仲景脉浮当以汗解，假令尺中迟者，为营血不足，不可发汗。又曰：脉浮数者，法当汗出而愈，若下之身重心悸者，不可发汗，当自汗出乃解。所以然者，尺中脉微，此里虚须表里实，津液自和，便自汗出愈。凡脉浮取之盛，按之不足，寸关盛，尺不足，其盛皆为假象，盖沉之与尺，犹树之有根也。故仲景于当汗之症，迟回顾虑，如此予更有说焉。夫浮以候表，寸以候阳，外邪初入，必先在表与阳分，表盛则里虚，上盛则下虚，此时似难以尺中迟微而误当汗之期，犹必须审其人之形气病气何如也。若其人无外邪，脉见沉候，与尺不足，此真是有阳无阴，枝叶虽茂．根本将拨，勿妄施攻击耳。
曰肾气独沉，曰肾气不衡，总是石而无胃，肾水不能上交于心火之象也。
促为阳，紧为阴，然仲景又曰：伤寒脉促，手足厥逆者，可灸之。又曰：手足厥冷，脉乍紧者，邪在胸中，当须吐之。是又不能拘也。
有者为实．无者为虚。仲景又谓阳脉微者汗出而愈，阴脉微者下之而愈，虽曰极虚之处，便是容邪之地，然既极虚矣，汗下岂可轻哉!此亦人存政举之法，后学不得藉以为口实也。
刘澹庵曰：从症不从脉，正在此处要人下手，仲景非立是空头论而眩后人持两端也。
风湿相合，热湿相合，便牵制其善行炎上之性，脉证最难辨别。
色诊以明泽者生，沉夭者死。亦犹脉之有无胃气也。别则于阳者，知死生之期，言无胃气，弹石解索是也。
病之浅者，邪未入于经，病之深者，亦有兼化之象，脉亦难拘。
阳主煦之，阴主濡之。真气虚是阳不能煦，阴不能濡，脉或馓而弱，或弦而紧，此一定之理。
色诊不论何色，俱欲其明泽，然光芒浮露之人，又非寿徽，是亦阳亡于外也。故善摄生者，其气深，其神藏，诸病皆有寒热虚实，断不可执已见以为凭。所可凭者，脉耳，然脉又有阴阳格拒之易惑，真假虚实之难明，与夫从脉从症之不可泥，医道可易言哉!
《内经》三部候法，右寸以候肺及胸中，左左寸以候心及膻中，此上附上一定不易之理。而叔和《脉诀》又云：右寸以候肺及大肠左寸候心及小肠。后人谓大小肠为下焦，传导浊秽之府，而诊于膈上，清虚之所，此理不伦，遂指《脉诀》为高阳生托叔和之名也。据兰谓《内经》、《脉诀》两论，俱不可废。在《内经》是言身形躯壳内外，在上者诊之于上，而言叔和则以五行配合经脉相络而言，何也？盖欲察病脉，先须知平脉，夫肺系足太阴，主金，大肠系于手阳明，亦主金，脉之浮涩而短，金之体也，安有浮涩而短之脉，亦诊于右尺乎？心系足少阴主火，小肠系手太阳亦主火，脉之浮大而散，火之体也，安有浮大而散之脉，亦诊于左尺乎？况肺与大肠，心与小肠，确显声应气求，不可移易之证，又宁可以部位拘耶？叔和叙论仲景《伤寒论》，其可指摘处颇多，至于《脉诀》则不可谤矣。又相火藏于九地之下守，谓禀命，确宜诊之于尺，膻中虽曰咽喉之司，当诊于上，然不过为相火之虚位，亦不必于寸求其诊也。
张永孚曰：《内经》以脏腑上下分部位候诊，叔和则以脏腑相络而候诊，不妨并存其说，不为悖理。
必先岁气，无伐天和
二分二至，病之轻者，可望其愈，病之重者，须防其笃，此阴阳互换，人气随之也。天地能鼓铸群品，人亦能范围天地，同在气交中，谁能逃两仪之侵薄？观圣人在位，天无疾风淫雨，非然耶？知此则养生，即病之理锤可在手矣。
寒肃之气，为生发之本。不然，造物者，岂好为此戕贼哉!知此则知天地不可无秋冬之令，吾人身中不可不保金水二脏。
升已而降，降已而生，两已字殊不妥贴。一边升便一边降，是升中有降，降中有升，升者自升，降者自降，奚俟其已耶!不观之二分二至乎？四时之春夏秋冬而配以木火土金水，治病须求其寒热温凉之宜，毋违时，毋违化，用热远热，用寒远寒，宜矣。至于运气则有常有变，有主气有客气，有阳年有阴年，有南政有北政，有胜气，有复气，虽皆一本于乾支，然刚柔强弱，杂乱纷纠，何能按图而索?如土平运曰：备化不及曰卑监，太过曰敦阜。此可考也。少宫之岁而实与太角之岁同，则难可考也。况乎太阳之人，或遇流衍之纪，太阴之人，而遇赫曦之纪，强者有制，弱者得扶，又未可以流衍赫曦之，故而病寒热也。且古今异气，方隅异宜，安能比而同之?故施之于治，往往不可不知。
刘澹庵曰：古今异气，方隅异宜，主气或同，客气则定，有不同者，此在察其气，以知所感者何?属为多比而同施而治之，自不可也。
世有日用寻常之事，童而习之，白首不知其所以然者，如五行相克，水克火，火克金，固易明矣。至于金克木，岂斧斤，以时入仙之谓乎?木克土，岂草木蕃茂土因之而瘠之谓乎?土克水，岂水来土掩之谓乎?是不易明也。在箕子主质而周子主气，后人茫无所宗，予谓水克火，火克金，是言其质之与性；金克木，木克土，土克水，是但言其性。木之敷荣条达，固其性也，金气肃杀，则克之矣。土居中央，其性缓，木之性劲急，则克之矣。水之性寒，湿土之性温燠则克之矣。速其所欲，谓之泻，泻即克也。推此而言，相生之理，亦莫能外之格物致知之学，由浅入深，由粗入精，此等粗浅之处不明，吻口而谈运气得乎!
