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为阴阳和平虽剧当
愈(针经禁服篇云寸口人迎两者相应若引绳大小齐等者名曰平人言手之寸口脉与喉旁之人迎脉等齐为平人后条云六脉阴
阳俱停必先振栗汗出而解者是也)凡得病厥脉动数服汤药更迟脉浮大减小初躁后静此皆愈证也脉浮数而微病患身温和者
欲解也凡病反能饮水者为欲愈太阴中风脉阳微阴涩而长者为欲愈少阴中风脉阳微阴浮者欲愈厥阴中风脉微浮者欲愈不
浮未愈
太阳病已至未解 阳明病申至戌解
少阳病寅至辰解 太阴病亥至丑解
少阴病子至寅解 厥阴病丑至卯解
问曰凡病欲知何时得何时愈答曰假令日中得病夜半愈者以阳得阴则解也夜半得病日中愈者以阴得阳则解也病家人
请云病患苦发热身体疼病患自卧师到诊其脉沉而迟者知其瘥也何以知之表有病者脉当浮大今反沉迟故知愈也假今病患
云腹内卒痛病患自坐师到脉之浮而大者知其瘥也何以知之若里有病者脉当沉而细今脉浮大故知愈也
问曰病有战而汗出者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
若脉浮而数按之不芤此人本不虚若欲自解但出汗耳不发战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
问曰病有不战不汗出而解者何也答曰其脉自微以其曾经发汗若吐若下若亡血以内无津液待阴阳自和必自愈故不战
不汗出而解也上海藏云战而后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太阳病未解脉阴阳俱停必先战
栗汗出而解阳微者汗解阴微者下解
海 太阳传阳明其中或有下证阳明证反退而无热与不渴却显少阳证是知可解也太阳证知可解者为头不痛项不强肢
节不痛则知表易解也阳明证知可解者为无发热恶热则知里易解也少阳知可解者寒热日不移时而作邪未退也若用柴胡而
移其时早移之于晏晏移之于早气移之于血血移之于气是邪无可容之地知可解也可解之脉浮而虚不可解之脉浮而实浮而
虚者只在表浮而实者知已在里也汗多不解者转属阳明也
问:脉象与病情的关系,想要知道疾病是否即将痊愈,如何辨别呢?答:在寸口、关上、尺中这三个部位,脉象的大小、浮沉、迟数都同等协调。即使仍有寒热症状没有解除,这种脉象表明阴阳处于平和状态,虽然病情严重,也应当痊愈。(《针经·禁服篇》说:“寸口与人迎两处脉象相应,像拉紧的绳子一样大小整齐相等,这叫做平人。”意思是手部的寸口脉与喉旁的人迎脉大小相等为正常。后一条又说:“六脉阴阳俱停,病人必定先出现振颤战栗,随后出汗而解。”指的就是这种情况。)凡是患病时出现厥逆脉象,脉搏动数,服用汤药后脉搏反而变迟,或者脉象由浮大变为减小,或者初起躁动后来安静,这些都是疾病将要痊愈的征象。脉象浮数但按之微细,病人身体温和的,是疾病将要解除的表现。凡是生病反而能喝水的,是想要痊愈的迹象。太阴中风,脉象阳部微、阴部涩且长,是想要痊愈;少阴中风,脉象阳部微、阴部浮,是想要痊愈;厥阴中风,脉象微浮,是想要痊愈;如果不浮,则未愈。
太阳病,从巳时到未时(9:00-15:00)可能解除;阳明病,从申时到戌时(15:00-21:00)解除;少阳病,从寅时到辰时(3:00-9:00)解除;太阴病,从亥时到丑时(21:00-3:00)解除;少阴病,从子时到寅时(23:00-3:00)解除;厥阴病,从丑时到卯时(1:00-7:00)解除。
问:凡是生病,想要知道何时得病、何时痊愈,怎么回答呢?答:假如中午得病,半夜痊愈,这是因为阳气得到阴气的调和而解除;假如半夜得病,中午痊愈,这是因为阴气得到阳气的调和而解除。病人的家属请求诊断,说病人痛苦于发热、身体疼痛,病人自己躺卧。医生到来诊察其脉象,沉而迟,就知道病好了。为什么知道呢?表证有病,脉象应当浮大,现在反而沉迟,所以知道要痊愈了。假如病人说腹内突然疼痛,病人自己坐着。医生诊察脉象,浮而大,就知道病好了。为什么知道呢?如果里有病,脉象应当沉而细,现在脉象浮大,所以知道要痊愈了。
问:有的病人发生战栗然后出汗而解,这是什么原因呢?答:脉象浮而紧,按之反觉中空如葱管(芤脉),这是因为本身体虚,所以应当战栗然后出汗而解。这个人本来体虚,所以发生战栗;因为脉浮,所以应当出汗而解。如果脉象浮而数,按之不空,这个人本来不虚,如果想自愈,只是出汗罢了,不会发生战栗。问:有的病人不战栗也不出汗而解,这是什么原因呢?答:脉象自微,因为他曾经发过汗,或者用过吐法、下法,或者失血,导致体内津液不足,等待阴阳自然调和,必定自愈,所以不战栗也不出汗而解。上海藏云:战栗而后解的,属于太阳病;不战栗但有汗而解的,属于阳明病;不战栗无汗而解的,属于少阳病。太阳病未解,脉象阴阳俱停,必须先战栗,出汗而解。阳脉微者,通过汗法解;阴脉微者,通过下法解。
海藏(李东垣/张元素学派观点):太阳病传变至阳明病,其中或有下证,但阳明证反而退去,没有发热且不口渴,却显现出少阳证,这是知道可以解除。太阳证知道可解的,是因为头不痛、项不强、肢节不痛,所以知道表邪容易解除。阳明证知道可解的,是因为没有发热、恶热,所以知道里邪容易解除。少阳证知道可解的,是寒热往来不再固定在一个时辰发作,说明邪气未退。如果使用柴胡剂,使发作时间提前或推后,使气机由气分转入血分或由血分转入气分,这样邪气就没有容身之地,就知道可以解除了。可解的脉象是浮而虚,不可解的脉象是浮而实。浮而虚的,病邪只在表;浮而实的,知道病邪已在里。出汗多但未解的,转属阳明病。
