脉濡而弱，弱反在关，濡反在巅，微反在上，涩反在下，微则阳气不足，涩则无血。阳气反微，中风汗出，
而反躁烦；涩则无血，厥而且寒，阳微发汗，躁不得眠。
【注】浮而无力，濡脉也。沉而无力，弱脉也。浮中沉俱无力，似有似无，微脉也。滞而不流利，涩脉也。
巅谓浮也，上谓寸也，下谓尺也。脉濡而弱，弱反在关，濡反在巅，微反在上，涩反在下，谓关脉浮濡沉弱。
寸脉微，尺脉涩，阳虚则寸脉微，血少则尺脉涩。此阳虚血少，不可汗之脉也。阳虚当汗出恶寒，血少当心烦
发热。此阳虚血少，不可汗之证也。若误认为太阳中风而发其汗，必致阴阳相失而两亡，则反烦躁不眠，厥而
且寒矣。
脉濡而弱，弱反在关，濡反在巅，弦反在上，微反在下。弦为阳运，微为阴寒，上实下虚，意欲得温，微
弦为虚，不可发汗，发汗则寒粟，不能自还。
【注】此谓关脉浮濡沉弱，寸脉弦，尺脉微也。弦为少阳热邪之诊，微为少阴寒邪之诊，故曰上实下虚也。
然微弦同见，虚实未审，惟察其人意欲得温，则非恶寒在表，而是畏寒在里也，故不可发汗。若误发其汗，则
阴愈盛而生寒栗，阳愈衰而不能自还矣。
诸脉得数动微弱者，不可发汗；发汗则大便难，腹中干，胃燥而烦。其形相像，根本异源。
【注】凡诸病得数动脉者，有余诊也，可发汗，若按之微弱者，是外假实而内真虚也，不可发汗。若误发
其汗，伤其津液，则腹中干，大便难，胃燥而烦，其形似胃实热结之阳明，究其根本，实由发虚家汗，致成津
枯虚燥之阳明也。故曰∶其形相像，根本异源也。
【集注】程知曰∶动数为热，微弱为虚，发汗动津液，则便难腹干，胃燥而烦。此与阳明里热之证。虽曰
其形相似，而根本则有虚实之不同也。
张志聪曰∶数动阳脉也，微弱阴脉也。诸脉得动数微弱者，犹言左右三部，或得动数之脉而按之微弱者，
皆不可发汗。发汗则津液内竭，故大便难；水气外泄，故腹中干；火热上蒸，故胃燥而烦。其形相像者，汗后
而燥证相同也。根本异源者，动数之脉属乎阳，微弱之脉属乎阴，有阴、有阳、有虚、有实也。
厥，脉紧，不可发汗；发汗则声乱咽嘶，舌萎声不得前。
【注】可发汗之脉，必阴阳俱紧，今厥而脉紧，乃少阴之紧，非太阳之紧也。若发其汗，则伤少阴之气，
声乱咽嘶，舌萎声不得前之证作矣。
【集注】成无己曰∶厥而脉紧，则少阴伤寒也。法当温里，而反发汗，则损少阴之气。其脉不能入肺中，
循喉咙挟舌本，故声乱咽嘶，舌萎声微，言语不得高也。
魏荔彤曰∶此段就厥证论脉，知阳虚禁汗，因明诸逆发汗之贻误也。厥也，凡厥有冷厥、热厥、蛔厥、寒
热相胜之厥。但见紧脉，无论何厥，病皆在阴。若发汗反攻其阳，则气散血竭。夫舌根于肾，声出于肺，声乱
咽嘶，肺气欲绝也。舌萎，即萎不为用也。声不得前，本气不振也。皆由于发汗，散亡其
肾肺二脏真气也。
动气在右，不可发汗，发汗则衄而渴，心苦烦，饮即吐水。动气在左，不可发汗，发汗则头眩，汗不止，
筋惕肉 。动气在上，不可发汗，发汗则气上冲，正在心端。动气在下，不可发汗，发汗则无汗，心中大烦，
骨节苦痛，目晕恶寒，食则反吐，谷不得前。
【注】动气者，筑筑然气跳动也。脐之上下左右，四脏之位也。四脏之气，不安其位故动也。缘素为客
邪所据，本脏之气，已失其守，尚赖中州胃气为主，即有表邪，不可发汗，恐胃中之气液两伤，本脏失养，则
所不胜之邪，因而同病也。动气在右，肺气不治，心不恒德。若误汗之，则心气愈热，血脉沸腾，故衄而渴、
苦烦也；肺失治节，不能通调水道，故饮即吐水也。动气在左，肝气不治，肺不恒德。若误汗之，则肝虚失升，
故头眩也；若汗出不止，津液失养筋肉，故惕 也。动气在上，心气不治，肾不恒德。若误汗之，则心气虚，
故肾气上冲，正在心端也。动气在下，肾气不治，脾不恒德。若误汗之，肾水虚竭，故骨痛、恶寒无汗，心烦
目晕也；脾土过燥，不守常化，故食则反吐，谷不得近也。
【集注】程知曰∶此言动气不可发汗也。盖正气内虚，脏气不治，故气筑筑然动。动气为里虚，故不可发汗。
程应旄曰∶脏气不安其位，故动。原素有邪据，本脏之气，反在根据附之间，最易离经，所恃奠定之者，
全赖胃气为之主。发汗虚其胃气，则四脏失所养，反被邪攻，各见离经之象，病虽左右上下之不同，要其失于
建中之义则一也。
咽中闭塞，不可发汗；发汗则吐血，气微绝，手足厥冷，欲得蜷卧，不能自温。
