初生之谓也。窃尝论之矣。夏至一阴生。而后有小暑大暑。冬至一阳生。而后有小寒大寒。非阴生而反热。
阳生而反寒也。天地之道。否不极则不泰。阴阳之气。剥不极则不复。夏至六阴尽于地上。而后一阴生于
地下。是阴生之时。正阳极之时也。冬至六阳尽于地上。而后一阳生于地下。是阳生之时。正阴极之时也。
阳极而大热。阴极而大寒。自然之道也。则所谓阳始生。天得温和者。不得与冬至阳生同论也审矣。至未得
甲子。而天大寒不解。或如盛夏五六月时。则气之有盈有缩。为候之或后或先。而人在气交之中者。往往
因之而病。惟至人为能与时消息。而无忤耳。
案冬至之后。得甲子少阳旺云云。本见于七难。而易通卦验。演而论之。文繁不录。
师曰。病患脉浮者在前。其病在表。浮者在后。其病在里。腰痛背强。不能行。必短气而极也。
〔徐〕以前后分浮脉之阴阳。而定表里。此仲景创论也。
〔沈〕此以关脉前后分表里。而辨内伤外感也。
前者。关前寸口脉也。寸口属阳主表。而浮者在前。邪在于表。即风中于前之外感也。后者。关后尺脉也。尺
脉属阴主里。而浮者在后。为病在里。即内伤精血之病也。两尺主肾。其脉贯脊。阴虚阳盛。则见脉浮。精
血虚而受邪。痹着不行。不能上贯于脊。腰痛背强不能行。精虚不能摄气归源。气反上逆。故
短气而急也。
案十四难。前大后小。即头痛目眩。前小后大。即胸满短气。张世贤注云。前者。谓寸。后者。谓尺。
正与本条之义合矣。扬雄方言。极。疲也。沈训急。未知何据。
问曰。经云。厥阳独行。何谓也。师曰。此为有阳无阴。故称厥阳。
〔程〕厥阳。即阳厥也。以其人秋冬夺于所用。有阳无阴。
内经谓。肾气日衰。阳气独胜。故手足为之热。此厥阳独行之义也。
案经云。今内经难经无所考。
问曰。寸脉沉大而滑。沉则为实。滑则为气。实气相搏。血气入脏即死。入腑即愈。此为卒厥。何
谓也。师曰。唇口青身冷。为入脏。即死。如身和汗自出。为入腑。即愈。
〔尤〕实。谓血实。气。谓气实。实气相搏者。血与气并而俱实也。五脏者。藏而不泻。血气入之。卒
不得还。神去机息。则唇青身冷而死。六腑者。传而不藏。血气入之。乍满乍泻。气还血行。则身和汗出
而愈。经云。血之与气。并走于上。则为大厥。厥则暴死。气复反则生。不反则死。是
也。（案出素调经论。）
〔沈〕邪气入脏。神明昏愦。卒倒无知。谓之卒厥。案寸脉。通三部而言。血气。程
本作厥气。金鉴云。寸脉沉大而滑。沉则为实。滑则为气。实气相搏之十八字。文理不顺。衍文也。血气
之血字。当是厥字。始与卒厥相合。必传写之讹也。并似有理。然据尤注。义不相乖。姑从之。
问曰。脉脱入脏即死。入腑即愈。何谓也。师曰。非为一病。百病皆然。譬如浸淫疮。从口起流向四
肢者。可治。从四肢流来入口者。不可治。病在外者。可治。入里者。即死。
〔尤〕脉脱者。邪气乍加。正气被遏。经隧不通。脉绝似脱。非真脱也。盖暴厥之属。经曰。趺阳
脉不出。脾不上下。身冷肤硬。又曰。少阴脉不至。肾气微。少精血。为尸厥。即脉脱之谓也。厥病入脏者。
深而难出。气竭不复则死。入腑者浅而易通。气行汗出即愈。浸淫疮。疮之浸淫不已。外台所谓。转广有汁。
流绕周身者也。从口流向四肢者。病自内而之外。故可治。从四肢流来入口者。病自外而之里。故
不可治。李玮西云。病在外二句。概指诸病而言。即上文百病皆然之意。入里者死。如痹气入腹。香港脚冲心
之类。
〔鉴〕赵良曰。脱者。去也。经脉。乃脏腑之隧道。为邪气所逼。故绝气脱去其脉。而入于内。
问曰。阳病十八。何谓也。师曰。头痛。项。腰。脊。臂。脚掣痛。阴病十八。何谓也。师曰。咳。上
气喘。哕。咽。肠鸣胀满。心痛拘急。五脏病各有十八。合为九十病。人又有六微。微有十八病。合为一百
八病。五劳七伤六极。妇人三十六病。不在其中。清邪居上。浊邪居下。大邪中表。小邪中里。 之邪。从
口入者。宿食也。五邪中人。各有法度。风中于前。寒中于暮。湿伤于下。雾伤于上。风令脉
浮。寒令脉急。雾伤皮腠。湿流关节。食伤脾胃。极寒伤经。极热伤络。（ 。赵本。作 饪是。徐作 饨。
沈作KT 。非。）
〔程〕阳病属表而在经络。故一头痛。二项。三腰。四脊。五臂。六脚掣痛。此病在三阳。三六一十
八病。阴病属里而在脏腑。故一咳。二上气喘。三哕。四咽。五肠鸣胀满。六心痛拘急。此病在三阴。三六
一十八病。合为九十病也。
〔沈〕六微者。小邪中里。邪袭六腑。
〔鉴〕此章曰十八。曰九十等文。乃古医
书之文。今不可考。难以强释。五劳七伤等说。亦详在千金。故不复注也。头痛。项。腰。脊。臂。脚
掣痛病皆在外。故为阳病也。咳。上气喘。哕。咽。肠鸣胀满。心痛拘急。病皆在内。故为阴病也。清邪居
上。谓雾邪本乎天也。浊邪居下。谓湿邪本乎地也。六淫天邪。故名大邪。六淫伤外。故曰中表也。七情人
邪。故名小邪。七情伤内。故曰中里也。 者。饮食也。饮食之邪。从口而入。食伤隔夜不化。故名曰宿食
也。五邪。谓风寒湿雾饮食也。夫五邪之中人。莫不各以类而从。前者。早也。风中于早。从阳类也。寒中
于暮。从阴类也。雾邪清轻。故伤皮肤。湿邪浊重。故流关节。饮食失节。故伤脾胃。
〔尤〕经脉阴而伤
于寒。络脉阳。而伤于热。合而言之。无非阳邪亲上。阴邪亲下。热气归阳。寒气归阴之理。
案十八病。九十病。金鉴不释为是。六微亦未详何义。程云。见千金。未有所考。咽。沈以为咽痛。恐
非。广韵。咽一结切。音噎。哽咽也。盖咽中哽塞之谓。 。赵本释音。 音谷。即谷也。案此古文异构。详
