（附杂证时病药禁一条 附伤寒三阳经禁一条）
原文允为定律，兹特申明十义，不更拟律。
一申治风寒不可发汗之律 伤寒有五，皆热病之类也。同病异名，同脉异经，病虽俱伤于风，其人素有锢疾，
则不得同法。其人素伤于风，因复伤于热，风热相搏，则发风温，四肢不收，头痛身热，常汗出不解。治在少阴厥阴，
不可发汗。汗出 语独语，内烦躁扰不得卧，善惊，目乱无精，治之复发其汗，如此死者，医杀之也。
伤寒有五，即伤寒、中风、风温、湿温、疫疟也。寒风温热凉各别，素有锢疾，不得同法。即动气在上下左右，不
可汗下之类，伤风重复伤热，两邪相搏于内。本属少阴里证，如温疟之病，而厥阴风木，则兼受之，热邪充斥两脏，尚
可用辛温发散助其疟乎？误发其汗，死证四出，不可复救矣。复发其汗，即申上文不可发汗者。复发其汗，非是死证已
出，复发其汗也。
一申治湿温不可发汗之律 伤寒湿温，其人常伤于湿，因而中 ，湿热相搏，则发湿温。病苦两胫逆冷，腹满
叉胸，头目痛，苦妄言。治在足太阴不可发汗，汗出必不能言，耳聋，不知痛所在，身青面色变，名曰重 。如此者死，
医杀之也。
湿温即暑与湿交合之温病，素伤于湿，因复伤暑，两邪相搏，深入太阴，以太阴主湿，召暑而入其中也。两胫逆冷
腹满，湿得暑而彰其寒。叉胸、头目痛、苦妄言，暑得湿而彰其热，此但当分解热湿之邪，而息其焰，宁可发汗，令两
邪混合为一耶？发汗则口不能言，耳不能闻，心不知苦，但身青面色变，显露于肌肉之外耳。 病而至重 ，又非虚虚
实实之比，直为医之所杀矣。二律出《脉经》，王叔和集医律之文，然则医律古有之矣，何以后世无传耶？详考仲景以前，
冬月之伤寒尚未备，况春月之风温，夏月之湿温乎？是则医律为仲景之书无疑矣，盖《伤寒论》全书皆律，其书中不及
载之证，另作律书以纬之。传至晋代，伤寒书且得之搜采之余，而律书更可知矣。所以叔和虽采二条入《脉经》，究竟不
知为何时何人之言也。再按律书虽亡，而三百九十七法具在，其法中之律，原可引伸触类，于以神而明之。如曰此医吐
之过也，此医下之所致也，与夫不可汗，不可下，不可火，不可用前药，此为小逆，此为大逆，此为一逆再逆，此为难
治，此为不治，条例森森，随证细心较勘，自能立于无过。兹将脉法中大戒，发明数则，俾察脉之时，预知凛焉。
一申治伤寒病令人亡血之律 病患脉微而涩者，此为医所病也。大发其汗，又数大下之，其人亡血，病当恶寒，
后乃发热，无休止时。夏月盛热，欲着复衣。冬月盛寒，欲裸其体。阳微则恶寒，阴弱则发热，此医发其汗，令阳气微，
又大下之，令阴气弱。五月之时，阳气在表，胃中虚冷，以阳气内微，不能胜冷，故欲着复衣。十一月之时，阳气在里，
胃中烦热，以阴气内弱，不能胜热，故欲裸其身，又阴脉迟涩，故知亡血也。
人身之脉，阴阳相抱，荣卫如环。伤寒病起之后，脉见阳微阴涩，知为医之所累，大汗大下，两伤其荣卫，以故恶
寒发热无休止时，乃至夏月反毗于阴，冬月反毗于阳。各造其偏，经年不复，其为累也大矣，即阳脉之微，以久持而
稍复，而但阴脉迟涩，亦为亡血，以阴血更易亏难复耳，设其人平素脉微且涩，医误大汗大下，死不终日矣。此论病时
汗下两伤，所以经年不复之脉也。
一申治伤寒病令人发KT 之律 寸口脉浮大，医反下之，此为大逆。浮为无血，大即为寒，寒气相搏，即为
肠鸣。医乃不知，而饮水令大汗出，水得寒气，冷必相搏，其人即KT 。
寸口脉浮大，病全在表。医反下之，则在表之阳邪下陷，而胃中之真阳不治，遂成结胸等证，故为大逆。浮主气，
故曰无血，即浮为在表，未入于阴之互辞。大即为寒，见外感之邪，全未外解也。中有一证，下陷之邪，与藏气相搏
而为肠鸣者，此必未尝痞结至极，盖痞结即不复转气也。医不知其人邪已内陷，当将差就错，内和其气，反饮水令大汗
出，是下之一损其胃中之阳，饮水再损其胃中之阳，腹中之邪，随汗出还返于胃，与水气相搏，且夹带浊气，上干
清气，其人即KT 。KT 者胃气垂绝之象，伤寒之危候也。然其死与不死，尚未可定。盖脉之浮大，本非微弱之比，
而邪之内陷，当大逆者，止成肠鸣小逆。倘发KT 已后，阳气渐回，水寒渐散，仍可得生。观后条仲景谓寒聚心下，
当奈何也？此则聚而不散，无可奈何，仁人之望绝矣。
一申治伤寒病致人胃寒之律 寸口脉濡而弱，濡即恶寒，弱即发热，濡弱相搏，藏气衰微，胸中苦烦，此非结
热，而反薄居。水渍布冷铫贴之，阳气遂微，诸府无所根据，阴脉凝聚，结在心下而不肯移。胃中虚冷，水谷不化，小便
纵通，复不能多。微则可救，聚寒不散，当奈何也！
此见寸口阳脉濡，阴脉弱，乃藏气素衰之征。阳濡则恶寒，阴弱即发热。其人胸中苦烦，即为虚烦，不当认为结热，
而以水渍布冷贴，重伤其胸中之阳也。盖胸中之阳，为诸府之所根据籍，阳气一微，阴气即凝结心下，如重阴蔽 ，胃中
