四十八难曰。人有三虚三实。何谓也。然。有脉之虚实。有病之虚实。有诊之虚实也。脉之虚实者。濡者为虚。紧
牢者为实。
丁曰。脉缓软者濡。按之而有力者牢实也。杨曰。按之如切绳之状。谓之紧也。
病之虚实者。出者为虚。入者为实。
丁曰。阴阳者、主其内外也。今阳不足。阴出乘之。在内俱阴。故知出者为虚也。阴不足。阳入乘之。在外俱阳。
故知入者为实也。杨曰。呼多吸少。吸多呼少。
言者为虚。不言者为实。
杨曰。肺主声。入心为言。故知言者为虚。肝主谋虑。故入心即不言。用为实邪。故知不言者为实也。杨曰。脏气
虚。精气脱。故多言语也。脏气实。邪气盛。故不欲言语也。
缓者为虚。急者为实。
丁曰。阳主躁。阴主静。阴即缓。阳即急。故知缓者为虚。急者为实也。杨曰。皮肉宽缓。皮肤满急也。
诊之虚实者。濡者为虚。
杨曰。皮肤濡缓也。
牢者为实。
杨曰。皮肉牢强也。
痒者为虚。
杨曰。身体虚痒也。
痛者为实。
杨曰。身形有痛处皆为实。
外痛内快。为外实内虚。
杨曰。轻手按之则痛。为外实。病浅故也。重手按之则快。为内虚。病深故也。
内痛外快。为内实外虚。
杨曰。重手按之则痛。为内实。病深故也。轻手按之则快。为外虚。病浅故也。凡人病。按之则痛者。皆为实。按
之则快者。皆为虚也。
故曰虚实也。
杨曰。是三虚三实之证也。丁曰。诊按之心腹皮肤内外。其痛按之而止者虚。接之而其痛甚者实。内外同法也。
四十九难曰。有正经自病。有五邪所伤。何以别之。然。经言忧愁思虑则伤心。
丁曰。心主脉。忧愁思虑。即心脉不得宣行。故伤心也。吕曰。心为神。五脏之君。聪明才智。皆由心出。忧劳之
甚。则伤其心。心伤神弱也。虞曰。任治于物清筝栖灵曰心。今忧愁思虑不息。故伤心也。
形寒饮冷则伤肺。
丁曰。肺主皮毛。恶其寒。所以形寒饮寒则令伤其肺也。吕曰。肺主皮毛。形寒者、皮毛寒也。饮冷者、伤肺也。
肺主受水浆。水浆不可冷冻饮料。肺又恶寒。故曰伤也。
恚怒气逆。上而不下。则伤肝。
丁曰。肝主谋虑。胆主勇断。故怒极即伤其肝也。吕曰。肝与胆为脏腑。其气勇。故主怒。怒则伤也。虞曰。素问
云。怒则血菀积于上焦。名曰逆厥。又曰。怒甚呕血。气逆使然。故伤也。
饮食劳倦则伤脾。
丁曰。脾主味。饮食味美。而过食之无度。劳动其力。倦局其足。故伤脾也。吕曰。饮食饱。胃气满。脾络恒急。
或走马跳跃。或以房劳脉络裂。故伤脾也。虞曰。脾为仓廪之官。五味出焉。谓纳其五味。化生五气。以养人身。今饮
食劳倦而致自伤。是故圣人谨和五味。骨正筋柔。谨道如法。长有尺命。安致自伤。养生之道。可不戒哉。
久坐湿地。强力入水。则伤肾。
丁曰。肾主腰。腰者、肾之府。久坐则肾气不得宣行。故损也。肾穴在足心底。名曰涌泉。居处湿地入水。故有损
也。强力者。务快其心。强合阴阳。故伤其肾也。吕曰。久坐湿地。谓遭忧丧。强力者。谓举重引弩。入水者。谓复溺
于水。或妇人经水未过。强合阴阳也。虞曰。土主湿。自然之理也。今久坐湿地。则外湿内感于肾。合之风寒。发为瘴
病。强力过用。必致自饮也。经脉别论曰。持重远行。必伤于肾。生气通天论曰。因而强力。肾气乃伤。高骨乃坏。经
脉别论曰。度水跌仆。喘出于肾与胃也。
是正经之自病也。
丁曰。此五者。皆正经自病。非谓他邪也。吕曰。此皆从其脏内自发病。不从外来也。虞曰。吕氏言其脏内自发其
病。不从外来。其义、非也。只如形寒饮冷伤肺者。谓外寒感于皮毛。内合于肺。此从外来也。又饮冷入口。内伤于肺。
亦从外来也。余悉如此。圣人大意。言正经虚则腠理开。腠理开则外感于内。故曰正经自病也。
何谓五邪。然有中风。
丁曰。中者、伤也。言中风者。调肝应风。主色邪。散于五脏。为之五色也。吕曰。肝主风也。虞曰。东方生风。
风生木。恶风。又巽木为风。
有伤暑。
丁曰。伤暑者。谓心应暑。主臭邪。放于五脏。为之五臭也。吕曰。心主暑也。虞曰。心火主暑。王于夏暑、热也。
素问曰。夏伤于暑。秋必 疟。
有饮食劳倦。
丁曰。脾应湿。主味邪。散入五脏为五味。吕曰。脾主劳倦也。虞曰。正经自病。亦言饮食劳倦。伤脾。今五邪亦
言饮食劳倦。正经病谓正经虚。又伤饮食五邪病。谓食饮伤于脾而致病也。
有伤寒。
丁曰。肺主燥。而其令清切。恶寒。主其声邪散入五脏。为之五声也。吕曰。肺主寒也。虞曰。谓寒感皮毛。故曰
伤寒也。
有中湿。
丁曰。肾应寒。主水邪散入五脏。为之五液也。吕曰。肾主湿也。虞曰。水流湿之义也。
此之谓五邪。
吕曰。此五病。从外来也。虞曰。此五行相胜也。作邪如下说也。
假令心病。何以知中风得之。然。其色当赤。何以言之。肝主色。
虞曰。巽为风。属木。故主中风。木之华萼。敷布五色。作五邪。乃如下说也。
自入为青。
虞曰。木经自病也。
入心为赤。
虞曰。肝邪入心。其色乃赤。
入脾为黄。
虞曰。肝邪入脾。其色黄也。
入肺为白。
虞曰。肝邪入肺。故其色白。
入肝为黑。
虞曰。肝邪在肾。其色黑。
肝为心邪。故知当赤色也。
吕曰。肝主中风。心主伤暑者。今心病中风。故知肝邪往伤心也。
其病身热。胁下满痛。
吕曰。身热者心。满痛者肝。二脏之病证也。虞曰。心主伤暑。病则身热。肝布两胁。故胁满。肝之乘心也。
其脉浮大而弦。
吕曰。浮大者心。弦者肝。二脏脉见应也。
何以知伤暑得之。然。当恶臭。何以言之。心主臭。
虞曰。心火也。火之化物。五臭出焉。
自入为焦臭。
虞曰。火性炎上。则生焦臭。此曰正经自病也。
入脾为香臭。
虞曰。火之化土。其臭乃香。
入肝为臊臭。
虞曰。火之化木。其臭乃臊。
入肾为腐臭。
虞曰。火之化水。其臭乃腐。
入肺为腥臭。
虞曰。火之化金，其臭乃腥。
故知心病伤暑得之也。（按此也字。当在下句之末。别本并脱去。）当恶臭。其病身热而烦。心痛。其脉浮大而散。
吕曰。心主暑。今伤暑。此正经自病。不中他邪。
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。
虞曰。稼穑作甘。礼云。甘受和。故主味也。
入肝为酸。
虞曰。脾主味。为邪乘肝病者。乃喜酸味也。
入心为苦。
虞曰。脾主味。为邪干心病者。乃喜苦味也。
入肺为辛。
虞曰。脾主味。为邪干肺病者。乃喜辛味也。
入肾为咸。
虞曰。脾主味。为邪干肾病者。乃喜咸味也。
自入为甘。
虞曰。土为稼穑。本经自病。乃喜甘味也。
故知脾邪入心。为喜苦味也。
吕曰。心主伤热。脾主劳倦。今心病以饮食劳倦得之。故知脾邪入心也。
其病身热。而体重嗜卧。四肢不收。
吕曰。身热者、心也。体重者、脾也。此二脏病证也。
其脉浮大而缓。
吕曰。浮大者、心脉。缓者、脾脉也。
何以知伤寒得之。然。当谵言妄语。何以言之。肺主声。
虞曰。五金击之有声。故五音出于肺也。
入肝为呼。
虞曰。木之畏金故呼。启玄子云。呼亦当啸。
入心为言。
虞曰。此云言。素问云笑。谓金火相当。夫妇相见。故言笑。
入脾为歌。
虞曰。土母金子。母子相见。故有歌义。
入肾为呻。
虞曰。金母水子。子之见母。发娇呻声也。
自入为哭。
