师曰。病患脉浮者在（关）前。（以关前为阳。）其病在表。浮者在（关）后。（
以关后为阴。）其病在里。（然关后虽为里之部位。而浮却非里证之正脉。不过为表
之里。而非里之里。故其病不在腹中少腹。而为）腰痛背强。（膝胫）不能行。（然形伤不去。
穷必及气。此关后脉浮，可以）必（其）短气而（为此证之）极也。
浮脉原主表。此于浮脉中分出表里。欲人知浮脉之变也。推之沉脉原主里。亦可于
沉脉中分出表里。迟脉原主寒。数脉原主热。更无不可于迟数中分出寒热也。是亦望
乎一隅而三反之。
问曰。经云、厥阳独行。何谓也。师曰。（阴阳偕行者。顺也。）此为有阳无阴。故
称厥阳。（厥者逆也。阴阳独行。逆而不顺之谓也。）
此举厥阳为问答。以见阴阳之不可偏也。内经云、阴平阳秘。精神乃治。阴阳离决。
精神乃绝。阴阳之道大矣哉。尤在泾云、厥阳独行者。孤阳之气。厥而上行。阳失阴
则越。犹夫无妻则荡也。千金方云。阴脉且解。血散不通。正阳遂厥。阴不往从。此即厥
阳独行之旨欤。
问曰。（两手）寸脉（乃心肺之部位。不见其浮。但见）沉大而（且）滑。沉则为
实。（谓血之实也。）滑则为气。（谓气之实也。）实（与）气（并两实）相搏。血气
入脏即死。入腑即愈。此（名）为卒厥。（以脏腑分其生死。）何谓也。师曰。（脏如
宝藏之藏。义取深藏。实邪一入而不出。故）唇口青身冷。为入脏。即死。（腑如外府
之府。本司出纳。实邪可入而可出。）如身和汗自出。为入腑。即愈。
此言邪气盛则实之生死也。尤在泾云、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。气复返则生。不返则死。是
也。
问曰。（邪气盛则实。正气夺则虚。如脉大而滑。实邪之强有力。脏固不能当其猛
矣。今卒厥。病脉不大而小。不滑而涩。尽脱去大且滑之象。因而别之曰）脉脱（是脱
换之脱。非脱散之脱。但脉既脱换。虚实悬殊。入脏入腑。吉凶亦宜更易。而仍守）入
脏即死。入腑即愈（之说。）何谓也。师曰。（斯说也。大旨以出阳为浅。传阴为深。
）非为（卒厥）一病。（凡）百病（入脏入腑）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。（盖以口属阴。四肢属阳。阴阳分属脏腑。脏腑二字。
隐而难测。以里外二字该之。浅而易晓。吾特为丁宁曰。凡）病在外者可治。入里者
即死。
此言正气夺则虚之生死也。按此因卒厥而推言百病。脉脱二字。诸家俱误解。
李玮西云、病在外二句。概指诸病而言。即上百病皆然之意。入里者死。如痹气入
腹。香港脚冲心之类。
问曰。阳病十八。何谓也。师曰。（三阳之气。主躯壳之外。如）头痛。项腰脊臂
脚掣痛。（六者虽兼上下。却以其在躯壳之外。故谓之阳病。病在外者。有营病卫病营卫
兼病之殊。是一病而有三也。三而六之。故合为十八病也。又问曰）阴病十八。何谓也。
师曰。（三阴之气。主躯壳之里。如）咳、上气喘哕咽肠鸣胀满心痛拘急。（九者虽兼
脏腑。以其在躯壳之里。故谓之阴病。病在里有或虚或实之异。是一病而有二也。九而
二之。故合为十八病也。然三阴三阳。六气之传变无形也。五脏六腑。脏腑之病证有形
也。脏腑受风寒暑湿燥火六淫之邪。又各有气分血分气血并受之三端。六而三之。则为
十八。）五脏病各有十八。合（而计之共）为九十病。人又有六（腑之病。视腑稍）微。
微有十八病。合（而计之共）为一百八病。（其数各井然而不紊。至于久视伤血。久
卧伤气。久坐伤肉。久立伤骨。久行伤筋。名为）五劳。（大饱伤脾。大怒气逆伤肝。
强力举重坐湿地伤肾。形寒饮冷伤肺。忧愁思虑伤心。风雨寒暑伤形。大怒恐惧不节伤
志。名为）七伤。（气极血极筋骨极肌极精极。名为）六极。妇人（十二瘕九痛七害五
伤三因。共计）三十六病。（非六气外淫所致。均）不在其中。（学人自当分别而论
也。虽然。以上所言阴阳脏腑各证。皆就人身之受邪者。分其名目。犹未就邪气之分属。
而究其所以然也。大抵轻）清（之）邪居上。（重）浊（之）邪居下。（从天得者。
为）大邪中表。（从人得者。为）小邪中里。 饪之邪从口入者。（为）宿食也。五邪中人。（以类相从。）各有法
度。风（为阳类而）中于（午）前。寒（为阴类而）中于暮。湿（重浊而）伤于下。雾
（轻清而）伤于上。（再验之一身。）风（为阳邪）令脉（缓而）
浮。寒（为阴邪）令脉（紧而）急。雾（邪轻清而）伤皮腠。湿（邪重浊而）流关节。
（宿）食（止）伤脾胃。（而不及经络腠理。）极寒（之时。令阳内伏而不固外。病多
）伤经。极热（之时。令阳浮于外。而暑热并之。汗出则络伤。病多）伤络。（合而
言之。无非以类相从之理也。）
此一节由阴阳脏腑五邪之分合异同。经气时候原委。以及所当然者如彼。所以然者
如此。欲学人体认于文本之外。则得矣。附录千金妇人三十六病。以备参考。十二瘕者。
