积阴感于下，则微阳消于上，故其候沉重。四肢逆冷，腹痛转甚，或咽喉不利，或心下
胀满
证者
散、
治阴毒瓦斯攻上腹痛。四肢逆冷恶候并治之。
川乌去皮脐，冷水浸七日后，薄切曝干，纸袋盛。有患者，取碾末一大钱，入盐一小钱
，水一盏半，煎至七分，通口服。压下阴毒。所往如猪血相似。未已，良久再进一服。
治阴毒面色青，四肢逆冷，心躁腹痛。
用硫黄末新汲水调下二钱，良久，或寒一起，或热一起，更看紧慢，再服，汗出瘥。
沉困之候。与前渐深之候皆同，而更加困重。六脉附骨，取之方有，按之即无，一息八
至以上
足不
而和
记有人患伤寒六七日，心烦昏睡多吐，小便白色，自汗。予诊之，寸口尺中俱紧。予曰
∶寒
下利
予
曰
唇口干燥，蜷卧足冷，鼻中涕出，舌上滑胎，勿妄治也。又云∶紧则为寒。又云∶诸紧为
。又云∶曾为人所难，紧脉从何而来？师云∶假令已汗若吐，以肺里寒，故令脉紧。假令咳
者，坐饮冷水，故令脉紧。假令下利以胃虚，故令脉紧。又云∶寸口脉微，尺脉紧，其人虚
损多汗。由是观之。则寒邪之气，入人经络所致，皆虚寒之脉也。其在阳经则浮而紧，在阴
经
也
又云∶少阴
沉而紧也。
迟数为定，
本孙吴，葬
舍律吕而
皆
大浮数动滑阳脉，阴病见阳生可得，沉涩弦微弱属阴，阳病见阴终死厄。
仲景云∶脉大浮数动滑，此名阳也。脉沉涩弱弦微，此名阴也。阴病见阳脉者生，阳病
见阴脉者死，阴阳交互最难明，轻重斟量当别白。
脉虽有阴阳，须看轻重，以分表里。
轻手脉浮为在表，表实浮而兼有力，但浮无力表中虚，自汗恶风常淅淅。
伤寒先要辨表里虚实，此四者为急。仲景浮为在表，沉为在里。然表症有虚有实。浮而
有力者，表实也，故无汗不恶风。浮而无力者，表虚也，故自汗恶风。
重手脉沉为在里，里实脉沉来亦实，重手无力大而虚，此是里虚宜审的。
里症亦有虚实。脉沉而有力者，里实也，故腹满大便不通。沉而无力者，里虚也，或泄
利，或阴症之类。以上八句，辨表里虚实尽矣。
风则虚浮寒牢坚，水停水 必沉潜。动则为痛数为热，支饮应须脉急弦。太过之脉为可
怪，不及之脉亦如然。
仲景云∶风则虚浮，寒则牢坚，沉潜水 ，支饮急弦，动则为痛，数则热烦，太过可怪
，不及亦然。邪不空见，中必有奸。
荣卫太盛名高章，高章相搏名曰纲。荣卫微时名 卑， 卑相搏损名扬。荣卫既和名缓
迟，缓迟名沉此最良。九种脉中辨疾症，长沙之诀妙难量。
仲景云∶寸口卫气盛，名曰高，荣气盛名曰章，高章相搏，名曰纲；卫气弱名曰 ，荣
气弱
仲景
瞥瞥有如羹上肥，此脉定知阳气微。萦萦来如蛛丝细，却是体中阴气衰。脉如泻漆之绝
者，病患亡血更何疑。
仲景云∶脉瞥瞥如羹上肥者，阳气微也。脉萦萦如蛛丝细者，阳气衰也。脉绵绵如泻漆
之绝者，亡血也。阳气衰。《千金》作阴气衰。
阳结蔼蔼如车盖，阴结循竿亦象之。
仲景云∶蔼蔼如车盖者，阳结也。累累如循竿者，阴结也。
阳盛则促来一止，阴盛则结缓而迟。
此谓促结二脉也。仲景云∶脉来缓时一止名曰结，脉来数时一止名曰促，阳盛则促。阴
盛则结。纵横逆顺宜审察，残贼灾怪要须知。
仲景云∶脉有相乘，有纵有横，有逆有顺，何谓也？曰水行乘火，金行乘木，名曰纵；
火行
顺也
作
脉静人病内虚故，人安脉病曰行尸。
仲景云∶脉病患不病曰行尸，以无主气，卒仆不知人。人病脉不病名曰内虚，以无谷神
，虽困无苦。右手气口当主气，主血人迎左其位。气口紧盛食必伤，人迎紧盛寒邪炽。
左为人迎，右为气口。人迎紧盛伤于寒，气口紧盛伤于食。
数为在腑迟为脏，浮为在表沉在里。
仲景云∶浮为在表，沉为在里，数为在腑，迟为在脏。
脉浮而缓风伤卫，浮紧坚涩寒伤荣，脉微大忌令人吐，欲下犹防虚且细。
仲景云∶脉微不可吐，虚细不可下。
沉微气弱汗为难，三者要须当审记。
孙用和云∶阴虚脉沉微而气弱者，不可汗。汗下吐三候脉有不可行者，切当审之。
阳加于阴有汗证，左手沉微却应未。
《素问》云∶阳加于阴谓之汗。
趺阳胃脉定死生。
《仲景论》言趺阳脉者，十有八九。
太溪肾脉为根蒂。
伤寒必诊太溪趺阳者，谓人以肾脉胃脉为主。仲景讥世人握手不及足者以此。
脉来六至或七至，邪气渐深须用意。浮大昼加病属阳，沉细夜加分阴位。九至以上来短
促，状若涌泉无入气。更加悬绝渐无根，命绝天真当死矣。
孙用和云∶脉及六至七至以上，浮大昼加病，沉细夜加病。更及八至，精气消，神气乱
，必
悬绝
病患三部脉调匀，大小浮沉迟数类，此是阴阳气已和，勿药自然应有喜。
仲景云∶寸口关上尺中三处，大小浮沉迟数同等，虽有寒热不解，此脉已和，为必愈。
