大法。春宜吐。
春气上行。万物伏藏者。皆冒土而上出。故病之发于春者。大率宜宣而吐以出之。法天道也。
凡用吐汤。中病即止。不必尽剂也。
此与第十六篇第三条。汗吐不同而意同。并上条亦皆叔和语。然中之为言。注的也。知注的
之为中。则知中病之节度矣。
宿食在上脘者。当吐之。
上脘。谓胃腑之口也。
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。
第九篇第六条。言脉乍紧。邪气在胸中。此言乍结。客气在胸中。紧者结之渐。结者紧之剧。
客气即邪气。彼则互相发而两见轻重之意。
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。
寸口脉微滑。此可吐之。吐之则利止。
诸实。总上文宿食邪气客气而概言之。
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。 则无血。厥而且寒。阳微不可下。下之则心下痞硬。
。与涩同。此下六条。即前十五篇第二条以下之六条。又以不可下再出。痞硬。即结胸痞气。
动气在右。不可下。下之则津液内竭。咽燥。鼻干。头眩。心悸也。
头眩者。肺属金。金衰不能制木。木甚则风生也。然木甚火必炽。而肺太阴之脉。行手少阴
心主之前。心为火脏。所以悸也。
动气在左。不可下。下之则腹内拘急。食不下。动气更剧。虽有身热。卧则欲 。
腹内拘急。食不下者。厥阴肝脉挟胃。络肝也。身热。胃合于脾。脾主肌肉而统四肢。然则
欲者。里寒也。
动气在上不可下。下之则掌握热烦。身上浮冷。热汗自泄。欲得水自灌。
掌握热烦者。手少阴心之脉。抵掌后兑骨之端。入掌内后廉。手心主之脉入掌中也。身上浮
冷者。火败而土无气也。热汗已下。汗生于血而主于心。心属火。败则液不敛。剧则自求救也。
动气在下。不可下。下之则腹胀满。卒起头眩。食则下清谷。心下痞也。
卒。清勿切。腹胀满。肾痹也。头眩者。肾少阴之脉。其直者从肾上贯肝膈。肝主风也。食
则下清谷者。水横溢也。心下痞者。肾主气。其脉之支者。从肺出络心。注胸中也。
咽中闭塞。不可下。下之则上轻下重。水浆不下。卧则欲 。身急痛。下利日数十行。
上轻。以咽言。下重。以胃言。水浆不下以下。详下重之状也。卧则欲 身急痛者。胃主肌
肉而统四肢也。下利。土败而水无制也。盖咽门小肠。太仓胃腑之传送也。故应病如此。夫汗下
者。法之对比也。两比以示教。前哲之心亦甚深切矣。后学当仰体。
诸外实者不可下。下之则发微热。亡脉。厥者当脐握热。
诸外实。指凡一切邪在表而言也。发微热。邪入里也。亡脉。阳内陷也。握。持也。谓当脐有
热。持而不散。盖以热入深者言也。
诸虚者不可下。下之则大渴。求水者欲愈。恶水者剧。
恶。去声。诸虚。指凡一切汗吐下后。若亡血。与精气夺。肉脱色败。脉不应者言也。大渴。
津液竭也。求水。阳回也。恶水。无阳也。然虚乃上文实之对。亦两比之意。
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。
此举第十五篇第五条后二节。而复以不可下重出。下文乃言下之之变也。
微则为逆。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。身冷若水。眼睛不慧。语言不
休而谷气多入。此为除中。口虽欲言。舌不得前。
啮。音孽。首二句乃总前第十五篇第五条。后两节之两首句。而通互其意。下之以下。言变
证也。寒以虚言。故曰反汗出。身冷若冰也。不得前。犹言不能出也。舌主于心。较之声属脉之
前条。则此为重矣。亦两比也。
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 。微弱在关。胸下为急。喘汗而不得呼吸。呼
吸之中。痛在于胁。振寒相搏。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。
首三句与上条同。上条弦反在上。弦则为阴。阴者寒也。故曰微反在下。此条浮反在上。浮
则为阳。阳者风也。故曰数反在下。盖两举中风伤寒之本虚者。绎其变以曲致叮咛之意。
脉数者。久数不止。止则邪结。正气不能复。正气却结于脏。故邪气浮之与皮毛相得。脉数
者不可下。下之则必烦利不止。
皮毛相得以上。明脉之所以浮数也。烦利。亦协热也。
脉浮大。应发汗。医反下之。此为大逆。
此重出第十四篇第十七条之大略。以申致叮咛之意。
呕多。虽有阳明证。不可攻之。
此即阳明篇第三十八条重出。
太阳病。外证未解。不可下。下之为逆。
此太阳上之第十七条。盖以凡在太阳皆然。故重出以申致叮咛之意。
夫病。阳多者热。下之则硬。
阳以风言。多。犹言胜也。热以自汗言。硬。亡津液也。
无阳阴强。大便硬者。下之则必清谷。腹满。
阴以寒言。强。犹言多也。清谷。阴不能化也。腹满。阴凝滞而内胀也。亦两匹配言以互
发之意。
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。
今反小便利而大汗出。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。必下污泥而死。
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。
伤寒发热。口中勃勃气出。颈痛目黄。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。若下则两目闭。贪水者。脉必厥。其声嘤。
咽喉塞。若发汗则战 。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。烦躁。脉数实。不大便。六七日后必便血。若发汗则小便自利也。
脉濡而紧。濡则胃气微。紧则荣中寒。阳微卫中风。发热而恶寒。荣紧胃气冷。微呕心内烦。医
为有大热。解肌而发汗。亡阳虚烦躁。心下苦痞坚。表里俱虚竭。卒起而头眩。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。客热应时罢。 而振寒。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
倒不得安。手足为微逆。身冷而内烦。迟欲从后救。安可复追还。
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。则两目闭。寒多者。便清谷。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。
下利脉大者。虚也。以其强下之故也。设脉浮革。因尔肠鸣者。属当归四逆汤。
以上六条。皆不见有不可下之言。伦类不清。疑非叔和之旧。亦后人之纷乱耳。不敢强为之
说。阙疑以待博识。
