柔和，像榆叶飘落的样子。其阴阳微升微降的景象就是这样。又说：死脉则为真肺脉至，大而虚，像羽毛中人皮肤。又说：脉来如物之浮，像风吹毛。又说：只有毛象而无胃气，则是阳气不下、阴气不上，盛阳应当变阴而不变化，既不收敛又不和缓，只见浮象，可知欲死。因火克金而导致阴亡，《内经》谓其不超过三天死，正与此相同。盖阴是阳的根本，浮脉有之，沉脉也有之。根本强壮而后枝叶茂盛。叙述平脉只贵在轻虚而浮，并非全无沉象，但浮沉都只止于三菽之重而已。不希望它像石头那样沉。如今轻取虚，重按又弱如葱叶，对于三菽之重还有多少呢？《难经》说：肝与肺有生熟浮沉的不同。生浮则熟沉，生沉则熟浮。盖阳极生阴，阴极生阳，更始体用之气在二脏。所以二脏的脉形也如此。因为肺居阳部，故体轻浮，主气以象阳，阳极变阴，故用收敛以象阴。肝居阴部，故体重沉，藏血以象阴，阴极变阳，故用升发以象阳。浮沉正是此理。五脏阴阳，各具一体用，不可不察。
肝脏受风邪侵袭。头晕目眩，两胁疼痛，行走时常弯腰曲背，使人喜欢吃甘甜的食物。
〔衍义〕五气在天为风，在地为木，在脏为肝，与筋相合。肝之筋与经脉，都出于足大趾之端，过股内侧，上行沿两胁，出胸中，至于头顶。如今中于风则动摇，向上者为头目眩晕。风甚则亢盛，亢盛则有害，承乃制，兼有金之体性，于是血液皆衰，经络尽从收敛而急束。所以两胁痛，不能俯仰，弯腰而行。经说：肝苦急，急食甘以缓之。所以使人嗜甘。若《内经》肝风的状貌，多汗恶风，善悲，面色苍，咽干，善怒，时憎女子。这又是综合其脏的体用而言的。
肝脏受寒邪侵袭。两臂不能举起，舌根干燥，喜欢叹气，胸中痛，不能转侧，进食则呕吐且出汗。（《千金方》云：有时盗汗出，咳，食已吐其汁）
〔衍义〕肝属阴中之阳，其气温和，启陈舒荣而魂居之，并与神出入。所畏惧的是金。金性凉，其气收敛肃杀，所以克肝。令其更中寒，金是水之母，母必从子而至，以害其木。凝泣气血，生化失职，不能荣养上面的筋脉，则两臂不能举起了。
肝脏败绝的死脉。轻取弱，重按如绳索不来，或弯曲如蛇行者死。
〔补注〕何谓死脏？已经没有了生气。肝属木应濡润，弱还是本脉。然而仅轻取弱，已经不是长竿末梢那样的柔顺了。等到重按如索，则弦紧俱见。说不来，则脉有来去，乃是阴阳往复之理。如今只有去，是直上下而无胃气。否则真气将散，出入勉强，有委顿不前，屈且难伸的状态。所以弯曲如蛇行。呜呼，木的生发，有鼓动条达、发荣柔婉的妙处。其死也，不是强直而不复，就是矫曲而不遂。木曰曲直，所以始终如此。
肝着病。其人应当踩踏胸部，起初未痛苦时，只想喝热饮。用旋复花汤主治。
旋复花汤方
旋复花（三两） 葱（十四茎） 新绛（少许）
以上三味，用水三升，煮取一升，一次服下。
〔补注〕肝主疏泄，说的是其用。倘若郁抑不舒，势必下乘中土，土必弱而时常胀满，气必结而不能开。所以喜欢人按压揉搓它。肝气之弱，说的是附着在心胸之间。先前想喝热的，是因为木汲在水，喜其生己，热则能行，乐其散结。以此斟酌，病情就得到了。所以以旋复花为君药，主结气胁下满，消胸上痰，而以葱通阳气。如果只治肝气而不及血，似乎与所着的病不相宜。所以取有色无质的药物，能入藏血之地而不滞着。
心中受风邪侵袭。翕翕发热，不能起身，心中觉饥，进食即呕吐。
〔补注〕心为君主，胞络护卫它。邪气岂能干扰它呢？那么心中风者，大概是胞络受邪。风为阳邪，善行数变，而所伤在君火之地，两热相合，势必外蒸。《伤寒论》言翕翕为温热而不至于大热。夫君火之官受困，则四肢自然不能起身，而蕴热于内，悬悬如饥状，乃是痰饮蓄聚上脘，初非胃虚。食物又何能下行呢？这就不会不呕吐不止。
心中受寒邪侵袭。其人苦于心病，感觉像吃了蒜一样难受。严重的，心痛彻背，背痛彻心，譬如蛊注。其脉浮的，自吐则愈。
