伤。庚与辛俱绝也。今诀所云。浮滑相成者。浮则为风。滑则为痰。风痰上
攻。壅塞气道。去其风痰。则上气自平矣。若微细。则元阳之气衰于下。无
根之气逆于上。欲其救也难矣。
中恶腹胀紧细生。若得浮大命逡巡。
巢元方云。中恶者。是人精神衰弱。为鬼神之气。卒中之也。夫人阴阳顺
理。荣卫调平。神守则强。邪不干正。若将摄失。宜精神衰弱。便中鬼毒之
气。其状卒然心腹刺痛。闷乱犹死。凡卒中恶。腹大而满者。诊其脉紧大
而浮者死。紧细而微者生。又中恶吐血数升。脉沉数细者死。浮焱如疾
者生。脉经云。卒中恶吐血数升。脉沉数细者死。浮大疾快者生。又曰。卒
中恶腹大。四肢满。脉大而缓者生。紧大而浮者死。紧细而微者亦生。愚
按中恶。乃阴邪之气也。夫里阴也。血阴也。先入里而伤血。从其类也。故
经云。中恶吐血数升。脉沉数细者死。受鬼毒之气。阴血既伤。邪气当循
窍而出。今脉反沉细而数。沉细则阴已大伤。数则毒犹在里。故曰死也。
若浮大疾快。邪气已出。而内无遗留。故曰生也。经中又云。卒中恶腹大。
四肢满。脉大而缓者生。紧大而浮者死。紧细而微者亦生。正与此诀相
合。夫中恶而至腹胀。邪已在里。若脉紧细。则毒犹不甚。故曰生。若脉浮
大。则既伤其阴。复戕其阳。安得而不命逡巡也。或难曰。上文既云浮大
疾快者生。又曰。紧大而浮者死。何前后之相违也。不知前所云者。其血
吐则毒瓦斯循窍而外出。故脉宜浮大疾快。后所云者。腹胀四肢满。毒在
里。紧大而浮者死。紧细而微者亦生。紧大而浮。既伤其阴。复伤其阳也。
紧细而微者。阴阳犹不甚也。
金疮血盛虚细活。急疾大数必危身。
凡遇金疮之证。须审去血盛与不盛。如去血不盛。其脉不必定欲虚细
也。张世贤曰。金疮刀刃所伤之疮也。血盛。去血多也。血既出多。脉当虚
细。反得急疾数大。风热乘之。其身之所以危也。
按经云。金疮血出太多。其脉虚细者生。实数大者死。又云。金疮出血。脉
沉小者生。浮大者死。又云。斫疮出血一二石。脉来大二十日死。又云。斫
刺俱有。病多少血出不自止者。七日死。滑细者生。又按金疮一证。最为
切要。如两人相争。其人自刎其颈。性命在于顷刻。两家之存亡系焉。倘
能救活。其功不小。金疮之方最多。求其万全。盖亦鲜矣。庸医无指。每用
活鸡皮敷之。究无一效。后余求得一方。屡试屡验。将药一上。其痛立止。
其血立止。真奇方也。况药品平常易制。如人刎颈气颡已断。将丝线缝
拢。以药末掺之。将软绢围定。不过数次。即能痊活。故不敢闭天之宝。谨
以告诸同人。其方用生松香为末六两。生半夏为末。四两。二共再碾候
用。至于些小金疮。不足论矣。
凡脉尺寸紧数形。又似钗直吐转增。此患蛊毒急须救。速求神药命应停。
按蛊字从虫从皿。是合聚虫蛇之类。以器皿盛之。任其相啖食。余一存
者。名为蛊。能变化为毒害人。有事之者。以毒害人。多因饮食内行之。中
其毒者。其状心痛如被物 。或时面目清黄。变化无常。先伤于膈上。则
吐血。食人五脏。下血瘀黑。如烂鸡肝。如不急治之。食脏腑至尽。则死。诊
其脉尺寸紧数。是其候也。旦起取井花水未食前当令病患唾水内。唾
如柱脚直下沉者。是蛊毒。沉散不至下者。是草毒。治之之法。如败鼓皮、
石榴皮、苦瓠瓤、胡荽根、车辖脂、刺 皮、牡丹根、胡荽子、蚯蚓之类。按方
治之。或有生者。张世贤释谓钗直如转索。肝气盛也。吐转增。脾气衰也。
木盛则脾绝。其死定无疑。其说恐亦未当。
按经云。三部脉坚而数。如银钗股。蛊毒病必死。数而软。蛊毒病得之生。
