五十七难曰。泄凡有几。皆有名不。然。泄凡有五。其名不同。有胃泄。有脾泄。有大肠泄。有小肠泄。有大瘕泄。
名曰后重。胃泄者、饮食不化。色黄。
杨曰。泄利也。胃属土。故其利色黄。而饮食不化焉。化变也。消也。言所食之物。皆完出不消变也。虞曰。此乃
风入于肠。上重于胃。故使食不消化。风论曰。久风入中。则为肠风飧泄。飧泄、为食不消化也。
脾泄者。腹胀满泄注。食即呕吐逆。
杨曰。注者、无节度也。言利下犹如注水。不可禁止焉。脾病不能化谷。故食即吐逆。虞曰。中央生湿。湿生土。
土生脾。脾恶湿。湿气之胜。故腹胀而泄注。土性主信。又主味。今土病于味。无信。故食则吐逆。阴阳应象论曰。湿
胜则濡泻。谓湿气内攻脾胃。则水谷不分。故泄注。
大肠泄者。食已窘迫。大便色白。肠鸣切痛。
杨曰。窘迫、急也。食讫即欲利。迫急不可止也。白者、从肺色焉。肠鸣切痛者、冷也。切者、言痛如刀切。其肠
之状也。虞曰。大肠气虚。所以食毕而急思厕。虚则邪传于内。真邪相击。故切痛也。
小肠泄者。溲而便脓血。少腹痛。
杨曰。小肠属心。心主血脉。故便脓血。小肠处在少腹。故小腹痛也。
大瘕泄者。里急后重。数至圊而不能便。茎中痛。此五泄之法也。
杨曰。瘕、结也。少腹有结而又下利者是也。一名后重。言大便处疼重也。数欲利。至所即不利。又痛引阴茎中。
此是肾泄也。按诸方家。利有二十余种。而此惟见五种者。盖举其宗维耳。虞曰。肾开窍于二阴。气虚故数思圊。后重
而不能便。茎中痛。肾气不足伤于冲脉。故里急也。灵枢病总曰。凡五泄者。春伤于风。寒邪留连。乃为洞泄。（按此文
见素问生气通天论。无凡五泄者句。灵枢无病总篇。惟论疾诊尺篇云。春伤于风。夏生飧泄肠 。亦与此文小异。然则
今之灵枢。非虞氏所见之旧矣。）此之谓也。丁曰。里急者。肠中痛。后重者。腰以下沉重也。余皆旧经有注。
五十八难曰。伤寒有几。其脉有变不。然。伤寒有五。有中风。有伤寒。有湿温。有热病。有温病。其所苦各不同。
中风之脉。阳浮而滑。阴濡而弱。
丁曰。肌肉之上。阳脉所行。轻手按之。状若太过。谓之滑。肌肉之下。阴脉所行。重手按之。不足。谓之弱。此
者是按之不足。举之有余。故知中风也。杨曰。自霜降至春分。伤于风冷即病者。谓之伤寒。其冬时受得寒气。至春又
中春风而病者。谓之温病。其至夏发者。多热病。病而多汗者。谓之湿温。其伤于八节之虚邪者。谓之中风。据此经言。
温病则是疫疠之病。非为春病也。疫疠者。谓一年之中、或一州一县、若大若小俱病者是也。按之乃觉往来如有。举之
如无者。谓之弱也。关以前浮滑、尺中濡弱者也。
湿温之脉。阳濡而弱。阴小而急。
丁曰。阳濡而弱者。肌肉之上。阳脉所行。濡弱者。是湿气所胜火也。肌肉之下。阴脉所行。小急者。是土湿之不
胜木。故见小急。所以言阳濡而弱。阴小而急也。杨曰。小、细也。急、疾也。虞曰。湿温之病。谓病患头多汗出。何
以言之。寸口谓阳脉见濡弱。此水之乘火也。本经曰。肾主液入心成汗。此之谓也。
伤寒之脉。阴阳俱盛而紧涩。
丁曰。阴阳俱盛者、极也。谓寸尺脉俱盛极而紧涩。此者中雾露之寒也。水得风寒而凝结。故知肾得寒而有此脉见
也。虞曰。如切绳状曰紧。如刀剖竹曰涩。
热病之脉。阴阳俱浮。浮之而滑。沉之散涩。
丁曰。阴阳俱浮者、谓尺寸俱浮也。浮之而滑者、轻手按之而滑。是心伤热脉也。（按心热二字当互易。）沉之而散
涩者、沉、手按之而散涩。是津液虚少也。杨曰。轻手按者名浮。重手按者名沉也。
温病之脉。行在诸经。不知何经之动也。各随其经所在而取之。
丁曰。肺者金。主气。散行诸经。不知何经虚而传受此邪。故随其所在取其病邪也。杨曰。兼鬼疠之气。散行诸经。
故不可预知。临病患而诊之。知其何经之动。即为治也。
伤寒有汗出而愈。下之而死者。有汗出而死、下之而愈者。何也。然。阳虚阴盛。汗出而愈。下之即死。阳盛阴虚。
汗出而死。下之而愈。
丁曰。其阴阳盛虚者、谓非言脉之浮沉也。谓寒暑病异。燥湿不同。人之五脏六腑。有十二经。皆受于病。其手太
