伤寒郁冒。何以明之。郁为郁结而气不舒也。冒为昏冒而神不清也。世谓之昏迷
者是也。郁冒之来。皆虚极而乘寒。则有之矣。经曰。诸乘寒者则为厥。郁冒不仁。又
曰。太阳病先下之而不愈。因复发汗。以此表里俱虚。其人因致冒。冒家汗出自愈。
所以然者。汗出表和故也。是知因虚乘寒。乃生郁冒。金匮要略曰。新产妇人有三
病。一者病痉。二者病郁冒。三者大便难。亡血复汗。寒多故令郁冒。又曰。产妇郁冒。
其脉微弱。呕不能食。大便坚。所以然者。血虚而厥。厥而必冒。冒家欲解。必大汗出。
即此观之。郁冒为虚寒可知矣。又或少阴病。下利止而头眩。时时自冒者。又为死
证。盖谓其虚极而脱也。观其郁冒。幸无忽焉。
伤寒动气。何以明之。动气者。为筑筑然动于腹中者是矣。脏气不治。随脏所主。发
泄于脐之四旁。动跳筑筑然。谓之动气。难经曰。肝内证脐左有动气。按之牢若痛。
心内证脐上有动气。按之牢若痛。肺内证脐右有动气。按之牢若痛。肾内证脐下
有动气。按之牢若痛。是脏气不治。腹中气候发动也。动气应藏。是皆真气虚。虽有
表里攻发之证。即不可汗下。经曰。动气左右。不可发汗。汗则头眩。汗不止。筋惕肉
。是发汗而动肝气者也。动气在左不可下。下之则腹内拘急。食不下。动气更剧。
虽有身热。卧则欲蜷。是下之而动肝气者也。动气在上。不可发汗。汗则气上冲。正
在心端。是发汗而动心气者也。动气在上不可下。下之则掌握热烦。身上浮冷。热
汗自泄。欲得水自灌。是下之而动心气者也。动气在右。不可发汗。汗则衄而渴。心
苦烦。饮即吐水。是发汗而动肺气者也。动气在右不可下。下之则津液内竭。咽燥
鼻干。头眩心悸。是下之而动肺气者也。动气在下。不可发汗。汗则无汗。心中大烦。
骨节苦痛。目运恶寒。食则反吐。谷不得下。是发汗而动肾气者也。动气在下不可
下。下之则腹胀满。卒起头眩。食则下清谷。心下痞。是下之而动肾气者也。且脾内
证。当脐有动气。经特曰脐之四旁动气。不可汗下。独不言脾候。当脐有动气者。以
脾居中州。为胃以行津液。发汗吐下。独先动脾。况脾家发动气者。讵可动之也。所
以特不言之也。伤寒所以看外证为当者。盖不在脉之可见。必待问之可得者。发
汗吐下。务要审谛。举此动气。类可知矣。
伤寒郁冒，该如何阐明呢？“郁”是指气机郁结而不得舒展；“冒”是指头目昏蒙而神志不清。世人所说的昏迷就是这种情况。郁冒的发生，都是因为正气极度虚弱，又遭受寒邪侵袭所致。《内经》说：“凡是遭受寒邪侵袭的就会发生厥逆，出现郁冒和肢体麻木。”又说：“太阳病如果先使用下法而没有痊愈，接着又发汗，这样导致表里两虚，病人因此出现郁冒。患有郁冒的人，如果自然出汗就能痊愈。之所以这样，是因为汗出之后表气调和的缘故。”由此可知，因虚受寒才会产生郁冒。《金匮要略》说：“刚生产完的妇女有三种病，一是痉病，二是郁冒，三是大便难。这是因为失血后又出汗，寒邪较多，所以导致郁冒。”又说：“产妇患郁冒，脉象微弱，呕吐不能进食，大便干硬。之所以这样，是因为血虚导致厥逆，厥逆必然导致郁冒。郁冒想要解除，一定会大汗出。”从这些情况来看，郁冒属于虚寒证是显而易见的。另外，少阴病如果下利停止却头晕，时常感到昏冒的，又是死证。这是说因为正气极度衰竭而脱散。观察这种郁冒的情况，千万不要忽视。
伤寒动气，该如何阐明呢？所谓动气，是指在腹中筑筑然跳动的感觉。脏腑之气失调，随着所主脏腑的表现，发泄在肚脐的四周，跳动筑筑然，称为动气。《难经》说：“肝的内证表现为脐左侧有动气，按压时坚实且疼痛；心的内证表现为脐上方有动气，按压时坚实且疼痛；肺的内证表现为脐右侧有动气，按压时坚实且疼痛；肾的内证表现为脐下方有动气，按压时坚实且疼痛。”这就是脏腑之气失调，腹中气机发动的表现。动气对应于五脏，这都是真气虚弱所致。即使有表里攻发的症状，也不可以使用汗法和下法。《内经》说：“动气在左右两侧，不可发汗。发汗则会导致头晕，汗出不止，筋肉跳动抽搐。”这是发汗损伤了肝气。动气在左侧，不可使用下法。使用下法会导致腹部拘急挛缩，饮食不下，动气更加剧烈。即使身体发热，躺下时想蜷缩，这是下法损伤了肝气。动气在上方，不可发汗。发汗会导致气上冲，正顶在心口部位，这是发汗损伤了心气。动气在上方，不可使用下法。使用下法会导致手掌发热烦躁，身上浮冷，热汗自出，想喝水自己浇灌。这是下法损伤了心气。动气在右侧，不可发汗。发汗会导致鼻出血且口渴，心中苦烦，喝水即吐，这是发汗损伤了肺气。动气在右侧，不可使用下法。使用下法会导致体内津液枯竭，咽喉干燥，鼻孔干涩，头晕心悸，这是下法损伤了肺气。动气在下方，不可发汗。发汗会导致无汗，心中大烦，骨节痛苦，眼睛眩晕怕冷，进食反而呕吐，食物无法下行。这是发汗损伤了肾气。动气在下方，不可使用下法。使用下法会导致腹部胀满，突然起身头晕，进食后排泄未消化的食物，心下痞塞，这是下法损伤了肾气。至于脾的内证，应当在肚脐处有动气。经文特别提到脐之四旁的动气不可汗下，唯独没有提及脾的征候。肚脐处有动气的情况，是因为脾居中州，为胃运行津液。发汗、催吐、泻下，最先损伤的是脾。况且脾家发动气，怎么可以再扰动它呢？所以经文特意没有提及这一点。伤寒诊疗之所以认为审察外证更为恰当，是因为这不仅仅依赖于可见的脉象，必须通过询问才能得知。使用发汗、催吐、泻下法，务必审慎仔细。列举这些动气的情况，其他类似情况就可以推知了。