中毒洪大脉应生。细微之脉必危倾。吐血但出不能止。命应难返没痊平。
熊宗立将此诀连属上文。非也。上四句言中蛊毒。此四句言中饮食药
饵之毒。其意盖曰。凡中毒者。其脉若洪大。则本人之元气。尚能胜毒。故
曰生脉。若沉细。则本人之元气。不能胜毒。故曰危也。若吐血不止。则不
论脉之洪大沉细。即当以死断之。何也。心为君。其主血脉。毒虽中而未
见血。则毒在肠胃。其毒尚缓。或吐或下而解矣。若吐血不止。则毒直犯
心君。则其死必矣。戴氏谓他证失血。皆以沉细为生。惟中毒吐血。以洪
大为生。其误甚矣。（按经云。人为百药所中伤。脉浮涩而疾者生。微
细者死。洪大而迟者生。）
损伤。庚金与辛金之气俱绝也。现今歌诀中所说的，浮脉与滑脉相兼成的情况。浮脉主风邪，滑脉主痰饮。风邪与痰饮向上攻冲，壅塞气道。祛除风邪和痰饮，那么上逆的气机自然平息。如果脉象微细，则是元阳之气在下衰竭，无根之气在上逆乱，想要救治就困难了。
中恶导致腹胀，脉象紧细则生，若得浮大脉象则生命危在旦夕。
巢元方说：所谓中恶，是因为人的精神衰弱，被鬼神之类的气突然侵袭所致。人如果阴阳顺理，营卫调和平衡，神志守持则身体强健，邪气不能侵犯正气。如果调摄失当，适宜于精神衰弱，就会中受鬼毒之气。其症状是突然心腹刺痛，烦闷扰乱如同将死之人。凡是突然中恶，腹部胀大满实的，诊察其脉象紧大而浮的预后不良（死），紧细而微的预后良好（生）。另外，中恶吐血数升，脉象沉数细的预后不良（死），浮大且快的预后良好（生）。《脉经》说：突然中恶吐血数升，脉象沉数细的预后不良（死），浮大疾快的预后良好（生）。又说：突然中恶腹部胀大，四肢胀满，脉象大而缓的预后良好（生），紧大而浮的预后不良（死），紧细而微的也预后良好（生）。我按语认为中恶，是阴邪之气。里属阴，血属阴，邪气先入里而伤血，这是同类相从的缘故。所以经文说：中恶吐血数升，脉象沉数细的预后不良（死）。受了鬼毒之气，阴血既然受伤，邪气应当顺着孔窍排出。现在脉象反而沉细而数，沉细则说明阴气已大伤，数则说明毒邪仍在里，所以说预后不良（死）。如果是浮大疾快，说明邪气已经外出，而内部没有遗留，所以说预后良好（生）。经文中又说：突然中恶腹部胀大，四肢胀满，脉象大而缓的预后良好（生），紧大而浮的预后不良（死），紧细而微的也预后良好（生）。这正与此歌诀相符合。中恶到了腹胀的程度，邪气已经在里，如果脉象紧细，则毒邪尚不严重，所以说预后良好（生）。如果脉象浮大，则既伤了阴，又伤害了阳，怎么能不生命危在旦夕呢？有人辩难道：上文既然说浮大疾快者生，又说紧大而浮者死，为什么前后矛盾呢？不知道前面所说的，是指吐血则毒瓦斯顺着孔窍向外排出，所以脉象宜见浮大疾快；后面所说的，是指腹胀四肢满，毒邪在里，紧大而浮的预后不良（死），紧细而微的预后良好（生）。紧大而浮，既伤了阴，又伤了阳；紧细而微，阴阳尚且不甚受损。
金疮出血多，脉象虚细则活，急疾大数必危及生命。
凡是遇到金疮的证候，必须审察去血多与不多。如果去血不多，其脉象不一定非要虚细不可。张世贤说：金疮是刀刃所伤的疮。血盛，指去血多。血既出得多，脉象应当虚细，反而得到急疾数大的脉象，是风热乘虚而入，所以身体危险。
