@@@
寸口脉动而弱，动即为惊，弱即为悸。
【注】
寸口通指三部也。脉动而弱，主惊悸病也。动即为惊，以惊为外触而动也；弱即为悸
，以悸为内生而怯也。
【集注】
徐彬曰：惊为外邪袭心，故其寸口脉动，动者脉来乱动也。悸乃神不自主，故其寸口
脉弱，弱者脉沉无力也。邪之所袭，因心之虚，故惊悸并见。
李□曰：此寸口脉兼三部而言。盖惊自外至者也，惊则气乱，故脉动而不宁；悸自内
惕者也，悸因中虚，故脉弱而无力。
@@@
师曰：夫脉浮，目睛晕黄，衄未止，晕黄去，目睛慧了，知衄今止。
【注】
浮脉主阳主表，若目睛清洁，主阳表病也；目睛晕黄，主血脉病也。盖以诸脉络于目
，而血热则赤，血瘀则黄。今目睛黄晕，知其衄未止也；若黄晕去，目睛慧了，知其
衄已止，故曰：衄今止也。
@@@
又曰：从春至夏衄者太阳，从秋至冬衄者阳明。
【注】
衄血阳络伤也，下血阴络伤也。太阳主外，春夏主外，故从春至夏衄血，属太阳也。
阳明主内，秋冬主内，故从秋至冬衄血，属阳明也。
【集注】
李□曰：衄血出于鼻，手太阳经上□抵鼻，目下为□；足太阳经，从巅入络脑，鼻与
脑通；手阳明经挟鼻孔；足阳明经起鼻交额中，四经皆循鼻分，故皆能致衄。太阳行
身之表，经云：太阳为开。是春生夏长，阳气在外有开之义，故春夏衄者太阳。阳明
行身之里，经云：阳明为阖。是秋敛冬藏，阳气在内，有藏之义，故秋冬衄者阳明。
尤怡曰：少阳之脉不入鼻额，故不主衄。
@@@
衄家不可汗，汗出必额上陷，脉紧急，直视，不能眴，不得眠。
【注】
衄该吐血而言也。衄血吐血之家，阴已亡矣，若发其汗，汗出液竭，诸脉失养，则额
角上陷中之脉为热所灼，紧且急也。目直视，目瞪不转睛也。不能眴，目睫不合也。
亦为热灼其脉，引缩使然也。不得眠，阳气不能行于阴也。凡此之病，皆阳盛阴微之
危证，故衄家慎不可汗也。
【集注】
赵良曰：足太阳经主表，上巅入额，贯目睛，衄则在上络脉之血已脱，若更发汗，是
重竭津液，津液竭则脉枯，故额上陷中脉紧而急，牵引其目，视不能合也。无血阴虚
，故不得眠。
@@@
病人面无血色，无寒热，脉沉弦者，衄；脉浮弱，手按之绝者，下血；烦欬者，必吐
血。
【按】
脉沉，当是「脉浮」；脉浮，当是「脉沉」，文义始属，必传写之□。
【注】
赤色血色也。面无血色，谓面白之人，纯白而无赤；面黄之人，纯黄而不红也。人有
恐怖则面色脱白，其状惊骇；人有愧心；乍白乍红，其状惶怯。今无故而面无血色，
则可知非惊愧致气乱血散也；且无寒热病，又可知非虚损不生血少血也，既非血散，
又非血少，当询之病人，必有失血之故。诊之于脉，必有吐衄、下血之因。衄吐属阳
，故脉见浮弦，按之必芤，荣血空也；下血属阴，脉见沉弱，按之欲绝，荣气微也。
且微色如斯，而证兼烦欬，是病在心肺，故必吐血也。
@@@
夫吐血，欬逆，上气，其脉数，而有热，不得卧者，死。
【注】
吐血欬逆，肺大伤也；上气，肺无降也；脉数有热，火烁肺金也；不得卧者，阳不入
阴，故曰死也。
【集注】
赵良曰：脉数有热，阳独胜也；不能卧，阴已绝也。阴既绝，阳岂独生耶？故死。
若得卧者，阴未绝，未可言死。
程林曰：吐血、欬逆、上气，则肺藏伤矣。脉数则虚热不去，火来刑金矣。阴血消亡
，故不得卧，死可必矣。
@@@
夫酒客欬者，必致吐血，此因极饮过度所致也。
【注】
酒性大热，溃脉伤经，极饮过度，必致欬嗽吐血也。
【集注】
徐彬曰：此言吐血，不必由于气不摄血，亦不必由于阴火炽盛。其有酒客而致咳，则
肺伤已极，又为欬所击动，必致吐血，故曰：极饮过度所致。则治之者，当以清酒热
为主也。
@@@
亡血不可发其表，汗出则寒栗而振。
【注】
凡失血之后，血气未复为亡血也，皆不可发汗。失血之初，固属阳热，亡血之后，热
随血去，热虽消而气逐血虚，阳亦微矣。若发其汗，则阳气衰微，力不能支，故身寒
