问曰脉有灾怪何谓也师曰假令人病脉得太阳与形证相应因为作汤比还送汤如食顷病患乃大吐下利腹中痛师曰我前来
不见此证今乃变易是名灾怪问曰缘何作此吐利答曰或有旧时服药今乃发作故为此灾怪耳
脉证无差而吐利忽作诚为怪异大抵药经人手容有别缘或者婢外家冤雠毒行暧昧事未可料也
太阳以寒水主令统领六经膀胱者太阳之腑太阳者膀胱之经六经之次三阴在里三阳在表太阳主皮毛之分次则阳明次则
少阳次则太阴少阴厥阴总以太阳为主阳盛于外在外之阳谓之卫气卫者卫外而为固也卫气之内则为营血营者营运而不息也
营司于肝为卫之根卫司于肺为营之叶营卫二气化于中宫饮食入胃游溢精气传输经络精专者行于脉中命曰营气 悍者行于
脉外命曰卫气营卫分司于金木而皆统于太阳故太阳经病有伤卫伤营之不同卫气为阳营血为阴然血升而化神魂是阴含阳也
故肝血温暖而升散气降而化精魄是阳含阴也故肺气清凉而降敛人之汗孔冬阖而夏开者以肝心主营木火旺于春夏则营血温
散而窍开肺肾主卫金水旺于秋冬则卫气清敛而窍阖寒去温来而木火不得发泄卫气敛闭而孔窍常阖袭之以风气欲敛而不能
敛故伤在卫气热退凉生而金水不得敛藏营血发散而孔窍常开侵之以寒血欲散而不能散故伤在营血风伤卫者因于气凉而窍
闭也寒伤营者因于天温而窍开也春夏而窍开则病寒而不病风秋冬而窍阖则病风而不病寒故秋冬寒盛而非不中风春夏风多
而亦有伤寒灵枢岁露四时八风之中人也故有寒暑寒则皮肤急而腠理闭暑则皮肤缓而腠理开因其开也其入深其病患也卒以
暴因其闭也其入浅其病患也徐以迟开则伤营闭则伤卫以营深而卫浅也风性疏泄而寒性闭塞气性收敛而血性发扬卫敛而窍
闭中风则气欲敛而风泄之是以有汗风愈泄而气愈欲敛故内遏营血而生里热营泄而窍开伤寒则血欲泄而寒束之是以无汗寒
愈束而血愈欲泄故外闭卫气而生表寒人之本气不郁则不盛郁则阳虚之人脏阴内盛而为寒阴虚之人经阳外盛而为热是传腑
传脏之由来也而其入腑入脏必先施于皮毛故六经之病总起于太阳一经以其在外而先伤也邪在营卫失于解散则或入于腑或
入于脏视其人之里气为分途阳衰则入太阴而为寒阴衰则入阳明而为热无异路也贵于营卫方病初治不瘥则后日诸变无自生
矣卫行脉外而内交于营营行脉中而外交于卫营卫调和是谓平人寒邪伤营则营血束闭其卫气故卫郁而生表寒风邪伤卫则
卫气遏闭其营血故营郁而生里热营卫外发则病解营卫内陷则病进陷而败没则死也伤寒中风之死证皆营卫之陷败也卫气之
外发赖乎经中之阳盛营血之外发赖于脏中之阴盛阳统于阳明阴统于太阴阳明之经气旺则卫气外发而汗出其阳虚者卫郁欲
发而不能则振栗战摇而后汗出其再虚者寒战而不见汗出是阳不胜阴卫气将陷当泄阴而扶阳开皮毛而发卫气太阴之经气旺
则营气外发而汗出其阴虚者营郁欲发而不能则烦躁怫郁而后汗出其更虚者躁闷而不见汗出是阴不胜阳营气将陷当泄阳以
扶阴开肌表而发营血阳盛于腑阴盛于脏卫气之陷者以其脏阴盛而内寒也营血之陷者以其腑阳盛而内热也太阳为六经之长
兼统营卫方其营卫初病外解经络内调脏腑使脏寒不动腑热不作异日无入脏入腑之患是善治太阳者也 太阳经病不过风寒
二者而已风用桂枝寒用麻黄风而兼寒寒而兼风则有桂麻各半之方风而火郁寒而水停则有大小青龙之制风寒已解而内燥则
有白虎清金之法风寒未透而内湿则有五苓利水之剂风寒外散血热里郁则有桃核承气抵当汤丸之设此皆太阳风寒之本病处
治之定法也人之本气不偏阳郁不至极热阴郁不至极寒本气稍偏病则阴盛而为寒阳盛而为热而以温凉补泄挽其气化之偏皆
可随药而愈不经误治断不至遂成坏病熟悉仲景太阳本病诸法则风寒之证解于太阳一经无复坏事已
问：脉象中所谓的“灾怪”是指什么？
老师回答说：假如一个人患病，脉象表现为太阳病，且症状与脉象相符，因此为他开具汤药。但在送药回去不久（约一顿饭的功夫），病人突然发生剧烈呕吐、腹泻，并伴有腹痛。老师说：“我先前诊察时并未见此证候，如今病情突然变化，这就叫做‘灾怪’。”
