问曰。脉有阴阳者。何谓也。答曰。凡脉大。浮。数。动。滑。此名阳也。脉沉。涩。弱。
弦。微。此名阴也。凡阴病见阳脉者
生。阳病见阴脉者死。
阴阳者。通脏腑血气表里虚实风寒寒热而总言之也。大。浮。数。动。滑。皆阳之性能。故
见则为阳气至。可知也。沉。涩。弱。弦。微。皆阴之体段。故见则为阴气至。可诊也。阴病。
三阴之属也。见阳脉。则阴消而阳长。阳主生。故有生之兆先见可明也。
阳病三阳之类也。见阴脉则阳退而阴进。阴主杀。故应死之机已着可审也。夫道不外乎阴阳。
万物生于阳气至而死于阴令行者。造化之枢机。固如是也。人亦化中之一物。焉能外阴阳而逃其生
死乎。圣贤为道之先觉。故阐明生死。神道以设教。众人囿于道。昧而不能察。故但醉生梦死于
形器之中。而不可与言神圣工巧之妙矣。学人诚能竭心思以尽力乎此。则脉道之大微。虽千绪万
端。大要此其推也。
问曰。脉有阳结阴结者。何以别之。答曰。其脉浮而数。能食不大便者。此为实。名曰阳结
也。期十七日当剧。其脉沉而迟。不能食。身体重。大便反硬。名曰阴结也。期十四日当剧。
浮数能食皆阳也。实谓胃家实。阳以风言。谓由中风而结为实硬也。沉迟不能食。身体重。
阴也。硬实互文。阴以寒言。谓由伤寒而结为胃实也。十七十四未详。
问曰。病有洒淅。恶寒而复发热者何。答曰。阴脉不足。阳往从之。阳脉不足。阴往乘之。
曰何谓阳不足。答曰。假令寸口脉微。名曰阳不足。阴气上入阳中。则洒淅恶寒也。曰。何谓阴
不足。答曰。假令尺脉弱。名曰阴不足。阳气下陷入阴中。则发热也。
阳先乎阴。以陷入也。故曰从。讳之也。阴随于阳。以上入也。故曰乘。伤之也。恶寒者。
阳不足以胜阴而与阴俱化也。发热
者。阴不足以胜阳而从阳之化也。上条明阳明内实。此明太阳发热恶寒。盖申二脉而详言之也。
阳脉浮。阴脉弱者。则血虚。血虚则筋急也。
筋赖血以荣。血虚则筋失其所荣润。故拘挛而急也。
其脉沉者。荣气微也。其脉浮而汗出。如流珠者。卫气衰也。荣气微者加烧针。则血流不行。
更发热而躁烦也。
沉以候里。荣行脉中。故衰微可知。浮以侯表。卫行脉外。汗出如流珠。则表不固。故衰惫
可诊。荣气微者以下。申上文而言其失治之变。流与从流下而亡反谓之流之流同。行即循行周行
之行也。言荣本衰微。则阴虚而有热。加以烧针。则反助阳而损阴。故血趋于流而不能循环。阳得
加助。则益作热而烦 躁扰也。
脉霭霭如车盖者。名曰。阳结也。脉累累如循长竿者。名曰阴结也。
霭霭。团聚貌。如车盖。言浮旋于上也。累累联系貌。如循长竿。言沉直于下也。
脉。瞥瞥如羹上肥者。阳气微也。脉。萦萦如蜘蛛丝者。阳气衰也。脉。绵绵如泻漆之绝者。
亡其血也。
瞥。音 。瞥。过目暂见也。羹上肥。言轻浮而若有若无也。萦萦犹绕绕也。蜘蛛丝言柔弱
而极细也。成氏曰。绵绵者。连绵而软也。如泻漆之绝者。前大而后细也。又曰。阳气前至。阴
气后至。则脉前为阳气。后为阴气。脉来前大后细为阳气有余阴气不足。是知亡血也。
脉来缓。时一止复来者。名曰结。脉来数。时一止复来者。名曰促。阳盛则促。阴盛则结。此
皆病脉。
缓者。迟于平而快于迟。舒徐之谓也。促。催速也。与短促不同。阳行健。故盛则促。阴行
钝。故盛则结。病脉者。言结促虽阴阳之剧盛。犹为可治之意。虽然。退则吉。进则主凶矣。读
者不可不察。
阴阳相搏名曰动。阳动则汗出。阴动则发热。形冷恶寒者。此三焦伤也。
搏。圜捏而攒聚也。动见下。阴阳相搏之阴阳。以二气言。阳动阴动之阴阳。以部位言。阳
动则阴随。故汗出。阴动则阳应。故发热。末二句不相蒙。疑有脱误。
若脉数见于关上。上下无头尾。如豆大。厥厥动摇者。名曰动也。
此言动有定位。与其形状。厥厥。举发貌。
阳脉浮大而濡。阴脉浮大而濡。阴脉与阳脉同等者。名曰缓也。
缓有二义。此以相兼言。盖谓气血平和。与前节之缓不同。
脉浮而紧者。名曰弦也。弦者状如弓弦。按之不移也。脉紧者。如转索无常也。
此明弦紧之辨。按之不移。言如弦之张于弓。一定而不可动移也。转索无常。言左右旋转而