〔补注〕心主散，寒入而火郁矣。郁则气既不舒，而津液聚为浊饮。所以其苦病如吃蒜的，正是形容心中懊恼不得舒坦，好像被辛浊所伤。至于严重的，正是由于阴凝之邪，袭于阳部，阻其升降，前后不通，也犹如胸痹之痛，彻背彻心，比如虫之蛊注。其状更有甚于吃蒜的了。其脉浮的，邪在上也。因高越之，使所结之饮上涌，则所受之邪亦外出。盖吐中自有发散之义。
心脏受伤的人。其人劳累疲倦，就头面赤红而下肢沉重，心中痛且自烦，发热，肚脐跳动。其脉弦。这是心脏受伤所致。
〔衍义〕《内经》说：心者，君主之官，神明出焉。主明则下安，否则十二官危矣。形体乃大大受伤，主不明则十二官危，何况所安之宅呢？仲景谓心伤者，心之神因七情所伤。盖神乃气之主帅，气乃神之从卒。懵乱则神迁，迁则脏真之气应之而乱，久则衰，衰则心伤。心既伤而复加之劳役，脏之真阴不能持守其火，而火乱动，动则上炎，其头目即发赤。脏真从火炎，不从下行，而阴独在下，故重。心虚则肾水乘之，内作心痛而烦，外作经络之阴不得入与脏通，故发热。心脉络于小肠，火气不行，伏鼓而动作，故当脐跳。仲景以弦脉为阴为虚，今见于心之阴脏，皆因心伤，所以得是脉。
心脏败绝的死脉。轻取实如丸豆，重按更加躁疾者死。
〔衍义〕《内经》心脉如钩，但钩无胃气曰死。心脉来前曲后居，如操带钩。又说：脉至坚而搏，如循薏苡子，累累然乃死。心死脉不可一气言。心脏气来，象虽不一，阴阳之道，未之或异。为什么呢？心脉主夏，阳气盛极于阴始生之时，极而不能生阴者死。阴极而反胜其阳者死。以阴静，往来候之而已。来者候其阳，去者候其阴。来盛而去衰如钩，终乏雍容和缓气象，其能久而不死乎？和平之钩者，则前曲后居之反也。所以如操带钩，无胃气故也。阴阳生化，从守其脏，若薏苡子短数而动，又能无死乎？动如麻豆，殆与薏苡子象同。盖躁疾者，气脱亡阴也。故主死。
邪哭，使魂魄不安的，是血气少。血气少属于心。心气虚的人，其人则害怕闭眼想睡觉，梦见远行而精神离散，魂魄妄行。阴气衰者为癫，阳气衰者为狂。
〔衍义〕神之所任物而不乱的，由气血维持而养之以静。若气血衰少，则神失所养而不宁。并神出入的谓之魂，守神之舍的谓之魄。神不宁则悲，悲则魂魄不安。心与目内外相关，目开则神存于中而应事，目合则神散于外而妄行。故畏合目。经云：阳盛则梦飞，阴盛则梦坠。今以虚不以盛，故梦远而不飞坠耳。所言癫狂，非阴阳上下相并之病，乃独持心脏，分气血，阴阳相倾。盖阴在内，为阳之守；阳在外，为阴之卫。若阴气衰，阳气并于内，神亦入于阴，故癫。癫病者，神与声皆闭藏而不发。若阳气衰，阴气并于外，神亦出于阳，故狂。狂病者，神与声皆散乱而妄动。
脾脏受风邪侵袭。翕翕发热，形态像醉人，腹中烦重，眼皮跳动且短气。
〔衍义〕风为阳邪，内应肝。在心脏者，尚有翕翕发热，况属脾土，是贼邪乎。故外掣其皮，目瞤，内乱其意，如醉人，而腹中烦。脾受贼邪，气力散解，故重而短气。且《内经》脾风者，身体怠惰，四肢不欲动，当不止腹中烦重而已。
脾脏败绝的死脉。轻取之大坚，重按如覆杯，洁洁状如摇者死。
〔衍义〕《内经》死脾脉至，脉来坚锐，如雀之啄，如鸟之距，状其独阴独阳而不柔和。如屋之漏状，其动止之不常。如水之流，状其去之无节。如弱而乍数乍疏，状其进退无度。今浮之大坚，非类鸟啄乎？按之如覆杯，非类鸟距乎？洁洁如摇者，非类屋漏与乍数乍疏乎？
趺阳脉浮而涩，浮则胃气强，涩则小便数，浮涩相搏，大便则坚，其脾为约。用麻子仁丸主治。
麻子仁丸方
麻仁（二升） 芍药（半斤） 枳实（半斤） 大黄（一斤）
浓朴（一尺） 杏仁（一升去皮尖）
以上研末，炼蜜丸，如梧子大，饮服十丸，日三，以知为度。
〔补注〕趺阳脉，属土。浮为阳，涩为阴，故浮之见阳，沉之见阴。夫阳有余，则胃气强，阴不足，则太阴不固，故小便数。然则脾正为胃行津液者也。脏涩而不能约束水津，则留于胃者甚少，而胃自失所润。然则胃之不润，脾为之也。故曰为约。于是以大黄、枳实去实，先以麻仁润燥，芍药养阴，且用浓朴佐杏仁以利肺气，兼补益阴气之用。斯得之矣。