General principles. In spring, the vomiting method is appropriate.
Spring qi ascends; things that were hidden and stored all emerge from beneath the soil. Therefore, diseases that arise in spring are generally suitable for being expelled through dispersion and vomiting. This follows the pattern of Heaven.
When using a vomiting decoction, stop as soon as the disease is addressed; there is no need to finish the entire dose.
This differs from Article 3 of Chapter 16 but shares the same intent. The preceding lines are also annotations by Wang Shuhe (Wang Huai-yin). However, "Zhong" (中) means "hitting the target accurately." Knowing what it means to hit the target accurately allows one to understand the degree and timing of treating the disease.
If retained food is located in the Upper Wan (upper part of the stomach), it should be vomited.
Upper Wan refers to the opening of the stomach organ.
If a patient has cold hands and feet, a pulse that suddenly becomes knotted (Jie), because external pathogenic factors (Ke Qi) are in the chest, causing fullness and irritability in the epigastrium, and desiring to eat but unable to do so, the disease is in the chest and should be treated with vomiting.
Article 6 of Chapter 9 states that a suddenly tight pulse indicates pathogenic factors in the chest; here, a suddenly knotted pulse indicates external pathogenic factors in the chest. "Tight" (Jin) is the gradual stage of "Knotted," and "Knotted" is the severe stage of "Tight."
External pathogenic factors (Ke Qi) are synonymous with pathogenic factors. The previous text and this text complement each other to express varying degrees of severity.
In cases of disease where there are various excess conditions in the upper chest, leading to depression and pain in the chest, inability to eat, a desire for someone to press on the area, yet producing saliva and phlegm, accompanied by diarrhea more than ten times a day, with a pulse that is surprisingly slow, and the Cun (inch) position pulse being faint and slippery, vomiting may be used. Vomiting will stop the diarrhea.
"Various excess conditions" generally refers to the retained food, pathogenic factors, and external pathogenic factors mentioned above.
A pulse that is soggy (Ru) and weak (Ruo), with the weak pulse surprisingly at the Guan (bar) position and the soggy pulse surprisingly at the Dian (tip/inch) position, a faint (Wei) pulse surprisingly at the upper position, and a choppy (Se) pulse surprisingly at the lower position. Faint indicates insufficient Yang qi; choppy indicates lack of blood. If Yang qi is surprisingly faint, wind-stroke causes sweating but results in restlessness and irritability; if there is no blood, there is coldness and cold limbs. When Yang is faint, purgation must not be used; purging leads to epigastric fullness and hardness.