阳少阴属火。主暄。手阳明太阴属金。主燥。手少阳厥阴属相火。主暑。此是燥暑暄六经。以通天气。病即不体重恶风
而有躁。素问曰诸浮躁者。病在手是也。若以承气下之即愈。服桂枝取汗。汗出即死。其足太阳少阴属水。主寒。足阳
明太阴属土。主湿。足厥阴少阳属木。主风。此是风寒湿六经。以通地气。病即体重恶寒。故素问曰诸浮不躁者。病在
足是也。若以桂枝取汗。汗出即愈。服承气下之即死。此是五脏六腑配合阴阳大法也。所以经云。阳虚阴盛。汗出而愈。
下之而死。其阳盛阴虚。汗出而死。下之而愈。此义非反颠倒也。杨曰。此说反倒于义不通。不可根据用也。若反此行之。
乃为顺尔。虞曰。诸经义皆不错。此经例义。必应传写误也。凡伤寒之病。脉浮大而数。可汗之则愈。病在表也。脉沉
细而数。可下之则愈。病在里也。推此行之。万无一失。
寒热之病。候之如何也。然。皮寒热者。皮不可近席。毛发焦。鼻 。不得汗。
丁曰。肺候身之皮毛。大肠为表里。脏病即寒。腑病即热。故言皮寒热也。皮不可近席者。谓手三阴三阳法天天动。
故病即不欲卧近席也。毛发焦。鼻 不得汗者。谓下有心火燥热之为病。不得汗之。汗之即死。下之即愈。谓肺主燥故
也。
肌寒热者。皮肤痛。唇舌 。无汗。
丁曰。脾候身之肌肉。胃为表里。脏病即体寒。腑病即体热。故言肌寒热也。皮肤痛。唇舌 。脾者应土。土主湿。
故皮肤津液出。体重。其津液外泄。即唇舌 。病名湿燥。无以汗之。汗之即肠胃泻不通。下之即泄注。此者是湿气之
为病。当温中调气也。
骨寒热者。病无所安。汗注不休。齿本 痛。
丁曰。肾主骨。与膀胱为表里。病在阳。即身热、体重、恶寒。在阴即寒。病无所安。肾主水。汗注不休。齿本
痛。汗即愈。下即死。阴盛阳虚故死。杨曰。五脏六腑。皆有寒热。此经惟出三状。余皆阙也。
五十九难曰。狂癫之病。何以别之。然。狂之始发。少卧而不饥。自高贤也。自辨智也。自贵倨也。妄笑好歌乐。
妄行不休是也。
丁曰。狂病者、病在手三阳。而反汗。故阳盛即发狂也。病在足三阴。而反下。故阴盛即发癫也。杨曰。狂病之候。
观其人初发之时。不欲眠卧。又不肯饮食。自言贤智尊贵。歌笑行走不休。皆阳气盛所为。故经言重阳者狂。此之谓也。
今人以为癫疾。谬矣。
癫疾始发。意不乐。直视僵仆。其脉三部阴阳俱盛是也。
丁曰。经言重阳者狂。重阴者癫。今三部阴阳俱盛者。寸为阳。尺为阴。寸尺俱盛极而沉也。杨曰。癫、颠也。发
则僵仆焉。故有颠蹶之言也。阴气太盛。故不得行立而侧仆也。今人以为痫病。误矣。
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。
丁曰。手三阳者。阳中之阳。今受风寒。伏留不去。即是三阳逆于上。故名曰厥头病。入连在脑者。名曰真头痛。
脑者。髓海。风寒入即死矣。杨曰。去者、行也。厥者、逆也。言手三阳之脉。伏留而不行。则壅逆而冲于头。故名厥
头痛也。足三阳留壅。亦作头痛。今经不言之。从省久故也。（按久字疑当作文。）虞曰。风冷之气。入于三阳之经。故
头厥痛也。其痛立已。真头痛者。谓风冷之气。入于泥丸宫。则为髓海。邪入则曰真头痛也。头脑中痛甚。而手足冷至
肘膝者。名真头痛。其寒气入深故也。风寒之气。循风府入于脑。故云入连脑也。
其五脏气相干。名厥心痛。
杨曰。诸经络皆属于心。若一经有病。其脉逆行。逆则乘心。乘心则心痛。故曰厥心痛。是五脏气冲逆致痛。非心
家自痛也。
其痛甚。但在心。手足青者。即名真心痛。其真心痛者。旦发夕死。夕发旦死。
丁曰。真心不病。外经受五邪相干。名曰厥心痛。其痛甚则手足青而冷。神门穴绝者死。病名真心痛也。杨曰。心
者、五脏六腑之主。法不受病。病即神去气竭。故手足为之青冷也。心痛手足冷者。为真心痛。手足温者。为厥心痛也。
头痛亦然。从今日平旦至明日平旦为一日。今云旦发夕死。夕发旦死。是正得半日而死也。
第五十七难问：泄泻总共有几种？都有什么名称吗？回答说：泄泻总共有五种，它们的名称各不相同。有胃泄、脾泄、大肠泄、小肠泄、大瘕泄。其中大瘕泄的名称也叫“后重”（排便时肛门重坠感）。
