平按∶此篇自篇首至末，见《灵枢》卷七第四十七《本藏》篇，又见《甲乙经》卷一第五。
黄帝问于岐伯曰∶人之血气精神者，所以奉于生而周于性命者也。（太初之无，谓之道也。
太极未形，物得以生，谓之德也。未形德者，有分且然无间，谓之命也。此命流动生物，物成生
理，谓之形也。形体保神，各有所仪，谓之性也。是以血气精神，奉于一形之生，周于形体所仪
之性，亦周有分无间之命。故命分流动成形，体保神为性，形性久居为生者，皆血气之所奉也。
平按∶奉下《灵枢》无于字。）经脉者，所以行血气，而营阴阳，濡筋骨，利关节者也。（十二
经脉也。十二经脉，行营血气，营于三阴三阳，濡润筋骨，利关节也。）卫气者，所以温分肉，
充皮肤，肥腠理，司关阖者也。（卫气 悍，行于分肉，司腠理关阖也。平按∶关字原抄作 ，
乃关字省文，袁刻作开，《灵枢》作关。）志意者，所以御精神，收魂魄，适寒温，和喜怒者也。
（脾肾之神志意者，能御精神，令之守身，收于魂魄，使之不散，调于寒暑，得于中和，和于喜
怒，不过其节者，皆志意之德也。平按∶和喜怒，和字原缺，袁刻作知，恐误《灵枢》作和，谨
根据《灵枢》补入。注御字原缺，据经文应作御。）是故血和则经脉流行，营覆阴阳，筋骨劲强，
关节滑利矣，（营气和益也。覆者，营气能营覆阴阳也。平按∶滑《灵枢》作清。）卫气和则分
解滑利，皮肤调柔，腠理致密矣。（卫司腠理，故致密也。平按∶分解滑利《灵枢》作分肉解利。）
志意和则精神专直，魂魄不散，悔怒不至，五脏不受邪气矣。（志意所为必当，故无悔矣。志意
司腠理，外邪不入，故五脏不受也。平按∶《灵枢》不至作不起，不受邪气作不受邪。）寒温和
则六腑化谷，风痹不作，（寒暑内适六腑，则中和谷化，贼风邪痹无由起也。）经脉通利，支节
得矣。此人之常平也。（若尔，血气营卫志意调者，乃是人之平和者。平按∶得下《灵枢》有安
字。）五脏者，所以
藏精神血气魂魄者也；六腑者，所以化谷而行津液者也。此人之所以具受于天也，愚智贤不肖，
毋以相倚也。（五脏藏神，六腑化谷，此乃天之命分，愚智虽殊，得之不相根据倚也。津液，即泣
汗涎涕唾也。平按∶谷上《灵枢》有水字。液者二字原缺，谨据《灵枢》补入。愚上《灵枢》有
无字。）然其有独尽天寿，而毋邪僻之病，百年不衰，虽犯风雨卒寒大暑，犹不能害也；有其不
离屏蔽室内，无怵惕之恐，然犹不免于病者，何也？愿闻其故。（人有劳神怵惕，无所不为，虽
犯贼风邪气，独尽天年。复有闲居无思，不预外邪，不免于病，不道伤命。同禀血气，何乃有殊？
愿闻其故也。平按∶其有《灵枢》作有其。犹不能害《灵枢》作犹有弗能害。邪僻僻字原缺，之
恐二字原缺，谨据《灵枢》补入。）岐伯对曰∶窘乎哉问也。（窘，奇殒反，急也。）五脏者，
所以参天地，副阴阳，而连四时，化五节者也。（肺心居其上，故参天也；肝脾肾在下，故参地
也。肝心为牡，副阳也；脾肺肾等牝，副阴也。肝春心夏肺秋肾冬，即连四时也。从五时而变，即
化五节。节，时也。平按∶五节者也，也字原缺，据《灵枢》补入。）五脏者，固有小大高下坚
脆端正偏倾者；六腑者，亦有长短小大浓薄结直缓急者。（天地阴阳，四时八节，造化不同，用
参五脏，何得一也？五脏各有五别□□六腑皆准五脏，亦有五别，故脏腑别言各有五别，五五二
十五也。五脏既五，六腑亦五，三焦一腑属于膀胱，故唯有五。平按∶注各有五别下空二格，别
本作各有五色五别，下二格不空。）凡此二十五者，各各不同，或善或恶，或吉或凶，请言其方。
（心小则安，此为善也。易伤以忧，即为恶也。心坚则脏安守固，此为吉也。心脆则喜病消瘅热中，
即为凶也。如此脏腑随义皆有善恶吉凶，请具陈也。平按∶其方，其字原缺，谨据《灵枢》补。）
心小
则安，邪弗能伤，易伤以忧；心大则忧不能伤，易伤于邪。（脏小则神□不敢自宽，故常安邪不
入也。脏大则神气宣纵，故忧不能伤，邪入不安也。平按∶《甲乙经》以忧作于忧。又按∶《甲乙
经》注云∶太素邪作外邪。今本仍无外字。又注神下一字原缺左旁，恐系收字，袁刻作敢。）心
高则满于肺中， 而喜忘，难开以言；（心脏高者，则神高也。心高肺逼□于心，故 喜忘也。
以其神高不受他言，故难开以言也。平按∶肺中，中字原缺，谨据《灵枢》补入。喜《灵枢》作
善。注心高，高字原缺下方，细玩剩处，于高字为近，谨据经文作高。过下一字原不全，细玩剩
处，与近字相似，袁刻作小，恐未安，谨空一格。）心下则藏外，易伤于寒，易恐以言。（心下
则在肺脏之外，神亦居外，故寒易伤也。亦以神下，故易恐以言也。）心坚则脏安守固，（脏坚
则神守亦坚固，故其心脏安不病，其神守坚固。）心脆则喜病消瘅热中。（五脏柔脆，神亦柔脆，
故脏柔脆人，血脉上行，转而为热消肌肤，故病消瘅热中也。瘅音丹。热中，胃中热故也。平按∶
脆原缺，谨据《灵枢》、《甲乙》补。热中，中字原缺，旁有小注中字，据注热中，胃中热也，
应作热中，《灵枢》、《甲乙》同，袁刻作注，刻在五脏柔脆上，则混经于注矣。）心端正则和
利难伤；（五脏端正，神亦端正也。神端正性亦和柔，故声色芳味之利难相伤也，斯乃贤人君子
所以得心神也。）心偏倾，操持不一，无守司也。（心脏偏倾不一，神亦如之，故操持百端，竟
无守司之恒，此为众人小人所得心神也。心脏言神，有此八变。后之四脏，但言脏变，皆不言神
变者，以神为魂魄意志之主，言其神变，则四种皆知，故略不言也。平按∶《甲乙经》注引杨上
善注云∶心脏言神有八变，后四脏但言脏变不言神变者，以神为魂魄意之主，言其神变则四脏可
知，故略而不言也。与此注正合。袁刻心脏言神误作之神，意志下空十一格，不合。）肺小则
少饮，不病喘喝；（人分所得，肺小则少饮浆水。又肺小不受外邪，故不病喘喝。喝，喘声。平
按∶《甲乙》无喝字。）大则喜病胸痹喉痹逆气。（肺大喜受外邪，故喜病痹及逆气也。平按∶
大则下《灵枢》、《甲乙》有多饮二字。《甲乙》无喉痹二字。）肺高则上气，肩息欲咳；（肺高
则上迫缺盆，故上气喘息。两肩并动，故曰肩息。又肺上迫，故数欲咳。平按∶肩息欲咳《灵枢》
无欲字《甲乙》作喘息咳逆。）肺下则居贲迫肝，善胁下痛。（贲，当膈也，补昆反。气来委膈，
下迫于肝，致胁下痛，以肝居胁下故也。平按∶居贲《甲乙》作逼贲。迫肝《灵枢》、《甲乙》
作迫肺。注委膈原校作垂膈。）肺坚则不病咳上气，（肺脏坚固，不为邪伤，故无咳与上气也。
平按∶咳《甲乙》作咳逆。）肺脆则善病消瘅易伤。（以上四脏之变，例同心脏。平按∶善《灵枢》
作苦。《甲乙》易伤下有也字，注云∶一云易伤于热，喘息鼻衄。）肺端正则和利难伤也，肺
偏倾则胸偏痛也。（偏倾者，随偏所在，即偏处胸痛也。）肝小则安，无胁下之病；（肝小不受
外邪，故安，无两胁下痛。平按∶安上《灵枢》有藏字。）肝大则逼胃迫咽，迫咽则喜鬲中，且
胁下痛。（胃居肝下，咽在肝旁，肝大下逼于胃，旁迫于咽，迫咽则咽膈不通饮食，故曰膈中也。
肝大受邪，故两胁下痛。平按∶咽迫咽三字原缺，谨据《甲乙》补。喜《灵枢》作苦。）肝高则
上支贲，切胁急，为息贲；（肝高上支于膈，又切于胁，支膈切胁既急，即喘息于贲，故曰息贲
也。平按∶切《甲乙》作加。急《灵枢》作 。）肝下则安胃，胁下空，空则易受邪。（胃居肝
下，是以肝下则安于胃上，胁下无物，故易受邪气。平按∶安胃《灵枢》作逼胃。）肝坚则脏安
难伤也，（肝坚则外邪不入，故安难伤也。）肝脆则喜病消瘅易伤也。肝端正则和利难伤也，肝偏
倾则胁下偏
痛也。（偏近一箱，则一箱空处偏痛也。平按∶偏痛，偏字《灵枢》无。）脾小则安，难伤于邪
也；（脾小外邪不入，故安而难伤也。）脾大则善凑 而痛，不能疾行。（ ，以沼反， 空处
也。脾大凑向空 而痛，大□不行则□ 空也。平按∶善《灵枢》、《甲乙》作苦。 《甲乙》
音停。注不行上原缺一字，袁刻作力。则下原缺一字，袁刻作胁。）脾高则 引季胁而痛；（脾下
则缓，高则 牵，季胁中痛也。）脾下则下加于大肠，加于大肠则脏外善受邪。（脾下即是大
肠，故脾下加，出于脾脏所居之外，故喜受邪。平按∶外善受邪《灵枢》无外字，善作苦。）脾
坚则脏安难伤也，（外邪不伤故安。）脾脆则喜病消瘅易伤也。脾端正则和利难伤也，脾偏倾则
