临症之际。已视其形容。观其坐卧矣。然有法焉。不拘于行住坐卧。难列于俯仰屈伸。屈指而计之。其纲有
四。曰KT KT 。曰振振。曰战。曰栗。KT KT 者何。项背强。KT KT 然。犹短羽之鸟。欲飞而不能飞也。振
振者何。身体动。振振然。若耸悚之容。欲定而不能定也。战则身为之摇矣。战之与振。振轻而战重也。栗则心为之战
矣。栗之与战。战外而栗内也。故其为病也。KT KT 者太阳实。甚则有卧不着席之形。振振者元气虚。甚则有身欲
擗地之状。战者其人本虚。邪在外而正与之争。正胜其邪。故势顺而易解。栗者其气愈微。邪入内而正与
之争。邪胜其正。故势逆而难瘳。且KT KT 者。太阳实。其证有有汗无汗之分。振振者。太阳虚。其证有汗前汗
后之辨。战在外。太阳之所属也。身温汗出。邪斯退矣。栗在内。少阴之所主也。身寒肢厥。邪则陷焉。故凡临
症之际。虽分观以审其常。必合论以通其变。盖不但不知其法者。不可为医。即知其法而泥于法。或知其
法而离于法。亦皆不可为医也。经曰。能合色脉。可以万全。斯诚活法也已。
望诊之法。既观身体视形容矣。然有时虽见于身体之外。实着于意态之间。又当存心省察。以诊其病焉。
析而言之。有因人之好恶者。有因时之寒暑者。有因体之寒热者。何谓因人之好恶。五十一难曰。病有欲
得温者。有欲得寒者。有欲见人者。有欲不见人者。而各不同。病在何脏腑也。然病欲得寒而欲见人者。病
在腑也。病欲得温而不欲见人者。病在脏也。何以言之。腑者阳也。阳病欲得寒。又欲见人。脏者阴也。阴病
欲得温。又欲闭户独处。恶闻人声。故别知脏腑之病也。是盖以寒热分阴阳。以阴阳分脏腑也。推之于喜
明属阳者。元气实。喜暗属阴者。元气虚。以及喜热饮寒饮。恶热饮寒饮。可广其好恶之意也。何谓因时之
寒暑。伤寒论曰。夏月盛热。欲着复衣。冬月盛寒。欲裸其身。所以然者。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。推之于夏月恶热者。知其阳气胜。冬
月恶寒者。知其阴气胜。以及春秋之恶寒恶热。喜寒喜热。可广其寒暑之意也。何谓因体之寒热。伤寒论
曰。病患身大热。反欲得近衣被者。热在皮肤。寒在骨髓也。身大寒。反不欲近衣被者。寒在皮肤。热在骨髓
也。推之于身热不欲近衣被者。则知骨髓不寒。身寒欲近衣被者。则知骨髓不热。以及外无寒热。欲近衣
被者。骨髓寒。外无寒热。不欲近衣被者。骨髓热。而凡衣多恶热。衣少畏寒之常。衣少恶热。衣多恶寒之变。
亦可广其寒热之意也。是皆见于意态之间。着于身体之外。可不存心省察。以诊其病欤。
医书汗牛充栋。何须祸枣灾梨。然余有不能已于言者。何则。炎黄之书。其旨深远。汉晋之书。其文缺
略。医家因陋就简。遂推趋时者为大名家。病家闻誉即延。亦信趋时者为真实学。自是术愈疏。方愈
乱。病不至死。而医死之。医不欲误。而书误之。安得岐黄复起。明其道以辨其非耶。是用忘其狂瞽。着
述遵经。非惟欲医家以是诊病。亦欲病家以是试医。且不欲医病之家以是遵我。亦欲医病之家以
是遵经。果尔。则虽祸枣灾梨。或未必无小补。
During clinical practice, one has already observed the patient's appearance and posture, as well as their sitting and lying positions. However, there are principles involved that are not strictly confined to walking, standing, sitting, or lying down, nor can they be simply listed under bending, extending, leaning forward, or backward. Counting them up, the main categories are four: first, stiffness and spasm (Jujin, referring to bodily rigidity and discomfort); second, tremor (Zhenzhen, referring to bodily shaking and trembling); third, shivering (Zhan, referring to violent trembling); and fourth, fearful trembling (Li, referring to inner fear and trembling).
What is stiffness and spasm? It refers to rigidity of the neck and back, appearing stiff and spasmodic, like a bird with short wings that wishes to fly but cannot. What is tremor? It refers to bodily movement, appearing shaky, resembling an expression of alarm and dread, wishing to stabilize but unable to do so. "Shivering" (Zhan) involves the body shaking. Compared to tremor, shivering is more severe. "Fearful trembling" (Li) involves the heart being frightened. Compared to shivering, shivering manifests externally while fearful trembling manifests internally.
Therefore, the diseases associated with them are as follows: Stiffness and spasm belong to Taiyang Excess (a syndrome of excess pathogenic factors in the Taiyang channel), and in severe cases, may present with a form where the back does not touch the bed when lying down. Tremor belongs to Yuanqi Deficiency (deficiency of the primordial Qi), and in severe cases, may present with a sensation that the body wants to collapse to the ground. Shivering occurs because the person is originally deficient; the pathogen is external and the righteous Qi struggles against it. If the righteous Qi overcomes the pathogen, the condition is favorable and easy to resolve. Fearful trembling occurs because the Qi is even more depleted; the pathogen has entered internally and the righteous Qi struggles against it. If the pathogen overcomes the righteous Qi, the condition is adverse and difficult to cure.
