端直以长。合为弦脉。夫濡弱。为脾土之气。木之所养也。轻虚。为肺金之气。木之所成也。滑。为肾水之气。木之
所滋也。然后端直以长。自露其调达畅茂之本性。故不特春不弦。弦不春。为非时。而且不濡弱为脾病。不轻
虚为肺病。不滑。为肾病。不端重则轻浮而为上焦晕眩胀满等病。不正直。则横肆。而为中下二焦沉坠切痛
等病。不匀长。则短滞。而为本脏郁结等病。故曰。皆当病者。其旨深矣。此又合言色脉二诊之上工也。
问曰。有未至而至。有至而不至。有至而不去。有至而太过。何谓也。师曰。冬至之后。甲子夜半。少阳起。少阳
之时。阳始生。天气温和。以未得甲子。天因温和。此为未至而至也。以得甲子。而天未温和。此为至而不至也。以得
甲子。而天大寒不解。此为至而不去也。以得甲子。而天温、如盛夏五六月时。此为至而太过也。
此条承上文非其时色脉句来。言非时之色脉。虽为人病。实为天气使然。上工负裁成辅相之任。所贵知天
时之变。而补救其偏弊之色脉也。夫天以从温而热。以至大热。复从清而寒。以至大寒。一岁凡十二月。以统
二十四节。人亦由少阳、历阳明、而至太阳。复由太阴、历少阴、而至厥阴。手足凡十二经。以应二十四气。天之
初温。起于冬至后之甲子。则人之微阳。应于足少阳之胆经。历冬至后之四节。而终手足少阳之气焉。天之
初热。交于雨水后之甲子。则人之正阳。应于足阳明之胃经。历雨水后之四节。而终手足阳明之气焉。天之
大热。交于谷雨后之甲子。则人之亢阳。应于足太阳之膀胱经。历谷雨后之四节。而终手足太阳之气焉。三
阴仿此。仲景假古经之文。而设为问答者。盖谓除却冬至后之甲子。天气温和。所谓时至而气即至者为平
气。天气平。则人之色脉俱应。而病者少矣。若夫早至。迟至。寒气不去。热气太过。皆为天地乖舛之气。而生人
遂多非时之色脉。大乖舛、则大不应。小乖舛、则小不应。知此。则寒热之宜。五味之用。施之各当。业此者其可
忽乎。举一冬至后之甲子。则夏至后之甲子可反悟矣。举一冬至后之甲子。则雨水谷雨等节后之甲子。又
可类推矣。旧注不特肤陋。且将此条。注为本经闲文。全用不着。以致如来放五色毫光之佛手。竟同赘疣息肉。悲哉。
师曰。病患脉浮者。在前。其病在表。浮者。在后。其病在里。腰痛、背强、不能行。必短气而极也。
上文所言之脉。因四时非时而见。从未病而诊其将病。此后言脉。是从既病而寻其病处。并诊其生死也。故
曰病患。前后。指关之前后而言。关前为表。关前见浮。是表气为风寒所伤。或暑湿燥火犯之。故表气不内附
而脉浮也。故曰病在表。关后为里。关后不当浮而见浮。是阴精内伤。阳无所附。而浮之象。故曰病在里。腰为
肾之府。背为足太阳膀胱之经。而五脏之俞穴附之。虚阳上炎。直逼腰俞。故腰痛背强也。足胫者。肾气之所
下强者也。肾气虚。故不能行也。真气生于真精。真精内伤。故短气。极者。急切之义。但言在里而不言在表之
病。另于太阳伤寒论中。详其症故也。
问曰。经云厥阳独行。何谓也。师曰。此为有阳无阴。故称厥阳。
此合下条。俱言厥症。神昏气阻。猝不知人者为厥。厥阳。犹言厥于阳也。肝肾之阴血虚于下。而阳气以无辅
而上浮胸膈。故曰有阳无阴。但胸膈者。心君出神明之治。肺气司百脉之全。心肺气实。则神明塞而百脉阻。
故不知人而厥。即下文实气相抟之脉。是也。然气机有升降。气暴聚、则厥。气渐散、则厥自回矣。不言生死者。
以有下入脏入腑之论也。
问曰。寸脉沉大而滑。沉则为实。滑则为气。实气相抟。血气入脏即死。入腑即愈。此为卒厥。何谓也。师曰。唇
口青。身冷。为入脏。即死。如身和汗自出。为入腑。即愈。
此条即上文厥阳之脉证也。沉为在里。大为阴虚。滑为气并于上。而血热随之之诊。今见于寸口。寸口应膻
中胸中之部。膻中为心神之所出入。胸中为宗气之所氤氲。神气一时闭阻。故猝然而厥。脏、指心肺而言。腑、
指三焦而言。膻中胸中内逼心肺。外通三焦。厥气入脏。则神气不能复通。故死。厥气入腑。则阳热可以涣散。
