Chapter 1, organs and meridians, its disease

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医宗金鉴 订正仲景全书金匮要略注

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『伤寒论』论伤寒,『金匮要略』论杂病,乃仲景全书。『伤寒论』得成无已创注,续者五十余家,故得昌明宇内;『金匮要略』人罕言之,虽有赵良、徐彬等注释,但其文义古奥,系千载残编错简,颇多疑义,阙文亦复不少,承袭谬,随文蔓衍,宜后人视为迂远,束诸高阁。今于其失次者序之,残缺者补之,博采群书,详加注释,俾二书并行于世,庶后之业医者,不为俗说所误,知仲景能治伤寒,未尝不能治杂证也。

 

藏府经络先后病脉证第一

Chapter 1, organs and meridians, its disease and pulse and clinic manifestations


夫人秉五常,因风气而生长,风气虽能生万物,亦能害万物,如水能浮舟,亦能覆舟。若五藏元真通畅,人即安和,客气邪风,中人多死,千般疢难,不越三条。一者,经络受邪入藏府,为内所因也;二者,四肢九窍,血脉相传,壅塞不通,为外皮肤所中也;三者,房室金刃,虫兽所伤。以此详之,病由都尽。

Human body takes neutrations from all five kinds of the elements and grows with the help and promotion by the Wind. The Wind is needed for the growth of all biological things, but it can also damage them. This is just as Water can float a boat, but can also turn off the boat. If the libido of the five major organ systems of the body is sufficient, the person is in health. The invasion of the Wind Xieqi into the body can usually result in death. The reason for all kinds of diseases, disorders, or disatrers together, are only three: one, the Xieqi invasion through the body surface meridian system, or into the organs; two, the Xieqi comes into the arms, legs, eyes, nose, ears, mouth, penis, anus, causing block of the blood circulation; three, the body is damaged or hurt by sharping material cutting, bitten by worms or animals, or depletion of libido by sexual activity.

若人能养慎,不令邪风干忤经络,适中经络,未流传府藏,即医治之,四肢才觉重滞,即导引吐纳,针灸膏摩,勿令九窍闭塞。更能无犯王法,禽兽灾伤,房室勿令竭乏,服食节其冷热,苦酸辛甘,不遣形体有衰,病则无由入其腠理。腠者,三焦通会元真之处,为血气所注。理者,是皮肤藏府之文理也。


 If a person pays attention to all of these aspects, not letting the Xieqi attack the meridian, or if the Xieqi attacks, starts the medical treatment before the Xieqi moving into the organs, his condition should be well maintained. Once he just feels heavy in the arms and legs, starts the Daoying, Tuna, acupuncture, massage, or use herbal paste, not letting the Xieqi to block the eyes, ears, nose, mouth, opens for urine and anus. Pay attention not to break the law so do not suffer from heavy physical and emotional punishment, not to be bitten by animals or worms, not to have too much sexual activity to deplete the libido, not to eat too much of either sweet, bitter, sour, or too hot, or too cold food; there should no reason for a disease. 
       

问曰:上工治未病,何也?师曰:夫治未病者,见肝之病,知肝传脾,当先实脾,四季脾王不受邪,即勿补之。中工不晓相传,见肝之病,不解实脾,惟治肝也。夫肝之病,补用酸,助用焦苦,益用甘味之药调之。酸入肝,焦苦人心,甘入脾,脾能伤肾,肾气微弱,则水不行,水不行,则心火气盛,则伤肺,肺被伤,则金气不行,金气不行,则肝气盛,肝气盛,则肝自愈,此治肝补脾之要妙也。肝虚则用此法,实则不再用之。经曰:虚虚实实,补不足,损有余。是其义也。余藏准此。

Asked: It is said that a great master doctor treats non-diseased disease, why and how? Mater: To treat non-diseased disease means to prevent the development of a current disease. For example, if the current disease is in the Liver, we should make the Spleen stronger, so that the disease in the Liver will not pass to the Spleen. Spleen belongs to the Soil in the five-element theory and it is ready to be affected by the Xieqi, so do not supply it. Lower level doctor do not know the transfer of a disease from one organ to another, so they deal with the Liver disease only.