肾着病。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。用甘姜苓术汤主治。
甘姜苓术汤方
白术（二两） 甘草（二两） 干姜（四两） 茯苓（四两）
以上四味，用水五升，煮三升，去滓，分温三服。腰即温。
〔补注〕肾为水脏，而真阳伏焉。肾着之病，肾气本衰，故水火俱虚，而后湿气得以着之。何也？水与水为类，故易召也。其人身重，湿也。腰如坐冷水，有水状，湿气胜也。不渴者，阳明未尝热也。小便利，膀胱未尝病也。饮食如故，中焦亦不病也。故曰病在下焦，而又申明所致病之由，言身劳则阳气张而汗出，湿入则阴气久而不散，以致冷痛腹重有如彼也。然论病固下焦症也，而立方皆中焦药，岂无故哉？人之阳气，原于下而盛于中。今因中州无恙之时，再一浓培脾土，使土旺可以制湿，阳壮足以发越。故取干姜之辛热，茯苓之淡渗，加于补中味内，三服可令腰温。全不及下焦药者，恐补肾则反助水益火，无由去湿。仲景明言下焦，药反出中焦者，不令人想见微旨耶？
肾脏败绝的死脉。轻取坚，重按乱如转丸，益下入尺中者死。
〔衍义〕《内经》死肾脉来，发如夺索，辟辟如弹石。又谓搏而绝，如指弹石，辟辟然。是皆无胃气而天真之阳已亡，惟真脏之残阴，随呼吸而动，单见本脏之象。浮以候外，外阳也。坚者，犹弹石夺索，乃真阴出于阳。按以候里，里、阴也。动则为阳，乱动如转丸，乃真阳将脱，动无伦序，不能去来，惟系息于其中。若益入尺，是阴阳离决，死兆彰彰矣。
问曰：三焦竭者，上焦竭，善噫。何也？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。
〔衍义〕竭者涸也。上焦属心肺，一阴一阳之部。肺主气，心主血，以行营卫，为气为血，有一衰弱，则营卫不能相持而行，上焦之化政竭矣。虽中焦受谷气，亦不消散，而聚于胸中，必待噫而出之。下焦属肝肾，亦是一阴一阳之部。肾主闭藏，肝主疏泄，其气不和，则营不能内守，卫亦不能外固。下焦如渎，气化之政竭矣。故小便不禁而遗溺。久而营卫和，则自愈。尝考《伤寒论》脉法中云：寸口脉微而涩，微者卫气不行，涩者营气不逮。营卫不能相将，三焦无所仰，不归其部。上焦不归者，噫而吞酸；中焦不归者，不能消谷引食；下焦不归者，则遗溺。正此之谓。出于上焦，而中焦亦噫。《内经》以督脉所生病为遗溺，《灵枢》以肝所生病为遗溺，则遗溺亦不惟此已。
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，亦令淋闭不通。大肠有寒者，多溏。有热者，便肠垢。小肠有寒者，其人下重便血。有热者必痔。
〔衍义〕热在上焦为肺痿，义同肺痿条。然中焦为坚满，亦与脾约同义。热在下焦尿血及淋闭者，三焦下输，入络膀胱，即与《内经》胞移热于膀胱为癃溺意同。盖膀胱为州都之官，气化而溺出焉。热在血，则血渗入膀胱，尿而出之。热在气，气郁成燥，水液因凝，故小便赤而淋闭不通。虽淋闭属气郁，亦有属血者。气病溺色白，血病溺色赤。为热在下焦，下焦固不独膀胱，若肾若肝若小肠，皆居下焦。
(Two general discussions, seventeen pulse and symptom patterns, three formulas)
When the Lung is invaded by Wind pathogen, symptoms include dry mouth and coughing with panting. The body feels dizzy and heavy, accompanied by a sensation of dizziness/fullness and swelling.