故愈。唇口者。内应脾胃。脾胃为后天诸阳之根蒂。青为肝色。又为冷。厥逆不论寒热。俱起于肝。而极于脾胃。
木邪克土之义。故除却寒厥。尽见色青之外。其阳厥之重症。亦见色青者。阳极似阴之理也。身冷者。卫阳解
散之象。内外之阳俱绝。故知其为入脏而即死也。身和者。卫阳无病之诊。汗为胃中之津液。运于三焦之阳
气。是厥阴入腑。而腑力足以送之出表也。夫卒厥、为实气相抟。而并于上之候。玄府自开。则实气散而厥自
平矣。故知即愈。寸脉沉大七句。亦古经文也。
问曰。脉脱。入脏即死。入腑即愈。何谓也。师曰。非为一病。百病皆然。譬如浸淫疮。从口起。流向四肢者可治。
从四肢流来入口者。不可治。病在外者可治。入里者即死。
脉脱、与伤寒条中之脉伏不同。脉伏有二。一则阳明胃腑之热实太甚也。脉之营气生于胃。营气不能灌注。
故热深厥深、而脉伏者。下之以通其胃气。则出矣。一则少厥二阴之肝肾。寒邪凝闭也。脉之至去。根于命门
之鼓伏。成于脾阳之应动。是灵火之神机。以为不息之妙。寒邪直入肝肾。阴凌阳气。微明欲熄之象。故一时
寒战厥逆而脉伏者。温之以回其脏阳。则出矣。本文之脉脱。既非寒极热极之伏。并与上文卒厥不涉。盖因
入脏入腑之类而连及之耳。旧注大谬、脉之来去、如贯珠循环自是不断。脉脱者。一时断而不续。如脱落之
义。故曰脱。然仲景之意不指内因。是就不内不外因而言也。盖内因而至脉脱。百不一生。何得有入腑即愈
之候耶。此言脉脱者。除腹痛、蛔厥等症外。是就跌、仆、笞、杖、种种重伤。一时昏迷脉绝者而言。入脏。则气血内
并。脏中之神志自去。故死。入腑。则气行瘀散。故愈。此下文浸淫疮。亦止就皮肉伤损者而言。其不指内因可
见矣。浸淫疮。俗注为今之黄水疮、非。以黄水疮。并无入口不治之禁故也。大概湿热流烂。俗所谓白蛇缠
之类是也。
问曰。阳病十八。何谓也。师曰。头痛。（句）项、（句）腰、（句）脊、（句）臂、（句）脚。（句）掣痛。
阴病十八。何谓也。师曰。咳、上气。（句）喘、（句）哕、（句）咽、（句）肠鸣腹胀。（句）心痛拘急。
五脏病各有十八。合为九十病。人又有六微。微有十八病。合为一百八病。五劳、七伤、六极。妇人三十六病。不
在其中。清邪居上。浊邪居下。大邪中表。小邪中里。 之邪。从口入者。宿食也。五邪中人。各有法度。
风中于前。寒中于暮。湿伤于下。雾伤于上。风令脉浮。寒令脉急。雾伤皮腠。湿流关节。食伤脾胃。极寒伤
经。极热伤络。
头为诸阳之首。项、指后发际及肩而言。为太阳并督脉所经之部。腰、指脊下中行之皮腠。非谓两肾之腰眼
也。腰脊痛、亦即经络之板强酸痛而言。非两肾中及脊内刺痛之谓。盖腰脊内中刺痛。即后文劳伤等之阴
病。而非阳病也。臂脚为阳气之充。掣痛、兼承项腰脊臂脚而言。臂脚掣痛、谓手足之外 。阳经所行之处。牵
引而痛也。夫头痛项腰脊臂脚之掣痛。俱风寒等气。中于经络之症。其病在表。故曰阳病也。咳为肺脏病。咳
而上气。为肝肾之气虚而上浮。即前条胸中上气而咳者。是也。喘、见吸促吸远下。哕、呃逆也。但有二因。经谓
新旧食不相浃者。言平人之哕也。今儿童饭后常有之。病患呃逆者。是命门真呼之气自虚。不能送呼满部。
中道伏还之象。咽者。饮食噎塞。是脏中之津液枯槁。故胃脘中之润机涩滞耳。脏腑之阳虚。而外气客之。则
肠鸣。又脏腑之阳虚。而下阴乘之。则胀满。肝肾之贼阴。凌犯心位。则切痛而拘急。六者俱脏腑之病。脏腑视
经络。则为里为阴。故曰阴病也。夫三焦之治。以火为用。内与五脏之元阳相通。外与十二经之表阳相会。阴
阳六症。各从上中下为三变。六三则十八也。下文一百八病。又从阴阳各十八病而申之。盖五脏之元阳精
汁。除自荣本脏外。其余绪亦旁出而与三焦交会。则阴病十八。各脏俱有之。合五脏而计之。总得九十病。此
申言上气等之阴病十八也。六微者。六腑之气。外行本经经络之末。行远力微。故谓之微。但六微之气。亦与
