金匮要略·脏腑经络先后病脉证第一
Synopsis of Golden Cabinet: Chapter One on Pulse Syndromes of Successive Diseases in Zang-Fu Organs, Meridians and Collaterals.
问曰：上工治未病，何也？Question: The superior physician treats diseases before they arise. Why?
师曰：“夫治未病者，见肝之病，知肝传脾，当先实脾。The teacher replies: "In treating diseases before they occur, when one sees a liver-related illness, they understand that the liver's condition can affect the spleen, and therefore should first strengthen the spleen.
四季脾旺不受邪，即勿补之。If the spleen is robust in all four seasons and does not succumb to pathogenic influences, there is no need to supplement it.
中工不晓相传，见肝之病，不解实脾，惟治肝也。”Mediocre physicians do not understand the transmission of diseases; when they see a liver-related illness, they do not understand the importance of strengthening the spleen and only treat the liver."
夫肝之病，补用酸，助用焦苦。益用甘味之药调之。For liver diseases, use sour substances for tonification, scorched and bitter substances for assistance. Use sweet-tasting medicines to regulate.
酸入肝，焦苦入心，甘入脾。Sour enters the liver, scorched and bitter enters the heart, and sweet enters the spleen.
脾能伤肾，肾气微弱，则水不行；The spleen can injure the kidney. When kidney qi is weak, water cannot flow;
水不行，则心火气盛，则伤肺；肺被伤，则金气不行；When water cannot flow, heart fire qi becomes exuberant and then injures the lung; when the lung is injured, metal qi cannot flow;
金气不行，则肝气盛，故实脾，则肝自愈。When metal qi cannot flow, liver qi becomes exuberant. Therefore, strengthening the spleen leads to the spontaneous recovery of the liver.
此治肝补脾之要妙也。肝虚则用此法，实则不在用之。This is the essential and wonderful principle of treating the liver and strengthening the spleen. This method is used for liver deficiency, but not for liver excess.
经曰：“虚虚实实，补不足，损有余”，是其义也。余脏准此。As it is said in the classics, 'Treat deficiency as deficiency and excess as excess, tonify what is insufficient and reduce what is excessive.' This is its meaning. The same principle applies to other viscera.
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。People abide by the five constants and grow due to the influence of wind qi. Although wind qi can give birth to all things, it can also harm them, just as water can float a boat but also capsize it.
若五脏元真通畅，人即安和，客气邪风，中人多死。If the primordial qi of the five viscera is unobstructed, people will be in a state of peace and harmony. Pathogenic qi and evil wind can cause many deaths when they invade people.
千般疢[chèn]难，不越三条：一者，经络受邪入脏腑，为内所因也；There are countless diseases and difficulties, but they do not exceed three categories. First, pathogenic factors invade the meridians and collaterals and enter the viscera, which is caused by internal factors.
二者，四肢九窍，血脉相传，壅塞不通，为外皮肤所中也；Second, the four limbs, nine orifices, and blood vessels are affected successively, resulting in congestion and obstruction. This is caused by external factors attacking the skin.
三者，房室、金刃、虫兽所伤．以此详之，病由都尽。Third, injuries caused by sexual intercourse, metal blades, insects, and beasts. When examined in detail in this way, all causes of diseases are exhausted.
若人能养慎，不令邪风干忤经络，适中经络，未流传腑脏，即医治之；If people can take good care and not allow pathogenic wind qi to violate the meridians and collaterals. If pathogenic factors just enter the meridians and have not spread to the viscera, they should be treated immediately.
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；When the four limbs just feel heavy and sluggish, one should use guidance, exhalation and inhalation, acupuncture, and ointment massage to prevent the nine orifices from being blocked. Moreover, one should not violate laws and regulations or be injured by beasts.
房室勿令竭乏，服食节其冷热苦酸辛甘，不遗形体有衰，病则无由入其腠理。Sexual intercourse should not be excessive. In taking food and drink, one should regulate cold, heat, bitterness, sourness, pungency, and sweetness to prevent the body from declining. Then diseases will have no way to enter the striae and interstices.
腠者，是三焦通会元真之处，为血气所注；理者，是皮肤脏腑之纹理也。The striae are the places where the triple energizer communicates with the primordial qi and are infused with qi and blood. The interstices are the textures of the skin and viscera.
