灵枢经·本藏 Discourse on the Root Nature of the Viscera
黄帝问于歧伯曰：人之血气精神者，所以奉生而周于性命者也；经脉者，所以行血气而营阴阳、濡筋骨，利关节者也；卫气者，所以温分肉，充皮肤，肥腠理，司开阖者也；志意者，所以御精神，收魂魄，适寒温，和喜怒者也。是故血和则经脉流行，营复阴阳，筋骨劲强，关节清利矣；卫气和则分肉解利，皮肤调柔，腠理致密矣；志意和则精神专直，魂魄不散，悔怒不起，五藏不受邪矣；寒温和则六府化谷，风痹不作，经脉通利，肢节得安矣，此人之常平也。五藏者，所以藏精神血气魂魄者也；六府者，所以化水谷而行津液者也。此人之所以具受于天也，无愚智贤不肖，无以相倚也。然有其独尽天寿，而无邪僻之病，百年不衰，虽犯风雨卒寒大暑，犹有弗能害也；有其不离屏蔽室内，无怵惕之恐，然犹不免于病，何也？愿闻其故。
歧伯对曰：窘乎哉问也。五藏者，所以参天地，副阴阳，而运四时，化五节者也；五藏者，固有小大、高下、坚脆、端正、偏倾者，六府亦有小大、长短、厚薄、结直、缓急。凡此二十五者，各不同，或善或恶，或吉或凶，请言其方。
心小则安，邪弗能伤，易伤以忧；心大则忧，不能伤，易伤于邪。心高则满于肺中，悗而善忘，难开以言；心下，则藏外，易伤于寒，易恐以言。心坚，则藏安守固；心脆则善病消瘅热中。心端正，则和利难伤；心偏倾则操持不一，无守司也。
肺小，则少饮，不病喘喝；肺大则多饮，善病胸痹、喉痹、逆气。肺高，则上气，肩息咳；肺下则居贲迫肺，善胁下痛。肺坚则不病，咳上气；肺脆，则苦病消痹易伤。肺端正，则和利难伤；肺偏倾，则胸偏痛也。
肺小则藏安，无胁下之病；肝大则逼胃迫咽，迫咽则苦膈中，且胁下痛。肝高，则上支贲切，胁挽为息贲；肝下则逼胃胁下空，胁下空则易受邪。肝坚则藏安难伤；肝脆则善病消痹，易伤。肝端正，则和利难伤；肝偏倾，则胁下痛也。
脾小，则藏安，难伤于邪也；脾大，则苦凑䏚而痛，不能疾行。脾高，则䏚引季胁而痛；脾下则下归于大肠，下加于大肠，则藏苦受邪。脾坚，则藏安难伤；脾脆，则善病消痹易伤。脾端正，则和利难伤；脾偏倾，则善满善胀也。
肾小，则藏安难伤；肾大，则善病腰痛，不可以俛仰，易伤以邪。肾高，则苦背膂痛，不可以俛仰；肾下则腰尻痛，不可以俛仰，为狐疝。肾坚，则不病腰背痛；肾脆，则善病消瘅，易伤。肾端正，则和利难伤；肾偏倾，则苦腰尻痛也。凡此二十五变者，人之所苦常病。
黄帝曰：何以知其然也？歧伯曰：赤色小理者，心小；粗理者，心大。无𩩲𩨗者，心高；𩩲𩨗小、短、举者，心下。𩩲𩨗长者，心下坚；𩩲𩨗弱小以薄者，心脆。𩩲𩨗直下不举者，心端正；𩩲𩨗倚一方者，心偏倾也。
白色小理者，肺小；粗理者，肺大。巨肩反膺陷喉者，肺高；合腋张胁者，肺下。好肩背厚者，肺坚；肩背薄者，肺脆。背膺厚者，肺端正；胁偏疏者，肺偏倾也。
青色小理者，肝小；粗理者，肝大。广胸反骹者，肝高；合胁兔骹者，肝下。胸胁好者，肝坚；胁骨弱者，肝脆。膺腹好相得者，肝端正；胁骨偏举者，肝偏倾也。
黄色小理者，脾小；粗理者，脾大。揭唇者，脾高；唇下纵者，脾下。唇坚者，脾坚；唇大而不坚者，脾脆。唇上下好者，脾端正；唇偏举者，脾偏倾也。
黑色小理者，肾小；粗理者，肾大。高耳者，肾高；耳后陷者，肾下。耳坚者，肾坚；耳薄不坚者，肾脆。耳好前居牙车者，肾端正；耳偏高者，肾偏倾也。凡此诸变者，持则安，减则病也。
帝曰：善。然非余之所问也，愿闻人之有不可病者，至尽天寿，虽有深扰大恐，怵惕之志，犹不能减也，甚寒大热，不能伤也；其有不离屏蔽室内，又无怵惕之恐，然不免于病者，何也？愿闻其故。歧伯曰：五藏六府，邪之舍也，请言其故。五藏皆小者，少病，苦憔心，大愁扰；五藏皆大者，缓于事，难使以扰。五藏皆高者，好高举措；五藏皆下者，好出人下。五藏皆坚者，无病；五藏皆脆者，不离于病。五藏皆端正者，和利得人心；五藏皆偏倾者，邪心而善盗，不可以为人平，反复言语也。
黄帝曰：愿闻六府之应。歧伯答曰：肺合大肠，大肠者，皮其应；心合小肠，小肠者，脉其应；肝合胆，胆者，筋其应；脾合胃，胃者，肉其应；肾合三焦膀胱，三焦膀胱者，腠理毫毛其应。
黄帝曰：应之奈何？歧伯曰：肺应皮。皮厚者，大肠厚，皮薄者，大肠薄；皮缓，腹里大者，大肠大而长；皮急者，大肠急而短；皮滑者，大肠直；皮肉不相离者，大肠结。
心应脉，皮厚者，脉厚，脉厚者，小肠厚；皮薄者，脉薄，脉薄者，小肠薄；皮缓者，脉缓，脉缓者，小肠大而长；皮薄而脉冲小者，小肠小而短。诸阳经脉皆多纡屈者，小肠结。
脾应肉，肉䐃坚大者，胃厚；肉䐃么者，胃薄。肉䐃小而么者，胃不坚；肉膕不称身者，胃下，胃下者，下管约不利。肉脾不坚者，胃缓；肉䐃无小里累者，胃急。肉䐃多少里累者，胃结，胃结者，上管约不利也。
肝应爪，爪厚色黄者，胆厚；爪薄色红者，胆薄；爪坚色青者，胆急；爪濡色赤者，胆缓；爪直色白无约者，胆直；爪恶色黑多纹者，胆结也。
肾应骨，密理厚皮者，三焦膀胱厚；粗理薄皮者，三焦膀胱薄。疏腠理者，三焦膀胱缓；皮急而无毫毛者，三焦膀胱急。毫毛美而粗者，三焦膀胱直，稀毫毛者，三焦膀胱结也。
黄帝曰：厚薄美恶，皆有形，愿闻其所病。歧伯答曰：视其外应，以知其内藏，则知所病矣。
