可汗 脉浮大者应发汗医反下之此为大逆
可吐 病患手足厥冷脉乍结以客气在胸中心下满而烦欲食不能食者病在胸中当吐之 病胸上诸实胸中郁郁而痛不能
食欲使人按之而反有涎唾下利日十余行其脉反迟寸口脉微涩吐之利即止宿食在上脘当吐之
可下 下利三部脉皆平按之心下硬者急下之宜大承气汤 脉双弦而迟者必心下硬脉大而紧者阳中有阴也可下之宜大
承气汤寸口脉浮而大按之反涩尺中亦微而涩知有宿食当下之宜大承气汤下利不欲食者以有宿食故也当下之宜大承气汤下
利脉反滑当有所去下之乃愈宜大承气汤 下利脉迟而滑者内实也利未欲止当下之宜大承气汤 伤寒后脉沉沉者内实也下
解之宜大柴胡汤 病患腹中满痛者此为实也当下之宜大承气汤 下利瘥后至其年月复发者以病不尽也当下之宜大承气汤
不可汗 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 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栗不能自还 脉濡而紧濡则卫气微紧则营中寒阳微卫中风发热而恶寒营紧胃中冷微呕心内烦医谓有
大热解肌而发汗亡阳虚烦躁心下苦痞坚表里俱虚竭杂起而头眩客热在皮肤怅怏不得眠不知胃气冷紧寒在关元技巧无所施
汲水灌其身客热因时罢栗栗而战寒重被而覆之汗出而冒巅体惕而又振小便为微难寒气因水发清谷不容间呕变反肠出颠倒
不能安手足为微逆身冷而内烦迟欲从后救安可复追还 诸脉得数动微弱者发汗则大便难腹中干胃燥而烦 厥脉紧发汗则
声乱咽嘶舌萎动气在左发汗则头眩汗不止筋惕肉 动气在右发汗即衄而渴心苦烦饮即吐水动气在上发汗则气上冲正在
心端 动气在下发汗则无汗心中大烦骨节苦疼目晕恶寒食则反吐 咽中闭塞发汗则吐血气欲绝手足逆冷欲得蜷卧不能自
温衄家不可发汗汗出必额上陷脉紧急直视不能 不得眠 亡血家发汗则寒栗而振 淋家发汗则便血 疮家虽身疼痛不可
汗汗出则痉 咽喉干燥不可汗 咳而小便利若失小便者不可汗汗则四肢厥冷 咳者则剧数吐涎沫咽中必干小便不利心中
饥烦杂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诸逆发汗病微者难瘥剧者言乱目眩者死
不可下 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
厥而且寒阳微不可下下之则心下痞硬 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
温微弦为虚虚者不可下也 脉濡而弱弱反在关濡反在巅浮反在上数反在下浮为阳虚数为无血浮为虚数为热浮为虚自汗出
而恶寒数为痛振寒而栗微弱在关胸下为急喘汗而不得呼吸呼吸之中痛在于胁振寒相迫形如疟状医反下之故令脉数发热狂
走见鬼心下为痞小便淋漓小腹甚硬小便则尿血也 脉浮而大浮为气实大为血虚血虚为无阴孤阳独下阴部者小盒饭赤而难
胞中当虚今反小便利而大汗法应卫家当微今反更实津液四射荣竭血尽干烦而不得眠血薄肉消而成暴液医复以毒药攻其胃
此为重虚客阳去有期必下如污泥而死 微则为咳咳则吐涎下之则咳止而利因不休利不休则胸中如虫啮粥入则出小便不利
两胁拘急喘息为难颈背相引臂则不仁极寒反汗出身冷若冰眼睛不慧语言不休而谷食多入此谓除中口虽欲言舌不得前 脉
数者久数不止止则邪结正气未复邪气却结于脏故正气浮之与皮毛相得脉数者不可下下之必烦利(不止)动气在右下之则
津液内竭咽燥鼻干头眩心悸也 动气在左下之则腹内拘急食不下动气更剧虽有身热卧则欲蜷 动气在上下之则掌握烦热
身上浮冷热汗自泄欲得水自灌动气在下下之则腹胀满杂起头眩食则下清谷心下痞 咽中闭塞者下之则上轻下重水浆不下
卧则欲蜷身急痛下利日数十行 诸外实者下之则发微热亡脉厥者当脐握热诸虚者下之则大渴求水者易愈恶水者剧 病阳
多者热下之则硬 无阳阴强大便硬者下之必清谷腹满 发汗多亡阳谵语者不可下与桂枝柴胡汤和其营卫以通津液后自愈
不可汗下 伤寒发热口中勃勃气出头痛目黄衄不可制贪水者必呕恶水者厥若下之咽中生疮假令手足温者必下重便脓
血头痛目黄者若下之则两目闭贪水者脉必厥其声嘤咽喉塞若发汗则战栗阴阳俱虚恶水者若下之则里冷不嗜食大便完谷出
若发汗则口中伤舌上白苔躁烦脉实数不大便六七日后必便血若发汗则小便自利也 伤寒脉阴阳俱紧恶寒发热则脉欲厥厥
者脉初来大渐渐小更来渐渐大是其候也如此者恶寒甚者翕翕汗出喉中痛热多者目赤脉多睛不慧医复发之咽中则伤若复下
之两目闭寒多者必清谷热多者便脓血若熏之则身发黄若熨之则咽燥若小便利者可救之小便难者为危殆 伤寒发热头痛形
象中风常微汗出自呕者下之益烦心中懊 如饥发汗则致痉身强难以屈伸熏之则发黄不得小便久则发咳吐 伤寒发热头痛
微汗出发汗则不识人熏之则喘不得小便心腹满下之则短气小便难头痛背强加温针则衄
[Indications for Sweating]
When the pulse is floating and large, sweating should be induced. If the physician instead uses purgation, this constitutes a major contraindication error.
[Indications for Emesis]
If the patient has cold hands and feet, the pulse suddenly presents with knots (irregularity), and due to rebellious qi (pathogenic factor) lodged in the chest, causing fullness and irritability below the heart, desiring to eat but unable to do so, the pathology is located in the chest; emesis should be induced. For all excess conditions in the upper chest, where there is郁结 (stagnation) and pain in the chest, inability to eat, and pressing on the area produces saliva, accompanied by diarrhea occurring more than ten times a day, with a pulse that is surprisingly slow and the cun position showing faint and choppy qualities, emesis should be induced; after vomiting, the diarrhea will cease. When food retention is located in the upper jiao (upper burner), emesis should be induced.
