五十四难曰∶脏病难冶，腑病易治，何谓也？
然∶脏病所以难治者，传其所胜也；腑病易治
者，传其子也。与七传间脏同法也。
脏病所以难治者，传其所胜也，若传其所生，亦易治也。腑病所以易治者，传其所生也，若
传其所胜、亦难治也。盖其义以脏病深，腑病浅，分其难易耳。然亦不可拘，故曰与七传间脏
同法也。
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，阳浮
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。
积者，五脏所生，脏属阴，阴邪渐积而成，故曰积。阴主静，故沉伏不离其处，乃脏阴气结
为病，而或兼乎血，故其部上下左右，其形大小长短，皆可循而按之也。聚者，六腑所生，腑属阳，
阳邪渐聚而成，故曰聚。阳主动，故浮动而无定处，乃纯乎气凝滞而不散，故其部无定位，其体无
定形。而上下左右，流行无常也，此阴阳积聚之所由分，与五十二难当是一章，或前后错简耳。
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，
在左胁下如覆杯，有头足，久不愈，令人发咳逆 疟,连岁不已，以季夏戊己日得之。何以言之？
肺病传于肝，肝当传脾，脾季夏适王，王者不受邪，肝复欲还肺，肺不肯受，故留结为积，故知肥
气以季夏戊己日得之。
积，蓄也，言血气不行，积蓄为病，亦由五邪相传而成也。肥气者，言其气之肥盛也。左胁
为肝木左升之部，如覆杯者，本大末小，肝木之象也。头足者，一本二末，木形歧出之义，亦
甚言其有形也。咳逆者，足厥阴之别脉，贯膈上注于肺，肝气上冲于肺，反乘所胜也。 疟即
疟，间二日发者是也。五脏皆有疟，在肝则为风疟，又疟多发于少阳，而厥阴于少阳为表里
也。病邪入深，连年不已。然何以得之？乃肺病传肝，传其所胜也。肝当传脾，脾土适旺于季
夏，土旺力能拒而不受邪，当复反于肺，而肝木又不能胜肺金，故曰不肯受也。邪因无道可行，
故留结于肝而成积矣。季夏戊己日得之者，季夏，未土月也。戊己，土日也，月日皆脾土极旺
之时，肝木不能克制，即于是月是日，而得是积也。可见虚则受邪，旺则邪不得入，今人徒事
攻积，大失经旨，非其治矣。此章唯出五积之名状，而不言诸聚者，盖聚无常处，故无名状可
定也。
心之积，名曰伏梁，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，王者不受邪，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。
伏梁者，伏而不动，横亘如梁木然，起脐上至心下者，脐上至心下，皆心之分部也。烦心者，
火郁则心烦也。然何以得之？乃肾病传心，传其所胜也。心当传肺，肺金当秋适旺，金旺力能
拒而不受邪，应复反于肾，而心火又不能胜肾水，故曰不肯受也。邪留结于心而成积，以秋庚
辛日得之者，秋当申酉金月，而庚辛金日也。金旺之月日，心火不能克制，即于是月是日而得
是积也。
按∶《灵枢·邪气脏腑病形篇》曰∶心脉微缓为伏梁，在心下上下行，时唾血。经筋篇曰∶
手少阴之筋，其病内急，心承伏梁，下为肘网，其成伏梁吐脓血者，死不治。是《灵枢》两章，
皆心病有余之积，虽未明言病状，其义则同。若《素问·腹中论》曰∶病有少腹上下左右皆有
根，病名伏梁，里大脓血，居肠胃之外，不可治，治之每切按之致死。此下则因阴，必下脓血，
上则迫胃脘，生膈挟胃脘内痈，此久病也，难治。居脐上为逆，居脐下为从。此病阳邪聚于血
分，致气失输转之机，非脏阴气结之积也。以其在少腹四旁太冲部分，阳毒之邪，聚而为脓为
血，下行必薄阴中，便下脓血，上行迫胃脘膈膜间而生内痈，此论阳毒之伏梁也。又曰∶人有
身体髀股 皆肿，环脐而痛，病名伏梁，此风根也，其气溢于大肠，而着于肓，肓之原在脐下，
故环脐而痛也，不可动，动之为水溺涩之病。此病风邪根聚于中，故环脐而痛，脐为人身之枢，
枢病则不能斡旋阴阳之气，故周身皆肿。设妄攻风气，鼓动其水，水溢于上，则小便为之不利，
此论风毒之伏梁也。是其名虽同，其证其治则异，若伏梁不辨乎风根，其不见诮于鸡峰难矣。
脾之积，名曰痞气，在胃脘，覆大如盘，久不愈，令人四肢不收，发黄瘅，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，王者不受邪，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。
痞者，否也，天地不交而为否，言痞结而成积也。脾位中央，土之象也，故积在胃脘，覆大
如盘。睥主四肢，邪气壅聚，正气不运，故四肢不收。脾有湿滞，则色征于外，故皮肤爪目皆