水谷，无阳以化，而水寒下流。小便纵宣通，然阳不化气，复不能多，履霜坚冰，可奈何耶？亦因平素脉之濡弱，知其
胸中之阳，不能复辟耳。
一申治伤寒病遇壮盛人发汗过轻之律 寸口脉洪而大，数而滑。洪大则荣气长，滑数则卫气实。荣长则阳盛拂
郁，不得出身；卫实则坚难，大便则干燥，三焦闭塞，津液不通。医发其汗，阳气不周，重复下之，胃燥干蓄，大便遂
摈，小便不利。荣卫相搏，心烦发热，两眼如火，鼻干面赤，舌燥齿黄焦，故大渴。过经成坏病，针药所不能制，与水
灌枯槁，阳气微散，身寒温衣复，汗出表里通，然其病即除，形脉多不同。此愈非法治，但医所当慎，妄犯伤荣卫。
此见荣卫强盛，三焦坚实之人，虽发其汗，未必周到，必须更汗通其怫郁。若误下之，则热证百出，遂至过经而成
坏证，针药所不能制，势亦危矣。与水灌令阳散汗出，因而病愈，以其人荣卫素盛，故幸痊耳。然人之形脉，多有不同，
设荣卫素弱，将奈之何？故叮咛云∶此愈非法治，医当谨持于汗下之先，勿使太过不及，乃为尽善。若不辨形脉之强弱，
而凭臆汗下，必犯太过不及之戒，而伤人之荣卫矣。
一申治伤寒病不审荣卫素虚之律 脉濡而紧，濡则阳气微，紧则荣中寒。阳微卫中风，发热而恶寒。荣紧胃气
冷，微呕心内烦。医以为大热，解肌而发汗。亡阳虚烦躁，心下苦痞坚。表里俱虚竭，卒起而头眩。客热在皮肤，怅怏
不得眠。不知胃气冷，紧寒在关元。技巧无所施，汲水灌其身。客热应时罢，栗栗而振寒。重被而复之，汗出而冒颠。
体惕而又振，小便为微难。寒气因水发，清谷不容间。呕变反肠出，颠倒不得安。手足为微逆，身冷而内烦。如欲从后
救，安可复追还？
此见脉之濡而紧者，为阳气微，荣中寒。阳微卫中风，外则发热恶寒；荣紧胃中冷，内则微呕心烦。医不知其外热
内冷，以为大热而从汗解之，则表里俱虚。客热浅在皮肤，紧寒深在关元，犹汲水灌其客热，致寒证四出，不可复救也。
前坏证汗下两误，针药莫制，与之以水而幸痊，以其荣卫素盛也。此一证荣卫素亏，虽不经下，但只误汗，误与之水，
即属不救，然则证同脉异。不察其脉，但验其证，徒法不能行矣，过愆其可免乎？
一申治伤寒病不审阳盛阴虚之律 脉浮而大，浮为气实，大为血虚。血虚为无阴，孤阳独下阴部，小便难，胸
中虚。今反小便利而大汗出，法当卫家微。今反更实，津液四射，荣竭血尽，干烦不眠，血薄肉消而成暴液，医复以毒
药攻其胃，此为重虚，客阳去有期，必下污泥而死。
脉浮而大，气实血虚，虽偏之为害，亦人所常有也。若此者，阴部当见不足，今反小便利大汗出，外示有余，殊非
细故矣。设卫气之实者，因得汗利而脉转微弱，籍是与荣无忤，庶可安全。若卫分之脉，较前加坚实者，则阳强于外。
阴必消亡于内。所为小便利大汗出者，乃津液四射之征，势必荣竭血尽，干烦不眠，血薄肉消，而成暴液下注之证。此
际安其胃，固其液，调和强阳，收拾残阴，岌岌不及。况复以毒药攻其胃，增奔迫之势，而蹈重虚之戒，令客阳亦去，
下血如泥而死哉。伤寒病，阳强于外，阴亡于内之证最多，医不知脉，其操刃可胜数耶。
一申治伤寒病不诊足脉强汗动其经血之律 跌阳脉浮，浮则为虚，浮虚相搏，故令气KT ，言胃气虚竭也。脉
滑则为哕，此为医咎，责虚取实，守空迫血，脉浮鼻中燥者，必衄也。
寸口脉浮，宜发其汗，谓邪在太阳荣卫间，未深入也。若至阳明，即在经之邪，以汗为大禁矣。设其人胃气充实，
亦何必禁之。故邪入阳明，必诊趺阳足脉，趺阳脉浮，即是胃气虚馁，不可发汗，所以有建中之法创建中气，然后汗
之，以汗即胃之津液也。津液不充，强发其汗，则邪与虚搏，其人必KT 。若脉见浮而且滑。则其搏虚者，且转为哕，
深于KT 矣。此皆医者不察足脉之咎，强责胃气之虚，劫汗以取其实邪，致令胃中之守空，而逼其血外出。盖阴在内，
为阳之守，胃中津液为阳，其不外泄者，赖阴血以守之，故强逼其津液为汗，斯动其所守之血矣。其外邪胜而鼻中燥者
必衄，其不衄者亦瘀蓄胃中，而生他患也。此与误发少阴汗者，同科而减等。少阴少血，动其血则下厥上竭而难治；阳
明多血，但酿患未已耳。
一申治伤寒病不诊足脉误下伤其脾胃之律 趺阳脉迟而缓，胃气如经也。趺阳脉浮而数，浮则伤胃，数则动脾，
此非本病，特医下之所为也。荣卫内陷，其数先微，脉反大浮，其人大便硬，气噫而除，何以知之？本以数脉动脾，其
数先微，故知脾气不治，大便硬，气噫而除。今脉反浮，其数改微，邪气独留，心中则饥，邪热不杀谷，潮热发渴。数
脉当迟缓，脉因前后度数如法，病者则饥，数脉不时，则生恶疮也。
趺阳足脉，以迟缓为经常，不当浮数。若见浮数，知医误下而伤胃动脾也，荣卫环转之气，以误下而内陷，其数脉
必先改为微，而脾气不治，大便硬，气噫而除，此皆邪客于脾所致。即《针经》脾病者善噫，得后出余气，则快然如衰