发热恶寒，近似伤寒者，有五种。脉浮而数，其人发热而恶寒者，伤寒之候也。脉浮而
紧，
呕吐
弦，
阴寒之邪积聚于下部，则微弱的阳气在上部消亡，所以症状表现为身体沉重。四肢逆冷，腹痛加剧，或者咽喉不畅，或者心下（胃脘部）胀满。
治疗阴毒之气攻冲上逆导致的腹痛、四肢逆冷等危重证候，一并治疗。
用川乌，去掉皮和脐，在冷水中浸泡七日后，切成薄片晒干，用纸袋盛装。若有患者，取碾成粉末的一大钱（约3-5克），加入盐一小钱，水一盏半，煎煮至七分，一次性口服。以压制阴毒之气。排出的病邪如同猪血相似。若未停止，过一段时间后再次服用一剂。
治疗阴毒导致的面色青黑、四肢逆冷、心中烦躁、腹痛。
用硫黄粉末，用新汲取的冷水调服二钱，过一段时间，如果感到一阵发冷或一阵发热，再根据脉象的紧慢情况，决定是否再次服药，出汗后病愈。
这是沉困的症状。与前面逐渐加深的证候相同，但更加困重。六脉在骨头上按压才能摸到，轻按即无，一呼一吸之间脉搏跳动八次以上。
曾记有一人患伤寒六七日，心烦昏睡，多呕吐，小便颜色白，自汗。我诊察他的脉象，寸口和尺中脉都紧。我说：这是寒邪……（此处原文有缺漏，结合下文推测为辨证分析）。我又说：唇口干燥，蜷缩而卧，足冷，鼻中流涕，舌面滑润，不要胡乱治疗。又说：紧脉主寒。又说：各种紧脉……（此处原文有缺漏）。又说：曾经被人问难，紧脉是从哪里来的？老师说：假如已经发汗或催吐，因为肺里有寒，所以导致脉紧。假如咳嗽，是因为喝了冷水，所以导致脉紧。假如下利，是因为胃气虚弱，所以导致脉紧。又说：寸口脉微，尺脉紧，此人虚损且多汗。由此看来，寒邪之气侵入人体经络所致，都是虚寒的脉象。如果在阳经，则脉浮而紧；在阴经……（此处原文有缺漏）……则是沉而紧。迟数和缓是定数……（此处原文有缺漏，涉及音律比喻）……皆……大浮数动滑为阳脉，阴病见到阳脉可生，沉涩弦微弱属阴，阳病见到阴脉终归死厄。
仲景说：脉大、浮、数、动、滑，这名叫阳脉。脉沉、涩、弱、弦、微，这名叫阴脉。阴病见到阳脉者生，阳病见到阴脉者死，阴阳交互最难明白，轻重斟酌衡量应当分辨清楚。
脉虽然有阴阳之分，必须看其轻重，以区分表里。
轻手按脉，脉浮表示病在表。表实证的脉浮而兼有力，只是浮而无力则是表中虚，会有自汗、恶风且常觉淅淅怕冷的症状。
伤寒首先要辨别表里虚实，这四点最为紧急。仲景说：浮脉表示在表，沉脉表示在里。然而表证有虚有实。浮而有力的，是表实证，所以无汗且不恶风。浮而无力的，是表虚证，所以自汗且恶风。
重手按脉，脉沉表示病在里。里实证的脉沉来也实，重手按之无力且大而虚，这是里虚证，应当仔细审察。
里证也有虚实。脉沉而有力的，是里实证，所以腹满大便不通。沉而无力的，是里虚证，或者泄利，或者阴证之类。以上八句，辨表里虚实已尽。
风邪致脉虚浮，寒邪致脉牢坚，水饮停聚必脉沉潜。动脉主痛，数脉主热，支饮应当脉急弦。太过之脉令人奇怪，不及之脉也是如此。
仲景说：风邪致脉虚浮，寒邪致脉牢坚，沉潜水饮致脉沉潜，支饮致脉急弦，动脉主痛，数脉主热烦，太过之脉可怪，不及之脉亦然。邪气不会空见，中间必有奸邪。
营卫太盛名叫高章，高章相搏名叫纲。营卫微弱时名叫卑，卑相搏损名叫扬。营卫既和名叫缓迟，缓迟名沉这是最好的。九种脉中辨别疾病症候，长沙（张仲景）的诀妙难以估量。
仲景说：寸口卫气盛，名叫高，荣气盛名叫章，高章相搏，名叫纲；卫气弱名叫……（缺字），荣气弱……（缺字）。仲景……（缺字）。
脉象瞥瞥如羹汤上的浮肥，此脉定知阳气微。脉萦萦如蛛丝细，却是体内阴气衰。脉如泻漆之绝断者，病患亡血更何疑。
仲景说：脉瞥瞥如羹上肥者，是阳气微。脉萦萦如蛛丝细者，是阳气衰。脉绵绵如泻漆之绝断者，是亡血。阳气衰。《千金方》作阴气衰。
阳结脉蔼蔼如车盖，阴结脉循竿亦像之。
仲景说：蔼蔼如车盖者，是阳结。累累如循竿者，是阴结。
阳盛则促脉来一止，阴盛则结脉缓而迟。
这说的是促脉和结脉。仲景说：脉来缓时一止名叫结，脉来数时一止名叫促，阳盛则促，阴盛则结。纵横逆顺应当审察，残贼灾怪脉要须知。
仲景说：脉有相乘，有纵有横，有逆有顺，是什么意思呢？回答说：水行乘火，金行乘木，名叫纵；火行……（缺字）……顺也。作……（缺字）。
脉静而人病，是内虚；人安而脉病，叫做行尸。
仲景说：脉病患不病叫做行尸，因为没有主气，突然仆倒不知人事。人病脉不病名叫内虚，因为没有谷神，虽然困顿但没有痛苦。右手气口当主气，主血的人迎在左手其位。气口紧盛食必伤，人迎紧盛寒邪炽。
左为人迎，右为气口。人迎紧盛伤于寒，气口紧盛伤于食。
