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。是正经之自病也。
正经，本经也。五邪，五脏之邪也。心主思虑，若忧劳过用，则伤其心。肺主皮毛，形寒者，
皮毛外受风寒也；饮冷者，内饮冷水也，其藏本寒，过则伤肺也。肝主怒恚，怒则木气郁而伤肝也。
脾主四肢，劳倦太过则伤脾，脾运五谷，饮食不洁，则亦伤也。肾主骨，用力作强，坐湿入水则
伤肾，盖肾属水，同气相感也。然忧思恚怒，饮食动作，人之不能无者，惟不可太过，过则伤人必矣。
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。
肝为风木，故风先入肝。心为君火，暑火之邪，故心受之。饮食劳倦，一味太过，则脾伤致
病矣。寒侵皮毛则伤肺。雨雾蒸湿之气则伤肾。此五者邪由外至，所谓外伤者也。
按∶《素问·本病论》、《灵枢·邪气脏腑病形篇》与此大同小异。若《素问·阴阳应象大论》
曰∶怒伤肝，喜伤心，思伤脾，忧伤肺，恐伤肾。乃内伤七情，本脏自病之证也。宣明五气篇曰∶
肝恶风，心恶热，肺恶寒，肾恶燥，脾恶湿。此六淫之邪，外感之证也。皆似同而异。或谓越人既
言本经自病，是从内而生，如形寒饮冷则伤肺，形寒是寒感于皮毛，此从外来也；饮冷，是冷入胸
腹，亦从外来也。饮食等亦然。况五邪亦有饮食劳倦，岂非自相矛盾乎？然其意谓正经虚，则不任
寒冷之侵伐，侵伐则每易致病。正经虚，又伤于饮食者，为内伤，若伤饮食而致病者，则外感也。
《素问》言肾恶燥者，言其水脏而恶燥气之耗竭也。此云水湿伤肾者，湿伤于下、故湿先归肾，肾
属水脏，同气相求也。是古圣先贤之义，虽有异同，而辨内伤外感之理则一。读书贵乎融贯，不可
执泥，先儒所谓以意逆志，是谓得之，信夫。
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。肝为心邪，故知当赤色也。其病身热，胁下满痛，其脉浮大而弦。
假令心病者，举心脏为例也。此言心病，肝邪入而得中风之病，盖风气通于肝也。肝开窍于目，
故主色，风邪自入肝经，则色青，肝在色为苍也。入心则色赤，心在色为赤也。入脾则色黄，脾在
色为黄也。入肺则色白，肺在色为白也。入肾则色黑，肾在色为黑也。故肝之风邪入
心，其色当赤也。其病身热者，外感之邪，先伤营卫，故身热，而又心属火，热为火邪之象也。
胁下满痛者，胁下，肝之位也。其脉浮大而弦者，浮大心脉本象，肝邪犯之，故现弦脉也。
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。故知心病伤暑得之，当恶臭。其病身热而烦，心痛，其脉浮大而散。
假令心病而伤暑，暑之伤人，心先得之，盖心主暑也。此正经自病，不涉他经，然心属火，暑
热之邪伤之，火邪化物，五臭出焉，暑邪自入本经，其臭焦，火之气也。入脾其臭香，土之气也。
入肝其臭臊，木之气也。入肾其臭腐，水之气也。入肺其臭腥，金之气也。故心受暑邪，发恶臭也。
其病身热而烦者，火郁则瞀乱也。心痛者，邪在心则痛也。其脉浮大而散者，浮大心之本脉，散则
浮大而空虚无神，心之病脉也。本脏自病，心主臭，故专以臭推也。
何以知饮食劳倦得之？
然∶当喜苦味也。虚为不欲食，实为欲食。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。
假令心病而伤饮食劳倦者，心主热，脾主劳倦，今心病以饮食劳倦得之，故知脾邪入心也。喜
苦味者，脾主味，心属火，火味苦，从其性也。虚则脾气不能化谷，实则能化谷，故有能食
不能食之分也。若肝受饮食劳倦之病，其味酸；心受病，其味苦，肺受病，其味辛；肾受病，其味
咸；脾自受病，其味甘。其病身热者，心也。体重，脾也。其脉浮大者，心之本脉也；缓，脾之脉
象也。此节饮食劳倦，独有虚实之分者，盖即明正经虚，又伤于饮食而为病，较伤饮食而致病者有间
也。
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。
假令心病而伤寒者，乃肺邪入心也。肺主声，故谵言妄语也。若寒邪入肝则呼，肝在声为呼也。
入心则多言，言为心声，又在声为笑也。入脾则歌，脾在声为歌也。入肾则呻。肾在声为呻也，自
入肺之本脏则哭，肺在声为哭也。其病身热恶寒者，心，火脏，故身热，肺本寒脏，故恶寒也。甚
则喘咳者，肺主咳，肺气上逆，则喘咳也。其脉浮大，心脉也，涩，肺之脉象也。
何以知中湿得之？
