黄帝问曰。余闻善言天者。必有验于人。善言古者。必有合于今。善言人者。必有厌于己。如此则道不惑而要数极。
所谓明也。（本经云。气伤痛。盖痛在有形之形身。而伤于无形之气分。是病皆生于寒热七情。而证见于脏腑经脉。举痛
而论。百病皆然。能会通此道。庶明而不惑。是以帝言知天道者。苟能验于人。知往古者。苟能合于今。善言人者。必
有足于己。如此则道不惑。而知要数之极。斯所谓之明道者也。）今余问于夫子。令言而可知。视而可见。扪而可得。冷
验于己。而发明解惑。可得而闻乎。（经云。知一为工。知二为上。知三为神。知斯三者。望见其色。按其脉。问其病也。
是以帝欲闻此三者之应验。而开发于未明。）岐伯再拜稽首对曰。何道之问也。（请示问端也。）帝曰。愿闻人之五脏卒痛。
何气使然。岐伯对曰。经脉流行不止。环周不休。寒气入经而稽迟。泣而不行。客于脉外则血少。客于脉中则气不通。
故卒然而痛。（泣音涩卒叶村入声经气流转。如环无端。寒气客之。则凝泣而不行矣。客于脉外则脉缩蜷而血少。客于脉
中则脉满而气不通。故卒然而痛也。张兆璜曰。气为阳。血为阴。气无形。血有形。气行脉外。血行脉中。客于脉外
则血少。客于脉中则气不通。正言其形气交感之要道。）帝曰。其痛或卒然而止者。或痛甚不休者。或痛甚不可按者。
或按之而痛止者。或按之无益者。或喘动应手者。或心与背相引而痛者。或胁肋与少腹相引而痛者。或腹痛引阴股者。
或痛宿昔而成积者。或卒然痛死不知人。有少间复生者。或痛而呕者。或腹痛而后泄者。或痛而闭不通者。凡此诸痛。
各不同形。别之奈何。（形、证也。言通证之各有不同。将何以别之。）岐伯曰。寒气客于脉外则脉寒。脉寒则缩蜷。缩
蜷则脉绌急。绌急则外引小络。故卒然而痛。得炅则痛立止。因重中于寒。则痛久矣。（绌音屈炅音炯重平声。绌、犹屈
也。寒则血凝泣。故脉缩蜷。缩蜷则绌急而外引小络。夫经脉为里。浮而外者为络。外内引急。故卒然而痛也。炅气、
太阳之气也。脉寒而得阳热之气。则缩绌即舒。故其痛立止。若复感于寒。则阳气受伤。故痛久而不止。莫子晋曰。太
阳、日中之火也。太阳主诸阳之气。阳热之甚者也。此受天之寒邪。得吾身之阳气以化热。故痛立止。）寒气客于经脉之
中。与炅气相搏则脉满。满则痛而不可按也。寒气稽留。炅气从上。则脉充大而气血乱。故痛甚不可按也。（荣血行于脉
中。阳气行于脉外。寒邪在脉。与阳相搏。则血气淖泽而脉满矣。脉满。故痛而不可按也。寒气稽留于脉中。阳气惟升
而从上。血气不能相将而循行。则乱矣。）寒气客于肠胃之间。膜原之下。血不得散。小络急引。故痛。按之则血气散。
故按之痛止。（膜原者。连于肠胃之脂膜。亦气分之腠理。金匮要略云。腠者。是三焦通会元真之处。理者。皮肤脏腑之
纹理也。盖在外则为皮肤肌肉之腠理。在内则为横连脏腑之膜原。皆三焦通会元气之处。如寒气客于肠胃膜原之间。则
内引小络。故痛也。夫痛者阴也。气为阳。经络为阴。是以本篇论痛。皆邪伤于经脉。如邪客于脉外之气分。而迫于经
络为痛者。或得炅。或按之则痛止。盖寒邪得气而易散也。如邪入于经络而为痛者。甚则不可按。或虽按之无益。盖阴
分之邪难散也。此邪在膜原之气分。牵引小络而痛。故按之即止。张兆璜曰。邪在肌腠之脉外。则外引小络而痛。邪
在膜原之脉外。则内引小络而痛。盖膜原之间。有血络也。）寒气客于挟脊之脉则深。按之不能及。故按之无益也。（挟
脊之脉。伏冲之脉也。伏冲之脉。上循背里。邪客之则深。按之不能及。故按之无益也。倪冲之曰。则深者。谓邪客
于挟脊之冲脉则深。在于腹之冲脉。则浮于外而浅矣。）寒气客于冲脉。冲脉起于关元。随腹直上。寒气客则脉不通。脉
不通则气因之。故喘动应手矣。（此言冲脉之循于腹者。会于咽喉。而散于脉外也。夫冲脉之循于背者注于经。其浮而外
循于腹者。至胸中而散于脉外之气分。故脉不通则气因之。而喘动应手。谓脉逆于胸之下。而气因病于胸之上。喘动应
手者。人迎气口。喘急应手也。倪冲之曰。分别冲脉之有挟脊循腹。故曰随腹直上。则气因之。）寒气客于背俞之脉则
脉泣。脉泣则血虚。血虚则痛。其俞注于心。故相引而痛。按之则热气至。热气至则痛止矣。（此言太阳为炅热之气。虽
寒客于经俞。得气至则痛止矣。背俞之脉者。足太阳之脉也。太阳之脉循于背。而五脏六腑之俞。皆注于心。故相引心
而痛。心为阳中之太阳。盖与太阳之气。标本相合。是以按之则热气至。而痛止矣。）寒气客于厥阴之脉。厥阴之脉者。
络阴器。系于肝。寒气客于脉中。则血泣脉急。故胁肋与少腹相引痛矣。（肝主血。故寒气客于厥阴之脉。则血泣脉急。
肝脉布胁肋。循阴器。故胁肋与少腹相引而痛。倪冲之曰。五脏六腑之经俞荣血。发原于冲脉。而藏于厥阴之肝经。寒
伤荣。故客于冲脉背俞厥阴也。）厥气客于阴股。寒气上及少腹。血泣在下相引。故腹痛引阴股。（此承上文而言。寒气
在上。厥气在下。上下相引。而为痛也。厥阴之脉。上抵少腹。下循阴股。故腹痛引阴股。盖言经气上下相通。故邪正
相引而为痛。）寒气客于小肠膜原之间。络血之中。血泣不得注于大经。血气稽留不得行。故宿昔而成积矣。（此言膜
原之间。亦有血络。寒气客于膜原之血络。不得入于大经而成积也。百病始生篇曰。虚邪之中人。在络之时。痛于肌肉。
其痛之时息。大经乃代。留而不去。传舍于肠胃之外。膜原之间。留着于脉。稽留而不去。息而成积。盖言脉在于外内
之络脉者。必转入于大经。而后乃代谢。如血气稽留于络脉。则宿昔而成积矣。宿昔、稽留久也。息、止也。大经、脏
腑之大络也。）寒气客于五脏。厥逆上泄。阴气竭。阳气未入。故卒然痛死不知人。气复反则生矣。（寒气客于五脏。
