腹胀浮大是出厄。虚小命殂须努力。
腹胀之病。有寒有热。有虚有实。有久有暴。病证不同。治法各异。大抵皆
由于阳气外虚。阴气内积。诊得其脉浮大。则阳气尚不甚虚。阴气犹不
甚积。且诸阳为表。阳气易已。故曰出厄。若脉虚小。则脾胃已虚。病当在
里。诸里为阴。阴病难已。故曰命殂。
按巢氏病源曰。腹痛者。由阳气外虚。阴气内积故也。阳气内虚。受风冷
邪气。风冷。阴气也。冷积于脏腑之间不散。与脾气相壅。虚则胀。故腹满
而气微喘。诊其脉。右手寸口气口以前。手阳明经也。脉浮为阳。按之牢
强。谓之为实。阳实者。病腹满气喘嗽。左手关上脉。足少阳经也。阴实者。
病腹胀满。烦扰不得卧也。关脉实。则腹满响。关上脉浮而大。风在胃内。
腹胀急。心内澹澹。食欲呕逆。关脉浮。腹满不欲食。脉浮为是虚满。左手
尺中。神门以后脉。足少阴经。沉者为阴。阴实者。病苦小腹满。左手尺中
阴实者。肾实也。苦腹胀善鸣。左手关后。尺中脉浮为阳。阳实者。膀胱实
也。苦少腹满。引腰痛。脉来外涩者。为奔腹胀满也。病苦腹满而喘。脉反
滑利而沉。皆为逆。死不治。腹胀脉浮者生。虚小者死。其汤熨针石。别有
正方。
下利微小却为生。脉大浮洪无瘥日。
下利之证。虽在脾肾。其见证在于大肠。大肠属庚金。脉若微小。则火犹
不甚。而庚金无伤。故曰生。若遇浮大而洪。则为丙火来克庚金。其邪方
炽。故曰无瘥日也。
按儒门事亲云。肠 下脓血。脉沉小流通者佳。数疾且大有热者死。经
云。肠 便血。身热则死。寒则生。又云。肠 下白沫。脉沉则生。浮则死。又
云。肠 下脓血。脉悬绝则死。滑大则生。又云。肠 之属。身热脉不悬。绝
滑大者生。悬涩者死。以藏期之。又云。肠 筋挛。其脉小细。安静者生。浮
大紧者死。洞泄食不化。不得留下。脓血。脉微小速者生。紧息者死。又云
泄注。脉缓明小结者生。浮大数者死。
恍惚之病定癫狂。其脉实牢保安吉。寸关尺奇沉细时。如此未闻人救得。
五十九难曰。狂癫之病。何以别之。然。狂之始发。少卧而不饥。自高贤也。
自辨智也。自贵倨也。妄笑好歌乐。妄行不休是也。癫病始发。意不乐。直
视僵仆。其脉三部阴阳俱盛。经言如此。所谓阴阳俱盛者。即诀所谓实
牢也。若寸关尺部沉细。是于三部阴阳俱盛。相反则正气已衰。故云未
闻人救得也。戴起宗脉诀刊误。复引难经重阴为癫。谓阴部内见沉涩
微短脉。是阳脉不见。而阴独盛。故为癫疾。殊失难经之旨矣。何也。据刊
误之意。盛字当作甚字。若仍作或字。则非沉涩微短可知矣。
按二十难云。重阳者狂。重阴者癫。疑于五十九难中错简者。脉经云。诊
得癫疾。虚则可治。实则死。又云。癫疾脉实坚者生。脉沉细小者死。又云。
癫疾脉搏大滑者。久久自已。其沉小急实不可治。小坚急。亦不可治。
巢氏病源云。脉虚则可治。实则死。又云。紧弦实牢者生。脉细小者死。
消渴脉数大者活。虚小命殂厄难脱。
数大者。阳有余而阴不足。尚可补阴以配阳。若脉虚小。则阴阳俱亏。求
其厄脱。不亦难乎。
按经云。消渴脉数大者生。细小浮短者死。又云。消渴脉沉小者生。实坚
大者死。
水气浮大得延生。沉细应当是死别。
经云。少阴何以主肾。肾何以主水。曰。肾者。至阴也。至阴者。盛水也。肺者。
太阴也。少阴者。冬脉也。故其本在肾。其末在肺。皆积水也。又曰。肾何以
能聚水而生病。曰。肾者。胃之关也。关门不利。故聚水从其类也。上下溢
于皮肤。故为 肿。 肿者。聚水而生病也。经言如此。究之由于脾土虚
弱。不能制肾水。以至泛滥皮肤而为病。若脉浮大。尚有可生之理。盖浮
属风。大属火。风与火皆能耗水。况浮大为阳。阳病易已。脉若沉细。沉细
为阴水。则水愈横流而土愈飘没。其不至于死也。盖亦鲜矣。
按脉经云。水病脉洪大可治。微细者不可治之。云水病胀闭。其脉浮大
软者生。沉细虚小者死。又云。水病腹大如鼓。脉实者生。虚者死。
霍乱之候脉微迟。气少不语大难医。三部浮洪必救得。古今课定更无疑。
巢氏病源曰。诊其脉来代者霍乱。又曰。脉代而绝者亦霍乱。霍乱脉大
可治。微细不可治。霍乱吐下脉迟气息劣。口不欲言者。不可治。观巢氏
