《黃帝八十一難經纂圖句解》Vol. 6

This scripture primarily addresses two medical questions: why the human face is particularly resistant to cold, and how to differentiate between deficiency (xu) and excess (shi) patterns in diseases.

Regarding the face's cold resistance, it explains that the head is where all the yang channels (specifically the three hand yang and three foot yang meridians) converge. While all yin channels (the three hand yin and three foot yin meridians) only reach the neck and chest before turning back, the yang channels ascend all the way to the head. Because yang qi gathers densely in the face and head, the facial region is more resilient to cold compared to other parts of the body.

The discussion then turns to diagnosing deficiency and excess patterns, outlining three key diagnostic criteria: pulse condition, symptoms, and clinical observation. In pulse diagnosis, a soggy (weak, floating) pulse indicates deficiency, while a tight or firm pulse suggests excess. For symptom differentiation, three principles apply:

1. Pathogens dispersing outward signify deficiency, while those penetrating inward indicate excess.

2. Patients who are talkative often exhibit deficiency, whereas silence tends to point to excess.

3. A gradual onset suggests deficiency, while a sudden, violent onset implies excess.

These diagnostic principles are rooted in yin-yang theory: yang qi governs the exterior and deficiency, while yin qi governs the interior and excess. When yang qi is insufficient, yin manifests externally as deficiency; conversely, when yin qi is deficient, yang invades internally, presenting as excess.

This passage explains methods for diagnosing deficiency (Xu) and excess (Shi) syndromes in traditional Chinese medicine, along with the different causes of damage to the five organs.

There are four key points for deficiency-excess diagnosis: First, soft and slack skin indicates deficiency, while tight and rigid skin suggests excess. Second, bodily itching signifies deficiency, whereas pain indicates excess. Third, tenderness upon light pressure reveals superficial excess (shallow illness), while comfort from deep pressure suggests internal deficiency (deep illness). Fourth, pain requiring strong pressure indicates internal excess (deep illness), while comfort from gentle touch points to superficial deficiency (shallow illness). These form the fundamental diagnostic principles for assessing deficiency and excess.

The text then details causes of organ damage: Excessive worry and overthinking injure the heart, as the heart governs the five organs and oversees mental activities—overexertion harms the heart-spirit (Shen). Cold exposure and chilled beverages damage the lungs, since the lungs govern skin/hair and fear cold. Frequent anger harms the liver; though anger is its natural emotion, the liver governs strategic thinking and excessive rage causes injury. Overeating and extreme physical strain hurt the spleen, which governs transformation and transportation—both gluttony and strenuous exercise impair it. Prolonged sitting on damp ground, overexertion, or sexual excess injure the kidneys, as the waist houses the kidneys—chronic sitting disrupts kidney Qi (vital energy). The kidney channel's Yongquan point on the sole makes damp living environments particularly harmful.

The concept of "damage by upright Qi or pathogenic factors" describes two disease pathways: illness arising from internal deficiency of upright Qi (Zheng Xu), or illness caused by invasion of external pathogens (Xie Qi). Diagnosis focuses on examining both causative factors and symptomatic manifestations.

This passage discusses how the five internal organs can be invaded by five pathogenic influences. These five external evils are: wind stroke (affecting the liver channel), summerheat damage (affecting the heart channel), dietary overexertion (affecting the spleen channel), cold damage (affecting the lung channel), and dampness invasion (affecting the kidney channel).

First, it explains the concept of "direct channel self-affliction" - when an organ's inherent weakness makes it directly susceptible to external pathogens. For example, when the liver is weakened and invaded by wind, this constitutes liver channel self-affliction.

The text then details the five pathogenic influences:

1. Wind stroke: Wind evil damages the liver and can spread to other organs. Exposure to wind in spring may lead to diarrhea.

2. Summerheat damage: Summerheat evil enters the heart. Those affected in summer are prone to malaria in autumn.

3. Dietary overexertion: Improper diet harms the spleen, and spleen deficiency makes it vulnerable to further dietary damage.

