特下之所为也。荣卫内陷。其数先微。脉反但浮。其人必大便硬。气噫而除。何以言之。
本以数脉动脾。其数先微。故知脾气不治。大便硬。气噫而除。今脉反浮。其数改微。
邪气独留。心中则饥。邪热不杀谷。潮热发渴。数脉当迟缓。脉因前后度数如法。病者
则饥。数脉不时。则生恶疮也。
经、常也。趺阳之脉。以候脾胃。故迟缓之脉为常。若脉浮数。则为医妄下。伤胃
动脾。邪气乘虚内陷也。邪在表。则见阳脉。邪在里。则见阴脉。邪在表之时。脉浮而
数也。因下里虚。荣卫内陷。邪客于脾。以数则动脾。今数先微。则是脾邪先陷于里也。
胃虚脾热。津液干少。大便必硬。针经曰。脾病善噫。得后出余气。则快然而衰。今脾
客邪热。故气噫而除。脾能消磨水谷。今邪气独留于脾。脾气不治。心中虽饥而不能杀
谷也。脾主为胃行其津液。脾为热烁。故潮热而发渴。趺阳之脉。
本迟而缓。因下之后。变为浮数。荣卫内陷。数复改微。是脉因前后度数如法。邪
热内陷于脾。而心中善饥也。数脉不时者。为数当改微而复不微。如此。则是邪气不传
于里。但郁于荣卫中。必出自肌皮为恶疮也。
师曰。病患脉微而涩者。此为医所病也。大发其汗。又数大下之。其人亡血。病当
恶寒。后乃发热。无休止时。夏月盛热。欲着复衣。冬月盛寒。欲裸其身。所以然者。
阳微则恶寒。阴弱则发热。此医发其汗。令阳气微。又大下之。令阴气弱。五月之时。
阳气在表。胃中虚冷。以阳气内微。不能胜冷。故欲着复衣。十一月之时。阳气在里。
胃中烦热。以阴气内弱。不能胜热。故欲裸其身。又阴脉迟涩。故知血亡也。
微为亡阳。涩则无血。不当汗而强与汗之者。令阳气微。阴气上入阳中则恶寒。
故曰阳微则恶寒。不当下而强与下之者。令阴气弱。阳气下陷入阴中则发热。
故曰阴弱则发热。气为阳。血为阴。阳脉以候气。阴脉以候血。阴脉迟涩。为荣血
不足。故知亡血。经曰。尺脉迟者。不可发汗。以荣气不足。血少故也。
王宇泰云。非必遇夏乃寒。遇冬乃热也。此但立其例。论其理耳。
又云。阴阳两伤。则气血俱损。而首末独言亡血者何也。曰、下之亡阳。不必言汗。
亦血类故也。
脉浮而大。心下反硬。有热属脏者。攻之。不令发汗。
浮大之脉。当责邪在表。若心下反硬者。则热已甚而内结也。有热属脏者。谓别
无虚寒。而但见里热也。脏属阴。为悉在里。故可下之。攻之。谓下之也。不可谓脉
浮大。便与发汗。病源曰。热毒瓦斯乘心。心下痞满。此为有实。宜速下之。
属腑者。不令溲数。溲数。则大便硬。汗多。则热愈。汗少。则便难。脉迟尚未可
攻。
虽心下硬。若余无里证。但见表证者。为病在阳。谓之属腑。当先解表。然后攻痞。
溲、小便也。勿为饮结而利小便。使其溲数。大便必硬也。经曰。小便数者。大便必硬。
谓走其津液也。汗多。则邪气除而热愈。汗少。则邪热不尽。又走其津液。必便难也。
硬家当下。设脉迟则未可攻。以迟为不足。即里气未实故也。
王三阳云。虽心下反硬。亦须脉紧有力。五六日不大便。方可下。虽下之。亦须用
大柴胡汤。切不可轻用承气也。不然。姑守之可也。何也。脉浮大故也。
又云。属腑者。病已传里。不当汗矣。但比上文入里浅耳。成不当注解表句。
唐不岩云。属腑亦有汗法。此以心下硬。有热。则非汗之所能除也。热愈。作热愈
甚为是。
上言脉虽浮大。心下硬而属脏者。则攻而不汗。此言亦有溲数则便硬。汗少则便
便难。虽为属肝。亦不可攻。以胃中津少故也。俟津液还。则自然解矣。
汗多则表热罢而传里。此阳明入腑证也。汗多汗少。皆就已然说。非谓发其汗也。
上言脉浮大。此言脉迟。断若两截。不可以属脏腑二句。合心下硬为一截看。
属腑不接上文脉浮大。心下反硬。一直说下。盖脉浮大者不宜攻。而属脏者则宜攻。
属腑便硬者则宜下。而溲数、汗少、脉迟。为津液不足。而不可攻。一似不可下之脉而必当下。
一似必当下之证而不可下。证书凭脉。盖互文以见意也。
脉浮而洪。身汗如油。喘而不休。水浆不下。体形不仁。乍静乍乱。此为命绝也。
病有不可治者。为邪气胜于正气也。内经曰。大则邪至。又曰。大则病进。脉浮而
洪者。邪气胜也。身汗如油。喘而不休者。正气脱也。四时以胃气为本。水浆不下者。
胃气尽也。一身以荣卫为充。形体不仁者。荣卫绝也。不仁。为痛痒俱不知也。针经曰。
荣卫不行。故为不仁。争则乱。安则静。乍静乍乱者。正与邪争。正负邪胜
也。正气已脱。胃气又尽。荣卫俱绝。邪气独胜。故曰命绝也。
王宇泰云。火之将灭也必明。脉来浮洪涌盛。此将去人体之兆也。然又必兼下一二
证。始可断其命绝。
又未知何脏先受其灾。若汗出发润。喘不休者。此为肺先绝也。
肺为气之主。为津液之帅。汗出发润者。津脱也。喘不休者。气脱也。
阳反独留。形体如烟熏。直视摇头。此心绝也。
肺主气。心主血。气为阳。血为阴。阳反独留者。则为身体大热。是血先绝而气独
在也。形体如烟熏者。为身无精华。是血绝不荣于身也。心脉挟咽系目。直视者。心经
绝也。头为诸阳之会。摇头者。阴绝而阳无根也。
张卿子云。论中凡无血血绝字面。皆要看得活。谓阴气先绝可耳。王文禄云。人死
者。气绝耳。以簪簪其皮肤。血犹然流出可见。
唇吻反青。四肢 习者。此为肝绝也。
唇吻者。脾之候。肝色青。肝绝则真色见于所胜之部也。四肢者。脾所主。肝主筋。
肝绝。则筋脉引急。发于所胜之分也。 习者。为振动若搐搦。手足时时引缩也。
环口黧黑。柔汗发黄者。此为脾绝也。
脾主口唇。绝则精华去。故环口黧黑。柔为阴。柔汗。冷汗也。脾胃为津液之本。
阳气之宗。柔汗发黄者。脾绝而阳脱。真色见也。
溲便遗失。狂言。目反直视者。此为肾绝也。
肾司开阖。禁固便溺。溲便遗失者。肾绝。不能约制也。肾藏志。狂言者。志不守
也。
内经曰。狂言者。是失志矣。失志者死。针经曰。五脏之精气。皆上注于目。骨之
精为瞳子。目反直视者。肾绝。则骨之精。不荣于瞳子。而瞳子不转也。
又未知何脏阴阳前绝。若阳气前绝。阴气后竭者。其人死。身色必青。阴气前绝。阳
气后竭者。其人死。身色必赤。腋下温。心下热也。
阳主热而色赤。阴主寒而色青。其人死也。身色青。则阴未离乎体。故曰阴气后竭。
身色赤。腋下温。心下热。则阳未离乎体。故曰阳气后竭。针经云。人有两死而无两生。
此之谓也。
