一难曰∶十二经皆有动脉。独取寸口，以决五脏六腑死生吉凶之法，何谓也？
十二经皆有动脉者，如手太阴脉动∶中府、云门、天府、侠白；手阳明脉动∶合谷、阳
溪；手少阴脉动∶极泉；手太阳脉动∶天窗；手厥阴脉动∶劳宫；手少阳脉动∶禾 ；足
太阴脉动∶箕门、冲门；足阳明脉动∶冲阳、大迎、人迎、气冲；足少阴脉动∶太溪、阴谷
；足太阳脉动∶委中；足厥阴脉动∶太冲、五里、阴廉；足少阳脉动∶下关、听会之类也。
谓之经者，以荣卫之流行经常不息者而言；谓之脉者，以血理之分袤行体者而言也。故经者
径也，脉者陌也。越人之意，盖谓凡此十二经，经皆有动脉，如上文所云者，今置不取
，乃独取寸口以决脏腑死生吉凶何耶？
然，寸口者，脉之大会，手太阴之脉动也（然者答词，余仿此）。
寸口，谓气口也。居手太阴鱼际却行一寸之分，气口之下曰关、曰尺云者。而荣卫之
行于阳者，二十五度，行于阴者，亦二十五度，出入阴阳，参交互注，无少间断，五十度毕
，适当漏下百刻，为一 时，又明日之平旦矣。乃复会于手太阴，此寸口所以为五脏六腑
之所终始，而法有取于是焉。人一呼一吸为一息、每刻一百三十五息，每时八刻，计一千八
十息，十二时九十六刻，计一万二千九百六十息，刻之余分，得五百四十息，合一万三千五
百息也。一息脉行六寸，每二刻二百七十息，脉行一十六丈二尺，每时八刻，脉行六十四丈
八尺。荣卫四周于身，十二时，计九十六刻，脉行七百七十七丈六尺，为四十八周身；刻之
余分，行二周身，得三十二丈四尺，总之为五十度周身，脉得八百一十丈也。此呼吸之息，
脉行之数，周身之度，合昼夜百刻之详也。行阳行阴，谓行昼行夜。
七难曰∶经言少阳之至，乍大乍小，乍短乍长；阳明之至，浮大而短；太阳之至，洪大
而长；太阴之至，紧大而长；少阴之至，紧细而微；厥阴之至，沉短而数。此六者，是平脉
邪？将病脉邪？然，皆王脉也。
六脉者之王，说见下文。
其气以何月各王几日？然，冬至之后，得甲子少阳王，复得甲子阳明王，复得甲子太
阳王，复得甲子太阴王，复得甲子少阴王，复得甲子厥阴王，王各六十日，六六三百六十日
，以成一岁。此三阳，三阴之王时日大要也。
上文言三阳、三阴之王脉，此言三阳三阴之王时，当其时，则见其脉也。
刘温舒曰∶至真要大论云∶厥阴之至其脉弦，少阴之至其脉钩、太阴之至其脉沉，少阳
之至大而浮，阳明之至短而涩。太阳之至大而长。亦随天地之气卷舒也。如春弦、夏洪、秋毛
、冬石之类，则五运六气四时亦皆应之，而见于脉耳。若平人气象论，太阳脉至洪大而长，
少阳脉至乍数乍疏，乍短乍长，阳明脉至浮大而短。《难经》引之以论三阴，三阳之脉者
，以阴阳始生之浅深而言之也。
十二难曰∶经言五脏脉已绝于内，用针者反实其外，五脏脉已绝于外，用针者反实其内
。内外之绝，何以别之？然，五脏脉已绝于内者，肾肝气已绝于内也，而医反补其心肺；五
脏脉已绝于外者，其心肺脉已绝于外也，而医反补其肾肝。阳绝补阴，阴绝补阳，是谓实实
虚虚，损不足而益有余。如此死者，医杀之耳。
《灵枢》云∶凡将用针，必先诊脉，视气之剧易，乃可以治也。又云∶所谓五脏之气，
已绝于内者，脉口气内绝不至，反取其外之病处，与阳经之合，有留针以致阳气，阳气至则
内重竭，重竭则死。其死也，无气以动，故静；所谓五脏之气，已绝于外者，脉口气外绝不
至，反取其四末之输，有留针以致其阴气、阴气至则阳气反入，入则逆，逆则死矣。其死也
，阴气有余，故躁。此《灵枢》以脉口内外言阴阳也。越人以心、肺、肾，肝内外别阴阳，
其理亦由是也。
二十二难曰∶经言脉有是动，有所生病。一脉变为二病者，何也？然，经言是动者气也
，所生病者血也，邪在气，气为是动；邪在血，血为所生病。气主 之，血主濡之，气留
而不行者，为气先病也；血壅而不濡者，为血后病也。故先为是动，后所生也。
三十五难曰∶五脏各有所腑，皆相近，而心、肺独去大肠、小肠远者，何谓也？然，经
言心荣肺卫，通行阳气、故居在上，大肠，小肠传阴气而下，故居在下，所以相去而远也。
四十难曰∶经言肝主色，心主臭，脾主味，肺主声，肾主液。鼻者肺之候，而反知香臭
，耳者肾之候，而反闻声，其义何也？然，肺者，西方金也，金生于巳，巳者，南方火也，
火者心，心主臭，故令鼻知香臭。肾者，北方水也。水生于申，申者，西方金，金者肺，肺主
声，故令耳闻声。
四明陈氏曰∶臭者心所主，鼻者肺之窍，心之脉上肺，故令鼻能知香臭也。声者肺所主
，耳者肾之窍，肾之脉上肺，故令耳能闻声也。愚按越人此说，盖以五行相生之义而言，且
见其相因而为用也。
四十三难曰∶人不食饮，七日而死者，何也？然，人胃中当有留谷二斗，水一斗五升。
故平人日再至圊，一行二升半，日中五升，七日，五七三斗五升，而水谷尽矣。故平人不
食饮七日而死者，水谷津液俱尽，即死矣。
水去则荣散，谷消则卫亡，荣散卫亡，神无所根据，故死。
四十六难曰∶老人卧而不寐，少壮寐而不寤者，何也？然，经言少壮者血气盛，肌肉滑
，气道通，荣卫之行，不失于常，故昼日精，夜不寤也。老人血气衰，肌肉不滑，荣卫之道
涩，故昼日不能精，夜不得寐也。
老卧不寐，少寐不寤，系乎荣卫血气之有余，不足也。
四十七难曰∶人面独能耐寒者，何也？然，人头者，诸阳之会也，诸阴脉皆至颈胸中而
还，独诸阳脉皆上至头耳，故令面耐寒也。
四十九难曰∶有正经自病，有五邪所伤，何以别之？然，忧愁思虑则伤心；形寒饮冷则
伤肺；恚怒气逆，上而不下，则伤肝；饮食劳倦则伤脾；久坐湿地，强力入水则伤肾。是正
何谓五邪？然，有中风，有伤暑，有饮食劳倦，有伤寒，有中湿，此之谓五邪。
谢氏曰∶饮食劳倦，自是二事，饮食得者，饥饱失时，此外邪伤也。劳倦得者，劳形力
而致倦怠，此正经自病也。
假令心病，何以知中风得之？然，其色当赤。何以言之？肝主色，自入为青，入心为赤，
入脾为黄。入肺为白，入肾为黑。故知肝邪入心当赤色。其病身热胁下满痛，其脉浮大而弦
何以知伤暑得之？然，当恶臭。何以言之？心主臭，自入为焦臭，入脾为香臭，入肝为
臊臭，入肾为腐臭，入肺为腥臭。故知心病当恶臭。其病身热而烦，心痛，其脉浮大而散
