趺阳脉沉而数沉为实数消谷紧者病难治
趺阳脉沉而数沉为内实数则消谷是胃阳之盛者也设使兼紧者则病为难治矣紧者阳为邪郁而不达也（风寒外束甲木郁
迫故见紧象）
趺阳脉大而紧者当即下利为难治
趺阳脉大而紧者胃阳为胆经所郁不能容纳水谷当即下利此为难治（汗下宜忌篇脉大而紧者阳中有阴也当下之宜大承
气汤即此证也）
寸口脉阴阳俱紧者法当清邪中于上焦浊邪中于下焦清邪中上名曰洁也浊邪中下名曰浑也阴中于邪必内栗也表气微虚
里气不守故使邪中于阴也阳中于邪必发热头痛项强颈挛腰痛胫酸所为阳中雾露之气故曰清邪中上浊邪中下阴气为栗足膝
厥冷溺便妄出表气微虚里气微急三焦相溷内外不通上焦怫郁脏气相薰口烂食龈也中焦不治胃气上冲脾气不转胃中为浊营
卫不通血凝不流若卫气前通者小便赤黄与热相搏因热作使游于经络出入脏腑热气所过则为痈脓若阴气前通者阳气厥微阴
无所使客气内入嚏而出之声 咽塞寒厥相逐为热所壅血凝自下状如豚肝阴阳俱厥脾气孤弱五液注下下焦不阖清便下重令
便数难脐筑湫痛命将难全
寸口脉尺寸俱紧者此有外邪之迫束也寸紧者法当清邪中于上焦尺紧者法当浊邪中于下焦清邪洁清名曰洁也浊邪混浊
名曰浑也下焦阴中于邪必阳气内虚而战栗也此因表气之微虚里气之不守故使邪中于阴部也上焦阳中于邪必发热头痛项强
颈挛腰痛胫酸所谓阳中雾露之气也故曰清邪中上浊邪中下以其同类之相感召金匮雾伤于上湿伤于下正此意也清邪中上则
为内热浊邪中下则为内寒上热下寒阴阳俱病而阳病则轻阴病则重以邪之清浊不同也今以浊邪之中下者言之阴中于邪内寒
而栗阳不下达足膝逆冷气不下摄便溺妄出此其表气微虚故外邪乘袭不能敛闭里气亦微郁作满急故三焦溷乱内外不通三焦
俱病其状自别其上焦之怫郁也热蒸于脏脏气相薰口烂食龈也此以上焦外有表邪之感内有下寒之逼火郁于上故证见如此其
中焦之不治也胃气逆行而上冲脾气郁陷而不转胃中为浊气所填营卫滞塞不通血因凝而不流以营卫流行赖乎中气之运中气
不运故气血阻隔也若卫阳前通乎下者气降于水则小便赤黄卫气将通而未通必郁而为热卫气与脏中之热相合卫气所到之处
热亦随之是因热而作使也卫与热游于经络出入脏腑热气所过则蒸腐而为痈脓是卫阳通而热伤于内也若里阴前通于上者阳
气厥寒而微弱不能作热阴无所使下焦客气之内入于胸膈者冲动肺气上逆嚏而出之出之不及乃声 而咽塞下焦寒厥攻逐于
上为上热所壅寒热相搏前之凝血自下状如豚肝阴阳俱致厥逆浊气不降清气不升则脾气孤弱不能统摄五脏之精液五液奔注
而下泄是里阴通而寒伤于内也其下焦之不阖也清便下重令便数而艰难脐上筑起而湫痛缘清气下陷则重坠而便数而寒凝气
滞不能顺下故便难而腹痛是其命将难全也
趺阳脉沉而数，沉主里实，数主消谷善饥，这是胃阳亢盛的表现。如果兼见紧脉，则病情难治。紧脉是因为阳气被邪气郁遏而不能通达（风寒外束，导致甲木郁迫，所以出现紧象）。
趺阳脉大而紧，应当立即出现下利，属于难治之证。趺阳脉大而紧，是胃阳被胆经之气所郁遏，不能容纳水谷，因此立即出现下利，此为难治（在《汗下宜忌篇》中提到，脉大而紧者，是阳中有阴，应当用下法，适宜使用大承气汤，即指此证）。
寸口脉的寸、尺两部阴阳俱紧，按照法则，应当是清邪侵犯上焦，浊邪侵犯下焦。清邪侵犯上部称为“洁”，浊邪侵犯下部称为“浑”。阴分受到邪气侵袭，必然在内战栗；因为表气微弱虚弱，里气不能固守，所以致使邪气侵入阴分。阳分受到邪气侵袭，必然发热、头痛、项强、颈挛、腰痛、小腿酸痛，这就是所谓的阳分遭受雾露之气侵袭。所以说清邪侵犯上部，浊邪侵犯下部。
阴分受邪而战栗，足膝厥冷，小便和大便失禁妄出。这是因为表气微弱虚弱，里气微急，导致三焦混杂混乱，内外不通。上焦怫郁，脏气相互熏蒸，导致口腔糜烂、牙龈腐烂。中焦失治，胃气上冲，脾气不转，胃中化为浊气，营卫不通，血液凝滞不流。
如果卫气先通，小便赤黄，与热相搏，因热而发挥作用，游走于经络，出入脏腑，热气所经过的地方，就会成为痈脓。如果阴气先通，阳气厥逆微弱，阴无所使，客气内入，打喷嚏而出，声音嘶哑，咽喉阻塞，寒厥相互追逐，被热所壅塞，血液凝滞自行下行，状如猪肝。阴阳都发生厥逆，脾气孤弱，五液注下泄泻，下焦不能闭合，大便清稀且肛门重坠，排便次数多而困难，脐部筑痛且疼痛剧烈，性命将难以保全。
寸口脉尺寸俱紧，这是有外邪迫束所致。寸脉紧，按照法则应当是清邪侵犯上焦；尺脉紧，按照法则应当是浊邪侵犯下焦。清邪洁净，称为“洁”；浊邪混浊，称为“浑”。下焦阴分受邪，必然阳气内虚而战栗。这是因为表气微弱虚弱，里气不能固守，致使邪气侵入阴部。上焦阳分受邪，必然发热、头痛、项强、颈挛、腰痛、小腿酸痛，这就是所谓阳分遭受雾露之气侵袭。所以说清邪侵犯上部，浊邪侵犯下部。因为同类事物相互感召，《金匮要略》说雾伤于上，湿伤于下，正是这个意思。