黄而成瘅，但黄瘅之因甚繁，然皆不离乎脾与湿也。脾主肌肉，今脾有积，不能布津液，则所
入饮食，而不为肌肤也。然何以得之？乃肝病传脾，传其所胜也。脾当传肾，肾水当冬适旺，
水旺力能拒不受邪，欲复反于肝，而脾土又不能胜肝木，故曰不肯受也。邪留结于脾而成积。
以冬壬癸日得之者，冬当亥子水月，而壬癸水日也，水旺之月日，脾土不能克制，即于是月是
日，而得是积也。
肺之积，名曰息贲，在右胁下，覆大如杯。久不愈，令人洒淅寒热，喘咳，发肺壅，以春甲乙
日得之。何以言之？心病传肺，肺当传肝，肝以春适王，王者不受邪，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。
贲，古通奔。息贲者，言气息贲迫也。右胁下为肺金右降之分部，洒淅寒热者，肺主皮毛也。
壅，痈，古通。肺病则喘咳，甚则发为肺痈。《素问·大奇论》曰∶肺之壅，喘而两 满者是
也。然何以得之？乃心病传肺，传其所胜也。肺当传肝，肝木当春适旺，木旺力能拒而不受邪，
复欲反于心，肺金又不能胜心火，故曰不肯受也。邪留结于肺而成积，以春甲乙日得之者，春
当寅卯木月，而甲乙木日也，木旺之月日，肺金不能克制，即于是月是日而得是积也。
按∶《灵枢·经筋篇》曰∶手心主之筋，其病当所过者支转筋，前及胸痛息贲。此言手心主
之筋，循胁腹，散胸中，下结于胃脘之贲门间，其病当筋之过接处为转筋，而前及胸痛，散于
胸中，结于贲门，故曰息贲。又曰∶太阴之筋，其病当所过者支转筋，痛甚则成息贲，胁急吐
血。此言手太阴之筋，散贯于贲门间，其病当筋之所过者为支度转筋，而痛甚则成息贲，胁急
吐血。盖十二经筋合阴阳六气，气逆则为喘急息奔，血随气奔，则为吐血也。《素问·阴阳别
论》曰∶二阳之病发心脾，有不得隐曲，女子不月，其传为风消，其传为息贲者，死不治。此
二阳者，足阳明胃，手阳明大肠也。病发于心脾者。其始必有得于隐曲之事，于是思则气结，
郁而为火，致损心营，心营既损，脾少生扶，则健运失职，饮食渐减，胃阴益亏；夫人身之精
血，全赖后天谷气荣养，今谷津日竭，郁火内焚，是以男子少精，女子不月，血液日见干枯，
而大肠之传道亦病，胃燥生火，火盛风生，则消烁肌肉，水精耗尽，金失其源，肾气不纳，逆
传于肺，致有喘息奔迫不治之证。此三者，似是而实非，不容不辨。奇病论帝曰∶病胁满气逆，
二三岁不已，是为何病？岐伯曰∶病名息积，此不妨于食，不可灸刺，积为导引服药，药不能
独治也，此与本篇差同。药难独治，必兼导引之功，又不可不知也。
肾之积，名曰贲豚，发于少腹，上至心下，若豚状，或上或下无时，久不愈
令人喘逆，骨痿少气，以夏丙丁日得之。何以言之？脾病传肾，肾当传心，心以夏适王，王者不受
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。此是五积之要法也。
贲豚者，其状如豚之奔突，以豚性躁动故也。发于少腹，上至心下者，少腹，肾之分部，由
少腹上冲至心下而止，上下无定时也。喘逆者，足少阴之支脉，从肺出络心，注胸中，肾气上
冲故也。肾主骨，故骨痿。肾不能纳气，故少气也。然何以得之？乃脾病传肾，传其所胜也。
肾当传心，心火当夏适旺，火旺力能拒而不受邪，当复反于脾，而肾水又不能胜脾土，故曰不
肯受也。邪留结于肾而成积，以夏丙丁日得之者，夏当己午火月，而丙丁火日也，火旺之月日，
肾水不能克制，即于是月是日而得是积也。
按∶《伤寒论·太阳篇》曰∶发汗后，脐下悸者，欲作奔豚。此因发汗虚其心液，脐下悸者，
欲动而上奔也，故用茯苓桂枝甘草大枣汤，以保心而制水也。又曰∶发汗后，烧针令其汗，针
处被寒，核起而赤者，必发奔豚，气从少腹上冲心。此言发汗既伤其血液，复用烧针令其汗，
是又伤其血脉矣。血脉受伤，则心气虚，加以寒凌心火，故核起而赤，心虚气浮，则肾气乘而
上奔，故灸核上各一壮，以通泄其经气，更与桂枝加桂汤，散寒邪以补心气也。此两节论外
感误治之证，与积久而成者有间。《金匮要略》师曰∶病有奔豚，有吐脓，有惊怖，有火邪，此
四部病，皆从惊发得之，此言肝胆因惊骇为病，木者，水之子也，子病发惊，母亦随而上奔也。
余三病亦因惊发而得，非奔豚，不为详解。又师曰∶奔豚病从少腹上冲咽喉，发作欲死，复还
止，皆从惊恐得之。此因惊则伤心，恐则伤肾，心肾水火之气虚，而不能互相交感，则肾之虚
邪，反乘心之虚而上奔矣。故总其治曰∶奔豚气上冲胸腹痛，往来寒热，奔豚汤主之。观《金
匮》两条，与本经之义相近，然同因惊得，而有肝胆心肾之异。况外感积聚之不同，是受病之
因，传变之理，不可不察，岂独奔豚一证为然。
五十四难说：脏病难以治愈，腑病容易治愈，这是什么意思呢？
