寸口诸微亡阳诸涩亡血诸弱发热诸紧为寒诸乘寒者。则为厥郁胃不仁以胃无谷气脾涩不通口急不能言战而栗也。
口急不能言是脾藏血少不能上通于心气也。
寸口脉微尺脉紧其人虚损多汗知阴常在绝不见阳也。
阳微阴胜加之多汗阳气愈虚也。
少阴脉不至肾气微少精血奔气促迫上入胸膈宗气反聚血结心下阳气退下热归阴股与阴相动令身不仁。此为尸厥当刺
期门巨阙。
肾中真阳之气不能统于周身。则阴气上迫于阳位。所以宗气郁聚血结。心下阳气。因而不伸。陷入至阴之地。周身
有阴。无阳遂至不仁。而厥也。治当刺期门以下。结血刺巨阙以行宗气。宗气布而阳气。自复厥自退矣。
寸口脉浮。而大浮为虚。大为实。在尺为关在寸为格关。则不得小便格则吐逆。
趺阳脉伏。而涩伏。则吐逆水谷不化涩。则食不得入名曰关格。
上条以脉之虚大倍常为关格见于尺部为关见于寸口为格故知。凡言寸口皆统三部而言也。○下条以关部伏涩异常为
关格盖伏。则气滞涩则血寒也。上条乃正衰邪实不治之证下条是寒邪闷拒可治之证不可不察。
趺阳脉不出。脾不上下体冷肤硬。
身冷者。胃气不温肤硬者。营血不濡以营卫气衰。故趺阳脉不出脾不上下竟成脏厥之证也。
寸脉下不至关为阳绝尺脉上不至关为阴绝此皆不治。
关为阴阳之交界。关上脉绝则阴阳离决。故不治。
寸口脉阴阳俱紧者。法当清邪中于上焦浊邪中于下焦阴中于邪必内栗也。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胫挛腰痛。胫酸。所谓阳中雾露之气。故曰清邪中上浊邪中下。阴气为栗足膝逆冷便溺妄出表气微
虚里气微急三焦相溷内外不通上焦怫郁脏气相熏口烂食 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拥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。（ 音银 音鹘）
此下五条俱论阴阳错杂之邪所谓三焦相溷内外不通为时行疫疠之总诀而伤寒坏证温热夹阴亦往往有内外合邪者。此
条言寸口脉阴阳俱紧者。邪气乘虚初犯中焦内外受伤未变为实也。寸脉浮而紧者清阳雾露之气伤于阳故曰清邪中于上焦
尺脉沉而紧者浊阴寒湿之邪伤于阴。故曰浊邪中于下焦清邪中上则发热头痛项强胫挛等证皆是外感表证浊邪中下。则阴
气为栗言身不战而但心惕惕然内栗足膝逆冷等证。皆邪客阴经之。证今表气征虚则阳气内入里气征急则阴邪上逆由是三
焦溷乱内外不通矣郁于上焦则龈伤不能啮物中焦不治。则不能营运水谷营卫不通而血凝不流。若阳气前通膀胱之邪欲散
故小便赤黄邪热游溢经络则为痈脓也。设阴气前通者。则阳气厥微不能卫外寒气内客于肺嚏而出之。以寒气客于肺。故
声咽塞言声塞不能出也。寒者外邪也。厥者内邪也。内外之邪合并相逐为热所拥。则血凝自下也。阴阳俱厥者。言脾
胃之气不相顺接胃中阳气不行不能敷布中外。故四肢逆冷脾中阴气孤弱不能约制下焦故五液注下圊便类数下重而难也。
脐为生气之源脐筑湫痛。则生气欲绝盖邪气伤犯中焦清浊相溷三焦俱病汗下。两难治稍失时。则变证百出矣。
脉阴阳俱紧者。口中气出唇口干燥蜷卧足冷鼻中涕出舌上苔滑勿妄治也。到七日以来其人微发热。手足温者。此为
欲解。若到八日以上反大发热者。此为难治设使恶寒者。必欲呕也。腹内痛者。必欲利也。
此脉此证表里阴阳混淆未的疑似之间慎勿妄投药饵徐而俟之。若七日之外当解之候微热。手足温。则为邪气解而自
愈矣。若致八日。以上当解不解反大发热。此为逆证不可治也。然仲景止言难治非直不治也。故下文言设寸脉浮紧恶寒
者。必呕清阳雾露之邪溢上焦也。尺脉沉紧而腹痛者。必利浊阴寒湿之邪走下焦也。邪气既得上下消散即可从其势而治
之矣。
脉阴阳俱紧至于吐利其脉独不解紧去人安。此为欲解。若脉迟至六七日不欲食。此为晚发水停。故也为未解食自可
者。为欲解。
脉阴阳俱紧内外皆邪至吐利后邪气已泄脉紧当去也。若吐利后紧独不解反不欲食皆为脾胃气虚。水饮停蓄为晚发变
证也若到七日脉紧渐退人安能食方为欲解。
伤寒脉阴阳俱紧恶寒发热。则脉欲厥。厥者。脉初来大渐渐小更来渐渐大是其候也。恶寒甚者。翕翕汗出喉中痛热
多者。目赤脉多睛不慧医复发之咽中。则伤若复下之则两目闭寒多者。便清谷热多者。便脓血。若熏之则身发黄。若熨
之则咽燥。若小便利者可救之小便难者。为危殆。
脉来厥者如厥逆之寒热交胜也初来大者为邪气鼓动渐渐小为正气受伤更来渐渐大为邪气复进也。盖缘其人正气本虚
不能主持随邪气进退。故其脉亦随邪气进退是以忽大忽小经云不大不小虽困可治其有大小者。为难治是也。恶寒甚者。
则发热翕翕汗出喉中痛以少阴之脉循喉咙。故也热多者太阳多也。目赤脉多睛不慧以太阳之脉起于目。故也发汗攻阳则
少阴之热因发而上行。故咽中伤若复下之则太阳之邪因虚。而内陷。故两目闭阴邪下行为寒多必便清谷阳邪下行为热。
多必便脓血熏之则火热伤表身必发黄熨之则火邪内逼必为咽燥小便利者。津液未竭犹可救之小便难者。津液已绝为危殆
也。
伤寒发热口中勃勃气出头痛。目黄衄不可制贪水者。必呕恶水者。厥若下之咽中生疮假令手足温者。必下重便脓血
头痛目黄者。若下之则两目闭贪水者。下之其脉必厥其声嘤咽喉塞。若发汗则战栗阴阳俱虚恶水者。若下之则里冷不嗜
食大便完谷出。若发汗则口中伤舌上白苔烦燥脉数实不大便六七日后。必便血若发汗则小便自利也。
发热口中勃勃气出邪气变热冲于膈上也头痛目黄衄不可制者。热郁于经也。贪水者。为无阴邪气并于上焦故必呕恶
水者。为无阳邪气并于中焦。故厥逆也。若下之里虚热结。必咽痛厥逆假令手足不厥则热邪不行而协热利也。若头痛目
黄者。为邪在太阳下之热气内伏。则目闭也贪水者热在上焦下之伤阴必脉厥声嘤咽喉闭塞汗之伤阳则阴阳俱虚而战栗恶
