十三条 脾中风者。翕翕发热。形如醉人。腹中烦重。皮目 而短气。
足太阴脾经。外走足内 之上侧。故脾从经穴而内中风也。风邪化热。由内而外蒸。故翕翕发热。形如醉人
者。就其面赤。及肢体倦怠而言。盖面为阳明胃腑之应。脾移热于胃。故面赤如醉人。又肢体者。脾阳之所贯
也。脾中真气。受伤于风热。则真阳痿顿。故肢体倦怠如醉人。热伤津液则烦。土气沉困则重。腹中为脾胃之
应。脾热。故液干气滞耳。皮者。周身之皮肉。目、指眼眶而言。经气虚而灌注不匀。则移宫易位而 动。皮目俱
者。脾病而气馁于外也。脾肺同治手足之太阴。而相为呼应。故息道深长。今肺吸而脾中邪实。艰于纳
受。故短气也。细玩全文。自是活症。亦不出方者。岂因风寒论中。已列借主桂枝之例乎。肝肺及心三脏。中
风条后。俱有中寒论。脾脏独不及者。盖因脾中寒之大法。已详腹满中。故不再论。同志者。不得认为漏且缺也。
十四条 脾死脏。浮之大坚。按之如覆杯。洁洁状如摇者死。
脾为黄泉之己土。其一种生物之善气。和柔相杂。不可得而见者也。若其脉中空散漫而大浮土灰尘之象。
真阴之欲绝也。凝冱切责而坚结土沙石之象。真阳之欲绝也。浮之、为在上在外之应。浮之大坚。是阴阳不
能蒸被之诊矣。如覆杯者。即上文大坚。而加以形圆、体空之象。盖形圆。则关下无来踪。关上无去迹。体空。则
底面无根脚。按之如覆杯。是为离绝之土矣。夫离绝而犹见余动者。譬之全蟹已经熟食。而生遗之腿足。其
动机尚在之应。故必死也。洁洁。孤洁无与之貌。摇者。言上下不见来去。底面不见鼓发。但觉从两旁摇动而
已。状之覆杯。不亦宜乎。此句。又仲景自注覆杯之义也。
十五条 趺阳脉浮而涩。浮则胃气强。涩则小便数。浮涩相搏。大便则坚。其脾为约。麻子仁丸主之。
麻子仁丸方 麻子仁（二升） 杏仁（一升） 芍药（半斤） 大黄（一斤） 枳实（一斤） 浓朴（半斤）
上六味。末之。炼蜜和丸如梧子大。饮服十丸。日三。以知为度。
此条见伤寒阳明篇。入此者。从脾病之类也。论条方意。详伤寒中。以脾家治例。不论风寒杂症俱同也。
十六条 肾着之病。其人身体重。腰中冷。如坐水中。形如水状。反不渴。小便自利。饮食如故。病属下焦。
身劳汗出。
衣里冷湿。久久得之。腰以下冷痛。腹重如带五千钱。甘姜苓术汤主之。
甘草干姜茯苓白术汤方（亦名肾着汤。）
甘草（二两） 干姜（四两） 茯苓（四两） 白术（二两）
上四味。以水五升。煮取三升。分温三服。腰中即温。
肾着者。寒湿之邪。着于肾而不去之义。盖肾为水脏。其气多寒。常与寒湿之外邪相召。故入则直着于肾者。
从其类也。肾中之真气。上贯周身。而轻便干健者。以先天之丙火胎于水。而庚金亦伏于水故也。寒湿着之。
寒则阳微。湿则气滞而不上贯。则失其轻便干健之用。故身体重也。腰为肾之府。肾着寒。故腰中冷。湿为水
之渐。肾着湿。故腰以下如坐水中。三句。言病患之自觉者。可从问诊而得之也。阳虚而寒着之。则浮肿如水
状。气虚而湿着之。则黄润如水状。故曰如水。而非真水也。夫如水而知其非水者。盖因不渴。则水之入者既
少。小便自利。则水之出者又多。而中无所蓄矣。三句。言旁人之共见者。又可从望诊而得之也。脏腑之阳虚
者。俱能病积滞痹着等候。身重如水。上焦之肺与膻中。不能呵嘘水道。及中焦之脾胃。不能分理。俱能病此。
而何独知为肾着乎。盖以其人之饮如故。故知非属上焦。食如故。故知非属中焦。而属下焦之肾脏矣。二句。
言辨肾着之确切处。里字。当是裹字之讹。肾为强力之官。所以任劳者也。身劳汗出。则肾虚矣。衣冷裹湿。则
冷湿之邪。乘虚而着之。况担延久久乎。二句。推言肾着之病因也。冷痛者。阴沁切责。冷气逼阳之象。腹重者。
坚癖沉坠。湿气下注之象。如五千钱者。正气不能上提。故着久而愈觉其重耳。二症。就上文之腰中冷。身体
重。而甚言之耳。主本汤者。原为肾中冷湿。而所以温之、燥之者。其用药注意。却又在中焦之脾胃。故君辛热
之干姜。以除冷。淡渗之茯苓、以除湿。而以甘温守中之甘草、白术佐之。盖因暖土。可以祛寒。而燥土。尤能胜
湿故也。观夫阳春回于大地。而幽壑冰消。堤岸固于江乡。而浸淫患息。仲景制方之意。概可知矣。他脏之
例。先言风寒。次及死脏。此独缺之者。以详少阴伤寒之直中也。
十七条 肾死脏。浮之坚。按之乱如转丸。益下入尺中者死。
万物以阳火为绵软。胶饧糕饼之属于蒸烙。可证也。浮之坚。是水无阳而冰冻之象。按之如转丸者。按处仍
见坚硬。更加无来无去。而形圆体滚。即脾脏如覆杯而微较数小之状。但彼则如两边动摇。故曰摇。此则如
上下圆转。故曰乱、曰转。是水泡上泛。水气底散之象。下入尺中。则其气已尽。不能远出。常有就地涣散之义。
故死。第他脏之死。俱合阴阳而两言之。肾脏独言阳绝者。以肾为水寒之脏。其阳气尤为贵重故也。
十八条 问曰。三焦竭部。上焦竭善噫。何谓也。师曰。上焦受中焦气。未和。不能消谷。故能噫耳。
下焦竭。即遗溺失便。其气不和。不能自禁制。不须治。久则愈。
竭者。非竭尽之谓。盖指一时虚乏而言。观下文未和。及不须治自见。噫。嗳气也。三焦竭部。当是古医经之篇