三焦相贯。腑各一微。微分三部。故亦有十八病。此申言头痛等之阳病十八也。李氏旧注。谓六微取之于合。
引内经胃合于三里等穴。是以针而刺微之病。非六微之为病。且微各一穴。无十八之数矣。肤谬。五劳者。心
劳神损。肺劳气损。脾劳食损。肝劳血损。肾劳精损。七伤者。大饱伤脾。大怒气逆伤肝。强力举重。久坐湿地伤
肾。形寒饮冷伤肺。忧愁思虑伤心。风雨寒暑伤形。大怒恐惧伤志。六极者。肝伤筋极。心伤脉极。脾伤肉极。肺
伤气极。肾伤骨极。脏腑气衰。视听已卸。为精极也。妇人三十六病。旧注谓千金方载十二症、九痛、七害、五伤、
三痼。于理颇顺。未知是否。不在其中者。谓一百八病。为内因外因之正病。五劳、七伤、六极、及妇人三十六病、
以首条房室灾伤服食等按之。仲景俱为不内不外因之病。故不入正病之例。清浊大小。兼下文之风寒雾
湿热。所谓五邪者。是也。风雾为清邪。天之阳气。动而为风。地之阳气。升而为雾。故其邪属阳。阳主轻清。故曰
清邪。凡动而升者。其性炎上。故清邪居人之上焦。以极于头面也。寒湿为浊邪。天之阴气。凝而为寒。地之阴
气。结而为湿。故其邪属阴。阴主重浊。故曰浊邪。凡凝而结者。其性流下。故浊邪居人之下焦。以极于足胫也。
大邪者。兼清浊邪之风寒而言。风为百病之长。寒为生阳之害。故曰大邪。然风寒之邪。善伤营卫。故曰中表。
小邪者。兼清浊邪之雾湿。并下文之热邪亦在内。盖雾横于太虚。于人为胸中。湿流于坎泽。于人为骨节。以
视风寒之伤营卫者。则为中里。故曰小邪中里。下文曰。热伤络。视经亦为里。故曰热邪亦在内。 字无所考。
未详。成无己作谷字。亦无所据。或曰。当是馨字之脱去其半也。然以象形会意按之。上半为古罄字。器之象
也。禾为稻属。以器覆稻。其为饭类可知。 、饼属也。五谷原以养生。冷热饥饱。经宿不行。则邪生矣。以上七句。
为末段之纲领。盖谓除宿食外。不过风寒雾湿热之五邪为病耳。法度、非治病之法度。言五邪中人。如有规
矩绳墨之义。前、日前也。风为木邪。木气王于寅卯日前之风邪自盛。故风中于前也。暮则人身之火气入墓。
寒邪易入。故寒中于暮也。湿伤下、雾伤上、注已见。风令脉浮。寒令脉急。别详伤寒论注。雾者。土气也。人身以
皮腠为土。湿者。水气也。人身以关节为泽。故各以其类应也。食伤脾胃。即宿食也。经血多而恶寒。寒则经血
泣。故寒极伤经。络血少而恶热。热则络血燥。故热极伤络。自五邪中人十三句。或言其时。或言其处。或言其
脉。或言其害。错综反复。正所以言阴阳十八病之因。且开后文二十四篇之治法也。
问曰。病有急当救里救表者。何谓也。师曰。病医下之。续得下利清谷不止。身体疼痛者。急当救里。后身体疼痛。
清便自调者。急当救表也。
此条与伤寒之文相似。入此、则迥别矣。盖伤寒三阳传变。重在急救其表。故治法宜先表后里者。恐阳邪外
盛。而阴津内伤也。此为治内因之法。当重看前半条。救表。特杂症中之带说耳。下利清谷。因医下之者。尚宜
急救。则未经误下者。更可知矣。夫卫气根于胃中之精悍。下利清谷者。则卫气衰薄。而六淫易犯。虽亦有身
体疼痛之表症。必俟救里后议及者。恐早则更伤表气。而为上下两脱之候也。注详伤寒本条下。
夫病痼疾。加以卒病。当先治其卒病。后乃治其痼疾。
痼疾者。坚固之义。经久之宿病。卒病者。猝然之病。如风寒之类。凡新感者皆是。不特痼疾之根深。法当缓取。
猝病之气锐。势必蔓延。且譬之积薪。后来者居上。而易于搬运。故当知先后之治也。
师曰。五脏病、各有得者。愈。五脏病。各有所恶。各随所不喜者为病。病者素不应食。而反暴思之。必发热也。
各有得、心病得肝气。肝病得肾气。肾病得肺气。肺病得脾气。脾病得心气者。一也。五脏各乘其王时。二也。心
肝脾肺肾之各有所喜者。三也。此单指得其所喜者而言。得其所喜者而愈。伤寒论谓渴欲饮水者。少少与
之。令胃气和则愈。是其义也。所恶、谓心恶热。肺恶寒。肝恶风。脾恶湿。肾恶燥。并各脏之所不胜者皆是。不喜、
