则曰天以六六为节。地以九九制会。六甲终岁三百六十日法也。五日为一候。三候为一气。六气为一
时。四时为一岁。而各从其治主焉。求其气之至也。皆从春始。未至而至。此为太过。则薄所不胜
乘所胜也。命曰气淫。至而不至。此为不及则所胜妄行而所生受病。所不胜薄之也。命曰气迫。然在
脉应春弦夏钩秋毛冬石。太过者病在外。不及者病在内。在五运相袭，而皆治之。终期之日，阳年先天而至当岁之运，
则气太过，阴年后
天而至当岁之运。则气不及。与其年和。则非太过不及而平。与司天地气不和。
则胜而报复。复则郁发待时而作。作则风湿燥热火寒之气。非常而暴。在六气则曰六气之胜。清气
大来。燥之胜也。风木受邪。肝病生焉。热气大来。火之胜也。燥金受邪。肺病生焉之类。在脉应则
曰厥阴之至弦。少阴之至钩。少阳之至大而浮。太阴之至沉。阳明之至短而涩。太阳之至大而长。至而
和则平。至而甚则病。至而反者病。至而不至者病。未至而至者病。阴阳易者危。然候六气之应。常
以正月朔旦平明视之。观其位而知其所在。而其至则从运之先天后天也。由是观之。仲景言四时之定
法者。若遇气运加临主位。则必将奉天政之寒温。虽与四时气有反者。难为逆时也。候同也。且经曰。
主胜逆。客胜从。又曰。必先岁气。毋伐天和。此又不在独守四时之气。而参之以运气者矣。
师曰。病患脉浮者在前。其病在表。浮者在后。其病在里。腰痛背强。不能行。必短气而极也。
〔衍义〕脉浮为虚。关前属阳。主表。关后属阴。主里。所谓表者。以足太阳言也。里者。
以足少阴言也。一腑一脏。是其表里所合。其太阳经自足从背至项腰者。肾府
也。是故表病则背强不能行。里病则腰痛短气而极少。虽然。寸尺脉浮。非一经一病之可尽。今独出
此病。何也。大抵用表里而言病。必举太阳肾为例。盖太阳是诸阳之属。凡受邪必自此始。肾是治内
之主事。书独言此例以推之。
问曰。经云厥阳独行。何谓也。师曰。此为有阳无阴。故称厥阳。
上言阳虚。此言亡阴。
〔衍义〕厥者。犹极也。独行无阴与配也。王冰注内经一水不胜五火。谓五脏厥阳
也。经又谓六阳并至。谓之至阳。又云。至阳盛。地气不足。由是观之。火即阳也。至
阳。即厥阳也。独行。独并至也。皆是阴不足而阳盛之极者也。
问曰。寸脉沉大而滑。沉则为实。滑则为气。实气相搏。厥气入脏即死。入腑即愈。此
为卒厥。何谓也。师曰。唇口青。身冷。为入脏。即死。如身和。汗自出。为入腑。即愈。
〔衍义〕沉、阴象也。滑、阳象也。阴主血。阳主气。邪在于血则血实。邪在于气则气实。
故血实者脉沉。气实者脉滑。邪盛者脉大。五脏治内属阴。主藏精宅神。今血气
并其邪而入。堵塞于脏。身之精气不行。神机化灭。升降出入之道皆绝。荣绝则
唇口青。灵枢曰。是厥阴气绝则唇青。夫六腑治外属阳。主传用水谷之气。充乎
内外者也。今血气并邪入于腑。腑阳动不比脏之阴静。静者得其邪。则因而堵
塞不行。动者邪虽入。终不能久闭其气道。何则。为在内之神机应乎外。主养荣
卫之气。则散行于表而身和。和则腠理开。邪散而汗自出。荣卫之气行。故愈矣。
此仲景举阴阳脏腑之大端如此。至若厥病多由。难以概论。内经曰。血气并走
于上。则为大厥暴死者。其上非膻中三焦之府者乎。而乃以气反则愈。不反则
死。又如邪客五络。状若尸厥者。以通脉络为治。非头面诸脉证为难概论也。
问曰。脉脱入脏即死。入腑即愈。何谓也。师曰。非为一病。百病皆然。譬如浸淫疮。从
口起流向四肢者可治。从四肢流来入口者。不可治。病在外者可治。入里者即死。
〔衍义〕脱者去也。经派乃脏腑之隧道。为邪气所逼。故绝气脱去其脉而入于内。
五脏阴也。六腑阳也。阴主死而阳主生。所以入脏即死。入腑即愈而可治。非惟
脏腑之阴阳然也。凡内外阴阳之邪毒出入表里者。皆然也。
问曰。阳病十八。何谓也。师曰。头痛项腰脊臂脚掣痛。阴病十八。何谓也。师曰。咳上
气喘哕咽肠鸣胀满心痛拘急。五脏病各有十八。合为九十病。人又有六微。微有
十八病。合为一百八病。五劳七伤六极。妇人三十六病。不在其中。清邪居上。浊邪
居下。大邪中表。小邪中里。 之邪。从口入者。宿食也。五邪中人。各有法度。风中
于前。寒中于暮。湿伤于下。雾伤于上。风令脉浮。寒令脉紧。雾伤皮腠。湿流关节。食
伤脾胃。极寒伤经。极热伤络。
〔补注〕此总内经所着之病。而为之分阴阳。悉表里。合上下内外以立言。庶几经
络明。腑脏着。所因显。不致散而难稽也。如三阳在外。病头痛等六证。则各有所
行之经。各显本经之证。三而六之。非十八乎。而三阴之在里者亦然。五脏各有
十八。合计为九十病。其为病则于灵枢论心脉为螈 。班班可考矣。若六腑则
何如。腑居内而实合于经者也。故言腑者取诸合。如胃合三里。大肠合巨虚上
廉。小肠合巨虚下廉。三焦合委阳。膀胱合委中央。胆合阳陵泉。故邪之在腑者
合外于经。其受患为浅。而欲散不难。不若五脏之深且甚焉。故曰微也。其为病。
内经有分属。仲景括为一百八病。盖因腑之六以为数也。凡此共二百三十四病。统内外而言之也。乃专
为内因者。如所谓五劳。即视久伤血等云云也。夫行立坐卧。俱不可强。乃至久者。必迫于所不得已也。
其为伤孰甚焉。然后知人之有体。固有以用之也。不用则体为不运。然使过于用。则体亦太劳而失所养矣。
若七伤。则太饱伤脾等云云也。夫五脏各有所司。苟无以节之。或贪于可欲之
事。或任其性气之偏。皆足害其和。而况形为外之气侵。志为内之情动乎。至极
者。又各极其偏之谓也。气血也。肌肉也。筋骨也。精神也。相均始为无弊。设有过
则必有不及者矣。妇人三十六病。瘕居十二谓月不应期。而所下之物不一色
