医脉摘要
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提要
本书上、下两卷，署为"萧廉泉先生所著"。同社陈龙池君，从友人李宇仁君处录示。李君酷嗜医籍，亦在旧书肆中所得原署"希琴叠研斋主人手抄"，未刊稿也。其间，鉴别证候之疑似，并验舌诊脉之方法，附以时方歌、药性赋，为医学入门之阶梯，与第一集第五种《医阶辨证》互相发明。古今医籍中不可多得之作，惜未审萧先生何许人也有知者，应惠函相告，俾表扬以志勿谖。
《医脉摘要》序
李君宇仁精于医，生平以搜罗医籍，为药且精于鉴别。偶见元明旧刻及前贤秘本，必重价购得之，虽质典，亦所不惜。自颜其斋曰"味异"，足见其所好之深也。予与李君有同嗜，朝夕过从，相与纵谈医学。往往夜深忘倦，而李君亦乐而忘返也。辛酉岁暮，朔风猎猎，细雨霏霏，予偶造其庐，见案头置一册，颜曰萧廉泉《医脉摘要》，下署"希琴叠砚斋主人手抄"。询之，系新得之旧书市者。假归一读，其选摘辨别至精至当，后附时方歌、药性赋，亦简洁可喜，盖亦医学中之识途老马也。亟录一过，置诸案右，以供浏览。因志数语，以弁于简端云。中华民国十一年壬戍春三月上完广陵龙池氏陈宗转识于守一斋医脉摘要卷上
发热辨
伤寒发热，多兼恶寒，有仲景成法可循。惟杂病发热，颇类伤寒，不可不辨。凡脉数、发热、头痛而身不痛、右脉或紧或滑而左脉平和者，伤食也。夏月，四肢发热、身体沉重、胸膈烦闷、但不恶风、不头痛者，湿热相搏也；一身尽痛，发热日哺时剧者，风湿也，身热而烦，但头不痛、脉不浮紧、不恶寒者，虚烦也。春夏之交，发热而渴，或微恶寒、左脉大于右者，温病也，身热、头痛、自污、多眠、阳脉浮数、阴脉濡弱者，风温也。夏月，脉虚、身热而喘乏者，伤暑也；四肢发热，口唇干燥、烦闷不宁、而身不热者，脾热也。每日晡时，憎寒壮热、脉数盛而有痛处者，痈毒始发也。(原注：又有夜间发热，天明则退，或自汗出者，乃血发热，热在荣分，故不作渴，也宜清荣之剂。)
太阳为先天之主阳，其热发于荣卫，故一身手足壮热。阳明乃太阳少阳相合之阳，其热发于肌肉，故蒸蒸发热。少阳为半表半里之阳，其热发于腠理，时开时合，故往来寒热。此三阳发热之分也。太阴为至阴，无热可发，因为胃行津液以灌四旁，故得主四肢而发热于手足，所以太阴伤寒，手足自温；太阴中风，四肢烦疼耳。少阴为封蛰之本，若少阴不藏，则坎阳无蔽，故有始受风寒，而脉沉反发热者，或始无表热，八九日来热入膀胱，致一身手足尽热者。厥阴当两阴交尽一阳初生，其伤寒也，有从阴而先厥后热者，有从阳而先热后厥者，或阳进而热多厥少，或阳退而热少厥多或阴阳和而厥与热相应。此三阴发热之分也。
伤寒发热，得汗则解。若汗出而热不退，或为风，或为湿，或风湿相搏，或风温不解，切勿专用发表之药。初病时之热，为虚实热，或表实或里实也。大病后之热，为虚热，或阳虚或阴虚也。
潮热辨
潮热有作有止，如潮水之来，不失其时。若每日申酉时发热，此阳明胃实也，宜下之。若潮热于寅卯，则属少阳；潮热于巳午，则属太阳，宜分别治之。
有潮热似疟、胸膈痞塞、背心疼痛、气弱、脉弦，服补药不效者，此痰饮随气而潮，故热亦随饮而潮也，宜涤痰之剂。
有气口脉滑，当薄暮发热，明日复止者，此内有宿食也，宜消食之剂。
有阴虚发热，夜热而朝退者，或产后下血过多，或内伤失血不止也，宜养阴而兼清火。
小儿发热辨
心热者，额上先赤，心烦，心痛，掌中热而哕，或壮热饮水，巳午时甚。肝热者，左颊先赤，便难，转筋，寻衣捻物，多怒多惊，四肢困倦，寅卯时甚。脾热者，鼻上先赤，怠惰嗜卧，身热，饮水遇夜益甚。肺热者，右颊先赤，手掐眉目喘咳，寒热饮水，日酉热甚。肾热者，颏下先赤，两足热甚，骨节如虫蚀热甚，不能起于床，夜间益甚。仍当辨其虚实：实则面赤，气粗，口燥唇肿，作渴饮冷，大小便难，或掀衣露体，烦啼暴叫，仰面而卧，睡不露睛，手足指热；虚则面色青白，恍惚神缓，口中虚冷，嘘气软弱，喜热恶寒，泄泻多尿，或乍凉乍温，怫郁惊惕，夜出虚汗，屈体而卧，睡露睛，手足指冷。大抵阴虚则内热，阳盛则外热。以手轻按之则热，重按之不热，此皮毛血脉之热，热在表也；重按之筋骨之分则热，轻按则不热，此筋骨之热，热在里也；不轻不重按之而热，此肌肉之热，热在表里之间也。壮热者，肢体大热，热不已则发惊痫；温热者，肢体微热，热不已则发惊搐。壮热恶风寒，表之虚热也；不恶风寒表之实热也。壮热饮汤，为津液亏，里之虚热也；壮热饮水，为内火炽，里之实热也。
恶寒辨
发热恶寒发于阳，无热恶寒发于阴。病人身大热反欲近衣者，热在皮肤，寒在骨髓也；身大寒反不欲近衣者，寒在皮肤，热在骨髓也。
