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Chapter 13 of 27
金匮要略
Overall Paraphrase
This chapter discusses the manifestations of the five viscera after being affected by wind and cold pathogens, the pulse characteristics indicating impending death when the genuine qi of the five viscera fails, and the methods for differentiating accumulation and gathering disorders.
Wind stroke in the lung: The mouth is dry with panting, the body sways and feels heavy, the head is clouded and dizzy with edema. Cold stroke in the lung: Turbid nasal discharge is expelled. Lung death-viscera pulse: Light palpation reveals vacuous and soft strengthlessness; heavy palpation reveals weakness like a hollow scallion leaf, the pulse base having no root — this is a death sign.
Wind stroke in the liver: The head and eyes, as well as the flesh, twitch; both hypochondria are painful; the person walks hunched over with a bent back, causing a craving for sweet flavors. Cold stroke in the liver: Both arms cannot be raised; the tongue root is dry; the person sighs frequently; there is chest pain; the person cannot turn sideways or lie on the side; eating induces vomiting with sweating. Liver death-viscera pulse: Light palpation reveals softness and weakness; heavy palpation reveals looseness like an untwisted rope that fails to arrive, or the pulse curves like a snake crawling — this is a death sign.
Liver fixity disease: The patient constantly desires to have someone trample on the chest. When the disease has not yet fully manifested, the patient only desires warm beverages. Xuanfuhua Decoction is indicated for its treatment.
Wind stroke in the heart: Slight fever, inability to rise from bed, hunger in the heart, but vomiting upon eating. Cold stroke in the heart: The person suffers as if the heart were burning like raw garlic; in severe cases, heart pain penetrates to the back, and back pain penetrates to the heart, like worm-boring pain. If the pulse is floating, recovery follows spontaneous vomiting. Heart injury: After fatigue and exertion, the face and head become red while the lower body feels heavy, with heart pain and a subjective sensation of heat and vexation, pulsation at the navel region, wiry pulse — this is due to heart injury. Heart death-viscera pulse: Light palpation reveals firmness like hemp seeds or beans; heavy palpation shows increasing agitation and racing rapidity — this is a death sign.
Pathological weeping causing the ethereal and corporeal souls to be unsettled is due to deficiency of blood and qi; blood and qi deficiency is ascribed to the heart. Those with heart qi deficiency are prone to fear, close their eyes wanting to sleep, dream of distant travels with the spirit scattered, and the ethereal and corporeal souls acting erratically. Yin qi decline manifests as depression (dian); yang qi decline manifests as mania (kuang).
Wind stroke in the spleen: Slight fever; the appearance resembles that of a drunken person; the abdomen feels vexingly stifled and heavy; the eyelids twitch with shortness of breath. Spleen death-viscera pulse: Light palpation reveals large and hard; heavy palpation resembles an inverted cup, smooth and glossy on the surface but shaking unsteadily — this is a death sign.
Fuyang pulse (dorsal pedal artery) is floating and rough: Floating indicates strong stomach qi; rough indicates frequent urination. When floating and rough interact, the stool will be hard — this is the spleen constraint pattern, treated with Mazi Ren Pills. Mazi Ren Pill formula: Mazi ren (hemp seed) 2 sheng, shaoyao (peony) 8 liang, zhishi (unripe bitter orange) 1 jin, dahuang (rhubarb) 1 jin, houpo (magnolia bark) 1 chi, xingren (apricot kernel) 1 sheng. The six ingredients are ground into powder, mixed with refined honey into pills the size of parasol tree seeds. Take 10 pills with water each time, three times daily, gradually increasing the dose until bowel movement is achieved. (For study purposes only; not intended as medication guidance.)
Kidney fixity disease: The patient's body feels heavy, the lower back is cold, as if sitting in water, externally resembling edema, yet without thirst; urination is spontaneous and free; eating and drinking remain normal. The disease is in the lower burner. It arises from physical labor with sweating, where clothing becomes cold and damp both inside and out, acquired over time. Cold and pain are present below the waist, and the abdomen feels heavy as if carrying five thousand copper coins. Ganjiang Lingzhu Decoction is indicated for its treatment. Gancao Ganjiang Fuling Baizhu Decoction formula: Gancao (licorice) 2 liang, baizhu (atractylodes) 2 liang, ganjiang (dried ginger) 4 liang, fuling (poria) 4 liang. These four ingredients are decocted in 5 sheng of water down to 3 sheng, taken warm in three divided doses, after which the lower back will become warm. (For study purposes only; not intended as medication guidance.)