问曰：病患有气色见于面部，愿闻其说。Question: Patients have complexion manifestations on the face. I would like to hear about this.
师曰："鼻头色青，腹中痛，苦冷者死（一云腹中冷，苦痛者死）。The teacher said: "If the tip of the nose is bluish, there is abdominal pain. If there is intense cold, it is fatal (one version says: if there is cold and intense pain in the abdomen, it is fatal).
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；If the tip of the nose is slightly blackish, there is fluid retention. If it is yellowish, there is cold in the chest. If it is whitish, there is loss of blood. If there is a slight redness at an inappropriate time, it is fatal.
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。"If the eyes are perfectly round, it is convulsion and incurable. Also, bluish complexion indicates pain, blackish complexion indicates consumptive disease, reddish complexion indicates wind disease, yellowish complexion indicates difficult defecation, and bright and distinct complexion indicates retained fluid."
师曰："病患语声寂然，喜惊呼者，骨节间病；The teacher said: "If a patient's voice is silent and they like to exclaim in surprise, it indicates disease in the joints.
语声喑[yīn]喑然不彻者，心膈间病；If the voice is muffled and not clear, it indicates disease in the heart and diaphragm.
语声啾[jiū]啾然细而长者，头中病（一作痛）。"If the voice is chirping and fine and long, it indicates disease in the head (one version says pain)."
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 teacher said: "If breathing causes the shoulders to shake, there is firmness in the heart. If breathing draws upward qi in the chest, it is cough. If breathing causes opening of the mouth and shortness of breath, it is pulmonary atrophy with frothy sputum."
师曰："吸而微数，其病在中焦，实也，当下之即愈，虚者不治。The teacher said: "If inhalation is slightly rapid, the disease is in the middle energizer and is due to excess. It will be cured by purging. If it is due to deficiency, it cannot be treated.
在上焦者，其吸促；在下焦者，其吸远，此皆难治。呼吸动摇振振者，不治。"If it is in the upper energizer, inhalation is short. If it is in the lower energizer, inhalation is deep. Both are difficult to treat. If breathing causes shaking and tremors, it is incurable."
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 teacher said: "The pulse at the inch opening pulsates according to the dominant season. Suppose it is the season when the liver is dominant and the complexion is bluish. In each season, the complexion follows its respective color. If the liver color is bluish but instead is whitish, which is not the color and pulse corresponding to the season, there will be disease."
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？Question: There are cases of something arriving before its due time, arriving but not as expected, arriving and not leaving, and arriving and being excessive. What does this mean?
师曰：“冬至之后，甲子夜半少阳起，少阳之时阳始生，天得温和。The teacher said: "After the winter solstice, at midnight on Jiazi, Lesser Yang begins. At this time, yang qi begins to grow and the weather becomes mild.
以未得甲子，天因温和，此为未至而至也；If it is not yet Jiazi but the weather is already mild, this is called arriving before its due time.
以得甲子而天未温和，为至而不至也；If it is Jiazi but the weather is not mild, this is called arriving but not as expected.
以得甲子而天大寒不解，此为至而不去也；If it is Jiazi but the severe cold does not disperse, this is called arriving and not leaving.
以得甲子而天温如盛夏五六月时，此为至而太过也。”If it is Jiazi and the weather is as warm as in the fifth or sixth month of summer, this is called arriving and being excessive."
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 teacher said: "If the floating pulse is felt on the anterior position in a patient, the disease is in the exterior. If the floating pulse is felt on the posterior position, the disease is in the interior. If there is low back pain, stiffness of the back, and inability to walk, there must be shortness of breath and extreme discomfort."
问曰：经云厥阳独行，何谓也？Question: It is said that 'extreme yang acts alone.' What does this mean?
师曰：此为有阳无阴，故称厥阳。The teacher said: "This means there is yang but no yin. Therefore, it is called extreme yang."
问曰：寸脉沉大而滑，沉则为实，滑则为气，实气相搏，血气入脏即死，入腑即愈，此为卒厥。何谓也？Question: If the inch pulse is deep, large, and slippery. Deep indicates excess, and slippery indicates qi. When excess and qi interact, if qi and blood enter the viscera, it is fatal. If they enter the fu-organs, it is curable. This is sudden syncope. What does this mean?