寸口脉浮大。而医反下之。此为大逆。浮则无血。大则为寒。寒气相搏。则为肠鸣。
医乃不知。而反饮冷水。冷汗大出。水得寒气。冷必相搏。其人即KT 。
经云。脉浮大。应发汗。若反下之。为大逆。浮大之脉。邪在表也。当发其汗。若
反下之。是攻其正气。邪气得以深入。故为大逆。浮则无血者。下后亡血也。大则为寒
者。邪气独在也。寒邪因里虚而入。寒气相搏。乃为肠鸣。医见脉大。以为有热。饮以
冷水。欲令水寒胜热而作大汗。里先虚寒。又得冷水。水寒相搏。使中焦之气涩滞。故
令KT 也。
寸口浮大。此正东垣所谓内伤宜补中益气者也。若误下饮冷。令胃虚竭。则为KT
为哕为衄。变证蜂起。有不胜言者矣。
趺阳脉浮。浮则为虚。浮虚相搏。故令气KT 。言胃气虚竭也。脉滑则为哕。此为
医咎。责虚取实。守空迫血。脉浮。鼻中燥者。必衄也。
趺阳脉浮为KT 。脉滑为哕。皆医之咎。责虚取实之过也。内经曰。阴在内阳之守
也。阳在外阴之使也。发汗攻阳。亡津液。而阳气不足者。谓之守空。经曰。表气微
虚。里气不守。故使邪中于阴也。阴不为阳守。邪气因得而入之。内搏阴血。阴失所守。
血乃妄行。未知从何道而出。若脉浮鼻燥者。知血必从鼻中出也。
唐不岩云。为KT 为哕。皆误下伤阴之咎。阴伤。则阳失所守。故曰守空。论文前后
二。并无当发其汗。与攻阳亡津液之语。学人详之。
尝见内伤一证。服凉药饮冷水。以致衄血不止者。往往有之。及服从治药。屡屡奏
效。此正经所谓责虚取实。守空迫血者也。
诸脉浮数。当发热而洒淅恶寒。若有痛处。饮食如常者。蓄积有脓也。
浮数之脉。主邪在经。当发热而洒淅恶寒。病患一身尽痛。不欲饮食者。伤寒也。
若虽发热恶寒。而痛偏着一处。饮食如常者。即非伤寒。是邪气郁结于经络之间。
血气壅遏不通。欲蓄聚而成痈脓也。
脉浮而迟。面热赤而战惕者。六七日。当汗出而解。反发热者。瘥迟。迟为无阳。
不能作汗。其身必痒也。
脉浮。面热赤者。邪气外浮于表也。脉迟。战惕者。本气不足也。六七日。为传经
尽。当汗出而解之时。若当汗不汗。反发热者。为里虚津液不多。不能作汗。既不汗。
邪无从出。是以瘥迟。发热为邪气浮于皮肤。必作身痒也。经曰。以其不能得小汗出。
故其身必痒也。
寸口脉阴阳俱紧者。法当清邪中于上焦。浊邪中于下焦。清邪中上。名曰洁也。浊
邪中下。名曰浑也。阴中于邪。必内栗也。表气微虚。里气不守。故使邪中于阴
也。阳中于邪。必发热。头痛、项强、颈挛、腰痛、胫酸。所谓阳中雾露之气。故曰清
邪中上。浊邪中下。阴气为栗。足膝逆冷。便溺妄出。表气微虚。里气微急。三焦相
溷。内外不通。上焦怫郁。脏气相熏。口烂食龈也。中焦不治。胃气上冲。脾气不转。
胃中为浊。荣卫不通。血凝不流。若卫气前通者。小便赤黄。与热相搏。因热作使。游
于经络。出入脏腑。热气所过。则为痈脓。若阴气前通者。阳气厥微。阴无所使。客气
内入。嚏而出之。声 咽塞。寒厥相逐。为热所拥。血凝自下。状如豚肝。阴阳俱厥。
脾气孤弱。五液注下。下焦不阖。清便下重。令便数难。脐筑湫痛。命将难全。
浮为阳。沉为阴。阳脉紧。则雾露之气中于上焦。阴脉紧。则寒邪中于下焦。上焦
者。太阳也。下焦者。少阴也。发热、头痛、项强、颈挛、腰疼、胫酸者。雾露之气。
中于太阳之经也。浊邪中下。阴气为栗。足胫逆冷。便溺妄出者。寒邪中于少阴也。因
表气微虚。邪入而客之。又里气不守。邪乘里弱。遂中于阴。阴虚遇邪。内为惧栗。致
气微急矣。内经曰。阳病者。上行极而下。阴病者。下行极而上。此上焦之邪甚。则下
干中焦。下焦之邪甚。则上干中焦。由是三焦溷乱也。三焦主持诸气。三焦既
相溷乱。则内外之气。俱不得通。膻中为阳气之海。气因不得通于内外。怫郁于上焦
而为热。与脏相熏。口烂食龈。内经曰。隔热不便。上为口糜。中焦为上下二焦之邪
溷乱。则不得平治。中焦在胃之中。中焦失治。胃气因上冲也。脾、坤也。坤助胃气。
消磨水谷。脾气不转。则胃中水谷。不得磨消。故胃中浊也。金匮要略曰。谷气不消。
胃中苦浊。荣者。水谷之精气也。卫者。水谷之悍气也。气不能布散。致荣卫不通。血
凝不流。卫气者。阳气也。荣血者。阴气也。阳主为热。阴主为寒。卫气前通者。阳气
先通而热气得行也。内经曰。膀胱者。津液藏焉。化则能出以小便赤黄。知卫气前通也。
热气与胃气相搏而行。出入脏腑。游于经络。经络客热。则血凝肉腐。而为痈脓。此见
其热气得行。若阴气前通者则不然。阳在外。为阴之使。因阳气厥微。阴无所使。遂阴
气前通也。内经曰。阳气者。卫外而为固也。阳气厥微。则不能卫外。寒气因而客之。
鼻者。肺之候。肺主声。寒气内入者。客于肺经。则嚏而出之。声 咽塞。寒者。外邪
也。厥者。内邪也。外内之邪。合并相逐为热。则血凝不流。今为热所壅。使血凝自下。
如豚肝也。上焦阳气厥。下焦阴气厥。二气俱厥。不相顺接。则脾气独弱。不能行化气
血。滋养五脏。致五脏俱虚。而五液注
下。针经曰。五脏不和。使液溢而下流于阴。阖、合也。清、圊也。下焦气脱而不合。故
数便而下重。脐为生气之原。脐筑湫痛。则生气欲绝。故曰命将难全。
沈亮宸云。卫气
前通者。下焦之邪。化而为热。阴病变阳。故为痈脓。阴气前通者。
上焦之邪。化而为寒。复遇外客之寒邪。则上下皆寒矣。故向日为热所壅之血凝自
下。如豚肝也。此阳病化阴。故曰阴阳俱厥。厥者寒逆之极也。所以命将难全。伤寒
之症。转热即佳。故少阴厥阴。皆以发热而愈。而凡下脓血与痈脓。皆非死症也。
王宇泰云。古人所云寸口。多兼关尺而言。如难经及后章所云。水下二刻。一周循
环。当复寸口。虚实见焉。皆谓手太阴之经渠穴也。知此。则不必曲为疏解矣。又云。
这是误用攻下法导致的后果。营气和卫气内陷。脉象中的数脉先变得微弱。脉象反而只呈现浮象。病人必定大便干硬，嗳气后感到舒缓。为什么这样说呢？
原本因为数脉扰动脾脏。数脉先变微弱，所以知道脾气功能失调。大便干硬，嗳气后舒缓。现在脉象反而浮，数脉改为微弱。
邪气独自留存。心中虽然饥饿，但邪热不能消化食物。出现潮热和口渴。数脉本应当转为迟缓。如果脉象的前后变化符合常理。病人就会感到饥饿。如果数脉不按时机改变。就会产生恶疮。
