篇名：上编 外治法
分类：经义
属性：『素问·脉要精微论』曰：肝脉搏坚而长，色不青，当病坠，若因血在胁
下，令人喘逆。
按、方剂：
注：[1]此言肝脉有刚柔，而病亦以异也。
[2]肝脉搏击于手，而且坚且长，其色又不青，当病或坠或搏，而血积于
胁下，令人喘逆不止也。
[3]正以厥阴之脉，布胁肋，循喉咙之后；其支别者，复从肝贯膈上注肺
，今血在胁下，则血之积气上熏于肺，故令人喘逆也。
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篇名：上编 外治法
分类：经义
属性：『金匮要略』曰：寸口脉浮，微而涩，然当亡血，若汗出。设不汗出者，
其身有疮，被刀斧所伤，亡血故也。
按、方剂：
注：[1]经言：夺血者无汗，夺汗者无血。盖二者皆当脉浮微而涩。
[2]今诊之如此，是有枯竭之象，而无汗出之证，非亡血而何？故知有金
伤或击扑而亡血之证也。
[3]又论曰：肝脉搏坚而色不变，必有击堕之事。
[4]因□肉无破，则恶血必留胁下，兼致呕逆，根据经针刺然谷足跗，或三
毛等穴出血，或饮利药使恶血开行，当自愈也。
[5]若脉浮微而涩，当知亡血过多，根据经于三结交关元穴灸之，或饮大补
气血之剂而调之，则病已矣。
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【上编 外治法 - 经义】
《素问·脉要精微论》中说：肝脉（肝脏经脉的脉象）搏动坚实而长，但面色并不发青，这应当是患有坠落伤，或者是因血液积聚在胁肋下方，导致人出现气喘、气逆的症状。
按语及方剂：
注释：
[1] 这段话讲的是肝脉有刚强与柔和的区别，因此疾病表现也各不相同。
[2] 肝脉在手指下搏动，既坚实又长，且面色不发青，这说明患者可能遭受了坠落或击打伤害，导致血液积聚在胁肋下方，使人不停止地气喘、气逆。
[3] 正因为足厥阴肝经的经脉，分布于胁肋部位，沿着喉咙后方上行；其分支从肝脏穿过膈肌，向上注入肺脏。现在血液积聚在胁肋下方，那么积血产生的邪气向上熏蒸于肺，所以导致人出现气喘、气逆的症状。
【上编 外治法 - 经义】
《金匮要略》中说：寸口脉（手腕桡动脉处诊得的脉象）浮取可见，脉势微弱且涩滞，此时应当是失血过多，或者是有汗出。如果不汗出的话，身上有疮疡，被刀斧等利器所伤，是因为失血造成的。
按语及方剂：
注释：
[1] 经典经文说：大量失血的人不能发汗，大量出汗的人不能耗血。大概这两种情况都应当表现为脉象浮、微、涩。
[2] 现在诊察脉象如此，这是气血枯竭的迹象，而没有汗出的症状，这不是失血是什么？所以知道有金属利器损伤或击打坠落导致失血的证候。
[3] 另外经文论述道：肝脉搏动坚实而面色没有改变，必定有击打或坠落的事情发生。
[4] 因为皮肤肌肉没有破损，那么恶血（瘀血）必然留滞在胁肋下方，兼带引起呕吐和气逆，根据经典记载针刺然谷穴和足跗部的三毛穴（大敦穴）使其出血，或者服用通利药物使恶血运行排出，应当能自愈。
[5] 如果脉象浮、微、涩，应当知道是失血过多，根据经典记载在“三结交”穴（即关元穴，此处指代特定灸疗位置或关联穴位）进行艾灸，或者服用大补气血的药物来调理，病就能痊愈了。
[Upper Compilation: External Treatment Methods - Classic Principles]
The *Suwen: Treatise on the Essential Subtleties of Pulse Diagnosis* states: When the Liver pulse (pulse of the Liver meridian) is firm and long upon palpation, yet the complexion is not green, it indicates a disease caused by falling or trauma, where blood accumulates beneath the hypochondrium, leading to wheezing and rebellious Qi.
Commentary and Formulas:
Annotations:
[1] This passage explains that the Liver pulse can manifest as either rigid or soft, and consequently, the diseases differ accordingly.
[2] When the Liver pulse beats firmly and is long under the fingers, and the complexion is not green, it indicates that the patient has likely suffered from a fall or blow, causing blood to accumulate beneath the hypochondrium, resulting in persistent wheezing and rebellious Qi.
[3] This is because the Foot-Jueyin Liver Meridian distributes along the hypochondriac region and ascends behind the throat; its branch diverges from the Liver, pierces the diaphragm, and flows upward into the Lungs. Now, with blood accumulating beneath the hypochondrium, the pathogenic qi generated by the stagnant blood steams upward to affect the Lungs, thus causing wheezing and rebellious Qi.
[Upper Compilation: External Treatment Methods - Classic Principles]
The *Jingui Yaolue* states: The Cun Kou pulse (pulse at the radial artery of the wrist) is floating, faint, and choppy. In such cases, there should be blood loss or sweating. If there is no sweating, but the body has sores or wounds inflicted by knives or axes, it is due to blood loss.
Commentary and Formulas:
Annotations:
[1] The classic texts state: "Those who have lost substantial blood should not be induced to sweat; those who have lost substantial sweat should not be depleted of blood." Generally, both conditions present with a floating, faint, and choppy pulse.
[2] Since the pulse diagnosis reveals this pattern, it indicates a sign of exhaustion without the symptom of sweating. How else could this be explained than by blood loss? Therefore, we know there are signs of blood loss caused by metal injuries or blows/falls.
[3] Furthermore, the classics discuss: "When the Liver pulse is firm and the complexion remains unchanged, there must have been an incident of beating or falling."
[4] Because the skin and muscles are not broken, the evil blood (stasis) must remain in the hypochondrium, accompanied by vomiting and rebellious Qi. According to the classics, one should puncture the Rangu point (KI2) and the Sanmao point (Dadun, LR1) on the dorsum of the foot to induce bleeding, or administer purgative medicines to promote the movement and expulsion of the stasis, which should lead to spontaneous recovery.
[5] If the pulse is floating, faint, and choppy, one should recognize excessive blood loss. Following the classics, moxibustion should be applied to the Sanjiaojie point (Guanyuan, CV4, referred to here in context of connection points), or large tonifying formulas for Qi and Blood should be administered to regulate the condition, thereby curing the disease.