洪脉关前热在胸。
洪为阳火。关前所以候胸中者也。关前而见洪脉。则知其热在胸矣。故
前赋中云。胸连胁满只为洪。当参看可也。
按脉经云。寸脉洪大。胸胁满。宜生姜汤。白薇丸亦可。紫菀汤下之。针上
管期门章门。
当关翻胃几千重。
关所以候脾胃者也。关中而见洪脉。是为火邪于胃。攻冲而为呕吐之
证矣。
按脉经云。关洪胃中热。必烦满。宜平胃丸。针胃管。先泻后补之。
更向尺中还若是。小便赤涩脚酸疼。
尺部而见洪脉。则为下焦有火。火旺则小便赤涩。火旺则水衰。水衰则
脚酸疼矣。按至真要大论云。少阴在泉。客胜则腰痛。尻股膝髀 。足
病瞀热以酸。腑肿不能久立。溲便变。此之谓也。
按脉影云。尺脉洪大。小便秘涩。便血脚酸。
洁古曰。八里脉者。乃右手三部。寸关尺受邪者也。阳乘阴也。是微沉缓涩
迟伏濡弱八里脉也。有里之表。乃三阴经络。各称标之名也。有里之里者。
乃三阴之本。脾肾肝总称之名也。且三阴标者。为阴中之阳。本者。为阴中
之阴也。盛则归于胃土。乃邪染有形。故里之表。是阴中之阳。当渍形以为
汗。宜发之。主宜缓。
内经曰。脉长者。为外病。脉短者。为内病。入里之脉。俱短脉也。俱在右手
三部受邪者也。病入于内。为阳邪乘乎阴也。顾有里之里。有里之表。里
之表者。邪在三阴经络中。为三阴之标也。三阴标者。仍是阳邪。尚未入
于胃土。故不可轻下。而当缓散之。若是里之里。阴中之阴也。邪归于胃
土。而染于有形迹之中。下之则愈。盖里之表。渍形以为汗者。身肤渍渍
潮润。乃阳邪在里中之表。本来正汗。非若取汗之证。发越而出者。主宜
缓也。
里之里。是阴中之阴分也。当急下之。客宜急。是知诸中客邪当急。诸主自
病。当缓。前说七表。乃春夏具三阳。后说八里。乃秋冬具三阴。经中论反交
错生疾。得本位以常法治中。互相为病。当推移所在主客。相合脉证。根据缓
急治之。假令恶寒也。里之表也。当与麻黄附子细辛汤缓发之。是渍形以
为汗也。如不恶风寒而反欲去衣。身凉面目赤。四肢逆。数日不大便。小便
赤涩引饮。身静重如山。谵语昏冒。脉沉细而疾数者。是足少阴经反受火
邪。是里之里病。乃阴中之阴。阳邪也。此客邪当速。急下去之。以大承气汤
除之。
里之里者。本中之里也。客邪尽净。里证急矣。故宜急下。凡客邪至于中
者。中在经络之中。虽为表而渐入里矣。尚可缓乎。故宜急表也。诸主自
病者。非外来之病也。五行中相乘相克。互相交变。多见八里脉也。宜分
别脉证。相合与相异治之。有轻重之分。如证宜急。而脉不宜急者。脉宜
急。而证不宜急者。止从缓而不宜急也。缓则能守其和平。急则乃交错
生疾。必当以本位常法治中。当推移所在主客。与相合脉证。根据缓急治
之。是多从脉而不从证也。若是交变互相为病。当分主客脉证。或证当
汗。而脉不可汗。证当下。而脉不可下。或脉可汗。而证不可汗。或证可下。
而脉不可下。互相交变。而又互相推移。主客轻重与缓急之法。如经中
谓渍形以为汗者。用麻黄又兼附子。一以治标。一以治本。是从其缓也。
如不恶风寒。而反欲去衣等证。此是阴中之阳。邪在内矣。宜急治其里。
治其里。是多从证。而不从其脉也。
今将七表脉有下者。八里脉有汗者。七表脉有汗者。八里脉有下者。此四
论为古今之则。于七表脉论。八里脉论内。交五说之。更有脉与证相杂之
法。当取仲景内桂枝脉（里）得麻黄证。（表）麻黄脉得桂枝证。递用麻黄桂枝
各半汤。如桂枝证二停。麻黄脉一停。当用桂枝二麻黄一汤法。或麻黄证
二停。桂枝脉一停。当用麻黄二桂枝一汤法。更有麻黄脉桂枝证。取脉为
主。脉便为二停。证为一停。用麻黄二桂枝一汤法治之。或桂枝脉麻黄证。
亦脉为二停。证作一停。用桂枝二麻黄一汤法治之。大抵圣人谓脉者。司
人之命。故以脉为主。多从脉而少从证也。举世脉证交互二法。是不合全
从于脉。亦不合不从于证。如合证当两取之。如证在交变法中。即合从脉
不从证也。然亦不拘。亦当临时消息。传受递从。元证来理。所投去处。没天
之时令。且七表有下者。为内外皆阳缓下。八里有汗者。为内外皆阴缓汗。
七表有汗者。为外阳而内阴急汗。八里有下者。为外阳而内阴急下。故素