不可拘也。
脉弦而大。弦则为减。大则为芤。减则为寒。芤则为虚。寒虚相搏。此名为革。妇人则半产
漏下。男子则亡血失精。
寒。言阳气减损而不足。芤。言阴血衰竭而空。革。言革易常度也。妇人阴血充足而能化。
则得坤顺之常。半产漏下。则不足以言坤之资生矣。男子阳精充盛而能施。则得干健之常。亡血
失精。则不足以言干之资始矣。天地之大德曰
生。男不足以言资始。女不足以言资生。则人道大坏。故曰革也。一说革读亟。变而促迫也。亦通。
问曰。病有战而汗出。因得解者。何也。答曰。脉浮而紧。按之反芤。此为本虚。故当战而
汗出也。其人本虚。是以发战。以脉浮。故当汗出而解也。
病久而脉浮者。邪见还表而外向也。紧为寒。阴也。战。邪争也。言邪虽还表而欲退。以阴
寒所持。而人又本虚。故邪得以与正争。惟争。所以战也。然脉浮矣。邪外向矣。故正卒胜。邪
卒散。汗所以出而病解也。
问曰。病有不战而汗出解者。何也。答曰。若脉浮而数。按之不芤。此人本不虚。若欲自解。
但汗出耳。不发战也。
此与上节是反对。数为热。阳也。阳热胜而人又不虚。则邪不能与正争。汗出。邪退也。不
发战。正胜也。此旧本皆二节。而颠倒差错。各不相同。今得蜀僧来本如此。故从而订之。
问曰。病有不战不汗出而解者。何也。答曰。其脉自微。此以曾经发汗。若吐。若下。若亡
血。以内无津液。此阴阳自和。必自愈。故不战不汗出而解也。
曾经多治。则邪已误衰。故脉微无津液。言无作汗之邪也。阴阳自和。言血气平复也。风寒
病解。大率不外如此三者。知此三者。则知所以解矣。
问曰。伤寒三日。脉浮数而微。病患身凉和者。何意也。答曰。此为欲解也。解以夜半。脉
浮而解者。 然汗出也。脉数而解者。必能食也。脉微而解者。必大汗出也。
三日。言遍三阳也。浮数。不传阴也。微。邪气衰也。夜半。阴尽阳生之时也。 然。和而
汗出貌。能食。胃回也。大汗者。其人虚多。虚多则受邪多。受邪多。故汗大也。
问曰。脉病欲知愈未愈者。何以别之。答曰。寸口。关上。尺中。三处大。小。浮。沉。迟。
数。同等。虽有寒热不解者。此脉阴阳为和平。虽剧当愈。
此以大概言。不独谓风寒也。
立夏得洪大脉。是其本位。其人病身体苦疼重者。须发其汗。若明日不疼不重者。不须发汗。
若汗 自出者。明日便解矣。何以言之。立夏得洪大脉。是其时脉。故使然也。四时仿此。
此言脉得应时而王。则病有当解之自然。举夏以例其余。式人推仿之意。
问曰。凡病欲知何时得。何时愈。答曰。假令夜半得病。明日日中愈。日中得病。夜半愈。
何以言之。日中得病夜半愈者。以阳得阴则解也。夜半得病。明日日中愈者。以阴得阳则解也。
凡以大概言。阳得阴。阴得阳。则阴阳相际。血气平复。所以自然当解。日中夜半以大意言。
余时仿此同推。
寸口脉浮为在表。沉为在里。数为在腑。迟为在脏。假令脉迟。此为在脏也。
此总大意言。
趺阳脉浮而涩。少阴脉如经也。其病在脾。法当下利。何以知之。若脉大者。气实血虚也。
今趺阳脉浮而涩。故知脾气不足。胃气虚也。以少阴脉弦而浮。才见此为调脉。故称如经也。若反
滑而数者。故知当屎脓也。
见。音现。少。当作太。故曰在脾。经。常也。滑为食。数为热。屎脓。谓脓血利也。
寸口脉浮而紧。浮则为风。紧则为寒。风则伤卫。寒则伤荣。荣卫俱病。骨节烦疼。当发其
汗也。
此举太阳下编首条。申其脉而详明其义。
趺阳脉迟而缓。胃气如经也。趺阳脉浮而数。浮则伤胃。数则动脾。此非本病。医特下之所
为也。荣卫内陷。其数先微。脉反但浮。其人必大便硬。气噫而除。何以知之。本以数脉动脾。
其数先微。故知脾气不治。大便硬。气噫而除。今脉反浮。其数改微。邪气独留。心中则饥。邪
热不杀谷。潮热发渴。数脉当除。缓脉因前后度数如法。病者则饥。数脉不时。则生恶疮也。
前条太阴以脾言。此言胃。对举而两见贯意。恶疮与屎脓虽不同。其为血热则皆然也。疮者。
如素问所谓膏粱之变。足生大疔。与夫多病痈疽之类是也。