之说。正与脉诀相符。非为臆说。戴起宗刊误。谓脉经所无。以脉诀为自
创之例。何其谬哉。而刊误所论。皆循纸上筌蹄。并未临证消息之耳。夫
霍乱者。乃冷热不和。清浊相干。以致卒然心腹绞痛。其疾挥霍撩乱。故
名霍乱。其始发也。则乱于里。甚则手足厥逆。而脉沉伏。不足为怪。将解。
则循手足阳明之窍以出。在上则吐。在下则泻。其脉渐复而出矣。若不
吐不泻。脉亦不出。手足厥逆。目闭而不欲言。此为阴霍乱。乃危证也。若
内服大温之剂。外用灸关元气海之法。亦有能活者。
鼻衄吐血沉细宜。忽然浮大即倾危。
血虚。脉虚。理也。今吐衄二病。皆失血之证也。血既去。其脉当沉细无力。
今反见浮大。浮大属火。乃火逼血而错经妄行。无巳时也。
病患脉健不用治。健人脉病号行尸。
所谓不用治者。乃不治自愈也。前诀形证相反。歌云健人脉病号行尸。
病患脉健亦如之。所谓亦如之者。即内经所云。形肉已脱。九候虽调犹
死也。此诀所云。正恐后人滞于前诀。而复歌曰。病患脉健不用治。健人
脉病号行尸。亦得经所云。形肉有余。脉气不足死。脉气有余。形肉不足
生。又仲景曰。脉病患不病。名曰行尺。以无生气。卒眩仆不识人则死。人
病脉不病。名曰内虚。以无谷神虽因无苦。刊误亦知有此二说。乃不为
此诀之释。而故为前诀之释。其偷心为何如也。
按脉经云。人病脉不病者生。脉病患不病者死。
心腹痛脉沉细宜。浮大弦长命必殂。
巢元方曰。心腹痛者。由脏腑虚弱。风寒客于其间。邪气发作。与正气相
击。上冲于心。则心痛。下攻于腹。则腹痛。上下相攻。故心腹绞痛气不得
息。诊其脉。左手寸口人迎以前脉。手少阴经也。沉者为阴。阴虚者病苦
心腹痛。难以言心。如寒伏心腹 痛不得息。脉沉小者生。大 疾者死。
心腹痛脉沉细小者生。浮大而疾者死。刊误引用巢氏病源而不及此。
是诚何心哉。
按经云。心腹痛。痛不得息。脉细小迟者生。坚大疾者死。
顿痛短涩应须死。浮滑风痰必易除。
头为诸阳之会。其痛因不一也。短涩为阴脉。故非所宜。若脉见浮滑。浮
则为风。滑则为痰。驱逐风痰。其病自已。故曰。必易除也。
按经言。形脉与病相反者死。奈何。然。病若头痛目痛。脉反短涩者死。
中风口噤迟浮吉。急实大数三魂孤。
巢氏病源曰。诸阳经皆在于头。三阳之经。并络入颔颊。夹于口。诸阳为
风寒所客。则筋急。故口噤不开也。诊其脉迟者生。准绳云。风邪中人。六
脉多沉伏。亦有脉随气奔指下洪盛者。迟浮吉。坚大急疾凶。大抵中风
之证。风火居多。绀珠经曰。以火为本。以风为标。心火暴甚。肾水必衰。肺
金既摧。肝木自旺。如脉浮而迟。浮则风犹在表。迟则火犹不炽。故以为
吉。若急实大数。则风火炽盛。而中藏入里矣。其病必凶也。
鱼口气粗难得瘥。面赤如妆不久居。
脉经云。病患口如鱼口。不能复闭。而气出多不反者死。是人身之元气。
不得归于丹田。奔越而上。故口如鱼口而气粗也。面赤如妆者。虚阳载
上也。
中气发直口吐沫。
张世贤曰。发乃血之余。心不能生血。发必焦枯梗直。涎乃脾之液。脾绝
则涎不收摄。故涎从口中吐出也。
喷药闷乱起复苏。
范曰。咽主咽物。咽为胃之系。下连胃脘。为水谷之道路。胃经为风痰
所扰。闷乱而药不下咽。喷吐于其外。岂可望有苏醒之期。张世贤释起
当作岂。愚谓亦不必改。诀之意。皆言有时闷乱。有时苏醒。暂开复闭。终
为不起之证也。
咽喉拽锯水鸡响。
咽喉者。气之道路也。风痰壅塞。道路窒碍。故作水鸡之声也。
摇头上窜气长嘘。
凡人之头。犹木之梢。火之尖也。风火相煽。故摇头上窜。张世贤曰。气长
嘘出多入少。皆真元散失之候也。
病患头面青黑暗。
青属肝。黑属肾。倘色明润。犹有可生之理。更加惨暗。则肝肾已绝矣。
汗透毛端恰似珠。
经曰。六阳气俱绝者。则阴与阳相离。阴阳相离。则腠理泄绝。汗乃出。大
如贯珠。转出不流。则气先死。
眼小目瞪不须治。
经云。睛不转而仰视。此太阳已绝。
诈汗如油不可苏。
别本诈字为作字。若根据油字义。当作榨汗。言阴阳相离。逼迫其汗以外
泄。如油之滑而不流也。已其并中风死候也。
