之愆。不如遵柯氏之说。故存其说于前。而又复辨之。
【纲】仲景曰。病患脉数。数为热。当消谷引食。而反吐者。此以发汗。令阳气微。膈气虚。
脉乃数也。数为客热。不能消谷。以胃中虚冷。故吐也。
【目】张从正曰。此节言当察症而消息其虚实。不是据脉而论症。盖未发汗而脉浮数。是胃气实。
发汗后而脉浮数。
是胃气虚。
【纲】仲景曰。发汗已。脉浮数。烦渴者。五苓散主之。
【目】柯琴曰。病在表之表。宜麻黄。病在表之里。宜桂枝。病在里之表。宜五苓。病在里之
里。宜猪苓以利水。不可用五苓兼发汗。要知五苓是太阳半表半里之剂。归重又在半表。本条更加
烦渴。则热已在里。而表邪未罢。故用五苓也。
【纲】仲景曰。小结胸。正在心下。按之作痛。脉浮滑者。小陷胸汤主之。
结胸症。其脉浮大者。不可下。下之则死。
【目】柯琴曰。大结胸。是水结在胸腹。故脉沉紧。小结胸。是痰结于心下。故脉浮滑。
鳌按。浮大在阳明脉。心下硬者。是浮大为心脉。火必就燥。须急下之以存津液。太阳虽因热
入而成结胸。而大而尚浮。仍为表脉。恐热未实。下之则利不止。故必待沉紧。乃可下也。
【纲】仲景曰。如结胸状。饮食如故。时时下利。寸脉浮。关脉小细沉紧。名曰脏结。舌上白
苔滑者死。
【目】陶华曰。关主中焦。妄下而中气伤。故沉。寒水留聚于胸胁之间。故紧。不及尺者。重
在关。举关可以统之也。
【纲】仲景曰。心下痞。按之濡。大便硬。而不恶寒。反恶热。其脉关上浮者。大黄黄连泻心
汤主之。
【目】程郊倩曰。按之濡为气痞者。无形也。其可下乎。结胸症脉浮大。不可下。岂心下痞而
关上浮。可下乎。小结胸之痛。固未尝用大黄。何此比陷胸更峻。是必有当急下之症。比结胸更甚
者。方可用此峻攻之剂也。恐此脉此症而用此方。（要语）下咽立毙耳。勿曲护其说而遗害后人也。
【纲】仲景曰。病患无表里症。发热七八曰。不大便。虽脉浮数者。可下之。假令已下。脉数
不解。令热则消谷善饥。至六七日不大便者。有瘀血也。宜抵当汤。若脉数不解。下利不止。必协
热而便脓血也。
【目】龚信曰。脉浮数而可下。特以无表里症之故。则无表里症句是此节要眼。
【纲】仲景曰。风湿为病。脉阴阳俱浮。自汗出。身重。多眠睡。鼻息必鼾。语言难出。
伤寒八九日。风湿相搏。身体烦疼。不能自转侧。不呕不渴。脉浮而涩者。桂枝附子汤主之。
【目】魏荔彤曰。八九日。或已发汗而不易衣衾。不密掩覆。致湿与风兼袭于表。本乘阳虚而
来者。入而遂相搏为害。仍是阳微不能御之故也。夫湿与寒类。再兼风杂合。所以身疼体痛。与伤
寒相似。然不呕不渴。知非表有寒邪里有郁热也。况脉又浮虚而涩。虚浮为中风。虚涩为中湿。而
虚又专主阳微之义。故不与伤寒相涉也。伤寒症呕逆而喘。内热盛也。伤寒脉浮紧。表邪在也。无
此二者。而身疼体痛。俱不作表治矣。此一要谛也。
柯琴曰。上条。风胜湿轻。故脉阴阳俱浮。有内热。故汗自出。宜桂枝汤。下条。湿胜风微。
故脉浮虚而涩。内无热。而不呕渴。故可加附子。
【纲】仲景曰。伤寒吐下后。复发汗。虚烦。脉甚微。八九日。心下痞硬。胁下痛。气上冲咽
喉。眩冒。经脉动惕者。久而成痿。
【目】龚信曰。此从吐下复汗脉微。看出是虚烦。则其余症象。皆当于虚中求之。而不得误为
实也。
【纲】仲景曰。太阳病。六七日。表症仍在。而反下之。脉微而沉。反不结胸。其人发狂者。
热在下焦。少腹当硬满。小便自利者。下血乃愈。所以然者。以太阳随经瘀热在里故也。抵当汤主
之。
【目】黄仲理曰。此病发于阳。误下热入之症也。脉微而沉。宜四逆汤救之。此因误下。热邪
随经入腑。结于膀胱。致血燥而蓄于中。惟攻其里而表自解也。
【纲】仲景曰。太阳病。身黄。脉沉结。少腹硬。小便不利者。为无血也。小便自利。其人如
狂者。血结症也。抵当汤主之。
【目】喻昌曰。小便不利。何以见非血症耶。盖小便不利。乃热瘀膀胱无形之气病。为发黄之
候也。小便自利。则膀胱之气化行。然后少腹满者。允为有形之蓄血矣。庸工不能辨一实。于此等处。
未着眼耳。
柯琴曰。沉为在里。凡下后热入之症。如结胸发黄蓄血。其脉必沉。或紧或微或结。在乎受病
之轻重。而不可以因症分也。
【纲】仲景曰。其脉沉者。营气微也。营气微者。加烧针。则血留不行。更发热而烦躁也。脉
浮。宜以汗解。用火灸之。邪无从出。因火而盛。病从腰以下必重而痹。名火逆也。脉浮热盛。反
灸之。此为实。实以虚治。因火而动。必咽燥吐血。
微数之脉。慎不可灸。因火为邪。则为烦逆。追虚逐实。血散脉中。大气虽微。内攻有力。焦
骨伤筋。血难复也。伤寒脉浮。医以火劫之。亡阳。必惊狂。起卧不安者。桂枝去芍药加蜀漆龙骨
牡蛎救逆汤主之。
【目】程郊倩曰。脉浮热甚不可灸者。以营分受邪束血为实故也。若血少阴虚之人。脉见微数。