谓所下之物。一如青泥。二如青血。三如紫汁。四如赤皮。五如脓痂。六如豆汁。七
如葵羹。八如凝血。九如青血似水。十如米汁。十一如月浣。十二如经度不应期也。九
痛者。一阴中痛伤。二阴中淋痛。三小便即痛。四寒冷痛。五月水来腹痛。六气满注痛。
七汗出阴如虫啮痛。八胁下痛。九腰痛。七害者。一害食。二害气。三害冷。四害劳。
五害房。六害娠。七害睡。五伤者。一孔痛。二中寒热痛。三小肠急牢痛。四脏不仁。
五子门不正。三因者。一月水闭塞不通。二绝产乳。三羸瘦不生肌肉。又康熙字典 字注
云、读与馨同。吴医唐立三云。饪为烹调生熟之节。则 饪句。为 香可口过食之而停
滞也。
问曰。病有急当救里救表者。何谓也。师曰。病（为）医（者误）下之。续得下利
清谷不止。（里证甚急。而）身体疼痛者。（表证亦不可缓。二者相权。）急当（先）
救（其下利清谷之）里。（姑且）后（其表之）身（体）疼痛。（若服药后）清便自调
（而身仍痛）者。急当救表也。
此言证有表里之殊。治有缓急之异也。伤寒论中最详。不必多赘。
夫病（者。有平时之）痼疾。（而）加以（一时之）卒病。（卒者易攻。痼者难拔。
审其先后。）当先治其卒病。后乃治其痼疾也。
前言病有表里之不同。治者权缓急而分其先后。此言病有新旧之不同。治者审难易
而分其先后也。
师曰。五腑病各有所得者愈。（有得之情志相胜者。如怒伤肝。得悲而愈。悲胜怒
之类。有得之时日者。如病在肝。愈于夏。喜得子气。制其胜我之类。有得之饮食者。
肝色青。宜食甘。心色赤。宜食酸。肺色白。宜食苦。脾色黄。宜食酸。肾色黑。宜
食辛是也。有得之自得其位者。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。起于壬癸是也。）五脏
病各有所恶。（心恶热。肺恶寒。肝恶风。脾恶湿。肾恶燥是也。而且）各随其所不
喜者为病。（何以谓之不喜。与其各有得者相反皆是。不仅以所恶为不喜也。姑即所
不喜者。举一端而言之。）病有素不应食。而反暴思之。（是脏气为邪气所变。而食
之转助病气。）必发热也。（若伤寒证渴欲饮水少与之法。不在此例也。）
此一节言病以脏气为本也。五脏病以有所得而愈者。谓得其所宜。足以安脏气而
却病气也。各有所恶。各随其所不喜为病者。谓失其所宜。适以忤脏气而
助病邪也。所得所恶所不喜。着一所字。所包者广。
夫诸病在脏。（法宜攻下。而阳明入腑则不传。腑犹脏治也。若果实在肠胃。虽十
日不更衣。无所苦。谓不宜急下也。而惟阳明少阴中。有急下之证。夫曰急下。似当直
攻而无疑矣。然攻之一法。最为元妙。若）欲攻之。当随其所（同中）得（其所独）而
攻之。（阳明中得其急下三证。一曰六七日。目中不了了。睛不和。一曰阳明病发热汗
多者。一曰发汗不解腹满痛者。此急防其悍气盛而阴绝也。少阴中得其急下三证。一曰
少阴病得之二三日。口燥舌干者。一曰少阴病自利清水。色纯青。心下必痛。口干燥者。
一曰少阴病六七日。腹胀不大便者。此急防其火不戢将自焚也。）如（所得者不在可
攻之例。第见其）渴者。（即论中所云。少阴病。下利六七日。咳而呕渴。心烦不得眠
者是也。阳明病。脉浮发热。渴欲饮水。小便不利者是也。二证均）与猪苓汤。（寓育
阴于利水之中。则热从小便去。而渴亦止。此与攻下法相表里也。）余皆仿此。
此一节言邪之在脏者宜攻。而攻法之神妙者。在于随其所得四字。徐忠可顺文敷衍。
绝无发明。尤在泾以水血痰食。添出蛇足。二君皆未得言中之旨。
老师说：病人脉象浮，在关脉的前部（以关前为阳位）。这说明病邪在表。脉象浮，在关脉的后部（以关后为阴位）。这说明病邪在里。（然而关后虽然属于里的部位，但浮脉并不是里证的典型脉象，只是表证影响到了里，而不是真正的里证。所以病不在腹部或少腹，而是）腰痛、背部僵硬、（膝盖和小腿）不能行走。（如果形体损伤久治不愈，最终必会伤及气机。这种关后脉浮的情况，可以推断出必然会出现）短气并且达到这种症状的极点。
浮脉原本主表证，这里从浮脉中区分出表里，是为了让人了解浮脉的变化。推而广之，沉脉原本主里证，也可以从沉脉中区分出表里；迟脉原本主寒证，数脉原本主热证，更可以在迟数和数脉中区分出寒热。这也是通过观察一个方面而能举一反三的道理。
问：医经说“厥阳独行”，这是什么意思？老师说：（阴阳协调运行是顺证。）这是只有阳而没有阴，所以称为厥阳。（厥的意思是逆乱。阴阳单独运行，就是逆乱而不顺的意思。）
这里举出厥阳作为问答，是为了说明阴阳不可偏废。《内经》说：“阴平阳秘，精神乃治；阴阳离决，精神乃绝。”阴阳之道真是伟大啊！尤在泾说：“厥阳独行的，是指孤阳之气，逆乱而上行。阳气失去阴液的制约就会外越，就像没有妻子就会放荡一样。”《千金方》说：“阴脉松弛，血液散乱不通，正阳于是逆乱，阴气不再跟随。这就是厥阳独行的旨意吧？”
