一条 肺中风者。口燥而喘。身运而重。冒而肿胀。
此篇就风寒之邪。中于本脏。而言其轻重之不同。以补伤寒论中之所未备也。盖伤寒论中。于直中三阴之
外。经脏同病。余俱先病经络。而后递入脏腑。故发热疼痛等候。俱经络之症。此则三时之风寒。单为中脏。故
其轻重生死之候。俱在本脏。而不及经络者。此也。五脏之经。各出而附于太阳之表。以与卫气相会。肺之
经穴。外走手内 之上侧。又肺附于脊。与背贴近。且肺主呼吸。故经穴脊背以及息道。俱能使肺中风寒也。
风为阳邪。善能化热以伤津液。故精气不能游溢而口燥。又肺受风热。则自剥其膏液以塞清虚之管。故喘
也。运与晕同。风邪善动。而实至高之肺。故其气上旺下衰而身运。脾肺同主太阴。故轻灵旋转。尝有上下合
德之妙。肺病。则天气不下交。而脾土失升降之用。故身重也。肺主气。气为风邪所抟。则上浮外惊。而不与阴
气相接。故头目躯壳。殊觉如两层而病冒。又肺病。则不能转运阳气。故肿。不能传送水道。故胀也。
二条 肺中寒。吐浊涕。
肺中寒。则叶卷而气结。不能蒸其津液于四布。而上泛为浊涕。且肺寒鼻塞者。出气难、而入气较易。故常缩
鼻中之浊涕而见于吐耳。
三条 肺死脏。浮之虚。按之弱。如葱叶。下无根者死。
死脏者。脏中所藏之阴阳。俱将死之候。与下文四脏同义。虚、就脉体之中空而言。弱、就脉机之鼓微而言。凡
脉之形体。阴血主于内。故充实。里阴竭。则脉体中空而虚。又脉之鼓动。神气努于下。故内强。里阳竭。则脉机
底软而弱。夫肺之精汁最高。浮之虚。是肺中之真阴将绝也。肺之神气在脾。按之弱。是肺中之真阳将绝也。
合而状之。竟如葱叶。盖浮取之。则见上皮。沉按之。则得中芤之象也。下字指关部而言。凡脉之来。俱自下而
上。平人重按寸口。本部脉虽不见。而关前隐隐有上引之势者。以脾胃之土气。为肺金之根蒂故也。若得浮
虚、按弱之脉。肺中本部之阴阳既竭。已为危诊。而关上寸下。又无上引之机。是无根也。不死何恃乎。古人
状肺脉者。曰毛。毛者。非牛、羊、犬、马、之毛。乃禽鸟之羽毛也。盖因按羽毛者。中既有主。而散见于两旁者。常
若
有不可寻其边际之状。是中实而外虚者。羽毛之象也。夫中实者。积阴而有质可凭。外虚者。积阳而无象可
得之妙也。今如葱叶。则外有边皮。而中无主令。正与毛脉之中实外虚者相反。况更无土气以托根乎。故必
死也。本篇言五脏风寒伤着者。共十六条。除第九条自愈不用药外。惟七条之肝着。十五条之脾约。十六
条之肾着。立有治例。余则并无方药者。以五脏风寒及伤损诸候。俱不治之症故也。所以第一条言中风之
死症。第二条言中寒之死症。此条合言其死脉耳。盖一条之口燥而喘属阴绝。与浮之而虚之脉相应。运重
而冒以及肿胀属阳绝。与沉之而弱之脉相应。二条之吐浊涕属阴阳两绝。与浮虚沉弱之脉双应。细玩自见。
四条 肝中风者。头目 。两胁痛。行常伛。令人嗜甘。
肝为木脏。与东方风气相通。故肝常出而应风也。脏中阴阳自虚。则肝因而中风矣。目皮之簌簌跳动者。曰
。气虚之候也。头目俱 者。肝中风。则脏真之气自结。而失其疏畅之用。故不能上贯头目。而气虚 动矣。
此与后文浮之而弱之脉应也。肝惟多血。故能养其筋脉。使之调达。肝络内布于胁。风淫血燥。则胁络拘急
而痛。伛者、腰屈不伸之貌。正因胁络拘急。故行常伛。而宽其脉以缓痛耳。甘为脾土之味。肝急而遗其苦于
所胜。故脾因之而俱急。嗜甘者。纵其所好以自救也。其曰令人嗜甘。则因病而嗜。而非平日之素性可知矣。
三句一意。盖两胁痛句为主。而以行伛。外诊其形。以嗜甘。内诊其性也。此即后文按之如索及不来。或曲如
蛇行之应。肝家之死候也。
五条 肝中寒者。两臂不举。舌本燥。喜太息。胸中痛。不得转侧。食则吐而汗出也。
肝居至阴之下。阳气常虚。而与客寒相召。故中寒也。手厥阴心包。行手之正内侧。得足厥阴上浮之阳。与之
交畅。故两臂轻便而能举。中寒。则肝气凝敛而不上充。故其内侧板滞而不能举矣。肝脉络舌本。脏寒。则火
不能蒸血以为津液。故舌本燥也。肝木苦急。故喜太息以少伸其寒郁耳。肝之内络。上贯于膈。胸中痛者。寒
邪阴沁而拘急也。不得转侧者。合两臂不举。及胸中痛而言。肝寒。则遗其祸于所胜。而脾胃受窘。故食则吐。