之谓也。邪热独留，心下虽饥，复不杀谷，抑且潮热发渴，未有愈期，必数脉之先微者，仍迟缓如其经常，始饥而消谷
也。若数脉从前不改为微，则邪热未陷于脾，但郁于荣卫，主生恶疮而已。
附申治伤寒不可犯六经之禁 足太阳膀胱经，禁下。若下之太早，必变证百出。足阳明胃经，禁发汗，禁利小
便。犯之则重损津液，脉必代结。足少阳胆经，禁汗禁下，禁利小便。汗则犯阳明，下则犯太阳，利小便则使生发之气，
陷入阴中。太阳经一禁，阳明经二禁，少阳经三禁，此定禁也。至三阴经则无定禁，但非胃实，仍禁下耳。
附申治杂证不可犯时禁病禁药禁 时禁者，春夏禁下，秋冬禁汗。春夏而下，秋冬而汗，是失天信，伐天和也。
然病有不得已，而从权汗下者，病去速改，若渎用之，是故意违天，自取不祥也。病禁者，病患阳气不足，阴气有余，
则禁助阴泻阳。病患阴气不足，阳气有余，则禁助阳泻阴，以及老少不同，新久异治之类。药禁者，津液内亡作渴，禁
用淡渗五苓。汗多禁利小便。小便多禁发汗。咽痛禁发汗利小便。大便快利，禁服栀子。大便秘涩，禁用燥药。吐多不
得复吐。吐而上气壅滞，大便不通，止可宣散上气，禁利大便。脉弦禁服平胃而虚虚。脉缓禁服建中而实实。
治天下有帝王之律，治仙神有上天之律。至于释门，其律尤严。三藏教典，仪律居三之一，由五戒而五百戒，由五
百戒直造自性清净，无戒可言，而道成矣。医为人之司命，先奉大戒为入门，后乃尽破微细诸惑，始具活人手眼，而成
其为大医，何可妄作聪明，草菅人命哉？尝羡释门犯戒之僧，即不得与众僧共住，其不退心者，自执粪秽杂役三年，乃
恳律僧二十众佛前保举，始得复为佛子。当今世而有自讼之医乎？昌望之以胜医任矣。
(Attached: One prohibition on medication for miscellaneous diseases and seasonal illnesses; Attached: One prohibition on the three Yang meridians in cold damage)
The original text serves as a definitive standard. Here, ten principles are specifically elucidated, without drafting new regulations.
First Principle: Elucidation of the regulation that sweating should not be induced for wind-cold treatment
Cold damage encompasses five types, all belonging to the category of heat diseases. The same etiology may have different disease names, and identical pulses may involve different meridians. Although the diseases are all caused by wind pathogen, if the patient has a chronic stubborn disease, the same treatment method cannot be applied. If the patient was previously injured by wind pathogen and subsequently injured by heat pathogen, wind and heat contend with each other, leading to Wind-Warmth disease. Symptoms include flaccidity and weakness of the four limbs preventing movement, headache, fever, frequent sweating without resolution. Treatment should target the Shaoyin (Lesser Yin) and Jueyin (Terminal Yin) meridians; inducing sweating is contraindicated. If sweating is erroneously induced, causing delirious speech, muttering alone, internal restlessness preventing sleep, frightfulness, and scattered gaze lacking spirit, and if the physician induces sweating again, resulting in death, this is murder by the physician.