Huangdi asked Qibo, saying: 'The blood, qi, essence, and spirit of a person are what sustain life and circulate throughout one's nature and destiny. The channels are what move the blood and qi, nourish yin and yang, moisten the sinews and bones, and benefit the joints. The defensive qi is what warms the flesh between the muscles, fills out the skin, makes the interstices firm and full, and governs their opening and closing. The will and intent are what govern the essence and spirit, gather in the ethereal and corporeal souls, adapt to cold and warmth, and harmonize joy and anger. Therefore, when the blood is harmonious, the channels flow freely, nutritive qi restores yin and yang in proper balance, the sinews and bones are strong and vigorous, and the joints move clearly and smoothly. When the defensive qi is harmonious, the flesh between the muscles is loose and free, the skin is well-regulated and supple, and the interstices are close and dense. When the will and intent are harmonious, the essence and spirit are focused and upright, the ethereal and corporeal souls do not scatter, regret and anger do not arise, and the five viscera do not receive evil qi. When cold and warmth are harmonious, the six bowels transform the grain properly, wind impediment does not arise, the channels flow freely and smoothly, and the limbs and joints find peace. This is the ordinary state of balance in a person. The five viscera are what store the essence, spirit, blood, qi, and the ethereal and corporeal souls. The six bowels are what transform water and grain and move the body fluids along. These are the endowments that every person alike receives from Heaven, whether foolish or wise, worthy or unworthy, with no difference to favor one over another. And yet there are those who alone live out their full heavenly span, free of evil and deviant illness, undiminished after a hundred years, so that even when they encounter wind and rain, sudden cold, or extreme heat, none of these are able to harm them; while there are others who never leave the shelter and shade of their own rooms, free from any apprehension or fright, and yet still cannot escape illness. Why is this? I wish to hear the reason.'