Moreover, stiffness and spasm belong to Taiyang Excess, and the symptoms may present with or without sweating. Tremor belongs to Taiyang Deficiency (deficiency of Qi in the Taiyang channel), and the symptoms require differentiation between before and after sweating. Shivering manifests externally and is associated with the Taiyang channel; if the body is warm and sweating occurs, the pathogen will retreat. Fearful trembling manifests internally and is governed by Shaoyin (Heart and Kidney); if the body is cold and the limbs are cold, the pathogen has sunk inward. Thus, in clinical practice, although one must observe separately to understand the normal patterns, one must also discuss comprehensively to grasp the variations. Generally speaking, those who do not know these methods cannot be physicians; even those who know them but adhere rigidly to them, or those who know them but deviate from them, also cannot be physicians. The Classic says, "If one can combine the observation of complexion and pulse, one can achieve perfection." This is indeed the method of flexible application.
The methods of inspection have already covered the observation of the body and appearance. However, sometimes what appears on the outside of the body actually resides in the demeanor and mental state. One must pay close attention and examine carefully to diagnose the disease.
Analyzing this, there are manifestations due to individual preferences, those due to seasonal cold and heat, and those due to constitutional cold and heat.
What is meant by individual preferences? The *Nan Jing* (Classic of Difficult Issues), Chapter 51, states: "Some patients desire warmth, some desire cold; some wish to see people, some wish not to see people." These vary, indicating which Zang-Fu organ is diseased. If a patient desires cold and wishes to see people, the disease is in the Fu organs. If a patient desires warmth and wishes not to see people, the disease is in the Zang organs. Why is this? Fu organs belong to Yang; Yang diseases desire cold and wish to see people. Zang organs belong to Yin; Yin diseases desire warmth and wish to stay indoors alone, disliking human voices. Thus, one can distinguish between Zang and Fu diseases. This essentially uses cold and heat to differentiate Yin and Yang, and Yin and Yang to differentiate Zang and Fu. Extending this logic, a preference for brightness belongs to Yang, indicating solid Yuanqi; a preference for darkness belongs to Yin, indicating deficient Yuanqi. Similarly, preferences for hot or cold drinks, and aversions to them, can broaden the understanding of these preferences to assess the condition.
What is meant by seasonal cold and heat? The *Shanghan Lun* (Treatise on Cold Damage) states: "In summer, when heat is intense, the patient desires to wear thick clothes; in winter, when cold is intense, the patient desires to expose their body." The reason is that weak Yang leads to aversion to cold, and weak Yin leads to fever. This often results from improper treatment: excessive sweating depletes Yang Qi, and harsh purging depletes Yin Qi. In the fifth month, Yang Qi is on the exterior, and the Stomach is cold and empty internally. Because internal Yang is weak and cannot overcome the cold, the patient desires thick clothes. In the eleventh month, Yang Qi is inside, and the Stomach is烦热 (hot and restless). Because internal Yin is weak and cannot overcome the heat, the patient desires to expose their body. Extending this, aversion to heat in summer indicates strong Yang; aversion to cold in winter indicates strong Yin. Preferences for cold or heat in spring and autumn can similarly expand the understanding of seasonal influences.
What is meant by constitutional cold and heat? The *Shanghan Lun* states: "If a patient has high fever but desires to be near clothing and bedding, the heat is superficial, and the cold is deep in the marrow. If a patient has low body temperature but does not desire to be near clothing and bedding, the cold is superficial, and the heat is deep in the marrow." Extending this, if the body is hot and the patient does not desire clothing/bedding, the marrow is not cold. If the body is cold and the patient desires clothing/bedding, the marrow is not hot. Furthermore, if there is no obvious external cold or heat sensation, but the patient desires clothing/bedding, the marrow is cold. If there is no obvious external cold or heat sensation, but the patient does not desire clothing/bedding, the marrow is hot. Common patterns include wearing many clothes yet fearing heat, or wearing few clothes yet fearing cold. Variations include wearing few clothes yet fearing heat, or wearing many clothes yet fearing cold. These can all broaden the understanding of constitutional thermal states. All these manifest in demeanor and appear on the body surface; how can one fail to pay close attention and examine them to diagnose the disease?
Medical books are numerous enough to make oxen sweat and fill barns with pears and dates (a metaphor for excessive publishing). Why add more? Yet I cannot remain silent. Why? Medical texts from the times of Yan and Huang have profound meanings; those from the Han and Jin dynasties are often incomplete. Physicians, relying on simplicity and convention, promote those who follow trends as famous masters. Patients, hearing of their reputation, hire them, believing them to possess true learning. Consequently, medical skills become more negligent, and prescriptions more chaotic. Diseases do not lead to death, but doctors do. Doctors do not intend to err, but books mislead them. How can we expect Qi Bo and Huang Di to rise again to clarify the correct way and refute errors? Therefore, disregarding my own arrogance and ignorance, I wrote this book following the Classics. Not only do I hope physicians will use it to diagnose diseases, but also that patients will use it to test physicians. I do not merely want medical families to follow my views, but to follow the Classics. If this happens, then even adding to the volume of books may offer some small benefit.