喜喜胀。（ ，充曳反，牵纵也。脾偏形近一箱，动而多痹，又气聚为胀也。平按∶喜 喜胀
《灵枢》作善满善胀，《甲乙经》作 喜胀。）肾小则安，难伤也；（肾小不受外邪，故安而
难伤也。）肾大则喜病腰痛，不可以俯仰，易伤以邪也。（肾大在于腰中，故俯仰皆痛也。）肾
高则善背膂痛，不可以俯仰；（肾高去腰，着于脊膂，故脊膂痛，不得俯仰也。）肾下则腰尻痛，
不可以俯仰，为狐疝。（肾下入于尻中，下迫膀胱，故尻痛不可俯仰。疝，所奸反，小腹痛，大
小便难，曰疝。疝有多种，此为狐疝，谓狐夜时不得小便，少腹处痛，日出方得，人亦如此，因
名狐疝也。）肾坚则不病腰背痛，（肾在腰背之间，故肾坚则腰不痛也。）肾脆则喜病消瘅。肾
端正则和利难伤也，肾偏倾则喜腰尻偏痛。（二肾有一偏倾，则偏处痛也。平按∶瘅下《灵枢》、
《甲乙》有易伤二字。）凡此二十五变者，人之所以喜常病也。（人之五脏，受之天分，有此二
十五变者，不由人之失养之愆，故虽不离屏蔽，常喜有前病也。）黄帝曰∶何以知其然也？（五
脏二十五变皆在身中，变生常病亦居其内，未知因候，知以为调养也。）岐伯曰∶赤色小理者心
小，粗理者心大。（理者，肉之文理。粗音粗也。）无 者心高， 小短举者心下。 长
者心坚， 弱以薄者心脆。 直下不举者心端正， 倚一方者心偏倾也。（ ，胸前蔽
骨，蔽心神也。其心上入肺中，不须蔽骨，故心高以无蔽骨为候也。高者，志意高远也。故短小
举者，为心下之候。下者，志意卑近也。平按∶ 《灵枢》作KT 。弱下《灵枢》、《甲乙》有
小字。）白色小理者肺小，粗理者肺大。巨肩反膺陷喉者肺高，合掖张胁者肺下。好肩背浓者肺
坚，肩背薄者肺脆。好肩膺者肺端正，胁偏竦者肺偏倾也。（大肩，胸膺反□喉骨陷入，肺必高
上。平按∶巨肩，巨字原抄作臣，谨根据《灵枢》、《甲乙》作巨。掖《灵枢》、《甲乙》作腋。
好肩膺《灵枢》、《甲乙》作背膺浓。竦《灵枢》作疏，《甲乙》作竦，注云一作欹。）青色小
理者肝小，粗理者肝大。广胸反 者肝高，合胁菟 者肝下。胸胁好者肝坚，胁骨弱者肝脆。膺
腹好好相得者肝端正，胁骨偏举者肝偏倾也。（ ，足胫也。反，前曲出也。平按∶菟《灵枢》作
兔，《甲乙》作脆。好好《灵枢》、《甲乙》均不重，恐衍。）黄色小理者脾小，粗理者脾大。
揭唇者脾高，唇下纵者脾下。唇坚者脾坚，唇大而不坚者脾脆。唇上下好者脾端正，唇偏举者脾
偏倾也。（揭，举也，起辄反。）黑色小理者肾小，粗理者肾大。高耳者肾高，耳后陷者肾下。
耳坚者肾坚，耳薄不坚者肾脆。耳好前居牙车者肾端正，耳偏高者肾偏倾。（一箱独高为偏。平
按∶高耳
《甲乙》作耳高。）凡此诸变者，持则安，减则病。（凡此二十五变，过分以为不善，减则为病，
持平安和，以为大则也。平按∶减原抄作咸，谨根据《灵枢》、《甲乙》作减。）黄帝曰∶善哉，
然非余之所问也。愿闻人之有不可病者，至尽天寿，虽有深忧大恐怵惕之志，犹不能感也，甚寒
大热，弗能伤也。其有不离屏蔽室内，又无怵惕之恐，然不免于病者，何也？愿闻其故。（子言五
脏之变，所知是要，然非吾之问本意。问本意者，人生尽于天寿，内则深忧大恐，外则甚寒极热，
然无所伤，不为病也。而有外无寒暑之侵，内去怵惕之怀，而疾病百端，其故何也？平按∶感
《灵枢》作减。）岐伯曰∶五脏六腑者，邪之舍也，请言其故。（五脏六腑坚端正者，和利得人，
则道之宅也。脏腑脆而偏倾，则邪气舍也。为道之宅，则其性和柔，神明聪利，人之受附也。为
邪之舍，不离病也，心奸邪也，喜为盗也，乖公正也，言不恒也。是知二十五变，虽得之于天，调
养得中，纵内外邪侵，不为病也。乖和失理，虽不离屏蔽，终为病也。前言一脏各有五病，未极理
【平按】：本篇从篇首到结尾，见于《灵枢》卷七第四十七《本藏》篇，也见于《甲乙经》卷一第五。
黄帝向岐伯问道：人的血气精神，是用来奉养生命并周流贯彻于性命之中的。（太初时的虚无状态，称为“道”。太极尚未成形时，万物得以产生，这称为“德”。在未成形而有德的状态中，既有分别又浑然无间，这称为“命”。这种命流动化生万物，万物形成生理结构，这称为“形”。形体保全精神，各自有所依持，这称为“性”。因此，血气精神奉养一个形体的生命，周流于形体所依持的性，也周流于有分别且浑然的命。所以命分流动形成形体，形体保全神成为性，形与性长久居住而成为生者，这些都是由血气所奉养的。）经脉，是运行血气，营卫阴阳，滋润筋骨，滑利关节的器官。（指十二经脉。十二经脉运行和营卫血气，营卫于三阴三阳，滋润筋骨，滑利关节。）卫气，是用来温煦肌肉，充实皮肤，肥厚腠理，主管毛孔开阖的。（卫气剽悍，运行于肌肉间隙，主管腠理的开阖。平按：“关”字原抄本作异体字，是“关”字的省文，袁刻本作“开”，《灵枢》作“关”。）志意，是用来驾驭精神，收敛魂魄，适应寒温，调和喜怒的。（脾肾之神志意，能驾驭精神使其守身，收敛魂魄使其不散，调节寒暑达到中和，调和喜怒不过节，这都是志意的功能。平按：“和喜怒”的“和”字原缺，袁刻本作“知”，恐怕有误，《灵枢》作“和”，谨根据《灵枢》补入。注中“御”字原缺，据经文应作“御”。）因此，血气和顺则经脉流通，营覆阴阳，筋骨强劲有力，关节滑利；（营气和谐增益。覆，指营气能营护覆盖阴阳。平按：“滑”在《灵枢》中作“清”。）卫气和顺则肌肉分解滑利，皮肤调和柔润，腠理致密；（卫气主管腠理，所以致密。平按：“分解滑利”在《灵枢》中作“分肉解利”。）志意和顺则精神专注正直，魂魄不散，悔恨愤怒不生，五脏就不受邪气侵袭。（志意行为得当，所以无悔。志意主管腠理，外邪不入，所以五脏不受邪。平按：《灵枢》中“不至”作“不起”，“不受邪气”作“不受邪”。）寒温适宜则六腑消化谷物，风痹不发生，（寒暑内部调适于六腑，则中和之气使谷物消化，贼风邪痹无从发生。）经脉通利，四肢关节得到安养。这是人的常态平和。（如果这样，血气营卫志意调和的人，就是人的平和状态。平按：“得”下《灵枢》有“安”字。）五脏，是用来储藏精神血气魂魄的；六腑，是用来消化谷物和运行津液的。这是人从天那里完全禀受的特性，无论愚笨、聪明、贤良还是不肖，都没有谁依靠谁的区别。（五脏藏神，六腑化谷，这是天的命分，虽然愚智不同，但禀受的天命不相依赖。津液，即泪、汗、涎、涕、唾。平按：“谷”上《灵枢》有“水”字。“液者”二字原缺，谨据《灵枢》补入。“愚”上《灵枢》有“无”字。）然而，有的人独自享尽天年，没有邪僻的疾病，百年不衰，即使遭受风雨、突然的严寒或酷暑，也不能伤害他；有的人从不离开遮蔽的室内，没有惊恐忧虑，然而仍然不免于生病，为什么呢？希望听您讲讲其中的缘故。（有人劳神惊恐，无所不为，即使遭受贼风邪气，也能独享天年。又有闲居无事，不接触外邪，却仍不免于病，这是因为损伤了性命。同样禀受血气，为何有差别？希望听您讲讲缘故。平按：“其有”在《灵枢》中作“有其”。“犹不能害”在《灵枢》中作“犹有弗能害”。“邪僻”的“僻”字原缺，“之恐”二字原缺，谨据《灵枢》补入。）
岐伯回答说：问得真急迫啊！（窘，音奇殒反，意为急切。）五脏，是用来参配天地，副合阴阳，连接四时，变化五季的器官。（肺心居上部，所以参天；肝脾肾居下部，所以参地。肝心为阳脏，副合阳；脾肺肾等阴脏，副合阴。肝应春、心应夏、肺应秋、肾应冬，这就是连接四时。随五时而变，就是变化五季。节，指时节。平按：“五节者也”的“也”字原缺，据《灵枢》补入。）五脏，本来就有小、大、高、下、坚、脆、端正、偏倾的区别；六腑，也有长、短、小、大、厚、薄、结、直、缓、急的区别。（天地阴阳，四时八节，造化不同，用来参配五脏，怎么能一样呢？五脏各有五种区别，六腑都准照五脏，也有五种区别，所以脏腑分别说各有五种区别，五五二十五种。五脏既为五，六腑亦为五，三焦一腑属于膀胱，所以只有五。平按：注中“各有五别”下空两格，“别”本作“各有五色五别”，下两格不空。）所有这些二十五种情况，各不相同，有的善，有的恶，有的吉，有的凶，请让我说明它们的方位表现。（心小则安稳，这是善。容易因忧愁而受伤，这就是恶。心坚则脏腑安稳守固，这是吉。心脆则容易患消瘅、热中等病，这就是凶。像这样，脏腑随义理都有善恶吉凶，请详细陈述。平按：“其方”的“其”字原缺，谨据《灵枢》补。）