回答说：脏病之所以难治，是因为病气传给它所克制的脏器（即“传其所胜”）；腑病之所以易治，是因为病气传给它所生的脏器（即“传其子”）。这与七传（相克相传）和间脏（相生相传）的道理相同。
脏病之所以难治，是因为它传给它所克制的脏器；如果传给它所生的脏器，也是容易治疗的。腑病之所以易治，是因为它传给它所生的脏器；如果传给它所克制的脏器，也是难治的。大概是因为脏病病位深，腑病病位浅，以此来区分难易罢了。但也不可拘泥于此，所以说与七传、间脏的法度相同。
五十五难说：疾病有积证和聚证两种，如何区别它们呢？
回答说：积证属于阴气，聚证属于阳气。所以阴气沉潜而潜伏，阳气浮越而变动。气积聚的地方叫做积，气聚集的地方叫做聚。所以积证是由五脏产生的，聚证是由六腑形成的。积证，是阴气所致，起初发病有固定的部位，疼痛不离开那个区域，上下有起止点，左右有穷尽处；聚证，是阳气所致，起初没有根本，上下没有停留止息之处，疼痛没有固定位置，这就叫作聚。所以根据这些特点来辨别积聚。
积证，是由五脏产生的，脏属阴，阴邪逐渐积累而成，所以叫作积。阴主静，所以沉伏而不离开原处，这是脏的阴气结聚成病，有时兼夹血瘀，所以在它的部位上下左右，其形状的大小长短，都可以顺着摸到并按压出来。聚证，是由六腑产生的，腑属阳，阳邪逐渐聚集而成，所以叫作聚。阳主动，所以浮动而没有定处，这是纯粹的气机凝滞而不散，所以它的部位没有定位，形体没有定形，在上下左右之间，流行无常。这就是阴阳积聚的区别所在，与五十二难应当是一章内容，可能是前后错简罢了。
五十六难说：五脏的积证，各有名字吗？是在哪个月、哪一天得的呢？
回答说：肝的积证，名叫肥气，位于左胁下，像倒扣的杯子，有头有脚，久不痊愈，使人发生咳嗽气逆、疟疾，连年不断。这是在季夏（夏季的最后一个月）戊己日得的。为什么这样说呢？肺病传变给肝，肝本该传变给脾，但脾在季夏正值旺盛之时，当令的脏器不受邪气侵袭，肝想再传回给肺，肺又不肯接受，所以邪气留结成为积证，因此知道肥气是在季夏戊己日得的。
积，就是蓄积的意思，指气血运行不畅，积蓄而成病，这也是由五邪（虚邪、实邪、贼邪、微邪、正邪）相传演变而成的。肥气，是说它的邪气肥盛。左胁是肝木左升的部位，像倒扣的杯子，是大端小尾，象征肝木之象。有头有脚，是一根生出两个末端，象征木形分叉的意义，也是极力形容它有具体的形态。咳逆，是足厥阴肝经的别脉，贯穿膈肌上行注入肺中，肝气上冲于肺，反过来克制它所胜的肺金。疟即疟疾，这里是隔两天发作的那种。五脏都有疟疾，在肝则称为风疟，而且疟疾多发生于少阳经，而厥阴与少阳互为表里。病邪入深，连年不愈。然而为什么会得这个病呢？乃是肺病传变给肝，这是传给它所克的脏器。肝本该传变给脾，脾土在季夏正值旺盛，土旺有力能拒绝而不受邪气，应当再反传回给肺，而肝木又不能战胜肺金，所以说肺不肯接受。邪气因为没有道路可行，所以留结在肝而形成积证。在季夏戊己日得病的，季夏是未土月，戊己是土日，月和日都是脾土极旺的时候，肝木不能克制，就在这个月、这一天，得了这个积证。可见虚弱时受邪，旺盛时邪气不得侵入，现在的人只知一味攻伐积证，大大违背了经旨，不是正确的治疗方法。这一章只列出了五积的名字和形态，而没有提到诸聚，大概是因为聚证没有固定位置，所以没有固定的名称和形态可以描述。
心的积证，名叫伏梁，起于脐上，大如手臂，向上延伸到心下，久不痊愈，使人患心烦病，这是在秋季庚辛日得的。为什么这样说呢？肾病传变给心，心本该传变给肺，肺在秋季正值旺盛，当令者不受邪，心想再传回给肾，肾又不肯接受，所以留结成为积证。因此知道伏梁是在秋季庚辛日得的。
伏梁，是指潜伏而不动，横亘在那里像梁木一样，从脐上到心下，都是心的分部。烦心，是火郁结导致心烦。然而为什么会得这个病呢？乃是肾病传变给心，这是传给它所克的脏器。心本该传变给肺，肺金在秋季正值旺盛，金旺有力能拒绝而不受邪气，应当再反传回给肾，而心火又不能战胜肾水，所以说肾不肯接受。邪气留结在心而形成积证，在秋季庚辛日得病的，秋季是申酉金月，庚辛是金日。在金旺的月日，心火不能克制，就在这个月、这一天得了这个积证。
