黄帝问曰∶五脏六腑,寒热相移者何?岐伯曰∶肾移寒于肝,痈肿少气。脾移寒于肝,痈肿筋挛。
肝移寒于心,狂隔中。心移寒于肺,肺消,肺消者饮一溲二,死不治。肺移寒于肾,为涌水,涌水者,按
腹不坚,水气客于大肠,疾行则鸣濯濯如囊裹浆,水之
病也。脾移热于肝,则为惊衄。肝移热于心,则死。心移热于肺,传为膈消。肺移热于肾,传为柔 。肾移热
于脾,传为虚,肠 死,不可治。胞移热于膀胱,则癃溺血。膀胱移热于小肠,膈肠不便,上为口麋。小
肠移热于大肠,为 瘕,为沉。大肠
移热于胃,善食而瘦入,谓之食亦。胃移热于胆,亦曰食亦。胆移热于脑,则辛 鼻渊,鼻渊者,浊涕下不止
也,传为衄蔑瞑目,故得之气厥也。
黄帝问曰∶肺之令人咳何也?岐伯对曰∶五脏六腑皆令人咳,非独肺也。帝曰∶愿闻其状。岐伯曰∶皮毛
者肺之合也,皮毛先受邪气,邪气以从其合也。其寒饮食入胃,从肺脉上至于肺则肺寒,肺寒则外内合邪因而
客之,则为肺咳。五脏各以其时受
病,非其时各传以与之。人与天地相参,故五脏各以治时感于寒则受病,微则为咳,甚者为泄为痛。乘
秋则肺先受邪,乘春则肝先受之,乘夏则心先受之,乘至阴则脾先受之,乘冬则肾先受之。帝曰∶何以异之?
岐伯曰∶肺咳之状,咳而喘息有音,甚则唾血。心咳之状,咳则心痛,喉仲介介如梗状,甚则咽肿喉痹。肝
咳之状,咳则两胁下痛,甚则不可以转,转则两 下满。脾咳之状,咳则右胁下痛阴阴引肩背,甚则不可以动,
动则咳剧。肾咳之状,咳则腰背相引而痛,甚则咳涎。帝曰∶六腑之咳奈何?安所
受病?岐伯曰∶五脏之久咳,乃移于六腑。脾咳不已,则胃受之,胃咳之状,咳而呕,呕甚则长虫出。肝咳不
已,则胆受之、胆咳之状、咳呕胆汁。肺咳不已,则大肠受之,大肠咳状,咳而遗失。心咳不已,则小肠受之,
小肠咳状,咳而失气,气与咳俱失。肾咳不已,则膀胱受之,膀胱咳状,咳而遗溺。久咳不已,则三焦受之,
三焦咳状,咳而腹满,不欲食饮,此皆聚于胃,关于肺,使人多涕唾而面浮肿气逆也。帝
曰∶治之奈何?岐伯曰∶治脏者治其俞,治腑者治其合,浮肿者治其经。帝曰∶善。
疟论∶ (火沃切)漉(音鹿)弭(绵婢切)
刺疟论∶ (音谒)悒(于急切) (音舜)
气厥论∶ (音炽)麋(武悲切) (音复)蔑(莫结切)
咳论∶蛔(音回)
黄帝问道:五脏六腑之间,寒气和热气相互转移是怎么回事?岐伯回答说:肾的寒气转移到肝,会出现痈肿、气短的症状。脾的寒气转移到肝,会出现痈肿、筋脉拘挛的症状。
肝的寒气转移到心,会出现发狂、胸膈痞塞不通的症状。心的寒气转移到肺,会形成肺消证;所谓肺消证,是指喝一份水却排出两份尿,这种病属于死症,无法治疗。肺的寒气转移到肾,会形成涌水证;所谓涌水证,是按压腹部并不坚硬,但水气停留于大肠,快速行走时肠鸣辘辘,像囊袋包裹着浆液一样,这是水气为患的疾病。
脾的热气转移到肝,会导致惊悸和鼻出血。肝的热气转移到心,会导致死亡。心的热气转移到肺,传变为膈消证。肺的热气转移到肾,传变为柔痉(肌肉强直痉挛)。肾的热气转移到脾,传变为虚损证,若出现肠中虫动或下利不止等危象则难以治愈。胞宫(此处指女子胞或下焦热结部位)的热气转移到膀胱,会导致小便淋漓不畅且尿血。膀胱的热气转移到小肠,会导致肠道阻隔不通、大便困难,热气上熏口腔则导致口舌生疮糜烂。小肠的热气转移到大肠,会形成瘕积(腹内结块),并伴有沉滞感。大肠的热气转移到胃,表现为食欲旺盛但身体消瘦,称为“食亦”病。胃的热气转移到胆,也称为“食亦”病。胆的热气转移到脑,会导致鼻窍辛辣不适,发展为鼻渊证;所谓鼻渊证,是指浊涕不断流出;若病情传变,会导致鼻衄、目盲或视物不清,这都是由于气机逆乱厥逆所致。
黄帝问道:为什么肺的病会导致咳嗽?岐伯回答说:五脏六腑的疾病都能让人咳嗽,不仅仅是肺脏本身的问题。黄帝说:我想听听其中的机理。岐伯说:皮毛是肺的外合组织,皮毛首先受到邪气侵袭,邪气就会顺着皮毛传入与其相合的肺脏。如果寒冷的饮食进入胃中,寒气会沿着肺脉上行至肺,导致肺脏受寒;肺脏受寒后,外感的邪气与内受的寒气相结合,从而客居于肺,这就形成了肺咳。
