温病之脉，前人谓右脉反大于左，此指邪热之达于肺、胃者言也。尝有伏温初发，其邪热郁于少阴，或连
及厥阴，而弦数之脉，遂见于左手关尺两部者甚多。更有邪机深伏，郁湮不达，病象颇深，而脉象转见细弱不
鼓之象∶逮托邪化热，脉始渐
见浮硬。此由肾气先亏，不能鼓邪外达，故脉象如此，其证必
非轻浅。总之，伏温外发，必从经气之虚处而出，初无一定路
径，所谓邪之所凑，其气必虚也。难经云∶温邪行在诸经，不知何经之动。此语空灵活泼，最合病情。盖其行
动，初无一定之径，外见无一定之证，故其脉亦无一定之脉。至舌苔之色，必邪在胃中蒸郁，其浊气乃上熏而
生苔。若邪伏阴经，不涉胃腑，则虽邪热已剧，仍不见有舌苔也。舌本为心、脾营气所结，故营分有热，舌底
必绛；心火亢盛。舌尖必红。然邪深伏下焦。而舌底不见紫绛者，间亦有之。迨邪热郁极而发，脉之细弱者，
忽变而浮大弦数∶舌之淡白者，倏变而灰黑干绛；则势已燎原，不可响迩。至此而始图挽救，恐热邪炽盛，脏
腑枯烂，虽有焦头烂额之客，而已无及矣。故视病者，必细察见证，再合之色脉，乃有把握。若徒执脉象、舌
苔，而求病之寒热、浅深，则误者多矣。诒阅历多年，确知伏温初起，凡病邪极深者，脉与证较多不合。其故
皆由邪气深伏，不易表见于外。视病者为其所惑，必多误治。故特表而出之，庶学人知所审择焉。
周禹载曰∶温病热病之脉，或见浮紧者，乃重感不正之暴寒。寒邪束于外，热邪蕴于内，故其脉外则绷急
，内则洪盛也。又或不识脉形，但见弦脉，便呼为紧，而妄治之。盖脉之盛而有力者，每每兼弦，岂可错认为
紧，而断以为寒乎。夫温病热病之脉，多在肌肉之分而不甚浮，且右手反盛于左手，诚由怫郁在内故也。其左
手盛或浮者，必有重感风寒；否则非温病热病，自是非时暴寒耳。
温病的脉象，前人认为右脉反而比左脉大，这是指邪热到达肺、胃的情况而言的。我曾遇到伏气温病初发时，邪热郁结在少阴经，或者牵连到厥阴经，导致弦数脉出现在左手关部和尺部这两种位置的情况非常多。更有邪气机深伏体内，郁结阻滞不能透达，病症表现相当严重，但脉象反而出现细弱无力鼓动的情况：等到正气托举邪气化为热邪外透时，脉象才逐渐变得浮而硬实。这是由于肾气先已亏损，不能推动邪气向外透达，所以脉象如此，这种病情必定不是轻浅的。总之，伏气温病向外发散，必然从经气虚弱之处透出，起初并没有固定的路径，这就是所说的“邪气聚集的地方，正气必然虚弱”。《难经》说：“温邪运行于各条经脉，不知道是哪条经脉受到触动。”这句话空灵活泼，最符合病情的实际。因为它的运行，起初没有固定的路径，外在表现没有固定的症状，所以它的脉象也没有固定的脉象。至于舌苔的颜色，一定是邪气在胃中蒸腾郁结，其浊气才向上熏蒸而生出舌苔。如果邪气潜伏在阴经，不涉及胃腑，那么即使邪热已经很剧烈，仍然看不到有舌苔。舌体是由心、脾的营气凝结而成，所以营分有热，舌底必定呈绛红色；心火亢盛，舌尖必定发红。然而邪气深伏在下焦，而舌底不见紫绛色的，间或也有这种情况。等到邪热郁积到极点而爆发，脉象由细弱突然变为浮大弦数；舌色由淡白突然变为灰黑干燥且绛红；这时病势已经像燎原大火一样，不可接近。到了这个时候才开始图谋挽救，恐怕热邪炽盛，导致脏腑枯烂，即使有擅长治疗头面疮疡（比喻擅长处理危急重症）的医生，也已经来不及了。所以诊治病人，必须仔细察见证候，再结合舌象和脉象，才有把握。如果只拘泥于脉象、舌苔，来探求疾病的寒热性质和深浅程度，那么犯错误的人就很多了。我柳宝诒阅历多年，确切知道伏气温病初起时，凡是病邪极深的，脉象与症状较多地不相符合。其原因都是因为邪气深伏，不容易表现在外面。诊治者被这些假象所迷惑，必然会导致误治。所以我特意陈述出来，希望学习中医的人知道如何审慎选择判断。
周禹载说：温病、热病的脉象，有时见到浮紧脉，这是因为再次感受了不正之气的暴寒。寒邪束缚在体表，热邪蕴结在体内，所以脉象外部绷急，内部洪盛。又或者是不识得脉形，只要见到弦脉，就称之为紧脉，从而胡乱治疗。大概脉象盛大而有力量时，常常兼带弦象，怎么能错认为是紧脉，并断定它是寒证呢？温病、热病的脉象，多在肌肉层次而不甚浮浅，而且右手脉反而强盛于左手，确实是因为邪气郁结在内部的缘故。如果左手脉盛或者浮，必定是再次感受了风寒；否则就不是温病、热病，而是非时之气导致的暴寒罢了。
The pulse of warm diseases (Wen Bing, febrile diseases caused by warm pathogens), according to predecessors, is often described as the right-side pulse being larger than the left-side pulse. This statement refers specifically to cases where pathogenic heat has reached the Lung and Stomach meridians. I have encountered instances where latent warm disease (Fu Wen, warm pathogens lying dormant in the body) first manifests with pathogenic heat constrained within the Shaoyin (Lesser Yin) meridian, or extending to the Jueyin (Terminal Yin) meridian, resulting in a wiry and rapid pulse appearing at the Guan (Bar) and Chi (Cun) positions on the left wrist, which is quite common. In other cases, the pathogenic mechanism is deeply concealed, constrained and obstructed without reaching the surface; although the clinical manifestations are severe, the pulse may instead appear fine, weak, and lacking in vigor. It is only after the body's righteous qi pushes out the pathogen and transforms it into heat that the pulse gradually becomes floating and firm. This occurs because the Kidney Qi was previously deficient and unable to drive the pathogen outward; thus, the pulse presents this way, indicating that the condition is certainly not mild or superficial. In summary, when latent warm disease emerges externally, it must exit through areas of deficiency in the meridian Qi, having no fixed initial pathway. This aligns with the principle that "wherever pathogenic factors gather, the Zheng Qi (Upright Qi) must be deficient." The *Nan Jing* (Classic of Difficult Issues) states: "Warm pathogens circulate among all meridians, making