见于方氏通雅。饪。熟食也。金鉴欲改作 。且以极寒为饮食之寒热。并不可从。
唐大烈吴医汇讲。以馨饪解之。亦非也。
尤云。大邪漫风。虽大而力散。故中于表。小邪户牖隙风。虽小而气锐。故中于里。程云。风寒即
大邪。故从表入。 饪。即小邪。故从口入。即后食伤脾胃也。二说亦通。
问曰。病有急当救里救表者。何谓也。师曰。病医下之。续得下利。清谷不止。身体疼痛者。急当
救里。后身体疼痛。清便自调者。急当救表也。
〔沈〕此病分表里。治有先后也。问急当救里救表者。乃病在表。而医反下之。诛伐无过。致伤脾胃
之气。所以下利清谷不止。然虽身疼表证未解。当救误下之逆为急。不可姑
虑表邪。以致内伤下脱。必俟元阳恢复。清便自调之后。急
当救表。然表当急救何也。盖恐内阳初复未充。外邪陷入。又变结胸痞满耳。（详见伤寒论辑义太阳中篇。）
夫病痼疾。加以卒病。当先治其卒病。后乃治其痼疾也。
〔鉴〕赵良曰。痼疾。病已沉痼。非旦夕可取效者。卒病。谓卒然而来新感之病。可取效于旦夕者。乘其
所入未深。急去其邪。不便稽留而为患也。且痼疾之人。正气素虚。邪尤
易传。设多瞻顾。致令两邪相合。为患不浅。故仲景立言于此。使后学人知所先后也。
师曰。五脏病。各有得者愈。五脏病。各有所恶。各随
其所不喜者为病。病者素不应食。而反暴思之。必发热也。
〔程〕内经曰。肝色青。宜食甘。心色赤。宜食酸。肺色白。宜食苦。脾色黄。宜食咸。肾色黑。
宜食辛。此五脏得饮食而愈者。肝病愈于丙丁。起于甲乙。心病愈于戊己。起于丙丁。脾病愈于庚辛。起于
戊己。肺病愈于壬癸。起于庚辛。肾病愈于甲乙。起于壬癸。此五脏自得其位而愈者。五脏所恶。心恶热。
肺恶寒。肝恶风。脾恶湿。肾恶燥。各随其所恶而不喜者为病也。若病患素不食。而暴食之。则食入
于阴。长气于阳。必发热也。暴思之。娄全善。作暴食之。为是。
案病者素不应食以下。必是别条。沈尤辈接上为义。未免强解。瘥后劳复病篇曰。病患脉已解。而日
暮微烦。以病新瘥。人强与谷。脾胃气尚弱。不能消谷。故令微烦。损谷则愈。正与此条相发。
夫诸病在脏。欲攻之。当随其所得而攻之。如渴者。与猪苓汤。余皆仿此。
〔尤〕无形之邪。入结于脏。必有所据。水血痰食。皆邪
薮也。如渴者。水与热得。而热结在水。故与猪苓汤。利其水。而热亦除。若有食者。食与热得。而热结在
食。则宜承气汤。下其食。而热亦去。若无所得。则无形之邪。岂攻法
所能去哉。猪苓汤方见后消渴证中。
〔鉴〕如渴者之下。当有小便不利四字。必传写之遗也。脏者里也。
这就是初生（指阴阳之气初生）的含义。我曾对此论述过：夏至时一阴气开始产生，之后才出现小暑和大暑；冬至时一阳气开始产生，之后才出现小寒和大寒。这并不是因为阴气产生反而变热，或阳气产生反而变冷。天地的规律是，否塞不达到极点就不会通达，阴阳之气剥蚀不达到极点就不会恢复。夏至时地上的六阴气耗尽，然后一阴气在地下产生，这是阴气产生的时候，正是阳极的时候。冬至时地上的六阳气耗尽，然后一阳气在地下产生，这是阳气产生的时候，正是阴极的时候。阳极则大热，阴极则大寒，这是自然的规律。那么所谓“阳气始生，天气温和”，就不能与冬至时阳气产生（伴随寒冷）的情况混为一谈，这已经很明确了。如果到了甲子日（冬至后六十日），天气仍然严寒不解，或者像盛夏五六月那样炎热，这是因为气候有盈满有亏缩，节气有时滞后有时提前，而处于气交之中的人，往往因此生病，只有修养极高的人能随季节变化调节自己，而不受其伤害。
按语：冬至之后，得甲子日少阳旺等说法，原本见于《难经·七难》，《易通卦验》加以推演论述，文字繁杂不再收录。
老师说：病人脉象浮，如果在寸口（关前），病在表；浮脉如果在尺部（关后），病在里。（若伴有）腰痛、背强、不能行走，必定短气且极度疲乏。
〔徐〕以前后部位区分浮脉的阴阳属性，从而确定表里，这是张仲景的创新理论。
〔沈〕这是以关脉的前后区分表里，来辨别内伤和外感。
前者，指关前的寸口脉。寸口属阳主表，浮脉出现在前面，说明邪气在表，即风邪从前面侵袭的外感病。后者，指关后的尺脉。尺脉属阴主里，浮脉出现在后面，说明病在里，即精血内伤的病证。两尺脉主要对应肾脏，其经脉贯穿脊柱。阴虚阳盛，则见脉浮。精血虚弱又感受邪气，痹阻不通，不能上贯于脊柱，导致腰痛、背强、不能行走。精气虚不能摄纳气机归源，气反而上逆，所以短气且急促。
按语：《难经·十四难》说，前大后小，即头痛目眩；前小后大，即胸满短气。张世贤注释说，前者指寸脉，后者指尺脉，正与本条的意义相符。扬雄《方言》中，“极”意为疲乏。沈氏训释“急”，不知依据何在。
问：经文说“厥阳独行”，是什么意思？老师说：这是因为有阳无阴，所以称为厥阳。
〔程〕厥阳，就是阳厥。因为人在秋冬时节过度耗损，导致有阳无阴。《内经》说，肾气日渐衰退，阳气独盛，所以手足发热。这就是厥阳独行的含义。
按语：经文说，现在《内经》和《难经》中无法考证。
问：寸脉沉大而滑，沉脉代表实，滑脉代表气，实与气相互搏结，血气入脏就会死，入腑就会好，这叫卒厥，是什么意思？老师说：嘴唇发青、身体冰冷，是入脏，就会死；如果身体温和、汗自出，是入腑，就会好。