五脏各自在其所主的季节容易受病,如果不是其主令的季节,其他脏腑也会通过传变将病邪传给肺。人与天地相应,所以五脏各自在其所主的时令感受寒邪就会生病,轻则表现为咳嗽,重则表现为泄泻或疼痛。逢秋季则肺先受邪,逢春季则肝先受邪,逢夏季则心先受邪,逢长夏(至阴之时)则脾先受邪,逢冬季则肾先受邪。
黄帝问:如何区分不同脏腑引起的咳嗽呢?岐伯说:肺咳的症状,是咳嗽伴有喘息且有声音,严重时唾中带血。心咳的症状,是咳嗽时心痛,咽喉部感觉介介然如有异物梗塞,严重时咽喉肿痛甚至喉痹。肝咳的症状,是咳嗽时两侧胁肋下疼痛,严重时身体不能转动,一转动两侧胁肋下就胀满。脾咳的症状,是咳嗽时右胁下疼痛,隐隐作痛牵引肩背,严重时不能活动,一动则咳嗽加剧。肾咳的症状,是咳嗽时腰背互相牵引而痛,严重时咳嗽出涎沫。
黄帝问:六腑的咳嗽是怎样的?病邪是从哪里受到的?岐伯说:五脏的久咳不愈,病邪就会转移至六腑。脾咳久治不愈,则胃病受之;胃咳的症状,是咳嗽伴呕吐,呕吐严重时蛔虫会被吐出。肝咳久治不愈,则胆病受之;胆咳的症状,是咳嗽并呕出胆汁。肺咳久治不愈,则大肠病受之;大肠咳的症状,是咳嗽伴大小便失禁。心咳久治不愈,则小肠病受之;小肠咳的症状,是咳嗽伴放屁,排气与咳嗽同时发生。肾咳久治不愈,则膀胱病受之;膀胱咳的症状,是咳嗽伴遗尿。久咳不愈,则三焦病受之;三焦咳的症状,是咳嗽伴腹部胀满,不想饮食。这些咳嗽的病机都在于胃气聚集、肺气相关,使人多涕唾且面部浮肿、气机上逆。
黄帝问:如何治疗呢?岐伯说:治疗五脏的咳嗽,应取用五脏的俞穴;治疗六腑的咳嗽,应取用六腑的合穴;对于伴有浮肿的,应取用六腑的经穴。黄帝说:很好。
疟论篇注: (火沃切)漉(音鹿)弭(绵婢切)
刺疟论篇注: (音谒)悒(于急切) (音舜)
气厥论篇注: (音炽)麋(武悲切) (音复)蔑(莫结切)
咳论篇注:蛔(音回)
Yellow Emperor asked, "What is the mechanism by which cold and heat shift among the five zang organs and six fu organs?" Qibo replied, "When kidney cold shifts to the liver, carbuncles and swelling occur with shortness of breath. When spleen cold shifts to the liver, carbuncles and swelling occur with tendon contraction.
When liver cold shifts to the heart, mania and chest diaphragm obstruction occur. When heart cold shifts to the lung, it transforms into Lung Xiao (Lung Consumption); in Lung Xiao, one drink yields two urinations, which is a fatal condition that cannot be treated. When lung cold shifts to the kidney, it forms Yong Shui (Surging Water); in Yong Shui, abdominal palpation reveals no hardness, but water qi resides in the large intestine, producing gurgling sounds like a bag containing liquid when walking quickly; this is a disease of water accumulation.