it unknown which specific meridian is affected." This statement is flexible and apt, best fitting the actual pathology. Since their movement initially lacks a fixed path, and external symptoms lack uniformity, their pulses also lack uniformity. Regarding tongue coating color, it arises only when pathogenic factors steam and constrain within the Stomach, causing turbid Qi to ascend and form the coating. If pathogens lie dormant in Yin meridians and do not involve the Stomach organ, even if the pathogenic heat is intense, no tongue coating will be observed. The tongue body is formed by the condensation of Ying (Nutritive) Qi from the Heart and Spleen; therefore, if there is heat in the Ying level, the base of the tongue will definitely be crimson; if Heart Fire is hyperactive, the tip of the tongue will definitely be red. However, there are occasional cases where pathogens are deeply dormant in the Lower Jiao (Lower Burner), yet the base of the tongue does not show purple-crimson discoloration. When pathogenic heat reaches its peak constraint and suddenly erupts, the pulse changes abruptly from fine and weak to floating, large, wiry, and rapid; the tongue color changes abruptly from pale white to gray-black, dry, and crimson. At this stage, the pathological momentum is like a prairie fire, approaching it is dangerous. To begin seeking rescue at this point, fearing that the blazing pathogenic heat has caused the Zang-Fu organs to wither and rot, even a physician skilled in treating severe head and face sores (a metaphor for experts in critical care) would find it too late. Therefore, when examining patients, one must carefully observe the presenting signs and combine them with tongue and pulse diagnoses to ensure accuracy. If one relies solely on pulse and tongue appearances to determine the cold-heat nature and depth of the disease, many errors will occur. Having years of clinical experience, I firmly know that in the early stages of latent warm disease, especially when the pathogen is extremely deep, the pulse and symptoms often do not correspond well. The reason is that the pathogenic factor lies deeply concealed and is difficult to manifest externally. Physicians can be misled by these deceptive signs, leading to frequent misdiagnoses. I specifically highlight this to help students make prudent judgments.
Zhou Yuzai stated: The pulses of warm diseases and heat diseases may sometimes present as floating and tight. This is due to a secondary exposure to sudden cold from improper environmental factors. Cold pathogens bind the exterior, while heat pathogens accumulate internally; thus, the pulse feels tense externally and surging internally. Alternatively, some physicians fail to recognize pulse qualities; upon seeing a wiry pulse, they mistakenly call it tight and treat it recklessly. Generally, pulses that are vigorous and forceful often accompany a wiry quality; how can one mistake this for a tight pulse and diagnose it as a cold syndrome? The pulses of warm and heat diseases usually reside in the muscle layer rather than being very superficial, and the right-hand pulse is often stronger than the left, indeed due to internal constraint and stagnation. If the left-hand pulse is strong or floating, it indicates a secondary exposure to wind-cold; otherwise, it is not a typical warm or heat disease, but rather sudden cold from abnormal seasonal timing.