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Chapter 5 of 29
伤寒杂病论
I. Treating Before Illness Occurs & Liver Disease Transmitting to the Spleen
Someone asked: What does a highly skilled physician mean by "treating before illness occurs"?
The Master said: What is called treating before illness occurs means that when one sees the liver has a disease, understanding that the liver disease will transmit to the spleen, one first supplements and strengthens the spleen. If during the current season the spleen qi itself is vigorous and not easily invaded by pathogens, then there is no need to specifically supplement the spleen. A mediocre physician does not understand this pattern of visceral transmission; upon seeing liver disease, they only know to treat the liver and do not know to strengthen the spleen.
In the case of liver disease, if it is a deficiency pattern, supplement with sour flavors, assist with scorched-bitter flavors, and harmonize with sweet-flavored medicinals. This is because sour enters the liver, scorched-bitter enters the heart, and sweet enters the spleen. When spleen qi is replete, it can restrain the kidneys; when kidney qi is weak, water fluids cannot flow normally; when water fluids do not flow, heart fire becomes hyperactive; when heart fire is hyperactive, it damages the lungs; when the lungs are damaged, metal qi cannot function; when metal qi cannot function, liver-wood qi is no longer restrained and becomes exuberant, and the liver disease can heal on its own. This is the subtle essence of treating the liver by supplementing the spleen.
Note: This method can be used for liver deficiency, but not for liver excess. The classics say: "Do not make the deficient more deficient, nor the excessive more excessive; supplement what is insufficient, reduce what is in excess." This is the principle. The same applies by analogy to other viscera.
II. Feng Qi, Three Causes, and Health Preservation Against Disease
Humans receive the qi of the five constant elements from Heaven and Earth, and rely on natural wind qi for growth. Wind qi can give birth to all things, but it can also harm all things, just as water can float boats but also capsize them. If the five viscera's yuanzhen (the body's fundamental genuine qi) is unobstructed and smooth, people remain peaceful and healthy. External abnormal pathogenic wind, when it injures people, can often cause critical conditions or even death.
Although diseases are numerous, they do not exceed three categories: first, pathogenic qi entering through the channels entering the viscera, which belongs to internal causes; second, the four limbs, nine orifices, and blood vessels being affected, with obstruction and blockage, which belongs to external pathogens injuring the skin; third, excess in sexual activity, wounds from swords and metal blades, and injuries from insects and wild animals. Investigating in this way, the causes of disease are essentially complete.
If people are cautious in preserving health, not allowing pathogenic wind to invade the channels and collaterals; if it has just entered the channels and collaterals and has not yet transmitted to the viscera, treating it promptly; if the four limbs only feel heavy and sluggish, using methods such as daoyin (guiding exercises), tunna (breathing exercises), acupuncture, moxibustion, and medicated massage to prevent the nine orifices from becoming blocked; moreover, not violating the laws of the land, avoiding harm from birds and beasts, not exhausting essence-qi through excessive sexual activity, moderating food and drink in terms of cold, heat, sour, bitter, pungent, and sweet—not allowing the body to decline and be damaged—then pathogenic qi has no way to enter the couli (the textural intervals between skin and muscle). What is called "cou" is the site where the Triple Burner communicates with yuanzhen, and it is also where blood and qi pour into; "li" is the texture of the skin and viscera.
III. Facial Complexion Diagnosis
Someone asked: How does one observe the patient's facial complexion?
The Master said: If the tip of the nose is blue-green, accompanied by abdominal pain and pronounced fear of cold, the prognosis is extremely poor. If the tip of the nose is slightly black, there is water qi; if yellow, there is cold in the chest; if white, there is blood loss. If the tip of the nose is slightly red, but it appears in an inappropriate season, the prognosis is poor. If both eyes are wide open like a perfect circle, accompanied by convulsive disease, the ancients considered it difficult to treat.
Also: A blue-green complexion indicates pain; black indicates strain and overwork; red indicates wind; yellow indicates difficult defecation; a bright and shiny complexion indicates retained fluid (retained water-drink) within the body.