也。夫妇人为阴。其痛属腰半以下居多者。以冲督任三脉之病。有九痛也。七害
五伤三因。各详于经。共为三十六病焉。然则人之病也。邪有以中之也。明乎所
中之邪。则此邪非彼邪。从可识矣。人之一身。上下表里尽之矣。而所谓清浊大
小邪者。一为雾露。一为地浊。本天者亲上。本地者亲下。百病之长。伤人之阳。肃
杀之气。伤人之阴者是也。从口入者为内伤。亦足使人发热腹痛。喘呕胀满。不
去其陈而致新。不足以为功。然邪之本于外中者。因乎六气。乃仲景以为五邪。
如风寒湿雾热。而遗燥之一气。岂非以风寒与火。皆足以成燥。则燥本非一致。
而其情已兼三气之内欤。夫风之伤人。三时俱有。若寒必于冬。故云暮。其脉证
详于伤寒论中矣。而仲景复详于此者。以其统论病之阴阳。不可不言天地之阴阳。
分论人之五脏。不可不言所淫之五邪。盖五气之胜在天地。五行之不足
在人也。故曰邪之所凑。其气必虚也。
问曰。病有急当救里救表者。何谓也。师曰。病医下之。续得下利清谷不止。身体疼
痛者。急当救里。后身体疼痛。清便自调者。急当救表也。
〔补注〕先表后里者。不易之法也。乃有救里先于表者。岂无谓乎。答曰。攻表者。正
以里为急也。邪在表。苟不根据法治之。将延迟时日。势必内入而大患。医乃不明
此理。下之或早或重。遂使下利清谷。至于不止。则里已急矣。表证虽在。法当救
里。里和而表未解。仍当救表。此亦一定之法也。然仲景何以不言所以救之之
法耶。而四逆以佐正。桂枝以退邪。已详于太阳篇中矣。
大病痼疾。加以卒病。当先治其卒病。后乃治其痼疾也。
〔补注〕痼疾。谓病已沉痼。非旦夕可取效者。卒病。谓卒然而来。新感而可取效于
旦夕者。乘其所入未深。急去其邪。不使稽留而为患也。且痼疾之人。正气素虚。
邪尤易传。设多瞻顾。致令两邪相合。为患不浅。故仲景立言于此。使后之学人。知所先后也。
问曰。五脏病各有得者愈。五脏病各有所恶。各随其所不喜者为病。病者素不应
食。而反暴思之。必发热也。（娄全善作暴食之）
〔补注〕五脏配五味。理之正也。言理之自然。而见其性焉。即以见其情焉。何也。如
仲景言脏之各得者。得其性之近也。内经则言欲。非以其情乎。仲景言所恶。亦
以其性也。而复云不喜。亦即内经之所云苦。非以其情乎。然则五脏既各有性。
则惟遂其性而情始洽焉。斯病者愈矣。使拂其性而所恶乘之。则情抑而为病。
固其常也。虽然。肝欲酸。喜其收也。又云肝欲辛。又喜其散。五脏皆然。岂其欲本
有相反者耶。殊不知木曰曲直。曲直作酸。酸以固其体也。木喜条达。实近于散
辛以益其用也。天下无体不立。无用不生。体用得而自和矣。论如肝恶风。木性
不喜动也。而木又自足生风。风性急。木失其养。足以生之。故又云肝苦急也。苦
急而肝病矣。经谓急食甘以缓之。则病可愈。假使忽思食苦。是反得子助。而气
为有余。则发热可必。他脏如之。故五味得其平。则足以相养。而无偏胜之患。四
时合于正。则各以相生。而无不足之虞。此在人之善调之也。
夫诸病在脏。欲攻之。当随其所得而攻之。如渴者。与猪苓汤。余皆仿此。
〔衍义〕此概言诸病在脏之属里者。治法有下之、泄之、夺之、消之、温之、寒之、和以
平之。各量轻重。从宜施治。务去其邪。以要其正。故引渴病以比类之。而是证之用猪苓汤。
见卷十三消渴证中。
所以说，天以六六之数作为节律。地以九九之数进行会合。这是六甲纪年三百六十天的法则。五天称为一候。三候构成一气。六气构成一时（季节）。四时构成一岁。而每一阶段都有其主治的气运。探求气运的到达时间，都从春季开始。未到该到之时却提前到了，这叫做“太过”，就会欺凌它所不能胜的气，并乘虚侵袭它所胜的气，命名为“气淫”。到了该到之时却没有到，这叫做“不及”，那么它所胜的气就会妄行，而它所生的气会受到侵害，同时它也不能胜的气也会来欺凌它，命名为“气迫”。然而，在脉象上应表现为春弦、夏钩、秋毛、冬石。太过则病在外，不及则病在内。在五运相袭替且都主治的时候，到了年终之日，阳年之气先天时而至，对应当年的岁运，则气太过；阴年之气后天时而至，对应当年的岁运，则气不及。如果当年的运气平和，则既不过分也不不足，处于平气状态。如果与司天、在泉之气不和，就会出现胜复的情况。复气则会郁积待发，等待时机发作。一旦发作，风、湿、燥、热、火、寒这些气就会非常暴烈而不正常。在六气中称为“六气之胜”。清气大来，是燥气偏胜，风木受邪，肝病由此产生。热气大来，是火气偏胜，燥金受邪，肺病由此产生，等等。在脉象上应表现为：厥阴之气至则脉弦，少阴之气至则脉钩，少阳之气至则脉大而浮，太阴之气至则脉沉，阳明之气至则脉短而涩，太阳之气至则脉大而长。气至而平和则为正常，气至而过甚则为病，气至而相反则为病，气至而未至则为病，阴阳错乱则为危证。然而观察六气的应验，通常以正月初一清晨为标准来观察，通过观察其位置而知其所处，而其到达的时间则取决于岁运的先天或后天。由此看来，仲景所说的四时的定法，如果遇到气运加临在主位之上，就必然要遵循天政的寒温变化。虽然这与四时之气有相反的情况，但难以视为逆时，因为候气是相同的。况且经书说：“主气胜为逆，客气胜为从。”又说：“必须先了解当年的岁气，不要损伤天和。”这又不仅仅是独自固守四时之气，而是参酌了运气学说。
老师说：患者脉象浮，如果在关前（寸部），病在表；浮脉如果在关后（尺部），病在里。（若见）腰痛、背强、不能行走，必定伴有短气和极度疲乏。