按：《灵枢·邪气脏腑病形篇》说：心脉微缓为伏梁，在心下上下移动，时常唾血。《灵枢·经筋篇》说：手少阴心经的筋，它的病在内侧拘急，心脏承受伏梁之病，向下形成肘部的网状症状，如果形成伏梁并吐脓血的，是死症，不可治。这两章经文，说的都是心病有余的积证，虽然没有明确说明病症形态，但道理是相同的。若《素问·腹中论》说：有病位在少腹，上下左右都有根基，病名伏梁，里面有大的脓血，位于肠胃之外，不可治疗，治疗时如果切按会导致死亡。这种病在下部则因阴邪，必然下排脓血，在上部则压迫胃脘，产生膈膜间挟带胃脘的内痈，这是久病，难治。位于脐上是逆证，位于脐下是从证。这是阳邪聚集在血分，导致气机失去输转的功能，不是脏阴气结成的积证。因为它在少腹四旁的太冲部位，阳毒之邪，聚集而为脓为血，下行必损伤阴中，导致便下脓血，上行压迫胃脘膈膜间而生内痈，这是论述阳毒引起的伏梁。又说：有人身体大腿股部都肿胀，环绕肚脐疼痛，病名伏梁，这是风邪的根源，邪气溢于大肠，附着于肓膜，肓膜的根源在脐下，所以环绕肚脐疼痛，不可触动，一动就会造成小便涩滞的病。这是风邪根源聚集在中焦，所以环绕肚脐疼痛，肚脐是人身的枢纽，枢纽生病就不能斡旋阴阳之气，所以周身都肿。如果妄用攻伐风气的方法，鼓动其水湿，水湿溢于上部，则小便为之不利，这是论述风毒引起的伏梁。虽然名字相同，但证候和治疗却不同，如果不分辨伏梁是否由风根引起，那被讥讽也就不足为奇了。
脾的积证，名叫痞气，位于胃脘，覆盖面积大如盘子，久不痊愈，使人四肢无力收持，发黄疸，饮食不能转化为肌肉，这是在冬季壬癸日得的。为什么这样说呢？肝病传变给脾，脾本该传变给肾，肾在冬季正值旺盛，当令者不受邪，脾想再传回给肝，肝又不肯接受，所以留结成为积证。因此知道痞气是在冬季壬癸日得的。
痞，通否，天地不交而成为否卦，意思是痞结而成积证。脾位居中央，象征土，所以积证在胃脘，覆盖大如盘子。脾主四肢，邪气壅聚，正气不运，所以四肢无力收持。脾有湿滞，则面色反映在外，所以皮肤、爪甲、眼睛都黄而成黄疸，虽然黄疸的原因很多，但都不离乎脾与湿。脾主肌肉，现在脾有积证，不能布散津液，那么摄入的饮食，就不能转化为肌肉。然而为什么会得这个病呢？乃是肝病传变给脾，这是传给它所克的脏器。脾本该传变给肾，肾水在冬季正值旺盛，水旺有力能拒绝而不受邪气，想再反传回给肝，而脾土又不能战胜肝木，所以说肝不肯接受。邪气留结在脾而形成积证。在冬季壬癸日得病的，冬季是亥子水月，壬癸是水日，在水旺的月日，脾土不能克制，就在这个月、这一天得了这个积证。
肺的积证，名叫息贲，位于右胁下，覆盖面积大如杯子。久不痊愈，使人洒淅寒热，喘咳，发为肺壅，这是在春季甲乙日得的。为什么这样说呢？心病传变给肺，肺本该传变给肝，肝在春季正值旺盛，当令者不受邪，肺想再传回给心，心又不肯接受，所以留结成为积证。因此知道息贲是在春季甲乙日得的。
贲，古通奔。息贲，是说气息奔迫。右胁下是肺金右降的分部，洒淅寒热，是因为肺主皮毛。壅，古通痈。肺病则喘咳，严重时发为肺痈。《素问·大奇论》说：肺的壅，喘促且两胁满闷就是这样。然而为什么会得这个病呢？乃是心病传变给肺，这是传给它所克的脏器。肺本该传变给肝，肝木在春季正值旺盛，木旺有力能拒绝而不受邪气，想再反传回给心，而肺金又不能战胜心火，所以说心不肯接受。邪气留结在肺而形成积证，在春季甲乙日得病的，春季是寅卯木月，甲乙是木日，在木旺的月日，肺金不能克制，就在这个月、这一天得了这个积证。
按：《灵枢·经筋篇》说：手心主心包络的筋，它的病在经过的地方出现支撑转筋，向前波及胸痛息贲。这是说手心主之筋，循行胁腹，散布胸中，向下结于胃脘的贲门之间，它的病在筋经过连接的地方出现转筋，向前波及胸痛，散布于胸中，结于贲门，所以叫息贲。又说：手太阴肺经的筋，它的病在经过的地方出现支撑转筋，痛严重时成为息贲，胁部拘急吐血。这是说手太阴之筋，散布贯穿于贲门之间，它的病在筋经过的地方出现支撑转筋，痛严重时成为息贲，胁部拘急吐血。大概十二经筋合阴阳六气，气逆则为喘急息奔，血随气奔，则为吐血。《素问·阴阳别论》说：二阳（阳明经）的病发于心脾，有难以启齿的隐曲之事，女子月经闭止，它的传变成为风消，它的传变成为息贲的，是死症，不可治。这二阳，指的是足阳明胃经和手阳明大肠经。病发于心脾，开始一定有因为隐曲之事导致的思虑，于是思则气结，郁结而为火，导致损伤心营，心营既已受损，脾缺少生扶，则健运失职，饮食逐渐减少，胃阴更加亏虚；人身上的精血，全靠后天谷气荣养，现在谷津日渐枯竭，郁火在内焚烧，所以男子精少，女子月经闭止，血液日渐干枯，而大肠的传导功能也病了，胃燥生火，火盛风生，则消烁肌肉，水精耗尽，金失其源，肾气不纳，逆传于肺，导致有喘息奔迫不治的证候。这三种情况，似是而非，不容不辨析。《素问·奇病论》黄帝问：病胁满气逆，两三年不愈，是什么病？岐伯回答：病名息积，这不妨碍进食，不可用灸刺治疗，积证需用导引配合服药，药不能单独治好，这与本篇大致相同。药难单独治好，必须兼用导引的功效，这也是不可忽视的。
肾的积证，名叫贲豚，发于少腹，向上延伸到心下，像小猪奔跑的样子，或上或下没有定时，久不痊愈，使人喘逆，骨痿少气，这是在夏季丙丁日得的。为什么这样说呢？脾病传变给肾，肾本该传变给心，心在夏季正值旺盛，当令者不受邪，肾想再传回给脾，脾又不肯接受，所以留结成为积证，因此知道贲豚是在夏季丙丁日得的。这是五积的要法。