尤不可灸。虚邪因火内入。上攻则为烦为逆。阴本虚也。而更加火。则为追虚。热本实也。而更
加火。则为逐实。夫行于脉中者。营血也。血少被追。脉中无复血聚矣。艾火虽微。孤行无御。内
攻有力矣。无血可逼。焦燎乃在筋骨。盖气主 之。血主濡之。筋骨失其所濡。而火所到处。其骨
必焦。其筋必损。盖内伤真阴者。未有不流散于经脉者也。虽更滋荣养血。终难复旧。此则枯槁之
形立见。纵善调。亦终身为残废之人而已。
魏荔彤曰。伤寒脉浮而不言紧。此风多寒少之症。应斟酌青龙越婢之间发汗。乃以火迫劫取之。
火邪入而真阳出。名曰阳亡。真阳出而神明乱。惊狂遂见。程注所谓汗者。心之液是也。以火劫
取汗。火邪入心。阳随汗亡。惊狂而起卧不安。皆有伤心液。无以养心之神。而空虚之地。邪火更
易为害也。法不可单治表。当兼治里也。
或问。汗。阴液也。误发而何以阳亡。所用桂枝及蜀漆等皆阳药。又何以益阴生液。答曰。汗
液为阴而实由阳化。故汗出而阳微。诸药为阳。生阳所以安阴。阳气聚则阴敛生津。阳气亡则阴扰
耗津。阴阳相济吉。相悖凶。虽阴阳皆有邪正。初无二气。能于屈伸往来间。调停均平。此大寿之
基也。
鳌按。古来灸法。本为虚症设。不为风寒设。首条固属虚症。但阴阳俱竭。一加烧针。必致发
热烦躁。津液耗亡。此虚者尚不可以火劫也。下四条。俱言灸之之变。腰下重而痹。腰以下不得汗
也。咽燥吐血。由于阳盛。比衄更甚也。至焦骨伤筋。血难复则无生理。惊狂起卧不安。并方寸元
阳之神飞腾散乱矣。烧针火灸。不可妄用如此。仲景所以再三告诫也。后人每遇风寒。即加针灸。
不大昧仲景之旨乎。
【纲】仲景曰。太阳病。发汗太多。因致痉。脉沉而细。身热。足寒。头项强急。恶寒。时头
热。面赤。目脉赤。独头面摇。卒口噤。背反张者。痉病也。
【目】吴绶曰。阳脉本当浮也。今反沉。非营气微乎。沉而兼细者。非阳气少乎。其不成痉者
几希。
【纲】仲景曰。太阳病。关节疼痛而烦。脉沉而细者。此名湿痹。
【目】柯琴曰。浮为风。细为湿。太阳脉本浮。风湿为病。脉阴阳俱浮。浮虚而涩。今关节烦
疼。脉反沉细者。是发汗不如法。但风气去。湿流骨节为着痹也。
【纲】仲景曰。湿家病。身上疼痛。发热面黄而喘。头痛鼻塞而烦。其脉大。自能饮食。腹中
和无病。病在头中寒湿。故鼻塞。内药鼻中则愈。
【目】柯琴曰。脉大不浮。不关风矣。脉不沉细。非湿痹矣。
【纲】仲景曰。太阳中暑者。身热疼重而恶寒。脉微弱。此以夏月伤冷水。水行皮中所致也。
太阳中暑者。发热恶寒。身重而疼痛。其脉弦细芤迟。小便已洒洒毛耸。手足逆冷。小有劳。身即
热。口开。前板齿燥。
【目】柯琴曰。身热脉微。本是暑伤于气。而疼重恶寒。实因寒水沐浴。留在皮肤而然。弦细
芤迟。不得连讲。言中暑夹寒之脉。或微弱。或弦细。或芤迟。皆是虚脉。如脉浮而紧者。曰弦。
弦而细。则为虚矣。脉弦而大。则为芤。芤固为虚。芤
而迟。更为虚矣。以此脉而见发热恶寒身重疼痛等症。虽当炎夏。而虚寒可知。
【纲】仲景曰。欲自解者。必当先烦。乃有汗而解。何以知之。脉浮。故知汗出解也。太阳病。
未解。脉阴阳俱停。必先振栗汗出而解。但阳脉微者。先汗出而解。但阴脉微者。下之而解。若
欲下之。宜调胃承气汤。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。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。
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
不汗出而自解也。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。必能食也。脉微而解者。必不汗出也。
【目】柯琴曰。首条。浮为阳盛之脉。脉浮则阳自内发矣。二条。脉微二句。承上之词。不与
阴脉微对。太阳病本阳浮而阴弱。是阳强也。今阳脉数。即是阴阳俱微。脉但浮者阳盛。阳脉微者
阳虚。但阴脉微而阳脉仍浮。阳重可知。三条。紧与数相似不同。盖有虚实之别。又必按之芤不芤。
而虚实之真伪毕定。四条。内无津液。阴阳岂能自和。必当调其阴阳。不然。脉微则为亡阳。将
转成阴症矣。五条。即伤寒三日。少阳脉小为欲愈之义也。此微与前条不同。因未曾妄治。津液未
亡。故三日自解。阴平阳秘。不须汗出。正教人不宜妄汗耳。
的过失。不如遵循柯琴的说法。所以将他的说法保存在前面，然后又加以辨析。
【纲】张仲景说：病人脉象数，数主热，应当消谷善饥、食欲旺盛，反而呕吐的，这是因为发汗过度，导致阳气微弱，膈间气虚，脉象才表现为数。这种数是客热（外来的假热），不能消化食物，因为胃中虚冷，所以发生呕吐。