〔衍义〕脉浮属于虚证。关前属阳，主表；关后属阴，主里。所谓表，是指足太阳膀胱经；所谓里，是指足少阴肾经。一腑一脏，构成了它们的表里配合。足太阳经从足部沿着背部上行至项部和腰部，这里是肾府所在。因此，表病则出现背强、不能行走；里病则出现腰痛、短气和极度疲乏。虽然如此，寸部和尺部的脉浮，并非仅由一经一病所能概括。现在单独提出这种病症，为什么呢？大体上用表里来说明病症，必须举足太阳和肾为例。因为太阳是诸阳之首，凡是受邪必定从这里开始；肾是治理内部的主事者。书中单独言此例是为了以此类推。
问：经书说“厥阳独行”，这是什么意思？老师说：这是因为只有阳而没有阴，所以称为厥阳。
上文说的是阳虚，这里说的是亡阴。
〔衍义〕“厥”就是极的意思。独行是指没有阴来配匹。王冰注释《内经》时说“一水不胜五火”，指的是五脏的厥阳。经书又说“六阳并至”，称为至阳。又说“至阳盛，地气不足”。由此看来，火就是阳。“至阳”就是“厥阳”。“独行”就是“独并至”。这些都是阴不足而阳盛至极的表现。
问：寸脉沉大而滑，沉代表实，滑代表气，实与气相互搏结，厥气入脏即死，入腑即愈。这叫卒厥，是什么意思？老师说：如果嘴唇口角发青，身体冰冷，这是邪气入脏，就会死亡；如果身体温和，汗自出，这是邪气入腑，就会痊愈。
〔衍义〕沉是阴象，滑是阳象。阴主血，阳主气。邪气在于血则血实，邪气在于气则气实。所以血实则脉沉，气实则脉滑，邪气盛则脉大。五脏治内属阴，主藏精舍神。现在血气并着邪气进入，堵塞于脏，身体的精气不能运行，神机化灭，升降出入的道路都断绝了。营气断绝则嘴唇口角发青，《灵枢》说：“厥阴气绝则唇青。”六腑治外属阳，主传导水谷之气，充盈内外。现在血气并着邪气进入腑，腑阳动而不像脏之阴静。静者得到邪气，就会因而堵塞不行；动者邪气虽入，终究不能长久闭塞气道。为什么呢？因为内在的神机应于外在，主养荣卫之气，则散行于体表而身体温和。温和则腠理开泄，邪气散去而汗自出。荣卫之气运行，所以痊愈了。这是仲景举出的阴阳脏腑的大致端绪。至于厥病多由什么引起，难以一概而论。《内经》说：“血气并走于上，则为大厥暴死者。”那上面不是膻中、三焦之府吗？却说气反则愈，不反则死。又如邪气客于五络，状如尸厥的，以通脉络为治法，不是头面诸脉证能轻易概论的。
问：脉脱入脏即死，入腑即愈，是什么意思？老师说：这不是针对一种病，百病都是这样。譬如浸淫疮，从口起流向四肢的可以治，从四肢流来入口的不可治。病在外面的可以治，入里面的就死。
〔衍义〕“脱”就是离去。经脉乃是脏腑的隧道，被邪气逼迫，所以绝气脱去其脉而入于内。五脏属阴，六腑属阳。阴主死而阳主生。所以入脏即死，入腑即愈而可治。不仅脏腑的阴阳是这样，凡内外阴阳的邪毒出入表里的，都是这样。
问：阳病有十八种，是什么？老师说：头痛、项痛、腰痛、脊痛、臂痛、脚掣痛。阴病有十八种，是什么？老师说：咳、上气、喘、哕、咽痛、肠鸣、胀满、心痛、拘急。五脏病各有十八种，合起来为九十病。人又有六微，微有十八病，合起来为一百零八病。五劳、七伤、六极，妇人三十六病，不在其中。清邪居上，浊邪居下，大邪中表，小邪中里，饐（yì，饱食之意）之邪从口入者，是宿食。五邪中人，各有法度：风中于前，寒中于暮，湿伤于下，雾伤于上。风令脉浮，寒令脉紧，雾伤皮腠，湿流关节，食伤脾胃，极寒伤经，极热伤络。
〔补注〕这是总括《内经》所记载的病，而为之区分阴阳，辨别表里，结合上下内外来立论，希望经络明了，脏腑显著，病因显露，不至于散乱而难以查考。比如三阳在外，病见头痛等六证，则各有所行的经脉，各显本经之证。三乘以六，不就是十八吗？而三阴在里的也是如此。五脏各有十八，合计为九十病。其发病则在《灵枢》论心脉为螈（抽搐）等处，班班可考。至于六腑怎么样呢？腑居内而实合于经。所以言腑取诸合穴，如胃合三里，大肠合巨虚上廉，小肠合巨虚下廉，三焦合委阳，膀胱合委中央，胆合阳陵泉。所以邪在腑者合外于经，其受害较浅，而欲消散不难。不像五脏之深且重。所以称为“微”。其发病，《内经》有分属，仲景括为一百八病，大概是因为以腑之六为数。凡此共二百三十四病，统内外而言之。乃专为内因者，如所谓的“五劳”，即视久伤血等云云。夫行立坐卧，俱不可强求过度，乃至久者，必迫于所不得已也。其为伤害孰甚焉。然后知人之有体，固有以用之也。不用则体为不运，然使过于用，则体亦太劳而失所养矣。若“七伤”，则太饱伤脾等云云也。夫五脏各有所司，苟无以节之，或贪于可欲之事，或任其性气之偏，皆足害其和，而况形为外之气侵，志为内之情动乎。至极者，又各极其偏之谓也。气血也，肌肉也，筋骨也，精神也，相均始为无弊。设有过则必有不及者矣。妇人三十六病，瘕居十二，谓月不应期，而所下之物不一色也。夫妇人为阴，其痛属腰半以下居多者，以冲督任三脉之病，有九痛也。七害、五伤、三因，各详于经，共为三十六病焉。然则人之病也，邪有以中之也。明乎所中之邪，则此邪非彼邪，从可识矣。人之一身，上下表里尽之矣。而所谓清浊大小邪者，一为雾露，一为地浊。本天者亲上，本地者亲下。百病之长，伤人之阳；肃杀之气，伤人之阴者是也。从口入者为内伤，亦足使人发热腹痛，喘呕胀满。不去其陈而致新，不足以为功。然邪之本于外中者，因乎六气，乃仲景以为五邪，如风寒湿雾热，而遗燥之一气。岂非以风寒与火，皆足以成燥，则燥本非一致，而其情已兼三气之内欤。夫风之伤人，三时俱有，若寒必于冬，故云暮。其脉证详于《伤寒论》中矣。而仲景复详于此者，以其统论病之阴阳，不可不言天地之阴阳；分论人之五脏，不可不言所淫之五邪。盖五气之胜在天地，五行之不足在人也。故曰邪之所凑，其气必虚也。
