原病式曰诸病上下所出水液澄彻清冷下痢清白吐痢腥秽食已不饥坚痞腹满急痛 瘕 疝
屈伸不便厥逆禁固皆属于寒
详见滞下等门
按以上诸论病机多属内中于寒口食生冷所致皆非外感证也因兹所类但以伤寒外感分例然
以上病机亦有标本不同故不复参附详见各门
难经曰伤寒之脉阴阳俱盛而紧涩
伤寒论曰脉阴阳俱紧者名曰伤寒 寸口脉浮而紧浮则为风紧则为寒 浮涩而紧为伤寒
谨按伤寒脉及六经传变本论已详兹不备录惟许学士百证歌第一篇甚得旨要但其中二句讹
舛如
脉浮而缓风伤荣浮紧兼涩寒伤卫正与仲景脉理差别此非许学士之不精盖亦后人传写之误也
许学士云仲景言脉大浮数动滑此名阳也沉涩弱弦微此名阴也脉诀以动脉为阴弦为阳何也
大抵
此兼众脉而合言之也唯伤寒如此杂病各见一脉仲景之意若曰浮大者阳也兼之以动滑数之类安
得不为阳沉细者阴也兼之以涩弦数之类安得不为阴故仲景论动脉则曰阳动则汗出阴动则发热
数脉见于关上上下无头尾如豆大厥厥动摇名曰动也又结胸证云脉浮而动浮则为风动则为痛故
兼数与浮而言动脉则阳脉阳病也宜矣仲景论弦者状如弓弦按之不移弦则为减又曰支饮急弦又
少阴证云手足寒脉弦迟故此兼迟而言弦则为阴证脉也宜矣故仲景伤寒脉不可与杂病脉同日而
语也今阳证往往浮大而厥厥厥动摇其沉细而弦者必阴证也何疑之有哉故知治伤寒当以仲景脉
法为本
脉经曰迟紧为寒 寒则紧弦 涩迟沉细为寒 脉小实而紧者病在内冷 脉沉而细下焦有
寒
脉累累而贯珠不前至有风寒在大肠 脉细小紧急病速进在中寒为疝瘕 寸口脉迟上焦有寒脉
紧寒之实也关脉迟胃中寒尺脉迟涩寒在下焦 弦小者寒癖迟而缓微而紧皆有寒也
《原病式》说：凡是疾病中，上下排出的水液清澈透明、寒冷，下痢颜色清白，呕吐物腥臭污秽，进食后没有饥饿感，腹部坚硬痞块、胀满、急痛，瘕聚、疝气，身体屈伸不便，四肢厥冷僵硬，这些都属于寒证。
详细内容参见“滞下”等章节。
按语：以上各种论述的病机，大多属于内伤于寒邪或食用生冷食物所致，都不是外感证候。因此这里分类时，仅以伤寒外感的分例为例。然而，以上病机也有标本不同的情况，所以不再详细附注，详见各相关章节。
《伤寒论》说：脉象阴阳两部都紧的，名叫伤寒。寸口脉浮而紧，浮代表风邪，紧代表寒邪。脉象浮涩而紧的，是伤寒。
谨按：关于伤寒脉象及六经传变的理论，在本论中已经详细说明，此处不再赘录。只有许学士《百证歌》的第一篇非常得其要领，但其中两句有误。例如：“脉浮而缓，风伤营；浮紧兼涩，寒伤卫。”这与仲景的脉理有差异。这并非许学士不精通，大概是后人传抄时的错误。
许学士说：仲景讲脉大、浮、数、动、滑，这叫阳脉；脉沉、涩、弱、弦、微，这叫阴脉。《脉诀》却将动脉定为阴，弦脉定为阳，为什么呢？
大体上，这是综合多种脉象而言的。唯独伤寒如此，杂病则各自显现一种主要脉象。仲景的本意是说：脉象浮大的属阳，如果兼见动、滑、数等脉，怎么能不认为是阳呢？脉象沉细的属阴，如果兼见涩、弦、数等脉，怎么能不认为是阴呢？所以仲景在论述动脉时说：阳动则汗出，阴动则发热。所谓数脉见于关上，上下无头尾，像豆子一样厥厥动摇，名叫动脉。又在结胸证的论述中说：脉浮而动，浮则为风，动则为痛。所以兼见数与浮而言动脉，则是阳脉主阳病，是适宜的。仲景论述弦脉时说：形状像弓弦，按之不移，弦则代表阳气减损（或正气不足）。又说支饮证脉象急弦。少阴证说：手足寒冷，脉象弦迟。所以这里兼见迟而言弦，则是阴证的脉象，也是适宜的。因此，仲景所论的伤寒脉象不能与杂病的脉象同日而语。如今阳证往往脉象浮大且四肢厥逆、厥厥动摇；脉象沉细而弦的，必定是阴证，有什么可怀疑的呢？所以知道治疗伤寒应当以仲景的脉法为根本。
《脉经》说：脉迟紧为寒。寒邪则致脉紧弦。脉涩、迟、沉、细为寒。脉小实而紧，病在内脏寒冷。脉沉而细，下焦有寒。脉象累累如贯珠而不前移，有风寒在大肠。脉细小紧急，病情迅速进展，在中焦寒邪导致疝瘕。寸口脉迟，上焦有寒。脉紧，是寒邪实证。关脉迟，胃中有寒。尺脉迟涩，寒在下焦。脉弦小，是寒癖；脉迟而缓，脉微而紧，都有寒邪。
The *Yuan Bing Shi* (Treatise on the Original Causes of Disease) states: In all diseases, if the fluids discharged from above or below are clear, transparent, and cold; if dysentery is white and clear; if vomit is fishy and foul; if there is no hunger after eating; if there are hard abdominal masses, fullness, and acute pain; if there are *jia* (masses that move), hernia, difficulty in bending and stretching, cold limbs with rigidity, these all belong to Cold.