贲豚，它的形状像小猪的奔突，因为猪性躁动。发于少腹，向上到心下，少腹是肾的分部，由少腹上冲到心下为止，上下没有定时。喘逆，是足少阴肾经的支脉，从肺出络心，注入胸中，肾气上冲的缘故。肾主骨，所以骨痿。肾不能纳气，所以少气。然而为什么会得这个病呢？乃是脾病传变给肾，这是传给它所克的脏器。肾本该传变给心，心火在夏季正值旺盛，火旺有力能拒绝而不受邪气，应当再反传回给脾，而肾水又不能战胜脾土，所以说脾不肯接受。邪气留结在肾而形成积证，在夏季丙丁日得病的，夏季是巳午火月，丙丁是火日，在火旺的月日，肾水不能克制，就在这个月、这一天得了这个积证。
按：《伤寒论·太阳篇》说：发汗后，脐下悸动的，是想作奔豚。这是因为发汗耗伤心液，脐下悸动，是想动而上奔，所以用茯苓桂枝甘草大枣汤，来保护心气而制约水邪。又说：发汗后，用烧针令其出汗，针孔处受寒，起了红核子的，一定会发奔豚，气从少腹上冲心。这是说发汗已经伤了血液，又用烧针令其出汗，这是又伤了血脉。血脉受伤，则心气虚，加上寒气凌犯心火，所以红核起而赤，心虚气浮，则肾气乘虚而上奔，所以在红核上各灸一壮，以通泄其经气，再给予桂枝加桂汤，散寒邪以补心气。这两段论述的是外感误治的证候，与积久而成的有所不同。《金匮要略》老师说：有病有奔豚，有吐脓，有惊怖，有火邪，这四种病，都是从惊恐引发的，这是说肝胆因惊骇而生病，木是水的儿子，儿子生病发惊，母亲也随着而上奔。其余三种病也是因为惊恐引发，不是奔豚，不作详细解释。又说：奔豚病从少腹上冲咽喉，发作时感觉快要死了，然后又停止，都是从惊恐得来的。这是因为惊伤心，恐伤肾，心肾水火之气虚，而不能互相交感，则肾的虚邪，反而乘心之虚而上奔。所以总的治疗原则说：奔豚气上冲胸腹痛，往来寒热，奔豚汤主治。看《金匮》的两条，与本经的意思相近，但是同因惊恐引发，而有肝胆心肾的不同。何况外感积聚的不同，这是受病的病因，传变的道理，不可不考察，难道只有奔豚这一个证是这样吗？
Chapter 54 states: Zang organ diseases are difficult to treat, while Fu organ diseases are easy to treat. What does this mean?
The response is: The reason Zang diseases are difficult to treat is that the pathogenic Qi transmits to the organ it overcomes (Chuan Qi Suo Sheng); the reason Fu diseases are easy to treat is that the pathogenic Qi transmits to the organ it generates (Chuan Qi Zi). This follows the same principle as Seven Transmissions (Qi Zhuan) and Inter-Zang transmissions (Jian Zang).
Zang diseases are difficult to treat because they transmit to the organ they overcome; if they transmit to the organ they generate, they are also easy to treat. Fu diseases are easy to treat because they transmit to the organ they generate; if they transmit to the organ they overcome, they are also difficult to treat. Generally, this distinction in difficulty arises because Zang diseases are deep-seated, whereas Fu diseases are superficial. However, one should not be rigidly bound by this, hence it is said that it follows the same rules as Seven Transmissions and Inter-Zang transmissions.
