歧伯曰：四支皆稟氣於胃，而不得至經。必因於脾，乃得禀也。
歧伯曰：四支皆禀气于胃，而不得至经。必因于脾，乃得禀也。
Qí bó yuē: sì zhī jiē bǐng qì yú wèi, ér bù dé zhì jīng.Bì yīn yú pí, nǎi dé bǐng yě.
Qibo says: the four limbs all receive their qi from the stomach, but it does not reach the channels by itself. It must depend on the spleen before they can obtain it.
此二句答「脾病而四支不用」之問，是全篇論脾之第一義。**「稟」讀 bǐng，受也、承也**；**底本「稟」三見、「禀」一見，同篇並見**，二字通用而筆畫微異，各從底本照錄——此處作「稟」，下句作「禀」，是本篇「同篇異形」最整齊之一例。「皆」讀 jiē；「得」讀 dé；「於」讀 yú；「而」讀 ér；「至」讀 zhì；「經」讀 jīng；「必」讀 bì；「因」讀 yīn；「乃」讀 nǎi。「不得至經」四字最要：胃之氣不能自達於四支之經脉，必待脾之轉輸而後至，故下文曰「今脾病不能爲胃行其津液」，是本篇「脾為胃行其津液」之說所本。
歧伯曰：四支者，諸陽之本也，陽盛則四支實，實則能登高也。
歧伯曰：四支者，诸阳之本也，阳盛则四支实，实则能登高也。
Qí bó yuē: sì zhī zhě, zhū yáng zhī běn yě, yáng shèng zé sì zhī shí, shí zé néng dēng gāo yě.
Qibo says: the four limbs are the root of all the yang. When yang is exuberant the four limbs become full, and being full they are able to climb high.
「四支」之目於本站已立（本篇二見），本篇獨標其為「諸陽之本」：「四支者，諸陽之本也，陽盛則四支實，實則能登高也」。**「四」讀 sì，本篇二見**；**「支」讀 zhī，本篇二見，底本作「支」，不作「肢」**——《內經》言四肢多作「四支」，「肢」為後起之形，本站各篇皆從底本作「支」。「歧」讀 qí；「伯」讀 bó；「曰」讀 yuē；「者」讀 zhě；「陽」讀 yáng；「之」讀 zhī；**「本」讀 běn，根本也**；「也」讀 yě；**「盛」讀 shèng，本篇四見**；「則」讀 zé；**「實」讀 shí，本篇二見，底本作「實」，不作「实」**——此處「實」謂充實有力，與「虚實」之實同名而取義稍別；「能」讀 néng；「登」讀 dēng；「高」讀 gāo。**此句與第二十九篇「四支皆稟氣於胃」義相表裏**：彼言四肢稟氣之源，此言四肢為諸陽之會，合觀則陽明與四肢之關係益明——陽明多氣多血，故陽盛而四肢獨實，實則能為素所不能為。
四支者陽也。
四肢者阳也。
Sì zhī zhě yáng yě.
The four limbs are yang.