目。长沙借为问答。以发其奥。曰。三焦竭之篇部中。有云上焦竭则善噫者。夫噫出于脾胃。似在中焦矣。而谓
由于上焦者何也。不知谷食之在中焦。虽由脾胃之运化。而实成于上焦之呵嘘蒸被。二便之在下焦。虽由
脾胃之提挈。而实成于下焦之关键纵送者也。故曰上焦氤氲之气。虽受之于中焦腐化中。而其下炎之用。
复能运饮熟谷。以为中焦之助。譬之太阳。聚万物之晶光。而还以照临万物。譬之人主。总万民之推奉。而还
以君临万民之道也。若此气一时虚乏而未和。则不能助理消谷。而谷停于胃。谷停则败。败气上熏心主。故
能噫耳。三焦竭部之所谓上焦竭而善噫者此也。夫胃腑如沤。化臭腐为神奇之气。从脾历肺而达于胸者。
纯是一种温暖轻灵。虚无恬淡之妙。故上焦喜之。若谷停未化。其直从胃脘而上逆者。惟渣质滞浊之气。为
清宁灵府之所见恶者。此噫而出之之所由来也。答语止此。推之下焦受中焦气。而以禁制助中焦之提挈
者。与上焦同义。倘下焦一时虚乏。则前阴遗溺。后阴失便者。亦非单责之中焦也。当知因下焦之气。不与中
上相和。故不能自禁制耳。禁制合守送两边而言。不禁。如热急后重之类。不制。谓传送不畅快也。不须治两
句。是双承上文。非单指下焦也。盖上焦之气。如遇惊恐嗔怒等类。则一时上虚下乘而不和。下焦之气。如遇
泄泻热淋等类。则一时后坠前结而不和。二者。俱常有之症。久则中气分贯之。而上下之不和者复和矣。故
久则愈也。
十九条 师曰。热在上焦者。因咳为肺痿。热在中焦者。则为坚。热在下焦者。则尿血。亦令淋闭不通。大肠
有寒者多 溏。有热者便肠垢。小肠有寒者。其人下重便血。有热者必痔。篇首至肾死脏。言五脏病。自上条及此。
言六腑病。言六腑而独详三焦者。以三焦虽属六腑之一。而其余五腑。俱丽三焦之部。如上焦如雾。虽单指
心肺夹空之气。而其实膻中一腑。亦属上焦所管。且阳明之脘。少阳之系。其上半截俱穿膈上。而为上焦之
所属也。中焦胃腑之外。下焦膀胱之外。可类推矣。此长沙以三焦该六腑之意乎。下焦独抽言大小肠者。以
四腑之病。散详别见。而大小肠二腑。合伤寒金匮中。未尝论及。故备言之耳。上条以虚竭言三焦之轻病。
此条以寒热言三焦之重病。不言死症者。以诸病入脏者死。入腑者愈也。热在上焦。火气逼清虚之管而
作痒。故咳。咳多则肺劳。劳热相并。故肺气痿顿。热在中焦。则脾胃之液渐干。而糟粕结滞。故肠胃殊觉坚硬。
热在下焦。膀胱之血分受伤。则吸入脬中。而血与尿并见。故尿血。若其气分受伤。自邪热燔炙而论。如煎饧
成质。煮海成盐之象。而为膏砂等淋。自真气不布而论。则传化艰涩。而闭塞不通也。至下焦所属之大肠有
寒。则不能以湿化燥化。收摄渣质中之余水。故粪与清水。两不融和。而便如骛鸭之溏屎。如大肠有热。则燥
化大过。刮下肠中之垢如白脓。其实即大肠所挂之津液也。又下焦所属之小肠有寒。则见下重便血。盖因
人身之大气。逐节相提。故宗气提脾胃。脾胃提小肠。小肠提大肠。而形脏不至沉坠者此也。小肠寒不能提。
而大肠之气陷下。故下重也。气者。血之主令。气不升举。则大肠之血。亦下脱而见于便矣。若小肠有热。除正
传膀胱而为癃闭等症之外。其热气又随渣质而贯注大肠。肛门者。大肠之尽处也。尽则无所传卸。故结为
瘿乳等类之痔矣。六腑之候。其统于三焦者如此。
二十条 问曰。病有积。有聚。有 气。何谓也。师曰。积者。脏病也。终不移。聚者。腑病也。发作有时。
展转痛移。为可治。 气者。胁下痛。按之则愈。复发为 气。诸积大法。脉来细而附骨者。乃积也。寸口。积在胸中。
微出寸口。积在喉中。关上。积在脐旁。上关上。积在心下。微下关。积在少腹。尺中。积在气冲。脉在左。积在左。
脉在右。积在右。脉两出。积在中央。各以其部处之。
积者。久积不行。聚者。暂聚未散之义。二者。皆脏腑之阴液。因阳衰、气寒而不能运动。故沉着于脏腑之内者
也。 气者。谷气也。胃中饱食过度。或久停未化。于是胃实气满。不从下行。而由胃络旁溢者是也。但积聚以
及气。其症俱能作痛。而其名义。颇相似而难辨。故问其所以为积、为聚、为 气之谓也。不知积为脏病。脏
者。收藏之象。其精常住而不散。故积之为病。亦因其脏精之居守。而始终不移。聚为腑病。腑者。府库之象。其
气既入而亦出。故聚之为病。亦因其腑气之流行。而发作有时。展转痛移。夫发作有时。则未发者。为阳气犹
有自振之机。展转痛移。则所聚者。为病邪已见腾挪之渐。投以辛甘。治以攻发。迎而导之。则聚者自散。宁与
脏积之始终不移。正邪相服。而无隙可乘者比哉。故可治也。聚曰可治。则积之不可治者。在言外矣。胃之络
脉通于胁。故实满之 气。溢于胁下。而作如刺如胀之痛也。按则其气复从络而还于胃。故其痛则愈。复发
者。指按起而言。不曰可治不可治者。其意或以减谷则愈者乎。此所谓 气之症也。下文二十一句。就五脏
之积而言其脉。且广言积之在募原内络中者。其诊法亦准脏积之例也。盖谓五脏诸积之大法。俱属有阴
无阳。而其阴液沉着之候。故其脉来必细以应无阳。必沉以应脏。必伏以应阴液沉着。此细而沉伏附骨者。
