荣卫俱病。不能一时而通。必有先后。欲知荣与卫之孰为先通。则于必先小便赤黄而后
发痈脓。与必先嚏 咽塞而后下血如豚肝可验。
脉阴阳俱紧者。口中出气。唇口干燥。蜷卧足冷。鼻中涕出。舌上苔滑。勿妄治也。
到七日以来。其人微发热。手足温者。此为欲解。或到八日以上。反大发热者。此为难
治。设使恶寒者。必欲呕也。腹内痛者。必欲利也。
脉阴阳俱紧。为表里客寒。寒为阴。得阳则解。口中气出。唇口干燥者。阳气渐复。
正气方温也。虽尔然而阴未尽散。蜷卧足冷。鼻中涕出。舌上苔滑。知阴犹在也。方
阴阳未分之时。不可妄治。以偏阴阳之气。到七日以来。其人微发热。手足温者。为
阴气已绝。阳气得复。是为欲解。若过七日不解。到八日以上。反发大热者。为阴极
变热。邪气胜正。故云难治。阳脉紧者。寒邪发于上焦。上焦主外也。阴脉紧者。寒邪
发于下焦。下焦主内也。设使恶寒者。上焦寒气胜。是必欲呕也。腹内痛者。下焦寒
气胜。是必欲利也。
脉阴阳俱紧。至于吐利。其脉独不解。紧去人安。此为欲解。若脉迟。至六七日不欲
食。此为晚发。水停故也。为未解。食自可者。为欲解。
脉阴阳俱紧。为寒气甚于上下。至于吐利之后。紧脉不罢者。为其脉独不解。紧去
则人安。为欲解。若脉迟。至六七日不欲食者。为吐利后。脾胃大虚。内经曰。饮入于
胃。游溢精气。上输于脾。脾气散精。上归于肺。通调水道。下输膀胱。水精四布。五
经并行。脾胃气强。则能输散水饮之气。若脾胃气虚。则水饮内停也。所谓晚发者。后
来之疾也。若至六七日而欲食者。则脾胃已和。寒邪已散。故云欲解。
唐不岩云。紧去人安为确。人安谓不吐利也。作入安未是。
病六七日。手足三部脉皆至。大烦而口噤不能言。其人躁扰者。必欲解也。
烦、热也。传经之时。病患身大烦。口噤不能言。内作躁扰。则阴阳争胜。若手足
三部脉皆至。为正气胜。邪气微。阳气复。寒气散。必欲解也。
若脉和。其人大烦。目重。睑内际黄者。止为欲解也。
脉经曰。病患两目 有黄色起者。其病方愈。病以脉为主。若目黄。大烦。脉不和
者。邪胜也。其病为进。目黄。大烦。而脉和者。为正气已和。故云欲解。
脉浮而数。浮为风。数为虚。风为热。虚为寒。风虚相搏。则洒淅恶寒也。
内经曰。有者为实。无者为虚。气并则无血。血并则无气。风则伤卫。数则无血。
浮数之脉。风邪并于卫。卫胜则荣虚也。卫为阳。风搏于卫。所以为热。荣为阴。荣气
虚。所以为寒。风并于卫者。发热恶寒之症具矣。
脉浮而滑。浮为阳。滑为实。阳实相搏。其脉数疾。卫气失度。浮滑之脉数疾。发
热。汗出者。此为不治。
浮为邪气并于卫。而卫气胜。滑为邪气并于荣。而荣气实。邪气胜实。壅于荣卫。
则荣卫行速。故脉数疾。一息六至曰数。平人脉一息四至。卫气行六寸。今一息
六至。则卫气行九寸。计过平人之半。是脉数疾。知卫气失其常度也。浮滑数疾之脉。
发热汗出而当解。若不解者。精气脱也。必不可治。经曰。脉阴阳俱盛。大汗出不解
者死。
伤寒。咳逆。上气。其脉散者死。谓其形损故也。
千金方云。以喘嗽为咳逆。上气者肺病。散者心脉。是心火刑于肺金也。内经曰。
心之肺。谓之死阴。死阴之属。不过三日而死。以形见其损伤故也。
Ying and Wei are both diseased and cannot become unobstructed simultaneously; there must be a sequence. To determine which of Ying or Wei becomes unobstructed first, one can verify by observing: if red-yellow urine appears first followed by the development of carbuncles and pus, or if sneezing and throat obstruction appear first followed by the discharge of blood resembling pig liver, this serves as evidence.
When the pulse is tight at both Yin and Yang positions, the patient exhales warm air from the mouth, lips and mouth are dry, lies curled up with cold feet, has nasal discharge, and has a slippery coating on the tongue. Do not treat rashly. If after seven days, the patient has slight fever and warm hands and feet, this indicates the disease is about to resolve. If after eight days or more, there is instead high fever, this is difficult to treat. If accompanied by aversion to cold, vomiting is inevitable; if there is abdominal pain, diarrhea is inevitable.
Tight pulses at both Yin and Yang positions indicate external pathogenic cold affecting both exterior and interior. Cold is Yin; it resolves upon encountering Yang. Exhaling warm air and dry lips/mouth indicate that Yang Qi is gradually recovering and Zheng Qi (Upright Qi) is warming up. Although so, Yin has not yet fully dispersed; lying curled up, cold feet, nasal discharge, and slippery tongue coating indicate that Yin still remains. When Yin and Yang Qi are not yet distinct, do not treat rashly, lest you bias the Yin or Yang Qi. After seven days, if the patient has slight fever and warm hands and feet, it means Yin Qi has exhausted and Yang Qi has recovered; this indicates the disease is about to resolve. If unresolved past seven days, reaching eight days or more with sudden high fever, it indicates extreme Yin transforming into heat, with Pathogenic Qi overcoming Zheng Qi; hence it is called difficult to treat. Tight Yang pulse indicates cold pathogen originating in the Upper Jiao (Upper Burner), which governs the exterior. Tight Yin pulse indicates cold pathogen originating in the Lower Jiao (Lower Burner), which governs the interior. If accompanied by aversion to cold, it is due to excess cold in the Upper Jiao, leading inevitably to vomiting. If there is abdominal pain, it is due to excess cold in the Lower Jiao, leading inevitably to diarrhea.