【目】张从正说：这一节讲的是应当观察症状来斟酌病证的虚实，不是单纯依据脉象来论断病症。大概没有发汗前脉象浮数，是胃气实；发汗后脉象仍浮数，则是胃气虚。
【纲】张仲景说：发汗之后，脉象浮数，心烦口渴的，用五苓散主治。
【目】柯琴说：病在表之表，宜用麻黄汤；病在表之里，宜用桂枝汤；病在里之表，宜用五苓散；病在里之里，宜用猪苓汤以利水。不可用五苓散兼以发汗。要知道五苓散是治疗太阳经半表半里的方剂，重点仍在半表。本条更加烦渴，说明热邪已在里，而表邪未解，所以用五苓散。
【纲】张仲景说：小结胸病，部位正在心下（胃脘部），按压时疼痛，脉象浮滑的，用小陷胸汤主治。结胸证，如果脉象浮大的，不可攻下，攻下则致死。
【目】柯琴说：大结胸是水饮结聚在胸腹，所以脉象沉紧；小结胸是痰浊结聚在心下，所以脉象浮滑。沈金鳌按语：浮大脉见于阳明经，心下硬满者，若浮大为心脉，火性就燥，必须急下以保存津液。太阳病虽然因热入而成结胸，但如果脉大而尚浮，仍属表脉，恐怕热邪尚未结实，攻下会导致腹泻不止。所以必须等到脉象沉紧，才可以攻下。
【纲】张仲景说：症状像结胸，但饮食如常，经常腹泻，寸脉浮，关脉小细沉紧，名叫脏结。舌上苔白滑的，预后不良，属死证。
【目】陶华说：关脉主中焦，误用攻下损伤中气，所以脉沉。寒水留聚于胸胁之间，所以脉紧。不及尺脉，是因为病重在于关脉，举按关脉可以统括整体情况。
【纲】张仲景说：心下痞塞，按之柔软，大便干硬，不恶寒，反恶热，脉象关部浮的，用大黄黄连泻心汤主治。
【目】程郊倩说：按之柔软属于气痞，是无形的邪气。这可以用攻下法吗？结胸证脉浮大，不可攻下，难道心下痞且关上脉浮，就可以攻下吗？小结胸的疼痛，本来就没有用过大黄，为什么这个方子比陷胸汤更峻猛？这必定有急需攻下的症状，比结胸更严重的，才可用此峻猛的攻下剂。如果对此脉此症用此方，（关键的话）药一下咽立刻毙命。不要曲意维护这种说法而遗害后人。
【纲】张仲景说：病人没有表证也没有里证，发热七八天，不大便，虽然脉象浮数，也可以用攻下法。假如已经攻下，脉数不解，身体发热则消谷善饥，到了六七天又不大便的，是有瘀血，宜用抵当汤。如果脉数不解，腹泻不止，必然协热而便脓血。
【目】龚信说：脉浮数而可下，特别是因为没有表里证的原因。“无表里症”这句话是这一节的要点。
【纲】张仲景说：风湿致病，脉象阴阳俱浮，自汗出，身体沉重，嗜睡，鼻息必鼾声，语言困难。伤寒八九日，风湿相搏，身体烦疼，不能自行转侧，不呕不渴，脉浮而涩的，用桂枝附子汤主治。
【目】魏荔彤说：八九日，或者已经发汗但没有更换衣被，没有严密覆盖，导致湿邪与风邪兼袭于体表。原本乘人体阳虚而来，进入体内遂相互搏结为害，仍然是阳气微弱不能抵御的缘故。湿邪与寒邪同类，再兼夹风邪杂合，所以身疼体痛，与伤寒相似。然而不呕不渴，知道不是表有寒邪里有郁热。况且脉象又浮虚而涩，虚浮为中风，虚涩为中湿，而虚脉专门主阳气微弱的含义，所以不与伤寒相混淆。伤寒症见呕逆而喘，是内热盛；伤寒脉浮紧，是表邪在。没有这两者，而身疼体痛，都不作为表证治疗了。这是关键要点。
柯琴说：上一条，风胜湿轻，所以脉阴阳俱浮，有内热，所以汗自出，宜用桂枝汤。下一条，湿胜风微，所以脉浮虚而涩，内无热，而不呕不渴，所以可加附子。
【纲】张仲景说：伤寒吐下之后，再次发汗，出现虚烦，脉象极微，八九日后，心下痞硬，胁下痛，气上冲咽喉，眩晕冒昧，经脉跳动惕惧的，日久会形成痿证。
【目】龚信说：这里从吐下复汗后脉微，看出是虚烦，那么其余症状表现，都应当在虚证中去寻求，而不能误认为是实证。
【纲】张仲景说：太阳病，六七天，表证仍在，反而攻下，脉象微而沉，反而不结胸，其人发狂的，热在下焦，少腹部应当硬满，小便自利的，下血才能痊愈。之所以这样，是因为太阳随经瘀热在里的缘故。用抵当汤主治。
【目】黄仲理说：此病发于阳，误下导致热邪内入的症状。脉微而沉，宜用四逆汤急救。这是因为误下，热邪随经入腑，结于膀胱，导致血燥而蓄积在中焦，只有攻逐里实而表证自然解除。
【纲】张仲景说：太阳病，身体发黄，脉象沉结，少腹硬，小便不利的，是无血证（非蓄血）。小便自利，其人如狂的，是血结证，用抵当汤主治。
【目】喻昌说：小便不利，怎么看出不是血症呢？盖小便不利，是热瘀阻膀胱无形之气分病变，是发黄的征候。小便自利，则膀胱的气化功能运行，然后少腹满，确实是形质的蓄血了。庸医不能辨别一个“实”字，在这些地方没有着眼点罢了。
柯琴说：沉脉主在里，凡是攻下后热邪内入的症状，如结胸、发黄、蓄血，其脉必沉，或紧或微或结，取决于受病的轻重，而不能因为症状不同而区别对待。