〔尤〕实，指血实；气，指气实。实气相搏，是指血与气都实并在一起。五脏是藏精气而不泻的，血气进入其中，突然不能返回，神志离去，机能停止，就会嘴唇发青、身体冰冷而死。六腑是传化物而不藏的，血气进入其中，忽满忽泻，气还血行，就会身体温和、出汗而痊愈。经文说：“血与气，并走于上，则为大厥，厥则暴死，气复反则生，不反则死。”说的就是这个情况。（案出《素问·调经论》。）
〔沈〕邪气入脏，神明昏乱，突然倒下无知觉，称为卒厥。关于寸脉，是通指三部而言。血气，程本写作“厥气”。《医宗金鉴》说，“寸脉沉大而滑，沉则为实，滑则为气，实气相搏”这十八个字，文理不顺，是衍文。“血气”的“血”字，应当是“厥”字，这才与“卒厥”相合，必然是传写之误。这种说法似乎有理，但根据尤注，义理并不冲突，暂且依从尤注。
问：脉脱入脏即死，入腑即愈，是什么意思？老师说：这不是针对某一种病，各种病都是这样。譬如浸淫疮，从口部起流向四肢的，可治；从四肢流来入口部的，不可治。病在外表的，可治；病入里的，即死。
〔尤〕脉脱，是指邪气突然加重，正气被遏制，经络隧道不通，脉绝似脱，并非真的脱失。这属于暴厥一类。经文说：“趺阳脉不出，脾不上下，身冷肤硬。”又说：“少阴脉不至，肾气微，少精血，为尸厥。”这就是所说的脉脱。厥病入脏的，病位深而难出，气竭不复则死；入腑的，病位浅而易通，气行汗出即愈。浸淫疮，是疮疡浸淫不止，《外台秘要》所谓“转广有汁，流绕周身”。从口流向四肢，是病自内而外，所以可治；从四肢流来入口，是病自外而里，所以不可治。李玮西说，“病在外二句”概指诸病而言，即上文“百病皆然”的意思。入里者死，如痹气入腹、香港脚冲心之类。
〔鉴〕赵良说：脱，是去的意思。经脉是脏腑的通道，被邪气逼迫，故绝气脱去其脉，而入于内。
问：阳病有十八种，是什么？老师说：头痛、项强、腰痛、脊强、臂痛、脚掣痛。阴病有十八种，是什么？老师说：咳、上气喘、哕、咽噎、肠鸣胀满、心痛拘急。五脏病各有十八种，合为九十病。人又有六微，微有十八病，合为一百零八病。五劳、七伤、六极、妇人三十六病，不在其中。清邪居上，浊邪居下，大邪中表，小邪中里，饪之邪，从口入者，宿食也。五邪中人，各有法度：风中于前，寒中于暮，湿伤于下，雾伤于上，风令脉浮，寒令脉急，雾伤皮腠，湿流关节，食伤脾胃，极寒伤经，极热伤络。（“饪”字，赵本作“饪”是正确的，徐本作“饨”，沈作“KT”，不对。）
〔程〕阳病属表而在经络，所以一是头痛，二是项强，三是腰痛，四是脊强，五是臂痛，六是脚掣痛。这些病在三阳经，三六一十八病。阴病属里而在脏腑，所以一是咳，二是上气喘，三是哕，四是咽噎，五是肠鸣胀满，六是心痛拘急。这些病在三阴经，三六一十八病。合为九十病。
〔沈〕六微，是指小邪中里，邪气侵袭六腑。
〔鉴〕此章中说十八、九十等文字，是古医书的文字，现在已不可考，难以强行解释。五劳七伤等说法，也在《千金方》中有详细记载，所以不再加注。头痛、项强、腰痛、脊强、臂痛、脚掣痛这些病都在外，所以称为阳病。咳、上气喘、哕、咽噎、肠鸣胀满、心痛拘急这些病都在内，所以称为阴病。清邪居上，是说雾邪本乎天；浊邪居下，是说湿邪本乎地。六淫天邪，所以叫大邪；六淫伤外，所以说中表。七情人邪，所以叫小邪；七情伤内，所以说中里。“饪”是饮食。饮食之邪，从口而入，食伤隔夜不化，所以名叫宿食。五邪，指风寒湿雾饮食。这五邪中人，莫不各以类而从。前者，指早晨。风邪在早晨侵袭，是从阳类；寒邪在傍晚侵袭，是从阴类。雾邪清轻，所以伤皮肤；湿邪浊重，所以流注关节。饮食失节，所以伤脾胃。
〔尤〕经脉属阴而伤于寒，络脉属阳而伤于热。合而言之，无非是阳邪亲上，阴邪亲下，热气归阳，寒气归阴的道理。
按语：十八病、九十病，《医宗金鉴》不解释是对的。六微也未详何义。程云说见于《千金方》，但未有所考。“咽”，沈以为咽痛，恐怕不对。《广韵》：“咽，一结切，音噎，哽咽也。”大概是咽中哽塞的意思。“饪”，赵本释音“任”，“谷”音“谷”，即谷也。案这是古文异构，详见方氏《通雅》。“饪”，熟食也。《医宗金鉴》想改作“饪”，且以极寒为饮食之寒热，都不可以听从。唐大烈《吴医汇讲》以“馨饪”解之，也不对。尤云：大邪漫风，虽大而力散，故中于表；小邪户牖隙风，虽小而气锐，故中于里。程云：风寒即大邪，故从表入；饪，即小邪，故从口入，即后食伤脾胃也。两种说法也通。
问：有病有急当救里、救表的，是什么意思？老师说：病人被医生误用下法，接着出现下利、完谷不化不止，身体疼痛的，急当救里。后来身体疼痛，大小便正常的，急当救表。
〔沈〕这是病分表里，治疗有先后之分。问急当救里救表，乃病在表，而医生反而用下法，诛伐无过，致使损伤脾胃之气，所以下利清谷不止。然而虽然身疼表证未解，应当先救治误下造成的逆证为急，不可姑且顾虑表邪，以致内伤下脱。必须等到元阳恢复，大小便正常之后，再急当救表。然而表证为何要急救呢？大概是因为内阳初复未充，外邪容易陷入，又变生结胸痞满等证。（详见《伤寒论辑义》太阳中篇。）
凡是患有久病痼疾，又加上突发新病，应当先治其新病，然后再治其久病。
〔鉴〕赵良说：痼疾，是病已沉痼，不是早晚就能见效的；卒病，是突然而来的新感之病，可以早晚见效。趁着邪气入侵未深，急去其邪，不便稽留而为患。而且痼疾之人，正气素虚，邪气更容易传变。如果多方瞻顾，致使两邪相合，为患不浅。所以张仲景立言于此，使后学者知道治疗的先后次序。
老师说：五脏病，各有适宜的饮食而痊愈；五脏病，各有其所厌恶的。随着它们所不喜欢的事物就会致病。病人平时不应吃的食物，却突然想吃，必定会发热。