吐则胃中之悍气愈虚。而不能摄其津液。故汗出也。此亦与下文死脉的对之症也。
六条 肝死脏。浮之弱。按之如索。不来或曲如蛇行者。死。
肝为多血少气之脏。故真阳最贵。真阳内固。则气温而脉体自和。真阳外充。则神完而脉机自满。今以木脉
而浮之见弱。是枝叶之不能上荣者。知神去而机将息矣。索者。紧短之状。按之如索。是根株之已经下结者。
知气削而质欲枯矣。此肝死脏之正脉。下文不来。及曲如蛇行两句。又承按之二字。而言死脉中之渐变者
也。按。非重按至骨。但比浮而轻取者。略略沉按之之谓。不来者。不特按时断绝。即再浮之。而亦不能乍还。残
阳不胜六菽九菽之重也。曲如蛇行者。伏而不鼓。但左右弯曲。如蛇之行走。即俗称屋漏痕者是。真气之有
去而不复返之象也。故皆主死。然断期之法。大概浮弱而按之如索者。以月计。浮弱而按之不来者。以日计。
浮弱而按之曲如蛇行者。惟以时计而已矣。
七条 肝着。其人常欲蹈其胸上。先未苦时。但欲饮热。旋复花汤主之。（方佚）
肝以阳气为贵。木得春而枝叶融和。性情舒畅之理也。着者。留滞之义。脏中阳虚。而阴寒之气。不能融和舒
畅。且肝络从少阳之胁而上贯于胸。故其粘滞之气。留着于胸也。夫肝之阴气。既着于胸。则其胸中。常有似
板似紧之候。重按之少可者。其理有三。盖按则以动而微开肝气之郁者。一也。按则以实而下驱着气之浮
者。二也。又按则以他人手足之阳热借温至阴之寒逆者。三也。曰常欲蹈其胸上。甚言其欲得重按之意。苦。
即胸中所谓扳紧者是。先未苦时。常欲饮热者。热乃阳类。胸将着而求救于外火也。不言食热而曰饮热。从
木性之喜水。而尤宜伏雨也。旋复花从春以及秋杪。丛生而繁花。得阴阳之气最胜。故为肝经之气药。且体
轻（体轻、就其瓣落。而花蒂如耳捻之状而言。）味盐。体轻、则盘旋于上焦。味盐、则终覆为下润。故又为胸
中之降药。以之主胸上之肝着宜矣。独是名存方缺。深为恨惜。以愚鄙拟之。或合桂甘姜半。及细辛等味。以
为佐使乎。或问肝在下焦。何以病肝着者。其症却在上焦耶。答曰。肝木藏精汁于下。而浮神气于上。胸中
者。神气之所荣也。木衰而巅顶之枝柯。先见枯劲。此肝着之象也。
八条 心中风者。翕翕发热。不能起。心中饥。食即呕吐。
手少阴经脉。外见于手内 之下侧。又口鼻之息道。内络心包。故心中风寒也。心为火脏。以善于化热之阳
邪中之。则风从火化。而脏中之真阴。不足以胜之。故浮而发为表热也。翕翕。见伤寒桂枝症注。风火交煽之
象。风木之邪。实于君火之脏。则飘忽如运枢。故不能起矣。饥出于胃。曰心中饥者。真阴受伤。干热之燥化。而
非真饥也。邪热剥心血于上。而中焦之阴。在悉索上供。而犹不敷之候。则连渣带汁以上奔。故食即呕吐也。
条中凡四症。前发热等三症。应下文四条浮之实之脉。食即呕吐一症。应按之益躁疾之脉。盖风火之邪上
盛。故浮之实如麻豆。真阴之液下竭。故按之益加躁疾。亦死候也。
九条 心中寒者。其人苦病心如啖蒜状。剧者心痛彻背。背痛彻心。譬如蛊注。其脉浮者。自吐乃愈。
心为君火之脏。体阴而用阳者也。中寒则阴邪剥阳。其一种阴沁克削之候。常有似疼非疼。似空非空。令人
愦愦然无奈。而莫可名状者。蒜性辛辣耗削。多啖、则心中之非疼非空者似之。故以之为喻也。然此犹苦之
未甚者。若剧、则寒邪已中于心。因从心而痛彻于背。或寒邪先中于背。因从背而痛彻于心。此中寒之最重。
又非啖蒜之比。竟如蛊毒之虫。连心及背。走注穿啮之象。夫心部之脉。浮主心气。按主心血。心气中寒则邪
实。故浮之实如麻豆。心血无阳则拘急。故按之益躁疾。与上条同为死症。但上条为心中真阴先死。此条为
心中真阳先死之异耳。脉浮二句。又就中寒者之活症而抽言之也。盖谓中寒之症既具。倘其脉得上浮。则
浮为阳热未服之应。又为大气上转之应。夫阳热未服。则能自振以驱寒。大气上转。则能高越而提气。故自
吐而愈可必也。其曰脉浮者。自吐乃愈。则不浮者之不能愈。已在言外矣。
十条 心伤者。其人劳倦。即头面赤而下重。心中痛而自烦。发热。当脐跳。其脉弦。此为心脏伤所致也。