虞曰。肺主于秋。秋者愁也。其音商。商、伤也。故自入为哭也。
故知肺邪入心。为谵言妄语也。
吕曰。心主暑。肺主寒。（按根据前后注例。此下脱今心病以伤寒六字。）得之。故知肺邪入心以为病也。
其病身热。洒洒恶寒。甚则喘咳。
吕曰。身热者心。恶寒者肺。此二脏病证也。
其脉浮大而涩。
吕曰。浮大者心脉。涩者、肺脉也。
何以知中湿得之。然。当喜汗出不可止。何以言之。肾主湿。
丁曰。肾主水。水化五液也。虞曰。肾主水。水流湿。故五湿皆出于肾。
入肝为泣。
虞曰。悲哀动中则伤魂。魂伤则感而泪下。谓肺主悲。悲则金有余。木乃畏之。水者木之母。母忧子。故肝为泣也。
入心为汗。
虞曰。水火交泰。蒸之为汗。
入脾为液。
虞曰。土夫水妻。妻从夫则生涎也。
入肺为涕。
虞曰。北方生寒。寒生肾。今寒感皮毛。内合于肺。肺寒则涕。是知入肺为涕。
自入为唾。
虞曰。肾之脉上络于舌。故生唾也。离中六二爻是也。此则正经自病。
故知肾邪入心。为汗出不可止也。
吕曰。心主暑。肾主湿。今心病以伤湿得知。故知肾邪入心也。
其病身热。而小腹痛。足胫寒而逆。
吕曰。身热者心。小腹痛者肾。肾邪干心。此二脏病证也。
其脉沉濡而大。
吕曰。大者、心脉。沉濡者、肾脉也。
此五邪之法也。
五十难曰。病有虚邪。有实邪。有贼邪。有微邪。有正邪。何以别之。然。从后来者为虚邪。
丁曰。假令心病得肝脉来乘。是为虚邪。肝是母。心是子。子能令母虚。故云从后来者为虚邪。吕曰。心王之时。
脉当洪大而长。反得弦小而急。是肝王毕木传于心。夺心之王。是肝往乘心。故言从后来也。肝为心之母。母之乘子。
是为虚邪也。
从前来者为实邪。
丁曰。脾脉来乘。是为实邪。心是母。脾是子。而母能令子实。故云从前来者为实邪也。吕曰。谓心王得脾脉。心
王毕。当传脾。今心王未毕。是脾来逆夺其王。故言从前来也。脾者心之子。子之乘母。是为实邪。
从所不胜来者为贼邪。
丁曰。火所不胜于水。心病肾脉来乘。故为贼邪。吕曰。心王得肾脉。水胜火。故是为贼邪也。
从所胜来者为微邪。
丁曰。火所胜于金。心病肺脉来乘。故云微邪。吕曰。心王反得肺脉。火胜金。故为微邪也。
自病者为正邪。
丁曰。无他邪相乘。则为正邪。吕曰。心王之时。脉实强太过。反得虚微。为正邪也。
何以言之。假令心病。中风得之为虚邪。伤暑得之为正邪。
吕曰。心主暑。今心自病伤暑。故为正邪也。
饮食劳倦得之为实邪。
吕曰。从前来者。脾乘心也。脾主劳倦。故为实邪。
伤寒得之为微邪。
吕曰。从所胜来者。肺乘心也。肺主寒。又畏心。故为微邪。
中湿得之为贼邪。
吕曰。从所不胜来者。肾乘心也。肾主湿。水克火。故为贼邪也。丁曰。夫在天之寒。在地为水。在人为肾。肾主
水与寒。在天之风。在地为木。在人为肝。肝主风。在天之暄暑。在地为火。在人为心。心主暑。在天之燥。在地为金。
在人为肺。肺主燥。在天之湿。在地为土。在人为脾。脾主湿。此是天地人三才相通也。今经以寒合肺。以湿合肾。以
饮食劳倦合脾。此三者。义理稍差。未详其旨。
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。病欲得温而不欲得见人者。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。
丁曰。手三阴三阳应天。主暄暑燥病。即欲得寒也。然阳者、明也。是以欲得见人。阳为腑。故言病在腑也。足三
阴三阳应地。主风寒湿。故病即欲得温。阴主脏。故不欲见人也。诸浮躁者。病在手。诸静不躁者。病在足。
五十二难曰。腑脏发病。根本等不。然。不等也。其不等奈何。然。脏病者。止而不移其病。不离其处。
丁曰。脏病为阴。阴主静。故止而不移。吕曰。脏者阴。决于地。（按决字疑当作法。）故不移动也。
腑病者。仿佛贲向。上下行流。居处无常。
丁曰。腑病为阳。主动。故上下行流。居处无常。吕曰。腑、阳也。阳者法天。天有回旋不休。故病流转。居无常
处也。
故以此知脏腑根本不同也。
第四十八难说：人有三种虚证和三种实证，是什么情况呢？回答说：有脉象的虚实，有病证的虚实，有诊察（按诊）的虚实。
脉象的虚实：脉象濡软的是虚证，脉象紧、牢的是实证。
丁氏说：脉象缓而柔软称为濡，重按时有力称为牢实。杨氏说：重按时感觉像切绳子一样紧绷，称为紧。
病证的虚实：病邪由内出外为虚，病邪由外入内为实。
丁氏说：阴阳分别主宰内外。现在阳气不足，阴气外出乘袭，体内全是阴气，所以知道“出”属于虚证。阴气不足，阳气进入乘袭，体外全是阳气，所以知道“入”属于实证。杨氏说：呼气多吸气少，或吸气多呼气少，都是虚实之象。
言语方面的虚实：多言语的是虚证，沉默不语的是实证。
杨氏说：肺主声音，声音进入心转化为言语，所以多言语是虚证。肝主谋虑，如果邪气入心导致肝气郁结，就会沉默不语，这是实证，所以知道沉默不语属于实证。杨氏又说：脏气虚弱，精气耗脱，所以多言语；脏气充实，邪气旺盛，所以不想说话。
脉势的虚实：脉势缓弱的是虚证，脉势紧急的是实证。
丁氏说：阳主动躁，阴主静缓。阴盛则脉缓，阳盛则脉急，所以知道缓者为虚，急者为实。杨氏说：皮肉宽弛为虚，皮肤紧绷为实。
诊察（按诊）的虚实：皮肤濡软的是虚证。
杨氏说：皮肤濡软松弛。
外部疼痛内部舒适，是外实内虚。
杨氏说：轻手按压就痛，说明病在表浅，属于外实；重手按压感到舒适，说明病在深层，属于内虚。
内部疼痛外部舒适，是内实外虚。
杨氏说：重手按压就痛，说明病在深层，属于内实；轻手按压感到舒适，说明病在表浅，属于外虚。大凡病人，按压时疼痛的，都是实证；按压时感到舒适的，都是虚证。
所以说这就是虚实的表现。
杨氏说：这就是上述三种虚证和三种实证的证候。丁氏说：诊察时用心腹皮肤的内外来辨别，按压后疼痛停止的是虚证，按压后疼痛加剧的是实证，内外的道理是一样的。
第四十九难说：有正经自病，有五邪所伤，如何区别它们呢？回答说：经书说忧愁思虑会伤心。
丁氏说：心主血脉，忧愁思虑会导致心脉运行不畅，从而损伤心脏。吕氏说：心藏神，是五脏的主宰，聪明才智都源于心。过度忧劳，就会损伤心脏，导致心神衰弱。虞氏说：心主宰万物清明，如今忧愁思虑不停，所以损伤心脏。
形体受寒、饮食生冷会伤肺。
丁氏说：肺主皮毛，厌恶寒冷，所以形体受寒、饮用冷水会损伤肺脏。吕氏说：肺主皮毛，形体受寒即皮毛受寒；饮食生冷会损伤肺。肺主管接受水浆，水浆不可冷冻，肺又厌恶寒冷，所以说会受伤。
愤怒气逆，气向上冲而不能下行，会损伤肝脏。
丁氏说：肝主谋虑，胆主勇断，所以大怒会损伤肝脏。吕氏说：肝与胆互为表里，其气刚勇，所以主怒，怒则伤肝。虞氏说：《素问》说：怒则气血郁积于上焦，名为逆厥；又说大怒会导致呕血，这都是气逆造成的，所以会受伤。
饮食不节、劳累过度会损伤脾脏。
