Formulas · Text · Donguibogam 東醫寶鑑

Examining Disease

Simbyeong

한글 심병 · Pinyin Shen Bing

Looking, listening, asking and feeling the pulse — how a physician reads a patient before naming the illness

審病

The short chapter that sets out the Donguibogam's method of examination, and the one that comes closest to a modern clinical manual. It begins with the four ways of knowing — looking, listening, asking, feeling the pulse — and the famous ranking of them: to know by looking is divine, to know by asking is merely skilled. From there it works through the face as a map of the body, the five colours as signs of life and death, the gait and the voice and the way a patient sits, the nineteen aetiological formulas of the Inner Classic, how to tell a new illness from an old one, which cases can be treated and which cannot, and finally the signs by which each viscus is judged to have failed.

Much of it is observation that survives translation intact. A patient who sits bent forward is short of breath; one who holds the belly as though cradling an egg has pain in the heart; breathing that heaves the shoulders means hardness within; a swelling under the eye like a sleeping silkworm means water. The last two sections, the death signs, are a different matter: they are a prognostic almanac, and the day counts in them — eight days, ten days, five days — are not to be relied on. They are kept here because they record what a seventeenth-century physician watched for at a bedside, and because the observations underneath the counts (cold hands with blue nails, Cheyne type breathing, oil-like sweat, a mouth that will not close) are real signs of a dying patient.

2.1 Divine, Sagely, Skilled and Clever 神聖工巧

2.1.1

Source원문

靈樞曰, 望而知之謂之神, 聞而知之謂之聖, 問而知之謂之工, 切脉而知之謂之巧. 以內知之曰神, 以外知之曰聖. 神聖工巧謂之四象.

Translation영역

The Yeongchu says: to know by looking is called divine; to know by listening is called sagely; to know by asking is called skilled; to know by feeling the pulse is called clever. To know it from within is called divine, to know it from without is called sagely. Divine, sagely, skilled and clever are called the four images.

Clinical note임상 주석

The four ways of examining a patient, and the chapter's frame. They are ranked, and the ranking is the point: looking comes first because it asks nothing of the patient, and asking comes third because it depends on what the patient can say. Feeling the pulse comes last of the four here, which is worth noticing in a tradition usually caricatured as pulse-bound — the Bogam gives the pulse a chapter of its own at 診脉 and still puts it fourth in the order of examination. 以內知之曰神 — to know it from within — means to read the illness from the body's own surface without being told anything; 以外, from without, is to work from what can be heard and asked. The 四象, four images, is the term the Bogam uses for the set; it has nothing to do with the four constitutional types of later Korean medicine, which borrowed the phrase.

Yeongchu 靈樞

2.1.2

Source원문

神聖工巧何謂也? 曰, 望而知之者, 望見其五色以知其病也. 聞而知之者, 聞其五音以別其病也. 問而知之者, 問其所欲五味以知其病所起所在也. 切脉而知之者, 診其寸口, 視其虛實, 以知其病在何藏府也. 經曰, 以內知之曰神, 以外知之曰聖. 《難經》

Translation영역

What is meant by divine, sagely, skilled and clever? It is said: to know by looking is to look at the five colours and so know the illness. To know by listening is to listen to the five tones and so distinguish the illness. To know by asking is to ask after the five flavours the patient craves and so know where the illness arose and where it lies. To know by feeling the pulse is to examine the inch opening, see whether it is vacuous or replete, and so know in which viscus or bowel the illness lies. The classic says: to know it from within is called divine, to know it from without is called sagely.

Clinical note임상 주석

The Nangyeong's gloss on each of the four, and each names what is actually being read: the five colours of the face (2.3 and 2.4), the five tones of the voice, the flavour the patient wants, and the pulse at the wrist. The third is a real clinical question and not a piece of system — a craving tells the examiner which viscus is involved, and it is asked because the patient knows it and the examiner cannot see it.

Nangyeong 難經

2.2 The Way of Examining Disease 診病之道

2.2.1

Source원문

內經曰, 善診者, 察色按脉, 先別陰陽, 審淸濁而知部分, 視喘息聽音聲而知所苦.

Translation영역

The Inner Classic says: one who examines well inspects the colour and presses the pulse, first distinguishing yin from yang, weighing the clear against the turbid and so knowing which part is affected, watching the breathing and listening to the voice and so knowing what the patient suffers from.

Naegyeong 內經

2.2.2

Source원문

診病之道, 觀人勇怯ㆍ骨肉ㆍ皮膚, 能知其情, 以爲診法也. 《內經》

Translation영역

The way of examining disease: observe whether the person is bold or timid, observe the bones and flesh and the skin, and so be able to know their condition. This is to be taken as the method of examination.

Clinical note임상 주석

勇怯, bold or timid, is constitution and not character: the Inner Classic holds that the same insult produces different illness in a robust and in a fearful person, and the examiner is told to read that before reading the complaint. Together with 骨肉 and 皮膚 — the build and the skin — this is the oldest layer of constitutional assessment in the tradition, and the one the Bogam keeps.

Naegyeong 內經

2.2.3

Source원문

五藏之象, 可以類推; 五藏相音, 可以意識; 五色微診, 可以目察. 能合脉色, 可以萬全. 《內經》

Translation영역

The images of the five viscera can be inferred by kind; the tones answering to the five viscera can be grasped by attention; the fine examination of the five colours can be inspected with the eye. If pulse and colour can be matched together, one may be entirely secure.

Naegyeong 內經

2.2.4

Source원문

切脉動靜而視精明, 察五色, 觀五藏有餘不足ㆍ六府強弱ㆍ形之盛衰, 以此參伍, 决死生之分. 精明穴名也, 在明堂左右兩目內眥也. 《內經》

Translation영역

Feel the pulse's movement and stillness and look at the jeongmyeong; inspect the five colours; observe whether the five viscera have a surplus or a shortfall, whether the six bowels are strong or weak, whether the bodily form flourishes or declines. Cross-check these one against another and the division between life and death is decided. Jeongmyeong is the name of a point, at the inner canthus of each eye, to the left and right of the hall of light.

Clinical note임상 주석

參伍, cross-checking, is the method the whole chapter rests on: no one sign decides anything, and the examiner is to set pulse against colour against build until they agree. The gloss on 精明 is the commentator's and stands in the text in small characters; the point is BL-1 jeongmyeong (睛明), at the inner corner of the eye, and the Bogam writes it 精明 here and at 2.4 where the same gloss is repeated.

Naegyeong 內經

2.2.5

Source원문

是故聲合五音, 色合五行, 脉合陰陽. 《內經》

Translation영역

Therefore the voice answers to the five tones, the colour to the five phases, and the pulse to yin and yang.

Naegyeong 內經

2.2.6

Source원문

色之與脉, 當參相應也. 《難經》

Translation영역

Colour and pulse should be cross-checked against each other for their correspondence.

Nangyeong 難經

2.3 Inspecting the Colour at the Hall of Light 明堂察色

2.3.1

Source원문

雷公問曰, 五色獨决于明堂, 小子未知其所謂也. 黃帝曰, 明堂者鼻也, 闕者眉間也, 庭者顔也卽額也, 蕃者頰側也, 蔽者耳門也. 其間欲方大, 去之十步皆見于外, 如是者壽必中百歲. 《靈樞》

Translation영역

Noegong asked: the five colours are decided at the hall of light alone, and I do not yet know what is meant by it. The Yellow Emperor said: the hall of light is the nose; the gate tower is between the eyebrows; the courtyard is the browthat is, the forehead; the hedge is the side of the cheeks; the screen is the ear gate. One wants the space between them square and broad, all of it visible from without at ten paces off; where it is so, the life span will reach a hundred years.

Clinical note임상 주석

The face is named like a house — courtyard, gate tower, hall, hedge, screen — and the naming is not decoration: each named part is then assigned to an organ in the passages that follow, so that a colour seen at one place means an illness in one viscus. The hall of light, 明堂, is the nose, and it gives the section its title. The last sentence is physiognomy rather than diagnosis and the Bogam records it without comment: a broad, open, well-proportioned face read at ten paces was taken as a sign of long life. It is kept here as part of the text; nothing in the chapter afterwards depends on it.

Yeongchu 靈樞

2.3.2

Source원문

庭者額中也, 闕中者兩眉之間也, 下極者兩目之間也, 直下者兩鼻而下也, 方者鼻隧也, 面王者鼻柱之端也. 《靈樞》

Translation영역

The courtyard is the middle of the forehead; the gate tower's centre is between the two eyebrows; the lower pole is between the two eyes; the straight-down is the line running down between the two sides of the nose; the square is the nasal passage; the king of the face is the tip of the nasal column.