(Note: The original text contains some disjointed commentary here regarding specific pulse patterns and their contraindications for purgation.)
These six lines correspond to the six lines following Article 2 of Chapter 15, repeated here to emphasize the contraindication of purgation. Fullness and hardness refer to Jie Xiong (chest binding) and Pi Qi (epigastric fullness).
If there is pulsation/movement in the right abdomen, purgation must not be used. Purging depletes internal body fluids, leading to dry throat, dry nose, dizziness, and palpitations.
Dizziness occurs because the Lung belongs to Metal; when Metal is deficient, it cannot control Wood. Excessive Wood generates Wind. However, excessive Wood leads to blazing Fire. The Hand Taiyin Lung meridian runs anterior to the Hand Shaoyin Pericardium meridian. The Heart is a Fire organ, hence palpitations occur.
If there is pulsation/movement in the left abdomen, purgation must not be used. Purging leads to abdominal tension and cramping, inability to eat, and intensified pulsation. Even if there is body heat, the patient desires to curl up.
Abdominal tension and inability to eat occur because the Foot Jueyin Liver meridian wraps around the Stomach and connects to the Liver. Body heat relates to the Stomach combining with the Spleen; the Spleen governs muscles and controls the four limbs. Thus, the desire to curl up indicates interior cold.
If there is pulsation/movement in the upper abdomen, purgation must not be used. Purging leads to heat and irritability in the palms, floating coldness on the body, spontaneous hot sweating, and a desire to pour water over oneself.
Heat and irritability in the palms relate to the Hand Shaoyin Heart meridian reaching the end of the wrist bone and entering the palm's posterior edge; the Hand Jueyin Pericardium meridian enters the palm. Floating coldness on the body indicates the failure of Fire and the lack of Qi in Earth. Hot sweat has already flowed; sweat is generated from Blood and governed by the Heart. The Heart belongs to Fire; when Fire fails, fluids do not consolidate, and in severe cases, the body seeks self-rescue.
If there is pulsation/movement in the lower abdomen, purgation must not be used. Purging leads to abdominal distension and fullness, dizziness upon sudden rising, passage of undigested food after eating, and epigastric fullness (Pi).
"Cu" (Sudden) is pronounced as "Cu." Abdominal distension and fullness indicate Kidney Bi (obstruction). Dizziness occurs because the Foot Shaoyin Kidney meridian, its straight branch, ascends from the Kidney through the Liver and Diaphragm; the Liver governs Wind. Passage of undigested food indicates Water overflowing. Epigastric fullness occurs because the Kidney governs Qi; its branch meridian emerges from the Lung, connects to the Heart, and pours into the chest.
If the throat feels obstructed, purgation must not be used. Purging leads to a sensation of lightness above and heaviness below, inability to swallow liquids, a desire to curl up when lying down, urgent body pain, and diarrhea dozens of times a day.
"Above light" refers to the throat; "below heavy" refers to the Stomach. The inability to swallow liquids and subsequent symptoms detail the state of "heaviness below." Curling up and urgent body pain occur because the Stomach governs muscles and controls the four limbs. Diarrhea occurs because Earth qi fails and Water is uncontrolled. Generally, the throat and Small Intestine are the transmission channels of the Tai Cang (Stomach). Thus, the disease manifests as described. Sweating and purging are contrasting methods; presenting them side-by-side serves as teaching. The ancients' intent was profound. Students should appreciate this.
For all exterior excess conditions, purgation must not be used. Purging induces slight fever, loss of pulse, cold limbs, and a sensation of heat held firmly around the umbilicus.
"All exterior excess" refers to any pathogenic factor remaining in the exterior. Slight fever indicates the pathogen entering the interior. Loss of pulse indicates Yang sinking inward. "Hold" (Wo) means to grasp or retain, describing deep penetration of heat.
For all deficiency conditions, purgation must not be used. Purging leads to extreme thirst. Those seeking water will recover; those rejecting water will worsen.