〔程〕《内经》说：肝色青，宜食甘；心色赤，宜食酸；肺色白，宜食苦；脾色黄，宜食咸；肾色黑，宜食辛。这是五脏通过饮食而痊愈。肝病愈于丙丁日，起于甲乙日；心病愈于戊己日，起于丙丁日；脾病愈于庚辛日，起于戊己日；肺病愈于壬癸日，起于庚辛日；肾病愈于甲乙日，起于壬癸日。这是五脏自得其位而痊愈。五脏所恶：心恶热，肺恶寒，肝恶风，脾恶湿，肾恶燥。各自随着他们所厌恶而不喜欢的事物就会致病。如果病人平时不吃某种食物，却暴食它，则食入于阴，长气于阳，必定发热。暴思之，娄全善作“暴食之”，认为是正确的。
按语：“病者素不应食”以下，必定是另一条的内容。沈、尤等人将其接在上文为义，未免牵强附会。《瘥后劳复病篇》说：“病患脉已解，而日暮微烦，以病新瘥，人强与谷，脾胃气尚弱，不能消谷，故令微烦，损谷则愈。”正与此条互相发明。
凡是诸病在脏，想要攻逐它，应当随着它所结合的因素而攻逐它。比如口渴的，给予猪苓汤。其余都仿照这个原则。
〔尤〕无形的邪气，进入结聚于脏，必然有所依附。水、血、痰、食，都是邪气的聚集处。比如口渴的，是水与热相结合，而热结在水，所以给予猪苓汤，利其水，而热也随之除去。如果有食的，是食与热相结合，而热结在食，则宜用承气汤，下其食，而热也随之去除。如果没有所得，那么无形的邪气，难道是攻法所能去除的吗？猪苓汤方见后消渴证中。
〔鉴〕“如渴者”之下，应当有“小便不利”四字，必然是传写遗漏。脏者，里也。
This refers to the initial generation (of Yin and Yang Qi). I have previously discussed this: At the Summer Solstice, a certain amount of Yin Qi begins to generate, after which come Minor Heat and Major Heat. At the Winter Solstice, a certain amount of Yang Qi begins to generate, after which come Minor Cold and Major Cold. This is not because the generation of Yin leads to heat, nor because the generation of Yang leads to cold. The way of Heaven and Earth is that if Pi (obstruction) does not reach its extreme, it will not turn into Tai (peace); if the Qi of Yin and Yang does not peel away to its extreme, it will not recover. At the Summer Solstice, the six Yin energies on the ground are exhausted, and then one Yin Qi generates beneath the ground. Thus, at the time when Yin Qi generates, it is precisely the time of extreme Yang. At the Winter Solstice, the six Yang energies on the ground are exhausted, and then one Yang Qi generates beneath the ground. Thus, at the time when Yang Qi generates, it is precisely the time of extreme Yin. Extreme Yang results in great heat; extreme Yin results in great cold. This is the natural way. Therefore, the so-called "when Yang Qi initially generates, the weather becomes mild" cannot be equated with the generation of Yang Qi at the Winter Solstice (which is accompanied by cold), which is clear. If, even after reaching the Jiazi day (sixty days after Winter Solstice), the weather remains severely cold without relief, or if it is as hot as in the fifth and sixth months of midsummer, this is because the climate has periods of fullness and deficiency, and the solar terms may be delayed or advanced. People living within the intersection of these Qi often fall ill due to this, whereas only those of supreme cultivation can adjust with the seasons and avoid harm.