即所恶。谓心恶热。热乘之。则心病。心不胜肾。肾乘之。则病且危矣。余脏仿此。不应食、指五味而言。人于五味
Straight and long. Combined, this is the Wiry Pulse (Xian Mai). The Soft and Weak pulse (Ru Ruo) represents the Qi of Spleen Earth, which nourishes Wood. The Light and Empty pulse (Qing Xu) represents the Qi of Lung Metal, which is controlled by Wood. The Slippery pulse (Hua) represents the Qi of Kidney Water, which is generated by Wood. Only then does it reveal its intrinsic nature of smoothness and flourishing. Therefore, not only does the absence of a Wiry pulse in Spring, or its presence outside of Spring, constitute an "out-of-season" pulse; furthermore, the absence of a Soft and Weak pulse indicates Spleen disease; the absence of a Light and Empty pulse indicates Lung disease; the absence of a Slippery pulse indicates Kidney disease. If not straight and heavy, it becomes light and floating, leading to diseases such as dizziness and distension/fullness in the Upper Jiao. If not upright, it becomes rampant, leading to diseases such as sinking pain and cutting pain in the Middle and Lower Jiao. If not uniform and long, it becomes short and stagnant, leading to diseases such as depression and knotting in the Zang organs. Thus it is said, "all should be diseased," the purport of which is profound. This again comprehensively discusses the superior physicians (Shang Gong) who integrate color diagnosis and pulse diagnosis.
Question: There is "that which has not arrived but arrives," "that which has arrived but does not arrive," "that which has arrived but does not depart," and "that which has arrived but is excessive." What does this mean?