师曰：唇口青，身冷，为入脏，即死；如身和，汗自出，为入腑，即愈。The teacher said: "If the lips are bluish and the body is cold, it means entering the viscera and is fatal. If the body is warm and sweating occurs spontaneously, it means entering the fu-organs and is curable."
问曰：脉脱入脏即死，入腑即愈，何谓也？Question: If the pulse disappears and enters the viscera, it is fatal. If it enters the fu-organs, it is curable. What does this mean?
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；The teacher said: "This is not limited to one disease. It is the same for all diseases. For example, in erosive sores, if it starts from the mouth and spreads to the limbs, it is curable.
从四肢流来入口者，不可治。病在外者可治，入里者即死。"If it starts from the limbs and spreads to the mouth, it is incurable. Diseases on the exterior are curable, while those entering the interior are fatal."
问曰：阳病十八，何谓也？Question: What are the eighteen yang diseases?
师曰：头痛，项、腰、脊、臂、脚掣痛。The teacher said: "Headache, pain in the nape, waist, spine, arms, and legs.
阴病十八，何谓也？What are the eighteen yin diseases?
师曰：“咳、上气、喘、哕、咽、肠鸣、胀满、心痛、拘急。The teacher said: "Cough, upward qi rushing, asthma, hiccup, pharyngeal discomfort, intestinal rumbling, fullness, heart pain, and spasm.
五脏病各有十八，合为九十病。There are eighteen diseases for each of the five viscera, totaling ninety diseases.
人又有六微，微有十八病，合为一百八病。People also have six subtle conditions, and each subtle condition has eighteen diseases, totaling one hundred and eight diseases.
五劳、七伤、六极、妇人三十六病，不在其中。”Five strains, seven injuries, six extremes, and thirty-six diseases in women are not included in these."
清邪居上，浊邪居下，大邪中表，小邪中里，法饪之邪，从口入者，宿食也。Clear pathogenic factors reside in the upper part, turbid pathogenic factors reside in the lower part. Strong pathogenic factors attack the exterior, and mild pathogenic factors attack the interior. Pathogenic factors from improper diet that enter through the mouth are undigested food.
五邪中人，各有法度。When the five pathogenic factors invade people, there are respective rules.
风中于前，寒中于暮，湿伤于下，雾伤于上，风令脉浮，寒令脉急。Wind attacks in the front, cold attacks in the evening. Dampness injures the lower part. Fog injures the upper part. Wind causes the pulse to be floating. Cold causes the pulse to be tense.
雾伤皮腠，湿流关节，食伤脾胃，极寒伤经，极热伤络。Fog injures the skin and striae. Dampness flows into the joints. Improper diet injures the spleen and stomach. Extreme cold injures the channels. Extreme heat injures the collaterals.
问曰：病有急当救里、救表者，何谓也？Question: There are cases where one should urgently treat the interior or exterior. What does this mean?
师曰："病，医下之，续得下利清谷不止，身体疼痛者，急当救里；The teacher said: "For a disease, if the physician purges and then continuous diarrhea with undigested food occurs without ceasing and there is body pain, one should urgently treat the interior.
后身体疼痛，清便自调者，急当救表也。Later, if there is body pain and normal bowel movements, one should urgently treat the exterior.
夫病痼疾，加以卒病，当先治其卒病，后乃治其痼疾也。"For a chronic disease complicated by an acute disease, one should first treat the acute disease and then treat the chronic disease."
师曰：“五脏病各有得者愈，五脏病各有所恶，各随其所不喜者为病。The teacher said: "For diseases of the five viscera, if there is something beneficial, the disease will be cured. For diseases of the five viscera, there are things that are disliked. Each disease occurs according to what is not liked.
病者素不应食，而反暴思之，必发热也。If a patient who usually does not eat a certain food suddenly has a strong desire for it, there must be fever.
夫诸病在脏，欲攻之，当随其所得而攻之，如渴者，与猪苓汤。余皆仿此。”For all diseases in the viscera, when treating them, one should attack according to what is obtained. For example, if there is thirst, give Zhuling Decoction. The same principle applies to other cases."