答：可能是病人以前服用的药物，到现在才发作，所以造成了这种看似怪异的情况。
脉象与证候原本没有差错，却突然发生吐利，确实显得怪异。大抵是因为药物经不同的人之手处理而有差异；或者是因为婢女、外家亲属或仇人暗中下毒，这种事难以预料。
太阳经以寒水之气主令，统领六经。膀胱是太阳的腑，太阳经是膀胱的经。在六经的次序中，三阴经位于体内，三阳经位于体表。太阳经主管皮毛之分，其次为阳明经，再次为少阳经，再其次是太阴经、少阴经和厥阴经，总体都以太阳经为主。
阳气旺盛于体表，体表的阳气称为卫气。“卫”意为护卫，具有固护体表的作用。卫气在内则化为营血。“营”意为营运，运行不息。营气由肝脏所司，是卫气的根本；卫气由肺脏所司，是营气的枝叶。营气和卫气化生于中焦脾胃（中宫）。饮食进入胃中，游溢精气，传输至经络，其中精纯的部分行于脉中，称为营气；剽悍滑利的部分行于脉外，称为卫气。
营卫二气分别归属于金（肺）木（肝），但都统属于太阳经。因此，太阳经发病有伤卫和伤营的不同。卫气属阳，营血属阴。然而，血上升而化生神魂，这是阴中包含阳；所以肝血温暖而升散。气下降而化生精魄，这是阳中包含阴；所以肺气清凉而降敛。
人的汗孔冬天闭合而夏天张开，是因为肝心主营，木火之气旺盛于春夏，则营血温散而汗孔张开；肺肾主卫，金水之气旺盛于秋冬，则卫气清敛而汗孔闭合。
如果寒气去除、温热到来，而木火之气不得发泄，卫气收敛闭藏，汗孔就会经常闭合。此时若袭受风气，想要收敛却不能收敛，所以伤害的是卫气。如果热退凉生，而金水之气不得敛藏，营血发散，汗孔就会经常张开。此时若侵袭寒气，想要发散却不能发散，所以伤害的是营血。
风邪伤害卫气，是因为天气凉爽导致汗孔闭合；寒邪伤害营血，是因为天气温暖导致汗孔张开。如果在春夏季节汗孔张开，则容易患寒病而不患风病；在秋冬季节汗孔闭合，则容易患风病而不患寒病。所以秋冬寒盛时并非不中风，春夏风多时也有伤寒。《灵枢·岁露》篇提到四时八风中人，故有寒暑之分。寒邪使人皮肤紧绷而腠理闭合，暑邪使人皮肤松弛而腠理开张。因为腠理开张时邪气侵入较深，发病急骤猛烈；因为腠理闭合时邪气侵入较浅，发病缓慢迟缓。
腠理开张则伤害营血，腠理闭合则伤害卫气，这是因为营气深而在内，卫气浅而在外。风性疏泄，寒性闭塞；气性收敛，血性发扬。卫气收敛而汗孔闭合，若患中风，则气欲收敛而风邪使其泄越，所以会有汗出；风愈泄而气愈欲收敛，从而内遏营血而生里热。营气泄越而汗孔张开，若患伤寒，则血欲泄越而寒邪束之，所以无汗；寒愈束而血愈欲泄越，从而外闭卫气而生表寒。
人的本气如果不郁结，就不会出现极盛的病态。郁结则阳虚之人，脏阴内盛而表现为寒证；阴虚之人，经阳外盛而表现为热证。这就是病邪传入腑或传入脏的由来。而且病邪入腑入脏，必定先作用于皮毛，所以六经的病总起于太阳一经，因为它位于最外层，最先受到损伤。
邪气在营卫之间，如果失于解散，就会或入于腑，或入于脏，视病人的里气情况而定。阳气衰则入太阴而为寒证，阴气衰则入阳明而为热证，没有不同的路径。关键在于在营卫刚生病时进行初期治疗，如果不痊愈，日后的各种变证就无从产生。
卫气行于脉外，向内交于营气；营气行于脉中，向外交于卫气。营卫调和，称为平人（健康人）。寒邪伤营，则营血束闭其卫气，所以卫气郁结而生表寒；风邪伤卫，则卫气遏闭其营血，所以营气郁结而生里热。营卫向外发散则病解，营卫向内陷落则病进，陷落而败亡则死亡。伤寒和中风的死证，都是营卫的陷败。
卫气的外发，依赖于经脉中的阳气旺盛；营血的外发，依赖于脏腑中的阴气旺盛。阳气统属于阳明，阴气统属于太阴。阳明经气旺盛，则卫气外发而汗出；如果阳气虚弱，卫气欲发而不能，则会振栗战摇而后汗出；如果再虚弱，则寒战而不见汗出，这是阳不胜阴，卫气将陷，应当泻阴扶阳，开皮毛而发卫气。