乃积脉也。若此脉见寸口。积在胸中。胸中者。心肺之所托也。微出寸口。积在喉中。喉中者。心肺上出之络之
所经也。见关上。积在脐旁。脐旁者。肝脾之所托也。上关上。积在心下。心下者。心肺下行之络之所经也。微下
关。积在少腹。少腹者。肝肾之所托也。见尺中。积在气冲。经名气街穴。针灸大成作气冲。在脐下横骨两端毛
际中。动脉应手者是。足阳明脉气之所发也。但于脏无取。未详其义。岂阳明之气。与阴会相合而通于肾脏
者乎。脉与积应。其左右中央。各根据其部者。如寸口左见。则积在心。右见。则积在肺。左右两见。则积在心肺中
央之内络。而穿于前后之募原者是矣。又如关上左见。则积在肝。右见。则积在脾。左右两见。则积在肝脾中
央之内络。而穿于前后之募原者是矣。下焦及寸关尺之微上微下者俱仿此。以五脏之系及络俱能病积。
故曰广言积之在募原内络中者。其诊法俱准脏积之例也。或曰。条端明列三病。仲景独言积脉。而不及
聚与 气者。何也。答曰。 气为一时之轻病。减谷则气消而痛愈。故可不必言其脉也。然愚尝试之。其人尺
寸俱平。关脉实而滑于右。弦而细涩于左者。乃 气之脉也。若夫聚之为脉。已具积脉中。而俟善读者之自
悟久矣。如诸聚大法。脉来细而于不浮不沉中见者。乃聚也。下文十九句。文则易积以聚。意则易脏以腑。而
细按之。则三焦之所属。六腑之所经。左右中央之所寄托。不与积脉同一彰明较着乎哉。
第十三条 脾脏感受风邪，表现为微微发热，面色潮红、肢体倦怠如同醉酒之人，腹部感觉烦闷沉重，眼睑跳动且呼吸短促。
足太阴脾经，向外走行于足内踝上侧。因此脾脏通过经络穴位受到风邪侵袭。风邪化为热邪，由内向外蒸腾，所以出现微微发热的症状。所谓“形如醉人”，是指面部发红以及肢体倦怠而言。因为面部是阳明胃腑的反映区域，脾将热邪转移给胃，所以面部发红如同醉酒之人。另外，肢体是脾阳贯穿之处。脾中的真气被风热所伤，导致真阳突然衰弱，所以肢体倦怠如同醉酒之人。热邪损伤津液则产生烦闷感，土气（脾）沉困则产生沉重感。腹部是脾胃的反映区域，脾热导致津液干枯、气机阻滞。皮，指全身的皮肉；目，指眼眶。经气虚弱且灌注不均匀，就会发生移位和变动，导致眼皮和眼眶跳动。这是脾病导致肺气在外表虚弱的表现。脾与肺同属手太阴和足太阴经，相互呼应。因此呼吸深长，现在肺吸气而脾中邪气实盛，难以纳受，所以出现短气。仔细研读全文，这显然是实证。不列出方剂的原因，可能是因为《伤寒论》中风寒篇中已经列出了借用桂枝汤的例子。肝、肺及心三脏的中风条文之后，都有中寒的论述，唯独脾脏没有涉及，这是因为脾脏中寒的大法已经在腹满篇中详细论述过，所以不再重复讨论。同道中人不要认为这是遗漏或缺失。
第十四条 脾的死脉，轻取浮大且坚硬，重按如同倒扣的杯子，洁净无根状如摇晃不定者主死。
脾属于黄泉之己土，那种孕育万物的善气，柔和混杂，是不可见的。如果脉象中空散漫而浮大，像土灰尘一样的形象，是真阴即将枯竭的表现。凝滞切责而坚结，像土沙石一样的形象，是真阳即将枯竭的表现。浮取，是应合在上在外的情况。浮大而坚硬，是阴阳不能蒸腾覆盖的诊候。如同倒扣的杯子，即上文所说的“大坚”，再加上形状圆润、体内空虚的形象。因为形状圆润，所以关下没有来路，关上没有去路；因为体内空虚，所以底面没有根基。重按如同倒扣的杯子，这是离绝的土象。既然离绝却还见到余动，就像全蟹已经煮熟后，遗留下来的腿脚，其动作还在，这是生机尚存的征象，所以必然死亡。“洁洁”，是孤洁无伴的样子。“摇”，是说上下不见来去，底面不见鼓动，只感觉到从两旁摇晃而已。形容为倒扣的杯子，不是很恰当吗？这句话又是张仲景对“覆杯”含义的自我注释。
第十五条 趺阳脉浮而涩，浮表示胃气强盛，涩表示小便频数。浮与涩相互搏结，大便就会干硬，这就是脾约证，用麻子仁丸主治。
麻子仁丸方：麻子仁（二升），杏仁（一升），芍药（半斤），大黄（一斤），枳实（一斤），厚朴（半斤）。
以上六味药，研成粉末，用炼蜜调和制成梧桐子大小的丸药。每次用水送服十丸，每日三次，以见效为度。
此条见于《伤寒论》阳明篇，收录于此是因为属于脾病类。关于条文和方义，在《伤寒论》中已有详述，此处仅从脾脏治疗法则的角度论述，不论风寒杂症都是相同的。
第十六条 肾着病，患者身体沉重，腰部寒冷，如同坐在水中，外形看起来像有水状，反而不口渴，小便自利，饮食正常。病属下焦，因身体劳累出汗，衣服里层冷湿，久而久之得病。腰部以下冷痛，腹部沉重如同带着五千枚铜钱。用甘姜苓术汤主治。
甘草干姜茯苓白术汤方（又名肾着汤）：
甘草（二两），干姜（四两），茯苓（四两），白术（二两）。
以上四味药，用水五升，煮取三升，分三次温服。腰部就会感到温暖。