数为在腑，迟为在脏，浮为在表，沉在里。
仲景说：浮为在表，沉为在里，数为在腑，迟为在脏。
脉浮而缓是风伤卫，浮紧坚涩是寒伤荣，脉微大忌让人吐，欲下犹防虚且细。
仲景说：脉微不可吐，虚细不可下。
沉微气弱汗为难，这三者必须要审慎记住。
孙用和说：阴虚脉沉微而气弱者，不可发汗。汗、下、吐三法，脉有不可行者，切当审察。
阳加于阴有汗证，左手沉微却应未（指不应出现或不宜发汗）。
《素问》说：阳加于阴谓之汗。
趺阳胃脉决定死生。
《仲景论》言及趺阳脉的，十有八九。
太溪肾脉为根蒂。
伤寒必定诊察太溪和趺阳脉，是说人以肾脉和胃脉为主。仲景讥笑世人握手不及足者就是以此原因。
脉来六至或七至，邪气渐深须用意。浮大昼加病属阳，沉细夜加分阴位。九至以上来短促，状若涌泉无入气。更加悬绝渐无根，命绝天真当死矣。
孙用和说：脉及六至七至以上，浮大昼加病，沉细夜加病。更及八至，精气消，神气乱，必……（缺字）……悬绝。
病患三部脉调匀，大小浮沉迟数类，这是阴阳气已和，勿药自然应有喜。
仲景说：寸口、关上、尺中三处，大小浮沉迟数同等，虽有寒热不解，此脉已和，为必愈。
发热恶寒，近似伤寒者，有五种。脉浮而数，其人发热而恶寒者，是伤寒的证候。脉浮而紧……（缺字）……呕吐……（缺字）……弦……（缺字）
When accumulated Yin pathogen gathers in the lower part, the slight Yang Qi dissipates in the upper part; thus, the manifestation is heaviness of the body. The four limbs are cold and reversed (cold extremities), abdominal pain intensifies, or there is throat obstruction, or fullness and distension in the epigastrium (Stomach region).
This treats the severe conditions of Yin Poison (Yin Du) attacking upward causing abdominal pain and cold extremities.
Take Chuanwu (Radix Aconiti Kusnezoffii), remove the skin and navel, soak in cold water for seven days, slice thinly, dry in the sun, and store in a paper bag. For a patient, take one large qian (approx. 3-5g) of the powdered form, add one small qian of salt, and one dan (approx. 200ml) of water. Decoct until reduced to seven parts, and administer orally in one dose. This suppresses the Yin Poison pathogen. The expelled pathogenic material resembles pig blood. If symptoms persist, administer another dose after a while.
This treats Yin Poison presenting with a bluish complexion, cold extremities, mental restlessness, and abdominal pain.
Take Sulfur powder, mix with newly drawn cold water, and administer two qian. After some time, if there is a sensation of cold or heat, observe the pulse tightness or slowness, and administer again if necessary. Recovery occurs with sweating.