问说标本之化。立四因之法。为此一说也。表里标本之化。七表论内说之。
脉证互参。谓桂枝证得麻黄脉。不宜过用麻黄。必兼以桂枝。勿使麻黄
大泄之意。此为证属阴不足。而脉属阳有余。故用麻黄二。多从脉之意。
桂枝一。少从证之意。不致偏僻之咎。今其阴阳扶抑之法。而太过不及。
自位乎中和之道也。致中和。天地位。万物育。何病之有。
八里脉
洪脉出现在寸口（关前），提示热邪位于胸中。
洪脉属于阳火之象。寸口部位是用来诊察胸中情况的。如果在寸口出现洪脉，就可以知道热邪在胸中。所以前面的赋文中说：“胸部连及胁肋胀满，仅仅是因为洪脉。”应当参考阅读。
根据《脉经》记载：寸脉洪大，伴有胸胁胀满，适宜使用生姜汤；白薇丸也可以使用；或者用紫菀汤攻下。针刺上管穴、期门穴、章门穴。
如果洪脉出现在关部，那是翻胃（反胃）症状重重叠加的表现。
关部是用来诊察脾胃情况的。如果在关部出现洪脉，这是火邪侵犯胃部，冲击导致呕吐的症状。
根据《脉经》记载：关脉洪大表示胃中有热，必然出现烦闷胀满，适宜使用平胃丸。针刺胃管穴，先泻后补。
如果在尺部（关后）也出现这种情况，就会出现小便赤红涩痛、脚部酸痛疼痛。
如果在尺部出现洪脉，说明下焦有火。火旺则小便赤红涩痛；火旺则肾水亏损；肾水亏损则脚部酸痛疼痛。根据《至真要大论》记载：“少阴司天或在泉时，客气胜则腰痛，臀部、大腿、膝盖、髀部不适，足部疾病表现为昏热和酸楚，腹部肿胀不能久立，大小便异常。”说的就是这种情况。
根据《脉影》记载：尺脉洪大，小便秘涩不通，便血，脚部酸痛。
李东垣（洁古）说：所谓的“八里脉”，是指右手三部（寸、关、尺）受到邪气侵袭。这是阳邪乘袭阴位。也就是微、沉、缓、涩、迟、伏、濡、弱这八种属于“里”的脉象。其中有“里之表”，指的是三阴经络，各自称为“标”的名称。有“里之里”，指的是三阴的本脏，脾、肾、肝总称为“本”。而且三阴的“标”，是阴中之阳；“本”，是阴中之阴。当邪气盛时归于胃土，这就变成了邪气沾染有形之物，所以“里之表”是阴中之阳，应当通过浸渍形体来发汗，适宜采用发散的方法，主治宜缓。
《内经》说：脉象长，是外病；脉象短，是内病。入里的脉象，都是短脉。都在右手三部受邪。病邪进入体内，是阳邪乘袭阴位。这里有“里之里”，也有“里之表”。“里之表”的邪气在三阴经络中，是三阴的“标”。三阴的“标”，仍然是阳邪，尚未进入胃土，所以不可以轻易攻下，而应当缓慢疏散它。如果是“里之里”，属于阴中之阴。邪气归于胃土，并沾染在有形迹之中，攻下它就会痊愈。所谓“里之表”，通过浸渍形体来发汗，身体皮肤微微湿润潮润，这是阳邪在里中的表层，本来就是正常的汗出，不像为了取汗而强行发越出来的情况，所以主治宜缓。
“里之里”，是阴中之阴的分野。应当紧急攻下。客邪适宜急治。由此可知，各种外来客邪应当急治，各种自身产生的主病应当缓治。前面所说的“七表”，是春夏具备三阳脉；后面所说的“八里”，是秋冬具备三阴脉。经书中论述了反常交错产生的疾病，得到本位以常规法治疗中间的情况，互相成为疾病，应当推移所在的主气和客气，结合脉证，根据缓急进行治疗。假如恶寒，这是“里之表”，应当给予麻黄附子细辛汤缓慢发汗，这就是浸渍形体来发汗。如果不恶风寒反而想脱去衣服，身体凉但面目发红，四肢厥冷，几天不大便，小便赤红涩痛且引饮，身体静止沉重如山，胡言乱语昏迷，脉象沉细而疾数，这是足少阴经反受火邪，属于“里之里”的病，是阴中之阴，阳邪。这种客邪应当迅速祛除，紧急攻下以去除它，使用大承气汤来清除。