脏阴之气。厥逆于上。而从上泄。则阴气内竭矣。阳热之气。又未入于内。则里气虚伤。故卒然痛死不知人。得阴阳之
气。复反于内则生矣。）寒气客于肠胃。厥逆上出。故痛而呕也。（寒气客于肠胃之间。从胃上出。故痛而呕。愚按在脏
之邪。溜腑而解。在肠胃之邪。从下泄而解。今脏腑之邪。皆从上逆而出者。病气而不入经也。）寒气客于小肠。小肠不
得成聚。故后泄腹痛矣。（此言寒气客于小肠之间。转入于肠内。故不成积聚而为后泄腹痛也。杨元如曰。邪在于膜原
血络之中。转注于大经。则入于肠内。盖邪入于经。则溜于腑。）热气留于小肠。肠中痛。瘅热焦渴。则坚干不得出。故
痛而闭不通矣。（此承上文而言小肠之邪。不得后泄而为热闭也。热气者。寒气稽留而化热也。小肠为赤肠。乃心脏之府。
故感火气而化热。瘅、消瘅也。小肠主液。肠中热则液消而为瘅热矣。焦者火之气。感火热之气而为焦渴也。液消热燥。
则受盛之物坚干而不得出。故痛闭不通矣。杨元如曰。此篇论寒气。而末结热气一条者。谓寒邪稽留不去。得阳热之
气而能化热者也。）帝曰。所谓言而可知者也。视而可见奈何。（言而可知者。言其病而知其处也。视而可见者。观其
色而见其病也。）岐伯曰。五脏六腑。固尽有部。视其五色。黄赤为热。白为寒。青黑为痛。此所谓视而可见者也。（五
脏六腑之气色。皆见于面。而各有所主之部位。视其五色而可见其病矣。中有热则色见黄赤。寒则血凝泣。故面白脱色
也。青黑乃阴寒凝滞之色。故为痛。）帝曰。扪而可得奈何。（谓按其脉而得其病也。）岐伯曰。视其主病之脉。坚而血及
陷下者。皆可扪而得也。（主病之脉者。脏腑所主之病脉也。坚而血者。邪气实也。陷下者。正气虚也。言邪正虚实。皆
可扪而得之。）帝曰。善。余知百病生于气也。（夫寒暑营运。天之阴阳也。喜怒七情。人之阴阳也。是以举痛而论阴阳
寒热。知百病之皆生于气焉。董子繁露曰。天有春夏秋冬。人有喜怒哀乐。张兆璜曰。智者之养生。顺四时而适寒温。
和喜怒而安居处。则苛疾不起。百病不生。）怒则气上。喜则气缓。悲则气消。恐则气下。寒则气收。炅则气泄。惊则
气乱。劳则气耗。思则气结。九气不同。何病之生。（问寒热七情。皆伤人气。而气有上下消耗之不同。是何病之所生也。）
岐伯曰。怒则气逆。甚则呕血及飧泄。故气上矣。（怒为肝志。肝主藏血。怒则肝气上逆。故甚则呕血。木气乘脾。故及
为飧泄。脾位中州。肝脏居下。故呕血飧泄。皆为气上。）喜则气和志达。荣卫通利。故气缓矣。（喜乃阳和之气。故志
意和达。荣卫疏通。其气舒徐而和缓矣。）悲则心系急。肺布叶举。而上焦不通。荣卫不散。热气在中。故气消矣。（心
气并于肺则悲。心悲气并则心系急。心系上连于肺。心系急则肺布而叶举矣。肺主气而位居上焦。主行荣卫阴阳。肺脏
布大。而肺叶上举。则上焦之气不通。而荣卫不能行散矣。气郁于中则热中。气不营运。故潜消也）恐则精却。却则上
焦闭。闭则气还。还则下焦胀。故气不行矣。（气者。水中之生阳也。肾为水脏。主藏精而为生气之原。恐伤肾。是以精
气退却。而不能上升。膻中为气之海。上出于肺。以司呼吸。然其原出于下焦。故精气却则上焦闭。闭则生升之气还归
于下。而下焦胀矣。上下之气。不相交通。故气不行矣。）寒则腠理闭。气不行。故气收矣。（腠理者。肌肉之纹理。乃
三焦通会元真之处。寒气客之。则腠理闭而气不通。故气收于内矣。）炅则腠理开。荣卫通。汗大泄。故气泄。（卫行脉
外之腠理。汗乃荣血之阴液。夫气为阴之固。阴为阳之守。炅则腠理开。汗大泄。则阳气从而外泄矣。）惊则心无所倚。
神无所归。虑无所定。故气乱矣。（惊则心气散而无所倚。神志越而无所归。思虑惑而无所定。故气乱矣。）劳则喘息汗
出。外内皆越。故气耗矣。（劳则肾气伤而喘息于内。阳气张而汗出于外。外内皆越。故气耗散矣。）思则心有所存。神
有所归。正气留而不行。故气结矣。（所以任物谓之心。心之所之谓之志。因志而在变谓之思。故思则心神内存。正气留
中而不行。故气结矣。）
黄帝问道：我听说，善于谈论天道的人，一定能在人体上得到验证；善于谈论古代历史的人，其道理一定符合当今实际；善于论述人事的人，一定能印证于自身。像这样，就不会对医道产生困惑，而且能掌握要领和规律的最高境界。这就是所谓的“明”（《本经》说：气分受伤导致疼痛。疼痛发生在有形的形体上，但损伤源于无形的气分。所有的疾病都产生于寒热邪气和七情内伤，而证候表现于脏腑经脉。列举疼痛来论述，百病的道理都是如此。如果能融会贯通这个道理，就能明白而不困惑。所以黄帝说，知道天道的人，如果能在人体上得到验证；知道过去的人，如果能与现在相合；善于论述人伦的人，一定能充实完善自己。像这样，医道就不会困惑，并能知晓要领和规律的极致，这就叫做“明道”。）现在我向先生请教，希望听到那些通过言语询问就能知道的、通过观察面色就能看到的、通过触摸脉象就能获得的，并且都能在自身得到验证的方法，从而阐明疑惑，可以讲给我听吗？（经文说：懂得一种诊法的是普通医生，懂得两种的是上等医生，懂得三种的是神妙医生。掌握了这三种方法，就能望见病人的面色，切按脉象，询问病情。所以黄帝想听闻这三者对应的验证方法，以开发那些尚未明了的知识。）岐伯拜了两拜并叩头回答说：您问的是哪方面的道理呢？（请示提问的缘由。）黄帝说：我希望听听人的五脏突然疼痛，是什么气造成的？岐伯回答说：经脉之气流行不止，循环周身不停息。寒气侵入经脉，使气血运行迟缓、涩滞而不能通行。寒气客居在脉外，则血液减少；寒气客居在脉中，则气机不通畅。所以会突然发生疼痛。（泣音同涩，卒音同村入声。经气流转，如环无端。寒气侵袭，就会凝涩而不行。寒气客于脉外，则经脉收缩蜷曲而血液减少；寒气客于脉中，则经脉胀满而气机不通畅，所以突然发生疼痛。张兆璜说：气属阳，血属阴；气无形，血有形；气行于脉外，血行于脉中。客于脉外则血少，客于脉中则气不通，这正是说明形与气相互感应的关键道理。）
