此承上章记奇病之广大。
肝满肾满肺满皆实。即为肿。（满谓脏气充满也。夫五脏者。藏精气而不泻。故满而不实。如满而皆实。是为太过。
当即为肿。然此论脏气实而为肿。与气伤痛。形伤肿之因证不同也。）肺之雍。喘而两 满。肝雍。两 满。卧则惊。不
得小便。肾雍。脚下至少腹满。胫有大小。髀 大跛。易偏枯。（雍者。谓脏气满而外壅于经络也。盖满在气。则肿在肌
肉。雍在经。则随经络所循之处而为病也。肺主呼吸。其脉从肺系横出腑下。故喘而 满。肝脉环阴器。抵小腹。属肝
络胆。上贯膈。布胁肋。故两 满。而不得小便。脏气雍满。卧则神魂不安。故发惊也。肾脉起于足下。循内踝。上
内。属肾络膀胱。故自脚下至少腹满。肾主骨而寒水主气。故足胫有大小。髀 大而跛。变易为偏枯。此论脏气雍于经
脉。而为此诸病。与邪在三焦之不得小便。虚邪偏客于形身。而发为偏枯之因证不同也。）心脉满大。痫螈筋挛。（痫
螈、抽掣也。挛、拘挛也。心为火脏。火热太过。是以脉大而痫螈筋挛。）肝脉小急。痫螈筋挛。（肝主筋而主血。小则
为虚。急则为寒。此肝脏虚寒。而不能荣养于筋。故为挛螈之病。此论筋之为病。有因心气之有余。有因肝气之不足。
与风伤筋脉。筋脉乃应之为病不同也。）肝脉骛暴。有所惊骇。（骛音务。骛、疾奔也。又乱驰也。言肝脉之来疾而暴
乱者。必有所惊骇故也。此言因惊骇。而致肝脉暴乱。非东方肝木。其病发惊骇也。兆璜曰。七情之中。心肝主惊。
因惊骇而致肝脉骛暴者。所谓病生于情也。东方肝木。其病发惊骇者。所谓情生于病也）脉不至。若喑。不治自已。
（脉络阻于下。则音不出于上。脉络疏通。其音自复。故脉不至而喑者。不须治之。其病自已。此系经脉所阻之病。与
邪搏于阴。则为喑之不同也。）肾脉小急。肝脉小急。心脉小急。不鼓。皆为瘕。（小急、虚寒之脉。瘕、聚也。脏气
有所留聚。故脉见小急而不鼓。）肾肝并沉为石水。（肝乃东方春生之木。主透发冬令闭藏之气。如肝肾之脉并沉。是
二脏之气皆闭逆于下。而为石水矣。石水者。肾水也。如石之沉。腹满而不喘。）并浮为风水。并虚为死。（肝主风木。
肾主寒水。如肝肾之脉并浮。是二脏所主之气。皆发于外。故名曰风水。如浮而并虚。是脏气不藏而外脱。故死。此言
肝肾之气。过于闭藏。则沉而为水。过于发越。则浮而兼风。皆本脏所主之气。而自以为水为风。与本经之热病论、水
热穴论、灵枢论疾诊尺篇。及金匮要略诸经。皆论石水风水之不同也。）并小弦欲惊。（小者。血气皆少。弦则为减为寒。
肝藏之气生于肾。脉并小弦。是二脏之气皆虚。而欲发惊也。前论肝雍之惊病有余。今弦小欲惊。病不足。皆本脏本气
之为病也。上节言虚脱于外者死。此言本虚于内者惊。）肾脉大急沉。肝脉大急沉。皆为疝。（大则为虚。急则为寒。
沉为在下在里。故皆为疝。）心脉搏滑急为心疝。肺脉沉搏为肺疝。（心疝之有形在少腹。其气上搏于心。故心脉搏而滑
急也。肺脉当浮而反沉搏。是肺气逆聚于内而为肺疝矣。）三阳急为瘕。三阴急为疝。（此言疝瘕之病。病三阴三阳之气
而见于脉也。子繇曰。瘕者假也。假物而成有形。疝字从山。有艮止高起之象。故病在三阳之气者为瘕。三阴之气者
为疝。玉师曰。瘕在肠胃之外。故三阳急。疝病五脏之气。故三阴急。）二阴急为痫厥。二阳急为惊。（二阴、少阴
也。痫厥者。昏迷仆扑。卒不知人。此水气乘心。是以二阴脉急。二阳、阳明也。阳明者土也。土气虚寒。则阳明脉病。
故发惊也。）脾脉外鼓沉为肠 。久自已。（肠 、下痢也。着至教论曰。三阳者至阳也。积并则为惊。病起疾风。至
如砺。九窍皆塞。阳气滂溢。干嗌喉塞。并于阴则上下无常。薄为肠 。此三阳并至。干薄脏阴。乃奇恒之下痢。与
外受六淫之邪。迫于经络。而为下利脓血者不同。故病见于脏脉。而各有死生之分。脾为阴脏。位居中央。受三阳阳盛
之气。迫而上行。则其脉外鼓。搏而下沉。则为肠 下痢。盖言阳气上下之无常也。脾为阴中之至阴。故虽受阳热之气。
其病久而自已。玉师曰。疝瘕肠 。皆病在三阴三阳之气分。首节论阳热之气伤脾藏之津液而为肠 。次论阳热之气伤
肝肾心藏之血而为肠 下血。后论三阳之气甚而三阴之气伤者死。）肝脉小缓为肠 。易治。（经云、缓者多热。小者血
气皆少。此阳热之气。干薄脏阴。致肝藏之血气下泄而虚。故其脉小缓也。肝主藏血。故虽受阳邪。尚为易治。）肾脉小
搏沉。为肠 下血。（肠 下血者。或下痢赤色。或下血也。肾主藏精。为精血之原。阳热之气。下薄于肾。故为肠 下
血。阴血伤。故脉小。热邪干肾。故沉而搏也。）血温身热者死。（夫阴阳相和则生。偏害则死。三阳为阳。三阴为阴。
气为阳。血为阴。三阳之热。薄于阴血。血受热伤。故血温也。身热者。三阳盛而三阴之气绝也。）心肝 。亦下血。二