肾着，是指寒湿之邪附着在肾脏而不离去的意思。因为肾是水脏，其气多寒，常与外来的寒湿邪气相召引，所以侵入后直接附着在肾脏，是同类相吸的缘故。肾中的真气，向上贯穿全身，使身体轻便干练，是因为先天之丙火胎藏于水中，而庚金也伏藏于水中的缘故。寒湿附着，寒则阳气微弱，湿则气机停滞而不能上贯，就失去了轻便干练的作用，所以身体沉重。腰是肾的府邸，肾着寒，所以腰部寒冷。湿是水的渐进状态，肾着湿，所以腰部以下如同坐在水中。这三句说的是患者的自觉症状，可以通过问诊获得。阳虚而寒邪附着，就会出现浮肿如水状；气虚而湿邪附着，就会出现黄润如水状。所以说“如水”，而不是真正的水。之所以知道不是水，是因为不渴，说明摄入的水少；小便通利，说明排出的水多，中间没有蓄积。这三句说的是旁人可见的症状，又可以通过望诊获得。脏腑阳虚的，都能出现积滞痹着等情况。身重如水，如果是上焦的肺与膻中，不能呵嘘水道，以及中焦的脾胃，不能分理，都能导致此病。为什么唯独知道是肾着呢？因为患者饮水如故，所以知道不属于上焦；进食如故，所以知道不属于中焦，而属于下焦的肾脏。这两句是辨别肾着的确切依据。“里字”应该是“裹字”的讹误。肾是强力之官，所以能任劳。身体劳累出汗，则肾虚；衣服冷湿包裹，则冷湿之邪乘虚附着。何况拖延日久呢？这两句推论肾着的病因。冷痛，是阴气浸渍切责，冷气逼迫阳气的现象。腹重，是坚癖沉坠，湿气下注的现象。如同五千枚铜钱，是因为正气不能上提，所以附着久了更加觉得沉重。这两个症状，是在上文“腰中冷”、“身体重”的基础上进一步加重描述。使用本汤，原本是为了温燥肾中的冷湿，但用药注意却在调理中焦的脾胃。所以用辛热的干姜作为君药以除冷，淡渗的茯苓以除湿，并用甘温守中的甘草、白术作为佐药。因为暖土可以祛寒，而燥土尤能胜湿。看那阳春回到大地，幽谷的冰就消融了；堤岸坚固于江乡，浸淫的祸患就停止了。张仲景制方的意思，大概就可以知道了。其他脏腑的条文，先言风寒，次及死脏，唯独这里缺失，是因为在少阴伤寒的直中篇中已经详细论述过了。
第十七条 肾的死脉，轻取坚硬，重按乱如转丸，益下入尺中者主死。
万物以阳火为绵软，胶饧糕饼属于蒸烙而成，可以证明这一点。轻取坚硬，是水没有阳气而冰冻的形象。重按如转丸，按处仍然见坚硬，加上没有来去，形状圆体滚，就是脾脏如覆杯而稍微较小一点的状况。只是脾脏是向两边动摇，所以说“摇”；这里是向上下圆转，所以说“乱”、说“转”。这是水泡上泛，水气底散的形象。下入尺中，则气已耗尽，不能远出，常有就地涣散的意义，所以主死。其他脏腑的死脉，都结合阴阳两方面来说，唯独肾脏只说阳绝，是因为肾是水寒之脏，其阳气尤为贵重。
第十八条 问：三焦竭部，上焦竭容易嗳气，为什么呢？老师说：上焦接受中焦之气，尚未调和，不能消化谷物，所以容易嗳气。下焦竭，就会遗尿或失禁排便，其气不和，不能自我控制，不需要治疗，时间久了就会痊愈。
“竭”不是竭尽的意思，而是指一时的虚乏。看下文“未和”以及“不须治”就能明白。噫，就是嗳气。三焦竭部，应当是古医经的篇目，长沙先生借用作问答，以阐发其中的奥妙。说：在三焦竭的篇部中，有说上焦竭则容易嗳气。嗳气出于脾胃，似乎在中焦，为什么说由于上焦呢？不知道谷物在中焦，虽然由脾胃运化，但实际上完成于上焦的呵嘘蒸被。二便在下焦，虽然由脾胃提挈，但实际上完成于下焦的关键纵送。所以说上焦氤氲之气，虽然受之于中焦腐化之中，但其下炎的作用，又能运化饮料熟谷，作为中焦的帮助。好比太阳，聚集万物的晶光，又反过来照耀万物；好比君主，总揽万民的推奉，又反过来统治万民之道。如果这种气一时虚乏而未调和，就不能协助消化谷物，导致谷物停积在胃中。谷物停积就会腐败，腐败之气上熏心主，所以容易嗳气。这就是三焦竭部所说的上焦竭而善噫。胃腑如沤，将臭腐化为神奇之气，从脾经过肺到达胸中，纯粹是一种温暖轻灵、虚无恬淡的妙气，所以上焦喜欢它。如果谷物停积未化，直接从胃脘而上逆的，只有渣质滞浊之气，是被清宁灵府所厌恶的，这就是嗳气产生的由来。回答到此为止。推论下焦接受中焦之气，并以禁制帮助中焦的提挈，与上焦意义相同。如果下焦一时虚乏，那么前阴遗尿，后阴失禁排便，也不是单责罚中焦。应当知道是因为下焦之气，不与中上相和，所以不能自我控制罢了。“禁制”包含守和送两方面而言。不禁，如热急后重之类；不制，谓传送不畅快。“不须治”两句，是双承上文，不单指下焦。因为上焦之气，如果遇到惊恐嗔怒等类，则一时上虚下乘而不和；下焦之气，如果遇到泄泻热淋等类，则一时后坠前结而不和。这两种情况，都是常见的病症，时间久了中气分布贯通，上下不和的情况就会恢复和谐。所以时间久了就会痊愈。
