五十七难曰。泄凡有几。皆有名不。然。泄凡有五。其名不同。有胃泄。有脾泄。有大肠泄。有小肠泄。有大瘕泄。
名曰后重。胃泄者、饮食不化。色黄。
杨曰。泄利也。胃属土。故其利色黄。而饮食不化焉。化变也。消也。言所食之物。皆完出不消变也。虞曰。此乃
风入于肠。上重于胃。故使食不消化。风论曰。久风入中。则为肠风飧泄。飧泄、为食不消化也。
脾泄者。腹胀满泄注。食即呕吐逆。
杨曰。注者、无节度也。言利下犹如注水。不可禁止焉。脾病不能化谷。故食即吐逆。虞曰。中央生湿。湿生土。
土生脾。脾恶湿。湿气之胜。故腹胀而泄注。土性主信。又主味。今土病于味。无信。故食则吐逆。阴阳应象论曰。湿
胜则濡泻。谓湿气内攻脾胃。则水谷不分。故泄注。
大肠泄者。食已窘迫。大便色白。肠鸣切痛。
杨曰。窘迫、急也。食讫即欲利。迫急不可止也。白者、从肺色焉。肠鸣切痛者、冷也。切者、言痛如刀切。其肠
之状也。虞曰。大肠气虚。所以食毕而急思厕。虚则邪传于内。真邪相击。故切痛也。
小肠泄者。溲而便脓血。少腹痛。
杨曰。小肠属心。心主血脉。故便脓血。小肠处在少腹。故小腹痛也。
大瘕泄者。里急后重。数至圊而不能便。茎中痛。此五泄之法也。
杨曰。瘕、结也。少腹有结而又下利者是也。一名后重。言大便处疼重也。数欲利。至所即不利。又痛引阴茎中。
此是肾泄也。按诸方家。利有二十余种。而此惟见五种者。盖举其宗维耳。虞曰。肾开窍于二阴。气虚故数思圊。后重
而不能便。茎中痛。肾气不足伤于冲脉。故里急也。灵枢病总曰。凡五泄者。春伤于风。寒邪留连。乃为洞泄。（按此文
见素问生气通天论。无凡五泄者句。灵枢无病总篇。惟论疾诊尺篇云。春伤于风。夏生飧泄肠 。亦与此文小异。然则
今之灵枢。非虞氏所见之旧矣。）此之谓也。丁曰。里急者。肠中痛。后重者。腰以下沉重也。余皆旧经有注。
五十八难曰。伤寒有几。其脉有变不。然。伤寒有五。有中风。有伤寒。有湿温。有热病。有温病。其所苦各不同。
中风之脉。阳浮而滑。阴濡而弱。
丁曰。肌肉之上。阳脉所行。轻手按之。状若太过。谓之滑。肌肉之下。阴脉所行。重手按之。不足。谓之弱。此
者是按之不足。举之有余。故知中风也。杨曰。自霜降至春分。伤于风冷即病者。谓之伤寒。其冬时受得寒气。至春又
中春风而病者。谓之温病。其至夏发者。多热病。病而多汗者。谓之湿温。其伤于八节之虚邪者。谓之中风。据此经言。
温病则是疫疠之病。非为春病也。疫疠者。谓一年之中、或一州一县、若大若小俱病者是也。按之乃觉往来如有。举之
如无者。谓之弱也。关以前浮滑、尺中濡弱者也。
湿温之脉。阳濡而弱。阴小而急。
丁曰。阳濡而弱者。肌肉之上。阳脉所行。濡弱者。是湿气所胜火也。肌肉之下。阴脉所行。小急者。是土湿之不
胜木。故见小急。所以言阳濡而弱。阴小而急也。杨曰。小、细也。急、疾也。虞曰。湿温之病。谓病患头多汗出。何
以言之。寸口谓阳脉见濡弱。此水之乘火也。本经曰。肾主液入心成汗。此之谓也。
伤寒之脉。阴阳俱盛而紧涩。
丁曰。阴阳俱盛者、极也。谓寸尺脉俱盛极而紧涩。此者中雾露之寒也。水得风寒而凝结。故知肾得寒而有此脉见
也。虞曰。如切绳状曰紧。如刀剖竹曰涩。
热病之脉。阴阳俱浮。浮之而滑。沉之散涩。
丁曰。阴阳俱浮者、谓尺寸俱浮也。浮之而滑者、轻手按之而滑。是心伤热脉也。（按心热二字当互易。）沉之而散
涩者、沉、手按之而散涩。是津液虚少也。杨曰。轻手按者名浮。重手按者名沉也。
温病之脉。行在诸经。不知何经之动也。各随其经所在而取之。
丁曰。肺者金。主气。散行诸经。不知何经虚而传受此邪。故随其所在取其病邪也。杨曰。兼鬼疠之气。散行诸经。
故不可预知。临病患而诊之。知其何经之动。即为治也。
伤寒有汗出而愈。下之而死者。有汗出而死、下之而愈者。何也。然。阳虚阴盛。汗出而愈。下之即死。阳盛阴虚。
汗出而死。下之而愈。
丁曰。其阴阳盛虚者、谓非言脉之浮沉也。谓寒暑病异。燥湿不同。人之五脏六腑。有十二经。皆受于病。其手太
阳少阴属火。主暄。手阳明太阴属金。主燥。手少阳厥阴属相火。主暑。此是燥暑暄六经。以通天气。病即不体重恶风
而有躁。素问曰诸浮躁者。病在手是也。若以承气下之即愈。服桂枝取汗。汗出即死。其足太阳少阴属水。主寒。足阳
明太阴属土。主湿。足厥阴少阳属木。主风。此是风寒湿六经。以通地气。病即体重恶寒。故素问曰诸浮不躁者。病在
足是也。若以桂枝取汗。汗出即愈。服承气下之即死。此是五脏六腑配合阴阳大法也。所以经云。阳虚阴盛。汗出而愈。
下之而死。其阳盛阴虚。汗出而死。下之而愈。此义非反颠倒也。杨曰。此说反倒于义不通。不可根据用也。若反此行之。
乃为顺尔。虞曰。诸经义皆不错。此经例义。必应传写误也。凡伤寒之病。脉浮大而数。可汗之则愈。病在表也。脉沉
细而数。可下之则愈。病在里也。推此行之。万无一失。
寒热之病。候之如何也。然。皮寒热者。皮不可近席。毛发焦。鼻 。不得汗。
