9.神清色泽亮音声, 身轻肤润脉和洪, 忽然口噤难言躁, 脉即停伏
战汗宁, 饮多消散知酿汗, 能食脉浮表还平, 子得午解阳来济, 午得
子解是阴从.
【注】易愈之病, 取于神则神清, 取于色则色泽, 取于声则音长, 取
于体则身轻, 取于皮则肤润, 取于脉则和洪, 皆一脉不死之证, 故曰
生证也. 若有如是之生证, 忽然口噤不语, 烦躁而甚, 六脉停伏, 宜
谨察之, 非变凶也, 乃邪正交争, 生战汗之候, 为将愈之兆也. 凡伤
寒渴者, 多阳证易愈, 若忽然饮多寻常, 消散无停, 知酿汗而作解也
.伤寒多不能食, 若忽然能食且脉浮, 知胃和邪还于表而作解也. 若
不即解者, 阴阳未得其时也, 子时得之午时必解, 阳济阴生而解也,
午时得之子时必解, 阴从阳化而解也.
10.伤寒死证阳见阴, 大热不止脉失神, 阴毒阳毒六七日, 色枯声败
死多闻. 心绝烟熏阳独留, 神昏直视及摇头. 环口黧黑腹满痢, 柔汗
阴黄脾败由. 肺绝脉浮而无胃, 汗出如油喘不休. 唇吻反青肢冷汗,
舌卷囊缩是肝忧. 面黑齿长且枯垢, 溲便遗失肾可愁. 水浆不入脉代
散,呃逆不已命难留. 大发风温而成痉, 湿温重暍促命终. 强发少阴
动经血, 口鼻目出厥竭名. 汗后狂言不食热, 脉躁阴阳交死形. 厥冷
不及七八日, 肤冷而躁暂难宁, 此病名之曰藏厥, 厥而无脉暴出凶,
厥而下痢当不食, 反能食者名除中.
【注】病有生死, 治有难易. 生病不药可愈, 死病虽药莫救. 何则?
以阴阳邪正有盛衰也, 正盛邪衰则生, 阴盛阳衰则死. 伤寒阳证, 见
浮大数动滑之阳脉, 则易愈而生, 见沉微涩弱弦之阴脉, 则难治而死
.故阴病见阳脉者生, 阳病见阴脉者死也. 大热不止, 邪盛脉失神正
虚,正虚邪盛, 故死也. 阴毒阳毒, 亢极不生化也; 色枯声败内外两
夺也, 故均主死. 形若烟熏, 神昏直视摇头者, 此阳邪独留, 攻心而
绝也. 环口黧黑, 腹满下痢不止, 柔汗阴黄者, 此为脾绝也. 脉但浮
无胃, 汗出如油, 喘息不休者, 此为肺绝也. 唇吻反青, 四肢冷汗,
舌卷囊缩, 此为肝绝也. 面黑齿长枯垢, 溲便遗失者, 此为肾绝也.
水浆不入, 生无所赖也. 脉代散, 真气衰散也. 呃逆无休, 元气不藏
也.误发风温之汗, 因而成痉, 误发湿温之汗, 名曰重暍, 皆促人命
也.强发少阴汗, 动其经血, 从口鼻目出, 名曰下厥上竭. 以上皆死
之候也. 汗后狂言不食, 仍复发热, 不为汗衰, 脉躁疾者, 名曰阴阳
交,死之形也. 厥逆不回, 至七、八日即通, 身肤冷而躁, 无暂宁时
者,名为藏厥, 为阴邪盛极, 真阳飞越也. 凡厥逆而甚者, 多无脉,
服四逆、白通等汤, 脉微续者, 真阳渐复也, 脉暴出者, 回光反照也
.凡厥逆多下痢, 当不能食, 今反能食, 名曰除中. 中者, 胃也. 除
者,去也, 谓胃气已去, 即反能食, 亦无补于胃也. 故仲景曰: 除中
者死. 凡诸病人不能食, 忽然大能食而即死者, 亦此类也.