心小则安稳，邪气不能伤害，但容易因忧愁而受伤；心大则忧愁不能伤害，但容易受邪气侵袭。（脏小则神不敢自宽，所以常安稳，邪气不入。脏大则神气宣散放纵，所以忧愁不能伤，邪气入而不安。平按：《甲乙经》中“以忧”作“于忧”。又按：《甲乙经》注云：太素中“邪”作“外邪”。今本仍无“外”字。又注神下一字原缺左旁，恐怕是“收”字，袁刻本作“敢”。）心高则满溢于肺中，导致善忘，难以用言语开导；（心脏位置高，则神也高。心高压迫肺，所以善忘。因为神高不接受其他言语，所以难以用言语开导。平按：“肺中”的“中”字原缺，谨据《灵枢》补入。“喜”在《灵枢》中作“善”。注中“心高”，“高”字原缺下方，细看剩余部分，接近“高”字，谨据经文作“高”。“过”下一字原不全，细看剩余部分，与“近”字相似，袁刻本作“小”，恐怕不妥，谨空一格。）心下则脏腑外露，容易受寒邪伤害，容易因言语而惊恐。（心下则在肺脏之外，神也居于外，所以寒邪易伤。也因为神下，所以容易因言语而惊恐。）心坚则脏腑安稳守固，（脏坚则神守也坚固，所以心脏安稳不病，神守坚固。）心脆则容易患消瘅、热中。（五脏柔脆，神也柔脆，所以脏柔脆的人，血脉上行，转而为热消耗肌肤，所以患消瘅热中。瘅音丹。热中，指胃中热。平按：“脆”原缺，谨据《灵枢》、《甲乙》补。“热中”，“中”字原缺，旁有小注“中”字，据注“热中，胃中热也”，应作“热中”，《灵枢》、《甲乙》同，袁刻作“注”，刻在“五脏柔脆”上，则混淆了经文与注释。）心端正则和顺便利难被伤害；（五脏端正，神也端正。神端正则性情和柔，所以声色芳味的诱惑难相伤害，这是贤人君子所以得心神的原因。）心偏倾，操持不一，没有坚守的主宰。（心脏偏倾不一，神也如此，所以操持百端，竟无坚守的恒心，这是众人小人所得的心神。心脏言神，有此八种变化。后四脏只言脏变，都不言神变，是因为神是魂魄意志的主宰，言其神变，则四种皆知，所以简略不言。平按：《甲乙经》注引杨上善注云：心脏言神有八变，后四脏但言脏变不言神变者，以神为魂魄意之主，言其神变则四脏可知，故略而不言也。与此注正合。袁刻“心脏言神”误作“之神”，“意志”下空十一格，不合。）
肺小则少饮，不患喘喝；（人禀受的份数，肺小则少饮水浆。又肺小不受外邪，所以不患喘喝。喝，喘声。平按：《甲乙》无“喝”字。）肺大则容易患胸痹、喉痹、气逆。（肺大喜受外邪，所以容易患痹及气逆。平按：“大则”下《灵枢》、《甲乙》有“多饮”二字。《甲乙》无“喉痹”二字。）肺高则气上逆，抬肩呼吸想咳嗽；（肺高则上迫缺盆，所以气上喘息。两肩并动，所以叫抬肩呼吸。又肺上迫，所以屡次想咳。平按：“肩息欲咳”《灵枢》无“欲”字，《甲乙》作“喘息咳逆”。）肺下则位于贲门压迫肝脏，善于胁下痛。（贲，当膈膜，音补昆反。气来委于膈，下迫于肝，导致胁下痛，因为肝居胁下。平按：“居贲”《甲乙》作“逼贲”。“迫肝”《灵枢》、《甲乙》作“迫肺”。注中“委膈”原校作“垂膈”。）肺坚则不患咳喘上气，（肺脏坚固，不为邪伤，所以无咳与上气。平按：“咳”《甲乙》作“咳逆”。）肺脆则善于患消瘅，容易受伤。（以上四脏的变化，例同心脏。平按：“善”《灵枢》作“苦”。《甲乙》“易伤”下有“也”字，注云：一说易伤于热，喘息鼻衄。）肺端正则和顺便利难被伤害，肺偏倾则胸部偏痛。（偏倾者，随偏所在，即偏处胸痛。）
肝小则安稳，无胁下病；（肝小不受外邪，所以安，无两胁下痛。平按：“安”上《灵枢》有“藏”字。）肝大则压迫胃和咽，压迫咽则容易膈中不通，且胁下痛。（胃居肝下，咽在肝旁，肝大下逼于胃，旁迫于咽，压迫咽则咽膈不通饮食，所以叫膈中。肝大受邪，所以两胁下痛。平按：“咽迫咽”三字原缺，谨据《甲乙》补。“喜”《灵枢》作“苦”。）肝高则上支膈膜，切压胁部紧急，为息贲；（肝高上支于膈，又切于胁，支膈切胁既急，即喘息于贲，所以叫息贲。平按：“切”《甲乙》作“加”。“急”《灵枢》作异体字。）肝下则安于胃，胁下空虚，空虚则容易受邪。（胃居肝下，是以肝下则安于胃上，胁下无物，故易受邪气。平按：“安胃”《灵枢》作“逼胃”。）肝坚则脏腑安稳难被伤害，（肝坚则外邪不入，所以安难伤。）肝脆则容易患消瘅，容易受伤。肝端正则和顺便利难被伤害，肝偏倾则胁下偏痛。（偏近一侧，则一侧空处偏痛。平按：“偏痛”，“偏”字《灵枢》无。）
脾小则安稳，难伤于邪；（脾小外邪不入，所以安而难伤。）脾大则善于凑聚空处而痛，不能快行。（ ，音以沼反，空处也。脾大凑向空处而痛，大□不行则□ 空也。平按：“善”《灵枢》、《甲乙》作“苦”。 《甲乙》音停。注中“不行”上原缺一字，袁刻作“力”。则下原缺一字，袁刻作“胁”。）脾高则牵引季胁而痛；（脾下则缓，高则牵，季胁中痛。）脾下则下加大肠，加大肠则脏腑外露善于受邪。（脾下即是大肠，故脾下加，出于脾脏所居之外，故喜受邪。平按：“外善受邪”《灵枢》无“外”字，“善”作“苦”。）脾坚则脏腑安稳难被伤害，（外邪不伤所以安。）脾脆则容易患消瘅，容易受伤。脾端正则和顺便利难被伤害，脾偏倾则喜欢胀满。（ ，音充曳反，牵纵也。脾偏形近一侧，动而多痹，又气聚为胀。平按：“喜 喜胀”《灵枢》作“善满善胀”，《甲乙经》作“ 喜胀”。）
肾小则安稳，难伤；（肾小不受外邪，所以安而难伤。）肾大则容易患腰痛，不能俯仰，容易受邪气伤害。（肾大在于腰中，所以俯仰皆痛。）肾高则善于背膂痛，不能俯仰；（肾高去腰，着于脊膂，所以脊膂痛，不得俯仰。）肾下则腰尻痛，不能俯仰，为狐疝。（肾下入于尻中，下迫膀胱，所以尻痛不可俯仰。疝，音所奸反，小腹痛，大小便难，叫疝。疝有多种，此为狐疝，谓狐狸夜间不得小便，少腹处痛，日出才得，人也如此，因名狐疝。）肾坚则不患腰背痛，（肾在腰背之间，所以肾坚则腰不痛。）肾脆则容易患消瘅。肾端正则和顺便利难被伤害，肾偏倾则喜欢腰尻偏痛。（二肾有一偏倾，则偏处痛。平按：“瘅”下《灵枢》、《甲乙》有“易伤”二字。）
所有这些二十五种变化，是人之所以常常患病的原因。（人的五脏，受之于天分，有此二十五种变化，不由人的失养之过，所以即使不离遮蔽，也常喜有前述疾病。）
黄帝说：怎么知道是这样的呢？（五脏二十五变都在身中，变生常病也在其中，不知因候，以此作为调养的依据。）
岐伯说：面色赤红纹理细腻的是心小，纹理粗糙的是心大。（理，指肉的纹理。粗音粗。）没有 骨的是心高， 骨小短而上举的是心下。 骨长的是心坚， 骨弱而薄的是心脆。 骨直下不上举的是心端正， 骨偏向一方的是心偏倾。（ ，胸前蔽骨，遮蔽心神。其心上入肺中，不需要蔽骨，所以心高以无蔽骨为征候。高者，志意高远。所以短小上举，是心下的征候。下者，志意卑近。平按： 在《灵枢》中作KT 。弱下《灵枢》、《甲乙》有“小”字。）
面色白纹理细腻的是肺小，纹理粗糙的是肺大。肩膀巨大、胸廓反张、喉骨陷入的是肺高，腋下收缩、胁肋张开的是肺下。肩膀背部厚实的是肺坚，肩膀背部薄的是肺脆。肩膀胸膺好（匀称）的是肺端正，胁肋偏耸的是肺偏倾。（大肩，胸膺反□喉骨陷入，肺必高上。平按：“巨肩”，“巨”字原抄作“臣”，谨根据《灵枢》、《甲乙》作“巨”。“掖”《灵枢》、《甲乙》作“腋”。“好肩膺”《灵枢》、《甲乙》作“背膺浓”。“竦”《灵枢》作“疏”，《甲乙》作“竦”，注云：一作欹。）
面色青纹理细腻的是肝小，纹理粗糙的是肝大。胸廓宽阔反 的是肝高，胁肋收敛 的是肝下。胸胁好（匀称）的是肝坚，胁骨弱的是肝脆。胸腹好好相得的是肝端正，胁骨偏举的是肝偏倾。（ ，足胫也。反，前曲出也。平按：“菟”《灵枢》作“兔”，《甲乙》作“脆”。“好好”《灵枢》、《甲乙》均不重，恐衍。）
面色黄纹理细腻的是脾小，纹理粗糙的是脾大。嘴唇上揭的是脾高，嘴唇下垂的是脾下。嘴唇坚实的是脾坚，嘴唇大而不自如的是脾脆。嘴唇上下好（匀称）的是脾端正，嘴唇偏举的是脾偏倾。（揭，举也，起辄反。）