黄帝说：这种疼痛有的突然停止，有的疼痛剧烈且不停止，有的疼痛剧烈且不可按压，有的按压后疼痛停止，有的按压后毫无益处，有的脉搏跳动应手可见，有的心口与背部互相牵引而痛，有的胁肋部与小腹部互相牵引而痛，有的腹痛牵引到大腿内侧，有的疼痛日久形成积块，有的突然剧痛昏死不知人事，过一会儿又苏醒过来，有的疼痛伴有呕吐，有的腹痛伴有腹泻，有的疼痛伴有大便闭塞不通。所有这些疼痛，形态各不相同，如何辨别它们呢？（形，指证候。意思是说通用的证候各有不同，将用什么方法来辨别它们？）岐伯说：寒气客居在脉外，则经脉受寒。经脉受寒则收缩蜷曲，收缩蜷曲则经脉拘急，经脉拘急则向外牵引细小的络脉，所以突然发生疼痛。遇到温热，疼痛立刻停止。如果再次受到寒邪侵袭，疼痛就会持续很久。（绌音同屈，炅音同炯，重读平声。绌，就是屈的意思。寒则血液凝涩，所以经脉收缩蜷曲。收缩蜷曲则拘急而向外牵引小络。经脉是里的脉络，浮行于外的叫络脉。内外牵引拘急，所以突然发生疼痛。炅气，就是太阳之气。经脉受寒，得到阳热之气，那么收缩拘急就会舒展，所以疼痛立刻停止。如果再感受寒邪，阳气就会受伤，所以疼痛持久不止。莫子晋说：太阳，就像中午的太阳之火。太阳主管诸阳之气，是阳气中最热烈的部分。这里承受天的寒邪，得到身体的阳气来化生为热，所以疼痛立刻停止。）
寒气客居在经脉之中，与阳热之气相互搏结，则经脉胀满。胀满则疼痛且不可按压。寒气稽留不去，阳热之气上升，则经脉充盛盛大，气血紊乱，所以疼痛剧烈且不可按压。（营血行于脉中，阳气行于脉外。寒邪在脉中，与阳气相搏结，则血气淖泽而经脉胀满。经脉胀满，所以疼痛且不可按压。寒气稽留在脉中，阳气只升而上行，血气不能相互引导而循行，就会紊乱。）
寒气客居在肠胃之间，膜原之下，血液不能散行，小络脉紧急牵引，所以疼痛。按压时，血气得以疏散，所以按压后疼痛停止。（膜原，是连属于肠胃的脂膜，也是气分的腠理。《金匮要略》说：腠，是三焦通会元真之处；理，是皮肤脏腑的纹理。在外则是皮肤肌肉的腠理，在内则是横连脏腑的膜原，都是三焦通会元气之处。如寒气客居在肠胃膜原之间，则向内牵引小络，所以疼痛。痛属于阴，气属于阳，经络属于阴。所以本篇论痛，都是邪气伤害经脉。如邪气客居在脉外的气分，而逼迫经络导致疼痛的，或者得到温热，或者按压后疼痛停止，这是因为寒邪得到气就容易消散。如邪气进入经络导致疼痛的，严重时不可按压，或者虽然按压也毫无益处，这是因为阴分之邪难以消散。此邪气在膜原的气分，牵引小络而痛，所以按压即止。张兆璜说：邪气在肌腠的脉外，则向外牵引小络而痛；邪气在膜原的脉外，则向内牵引小络而痛。大概膜原之间，有血络存在。）
寒气客居在挟脊的经脉，位置较深，按压不能达到，所以按压后毫无益处。（挟脊的经脉，就是伏冲之脉。伏冲之脉，上行沿着背部里面，邪气客居于此则位置深，按压不能达到，所以按压后毫无益处。倪冲之说：所谓深，是指邪气客居在挟脊的冲脉，位置就深；如果在腹部的冲脉，则浮于外面而浅。）
寒气客居在冲脉，冲脉起于关元穴，随着腹壁直上。寒气客居于此，则脉道不通畅。脉道不通畅，气机随之逆乱，所以脉搏跳动应手可见。（这是说冲脉在腹部的循行，会合于咽喉，而散布于脉外的气分。冲脉在背部的循行注入经脉，其浮行于腹部外面的，到达胸中而散布于脉外的气分。所以脉道不通畅，气机随之逆乱，而脉搏跳动应手。所谓喘动应手，是指人迎穴和气口穴，脉搏急促应手。倪冲之说：区分冲脉有挟脊和循腹的不同，所以说随腹直上，气机随之逆乱。）
寒气客居在背俞脉，则血脉凝涩。血脉凝涩则血虚，血虚则疼痛。背俞脉注于心，所以心与背部互相牵引而痛。按压时，热气到达，热气到达则疼痛停止。（这是说太阳主司阳热之气，虽然寒气客居在经俞，得到热气到达则疼痛停止。背俞脉，就是足太阳膀胱经的经脉。太阳经的经脉循行于背部，而五脏六腑的俞穴，都注于心。所以互相牵引心痛。心为阳中之太阳，大概与太阳之气，标本相合。所以按压时热气到达，而疼痛停止。）
寒气客居在厥阴肝经，厥阴肝经，联络阴器，系属于肝。寒气客居在脉中，则血液凝涩，经脉拘急，所以胁肋部与小腹部互相牵引而痛。（肝主藏血，所以寒气客居在厥阴肝经，则血液凝涩，经脉拘急。肝经布散于胁肋，循行经过阴器，所以胁肋与小腹部互相牵引而痛。倪冲之说：五脏六腑的经俞和营血，发源于冲脉，而贮藏于厥阴肝经。寒邪伤害营血，所以客居在冲脉、背俞和厥阴经。）
厥气客居在大腿内侧，寒气向上波及小腹部，血液凝涩在下部互相牵引，所以腹痛牵引到大腿内侧。（这是承接上文而言，寒气在上，厥气在下，上下互相牵引，而发生疼痛。厥阴肝经，上抵少腹，下循大腿内侧，所以腹痛牵引到大腿内侧。大概是说经气上下相通，所以邪正互相牵引而发生疼痛。）
寒气客居在小肠膜原之间，络脉之中，血液凝涩不能注入大经脉，血气稽留不能通行，所以日久形成积块。（这是说膜原之间，也有血络。寒气客居在膜原的血络，不能进入大经脉而形成积块。《百病始生篇》说：虚邪中人，在络脉的时候，疼痛在肌肉，疼痛时有时无，大经脉随后受影响。停留不去，传舍在肠胃之外，膜原之间，留着在脉中，稽留不去，逐渐形成积块。大概是说脉在外内的络脉，必须转入大经脉，然后才进行新陈代谢。如血气稽留在络脉，则日久形成积块。宿昔，指稽留很久；息，指停止；大经，指脏腑的大络。）
