虚取实。守空迫血。脉浮鼻中燥者。必衄也。
此承上条。又出趺阳而以哕与衄言。皆逼汗而不得汗之所致也。咎过愆也。责虚。言求病于
虚。虚与上条寒互文。取实。言反以虚为实。而攻取之也。血属阴而为内守。故曰空。迫血。言
劫汗也。
诸脉浮数。当发热而洒淅恶寒。若有痛处。饮食如常者。蓄积有脓也。
此与第十三条互意。
脉浮而迟。面热赤而战惕者。六七日当汗出而解。反发热者瘥迟。迟为无阳。不能作汗。其
身必痒也。
此与太阳下编第七条互意。
寸口脉阴阳俱紧者。法当清邪中于上焦。浊邪中于下焦。清邪中上。名曰洁也。浊邪中下。
名曰浑也。阴中于邪。必内 也。表气微虚。里气不守。故使邪中于阴也。阳中于邪。必发热。
头痛。项强。颈挛。腰痛。胫酸。所谓阳中雾露之气。故曰清邪中上。浊邪中下。阴气为 。足
膝逆冷。便溺妄出。表气微虚。里气微急。三焦相溷。内外不通。上焦怫郁。脏气相熏。口烂食
龈也。中焦不治。胃气上冲。脾气不转。胃中为浊。荣卫不通。血凝不流。若卫气前通者。小便
赤黄。与热相搏。因热作使。游于经络。出入脏腑。热气所过。则为痈脓。若阴气前通者。阳气
厥微。阴无所使。客气内入。嚏而出之。声 咽寒。寒厥相逐。为热所拥。血凝自下。状如豚肝。
阴阳俱
厥。脾气孤弱。五液注下。下焦不阖。清便下重。令便数难。脐筑湫痛。命将难全。
龈。音银。 。音 。清便之清。读圊。令。平声。数。音朔。清指风。浊指寒。曰洁。曰
浑。以天地之偏气言也。阴中于邪以下。至浊邪中上一节。是释上文阴即下焦。阳即上焦也。阴
气为 以下。至血凝不流。是言证。若卫气前通以下。言变痈脓之故。
若阴气前通以下。言变脓血利之故。卫气即阳气。荣气亦阴气。乃承上文荣卫不通而言清浊
之所以为病在其中矣。阴阳俱厥以下。言证并于里而加重。故曰。命难全也。下重。后重也。湫。
以水脏言也。
脉阴阳俱紧者。口中气出。唇口干燥。 卧足冷。鼻中涕出。舌上苔滑。勿妄治也。到七日
以来。其人微发热。手足温者。此为欲解。或到八日以上。反大发热者。此为难治。设使恶寒者。
必欲呕也。腹内痛者。必欲利也。
此以上条同感而异变者言。微发热。邪退也。大发热。邪胜也。恶寒。表在也。腹内痛。入阴也。
脉阴阳俱紧。至于吐利。其脉独不解。紧去人安。此为欲解。若脉迟。至六七日不欲食。此
为晚发。水停故也。为未解。食自可者。为欲解。
至于吐利。乃承上条欲呕欲利。而又以其变成者言。独不解。言证变而脉独在也。晚发。言后
来更又发也。以上三条。一证而三变耳。
病六七日。手足三部脉皆至。大烦而口噤不能言。其人躁扰者。必欲解也。
六指伤寒。七指中风。盖详其欲解之状而总言之也。然手足三部脉皆至。则是以十二经之病
皆退言。伤寒不独传足经明矣。
若脉和。其人大烦。目重。睑内际黄者。此为欲解也。
上节以脉但皆至而未和。故有口噤躁扰。此以和也。故惟大烦。目重。而睑内际见黄。与太
阳上编第十一条互意。但此以大概言耳。
脉浮而数。浮为风。数为虚。风为热。虚为寒。风虚相搏。则洒淅恶寒也。
此概出恶寒之所以然。
脉浮而滑。浮为阳。滑为实。阳实相搏。其脉数疾。卫气失度。浮滑之脉数疾。发热汗出
者。此为不治。
滑与前第十六条洪是互文。与第九篇第四条皆一意。但详略不同耳。
伤寒咳逆上气。其脉散者。死。谓其形损故也。
咳逆上气。肺衰也。脉散。血衰也。肺主气而卫外。血为阴而荣内。两者俱衰。故曰形损。
少阴脉弱而涩。弱者微烦。涩者厥逆。
弱为虚损而不足。阴虚生内热所以烦。然属少阴。故虽烦亦微也。涩为少血而不滑。不能上
与阳相顺接。所以厥而逆冷也。
此一条乃补脉法上编中之缺。
Light palpation for deficiency pulses, heavy palpation for excess pulses. If upon examining the foot-Yang (Duzhong) pulse, excessive pressure forces the blood, resulting in a floating pulse and dryness in the nose, epistaxis (nosebleed) will certainly occur.