面色黑纹理细腻的是肾小，纹理粗糙的是肾大。耳朵高的是肾高，耳后凹陷的是肾下。耳朵坚实的是肾坚，耳朵薄而不坚实的是肾脆。耳朵好（匀称）前居牙车的是肾端正，耳朵偏高的是肾偏倾。（一侧独高为偏。平按：“高耳”《甲乙》作“耳高”。）
所有这些变化，保持平衡则安，减弱则病。（所有这些二十五种变化，过分以为不善，减则为病，持平安和，视为大则。平按：“减”原抄作“咸”，谨根据《灵枢》、《甲乙》作“减”。）
黄帝说：好啊，但这不是我问的意思。我希望听说人有不可生病的，直到享尽天年，虽然有深忧大恐惊惕的念头，也不能感动（致病），极寒大热，也不能伤害。那些从不离开遮蔽室内，又没有惊惕恐惧，然而不免于病的，为什么呢？希望听您讲讲缘故。（您说的五脏变化，所知是要点，但这不是我问的本意。问的本意是，人生尽于天年，内则有深忧大恐，外则有甚寒极热，然而无所伤，不生病。而有外无寒暑侵扰，内去惊惕情怀，而疾病百端，其故何也？平按：“感”《灵枢》作“减”。）
岐伯说：五脏六腑，是邪气的客舍，请让我讲讲缘故。（五脏六腑坚端正者，和利得人，则是道的宅邸。脏腑脆而偏倾，则是邪气的客舍。作为道的宅邸，则其性和柔，神明聪利，人依附于此。作为邪气的客舍，则不离病，心奸邪，喜为盗，乖公正，言不恒。由此可知二十五变，虽得之于天，调养得中，纵内外邪侵，也不为病。乖和失理，虽不离遮蔽，终将为病。前言一脏各有五病，未极理……）
[Ping An]: This chapter, from the beginning to the end, is found in *Ling Shu* (Spiritual Pivot), Volume 7, Chapter 47 "Ben Cang" (Roots of Storage), and also in *Jia Yi Jing* (Classical Text of Jia Yi), Volume 1, Chapter 5.
The Yellow Emperor asked Qibo: The blood, qi, spirit, and essence of a person are what nourish life and permeate the nature of existence. (The void state of Taichu is called Dao. When Taiji has not yet taken form, and things come into being, this is called De. In the state where form has not appeared but De exists, there is distinction yet no gap; this is called Ming. This Ming flows and generates all things; when things take shape and develop physiology, this is called Xing. The physical body preserves the spirit, each having its own support; this is called Xing [Nature]. Therefore, blood, qi, spirit, and essence nourish the life of one body, permeate the nature supported by the physical form, and also permeate the Ming that has distinction yet no gap. Thus, Ming flows to form the body, the body preserves the spirit to become Nature, and the longevity of Form and Nature constitutes Life; all these are sustained by Blood and Qi.) The meridians are the pathways that circulate blood and qi, nourish Yin and Yang, moisten sinews and bones, and facilitate joint movement. (Referring to the Twelve Meridians. The Twelve Meridians circulate and nourish blood and qi, nurturing the Three Yin and Three Yang meridians, moistening sinews and bones, and facilitating joint movement.) Wei Qi (Defensive Qi) is what warms the muscles, fills the skin, thickens the interstices (Cou Li), and controls the opening and closing of pores. (Wei Qi is swift and fierce, circulating in the muscle spaces, controlling the opening and closing of the interstices. Ping An: The character "Guan" [close] in the original manuscript is written as a variant, a shorthand for "Guan". Yuan's edition writes it as "Kai" [open], while *Ling Shu* writes "Guan".) Zhi Yi (Will and Intent) is what commands the spirit, gathers the soul and hun, adapts to cold and heat, and harmonizes joy and anger. (The spirit, will, and intent of the Spleen and Kidney can command the spirit to guard the body, gather the hun and po so they do not scatter, regulate cold and heat to achieve harmony, and harmonize joy and anger without exceeding moderation; these are the virtues of Zhi Yi. Ping An: The character "He" [harmonize] in "He Xi Nu" was originally missing; Yuan's edition writes "Zhi", which is likely incorrect. *Ling Shu* writes "He". It is added here based on *Ling Shu*. Note: The character "Yu" [command] was originally missing; it should be "Yu" according to the text.) Therefore, when blood is harmonious, the meridians flow smoothly, Ying Qi covers Yin