Yeongchu 靈樞

2.3.3

Source원문

自額而下闕上, 屬首ㆍ咽喉之部分也. 自闕中循鼻而下鼻端, 屬肺ㆍ心ㆍ肝ㆍ脾ㆍ腎五藏之部分也. 自目內眥挾鼻而下至承漿穴名, 屬膽ㆍ胃ㆍ大小腸ㆍ膀胱六府之部分也. 自顴而下頰, 則屬肩ㆍ臂ㆍ手之部分也. 自牙車而斜下頤, 屬股ㆍ膝ㆍ脛ㆍ足之部分也. 《綱目》

Translation영역

From the forehead down to above the gate tower belongs to the division of the head and throat. From the centre of the gate tower following the nose down to its tip belongs to the division of the five viscera — lung, heart, liver, spleen and kidney. From the inner canthus flanking the nose and down as far as seungjangthe name of a point belongs to the division of the six bowels — gallbladder, stomach, large and small intestine, bladder. From the cheekbone down over the cheek belongs to the division of the shoulder, arm and hand. From the jaw slanting down to the chin belongs to the division of the thigh, knee, shin and foot.

Clinical note임상 주석

A map of the whole body onto the face: midline for the viscera, the strip beside the nose for the bowels, the cheek for the upper limb, the jaw for the lower. The viscera run down the nose in the order lung, heart, liver, spleen, kidney — top to bottom, which is their order in the trunk — and the limbs are placed lateral and low. Seungjang is CV-24, in the hollow below the lower lip.

Gangmok 綱目

2.3.4

Source원문

額爲心之部, 鼻爲脾之部, 左頰肝之部, 右頰肺之部, 頤爲腎之部. 《丹心》

Translation영역

The forehead is the heart's division, the nose the spleen's, the left cheek the liver's, the right cheek the lung's, the chin the kidney's.

Clinical note임상 주석

A second and simpler map, and it does not agree with the first. Here the five viscera are spread across the face by the five phases — fire above, metal right, wood left, earth centre, water below — where the Gangmok ran them down the nose. The Bogam prints both without choosing, which is how it handles most such disagreements; in practice the five-phase map is the one later Korean texts use, and it is the one still taught for facial inspection.

Dansim 丹心

2.3.5

Source원문

五藏六部固盡有部, 視其五色, 黃赤爲熱, 白爲寒, 靑黑爲痛, 此所謂視而可見者也. 《內經》

Translation영역

The five viscera and six bowels each certainly have their division. Look at the five colours there: yellow and red are heat, white is cold, blue-green and black are pain. This is what is meant by what can be seen by looking.

Naegyeong 內經

2.3.6

Source원문

明堂之色, 沉濁爲內, 浮澤爲外. 黃赤爲風, 靑黑爲痛, 白爲寒, 黃而膏潤爲膿, 赤甚爲血, 痛甚爲攣, 寒甚爲皮不仁. 五色各見其部, 祭其浮沉以知淺深, 察其澤夭以觀成敗. 《靈樞》

Translation영역

As for the colour at the hall of light: sunken and turbid means the trouble is within, floating and glossy that it is without. Yellow and red are wind, blue-green and black are pain, white is cold; yellow with a greasy sheen is pus; a deep red is blood; severe pain brings cramping; severe cold brings numbness of the skin. The five colours each appear in their own division — weigh whether they float or sink and so know whether the trouble is shallow or deep; inspect whether they are glossy or withered and so observe whether the case will come right or fail.

Clinical note임상 주석

The most useful passage in the section, because it reads two dimensions and not one. The colour says which trouble; whether it floats or sinks says how deep; whether it is glossy or withered says whether the patient is holding. 澤夭, glossy against withered, is the chapter's recurring sign of prognosis and returns at 2.3's last passage and throughout 2.10.

Yeongchu 靈樞

2.3.7

Source원문

目赤色者病在心, 白在肺, 靑在肝, 黃在脾, 黑在腎, 黃色不可名者病在胸中. 《靈樞》

Translation영역

Where the eye is red the illness is in the heart; white, in the lung; blue-green, in the liver; yellow, in the spleen; black, in the kidney. Where the yellow is of no nameable shade, the illness is in the chest.

Yeongchu 靈樞

2.3.8

Source원문

視其顔色, 黃赤者多熱氣, 靑白者少熱氣, 黑色者多血少氣. 《靈樞》

Translation영역

Look at the colour of the brow: yellow and red mean abundant heat qi; blue-green and white, scant heat qi; black, abundant blood and scant qi.

Yeongchu 靈樞

2.3.9

Source원문

五藏已敗, 其色必夭, 夭必死矣. 註曰, 夭謂死生異常之候也. 色者神之旗, 藏者神之舍, 故神去則藏敗, 藏敗則色見異常之候也. 《內經》

Translation영역

When the five viscera have already failed the colour is necessarily withered, and withered colour means death. The commentary says: withered means a sign of life and death out of its ordinary course. Colour is the banner of the spirit and the viscera are its dwelling; so when the spirit departs the viscera fail, and when the viscera fail the colour shows signs out of its ordinary course.

Clinical note임상 주석

色者神之旗 — colour is the banner of the spirit — is the sentence that licenses the whole practice of facial inspection: the face is read not because it is the organ of disease but because it is where the spirit flies its flag. The clinical content is the inference, and it is sound enough on its own terms: a face that has lost its lustre in a seriously ill patient is a bad sign, whatever the theory behind it.

Naegyeong 內經

2.4 Divining Fortune and Misfortune from the Five Colours 五色占吉凶

2.4.1

Source원문

夫心者五藏之專精也, 目者其竅也, 華色者其榮也. 《內經》

Translation영역

The heart is the concentrated essence of the five viscera; the eye is its orifice; the bloom of colour is its flowering.

Naegyeong 內經

2.4.2

Source원문

夫精明五色者氣之華也. 赤欲如帛裹朱, 不欲如赭; 白欲如鵝羽, 不欲如鹽; 靑欲如蒼璧之澤, 不欲如藍; 黃欲如羅裹雄黃, 不欲如黃土; 黑欲如重漆色, 不欲如地蒼一本地蒼作炭. 註曰, 精明穴名也, 在明堂左右兩目內眥也. 五氣之精華者, 上見爲五色, 變化於精明之間也. 《內經》

Translation영역

The five colours at jeongmyeong are the flowering of the qi. One wants red like cinnabar wrapped in silk, not like red ochre; white like a goose's feather, not like salt; blue-green like the gloss of dark jade, not like indigo; yellow like realgar wrapped in gauze, not like yellow earth; black like a deep lacquer, not like the dark of the groundone edition has 炭, charcoal, for 地蒼. The commentary says: jeongmyeong is the name of a point, at the inner canthus of each eye, to the left and right of the hall of light. The flowering essence of the five qi appears above as the five colours, and its changes are to be seen about jeongmyeong.

Clinical note임상 주석

Each pair contrasts the same colour alive and dead, and the difference is always lustre: cinnabar seen through silk against dry ochre, goose down against crusted salt, wet jade against flat indigo, fresh lacquer against ash. This is the one piece of colour diagnosis in the chapter that can be used without the five-phase scheme at all — what is being judged is whether the colour has depth and moisture in it, and that is a real observation about a face.

Naegyeong 內經

2.4.3

Source원문

五藏之氣色, 見靑如草滋者死, 黃如枳實者死, 黑如炱者死, 赤如衃血者死, 白如枯骨者死, 此五色之見死也. 《內經》

Translation영역

As for the colour of the qi of the five viscera: blue-green seen like rank grass means death; yellow like a bitter-orange fruit means death; black like soot means death; red like clotted blood means death; white like a dry bone means death. These are the five colours showing death.

Naegyeong 內經

2.4.4

Source원문

靑如翠羽者生, 赤如雞冠者生, 黃如蟹腹者生, 白如豕膏者生, 黑如烏羽者生, 此五色之見生也. 《內經》

Translation영역

Blue-green like a kingfisher's feather means life; red like a cockscomb means life; yellow like a crab's belly means life; white like pig's fat means life; black like a crow's feather means life. These are the five colours showing life.

Clinical note임상 주석

Set against the previous passage, the two make one test. The living colours are all of them wet and bright — a kingfisher's wing, a cockscomb, fresh fat, a crow's gloss — and the dying ones all dry and matt. The pairing is the same one as 2.3's 澤夭, put in images a seventeenth-century reader would have in front of him.

Naegyeong 內經

2.4.5

Source원문

生於心, 如以縞裹朱; 生於肺, 如以縞裹紅; 生於肝, 如以縞裹紺; 生於脾, 如以縞裹瓜蔞實; 生於腎, 如以縞裹紫. 此五藏所生之外榮也. 《內經》

Translation영역

What is engendered by the heart is like cinnabar wrapped in white silk; by the lung, like crimson wrapped in white silk; by the liver, like dark violet wrapped in white silk; by the spleen, like a snakegourd fruit wrapped in white silk; by the kidney, like purple wrapped in white silk. These are the outward flowerings engendered by the five viscera.

Naegyeong 內經

2.4.6

Source원문

面黃目靑ㆍ面黃目赤ㆍ面黃目白ㆍ面黃目黑, 皆不死也. 面靑目赤ㆍ面赤目白ㆍ面靑目黑ㆍ面黑目白ㆍ面赤目靑, 皆死也. 《內經》

Translation영역

A yellow face with blue-green eyes, a yellow face with red eyes, a yellow face with white eyes, a yellow face with black eyes — none of these means death. A blue-green face with red eyes, a red face with white eyes, a blue-green face with black eyes, a black face with white eyes, a red face with blue-green eyes — all of these mean death.