寒气客居在五脏，导致阴气厥逆上泄，阴气竭绝，阳气未能入内，所以突然剧痛昏死不知人事。如果气机恢复反回体内，就能生存。（寒气客居在五脏，脏中的阴气，厥逆于上，而从上面泄出，则阴气在内竭绝了。阳热之气，又不能进入内部，则里气虚伤，所以突然剧痛昏死不知人事。得到阴阳之气，复返于内，就能生存。）
寒气客居在肠胃，导致气机厥逆向上溢出，所以疼痛且呕吐。（寒气客居在肠胃之间，从胃向上溢出，所以疼痛且呕吐。我按：在脏的邪气，流注到腑而解；在肠胃的邪气，从下面泄出而解。现在脏腑的邪气，都从上面逆而出，是病气而不入经脉的表现。）
寒气客居在小肠，小肠不能正常聚糟粕，所以出现腹泻和腹痛。（这是说寒气客居在小肠之间，转入肠内，所以不能形成积聚，而是出现腹泻和腹痛。杨元如说：邪气在膜原血络之中，转注于大经脉，则进入肠内。大概是邪气进入经脉，则流注于腑。）
热气留滞在和小肠，肠中疼痛。湿热炽盛，津液焦枯口渴，则大便坚硬干燥无法排出，所以疼痛且闭塞不通。（这是承接上文而言，小肠的邪气，不能从后面泄出而成为热闭。热气，是寒气稽留不去，得到阳热之气而化生的热。小肠为赤肠，是心脏的府，所以感受火气而化热。瘅，指消瘅。小肠主液，肠中热则津液消耗而为瘅热。焦，是火的气味，感受火热之气而为焦渴。津液消耗，热燥，则受盛的食物变得坚硬干燥而无法排出，所以疼痛闭塞不通。杨元如说：本篇论述寒气，最后归结一条热气，是说寒邪稽留不去，得到阳热之气就能化热。）
黄帝说：所谓通过言语询问就能知道的，是怎样的呢？观察面色就能看到的，又是怎样的呢？（言而可知，是说通过询问病情就知道病变的部位。视而可见，是说观察面色就能看到病症。）岐伯说：五脏六腑，本来都有相应的部位。观察五色，黄色和红色主热，白色主寒，青色和黑色主痛。这就是所说的通过观察面色就能看到的。（五脏六腑的气色，都显现于面部，而各有所主的部位。观察五色就能看到病症。中有热则颜色显现黄赤，寒则血液凝涩，所以面色白而失血色。青黑是阴寒凝滞的颜色，所以主痛。）
黄帝说：通过触摸脉象就能获得的，是怎样的呢？（谓按其脉而得其病。）岐伯说：观察主病之脉，如果脉象坚实而有瘀血，或者脉象陷下的，都可以通过触摸获得。（主病之脉，是脏腑所主的病脉。坚实而有瘀血，是邪气实；脉象陷下，是正气虚。意思是说邪正虚实，都可以通过触摸获得。）
黄帝说：好。我知道百病都产生于气。（寒暑运行动荡，是天的阴阳；喜怒七情，是人的阴阳。所以列举疼痛来论述阴阳寒热，知道百病都产生于气。董仲舒《繁露》说：天有春夏秋冬，人有喜怒哀乐。张兆璜说：明智的人养生，顺应四时而适应寒温，调和喜怒而安居处，那么重疾不起，百病不生。）
怒则气机上逆，严重时会呕血和完谷不化的腹泻，所以气往上冲。（怒是肝的情志，肝主藏血，怒则肝气上逆，所以严重时呕血。木气乘脾，所以导致完谷不化的腹泻。脾位居中州，肝脏居下，所以呕血和飧泄，都是气机上逆的表现。）
喜则气和顺，意志通达，营卫通畅流利，所以气机舒缓。（喜是阳和之气，所以意志和顺通达，营卫疏通，气机舒徐而和缓。）
悲则心系紧急，肺叶举扬，而上焦不通畅，营卫不能散发，热气郁结在中焦，所以气机消耗。（心气并于肺则悲，心悲气并则心系紧急。心系上连于肺，心系紧急则肺布张而肺叶上举。肺主气而位居上焦，主行营卫阴阳。肺脏布张大，而肺叶上举，则上焦之气不通畅，而营卫不能行散。气郁于中则热中，气不营运，所以潜然消耗。）
恐则精气退却，退却则上焦闭塞，闭塞则气还归下部，还归下部则下焦胀满，所以气机不行。（气，是水中之生阳。肾为水脏，主藏精而为生气之源。恐伤肾，所以精气退却，而不能上升。膻中为气海，上出于肺，以司呼吸，然而其源出于下焦，所以精气退却则上焦闭塞，闭塞则生升之气还归于下，而下焦胀满。上下之气，不相交通，所以气机不行。）
寒则腠理闭合，气机不行，所以气机收敛。（腠理，是肌肉的纹理，乃三焦通会元真之处。寒气客居于此，则腠理闭合而气不通畅，所以气机收敛于内。）
热则腠理开放，营卫通畅，汗大泄，所以气机外泄。（卫气行于脉外之腠理，汗是营血的阴液。气为阴之固守，阴为阳之守卫。热则腠理开放，汗大泄，则阳气随之外泄。）
惊则心无所依托，神无所归依，思虑无所定夺，所以气机紊乱。（惊则心气散漫而无所依托，神志越出而无所归依，思虑惑乱而无所定夺，所以气机紊乱。）
劳则喘息汗出，内外之气皆越散，所以气机耗损。（劳则肾气受伤而在内喘息，阳气张扬而在外出汗。内外之气皆越散，所以气机耗散。）
思则心神内存，正气留滞而不行，所以气机结聚。（所以承担事物叫心，心的所向叫志，因志而变化叫思。所以思则心神内存，正气留滞在中而不行，所以气机结聚。）
Huangdi asked, "I have heard that those who are good at discussing the Way of Heaven must have verification in human beings; those who are good at discussing ancient history must align with the present; and those who are good at discussing human affairs must find confirmation within themselves. In this way, the Dao will not be confused, and one can reach the ultimate principles of its essential