胃泄的症状是：饮食不消化，大便颜色发黄。
杨氏说：这是泄利之症。胃属土，所以其排泄物颜色发黄，且食物不能消化。“化变”即指食物的转化与消解，意思是吃下去的食物都原样排出，没有经过消化吸收的变化。虞氏说：这是因为风邪侵入肠道，向上影响胃部，导致食物无法消化。《风论》中说：“久风入中，则为肠风飧泄。”飧泄就是指食物不消化而泻出。
脾泄的症状是：腹部胀满，泄泻如水注下，进食后即发生呕吐逆气。
杨氏说：“注”是指没有节制，形容腹泻像流水一样倾泻，无法禁止。脾病不能运化水谷，所以吃东西就会呕吐逆气。虞氏说：中央方位产生湿气，湿气生土，土生脾。脾恶湿，当湿气过胜时，就会导致腹胀和水注样的泄泻。土性主信，也主味。现在脾土在味觉功能上失常，失去了“信”的特性，所以一进食就呕吐逆气。《阴阳应象大论》中说：“湿胜则濡泻。”意思是湿气内攻脾胃，导致水谷不分，从而出现水注样的泄泻。
大肠泄的症状是：吃完饭后感到窘迫急迫，大便颜色发白，肠鸣音明显且疼痛剧烈如刀割。
杨氏说：“窘迫”就是急迫的意思。吃完饭就想排便，紧迫得无法停止。白色是从肺的颜色而来（肺属金，色白）。肠鸣且痛如刀切，是因为寒冷所致。“切”形容疼痛像被刀切一样的感觉，描述肠道的状态。虞氏说：大肠气虚，所以吃完饭后就急着想去厕所。虚则邪气传入体内，正气与邪气相搏结，所以产生剧烈的疼痛。
小肠泄的症状是：小便同时排出脓血，小腹部疼痛。
杨氏说：小肠属于心，心主血脉，所以会出现便脓血的情况。小肠位于少腹部位，所以会引起小腹痛。
大瘕泄的症状是：腹内急迫，肛门重坠，频繁去厕所却排不出大便，尿道或阴茎内部疼痛。这就是五种泄泻的治法概要。
杨氏说：“瘕”指结块。少腹有结滞而又伴有下利的情况就是这样。这种病又名“后重”，意思是排便处疼痛且有沉重感。想频繁排便，到了厕所却又排不出来，并且疼痛牵引至阴茎内部。这实际上是肾泄。查阅各家方书，泄利有二十多种，这里只列出五种，大概是列举其主要的纲领罢了。虞氏说：肾开窍于前后二阴，气虚所以频繁想上厕所。肛门重坠却排不出大便，阴茎疼痛，这是因为肾气不足损伤了冲脉，所以导致里急。《灵枢·病传》篇说：“凡是五泄，春季伤于风，寒邪留连不去，就会变成洞泄。”（按：这段文字实际见于《素问·生气通天论》，并没有“凡五泄者”这句话；《灵枢》也没有《病传》篇，只有《论疾诊尺》篇说：“春伤于风，夏生飧泄肠澼”，与此文略有不同。由此可见，现在的《灵枢》已经不是虞氏所见的旧本了。）说的就是这个意思。丁氏说：“里急”是指肠中疼痛，“后重”是指腰部以下感觉沉重。其余的内容都是古代经典原有的注释。
第五十八难问：伤寒有几类？其脉象会有变化吗？回答说：伤寒有五类，有中风、有伤寒、有湿温、有热病、有温病。它们各自带来的痛苦症状各不相同。
中风的脉象是：阳脉（寸部）浮而滑，阴脉（尺部）濡而弱。
丁氏说：肌肉表层是阳脉运行的地方，轻手按压，感觉过于有力，称为“滑”。肌肉深层是阴脉运行的地方，重手按压，感觉力量不足，称为“弱”。这就是按之不足、举之有余，所以知道是中风的病症。杨氏说：从霜降到春分这段时间，因受风冷而发病的，称为伤寒。如果在冬天感受寒气，到春天又受到春风侵袭而发病的，称为温病。如果到夏天发作的，多是热病。生病且多汗的，称为湿温。如果伤害于八节时的虚邪贼风的，称为中风。根据这部经书的说法，温病其实是疫疠之病，并不是专指春天的病。疫疠是指一年之中，或者一个州县，无论大小人群都普遍患病的情况。脉搏按下去觉得若有若无，举起来却好像没有的，称为“弱”。关前脉浮滑，尺中脉濡弱，这就是中风的脉象。
湿温的脉象是：阳脉（寸部）濡而弱，阴脉（尺部）小而急。
丁氏说：阳脉濡弱，是因为肌肉表层阳脉运行之处，濡弱是湿气胜过火气的表现。肌肉深层阴脉运行之处，脉小而急，是土湿不胜木气的表现，所以出现小急的脉象。因此说阳脉濡弱，阴脉小而急。杨氏说：“小”即细，“急”即疾速。虞氏说：湿温的病，表现为病人头部出汗多。为什么呢？因为寸口阳脉见濡弱，这是水气乘袭火气的表现。《本经》说：“肾主液，入心成汗。”说的就是这个道理。