师曰。病患脉微而涩者。此为医所病也。大发其汗。又数大下之。其人亡血。病当恶寒。后
乃发热。无休止时。夏月盛热。欲着复衣。冬月盛寒。欲裸其身。所以然者。阳微则恶寒。阴弱
则发热。此医发其汗。令阳气微。又大下之。令阴气弱。五月之时。阳气在表。胃中虚冷。以阳
气内微。不能胜冷。故欲着复衣。十一月之时。阳气在里。胃中烦热。以阴气内弱。不能胜热。
故欲裸其身。又阴脉迟涩。故知亡血也。
数。音速。令。胜。皆平声。此以医误致恶寒发热者言。所以然者以下。申明上文之词。复。
夹衣也。
脉浮而大。心下反硬。有热属脏者。攻之不令发汗。属腑者。不令溲数。溲数。则大便硬。
汗多。则热愈。汗少。则便难。脉迟。尚未可攻。
此举结胸痞气胃实等之当下者。概致叮咛戒慎之意。属脏。主结胸痞气也。故曰。攻之不令
发热。属腑。指胃实等也。故曰。不令溲数。谓不可利小便也。
脉浮而洪。身汗如油。喘而不休。水浆不下。体形不仁。乍静乍乱。此为命绝也。
此节乃此条之总。下五节乃五目。末节。乃总结上文之词。盖指第九篇第四条。而以其不可
治者。详言之之意也。
又未知何脏先受其灾。若汗出发润。喘而不休者。此为肺先绝也。
首句乃承上文重起设问之词。若汗出以下。至此为肾绝也。乃五答词。汗出发润。即身汗如
油。变文之互词。喘而不休同。然上节曰命绝。此曰肺绝。何也。曰。人以气在则生。气绝则死。
肺主气。气主命。故以总一身而概言之。则曰命绝。及以通下文析五脏而详言之。则又曰肺先绝
也。
阳反独留。形体如烟熏。直视摇头者。此心绝也。
此下当有为字。阳反独留。乃承上接下之词。人之有生。气血焉耳。气在则生。气去则死。
死道之常。气先绝也。然血气之交。亦有偏胜而不可以常论者。故曰。阳反独留。言上节之证。
若不先见。则是肺不先绝。阳气反独迟留。阳反独留。则阴先绝。阴。血也。心主血。故次言之。
烟熏。火欲烬而昏暗先形也。直视者。少阴之脉。其支者。从心系上挟咽系目也。摇头者。头为
诸阳之会。阴去则阳无所根据附。故不宁也。
唇吻反青。四肢 习者。此为肝绝也。
吻。微衮切。口唇边曰吻。肝之脉。其支者。从目系。下颊里。环口里。青。肝之色也。四
肢手足也。 。汗出焉。习。鸟数飞也。头摇。如鸟之习飞奋振而不已。盖肝属木而主风。脾属
土而主四肢。土受木贼。木欲折而风不息。土受伤而欲崩坏也。
环口黧黑。柔汗。发黄者。此为脾绝也。
黧。音黎。口为脾之窍。黧黑。熏黄黑暗。土败之色也。柔汗。俗谓冷汗是也。盖汗者。血
之液。血虽阴。行之者阳。脾败。不统血。则阴不守阳不固也。发黄者。脾属土而主肌肉。土欲
败而色外夺也。
溲便遗矢。狂言。目反。直视者。此为肾绝也。
矢。与屎同。溲便。遗溺也。肾司阖辟。阖辟废。故二便皆无禁约也。肾藏志。经曰。狂言者。
是失志矣。失志者死。肾主骨。骨之精为瞳子。目反直视者。骨之精不上荣于瞳子。瞳子背而不
能转也。
又未知何脏阴阳前绝。若阳气前绝。阴气后竭者。其人死。身色必青。阴气前绝。阳气后竭
者。其人死。身色必赤。腋下温。心下热也。
首句又承上文重起设问之词。下乃答词也。盖五脏绝之先后。不可以上文之次第为拘。故复
言脏气之阴阳前后绝竭。有以验之于既死之后。则脏有胜负。绝有迟速。大率可见矣。腋。左
右肘胁之间也。成氏曰。阳主热而色赤。阴主寒而色青。其人死也。身色青。则阴未离乎体。故
知阴气后竭也。身色赤。腋下温。心下热。则阳未离乎体。故知阳气后竭也。
寸口脉浮大。而医反下之。此为大逆。浮则无血。大则为寒。寒气相搏。则为肠鸣。医乃不知
而反饮冷水。令汗大出。水得气寒。冷必相搏。其人即KT 。
KT 。与噎通。饮。去声。令。平声。浮为气。故曰无血。大为虚。故曰寒。KT 。俗谓之
KT。义见下条。
趺阳脉浮。浮则为虚。浮虚相搏。故令气KT 。言胃气虚竭也。脉滑则为哕。此为医咎。责
Question: The pulse has yin and yang distinctions. What does this mean?
