〔仲〕凡伤于寒，则为病热，热虽甚不死，若两感于寒而病者必死。尺寸俱浮者，太阳受病也，当一二
日发，以其脉上连风府，故头项痛，腰脊强。尺寸惧长者，阳明受病也，当二三日发，以其脉侠鼻络于目，
故身热目疼鼻干不得卧。尺寸俱弦者，少阳受病也，当三四日发，以其脉循胁络于耳，故胸胁痛而耳聋，此
三经皆受病，未入于腑者，可汗而已。
尺寸俱沉细者，太阴受病也，当四五日发，以其脉布胃中，络于嗌，故腹满而嗌干。尺寸俱沉者，少阴
受病也，当五六日发，以其脉贯肾络于肺系舌本，故口燥舌干而渴。（《活人》云∶经云一二日少阴者，
谓国中病时便入少阴，不经三阳也。大抵伤寒发于阳则太阳也，发于阴则少阴也。凡病一日至十二三日太阳
症不能罢者，俱治太阳。有初得病便见少阴症者，宜攻少阴，亦不必先自巨阳。盖寒入太阳即发热而恶寒，
入少阴即恶寒而不热。）尺寸俱微缓者，厥阴受病也，当六七日发。以其脉循阴器络于肝，故烦满而囊缩。
（烦满谓少腹烦满也。下文云∶十二日厥阴病，阴囊缩。少腹微下，谓向者囊之缩者，今复病少腹之烦满，
故令微下也。）此三经皆受病，已入于腑，可下而已。
若两感于寒者，一日太阳受之，即与少阴俱病，则头痛、口干、烦满而渴。二日阳明受之，即与太阴俱病，
则腹满、身热、不欲食、谵语。三日少阳受之，即与厥阴俱病，则耳聋囊缩而厥，水浆不入。不知人者，六日
死。若三阴三阳五脏六腑皆受病，则荣卫不行，脏腑不通，而死矣。
伤寒一日太阳受之，脉若静者为不传，颇欲吐，若躁烦，脉微急者，为欲传也。伤寒二三日，阳明、少阳
症不见者，不传也。
伤寒三日，三阳为尽，三阴当受邪，其人反能食而不呕，此为三阴不受邪也。
问曰∶伤寒三日，脉浮数而微，病患身温和者，何也？答曰∶此为欲解也，以夜半。脉浮而解者， 然
汗出也，脉浮而解者，必能食也；脉不浮而解者，必大汗出也。三日少阳脉小，欲已也。（论见口苦、舌干。）
其不两感于寒，更不传经，不加异气者，至七日太阳病衰，头痛少愈也；八日阳明病衰，身热少歇也；九
日少阳病衰，耳聋微闻也；十日太阴病衰，腹减如故，则思饮食；十一日少阴病衰，渴止舌干已而嚏也；十二
日厥阴病衰，囊缩少腹微下，大气皆去，病患精神爽慧也。太阳病，头痛至七日以上自愈者，行其经尽故也。
若欲再传经者，针足阳明，使不传则愈。
六七日脉至皆大，烦而口噤不言，躁扰者，必欲解也。（论见后条。）伤寒六七日，无大热，其人躁烦，
此为阳去入阴故也。
若过十三日以上不间，（间，瘳也。）尺寸陷者，大危。
若更感异气变为他病者，当依旧坏症而治之。若脉阴阳俱盛，重感于寒者，变为温疟。阳脉浮滑，阴脉濡
弱者，更遇于风，变为风温。阳脉洪数，阴脉实大者，遇温热变为温毒，为病最重也。阳脉濡弱阴脉弦紧者，
更遇温气，变为温疫，以冬伤于寒，发为温病，脉之变症方治如说。（见后条。）
凡发汗，欲令手足皆周至， 然一时间许益佳，不可令如水流漓耳。若病不解，当重发汗，汗多则亡阳，
阳虚不得重发汗也。（《活人》云∶发汗必须如常覆盖，腰以上浓衣覆之，腰以下盖之。若腰以上淋满而腰
以下至足心微润，病终不解。）凡云可发汗而无汤者，丸散亦可用，要以汗出为解，然不如汤随症良验。凡发
汗，温服汤药，其方虽言日一二服，若病剧不解，当促其服，可半日间尽一二服。若与病相值，即便有所觉。
重病者一日一夜，当 时观之。如服一剂，病症犹在，故当复作本汤服之。至有不肯汗出，服三剂乃解。若
汗不出者，死病也。凡服汤药发汗，中病即止，
不必尽剂。吐下亦如之。
许学士云∶记一乡人伤寒身热，大便不通，烦渴郁冒。医者用巴豆下之，顷得溏利，宛然如旧。予观之，
阳明结热在里，非大柴胡、承气不可，巴豆止去积，不能荡涤邪热蕴毒，亟进大柴胡等三服得汗而解。尝谓仲
景一百一十三方，为丸者有五，理中、陷胸、抵当、乌梅、麻仁。是以理中、陷胸、抵当，皆大如弹子，煮化
而服，与汤散无异。至于麻仁治脾约、乌梅治湿 ，皆用小丸以达下部。其他逐邪毒，破坚癖，导淤血，润燥
粪之类，皆凭汤剂，未闻用巴豆小丸药以下邪气也。既下而病不除，不免重以大黄、芒硝下之，安能无损也哉。
凡伤寒之病，多从风寒得之，始表中风寒，入里则不消矣。拟欲攻之，犹当先解表乃可下之。若表已解而
内不消，大满大实，坚有燥屎者，自可除下之，虽四五日不能为祸也。
服桂枝汤大汗出脉洪大者，复与桂枝汤如前法。（论见疟。）
发汗解，半日许复烦，脉浮数者，可更发汗。（《活人》云∶凡发汗病症仍在者，三日内可二三汗之，
令腰以下周遍为度。）
凡病，若发汗，若吐若下，若亡津液，阴阳自和者，必自愈。（重亡津液则不能作汗，故必待自和乃愈。）
太阳病三日，已发汗、若吐、若下、若温针仍不解者，此为坏症，桂枝不中与也。观其脉症，知犯何逆，当
随证治之。
夫病阳多者热，下之则硬。无阳阴强大便硬者，下之则必清谷腹满。
〔《脉》〕师持脉，病患欠者，无病也。脉之呻者，病也。言迟者，风也。摇头言者，里痛也。行迟者，表强也。
坐而伏者，气短也。坐而下一脚者，腰痛也。里实护腹如怀卵物者，心痛也。寸口诸微亡阳，诸濡亡血，诸弱
发热，诸紧为寒，诸乘寒者则为厥，郁冒不仁，以胃无谷气，脾涩不通，口急不能言，战而栗也。（微脉极细
而软，濡脉极软而浮细，弱脉极软而沉细。）
病六七日手足三部脉皆至，大烦而口噤不能言，其人躁扰，必欲自解者，必当先烦，乃有汗而解。何以知？