"E" (Dislike/Reject) is pronounced with the departing tone. "All deficiency" refers to conditions after sweating, vomiting, or purging, such as blood loss, depletion of essence and Qi, emaciation, poor complexion, and mismatched pulses. Extreme thirst indicates exhaustion of body fluids. Seeking water indicates the return of Yang. Rejecting water indicates the absence of Yang. "Deficiency" is the counterpart to "Excess" mentioned earlier, serving a comparative purpose.
A pulse that is soggy (Ru) and weak (Ruo), with the weak pulse surprisingly at the Guan position and the soggy pulse surprisingly at the Cun position, a wiry (Xian) pulse surprisingly at the upper position, and a faint (Wei) pulse surprisingly at the lower position. Wiry represents Yang movement; faint represents Yin cold. Upper excess and lower deficiency indicate a desire for warmth. Faint and wiry indicate deficiency; deficiency conditions must not be purged.
This cites the latter two sections of Article 5 in Chapter 15, repeating the contraindication of purgation. The following text describes the complications of purging.
Faint indicates a adverse condition; coughing produces saliva. Purging stops the cough but diarrhea continues incessantly. Incessant diarrhea causes a sensation like insect bites in the chest; ingested porridge is immediately expelled; urination is difficult; bilateral hypochondriac tension makes breathing difficult; neck and back pull against each other; arms become numb; extreme cold causes sweating; the body is cold as water; eyes are dim; speech is incessant but grain qi enters without transforming. This is called "Chu Zhong" (Elimination of the Middle). Although the mouth wants to speak, the tongue cannot protrude.
"Nie" (Bite) sounds like "Nie." The first two sentences summarize the first sentences of the latter two sections of Article 5 in Chapter 15, interchanging their meanings. From "purging" onwards, it describes complication syndromes. Cold is due to deficiency, hence the paradoxical sweating and icy body. "Cannot protrude" means unable to come out. The tongue is governed by the Heart; compared to the previous line regarding voice and pulse, this is more severe. It also serves a comparative function.
A pulse that is soggy (Ru) and weak (Ruo), with the weak pulse surprisingly at the Guan position and the soggy pulse surprisingly at the Cun position, a floating (Fu) pulse surprisingly at the upper position, and a rapid (Shu) pulse surprisingly at the lower position. Floating indicates Yang deficiency; rapid indicates lack of blood. Floating is deficiency; rapid is heat. Floating deficiency causes spontaneous sweating and aversion to cold; rapid indicates pain, chills, and a desire to curl up. Weakness at the Guan position causes urgency below the chest, panting, sweating, and inability to breathe. During respiration, pain occurs in the hypochondrium. Chills and cold clash, resembling malaria. If the physician incorrectly uses purgation, it causes a rapid pulse, fever, running wildly seeing ghosts, epigastric fullness, dribbling urination, severe lower abdominal hardness, and hematuria.
The first three sentences are identical to the previous line. In the previous line, the wiry pulse was at the top, representing Yin/Cold, hence the faint pulse at the bottom. Here, the floating pulse is at the top, representing Yang/Wind, hence the rapid pulse at the bottom. This twice presents the fundamental deficiency in Wind-Stroke and Cold Damage, deducing changes to emphasize caution.
A rapid pulse that remains rapid for a long time without stopping, if it stops, indicates pathogenic knotting. Zheng Qi (Upright Qi) cannot recover; Zheng Qi retreats and knots in the Zang organs. Thus, pathogenic factors float and associate with the skin and hair. A rapid pulse contraindicates purgation; purging causes irritability and incessant diarrhea.
The section "associating with skin and hair" explains why the pulse is floating and rapid. Irritable diarrhea is also heat-collateral diarrhea.
A floating and large pulse indicates the need for sweating; if the physician incorrectly uses purgation, this is a major violation.
This repeats the gist of Article 17 in Chapter 14 to emphasize caution.
If there is frequent vomiting, even if there are Yangming syndrome signs, attack/purgation must not be used.
This repeats Article 38 of the Yangming Chapter.
In Taiyang disease, if exterior signs are unresolved, purgation must not be used; purging is an adverse treatment.
This corresponds to Article 17 in the Taiyang section, repeated because it applies generally to all Taiyang conditions, emphasizing caution.
Generally, diseases with abundant Yang present as heat; purging leads to hardness.
"Yang" refers to Wind; "abundant" means prevailing. "Heat" refers to spontaneous sweating; "hardness" indicates loss of body fluids.