Answer: Whenever the pulse is large (Da), floating (Fu), rapid (Shu), moving (Dong), or slippery (Hua), these are named yang pulses. Whenever the pulse is deep (Chen), choppy (Se), weak (Ruo), wiry (Xian), or minute (Wei), these are named yin pulses. In general, if a yin disease (San Yin Jing pathology) presents with a yang pulse, there is hope for life; if a yang disease (San Yang Jing pathology) presents with a yin pulse, it indicates death.
The terms yin and yang comprehensively cover zang-fu organs, blood and qi, exterior and interior, deficiency and excess, wind-cold, and cold-heat. Large, floating, rapid, moving, and slippery pulses all reflect the nature of yang qi. Therefore, their appearance indicates the arrival of yang qi, which can be known. Deep, choppy, weak, wiry, and minute pulses all reflect the form of yin qi. Therefore, their appearance indicates the arrival of yin qi, which can be diagnosed. Yin diseases belong to the Three Yin categories. If a yang pulse appears, it means yin declines and yang grows. Since yang governs life, the signs of vitality appear first, which is clear.
Yang diseases belong to the Three Yang categories. If a yin pulse appears, it means yang retreats and yin advances. Since yin governs killing/death, the signs of impending death become evident, which can be examined. The Dao does not go beyond yin and yang. All things are born when yang qi arrives and die when yin commands prevail; this is the pivot of creation, and it is indeed so. Humans are also creatures within this transformation; how can they escape life and death by excluding yin and yang? Sages and worthies are the first to awaken to the Dao, so they clarify life and death, establishing teachings through spiritual ways. The masses are confined by the Dao, ignorant and unable to perceive, thus living drunk and dreaming in the realm of physical forms, and cannot be spoken to regarding the wonders of divine, sacred, skillful, and adept medical practices. If learners can truly exhaust their minds and exert themselves in this area, then although the subtleties of pulse diagnosis involve thousands of threads and ends, the main principles can be deduced from this.
Question: There are pulses called Yang Jie (Yang Knotting) and Yin Jie (Yin Knotting). How can they be distinguished?
Answer: If the pulse is floating and rapid, and the patient can eat but has constipation, this is an Excess pattern, named Yang Jie. It is expected that the condition will worsen on the seventeenth day. If the pulse is deep and slow, the patient cannot eat, feels heavy in the body, and the stool is conversely hard, this is named Yin Jie. It is expected that the condition will worsen on the fourteenth day.
Floating, rapid, and ability to eat all belong to Yang. "Excess" refers to Stomach Excess (Wei Jia Shi). Yang is discussed in terms of Wind, meaning結 (knotting/excess) resulting from Wind-Strike leading to hardness. Deep, slow, inability to eat, and heaviness in the body belong to Yin. Hardness and Excess are mutually explanatory. Yin is discussed in terms of Cold, meaning knotting/excess resulting from Cold-Strike leading to Stomach Excess. The specifics of the 17th and 14th days are unclear.
Question: In illness, there is shivering aversion to cold followed by fever. What is this?
Answer: When Yin pulses are deficient, Yang Qi moves to attach to it. When Yang pulses are deficient, Yin Qi moves to invade it.
Question: What is meant by Yang deficiency?
Answer: For example, if the Cun Kou (inch position) pulse is minute, it is named Yang deficiency. Yin Qi enters upward into the Yang region, causing shivering aversion to cold.
Question: What is meant by Yin deficiency?
Answer: For example, if the Chi (cubit position) pulse is weak, it is named Yin deficiency. Yang Qi sinks downward into the Yin region, causing fever.