第十九条 老师说：热在上焦的，因咳嗽导致肺痿。热在中焦的，则为大便坚硬。热在下焦的，则尿血，也会引起淋证闭阻不通。大肠有寒的，多便溏；有热的，则便肠垢。小肠有寒的，其人下重便血；有热的，必生痔疮。篇首至肾死脏，讲的是五脏病。从上一条至此，讲的是六腑病。讲六腑而独详三焦，是因为三焦虽属六腑之一，但其余五腑，都隶属于三焦的部位。如上焦如雾，虽单指心肺夹空之气，但其实膻中一腑，也属于上焦管辖。而且阳明之脘，少阳之系，其上半截都穿过膈膜之上，成为上焦所属。中焦胃腑之外，下焦膀胱之外，可以类推了。这是长沙先生以三概括六腑的意思吗？下焦独抽出来讲大小肠，是因为四腑的病，分散详细记载在其他地方，而大小肠二腑，合并在《伤寒》《金匮》中未曾论述，所以特意详尽论述。上一条以虚竭讲三焦的轻病，这一条以寒热讲三焦的重病。不讲死症，是因为诸病入脏者死，入腑者愈。热在上焦，火气逼迫清虚之管而作痒，所以咳嗽。咳嗽多则肺劳，劳热相并，所以肺气痿顿。热在中焦，则脾胃之液逐渐干枯，而糟粕结滞，所以肠胃特别觉得坚硬。热在下焦，膀胱之血分受伤，则吸入脬中，而血与尿并见，所以尿血。如果其气分受伤，从邪热燔炙而论，如煎饧成质、煮海成盐的景象，而为膏砂等淋；从真气不布而论，则传化艰涩，而闭塞不通。至于下焦所属的大肠有寒，则不能以湿化燥化，收摄渣质中的余水，所以粪与清水，两者不融合，而大便如鸭子粪便般的溏屎。如果大肠有热，则燥化太过，刮下肠中之垢如白脓，其实也就是大肠所挂的津液。又下焦所属的小肠有寒，则见下重便血。因为人身的大气，逐节相提，所以宗气提脾胃，脾胃提小肠，小肠提大肠，而形脏不至沉坠就是这个原因。小肠寒不能提，而大肠之气陷下，所以下重。气是血的主令，气不升举，则大肠之血，也下脱而见于大便。如果小肠有热，除了正传膀胱而为癃闭等症之外，其热气又随渣质而贯注大肠。肛门是大肠的尽头，尽则无所传卸，所以结为瘿乳等类的痔疮。六腑的征候，统属于三焦的如此。
第二十条 问：病有积，有聚，有奔气，是什么呢？老师说：积，是脏病，始终不移；聚，是腑病，发作有时，辗转疼痛移动，是可以治疗的。奔气，是胁下痛，按压则好转，复发为奔气。各种积的大法，脉来细而附骨者，乃是积。寸口脉，积在胸中；微出寸口，积在喉中；关上，积在脐旁；上关上，积在心下；微下关，积在少腹；尺中，积在气冲。脉在左，积在左；脉在右，积在右；脉两出，积在中央。各以其部位判断。
积，是久积不行；聚，是暂聚未散。两者，都是脏腑的阴液，因阳衰、气寒而不能运动，所以沉着于脏腑之内。奔气，是谷气。胃中饱食过度，或久停未化，于是胃实气满，不从下行，而从胃络旁溢。但是积聚以及奔气，其症状都能作痛，而其名义，颇相似而难辨，所以问其所以为积、为聚、为奔气的原因。不知道积为脏病，脏是收藏的象征，其精常住而不散，所以积之为病，也因其脏精的居守，而始终不移。聚为腑病，腑是府库的象征，其气既入而亦出，所以聚之为病，也因其腑气的流行，而发作有时，辗转疼痛移动。发作有时，则未发时，阳气犹有自振之机；辗转疼痛移动，则所聚者，为病邪已见腾挪之渐。投以辛甘，治以攻发，迎而导之，则聚者自散，岂能与脏积的始终不移，正邪相争而无隙可乘相比呢？所以说可治。聚曰可治，则积之不可治的意思就在言外了。胃的络脉通于胁，所以实满的奔气，溢于胁下，而产生如刺如胀的痛。按压则其气复从络而还于胃，所以痛则愈。复发，指按起而言。不说可治不可治，其意或许是以减少饮食则痊愈吧。这就是所谓的奔气症状。下文二十一条，就五脏之积而言其脉，并且广言积在募原内络中的，其诊法也准脏积的例子。意思是五脏诸积的大法，都属于有阴无阳，而其阴液沉着的征候，所以其脉来必细以应无阳，必沉以应脏，必伏以应阴液沉着。这是细而沉伏附骨者，乃是积脉。如果此脉见于寸口，积在胸中。胸中，是心肺之所托。微出寸口，积在喉中。喉中，是心肺上出之络所经过。见于关上，积在脐旁。脐旁，是肝脾之所托。上关上，积在心下。心下，是心肺下行之络所经过。微下关，积在少腹。少腹，是肝肾之所托。见于尺中，积在气冲。经名气街穴，《针灸大成》作气冲，在脐下横骨两端毛际中，动脉应手者是。足阳明脉气所发。但在脏无取，不详其义。难道是阳明之气，与阴会相合而通于肾脏吗？脉与积相应，其左右中央，各根据其部位。如寸口左见，则积在心；右见，则积在肺。左右两见，则积在心肺中央之内络，而穿于前后之募原者。又如关上左见，则积在肝；右见，则积在脾。左右两见，则积在肝脾中央之内络，而穿于前后之募原者。下焦及寸关尺的微上微下者都仿照此例。因为五脏的系及络都能病积，所以说广言积在募原内络中。其诊法都准脏积的例子。有人说：条端明列三病，仲景独言积脉，而不及聚与奔气，为什么呢？回答说：奔气为一时的轻病，减谷则气消而痛愈，所以不必言其脉。然而我尝试过，其人尺寸俱平，关脉实而滑于右，弦而细涩于左者，乃是奔气的脉。至于聚的脉，已具备在积脉中，而等待善于阅读的读者自己领悟已久。如诸聚大法，脉来细而在不浮不沉中见者，乃是聚。下文十九句，文字则是易积以聚，意思则是易脏以腑，而细细分析，则三焦的所属，六腑所经过，左右中央所寄托，不与积脉同样彰明较著吗？
Article 13 When the Spleen is struck by Wind, there is a slight fever, the appearance resembles that of a drunken person (facial flushing and limb fatigue), abdominal discomfort and heaviness, eyelid twitching, and shortness of breath.