Question: Regarding the relationship between pulse and disease, how can one distinguish whether a disease is about to heal? Answer: At the three positions of Cunkou (Radial Pulse at the wrist crease), Guanshang (Middle position of the radial artery), and Chizhong (Distal position of the radial artery), if the size, floating/sinking, and slow/rapid characteristics of the pulse are equal and harmonious, even if there are still unresolved cold or heat symptoms, this pulse indicates that Yin and Yang are in a state of peace. Although the condition may be severe, it will likely heal. (The *Needle Classic · Forbidden Service Chapter* states: "The pulses at Cunkou and Renying (Carotid pulse) correspond with each other, being equal in size like a taut rope; this is called a 'Ping Ren' (healthy person)." This means the Cunkou pulse on the hand and the Renying pulse beside the throat are equal in size, indicating normalcy. The subsequent clause states: "When the Yin and Yang of all six pulses cease [to show extreme deviation], the patient will first experience chills and tremors, then sweat, and subsequently recover." This refers to the aforementioned situation.) Generally, when a patient presents with Jue (Cold Extremities) pulse, which is rapid and active, but after taking herbal decoctions the pulse becomes slower, or changes from floating and large to smaller, or shifts from restless/agitated to calm, these are all signs of impending recovery. If the pulse is floating and rapid but feels fine upon pressure, and the patient's body temperature is moderate, the disease is about to resolve. If a patient suffering from illness desires to drink water, it is a sign of impending recovery. In Taiyin Wind Strike, if the Yang aspect of the pulse is slight, the Yin aspect is choppy yet long, it indicates impending recovery. In Shaoyin Wind Strike, if the Yang aspect is slight and the Yin aspect is floating, it indicates impending recovery. In Jueyin Wind Strike, if the pulse is slightly floating, it indicates impending recovery; if not floating, it has not yet recovered.