何以知饮食劳倦得之？然，当喜苦味也。虚为不欲食，实为饮食。何以言之？脾主味，入
肝为酸，入心为苦，入肺
为辛，入肾为咸，自入为甘，故知脾邪入心，为喜苦味也。其病身热而体重嗜卧，四肢不收
，其脉浮大而缓。
何以知伤寒得之？然，当谵言妄语。何以言之？肺主声，入肝为呼，入心为言，入脾为歌
，入肾为呻，自入为哭，故知肺邪入心，为谵言妄语也。其病身热，洒洒恶寒，甚则喘咳，
其脉浮大而涩。
何以知中湿得之？然，当喜汗出不可止。何以言之？肾主湿，入肝为泣，入心为汗，入脾
为涎，入肺为涕，自入为唾。故知肾邪入心，为汗出不可止也。其病身热而少腹痛，足胫寒
而逆。其脉沉濡而大，此五邪之法也。
此篇越人盖言阴阳脏腑经络之偏虚偏实者也。由偏实也，故内邪得而生；由偏虚也，故
外邪得而入。
五十难曰∶病有虚邪，有实邪，有微邪，有贼邪，有正邪，何以别之？然，从后来者为
虚邪，从前来者为实邪，从所不胜来者为贼邪，从所胜来者为微邪，自病者为正邪。
\r五邪举心为例图\pG-G3.bmp\r
（五行之道，生我者休，其气虚也，居吾之后而来为邪，故曰虚邪；我生者相，气方
实也，居吾之前而来为邪，故曰实邪。正邪，则本经自病者也。）
何以言之？假令心病，中风得之为虚邪，伤暑得之为正邪，饮食劳倦得之为实邪，伤寒
得之为微邪，中湿得之为贼邪。
五十一难曰∶病有欲得温者，有欲得寒者，有欲得见人者，有不欲得见人者，而各不同
病在何脏腑也？然，病欲得寒而欲见人者，病在腑也；病欲得温而不欲见人者，病在脏也。
何以言之？腑者阳也，阳病欲得寒，又欲见人；脏者阴也，阴病欲得温，又欲闭户独处，恶
闻人声，故以别知脏腑之病也。
五十二难曰∶腑脏发病，根本等否？然，不等也。其不等奈何？然，脏病者，止而不移，
其病不离其处；腑病者，仿佛贲向，上下行流，居处无常。故以此知脏腑根本不同也。
五十五难曰∶病有积、有聚，何以别之？然，积者阴气也，聚者阳气也。故阴沉而伏，
浮而动。气之所积，名曰积，气之所聚，名曰聚。故积者五脏所生，聚者六腑所成也。积者
阴气也，其始发有常处，其痛不离其部，上下有所终始，左右有所穷处；聚者阳气也，其始
发无根本，上下无所留止，其痛无常处，谓之聚。故以是别知积聚也。
五十六难曰∶五脏之积，各有名乎？以何月，何日得之？然，肝之积名曰肥气（盛也）。在
左胁下，如覆杯，有头足。久不愈，令人发咳逆 疟，连岁不已。以季夏戊巳日得之。何
以言之？肺病传于肝，肝当传脾，脾季夏适王，王不受邪，肝复欲还肺，肺不肯受，故留结
为积。故知肥气以季夏戊巳日得之。
心之积名曰伏梁（伏而不动，如梁木然）。起脐上，大如臂，上至心下。久不愈，令人病
烦心。以秋庚辛日得之。何以言之？肾病传心，心当传肺，肺以秋适王，王不受邪，心复欲
还肾，肾不肯受，故留结为积。故知伏梁以秋庚辛日得之。
脾之积名曰痞气（痞塞不通）。在胃脘，复大如盘。久不愈，令人四肢不收，发黄胆
，饮食不为肌肤。以冬壬癸日得之
。何以言之？肝病传脾，脾当传肾，肾以冬适王，王不受邪，脾复欲还肝，肝不肯受，故留
结为积。故知痞气以冬壬癸日得之。
肺之积名曰息贲（或息或贲）。在右胁下，覆大如杯，久不已，令人洒淅寒热而咳，发肺
痈。以春甲乙日得之。何以言之？心病传肺，肺当传肝，肝以春适王，王不受邪，肺复欲还
心，心不肯受，故留结为积。故知息贲以春甲乙日得之。
肾之积名曰贲豚（若豚之贲，不常定也。豚性躁，故名之）。发于少腹，上至心下，若豚
状
，肾当传心，心以夏适王，王不受邪，肾复欲还脾，脾不肯受，故留结为积。故知贲豚以夏
丙丁日得之。此五积之要法也。
五十九难曰∶狂癫之病，何以别之？然，狂疾之始发，少卧而不饥，自高贤也，自辨智
也，自倨贵也，妄笑好歌乐，妄行不休是也。癫疾始发，意不乐，僵仆直视，其脉三部阴
阳俱盛是也。
六十难曰∶头、心之病，有厥痛，有真痛，何谓也？然，手三阳之脉受风寒，伏留而不
去者，则名厥头痛；入连在脑者，名真头痛。其五脏气（邪气），相干，名厥心痛；其痛甚，
但在心，手足青者，即名真心痛。其真头、心痛者，旦发夕死，夕发旦死。
六十一难曰∶经言望而知之谓之神，闻而知之谓之圣，问而知之谓之工，切脉而知之谓
之巧，何谓也？然，望而知之者，望见其五色以知其病。
《素问》五脏生成篇云∶色见青如草滋，黄如枳实，黑如 ，赤如 血，白如枯骨
者，皆死；青如翠羽，赤如鸡冠，黄如蟹腹，白如豕膏，黑如乌翎者，皆生。《灵枢》云∶
青黑为痛，黄赤为热，白为寒。又云∶赤色出于两颧，大如拇指者，病虽小愈，必卒死；黑
色出于庭（颜色），大如拇指，必不病而卒。又云∶诊血脉者，多赤多热，多青多痛，多黑为
久痹，多黑、多赤、多青、皆见者，为寒热身痛，面色微黄，齿垢黄，爪甲上黄，黄胆也。
又如验产妇，面赤舌青，母活子死，面青舌赤沫出，母死子活，唇口俱青，子母俱死之类也
闻而知之者，闻其五音以别其病。
四明陈氏曰∶五脏有声，而声有音，肝声呼，音应角，调而直，音声相应则无病，角乱
则病在肝；心声笑，音应征，和而长，音声相应则无病，征乱则病在心，脾声歌，音应宫，
大而和，音声相应则无病，宫乱则病在脾；肺声哭，音应商，轻而劲，音声相应则无病，商
乱则病在肺；肾声呻，音应羽，沉而深，音声相应则无病，羽乱则病在肾。
问而知之者，问其所欲五味，以知其病所起所在也。
《灵枢》云∶五味入口，各有所走，各有所病。酸走筋，多食之，令人癃；咸走血，多
食之，令人渴；辛走气，多食之，令人洞心。辛与气俱行，故辛入心而与汗俱出；苦走骨，
多食之，令人变呕；甘走肉，多食之，令人 心（ 音闷）。推此，则知问其所欲五味，
以知其病之所起所在也。
第一难说：十二经脉都有搏动的动脉。唯独取寸口脉，来判断五脏六腑的死生吉凶，这是什么道理呢？