水者。为阳虚下之。则里冷不食完谷不化汗之。虚阳上乘口伤舌上白苔烦燥。若目黄漱水不大便者。六七日后必便血。
若发其汗则小盒饭不利今反自利者。太阳之瘀热结于膀胱。而小便偏渗也。瘀血为阴邪虽有如任实证而不能消耗津液。
故小便自利耳。○下之其三字从玉雨经增入。
脉濡而弱弱反在关濡反在巅弦反在上微反在下弦为阳运微为阴寒上实下虚意欲得温微弦为虚不可发汗。发汗则寒栗
不能自还咳者。则剧数吐涎沫咽中必干小便不利必中饥烦 时。而发其形似疟有寒无热虚。而寒栗刻。而发汗蜷。而苦
满腹中复坚。
脉濡而弱。弱反在关濡反在巅弦反在上微反在下弦为阳运微为阴寒上实下虚意欲得温微弦为虚虚者。不可下也。微
则为咳。咳则吐涎下之则咳止而利困不休利不休。则胸中如虫啮粥入。则出小便不利两胁拘急喘息为难颈背相引臂则不
仁极寒反汗出身冷。若冰眼睛不慧语言不休而谷气多入。此为除中口虽欲言舌不能前。
此二条言尺中微弱者。不可汗下也。观其意欲得温一语可以灼见病情上条言寸口微见弦脉而咳剧吐涎等证知为胃气
本虚而挟寒饮速宜温养中上误发汗。则胃中阳气愈伤客邪固结愈甚。或因刻而复汗之遂至蜷而苦满腹中复坚皆阴邪水饮
痞塞之象也。下条言寸口微见弦脉而咳吐涎沫等证仍为胃气本虚亦宜培理中土。若误吐之下利不止胃中空虚而反暴食为
除中少阴虚寒而反冷汗为外脱及口虽欲言舌萎不能前等死证 起较。上条证更剧以下更甚于汗也。
脉濡而弱弱反在关濡反在巅微反在上涩反在下微。则阳气不足涩。则无血阳气反微中风汗出而反躁烦涩。则无血厥
而且寒阳微发汗躁不得眠。
脉濡而弱弱反在关濡反在巅微反在上涩反在下微。则阳气不足涩。则无血阳气反微中风汗出而反躁烦涩则无血厥而
且寒阳微不可下下之则心下痞硬。
此二条言尺中脉涩者。不可汗下也。阳微阴涩气血两亏而关上脉复弱胃土亦衰。所以汗下俱禁也。阳微复用阳药发
汗则阳气转伤必躁不得眠阳微而用阴药攻下。则阳气内陷必心下痞硬也。
脉濡而弱弱反在关濡反在巅浮反在上数反在下浮为阳虚数为衄血浮为虚数为热浮为虚自汗出而恶寒数为痛伏寒而栗
微弱在关胸下为急喘汗而不得呼吸。呼吸之中痛在于胁怅寒相搏形如疟状医反下之。故令脉数发热狂走见鬼心不为痞小
便淋沥小腹甚硬小便则尿血也。
寸口浮濡而关弱尺数者。以其人阳气本虚虚阳陷于阴分也若误下伤血必致狂走痞满尿血耳脉濡而紧濡则阳气微紧则
营中寒阳微卫中风发热而恶寒营坚胃气冷微呕心内烦医为有大热解肌而发汗亡阳虚烦躁心下苦痞坚表里俱虚竭卒起而头
眩客热在皮肤怅快不得眠不知胃气冷紧寒在关元技巧无所施汲水灌其身客热应时罢溧栗而振寒重被而覆之汗出而冒巅体
惕而又振小便为微难寒气因水发清谷不容间呕变反肠出颠倒不得安手足为微逆身冷而内烦迟欲从后救安可复追还。
此见脉濡而紧者。为阳气微营中寒阳微卫中风外则发热恶寒营紧胃中冷内则微呕心烦医不知其外热内冷以为大热而
从汗解之则表里俱虚客热浅在皮肤紧寒深在关元犹汲水灌其客热致寒证四出不可复救也。
脉浮而大浮为气实大为血虚血虚为无阴孤阳独下阴部者。小盒饭赤而难胞中当虚今反小便利而大汗出法应卫家当微
今反更实津液四射营竭血尽干烦而不得眠血薄肉消而成暴液医复以毒药攻其胃。此为重虚客阳去有期必下如污泥而死。
脉浮而大气实血虚虽偏之为害亦人所当有也。若此者阴部当见不足今反小便利大汗出外示有余殊非细。故设卫气之
实者。因得汗利而脉转微弱藉是与营无忤庶可安全若阳分之脉较前更加坚实则阳强于外阴必消亡于内所谓小便利大汗出
者。乃津液四射之征势必营竭血尽干烦不眠血薄肉消而成暴液下注之证此际安其胃固其液调和强阳收拾残阴岌岌不及况
复以毒药攻其胃转增奔迫之势而蹈重虚之戒令客阳亦去下血如污泥而死哉。
师曰病患脉微而涩者。此为医所病也大发其汗又数大下之其人亡血病当恶寒后乃发热无休也时夏月盛热欲着复衣冬
月盛寒欲裸其身。所以然者。阳微则恶寒阴弱则发热。此医发其汗令阳气微利天下之令阴气弱五月之时阳气在表胃中虚
冷以阳气内微不能胜冷故欲着复衣十一月之时阳气在里胃中烦热以阴气内弱不能胜热。故欲裸其身又阴脉迟涩。故知亡
血也。
王肯堂曰大发其汗伤阳也。宜其脉微而恶寒又数大下之伤阴也。宜其脉涩而发热阴阳两伤则气血俱损而首末独言亡
血者何也曰下之亡阴不必言汗亦血类故也内虚之人夏月阳气在表则内无阳也故不胜其寒冬月阳气在里里阴既虚不能当邪
气之灼烁故不胜其热然诸脉弦细而涩按之无力者。往往恶寒苦振栗不止或时发躁蒸蒸而热如坐甑中必得去衣居寒处或饮
寒水则便如故其振寒复至非必遇夏乃寒遇冬乃热也此但言其例论其理耳。
立夏得洪大脉是其本位其人病身体苦疼重者须发其汗若明日身不疼不重者。不须发汗若汗 自出者明日便解矣何
以言之立夏得洪大脉是其时脉故使然也四时仿此。
立夏得洪大脉是温病之本脉若其人苦疼重乃热郁肌表未得发越之故须以辛凉苦寒药泄其郁热乃伏气发汗之正法也。
若明日身不疼重则营卫自和 然汗出自解无藉于药矣。
脉盛身寒得之伤寒脉虚身热得之伤暑。
寒伤形故脉盛身寒而后周身发热暑伤气故脉虚身热而独背微恶寒。
问曰病有战而汗出因得解者。何也答曰脉浮而紧。按之反芤此为本虚故当战而汗出也其人本虚是以发战以脉浮故当
汗出而解也。
问曰病有不战而汗出解者。何也答曰脉大而浮数故知不战汗出而解也若脉浮而数按之不芤此人本不虚若欲自解但汗
出耳不发战也。
问曰病有不战不汗出而解者何也答曰其脉自微此以曾经发汗若吐若下若亡血以内无津液此阴阳自和必自愈故不战不
汗出而解也。
问曰伤寒三日脉浮数而微病患身凉和者何也。答曰此为欲解也。解以夜半脉浮而解者。 然汗出也。
脉数而解者必欲食也脉微而解者必大汗出也。
上言脉微故不战汗出而解此言脉微而解者必大汗出二说相左何耶然上以曾经吐下亡血邪正俱衰不能作汗而解此以未
经汗下血气未伤邪正俱盛故必大战作汗而解不相左也。东垣云战而汗出解者太阳也不战有汗而解者。阳明也不战无汗而