清邪侵犯上部则为内热，浊邪侵犯下部则为内寒。上热下寒，阴阳都患病，但阳病较轻，阴病较重，这是因为邪气的清浊不同。现在以浊邪侵犯下部为例：阴分受邪，内寒而战栗，阳气不能下达，足膝逆冷，冷气不能摄纳，导致大小便失禁妄出。这是因为表气微弱虚弱，所以外邪乘袭，不能敛闭；里气也微郁作满急，所以三焦混乱，内外不通。三焦都患病，其症状各自不同。
上焦的怫郁，热蒸于脏，脏气相互熏蒸，导致口腔糜烂、牙龈腐烂。这是因为上焦外有表邪之感，内有下寒之逼，火郁于上，所以症状如此。中焦的不治，胃气逆行而上冲，脾气郁陷而不转，胃中被浊气填满，营卫滞塞不通，血液因凝滞而不流。因为营卫的流行依赖于中气的运化，中气不运，所以气血阻隔。
如果卫阳先通于下，气降于水，则小便赤黄。卫气将要通而未通，必然郁而为热，卫气与脏中之热相合，卫气所到之处，热也随之而来，是因热而发挥作用。卫与热游走于经络，出入脏腑，热气所过之处，蒸腐而为痈脓，这是卫阳通而热伤于内。
如果里阴先通于上，阳气厥寒而微弱，不能作热，阴无所使，下焦客气内入胸膈，冲动肺气上逆，打喷嚏而出，出之不及乃声音嘶哑而咽喉阻塞。下焦寒厥攻逐于上，为上热所壅，寒热相搏，之前的凝血自行下行，状如猪肝。阴阳都致厥逆，浊气不降，清气不升，则脾气孤弱，不能统摄五脏之精液，五液奔注而下泄，这是里阴通而寒伤于内。
下焦不能闭合，大便清稀且肛门重坠，令排便次数多而艰难，脐上筑起而湫痛。因为清气下陷则重坠而便数，而寒凝气滞不能顺下，所以便难而腹痛，是其性命将难以保全。
The Fuyang pulse is deep and rapid. Deep indicates interior excess, and rapid indicates the ability to digest food (xiao gu). This represents the flourishing of Stomach Yang. If accompanied by a tight pulse, the disease is difficult to treat. The tight pulse occurs because Yang Qi is constrained by pathogenic factors and cannot flow freely (external constraint of Wind-Cold causes the Jia Wood to be depressed and pressured, thus presenting a tight image).
The Fuyang pulse is large and tight; there should immediately be diarrhea, which is difficult to treat. A large and tight Fuyang pulse indicates that Stomach Yang is constrained by the Gallbladder channel, unable to accommodate food and fluids, leading to immediate diarrhea. This is difficult to treat (In the chapter "Indications and Contraindications for Sweating and Purging," it states that a large and tight pulse indicates Yin within Yang, requiring purgation, suitable for Da Cheng Qi Tang, referring to this condition).
When both the Yin (Chi) and Yang (Cun) positions of the Cun Kou pulse are tight, according to the principle, clear pathogens attack the Upper Jiao, and turbid pathogens attack the Lower Jiao. Clear pathogens attacking the upper part are called "Jie" (pure/clear), and turbid pathogens attacking the lower part are called "Hun" (turbid/muddy). When the Yin aspect is attacked by