【注】少阴之脉，循喉咙系舌本，咽中闭塞，少阴之气不能上通也。若强发少阴汗，阳微不能作汗，必
动其血，故吐血，气微绝，蜷卧厥冷，不能自温也。
【集注】程知曰∶咽中闭塞，不可发汗，盖阴邪盛也，强发其汗，必动其血。至于吐血、气欲绝，则并肾
中之微阳不能自存，故遂手足厥冷，欲得蜷卧，不能自温。夫下厥上竭，蜷卧厥冷，在少阴皆危证也。
程应旄曰∶汗剂为阳，施于阴经则逆。咽中闭塞，由少阴液少，肾气不能上通也。发少阴汗，则下厥上竭，
故见证如此。
咳者则剧，数吐涎沫，咽中必干，小便不利，心中饥烦， 时而发，其形似疟，有寒无热，虚而寒栗。咳
而发汗，蜷而苦满，腹中复坚。
【注】咳者则剧，咳之甚也。数吐涎沫，肺伤液耗矣。故咽干、小便不利，心中饥烦也。 时，周时也，
谓周时一发。其形似疟，有寒无热，中虚而生寒栗也。若误以为形寒之咳而发其汗，则肺气既虚而卫阳又亡，
阳气两伤，不能温及中下，阴气凝于内外，自蜷而苦满，腹中复坚矣。
【集注】程知曰∶此承上言濡弱弦微之脉，其有咳者，则病剧，而不可汗也。咳则数吐涎沫，其咽中必干，小
便必不利；膈中阳虚，必心中饥而烦。卫气一日夜五十度周于身，阳虚不能自卫，故 时寒栗如疟，但有寒无热。
此而发汗，则阳气愈虚阴寒益盛，必蜷而苦满，腹中转坚也。
咳而小便利，若失小便者，不可发汗，汗出则四肢厥而逆。
【注】咳多饮病，小便应不利，若小便利，知无饮也。今咳而遗失小便，是不但无饮，且系下焦阳虚，
膀胱不固之咳也。故不可发汗，汗出则阳气愈衰，四肢逆冷矣。
【集注】程知曰∶《内经》谓肾咳不已，膀胱受之，膀胱咳状，咳而遗尿，故咳而小便利。若失小便者，
是肾中阳虚也，发汗则阳
气益亡，故厥冷。
诸逆发汗，病微者难瘥；剧者言乱，目眩者死，命将难全。
【注】不当汗而汗，当汗而过汗，皆致逆，故曰∶诸逆也。发汗致逆之病，病微者难瘥，病剧者则死。剧
者，谓阳脱见鬼则言乱，阴脱目盲则目眩也。
【集注】程应旄曰∶诸逆属少阴居多，阴寒极矣。发汗是重夺其阳，虽有微剧不同，皆关于死，明乎阳为
人命之根也。
伤寒头痛，翕翕发热，形象中风，常微汗出，自呕者，下之益烦，心懊 如饥；发汗则致痉，身强难以屈
伸；熏之则发黄，不得小便；灸则发咳唾。
【注】头痛翕翕发热，汗出则呕，形相中风者，当以桂枝汤解肌。若下之，重则变结胸痞硬，轻则为心中
益烦、懊 如饥。不以桂枝汤解肌，而以麻黄汤发汗，表虚风入则致痉，故身强难以屈伸也。或以火熏蒸劫汗，
则不得小便，热从湿化而发黄也。灸则火邪伤肺，故发咳唾不已也。
【集注】成无己曰∶若反下之，邪热乘虚流于胸中为虚烦，心中懊 如饥。若发汗则虚表，热归经络，热
甚生风，故身强直而成痉。若熏之则火热相合，消烁津液，故小便不利而发黄。肺恶火，灸则火热伤肺，必发
嗽而咳唾也。
高士宗曰∶汗下火熏，施治各异，损正则一，故举下之、熏之，与发汗而并论之也。
魏荔彤曰∶此申明虽有表证宜汗，亦当详察知禁也。似中风头痛，翕翕发热，桂枝证也，呕则仍是水饮内
蓄矣。误下益烦，懊 如饥，则未下时已烦可知，此特更甚耳。若再误汗，表虚风入，故身强难以屈伸，火熏
逼汗，热入于里，故小便不得。盖小便利者不成黄证，发黄则小便为湿邪所阻，热邪所耗可知。灸则热上冲，
故咳唾脓血也。
【原文】脉象濡软而细弱，弱脉反而出现在关部，濡脉反而出现在浮取（巅），微脉反而出现在寸部（上），涩脉反而出现在尺部（下）。阳气微弱则说明阳气不足，脉涩则说明无血。阳气反而微弱，中风后出汗，反而出现躁动烦乱；脉涩则无血，四肢厥冷而且发寒，对阳气微弱的情况误用发汗法，会导致躁动且无法入睡。
【注】浮取而无力，是濡脉。沉取而无力，是弱脉。浮、中、沉三部都无力，似有似无，是微脉。滞涩而不流利，是涩脉。“巅”指浮取，“上”指寸口，“下”指尺部。所谓“脉濡而弱，弱反在关，濡反在巅，微反在上，涩反在下”，是指关脉浮取濡软、沉取细弱；寸脉微，尺脉涩。阳虚则寸脉微，血少则尺脉涩。这是阳虚血少，不可使用发汗法的脉象。阳虚应当表现为出汗、恶寒，血少应当表现为心烦、发热。这是阳虚血少，不可使用发汗法的证候。如果错误地认为是太阳中风证而使用发汗法，必然导致阴阳两伤而亡失，从而反而出现烦躁不眠，四肢厥冷而且发寒的症状。