内实胀腹痛满盈。心下牢强干呕频。手足烦热脉沉细。大小便涩死多真。
肚腹胀满而痛。心下牢强而呕。手足烦热。而大小便涩。池氏谓其内实
结绝。气不宣通。若脉大有力。下之犹有可生之理。今脉反见沉细。则又
不可下。是阳证而见阴脉也。死可知矣。
外实内热吐相连。下清注谷转难安。忽然诊得脉洪大。莫费神功定不痊。
外实者。表实而无汗。则热气不得外泄。而内迫肠胃。迫于胃故呕。迫于
肠故下利清谷。肠与胃。手足阳明也。阳明为燥金。反见洪大之脉。是火
来克金。鬼克之邪也。望其痊也难矣。张世贤曰。既泻之后。脉当细小。反
得洪大。此为不治之证。勿听子以内热字疑为冷字。非也。
内外俱虚身冷寒。汗出如珠微呕烦。忽然手足脉厥逆。体不安宁必死拼。
勿听子曰。阴盛阳绝则外寒。故汗出如珠而不流。无阳则四肢逆冷。致
脾胃无所养。故呕烦。此恶候也。问得脉实而滑。尚有可生之理。谓阴病
见阳脉者生也。愚谓身体手足冷。而厥且汗出不止。此阳将脱也。若人
安静而不呕烦。脉虽弱而不至悬绝。犹可温而兴也。加以烦躁不宁而
呕。则又不可以用辛温之剂。不死奚待也。
按脉经云。内外俱虚。身体冷而汗出。微呕而烦扰。手足厥逆。体不安静
者死。
上气喘急候何宁。手足温暖净滑生。反得寒涩脉厥逆。必知归死命须倾。
巢元方曰。肺主于气。若肺气虚实不调。或暴为风邢所乘。则腑脏不利。
经络痞涩。气不宣和。则上气也。又曰。喘息低抑其脉滑。手足温者生。涩
而四末寒者。死也。愚按上气喘息之人。手足寒者。十居其半。若脉不大
不小。得汤火而手足即温。其气稍缓者。未必尽死。若手足寒而脉涩小。
得汤火而犹寒者。其死无疑矣。
按脉经云。上气喘息仰昂。其脉滑。手足温者生。脉涩四肢寒者死。又云。
上气脉数者死。谓其形损故也。又云。上气注液。其脉虚。宁宁伏匿者生。
坚强者死。又云。寒气上攻。脉实而顺滑者生。实而逆涩则死。注太素云。
寒气暴上满实如何。曰实而滑则生。实而逆则死矣。其形尽满如何。曰
举形尽满者。脉急大坚。尺满而不应如是者。顺则生。逆则死。何为顺则
生。逆则死。曰所谓顺者。手足温也。谓逆者。手足寒也。
咳而尿血羸瘦形。其脉疾大必难任。
巢氏曰。肺咳之状。咳而喘息有音声。甚则咳血。又曰。心主血。与小肠合。
若心家有热结于小肠。故小便血也。愚谓咳。心火乘肺也。尿血。心火传
于小肠也。咳而尿血。以至羸瘦。则病已剧矣。倘脉缓而小。则金不受火
克。而咳可已。肺为水之上源。源清则流洁。而尿血可愈。形虽羸瘦。犹有
望其生也。今脉反见疾大。则火愈炽。而咳愈增。而小便愈血。欲其生也
难矣。
唾血之脉沉弱吉。忽若实大死来侵。
唾血与前鼻衄吐血不同。前之吐血为。呕吐之吐。此之唾血。为唾中见
血。圣济总录论曰。邪热熏于肺。则损肺。恚怒气逆。伤于肝。则损肝。肺肝
伤动。故令人唾血。如唾中有若红缕者。属肺藏。如胁下先苦痛。而后唾
血者。属肝经。俱可折而治之。用紫菀汤。蒲黄散。巢氏病源。复有关上脉
微芤为伤肝以唾血。脉沉弱者生。牢实者死。
按脉经云。吐血衄血。脉滑小弱者生。实大者死。又云。唾血脉紧强者死。
滑者生。又云。吐血而咳上气。其脉数有热。不得卧者死。
上气浮肿肩息频。浮滑之脉即相成。忽然微细难应救。神功用尽也无生。
巢氏病源曰。肺主于气。候身之皮毛。而气之行。循环脏腑。流通经络。若
外为邪所乘。则肤腠闭密。使气内壅。与津液相并。不得洪越。故上气而
身肿也。经云。上气面浮肿肩息。其脉大不治。加利必死。今诀云。微细难
救。似与脉经相悖。不知脉经所云大不治者。以其上气浮肿属肺病。浮
大属火。火能克金。故云大不治。加利必死者。利则大肠亦病。脏与腑俱
Abdominal distension with a floating and large pulse indicates escape from danger; if the pulse is deficient and small, life is in peril, requiring utmost effort to save.