脏同病者。可治。（此承上文而言。阴血盛者。虽受阳薄。尚为可治。盖重阴血以待阳也。夫心主生血。肝主藏血。是以
心肝二脏。受阳盛之气。而为肠 者。亦下血。如二脏同病。则阴血盛而可以对待阳邪。故尚为可治之证。）其脉沉小涩
为肠 。其身热者死。热见七日死。（上节分血气为阴阳。此复以三阴三阳之气论阴阳也。脉小沉滞者。三阴之气。为阳
薄所伤也。其身热者。阳盛而阴绝也。七日死者。六脏之阴气终也。按此系奇恒之病。缘于阴阳不和。非关外淫之气。
医者大宜体析。如因表邪而发热者。其脉必浮。或见滑大。初起之时。必骨痛头疼。或恶寒喘急。表证始盛。里证尚微。
盖先表而后入于里也。此系三阳之气。直并于阴。阴气受伤。是以脉小沉涩。一起之时。里证即急。或噤口腹痛。或下
重痢甚。或发惊昏沉。或嗌干喉塞。身虽热而热微。外证轻而里急。此三阳之气。疾起如风。至如 砺。当急用抑阳养
阴之药以救援。若见身有微热。而用表散之轻剂。因脉小涩。而用和调之缓方。三日之后。即成不救矣。存德好生之士。
当合参诸经。细心体认。幸勿以人命为轻忽也。张兆璜曰。危险之证。当用瞑眩之药以急救。若用平和汤而愈者。原
不死之病也。服平和汤而后成不救者。医之罪也。张应略曰。当汗而急汗之。正所以养阳也。当急下而大下之。正所
以养阴也。常须识此。勿令误也。）胃脉沉鼓涩。胃外鼓大。心脉小坚急。皆膈偏枯。（此言荣卫血气虚逆。而成偏枯
也。夫经脉者。所以行气血而荣阴阳。濡筋骨以利关节。卫气者。所以温分肉。充皮肤。肥腠理。司开阖。是故荣卫调。
则筋骨强健。肌肉致密。如血气虚逆。则皮肤筋骨。失其荣养。而成偏枯之患矣。荣卫之气。由阳明之所生。血脉乃心
脏之所主。阳明气血皆多。其脉当浮大。今脉沉而鼓动带涩。灵枢经曰。涩为少气。伤寒论曰。涩则无血。是血气虚于
内矣。推而外之。胃外以候形身之中。其脉鼓大。大则为虚。此血气虚于外矣。是以成膈偏枯。膈者。里之膈肉。前连
于胸。旁连于胁。后连于脊之十一椎。盖营卫血气。皆从此内膈而外达于形身。营卫不足。则膈气虚矣。膈气虚。是以
胸胁脊背之间。而成麻痹不仁之证。故名曰膈偏枯也。夫心主血脉之气。小则血气皆少。坚急为寒。心气虚寒。则血脉
不行。筋骨无所荣养。而亦成膈外之偏枯。夫邪之偏中于身。及风之伤人而成偏枯者。乃外受之邪。当主半身不遂。此
由在内所生之血气虚逆。故主于膈偏枯。膈偏枯者。只病在胸胁腰脊之间。而不及周身之上下也。）男子发左。女子发右。
（左右者。阴阳之道路也。男子血气从左而转。女子气血从右而旋。是以男子之病发于左。而女子之病发于右也。）不喑
舌转可治。三十日起。（夫营卫气血。虽生于阳明。主于心脏。然始于先天之肾中。少阴之脉。贯肾系舌本。不喑舌转。
是先天之根气不伤。故为可治。偏枯而主三十日起者。言其愈之速也。其从者喑。三岁起。从、顺也。谓男子发左。女
子发右。阴阳血气虽顺。而喑者至三岁之久。而后能复也。兆璜曰。不喑舌转。先天之气在也。其从者喑。后天之气
复也。）年不满二十者。三岁死。（年不满二十者。脏腑正盛。血气方殷。而反有此衰败之证。比及三年。五脏胃腑之气。
渐次消灭而死矣。兆璜曰。如外感风邪者。值此少壮之年。更易愈矣。此因于内损。故名曰膈偏枯。）肺至而搏。血衄身
热者死。脉来悬钩浮。为常脉。（血衄、血出于鼻也。脉搏击而血衄者。经热盛而迫血妄行。血脱。故身热也。脉来悬钩
者。心之脉也。浮者。肺之脉也。心主血脉。肺主皮肤。而开窍在鼻。心脉来盛。上乘于肺而致衄者。此血衄之常脉也。
夫因外感风寒。表阳盛而迫于经络之衄者自愈。若心脉盛而迫于皮肤之血以致衄者。为常脉。此表里阴阳。外内出入。
而皆为衄病之常。若脏气不守。经血沸腾。脉至而搏击应手者。此热盛而血流妄行。一丝不续。则穹坏判矣。玉师曰。
搏者阴阳相搏。血衄身热者。血气俱脱。故死。悬钩浮脉。乃血衄之常脉。故不死。不死者。如奇恒之衄也。）脉至如
喘。名曰暴厥。暴厥者。不知与人言。（如喘者。脉来滑急也。此痰水上壅。故脉来急滑。名曰暴厥。暴厥者。一时昏厥。
而不能与人言。）脉至如数。使人暴惊。三四日自已。（夫有形之邪上乘。则脉至如喘。无形之气上逆。则脉至数疾。邪
薄心下。故发惊也。盖心不受邪。至三四日。邪自下而惊厥之病自已。非比外淫卒厥之难愈也。）脉至浮合。浮合如数。
一息十至以上。是经气予不足也。微见九十日死。（此论脏腑经俞之气不足。而各有死期也。浮合者。如浮波之合。来去
之无根也。浮合如数。而一息十至以上。是经气予之不足也。微见此脉。至九日十日之交而死。盖九者阳之终。十者阴
之尽。此三阴三阳。十二经脉之气终也。予与同。夫五脏相通。移皆有次。脏腑之气。各传与之。如五脏有病而逆传其
所胜者死。如顺传其所生。而受所与之气不足者亦死。故曰气予之不足也。又五脏各以其时而主于手太阴者。脏气传与
