凡阳虚之人，阴气自然必盛（阴气二字，指水旺，水即血也。血盛则气衰，此阳虚之所由来也）。外虽现一切火症（此火名虚火，与实火有别。实火本客气入阳经，抑郁所致。虚火即阴气上僭，阴指水，气即水中先天之阳，故曰虚火。水气以下流为顺，上行为逆，实由君火太弱，不能镇纳，以致上僭而为病）,近似实火，俱当以此法辨之，万无一失。阳虚病，其人必面色唇口青白无神，目瞑倦卧，声低息短，少气懒言，身重畏寒，口吐清水，饮食无味，舌青滑，或黑润青白色，淡黄润滑色，满口津液，不思水饮，即饮亦喜热汤，二便自利，脉浮空，细微无力，自汗肢冷，爪甲青，腹痛囊缩，种种病形，皆是阳虚的真面目，用药即当扶阳抑阴（扶阳二字，包括上中下，如桂枝、参、芪，扶上之阳；姜、蔻、西砂，扶中之阳；天雄、附子、硫黄，扶下之阳）。然又有近似实火处，又当指陈。阳虚症，有面赤如硃而似实火者（元阳外越也，定有以上病情可凭），有脉极大劲如石者（元阳暴脱也，定有以上病情可凭），有身大热者（此条有三：一者元阳外越，身必不痛不渴，无外感可凭；一者产妇血骤虚，阳无所附；一者吐血伤阴，元气无依，吐则气机发外，元气亦因而发外也），有满口齿缝流血者（阳气虚不能统血，血盛故外越也），有气喘促、咳嗽痰涌者（肺为清虚之脏，着不得一毫阴气，今心肺之阳不足，故不能制僭上之阴气也。阴气指肾水肾火，此条言内伤），有大、小便不利者（阳不足以化阴也，定有以上病情可凭）。此处略具一二，再玩阳虚门问答便知。
【阐释】郑氏谓：天雄、附子、硫黄扶下之阳，是有特点的。李时珍《本草纲目》谓乌、附、天雄皆是补下焦命门阳虚之药，以其皆同种而异名，同具辛、热气味而有毒，须制熟始可用，确为治下焦阳虚的要药。至硫黄亦大热纯阳，能补命门真火不足，龙绘堂《蠢子医》并谓："硫黄原是火之精，一切湿热它能清。"但因其味酸有毒，一般少用以内服，惟张钖纯善用之，其所著《医学衷中参西录》云："十馀年间，用生硫黄治愈沉寒痼冷之病不胜计。盖硫黄原无毒，其毒即其热也，使少服不会觉热，即于人分毫无损，故不用制熟即可服，更可常服也。且自古论硫黄者，莫不谓其功胜桂、附，惟径用生者系愚之创见，而实由自家徐徐尝验，确知其功效甚奇，又甚稳妥，然后敢以之治病。今邑中日服生硫黄者数百人，莫不饮食加多，身体强壮，皆愚为之引导也。"笔者亦常用硫黄为人治病，凡命门火衰，沉寒痼冷之症，用之特效，惟不用生者，需制熟而后用于汤药或丸药。其法以萝卜剜空，入硫黄在内，合定，放锅内煮二小时，去其臭气；或用豆腐同煮二小时亦可。患者刘××，食不下，饮水都吐，经检查为贲门癌，必须手术切除。笔者诊断为哽噎病，阳虚症状明显，命门火衰，即用附子理中汤加味，入硫黄20 克至30 克，服药三月而全愈，今已五年未复发，足证硫黄功用，尚可推广。至于郑氏提到满口齿缝流血，系阳虚不能统血，血盛因而外越，亦属确见。笔者常本"齿属肾"之义，用四逆汤加上桂以治此等症候，而取得显著效果。有气喘促、咳嗽痰涌者，郑氏指为心肺之阳不足，故不能制僭上之肾水肾火，确属经验有得之言。笔者对治此种病症，只要所吐系白泡沫痰或涎痰，略带咸味，气喘促，恶寒，投以附子理中汤加砂仁，无不应手辄效。至大便不利，有如羊矢，一般都认为火大，郑氏指出有阳不化阴，亦即阴结。笔者师其意，而用附子理中汤合半硫丸加肉苁蓉、麻仁、杏仁取效。硫黄性大热，能补命门真火，推动阳气以疏利大肠，又佐半夏之降浊。故半硫丸向为治阴结之良剂。
辨认一切阴虚证法
凡阴虚之人，阳气自然必盛（阳气二字，指火旺。火旺则水亏，此阴虚之所由来也）。外虽现一切阴象，近似阳虚症，俱当以此法辨之，万无一失。
阴虚病，其人必面目唇口红色，精神不倦，张目不眠，声音响亮，口臭气粗，身轻恶热，二便不利，口渴饮冷，舌苔干黄或黑黄，全无津液，芒刺满口，烦躁谵语，或潮热盗汗，干咳无痰，饮水不休，六脉长大有力，种种病形，皆是阴虚的真面目，用药即当益阴以破阳（益阴二字，包括六阴在内，照上气血盛衰篇，论气有馀便是火一段，存阴、救阴、化阴、育阴诸方俱备，仔细揣摩，便知阴虚之道也）。然亦有近似阳虚者，历指数端。阴虚症，有脉伏不见，或细如丝，而若阳虚极者（热极则脉伏也，定有以上病形可凭），有四肢冷如冰，而若阳绝者（邪热内伏，而阳气不达于四末也，定有以上病情可凭），有忽然吐泻，大汗如阳脱者（此热伏于中，逼出吐泻也，定有以上病形可凭），有欲言不能，而若气夺者（热痰上升蔽壅也，定有以上病情可凭）。此处不过具其一二，余于阴虚证作有问答数十条，反复推明，细玩便知。
按阴虚症皆缘火旺（火即气），火盛则伤血，此千古不易之理。后贤专以火立论，而阴虚症之真面目尽掩矣。仲景存阴、化阴、育阴、救阴之法俱废，无人识矣，今特证之。
【阐释】阴虚之人，由于气有馀，则火旺，故多水亏血衰，其所现病情，多与阳虚相反。阳虚之人，由于气不足不能统血，血行郁滞缓慢，体温常偏低。阴虚之人，水亏火旺，故体温常偏高而多有各种发热现象。临症凡见有所举阴虚病情的，用药即当益阴以抑阳。外虽现阴象，貌似阳虚，如郑氏所举的几种情况，只要有阴虚的各种病情，仍当按阴虚施治。
外感说