问：病有急当救里救表者，是什么意思？老师说：病人被医生误用下法，随后出现下利清谷不止，身体疼痛的，应当急当救里。后来身体疼痛，大便自调的，应当急当救表。
〔补注〕先表后里是不变的法则。乃有救里先于表的，难道没有理由吗？回答说：攻表，正是因为里急。邪在表，如果不根据法治之，将延迟时日，势必内入而产生大患。医生不明白此理，下之或早或重，遂使下利清谷，至于不止，则里已急矣。表证虽在，法当救里。里和而表未解，仍当救表。这也是一个固定的法则。然而仲景为什么不说所以救之的方法呢？而四逆汤以佐正，桂枝汤以退邪，已在太阳篇中详细论述过了。
大病痼疾，加上卒病，应当先治其卒病，后乃治其痼疾。
〔补注〕痼疾，谓病已沉痼，非旦夕可取效者。卒病，谓卒然而来，新感而可取效于旦夕者。乘其所入未深，急去其邪，不使稽留而为患也。且痼疾之人，正气素虚，邪尤易传。设多瞻顾，致令两邪相合，为患不浅。故仲景立言于此，使后之学人，知所先后也。
问：五脏病各有得者愈，五脏病各有所恶，各随其所不喜者为病。病者素不应食，而反暴思之，必发热也。（娄全善作暴食之）
〔补注〕五脏配五味，理之正也。言理之自然，而见其性焉。即以见其情焉。何也？如仲景言脏之各得者，得其性之近也。《内经》则言欲，非以其情乎？仲景言所恶，亦以其性也，而复云不喜，亦即《内经》之所云苦，非以其情乎？然则五脏既各有性，则惟遂其性而情始洽焉，斯病者愈矣。使拂其性而所恶乘之，则情抑而为病，固其常也。虽然，肝欲酸，喜其收也；又云肝欲辛，又喜其散。五脏皆然，岂其欲本有相反者耶？殊不知木曰曲直，曲直作酸，酸以固其体也。木喜条达，实近于散，辛以益其用也。天下无体不立，无用不生，体用得而自和矣。论如肝恶风，木性不喜动也，而木又自足生风。风性急，木失其养，足以生之，故又云肝苦急也。苦急而肝病矣。经谓急食甘以缓之，则病可愈。假使忽思食苦，是反得子助，而气为有余，则发热可必。他脏如之。故五味得其平，则足以相养，而无偏胜之患。四时合于正，则各以相生，而无不足之虞。此在人之善调之也。
夫诸病在脏，欲攻之，当随其所得而攻之。如渴者，与猪苓汤。余皆仿此。
〔衍义〕此概言诸病在脏之属里者，治法有下之、泄之、夺之、消之、温之、寒之、和以平之。各量轻重，从宜施治，务去其邪，以要其正。故引渴病以比类之。而是证之用猪苓汤，见卷十三消渴证中。
It is said that Heaven uses the number six-six as its rhythm. Earth uses the number nine-nine for its convergence. This is the method of the sixty Jia cycles totaling three hundred and sixty days in a year. Five days constitute one Hou (pentad). Three Hous form one Qi (solar term). Six Qis form one Shi (season). Four Shis form one Sui (year). Each period has its governing Qi (vital energy/astrological influence). To seek the arrival of these Qis, they all begin from Spring. If it arrives before its time, this is called "Excess" (Tai Guo), which will oppress the Qi it cannot overcome and take advantage of the Qi it overcomes. It is named "Qi Yin" (Flourishing Qi). If it does not arrive when it should, this is called "Deficiency" (Bu Ji), then the Qi it overcomes will act recklessly, while the Qi it generates will suffer disease, and the Qi that cannot be overcome will also oppress it. It is named "Qi Po" (Oppressed Qi). However, in pulse diagnosis, Spring corresponds to Xian (Wiry), Summer to Gou (Hooked), Autumn to Mao (Hairy/Floating), and Winter to Shi (Stone/Deep). Excess indicates disease in the Exterior, while Deficiency indicates disease in the Interior. When the Five Movements (Wu Yun) succeed each other and govern their respective periods, at the end of the year: if the