经，指常规。趺阳脉，用来候察脾胃。所以迟缓的脉象是常态。如果脉象浮数，就是医生妄用攻下法。损伤胃气，扰动脾气。邪气乘虚内陷。邪气在表，就出现阳脉。邪气在里，就出现阴脉。邪气在表的时候，脉象浮而数。因为误下导致里虚。营卫内陷。邪气客居在脾。因为数脉会扰动脾脏。现在数脉先变微弱，这就是脾部的邪气先陷入体内。
胃虚脾热，津液干枯减少，大便必定干硬。《针经》说：脾病容易嗳气。得到排便排出余气后，就会爽快并减轻。现在脾脏客居邪热，所以嗳气后舒缓。脾能消磨水谷。现在邪气独留于脾，脾气功能失调，心中虽然饥饿但不能消化食物。脾主为胃输送津液。脾被热邪灼烧，所以出现潮热和口渴。趺阳脉。
本来迟而缓。因为误下之后，变为浮数。营卫内陷。数脉又改为微弱。这是脉象前后变化符合常理。邪热内陷于脾，所以心中容易饥饿。数脉不按时机改变，是指数脉应当改为微弱却不再微弱。像这样，就是邪气不传入里部，只是郁结在营卫之中。必定从肌肤皮肤发出成为恶疮。
老师说：病人脉象微而涩。这是医生治疗造成的病患。大发其汗，又多次大用攻下法。病人亡失血液。病应当恶寒。后来才发热，没有停止的时候。夏天酷热，想要穿厚衣服。冬天严寒，想要裸露身体。之所以这样，
阳气微弱则恶寒。阴气虚弱则发热。这是医生发汗，使阳气微弱。又大用攻下，使阴气虚弱。五月的时候，
阳气在体表。胃中虚冷。因为阳气内部微弱，不能战胜寒冷。所以想要穿厚衣服。十一月的时候，阳气在体内。
胃中烦热。因为阴气内部虚弱，不能战胜热邪。所以想要裸露身体。另外阴脉迟涩，所以知道血液亡失。
微脉代表亡阳。涩脉代表无血。不应当发汗而强行发汗，使阳气微弱。阴气上入阳分则恶寒。
所以说阳气微弱则恶寒。不应当攻下而强行攻下，使阴气虚弱。阳气下陷入阴分则发热。
所以说阴气虚弱则发热。气属于阳。血属于阴。阳脉用来候察气。阴脉用来候察血。阴脉迟涩，是因为营血不足。
所以知道亡血。《内经》说：尺脉迟的，不可发汗。因为营气不足，血少的原因。
王宇泰说：不一定遇到夏天就恶寒，遇到冬天就发热。这只是确立其法则，论述其原理罢了。
又说：阴阳两伤，则气血都受损。而开头结尾唯独说亡血的原因是什么？回答说：攻下导致亡阳，不必说发汗。
也是因为血同类的原因。
脉象浮而大，心下反而坚硬，有热邪归属于脏的，应当攻下。不让发汗。
浮大的脉象，应当责求邪气在表。如果心下反而坚硬，则是热邪已经很盛并且内结。有热邪归属于脏的，意思是别
无虚寒，而只见到里热。脏属于阴，完全在里部。所以可以攻下。攻下，指的是用下法。不可以说脉
象浮大，就给发汗药。《病源》说：热毒之气侵犯心脏，心下痞满。这是有实邪。应当迅速攻下。
归属于腑的，不让小便频数。小便频数，则大便干硬。汗多，则热更盛。汗少，则排便困难。脉迟还不可以
攻下。
虽然心下坚硬，如果其余没有里证，只见到表证的，是病在阳分。叫做归属于腑。应当先解表。然后攻除痞块。
溲，指小便。不要因为饮水停聚而利小便。使其小便频数。大便必定干硬。《内经》说：小便频数的，大便必定干硬。
说的是流失津液。汗多，则邪气去除而热更盛。汗少，则邪热不尽。又流失津液。必定排便困难。
大便干硬的病人应当攻下。假设脉迟则还不可以攻下。因为迟脉表示不足。即里气未充实的缘故。
王三阳说：虽然心下反而坚硬，也必须脉紧有力。五六天不大便。才可以攻下。即使攻下，也必须用
大柴胡汤。切不可轻率使用承气汤。不然，姑且保守治疗也可以。为什么呢？因为脉象浮大的缘故。
又说：归属于腑的，病已经传入里部。不应当发汗了。只是比上文传入里部较浅而已。不应注解为解表句。
唐不岩说：归属于腑也有发汗法。这里因为心下坚硬，有热邪，则不是发汗所能消除的。热愈，解释为热更
严重是正确的。
上面说脉象虽然浮大，心下坚硬而归属于脏的，则攻下而不发汗。这里说如果有小便频数则大便干硬，汗少则大便
困难。虽然为归属于肝（注：此处原文可能有误，结合上下文应指属腑或津亏），也不可以攻下。因为胃中津液少的缘故。等到津液恢复。则自然解除。
汗多则表热罢而传里。这是阳明传入腑的证候。汗多汗少，都是就已然的情况来说。不是说发其汗。
上面说脉浮大。这里说脉迟。断若两截。不可以把“属脏腑”两句，合着“心下硬”看作一截。
“属腑”不承接上文的“脉浮大”、“心下反硬”。一直说下去。盖因脉浮大的不宜攻下。而属脏的则宜攻下。
属腑大便干硬的则宜攻下。而小便频数、汗少、脉迟，是津液不足。而不可以攻下。一种情况是看似不可下的脉象而必须当下。
一种情况是看似必当下的证候而不可下。凭脉诊来定证候。这是互文见意的手法。
脉象浮而洪，身体出汗如油，喘息不停止，水浆喝不下，身体麻木不仁，时而安静时而混乱。这是命绝的征象。
有病不可治的，是因为邪气胜过正气。《内经》说：脉大则邪气至。又说：脉大则病进。脉象浮而
洪的，是邪气胜。身体出汗如油，喘息不停止的，是正气脱失。四时以胃气为本。水浆喝不下的，
是胃气竭尽。一身以营卫为充养。形体麻木不仁的，是营卫绝灭。不仁，是指痛痒都不知道。《针经》说：
营卫不行，所以为不仁。争则乱。安则静。时而安静时而混乱的，是正邪相争。正气负于邪气。
正气已脱，胃气又尽。营卫俱绝。邪气独胜。所以说命绝。
王宇泰说：火将要熄灭时必定明亮。脉象来势浮洪涌盛。这是即将离开人体的征兆。然而又必须兼见下一二
个证候，才可以断定命绝。
又不知道哪个脏器先遭受灾祸。如果出汗头发湿润，喘息不停止的。这是肺先绝。
肺为气的主宰，为津液的统帅。出汗头发湿润的，是津液脱失。喘息不停止的，是气脱失。
阳气反而单独留存，身体形态如烟熏，眼睛直视摇头。这是心绝。
肺主气。心主血。气为阳。血为阴。阳气反而单独留存的。则为身体大热。是血先绝而气独
在。身体形态如烟熏的，是身体没有精华。是血绝不荣养身体。心脉挟咽喉连系目系。直视的。是心经
绝。头为诸阳之会。摇头的。是阴绝而阳无根。
张卿子说：《伤寒论》中凡是无“血绝”字面的，都要看得灵活。说是阴气先绝即可。王文禄说：人死
者，是气绝罢了。用簪子刺其皮肤，血仍然流出可见。
嘴唇周围发青，四肢抽搐的。这是肝绝。
嘴唇周围，是脾的征候。肝色青。肝绝则真色见于所胜的部位。四肢，是脾所主。肝主筋。
肝绝。则筋脉拘急。发生在所胜的部位。 习，指振动如搐搦。手足时时收缩。