问：（两手）寸脉（是心和肺的部位，不见其浮，只见到）沉大而（且）滑。沉脉代表血实。（指血的实证。）滑脉代表气实。（指气的实证。）实邪与气实相互搏结，血气进入脏就会死，进入腑就会好。这（名叫）卒厥。（用脏腑来区分生死预后。）这是什么意思呢？老师说：（脏如同宝藏之库，义取深藏之意，实邪一旦进入就无法排出，所以）嘴唇发青、身体冰冷，这是邪气入脏，就会死亡。（腑如同外府之署，本来主管纳受和排泄，实邪可以进入也可以排出。）如果身体温和、汗自出，这是邪气入腑，就会痊愈。
这段话讲的是邪气盛则实的生死预后。尤在泾说：“实指的是血实，气指的是气实。实与气相搏，就是血与气并聚而都呈实证状态。五脏的功能是藏精气而不泻，血气进入其中，突然无法返还，神气离去，机能停止，就会出现唇青身冷而死。六腑的功能是传化物而不藏，血气进入其中，时而满溢时而排泄，气还血行，就会身体温和、出汗而痊愈。”《内经》说：“血与气，并走于上，就会发生大厥。厥则暴死，如果气能返回则生，不返回则死。”说的就是这个道理。
问：（邪气盛则实，正气夺则虚。如脉大而滑，是实邪强有力，脏固然承受不住它的猛烈。现在卒厥，病脉不大而小，不滑而涩，完全脱去了大且滑的表象，因此另外称之为）脉脱（这里的“脱”是变换、更替的意思，不是脱散的意思。既然脉象已经变换，虚实悬殊，入脏入腑的吉凶也应当改变，但仍然坚持）入脏即死、入腑即愈（的说法。）这是什么意思？老师说：（这个说法的大意是以出阳为浅，传入阴为深。）并不是针对（卒厥）这一种病。（凡是）各种疾病（入脏入腑）都是这样的。譬如浸淫疮，从口开始流向四肢的可以治疗，从四肢流回入口的不可治疗。（因为口属阴，四肢属阳，阴阳分别归属于脏腑，脏腑二字隐晦难测，用表里二字概括，浅显易懂。我特别叮嘱大家：凡）病在表的可治，入里的即死。
这段话讲的是正气夺则虚的生死预后。按此因卒厥而推论百病。“脉脱”二字，各家都误解了。李玮西说：“病在外二句，概指诸病而言，即上百病皆然的意思。入里者死，如痹气入腹、香港脚冲心之类。”
问：阳病有十八种，是什么？老师说：（三阳之气，主管躯壳之外，如）头痛、项背腰脊臂脚掣痛。（这六种病虽兼涉上下，但因为它们在躯壳之外，所以称为阳病。病在外的，有营病、卫病、营卫兼病的区别，是一种病而有三种情况。三乘以六，所以合为十八病。）又问：阴病有十八种，是什么？老师说：（三阴之气，主管躯壳之里，如）咳、上气喘哕、咽痛、肠鸣、胀满、心痛、拘急。（这九种病虽兼涉脏腑，但因为它们在躯壳之里，所以称为阴病。病在里的，或有虚或实的不同，是一种病而有两种情况。九乘以二，所以合为十八病。然而三阴三阳，六气的传变是无形的；五脏六腑，脏腑的病证是有形的。脏腑受到风寒暑湿燥火六淫之邪的侵袭，又各有气分、血分、气血并受这三种情况。六乘以三，则为十八。）五脏病各有十八种，合计（共）为九十病。人又有六腑的病，比腑稍轻，轻微有十八种病，合计（共）为一百零八病。（这些数目各自井然有序不紊乱。至于久视伤血，久卧伤气，久坐伤肉，久立伤骨，久行伤筋，名为）五劳。（饱食过度伤脾，大怒气逆伤肝，强力举重坐湿地伤肾，形寒饮冷伤肺，忧愁思虑伤心，风雨寒暑伤形，大怒恐惧不节伤志，名为）七伤。（气极、血极、筋骨极、肌极、精极，名为）六极。妇人（十二瘕、九痛、七害、五伤、三因，共计）三十六病。（并非由六气外淫所致，均）不在上述分类中。（学者应当分别论述。虽然如此，以上所言阴阳脏腑各证，都是从人身受邪的角度，区分其名目，还没有就邪气的分属，去探究其所以然的道理。大抵轻）清（之）邪居上。（重）浊（之）邪居下。（从天而来的，为）大邪中表。（从人而来的，为）小邪中里。饮食之邪从口入者，（为）宿食。五邪中人，（以类相从。）各有法度。风（为阳类而）中于（午）前，寒（为阴类而）中于暮，湿（重浊而）伤于下，雾（轻清而）伤于上。（再验证于全身。）风（为阳邪）令脉（缓而）浮，寒（为阴邪）令脉（紧而）急，雾（邪轻清而）伤皮腠，湿（邪重浊而）流关节。（宿）食（仅）伤脾胃。（而不涉及经络腠理。）极寒（之时，令阳气内伏而不能固护体表，病多）伤经。极热（之时，令阳气浮于外，而暑热并至，汗出则络伤，病多）伤络。（总而言之，无非是以类相从的道理。）
这一段由阴阳脏腑五邪的分合异同，经气运行的时候原委，以及所当然者如彼，所以然者如此。想要学习的人要在文本之外体认，就能得到了。附录《千金方》妇人三十六病，以备参考。十二瘕，谓所下之物，一如青泥，二如青血，三如紫汁，四如赤皮，五如脓痂，六如豆汁，七如葵羹，八如凝血，九如青血似水，十如米汁，十一如月浣（月经），十二如经度不应期（月经周期不准）。九痛者，一阴中痛伤，二阴中淋痛，三小便即痛，四寒冷痛，五月水来腹痛，六气满注痛，七汗出阴如虫啮痛，八胁下痛，九腰痛。七害者，一害食，二害气，三害冷，四害劳，五害房，六害娠，七害睡。五伤者，一孔痛，二中寒热痛，三小肠急牢痛，四脏不仁，五子门不正。三因者，一月水闭塞不通，二绝产乳，三羸瘦不生肌肉。又《康熙字典》字注云：“读与馨同。”吴医唐立三说：“饪为烹调生熟之节，则‘饪’句，为香可口过食之而停滞也。”