化气必以五，故五行不可增之为六，减之为四，亦自然之理。
五运六气各具一体用，各具一太极，亢害承制，归于和平。和平者，阴阳相抱，无偏无倚，之谓千万法门，不过欲全此气耳。医有喜寒凉而恶温热，喜温熟而恶寒凉，均未谙此。
运气之说，若按图索骥，似堕马宗素术中。然不深求其理，安知人在气交中，五运六气太过不及，阴阳胜复内外合邪，皆能为病?中庸之理，无往不宜。试以运言之太过不及，皆能致病。如土太过则水受克而火无制矣。土不及则不能生金，而木横肆矣。故曰：母能令子虚，子能令母实，是虚则补其母，实则泻其子之义也。又子逢窃气，母乃力争，母被鬼伤，子来力救之义也。不然造物既以生物为心，又杀之何也?盖理之不得不然者耳。
有毒，无毒固宜常制矣
统而言之，天为阳，地为阴。分而言之，天有天之阴阳，地有地之阴阳，故治者，要知补益阴阳矣。尤不可不知补益阳中之阴，阴中之阳。补阳中之阴，甘寒而气厚味薄者是也；补阴中之阳，苦温而质重味厚者是也。
咸走肾，肿胀之却咸味，以防贼邪者，因脾胃虚不能运化水谷而生湿热，湿热下流，则膀胱之气化不行，小便不通。今使咸味引土邪入肾，肿满不能愈也。茶内着盐，便能消肾，亦是此义耳。
五味子味厚而酸，故能收至高之气以藏极下之地，譬之车论焉，上者能下，而下者方能上。五味如大力者，将此车轮扳之使下耳。
能知桂枝开腠致津液通气，白术、茯苓之生津，则医学之上乘也。
方者，仿也。务必相时令之虚实与时序之寒温仿而用之。王宇泰云：小续命汤亦麻黄桂枝之变，麻黄不施于冬月即之伤寒，而泛施于温热之证，未有不杀人者，其可执乎?
夫辛能燥，以开窍走津液故也。然又曰：辛以润之，其义何居?不知燥气在里，则津液不行，而元府闭塞，故曰肾恶燥，急食辛以润之。开腠理，致津液，通气也。风药治秘，盖本诸此。
有宜先攻后补，其功在补，有宜先补后攻，其功在攻。易医而治，毁誉生焉。殊不知后医之有功即前医无功者有以成之也。易时而治，皆无功焉。所谓客医之治热病，即旧医之乳药也，岂可以有毒为是，无毒为非，无毒为是，有毒为非乎?