[Commentary] The Lung belongs to Hand-Taiyin Dry Metal Qi, sharing damp transformation with Foot-Taiyin Spleen. Internally it governs voice, externally it unites with skin and hair. It resides in the Upper Jiao Yin region.
It circulates Ying (Nutritive) and Wei (Defensive) Qi. In the Five Elements generation and restriction cycle, the Lung fears Fire restricting it and Wood insulting it. Now, being struck by Wind, which corresponds to Liver Wood Qi, if Fire is present, it insults the Metal that it cannot overcome. However, Fire is the child of Wood, so Fire must follow Wood. Wind can overcome Dampness, and Heat can dry fluids. Hence, dry mouth occurs. Both Wind and Fire are Yang; when combined, they cause restless shaking. Movement in the Lung dries its moistening fluids and agitates its voice, making exhalation difficult while inhalation is obstructed, leading to wheezing. Movement in Ying and Wei agitates meridians and muscles, causing dizziness, abnormal movement, and swelling. Although this is merely one manifestation of Wind striking the Lung and impairing its function, as discussed in the *Nei Jing* regarding Lung Wind, symptoms often include profuse sweating, aversion to cold, white complexion, frequent coughing, improvement during the day, and worsening at night. This describes the pathological state when pathogen resides in the Lung. Each establishes a principle as an example. From this, later generations can deduce others. Whether in Zang organs, Shu cavities, or meridians, all observed diseases can be comprehensively understood without fear of incompleteness. The same applies to other Zang organs.
When the Lung is invaded by Cold pathogen, thick turbid nasal discharge is expectorated.
[Commentary] The Lung is Yin but resides in a Yang region, thus called "Yin within Yang." It is termed the Delicate Organ, fearing both Heat and Cold. Excessive Heat damages its endowed Yin, while excessive Cold damages its governing Yang. As the Minister Official, it distributes Qi transformation and fluids throughout the interior and exterior. Damage to Yang leads to Qi consumption; damage to Yin leads to fluid depletion. Now, Cold strikes the Lung, causing Qi and fluids to accumulate in the chest, forming turbid fluid retention. Saliva exits from the mouth; retained in meridians, it becomes turbid nasal discharge flowing from the nose, as the nose is the gateway for Lung respiration.
The dying pulse of the Lung: Light pressure feels empty; deep pressure feels weak like a scallion leaf, lacking a root below indicates death.
[Commentary] Lung Metal governs Autumn, occurring after forty-five days of Start of Autumn, when Yin Qi slightly ascends and Yang Qi slightly descends. The *Nei Jing* describes its healthy pulse as: Qi comes light, void, and floating, arriving swiftly and dispersing slowly. It also states: slightly hairy with Stomach Qi. Or: gentle and soft, like falling elm leaves. Such is the image of slight Yin-Yang ascent and descent. Regarding the dying pulse, it is the True Lung Pulse arriving: large and empty, like feathers penetrating human skin. Or: coming like floating objects, like wind blowing feathers. Or: only hairy without Stomach Qi, indicating Yang Qi does not descend and Yin Qi does not ascend. Abundant Yang should transform into Yin but fails to do so; neither converging nor harmonizing, only floating is seen, indicating impending death. Due to Fire restricting Metal and Yin perishing, the *Nei Jing* states death occurs within three days, consistent with this. Yin is the root of Yang. Floating pulses exist, as do Sunken pulses. A strong root leads to lush branches. Describing healthy pulses values lightness, voidness, and floating, but does not exclude Sunken qualities entirely; however, both Floating and Sunken should only reach the depth of three beans' weight. It should not be as deep as a stone. Now, light pressure is empty, and deep pressure is weak like a scallion leaf, far exceeding the depth of three beans. The *Nan Jing* states: Liver and Lung have differences in shallow/deep and mature/immature pulses. Immature Floating leads to Mature Sunken, and Immature Sunken leads to Mature Floating. This reflects Extreme Yang generating Yin and Extreme Yin generating Yang, specifically regarding the Body-Function Qi of these two organs. Thus, their pulse forms are similar. Since Lung resides in a Yang region, its form is light and floating, governing Qi to resemble Yang. Extreme Yang transforms into Yin, so its function is收敛 (converging/astringing) to resemble Yin. Liver resides in a Yin region, so its form is heavy and sunken, storing Blood to resemble Yin. Extreme Yin transforms into Yang, so its function is ascending and dispersing to resemble Yang. Floating and Sunken reflect this principle. The Yin-Yang of the five Zang organs each possess a unique Body-Function, which must be carefully observed.
When the Liver is invaded by Wind pathogen, symptoms include dizziness and blurred vision, pain in both hypochondria, habitual stooping while walking, and a craving for sweet flavors.