丁氏说：脾主五味，饮食美味而过食无度，劳累体力，倦怠肢体，所以损伤脾脏。吕氏说：饮食过饱，胃气充盈，脾络经常紧张；或者骑马跳跃，或者房劳导致脉络破裂，所以损伤脾脏。虞氏说：脾是仓廪之官，五味由此化生，摄取五味，化生五气，以滋养人体。如今因饮食劳倦导致自我损伤，所以圣人谨慎调和五味，使骨骼端正、筋脉柔和，遵循养生之道，才能长寿安康，怎么会自我损伤呢？养生之道，能不警惕吗？
久坐湿地、强力涉水，会损伤肾脏。
丁氏说：肾主腰部，腰是肾的府邸，久坐会导致肾气运行不畅，所以受损。肾穴在足底，名叫涌泉，居住在潮湿之地或涉水，所以会受损。“强力”指为了追求快感，强行进行房事，所以损伤肾脏。吕氏说：久坐湿地，比喻遭遇忧丧之事；强力，指举重拉弓；入水，指再次溺水，或者妇女月经未净强行房事。虞氏说：土主湿，这是自然之理。如今久坐湿地，外湿内侵肾脏，结合风寒，发作为瘴病。强力过度使用，必然导致自我损伤。《经脉别论》说：持重物远行，必伤肾脏。《生气通天论》说：因而强力，肾气乃伤，高骨（脊椎）乃坏。《经脉别论》说：渡水跌仆，气喘出于肾与胃。
这就是正经自病的情况。
丁氏说：这五种情况，都是正经自病，不是其他邪气所致。吕氏说：这些都是从脏腑内部自发疾病，不从外部侵入。虞氏说：吕氏说病从内脏自发，不从外来，这种观点不对。就像形寒饮冷伤肺，是说外寒感应皮毛，内合于肺，这是从外来的。还有冷饮入口，内伤于肺，也是从外来的。其余也都如此。圣人的大意是说，正经虚弱则腠理开泄，腠理开泄则外邪容易内侵，所以叫正经自病。
什么是五邪呢？回答说：有中风。
丁氏说：“中”就是伤的意思。说中风，是因为肝应风，主色邪，散布于五脏，表现为五色。吕氏说：肝主风。虞氏说：东方生风，风生木，恶风，又巽卦属木为风。
有伤暑。
丁氏说：伤暑，是指心应暑，主臭邪，散布于五脏，表现为五臭。吕氏说：心主暑。虞氏说：心火主暑，旺于夏季，暑即热。《素问》说：夏伤于暑，秋必疟疾。
有饮食劳倦。
丁氏说：脾应湿，主味邪，散入五脏表现为五味。吕氏说：脾主劳倦。虞氏说：正经自病中也提到饮食劳倦伤脾。现在五邪中也提到饮食劳倦，正经病是指正经虚弱，而伤饮食五邪病是指饮食损伤脾脏而致病。
有伤寒。
丁氏说：肺主燥，其令清切，恶寒，主声邪，散入五脏表现为五声。吕氏说：肺主寒。虞氏说：寒邪感应皮毛，所以叫伤寒。
有中湿。
丁氏说：肾应寒，主水邪，散入五脏表现为五液。吕氏说：肾主湿。虞氏说：水流向湿处的意思。
这就叫做五邪。
吕氏说：这五种病是从外部侵入的。虞氏说：这是五行相克的关系，作为邪气如下所述。
假如是心病，怎么知道是中风引起的呢？回答说：面色应当发红。为什么这么说呢？肝主五色。
虞氏说：巽卦为风，属木，所以主中风。木之精华敷布五色，形成五邪，如下所述。
传入肾呈现黑色。
虞氏说：肝邪传入肾（注：原文此处逻辑似有误，通常言入肝为黑，或肝邪在肾），面色黑。
肝成为心的邪气，所以知道面色当红。
吕氏说：肝主中风，心主伤暑。现在是心病由中风引起，所以知道是肝邪往伤心。
病症是身体发热，胁下胀满疼痛。
吕氏说：身热是心的症状，满痛是肝的症状，这是两脏的病证。虞氏说：心主伤暑，生病则身热；肝布于两胁，所以胁下胀满，这是肝乘心的表现。
脉象浮大而弦。
吕氏说：浮大是心脉，弦是肝脉，这是两脏脉象相应的表现。
怎么知道是伤暑引起的呢？回答说：应当厌恶异味。为什么这么说呢？心主嗅觉。
虞氏说：心属火，火能化物，产生五臭。
心病自病呈现焦臭味。
虞氏说：火性炎上，产生焦臭味，这叫正经自病。
所以知道心病是由伤暑引起的。（按：此“也”字应在下一句末尾，其他版本并脱去。）应当厌恶异味，病症是身体发热且烦躁，心痛，脉象浮大而散。
吕氏说：心主暑，现在伤暑，这是正经自病，没有中其他邪气。
怎么知道是饮食劳倦引起的呢？回答说：应当喜欢苦味。虚证不想吃东西，实证想吃东西。为什么这么说呢？脾主五味。
虞氏说：稼穑作甘，礼记说甘味能调和五味，所以脾主味。
传入肝呈现酸味。
虞氏说：脾主味，如果是邪气侵犯肝病，就会喜欢酸味。
传入心呈现苦味。
虞氏说：脾主味，如果是邪气侵犯心病，就会喜欢苦味。
传入肺呈现辛味。
虞氏说：脾主味，如果是邪气侵犯肺病，就会喜欢辛味。
传入肾呈现咸味。
虞氏说：脾主味，如果是邪气侵犯肾病，就会喜欢咸味。
自病呈现甘味。
虞氏说：土主稼穑，本经自病，就会喜欢甘味。
所以知道脾邪入心，表现为喜欢苦味。
吕氏说：心主伤热，脾主劳倦。现在是心病由饮食劳倦引起，所以知道是脾邪入心。
病症是身体发热，身体沉重，嗜睡，四肢无力收引。
吕氏说：身热是心的症状，体重是脾的症状，这是两脏的病证。
怎么知道是伤寒引起的呢？回答说：应当胡言乱语。为什么这么说呢？肺主声音。
虞氏说：金属撞击有声，所以五音出于肺。
传入肝表现为呼。
虞氏说：木畏金，所以呼。启玄子说：呼也可以啸。
传入心表现为言。
虞氏说：这里说的言，《素问》说是笑，谓金火相当，如夫妇相见，所以言笑。
传入脾表现为歌。
虞氏说：土是金之母，母子相见，所以有歌的意义。
传入肾表现为呻。
虞氏说：金是水之母，子见母，发出娇弱的呻吟声。
自病表现为哭。
虞氏说：肺主秋，秋者愁也，其音商，商即伤，所以自病表现为哭。
所以知道肺邪入心，表现为胡言乱语。
吕氏说：心主暑，肺主寒。（按根据前后注释体例，此处脱漏了“今心病以伤寒”六字。）引起，所以知道肺邪入心成为病证。
病症是身体发热，瑟瑟恶寒，严重时气喘咳嗽。
吕氏说：身热是心的症状，恶寒是肺的症状，这是两脏的病证。
怎么知道是中湿引起的呢？回答说：应当喜欢汗出不止。为什么这么说呢？肾主湿。
丁氏说：肾主水，水化为五液。虞氏说：肾主水，水流湿，所以五湿都出于肾。
传入肝表现为泣（泪）。
虞氏说：悲哀动中则伤魂，魂伤则感而泪下。谓肺主悲，悲则金有余，木乃畏之。水是木之母，母忧子，所以肝表现为泣。
传入肺表现为涕。
虞氏说：北方生寒，寒生肾，今寒感皮毛，内合于肺，肺寒则涕，所以知道入肺为涕。
自病表现为唾。
虞氏说：肾之脉上络于舌，所以生唾。离卦六二爻是也，这是正经自病。
所以知道肾邪入心，表现为汗出不止。
吕氏说：心主暑，肾主湿。现在是心病由伤湿得知，所以知道是肾邪入心。
病症是身体发热，小腹痛，足胫寒冷逆冷。
吕氏说：身热是心的症状，小腹痛是肾的症状，肾邪干犯心，这是两脏的病证。
这就是五邪的方法。
第五十一难说：病有虚邪，有实邪，有贼邪，有微邪，有正邪，如何区别它们呢？回答说：从后来者为虚邪。
丁氏说：假如心病得到肝脉来乘袭，这是虚邪。肝是母，心是子，子能令母虚，所以叫从后来者为虚邪。吕氏说：心王之时，脉应当洪大而长，反而得到弦小而急的脉，这是肝王之气毕，木传于心，夺取心的王气，是肝往乘心，所以叫从后来。肝为心之母，母之乘子，是为虚邪。
从前来者为实邪。
丁氏说：脾脉来乘袭，这是实邪。心是母，脾是子，母能令子实，所以叫从前来者为实邪。吕氏说：谓心王得到脾脉，心王之气毕，应当传脾，现在心王之气未毕，是脾来逆夺其王气，所以叫从前来。脾是心之子，子之乘母，是为实邪。