Chapter 55 states: Diseases can be classified into Accumulation (Ji) and Gathering (Ju). How can they be distinguished?
The response is: Accumulation belongs to Yin Qi, while Gathering belongs to Yang Qi. Therefore, Yin is sunken and latent, while Yang is floating and active. Where Qi accumulates, it is called Accumulation; where Qi gathers, it is called Gathering. Thus, Accumulations arise from the Five Zang organs, while Gatherings are formed by the Six Fu organs. Accumulation is caused by Yin Qi; its onset has a fixed location, the pain remains within that area, moving up and down with definite beginnings and endings, and extending left and right to specific limits. Gathering is caused by Yang Qi; its onset has no root, it moves up and down without staying in any place, and the pain has no fixed location, which is why it is called Gathering. Therefore, these characteristics allow us to distinguish between Accumulation and Gathering.
Accumulations are generated by the Five Zang organs. Since Zang organs belong to Yin, Yin pathogenic factors gradually accumulate to form Accumulation, hence the name. Yin governs stillness, so the accumulation sinks and remains fixed in its place. This is a disease formed by the knotting of Yin Qi in the Zang organs, sometimes accompanied by Blood stasis. Therefore, in the areas above, below, to the left, and to the right of the lesion, the size and shape of the mass can be palpated and traced. Gatherings are generated by the Six Fu organs. Since Fu organs belong to Yang, Yang pathogenic factors gradually gather to form Gathering, hence the name. Yang governs movement, so the gathering floats and lacks a fixed location. This is purely a stagnation of Qi that does not disperse. Therefore, its location is undefined, its shape is indeterminate, and it flows irregularly in all directions. This explains the distinction between Yin Accumulation and Yang Gathering. This chapter likely corresponds to Chapter 52, possibly due to textual displacement (Cuo Jian).
Chapter 56 states: Do the five Accumulations have specific names? On which months and days do they occur?
The response is: The Accumulation of the Liver is named Fei Qi (Fat Qi / Luxuriant Qi). It is located under the left hypochondrium, resembling an inverted cup, with distinct head and foot structures. If untreated for a long time, it causes coughing, counterflow Qi, and malaria, persisting for years. It occurs on Wu and Ji days during the late summer (Ji Xia). Why is this so? When Lung disease transmits to the Liver, the Liver should transmit to the Spleen. However, the Spleen is prosperous in late summer, and the ruling organ does not accept pathogenic invasion. The Liver then attempts to transmit back to the Lung, but the Lung refuses to accept it. Consequently, the pathogen remains and knots to form an Accumulation. Thus, Fei Qi is acquired on Wu and Ji days in late summer.
"Accumulation" implies storage, referring to the stagnation and accumulation of Qi and Blood. It also results from the transmission of the Five Pathogens (Wu Xie). "Fei Qi" describes the luxuriance of the pathogenic Qi. The left hypochondrium is the region where Liver Wood ascends. The shape resembling an inverted cup, broad at the base and narrow at the top, symbolizes the nature of Liver Wood. The "head and foot" represent one root branching into two ends, further emphasizing the tangible form of the wood element. Coughing and counterflow Qi occur because the collateral channel of the Foot Jueyin Liver meridian passes through the diaphragm and connects to the Lung. Liver Qi rushes upward to the Lung, counteracting the Metal it normally controls. Malaria here refers to intermittent fever occurring every other day. All five Zang organs can manifest malaria; when in the Liver, it is called Wind Malaria. Malaria often involves the Shaoyang channel, and Jueyin and Shaoyang are exterior-interior pairs. The pathogen penetrates deeply, causing chronic illness. The etiology is Lung transmitting to Liver (transmitting to what it overcomes). The Liver should transmit to the Spleen, but Spleen Earth is strong in late summer and rejects the pathogen. The pathogen tries to return to the Lung, but Liver Wood cannot overcome Lung Metal, so the Lung refuses it. With no path to travel, the pathogen knots in the Liver. Late summer corresponds to the Wei Earth month, and Wu/Ji correspond to Earth days. During times of extreme Spleen Earth prosperity, Liver Wood cannot control it, leading to the formation of this Accumulation on those specific months and days. This demonstrates that deficiency invites pathogens, while prosperity repels them. Modern practitioners who only use attacking methods for Accumulations greatly deviate from the classic principles. This chapter lists the names and forms of the five Accumulations but omits Gatherings because Gatherings lack fixed locations and thus have no fixed names or forms.
The Accumulation of the Heart is named Fu Liang (Hidden Beam). It starts above the umbilicus, is as thick as an arm, and extends up to the epigastrium. If untreated for a long time, it causes mental restlessness. It occurs on Geng and 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 pathogen. The Heart tries to transmit back to the Kidney, but the Kidney refuses. The pathogen knots in the Heart, forming the Accumulation. Thus, Fu Liang is acquired on Geng and Xin days in autumn.
"Fuliang" means lying hidden and motionless, stretching horizontally like a beam. The area from the umbilicus to the epigastrium belongs to the Heart. Mental restlessness is caused by Fire stagnation. The etiology is Kidney transmitting to Heart (transmitting to what it overcomes). The Heart should transmit to the Lung, but Lung Metal is strong in autumn and rejects the pathogen. The pathogen tries to return to the Kidney, but Heart Fire cannot overcome Kidney Water, so the Kidney refuses. The pathogen knots in the Heart. Autumn corresponds to Shen/You Metal months, and Geng/Xin are Metal days. During times of extreme Metal prosperity, Heart Fire cannot control it, leading to this Accumulation.