十二经脉都有动脉，例如手太阴肺经的动脉在：中府、云门、天府、侠白；手阳明大肠经的动脉在：合谷、阳溪；手少阴心经的动脉在：极泉；手太阳小肠经的动脉在：天窗；手厥阴心包经的动脉在：劳宫；手少阳三焦经的动脉在：禾髎；足太阴脾经的动脉在：箕门、冲门；足阳明胃经的动脉在：冲阳、大迎、人迎、气冲；足少阴肾经的动脉在：太溪、阴谷；足太阳膀胱经的动脉在：委中；足厥阴肝经的动脉在：太冲、五里、阴廉；足少阳胆经的动脉在：下关、听会等等。所谓“经”，是指营卫之气流行不息的道路；所谓“脉”，是指血液纹理分行于体表的通道。所以，“经”是直行的路径，“脉”是横行的网络。越人（秦越人）的意思大概是说，这十二条经脉虽然每条都有动脉，如上文所说的那些部位，现在却舍弃不取，偏偏只取寸口脉来判断脏腑的死生吉凶，这是为什么呢？
回答说：寸口，是脉气的总会聚之处，也就是手太阴肺经的动脉搏动处。（“然”是应答之词，其余仿此。）
寸口，就是气口。位于手太阴肺经鱼际穴后方一寸的地方，气口之下称为关、称为尺。营卫之气行于阳分二十五周次，行于阴分也是二十五周次，出入阴阳，参交互注，没有片刻间断，五十周次完毕，正好对应漏壶滴下一百刻的时间，为一个昼夜，又是第二天清晨的时候。此时脉气重新会聚于手太阴肺经，这就是寸口之所以成为五脏六腑气血终始之处，因此诊断方法取法于此。人一呼一吸称为一息，每一刻有一百三十五息，每一个时辰有八刻，共计一千零八十息，十二个时辰共九十六刻，共计一万两千九百六十息，加上刻数的余分，得到五百四十息，合计一万三千五百息。每一息脉气运行六寸，每两刻二百七十息，脉气运行一十六丈二尺，每个时辰八刻，脉气运行六十四丈八尺。营卫之气环绕身体一周，十二个时辰计九十六刻，脉气运行七百七十七丈六尺，相当于四十八周身；加上刻数的余分，再行两周身，得三十二丈四尺，总共为五十周次周身，脉气共运行八百一十丈。这就是呼吸的节律、脉运行的次数、周身循环的周数，以及合昼夜一百刻的详细数据。所谓“行阳行阴”，就是指行于昼和行于夜。
第七难说：经文说少阳脉至，忽大忽小，忽短忽长；阳明脉至，浮大而短；太阳脉至，洪大而长；太阴脉至，紧大而长；少阴脉至，紧细而微；厥阴脉至，沉短而数。这六种脉象，是平脉（正常脉象）呢？还是病脉（异常脉象）？回答说：都是王脉（当令之脉）。
关于这六种脉象的当令，说法见下文。
它们的脉气在何月各当令几日？回答说：冬至之后，遇到甲子日，少阳当令；再遇甲子日，阳明当令；再遇甲子日，太阳当令；再遇甲子日，太阴当令；再遇甲子日，少阴当令；再遇甲子日，厥阴当令。每种脉气当令各六十天，六个六十天共三百六十天，构成一年。这是三阳、三阴当令时间的概要。
上文论述了三阳、三阴的当令脉象，这里论述三阳三阴的当令时间，到了那个时令，就会见到相应的脉象。
刘温舒说：《素问·至真要大论》说：厥阴脉至其脉弦，少阴脉至其脉钩，太阴脉至其脉沉，少阳脉至大而浮，阳明脉至短而涩，太阳脉至大而长。这也是随着天地之气的卷舒而变化。如春弦、夏洪、秋毛、冬石等，五运六气和四季也都相应，并显现于脉象上。若参照《素问·平人气象论》，太阳脉至洪大而长，少阳脉至乍数乍疏、乍短乍长，阳明脉至浮大而短。《难经》引用这些来论述三阴、三阳之脉，是从阴阳初生的深浅程度来说的。
第十二难说：经文说五脏脉气在内已绝，用针的人反而充实其外；五脏脉气在外已绝，用针的人反而充实其内。内外的脉绝，如何区别？回答说：五脏脉气在内已绝，是指肾肝之气在内已绝，但医生反而补益心肺；五脏脉气在外已绝，是指心肺脉气在外已绝，但医生反而补益肾肝。阳绝反补阴，阴绝反补阳，这叫作“实实虚虚”，损害不足而增加有余。像这样致死的，是医生杀死了病人。
《灵枢》说：凡是要使用针刺，必须先诊察脉象，观察病气的轻重难易，然后才可以治疗。又说：所谓五脏之气在内已绝，是指脉口内侧脉气断绝不至，反而取其外侧的病处及阳经的合穴，留针以引致阳气，阳气至则内部更加枯竭，双重枯竭就会死亡。这种死亡，是因为体内无气以动，所以表现为安静；所谓五脏之气在外已绝，是指脉口外侧脉气断绝不至，反而取其四肢末端的输穴，留针以引致阴气，阴气至则阳气反而内入，内入则逆乱，逆乱就会死亡。这种死亡，是因为阴气有余，所以表现为躁动。这是《灵枢》以脉口的内外来区分阴阳。越人（秦越人）用心、肺与肾、肝来分别内外阴阳，其道理也是由此而来。
第二十二难说：经文说脉有“是动”病，有“所生病”。一脉变为两种病，是什么道理？回答说：经文说“是动”属于气，“所生病”属于血。邪气在气分，气分为是动病；邪气在血分，血分为所生病。气主煦之，血主濡之。气停留而不运行，是气先病；血壅滞而不能濡养，是血后病。所以先出现是动病，后出现所生病。
第三十五难说：五脏各有相表里的腑，位置都相近，唯独心、肺距离大肠、小肠很远，这是什么道理？回答说：经文说心主荣、肺主卫，通行阳气，所以位居在上；大肠、小肠传导阴气而下，所以位居在下，因此相距遥远。
第四十难说：经文说肝主色，心主嗅，脾主味，肺主声，肾主液。鼻是肺的外候，却反而能辨别香臭；耳是肾的外候，却反而能听到声音，这是什么含义？回答说：肺属西方金，金生于巳，巳属南方火，火对应心，心主嗅，所以使鼻能辨别香臭。肾属北方水，水生于申，申属西方金，金对应肺，肺主声，所以使耳能听到声音。
四明陈氏说：嗅是心所主的，鼻是肺的窍，心的经脉上行至肺，所以使鼻能辨别香臭。声是肺所主的，耳是肾的窍，肾的经脉上行至肺，所以使耳能听到声音。我认为越人的这种说法，大概是以五行相生的意义而言，并且体现了它们相互依赖而发挥作用。
第四十三难说：人不进食饮水，七天就死亡的，是什么原因？回答说：人胃中通常留有谷物二斗，水一斗五升。所以正常人每天两次去厕所，每次排便二升半，一天排出五升，七天共排出三斗五升，这样水和谷物就排尽了。所以正常人如果不进食饮水七天就会死亡，这是因为水谷津液都耗尽了，所以死亡。
水液耗尽则营气散失，谷物消尽则卫气亡失，营散卫亡，神志无所依附，所以死亡。
第四十六难说：老人躺下不能入睡，年轻人睡着却不醒，是什么原因？回答说：经文说年轻人血气旺盛，肌肉滑利，气道通畅，营卫的运行不失常态，所以白天精神饱满，夜晚睡眠深沉不醒。老人血气衰弱，肌肉不滑利，营卫之道涩滞，所以白天精神不能饱满，夜晚不能入睡。