This is a state of deep lethargy. It is similar to the previously described progressive deepening syndrome but more severe. All six pulses are only palpable when pressed deeply against the bone and disappear with light pressure. There are eight or more beats per respiration cycle.
I once recorded a case where a person suffered from Taiyang Cold Damage (Shanghan) for six or seven days, experiencing mental irritability, drowsiness, frequent vomiting, white urine, and spontaneous sweating. Upon diagnosis, both the Cun (inch) and Chi (cubit) positions at the radial artery were tight. I said: [Cold pathogen...] I also said: Dry lips and mouth, curling up in bed with cold feet, runny nose, and a slippery tongue coating indicate that one should not treat rashly. It is also stated: Tight pulse indicates Cold. Furthermore: Various tight pulses... Also: Once asked how the tight pulse arises? The Master said: Suppose sweating or emesis has already occurred; due to Cold in the Lung, the pulse becomes tight. Suppose coughing exists; it is caused by drinking cold water, hence the tight pulse. Suppose diarrhea exists; it is caused by Stomach deficiency, hence the tight pulse. Also: Cun position pulse is faint, Chi position pulse is tight; the person suffers from deficiency and excessive sweating. From this, we see that Cold pathogen entering the meridians results in deficiency-Cold pulses. If in the Yang meridians, the pulse is floating and tight; if in the Yin meridians... it is sinking and tight. Slow and rapid are fixed... [Text missing regarding musical pitch analogy]... Large, Floating, Rapid, Moving, and Slippery are Yang pulses; if Yin disease presents Yang pulses, life is possible. Sinking, Choppy, Weak, String-taut, and Faint belong to Yin; if Yang disease presents Yin pulses, death is inevitable.