"Five types of Cold Damage" refers to Cold Damage, Wind Strike, Wind-Warmth, Damp-Warmth, and Epidemic Malaria. Cold wind, warm heat, and cool pathogens differ in nature. If the patient has a chronic stubborn disease, uniform treatment methods are prohibited. For instance, moving Qi appearing in the upper, lower, left, or right positions prohibits the use of sweating or purging methods. After contracting wind, repeated injury by heat causes two pathogens to contend internally. This fundamentally belongs to a Shaoyin interior syndrome, similar to Warm Malaria, while Jueyin Wind-Wood qi is also affected. With heat pathogens filling both organs, can one still use acrid-warm dispersing agents to aid the malaria? Erroneous sweating leads to four fatal syndromes emerging, which cannot be rescued. "Inducing sweating again" reiterates the aforementioned prohibition on sweating. It does not mean inducing sweating after death signs appear, but rather forcing sweating when it is contraindicated.
Second Principle: Elucidation of the regulation that sweating should not be induced for Damp-Warmth treatment
Patients suffering from Cold Damage Damp-Warmth are usually injured by dampness, subsequently contracting summerheat-dampness. When damp-heat contend, Damp-Warmth erupts. Patients suffer from reverse coldness in both calves, abdominal fullness with chest tightness, headache and eye pain, and distress from delirious speech. Treatment should focus on the Foot-Taiyin Spleen meridian; inducing sweating is contraindicated. If sweating is erroneously induced, the patient will lose the ability to speak, become deaf, be unaware of pain location, develop cyanosis of the body, and change facial color. This is called "Chong Ming" (Deep Coma). Such patients will die; this is murder by the physician.