The Foot-Taiyin Splein Meridian runs externally along the upper side of the medial malleolus. Thus, the Spleen is invaded by Wind pathogen through its meridian acupoints. The Wind pathogen transforms into Heat and steams from the interior to the exterior, causing slight fever. The description "resembling a drunken person" refers to facial redness and limb fatigue. Since the face reflects the Yangming Stomach organ, when Spleen Heat transfers to the Stomach, the face becomes red like that of a drunkard. Furthermore, the limbs are penetrated by Spleen Yang. When the true Qi within the Spleen is injured by Wind-Heat, the True Yang suddenly weakens, leading to limb fatigue resembling drunkenness. Heat damaging body fluids causes irritability; the sinking and stagnation of Earth Qi causes heaviness. The abdomen reflects the Spleen and Stomach; Spleen Heat leads to dry fluids and stagnant Qi. "Skin" refers to the skin and flesh of the whole body; "eyes" refer to the eye sockets. When meridian Qi is deficient and unevenly distributed, it shifts position, causing twitching of the eyelids and eye sockets. This indicates that Spleen disease causes Lung Qi to weaken at the exterior. The Spleen and Lung belong to the Hand-Taiyin and Foot-Taiyin meridians respectively and respond to each other. Therefore, breathing is deep and long. Now, the Lung inhales while the Spleen is filled with excess pathogens, making reception difficult, resulting in shortness of breath. Careful study of the full text reveals this is an excess syndrome. The reason no formula is provided may be because the *Treatise on Cold Damage* has already listed examples of borrowing Guizhi Tang (Cinnamon Twig Decoction) for Wind-Cold. After the Wind-strike articles for the Liver, Lung, and Heart, there are articles on Cold-strike, but none for the Spleen. This is because the general principles of Cold striking the Spleen were detailed in the article on Abdominal Fullness, so they are not repeated. Colleagues should not consider this an omission or deficiency.
Article 14 A dying Pulse of the Spleen is floating, large, and hard; upon pressing, it feels like an inverted cup, clean and rootless, shaking as if unstable, indicating death.
The Spleen belongs to Ji Earth of the Yellow Springs. Its vital Qi that nurtures life is soft and mixed, invisible. If the pulse is hollow, scattered, large, and floating, resembling dust, it indicates the impending exhaustion of True Yin. If it is congealed, harsh, and hard, resembling sand and stones, it indicates the impending exhaustion of True Yang. Floating corresponds to the exterior and upper levels. A floating, large, and hard pulse indicates that Yin and Yang cannot steam and cover. Feeling like an inverted cup means the previously mentioned "large and hard," combined with a round shape and hollow interior. Because it is round, there is no incoming trace below Guan, nor outgoing trace at Guan; because it is hollow, there is no root at the bottom. Pressing like an inverted cup signifies Earth that is severed. Even though severed, if residual movement remains, it is like the legs of a fully cooked crab still moving, indicating lingering vitality, hence death. "Jie Jie" describes a lonely and isolated appearance. "Yao" (shaking) means there is no coming or going up and down, and no pulsation at the bottom, only lateral shaking. Describing it as an inverted cup is appropriate. This sentence is Zhang Zhongjing's own annotation of the meaning of "inverted cup."
Article 15 The Fuyang pulse is floating and choppy. Floating indicates strong Stomach Qi; choppy indicates frequent urination. The interplay of floating and choppy pulses leads to hard stool. This is Spleen Constriction (Pi Yue), treated with Hemp Seed Pill (Maziren Wan).
Hemp Seed Pill Formula:
Hemp Seed (Er Sheng), Apricot Kernel (Yi Sheng), White Peony Root (Ban Jin), Rhubarb (Yi Jin), Immature Bitter Orange (Yi Jin), Magnolia Bark (Ban Jin).
Grind these six herbs into powder, mix with refined honey to make pills the size of mulberry seeds. Take ten pills with water, three times a day, adjusting dosage until effect is achieved.
This article appears in the Yangming Chapter of the *Treatise on Cold Damage*. It is included here as it pertains to Spleen diseases. The discussion of the article and formula details are found in the *Treatise on Cold Damage*; here, only the treatment principles for the Spleen are discussed, applicable to both Wind-Cold and miscellaneous diseases.
Article 16 Kidney Binding Disease (Shen Zhuo): The patient feels heavy throughout the body, cold in the waist, as if sitting in water, appearing watery in form, yet without thirst, with normal urination and appetite. The disease is located in the Lower Jiao, caused by physical exertion and sweating, with cold and dampness penetrating the clothing over time. There is cold pain below the waist and heaviness in the abdomen as if carrying five thousand coins. Treat with Ginger and Licorice Poria and Atractylodes Macrocephala Decoction (Gan Jiang Ling Zhu Tang).