从所不胜方来者为贼邪。
丁氏说：火所不胜于水，心病得肾脉来乘袭，所以为贼邪。吕氏说：心王得肾脉，水胜火，所以为贼邪。
从所胜方来者为微邪。
丁氏说：火所胜于金，心病得肺脉来乘袭，所以叫微邪。吕氏说：心王反得肺脉，火胜金，所以为微邪。
自病者为正邪。
丁氏说：没有其他邪气相乘，就是正邪。吕氏说：心王之时，脉实强太过，反而变得虚微，为正邪。
为什么这么说呢？假如是心病，中风得之为虚邪，伤暑得之为正邪。
吕氏说：心主暑，现在心自病伤暑，所以为正邪。
饮食劳倦得之为实邪。
吕氏说：从前来者，是脾乘心。脾主劳倦，所以为实邪。
伤寒得之为微邪。
吕氏说：从所胜来者，是肺乘心。肺主寒，又畏心，所以为微邪。
中湿得之为贼邪。
吕氏说：从所不胜来者，是肾乘心。肾主湿，水克火，所以为贼邪。丁氏说：在天之寒，在地为水，在人为肾，肾主水与寒；在天之风，在地为木，在人为肝，肝主风；在天之暄暑，在地为火，在人为心，心主暑；在天之燥，在地为金，在人为肺，肺主燥；在天之湿，在地为土，在人为脾，脾主湿。这是天地人三才相通。现在经书以寒合肺，以湿合肾，以饮食劳倦合脾，这三者，义理稍有差异，不详其旨意。
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，各不相同，病在哪个脏腑呢？回答说：病想要寒冷又想见人的，病在腑。病想要温暖又不想见人的，病在脏。为什么这么说呢？腑属阳，阳病想要寒冷，又想见人。脏属阴，阴病想要温暖，又想关上门独自居住，厌恶听到人声。所以以此区别脏腑之病。
丁氏说：手三阴三阳应天，主暄暑燥病，所以想要寒冷。然而阳者明也，所以想见人。阳为腑，所以说病在腑。足三阴三阳应地，主风寒湿，所以病想要温暖。阴主脏，所以不想见人。诸浮躁者，病在手经；诸静不躁者，病在足经。
第五十二难说：腑脏发病，根本是否相同？回答说：不相同。它们的不同在哪里呢？回答说：脏病，静止而不移动，病不离其处。
丁氏说：脏病属阴，阴主静，所以静止而不移动。吕氏说：脏者阴，决于地（按：“决”字疑当作“法”），所以不移动。
腑病，仿佛奔趋向前，上下流动，居处无常。
丁氏说：腑病属阳，主动，所以上下流动，居处无常。吕氏说：腑属阳，阳者法天，天有回旋不休，所以病流转，居处无常。
所以以此知道脏腑的根本不同。
Chapter 48 states: Humans have three types of deficiency syndromes (Xu Zheng) and three types of excess syndromes (Shi Zheng). What does this mean? The response is: There are pulse deficiencies and excesses, disease deficiencies and excesses, and diagnostic (palpation) deficiencies and excesses.
Regarding pulse deficiencies and excesses: A soft and floating pulse indicates a deficiency syndrome; a tight or deep-firm pulse indicates an excess syndrome.
Master Ding says: A pulse that is slow and soft is called "Ru" (Soft); one that is forceful upon heavy pressure is called "Lao" (Deep-firm). Master Yang says: When pressed, it feels like cutting a rope, which is called "Jin" (Tight).
Regarding disease deficiencies and excesses: Pathogens moving from the interior to the exterior indicate deficiency; pathogens moving from the exterior to the interior indicate excess.
Master Ding says: Yin and Yang govern the interior and exterior respectively. If Yang Qi is insufficient and Yin Qi moves outward to invade, the interior becomes purely Yin, thus "moving out" signifies deficiency. If Yin Qi is insufficient and Yang Qi enters to invade, the exterior becomes purely Yang, thus "moving in" signifies excess. Master Yang adds: Excessive exhalation with insufficient inhalation, or excessive inhalation with insufficient exhalation, are signs of deficiency and excess.
Regarding speech: Excessive talking indicates deficiency; silence indicates excess.
Master Yang says: The Lung governs sound, and sound entering the Heart transforms into speech; thus, excessive talking indicates deficiency. The Liver governs planning and deliberation; if pathogenic factors enter the Heart causing Liver Qi stagnation, one remains silent, which is an excess syndrome. Therefore, silence indicates excess. Master Yang further states: When Zang Qi is deficient and Essence-Qi is depleted, there is excessive talking; when Zang Qi is solid and pathogenic factors are abundant, there is no desire to speak.
