夫以为疾病至急。仓卒寻按。要旨难得。故重集诸可与不可方治。比之三阴三阳篇中。此易
见也。又时有不止是三阴三阳。出在诸可与不可中也。
此叔和自揭其编述以下诸篇之由。
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。
此疑太阳下编首条末节之互意。叔和以不可汗类此。伦序 难晓。似此者皆当缺疑可也。
动气在右。不可发汗。发汗则衄而渴。心苦烦。饮即吐水。
五脏皆有动气。详见难经。在右。以肺言也。不可发汗。内证也。衄渴烦吐。皆见太阳上编。
盖手太阴之脉。起于中焦。下络大肠。还循胃口。上膈。属肺。从肺系横出腋下。下循腰内。行
少阴心主之前。而其脏通窍于鼻。所以有诸证之变见如此。
动气在左。不可发汗。发汗则头眩。汗不止。筋惕肉 。
在左。肝之内证也。肝属少阳。其脉络胆。上贯膈。布胁肋。循喉咙之后。上入颃颡。连目系。
上出额。与督脉会于巅。其主风。故头眩也。汗不止者。肝纳血。血之液为汗。迫汗则肝不纳血。
血不归经。故液有出而无敛也。筋惕肉 者。筋赖血以荣。血虚则荣衰。汗多则亡阳而亡津液。
所以然也。
动气在上。不可发汗。发汗则气上冲。正在心端。
在上。心之内证也。气上冲正在心端者。心属火而主血。肾属水而主气。逼汗则心虚。水能
克火。故肾乘心之虚欲上凌之也。而心之脉起于心中。出属心系。下膈。络小腹。肾足少阴之别。
名曰大钟。当踝后绕跟。别走太阳。其别者并经上走于心包。然则上冲之气。亦当正在心端也。
动气在下。不可发汗。发汗则无汗。心中大烦。骨节苦疼。目晕恶寒。食则反吐。谷不得前。
在下。肾之内证也。无汗者。肾水脏。在时为冬。阴沉在下。其主闭藏。其经少血也。大烦
者。强发其汗则水干。火无制也。骨节苦疼。目晕者。肾主骨。骨之精为瞳子。水干则骨枯。而
瞳子无荣养也。恶寒者。肾合太阳也。食则反吐谷不得前者。王冰曰。病呕而吐。食久反出。是
无水也。此之谓也。难经动气有五。此言四脏而无脾。岂以脾不与四脏同禁邪。抑欲人与四脏同
推也。
咽中闭塞。不可发汗。发汗则吐血。气欲绝。手足厥冷。欲得 卧。不能自温。
咽门乃胃之系。而脾之脉络胃。上膈。挟咽。连舌本。然则咽中闭塞者。脾胃之邪。上客于
咽而作逆阻也。吐血者。脾统血而胃为之合。脾伤不能统血。故妄行上溢而从胃道出也。气欲绝
者。亡阳也。手足为四肢。乃诸阳之本。阳欲外绝。则阴亦不能内守。阴阳不相顺接而厥冷。故
畏寒而欲得 卧也。夫如此。温之且未得。岂能自得其温乎。
诸脉得动数微弱者。不可发汗。发汗则大便难。腹中干。胃燥而烦。其形相象。根本异源。
此条三节。脉经只作通长一条。不分截。今按文意。此疑是末节。其形至末。乃总全条之结
句。盖谓寒 不能自还。后节
苦满腹中坚。与此大便难。腹中干。三者之变虽相似。其本源则不同之意也。不如此。则上下皆
不相蒙。
脉微而弱。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 不能自还。
此疑是上节。阳以风言。运。动也。故曰上实。谓邪气实也。阴以里言。寒。虚也。故曰下
虚。谓里气虚也。微弦为虚承上起下之词。寒 不能自还。阳亡而阴独治也。
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 。咳而发汗。 而苦满。腹中复坚。
此当是中节。首句是承上而言咳为病加剧之词也。数吐以下。言剧之状也。有寒无热二句。
申似疟也。咳而发汗亦承上起下之词。 。谓咳属肺。肺金寒。病则胀满。所以反坚也。
咳而小便利。若失小便者。不可发汗。汗出则四肢厥逆冷。
小便利。失小便。肺肾二经俱病也。不可发汗。二经少血也。四肢厥冷。金水伤而土亦同败也。
厥脉紧。不可发汗。发汗则声乱。咽嘶。舌萎。声不得前。
厥欲温。紧则寒胜。不可发汗。阴阳不相顺接也。声乱咽嘶舌萎。病至少阴厥阴则厥。少阴
之脉循喉咙。挟舌本。而厥阴之脉循喉咙之外也。声不得前者。声出于肺而生于气。气生于肾。然
则少阴肾者。声之本。太阴肺者。声之标。标本俱病。此又上败而金水亦衰。合上条反复示教之意。
诸逆发汗。病微者。难瘥。剧者。言乱。目眩者。死。命将难全。
逆。亦厥也。言乱。少阴衰而志丧也。目眩。厥阴衰而风乱也。盖厥逆。无非少阴厥阴之证故也。
（一）汗家重发汗。必恍惚心乱。小便已。阴疼。与禹余粮丸。阙。
心主血而藏神。汗多则血虚而舍空。乱。舍空则神纷散也。阴。宗筋也。疼。液竭而失其所荣
养也。
（二）亡血家不可发汗。发汗则寒 而振。
伏皮为血。出则为汗。阴也。阴不自出。出之者。阳也。亡血。阴虚矣。寒 而振。反汗复
亡其阳也。
（三）衄家不可发汗。汗出必额上陷。脉急紧。直视不能 。不得眠。
衄。鼻血也。额上。通乎鼻也。不能 。谓目上瞪。不能开阖而动摇也。所以不得瞑而眠也。
（四）淋家不可发汗。发汗必便血。
膀胱蓄热而血妄。则淋。复发汗以迫其血。则血愈不循经而愈妄。便出者。其道顺故也。
（五）疮家虽身疼痛。不可发汗。发汗则 。
。通作痉。病疮。身疼痛。血热表虚。非实也。发汗则表益虚。而易得重感。痉病出于重
感。故禁。
（六）咽喉干燥者。不可发汗。
咽喉干燥者。胃中无津液。肾水亦耗衰。少阴之脉循喉咙也。发汗则津液愈亡。而肾水益衰。
故致戒如此。末后无发汗之变。疑有漏落。以上六条。旧本太阳中篇。今移。
伤寒头痛。翕翕发热。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。灸则发咳唾。
此互第九篇第四条。曲致其不可误治之详。以重致叮咛戒谨之意。
It is believed that diseases arise with great urgency, and in a hurried search for reference, the key points are difficult to grasp. Therefore, the various prescriptions for conditions where sweating is permitted and not permitted have been recompiled. Compared to the chapters on the Three Yin and Three Yang meridians, these are easier to identify. Moreover, sometimes the situations extend beyond just the Three Yin and Three Yang, appearing among the various categories of "permitted" and "not permitted."
This is Wang Shuhe's self-explanation for compiling the following chapters.