Qibo replied: 'This is indeed a searching question. The five viscera are what participate with Heaven and Earth, correspond to yin and yang, set the four seasons in motion, and transform the five periods. The five viscera themselves inherently differ in being small or large, high or low in position, hard or brittle, upright or tilted; and the six bowels likewise differ in being small or large, long or short, thick or thin, coiled or straight, slack or tense. In all, these are twenty-five distinct variations, each different from the others — some favorable, some unfavorable, some auspicious, some inauspicious. Allow me to explain their particulars.'
When the heart is small, it is at ease, and evil qi cannot injure it, though it is easily injured by worry. When the heart is large, worry cannot injure it, but it is easily injured by evil qi. When the heart is positioned high, it presses full against the lung, causing oppression and forgetfulness, and such a person is difficult to move with words. When the heart is positioned low, the viscus lies exposed toward the exterior, easily injured by cold, and such a person is easily frightened by words. When the heart is firm, the viscus is secure and well-guarded. When the heart is brittle, one is prone to wasting-thirst and heat in the middle. When the heart is upright and centered, it is harmonious and smooth, and difficult to injure. When the heart is tilted to one side, one's conduct lacks consistency, with no proper self-governance.
When the lung is small, one drinks little and does not suffer panting and wheezing. When the lung is large, one drinks much, and is prone to chest impediment, throat impediment, and rebellious qi. When the lung is positioned high, qi rises upward, causing labored breathing with the shoulders heaving and coughing. When the lung is positioned low, it presses down against the diaphragm and crowds the lung itself, and one is prone to pain beneath the rib-side. When the lung is firm, one does not suffer illness — apart from cough with rising qi. When the lung is brittle, one suffers from wasting-thirst and impediment and is easily injured. When the lung is upright and centered, it is harmonious and smooth, and difficult to injure. When the lung is tilted to one side, one suffers pain on one side of the chest.
When the liver is small, the viscus is secure, and there is no disease beneath the rib-side. When the liver is large, it presses upon the stomach and crowds against the throat; crowding the throat causes distress within the diaphragm, together with pain beneath the rib-side. When the liver is positioned high, it presses upward and cuts against the diaphragm, and the rib-side is drawn taut, producing 'panting mass.' When the liver is positioned low, it presses upon the stomach, leaving the region beneath the rib-side empty and hollow; when this region is hollow, it is easily invaded by evil qi. When the liver is firm, the viscus is secure and difficult to injure. When the liver is brittle, one is prone to wasting-thirst and impediment, and is easily injured. When the liver is upright and centered, it is harmonious and smooth, and difficult to injure. When the liver is tilted to one side, one suffers pain beneath the rib-side.