Regarding pulse momentum: A slow/weak pulse momentum indicates deficiency; a rapid/tense pulse momentum indicates excess.
Master Ding says: Yang governs agitation/movement, while Yin governs stillness/slowness. Yin abundance leads to a slow pulse, Yang abundance leads to a tense pulse; thus, slow indicates deficiency and tense indicates excess. Master Yang says: Loose skin and flesh indicate deficiency; tight skin indicates excess.
Regarding diagnostic (palpation) deficiencies and excesses: Soft and flaccid skin indicates deficiency.
Master Yang says: The skin is soft and relaxed.
Firm and rigid skin and flesh indicate excess.
Master Yang says: The skin and flesh are firm and strong.
Itching indicates deficiency.
Master Yang says: The body itches due to deficiency.
Pain indicates excess.
Master Yang says: Any painful area on the body belongs to excess.
Pain on the exterior but comfort on the interior indicates Exterior Excess and Interior Deficiency.
Master Yang says: Pain upon light pressure indicates Exterior Excess because the disease is superficial. Comfort upon heavy pressure indicates Interior Deficiency because the disease is deep.
Pain on the interior but comfort on the exterior indicates Interior Excess and Exterior Deficiency.
Master Yang says: Pain upon heavy pressure indicates Interior Excess because the disease is deep. Comfort upon light pressure indicates Exterior Deficiency because the disease is superficial. Generally, for any patient, pain upon palpation indicates excess; comfort upon palpation indicates deficiency.
Thus, these are the manifestations of deficiency and excess.
Master Yang says: These are the aforementioned three deficiencies and three excesses. Master Ding says: During diagnosis, by examining the heart, abdomen, and skin internally and externally, if pain stops upon pressing, it is deficiency; if pain worsens upon pressing, it is excess. The principle is the same for internal and external conditions.
Chapter 49 states: There are diseases originating from the regular meridians themselves (Zheng Jing Zi Bing) and injuries caused by the Five Pathogenic Factors (Wu Xie). How can they be distinguished? The response is: The Classics state that worry and overthinking damage the Heart.
Master Ding says: The Heart governs the vessels. Worry and overthinking cause the Heart vessels to fail to circulate freely, thereby damaging the Heart. Master Lu says: The Heart houses the Spirit (Shen) and is the ruler of the five Zang organs; wisdom and intelligence all originate from the Heart. Extreme worry and fatigue damage the Heart, leading to weak Spirit. Master Yu says: The Heart governs clarity in handling matters. Since worry and overthinking ceaselessly continue, the Heart is damaged.