The pulse is soft (Ru) and weak (Ruo). The weak pulse appears at the Guan position, while the soft pulse appears at the Cun position (Dian refers to the Cun position). The thready (Wei) pulse appears at the upper part (referring to the Cun position), and the choppy (Se) pulse appears at the lower part (referring to the Chi position). Thready indicates insufficient Yang Qi; choppy indicates lack of Blood. If Yang Qi is weak, wind-stroke with sweating may lead to restlessness and irritability. Choppy indicates lack of Blood, leading to cold limbs and chills. If sweating is induced in cases of weak Yang Qi, it results in restlessness and inability to sleep.
This is suspected to be the cross-reference meaning at the end of the first clause of the lower section of Taiyang disease. Wang Shuhe grouped these non-sweating conditions together, making the order difficult to understand. Such cases should ideally be omitted due to doubt.
If there is pulsation (Dong Qi) on the right side, sweating is contraindicated. Inducing sweating will cause epistaxis (Nü), thirst, mental distress and irritability, and vomiting water upon drinking.
All five Zang organs have pulsations, as detailed in the *Nan Jing* (Classic of Difficult Issues). Pulsation on the right refers to the internal condition of the Lung. Sweating is contraindicated because this is an internal excess condition. Epistaxis, thirst, irritability, and vomiting are all described in the upper section of Taiyang disease. This is because the Hand-Taiyin Lung Meridian originates in the middle Jiao, descends to connect with the Large Intestine, returns along the stomach opening, passes through the diaphragm, and belongs to the Lung. From the lung system, it emerges horizontally under the axilla, descends along the arm, running anterior to the Hand-Shaoyin Pericardium Meridian. Its orifice connects to the nose, hence such variations in symptoms occur.
If there is pulsation on the left side, sweating is contraindicated. Inducing sweating will cause dizziness, incessant sweating, and twitching of muscles and sinews.
Pulsation on the left is an internal condition of the Liver. The Liver belongs to Shaoyang, its meridian connects with the Gallbladder, ascends through the diaphragm, distributes in the hypochondrium, follows the throat posteriorly, enters the pharynx, connects with the eye system, ascends to the forehead, and meets the Du Meridian at the vertex. The Liver governs Wind, hence dizziness. Incessant sweating occurs because the Liver stores Blood, and the fluid of Blood is sweat. Forced sweating prevents the Liver from storing Blood, causing blood to leave the vessels, so fluids flow out without being contained. Twitching of muscles and sinews occurs because sinews rely on Blood for nourishment; when Blood is deficient, nourishment declines. Excessive sweating leads to loss of Yang Qi and body fluids, hence this result.