【原文】脉象濡软而细弱，弱脉反而出现在关部，濡脉反而出现在浮取，弦脉反而出现在寸部（上），微脉反而出现在尺部（下）。弦脉主阳气运行（此处指少阳热邪或气机郁滞），微脉主阴寒，上部实下部虚，患者想要温暖，脉象微弦属于虚证，不可发汗，发汗则会出现寒战，身体不能恢复。
【注】这是指关脉浮取濡软、沉取细弱，寸脉弦，尺脉微。弦脉是少阳热邪的脉象，微脉是少阴寒邪的脉象，所以说上部实下部虚。然而微脉和弦脉同时出现，虚实难以判断，只有观察患者是否想要温暖，如果不是表证的恶寒，而是里证的畏寒，所以不可发汗。如果错误地发汗，则阴气更盛而生寒战，阳气更衰而不能自我恢复。
【原文】各种脉象如果出现数动而微弱者，不可发汗；发汗则导致大便困难，腹中干燥，胃燥而烦。其症状形态相似，但根本原因不同。
【注】凡是各种疾病出现数动脉，是有余的脉象，可以发汗，如果按之感觉微弱，这是外假实而内真虚，不可发汗。如果错误地发汗，损伤津液，则腹中干燥，大便困难，胃燥而烦。其症状看似阳明腑实热结，究其根本，实际上是由发汗损伤虚人所致，形成津枯虚燥的阳明证。所以说：其形态相似，根本来源不同。
【集注】程知说：动数为热，微弱为虚，发汗扰动津液，则导致便难、腹干、胃燥而烦。这与阳明里热证相比，虽然形态相似，但根本有虚实不同。
张志聪说：数动是阳脉，微弱是阴脉。各种脉象出现动数而微弱，意思是左右三部，或者出现动数的脉象但按之微弱，都不可发汗。发汗则津液内竭，所以大便困难；水气外泄，所以腹中干燥；火热上蒸，所以胃燥而烦。其形态相似，是指发汗后燥证相同。根本来源不同，是指动数之脉属阳，微弱之脉属阴，有阴、有阳、有虚、有实。
【原文】四肢厥冷，脉紧，不可发汗；发汗则声音混乱、咽喉嘶哑，舌体萎软、声音发不出。
【注】可以发汗的脉象，必须是阴阳俱紧（指太阳伤寒），现在四肢厥冷而脉紧，这是少阴病的紧脉，不是太阳病的紧脉。如果发汗，则损伤少阴之气，导致声音混乱、咽喉嘶哑、舌体萎软、声音发不出等症状出现。
【集注】成无己说：四肢厥冷而脉紧，则是少阴伤寒。治法应当温里，反而发汗，则损伤少阴之气。脉气不能入肺，循喉咙挟持舌本，所以声音混乱、咽喉嘶哑、舌体萎软、声音微弱，言语不能高声。
魏荔彤说：这段论述厥证的脉象，知道阳虚禁止发汗，从而阐明各种逆治发汗造成的贻误。厥证，凡厥有冷厥、热厥、蛔厥、寒热相胜之厥。只要见到紧脉，无论何种厥证，病都在阴经。如果发汗反攻其阳，则气散血竭。舌根于肾，声音出于肺，声音混乱、咽喉嘶哑，是肺气欲绝的表现。舌萎，即萎缩无用。声音发不出，是本气不振。这都是由于发汗，散亡了肾肺二脏的真气。
【原文】脐右动气，不可发汗，发汗则鼻衄且口渴，心中苦烦，喝水即吐。脐左动气，不可发汗，发汗则头晕目眩，汗出不止，筋肉跳动。脐上动气，不可发汗，发汗则气上冲，正在心窝处。脐下动气，不可发汗，发汗则无汗，心中大烦，骨节痛苦，头晕怕冷，进食反而呕吐，食物不能下行。
【注】动气，是指腹部筑筑然跳动的感觉。脐的上下左右，对应四脏的位置。四脏之气，不安守其位所以跳动。因为素来被客邪占据，本脏之气，已经失去守御，尚依赖中焦胃气为主宰，即使有表邪，也不可发汗，恐怕胃中的气液两伤，本脏失去滋养，那么所不胜之邪，就会随之发病。动气在右，肺气不治，心不恒德。如果误用发汗，则心气更热，血脉沸腾，所以鼻衄且口渴、心中苦烦；肺失治节，不能通调水道，所以喝水即吐。动气在左，肝气不治，肺不恒德。如果误用发汗，则肝虚失升，所以头晕目眩；如果汗出不止，津液失养筋肉，所以筋肉跳动。动气在上，心气不治，肾不恒德。如果误用发汗，则心气虚，所以肾气上冲，正在心窝处。动气在下，肾气不治，脾不恒德。如果误用发汗，肾水虚竭，所以骨痛、恶寒无汗、心烦目晕；脾土过燥，不守常化，所以进食反而呕吐，食物不能近受。
【集注】程知说：这说的是动气不可发汗。正气内虚，脏气不治，所以气筑筑然跳动。动气为里虚，所以不可发汗。
程应旄说：脏气不安守其位，所以跳动。原本素有邪气占据，本脏之气，反而依附在根据之间，最容易离经，所依赖奠定的是全赖胃气为主宰。发汗耗虚胃气，则四脏失去滋养，反而被邪气攻击，各自出现离经的现象，病虽在左右上下不同，但其违背建中之义则是一样的。