Physical cold exposure and drinking cold beverages damage the Lungs.
Master Ding says: The Lungs govern the skin and hair and dislike cold. Therefore, physical cold and cold drinks injure the Lungs. Master Lu says: The Lungs govern the skin and hair; physical cold means the skin and hair are cold; drinking cold damages the Lungs. The Lungs receive fluids, but fluids should not be frozen/cold, and the Lungs dislike cold, hence injury occurs.
Anger and rebellious Qi rising upward without descending damage the Liver.
Master Ding says: The Liver governs planning, and the Gallbladder governs courage and decision-making. Thus, extreme anger damages the Liver. Master Lu says: The Liver and Gallbladder are interior-exterior pairs with courageous Qi, governing anger; anger causes injury. Master Yu says: *Su Wen* states: Anger causes blood to stagnate in the upper Jiao, named Ni Jue (Rebellious Cold); it also states that extreme anger causes vomiting of blood, resulting from rebellious Qi, hence injury.
Improper diet and overwork damage the Spleen.
Master Ding says: The Spleen governs the five flavors. Delicious food eaten excessively without restraint, along with physical labor and limb fatigue, damages the Spleen. Master Lu says: Overeating fills the Stomach Qi, keeping the Spleen collaterals constantly tense; or riding horses/jumping, or sexual exhaustion causing collateral rupture, damages the Spleen. Master Yu says: The Spleen is the official of granaries, from which the five flavors emerge. It takes the five flavors, transforms them into five Qi, and nourishes the body. Now, self-injury due to diet and overwork occurs; therefore, sages carefully harmonize the five flavors, ensuring straight bones and flexible tendons, following the Way, to achieve longevity. How could one self-injure? One must beware of the way of health preservation.
Sitting long in damp places and forcing entry into water damages the Kidneys.
Master Ding says: The Kidneys govern the waist, which is the mansion of the Kidneys. Long sitting prevents Kidney Qi from circulating freely, causing damage. The Kidney acupoint at the sole of the foot is named Yongquan (Bubble Spring). Dwelling in damp places or wading into water causes damage. "Forcing strength" refers to seeking pleasure through forced intercourse, damaging the Kidneys. Master Lu says: Sitting long in damp places metaphorically refers to encountering mourning/grief; "forcing strength" refers to lifting weights or drawing bows; "entering water" refers to drowning again, or forced intercourse during menstruation. Master Yu says: Earth governs dampness, which is natural law. Sitting long in damp places allows external dampness to invade the Kidneys internally, combining with wind-cold to manifest as miasma disease. Overuse of strength inevitably leads to self-injury. *Jing Mai Bie Lun* states: Carrying heavy loads and traveling far will surely injure the Kidneys. *Sheng Qi Tong Tian Lun* states: Due to forced strength, Kidney Qi is injured, and the high bones (spine) are destroyed. *Jing Mai Bie Lun* states: Wading water and falling results in panting originating from the Kidneys and Stomach.
This constitutes the self-disease of the regular meridians.
Master Ding says: These five cases are all self-diseases of the regular meridians, not caused by other pathogens. Master Lu says: These all arise spontaneously from within the Zang organs, not invading from outside. Master Yu says: Master Lu's view that the disease originates internally and not externally is incorrect. For example, physical cold and cold drinks damaging the Lungs implies external cold affecting the skin/hair and merging internally with the Lungs; this comes from outside. Also, cold drinks entering the mouth and injuring the Lungs internally also come from outside. The rest are similar. The sage's main point is that when the regular meridians are deficient, the Cou Li (interstices) open; when Cou Li open, external pathogens easily invade internally, hence it is called "self-disease of the regular meridians."
What are the Five Pathogenic Factors? The response is: There is Wind Strike (Zhong Feng).
Master Ding says: "Zhong" means injury. Speaking of Wind Strike, the Liver corresponds to Wind, governs color pathogens, scatters into the five Zang organs, manifesting as five colors. Master Lu says: The Liver governs Wind. Master Yu says: The East generates Wind; Wind generates Wood; one dislikes wind; the Xun trigram belongs to Wood and represents Wind.
There is Heatstroke Injury (Shang Shu).
Master Ding says: Heatstroke injury means the Heart corresponds to Summerheat, governs odor pathogens, scatters into the five Zang organs, manifesting as five odors. Master Lu says: The Heart governs Summerheat. Master Yu says: Heart Fire governs Summerheat, flourishing in summer; Summerheat is heat. *Su Wen* states: Injuring oneself to Summerheat in summer leads to Malaria in autumn.
There is Diet and Overwork.
Master Ding says: The Spleen corresponds to Dampness, governs flavor pathogens, scatters into the five Zang organs manifesting as five flavors. Master Lu says: The Spleen governs overwork. Master Yu says: Self-disease of regular meridians also mentions diet and overwork damaging the Spleen. Now, the Five Pathogenic Factors also mention diet and overwork. Regular meridian disease refers to regular meridian deficiency, while the disease of injuring diet via the Five Pathogens refers to food/drink injuring the Spleen and causing illness.
There is Cold Damage (Shang Han).
Master Ding says: The Lungs govern Dryness, their command is clear and cutting, they dislike cold, and govern sound pathogens, scattering into the five Zang organs manifesting as five sounds. Master Lu says: The Lungs govern Cold. Master Yu says: Cold pathogens affect the skin/hair, hence it is called Cold Damage.
There is Dampness Strike (Zhong Shi).
Master Ding says: The Kidneys correspond to Cold, govern Water pathogens, scatter into the five Zang organs manifesting as five fluids. Master Lu says: The Kidneys govern Dampness. Master Yu says: It is the meaning of water flowing toward dampness.
These are called the Five Pathogenic Factors.
Master Lu says: These five diseases come from outside. Master Yu says: This is the mutual overcoming of the Five Phases, acting as pathogens as described below.
Suppose there is Heart disease. How do we know it was caused by Wind Strike? The response is: The complexion should be red. Why say so? The Liver governs colors.
Master Yu says: The Xun trigram is Wind, belonging to Wood, thus governing Wind Strike. The essence of Wood spreads five colors, forming the five pathogens as follows.
Self-disease of Wood manifests as Green/Cyan.
Master Yu says: This is the self-disease of the Wood Meridian.
Entering the Heart manifests as Red.
Master Yu says: Liver pathogen entering the Heart makes the complexion red.
Entering the Spleen manifests as Yellow.
Master Yu says: Liver pathogen entering the Spleen makes the complexion yellow.
Entering the Lungs manifests as White.