噤憟而振振耸动也。发阴虚之汗，汗出则亡阴，即发吐衄之汗也，故见不得眴，不得
眠，亡阴之病也。发阳虚之汗，汗出则亡阳，即发亡血之汗也，故见寒憟而振，亡阳
之病也。
【集注】
李□曰：夺血者无汗，以汗与血，俱属心液，血亡液竭，无复余液作汗也。今又发表
，则阴虚且更亡阳，表间卫气虚极，故寒憟而振。
@@@
吐血不止者，柏叶汤主之。
【注】
吐血之病，热伤阳络，当清其热；劳伤阳络，当理其损。今以柏叶汤温散之品，而治
吐血不止者，则必是热伏阴分，用此宣发，使热行阳分，血不为热所迫，则自止矣。
【注释】
寸口泛指寸、关、尺三部脉。脉象既跳动又微弱，主病为惊悸。脉动是因为惊骇导致气机外触而动；脉弱是因为心悸源于内生且伴有怯意。
【集注】
徐彬说：惊是外邪侵袭心脏，所以寸口脉表现为动，所谓“动”，是指脉搏来去杂乱跳动。悸则是神志不能自主，所以寸口脉表现为弱，所谓“弱”，是指脉搏沉取无力。邪气之所以能侵袭，是因为心脏虚弱，所以惊和悸往往同时出现。
李□说：这里的寸口脉是兼指三部而言。大概惊是从外部引起的，惊则气机紊乱，所以脉象跳动而不安宁；悸是从内部产生的恐惧，悸因为中焦虚弱，所以脉象微弱而无力。
老师说：如果脉象浮，眼睛周围有黄晕，说明鼻衄（鼻出血）尚未停止；如果黄晕消退，眼睛变得清澈明亮，就知道鼻衄现在已经停止了。
【注释】
浮脉主阳证、表证。如果眼睛清澈，主阳表病；如果眼睛周围有黄晕，主血脉病。因为各种脉络都联系到眼睛，血热则眼红，血瘀则眼黄。现在眼睛周围有黄晕，知道鼻衄没有停止；如果黄晕消退，眼睛清澈明亮，知道鼻衄已经停止，所以说：“鼻衄现已停止”。
又说：从春季到夏季发生的鼻衄，属于太阳经病变；从秋季到冬季发生的鼻衄，属于阳明经病变。
【注释】
鼻衄是阳络受伤，便血是阴络受伤。太阳经主表，春夏季节主表，所以从春到夏的鼻衄，属于太阳经。阳明经主里，秋冬季节主里，所以从秋到冬的鼻衄，属于阳明经。
【集注】
李□说：鼻衄出于鼻腔，手太阳经上行至鼻根，眼下为眶下缘；足太阳经，从头顶入络于脑，鼻与脑相通；手阳明经挟持鼻孔两侧；足阳明经起于鼻旁交于额中，这四条经脉都循行经过鼻子部位，所以都能导致鼻衄。太阳经行于身体表面，《内经》说：太阳为开。这是春生夏长，阳气在外，有开启的含义，所以春夏季鼻衄者属太阳。阳明经行于身体内部，《内经》说：阳明为阖。这是秋敛冬藏，阳气在内，有闭藏的含义，所以秋冬季鼻衄者属阳明。
尤怡说：少阳经的脉气不进入鼻部和额部，所以不主鼻衄。
患有鼻衄的人不可使用发汗法，如果误用发汗导致出汗，必然出现额角动脉凹陷，脉象紧急，两眼直视，不能眨眼，无法入睡。
【注释】
“衄”这里包括吐血而言。经常流鼻血或吐血的人，阴血已经耗亡。如果强行发汗，汗出则津液枯竭，各条经脉失去滋养，那么额角上凹陷处的脉就会受到热邪灼烧，变得紧且急。目直视，是指眼睛瞪大不转动。不能眴（xuàn），是指眼睑不能闭合。这也是因为热邪灼伤经脉，牵引收缩所致。不得眠，是因为阳气不能入于阴分。凡是这些病症，都是阳盛阴微的危险证候，所以患鼻衄的人千万不可发汗。
【集注】
赵良说：足太阳经主表，上行至头顶入额部，贯穿眼睛。鼻衄意味着上部络脉的血已经脱失，如果再发汗，就是再次竭尽津液。津液枯竭则经脉枯槁，所以额上凹陷处的脉紧而急，牵引眼部，导致视物不能闭合。无血导致阴虚，所以无法入睡。
病人面色苍白无血色，没有恶寒发热的症状，如果脉象沉弦，是鼻衄；如果脉象浮弱，重按感觉中断消失，是便血；如果伴有烦躁咳嗽，必定吐血。
【按语】
原文中的“脉沉”应当是“脉浮”；“脉浮”应当是“脉沉”，这样文义才通顺，必然是传抄过程中的错误。
【注释】