【原文】咽喉闭塞，不可发汗；发汗则吐血，气息微弱将绝，手足厥冷，想要蜷缩卧倒，不能自我温暖。
【注】少阴经脉，循喉咙系舌本，咽喉闭塞，是少阴之气不能上通。如果强行发少阴汗，阳微不能作汗，必动其血，所以吐血，气息微弱将绝，蜷卧厥冷，不能自我温暖。
【集注】程知说：咽喉闭塞，不可发汗，盖因阴邪盛也，强行发汗，必动其血。至于吐血、气欲绝，则连肾中的微阳也不能自存，所以于是手足厥冷，想要蜷缩卧倒，不能自我温暖。下厥上竭，蜷卧厥冷，在少阴都是危重证候。
程应旄说：汗剂为阳，施用于阴经则逆。咽喉闭塞，由少阴液少，肾气不能上通所致。发少阴汗，则下厥上竭，所以见证如此。
【原文】咳嗽剧烈，频繁吐涎沫，咽喉必定干燥，小便不利，心中饥烦，时而发作，其形态类似疟疾，只有寒战没有发热，虚而寒战。咳嗽而发汗，蜷缩而苦于胀满，腹中又坚硬。
【注】咳嗽剧烈，是咳得很厉害。频繁吐涎沫，是肺伤液耗了。所以咽干、小便不利，心中饥烦。时而，指一周的时间，谓一周时发作一次。其形态类似疟疾，只有寒战没有发热，是中虚而生寒战。如果错误地认为形寒之咳而发汗，则肺气既虚而卫阳又亡，阳气两伤，不能温及中下，阴气凝于内外，自然蜷缩而苦于胀满，腹中又坚硬。
【集注】程知说：这承接上文说濡弱弦微之脉，如果有咳嗽，则病情加重，而不可发汗。咳嗽则频繁吐涎沫，其咽喉必定干燥，小便必定不利；膈中阳虚，必定心中饥而烦。卫气一日一夜五十度周于身，阳虚不能自卫，所以时而寒战如疟，但有寒无热。此时发汗，则阳气愈虚阴寒益盛，必蜷缩而苦于胀满，腹中转坚。
【原文】咳嗽而小便利，或者遗尿的，不可发汗，发汗则四肢厥冷而逆。
【注】咳嗽多因饮病，小便应当不利，如果小便利，知道无饮。现在咳嗽而遗失小便，是不但没有饮，而且是下焦阳虚，膀胱不固的咳嗽。所以不可发汗，发汗则阳气更衰，四肢逆冷。
【集注】程知说：《内经》说肾咳不已，膀胱受之，膀胱咳状，咳嗽而遗尿，所以咳嗽而小便利。如果遗失小便，是肾中阳虚，发汗则阳气更亡，所以厥冷。
【原文】各种逆治发汗，病轻的难以痊愈；病重的胡言乱语，头晕目眩的会死亡，性命将难保全。
【注】不当汗而汗，当汗而过汗，都导致逆证，所以说“诸逆”。发汗导致逆证之病，病轻的难以痊愈，病重的则死。重的，指阳脱见鬼则胡言乱语，阴脱目盲则头晕目眩。
【集注】程应旄说：诸逆属于少阴居多，阴寒极矣。发汗是重夺其阳，虽有微剧不同，都关系到死，明白阳是人命的根本。
【原文】伤寒头痛，翕翕发热，形象中风，经常微微出汗，自己呕吐的，误下则更加烦乱，心中懊恼如饥；发汗则导致痉病，身体僵硬难以屈伸；熏之则发黄，不得小便；灸则引发咳嗽唾脓血。
【注】头痛翕翕发热，出汗则呕，形象像中风，应当用桂枝汤解肌。如果误下，重则变为结胸痞硬，轻则为心中更加烦乱、懊恼如饥。不用桂枝汤解肌，而用麻黄汤发汗，表虚风入则导致痉病，所以身体僵硬难以屈伸。或者用火熏蒸劫汗，则不得小便，热从湿化而发黄。灸则火邪伤肺，所以引发咳嗽唾脓血不止。
【集注】成无己说：如果反用下法，邪热乘虚流于胸中为虚烦，心中懊恼如饥。如果发汗则虚表，热归经络，热甚生风，所以身体强直而成痉。如果熏之则火热相合，消烁津液，所以小便不利而发黄。肺恶火，灸则火热伤肺，必发嗽而咳唾。
高士宗说：汗下火熏，施治各异，损正一致，所以列举下法、熏法，与发汗并论。
魏荔彤说：这申明虽然有表证宜汗，也应当详察禁忌。似中风头痛，翕翕发热，是桂枝证，呕吐则是水饮内蓄。误下益烦，懊恼如饥，则未下时已烦可知，这只是更严重罢了。如果再误汗，表虚风入，所以身体僵硬难以屈伸，火熏逼汗，热入于里，所以小便不得。盖小便利者不成黄证，发黄则小便为湿邪所阻，热邪所耗可知。灸则热上冲，所以咳唾脓血。