《内经释要》终
《医津一筏》跋
《医津一筏》一卷，《四库全书》存目中简称曰《医津筏》，清初江之兰撰。书凡十四篇，以《内经》数语为题，而分条疏论于后，说理精确，措词简明。此本乃江君同邑友辑，刊人昊江沈氏昭代业书一集者。沈氏刊书甚多，惜板烬于火，故印本罕见。今春偶检得此册，阅之似与去年《三三医书》第一集内《医经秘旨》相似，遂对校一过，方知《秘旨》前十篇全袭江书，而第一篇内，厕入盛君东宫一案，推本阴阳篇下，缺食养尽之四篇，而增脱阳、遗精等十二则，笔墨不同，体例亦不合，大约坊间射利之徒，因江君无鼎鼎大名，遂伪托盛、高、顾三名。医之名，而著作人之名，与书名均湮没矣。方拟将校勘表覆佼缮正，并江书寄社重刊，因俗事鲜暇，因循未寄。近见医报有高思潜君《医经秘旨》校言，知高君藏有《内经释要》铅字本，乃光绪干寅敏修斋所印，幸书名虽改，江君之名未改，高君亦考出伪托之证，且裘君又将《内经释要》拟重刊人《三三医书》三集中，自恨余之因循贻误，未早将此书寄社，依此原本重印。沈氏原本甚精，必较铅本少误夺，以彼易此，使书名及内容数百年后仍复汉氏原书真面目，亦一快事。想高君闻之，谅亦赞成，因邮致吉生社长，未知能俯如所请否。时
民国十四年七月吴门张炳翔叔鹤氏跋时年六十有七
张仲景认为，脉象浮起时应当用发汗法治疗。假如尺部脉搏迟缓，这是营血不足的表现，不可使用发汗法。又说：脉象浮数者，按照法则应当通过出汗而痊愈，如果误用泻下法导致身体沉重、心悸，则不可再发汗，必须等待患者自然出汗才能痊愈。之所以这样，是因为尺部脉微，这表示里气虚弱，需要表里之气充实，津液调和，便会自然出汗而病愈。凡是脉象轻取（浮取）盛大，重按（沉取）不足的，寸部和关部脉盛，尺部脉不足，这种盛大都是假象，因为沉取和尺部脉就像树木的根一样重要。所以张仲景在应当发汗的症状面前，总是迟疑顾虑，像这样谨慎。对此我更有进一步的论述。浮脉候表证，寸脉候阳气，外邪初入人体，必定先在体表与阳分，表气盛则里气虚，上气盛则下气虚，此时似乎难以因为尺部脉迟微就误判为应当发汗的时期，仍然必须审察病人的形体气质和病气状况如何。如果此人没有外邪，脉象呈现沉候无力，以及尺部脉不足，这才是真正的有阳无阴，虽然枝叶茂盛，但根本即将动摇，切勿妄加攻伐。
说肾气独沉，说肾气不衡，总是表现为石脉而无胃气，是肾水不能上交于心火的征象。
促脉属阳，紧脉属阴，然而张仲景又说：伤寒病脉象促，手足逆冷的，可以用灸法治疗。又说：手足厥冷，脉象突然变紧的，邪气在胸中，应当用吐法治疗。这说明又不能拘泥于前面的说法。
有邪气停留为实，无邪气停留为虚。张仲景又说阳脉微弱的通过发汗而愈，阴脉微弱的通过泻下而愈，虽然说极度虚弱的地方，就是邪气容留的地方，既然已经极度虚弱了，发汗和泻下怎么可以轻易使用呢！这也是人存政举的道理，后学者不得借此作为借口。
刘澹庵说：从症状而不从脉象，正是在这里要求医生下手判断，张仲景并非设立这些空泛的理论来迷惑后人持两端不定也。
风湿相合，热湿相合，就会牵制其善行炎上的特性，脉象和症状最难辨别。
望色诊断以面色明润光泽者为生，沉滞枯夭者为死。这也如同脉象是否有胃气一样。辨别清楚则在阳分，可知死生的期限，所谓无胃气的脉象，如弹石脉、解索脉就是这类。
病情浅的，邪气未进入经脉；病情深的，也有兼夹转化的征象，脉象也不能拘泥。
阳气主温煦，阴气主濡润。真气虚弱是阳气不能温煦，阴气不能濡润，脉象或细软而弱，或弦硬而紧，这是一定的道理。
望色诊断不论什么颜色，都希望其明润光泽，然而光芒浮露的人，又不是长寿的征兆，这也是阳气亡失于外的表现。所以善于养生的人，他的气深沉，他的神内藏，各种疾病都有寒热虚实之分，绝对不可固执己见作为凭据。所可凭借的只有脉象，然而脉象又有阴阳格拒容易迷惑，真假虚实难以辨明，以及从脉还是从症不可拘泥的问题，医道怎么能轻易谈论呢！
《内经》的三部候法，右寸脉用来候肺及胸中，左寸脉用来候心及膻中，这是上下对应一定不变的真理。而王叔和的《脉诀》又说：右寸脉候肺及大肠，左寸脉候心及小肠。后人认为大小肠属于下焦，是传导浊秽的腑，而在膈以上的清虚之所进行诊察，这个理论不合伦次，于是指《脉诀》是高阳生托名王叔和所作。据江兰所说，《内经》和《脉诀》两种理论，都不可废弃。在《内经》中是说身形躯壳内外，在上部的诊察上部，而王叔和则是以五行配合经脉相连络来说，为什么呢？大概想要察看病脉，先要知道平脉（正常脉象）。肺系足太阴经，主金，大肠系手阳明经，也主金，脉象浮涩而短，是金的体性，哪里有浮涩而短的脉象，却诊察在右尺呢？心系足少阴经主火，小肠系手太阳经也主火，脉象浮大而散，是火的体性，哪里有浮大而散的脉象，却诊察在左尺呢？况且肺与大肠，心与小肠，确实显现出声应气求，不可移易的证候，又怎能以部位来拘泥呢？王叔和在叙述评论张仲景《伤寒论》时，可指摘的地方很多，至于《脉诀》则不可诽谤了。又说相火藏于九地之下守位，禀受天命，确实适宜诊察于尺部，膻中虽然是咽喉的主管，应当诊察于上部，然而不过是相火的虚位，也不必在寸部寻求诊察。
张永孚说：《内经》以脏腑上下分部位置候诊，王叔和则以脏腑相连络而候诊，不妨并存这两种说法，并不违背事理。
必须首先了解当年的岁气，不要破坏天和的自然平衡。
春分秋分二分，冬至夏至二至，病情轻的，有望痊愈，病情重的，必须防止加重，这是阴阳互换，人气随之变化的结果。天地能鼓铸万物，人也能规范天地，同在气交之中，谁能逃脱两仪的侵扰？看圣人在位时，天没有疾风暴雨，不是这样吗？知道这一点，那么养生和治病的原理就在手中了。