With tight pulses at both Yin and Yang positions progressing to vomiting and diarrhea, if the pulse alone does not resolve, but the tightness disappears and the person feels comfortable, this indicates the disease is about to resolve. If the pulse is slow, and after six or seven days the patient desires no food, this is "late onset" caused by fluid retention, indicating the disease is unresolved. If the patient can eat normally, it indicates the disease is about to resolve.
Tight pulses at both Yin and Yang positions indicate severe cold in the upper and lower regions. After vomiting and diarrhea, if the tight pulse persists, it is because the pulse alone has not resolved. When the tightness disappears, the person feels comfortable, indicating resolution. If the pulse is slow, and after six or seven days the patient desires no food, it is because the Spleen and Stomach are greatly deficient after vomiting and diarrhea. The *Nei Jing* states: "Food enters the Stomach, its essence floats and overflows, transporting upwards to the Spleen. The Spleen scatters the essence, sending it upwards to the Lung, which regulates water passages and transports downwards to the Bladder. Water essence distributes throughout, and the Five Channels proceed together." Strong Spleen and Stomach Qi can transport and scatter fluid-dampness; weak Spleen and Stomach Qi leads to internal fluid retention. "Late onset" refers to subsequent illness. If by six or seven days the patient desires food, it means the Spleen and Stomach have harmonized and cold pathogen has scattered; hence it is said to be resolving.
Tang Buyan stated: "Tightness disappearing brings comfort" is accurate. "Person comfortable" means no vomiting or diarrhea. Writing it as "entering comfort" is incorrect.
After six or seven days of disease, if the pulses of Hand and Foot (all six positions) are all palpable, and the patient is greatly vexed, jaw clenched unable to speak, and restless, this indicates the disease is about to resolve.
Vexation is a sign of Heat. During transmission of meridians, if the patient has great bodily vexation, jaw clenching inability to speak, and internal restlessness, it signifies contention between Yin and Yang. If the Hand and Foot pulses are all palpable, it indicates Zheng Qi is victorious, Pathogenic Qi is slight, Yang Qi recovers, and Cold dissipates; thus, resolution is certain.
If the pulse is harmonious, the patient is greatly vexed, eyes heavy, and the inner eyelids are yellow, this merely indicates the disease is about to resolve.
The *Mai Jing* states: "If yellow color arises in both eyes of the patient, the disease is nearing cure." Disease is judged primarily by the pulse. If eyes are yellow, great vexation, and pulse is unharmonious, Pathogenic Qi is victorious, and the disease progresses. If eyes are yellow, great vexation, but the pulse is harmonious, Zheng Qi has harmonized; hence it is said to be resolving.
A floating and rapid pulse: Floating indicates Wind, Rapid indicates Deficiency. Wind indicates Heat, Deficiency indicates Cold. Wind and Deficiency contend, resulting in shivering aversion to cold.
The *Nei Jing* states: "Having is Excess, lacking is Deficiency." Qi merging results in lack of Blood; Blood merging results in lack of Qi. Wind injures Wei (Defensive Qi); Rapid pulse indicates lack of Blood. In a floating-rapid pulse, Wind pathogen merges into Wei, Wei wins causing Ying (Nutritive Qi) to be deficient. Wei is Yang; Wind contending with Wei causes Heat. Ying is Yin; Ying Qi deficiency causes Cold. Wind merging into Wei presents both fever and aversion to cold symptoms.
A floating and slippery pulse: Floating is Yang, Slippery is Excess. Yang and Excess contend, resulting in a rapid and hurried pulse, with Wei Qi losing its normal measure. A floating-slippery pulse that is rapid and hurried, presenting with fever and sweating, is an untreatable condition.
Floating indicates Pathogenic Qi merging into Wei, with Wei Qi prevailing. Slippery indicates Pathogenic Qi merging into Ying, with Ying Qi being excess. Pathogenic Qi is excessive and obstructs Ying and Wei, causing their movement to accelerate, hence the rapid pulse. Six beats per breath is called Rapid. Normal pulse is four beats per breath. Wei Qi normally travels six cun; now with six beats per breath, Wei Qi travels nine cun, exceeding the normal by half. Thus, the rapid pulse indicates Wei Qi has lost its constant measure. With floating-slippery-rapid pulse, fever and sweating should lead to resolution. If unresolved, it indicates exhaustion of Essence and Qi, making it untreatable. The Classics state: "Pulses at both Yin and Yang are full/excessive, with profuse sweating without resolution, death ensues."
In Shanghan (Cold Damage), with coughing and rebellious Qi, if the pulse is scattered, death occurs, due to damage to the physical form.
The *Qianjin Fang* states: Coughing and wheezing constitute rebellious Qi; rebellious Qi is a Lung disease. Scattered pulse is the Heart pulse; this represents Heart Fire punishing Lung Metal. The *Nei Jing* states: "Heart affecting the Lung is called Dead Yin." Those belonging to Dead Yin will die within three days, as the damage is evident in the form.