[Commentary] The Five Qi manifest as Wind in Heaven, Wood on Earth, and Liver in the Zang organs, associating with sinews. Liver sinews and meridians originate from the tip of the great toe, pass through the inner thigh, ascend along both hypochondria, emerge from the chest, and reach the vertex. When struck by Wind, movement occurs. Upward movement causes dizziness and blurred vision. Severe Wind leads to hyperactivity; hyperactivity brings harm, requiring control. Combined with the metallic nature, blood and essence decline, and meridians contract and tighten due to convergence. Thus, hypochondriac pain occurs, preventing bending and straightening, resulting in a stooped gait. The Classic states: "Liver suffers from tension; eat sweet to relax it." Hence, the craving for sweets. If describing Liver Wind from the *Nei Jing*, symptoms include profuse sweating, aversion to wind, sadness, greenish complexion, dry throat, irritability, and occasional aversion to women. This integrates the organ's structure and function.
When the Liver is invaded by Cold pathogen, both arms cannot be raised, the base of the tongue feels dry, sighing is frequent, chest pain occurs, turning sideways is difficult, eating induces vomiting and sweating. (*Qian Jin Fang* notes: occasional night sweats, cough, vomiting food contents after eating).
[Commentary] Liver is Yin within Yang; its Qi is mild and warm, promoting renewal and flourishing, housing Hun (Ethereal Soul), and entering/exiting with Shen (Spirit). It fears Metal. Metal is cool, its Qi is converging and肃杀 (severe/killing), thus restricting it. If further invaded by Cold, since Metal is the mother of Water, the mother follows the child to harm Wood. Qi and blood coagulate and stagnate, failing to perform biosynthesis and nourish upper sinews and meridians, causing inability to raise both arms.
The dying pulse of the Liver: Light pressure feels weak; deep pressure feels like a cord without rebound, or winding like a snake indicates death.
[Supplementary Note] Why is it a dying organ? Vital energy is absent. Liver belongs to Wood and should be supple; weakness is still the fundamental pulse. However, merely feeling weak upon light pressure lacks the flexibility of a long bamboo tip. Upon deep pressure feeling like a cord, both String-taut (Xian) and Tight (Jin) qualities appear. "No rebound" implies the pulse has arrival and departure, reflecting Yin-Yang reciprocity. Now, only departure exists, moving up and down without Stomach Qi. Otherwise, True Qi scatters, entry and exit are forced, showing a state of reluctance to advance and difficulty extending. Hence, winding like a snake. Alas, the generation of Wood possesses the subtlety of stirring, directing, flourishing, and softness. Its death manifests either as rigid stiffness without recovery or twisted curvature without smoothness. Wood is described as "curved and straight," marking its beginning and end.
Gan Zhuo (Liver Fixation): The patient desires to tread on their chest. Initially, before suffering, they only desire hot drinks. Xuan Fu Hua Tang (Inula Flower Decoction) is indicated.
Formula: Xuan Fu Hua Tang
Xuan Fu Hua (Inulae Flos, 3 liang) Cong (Scallion Stem, 14 stalks) Xin Jiang (New Crimson Silk/Dyed Fabric, a small amount)
These three ingredients are boiled in 3 sheng of water to obtain 1 sheng. Take once.
[Supplementary Note] Liver governs Shu Xie (free flow and drainage), referring to its function. If depressed and unrelieved, it inevitably attacks Middle Jiao Earth. Earth becomes weak and distended; Qi knots and fails to open. Hence, preference for massage. "Fixation" refers to Liver Qi weakness attaching to the chest and heart region. Desire for heat initially arises because Wood draws from Water, favoring its own growth; heat promotes movement and disperses knots. By adjusting accordingly, the pathology is resolved. Thus, Xuan Fu Hua is used as the Sovereign herb to resolve Qi knots and hypochondriac fullness, eliminating phlegm in the upper chest, while Cong unblocks Yang Qi. Treating only Liver Qi without addressing Blood seems inappropriate for fixation. Therefore, colored yet substance-less herbs are chosen to enter Blood-storage regions without stagnation.
When the Heart is invaded by Wind pathogen, there is a mild fever (Xi Xi Fa Re), inability to rise, a sensation of hunger in the chest, and vomiting immediately after eating.
[Supplementary Note] The Heart is the Monarch, guarded by Pericardium Meridian. How can pathogen interfere? Thus, "Heart Wind" likely refers to Pericardium pathogen invasion. Wind is a Yang pathogen, agile and changing, injuring the Ruler Fire territory. Two heats combine, inevitably steaming outward. *Shang Han Lun* describes "Xi Xi" as warm heat, not extreme heat. With Ruler Fire official constrained, limbs cannot rise. Heat accumulates internally, feeling like hunger. This is phlegm-fluid retention in the Upper Wan, not stomach deficiency. Food cannot descend, leading to persistent vomiting.