4. Cold damage: Cold evil injures the lungs. Winter exposure to cold may cause warm diseases in spring.

5. Dampness invasion: Dampness evil harms the kidneys. Autumn exposure may lead to coughing and limb weakness.

Using liver disease as an example, it explains diagnostic methods: Wind-induced liver disease manifests with a greenish complexion. If liver evil transmits to the heart, the face turns reddish; transmission to the spleen results in a yellowish hue, and so on. Observing these color changes helps trace the pathogen's origin and transmission path.

Finally, it describes characteristic symptoms of summerheat damage: fever, flank distension and pain, a floating-large-wiry pulse (floating-large indicating heart channel, wiry indicating liver channel), and aversion to foul odors - all crucial diagnostic markers for summerheat damage.

In traditional Chinese medicine theory, the heart corresponds to summer heat and governs the sense of smell. The heart belongs to the Fire phase (Huo), and fire has the capacity to transform substances, thereby generating odors. When the heart itself is diseased, one may perceive a scorched smell, as the upward-burning nature of fire produces charred, bitter aromas.

The heart's relationship with other organs manifests through distinct odors: when affecting the spleen, a fragrant scent arises (Fire generates Earth); when influencing the liver, a rancid odor emerges (Fire generates Wood); when impacting the kidneys, a putrid smell occurs (Fire overcomes Water); and when disturbing the lungs, a fishy odor is detected (Fire overcomes Metal). Thus when the heart is injured by summer heat, patients develop an aversion to smells accompanied by fever, irritability, heart pain, and a floating, expansive, and scattered pulse.

Regarding dietary and fatigue-related illnesses: the spleen governs taste perception. When the spleen is deficient, appetite diminishes; when excessive, appetite increases. The spleen's interactions with other organs produce specific taste preferences: when affecting the liver, sour tastes are favored; when influencing the heart, bitter flavors are preferred; when disturbing the lungs, pungent tastes are desired; when impacting the kidneys, salty flavors are craved; when the spleen itself is diseased, sweet tastes become appealing. Therefore when spleen disorders affect the heart, patients develop a preference for bitter tastes accompanied by fever, bodily heaviness, lethargy, limb weakness, and a floating, expansive yet moderate pulse.

Concerning cold damage symptoms: the lungs govern vocal expression. When cold pathogens injure the lungs, speech function becomes impaired, leading to incoherent rambling. Specific manifestations include: when affecting the liver, shouting occurs (as Wood fears Metal's restriction) - this illustrates how cold-damaged lungs disrupt proper speech patterns.

This passage explains the relationship between the Five Phases (Wuxing) theory in Chinese medicine and pathological changes in the five organs. The lungs correspond to Metal, while the heart corresponds to Fire. When pathogenic factors from the lungs invade the heart—just as metal meeting fire produces sound—the patient may exhibit symptoms of incoherent speech. The spleen corresponds to Earth, and the lungs to Metal. Earth generates Metal like a mother meeting her child and singing, so when spleen pathogens enter the lungs, the patient may produce singing-like sounds.

The kidneys correspond to Water, and the lungs to Metal. Metal generates Water, so when kidney pathogens invade the lungs—like a child clinging to its mother—the patient may moan. The lungs govern autumn, a season associated with melancholy, so when the lungs are diseased, the patient may weep.

The heart governs summer heat, while the lungs govern cold. When cold pathogens from the lungs invade the heart, the patient may experience fever with chills, and in severe cases, panting and coughing. The pulse manifestation of this condition is floating (fu), large (da), and rough (se)—the floating and large qualities reflect the heart’s pulse, while the roughness reflects the lung’s pulse.

Regarding the effects of dampness: The kidneys govern water and dampness. When kidney pathogens invade the heart, it can lead to incessant sweating, as the interaction of Fire (heart) and Water (kidneys) generates sweat. The kidney meridian connects to the tongue, so kidney disorders may manifest as abnormal salivation.

The liver corresponds to Wood. When excessive grief damages the liver’s ethereal soul (hun), it may cause tears. The spleen corresponds to Earth, and the kidneys to Water. Earth restrains Water, so spleen disorders can lead to excessive drooling. When the lungs are affected by cold, it may result in a runny nose.