丁曰。肺候身之皮毛。大肠为表里。脏病即寒。腑病即热。故言皮寒热也。皮不可近席者。谓手三阴三阳法天天动。
故病即不欲卧近席也。毛发焦。鼻 不得汗者。谓下有心火燥热之为病。不得汗之。汗之即死。下之即愈。谓肺主燥故
也。
肌寒热者。皮肤痛。唇舌 。无汗。
丁曰。脾候身之肌肉。胃为表里。脏病即体寒。腑病即体热。故言肌寒热也。皮肤痛。唇舌 。脾者应土。土主湿。
故皮肤津液出。体重。其津液外泄。即唇舌 。病名湿燥。无以汗之。汗之即肠胃泻不通。下之即泄注。此者是湿气之
为病。当温中调气也。
骨寒热者。病无所安。汗注不休。齿本 痛。
丁曰。肾主骨。与膀胱为表里。病在阳。即身热、体重、恶寒。在阴即寒。病无所安。肾主水。汗注不休。齿本
痛。汗即愈。下即死。阴盛阳虚故死。杨曰。五脏六腑。皆有寒热。此经惟出三状。余皆阙也。
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。
丁曰。狂病者、病在手三阳。而反汗。故阳盛即发狂也。病在足三阴。而反下。故阴盛即发癫也。杨曰。狂病之候。
观其人初发之时。不欲眠卧。又不肯饮食。自言贤智尊贵。歌笑行走不休。皆阳气盛所为。故经言重阳者狂。此之谓也。
今人以为癫疾。谬矣。
癫疾始发。意不乐。直视僵仆。其脉三部阴阳俱盛是也。
丁曰。经言重阳者狂。重阴者癫。今三部阴阳俱盛者。寸为阳。尺为阴。寸尺俱盛极而沉也。杨曰。癫、颠也。发
则僵仆焉。故有颠蹶之言也。阴气太盛。故不得行立而侧仆也。今人以为痫病。误矣。
六十难曰。头心之病。有厥痛。有真痛。何谓也。然。手三阳之脉。受风寒。伏留而不去者。则名厥头痛。入连在
脑者。名真头痛。
丁曰。手三阳者。阳中之阳。今受风寒。伏留不去。即是三阳逆于上。故名曰厥头病。入连在脑者。名曰真头痛。
脑者。髓海。风寒入即死矣。杨曰。去者、行也。厥者、逆也。言手三阳之脉。伏留而不行。则壅逆而冲于头。故名厥
头痛也。足三阳留壅。亦作头痛。今经不言之。从省久故也。（按久字疑当作文。）虞曰。风冷之气。入于三阳之经。故
头厥痛也。其痛立已。真头痛者。谓风冷之气。入于泥丸宫。则为髓海。邪入则曰真头痛也。头脑中痛甚。而手足冷至
肘膝者。名真头痛。其寒气入深故也。风寒之气。循风府入于脑。故云入连脑也。
其五脏气相干。名厥心痛。
杨曰。诸经络皆属于心。若一经有病。其脉逆行。逆则乘心。乘心则心痛。故曰厥心痛。是五脏气冲逆致痛。非心
家自痛也。
其痛甚。但在心。手足青者。即名真心痛。其真心痛者。旦发夕死。夕发旦死。
丁曰。真心不病。外经受五邪相干。名曰厥心痛。其痛甚则手足青而冷。神门穴绝者死。病名真心痛也。杨曰。心
者、五脏六腑之主。法不受病。病即神去气竭。故手足为之青冷也。心痛手足冷者。为真心痛。手足温者。为厥心痛也。
头痛亦然。从今日平旦至明日平旦为一日。今云旦发夕死。夕发旦死。是正得半日而死也。
Chapter 57 asks: How many types of diarrhea (Xie) are there in total? Do they all have specific names? The answer is: There are five types of diarrhea, and their names differ. They are Wei Xie (Stomach Diarrhea), Pi Xie (Spleen Diarrhea), Dachang Xie (Large Intestine Diarrhea), Xiaochang Xie (Small Intestine Diarrhea), and Da Jia Xie (Great Mass Diarrhea). Da Jia Xie is also known as "Hou Zhong" (Tenesmus/Rectal Heaviness).
Symptoms of Wei Xie (Stomach Diarrhea): Food is not digested, and the stool color is yellow.
Yang states: This is a condition of dysentery/diarrhea. The Stomach belongs to Earth, so its discharge is yellow, and food fails to digest. "Transformation and change" refers to the digestion and breakdown of food; it means the ingested food is excreted intact without undergoing digestive transformation. Yu states: This occurs because Wind pathogen enters the intestines and affects the Stomach from above, causing food indigestion. The *Feng Lun* (Treatise on Wind) states: "Long-standing Wind entering the interior leads to Chang Feng Sun Xie (Intestinal Wind with undigested food diarrhea)." Sun Xie refers to diarrhea with undigested food.
Symptoms of Pi Xie (Spleen Diarrhea): Abdominal distension and fullness, profuse watery diarrhea like pouring water, and vomiting/regurgitation immediately after eating.
Yang states: "Zhu" (pouring) implies lack of control, describing diarrhea flowing like water that cannot be stopped. Spleen disease fails to transform and transport grain, leading to vomiting upon eating. Yu states: The Central direction generates Dampness, Dampness generates Earth, and Earth generates the Spleen. The Spleen dislikes Dampness. When Dampness is excessive, it causes abdominal distension and pouring diarrhea. Earth's nature is associated with Trustworthiness and Taste. Now, if Earth pathology affects taste function, losing this "trust," one vomits upon eating. The *Yin Yang Ying Xiang Da Lun* states: "Excessive Dampness leads to Ru Xie (soft/watery diarrhea)." This means when Dampness attacks the Spleen and Stomach internally, water and grain are not separated, resulting in pouring diarrhea.
Symptoms of Dachang Xie (Large Intestine Diarrhea): Urgency and distress after eating, white-colored stool, borborygmus (bowel sounds), and severe cutting pain.
Yang states: "Jiong Po" means urgency. One feels the immediate need to defecate after eating, which is urgent and uncontrollable. White color derives from the Lung (Metal element, color white). Borborygmus and cutting pain indicate Cold. "Qie" describes pain as sharp as if cut by a knife, depicting the state of the intestines. Yu states: Qi deficiency in the Large Intestine causes an urgent desire to use the toilet after meals. Deficiency allows pathogenic factors to enter the interior; the struggle between True Qi and Pathogen causes severe pain.