第四十七难说：人脸唯独能耐寒，是什么原因？回答说：人的头部是诸阳经交会的地方，所有阴脉都只到达颈胸中便返回，只有诸阳脉都上行至头耳，所以使面部能够耐寒。
第四十九难说：有正经自病，有五邪所伤，如何区别？回答说：忧愁思虑则伤心；形体受寒、饮食生冷则伤肺；愤怒气逆，气上不下则伤肝；饮食不节、过度劳累则伤脾；久坐湿地、强力涉水则伤肾。什么是五邪？回答说：有中风，有伤暑，有饮食劳倦，有伤寒，有中湿，这就叫五邪。
谢氏说：饮食和劳倦本是两件事。因饮食不当得的病，是饥饱失时，这是外邪伤害。因劳倦得的病，是形体劳累导致倦怠，这是正经自病。
假如是心病，如何知道是中风引起的？回答说：面色应当发赤。为什么这么说？肝主色，青色入肝，赤色入心，黄色入脾，白色入肺，黑色入肾。所以知道肝邪传入心应当面色发赤。病症表现为身体发热、胁下满痛，脉象浮大而弦。
如何知道是伤暑引起的？回答说：应当厌恶异味。为什么这么说？心主嗅，焦臭味入心，香臭味入脾，臊臭味入肝，腐臭味入肾，腥臭味入肺。所以知道心病应当厌恶异味。病症表现为身体发热且烦躁、心痛，脉象浮大而散。
如何知道是饮食劳倦引起的？回答说：应当喜欢苦味。虚证是不想吃饭，实证是食欲旺盛。为什么这么说？脾主味，酸味入肝，苦味入心，辛味入肺，咸味入肾，甘味自入脾。所以知道脾邪传入心，表现为喜欢苦味。病症表现为身体发热、身体沉重嗜睡、四肢无力，脉象浮大而缓。
如何知道是伤寒引起的？回答说：应当胡言乱语。为什么这么说？肺主声，呼声入肝，言语入心，歌声入脾，呻吟入肾，哭声自入肺。所以知道肺邪传入心，表现为胡言乱语。病症表现为身体发热、洒洒恶寒，严重时气喘咳嗽，脉象浮大而涩。
如何知道是中湿引起的？回答说：应当汗出不止。为什么这么说？肾主湿，泪液入肝，汗液入心，涎液入脾，涕液入肺，唾液自入肾。所以知道肾邪传入心，表现为汗出不止。病症表现为身体发热、少腹痛，足胫寒冷逆冷。脉象沉濡而大，这就是五邪的诊断方法。
这一篇越人讲的是阴阳脏腑经络偏虚偏实的道理。因为偏实，所以内邪得以产生；因为偏虚，所以外邪得以侵入。
第五十难说：病有虚邪，有实邪，有微邪，有贼邪，有正邪，如何区别？回答说：从后来者为虚邪，从前来者为实邪，从所不胜者来者为贼邪，从所胜者来者为微邪，本经自病者为正邪。
（五行之道，生我者休，其气虚，居吾之后而来为邪，故曰虚邪；我生者相，气方实，居吾之前而来为邪，故曰实邪。正邪，则是本经自病。）
为什么这么说？假如是心病，中风引起的是虚邪，伤暑引起的是正邪，饮食劳倦引起的是实邪，伤寒引起的是微邪，中湿引起的是贼邪。
第五十一难说：有的病人想要温暖，有的想要寒冷，有的想见人，有的不想见人，病情各不相同，病在哪个脏腑？回答说：病想要寒冷且想见人的，病在腑；病想要温暖且不想见人的，病在脏。
为什么这么说？腑属阳，阳病想要寒冷，又想见人；脏属阴，阴病想要温暖，又想关门独处，厌恶听到人声，所以以此区别脏腑之病。
第五十二难说：脏和腑发病，根本情况一样吗？回答说：不一样。怎么不一样？回答说：脏病，静止不移，病位不离原处；腑病，仿佛奔趋向旁，上下流动，位置无常。所以以此知道脏腑的根本不同。
第五十五难说：病有积，有聚，如何区别？回答说：积是阴气，聚是阳气。所以阴静而伏，阳动而浮。气积聚的地方，名叫积；气聚集的地方，名叫聚。所以积由五脏产生，聚由六腑形成。积是阴气，起始有固定部位，疼痛不离该部，上下有起止，左右有尽头；聚是阳气，起始没有根本，上下无处停留，疼痛没有固定部位，这叫聚。所以以此区别积聚。
第五十六难说：五脏的积，各有名字吗？在何月、何日形成？回答说：肝的积名叫肥气（盛也）。在左胁下，像倒扣的杯子，有头有足。久治不愈，使人发生咳逆疟疾，连年不止。在季夏戊己日形成。为什么这么说？肺病传于肝，肝应当传脾，脾在季夏正当旺，旺不受邪，肝又想传回肺，肺不肯接受，所以留结为积。所以知道肥气在季夏戊己日形成。
心的积名叫伏梁（伏而不动，像梁木一样）。起于脐上，大如手臂，上至心下。久治不愈，使人烦心。在秋季庚辛日形成。为什么这么说？肾病传心，心应当传肺，肺在秋季正当旺，旺不受邪，心又想传回肾，肾不肯接受，所以留结为积。所以知道伏梁在秋季庚辛日形成。
脾的积名叫痞气（痞塞不通）。在胃脘部，大如盘子。久治不愈，使人四肢无力，发黄疸，饮食不能化为肌肤。在冬季壬癸日形成。为什么这么说？肝病传脾，脾应当传肾，肾在冬季正当旺，旺不受邪，脾又想传回肝，肝不肯接受，所以留结为积。所以知道痞气在冬季壬癸日形成。
肺的积名叫息贲（或息或贲）。在右胁下，覆盖大如杯子，久治不愈，使人洒淅寒热而咳，发为肺痈。在春季甲乙日形成。为什么这么说？心病传肺，肺应当传肝，肝在春季正当旺，旺不受邪，肺又想传回心，心不肯接受，所以留结为积。所以知道息贲在春季甲乙日形成。
肾的积名叫贲豚（像小猪奔跑，不定常。猪性躁，所以这么命名）。发于小腹，上至心下，像小猪状。肾应当传心，心在夏季正当旺，旺不受邪，肾又想传回脾，脾不肯接受，所以留结为积。所以知道贲豚在夏季丙丁日形成。这是五种积的要法。
第五十九难说：狂病和癫病，如何区别？回答说：狂病刚开始发作，睡眠少且不饿，自认为贤能，自认为聪明，自认为尊贵，无故大笑喜好唱歌快乐，胡乱行动不停止。癫病刚开始发作，情绪不乐，僵仆直视，三部脉阴阳俱盛。
第六十难说：头、心的病，有厥痛，有真痛，是什么道理？回答说：手三阳经脉受风寒，潜伏停留不去的，名叫厥头痛；邪气深入连及脑部的，名叫真头痛。五脏气（邪气）相互干扰，名叫厥心痛；疼痛非常剧烈，仅在心部，手足青紫的，即名叫真心痛。真头痛和真心痛，早上发作晚上死，晚上发作早上死。
第六十一难说：经文说望而知之谓之神，闻而知之谓之圣，问而知之谓之工，切脉而知之谓之巧，是什么道理？回答说：望而知之，是看到五色从而知道疾病。
