传经必始太阳终厥阴者。太阳主气。厥阴主血也。邪气初伤。必在于气。渐深必及于血。血脉者。脏腑之道路
也。邪既入血。遂听其入腑入脏而不可御矣。治之必以行血活络。使血络松活。邪乃易消。养津强膜。使津膜相养。
正气乃固。否则血死气散水停筋弛。脏腑之腠理系络。渐见肿硬。无嘘 之气。以相循环。无伸缩之力以自兜裹。
而肩助引痛。不能转侧。一边不能眠。唇面青黑。 肿气喘。小涩大滑。脐筑湫痛。五液注下。诸败证见矣。故少
阴一经。虽多死证而偏属于寒。犹可温化。厥阴死证寒热夹杂不清。无从着手。由是言之。太阳病。只是表之气分。
病不必拘于膀胱小肠经也。厥阴病。只是里之血分病。不必拘于肝与心主经也。推之阳明太阴少阳少阴。莫不皆然。
故曰当在气化上讲求。勿在部位上拘泥。（上传经始太阳终厥阴解）
伤于寒毒为伤寒。伤于温毒为温病。与伤寒传化之温病。治法大异而小同。温毒起手须用凉散。接手即宜苦寒
以化之。咸寒以润之。甘寒以补之。而收功焉。甚有迭用苦寒。如吴又可所谓俟热邪复淤到胃。再三下之者。伤寒
转化之温。乃正气所化。是无根之邪。不宜重用驱逐。不但无须凉散。即苦寒亦不宜早用。更不宜迭用。故有下不
厌迟之说。王叔和伤寒例。剖析界限极明。后人反从而斥之。何也。至于瘟疫别是天地一种乖戾之气。或偏于湿。
或偏于燥。或偏于寒。不专属热也。初起。即在血分。血分。浊恶甚于温病末候。与温病为别派。如慎柔五书辨虚
损痨瘵之例相似。虚损无虫而瘵有虫。温热无虫而疫有虫。一常气。一奇气也。惟其奇也。故猪瘟不死鸡。鸡瘟不
死牛。其伤人也。或专杀贵逸。或专杀劳贱。或专杀强壮。或专杀幼稚。有不可以常理喻者。温病重症与瘟疫轻症。
往往相似。即 疹软脚大头粗颈。温病亦间有此症。大抵温病必由渐而成。气候专属于热。瘟疫一起即见。气候寒
热燥湿并有之。又有瘴毒溪毒。与瘟疫异源同派。疫有寒有热。多偏于燥。瘴亦有寒有热而多偏于湿。一发于天气。
一发于地气也。（上寒温疫瘴解）
辨脉篇。脉浮而大。医反下之。更饮冷水。其人即KT 。此节是仲景作论本旨。族人误死于伤寒者。误以治
温法治之也。寒水相搏。胃气愈促。能无呃乎。曾诊龚某。正与此合。二月。先忽大吐。喉伤碍食。以为火也。用
凉剂。遂发寒热。以为春温也。加重之。遂作呃。三日邀诊。脉来。弦长挺互。应指战栗。沉分。尺中尤甚。呃声
频仍。气从脐下直上撞心。曰。此下焦伏寒。乘时阳而上越。为凉药所抑而作呃耳。三日内当转关。否则再七日可
危。以生附子肉桂子细辛吴萸羌活独活胡芦巴破故纸。加泽泻牛膝导之。嘱令停温急服。三日复诊。其父喜迎于门
口。呃大减矣。小便鬯矣。筋骨痛减。能自起坐矣。及入诊。见面色枯黄。唇舌燥萎。脉来 长。无神摇摆尤甚。
惊曰。得毋改方乎。乃言小儿体弱。尊方力大。前日头煎。分三次服。每次皆呃止。熟睡两时。夜得微汗。昨日某
医来。以尊方一剂已足。改用平补。视之。则大剂参 归术。加姜汁胆汁也。我避中焦。急趋下焦。彼补中焦。升
提下焦。况术尤动气所忌。病患自室中大喊曰。自服彼方小便复闭。胸满气急难受也。此时若肯重服黑锡丹破阴丹。
或可希冀。勉照前方加竹茹知母与之。应期见鬼而逝。（上妄下变呃）
平脉之平读若骈。犹辨也。
关犹部也。寸关尺三部谓之三关。动脉见于关上无头尾者。谓形圆如豆。分见于各关之上。而不能通长有头尾
也。
微脉名。又不甚也。以句中有无而字别之。
若或也。发汗若下之。又此以曾经发汗若吐若下若亡血。
坐犹因也。但坐汗出不彻故也。如陌上编。归来怨新妇。但坐观罗敷。又无因而突然也。以手把刃。坐作疮
也。如鲍照芜城赋。孤蓬自振。惊沙坐飞。
反脉名。来微去大故名反。又金匮来近去远故曰反。
又不应也。脉浮而大。医反下之。又复也。少阴病。始得之。反发热。脉沉者谓既始得之。复有发热表证也。
太阳病。项背强KT KT 。反汗出恶风者。谓既项背KT KT 。复汗出恶风也。又却也。语助词。
其数先微。脉反但浮。谓其脉先微后数。却始终只在于浮也。又脉濡而弱。弱反在关。濡反在巅。（上字训正误）
传经（病邪由一经传入另一经）必定始于太阳经，终于厥阴经。这是因为太阳经主管气，而厥阴经主管血。病邪初伤人体时，必然先影响气分；随着病情逐渐深入，必然会波及血分。血脉是脏腑运行的通道。一旦邪气进入血分，就会任由其侵入腑和脏，此时便无法抵御了。治疗时必须采用行血活络的方法，使血络松弛通畅，邪气才容易消除；同时滋养津液、强健筋膜，使津液与筋膜相互滋养，正气才能稳固。否则，血液凝滞死结，气机散乱，水湿停聚，筋脉弛缓，脏腑的腠理和系络会逐渐出现肿胀坚硬，缺乏嘘吸之气来维持循环，也缺乏伸缩之力来自我包裹保护。于是肩膀辅助呼吸牵引作痛，身体不能转动侧身，只能偏向一侧睡眠，嘴唇和面色青黑，浮肿气喘，脉象小则涩、大则滑，脐部筑筑作痛且疼痛轻微持续，五种体液注泄而下，各种败坏的症状就都出现了。所以少阴经虽然有很多死证，但多属于寒证，还可以用温法化解；而厥阴经的死证则是寒热夹杂、界限不清，无从下手治疗。由此说来，太阳病只是表浅的气分病，不必拘泥于膀胱和小肠经；厥阴病只是深层的血分病，不必拘泥于肝和心包经。推及其他阳明、太阴、少阳、少阴各经，没有不是这样的。所以说应当在气化理论上去探求，不要在具体的经络部位上拘泥。（以上解释传经始太阳终厥阴）