然∶当喜汗出不可止。何以言之？肾主液，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。其病身热而小腹痛，足胫寒而逆，其
脉沉濡而大。此五邪之法也。
假令心病而中湿者，心主暑，肾主湿，今心病以伤湿得之，故知肾邪入心也。肾化五液，肾
为心邪，故汗出不可止也。湿邪入肝为泣，肝主泣也。入心为汗，心主汗也。入脾为涎，脾主
涎也。入肺为涕，肺主涕也。自入肾之本脏，则为唾，肾主唾也。其病身热者，心也。小腹痛
者，肾之位也。；足胫寒而逆者，足胫肾经所过之处，故畏寒而逆冷，湿性亦近寒也。其脉沉濡
而大者，沉，肾脉之象，濡，湿气之候，大则心脉之象也。心脉浮大，独不言浮者，沉则不能
浮也。夫法者，举一为例之法也。五邪者，五脏得五行之邪也。欲知五邪之证，必审肝病见于
色，心病见于臭，脾病见于味，肺病见于声，肾病见于液。其脉以本脏之脉为主，而兼受邪之
脉也。此以心一经为主病，而以各证验其所从来，其义与十难诊脉法同。明乎此，不特五脏互
受五邪，凿然可晓。即百病见证，莫不皆可类测，而为诊脉辨证之法程也。
第四十九难说：有本经自生的病，也有被五种邪气所伤的病。如何区分它们呢？
回答说：忧愁思虑会损伤心脏；形体受寒、饮食生冷会损伤肺脏；愤怒气逆，气机上冲而不能下行，会损伤肝脏；饮食不节、过度劳累会损伤脾脏；久坐湿地、强力涉水，会损伤肾脏。这就是本经自生的病。
所谓“正经”，就是本经。“五邪”，是指五脏受到的邪气。心主管思虑，如果忧劳过度，就会损伤心脏。肺主管皮毛，形体受寒，是皮毛外受风寒；饮食生冷，是内饮冷水，其脏本属寒，过度则会损伤肺脏。肝主管愤怒，发怒则肝木之气郁结而损伤肝脏。脾主管四肢，过度劳累倦怠会损伤脾脏，脾运化五谷，饮食不洁也会造成损伤。肾主管骨骼，用力作强、坐湿入水会损伤肾脏，因为肾属水，同气相感。然而忧愁、思虑、愤怒、饮食、动作，是人不能避免的，只是不可过度，过度了就必然伤人。
什么是五邪呢？
回答说：有中风，有伤暑，有饮食劳倦，有伤寒，有中湿。这就叫做五邪。
肝属风木，所以风邪先侵入肝脏。心属君火，暑火之邪，所以心脏受之。饮食劳倦，一味过度，就会损伤脾脏导致疾病。寒邪侵袭皮毛则损伤肺脏。雨雾蒸腾潮湿之气则损伤肾脏。这五种邪气由外而来，所谓的“外伤”。
按语：《素问·本病论》、《灵枢·邪气脏腑病形篇》与此大同小异。如《素问·阴阳应象大论》说：怒伤肝，喜伤心，思伤脾，忧伤肺，恐伤肾。这是内伤七情，本脏自病的证候。《宣明五气篇》说：肝恶风，心恶热，肺恶寒，肾恶燥，脾恶湿。这是六淫之邪，外感的证候。这些都看似相同实则不同。有人说，《难经》既言本经自病，是从内而生，如形寒饮冷则伤肺，形寒是寒感于皮毛，这是从外来；饮冷，是冷入胸腹，也是从外来。饮食等也是如此。况且五邪中也有饮食劳倦，难道不是自相矛盾吗？其实它的意思是，本经正气虚弱，就不能承受寒冷的侵伐，受到侵伐就容易致病。本经正气虚弱，又损伤于饮食，这叫内伤；如果是因伤饮食而致病，那叫外感。《素问》说肾恶燥，是说肾为水脏而厌恶燥气耗竭。这里说水湿伤肾，是因为湿伤于下部，所以湿气先归于肾，肾属水脏，同气相求。古代圣贤的道理，虽然有异同，但辨别内伤外感的原理是一致的。读书贵在融会贯通，不可拘泥固执，正如先儒所说“以意逆志”，才算真正得到精髓，确实如此。
回答说：面色应当发红。为什么这样说？肝主管五色，青色自入肝，赤色入心，黄色入脾，白色入肺，黑色入肾。肝成为心的邪气，所以知道面色应当发红。病症表现为身体发热，胁下胀满疼痛，脉象浮大而弦。
假如说是心病，这里是举心脏为例。这里说的心病，是肝邪侵入而得中风之病，因为风气通于肝。肝开窍于目，所以主管颜色，风邪自入肝经，则面色青，肝在五色中为苍色。进入心则面色赤，心在五色中为赤色。进入脾则面色黄，脾在五色中为黄色。进入肺则面色白，肺在五色中为白色。进入肾则面色黑，肾在五色中为黑色。所以肝的风邪进入心，面色应当发红。病症身体发热，是因为外感邪气，先伤营卫，所以身体发热，而且心属火，热是火邪的表现。胁下胀满疼痛，是因为胁下是肝的部位。脉象浮大而弦，浮大是心脉的本象，肝邪侵犯它，所以现出弦脉。
怎么知道是伤暑引起的呢？
回答说：应当厌恶气味。为什么这样说？心主管五臭，焦臭味自入心，香味入脾，臊味入肝，腐臭味入肾，腥臭味入肺。所以知道心病伤暑引起，应当厌恶气味。病症表现为身体发热且烦躁，心痛，脉象浮大而散。