太阴经气旺盛，则营气外发而汗出；如果阴气虚弱，营气欲发而不能，则会烦躁怫郁而后汗出；如果再虚弱，则躁闷而不见汗出，这是阴不胜阳，营气将陷，应当泻阳扶阴，开肌表而发营血。
阳气盛于腑，阴气盛于脏。卫气陷落，是因为脏阴盛而内寒；营血陷落，是因为腑阳盛而内热。太阳经是六经之长，兼统营卫。当其营卫初病时，若能外解经络，内调脏腑，使脏寒不动、腑热不作，日后便无入脏入腑的祸患，这就是善于治疗太阳病的人。
太阳经的病，不过是风寒两种而已。风邪用桂枝汤，寒邪用麻黄汤。风兼寒、寒兼风，则有桂枝麻黄各半汤的方剂；风兼火郁、寒兼水停，则有大小青龙汤的制剂。风寒已解而内燥，则有白虎汤清金之法；风寒未透而内湿，则有五苓散利水之剂。风寒外散而血热里郁，则有桃核承气汤、抵当汤丸的设制。这些都是治疗太阳风寒本病的定法。
人的本气如果不偏颇，阳郁不至极热，阴郁不至极寒。本气稍偏，病则阴盛而为寒，阳盛而为热，而以温凉补泻来挽回气化的偏颇，都可以随药而愈。不经误治，断不至于成为坏病。熟悉仲景关于太阳本病的诸法则，则风寒之证可在太阳一经解除，不再变成坏病。
Question: What is meant by "disaster and strangeness" (Zaiguai) in pulse diagnosis?
The Master said: Suppose a person is ill, the pulse presents as Taiyang disease, and the clinical manifestations correspond to the pulse. A decoction is prescribed accordingly. However, shortly after the medicine is delivered (about the time it takes to eat a meal), the patient suddenly experiences severe vomiting, diarrhea, and abdominal pain. The Master said: "When I examined the patient earlier, these symptoms were not present. Now the condition has changed abruptly; this is called 'disaster and strangeness'."
Question: Why does such vomiting and diarrhea occur?
Answer: It may be due to medication taken previously that is now taking effect, thus causing this seemingly strange occurrence.
Although the pulse and symptoms initially showed no discrepancy, the sudden onset of vomiting and diarrhea is indeed peculiar. Generally, this may arise because different people handle the preparation of the medicine differently; or it could be due to malicious acts, such as poisoning by maids, relatives from the wife's family, or enemies, which are unpredictable.