The disease of abdominal distension has cold, heat, deficiency, and excess patterns, as well as chronic and acute variations. Different pathological conditions require different treatment methods. Generally, it results from the deficiency of Yang Qi on the exterior and the accumulation of Yin Qi internally. If the pulse is found to be floating and large, it means that Yang Qi is not yet severely deficient, and Yin Qi is not excessively accumulated. Furthermore, all Yang meridians govern the exterior, and Yang Qi is easy to recover; therefore, it is said to "escape danger" (chu e). If the pulse is deficient and small, it indicates that the Spleen and Stomach are already deficient, and the disease is located in the interior. All interior aspects belong to Yin, and Yin diseases are difficult to cure; therefore, it is said that life will end (ming cu).
According to *Chao Shi Bing Yuan* (Source of Diseases by Chao): Abdominal pain is caused by the deficiency of Yang Qi externally and the accumulation of Yin Qi internally. When internal Yang Qi is deficient, it is susceptible to Wind-Cold pathogenic factors. Wind-Cold belongs to Yin Qi. Cold accumulates between the Zang-Fu organs and does not dissipate, obstructing with Spleen Qi. Deficiency leads to distension; thus, there is abdominal fullness and slight panting. Upon examining the pulse: at the Cun Kou position on the right hand before the Qi Kou, it corresponds to the Hand-Yangming Large Intestine Meridian. A floating pulse is Yang; if it feels firm and strong upon pressure, it is called an Excess pattern. Yang Excess manifests as abdominal fullness, panting, and cough. The Guan position on the left hand corresponds to the Foot-Shaoyang Gallbladder Meridian. Yin Excess manifests as abdominal distension and fullness, restlessness, and inability to sleep. An Excess Guan pulse indicates abdominal fullness with rumbling sounds. A floating and large pulse at the Guan position indicates Wind in the Stomach, causing urgent abdominal distension, palpitations, loss of appetite, and nausea/vomiting. A floating Guan pulse with abdominal fullness and anorexia indicates false fullness due to deficiency. At the Chi position on the left hand, after Shenmen, it corresponds to the Foot-Shaoyin Kidney Meridian. A deep pulse is Yin; Yin Excess manifests as painful fullness of the lower abdomen. Left Chi Yin Excess indicates Kidney Excess, characterized by abdominal distension and frequent borborygmi. A floating pulse at the Chi position behind the Guan on the left indicates Yang; Yang Excess indicates Bladder Excess, manifesting as painful fullness of the lower abdomen radiating to the waist. An external roughness in the pulse indicates Ben Tun (rushing) abdominal distension. The patient suffers from abdominal fullness and panting. If the pulse becomes slippery and deep instead, these are adverse signs indicating death and untreatability. Abdominal distension with a floating pulse indicates survival; a deficient and small pulse indicates death. Regarding decoctions, moxibustion, acupuncture, and bian stones, there are separate specific formulas.
Diarrhea with a minute and small pulse indicates survival; a floating, large, and surging pulse indicates no days of recovery.
Although diarrhea involves the Spleen and Kidney, its manifestations lie in the Large Intestine. The Large Intestine belongs to Geng Metal. If the pulse is minute and small, Fire is not excessive, and Geng Metal is undamaged; thus, it indicates survival. If a floating, large, and surging pulse is encountered, it signifies Bing Fire overcoming Geng Metal, with the pathogen being vigorous; thus, it indicates no days of recovery.