《素问·五脏生成篇》说：面色青如草兹，黄如枳实，黑如炁，赤如衃血，白如枯骨，这些都是死色；青如翠羽，赤如鸡冠，黄如蟹腹，白如豕膏，黑如乌翎，这些都是生色。《灵枢》说：青黑为痛，黄赤为热，白为寒。又说：赤色出现在两颧，大如拇指，即使病稍好，必定突然死亡；黑色出现在庭（面部中央），大如拇指，必定不病而突然死亡。又说：诊血脉，多赤多热，多青多痛，多黑为久痹，多黑、多赤、多青都出现的，为寒热身痛。面色微黄，齿垢黄，爪甲上黄，是黄疸。又如检验产妇，面赤舌青，母活子死；面青舌赤沫出，母死子活；唇口俱青，子母俱死之类。
四明陈氏说：五脏有声，而声有音。肝声呼，音应角，调而直，音声相应则无病，角乱则病在肝；心声笑，音应征，和而长，音声相应则无病，征乱则病在心；脾声歌，音应宫，大而和，音声相应则无病，宫乱则病在脾；肺声哭，音应商，轻而劲，音声相应则无病，商乱则病在肺；肾声呻，音应羽，沉而深，音声相应则无病，羽乱则病在肾。
问而知之，是询问病人想要吃的五味，从而知道疾病的起因和所在。
《灵枢》说：五味入口，各有所走，各有所病。酸走筋，多吃令人癃闭；咸走血，多吃令人口渴；辛走气，多吃令人洞心。辛与气俱行，所以辛入心而与汗俱出；苦走骨，多吃令人变呕；甘走肉，多吃令人闷心（闷音闷）。推此可知，询问病人想要吃的五味，可以知道疾病之所起所在。
Difficulty 1 states: All twelve meridians have pulsating arteries. Why is it that by taking only the Cun Kou (Inch Port) pulse, one can determine the life and death, fortune and misfortune of the five Zang organs and six Fu organs?
Regarding the fact that all twelve meridians have arteries: for example, the hand Taiyin Lung meridian has pulses at Zhongfu (LU-1), Yunmen (LU-2), Tianfu (LU-3), and Xiabai (LU-4); the hand Yangming Large Intestine meridian has pulses at Hegu (LI-4) and Yangxi (LI-5); the hand Shaoyin Heart meridian has a pulse at Jiquan (HT-1); the hand Taiyang Small Intestine meridian has a pulse at Tianchuang (SI-16); the hand Jueyin Pericardium meridian has a pulse at Laogong (PC-8); the hand Shaoyang Sanjiao meridian has a pulse at Heliao (TE-17); the foot Taiyin Spleen meridian has pulses at Jimen (SP-11) and Chongmen (SP-12); the foot Yangming Stomach meridian has pulses at Chongyang (ST-42), Daying (ST-5), Renying (ST-9), and Qichong (ST-30); the foot Shaoyin Kidney meridian has pulses at Taixi (KI-3) and Yinggu (KI-10); the foot Taiyang Bladder meridian has a pulse at Weizhong (BL-40); the foot Jueyin Liver meridian has pulses at Taichong (LR-3), Wuli (LR-11), and Yinlian (LR-9); the foot Shaoyang Gallbladder meridian has pulses at Xiaguan (ST-7) and Tinghui (GB-2), and so on. The term "Jing" (Meridian/Vessel) refers to the continuous flow of Ying (Nutrient) and Wei (Defensive) Qi; the term "Mai" (Pulse/Vessel) refers to the branching network through which blood flows in the body. Thus, "Jing" implies a direct path, while "Mai" implies a crosswise network. Yué Rén's (Qin Yueren) meaning is likely this: although all twelve meridians have arteries as mentioned above, why are these other points discarded and only the Cun Kou pulse taken to judge the fate of the Zang and Fu organs?
The answer is: Cun Kou is the great convergence of pulses, specifically the pulsating point of the hand Taiyin Lung meridian. ("Ran" is an affirmative particle used in response; others follow this pattern.)