Note: *Ling Shu: Pathogenic Factors, Zang-Fu Organs, and Disease Manifestations* states: A slightly slow Heart pulse indicates Fu Liang, located below the heart, moving up and down, with occasional hemoptysis. *Ling Shu: Muscle Sinews* states: Disease of the Hand Shaoyin sinew involves internal tension, with the Heart bearing the burden of Fu Liang, extending down to the elbow network. If Fu Liang develops with pus and blood expectoration, it is incurable. Both chapters describe excess-type Accumulations of the Heart. Although symptoms are not fully detailed, the principle is consistent. In contrast, *Su Wen: Abdominal Discussion* describes a different condition named Fu Liang: rooted in the lower abdomen, containing large amounts of pus and blood, located outside the intestines and stomach. It is untreatable; pressing it can cause death. Lower lesions involve Yin, leading to purulent stools; upper lesions press on the stomach, causing internal abscesses in the diaphragm. This is a chronic, difficult-to-treat condition. Located above the umbilicus is adverse; below is favorable. This condition involves Yang pathogens accumulating in the Blood aspect, disrupting Qi transformation, rather than Yin Qi knotting in the Zang. Located in the Taichong region of the lower abdomen, Yang toxicity gathers into pus and blood. Downward flow damages Yin, causing purulent stools; upward flow presses the stomach/diaphragm, causing internal abscesses. This describes Yang-toxicity-induced Fu Liang. Another passage states: Swelling of thighs and legs with periumbilical pain is named Fu Liang, rooted in Wind. Qi overflows into the Large Intestine and attaches to the Huang (Tri-Jiao membrane). The source of Huang is below the umbilicus, causing periumbilical pain. Manipulation leads to urinary retention. This describes Wind-toxicity-induced Fu Liang. Though named similarly, the syndromes and treatments differ. Failure to distinguish wind-rooted Fu Liang invites criticism.
The Accumulation of the Spleen is named Pi Qi (Obstruction Qi). It is located in the epigastrium, covering an area as large as a plate. If untreated for a long time, it causes weakness of the four limbs, jaundice, and failure of food to nourish the muscles. It occurs on Ren and 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 pathogen. The Spleen tries to transmit back to the Liver, but the Liver refuses. The pathogen knots in the Spleen, forming the Accumulation. Thus, Pi Qi is acquired on Ren and Gui days in winter.
"Pi" relates to "Pi" (Stagnation/Blockage), symbolizing Heaven and Earth not interacting. The Spleen resides in the center, symbolizing Earth, so the accumulation is in the epigastrium. The Spleen governs the limbs; pathogenic congestion prevents Zheng Qi circulation, causing limb weakness. Dampness stagnation in the Spleen manifests as yellowing of skin, nails, and eyes (Jaundice). While jaundice has many causes, it always involves the Spleen and Dampness. The Spleen governs muscles; with Spleen Accumulation, fluids are not distributed, so food fails to nourish muscles. Etiologically, Liver transmits to Spleen (overcoming). Spleen should transmit to Kidney, but Kidney Water is strong in winter and rejects the pathogen. The pathogen tries to return to the Liver, but Spleen Earth cannot overcome Liver Wood, so the Liver refuses. Winter corresponds to Hai/Zi Water months, and Ren/Gui are Water days. During Water prosperity, Spleen Earth cannot control it, leading to this Accumulation.
The Accumulation of the Lung is named Xi Ben (Rushing Breath). It is located under the right hypochondrium, covering an area as large as a cup. If untreated for a long time, it causes chills and fever, wheezing and coughing, and Lung obstruction. It occurs on Jia and 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 pathogen. The Lung tries to transmit back to the Heart, but the Heart refuses. The pathogen knots in the Lung, forming the Accumulation. Thus, Xi Ben is acquired on Jia and Yi days in spring.
"Ben" is anciently synonymous with "Ben" (Run/Flee). Xi Ben refers to rushing breath. The right hypochondrium is where Lung Metal descends. Chills and fever relate to the Lung governing skin and hair. "Yong" is anciently synonymous with "Yong" (Abscess). Severe Lung disease causes wheezing/coughing and may develop into Lung Abscess. *Su Wen: Extraordinary Oddities* states: Lung obstruction presents with wheezing and bilateral fullness. Etiologically, Heart transmits to Lung (overcoming). Lung should transmit to Liver, but Liver Wood is strong in spring and rejects the pathogen. The pathogen tries to return to the Heart, but Lung Metal cannot overcome Heart Fire, so the Heart refuses. Spring corresponds to Yin/Mao Wood months, and Jia/Yi are Wood days. During Wood prosperity, Lung Metal cannot control it, leading to this Accumulation.