此条当与虚劳及惊悸门参看。心伤者。指心气、心血、两伤而言也。劳倦、因劳而倦。凡外而劳形。内而劳神者
皆是。头面赤者。劳则生热。心血虚而不足以胜之。故浮其热于头面也。下重者。因劳而心气愈馁。不能上提。
而有下脱之机致也。气削则不能自温。故心中塞痛。血虚则不能内润。故干烦也。发热者。即头面赤之理。而
外发为表热也。当脐跳者。心气虚于阳位。将下招浊阴之上乘。而当脐之气自动也。脉指左寸而言。弦者。气
虚脉削。（从横处而言其减瘦）气寒脉急（从直处而言其拘紧）之应。夫症则阴阳两亏。脉则神气顿
减。岂非心脏受伤之所致乎。细按此条。俱系活症。其不出方者。或以虚劳中已详之也。今援虚劳之例。拟
之以小建中。而加参 归麦。其庶几耶。
十一条 心死脏。浮之实。如麻豆。按之益躁疾者。死。
心之为脏。于卦属离。常外阳而内阴。外阳则为气为火。其象有光焰而无形质。故其脉浮而举之。常似大而
且散者。以心中阳气之充周也。内阴则为精为水。其性宜流利而尤喜安顿。故其脉沉而按之。常似滑而且
缓者。以心中阴血之静镇也。若浮之实而如芝麻小豆之状。是火无光焰。而形质代呈。则知脏中之真阳外
亡矣。按之而麻豆之形仍在。但觉益加躁疾。夫躁者。浮散而不返。疾者。坚搏而不和。是水源倾注而出之象。
则知脏中之真阴内竭矣。故主死也。前中风中寒之死症。配合此条之死脉。另是一种解法。非与此条之
实脉及躁疾者。自相矛盾也。盖本条为正解。前二条从风寒之贼阴贼阳而言。故实脉为邪实。躁疾为无阳
无阴之诊。确有至理。识者辨之。
十二条 邪哭。使魂魄不安者。血气少也。血气少者属于心。心气虚者。其人则畏。合目欲眠。梦远
行。而精神离散。魂魄妄行。阴气衰者为癫。阳气衰者为狂。
无因而哭。如妖邪之状。故曰邪哭。独言哭者。血虚则咽塞。气虚则卑陷。二者并合。故好为无端之哭泣矣。肝
主阴血。血中阳神为魂。肺主阳气。气中阴精为魄。气血两充。则魂魄各安其宅。且相抱而入心。以神其神。反
此、则魂魄不安。而妄哭如中邪矣。故曰血气少也。二句先言肝肺中之血气虚。心为离象。外阳而内阴者。气
表而血里也。气表。故与主气之肺相属。血里。故与统血之肝相属。是肝肺血气之多少。与心相连属。故曰血
气少者。属于心也。二句。言肝肺虚而心气相应而亦虚。心为神脏。而神以气之虚实为盈缩。心血虚而致心
气虚者。则神气损削。而灵道扩窃。譬之孤舟夜泊空江。孤身夜入荒山之象。故其人常自畏也。又气盛。则神
起而喜外用。旦昼之象。气虚。则神倦而甘内藏。暮夜之象。故合目欲眠。即足少阴喜寐之候。以手足少阴之
情性颇同故也。三句。单言心气虚。是此条入心脏之正文。心血内虚。则神窘于所宅。有如国难出亡。家贫流
荡之义。故梦作远行。夫心神之所梦者。要不出乎本身之脏腑经络。虽相去仅经尺寸。而神劳气阻。遂生关
山间隔之境。至其虚幻泡影。却根据金木水火土之相冲。与恐惧震怖之妄情相合。而各为类应者也。精神离
散两句。又合心肾肝肺而言其俱虚。且自注梦远行之故。盖因心中之神。托根于肾精。抱一于肝魂肺魄。而
成合德之妙者。今精不根神。而两相离散。魂魄不抱一。而妄为上升下坠之行。梦则神明欲内伏而不得。故
见种种之境也。阴气两句。又从正虚、而推言客气之上并也。癫者。颠倒。狂者。狂悖之义。但癫属阴病。阴气惨
毒。狂属阳病。阳气高迈。盖心中之气血偏衰。自为病者。如上文所云。若下焦肝肾之阴阳。各因其类而并之。
则神君逊位而出。故阴气衰者为癫。阳气衰者为狂矣。然亦有阴阳互并者。阴衰见阳并。则大笑大乐。好登
高远行。而日夜不寐。阳衰见阴并。则大惊大畏。好深藏畏避。而终不自安。此又癫狂之变症。不可不知者也。
其互并而不病癫狂。即吐衄惊悸中之所论者。是也。
Article 1: When the Lung is struck by Wind pathogen, there will be dryness of the mouth and panting (asthma), dizziness with heaviness of the body, vertigo (dizziness) accompanied by swelling.