【纲】张仲景说：脉象沉的，是营气微弱。营气微弱的，再加烧针，则血液留滞不行，更加发热而烦躁。脉浮，宜用发汗法解除，如果用火灸，邪气无从出路，因火而邪盛，病从腰以下必定沉重而麻痹，名叫火逆。脉浮热盛，反而灸它，这是实证，以虚法治实，因火而动，必然咽干吐血。脉微数的，千万不可灸，因火成为邪气，则产生烦逆，追虚逐实，血液散乱于脉中，大气虽然微弱，内攻有力，焦骨伤筋，血液难以恢复。伤寒脉浮，医生用火法劫夺汗液，亡阳，必然惊狂，起卧不安的，用桂枝去芍药加蜀漆龙骨牡蛎救逆汤主治。
【目】程郊倩说：脉浮热甚不可灸的，因为营分受邪束血为实的缘故。如果血少阴虚的人，脉见微数，尤其不可灸。虚邪因火内入，上攻则为烦为逆。阴本虚，而再加火，则为追虚；热本实，而再加火，则为逐实。行于脉中的是营血，血少被追，脉中不再聚血。艾火虽然微弱，孤行无御，内攻有力。无血可逼，焦燎乃在筋骨。盖气主煦之，血主濡之。筋骨失去所濡养，而火所到之处，其骨必焦，其筋必损。内伤真阴的，无不流散于经脉之中。即使再滋荣养血，终难恢复旧观。这就枯槁之形立即显现，纵然善于调治，也终身成为残废之人而已。
魏荔彤说：伤寒脉浮而不言紧，这是风多寒少的症状，应斟酌在青龙汤、越婢汤之间发汗，却用火迫劫取汗液。火邪入而真阳出，名叫阳亡。真阳出而神明乱，惊狂遂现。程注所谓汗是心之液，用火劫取汗，火邪入心，阳随汗亡，惊狂而起卧不安，都有伤心液，无以养心之神，而空虚之地，邪火更易为害。法不可单治表，当兼治里。
有人问：汗，是阴液，误发汗为何导致阳亡？所用桂枝及蜀漆等皆是阳药，又何以益阴生津？回答说：汗液为阴而实际上由阳化生，故汗出而阳微。诸药为阳，生阳所以安阴，阳气聚则阴敛生津，阳气亡则阴扰耗津。阴阳相济吉，相悖凶。虽然阴阳皆有邪正，初无二气，能在屈伸往来间，调停均平，这是大寿的基础。
沈金鳌按语：古来的灸法，本是为虚证设立，不为风寒设立。首条固然属虚证，但阴阳俱竭，一加烧针，必致发热烦躁，津液耗亡，这虚证尚且不可以火劫。下四条，都是讲灸法的变证。腰下重而痹，是腰以下不得汗。咽燥吐血，由于阳盛，比衄血更严重。至于焦骨伤筋，血难复则无生理。惊狂起卧不安，并方寸元阳之神飞腾散乱矣。烧针火灸，不可妄用如此。张仲景所以再三告诫。后人每遇风寒，即加针灸，不是很不明白张仲景的宗旨吗？
【纲】张仲景说：太阳病，发汗太多，因而导致痉病，脉沉而细，身热，足寒，头项强急，恶寒，有时头热，面赤，目脉赤，独头面摇动，突然口噤，背反张的，是痉病。
【目】吴绶说：阳脉本当浮，现在反沉，不是营气微吗？沉而兼细，不是阳气少吗？不成痉病的几率很小。
【纲】张仲景说：太阳病，关节疼痛而烦，脉沉而细的，这名叫湿痹。
【目】柯琴说：浮为风，细为湿。太阳脉本浮，风湿为病，脉阴阳俱浮，浮虚而涩。现在关节烦疼，脉反沉细，是发汗不如法，只风气去，湿流骨节为着痹。
【纲】张仲景说：湿家病，身上疼痛，发热面黄而喘，头痛鼻塞而烦，脉大，能饮食，腹中和无病，病在头中寒湿，所以鼻塞，内药鼻中则愈。
【纲】张仲景说：太阳中暑者，身热疼重而恶寒，脉微弱，这是夏天伤冷水，水行皮中所致的。太阳中暑者，发热恶寒，身重而疼痛，脉弦细芤迟，小便已洒洒毛耸，手足逆冷，小有劳，身即热，口开，前板齿燥。
【目】柯琴说：身热脉微，本是暑伤于气，而疼重恶寒，实因寒水沐浴，留在皮肤而然。弦细芤迟，不得连讲，言中暑夹寒之脉，或微弱，或弦细，或芤迟，皆是虚脉。如脉浮而紧，曰弦，弦而细，则为虚矣。脉弦而大，则为芤，芤固为虚，芤而迟，更为虚矣。以此脉而见发热恶寒身重疼痛等症，虽当炎夏，而虚寒可知。
【纲】张仲景说：想要自愈的，必定先烦，才有汗而解。怎么知道？脉浮，所以知汗出解。太阳病，未解，脉阴阳俱停，必先振栗汗出而解。但阳脉微者，先汗出而解。但阴脉微者，下之而解。若想下之，宜用调胃承气汤。脉浮而紧，按之反芤，这是为本虚，所以当战而汗出。其人本虚，是以发战，以脉浮，故当汗出而解。若脉浮而数，按之不芤，此人本不虚，若想自愈，但汗出耳，不发战。其脉自微，这是曾经发汗，若吐，若下，若亡血，以内无津液，此阴阳自和，必自愈，故不战不汗出而自解。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，濈然汗出也。脉数而解者，必能食也。脉微而解者，必不汗出也。
【目】柯琴说：首条，浮为阳盛之脉，脉浮则阳自内发。二条，脉微二句，承上之词，不与阴脉微对。太阳病本阳浮而阴弱，是阳强。今阳脉数，即是阴阳俱微。脉但浮者阳盛，阳脉微者阳虚。但阴脉微而阳脉仍浮，阳重可知。三条，紧与数相似不同，盖有虚实之别，又必按之芤不芤，而虚实之真伪毕定。四条，内无津液，阴阳岂能自和，必当调其阴阳，不然，脉微则为亡阳，将转成阴症。五条，即伤寒三日，少阳脉小为欲愈之义。此微与前条不同，因未曾妄治，津液未亡，故三日自解，阴平阳秘，不须汗出，正教人不宜妄汗耳。
