太阴，脾土也。阳明，胃土也。胃纳水谷，借脾气营运，充于腑脏，而经脉以和，四肢以荣，土
者生万物而法天地，故为太阴阳明论。
黄帝问曰∶太阴阳明为表里，脾胃脉也，生病而异者，何也？
阳明为表，太阴为里，太阴主脾，阳明主胃，脾胃表里，皆属
乎土，何以生病而异？
岐伯对曰∶阴阳异位，更虚更实，更逆更从，或从内，或从外，所从不同，故病异名也。
更，平声。太阴，阴也，阴在内；阳明，阳也，阳在外，是阴阳异位也。春夏为阳，则阳实阴虚，秋
冬为阴，则阴实阳虚，是更虚更实也。春夏为阳而阴盛则逆，秋冬则从；秋冬为阴而阳盛则逆，春夏则从，是
更逆更从也。阴在内为阳之守，阳在外为阴之使，秋冬从阴，春夏从阳，阴阳互从，是或从内，或从外也。
一岁之中，所从不同，故发而为病，亦有阴阳之异名也。
帝曰∶愿闻其异状也。
有异名必有异状，状名之实也。
岐伯曰∶阳者，天气也，主外，阴者，地气也，主内，故阳道实，阴道虚。故犯贼风虚邪者，阳
受之，食饮不节，起居不时者，阴受之。阳受之则入六腑，阴受之则入五脏，入六腑则身热，不时
卧，上为喘呼，入五脏则 满闭塞，下为飧泄，久为肠 。
天为阳，故阳者，天气也，主外，地为阴，故阴者，地气也，主内。阳刚有余，阴柔不足，故阳道实、
阴道虚。阳主外，故犯贼风虚邪者阳受之，阴主内，故食饮不节，起居不时者，阴受之。腑
为阳，故阳受之则入六腑，脏为阴，故阴受之则入五脏。入六腑，则阳气外浮，不归于阴，故身热不能时卧，
而上为喘呼；入五脏，则阴寒内盛，不和于阳，故 满闭塞，下为飧泄，而久为肠 。此
阴阳不同，而腑脏外内之病，所以异也。
故喉主天气，咽主地气。故阳受风气，阴受湿气。故阴气从足上行至头，而下行循臂，至指端；
阳气从手上行至头，而下行至足。故曰阳病者，上行极而下，阴病者，下行极而上。故伤于风
者，上先受之；伤于湿者，下先受之。
喉司呼吸，肺气所出，故喉主天气；咽纳水谷，下通于胃，故咽主地气。风为阳邪，故阳受风气；湿
为阴邪，故阴受湿气。阴气从下而上，上而外，故阴气从足上行至头，而下行循臂，至手指之
端；阳气从外而上，上而下，故阳气从手上行至头，而下行至足。阳气在上，极则乃下；阴气在下，极则
始上，故曰阳病者，上行极而下，阴病者，下行极而上。故伤于风者，上先受之，极乃下也；
伤于湿者，下先受之，极乃上也。此阴阳不同，而风湿上下之病，所以异也。
此一节，论腑脏外内风湿上下，而太阴阳明之病，所以异也。
帝曰∶脾病而四肢不用，何也？
上文言腑脏外内，风湿上下受病之异，未明其状，故有脾病而四肢不用之问。四肢不用，其状异矣。
岐伯曰∶四肢皆禀气于胃，而不得至经，必因于脾，乃得禀也。
今脾病不能为胃行其津，四肢不得禀水谷气，气日以衰，脉道不利，
筋骨肌肉，皆无气以生，故不用焉。
为，去声下同。禀，犹受也。四肢皆受气于胃，而阳明胃气不得至于四肢之经，必因于脾，乃得至经
而受气于胃也。今脾病不能为胃行其津液，则四肢不得受胃中水谷之气，而水谷之气，外行四
肢，内资五脏，气日以衰。肺主气也，脉道不利，心主脉也，而肝主之筋，肾主之骨，脾主之肌肉，皆无
水谷之气以生，故四肢不用焉，所以脾病而四肢不用也。
帝曰∶脾不主时何也？
肝心肺肾，主春夏秋冬四时，脾不主时，故举以问。
岐伯曰∶脾者土也，治中央，常以四时长四脏，各十八日寄治，不得独主于时也。
长，上声。脾不主时者，以脾脏属土，位治中央，常以春夏秋冬四时，为肝心肺肾四脏之长，一时
各十八日寄治，一脏之中，共主七十二日，所以不得独主于时。
脾脏者，常着胃土之精也。土者，生万物而法天地，故上下至头足，不得主时也。
着，昭着也。胃土水谷之精，昭着于外，由脾脏之气营运，故脾脏者，常着胃土之精也，万物皆
生于土，故土者生万物而法天地。
经脉上下资生于土，故上至头，下至足，无处不周，虽欲主时，不可得也。
帝曰∶脾与胃，以膜相连耳，而能为之行其津液，何也？
上文云脾病不能为胃行其津液，故问脾胃皆属土，以膜相连，何以能为胃行其津液。
岐伯曰∶足太阴者，三阴也，其脉贯胃，属脾络嗌，故太阴为
之行气于三阴。阳明者，表也，五脏六腑之海也，亦为之行气于三阳。
厥阴为一阴，少阴为二阴，太阴为三阴，故足太阴者，三阴也。足太阴主脾，其脉中贯胃，下属脾，
上络嗌，而脾土之气通于五脏之阴，故太阴为之行气于三阴。三阴，主五脏也。阴主里，阳主表，
故阳明者表也。胃纳水谷为五脏之腑之海也，禀太阴之运动，而亦为之行气于三阳，三阳，主六腑也。
脏腑各因其经，而受气于阳明，故为胃行其津液，四肢不得禀水谷气，日以益衰，阴道不利，
筋骨肌肉，无气以生，故不用焉。
太阴行气于三阴，阳明禀太阴之气，而行气于三阳，是五脏六腑，各因其经，而受气于阳明，受
气于阳明，实受气于太阴，故脾脏为胃行其津液，所以以膜相连，而能为之行其津液也。若脾脏不