Taiyang governs with Cold-Water qi and commands the Six Meridians. The Bladder is the Fu organ of Taiyang, and the Taiyang Meridian is the meridian of the Bladder. In the sequence of the Six Meridians, the Three Yin meridians are interior, and the Three Yang meridians are exterior. Taiyang governs the skin and hair layer. Its sequence follows: first Taiyang, then Yangming, then Shaoyang, then Taiyin, Shaoyin, and Jueyin. Overall, Taiyang serves as the primary commander.
Yang qi is abundant at the exterior; the exterior yang is called Wei Qi (Defensive Qi). "Wei" means to guard, providing consolidation and protection of the exterior. Internally, Wei Qi transforms into Ying Qi (Nutritive Blood). "Ying" means to circulate continuously. Ying Qi is governed by the Liver, serving as the root of Wei Qi; Wei Qi is governed by the Lung, serving as the leaf of Ying Qi. Ying and Wei Qi are transformed in the Middle Jiao (Spleen and Stomach). Food enters the Stomach, its essence floats and overflows, transmitting through the collaterals. The purest part travels within the vessels and is named Ying Qi; the fierce and rapid part travels outside the vessels and is named Wei Qi.
Ying and Wei Qi are distributed among Metal (Lung) and Wood (Liver) but are unified under Taiyang. Therefore, Taiyang meridian diseases differ between injuring Wei and injuring Ying. Wei Qi is Yang, and Ying Blood is Yin. However, blood ascends to transform into Hun and Po (Soul and Spirit); this is Yin containing Yang. Thus, Liver Blood is warm and ascending/dispersing. Qi descends to transform into Jing and Po (Essence and Spirit); this is Yang containing Yin. Thus, Lung Qi is cool and descending/converging.
Human sweat pores close in winter and open in summer because the Liver and Heart govern Ying, and Wood-Fire qi is prosperous in Spring and Summer, causing Ying Blood to be warm and dispersing, opening the pores. The Lung and Kidney govern Wei, and Metal-Water qi is prosperous in Autumn and Winter, causing Wei Qi to be cool and converging, closing the pores.
If cold departs and warmth arrives, but Wood-Fire qi cannot vent, Wei Qi converges and closes, so the pores remain often closed. If attacked by Wind Qi while wanting to converge but unable to, the injury is to Wei Qi. If heat recedes and coolness arises, but Metal-Water qi cannot store, Ying Blood disperses, so the pores remain often open. If invaded by Cold while wanting to disperse but unable to, the injury is to Ying Blood.
Wind injuring Wei Qi occurs because cool weather causes pore closure. Cold injuring Ying Blood occurs because warm weather causes pore opening. When pores are open in Spring and Summer, one contracts Cold disease rather than Wind disease. When pores are closed in Autumn and Winter, one contracts Wind disease rather than Cold disease. Thus, even when Cold is prevalent in Autumn and Winter, Wind can still strike; even when Wind is frequent in Spring and Summer, Cold can still injure. The *Lingshu* chapter "Sui Lu" states that the Eight Winds of the four seasons enter humans, resulting in Cold and Heat distinctions. Cold makes the skin tight and pores close; Heat makes the skin loose and pores open. Because they enter when open, the invasion is deep, and the illness is sudden and violent. Because they enter when closed, the invasion is shallow, and the illness is slow and delayed.
Opening leads to injury of Ying (deep); closing leads to injury of Wei (superficial). Wind nature is dispersing; Cold nature is obstructing. Qi nature is converging; Blood nature is expanding. Wei Qi converges and pores close. In Wind Strike (Zhong Feng), Qi wants to converge but Wind disperses it, leading to sweating. The more Wind disperses, the more Qi tries to converge, thereby internally restraining Ying Blood and generating interior Heat. Ying disperses and pores open. In Cold Damage (Shang Han), Blood wants to disperse but Cold binds it, leading to no sweating. The more Cold binds, the more Blood tries to disperse, thereby externally closing Wei Qi and generating exterior Cold.