问：病有急当救里、救表的，是什么意思？老师说：病（被医生误）下之后，接着出现下利清谷不止。（里证非常紧急，而）身体疼痛。（表证也不可迟缓，两者权衡。）急当（先）救（其下利清谷之）里。（暂时搁置）后（处理表之）身（体）疼痛。（如果服药后）大便正常（而身仍痛）者，急当救表也。
这段话讲的是证有表里之分，治有缓急之别。《伤寒论》中讲得很详细，不必多赘。
夫病（有平时之）痼疾。（而）加上（一时之）卒病。（卒病易攻，痼疾难拔。审察其先后。）应当先治其卒病，然后才治其痼疾。
前面讲病有表里之不同，治疗者权衡缓急而分其先后；这里讲病有新旧之不同，治疗者审察难易而分其先后。
老师说：五脏病各有所得者愈。（“得”的情志相胜者，如怒伤肝，得悲而愈，悲胜怒之类；“得”之时日者，如病在肝，愈于夏，喜得子气，制其胜我之类；“得”之饮食者，肝色青，宜食甘，心色赤，宜食酸，肺色白，宜食苦，脾色黄，宜食酸，肾色黑，宜食辛是也；“得”之自得其位者，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，起于壬癸是也。）五脏病各有所恶。（心恶热，肺恶寒，肝恶风，脾恶湿，肾恶燥是也。而且）各随其所不喜者为病。（什么叫不喜？与其各有得者相反皆是，不仅以所恶为不喜。姑且就所不喜者，举一端而言之。）病有素不应食，而反暴思之。（这是脏气为邪气所变，而食之转助病气。）必发热也。（若伤寒证渴欲饮水少与之法，不在此例。）
这一段讲的是病以脏气为本。五脏病以有所得而愈，谓得其所宜，足以安脏气而却病气。各有所恶，各随其所不喜为病，谓失其所宜，适以忤脏气而助病邪。所得、所恶、所不喜，着一“所”字，所包者广。
夫诸病在脏，（法宜攻下，而阳明入腑则不传，腑犹脏治也。若果实在肠胃，虽十日不更衣，无所苦，谓不宜急下也。而惟阳明少阴中，有急下之证。夫曰急下，似当直攻而无疑矣。然攻之一法，最为元妙。若）欲攻之，当随其所（同中）得（其所独）而攻之。（阳明中得其急下三证，一曰六七日，目中不了了，睛不和；一曰阳明病发热汗多者；一曰发汗不解腹满痛者。此急防其悍气盛而阴绝也。少阴中得其急下三证，一曰少阴病得之二三日，口燥舌干者；一曰少阴病自利清水，色纯青，心下必痛，口干燥者；一曰少阴病六七日，腹胀不大便者。此急防其火不戢将自焚也。）如（所得者不在可攻之例，第见其）渴者。（即论中所云，少阴病，下利六七日，咳而呕渴，心烦不得眠者是也。阳明病，脉浮发热，渴欲饮水，小便不利者是也。二证均）与猪苓汤。（寓育阴于利水之中，则热从小便去，而渴亦止。此与攻下法相表里也。）余皆仿此。
这一段讲的是邪之在脏者宜攻，而攻法之神妙者，在于“随其所得”四字。徐忠可顺文敷衍，绝无发明；尤在泾以水血痰食添出蛇足。二君皆未得言中之旨。
The Master said: When a patient's pulse is floating at the anterior part of the Guan position (the anterior part of the Guan is considered Yang), the disease is in the Exterior. When the pulse is floating at the posterior part of the Guan position (the posterior part of the Guan is considered Yin), the disease is in the Interior. (However, although the posterior Guan belongs to the Interior region, a floating pulse is not the typical pulse for an Interior syndrome; it merely indicates that the Exterior pathogen has affected the Interior, rather than being a true Interior condition. Therefore, the disease is not located