阳乘阴者，腰以下至足热、腰以上寒，宜栀子豆豉汤吐以升之，或用升阳散火汤以达之。若阴气上争，心腹满者，死。阴乘阳者，腰以上至头热、腰以下寒，桂苓丸以导之。若阳气上争，得汗者，生。(原注：阳邪陷入阴分，阴邪上干阳位二层，为辨证关键。)
内伤恶寒，得暖便减。外感恶寒，絮火不除。恶寒者，周身毛窍被寒遏郁，不得阳气以卫外，故皮毛洒淅，虽向火覆被，不能御其寒也。人身八万四千毛窍，太阳卫外之气也。若病在太阳之气，则通身恶寒。从头项而至背膂，太阳循行之经也。若病在太阳之经，则背恶寒。恶寒之外，又有身寒，着衣重复而身尚冷，乃三焦火热之气不能温肌肉也，急温之、灸之。
背恶寒者，背为阳气行道，或阴邪凝滞，或阳极似阴，故恶寒也。若寒邪在里，口中和而背恶寒者，属少阴证，宜附子汤；阳邪陷内，口燥渴而背恶寒者，属阳明证，宜人参白虎汤。若心下有留饮，背寒冷如掌大者，宜十枣汤。若湿痰凝聚背心，时有一块冷者，宜苓桂苍术甘汤加半夏、南星、芥子。
寒热辨
阳盛则热，阴盛则寒。重寒则热，重热则寒。(原注：热极生寒，寒极生热，所谓亢则害也。)
风气客于皮肤之间，内不得通，外不得泄，腠理开则洒然，寒闭则热。而闷其寒也则减饮食，其热也则消肌肉，使人tR栗而不能食，名曰寒热。
往来寒热少阳证。寒热相因，小柴胡。如疟，寒热三五发，太阳麻桂等汤除。
伤寒伤风辨
伤寒郁而后发热，伤风初起热即发。伤寒肢冷脉浮紧，伤风肢温浮缓脉。伤寒恶食汗涕无，伤风能食汗涕出。(原注：风为阳邪，寒为阴邪。)风寒相因相离少，三阳俱有恶寒风，恶风属阳法从表，三阴恶寒不恶风。
自汗在太阳，为风邪，桂枝汤证也；在阳明，为热越，白虎承气汤证也。若表虚自汗者，宜玉屏风散；阴虚盗汗者，宜当归六黄汤。
头汗
头为诸阳之会，瘀热在里，不能发越，故热蒸于头，但头汗出也。有发热而头汗者，宜清理湿热。有水结而头汗者，宜温散水气。若火邪疫邪而头汗者，或白虎汤清之，或承气汤下之。惟虚阳上脱，汗出如珠者，不治。
手足汗
四肢者，诸阳之本，胃主四肢。今热聚胃中，逼其津液旁达于四肢，故手足濈濈然汗出也，宜急下之。若虚寒已极，手足出冷汗者，宜四逆汤。
发汗有二法，湿邪用香燥药发汗，即以去湿燥病，用滋润药滋水，即以作汗。凡脉微，汗冷如膏，手足厥逆而舌润者，亡阳也，宜温药救阳；脉洪，汗热不黏，手足温和而舌干者，亡阴也，宜凉药救阴。(原注：止热汗，用浮小麦一两、大枣七枚，水煎服。)
头痛少阳盛两边，太阳连项厥阴巅，阳明在额眼眶甚，太少二阴痛亦连。
三阴经皆有头痛、身必发热，各随其经治之。若无热，干呕，吐涎沫而头痛者，厥阴经证也，宜吴茱萸汤；若疫证头胀痛如破者，胃家邪实，气不下降也，宜承气汤；若痰厥头痛者，时重时轻，宜半夏白术天麻汤。
外感头痛，痛甚不休；内伤头痛，乍痛乍止。昼痛暮止者，气虚也；暮痛昼止者，血虚也。
身痛而发热无汗者，表实也，宜麻黄汤。身痛而不能转侧者，风湿也，宜桂枝加附子汤。身痛如被杖者，阴证也，宜四逆汤。身痛而脉迟者，血虚也，宜黄耆建中汤。若劳伤，身痛、脉虚、体倦者，宜补中益气汤。
头重
太阳项强恶寒，而头重不能举者，表邪也，宜汗之。若阴阳易病，眼中生花者，宜烧军散。若杂病，百节解散者，宜补剂。若湿痰随气上升而头重者，宜涤痰利湿。
头眩
上虚则眩。头旋者，为眩运；头昏者，为眩冒。有因风、因痰、因火、因虚之不同。
项强
项背儿儿(音殊)强太阳，脉浮无汗葛根汤；有汗桂枝添葛入，脉沉括蒌桂枝方；结胸项强如柔痉，大陷胸丸下必康；但见少阳休汗下，小柴去(半)夏入(栝)蒌良。
痉
痉病汗多血液伤，恶寒身热脉弦长，颈项强急面目赤，头摇口噤背反张。
咽痛咽痒
咽痛有二，脉浮数、面赤、吐浓血而咽痛者，阳毒证也；脉沉迟、手足冷、或吐利而咽痛者，少阴证也。咽痒亦有二，或实火上攻，或虚火上冲，随证治之。
耳聋
耳暴聋者，邪传少阳之经也。未汗者，宜和解；已汗者，宜养阴。若脱精而耳聋者，虚极之候也，宜补中益气汤合六味地黄汤治之。
邪气传里必先胸，由胸引胁少阳经。胸满桂枝加杏仁，胁满宜和小柴平。干呕潮热胸胁满，大柴加硝两解行。
不应下而下之，实邪留结，则硬满而痛，为结胸(宜陷胸汤)。虚邪留滞，则硬满而不痛，为痞气(宜泻心汤)。热微而头汗者，水结胸也(宜半夏茯苓汤)。漱水不欲咽者，血结胸也(宜桃仁承气汤)。若未下而胸满者，邪尚在表也，宜小柴胡汤加枳桔。若状如结胸、舌胎白滑、饮食如故、时时下利者，藏结也，难治，宜用温散之剂。
阳证痞硬为热痞，大黄黄连泻心汤。汗出恶寒寒热痞，附子泻心芩连黄。
腹满而痛者，为里实，当下之，宜承气汤。腹满时减者，为虚寒，当温之，宜参夏朴姜甘草汤。若吐利而腹满者，属太阴证，宜理中。(原注：藏寒生满病。)
小腹满
脐下满而小便利者，畜血也；小便不利者，畜水也。若厥逆尿白者，阴寒凝结也，宜桂附吴萸。(原注：肾虚，则寒动于中，当温之。)
烦出于心，阳盛而内热也。躁出于肾，阳浮而外热也。太阳有不汗出之烦躁，宜大青龙汤。阳明有心下硬满之烦躁，宜大承气汤。少阴有吐利厥逆之烦躁，宜吴茱萸汤。若汗下之后身无大热，脉沉微而昼臼烦躁者，阳虚也，宜附子干姜汤。若不烦而躁，面赤身热，欲入水而不能饮水者，阴盛格阳也(原注：戴阳证)，宜白通加人尿猪胆汁汤(原注：冷服)。惟结胸证具而烦躁、恶寒蜷卧而烦躁者，不治。
(原注：凡病喜仰卧者，实热；喜合面卧者，虚邪；喜向里卧者阴证。)
夜以阴为主，阳不入阴，故烦躁不得眠也。或汗后而心血大虚，或热甚而神气不宁，或新愈而阴气未复，各随见证治之。又有胆气虚而不眠者，宜枣仁汤；胃不和而不眠者，宜半夏秫米汤。(原注：开目欲见人者，阳证也。闭目不欲见人者，阴证也。目中不了了，睛不和，目赤、目黄、目眩，皆热证。瞠目直视，目胞陷下，戴眼反折，皆难治。)
(原注：足太阳之筋，为目上纲。足阳明之筋，为目下纲。热甚而目不开者，筋纵也。寒甚而目不暝者，筋急也。)
阳虚则欲寐，脾亏则嗜卧。汗出、身重而鼾睡者，风温也。唇黑、声哑而多眠者，狐惑也。若汗下之后，身凉、脉静而酣睡者，荣卫和也。
懊依
懊侬者，心中郁闷也。或表邪内陷，或余热未清，或汗下之后水火不交，当随证治之。
阳明衄血热在里，太阳衄血热瘀经。太阳头痛目瞑兆，阳明漱水不咽徵。衄后身凉知作解，不解犀角地黄清。未衄表实麻黄汗，里热犀角益连芩。
哕与干呕相似，其声浊而长。盖因胃气本虚或汗下太过，胃中虚冷；或恣饮冷水，水寒相搏，理中汤加半夏丁香主之。噫气者，中焦．不和，不能消谷，故气逆不降也，宜香砂六君子汤；兼痞硬者，宜代赭旋覆汤。(原注：连声哕者，属中焦。声断续，时微时甚者，属下焦。)
Summary of Medical Pulse
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Abstract
This book is divided into upper and lower volumes, attributed to "Mr. Xiao Lianquan". Mr. Chen Longchi of the same society copied and presented it from his friend Mr. Li Yuren. Mr. Li was passionate about medical books; this manuscript was also obtained by him in an old bookstore, originally titled "Hand-copied by the Master of Xiqin Dieyan Studio", and is an unpublished draft. It differentiates between similar and doubtful syndromes (Zheng Hou), verifies methods for tongue diagnosis (She Zhen) and pulse diagnosis (Mai Zhen), and includes songs for contemporary prescriptions (Shi Fang Ge) and the Ode to Medicinal Properties (Yao Xing Fu), serving as a ladder for entering medicine. It illuminates each other with the first collection's fifth type, "Medical Stages for Differentiation" (Yi Jie Bian Zheng). It is a rare work among ancient and modern medical texts. Unfortunately, it is unclear who Mr. Xiao was. Those who know should kindly inform us via letter, so that we may praise him to remember without forgetting.
Preface to Summary of Medical Pulse
Mr. Li Yuren is proficient in medicine. Throughout his life, he has devoted himself to collecting medical books and is also precise in identifying medicines. Whenever he encounters old prints from the Yuan and Ming dynasties or secret manuscripts of former sages, he buys them at high prices, even if it means pawning his clothes. He named his studio "Wei Yi" (Tasting Differences), showing the depth of his passion. I share the same hobby with Mr. Li, visiting each other day and night, engaging in free discussions on medicine. Often, we forget fatigue late into the night, and Mr. Li enjoys it so much that he forgets to return home. At the end of the Xin You year, with the north wind howling and drizzle falling, I accidentally visited his residence and saw a volume on the desk titled Xiao Lianquan's "Summary of Medical Pulse", signed "Hand-copied by the Master of Xiqin Dianyuan Studio". Upon inquiry, I learned it was a newly acquired old book from the market. Borrowing it home to read, I found its selections and distinctions to be extremely precise and appropriate. The appended songs for contemporary prescriptions and odes to medicinal properties are also concise and pleasing. It can be said to be an experienced horse knowing the way in medicine. I hurriedly copied it once and placed it on the right side of my desk for browsing. Therefore, I write a few words to place at the beginning of the scroll. Completed in the spring of the third month of the Ren Xu year, the eleventh year of the Republic of China. Recorded by Chen Zongzhuan of Longchi, Guangling, at Shouyi Studio.
Summary of Medical Pulse, Volume Upper
Differentiation of Fever
Fever caused by Shang Han (Cold Damage) is often accompanied by aversion to cold, following the established methods of Zhang Zhongjing. However, fever caused by miscellaneous diseases resembles Shang Han closely and must be differentiated. If the pulse is rapid, there is fever and headache but no body pain, and the right pulse is either tight or slippery while the left pulse is peaceful, it is food retention (Shang Shi). In summer, if the four limbs are hot, the body feels heavy, there is chest and diaphragm oppression, but no aversion to wind or headache, it is a struggle between dampness and heat. If the whole body hurts and fever worsens at dusk, it is wind-dampness. If the body is hot and irritable, but the head does not hurt, the pulse is not floating and tight, and there is no aversion to cold, it is deficiency irritability (Xu Fan). In the transition between spring and summer, if there is fever and thirst, or slight aversion to cold, and the left pulse is larger than the right, it is Warm Disease (Wen Bing). If the body is hot, there is headache, spontaneous diarrhea, excessive sleepiness, the yang pulse (cun position) is floating and rapid, and the yin pulse (chi position) is soggy and weak, it is Wind-Warmth (Feng Wen). In summer, if the pulse is empty, the body is hot, and there is panting and fatigue, it is Summerheat Injury (Shang Shu). If the four limbs are hot, lips are dry, there is irritability and restlessness, but the body is not hot, it is Spleen Heat (Pi Re). Every day at dusk, if there is aversion to cold and high fever, the pulse is rapid and full, and there is a painful area, it is the initial onset of carbuncle toxin (Yong Du). (Original Note: There is also fever at night that subsides at dawn, or with spontaneous sweating. This is blood-level fever, heat in the Ying (Nutrient) level, so there is no thirst. Clearing Ying agents should be used.)
The Tai Yang meridian is the master of congenital Yang. Its heat arises from the Ying and Wei levels, causing robust heat throughout the body and limbs. The Yang Ming meridian is the combination of Tai Yang and Shao Yang Yang. Its heat arises in the muscles, causing steaming heat. The Shao Yang meridian is the half-exterior, half-interior Yang. Its heat arises in the interstices (Cou Li), opening and closing intermittently, causing alternating chills and fever. This distinguishes the fever of the Three Yang meridians. The Tai Yin meridian is extreme Yin and has no heat to emit. Because the stomach distributes fluids to irrigate the four sides, it governs the limbs and causes heat in the hands and feet. Thus, in Tai Yin Shang Han, the hands and feet are naturally warm; in Tai Yin Wind Strike, the four limbs are annoyed and painful. The Shao Yin meridian is the root of sealing and storing. If Shao Yin fails to store, Kan Yang has no cover. Thus, one may initially contract wind-cold, yet have a deep pulse but still feel feverish; or initially have no exterior heat, but after eight or nine days, heat enters the Bladder, causing heat throughout the body and limbs. The Jue Yin meridian represents the end of two Yins and the birth of one Yang. In its Shang Han, some progress from Yin, experiencing cold extremities first then fever; others progress from Yang, experiencing fever first then cold extremities. Or, as Yang advances, there is more heat and less cold; as Yang retreats, less heat and more cold. Or, when Yin and Yang harmonize, cold extremities and fever correspond. This distinguishes the fever of the Three Yin meridians.
In Shang Han, fever resolves with sweating. If fever persists after sweating, it may be due to Wind, Dampness, Wind-Dampness struggle, or unresolved Wind-Warmth. Do not exclusively use exterior-releasing drugs. Initial fever is excess-deficiency heat, either exterior excess or interior excess. Post-illness fever is deficiency heat, either Yang deficiency or Yin deficiency.
Differentiation of Tidal Fever
Tidal fever comes and goes like the tide, never missing its time. If fever occurs daily at Shen and You hours (3 PM - 7 PM), this is Yang Ming Stomach Excess, suitable for purgation. If tidal fever occurs at Yin and Mao hours (3 AM - 7 AM), it belongs to Shao Yang; if at Si and Wu hours (9 AM - 1 PM), it belongs to Tai Yang. Treat accordingly.
If tidal fever resembles malaria, with chest/diaphragm obstruction, back pain, weak Qi, and a wiry pulse, and responds poorly to tonics, this is Phlegm-Fluid moving with Qi, causing heat to follow the fluid. Use phlegm-resolving agents.
If the Qi Kou pulse is slippery, with fever at dusk resolving the next day, this is retained food inside. Use food-resolving agents.
If there is Yin deficiency fever, with night fever and morning resolution, or excessive postpartum bleeding, or internal injury with continuous blood loss, nourish Yin and clear fire simultaneously.
Differentiation of Pediatric Fever
Heart Heat: Forehead reddens first, heart irritability, heart pain, hot palms, hiccups, or high fever with desire to drink water, worsening at Si/Wu hours.
Liver Heat: Left cheek reddens first, difficult defecation, tendon contraction, grasping at clothes/objects, anger/fright, limb fatigue, worsening at Yin/Mao hours.
Spleen Heat: Nose bridge reddens first, lethargy/sleepiness, body heat, drinking water worsens at night.
Lung Heat: Right cheek reddens first, scratching brows/eyes, panting/cough, chills/fever, desire to drink water, worsening at Ri/You hours.
Kidney Heat: Chin reddens first, hot soles, bone joints feeling like insect-biting heat, inability to rise from bed, worsening at night.
Still differentiate deficiency/excess: Excess features red face, coarse breath, dry mouth/swollen lips, thirst for cold drinks, difficulty urinating/defecating, kicking off covers, crying wildly, lying supine with eyes closed during sleep, hot finger tips. Deficiency features blue-white complexion, vague spirit/sluggishness, cold sensation in mouth, weak sighing, preference for warmth/aversion to cold, diarrhea/polyuria, alternating cool/warm, depression/fright, night sweats, curled posture, open eyes during sleep, cold finger tips. Generally, Yin deficiency causes internal heat; Yang excess causes external heat. Light pressure yields heat, heavy pressure does not: heat in skin/blood vessels, exterior heat. Heavy pressure on bones/muscles yields heat, light pressure does not: heat in bones/muscles, interior heat. Neither light nor heavy pressure yields heat: heat in flesh, heat between exterior and interior. High fever involves large body heat; unrelenting heat leads to convulsions/seizures. Mild warmth involves slight body heat; unrelenting warmth leads to tremors/spasms. High fever with aversion to wind/cold is exterior deficiency heat; no aversion is exterior excess heat. High fever desiring hot soup indicates fluid deficit, interior deficiency heat; high fever desiring cold water indicates blazing internal fire, interior excess heat.
Differentiation of Aversion to Cold
Fever with aversion to cold originates in Yang; no fever with aversion to cold originates in Yin. If the patient's body is very hot but desires clothing, heat is in the skin, cold is in the marrow. If the body is very cold but does not desire clothing, cold is in the skin, heat is in the marrow.
Yang invading Yin: Heat from waist down to feet, cold from waist up. Use Gardenia and Fermented Soybean Decoction (Zhizi Dou Chi Tang) to induce vomiting and lift, or Ascending Yang and Scattering Fire Decoction (Sheng Yang San Huo Tang) to disperse. If Yin Qi rises competitively causing heart/abdominal fullness, death ensues. Yin invading Yang: Heat from waist up to head, cold from waist down. Guide with Cinnamon Twig and Polyporus Pill (Guiling Wan). If Yang Qi rises competitively and sweating occurs, survival ensues. (Original Note: Yang pathogen sinking into Yin level, Yin pathogen interfering with Yang level—these two layers are key to differentiation.)
Internal injury aversion to cold decreases with warmth. External contraction aversion to cold persists despite warming. Aversion to cold occurs when hair follicles are constrained by cold, preventing Yang Qi from defending the exterior, causing shivering. Even near fire or under blankets, cold cannot be resisted. The 84,000 pores are the defensive Qi of Tai Yang. If disease affects Tai Yang Qi, the whole body feels cold. From head/neck to back is the Tai Yang channel pathway. If disease affects Tai Yang Channel, only the back feels cold. Besides aversion to cold, there is body coldness where layered clothing still leaves the body cold; this is San Jiao fire-heat failing to warm muscles. Urgently warm and moxa.
Back aversion to cold: The back is the pathway of Yang Qi. It may be due to Yin pathogen stagnation or extreme Yang resembling Yin. If cold pathogen is interior, mouth is neutral, back feels cold: Shao Yin syndrome, use Aconite Decoction (Fuzi Tang). If Yang pathogen sinks interior, mouth is dry/thirsty, back feels cold: Yang Ming syndrome, use Ginseng and White Tiger Decoction (Renshen Baihu Tang). If fluid retention exists in the epigastrium, back feels cold like a palm print: Ten Dates Decoction (Shi Zao Tang). If damp-phlegm condenses on the back, creating a cold patch: Poria, Cinnamon Twig, Atractylodes Macrocephala, Licorice Decoction (Ling Gui Zhu Gan Tang) plus Pinellia, Arisaema, Mustard Seed.
Differentiation of Chills and Fever
Yang excess causes heat; Yin excess causes cold. Extreme cold generates heat; extreme heat generates cold. (Original Note: Extreme heat generates cold, extreme cold generates heat, known as 'Exuberance brings disaster'.)
Yang deficiency causes exterior cold; Yin deficiency causes interior heat. Yang excess causes exterior heat; Yin excess causes interior cold.
Wind pathogen lodging between skin, unable to penetrate inward or excrete outward. When pores open, there is a chill; when pores close, heat accumulates. Cold constriction reduces appetite; heat consumes muscle, causing shivering and anorexia, named "Chills and Fever".
Alternating chills and fever is Shao Yang syndrome. For chills/fever linked, use Minor Bupleurum Decoction (Xiao Chai Hu Tang). Like malaria, chills/fever occurring 3-5 times, resolve with Tai Yang Ma Huang Tang or Gui Zhi Tang.
Differentiation of Shang Han and Shang Feng
(Original Note: Wind injures Wei (Defensive); Wei governs Qi, which is Yang. Cold injures Ying (Nutrient); Ying governs Blood, which is Yin.)
Shang Han: Heat develops after stagnation. Shang Feng: Heat appears immediately upon onset. Shang Han: Cold limbs, floating-tight pulse. Shang Feng: Warm limbs, floating-slow pulse. Shang Han: Aversion to food, no sweat/runny nose. Shang Feng: Can eat, sweat/runny nose present. (Original Note: Wind is Yang pathogen; Cold is Yin pathogen.) Wind and Cold are related yet distinct. All Three Yang meridians have aversion to wind. Aversion to wind belongs to Yang, treated via exterior. Three Yin meridians have aversion to cold but not aversion to wind.
Spontaneous Sweating
(Original Note: Sweating with unresolved exterior may be incomplete Wind pathogen or Wind-Dampness struggle.)
Spontaneous sweating in Tai Yang is due to Wind pathogen, Gui Zhi Tang syndrome. In Yang Ming, it is heat venting, Bai Hu Cheng Qi Tang syndrome. If exterior deficiency causes spontaneous sweating, use Jade Screen Powder (Yu Ping Feng San). If Yin deficiency causes night sweating, use Dang Gui Liu Huang Tang.
Head Sweating
(Original Note: Pathogen excess causes sweating, necessarily with heat. Yang collapse causes sweating, necessarily with cold.)
The head is the meeting of all Yang meridians. Stagnant heat in the interior cannot vent, steaming upwards, causing only head sweating. If fever accompanies head sweating, clear heat and dampness. If water accumulation causes head sweating, warm and disperse water qi. If fire/epidemic pathogen causes head sweating, clear with Bai Hu Tang or purge with Cheng Qi Tang. Only if deficient Yang floats upward, with beads-like sweating, is it untreatable.
Hand and Foot Sweating
Limbs are the root of all Yang; the Stomach governs limbs. Now heat gathers in the Stomach, forcing fluids to reach the limbs peripherally, causing persistent hand/foot sweating. Urgently purge. If extreme deficiency-cold causes cold sweat on hands/feet, use Four Reversal Decoction (Si Ni Tang).
There are two methods of inducing sweat: For damp pathogen, use aromatic-dry herbs to induce sweat, thereby removing dampness and drying disease. Use moistening herbs to nourish water, thereby generating sweat. If pulse is faint, sweat is cold like paste, limbs are inverted, tongue is moist: Yang collapse. Use warming herbs to rescue Yang. If pulse is surging, sweat is hot and non-sticky, limbs are warm, tongue is dry: Yin collapse. Use cooling herbs to rescue Yin. (Original Note: To stop hot sweat, use Floating Wheat 1 liang, Jujube 7 pieces, decoct in water.)
Headache
Headache in Shao Yang dominates the sides; Tai Yang connects to the nape; Jue Yin reaches the vertex; Yang Ming is in the forehead/orbits. Tai Yang and Shao Yin headaches also connect.
All Three Yin meridians can cause headache with fever; treat according to the meridian. If no fever, dry retching, vomiting saliva/phlegm, and headache: Jue Yin channel syndrome, use Evodia Decoction (Wu Zhu Yu Tang). If epidemic syndrome causes head swelling/pain like breaking: Stomach excess pathogen, Qi failing to descend, use Cheng Qi Tang. If Phlegm-Jue headache, varying severity: use Pinellia, Atractylodes Macrocephala, and Gastrodia Decoction (Ban Xia Bai Zhu Tian Ma Tang).
External contraction headache: severe and unceasing. Internal injury headache: intermittent. Pain stopping at dusk: Qi deficiency. Pain stopping at day: Blood deficiency.
Body Pain
Body pain with fever and no sweat: Exterior excess, use Ephedra Decoction (Ma Huang Tang). Body pain with inability to turn: Wind-Dampness, use Cinnamon Twig Plus Aconite Decoction (Gui Zhi Jia Fu Zi Tang). Body pain like being beaten: Yin syndrome, use Four Reversal Decoction (Si Ni Tang). Body pain with slow pulse: Blood deficiency, use Astragalus and Middle-Building Decoction (Huang Qi Jian Zhong Tang). If labor injury, body pain, empty pulse, fatigue: use Tonify Middle and Boost Qi Decoction (Bu Zhong Yi Qi Tang).
Heavy Head
(Original Note: Turbid Yin cold-damp pathogen interferes with Clear Yang position, causing heavy head.)
Tai Yang neck stiffness, aversion to cold, heavy head unable to lift: Exterior pathogen, induce sweat. If Yin-Yang exchange disease with visual spots: use Burnt Army Powder (Shao Jun San). If miscellaneous disease with joint dissolution: use tonics. If damp-phlegm rises with Qi causing heavy head: resolve phlegm and promote dampness.
Dizziness
Upper deficiency causes dizziness. Spinning sensation is Xuan Yun; blurry vision is Xuan Mao. Causes differ: Wind, Phlegm, Fire, Deficiency.
Neck Stiffness
Neck/back stiffness in Tai Yang: Floating pulse, no sweat, Ge Gen Tang. With sweat, add Ge Gen to Gui Zhi Tang. Deep pulse, Gua Lou Gui Zhi Fang. Chest binding with neck stiffness resembling soft spasm: Da Xian Xiong Wan will cure. If Shao Yang signs appear, do not sweat or purge; use Xiao Chai Hu minus Ban Xia, add Gua Lou.
Spasm
Spasm disease with profuse sweat damages blood/yin. Aversion to cold, body heat, long wiry pulse. Neck stiffness, red face/eyes, head shaking, jaw clenching, opisthotonos.
Throat Pain and Itch
Two types of throat pain: Floating-rapid pulse, red face, vomiting thick blood, throat pain: Yang Du syndrome. Deep-slow pulse, cold limbs, or vomiting/diarrhea with throat pain: Shao Yin syndrome. Two types of throat itch: Real fire attacking upward, or deficient fire rushing upward. Treat according to syndrome.
Deafness
Sudden deafness: Pathogen transmitted to Shao Yang channel. If not yet sweated, harmonize. If already sweated, nourish Yin. If essence depletion causes deafness, extreme deficiency: use Tonify Middle and Boost Qi Decoction combined with Six-Ingredient Rehmannia Pill (Liu Wei Di Huang Tang).
Chest and Hypochondriac Fullness
Pathogen transmitting interior first affects chest, then hypochondrium (Shao Yang channel). Chest fullness: Gui Zhi Tang plus Apricot Kernel. Hypochondriac fullness: Harmonize with Minor Bupleurum (Xiao Chai Hu). Dry retching, tidal fever, chest/hypochondriac fullness: Major Bupleurum (Da Chai Hu) plus Niter for dual resolution.
Epigastric Oppression, Chest Binding, Viscera Binding
Purging when inappropriate leaves real pathogen binding, causing hardness/fullness/pain: Chest Binding (use Xian Xiong Tang). Deficient pathogen lingering causes hardness/fullness without pain: Pi Qi (use Xie Xin Tang). Mild heat with head sweat: Water binding in chest (use Ban Xia Fu Ling Tang). Rinsing mouth without swallowing: Blood binding in chest (use Tao Ren Cheng Qi Tang). If chest fullness before purging, pathogen still exterior: Xiao Chai Hu Tang plus Zhi Ju. If resembling chest binding, white slippery tongue coating, normal diet, frequent diarrhea: Zang Jie (Viscera Binding), difficult to treat, use warming-dispersing agents.
Yang syndrome Pi hardness is Heat Pi: Da Huang Huang Lian Xie Xin Tang. Sweating, aversion to cold, chills/fever Pi: Fu Zi Xie Xin Tang (Qin Lian Huang).
Abdominal Fullness
(Original Note: Pressable fullness is deficiency fullness; unpressable is excess.)
Abdominal fullness with pain: Interior excess, purge, use Cheng Qi Tang. Abdominal fullness that reduces intermittently: Deficiency-cold, warm, use Shen Xia Po Jiang Gan Cao Tang. Vomiting/diarrhea with abdominal fullness: Tai Yin syndrome, use Li Zhong Tang. (Original Note: Visceral cold generates fullness disease.)
Lower Abdominal Fullness
(Original Note: Below umbilicus is lower abdomen; left/right are Shao Fu.)
Below umbilicus fullness with normal urination: Blood retention. Impaired urination: Water retention. Cold extremities with white urine: Yin-cold coagulation, use Gui Fu Wu Zhu Yu. (Original Note: Kidney deficiency causes internal cold, must warm.)
Irritability and Restlessness
Fan (Irritability) originates in Heart, Yang excess with interior heat. Zao (Restlessness) originates in Kidney, Yang floating with exterior heat. Tai Yang with no sweat: Irritability, use Da Qing Long Tang. Yang Ming with epigastric hardness/fullness: Irritability, use Da Cheng Qi Tang. Shao Yin with vomiting/diarrhea/cold extremities: Irritability, use Wu Zhu Yu Tang. After sweating/purging, no high fever, deep-micro pulse, daytime irritability: Yang deficiency, use Fu Zi Gan Jiang Tang. No irritability but restlessness, red face/body heat, desire to enter water but cannot drink: Yin excess repelling Yang (Original Note: Dai Yang syndrome), use Bai Tong Plus Human Urine and Pig Gallbladder Bile Decoction (Original Note: Take cold). If Chest Binding symptoms complete with irritability, aversion to cold, curled posture with irritability: Untreatable.
Insomnia
(Original Note: Preference for supine position indicates excess-heat; prone position indicates deficiency-pathogen; lying inward indicates Yin syndrome.)
Night belongs to Yin. Yang failing to enter Yin causes irritability and insomnia. Post-sweat severe Heart Blood deficiency, or intense heat disturbing Spirit, or recent recovery with unrecovered Yin Qi: treat according to signs. Gallbladder Qi deficiency causing insomnia: Suan Zao Ren Tang. Stomach disharmony causing insomnia: Ban Xia Shu Mi Tang. (Original Note: Open eyes wanting to see people: Yang syndrome. Closed eyes not wanting to see people: Yin syndrome. Unclear vision, unstable pupils, red/yellow eyes, dizziness: Heat syndrome. Staring straight, sunken eye sockets, rolling eyes back, opisthotonos: Difficult to treat.)
Desire to Sleep
(Original Note: Foot Tai Yang tendon is upper eyelid. Foot Yang Ming tendon is lower eyelid. Heat severe, eyes won't open: tendon flaccidity. Cold severe, eyes won't close: tendon tension.)
Yang deficiency causes desire to sleep; Spleen deficiency causes somnolence. Sweating, heavy body, snoring sleep: Wind-Warmth. Black lips, hoarse voice, excessive sleep: Hu Huo syndrome. After sweating/purging, cool body, quiet pulse, sound sleep: Ying and Wei harmonized.
Agitation
Ao Nong refers to inner depression. Table pathogen sinking interior, residual heat unclarified, or post-sweat/purge failure of Water-Fire interaction: treat according to syndrome.
Nosebleed
(Original Note: Yang channel heat severe, forcing blood to act recklessly, exiting through nose.)
Yang Ming nosebleed: Heat in interior. Tai Yang nosebleed: Heat stasis in channel. Tai Yang headache/eye closure signals; Yang Ming rinsing mouth without swallowing marks. After nosebleed, body cool indicates resolution; if unresolved, clear with Xi Jiao Di Huang Qing. Before nosebleed, exterior excess: Ma Huang induces sweat. Interior heat: Xi Jiao Yi Lian Qin clears.
Hiccups and Belching
Hiccups resemble dry heaving, sound turbid and long. Due to original Stomach Qi deficiency or excessive sweating/purging causing Stomach deficiency-cold; or excessive cold water drinking causing water-cold struggle. Li Zhong Tang plus Ban Xia and Ding Xiang treats. Belching: Middle Jiao disharmony, inability to digest grain, Qi rebels upward. Use Xiang Sha Liu Jun Zi Tang. With Pi hardness: Dai Zhe Xuan Fu Tang. (Original Note: Continuous hiccups belong to Middle Jiao. Intermittent, varying intensity hiccups belong to Lower Jiao.)
Hiccups (E Ni)