Clinical note임상 주석

The rule under the list is that yellow in the face is survivable whatever the eyes show, because yellow is the colour of the spleen and so of the stomach qi: while the face keeps it the patient is still being fed. It is the same reasoning the chapter uses at 2.17's first line, 欲愈之病目眥黃, where yellow at the canthus is glossed 胃氣行也 — the stomach qi is moving.

Naegyeong 內經

2.4.7

Source원문

病人面靑目白者死, 面靑目黃者五日死, 面赤目白者十日死, 面赤目靑者六日死, 面黑目白者八日死, 面白目黑者死, 面黑目直視惡風者死, 赤色出兩顴大如拇指者, 病雖少愈必卒死. 《華佗》

Translation영역

A sick person with a blue-green face and white eyes dies; with a blue-green face and yellow eyes, dies in five days; with a red face and white eyes, in ten days; with a red face and blue-green eyes, in six days; with a black face and white eyes, in eight days; with a white face and black eyes, dies; with a black face, a fixed stare and an aversion to wind, dies. Where red comes out on both cheekbones in a patch the size of a thumb, then even if the illness eases a little the patient will certainly die suddenly.

Clinical note임상 주석

The day counts are not to be relied on and the chapter gives no ground for them. What is worth keeping is the last sign: a circumscribed flush over both cheekbones in a patient who seems to be improving, read as a warning of sudden death. The combination described — malar flush with apparent improvement — is what a physician would now think of in advanced consumption or in a failing heart, and the text's insistence that the improvement is not to be trusted is the clinically useful part.

Hwata 華佗

2.4.8

Source원문

病人耳目及頰顴赤者死, 黑色出於天庭ㆍ天中者死, 耳目鼻黑色起入口者死, 面黑唇靑者ㆍ面靑唇黑者亦死. 《華佗》

Translation영역

A sick person whose ears, eyes, cheeks and cheekbones are red dies; where black comes out at the heavenly courtyard or the heavenly centre, dies; where black rises at the ears, eyes or nose and enters the mouth, dies; a black face with blue-green lips, or a blue-green face with black lips, likewise dies.

Hwata 華佗

2.4.9

Source원문

病人面㿠白ㆍ直視ㆍ肩息者, 一日死. 《扁鵲》

Translation영역

A sick person with a pallid white face, a fixed stare and breathing that heaves the shoulders dies within a day.

Clinical note임상 주석

Three signs together, and all three are signs a modern examiner would also take as grave: pallor, a fixed unseeing gaze, and accessory-muscle breathing. 肩息, shoulder breathing, recurs at 2.5 as a sign of hardness in the chest; here, with pallor and a fixed stare, it is read as agonal.

Pyeonjak 扁鵲

2.4.10

Source원문

鼻頭色靑, 腹中痛, 舌冷者死. 鼻頭色微黑者有水氣, 色黃者胸上有寒, 色白者亡血也, 設微赤非時者死, 色靑爲痛, 色黑爲勞, 色赤爲風, 色黃者便難也, 色鮮明者有留飮也. 《仲景》

Translation영역

Where the tip of the nose is blue-green, with pain in the abdomen and a cold tongue, the patient dies. Where the tip of the nose is faintly black there is water qi; yellow, there is cold above the chest; white, blood has been lost; and should it be faintly red out of season, the patient dies. Blue-green is pain, black is taxation, red is wind, yellow means difficulty in passing stool, and a fresh bright colour means there is retained fluid.

Junggyeong 仲景

2.4.11

Source원문

人有病, 面上忽見紅點者多死. 《丹心》

Translation영역

When a sick person's face suddenly shows red spots, most such cases die.

Dansim 丹心

2.4.12

Source원문

臍下忽大痛, 人中如墨色者多死. 《丹心》

Translation영역

Where there is sudden severe pain below the navel and the philtrum is the colour of ink, most such cases die.

Clinical note임상 주석

Sudden severe pain below the umbilicus with a dusky, blackened philtrum: the two signs together are what would now be read as an abdominal catastrophe with shock — a perforation, a strangulated bowel, a ruptured ectopic — and the Bogam's 多死, most die, was accurate before surgery. A patient presenting this way needs an emergency surgical assessment, not a prescription.

Dansim 丹心

2.5 The Hidden Mechanism of Examining Disease 察病玄機

2.5.1

Source원문

靈樞曰, 五藏爲紀, 陰陽定矣. 陰者主藏, 陽者主府. 陽受氣于四末, 陰受氣于五藏.

Translation영역

The Yeongchu says: take the five viscera as the warp and yin and yang are settled. Yin governs the viscera, yang governs the bowels. Yang receives its qi at the four extremities, yin receives its qi at the five viscera.

Yeongchu 靈樞

2.5.2

Source원문

帝曰, 何以知皮肉氣血筋骨之病也. 歧伯曰, 色起兩眉薄澤者病在皮, 唇靑黃赤白黑者病在肌肉, 榮衛濡然者病在血氣, 目色靑黃赤白黑者病在筋, 耳焦枯受塵垢者病在骨. 《靈樞》

Translation영역

The Emperor said: how is an illness of the skin, the flesh, the qi, the blood, the sinews or the bones to be known? Gibaek said: when the colour rises at the two eyebrows and the sheen is thin, the illness is in the skin. When the lips are blue-green, yellow, red, white or black, the illness is in the flesh. When the construction and defence qi are sodden, the illness is in the blood and qi. When the eyes are coloured blue-green, yellow, red, white or black, the illness is in the sinews. When the ears are scorched and withered and take on dust and grime, the illness is in the bones.

Clinical note임상 주석

Five tissues, each with its own window: the brow for the skin, the lips for the flesh, the general sodden look for blood and qi, the eye for the sinews, the ear for the bone. The last is the one worth keeping: dry, scurfy, grimy ears in a chronically ill patient as a sign of the deepest layer being involved. The scheme reads the depth of an illness from the place a sign appears rather than from the sign itself, which is the method of the whole section.

Yeongchu 靈樞

2.5.3

Source원문

帝曰, 獨調其尺以言其病奈何. 歧伯曰, 尺膚滑而澤脂者, 風也. 尺膚澁者, 風痺也. 尺膚麄如枯魚之鱗者, 水溢飮也. 尺膚熱甚, 脉盛躁者, 病溫也. 尺膚寒, 其脉小者, 泄少氣也. 肘後麄以下三四寸熱者, 腸中有蟲也. 掌中熱者腹中熱, 掌中寒者腹中寒. 魚上白肉有靑血脉者, 胃中有寒. 《靈樞》

Translation영역

The Emperor said: how is an illness to be told from regulating the cubit alone? Gibaek said: when the skin of the cubit is slippery and glossy with grease, it is wind. When the skin of the cubit is rough, it is wind impediment. When the skin of the cubit is coarse like the scales of a dried fish, it is water flooding into fluid. When the skin of the cubit is very hot and the pulse full and agitated, the illness is warm disease. When the skin of the cubit is cold and the pulse small, there is diarrhoea and scant qi. When the three or four inches below the rough part behind the elbow are hot, there are worms in the intestines. A hot palm means heat in the abdomen, a cold palm means cold in the abdomen. When the white flesh above the fish has blue-green vessels in it, there is cold in the stomach.

Clinical note임상 주석

Examination by palpating the forearm rather than the pulse, and the one passage in the chapter that describes touching the patient at length. 尺, the cubit, is the stretch of forearm from wrist to elbow — the same word as the cubit position of the pulse, but here it means the skin over that whole span. What is read is texture and temperature: greasy, rough, fish-scaled, hot, cold. The fish, 魚, is the thenar eminence at the base of the thumb, named for its shape. Dry, scaling forearm skin read as water held in the body is a connection a modern examiner would not make, but the observation itself — ichthyotic skin in a patient with oedema — is real enough. The hot and cold palm as a reading of the abdomen is still used in Korean clinics.

Yeongchu 靈樞

2.5.4

Source원문

形盛脉細, 少氣不足以息者危. 形瘦脉大, 胸中多氣者死. 形氣相得者生, 參伍不調者病. 目內陷者死. 形肉已脫, 九候雖調, 猶死. 七診雖見, 九候皆從者, 不死. 《內經》

Translation영역

A full build with a fine pulse, with scant qi insufficient for breathing, is perilous. A wasted build with a large pulse, with much qi in the chest, means death. Where build and qi match each other the patient lives; where the cross-checks do not agree, there is illness. Sunken eyes mean death. Where the flesh of the body has already been stripped away, then even if the nine indicators are regular the patient still dies. Where the seven examinations appear but the nine indicators are all compliant, the patient does not die.