按经文说：金疮出血太多，脉象虚细的预后良好（生），实数大的预后不良（死）。又说：金疮出血，脉象沉小的预后良好（生），浮大的预后不良（死）。又说：砍伤出血一二石，脉来大的二十天死。又说：砍刺都有，病多少血出不止的，七天死，脉象滑细的预后良好（生）。我又按语认为金疮一证，最为切要。如两人相争，那人自刎其颈，性命在于顷刻之间，两家之存亡系于此。如果能救活，功劳不小。金疮的方子最多，求其万全的，大概很少。庸医没有指针，每用活鸡皮敷在上面，终究没有一种有效。后来我求得一方，屡试屡验，将药一上，疼痛立即停止，出血立即停止，真是奇方啊。况且药品平常容易制作，如人刎颈气喉已断，用丝线缝合拢，将药末掺入，用软绢围定，不过数次，就能痊愈存活。所以不敢闭藏上天之宝，恭敬地告诉各位同仁。其方用生松香为末六两，生半夏为末四两，二者再共同碾碎备用。至于些小金疮，就不必说了。
凡脉象尺寸部紧数形态，又似钗股直硬，呕吐转增。此患蛊毒急需救治，速求神药命应停止（死亡）。
按“蛊”字从虫从皿，是合聚虫蛇之类，以器皿盛放，任其相互啖食，剩下一只存活的，名为蛊。能变化为毒害人。有事奉蛊的人，用毒害人，多因饮食内行之。中其毒者，其症状心痛如被物击打，有时面目清黄，变化无常。先伤于膈上，则吐血，食人五脏，下血瘀黑，如烂鸡肝。如不急救治它，食尽脏腑则死。诊察其脉象尺寸部紧数，是其征候。早晨取井花水，未进食前应当让病患唾水在内，唾沫如柱脚直下沉的，是蛊毒；沉散不至下的，是草毒。治疗的方法，如败鼓皮、石榴皮、苦瓠瓤、胡荽根、车辖脂、刺蒺藜皮、牡丹根、胡荽子、蚯蚓之类，按方治疗。或许有活的。张世贤解释谓钗直如转索，是肝气盛；吐转增，是脾气衰。木盛则脾绝，其死定无疑。他的说法恐怕也不恰当。
按经文说：三部脉坚而数，如银钗股，蛊毒病必死；数而软，蛊毒病得之生。
中毒洪大脉象应生，细微之脉必危倾。吐血但出不能止，命应难返没痊平。
熊宗立将此诀连属上文，是不对的。上四句言中蛊毒，此四句言中饮食药饵之毒。其意大概是说：凡中毒者，其脉若洪大，则本人的元气，尚能胜毒，所以说生脉；若沉细，则本人的元气，不能胜毒，所以说危也。如果吐血不止，则不论脉之洪大沉细，即当以死断之。为什么呢？心为君，其主血脉，毒虽中而未看见血，则毒在肠胃，其毒尚缓，或吐或下而解了。如果吐血不止，则毒直接犯心君，则其死必矣。戴氏说他证失血，皆以沉细为生，惟中毒吐血，以洪大为生，错误很大。（按经文说：人为百药所中伤，脉浮涩而疾者生，微细者死，洪大而迟者生。）
Injury. The Qi of Geng Metal and Xin Metal are both exhausted. What the current rhyme says, "when floating and slippery pulses combine," indicates that a floating pulse signifies Wind, and a slippery pulse signifies Phlegm. When Wind and Phlegm attack upwards, obstructing the airway, removing the Wind and Phlegm will naturally calm the rebellious Qi. If the pulse is fine and minute (Wei Xi), it means the Yuan Yang Qi is depleted below, and rootless Qi rebels above; saving such a case would be difficult.