Shanghan Yu Mao (Depression and Dizziness), how should it be elucidated? "Yu" refers to Qi stagnation where the Qi is constrained and fails to flow freely; "Mao" refers to dizziness and clouding of consciousness. What is commonly referred to as coma in the world corresponds to this condition. The onset of Yu Mao invariably stems from extreme deficiency compounded by cold pathogenic factors. The Classics state: "All conditions resulting from cold invasion lead to Jue (cold extremities/reversal), accompanied by Yu Mao and numbness." It also states: "In Taiyang disease, if purgation is applied first without resolution, followed by sweating, this results in both exterior and interior deficiency, causing the patient to develop Mao. Patients with Mao will recover spontaneously through sweating. This is because sweating harmonizes the exterior Qi." From this, we know that Yu Mao arises from deficiency combined with cold invasion. *Jingui Yaolue* states: "Postpartum women suffer from three diseases: one is Jing (spasm), two is Yu Mao, and three is difficulty in defecation. Loss of blood followed by sweating, with abundant cold, causes Yu Mao." It further states: "When a postpartum woman suffers from Yu Mao, her pulse is faint and weak, she vomits and cannot eat, and her stool is hard. This is because blood deficiency leads to Jue, and Jue inevitably leads to Mao. For Yu Mao to resolve, profuse sweating must occur." Observing these cases, it is evident that Yu Mao belongs to deficiency-cold patterns. Additionally, in Shaoyin disease, if diarrhea stops but dizziness occurs, and the patient frequently experiences clouding of consciousness, this indicates a fatal syndrome. This signifies extreme depletion and collapse of Zheng Qi (True Qi). One must not overlook such presentations of Yu Mao.