For a Liver disease, herbs with a sour taste will nourish the Liver, bitter herb helps it, sweet herb adjusts it. The sour taste goes into the Liver, jar and bitter into Heart, sweat into Spleen. The Spleen (Soil) is against the Kidney (Water). The Kidney is weak, the water metabolism is out of order. The Water distribution is out of order, so the Heart (Fire) becomes overwhelming. The Heart (Fire) so burns the Lung (the Metal), so the function of the Lung is out of order. When the Lung is in disorder, the Liver function returns better, so the Liver disease cured by itself. This is the trick in the treatment of Liver and the Spleen. This principle works when the Liver condition is in weak condition, it doesn’t work if the Liver is in a fullness condition. [1]
       

Medical bibble said: “the treatment can be noursing, or depleting, use the nourishing therapy when the organ is in a weakness condition and use depleting therapy when it is in a fullness condition. ”  This principle works for all organs.


问曰:病人有气色见于面部,愿闻其说?师曰:鼻头色青,腹中痛,苦冷者死(一云:腹中冷,苦痛者死。);鼻头色微黑者,有水气;色黄者,胸上有寒;色白者,亡血也;设微赤非时者,死。其目正圆者,痉,不治。又色青为痛,色黑为劳,色赤为风,色黄者便难,色鲜明者有留饮。

Asked: please explain to me how a disease can be told from the Qise[2] in the face. The Master[3]:  If the nose tip is blue in color, and the person has stomach pain, and feels very cold, the condition may indicate a death; mild dark color in the nose tip suggests a wetness condition in this body; yellow nose suggests a Cold in the chest; white color, blood depletion; mild red in color on the nose tip, die suddenly; if the person has Jing syndrome/condition (spasm condition) with eyes opening and staring, it is hard to recover. Blue color suggests pain; black color suggests exhaust by labor work; red color indicates Wind invasion, yellow color suggests the person has constipation; bright yellow suggests the water-liquid condition in the body.
      

师曰:病人语声寂然,喜惊呼者,骨节间病;语声喑喑然,不彻者,心膈间病;语声啾啾然,细而长者,腹中病(一作痛)[4]

The Master: if patients has quiet talking but sudden and erupted cry, it suggests he has disease in joints; if his voice is harsh and not clear the end of the sentence, his disease is in the chest, heart, diagram; if the voice is as a bird ringing, the thin and long, his disease is in the abdomen.
       

师曰:息摇肩者,心中坚;息引胸中上气者,咳;息张口短气者,肺痿唾沫。

The Master: if a patient shaking the shoulder when breath, he has fullness condition in the chest; if he feels air pushing up when breath, he has cough; if he opens mouth, feels short of breath, he has shrink and collapse in the lung, and he cough and spit saliva. 
       

师曰:吸而微数,其病在中焦,实也。当下之即愈。虚者不治。在上焦者,其吸远;在下焦者,其吸促,此皆难治。呼吸动摇振振者,不治。[5]

The Master: if the person has slight frequent inhalation, the disease is in the Middle Jiao Cavity[6], this is a fullness condition, a bowel-cleansing therapy will solve this problem. If it is a weakness condition, it is hard to treat; if the disease is in the Upper Cavity, the person’s inhalation is frequent and long; if it is in the Lower Cavity, the inhalation is urgent. Both conditions are hard to treat. If the person has body shaking when have a breath, it is hard to treat.
       

师曰:寸口脉动者,因其王时而动,假令肝王色青,四时各随其色,肝色青而反色白,非其时色脉,皆当病。

The Master: if the pulse in the Chun position is pumping, it jumps according to its main time-point. If the Liver is associated to blue in color, the time is also associated with its own color. For instance, the Liver is associated with the blue; the Heart to red; the Lung to the white; the Kidney to the black; and the Spleen to the yellow. If the person’s biological physical condition[7] belongs to the Liver (to the blue in color), but his skin color is white (white is Lung, is Metal), however, it means the color doesn’t match the biological body constitution, the Metal is against the Wood, e.g. the Lung is against the Liver, so the person will have healthy problem. Same way, the pulse jumping is according to the overwhelming time of each organs/element, for example, the Liver pulse should felt on the left Guan position, and its overwhelming time is 1 am to 5 am. It means normally at this time period, the liver pulse is stronger than the pulse at the other position on the wrist. If it is stronger at the Guan position on the right side wrist (the Spleen position), especially if it felt as a string in feeling, it suggests the Spleen (the Soil) is attacked by the Liver (the Wood), since in the five-element theory, the Wood (the Liver) struggles against the Soil (the Spleen). Therefore, even if a person does not feel anything wrong in his body, it can still be predicted by the jumping time of pulse, the skin color and other clues on the body. [8]
        