and Yang, sinews and bones are strong, and joints are supple; (Ying Qi is harmonious and beneficial. "Fu" means Ying Qi can nourish and cover Yin and Yang. Ping An: "Hua" [smooth] in *Ling Shu* is written as "Qing" [clear].) When Wei Qi is harmonious, the muscles are loose and supple, the skin is smooth and soft, and the interstices are dense; (Wei Qi governs the interstices, hence they are dense. Ping An: "Fen Jie Hua Li" in *Ling Shu* is written as "Fen Rou Jie Li" [muscle fibers loose and supple"].) When Zhi Yi is harmonious, the spirit is focused and upright, the hun and po do not scatter, regret and anger do not arise, and the Five Zang Organs are not invaded by pathogenic factors. (When Zhi Yi acts appropriately, there is no regret. Zhi Yi governs the interstices, preventing external pathogens from entering, thus the Five Zang Organs are not affected. Ping An: In *Ling Shu*, "Bu Zhi" [not reach] is written as "Bu Qi" [not rise], and "Bu Shou Xie Qi" [not receive evil qi] is written as "Bu Shou Xie" [not receive evil].) When cold and heat are moderate, the Six Fu Organs digest grain, and wind-bi does not occur; (When cold and heat are internally adapted to the Six Fu Organs, then the medium-and-harmonious transformation of grain occurs, and thief-wind and pathogenic bi have no opportunity to arise.) the meridians are unobstructed, and the limbs and joints are nourished. This is the normal state of peace in humans. (If so, those whose blood, qi, Ying, Wei, Zhi, and Yi are harmonious are indeed in a state of human peace. Ping An: Under "De" [obtain], *Ling Shu* has the character "An" [peace].) The Five Zang Organs store spirit, blood, qi, hun, and po; the Six Fu Organs transform grain and transport fluids. This is what humans fully receive from Heaven; whether foolish or wise, virtuous or unworthy, none relies on another. (The Five Zang store the spirit; the Six Fu transform grain. This is the Mandate of Heaven. Although wisdom differs, the received mandate does not depend on others. Fluids include tears, sweat, saliva, nasal mucus, and spit. Ping An: Above "Gu" [grain], *Ling Shu* has "Shui" [water]. The characters "Ye Zhe" [are fluids] were originally missing; added here based on *Ling Shu*. Above "Yu" [foolish], *Ling Shu* has "Wu" [no/not].) However, some people alone enjoy their full natural lifespan, free from deviant diseases, remaining vigorous for a hundred years; even if exposed to wind, rain, sudden cold, or intense heat, they cannot be harmed. Others never leave sheltered rooms, have no fear or alarm, yet still cannot avoid illness. Why is this? I wish to hear the reason. (Some exhaust their spirit and feel alarmed, doing everything possible; yet even if exposed to thief-wind and pathogenic factors, they alone complete their natural years. Others live in leisure without thought, avoiding external pathogens, yet still cannot avoid illness because they fail to understand how they injure their life. Both share the same blood and qi, why is there such difference? I wish to hear the reason. Ping An: "Qi You" in *Ling Shu* is written as "You Qi". "You Bu Neng Hai" in *Ling Shu* is written as "You You Fu Neng Hai". The character "Pi" in "Xie Pi" was originally missing; "Zhi Kong" [of fear] two characters were originally missing; added here based on *Ling Shu*.)