errors. It is better to follow Ke Qin's theory. Therefore, his theory is preserved above, and then further analyzed.
[Gang] Zhang Zhongjing said: When a patient has a rapid pulse (Shu Mai, Rapid Pulse), which indicates heat, one would expect increased appetite and digestion (Xiao Gu Yin Shi). However, if vomiting occurs instead, this is due to excessive sweating causing slight Yang Qi (Yang Qi) and deficiency of Qi in the Diaphragm (Ge Qi), resulting in a rapid pulse. This rapidness represents "guest heat" (Ke Re, transient/false heat) that cannot digest food; it is caused by cold deficiency in the Stomach (Wei Zhong Xu Leng), leading to vomiting.
[Mu] Zhang Congzheng said: This section emphasizes observing symptoms to assess excess or deficiency, rather than diagnosing solely based on the pulse. Generally, before sweating, a floating and rapid pulse indicates fullness of Stomach Qi (Wei Qi); after sweating, a persistent floating and rapid pulse indicates deficiency of Stomach Qi.
[Gang] Zhang Zhongjing said: After sweating, if the pulse is floating and rapid, accompanied by irritability and thirst, Wu Ling San (Five-Ingredient Powder with Poria) should be used as the primary treatment.
[Mu] Ke Qin said: If the disease is at the exterior-exterior, Mahuang Tang (Ephedra Decoction) is suitable. If at the interior-exterior, Guizhi Tang (Cinnamon Twig Decoction) is suitable. If at the exterior-interior, Wu Ling San is suitable. If at the interior-interior, Zhu Ling Tang (Polyporus Decoction) is suitable for draining water. Wu Ling San should not be used to induce sweating simultaneously. One must understand that Wu Ling San is a formula for the half-exterior half-interior stage of the Taiyang (Greater Yang) meridian, focusing primarily on the half-exterior. In this clause, the addition of irritability and thirst indicates heat has entered the interior while exterior pathogens remain unresolved, hence Wu Ling San is used.