感受寒毒称为伤寒，感受温毒称为温病。这与伤寒转化而来的温病，在治疗大法上大不相同，但在细节上有相似之处。温毒发病初期必须使用凉散之法，接手之后即宜用苦寒药以化解，咸寒药以滋润，甘寒药以补益，从而收功。甚至有反复使用苦寒药的情况，像吴又可所说的等待热邪再次瘀积到胃，再三使用下法。而伤寒转化来的温病，是由正气所化生的，是无根之邪，不宜重用驱逐之法。不仅不需要凉散，即使苦寒药也不宜过早使用，更不宜反复使用。所以有“下法不宜过迟”的说法。王叔和在《伤寒例》中剖析界限极为明确，后人反而加以斥责，这是为什么呢？至于瘟疫，它是天地间一种乖戾之气，有的偏于湿，有的偏于燥，有的偏于寒，并不专属于热。瘟疫初起就在血分，血分的浊恶程度甚于温病的末期，与温病属于不同的流派，就像慎柔在《五书》中辨别虚损和痨瘵的例子那样。虚损没有虫，而痨瘵有虫；温热病没有虫，而瘟疫有虫。这是一般之气与奇异之气的区别。正因为奇异，所以猪瘟不死鸡，鸡瘟不死牛。它伤人时，有的专门杀害富贵安逸之人，有的专门杀害劳苦卑贱之人，有的专门杀害强壮之人，有的专门杀害幼稚之人，有不能用常理来解释的。温病的重症与瘟疫的轻症，往往相似，甚至出疹、脚软、大头瘟、粗颈等症状，温病偶尔也有。大致来说，温病一定是逐渐形成的，气候属性专属于热；瘟疫一起病就显现出来，气候属性寒热燥湿并存。还有瘴毒、溪毒，与瘟疫异源同派。瘟疫有寒有热，多偏于燥；瘴气也有寒有热，但多偏于湿。瘴气一发于天气，一发于地气。（以上解释寒、温、疫、瘴的区别）
《辨脉篇》中说：脉浮而大，医生反而用下法，又让病人喝冷水，病人立即发生呃逆。这一节是张仲景撰写论著的宗旨本意。我的族人误死于伤寒，是因为误用了治疗温病的方法来治疗。寒水相互搏结，胃气更加急促，能不产生呃逆吗？我曾诊治龚某，情况与此完全吻合。二月，病人突然剧烈呕吐，咽喉受伤妨碍进食，以为是火证，使用了凉剂，随即发出发冷发热，以为是春温，加重了凉药剂量，结果产生了呃逆。第三天邀请我去诊病，脉象弦长挺硬互见，按指时感到战栗，沉取时尺部尤其明显，呃声频繁，气从脐下直冲撞心。我说：这是下焦潜伏的寒邪，趁着时令阳气上越，被凉药抑制而产生的呃逆。三天内应当转机，否则再过七天就有危险。我用生附子、肉桂、细辛、吴茱萸、羌活、独活、胡芦巴、破故纸，加泽泻、牛膝引导药力下行。嘱咐停止服用温补药，紧急服用此方。三天后复诊，病人的父亲在门口迎接，说呃逆大大减轻，小便通畅了，筋骨疼痛减少，能自己坐起了。等到进去诊察，见面色枯黄，嘴唇舌头干燥萎缩，脉象短促无力，无神摇摆更加严重。我惊讶地问：难道换了方子吗？他说孩子体质弱，您的方子药力太大，前天的头煎药分三次服，每次喝完呃逆都止住，熟睡两小时，夜里出了微汗。昨天另一位医生来，认为您的一剂药已经足够，改用平补药。我看那方子，是大剂量的参、芪、归、术，加了姜汁和胆汁。我避开中焦，急趋下焦；他补益中焦，反而升提了下焦的气机。况且白术更是动气所忌讳的。病患自己在卧室中大喊：自从服用了那位医生的方子，小便又闭塞了，胸满气急难受。此时如果肯重新服用黑锡丹或破阴丹，或许还有一线希望。勉强照原方加入竹茹、知母给他服用，最终如期见到鬼魂（形容濒死幻觉）而去世。（以上辨析妄用下法导致变证呃逆）
“平”字在平脉中读若“骈”，意思是辨别。
“关”犹言“部”。寸、关、尺三部称为三关。动脉出现在关上，没有头尾的，是指脉形圆如豆粒，分别见于各关之上，而不能贯通全长具有头尾。
“微”是脉名，意思是不显著。根据句中有无“不”字来区分字形。
“若”表示或者。如“发汗若下之”，这里指曾经发汗、或者吐、或者下、或者亡血。
“坐”犹言“因”。如“但坐汗出不彻故也”。又如《陌上桑》：“归来怨新妇，但坐观罗敷。”以及“无因而突然也”，如“以手把刃，坐作疮也”。又如鲍照《芜城赋》：“孤蓬自振，惊沙坐飞。”
“反”是脉名，来势微弱去势盛大所以叫反脉。又《金匮要略》中来近去远也叫反。
“反”又表示不、却。如“脉浮而大，医反下之”。又表示重复、反而。如“少阴病，始得之，反发热，脉沉者”，谓既然始得病，反而又有发热表证。“太阳病，项背强几几，反汗出恶风者”，谓既然项背强几几，反而又有汗出恶风。
“反”又表示语助词，却。如“其数先微，脉反但浮”，谓其脉先前微弱后来数，却始终只在于浮。“又脉濡而弱，弱反在关，濡反在巅。”（以上校正字词训诂错误）
The transmission of disease (Chuan Jing) must begin with the Taiyang channel and end with the Jueyin channel. This is because the Taiyang channel governs Qi, while the Jueyin channel governs Blood. When pathogenic factors initially injure the body, they inevitably affect the Qi level first; as the condition gradually deepens, it will inevitably involve the Blood level. Blood vessels are the pathways for Zang-Fu organs. Once pathogens enter the Blood level, they will be allowed to invade the Fu and Zang organs, at which point resistance becomes impossible. Treatment must employ methods to promote blood circulation and unblock collaterals, making the blood collaterals loose and smooth so that pathogens can be easily eliminated; simultaneously, nourish Body Fluids and strengthen sinews and membranes, allowing Body