This continues from the previous clause, reiterating the diagnosis of the foot-Yang pulse, discussing it in terms of hiccups and epistaxis. These are all caused by forcing sweating without achieving diaphoresis. "Jiu" refers to fault; "Ze Xu" means seeking the pathology in deficiency; "Xu" is parallel in meaning to "Han" (cold) in the previous clause; "Qu Shi" means mistakenly treating deficiency as excess and applying purgative or draining methods. Blood belongs to Yin and maintains internal retention, hence termed "Kong" (empty). "Po Xue" refers to robbing fluids to induce sweating.
When various pulses are floating and rapid, one should expect fever accompanied by shivering aversion to cold. If there is a fixed painful area but appetite remains normal, it indicates accumulation of pus within.
This corresponds in meaning to Clause 13.
If the pulse is floating and slow, with facial heat and redness accompanied by trembling and fear, after six or seven days, resolution through sweating should occur. If instead there is persistent fever, recovery will be delayed. "Slow" indicates insufficient Yang Qi, unable to generate sweat, thus the body will likely feel itchy.
This corresponds in meaning to Clause 7 of the Lower Section of the Taiyang Chapter.
If both the Yin and Yang positions at the Cun Kou (radial artery) present with tight pulses, according to medical principles, clear pathogenic factors attack the Upper Jiao, while turbid pathogenic factors attack the Lower Jiao. Clear pathogens attacking the upper region are called "Jie" (pure); turbid pathogens attacking the lower region are called "Hun" (turbid). When Yin aspects are attacked by pathogens, internal cold必定 occurs. This is because exterior Qi is slightly deficient and interior Qi fails to maintain integrity, allowing pathogens to invade Yin aspects. When Yang aspects are attacked by pathogens, fever, headache, neck stiffness, cervical spasms, lower back pain, and leg soreness必定 occur. This is referred to as Yang being attacked by mist and dew, hence clear pathogens attack the upper, and turbid pathogens attack the lower.
Cold sensation reversing upwards in the feet and knees, along with involuntary urination and defecation, result from slight exterior deficiency and slight interior urgency, causing confusion among the Three Jiaos and obstruction of internal-external communication. The Upper Jiao becomes stagnant, with organ Qi steaming each other, leading to oral ulcers and gingival erosion. Dysfunction of the Middle Jiao causes Stomach Qi to rebel upward, Spleen Qi fails to transform, turbidity accumulates in the Stomach, Ying and Wei Qi do not circulate freely, and blood coagulates and stagnates.
If Wei Qi (Defensive Qi) flows first, urine will be dark yellow, clashing with heat. Driven by heat, it wanders through meridians, entering and exiting Zang-Fu organs. Wherever heat passes, abscesses and pus form.
If Yin Qi flows first, Yang Qi becomes extremely weak, leaving Yin without direction. Exogenous pathogens enter internally, expelled via sneezing, accompanied by hoarseness and throat cold. Cold and cold-reversal chase each other, suppressed by heat, causing blood to coagulate and discharge spontaneously, resembling pig liver.
When both Yin and Yang Qi experience reversal, Spleen Qi becomes isolated and weak, five fluids pour downward, and the Lower Jiao fails to close. This results in tenesmus (feeling of incomplete evacuation), frequent difficult bowel movements, severe umbilical cramping pain, and a life-threatening condition.
"Yin" (gingiva) is pronounced "Yin". "Hun" is pronounced "Hun". In "Qing Bian", "Qing" is read as "Qing" (toilet). "Ling" is pronounced with the level tone. "Shuo" (frequency) is pronounced "Shuo". "Qing" refers to wind pathogens, "Zhuo" refers to cold pathogens. Terms "Jie" and "Hun" describe the partial qi of heaven and earth. The section from "Yin Zhong Yu Xie" to "Zhuo Xie Zhong Xia" explains that Yin refers to the Lower Jiao and Yang refers to the Upper Jiao. The section from "Yin Qi Wei Hun" to "Xue Ning Bu Liu" describes symptoms. From "Ruo Wei Qi Qian Tong", it explains the cause of transforming into abscesses/pus. From "Ruo Yin Qi Qian Tong", it explains the cause of transforming into pus-blood dysentery. Wei Qi is Yang Qi; Ying Qi is Yin Qi. This follows the discussion on Ying-Wei obstruction to explain how clear and turbid factors cause disease. From "Yin Yang Ju Jue", it states that symptoms concentrate in the interior and worsen, hence "life is hard to preserve". "Xia Zhong" refers to tenesmus. "Qiu" refers to water-damp accumulation.