Damp-Warmth is a warmth disease formed by the intersection of summerheat and dampness. Previously injured by dampness and re-injured by summerheat, the two pathogens contend and penetrate deeply into the Taiyin meridian. Since Taiyin governs dampness, it attracts summerheat into itself. Reverse coldness in calves and abdominal fullness occur because dampness manifests coldness upon receiving summerheat. Chest tightness, headache, eye pain, and delirium occur because summerheat manifests heat upon receiving dampness. In such cases, one should only resolve the heat and damp pathogens and extinguish their flame. How can one induce sweating, allowing the two pathogens to merge? Sweating leads to inability to speak, deafness, lack of internal sensation of pain, merely showing cyanosis and altered facial color on the muscles. "Chong Ming" represents an extreme severity, beyond simple deficiency-excess complexity, essentially killing the patient by the physician's hand. These two regulations originate from *Mai Jing* (Pulse Classic), compiled by Wang Shuhe. Thus, medical regulations existed in antiquity; why did they not transmit to later generations? Detailed examination shows that before Zhang Zhongjing, winter Cold Damage was not yet complete, let alone spring Wind-Warmth or summer Damp-Warmth. Therefore, medical regulations undoubtedly belong to Zhang Zhongjing's works. Essentially, the entire *Shanghan Lun* (Treatise on Cold Damage) consists of regulations; syndromes not recorded in the book were supplemented by separate regulatory texts. By the Jin Dynasty, even Cold Damage books were recovered from remnants, so regulatory texts would be even scarcer. Although Wang Shuhe included two items in *Mai Jing*, he ultimately did not know the time or author. Although the regulatory texts are lost, the 397 methods remain. The regulations within these methods can be extended and analogized to illuminate them divinely. For example: "This is the fault of the physician using emesis," "This is caused by the physician using purgatives," and prohibitions against sweating, purging, moxibustion, or previous medications. These are minor reversals, major reversals, single or double reversals, difficult-to-treat, or untreatable cases. The rules are strict; careful comparison with symptoms ensures no error. Here, several major taboos from pulse diagnosis are elucidated, so that during pulse inspection, one may anticipate and reverence them.
Third Principle: Elucidation of the regulation that Cold Damage treatment causes blood loss
If the patient's pulse is faint and choppy, this is iatrogenic harm. Profuse sweating followed by frequent purging causes blood loss. The patient should feel aversion to cold, followed by fever without cessation. In midsummer heat, the patient desires thick clothing; in midwinter cold, the patient desires to naked. Faint yang causes aversion to cold; weak yin causes fever. This results from the physician inducing sweating to weaken yang, and purging to weaken yin. In May, yang is at the exterior, and the stomach is cold due to internal yang deficiency, unable to overcome cold, hence desiring thick clothing. In November, yang is at the interior, and the stomach is vexed with heat due to internal yin deficiency, unable to overcome heat, hence desiring to naked. Combined with a slow and choppy yin pulse, blood loss is confirmed.
In the human body, pulses of yin and yang embrace each other, and Ying and Wei circulate like a ring. After Cold Damage begins, a faint yang and choppy yin pulse indicates iatrogenic burden. Profuse sweating and purging injure both Ying and Wei, causing ceaseless aversion to cold and fever. Summer becomes contrary to yin, winter contrary to yang. Each creates bias, remaining unrecovered for years, causing great harm. Even if the faint yang pulse recovers slightly over time, a slow and choppy yin pulse still indicates blood loss, as yin blood is harder to replenish. If a patient normally has faint and choppy pulses, erroneous profuse sweating and purging will cause death within a day. This discusses how simultaneous sweating and purging during illness leads to unrecoverable pulses over years.
Fourth Principle: Elucidation of the regulation that Cold Damage treatment causes hiccups (Yue)
A floating and large pulse at Cun Kou indicates that if the physician erroneously uses purgatives, it is a major reversal. Floating indicates lack of blood; large indicates cold. Contention of cold qi causes intestinal rumbling. Unaware of this, the physician gives water to induce profuse sweating. Water encountering cold qi contends, causing the patient to develop hiccups (Yue).