解者。少阳也若先曾汗下必不尔矣。
问曰脉病欲知愈未愈者。何以别之答曰寸口关上尺中三处大小浮沉迟数同等虽有寒热不解者。此脉阴阳为和平虽剧
当愈。
病六七日手足三部脉皆至大烦而口噤不能言其人躁扰者必欲解也。
寸口脉微，是阳气亡失；脉涩，是阴血耗伤；脉弱而发热，是正气虚弱；脉紧，是寒邪侵袭。凡是寒邪乘虚而入的，就会发生四肢厥冷、胃气郁滞、肢体麻木不仁。这是因为胃中缺乏水谷精气的滋养，脾运迟滞、气机不通，导致口唇拘急、不能言语，身体战栗发抖。
口唇拘急、不能言语，是因为脾脏所藏之血不足，无法上通于心气所致。
寸口脉微，尺脉紧，此人属于虚损体质且多汗，说明阴气偏盛而阳气绝迹，不见阳脉。
少阴脉不至，说明肾气微弱，精血亏少。奔豚之气急促迫逆，向上冲入胸膈，导致宗气郁结，血液凝结在心下（心前区），阳气退居下部，热气归于阴股（大腿内侧）。阴阳之气相互激荡，导致身体麻木不仁。这称为“尸厥”，应当针刺期门穴和巨阙穴。
肾中的真阳之气不能统摄于周身，则阴气上迫于阳位，所以宗气郁聚、血液凝结。心下的阳气因此不得舒展，陷入至阴之地，周身只有阴气而没有阳气，遂致麻木不仁和厥冷。治疗应当针刺期门穴以破除结血，针刺巨阙穴以运行宗气。宗气布散，阳气自然恢复，厥冷自退。
寸口脉浮而大：浮脉主虚，大脉主实。若见于尺部为“关”证，见于寸部为“格”证。“关”证则小便不通，“格”证则呕吐逆反。
趺阳脉伏而涩：脉伏则呕吐逆反、水谷不化；脉涩则饮食难入。这称为“关格”。
上一条论述以脉象虚大倍于常人为关格，见于尺部为关，见于寸口为格，所以知道凡言“寸口”都是统括三部脉而言的。○下一条论述以关部脉伏涩异常为关格，盖因脉伏则气机阻滞，脉涩则血行寒凝。上一条乃是正气衰败、邪气实盛的不可治之证；下一条是寒邪闭拒、尚可治疗的证候，不可不仔细辨别。
趺阳脉不出，说明脾气不能上下输布，导致身体寒冷、皮肤坚硬。
身体寒冷，是因为胃气不能温煦；皮肤坚硬，是因为营血不能濡润。由于营卫之气衰败，所以趺阳脉不出，脾气不能上下输布，最终形成脏厥的证候。
寸脉向下不及关部，称为阳绝；尺脉向上不及关部，称为阴绝。这些都属于不治之症。
关部是阴阳交汇的交界点，关上脉绝则意味着阴阳离决，所以不治。
寸口脉阴阳俱紧，按照法度，这是清邪（雾露之气）中于上焦，浊邪（寒湿之气）中于下焦。阴邪侵入人体，必然引起体内战栗。表气微微虚弱，里气不能固守，所以使邪气中于阴分。阳邪侵入人体，必然引起发热、头痛、项强、小腿挛急、腰痛、小腿酸楚。这就是所谓阳中雾露之气，所以说清邪中于上焦，浊邪中于下焦。阴气战栗表现为足膝逆冷，大小便失控。表气微微虚弱，里气微微紧急，三焦混杂不清，内外气机不通。上焦郁结，脏气相互熏蒸，导致口腔糜烂、食物难咽。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，与热邪相搏，热邪游走于经络，出入脏腑，热气经过的地方就会形成痈脓。如果阴气先通，阳气微弱，阴气无所依附，客气内入，打喷嚏后声音嘶哑，咽喉堵塞，寒厥与热邪相互追逐，被热邪拥遏，血液凝滞自行下泄，状如猪肝。阴阳都发生厥逆，脾气孤弱，五液注泄下行，下焦关门不固，大便频数困难，脐腹筑痛，性命难保。
以下五条都论述阴阳错杂之邪，所谓“三焦混杂，内外不通”，是时行疫疠病的总诀。而伤寒坏证、温热夹阴证也往往有内外合邪的情况。这一条说寸口脉阴阳俱紧，是邪气乘虚初犯中焦，内外受伤但尚未变为实证。寸脉浮而紧，是清阳雾露之气伤了阳分，所以说清邪中于上焦；尺脉沉而紧，是浊阴寒湿之邪伤了阴分，所以说浊邪中于下焦。清邪中于上焦，则出现发热、头痛、项强、小腿挛急等症状，这些都是外感表证；浊邪中于下焦，则阴气战栗，表现为身体不战栗但心中惕惕然内惧，足膝逆冷等症状，这都是邪客阴经的证候。现在表气征象虚弱，则阳气内入；里气征象紧急，则阴邪上逆，因此三焦混乱，内外不通。郁于上焦则牙龈损伤不能咀嚼；中焦失治，则不能运化水谷；营卫不通而血液凝滞不流。如果阳气先通，膀胱之邪欲散，所以小便赤黄；邪热游溢经络，则形成痈脓。假如阴气先通，则阳气微弱，不能卫外，寒气内客于肺，打喷嚏后声音嘶哑，因为寒气客于肺，所以声音闭塞不能发出。寒指外邪，厥指内邪。内外之邪合并相互追逐，被热邪拥遏，则血液凝滞自行下泄。阴阳都发生厥逆，是说脾胃之气不相顺接，胃中阳气不行，不能敷布中外，所以四肢逆冷；脾中阴气孤弱，不能约制下焦，所以五液注泄，排便次数多、肛门重坠且困难。脐是生气之源，脐腹筑痛，说明生气将绝。盖因邪气伤犯中焦，清浊混杂，三焦都生病，汗法和下法都难以施用，治疗稍有失误，就会变证百出。
脉象阴阳俱紧，口中气息粗出，嘴唇口舌干燥，蜷卧，脚冷，鼻中流涕，舌上苔滑，不要妄加治疗。等到第七天，如果病人微微发热，手足温暖，这是病情将要解除的征兆。如果到了第八日以上反而大发热的，这是难治之证。假使恶寒的，必定想呕吐；腹内痛的，必定想腹泻。
这种脉象和证候，表里阴阳混淆，处于未确定的疑似之间，千万不要妄投药物，应从容等待。如果在七日之外出现当解的征兆，如微热、手足温，则是邪气解除而自愈。如果到了八日以上，本该解除却不解，反而大发热，这是逆证，不可治。然而张仲景只说“难治”，并非直接说“不治”。所以下文说：如果寸脉浮紧且恶寒的，必定呕吐，这是清阳雾露之邪溢于上焦；尺脉沉紧且腹痛的，必定腹泻，这是浊阴寒湿之邪走于下焦。邪气既然得以从上下消散，就可以顺着病势进行治疗了。
脉象阴阳俱紧，直到出现吐利，如果脉象唯独紧象不退，人反而安和，这是将要解除的征兆。如果脉迟，到了六七天不想吃东西，这是晚发，因为有水饮停蓄，所以为未解。如果能正常进食，就是将要解除。