口周发黑，出冷汗发黄色的。这是脾绝。
脾主口唇。绝则精华离去。所以口周发黑。柔为阴。柔汗，即冷汗。脾胃为津液之本。
阳气的宗主。出冷汗发黄色的。是脾绝而阳脱。真色显现。
大小便失禁，胡言乱语，眼睛反向直视的。这是肾绝。
肾司开阖。控制大小便。大小便失禁的，是肾绝。不能约束控制。肾藏志。胡言乱语的。是志不守。
《内经》说：胡言乱语的，是失志了。失志的会死。《针经》说：五脏的精气，都上注于目。骨
的精气为瞳子。眼睛反向直视的，是肾绝。则骨的精气。不荣养瞳子。而瞳子不转动。
又不知道哪个脏器的阴阳先绝。如果阳气先绝，阴气后竭的。其人死。身体颜色必定青。阴气先绝，阳
气后竭的。其人死。身体颜色必定赤。腋下温暖，心下热。
阳主热而色赤。阴主寒而色青。其人死也。身体色青。则阴未离开身体。所以说阴气后竭。
身体色赤。腋下温。心下热。则阳未离开身体。所以说阳气后竭。《针经》说：人有两死而无两生。
说的就是这个意思。
寸口脉浮大。而医生反而攻下。这是大逆。浮则无血。大则为寒。寒气相搏。则为肠鸣。
医生却不知道。反而给喝冷水。冷汗大量流出。水得寒气。冷必相搏。其人即呃逆。
《内经》说：脉浮大，应当发汗。如果反而攻下。为大逆。浮大的脉象，邪气在表。应当发汗。如果
反而攻下。是攻伐正气。邪气得以深入。所以为大逆。浮则无血的，是攻下后亡血。大则为寒
的，是邪气独存。寒邪因里虚而入。寒气相搏。乃为肠鸣。医生见脉大。以为有热。给喝
冷水。想让水寒胜热而作大汗。里先虚寒。又得冷水。水寒相搏。使中焦之气涩滞。故
令呃逆。
寸口浮大。这正是东垣所说的内伤宜补中益气的情况。如果误下饮冷。使胃虚竭。则为呃
逆、哕、衄。变证蜂起。有说不完的了。
趺阳脉浮。浮则为虚。浮虚相搏。所以令气呃逆。说的是胃气虚竭。脉滑则为哕。此为
医生的过错。责虚取实。守空迫血。脉浮。鼻中干燥的。必定衄血。
趺阳脉浮为呃逆。脉滑为哕。都是医生的过错。责虚取实的过失。《内经》说：阴在内为阳之守。
阳在外为阴之使。发汗攻阳。亡津液。而阳气不足者。叫做守空。《内经》说：表气微
虚。里气不守。所以使邪中于阴。阴不为阳守。邪气因而得入。内搏阴血。阴失所守。
血乃妄行。不知道从哪条道而出。如果脉浮鼻燥的。知道血必定从鼻中出。
唐不岩说：为呃逆为哕。都是误下伤阴的过错。阴伤。则阳失所守。所以说守空。论文前后
两段。并没有当发其汗。与攻阳亡津液的话。学人详察。
曾见内伤一证。服凉药饮冷水。以致衄血不止的。往往有之。及服从治药。屡屡奏
效。这正是经文所说的责虚取实。守空迫血。
各种脉象浮数。应当发热而洒淅恶寒。如果有痛处。饮食如常的。是蓄积有脓。
浮数的脉象。主邪在经。应当发热而洒淅恶寒。病人一身尽痛。不欲饮食的。是伤寒。
如果虽发热恶寒。而痛偏着一处。饮食如常的。即非伤寒。是邪气郁结于经络之间。
血气壅遏不通。欲蓄聚而成痈脓。
脉浮而迟。面热赤而战栗恐惧的。六七天。应当汗出而解。反而发热的。痊愈延迟。迟为无阳。
不能作汗。其身必定发痒。
脉浮。面热赤的。邪气外浮于表。脉迟。战栗恐惧的。是本气不足。六七天。为传经
尽。应当汗出而解的时候。如果当汗不汗。反而发热的。为里虚津液不多。不能作汗。既不汗。
邪无从出。所以痊愈延迟。发热为邪气浮于皮肤。必定身痒。《内经》说：因为不能得小汗出。
所以其身必定痒。
寸口脉阴阳俱紧的。依法当清邪中于上焦。浊邪中于下焦。清邪中上。名叫洁。浊
邪中下。名叫浑。阴受邪。必定内栗。表气微虚。里气不守。所以使邪中于阴。
阳受邪。必定发热。头痛、项强、颈挛、腰痛、胫酸。所谓阳中雾露之气。所以曰清
邪中上。浊邪中下。阴气为栗。足膝逆冷。大小便妄出。表气微虚。里气微急。三焦相
混。内外不通。上焦怫郁。脏气相熏。口烂食龈。中焦不治。胃气上冲。脾气不转。
胃中为浊。营卫不通。血凝不流。如果卫气先通。小便赤黄。与热相搏。因热作使。游
于经络。出入脏腑。热气所过。则为痈脓。如果阴气先通。阳气厥微。阴无所使。客气
内入。嚏而出之。声音嘶哑咽塞。寒厥相逐。为热所拥。血凝自下。状如豚肝。阴阳俱厥。
脾气孤弱。五液注下。下焦不合。清便下重。令便数难。脐筑湫痛。命将难全。
浮为阳。沉为阴。阳脉紧。则雾露之气中于上焦。阴脉紧。则寒邪中于下焦。上焦
者。太阳也。下焦者。少阴也。发热、头痛、项强、颈挛、腰疼、胫酸者。雾露之气。
中于太阳之经。浊邪中下。阴气为栗。足胫逆冷。大小便妄出者。寒邪中于少阴。因
表气微虚。邪入而客之。又里气不守。邪乘里弱。遂中于阴。阴虚遇邪。内为惧栗。致
气微急。《内经》说：阳病者。上行极而下。阴病者。下行极而上。此上焦之邪甚。则下
干中焦。下焦之邪甚。则上干中焦。由是三焦混乱。三焦主持诸气。三焦既
相混乱。则内外之气。俱不得通。膻中为阳气之海。气因不得通于内外。怫郁于上焦
而为热。与脏相熏。口烂食龈。《内经》说：隔热不便。上为口糜。中焦为上下二焦之邪
混乱。则不得平治。中焦在胃之中。中焦失治。胃气因上冲。脾、坤也。坤助胃气。
消磨水谷。脾气不转。则胃中水谷。不得磨消。故胃中浊。《金匮要略》说：谷气不消。
胃中苦浊。营者。水谷之精气也。卫者。水谷之悍气也。气不能布散。致营卫不通。血
凝不流。卫气者。阳气也。营血者。阴气也。阳主为热。阴主为寒。卫气先通者。阳气
先通而热气得行。《内经》说：膀胱者。津液藏焉。化则能出。以小便赤黄。知卫气先通。
热气与胃气相搏而行。出入脏腑。游于经络。经络客热。则血凝肉腐。而为痈脓。此见
其热气得行。如果阴气先通则不然。阳在外。为阴之使。因阳气厥微。阴无所使。遂阴
气先通。《内经》说：阳气者。卫外而为固。阳气厥微。则不能卫外。寒气因而客之。
鼻者。肺之候。肺主声。寒气内入者。客于肺经。则嚏而出之。声音嘶哑咽塞。寒者。外邪
也。厥者。内邪也。外内之邪。合并相逐为热。则血凝不流。今为热所壅。使血凝自下。
如豚肝。上焦阳气厥。下焦阴气厥。二气俱厥。不相顺接。则脾气独弱。不能行化气血。
滋养五脏。致五脏俱虚。而五液注
下。《针经》说：五脏不和。使液溢而下流于阴。阖、合也。清、圊也。下焦气脱而不合。故