寒肃之气，是生发的根本。不然，造物者怎么会喜欢做这种残害的事情呢！知道这一点就知道天地不可没有秋冬的命令，我们人身中不可不保护金（肺）水（肾）两脏。
升完然后降，降完然后生，两个“已”字特别不妥贴。一边升便一边降，是升中有降，降中有升，升的自升，降的自降，何必等它结束呢！不看二分二至吗？四季春夏秋冬配以木火土金水，治病须求其寒热温凉的适宜，不要违逆时令，不要违逆气化，用热药避开热令，用寒药避开寒令，这是适宜的。至于运气学说则有常有变，有主气有客气，有阳年有阴年，有南政有北政，有胜气有复气，虽然都一本于干支，然而刚柔强弱，杂乱纷纠，怎么能按图索骥去寻找呢？如土平运叫做备化，不及叫做卑监，太过叫做敦阜。这是可以考证的。少宫之岁与太角之岁相同，则难以考证了。何况太阳之人，如果遇到流衍之纪，太阴之人，遇到赫曦之纪，强者有制约，弱者得扶助，又不可以因为流衍赫纪的缘故就断定是寒热病。况且古今气候不同，方位适宜也不同，怎么能等同对待呢？所以施用于治疗，往往不可不知这些。
刘澹庵说：古今气候不同，方位适宜也不同，主气或许相同，客气则确定，有不同之处，这在于观察其气，以知道感受的是什么？属于多比而同施治疗的，自然不可以。
世间有日用寻常之事，从小学习，直到白头不知道其中的原因，比如五行相克，水克火，火克金，固然容易明白。至于金克木，难道是斧头按时进入山林砍伐的意思吗？木克土，难道是草木繁茂土地因此变得贫瘠的意思吗？土克水，难道是水来土掩的意思吗？这些不容易明白。在箕子讲体质而周敦颐讲气，后人茫然无所宗奉，我认为水克火，火克金，是讲它们的质与性；金克木，木克土，土克水，只是讲它们的性。木的敷荣条达，固然是它的性，金气肃杀，则克制它了。土居中央，其性缓，木之性劲急，则克制它了。水之性寒，湿土之性温燠则克制它了。顺从其欲望，叫做泻，泻即克也。推此而言，相生的道理，也没有超出格物致知的学问，由浅入深，由粗入精，这些粗浅之处不明白，张口谈论运气能得到吗！
化气必然以五为基础，所以五行不可增加为六，减少为四，也是自然的道理。
五运六气各具一体用，各具一太极，亢害承制，归于和平。和平，就是阴阳相抱，无偏无倚，所谓的千万法门，不过是想保全这股气罢了。医生有的喜欢寒凉而厌恶温热，有的喜欢温熟而厌恶寒凉，都没有精通这个道理。
运气之说，如果按图索骥，似乎堕入马宗素的技术中。然而不深究其理，怎么知道人在气交中，五运六气太过不及，阴阳胜复内外合邪，都能致病？中庸的道理，无处不宜。试着以运来说，太过不及，都能致病。如土太过则水受克而火无制约了。土不及则不能生金，而木横行了。所以说：母能令子虚，子能令母实，这就是虚则补其母，实则泻其子的含义。又子逢窃气，母乃力争，母被鬼伤，子来力救的含义。不然造物既以生物为心，又杀之为什么呢？大概是理之不得不然罢了。
有毒无毒固然应该常制定法度。
统而言之，天为阳，地为阴。分而言之，天有天之阴阳，地有地之阴阳，所以治病，要知道补益阴阳。尤其不可不知补益阳中之阴，阴中之阳。补阳中之阴，是甘寒而气厚味薄的药物；补阴中之阳，是苦温而质重味厚的药物。
咸味走肾，肿胀病忌咸味，以防贼邪，是因为脾胃虚弱不能运化水谷而生湿热，湿热下流，则膀胱的气化不行，小便不通。现在如果让咸味引土邪入肾，肿满就不能痊愈了。茶里加盐，便能消肾，也是这个意思。
五味子味厚而酸，所以能收摄至高之气以藏于极下之地，就像车轮一样，上面的能向下，下面的才能向上。五味子像大力士，将这个车轮扳动使其向下而已。
能知道桂枝开腠理、致津液、通气，白术、茯苓生津液，就是医学的上乘境界了。
方，是仿效的意思。务必相时令的虚实与时序的寒温仿效而使用。王宇泰说：小续命汤也是麻黄桂枝的变法，麻黄不施用于冬月即伤寒，而泛施于温热的证候，没有不杀人的，怎么能固执呢？
辛味能燥，是因为开窍走津液的缘故。然而又说：辛以润之，这是什么道理？不知道燥气在里，则津液不行，而元府闭塞，所以说肾恶燥，急食辛以润之。开腠理，致津液，通气也。风药治便秘，大概基于此。
有宜先攻后补，其功效在补，有宜先补后攻，其功效在攻。更换医生治疗，毁誉就产生了。殊不知后医的成功就是前医无功的原因造成的。更换时机治疗，都无功绩。所谓客医治疗热病，就是旧医的乳药（无效药），难道可以说有毒是对的，无毒是错的，无毒是对的，有毒是错的吗？
《内经释要》终
《医津一筏》跋
《医津一筏》一卷，《四库全书》存目中简称曰《医津筏》，清初江之兰撰。书凡十四篇，以《内经》数语为题，而分条疏论于后，说理精确，措词简明。此本乃江君同邑友辑，刊入吴江沈氏昭代业书一集者。沈氏刊书甚多，惜板烬于火，故印本罕见。今春偶检得此册，阅之似与去年《三三医书》第一集内《医经秘旨》相似，遂对校一过，方知《秘旨》前十篇全袭江书，而第一篇内，厕入盛君东宫一案，推本阴阳篇下，缺食养尽之四篇，而增脱阳、遗精等十二则，笔墨不同，体例亦不合，大约坊间射利之徒，因江君无鼎鼎大名，遂伪托盛、高、顾三名医之名，而著作人之名，与书名均湮没矣。方拟将校勘表覆佼缮正，并江书寄社重刊，因俗事鲜暇，因循未寄。近见医报有高思潜君《医经秘旨》校言，知高君藏有《内经释要》铅字本，乃光绪干寅敏修斋所印，幸书名虽改，江君之名未改，高君亦考出伪托之证，且裘君又将《内经释要》拟重刊入《三三医书》三集中，自恨余之因循贻误，未早将此书寄社，依此原本重印。沈氏原本甚精，必较铅本少误夺，以彼易此，使书名及内容数百年后仍复汉氏原书真面目，亦一快事。想高君闻之，谅亦赞成，因邮致吉生社长，未知能俯如所请否。时