Note: The statement regarding Shao Yang being prosperous after the Jiazi day following Winter Solstice, etc., originally appears in Nan Jing (Classic of Difficult Issues), Chapter 7. Yi Tong Gua Yan elaborates on it, but the text is too lengthy to record here.
The Master said: In patients, if the pulse is floating (Fu Mai, Floating Pulse) at the Cun position (front/upper part of the wrist), the disease is in the Exterior (Biao). If the floating pulse is at the Chi position (back/lower part of the wrist), the disease is in the Interior (Li). (If accompanied by) lower back pain, stiffness of the back, inability to walk, there will definitely be shortness of breath and extreme fatigue.
[Xu] Distinguishing the Yin-Yang nature of the floating pulse by front and back positions to determine Exterior-Interior is an innovative theory of Zhang Zhongjing.
[Shen] This distinguishes Exterior-Interior by the front and back of the Guan pulse to differentiate between internal injury and external contraction.
The former refers to the Cun Kou pulse (Cun position) before the Guan. Cun belongs to Yang and governs the Exterior. A floating pulse appearing at the front indicates pathogenic factors in the Exterior, i.e., an external contraction where Wind pathogen attacks from the front. The latter refers to the Chi pulse after the Guan. Chi belongs to Yin and governs the Interior. A floating pulse appearing at the back indicates disease in the Interior, i.e., a condition of internal injury to Essence and Blood. The two Chi pulses primarily correspond to the Kidneys, whose meridians penetrate the spine. Yin deficiency with Yang hyperactivity manifests as a floating pulse. When Essence and Blood are deficient and susceptible to pathogens, obstruction occurs, preventing upward penetration to the spine, resulting in lower back pain, back stiffness, and inability to walk. Deficiency of Essence fails to grasp Qi and return it to its source, causing Qi to rebel upwards, hence shortness of breath and urgency.