脉浮故知汗出解也。若脉和平，其人大烦，目重睑内际黄者，皆为欲解也。
问曰∶脉病欲如愈未愈者，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，
此脉为阴阳和平，虽剧当愈。（《针经》禁服篇云∶寸口人迎两者相应，若引绳大小齐等者，名曰平人。言手之寸口脉与
喉
旁之人迎脉等齐为平人。后条云∶六脉阴阳俱停，必先振栗汗出而解者是也。）凡得病，厥脉动数，
服汤药更迟，脉浮大减小，初躁后静，此皆愈症也。脉浮数而微，病患身温和者，欲解也。（论见前条。）凡病反能
饮水者，为欲愈。（论见腹渴。）太阴中风，脉阳微阴涩而长者，为欲愈。（论见腹满。）少阴中风，脉阳微
阴浮者欲愈。（论见欲寐。）厥阴中风，脉微浮者欲愈，不浮未愈。
太阳病巳至未解。（见发热。）阳明病申至戌解。（见胃实。）
少阳病寅至辰解。（见口苦。）太阴病亥至丑解。（见腹满。）
少阴病子至寅解。（见欲寐。）厥阴病丑至卯解。（见气上撞心。）
问曰∶凡病欲知何时得，何时愈？答曰∶假令日中得病，夜半愈者，以阳得阴则解也。夜半得病，日中愈
者，以阴得阳则解也。病家人请云∶病患苦发热，身体疼，病患自卧，师到诊其脉，沉而迟者，知其瘥也。何
以知之？表有病者，脉当浮大，今反沉迟，故知愈也。假令病患云∶腹内卒痛，病患自坐，师到脉之，浮而大
者，知其瘥也。何以知之？若里有病者，脉当沉而细，今脉浮大，故知愈也。
问曰∶病有战而汗出者因得解者，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。
若脉浮而数，按之不芤，此人本不虚，若欲自解，但出汗耳，不发战也。问曰∶病有不战而汗出解者，何
也？答曰∶脉大而浮数，故知不战汗出而解也。
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，
待阴阳自和，必自愈，故不战不汗出而解也。
上海藏云∶战而后解者，太阳也，不战有汗而解者，阳明也，不战无汗而解者，少阳也。
太阳病未解，脉阴阳俱停，必先战栗汗出而解。阳微者汗解，阴微者下解。（论见发热篇。）凡脉大、浮、
数、动、滑，此名阳也；沉、涩、弦、弱、微，此名阴也。凡阴病见阳脉者生、阳病见阴脉者死。阴阳俱盛，
大汗出不
解者，死。阴阳俱虚，热不止者，死。又诊生死详法。（并见诊法门。）
服药不如方法，纵意违师，不须治之。
脉沉为在里，而反发其汗，则津液越出，大便难，表虚里实，久则谵语也。（论见谵语。）脉浮紧者，
法当身疼痛，宜以汗解之。假令尺中迟者，不可发汗。何以知之？以荣气不足血少故也。（《活人》云∶先以
小建中汤加黄 ，如尺脉尚迟，再作一剂，却服柴胡桂枝二越婢一汤，其汤分小剂和解之愈。）
许学士云∶一乡人丘生者，病伤寒发热，头疼，烦渴，脉虽浮数无力，尺以下迟而弱。予曰∶此虽麻黄症，
而尺迟弱。仲景云∶尺中迟者，荣气不足，血气微少，未可发汗。予于建中汤加当归、黄 令饮，翌日脉尚尔，
其家煎迫，日夜督发汗药，几不逊矣。予忍之，但只用建中调荣而已。至五日，尺部方应，遂投麻黄汤，啜二
服，发狂，须臾稍定，略睡，已中汗矣。信知此事诚难，仲景虽云不避晨夜，即宜便治，医者亦须顾其表里虚
实，待其时日，若不循次第，临时得安，损亏五脏，以促寿限，何足贵哉。昔《南史》载范云伤寒，恐不得预
武帝九锡之庆，召徐文伯诊视，以实恳之曰∶可便得愈乎？文伯曰∶便瘥甚易，只恐二年后不复起耳。云曰∶
朝闻道夕死犹可，况二年乎。文伯以火烧地，布桃叶，设席，置云于其上，顷刻汗解，扑以温粉，翌日果愈。
云甚喜。文伯曰∶不足喜也。后二年果卒。夫取汗先期，尚促寿限，况罔顾表里，不待时日，便欲速效乎。每
见病家不奈，病未三四昼夜，促汗，医者随情顺意，鲜不败事。予故书此为戒。
脉浮大，应发汗，医者反下之，此为大逆。诸外实者不可下，下之则发微热。脉厥者，当脐握热。诸虚者
不可下，下之则大渴。求水者易愈，恶水者剧。太阳症表未解不可下，下之为逆。（论见发热。）
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。阳微不可下，下之则心下痞硬。（“阳微不可下”，
当是“复不可下之”。）
脉浮热甚反灸之，此为实以虚治，因火而动，必咽燥唾吐。微数之脉，慎不可灸，因火为邪，则为烦逆，
追虚逐实，血散脉中，火气虽微，内攻有力，焦骨伤筋，血难复也。脉浮且汗，反用火灸之，邪无从出，腰以
下必重而痹。（论见下重。）
桂枝本为解肌，若其脉浮紧发热无汗者，不可与也，常须识此，勿令误也。脉浮自汗，小便数，微恶寒，
脚挛急，忌桂枝汤攻表。（论见厥。）酒客病，不可与桂枝汤，得汤则呕，以酒客不喜甘故也。
凡用栀子汤，病患旧微溏者，不可与服之。
若不宜下而便攻之，内虚热入，挟热遂利，烦躁，诸变不可胜数，轻者困笃，重者必死矣。太阳病下之，
其脉促不结胸者，此为欲解也，脉浮者，必结胸也。脉紧者，必咽痛。脉弦者，两胁必拘急。脉细数者，头痛
未止。脉沉紧者，必欲呕。脉沉滑者，挟热利。脉浮滑者，必下血。
[Background Information]
Book: *Medical Outline* (Yixue Gangmu)