This chapter discusses the invasion of Cold and Wind pathogens directly into the Zang organs, illustrating the differences in severity to supplement what was not fully covered in the *Shanghan Lun* (Treatise on Cold Damage). Generally, in the *Shanghan Lun*, apart from direct transmission to the Three Yin meridians, when both meridians and Zang organs are diseased, it usually begins in the meridians and then sequentially enters the Zang organs. Therefore, symptoms such as fever and pain belong to meridian diseases. Here, however, it refers to Wind and Cold from the three seasons striking only the Zang organs. Thus, the signs of lightness, severity, life, and death all reside in the Zang organs themselves, without involving the meridians; this is the reason. The meridians of the Five Zang organs emerge and attach to the exterior of the Taiyang (Greater Yang) meridian to meet with Wei Qi (Defensive Qi). The Lung meridian acupoints extend outward to the upper side of the inner aspect of the hand. Furthermore, the Lung attaches to the spine and is close to the back. Since the Lung governs respiration, the meridians, acupoints, spine, back, and respiratory tract can all allow the Lung to be struck by Wind and Cold.
Wind is a Yang pathogen that easily transforms into Heat and damages Body Fluids (Jin Ye). Therefore, Essence and Qi cannot circulate freely, leading to dryness of the mouth. Additionally, when the Lung is affected by Wind-Heat, it depletes its moistening fluids to obstruct the clear and empty airways, resulting in panting (asthma). "Yun" (movement/dizziness) is synonymous with "Yun" (vertigo). Wind pathogen tends to cause movement, and since the Lung is located at the highest position, its Qi rises excessively while declining below, causing dizziness. Spleen and Lung both belong to the Taiyin system; thus, they possess the subtle function of light rotation and harmonious interaction between Heaven (Lung/Qi) and Earth (Spleen/Food). When the Lung is diseased, Heavenly Qi fails to descend and interact, and the Spleen Earth loses its ascending and descending functions, resulting in heaviness of the body. The Lung governs Qi. When Qi is constrained by Wind pathogen, it floats upward and startles externally, failing to connect with Yin Qi. Consequently, the head, eyes, and body feel as if separated into two layers, experiencing a sensation of being muddled or obscured (Mao). Moreover, when the Lung is diseased, it cannot transport Yang Qi, leading to edema (swelling); it cannot transmit water passages, leading to distension.
Article 2: When the Lung is struck by Cold, turbid nasal discharge is expectorated.
When the Lung is struck by Cold, the lung lobes curl inward and Qi becomes knotted, unable to vaporize and distribute Body Fluids. Instead, fluids overflow upward as turbid nasal discharge. In cases of nasal congestion due to Lung Cold, exhalation is difficult while inhalation is relatively easier. Therefore, one often contracts the turbid nasal discharge and expectorates it.
Article 3: A dying Lung pulse is floating and deficient upon light pressure, weak upon heavy pressure, resembling the leaf of a green onion, and lacking a root at the bottom indicates death.
A "dying Zang" refers to the state where the Yin and Yang stored within the Zang organ are about to perish, which has the same meaning as the four subsequent Zang organs. "Deficient" (Xu) refers to the hollow nature of the pulse body; "Weak" (Ruo) refers to the faint pulsation force. Generally, the form of the pulse is governed by Yin Blood internally, making it full. If Interior Yin is exhausted, the pulse body becomes hollow and appears deficient. The pulsation is driven by Shen Qi (Spirit Qi) from below, making the interior strong. If Interior Yang is exhausted, the pulse mechanism becomes soft at the base and appears weak. The essence fluid of the Lung is located at the highest point. Floating and deficient indicates that the True Yin of the Lung is about to extinguish. The Shen Qi of the Lung resides in the Spleen; weak upon heavy pressure indicates that the True Yang of the Lung is about to extinguish. Describing this combined state, it resembles a green onion leaf. Light pressure reveals only the outer skin, while deep pressure reveals a hollow center. The character "Xia" (below) refers to the Guan (Cun-Guan-Chi) position. Generally, pulses come from below upwards. In a healthy person, even if the Cun (Inch) position is not visible upon heavy pressure, there is a hidden tendency for the pulse to pull upward from the Guan area because the Earth Qi of the Spleen and Stomach serves as the root for Lung Metal. If a floating-deficient and weak-upon-pressure pulse is obtained, the Yin and Yang of the Lung's own position are exhausted, indicating a critical condition. If there is also no upward-pulling mechanism below the Guan and Cun positions, it means there is no root. How could one survive without a root? Ancients described the Lung pulse as "Mao" (Hair/Feather). This "Mao" does not refer to the hair of cattle, sheep, dogs, or horses, but to the feathers of birds. When pressing a feather, there is a central main stem, while the parts scattered on both sides seem to have indistinct boundaries; this represents an image of being solid in the center and empty on the outside. Being solid in the center implies accumulated Yin with tangible substance; being empty on the outside implies accumulated Yang without fixed form. Now, resembling a green onion leaf, there is an outer edge but no central stem, which is exactly opposite to the Mao pulse's solid-center-and-empty-outside characteristic. Furthermore, there is no Earth Qi to support the root. Therefore, death is certain.