[Gang] Zhang Zhongjing said: For minor Jie Xiong (Chest Binding/Knotting) syndrome, located exactly at the Xin Xia (Epigastrium/Heart Below), pain upon pressure, and a floating-slippery pulse (Fu Hua Mai), Xiao Xian Xiong Tang (Minor Chest-Penetrating Decoction) should be used. For Jie Xiong syndrome, if the pulse is floating and large, purgation is contraindicated; purging will lead to death.
[Mu] Ke Qin said: Major Jie Xiong is water binding in the chest and abdomen, hence the pulse is deep-tight (Chen Jin). Minor Jie Xiong is phlegm binding in the epigastrium, hence the pulse is floating-slippery. Shen Jin'ao's Note: A floating-large pulse appears in the Yangming meridian. If the epigastrium is hard, a floating-large pulse relates to the Heart pulse; Fire follows dryness, requiring urgent purgation to preserve fluids. Although Taiyang Jie Xiong forms due to heat entering, if the pulse is large yet still floating, it remains an exterior pulse. Fear that heat is not fully solidified, purging may cause unceasing diarrhea. Thus, one must wait for a deep-tight pulse before purging.
[Gang] Zhang Zhongjing said: Symptoms resembling Jie Xiong, but with normal diet and frequent diarrhea, a floating Cun (Inch) pulse, and small-fine-deep-tight Guan (Bar) pulse, is named Zang Jie (Zang Knotting). If the tongue has white slippery coating, it is a fatal prognosis.
[Mu] Tao Hua said: The Guan pulse governs the Middle Jiao. Improper purging damages Middle Qi, causing a deep pulse. Cold-water retention between the chest and hypochondrium causes a tight pulse. The absence of Chi (Cubit) pulse involvement indicates the pathology focuses on the Guan pulse; palpating the Guan pulse can summarize the condition.
[Gang] Zhang Zhongjing said: Epigastric stuffiness (Pi Syndrome), soft upon pressure, hard stool, aversion to cold absent but aversion to heat present, and a floating Guan pulse are treated with Da Huang Huang Lian Xie Xin Tang (Rhubarb and Scutellaria Decoction to Drain the Epigastrium).
[Mu] Cheng Jiaoqian said: Softness upon pressure indicates Qi Pi (Qi Stuffiness), which is formless. Can purgation be used? Jie Xiong with a floating-large pulse cannot be purged. How could Pi with a floating Guan pulse be purged? Minor Jie Xiong pain never used Rhubarb. Why is this formula more severe than Xian Xiong Tang? There must be symptoms requiring urgent purgation, worse than Jie Xiong, to justify such a harsh purgative. Using this formula for this pulse and symptom would cause immediate death upon swallowing. Do not blindly defend this theory and harm future generations.
[Gang] Zhang Zhongjing said: Patients without exterior or interior symptoms, feverish for seven to eight days, constipated, even with a floating-rapid pulse, may undergo purgation. If purged and the rapid pulse persists, heat causes increased appetite. By the sixth or seventh day, if constipation returns, there is blood stasis (Yu Xue); Di Dang Tang (Di-Dang Decoction) is indicated. If the rapid pulse persists with unceasing diarrhea, bloody pus in stool due to heat-collusion will occur.
[Mu] Gong Xin said: Purging despite a floating-rapid pulse is specific because there are no exterior or interior symptoms. "No exterior or interior symptoms" is the key point of this clause.
[Gang] Zhang Zhongjing said: Wind-Damp pathogenic factors cause both Ying and Yang pulses to be floating, spontaneous sweating, heavy body, somnolence, snoring nasal breathing, and difficulty speaking. After eight or nine days of Shang Han (Cold Damage), Wind-Damp interlocking causes painful body, inability to turn independently, no vomiting or thirst, and a floating-choppy pulse; Gui Zhi Fu Zi Tang (Cinnamon Twig and Aconite Decoction) is indicated.
[Mu] Wei Litong said: Eight or nine days later, perhaps after sweating without changing clothes or covering properly, Dampness and Wind attack the exterior together. Originally attacking due to Yang deficiency, they bind internally. This is still due to weak Yang failing to resist. Dampness is similar to Cold; mixed with Wind, it causes body pain similar to Shang Han. However, no vomiting/thirst indicates no exterior Cold or interior郁 Heat. Furthermore, the floating-deficient-choppy pulse indicates Wind-strike (floating-deficient) and Dampness-wind (deficient-choppy), with deficiency specifically indicating weak Yang. Thus, it differs from Shang Han. Shang Han presents with vomiting/wheezing (interior heat) or floating-tight pulse (exterior pathogen). Without these, body pain is not treated as an exterior syndrome. This is a crucial principle.
Ke Qin said: In the previous clause, Wind dominates Damp, so pulses are floating; interior heat causes sweating, so Guizhi Tang is used. In the next clause, Damp dominates Wind, so the pulse is floating-deficient-choppy; no interior heat means no vomiting/thirst, so Aconite is added.
[Gang] Zhang Zhongjing said: After Shang Han vomiting/purging and subsequent sweating, if vexation (Fan) occurs with a very faint pulse, and after eight or nine days, epigastric hardness, hypochondriac pain, Qi rushing to the throat, dizziness, and twitching meridians occur, it will eventually become Wei Syndrome (Atrophy Syndrome).