脉象阴阳俱紧，说明内外都有邪气。到了吐利之后，邪气已随吐利排出，脉紧应当消退。如果吐利后紧脉独存，反而不想吃东西，都是因为脾胃气虚，水饮停蓄，成为晚发的变证。如果到了七天，脉紧逐渐消退，人安和能食，这才是将要解除。
伤寒脉象阴阳俱紧，伴有恶寒发热，则脉象会出现“厥”象。“厥”是指脉象初来时大，渐渐变小，再来的时候又渐渐变大，这就是其征候。恶寒严重的，会翕翕出汗，喉咙痛；热多的，眼睛红，脉象多而眼神不明亮。医生如果再次发汗，会损伤咽喉；如果再次攻下，会导致两眼闭合。寒多的，大便中有未消化的食物；热多的，大便有脓血。如果用火熏疗法，身体会发黄；如果用火熨疗法，会咽喉干燥。如果小便利的，可以救治；小便困难的，情况危急。
脉来呈“厥”象，如同厥逆证的寒热交争。初来时脉大，是邪气鼓动；渐渐变小，是正气受伤；再来的时候渐渐变大，是邪气复进。大概是因为其人正气本虚，不能主持，随邪气的进退而进退，所以脉象忽大忽小。经云：“不大不小，虽困可治；其有大小者，为难治。”说的就是这个道理。恶寒严重，则发热、翕翕出汗、喉咙痛，因为少阴经脉循行喉咙，所以如此。热多，是太阳经受邪多。眼睛红，脉象多而眼神不明亮，因为太阳经脉起于目，所以如此。发汗攻伐阳分，则少阴之热因发汗而上行，所以咽喉受伤；如果再次攻下，则太阳之邪因虚而内陷，所以两眼闭合。阴邪下行为寒多，必大便清谷；阳邪下行为热多，必大便脓血。熏之，火热伤表，身体必发黄；熨之，火邪内逼，必为咽喉干燥。小便利，津液未竭，犹可救之；小便难，津液已绝，为危殆之证。
伤寒发热，口中勃勃热气外出，头痛，眼睛黄，鼻衄不止，想喝水的，必定呕吐；厌恶水的，会发生厥逆。如果误用下法，咽喉会长疮。假如手足温暖的，必定肛门重坠，大便脓血。头痛、眼睛黄的，如果误用下法，会导致两眼闭合。想喝水的，误下后脉象必现厥象，声音嘶哑，咽喉闭塞。如果误用发汗，则阴阳俱虚，发生战栗。厌恶水的，如果误用下法，则里冷，不想吃东西，大便完谷不化。如果误用发汗，则口中生疮，舌上白苔，烦躁，脉数实，不大便六七日后，必定便血。如果误用发汗，则小便利。
发热，口中勃勃热气外出，是邪气变热冲于膈上。头痛、眼睛黄、鼻衄不止，是热郁于经络。想喝水，是因为无阴，邪气并于上焦，所以必定呕吐。厌恶水，是因为无阳，邪气并于中焦，所以发生厥逆。如果误用下法，里虚热结，必定咽喉痛、厥逆。假如手足不厥冷，则热邪不行而发生协热利。如果头痛、眼睛黄，是邪在太阳经，误下后热气内伏，则目闭。想喝水的，热在上焦，误下伤阴，必脉厥、声嘶、咽喉闭塞。发汗伤阳，则阴阳俱虚而战栗。厌恶水的，是阳虚，误下则里冷，不食，完谷不化。发汗，虚阳上乘，口伤，舌上白苔，烦躁。如果目黄、漱水不欲咽、不大便，六七日后必定便血。如果发其汗，则小便自利。今反自利的，是太阳之瘀热结于膀胱，而小便偏渗。瘀血为阴邪，虽然存在，但像任脉实证一样，不能消耗津液，所以小便自利。○“下之”二字是从《玉函经》增入的。
脉濡而弱，弱脉反见于关部，濡脉反见于巅部（寸部），弦脉反见于上部，微脉反见于下部。弦脉主阳气运行不利，微脉主阴寒。上实下虚，想要温暖。微弦为虚，不可发汗。发汗则寒战，不能自还。咳嗽的，则病情加重，频繁吐涎沫，咽喉必定干燥，小便不利，常常感到饥饿，心烦时发作，形体似疟疾，有寒无热，虚而寒战。刻刻发汗，蜷缩而苦于胀满，腹中又坚实。
脉濡而弱，弱脉反见于关部，濡脉反见于巅部，弦脉反见于上部，微脉反见于下部。弦脉主阳气运行不利，微脉主阴寒。上实下虚，想要温暖。微弦为虚，虚者不可下。微则为咳，咳则吐涎。下之则咳止而腹泻，困顿不休。腹泻不休，则胸中如虫咬，喝粥则吐出，小便不利，两胁拘急，喘息困难，颈背牵引，手臂麻木不仁。极寒反而出汗，身体冷如冰，眼睛不明亮，语言不休，但谷气多入，这称为“除中”。口虽想说话，舌头却不能伸出。
这两条论述尺中脉微弱者，不可汗下。看其“意欲得温”一句话，就可以清楚看出病情。上一条说寸口微见弦脉而咳嗽剧烈、吐涎等证，知道是胃气本虚而挟带寒饮，速宜温养中上焦。误发汗，则胃中阳气愈伤，客邪固结愈甚。或因刻刻发汗，遂至蜷缩而苦于胀满，腹中又坚实，都是阴邪水饮痞塞的现象。下一条说寸口微见弦脉而咳吐涎沫等证，仍为胃气本虚，也宜培理中土。若误用吐下之法，下利不止，胃中空虚而反暴食，为“除中”；少阴虚寒而反冷汗，为外脱；及口虽想说话，舌萎不能前伸等死证，较上一条证更剧，以下更甚于汗法。
脉濡而弱，弱脉反见于关部，濡脉反见于巅部，微脉反见于上部，涩脉反见于下部。微，则阳气不足；涩，则无血。阳气反微，中风汗出而反躁烦。涩，则无血，厥而且寒。阳微，发汗则躁不得眠。
脉濡而弱，弱脉反见于关部，濡脉反见于巅部，微脉反见于上部，涩脉反见于下部。微，则阳气不足；涩，则无血。阳气反微，中风汗出而反躁烦。涩，则无血，厥而且寒。阳微，不可下。下之则心下痞硬。
这两条论述尺中脉涩者，不可汗下。阳微阴涩，气血两亏，而关上脉复弱，胃土亦衰。所以汗下俱禁。阳微复用阳药发汗，则阳气转伤，必躁不得眠；阳微而用阴药攻下，则阳气内陷，必心下痞硬也。
脉濡而弱，弱脉反见于关部，濡脉反见于巅部，浮脉反见于上部，数脉反见于下部。浮为阳虚，数为衄血。浮为虚，数为热。浮为虚则自汗出而恶寒，数为痛，伏寒而战栗。微弱在关部，胸下紧急，喘汗而不得呼吸。呼吸之中痛在于胁，怅然寒热相搏，形如疟状。医生反而下之，所以令脉数、发热、狂走、见鬼、心不为痞、小便淋沥、小腹甚硬、小便尿血。