为胃行其津液，则四肢不得禀阳明水谷之气，气日益衰，肺气虚也。阴道不利，即脉道不利，心气虚也。
而肝主之筋，肾主之骨，脾主之肌肉，皆无阳明水谷之气以生，故四肢不用焉。
此一节，言太阴脾脏，为胃行其津液，而充于腑脏，达于四肢，所以脾病而四肢不用也。
太阴经，对应脾脏，属土。阳明经，对应胃腑，也属土。胃负责受纳水谷，依赖脾气的运化功能，将精微物质输送到脏腑，从而使经脉调和，四肢得到滋养。土能生化万物并效法天地之道，因此本篇论述太阴与阳明的关系。
黄帝问道：太阴和阳明互为表里，分别对应脾和胃的脉象，但它们生病时表现不同，这是什么原因呢？
阳明主表，太阴主里，太阴主管脾，阳明主管胃，脾胃互为表里，都归属于土，为什么生病的表现会不同呢？
岐伯回答说：阴阳所处的位置不同，虚实状态交替变化，气机逆顺也不同，病邪有的从内部产生，有的从外部侵入，来源不同，所以疾病名称各异。
更（gēng），读平声。太阴属阴，阴气在内；阳明属阳，阳气在外，这就是阴阳位置不同。春夏季节属阳，此时阳气实而阴气虚；秋冬季节属阴，此时阴气实而阳气虚，这就是虚实交替变化。春夏属阳，若阴气过盛则为逆，应顺应秋冬之理；秋冬属阴，若阳气过盛则为逆，应顺应春夏之理，这就是逆顺交替变化。阴气在内作为阳气的守持，阳气在外作为阴气的役使，秋冬顺应阴气，春夏顺应阳气，阴阳相互顺从，这就是有的从内、有的从外。一年之中，顺应的方式不同，所以发作的疾病也有阴阳不同的名称。
黄帝说：我想听听它们具体的症状差异。
有不同的名称必然有不同的症状，症状是名称的实际体现。
岐伯说：阳，代表天气，主司外部；阴，代表地气，主司内部，所以阳道多实，阴道多虚。因此，遭受贼风虚邪侵袭的，阳先受病；饮食不节制，起居无规律的，阴先受病。阳受邪则传入六腑，阴受邪则传入五脏。邪入六腑则出现身体发热，不能按时安卧，向上发展为气喘呼叫；邪入五脏则出现腹满闭塞，向下发展为完谷不化的泄泻，日久则发展为肠澼（痢疾）。
天为阳，所以阳代表天气，主司外部；地为阴，所以阴代表地气，主司内部。阳刚有余，阴柔不足，所以阳道多实，阴道多虚。阳主外，所以遭受贼风虚邪侵袭的由阳受之；阴主内，所以饮食不节、起居不时的由阴受之。腑属阳，所以阳受邪则传入六腑；脏属阴，所以阴受邪则传入五脏。邪入六腑，则阳气外浮，不能归于阴，所以身体发热，不能按时安卧，向上发展为气喘呼叫；邪入五脏，则阴寒内盛，不能与阳和谐，所以腹部胀满闭塞，向下发展为完谷不化的泄泻，日久则发展为肠澼。这是因为阴阳不同，导致腑脏内外病症的差异。
所以喉主管呼吸，通天气；咽主管吞咽，接地气。所以阳经受风气，阴经受湿气。阴气从足部上行至头部，再下行沿手臂到达手指末端；阳气从手部上行至头部，再下行到达足部。所以说阳病者，向上发展到极点就向下传变；阴病者，向下发展到极点就向上转归。所以被风邪所伤的，上部先受病；被湿邪所伤的，下部先受病。
喉司掌呼吸，是肺气出入之处，所以喉主天气；咽接纳水谷，向下连通于胃，所以咽主地气。风为阳邪，所以阳经受风气；湿为阴邪，所以阴经受湿气。阴气从下往上，从内往外，所以阴气从足部上行至头部，再下行沿手臂到达手指末端；阳气从外往上，从上往下，所以阳气从手部上行至头部，再下行到达足部。阳气在上，到了极点就会向下；阴气在下，到了极点就会开始向上，所以说阳病者，上行极而下，阴病者，下行极而上。所以伤于风者，上部先受病，极则向下；伤于湿者，下部先受病，极则向上。这是阴阳不同，导致风湿上下病症差异的原因。
这一节，论述了腑脏内外、风湿上下以及太阴阳明病症之所以不同的道理。
上文论述了腑脏内外、风湿上下受病的差异，尚未阐明具体情形，所以有脾病导致四肢不用的疑问。四肢不用，其症状表现确实不同。
岐伯说：四肢都禀受胃中的精气，但胃气不能直接到达四肢的经脉，必须依靠脾的转输，才能将精气送达四肢。
为（wèi），去声，以下同。禀，即接受的意思。四肢的气都来源于胃，但阳明胃气不能直接到达四肢的经脉，必须通过脾的转输，才能到达经脉并从胃中接受精气。现在脾病不能为胃运行津液，四肢就无法接受水谷之气，水谷之气日渐衰少，脉道运行不畅，筋骨肌肉都缺乏精气以生成，所以四肢就不能使用了。
肝、心、肺、肾分别主宰春、夏、秋、冬四个季节，脾不单独主宰一个季节，所以以此发问。
岐伯说：脾属土，治理中央，常在四季中辅助肝心肺肾四脏，每季最后十八天由脾寄治，所以不能单独主宰一个季节。
长（zhǎng），上声。脾不主时，是因为脾脏属土，位处中央，常在春夏秋冬四季中，作为肝心肺肾四脏的长官，每一季的最后十八天由脾寄治，一脏共主七十二天，所以不能单独主宰一个季节。
脾脏，常常彰显胃中土的精微。土能生化万物并效法天地，所以精气上至头、下至足，无处不到，不能单独主宰一个季节。