[Original Text] The pulse is soft and weak (Ru and Ruo). The weak pulse appears at the Guan position, while the soft pulse appears at the superficial level (Dian). The faint pulse appears at the Cun position (Upper), and the choppy pulse appears at the Chi position (Lower). Faintness indicates insufficiency of Yang Qi; choppy indicates lack of Blood. If Yang Qi is weak, wind-stroke with sweating occurs, accompanied by restlessness and vexation. Choppy pulse indicates lack of Blood, leading to cold extremities and chills. Applying diaphoresis to a condition of faint Yang Qi causes restlessness and insomnia.
[Annotation] A superficial pulse that is forceless is the Soft Pulse (Rumai). A deep pulse that is forceless is the Weak Pulse (Ruomai). A pulse that is forceless at superficial, middle, and deep levels, seeming to exist yet not, is the Faint Pulse (Weimai). A pulse that is stagnant and unsmooth is the Choppy Pulse (Semai). "Dian" refers to superficial palpation; "Upper" refers to the Cun position; "Lower" refers to the Chi position. "Pulse soft and weak, weak at Guan, soft at superficial, faint at Upper, choppy at Lower" means the Guan pulse is soft on superficial palpation and weak on deep palpation; the Cun pulse is faint, and the Chi pulse is choppy. Yang deficiency leads to a faint Cun pulse; Blood deficiency leads to a choppy Chi pulse. This is the pulse pattern of Yang deficiency and Blood deficiency, where diaphoresis is contraindicated. Yang deficiency typically presents with sweating and aversion to cold; Blood deficiency typically presents with mental vexation and fever. This is the symptom pattern of Yang deficiency and Blood deficiency, where diaphoresis is contraindicated. If mistakenly diagnosed as Taiyang Wind-Stroke and treated with diaphoresis, it will inevitably cause Yin and Yang to lose their connection and perish, resulting in restlessness, insomnia, cold extremities, and chills.