According to *Ru Men Shi Qin*: Dysentery with pus and blood in the stool, if the pulse is deep, small, and free-flowing, is favorable; if rapid, frequent, and large with heat signs, it indicates death. The Classics state: Dysentery with bloody stool, body heat indicates death, body cold indicates survival. Also: Dysentery with white mucus, a deep pulse indicates survival, a floating pulse indicates death. Also: Dysentery with pus and blood, a suspended and severed pulse indicates death, a slippery and large pulse indicates survival. Also: For dysentery, if the body is hot but the pulse is not suspended/severed, and is slippery and large, it indicates survival; if suspended and rough, it indicates death. Predict based on the Zang organs. Also: Dysentery causing tendon spasms, a small and fine pulse with calm demeanor indicates survival; a floating, large, and tight pulse indicates death. Profuse watery diarrhea with undigested food, inability to retain stool, accompanied by pus and blood, a minute and small pulse with rapid movement indicates survival; a tight and slow pulse indicates death. Also: Diarrhea like pouring, a slow, clear, small, and knotted pulse indicates survival; a floating, large, and rapid pulse indicates death.
Hesitant illness is determined as Mania or Epilepsy; a solid and firm pulse ensures safety and auspiciousness. If the Cun, Guan, and Chi pulses are unusually deep and fine, such cases have never been heard of being saved.
*Nan Jing* (Classic of Difficult Issues), Chapter 59 states: How to distinguish between Mania and Epilepsy? Answer: Mania begins with little sleep and no hunger, arrogance, self-perception of wisdom, pride, irrational laughter, singing, joy, and incessant erratic behavior. Epilepsy begins with unhappiness, staring straight, and sudden collapse. Its pulse shows both Yin and Yang sections as vigorous. The Classics say this. "Both Yin and Yang vigorous" refers to what the verse calls "solid and firm." If the Cun, Guan, and Chi pulses are deep and fine, this contradicts the "both Yin and Yang vigorous" description, indicating that righteous Qi has declined; hence, it is said that no one has been heard to save such cases. Dai Qizong, in *Mai Jue Kan Wu* (Correction of Pulse Verses), cites *Nan Jing*'s "Heavy Yin is Epilepsy," stating that seeing deep, rough, minute, and short pulses in the Yin positions means Yang pulses are absent and Yin alone is vigorous, thus causing epilepsy. This completely misses the intent of *Nan Jing*. Why? According to the intent of *Kan Wu*, the character "Sheng" (vigorous) should be read as "Shen" (severe/extreme). If interpreted as "or," it would clearly not be deep, rough, minute, and short.
According to *Nan Jing*, Chapter 20: Heavy Yang is Mania, Heavy Yin is Epilepsy. It is suspected that there is a misplaced slip in Chapter 59. *Mai Jing* (Pulse Classic) states: Diagnosing epilepsy, a deficient pulse is treatable, a solid pulse indicates death. Also: Solid and firm pulse in epilepsy indicates survival, deep and small pulse indicates death. Also: If the epilepsy pulse is large and slippery, it will heal itself over time. Deep, small, urgent, and solid is untreatable. Small, firm, and urgent is also untreatable. *Chao Shi Bing Yuan* states: Deficient pulse is treatable, solid pulse indicates death. Also: Tight, string-like, solid, and firm pulse indicates survival, small and fine pulse indicates death.
Xiao Ke (Wasting-Thirst) with a rapid and large pulse indicates life; a deficient and small pulse brings death and inescapable disaster.
A rapid and large pulse indicates excess Yang and insufficient Yin, which can still be treated by nourishing Yin to harmonize with Yang. If the pulse is deficient and small, both Yin and Yang are depleted; seeking escape from disaster is indeed difficult.
According to the Classics: Xiao Ke with a rapid and large pulse indicates survival, small, fine, floating, and short pulse indicates death. Also: Xiao Ke with a deep and small pulse indicates survival, solid, firm, and large pulse indicates death.
Water Qi disease with a floating and large pulse allows for extended life; a deep and small pulse should be a parting with death.
The Classics ask: Why does Shao Yin govern the Kidney? Why does the Kidney govern Water? Answer: The Kidney is the Ultimate Yin. Ultimate Yin stores water. The Lung is Tai Yin. Shao Yin is the Winter pulse. Thus, the root of the disease is in the Kidney, and the branch is in the Lung; both involve water accumulation. It also asks: How can the Kidney gather water to cause disease? Answer: The Kidney is the gate of the Stomach. If the gate is not functional, water gathers according to its kind. Overflowing up and down onto the skin causes edema. Edema is gathering water to cause disease. The Classics say this. Investigating further, it stems from Spleen Earth deficiency failing to control Kidney Water, leading to flooding the skin and causing disease. If the pulse is floating and large, there is still a possibility of survival. Floating belongs to Wind, Large belongs to Fire; Wind and Fire can both consume Water. Moreover, floating and large are Yang; Yang diseases are easy to cure. If the pulse is deep and small, deep and small represent Yin Water; then water flows wildly and Earth drifts away. Death is rare.