伤寒的脉象是：阴阳两部脉都盛大且紧涩。
丁氏说：阴阳俱盛是指极盛的状态。指寸部和尺部的脉都极度盛大且紧涩。这是中了雾露之寒所致。水遇到风寒就会凝结，所以知道肾脏受寒会出现这种脉象。虞氏说：像切绳子一样紧绷的感觉叫“紧”，像刀剖竹子一样粗糙阻滞的感觉叫“涩”。
热病的脉象是：阴阳两部脉都浮，轻取滑利，重取散涩。
丁氏说：阴阳俱浮是指寸部和尺部脉都浮。轻取而滑，是心脏受热导致的脉象。（按：原文“心热”二字应当互换位置，应为“热伤心脉”之意）。重取而散涩，是津液亏虚少的表现。杨氏说：轻手按压叫浮，重手按压叫沉。
温病的脉象：流行在各个经络，不知道是哪条经络受了邪动，要随着该经络所在的位置来诊察和治疗。
丁氏说：肺属金，主气，散布运行于各条经络。不知道是哪条经络虚弱而传受了这个邪气，所以要跟随邪气所在之处来祛除病邪。杨氏说：兼夹鬼疠之气，散布运行于各条经络，所以不可预先知晓。临诊病人时诊断，知道是哪条经络受邪，就针对该经络进行治疗。
伤寒有的出汗就能痊愈，用泻下法反而致死的；有的出汗反而致死，用泻下法却能痊愈的，这是什么原因呢？回答说：如果是阳虚阴盛，出汗就能痊愈，用泻下法就会致死。如果是阳盛阴虚，出汗就会致死，用泻下法就能痊愈。
丁氏说：这里的阴阳盛虚，不是指脉象的浮沉，而是指寒暑疾病的不同，燥湿性质的差异。人的五脏六腑有十二经脉，都会受到病邪侵害。手太阳、手少阴属火，主温暖；手阳明、手太阴属金，主干燥；手少阳、手厥阴属相火，主暑热。这是燥、暑、暄六经，以通天气。患病时身体不会沉重，厌恶风邪且烦躁。《素问》说：各种浮躁的脉象，病在手经。如果用承气汤类泻下就能痊愈，服用桂枝汤发汗，出汗就会致死。足太阳、足少阴属水，主寒冷；足阳明、足太阴属土，主湿润；足厥阴、足少阳属木，主风。这是风、寒、湿六经，以通地气。患病时身体沉重，厌恶寒冷。所以《素问》说：各种浮而不躁的脉象，病在足经。如果用桂枝汤发汗，出汗就能痊愈，服用承气汤泻下就会致死。这是五脏六腑配合阴阳的大法。所以经文说：阳虚阴盛，出汗痊愈，泻下致死；阳盛阴虚，出汗致死，泻下痊愈。这个义理并不是颠倒混乱的。杨氏说：这种说法在义理上是颠倒不通的，不可依据使用。如果反过来这样做，才是顺理成章的。虞氏说：其他各经的义理都没有错误，这一条经文例的义理，一定是传抄书写时出了误。凡是伤寒病，脉象浮大而数，可以用发汗法治疗则痊愈，因为病在表。脉象沉细而数，可以用泻下法治疗则痊愈，因为病在里。按照这个原则推行，万无一失。
寒热病候是怎样的呢？回答说：皮寒热的症状是：皮肤不能贴近席子，毛发焦枯，鼻孔干燥，不能出汗。
丁氏说：肺主管身体的皮毛，大肠与肺互为表里。脏病则寒，腑病则热，所以称为皮寒热。皮肤不能贴近席子，是说手三阴三阳经的气机天天变动，所以生病后不想卧近席子。毛发焦枯，鼻孔干燥不能出汗，是说下部有心火燥热作为病因。如果不能发汗，发汗就会致死；如果能泻下，泻下就能痊愈。这是因为肺主燥的缘故。
肌寒热的症状是：皮肤疼痛，嘴唇和舌头干燥，无汗。
丁氏说：脾主管身体的肌肉，胃与脾互为表里。脏病则身体寒，腑病则身体热，所以称为肌寒热。皮肤疼痛，嘴唇舌头干燥。脾对应土，土主湿，所以皮肤津液外泄，身体沉重。津液外泄，导致嘴唇舌头干燥。这种病名叫湿燥。不能用发汗法，发汗会导致肠胃泻下不通；用泻下法会导致泄注。这是湿气致病，应当用温中调气的方法治疗。
骨寒热的症状是：病人坐卧不安，汗水如注般不停流出，齿根疼痛。
丁氏说：肾主骨，与膀胱互为表里。病在阳分，则身热、体重、恶寒；病在阴分则寒。病人坐卧不安。肾主水，汗水如注不休，齿根疼痛。通过发汗可以痊愈，用泻下法就会致死。因为阴盛阳虚所以致死。杨氏说：五脏六腑都有寒热证，这部经文只列出了这三种情况，其他的都缺失了。