假如说是心病而伤暑，暑邪伤人，心脏首先受之，因为心主暑。这是本经自病，不涉及其他经脉，然而心属火，暑热之邪伤害它，火邪化生万物，五臭由此产生，暑邪自入本经，其气味焦，这是火的气。进入脾其气味香，这是土的气。进入肝其气味臊，这是木的气。进入肾其气味腐，这是水的气。进入肺其气味腥，这是金的气。所以心受暑邪，发出恶臭。病症身体发热且烦躁，是因为火郁则神志昏乱。心痛，是因为邪在心则痛。脉象浮大而散，浮大是心的本脉，散则是浮大而空虚无神，是心的病脉。本脏自病，心主臭，所以专门通过气味来推断。
怎么知道是饮食劳倦引起的呢？
回答说：应当喜欢苦味。虚证是不想进食，实证是想进食。为什么这样说？脾主管五味，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，四肢无力收持，脉象浮大而缓。
假如说是心病而伤饮食劳倦，心主热，脾主劳倦，现在心病因饮食劳倦引起，所以知道是脾邪入心。喜欢苦味，是因为脾主味，心属火，火味苦，顺应其本性。虚则脾气不能化谷，实则能化谷，所以有能吃和不能吃之分。如果肝受饮食劳倦的病，其味酸；心受病，其味苦；肺受病，其味辛；肾受病，其味咸；脾自受病，其味甘。病症身体发热，是心的表现。身体沉重，是脾的表现。脉象浮大，是心的本脉；缓，是脾的脉象。这一节关于饮食劳倦，独有虚实之分，大概是明确本经正气虚弱，又损伤于饮食而致病，与单纯伤饮食而致病有所区别。
怎么知道是伤寒引起的呢？
回答说：应当胡言乱语。为什么这样说？肺主管声音，呼声响入肝，言语入心，歌声入脾，呻吟入肾，哭声自入肺。所以知道肺邪入心，表现为胡言乱语。病症表现为身体发热，瑟瑟怕冷，严重时气喘咳嗽，脉象浮大而涩。
假如说是心病而伤寒，那是肺邪入心。肺主管声音，所以胡言乱语。如果寒邪入肝则呼声响，肝在声音中为呼。入心则多言，言为心声，又在声音中为笑。入脾则唱歌，脾在声音中为歌。入肾则呻吟。肾在声音中为呻吟。自入肺之本脏则哭，肺在声音中为哭。病症身体发热怕冷，心是火脏，所以身体发热，肺本是寒脏，所以怕冷。严重时气喘咳嗽，是因为肺主咳，肺气上逆，就气喘咳嗽。脉象浮大，是心脉，涩，是肺的脉象。
怎么知道是中湿引起的呢？
回答说：应当喜欢出汗且汗出不止。为什么这样说？肾主管五液，泪入肝，汗入心，涎入脾，涕入肺，唾自入肾。所以知道肾邪入心，表现为汗出不止。病症表现为身体发热、小腹痛，足胫寒冷且逆冷，脉象沉濡而大。这是五邪的诊断方法。
假如说是心病而中湿，心主暑，肾主湿，现在心病因伤湿引起，所以知道是肾邪入心。肾化生五液，肾成为心的邪气，所以汗出不止。湿邪入肝为泪，肝主泪。入心为汗，心主汗。入脾为涎，脾主涎。入肺为涕，肺主涕。自入肾之本脏，则为唾，肾主唾。病症身体发热，是心的表现。小腹痛，是肾的部位。足胫寒冷且逆冷，是因为足胫是肾经经过的地方，所以畏寒而逆冷，湿性也偏寒。脉象沉濡而大，沉，是肾脉的象，濡，是湿气的征候，大则是心脉的象。心脉浮大，唯独不说浮，是因为沉就不能浮了。法，是举一例作为法则的方法。五邪，是五脏得到五行之邪。想要知道五邪的证候，必须审察肝病见于色，心病见于臭，脾病见于味，肺病见于声，肾病见于液。脉象以本脏之脉为主，兼受邪之脉。这里以心一经为主病，而以各证候验证其来源，其义理与第十难的诊脉法相同。明白这一点，不仅五脏互受五邪，清晰可晓。即使百病见证，没有不可以类推测度的，从而成为诊脉辨证的法式。
Chapter 49 states: There are diseases originating from the meridian itself (Zengjing Zibing) and those caused by injury from the Five Evils (Wuxie). How can they be distinguished?
The response is: Sorrow and excessive thinking damage the Heart; exposure to cold in the body and consumption of cold drinks damage the Lungs; anger with rebellious Qi rising upward without descending damages the Liver; improper diet and overexertion fatigue damage the Spleen; sitting for long periods in damp places or forcing oneself into water while exerting strength damages the Kidneys. These constitute diseases originating from the meridians themselves.