Malignant Qi invasion causing abdominal distension: a tight and fine pulse indicates survival; if a floating and large pulse appears, life is in imminent danger.
Chao Yuanfang stated: Malignant Qi invasion occurs when a person's spirit is weak and is suddenly attacked by demonic or ghostly Qi. When Yin and Yang are harmonious, Ying and Wei (Nutritive and Defensive Qi) are balanced, and the Spirit remains guarded, the body is strong, and pathogenic factors cannot invade healthy Qi. However, if care is neglected leading to spiritual weakness, one may be struck by toxic Qi from ghosts or poisons. The symptoms include sudden stabbing pain in the heart and abdomen, severe confusion resembling death. In cases of sudden malignant Qi invasion with abdominal distension and fullness, if the pulse is tight, large, and floating, the prognosis is poor (death); if it is tight, fine, and minute, the prognosis is good (survival). Additionally, in malignant Qi invasion with several shengs of hematemesis, a deep, rapid, and fine pulse indicates poor prognosis (death), while a floating, large, and rapid pulse indicates good prognosis (survival). *Mai Jing* states: In sudden malignant Qi invasion with several shengs of hematemesis, a deep, rapid, and fine pulse indicates poor prognosis (death), while a floating, large, and rapid pulse indicates good prognosis (survival). It also states: In sudden malignant Qi invasion with abdominal distension and fullness of the four limbs, a large and slow pulse indicates survival; a tight, large, and floating pulse indicates death; a tight, fine, and minute pulse also indicates survival. My commentary suggests that malignant Qi invasion involves Yin pathogenic Qi. The interior belongs to Yin, and Blood belongs to Yin; the pathogen enters the interior first and damages Blood, following the principle of like attracting like. Thus, the classics state: In malignant Qi invasion with several shengs of hematemesis, a deep, rapid, and fine pulse indicates poor prognosis (death). Having received demonic toxic Qi, once Yin Blood is damaged, the pathogen should exit through the orifices. However, if the pulse is instead deep, fine, and rapid, it indicates that Yin is severely damaged (deep and fine) and the toxin remains inside (rapid), hence the prognosis is poor (death). If the pulse is floating, large, and rapid, it indicates the pathogen has exited and no residue remains internally, hence the prognosis is good (survival). The classics further state: In sudden malignant Qi invasion with abdominal distension and fullness of the four limbs, a large and slow pulse indicates survival; a tight, large, and floating pulse indicates death; a tight, fine, and minute pulse also indicates survival. This aligns perfectly with this rhyme. When malignant Qi invasion leads to abdominal distension, the pathogen is already in the interior. If the pulse is tight and fine, the toxin is not severe, hence survival. If the pulse is floating and large, it damages both Yin and Yang, leading to imminent danger. One might ask: The text previously stated that a floating, large, and rapid pulse indicates survival, but later said a tight, large, and floating pulse indicates death. Why the contradiction? The former refers to hematemesis where toxic vapors exit via orifices, so a floating, large, and rapid pulse is appropriate. The latter refers to abdominal distension and limb fullness where the toxin is internal; here, a tight, large, and floating pulse indicates damage to both Yin and Yang (death), whereas a tight, fine, and minute pulse indicates Yin and Yang are not severely compromised (survival).
Metal wounds with excessive bleeding: a void and fine pulse indicates survival; an urgent, rapid, large, and numerous pulse endangers life.
In cases of metal wounds, one must assess whether blood loss is excessive. If blood loss is not excessive, the pulse need not necessarily be void and fine. Zhang Shixian stated: Metal wounds are injuries caused by blades. "Excessive blood" refers to significant blood loss. After significant blood loss, the pulse should be void and fine. If it instead becomes urgent, rapid, large, and numerous, it indicates Wind-Heat invading due to deficiency, endangering the body.