数便而下重。脐为生气之原。脐筑湫痛。则生气欲绝。故曰命将难全。
沈亮宸说：卫气
先通者。下焦之邪。化而为热。阴病变阳。故为痈脓。阴气先通者。
上焦之邪。化而为寒。复遇外客之寒邪。则上下皆寒。所以向曰为热所壅之血凝自
下。如豚肝。此阳病化阴。故曰阴阳俱厥。厥者寒逆之极。所以命将难全。伤寒
之症。转热即佳。故少阴厥阴。皆以发热而愈。而凡下脓血与痈脓。皆非死症。
王宇泰说：古人所说的寸口。多兼关尺而言。如《难经》及后章所说。水下二刻。一周循
环。当复寸口。虚实见焉。皆谓手太阴之经渠穴。知此。则不必曲为疏解。又说：
This is the result of improper purgation. Ying and Wei Qi sink inward. The rapid pulse first becomes faint. The pulse reversely presents only as floating. The patient will certainly have hard stools, and feel relief after belching. Why do we say this?
Originally, the rapid pulse agitates the Spleen. Since the rapid pulse first becomes faint, we know that Spleen Qi is dysfunctional. Stools become hard, and relief follows belching. Now the pulse reversely floats, and the rapid pulse changes to faint.
The pathogenic factor remains alone. The heart feels hungry, but the pathogenic heat cannot digest food. Tidal fever occurs with thirst. A rapid pulse should transform into a slow and moderate pulse. If the pulse's progression and regression follow the standard pattern, the patient will feel hunger. If the rapid pulse does not change at the proper time, malignant sores will arise.
"Jing" refers to the norm. The Fuyang pulse is used to observe the Stomach and Spleen. Therefore, a slow and moderate pulse is the norm. If the pulse is floating and rapid, it indicates the physician's reckless use of purgation, damaging Stomach Qi and agitating Spleen Qi, allowing the pathogenic factor to sink inward due to deficiency. When the pathogen is in the exterior, Yang pulses appear. When the pathogen is in the interior, Yin pulses appear. When the pathogen is in the exterior, the pulse is floating and rapid. Due to internal deficiency caused by purgation, Ying and Wei Qi sink inward. The pathogen lodges in the Spleen. Since the rapid pulse agitates the Spleen, and now the rapid pulse first becomes faint, this means the Spleen's pathogen has sunk inward first.
Stomach deficiency and Spleen heat cause dryness and scarcity of body fluids, leading to hard stools. The *Zhen Jing* states: "Spleen disease predisposes to belching. Relief and reduction occur when residual gas is expelled through defecation." Now, pathogenic heat lodges in the Spleen, causing relief after belching. The Spleen digests food and water. Now, pathogenic factors remain solely in the Spleen, Spleen Qi is dysfunctional; although the heart feels hungry, it cannot digest food. The Spleen distributes body fluids for the Stomach. Scorched by heat, tidal fever and thirst occur. The Fuyang pulse...