[Mu] Gong Xin said: From the faint pulse after vomiting/purging/sweating, we identify vexation as deficiency-related. Other symptoms should also be sought within deficiency, avoiding misdiagnosis as excess.
[Gang] Zhang Zhongjing said: In Taiyang disease, after six or seven days, if exterior symptoms persist but purgation was wrongly applied, resulting in a faint-deep pulse, no Jie Xiong, but mania (Kuang), the heat is in the Lower Jiao. The lower abdomen should be hard and full. If urination is free, bleeding resolves the condition. This is because Taiyang heat enters via the meridians and accumulates in the interior as blood stasis. Di Dang Tang is indicated.
[Mu] Huang Zhongli said: This illness originates in Yang; erroneous purging leads to heat entering. Faint-deep pulse suggests using Si Ni Tang (Frigid Extremities Decoction) for rescue. Due to erroneous purging, heat enters the Fu organs via meridians, binding in the Bladder, causing blood dryness and accumulation. Only by attacking the interior will the exterior resolve spontaneously.
[Gang] Zhang Zhongjing said: In Taiyang disease, if the body is yellow, pulse is deep-knotted, lower abdomen is hard, and urination is difficult, it is no-blood syndrome (non-hemostasis). If urination is free and the patient resembles madness, it is Blood Binding Syndrome; Di Dang Tang is indicated.
[Mu] Yu Chang said: How does difficult urination indicate non-blood syndrome? Difficult urination indicates heat stagnation in the formless Qi of the Bladder, a sign of jaundice. Free urination indicates Bladder Qi transformation is functioning; thus, lower abdominal fullness confirms tangible blood accumulation. Quack doctors fail to distinguish "excess" here.
Ke Qin said: Deep pulse indicates interior location. For post-purgation heat entering conditions like Jie Xiong, jaundice, or blood accumulation, the pulse must be deep, varying in tightness, faintness, or knotting depending on severity, not distinguished by symptoms alone.
[Gang] Zhang Zhongjing said: A deep pulse indicates deficient Ying Qi (Nutritive Qi). If Ying Qi is deficient and Moxibustion/Burning Needle (Shao Zhen) is applied, blood stagnates, causing further fever and restlessness. If the pulse is floating, sweating is appropriate; applying moxibustion traps the pathogen, exacerbating heat, leading to heaviness and numbness below the waist, named Huo Ni (Fire Deviation). If the pulse is floating with intense heat, moxibustion is wrongly applied to an excess condition treated as deficiency; fire agitates blood, causing dry throat and hematemesis. A fine-rapid pulse strictly forbids moxibustion; fire becomes a pathogen causing vexation and rebellion, chasing deficiency and pursuing excess, scattering blood in vessels. Though the Great Qi is weak, internal attack is powerful, scorching bones and damaging sinews, making blood recovery impossible. For Shang Han with floating pulse, if the doctor uses fire to force sweat, causing Yang collapse, mania, restlessness, Gui Zhi Qu Shao Yao Jia Shu Xi Long Gu Mu Li Jiu Ni Tang (Cinnamon Twig Decoction minus Peony plus Chinese Poppy Seed, Dragon Bone, and Oyster Shell Rescue-Normalizing Decoction) is indicated.
[Mu] Cheng Jiaoqian said: Floating pulse with intense heat forbids moxibustion because Ying level pathogen binds blood creating excess. For blood-deficient Yin-deficient persons with fine-rapid pulse, moxibustion is especially forbidden. Deficient pathogen enters via fire, attacking upward causing vexation/rebellion. Yin is already deficient; adding fire chases deficiency. Heat is already excess; adding fire pursues excess. Ying blood flows in vessels; if blood is scarce and chased, vessels lack blood aggregation. Mugwort fire, though weak, attacks inward powerlessly against empty vessels, scorching sinews and bones. Qi warms, Blood moistens. Sinews/bones lose moisture; where fire goes, bones scorch, sinews damage. True Yin injured internally scatters in meridians. Even nourishing blood cannot restore original state. Withered form appears immediately; even with good care, lifelong disability results.
Wei Litong said: Shang Han with floating pulse but not tight indicates more Wind than Cold. Sweating should be moderated between Qing Long Tang and Yue Bi Tang. Using fire to force sweat expels True Yang, named Yang Collapse. True Yang loss confuses Spirit, causing mania. Sweat is Heart fluid; fire forces sweat, heart fire enters, Yang collapses with sweat. Mania and restlessness stem from damaging Heart fluid, failing to nourish Heart Spirit. Empty space allows evil fire to harm. Treatment cannot focus only on exterior; interior must be addressed.
Question: Sweat is Yin fluid; why does erroneous sweating cause Yang collapse? Gui Zhi and Shu Xi are Yang herbs; how do they generate Yin/fluid? Answer: Sweat is Yin but transformed by Yang; thus sweating depletes Yang. Herbs are Yang; generating Yang stabilizes Yin. Yang gathering gathers Yin to generate fluid; Yang loss disturbs Yin consuming fluid. Yin-Yang harmony brings auspiciousness; opposition brings disaster. Though Yin-Yang have correct/incorrect aspects, they are one Qi. Balancing them during movement is the foundation of longevity.