9. 神志清醒,面色光泽明亮,声音洪亮,身体轻盈,皮肤润泽,脉象和缓而洪大,这些都是易愈的征象。如果突然出现牙关紧闭、难以言语且烦躁不安,脉搏变得沉伏或停止,随后出现战栗出汗而病情安宁,这是即将痊愈的表现。如果患者大量饮水后症状消散,知道这是酝酿汗出而病解;如果患者突然能够进食且脉象浮起,说明胃气调和,邪气返还体表而病解。如果在子时发病,到午时必然解除,这是因为阳气来资助阴气;如果在午时发病,到子时必然解除,这是因为阴气顺从阳气而化解。
【注】容易治愈的疾病,观察其神志则神志清醒,观察其面色则色泽光亮,观察其声音则音长有力,观察其体态则身体轻盈,观察其皮肤则润泽,观察其脉象则和缓洪大,这些都是不死之证,所以称为生证(预后良好的征象)。如果有上述的生证,却突然出现口噤不语、极度烦躁,六脉沉伏不起,应当仔细诊察,这并不是病情转凶,而是正气与邪气相互交争,将要发生战汗的征兆,是即将痊愈的迹象。凡是伤寒口渴的患者,多属于阳证,容易治愈。如果突然像平常一样大量饮水,水液迅速消散没有停积,知道这是酝酿汗出而病解。伤寒病大多不能进食,如果突然能进食且脉象浮起,知道这是胃气调和,邪气还于体表而作解。如果不能立即解除,是因为阴阳未得其时机,若在子时得病,午时必解,这是阳气济助阴气而解;若在午时得病,子时必解,这是阴气顺从阳气而化解。
10. 伤寒死证中,阳证见到阴脉,高热不止且脉象失神,阴毒或阳毒病至六七日,面色枯槁、声音败坏,大多死亡。心气绝者,面色如烟熏,阳气独留,神志昏迷、直视及摇头。环口发黑、腹部胀满、下痢不止,冷汗淋漓、阴黄,这是脾气败绝所致。肺气绝者,脉象浮取无胃气,汗出如油、喘息不休。嘴唇吻部反青、四肢冷汗、舌卷缩、睾丸上缩,这是肝气忧绝之象。面色黑、牙齿显得长且枯垢、大小便失禁,这是肾气可忧之兆。水浆不入、脉象代散,呃逆不止,性命难留。大发风温导致成痉,湿温重感暑热促命终。强行发少阴经之汗而动经血,口鼻目出血,名为厥竭。汗后狂言、不食、发热,脉象躁疾,此为阴阳交,属死形。厥冷不及七八日,肌肤冷而躁动暂难安宁,此病名为藏厥。厥逆而无脉,若脉暴出则凶险。厥逆而下痢本当不能食,若反能食者名为除中。
【注】疾病有生死之分,治疗有难易之别。生病若不药可愈,死病虽用药亦无法挽救。为什么呢?因为阴阳邪正的盛衰不同,正气盛而邪气衰则生,阴气盛而阳气衰则死。伤寒阳证,若见到浮、大、数、动、滑等阳脉,则易愈而生;若见到沉、微、涩、弱、弦等阴脉,则难治而死。所以阴病见阳脉者生,阳病见阴脉者死。高热不止,邪气盛而脉象失神,正气虚而邪气盛,故死。阴毒和阳毒,是亢极而不能生化;面色枯槁、声音败坏,是内外精气两夺,故均主死。形体如烟熏,神志昏迷、直视、摇头,这是阳邪独留,攻心而绝。环口黧黑,腹部胀满、下痢不止,冷汗淋漓、阴黄,这是脾绝。脉但浮而无胃气,汗出如油,喘息不休,这是肺绝。嘴唇吻部反青,四肢冷汗,舌卷缩、囊缩,这是肝绝。面色黑、牙齿长且枯垢,二便遗失,这是肾绝。水浆不入,生机无所依赖。脉象代散,真气衰散。呃逆无休,元气不藏。误发风温之汗,因而成痉;误发湿温之汗,名为重暍,都促使人命终结。强行发少阴汗,动其经血,从口鼻目出,名为下厥上竭。以上都是死候。汗后狂言、不食、仍复发热,不为汗衰,脉象躁疾者,名为阴阳交,是死之形。厥逆不回,至七、八日即通,身肤冷而躁,无暂宁时者,名为藏厥,为阴邪盛极,真阳飞越。凡厥逆而甚者,多无脉,服用四逆汤、白通汤等,脉微续者,是真阳渐复;脉暴出者,是回光返照。凡厥逆多下痢,当不能食,今反能食,名为除中。中,指胃。除,去也,谓胃气已去,即使反能食,也无补于胃。所以仲景说:除中者死。凡诸病人不能食,忽然大能食而即死者,也是此类情况。
9. Clear spirit, bright luster of complexion, resonant voice, light body, moist skin, and harmonious yet full pulse are signs of easy recovery. If suddenly there is lockjaw with difficulty in speaking and restlessness, and the pulse becomes deep, hidden, or imperceptible, followed by chills and sweating leading to calmness, this indicates impending resolution. If excessive drinking leads to symptom dissipation, knowing that sweat is brewing for resolution; if sudden ability to eat and a floating pulse indicate stomach harmony and pathogenic factors returning to the exterior for resolution. If onset occurs at Zi hour (11 PM - 1 AM), it must resolve at Wu hour (11 AM - 1 PM), as Yang aids Yin; if onset occurs at Wu hour, it must resolve at Zi hour, as Yin follows Yang.
[Note] Diseases that are easy to heal show clear spirit, bright complexion, long voice, light body, moist skin, and harmonious-full pulse; these are all non-lethal signs, hence called "Sheng Zheng" (signs of life/recovery). If such signs of life are present, but suddenly there is lockjaw, muteness, severe irritability, and six pulses becoming deep/hidden, careful observation is required; this is not a change to ominous, but rather a sign of struggle between healthy Qi and pathogenic factors, heralding "Zhan Han" (chills and sweating), a兆兆 of healing. In cold damage diseases with thirst, mostly Yang patterns are easy to heal. If suddenly drinking like normal, with rapid dispersion without stagnation, knowing that sweat is brewing for resolution. Cold damage usually involves inability to eat; if suddenly able to eat and pulse is floating, knowing that Stomach Qi is harmonious and pathogens return to the exterior for resolution. If not immediately resolved, it is because Yin and Yang have not found their timing. Onset at Zi hour resolves at Wu hour, as Yang nourishes Yin; onset at Wu hour resolves at Zi hour, as Yin transforms following Yang.