laws. This is what is called 'clarity' (The Classic states: Injury to Qi causes pain. Pain occurs in the有形 [form/structure] body, but the injury originates from the无形 [formless] Qi aspect. All diseases arise from cold-heat pathogens and the Seven Emotions, and manifestations appear in the Zang-Fu organs and meridians. By listing pains to discuss, the principles of all hundred diseases are thus revealed. If one can integrate and understand this Dao, one will be clear and not confused. Therefore, Huangdi said: One who knows the Way of Heaven, if verified in humans; one who knows the past, if aligned with the present; one who is good at discussing humanity, if sufficient within oneself. In this way, the Dao is not confused, and the extremes of essential laws are known. This is called 'understanding the Dao'.) Now I ask you, Master, hoping to hear methods that can be known through inquiry, seen through observation, obtained through palpation, and verified in oneself, thereby clarifying doubts. May I hear them?" (The Canon states: Knowing one method makes a common physician; knowing two makes an excellent physician; knowing three makes a divine physician. Mastering these three allows one to observe colors, palpate pulses, and inquire about illnesses. Thus, Huangdi wishes to hear the verification of these three correspondences to enlighten the unknown.) Qibo bowed twice and kowtowed, replying, "What question do you ask?" (Requesting the premise of the inquiry.) Huangdi said, "I wish to hear why sudden pain in the five Zang organs occurs, and what Qi causes it." Qibo replied, "Meridian Qi flows continuously, circling around without rest. When Cold pathogen enters the meridians, it causes stagnation and sluggishness, preventing smooth flow. If it lodges outside the vessels, blood volume decreases; if it lodges inside the vessels, Qi mechanism becomes obstructed. Hence, sudden pain occurs." (Qi flows like a circle without end. When Cold invades, it coagulates and stagnates. Lodging outside vessels causes contraction and reduced blood; lodging inside causes vessel fullness and Qi obstruction, leading to sudden pain. Zhang Zhaohuang stated: Qi is Yang, Blood is Yin; Qi is formless, Blood is formed; Qi moves outside vessels, Blood moves inside. Lodging outside reduces blood; lodging inside obstructs Qi. This correctly describes the key interaction between Form and Qi.)