Note: *Ling Shu: Muscle Sinews* states: Disease of the Pericardium sinew causes spasms along its pathway, extending forward to chest pain and Xi Ben. The Pericardium sinew traverses the hypochondrium and abdomen, disperses in the chest, and knots at the cardia of the stomach. Spasms occur at the sinew junctions, with pain radiating to the chest and knotting at the cardia, hence "Xi Ben." Also, disease of the Hand Taiyin sinew causes spasms; severe pain leads to Xi Ben, hypochondriac stiffness, and hemoptysis. The Hand Taiyin sinew disperses through the cardia. Spasms occur along the pathway; severe pain causes Xi Ben and hemoptysis due to Qi rebellion driving Blood. *Su Wen: Differentiations of Yin and Yang* states: Diseases of the Two Yang (Yangming Stomach and Large Intestine) originating in Heart and Spleen involve unspoken grievances and amenorrhea in women. Progression leads to Wind Wasting or Xi Ben, which is incurable. The Two Yang refer to Foot Yangming Stomach and Hand Yangming Large Intestine. Originating in Heart/Spleen implies initial emotional constraint leading to Qi stagnation and Fire, damaging Heart Ying (Nutrient) Qi. Damaged Ying Qi fails to support the Spleen, impairing transportation. Food intake decreases, Stomach Yin declines. Essence and Blood rely on postnatal Gu Qi. As Gu Qi depletes and Internal Fire burns, men suffer low essence, women amenorrhea, and Blood dries up. Large Intestine function fails, Stomach Dryness generates Fire, Fire generates Wind, wasting muscles. Water/Essence exhausts, Metal loses its source, Kidney Qi fails to grasp, rebelling into the Lung, causing fatal wheezing. These three scenarios seem similar but are distinct. *Su Wen: Rare Diseases* states: Hypochondriac fullness with Qi rebellion lasting years is named Xi Ji (Accumulated Breath). It does not affect eating. Moxibustion/acupuncture are contraindicated; treatment requires Daoyin (qigong/exercise) combined with herbs, as herbs alone are insufficient. This aligns with the current chapter.
The Accumulation of the Kidney is named Ben Tun (Rushing Pig). It originates in the lower abdomen, extends to the epigastrium, resembles a running pig, and moves up and down without fixed timing. If untreated for a long time, it causes wheezing/reversal, bone萎 (weakness), and shortness of breath. It occurs on Bing and Ding days in summer. Why? Spleen disease transmits to the Kidney. The Kidney should transmit to the Heart. The Heart is prosperous in summer and rejects the pathogen. The Kidney tries to transmit back to the Spleen, but the Spleen refuses. The pathogen knots in the Kidney, forming the Accumulation. Thus, Ben Tun is acquired on Bing and Ding days in summer. This is the key method for the five Accumulations.
"Ben Tun" resembles a pig's frantic running due to its restless nature. Originating in the lower abdomen (Kidney region) and rising to the epigastrium without fixed timing reflects Kidney Qi rebellion. Wheezing/reversal occurs because the branch of the Foot Shaoyin Kidney meridian emerges from the Lung, connects to the Heart, and enters the chest; Kidney Qi rushes upward. The Kidney governs bones, hence bone weakness. The Kidney fails to grasp Qi, hence shortness of breath. Etiologically, Spleen transmits to Kidney (overcoming). Kidney should transmit to Heart, but Heart Fire is strong in summer and rejects the pathogen. The pathogen tries to return to the Spleen, but Kidney Water cannot overcome Spleen Earth, so the Spleen refuses. Summer corresponds to Si/Wu Fire months, and Bing/Ding are Fire days. During Fire prosperity, Kidney Water cannot control it, leading to this Accumulation.
Note: *Shang Han Lun: Taiyang Chapter* states: After sweating, palpitations below the umbilicus indicate impending Ben Tun. Sweating depleted Heart Fluid, causing Qi to move upward. Treat with Fuling Guizhi Gancao Dazao Tang to protect Heart Qi and control Water. Also: After sweating and using burning needles, cold entering the needle site causes red nodules and Ben Tun, with Qi rushing from the lower abdomen to the heart. Sweating damaged Blood; burning needles further injured the vessels. Vessel injury weakens Heart Qi; Cold insults Heart Fire, causing red nodules. Heart deficiency allows Floating Qi, enabling Kidney Qi to rush upward. Moxa each nodule once to unblock meridians, then give Guizhi Jia Gui Tang to dispel Cold and tonify Heart Qi. These sections discuss mismanaged exogenous diseases, distinct from chronic Accumulations. *Jin Gui Yao Lue* states: Ben Tun, pus expectoration, fright, and Fire Pathogen all stem from sudden fright. Gallbladder/Liver pathology from fright affects Water (Mother), causing upward rushing. Other conditions are fright-related but not Ben Tun. Also: Ben Tun rushes from lower abdomen to throat, feeling fatal before subsiding, all from fright/fear. Fright injures Heart, Fear injures Kidney. Deficiency of Heart Fire/Kidney Water disrupts interaction, allowing Kidney deficient pathogen to rush upward. Treatment: Ben Tun Qi rushing to chest/abdomen with alternating chills/fever is treated with Bentun Tang. Comparing *Jin Gui* passages with this chapter, both link to fright but differ in organ involvement (Gallbladder/Liver vs. Heart/Kidney). Furthermore, exogenous vs. Accumulation etiologies differ. Understanding disease origin and transmission is crucial, not just for Ben Tun.