Originally was slow and moderate. After purgation, it changed to floating and rapid. Ying and Wei Qi sank inward. The rapid pulse again changed to faint. This indicates the pulse's progression and regression followed the standard pattern. Pathogenic heat sank into the Spleen, causing frequent hunger. "Rapid pulse not changing at the proper time" means the rapid pulse should have changed to faint but did not. In such cases, the pathogen does not transmit to the interior but stagnates within Ying and Wei. It must manifest from the skin and muscles as malignant sores.
The Master said: "If a patient's pulse is faint and choppy, this is iatrogenic injury. Profuse sweating followed by repeated severe purgation causes loss of blood. The illness should present with aversion to cold, later transforming into fever without cessation. In summer heat, one desires to wear thick clothes. In winter cold, one desires to be naked. The reason is: Yang deficiency causes aversion to cold. Yin weakness causes fever. The physician's profuse sweating made Yang Qi faint. Severe purgation made Yin Qi weak. In the fifth month, Yang Qi is in the exterior. The Stomach is cold and deficient. Because internal Yang is faint, it cannot overcome cold, hence the desire for thick clothes. In the eleventh month, Yang Qi is in the interior. The Stomach is vexed and hot. Because internal Yin is weak, it cannot overcome heat, hence the desire to be naked. Furthermore, a slow and choppy Yin pulse indicates blood loss."
Faint indicates loss of Yang. Choppy indicates lack of blood. Forcing sweat when not indicated makes Yang Qi faint. Yin Qi ascending into the Yang aspect causes aversion to cold. Hence, "Yang deficiency causes aversion to cold." Forcing purgation when not indicated makes Yin Qi weak. Yang Qi sinking into the Yin aspect causes fever. Hence, "Yin weakness causes fever." Qi is Yang. Blood is Yin. Yang pulses observe Qi. Yin pulses observe Blood. Slow and choppy Yin pulses indicate insufficient Ying Blood, confirming blood loss. The *Nei Jing* states: "If the Chi pulse is slow, do not induce sweating, because Ying Qi is insufficient and blood is scarce."
Wang Yutai stated: "It is not necessarily that cold occurs in summer and heat in winter. This merely establishes the principle and discusses the theory."
He further asked: "If both Yin and Yang are injured, affecting both Qi and Blood, why do the beginning and end mention only blood loss?" The answer is: Purgation causes loss of Yang; sweating need not be mentioned separately because blood is of the same category.
If the pulse is floating and large, and the epigastrium is conversely hard, with heat belonging to the Zang organs, attack it with purgation. Do not induce sweating.
A floating and large pulse usually indicates the pathogen is in the exterior. If the epigastrium is conversely hard, the heat is severe and internally knotted. "Heat belonging to the Zang" means there is no deficiency-cold, only interior heat. Zang organs belong to Yin and are entirely in the interior, so purgation is applicable. "Attack" here refers to purgation. One should not assume that a floating and large pulse warrants diaphoresis. The *Bing Yuan* states: "When heat-toxin invades the Heart, causing epigastric fullness, this is excess; rapid purgation is appropriate."
If belonging to the Fu organs, avoid frequent urination. Frequent urination leads to hard stools. Profuse sweating increases heat. Scant sweating leads to difficult defecation. If the pulse is slow, purgation is not yet indicated.
Although the epigastrium is hard, if there are no other interior signs and only exterior signs are present, the disease is in the Yang aspect, termed "belonging to the Fu organs." Resolve the exterior first, then attack the fullness.
"Sou" refers to urination. Do not promote urination due to fluid retention, which would cause frequent urination and hard stools. The *Nei Jing* states: "Frequent urination leads to hard stools," meaning the loss of body fluids. Profuse sweating removes pathogens but intensifies heat. Scant sweating leaves pathogens and heat unresolved, while also losing fluids, leading to difficult defecation.
Patients with hard stools should be purged. However, if the pulse is slow, purgation is contraindicated because slow indicates insufficiency, meaning interior Qi is not yet solid.
Wang Sanyang stated: "Even if the epigastrium is conversely hard, the pulse must be tight and forceful, and there must be constipation for five or six days before purgation is appropriate. Even then, Da Chai Hu Tang must be used. Cheng Qi Tang should never be used lightly. Otherwise, conservative management is acceptable. Why? Because the pulse is floating and large."
He added: "Belonging to the Fu organs means the disease has transmitted to the interior; sweating is inappropriate. It is shallower than the interior transmission mentioned earlier. It should not be interpreted as resolving the exterior."
Tang Buyan stated: "Belonging to the Fu organs also includes sweating methods. Here, because the epigastrium is hard and there is heat, sweating cannot resolve it. 'Re' (heat) should be interpreted as 'heat worsening'."
The previous text stated that even if the pulse is floating and large, if the epigastrium is hard and belongs to the Zang, attack with purgation rather than sweating. This text states that frequent urination leads to hard stools, and scant sweating leads to difficult defecation. Even if belonging to the Liver (note: context suggests Fu organs or fluid deficiency), purgation is contraindicated because Stomach fluids are scarce. Wait for fluids to return, and it will resolve naturally.
Profuse sweating resolves exterior heat and transmits to the interior. This is the Yangming transmitting to Fu organ syndrome. "Profuse sweating" and "scant sweating" describe existing conditions, not the act of inducing sweating.
The previous text discussed floating and large pulses. This text discusses slow pulses. They are distinct. Do not combine "belonging to Zang/Fu" with "epigastric hardness" into one segment.
"Belonging to Fu" does not connect to the previous "floating and large pulse" and "conversely hard epigastrium." It continues directly. Floating and large pulses are unsuitable for purgation, whereas those belonging to Zang are suitable. Hard stools belonging to Fu organs require purgation. However, frequent urination, scant sweating, and slow pulses indicate fluid insufficiency, making purgation contraindicated. One case seems like a pulse requiring purgation despite appearing contraindicated. Another seems like a condition requiring purgation but is actually contraindicated. Diagnosis relies on the pulse. This is an intertextual rhetorical device.
If the pulse is floating and surging, sweat is like oil, panting does not cease, food and drink cannot be taken, the body is insensible, and consciousness fluctuates between quiet and chaotic. This is death.
Some diseases are incurable because pathogenic factors overpower healthy Qi. The *Nei Jing* states: "Large pulse indicates pathogen arrival." Also: "Large pulse indicates disease progression." A floating and surging pulse indicates pathogen dominance. Sweat like oil and ceaseless panting indicate healthy Qi exhaustion. The four seasons rely on Stomach Qi. Inability to take food and drink indicates Stomach Qi exhaustion. The body relies on Ying and Wei for nourishment. Insensibility indicates Ying and Wei exhaustion. Insensibility means inability to perceive pain or itch. The *Zhen Jing* states: "When Ying and Wei do not circulate, insensibility results." Conflict causes chaos. Peace causes quiet. Fluctuating between quiet and chaotic indicates Zheng and Xie struggling, with Zheng defeated by Xie. Healthy Qi is exhausted, Stomach Qi is gone, Ying and Wei are severed, and pathogen dominates. Hence, "death."