Symptoms of Xiaochang Xie (Small Intestine Diarrhea): Passing pus and blood in stool along with urination, and lower abdominal pain.
Yang states: The Small Intestine relates to the Heart, and the Heart governs Blood vessels; thus, pus and blood appear in the stool. The Small Intestine is located in the lower abdomen (Shao Fu), causing lower abdominal pain.
Symptoms of Da Jia Xie (Great Mass Diarrhea): Internal urgency (Li Ji), tenesmus (Hou Zhong), frequent trips to the toilet with inability to pass stool, and pain in the penis/urethra. These are the methods for the five types of diarrhea.
Yang states: "Jia" refers to a knot or mass. This condition involves lower abdominal stagnation/mass accompanied by diarrhea. It is also called "Hou Zhong," meaning pain and heaviness at the anus. Frequent urge to defecate but inability to do so at the toilet, with pain radiating to the penis, indicates Kidney Xie. Consulting various medical texts, there are over twenty types of diarrhea, but only these five are listed here as the main categories. Yu states: The Kidney opens into the two yin orifices (anterior and posterior). Qi deficiency causes frequent urges. Tenesmus with inability to pass stool and penile pain result from Kidney Qi deficiency injuring the Chong Mai (Penetrating Vessel), causing internal urgency. The *Ling Shu: Bing Zhuan* chapter states: "Regarding the five diarrheas, if Wind injures in Spring, and Cold pathogen lingers, it becomes Dong Xie (cavity diarrhea)." (Note: This text actually appears in *Su Wen: Sheng Qi Tong Tian Lun*, without the phrase "regarding the five diarrheas"; *Ling Shu* has no *Bing Zhuan* chapter, but *Lun Ji Zhen Chi* says: "Wind injury in Spring leads to Sun Xie or Chang Pi in Summer," which differs slightly. Thus, current *Ling Shu* is not the old version seen by Yu.) This refers to such cases. Ding states: "Li Ji" (internal urgency) means intestinal pain; "Hou Zhong" (tenesmus) means heaviness below the waist. The rest are annotations from ancient classics.
Chapter 58 asks: How many types of Shang Han (Cold Damage) are there? Do their pulses change? The answer is: There are five types of Shang Han: Zhong Feng (Wind Strike), Shang Han (Cold Damage), Shi Wen (Damp-Warmth), Re Bing (Heat Disease), and Wen Bing (Warm Disease). Their respective symptoms of suffering differ.
Pulse of Zhong Feng (Wind Strike): Yang pulse (Cun position) is Floating and Slippery; Yin pulse (Chi position) is Ru (Soft/Flaccid) and Weak.
Ding states: The superficial muscle layer is where Yang pulses run; light pressure feeling overly forceful is called Slippery. The deep muscle layer is where Yin pulses run; heavy pressure feeling insufficient is called Weak. This is "insufficient on pressing, abundant on lifting," indicating Zhong Feng. Yang states: From Frost Descent to Spring Equinox, illness caused by Wind-Cold is called Shang Han. If Cold is contracted in Winter and then Wind strikes in Spring, it is called Wen Bing. If it manifests in Summer, it is mostly Re Bing. Illness with excessive sweating is called Shi Wen. Injury by empty evils of the eight seasonal transitions is called Zhong Feng. According to this classic, Wen Bing is actually an epidemic pestilence, not just a spring disease. Epidemic pestilence refers to widespread illness across regions regardless of scale. A pulse felt as intermittent upon pressing and absent upon lifting is called Weak. Floating/Slippery before the Guan position and Ru/Weak at Chi indicates Zhong Feng.
Pulse of Shi Wen (Damp-Warmth): Yang pulse (Cun) is Ru and Weak; Yin pulse (Chi) is Small and Rapid/Tight.
Ding states: Yang pulse Ru/Weak indicates Dampness overcoming Fire in the superficial Yang pulse area. Yin pulse Small/Rapid indicates Earth Dampness failing to overcome Wood in the deep Yin pulse area. Hence, Yang is Ru/Weak, Yin is Small/Rapid. Yang states: "Small" means fine; "Rapid" means fast. Yu states: In Shi Wen disease, the patient sweats heavily on the head. Why? Because Cun Yang pulse shows Ru/Weak, indicating Water overcoming Fire. The *Ben Jing* states: "Kidney governs fluids, entering Heart to form sweat." This explains it.