The Master said: After the Winter Solstice, at midnight on the Jia-Zi day, the Shaoyang (Lesser Yang) Qi begins. During the time of Shaoyang, Yang Qi begins to grow, and the weather becomes mild. If the weather becomes mild before the arrival of the Jia-Zi day, this is called "that which has not arrived but arrives." If the Jia-Zi day has arrived but the weather has not become mild, this is called "that which has arrived but does not arrive." If the Jia-Zi day has arrived but severe cold persists, this is called "that which has arrived but does not depart." If the Jia-Zi day has arrived but the weather is warm like mid-summer (fifth and sixth lunar months), this is called "that which has arrived but is excessive."
This passage follows up on the previous discussion of "out-of-season color and pulse," stating that out-of-season colors and pulses, although manifesting as human disease, are actually caused by changes in heavenly weather. Superior physicians bear the responsibility of assisting nature's transformation and supplementation. Their value lies in knowing the changes of heavenly timing and remedying the deviations in color and pulse. Heaven moves from slight warmth to heat, to great heat, then from coolness to cold, to great cold. In one year of twelve months, there are twenty-four solar terms. Similarly, the human body progresses from Shaoyang, through Yangming, to Taiyang, and then from Taiyin, through Shaoyin, to Jueyin. The twelve meridians of the hands and feet correspond to the twenty-four Qi. The initial warmth of heaven begins on the Jia-Zi day after the Winter Solstice; thus, the subtle Yang of man corresponds to the Foot Shaoyang Gallbladder Meridian. After passing four solar terms following the Winter Solstice, the Qi of the Hand and Foot Shaoyang concludes. The initial heat of heaven intersects on the Jia-Zi day after Rain Water; thus, the regular Yang of man corresponds to the Foot Yangming Stomach Meridian. After passing four solar terms following Rain Water, the Qi of the Hand and Foot Yangming concludes. The great heat of heaven intersects on the Jia-Zi day after Grain Rain; thus, the hyperactive Yang of man corresponds to the Foot Taiyang Bladder Meridian. After passing four solar terms following Grain Rain, the Qi of the Hand and Foot Taiyang concludes. The Three Yin meridians follow this pattern. Zhang Zhongjing borrowed ancient scriptural text and set up questions and answers, likely meaning that except for the period after the Winter Solstice's Jia-Zi day, when the weather is mild—referred to as "time arrives and Qi arrives"—this is considered balanced Qi. When heavenly Qi is balanced, human color and pulse also correspond normally, and fewer people fall ill. However, early arrival, late arrival, persistence of cold, and excess of heat are all rebellious Qi of heaven and earth, causing many people to exhibit out-of-season colors and pulses. Severe rebellion leads to significant non-correspondence in pulse; slight rebellion leads to minor non-correspondence. Understanding this, the appropriateness of cold and heat, and the use of the five flavors, can be applied correctly. Those engaged in this profession cannot afford to ignore it. Taking the Jia-Zi day after the Winter Solstice as an example, the Jia-Zi day after the Summer Solstice can be understood by analogy. Taking the Jia-Zi day after the Winter Solstice as an example, the Jia-Zi days after Rain Water and Grain Rain can also be deduced. Old annotations are not only superficial but also treat this passage as irrelevant filler in the classic, rendering the Buddha's hand emitting five-colored rays no different from a wart or polyp. How sad.
The Master said: If a patient's pulse is Floating (Fu) in the anterior position (cun), the disease is in the Exterior (Biao). If the pulse is Floating in the posterior position (chi), the disease is in the Interior (Li). Accompanied by lower back pain, stiffness of the back, inability to walk, there will definitely be shortness of breath and extreme exhaustion.
The pulses mentioned above appeared due to out-of-season seasons, diagnosing potential illness before disease onset. The pulses mentioned here diagnose the location of existing disease and determine life and death. Thus it says "patient." "Anterior and posterior" refer to the positions relative to the Guan (Bar) position. Anterior to Guan is Exterior; a Floating pulse here indicates Exterior Qi injured by Wind-Cold or invaded by Summer-Heat, Dampness, Dryness, or Fire, so Exterior Qi cannot attach inwardly, resulting in a Floating pulse. Thus, the disease is in the Exterior. Posterior to Guan is Interior; a Floating pulse here is abnormal, indicating internal injury to Yin Essence, with Yang having no attachment and floating outward. Thus, the disease is in the Interior. The waist is the mansion of the Kidneys; the back is the pathway of the Foot Taiyang Bladder Meridian, where the Back-Shu points of the Zang organs are attached. Deficient Yang flares upward, pressing directly on the Yao-Shu point, causing lower back pain and stiffness. The calves/shins are where Kidney Qi descends; Kidney Qi deficiency causes inability to walk. True Qi is born from True Essence; internal injury to True Essence causes shortness of breath. "Ji" means urgent/extreme. The reason for mentioning Interior but not Exterior disease here is explained in detail in the Taiyang Cold Damage Treatise regarding symptoms.