Huangdi said, "This pain sometimes stops suddenly, sometimes persists severely, sometimes is too painful to press, sometimes stops when pressed, sometimes pressing brings no relief, sometimes pulsation is felt under the hand, sometimes heart and back pain radiate to each other, sometimes hypochondrium and lower abdomen pain radiate to each other, sometimes abdominal pain radiates to the inner thighs, sometimes pain lingers for days forming accumulations, sometimes sudden severe pain causes unconsciousness with recovery after a while, sometimes pain accompanies vomiting, sometimes abdominal pain accompanies diarrhea, sometimes pain accompanies constipation. All these pains differ in form. How should they be distinguished?" (Form refers to syndrome. Meaning that general syndromes differ; how to distinguish them?) Qibo said, "When Cold lodges outside the vessels, the vessels become cold. Cold causes contraction and curling, which leads to tension and cramping, pulling on small collaterals externally, causing sudden pain. Upon receiving warmth (Jiong), pain stops immediately. If repeatedly struck by Cold, pain lasts long." (Chù means bent. Cold coagulates blood, causing vessel contraction. Vessel contraction leads to tension, pulling small collaterals. Meridians are internal; floating external ones are collaterals. Internal and external tension causes sudden pain. Jiong Qi is Taiyang Qi. Vessels cold receive Yang heat, relaxing tension, so pain stops. If Cold returns, Yang is injured, so pain persists. Mo Zijin said: Taiyang is like the noon sun, governing all Yang Qi, the most intense heat. Receiving heavenly Cold, transformed by bodily Yang into heat, pain stops immediately.)
When Cold lodges inside the meridians, it fights with Warmth (Jiong), causing vessel fullness. Fullness leads to pain that cannot be pressed. Cold stagnates, Warmth rises, vessels swell, and Qi/Blood disorder, causing severe pain unresponsive to pressure. (Ying Blood moves inside vessels, Wei Qi moves outside. Cold in vessels fights Yang, causing blood/Qi saturation and vessel fullness, making pain unpressable. Cold stagnates inside, Yang rises only, blood/Qui cannot guide each other, causing disorder.)