着（zhuó），昭著、显明之意。胃中土的水谷精微，显明于外，通过脾脏之气的运化，所以脾脏常常彰显胃土的精微。万物都生于土，所以土能生化万物并效法天地。
经脉上下都资生于土，所以上至头，下至足，无处不周遍，即使想单独主宰一个季节，也不可能做到。
黄帝问：脾和胃，只是通过膜相连而已，却能帮助胃运行津液，为什么呢？
上文说脾病不能为胃运行津液，所以问既然脾胃都属土，仅以膜相连，为什么能为胃运行津液。
岐伯说：足太阴脾经，是三阴经之一，其经脉贯穿胃，属于脾，联络咽喉，所以太阴为三阴经运行精气。阳明胃经，主表，是五脏六腑气血的海源，也为三阳经运行精气。
厥阴为一阴，少阴为二阴，太阴为三阴，所以足太阴是三阴经。足太阴主脾，其经脉中间贯穿胃，下属脾，上络咽喉，而脾土之气通达五脏之阴，所以太阴为三阴经运行精气。三阴经，主管五脏。阴主里，阳主表，所以阳明主表。胃受纳水谷，是五脏六腑的海源，禀受太阴的运化运动，也为三阳经运行精气。三阳经，主管六腑。
脏腑各自顺着各自的经脉，从阳明接受精气，所以胃能为其运行津液。如果四肢不能禀受水谷之气，气日益衰败，阴道（指阴经或体内通道）不利，筋骨肌肉没有精气以生，所以四肢不能使用。
太阴为三阴经运行精气，阳明禀受太阴之气，而为三阳经运行精气，这样五脏六腑各自顺着经脉，从阳明接受精气。从阳明接受精气，实际上是接受太阴之气，所以脾脏能为胃运行津液。这就是虽然仅以膜相连，却能为其运行津液的原因。如果脾脏不为胃运行津液，则四肢不能禀受阳明水谷之气，气日益衰败，肺气虚。阴道不利，即脉道不利，心气虚。而肝主的筋，肾主的骨，脾主的肌肉，都没有阳明水谷之气以生，所以四肢不能使用。
Taiyin (Great Yin) corresponds to the Spleen Zang organ, belonging to Earth. Yangming (Bright Yang) corresponds to the Stomach Fu organ, also belonging to Earth. The Stomach receives water and grain, relying on the transportation and transformation function of Spleen Qi to deliver essence to the Zang and Fu organs, thereby harmonizing the meridians and nourishing the four limbs. Earth generates all things and models itself after Heaven and Earth; therefore, this chapter discusses Taiyin and Yangming.
Huangdi asked: Taiyin and Yangming are exterior and interior counterparts, corresponding to the pulses of the Spleen and Stomach respectively. Why do they manifest different diseases?
Yangming governs the exterior, Taiyin governs the interior. Taiyin governs the Spleen, Yangming governs the Stomach. The Spleen and Stomach are exterior-interior pairs, both belonging to Earth. Why do their disease manifestations differ?
Qibo replied: Yin and Yang occupy different positions; deficiency and excess alternate; reversal and compliance alternate. Pathogens may arise from within or invade from without. Since the origins differ, the disease names vary.