When the Heart is invaded by Cold pathogen, the patient suffers from Heart disease, feeling as if eating garlic. Severe cases involve heart pain piercing the back, and back pain piercing the heart, resembling Gu Zhu (worm infusion). If the pulse is Floating, spontaneous vomiting leads to recovery.
[Supplementary Note] Heart governs dispersion; Cold enters, suppressing Fire. Suppression causes Qi stagnation, and fluids gather into turbid fluid. The suffering "like eating garlic" describes internal restlessness and discomfort, akin to injury by pungent turbidity. In severe cases, Yin-congealing pathogen attacks the Yang region, blocking ascent and descent, causing blockage front and back, similar to Chest Bi pain piercing back and heart, or Gu Zhu worms. Symptoms are worse than eating garlic. A Floating pulse indicates pathogen in the Upper Jiao. Using emesis (higher method) forces retained fluid upward, expelling pathogen outward. Emesis inherently contains dispersing meaning.
If Heart Essence is damaged, the patient experiences fatigue and exhaustion, leading to redness of the head and face, heaviness in the lower body, heart pain, internal vexation, fever, pulsation at the umbilicus, and a String-taut (Xian) pulse. This results from Heart damage.
[Commentary] *Nei Jing* states: "Heart is the Monarch Official, where Shen emerges. If the Ruler is clear, the subordinates are peaceful; otherwise, the twelve officials are endangered." Physical form suffers greatly. If the Ruler is unclear, twelve officials are endangered, let alone the dwelling place. Zhang Zhongjing states Heart damage results from Seven Emotions injuring Heart Shen. Shen is commander of Qi; Qi is attendant of Shen. Confusion causes Shen migration; migration disrupts Zhen Qi of Zang organs. Prolonged disruption leads to decline, resulting in Heart damage. If Heart is damaged and subjected to labor, Zhen Yin cannot control Fire, causing chaotic Fire movement. Rising Fire reddens head and eyes. Zhen Qi follows Fire upward instead of descending, leaving Yin isolated below, causing heaviness. Heart deficiency allows Kidney Water to invade, causing internal heart pain and vexation. Externally, Yin in meridians cannot enter and connect with Zang, causing fever. Heart meridian connects to Small Intestine; stagnant Fire qi beats and moves, causing umbilical pulsation. Zhang Zhongjing considers Xian pulse as Yin and Deficiency. Seeing this in the Yin Heart Zang confirms Heart damage caused this pulse.
The dying pulse of the Heart: Light pressure feels solid like pills/beans; deep pressure feels increasingly rapid and restless indicates death.
[Commentary] *Nei Jing* Heart pulse resembles a hook. Hook without Stomach Qi indicates death. Heart pulse arrives curved then settles, like holding a belt hook. Also: pulse arrives firm and beating, like tracing Job's tears seeds, continuously rolling, indicates death. Dying Heart pulse cannot be described in one breath. Though images vary, Yin-Yang principles remain unchanged. Heart pulse governs Summer; Yang Qi peaks when Yin begins to generate. Failure to generate Yin after peaking leads to death. Extreme Yin overcoming Yang leads to death. Observing via Yin stillness: arrival monitors Yang, departure monitors Yin. Arrival abundant, departure declining like a hook, lacking magnanimous and slow demeanor, how can it survive long? Healthy hook pulse reverses "arrive curved, settle." Lacking Stomach Qi, it resembles holding a belt hook. Yin-Yang biosynthesis relies on Zang preservation. If Job's tears seed-like short, frequent, and moving, how can it avoid death? Moving like hemp beans resembles Job's tears. Restlessness indicates Qi escape and Yin loss, hence fatal.
Evil weeping causing insecurity of Hun and Po is due to scarcity of Blood and Qi. Scarcity of Blood and Qi belongs to the Heart. Heart Qi deficiency causes fear of closing eyes and desire to sleep, dreaming of long journeys, scattered spirit, and wandering Hun/Po. Yin Qi decline leads to Dian (depressive psychosis); Yang Qi decline leads to Kuang (manic psychosis).
[Commentary] Shen managing objects without disorder relies on Blood and Qi maintaining tranquility. If Blood and Qi decline, Shen loses nourishment and becomes restless. Entering/exiting with Shen is Hun; guarding Shen's residence is Po. Restless Shen causes sorrow; sorrow makes Hun/Po insecure. Heart and eyes relate internally and externally. Eyes open: Shen stays inside to handle affairs. Eyes closed: Shen scatters outside and wanders. Hence, fear of closing eyes. Classic states: Yang excess dreams of flying; Yin excess dreams of falling. Here, deficiency rather than excess causes dreaming of distance without flying or falling. Dian/Kuang discussed here are not diseases of Yin-Yang overlapping above/below, but solely involving Heart, dividing Blood/Qi, with Yin-Yang tilting. Yin inside guards Yang; Yang outside protects Yin. If Yin declines, Yang merges inward, Shen enters Yin, causing Dian. In Dian, Shen and voice are hidden and unreleased. If Yang declines, Yin merges outward, Shen exits to Yang, causing Kuang. In Kuang, Shen and voice are scattered and erratic.