If human fundamental Qi is not stagnant, it does not become excessively strong. Stagnation causes those with Yang deficiency to have excess internal Yin Cold, manifesting as Cold syndromes; those with Yin deficiency have excessive external Yang Heat, manifesting as Heat syndromes. This is the origin of transmission to Fu or Zang organs. Pathogens entering Fu or Zang must first affect the skin and hair; thus, all Six Meridian diseases originate in Taiyang because it is the most exterior and injured first.
Pathogens in Ying and Wei, if not resolved, may enter Fu or Zang depending on the patient's interior Qi. Yang decline leads to Taiyin Cold syndrome; Yin decline leads to Yangming Heat syndrome. There is no alternative path. It is crucial to treat early during the initial stage of Ying-Wei disease. If not cured then, subsequent complications will not arise.
Wei Qi moves outside the vessels and interacts internally with Ying Qi; Ying Qi moves inside the vessels and interacts externally with Wei Qi. Harmonious Ying and Wei constitute a healthy person. Cold injuring Ying binds Ying Blood, which in turn constrains Wei Qi, causing Wei stagnation and exterior Cold. Wind injuring Wei blocks Wei Qi, which in turn restrains Ying Blood, causing Ying stagnation and interior Heat. Exterior emission of Ying and Wei resolves the disease; interior collapse of Ying and Wei advances the disease. Collapse and failure lead to death. Death from Shang Han or Zhong Feng is due to the collapse of Ying and Wei.
The exterior emission of Wei Qi relies on the prosperity of Yang Qi within the meridians; the exterior emission of Ying Blood relies on the prosperity of Yin Qi within the zang-fu. Yang is commanded by Yangming; Yin is commanded by Taiyin. When Yangming meridian Qi is prosperous, Wei Qi emits externally and sweating occurs. If Yang is deficient, Wei Qi desires to emit but cannot, leading to trembling and shivering before sweating. If further deficient, there is cold shivering without sweating; this is Yang failing to overcome Yin, with Wei Qi about to collapse. One should drain Yin and support Yang, open the skin and hair, and emit Wei Qi.
When Taiyin meridian Qi is prosperous, Ying Qi emits externally and sweating occurs. If Yin is deficient, Ying Qi desires to emit but cannot, leading to irritability and oppression before sweating. If further deficient, there is restlessness and stifling without sweating; this is Yin failing to overcome Yang, with Ying Qi about to collapse. One should drain Yang and support Yin, open the muscle surface, and emit Ying Blood.
Yang is prosperous in Fu organs; Yin is prosperous in Zang organs. The collapse of Wei Qi is due to excessive Zang Yin and interior Cold. The collapse of Ying Blood is due to excessive Fu Yang and interior Heat. Taiyang is the head of the Six Meridians, commanding both Ying and Wei. When Ying and Wei are initially diseased, if the exterior meridians are resolved and interior zang-fu are regulated, preventing interior Cold from moving and interior Heat from arising, there will be no future risk of entering Zang or Fu. This is the skillful treatment of Taiyang disease.
Taiyang meridian diseases involve only Wind and Cold. For Wind, Guizhi Tang is used; for Cold, Mahuang Tang is used. If Wind combines with Cold or Cold combines with Wind, Guizhi Mahuang Gemi Tang is used. If Wind combines with Fire stagnation or Cold combines with Water retention, Da Qinglong Tang or Xiao Qinglong Tang are employed. If Wind-Cold is resolved but interior dryness remains, Baihu Tang clears Metal. If Wind-Cold is not fully penetrated but interior dampness exists, Wuling San promotes urination. If Wind-Cold scatters externally but Blood Heat stagnates internally, Taohe Chengqi Tang or Didang Tang/Pills are set. These are fixed methods for treating the primary diseases of Taiyang Wind-Cold.
If human fundamental Qi is unbalanced, Yang stagnation does not reach extreme Heat, and Yin stagnation does not reach extreme Cold. Slight imbalance leads to Yin excess causing Cold or Yang excess causing Heat. Using warming, cooling, tonifying, and draining methods to restore the balance of Qi transformation allows recovery with appropriate herbs. Without misdiagnosis and mistreatment, it certainly will not become a complicated disease. Familiarity with Zhang Zhongjing's principles regarding Taiyang primary diseases ensures that Wind-Cold syndromes are resolved in the Taiyang meridian without becoming complicated diseases.