Clinical note임상 주석

The rule here is that build and pulse must agree, and a mismatch between them is worse than a bad finding in either. A big man with a thread of a pulse and a wasted man with a bounding one are both read as grave, which is a sound enough piece of clinical sense: the question is whether the circulation matches the body it has to supply. 形肉已脫 — the flesh already stripped away — overrides every other finding, and that is the chapter's one firm prognostic statement: cachexia outweighs a reassuring pulse. The seven examinations are listed at 2.15 and the nine indicators belong to the three-part nine-indicator method of the 診脉 chapter.

Naegyeong 內經

2.5.5

Source원문

頸脉動, 喘疾咳, 曰水. 目裏微腫如卧蠶之狀, 曰水. 尿黃赤, 安卧者, 黃疸. 已食如飢者, 胃疸. 面腫曰風. 足脛腫曰水. 目黃者曰黃疸. 《內經》

Translation영역

A throbbing vessel in the neck with panting, rapid breathing and cough is called water. A slight swelling inside the eye in the shape of a sleeping silkworm is called water. Yellow-red urine in a patient who lies quietly is yellow jaundice. One who is hungry again as soon as he has eaten has stomach jaundice. A swollen face is called wind. Swollen feet and shins are called water. Yellow eyes are called yellow jaundice.

Clinical note임상 주석

The most clinically recognizable passage in the chapter. Visible pulsation in the neck veins with breathlessness and cough, puffiness of the lower lids, and swollen feet and shins are the three cardinal signs of congestive heart failure, and the Bogam groups all three under one word, 水 — water. A patient who presents this way needs assessment for heart failure and for renal and hepatic disease. 卧蠶, the sleeping silkworm, is the fold of the lower lid, and the image is exact: a soft fusiform swelling lying under the eye. 已食如飢, hungry as soon as fed, is listed among the jaundices here, and the pairing of polyphagia with wasting is how the chapter's own era described what a modern reader would consider as diabetes — the Bogam treats that picture under 消渴.

Naegyeong 內經

2.5.6

Source원문

言遲者, 風也. 摇頭言者, 其裏痛也. 行遲者, 表強也. 坐而伏者, 短氣也. 坐而下一膝者, 必腰痛也. 裏實護腹如懷卵者, 必心痛也. 息摇肩者, 心中堅也. 息引胸中上氣者, 咳也. 息張口短氣者, 肺痿吐沫也. 《仲景》

Translation영역

Slow speech is wind. One who shakes the head while speaking has pain within. A slow gait means the exterior is stiff. One who sits bent forward is short of breath. One who sits with one knee dropped will have lumbar pain. One whose interior is replete and who guards the abdomen as though cradling an egg will have heart pain. One whose breathing heaves the shoulders has hardness within the heart. One whose breathing draws up qi from the chest has cough. One who breathes with the mouth open and is short of breath has wilting lung and spits froth.

Clinical note임상 주석

Nine signs read from how a patient sits, stands, speaks and breathes before a word of history is taken, and most of them hold. Sitting bent forward in breathlessness, guarding the abdomen, shifting the weight off one side in back pain, shoulder-heaving breathing, and open-mouthed breathing with frothy sputum are all signs a clinician still reads from the doorway. 肺痿, wilting lung, with frothy spittle is the Bogam's term for a chronically destroyed lung, and the picture described — open-mouthed breathlessness with frothy sputum — covers both bronchiectasis and pulmonary oedema as a modern reader would divide them. This is the chapter at its best: a list of what to notice, free of any theory that has to be believed first.

Junggyeong 仲景

2.5.7

Source원문

聲嘶者死. 舌卷卵縮者死. 面腫蒼黑者死. 尸臭不可近者死. 《仲景》

Translation영역

A hoarse, cracked voice means death. A curled tongue with retracted testicles means death. A swollen face of a dark sallow black means death. A corpse-stench that cannot be approached means death.

Junggyeong 仲景

2.5.8

Source원문

陽病瞋目而動輕, 陰病閉目而靜重. 《綱目》

Translation영역

In a yang illness the eyes are glaring and the patient restless, and it is light; in a yin illness the eyes are closed and the patient still, and it is grave.

Gangmok 綱目

2.5.9

Source원문

凡病眼無魂, 朦朧白雲如外障, 不治. 《直指》

Translation영역

In any illness, where the eye has no spirit in it and a dim white cloud lies over it like an external screen, the case is not to be treated.

Jikji 直指

2.5.10

Source원문

心肺損而色弊, 肝腎損而形痿. 《保命》

Translation영역

When heart and lung are damaged the colour fails; when liver and kidney are damaged the bodily form wilts.

Bomyeong 保命

2.5.11

Source원문

上虛則眩, 下虛則厥. 肥人多濕, 瘦人多熱. 《入門》

Translation영역

Vacuity above brings dizziness, vacuity below brings reversal. Fat people have much damp, thin people much heat.

Immun 入門

2.6 The Disease Mechanisms of the Inner Classic 內經病機

2.6.1

Source원문

黃帝曰, 願問病機何如. 歧伯曰, 諸風掉眩, 皆屬於肝.

Translation영역

The Yellow Emperor said: I should like to ask how the mechanisms of disease stand. Gibaek said: all wind with shaking and dizziness belongs to the liver.

Clinical note임상 주석

The nineteen mechanisms, the most quoted passage in the Inner Classic and the nearest thing the tradition has to a list of aetiologies. Each takes the form "all X belongs to Y", where X is a group of signs and Y a viscus or a qi, and together they are the rule by which a sign is assigned a cause. Nine of the nineteen end in 火 or 熱, which is why later fire-doctrine physicians could cite the passage as scripture. 掉眩, shaking and dizziness, assigned to the liver, is the one that has lasted: tremor and vertigo are still treated as liver patterns, and 肝風內動 — internal stirring of liver wind — is the modern form of this line.

Naegyeong 內經

2.6.2

Source원문

諸寒收引, 皆屬於腎.

Translation영역

All cold with contraction and drawing in belongs to the kidney.

Naegyeong 內經

2.6.3

Source원문

諸氣賁鬱, 皆屬於肺.

Translation영역

All qi that rushes up and is depressed belongs to the lung.

Naegyeong 內經

2.6.4

Source원문

諸濕腫滿, 皆屬於脾.

Translation영역

All damp with swelling and fullness belongs to the spleen.

Naegyeong 內經

2.6.5

Source원문

諸熱瞀瘈, 皆屬於火.

Translation영역

All heat with dim-sightedness and tugging spasm belongs to fire.

Naegyeong 內經

2.6.6

Source원문

諸痛痒瘡, 皆屬於心.

Translation영역

All painful, itching sores belong to the heart.

Naegyeong 內經

2.6.7

Source원문

諸厥固泄, 皆屬於下.

Translation영역

All reversal with retention or with outflow belongs to the lower body.

Naegyeong 內經

2.6.8

Source원문

諸痿喘嘔, 皆屬於上.

Translation영역

All wilting with panting and retching belongs to the upper body.

Naegyeong 內經

2.6.9

Source원문

諸禁鼓慄, 如喪神守, 皆屬於火.

Translation영역

All clenching, chattering and shivering, as though the spirit had lost its guard, belongs to fire.

Naegyeong 內經

2.6.10

Source원문

諸痙項強, 皆屬於濕.

Translation영역

All tetany with a stiff nape belongs to damp.

Naegyeong 內經

2.6.11

Source원문

諸逆衝上, 皆屬於火.

Translation영역

All counterflow surging upward belongs to fire.

Naegyeong 內經

2.6.12

Source원문

諸腹脹大, 皆屬於熱.

Translation영역

All great distension of the abdomen belongs to heat.

Naegyeong 內經

2.6.13

Source원문

諸躁狂越, 皆屬於火.

Translation영역

All agitation, mania and transgression belongs to fire.

Naegyeong 內經

2.6.14

Source원문

諸暴強直, 皆屬於風.

Translation영역

All sudden rigidity belongs to wind.

Naegyeong 內經

2.6.15

Source원문

諸病有聲, 鼓之如鼓, 皆屬於熱.

Translation영역

All illnesses that have a sound, which when tapped sound like a drum, belong to heat.

Clinical note임상 주석

鼓之如鼓 is percussion, and the sign is tympany: a belly that resonates when struck. The Bogam is describing the examination technique as well as the finding, which makes this one of the few places in the classical literature where percussion of the abdomen is explicitly taught.

Naegyeong 內經

2.6.16

Source원문

諸病胕腫ㆍ疼痠ㆍ驚駭, 皆屬於火.

Translation영역

All illnesses with swollen feet, aching soreness and startled fright belong to fire.

Naegyeong 內經

2.6.17

Source원문

諸轉反戾, 水液渾濁, 皆屬於熱.

Translation영역

All writhing, arching and twisting, with turbid cloudy fluids, belongs to heat.

Naegyeong 內經

2.6.18

Source원문

諸病水液澄澈淸冷, 皆屬於寒.

Translation영역

All illnesses whose fluids are clear, limpid and cold belong to cold.

Clinical note임상 주석

This line and the one before it make a pair, and together they are the most useful single test in the list: cloudy, turbid discharges are read as heat, clear and watery ones as cold. It applies across the board — urine, sputum, stool, vaginal discharge, the fluid from a sore — and it is the rule by which a Korean physician still decides between a cold and a hot pattern when the other signs are ambiguous.