寸口浮濡而关弱尺数者，是因为其人阳气本虚，虚阳陷于阴分。如果误下伤血，必致狂走、痞满、尿血。耳脉濡而紧，濡则阳气微，紧则营中寒。阳微卫中风，发热而恶寒；营坚胃气冷，微呕，心内烦。医生以为有大热，解肌而发汗，亡阳虚烦躁，心下苦痞坚。表里俱虚竭，卒起而头眩。客热在皮肤，怅快不得眠。不知胃气冷，紧寒在关元。技巧无所施，汲水灌其身。客热应时罢，溧栗而振寒。重被而覆之，汗出而冒巅。体惕而又振，小便为微难。寒气因水发，清谷不容间。呕变反肠出，颠倒不得安。手足为微逆，身冷而内烦。迟欲从后救，安可复追还。
此见脉濡而紧者，为阳气微，营中寒。阳微卫中风，外则发热恶寒；营紧胃中冷，内则微呕心烦。医生不知其外热内冷，以为大热而从汗解之，则表里俱虚。客热浅在皮肤，紧寒深在关元，犹汲水灌其客热，致寒证四出，不可复救也。
脉浮而大，浮为气实，大为血虚。血虚为无阴，孤阳独下阴部者，小便当赤而难，胞中当虚。今反小便利而大汗出，法应卫家当微，今反更实。津液四射，营竭血尽，干烦而不得眠，血薄肉消，而成暴液。医复以毒药攻其胃，此为重伤其虚。客阳去有期，必下如污泥而死。
脉浮而大，气实血虚，虽偏之为害，亦人所当有也。若此者，阴部当见不足，今反小便利、大汗出，外示有余，殊非细故。故设卫气之实者，因得汗利而脉转微弱，藉是与营无忤，庶可安全。若阳分之脉较前更加坚实，则阳强于外，阴必消亡于内。所谓小便利、大汗出者，乃津液四射之征，势必营竭血尽，干烦不眠，血薄肉消，而成暴液下注之证。此际安其胃，固其液，调和强阳，收拾残阴，岌岌不及，况复以毒药攻其胃，转增奔迫之势，而蹈重虚之戒，令客阳亦去，下血如污泥而死哉。
老师说：病人脉微而涩，这是医生治疗不当造成的。大发其汗，又多次大下之，其人亡血。病本当恶寒，后来乃发热无休。夏天盛热时，想穿厚衣；冬天盛寒时，想裸露身体。之所以这样，是因为阳微则恶寒，阴弱则发热。这是医生发其汗，令阳气微；利天下之令，阴气弱。五月之时，阳气在表，胃中虚冷，以阳气内微，不能胜冷，故欲着复衣。十一月之时，阳气在里，胃中烦热，以阴气内弱，不能胜热，故欲裸其身。又阴脉迟涩，故知亡血也。
王肯堂说：大发其汗，伤阳也，宜其脉微而恶寒；又数大下之，伤阴也，宜其脉涩而发热。阴阳两伤，则气血俱损。而首末独言亡血者何也？曰：下之亡阴不必言，汗亦血类故也。内虚之人，夏月阳气在表，则内无阳也，故不胜其寒；冬月阳气在里，里阴既虚，不能当邪气之灼烁，故不胜其热。然诸脉弦细而涩，按之无力者，往往恶寒苦振栗不止，或时发躁，蒸蒸而热，如坐甑中，必得去衣居寒处，或饮寒水则便如故。其振寒复至，非必遇夏乃寒，遇冬乃热也。此但言其例，论其理耳。
立夏得洪大脉，是其本位。其人病身体苦疼重者，须发其汗。若明日身不疼不重者，不须发汗。若汗自出者，明日便解矣。何以言之？立夏得洪大脉，是其时脉，故使然也。四时仿此。
立夏得洪大脉，是温病之本脉。若其人苦疼重，乃热郁肌表，未得发越之故，须以辛凉苦寒药泄其郁热，乃伏气发汗之正法也。若明日身不疼重，则营卫自和，漐然汗出自解，无藉于药矣。
寒伤形，故脉盛身寒，而后周身发热；暑伤气，故脉虚身热，而独背微恶寒。
问曰：病有战而汗出因得解者，何也？答曰：脉浮而紧，按之反芤，此为本虚，故当战而汗出也。其人本虚，是以发战；以脉浮，故当汗出而解也。
问曰：病有不战而汗出解者，何也？答曰：脉大而浮数，故知不战，汗出而解也。若脉浮而数，按之不芤，此人本不虚，若欲自解，但汗出耳，不发战也。
问曰：病有不战不汗出而解者，何也？答曰：其脉自微，此以曾经发汗，若吐，若下，若亡血，以内无津液，此阴阳自和，必自愈，故不战不汗出而解也。
问曰：伤寒三日，脉浮数而微，病患身凉和者，何也？答曰：此为欲解也。解以夜半，脉浮而解者，漐然汗出也。脉数而解者，必欲食也；脉微而解者，必大汗出也。
上言脉微，故不战汗出而解；此言脉微而解者，必大汗出。二说相左，何耶？然上以曾经吐下亡血，邪正俱衰，不能作汗而解；此以未经汗下，血气未伤，邪正俱盛，故必大战作汗而解，不相左也。东垣云：战而汗出解者，太阳也；不战有汗而解者，阳明也；不战无汗而解者，少阳也。若先曾汗下，必不尔矣。
问曰：脉病欲知愈未愈者，何以别之？答曰：寸口、关上、尺中三处，大小、浮沉、迟数同等，虽有寒热不解者，此脉阴阳为和平，虽剧当愈。
The pulse at the Cun Kou (Cun position of the radial artery) being faint indicates the loss of Yang Qi. A choppy pulse indicates the depletion of Yin Blood. A weak pulse with fever indicates deficiency of Zheng Qi (Upright Qi). A tight pulse indicates the invasion of Cold Evil. When Cold Evil takes advantage of deficiency, it leads to Jue syndrome (cold extremities), stagnation of Stomach Qi, and numbness of the body. This is because the Stomach lacks the Qi derived from food and drink, and the Spleen's transport function is sluggish, causing Qi obstruction. This results in stiffness of the mouth and inability to speak, along with shivering and trembling.