Yang year's Qi arrives prior to the natural timing corresponding to the annual movement, the Qi is Excessive; if the Yin year's Qi arrives after the natural timing corresponding to the annual movement, the Qi is Deficient. If the year's Qi is harmonious, it is neither excessive nor deficient, but balanced. If it is out of harmony with the Si Tian (Governing Heaven) and Zai Quan (Inaugural Earth) Qis, there will be Victory and Retaliation. The Retaliatory Qi will accumulate and wait for the right moment to erupt. Once erupted, Wind, Dampness, Dryness, Heat, Fire, and Cold will become abnormal and violent. In the context of the Six Qis, this is called "Victory of the Six Qis." An abundance of Clear Qi indicates an excess of Dryness, causing pathogenic invasion of Wind-Wood, leading to Liver disease. An abundance of Hot Qi indicates an excess of Fire, causing pathogenic invasion of Dryness-Metal, leading to Lung disease, and so on. In pulse manifestation: Arrival of Jue Yin manifests as Wiry; Shaoyin as Hooked; Shaoyang as Large and Floating; Taiyin as Deep; Yangming as Short and Choppy; Taiyang as Large and Long. Arrival with harmony indicates normalcy; arrival with severity indicates disease; arrival contrary to expectation indicates disease; failure to arrive when expected indicates disease; interchange of Yin and Yang indicates critical condition. However, to observe the response of the Six Qis, one usually observes at dawn on the first day of the first lunar month. By observing their position, one knows their location, and their arrival depends on whether the annual movement is early or late. From this, we see that Zhang Zhongjing's fixed rules for the four seasons must accommodate the climate dictated by Heaven when Qi movements overlay the principal positions. Although this may contradict the seasonal Qi, it cannot be considered contrary to time because the observation of Qi remains consistent. Moreover, the Classics state: "If the Principal Qi wins, it is Rebellious; if the Guest Qi wins, it follows." It also states: "One must first know the annual Qi and not violate the Harmony of Heaven." This implies that one should not solely adhere to the Qi of the four seasons but must also consider the theory of Qi movements (Yun Qi).