"Geng" is pronounced with the level tone. Taiyin is Yin, with Yin residing internally; Yangming is Yang, with Yang residing externally. This is the difference in position between Yin and Yang. Spring and Summer belong to Yang, at which time Yang is full and Yin is deficient; Autumn and Winter belong to Yin, at which time Yin is full and Yang is deficient. This is the alternation of deficiency and excess. In Spring and Summer, when Yang prevails, if Yin becomes excessive it is a deviation (reversal), requiring compliance with the logic of Autumn and Winter; in Autumn and Winter, when Yin prevails, if Yang becomes excessive it is a deviation, requiring compliance with the logic of Spring and Summer. This is the alternation of reversal and compliance. Yin resides internally as the guardian of Yang; Yang resides externally as the attendant of Yin. In Autumn and Winter, one complies with Yin; in Spring and Summer, one complies with Yang. Yin and Yang mutually comply, meaning some conditions originate internally and others externally. Throughout the year, the mode of compliance differs; thus, the diseases that manifest have different Yin-Yang designations.
Huangdi said: I wish to hear about their specific symptomatic differences.
Different names necessarily imply different symptoms; symptoms are the reality behind the names.
Qibo said: Yang represents Heavenly Qi and governs the exterior; Yin represents Earthly Qi and governs the interior. Therefore, the Path of Yang tends toward Excess (Shi), and the Path of Yin tends toward Deficiency (Xu). Consequently, when attacked by treacherous winds and empty pathogens, Yang receives them first; when diet is irregular and daily routine is untimely, Yin receives them first. When Yang receives pathogens, they enter the Six Fu organs; when Yin receives pathogens, they enter the Five Zang organs. Entering the Six Fu organs results in body heat, inability to lie down at proper times, and upward progression to panting and calling out. Entering the Five Zang organs results in abdominal fullness and obstruction, downward progression to undigested diarrhea (Sun Xie), and over time, intestinal dysentery (Chang Pi).