Taiyang Disease may resolve between Si and Wei hours (09:00–15:00); Yangming Disease resolves between Shen and Xu hours (15:00–21:00); Shaoyang Disease resolves between Yin and Chen hours (03:00–09:00); Taiyin Disease resolves between Hai and Chou hours (21:00–03:00); Shaoyin Disease resolves between Zi and Yin hours (23:00–03:00); Jueyin Disease resolves between Chou and Mao hours (01:00–07:00).
Question: For any illness, how does one determine when it was contracted and when it will heal? Answer: Suppose a person contracts the disease at noon and recovers at midnight; this is because Yang obtains Yin and thus resolves. Suppose a person contracts the disease at midnight and recovers at noon; this is because Yin obtains Yang and thus resolves. A family member requests an examination, stating the patient suffers from fever and body pain, lying down. When the physician arrives and palpates the pulse, finding it deep and slow, they know the patient is recovering. Why? Because for exterior diseases, the pulse should be floating and large; since it is now deep and slow, we know recovery is imminent. Suppose the patient complains of sudden abdominal pain, sitting upright. When the physician palpates the pulse and finds it floating and large, they know the patient is recovering. Why? Because for interior diseases, the pulse should be deep and fine; since it is now floating and large, we know recovery is imminent.
Question: Why do some patients experience shaking/chills followed by sweating and resolution? Answer: If the pulse is floating and tight, but feels hollow (Kou Pulse) upon pressure, this is due to underlying deficiency. Therefore, shaking/chills and subsequent sweating leading to resolution are expected. The person is inherently deficient, hence the shaking; because the pulse is floating, sweating and resolution are expected. If the pulse is floating and rapid, and does not feel hollow upon pressure, the person is not inherently deficient. If self-resolution occurs, it will be through sweating alone, without shaking/chills. Question: Why do some patients resolve without shaking/chills and without sweating? Answer: The pulse is naturally faint. This is because the patient previously underwent diaphoresis (sweating therapy), emesis, purgation, or lost blood, resulting in a lack of internal Jin-Ye (Body Fluids). Waiting for Yin and Yang to naturally harmonize leads to self-healing; thus, there is no shaking/chills and no sweating, yet resolution occurs. Shanghai Zang Yun (referring to Li Dongyuan/Zhang Yuansu school): Resolution after shaking/chills belongs to Taiyang Disease; resolution without shaking/chills but with sweating belongs to Yangming Disease; resolution without shaking/chills and without sweating belongs to Shaoyang Disease. In Taiyang Disease unresolving, if the Yin and Yang aspects of the pulse both cease [showing extreme stagnation], there must first be shaking/chills, then sweating and resolution. If the Yang pulse is slight, resolution occurs via sweating; if the Yin pulse is slight, resolution occurs via purgation.
Hai Zang (Li Dongyuan): When Taiyang Disease transmits to Yangming Disease, although there may be indications for purgation, the Yangming syndrome反而 (instead) recedes, with no fever, no thirst, yet Shaoyang syndrome appears. This indicates resolution is possible. For Taiyang syndrome, resolution is indicated if there is no headache, no stiffness of the neck, and no pain in the limbs/joints, indicating the exterior pathogen is easily resolved. For Yangming syndrome, resolution is indicated if there is no fever or aversion to heat, indicating the interior pathogen is easily resolved. For Shaoyang syndrome, resolution is indicated if the alternating chills and fever no longer occur at a fixed time, showing the pathogen has not fully retreated. If Chaihu Tang (Bupleurum Decoction) is used, shifting the timing of symptoms—either earlier or later, moving Qi into Blood or Blood into Qi—the pathogen loses its place of residence, indicating resolution is possible. The pulse indicating resolution is Floating and Deficient (Xu); the pulse indicating non-resolution is Floating and Excess (Shi). Floating and Deficient indicates the pathogen remains in the Exterior; Floating and Excess indicates the pathogen has entered the Interior. Profuse sweating without resolution indicates transmission to Yangming Disease.