Pulse of Shang Han (Cold Damage): Both Yin and Yang pulses are Exuberant, Tight, and Choppy.
Ding states: "Both Yin and Yang exuberant" means extreme fullness. Cun and Chi pulses are extremely full, tight, and choppy. This results from misty/dewy Cold. Water congeals with Wind-Cold, indicating Kidney Cold produces this pulse. Yu states: "Tight" feels like cutting a rope; "Choppy" feels like splitting bamboo with a knife.
Pulse of Re Bing (Heat Disease): Both Yin and Yang pulses are Floating. Light pressure reveals Slipperiness; heavy pressure reveals Scattered and Choppy qualities.
Ding states: "Both Yin and Yang floating" means both Cun and Chi are floating. Slippery on light pressure indicates Heart Heat affecting the pulse. (Note: "Heart Heat" characters should likely be swapped). Scattered/Choppy on heavy pressure indicates deficiency of Body Fluids. Yang states: Light pressure is Floating; heavy pressure is Sinking.
Pulse of Wen Bing (Warm Disease): Moves through various meridians; unknown which meridian is affected. Treatment depends on locating the affected meridian.
Ding states: Lung belongs to Metal, governs Qi, and distributes through meridians. Unknown which meridian is deficient and transmits the pathogen, so treatment targets the location of the pathogen. Yang states: Combined with Ghost Pestilence Qi, spreading through meridians, making it unpredictable. Diagnose clinically to identify the affected meridian and treat accordingly.
In Shang Han, some recover with sweating but die with purging; some die with sweating but recover with purging. Why? The answer is: In Yang Deficiency and Yin Excess, sweating leads to recovery, purging leads to death. In Yang Excess and Yin Deficiency, sweating leads to death, purging leads to recovery.
Ding states: Yin/Yang excess/deficiency here refers not to pulse floating/sinking, but to differences in Cold/Heat diseases and Dry/Damp natures. The twelve meridians of Zang-Fu are affected. Hand Taiyang/Shaoyin belong to Fire (warmth); Hand Yangming/Taiyin belong to Metal (dryness); Hand Shaoyue/Jueyin belong to Ministerial Fire (summer heat). These six meridians connect to Heaven Qi. Illness presents without body heaviness, aversion to wind, and irritability. *Su Wen* states: Restless pulses indicate Hand meridian disease. Purging with Chengqi Tang cures; sweating with Guizhi Tang kills. Foot Taiyang/Shaoyin belong to Water (cold); Foot Yangming/Taiyin belong to Earth (dampness); Foot Jueyin/Shaoyang belong to Wood (wind). These six meridians connect to Earth Qi. Illness presents with body heaviness and aversion to cold. *Su Wen* states: Floating but non-restless pulses indicate Foot meridian disease. Sweating with Guizhi Tang cures; purging with Chengqi Tang kills. This is the great law of Zang-Fu Yin-Yang coordination. Thus, the text says: Yang Def/Yin Excess -> Sweat cures, Purge kills; Yang Excess/Yin Def -> Sweat kills, Purge cures. This is not contradictory. Yang states: This interpretation is logically inverted and invalid. Doing the opposite would be correct. Yu states: Other chapters are correct; this chapter's logic is likely a transcription error. Generally, for Shang Han, Floating/Large/Rapid pulse (Exterior) requires sweating; Sinking/Fine/Rapid pulse (Interior) requires purging. Following this ensures success.
How to observe Cold-Heat diseases? The answer is: Pi Han Re (Skin Cold-Heat) symptoms include: Skin cannot tolerate lying on mats, hair becomes brittle, nasal dryness, and inability to sweat.
Ding states: Lung governs skin/hair; Large Intestine is its paired organ. Zang disease is Cold, Fu disease is Heat, hence Pi Han Re. Intolerance to mats relates to hand Yin/Yang meridian dynamics. Brittle hair, dry nose, no sweat indicates Lower Heart Fire/Dryness. Failure to sweat leads to death; purging leads to cure due to Lung governing Dryness.
Ji Han Re (Muscle Cold-Heat) symptoms include: Skin pain, dry lips/tongue, no sweat.