Wang Yutai stated: "When fire is about to extinguish, it flares up brightly. A floating, surging, and vigorous pulse indicates the body is about to depart. However, one or two additional signs must be present to confirm death."
One must also determine which Zang organ fails first. If sweat wets the hair and panting ceases not, this is Lung failure first.
The Lung is the master of Qi and commander of fluids. Sweat wetting the hair indicates fluid exhaustion. Ceaseless panting indicates Qi exhaustion.
Yang remains alone, the body looks like smoke staining, eyes stare fixedly, and the head shakes. This is Heart failure.
The Lung governs Qi. The Heart governs Blood. Qi is Yang. Blood is Yin. If Yang remains alone, the body becomes very hot. This means Blood failed first, leaving Qi alone. A body looking like smoke staining indicates the body lacks essence; Blood failure fails to nourish the body. The Heart meridian connects to the throat and eyes. Fixed staring indicates Heart meridian failure. The head is the meeting point of all Yang meridians. Head shaking indicates Yin failure and Yang having no root.
Zhang Qingzi stated: "In the *Shanghan Lun*, any mention lacking the phrase 'blood failure' should be interpreted flexibly as 'Yin Qi failing first'." Wang Wenlu stated: "Death is Qi failure. Pricking the skin with a hairpin still shows blood flowing."
Lips and mouth turn blue, limbs twitch. This is Liver failure.
Lips and mouth are the manifestation of the Spleen. Liver color is green. Liver failure reveals its true color in the conquered area. Limbs are governed by the Spleen. Liver governs sinews. Liver failure causes sinew contraction, manifesting in the conquered area. "Xi" refers to trembling like spasms, with hands and feet constantly contracting.
Around the mouth turns dark, sweat is cold and yellow. This is Spleen failure.
The Spleen governs lips and mouth. Failure means essence departs, causing darkness around the mouth. "Rou" is Yin. "Rou han" is cold sweat. Spleen and Stomach are the source of fluids and the patriarch of Yang. Cold sweat turning yellow indicates Spleen failure and Yang exhaustion, revealing the true color.
Urination and defecation are incontinent, speech is delirious, eyes stare fixedly backward. This is Kidney failure.
The Kidney controls opening and closing, retaining urine and feces. Incontinence indicates Kidney failure and inability to restrain. The Kidney stores Zhi (Will). Delirious speech indicates loss of Will.
The *Nei Jing* states: "Delirious speech is loss of Will. Loss of Will leads to death." The *Zhen Jing* states: "Essence-Qi of all five Zang organs ascends to the eyes. The essence of bone forms the pupil." Eyes staring fixedly backward indicate Kidney failure; the bone's essence fails to nourish the pupil, so the pupil does not move.
One must also determine which Zang's Yin or Yang fails first. If Yang fails first and Yin exhausts later, the person dies, and the body color will be blue. If Yin fails first and Yang exhausts later, the person dies, and the body color will be red. Axillae are warm, epigastrium is hot.
Yang governs heat and red color. Yin governs cold and blue color. Upon death, if the body is blue, Yin has not left the body, hence "Yin exhausts later." If the body is red, axillae are warm, and epigastrium is hot, Yang has not left the body, hence "Yang exhausts later." The *Zhen Jing* says: "Humans can die twice but not live twice." This refers to this situation.
Cunkou pulse is floating and large, but the physician erroneously purges. This is a major deviation. Floating indicates lack of blood. Large indicates cold. Cold qi clashes, causing borborygmus.
The physician, unaware, gives cold water instead. Cold sweat pours out. Water meets cold qi; cold clashes, causing hiccups.
The *Nei Jing* states: "Floating and large pulses warrant sweating. Purging them is a major deviation." Floating and large pulses indicate the pathogen is in the exterior. Sweating is indicated. Purging attacks healthy Qi, allowing the pathogen to penetrate deeply, constituting a major deviation. "Floating indicates lack of blood" means blood loss after purgation. "Large indicates cold" means the pathogen remains alone. Cold pathogen enters due to interior deficiency. Clashing cold qi causes borborygmus. Seeing a large pulse, the physician assumes heat and administers cold water, hoping cold water overcomes heat to induce sweating. The interior is already deficient and cold. Adding cold water causes water and cold to clash, stagnating Middle Jiao Qi, resulting in hiccups.
Cunkou floating and large corresponds to Dongyuan's view that internal injury requires Bu Zhong Yi Qi Tang. Erroneous purgation and drinking cold water exhaust the Stomach, leading to hiccups, belching, and epistaxis. Complications arise endlessly.
Fuyang pulse floating indicates deficiency. Floating and deficiency clash, causing hiccups, indicating Stomach Qi exhaustion. Slippery pulse indicates belching. This is the physician's fault, treating deficiency as excess, guarding emptiness while forcing blood. Floating pulse with dry nose indicates epistaxis.
Fuyang pulse floating causes hiccups. Slippery pulse causes belching. Both are the physician's fault, the error of treating deficiency as excess. The *Nei Jing* states: "Yin inside is the guardian of Yang. Yang outside is the servant of Yin." Sweating attacks Yang, exhausting fluids, leaving Yang insufficient. This is called "guarding emptiness." The *Nei Jing* states: "Exterior Qi is slightly deficient, Interior Qi does not guard, allowing pathogen to enter Yin." Yin fails to guard Yang, allowing pathogen entry. Internally clashing with Yin Blood, Yin loses its guard, and blood flows recklessly. Unknown which pathway it exits. If pulse is floating and nose is dry, blood will exit via the nose.
Tang Buyan stated: "Hiccups and belching are faults of erroneous purgation injuring Yin. Yin injury causes Yang to lose its guard, hence 'guarding emptiness.' The text前后 does not mention inducing sweating or attacking Yang to exhaust fluids. Students should examine this carefully."
I have seen internal injury cases where cooling medicines and cold water caused unceasing epistaxis. Treatment with correct formulas often succeeded. This is exactly what the classic calls "treating deficiency as excess, guarding emptiness while forcing blood."
Various floating and rapid pulses indicate fever and chills. If there is a painful area but diet is normal, pus is accumulating.
Floating and rapid pulses indicate pathogen in the channels, causing fever and chills. If the whole body hurts and appetite is lost, it is Shanghan. If there is fever and chills but pain is localized and diet is normal, it is not Shanghan. Pathogen stagnates in the channels, blocking Qi and Blood, accumulating to form abscess/pus.
Floating and slow pulse, facial heat and redness with tremors. After six or seven days, sweating should resolve it. If fever persists, recovery is delayed. Slow indicates lack of Yang, inability to produce sweat, causing body itching.