When the Spleen is invaded by Wind pathogen, there is mild fever (Xi Xi Fa Re), appearance resembling drunkenness, abdominal烦重 (vexation and heaviness), eyelid twitching (Mu Chun), and shortness of breath.
[Commentary] Wind is a Yang pathogen, internally corresponding to Liver. Even in Heart, there is mild fever; in Spleen Earth, it is a Zei (Thieving) pathogen. Thus, it pulls external skin, twitches eyes, disturbs mind internally, resembling drunkenness, with abdominal vexation. Spleen receiving Thieving pathogen scatters Qi and strength, causing heaviness and shortness of breath. *Nei Jing* Spleen Wind includes body lethargy and unwillingness to move limbs, exceeding just abdominal vexation/heaviness.
The dying pulse of the Spleen: Light pressure is large and hard; deep pressure feels like an overturned cup, clean/shaking like swaying indicates death.
[Commentary] *Nei Jing* dying Spleen pulse arrives firm and sharp, like a sparrow pecking or bird claw, depicting solitary Yin/Yang without softness. Like leaking roof, irregular stopping/moving. Like flowing water, unregulated departure. Weak and alternating rapid/sparse, depicting unregulated advance/retreat. Now, light pressure large/hard resembles sparrow pecking? Deep pressure like overturned cup resembles bird claw? Clean/shaking resembles leaking roof or alternating rapid/sparse?
Fu Yang pulse Floating and Se (Rough). Floating indicates strong Stomach Qi; Se indicates frequent urination. Floating and Se interacting leads to hard stool; Spleen is constrained (Yue). Ma Zi Ren Wan (Hemp Seed Pill) is indicated.
Formula: Ma Zi Ren Wan
Ma Ren (Cannabis Fructus, 2 sheng) Shao Yao (Paeoniae Radix Alba, 0.5 jin) Zhi Shi (Aurantii Fructus Immaturus, 0.5 jin) Da Huang (Rhei Radix et Rhizoma, 1 jin)
Niu Bang Zi/Ba Dou? No, Niu Xi? Text says Nong Po (Magnoliae Cortex, 1 chi) Xing Ren (Armeniacae Semen Amarum, 1 sheng, peeled and split)
Grind to powder, refine honey into pills, size of wu zi (walnut seed). Take 10 pills with water, three times daily. Stop when effective.
[Supplementary Note] Fu Yang pulse belongs to Earth. Floating is Yang, Se is Yin; thus, Floating reveals Yang, Sunken reveals Yin. Excess Yang strengthens Stomach Qi; insufficient Yin fails to secure Taiyin, causing frequent urination. Spleen transports fluids for Stomach. If Zang is Se and cannot constrain water fluids, little remains in Stomach, causing Stomach dryness. Thus, Stomach dryness is caused by Spleen. Hence "constrained." Da Huang and Zhi Shi remove excess; Ma Ren moistens dryness first; Shao Yao nourishes Yin; Nong Po assists Xing Ren to benefit Lung Qi, supplementing Yin. This resolves the issue.
Shen Zhuo (Kidney Fixation): Patient feels heavy body, cold waist, as if sitting in water, appearing watery, yet no thirst, normal urination, normal diet. Disease belongs to Lower Jiao. Caused by labor-induced sweating, cold/wet clothing remaining against skin over time. Cold pain below waist, abdominal heaviness like carrying 5000 coins. Gan Jiang Ling Zhu Tang (Dried Ginger, Poria, Atractylodes, Licorice Decoction) is indicated.
Formula: Gan Jiang Ling Zhu Tang
Bai Zhu (Atractodis Macrocephalae Rhizoma, 2 liang) Gan Cao (Glycyrrhizae Radix et Rhizoma, 2 liang) Gan Jiang (Zingiberis Rhizoma, 4 liang) Fu Ling (Poria, 4 liang)
Four ingredients boiled in 5 sheng water to 3 sheng. Strain. Divide into three warm doses. Waist warms.