A floating and large pulse at Cun Kou means the pathogen is entirely at the exterior. Erroneous purging causes exterior yang pathogen to sink, leaving true yang in the stomach unregulated, leading to Tie Syndrome etc., thus constituting a major reversal. Floating governs qi, hence "lack of blood"; floating indicates exterior presence, not having entered yin. Large indicates cold, showing external pathogen has not resolved externally. In one syndrome, sinking pathogen contends with zang qi causing intestinal rumbling, indicating no extreme stagnation, as extreme stagnation prevents qi movement. Unaware of internal sinking, the physician should harmonize internal qi instead of giving water to induce sweating. Purging damages stomach yang once; water damages it again. Abdominal pathogen returns to the stomach with sweat, contending with water qi and turbid qi, attacking clear qi, causing hiccups (Yue). Yue is a sign of failing stomach qi, a critical Cold Damage sign. Death is not certain, as floating-large pulse is not weak. Though a major reversal, it resulted only in intestinal rumbling (minor reversal). If yang recovers and cold-water dissipates after Yue, survival is possible. Later, Zhang Zhongjing asks about cold gathering at the heart; here it gathers and does not disperse, leaving benevolent hope extinct.
Fifth Principle: Elucidation of the regulation that Cold Damage treatment causes stomach cold
A soft (Ru) and weak (Ruo) pulse at Cun Kou: Ru indicates aversion to cold; Ruo indicates fever. Contention of Ru and Ruo signifies declining zang qi, vexation in the chest. This is not constrained heat but rather thin dwelling (cold stagnation). Applying cold wet cloth wrapped around a cold iron vessel to the body further diminishes yang. All fu organs lose support; yin pulses condense, knotting at the epigastrium without moving. Stomach cold fails to digest food and water; urination is free but scant. Mild cases can be saved; if cold accumulates and does not disperse, what then?
Here, superficial pulse is Ru and deep pulse is Ruo, signs of inherent zang qi decline. Superficial Ru causes aversion to cold; deep Ruo causes fever. Vexation in the chest is deficiency vexation, not constrained heat. Applying cold compress severely injures chest yang. Chest yang supports all fu organs; once diminished, yin condenses at the epigastrium like heavy clouds covering. Without yang, food and water in the stomach cannot transform, and cold water flows down. Urination is free but scant due to lack of qi transformation. Like treading frost leading to hard ice, what can be done? This relies on knowing from the normal Ru-Ruo pulse that chest yang cannot be restored.
Sixth Principle: Elucidation of the regulation that treating robust individuals with insufficient sweating in Cold Damage
A洪 (Hong) and large, rapid and slippery pulse at Cun Kou: Hong and large indicate abundant Ying qi; slippery and rapid indicate solid Wei qi. Abundant Ying leads to excess yang and depression, preventing emergence; solid Wei leads to hardness and dry stool, closing Sanjiao and blocking fluids. If the physician induces sweating but yang is not circulated, and repeats purging, stomach dryness accumulates, stool is rejected, and urination is difficult. Ying and Wei contend, causing vexation, fever, fiery eyes, dry nose, red face, dry tongue, yellow scorched teeth, and intense thirst. Passing the meridian stage creates complicated diseases uncontrollable by acupuncture or herbs. Pouring water on the withered body scatters yang; wearing clothes induces sweating connecting interior and exterior. Although the disease resolves, form and pulse differ greatly. This recovery is not legal treatment; physicians must be cautious not to recklessly injure Ying and Wei.
Here, robust Ying and Wei with solid Sanjiao require thorough sweating to resolve depression. Erroneous purging causes myriad heat syndromes, passing the meridian into complicated states uncontrollable by medicine, posing danger. Pouring water to scatter yang and induce sweating cures because Ying and Wei are inherently strong. However, forms and pulses vary. If Ying and Wei are inherently weak, what then? Thus, it is emphasized: this recovery is not legal treatment. Physicians must guard against excessive or insufficient sweating/purging. Ignoring pulse strength and guessing leads to violating prohibitions and injuring Ying and Wei.