In summary, the manifestations of pathogenic influences among the five organs are as follows: Kidney pathogens invading the heart cause incessant sweating, presenting as fever, lower abdominal pain, and cold calves. Heart pathogens invading the lungs lead to incoherent speech. Liver pathogens invading the lungs induce weeping. Spleen pathogens invading the kidneys cause drooling. Lung pathogens invading the kidneys result in a runny nose. Each of these conditions has corresponding pulse characteristics, which form the basis for diagnosing pathogenic influences among the five organs.

The 50th Difficulty (from the Classic of Difficulties) mentions that pathogenic factors can be categorized as deficiency (xu), excess (shi), mild (wei), or direct (zheng) evils, which must be distinguished through pulse diagnosis and other symptoms.

This passage explains the diagnostic method of "Five Pathogenic Factors" in traditional Chinese medicine, along with how different diseases manifest preferences for environmental temperature and social interaction.

Regarding the identification of the Five Pathogenic Factors: When the pulse of the heart, which should normally be full and expansive (洪大而长), instead appears wiry, thin, and rapid (弦小而急), it indicates that pathogenic Qi from the liver (the mother organ of the heart) has transmitted to the heart—this is called "deficiency evil" (虚邪). If the pathogenic Qi originates from the spleen (the child organ of the heart), it is termed "excess evil" (实邪). When the pathogenic Qi comes from the kidneys (the water organ that overcomes the heart), it is called "thief evil" (贼邪); if it stems from the lungs (the metal organ that the heart overcomes), it is referred to as "minor evil" (微邪); and when the heart itself is the source of illness, it is called "proper evil" (正邪).

To elaborate: If the heart is directly harmed by summer heat, it is a "proper evil." If dietary overexertion leads to spleen disease transmitting to the heart, it is an "excess evil." If cold-induced damage causes lung disease to transmit to the heart, it is a "minor evil." If dampness leads to kidney disease transmitting to the heart, it is a "thief evil."

Concerning disease preferences: The Classic of Difficulties (第五十一难) states that a patient's environmental inclinations can reveal the location of the disease. Those who prefer warmth have illness in the fu (腑, hollow organs), while those who prefer coolness have illness in the zang (脏, solid organs). Similarly, patients who enjoy social interaction have illness in the fu, while those who avoid it have illness in the zang. This is because the fu organs belong to Yang and connect with the external world, while the zang organs belong to Yin and govern internal storage. These differing preferences reflect the disease's location in the zang-fu system and its corresponding Yin-Yang nature.

This passage explains the distinct manifestations of disorders in the five yin organs (liver, heart, spleen, lungs, kidneys) and six yang organs (gallbladder, stomach, large intestine, small intestine, bladder, and triple burner), along with the patterns of disease progression.

The five yin organs belong to yin, and yin disorders prefer warmth. Patients often desire solitude, keep doors and windows closed, and dislike human voices. Since yin governs stillness and internal contraction, disorders of the five organs typically remain fixed in specific locations without shifting. For example, a heart disorder consistently manifests as heart-related issues.

The six yang organs belong to yang, and yang disorders prefer coolness. Patients tend to seek human interaction. As yang governs movement, symptoms of yang organ disorders often wander unpredictably, moving up and down without fixed positions. For instance, a stomach disorder may manifest sometimes as stomach pain, other times as acid reflux or abdominal distension.

Regarding disease transmission patterns: Direct transmission to an organ that overcomes it in the Five Phases cycle (called "seven transmissions") can be fatal. For example, when heart disease transmits to the lungs (Fire overcomes Metal), this progression is dangerous. However, transmission to an organ that nourishes it in the generative cycle (called "inter-organ transmission") allows survival. For instance, when heart disease transmits to the spleen (Fire generates Earth), the progression is milder.

This classification method helps physicians determine whether a disorder resides in the yin or yang organs by observing the patient's temperature preferences, environmental inclinations, and whether symptoms remain fixed. Such observations guide appropriate treatment strategies.

This scripture discusses the Five Phases (Wuxing) mutual restraint theory in traditional Chinese medicine and the patterns of disease transmission among internal organs. The Five Phases—Metal, Wood, Water, Fire, and Earth—restrain one another in this sequence: Fire restrains Metal, Earth restrains Water, Metal restrains Wood, Wood restrains Earth, and Water restrains Fire. Disease transmission among the five zang organs follows this same pattern. For example, lung disease may transfer to the liver (Metal restraining Wood), liver disease to the spleen (Wood restraining Earth), spleen disease to the kidneys (Earth restraining Water), and kidney disease to the heart (Water restraining Fire).