之俞。俞气传与之经。脉气与之络。络与之肌。此经脉之气。受五脏所与之气不足。故脉至如此虚数之极也。士宗曰。
微对显言。微现此脉。期以九十日而死。若显露之。不超时日矣。后之交漆。亦犹是也。兆璜曰。络与之肌。肌络之
气。外内相通。故脉急者。尺之皮肤亦急。脉缓者。尺之皮肤亦缓。）脉至如火薪然。是心精之予夺也。草干而死。（如
火薪然者。心气不藏。虚炎之极也。精者。五脏主藏精。谓所与之气。精气也。曰夺曰虚曰不足者。谓夺其所与之精气。
以致虚而不足也。草干冬令之时。当遇胜克之气而死。所谓脉至者。概左右三部而言也。玉师曰。心脉如火薪。肝脉
如散叶。胃脉如泥丸。太阳如涌泉。肌脉如颓土。皆以五行之气效象形容。盖此乃五脏虚败之气变见于脉。非五脏之病
脉也。斯之谓奇恒之脉。应略曰。予者谓脏腑之气传与之脉也。）脉至如散叶。是肝气予虚也。木叶落而死。（散叶、飘
零虚散之象。肝木之气虚。故当至秋令之时而死。）脉至如省客。省客者。脉塞而鼓。是肾气予不足也。悬去枣华而死。
（脉塞而鼓。谓脉始来充塞于指下。旋即鼓动而去。有如省问之客。方及门而即去也。悬、隔也。悬去枣华者。谓相隔
于枣华之时而死也。张兆璜曰。脏腑之气。外合五行之生克。而草木之荣枯。只以四时之气候之。火土之气。皆主于
夏。故曰悬去枣华者。谓相去枣华之初夏。而死于土令之长夏也。应略曰。脉始于肾。故肾气虚而脉至如省客。）脉至
如丸泥。是胃精予不足也。榆荚落而死。（丸泥者。如泥丸而不滑也。胃为阳土。位居中央。其性柔。其体圆。故曰脉弱
以滑。是有肾气。盖往来流利如珠曰滑。如丸泥者。无滑动之象。胃将死败之征也。榆荚至春而落。木令之时也。脏腑
之气。生于胃腑水谷之精。故曰精予不足。）脉至如横格。是胆气予不足也。禾熟而死。（胆属甲子。主一阳初生之气。
胆气升。十一脏腑之气皆升。如横格者。有如横拒而不得上下。是胆气虚而不能升也。灵枢经曰。其胆乃横。是胆气横
而脉亦见其横格也。禾熟、秋深之时也。兆璜曰。人生于寅。天三生木。故在人脏腑阴阳之生死。应四时草木之荣枯。
按宋史钱乙传曰。一乳妇因悸而目张不得瞑。乙曰。此气结而胆横不下。用青郁李酒饮之而愈。）脉至如弦缕。是胞精予
不足也。病善言。下霜而死。不言可治。（弦缕者。精血虚而如缕之细也。胞精、胞络之精气也。胞络者。系于肾。少阴
Following the previous chapter, this section records the extensive manifestations of various *Qi Bing* (Strange Diseases).
When the Qi of the Liver, Kidney, and Lung is full (*Man*) and solid (*Shi*), edema will occur. ("Full" refers to the abundance of Zang organ Qi. The Five Zang organs store Essence and Qi without draining, so their state is "full" but not "solid". If they are both full and solid, it indicates an excess condition.)
If Lung Qi is congested (*Yong*), wheezing and distension in both hypochondriac regions will occur. If Liver Qi is congested, there will be distension in both hypochondriac regions, fright during sleep, and inability to urinate. If Kidney Qi is congested, there will be distension from the sole of the foot to the lower abdomen, unequal size of the calves, enlarged thighs with limping gait, and a tendency to develop *Pian Ku* (hemiplegia). ("Congested" means that Zang Qi is excessive and externally obstructs the meridians. When