[Indications for Purging]
In cases of diarrhea where the pulses at the three positions (cun, guan, chi) are all level, but palpation reveals hardness below the heart, urgent purgation is indicated; Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate. If the pulse is double-string-like and slow, hardness below the heart is certain; if the pulse is large and tight, it indicates yang pathology containing yin characteristics, and purgation is permissible; Da Cheng Qi Tang is appropriate. If the cun pulse is floating and large, but feels choppy upon pressure, and the chi position is also faint and choppy, this indicates food retention, and purgation is indicated; Da Cheng Qi Tang is appropriate. In cases of diarrhea with anorexia, this is due to food retention, and purgation is indicated; Da Cheng Qi Tang is appropriate. If diarrhea presents with a slippery pulse, it indicates internal accumulation that must be expelled; purgation leads to recovery; Da Cheng Qi Tang is appropriate. If diarrhea presents with a slow and slippery pulse, it indicates internal excess; the diarrhea will not stop on its own, so purgation is indicated; Da Cheng Qi Tang is appropriate. After Shanghan (Cold Damage), if the pulse is deep and forceful, it indicates internal excess, and purgation is indicated; Da Chai Hu Tang (Major Bupleurum Decoction) is appropriate. If the patient experiences abdominal fullness and pain, this is an excess pattern, and purgation is indicated; Da Cheng Qi Tang is appropriate. If diarrhea resolves but recurs at the same time of year or month, it is because the pathogen was not fully eliminated; purgation is indicated; Da Cheng Qi Tang is appropriate.
[Contraindications for Sweating]
If the pulse is soft (Ru) and weak (Ruo), with the weak quality appearing at the Guan position, the soft quality at the Dian (Cun/Upper) position, the faint (Wei) quality at the Upper position, and the choppy (Se) quality at the Lower position: Faint indicates insufficiency of Yang Qi; Choppy indicates absence of Blood. With Yang Qi being faint, if Wind-Strike occurs with sweating followed by restlessness and irritability; Choppy indicates absence of Blood, leading to Jue (cold extremities) and cold. If Yang Qi is faint and sweating is induced, restlessness and insomnia will result.