Seventh Principle: Elucidation of the regulation that failing to assess inherent Ying-Wei deficiency in Cold Damage
Pulse is soft and tight: Soft indicates faint yang; tight indicates cold in Ying. Faint yang allows wind to strike Wei, causing fever and aversion to cold. Tight Ying indicates cold stomach qi, slight vomiting, and internal vexation. Physician mistakes this for excess heat, uses muscle-releasing sweating. This causes yang loss, deficiency vexation, and epigastric hardness. Exterior and interior are exhausted; sudden rising causes dizziness. Guest heat remains in skin, causing restlessness and insomnia. Ignoring cold stomach qi and tight cold at Guan Yuan, skills are useless. Pouring water on the body stops guest heat but causes shivering and cold. Covering with blankets induces sweating and head vertigo. Body trembles, urination is difficult. Cold pathogen triggered by water, clear grains expelled continuously. Vomiting and intestinal prolapse occur, turning upside down in discomfort. Hands and feet become slightly inverted, body cold with internal vexation. If seeking rescue afterwards, how can it be retrieved?
Here, soft and tight pulse indicates faint yang and cold in Ying. Faint yang/wind-striking Wei causes exterior fever/aversion to cold; tight Ying/cold stomach causes interior vomiting/vexation. Physician ignores exterior heat/interior cold, treats as excess heat with sweating, exhausting exterior and interior. Guest heat is superficial; tight cold is deep at Guan Yuan. Pouring water on guest heat exacerbates cold syndromes irreversibly. Previous complicated cases cured by water had strong Ying-Wei. This case has deficient Ying-Wei; even without purging, erroneous sweating and water pouring lead to non-survival. Syndromes are similar, but pulses differ. Not examining pulses but only symptoms renders laws useless. How can errors be avoided?
Eighth Principle: Elucidation of the regulation that failing to assess yang-excess and yin-deficiency in Cold Damage
Pulse is floating and large: Floating indicates qi excess; large indicates blood deficiency. Blood deficiency means lack of yin; lone yang descends into yin regions, causing difficult urination and chest emptiness. Now, urination is free and sweating is profuse. Normally, Wei should be faint. Now it is more solid, fluids spray out, Ying exhausts, blood finishes, causing dry vexation, insomnia, thin blood, wasting flesh, and sudden fluid discharge. Physician attacks stomach with toxic drugs, causing double deficiency. Guest yang departs, leading to death with bloody diarrhea.
Floating-large pulse indicates qi excess and blood deficiency. Though biased harm is common, yin regions should show insufficiency. Free urination and profuse sweating suggest exterior surplus, which is significant. If Wei qi solidifies and pulse becomes weak after sweating/urination, it may be safe. If Wei pulse becomes stronger, yang is strong externally, yin perishes internally. Free urination and profuse sweating signal fluid spraying, inevitably leading to Ying exhaustion, blood depletion, dry vexation, insomnia, wasting, and sudden fluid discharge. At this moment, stabilizing stomach and securing fluids, harmonizing strong yang, and gathering residual yin is urgent. Attacking stomach with toxic drugs increases urgency, violating double deficiency prohibition, causing guest yang departure and death with muddy blood. Cold Damage often presents with strong exterior yang and internal yin loss. Physicians ignoring pulses are numerous in causing harm.
Ninth Principle: Elucidation of the regulation that failing to diagnose foot pulse and forcing sweating moves channel blood
Duyang pulse is floating: Floating indicates deficiency. Floating and deficiency contend, causing qi hiccups (KT), indicating stomach qi exhaustion. Slippery pulse indicates hiccups (Yue), physician's fault. Blaming deficiency for excess, guarding emptiness, pressing blood. Floating pulse with dry nose indicates epistaxis.
Cun Kou floating pulse suggests sweating is appropriate, indicating pathogen in Taiyin Ying-Wei, not deep. If entering Yangming, pathogen in channel makes sweating a major taboo. Unless stomach qi is solid, it is prohibited. Thus, for Yangming pathogen, Duyang foot pulse must be checked. Floating Duyang indicates deficient stomach qi; sweating is prohibited. Jianzhong method builds middle qi before sweating, as sweat is stomach fluid. Insufficient fluid forces sweating, pathogen contends with deficiency, causing hiccups (KT). If floating and slippery, contention with deficiency turns to hiccups (Yue), deeper than KT. This is physician's fault for not checking foot pulse, forcing stomach deficiency, robbing sweat for real pathogen, emptying stomach guards, and forcing blood outward. Yin inside guards yang; stomach fluid is yang, guarded by yin blood. Forcing fluid to sweat moves the guarded blood. External pathogen winning causes dry nose and epistaxis;若不衄 (if no epistaxis), blood stasis in stomach causes other issues. This is similar to erroneous Shaoyin sweating but less severe. Shaoyin has little blood; moving it causes lower jue and upper exhaustion, difficult to treat. Yangming has much blood; trouble brews but is not immediate.