According to the classics: In metal wounds with excessive bleeding, a void and fine pulse indicates survival, while a solid, rapid, and large pulse indicates death. Also: In metal wound bleeding, a deep and small pulse indicates survival, while a floating and large pulse indicates death. Also: For chop wounds losing one or two shengs of blood, a large pulse predicts death within twenty days. Also: For combined chop and stab wounds with continuous bleeding, death occurs within seven days; however, a slippery and fine pulse indicates survival. I further note that metal wounds are critical. Consider two people fighting, one cutting their own throat; life hangs in the balance. Saving them brings great merit. There are many formulas for metal wounds, but few guarantee complete safety. Quack doctors, lacking guidance, often apply live chicken skin, which is ineffective. I later obtained a formula that proved effective repeatedly: applying the medicine stops pain and bleeding immediately. It is a miraculous formula using common, easy-to-make ingredients. For example, if someone cuts their throat severing the windpipe, suture it with silk thread, apply the powder, wrap with soft silk, and they can recover after a few applications. I dare not hoard this heavenly treasure and share it with colleagues. The formula uses six liang of raw Pine Resin powder and four liang of raw Pinellia Rhizome powder, ground together again for use. Minor metal wounds need not be discussed.
When the Cun and Chi pulses are tight and numerous, resembling a straight hairpin, and vomiting increases. This Gu Poison requires urgent rescue; seeking divine medicine may stop death.
The character "Gu" consists of "insect" and "vessel," referring to collecting insects and snakes in a vessel to let them devour each other until only one survives, named Gu. It transforms into poison to harm humans. Those who practice Gu use it to harm others, often through food or drink. Victims suffer heart pain as if struck, sometimes with clear-yellow complexion changes. The poison first affects the upper Jiao, causing hematemesis, then consumes the five Zang organs, resulting in dark, clotted lower blood resembling rotten chicken liver. Without urgent treatment, consumption of all Zang organs leads to death. Diagnosis shows tight and numerous pulses at Cun and Chi positions. In the morning, before eating, have the patient spit into well water. If the saliva sinks straight down like a pillar, it is Gu Poison; if it scatters and does not sink, it is Grass Poison. Treatments include Decayed Drum Bark, Pomegranate Bark, Bitter Bottle Gourd Rind, Coriander Root, Axle Grease, Tribulus Fruit Skin, Tree Peony Root, Coriander Seed, Earthworms, etc., prescribed according to the formula. Some may survive. Zhang Shixian interpreted "hairpin straight" as resembling a turning cord, indicating Liver Qi excess; "vomiting increases" indicates Spleen Qi decline. Wood excess leads to Spleen extinction, ensuring death. This interpretation is likely incorrect.
The classics state: If the three positions' pulses are firm and numerous, like a silver hairpin, Gu Poison is fatal; if numerous and soft, Gu Poison allows survival.
Poisoning with a洪大 (Surging-Large) pulse indicates survival; a fine and minute pulse indicates peril. Unstoppable hematemesis means life cannot return, recovery is impossible.
Xiong Zongli incorrectly linked this verse to the previous one. The first four lines discuss Gu Poison; these four lines discuss poisoning from food or herbs. The meaning is: In general poisoning, if the pulse is Surging-Large, the patient's Yuan Qi can still overcome the toxin, indicating survival. If deep and fine, Yuan Qi cannot overcome the toxin, indicating peril. If hematemesis is unstoppable, regardless of whether the pulse is Surging-Large or deep/fine, the prognosis is death. Why? The Heart is the Sovereign, governing Blood vessels. If poisoned but without visible blood, the toxin is in the Stomach and Intestines, relatively mild, resolvable via vomiting or purging. If hematemesis is unstoppable, the toxin directly attacks the Heart Sovereign, ensuring death. Dai Shi claimed that for other conditions involving blood loss, a deep/fine pulse indicates survival, but for poisoned hematemesis, a Surging-Large pulse indicates survival; this is a significant error. (Note: The classics state: For poisoning by various medicines, a floating, choppy, and rapid pulse indicates survival; a fine and minute pulse indicates death; a Surging-Large and slow pulse indicates survival.)