Licorice, Dried Ginger, Poria, and Atractylodes Macrocephala Decoction Formula (also known as Kidney Binding Decoction):
Licorice Root (Liang Liang), Dried Ginger (Si Liang), Poria (Si Liang), Atractylodes Macrocephala Rhizome (Liang Liang).
Boil these four herbs in five sheng of water to obtain three sheng. Divide into three warm doses. The waist will feel warm.
Kidney Binding refers to Cold-Damp pathogens adhering to the Kidney and not departing. The Kidney is a Water organ with inherently Cold Qi, often attracting external Cold-Damp pathogens due to similarity. Thus, pathogens directly adhere to the Kidney. The True Qi of the Kidney penetrates the whole body, keeping it light and agile, due to Congenital Bing Fire gestating in Water and Geng Metal hiding in Water. Cold-Damp adherence causes Yang to weaken and Qi to stagnate, losing its light and agile function, resulting in body heaviness. The waist is the mansion of the Kidney; Kidney Cold causes coldness in the waist. Dampness is the gradual state of Water; Kidney Dampness makes the area below the waist feel like sitting in water. These three sentences describe the patient's subjective symptoms, obtainable via inquiry. Yang deficiency with Cold adherence causes edema resembling water; Qi deficiency with Damp adherence causes yellowish moisture resembling water. Hence "like water," but not actual water. We know it is not water because there is no thirst (low intake) and urination is free (high output), with no accumulation internally. These three sentences describe objective signs visible to others, obtainable via observation. Organ Yang deficiency can lead to stagnation and binding syndromes. Body heaviness like water can result from Upper Jiao Lung and Qimotore failing to regulate water passages, or Middle Jiao Spleen and Stomach failing to separate clear and turbid. Why specifically identify it as Kidney Binding? Because drinking habits are normal, ruling out Upper Jiao; eating habits are normal, ruling out Middle Jiao; thus it belongs to the Lower Jiao Kidney. These two sentences are key to differentiating Kidney Binding. The character "Li" (inside) is likely a typo for "Guo" (wrap). The Kidney is the official of strength, enduring labor. Physical exertion and sweating deplete Kidney Qi; cold and damp clothing allow pathogens to adhere to the deficiency. Prolonged duration exacerbates this. These two sentences deduce the etiology. Cold pain indicates Yin infiltration forcing out Yang; abdominal heaviness indicates solid stagnation and downward pouring of Dampness. "Like five thousand coins" indicates failure of healthy Qi to ascend, feeling heavier over time. These symptoms intensify the previous "cold waist" and "heavy body." The decoction warms and dries Cold-Damp in the Kidney, but focuses on the Middle Jiao Spleen and Stomach. Dried Ginger (acrid-hot) removes cold; Poria (bland-leaching) removes dampness; Licorice and Atractylodes (sweet-warm) support the center. Warming Earth dispels Cold; drying Earth overcomes Dampness. Just as spring warmth melts ice in valleys and strengthens riverbanks to stop erosion, so too does Zhang Zhongjing's formula work. Other organs discuss Wind-Cold then dying pulses; this section omits them because Cold striking the Shaoyin directly was detailed elsewhere.
Article 17 A dying Pulse of the Kidney is hard on light palpation; on deep palpation, it feels chaotic like a rolling pill, descending into the Chi position, indicating death.
All things become soft with Yang fire, as seen in steamed pastes and cakes. Hardness on light palpation indicates Water frozen without Yang. Chaos like a rolling pill on deep palpation indicates hardness remaining, with no coming or going, round and rolling shape, similar to the Spleen's inverted cup but smaller. Unlike the Spleen which shakes laterally ("Yao"), this rolls vertically ("Luan", "Zhuan"). This indicates water bubbles rising and water Qi scattering at the base. Descending into Chi means Qi is exhausted and cannot extend far, having a tendency to dissipate locally, hence death. Dying pulses of other organs discuss both Yin and Yang; the Kidney discusses only Yang exhaustion because the Kidney is a Cold-Water organ where Yang Qi is particularly precious.
Article 18 Question: In the chapter on Exhaustion of the Three Jiaos, why does Upper Jiao exhaustion lead to belching? Master says: The Upper Jiao receives Qi from the Middle Jiao. If unharmonized, it cannot digest grains, leading to belching. Lower Jiao exhaustion leads to urinary incontinence or fecal loss. Due to Qi disharmony, self-control is lost. No treatment is needed; it will heal after time.
"Exhaustion" (Jie) does not mean complete depletion, but temporary deficiency. This is evident from "unharmonized" and "no treatment needed." Belching (Yi) is eructation. The chapter title "Exhaustion of the Three Jiaos" is likely from ancient medical classics, used by Changsha (Zhang Zhongjing) for dialogue to reveal profound truths. Belching originates from Spleen and Stomach (Middle Jiao), yet is attributed to Upper Jiao. Although digestion occurs in the Middle Jiao via Spleen-Stomach transformation, it is completed by the steaming and covering action of the Upper Jiao. Defecation/urination in the Lower Jiao relies on Spleen-Stomach lifting, but is finalized by the opening and closing mechanisms of the Lower Jiao. Thus, the misty Qi of the Upper Jiao, though derived from Middle Jiao transformation, aids digestion by descending heat. Like the sun gathering light to illuminate all, or a ruler governing subjects. If this Qi is temporarily deficient and unharmonized, it fails to assist digestion, causing grain stagnation in the Stomach. Stagnant grain rots, generating foul Qi that harasses the Heart Master, causing belching. The Stomach ferments food into pure, warm, light Qi, which ascends via Spleen and Lung to the chest, pleasing the Upper Jiao. If grain stagnates and fails to transform, turbid Qi rises directly from the stomach, offending the pure mind, causing belching. Regarding the Lower Jiao receiving Middle Jiao Qi to assist lifting, the principle is the same. Temporary Lower Jiao deficiency causes incontinence. This is not solely blamed on the Middle Jiao but on the lack of harmony between Lower and Middle/Upper Jiao Qi. "Control" involves holding and releasing. Failure to hold resembles urgent tenesmus; failure to release implies poor transmission. "No treatment needed" applies to both Upper and Lower Jiao. Upper Jiao disharmony arises from fright or anger; Lower Jiao disharmony from diarrhea or hot strangury. Both are common; over time, Middle Jiao Qi distributes, restoring harmony. Hence, it heals spontaneously.