in the abdomen or hypogastrium, but manifests as) lower back pain, stiffness of the back, (and inability to walk due to) knee and calf issues. (If physical injury persists untreated, it will inevitably affect Qi. In cases where the pulse floats at the posterior Guan, one can infer that there will inevitably be shortness of breath, reaching the extreme of these symptoms.)
The floating pulse originally indicates the Exterior. Here, distinguishing between Exterior and Interior within the floating pulse aims to make practitioners understand the variations of the floating pulse. By extension, the deep pulse originally indicates the Interior, yet one can also distinguish between Exterior and Interior within the deep pulse; the slow pulse originally indicates Cold, and the rapid pulse originally indicates Heat, so it is equally valid to distinguish between Cold and Heat within slow and rapid pulses. This is also a matter of inferring three aspects from observing one corner (using induction).
Question: The classics state, "Jue Yang travels alone." What does this mean? The Master said: (When Yin and Yang move together, it is smooth/harmonious.) This refers to having Yang without Yin, hence called Jue Yang. ("Jue" means rebellion/reversal. Yin and Yang moving independently implies reversal and lack of harmony.)
This dialogue on Jue Yang serves to illustrate that Yin and Yang cannot be neglected. The *Neijing* states: "When Yin is peaceful and Yang is firm, spirit thrives; when Yin and Yang separate, spirit perishes." The Way of Yin and Yang is truly great! You Zaijing stated: "In Jue Yang traveling alone, it refers to solitary Yang Qi rebelling and ascending. When Yang loses its Yin constraint, it scatters outward, just as a man without a wife may become dissolute." The *Qianjin Fang* states: "When Yin pulses relax, blood scatters and flow obstructs; Zheng Yang rebels, and Yin fails to follow. This is the essence of Jue Yang traveling alone."