Yang precedes Yin because it sinks in; hence it is said to "follow" (Cong), which is a euphemism. Yin follows Yang because it enters upward; hence it is said to "invade/mount" (Cheng), which implies injury. Aversion to cold occurs because Yang is insufficient to overcome Yin and transforms together with Yin. Fever occurs because Yin is insufficient to overcome Yang and transforms according to Yang. The previous section clarified internal excess of Yang Ming; this section clarifies fever and aversion to cold of Tai Yang. This elaborates on the two pulses and explains them in detail.
If the Yang pulse is floating and the Yin pulse is weak, there is Blood deficiency. Blood deficiency leads to tendon tension.
Tendons rely on Blood for nourishment. When Blood is deficient, tendons lose their nourishment and moisture, leading to spasms and tension.
A deep pulse indicates Wei Qi (Defensive Qi) weakness. A floating pulse with sweating like flowing pearls indicates Wei Qi decline.
Deep pulses examine the Interior; Ying Qi (Nutritive Qi) circulates within the vessels, so its weakness is known. Floating pulses examine the Exterior; Wei Qi circulates outside the vessels. Sweating like flowing pearls indicates insecure Exterior, so decline can be diagnosed. The following text elaborates on the changes due to mis-treatment mentioned above. "Liu" is the same as "flowing down and not returning." "Xing" refers to circulating. It means Ying was originally weak, leading to Yin deficiency with heat. Adding moxibustion (burning needle) further assists Yang and damages Yin, so blood tends to flow without circulating. Yang receives additional assistance, generating more heat and restlessness.
A pulse that looks dense and clustered like a chariot canopy is named Yang Jie. A pulse that feels linked and continuous like touching a long bamboo pole is named Yin Jie.
"Aiai" describes a clustered appearance. Like a chariot canopy, it means floating and rotating upwards. "Leilei" describes a connected appearance. Like touching a long pole, it means deep and straight downwards.
A pulse that flits like fat floating on soup indicates weak Yang Qi. A pulse that winds like a spider's silk indicates declining Yang Qi. A pulse that is continuous like lacquer pouring out at its end indicates loss of Blood.
"Pie" means a fleeting glance. Fat on soup is light, floating, and seemingly present yet absent. "Yingying" is like winding. Spider silk is soft and extremely thin. Cheng Wuji said: "Mianmian" is continuous and soft. Like lacquer pouring out at its end means large at the front and thin at the back. He also said: When Yang Qi arrives first and Yin Qi arrives last, the front of the pulse represents Yang Qi and the back represents Yin Qi. A pulse coming large at the front and thin at the back indicates excess Yang Qi and deficiency of Yin Qi, thus indicating loss of Blood.
A pulse that is slow and occasionally stops before resuming is named Jie (Knotted) pulse. A pulse that is rapid and occasionally stops before resuming is named Cu (Crisis) pulse. Yang excess leads to Cu pulse; Yin excess leads to Jie pulse. These are all pathological pulses.
"Huan" is slower than the normal pulse but faster than "Chi" (slow); it means leisurely. "Cu" means hurried/rapid. It is different from shortness. Yang moves vigorously, so excess leads to Cu. Yin moves sluggishly, so excess leads to Jie. Calling them pathological pulses means that although Jie and Cu represent extreme excess of Yin and Yang, they are still treatable. However, regression brings good fortune, while progression indicates bad omens. Readers must examine this carefully.
When Yin and Yang struggle against each other, it is named Dong (Moving) pulse. Yang Dong causes sweating; Yin Dong causes fever. Cold body and aversion to cold indicate injury to the San Jiao (Triple Burner).
"Bo" means gathering in a circle. Dong is explained below. The Yin and Yang in "struggle between Yin and Yang" refer to the two Qi. The Yin and Yang in "Yang Dong/Yin Dong" refer to positions. Yang Dong means Yin follows, causing sweating. Yin Dong means Yang responds, causing fever. The last two sentences do not connect well; there may be missing text.
If a rapid pulse appears at Guan (barrier position), with no head or tail above or below, about the size of a bean, trembling violently, it is named Dong pulse.
This describes the fixed location and shape of the Dong pulse. "Juejue" describes a sudden rising motion.
If Yang pulse is floating, large, and soft, and Yin pulse is floating, large, and soft, and Yin pulse equals Yang pulse in magnitude, it is named Huan (Slow/Relaxed) pulse.
"Huan" has two meanings. Here it refers to combined pulses, indicating harmonious Blood and Qi, different from the previous section's Huan pulse.
A pulse that is floating and tight is named Xian (Wiry) pulse. The Xian pulse feels like a bowstring, unmovable upon pressure. A Jin (Tight) pulse feels like a turning rope, changing constantly.