民国十四年七月吴门张炳翔叔鹤氏跋时年六十有七
Zhang Zhongjing holds that when the pulse is floating (Fu Mai, superficial pulse), sweating therapy should be employed. However, if the chi position (Cun Kou pulse diagnosis at the wrist) is slow (Chi Mai, slow pulse), it indicates a deficiency of Ying Blood (Nutritive Blood), and sweating therapy must not be used. He further states: When the pulse is floating and rapid (Shu Mai, rapid pulse), recovery through sweating is the standard method. If purgation is mistakenly applied, resulting in heavy body and palpitations (Xin Ji), sweating therapy is contraindicated; recovery will occur only when spontaneous sweating (Zi Han Chu) happens naturally. This is because a faint pulse at the chi position indicates interior deficiency (Li Xu). The exterior and interior must become solid, and once the Body Fluids (Jin Ye) harmonize, spontaneous sweating will occur, leading to cure. Whenever a pulse appears vigorous upon light palpation (Fu Qu) but deficient upon heavy pressure (Chen Qu), with excess at the cun (inch) and guan (middle) positions but deficiency at the chi (cubit) position, this apparent vigor is illusory. The deep pulse and chi position are like the roots of a tree. Therefore, Zhang Zhongjing exercises great caution regarding conditions requiring sweating. I have further observations. Floating pulses indicate exterior patterns; cun pulses indicate Yang Qi. When external pathogens first invade, they reside in the exterior and Yang divisions. Exterior excess leads to interior deficiency; upper excess leads to lower deficiency. At this stage, one should not mistake the timing for sweating merely because the chi pulse is slow or faint. One must examine the patient's constitution (Xing Qi) and pathogenic qi status. If there is no external pathogen, and the pulse shows weakness in deep palpation and deficiency at the chi position, this truly represents "Yang without Yin." Although the branches and leaves may be lush, the root is about to be uprooted; do not recklessly apply attacking therapies.
Saying "Kidney Qi sinks alone" or "Kidney Qi is unbalanced" always refers to a stone-like pulse (Shi Mai, hard pulse) lacking Stomach Qi (Wei Qi, digestive vitality), indicating that Kidney Water fails to ascend to communicate with Heart Fire.