Naegyeong 內經

2.6.19

Source원문

諸嘔吐酸ㆍ暴注下迫, 皆屬於熱. 註云, 心盛則生熱, 腎盛則生寒. 腎虛則寒動於中, 心虛則熱收於內. 又熱不得寒, 是無火也; 寒不得熱, 是無水也. 夫寒之不寒, 責其無水; 熱之不熱, 責其無火. 熱之無久, 責心之虛; 寒之無久, 責腎之少. 《內經》

Translation영역

All retching and vomiting of sour fluid, and sudden pouring diarrhoea with urgency, belongs to heat. The commentary says: when the heart is full heat is engendered, when the kidney is full cold is engendered. When the kidney is vacuous cold stirs within; when the heart is vacuous heat gathers inside. Again, if heat will not take cooling, it is that there is no fire; if cold will not take warming, it is that there is no water. Where cooling does not cool, hold the want of water to account; where warming does not warm, hold the want of fire to account. Where the heat does not last, hold the heart's vacuity to account; where the cold does not last, hold the kidney's scantness to account.

Clinical note임상 주석

The commentary is Wang Bing's and it is the argument that made the nineteen mechanisms usable. The list assigns signs to fire, heat, cold and damp; the commentary says what to do when the assignment fails — when a heat pattern will not answer to cooling, the fault is not in the diagnosis but in the water that should have restrained the fire. 寒之不寒, 責其無水 — where cooling does not cool, hold the want of water to account — is the sentence later quoted to justify nourishing yin rather than draining fire, and it is the root of the whole 滋陰降火 approach the Bogam uses throughout the Internal Bodily Elements.

Naegyeong 內經

2.7 The Five Viscera as the Guard of the Centre 五臟者中之守

2.7.1

Source원문

五藏者中之守也. 中盛藏滿, 氣勝傷恐者, 聲如從室中言, 是中氣之濕也. 言而微, 終日乃復言者, 此奪氣也. 衣被不斂, 言語善惡不避親疏者, 此神明之亂也. 倉廩不藏者, 是門戶不要也. 水泉不止者, 是膀胱不藏也. 得守者生, 失守者死. 註曰, 要謂禁要也. 《內經》

Translation영역

The five viscera are the guard of the centre. When the centre is full and the viscera replete, and the qi prevails so that fright does harm, the voice sounds as though spoken from inside a room: this is damp in the central qi. When the speech is faint and the patient speaks again only after a whole day, this is qi robbed away. When the clothes are left untidied and the speech runs good and ill alike without distinguishing kin from stranger, this is derangement of the spirit light. When the granary does not store, the gate is not kept shut. When the water spring does not stop, the bladder is not storing. Where the guard is kept the patient lives; where the guard is lost the patient dies. The commentary says: 要 means keeping shut.

Clinical note임상 주석

Five signs of the centre failing, and three of them are mental. A muffled, boxed-in voice; speech so sparse that a whole day passes between sentences; and clothing left unfastened with talk that no longer distinguishes family from strangers. The last is a clinical description of delirium and of advanced dementia both, and the sign the Bogam picks out — loss of the ordinary social filter, not loss of memory — is exactly what a carer notices first. 倉廩不藏, the granary that will not store, is faecal incontinence, and 水泉不止, the spring that will not stop, is urinary incontinence. Taken together the section is a list of the ways in which a patient stops holding themselves together, and 得守者生, 失守者死 — the guard kept or lost — is its prognosis.

Naegyeong 內經

2.8 The Five Viscera as the Strength of the Body 五臟者身之强

2.8.1

Source원문

五藏者身之强也. 頭者精明之府, 頭傾視深, 精神將奪矣. 背者胸中之府, 背曲肩隨, 胸將壞矣. 腰者腎之府, 轉腰不能, 腎將憊矣. 膝者筋之府, 屈伸不能, 行則僂俯, 筋將憊矣. 骨者髓之府, 不能久立, 行則振掉, 骨將憊矣. 得强則生, 失强則死. 《內經》

Translation영역

The five viscera are the strength of the body. The head is the palace of the bright essence; when the head hangs and the gaze is sunken, the essence-spirit is about to be robbed away. The back is the palace of the chest; when the back is bowed and the shoulders follow it down, the chest is about to break. The lumbus is the palace of the kidney; when the lumbus cannot be turned, the kidney is about to be worn out. The knee is the palace of the sinews; when it cannot be bent and stretched and the patient walks stooped and bent over, the sinews are about to be worn out. The bone is the palace of the marrow; when the patient cannot stand for long and walks with a shaking unsteadiness, the bone is about to be worn out. Where the strength is kept the patient lives; where the strength is lost the patient dies.

Clinical note임상 주석

Five postures, read as five failures. A dropped head with a sunken stare, a kyphotic back with the shoulders rolled forward, a lumbus that will not rotate, knees that will not straighten so that the patient walks bent, and a shaking unsteadiness on standing: the passage is a description of the frail elderly body, written as prognosis. 得强則生, 失强則死 — strength kept or lost — says the same thing as a modern frailty assessment, and for the same reason, that the capacity to hold the body upright and move it is what predicts survival.

Naegyeong 內經

2.9 Telling a New Illness from an Old One 占新久病

2.9.1

Source원문

脉小弱以澁者, 謂之久病. 脉滑浮而疾者, 謂之新病.

Translation영역

A pulse that is small, weak and rough is called an old illness. A pulse that is slippery, floating and rapid is called a new illness.

Naegyeong 內經

2.9.2

Source원문

徵其脉小, 色不奪者, 新病也. 徵其脉不奪, 其色奪者, 久病也.

Translation영역

Where the examination finds the pulse small but the colour not robbed away, it is a new illness. Where the examination finds the pulse not robbed away but the colour robbed, it is an old illness.

Naegyeong 內經

2.9.3

Source원문

徵其脉與五色俱奪者, 久病也. 徵其脉與五色俱不奪者, 新病也. 《內經》

Translation영역

Where the examination finds pulse and the five colours both robbed away, it is an old illness. Where it finds pulse and the five colours both unrobbed, it is a new illness.

Clinical note임상 주석

The test is which of the two has gone first. A pulse can be knocked down overnight; colour takes time to fail, because it depends on the stores being drawn down. So a bad pulse with a good face is acute and a good pulse with a failed face is chronic — a piece of reasoning that holds for any pair of a fast-moving and a slow-moving sign.

Naegyeong 內經

2.10 Signs of What Can and Cannot Be Treated 可治難治證

2.10.1

Source원문

凡治病, 察其形氣色澤ㆍ脉之盛衰ㆍ病之新故, 乃治之, 無後其時. 形氣相得, 謂之可治. 色澤以浮, 謂之易已. 脉從四時, 謂之可治. 脉弱以滑, 是有胃氣, 命曰易治, 取之以時.

Translation영역

In treating any illness, inspect the build and the qi, the colour and its lustre, whether the pulse is full or failing, whether the illness is new or long-standing — then treat it, and do not fall behind its season. Where build and qi match each other, it is called treatable. Where the colour has lustre and floats, it is called easily ended. Where the pulse follows the four seasons, it is called treatable. A pulse that is weak but slippery still has stomach qi in it; this is called easy to treat, and it is to be taken in its season.

Naegyeong 內經

2.10.2

Source원문

形氣相失, 謂之難治. 色夭不澤, 謂之難已. 脉實以堅, 謂之益甚. 脉逆四時, 爲不可治. 必察四難而明告之. 所謂逆四時者, 春得肺脉, 夏得腎脉, 秋得心脉, 冬得脾脉, 其至皆懸絶沉澁者, 名曰逆四時. 《內經》

Translation영역

Where build and qi have lost each other, it is called hard to treat. Where the colour is withered and without lustre, it is called hard to end. Where the pulse is replete and hard, it is called growing worse. Where the pulse runs contrary to the four seasons, it is untreatable. The four difficulties must be inspected and plainly declared. Running contrary to the four seasons means: getting a lung pulse in spring, a kidney pulse in summer, a heart pulse in autumn, a spleen pulse in winter, and all of them arriving suspended and cut off, sunken and rough — this is called running contrary to the four seasons.

Clinical note임상 주석

必察四難而明告之 — the four difficulties must be inspected and plainly declared — is the one line in the chapter about what to say to the patient, and it says to say it. The Inner Classic's position, kept by the Bogam without softening, is that a physician who has established that a case is untreatable owes the patient and the family that finding openly; the modern name for it is disclosure of prognosis. The four difficulties are the four just listed: build and qi mismatched, colour withered, pulse hard, pulse contrary to the season. 有胃氣 in the passage before — some stomach qi still in the pulse — is the single most important favourable sign in the whole prognostic apparatus, and it means the patient is still digesting.

Naegyeong 內經

2.11 Illness Has Five Evils 病有五邪

2.11.1

Source원문

何謂五邪? 有中風, 有傷暑, 有飮食勞倦, 有傷寒, 有中濕. 《難經》

Translation영역

What are the five evils? There is being struck by wind, damage by summerheat, food and drink with taxation fatigue, damage by cold, and being struck by damp.