“里之里”，是本脏中的里层。客邪已经净尽，里证危急了，所以适宜紧急攻下。凡是客邪到达中焦的，停留在经络之中，虽然属于表但逐渐入里了，还可以缓治吗？所以适宜急解其表。各种自身产生的主病，不是外来的病，而是五行中相乘相克，互相交变，多见八里脉。应当分别脉证，结合相同与不同之处治疗。有轻重的区分。如证候适宜急治，而脉象不适宜急治的，脉象适宜急治，而证候不适宜急治的，都只从缓而不宜急。缓则能保持平和，急则会导致交错生疾，必须用本位的常法来治理，应当推移所在的主客，结合相合的脉证，根据缓急治疗。这是多从脉而不从证。如果是交变互相为病，应当分主客脉证。或者证候应当发汗，而脉象不可发汗；证候应当攻下，而脉象不可攻下；或者脉象可发汗，而证候不可发汗；或者证候可攻下，而脉象不可攻下。互相交变，而又互相推移。主客轻重与缓急的方法，如经中所说浸渍形体来发汗，使用麻黄又兼用附子，一个治标，一个治本，这是从其缓治。如不恶风寒，反而想脱去衣服等证候，这是阴中之阳，邪气在内了，适宜急治其里。治其里，是多从证而不从其脉。
现在将七表脉中有适用攻下的，八里脉中有适用发汗的，七表脉中有适用发汗的，八里脉中有适用攻下的。这四条论断是古今的准则。在七表脉论、八里脉论内，综合五种说法。更有脉与证混杂的方法，应当取仲景书中的桂枝脉（对应里证）得麻黄证（对应表证），麻黄脉得桂枝证，交替使用麻黄桂枝各半汤。如桂枝证占两份，麻黄脉占一份，应当使用桂枝二麻黄一汤法。或者麻黄证占两份，桂枝脉占一份，应当使用麻黄二桂枝一汤法。更有麻黄脉桂枝证，以脉为主，脉占两份，证占一份，用麻黄二桂枝一汤法治之。或者桂枝脉麻黄证，也是脉占两份，证作一份，用桂枝二麻黄一汤法治之。大抵圣人认为脉是掌管人命的，所以以脉为主，多从脉而少从证。举世流行的脉证交互两种方法，是不完全从于脉，也不完全不从于证。如果符合证候，就两者兼取。如证候在交变法中，就合从脉不从证。然而也不拘泥，应当临时斟酌，传授递进遵循，元证来理，所投药去处，没有固定的天时令。况且七表有适用攻下的，是因为内外皆阳，缓下；八里有适用发汗的，是因为内外皆阴，缓汗；七表有适用发汗的，是因为外阳而内阴，急汗；八里有适用攻下的，是因为外阳而内阴，急下。所以《素问》说标本的变化，确立四因之法，为此一说。表里标本的变化，在七表论内说过。脉证互参，谓桂枝证得麻黄脉，不宜过用麻黄，必须兼以桂枝，不要使麻黄过度泄散的意思。这是因为证属阴不足，而脉属阳有余，所以用麻黄二份，多从脉的意思；桂枝一份，少从证的意思，不致产生偏颇的过错。如今阴阳扶抑的方法，使得太过与不及，自然处于中和之道。达到中和，天地定位，万物化育，有什么疾病呢？
八里脉
The Hong (Surging) pulse appearing at the Cun position (proximal to the Guan) indicates heat in the chest.
Hong is a Yang fire pattern. The Cun position is used to inspect the chest. If a Hong pulse is seen at the Cun, it is known that heat resides in the chest. Therefore, as stated in the preceding Fu text: "Chest extending to hypochondriac fullness is solely due to the Hong pulse." This should be consulted.
According to the *Mai Jing* (Pulse Classic): When the Cun pulse is Hong and large, accompanied by chest and hypochondriac fullness, Shengjiang Tang (Fresh Ginger Decoction) is suitable; Baiwei Wan (Baiwei Pill) may also be used; or Ziwann Tang (Aster Decoction) can be used to purge. Acupuncture points Shangguan, Qimen, and Zhangmen should be needled.