赤色即血色。面无血色，指的是面色纯白而无红润；或者面黄之人，纯黄而不红。人如果有恐怖情绪，面色会脱白，神情惊骇；人如果有羞愧之心，面色乍白乍红，神情惶怯。现在无缘无故面色无血色，可知不是因惊恐羞愧导致气乱血散；而且没有寒热病，又可知道不是因虚损导致生血不足。既然不是血散，也不是血少，应当询问病人，必定有失血的缘故。诊察其脉，必定有吐血、鼻衄或便血的原因。吐衄属于阳证，所以脉见浮弦，重按必有空豁感（芤脉），这是营血空虚的表现；便血属于阴证，脉见沉弱，重按欲绝，这是荣气微弱的表现。况且面色如此苍白，症状兼有烦躁咳嗽，这是病在心肺，所以必定吐血。
凡是吐血，伴有咳嗽气逆、气息上冲，脉数且有发热，不能安卧的，预后不良，主死。
【注释】
吐血、咳嗽气逆，说明肺脏严重受损；气息上冲，说明肺气不能肃降；脉数且有热，说明火邪灼伤肺金；不能安卧，说明阳气不能入阴，所以说主死。
【集注】
赵良说：脉数有热，说明阳气独盛；不能卧，说明阴气已绝。阴气既然已绝，阳气岂能单独生存？所以主死。如果能安卧，说明阴气未绝，还不能断言死亡。
程林说：吐血、咳嗽气逆、气息上冲，说明肺脏受伤。脉数表示虚热不去，火来刑克肺金。阴血消亡，所以不能安卧，死亡是必然的。
凡是嗜酒之人发生咳嗽，必定会导致吐血，这是因为过度饮酒所致。
【注释】
酒的性质大热，会溃坏血脉损伤经络。极度饮酒过度，必然导致咳嗽吐血。
【集注】
徐彬说：这里说吐血，不一定由于气不摄血，也不一定由于阴火炽盛。如果是嗜酒之人导致咳嗽，说明肺脏损伤已极，又因咳嗽震动，必定导致吐血，所以说这是由过度饮酒所致。因此治疗时，应当以清除酒热为主。
失血患者不可发汗解表，如果发汗导致出汗，会出现畏寒战栗、身体震颤。
【注释】
凡是失血之后，气血尚未恢复称为亡血，都不可发汗。失血初期，固然属于阳热证，但亡血之后，热随血去，虽然热势消退，但气随血虚，阳气也微弱了。如果强行发汗，则阳气衰微，力量不能支撑，所以身体寒冷、颤抖耸动。发阴虚之汗，汗出则亡阴，也就是引发吐衄那样的汗证，所以出现不能眨眼、不能入睡，这是亡阴的病证。发阳虚之汗，汗出则亡阳，也就是引发亡血那样的汗证，所以出现寒冷颤抖，这是亡阳的病证。
【集注】
李□说：夺血者无汗，因为汗与血都属于心液，血亡则液竭，没有剩余的液体可以化作汗液。现在又使用发表药，则阴虚且更亡阳，体表的卫气极度虚弱，所以寒冷颤抖。
【注释】
吐血的病，如果是热伤阳络，应当清热；如果是劳损伤及阳络，应当调理损伤。现在用柏叶汤这种温散的药物来治疗吐血不止，那么必定是热邪伏藏在阴分，使用此方宣发，使热邪运行到阳分，血液不被热邪逼迫，自然就会停止。
The pulse at the Cun Kou (Inch Port, radial artery) is agitated and weak. Agitation indicates Jing syndrome (startle disorder), and weakness indicates Ji syndrome (palpitation).
[Annotation]
Cun Kou generally refers to the three positions: Cun, Guan, and Chi. A pulse that is both agitated and weak indicates the disease of Jing-Ji (startle and palpitation). "Agitation" corresponds to Jing, as startle causes external agitation; "weakness" corresponds to Ji, as palpitation arises internally with timidity.