Qi is full, swelling occurs in the muscles; when meridians are congested, disease manifests along the meridian pathways. The Lung governs respiration, and its meridian emerges horizontally from the lung system under the axilla, hence wheezing and hypochondriac fullness. The Liver meridian circles the external genitalia, reaches the lower abdomen, connects with the Liver and Gallbladder, passes through the diaphragm, and spreads over the costal region, hence hypochondriac fullness and urinary retention. When Zang Qi is congested and full, the Spirit and Soul are unsettled during sleep, causing fright. The Kidney meridian originates at the sole, ascends along the medial malleolus, enters the kidney and connects with the Bladder, hence distension from the foot to the lower abdomen. The Kidney governs bones, and Cold Water governs Qi, hence unequal calf sizes, enlarged thighs with limping, and transformation into hemiplegia. This discusses diseases caused by Zang Qi congesting the meridians, which differs from urinary retention caused by pathogenic factors in the Triple Burner or hemiplegia caused by deficient pathogens lodging in the body.)
If the Heart pulse is full and large, epilepsy with convulsions and tendon spasms (*Xian Yuan Jin Luan*) will occur. (*Xian Yuan* refers to twitching and jerking; *Luan* refers to spasm. The Heart is a Fire Zang; excessive Heat-Fire causes the pulse to be large and leads to convulsions and spasms.)
If the Liver pulse is small and rapid/tense (*Xiao Ji*), epilepsy with convulsions and tendon spasms will also occur. (The Liver governs tendons and Blood. A small pulse indicates deficiency; a tense pulse indicates Cold. This is Liver deficiency and Cold, failing to nourish the tendons, thus causing spasms and convulsions. This discusses tendon diseases caused either by Heart Qi excess or Liver Qi deficiency, differing from diseases caused by Wind damaging tendons and meridians.)