Question: (The Cun pulse of both hands) represents the locations of the Heart and Lung. It does not appear floating, but rather deep, large, and slippery. A deep pulse indicates Blood excess (meaning excess of Blood). A slippery pulse indicates Qi excess (meaning excess of Qi). When Excess (of Blood) and Qi (excess) contend with each other, if Blood and Qi enter the Zang organs, death ensues; if they enter the Fu organs, recovery occurs. This is named sudden syncope (Zuì Jué) (distinguishing life and death based on Zang and Fu). What does this mean? The Master said: (Zang organs are like treasuries, implying deep storage; once excess pathogens enter, they cannot exit. Thus,) bluish lips and cold body indicate entry into the Zang organs, leading to death. (Fu organs are like external offices, originally responsible for intake and discharge; excess pathogens can enter and exit.) If the body is warm and sweat occurs spontaneously, it indicates entry into the Fu organs, leading to recovery.
This passage discusses life and death outcomes when pathogens are excessive (Excess syndromes). You Zaijing stated: "Excess refers to Blood excess, and Qi refers to Qi excess. When Excess and Qi contend, Blood and Qi gather together in an excess state. The Five Zang organs store essence and do not drain; if Blood and Qi enter, they suddenly cannot return. Spirit departs, mechanisms cease, resulting in death with bluish lips and cold body. The Six Fu organs transmit transformations and do not store; if Blood and Qi enter, they fill and empty intermittently. When Qi returns and Blood flows, the body becomes warm and sweating occurs, leading to recovery." The classics state: "When Blood and Qi rush upward together, it causes Great Syncope. Syncope leads to sudden death; if Qi returns, life is preserved; if it does not return, death occurs." This refers to such cases.
Question: (Pathogens becoming excessive constitutes Excess; loss of healthy Qi constitutes Deficiency. For instance, a large and slippery pulse indicates strong and powerful excess pathogens, which the Zang organs naturally cannot withstand. However, in sudden syncope, the pathological pulse is not large but small, not slippery but choppy, completely shedding the appearance of large and slippery. Hence, it is distinguished as) Pulse Transformation (here, "Tuo/Transformation" means change/transformation, not dispersion/collapse. Since the pulse has transformed, the disparity between Excess and Deficiency is significant, and the prognosis of entering Zang or Fu should also change, yet we still adhere to the theory that) entry into Zang leads to death, and entry into Fu leads to recovery. What does this mean? The Master said: (The main idea of this statement is that emerging to Yang is shallow, while transmitting to Yin is deep.) This is not specific to (sudden syncope) alone. (For all) diseases (entering Zang or Fu), this principle applies. For example, in impetigo-like sores, if they start from the mouth and flow to the limbs, they are treatable; if they start from the limbs and flow back to the mouth, they are untreatable. (Because the mouth belongs to Yin, and limbs belong to Yang. Yin and Yang correspond to Zang and Fu respectively. The terms Zang and Fu are obscure and difficult to fathom, whereas Superficial and Interior are comprehensive and easy to understand. I specifically warn you: Any) disease remaining in the Exterior is treatable; entering the Interior leads to death.
This section discusses life and death outcomes when healthy Qi is depleted (Deficiency syndromes). This reasoning extends from sudden syncope to all diseases. The term "Pulse Transformation" has been misunderstood by various commentators. Li Weixi stated: "The sentences 'Disease in the Exterior' generally refer to all diseases, meaning the same applies to hundreds of diseases. 'Entering Interior leads to death' includes conditions like Bi-Qi entering the abdomen or gout attacking the heart."