Nangyeong 難經

2.11.2

Source원문

肝主色五色, 心主臭五臭, 脾主味五味, 肺主聲五聲, 腎主液五液. 五色者靑ㆍ赤ㆍ黃ㆍ白ㆍ黑, 五臭者臊ㆍ焦ㆍ香ㆍ腥ㆍ腐, 五味者酸ㆍ苦ㆍ甘ㆍ辛ㆍ鹹, 五聲者呼ㆍ言ㆍ歌ㆍ哭ㆍ呻, 五液者泣ㆍ汗ㆍ涎ㆍ涕ㆍ唾也. 《難經》

Translation영역

The liver governs colour and the five colours; the heart governs odour and the five odours; the spleen governs flavour and the five flavours; the lung governs sound and the five sounds; the kidney governs fluid and the five fluids. The five colours are blue-green, red, yellow, white and black. The five odours are rank, scorched, fragrant, fishy and putrid. The five flavours are sour, bitter, sweet, acrid and salty. The five sounds are shouting, talking, singing, weeping and groaning. The five fluids are tears, sweat, drool, snivel and spittle.

Clinical note임상 주석

The key to the table that follows. Each of the five viscera owns one channel of perception — the liver colour, the heart smell, the spleen taste, the lung sound, the kidney fluid — and each channel has five values. A sign is then read twice over: which channel it comes in by, and which of the five values it shows.

Nangyeong 難經

2.11.3

Source원문

靑色自入爲靑, 臊臭入肝爲臊, 酸味入肝爲酸, 呼聲入肝爲呼, 泣液入肝爲泣.

Translation영역

Blue-green colour entering its own viscus is blue-green; a rank odour entering the liver is rank; a sour flavour entering the liver is sour; a shouting voice entering the liver is shouting; tears as the fluid entering the liver are tears.

Nangyeong 難經

2.11.4

Source원문

赤色入心爲赤, 焦臭自入爲焦, 苦味入心爲苦, 言聲入心爲言, 汗液入心爲汗.

Translation영역

Red colour entering the heart is red; a scorched odour entering its own viscus is scorched; a bitter flavour entering the heart is bitter; a talking voice entering the heart is talking; sweat as the fluid entering the heart is sweat.

Nangyeong 難經

2.11.5

Source원문

黃色入脾爲黃, 香臭入脾爲香, 甘味自入爲甘, 歌聲入脾爲歌, 涎液入脾爲涎.

Translation영역

Yellow colour entering the spleen is yellow; a fragrant odour entering the spleen is fragrant; a sweet flavour entering its own viscus is sweet; a singing voice entering the spleen is singing; drool as the fluid entering the spleen is drool.

Nangyeong 難經

2.11.6

Source원문

白色入肺爲白, 腥臭入肺爲腥, 辛味入肺爲辛, 哭聲自入爲哭, 涕液入肺爲涕.

Translation영역

White colour entering the lung is white; a fishy odour entering the lung is fishy; an acrid flavour entering the lung is acrid; a weeping voice entering its own viscus is weeping; snivel as the fluid entering the lung is snivel.

Nangyeong 難經

2.11.7

Source원문

黑色入腎爲黑, 腐臭入腎爲腐, 鹹味入腎爲鹹, 呻聲入腎爲呻, 唾液自入爲唾.

Translation영역

Black colour entering the kidney is black; a putrid odour entering the kidney is putrid; a salty flavour entering the kidney is salty; a groaning voice entering the kidney is groaning; spittle as the fluid entering its own viscus is spittle.

Clinical note임상 주석

自入, entering its own, marks the one cell in each column where the value and the viscus belong together — blue-green with the liver, scorched with the heart, sweet with the spleen, weeping with the lung, spittle with the kidney. Those five are the diagonal of the chart, and a sign that falls on the diagonal is a 正邪, a proper evil, while one that falls off it means a second viscus is involved. The passage that follows works the chart in the other direction, from an illness of the heart back to the evil that caused it.

Nangyeong 難經

2.11.8

Source원문

假令心病, 何以知中風得之? 其色當赤. 肝爲心邪, 故知當赤色也.

Translation영역

Suppose the heart is ill: how is it known that it was got by being struck by wind? The colour should be red. The liver has become the heart's evil, and so one knows the colour should be red.

Nangyeong 難經

2.11.9

Source원문

何以知傷暑得之? 當惡臭也.

Translation영역

How is it known that it was got by damage from summerheat? There should be a foul odour.

Nangyeong 難經

2.11.10

Source원문

何以知飮食勞倦得之? 當喜苦味也.

Translation영역

How is it known that it was got by food and drink with taxation fatigue? The patient should relish a bitter flavour.

Nangyeong 難經

2.11.11

Source원문

何以知傷寒得之? 當譫言妄語也.

Translation영역

How is it known that it was got by damage from cold? There should be delirious talk and raving speech.

Nangyeong 難經

2.11.12

Source원문

何以知中濕得之? 爲汗出不可止也. 《難經》

Translation영역

How is it known that it was got by being struck by damp? There is sweating that cannot be stopped.

Clinical note임상 주석

Five questions, each answered by one sign, and all of them asked of the same illness. This is the Nangyeong's method: the illness is already located, in the heart, and what the five signs decide is where it came from. The reasoning runs through the chart above — wind belongs to the liver, whose colour is blue-green, but an evil entering the heart takes the heart's colour, so a wind-caused heart illness shows red.

Nangyeong 難經

2.11.13

Source원문

又曰, 病有虛邪, 有實邪, 有賊邪, 有微邪, 有正邪, 何以別之? 曰, 從後來者爲虛邪, 從前來者爲實邪, 從所不勝來者爲賊邪, 從所勝來者爲微邪, 自病者爲正邪. 何以言之? 假令心病, 中風得之爲虛邪母乘子, 傷暑得之爲正邪自己病, 飮食勞倦得之爲實邪子乘母, 傷寒得之爲微邪妻乘夫, 中濕得之爲賊邪夫乘妻. 餘倣此. 《難經》

Translation영역

It says again: illness has a vacuous evil, a replete evil, a robber evil, a slight evil and a proper evil — how are they distinguished? It is said: what comes from behind is a vacuous evil; what comes from in front is a replete evil; what comes from what one cannot overcome is a robber evil; what comes from what one overcomes is a slight evil; what sickens of itself is a proper evil. How is this said? Suppose the heart is ill: got by being struck by wind, it is a vacuous evilthe mother overriding the child; got by damage from summerheat, a proper evilits own illness; got by food and drink with taxation fatigue, a replete evilthe child overriding the mother; got by damage from cold, a slight evilthe wife overriding the husband; got by being struck by damp, a robber evilthe husband overriding the wife. The rest follow this pattern.

Clinical note임상 주석

The five evils named by direction of transmission rather than by cause. Behind and in front are positions on the engendering cycle: the liver engenders the heart and so stands behind it, the spleen is engendered by it and so stands in front. An evil arriving from the mother finds the child already weak, hence vacuous; one arriving from the child finds it overfull, hence replete. 賊邪, the robber, comes from the phase that restrains one — water over fire, the husband over the wife in the glosses — and is the most serious of the five. The small-character glosses are in the base text and use the kinship terms of the five-phase cycle: mother and child for engendering, husband and wife for restraining. They are the reason the scheme was memorable, and they are also why it was criticized: the relations are fixed in advance, so the diagnosis follows from the chart rather than from the patient.

Nangyeong 難經

2.12 Distinguishing Qi, Blood, Phlegm and Fire 辨氣血痰火

2.12.1

Source원문

氣證飮水, 血證不飮水. 《海藏》

Translation영역

In a qi pattern the patient drinks water; in a blood pattern the patient does not drink water.

Haejang 海藏

2.12.2

Source원문

熱在上焦氣分則渴, 熱在下焦血分則不渴. 盖血中有濕, 故不渴也. 熱在下焦多不渴. 《東垣》

Translation영역

When the heat is in the upper burner, in the qi aspect, there is thirst; when the heat is in the lower burner, in the blood aspect, there is no thirst. Since there is damp within the blood, there is no thirst. Heat in the lower burner mostly brings no thirst.

Dongwon 東垣

2.12.3

Source원문

血之外證, 常以湯水漱口. 《直指》

Translation영역

The outward sign of blood: the patient is for ever rinsing the mouth with hot water.

Clinical note임상 주석

Thirst against a dry mouth that wants rinsing but not swallowing, and the distinction is the most practical thing in the section. A patient who drinks is dry throughout, in the qi; a patient who only wets the mouth is dry at the surface while the fluid is held elsewhere — the blood, in the chapter's terms. The same observation is still taken as pointing to blood stasis or to a yin-vacuity dryness rather than to simple dehydration.

Jikji 直指

2.12.4

Source원문

氣病則麻, 血病則痛. 《海藏》

Translation영역

An illness of the qi brings numbness; an illness of the blood brings pain.