The Master said: If a patient's pulse is Floating and located at the front (Cun/Inch position), the disease is in the Exterior. If the Floating pulse is at the rear (Chi/Cubit position), the disease is in the Interior. (Symptoms such as) lower back pain, stiffness of the back, inability to walk, accompanied by shortness of breath and extreme fatigue, indicate severe deficiency.
[Commentary]: A Floating pulse indicates Deficiency. The front (Cun) belongs to Yang and governs the Exterior; the rear (Chi) belongs to Yin and governs the Interior. The "Exterior" refers to the Foot-Taiyang Bladder Meridian; the "Interior" refers to the Foot-Shaoyin Kidney Meridian. One Fu organ and one Zang organ form their interior-exterior pairing. The Foot-Taiyang meridian runs from the foot up the back to the neck and waist, which is the residence of the Kidney. Therefore, Exterior disease manifests as back stiffness and inability to walk; Interior disease manifests as lower back pain, shortness of breath, and extreme fatigue. Although a Floating pulse in the Cun and Chi positions is not limited to a single meridian or disease, why is this specific case highlighted? Generally, when using Interior-Exterior to describe disease, the Foot-Taiyang and Kidney are used as examples. Taiyang is the head of all Yang meridians, where pathogens typically enter first; the Kidney is the master of internal governance. The text cites this example to illustrate broader principles.
Question: The Classics say "Jue Yang travels alone." What does this mean? The Master said: This occurs when there is Yang without Yin, hence it is called Jue Yang.
The previous section discussed Yang Deficiency; this section discusses Yin Exhaustion.
[Commentary]: "Jue" means extreme. "Traveling alone" means lacking Yin to pair with. Wang Bing, commenting on the *Neijing*, stated "One Water cannot overcome Five Fires," referring to the Jue Yang of the five Zang organs. The Classics also say "When the Six Yangs converge, it is called Zhi Yang." And again, "When Zhi Yang is excessive, Earth Qi is insufficient." Thus, Fire is Yang. "Zhi Yang" is synonymous with "Jue Yang." "Traveling alone" means converging exclusively. These all represent the extreme state of Insufficient Yin and Excessive Yang.
Question: The Cun pulse is Deep, Large, and Slippery. Deep indicates Solidity; Slippery indicates Qi. When Solidity and Qi contend, if Jue Qi enters the Zang, death ensues; if it enters the Fu, recovery occurs. This is called Cu Jue (Sudden Syncope). What does this mean? The Master said: If the lips and mouth turn blue and the body is cold, the pathogen has entered the Zang, leading to death. If the body is warm and sweat appears spontaneously, the pathogen has entered the Fu, leading to recovery.
[Commentary]: Deep is a Yin image; Slippery is a Yang image. Yin governs Blood; Yang governs Qi. Pathogens in Blood cause Blood Solidity; pathogens in Qi cause Qi Solidity. Hence, Blood Solidity presents with a Deep pulse, and Qi Solidity with a Slippery pulse. Excessive pathogens present with a Large pulse. The five Zang organs govern the interior, belong to Yin, and store Essence and Spirit. Now, Blood and Qi, along with pathogens, enter and block the Zang. The body's essential Qi cannot circulate, the Spirit mechanism perishes, and the pathways of ascent, descent, exit, and entry are severed. When Ying (Nutritive) Qi is cut off, the lips and mouth turn blue. The *Lingshu* states: "When Jue Yin Qi fails, the lips turn blue." The six Fu organs govern the exterior, belong to Yang, and transmit the Qi of water and grain, filling the interior and exterior. Now, when Blood, Qi, and pathogens enter the Fu, the active nature of Fu-Yang differs from the static nature of Zang-Yin. Static entities, when invaded, become blocked and stagnant. Active entities, even when invaded, cannot permanently obstruct the airways. Why? Because the internal Spirit mechanism responds externally, nourishing Ying and Wei (Defensive) Qi, which circulates to the surface, resulting in a warm body. Warmth opens the pores, allowing pathogens to disperse and sweat to appear. With the circulation of Ying and Wei Qi, recovery occurs. This illustrates Zhang Zhongjing's general principles of Yin-Yang and Zang-Fu. As for the causes of Jue diseases, they vary and cannot be generalized. The *Neijing* states: "When Blood and Qi rush upward together, it becomes Da Jue (Great Syncope) and sudden death." Is this not related to the San Jiao and Danzhong? Yet it says recovery depends on the reversal of Qi, and death if it does not reverse. Similarly, when pathogens invade the five collaterals, resembling corpse-like syncope, treatment involves unblocking the collaterals, which is difficult to generalize merely from head and face symptoms.