"Zhengjing" refers to the primary meridian. "Wuxie" refers to the pathogenic factors affecting the five Zang organs. The Heart governs thought; if sorrow and labor are excessive, it injures the Heart. The Lungs govern the skin and hair; bodily coldness indicates external contraction of wind-cold on the skin and hair; drinking cold liquids indicates internal intake of cold water. Since the Lung organ inherently possesses a cold nature, excess leads to injury of the Lungs. The Liver governs anger; anger causes stagnation of Wood Qi, injuring the Liver. The Spleen governs the four limbs; excessive labor and fatigue injure the Spleen. The Spleen transforms and transports grain and food; unclean diet also causes injury. The Kidneys govern the bones; forceful exertion, sitting in dampness, or entering water injures the Kidneys, because the Kidney belongs to Water, and similar energies resonate with each other. However, sorrow, thinking, anger, diet, and movement are things humans cannot avoid; one must simply not go to extremes. Extremes will inevitably cause injury.
What are the Five Evils?
The response is: There is Wind Strike (Zhongfeng), Summerheat Injury (Shangshu), Diet and Fatigue Injury (Yinshi Laojuan), Cold Damage (Shanghan), and Dampness Strike (Zhongshi). This is called the Five Evils.
The Liver corresponds to Wind-Wood, so Wind pathogen enters the Liver first. The Heart corresponds to Sovereign Fire; Summerheat-Fire pathogen affects the Heart. Excessive diet and fatigue injure the Spleen, leading to disease. Cold invading the skin and hair injures the Lungs. Moist vapor and misty dampness injure the Kidneys. These five pathogens come from outside, hence termed "external injuries."