According to *Mai Jing*: Water disease with a洪 (surging/large) pulse is treatable, micro and fine pulses are untreatable. It says: Water disease with distension and closure, floating and large soft pulse indicates survival, deep, small, deficient, and small pulse indicates death. Also: Water disease with abdomen large as a drum, solid pulse indicates survival, deficient pulse indicates death.
Huoluan (Colic with vomiting and diarrhea) presents with a micro and slow pulse; scanty Qi and inability to speak make it hard to treat. If the three positions show floating and surging pulses, they can surely be saved; ancient and modern lessons confirm this without doubt.
*Chao Shi Bing Yuan* states: Diagnosing a pulse that comes and goes with intervals (Dai pulse) indicates Huoluan. Also: A Dai pulse that cuts off also indicates Huoluan. Huoluan with a large pulse is treatable, micro and fine pulses are untreatable. Huoluan with vomiting/diarrhea, slow pulse, weak breath, and unwillingness to speak is untreatable. Viewing Chao's statements, they align perfectly with *Mai Jue*, not mere speculation. Dai Qizong in *Kan Wu* claims *Mai Jing* lacks this, calling *Mai Jue* self-created, which is absurd. *Kan Wu* follows bookish dogma without clinical observation. Huoluan is disharmony of cold and heat, mixing of clear and turbid Qi, causing sudden heart and abdominal colic, chaotic and sudden, hence named Huoluan. Initially, it disrupts the interior; severely, limbs become cold and pulse deep/faint, which is not strange. As it resolves, it exits through the Hand/Foot Yangming orifices: vomiting above, diarrhea below, and the pulse gradually recovers. If no vomiting/diarrhea, pulse does not emerge, limbs cold, eyes closed, unwilling to speak, this is Yin Huoluan, a critical condition. Internal administration of strongly warming agents and external moxibustion on Guanyuan and Qihai can save some.
Bi-bleeding (Epistaxis) and hematemesis favor a deep and small pulse; sudden floating and large indicates imminent peril.
Blood deficiency leads to a deficient pulse, which is logical. Now, epistaxis and hematemesis are both blood-loss syndromes. After blood loss, the pulse should be deep, small, and forceless. Seeing floating and large instead, floating and large belong to Fire, meaning Fire forces blood to flow recklessly without cessation.
If the patient's pulse is robust, no treatment is needed; if a healthy person has a diseased pulse, they are called a "walking corpse."
"No treatment needed" means spontaneous healing. The previous verse contrasts form and pulse. The song says: A healthy person with a diseased pulse is called a walking corpse. A patient with a robust pulse is similar. "Similar" refers to *Nei Jing*: "If flesh and muscle are exhausted, even if the nine pulses are harmonious, death occurs." This verse warns against sticking to the previous one, so it sings: Patient with robust pulse needs no treatment; healthy person with diseased pulse is a walking corpse. This also fits *Nei Jing*: "Excess flesh/muscle, insufficient Qi pulse = death; Excess Qi pulse, insufficient flesh/muscle = survival." Zhang Zhongjing said: "Pulse indicates disease, person does not, called 'Walking Corpse'; lacking vital Qi, sudden dizziness/collapse/unconsciousness leads to death." "Person is diseased, pulse is not, called 'Internal Deficiency'; lacking Grain Spirit, though no suffering..." *Kan Wu* knows these two views but fails to explain this verse, instead explaining the previous one. What is their intent?
According to *Mai Jing*: Person diseased, pulse not = survival; Pulse diseased, person not = death.
Heart and abdominal pain favor a deep and small pulse; floating, large, string-taut, and long indicate certain death.
Chao Yuanfang states: Heart and abdominal pain result from Zang-Fu weakness, with Wind-Cold lodging within. Pathogenic Qi attacks Righteous Qi. Rising to the heart causes heart pain; attacking the abdomen causes abdominal pain. Mutual attack causes severe colic and breathlessness. Examining the pulse: Left Cun Kou before Ren Ying corresponds to Hand-Shaoyin Heart Meridian. Deep is Yin; Yin deficiency causes heart/abdominal pain, difficult to articulate, like cold lodged in heart/abdomen causing pain and breathlessness. Deep and small pulse indicates survival, large and rapid indicates death. Deep, small, and fine pulse indicates survival; floating, large, and rapid indicates death. *Kan Wu* cites *Chao Shi Bing Yuan* but omits this. What is their mind?
According to the Classics: Heart/abdominal pain with breathlessness, small and fine/slow pulse indicates survival, firm/large/rapid indicates death.