Shen Jin'ao's Note: Ancient moxibustion was for deficiency, not Wind-Cold. The first clause is deficiency; with exhausted Yin-Yang, burning needles cause fever/restlessness and fluid loss. Even deficiency cannot tolerate fire coercion. The next four clauses discuss moxibustion complications. Heaviness/numbness below waist implies no sweat below. Dry throat/hematemesis indicates excess Yang, worse than nosebleed. Scorched bones/damaged sinews imply no survival. Mania/restlessness implies scattered Yuan Yang Spirit. Burning needles/moxibustion must not be used recklessly. Zhang Zhongjing warns repeatedly. Later doctors use acupuncture/moxa for every Wind-Cold case, misunderstanding Zhang Zhongjing's intent.
[Gang] Zhang Zhongjing said: Taiyang disease with excessive sweating leads to Jing Syndrome (Spasm). Pulse is deep-fine, body hot, feet cold, neck/back stiffness, aversion to cold, occasional head heat, red face, red eye vessels, isolated head/facial tremor, sudden jaw lock, opisthotonos (back arching). This is Jing Syndrome.
[Mu] Wu Shou said: Yang pulse should be floating; now deep, indicating deficient Ying Qi. Deep-fine indicates deficient Yang Qi. Rarely does it not become Jing Syndrome.
[Gang] Zhang Zhongjing said: Taiyang disease with joint pain and vexation, deep-fine pulse, is named Shi Bi (Damp Bi).
[Mu] Ke Qin said: Floating indicates Wind, fine indicates Damp. Taiyang pulse is naturally floating. Wind-Damp disease usually has floating pulses. Here, joint pain with deep-fine pulse indicates improper sweating; Wind left, Damp flows into joints causing Zhuo Bi (Fixed Bi).
[Gang] Zhang Zhongjing said: Shi Jia (Damp Patient) disease with body pain, fever, yellow face, wheezing, headache, nasal congestion, vexation, large pulse, able to eat, harmonious abdomen (no abdominal disease). Pathology is Cold-Damp in the head causing nasal congestion; inserting medicine into the nose cures it.
[Mu] Ke Qin said: Large but not floating pulse excludes Wind. Not deep-fine excludes Damp Bi.
[Gang] Zhang Zhongjing said: Taiyang Shu Zhong (Summerheat) presents with body heat, pain/heaviness, aversion to cold, and faint pulse. This is caused by drinking cold water in summer, water moving in the skin. Taiyang Shu Zhong also presents with fever, aversion to cold, body heaviness/pain, string-tiny-empty-slow pulse, chills after urination, cold extremities, fever upon slight exertion, open mouth, dry front teeth.
[Mu] Ke Qin said: Body heat with faint pulse indicates Summerheat damaging Qi. Pain/heaviness/aversion to cold is due to cold water bathing leaving residue in skin. String-tiny-empty-slow pulses should not be read continuously; they describe Summerheat complicated by Cold. Pulses may be faint, string-tiny, or empty-slow, all indicating deficiency. Floating-tight is called String; String-fine is deficiency. String-large is Empty; Empty is deficiency; Empty-slow is greater deficiency. With these pulses and symptoms (fever, aversion to cold, heaviness, pain), even in summer, deficiency-cold is evident.
[Gang] Zhang Zhongjing said: Spontaneous resolution begins with vexation, followed by sweating and resolution. How do we know? Floating pulse indicates sweating resolves it. In Taiyang disease unresolved, if Ying and Yang pulses stop, shaking/chills precede sweating and resolution. If only Yang pulse is faint, sweating resolves it. If only Yin pulse is faint, purging resolves it. To purge, Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct the Qi Decoction) is used. If pulse is floating-tight but feels empty upon pressure, this is root deficiency, causing shivering and sweating. Root deficiency causes shivering; floating pulse mandates sweating. If pulse is floating-rapid and not empty upon pressure, root is not deficient; spontaneous resolution requires only sweating, no shivering. If pulse is naturally faint due to prior sweating, vomiting, purging, or blood loss, lacking fluids, Yin-Yang self-harmonization ensures spontaneous resolution without shivering or sweating. Question: Shang Han on day three, floating-rapid-faint pulse, cool/even body temperature? Answer: Resolution is imminent. Resolution occurs at midnight. Floating pulse resolving means steady sweating. Rapid pulse resolving means ability to eat. Faint pulse resolving means no sweating.
[Mu] Ke Qin said: First clause: Floating is Yang-excess pulse; floating means Yang emerges from interior. Second clause: "Pulse faint" phrases continue previous context, contrasting with Yin pulse faintness. Taiyang disease naturally has floating Yang and weak Yin (Yang strong). Now Yang pulse rapid means both Yin and Yang are faint. Only floating indicates Yang excess; Yang faint indicates Yang deficiency. If Yin faint but Yang still floating, Yang dominance is known. Third clause: Tight and rapid are similar but differ in excess/deficiency. Pressing for emptiness determines truth. Fourth clause: Lack of fluids prevents Yin-Yang self-harmony; regulation is needed. Otherwise, faint pulse leads to Yang collapse and Yin syndrome. Fifth clause: Relates to Shaoyang pulse shrinking indicating recovery. This "faint" differs from previous; no erroneous treatment, fluids intact, resolving spontaneously in three days. Yin balanced, Yang secure, no sweating needed; teaching against reckless sweating.