[Original Text] The pulse is soft and weak, with the weak pulse at the Guan position and the soft pulse at the superficial level. The wiry pulse appears at the Upper (Cun), and the faint pulse appears at the Lower (Chi). Wiry indicates Yang movement [here referring to Shaoyang heat or qi stagnation]; faint indicates Yin cold. Upper excess and Lower deficiency, with a desire for warmth. A faint and wiry pulse indicates deficiency; diaphoresis is contraindicated. Diaphoresis will cause shivering, and the body will not recover.
[Annotation] This refers to the Guan pulse being soft on superficial palpation and weak on deep palpation, the Cun pulse being wiry, and the Chi pulse being faint. Wiry is the pulse of Shaoyang Heat Pathogen; faint is the pulse of Shaoyin Cold Pathogen, hence "Upper excess and Lower deficiency." However, when faint and wiry pulses appear together, deficiency and excess are hard to distinguish. Only by observing if the patient desires warmth can we determine that this is not aversion to cold from the exterior, but fear of cold from the interior; thus, diaphoresis is contraindicated. If mistakenly induced to sweat, Yin becomes more abundant causing shivering, and Yang becomes more depleted, preventing self-recovery.
[Original Text] In various pulse patterns, if there is rapidity and agitation but also weakness and faintness upon pressure, diaphoresis is contraindicated. Diaphoresis will lead to difficult defecation, dryness in the abdomen, dry stomach, and mental vexation. The symptoms may appear similar, but the root causes are different.
[Annotation] Generally, diseases presenting with rapid and agitated pulses indicate an Excess syndrome, which may be treated with diaphoresis. However, if these pulses feel weak and faint upon pressure, it indicates false Excess on the outside and true Deficiency on the inside; diaphoresis is contraindicated. Mistaken diaphoresis damages Body Fluids, leading to abdominal dryness, difficult defecation, dry stomach, and vexation. Although the presentation resembles Yangming Fu-Excess Heat Binding, its root cause is actually Jinchu (Fluid Depletion) and Xu Zao (Deficiency Dryness) caused by sweating a deficient patient. Hence, "the appearance is similar, but the origin is different."
[Ji Zhu - Collected Annotations] Cheng Zhi states: Agitation and rapidity indicate Heat; weakness and faintness indicate Deficiency. Sweating disturbs Body Fluids, leading to difficult defecation, abdominal dryness, and gastric dryness with vexation. Compared to Yangming Interior Heat syndrome, although the appearance is similar, the roots differ between Excess and Deficiency.
Zhang Zhicong states: Rapid and agitated pulses are Yang pulses; weak and faint pulses are Yin pulses. When various pulses show rapidity/agitation but feel weak/faint upon pressure, regardless of whether it is left or right, three positions, diaphoresis is contraindicated. Sweating depletes internal fluids, causing difficult defecation; external leakage of water qi causes abdominal dryness; fire-heat steaming upward causes gastric dryness and vexation. The similarity in appearance refers to identical dryness syndromes post-sweating. The difference in origin refers to rapid/agitated pulses belonging to Yang, and weak/faint pulses belonging to Yin, encompassing Yin, Yang, Deficiency, and Excess.
[Original Text] Cold extremities with a tight pulse: diaphoresis is contraindicated. Diaphoresis will cause voice disorder and hoarseness, tongue flaccidity, and inability to speak.
[Annotation] A pulse suitable for diaphoresis must be tightly bound on both Yin and Yang levels (Taiyang Cold Damage). Here, cold extremities with a tight pulse indicate a Shaoyin tight pulse, not a Taiyang one. Diaphoresis will damage Shaoyin Qi, leading to voice disorder, hoarseness, tongue flaccidity, and speech impairment.
[Ji Zhu - Collected Annotations] Cheng Wuji states: Cold extremities with a tight pulse indicate Shaoyin Cold Damage. The treatment should warm the interior; mistakenly using diaphoresis damages Shaoyin Qi. The pulse qi cannot enter the Lung, follow the throat, and attach to the tongue base, resulting in voice disorder, hoarseness, tongue flaccidity, weak voice, and inability to speak loudly.
Wei Litong states: This section discusses the pulse of Jue syndromes to show that Yang deficiency prohibits diaphoresis, clarifying the errors of various counter-productive sweating methods. Jue syndromes include Cold Jue, Heat Jue, Roundworm Jue, and Jue from alternating Cold and Heat. Whenever a tight pulse is seen, regardless of the type of Jue, the disease is in the Yin channels. Diaphoresis attacks Yang, scattering Qi and exhausting Blood. The tongue is rooted in the Kidney; voice originates from the Lung. Voice disorder and hoarseness indicate impending Lung Qi exhaustion. Tongue flaccidity means loss of function. Inability to speak indicates failure of original Qi. All result from diaphoresis dispersing the True Qi of the Kidney and Lung.