If the pulse is soft and weak, with the weak quality at Guan, the soft quality at Dian, the string-like (Xian) quality at the Upper position, and the faint quality at the Lower position: String-like indicates impaired Yang movement; Faint indicates Yin-Cold. There is excess above and deficiency below, with a desire for warmth. Faint and string-like indicates deficiency; sweating is contraindicated. Inducing sweating will cause chills and failure of the body to recover.
If the pulse is soft and tight: Soft indicates deficient Wei Qi; Tight indicates Cold in Ying (Nutritive) Qi. Deficient Wei Qi allows Wind invasion, causing fever and aversion to cold; Tight Ying Qi causes Cold in the Stomach, slight vomiting, and internal irritability. If the physician mistakes this for excessive Heat and induces sweating via muscle-releasing methods, it leads to collapse of Yang Qi, deficiency-induced irritability, and bitter feeling of pi (stuffiness/hardness) below the heart. With both exterior and interior exhausted, various diseases arise causing dizziness. External heat remains in the skin, causing discomfort and insomnia. The physician fails to recognize the Cold in the Stomach Qi and the Tight-Cold at the Guanyuan point, leaving even skilled practitioners helpless. Pouring water on the body may temporarily dissipate external heat, but causes severe chills. Covering with heavy blankets leads to sweating and head oppression (mao dian). Body tremors occur, urination becomes difficult, and Cold is exacerbated by the water, causing continuous diarrhea of undigested food, vomiting, and potential intestinal prolapse. The patient lies in disorder, unable to find comfort, with slightly inverted cold limbs and internal irritability despite cold body. At this stage, seeking rescue from behind is futile; regret cannot reverse the course.
For various pulses presenting with rapid (Shu) movements that are faint and weak, inducing sweating leads to dry stool, abdominal dryness, Stomach dryness, and irritability.
In Jue patterns with a tight pulse, inducing sweating causes voice disorder, hoarseness, and tongue flaccidity. If Dong Qi (pulsating mass) is on the Left, sweating causes dizziness, incessant sweating, twitching of tendons and muscles. If Dong Qi is on the Right, sweating causes epistaxis (nosebleed), thirst, bitter irritability, and vomiting of water after drinking. If Dong Qi is Above, sweating causes Qi rushing upward directly to the center of the heart. If Dong Qi is Below, sweating causes absence of sweat, severe internal irritability, bone and joint pain, dizziness, aversion to cold, and vomiting after eating.
If the throat is closed/stifled, inducing sweating causes hematemesis (vomiting blood), impending death of Qi, cold extremities, desire to curl up, and inability to warm oneself.
Patients prone to nosebleeds (Nu Jia) must not undergo sweating. Sweating will cause depression of the forehead, tight pulse, fixed gaze, and insomnia.
Patients who have lost blood (Wang Xue Jia) must not undergo sweating. Sweating causes chills and trembling.
Patients with Lin syndrome (dysuria) must not undergo sweating. Sweating causes hematochezia/blood in urine.
Patients with sores/ulcers (Chuang Jia), even if experiencing body pain, must not undergo sweating. Sweating leads to Jing disease (spasm/stiffness).
Patients with dry throat must not undergo sweating.
Patients with cough and clear/uncontrolled urination must not undergo sweating. Sweating causes cold extremities.
Patients with severe cough, frequent salivation, dry throat, difficulty urinating, and hunger-irritability resembling malaria (chills without fever, deficiency-cold) must not undergo sweating. Sweating leads to curling up, distension, and abdominal hardness. For various adverse conditions, inducing sweating makes mild cases difficult to cure and severe cases (with speech disorder and dizziness) fatal.
[Contraindications for Purging]
If the pulse is soft and weak, with weak at Guan, soft at Dian, faint at Upper, and choppy at Lower: Faint indicates Yang insufficiency; Choppy indicates Blood absence. Yang is faint; Wind-Strike with sweating leads to restlessness. Choppy indicates Blood absence, leading to Jue and cold. Yang deficiency contraindicates purging. Purging causes pi-hardness below the heart.
If the pulse is soft and weak, with weak at Guan, soft at Dian, string-like at Upper, and faint at Lower: String-like indicates Yang stagnation; Faint indicates Yin-Cold. Excess above, deficiency below, desire for warmth. Faint-string indicates deficiency. Deficiency contraindicates purging.
If the pulse is soft and weak, with weak at Guan, soft at Dian, floating at Upper, and rapid at Lower: Floating indicates Yang deficiency; Rapid indicates Blood absence. Floating-deficiency causes spontaneous sweating and aversion to cold. Rapid-pain causes chills and tremors. Weakness at Guan causes chest urgency, panting, sweating, and dyspnea. Pain in ribs during breathing, chills, and malaria-like symptoms. If the physician incorrectly purges, it causes rapid pulse, fever, mania, hallucinations, pi-fullness, dribbling urination, hard lower abdomen, and hematuria.