Author: Lou Ying
Dynasty: Ming
Chapter: General Discussion on Cold Damage (Shanghan Tonglun)
Category: Medical Theory
[Translation]
Zhang Zhongjing said: Whenever one is injured by cold pathogen, it manifests as a febrile disease. Even if the heat is severe, death will not occur; however, if one suffers from simultaneous infection of exterior and interior meridians by cold (Lianggan Yu Han), death is inevitable. If both the Cun (inch) and Chi (cubit) positions present with floating pulses, this indicates Taiyang meridian involvement. Symptoms typically appear within one to two days. Because its pulse pathway connects upward to the Fengfu point (GV16), symptoms include headache, stiffness of the neck and back, and rigidity of the lumbar spine. If both Cun and Chi positions present with long pulses, this indicates Yangming meridian involvement. Symptoms typically appear within two to three days. Because its pulse pathway runs alongside the nose and connects to the eyes, symptoms include body heat, eye pain, nasal dryness, and inability to rest. If both Cun and Chi positions present with wiry pulses, this indicates Shaoyang meridian involvement. Symptoms typically appear within three to four days. Because its pulse pathway follows the hypochondrium and connects to the ears, symptoms include chest and hypochondriac pain and deafness. For these three meridians, if the pathogen has entered but not yet reached the Fu organs, it can be cured through sweating methods.
If both Cun and Chi positions present with deep and fine pulses, this indicates Taiyin meridian involvement. Symptoms typically appear within four to five days. Because its pulse pathway distributes in the stomach and connects to the throat, symptoms include abdominal fullness and dry throat. If both Cun and Chi positions present with deep pulses, this indicates Shaoyin meridian involvement. Symptoms typically appear within five to six days. Because its pulse pathway penetrates the kidney and connects to the lung system and the root of the tongue, symptoms include dry mouth, dry tongue, and thirst. (*Qiren Shu* states: The text mentioning "Shaoyin on day one or two" refers to