[Original Text] Pulsation in the Right abdomen: diaphoresis is contraindicated. Diaphoresis causes epistaxis, thirst, severe mental vexation, and vomiting water immediately after drinking. Pulsation in the Left abdomen: diaphoresis is contraindicated. Diaphoresis causes dizziness, incessant sweating, and muscle twitching. Pulsation above the umbilicus: diaphoresis is contraindicated. Diaphoresis causes Qi rushing upward, centered at the heart region. Pulsation below the umbilicus: diaphoresis is contraindicated. Diaphoresis causes absence of sweat, severe mental vexation, painful joints, dizziness, aversion to cold, vomiting after eating, and food failing to descend.
[Annotation] "Dong Qi" (Pulsation) refers to the sensation of throbbing Qi. The areas above, below, left, and right of the umbilicus correspond to the Four Viscera. The Qi of these four viscera does not remain in its proper position, hence the pulsation. Because the organ has long been occupied by exogenous pathogens, its own Qi has lost its defense, relying only on the Middle Jiao Stomach Qi as the master. Even if there is an exterior pathogen, diaphoresis is contraindicated, lest the Qi and Fluids of the Stomach be damaged, leaving the primary organ un-nourished, allowing the conquering pathogen to invade simultaneously.
If pulsation is on the Right, Lung Qi is disordered, and Heart fails to maintain its virtue. Mistaken diaphoresis increases Heart Heat, boiling blood vessels, causing epistaxis, thirst, and vexation; Lung loses regulation, failing to regulate water passages, causing immediate vomiting of water.
If pulsation is on the Left, Liver Qi is disordered, and Lung fails to maintain its virtue. Mistaken diaphoresis causes Liver deficiency and failure to ascend, leading to dizziness; incessant sweating deprives muscles/tendons of fluids, causing twitching.
If pulsation is Above, Heart Qi is disordered, and Kidney fails to maintain its virtue. Mistaken diaphoresis causes Heart Qi deficiency, leading to Kidney Qi rushing upward to the heart region.
If pulsation is Below, Kidney Qi is disordered, and Spleen fails to maintain its virtue. Mistaken diaphoresis exhausts Kidney Water, causing bone pain, aversion to cold, no sweat, vexation, and dizziness; Spleen Earth becomes overly dry, failing normal transformation, causing vomiting after eating and food refusal.
[Ji Zhu - Collected Annotations] Cheng Zhi states: This explains that Dong Qi prohibits diaphoresis. Internal Zheng Qi deficiency and disordered Zang Qi cause throbbing pulsation. Dong Qi indicates interior deficiency, so diaphoresis is contraindicated.
Cheng Yingmao states: Zang Qi not remaining in position causes pulsation. Originally occupied by pathogens, the primary organ's Qi is attached to the root and easily deviates. It relies entirely on Stomach Qi for stability. Diaphoresis depletes Stomach Qi, leaving the Four Zang un-nourished and attacked by pathogens, showing signs of deviation. Though location varies, the violation of the principle of "Jian Zhong" (Strengthening the Center) is the same.
[Original Text] Throat obstruction: diaphoresis is contraindicated. Diaphoresis causes hematemesis, faint breath nearing extinction, cold hands and feet, a desire to curl up, and inability to self-warm.
[Annotation] The Shaoyin meridian follows the throat and attaches to the tongue base. Throat obstruction indicates Shaoyin Qi failing to ascend. Forcing diaphoresis in Shaoyin, where Yang is too weak to produce sweat, will disturb Blood, causing hematemesis, faint breath, curled posture, cold extremities, and inability to self-warm.
[Ji Zhu - Collected Annotations] Cheng Zhi states: Throat obstruction prohibits diaphoresis due to盛 (abundance) of Yin Pathogen. Forcing sweat disturbs Blood. Hematemesis and near-extinction of breath indicate even the slight Yang of the Kidney cannot sustain itself, leading to cold extremities, curled posture, and inability to self-warm. "Lower Jue and Upper Exhaustion," curled posture and cold extremities are critical Shaoyin syndromes.
Cheng Yingmao states: Diaphoretics are Yang in nature; applying them to Yin meridians is counter-productive. Throat obstruction results from Shaoyin fluid deficiency and Kidney Qi failing to ascend. Forcing Shaoyin sweat causes Lower Jue and Upper Exhaustion, leading to these manifestations.
[Original Text] Severe cough with frequent spitting of saliva and foam, dry throat, difficult urination, mental hunger/vexation, intermittent发作 (attacks), resembling malaria but with chills only and no fever, indicating deficiency and chills. Cough with diaphoresis leads to curled posture, fullness/distress, and abdominal hardness.