This clarifies the distinction between Xian and Jin. "Unmovable upon pressure" means like a string stretched on a bow, fixed and immovable. "Turning rope" means rotating left and right without constraint.
A pulse that is Xian and large: Xian indicates reduction (deficiency), Large indicates Kong (Hollow). Reduction indicates Cold, Kong indicates Deficiency. Cold and Deficiency struggling together is named Ge (Leather) pulse. In women, it manifests as miscarriage and dripping blood; in men, as loss of blood and essence.
Cold refers to reduced and insufficient Yang Qi. Kong refers to exhausted and empty Yin Blood. Ge refers to changing the normal state. Women have sufficient Yin Blood for transformation, achieving the constant of Kun (Earth/Receptive). Miscarriage and dripping blood fail to achieve Kun's generative function. Men have abundant Yang Essence for expression, achieving the constant of Qian (Heaven/Creative). Loss of blood and essence fails to achieve Qian's initiating function. The great virtue of Heaven and Earth is Life. If men cannot initiate and women cannot generate, human way is greatly damaged, hence called Ge. Another interpretation reads Ge as Ji (urgent), meaning change and urgency, which is also valid.
Question: In illness, there is shivering followed by sweating, leading to resolution. Why?
Answer: The pulse is floating and tight, but hollow upon pressure. This is due to fundamental deficiency, so shivering and sweating occur. The person is fundamentally deficient, hence shivering. Because the pulse is floating, sweating leads to resolution.
Pulse floating after long illness means pathogen returns to the Exterior and moves outward. Tight indicates Cold, which is Yin. Shivering is pathogen-struggle. Although the pathogen returns to the Exterior and wants to retreat, held by Yin-Cold and compounded by fundamental deficiency, the pathogen struggles with Zheng Qi (Upright Qi). Because of struggle, there is shivering. However, since the pulse is floating and the pathogen is moving outward, Zheng Qi ultimately wins, and the pathogen scatters. Hence sweating occurs and the disease resolves.
Question: In illness, there is resolution through sweating without shivering. Why?
Answer: If the pulse is floating and rapid, and not hollow upon pressure, the person is fundamentally not deficient. If self-resolution is desired, only sweating occurs, without shivering.
This opposes the previous section. Rapid indicates Heat, which is Yang. If Yang-Heat prevails and the person is not deficient, the pathogen cannot struggle with Zheng Qi. Sweating indicates pathogen retreat. No shivering indicates Zheng Qi victory. In old editions, these two sections were inverted and varied. Now, based on the version from a Shu monk, they are corrected here.
Question: In illness, there is resolution without shivering or sweating. Why?
Answer: The pulse is naturally minute. This is because of prior sweating, vomiting, purging, or blood loss, leading to lack of fluids inside. This is Yin-Yang self-harmonization, leading to inevitable self-healing. Hence, resolution occurs without shivering or sweating.
After multiple treatments, the pathogen is already weakened, so the pulse is minute without fluids. Saying "no fluids" means no pathogen to induce sweating. Yin-Yang self-harmonization means blood and Qi are restored. Resolution of Wind-Cold diseases generally falls into these three categories. Knowing these three allows one to understand resolution.
Question: After three days of Shang Han, the pulse is floating, rapid, and minute, and the patient's body is cool and harmonious. What does this mean?
Answer: This means resolution is approaching. Resolution occurs at midnight. Floating pulse resolving means gentle sweating. Rapid pulse resolving means appetite returns. Minute pulse resolving means profuse sweating.
Three days means transmission through the Three Yang channels. Floating and rapid mean no transmission to Yin. Minute means pathogen is declining. Midnight is when Yin ends and Yang begins. "Jiran" means harmonious sweating. Appetite return indicates Stomach Qi recovery. Profuse sweating occurs because the person is largely deficient. Greater deficiency means greater pathogen invasion, hence profuse sweating.
Question: Regarding pulse and disease, how to know if recovery is near or not?
Answer: At Cun Kou, Guan, and Chi positions, regardless of size, floating/sinking, slow/rapid, if they are equal and harmonious, even if cold/heat persist, the pulse indicates Yin-Yang harmony. Even if severe, recovery is certain.
This is a general statement, not limited to Wind-Cold.
At Lixia (Start of Summer), obtaining a Hong Da (Surging and Large) pulse is its proper seasonal pulse. If the patient suffers from body pain and heaviness, sweating should be induced. If tomorrow pain and heaviness cease, sweating is unnecessary. If spontaneous sweating occurs, resolution happens tomorrow. Why? Because Hong Da pulse at Lixia is the seasonal pulse, hence the result. This applies to all four seasons.
This states that when the pulse corresponds to the season and reigns, the disease has a natural time for resolution. Summer is used as an example to infer others, encouraging readers to apply this logic.