This chapter discusses injuries to the Five Zang organs by Wind and Cold, totaling sixteen articles. Excluding Article 9 which heals spontaneously without medication, only Article 7 (Liver Fixation), Article 15 (Spleen Constriction), and Article 16 (Kidney Fixation) have established treatment examples. The rest lack prescriptions because injuries to the Five Zang organs by Wind, Cold, and trauma are generally incurable conditions. Thus, Article 1 describes the fatal syndrome of Wind strike, Article 2 describes the fatal syndrome of Cold strike, and this article combines them to describe their fatal pulses. Roughly speaking, the dry mouth and panting in Article 1 belong to Yin exhaustion, corresponding to the floating-deficient pulse. Dizziness, heaviness, vertigo, and swelling belong to Yang exhaustion, corresponding to the sinking-weak pulse. The expectoration of turbid nasal discharge in Article 2 belongs to dual exhaustion of Yin and Yang, corresponding doubly to the floating-deficient and sinking-weak pulses. Careful study will reveal this.
Article 4: When the Liver is struck by Wind, there is twitching of the head and eyes, pain in both hypochondria, habitual stooping during walking, and a craving for sweet flavors.
The Liver is a Wood organ, communicating with the Wind Qi of the East; thus, the Liver often interacts with Wind. When the Yin and Yang within the Zang are naturally deficient, the Liver becomes susceptible to Wind strike. Twitching of the eyelids is called "Shu," a sign of Qi deficiency. Twitching of both head and eyes occurs because when the Liver is struck by Wind, the True Qi of the Zang knots itself and loses its free-flowing function, failing to ascend to the head and eyes, leading to Qi-deficiency-induced twitching. This corresponds to the floating-weak pulse mentioned later. The Liver is unique in having abundant blood, which nourishes the sinews and tendons, allowing them to be flexible. The Liver collaterals spread internally to the hypochondrium. When Wind pathogen causes Blood dryness, the hypochondrial collaterals become contracted and painful. "Yu" refers to the appearance of bending the waist and not extending. Precisely because the hypochondrial collaterals are contracted, the patient habitually walks stooped to relax the vessels and alleviate pain. Sweet is the flavor of Spleen Earth. When the Liver is tense, it transmits its bitterness to the element it overcomes (Earth/Spleen), causing the Spleen to become tense as well. Craving for sweetness is indulging in what is liked to self-rescue. The phrase "causing people to crave sweetness" indicates that this is due to illness, not the person's normal disposition. These three sentences convey one idea: "Pain in both hypochondria" is the main clause, while "walking stooped" diagnoses the form externally, and "craving sweetness" diagnoses the nature internally. This corresponds to the Liver's fatal signs mentioned later: pressing like a cord, absence of pulse, or winding like a snake.
Article 5: When the Liver is struck by Cold, the arms cannot be raised, the root of the tongue is dry, there is frequent sighing, chest pain, inability to turn sideways, vomiting after eating, and sweating.
The Liver resides below the Extreme Yin, so its Yang Qi is often deficient, attracting external Cold pathogens, leading to Cold strike. The Hand Jueyin Pericardium Meridian runs along the medial aspect of the arm, receiving the ascending Yang Qi from the Foot Jueyin Liver Meridian to ensure smooth circulation, making the arms light and able to lift. When struck by Cold, Liver Qi condenses and fails to ascend, causing stiffness in the medial aspect and inability to lift. The Liver meridian connects to the root of the tongue. When the Zang is cold, Fire cannot vaporize Blood to create Body Fluids, resulting in dryness of the root of the tongue. Liver Wood suffers from tension, so it likes to sigh to slightly relieve the Cold stagnation. The internal collaterals of the Liver ascend through the diaphragm. Chest pain is caused by Cold pathogen infiltrating and contracting. Inability to turn sideways relates to the inability to raise the arms and chest pain. Liver Cold transfers its harm to the overcame element (Spleen/Stomach), causing distress; thus, vomiting occurs after eating. Vomiting further depletes the vigorous Qi of the Stomach, which fails to control Body Fluids, leading to sweating. This also corresponds to the symptoms paired with the fatal pulse mentioned later.