If the Liver pulse comes rapidly and chaotically (*Wu Bao*), it is due to fright and alarm. (*Wu* sounds like "wu", meaning to gallop rapidly or run chaotically. This means a Liver pulse arriving rapidly and chaotically must be caused by fright. This states that fright causes chaotic Liver pulses, rather than the Liver Wood itself inherently causing fright. Zhang Zhaohuang said: Among the Seven Emotions, the Heart and Liver govern Fright. Fright causing chaotic Liver pulses is "disease born from emotion"; Liver Wood disease manifesting as fright is "emotion born from disease".)
If the pulse is absent, or if the patient is aphasic (*Yin*), the disease may resolve spontaneously without treatment. (If meridians are blocked below, sound cannot emerge above. Once meridians are unblocked, speech returns. Thus, aphasia with an absent pulse does not require treatment and will heal itself. This is a disease of meridian obstruction, differing from aphasia caused by pathogens battling Yin.)
If the Kidney, Liver, and Heart pulses are all small, tense, and non-pulsating (*Bu*), these are all classified as *Jia* (masses/gatherings). (Small and tense indicate deficiency-Cold. *Jia* refers to accumulation. Zang Qi stagnates and gathers, resulting in a small, tense, and non-pulsating pulse.)
If both the Kidney and Liver pulses are deep (*Chen*), it is called *Shi Shui* (Stone Water). (The Liver is Spring Wood of the East, governing the emergence of Winter's storage. If both Kidney and Liver pulses are deep, it means the Qi of both organs is closed and reversed downward, forming Stone Water. Stone Water is Kidney Water, heavy as stone, causing abdominal fullness without wheezing.)
If both are floating (*Fu*), it is called *Feng Shui* (Wind Water); if both are empty/deficient (*Xu*), death ensues. (The Liver governs Wind-Wood, the Kidney governs Cold-Water. If both pulses are floating, the Qi governed by both organs issues outward, hence Wind Water. If floating and empty, Zang Qi fails to store and escapes outward, leading to death. This explains that excessive closure leads to sinking water, while excessive issuance leads to floating wind, both being manifestations of the Zang's own Qi, differing from discussions in *Re Bing Lun*, *Shui Re Xue Lun*, *Ling Shu: Lun Ji Zhen Chi*, and *Jin Gui Yao Lue*.)
If both are small and wiry (*Xian*), there is a tendency toward fright. (Small indicates deficiency of Qi and Blood; wiry indicates reduction and Cold. Liver Qi is born from the Kidney. Pulses being small and wiry indicate deficiency in both organs, leading to a tendency for fright. The previous discussion on Liver Yong fright was excess; this small/wiry fright is deficiency, both being diseases of the Zang's own Qi. The previous section stated death from external deficiency/escape; this states fright from internal deficiency.)
If the Kidney pulse is large, tense, and deep, and the Liver pulse is large, tense, and deep, both are classified as *Shan* (hernia/lump). (Large indicates deficiency, tense indicates Cold, deep indicates location in the lower interior, hence both are Shan.)
If the Heart pulse is slippery, rapid, and tense, it is Heart Shan; if the Lung pulse is deep and pounding, it is Lung Shan. (Heart Shan has a tangible mass in the lower abdomen, with Qi rushing upward to the Heart, hence the Heart pulse is pounding, slippery, and rapid. The Lung pulse should be floating but is instead deep and pounding, indicating Lung Qi reversing and gathering internally to form Lung Shan.)
If the Three Yang pulses are tense, it forms Jia; if the Three Yin pulses are tense, it forms Shan. (This states that Shan and Jia diseases reflect disturbances in the Qi of the Three Yin and Three Yang manifested in the pulse. Zi You said: Jia implies "false," taking form from objects; Shan contains the radical for mountain, implying a high, raised lump. Thus, disease in Three Yang Qi is Jia, and in Three Yin Qi is Shan. Master Yu said: Jia is outside the intestines and stomach, hence Three Yang tension; Shan affects Five Zang Qi, hence Three Yin tension.)
If the Two Yin pulses are tense, epilepsy and syncope (*Xian Jue*) occur; if the Two Yang pulses are tense, fright occurs. (Two Yin refers to Shaoyin. Xian Jue involves coma, falling, and sudden loss of consciousness. This is Water Qi attacking the Heart, hence tense Two Yin pulses. Two Yang refers to Yangming. Yangming belongs to Earth; Earth Qi deficiency and Cold cause Yangming pulse pathology, leading to fright.)