Tenth Principle: Elucidation of the regulation that failing to diagnose foot pulse and erroneous purging injures spleen and stomach
Duyang pulse slow and moderate indicates normal stomach qi. Floating and rapid Duyang pulse: Floating injures stomach; rapid moves spleen. This is not original disease but physician's erroneous purging. Ying-Wei sink internally; rapid pulse first becomes faint. Pulse reverses to large-floating; patient has hard stool, belching relief. Why? Rapid pulse moves spleen; initial faintness indicates spleen qi disorder, hard stool, belching relief. Now pulse floats, rapid becomes faint; pathogen remains alone, hunger in heart, pathogenic heat fails to digest food, tidal fever, thirst. Rapid pulse should be slow/moderate. If pulse degrees follow norms, patient hungers. If rapid pulse is irregular, malignant sores arise.
Duyang foot pulse should be slow/moderate, not floating/rapid. Floating/rapid indicates physician's erroneous purging injuring stomach and moving spleen. Ying-Wei circulating qi sinks internally due to purging; rapid pulse changes to faint, spleen qi disorders, hard stool, belching relief, caused by pathogen lodging in spleen. As *Zhen Jing* says, spleen disease causes belching; after bowel movement, residual gas exits, feeling relieved. Pathogenic heat remains alone; though hungry, digestion fails, plus tidal fever/thirst, no cure date. Only if rapid pulse returns to faint then slow/moderate as norm, will hunger and digestion resume. If rapid pulse never becomes faint, pathogenic heat hasn't sunk to spleen but stagnates in Ying-Wei, mainly causing malignant sores.
Appendix: Prohibitions on violating Six Meridians in Cold Damage
Foot-Taiyang Bladder Meridian: Purging prohibited. Early purging causes myriad variable syndromes. Foot-Yangming Stomach Meridian: Sweating and diuresis prohibited. Violation heavily damages fluids, pulse becomes intermittent/knotted. Foot-Shaoyang Gallbladder Meridian: Sweating, purging, and diuresis prohibited. Sweating violates Yangming; purging violates Taiyang; diuresis traps ascending qi in yin. Taiyang has one prohibition; Yangming has two; Shaoyang has three. These are fixed prohibitions. Three Yin meridians have no fixed prohibitions, except purging is prohibited unless stomach excess exists.
Appendix: Prohibitions on Time, Disease, and Medication for Miscellaneous Diseases
Time prohibitions: Purging prohibited in Spring/Summer; Sweating prohibited in Autumn/Winter. Purging in Spring/Summer or sweating in Autumn/Winter loses heavenly trust and harms heavenly harmony. Exceptions exist for urgent cases requiring temporary sweating/purging; stop immediately after disease removal. Reckless use violates heaven and brings misfortune.
Disease prohibitions: If patient has insufficient yang/excess yin, prohibit aiding yin/draining yang. If insufficient yin/excess yang, prohibit aiding yang/draining yin. Also age differences and acute/chronic treatment variations.
Medication prohibitions: Internal fluid loss with thirst prohibits mild leaching formulas like Wuling San. Profuse sweating prohibits diuresis. Profuse urination prohibits sweating. Sore throat prohibits sweating/diuresis. Loose stools prohibit Gardenia. Constipation prohibits drying drugs. Frequent vomiting prohibits further emesis. Vomiting with qi stagnation and constipation allows only dispersing upper qi, prohibiting purging. String-like pulse prohibits Pingwei formula (avoiding deficiency of deficiency). Slow pulse prohibits Jianzhong formula (avoiding excess of excess).
Governing the world has imperial laws; governing immortals has heavenly laws. Buddhist laws are especially strict. Tripitaka teachings include rituals/laws as one-third, from Five Precepts to Five Hundred Precepts, leading to intrinsic purity where no precept is needed, achieving the Dao. Physicians are life-givers, starting with major precepts, breaking minor doubts, gaining life-saving skills, becoming great physicians. One must not act arrogantly or disregard lives. I envy Buddhist monks who break precepts and cannot live with others; those not abandoning faith serve waste duties for three years, then seek recommendation from twenty precept monks before Buddha to restore status. Are there self-reproaching physicians today? Chang hopes for physicians capable of bearing this responsibility.