[Annotation] Severe cough indicates severity. Frequent spitting of saliva/foam indicates Lung injury and fluid depletion, causing dry throat, difficult urination, and mental hunger/vexation. "Intermittent" refers to an attack once per day/cycle. Resembling malaria but with chills only indicates interior deficiency generating chills. Mistakenly treating this "cold-form" cough with diaphoresis injures both Lung Qi and Wei Yang. Dual Yang injury fails to warm the Middle/Lower Jiao; Yin Qi condenses internally and externally, causing curled posture, distress from fullness, and abdominal hardness.
[Ji Zhu - Collected Annotations] Cheng Zhi states: Following the discussion of Ru/Ruo/Xian/Wei pulses, if cough is present, the disease is severe and diaphoresis is prohibited. Cough with frequent saliva/foam implies dry throat and difficult urination; Middle Jiao Yang deficiency causes mental hunger/vexation. Wei Qi circulates 50 times daily; Yang deficiency fails to protect the exterior, causing intermittent chills like malaria (chills only). Diaphoresis here further depletes Yang and increases Yin-Cold, leading to curled posture, fullness, and abdominal hardness.
[Original Text] Cough with free urination, or urinary incontinence: diaphoresis is contraindicated. Diaphoresis leads to cold extremities reversing upwards.
[Annotation] Cough often involves fluid retention, where urination should be difficult. If urination is free, there is no fluid retention. Cough with urinary incontinence indicates not only absence of fluid retention but also Lower Jiao Yang deficiency and Bladder insecurity. Thus, diaphoresis is contraindicated; sweating further depletes Yang, causing reverse cold in extremities.
[Ji Zhu - Collected Annotations] Cheng Zhi states: *Neijing* says prolonged Kidney Cough affects the Bladder. Bladder Cough presents with coughing and enuresis. Thus, cough with free urination. If incontinence occurs, it indicates Kidney Yang deficiency. Diaphoresis further depletes Yang, causing cold reversal.
[Original Text] Various counter-productive diaphoresis: mild cases are difficult to cure; severe cases involve delirium and dizziness, leading to death, with life barely salvageable.
[Annotation] Diaphoresis when inappropriate, or excessive diaphoresis when appropriate, all lead to "Ni" (counter-productive/rebellious) conditions. Mild counter-productive cases are hard to cure; severe cases result in death. Severe cases involve Yang collapse (seeing ghosts/delirium) and Yin collapse (blindness/dizziness).
[Ji Zhu - Collected Annotations] Cheng Yingmao states: Most "Ni" cases belong to Shaoyin, indicating extreme Yin-Cold. Diaphoresis heavily夺 (seizes) Yang. Whether mild or severe, it concerns death, highlighting that Yang is the root of life.
[Original Text] Cold damage headache, moderate fever (Xi Xi Fa Re), resembling wind-stroke, with constant slight sweating and spontaneous vomiting: Misusing purgatives increases vexation and mental restlessness/hunger-like feeling; Diaphoresis causes Spasm (Jing), stiff body difficult to flex/extend; Moxibustion/Fumigation causes Jaundice and urinary retention; Moxibustion causes cough and expectoration.
[Annotation] Headache, moderate fever, sweating, vomiting, resembling wind-stroke, should be treated with Guizhi Tang to resolve the muscle layer. Purging worsens it to chest binding/stiffness (severe) or increased mental vexation/restlessness (mild). Using Mahuang Tang instead of Guizhi Tang for diaphoresis in this exterior-deficient state invites wind, causing Spasm (stiffness). Fumigation forces sweat, leading to urinary retention and Jaundice (heat transforming with dampness). Moxibustion injures Lung with Fire, causing persistent cough and expectoration.
[Ji Zhu - Collected Annotations] Cheng Wuji states: Purging allows evil heat to flow into the chest as empty vexation (Ao Nu). Diaphoresis leaves the exterior empty; heat enters collaterals, generating wind, causing stiffness/spasm. Fumigation combines fire/heat, consuming fluids, causing urinary difficulty and jaundice. Lung fears fire; moxibustion injures Lung, causing cough/expectoration.
Gao Shizong states: Diaphoresis, purging, and fumigation differ in method but equally damage Zheng Qi; thus they are discussed together.
Wei Litong states: This clarifies that even with exterior signs requiring sweating, contraindications must be carefully observed. Headache/moderate fever resembling wind-stroke is a Guizhi Tang pattern. Vomiting indicates internal fluid retention. Mistaken purging increases vexation/restlessness, implying pre-existing vexation. Mistaken diaphoresis leaves exterior empty, inviting wind (stiffness). Fumigation forces heat inward, blocking urination. Jaundice implies urine blockage by dampness and consumption by heat. Moxibustion sends heat upward, causing cough and purulent sputum.