If the Spleen pulse beats externally but is deep internally, it is Chang Pi (dysentery), which will resolve after a long time. (Chang Pi refers to dysentery. *Zhe Zhi Jiao Lun* states: Three Yang is Supreme Yang; accumulation and merging cause fright. Disease arises swiftly like wind, fast as a whetstone, blocking nine orifices, overflowing Yang Qi, drying the throat. Merging into Yin causes irregularity, pressing into the intestines as Chang Pi. This is Three Yang merging, attacking Yin Zang Qi, constituting a strange dysentery, differing from dysentery with pus and blood caused by Six Excesses pressing on meridians. Thus, diseases appearing in Zang pulses have different prognoses. The Spleen is a Yin Zang, central, receiving forced upward-moving Yang Qi from Three Yang, causing the pulse to beat externally and sink internally, forming dysentery. This describes irregular Yang Qi movement. As the Supreme Yin within Yin, even if affected by Yang-Heat, it resolves over time. Master Yu said: Shan, Jia, and Chang Pi are diseases of Three Yin/Yang Qi. The first section discussed Yang-Heat injuring Spleen fluids causing Chang Pi; the second, Yang-Heat injuring Liver/Kidney/Heart blood causing Chang Pi with blood; the third, excessive Three Yang injuring Three Yin leading to death.)
If the Liver pulse is small and slow/harmonious (*Huan*), it is Chang Pi, which is easy to treat. (The Classic states: Huan often indicates Heat; Xiao indicates deficiency of Qi and Blood. Yang-Heat attacks Yin Zang, causing Liver Blood/Qi to leak downward and become deficient, hence small and Huan pulse. The Liver stores Blood, so despite Yang pathogen, it is easy to treat.)
If the Kidney pulse is small, pounding, and deep, it is Chang Pi with bloody stool. (Chang Pi with bloody stool involves red dysentery or pure blood. The Kidney stores Essence, the source of Essence and Blood. Yang-Heat presses downward on the Kidney, causing Chang Pi with blood. Yin Blood injury makes the pulse small; Heat pathogen attacking the Kidney makes it deep and pounding.)
If the blood is warm and the body is hot, death ensues. (Yin and Yang harmony brings life; imbalance brings death. Three Yang is Yang, Three Yin is Yin; Qi is Yang, Blood is Yin. Heat from Three Yang attacks Yin Blood, warming the blood. Body heat indicates Three Yang excess and Three Yin exhaustion.)
If the Heart and Liver are affected, there is also bloody stool. If both Zang organs are diseased together, it is treatable. (Continuing from above: If Yin Blood is abundant, it can withstand Yang pressure and is treatable, relying on Yin Blood to counter Yang. The Heart generates Blood, the Liver stores Blood. Thus, Heart and Liver affected by Yang-Excess causing Chang Pi also present with bloody stool. If both Zang organs are involved, Yin Blood is abundant enough to counter Yang pathogens, making it treatable.)
If the pulse is deep, small, and choppy (*Se*), it is Chang Pi. If the body is hot, death ensues; if heat persists for seven days, death occurs. (The previous section divided Blood and Qi into Yin and Yang; this uses Three Yin/Yang Qi. Small, deep, and stagnant pulses indicate Three Yin Qi injured by Yang attack. Body heat indicates Yang excess and Yin exhaustion. Death in seven days marks the end of Yin Qi in the six Zang organs. Note: This is a strange disease due to Yin-Yang disharmony, not external pathogens. Physicians must analyze carefully. If fever is due to exterior pathogens, the pulse will be floating or slippery-large, with bone pain, headache, aversion to cold, or wheezing initially (exterior syndrome dominant, interior weak). Here, Three Yang Qi directly merges into Yin, injuring Yin, causing small/deep/choppy pulses. Interior syndrome is urgent at onset: locked jaw, abdominal pain, tenesmus, severe dysentery, fright/coma, or dry throat. Though hot, the heat is mild; exterior signs are light, interior urgency is high. Three Yang Qi rises swiftly like wind. Urgently use herbs to suppress Yang and nourish Yin. Using exterior-releasing agents for mild heat, or harmonizing formulas for choppy pulses, will lead to untreatable status within three days. Ethical physicians should study all classics carefully. Do not neglect human life. Zhang Zhaohuang said: Dangerous conditions require drastic (*Ming Xuan*) herbs for emergency rescue. Curing with mild herbs means the disease wasn't fatal; failing with mild herbs is the physician's fault. Zhang Yinglue said: Sweating when indicated preserves Yang; purging when indicated preserves Yin. Remember this.)