Cu pulse (Surging/Interrupted pulse) belongs to Yang; Jin pulse (Tight pulse) belongs to Yin. However, Zhang Zhongjing also states: In cold damage diseases, if the pulse is Cu and the hands and feet are cold (Jue Ni), moxibustion (Jiu Fa) may be used. He also states: If the hands and feet are cold and the pulse suddenly becomes Jin, the pathogen is in the chest, and emesis (Tu Fa) is required. Thus, one cannot rigidly adhere to previous rules.
Presence of pathogen constitutes Excess (Shi); absence constitutes Deficiency (Xu). Zhang Zhongjing also says: If the Yang pulse is faint, recovery comes through sweating; if the Yin pulse is faint, recovery comes through purgation. Although it is said that extreme deficiency is where pathogens lodge, once extremity deficiency exists, how can sweating or purgation be used lightly! This follows the principle that human effort sustains governance; later students must not use this as an excuse.
Liu Dan'an said: "Following symptoms rather than pulses" requires precise clinical judgment here. Zhang Zhongjing did not establish empty theories to confuse successors into indecision.
When Wind-Dampness combines, or Heat-Dampness combines, their nature of moving freely and flaming upward is constrained, making pulse and symptom differentiation most difficult.
In color diagnosis, bright and lustrous complexions indicate life; dull and withered complexions indicate death. This is analogous to whether the pulse possesses Stomach Qi. Differentiation in the Yang aspect allows prediction of the time of death; pulses lacking Stomach Qi include the Stone Pulse (Tan Shi Mai) and Unraveling Rope Pulse (Jie Suo Mai).
For shallow diseases, pathogens have not entered the meridians; for deep diseases, there may be combined transformations, so pulse diagnosis cannot be rigidly applied.
Yang governs warming and nourishing; Yin governs moistening. True Qi deficiency means Yang cannot warm and Yin cannot moisten. The pulse may be fine and weak (San Ruo) or wiry and tight (Xian Jin); this is a fixed principle.
In color diagnosis, regardless of the hue, brightness and luster are desired. However, overly radiant or floating brilliance in a person is not a sign of longevity; it indicates Yang collapsing outwardly. Therefore, those skilled in health preservation keep their Qi deep and their Shen (Spirit) concealed. All diseases involve Cold, Heat, Excess, and Deficiency; one must never rely solely on personal preconceptions. What can be relied upon is the pulse. Yet, pulses can be confusing due to Yin-Yang repulsion (Ge Ju), and true/false, excess/deficiency are hard to distinguish. Moreover, one cannot rigidly adhere to either following the pulse or following the symptoms. Can the medical way be discussed lightly!
The *Neijing* three-position diagnostic method uses the right Cun position to inspect the Lung and Chest Middle, and the left Cun position to inspect the Heart and Danzhong. This correspondence between upper and lower is immutable. However, Wang Shuhe's *Mai Jue* (Pulse Classic) states: Right Cun inspects Lung and Large Intestine; Left Cun inspects Heart and Small Intestine. Later scholars argued that the Large and Small Intestines belong to the Lower Jiao, being fu organs that transport turbid waste, yet they are diagnosed at the Diaphragm level, a clear and empty region above. This theory is inconsistent, leading some to claim *Mai Jue* was forged by Gao Yangsheng under Wang Shuhe's name. Jiang Lan argues that both *Neijing* and *Mai Jue* theories should not be discarded. *Neijing* discusses the internal and external aspects of the physical body, diagnosing upper regions from above. Wang Shuhe, however, bases his theory on Five Elements matching connected meridians. Why? To understand pathological pulses, one must first know normal pulses (Ping Mai). The Lung connects to the Foot Taiyin Spleen Meridian, governs Metal; the Large Intestine connects to the Hand Yangming Large Intestine Meridian, also governs Metal. A floating, choppy, and short pulse is the characteristic of Metal. How could such a pulse be diagnosed at the Right Chi position? The Heart connects to the Foot Shaoyin Kidney Meridian, governs Fire; the Small Intestine connects to the Hand Taiyang Small Intestine Meridian, also governs Fire. A floating, large, and scattered pulse is the characteristic of Fire. How could such a pulse be diagnosed at the Left Chi position? Furthermore, the Lung and Large Intestine, Heart and Small Intestine, clearly demonstrate resonant Qi relationships that cannot be shifted; why restrict them by anatomical position? While Wang Shuhe has many points to criticize in his commentary on Zhang Zhongjing's *Shanghan Lun*, his *Mai Jue* should not be slandered. He also states that Ministerial Fire (Xiang Huo) resides deep below, receiving its mandate, and is indeed suitable for diagnosis at the Chi position. Although Danzhong is the hub of the throat and should be diagnosed above, it is merely a virtual position for Ministerial Fire, so diagnosis need not be sought at the Cun position.