When spleen heat shifts to the liver, it causes fright and epistaxis. When liver heat shifts to the heart, death ensues. When heart heat shifts to the lung, it transmits as Ge Xiao (Diaphragmatic Consumption). When lung heat shifts to the kidney, it transmits as Rou Jing (Soft Spasm/Stiffness). When kidney heat shifts to the spleen, it transmits as deficiency; if intestinal worms or severe diarrhea occurs, it is incurable. When the Bao Organ (Uterus/Lower Jiao) heat shifts to the bladder, it causes Lin syndrome (dysuria) with hematuria. When bladder heat shifts to the small intestine, it causes intestinal obstruction and constipation, and heat rising to the mouth causes oral ulcers (Kou Mi). When small intestine heat shifts to the large intestine, it forms Zha masses (abdominal lumps) and heaviness. When large intestine heat shifts to the stomach, it causes excessive hunger with emaciation, termed Shi Yi (Eating Without Gaining Weight). When stomach heat shifts to the gallbladder, it is also called Shi Yi. When gallbladder heat shifts to the brain, it causes nasal pungency and Bi Yuan (Nasal Sinusitis); Bi Yuan is characterized by continuous discharge of turbid mucus; if transmitted further, it causes epistaxis, blindness, or dim vision. This arises from Qi Jue (Qi Reversal).
Yellow Emperor asked, "Why does lung pathology cause cough?" Qibo answered, "Diseases of the five zang and six fu organs can all cause cough, not solely the lung itself." The Emperor said, "I wish to hear the details." Qibo said, "The skin and hair are the exterior correspondence of the lung. Pathogenic factors first invade the skin and hair, then enter the lung through this correspondence. If cold food and drink enter the stomach, the cold travels up along the lung meridian to the lung, causing lung cold. External pathogens and internal cold combine to lodge in the lung, resulting in Lung Cough.
Each of the five zang organs is susceptible to disease during its respective season; outside these seasons, pathogenic transmission still occurs. Humans correspond with heaven and earth; thus, each zang organ is affected by cold during its ruling season. Mild cases result in cough, while severe cases result in diarrhea or pain. In autumn, the lung is primarily affected; in spring, the liver; in summer, the heart; in late summer (Zhi Yin), the spleen; and in winter, the kidney.
The Emperor asked, "How can they be distinguished?" Qibo said, "The manifestation of Lung Cough includes coughing with wheezing and audible sounds; severely, blood may be expectorated. The manifestation of Heart Cough includes coughing accompanied by heart pain, a sensation of obstruction in the throat as if something were stuck; severely, the throat becomes swollen and obstructed (Hou Bi). The manifestation of Liver Cough includes coughing with pain under both hypochondria; severely, turning the body is impossible, and turning exacerbates fullness under the hypochondria. The manifestation of Spleen Cough includes coughing with pain under the right hypochondrium radiating to the shoulder and back; severely, movement is impossible, and movement aggravates the cough. The manifestation of Kidney Cough includes coughing with pulling pain between the waist and back; severely, saliva is coughed up.
The Emperor asked, "What about Cough of the six fu organs? Where does the disease originate?" Qibo said, "Prolonged cough of the five zang organs transfers to the six fu organs. If Spleen Cough persists, the Stomach is affected; Stomach Cough presents with coughing and vomiting; severely, roundworms may be expelled. If Liver Cough persists, the Gallbladder is affected; Gallbladder Cough presents with coughing and vomiting of bile. If Lung Cough persists, the Large Intestine is affected; Large Intestine Cough presents with coughing and loss of feces/urine control. If Heart Cough persists, the Small Intestine is affected; Small Intestine Cough presents with coughing and passing gas simultaneously. If Kidney Cough persists, the Bladder is affected; Bladder Cough presents with coughing and urinary incontinence. If prolonged cough persists, the San Jiao (Triple Burner) is affected; San Jiao Cough presents with coughing, abdominal fullness, and anorexia. The pathology of all these coughs gathers in the stomach and relates to the lung, causing excessive phlegm/saliva, facial edema, and rebellious qi.
The Emperor asked, "How should they be treated?" Qibo said, "To treat zang coughs, use the Shu (Transport) points of the zang organs; to treat fu coughs, use the He (Sea) points of the fu organs; for edema, use the Jing (River) points." The Emperor said, "Excellent."
Notes on Malaria Treatise: (Huowo qie) Lu (sound Lu) Mi (Mianbi qie)
Notes on Acupuncture for Malaria Treatise: (Sound Ye) Yi (Yuji qie) (Sound Shun)
Notes on Qi Jue Treatise: (Sound Chi) Mi (Wubei qie) (Sound Fu) Mie (Mo jie qie)
Notes on Cough Treatise: Hui (Sound Hui)