问曰:有未至而至,有至而不至,有至而不去,有至而太过,何谓也?师曰:冬至之后,甲子夜半,少阳起,少阳之时,阳始生,天得温和。以未得甲子,天因温和,此为未至而至也;以得甲子,而天未温和,此为至而不至也;以得甲子,而天大寒不解,此为至而不去也;以得甲子,而天温如盛夏五六月时,此为至而太过也。

Asked: what means the weather Qi should not come, but comes; it supposes to come, but not come; it comes and should leave, but not leave; it comes and comes too much? The Master: after the season point of Dongzhi,[9] on the middle night of the Jiazi day[10], the Shaoyang starts. This is the time the Yangqi starts to grow, and the day starts to become warm (though the body has not started to feel it).  If it has not been in the Jiazi day but the weather becomes warm, it means it should not come but comes; if on the Jiazi day, the weather does not become warm, it means it should come but not comes; if on the Jiazi day, the weather is very cold, it means it means the cold weather comes but not leaves; if on the Jiazi day, the weather is so hot as summer of May or June, it means the hot weather comes too much.

师曰:病人脉浮者在前,其病在表;浮者在后,其病在里,腰痛背强不能行,必短气而极也。

The Master: if the pulse is floating at the Chun position, the disease is on the body surface layer; if the floating pulse is felt on the Chi position, it indicates the disease is inside. The person should feel tightness on the lower back and hard to walk, and feels short of breath very much.

问曰:经云:厥阳独行,何谓也?师曰:此为有阳无阴,故称厥阳。

Asked: the medical bible said, Jueyang goes alone, what does this mean? The Master: it means there is only Yang, but no any Yin, so it is called Jueyang.

问曰:寸脉沉大而滑,沉则为实,滑则为气,实气相抟,厥气入藏即死[11],入府即愈,

此为卒厥何谓也?师曰:唇口青,身冷,为入藏,即死;如身和,汗自出,为入腑,即愈。

Asked: if Jueqi develops into the solid organs[12], the person will die; if it moves into the hollow organs[13], the person will be alive. It is called sudden Jue condition. What it is? Master: the person has purple lips, cold body, indicating the Jueqi in the solid organs. He is to die. If he has no problem in the body but sweat, it indicates that the Jueqi has moves only in the hollow organs, he is to be better.  

问曰:脉脱入藏即死,入府即愈,何谓也?师曰:非为一病,百病皆然。譬如浸淫疮,从口起流向四肢者,可治;从四肢流来入口者,不可治。病在外者可治,入里者即死。

Asked: why if the pulse is hard to felt, and if the disease develops into the fullness organs, the person will die, and if it develops into the hollow organs, he may be alive? Master: this is true for all kinds of diseases. For instance, if a skin ulcer develops from mouth to the extremes of the body, the disease is treatable, if it develops from the arm and leg to the mouth direction, it is hard to treat. A disease in the out layer of the body is easier to treat, and a disease developing into the organs is hard to treat.


问曰;阳病十八,何谓也?师曰:头痛,项、腰、脊、臂、脚掣痛。

Asked: what means eighteen Yang diseases? Master: the headache, spasm and pain in the neck, lower back, the spine, the shoulder, the feet. 
       

阴病十八,何谓也?师曰:欬,上气、喘、哕、咽、肠鸣、胀满、心痛、拘急。

Asked: what means eighteen Yin diseases? Master: cough, pushing up feeling, asthma, Ye syndrome, sour throat, intestine noise, abdomen fullness or bloating, heart pain, spasm inside of the body.
       

五藏病各有十八,合为九十病;人又有六微,微有十八病,合为一百八病。五劳,七伤,六极,妇人三十六病,不在其中。

Every organ has eighteen diseases, so all together for the five organs, there are ninety diseases. A person can also have six weakness conditions, all together there are one hundred and eight diseases. This does not include the five Lao, seven damage, six extreme and woman’s thirteen six diseases.
       

清邪居上,浊邪居下,大邪中表,小邪中里,饦之邪,从口入者,宿食也。五邪中人,各有法度,风中于前,寒中于暮,湿伤于下,雾伤于上,风令脉浮,寒令脉急,雾伤皮腠,湿流关节,食伤脾胃,极寒伤经,极热伤络。

Light Xieqi[14] floats and affects the upper part of the body, heavy and condensed Xieqi influences the lower part of the body. Strong Xieqi attacks the body surface layer, small or weak Xieqi influences the inside of the body. Xieqi in the food comes from the mouth to cause hosting food (accumulated food or food residue in the abdomen). There is rule for the Xieqi to attack the body: the Wind attacks the front of the body, Cold attacks during the evening, Wetness attacks the lower part of the body, Fog influences the upper part of the body. The Wind Xieqi makes the pulse floating, Cold Xieqi makes the pulse frequent, Fog Xieqi damages the skin and the tissues under the skin, Wetness accumulates in the joints, Food affects the digestive system. Extreme Cold Xieqi injures the meridian stems, and extreme Hot Xieqi damages the meridian branches.
       