pathogens, internal shivering must occur. Because the exterior Qi is slightly deficient and the interior Qi fails to maintain its post, pathogens invade the Yin aspect. When the Yang aspect is attacked by pathogens, fever, headache, stiffness of the neck and occiput, cervical spasms, lower back pain, and soreness of the calves will occur. This is referred to as the Yang aspect being affected by mist and dew. Thus, it is said that clear pathogens attack the upper, and turbid pathogens attack the lower.
When the Yin aspect is attacked and shivers, the feet and knees become cold, and urination and defecation may occur involuntarily. This is because the exterior Qi is slightly deficient and the interior Qi is slightly urgent, causing the Three Jiao to become mixed and confused, with no communication between inside and outside. The Upper Jiao becomes stifled, and organ Qi steams each other, leading to oral ulcers and rotting gums. The Middle Jiao loses regulation; Stomach Qi rebels upward, Spleen Qi fails to transform, and the stomach becomes filled with turbidity. Ying and Wei Qi do not circulate, and blood coagulates and stagnates.
If Wei Qi flows first, urine will be dark yellow. It clashes with heat, driven by heat to act as an agent, wandering through the meridians and entering/exiting the Zang-Fu organs. Wherever the hot Qi passes, carbuncles and pus form. If Yin Qi flows first, Yang Qi becomes inverted and weak, leaving Yin without direction. Guest Qi enters internally, causing sneezing and expulsion of sound, hoarseness, and throat obstruction. Cold inversion chases each other, blocked by heat. Coagulated blood descends spontaneously, resembling pig liver. Both Yin and Yang experience inversion; Spleen Qi becomes isolated and weak. The five fluids pour downward, and the Lower Jiao fails to close. Clear stool feels heavy in the anus, frequent but difficult defecation occurs, and there is pounding pain in the umbilical region. Life is difficult to preserve.
