Igaku Keigo (Kokun Iden) Digital Viewer

Medical literature is indeed vast, leaving no matter untreated.
Yet the essential purpose of medicine never departs from the single path of treating illness; it does not discuss matters outside the human body.
The causes of illness in the body vary endlessly, and no two people are alike. Thus, however extensive medical literature may be, it still seems incomplete.
This is because each person has a different inborn constitution, and each illness differs according to which of wind, cold and heat is primary and which is secondary.
When differences in constitution are added to differences in wind, cold and heat, disease presentations arise one after another without limit.

The body’s fluids are exhausted, and even what remains is pushed out by heat, attacking outward and pressing upward. Thus not a drop of moisture remains in the stomach; heat steams and fills the interior. Constipation and masses of dry stool therefore necessarily occur.
‘Tide’ means that when the tide rises, even the small channels along the seashore fill and overflow everywhere.
Tidal fever is similar: heat forcefully fills the intestines and stomach, and its overflowing momentum pushes bodily fluids outward, filling the space from outside the stomach to the skin’s surface.
Yet commentators, without investigating why this happens, explain it as heat arriving at a fixed time like the tides.
Some call it heat filling the entire body; others call it heat appearing from afternoon into the night.
They all interpret ‘tidal’ solely as a description of heat, overlooking the crucial point that this heat drives fluids upward and outward.
Hearing their arguments and reading their writings, one might think they distinguish fever, bodily heat, scorching heat and aversion to heat. Tested against actual illness, however, these distinctions are vague and lack a reliable basis.
For fever, bodily heat, scorching heat and aversion to heat also come and go and fill the whole body. What distinction, then, could differentiate them in actual illness? None can.
There are therefore occasional cases of tidal fever in which the upward-pressing fluids become primary and stomach heat becomes secondary.
This tidal fever must not be understood through heat alone.
The Yangming chapter of the Shanghan Lun says: in Yangming disease with tidal fever, loose stool, normal urination and persistent chest and hypochondriac fullness, Xiao Chai Hu Tang governs treatment.
Can such tidal fever be called heat arriving at a fixed time, or heat appearing from afternoon to night? No.
In this presentation, heat within the Yangming stomach pushes fluids into the chest and hypochondria and moves there together with those fluids.
The intestines, stomach and regions below are therefore at ease, without pathological heat. This is why the clause says ‘loose stool and normal urination.’
From this it is beyond doubt that tidal fever is stomach heat that pushes fluids upward and outward.
It also says, that…

[Continued from the preceding page.] Otherwise, one cannot be said to have fulfilled the physician’s proper aspiration.
Unless careful attention is paid to the clarity or roughness of the voice, coughing and retching, and varied changes in odor, it is difficult to distinguish favorable from unfavorable signs.
Students of medicine should apply themselves to this.
Discussion of Abdominal Signs (on abdominal examination)
Abdominal examination is a form of palpation, like pulse examination, and is central to the Four Examinations—observation, listening, questioning and palpation. It must therefore be investigated carefully.
It does not examine the abdomen alone. The chest, back, waist, shins, hands and feet are carefully pressed and stroked to observe the thickness and firmness of the flesh, and the dryness or luster and favorable or unfavorable appearance of the skin, thereby determining yin–yang and deficiency–excess.
Facing the patient, the physician first takes the pulse, observes complexion and tongue coating, listens to the voice and asks where suffering is felt. Then, sitting to the patient’s left, the physician first uses the right hand to press to either side of the central chest, then strokes and presses the left rib region, carefully examining each location with the palm from just above the breast to the lower hypochondrium. First assess the pulsation at xuli; its height, weakness or strength, and depth or shallowness distinguish primary and secondary roles of qi, blood and water, and yin–yang and deficiency–excess.
Examine the right side in the same manner.
After examining both sides of the chest and ribs, move the fingertips to the epigastrium. Gently press down the center of the chest several times to assess epigastric firmness or softness. Spread the fingers to either side and press beneath the ribs, sliding diagonally along the ribs from the xiphoid region to assess tension above, below and on both sides; obstruction, hardness, softness, strength and weakness; skin and flesh thickness; and the presence of scars. Return the fingers to the epigastrium, press down either side of the midline (Ren channel), and proceed by alternating pressure and downward movement to the center of the navel and both sides.
Then quietly focus the mind and assess the pulsation between the kidneys below the navel, regarded as a manifestation of vital force.
Next, press both flanks with the palms, as though embracing from the back… [Continues on the next page.]