Heaven is Yang, so Yang represents Heavenly Qi and governs the exterior. Earth is Yin, so Yin represents Earthly Qi and governs the interior. Yang has surplus rigidity, Yin has insufficient softness; thus, the Path of Yang is Excess, and the Path of Yin is Deficient. Yang governs the exterior, so treacherous winds and empty pathogens are received by Yang. Yin governs the interior, so irregular diet and untimely routine are received by Yin. Fu organs are Yang, so Yang pathogens enter the Six Fu organs. Zang organs are Yin, so Yin pathogens enter the Five Zang organs. Upon entering the Six Fu organs, Yang Qi floats outward and does not return to Yin, causing body heat, inability to rest properly, and upward panting. Upon entering the Five Zang organs, Yin Cold盛 (excessively flourishes) internally and fails to harmonize with Yang, causing abdominal fullness and obstruction, downward undigested diarrhea, and over time, intestinal dysentery. This difference between Yin and Yang explains the divergence in Fu-Zang and exterior-interior diseases.
Therefore, the throat governs Heavenly Qi, and the pharynx governs Earthly Qi. Thus, Yang meridians receive Wind Qi, and Yin meridians receive Dampness Qi. Yin Qi ascends from the feet to the head, then descends along the arms to the fingertips. Yang Qi ascends from the hands to the head, then descends to the feet. Hence, it is said that Yang diseases ascend to the extreme and then descend; Yin diseases descend to the extreme and then ascend. Therefore, those injured by Wind suffer first in the upper parts; those injured by Dampness suffer first in the lower parts.
The throat controls respiration, being the exit of Lung Qi, thus governing Heavenly Qi. The pharynx accepts food and drink, connecting downward to the Stomach, thus governing Earthly Qi. Wind is a Yang pathogen, so Yang meridians receive Wind Qi. Dampness is a Yin pathogen, so Yin meridians receive Dampness Qi. Yin Qi moves from below upward and from inside outward; thus, it ascends from the feet to the head, then descends along the arms to the finger tips. Yang Qi moves from outside upward and from above downward; thus, it ascends from the hands to the head, then descends to the feet. Yang Qi is above; upon reaching the extreme, it goes down. Yin Qi is below; upon reaching the extreme, it begins to go up. Hence, Yang diseases ascend to the extreme and then descend; Yin diseases descend to the extreme and then ascend. Those injured by Wind suffer first in the upper parts, eventually descending; those injured by Dampness suffer first in the lower parts, eventually ascending. This difference in Yin and Yang explains the divergence in Wind-Damp diseases affecting the upper and lower regions.
This section discusses the differences in Fu-Zang, exterior-interior, Wind-Damp, and upper-lower pathology, explaining why Taiyin and Yangming diseases differ.
Huangdi asked: Why does Spleen disease lead to the inability to use the four limbs?
The preceding text discussed the differences in pathology regarding Fu-Zang, exterior-interior, Wind-Damp, and upper-lower regions, but did not clarify the specific manifestations, hence the question regarding Spleen disease causing limb paralysis. The manifestation of limb inability is indeed distinct.
Qibo said: The four limbs all receive Qi from the Stomach, but Stomach Qi cannot reach the meridians of the limbs directly; it must rely on the Spleen to transport it, thereby receiving it.
"Wei" is pronounced with the departing tone, same for subsequent instances. "Bing" means to receive. The Qi of the four limbs originates from the Stomach, but Mingyang Stomach Qi cannot reach the limb meridians directly; it must pass through the Spleen to reach the meridians and receive Qi from the Stomach. Now, if Spleen disease prevents the Stomach from transporting fluids and essence, the four limbs cannot receive Water-Grain Qi. The Water-Grain Qi declines day by day, the vessel pathways become obstructed, and the sinews, bones, muscles, and flesh lack Qi to generate themselves, resulting in non-function.
Huangdi asked: Why does the Spleen not govern a specific season?