第五十九难问：狂病和癫病，如何区别呢？回答说：狂病刚开始发作时，睡眠少且不觉得饿，自认为高明贤能，自认为辩才智慧，自认为尊贵傲慢，无故发笑，喜欢唱歌娱乐，胡乱行走不停止。
丁氏说：狂病是病在手三阳经，反而出汗，所以阳气盛就会发狂。病在足三阴经，反而用泻下法，所以阴气盛就会发癫。杨氏说：观察狂病患者的初期症状，不想睡觉，也不肯吃东西，自称贤智尊贵，歌笑行走不停，这都是阳气盛造成的。所以经文说“重阳者狂”，说的就是这个意思。现在的人把它当作癫疾，是错误的。
癫病刚开始发作时，心情不快乐，两眼直视，突然僵倒仆地。其脉象是三部阴阳脉都盛大。
丁氏说：经文说“重阳者狂，重阴者癫”。现在三部阴阳脉都盛大，寸为阳，尺为阴，寸尺两部脉都极度盛大且沉伏。杨氏说：“癫”通“颠”，发作时僵硬仆倒，所以有“颠蹶”的说法。阴气太盛，所以不能行走站立而侧身仆倒。现在的人把它当作痫病，也是错误的。
第六十难问：头心和心的疼痛，有厥痛，有真痛，这是什么意思呢？回答说：手三阳经的脉，受到风寒侵袭，潜伏停留而不消散的，叫做厥头痛。如果邪气深入连及脑部的，叫做真头痛。
丁氏说：手三阳经是阳中之阳，现在受到风寒，潜伏停留不去，就是三阳经之气逆乱于上，所以名叫厥头病。邪气深入连及脑部，名叫真头痛。脑是髓海，风寒进入脑部就会致死。杨氏说：“去”指运行，“厥”指逆乱。意思是手三阳经的脉，潜伏停留而不运行，就会壅滞逆乱冲撞头部，所以名叫厥头痛。足三阳经如果留滞壅塞，也会引起头痛，这里经文没有提及，是为了省略篇幅的缘故。（按：“久”字怀疑应该是“文”字）。虞氏说：风冷之气，侵入三阳经，所以头部出现厥痛。这种疼痛可能立即缓解。真头痛，是指风冷之气侵入泥丸宫（脑部），成为髓海的病变，邪气进入就叫真头痛。头脑中疼痛非常剧烈，且手脚冰冷直到肘膝关节，名叫真头痛。这是因为寒气侵入太深的缘故。风寒之气，顺着风府穴进入脑部，所以说“入连脑”。
如果是五脏之气相互干犯引起的疼痛，名叫厥心痛。
杨氏说：所有经络都归属于心。如果某一经有病，其脉逆行，逆则乘袭心脏，乘袭心脏就会心痛。所以叫厥心痛。这是五脏之气冲逆导致的疼痛，并不是心脏本身直接生病疼痛。
如果疼痛非常剧烈，但疼痛仅局限于心部，手足青紫冰冷的，就名叫真心痛。真心痛的患者，早上发病晚上就会死，晚上发病第二天早上就会死。
丁氏说：真心本身不生病，是外经受五邪干犯，名叫厥心痛。如果疼痛剧烈到手足青紫冰冷，神门穴脉绝的就死，这种病名叫真心痛。杨氏说：心是五脏六腑的主宰，法则是不受病的，一旦生病就是神气离去、元气衰竭，所以手足会青紫冰冷。心痛且手足冷的，是真心痛；手足温暖的，是厥心痛。头痛也是如此。从今天早晨到明天早晨算作一天。现在说早上发病晚上死，晚上发病早上死，这正好是半天就死亡了。
Chapter 57 asks: How many types of diarrhea (Xie) are there in total? Do they all have specific names? The answer is: There are five types of diarrhea, and their names differ. They are Wei Xie (Stomach Diarrhea), Pi Xie (Spleen Diarrhea), Dachang Xie (Large Intestine Diarrhea), Xiaochang Xie (Small Intestine Diarrhea), and Da Jia Xie (Great Mass Diarrhea). Da Jia Xie is also known as "Hou Zhong" (Tenesmus/Rectal Heaviness).
Symptoms of Wei Xie (Stomach Diarrhea): Food is not digested, and the stool color is yellow.