Zhang Yongfu said: *Neijing* diagnoses based on the upper/lower locations of Zang-Fu organs, while Wang Shuhe diagnoses based on meridian connections. Both theories can coexist without contradiction.
One must first consider the annual climate (Sui Qi) and not disrupt the natural harmony (Tian He).
At the Equinoxes (Fen) and Solstices (Zhi), mild illnesses may hope for recovery, while severe illnesses require prevention of worsening. This is due to the interchange of Yin and Yang, with human Qi following suit. Heaven and Earth forge all things; humans can also regulate within Heaven and Earth. All exist within the Qi intersection; who can escape the invasion of the Two Powers (Yin-Yang)? Observing sages in power, heaven does not produce violent winds or excessive rain—is this not so? Knowing this places the principles of health preservation and disease treatment in hand.
Cold and austere Qi is the foundation of growth and development. Otherwise, why would the Creator engage in such destruction! Knowing this reveals that Heaven and Earth cannot lack Autumn/Winter commands, and our bodies must preserve the Metal (Lung) and Water (Kidney) Zang organs.
"Rising then falling, falling then generating"—the word "then" (Yi) is inappropriate. Rising occurs simultaneously with falling; rising contains falling, and falling contains rising. The rising rises itself, the falling falls itself; why wait for completion? Do we not observe the Equinoxes and Solstices? The four seasons Spring, Summer, Autumn, Winter correspond to Wood, Fire, Earth, Metal, Water. Treatment must seek appropriateness in Cold, Heat, Warmth, and Coolness, not violating seasonal timing or transformational laws. Use hot remedies avoiding hot seasons; use cold remedies avoiding cold seasons—this is appropriate. Regarding Luck (Yun Qi) theory, there are constants and variables, dominant and guest Qi, Yang years and Yin years, Southern and Northern regimes, Winning and Repaying Qi. Although all stem from Heavenly Stems and Earthly Branches, the interplay of rigidity/flexibility and strength/weakness is chaotic. How can one simply follow a chart? For example, Earth balanced luck is called "Bei Hua"; deficiency is "Bei Jian"; excess is "Dun Fu." These can be verified. However, years of Shao Gong and Tai Jiao being similar makes verification difficult. Moreover, individuals with Taiyang constitutions encountering Liuyan periods, or Taiyin constitutions encountering Hexi periods, see the strong restrained and the weak supported. One cannot simply attribute cold-heat diseases to these periods. Ancient and modern climates differ; regional preferences vary. How can they be treated identically? Thus, in treatment, these factors must often be considered.
Liu Dan'an said: Ancient and modern climates differ, and regional suitability varies. Dominant Qi may be similar, but Guest Qi is fixed. Differences lie in observing the Qi to determine what is affected. Applying uniform treatment based on similarity is inadvisable.
There are common daily matters learned since childhood but understood only in old age, such as the Five Elements overcoming each other. Water overcoming Fire, and Fire overcoming Metal, are easy to understand. But what does Metal overcoming Wood mean? Is it axes entering forests seasonally? Does Wood overcoming Earth mean vegetation flourishing until soil becomes barren? Does Earth overcoming Water mean earth blocking water? These are not obvious. Ji Zi focused on substance, while Zhou Dunyi focused on Qi; later generations were lost. I believe Water overcoming Fire and Fire overcoming Metal refer to substance and nature; Metal overcoming Wood, Wood overcoming Earth, and Earth overcoming Water refer only to nature. The spreading and thriving of Wood is its nature; the austere killing Qi of Metal overcomes it. Earth resides centrally with a slow nature; the urgent nature of Wood overcomes it. Water is cold; the warm nature of damp Earth overcomes it. Accelerating desires is called Purging (Xie); purging is overcoming. Extending this, the principle of generation also falls under the study of investigating things to extend knowledge, progressing from shallow to deep, coarse to refined. Without understanding these basics, how can one discuss Luck theory!
Transforming Qi relies on five; thus, the Five Elements cannot be increased to six or decreased to four, which is natural law.
The Five Movements and Six Qi each possess a unity of substance and function, and each contains a Taiji. Overcoming and controlling lead to peace. Peace means Yin and Yang embrace, neither biased nor leaning. Thousands of methods aim only to preserve this Qi. Some doctors prefer cold/cool and dislike warm/hot; others prefer warm/cooked and dislike cold/raw. None have fully grasped this.
Luck theory, if followed mechanically like a map, falls into Ma Zongsu's technical trap. But without deep inquiry, how can one know that humans in the Qi intersection suffer disease from excess/deficiency of Five Movements and Six Qi, Yin-Yang winning/repaying, and internal-external pathogenic combination? The Doctrine of the Mean applies everywhere. Taking Movement as an example: excess and deficiency both cause disease. Earth excess overcomes Water, leaving Fire unchecked. Earth deficiency fails to generate Metal, allowing Wood to run rampant. Thus, "Mother causes Child deficiency; Child causes Mother excess," meaning tonify the Mother in deficiency, purge the Child in excess. Also, if the Child is robbed of Qi, the Mother strives; if the Mother is injured by the "Ghost" (Overcoming element), the Child rescues. Otherwise, if the Creator intends to generate life, why kill? It is simply the necessity of principle.