When both the Cun and Chi positions of the Cun Kou pulse are tight, this is due to external pathogenic constraint. A tight Cun pulse indicates clear pathogens attacking the Upper Jiao; a tight Chi pulse indicates turbid pathogens attacking the Lower Jiao. Clear pathogens are pure, called "Jie"; turbid pathogens are muddy, called "Hun." When the Lower Jiao Yin is attacked, interior Yang deficiency leads to shivering. This is because the exterior Qi is slightly deficient and the interior Qi fails to guard, allowing pathogens to invade the Yin regions. When the Upper Jiao Yang is attacked, fever, headache, neck stiffness, cervical spasms, lower back pain, and calf soreness occur, known as the Yang aspect being affected by mist and dew. Thus, clear pathogens attack the upper, and turbid pathogens attack the lower. Since similar things attract each other, as stated in *Jin Gui Yao Lue*, mist injures the upper, and dampness injures the lower, which is exactly this meaning.
Clear pathogens attacking the upper cause interior heat; turbid pathogens attacking the lower cause interior cold. Upper heat and lower cold mean both Yin and Yang are diseased, but Yang disease is lighter and Yin disease is heavier, due to the difference in the clarity or turbidity of the pathogens. Now speaking of turbid pathogens attacking the lower: Yin is attacked, causing interior cold and shivering; Yang cannot descend, leading to cold feet and knees, failure of cold Qi to control, and involuntary urination and defecation. This is because the exterior Qi is slightly deficient, allowing external pathogens to invade without being contained; the interior Qi is also slightly constrained, causing fullness and urgency, so the Three Jiao become chaotic with no internal-external communication. All three Jiao are diseased, with distinct symptoms.
The stifling of the Upper Jiao involves heat steaming the organs, where organ Qi steams each other, causing oral ulcers and rotting gums. This is because the Upper Jiao has external exterior pathogen sensation and internal lower cold pressure, trapping fire in the upper, hence these symptoms. The dysfunction of the Middle Jiao involves rebellious Stomach Qi rushing upward and depressed Spleen Qi failing to transform. The stomach is filled with turbid Qi, blocking Ying and Wei circulation, causing blood coagulation and stagnation. Since Ying and Wei circulation depends on the movement of Middle Qi, if Middle Qi does not move, Qi and Blood are obstructed.
If Wei Yang flows first to the lower, Qi descends into water, resulting in dark yellow urine. As Wei Qi attempts to flow but is not yet free, it becomes constrained and generates heat. Wei Qi combines with heat in the organs; wherever Wei Qi goes, heat follows, acting through heat. Wei and heat wander through meridians, entering/exiting Zang-Fu organs. Wherever hot Qi passes, it steams and rots, forming carbuncles and pus. This is Wei Yang flowing while heat injures the interior.
If Li Yin flows first to the upper, Yang Qi is cold and weak, unable to generate heat, leaving Yin without direction. Guest Qi from the Lower Jiao enters the chest and diaphragm, stirring Lung Qi upward, causing sneezing and expulsion of sound, followed by hoarseness and throat obstruction. Lower Jiao cold inversion attacks upward, blocked by upper heat. Cold and heat clash, and previous coagulated blood descends spontaneously, resembling pig liver. Both Yin and Yang reach inversion; turbid Qi does not descend, clear Qi does not ascend. Spleen Qi becomes isolated and weak, unable to control the essence and fluids of the five Zang organs. The five fluids rush downward and泄 out. This is Li Yin flowing while cold injures the interior.
The Lower Jiao fails to close, causing a feeling of heaviness in the anus with frequent but difficult defecation, and pounding pain above the navel. This is because clear Qi sinks, causing heaviness and frequency, while cold coagulation and Qi stagnation prevent smooth descent, making defecation difficult and causing abdominal pain. Thus, life is difficult to preserve.