Sudden pain with short and rough pulse must lead to death; floating and slippery pulse (Wind-Phlegm) will surely be easily eliminated.
The head is the meeting of all Yang meridians; pain causes vary. Short and rough is a Yin pulse, thus unfavorable. If the pulse is floating and slippery, floating indicates Wind, slippery indicates Phlegm; expelling Wind-Phlegm cures the disease. Hence, "surely easy to eliminate."
According to the Classics: Form and pulse contrary to disease indicate death. However, if headache/eye pain has a reverse short/rough pulse, it indicates death.
Stroke with mouth lock favors slow and floating pulse; urgent, solid, large, and rapid pulse indicates solitary soul (death).
*Chao Shi Bing Yuan* states: All Yang meridians are in the head; Three Yang meridians connect to jaw/cheeks, flanking the mouth. If Wind-Cold lodges in Yang meridians, tendons tighten, causing locked mouth. Slow pulse indicates survival. *Zhun Sheng* states: Wind pathogen entering people often shows deep/faint six pulses, or surging pulses rushing under fingers. Slow and floating is auspicious, firm/large/urgent/fast is ominous. Generally, stroke involves much Wind-Fire. *Gan Zhu Jing* states: Fire is root, Wind is branch. Heart Fire suddenly severe, Kidney Water declines, Lung Metal destroyed, Liver Wood overacts. Floating and slow pulse: floating means Wind still in exterior, slow means Fire not intense, thus auspicious. Urgent, solid, large, rapid means Wind-Fire intense, penetrating internal organs; disease is fatal.
Fish-mouth with coarse breathing is hard to cure; face red like makeup indicates short remaining life.
*Mai Jing* states: Patient's mouth like a fish's, unable to close, exhaling much without returning indicates death. This means Yuan Qi cannot return to Dantian, rushing upward, causing fish-mouth and coarse breathing. Face red like makeup is Empty Yang floating upward.
Central Qi disorder with stiff hair and foaming from mouth.
Zhang Shixian states: Hair is surplus of Blood; if Heart cannot generate Blood, hair becomes dry, stiff, and upright. Saliva is fluid of Spleen; if Spleen perishes, saliva is not retained, thus foaming from mouth.
Spraying medicine, confusion, rising to revival (Rhetorical question: Can we expect revival?).
Fan states: Throat swallows; throat is connection of Stomach, connecting to stomach chamber, path for food/water. Stomach Meridian disturbed by Wind-Phlegm, causing confusion, medicine not swallowed but sprayed out externally. How can revival be expected? Zhang Shixian interprets "Qi" as "Qi" (how/rhetorical). I believe no change is needed. The verse implies alternating confusion and revival, temporarily opening then closing, ultimately unrevivable.
Throat rattling like sawing/frog croaking.
Throat is passage of Qi. Wind-Phlegm obstruction blocks passage, creating frog-like sound.
Head shaking, upward staring, long sighing.
Human head is like tree tip or fire flame. Wind-Fire fanning causes head shaking and upward staring. Zhang Shixian states: Long sighing with more out than in indicates dispersion of True Yuan.
Patient's head and face dark and black.
Green belongs to Liver, Black to Kidney. If color is bright and lustrous, survival is possible. If additionally grim and dark, Liver and Kidney are extinct.
Sweat permeating hair tips like pearls.
Classics state: When Six Yang Qi perish, Yin and Yang separate. Separation causes pores to leak, sweat emerges large like threaded pearls, turning out but not flowing; Qi dies first.
Small eyes and wide-open stare need no treatment.
Classics state: Eyes not turning, looking upward, indicates Tai Yang extinction.
Fake/Oily sweat cannot revive.
Other versions write "Zuo" (make) instead of "Zha" (fake). Based on "oil," it should be "pressing sweat." Meaning Yin/Yang separation forces sweat out like sliding oil that doesn't flow. This is also a stroke death sign.
Internal excess with distension/pain/fullness, rigid epigastric region with frequent dry retching. Hot hands/feet with deep/small pulse, difficult urination/defecation truly indicates death.
Abdominal distension/pain, rigid epigastrium with vomiting, hot extremities, difficult urine/stool. Chi attributes this to internal excess blockage, Qi not circulating. If pulse is large and forceful, purging might save. But pulse is deep/small, so purging is contraindicated; this is Yang syndrome with Yin pulse. Death is known.
External excess with internal heat, continuous vomiting, clear diarrhea with undigested grain makes comfort difficult. Suddenly diagnosing large/surging pulse, do not waste skill, definitely incurable.
External excess means exterior excess with no sweat, trapping heat internally pressing on intestines/stomach. Pressing stomach causes vomiting; pressing intestines causes clear diarrhea with undigested grain. Intestines/Stomach are Hand/Foot Yangming. Yangming is Dry Metal; large/surging pulse indicates Fire overcoming Metal, ghost-overcoming pathogen. Recovery is difficult. Zhang Shixian states: After diarrhea, pulse should be small/fine; getting large/surging is untreatable. Do not confuse "internal heat" with "cold"; incorrect.