If the Guan pulse flips to Hong, it signifies severe regurgitation (Fanwei).
The Guan position is used to inspect the Spleen and Stomach. If a Hong pulse appears at the Guan, this represents Fire pathogen attacking the Stomach, causing冲 (rushing) leading to vomiting symptoms.
According to the *Mai Jing*: A Guan pulse that is Hong indicates Heat in the Stomach, inevitably causing irritability and fullness. Pingwei Wan (Pingwei Pill) is suitable. Needling Weiguan point, with reducing method first followed by reinforcing method.
Furthermore, if the Chi position also presents thus, there will be dark, scanty, painful urination and soreness/pain in the legs.
If a Hong pulse is seen at the Chi position, it indicates Fire in the Lower Jiao. Excessive Fire leads to dark, scanty, painful urination; Excessive Fire depletes Water; Depleted Water leads to soreness and pain in the legs. According to the *Zhi Zhen Yao Da Lun* (Essential Requirements of the Supreme Truth): "When Shaoyin is in control, if the guest wins, there is lower back pain, discomfort in the buttocks, thighs, knees, and thighs, foot diseases manifesting as dizziness, heat, and sourness, abdominal swelling inability to stand long, and changes in urination and defecation." This refers to such cases.
According to *Mai Ying*: A Chi pulse that is Hong and large, with constipated and difficult urination, bloody stool, and leg soreness.
Jiegu (Li Dongyuan) said: The so-called "Ba Li" (Eight Interior) pulses refer to the three positions (Cun, Guan, Chi) on the right hand being affected by pathogens. This is Yang invading Yin. These are the eight interior pulses: Wei (Fine), Chen (Deep), Huan (Moderate), Se (Choppy), Chi (Slow), Fu (Hidden), Ru (Soggy), Ruo (Weak). Among them, there is "Interior of Exterior," which refers to the Three Yin meridians, each called by its name of "Biao" (Branch/Mark). There is "Interior of Interior," which refers to the roots of the Three Yin, collectively named "Ben" (Root), encompassing Spleen, Kidney, and Liver. Moreover, the Biao of the Three Yin is Yang within Yin; the Ben is Yin within Yin. When excessive, it returns to Earth of the Stomach, becoming pathogen staining有形 (form/substance). Thus, "Interior of Exterior" is Yang within Yin, and one should soak the form to induce sweat, favoring dispersal, with treatment principle being slow/gentle.
The *Nei Jing* (Inner Canon) states: A long pulse indicates external disease; a short pulse indicates internal disease. Pulses entering the interior are all short pulses, affecting the three positions of the right hand. Disease entering the interior is Yang pathogen multiplying upon Yin. Here, there is "Interior of Interior" and "Interior of Exterior." The "Interior of Exterior" has pathogen in the Three Yin meridians, which is the Biao of the Three Yin. The Biao of the Three Yin remains Yang pathogen, not yet entered into Earth of the Stomach, so it cannot be lightly purged but should be slowly dispersed. If it is "Interior of Interior," it is Yin within Yin. Pathogen returns to Earth of the Stomach and stains within tangible traces; purging it will cure it. Regarding "Interior of Exterior," soaking the form to induce sweat results in skin slightly moist and humid, which is Yang pathogen in the exterior layer of the interior, originally normal sweating, not like forcing sweat out through aggressive methods, so the treatment principle is slow.
"Interior of Interior" is the division of Yin within Yin. It should be urgently purged. Guest pathogens suit urgent treatment. From this, we know that various incoming guest pathogens should be treated urgently, while various self-generated main diseases should be treated slowly. The previously mentioned "Qi Biao" (Seven Exterior) corresponds to Spring and Summer possessing Three Yang; the subsequently mentioned "Ba Li" corresponds to Autumn and Winter possessing Three Yin. The classics discuss diseases arising from reverse and交错 (interlaced) patterns. Obtaining the proper position allows treating the middle with standard methods, where they mutually cause disease. One must consider the location of host and guest factors, combine pulse and syndrome, and treat according to urgency and slowness. For example, aversion to cold indicates "Interior of Exterior"; one should administer Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) to slowly induce sweat, which is soaking the form to induce sweat. If there is no aversion to wind/cold but instead a desire to remove clothes, cool body but red face and eyes, cold limbs, no bowel movement for several days, dark scanty painful urination with thirst, body still and heavy as a mountain, delirium and coma, with a deep, fine, rapid pulse, this is the Foot Shaoyin Meridian counter-affected by Fire pathogen, representing "Interior of Interior" disease, Yin within Yin, Yang pathogen. This guest pathogen should be removed quickly by urgently purging it using Dachengqi Tang (Major Order the Qi Decoction).