Question: The classics say "Jue Yang travels alone." What does this mean?
The Master said: This is because there is Yang without Yin, hence called Jue Yang.
This passage and the next discuss Jue syndromes. Confusion of spirit, obstruction of Qi, and sudden loss of consciousness are called Jue. Jue Yang implies Jue affecting Yang. Yin Blood of Liver and Kidney is deficient below, while Yang Qi floats upward to the chest and diaphragm due to lack of support, hence "Yang without Yin." The chest and diaphragm are where the Heart Monarch governs Spirit and the Lungs manage all vessels. If Heart and Lung Qi are excess, Spirit is blocked and vessels obstructed, causing unconsciousness and Jue. This corresponds to the pulse of "excess Qi clashing" mentioned later. However, Qi mechanism involves ascending and descending; sudden accumulation causes Jue, gradual dispersion resolves Jue. Life and death are not discussed here because of the subsequent discussion on entering Zang or Fu organs.
Question: The Cun (Inch) pulse is Deep (Chen) and Large (Da); Deep indicates Excess, Slippery (Hua) indicates Qi. Excess and Qi clash. If Blood and Qi enter the Zang, death ensues; if they enter the Fu, recovery ensues. This is called Su Jue (Sudden Jue). What does this mean?
The Master said: Blue lips and mouth, cold body, indicate entry into Zang, leading to death. If the body is warm and sweat comes out spontaneously, it indicates entry into Fu, leading to recovery.
This passage describes the pulse and syndrome of Jue Yang previously mentioned. Deep indicates Interior; Large indicates Yin deficiency; Slippery indicates Qi moving upward with accompanying Blood Heat. Now appearing at Cun, which corresponds to Danzhong and the Chest. Danzhong is the exit/entry of Heart Spirit; the Chest is where Zong Qi gathers. Sudden blockage of Spirit and Qi causes sudden Jue. "Zang" refers to Heart and Lung; "Fu" refers to San Jiao. Danzhong/Chest presses inward on Heart/Lung and connects outward to San Jiao. If Jue Qi enters Zang, Spirit and Qi cannot reconnect, leading to death. If Jue Qi enters Fu, Yang Heat can dissipate, leading to recovery. Lips and mouth internally correspond to Spleen and Stomach, the root of post-heaven Yang. Blue is Liver color and indicates cold. Jue, whether cold or hot, originates in Liver and extremizes in Spleen/Stomach, reflecting Wood overcoming Earth. Except for Cold Jue, seeing blue color generally indicates severe Yang Jue, following the principle of extreme Yang resembling Yin. Cold body indicates dissolution of Wei Yang; internal and external Yang are exhausted, confirming entry into Zang and death. Warm body indicates healthy Wei Yang. Sweat is Stomach fluid transported by San Jiao Yang Qi; this shows Jue Yin entering Fu, and Fu strength is sufficient to expel it to the Exterior. Su Jue is a sign of clashing excess Qi moving upward. If pores open naturally, excess Qi disperses and Jue resolves, indicating recovery. The seven phrases regarding Cun pulse are also ancient scripture.
Question: Pulse Tuojue (Disappearance), entering Zang leads to death, entering Fu leads to recovery. What does this mean?
The Master said: This applies not to one disease but to all diseases. For example, in Jin Yin Chuang (oozing sores), if it starts at the mouth and flows to the limbs, it is treatable; if it starts at the limbs and flows to the mouth, it is untreatable. Disease remaining in the Exterior is treatable; entering the Interior leads to death.