Master Yu says: Liver pathogen entering the Lungs makes the complexion white.
Entering the Kidneys manifests as Black.
Master Yu says: Liver pathogen entering the Kidneys makes the complexion black.
The Liver becomes the pathogen of the Heart, so the complexion is known to be red.
Master Lu says: The Liver governs Wind Strike, and the Heart governs Heatstroke Injury. Now, Heart disease is caused by Wind Strike, so we know it is Liver pathogen invading the Heart.
Symptoms include body heat, fullness and pain under the ribs.
Master Lu says: Body heat is a Heart symptom; fullness and pain are Liver symptoms. These are the syndromes of the two Zang organs. Master Yu says: The Heart governs Heatstroke Injury; illness brings body heat. The Liver distributes across the hypochondrium, hence rib fullness; this is Liver overacting on the Heart.
The pulse is Floating, Large, and Wiry.
Master Lu says: Floating and Large is the Heart pulse; Wiry is the Liver pulse. This is the corresponding pulse manifestation of the two Zang organs.
How do we know it was caused by Heatstroke Injury? The response is: One should dislike foul odors. Why say so? The Heart governs smell.
Master Yu says: The Heart is Fire; Fire transforms things, producing five odors.
Self-disease of Fire manifests as Scorched Odor.
Master Yu says: Fire nature flares upward, producing scorched odor. This is called self-disease of the regular meridian.
Entering the Spleen manifests as Fragrant Odor.
Master Yu says: Fire transforms into Earth, the odor is fragrant.
Entering the Liver manifests as Pungent/Fishy Odor (Sao).
Master Yu says: Fire transforms into Wood, the odor is pungent/fishy.
Entering the Kidneys manifests as Putrid Odor.
Master Yu says: Fire transforms into Water, the odor is putrid.
Entering the Lungs manifests as Raw/Fishy Odor (Xing).
Master Yu says: Fire transforms into Metal, the odor is raw/fishy.
Thus, we know Heart disease is caused by Heatstroke Injury. (Note: The character "ye" here should be at the end of the next sentence; other versions omit it.) One should dislike foul odors. Symptoms include body heat with vexation, Heart pain, and a Floating, Large, and Scattered pulse.
Master Lu says: The Heart governs Summerheat. Now, injuring oneself to Summerheat is self-disease of the regular meridian, not struck by other pathogens.
How do we know it was caused by Diet and Overwork? The response is: One should desire bitter taste. Deficiency means no desire to eat; Excess means desire to eat. Why say so? The Spleen governs flavors.
Master Yu says: Sowing and reaping produce Sweetness. The Book of Rites states sweetness accepts harmony, thus the Spleen governs flavor.
Entering the Liver manifests as Sour Taste.
Master Yu says: The Spleen governs flavor. If pathogen invades Liver disease, one desires sour taste.
Entering the Heart manifests as Bitter Taste.
Master Yu says: The Spleen governs flavor. If pathogen invades Heart disease, one desires bitter taste.
Entering the Lungs manifests as Acrid/Pungent Taste.
Master Yu says: The Spleen governs flavor. If pathogen invades Lung disease, one desires acrid taste.
Entering the Kidneys manifests as Salty Taste.
Master Yu says: The Spleen governs flavor. If pathogen invades Kidney disease, one desires salty taste.
Self-disease manifests as Sweet Taste.
Master Yu says: Earth governs sowing and reaping; self-disease of the original meridian makes one desire sweet taste.
Thus, we know Spleen pathogen entering the Heart manifests as desiring bitter taste.
Master Lu says: The Heart governs Heat/Injury, and the Spleen governs overwork. Now, Heart disease is caused by diet and overwork, so we know it is Spleen pathogen entering the Heart.
Symptoms include body heat, heavy body, drowsiness, and inability to gather/strengthen the four limbs.
Master Lu says: Body heat is a Heart symptom; heavy body is a Spleen symptom. These are the syndromes of the two Zang organs.
The pulse is Floating, Large, and Slow.
Master Lu says: Floating and Large is the Heart pulse; Slow is the Spleen pulse.
How do we know it was caused by Cold Damage? The response is: One should talk deliriously and妄语 (nonsense). Why say so? The Lungs govern sound.
Master Yu says: Metal striking produces sound, thus the five tones originate from the Lungs.
Entering the Liver manifests as Calling Out (Hu).
Master Yu says: Wood fears Metal, thus calling out. Qixuanzi says: Calling out can also be whistling.
Entering the Heart manifests as Speech (Yan).
Master Yu says: Here "speech," *Su Wen* says "laughter." It means Metal and Fire are balanced, like husband and wife meeting, hence speech and laughter.
Entering the Spleen manifests as Singing (Ge).
Master Yu says: Earth is the mother of Metal; mother and son meet, hence the meaning of singing.
Entering the Kidneys manifests as Moaning (Shen).
Master Yu says: Metal is the mother of Water; child sees mother, emitting delicate moaning sounds.
Self-disease manifests as Crying (Ku).
Master Yu says: The Lungs govern Autumn; Autumn is sorrow. Its tone is Shang, Shang means injury. Thus, self-disease manifests as crying.
Thus, we know Lung pathogen entering the Heart manifests as delirious speech.
Master Lu says: The Heart governs Summerheat, and the Lungs govern Cold. (Note: Based on preceding commentary style, six characters "now Heart disease due to Cold Damage" are missing here.) Causing it, we know Lung pathogen entering the Heart becomes illness.
Symptoms include body heat, shivering aversion to cold, and severe panting/coughing.
Master Lu says: Body heat is a Heart symptom; aversion to cold is a Lung symptom. These are the syndromes of the two Zang organs.
The pulse is Floating, Large, and Choppy.
Master Lu says: Floating and Large is the Heart pulse; Choppy is the Lung pulse.
How do we know it was caused by Dampness Strike? The response is: One should desire unstoppable sweating. Why say so? The Kidneys govern dampness.
Master Ding says: The Kidneys govern Water; Water transforms into five fluids. Master Yu says: The Kidneys govern Water; water flows to dampness, thus all five dampnesses originate from the Kidneys.
Entering the Liver manifests as Weeping/Tears (Qi).
Master Yu says: Sorrow moving internally injures Hun (Ethereal Soul). When Hun is injured, sensation causes tears to fall. The Lungs govern sorrow; sorrow means Metal is excessive, Wood fears it. Water is the mother of Wood; the mother worries about the child, thus the Liver manifests as weeping.
Entering the Heart manifests as Sweat (Han).
Master Yu says: Water and Fire interact and transform, steaming into sweat.
Entering the Spleen manifests as Fluid/Saliva (Ye).
Master Yu says: Earth is husband, Water is wife; wife follows husband, generating saliva.