Cun Kou is also called Qi Kou. It is located one cun posterior to the大鱼际 (Thenar eminence) of the hand Taiyin meridian. Below Qi Kou are Guan (Gate) and Chi (Depth). Ying and Wei Qi circulate twenty-five cycles in the Yang aspects and twenty-five cycles in the Yin aspects. Entering and exiting Yin and Yang, they intersect and intermingle without any interruption. After fifty cycles, exactly one hundred ke (water clock units) have elapsed, marking the end of a day and night cycle and the arrival of dawn the next day. At this time, the Qi converges again at the hand Taiyin meridian. This is why Cun Kou serves as the beginning and end of the Qi of the five Zang and six Fu organs, and thus diagnostic methods are derived from it. One inhalation and exhalation constitute one Xi (breath/respiration). There are 135 Xi per ke. Each Shi (two-hour period) has eight ke, totaling 1,080 Xi. Twelve Shi make up ninety-six ke, totaling 12,960 Xi. Adding the fractional parts of the ke yields 540 Xi, bringing the total to 13,500 Xi per day. In each Xi, the pulse travels six cun. In two ke (270 Xi), the pulse travels sixteen zhang and two chi. In one Shi (eight ke), the pulse travels sixty-four zhang and eight chi. Ying and Wei Qi circulate around the body once every twelve Shi (ninety-six ke), traveling seven hundred seventy-seven zhang and six chi, equivalent to forty-eight full circuits of the body. Adding the fractional parts allows for two more circuits, covering thirty-two zhang and four chi. In total, over fifty circuits of the body, the pulse travels eight hundred ten zhang. This details the rhythm of respiration, the number of pulse travels, the degree of bodily circulation, and the precise measurement of the hundred ke of day and night. "Traveling Yang and Yin" refers to traveling during the day and night respectively.
Difficulty 7 states: The classics say that when Shao Yang arrives, the pulse is suddenly large, suddenly small, suddenly short, and suddenly long; when Yang Ming arrives, it is floating, large, and short; when Tai Yang arrives, it is surging, large, and long; when Tai Yin arrives, it is tight, large, and long; when Shao Yin arrives, it is tight, fine, and faint; when Jue Yin arrives, it is deep, short, and rapid. Are these six types Ping Mai (Normal Pulses) or Bing Mai (Pathological Pulses)? The answer is: they are Wang Mai (Wang/Prosperous Pulses, i.e., pulses corresponding to the season).
The explanation of the Wang status of these six pulses is found below.
Which month does each govern for how many days? The answer is: After the Winter Solstice, upon encountering a Jia Zi day, Shao Yang governs; upon encountering another Jia Zi day, Yang Ming governs; then Tai Yang; then Tai Yin; then Shao Yin; then Jue Yin. Each governs for sixty days. Six times sixty equals three hundred sixty days, completing one year. This is the general rule for the timing of the Wang periods of the Three Yang and Three Yin.
The previous text discussed the Wang pulses of the Three Yang and Three Yin; this text discusses their Wang times. When the time arrives, the corresponding pulse appears.
Liu Wenshu said: In *Su Wen: Zhi Zhen Yao Da Lun*, it is stated: When Jue Yin arrives, the pulse is Xian (String-like); when Shao Yin arrives, the pulse is Gou (Hook-like); when Tai Yin arrives, the pulse is Chen (Deep); when Shao Yang arrives, it is large and floating; when Yang Ming arrives, it is short and Se (Choppy); when Tai Yang arrives, it is large and long. This also follows the expansion and contraction of Heaven and Earth Qi. Just as Spring is Xian, Summer is Hong (Surging), Autumn is Mao (Feather-like), and Winter is Shi (Stone-like), the Five Movements and Six Qi correspond to the four seasons and manifest in the pulse. Referring to *Ping Ren Qi Xiang Lun*, Tai Yang pulse is surging, large, and long; Shao Yang pulse is suddenly rapid, suddenly sparse, suddenly short, suddenly long; Yang Ming pulse is floating, large, and short. *Nan Jing* cites these to discuss the pulses of the Three Yin and Three Yang, speaking from the perspective of the depth of the initial generation of Yin and Yang.
Difficulty 12 states: The classics say that if the pulse of the five Zang organs is exhausted internally, the acupuncturist erroneously tonifies the exterior; if the pulse of the five Zang organs is exhausted externally, the acupuncturist erroneously tonifies the interior. How are internal and external exhaustion distinguished? The answer is: Internal exhaustion of the five Zang pulse means the Qi of the Kidney and Liver is exhausted internally, yet the physician erroneously tonifies the Heart and Lung. External exhaustion means the pulse of the Heart and Lung is exhausted externally, yet the physician erroneously tonifies the Kidney and Liver. Tonifying Yin when Yang is exhausted, and tonifying Yang when Yin is exhausted, is called "making the excess more excessive and the deficiency more deficient," damaging what is insufficient and benefiting what is already sufficient. Death resulting from such treatment is effectively murder by the physician.
*Ling Shu* states: Whenever using acupuncture, one must first diagnose the pulse to assess the severity and ease of the condition before treating. It also states: "Exhaustion of Zang Qi internally" means the pulse at the Kou (Gate) position does not reach internally. If one erroneously treats external disease sites and combines them with He-Sea points of Yang meridians, retaining the needle to draw in Yang Qi, the arrival of Yang Qi will cause double exhaustion internally, leading to death. Such death is characterized by stillness because there is no Qi to move. "Exhaustion of Zang Qi externally" means the pulse at the Kou position does not reach externally. If one erroneously treats Shu points of the four limbs, retaining the needle to draw in Yin Qi, the arrival of Yin Qi causes Yang Qi to retreat inward. Retreating inward leads to rebellion/negation, causing death. Such death is characterized by restlessness because Yin Qi is in excess. *Ling Shu* uses the internal and external aspects of the pulse Kou to distinguish Yin and Yang. Yué Rén distinguishes Yin and Yang by placing Heart/Lung externally and Kidney/Liver internally, but the principle remains the same.
Difficulty 22 states: The classics mention "Shi Dong" (Is Moving) diseases and "Suo Sheng Bing" (So Producing Disease) conditions. How does one meridian give rise to two types of disease? The answer is: The classics state that "Shi Dong" relates to Qi, and "Suo Sheng Bing" relates to Blood. Pathogen in Qi causes Shi Dong disease; pathogen in Blood causes Suo Sheng Bing. Qi provides warmth (Xu), and Blood provides nourishment (Ru). If Qi stagnates and fails to circulate, it is a Qi disease occurring first; if Blood becomes obstructed and fails to nourish, it is a Blood disease occurring later. Hence, Shi Dong comes first, followed by Suo Sheng Bing.
Difficulty 35 states: Each of the five Zang organs has a paired Fu organ, and they are generally close to each other. Why are the Heart and Lung far from the Large and Small Intestines? The answer is: The classics state that the Heart governs Ying and the Lung governs Wei, circulating Yang Qi, hence they reside in the upper body. The Large and Small Intestines transmit Yin Qi downward, hence they reside in the lower body. This is why they are distant from each other.
Difficulty 40 states: The classics say the Liver governs color, the Heart governs smell, the Spleen governs taste, the Lung governs sound, and the Kidney governs fluids. The nose is the opening of the Lung, yet it perceives smells; the ear is the opening of the Kidney, yet it hears sounds. What is the rationale? The answer is: The Lung belongs to Metal in the West. Metal is born in Si (Snake), which belongs to Fire in the South. Fire corresponds to the Heart, which governs smell. Therefore, the nose can perceive smells. The Kidney belongs to Water in the North. Water is born in Shen (Monkey), which belongs to Metal in the West. Metal corresponds to the Lung, which governs sound. Therefore, the ear can hear sounds.