Kidney death-viscera pulse: Light palpation reveals firmness; heavy palpation reveals chaotic movement like a rolling pill, the pulse force descending into the chi section — this is a death sign.
Question: The three burners exhaust their functions — when the upper burner is exhausted, there is frequent belching; what does this mean? The Master answers: The upper burner receives qi from the middle burner; when the qi is not harmonized, it cannot digest grain, therefore belching occurs. When the lower burner is exhausted, there is enuresis and loss of fecal control; when its qi is disharmonized, one cannot self-restrain. No treatment is necessary; prolonged duration brings spontaneous recovery.
The Master says: Heat in the upper burner causes coughing leading to lung wilting. Heat in the middle burner causes hard stool. Heat in the lower burner causes blood in the urine and also causes dribbling and obstructed urination. Cold in the large intestine causes watery stools mixed with undigested food (wù táng); heat in the large intestine causes expulsion of intestinal debris. Cold in the small intestine causes heavy bearing-down with blood in the stool; heat in the small intestine inevitably gives rise to hemorrhoids.
Question: Diseases manifest as accumulation (ji), gathering (ju), and xin qi — how are they differentiated? The Master answers: Accumulation is a visceral disease, fixed and unmoving throughout. Gathering is a bowel disease, occurring at times, with shifting pain that moves about; it can be cured. Xin qi manifests as pain below the costal region that is relieved by pressure but recurs. The general principle for all accumulation diseases: when the pulse arrives fine and adhering to the bone, it is accumulation. When the cunkou pulse is fine and adhering to the bone, accumulation is in the chest. When it slightly emerges beyond the cunkou, accumulation is in the throat. When the guan pulse is fine and adhering to the bone, accumulation is beside the navel. When it emerges above the guan, accumulation is below the heart. When it slightly descends below the guan, accumulation is in the lower abdomen. When the chi pulse is fine and adhering to the bone, accumulation is in the qi-chong region (inguinal area). When the pulse emerges on the left, accumulation is on the left; when it emerges on the right, accumulation is on the right; when it emerges on both left and right, accumulation is in the center. Each is judged according to its location.
The core academic thought of this chapter lies in using the five viscera as the guiding framework to govern both external contraction and internal damage. The Synopsis of the Golden Chamber here examines the five viscera within a framework of "substance and function":
Substance-function of the five viscera and routes of pathogenic attack: Each viscus has both "substance" (essential structures and stored essence) and "function" (qi-transforming activities). Wind is a yang pathogen; when it strikes the five viscera, it disturbs their "function," hence manifesting signs of yang activity such as fever, panting, and body swaying. Cold is a yin pathogen; when it strikes the five viscera, it congeals their "substance," hence manifesting signs of yin congelation such as turbid nasal discharge, inability to raise the arms, and dry tongue. This diagnostic logic of "wind stroke causes movement; cold stroke causes congelation" embodies the ancients' systematic understanding of the relationship between pathogenic nature and visceral reactions.
The "true visceral pulse" concept in death-viscera pulses: The descriptions of the five viscera death pulses in this chapter (lung like a scallion leaf without root, liver like an untwisted rope or curving like a snake, heart like hemp seeds with agitated rapidity, spleen like an inverted cup shaking, kidney like a rolling pill entering the chi) are essentially the concrete application of the Inner Canon's "true visceral pulse" theory. The core logic: normal pulses should possess stomach qi (harmonious and relaxed qualities); when the pulse loses the nourishment and constraint of stomach qi, exposing only the partiality of the visceral essential qi (whether hard, vacuous, or chaotic), this indicates that stomach qi has already expired and the genuine qi of the viscera has dispersed, hence the judgment of death.