situations where epidemic diseases directly invade Shaoyin without passing through the Three Yang meridians. Generally, Shanghan originating in Yang meridians involves Taiyang, while originating in Yin meridians involves Shaoyin. For any illness lasting from one to twelve or thirteen days where Taiyang symptoms persist, treat Taiyang. If Shaoyin symptoms appear immediately upon onset, treat Shaoyin; there is no need to start from Juyang (Taiyang). Roughly speaking, cold entering Taiyang causes fever and aversion to cold, while entering Shaoyin causes aversion to cold without fever.) If both Cun and Chi positions present with faint and moderate pulses, this indicates Jueyin meridian involvement. Symptoms typically appear within six to seven days. Because its pulse pathway follows the genitalia and connects to the liver, symptoms include vexation and fullness, and retraction of the scrotum. ("Vexation and fullness" refers to vexation and fullness in the lower abdomen. The following text states: "On the twelfth day, Jueyin disease presents with scrotal retraction." The slight lowering of the lower abdomen indicates that previously the scrotum was retracted, and now suffering from lower abdominal vexation and fullness causes the abdomen to sag slightly.) For these three meridians, if the pathogen has already entered the Fu organs, it can be cured through purging methods.
In cases of simultaneous infection (Lianggan Yu Han): On the first day, Taiyang is affected, and simultaneously Shaoyin is affected, presenting with headache, dry mouth, vexation, fullness, and thirst. On the second day, Yangming is affected, and simultaneously Taiyin is affected, presenting with abdominal fullness, body heat, anorexia, and delirious speech. On the third day, Shaoyang is affected, and simultaneously Jueyin is affected, presenting with deafness, scrotal retraction, and cold extremities, with inability to take fluids. If consciousness is lost, death occurs on the sixth day. If all Three Yin and Three Yang meridians, as well as the Five Zang and Six Fu organs, are affected, the movement of Ying and Wei Qi ceases, and organ function becomes blocked, leading to death.