For details, please refer to the sections on "Dysentery" and others.
Commentary: The pathogenesis described in the above discussions mostly belongs to internal invasion by Cold or consumption of raw and cold foods, rather than exogenous contraction. Therefore, in this classification, only the examples of Taiyang disease (Exogenous Cold) are cited. However, the pathogenesis mentioned above also varies in its root (*ben*) and branch (*biao*), so further annotations are omitted for brevity; see respective sections for details.
The *Nan Jing* (Classic of Difficult Issues) states: In Taiyang disease, the pulse at the yin and yang positions is both excessive and tight and choppy.
The *Shang Han Lun* (Treatise on Cold Damage) states: When the pulse at both yin and yang positions is tight, it is named Taiyang disease. If the cunkou (radial artery at the wrist) pulse is floating and tight, floating indicates Wind, and tight indicates Cold. A pulse that is floating, choppy, and tight indicates Taiyang disease.
Respectfully noted: The theories regarding Taiyang disease pulses and the transmission through the Six Channels have been detailed in this treatise, so they are not recorded here exhaustively. Only the first chapter of Xu Xueshi’s (*Academician Xu*) *Baizheng Ge* (Song of Hundred Symptoms) captures the essence well, but two lines therein contain errors. For example: "Floating and slow pulse, Wind injures Ying (Nutritive Qi); Floating, tight, and choppy pulse, Cold injures Wei (Defensive Qi)." This differs from Zhongjing’s pulse theory. This is not due to Xu Xueshi’s lack of expertise, but likely a transcription error by later generations.
Xu Xueshi states: Zhongjing says that large, floating, rapid, moving, and slippery pulses are named Yang pulses; sinking, choppy, weak, wiry, and minute pulses are named Yin pulses. The *Mai Jue* (Pulse Rhymes) classifies the Moving pulse as Yin and the Wiry pulse as Yang. Why?
Generally speaking, this refers to a combination of various pulse qualities. Only in Taiyang disease does this occur; in miscellaneous diseases, each presents a single primary pulse quality. Zhongjing’s intent was: If the pulse is floating and large, it is Yang; if accompanied by moving, slippery, or rapid qualities, how could it not be considered Yang? If the pulse is sinking and fine, it is Yin; if accompanied by choppy, wiry, or rapid qualities, how could it not be considered Yin? Therefore, when discussing the Moving pulse, Zhongjing said: Yang movement causes sweating; Yin movement causes fever. The Moving pulse is described as appearing at the guan position, without head or tail, resembling a bean quivering and shaking. Regarding the Chest Bind syndrome, it is stated: "The pulse is floating and moving; floating indicates Wind, moving indicates Pain." Thus, combining rapid and floating qualities to describe the Moving pulse, it is indeed appropriate for a Yang pulse indicating a Yang disease. When discussing the Wiry pulse, Zhongjing said: It resembles a bowstring, unyielding to pressure; "Wiry indicates deficiency/reduction." He also stated that in Phlegm-Fluid retention, the pulse is urgently wiry. In Shaoyin syndrome, he said: "Cold hands and feet, wiry and slow pulse." Thus, combining slowness with wiriness, it is appropriate for a Wiry pulse indicating a Yin syndrome. Therefore, Zhongjing’s discussion of Taiyang disease pulses cannot be compared to those of miscellaneous diseases. Today, Yang syndromes often present with floating and large pulses accompanied by quivering movements; sinking, fine, and wiry pulses must indicate Yin syndromes. Is there any doubt? Hence, we know that treating Taiyang disease should take Zhongjing’s pulse methodology as the foundation.
The *Mai Jing* (Pulse Classic) states: Slow and tight indicates Cold. Cold leads to tight and wiry pulses. Choppy, slow, sinking, and fine pulses indicate Cold. A small, solid, and tight pulse indicates internal cold in the organs. A sinking and fine pulse indicates Cold in the Lower Jiao. A pulse that is continuous like beads strung together but fails to advance indicates Wind-Cold in the Large Intestine. A small, fine, and urgent pulse, progressing rapidly, indicates Cold in the Middle Jiao causing Hernia and Masses. A slow cunkou pulse indicates Cold in the Upper Jiao. A tight pulse indicates Excess Cold. A slow guan pulse indicates Cold in the Stomach. A slow and choppy chi pulse indicates Cold in the Lower Jiao. A wiry and small pulse indicates Cold accumulation (Han Pi); a slow and relaxed pulse, or a minute and tight pulse, all indicate Cold.