Commentary: *Suwen: Benbing Lun* and *Lingshu: Xieqi Zangfu Bingxing Pian* are largely similar to this. For instance, *Suwen: Yin-Yang Yingxiang Dalun* states: Anger injures the Liver, Joy injures the Heart, Thinking injures the Spleen, Sorrow injures the Lungs, Fear injures the Kidneys. These are internal injuries from the Seven Emotions, representing self-disease of the primary organs. *Xuanming Wuqi Pian* states: The Liver dislikes Wind, the Heart dislikes Heat, the Lungs dislike Cold, the Kidneys dislike Dryness, the Spleen dislikes Dampness. These are manifestations of the Six Excesses (Liuyin) as external contractions. All appear similar but differ in essence. Some argue that since Nan Jing mentions primary meridian self-disease arising internally, yet cites bodily cold and cold drinks damaging the Lungs—where bodily cold is external cold affecting the skin and hair, and cold drinks enter the chest and abdomen externally—it seems contradictory, especially since the Five Evils include diet and fatigue. However, the intent is that when the primary meridian is deficient, it cannot withstand cold invasion; such invasion easily causes disease. If the primary meridian is deficient and further injured by diet, it is an internal injury; if disease results merely from dietary indiscretion, it is an external contraction. When *Suwen* says the Kidney dislikes Dryness, it means the Water organ dislikes dryness that depletes fluids. Here, water-dampness injures the Kidney because dampness affects the lower body and thus returns to the Kidney first; the Kidney belongs to Water, and similar energies seek each other. Although the meanings of ancient sages may differ slightly, the principle of distinguishing internal from external injuries remains consistent. Reading requires integration; one should not be rigid. As former scholars said, "reaching the intention to understand the will," this is true acquisition. Truly so.
Suppose there is Heart disease; how do we know it arises from Wind Strike?
The response is: The complexion should be red. Why? The Liver governs colors; Green enters the Liver, Red enters the Heart, Yellow enters the Spleen, White enters the Lungs, Black enters the Kidneys. Since the Liver becomes the evil for the Heart, we know the complexion should be red. Symptoms include fever, fullness and pain in the hypochondrium, and a pulse that is floating, large, and wiry (Xian).
"Suppose Heart disease" uses the Heart as an example. This refers to Heart disease where Liver evil invades, resulting in Wind Strike, as Wind Qi connects with the Liver. The Liver opens into the eyes and thus governs color. When Wind pathogen enters the Liver meridian, the color is green (Cang); when it enters the Heart, the color is red; when it enters the Spleen, yellow; when it enters the Lungs, white; when it enters the Kidneys, black. Therefore, Liver Wind evil entering the Heart results in a red complexion. Fever occurs because external pathogens first injure Ying and Wei (Nutritive and Defensive levels), causing fever; additionally, the Heart belongs to Fire, and heat is the manifestation of Fire evil. Hypochondriac fullness and pain occur because the hypochondrium is the region of the Liver. A floating, large, and wiry pulse: floating and large are the original characteristics of the Heart pulse; the Liver evil invading causes the wiry quality to appear.
How do we know it arises from Summerheat Injury?
The response is: There should be aversion to odors. Why? The Heart governs odors; Scorched odor enters the Heart, Fragrant odor enters the Spleen, Fishy/Sanguine odor enters the Liver, Putrid odor enters the Kidneys, Raw/Fishy odor enters the Lungs. Thus, knowing Heart disease arises from Summerheat, there should be aversion to odors. Symptoms include fever with irritability, heart pain, and a pulse that is floating, large, and scattered (San).
If Heart disease arises from Summerheat, the Summerheat pathogen affects the Heart first, as the Heart governs Summerheat. This is self-disease of the primary meridian, not involving other meridians. However, the Heart belongs to Fire; Summerheat-Heat evil injures it. Fire transforms into substances, producing the five odors. Summerheat entering the primary meridian produces a scorched odor (Qi of Fire). Entering the Spleen produces a fragrant odor (Qi of Earth). Entering the Liver produces a sanguine odor (Qi of Wood). Entering the Kidneys produces a putrid odor (Qi of Water). Entering the Lungs produces a raw/fishy odor (Qi of Metal). Thus, the Heart receiving Summerheat evil emits foul odors. Fever with irritability occurs because Fire stagnation leads to confusion. Heart pain occurs because evil in the Heart causes pain. A floating, large, and scattered pulse: floating and large are the original Heart pulse; scattered means floating, large, empty, and lacking spirit, which is the pathological pulse of the Heart. In self-disease of the primary organ, since the Heart governs odors, diagnosis relies specifically on odors.
How do we know it arises from Diet and Fatigue Injury?
The response is: There should be a preference for bitter taste. Deficiency manifests as lack of appetite; excess manifests as desire to eat. Why? The Spleen governs tastes; Sour enters the Liver, Bitter enters the Heart, Pungent enters the Lungs, Salty enters the Kidneys, Sweet enters the Spleen. Thus, knowing Spleen evil enters the Heart, there is a preference for bitter taste. Symptoms include fever, heavy body, lethargy, inability to control the four limbs, and a pulse that is floating, large, and slow (Huan).