If the Stomach pulse is deep, beating, and choppy; if the Stomach pulse beats large externally; and if the Heart pulse is small, firm, and tense, all indicate Ge Pian Ku (Diaphragmatic Hemiplegia). (This describes hemiplegia caused by deficiency and reversal of Ying and Wei Qi/Blood. Meridians circulate Qi and Blood to nourish Yin/Yang, moisten bones/joints. Wei Qi warms flesh, fills skin, thickens pores, controls opening/closing. Harmonious Ying/Wei ensures strong bones/muscles. Deficient/reversed Qi/Blood causes loss of nourishment, leading to hemiplegia. Ying/Wei Qi is generated by Yangming; Blood vessels are governed by the Heart. Yangming Qi/Blood is abundant, so its pulse should be floating and large. Now, the pulse is deep, beating, and choppy. *Ling Shu* says: Choppy indicates Qi deficiency. *Shang Han Lun* says: Choppy indicates Blood deficiency. This is internal Qi/Blood deficiency. Externally, the Stomach pulse reflects the body; a large beating pulse indicates external deficiency (Large = Deficiency). Thus, Diaphragmatic Hemiplegia forms. "Ge" refers to the inner diaphragm muscle, connecting front to chest, sides to ribs, back to the 11th thoracic vertebra. Ying/Wei Qi moves from this inner diaphragm to the body. Deficient Ying/Wei leads to deficient Diaphragm Qi, causing numbness/paralysis in the chest, ribs, and back, named Ge Pian Ku. The Heart governs Blood vessel Qi; small indicates Qi/Blood deficiency; firm/tense indicates Cold. Heart Qi deficiency/Cold stops blood flow, failing to nourish bones/tendons, causing external hemiplegia. External Wind causing hemiplegia affects half the body. This internal Qi/Blood deficiency causes Ge Pian Ku, affecting only the chest, ribs, waist, and back, not the whole body.)
Men develop it on the left; women on the right. (Left and Right are the pathways of Yin and Yang. Men's Qi/Blood turns from the left; Women's Qi/Blood rotates from the right. Hence men's disease starts on the left, women's on the right.)
If there is no aphasia and the tongue can move, it is treatable, recovering in thirty days. (Ying/Wei Qi/Blood, though generated by Yangming and governed by the Heart, originates in the先天 Kidney. Shaoyin meridian passes through the Kidney and ties to the root of the tongue. No aphasia and mobile tongue indicate intact congenital Root Qi, hence treatable. Thirty days recovery indicates speed. If accompanied by aphasia, recovery takes three years. "Cong" means smooth/normal. Even if Qi/Blood flow is normal (left/right), aphasia requires three years for recovery. Zhang Zhaohuang said: No aphasia/mobile tongue means Congenital Qi remains. Aphasia means Post-natal Qi is recovering.)
Those under twenty years old die in three years. (Under twenty, Zang Qi is vigorous and Blood/Qi is abundant. Developing this degenerative condition indicates severe damage. By three years, Zang and Fu Qi gradually exhausts, leading to death. Zhang Zhaohuang said: Exterior Wind would heal easily in youth. This is internal damage, hence Ge Pian Ku.)
If the Lung pulse is pounding, with nasal bleeding (*Xu*) and body heat, death ensues. A pulse that is "Xuan Gou" (hanging hook) and floating is a normal pulse. (*Xu* is nasal bleeding. Pounding pulse with bleeding indicates intense meridian Heat forcing blood recklessly; blood loss causes body heat. "Xuan Gou" is the Heart pulse; Floating is the Lung pulse. Heart governs Blood vessels, Lung governs skin/nose. Strong Heart pulse ascending to Lung causes bleeding; this is a normal pulse pattern for bleeding. Exterior Wind-Cold causing superficial Yang Heat and bleeding resolves spontaneously. Heart Heat forcing skin bleeding is a "normal" pathological pattern. This illustrates Yin/Yang and interior/exterior dynamics in bleeding. If Zang Qi fails to hold, meridian blood boils, and the pulse pounds forcefully, Heat forces blood recklessly until exhausted, leading to collapse. Master Yu said: Pounding indicates Yin/Yang battle. Bleeding with body heat means total Qi/Blood depletion, hence death. Xuan Gou/Floating is the normal pulse for bleeding, hence survival. Survival applies to strange bleeding cases.)
A pulse coming like panting (*Chuan*) is called *Bao Jue* (Sudden Syncope). Patients with Bao Jue cannot speak with others. (Like panting means the pulse is slippery and rapid. This is Phlegm-Water surging upward, causing a rapid-slippery pulse, named Bao Jue. It is sudden coma preventing speech.)
A pulse coming rapid (*Shu*) causes sudden fright, resolving in three to four days. (Formidable pathogens surging up cause a panting pulse; formless Qi reversing upward causes a rapid pulse. Pathogens pressing on the Heart cause fright. The Heart does not easily accept pathogens; after three to four days, pathogens descend, and the fright/syncope resolves, unlike difficult-to-treat exterior Wind syncope.)