When the spleen is small, the viscus is secure and difficult to injure with evil qi. When the spleen is large, one suffers pain from crowding at the soft flank, and cannot walk quickly. When the spleen is positioned high, the soft flank draws upon the free ribs and causes pain. When the spleen is positioned low, it descends and presses down toward the large intestine; pressing down upon the large intestine, the viscus readily receives evil qi. When the spleen is firm, the viscus is secure and difficult to injure. When the spleen is brittle, one is prone to wasting-thirst and impediment, and is easily injured. When the spleen is upright and centered, it is harmonious and smooth, and difficult to injure. When the spleen is tilted to one side, one is prone to fullness and distension.
When the kidney is small, the viscus is secure and difficult to injure. When the kidney is large, one is prone to lower back pain, unable to bend forward or backward, and easily injured by evil qi. When the kidney is positioned high, one suffers pain along the back and spine, unable to bend forward or backward. When the kidney is positioned low, one suffers pain in the lower back and sacrum, unable to bend forward or backward, and develops fox-mounting hernia. When the kidney is firm, one does not suffer pain in the lower back. When the kidney is brittle, one is prone to wasting-thirst, and is easily injured. When the kidney is upright and centered, it is harmonious and smooth, and difficult to injure. When the kidney is tilted to one side, one suffers pain in the lower back and sacrum. In all, these twenty-five variations are the recurring afflictions that trouble people.
Huangdi said: 'How can one know this?' Qibo said: 'One whose complexion is red and whose skin texture is fine has a small heart; one whose texture is coarse has a large heart. One who lacks a xiphoid process has a heart positioned high; one whose xiphoid process is small, short, and raised has a heart positioned low. One whose xiphoid process is long has a firm heart; one whose xiphoid process is weak, small, and thin has a brittle heart. One whose xiphoid process extends straight down without being raised has an upright, centered heart; one whose xiphoid process leans to one side has a heart tilted to one side.'
One whose complexion is white and whose skin texture is fine has a small lung; one whose texture is coarse has a large lung. One with broad shoulders, a projecting chest, and a sunken throat has a lung positioned high; one whose armpits are drawn close and whose rib-sides are spread wide has a lung positioned low. One with well-formed shoulders and back, thick and full, has a firm lung; one whose shoulders and back are thin has a brittle lung. One whose back and chest are thick has an upright, centered lung; one whose rib-sides are uneven and loosely formed has a lung tilted to one side.
One whose complexion is green-blue and whose skin texture is fine has a small liver; one whose texture is coarse has a large liver. One with a broad chest and flaring lower ribs has a liver positioned high; one whose rib-sides are drawn close with narrow, rabbit-like lower ribs has a liver positioned low. One whose chest and rib-sides are well-formed has a firm liver; one whose rib bones are weak has a brittle liver. One whose chest and abdomen are well-proportioned and matched has an upright, centered liver; one whose rib bones are raised unevenly to one side has a liver tilted to one side.
One whose complexion is yellow and whose skin texture is fine has a small spleen; one whose texture is coarse has a large spleen. One whose lips are raised and everted has a spleen positioned high; one whose lower lip hangs loose has a spleen positioned low. One whose lips are firm has a firm spleen; one whose lips are large but not firm has a brittle spleen. One whose upper and lower lips are well-matched has an upright, centered spleen; one whose lips are raised unevenly to one side has a spleen tilted to one side.
One whose complexion is black and whose skin texture is fine has a small kidney; one whose texture is coarse has a large kidney. One with high-set ears has a kidney positioned high; one whose ears are sunken behind has a kidney positioned low. One whose ears are firm has a firm kidney; one whose ears are thin and not firm has a brittle kidney. One whose ears are well-formed and set forward near the jaw has an upright, centered kidney; one whose ears are set unevenly high has a kidney tilted to one side. In all these various conditions, when the corresponding feature is well-maintained, the person is at ease; when it is diminished or deficient, illness results.