Fluids and membranes to mutually nourish each other, thereby consolidating Healthy Qi. Otherwise, blood stagnates and dies, Qi scatters, water dampness accumulates, and sinews relax. The pores and connecting networks of the Zang-Fu organs will gradually show swelling and hardness, lacking the "exhaling" Qi to maintain circulation, and lacking the power of contraction and expansion to self-enclose and protect. Consequently, the shoulders assist in breathing with pulling pain, the body cannot turn or shift position, sleep is only possible on one side, lips and face appear cyanotic and dark, edema and asthma occur, the pulse is choppy when small and slippery when large, the umbilical region feels pounding and aching with mild persistent pain, the five fluids pour down, and various signs of collapse appear. Therefore, although the Shaoyin channel has many fatal syndromes, they mostly belong to Cold patterns, which can still be transformed using warming methods. In contrast, fatal syndromes of the Jueyin channel involve mixed Cold and Heat that are unclear, leaving no clear approach for treatment. From this perspective, Taiyang disease is merely a superficial Qi-level disorder and should not be confined to the Bladder and Small Intestine channels; Jueyin disease is merely a deep Blood-level disorder and should not be confined to the Liver and Pericardium channels. Extending this logic to Yangming, Taiyin, Shaoyang, and Shaoyin channels, none are exceptions. Thus, it is said that one should seek understanding in Qi transformation theory, rather than being rigidly attached to specific anatomical locations. (Above explains the transmission beginning with Taiyang and ending with Jueyin)
Contracting cold toxicity is termed Shanghan (Cold Damage); contracting warm toxicity is termed Wenbing (Warm Disease). These differ significantly but share minor similarities in treatment compared to Warm Diseases arising from the transformation of Shanghan. For Warm Toxicity, initial treatment must use cooling and dispersing methods; upon subsequent management, bitter-cold herbs should be used to resolve heat, salty-cold herbs to moisten, and sweet-cold herbs to tonify, thereby achieving recovery. There are cases where bitter-cold herbs are used repeatedly, as described by Wu Keyang: waiting for heat pathogens to re-stagnate in the Stomach before purging multiple times. However, Warm