The Liver, Heart, Lung, and Kidney govern the four seasons of Spring, Summer, Autumn, and Winter respectively. The Spleen does not govern a single season, hence the inquiry.
Qibo said: The Spleen belongs to Earth, governs the Center, and constantly aids the four Zang organs (Liver, Heart, Lung, Kidney) throughout the four seasons. It governs for eighteen days during each season's transition, and thus cannot exclusively govern one season.
"Zhang" is pronounced with the rising tone. The Spleen does not govern a specific season because it belongs to Earth and occupies the Central position. It acts as the leader for the Liver, Heart, Lung, and Kidney throughout the four seasons, governing for eighteen days at the end of each season. One Zang organ governs for seventy-two days in total, so it cannot exclusively govern one season.
The Spleen organ constantly manifests the essence of Stomach Earth. Earth generates all things and models itself after Heaven and Earth. Therefore, Qi extends from the head to the feet, nowhere missing, making it impossible to govern only one season.
"Zhuo" means manifest or obvious. The essence of Water-Grain from Stomach Earth manifests externally through the transformative Qi of the Spleen organ. All things are born of Earth; thus, Earth generates all things and models itself after Heaven and Earth. The meridians above and below derive nourishment from Earth, extending from the head to the feet, encompassing all areas. Even if it wished to govern a specific season, it could not.
Huangdi asked: The Spleen and Stomach are connected merely by membranes, yet they can assist the Stomach in transporting fluids. Why?
The preceding text stated that Spleen disease prevents the transport of fluids for the Stomach. Thus, the question arises: since both Spleen and Stomach belong to Earth and are connected by membranes, how can the Spleen transport fluids for the Stomach?
Qibo said: Foot Taiyin is one of the Three Yin meridians. Its vessels penetrate the Stomach, belong to the Spleen, and connect to the pharynx. Therefore, Taiyin transports Qi to the Three Yin meridians. Yangming is the exterior and the Sea of the Five Zang and Six Fu organs; it also transports Qi to the Three Yang meridians.
Jueyin is First Yin, Shaoyin is Second Yin, and Taiyin is Third Yin; thus, Foot Taiyin is the Third Yin. Foot Taiyin governs the Spleen. Its vessels penetrate the Stomach centrally, belong to the Spleen inferiorly, and connect to the pharynx superiorly. The Qi of Spleen Earth communicates with the Yin of the Five Zang organs; thus, Taiyin transports Qi to the Three Yin meridians. The Three Yin meridians govern the Five Zang organs. Yin governs the interior, Yang governs the exterior; thus, Yangming governs the exterior. The Stomach receives water and grain and serves as the Sea of the Five Zang and Six Fu organs. It relies on the movement of Taiyin and transports Qi to the Three Yang meridians. The Three Yang meridians govern the Six Fu organs.
The Zang and Fu organs each follow their respective meridians to receive Qi from Yangming. Therefore, the Stomach can transport fluids. If the four limbs cannot receive Water-Grain Qi, Qi declines daily, the Yin pathways (vessel channels) become obstructed, and the sinews, bones, muscles, and flesh lack Qi to generate themselves, resulting in non-function.
Taiyin transports Qi to the Three Yin meridians. Yangming receives the Qi of Taiyin and transports it to the Three Yang meridings. Thus, the Five Zang and Six Fu organs each follow their meridians to receive Qi from Yangming. Receiving Qi from Yangming is essentially receiving Qi from Taiyin. Therefore, the Spleen organ transports fluids for the Stomach. This is why, despite being connected only by membranes, it can transport fluids. If the Spleen organ does not transport fluids for the Stomach, the four limbs cannot receive Yangming Water-Grain Qi, Qi declines daily, Lung Qi becomes deficient. Obstruction of Yin pathways implies obstruction of vessel pathways, leading to Heart Qi deficiency. The sinews governed by the Liver, bones governed by the Kidney, and muscles governed by the Spleen all lack Yangming Water-Grain Qi to generate themselves, resulting in the non-function of the four limbs.
This section explains that the Taiyin Spleen organ transports fluids for the Stomach, thereby nourishing the Zang and Fu organs and reaching the four limbs. This is why Spleen disease leads to the inability to use the four limbs.