IV. Listening to Voice and Observing Respiration
The Master said: If the voice is low and weak, and then suddenly emits a startling cry, the disease is in the bone joints; if the voice is low and hoarse, not clear and bright, the disease is in the region between the heart and diaphragm; if the voice is thin and long like a chirping sound, the disease is in the head.
Regarding respiration: If the shoulders rise when breathing, there is hardness and fullness in the chest; if breathing draws the qi in the chest to rebel upward, there is likely coughing; if the mouth is open breathing with short breath, this is a type of lung atrophy (lung flaccidity, primarily characterized by coughing up saliva and drool).
Regarding inhalation: If inhalation is shallow and rapid, the disease is in the middle burner; if it is of an excess pattern, the ancients believed it could be cured by purgation; if it is of a deficiency pattern, it is difficult to treat. If the disease is in the upper burner, inhalation is short and hurried; if the disease is in the lower burner, inhalation is deep and prolonged but laborious—both are difficult to treat. If the body shakes and trembles with breathing, the ancients did not treat this.
V. Complexion, Pulse, and Seasons
The Master said: The beating of the pulse at the cun (inch) position changes according to the prevailing season. For example, when the liver is vigorous, the complexion should be blue-green; each of the four seasons has its corresponding color. In liver disease, the complexion should be blue-green; if it appears white instead, this is the complexion not corresponding to its season; when complexion and pulse do not conform to the seasons, by this rule all indicate disease.
Someone asked: The seasons have "arriving before it has arrived," "not arriving when it should arrive," "not departing when it should depart," and "arriving in excess." What does this mean?
The Master said: After the winter solstice, on the ziji day at midnight, the qi of lesser yang (the stage of initial yang emergence) begins to be generated. When yang qi begins to emerge, the weather should turn mild and warm. If before the ziji day has arrived, the weather has already become mild, this is called "arriving before it has arrived"; if upon the ziji day the weather is still not mild and warm, this is called "not arriving when it should arrive"; if upon the ziji day the great cold still does not retreat, this is called "not departing when it should depart"; if upon the ziji day the weather is warm like the fifth or sixth month of summer, this is called "arriving in excess."
VI. Jue Yang, Sudden Collapse, and Disease Course Auspiciousness
Someone asked: The classics say "jue yang walks alone." What does this mean?
The Master said: This is having only yang without yin, and is therefore called jue yang.
Question: The cun pulse is deep, large, and slippery. Deep indicates excess, slippery indicates qi. Excess and qi mutually contend. If blood-qi enters the viscera, death follows; if it enters the fu organs, recovery follows. This is called "sudden collapse." How is this understood?
The Master said: Blue-purple lips and cold body indicate entry into the viscera, with a poor prognosis; a warm body with natural sweating indicates entry into the fu organs, and recovery is possible.
Question: When the pulse is in a state of disappearance (pulse desertion), how is "death if entering the viscera, recovery if entering the fu organs" to be understood?
The Master said: This is not limited to a single disease—all hundred diseases follow this principle. For example, in the case of spreading sores (infectious skin lesions), those spreading from the mouth toward the four limbs are treatable, while those spreading from the four limbs toward the mouth are untreatable; diseases in the superficial layers are treatable, while those entering deeply are mostly critical.
VII. Disease Classification and Location of Causes
Question: What are the eighteen types of yang diseases?
The Master said: Head and nape pain, lower back, spine, arm, and leg pulling pain, etc. What are the eighteen types of yin diseases? The Master said: Coughing, qi rushing upward, wheezing, hiccups, throat pain, intestinal rumbling, fullness and distension, heart pain, cramping and contraction, etc. There are thirty-six visceral diseases and thirty-six fu organ diseases, totaling one hundred and eight diseases. In addition, the five strains, seven injuries, six extremes, and the thirty-six diseases of women are not included among these.
Light and clear pathogens tend to invade the upper body; turbid and heavy pathogens tend to invade the lower body; large external pathogens mostly injure the body surface; small pathogens mostly enter the interior; pathogens from food and drink enter through the mouth and mostly form retained food.