Article 6: A dying Liver pulse is weak upon light pressure, feels like a cord upon heavy pressure, lacks flow (Bu Lai), or winds like a snake; this indicates death.
The Liver is an organ with abundant Blood and scarce Qi, so True Yang is most precious. When True Yang is secured internally, the Qi is warm and the pulse body is harmonious; when True Yang fills externally, the Spirit is complete and the pulse mechanism is full. Now, if a Wood-type pulse is weak upon light pressure, it indicates that the branches and leaves fail to nourish the top, showing that the Spirit has departed and the mechanism is about to cease. "Suo" (Cord) describes a tight and short shape. Feeling like a cord upon heavy pressure indicates that the roots have knotted downwards, showing that Qi is depleted and the substance is withering. This is the correct pulse for a dying Liver. The following phrases "Bu Lai" (no return/absence) and "Qu Ru She Xing" (winding like a snake) elaborate on the gradual changes of the fatal pulse under "heavy pressure." "Pressing" here does not mean pressing to the bone, but rather slightly deeper than light pressure. "Bu Lai" means not only is the pulse absent upon pressure, but even upon re-floating, it cannot suddenly return; the residual Yang cannot withstand the weight of six or nine beans. "Qu Ru She Xing" means the pulse lies flat without pulsation, curving left and right like a snake walking, also known as "House Leak Mark." This is the image of True Qi departing and never returning. Therefore, all indicate death. However, methods to predict the time of death vary: for floating-weak and cord-like upon pressure, count in months; for floating-weak and absent upon pressure, count in days; for floating-weak and winding like a snake, count only in hours.
Article 7: Liver Fixation (Gan Zhuo): The patient constantly desires someone to tread on their chest. Initially, before suffering, they only desire hot drinks. Xuan Fu Dai Zhe Tang (Inula and Hematite Decoction) is the primary formula. (Formula lost).
The Liver values Yang Qi. Wood thrives in spring with harmonious branches and leaves, reflecting its soothing nature. "Zhuo" means fixation or stagnation. Due to Zang Yang deficiency, Yin-Cold Qi cannot harmonize and soothe. The Liver collaterals ascend from the Shaoyang hypochondrium to the chest, so sticky Qi fixes in the chest. Once Liver Yin Qi fixes in the chest, there is a sensation of hardness and tightness in the chest, which is slightly relieved by heavy pressure. There are three reasons: first, pressing opens the Liver Qi depression slightly; second, pressing drives down the floating stagnant Qi; third, pressing borrows the Yang heat from others' hands/feet to warm the Extreme Yin Cold. Saying "constantly desires treading on the chest" emphasizes the desire for heavy pressure. "Ku" (bitterness/suffering) refers to the tightening in the chest. Before suffering, desiring hot drinks reflects seeking external Fire (Yang) to save the impending fixation. Saying "drink hot" rather than "eat hot" aligns with Wood's affinity for Water and rain. Xuan Fu Hua (Flower of Inula) blooms profusely from spring to late autumn, possessing supreme Yin-Yang Qi, making it a Qi medicine for the Liver channel. It is light in texture (petals fall, calyx resembles an ear-twist) and salty in taste. Lightness allows it to rotate in the Upper Jiao; saltiness allows it to descend and moisten. Thus, it is a descending medicine for the chest, suitable for treating Liver Fixation in the chest. It is regrettable that the name exists but the formula is missing. I tentatively suggest combining Guizhi (Cinnamon Twig), Gancao (Licorice), Ganjiang (Dried Ginger), Banxia (Pinellia), and Xixin (Asarum) as assistants. Question: The Liver is in the Lower Jiao, why do symptoms of Liver Fixation appear in the Upper Jiao? Answer: Liver Wood stores essence fluid in the lower part but floats Shen Qi to the upper part. The chest is where Shen Qi flourishes. When Wood is weak, the branches at the crown wither first, which is the image of Liver Fixation.
Article 8: When the Heart is struck by Wind, there is mild fever (Xi Xi Fa Re), inability to rise, a sensation of hunger in the Heart region, and vomiting immediately after eating.