Qibo replied: Your question is quite urgent! (Jiong, pronounced Qi Yun fan, means urgent/awkward.) The Five Zang Organs correspond to Heaven and Earth, match Yin and Yang, connect with the Four Seasons, and transform the Five Solar Terms. (Lung and Heart reside above, thus corresponding to Heaven; Liver, Spleen, and Kidney reside below, thus corresponding to Earth. Liver and Heart are Yang organs, matching Yang; Spleen, Lung, and Kidney are Yin organs, matching Yin. Liver corresponds to Spring, Heart to Summer, Lung to Autumn, Kidney to Winter; this connects the Four Seasons. Changing according to the Five Times transforms the Five Solar Terms. Jie [term] refers to time. Ping An: The character "Ye" at the end of "Wu Jie Zhe Ye" was originally missing; added based on *Ling Shu*.) The Five Zang Organs inherently vary in size (small/large), position (high/low), texture (firm/brittle), and alignment (upright/tilted); the Six Fu Organs also vary in length (long/short), size (small/large), thickness (thick/thin), structure (knotted/straight), and tone (tight/relaxed). (Heaven and Earth, Yin and Yang, the Four Seasons and Eight Solar Terms, create differences in formation. Using them to correspond to the Five Zang, how can they be identical? Each of the Five Zang has five variations; the Six Fu follow the Five Zang and also have five variations. Thus, Zang and Fu are discussed separately, each having five variations, totaling twenty-five. Since there are five Zang, there are also five Fu; the San Jiao [Triple Burner] is one Fu belonging to the Bladder, so there are only five. Ping An: The note under "Ge You Wu Bie" [each has five variations] has two empty spaces. 'Bie' originally read "Ge You Wu Se Wu Bie" [each has five colors and five variations]; the lower two spaces are not empty.) All these twenty-five cases differ from each other; some are good, some bad; some auspicious, some inauspicious. Please explain their manifestations. (If the Heart is small, it is peaceful; this is good. If easily injured by worry, this is bad. If the Heart is firm, the Zang is peaceful and secure; this is auspicious. If the Heart is brittle, it tends to suffer from Xiao Dan [wasting-thirst] and Re Zhong [heat in the middle]; this is inauspicious. Thus, Zang and Fu, according to meaning, all have good/bad and auspicious/inauspicious aspects. Please state them fully. Ping An: The character "Qi" in "Qi Fang" was originally missing; added based on *Ling Shu*.)
If the Heart is small, it is peaceful, and pathogens cannot harm it, but it is easily injured by sorrow; if the Heart is large, sorrow cannot harm it, but it is easily injured by pathogens. (If the Zang is small, the Spirit dares not relax, thus always peaceful, and pathogens do not enter. If the Zang is large, the Spirit Qi spreads and indulges, thus sorrow cannot harm, but pathogens enter and cause unrest. Ping An: In *Jia Yi Jing*, "Yi You" [by worry] is written as "Yu You" [with worry]. Also, *Jia Yi Jing* notes: In *Tai Su*, "Xie" [pathogen] is written as "Wai Xie" [external pathogen]. The current text lacks "Wai". Also, the character under "Shen" [spirit] is missing on the left side, possibly "Shou" [gather]; Yuan's edition writes "Gan" [dare].) If the Heart is high, it overflows into the Lungs, causing forgetfulness, and is difficult to open with words; (If the Heart organ is high, the Spirit is also high. A high Heart compresses the Lungs, thus causing forgetfulness. Because the Spirit is high and does not accept other words, it is difficult to open with speech. Ping An: The character "Zhong" in "Fei Zhong" [in the Lung] was originally missing; added based on *Ling Shu*. "Xi" [like/easily] in *Ling Shu* is written as "Shan" [good]. In the note, "Xin Gao" [Heart high], the character "Gao" is missing at the bottom; examining the remainder, it resembles "Gao"; added based on the text. The character after "Guo" [exceed/pass] is incomplete; examining the remainder, it resembles "Jin" [near]; Yuan's edition writes "Xiao" [small], which is likely inappropriate; leaving one space blank.) If the Heart is low, the Zang is exposed externally, easily injured by cold, and easily frightened by words. (If the Heart is low, it lies outside the Lung Zang, and the Spirit also resides externally, thus cold easily harms. Also, because the Spirit is low, it is easily frightened by words.) If the Heart is firm, the Zang is peaceful and secure; (If the Zang is firm, the Spirit Guard is also firm, thus the Heart is peaceful and disease-free, and the Spirit Guard is solid.) if the Heart is brittle, it tends to suffer from Xiao Dan [wasting-thirst] and Re Zhong [heat in the middle]. (If the Five Zang are soft and brittle, the Spirit is also soft and brittle. Thus, people with soft and brittle Zang have blood vessels flowing upward, turning into heat that consumes flesh and skin, leading to Xiao Dan and Re Zhong. Dan sounds like Dan. Re Zhong refers to heat in the Stomach. Ping An: "Cui" [brittle] was originally missing; added based on *Ling Shu* and *Jia Yi*. For "Re Zhong", the character "Zhong" was originally missing; there is a small note "Zhong" beside it. Based on the note "Re Zhong, Wei Zhong Re Ye" [Re Zhong is heat in the Stomach], it should be "Re Zhong". *Ling Shu* and *Jia Yi* agree. Yuan's edition writes "Zhu" [note], placed above "Wu Zang Rou Cui", confusing the text with the annotation.) If the Heart is upright, it is harmonious and difficult to harm; (If the Five Zang are upright, the Spirit is also upright. If the Spirit is upright, the nature is gentle and flexible, thus the allure of sounds, colors, and flavors is hard to harm; this is how sages and gentlemen obtain the Heart-Spirit.) If the Heart is tilted, its grasp is inconsistent, lacking a steadfast master. (If the Heart organ is tilted and inconsistent, the Spirit is likewise. Thus, grasping at a hundred ends, yet lacking constancy in guardianship; this is the Heart-Spirit obtained by commoners and petty people. The Heart discusses the Spirit, having these eight changes. For the subsequent four Zang, only Zang changes are mentioned, not Spirit changes, because the Spirit is the master of Hun, Po, Yi, and Zhi. Discussing Spirit changes implies knowledge of the four Zang, hence briefly omitted. Ping An: *Jia Yi Jing* note quotes Yang Shangshan: The Heart discusses Spirit having eight changes; for the latter four Zang, only Zang changes are mentioned, not Spirit changes, because the Spirit is the master of Hun, Po, and Yi. Discussing Spirit changes makes the four Zang known, hence briefly omitted. This matches the note exactly. Yuan's edition mistakenly writes "Zhi Shen" [of Spirit] instead of "Xin Zang Yan Shen" [Heart Zang speaks of Spirit]; eleven spaces are left blank after "Yi Zhi" [Intent Will], which is incorrect.)