A key principle mentioned is "one organ not being injured twice"—meaning that after a disease transfers from the heart to the lungs, for instance, the lungs, once severely affected, will not continue the transmission. If a disease spreads through seven organs, it becomes fatal. Meanwhile, "indirect organ transmission" refers to disease passing from a "mother" organ to its "child" organ (e.g., heart disease transferring to the spleen). This mother-child transmission is gentler, akin to the generative cycle of the Five Phases (Wood generating Fire, Fire generating Earth, etc.), resulting in milder illness.

Chapter 54 of the Classic of Difficulties (Nanjing) notes that diseases of the five zang organs are harder to treat because they follow the restraining pattern (e.g., liver restraining spleen, spleen restraining kidneys), while diseases of the six fu organs are easier to treat as they follow the generative pattern (e.g., Wood generating Fire, Fire generating Earth). Chapter 55 distinguishes between "accumulation diseases" (ji bing), which are yin in nature—deep-seated and latent—and "gathering diseases" (ju bing), which are yang—superficial and easily detectable. These transmission patterns align with the earlier-discussed rules of "seven transmissions" and "indirect organ transmission."

(Note: The term "difficulty" refers to chapter numbers in the Classic of Difficulties, an ancient Chinese medical text written in a question-and-answer format.)

Yang Qi (the active, ascending energy within the human body) tends to rise and circulate dynamically. When Qi accumulates within the body, it forms "Ji" (accumulation); when it gathers collectively, it becomes "Ju" (congregation).

"Ji" arises from Yin Qi generated by the Five Zang organs (Liver, Heart, Spleen, Lung, Kidney). These Yin organs, if functionally imbalanced during their corresponding seasons, develop fixed accumulations. These accumulations initially form at specific locations: Liver Ji manifests below the left ribs, Lung Ji below the right ribs, Heart Ji above the navel, Kidney Ji below the navel, and Spleen Ji at Zhongwan (the stomach region). The pain remains fixed at the affected site with clearly defined boundaries.

"Ju" originates from Yang Qi produced by the Six Fu organs (Gallbladder, Stomach, Large Intestine, Small Intestine, Bladder, Triple Burner). These Yang organs create mobile congregations that lack fixed foundations—the Qi gatherings wander without settling, and the pain shifts locations unpredictably.

The 56th Difficulty asks: Do the Five Zang accumulations have specific names? During which months and days do they form?

The response states: The Liver's accumulation is called "Fei Qi" (Exuberant Qi), resembling thick fleshy masses, commonly seen in children. Located below the left ribs like an inverted cup, it has distinct "head" and "foot" portions. If untreated for prolonged periods, it may cause chronic coughing, rebellious Qi, and malaria persisting for years. This accumulation typically forms on Wuji days (Earth phase days) during the last month of summer (Jixia).

This passage explains the relationship between the Five Phases (Wuxing) mutual restriction theory in Chinese medicine and disease transmission. According to the Five Phases doctrine, the five zang organs correspond to the Five Phases: the spleen belongs to Earth, lungs to Metal, liver to Wood, heart to Fire, and kidneys to Water. Diseases transmit between organs following their mutual restriction patterns.

The sixth lunar month of summer is the season when spleen-Earth dominates, and the Wuji days (戊己) also belong to Earth. Spleen disorders often manifest on Wuji days. For instance, lung disease (Metal) transmits to the liver (Metal restricts Wood), and liver disease (Wood) would then transmit to the spleen (Wood restricts Earth). However, during the sixth month when spleen-Earth is at its peak strength, it can resist pathogenic invasion, preventing liver disease from transmitting further. The disease then rebounds back to the lungs, which also reject it, causing stagnation that forms an accumulation disorder called "Feiqi" (肥气). Therefore, Feiqi often develops during summer Wuji days.