Stiffness of the mouth and inability to speak occur because the Blood stored in the Spleen is insufficient to ascend and connect with the Heart Qi.
If the pulse at the Cun Kou is faint and the Chi pulse (distal radial pulse) is tight, the person suffers from deficiency and exhaustion with profuse sweating. This indicates that Yin Qi is prevalent while Yang Qi is absent, as no Yang pulse is seen.
When Yang Qi is weak and Yin Qi prevails, compounded by profuse sweating, the Yang Qi becomes even more deficient.
When the Shao Yin pulse (radial pulse at the Shao Yin position or deep pulse indicating Kidney condition) is absent, it signifies that Kidney Qi is weak and Essence-Blood is scant. The rushing Qi (Ben Teng Qi) rushes upward into the chest and diaphragm, causing Zong Qi (Pectoral Qi) to stagnate and blood to congeal below the heart. Yang Qi retreats downward, and heat returns to the inner thighs. The interaction between Yin and Yang causes numbness of the body. This is called "Corpse Jue" (Shi Jue), and one should puncture the Qimen (LR14) and Juque (CV14) acupoints.
When the True Yang Qi in the Kidneys cannot govern the whole body, Yin Qi presses upward into the Yang regions. Consequently, Zong Qi stagnates and blood congeals. The Yang Qi below the heart fails to extend, sinking into the deepest Yin areas. With only Yin and no Yang throughout the body, numbness and Jue syndrome ensue. Treatment involves puncturing Qimen to break up congealed blood and Juque to promote the movement of Zong Qi. Once Zong Qi circulates, Yang Qi naturally recovers, and Jue subsides.
If the pulse at Cun Kou is floating and large: Floating indicates deficiency; Large indicates excess. If seen at the Chi position, it is called Guan (Obstruction); if seen at the Cun position, it is called Ge (Rebellion). Guan leads to inability to urinate; Ge leads to vomiting and reflux.
If the Fu Yang pulse (pulse at the dorsum of the foot) is hidden (Fu) and choppy (Se): Hidden indicates vomiting and reflux with undigested food and water; Choppy indicates difficulty in swallowing food. This is termed Guan Ge (Obstruction and Rebellion).
The previous passage discusses Guan Ge characterized by a pulse significantly larger than normal due to deficiency and excess. Guan is seen at the Chi position, and Ge at the Cun Kou. Thus, when "Cun Kou" is mentioned, it generally refers to all three positions (Cun, Guan, Chi). The next passage discusses Guan Ge characterized by an abnormal hidden and choppy pulse at the Guan position. Hidden pulse indicates Qi stagnation; Choppy pulse indicates Cold in the Blood. The former case represents a terminal stage of righteous Qi decline and evil excess, which is untreatable. The latter case involves Cold Evil blocking and rejecting, which is treatable. These must be carefully distinguished.
If the Fu Yang pulse is imperceptible, it indicates that Spleen Qi cannot distribute upwards and downwards, leading to cold body and hard skin.
A cold body indicates that Stomach Qi fails to warm; hard skin indicates that Ying Blood fails to moisten. Due to the decline of Ying and Wei (Defensive) Qi, the Fu Yang pulse becomes imperceptible, Spleen Qi fails to distribute, and finally, Zang Jue (Visceral Cold Extremities) develops.
If the Cun pulse does not reach down to the Guan position, it is called Yang Jue (Yang Termination). If the Chi pulse does not reach up to the Guan position, it is called Yin Jue (Yin Termination). Both are untreatable.
The Guan position is the junction of Yin and Yang. If the pulse at Guan is absent, it signifies the separation of Yin and Yang, hence untreatable.
If the Yin and Yang pulses at Cun Kou are both tight, according to the principles, Clear Evil (misty dew) attacks the Upper Jiao, and Turbid Evil (cold-dampness) attacks the Lower Jiao. Invasion by Yin Evil causes internal shivering. Slight deficiency of Exterior Qi and failure of Interior Qi to guard allow the Evil to invade the Yin aspects. Invasion by Yang Evil causes fever, headache, neck stiffness, calf cramping, lower back pain, and leg soreness. This is referred to as Yang being attacked by misty dew. Hence, Clear Evil attacks the Upper Jiao, and Turbid Evil attacks the Lower Jiao. Yin Evil causes shivering, manifested as cold feet and knees, and involuntary urination and defecation. Slight deficiency of Exterior Qi and slight urgency of Interior Qi cause chaos in the Three Jiao and blockage of interior-exterior communication. Stagnation in the Upper Jiao causes organ Qi to harass each other, leading to oral ulcers and difficulty swallowing. Failure of the Middle Jiao leads to rebellious Stomach Qi, stagnant Spleen Qi, turbidity in the Stomach, blocked Ying-Wei circulation, and stagnant blood flow. If Wei Qi flows first, urine becomes dark yellow, clashing with Heat to create abscesses and pus where Heat passes through the meridians and organs. If Yin Qi flows first, Yang Qi is weak and Yin has no anchor, allowing Guest Evil to enter internally. Sneezing occurs, followed by hoarseness and throat blockage. Cold Jue and Heat chase each other, suppressed by Heat, causing blood to coagulate and pass spontaneously, resembling pig liver. Simultaneous Jue of Yin and Yang leads to isolated and weak Spleen Qi, leakage of the Five Fluids, and lower Jiao failing to close, resulting in frequent, difficult defecation with heavy sensation and umbilical pain, threatening life.
The following five passages discuss mixed Yin-Yang evils. "Chaos in the Three Jiao and blockage of interior-exterior" is the general principle for epidemic febrile diseases. Complicated cases of Shang Han (Cold Damage), Warm Diseases with Yin involvement, often feature combined interior-exterior evils. This passage states that simultaneous tightness of Yin and Yang pulses at Cun Kou indicates Evil initially attacking the Middle Jiao due to deficiency, injuring both interior and exterior without yet becoming Excess. Floating and tight Cun pulse indicates Clear Yang (misty dew) injuring Yang aspects (Clear Evil attacks Upper Jiao). Deep and tight Chi pulse indicates Turbid Yin (cold-damp) injuring Yin aspects (Turbid Evil attacks Lower Jiao). Clear Evil attacking Upper Jiao causes exterior symptoms like fever, headache, neck stiffness, and leg cramps. Turbid Evil attacking Lower Jiao causes Yin shivering, manifesting as internal palpitations without external shivering, and cold feet/knees, indicating Evil in Yin meridians. Now, signs of deficient Exterior Qi allow Yang to enter inward; signs of urgent Interior Qi allow Yin Evil to rebel upward, causing Three Jiao chaos and blockage. Stagnation in Upper Jiao damages gums and chewing; Middle Jiao failure prevents digestion; blocked Ying-Wei leads to blood stasis. If Yang Qi opens first, Bladder Evil disperses, causing dark yellow urine; Heat wandering meridians causes abscesses. If Yin Qi opens first, Yang is weak, Cold invades Lungs, causing sneezing and hoarseness. Cold refers to External Evil; Jue refers to Internal Evil. Combined evils clash, suppressed by Heat, causing spontaneous bloody discharge. Simultaneous Yin-Yang Jue means Spleen-Stomach Qi fail to connect; Stomach Yang fails to distribute, causing cold extremities; Spleen Yin is weak, failing to control Lower Jiao, causing fluid leakage and difficult, heavy defecation. Umbilicus is the source of vital Qi; umbilical pain indicates impending death of vital Qi. Evil injures Middle Jiao, mixing Clear and Turbid, affecting all Three Jiao. Both sweating and purging methods are difficult; slight timing errors lead to myriad complications.