Shanghan Dong Qi (Abdominal Pulsation), how should it be elucidated? Dong Qi refers to the sensation of pulsating or throbbing within the abdomen. When Zang organ Qi becomes disordered, it manifests according to its respective Zang, appearing as throbbing movements around the four sides of the umbilicus, termed Dong Qi. *Nan Jing* states: "For Liver internal signs, there is pulsation at the left side of the umbilicus, which feels firm and painful upon pressure; for Heart internal signs, there is pulsation above the umbilicus, firm and painful on pressure; for Lung internal signs, there is pulsation at the right side of the umbilicus, firm and painful on pressure; for Kidney internal signs, there is pulsation below the umbilicus, firm and painful on pressure." These represent the disorder of Zang Qi and the activation of abdominal Qi. Dong Qi corresponds to the Zang organs, all indicating deficiency of True Qi. Even if there are symptoms suggesting exterior or interior excess requiring attack, neither sweating nor purging methods should be used. The Classics state: "If Dong Qi is present on the left or right, sweating is contraindicated. Sweating will cause dizziness, ceaseless sweating, and twitching of muscles and sinews." This is because sweating disturbs Liver Qi. If Dong Qi is on the left, purging is contraindicated. Purging will cause abdominal tension and cramping, inability to eat, and exacerbation of the pulsation. Even if there is body heat and a desire to curl up when lying down, this results from purging disturbing Liver Qi. If Dong Qi is superior (upper), sweating is contraindicated. Sweating will cause Qi to rush upward, stopping precisely at the heart region; this is because sweating disturbs Heart Qi. If Dong Qi is superior, purging is contraindicated. Purging will cause heat and irritability in the palms, floating coldness on the body, spontaneous hot sweating, and a desire to drink water for self-irrigation; this results from purging disturbing Heart Qi. If Dong Qi is on the right, sweating is contraindicated. Sweating will cause epistaxis and thirst, mental vexation, and vomiting immediately after drinking; this is because sweating disturbs Lung Qi. If Dong Qi is on the right, purging is contraindicated. Purging will lead to exhaustion of internal body fluids, dry throat and nose, dizziness, palpitations; this results from purging disturbing Lung Qi. If Dong Qi is inferior (lower), sweating is contraindicated. Sweating will result in anhidrosis, severe mental restlessness, pain in bone joints, vertigo with aversion to cold, vomiting after eating, and inability to retain food; this is because sweating disturbs Kidney Qi. If Dong Qi is inferior, purging is contraindicated. Purging will cause abdominal fullness, dizziness upon sudden rising, passage of undigested food in stool, and epigastric stuffiness; this results from purging disturbing Kidney Qi. Regarding Spleen internal signs, pulsation should occur at the umbilicus. The Classic specifically mentions that pulsation at the four sides of the umbilicus precludes sweating and purging, yet uniquely omits mention of the Spleen's sign. In cases of pulsation at the umbilicus itself, it is because the Spleen resides in the Central Region (Zhong Zhou) and transports fluids for the Stomach. Sweating, vomiting, and purging damage the Spleen first. Moreover, if the Spleen's Qi is already activated, how can it be further disturbed? Therefore, it is specifically omitted. In treating Shanghan, prioritizing the examination of external signs is appropriate because diagnosis relies not only on visible pulses but also on information obtained through inquiry. When employing sweating, vomiting, or purging methods, utmost caution and deliberation are required. By examining these cases of Dong Qi, similar situations can be inferred.