Pulse Tuojue differs from Pulse Fu (Hidden) in Cold Damage chapters. Pulse Fu has two types: one is extreme heat excess in Yangming Stomach Fu. Ying Qi is born in Stomach; if Ying Qi cannot circulate, deep heat causes deep Jue and hidden pulse; purgation unblocks Stomach Qi, and pulse returns. The other is cold pathogen condensing in Shaoyin/Jueyin Liver-Kidney. Pulse movement roots in Mingmen drumming and manifests via Spleen Yang. Cold pathogen enters Liver/Kidney directly, Yin overwhelms Yang, showing fading fire; chills and Jue cause hidden pulse; warming restores Zang Yang, and pulse returns. The Pulse Tuojue in this text is neither extreme cold/heat hidden pulse nor related to Su Jue; it is merely linked by the concept of entering Zang/Fu. Old annotations are greatly mistaken. Pulse flow is continuous like pearls on a string. Pulse Tuojue means a temporary discontinuation, like falling off, hence "Tuojue." However, Zhang Zhongjing's intent here does not refer to internal causes but to "neither internal nor external causes." If internal causes led to Pulse Tuojue, survival would be rare, making "entering Fu leads to recovery" impossible. Here, Pulse Tuojue refers to cases excluding abdominal pain or ascariasis Jue, specifically sudden coma and absent pulse after severe trauma like falls, blows, or beatings. Entering Zang means Qi and Blood gather internally, Zang Spirit departs, leading to death. Entering Fu means Qi moves and stasis disperses, leading to recovery. The subsequent Jin Yin Chuang also refers only to skin/flesh damage, confirming it does not refer to internal causes. Jin Yin Chuang is wrongly annotated by some as modern Huang Shui Chuang (yellow water sore), which lacks the taboo of mouth entry. It is likely damp-heat rotting, commonly known as Bai She Chan (white snake winding).
Question: What are the Eighteen Yang Diseases?
The Master said: Headache, neck stiffness, lower back pain, spine stiffness, arm pain, leg pulling pain.
What are the Eighteen Yin Diseases?
The Master said: Cough, rising Qi, panting, hiccups, throat obstruction, intestinal rumbling, abdominal distension, heart pain with spasm.
Each of the Five Zang organs has eighteen diseases, totaling ninety diseases. Humans also have Six Micro conditions, each with eighteen diseases, totaling one hundred eight diseases. Wu Lao (Five Exhaustions), Qi Shang (Seven Injuries), Liu Ji (Six Extremes), and Women's Thirty-Six Diseases are not included. Clear pathogens reside above, turbid pathogens reside below, major pathogens strike the Exterior, minor pathogens strike the Interior. [Grain/Bread] pathogens enter via the mouth, constituting retained food. The Five Pathogens attacking humans each have their rules. Wind strikes in the morning, Cold strikes in the evening, Dampness injures the lower part, Fog injures the upper part. Wind makes the pulse Floating, Cold makes the pulse Tense. Fog injures skin and interstices, Dampness flows into joints. Food injures Spleen and Stomach, extreme cold injures Channels, extreme heat injures Collaterals.
The head is the summit of all Yang. Neck refers to the posterior hairline and shoulders, pathways of Taiyang and Du meridians. Waist refers to the skin/muscle between the lower spine, not the kidney area. Lower back/spine pain refers to channel stiffness/soreness, not stabbing pain inside kidneys/spine, which belongs to Yin diseases like labor injuries. Arms and legs are filled with Yang Qi. Pulling pain refers to牵引 pain in the outer aspects of limbs where Yang channels run. These pains are caused by Wind-Cold invading channels, located in the Exterior, hence Yang diseases. Cough is Lung disease. Cough with rising Qi is deficiency of Liver/Kidney Qi floating upward, similar to previous chest Qi rising cough. Panting involves rapid/deep inhalation. Hiccups are reverse Qi flow. Two causes exist: mismatched food digestion in healthy people vs. Kidney Qi deficiency in patients. Throat obstruction is dryness of Zang fluids causing Stomach涩滞. Zang-Fu Yang deficiency allows external pathogens causing rumbling; Yin invasion causing distension. Liver/Kidney Yin invading Heart causes cutting pain/spasm. These six