Question: There are eighteen types of Yang diseases. What are they? The Master said: (The Qi of the Three Yang channels governs the exterior of the body shell, such as) headache, neck/back/waist/spine/arm/leg pulling pain. (Although these six involve upper and lower parts, because they are outside the body shell, they are called Yang diseases. Diseases in the Exterior have distinctions among Ying-Nutrient disease, Wei-Defensive disease, and combined Ying-Wei disease. Thus, one disease type has three variations. Three multiplied by six equals eighteen diseases.) Question: There are eighteen types of Yin diseases. What are they? The Master said: (The Qi of the Three Yin channels governs the interior of the body shell, such as) cough, asthma/wheezing, hiccups, throat pain, borborygmus, distension/fullness, heart pain, and spasms/tightness. (Although these nine involve Zang and Fu, because they are inside the body shell, they are called Yin diseases. Diseases in the Interior have differences between Deficiency and Excess. Thus, one disease type has two variations. Nine multiplied by two equals eighteen diseases. However, the transmission of the Six Qi (Three Yin and Three Yang) is formless, whereas the diseases of the Five Zang and Six Fu organs are有形 (form-based). When Zang and Fu are invaded by the Six Pathogenic Factors (Wind, Cold, Summerheat, Dampness, Dryness, Fire), they further involve Qi level, Blood level, or combined Qi-Blood involvement—three categories. Six multiplied by three equals eighteen.) Each of the Five Zang organs has eighteen diseases, totaling ninety diseases. Humans also have diseases of the Six Fu organs, which are slightly milder, amounting to eighteen diseases, totaling one hundred and eight diseases. (These numbers are orderly and distinct. As for prolonged vision damaging Blood, prolonged lying damaging Qi, prolonged sitting damaging Flesh, prolonged standing damaging Bone, and prolonged walking damaging Sinew, these are named) Five Exhaustions. (Overeating damages Spleen, intense anger causing Qi rebellion damages Liver, heavy lifting while sitting on damp ground damages Kidney, cold exposure and drinking cold beverages damage Lung, sorrow and worry damaging Heart, wind/rain/cold/summerheat damaging Form, and intense anger/fear/immoderation damaging Will/Zhi, these are named) Seven Damages. (Extreme exhaustion of Qi, Blood, Sinew/Bone, Muscle, and Essence, these are named) Six Extremes. Women have (Twelve Masses, Nine Pains, Seven Harms, Five Damages, and Three Causes, totaling) Thirty-Six Diseases. (These are not caused by the Six External Pathogens and are thus) not included in the above classifications. (Students should discuss them separately. Although, the aforementioned Yin/Yang and Zang/Fu syndromes are categorized based on pathogen invasion in the human body, naming them without exploring the attribution of pathogens and their underlying causes. Generally, Light/Clear) pathogens reside superiorly. (Heavy/Turbid) pathogens reside inferiorly. (Those derived from Heaven constitute) Major Pathogens affecting the Exterior. (Those derived from Human activities constitute) Minor Pathogens affecting the Interior. Dietary pathogens entering via the mouth (constitute) retained food. The Five Pathogens invading humans (follow similar categories.) each having its own rules. Wind (being Yang category) attacks before noon. Cold (being Yin category) attacks in the evening. Dampness (being heavy/turbid) injures the lower body. Fog/Mist (being light/clear) injures the upper body. (Verifying this on the whole body:) Wind (being Yang pathogen) makes the pulse (slow and) floating. Cold (being Yin pathogen) makes the pulse (tight and) rapid. Mist (light/clear pathogen) injures skin and pores. Dampness (heavy/turbid pathogen) flows into joints. (Retained) food (only) damages Spleen and Stomach. (Without involving meridians and pores.) Extreme Cold (causes Yang to hide internally and fail to protect the exterior, so diseases mostly) damage meridians. Extreme Heat (causes Yang to float externally, combining with summerheat; sweating damages collaterals, so diseases mostly) damage collaterals. (In summary, this is nothing but the principle of similarity attracting similarity.)
This section covers the division, combination, differences, and similarities of Yin/Yang, Zang/Fu, and Five Pathogens; the origins and timing of Jing-Qi circulation; what ought to happen as described, and why it happens as explained. Those who study should comprehend this beyond the text itself. Appendix: Thirty-Six Diseases of Women from *Qianjin Fang*, for reference. Twelve Masses (Xia): discharge resembling 1. green mud, 2. green blood, 3. purple juice, 4. red skin, 5. pus crust, 6. bean soup, 7. okra soup, 8. clotted blood, 9. green blood like water, 10. rice water, 11. menstrual wash, 12. irregular menstruation cycle. Nine Pains: 1. pain in yin organ injury, 2. painful dripping in yin organ, 3. immediate pain upon urination, 4. cold pain, 5. abdominal pain during menstruation, 6. fullness/pain from Qi stagnation, 7. pain in yin organ like insect bite after sweating, 8. hypochondriac pain, 9. lower back pain. Seven Harms: 1. harm from food, 2. harm from Qi, 3. harm from cold, 4. harm from labor, 5. harm from sexual activity, 6. harm from pregnancy, 7. harm from sleep. Five Damages: 1. orifice pain, 2. alternating cold/heat pain, 3. urgent/stiff small intestine pain, 4. numbness of Zang organs, 5. abnormal cervical opening. Three Causes: 1. amenorrhea/blockage, 2. infertility/miscarriage, 3. emaciation/lack of muscle growth. Also, *Kangxi Dictionary* annotation says: "Read as 'Xin' (fragrant)." Physician Tang Lisan of Wu states: "Ren refers to the degree of cooking raw and cooked food. Thus, the 'Ren' sentence refers to stopping/stagnation caused by overeating delicious, fragrant food."
Question: In diseases, there are urgent cases requiring rescue of the Interior or rescue of the Exterior. What does this mean? The Master said: If a disease (is mistakenly treated with purgatives by the physician), followed by continuous diarrhea with undigested food. (The Interior syndrome is extremely urgent, while) body pain exists. (Both conditions require attention, but weighing them,) urgently rescue (the Interior first, specifically the) diarrhea with undigested food. (Temporarily defer treating the Exterior) body pain. (If after medication) bowel movements normalize (while body pain persists,) urgently rescue the Exterior.