On the first day of Shanghan, when Taiyang is affected, if the pulse remains quiet, transmission has not occurred. If the patient desires to vomit, or is restless and irritable, and the pulse is slightly urgent, transmission is impending. On the second and third days, if Yangming and Shaoyang symptoms do not appear, transmission has not occurred.
On the third day of Shanghan, having exhausted the Three Yang meridians, the Three Yin meridians should theoretically be affected. However, if the patient can eat and does not vomit, this indicates that the Three Yin meridians have not been affected.
Question: On the third day of Shanghan, the pulse is floating, rapid, and slightly weak, and the patient's body temperature is mild. What is the reason? Answer: This indicates the disease is about to resolve, likely at midnight. Resolution with a floating pulse involves slight sweating; resolution with a floating pulse implies the ability to eat; resolution without a floating pulse involves profuse sweating. On the third day, if the Shaoyang pulse becomes small, the disease is about to heal. (This discussion is found under "Bitter taste in mouth, dry tongue".)
For those not suffering from simultaneous infection, without further transmission, and without superimposed heterogeneous pathogens, by the seventh day, Taiyang disease declines, and headache lessens; by the eighth day, Yangming disease declines, and body heat subsides slightly; by the ninth day, Shaoyang disease declines, and hearing improves slightly; by the tenth day, Taiyin disease declines, abdominal distension resolves, appetite returns; by the eleventh day, Shaoyin disease declines, thirst stops, tongue dryness resolves, and sneezing occurs; by the twelfth day, Jueyin disease declines, scrotal retraction and lower abdominal sagging disappear, healthy Qi is fully restored, and the patient regains mental clarity and vigor. Taiyang disease with headache resolving after seven days occurs because the pathogen has exhausted its course in the meridian. If transmission is desired again, acupuncture at the Foot-Yangming meridian can prevent transmission and cure the disease.
At six or seven days, if the pulse is large throughout, accompanied by vexation, locked jaw, inability to speak, and restlessness, it indicates imminent resolution. (This discussion is found in subsequent sections.) In Shanghan at six or seven days, if there is no significant heat but the patient is restless and irritable, this is due to Yang moving into Yin.
If the condition persists beyond thirteen days without remission (Jian means recovery), and both Cun and Chi pulses sink deeply, the prognosis is critical.
If a new heterogeneous pathogen is contracted, transforming the disease into another type, treatment should follow the original pattern of complicated disease (Huai Zheng). If both Yin and Yang pulses are excessive, and cold is re-contracted, it transforms into Warm Malaria (Wen Nue). If the Yang pulse is floating and slippery, and the Yin pulse is soft and weak, exposure to wind transforms it into Wind-Warmth (Feng Wen). If the Yang pulse is surging and rapid, and the Yin pulse is solid and large, exposure to warm-heat transforms it into Warm-Toxin (Wen Du), which is the most severe condition. If the Yang pulse is soft and weak, and the Yin pulse is wiry and tight, exposure to warm Qi transforms it into Warm Epidemic (Wen Yi). This results from winter cold injury manifesting as Warm Disease later; the pulse variations, symptoms, and treatments are as described previously. (See subsequent sections.)
When inducing sweating, ensure sweat covers the entire body evenly over approximately one hour; profuse dripping sweat should be avoided. If the disease persists, sweating may be repeated, but excessive sweating leads to loss of Yang Qi; thus, patients with Yang deficiency must not be sweated again. (*Qiren Shu* states: During sweating therapy, cover normally, using thick clothing above the waist and blankets below. If the upper body is soaked but the area from the waist to the soles of the feet is only slightly moist, the disease will not resolve.) Where sweating is indicated but decoctions are unavailable, pills or powders may be used, provided they induce sweating. However, decoctions tailored to specific patterns are superior. Decoctions for sweating should be taken warm. Although prescriptions may specify one or two doses per day, if the disease is severe and unresolved, administration frequency should be increased, potentially completing one or two doses within half a day. If the medicine interacts with the pathogen, effects will be felt immediately. For severe illnesses, monitor every four hours over twenty-four hours. If symptoms persist after one dose, continue administering the same decoction. Some patients may require three doses before sweating occurs. If sweating fails to occur despite treatment, the prognosis is fatal. When using decoctions to induce sweating, stop once the disease is addressed; there is no need to finish the entire prescription. The same applies to emesis and purgation.