Internal/external deficiency with cold body, pearl-like sweat, slight vomiting/restlessness. Sudden cold limbs/pulse reversal, restless body guarantees death.
Do not listen to Zi saying: Yin excess/Yang absence causes external cold, pearl-like non-flowing sweat. No Yang causes limb cold, starving Spleen/Stomach, causing vomiting/restlessness. This is evil omen. If pulse is solid/slippery, survival possible (Yin disease with Yang pulse lives). I say: Cold body/limbs, sweating profusely, Yang is about to collapse. If calm without vomiting/restlessness, weak but not suspended pulse, warming can revive. Adding restlessness/vomiting makes acrid-warm agents unusable; death awaits.
According to *Mai Jing*: Internal/external deficiency, cold body/sweating, slight vomiting/restlessness, cold limbs, restless body indicates death.
Upper Qi panting urgency, how peaceful? Warm hands/feet with smooth pulse indicate survival. Reverse cold/rough pulse with cold limbs, know returning to death, life must decline.
Chao Yuanfang states: Lung governs Qi. If Lung Qi imbalance or sudden Wind attack, Zang-Fu dysfunction, meridian blockage, Qi not harmonious causes Upper Qi. Also: Panting low/repressed with slippery pulse, warm hands/feet survive; rough pulse with cold extremities dies. I note: Half of Upper Qi patients have cold limbs. If pulse normal, warming restores warmth/breath, not necessarily dead. If limbs cold, pulse rough/small, warming fails, death certain.
According to *Mai Jing*: Upper Qi panting looking up, slippery pulse, warm hands/feet survive. Rough pulse, cold limbs die. Also: Rapid pulse Upper Qi dies (form damaged). Also: Upper Qi with fluid, deficient pulse, quiet/hiding survives, firm/stiff dies. Also: Cold Qi attacking, solid/smooth pulse survives, solid/reverse-rough dies. Note *Tai Su*: Cold Qi sudden upper fullness/excess? Solid/smooth survives, solid/reverse dies. Full form? Urgent/large/firm pulse, Chi full unresponsive? Smooth survives, reverse dies. Why smooth/live? Warm limbs. Why reverse/dead? Cold limbs.
Cough with bloody urine and emaciated form, rapid/large pulse surely unbearable.
Chao states: Lung cough: panting with sound, severe hemoptysis. Also: Heart governs Blood, combines with Small Intestine. Heart Heat binding Small Intestine causes bloody urine. I reason: Cough is Heart Fire invading Lung. Bloody urine is Heart Fire transmitting to Small Intestine. Cough + bloody urine + emaciation = severe disease. If pulse slow/small, Metal not overcome by Fire, cough heals. Lung is source of Water; clear source cleans stream, bloody urine heals. Emaciated but hope remains. Now pulse rapid/large, Fire intensifies, cough increases, bleeding worsens; survival difficult.
Spitting blood favors deep/weak pulse; sudden solid/large brings death invasion.
Spitting blood differs from nosebleed/vomiting blood. Former is vomiting; latter is blood in saliva. *Sheng Ji Zong Lu* discusses: Evil heat damaging Lung, anger injuring Liver causes spitting blood. Red threads in saliva belong to Lung; flank pain then spitting blood belongs to Liver Meridian. Treat with Zi Wan Tang, Pu Huang San. *Chao Shi Bing Yuan* adds: Guan pulse micro/kou indicates Liver injury spitting blood; deep/weak survives, solid/firm dies.
According to *Mai Jing*: Hematemesis/epistaxis, slippery/small/weak survives, solid/large dies. Also: Spitting blood, tight/firm dies, slippery survives. Also: Hematemesis with cough/Upper Qi, rapid pulse with heat, insomnia dies.
Upper Qi with edema and frequent shoulder-lifting breathing, floating/slippy pulse matches. Suddenly micro/small hard to save, divine skill useless, no life.
*Chao Shi Bing Yuan* states: Lung governs Qi, monitors skin/hair. Qi circulates Zang-Fu/meridians. External pathogen closes pores, Qi stagnates internally, combines with fluids, cannot overflow, causing Upper Qi and body swelling. Classics: Upper Qi facial edema shoulder-lifting, large pulse untreatable. With diarrhea, death. Verse says micro/small hard to save, seeming contradictory to *Mai Jing*. Unknown that *Mai Jing* says large untreatable because Upper Qi edema is Lung disease, floating/large is Fire, Fire overcomes Metal, hence large untreatable. Diarrhea means Large Intestine also diseased, Zang and Fu...