Yang states: This is a condition of dysentery/diarrhea. The Stomach belongs to Earth, so its discharge is yellow, and food fails to digest. "Transformation and change" refers to the digestion and breakdown of food; it means the ingested food is excreted intact without undergoing digestive transformation. Yu states: This occurs because Wind pathogen enters the intestines and affects the Stomach from above, causing food indigestion. The *Feng Lun* (Treatise on Wind) states: "Long-standing Wind entering the interior leads to Chang Feng Sun Xie (Intestinal Wind with undigested food diarrhea)." Sun Xie refers to diarrhea with undigested food.
Symptoms of Pi Xie (Spleen Diarrhea): Abdominal distension and fullness, profuse watery diarrhea like pouring water, and vomiting/regurgitation immediately after eating.
Yang states: "Zhu" (pouring) implies lack of control, describing diarrhea flowing like water that cannot be stopped. Spleen disease fails to transform and transport grain, leading to vomiting upon eating. Yu states: The Central direction generates Dampness, Dampness generates Earth, and Earth generates the Spleen. The Spleen dislikes Dampness. When Dampness is excessive, it causes abdominal distension and pouring diarrhea. Earth's nature is associated with Trustworthiness and Taste. Now, if Earth pathology affects taste function, losing this "trust," one vomits upon eating. The *Yin Yang Ying Xiang Da Lun* states: "Excessive Dampness leads to Ru Xie (soft/watery diarrhea)." This means when Dampness attacks the Spleen and Stomach internally, water and grain are not separated, resulting in pouring diarrhea.
Symptoms of Dachang Xie (Large Intestine Diarrhea): Urgency and distress after eating, white-colored stool, borborygmus (bowel sounds), and severe cutting pain.
Yang states: "Jiong Po" means urgency. One feels the immediate need to defecate after eating, which is urgent and uncontrollable. White color derives from the Lung (Metal element, color white). Borborygmus and cutting pain indicate Cold. "Qie" describes pain as sharp as if cut by a knife, depicting the state of the intestines. Yu states: Qi deficiency in the Large Intestine causes an urgent desire to use the toilet after meals. Deficiency allows pathogenic factors to enter the interior; the struggle between True Qi and Pathogen causes severe pain.
Symptoms of Xiaochang Xie (Small Intestine Diarrhea): Passing pus and blood in stool along with urination, and lower abdominal pain.
Yang states: The Small Intestine relates to the Heart, and the Heart governs Blood vessels; thus, pus and blood appear in the stool. The Small Intestine is located in the lower abdomen (Shao Fu), causing lower abdominal pain.
Symptoms of Da Jia Xie (Great Mass Diarrhea): Internal urgency (Li Ji), tenesmus (Hou Zhong), frequent trips to the toilet with inability to pass stool, and pain in the penis/urethra. These are the methods for the five types of diarrhea.
Yang states: "Jia" refers to a knot or mass. This condition involves lower abdominal stagnation/mass accompanied by diarrhea. It is also called "Hou Zhong," meaning pain and heaviness at the anus. Frequent urge to defecate but inability to do so at the toilet, with pain radiating to the penis, indicates Kidney Xie. Consulting various medical texts, there are over twenty types of diarrhea, but only these five are listed here as the main categories. Yu states: The Kidney opens into the two yin orifices (anterior and posterior). Qi deficiency causes frequent urges. Tenesmus with inability to pass stool and penile pain result from Kidney Qi deficiency injuring the Chong Mai (Penetrating Vessel), causing internal urgency. The *Ling Shu: Bing Zhuan* chapter states: "Regarding the five diarrheas, if Wind injures in Spring, and Cold pathogen lingers, it becomes Dong Xie (cavity diarrhea)." (Note: This text actually appears in *Su Wen: Sheng Qi Tong Tian Lun*, without the phrase "regarding the five diarrheas"; *Ling Shu* has no *Bing Zhuan* chapter, but *Lun Ji Zhen Chi* says: "Wind injury in Spring leads to Sun Xie or Chang Pi in Summer," which differs slightly. Thus, current *Ling Shu* is not the old version seen by Yu.) This refers to such cases. Ding states: "Li Ji" (internal urgency) means intestinal pain; "Hou Zhong" (tenesmus) means heaviness below the waist. The rest are annotations from ancient classics.
Chapter 58 asks: How many types of Shang Han (Cold Damage) are there? Do their pulses change? The answer is: There are five types of Shang Han: Zhong Feng (Wind Strike), Shang Han (Cold Damage), Shi Wen (Damp-Warmth), Re Bing (Heat Disease), and Wen Bing (Warm Disease). Their respective symptoms of suffering differ.
Pulse of Zhong Feng (Wind Strike): Yang pulse (Cun position) is Floating and Slippery; Yin pulse (Chi position) is Ru (Soft/Flaccid) and Weak.