「四支」之目於本站已立（id 894），現收二條：第二十九篇「四支皆稟氣於胃，而不得至經，必因於脾，乃得禀也」言其所稟，第三十篇「四支者，諸陽之本也，陽盛則四支實，實則能登高也」言其屬陽。**本篇「四支者陽也」四字，與第三十篇若合符節而更為斬截**——「四」讀 sì，本篇 2 見；**「支」讀 zhī，本篇二見，皆作「四支」**——底本作「支」，**不作「肢」（「肢」）**；「四支」是先秦兩漢之常語，「四肢」為後起之專字；「者」讀 zhě，本篇 25 見；「陽」讀 yáng，本篇 13 見；「也」讀 yě，本篇 31 見。**四字自成一句，是本篇最短之句，而為下文「兩陽相得」立基**：四支屬陽，人身之陽亦屬陽，二者相加是為「兩陽」；**陽既兩合而陰又虚少，故曰「少水不能滅盛火，而陽獨治」**——本段一句四字，實為全節推論之第一前提。**與第三十篇對讀最見字法**：彼作「四支者，諸陽之本也」，此作「四支者陽也」，**省「諸陽之本」四字而徑斷之曰「陽」**——義同而辭益峻，讀者勿以辭之繁簡疑其義之有別。**與第二十九篇對讀又見其分**：彼言四支稟氣於胃而必因於脾（**言其生**），此言四支屬陽（**言其性**）；一生一性，合之乃知四支之所以為四支。與本篇第五段「人有四支熱，逢風寒如炙如火者」合觀：**正以四支屬陽，故四支之熱為陽熱之尤甚者**。
帝曰：有病胸脅支滿者，妨於食，病至則先聞腥臊臭，出清液，先唾血，四支清，目眩，時時前後血，病名爲何？何以得之？
帝曰：有病胸胁支满者，妨于食，病至则先闻腥臊臭，出清液，先唾血，四肢清，目眩，时时前后血，病名为何？何以得之？
Dì yuē: yǒu bìng xiōng xié zhī mǎn zhě, fáng yú shí, bìng zhì zé xiān wén xīng sāo xiù, chū qīng yè, xiān tuò xuè, sì zhī qīng, mù xuàn, shí shí qián hòu xuè, bìng míng wéi hé? hé yǐ dé zhī?
The Emperor says: there is an illness in which the chest and flanks are propped full, so that eating is hindered; when the illness comes on one first smells a fishy, rank odour, brings up clear fluid, then spits blood; the four limbs are cold, the eyes are dazzled, and there is blood from time to time in front and behind. What is the illness named? How is it got?
**「四支清」之「支」，寫四肢之肢**，**本篇「支」2見，皆讀 zhī**——**「胸脅支滿」之支是撐拄之義，此一「支」乃手足之肢，同形而異義**。「四」讀 sì、**本篇2見**（四支、四烏鰂骨）；「清」讀 qīng，**本篇2見**（出清液、四支清）——**一出清液、一四支清，同一「清」字而一為液、一為涼**；「目」讀 mù；「眩」讀 xuàn；「時」讀 shí，**本篇6見**；「前」讀 qián；「後」讀 hòu，**本篇2見**（前後血、後飯）。**血枯之證自上而下**：**先聞腥臊臭、出清液、先唾血（上），四支清（外），目眩（上），時時前後血（下）**——**四支清冷與前後下血並見，是上下俱不足之象**。
脾風之狀，多汗惡風，身體怠墯，四支不欲動，色薄微黄，不嗜食，診在鼻上，其色黄。
脾风之状，多汗恶风，身体怠墯，四支不欲动，色薄微黄，不嗜食，诊在鼻上，其色黄。
Pí fēng zhī zhuàng, duō hàn wù fēng, shēn tǐ dài duò, sì zhī bù yù dòng, sè bó wēi huáng, bù shì shí, zhěn zài bí shàng, qí sè huáng.
In spleen wind the patient sweats freely and loathes wind; the body is heavy and slack, the four limbs do not want to move; the colour is thin and faintly yellow and there is no desire for food. It is diagnosed on the nose, and the colour is yellow.