Floating pulse and facial heat/redness indicate pathogen floating outward. Slow pulse and tremors indicate intrinsic Qi deficiency. Six or seven days marks the completion of channel transmission, when sweating should resolve the disease. If sweating does not occur and fever persists, it is due to interior deficiency and scant fluids, unable to produce sweat. Without sweat, pathogen has no exit, hence delayed recovery. Fever indicates pathogen floating on the skin, causing itching. The *Nei Jing* states: "Inability to produce slight sweat causes itching."
Cunkou pulse Yin and Yang both tight. According to law, clear pathogen attacks the Upper Jiao, turbid pathogen attacks the Lower Jiao. Clear pathogen attacking upper is called "Jie" (pure). Turbid pathogen attacking lower is called "Hun" (turbid). Yin attacked by pathogen causes internal shivering. Exterior Qi slightly deficient, Interior Qi not guarding, allowing pathogen to enter Yin. Yang attacked by pathogen causes fever, headache, stiff neck, cervical spasm, lumbar pain, and leg soreness. This is Yang attacked by fog and dew Qi, hence "clear pathogen attacks upper, turbid pathogen attacks lower." Yin Qi shivers, feet and knees are cold, urination and defecation are involuntary. Exterior Qi slightly deficient, Interior Qi slightly urgent. Three Jiaos mix. Interior and exterior blocked. Upper Jiao stagnates, Zang Qi熏 (fumes), causing oral ulcers and gum erosion. Middle Jiao dysfunction, Stomach Qi rushes upward, Spleen Qi does not rotate, Stomach becomes turbid, Ying and Wei do not communicate, blood coagulates and stops flowing. If Wei Qi communicates first, urine is dark yellow. Clashing with heat, acting as a vehicle, wandering through channels, entering and exiting Zang-Fu. Where heat passes, abscesses form. If Yin Qi communicates first, Yang Qi is厥 (reverted/cold), Yin has no使者 (messenger). Guest Qi enters internally, sneezing expels it, voice is hoarse, throat obstructed. Cold and厥 chase each other,擁 (blocked) by heat, blood coagulates and exits downward, resembling pig liver. Both Yin and Yang are厥. Spleen Qi is isolated and weak. Five fluids pour downward. Lower Jiao does not close. Clear stool feels heavy, frequent difficult defecation, umbilical colic and pain, life is hard to save.
Floating is Yang. Sunken is Yin. Tight Yang pulse indicates fog/dew Qi attacking Upper Jiao. Tight Yin pulse indicates cold pathogen attacking Lower Jiao. Upper Jiao is Taiyang. Lower Jiao is Shaoyin. Fever, headache, stiff neck, cervical spasm, lumbar pain, leg soreness indicate fog/dew Qi attacking Taiyang channel. Turbid pathogen attacking lower, Yin Qi shivering, cold feet/shins, involuntary urination/defecation indicate cold pathogen attacking Shaoyin. Due to slightly deficient exterior Qi, pathogen enters and lodges. Due to non-guarding interior Qi, pathogen exploits interior weakness, entering Yin. Yin deficiency meeting pathogen causes internal fear/shivering, making Qi slightly urgent. The *Nei Jing* states: "Yang diseases ascend to extreme then descend. Yin diseases descend to extreme then ascend." Excessive Upper Jiao pathogen affects Middle Jiao. Excessive Lower Jiao pathogen affects Middle Jiao. Thus, Three Jiaos become chaotic. Three Jiaos govern all Qi. Once chaotic, interior and exterior Qi cannot communicate. Danzhong is the sea of Yang Qi. Qi cannot communicate internally/externally, stagnates in Upper Jiao becoming heat, fuming with Zang Qi, causing oral ulcers. The *Nei Jing* states: "Obstruction leads to upper mouth ulcers." Middle Jiao, confused by upper/lower pathogens, cannot function normally. Located in the Stomach, Middle Jiao dysfunction causes Stomach Qi to rush upward. Spleen is Kun. Kun assists Stomach Qi to digest food. Spleen Qi not rotating means food/water in Stomach is not digested, causing Stomach turbidity. *Jin Gui Yao Lue* states: "Grain Qi not digesting, Stomach suffers turbidity." Ying is essence-Qi of grain/water. Wei is fierce Qi of grain/water. Qi cannot distribute, causing Ying-Wei blockage, blood coagulation. Wei Qi is Yang Qi. Ying Blood is Yin Qi. Yang governs heat. Yin governs cold. If Wei Qi communicates first, Yang Qi communicates first, allowing heat to move. The *Nei Jing* states: "Bladder stores fluids, transforms to excrete." Dark yellow urine indicates Wei Qi communicating first. Heat clashes with Stomach Qi, moving in/out of Zang-Fu, wandering channels. Channel heat causes blood coagulation and flesh rot, forming abscess. This shows heat moving. If Yin Qi communicates first, it is different. Yang outside is Yin's messenger. Due to Yang Qi being reverted/cold, Yin has no messenger, so Yin Qi communicates first. The *Nei Jing* states: "Yang Qi guards the exterior and stabilizes." Reverted/cold Yang cannot guard exterior, allowing cold pathogen to lodge. Nose is Lung's indicator. Lung governs sound. Internal cold lodging in Lung meridian causes sneezing. Hoarse voice and throat obstruction. Cold is external pathogen. Jue is internal pathogen. External and internal pathogens merge, chasing each other to create heat, causing blood coagulation. Now blocked by heat, blood coagulates and exits downward, resembling pig liver. Upper Jiao Yang Qi reverted, Lower Jiao Yin Qi reverted. Both Qi reverted, not connecting smoothly, leaving Spleen Qi weak, unable to transform Qi/Blood, nourish Zang organs, causing Zang deficiency and five fluids pouring downward. The *Zhen Jing* states: "Five Zang disharmony causes fluids to overflow and flow downward to Yin." He means closure. Qing means toilet. Lower Jiao Qi escapes and does not close, causing frequent heavy stool. Umbilicus is the origin of vital Qi. Umbilical colic and pain indicate vital Qi nearing extinction, hence "life hard to save."
Shen Liangchen stated: "If Wei Qi communicates first, Lower Jiao pathogen transforms to heat, Yin disease becomes Yang, forming abscess. If Yin Qi communicates first, Upper Jiao pathogen transforms to cold. Meeting external cold, both upper and lower become cold. Hence, previously heat-blocked blood coagulates and exits downward, resembling pig liver. This is Yang disease transforming to Yin, hence 'both Yin and Yang are reverted.' Jue is extreme cold reversal. Hence, life hard to save. In Shanghan, transformation to heat is good. Shaoyin and Jueyin both recover with fever. Passing pus/blood or abscesses are not fatal."
Wang Yutai stated: "Ancient mentions of Cunkou often include Guan and Chi. As in *Nan Jing* and later chapters: 'After two ke of water drop, one cycle completes, returning to Cunkou, revealing deficiency/excess.' All refer to the Jingquan acupoint of Hand Taiyin. Knowing this, no forced interpretation is needed." He further stated: