桂林古本伤寒杂病论上
桂林罗哲初 手抄
据广西人民出版社1980年7月第2版
伤寒杂病论序(张机序)
论曰：余每览越人入虢之诊，望齐侯之色，未尝不慨然叹其才秀也。怪当今居世之士，曾不留神医药，精究方术，上以疗君亲之疾，下以救贫贱之厄，中以保身长全，以养其生，但竞逐荣势，企踵权豪，孜孜汲汲，惟名利是务，崇饰其末，忽弃其本，华其外，而悴其内，皮之不存，毛将安附焉。卒然遭邪风之气，婴非常之疾，患及祸至，而方震栗，降志屈节，钦望巫祝，告穷归天，束手受败，賫百年之寿命，持至贵之重器，委付凡医，恣其所措，咄嗟嗚呼！厥身已毙，神明消灭，变为异物，幽潜重泉，徒为啼泣，痛夫！举世昏迷，莫能觉悟，不惜其命，若是轻生，彼何荣势之足云哉！而进不能爱人知人，退不能爱身知己，遇灾值祸，身居厄地，蒙蒙昧昧，蠢若游魂。哀乎！趋势之士，驰竞浮华，不固根本，忘躯徇物，危若冰谷，至于是也。余宗族素多，向余二百，建安纪元以来，犹未十稔，其死亡者，三分有二，伤寒十居其七。感往昔之沦丧，伤横夭之莫救，乃勤求古训，博采众方，撰用《素问》、《九卷》、《八十一难》、《阴阳大論》、《胎臚药录》，并平脉辨证，为《伤寒杂病论》合十六卷，虽未能尽愈诸病，庶可以见病知源，若能寻余所集，思过半矣。夫天布五行，以运万类，人禀五常，以有五脏，经络府俞，阴阳会通，玄冥幽微，变化难极，自非才高识妙，岂能探其理致哉！上古有神农、黄帝、歧伯、伯高、雷公、少俞、少师、仲文，中世有长桑、扁鹊，汉有公乘阳庆及仓公，下此以往，未之闻也。观今之医，不念思求经旨，以演其所知，各承家技，终始顺旧，省疾问病，务在口给。相对须臾，便处汤药，按寸不及尺，握手不及足，人迎趺阳，三部不参，动数发息，不满五十，短期未知决诊，九候曾无仿佛，明堂闕庭，尽不见察，所谓窥管而已。夫欲视死别生，实为难矣。孔子云：生而知之者上，学则亚之，多闻博识，知之次也。余宿尚方术，请事斯语。 汉长沙太守南阳张机序
伤寒杂病论序(桂林左德序)
余闻吾师张绍祖先生之言曰："吾家伤寒一书，相传共有一十三稿，每成一稿，传抄殆遍城邑，兹所存者为第十二稿，余者或为族人所秘，或付劫灰，不外是矣；叔和所得相传为第七次稿，与吾所脏者较，其间阙如固多，编次亦不相类，或为叔和所篡乱，或疑为宋人所增删，聚讼纷如，各执其说；然考晋时尚无刊本，犹是传抄，唐末宋初始易传抄为刊刻，遂称易简，以此言之，则坊间所刊者，不但非汉时之原稿，恐亦非叔和之原稿也。"余聆训之下，始亦疑之，及读至伤寒例一卷，见其于可汗不可汗，可吐不可吐，可下不可下法，尽载其中，于六经已具之条为并不重引，法律谨严，始知坊间所刻之辨可汗不可汗，可吐不可吐，可下不可下，以及发汗 吐下后各卷，盖后人以读书之法，错杂其间，而未计及编书之法固不如是也，不然孔氏之徒，问仁者众，问政者繁，何不各类其类，而惮烦若此耶!吾师讳学正，自言为仲氏四十六世孙，自晋以后迁徙不一，其高祖复初公，自岭南复迁原籍，寄居光州，遂聚族焉。吾师虽承家学，不以医名，亦不轻出此书以三示人，余得之受业者，殆有天焉。余宿好方术，得针灸之学于永川邓师宪章公，后随侍先严游宦岭南，与吾师同寅，朝夕相过从，见余手执宋本伤寒论，笑问曰："亦嗜此乎？"时余年仅弱冠，答曰："非敢云嗜，尚未得其要领，正寻绎耳。"师曰："子既好学，复知针灸，可以读伤寒论矣，吾有世传抄本伤寒杂病论十六卷，向不示人，得人不传，恐成坠绪。"遂历言此书颠末，及吾师家世滔滔不倦。先严促余曰："速下拜。"于是即席拜之，得师事焉。今罗生哲初为吾邑知名人士，从习针灸历有年所，颇能好余之所好，余亦以所得者尽授之，余不负吾师，罗生亦必不负余，故特序其原起，罗生其志之，罗生其勉之。 光绪二十年岁次甲午三月桂林左盛德序
伤寒杂病论卷第一
平脉法第一
问曰：脉何以知气血脏腑之诊也？师曰：脉乃气血先见，气血有盛衰，脏腑有偏胜。气血俱盛，脉阴阳俱盛；气血俱衰，脉阴阳俱衰。气独胜者，则脉强；血独盛者，则脉滑；气偏衰者，则脉微；血偏衰者，则脉涩；气血和者，则脉缓；气血平者，则脉平；气血乱者，则脉乱；气血脱者，则脉绝；阳迫气血，则脉数；阴阻气血，则脉迟；若感于邪，气血扰动，脉随变化，变化无穷，气血使之；病变百端，本原别之；欲知病源，当凭脉变；欲知病变，先揣其本，本之不齐，在人体躬，相体以诊，病无遁情。
问曰：脉有三部，阴阳相乘。荣卫血气，在人体躬。呼吸出入，上下于中，因息游布，津液流通。随时动作，肖象形容，春弦秋浮，冬沉夏洪。察色观脉，大小不同，一时之间，变无经常，尺寸参差，或短或长。上下乖错，或存或亡。病辄改易，进退低昂。心迷意惑，动失纪纲。愿为具陈，令得分明。师曰：子之所问，道之根源。脉有三部，尺寸及关。荣卫流行，不失衡铨。肾沉、心洪、肺浮、肝弦，此自经常，不失铢分。出入升降，漏刻周旋，水下二刻，一周循环。当复寸口，虚实见焉。变化相乘，阴阳相干。风则浮虚，寒则牢坚；沉潜水蓄，支饮急弦；动则为痛，数则热烦。设有不应，知变所缘，三部不同，病各异端。太过可怪，不及亦然，邪不空见，中必有奸，审察表里，三焦别焉，知其所舍，消息诊看，料度脏腑，独见若神。为子条记，传与贤人。
师曰：平脉大法，脉分三部。浮部分经，以候皮肤经络之气；沉部分经，以候五脏之气；中部分经，以候六腑之气。
师曰：脉分寸关尺，寸脉分经以候阳，阳者气之统也；尺脉分经以候阴，阴者血之注也；故曰阴阳。关上阴阳交界，应气血升降，分经以候中州之气。
问曰：经说，脉有三菽、六菽重者，何谓也？师曰：脉，人以指按之，如三菽之重者，肺气也；如六菽之重者，心气也；如九菽之重者，脾气也；如十二菽之重者，肝气也；按之至骨者，肾气也。假令下利，寸口、关上、尺中，悉不见脉，然尺中时一小见，脉再举头者，肾气也。若见损至脉来，为难治。
问曰：东方肝脉，其形何似？师曰：肝者木也，名厥阴，其脉微弦濡弱而长，是肝脉也。肝病自得濡弱者，愈也。假令得纯弦脉者，死，何以知之？以其脉如弦直，此是肝脏伤，故知死也。
南方心脉，其形何似？师曰：心者火也，名少阴，其脉洪大而长，是心脉也。心病自得洪大者，愈也。假令脉来微去大，故名反，病在里也。脉来头小本大，故曰复，病在表也。上微头小者，则汗出；下微本大者，则为关格不通，不得尿。头无汗者可治，有汗者死。
西方肺脉，其形何似？师曰：肺者金也，名太阴，其脉毛浮也，肺病自得此脉。若得缓迟者，皆愈；若得数者，则剧。何以知之？数者南方火也，火克西方金，法当痈肿，为难治也。
北方肾脉其形何似？师曰：肾者水也，其脉沉而石，肾病自得此脉者，愈；若得实大者，则剧；何以知之？实大者，长夏土王，土克北方水，水脏立涸也。
师曰：人迎脉大，趺阳脉小，其常也；假令人迎趺阳平等为逆；人迎负趺阳为大逆；所以然者，胃气上升动在人迎，胃气下降动在趺阳，上升力强故曰大，下降力弱故曰小，反此为逆，大逆则死。
师曰：六气所伤，各有法度；舍有专属，病有先后；风中于前，寒中于背；湿伤于下，雾伤于上；雾客皮腠，湿流关节；极寒伤经，极热伤络；风令脉浮，寒令脉紧，又令脉急；暑则浮虚，湿则濡涩；燥短以促，火躁而数；风寒所中，先客太阳；暑气炎热，肺金则伤；湿生长夏，病入脾胃；燥气先伤，大肠合肺；壮火食气，病生于内，心与小肠，先受其害；六气合化，表里相传；脏气偏胜，或移或干；病之变证，难以殚论；能合色脉，可以万全。
问曰：上工望而知之，中工问而知之，下工脉而知之，愿闻其说。师曰：夫色合脉，色主形外，脉主应内；其色露脏，亦有内外；察色之妙，明堂阙庭；察色之法，大指推之；察明堂推而下之，察阙庭推而上之；五色应五脏，如肝色青，脾色黄，肺色白，心色赤，肾色黑，显然易晓；色之生死，在思用精，心迷意惑，难与为言。
色青者，病在肝与胆；假令身色青，明堂色微赤者，生；白者，死；黄白者，半死半生也。
色赤者，病在心与小肠；假令身色赤，明堂微黄者，生；黑者，死；黄黑者，半死半生也。
色黄者，病在脾与胃；假令身色黄，明堂微白者，生；青者，死；黄青者，半死半生也。
色白者，病在肺与大肠；假令身色白，明堂色微黑者，生；赤者，死；黄赤者，半死半生也。
色黑者，病在肾与膀胱；假令身色黑，明堂色微青者，生；黄者，死；黄赤者，半死半生也。
阙庭脉色青而沉细，推之不移者，病在肝；青而浮大，推之随转者，病在胆。
阙庭脉色赤而沉细，推之参差不齐者，病在心；赤而横弋，推之愈赤者，病在小肠。
阙庭脉色青黑直下睛明，推之不变者，病在肾；推之即至者，病在膀胱。
明堂阙庭色不见，推之色青紫者，病在中焦有积；推之明于水者，病在上焦有饮；推之黑赤参差者，病在下焦有寒热。
问曰：色有内外，何以别之？师曰：一望而知者，谓之外；在明堂阙庭，推而见之者，谓之内。
病暴至者，先形于色，不见于脉；病久发者，先见于脉，不形于色；病入于脏，无余证者，见于脉，不形于色；病痼疾者，见于脉，不形于色也。
问曰：色有生死，何谓也？师曰：假令色黄如蟹腹者，生；如枳实者，死；有气则生，无气则死，余色仿此。
师曰：人秉五常，有五脏，五脏发五声，宫、商、角、徵、羽是也；五声在人，各具一体；假令人本声角变商声者，为金克木，至秋当死；变宫、徵、羽皆病，以本声不可变故也。
以上所言，皆人不病而声先病者，初变可治，变成难瘳；词声之妙，差在毫厘，本不易晓，若病至发声则易知也。
师曰：持脉，病人欠者，无病也。脉之，呻者，病也。言迟者，风也。摇头言者，里痛也。行迟者，表强也。坐而伏者，短气也。坐而下一脚者，腰痛也。里实护腹，如怀卵物者，心痛也。
病人长叹声，出高入卑者，病在上焦；出卑入高者，病在下焦；出入急促者，病在中焦有痛处；声唧唧而叹者，身体疼痛；问之不欲语，语先泪下者，必有忧郁；问之不语，泪下不止者，必有隐衷；问之不语，数问之而微笑者，必有隐疾。
实则谵语，虚则郑声；假令言出声卑者，为气虚；言出声高者，为气实；欲言手按胸中者，胸中满痛；欲言手按腹者，腹中满痛；欲言声不出者，咽中肿痛。
师曰：脉病人不病，名曰行尸，以无王气，卒眩仆，不识人者，短命则死。人病脉不病，名曰内虚，以少谷神，虽困无苦。
师曰：脉，肥人责浮，瘦人责沉。肥人当沉，今反浮；瘦人当浮，今反沉，故责之。
师曰：呼吸者，脉之头也。初持脉来疾去迟，此出疾入迟，名曰内虚外实也。初持脉，来迟去疾，此出迟入疾，名曰内实外虚也。
寸口卫气盛，名曰高；荣气盛，名曰章；高章相搏，名曰纲。卫气弱，名曰惵；荣气弱，名曰卑；惵卑相搏，名曰损。卫气和，名曰缓；荣气和，名曰迟；迟缓相搏，名曰沉。
问曰：二月得毛浮脉，何以处言至秋当死。师曰：二月之时，脉当濡弱，反得毛浮者，故知至秋死。二月肝用事，肝属木，脉应濡弱，反得毛浮者，是肺脉也。肺属金，金来克木，故知至秋死。他皆仿此。
师曰：立夏得洪大脉是其本位。其人病身体苦疼重者，须发其汗。若明日身不疼不重者，不须发汗。若汗濈濈自出者，明日便解矣。何以言之？立夏脉洪大是其时脉，故使然也。四时仿此。
问曰：凡病欲知何时得，何时愈，何以知之？师曰：假令夜半得病者，明日日中愈；日中得病者，夜半愈。何以言之？日中得病，夜半愈者，以阳得阴则解也。夜半得病，明日日中愈者，以阴得阳则解也。
问曰：脉病欲知愈未愈者，何以别之？答曰：寸口、关上、尺中三处，大、小、浮、沉、迟、数同等，虽有寒热不解者，此脉阴阳为和平，虽剧当愈。师曰：寸脉下不至关，为阳绝；尺脉上不至关，为阴绝。此皆不治，决死也。若计其余命生死之期，期以月节克之也。
《桂林古本伤寒杂病论》上卷
桂林罗哲初 手抄
据广西人民出版社1980年7月第2版
《伤寒杂病论》序（张机序）
论述说：我每次读到扁鹊诊断虢国太子、望见齐桓侯气色的记载，没有不感慨赞叹他才华出众的。奇怪的是当今在世的人士，竟然不留心医药，不精心研究医术方技，不能上以治疗君主父母的疾病，下以拯救贫贱者的困厄，中以保全自身长久安康，以养护生命，却只竞相追逐荣华权势，踮起脚跟仰慕权贵豪门，急切忙碌，只致力于名利，崇尚修饰细枝末节，忽视抛弃根本，外表华丽，内心憔悴，皮都不存在了，毛将依附在哪里呢？突然遭受邪风侵袭，患上非常严重的疾病，灾祸临头，才惊恐战栗，降低志节屈膝，恭敬地祈求巫祝，告穷无计归依上天，束手等待失败，拿着百年的寿命，握着最珍贵的身体，托付给平庸的医生，任凭他们处置，唉！身体已经死亡，精神消灭，变成异物，深埋地下，只能让人啼哭哀悼，悲痛啊！举世之人昏迷不悟，没有人能觉悟，不爱惜自己的生命，像这样轻视生命，那些荣华权势有什么值得称道的呢！进不能爱护别人了解别人，退不能爱护自己了解自己，遇到灾难遭遇祸患，身处困境，糊里糊涂，愚蠢得像游魂一样。可悲啊！趋炎附势之士，奔驰竞争于浮华，不巩固根本，忘记身体追逐外物，危险如同在冰谷中行走，以至于到了这种地步。我的宗族原本人口众多，从前有一百多人，自建安纪元以来，还不到十年，其中死亡的，占了三分之二，其中因伤寒死的占十分之七。感叹往昔的沦丧，哀伤横死夭折者无法救治，于是勤奋探求古代训诫，广泛采集各方医方，撰写运用《素问》、《九卷》（即《灵枢》）、《八十一难》（即《难经》）、《阴阳大论》、《胎臚药录》，并综合平脉与辨证，写成《伤寒杂病论》共十六卷，虽然不能完全治愈各种疾病，或许可以见到病症知道本源，如果能寻究我所汇集的内容，思虑也就超过一半了。天分布五行，用来运行万物，人禀受五常，从而拥有五脏，经络腑俞，阴阳会通，玄妙幽微，变化难以穷尽，如果不是才高识妙，怎么能探究其中的理趣呢！上古有神农、黄帝、歧伯、伯高、雷公、少俞、少师、仲文，中古有长桑君、扁鹊，汉代有公乘阳庆和仓公，这以下的人，就没听说过了。观察现在的医生，不想着思考探求经典旨意，来推演他们所知道的，各自继承家传技艺，始终沿袭旧法，诊察疾病询问病情，务必在于口齿伶俐。相对片刻，就开处方剂，切寸口脉不到尺部，握手脉不到足部，人迎脉和趺阳脉，三部不参合，脉搏跳动呼吸次数，不满五十次，短期无法决断诊断，九候脉象毫无印象，明堂阙庭，完全不见察视，这就是所谓的管中窥豹。想要看清生死区别，确实很难了。孔子说：生来就知道的人是上等，学习然后知道的是次一等，多闻博识，是知道的下等。我向来崇尚方术，请践行这句话。 汉代长沙太守南阳张机序
《伤寒杂病论》序（桂林左德序）
我听说我的老师张绍祖先生说：“我家《伤寒》一书，相传共有十三稿，每完成一稿，传抄几乎遍城邑，现在保存下来的是第十二稿，其他的或被族人秘藏，或付之一炬，不外乎如此；王叔和所得相传为第七次稿，与我所藏的相比，其中缺失固然很多，编排次序也不相类似，或许是王叔和篡改混乱，或怀疑是宋人增删，聚讼纷纷，各执己见；然而考察晋代时尚无刊印本，还是传抄，唐末宋初才开始由传抄变为刊刻，于是称为易简，由此说来，那么坊间所刊印的，不但不是汉时的原稿，恐怕也不是王叔和的原稿。”我聆听教诲之下，起初也怀疑，等到读到《伤寒例》一卷，看到其中详细记载了可汗不可汗、可吐不可吐、可下不可下的方法，对于六经已具备的条文并不重复引用，法律严谨，才知道坊间所刻的辨别可汗不可汗、可吐不可吐、可下不可下，以及发汗吐下后各卷，大概是后人用读书的方法，错杂在其中，而没有考虑到编书的方法本来就不应该是这样的，否则孔子的弟子，问仁的多，问政的繁，为什么不分类别，而怕麻烦到这种地步呢！我的老师名学正，自称是张氏四十六世孙，自晋代以后迁徙不定，他的曾祖父复初公，从岭南又迁回原籍，寄居光州，于是聚集家族于此。我的老师虽然承袭家学，不以医名扬，也不轻易拿出这本书示人，我得以跟随他学习，大概是有天命吧。我向来喜好方术，向永川邓宪章先生学习针灸，后来随侍先父游历做官于岭南，与我的老师同僚，朝夕交往，见我手持宋本《伤寒论》，笑着问我说：“也嗜好这个吗？”当时我年仅二十岁，回答说：“不敢说嗜好，尚未得其要领，正在寻究罢了。”老师说：“你既然好学，又懂针灸，可以读《伤寒论》了，我有世代相传抄本的《伤寒杂病论》十六卷，向来不示人，得人不传，恐怕成为断绝的线索。”于是详尽讲述这本书的始末，以及我老师的家世滔滔不绝。先父催促我说：“赶快拜师。”于是当场拜师，得以奉他为师。现在罗生哲初是我县知名人士，跟从学习针灸已有多年，很能喜好我所喜好的，我也把他所知道的尽数传授给他，我不辜负我的老师，罗生也必定不辜负我，所以特别序述其起源，罗生要记取它，罗生要勉励它。光绪二十年岁次甲午三月桂林左盛德序
问曰：脉象凭什么能诊断气血脏腑的情况呢？老师说：脉是气血最先显现的地方，气血有盛衰，脏腑有偏胜。气血都盛，脉象阴阳都盛；气血都衰，脉象阴阳都衰。气独胜，则脉强劲；血独盛，则脉滑利；气偏衰，则脉微弱；血偏衰，则脉涩滞；气血调和，则脉缓；气血平和，则脉平；气血紊乱，则脉乱；气血脱失，则脉绝；阳气逼迫气血，则脉数；阴气阻滞气血，则脉迟；如果感受邪气，气血扰动，脉随之变化，变化无穷，是气血使之然；病变百端，根据本源辨别；想知道病源，应当凭脉象变化；想知道病变，先揣测其根本，根本不齐，在于人体自身，观察体质来诊断，病情没有隐瞒的。
问曰：脉有三部，阴阳相互影响。营卫血气，在人体自身。呼吸出入，上下于中，因气息游走布散，津液流通。随时动作，形象描述，春弦秋浮，冬沉夏洪。观察面色观看脉象，大小不同，一时之间，变化无常，尺寸参差，或短或长。上下乖错，或存或亡。病情改变，进退低昂。心里迷惑，动失纪纲。希望你详细陈述，让我分得清楚。老师说：你所问的，是道的根源。脉有三部，寸关及尺。营卫流行，不失权衡。肾脉沉、心脉洪、肺脉浮、肝脉弦，这是常道，不失毫厘。出入升降，漏刻周旋，水下二刻，一周循环。应当复至寸口，虚实显现。变化相乘，阴阳相干。风邪则脉浮虚，寒邪则脉牢坚；水饮潜伏，支饮脉急弦；动脉主痛，数脉主热烦。如果有不应验的，知道变化的缘由，三部不同，病各异端。太过可怪，不及亦然，邪气不会空见，中间必有奸邪，审察表里，三焦分别，知道其所舍，斟酌诊看，料度脏腑，独见如神。为你条记，传给贤人。
老师说：平脉的大法，脉分三部。浮部分经，以候皮肤经络之气；沉部分经，以候五脏之气；中部分经，以候六腑之气。
老师说：脉分寸、关、尺，寸脉分经以候阳，阳是气的统帅；尺脉分经以候阴，阴是血的注入；所以说阴阳。关上阴阳交界，应气血升降，分经以候中州之气。
问曰：经书说，脉有三菽、六菽重者，是什么意思？老师说：脉，人用手指按之，如三颗豆子的重量，是肺气；如六颗豆子的重量，是心气；如九颗豆子的重量，是脾气；如十二颗豆子的重量，是肝气；按至骨头，是肾气。假如下利，寸口、关上、尺中，都看不见脉，然而尺中偶尔小现一次，脉再举头（指脉象起伏），是肾气。如果见到损至脉来，为难治。
问曰：东方肝脉，它的形状像什么？老师说：肝属木，名叫厥阴，其脉微弦濡弱而长，这是肝脉。肝病自得濡弱脉，会痊愈。假如得纯弦脉，会死，怎么知道？因为脉如弦直，这是肝脏受伤，所以知道会死。
南方心脉，它的形状像什么？老师说：心属火，名叫少阴，其脉洪大而长，这是心脉。心病自得洪大脉，会痊愈。假如脉来头小本大，名叫反，病在里。脉来头小本大，名叫复，病在表。上微头小，则汗出；下微本大，则为关格不通，不得尿。头无汗者可治，有汗者死。
西方肺脉，它的形状像什么？老师说：肺属金，名叫太阴，其脉毛浮，肺病自得此脉。如果得缓迟脉，都会痊愈；如果得数脉，则病情加重。怎么知道？数是南方火，火克西方金，法当痈肿，为难治。
北方肾脉它的形状像什么？老师说：肾属水，其脉沉而石，肾病自得此脉，会痊愈；如果得实大脉，则病情加重；怎么知道？实大脉，长夏土旺，土克北方水，水脏立刻枯竭。
老师说：人迎脉大，趺阳脉小，这是常态；假如人迎趺阳平等为逆；人迎负于趺阳为大逆；之所以这样，胃气上升动在人迎，胃气下降动在趺阳，上升力强故曰大，下降力弱故曰小，反过来为逆，大逆则死。
老师说：六气所伤，各有法度；病位有专属，病情有先后；风邪中于前，寒邪中于背；湿邪伤于下，雾邪伤于上；雾邪客于皮腠，湿邪流注关节；极寒伤经，极热伤络；风令脉浮，寒令脉紧，又令脉急；暑则浮虚，湿则濡涩；燥短以促，火躁而数；风寒所中，先客太阳；暑气炎热，肺金则伤；湿生长夏，病入脾胃；燥气先伤，大肠合肺；壮火食气，病生于内，心与小肠，先受其害；六气合化，表里相传；脏气偏胜，或移或干；病的变证，难以尽论；能结合色脉，可以万全。
问曰：上工望而知之，中工问而知之，下工脉而知之，希望听听其中的说法。老师说：色合脉，色主形外，脉主应内；其色露脏，也有内外；察色的奥妙，在明堂阙庭；察色的方法，大拇指推之；察明堂推而下之，察阙庭推而上之；五色应五脏，如肝色青，脾色黄，肺色白，心色赤，肾色黑，显然易晓；色的生死，在于思虑用精，心迷意惑，难与之言。
色青者，病在肝与胆；假如身色青，明堂色微赤者，生；白者，死；黄白者，半死半生也。
色赤者，病在心与小肠；假如身色赤，明堂微黄者，生；黑者，死；黄黑者，半死半生也。
色黄者，病在脾与胃；假如身色黄，明堂微白者，生；青者，死；黄青者，半死半生也。
色白者，病在肺与大肠；假如身色白，明堂色微黑者，生；赤者，死；黄赤者，半死半生也。
色黑者，病在肾与膀胱；假如身色黑，明堂色微青者，生；黄者，死；黄赤者，半死半生也。
阙庭脉色青而沉细，推之不移者，病在肝；青而浮大，推之随转者，病在胆。
阙庭脉色赤而沉细，推之参差不齐者，病在心；赤而横弋，推之愈赤者，病在小肠。
阙庭脉色青黑直下睛明，推之不变者，病在肾；推之即至者，病在膀胱。
明堂阙庭色不见，推之色青紫者，病在中焦有积；推之明于水者，病在上焦有饮；推之黑赤参差者，病在下焦有寒热。
问曰：色有内外，怎么区别？老师说：一望而知者，谓之外；在明堂阙庭，推而见之者，谓之内。
病暴至者，先形于色，不见于脉；病久发者，先见于脉，不形于色；病入于脏，无余证者，见于脉，不形于色；病痼疾者，见于脉，不形于色也。
问曰：色有生死，什么意思？老师说：假如色黄如蟹腹者，生；如枳实者，死；有气则生，无气则死，其余颜色仿照此例。
老师说：人秉受五常，有五脏，五脏发五声，宫、商、角、徵、羽就是；五声在人，各具一体；假如人本声角变商声者，为金克木，至秋当死；变宫、徵、羽皆病，以本声不可变故也。
以上所言，都是人不病而声先病者，初变可治，变成难瘳；词声的奥妙，差在毫厘，本来不易晓，若病至发声则易知也。
老师说：持脉，病人打欠伸的，无病。脉之，呻吟的，有病。说话迟缓的，中风。摇头说话的，里有痛。行走迟缓的，表强。坐而伏着的，短气。坐而下一只脚的，腰痛。里有实邪护腹，如怀卵物者，心痛。
病人长叹声，出高入卑者，病在上焦；出卑入高者，病在下焦；出入急促者，病在中焦有痛处；声唧唧而叹者，身体疼痛；问之不欲语，语先泪下者，必有忧郁；问之不语，泪下不止者，必有隐衷；问之不语，数问之而微笑者，必有隐疾。
实则谵语，虚则郑声；假如言出声卑者，为气虚；言出声高者，为气实；欲言手按胸中者，胸中满痛；欲言手按腹者，腹中满痛；欲言声不出者，咽中肿痛。
老师说：脉病人不病，名叫行尸，因为没有王气，突然眩晕仆倒，不识人者，短命则死。人病脉不病，名叫内虚，因为少谷神，虽然困顿无苦。
老师说：脉，肥人责浮，瘦人责沉。肥人当沉，今反浮；瘦人当浮，今反沉，所以责之。
老师说：呼吸者，脉的头绪。初持脉来疾去迟，这是出疾入迟，名叫内虚外实。初持脉，来迟去疾，这是出迟入疾，名叫内实外虚。
寸口卫气盛，名叫高；营气盛，名叫章；高章相搏，名叫纲。卫气弱，名叫惵；营气弱，名叫卑；惵卑相搏，名叫损。卫气和，名叫缓；营气和，名叫迟；迟缓相搏，名叫沉。
问曰：二月得毛浮脉，为什么说至秋当死。老师说：二月之时，脉当濡弱，反得毛浮者，所以知道至秋死。二月肝用事，肝属木，脉应濡弱，反得毛浮者，是肺脉也。肺属金，金来克木，所以知道至秋死。其他都仿照此例。
老师说：立夏得洪大脉是其本位。其人病身体苦疼重者，须发其汗。如果明天身不疼不重者，不发汗。如果汗濈濈自出者，明天便解除了。为什么这样说？立夏脉洪大是其时脉，所以使然。四季仿照此例。
问曰：凡病想知道何时得，何时愈，怎么知道？老师说：假如夜半得病者，明日日中愈；日中得病者，夜半愈。为什么这样说？日中得病，夜半愈者，以阳得阴则解也。夜半得病，明日日中愈者，以阴得阳则解也。
问曰：脉病想知道愈未愈，怎么区别？回答说：寸口、关上、尺中三处，大、小、浮、沉、迟、数同等，虽然有寒热不解者，此脉阴阳为和平，虽然剧烈当愈。老师说：寸脉下不至关，为阳绝；尺脉上不至关，为阴绝。这些都不治，决死也。如果计算其余命生死之期，期以月节克之也。
Preface to Shanghan Zabing Lun (Preface by Zhang Ji)
It is said: Every time I read about Bian Que's diagnosis of the Crown Prince of Guo and his observation of Duke Huan of Qi's complexion, I cannot help but sigh with admiration for his outstanding talent. It is strange that scholars of today, living in the world, do not pay attention to medicine and pharmacology, nor do they carefully study medical techniques. They fail to treat the illnesses of rulers and parents above, save the poor and lowly below, preserve their own bodies for longevity in the middle, and nourish their lives. Instead, they compete for glory and power, stretching on tiptoes to admire the wealthy and powerful, busily striving, only concerned with fame and profit. They embellish the trivial while neglecting the fundamental, appearing splendid on the outside but emaciated within. If the skin does not exist, where can the hair attach? Suddenly encountering pathogenic wind-qi, suffering from extraordinary diseases, when disaster strikes, they tremble in fear, lower their will and yield, reverently hoping in shamans and diviners, running out of options and attributing it to Heaven, helpless and accepting defeat. Entrusting a century-long lifespan and the precious vessel of the body to mediocre physicians, leaving them to act as they please. Alas! The body perishes, spirit vanishes, turning into an object, hidden deep in the underworld, leaving only tears and weeping. How painful! The whole world is confused and unaware, no one awakens, not sparing their lives. To treat life so lightly, what glory or power is worth mentioning! One cannot love or understand others when advancing, nor love or understand oneself when retreating. Encountering disaster and misfortune, dwelling in adversity, ignorant and dim-witted, foolish as a wandering soul. How sorrowful! Those who follow trends gallop and compete in vanity, failing to consolidate the root, forgetting the body to pursue external things, dangerous as walking in a valley of ice, reaching such a state. My clan was originally numerous, formerly over two hundred people. Since the Jian'an era, less than ten years have passed, yet two-thirds have perished, seven out of ten due to Cold Damage (Shanghan). Grieving the loss of the past, mourning those who died prematurely and could not be saved, I diligently sought ancient teachings, widely collected various prescriptions, utilized the *Suwen*, *Jiujuan* (Lingshu), *Bayishinan* (Nanjing), *Yinyang Dalun*, and *Tailu Yaolu*, combined pulse differentiation and syndrome differentiation, and compiled the *Shanghan Zabing Lun* into sixteen volumes. Although unable to cure all diseases completely, it may allow one to see the disease and know its source. If one seeks the collection I have assembled, half of the understanding will be gained. Heaven distributes the Five Elements to operate all categories; humans inherit the Five Constants to possess the Five Zang organs. Meridians, Fu organs, and Shu points connect Yin and Yang; profound and subtle, changes are hard to exhaust. Without high talent and profound insight, how can one explore its principles? In ancient times, there were Shennong, Huangdi, Qibo, Bogao, Leigong, Shaoyu, Shaoshi, and Zhongwen. In the middle ages, there were Changsang Jun and Bian Que. In the Han dynasty, there were Gongcheng Yangqing and Cang Gong. Below these, none have been heard of. Observing modern physicians, they do not think to seek the essence of classics to expand their knowledge. Each inherits family skills, following old ways from start to finish. Examining illnesses and asking about diseases, they focus on eloquence. Facing each other for a moment, they prescribe decoctions immediately. Checking the Cun position without reaching Chi, holding the wrist without reaching the foot, Renying and Duzhong pulses are not compared. Pulse rate and breath count do not reach fifty. Short-term diagnosis is unknown, Nine Pulses show no resemblance. Mingtang and Yueting are not observed at all. This is called looking through a tube. To distinguish death from life truly is difficult. Confucius said: Those who know from birth are superior; those who learn are second best; those who hear much and know broadly are next best. I have long esteemed medical arts; I request to practice these words. Preface to Shanghan Zabing Lun by Zhang Ji, Chancellor of Changsha, Nanyang, Han Dynasty.
Preface to Shanghan Zabing Lun (Preface by Zuo De of Guilin)
I heard my teacher, Mr. Zhang Shozu, say: "Our family's book on Cold Damage has been transmitted in thirteen drafts. Each completed draft was copied throughout the city. What remains now is the twelfth draft; others were either kept secret by clan members or destroyed by fire, nothing more remains. Wang Shuhe obtained the seventh draft, which differs greatly from mine in missing content and arrangement. It may have been tampered with by Wang Shuhe or added/edited by Song people, leading to endless disputes. However, examining the Jin dynasty, there were no printed editions, only manuscripts. Printing began in the late Tang and early Song dynasties, hence the name 'Yijian'. Thus, the printed versions in the market are not only not the original Han manuscripts, but likely not even Wang Shuhe's originals." Hearing this, I initially doubted it. But upon reading the *Shanghan Li* volume, seeing detailed methods for sweating, vomiting, and purging, and noting that existing Six Channels syndromes were not repeated, the rules were strict. I realized the printed sections on sweating/vomiting/purging and post-treatment volumes were likely inserted by later readers using reading methods, ignoring compilation logic. Otherwise, why did Confucius' disciples ask about Ren and Zheng so frequently without categorization? My teacher, named Xuezheng, claimed to be the 46th generation descendant of Zhang Zhongjing. After the Jin dynasty, migrations varied. His great-grandfather, Fuchu, moved back to the ancestral home from Lingnan, settling in Guangzhou, gathering the clan there. Though inheriting family learning, my teacher did not gain fame as a physician nor easily showed this book to others. I received it through destiny. I have long loved medical arts, learning acupuncture from Master Deng Xianzhang of Yongchuan. Later, I accompanied my father on official duties in Lingnan, becoming colleagues with my teacher. We interacted daily. Seeing me hold a Song edition of *Shanghan Lun*, he smiled and asked, "Do you also like this?" I was barely twenty, replying, "I dare not say I like it; I haven't grasped the essentials, just studying." He said, "Since you love learning and know acupuncture, you can read *Shanghan Lun*. I have a generational manuscript copy of *Shanghan Zabing Lun* in sixteen volumes, never shown to anyone. If not passed to the right person, the lineage may end." He then recounted the book's history and his family background tirelessly. My father urged me, "Kneel quickly." So I knelt on the spot and became his student. Now, Luo Zhechu is a famous figure in our county, having studied acupuncture for years, sharing my interests. I taught him everything I knew. I hope not to disappoint my teacher, and Luo will surely not disappoint me. Thus, I specially preface its origin. Luo, remember it, Luo, strive for it. Preface by Zuo Shengde of Guilin, March, Jiawu Year, 20th Year of Guangxu.
Volume One of Shanghan Zabing Lun
Chapter One: Ping Mai Fa (Method of Assessing Normal Pulses)
Question: How can pulses diagnose Qi, Blood, and Zang-Fu conditions? Master said: Pulses are the first manifestation of Qi and Blood. Qi and Blood have excess and deficiency; Zang and Fu have dominance and weakness. If both Qi and Blood are excessive, Yin and Yang pulses are excessive. If both are deficient, Yin and Yang pulses are deficient. If Qi alone dominates, the pulse is strong. If Blood alone dominates, the pulse is slippery. If Qi is relatively deficient, the pulse is faint. If Blood is relatively deficient, the pulse is choppy. If Qi and Blood are harmonious, the pulse is moderate. If Qi and Blood are balanced, the pulse is level. If Qi and Blood are chaotic, the pulse is disordered. If Qi and Blood are exhausted, the pulse ceases. If Yang forces Qi and Blood, the pulse is rapid. If Yin obstructs Qi and Blood, the pulse is slow. If affected by pathogens, Qi and Blood are disturbed, and the pulse changes accordingly, infinitely varying due to Qi and Blood. Diseases vary endlessly, distinguished by their origin. To know the source, rely on pulse changes. To know the variation, examine the root. Roots differ based on individual constitution; diagnosing by physique reveals hidden conditions.
Question: Pulses have three positions, interacting Yin and Yang. Ying and Wei, Blood and Qi reside in the body. Breathing enters and exits, moving up and down, distributing fluids via breath. Movements correspond to seasons: Spring wiry, Autumn floating, Winter deep, Summer surging. Observing color and pulse, sizes differ. Changes are unpredictable within moments. Cun and Chi positions vary, sometimes short, sometimes long. Upper and lower positions mismatch, appearing or disappearing. Conditions change, advancing or retreating. The mind becomes confused, losing guidelines. Please explain clearly. Master said: You ask about the root of the Dao. Pulses have three positions: Cun, Guan, and Chi. Ying and Wei flow without losing balance. Kidney pulse is deep, Heart pulse is surging, Lung pulse is floating, Liver pulse is wiry. These are constants, precise to the finest degree. Entering and exiting, rising and falling, cycles complete in two water-clock units. Returning to Cun, deficiency and excess appear. Changes multiply, Yin and Yang interfere. Wind causes floating and empty pulses; Cold causes firm and solid pulses. Submerged water accumulation and Phlegm-Fluid cause urgent wiry pulses. Moving pulse indicates pain; Rapid pulse indicates heat and restlessness. If responses don't match, understand the cause. Three positions differ, diseases vary. Excess is abnormal, deficiency is also abnormal. Pathogens don't appear without cause; there is always internal deviation. Examine exterior and interior, differentiate San Jiao. Know where the pathogen resides, observe carefully, judge Zang and Fu, seeing with divine clarity. I record this for you to pass to the wise.
Master said: The general method of assessing normal pulses divides them into three parts. The superficial part corresponds to meridians, observing Qi of skin and meridians. The deep part corresponds to meridians, observing Qi of the Five Zang organs. The middle part corresponds to meridians, observing Qi of the Middle Jiao (Six Fu organs).
Master said: Pulses divide into Cun, Guan, and Chi. Cun pulse corresponds to meridians to observe Yang, the commander of Qi. Chi pulse corresponds to meridians to observe Yin, the reservoir of Blood. Hence, Yin and Yang. Guan is the junction of Yin and Yang, responding to Qi and Blood ascent and descent, corresponding to meridians to observe Middle Jiao Qi.
Question: Classics mention pulses weighted like three beans or six beans. What does this mean? Master said: When pressing the pulse with fingers, weight equivalent to three beans indicates Lung Qi; six beans indicates Heart Qi; nine beans indicates Spleen Qi; twelve beans indicates Liver Qi; pressing to the bone indicates Kidney Qi. In cases of diarrhea, if Cun, Guan, and Chi pulses are invisible, but Chi occasionally shows a small pulse that rises again, it indicates Kidney Qi. If a damaged or extreme pulse appears, it is difficult to treat.
Question: What does the Eastern Liver pulse look like? Master said: Liver belongs to Wood, named Jueyin. Its pulse is slightly wiry, soft, weak, and long. This is the Liver pulse. If Liver disease presents with soft and weak pulse, recovery occurs. If a pure wiry pulse appears, death ensues. Why? Because the pulse is straight like a bowstring, indicating Liver injury.
What does the Southern Heart pulse look like? Master said: Heart belongs to Fire, named Shaoyin. Its pulse is surging, large, and long. This is the Heart pulse. If Heart disease presents with surging pulse, recovery occurs. If the pulse head is small and base is large, it is called "Reverse," indicating interior disease. If the pulse head is small and base is large, it is called "Return," indicating exterior disease. If the upper part is small, sweating occurs. If the lower part is large, obstruction and blockage occur, preventing urination. No sweat on the head is treatable; sweat indicates death.
What does the Western Lung pulse look like? Master said: Lung belongs to Metal, named Taiyin. Its pulse is light and floating, like hair. If Lung disease presents with this pulse, recovery occurs if slow and delayed. If rapid, the condition worsens. Why? Rapid indicates Southern Fire. Fire conquers Western Metal, leading to carbuncles, making it difficult to treat.
What does the Northern Kidney pulse look like? Master said: Kidney belongs to Water. Its pulse is deep and stone-like. If Kidney disease presents with this pulse, recovery occurs. If solid and large, the condition worsens. Why? Solid and large indicates Earth dominance in Late Summer. Earth conquers Northern Water, causing Water organs to dry up.
Master said: Renying pulse large and Duzhong pulse small is normal. If Renying and Duzhong are equal, it is adverse. If Renying is weaker than Duzhong, it is severely adverse. Stomach Qi ascends, manifesting in Renying; Stomach Qi descends, manifesting in Duzhong. Ascension is strong (large), descent is weak (small). Reversal is adverse; severe adverse leads to death.
Master said: Injury by the Six Qi has specific rules. Locations are specific, timing varies. Wind attacks the front, Cold attacks the back. Dampness injures the lower, Fog injures the upper. Fog affects skin and pores; Dampness flows into joints. Extreme Cold injures meridians; Extreme Heat injures collaterals. Wind causes floating pulses; Cold causes tight and urgent pulses. Summerheat causes floating and empty; Dampness causes soft and choppy. Dryness causes short and hurried; Fire causes restless and rapid. Wind and Cold first affect Taiyang. Summerheat heat injures Lung Metal. Dampness arises in Late Summer, affecting Spleen and Stomach. Dryness injures first, Large Intestine combining with Lung. Strong Fire consumes Qi, disease arises internally, affecting Heart and Small Intestine first. Six Qi combine and transform, transmitting between interior and exterior. Zang Qi dominance shifts or interferes. Disease variations are countless. Combining color and pulse ensures perfection.
Question: Superior doctors know by observation, average by inquiry, inferior by palpation. Explain. Master said: Color matches pulse. Color manifests externally, pulse responds internally. Color reveals Zang status, having interior and exterior aspects. The subtlety of observing color lies in Mingtang and Yueting. The method involves pushing with the thumb. Push down from Mingtang, push up from Yueting. Five colors correspond to Five Zang: Liver Green, Spleen Yellow, Lung White, Heart Red, Kidney Black. Clear and easy to understand. Life and death in color depend on mental focus. Confused minds cannot be instructed.
Green color indicates Liver and Gallbladder disease. If body is green but Mingtang is slightly red, survival; white indicates death; yellow-white indicates half-survival.
Red color indicates Heart and Small Intestine disease. If body is red but Mingtang is slightly yellow, survival; black indicates death; yellow-black indicates half-survival.
Yellow color indicates Spleen and Stomach disease. If body is yellow but Mingtang is slightly white, survival; green indicates death; yellow-green indicates half-survival.
White color indicates Lung and Large Intestine disease. If body is white but Mingtang is slightly black, survival; red indicates death; yellow-red indicates half-survival.
Black color indicates Kidney and Bladder disease. If body is black but Mingtang is slightly green, survival; yellow indicates death; yellow-red indicates half-survival.
Yueting pulse color green, deep and thin, immovable upon pushing indicates Liver disease. Green, floating and large, movable indicates Gallbladder disease.
Yueting pulse color red, deep and thin, irregular upon pushing indicates Heart disease. Red, horizontal and jagged, redder upon pushing indicates Small Intestine disease.
Yueting pulse color yellow, stagnant like water indicates Spleen disease; flowing rapidly indicates Stomach disease.
Yueting pulse color green-white, slow to return indicates Lung disease; quick to return indicates Large Intestine disease.
Yueting pulse color green-black descending to Jingming, unchanging indicates Kidney disease; quick to return indicates Bladder disease.
If Mingtang/Yueting color is not visible, pushing reveals blue-purple indicates Middle Jiao accumulation; clear like water indicates Upper Jiao Fluid retention; mixed black and red indicates Lower Jiao cold-heat complex.
Question: How to distinguish interior and exterior colors? Master said: Visible at a glance is exterior; revealed by pushing Mingtang/Yueting is interior.
Sudden diseases manifest in color first, not pulse. Chronic diseases manifest in pulse first, not color. Interior Zang diseases with no residual symptoms manifest in pulse, not color. Stubborn diseases manifest in pulse, not color.
Question: What determines life and death in color? Master said: Yellow like crab belly indicates life; like sophora fruit indicates death. Presence of Qi means life; absence means death. Other colors follow this pattern.
Master said: Humans inherit Five Constants, possessing Five Zang, emitting Five Sounds: Gong, Shang, Jue, Zhi, Yu. Each sound corresponds to a body type. If Jue (Wood) changes to Shang (Metal), Metal conquers Wood, death in Autumn. Changes to Gong, Zhi, Yu indicate illness because the original sound should not change.
If Gong (Earth) changes to Jue (Wood), Wood conquers Earth, death in Spring. Changes to Shang, Zhi, Yu indicate illness.
If Shang (Metal) changes to Zhi (Fire), Fire conquers Metal, death in Summer. Changes to Gong, Jue, Yu indicate illness.
If Zhi (Fire) changes to Yu (Water), Water conquers Fire, death in Winter. Changes to Jue, Gong, Shang indicate illness.
If Yu (Water) changes to Gong (Earth), Earth conquers Water, death in Late Summer. Changes to Jue, Shang, Zhi indicate illness.
These refer to cases where voice sickens before the body. Early change is treatable; established change is hard to cure. Voice subtleties differ by hairsbreadth, hard to discern unless disease manifests in voice.
Master said: Yawning during pulse taking indicates health. Groaning indicates disease. Slow speech indicates Wind. Head-shaking while speaking indicates interior pain. Slow walking indicates exterior stiffness. Sitting and bending forward indicates shortness of breath. Sitting with one leg down indicates lower back pain. Protecting abdomen like holding an egg indicates Heart pain.
Long sighs rising high and falling low indicate Upper Jiao disease; rising low and falling high indicate Lower Jiao disease; urgent breathing indicates pain in Middle Jiao. Whimpering sighs indicate body pain. Reluctance to speak with tears indicates depression. Unanswered questions with continuous tears indicate hidden grief. Unanswered questions with smiles indicate hidden illness.
Excess causes rambling speech; Deficiency causes repetitive speech. Low voice indicates Qi deficiency; High voice indicates Qi excess. Pressing chest while wanting to speak indicates chest fullness/pain. Pressing abdomen indicates abdominal fullness/pain. Unable to speak indicates throat swelling/pain.
Master said: Pulse abnormal but patient healthy is called "Walking Corpse" due to lack of Sovereign Qi. Sudden dizziness and unconsciousness lead to short life. Patient ill but pulse normal is called "Interior Deficiency" due to lack of Grain Spirit. Though distressed, no suffering.
Master said: For obese persons, check for floating; for thin persons, check for deep. Obese should be deep, if floating, investigate. Thin should be floating, if deep, investigate.
Master said: Respiration is the guide of the pulse. Fast arrival, slow departure indicates fast exit, slow entry, named Interior Deficiency Exterior Excess. Slow arrival, fast departure indicates slow exit, fast entry, named Interior Excess Exterior Deficiency.
Cun position with abundant Wei Qi is called "Gao"; abundant Ying Qi is called "Zhang". Gao and Zhang combined is called "Gang". Weak Wei Qi is called "Die"; weak Ying Qi is called "Bei". Die and Bei combined is called "Sun". Harmonious Wei Qi is called "Huan"; harmonious Ying Qi is called "Chi". Huan and Chi combined is called "Chen".
Yang pulse floating, large, and soft; Yin pulse floating, large, and soft. Equal Yin and Yang pulses are called "Huan" (Moderate).
Question: Why does a floating pulse in the second month (Spring) predict death in Autumn? Master said: In the second month, pulses should be soft and weak. Floating indicates Lung Metal. Lung (Metal) conquers Liver (Wood). Hence, death in Autumn. Others follow this logic.
Master said: Surging-large pulse at Start of Summer is correct for the season. If body aches heavily, induce sweating. If pain resolves next day, no sweating needed. Profuse sweating indicates resolution. Seasonal pulses follow this rule.
Question: How to know onset and recovery time? Master said: Illness at midnight recovers at noon. Illness at noon recovers at midnight. Noon illness recovering at midnight: Yang obtains Yin to resolve. Midnight illness recovering at noon: Yin obtains Yang to resolve.
Question: How to distinguish recovery from non-recovery? Answer: If Cun, Guan, and Chi are equal in size, depth, and rate, even with persistent cold/heat, Yin-Yang harmony predicts recovery. Master said: Cun pulse not reaching Guan is Yang Extinction; Chi pulse not reaching Guan is Yin Extinction. Both are untreatable and fatal. Remaining lifespan depends on elemental overcoming cycles.