Whether toxic or non-toxic, regulations should always be established.
Generally speaking, Heaven is Yang, Earth is Yin. Specifically, Heaven has its own Yin-Yang, and Earth has its own Yin-Yang. Therefore, treatment requires knowing how to tonify Yin and Yang. Crucially, one must know how to tonify Yin within Yang and Yang within Yin. Tonifying Yin within Yang involves sweet-cold herbs with thick Qi and thin flavor. Tonifying Yang within Yin involves bitter-warm herbs with heavy substance and thick flavor.
Salty taste travels to the Kidney. Avoiding salty taste in edema prevents "robber pathogens" because Spleen-Stomach deficiency fails to transform food/water, generating Damp-Heat. Damp-Heat flows downward, impairing Bladder Qi transformation, causing urinary retention. If salty taste draws Earth pathogen into the Kidney, edema will not resolve. Adding salt to tea affects the Kidney similarly.
Wuweizi (Schisandra Chinensis Fruit) has thick substance and sour taste, allowing it to gather high Qi to store in the lowest place, like a wheel: the top goes down so the bottom can go up. Wuweizi acts like a strongman turning the wheel downward.
Knowing Guizhi Tang (Cinnamon Twig Decoction) opens pores, generates fluids, and moves Qi, along with Baizhu (Atractylodis Macrocephalae Rhizoma) and Fuling (Poria) generating fluids, represents the highest level of medicine.
"Fang" (Formula) means imitation. One must imitate the excess/deficiency of seasonal timing and the cold/warmth of chronological order. Wang Yutai said: Xiaoxuming Tang is a variation of Mahuang Tang (Ephedra Decoction) and Guizhi Tang. Using Mahuang outside winter for cold damage, or broadly applying it to warm-heat syndromes, kills patients. One cannot be rigid.
Acrid taste dries because it opens orifices and moves fluids. Yet it is said: "Acrid moistens." Why? Dryness inside blocks fluid flow and closes Yuan Fu (pores). Thus, "Kidney dislikes dryness; urgently eat acrid to moisten." Opening pores, generating fluids, and moving Qi. Wind herbs treating constipation derive from this.
Some cases require attacking first, then tonifying (efficacy in tonification); others require tonifying first, then attacking (efficacy in attack). Changing doctors brings praise/blame. The success of the latter doctor proves the former's failure. Changing timing yields no result. A visiting doctor treating febrile disease is like the previous doctor's ineffective milk medicine. Can we say toxic is correct and non-toxic wrong, or vice versa?
End of *Interpretation of Neijing Essentials*.
Postscript to *Medical Ferry*
*Medical Ferry* (Yi Jin Yi Fa), one volume, abbreviated as *Yi Jin Fa* in the *Siku Quanshu* catalog, was written by Jiang Zhilan in the early Qing Dynasty. The book contains fourteen chapters, titled with phrases from the *Neijing*, followed by detailed discussions. The reasoning is precise, and the language concise. This edition was compiled by Jiang's fellow townsman and published in Shen's *Zhaodai Yeshu* collection. Shen published many books, but the woodblocks burned, making prints rare. This spring, I found this volume, which resembled *Medical Secrets of the Classics* (Yijing Mizhi) in the first collection of *Sanyiyishu*. Upon comparison, I realized the first ten chapters of *Mizhi* plagiarized Jiang's work. Chapter 1 included a case by Master Sheng Donggong. Below the Yin-Yang chapter, four chapters on dietary therapy were missing, replaced by twelve sections on Yang loss and seminal emission. The style and structure differed. Likely, profit-seeking publishers, noting Jiang's lack of fame, falsely attributed the work to Masters Sheng, Gao, and Gu, obscuring the author and title. I planned to collate and reprint it via the society, but delayed due to busy affairs. Recently, seeing Gao Siqian's correction notes on *Mizhi* in the Medical Journal, I learned Gao possessed a printed version of *Interpretation of Neijing Essentials*, printed by Minxiuzhai in Guangxu Year 32. Fortunately, although the title changed, Jiang's name remained. Gao identified the forgery evidence. Mr. Qiu plans to reprint *Interpretation* in the third collection of *Sanyiyishu*. I regret my delay in sending this original to the society for reprinting. Shen's original is exquisite and likely more accurate than the printed version. Swapping them restores the Han dynasty text's true appearance after centuries, a joy. I trust Gao agrees. I mailed President Jisheng; hope he complies.
July, 14th Year of the Republic of China. Postscript by Zhang Bingxiang (Shuhe) of Wumen, aged 67.