Note: Nan Jing, Chapter 14 states: "Large anteriorly and small posteriorly implies headache and dizziness; small anteriorly and large posteriorly implies chest fullness and shortness of breath." Zhang Shixian's commentary says the former refers to the Cun pulse and the latter to the Chi pulse, which aligns perfectly with the meaning of this clause. Yang Xiong's Fangyan defines "Ji" as fatigue. Shen's interpretation of "Ji" as urgent is unclear in basis.
Question: The classic states "Jue Yang travels alone," what does this mean? The Master said: This is because there is Yang without Yin, thus it is called Jue Yang.
[Cheng] Jue Yang is Yang Jue. Because people overexert themselves during Autumn and Winter, leading to having Yang without Yin. Nei Jing states: "Kidney Qi declines daily, while Yang Qi stands alone, causing heat in the hands and feet." This is the meaning of Jue Yang traveling alone.
Note: The classic mentions this, but it cannot be verified in Nei Jing or Nan Jing.
Question: The Cun pulse is deep (Chen Mai, Deep Pulse), large, and slippery (Hua Mai, Slippery Pulse). Deep indicates Excess (Shi), slippery indicates Qi. When Excess and Qi contend, if Blood and Qi enter the Zang organs, death ensues; if they enter the Fu organs, recovery occurs. This is called Cu Jue (Sudden Syncope). What does this mean? The Master said: Blue lips and mouth, cold body indicate entry into Zang organs, leading to death. If the body is warm and sweat comes out spontaneously, it indicates entry into Fu organs, leading to recovery.
[You] "Excess" refers to Blood Excess; "Qi" refers to Qi Excess. Contention of Excess and Qi means Blood and Qi are both excessive and conjoined. The Five Zang organs store essence and do not discharge; if Blood and Qi enter them, they suddenly cannot return. When Spirit departs and mechanisms cease, lips turn blue, body becomes cold, and death occurs. The Six Fu organs transmit transformations and do not store; if Blood and Qi enter them, they fill and empty intermittently. When Qi returns and Blood flows, the body becomes warm and sweating occurs, leading to recovery. The classic states: "When Blood and Qi rush together upwards, it becomes Da Jue (Great Syncope); syncope causes sudden death. If Qi returns, life is preserved; if not, death ensues." This describes that situation. (Note: From Su Wen, Tiao Jing Lun.)
[Shen] Pathogenic factors entering Zang organs cause confusion of Spirit and Mind, sudden collapse, and unconsciousness, called Cu Jue. Regarding the Cun pulse, it generally refers to all three positions. "Blood and Qi": Cheng's edition writes "Jue Qi". Yi Zong Jin Jian states that the eighteen characters "Cun pulse deep, large, and slippery; deep indicates Excess, slippery indicates Qi, contention of Excess and Qi" are logically inconsistent and are likely interpolations. The character "Xue" (Blood) in "Xue Qi" should be "Jue", which would align with "Cu Jue"; this must be a transcription error. This reasoning seems plausible, but according to You's annotation, the meaning is not contradictory. For now, we follow You.
Question: Pulse disappearance (Mai Tuo) entering Zang leads to death, entering Fu leads to recovery. What does this mean? The Master said: This applies not to just one disease, but to all diseases. For example, in Jin Yin Chuang (oozing sores), if it starts at the mouth and flows to the limbs, it is treatable; if it flows from the limbs to the mouth, it is untreatable. Disease remaining in the Exterior is treatable; disease entering the Interior leads to death.
[You] Pulse disappearance refers to pathogenic factors suddenly intensifying, suppressing Zheng Qi, blocking the meridians, making the pulse vanish resembling depletion, but it is not true depletion. It belongs to the category of sudden syncope. The classic states: "If the foot Yang pulse does not appear, Spleen Qi does not ascend or descend, body becomes cold and skin hard." It also states: "If the Shao Yin pulse does not appear, Kidney Qi is weak, Essence and Blood are scant, resulting in Shi Jue (Corpse-like Syncope)." This is what is meant by pulse disappearance. Diseases of syncope entering Zang are deep and difficult to exit; if Qi exhausts and does not recover, death ensues. Those entering Fu are shallow and easy to unblock; if Qi moves and sweating occurs, recovery ensues. Jin Yin Chuang refers to sores oozing incessantly, as described in Waitai Miyao: "spreading wide with fluid, flowing around the whole body." Flowing from mouth to limbs means disease moves from Interior to Exterior, hence treatable. Flowing from limbs to mouth means disease moves from Exterior to Interior, hence untreatable. Li Weixi states that the two sentences "Disease in Exterior... Disease entering Interior..." generally refer to all diseases, consistent with the previous "all diseases are like this." Death from entering Interior includes conditions like Bi Qi entering the abdomen or Hong Kong Foot rushing to the heart.