The Hand Shaoyin Heart Meridian appears on the lower medial aspect of the hand. The respiratory passages of the mouth and nose connect internally to the Pericardium; thus, the Heart can be struck by Wind and Cold. The Heart is a Fire organ. When attacked by Yang pathogens that easily transform into Heat, Wind transforms into Fire. The True Yin within the Zang cannot overcome it, so Heat floats to the surface as exterior Heat. "Xi Xi" (mild/warm) is explained in the Guizhi Syndrome note of *Shanghan Lun*; it is the image of Wind and Fire fanning each other. Wind-Wood pathogen filling the Jun Fire (Heart) organ makes it erratic like a turning pivot, hence the inability to rise. Hunger originates from the Stomach; saying "Hunger in the Heart" means True Yin is injured, causing dry Heat燥化 (dry transformation), which is not true hunger. Evil Heat strips Heart Blood from above, while Middle Jiao Yin struggles to supply upwards but remains insufficient. Consequently, food and juice rush upward, causing immediate vomiting upon eating. Among the four symptoms in this article, the first three (fever, etc.) correspond to the floating-excess pulse mentioned later. The symptom of immediate vomiting corresponds to the heavy-pressure-irregular pulse. Generally, excess Wind-Fire above causes the floating pulse to feel solid like hemp seeds or beans; depletion of True Yin fluids below causes the heavy-pressure pulse to become increasingly restless. This is also a fatal sign.
Article 9: When the Heart is struck by Cold, the patient suffers as if swallowing garlic. In severe cases, heart pain penetrates to the back, and back pain penetrates to the heart, resembling the injection of venomous insects. If the pulse is floating, spontaneous vomiting leads to recovery.
The Heart is the Zang of Monarch Fire, with Yin structure and Yang function. Struck by Cold, Yin pathogen strips Yang. This Yin infiltration and consumption creates a sensation that is neither pain nor emptiness, leaving the patient confused and helpless, indescribable. Garlic is pungent, spicy, and consuming; eating much mimics this non-pain/non-emptiness sensation in the Heart, hence the metaphor. However, this is mild suffering. If severe, Cold pathogen has entered the Heart, causing pain from the Heart penetrating to the back, or from the back penetrating to the Heart. This is the heaviest Cold strike, worse than swallowing garlic, resembling venomous insects biting through the Heart and back. In the Heart region, floating governs Heart Qi, and pressing governs Heart Blood. Cold in Heart Qi causes evil excess, so floating feels solid like hemp seeds. Lack of Yang in Heart Blood causes contraction, so pressing feels increasingly restless. Like the previous article, this is a fatal sign. The difference is that the previous article involves the prior death of True Yin in the Heart, while this involves the prior death of True Yang in the Heart. The phrases "Pulse floating... recovers by vomiting" discuss the viable condition of Cold strike. If the pulse floats despite Cold strike symptoms, floating indicates Yang Heat has not failed and represents the upward movement of Grand Qi. Unfailed Yang Heat can shake off Cold; upward-moving Grand Qi can lift Qi. Thus, spontaneous vomiting ensures recovery. Saying "If pulse floats, recovery follows" implies that if the pulse does not float, recovery is impossible.
Article 10: When the Heart is injured, the patient becomes fatigued and weary; upon exertion, the head and face turn red while the lower body feels heavy. There is heart pain, internal vexation, fever, jumping at the navel, and a wiry pulse. This is caused by Heart injury.
This article should be cross-referenced with the Deficiency Consumption and Palpitations sections. "Heart injury" refers to damage to both Heart Qi and Heart Blood. Fatigue results from exertion, whether physical or mental. Head and face redness occurs because exertion generates Heat; deficient Heart Blood cannot contain it, so Heat floats to the head and face. Heaviness in the lower body occurs because exertion further weakens Heart Qi, preventing it from lifting, leading to a tendency to sink. Depleted Qi cannot self-warm, causing stifling pain in the Heart; deficient Blood cannot moisten internally, causing dry vexation. Fever is the principle behind head/face redness manifesting as exterior Heat. Jumping at the navel occurs because Heart Qi is deficient in its Yang position, inviting turbid Yin to ascend, causing Qi at the navel to move spontaneously. The pulse refers to the Left Cun position. Wiry (Xian) indicates Qi deficiency leading to a thinned pulse (from the horizontal aspect) and Cold Qi leading to a tense pulse (from the vertical aspect). The symptoms show dual deficiency of Yin and Yang; the pulse shows sudden reduction of Shen Qi. Is this not caused by Heart injury? Upon careful examination, all symptoms here are viable. No formula is given, perhaps because it is detailed in Deficiency Consumption. Following the example of Deficiency Consumption, I propose Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) added with Renshen (Ginseng), Huangqi (Astragalus), Danggui (Angelica), and Maidong (Ophiopogon). This might be appropriate.
Article 11: A dying Heart pulse is solid upon light pressure, like hemp seeds or beans, and increasingly restless upon heavy pressure; this indicates death.