10. In fatal syndromes of Cold Damage, Yang patterns showing Yin pulses, unceasing high fever with spiritless pulse, Yin Toxin or Yang Toxin persisting for six to seven days, withered complexion and ruined voice, mostly lead to death. Heart Qi exhaustion manifests as smoke-like facial color, solitary remaining Yang, coma, fixed gaze, and head shaking. Blackness around the mouth, abdominal distension, unceasing dysentery, soft sweat, and Yin Jaundice are due to Spleen failure. Lung Qi exhaustion shows floating pulse without Stomach Qi, oily sweat, and ceaseless panting. Reversed cyanosis of lips and corners of mouth, cold sweat on limbs, curled tongue, and retracted testicles indicate Liver distress. Black face, elongated and withered/dirty teeth, loss of urination and defecation indicate Kidney worry. Inability to take water/grain, intermittent and scattered pulse, incessant hiccups make life hard to retain. Severe wind-heat causing spasms, heavy damp-heat heatstroke hastening death. Forcibly inducing sweat in Shaoyin damaging channel blood, bleeding from mouth, nose, and eyes, named Jue Jie (exhaustion of Jue). Restlessness after sweating, refusal to eat, fever, restless pulse indicate Yin-Yang Intersection, a form of death. Cold extremities lasting less than seven to eight days, cold skin with restlessness difficult to calm, is named Zang Jue (Viscera Cold). Cold with no pulse, if pulse suddenly emerges is ominous. Cold with dysentery should imply inability to eat; if suddenly able to eat, it is named Chu Zhong (Elimination of the Middle).
[Note] Diseases have life and death; treatments have ease and difficulty. Some illnesses heal without medicine; fatal diseases cannot be saved even with medicine. Why? Because of the prosperity or decline of Yin/Yang and Healthy Qi/Pathogens. Healthy Qi prosperous, Pathogen declining leads to life; Yin prosperous, Yang declining leads to death. In Cold Damage Yang patterns, seeing Floating, Large, Rapid, Agitated, Slippery Yang pulses means easy recovery and life; seeing Deep, Micro, Choppy, Weak, Taut Yin pulses means difficult treatment and death. Thus, Yin disease showing Yang pulses lives; Yang disease showing Yin pulses dies. Unceasing high fever, pathogen excess, pulse losing spirit, healthy Qi deficiency, pathogen excess, therefore death. Yin Toxin and Yang Toxin represent extreme hyperactivity failing to generate/transform; withered complexion and ruined voice represent internal and external essence depletion, thus both indicate death. Body color like smoke, coma, fixed gaze, head shaking: this is Yang pathogen remaining alone, attacking the Heart leading to exhaustion. Blackness around mouth, abdominal distension, unceasing dysentery, soft sweat, Yin Jaundice: this is Spleen exhaustion. Pulse only floating without Stomach Qi, oily sweat, ceaseless panting: this is Lung exhaustion. Reversed cyanosis of lips/mouth, cold sweat on limbs, curled tongue, retracted scrotum: this is Liver exhaustion. Black face, elongated/withered/dirty teeth, loss of urine/stool: this is Kidney exhaustion. Inability to take fluids, life has no reliance. Intermittent/scattered pulse, True Qi decaying. Incessant hiccups, Yuan Qi not stored. Forcibly inducing sweat in Wind-Warmth causing spasms; forcibly inducing sweat in Damp-Warmth named Heavy Heatstroke, both hasten death. Forcibly inducing sweat in Shaoyin, disturbing channel blood, bleeding from mouth/nose/eyes, named Xia Jue Shang Jie (Lower Jue Upper Exhaustion). All above are signs of death. Restlessness after sweating, refusal to eat, persistent fever, not alleviated by sweat, restless pulse: named Yin-Yang Intersection, form of death. Cold reversal not returning, reaching seven/eight days, body/skin cold and restless, no moment of calm: named Zang Jue, Yin pathogen extremely prosperous, True Yang flying away. Generally, severe cold reversal often has no pulse; taking Si Ni Tang or Bai Tong Tang, if pulse slowly continues, True Yang gradually recovers; if pulse suddenly emerges, it is false vitality returning (terminal lucidity). Generally, cold reversal with dysentery implies inability to eat; now suddenly able to eat, named Chu Zhong. Zhong refers to Stomach. Chu means removal. It means Stomach Qi is gone; even if able to eat, it does not benefit the Stomach. Thus Zhang Zhongjing said: Chu Zhong means death. Generally, patients unable to eat who suddenly become able to eat and then die, are also of this category.