The heart's accumulation disorder is called "Fuliang" (伏梁), appearing like a roof beam extending from above the navel—about the thickness of an arm—up to the heart region. This condition typically manifests during autumn Gengxin days (庚辛, Metal days). This occurs because kidney disease (Water) transmits to the heart (Water restricts Fire), and heart disease (Fire) would then transmit to the lungs (Fire restricts Metal). But during autumn when lung-Metal dominates and rejects the pathogen, the heart attempts to transmit it to the kidneys, which also refuse, resulting in Fuliang accumulation. Hence, Fuliang often arises during autumn Gengxin days.

The term "dominating" (王) here refers to the organ's seasonal sovereignty and strengthened resistance. Each zang organ reaches peak defensive capacity during its corresponding season, able to resist pathogenic transmission. When disease transmission encounters such resistance, stagnation forms internally as accumulation disorders. This theory embodies Chinese medicine's holistic "correspondence between heaven and human" concept, analyzing diseases through their connection with seasons and celestial stems/earthly branches calendrical cycles.

The pathogenic Qi accumulation in the spleen is called "Pí Qi" (Obstructive Energy). Pí signifies blockage and stagnation—when Qi movement becomes congested, it forms accumulations, manifesting as the spleen's accumulation disorder. Pí Qi lodges in the gastric region, appearing like an inverted plate in size. If left untreated for prolonged periods, it leads to limb weakness, jaundice (yellowish skin), and failure of ingested food to nourish the muscles and skin.

This disorder typically flares up during winter on Ren-Gui days (water-element days in the Chinese calendar). Why is this so? Initially, it may stem from liver disease transmission (the liver, belonging to wood, overacts on the spleen, which belongs to earth). The spleen disorder should then transmit to the kidneys (spleen-earth overacts on kidney-water), but during winter, kidney-water is in its dominant phase (kidney Qi is vigorous) and rejects the pathogenic influence. The spleen then attempts to return the disorder to the liver, but the liver also refuses it, causing the stagnation to accumulate in the spleen as Pí Qi.

The accumulation disorder in the lungs is called "Xī Bēn" (Panting Surge). "Xī" refers to breathing, while "Bēn" denotes the diaphragm—meaning lung Qi becomes obstructed above the diaphragm, gradually accumulating and pressing against it. This disorder manifests below the right ribcage, resembling an inverted cup in shape. Prolonged cases result in alternating chills and fever, panting, coughing, and lung Qi congestion.

This condition often erupts in spring on Jia-Yi days (wood-element days). Initially, it may arise from heart disease transmission (heart-fire overacts on lung-metal)... (subsequent content incomplete)

When the lungs fail to resist pathogenic Qi transmitted from the heart, the Metal element (governing the lungs) will overcome the Wood element (governing the liver), allowing the pathogenic Qi to transfer from the lungs to the liver.

The liver governs spring (Wood phase in the Five Phases corresponds to spring and the liver). A governing organ is less susceptible to pathogenic invasion. During spring—the season when liver-Wood dominates—the liver won't accept pathogenic Qi transmitted from the lungs. Thus, the pathogenic Qi attempts to return to the heart.

Since the governing liver rejects the pathogen, the lung's pathogenic Qi seeks to return to the heart, but the heart also refuses acceptance. The stagnating Qi accumulates, forming an abdominal mass called "Xiben." Therefore, Xiben typically manifests on the Jia-Yi days (heavenly stems associated with Wood) during spring.

The kidney's accumulation disorder is called "Bentun"—"Ben" meaning gathering, appearing like a darting piglet. This kidney disorder originates in the lower abdomen, surging upward toward the heart region, mimicking a piglet's erratic movements. If untreated, it leads to wheezing, bone atrophy, and shortness of breath. This condition often arises on the Bing-Ding days (heavenly stems of Fire) during summer.

Why does Bentun occur on Bing-Ding days? Initially, spleen disorders (Earth phase) overcome kidney-Water, transmitting pathogens to the kidneys. The kidneys should transfer this to the heart, but since kidneys reject spleen pathogens and Water overcomes Fire, it redirects to the heart. In summer, heart-Fire governs and rejects the pathogen. When kidneys attempt to return the pathogen to the spleen—which also refuses—the stagnating Qi forms Bentun. Hence, Bentun predominantly emerges on summer's Bing-Ding days.

This reveals the fundamental mechanism behind the Five Accumulation Disorders (pathological gatherings of the five viscera).