Question: Pulse disappearance entering the Zang leads to death; entering the Fu leads to recovery. What does this mean? The Master said: This applies not to just one disease, but to all hundred diseases. For example, in impetigo (weeping sores), if it starts at the mouth and flows to the limbs, it is treatable; if it starts at the limbs and flows to the mouth, it is untreatable. Disease remaining in the Exterior is treatable; disease entering the Interior leads to death.
[Commentary]: "Tuo" (Disappearance) means departure. The meridians are tunnels between Zang and Fu organs. Pressured by pathogens, Qi severs from the pulse and enters inward. The five Zang are Yin; the six Fu are Yang. Yin governs death; Yang governs life. Thus, entry into Zang leads to death, while entry into Fu leads to recovery and treatability. This applies not only to Zang-Fu Yin-Yang but to all external/internal Yin-Yang pathogens entering or exiting the Exterior/Interior.
Question: There are eighteen Yang diseases. What are they? The Master said: Headache, neck pain, lower back pain, spine pain, arm pain, and leg cramping pain. There are eighteen Yin diseases. What are they? The Master said: Cough, hyperpnea, wheezing, hiccups, throat pain, borborygmus, abdominal distension, heart pain, and spasm/tightness. Each of the five Zang organs has eighteen diseases, totaling ninety diseases. Humans also have six minor categories, each with eighteen diseases, totaling one hundred and eight diseases. The five labors, seven injuries, six extremes, and thirty-six women's diseases are not included here. Clear pathogens reside above; turbid pathogens reside below. Major pathogens attack the Exterior; minor pathogens attack the Interior. Overeating (Yi) pathogens enter via the mouth, causing retained food. The five types of pathogens affecting humans follow specific patterns: Wind attacks in the morning; Cold attacks in the evening; Dampness injures the lower body; Fog injures the upper body. Wind causes a Floating pulse; Cold causes a Tight pulse; Fog injures skin and interstices; Dampness flows into joints; Food injures the Spleen and Stomach; Extreme Cold injures the Channels; Extreme Heat injures the Collaterals.
[Supplementary Note]: This summarizes the diseases recorded in the *Neijing*, classifying them by Yin-Yang, Exterior-Interior, Upper-Lower, and Internal-External, to clarify meridians, organs, and etiologies, preventing confusion. For instance, the three Yang meridians are external; diseases like headache involve six symptoms, each following its specific meridian, displaying its own signs. Three multiplied by six equals eighteen. The same logic applies to the three Yin meridians internally. Each of the five Zang has eighteen diseases, totaling ninety. Their manifestations are documented in texts like the *Lingshu*. What about the six Fu organs? They reside internally but connect externally to the meridians. Thus, treating Fu diseases often involves their He-Sea points: Stomach connects to Zusanli, Large Intestine to Shanglian, Small Intestine to Xialian, San Jiao to Weiyang, Bladder to Weizhong, Gallbladder to Yanglingquan. Pathogens in Fu organs affect the exterior meridians, making the pathology shallower and easier to dissipate compared to the deeper and more severe Zang diseases. Hence, they are termed "minor." The *Neijing* categorizes these, while Zhang Zhongjing consolidates them into one hundred and eight diseases, likely based on the number six associated with Fu organs. In total, there are two hundred and thirty-four diseases covering both internal and external factors. Specifically regarding internal causes, such as the "five labors," which refer to long-term strain damaging blood, etc. Standing, walking, sitting, and lying should not be forced excessively. Prolonged postures are usually due to necessity. Such strain causes significant damage. Thus, the human body is meant for use; non-use leads to stagnation, but overuse leads to exhaustion and loss of nourishment. Regarding the "seven injuries," such as overeating injuring the Spleen, etc. Each Zang organ has its function. Without moderation, indulgence in desires or emotional imbalances harm harmony, especially when external Qi invades the form and internal emotions agitate the mind. "Extremes" refer to reaching the peak of imbalance. Blood, muscle, sinews, bones, spirit, and essence must be balanced to avoid detriment. Excess in one leads to deficiency in another. The thirty-six women's diseases include twelve types of masses (Jia), characterized by irregular menstruation and varied discharge colors. Women belong to Yin, and pain in the lower half of the waist is common due to diseases of the Chong, Du, and Ren meridians, involving nine types of pain. The seven harms, five injuries, and three causes are detailed in the classics, totaling thirty-six diseases. Thus, disease arises from pathogenic invasion. Understanding the invading pathogen distinguishes one pathogen from another. The human body encompasses all upper/lower and interior/exterior aspects. The clear/turbid and major/minor pathogens refer to fog/dew and earthy turbidity. Heavenly origins tend upward; earthly origins tend downward. The chief of hundred diseases (Wind) injures Human Yang; the killing Qi (Cold) injures Human Yin. Entry via the mouth constitutes internal injury, causing fever, abdominal pain, asthma, vomiting, and distension. Removing old accumulation to make way for new is essential. External pathogens originate from the Six Qis, but Zhang Zhongjing identifies five types: Wind, Cold, Dampness, Fog, and Heat, omitting Dryness. Perhaps because Wind, Cold, and Fire can all generate Dryness, implying Dryness inherently contains elements of these three. Wind affects humans in all three warm seasons; Cold is specific to winter, hence "evening" (metaphorically late/cold). Pulse signs are detailed in the *Shanghan Lun*. Zhang Zhongjing elaborates here to discuss the Yin-Yang of diseases comprehensively, requiring mention of Heaven-Earth Yin-Yang, and to analyze the five Zang, requiring mention of the five invading pathogens. The victory of five Qi lies in Heaven-Earth; the deficiency of five Elements lies in humans. Hence, "Where pathogens gather, Qi must be deficient."