With simultaneous tightness of Yin and Yang pulses, coarse breath, dry lips/mouth, curled posture, cold feet, runny nose, and slippery tongue coating, do not treat rashly. By the seventh day, if mild fever and warm hands/feet appear, resolution is imminent. If after the eighth day high fever returns, it is difficult to treat. Chills imply impending vomiting; abdominal pain implies impending diarrhea.
Given this confusing mix of Yin-Yang and interior-exterior, avoid rash medication. Wait patiently. If after seven days mild fever and warm extremities appear, Evil resolves spontaneously. If after eight days unresolved high fever persists, it is a counter-indication and untreatable. However, Zhang Zhongjing says "difficult to treat," not "untreatable." Subsequently, if Cun pulse is floating-tight with chills, vomiting occurs (Clear Evil overflowing Upper Jiao); if Chi pulse is deep-tight with abdominal pain, diarrhea occurs (Turbid Evil moving to Lower Jiao). Once Evil dissipates via upper/lower pathways, treatment can follow the momentum.
With simultaneous tightness of Yin and Yang pulses, if vomiting/diarrhea occur but the tight pulse remains, and the patient feels better, resolution is imminent. If the pulse becomes slow, and by day 6-7 there is anorexia, it is a late onset due to water retention, indicating non-resolution. Normal appetite indicates resolution.
Simultaneous tightness of Yin and Yang pulses indicates Evil inside and out. After vomiting/diarrhea, Evil is expelled, and the tight pulse should disappear. If the tight pulse persists post-vomit/diarrhea with anorexia, it indicates Spleen-Stomach Qi deficiency and water-fluid retention, a late complication. By day 7, if the tight pulse fades, the patient feels well and eats, resolution is confirmed.
In Shang Han, with simultaneous tightness of Yin and Yang pulses, chills, and fever, the pulse exhibits "Jue" characteristics: initially large, then gradually smaller, then gradually larger again. Severe chills cause sweating, sore throat; severe heat causes red eyes and dull vision. Re-sweating damages the throat; re-purging closes the eyes. Severe cold causes undigested stool; severe heat causes bloody/purulent stool. Moxibustion causes jaundice; ironing causes dry throat. Favorable prognosis if urination is free; critical if difficult.
"Pulse Jue" resembles alternating cold and heat. Initially large indicates Evil agitation; shrinking indicates Righteous Qi injury; enlarging again indicates Evil resurgence. Due to inherent Righteous Qi deficiency, the pulse follows the Evil's advance and retreat. Classics state: "Unchanged size, though severe, is treatable; varying sizes are difficult." Severe chills lead to sweating and sore throat (Shao Yin channel connects to throat). Severe heat leads to red eyes (Tai Yang channel originates in eyes). Sweating drives Shao Yin Heat upward, damaging the throat. Purging allows Tai Yang Evil to sink inward, closing the eyes. Yin Evil descending causes cold undigested stool; Yang Evil descending causes heat bloody stool. Moxibustion burns the exterior causing jaundice; ironing forces Fire inward causing dry throat. Free urination indicates fluids remain (treatable); difficult urination indicates fluid exhaustion (critical).
Shang Han fever with bubbling breath, headache, yellow eyes, uncontrollable epistaxis, desire to drink indicates vomiting (Yin deficiency, Evil in Upper Jiao). Aversion to water indicates Jue (Yang deficiency, Evil in Middle Jiao). Incorrect purging causes throat sores. If hands/feet are warm, tenesmus and bloody stool occur. Headache/yellow eyes worsen with purging (Eye closure). Desire to drink + purging causes Pulse Jue, hoarseness, throat blockage. Sweating causes Yin-Yang deficiency and shivering. Aversion to water + purging causes interior cold, anorexia, undigested stool. Sweating causes oral lesions, white tongue coating, irritability. If yellow eyes, rinsing mouth without swallowing, constipation for 6-7 days, hematochezia occurs. Sweating causes free urination (Sun Tai Yang stasis-heat in Bladder causing biased urination). Stasis-blood, being Yin Evil, does not consume fluids, hence free urination. ("Purging" added from Yu Han Jing).
Ruo (Soggy) and Ruo (Weak) pulses: Weak at Guan, Ruo at Cun, Xian (Wiry) at Upper, Wei (Faint) at Lower. Xian indicates Yang operation issues; Wei indicates Yin Cold. Upper Excess, Lower Deficiency, desire for warmth. Wei-Xian indicates deficiency; do not sweat. Sweating causes shivering and immobility. Coughing worsens with salivation, dry throat, dysuria, hunger, irritability, malaria-like symptoms (chills only). Continuous sweating causes curling, fullness, hard abdomen.
Ruo and Ruo pulses: Weak at Guan, Ruo at Cun, Xian at Upper, Wei at Lower. Xian indicates Yang issues; Wei indicates Yin Cold. Upper Excess, Lower Deficiency, desire for warmth. Wei-Xian indicates deficiency; do not purge. Wei indicates cough with salivation. Purging stops cough but causes endless diarrhea, chest discomfort, regurgitation of porridge, dysuria, hypochondriac tension, dyspnea, neck/back traction, arm numbness. Extreme cold with sweating, ice-cold body, dull eyes, incessant speech, excessive food intake indicates Chu Zhong (False Appetite). Mouth wants to speak, tongue cannot protrude.
These two passages warn against sweating/purging when Chi pulse is weak/faint. "Desire for warmth" reveals the pathology. First passage: Cun shows Xian with severe cough/salivation, indicating Spleen-Stomach deficiency with Cold-Fluid. Warmth is needed. Sweating injures Stomach Yang, consolidating Evil. Continuous sweating causes curling, fullness, hard abdomen (Yin-Fluid stagnation). Second passage: Similar Spleen-Stomach deficiency. Purging/vomiting causes endless diarrhea, empty stomach, false appetite (Chu Zhong). Shaoyin Cold with cold sweat indicates exterior collapse. Tongue atrophy indicates death. Second case is worse than the first.
Ruo and Ruo pulses: Weak at Guan, Ruo at Cun, Wei at Upper, Se (Choppy) at Lower. Wei indicates Yang insufficiency; Se indicates Blood deficiency. Yang Wei, Wind-Strike with sweating and irritability. Se indicates Blood deficiency, Jue with cold. Yang Wei, sweating causes irritability and insomnia.
Ruo and Ruo pulses: Weak at Guan, Ruo at Cun, Wei at Upper, Se at Lower. Wei indicates Yang insufficiency; Se indicates Blood deficiency. Yang Wei, Wind-Strike with sweating and irritability. Se indicates Blood deficiency, Jue with cold. Yang Wei, do not purge. Purging causes Epigastric fullness/hardness.