The Heart belongs to the Li trigram, typically Exterior Yang and Interior Yin. Exterior Yang constitutes Qi and Fire, appearing luminous but formless; thus, its pulse floats and feels large and scattered upon lifting, due to the abundance of Heart Yang Qi. Interior Yin constitutes Essence and Water, preferring smooth flow and stability; thus, its pulse sinks and feels slippery and slow upon pressing, due to the calmness of Heart Yin Blood. If floating feels solid like sesame seeds or beans, it means Fire has lost its luminosity and taken on form, indicating the loss of True Yang from the Zang. If pressing retains the bean-like shape but feels increasingly restless, it indicates that Restlessness (Zao) is floating and scattering without returning, and Rapidity (Ji) is hard and clashing without harmony. This is the image of the water source pouring out, indicating the exhaustion of True Yin within the Zang. Therefore, it indicates death. The fatal signs of Wind and Cold strikes previously discussed, matched with this fatal pulse, offer another interpretation, not contradicting the solid and restless pulse of this article. This article is the standard explanation; the previous two articles view it from the perspective of Wind-Cold thieves damaging Yin and Yang, where solid pulse means evil excess and restless pulse means absence of Yang and Yin. This has profound truth; discerning scholars should distinguish them.
Article 12: Evil crying, causing instability of Hun and Po, is due to scarcity of Blood and Qi. Scarcity of Blood and Qi belongs to the Heart. When Heart Qi is deficient, the person fears, closes their eyes wanting to sleep, dreams of traveling far, and their Spirit scatters while Hun and Po wander erratically. Deficiency of Yin Qi leads to Dian (catatonic schizophrenia), and deficiency of Yang Qi leads to Kuang (manic schizophrenia).
Crying without cause, resembling possession, is called "Evil Crying." Specifically mentioning crying is because Blood deficiency causes throat constriction, and Qi deficiency causes sinking; together, they lead to unprovoked weeping. The Liver governs Yin Blood; the Yang Spirit within Blood is Hun (Ethereal Soul). The Lung governs Yang Qi; the Yin Essence within Qi is Po (Corporeal Soul). When Blood and Qi are abundant, Hun and Po reside peacefully in their homes, embracing and entering the Heart to illuminate the Shen (Spirit). Conversely, Hun and Po are unstable, causing wild crying as if possessed. Hence, "scarcity of Blood and Qi." These two sentences first address Blood and Qi deficiency in Liver and Lung. The Heart is the Li trigram, Exterior Yang and Interior Yin, with Qi on the exterior and Blood on the interior. Qi being exterior links it to the Lung (governing Qi); Blood being interior links it to the Liver (governing Blood). Thus, the amount of Blood and Qi in Liver and Lung is connected to the Heart, hence "Scarcity of Blood and Qi belongs to the Heart." These sentences imply that Liver and Lung deficiency causes corresponding Heart Qi deficiency. The Heart is the Zang of Spirit, and Spirit expands or contracts based on Qi deficiency or excess. When Heart Blood deficiency leads to Heart Qi deficiency, Spirit and Qi are depleted, and spiritual pathways are compromised, like a lone boat moored in an empty river at night or a solitary figure entering a desolate mountain at night. Hence, the person often feels fear. When Qi is abundant, Spirit rises and prefers external activity (daytime image); when Qi is deficient, Spirit is tired and prefers internal storage (nighttime image). Hence, closing eyes and wanting to sleep, similar to the Foot Shaoyin preference for slumber, as Hand and Foot Shaoyin share similar natures. The next three sentences focus solely on Heart Qi deficiency, the core of this article regarding Heart injury. Internal Heart Blood deficiency confines the Spirit in its residence, like fleeing a national disaster or wandering due to poverty, hence dreaming of long journeys. Dreams of the Heart Spirit generally involve one's own Zang organs and meridians. Though distances are small, Spirit fatigue and Qi obstruction create imagined barriers like mountains and passes. Illusory shadows arise from clashes among Metal, Wood, Water, Fire, and Earth, matching fearful emotions. "Spirit scatters" combines Heart, Kidney, Liver, and Lung to describe universal deficiency, explaining the dream of long journeys. The Spirit in the Heart takes root in Kidney Essence and embraces Liver Hun and Lung Po to achieve harmonious synergy. Now, Essence does not root Spirit, causing separation; Hun and Po do not embrace, causing erratic rising and falling. Dreams occur because Spirit wants to settle internally but cannot, hence seeing various scenes. The sentences on Yin and Yang deficiency deduce from Zheng (True) deficiency that Ke (Pathogenic) Qi ascends. "Dian" means inversion/catatonia; "Kuang" means madness/manic behavior. Dian belongs to Yin disease (Yin Qi is cruel/toxic); Kuang belongs to Yang disease (Yang Qi is high/arrogant). If Heart Blood and Qi are unevenly deficient, it causes illness as described above. If Yin and Yang of Lower Jiao Liver and Kidney merge according to their kinds, the Spirit Lord abdicates, so Yin deficiency leads to Dian and Yang deficiency leads to Kuang. However, there are mutual mergers. Yin deficiency with Yang merging causes laughter, joy, climbing heights, traveling far, and insomnia day and night. Yang deficiency with Yin merging causes great fear, hiding, avoidance, and perpetual insecurity. These are variable syndromes of Dian and Kuang, which must be known. Those who merge without developing Dian or Kuang are discussed in the sections on Epistaxis, Vomiting Blood, Palpitations, and Fright.