[Jian] Zhao Liang says: "Tuo" means departure. Meridians are tunnels for Zang and Fu organs. Forced by pathogenic factors, Qi abandons the pulse and enters the interior.
Question: There are eighteen Yang diseases. What are they? The Master said: Headache, neck stiffness, lower back pain, spine stiffness, arm pain, leg pulling pain. There are eighteen Yin diseases. What are they? The Master said: Cough, asthma/wheezing, hiccups, throat obstruction, borborygmus with abdominal distension, heart pain with tension. Each of the Five Zang organs has eighteen diseases, totaling ninety diseases. Humans also have Liu Wei (Six Micro), each having eighteen diseases, totaling one hundred eight diseases. Wu Lao (Five Labors), Qi Shang (Seven Injuries), Liu Ji (Six Extremes), and the Thirty-Six Diseases of Women are not included. Qing Xie (Clear Pathogens) reside above, Zhuo Xie (Turbid Pathogens) reside below, Da Xie (Great Pathogens) strike the Exterior, Xiao Xie (Small Pathogens) strike the Interior. Ren (Cooked Food/Dietary) pathogens enter through the mouth and are Su Shi (Retained Food). The Five Pathogens affecting humans each have their rules: Wind strikes in the morning, Cold strikes in the evening, Dampness injures the lower parts, Fog injures the upper parts. Wind causes the pulse to be floating, Cold causes the pulse to be tight. Fog injures skin and pores, Dampness flows into joints. Food injures Spleen and Stomach, extreme Cold injures meridians, extreme Heat injures collaterals. ("Ren" character: Zhao edition writes "Ren" correctly; Xu writes "Tun"; Shen writes "KT", which is incorrect.)
[Cheng] Yang diseases belong to the Exterior and involve meridians. Thus: 1. Headache, 2. Neck stiffness, 3. Lower back pain, 4. Spine stiffness, 5. Arm pain, 6. Leg pulling pain. These diseases are in the Three Yang meridians. Three times six equals eighteen diseases. Yin diseases belong to the Interior and involve Zang organs. Thus: 1. Cough, 2. Asthma/wheezing, 3. Hiccups, 4. Throat obstruction, 5. Borborygmus with abdominal distension, 6. Heart pain with tension. These diseases are in the Three Yin meridians. Three times six equals eighteen diseases. Together they total ninety diseases.
[Shen] Liu Wei refers to Xiao Xie striking the Interior, where pathogens invade the Six Fu organs.
[Jian] The text mentioning eighteen, ninety, etc., originates from ancient medical texts and cannot be verified today; it is difficult to force an explanation. The concepts of Five Labors and Seven Injuries are detailed in Qian Jin Fang, so no further notes are added. Headache, neck stiffness, lower back pain, spine stiffness, arm pain, and leg pulling pain are all external, hence called Yang diseases. Cough, asthma/wheezing, hiccups, throat obstruction, borborygmus with abdominal distension, and heart pain with tension are all internal, hence called Yin diseases. Qing Xie residing above refers to Fog pathogens originating from Heaven. Zhuo Xie residing below refers to Dampness pathogens originating from Earth. Liu Yin (Six Evils) are Heavenly pathogens, hence called Da Xie; injuring the Exterior, they are said to strike the Biao. Seven Emotions are Human pathogens, hence called Xiao Xie; injuring the Interior, they are said to strike the Li. "Ren" refers to diet. Dietary pathogens enter through the mouth; food retained overnight and undigested is named Su Shi. The Five Pathogens are Wind, Cold, Dampness, Fog, and Diet. When these five pathogens affect humans, they follow their respective categories. "Front" refers to morning. Wind attacking in the morning follows the Yang category. Cold attacking in the evening follows the Yin category. Fog pathogens are light and clear, thus injuring the skin. Dampness pathogens are heavy and turbid, thus flowing into joints. Irregular diet injures Spleen and Stomach.
[You] Meridians are Yin and injured by Cold; Collaterals are Yang and injured by Heat. Generally speaking, this reflects the principle that Yang pathogens favor the upper, Yin pathogens favor the lower, Heat Qi returns to Yang, and Cold Qi returns to Yin.
Note: Yi Zong Jin Jian is correct not to explain the eighteen and ninety diseases. The meaning of Liu Wei is also unclear. Cheng claims it appears in Qian Jin but provides no verification. Shen interprets "Yan" as sore throat, which is likely incorrect. Guang Yun states: "Yan, yi jie qie, sound ye, choking/gurgling." It likely refers to a sensation of blockage in the throat. "Ren": Zhao edition pronounces "Ren"; "Gu" sounds like "Gu", meaning grain. Note: This is an ancient variant character, detailed in Fang Shi Tong Ya. "Ren" means cooked food. Yi Zong Jin Jian attempts to change it to "Ren" and interprets extreme Cold as dietary cold/heat, which should not be followed. Tang Dalie's Wu Yi Hui Jiang interprets it as "Xin Ren", which is also incorrect. You states: Great pathogen is diffuse wind; although strong, its force is scattered, thus striking the Exterior. Small pathogen is wind through window cracks; although weak, its energy is sharp, thus striking the Interior. Cheng states: Wind and Cold are Great Pathogens, thus entering from the Exterior. "Ren" is Small Pathogen, thus entering through the mouth, i.e., later dietary injury to Spleen and Stomach. Both explanations are valid.