If the Yin and Yang pulses are both tight, with warm breath exhaled from the mouth, dry lips and mouth, cold feet during rest, nasal discharge, and a slippery tongue coating, do not treat rashly. After seven days, if the patient has slight fever and warm hands and feet, this indicates impending resolution. However, if after eight or more days, high fever returns, this is difficult to treat. If accompanied by aversion to cold, vomiting will likely occur. If there is abdominal pain, diarrhea will likely occur.
This addresses cases where the initial pathogen is the same but the manifestation differs. Slight fever indicates pathogen decline; high fever indicates pathogen excess. Aversion to cold indicates the pathogen remains in the exterior. Abdominal pain indicates entry into the Yin aspect.
Regarding tight Yin and Yang pulses accompanied by vomiting and diarrhea, if the pulse alone does not resolve: if the tightness disappears and the patient feels comfortable, this indicates resolution. If the pulse becomes slow, and after six or seven days there is loss of appetite, this is a late onset due to fluid retention, indicating unresolved disease. If appetite returns normally, it indicates impending resolution.
The mention of vomiting and diarrhea continues from the previous clause regarding the desire to vomit or have diarrhea, further discussing subsequent changes. "Du Bu Jie" means symptoms change but the pulse remains tight. "Wan Fa" means later recurrence. The above three clauses describe one syndrome undergoing three variations.
After six or seven days of illness, if pulses at hand and foot positions are all palpable, and the patient is extremely restless with locked jaws unable to speak, yet shows signs of agitation, this indicates impending resolution.
"Six" refers to Shanghan (Cold Damage); "Seven" refers to Fengshang (Wind Strike). This generally summarizes the state of impending resolution. Since pulses at hand and foot positions are all palpable, it implies that pathogens in the twelve meridians are receding. This clearly shows that Shanghan transmits beyond just the Foot meridians.
If the pulse is harmonious, and although the patient is extremely restless, eyes are heavy, and the inner eyelids appear yellow, this indicates impending resolution.
In the previous section, because pulses were present but not harmonious, symptoms included jaw locking and agitation. Here, because the pulse is harmonious, symptoms are limited to extreme restlessness, heavy eyes, and yellow inner eyelids. This corresponds in meaning to Clause 11 of the Upper Section of the Taiyang Chapter, though stated generally here.
If the pulse is floating and rapid, floating indicates Wind, rapid indicates Deficiency. Wind manifests as Heat, Deficiency manifests as Cold. The interaction of Wind and Deficiency leads to shivering and aversion to cold.
This generally explains the mechanism of aversion to cold.
If the pulse is floating and slippery, floating indicates Yang, slippery indicates Excess. The interaction of Yang and Excess results in a rapid and hurried pulse, indicating loss of regulation in Wei Qi. If a floating-slippery pulse becomes rapid and hurried, accompanied by fever and sweating, this is an untreatable condition.
"Slippery" is parallel in meaning to "Surging" in Clause 16 previously, and shares the same intent as Clause 4 of Chapter 9, differing only in detail.
In Shanghan, if coughing and rebellious Qi present with a scattered pulse, death ensues. This is due to the depletion of physical essence.
Coughing and rebellious Qi indicate Lung Qi failure. A scattered pulse indicates Blood Qi failure. The Lung governs Qi and protects the exterior; Blood belongs to Yin and nourishes the interior. With both failing, it is termed "Form Depletion".
In Shaoyin, if the pulse is weak and choppy, weakness indicates slight irritability, and choppiness indicates cold extremities.
Weakness indicates deficiency and insufficiency; Yin deficiency generates internal heat, causing irritability. However, since it belongs to Shaoyin, the irritability is slight. Choppiness indicates scanty blood and lack of smoothness, preventing connection with Yang Qi ascending, thus causing cold extremities.
This clause supplements missing content from the Pulse Methods Upper Section.