「身體怠墯，四支不欲動」——**本篇「四支」1見，即此**；**脾風而四支不欲動，與第二十九篇「四支不得稟氣於胃」之義相發**。「支」讀 zhī**本篇作「支」，不作「肢」**；「怠」讀 dài、「墯」讀 duò**「怠墯」讀 dài duò**；「身」讀 shēn、「體」讀 tǐ**「身體」讀 shēn tǐ**。
凡痺之客五藏者，肺痺者，煩滿喘而嘔；心痺者，脉不通，煩則心下鼓，暴上氣而喘，嗌乾善噫，厥氣上則恐；肝痺者，夜卧則驚，多飲數小便，上爲引如懷；腎痺者，善脹，凥以代踵，脊以代頭；脾痺者，四支解墯，發欬嘔汁，上爲大塞；腸痺者，數飲而出不得，中氣喘爭，時發飱泄；胞痺者，少腹膀胱，按之内痛，若沃以湯，澀於小便，上爲清涕。
凡痹之客五脏者，肺痹者，烦满喘而呕；心痹者，脉不通，烦则心下鼓，暴上气而喘，嗌干善噫，厥气上则恐；肝痹者，夜卧则惊，多饮数小便，上为引如怀；肾痹者，善胀，凥以代踵，脊以代头；脾痹者，四肢解惰，发咳呕汁，上为大塞；肠痹者，数饮而出不得，中气喘争，时发飧泄；胞痹者，少腹膀胱，按之内痛，若沃以汤，涩于小便，上为清涕。
Fán bì zhī kè wǔ zàng zhě, fèi bì zhě, fán mǎn chuǎn ér ǒu; xīn bì zhě, mài bù tōng, fán zé xīn xià gǔ, bào shàng qì ér chuǎn, yì gān shàn ài, jué qì shàng zé kǒng; gān bì zhě, yè wò zé jīng, duō yǐn shuò xiǎo biàn, shàng wéi yǐn rú huái; shèn bì zhě, shàn zhàng, jū yǐ dài zhǒng, jǐ yǐ dài tóu; pí bì zhě, sì zhī jiě duò, fā kài ǒu zhī, shàng wéi dà sè; cháng bì zhě, shuò yǐn ér chū bù dé, zhōng qì chuǎn zhēng, shí fā sūn xiè; bāo bì zhě, shào fù páng guāng, àn zhī nèi tòng, ruò wò yǐ tāng, sè yú xiǎo biàn, shàng wéi qīng tì.
For obstruction lodging in the five stores: lung obstruction is fullness and distress, panting and vomiting; heart obstruction is the vessels not passing through — distress brings a beating below the heart, sudden rising qi and panting, a dry pharynx and frequent belching, and when the counterflow qi rises, fear; liver obstruction is starting in the night, drinking much and passing water often, with a drawing upward that feels like carrying a child; kidney obstruction is a readiness to swell, the rump taking the place of the heel and the spine taking the place of the head; spleen obstruction is slackness of the four limbs, coughing and vomiting fluid, and great stoppage above; intestinal obstruction is drinking often and yet not passing it, the central qi contending with panting, and from time to time outflow diarrhea; bladder obstruction is pain within the lower abdomen and bladder when pressed, as though hot water had been poured in, rough passage of urine, and clear snivel above.
「四支解墯」——**本篇「四支」1見**；「支」讀 zhī，**底本作「支」不作「肢」**；「解」讀 jiě、「墯」讀 duò，**解墯讀 jiě duò，懈惰也**，**與 ch16、ch42「四支解墯」同例**——**「墯」从底本，不作「惰」**；**脾主四支，故脾痺見此**。
陰氣虚則陽氣入，陽氣入則胃不和，胃不和則精氣竭，精氣竭則不營其四支也。
阴气虚则阳气入，阳气入则胃不和，胃不和则精气竭，精气竭则不营其四支也。
Yīn qì xū zé yáng qì rù, yáng qì rù zé wèi bù hé, wèi bù hé zé jīng qì jié, jīng qì jié zé bù yíng qí sì zhī yě.
When yin qi is empty yang qi enters; once yang qi enters, the stomach is disordered; once the stomach is disordered, the essence qi is exhausted; and once that is exhausted, the four limbs are not nourished.