This explains that syndromes differ in Exterior/Interior nature, and treatments differ in urgency. This is detailed in the *Shanghan Lun*; no need for further elaboration.
Regarding diseases, (there are chronic) entrenched diseases. (Added to) acute/sudden diseases. (Acute diseases are easier to attack; entrenched diseases are hard to eradicate. Assessing the sequence.) One should first treat the acute disease, then treat the entrenched disease.
The previous section discussed differences in Exterior/Interior, where treatment prioritizes urgency. This section discusses differences in New/Old diseases, where treatment prioritizes difficulty/ease.
The Master said: Diseases of the Five Zang organs heal when they obtain favorable conditions. (Favorable conditions include emotional counteraction, e.g., anger damages Liver, healed by grief, as grief conquers anger; temporal favorability, e.g., Liver disease heals in Summer, benefiting from Zi/Water element controlling Wood; dietary favorability, e.g., Liver color is Green, suitable for Sweet taste; Heart color is Red, suitable for Sour taste; Lung color is White, suitable for Bitter taste; Spleen color is Yellow, suitable for Sour taste; Kidney color is Black, suitable for Pungent taste; positional favorability, e.g., Liver disease heals on Bing/Ding days, starts on Jia/Yi days; Heart disease heals on Wu/Ji days, starts on Bing/Ding days; Spleen disease heals on Geng/Xin days, starts on Wu/Ji days; Lung disease heals on Ren/Gui days, starts on Geng/Xin days; Kidney disease heals on Jia/Yi days, starts on Ren/Gui days.) Diseases of the Five Zang organs each have aversions. (Heart dislikes Heat, Lung dislikes Cold, Liver dislikes Wind, Spleen dislikes Dampness, Kidney dislikes Dryness. Moreover,) each develops pathology according to what it dislikes. (Why call it dislike? It is opposite to what is favorable, not just limited to what is abhorred. Taking one aspect of what is disliked as an example:) Patients may crave foods they normally shouldn't eat. (This indicates Zang Qi has been altered by pathogens, and eating such foods aids the pathogenic Qi.) It will definitely cause fever. (Note: The method for thirst and desire for water in Cold Damage syndromes is not included here.)
This section emphasizes that disease is rooted in Zang Qi. Healing through obtaining favorable conditions means obtaining what is suitable, stabilizing Zang Qi, and repelling pathogenic Qi. Having aversions and developing pathology based on dislikes means losing suitability, offending Zang Qi, and aiding pathogens. The word "Suò" (that which) in "Suo De" (what is obtained), "Suo E" (what is abhorred), and "Suo Bu Xi" (what is disliked) encompasses a broad range.
For all diseases located in the Zang organs, the method should ideally be purgation. However, when Yangming enters the Fu organs, it does not transmit further; treating Fu like Zang is applicable. If there is actual accumulation in the intestines and stomach, even if ten days pass without defecation, there is no distress, indicating urgent purgation is not suitable. Only in Yangming and Shaoyin are there indications for urgent purgation. Urgent purgation seems to imply direct attack without doubt. However, the method of attack is most subtle. If) intending to attack, one should attack according to what is uniquely obtained (within the commonality). (Yangming has three urgent purgation indications: 1. After six or seven days, eyes are unclear and pupils are unresponsive; 2. Yangming disease with fever and profuse sweating; 3. Failure to resolve after sweating, with abdominal fullness and pain. These urgently prevent vigorous Qi from becoming excessive and Yin from perishing. Shaoyin has three urgent purgation indications: 1. Shaoyin disease for two or three days with dry mouth and tongue; 2. Shaoyin disease with spontaneous diarrhea of clear water, pure green color, pain in the epigastrium, and dry mouth; 3. Shaoyin disease for six or seven days with abdominal distension and constipation. These urgently prevent fire from raging and self-immolation.) If (the obtained factor is not in the category for purgation, but only presents with) thirst. (As mentioned in the Treatise: Shaoyin disease with diarrhea for six or seven days, cough, vomiting, thirst, irritability, and insomnia; or Yangming disease with floating pulse, fever, desire to drink water, and dysuria. Both cases) administer Zhu Ling Tang. (Nurturing Yin within diuresis allows heat to exit via urine, stopping thirst. This is complementary to the purgation method.) Others follow this pattern.
This section states that pathogens in Zang organs should be attacked, and the subtlety of attack lies in the four characters "following what is obtained." Xu Zhongke merely expanded on the text without insight; You Zaijing added extraneous elements like water, blood, phlegm, and food. Neither understood the core intent.