A pulse that is "Fu He" (floating and merging), resembling a rapid count, exceeding ten beats per breath, indicates insufficiency of Jing Qi transmission. Death occurs in ninety days if slightly visible. (This discusses insufficiency of Zang/Meridian Qi and respective death periods. "Fu He" resembles merging waves, rootless. Rapid and >10 beats/breath indicates Jing Qi insufficiency. Slight visibility predicts death around day 9-10. Nine is the end of Yang, Ten is the end of Yin, marking the end of Twelve Meridian Qi. "Yu" means "to give/transmit". Five Zang are connected, transmitting in order. Reverse transmission to overcoming Zang causes death; forward transmission to generating Zang with insufficient received Qi also causes death. Hence "Qi insufficiency in transmission". Also, Zang Qi transmits to Shu points, then to Meridians, Collaterals, and Muscle. Insufficient Qi transmission results in this extremely deficient/rapid pulse. Shi Zong said: "Slight" contrasts with "obvious". Slight appearance predicts death in 90 days; obvious appearance shortens the period. The following "Jiao Qi" is similar. Zhang Zhaohuang said: Collaterals connect to muscle, allowing internal/external communication; thus, rapid pulse correlates with tight skin at Cun Kou, slow pulse with loose skin.)
A pulse burning like firewood indicates deprivation of Heart Essence. Death occurs when grass dries. (Burning like firewood indicates Heart Qi failing to store, extreme deficiency-fire. "Essence" refers to the Qi transmitted by Zang organs. Terms like "deprived," "deficient," or "insufficient" mean the loss of transmitted Essence-Qi. Grass drying signifies winter, when controlling/clashing Qi causes death. "Pulse arrival" refers to all three positions on left and right. Master Yu said: Heart pulse like firewood, Liver like scattered leaves, Stomach like mud balls, Taiyang like gushing springs, Muscle like collapsing earth—all use Five Elements imagery to describe Zang deficiency/death signs, not typical Zang disease pulses. These are Strange-Normal Pulses. Yinglue said: "Yu" means transmission of Zang Qi to the pulse.)
A pulse like scattered leaves indicates deficiency in Liver Qi transmission. Death occurs when leaves fall. (Scattered leaves symbolize drifting deficiency. Liver Wood Qi is deficient, so death occurs in Autumn.)
A pulse like a visiting guest (*Sheng Ke*), where the pulse feels blocked then beats and departs, indicates deficiency in Kidney Qi transmission. Death occurs before jujube flowers bloom. (Blocked then beating/departing resembles a visitor who arrives and immediately leaves. "Xuan" means interval. "Before jujube flowers" means dying before early summer. Zhang Zhaohuang said: Zang Qi aligns with Five Elements; plant flourishing/withering follows seasons. Fire/Earth dominate Summer, so "before jujube flowers" means dying in Late Summer (Earth season). Yinglue said: Pulse originates in Kidney, so Kidney deficiency causes this pulse.)
A pulse like a mud pellet indicates deficiency in Stomach Essence transmission. Death occurs when elm seeds fall. (Mud pellet implies lack of slipperiness. Stomach is Yang Earth, central, soft nature, round form. Weak/slipping pulse indicates Kidney Qi presence (slippery = pearl-like rolling). Mud pellet lacks sliding quality, signaling Stomach death. Elm seeds fall in Spring (Wood season). Zang Qi is born from Stomach Grain Essence, hence "Essence insufficiency".)
A pulse like a horizontal bar indicates deficiency in Gallbladder Qi transmission. Death occurs when grain ripens. (Gallbladder is Jia-Zi, governing initial Yang generation. Gallbladder Qi rising lifts all Eleven Zang/Fu Qi. Horizontal bar implies blockage preventing ascent, indicating Gallbladder deficiency/inability to rise. *Ling Shu* says: "Its Gallbladder is horizontal," matching the horizontal pulse. Grain ripening signifies deep Autumn. Zhang Zhaohuang said: Humans born in Yin, Heaven generates Wood; thus Zang/Fu life/death corresponds to seasonal plant cycles. Song History records Qian Yi treating a nursemaid with palpitations/insomnia as "Qi knot and Gallbladder horizontal not descending," cured with Qing Yu Li wine.)
A pulse like a string/thread indicates deficiency in Bao (Uterus/Microcosm) Essence transmission. If the patient talks excessively, death occurs at frost; if silent, it is treatable. (String/thread indicates fine deficiency of Essence/Blood. Bao Essence is the Qi/Blood of the Bao Luo (Connecting Vessel). Bao Luo connects to the Kidney, Shaoyin...)