刘中道初得病。四肢逆冷。脐中筑痛。身疼如被杖。盖阴证也。急投金液来复之类。其脉得
沉而滑。盖沉者阴证也。滑者阳脉也。病虽阴而是阳脉。仲景所谓阴证见阳脉生也。于是再灸脐
下丹田百壮。谓手足温。阳回。体热。而汗解。
或问滑脉之状如何。曰仲景云翕奄沉名曰滑。古人论滑脉。虽云往来前却。流利展转。替替
然与数相似。曾未若仲景三语而足也。翕合也。言张而复合也。故云翕为正阳。沉言脉降而下也。
故曰沉为纯阴。方翕而合。俄降而下。奄谓奄忽之间复降也。仲景论滑脉。方为谛当也。
玄华得伤寒六七日。烦。昏。睡多吐呕。小便白色。自汗出。予诊其脉。寸口尺中俱紧。谓
曰寒中少阴经中。是以脉紧。当作少阴治也。仲景云病患脉紧反汗出。亡阳也。属少阴证。当咽
痛而复吐利。盖谓此也。
有难者曰。脉诀以紧为七表。仲景以紧为少阴。紧脉为阴耶。予曰寸口脉俱紧者。口中气出。
唇口干燥。蜷卧。足冷。鼻中涕出。舌上白苔。勿妄治也。又云紧则为寒。又云曾为人所难。紧
脉从何而来。师曰。假令亡汗若吐。以肺里寒。故令脉紧。又曰寸口脉微。尺中紧。其人虚损多
汗。由是观之。则是寒邪入经络所致。皆虚寒之脉也。其在阳经则浮而紧。在阴经则沉而紧。故
仲景云浮紧者名为伤寒。又云阳明脉浮而紧者。必潮湿。此在阳则脉浮而紧者。仲景又云病患脉
阴阳俱紧者。属少阴。又云寸口脉微。尺脉紧。其人虚损多
汗。则阴常在绝不见阳。又云少阴。脉紧至七八日。自下利。脉暴微。手足反温。脉紧反去者。
此欲解也。此在阴沉而紧也。仲景云浮为在表。沉为在里。数为在腑。迟为在脏。欲知表里脏腑。
先以浮沉迟数为定。然后兼余脉而定阳阴也。若于脉诀而言。则疏矣。故予尝谓伤寒脉者。当以
仲景脉为准法。
Liu Zhongdao initially contracted the disease. His four limbs were cold and inverted (cold extremities), there was severe throbbing pain in the navel, and his whole body ached as if beaten with a stick. This was a Yin syndrome (syndrome characterized by deficiency, cold, or interior pathology). He was urgently administered medicines similar to Jinye Dan (Golden Liquid Pill) and Laifu Dan (Returning Vitality Pill). His pulse became deep and slippery (smooth and flowing). A deep pulse indicates a Yin syndrome, while a slippery pulse is a Yang pulse (indicating excess or phlegm-dampness). Although the disease was Yin, the appearance of a Yang pulse aligns with Zhang Zhongjing’s statement that “Yin syndrome presenting with a Yang pulse indicates survival.” Consequently, he underwent moxibustion at the Dantian acupoint below the navel for one hundred moxa cones (zhuang). Subsequently, his hands and feet warmed, Yang qi returned, his body temperature rose, and he recovered through sweating.
Someone asked: What is the morphology of a slippery pulse? I replied: Zhang Zhongjing stated that “xi (gathering) and an (sudden) chen (deep)” constitutes a slippery pulse. Ancient discussions on the slippery pulse describe it as flowing smoothly back and forth, turning over and over, resembling a rapid pulse. However, none match the sufficiency of Zhang Zhongjing’s three terms. “Xi” means gathering; it refers to the pulse expanding and then closing, hence “Xi represents pure Yang.” “Chen” means the pulse descends, hence “Chen represents pure Yin.” Just as the pulse gathers and closes, it suddenly descends. “An” refers to the suddenness of this descent. Zhang Zhongjing’s discussion on the slippery pulse is therefore most accurate.
Xuanhua suffered from Shanghan (Cold Damage) for six or seven days, experiencing irritability, mental confusion, excessive sleepiness, vomiting, clear urine, and spontaneous sweating. Upon examining his pulse, both the Cun (inch) and Chi (cubit) positions were tight (string-taut). I said, “This is Cold invading the Shaoyin meridian, which causes the tight pulse. It should be treated as a Shaoyin disease.” Zhang Zhongjing stated: “If a patient has a tight pulse but sweats spontaneously, it indicates the loss of Yang qi.” This belongs to the Shaoyin syndrome, typically accompanied by sore throat and alternating vomiting and diarrhea. This describes exactly such a case.
A skeptic questioned: The Maijue (Pulse Classic) classifies the tight pulse among the Seven Superficial pulses (Yang pulses), whereas Zhang Zhongjing associates it with Shaoyin (Yin syndrome). Is the tight pulse Yin or Yang? I answered: If both Cun and Chi pulses are tight, accompanied by breath exiting the mouth, dry lips and tongue, curling up to lie down, cold feet, runny nose, and white coating on the tongue, do not treat rashly. It is also said that tightness indicates Cold. Someone once challenged: From where does the tight pulse arise? The Master said: For instance, if there is profuse sweating or vomiting leading to Cold in the Lung, the pulse becomes tight. It is also said: If the Cun pulse is faint and the Chi pulse is tight, the person suffers from deficiency and excessive sweating. From this, we see that this is caused by Cold pathogenic factors entering the meridians; these are all pulses of deficiency and Cold. When located in Yang meridians, the pulse is floating and tight; when in Yin meridians, it is deep and tight. Thus, Zhang Zhongjing stated that “floating and tight is named Shanghan.” He also said, “If the Yangming pulse is floating and tight, there must be dampness.” This refers to the situation in Yang meridians where the pulse is floating and tight. Zhang Zhongjing further stated: “If a patient’s pulse is tight at both Yin and Yang positions, it belongs to Shaoyin.” He also said: “If the Cun pulse is faint and the Chi pulse is tight, the person suffers from deficiency and excessive sweating,” implying that Yin remains constant while Yang is extinguished and unseen. He also stated: “In Shaoyin, if the pulse is tight and after seven or eight days, spontaneous diarrhea occurs, the pulse suddenly becomes faint, the hands and feet become warm, and the tightness disappears, this indicates impending resolution.” This refers to the situation in Yin meridians where the pulse is deep and tight. Zhang Zhongjing stated: “Floating indicates exterior, Deep indicates interior, Rapid indicates Fu organs, Slow indicates Zang organs.” To determine whether the pathology is in the exterior/interior or Zang/Fu, one must first establish the diagnosis using Floating, Deep, Rapid, and Slow, and then combine other pulse qualities to determine Yin and Yang. If relying on the Maijue, the theory is flawed. Therefore, I have often said that for Shanghan pulse diagnosis, one should take Zhang Zhongjing’s pulse methodology as the standard.