Scholar Xu stated: I recall a fellow townsman suffering from Shanghan with fever, constipation, vexation, thirst, and mental cloudiness. The physician administered Radix Euphorbiae Pekingensis (Badou) for purgation. He soon had loose stools and seemed recovered. Upon examination, I determined the pathology was Yangming internal heat accumulation, requiring Da Chaihu Tang or Chengqi Tang. Badou only removes stagnation but cannot clear accumulated toxic heat. I urgently prescribed Da Chaihu Tang for three doses, resulting in sweating and resolution. I often note that among Zhang Zhongjing’s 113 formulas, only five are pills: Lizhong Wan, Xiongxiong Wan, Didang Wan, Wumei Wan, and Mahuang Ren Wan. Lizhong, Xiongxiong, and Didang pills are made large like marbles, boiled, and consumed like decoctions. Mahuang Ren Wan for Spleen Restriction and Wumei Wan for ascariasis use small pills to reach lower regions. Other formulas expelling toxins, breaking accumulations, guiding blood stasis, or moistening dry feces rely on decoctions; I have never heard of using Badou pills to purge pathogenic qi. If purgation fails to resolve the disease, resorting to Rhizoma Pinelliae Preparata (Dahuang) and Natrii Sulfas (Mangxiao) inevitably causes damage.
Generally, Shanghan arises from wind-cold. Initially, wind-cold resides in the exterior; once it enters the interior, it cannot dissipate. To attack the interior, one must first release the exterior before purging. If the exterior is resolved but internal stagnation persists, presenting with severe fullness, solidity, and hard dry feces, purging is appropriate even after four or five days without causing harm.
After taking Guizhi Tang (Cinnamon Twig Decoction), if profuse sweating occurs followed by a surging pulse, administer Guizhi Tang again according to previous instructions. (This discussion is found under "Malaria".)
If sweating resolves the condition, but vexation recurs after half a day with a floating and rapid pulse, sweating may be repeated. (*Qiren Shu* states: If symptoms persist after sweating, up to two or three sweating sessions may be conducted within three days, ensuring sweat reaches below the waist.)
For any illness, whether treated by sweating, vomiting, or purging, if fluids are depleted, spontaneous harmony between Yin and Yang will lead to self-healing. (Severe fluid depletion prevents sweating; thus, healing depends on the restoration of Yin-Yang balance.)
If Taiyang disease persists for three days despite sweating, vomiting, purging, or warm needle therapy, it is considered a complicated disease (Huai Zheng); Guizhi Tang is contraindicated. Observe the pulse and symptoms, identify the error committed, and treat according to the current pattern.
Diseases characterized by excess Yang manifest as heat; purging such conditions leads to hardness. In cases lacking Yang signs but presenting with Yin excess and hard stool, purging leads to diarrhea of undigested food and abdominal fullness.
The *Mai Jing* (Pulse Classic) states: A patient yawning during pulse diagnosis indicates health. Moaning indicates disease. Slurred speech indicates wind strike. Head shaking while speaking indicates internal pain. Slow walking indicates exterior stiffness. Sitting with the body bent forward indicates shortness of breath. Sitting with one leg extended indicates lower back pain. Guarding the abdomen as if holding an egg indicates heart pain. All faint pulses indicate loss of Yang; all soft pulses indicate loss of blood; all weak pulses indicate fever; all tight pulses indicate cold. Cold invasion leads to cold extremities, mental cloudiness, and numbness due to lack of stomach Qi, spleen stagnation, oral tension, inability to speak, and tremors. (Faint pulses are extremely thin and soft; soft pulses are extremely soft, floating, and thin; weak pulses are extremely soft, sinking, and thin.)
At six or seven days of illness, if pulses at all three positions on hands and feet are present, accompanied by severe vexation, locked jaw, inability to speak, and restlessness, resolution is imminent. Vexation precedes sweating and resolution. How do we know? Because the pulse is floating, indicating sweating will resolve it. If the pulse is peaceful, the patient is very vexed, and the inner canthus is yellow, resolution is also indicated.