Jingue (Zhang Zhongjing) said: Large, Floating, Rapid, Moving, and Slippery pulses are named Yang. Sinking, Choppy, Weak, String-taut, and Faint pulses are named Yin. In Yin diseases, the appearance of Yang pulses indicates survival; in Yang diseases, the appearance of Yin pulses indicates death. The interaction of Yin and Yang is hardest to clarify; one must carefully weigh the severity and distinguish clearly.
Although pulses have Yin and Yang distinctions, one must examine their depth/force to differentiate Exterior and Interior.
Light pressure revealing a Floating pulse indicates the disease is in the Exterior. Exterior Excess presents as Floating and forceful; merely Floating without force indicates Exterior Deficiency, accompanied by spontaneous sweating, aversion to wind, and a chilly sensation.
In Cold Damage, distinguishing Exterior/Interior and Excess/Deficiency is urgent. Jingue said: Floating indicates Exterior, Sinking indicates Interior. However, Exterior syndromes can be Excess or Deficient. Floating and forceful indicates Exterior Excess, hence no sweating and no aversion to wind. Floating and non-forceful indicates Exterior Deficiency, hence spontaneous sweating and aversion to wind.
Heavy pressure revealing a Sinking pulse indicates the disease is in the Interior. Interior Excess presents as Sinking and solid; heavy pressure revealing weakness and largeness indicates Interior Deficiency, which requires careful examination.
Interior syndromes also have Excess and Deficiency. Sinking and forceful indicates Interior Excess, hence abdominal fullness and constipation. Sinking and non-forceful indicates Interior Deficiency, possibly diarrhea or Yin syndromes. The above eight sentences exhaustively distinguish Exterior/Interior and Excess/Deficiency.
Wind causes Empty-Floaty pulses; Cold causes Firm-Fixed pulses; Water retention causes Deep-Sunken pulses. Moving pulse indicates Pain; Rapid pulse indicates Heat; Fluid retention (Zhi Yin) requires String-taut pulses. Excessive pulses are strange; insufficient pulses are likewise so.
Jingue said: Wind causes Empty-Floaty pulses; Cold causes Firm-Fixed pulses; Deep-Sunken Water causes Deep-Sunken pulses; Zhi Yin causes String-taut pulses; Moving indicates Pain; Rapid indicates Heat/Vexation; Excessive is strange; Insufficient is so. Pathogens do not appear empty; there must be internal deviation.
Excessive Ying and Wei Qi is named Gao Zhang; Gao Zhang clashing is named Gang. When Ying and Wei are weak, it is named Bei; Bei clashing and damaging is named Yang. When Ying and Wei are harmonious, it is named Huan Chi; Huan Chi named Chen is best. Distinguishing diseases among nine types of pulses, Changsha's [Zhang Zhongjing's] secrets are immeasurable.
Jingue said: Cun position Wei Qi excess is named Gao; Ying Qi excess is named Zhang; Gao Zhang clashing is named Gang; Wei Qi weakness is named [Missing]; Ying Qi weakness [Missing]. Jingue [Missing].
Pulse flickering like fat on soup surface indicates deficient Yang Qi. Pulse winding like spider silk indicates declining Yin Qi. Pulse cutting off like dripping lacquer indicates loss of Blood.
Jingue said: Pulse flickering like fat on soup indicates deficient Yang Qi. Pulse winding like spider silk indicates declining Yang Qi. Pulse continuous yet cutting off like dripping lacquer indicates loss of Blood. Declining Yang Qi. *Qianjin Fang* reads declining Yin Qi.
Yang Knotting appears lush like a carriage canopy; Yin Knotting resembles walking along a bamboo pole.