These two passages warn against sweating/purging when Chi pulse is Se. Yang Wei and Yin Se indicate Qi-Blood dual deficiency, with Guan weakness indicating Spleen decline. Both sweating and purging are contraindicated. Sweating Yang Wei with Yang drugs injures Yang further (irritability/insomnia). Purging Yang Wei with Yin drugs sinks Yang (epigastric fullness).
Ruo and Ruo pulses: Weak at Guan, Ruo at Cun, Fu (Floating) at Upper, Shu (Rapid) at Lower. Fu indicates Yang deficiency; Shu indicates Epistaxis. Fu indicates Deficiency; Shu indicates Heat. Fu-Deficiency causes sweating and aversion to cold; Shu-Pain indicates hidden Cold and shivering. Weakness at Guan causes chest urgency, panting, breathing pain in hypochondrium, malaria-like chill-heat. Incorrect purging causes rapid pulse, fever, mania, hallucinations, urinary dribbling, lower abdominal hardness, hematuria.
Cun Fu-Ruo, Guan Weak, Chi Rapid indicates Yang deficiency with Sunken Yang in Yin. Incorrect purging injures Blood, causing mania, fullness, hematuria. Ruo and Jin (Tight) pulses: Ruo indicates Yang micro; Jin indicates Ying Cold. Yang Micro/Wind strikes exterior (fever/chills); Ying Firm/Stomach Cold causes interior mild vomiting and vexation. Doctor mistakes exterior heat for interior heat, induces sweating, causing Yang loss, deficiency vexation, epigastric hardness. Interior-Exterior exhaustion causes dizziness upon rising. Guest heat on skin causes restlessness. Ignoring Stomach Cold and Guan Yuan Cold, using cold water irrigation extinguishes guest heat but triggers severe chills. Heavy blankets cause head sweating, tremors, difficult urination. Water-induced Cold causes undigested stool, vomiting, prolapse, restlessness, cold extremities, interior vexation. Late rescue is impossible.
Ruo-Jin pulse indicates Yang micro and Ying Cold. Yang micro/Wind causes exterior fever/chills; Ying Jin/Stomach Cold causes interior vomiting/vexation. Doctor treating exterior heat with sweating exhausts interior-exterior. Guest heat is superficial; Cold is deep at Guan Yuan. Irrigation fails to save.
Fu (Floating) and Da (Large) pulse: Fu indicates Qi Excess; Da indicates Blood Deficiency. Blood deficiency means Yin absence, solitary Yang sinking into Yin parts. Urine should be red/difficult, bladder empty. Instead, urine is free and sweating is profuse. Wei Qi should be weak, but appears strong. Fluids scatter everywhere, Ying empties, Blood exhausts, dryness/vexation/insomnia, thin flesh/blood loss, sudden fluid leakage. Doctor uses toxic drugs to attack Stomach, causing double deficiency. Guest Yang departs, leading to death with sludge-like stool.
Fu-Da pulse indicates Qi Excess/Blood Deficiency. If Yin parts show insufficiency but urine is free and sweating profuse, it falsely suggests Excess. If Wei Qi remains strong, pulse weakens after sweating/urination, allowing safety. If Yang pulse strengthens, Yang dominates externally, Yin perishes internally. Free urine/profuse sweating indicates fluid scattering, Ying/Blood exhaustion, dryness/vexation/insomnia, flesh wasting. At this critical juncture, stabilizing Stomach and securing fluids is urgent. Using toxic drugs increases pressure, leading to double deficiency and death with sludge-like stool.
Master says: Patient with Wei (Faint) and Se (Choppy) pulse is iatrogenic. Profuse sweating and repeated purging caused Blood loss. Initially chills, then unremitting fever. In summer heat, desires heavy clothes; in winter cold, desires nakedness. Yang Wei causes chills; Yin Weak causes fever. Sweating weakened Yang; purging weakened Yin. In May (Summer), Yang is in Exterior, Stomach is cold/deficient; internal Yang cannot overcome cold, hence desiring warmth. In November (Winter), Yang is in Interior, Stomach is hot; internal Yin cannot overcome heat, hence desiring coolness. Slow-Choppy Yin pulse confirms Blood loss.
Wang Kentang notes: Profuse sweating injures Yang (Wei pulse, chills); repeated purging injures Yin (Se pulse, fever). Yin-Yang dual injury damages Qi-Blood. Why focus on Blood loss? Purging injures Yin implicitly; sweating also affects Blood. In internal deficiency, Summer Yang in Exterior leaves Interior Yang-deficient (cannot bear cold). Winter Yang in Interior leaves Interior Yin-deficient (cannot bear heat flare). Generally, Xian (Wiry)-Xi (Fine)-Se (Choppy) pulses with forcelessness cause chills/shivering or irritability/heat like sitting in a steamer, relieved by cooling. This is not limited to seasonal chills/heat but illustrates the principle.
Hong Da (Surging-Large) pulse at Start of Summer is the normal seasonal pulse. Body ache/heaviness requires sweating. If ache/heaviness resolve next day, no sweating needed. Spontaneous sweating resolves it next day. Hong Da at Start of Summer is the root pulse of Wen Bing (Warm Disease). Body ache/heaviness indicates Heat stagnating in muscle surface. Acrid-cool/bitter-cold herbs vent Heat. If symptoms resolve next day, Ying-Wei harmonize, spontaneous sweating resolves it without medicine.
Pulse Strong/Body Cold indicates Shang Han; Pulse Weak/Body Hot indicates Shang Shu (Summerheat). Cold injures Form (Pulse Strong, Body Cold then Fever); Summerheat injures Qi (Pulse Weak, Body Hot, slight back chills).
Q: Why does battle with sweating resolve disease? A: Floating-Tight pulse, hollow on pressure indicates Root Deficiency. Battle occurs due to deficiency; sweating resolves due to Floating pulse.
Q: Why does non-battle sweating resolve disease? A: Large-Floating-Rapid pulse indicates no battle, resolution by sweating. Floating-Rapid, not hollow indicates no root deficiency; simple sweating resolves without battle.
Q: Why does non-battle, non-sweating resolve disease? A: Self-micro pulse indicates prior sweating/vomiting/purging/Blood loss, lacking fluids. Yin-Yang self-harmony leads to spontaneous recovery without battle or sweating.
Q: Shang Han day 3, Floating-Rapid-Micro pulse, cool/even body, what? A: Resolution imminent. Resolves at midnight. Floating pulse resolves with slight sweating. Rapid pulse resolves with appetite return; Micro pulse resolves with profuse sweating.
Previous micro pulse resolution lacked battle/sweating due to prior injury (Qi/Yin deficiency). Current micro pulse resolution involves battle/sweating because no prior injury (Qi/Blood intact, Strong Righteous/Evil). Dong Yuan clarifies: Battle+sweating = Tai Yang; No battle+sweating = Yang Ming; No battle/no sweat = Shao Yang. Prior treatment alters this.
Q: How to distinguish recovery? A: Cun, Guan, Chi positions equal in size, depth, rate. Even with lingering cold/heat, balanced Yin-Yang pulse indicates recovery despite severity.
Day 6-7, all three pulses present, severe vexation, locked jaw, inability to speak, restlessness indicates impending resolution.