Haejang 海藏

2.12.5

Source원문

血之爲病, 上焦瘀血, 小便必難; 下焦瘀血, 小便必自利. 《直指》

Translation영역

As for blood as an illness: with static blood in the upper burner, urination is certainly difficult; with static blood in the lower burner, urination certainly runs freely of itself.

Jikji 直指

2.12.6

Source원문

一切血證日輕夜重, 一切痰證食少肌色如故, 一切火證性急潮盛, 一切水證脇硬心下怔忡. 《入門》

Translation영역

Every blood pattern is lighter by day and heavier by night. In every phlegm pattern the patient eats little while the colour of the flesh stays as it was. In every fire pattern the temper is quick and the tidal surges strong. In every water pattern the flanks are hard and there is fearful throbbing below the heart.

Clinical note임상 주석

Four one-line discriminations, and they are the section's working tool. Night-worse pain for blood; poor appetite with a face that stays well-coloured for phlegm; quick temper with tidal flushes for fire; hard flanks with palpitation for water. The second is the sharpest: weight and colour preserved in spite of a poor appetite is what distinguishes a phlegm pattern from the wasting of a true vacuity, and it is still the sign used to make that call. 怔忡 is a palpitation felt as fear rather than as a fast beat; with hard flanks it points to fluid — in modern terms to the congested liver and palpitation of right heart failure, the same picture 2.5 gathered under 水.

Immun 入門

2.12.7

Source원문

無陽則厥, 無陰則嘔. 《直指》

Translation영역

Without yang there is reversal; without yin there is retching.

Jikji 直指

2.13 Whether an Illness Is Light or Heavy by Day and by Night 凡病晝夜輕重

2.13.1

Source원문

凡病晝則增劇, 夜則安靜, 是陽病有餘, 乃氣病而血不病也. 夜則增劇, 晝則安靜, 是陰病有餘, 乃血病而氣不病也. 《東垣》

Translation영역

In any illness that worsens by day and is quiet by night, there is a surplus of yang illness: it is the qi that is ill and not the blood. In any that worsens by night and is quiet by day, there is a surplus of yin illness: it is the blood that is ill and not the qi.

Clinical note임상 주석

The whole section is built on one observation — that the hour at which an illness worsens tells which half of the body is at fault — and it is a real clinical regularity. Pain that is worse at night is still read as blood or yin; breathlessness and agitation worse by day as qi or yang. A modern reader will recognize the underlying fact as circadian variation, and the examples the section goes on to give are the recognizable ones: fever that spikes in the evening, chills that come on at night, agitation that peaks in the small hours.

Dongwon 東垣

2.13.2

Source원문

晝則發熱, 夜則安靜, 是陽氣自旺於陽分也. 夜則惡寒, 晝則安靜, 是陰血自旺於陰分也. 《東垣》

Translation영역

Fever by day with quiet by night: the yang qi is flourishing of itself in the yang aspect. Aversion to cold by night with quiet by day: the yin blood is flourishing of itself in the yin aspect.

Dongwon 東垣

2.13.3

Source원문

晝則安靜, 夜則發熱煩躁, 是陽氣下陷入陰中也, 名曰熱入血室. 夜則安靜, 晝則惡寒, 是陰氣上溢於陽中也. 《東垣》

Translation영역

Quiet by day with fever and vexed agitation by night: the yang qi has fallen down into the yin, and this is called heat entering the blood chamber. Quiet by night with aversion to cold by day: the yin qi has overflowed upward into the yang.

Clinical note임상 주석

熱入血室, heat entering the blood chamber, is a named pattern and not just a description: it is the Junggyeong term for fever with nocturnal delirium in a woman, bound up with menstruation or the puerperium, and the Bogam treats it in the 婦人 chapter. Its appearance here is as the type case of a fever that is quiet all day and breaks out at night.

Dongwon 東垣

2.13.4

Source원문

晝則發熱煩燥, 夜亦發熱煩躁, 是重陽無陰, 當亟瀉其陽, 峻補其陰. 夜則惡寒, 晝亦惡寒, 是重陰無陽, 當亟瀉其陰, 峻補其陽. 《東垣》

Translation영역

Fever with vexed agitation by day and fever with vexed agitation by night as well: this is doubled yang with no yin, and the yang should be drained at once and the yin steeply supplemented. Aversion to cold by night and aversion to cold by day as well: this is doubled yin with no yang, and the yin should be drained at once and the yang steeply supplemented.

Dongwon 東垣

2.13.5

Source원문

晝則惡寒, 夜則煩燥, 飮食不入, 名曰陰陽交錯者死. 《東垣》

Translation영역

Aversion to cold by day, vexed agitation by night, and no food or drink taken: this is called yin and yang crossed and tangled, and the patient dies.

Clinical note임상 주석

The section's end point, and the sign that matters in it is the third one. Chills by day and agitation by night can be read either way; the patient who has also stopped eating and drinking is the one Dongwon calls 交錯 and gives up on. 飮食不入 is the chapter's recurring hinge — stomach qi present or absent — and here, as at 2.10, it decides the prognosis.

Dongwon 東垣

2.14 The Day and Hour an Illness Resolves 病愈日時

2.14.1

Source원문

凡病欲知何時得ㆍ何時愈. 荅曰, 假令夜半得病, 明日日中愈; 日中得病, 夜半愈. 何以言之? 日中得病夜半愈者, 以陽得陰則解也; 夜半得病日中愈者, 以陰得陽則解也. 《仲景》

Translation영역

In any illness one wishes to know at what hour it was got and at what hour it will resolve. The answer: suppose it was got at midnight, it resolves at noon the next day; got at noon, it resolves at midnight. Why is this said? One got at noon and resolving at midnight does so because yang, meeting yin, is released; one got at midnight and resolving at noon does so because yin, meeting yang, is released.

Clinical note임상 주석

A twelve-hour rule, and the shortest section in the chapter. It is prognosis by symmetry rather than by observation — an illness contracted at the yang peak is released at the yin peak — and nothing in the chapter supports it. What is worth taking from it is the habit behind it: Junggyeong's clinical method records the hour of onset as a matter of course, and the hour at which a fever or a pain began is still worth asking about, if not for this reason.

Junggyeong 仲景

2.15 The Seven Examinations and the Signs of Death 七診死候

2.15.1

Source원문

九候之脉皆沉細懸絶者爲陰, 主冬, 故以夜半死.

Translation영역

When the pulses at all nine indicators are sunken, fine, suspended and cut off, this is yin; it governs winter, and so death comes at midnight.

Naegyeong 內經

2.15.2

Source원문

盛躁喘數者爲陽, 主夏, 故以日中死.

Translation영역

When they are full, agitated, panting and rapid, this is yang; it governs summer, and so death comes at noon.

Naegyeong 內經

2.15.3

Source원문

是故寒熱病者, 以平朝死.

Translation영역

Therefore one ill with cold and heat dies at daybreak.

Naegyeong 內經

2.15.4

Source원문

熱中及熱病者, 以日中死.

Translation영역

One with heat in the centre, or with a heat illness, dies at noon.

Naegyeong 內經

2.15.5

Source원문

病風者, 以日夕死.

Translation영역

One ill with wind dies at dusk.

Naegyeong 內經

2.15.6

Source원문

病水者, 以夜半死.

Translation영역

One ill with water dies at midnight.

Naegyeong 內經

2.15.7

Source원문

其脉乍疏乍數ㆍ乍遲乍疾者, 日乘四季死. 《內經》

Translation영역

One whose pulse is now sparse and now rapid, now slow and now hurried, dies as the sun passes through the four quarters.

Naegyeong 內經

2.15.8

Source원문

陰盛ㆍ陽盛ㆍ寒熱ㆍ熱中ㆍ病風ㆍ病水ㆍ脉疏數, 爲七診. 《內經》

Translation영역

Yin full, yang full, cold and heat, heat in the centre, illness of wind, illness of water, and a pulse now sparse now rapid: these are the seven examinations.

Clinical note임상 주석

The seven examinations named, after six passages that each assign one of them an hour of death. The hours are the scheme — yin illnesses killing at midnight, yang at noon — and they are not to be relied on; the pairing of a state with the hour of day at which it would prove fatal is an inference from the yin-yang cycle, not a record of deaths observed. The seventh is the exception and is worth keeping: a pulse that alternates unpredictably between sparse and rapid, slow and hurried. An irregularly irregular pulse in a seriously ill patient is a grave finding, and the Inner Classic lists it last and gives it no fixed hour, which is as much as to say that such a patient may die at any time.

Naegyeong 內經

2.16 The Signs of the Five Viscera and of Yin and Yang Being Cut Off 五臟及陰陽絶候

2.16.1

Source원문

脉浮而洪, 身汗如油, 喘而不休, 水漿不下, 體形不仁, 乍靜乍亂, 此爲命絶也.

Translation영역

A pulse floating and surging, the body sweating like oil, panting that does not let up, neither water nor gruel going down, the body numb and insensible, now still and now thrown into disorder: this is life cut off.