Huangdi said: 'Excellent. But this is not what I originally asked. I wish to hear about those people who cannot be made ill — who live out their full heavenly span, and even when deeply disturbed or greatly frightened, their resolve cannot be diminished, and even severe cold or extreme heat cannot harm them — as well as about those who never leave the shelter of their own rooms and have no apprehension or fright, and yet still cannot escape illness. Why is this? I wish to hear the reason.' Qibo said: 'The five viscera and six bowels are the lodging places of evil qi — allow me to explain the reason. When all five viscera are small, one has little illness but suffers from an anxious, troubled heart and great worry and disturbance. When all five viscera are large, one is slow to attend to affairs and difficult to disturb or trouble. When all five viscera are positioned high, one is inclined to lofty ambition and grand undertakings. When all five viscera are positioned low, one is inclined to place oneself below others. When all five viscera are firm, one has no illness. When all five viscera are brittle, one is never free of illness. When all five viscera are upright and centered, one is harmonious and agreeable and wins the hearts of others. When all five viscera are tilted to one side, one harbors a deceitful heart and is inclined to thieving, cannot deal fairly with others, and is inconsistent and duplicitous in speech.'
Huangdi said: 'I wish to hear of the correspondences of the six bowels.' Qibo answered: 'The lung is paired with the large intestine, and the large intestine corresponds to the skin. The heart is paired with the small intestine, and the small intestine corresponds to the vessels. The liver is paired with the gallbladder, and the gallbladder corresponds to the sinews. The spleen is paired with the stomach, and the stomach corresponds to the flesh. The kidney is paired with the triple burner and bladder, and the triple burner and bladder correspond to the interstices and fine body hair.'
Huangdi said: 'How does this correspondence work?' Qibo said: 'The lung corresponds to the skin. When the skin is thick, the large intestine is thick; when the skin is thin, the large intestine is thin. When the skin is loose and the abdomen is large within, the large intestine is large and long. When the skin is tight, the large intestine is tight and short. When the skin is smooth, the large intestine is straight. When the skin and flesh do not separate easily from each other, the large intestine is knotted.'
The heart corresponds to the vessels. When the skin is thick, the vessels are thick, and when the vessels are thick, the small intestine is thick. When the skin is thin, the vessels are thin, and when the vessels are thin, the small intestine is thin. When the skin is loose, the vessels are loose, and when the vessels are loose, the small intestine is large and long. When the skin is thin and the pulsing vessels are small, the small intestine is small and short. When the yang channel vessels are all markedly winding and tortuous, the small intestine is knotted.
The spleen corresponds to the flesh. When the muscular flesh is firm and full, the stomach is thick; when the muscular flesh is slight, the stomach is thin. When the muscular flesh is small and slight, the stomach is not firm. When the flesh does not match the body in proportion, the stomach is positioned low, and when the stomach is low, the lower duct is constricted and does not function smoothly. When the flesh is not firm, the stomach is slack. When the muscular flesh lacks small knotted masses within, the stomach is tight. When the muscular flesh has a moderate number of small knotted masses within, the stomach is knotted, and when the stomach is knotted, the upper duct is constricted and does not function smoothly.
The liver corresponds to the nails. When the nails are thick and yellow in color, the gallbladder is thick. When the nails are thin and red in color, the gallbladder is thin. When the nails are firm and green-blue in color, the gallbladder is tight. When the nails are soft and red in color, the gallbladder is slack. When the nails are straight and white in color without curvature, the gallbladder is straight. When the nails are poorly formed, black in color, with many ridges, the gallbladder is knotted.
The kidney corresponds to the bones. When the skin texture is dense and the skin is thick, the triple burner and bladder are thick; when the skin texture is coarse and the skin is thin, the triple burner and bladder are thin. When the interstices are loose, the triple burner and bladder are slack. When the skin is tight and lacks fine body hair, the triple burner and bladder are tight. When the fine body hair is fine yet full, the triple burner and bladder are straight. When the fine body hair is sparse, the triple burner and bladder are knotted.
Huangdi said: 'Thickness and thinness, fine form and poor form, all have their outward manifestations. I wish to hear of the illnesses associated with each.' Qibo answered: 'By observing the outward correspondence, one comes to know the condition of the inner viscus, and thus one knows what illness will occur.'