Question: How to distinguish between impending resolution and non-resolution based on pulse? Answer: If Cun, Guan, and Chi positions show equal magnitude, floating/sinking, and slow/rapid qualities, even if cold-heat symptoms persist, this "peaceful Yin-Yang" pulse indicates eventual recovery. (*Zhen Jing* Jin Fu Pian states: When Cun Kou and Ren Ying pulses correspond like a drawn rope of equal size, it is called a healthy person. Meaning hand Cun Kou pulse equals throat Ren Ying pulse. Subsequent section states: If all six pulses cease temporarily, chills and sweating will precede resolution.) Generally, if a disease presents with rapid Jue pulse, but after medication the pulse becomes slower, floating/large decreases, initial restlessness turns to calmness, these are signs of recovery. Floating, rapid, and slightly weak pulse with mild body temperature indicates impending resolution. (See previous section.) Ability to drink water indicates impending recovery. (See "Abdominal Thirst".) Taiyin wind strike with faint superficial and choppy-long deep pulses indicates recovery. (See "Abdominal Fullness".) Shaoyin wind strike with faint superficial and floating deep pulses indicates recovery. (See "Desire to Sleep".) Jueyin wind strike with slightly floating pulse indicates recovery; non-floating indicates no recovery.
Taiyang disease resolves between Si and Wei hours. (See "Fever".) Yangming disease resolves between Shen and Xu hours. (See "Stomach Excess".)
Shaoyang disease resolves between Yin and Chen hours. (See "Bitter Taste in Mouth".) Taiyin disease resolves between Hai and Chou hours. (See "Abdominal Fullness".)
Shaoyin disease resolves between Zi and Yin hours. (See "Desire to Sleep".) Jueyin disease resolves between Chou and Mao hours. (See "Qi Rushing Up to Heart".)
Question: How to determine when a disease started and when it will heal? Answer: If contracted at noon and healed at midnight, it is because Yang obtains Yin to resolve. If contracted at midnight and healed at noon, it is because Yin obtains Yang to resolve. Family reports fever and body pain; patient lies down. Physician finds deep and slow pulse, indicating recovery. Why? Exterior disease usually presents with floating/large pulse; deep/slow indicates resolution. If patient reports sudden abdominal pain; patient sits. Physician finds floating/large pulse, indicating recovery. Why? Interior disease usually presents with deep/thin pulse; floating/large indicates resolution.
Question: Why does some disease resolve with chills and sweating? Answer: Floating and tight pulse, hollow upon pressure, indicates underlying deficiency, leading to chills and sweating. Deficiency causes chills. Floating pulse indicates sweating will resolve it.
If pulse is floating and rapid, not hollow upon pressure, indicating no underlying deficiency, resolution occurs via sweating without chills. Question: Why does some disease resolve with sweating but no chills? Answer: Large, floating, and rapid pulse indicates resolution without chills.
Question: Why does some disease resolve without chills or sweating? Answer: Faint pulse indicates prior sweating, vomiting, purging, or blood loss, leading to internal fluid depletion. Healing occurs through Yin-Yang self-harmony without chills or sweating.
Shanghai Zang stated: Resolution with chills is Taiyang; resolution with sweating but no chills is Yangming; resolution without sweating or chills is Shaoyang.
In unresolved Taiyang disease, if Yin and Yang pulses cease, chills and sweating will precede resolution. Faint Yang pulse resolves via sweating; faint Yin pulse resolves via purging. (See "Fever" section.) Large, floating, rapid, moving, and slippery pulses are Yang pulses; deep, choppy, wiry, weak, and faint pulses are Yin pulses. Yin disease showing Yang pulse indicates life; Yang disease showing Yin pulse indicates death. Excessive Yin and Yang with profuse sweating without resolution indicates death. Deficient Yin and Yang with persistent heat indicates death. See detailed methods for diagnosing life and death. (See "Diagnosis Methods".)
Improper medication or disregarding medical advice renders treatment futile.
Deep pulse indicates interior location; inducing sweating here causes fluid loss, difficult defecation, exterior deficiency and interior excess, eventually leading to delirium. (See "Delirium".) Floating and tight pulse indicates body pain, suitable for sweating. However, if Chi pulse is slow, sweating is contraindicated due to insufficient Ying Qi and blood deficiency. (*Qiren Shu* states: First use Xiao Jianzhong Tang plus Huangqi. If Chi pulse remains slow, prepare another dose, then administer Chaihu Guizhi Er Yuebi Yi Tang in small doses to harmonize and cure.)