[Collected Annotations]
Xu Bin stated: Jing (startle) is caused by external pathogens invading the Heart, hence the Cun Kou pulse appears agitated. "Agitated" means the pulse comes and goes in a chaotic, trembling manner. Ji (palpitation) is when the Spirit lacks autonomy, hence the Cun Kou pulse appears weak. "Weak" means the pulse is deep and forceless. The reason pathogens can invade is due to Heart deficiency, so Jing and Ji often appear together.
Li [Name obscured] stated: Here, Cun Kou refers to all three positions. Generally, Jing originates from outside; startle causes Qi chaos, hence the pulse is agitated and restless. Ji originates from internal fear; Ji is due to Middle Jiao deficiency, hence the pulse is weak and forceless.
The Master said: If the pulse is Floating (Fu), and there is yellow discoloration around the eyes, the Nosebleed (Nu) has not stopped. If the yellow discoloration disappears and the eyes become clear and bright, one knows that the Nosebleed has now stopped.
[Annotation]
A Floating pulse indicates Yang and Exterior conditions. If the eyes are clear, it indicates an Exterior Yang disease; if there is yellow discoloration around the eyes, it indicates Blood vessel disease. Since all collaterals connect to the eyes, Heat in the Blood causes redness, while Blood Stasis causes yellowing. Now, seeing yellow discoloration around the eyes indicates the Nosebleed has not stopped; if the yellow discoloration fades and the eyes become clear, it indicates the Nosebleed has stopped. Thus, it is said: "The Nosebleed has now stopped."
It is also said: Nosebleeds occurring from Spring to Summer belong to the Taiyang (Greater Yang) channel; those occurring from Autumn to Winter belong to the Yangming (Bright Yang) channel.
[Annotation]
Nosebleed results from injury to Yang collaterals; hematochezia (blood in stool) results from injury to Yin collaterals. The Taiyang channel governs the exterior; Spring and Summer govern the exterior. Therefore, nosebleeds from Spring to Summer belong to Taiyang. The Yangming channel governs the interior; Autumn and Winter govern the interior. Therefore, nosebleeds from Autumn to Winter belong to Yangming.
[Collected Annotations]
Li [Name obscured] stated: Nosebleed issues from the nose. The Hand-Taiyang channel ascends to the root of the nose and below the eye; the Foot-Taiyang channel enters from the vertex to connect with the brain, linking the nose and brain; the Hand-Yangming channel flanks the nostrils; the Foot-Yangming channel begins at the side of the nose and crosses the forehead. These four channels all traverse the nasal area, so they can all cause nosebleed. The Taiyang channel runs on the surface of the body. The Classic states: "Taiyang is the Opening." This corresponds to the generation in Spring and growth in Summer, where Yang Qi is external, having the meaning of opening. Hence, nosebleeds in Spring/Summer belong to Taiyang. The Yangming channel runs inside the body. The Classic states: "Yangming is the Closing." This corresponds to gathering in Autumn and storing in Winter, where Yang Qi is internal, having the meaning of closing. Hence, nosebleeds in Autumn/Winter belong to Yangming.
You Yi stated: The Shaoyang (Lesser Yang) channel does not enter the nose or forehead, so it does not primarily govern nosebleed.
Patients prone to nosebleed should not undergo diaphoresis (sweating therapy). If sweating occurs, there will inevitably be depression of the arteries above the forehead, an urgent and tight pulse, fixed staring gaze, inability to blink, and insomnia.
[Annotation]
"Nü" here includes vomiting blood. Patients with chronic nosebleeds or hematemesis have already lost Yin Blood. If diaphoresis is forced, sweat loss leads to fluid exhaustion, causing all vessels to lose nourishment. The arteries in the depression above the forehead will be scorched by heat, becoming tight and urgent. Fixed staring gaze means the eyes stare without moving. Inability to blink (Xuan) means the eyelids cannot close. This is also caused by heat scorching the vessels, leading to contraction and traction. Insomnia occurs because Yang Qi cannot enter Yin. All these conditions are critical signs of Excess Yang and Deficient Yin; therefore, patients with nosebleeds must strictly avoid diaphoresis.
[Collected Annotations]
Zhao Liang stated: The Foot-Taiyang channel governs the exterior, ascending to the vertex and forehead, penetrating the eyes. Nosebleed implies that blood in the upper collaterals has been depleted. Further diaphoresis would further exhaust fluids. When fluids are exhausted, vessels wither, causing the arteries in the forehead depression to become tight and urgent, pulling on the eyes and preventing closure. Lack of blood leads to Yin deficiency, hence insomnia.