Ding states: The superficial muscle layer is where Yang pulses run; light pressure feeling overly forceful is called Slippery. The deep muscle layer is where Yin pulses run; heavy pressure feeling insufficient is called Weak. This is "insufficient on pressing, abundant on lifting," indicating Zhong Feng. Yang states: From Frost Descent to Spring Equinox, illness caused by Wind-Cold is called Shang Han. If Cold is contracted in Winter and then Wind strikes in Spring, it is called Wen Bing. If it manifests in Summer, it is mostly Re Bing. Illness with excessive sweating is called Shi Wen. Injury by empty evils of the eight seasonal transitions is called Zhong Feng. According to this classic, Wen Bing is actually an epidemic pestilence, not just a spring disease. Epidemic pestilence refers to widespread illness across regions regardless of scale. A pulse felt as intermittent upon pressing and absent upon lifting is called Weak. Floating/Slippery before the Guan position and Ru/Weak at Chi indicates Zhong Feng.
Pulse of Shi Wen (Damp-Warmth): Yang pulse (Cun) is Ru and Weak; Yin pulse (Chi) is Small and Rapid/Tight.
Ding states: Yang pulse Ru/Weak indicates Dampness overcoming Fire in the superficial Yang pulse area. Yin pulse Small/Rapid indicates Earth Dampness failing to overcome Wood in the deep Yin pulse area. Hence, Yang is Ru/Weak, Yin is Small/Rapid. Yang states: "Small" means fine; "Rapid" means fast. Yu states: In Shi Wen disease, the patient sweats heavily on the head. Why? Because Cun Yang pulse shows Ru/Weak, indicating Water overcoming Fire. The *Ben Jing* states: "Kidney governs fluids, entering Heart to form sweat." This explains it.
Pulse of Shang Han (Cold Damage): Both Yin and Yang pulses are Exuberant, Tight, and Choppy.
Ding states: "Both Yin and Yang exuberant" means extreme fullness. Cun and Chi pulses are extremely full, tight, and choppy. This results from misty/dewy Cold. Water congeals with Wind-Cold, indicating Kidney Cold produces this pulse. Yu states: "Tight" feels like cutting a rope; "Choppy" feels like splitting bamboo with a knife.
Pulse of Re Bing (Heat Disease): Both Yin and Yang pulses are Floating. Light pressure reveals Slipperiness; heavy pressure reveals Scattered and Choppy qualities.
Ding states: "Both Yin and Yang floating" means both Cun and Chi are floating. Slippery on light pressure indicates Heart Heat affecting the pulse. (Note: "Heart Heat" characters should likely be swapped). Scattered/Choppy on heavy pressure indicates deficiency of Body Fluids. Yang states: Light pressure is Floating; heavy pressure is Sinking.
Pulse of Wen Bing (Warm Disease): Moves through various meridians; unknown which meridian is affected. Treatment depends on locating the affected meridian.
Ding states: Lung belongs to Metal, governs Qi, and distributes through meridians. Unknown which meridian is deficient and transmits the pathogen, so treatment targets the location of the pathogen. Yang states: Combined with Ghost Pestilence Qi, spreading through meridians, making it unpredictable. Diagnose clinically to identify the affected meridian and treat accordingly.
In Shang Han, some recover with sweating but die with purging; some die with sweating but recover with purging. Why? The answer is: In Yang Deficiency and Yin Excess, sweating leads to recovery, purging leads to death. In Yang Excess and Yin Deficiency, sweating leads to death, purging leads to recovery.
Ding states: Yin/Yang excess/deficiency here refers not to pulse floating/sinking, but to differences in Cold/Heat diseases and Dry/Damp natures. The twelve meridians of Zang-Fu are affected. Hand Taiyang/Shaoyin belong to Fire (warmth); Hand Yangming/Taiyin belong to Metal (dryness); Hand Shaoyue/Jueyin belong to Ministerial Fire (summer heat). These six meridians connect to Heaven Qi. Illness presents without body heaviness, aversion to wind, and irritability. *Su Wen* states: Restless pulses indicate Hand meridian disease. Purging with Chengqi Tang cures; sweating with Guizhi Tang kills. Foot Taiyang/Shaoyin belong to Water (cold); Foot Yangming/Taiyin belong to Earth (dampness); Foot Jueyin/Shaoyang belong to Wood (wind). These six meridians connect to Earth Qi. Illness presents with body heaviness and aversion to cold. *Su Wen* states: Floating but non-restless pulses indicate Foot meridian disease. Sweating with Guizhi Tang cures; purging with Chengqi Tang kills. This is the great law of Zang-Fu Yin-Yang coordination. Thus, the text says: Yang Def/Yin Excess -> Sweat cures, Purge kills; Yang Excess/Yin Def -> Sweat kills, Purge cures. This is not contradictory. Yang states: This interpretation is logically inverted and invalid. Doing the opposite would be correct. Yu states: Other chapters are correct; this chapter's logic is likely a transcription error. Generally, for Shang Han, Floating/Large/Rapid pulse (Exterior) requires sweating; Sinking/Fine/Rapid pulse (Interior) requires purging. Following this ensures success.
How to observe Cold-Heat diseases? The answer is: Pi Han Re (Skin Cold-Heat) symptoms include: Skin cannot tolerate lying on mats, hair becomes brittle, nasal dryness, and inability to sweat.