When Cold lodges between the stomach/intestines and below the membrane source (Moyuan), blood cannot disperse, small collaterals tighten and pull, causing pain. Pressing disperses blood/Qi, stopping pain. (Moyuan connects to stomach/intestines, a lipid membrane, also the collateral tissue of Qi aspect. *Jin Gui Yao Lue* says: Collateral (Cou) is where Sanjiao meets Yuanzhen; Li is texture of skin/organs. External is skin/muscle Couli; internal is Moyuan connecting organs. Both are where Sanjiao meets Yuan Qi. Cold here pulls internal small collaterals, causing pain. Pain is Yin, Qi is Yang, Meridians are Yin. This chapter discusses pain as pathogen injuring meridians. Pathogen in external Qi aspect forcing meridions: relieved by warmth or pressure, as Cold dissipates easily with Qi. Pathogen entering meridians: severe pain unpressable, or pressure useless, as Yin pathogen is hard to dissipate. Pathogen in Moyuan Qi aspect pulling small collaterals: pressure stops pain. Zhang Zhaohuang said: Pathogen outside muscle Couli pulls external collaterals; pathogen outside Moyuan pulls internal collaterals. Moyuan contains blood collaterals.)
When Cold lodges in the paravertebral vessels, it is deep; pressure cannot reach, so pressing is useless. (Paravertebral vessels are Fu Chong vessels. Fu Chong runs up along the back interior; pathogen here is deep, unreachable by pressure. Ni Chongzhi said: Deep means pathogen in paravertebral Chong is deep; in abdominal Chong, it is superficial.)
When Cold lodges in the Chong Mai, which starts at Guanyuan and ascends straight up the abdomen, the vessels become obstructed. Obstruction causes Qi to follow suit, resulting in pulsation felt under the hand. (This discusses Chong Mai running in abdomen, meeting throat, scattering to external Qi. Back Chong injects into meridians; abdominal Chong scatters to chest external Qi. Obstruction causes Qi disorder, pulsation felt. Renying/Kouci pulses rapid. Ni Chongzhi said: Distinguishing Chong's paravertebral vs abdominal paths explains 'ascending straight up', hence Qi follows.)
When Cold lodges in the Back-Shu vessels, blood stagnates. Stagnation causes blood deficiency, deficiency causes pain. Shu points connect to Heart, so heart and back pain radiate. Pressing brings heat, stopping pain. (Taiyang governs Yang heat. Even if Cold lodges in Shu, arrival of heat stops pain. Back-Shu vessels are Foot-Taiyang. Taiyang runs on back; Zang-Fu Shu points connect to Heart. Radiating heart pain. Heart is Yang among Yang, matching Taiyang. Pressure brings heat, stopping pain.)
When Cold lodges in Jueyin vessels, which link the genitalia and attach to Liver, blood stagnates and vessels tense inside, causing radiating pain between hypochondrium and lower abdomen. (Liver governs Blood. Cold in Jueyin causes blood stagnation/tension. Liver channel distributes to hypochondrium/genitalia. Radiating pain. Ni Chongzhi said: Zang-Fu Shu/Ying originate in Chong, store in Jueyin Liver. Cold injures Ying, lodging in Chong/Shu/Jueyin.)
Juevi Qi lodges in the inner thigh, Cold reaches upper lower abdomen. Blood stagnates below, pulling together, causing abdominal pain radiating to inner thighs. (Cold above, Jueqi below, pulling each other. Jueyin channel reaches lower abdomen, runs inner thigh. Radiating pain. Meridian Qi connects up/down, pathogen/righteousness pull causing pain.)
When Cold lodges in Xiaochang (Small Intestine) Moyuan and collaterals, blood stagnates, cannot enter large meridians, Qi/Blood stagnate, forming accumulation over time. (Moyuan has blood collaterals. Cold in Moyuan collaterals cannot enter large meridians, forming accumulation. *Bai Bing Shi Sheng Pian*: Empty pathogen enters Luo, pain in muscle, intermittent, then affects large meridians. Stays in exterior of gut/Moyuan, lodges in vessels, stagnates, forms accumulation. External/internal collaterals must turn to large meridians for metabolism. Stagnation in collaterals forms accumulation over time. Suxi = long stagnation; Xi = stop; Da Jing = large collaterals of Zang-Fu.)
When Cold lodges in the Five Zang, Yin Qi rebels and leaks upward, Yin exhausts, Yang fails to enter, causing sudden severe pain, unconsciousness. If Qi returns, life is saved. (Cold in Zang, Yin Qi rebels/leaks, exhausting Yin internally. Yang heat fails to enter, damaging interior Qi, causing sudden pain/unconsciousness. Return of Yin/Yang Qi saves life.)
When Cold lodges in stomach/intestines, Qi rebels upward, causing pain and vomiting. (Cold in gut/stomach, exits via stomach upward, causing pain/vomit. Note: Pathogen in Zang resolves by flowing to Fu; in Gut/Stomach resolves by exiting downward. Here, Zang/Fu pathogen exits upward, indicating disease Qi does not enter meridians.)