问曰:病有急当救里救表者,何谓也?师曰:病,医下之,续得下利,清谷不止,身体疼痛者,急当救里;后身体疼痛,清便自调者,急当救表也。

Asked: in a urgent cases, when to save the inside and when to save the body surface condition? Master: if a person is given a bowel-cleansing therapy and it causes continuous diarrhea and pain in whole body, the inside body condition should be first solved; later, if he feels pain in the whole body, but the urine and bowel movement is pretty normal, start to save the body surface condition.
       

夫病痼疾,加以卒病,当先治其卒病,后乃治其痼疾也。

If a person has both a chronic disease and an acute disease, save and treat the acute condition first and treat the old condition later.
       

 师曰:五藏病各有得者愈,五藏病各有所恶,各随其所不喜者为病。病者素不应食,而反暴思之,必发热也。

Master: for the five organ systems, if they get what they like[15], their disease will cure; if they gets what they dislike, they will be ill. If a person has low appetite for a long time, now he has strong willing to eat, he will have fever.

夫诸病在藏,欲攻之,当随其所得而攻之,如渴者,小便不利[16], 猪苓汤,余皆仿此。

If a disease is in a fullness organ, and if the treatment principle is to deplete the Xieqi (rather than to nourish, or to supply it), deplete what it gets. For example for a person with thirst, he has willing to drink and has difficult in urine, use the Zhuling Tang to deplete the water, to solve the problem.



[1] Every organ, once out of disorder, has either of the two conditions: weakness condition, or a fullness condition. When it is in a weakness condition, the nourshing therapy is needed. When it is in a fullness condition, a depletion therapy is nedded to deplete the Xieqi.

[2] Qise, Qi: the moving power, the activating power, the biological energy. Se: color, tint of a color.

[3] Master Zhang Zhongjing.

[4]头中病之「头」字,当是「腹」字。经中从无头中病之文,且文义不属,必是传写之误。

[5]吸促之「促」字,当是「远」字;吸远之「远」字,当是「促」字,方合病义,必传写之误。

[6] Middle Jiao Cavity: the body is separated into three major parts: the Upper Jiao Cavity, or the Upper Cavity: the chest; the Middle Jiao Cavity, or the Middle Cavity: the stomach and spleen; the Lower Cavity: the liver and kidney, the lower abdomen.

[7] Biological condition means each person’s body shape, skin color, temple, etc can be classified into five major body constitutions: Wood, Fire, Soil, Metal, and Water. Normally, the Wood person should have blue skin color; Fire person, red color; Soil person, yellow color; Metal person, white color, and Water person, dark color.

[8] The meaning of the original Chinese version is felt incomplete and hard to understand and explain.

[9] Dongzhi, the time point of the season. It is about December 21th or 22th every year. It is the day on which the night is the longest but the day time is the shortest in north part of the earth.

[10] Jiazi day: the first day of a Chinese calendar counts days. Every 60-day is one circle. The Jiazi day after the Dongzhi day on year 2009, falls on January 14, year 2010.

[11]血气入藏之「血」字,当是「厥」字,始与卒厥相合,必传写之误也。

[12] Fullness organ: the heart, the lung, the liver, the spleen and the kidney.

[13] Hollow organ: the stomach, the gall bladder, the small and large intestine, and the urine bladder.

[14] Light Xieqi: this is a relative concept to separate various Xieqi. The light Xieqi are such as Wind, Fire, Dryness and the heavy and condensed Xieqi are such as Water, Phlegm, Wetness.

[15] In TCM, it is believed that the Heart system (including the heart meridian, the small intestine and its meridian) prefers bitter taste; the Spleen system (including the Spleen meridian, and stomach and its meridian) prefers sweat taste; so as the Liver system, the Kidney system and the Lung system has their own specific preference taste and taste they do not like. Give the body the taste that an organ system like, the taste will nourish that organ system, if give the taste an organ system dislike, the taste will damage that organ system. However, give any state to the body, it will anyway nourish one organ system but will also damage another organ system. Nothing is absolutely good or bad to the body. TCM always keep such balance concept in the mind.

[16]如渴者之下,当有「小便不利」四字,必传写之误也。