If there is pulsation above, sweating is contraindicated. Inducing sweating will cause Qi to rush upward, directly at the heart region.
Pulsation above is an internal condition of the Heart. Qi rushing upward at the heart region occurs because the Heart belongs to Fire and governs Blood, while the Kidney belongs to Water and governs Qi. Forced sweating causes Heart deficiency; since Water overcomes Fire, the Kidney Qi takes advantage of the Heart's deficiency to ascend and oppress it. The Heart meridian originates in the heart, emerges to belong to the Heart system, descends through the diaphragm, and connects with the lower abdomen. The collateral branch of the Foot-Shaoyin Kidney Meridian is named Da Zhong, located behind the ankle, winding around the heel, diverging to the Taiyang Meridian. Its branch runs up along with the main channel to the Pericardium. Thus, the rushing Qi should indeed be centered at the heart region.
If there is pulsation below, sweating is contraindicated. Inducing sweating will result in no sweat, extreme mental irritability, painful bone joints, blurred vision with aversion to cold, vomiting after eating, and food failing to pass forward.
Pulsation below is an internal condition of the Kidney. No sweat occurs because the Kidney is a Water organ, corresponds to Winter in seasons, is Yin and heavy below, governs closure and storage, and its meridian has little Blood. Extreme irritability occurs because forced sweating dries up Kidney Water, leaving Fire uncontrolled. Painful bone joints and blurred vision occur because the Kidney governs bones, and the essence of bones manifests in the pupils. When Water is dry, bones become withered, and pupils lose nourishment. Aversion to cold occurs because the Kidney harmonizes with Taiyang. Vomiting after eating and food failing to pass forward: Wang Bing stated, "Vomiting and regurgitation, food coming up after a long time, is due to lack of Water." This refers to that situation. The *Nan Jing* mentions five locations for pulsation, but here only four Zang organs are mentioned, excluding the Spleen. Is it because the Spleen is not prohibited like the other four? Or is it intended for people to infer similarly for the Spleen?
If the throat feels obstructed, sweating is contraindicated. Inducing sweating will cause hematemesis, impending collapse of Qi, cold hands and feet, a desire to curl up and lie down, and inability to warm oneself.
The throat gate is the connection of the Stomach, and the Spleen meridian connects with the Stomach, ascends through the diaphragm, flanks the throat, and connects to the root of the tongue. Thus, throat obstruction is caused by pathogenic factors of the Spleen and Stomach lodging in the throat and causing reverse obstruction. Hematemesis occurs because the Spleen controls Blood and the Stomach is its partner; if the Spleen is injured and cannot control Blood, it flows recklessly upwards and exits via the Stomach pathway. Impending collapse of Qi is loss of Yang Qi. Hands and feet are the four extremities, the root of all Yang Qi. If Yang Qi is about to escape externally, Yin cannot remain internally. When Yin and Yang do not connect smoothly, cold limbs occur. Hence, aversion to cold and a desire to curl up. In such cases, even warming treatment is insufficient; how can one warm oneself naturally?
For any pulse showing agitation-speed (Dong Shu) or weakness (Wei), sweating is contraindicated. Inducing sweating will cause difficulty in defecation, dryness in the abdomen, gastric dryness with irritability. Although the manifestations appear similar, their fundamental origins differ.
This clause consists of three sections. The *Mai Jing* (Pulse Classic) treats it as one continuous passage without division. Analyzing the text, this is suspected to be the final section. "Although the forms resemble each other" to the end serves as a concluding sentence for the entire clause. It likely means that cold and heat cannot resolve themselves. The later section discusses abdominal fullness and hardness, which, along with difficulty in defecation and abdominal dryness here, share similar changes but different origins. Otherwise, the upper and lower parts would not relate.
The pulse is thready (Wei) and weak (Ruo). The weak pulse appears at the Guan position, the soft pulse at the Cun position, the wiry (Xian) pulse at the upper position, and the thready pulse at the lower position. Wiry indicates Yang movement; thready indicates Yin cold. Upper excess and lower deficiency indicate a desire for warmth. Thready and wiry indicate deficiency; sweating is contraindicated. Inducing sweating will result in cold and heat failing to resolve themselves.
This is suspected to be the preceding section. Yang refers to Wind; movement implies action, hence "upper excess" refers to pathogenic excess. Yin refers to the interior; cold implies deficiency, hence "lower deficiency" refers to interior Qi deficiency. "Thready and wiry indicate deficiency" is a transitional phrase connecting the preceding and following. Cold and heat failing to resolve themselves indicates loss of Yang with Yin dominating alone.