Question: Regarding any illness, how to know when it started and when it will heal?
Answer: For example, if illness starts at midnight, it heals at noon the next day. If it starts at noon, it heals at midnight.
Why? Illness starting at noon and healing at midnight: Yang resolves by receiving Yin. Illness starting at midnight and healing at noon: Yin resolves by receiving Yang.
Generally, when Yang receives Yin and Yin receives Yang, Yin and Yang interact, and blood and Qi restore, leading to natural resolution. Noon and midnight are used for general inference; other times follow similarly.
Cun Kou pulse floating indicates Exterior; deep indicates Interior; rapid indicates Fu organs; slow indicates Zang organs. If the pulse is slow, it is in the Zang organs.
This summarizes the general principle.
Fu Yang pulse floating and Se (choppy), while Shao Yin pulse is normal. The disease is in the Spleen, and diarrhea is expected. How is this known? If the pulse is large, it is Qi excess and Blood deficiency. Now, Fu Yang pulse is floating and Se, so Spleen Qi is insufficient and Stomach Qi is weak. Because Shao Yin pulse is Xian and floating, this is considered a balanced pulse, hence "normal." If it reverses to Slippery and Rapid, pus in stool is expected.
"Jian" sounds like "xian." "Shao" should be "Tai." Hence disease in Spleen. "Jing" means normal. Slippery indicates food retention; Rapid indicates heat. Pus in stool refers to bloody purulent diarrhea.
Cun Kou pulse floating and tight: Floating indicates Wind; Tight indicates Cold. Wind injures Wei Qi; Cold injures Ying Qi. Both Ying and Wei are diseased, causing bone and joint pain. Sweating should be induced.
This cites the first line of the Tai Yang lower section, elaborating on the pulse and meaning.
Fu Yang pulse slow and relaxed indicates Stomach Qi is normal. Fu Yang pulse floating and rapid: Floating injures Stomach; Rapid disturbs Spleen. This is not the original disease but caused by the doctor's purgation. Ying and Wei sink inward. The rapid pulse becomes minute first, and the pulse reverses to only floating. The patient will likely have hard stool and belching. How is this known? Originally, the rapid pulse disturbed the Spleen, making it minute first, indicating Spleen Qi dysfunction, hard stool, and belching. Now the pulse reverses to floating, the rapidness changes to minute, leaving only the pathogen. The heart feels hungry, but pathogenic heat cannot digest food. Tide-like fever and thirst occur. The rapid pulse should disappear. If the relaxed pulse follows standard timing, the patient feels hungry. If the rapid pulse persists, malignant sores may develop.
The previous section discussed Tai Yang via Spleen; this discusses Stomach. They contrast and complement each other. Malignant sores and pus in stool differ but both involve blood-heat. Sores refer to conditions like "large carbuncles on feet" from rich foods in Su Wen, or various abscesses.
The Master said: If the patient's pulse is minute and Se, this is iatrogenic illness. Caused by excessive sweating and repeated severe purging. The patient loses Blood. The illness involves aversion to cold, later fever, without cessation. In summer heat, the patient desires to wear extra clothes. In winter cold, the patient desires to strip naked. Why? Yang minute causes aversion to cold; Yin weak causes fever. The doctor's sweating made Yang Qi minute; purging made Yin Qi weak. In May, Yang Qi is at the Exterior, Stomach is cold internally. Due to internal Yang deficiency, it cannot overcome cold, hence desiring extra clothes. In November, Yang Qi is at the Interior, Stomach is hot internally. Due to internal Yin deficiency, it cannot overcome heat, hence desiring to strip naked. Additionally, Yin pulse is slow and Se, confirming blood loss.
"Shu" sounds like "su." "Ling" and "Sheng" are level tone. This explains chills and fever caused by medical error. "Suo yi ran zhe" explains the previous text. "Fu" means layered clothing.
Pulse floating and large, with hardness in the epigastrium, heat belonging to Zang organs: Attack it, do not induce sweating. Heat belonging to Fu organs: Do not cause frequent urination. Frequent urination leads to hard stool. Profuse sweating increases heat; less sweating leads to difficult stool. Slow pulse: Not yet ready for attack.
This warns against attacking cases like Jie Xiong (Chest Binding), Pi Qi (Stagnant Qi), and Wei Shi (Stomach Excess). "Belonging to Zang" refers to Jie Xiong/Pi Qi; hence "attack, do not induce sweating." "Belonging to Fu" refers to Stomach Excess; hence "do not cause frequent urination," meaning do not promote diuresis.
Pulse floating and Hong (Surging), sweat like oil, panting without rest, inability to take fluids, insensitivity of body, alternating calmness and chaos: This is Life Extinction (Ming Jue).