If a patient's face lacks ruddy color, without chills or fever, and the pulse is Deep and Wiry, it indicates nosebleed; if the pulse is Floating and Weak, and feels absent upon heavy pressure, it indicates lower bleeding (hematochezia/melena); if accompanied by irritability and cough, hematemesis (vomiting blood) will certainly occur.
[Commentary]
The text likely contains a transcription error: "Deep" should be "Floating," and "Floating" should be "Deep," for the logic to hold.
[Annotation]
Red color represents blood. "Face lacking ruddy color" means a purely white face without redness, or a purely yellow face without pinkness. Fear causes pallor and a startled appearance; shame causes alternating pallor and flushing with a timid demeanor. Now, without cause, the face lacks color, indicating this is not due to Qi chaos and Blood scattering from fright or shame. Furthermore, without chills or fever, it is not due to deficiency failing to generate blood. Since it is neither blood scattering nor simple blood shortage, one must ask the patient about blood loss history. Pulse diagnosis reveals the cause: vomiting or nosebleeding belongs to Yang, presenting with a Floating-Wiry pulse that feels hollow (Kou) upon pressure, indicating empty Ying Blood; lower bleeding belongs to Yin, presenting with a Deep-Weak pulse that feels nearly absent upon pressure, indicating faint Ying Qi. Given the pale complexion and symptoms of irritability and cough, the disease is in the Heart and Lungs, so hematemesis is certain.
For those who vomit blood, accompanied by cough, rebellious Qi, and upward rushing Qi, if the pulse is Rapid, there is heat, and they cannot lie down, death ensues.
[Annotation]
Vomiting blood and cough/rebellious Qi indicate severe Lung damage. Upward rushing Qi indicates failure of Lung Qi to descend. A Rapid pulse with heat indicates Fire scorching Lung Metal. Inability to lie down indicates Yang cannot enter Yin; thus, it is fatal.
[Collected Annotations]
Zhao Liang stated: Rapid pulse with heat indicates Yang excess alone; inability to lie down indicates Yin extinction. If Yin is extinct, how can Yang survive alone? Thus, death. If they can lie down, Yin is not yet extinct, and death cannot be declared.
Cheng Lin stated: Vomiting blood, cough, and upward rushing Qi injure the Lung organ. A Rapid pulse indicates lingering deficient heat, with Fire punishing Metal. As Yin Blood is consumed, inability to lie down occurs, making death inevitable.
For wine drinkers who develop cough, hematemesis will inevitably result, caused by excessive drinking.
[Annotation]
Wine is intensely hot; it damages vessels and meridians. Excessive drinking inevitably leads to cough and hematemesis.
[Collected Annotations]
Xu Bin stated: This discusses hematemesis, which need not be due to Qi failing to control blood, nor necessarily due to blazing Yin fire. If a wine drinker develops cough, the Lung is extremely damaged. The act of coughing disturbs the injured vessels, inevitably causing hematemesis. Thus, it is said to be caused by excessive drinking. Treatment should focus on clearing Wine Heat.
Patients with blood loss should not undergo exterior-releasing therapy. If sweating occurs, there will be chills and tremors.
[Annotation]
After any blood loss, before Qi and Blood recover, it is termed "loss of blood"; diaphoresis is contraindicated. Initially, blood loss may involve Yang Heat, but after significant loss, Heat leaves with the Blood. Although Heat subsides, Qi follows Blood into deficiency, and Yang becomes weak. Forced diaphoresis depletes Yang Qi further, leaving insufficient strength to support the body, resulting in coldness, rigors, and trembling. Inducing sweat in Yin deficiency leads to loss of Yin (similar to sweating from hematemesis/nosebleed), causing inability to blink and insomnia (Yin loss pathology). Inducing sweat in Yang deficiency leads to loss of Yang (similar to sweating from blood loss), causing coldness and tremors (Yang loss pathology).
[Collected Annotations]
Li [Name obscured] stated: Those who suffer blood loss do not sweat, as sweat and blood both originate from Heart fluids. When blood is lost and fluids exhausted, no residual fluid remains to form sweat. Using exterior-releasing herbs now causes both Yin and Yang loss. With extreme deficiency of Wei Qi at the exterior, coldness and tremors occur.
For incessant hematemesis, Bo Ye Tang (Catalpa Twig Decoction) is the primary formula.
[Annotation]
For hematemesis caused by Heat injuring Yang collaterals, one should clear Heat; for injury due to overwork damaging Yang collaterals, one should repair the damage. However, using Bo Ye Tang, a warming and dispersing formula, to treat incessant hematemesis implies that Heat is hidden in the Yin division. This formula promotes dispersion, moving Heat to the Yang division. Once Blood is no longer forced by Heat, it will stop naturally.