Severe coughing with frequent expectoration of saliva and foam, dry throat, dysuria, mental hunger-like irritability, intermittent attacks resembling malaria with cold but no heat: if the patient is deficient and chills, and sweating is induced, they will suffer from chest fullness and abdominal hardness.
This is likely the middle section. The first sentence continues the previous context, stating that cough indicates worsening of the disease. Frequent expectoration describes the severity. "Cold but no heat" elaborates on the malaria-like appearance. "Cough and sweating" is also a transitional phrase. Cough belongs to the Lung; Lung Metal is cold, disease causes distension, hence abdominal hardness.
If coughing is accompanied by free urination or urinary incontinence, sweating is contraindicated. Sweating will cause cold reversal of the four limbs.
Free urination or incontinence indicates disease in both the Lung and Kidney meridians. Sweating is contraindicated because these two meridians have little Blood. Cold reversal of the four limbs indicates damage to Metal and Water, leading to failure of Earth as well.
For cold reversal with a tight (Jin) pulse, sweating is contraindicated. Inducing sweating will cause voice disorder, hoarseness, tongue atrophy, and inability to speak.
Cold reversal requires warmth; a tight pulse indicates prevailing cold. Sweating is contraindicated because Yin and Yang do not connect smoothly. Voice disorder, hoarseness, and tongue atrophy occur when disease reaches the Shaoyin and Jueyin meridians, leading to cold reversal. The Shaoyin meridian follows the throat and flanks the tongue root, while the Jueyin meridian follows outside the throat. Inability to speak occurs because sound originates from the Lung and is generated by Qi, which is produced by the Kidney. Thus, the Shaoyin Kidney is the root of sound, and the Taiyin Lung is the branch. When both root and branch are diseased, this represents upper failure and decline of Metal and Water, reiterating the teaching intent of the previous clause.
For any reverse condition inducing sweating: if the disease is mild, recovery is difficult; if severe, speech becomes disordered, and if dizziness occurs, death ensues, and life cannot be saved.
Reverse refers to cold reversal. Disordered speech indicates Shaoyin decline and loss of Will. Dizziness indicates Jueyin decline and chaotic Wind. Generally, cold reversal is always a syndrome of the Shaoyin and Jueyin meridians.
(1) For habitual sweaters, inducing sweating again will cause mental confusion and vagueness. After urination, pain in the genitalia occurs. Administer the Yu Yu Liang Wan (Hematite Pill). [Formula missing].
The Heart governs Blood and houses the Spirit. Excessive sweating leads to Blood deficiency and empty housing. Confusion arises because the empty housing causes the Spirit to scatter. Genitalia refer to the tendons. Pain occurs because fluids are exhausted and lose nourishment.
(2) For those who have lost Blood, sweating is contraindicated. Inducing sweating will cause chills and tremors.
Blood hidden in the skin is Yin; sweat exiting the body is also Yin. Yin does not exit on its own; Yang drives it out. Loss of Blood means Yin deficiency. Chills and tremors indicate that forcing sweat further depletes Yang.
(3) For those prone to epistaxis, sweating is contraindicated. Inducing sweating will cause depression of the temporal arteries, tense and tight pulse, staring eyes unable to move, and insomnia.
Epistaxis refers to nasal bleeding. The temples connect to the nose. Unable to move refers to eyes staring upward, unable to open, close, or roll. Hence, insomnia occurs.
(4) For patients with strangury (Lin syndrome), sweating is contraindicated. Inducing sweating will cause hematuria.
Strangury is caused by heat accumulation in the Bladder causing reckless Blood movement. Further sweating forces Blood further, causing it to leave the vessels recklessly. Exiting via urine is because the pathway is smooth.
(5) For patients with sores/ulcers, even if they have body pain, sweating is contraindicated. Inducing sweating will lead to spasms (Jing syndrome).
Spasms refer to convulsions. Patients with sores have body pain due to Blood heat and exterior deficiency, not excess. Sweating increases exterior deficiency and susceptibility to secondary pathogens. Spasms result from secondary pathogens, hence it is prohibited.
(6) For those with dry throat, sweating is contraindicated.
Dry throat indicates lack of fluids in the Stomach and depletion of Kidney Water. The Shaoyin meridian follows the throat. Sweating further depletes fluids and worsens Kidney Water deficiency. Hence this warning. The absence of post-sweating complications suggests missing text. These six clauses were originally in the Middle Section of Taiyang and are now moved here.
In Shanghan (Cold Damage) headache, with slight fever resembling wind-stroke, frequent slight sweating, and spontaneous vomiting: purgation increases irritability and mental restlessness like hunger. Inducing sweating causes spasms, stiff body with difficulty bending and stretching. Moxibustion causes jaundice and inability to urinate. Cauterization causes cough and expectoration.
This cross-references Clause 4 of Chapter 9, detailing why mis-treatment must be avoided, emphasizing caution and vigilance.