Article 19 Master says: Heat in the Upper Jiao causes cough leading to Lung萎 (Fei Wei / Lung Flaccidity). Heat in the Middle Jiao causes hard stool. Heat in the Lower Jiao causes hematuria and strangury/obstruction. Cold in the Large Intestine causes loose stools; Heat causes intestinal mucus. Cold in the Small Intestine causes bearing-down sensation and bloody stool; Heat causes hemorrhoids. From the beginning to the dying pulse of the Kidney, Five Zang diseases are discussed. From the previous article to this, Six Fu diseases are discussed. Discussing Six Fu highlights the Three Jiaos because although the Three Jiaos is one of the Six Fu, the other five are subordinate to it. Upper Jiao like mist refers to Qi between Heart/Lung and diaphragm, including the Qimotore. Yangming Stomach and Shaoyang Gallbladder upper parts pierce the diaphragm into the Upper Jiao. Similarly for Middle and Lower Jiao. This illustrates using Three Jiaos to encompass Six Fu. Only Large and Small Intestines are singled out in Lower Jiao because their diseases were discussed elsewhere in *Cold Damage* and *Essential Prescriptions*, so they are detailed here. The previous article discussed mild Three Jiao exhaustion; this one discusses severe Three Jiao Cold-Heat. No dying pulses are mentioned because diseases entering Zang die, while those entering Fu recover. Heat in Upper Jiao irritates clear vessels, causing cough; chronic cough leads to Lung Flaccidity. Heat in Middle Jiao dries Spleen-Stomach fluids, causing constipation. Heat in Lower Jiao damages Bladder blood, mixing with urine (hematuria); if Qi is damaged, heat cooks fluids into gravel-like strangury or blocks flow completely. Cold in Large Intestine prevents drying of waste, causing watery diarrhea (duck-like stool). Heat causes excessive drying, scraping intestinal mucus (white pus-like substance). Cold in Small Intestine causes bearing-down and bloody stool because healthy Qi lifts sequentially (Zong Qi lifts Spleen/Stomach, which lifts Small Intestine, which lifts Large Intestine). Small Intestine Cold fails to lift, causing Large Intestine Qi to sink. Qi commands Blood; without ascent, Blood descends. Heat in Small Intestine can cause strangury or transmit heat to Large Intestine, forming hemorrhoids at the anus (end of Large Intestine). Thus, Six Fu manifestations are unified under the Three Jiaos.
Article 20 Question: What are Accumulation (Ji), Gathering (Ju), and Ben Qi (Rushing Qi)? Master says: Accumulation is a Zang disease, fixed and immovable. Gathering is a Fu disease, intermittent with migrating pain, treatable. Ben Qi causes hypochondriac pain relieved by pressure, recurring later. General rule for Accumulation: Pulse is fine and adherent to bone. At Cun Kou, accumulation is in the chest; slightly above Cun Kou, in the throat; at Guan, beside the umbilicus; above Guan, below the heart; slightly below Guan, in the lower abdomen; at Chi, at Qichong. Left pulse indicates left accumulation; right pulse indicates right accumulation; bilateral pulse indicates central accumulation. Diagnose based on location.
Accumulation implies long-standing stagnation; Gathering implies temporary aggregation. Both result from Yin fluids settling in Zang-Fu due to Yang deficiency and Cold Qi preventing movement. Ben Qi is Grain Qi from overeating or undigested food causing Stomach fullness, overflowing via Stomach collaterals to the hypochondrium. All three cause pain and are similar but distinct. Accumulation is Zang disease; Zangs store essence permanently, so Accumulations are fixed. Gathering is Fu disease; Fus store and release Qi, so Gatherings are intermittent and migratory. Intermittency suggests Yang can still rise; migration suggests pathogen shifting. Treating with acrid-sweet and attacking methods can disperse Gatherings. Unlike Accumulations where pathogen and healthy Qi struggle without gap, Gatherings are treatable. Implied: Accumulations are untreatable. Stomach collaterals connect to hypochondrium; Ben Qi overflow causes stabbing/distending pain. Pressure returns Qi to Stomach, relieving pain. Recurrence happens after pressure stops. Untreated because reducing food resolves it. Article 21 discusses pulses for Five Zang Accumulations and Accumulations in Mu-Yuan and internal collaterals. All Accumulations are Yin-dominant/Yang-absent, with sinking Yin fluids. Pulses are fine (no Yang), deep (Zang), and hidden (sinking Yin). Fine/deep/adherent-to-bone pulse indicates Accumulation. Cun Kou: Chest (Heart/Lung). Above Cun Kou: Throat (collaterals). Guan: Beside umbilicus (Liver/Spleen). Above Guan: Below heart (collaterals). Below Guan: Lower abdomen (Liver/Kidney). Chi: Qichong (Stomach Meridian, near pubic hairline). Left pulse: Left accumulation; Right pulse: Right accumulation. Bilateral: Central collateral/Mu-Yuan. Same logic applies to Guan and Chi variations. Since Zang systems and collaterals can harbor Accumulations, diagnosis follows Zang Accumulation rules. Some ask why only Accumulation pulse is given, not Gathering or Ben Qi. Ben Qi is mild, resolving with diet change, so no pulse needed. I have observed Ben Qi pulse: Ping at Cun/Chi, Shi-Hua at Guan (Right), Xian-Xi-Se at Guan (Left). Gathering pulse is implied within Accumulation pulse; discerning readers will realize it. General rule for Gathering: Fine pulse, neither floating nor deep. The following nineteen sentences replace Accumulation with Gathering and Zang with Fu, showing Three Jiao locations and Fu pathways mirror Accumulation patterns clearly.