With no Yang and strong Yin, if the stool is hard, purging leads to passage of undigested food and abdominal fullness.
"Yin" refers to Cold; "strong" means abundant. Passage of undigested food indicates Yin failing to transform. Abdominal fullness indicates Yin stagnation and internal bloating. This also uses matching language to mutually elaborate.
A pulse that is floating and large: floating indicates Qi excess, large indicates Blood deficiency. Blood deficiency is Yin deficiency. If solitary Yang descends alone into the Yin region, urination should be red and difficult, and the Bao Zhong (uterus/bladder) should be empty. Now, conversely, urination is free and there is profuse sweating. According to principle, the Wei Qi (Defensive Qi) should be weak, but now it is surprisingly solid. Body fluids scatter in all directions, Ying Blood (Nutritive Blood) is exhausted, dry irritability prevents sleep, blood becomes thin and muscles waste away leading to sudden thirst. If the physician again attacks the Stomach with toxic drugs, this is double deficiency. The guest Yang has a limited time to depart; death will result from passing mud-like feces.
In Cold Damage with fever and headache, slight sweating: if sweating is induced, the patient becomes disoriented and does not recognize people; if moxibustion/fumigation is used, asthma develops, urination is blocked, and the heart and abdomen become full; if purgation is used, shortness of breath, difficult urination, headache, and stiff back occur; if warm needles are added, nasal bleeding occurs.
In Cold Damage with fever, bubbling qi exiting the mouth, neck pain, yellow eyes, uncontrollable nasal bleeding: those craving water will vomit; those rejecting water will have cold limbs. If purgation is used, sores form in the throat; if hands and feet are warm, there will be rectal heaviness and pus-blood in stool. For headache and yellow eyes, purging causes closed eyes. Craving water implies a wiry pulse, low voice, and throat obstruction. If sweating is induced, shivering occurs. Both Yin and Yang are deficient. Rejecting water, if purged, leads to interior cold, anorexia, and complete undigested food in stool. If sweating is induced, oral injury, white tongue coating, irritability, rapid and solid pulse, and constipation occur; after six or seven days, bloody stool will appear. If sweating is induced, urination becomes spontaneous.
A pulse that is soggy and tight: soggy indicates weak Stomach Qi; tight indicates cold in the Ying level. Yang is weak, Wei is affected by Wind, causing fever and aversion to cold; Ying is tight, Stomach Qi is cold, causing mild vomiting and internal irritability. The physician mistakes this for high heat and uses muscle-relaxing sweating, leading to Yang collapse, void irritability, and painful epigastric hardness. Exterior and Interior are both exhausted. Sudden rising causes dizziness; guest heat is in the skin, causing melancholy insomnia. Not knowing the Stomach Qi is cold and tight cold is at the Guan Yuan point, skill is useless. Pouring water on the body makes guest heat vanish, leaving wetness and chills. Covering with heavy blankets causes sweating and dizziness over the head, trembling, difficult urination. Cold qi arises from water, undigested diarrhea leaves no interval, vomiting turns into intestinal prolapse, turning upside down in distress, mild limb inversion, cold body with internal irritability. Delayed rescue cannot restore life.
In Cold Damage, if Yin and Yang pulses are both tight, with aversion to cold and fever, the pulse desires to Jue (reverse/extremity). Jue means the pulse starts large, gradually becomes small, then grows large again; this is the sign.
In such cases, severe aversion to cold brings翕翕 (gentle/light) sweating and sore throat; heat predominance brings red eyes, many visible vessels, and dim vision. If the physician re-induces sweating, the throat is injured; if purged, eyes close. Cold predominance brings clear stool; heat predominance brings pus-blood. If fumigated, jaundice appears; if ironed/warmed, throat dries. If urination is free, it can be saved; if difficult, it is critical.
Diarrhea with a large pulse indicates deficiency, caused by forced purgation. If the pulse is floating and革 (leather-like), accompanied by borborygmus (stomach rumbling), it belongs to Dang Gui Si Ni Tang (Angelica Sinensis Four Reversals Decoction).
The above six lines do not explicitly mention "do not purge." The categorization is unclear, suspected to be non-Shuhe original, likely later confusion. I dare not force an explanation; I leave doubts for the learned.