Clinical note임상 주석

The general picture of a dying patient, given before the five viscera are taken one by one. Every item in it is a sign a clinician would still record at a deathbed: a bounding pulse, clammy sweat that will not dry, unrelieved breathlessness, inability to swallow, loss of responsiveness, and fluctuating consciousness. 汗如油, sweat like oil, is the term the tradition keeps for the thick cold sweat of a failing circulation, and the chapter uses it again as 油汗 in the gloss at the spleen below.

Junggyeong 仲景

2.16.2

Source원문

又未知何藏先受其災. 若汗出髮潤ㆍ喘不休者, 此爲肺先絶也.

Translation영역

Again, it is not yet known which viscus received the calamity first. If there is sweating with the hair damp and panting that does not let up, this is the lung cut off first.

Junggyeong 仲景

2.16.3

Source원문

陽反獨留, 形體如烟熏, 直視摇頭者, 此爲心絶也.

Translation영역

Where the yang is left alone in its turn, the body as though smoke-blackened, with a fixed stare and the head rocking, this is the heart cut off.

Junggyeong 仲景

2.16.4

Source원문

唇吻反靑, 四肢漐習汗出者, 此爲肝絶也漐習者爲振動, 若搐搦, 手與足時時引縮也.

Translation영역

Where the lips turn blue-green and the four limbs twitch and sweat, this is the liver cut offjipseup means trembling, as in clonic spasm, the hands and feet drawing in and shortening from time to time.

Clinical note임상 주석

Blue lips with twitching of the limbs and sweating, glossed in the base text itself as a clonic movement in which the hands and feet draw in. Cyanosis with myoclonic jerking is a recognizable terminal picture, seen in hypoxia and in metabolic failure, and the gloss is careful enough that the sign can be identified at this distance.

Junggyeong 仲景

2.16.5

Source원문

環口黧黑, 柔汗發黃者, 此爲脾絶也油汗, 粘汗也; 柔汗, 冷汗也.

Translation영역

Where the ring about the mouth is a dusky black and a soft sweat breaks out yellow, this is the spleen cut offoil sweat is a sticky sweat; soft sweat is a cold sweat.

Junggyeong 仲景

2.16.6

Source원문

溲便遺失, 狂言ㆍ目反直視者, 此爲腎絶也.

Translation영역

Where urine and stool are let go, with wild talk and the eyes turned up in a fixed stare, this is the kidney cut off.

Junggyeong 仲景

2.16.7

Source원문

又未知何藏陰陽前絶. 若陽氣前絶, 陰氣後竭者, 其人死, 身色必靑; 陰氣前絶, 陽氣後竭者, 其人死, 身色必赤, 腋下溫, 心下熱也. 《仲景》

Translation영역

Again, it is not yet known in which viscus the yin or the yang was cut off first. If the yang qi is cut off first and the yin qi is exhausted after, then when the person dies the colour of the body will certainly be blue-green; if the yin qi is cut off first and the yang qi is exhausted after, then when the person dies the colour of the body will certainly be red, with warmth under the armpits and heat below the heart.

Clinical note임상 주석

The last passage reads the body after death and infers the order in which yin and yang failed: a cyanotic body means the yang went first, a flushed body still warm in the axilla and epigastrium that the yin did. It is post-mortem inference rather than diagnosis, and it belongs to the same effort as the rest of the section — to say, of a death already happening or already over, which part of the body gave way first.

Junggyeong 仲景

2.17 Divining the Signs of Death in Miscellaneous Illnesses 雜病占死候

2.17.1

Source원문

欲愈之病目眥黃胃氣行也. 眼胞忽陷定知亡五藏絶也. 耳目口鼻黑色起入口, 十死七難當腎乘胃也. 面黃目靑酒亂頻, 邪風在胃衮其身木剋土也. 面黑目白命門敗, 困極八日死來侵神去也. 面色忽然望之靑, 進之如黑卒難當肝腎絶也. 面赤目白怕喘氣, 待過十日定存亡火剋金也. 黃黑白色起入目, 更兼口鼻有災殃水乘脾也. 面靑目黃中時死, 餘候須看兩日強木剋土也. 目無精光齒齦黑, 面白目黑亦災殃肺腎絶也. 口如魚口不能合脾絶, 氣出不返命飛揚肝腎絶也. 妄語錯亂及不語, 尸臭元知壽不高心絶. 人中盡滿兼背靑, 三日須知命必傾木剋土也. 兩頰顴赤心病久, 口張氣直命難停脾肺絶也. 足趺趾腫膝如斗, 十日須知難保守脾絶. 項筋舒展定知殂督脉絶也. 掌內無紋也不久心包絶也. 唇靑體冷及遺尿膀胱絶也. 背而飮食四日期肝絶. 手足爪甲皆靑黑, 更過八日定難醫肝腎絶也. 脊痛腰重反覆難, 此是骨絶五日看腎絶. 體重尿赤時不止, 肉絶六日便高拚脾絶. 手足甲靑呼罵多, 筋絶九日定難過肝絶. 髮直如麻半日死小腸絶. 尋衣語死十知麽心絶. 《脉訣》

Translation영역

An illness about to mend shows yellow at the canthusthe stomach qi is moving. When the eyelids suddenly sink in, know for certain the patient is lostthe five viscera are cut off. When a black colour rises at the ears, eyes, mouth and nose and enters the mouth, of ten who die seven could not be withstoodthe kidney is overriding the stomach. A yellow face with blue-green eyes and frequent drunken disorder: an evil wind is in the stomach and swathes the bodywood is restraining earth. A black face with white eyes means the gate of life has failed; at the utmost of exhaustion, in eight days death comes to invadethe spirit has departed. When the colour of the face suddenly looks blue-green from a distance and black as one comes near, the end is sudden and not to be withstoodliver and kidney are cut off. A red face with white eyes and a dread of breathing hard: wait ten days and survival is decidedfire is restraining metal. When yellow, black and white rise and enter the eyes, and the mouth and nose too are affected, there is calamitywater is overriding the spleen. A blue-green face with yellow eyes dies at midday; for the remaining signs one must watch two days morewood is restraining earth. Eyes without a glint of essence and black gums; a white face with black eyes is likewise calamitylung and kidney are cut off. A mouth like a fish's that cannot closethe spleen is cut off, and the qi going out and not returning, means life has flown awayliver and kidney are cut off. Raving, confusion and then no speech at all, with the stench of a corpse: it was known from the first that the life would not be longthe heart is cut off. The philtrum filled out and the back blue-green: in three days know that the life must fallwood is restraining earth. Both cheeks and cheekbones red with a long-standing heart illness, the mouth open and the breath running straight out: the life can hardly be heldspleen and lung are cut off. The instep and toes swollen and the knee like a bushel measure: in ten days know it can hardly be heldthe spleen is cut off. The sinews of the nape stretched out slack — know for certain the patient is gonethe governing vessel is cut off. No lines in the palm, and it will not be longthe pericardium is cut off. Blue-green lips, a cold body and incontinence of urinethe bladder is cut off. Turning the back on food and drink: four days is the termthe liver is cut off. Hands and feet with nails all blue-green and black: let eight days more pass and it is certainly beyond medicineliver and kidney are cut off. Pain in the spine and a heavy lumbus, hard to turn over: this is the bone cut off, and look to five daysthe kidney is cut off. A heavy body and red urine that does not stop: the flesh is cut off, and in six days the body is carried highthe spleen is cut off. Blue-green nails on hands and feet with much shouting and cursing: the sinews are cut off, and nine days will hardly be got throughthe liver is cut off. Hair standing straight like hemp: death in half a daythe small intestine is cut off. Groping at the clothes and talking of death — of ten, do you know one?the heart is cut off

Clinical note임상 주석

A mnemonic verse of the Maekgyeol, twenty-five couplets of seven characters, each with a small-character gloss assigning the sign to a viscus. It is the chapter's close and the least reliable thing in it: the day counts — three days, four, five, six, eight, nine, ten — are a scheme, not a record, and the glosses are five-phase attributions added after the fact. None of it should be used to tell a patient or a family how long is left. What survives inside the verse is a list of terminal signs that a modern clinician reads the same way. Sunken eyes; a dusky discolouration spreading from the nose and mouth; circumscribed malar flush in long-standing heart disease, with open-mouthed breathing; swelling of the instep and toes with a knee swollen like a measuring bushel; cold blue lips with incontinence; nails cyanosed on hands and feet; a mouth hanging open that cannot be closed; refusal of food and drink; and 尋衣 — picking and groping at the bedclothes, which is the terminal delirium every bedside manual since has described. The Bogam sets that one last, and the line it ends on is a question rather than a count. 目眥黃 at the head of the verse is the one favourable sign in the whole of it, and the gloss gives the reason: 胃氣行也, the stomach qi is moving. The chapter began with the four ways of examining and ends by asking the same question it asks at 2.10 and 2.13 — whether the patient is still being fed.

Maekgyeol 脉訣

About this translation 凡例

Base text: Donguibogam (東醫寶鑑, 1613 first edition), Miscellaneous Disorders, Volume 1, Examining Disease chapter. The Chinese text is collated against the Kyujanggak transcription of the 1613 edition; collation notes are given on the passages they concern. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.