This section is the summary of the whole article; the following five sections are the five items. The last sentence summarizes the preceding text, referring to Article 4 of Chapter 9, detailing untreatable conditions.
It is unknown which Zang organ suffers first. If sweating wets the hair, panting without rest, this is Lung Extinction first.
The first sentence restarts the question. From "if sweating..." to here is Kidney Extinction, being the fifth answer. "Sweating wets hair" is synonymous with "sweat like oil." "Panting without rest" is the same. Why did the previous section say "Life Extinction" and this one "Lung Extinction"? Humans live by Qi; death comes when Qi extinguishes. Lung governs Qi; Qi governs Life. Thus, speaking generally of the whole body, it is called "Life Extinction." Analyzing the five Zang organs in detail, it is called "Lung Extinction first."
Yang remains alone, body looks like smoke staining, staring straight ahead, shaking head: This is Heart Extinction.
There should be a verb here. "Yang remains alone" connects previous and next. Human life depends on Qi and Blood. Qi presence means life; absence means death, the normal way of dying, where Qi extinguishes first. However, interaction of Qi and Blood can have imbalance not fitting normal rules. Hence "Yang remains alone." If the previous symptoms didn't appear first, Lung didn't extinguish first; instead, Yang lingers late. Yang lingering alone means Yin extinguishes first. Yin is Blood. Heart governs Blood, hence mentioned next. "Smoke staining" is darkness appearing before fire dies. "Staring straight": The branch of Shao Yin channel goes from Heart connection up throat to eyes. "Shaking head": Head is meeting of all Yang. When Yin leaves, Yang has no foundation, hence restless.
Lips and corners of mouth turn blue, limbs twitching: This is Liver Extinction.
"Wen" is the corner of the mouth. Liver channel branch goes from eye connection, down cheek, around mouth. Blue is Liver color. Limbs are hands and feet. "Xi" means bird flying frequently. Head shaking like bird fluttering incessantly. Liver belongs to Wood and governs Wind; Spleen belongs to Earth and governs limbs. Earth is attacked by Wood; Wood wants to break but Wind doesn't stop; Earth is injured and collapsing.
Black ring around mouth, cold sweat, yellow complexion: This is Spleen Extinction.
"Lí" sounds like "li." Mouth is Spleen orifice. Black/dark yellow is color of Earth failure. Cold sweat is common term for cold sweat. Sweat is fluid of Blood. Though Blood is Yin, Yang moves it. Spleen failure fails to control Blood, so Yin doesn't guard and Yang doesn't secure. Yellowing: Spleen belongs to Earth and governs muscles; Earth failing causes color to emerge externally.
Incontinence of urine and feces, delirious speech, eyes rolling back, staring straight: This is Kidney Extinction.
"Shi" is same as "shi" (stool). "Sou bian" is urinary incontinence. Kidney controls opening and closing. Failure means no control over excretion. Kidney stores Zhi (Will). Classic says: Delirious speech is loss of Will. Loss of Will means death. Kidney governs bones; bone essence is pupil. Eyes rolling back and staring means bone essence doesn't nourish pupil, pupil turns away and cannot rotate.
It is unknown which Zang's Yin or Yang extinguishes first. If Yang extinguishes first and Yin later, the person dies, body color must be green. If Yin extinguishes first and Yang later, the person dies, body color must be red. Axilla warm, epigastrium hot.
First sentence restarts question. Next is answer. Order of Zang extinction isn't fixed by previous order. Reiterating Yin/Yang extinction sequence verifies post-mortem: Zang has dominance, extinction has speed, generally visible. Axilla is between elbow and rib. Cheng Wuji said: Yang governs heat and red color; Yin governs cold and green color. Death with green body means Yin hasn't left body, so Yin extinguishes later. Death with red body, warm axilla, hot epigastrium means Yang hasn't left body, so Yang extinguishes later.
Cun Kou pulse floating and large, but doctor incorrectly purges: This is major reversal. Floating means no Blood; Large indicates Cold. Cold Qi struggles, causing bowel sounds. Doctor doesn't know, gives cold water to induce profuse sweating. Water meets Qi cold, cold struggles, patient gets Yì (choking/gagging).
Yì is same as Yi (choking). "Yin" is falling tone. "Ling" is level tone. Floating is Qi, hence "no Blood." Large is deficiency, hence "Cold." Yì is commonly called choking. Meaning seen in next section.
Fu Yang pulse floating: Floating indicates deficiency. Floating and deficiency struggle, causing belching. Indicates Stomach Qi exhaustion. Pulse Slippery indicates hiccups (Yue). This is doctor's fault. Blame...