Ding states: Spleen governs muscles; Stomach is its paired organ. Zang disease is Body Cold, Fu disease is Body Heat, hence Ji Han Re. Skin pain, dry lips/tongue. Spleen corresponds to Earth/Dampness. Skin fluid leakage causes heaviness. Dry lips/tongue indicates Wet-Dry pathology. Sweating is contraindicated (causes bowel obstruction); purging causes diarrhea. Treat with Warming Middle and Regulating Qi.
Gu Han Re (Bone Cold-Heat) symptoms include: Restlessness, continuous profuse sweating, root-of-tooth pain.
Ding states: Kidney governs bones; Bladder is its paired organ. Exterior/Yang disease brings heat/heaviness/cold aversion; Interior/Yin disease brings cold. Restlessness. Kidney governs Water; profuse sweat and tooth root pain. Sweating cures; purging kills due to Yin Excess/Yang Deficiency. Yang states: All Zang-Fu have Cold-Heat patterns; this chapter only lists three, omitting others.
Chapter 59 asks: How to distinguish Kuang (Mania) and Dian (Episodic Psychosis)? The answer is: Initial Kuang presents with little sleep, no hunger, arrogance (claiming wisdom/virtue), delusions of grandeur, inappropriate laughter, singing, and constant aimless walking.
Ding states: Kuang involves Hand Three Yang meridians with abnormal sweating, leading to Yang Excess and Mania. Dian involves Foot Three Yin meridians treated incorrectly with purging, leading to Yin Excess and Episodic Psychosis. Yang states: Observing initial Kuang: insomnia, refusal to eat, claims of superiority, laughing/walking incessantly. Caused by Yang Excess. Text says "Double Yang leads to Kuang." Confusing it with Dian is wrong.
Initial Dian presents with unhappiness, fixed gaze, sudden stiff collapse. Pulse shows Exuberance in all three positions (Yin and Yang).
Ding states: Text says "Double Yang is Kuang, Double Yin is Dian." Here, all three positions are exuberant. Cun is Yang, Chi is Yin; both are extremely full and sinking. Yang states: "Dian" connects to "Dian" (topple). Collapse during attack is due to Yin Excess preventing standing/walking. Confusing it with Xi (Epilepsy) is wrong.
Chapter 60 asks: Regarding Head and Heart pain, what are Jue Tong (Rebellious Pain) and Zhen Tong (True Pain)? The answer is: Hand Three Yang meridians invaded by Wind-Cold, lingering without dispersing, cause Jue Tou Tong (Rebellious Headache). If pathogen enters and connects to the Brain, it is Zhen Tou Tong (True Headache).
Ding states: Hand Three Yang are Yang within Yang. Wind-Cold lingering causes rebellion upward, hence Jue Tou Bing. Entering the Brain is Zhen Tou Tong. Brain is Sea of Marrow; Wind-Cold entering causes death. Yang states: "Qu" means movement; "Jue" means rebellion. Hand Three Yang stagnating and rebelling against the head causes Jue Tou Tong. Foot Three Yang stagnation also causes headache, omitted here for brevity. (Note: "Jiu" likely typo for "Wen"). Yu states: Wind-Cold in Three Yang causes head rebellious pain, which may resolve quickly. Zhen Tou Tong is Wind-Cold entering Ni Wan Gong (Brain/Sea of Marrow). Severe head pain with cold hands/feet to elbows/knees is Zhen Tou Tong due to deep Cold invasion via Fengfu point connecting to Brain.
If Five Zang Qi interfere with each other, it is named Jue Xin Tong (Rebellious Heart Pain).
Yang states: All meridians connect to the Heart. Disease in one meridian with reverse pulse flow attacks the Heart, causing Heart Pain. This is Jue Xin Tong, caused by Qi rebellion, not intrinsic Heart disease.
If pain is severe, localized strictly to the Heart, with blue/cold hands and feet, it is named Zhen Xin Tong (True Heart Pain). Zhen Xin Tong patients die if onset is morning (evening death) or evening (morning death).
Ding states: True Heart does not get sick; external pathogens attacking constitute Jue Xin Tong. Severe pain with blue/cold limbs indicates Shenmen pulse cessation and death, named Zhen Xin Tong. Yang states: Heart is master of Zang-Fu, normally immune. Disease means Spirit departure and Qi exhaustion, causing blue/cold limbs. Heart pain with cold limbs is Zhen Xin Tong; warm limbs is Jue Xin Tong. Same for headaches. "Morning to next morning" is one day. "Morning onset evening death" implies death within half a day.