"Interior of Interior" is the interior of the root. Once guest pathogens are completely cleared, the interior syndrome becomes critical, hence urgent purging is suitable. Whenever guest pathogens reach the Middle, staying within meridians, although initially exterior, they gradually enter the interior; can they be treated slowly? Hence, urgent release of the exterior is suitable. Various self-generated main diseases are not external illnesses but result from mutual multiplication and restriction among the Five Elements, often presenting Ba Li pulses. Pulse and syndrome should be distinguished separately, combining similarities and differences in treatment. There are distinctions of severity. If the syndrome suits urgent treatment but the pulse does not, or the pulse suits urgent treatment but the syndrome does not, one should only follow slowness, not urgency. Slowness maintains harmony; urgency causes interlaced diseases. One must use standard methods of the proper position, considering host and guest factors, combining compatible pulse and syndrome, and treating based on urgency and slowness. This prioritizes pulse over syndrome. If interlaced mutual pathology occurs, distinguish host/guest pulse/syndrome. Or syndrome requires sweating but pulse forbids it; syndrome requires purging but pulse forbids it; or pulse allows sweating but syndrome forbids it; or syndrome allows purging but pulse forbids it. Mutual interlacing and shifting occur. Methods of host/guest severity and urgency, such as soaking the form to induce sweat using Mahuang combined with Fuzi, one treating Biao and one treating Ben, follows slowness. If no aversion to wind/cold but desire to remove clothes etc., this is Yang within Yin, pathogen inside, requiring urgent treatment of the interior. Treating the interior prioritizes syndrome over pulse.
Now, regarding Seven Exterior pulses having applicable purgatives, Eight Interior pulses having applicable diaphoretics, Seven Exterior pulses having applicable diaphoretics, and Eight Interior pulses having applicable purgatives. These four theories are standards of ancient and modern times. Within the Seven Exterior and Eight Interior pulse discussions, five sayings are synthesized. There are also methods of mixing pulse and syndrome. One should refer to Zhang Zhongjing's texts: Gui Zhi pulse (Interior) obtaining Ma Huang syndrome (Exterior), or Ma Huang pulse obtaining Gui Zhi syndrome, alternately using Mahuang Guizhi Ban Tang (Half Ephedra and Cinnamon Twig Decoction). If Gui Zhi syndrome accounts for two parts and Ma Huang pulse for one part, use Guizhi Er Mahuang Yi Tang (Two Parts Cinnamon Twig, One Part Ephedra Decoction) method. Or if Ma Huang syndrome accounts for two parts and Gui Zhi pulse for one part, use Mahuang Er Guizhi Yi Tang (Two Parts Ephedra, One Part Cinnamon Twig Decoction) method. Furthermore, with Ma Huang pulse and Gui Zhi syndrome, taking pulse as primary, pulse accounts for two parts, syndrome for one part, use Mahuang Er Guizhi Yi Tang method. Or Gui Zhi pulse and Ma Huang syndrome, pulse accounts for two parts, syndrome for one part, use Guizhi Er Mahuang Yi Tang method. Generally, sages state that pulse governs life, so pulse is primary, prioritizing pulse over syndrome. The world's interactive methods of pulse and syndrome do not fully follow pulse nor ignore syndrome. If matching syndrome, take both. If syndrome falls within interlaced methods, follow pulse over syndrome. However, do not be rigid; decide temporarily, transmit progressively, understand original syndrome logic, and apply appropriately without fixed seasonal constraints. Moreover, Seven Exterior with purgatives implies exterior-interior both Yang, slow purging; Eight Interior with diaphoretics implies exterior-interior both Yin, slow sweating; Seven Exterior with diaphoretics implies exterior Yang and interior Yin, urgent sweating; Eight Interior with purgatives implies exterior Yang and interior Yin, urgent purging. Thus, *Su Wen* discusses transformation of Biao and Ben, establishing four causes for this theory. Transformation of exterior-interior Biao-Ben is discussed in Seven Exterior theory. Pulse-syndrome mutual reference: Gui Zhi syndrome with Ma Huang pulse should not overuse Mahuang, must combine with Guizhi, preventing Mahuang from excessive draining. This is because syndrome belongs to Yin deficiency and pulse to Yang excess. Hence, use two parts Mahuang (more following pulse) and one part Guizhi (less following syndrome), avoiding bias. Now, the method of supporting/restraining Yin-Yang places excess and deficiency in the Way of Zhonghe (Mean Harmony). Achieving Zhonghe, Heaven and Earth settle, all things nurture. What disease would exist?
Eight Interior pulses