Question: In some cases, one must urgently treat the Interior or the Exterior. What does this mean? The Master said: If a patient was incorrectly treated with purgatives, resulting in continuous diarrhea with undigested food and body pain, one must urgently treat the Interior. Later, if body pain persists but bowel movements normalize, one must urgently treat the Exterior.
[Supplementary Note]: Treating Exterior before Interior is the standard rule. However, treating Interior first has its rationale. Responding to this: Treating the Exterior is necessary precisely because the Interior is urgent. If pathogens are in the Exterior and not treated correctly, they will linger and penetrate inward, causing serious illness. Doctors who fail to understand this may purge too early or heavily, causing continuous diarrhea with undigested food, indicating an urgent Interior condition. Even if Exterior signs remain, the protocol dictates treating the Interior first. Once the Interior is harmonized and the Exterior remains unresolved, then treat the Exterior. This is a fixed rule. Why did Zhang Zhongjing not specify the methods here? The methods, such as using Sini Tang to support Zheng Qi and Guizhi Tang to dispel pathogens, were detailed in the Taiyang chapter.
For chronic entrenched diseases complicated by acute illnesses, one should first treat the acute illness, and subsequently treat the chronic disease.
[Supplementary Note]: "Entrenched disease" refers to deep-seated conditions not curable in a day or night. "Acute disease" refers to sudden onset, newly acquired conditions potentially curable quickly. One must eliminate the pathogen while it has not penetrated deeply, preventing it from lingering and causing harm. Patients with chronic diseases have constitutionally weak Zheng Qi, making them susceptible to rapid transmission of pathogens. Hesitation may allow both pathogens to combine, causing significant harm. Thus, Zhang Zhongjing established this principle to guide future practitioners in prioritizing treatment.
Question: Diseases of the five Zang organs improve when they obtain what they favor; each Zang has what it dislikes. Following what they dislike exacerbates the disease. If a patient suddenly craves food they normally do not eat, fever will likely occur. (Lou Quanshan reads this as binge eating.)
[Supplementary Note]: The correspondence between the five Zang organs and the five flavors is correct reasoning. It reveals their natural nature and thus their emotional tendencies. When Zhang Zhongjing says the Zang obtains what it favors, he means obtaining what is close to its nature. The *Neijing* speaks of "desires," reflecting emotion. Zhang Zhongjing speaks of "dislikes," reflecting nature, and further mentions "dislike," which corresponds to the *Neijing*'s concept of "distress" (Ku), also reflecting emotion. Since each Zang has its nature, following its nature harmonizes emotion, leading to recovery. Violating its nature allows what it dislikes to prevail, suppressing emotion and causing disease, which is normal. However, the Liver desires Sour (for astringency) but also desires Pungent (for dispersal). All five Zangs exhibit this. Does this mean desires are contradictory? Not necessarily. Wood is described as "bending and straightening." Bending/straightening produces Sour, which solidifies the structure. Wood prefers free growth, which is close to dispersal; Pungent aids its function. No structure exists without function, and no function arises without structure. When structure and function harmonize, balance is achieved. For example, the Liver dislikes Wind because Wood's nature dislikes movement, yet Wood generates Wind. Wind is swift; if Wood loses nourishment, it generates Wind, hence "Liver suffers from urgency." Urgency causes Liver disease. The Classic states: "Eat Sweet to relieve urgency," and the disease heals. If one suddenly craves Bitter, it is akin to receiving assistance from the "son" element, causing Qi excess and inevitable fever. Other Zangs follow similar logic. Thus, when the five flavors are balanced, they nourish each other without dominance. When the four seasons align with correctness, they generate each other without deficiency. This depends on proper regulation by the individual.
For diseases residing in the Zang organs, when attacking them, one should follow what they have obtained/gathered. For example, for thirst, administer Zhu Ling Tang. Apply this principle to others.
[Commentary]: This generally discusses the treatment of diseases in the Zang organs belonging to the Interior category. Treatment methods include purging, draining, reducing, dissipating, warming, cooling, and harmonizing to achieve balance. One must assess severity and apply appropriate treatment to eliminate pathogens and preserve Zheng Qi. Thirst is cited as an analogy. The use of Zhu Ling Tang for this condition is detailed in Volume 13 under the Xiao Ke (Wasting-Thirst) chapter.