When Cold lodges in Small Intestine, it fails to consolidate feces, causing diarrhea and abdominal pain. (Cold in Small Intestine enters intestine, failing to form accumulation, causing diarrhea/pain. Yang Yuanru said: Pathogen in Moyuan collaterals turns to large meridians, entering intestine. Pathogen entering meridians flows to Fu.)
When Heat stays in Small Intestine, intestinal pain occurs. Damp-Heat scorches fluids, causing thirst, hard dry stool unable to pass, leading to painful constipation. (Continuing: Small Intestine pathogen fails to exit downward, becoming Heat closure. Heat arises from Cold stagnation transforming via Yang heat. Small Intestine is Red Intestine, Fu of Heart, transforms to Heat via Fire. Dan refers to wasting-thirst. Small Intestine governs fluids; heat consumes fluids into Dan-Heat. Jiao is fire's nature; feeling fire heat causes thirst. Fluid loss/dryness makes food hard/dry, unable to pass, causing painful blockage. Yang Yuanru said: Chapter discusses Cold, ends with Heat line, meaning Cold stagnation transforms to Heat via Yang.)
Huangdi said, "What is meant by 'known through speech'? What is meant by 'visible through observation'?" (Speech-known: knowing location via inquiry. Visible: seeing disease via color.) Qibo said, "Zang-Fu have fixed areas. Observing five colors: Yellow/Red indicate Heat; White indicates Cold; Blue/Black indicate Pain. This is 'visible through observation'." (Zang-Fu colors appear on face, each ruling an area. Observing colors reveals disease. Heat shows Yellow/Red; Cold coagulates blood, showing pale/loss of color. Blue/Black are Yin-Cold stagnation colors, indicating pain.)
Huangdi said, "What is meant by 'obtainable through palpation'?" (Palpating pulse to find disease.) Qibo said, "Observe the pulse governing the disease. If firm with blood stasis, or sunken/depressed, both can be obtained by palpation." (Pulse governing disease is the pathological pulse of Zang-Fu. Firm/blood stasis indicates Excess pathogen; Sunken indicates Deficient righteous Qi. Both Excess/Deficiency can be palpated.)
Huangdi said, "Excellent. I know all diseases arise from Qi." (Cold/Heat movement is Heaven's Yin/Yang; Joy/Anger Seven Emotions are Human Yin/Yang. Listing pain discusses Yin/Yang Cold/Heat, knowing all diseases arise from Qi. Dong Zhongshu: Heaven has seasons, Humans have emotions. Zhang Zhaohuang: Wise nourish life following seasons/warmth, harmonizing emotions/rest, preventing severe illness/hundred diseases.)
Anger causes Qi to rise; severely, hematemesis and undigested diarrhea occur, so Qi goes up. (Anger is Liver emotion; Liver stores Blood. Anger causes Liver Qi rebellion, severe hematemesis. Wood attacks Spleen, causing undigested diarrhea. Spleen central, Liver inferior; vomiting/diarrhea are Qi rising.)
Joy causes Qi to harmonize, will to reach, Ying/Wei to flow freely, so Qi relaxes. (Joy is Yang harmony; will harmonizes/reaches, Ying/Wei unblocks, Qi relaxes/slow.)
Sorrow causes Heart Tie to tighten, Lung leaves to raise, Upper Jiao blocked, Ying/Wei not dispersed, Heat stays middle, so Qi consumes. (Heart Qi merging with Lung causes sorrow. Heart sorrow tightens Heart Tie. Heart Tie connects to Lung; tightening raises Lung leaves. Lung governs Qi/Upper Jiao/Ying/Wei. Lung expands/leaves raise, blocking Upper Jiao, hindering Ying/Wei dispersion. Qi stagnates middle creating heat, failing to circulate, consuming Qi.)
Fear causes Essence to retreat; retreat blocks Upper Jiao; blockage returns Qi downward; return distends Lower Jiao, so Qi does not move. (Qi is Yang born in Water. Kidney is Water organ, stores Essence, source of Qi. Fear injures Kidney, Essence retreats, cannot rise. Danzhong is Sea of Qi, exits Lung for respiration, origin Lower Jiao. Essence retreats blocks Upper Jiao; blockage returns ascending Qi to Lower Jiao, distending it. Up/Down Qi fail to communicate, so Qi does not move.)
Cold closes Couli, Qi does not move, so Qi gathers/inwardly contracts. (Couli is muscle texture, Sanjiao Yuanzhen meeting place. Cold closes Couli, blocking Qi, gathering Qi inward.)
Heat opens Couli, Ying/Wei flow, sweat profusely, so Qi leaks outward. (Wei moves external Couli; sweat is Ying Yin fluid. Qi secures Yin; Yin guards Yang. Heat opens Couli, sweat leaks, Yang follows outward leak.)
Fright causes Heart to have no support, Spirit no return, Thought no certainty, so Qi disorders. (Fright scatters Heart Qi/support, Spirit wanders/returns, Thought confuses/certain, so Qi disorders.)
Labor causes panting/sweating, internal/external escape, so Qi耗 (consumes). (Labor injures Kidney Qi, panting internally; Yang张扬, sweating externally. Internal/external escape, Qi consumes.)
Thought causes Heart to retain, Spirit to return, Zheng Qi stays/stagnates, so Qi knots. (Responsibility is Heart; direction is Will; change due to Will is Thought. Thought retains Heart Spirit, Zheng Qi stays middle, Qi knots.)