[Supplementary Note] Kidney is Water organ, hiding True Yang. In Shen Zhuo, Kidney Qi is originally weak, so Water and Fire are both deficient, allowing Dampness to fixate. Why? Water attracts Water. Heaviness is Dampness. Waist cold like sitting in cold water indicates dominant Dampness. No thirst means Yangming is not hot. Normal urination means Bladder is not diseased. Normal diet means Middle Jiao is not diseased. Thus, disease in Lower Jiao. Explaining cause: Labor expands Yang Qi, causing sweat; Damp enters, Yin Qi lingers不散 (does not dissipate), causing cold pain and abdominal heaviness. Although pathology is Lower Jiao, formula uses Middle Jiao herbs. Why? Human Yang Qi originates below but thrives in Middle. Cultivating Spleen Earth when Middle Jiao is safe allows Earth to control Damp and strong Yang to disperse. Gan Jiang's pungent heat and Fu Ling's bland leaching added to Middle-Jiao tonics warm waist in three doses. Avoiding Lower Jiao herbs prevents tonifying Kidney from aiding Water/Fire, hindering Damp removal. Zhang Zhongjing explicitly mentions Lower Jiao but prescribes Middle Jiao herbs, revealing profound intent.
The dying pulse of the Kidney: Light pressure is hard; deep pressure is chaotic like a turning pill, sinking deeper into Chi position indicates death.
[Commentary] *Nei Jing* dying Kidney pulse comes like pulling a rope, crisp like striking stones. Or beating and cutting off, like finger striking stones, crisp. All lack Stomach Qi and True Yang is lost; only residual True Zang Yin moves with respiration, showing sole Zang image. Floating examines exterior (Yang). Hardness resembles striking stones/pulling rope, indicating True Yin emerging to Yang. Deep pressure examines interior (Yin). Movement is Yang. Chaotic movement like turning pill indicates True Yang about to escape, disordered movement, unable to arrive/depart, lingering within. If sinking deeper into Chi, Yin-Yang separation is evident, clear sign of death.
Question: If San Jiao is exhausted, Upper Jiao exhaustion causes frequent belching (Yi). Why? Master says: Upper Jiao receives Qi from Middle Jiao which is unharmonized, unable to digest grains, hence belching. Lower Jiao exhaustion causes enuresis and incontinence. Qi is unharmonized, unable to self-control. No treatment needed; it heals itself over time.
[Commentary] Exhaustion means drying up. Upper Jiao belongs to Heart/Lung, Yin-Yang region. Lung governs Qi, Heart governs Blood, circulating Ying/Wei. If one weakens, Ying/Wei cannot support each other, Upper Jiao transformation governance exhausts. Even if Middle Jiao receives grain Qi, it does not dissipate but gathers in chest, requiring belching to release. Lower Jiao belongs to Liver/Kidney, Yin-Yang region. Kidney governs closure, Liver governs drainage. Unharmonized Qi means Ying cannot guard internally, Wei cannot secure externally. Lower Jiao like a drain, Qi transformation governance exhausts. Hence incontinence. Over time, Ying/Wei harmonize, healing occurs. Examining *Shang Han Lun* pulse methods: Cun Kou pulse微弱 (weak) and Se (rough). Weak means Wei Qi does not flow; Se means Ying Qi does not reach. Ying/Wei cannot assist each other, San Jiao has no reliance, returns not to its sector. Upper Jiao returning not: belching and acid regurgitation. Middle Jiao returning not: unable to digest grains/food. Lower Jiao returning not: enuresis. This matches. Originating from Upper Jiao, Middle Jiao also belches. *Nei Jing* attributes enuresis to Du Mai diseases; *Ling Shu* to Liver diseases. Enuresis is not limited to this.
Master says: Heat in Upper Jiao causes lung萎 (withering) due to cough. Heat in Middle Jiao causes hardness/firmness. Heat in Lower Jiao causes hematuria and stranguria/obstruction. Large Intestine with Cold causes loose stools; with Heat causes intestinal mucus. Small Intestine with Cold causes tenesmus and bloody stool; with Heat causes hemorrhoids.
[Commentary] Heat in Upper Jiao causing Lung Withering shares meaning with Lung Withering section. Middle Jiao hardness/fullness aligns with Spleen Constraint. Heat in Lower Jiao causing hematuria/stranguria involves Lower San Jiao輸 (transport) connecting to Bladder, matching *Nei Jing* concept of uterus transferring heat to Bladder causing stranguria. Bladder is Officer of Storage, Qi transformation produces urine. Heat in Blood causes blood to seep into Bladder and exit in urine. Heat in Qi causes Qi stagnation into dryness, fluid coagulation, resulting in red, obstructed urine. Although stranguria relates to Qi stagnation, some relate to Blood. Qi disease: urine white; Blood disease: urine red. Heat in Lower Jiao implies Lower Jiao is not just Bladder; Kidney, Liver, Small Intestine also reside in Lower Jiao.