Visceral localization and differentiation of accumulation versus gathering: Accumulation belongs to the viscera, gathering to the bowels — this is one of the earliest Chinese medical classifications of "space-occupying lesions." Accumulation is fixed and unmoving, corresponding to substantive lesions; gathering is intermittent and dispersed, corresponding to functional or qi-mechanism disorders; xin qi disperses with pressure, representing a mild pattern of qi stagnation. Using pulse positions (cun, guan, chi) to correspond to disease locations (chest, abdomen, lower burner), a systematic pulse-diagnosis localization framework is constructed.
Triple burner qi transformation and water pathways: The discussion of the upper burner receiving qi from the middle burner and the lower burner's self-restraint emphasizes that the triple burner is a functional synergy unit. When the upper burner cannot receive qi, belching results; when lower burner qi fails to restrain, enuresis results. This qi-transformation view centered on "acquired foundation spleen and stomach" laid the groundwork for later "triple burner pattern differentiation."
Clinical mapping of wind-cold in the five viscera: The symptoms described for lung wind stroke — "dry mouth with panting, body swaying with heaviness, clouding with edema" — are highly similar to acute respiratory infection with systemic symptoms. The chest pain of liver cold stroke, with inability to turn and vomiting upon eating, may correspond to hepatobiliary disorders with radiation to the chest and hypochondrium. The ancients' observations were empirical and phenomenological, yet the precision of their symptom descriptions indicates remarkably careful clinical observation.
Scientific perspective on true visceral pulses: Modern pulse research confirms that certain severe organic diseases (such as heart failure, advanced liver disease, renal failure) can indeed cause abnormal pulse changes (such as increased pulse pressure, pulse rhythm irregularities, arterial stiffening). However, the absolute judgment that "true visceral pulse signifies death" should be viewed rationally — the ancients faced an era lacking modern rescue measures, and their "death signs" reflect prognostic understanding under those conditions, and should not be directly applied in modern clinical practice.
Pathological mechanism of kidney fixity: The symptoms of kidney fixity — "cold in the lower back, as if sitting in water, abdominal heaviness like carrying five thousand coins" — align remarkably well with descriptions of chronic lumbar strain and cold-dampness type lower back pain. Its attribution of cause to "physical labor with sweating, clothing damp from within and without" echoes modern sports medicine's understanding of "post-exercise chilling leading to muscular fascial inflammation." However, the visceral attribution of "disease in the lower burner" reflects the ancients' theoretical model.
Accumulation, gathering, and early classification of tumors: Accumulation (fixed and immovable, fine pulse adhering to bone) bears similarity to descriptions of space-occupying tumor lesions; gathering (intermittently present, intermittently dispersed) more closely corresponds to intestinal spasm, functional bowel obstruction, and other non-organic conditions. The ancients' ability to distinguish the "curable" (gathering) from the difficult-to-cure (accumulation) demonstrates a rudimentary grasp of prognosis.
Avoid cold-dampness invasion after exertion: This chapter's dictum — "physical labor with sweating, clothing cold and damp inside and out, acquired over time" — reminds us that after exercise or physical labor with sweating, one should change damp clothing promptly and avoid direct cold wind; this is common-sense prevention of lower back discomfort.
Emotional states and heart qi: "Deficient heart qi manifests as fear, closing the eyes desiring sleep, dreaming of distant travels" suggests the relationship between spiritual tranquility and qi-blood nourishment. Maintaining regular routines and avoiding excessive mental depletion in daily life helps preserve heart qi stability.
Moderation in diet and the spleen-stomach: Spleen constraint originates from strong stomach and weak spleen, suggesting that excessive eating (especially of drying-heating foods) with inadequate transformation can lead to bowel movement abnormalities. Diet should favor lightness, regular timing, and seven-tenths fullness, leaving margin for the spleen and stomach.
Moderation of cold and heat: The discussions of cold and wind stroke in the five viscera center on "avoiding vacuity-pathogen thief winds." Daily living should adjust clothing according to seasonal changes and avoid prolonged exposure to excessively cold or hot environments.
Related Concepts:
Further Reading:
This content is based on classical Chinese medicine texts and is provided solely for traditional cultural study and research. It does not constitute any medical diagnosis, medication advice, or treatment recommendation. If unwell, please seek prompt medical attention.