Question: In some diseases, it is urgent to rescue the Interior or the Exterior. What does this mean? The Master said: If a patient is treated with purgatives by a physician, and subsequently suffers from diarrhea with undigested food continuing endlessly, accompanied by body pain, it is urgent to rescue the Interior. Later, if the body pain persists but bowel movements and urination normalize, it is urgent to rescue the Exterior.
[Shen] This divides disease into Exterior and Interior, indicating treatment priorities. The question of urgently rescuing Interior or Exterior arises when the disease is in the Exterior, but the physician incorrectly uses purgation, damaging the righteous Qi of Spleen and Stomach, resulting in endless diarrhea with undigested food. Although body pain indicates unresolved Exterior syndrome, priority must be given to correcting the adverse effects of mistaken purgation. One cannot merely consider the Exterior pathogen, risking internal injury and sinking of deficiency. Only after Yuan Yang recovers and bowel/urinary functions normalize should one urgently rescue the Exterior. Why urgently rescue the Exterior? Because the newly recovered Interior Yang is not yet robust, and External pathogens may sink in, causing complications like Jie Xiong (Chest Binding) or Pi Man (Epigastric Fullness). (See detailed discussion in Shang Han Lun Ji Yi, Tai Yang Middle Section.)
Generally, when a chronic disease (Gu Ji) is complicated by an acute disease (Cu Bing), one should first treat the acute disease, and then treat the chronic disease.
[Jian] Zhao Liang says: Gu Ji refers to entrenched diseases that cannot be cured quickly. Cu Bing refers to sudden new-onset diseases that can be resolved quickly. Taking advantage of the pathogen not yet penetrating deeply, one should urgently eliminate it to prevent lingering complications. Moreover, patients with chronic diseases have inherently deficient Righteous Qi, making them more susceptible to pathogen transmission. If one hesitates, allowing both pathogens to combine, the harm will be significant. Thus, Zhang Zhongjing established this rule to teach future generations the order of treatment.
The Master said: Diseases of the Five Zang organs heal when they receive what suits them; however, each Zang organ has what it dislikes. Following what they dislike causes disease. If a patient who usually does not eat a certain food suddenly craves it intensely, fever will surely occur.
[Cheng] Nei Jing states: Liver color is green, suitable for eating Sweet taste; Heart color is red, suitable for eating Sour taste; Lung color is white, suitable for eating Bitter taste; Spleen color is yellow, suitable for eating Salty taste; Kidney color is black, suitable for eating Pungent taste. This describes healing through diet. Liver disease heals on Bing-Ding days, starting on Jia-Yi days; Heart disease heals on Wu-Ji days, starting on Bing-Ding days; Spleen disease heals on Geng-Xin days, starting on Wu-Ji days; Lung disease heals on Ren-Gui days, starting on Geng-Xin days; Kidney disease heals on Jia-Yi days, starting on Ren-Gui days. This is healing when each Zang obtains its proper position. What the Five Zang organs dislike: Heart dislikes Heat, Lung dislikes Cold, Liver dislikes Wind, Spleen dislikes Dampness, Kidney dislikes Dryness. Disease occurs by following what they dislike and do not enjoy. If a patient who usually avoids a food eats it excessively, the food enters Yin and nourishes Yang, inevitably causing fever. Lou Quanshan reads "bao si zhi" (suddenly craving) as "bao shi zhi" (eating excessively), which is considered correct.
Note: The section "Patients who usually should not eat..." likely belongs to another clause. Shen and You forcing it to connect with the preceding text is somewhat strained. The chapter on Post-Illness Labor and Recurrence states: "When the patient's pulse has resolved, but there is slight irritability at dusk, because the illness has just healed, people force them to eat, but Spleen and Stomach Qi are still weak and cannot digest the food, causing slight irritability. Reducing food intake leads to recovery." This illuminates the current clause.
For all diseases located in the Zang organs, if one wishes to attack them, one should follow what they have combined with to attack them. For example, for thirst, administer Zhu Ling Tang. Apply this principle to others.
[You] Formless pathogens, when entering and knotting in the Zang organs, must have something to rely upon. Water, Blood, Phlegm, and Food are all gathering places for pathogens. For instance, in cases of thirst, Water and Heat combine, and Heat knots in Water; thus, Zhu Ling Tang is given to promote urination, removing the Heat along with the Water. If Food is involved, Food and Heat combine, and Heat knots in Food; then Cheng Qi Tang should be used to purge the Food, removing the Heat. If there is nothing to combine with, how can formless pathogens be removed by purgative methods? Zhu Ling Tang formula is found later in the Thirst Syndrome section.
[Jian] After "For example, for thirst," the four characters "with difficulty in urination" should exist, likely lost in transcription. Zang organs refer to the Interior.