are Zang-Fu diseases, Interior/Yin relative to channels, hence Yin diseases. San Jiao uses Fire, connecting internally with Zang Yuan Yang and externally with Channel Exterior Yang. Yin/Yang six syndromes vary by Upper/Middle/Lower, 6x3=18. The 108 diseases derive from these. Zang Yuan Jingzhi nourishes own Zang and branches to San Jiao, so Yin diseases exist in each Zang, totaling 90. Six Micro refers to Fu Qi reaching terminal channels with weak force. Each Fu has one micro, divided into three parts, totaling 18. Li's old note incorrectly links Six Micro to He-Sea acupuncture points. Wu Lao: Heart spirit, Lung Qi, Spleen food, Liver blood, Kidney essence exhaustion. Qi Shang: Overeating spleen, anger liver, heavy lifting/wet sitting kidneys, cold drink/lung, worry heart, weather shape, fear will. Liu Ji: Liver sinew, Heart vessel, Spleen flesh, Lung Qi, Kidney bone exhaustion. Zang-Fu Qi decline, hearing/vision loss is Essence exhaustion. Women's 36 diseases: Qianjin Fang lists 12 syndromes, 9 pains, 7 harms, 5 injuries, 3 chronicities. Not included means 108 diseases are standard internal/external causes; Wu Lao etc. are neither/internal/external causes like sexual injury/diet. Clear/Turbent/Major/Minor refer to Wind/Cold/Fog/Damp/Heat (Five Pathogens). Wind/Fog are Clear Yang, rising to Upper Jiao/head. Cold/Damp are Turbid Yin, sinking to Lower Jiao/feet. Major pathogens (Wind/Cold) attack Ying/Wei (Exterior). Minor pathogens (Fog/Damp/Heat) attack Interior/joints/chest. Heat injures Collaterals (Interior). The character [missing] is unknown; Cheng Wuji reads "Gu" (grain), others suggest "Xing" or "Bing". Grains nourish life; improper consumption creates pathogens. These seven sentences summarize the section: besides retained food, only Five Pathogens cause disease. Rules imply natural laws. Wind (Wood) peaks in Yin/Mao days (morning); Cold enters when Fire rests (evening). Fog corresponds to Skin (Earth element metaphor); Damp to Joints (Water element metaphor). Extreme cold congeals Blood in Channels; extreme heat dries Blood in Collaterals. These thirteen sentences explain causes of 18 Yin/Yang diseases and precede treatment chapters.
Question: When should one urgently rescue the Interior or Exterior?
The Master said: If a patient was treated with purgatives and subsequently suffers persistent diarrhea with undigested food and body pain, urgently rescue the Interior. Later, if body pain persists but bowel/bladder functions normalize, urgently rescue the Exterior.
This resembles Cold Damage text but differs significantly. Cold Damage focuses on saving the Exterior first to prevent Yin depletion from Yang excess. This text prioritizes Internal Causes. Persistent diarrhea with undigested food indicates weakened Wei Qi (rooted in Stomach Jinghan), making one susceptible to Six Evens. Even with Exterior symptoms (body pain), one must save the Interior first to avoid double depletion. See Cold Damage commentary.
When a patient has a chronic disease (Gu Ji) plus an acute disease (Cu Bing), treat the acute disease first, then the chronic disease.
Gu Ji means solid/long-standing disease. Cu Bing means sudden/new disease like Wind-Cold. Chronic diseases are deep-rooted and require slow treatment; acute diseases are aggressive and spread quickly. Like stacking firewood, the top layer is easier to move. Hence, know the order of treatment.
The Master said: Zang diseases improve when they obtain what they favor. Zang diseases worsen according to what they dislike. If a patient suddenly craves food they usually reject, fever will occur.
"Obtaining what they favor": Heart benefits from Liver Qi, Liver from Kidney Qi, etc., or ruling seasonal Qi, or liking specific elements. Recovery occurs when favored. Cold Damage states giving small amounts of water to quench thirst harmonizes Stomach Qi. "Dislike": Heart dislikes Heat, Lung Cold, Liver Wind, Spleen Damp, Kidney Dryness, and overacting elements. "Do not like" equals dislike. If Heart dislikes Heat and Heat attacks, Heart disease worsens; if Kidney overacts, danger ensues. Other Zangs follow suit. "Usually reject food" refers to Five Flavors. People regarding Five Flavors...