Chen of Siming said: Smell is governed by the Heart, and the nose is the opening of the Lung. The Heart meridian ascends to the Lung, enabling the nose to perceive smells. Sound is governed by the Lung, and the ear is the opening of the Kidney. The Kidney meridian ascends to the Lung, enabling the ear to hear sounds. I believe Yué Rén's statement relies on the principle of mutual generation among the Five Elements, demonstrating their interdependent function.
Difficulty 43 states: Why do people die after seven days without food or water? The answer is: The human stomach normally contains two dou of grain and one dou five sheng of water. A healthy person defecates twice daily, passing two and a half sheng each time, totaling five sheng per day. Over seven days, this amounts to three dou five sheng. Thus, when water and grain are exhausted, death occurs.
When water is gone, Ying Qi scatters; when grain is consumed, Wei Qi perishes. With Ying scattering and Wei perishing, Shen (Spirit) has no foundation, leading to death.
Difficulty 46 states: Why do elderly people lie down but cannot sleep, while young and strong people sleep deeply and do not wake easily? The answer is: The classics state that young people have abundant Qi and Blood, smooth muscles, and unobstructed Qi channels. Their Ying and Wei circulation is normal, so they are energetic during the day and sleep soundly at night. Elderly people have declining Qi and Blood, rough muscles, and sluggish Ying and Wei pathways. Thus, they lack energy during the day and cannot sleep at night.
Elderly insomnia and youthful deep sleep depend on the abundance or deficiency of Ying, Wei, Qi, and Blood.
Difficulty 47 states: Why is the face uniquely able to resist cold? The answer is: The head is the convergence of all Yang meridians. All Yin meridians ascend only to the neck and chest before returning, whereas all Yang meridians ascend to the head and ears. This allows the face to resist cold.
Difficulty 49 states: There are diseases caused by the meridians themselves (Zheng Jing Zi Bing) and those caused by the Five Evils (Wu Xie). How are they distinguished? The answer is: Worry and overthinking injure the Heart; exposure to cold and consumption of cold drinks injure the Lung; anger with reversed Qi rising upward injures the Liver; improper diet and fatigue injure the Spleen; sitting long in damp places or forcing oneself into cold water injures the Kidney. What are the Five Evils? They are Wind Strike (Zhong Feng), Summerheat Injury (Shang Shu), Diet and Fatigue (Yin Shi Lao Juan), Cold Damage (Shang Han), and Dampness Strike (Zhong Shi).
Xie Shi said: Diet and fatigue are distinct. Diseases from diet arise from irregular eating habits (hunger/fullness imbalance), which is an external evil injury. Diseases from fatigue arise from physical exertion leading to exhaustion, which is a self-injury of the proper meridian.
For example, regarding Heart disease: How do we know it is caused by Wind Strike? The complexion should be red. Why? The Liver governs color. Green enters the Liver, Red enters the Heart, Yellow enters the Spleen, White enters the Lung, Black enters the Kidney. Thus, Liver evil entering the Heart manifests as redness. Symptoms include fever, fullness and pain under the ribs, with a floating, large, and string-like pulse.
How do we know it is caused by Summerheat Injury? The patient should dislike odors. Why? The Heart governs smell. Scorched odor enters the Heart, fragrant odor enters the Spleen, fishy odor enters the Liver, putrid odor enters the Kidney, raw/fishy odor enters the Lung. Thus, Heart disease involves aversion to odors. Symptoms include fever, irritability, heart pain, with a floating, large, and scattered pulse.
How do we know it is caused by Diet and Fatigue? The patient should crave bitter taste. Deficiency leads to anorexia; excess leads to voracious appetite. Why? The Spleen governs taste. Sour enters the Liver, Bitter enters the Heart, Pungent enters the Lung, Salty enters the Kidney, Sweet enters the Spleen itself. Thus, Spleen evil entering the Heart manifests as craving bitter taste. Symptoms include fever, heavy body, lethargy, limp limbs, with a floating, large, and slow pulse.
How do we know it is caused by Cold Damage? The patient should speak deliriously. Why? The Lung governs sound. Crying enters the Liver, Speaking enters the Heart, Singing enters the Spleen, Moaning enters the Kidney, Weeping enters the Lung itself. Thus, Lung evil entering the Heart manifests as delirious speech. Symptoms include fever, chills, severe coughing and wheezing, with a floating, large, and choppy pulse.
How do we know it is caused by Dampness Strike? The patient should have uncontrollable sweating. Why? The Kidney governs dampness. Tears enter the Liver, Sweat enters the Heart, Saliva enters the Spleen, Mucus enters the Lung, Spittle enters the Kidney itself. Thus, Kidney evil entering the Heart manifests as uncontrollable sweating. Symptoms include fever, lower abdominal pain, cold legs and feet, with a deep, soggy, and large pulse. These are the methods for diagnosing the Five Evils.
In this chapter, Yué Rén discusses the partial deficiency and excess of Yin/Yang, Zang/Fu, and meridians. Due to partial excess, internal evils arise; due to partial deficiency, external evils invade.
Difficulty 50 states: Diseases include Xu Xie (Empty Evil), Shi Xie (Solid Evil), Wei Xie (Minor Evil), Zei Xie (Thief Evil), and Zheng Xie (Proper Evil). How are they distinguished? The answer is: Coming from behind is Xu Xie; coming from ahead is Shi Xie; coming from the element that does not overcome me is Zei Xie; coming from the element that I overcome is Wei Xie; originating from the meridian itself is Zheng Xie.
(Note: In the Five Elements, the element that generates me is "Xiu" (Resting), its Qi is weak, coming from behind as evil, hence Xu Xie. The element I generate is "Xiang" (Assistant), its Qi is strong, coming from ahead as evil, hence Shi Xie. Zheng Xie is the disease of the meridian itself.)
Why? For example, in Heart disease: Wind Strike is Xu Xie; Summerheat Injury is Zheng Xie; Diet and Fatigue is Shi Xie; Cold Damage is Wei Xie; Dampness Strike is Zei Xie.
Difficulty 51 states: Some patients desire warmth, some desire cold, some wish to see people, some do not. These differ in pathology. Which Zang or Fu organ is affected? The answer is: Desire for cold and wanting to see people indicates disease in the Fu organs. Desire for warmth and not wanting to see people indicates disease in the Zang organs.
Why? Fu organs belong to Yang. Yang diseases desire cold and social interaction. Zang organs belong to Yin. Yin diseases desire warmth and isolation, closing doors and avoiding voices. Thus, we distinguish Zang and Fu diseases by these preferences.
Difficulty 52 states: Is the root of Zang and Fu diseases equal? The answer is: No. How are they unequal? Zang diseases are stationary and immobile, remaining in their original location. Fu diseases are like rushing waters, moving up and down, with no fixed location. Thus, the fundamental nature of Zang and Fu diseases differs.