Entering the Lungs manifests as Nasal Discharge (Ti).
Master Yu says: North generates Cold; Cold generates Kidneys. Now cold affects skin/hair, merging internally with Lungs. Lung cold causes nasal discharge, thus entering Lungs manifests as nasal discharge.
Self-disease manifests as Spittle (Tuo).
Master Yu says: The Kidney meridian connects to the tongue, thus generating spittle. This corresponds to the Six-Two line of the Li Trigram. This is self-disease of the regular meridian.
Thus, we know Kidney pathogen entering the Heart manifests as unstoppable sweating.
Master Lu says: The Heart governs Summerheat, and the Kidneys govern Dampness. Now, Heart disease is known from injuring dampness, so we know it is Kidney pathogen entering the Heart.
Symptoms include body heat, lower abdominal pain, and cold/reversal in the calves and feet.
Master Lu says: Body heat is a Heart symptom; lower abdominal pain is a Kidney symptom. Kidney pathogen interfering with the Heart; these are the syndromes of the two Zang organs.
The pulse is Deep, Soft, and Large.
Master Lu says: Large is the Heart pulse; Deep and Soft is the Kidney pulse.
This is the method of the Five Pathogenic Factors.
Chapter 51 states: Diseases include Deficient Pathogen (Xu Xie), Excess Pathogen (Shi Xie), Robber Pathogen (Ze Xie), Minor Pathogen (Wei Xie), and Correct Pathogen (Zheng Xie). How to distinguish them? The response is: Coming from the later stage is Deficient Pathogen.
Master Ding says: Suppose Heart disease receives Liver pulse invasion; this is Deficient Pathogen. Liver is Mother, Heart is Child. The child can make the mother deficient, hence "coming from the later" is Deficient Pathogen. Master Lu says: When the Heart is King (dominant), the pulse should be Hong Da Chang (Vast, Large, Long). Instead, getting Xian Xiao Ji (Wiry, Small, Rapid) means Liver dominance has ended, Wood transmits to Heart, seizing Heart's dominance. This is Liver invading Heart, hence "coming from the later." Liver is Heart's Mother; Mother invading Child is Deficient Pathogen.
Coming from the earlier stage is Excess Pathogen.
Master Ding says: Spleen pulse invasion is Excess Pathogen. Heart is Mother, Spleen is Child. The mother can make the child excess, hence "coming from the earlier" is Excess Pathogen. Master Lu says: When Heart is King, receiving Spleen pulse. Heart dominance ends, should transmit to Spleen. Now Heart dominance hasn't ended, Spleen comes to reverse-seize its dominance, hence "coming from the earlier." Spleen is Heart's Child; Child invading Mother is Excess Pathogen.
Coming from the non-conquering direction is Robber Pathogen.
Master Ding says: Fire is not conquered by Water. Heart disease receiving Kidney pulse invasion is Robber Pathogen. Master Lu says: Heart King receiving Kidney pulse; Water conquers Fire, hence Robber Pathogen.
Coming from the conquering direction is Minor Pathogen.
Master Ding says: Fire conquers Metal. Heart disease receiving Lung pulse invasion is Minor Pathogen. Master Lu says: Heart King contrary-receiving Lung pulse; Fire conquers Metal, hence Minor Pathogen.
Self-disease is Correct Pathogen.
Master Ding says: Without other pathogens invading, it is Correct Pathogen. Master Lu says: When Heart is King, pulse is overly solid/strong, suddenly becoming deficient/weak, this is Correct Pathogen.
Why say so? Suppose Heart disease: Wind Strike makes it Deficient Pathogen; Heatstroke Injury makes it Correct Pathogen.
Master Lu says: The Heart governs Summerheat. Now Heart self-disease from Summerheat is Correct Pathogen.
Diet and Overwork make it Excess Pathogen.
Master Lu says: Coming from the earlier stage is Spleen invading Heart. Spleen governs overwork, hence Excess Pathogen.
Cold Damage makes it Minor Pathogen.
Master Lu says: Coming from the conquering direction is Lung invading Heart. Lung governs Cold, and fears Heart, hence Minor Pathogen.
Dampness Strike makes it Robber Pathogen.
Master Lu says: Coming from the non-conquering direction is Kidney invading Heart. Kidney governs Dampness; Water conquers Fire, hence Robber Pathogen. Master Ding says: Cold in Heaven is Water on Earth, Kidney in Man; Kidney governs Water and Cold. Wind in Heaven is Wood on Earth, Liver in Man; Liver governs Wind. Summerheat in Heaven is Fire on Earth, Heart in Man; Heart governs Summerheat. Dryness in Heaven is Metal on Earth, Lung in Man; Lung governs Dryness. Dampness in Heaven is Earth on Earth, Spleen in Man; Spleen governs Dampness. This is the connection of Heaven, Earth, and Man. Now the Classic matches Cold with Lung, Dampness with Kidney, and Diet/Overwork with Spleen. These three have slight discrepancies in principle, and their intent is unclear.
Chapter 51 states: Some patients desire warmth, some desire cold, some desire to see people, some do not desire to see people, each different. Which Zang or Fu organ is diseased? The response is: Disease desiring cold and wanting to see people is in the Fu organs. Disease desiring warmth and not wanting to see people is in the Zang organs. Why say so? Fu organs are Yang. Yang diseases desire cold and want to see people. Zang organs are Yin. Yin diseases desire warmth and want to close doors and stay alone, disliking human voices. Thus, we distinguish Zang and Fu diseases.
Master Ding says: Hand Three Yin and Three Yang correspond to Heaven, governing warm/summer/dry diseases, thus desiring cold. However, Yang is brightness, thus wanting to see people. Yang is Fu, hence disease in Fu. Foot Three Yin and Three Yang correspond to Earth, governing wind/cold/damp, thus desiring warmth. Yin governs Zang, thus not wanting to see people. Agitated/restless diseases are in Hand meridians; quiet/non-agitated diseases are in Foot meridians.
Chapter 52 states: Do Zang and Fu diseases have the same root? The response is: They are not equal. How are they unequal? The response is: Zang diseases are static and do not move; the disease does not leave its location.
Master Ding says: Zang diseases are Yin; Yin governs stillness, thus static and unmoving. Master Lu says: Zang is Yin, determined by Earth (Note: "Jue" likely a typo for "Fa" - method/law), thus not moving.
Fu diseases are like running forward, flowing up and down, having no fixed residence.
Master Ding says: Fu diseases are Yang; Yang governs movement, thus flowing up and down, having no fixed residence. Master Lu says: Fu is Yang; Yang follows Heaven. Heaven rotates incessantly, thus disease flows and has no fixed residence.
Thus, we know the roots of Zang and Fu are different.