VIII. Rescuing the Interior vs. Exterior and Chronic Illness with Acute Disease
Someone asked: When diseases require urgent treatment of either the interior or the exterior pattern, how does one distinguish?
The Master said: After the disease has been mistakenly treated with purgatives by a physician, if incessant diarrhea with undigested food continuing, and there is also body pain, one should urgently rescue the interior; once body pain persists but urination and defecation have returned to normal, then urgently rescue the exterior. If one has a chronic illness (old disease) and is newly afflicted with an acute disease, one should first treat the acute disease and then treat the chronic illness.
IX. Five Viscera Preferences/Dislikes and Treating According to What Is Obtained
The Master said: Each of the five visceral diseases has suitable conditions under which it more readily heals, and each also has disliked conditions; if exposed to disliked conditions, the disease may worsen. For example, if a patient normally does not enjoy eating a certain food but suddenly has a strong craving for it, this often indicates that fever is developing. In treating the five visceral diseases, one should treat according to the pathological key point to which the pathogen is attached. For instance, in cases of thirst, the ancients cited Zhuling Decoction as an example, demonstrating the diagnostic reasoning of "attacking according to what has been obtained" (this is an example for theoretical discussion, not medication guidance). The rest can be deduced by analogy.
X. Exhaustion of Internal and External Qi, and Triple Burner Cold/Heat
The Master said: If the patient has cold hands and feet, qi rushing upward, and foot cramping and contraction, this is the exhaustion of the six fu organs' qi externally. If there is incessant diarrhea and numbness of the hands and feet, this is the exhaustion of the five viscera's qi internally. If both internal and external qi are exhausted, the prognosis is poor.
When heat is in the upper burner, chronic coughing over time may develop into lung atrophy; when heat is in the middle burner, the abdomen becomes hard; when heat is in the lower burner, it may cause blood in the urine, or difficult and painful urination. When the large intestine has cold, there is watery diarrhea mixed with undigested food like duck droppings; when it has heat, there is passage of sticky and turbid matter. When the small intestine has cold, there is tenesmus (rectal heaviness) and passage of pus and blood; when it has heat, hemorrhoids readily develop.
XI. Exhaustion of the Triple Burner
Question: What does exhaustion of the Triple Burner mean?
The Master said: The upper burner receives the qi of water and grain transformed by the middle burner. When the middle burner is disharmonious and cannot digest grains, the upper burner loses its nourishment, hence frequent belching. The lower burner also receives qi from the middle burner; when middle qi is disharmonious, the qi of water and grain cannot be properly distributed, and the lower burner loses its restraint, hence enuresis (bedwetting) or fecal incontinence.
XII. Accumulation, Aggregation, Grain Qi, and Accumulation Pulse Location
Question: Diseases include accumulation, aggregation, and grain qi—how are they distinguished?
The Master said: Accumulation pertains to visceral disease, fixed and unmoving; aggregation pertains to fu organ disease, arising and ceasing intermittently, with pain that moves around. Grain qi (referred to as "fragrant qi" later in the original text) manifests as pain below the ribcage that is relieved by pressing and recurs after recovery.
The pulse patterns for various accumulations: deep, thin, and clinging to the bone like a violin string. If it appears at the cun position, the accumulation is in the chest; if slightly above the cun position, the accumulation is in the throat; at the guan position, the accumulation is beside the navel; above the guan position, the accumulation is below the heart (epigastrium); slightly below the guan position, the accumulation is in the lower abdomen. At the chi position, the accumulation is in the region of qichong. If the pulse deviates to the left, the accumulation is on the left; if it deviates to the right, the accumulation is on the right; if it protrudes on both sides, the accumulation is in the center. The location of the accumulation is determined according to where the pulse abnormality appears.
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Further Reading
Bua Tip: This content is based on classical Chinese medical texts and is provided solely for the study and research of traditional culture. It does not constitute any medical diagnosis, medication guidance, or treatment advice. If you feel unwell, please consult a doctor in a timely manner.