If the pulse is floating and large: Floating indicates Qi excess; Large indicates Blood deficiency. Blood deficiency means Yin absence, leaving solitary Yang. If descending to the Yin region, urine becomes red and difficult, and the Bao (uterus/bladder) is deficient. Now, with free urination and profuse sweating, the Wei Qi should be weak but appears excess. Fluids scatter, Ying exhaustion, Blood depletion, dryness, irritability, and insomnia result. Blood thins, muscles waste, leading to acute illness. If the physician uses toxic drugs to attack the Stomach, this is double deficiency. The departure of external Yang has a limit; death by purging black sludge ensues.
Faint pulse causes cough and salivation. Purging stops cough but causes incessant diarrhea, leading to a sensation of insect bites in the chest. Food is vomited immediately, urination is difficult, hypochondriac tension, dyspnea, neck-back traction, arm numbness. Extreme cold with sweating, icy body, dull eyes, incessant speech, and excessive intake characterize "Chu Zhong" (Elimination of the Middle/Stomach Qi exhaustion), where the tongue cannot extend forward despite wanting to speak.
Rapid pulse persisting long indicates pathogen binding as Zheng Qi recovers. Pathogen binds in Zang organs. Zheng Qi floats to the skin. Rapid pulse contraindicates purging. Purging causes irritability and incessant diarrhea.
If Dong Qi is on the Lower Right, purging depletes internal fluids, causing dry throat/nose, dizziness, and palpitations.
If Dong Qi is on the Lower Left, purging causes abdominal tension, inability to eat, worsened Dong Qi, and desire to curl up despite fever.
If Dong Qi is Above, purging causes palm heat, edema, alternating cold/heat, spontaneous sweating, and desire for self-watering.
If Dong Qi is Below, purging causes abdominal fullness, dizziness, diarrhea of undigested food, and pi-fullness below the heart.
If the throat is closed, purging causes upper lightness/lower heaviness, inability to swallow liquids, curling up, acute pain, and frequent diarrhea.
For various exterior excess patterns, purging causes mild fever. For Jue with pulse loss and umbilical warmth, and various deficiency patterns, purging causes extreme thirst (easy to cure if drinking water; severe if rejecting water).
Yang-excess heat patterns become hardened after purging.
Yin-excess with constipation leads to undigested diarrhea and abdominal fullness after purging.
Excessive sweating causing Yang collapse and delirium contraindicates purging. Use Gui Zhi Tang or Chai Hu Tang to harmonize Ying-Wei and unblock fluids for self-healing.
[Contraindications for Both Sweating and Purging]
Shanghan with fever, bubbling breath, headache, yellow eyes, uncontrollable epistaxis: Thirsty patients vomit; water-averse patients have cold extremities. Purging causes throat sores. If hands/feet are warm, lower heaviness and pus-blood stool occur. Headache/yellow eyes worsen with purging (eyes close). Thirsty patients have Jue pulse, humming voice, throat blockage. Sweating causes chills and Yin-Yang deficiency. Water-averse patients purged develop interior cold, anorexia, and undigested stool. Sweating causes mouth injury, white tongue coating, irritability, rapid/excess pulse, constipation for 6-7 days followed by blood in stool. Sweating causes free urination.
Shanghan with Yin-Yang tight pulses, aversion to cold, and fever indicates Jue pulse (initially large, then small, then large again). Severe cold causes slight sweating and sore throat. Heat excess causes red eyes and dull vision. Further sweating injures the throat. Further purging closes the eyes. Cold excess causes undigested stool; heat excess causes pus-blood stool. Moxibustion/fumigation causes jaundice; cupping/warming causes dry throat. Prognosis is good if urination is free; critical if difficult.
Shanghan with fever, headache, Wind-Strike appearance, slight sweating, and spontaneous vomiting: Purging increases irritability and mental anguish. Sweating causes spasm and stiffness. Fumigation causes jaundice, urinary retention, chronic cough, and expectoration.
Shanghan with fever, headache, slight sweating: Sweating causes confusion. Fumigation causes dyspnea, urinary retention, and abdominal fullness. Purging causes shortness of breath, difficult urination, headache, and stiff neck. Warming needles cause epistaxis.