夫病而曰外感者，病邪由外而入内也。外者何？风、寒、暑、湿、燥、火六淫之气也。人若调养失宜，阴阳偶乖，六邪即得而干之。六气首重伤寒，因寒居正冬子令，冬至一阳生，一年之气机，俱从子时始起，故仲景先师，首重伤寒，提出六经大纲，病气挨次传递，始太阳而终厥阴，论伤寒，而暑、湿、燥、火、风俱括于内；论六日传经，而一年之节令已寓于中。真是仙眼仙心，窥透乾坤之秘；立方立法，实为万世之师。学者欲入精微，即在伤寒六经提纲病情方法上探求，不必他书上追索。须知伤寒论阳明，而燥症之外感已寓其方；论太阴，而湿症之外感可推其药。他如言少阳、少阴、厥阴，而风、火之外感，亦莫不具其法也。世之论外感者，务宜于仲景伤寒书上求之可也。
病之浅深轻重，固是不同，总不外乎六经。六经各有提纲病情，昭然如日月之经天，丝毫莫混。学者只要刻刻将提纲病情，熟记胸中，再玩后之六经定法贯解，细心领会，便得步步规矩，头头是道之妙，方可以为世之良医也。
内伤说
内伤之论多矣，诸书统以七情赅之。喜盛伤心，怒盛伤肝，恐惧伤肾，忧思伤脾，悲哀伤肺，是就五脏之性情而论也。而余则统以一心括之。夫心者，神之主也。凡视听言动，及五劳等情，莫不由心感召。人若心体泰然，喜怒不能役其神，忧思不能夺其柄，心阳不亏，何内伤之有乎？凡属内伤者，皆心气先夺，神无所主，不能镇定百官，诸症于是蜂起矣。此等症，往往发热咳嗽，少气懒言，身重喜卧，不思饮食，心中若有不胜其愁苦之境者，是皆心君之阳气弱，阳气弱一分，阴自盛一分，此一定之至理也。阳气过衰（即不能制阴），阴气过盛（势必上干），而阴中一线之元阳，势必随阴气而上行，便有牙疼、腮肿、耳肿、喉痛之症，粗工不识，鲜不以为阴虚火旺也。不知病由君火之弱，不能消尽群阴，阴气上腾，故牙疼诸症作矣。再观于地气上腾，而为黑云，遮蔽日光，雨水便降，即此可悟虚火之症，而知为阳虚阴盛无疑矣。古人有称痨字从火者，即是内伤之主脑，惜乎言之未畅，而说之未当也。余故反复推明虚火之由，以为将来告。
望色
望色无他术，专在神气求。
实症多红艳，虚症白青浮。
部位须分定，（额心、颏肾、鼻脾、左腮肝、右腮肺）生克仔细筹。
吉凶都可料，阳浮记心头（久病之人，未受外感，忽面现红光，若无病者，乃元阳外越，旦夕死亡之征）。
闻声
细听呼与吸（呼出心肺，吸入肝肾），痰喘有无声。
呃逆分新久，微（微言也）厉（声大也）判盈缩。
抑郁多长气，腹痛定呻吟。
谵语虚实异，留神仔细评（阳明实症谵语，乃热甚神昏，热极者，狂叫喜笑不休。少阴虚寒症，言语错乱若谵语，其实非谵语也，乃气虚阳脱，神无所主也）。
【阐释】《难经》谓："呼出心肺主之，吸入肝肾主之，呼吸之中，脾胃主之。"故闻呼吸声息，可为察知五脏之助，自当细心听取。至于痰喘之有声无声，呃逆之新久轻重，声音之大小，气息之长短，以及呻吟谵语等，均属闻诊中的主要项目，故须仔细留神。石寿棠《医原·闻声须察阴阳论》以燥湿为纲，分辨各种声音，而知其病之所在，颇为精审。其说谓："五音不外阴阳，阴阳不外燥湿。……燥邪干涩，声多属仄，或干哕，或咳声不扬，或咳则牵痛，或干咳连声，或太息气短；化火则多言，甚则谵狂，其声似破似哑，听之有干涩不利之象。湿邪重浊，声必低平，壅塞不宣，古谓如从瓮中作声者然。或默默懒言，或昏昏倦怠，或多嗽多痰，或痰在喉中漉漉有声，或水停心下汨汨有声，或多噫气；化火则上蒸心肺，神智模糊，呢喃自语，或昏沉迷睡，一派皆重浊不清之象，流露于呼吸之间。"又谓："实喘责在肺，虚喘责在肾。实喘者，胸满声粗，气长而有馀；虚喘者，呼长吸短，息促而不足。实喘者，出气不爽；虚喘者，入气有音。实喘，有水邪射肺，有痰饮遏肺，有客邪干肺，上焦气壅，治宜疏利；虚喘为肾不纳气，孤阳无根，治宜固摄。虚实分途，阴阳异治，然则闻声之道，顾不重哉！"可供辨证参考。
问症
探病须细问，疼痛何由生。
寒热分新久，痞满判重轻。
喜饮冷和热，二便黄与清。
妇女胎产异，经信最为凭。
切脉
脉分上、中、下，浮、沉、迟、数衡，有力与无力，虚、实自然明，大、小兼长、短，阴阳盛衰情，二十八脉象，堪为学者绳（脉之一途，千变万化，总在这阴阳两字上求之，其要不出浮、沉、迟、数，有力与无力耳。李士材之二十八脉，虽说繁冗，然逐步以言病，亦大费苦心，初学原不可少，此特明其要）。
【阐释】脉学自《内经》、《难经》以后，历代医家多有论述，明李士材二十八脉最为流行，至清周学海著脉学四书，精详条畅，可谓集脉学之大成。其说谓："总以浮、沉、迟、数、虚、实、长、短，八者为之提纲，得其纲则中有主宰，乃可应于无穷。故芤、革，浮也；牢、伏，沉也；代、迟也；促、数也；濡、弱、细、微，虚也；洪（促、牢、滑、动），实也；弦、缓，长也；动、结、滑、涩、紧、散，短也"。并说这些都是脉的位、数、形、势，而其根源则在于阴阳、血气、寒热、虚实的病机。察脉即所以察病机，必须察脉准而后辨病始真。郑氏切脉诗大体与周氏相近，而极简明扼要，便于应用。并谓二十八脉虽繁冗，但初学原不可少，亦属切当之论。较郑氏稍后的蜀中名医家唐宗海，除著《中西汇通五种》外，还著有《医学一见能》一书，以示初学。其中对二十八脉的脉象与病机，有扼要的叙说，特转录以资参考。
浮脉，轻按即见，主表实，亦主里气内虚。
沉脉，重按乃见，主里实，亦主里气内虚。
迟脉，一息三至，主虚寒，亦主在脏之病。
数脉，一息六至，主实热，亦主真寒假热。
虚脉，三部无力，主诸虚，亦主素禀不足。
实脉，三部有力，主诸实，亦主素禀有馀。
大脉，应指洪阔，主病进，亦主正气内虚。
缓脉，应指柔和，主病退，亦主胃气有馀。
长脉，过于三指，主气盛，亦主阳盛阴虚。
短脉，不满三指，主气损，亦主中有窒塞。
滑脉，往来流利，主血走，亦主痰饮为病。
涩脉，往来艰滞，主血虚，亦主瘀血凝积。
洪脉，涌沸有力，主实热，亦主内虚不足。
紧脉，劲疾无定，主寒实，亦主身体疼痛。
细脉，窄小不粗，主冷气，亦主血脉不足。
微脉，模糊不显，主阳虚，亦主元气败绝。
芤脉，浮大中空，主亡血，亦主遗精小产。
弦脉，端直中劲，主木旺，亦主痰饮内痛。
革脉，浮极有力，主阴亡，亦主阳不入阴。
牢脉，沉极有力，主寒实，亦主内有积聚。
濡脉，浮细无力，主气虚，亦主外受湿气。
弱脉，沉细无力，主血虚，亦主胃气不盛。
动脉，摇曳在关，主惊气，亦主阴阳相搏。
伏脉，沉潜着骨，主邪闭，亦主阴寒在内。
促脉，数中时止，主郁热，亦主邪气内陷。
结脉，迟中时止，主寒结，亦主气血渐衰。
代脉，止有定候，主气绝，亦主经隧有阻。
散脉，去来缭乱，主气散，亦主产妇之凶。
浮沉分表里，迟数定寒热，虚实分盛衰，大缓辨进退。长有馀而短不足，滑流利而涩艰难，寒、热、紧、洪俱属实，细、微、血气总为虚。芤中空而血亡故道，弦中劲而木乘脾经。革则阳气外越，牢则阴邪内固。濡气虚，弱血虚，虚各有别；动气搏，伏气闭，气总乖和。结阴促阳，辨迟与数；代亡散绝，有去无来。
脉法多端，此为总索。
[Background Information]
Book: Yili Zhuan (True Transmission of Medical Principles)
Chapter: Main Text (2/16)
Category: Medical Discourse
[Original Text Translation]
For those with Yang deficiency, Yin Qi naturally becomes excessive ("Yin Qi" refers to the flourishing of Water; Water is Blood. When Blood is excessive, Qi declines, which is the origin of Yang deficiency). Although all Fire symptoms may appear on the exterior (this Fire is called Deficient Fire, distinct from Excess Fire. Excess Fire arises from pathogenic Qi invading the Yang meridians and causing stagnation; Deficient Fire results from Yin Qi usurping upwards. Yin refers to Water, and Qi refers to the Innate Yang within Water, hence it is called Deficient Fire. Water Qi flows smoothly downwards but rebels upwards; this is actually due to the weakness of Ministerial Fire, failing to anchor and contain, leading to upward usurpation and disease), resembling Excess Fire, all should be differentiated by this method, ensuring no errors. In Yang deficiency diseases, the patient must have a bluish-white, spiritless complexion and lips/mouth, eyes closed in fatigue, low voice and short breath, reluctance to speak, heavy body with aversion to cold, spitting clear saliva, loss of taste for food, a bluish-slippery tongue, or black-moist bluish-white, pale-yellow slippery colors, full mouth of saliva, no desire for water or drinks; if drinking, they prefer hot soups, free urination and defecation, floating and empty pulse, fine and weak pulse, spontaneous sweating with cold limbs, bluish nails, abdominal pain with testicular retraction. All these forms are the true face of Yang deficiency. Medication should support Yang and suppress Yin ("Supporting Yang" includes the Upper, Middle, and Lower Jiao: e.g., Guizhi Tang (Cinnamon Twig Decoction), Renshen (Ginseng Root), Huangqi (Astragalus Root) support Upper Yang; Jiang (Dried Ginger Rhizome), Doukou (Black Cardamom Fruit), Xisha Ren (Amomum Villosum Fruit) support Middle Yang; Tianxiong (Aconitum Kusnezoffii Radix), Fuzi (Prepared Aconite Lateralis Radix), Liuhuang (Sulfur) support Lower Yang). However, there are cases resembling Excess Fire that must be pointed out. In Yang deficiency syndromes, there are cases with a red face like cinnabar resembling Excess Fire (this is Yuan Yang escaping outward, definitely accompanied by the above symptoms); cases with a pulse extremely large and hard like stone (this is sudden collapse of Yuan Yang, definitely accompanied by the above symptoms); cases with high fever (three possibilities: first, Yuan Yang escaping outward, body definitely not painful or thirsty, no external contraction signs; second, postpartum blood sudden deficiency, Yang has no attachment; third, hematemesis injuring Yin, Yuan Qi has no reliance, vomiting causes Qi mechanism to emit outward, Yuan Qi also emits outward); cases with bleeding from all gums (Yang deficiency fails to control Blood, Blood excess leads to outward escape); cases with panting, coughing, and surging phlegm (Lung is a clear and empty organ, tolerating no Yin Qi; now Heart and Lung Yang are insufficient, thus unable to control usurping Yin Qi. Yin Qi refers to Kidney Water and Kidney Fire, this point discusses internal injury); cases with difficulty in urination and defecation (Yang insufficient to transform Yin, definitely accompanied by the above symptoms). I briefly list one or two here; reading the Q&A in the Yang deficiency section will clarify.
[Commentary] Zheng states that Tianxiong, Fuzi, and Liuhuang supporting Lower Yang is distinctive. Li Shizhen's Bencao Gangmu (Compendium of Materia Medica) states that Wutou (Aconitum Carmichaelii Radix), Fuzi, and Tianxiong are all medicines tonifying Kidney Mingmen Yang deficiency, as they are the same species with different names, sharing acrid and hot properties and toxicity, requiring processing before use, truly essential medicines for Lower Jiao Yang deficiency. As for Liuhuang (Sulfur), it is also intensely hot and purely Yang, capable of tonifying Mingmen True Fire insufficiency. Long Huitang's Chunzi Yi (Stupid Son's Medical Book) says: "Liuhuang is originally the essence of Fire, clearing all damp-heat." But due to its sour taste and toxicity, it is rarely used internally; only Zhang Xichun used it skillfully. His Yixue Zhongzhong Canxi Lu (Records of Medicine: Combining Chinese and Western) says: "In over ten years, I cured countless cases of deep-seated cold with raw Liuhuang. Liuhuang is inherently non-toxic; its toxicity is its heat. If taken in small doses without feeling hot, it harms nothing, so processed preparation is unnecessary, and it can be taken long-term. Moreover, ancient discussions on Liuhuang claim its efficacy surpasses Guizhi and Fuzi. My innovation is using it raw, verified by personal trial to be effective and safe, then daring to use it clinically. Now hundreds in my county take raw Liuhuang daily, increasing appetite and strength, guided by me." I also frequently use Liuhuang for patients with Mingmen Fire decline and deep-seated cold, achieving special effects, but I do not use it raw; it must be processed for decoctions or pills. Method: hollow out a radish, insert Liuhuang, seal, boil for two hours to remove odor; or boil with tofu for two hours. Patient Liu XX, unable to eat, vomiting even water, diagnosed with cardia cancer requiring surgery. I diagnosed it as Geye Disease (dysphagia), obvious Yang deficiency, Mingmen Fire decline, treated with Fuzi Lizhong Tang (Aconite Pill to Regulate the Middle) modified, adding 20-30g Liuhuang. Cured after three months, no recurrence for five years, proving Liuhuang's utility can be expanded. Regarding Zheng's mention of gum bleeding due to Yang deficiency failing to control Blood, this is also an accurate observation. I often treat such conditions based on "Teeth belong to Kidney," using Sini Tang (Frigid Extremities Decoction) plus Guizhi (Cinnamon Twig), achieving significant results. For panting and coughing with surging phlegm, Zheng attributes it to insufficient Heart and Lung Yang failing to control usurping Kidney Water/Fire, which is indeed experiential wisdom. For such cases, if the sputum is white foamy or salivary, slightly salty, with panting and aversion to cold, I prescribe Fuzi Lizhong Tang plus Sha Ren (Amomum Fruit), invariably effective. Regarding constipation with stool like sheep dung, generally considered Excess Heat, Zheng points out Yang failing to transform Yin, i.e., Yin Constipation. Following his idea, I use Fuzi Lizhong Tang combined with Banshu Wan (Pinellia and Sulfur Pill) plus Rongzong (Cistanche Stem), Huren (Hemp Seed), Xingren (Apricot Seed) with success. Liuhuang is intensely hot, tonifies Mingmen True Fire, promotes Yang to lubricate the Large Intestine, assisted by Banxia (Pinellia Tuber) to descend turbidity. Thus, Banshu Wan is a good remedy for Yin Constipation.
Identifying All Yin Deficiency Syndromes
For those with Yin deficiency, Yang Qi naturally becomes excessive ("Yang Qi" refers to Fire flourishing. Fire flourishing leads to Water depletion, which is the origin of Yin deficiency). Although all Yin-like manifestations appear on the exterior, resembling Yang deficiency, all should be differentiated by this method, ensuring no errors.
In Yin deficiency diseases, the patient must have a red complexion and lips/mouth, unweary spirit, wide-eyed insomnia, loud voice, foul breath and coarse respiration, light body with aversion to heat, difficult urination and defecation, thirst preferring cold drinks, dry yellow or black-yellow tongue coating, no saliva, prickles all over the mouth, irritability and delirious speech, tidal fever and night sweats, dry cough without phlegm, incessant drinking, six pulses large, long, and forceful. All these forms are the true face of Yin deficiency. Medication should nourish Yin to break Yang ("Nourishing Yin" includes the Six Yin organs; referring to the previous section on Qi/Blood balance, discussing 'excess Qi is Fire', methods for preserving, saving, transforming, and nurturing Yin are prepared; careful contemplation reveals the way of Yin deficiency"). However, there are cases resembling Yang deficiency, listed below. In Yin deficiency syndromes, there are cases with a hidden pulse or thread-thin, resembling extreme Yang deficiency (extreme heat causes pulse to hide, definitely accompanied by the above forms); cases with ice-cold limbs, resembling Yang extinction (pathogenic heat trapped inside, Yang Qi not reaching extremities, definitely accompanied by the above symptoms); cases with sudden vomiting/diarrhea and profuse sweating resembling Yang collapse (heat trapped inside forces vomiting/diarrhea, definitely accompanied by the above forms); cases with inability to speak, resembling Qi exhaustion (hot-phlegm rising and obstructing, definitely accompanied by the above symptoms). I list only one or two here; read the dozens of Q&As on Yin deficiency I wrote, repeatedly clarified, to understand.
Note: Yin deficiency syndromes originate from Fire flourishing (Fire is Qi); Flourishing Fire injures Blood, an immutable principle since antiquity. Later scholars focused solely on Fire, obscuring the true face of Yin deficiency. Zhang Zhongjing's methods of preserving, transforming, nurturing, and saving Yin were abandoned and unrecognized; I hereby prove this.
[Commentary] Those with Yin deficiency, having excess Qi leading to Fire flourishing, suffer Water depletion and Blood decline, presenting symptoms opposite to Yang deficiency. Those with Yang deficiency, lacking Qi to control Blood, have stagnant/slow blood flow and lower body temperature. Those with Yin deficiency, with Water depletion and Fire flourishing, have higher body temperature and various fevers. Clinically, whenever Yin deficiency symptoms are observed, medication should nourish Yin to suppress Yang. Even if exterior signs resemble Yang deficiency, as Zheng lists, provided Yin deficiency symptoms exist, treatment should follow Yin deficiency principles.
When a disease is called "external contraction," it means pathogens enter from outside. What is "outside"? The Six Excesses: Wind, Cold, Summerheat, Dampness, Dryness, Fire. If regulation is improper and Yin/Yang occasionally discordant, the Six Evils invade. Among the Six Qi, Cold is prioritized because Cold rules Winter (Zi hour). At Winter Solstice, one Yang is born; the year's Qi mechanism starts at Zi hour. Thus, Master Zhongjing prioritized Cold Damage, proposing the Six Meridian outline. Pathogens transmit sequentially from Taiyang to Jueyin. Discussing Cold Damage encompasses Summerheat, Dampness, Dryness, Fire, and Wind; discussing six-day transmission contains the year's solar terms. This is a divine eye and heart, penetrating heaven and earth secrets; prescribing formulas and laws makes him a teacher for ten thousand generations. Scholars seeking subtlety should explore the Six Meridian outlines in Shanghan Lun (Treatise on Cold Damage), not seek elsewhere. Note that discussing Yangming implies formulas for Dryness external contraction; discussing Taiyin implies medicines for Dampness external contraction. Similarly, Shaoyang, Shaoyin, Jueyin cover Wind and Fire external contraction methods. Those discussing external contraction should seek answers in Zhongjing's Shanghan Lun.
The depth and severity of diseases differ but always fall within the Six Meridians. Each meridian has an outline of symptoms, clear as sun and moon in the sky, never confused. Scholars must memorize these outlines, study the subsequent Six Meridian interpretations, and comprehend carefully to master rules and logic, becoming excellent physicians.
Discussions on internal injury are numerous, books summarizing them under Seven Emotions. Excessive Joy injures Heart, Excessive Anger injures Liver, Fear injures Kidney, Worry/Thought injures Spleen, Grief injures Lung—this discusses Five Zang natures. I summarize them under One Heart. The Heart is the master of Spirit. All seeing, hearing, speaking, moving, and Five Exhaustions stem from Heart induction. If the Heart mind is tranquil, Joy/Anger cannot enslave Spirit, Worry/Thought cannot seize control, Heart Yang is not deficient, how could there be internal injury? All internal injuries begin with Heart Qi exhaustion, Spirit having no master, failing to calm the Hundred Officials, causing symptoms to swarm. Such cases often feature fever, cough, shortness of breath, reluctance to speak, heavy body, preference for lying down, loss of appetite, feeling of unbearable sorrow. These are due to weak Heart Monarch Yang. For every point Yang weakens, Yin strengthens by one point, an absolute truth. If Yang excessively declines (unable to control Yin), Yin excessively surges (necessarily affecting upper parts), the single thread of Yuan Yang within Yin rises with Yin, causing toothache, mumps, ear swelling, sore throat. Crude practitioners fail to recognize this, rarely failing to diagnose Yin Deficiency with Floating Fire. They do not know the disease stems from weak Ministerial Fire failing to dissolve Yin, causing Yin Qi to rise, triggering toothache etc. Observe earth Qi rising forming black clouds, blocking sunlight, causing rain; thus realize Deficient Fire symptoms indicate Yang deficiency and Yin excess beyond doubt. Ancients noted the character for Tuberculosis (Lao) contains Fire, indicating the core of internal injury, but their explanation was incomplete/inaccurate. I repeatedly clarify the origin of Deficient Fire for future reference.
Observing Complexion
Observing complexion requires no other skill, focus solely on Shen Qi (Spirit/Energy).
Excess syndromes show bright red; deficiency shows white/blue floating.
Locations must be fixed (Forehead-Heart, Chin-Kidney, Nose-Spleen, Left Cheek-Liver, Right Cheek-Lung), analyze generation/restriction carefully.
Fortune/misfortune can be predicted; remember Floating Yang (in chronic illness without external contraction, sudden red glow on face indicates Yuan Yang escaping outward, sign of imminent death).
Listening to Voice
Listen carefully to exhalation and inhalation (Exhalation governed by Heart/Lung, Inhalation by Kidney/Liver), check for phlegm/wheezing sounds.
Differentiate hiccups by new/old, subtle/loud to judge surplus/deficit.
Depression causes frequent sighing; abdominal pain causes groaning.
Delirious speech differs in excess/deficiency; observe carefully (Yangming Excess delirium is severe heat confusing Spirit, extreme heat causes wild laughter/crying. Shaoyin Deficiency-Cold speech confusion resembles delirium but is not; it is Qi deficiency/Yang collapse, Spirit having no master).
[Commentary] Nan Jing states: "Exhalation governed by Heart/Lung, inhalation by Kidney/Liver, breathing center governed by Spleen/Stomach." Thus, listening to breath aids observing Five Zang, requiring careful attention. Phlegm/wheezing sounds, hiccup duration/severity, voice volume, breath length, groaning, delirium are main components of Auscultation/Olfaction, requiring careful observation. Shi Shoutang's Yiyuan (Medical Origins) uses Dryness/Dampness as criteria to distinguish voices and locate disease, quite precise. He states: "Five tones are Yin/Yang; Yin/Yang are Dryness/Dampness... Dryness pathogen causes dryness/stiffness, tones are sharp, or dry retching, hoarse cough, pain on coughing, continuous dry cough, frequent sighs/short breath; transforming into Fire causes excessive talking, even delirium/manic behavior, voice broken/husky, sounding dry/stiff. Dampness pathogen is heavy/turbid, tone low/flat, obstructed, anciently described as sound from a jar. Or silent/reluctant to speak, drowsy/lethargic, frequent cough/phlegm, rattling phlegm in throat, gurgling fluid in heart/lower jiao, frequent belching; transforming into Fire steams Heart/Lung, mental confusion, muttering, coma/sleep, all heavy/turbid images manifesting in respiration." He also states: "Excess panting blames Lung, deficiency panting blames Kidney. Excess panting: chest full, rough voice, long breath with surplus; deficiency panting: long exhale, short inhale, rapid breath with deficit. Excess panting: difficult exhalation; deficiency panting: noisy inhalation. Excess panting: water evil shooting Lung, phlegm-fluid obstructing Lung, external pathogen affecting Lung, Upper Jiao Qi congestion, treatment should disperse/propel; deficiency panting: Kidney failing to grasp Qi, lone Yang rootless, treatment should consolidate/astringe. Excess/deficiency paths differ, Yin/Yang treatments vary; thus, is listening to voice not important?" Available for syndrome differentiation reference.
Asking Symptoms
Investigate disease by detailed questioning, why does pain arise?
Differentiate new/old cold/heat, assess heaviness/lightness of fullness.
Preference for cold/hot drinks, yellow/clear urine and stool.
Women's pregnancy/birth differ, menstrual cycle is the key evidence.
Pulse Taking
Pulses divide into Upper/Middle/Lower, balanced by Floating/Sinking, Slow/Rapid, Forceful/Forceless, Excess/Deficiency naturally clear. Large/Small combined with Long/Short, Yin/Yang surplus/deficit emotions. Twenty-eight pulse images serve as a ruler for scholars (Pulse pathology varies infinitely, always seeking Yin/Yang, essentials are Floating/Sinking, Slow/Rapid, Forceful/Forceless. Li Shicai's twenty-eight pulses, though verbose, painstakingly describe diseases step-by-step, indispensable for beginners, here clarifying essentials).
[Commentary] Pulseology since Neijing and Nanjing has many discussions. Ming Dynasty Li Shicai's twenty-eight pulses were most popular. Qing Dynasty Zhou Xuehai's Four Books on Pulseology is precise and comprehensive, collecting pulseology achievements. He states: "Summarize Floating, Sinking, Slow, Rapid, Deficiency, Excess, Long, Short as eight outlines. Grasping the outline provides mastery, responding infinitely. Thus Kous/Ges are Floating; Laos/Fus are Sinking; Dai is Slow; Cu is Rapid; Rus/Ruoxis/Ximis/Weis are Deficiency; Hong (Cu/Laos/Huados) are Excess; Xians/Huans are Long; Dong/Jies/Huas/Ses/Jins/Sans are Short." These are pulse position, number, form, momentum, rooted in Yin/Yang, Blood/Qi, Cold/Heat, Excess/Deficiency pathogenesis. Observing pulses observes pathogenesis; accurate pulse diagnosis ensures true syndrome differentiation. Zheng's pulse poem is similar to Zhou's but simpler/practical. He notes twenty-eight pulses are verbose but necessary for beginners, a valid view. Tang Zonghai, slightly later Sichuan physician, authored Zhongxi Huitong Wuzhong and Yixue Yijian Neng (Medicine Easily Understood) for beginners. It briefly describes twenty-eight pulse images and pathogenesis, transcribed here for reference.
Floating Pulse: Visible with light pressure, indicates Exterior Excess, also Interior Qi deficiency.
Sinking Pulse: Visible with heavy pressure, indicates Interior Excess, also Interior Qi deficiency.
Slow Pulse: Three beats per breath, indicates Deficiency-Cold, also Zang organ disease.
Rapid Pulse: Six beats per breath, indicates Excess-Heat, also True Cold False Heat.
Deficiency Pulse: Weak in all three positions, indicates all deficiencies, also constitutional insufficiency.
Excess Pulse: Strong in all three positions, indicates all excesses, also constitutional surplus.
Large Pulse: Broad and forceful, indicates disease progression, also Righteous Qi interior deficiency.
Moderate Pulse: Soft and gentle, indicates disease retreat, also Stomach Qi surplus.
Long Pulse: Extends beyond three fingers, indicates Qi excess, also Yang excess/Yin deficiency.
Short Pulse: Does not reach three fingers, indicates Qi damage, also internal obstruction.
Slippery Pulse: Smooth and fluent, indicates Blood movement, also phlegm-fluid disease.
Choppy Pulse: Difficult and stagnant, indicates Blood deficiency, also blood stasis accumulation.
Surging Pulse: Boiling and forceful, indicates Excess-Heat, also interior deficiency insufficiency.
Tight Pulse: Hard and rapid without regularity, indicates Cold Excess, also body pain.
Fine Pulse: Narrow and thin, indicates Cold Qi, also blood vessel insufficiency.
Micro Pulse: Indistinct and faint, indicates Yang deficiency, also Yuan Qi collapse.
Hollow Pulse: Floating, large, and empty in center, indicates blood loss, also spermatorrhea/miscarriage.
Wiry Pulse: Straight and hard, indicates Wood excess, also internal phlegm-fluid pain.
Leather Pulse: Extremely floating and forceful, indicates Yin loss, also Yang failing to enter Yin.
Deep Pulse: Extremely sinking and forceful, indicates Cold Excess, also internal accumulation.
Soft Pulse: Floating, fine, and weak, indicates Qi deficiency, also external dampness invasion.
Weak Pulse: Sinking, fine, and weak, indicates Blood deficiency, also Stomach Qi not flourishing.
Agitated Pulse: Trembling at Guan position, indicates Shock Qi, also Yin/Yang struggling.
Hidden Pulse: Sinking deep to bone, indicates pathogen closure, also interior Yin-Cold.
Rapid-Pulsating Pulse: Rapid with intermittent stops, indicates stagnant heat, also pathogen sinking inward.
Knotted Pulse: Slow with intermittent stops, indicates Cold knot, also gradual Qi/Blood decline.
Intermittent Pulse: Stops at fixed intervals, indicates Qi exhaustion, also meridian blockage.
Scattered Pulse: Chaotic coming and going, indicates Qi scattering, also ominous for postpartum women.
Floating/Sinking differentiate Exterior/Interior; Slow/Rapid determine Cold/Heat; Excess/Deficiency distinguish Surplus/Decline; Large/Moderate discern Progression/Retreat. Long indicates surplus, Short indicates deficit; Slippery indicates fluency, Choppy indicates difficulty; Cold, Heat, Tight, Surging all belong to Excess; Fine, Micro, Blood, Qi always belong to Deficiency. Hollow is empty center due to blood loss; Wiry is hard center due to Wood attacking Spleen. Leather indicates Yang escaping outward; Deep indicates Yin pathogen solidified inside. Soft indicates Qi deficiency, Weak indicates Blood deficiency, distinctions vary; Agitated indicates Qi struggle, Hidden indicates Qi closure, Qi always disharmonious. Knotted is Yin, Rapid-Pulsating is Yang, distinguish Slow/Rapid; Intermittent indicates death, Scattered indicates extinction, leaving without return.
Pulse methods are manifold, this is the general summary.