If the Lung is small, one drinks little, and does not suffer from panting and wheezing; (According to one's allotted portion, if the Lung is small, one drinks little water/gruel. Also, a small Lung does not accept external pathogens, thus not suffering from panting and wheezing. He [wheeze] is the sound of panting. Ping An: *Jia Yi* lacks the character "He".) If the Lung is large, it tends to suffer from Xiong Bi [chest obstruction], Hou Bi [throat obstruction], and rebellious Qi. (A large Lung easily accepts external pathogens, thus tending to suffer from Bi and rebellious Qi. Ping An: After "Da Ze" [if large], *Ling Shu* and *Jia Yi* have "Duo Yin" [drink much]. *Jia Yi* lacks "Hou Bi".) If the Lung is high, there is rebellious Qi, shoulder breathing, and desire to cough; (If the Lung is high, it presses up on the Quepen area, thus causing rebellious Qi and panting. Both shoulders move, thus called shoulder breathing. Also, the Lung presses upward, thus frequently desiring to cough. Ping An: "Jian Xi Yu Ke" [shoulder breathing and desire to cough] in *Ling Shu* lacks "Yu" [desire]; *Jia Yi* writes "Chuan Xi Ke Ni" [panting, coughing, and rebellious Qi".) If the Lung is low, it resides at Ben [diaphragm] pressing on the Liver, prone to pain under the ribs. (Ben refers to the diaphragm, pronounced Bu Kun fan. Qi comes down to the diaphragm, pressing downward on the Liver, causing pain under the ribs, because the Liver resides under the ribs. Ping An: "Ju Ben" in *Jia Yi* is written as "Bi Ben" [press Ben]. "Po Gan" [press Liver] in *Ling Shu* and *Jia Yi* is written as "Po Fei" [press Lung]. The note "Wei Ge" [recline diaphragm] was collated as "Chui Ge" [droop diaphragm".) If the Lung is firm, it does not suffer from cough and rebellious Qi; (If the Lung Zang is firm, it is not injured by pathogens, thus no cough or rebellious Qi. Ping An: "Ke" [cough] in *Jia Yi* is written as "Ke Ni" [cough and rebellious Qi".) If the Lung is brittle, it tends to suffer from Xiao Dan [wasting-thirst] and is easily injured. (The variations of the above four Zang follow the example of the Heart. Ping An: "Shan" [tend to] in *Ling Shu* is written as "Ku" [suffer]. *Jia Yi* has "Ye" [particle] after "Yi Shang" [easily injured]; the note says: Alternatively, easily injured by heat, panting, and nosebleed.) If the Lung is upright, it is harmonious and difficult to harm; if the Lung is tilted, there is pain on one side of the chest. (Tilted means, depending on the direction of tilt, there is pain on that side of the chest.)
If the Liver is small, it is peaceful, with no disease under the ribs; (If the Liver is small, it does not accept external pathogens, thus peaceful, with no pain under both ribs. Ping An: Above "An" [peaceful], *Ling Shu* has "Cang" [store".) If the Liver is large, it presses on the Stomach and throat; pressing the throat tends to cause obstruction in the diaphragm/chest, and pain under the ribs. (The Stomach resides below the Liver, the throat is beside the Liver. If the Liver is large, it presses down on the Stomach and sideways on the throat. Pressing the throat causes obstruction in the throat and diaphragm regarding food and drink, thus called Ge Zhong [diaphragm middle]. If the Liver is large and accepts pathogens, there is pain under both ribs. Ping An: The three characters "Yan Po Yan" [throat presses throat] were originally missing; added based on *Jia Yi*. "Xi" [tend to] in *Ling Shu* is written as "Ku" [suffer".) If the Liver is high, it supports upward against the diaphragm, cuts into the ribs tightly, causing Xi Ben [breathful accumulation]; (If the Liver is high, it supports upward against the diaphragm and cuts into the ribs. Since supporting the diaphragm and cutting the ribs is tight, there is panting at Ben, thus called Xi Ben. Ping An: "Qie" [cut/tight] in *Jia Yi* is written as "Jia" [add]. "Ji" [tight] in *Ling Shu* is written as a variant character.) If the Liver is low, it rests on the Stomach, leaving the rib area empty; emptiness makes it easy to accept pathogens. (The Stomach resides below the Liver; thus, if the Liver is low, it rests on the Stomach, and the rib area is empty, thus easily accepting pathogenic Qi. Ping An: "An Wei" [peace Stomach] in *Ling Shu* is written as "Bi Wei" [press Stomach".) If the Liver is firm, the Zang is peaceful and difficult to harm; (If the Liver is firm, external pathogens do not enter, thus peaceful and difficult to harm.) if the Liver is brittle, it tends to suffer from Xiao Dan [wasting-thirst] and is easily injured. If the Liver is upright, it is harmonious and difficult to harm; if the Liver is tilted, there is pain on one side of the ribs. (Tilting near one side leaves the other side empty, causing pain on that side. Ping An: "Pian Tong" [partial pain], the character "Pian" [partial] is absent in *Ling Shu*.)
If the Spleen is small, it is peaceful, and difficult to harm by pathogens; (If the Spleen is small, external pathogens do not enter, thus peaceful and difficult to harm.) If the Spleen is large, it tends to crowd into empty spaces causing pain, and cannot walk quickly. ( , pronounced Yi Zhao fan, means empty space. If the Spleen is large, it crowds into empty spaces causing pain. Large □ cannot walk, then □ is empty. Ping An: "Shan" [tend to] in *Ling Shu* and *Jia Yi* is written as "Ku" [suffer]. in *Jia Yi* is pronounced Ting. The note missing one character above "Bu Xing" [cannot walk]; Yuan's edition writes "Li" [strength]. One character missing after "Ze" [then]; Yuan's edition writes "Xie" [ribs".) If the Spleen is high, it pulls the hypochondrium causing pain; (If the Spleen is low, it is lax; if high, it pulls, causing pain in the hypochondrium.) If the Spleen is low, it adds pressure to the Large Intestine; adding pressure to the Large Intestine exposes the Zang externally, making it prone to accepting pathogens. (If the Spleen is low, it is the Large Intestine; thus, if the Spleen is low, it extends out from where the Spleen Zang resides, thus tending to accept pathogens. Ping An: "Wai Shan Shou Xie" [externally tend to accept pathogens] in *Ling Shu* lacks "Wai" [externally], and "Shan" [tend to] is written as "Ku" [suffer".) If the Spleen is firm, the Zang is peaceful and difficult to harm; (External pathogens do not harm, thus peaceful.) if the Spleen is brittle, it tends to suffer from Xiao Dan [wasting-thirst] and is easily injured. If the Spleen is upright, it is harmonious and difficult to harm; if the Spleen is tilted, it tends to feel distended. ( , pronounced Chong Ye fan, means pulling and stretching. If the Spleen is tilted near one side, movement causes more bi [obstruction], and Qi gathers causing distension. Ping An: "Xi Xi Zhang" [tend to tend to distend] in *Ling Shu* is written as "Shan Man Shan Zhang" [good fullness good distension]; *Jia Yi Jing* writes " Zhang" [distension".)