Ding states: Lung governs skin/hair; Large Intestine is its paired organ. Zang disease is Cold, Fu disease is Heat, hence Pi Han Re. Intolerance to mats relates to hand Yin/Yang meridian dynamics. Brittle hair, dry nose, no sweat indicates Lower Heart Fire/Dryness. Failure to sweat leads to death; purging leads to cure due to Lung governing Dryness.
Ji Han Re (Muscle Cold-Heat) symptoms include: Skin pain, dry lips/tongue, no sweat.
Ding states: Spleen governs muscles; Stomach is its paired organ. Zang disease is Body Cold, Fu disease is Body Heat, hence Ji Han Re. Skin pain, dry lips/tongue. Spleen corresponds to Earth/Dampness. Skin fluid leakage causes heaviness. Dry lips/tongue indicates Wet-Dry pathology. Sweating is contraindicated (causes bowel obstruction); purging causes diarrhea. Treat with Warming Middle and Regulating Qi.
Gu Han Re (Bone Cold-Heat) symptoms include: Restlessness, continuous profuse sweating, root-of-tooth pain.
Ding states: Kidney governs bones; Bladder is its paired organ. Exterior/Yang disease brings heat/heaviness/cold aversion; Interior/Yin disease brings cold. Restlessness. Kidney governs Water; profuse sweat and tooth root pain. Sweating cures; purging kills due to Yin Excess/Yang Deficiency. Yang states: All Zang-Fu have Cold-Heat patterns; this chapter only lists three, omitting others.
Chapter 59 asks: How to distinguish Kuang (Mania) and Dian (Episodic Psychosis)? The answer is: Initial Kuang presents with little sleep, no hunger, arrogance (claiming wisdom/virtue), delusions of grandeur, inappropriate laughter, singing, and constant aimless walking.
Ding states: Kuang involves Hand Three Yang meridians with abnormal sweating, leading to Yang Excess and Mania. Dian involves Foot Three Yin meridians treated incorrectly with purging, leading to Yin Excess and Episodic Psychosis. Yang states: Observing initial Kuang: insomnia, refusal to eat, claims of superiority, laughing/walking incessantly. Caused by Yang Excess. Text says "Double Yang leads to Kuang." Confusing it with Dian is wrong.
Initial Dian presents with unhappiness, fixed gaze, sudden stiff collapse. Pulse shows Exuberance in all three positions (Yin and Yang).
Ding states: Text says "Double Yang is Kuang, Double Yin is Dian." Here, all three positions are exuberant. Cun is Yang, Chi is Yin; both are extremely full and sinking. Yang states: "Dian" connects to "Dian" (topple). Collapse during attack is due to Yin Excess preventing standing/walking. Confusing it with Xi (Epilepsy) is wrong.
Chapter 60 asks: Regarding Head and Heart pain, what are Jue Tong (Rebellious Pain) and Zhen Tong (True Pain)? The answer is: Hand Three Yang meridians invaded by Wind-Cold, lingering without dispersing, cause Jue Tou Tong (Rebellious Headache). If pathogen enters and connects to the Brain, it is Zhen Tou Tong (True Headache).
Ding states: Hand Three Yang are Yang within Yang. Wind-Cold lingering causes rebellion upward, hence Jue Tou Bing. Entering the Brain is Zhen Tou Tong. Brain is Sea of Marrow; Wind-Cold entering causes death. Yang states: "Qu" means movement; "Jue" means rebellion. Hand Three Yang stagnating and rebelling against the head causes Jue Tou Tong. Foot Three Yang stagnation also causes headache, omitted here for brevity. (Note: "Jiu" likely typo for "Wen"). Yu states: Wind-Cold in Three Yang causes head rebellious pain, which may resolve quickly. Zhen Tou Tong is Wind-Cold entering Ni Wan Gong (Brain/Sea of Marrow). Severe head pain with cold hands/feet to elbows/knees is Zhen Tou Tong due to deep Cold invasion via Fengfu point connecting to Brain.
If Five Zang Qi interfere with each other, it is named Jue Xin Tong (Rebellious Heart Pain).
Yang states: All meridians connect to the Heart. Disease in one meridian with reverse pulse flow attacks the Heart, causing Heart Pain. This is Jue Xin Tong, caused by Qi rebellion, not intrinsic Heart disease.
If pain is severe, localized strictly to the Heart, with blue/cold hands and feet, it is named Zhen Xin Tong (True Heart Pain). Zhen Xin Tong patients die if onset is morning (evening death) or evening (morning death).
Ding states: True Heart does not get sick; external pathogens attacking constitute Jue Xin Tong. Severe pain with blue/cold limbs indicates Shenmen pulse cessation and death, named Zhen Xin Tong. Yang states: Heart is master of Zang-Fu, normally immune. Disease means Spirit departure and Qi exhaustion, causing blue/cold limbs. Heart pain with cold limbs is Zhen Xin Tong; warm limbs is Jue Xin Tong. Same for headaches. "Morning to next morning" is one day. "Morning onset evening death" implies death within half a day.