Jingue said: Lush like a carriage canopy is Yang Knotting. Cumulative like walking along a pole is Yin Knotting.
Yang Excess leads to Cu (Hasty) pulse with occasional stops; Yin Excess leads to Jie (Knotted) pulse, slow and delayed.
These refer to Cu and Jie pulses. Jingue said: Pulse arriving slowly with occasional stops is named Jie; pulse arriving rapidly with occasional stops is named Cu. Yang Excess leads to Cu; Yin Excess leads to Jie. One must examine longitudinal/lateral and reverse/oblique patterns; know the destructive and abnormal pulses.
Jingue said: Pulses have mutual overacting, with Vertical (Zong) and Horizontal (Heng), Reverse (Ni) and Oblique (Shun). What does this mean? Answer: Water overacting on Fire, Metal overacting on Wood is named Zong; Fire overacting [Missing] Shun. Make [Missing].
Quiet pulse with sick person indicates Internal Deficiency; healthy person with sick pulse is called "Walking Corpse" (Xing Shi).
Jingue said: Pulse indicates sickness but person is healthy is called Xing Shi, lacking master Qi, suddenly collapsing and unconscious. Person is sick but pulse is normal is named Internal Deficiency, lacking Grain Spirit, though distressed, without suffering. Right hand Qikou position governs Qi; Renying governing Blood is on the Left. Qikou tight and full indicates Food injury; Renying tight and full indicates fierce Cold pathogen.
Left is Renying, Right is Qikou. Renying tight/full injures by Cold; Qikou tight/full injures by Food.
Rapid indicates Fu organs; Delayed indicates Zang organs; Floating indicates Exterior; Sinking indicates Interior.
Jingue said: Floating indicates Exterior, Sinking indicates Interior, Rapid indicates Fu, Delayed indicates Zang.
Floating and Slow pulse indicates Wind injuring Wei; Floating, Tight, Firm, and Choppy pulse indicates Cold injuring Ying. Large and Faint pulse prohibits vomiting; if purging is desired, guard against Deficiency and Thinness.
Jingue said: Faint pulse cannot be vomited; Thin and Fine pulse cannot be purged.
Sinking, Faint, and Qi weakness make sweating difficult; these three must be carefully remembered.
Sun Yonghe said: In Yin Deficiency with Sinking-Faint pulse and Qi weakness, sweating is contraindicated. For Sweating, Purging, and Vomiting methods, if the pulse indicates they cannot be performed, one must strictly examine.
Yang adding to Yin produces sweating; Left hand Sinking-Faint should not [appear/be treated with sweating].
*Suzhou* says: Yang adding to Yin is called Sweat.
Duyang Stomach pulse determines life and death.
*Zhongjing Lun* mentions Duyang pulse in eighteen out of twenty cases.
Taixi Kidney pulse is the root.
In Cold Damage, Taixi and Duyang pulses must always be examined because the human body relies on Kidney and Stomach pulses. Jingue mocked those who only checked hands and not feet for this reason.
Pulse arriving six or seven times per breath indicates deepening pathogen; attention is required. Floating and Large worsening during day belongs to Yang; Sinking and Fine worsening during night belongs to Yin. Nine or more beats per breath, short and hasty, resembling a gushing spring with no return qi. Further extreme separation and gradual loss of root indicate life extinction and death.
Sun Yonghe said: Pulse reaching six or seven beats or more, Floating-Large worsening by day, Sinking-Fine worsening by night. Reaching eight beats, essence and Qi dissipate, spirit and Qi become chaotic, inevitably [Missing] Extreme Separation.
If the three positions of the patient's pulse are uniform, similar in size, floating/sinking, slow/rapid, this indicates Yin and Yang Qi are harmonious; without medication, recovery is naturally expected.
Jingue said: At Cun, Guan, and Chi positions, if size, floating/sinking, slow/rapid are equal, even if cold/heat are not resolved, the pulse is harmonious, indicating certain recovery.
Fever and aversion to cold, resembling Cold Damage, have five types. Pulse Floating and Rapid, with fever and aversion to cold, is the sign of Cold Damage. Pulse Floating and Tight [Missing] Vomiting [Missing] String-taut [Missing]