「精氣竭則不營其四支也」——**本篇「四支」惟此一見，不作「四肢」**；「竭」讀 jié、**竭讀 jié**；**「支」讀 zhī，與下文「支滿」之支同字**。
歧伯曰：頭上五行，行五者，以越諸陽之熱逆也；大杼、膺俞、缺盆、背俞，此八者，以冩胸中之熱也；氣街、三里、巨虚、上下廉，此八者，以冩胃中之熱也；雲門、髃骨、委中、髓空，此八者，以冩四支之熱也；五藏俞傍五，此十者，以冩五藏之熱也；凡此五十九穴者，皆熱之左右也。
歧伯曰：头上五行，行五者，以越诸阳之热逆也；大杼、膺俞、缺盆、背俞，此八者，以写胸中之热也；气街、三里、巨虚、上下廉，此八者，以写胃中之热也；云门、髃骨、委中、髓空，此八者，以写四支之热也；五藏俞傍五，此十者，以写五藏之热也；凡此五十九穴者，皆热之左右也。
Qí bó yuē: tóu shàng wǔ háng, háng wǔ zhě, yǐ yuè zhū yáng zhī rè nì yě; dà zhù, yīng shù, quē pén, bèi shù, cǐ bā zhě, yǐ xiè xiōng zhōng zhī rè yě; qì jiē, sān lǐ, jù xū, shàng xià lián, cǐ bā zhě, yǐ xiè wèi zhōng zhī rè yě; yún mén, yú gǔ, wěi zhōng, suǐ kōng, cǐ bā zhě, yǐ xiè sì zhī zhī rè yě; wǔ zàng shù bàng wǔ, cǐ shí zhě, yǐ xiè wǔ zàng zhī rè yě; fán cǐ wǔ shí jiǔ xué zhě, jiē rè zhī zuǒ yòu yě.
Qi Bo says: five rows on the head, five points to a row, serve to let out the hot counterflow of all the yang. Great Shuttle, the transport points at the chest, Empty Basin and the back transport points – these eight – drain the heat in the chest. Qi Street, Three Li, the great hollows and the upper and lower border – these eight – drain the heat in the stomach. Cloud Gate, the shoulder bone, the bend in the middle and the marrow opening – these eight – drain the heat of the four limbs. Five beside the transport points of the five depots – these ten – drain the heat of the five depots. All fifty-nine of these points are what stands to either side of the heat.
「以冩「四」讀 sì「支」讀 zhī之熱也」——**「四支」本篇1見，謂手足**；**寫胸中之熱、寫胃中之熱、寫四支之熱、寫五藏之熱四項，凡五十九穴**；**「冩」讀 xiè，即「寫」之俗省，本篇5見**
歧伯曰：形有餘則腹脹，涇溲不利；不足則四支不用。血氣未并，五藏安定，肌肉蠕動，命曰微風。
歧伯曰：形有余则腹胀，泾溲不利；不足则四支不用。血气未并，五藏安定，肌肉蠕动，命曰微风。
Qí bó yuē: xíng yǒu yú zé fù zhàng, jīng sōu bù lì; bù zú zé sì zhī bù yòng. Xuè qì wèi bìng, wǔ zàng ān dìng, jī ròu rú dòng, mìng yuē wēi fēng.
Qi Bo says: when the body is in excess there is swelling of the belly and the stools and urine do not pass freely; when it is insufficient the four limbs cannot be used. If blood and qi have not pooled and the five depots are settled, and the flesh only faintly stirs, this is called faint wind.
「形有餘則腹脹，涇溲不利；不足則四支不用」——**「四支」本篇2見**：**一在開篇「人有精氣津液，四支、九竅」，與九竅對舉，是人身之形**；**一在「不足則四支不用」，是形不足之證**；**「支」讀 zhī，與「肢」同**
土不及，四維有埃雲潤澤之化，則春有鳴條鼓拆之政；四維發振拉飄騰之變，則秋有肅殺霖霪之復。其眚四維，其藏脾，其病内舍心腹，外在肌肉四支。
土不及，四维有埃云润泽之化，则春有鸣条鼓拆之政；四维发振拉飘腾之变，则秋有肃杀霖霪之复。其眚四维，其藏脾，其病内舍心腹，外在肌肉四支。
Tǔ bù jí, sì wéi yǒu āi yún rùn zé zhī huà, zé chūn yǒu míng tiáo gǔ chāi zhī zhèng; sì wéi fā zhèn lā piāo téng zhī biàn, zé qiū yǒu sù shā lín yín zhī fù. Qí shěng sì wéi, qí zàng pí, qí bìng nèi shè xīn fù, wài zài jī ròu sì zhī.
When earth falls short, if the four corners have the transformation of dusty clouds that moisten and enrich, then spring has the governance of sounding branches and the splitting open of the buds; if the four corners give out the change of shaking, snapping, whirling and rising, then autumn has the revenge of severity and killing and long soaking rain. Its calamity is in the four corners, its viscus is the spleen, and its illness lodges within in the heart and abdomen and shows without in the flesh and the four limbs.
「其眚四維，其藏脾，其病内舍心腹，外在肌肉四支」——**「四支」本篇2見：此一見、「四支不舉」一見**；**本篇五方之「外在」凡五：關節、經絡、肌肉四支、皮毛、谿谷踹膝，四支在中央脾一部**；**底本作「支」，不从「肢」；「四」讀 sì、「支」讀 zhī**
故春氣者，病在頭；夏氣者，病在藏；秋氣者，病在肩背；冬氣者，病在四支。
故春气者，病在头；夏气者，病在藏；秋气者，病在肩背；冬气者，病在四支。
gù chūn qì zhě, bìng zài tóu; xià qì zhě, bìng zài zàng; qiū qì zhě, bìng zài jiān bèi; dōng qì zhě, bìng zài sì zhī.
Thus the qi of spring brings disease in the head; the qi of summer, disease in the viscera; the qi of autumn, disease in the shoulder and back; the qi of winter, disease in the four limbs.
「冬氣者，病在四支」——春在頭，夏在藏，秋在肩背，冬在四支；**「四支」本篇1見**
故清陽爲天，濁陰爲地。地氣上爲雲，天氣下爲雨，雨出地氣，雲出天氣。故清陽出上竅，濁陰出下竅。清陽發腠理，濁陰走五藏；清陽實四支，濁陰歸六府。
故清阳为天，浊阴为地。地气上为云，天气下为雨，雨出地气，云出天气。故清阳出上窍，浊阴出下窍。清阳发腠理，浊阴走五藏；清阳实四支，浊阴归六府。
gù qīng yáng wéi tiān, zhuó yīn wéi dì. dì qì shàng wéi yún, tiān qì xià wéi yǔ, yǔ chū dì qì, yún chū tiān qì. gù qīng yáng chū shàng qiào, zhuó yīn chū xià qiào. qīng yáng fā còu lǐ, zhuó yīn zǒu wǔ zàng; qīng yáng shí sì zhī, zhuó yīn guī liù fǔ.
Thus clear yang is heaven and turbid yin is earth. Earth qi rising becomes cloud; heaven qi descending becomes rain. Rain issues from earth qi, cloud from heaven qi. Therefore clear yang exits by the upper orifices, turbid yin by the lower orifices. Clear yang spreads through the interstices, turbid yin travels to the five viscera; clear yang fills the four limbs, turbid yin returns to the six bowels.
「清陽實四支」——清陽充實四支，濁陰歸於六府；**「四支」本篇1見**
三陽三陰發病，爲偏枯痿易，四支不舉。
三阳三阴发病，为偏枯痿易，四支不举。
sān yáng sān yīn fā bìng, wéi piān kū wěi yì, sì zhī bù jǔ.
When the third yang and the third yin are diseased together, it becomes one-sided wasting and flaccid weakness, and the four limbs cannot be raised.
「四支不舉」——三陽三陰俱病，為偏枯、痿易而四肢不能舉；底本作「支」，支、肢古今字；**「四支」本篇2見**
帝曰：夫子言脾爲孤藏，中央土以灌四傍，其太過與不及，其病皆何如？歧伯曰：太過則令人四支不舉，其不及則令人九竅不通，名曰重強。
帝曰：夫子言脾为孤藏，中央土以灌四傍，其太过与不及，其病皆何如？歧伯曰：太过则令人四支不举，其不及则令人九窍不通，名曰重强。
Dì yuē: fū zǐ yán pí wéi gū zàng, zhōng yāng tǔ yǐ guàn sì bàng, qí tài guò yǔ bù jí, qí bìng jiē hé rú? Qí bó yuē: tài guò zé lìng rén sì zhī bù jǔ, qí bù jí zé lìng rén jiǔ qiào bù tōng, míng yuē chóng qiáng.
Excess makes the four limbs unable to lift; deficiency makes the nine orifices fail to communicate. It is called doubled rigidity.
「四支不舉」，脾脉太過則令人四支不舉。支即肢，四支稟氣於胃而脾為之行，脾病則四支不用。
敦阜之紀，是謂廣化，厚德清靜，順長以盈，至陰内實，物化充成，煙埃朦鬱，見於厚土，大雨時行，濕氣乃用，燥政乃辟，其化圓，其氣豐，其政靜，其令周備，其動濡積并蓄，其德柔潤重淖，其變震驚、飄驟、崩潰，其榖稷、麻，其畜牛、犬，其果棗、李，其色黅、𤣥、蒼，其味甘、鹹、酸，其象長夏，其經足太陰、陽明，其藏脾、腎，其蟲倮毛，其物肌核，其病腹滿，四支不舉，大風迅至，邪傷脾也。
敦阜之纪，是谓广化，厚德清静，顺长以盈，至阴内实，物化充成，烟埃朦郁，见于厚土，大雨时行，湿气乃用，燥政乃辟，其化圆，其气丰，其政静，其令周备，其动濡积并蓄，其德柔润重淖，其变震惊、飘骤、崩溃，其谷稷、麻，其畜牛、犬，其果枣、李，其色黅、𤣥、苍，其味甘、咸、酸，其象长夏，其经足太阴、阳明，其藏脾、肾，其虫倮毛，其物肌核，其病腹满，四支不举，大风迅至，邪伤脾也。
Dūn fù zhī jì, shì wèi guǎng huà, hòu dé qīng jìng, shùn zhǎng yǐ yíng, zhì yīn nèi shí, wù huà chōng chéng, yān āi méng yù, xiàn yú hòu tǔ, dà yǔ shí xíng, shī qì nǎi yòng, zào zhèng nǎi bì, qí huà yuán, qí qì fēng, qí zhèng jìng, qí lìng zhōu bèi, qí dòng rú jī bìng xù, qí dé róu rùn zhòng nào, qí biàn zhèn jīng, piāo zhòu, bēng kuì, qí gǔ jì, má, qí chù niú, quǎn, qí guǒ zǎo, lǐ, qí sè jīn, xuán, cāng, qí wèi gān, xián, suān, qí xiàng zhǎng xià, qí jīng zú tài yīn, yáng míng, qí zàng pí, shèn, qí chóng luǒ máo, qí wù jī hé, qí bìng fù mǎn, sì zhī bù jǔ, dà fēng xùn zhì, xié shāng pí yě.
The era of Mounded Height is called widened transformation: its thick virtue is clear and still, it follows growth and fills, the utmost yin is full within, and beings are transformed and brought to fullness; smoke and dust are murky and pent up and appear upon the thick earth; great rain moves in its season, the damp qi comes into use and the governance of dryness is turned aside. Its transformation round, its qi abundant, its governance still, its command complete all round, its movement dampness accumulating and gathering together, its virtue soft, moist, heavy and muddy, its change thunder-shaking, wind-driven rain and collapse, its grain panicled millet and hemp, its domestic animal the ox and the dog, its fruit the jujube and the plum, its colour yellow, black and blue-green, its flavour sweet, salty and sour, its image late summer, its channels the foot greater yin and yang brightness, its viscera the spleen and kidney, its creature the naked and the hairy, its thing flesh and pit, its illness abdominal fullness and limbs that cannot be raised. A great wind comes swiftly and evil injures the spleen.
**「四支」本篇1見，止在敦阜之紀「四支不舉」**；**土太過則腹滿而四支不舉，此五太過之病之一**