If the Kidney is small, it is peaceful, and difficult to harm; (If the Kidney is small, it does not accept external pathogens, thus peaceful and difficult to harm.) If the Kidney is large, it tends to suffer from lower back pain, inability to bend or extend, and is easily injured by pathogens. (If the Kidney is large, it resides in the waist, thus bending and extending both cause pain.) If the Kidney is high, it tends to cause pain in the back and spine, unable to bend or extend; (If the Kidney is high, it moves away from the waist and attaches to the spinal column, thus causing spinal pain, unable to bend or extend.) If the Kidney is low, there is pain in the loins and sacrum, inability to bend or extend, constituting Hu Shan [fox hernia]. (If the Kidney is low, it enters the sacrum, pressing downward on the Bladder, thus sacral pain, unable to bend or extend. Shan, pronounced Suo Jian fan, is lower abdominal pain with difficulty in urination and defecation, called Shan. There are many types of Shan; this is Fox Hernia, named so because foxes cannot urinate at night, experiencing lower abdominal pain, and can only urinate after sunrise; humans are similar, hence the name Fox Hernia.) If the Kidney is firm, it does not suffer from lower back and back pain; (The Kidney is between the waist and back; thus, if the Kidney is firm, the waist does not hurt.) if the Kidney is brittle, it tends to suffer from Xiao Dan [wasting-thirst]. If the Kidney is upright, it is harmonious and difficult to harm; if the Kidney is tilted, it tends to have pain on one side of the loins and sacrum. (If one of the two Kidneys is tilted, there is pain on the tilted side. Ping An: Below "Dan" [wasting-thirst], *Ling Shu* and *Jia Yi* have "Yi Shang" [easily injured".)
All these twenty-five variations are why humans commonly suffer from illness. (Human Five Zang, received from Heavenly allotment, have these twenty-five variations. Not due to human negligence in nourishment, thus even if not leaving shelter, one often suffers from the aforementioned illnesses.)
The Yellow Emperor said: How do we know this? (The twenty-five variations of the Five Zang are all within the body; the variations generating common illnesses also reside within. Unknown due to signs, knowing this serves as a basis for regulation and nourishment.)
Qibo said: Red complexion with fine texture indicates a small Heart; coarse texture indicates a large Heart. (Texture refers to the grain of the flesh. Coarse sounds like Cu.) Absence of Xian Gu [xiphoid process/sternum] indicates a high Heart; small, short, and raised Xian Gu indicates a low Heart. Long Xian Gu indicates a firm Heart; weak and thin Xian Gu indicates a brittle Heart. Xian Gu straight down without raising indicates an upright Heart; Xian Gu leaning to one side indicates a tilted Heart. (Xian, the anterior sternum/xiphoid bone, shields the Heart Spirit. The Heart goes up into the Lungs, not needing the xiphoid shield, thus a high Heart is indicated by the absence of the xiphoid. High means lofty will/intent. Thus, short and raised indicates a low Heart. Low means humble/near intent. Ping An: in *Ling Shu* is written as KT. Below "Ruo" [weak], *Ling Shu* and *Jia Yi* have "Xiao" [small".)
White complexion with fine texture indicates a small Lung; coarse texture indicates a large Lung. Huge shoulders, reversed chest, and depressed throat bone indicate a high Lung; contracted armpits and flared ribs indicate a low Lung. Good/firm shoulders and back indicate a firm Lung; thin shoulders and back indicate a brittle Lung. Good/symmetrical shoulders and chest indicate an upright Lung; flared/asymmetric ribs indicate a tilted Lung. (Large shoulders, chest protruding, throat bone depressed, Lung must be high. Ping An: "Ju Jian" [huge shoulder], the character "Ju" was originally copied as "Chen"; corrected to "Ju" based on *Ling Shu* and *Jia Yi*. "Ye" [armpit] in *Ling Shu* and *Jia Yi* is written as "Ye" [axilla]. "Hao Jian Ying" [good shoulder chest] in *Ling Shu* and *Jia Yi* is written as "Bei Ying Nong" [back chest thick]. "Song" [flared] in *Ling Shu* is written as "Shu" [sparse]; in *Jia Yi* as "Song"; note says: alternatively "Qi" [lean".)
Green complexion with fine texture indicates a small Liver; coarse texture indicates a large Liver. Broad chest and reversed indicate a high Liver; contracted ribs and indicate a low Liver. Good/symmetrical chest and ribs indicate a firm Liver; weak rib bones indicate a brittle Liver. Good/symmetrical chest and abdomen indicate an upright Liver; asymmetrically raised rib bones indicate a tilted Liver. ( , refers to the shin/calf. Fan [reverse], curves forward. Ping An: "Tu" [rabbit] in *Ling Shu* is written as "Tu" [rabbit]; in *Jia Yi* as "Cui" [brittle]. "Hao Hao" [good good] in *Ling Shu* and *Jia Yi* are not repeated, likely redundant.)
Yellow complexion with fine texture indicates a small Spleen; coarse texture indicates a large Spleen. Raised lips indicate a high Spleen; drooping lips indicate a low Spleen. Firm lips indicate a firm Spleen; large and non-firm lips indicate a brittle Spleen. Good/symmetrical upper and lower lips indicate an upright Spleen; asymmetrically raised lips indicate a tilted Spleen. (Jie [raise], means lift, pronounced Qi Zhe fan.)
Black complexion with fine texture indicates a small Kidney; coarse texture indicates a large Kidney. High ears indicate a high Kidney; depressed areas behind ears indicate a low Kidney. Firm ears indicate a firm Kidney; thin and non-firm ears indicate a brittle Kidney. Good/symmetrical ears positioned forward on the jaw indicate an upright Kidney; ears positioned higher on one side indicate a tilted Kidney. (One side uniquely high is tilted. Ping An: "Gao Er" [high ear] in *Jia Yi* is written as "Er Gao" [ear high".)
All these variations: maintaining balance brings peace; diminishing brings illness. (All these twenty-five variations: excess is considered not good; diminution leads to illness; maintaining peace and harmony is the great principle. Ping An: "Jian" [diminish] was originally copied as "Xian"; corrected to "Jian" based on *Ling Shu* and *Jia Yi*.)
The Yellow Emperor said: Excellent, but this is not what I asked. I wish to hear about people who cannot get sick, enjoying their full natural lifespan. Even with deep worries, great fears, and alarmed intentions, they cannot be affected; extreme cold and heat cannot harm them. Those who never leave sheltered rooms, have no fear or alarm, yet still cannot avoid illness—why? I wish to hear the reason. (You spoke of the variations of the Five Zang, which are important, but not my original question. The original question is: Humans reach their natural lifespan; internally there are deep worries and great fears, externally extreme cold and heat, yet they are unharmed and do not get sick. But some, with no external invasion of cold/heat, and internal removal of alarm/fear, still suffer from myriad illnesses. What is the reason? Ping An: "Gan" [affect/move] in *Ling Shu* is written as "Jian" [diminish".)
Qibo said: The Five Zang and Six Fu Organs are the dwellings of pathogens. Let me explain the reason. (If the Five Zang and Six Fu are firm and upright, harmonious and benefiting people, they are the residence of Dao. If the Zang and Fu are brittle and tilted, they are the dwelling of pathogens. Being the residence of Dao means their nature is gentle, spirit and mind are clear and sharp, and people attach to them. Being the dwelling of pathogens means they do not escape illness; the Heart harbors evil, likes theft, deviates from justice, and speech is inconsistent. Thus, knowing the twenty-five variations, although received from Heaven, if regulated moderately, even with internal and external pathogen invasion, one does not get sick. Deviating from harmony and losing reason, even if not leaving shelter, one ultimately gets sick. Previously, I mentioned five illnesses for each Zang, but did not exhaust the principles...)