If Heart disease arises from diet and fatigue, the Heart governs Heat, and the Spleen governs fatigue. Now, Heart disease arises from diet and fatigue, indicating Spleen evil enters the Heart. Preference for bitter taste occurs because the Spleen governs taste, the Heart belongs to Fire, and Fire's taste is bitter, conforming to its nature. Deficiency means Spleen Qi cannot transform grain; excess means it can, explaining the difference between ability and inability to eat. If the Liver receives diet/fatigue disease, the taste is sour; if the Heart receives disease, the taste is bitter; if the Lungs receive disease, the taste is pungent; if the Kidneys receive disease, the taste is salty; if the Spleen receives disease itself, the taste is sweet. Fever is a manifestation of the Heart. Heavy body is a manifestation of the Spleen. Floating and large pulse is the original Heart pulse; slow is the Spleen pulse characteristic. This section on diet and fatigue uniquely distinguishes deficiency and excess, clarifying that primary meridian deficiency combined with dietary injury differs from mere dietary indiscretion causing disease.
How do we know it arises from Cold Damage?
The response is: There should be delirious speech. Why? The Lungs govern sounds; Calling out enters the Liver, Speaking enters the Heart, Singing enters the Spleen, Moaning enters the Kidneys, Crying enters the Lungs. Thus, knowing Lung evil enters the Heart, there is delirious speech. Symptoms include fever, shivering aversion to cold, severe panting and coughing, and a pulse that is floating, large, and choppy (Se).
If Heart disease arises from Cold Damage, it is Lung evil entering the Heart. The Lungs govern sounds, hence delirious speech. If Cold evil enters the Liver, there is calling out (Liver sound is call). If it enters the Heart, there is much speaking (Speech is Heart voice; Lung sound is laughter). If it enters the Spleen, there is singing (Spleen sound is song). If it enters the Kidneys, there is moaning (Kidney sound is moan). If it enters the Lung itself, there is crying (Lung sound is cry). Fever and aversion to cold: the Heart is a Fire organ, hence fever; the Lung is originally a Cold organ, hence aversion to cold. Severe panting and coughing occur because the Lungs govern coughing; rebellious Lung Qi causes panting and coughing. Floating and large pulse is the Heart pulse; choppy is the Lung pulse characteristic.
How do we know it arises from Dampness Strike?
The response is: There should be profuse sweating that cannot stop. Why? The Kidneys govern fluids; Tears enter the Liver, Sweat enters the Heart, Saliva enters the Spleen, Nasal mucus enters the Lungs, Spittle enters the Kidneys. Thus, knowing Kidney evil enters the Heart, there is unstoppable sweating. Symptoms include fever, lower abdominal pain, cold and reversed coldness in the calves, and a pulse that is deep (Chen), soggy (Ru), and large. This is the method for the Five Evils.
If Heart disease arises from Dampness Strike, the Heart governs Summerheat, and the Kidneys govern Dampness. Now, Heart disease arises from dampness injury, indicating Kidney evil enters the Heart. The Kidneys transform the five fluids; Kidney becoming Heart evil causes unstoppable sweating. Dampness entering the Liver becomes tears (Liver governs tears). Entering the Heart becomes sweat (Heart governs sweat). Entering the Spleen becomes saliva (Spleen governs saliva). Entering the Lungs becomes nasal mucus (Lungs govern mucus). Entering the Kidneys themselves becomes spittle (Kidneys govern spittle). Fever is a manifestation of the Heart. Lower abdominal pain is the region of the Kidneys. Cold and reversed coldness in the calves occurs because the calves are the pathway of the Kidney meridian, hence fear of cold and reversal coldness; Dampness nature is also near cold. Deep, soggy, and large pulse: deep is the Kidney pulse characteristic; soggy is the sign of Dampness; large is the Heart pulse characteristic. The Heart pulse is floating and large, but only "large" is mentioned here because a deep pulse cannot be floating.
Fa refers to using one case as a representative method. Wuxie refers to the five Zang organs receiving evils corresponding to the Five Elements. To know the symptoms of the Five Evils, one must examine: Liver disease manifests in color, Heart disease in odor, Spleen disease in taste, Lung disease in sound, Kidney disease in fluid. The pulse is primarily based on the primary organ's pulse, combined with the pulse of the invading evil. Here, the Heart meridian is the primary diseased organ, and various symptoms verify the source. This principle is identical to the pulse diagnosis method in Chapter 10. Understanding this makes it clear that not only do the five Zang organs mutually receive the five evils, but also that all hundred diseases' manifestations can be analogously deduced, serving as a standard for pulse diagnosis and syndrome differentiation.