Scholar Xu stated: A townsman named Qiu suffered from Shanghan fever, headache, vexation, and thirst. Pulse was floating, rapid, and weak, with slow and weak Chi position. I stated: Although this resembles Mahuang Tang syndrome, the slow Chi pulse indicates contraindication. Zhongjing says: Slow Chi pulse indicates insufficient Ying Qi and blood; sweating is premature. I prescribed Jianzhong Tang with Danggui and Huangqi. The next day, pulse remained unchanged. His family pressured for sweating drugs daily. I resisted, using only Jianzhong Tang to nourish Ying. On the fifth day, Chi pulse responded, so I administered Mahuang Tang. After two doses, he became manic, then calmed, slept briefly, and sweated. Indeed, this matter is difficult. Although Zhongjing advises treating promptly regardless of time, physicians must consider exterior-interior deficiency-excess and wait for the right timing. Disregarding sequence for temporary relief damages the Five Zang organs and shortens lifespan. The *History of Southern Dynasties* records Fan Yun suffering from Shanghan, fearing missing Emperor Wu's enfeoffment ceremony. He summoned Xu Wenbo. Wenbo said: Recovery is easy, but fear you will not rise again in two years. Yun replied: Hearing the Dao in the morning is worth dying in the evening, let alone two years. Wenbo heated the floor, spread peach leaves, set a mat, placed Yun upon it, and induced sweating quickly, dusting him with warm powder. He recovered the next day. Yun was pleased. Wenbo said: Do not rejoice. Two years later, Yun indeed died. Inducing sweating prematurely shortens lifespan; how much more so ignoring exterior-interior status and timing for quick results? I often see impatient families urging sweating within three or four days; physicians complying rarely avoid failure. I record this as a warning.
Floating and large pulse requires sweating; purging instead is a major error. Exterior excess conditions must not be purged; purging causes slight fever. Cold extremities with warmth at the navel. Deficiency conditions must not be purged; purging causes severe thirst. Those seeking water recover easily; those rejecting water worsen. Taiyang exterior unresolved must not be purged; purging is erroneous. (See "Fever".)
Soft and weak pulse, weak at Guan, soft at Dian, faint at Upper, choppy at Lower. Faint indicates insufficient Yang Qi; choppy indicates blood deficiency. Yang deficiency with wind-strike sweating leads to irritability. Choppy indicates blood deficiency, cold extremities, and cold limbs. Yang deficiency sweating leads to irritability and insomnia. Yang deficiency must not be purged; purging leads to epigastric fullness and hardness. ("Yang deficiency must not be purged" likely means "further must not be purged".)
Floating pulse with severe heat treated with moxibustion is treating excess as deficiency. Fire pathogen moves, causing dry throat and spitting. Fine and rapid pulse must not be moxa-ed; fire becomes pathogen, causing vexation and rebellion, chasing deficiency and pursuing excess, scattering blood in vessels. Though fire energy is slight, internal attack is powerful, scorching bones and injuring sinews, making blood recovery difficult. Floating pulse with sweating treated with moxibustion prevents pathogen exit, causing heaviness and bi-syndrome below the waist. (See "Heaviness Below".)
Guizhi Tang is for releasing muscle layer. If pulse is floating, tight, with fever and no sweating, it is contraindicated. Remember this to avoid error. Floating pulse, spontaneous sweating, frequent urination, slight aversion to cold, and leg cramping contraindicate Guizhi Tang attacking the exterior. (See "Cold Extremities".) Wine drinkers should not receive Guizhi Tang; it causes vomiting because wine drinkers dislike sweet flavors.
Zizhi Tang (Gardenia Decoction) is contraindicated in patients with chronic loose stools.
Purging when inappropriate causes internal deficiency, heat entry, heat-associated diarrhea, and vexation. Complications are numerous; mild cases become critical, severe cases die. Purging Taiyang disease: if pulse is hurried without chest binding, disease resolves; if floating, chest binding occurs; if tight, sore throat; if wiry, hypochondriac stiffness; if fine and rapid, headache persists; if deep and tight, vomiting; if deep and slippery, heat-associated diarrhea; if floating and slippery, bloody stool.