Difficulty 55 states: Diseases include Ji (Accumulation) and Ju (Gathering). How are they distinguished? Ji is Yin Qi; Ju is Yang Qi. Yin is still and hidden; Yang is active and floating. Where Qi accumulates, it is called Ji; where Qi gathers, it is called Ju. Ji arises from the five Zang organs; Ju forms from the six Fu organs. Ji is Yin Qi; it starts at a fixed location, pain remains in that area, with definite upper/lower and left/right boundaries. Ju is Yang Qi; it has no fixed origin, moves freely without stopping, and pain has no fixed location. Thus, Ji and Ju are distinguished by these characteristics.
Difficulty 56 states: Do the five Zang accumulations have specific names? On what months and days do they form? The answer is: The Liver accumulation is named Fei Qi (Abundant Qi). It is located under the left hypochondrium, resembling an inverted cup with a head and feet. If untreated, it causes coughing, asthma, and malaria persisting for years. It forms on Wu/Ji days in late summer (Ji Xia). Why? Lung disease transmits to the Liver. The Liver should transmit to the Spleen. However, the Spleen is prosperous in late summer and rejects the evil. The Liver tries to return the evil to the Lung, but the Lung refuses. Thus, it stagnates and forms an accumulation. Hence, Fei Qi forms on Wu/Ji days in late summer.
The Heart accumulation is named Fu Liang (Hidden Beam). It starts above the umbilicus, as thick as an arm, extending up to the epigastrium. If untreated, it causes mental agitation. It forms on Geng/Xin days in autumn. Why? Kidney disease transmits to the Heart. The Heart should transmit to the Lung. The Lung is prosperous in autumn and rejects the evil. The Heart tries to return the evil to the Kidney, but the Kidney refuses. Thus, it stagnates and forms an accumulation. Hence, Fu Liang forms on Geng/Xin days in autumn.
The Spleen accumulation is named Pi Qi (Obstruction Qi). It is in the epigastrium, large as a plate. If untreated, it causes limb weakness, jaundice, and failure of food to nourish the body. It forms on Ren/Gui days in winter. Why? Liver disease transmits to the Spleen. The Spleen should transmit to the Kidney. The Kidney is prosperous in winter and rejects the evil. The Spleen tries to return the evil to the Liver, but the Liver refuses. Thus, it stagnates and forms an accumulation. Hence, Pi Qi forms on Ren/Gui days in winter.
The Lung accumulation is named Xi Ben (Breathing Rush). It is under the right hypochondrium, covering an area large as a cup. If untreated, it causes chills, fever, cough, and lung abscess. It forms on Jia/Yi days in spring. Why? Heart disease transmits to the Lung. The Lung should transmit to the Liver. The Liver is prosperous in spring and rejects the evil. The Lung tries to return the evil to the Heart, but the Heart refuses. Thus, it stagnates and forms an accumulation. Hence, Xi Ben forms on Jia/Yi days in spring.
The Kidney accumulation is named Ben Tun (Rushing Pig). It originates in the lower abdomen and extends up to the epigastrium, resembling a pig. The Kidney should transmit to the Heart. The Heart is prosperous in summer and rejects the evil. The Kidney tries to return the evil to the Spleen, but the Spleen refuses. Thus, it stagnates and forms an accumulation. Hence, Ben Tun forms on Bing/Ding days in summer. These are the essential rules for the five accumulations.
Difficulty 59 states: How are Kuang (Mania) and Dian (Epilepsy/Melancholia) distinguished? The answer is: Kuang begins with little sleep, lack of hunger, arrogance, self-perceived wisdom, self-perceived nobility, inappropriate laughter, singing, joy, and incessant erratic behavior. Dian begins with unhappiness, sudden collapse, staring straight ahead, and a pulse that is excessively strong in both Yin and Yang positions across the three levels.
Difficulty 60 states: Head and Heart diseases include Jue Tong (Rebellious Pain) and Zhen Tong (True Pain). What is the difference? The answer is: When the three hand-Yang meridians are invaded by wind and cold, which linger and do not depart, it is called Jue Tou Tong (Rebellious Headache). If the pathogen penetrates and connects to the brain, it is called Zhen Tou Tong (True Headache). When the Qi of the five Zang organs interferes with each other, it is called Jue Xin Tong (Rebellious Heart Pain). If the pain is extreme, localized solely in the heart, and accompanied by cyanosis of the hands and feet, it is called Zhen Xin Tong (True Heart Pain). True Headache and True Heart Pain are fatal: if onset is in the morning, death occurs in the evening; if onset is in the evening, death occurs in the morning.
Difficulty 61 states: The classics say: Diagnosing by observation is called Divine; diagnosing by listening/smelling is called Sage; diagnosing by questioning is called Skilled; diagnosing by palpation is called Clever. What does this mean? The answer is: Diagnosing by observation involves seeing the five complexions to identify the disease.
*Suu Wen: Wu Zang Sheng Cheng Pian* states: Complexions like dead grass (green), dried orange peel (yellow), coal dust (black), clotted blood (red), and dry bone (white) indicate death. Complexions like kingfisher feathers (green), chicken comb (red), crab belly (yellow), pig fat (white), and crow feathers (black) indicate life. *Ling Shu* states: Green/black indicates pain; yellow/red indicates heat; white indicates cold. It also states: Red appearing on the cheeks, size of a thumb, indicates imminent death even if symptoms seem mild. Black appearing on the forehead (Ting), size of a thumb, indicates sudden death. Regarding pulse diagnosis: Many red indicates heat; many green indicates pain; many black indicates chronic bi-syndrome; mixed black, red, and green indicates alternating chills and fever with body pain. Slight yellow complexion, yellow dental plaque, and yellow nails indicate jaundice. In obstetrics: Red face and blue tongue indicate living mother and dead fetus; blue face and red tongue with foam indicate dead mother and living fetus; blue lips and mouth indicate death of both.
Diagnosing by listening/smelling involves distinguishing disease by the five vocal tones.
Chen of Siming said: The five Zang produce sounds, which correspond to musical tones. Liver sound is calling, tone Jue (Wood), clear and straight; harmony indicates health, discord indicates Liver disease. Heart sound is laughing, tone Zhi (Fire), harmonious and long; harmony indicates health, discord indicates Heart disease. Spleen sound is singing, tone Gong (Earth), broad and harmonious; harmony indicates health, discord indicates Spleen disease. Lung sound is crying, tone Shang (Metal), light and vigorous; harmony indicates health, discord indicates Lung disease. Kidney sound is moaning, tone Yu (Water), deep and沉; harmony indicates health, discord indicates Kidney disease.
Diagnosing by questioning involves asking about the desired flavors to determine the origin and location of the disease.
*Ling Shu* states: The five flavors enter the mouth and travel to specific tissues, causing disease in those areas. Sour travels to sinews; excessive intake causes urinary retention. Salty travels to blood; excessive intake causes thirst. Pungent travels to Qi; excessive intake causes hollow heart sensation. Pungent moves with Qi, so pungent enters the Heart and exits with sweat. Bitter travels to bones; excessive intake causes vomiting. Sweet travels to flesh; excessive intake causes chest oppression. From this, we know that asking about desired flavors reveals the disease's origin and location.