Diseases transformed from Shanghan are generated by Healthy Qi itself; they are rootless pathogens and should not be aggressively expelled. Not only is cooling and dispersing unnecessary, but bitter-cold herbs should also not be used early or repeatedly. Hence, there is the saying that purgation should not be delayed excessively. Wang Shuhe’s *Shanghan Li* clearly delineates these boundaries, yet later scholars criticized him. Why? As for Plague (Wenyi), it is a type of perverse Qi from Heaven and Earth, which may lean towards Dampness, Dryness, or Cold, and does not exclusively belong to Heat. Plague begins in the Blood level immediately; the turbidity and filth of the Blood level in plague are worse than the late stage of Warm Disease, placing it in a separate category. This is similar to how Shen Rou distinguished between Xu Sun (Deficiency Consumption) and Lao Zhai (Tuberculosis) in his *Five Books*. Xu Sun involves no parasites, whereas Lao Zhai involves parasites; Warm diseases involve no parasites, whereas Plagues do. One is ordinary Qi, the other is extraordinary Qi. Because it is extraordinary, Pig Plague does not kill chickens, and Chicken Plague does not kill cattle. When injuring humans, it may specifically target the wealthy and idle, the laboring and lowly, the strong, or the young and weak—phenomena that cannot be explained by ordinary reasoning. Severe cases of Warm Disease often resemble mild cases of Plague; symptoms such as rashes, soft legs, Big Head Plague, and swollen necks occasionally appear in Warm Disease. Generally, Warm Disease develops gradually, and its climatic nature belongs exclusively to Heat; Plague manifests immediately upon onset, and its climatic nature includes Cold, Heat, Dryness, and Dampness. Additionally, Zhang Du (Miasma Poison) and Xi Du (Stream Poison) share the same lineage as Plague but have different origins. Plague has Cold and Heat types, mostly leaning towards Dryness; Miasma also has Cold and Heat types, mostly leaning towards Dampness. Miasma arises from Heavenly Qi, while Plague arises from Earthly Qi. (Above explains the distinctions among Cold, Warm, Plague, and Miasma)
In the *Bian Mai Pian* (Chapter on Differentiating Pulses), it states: "If the pulse is floating and large, and the physician erroneously applies purgation, followed by giving cold water, the patient will immediately develop hiccups." This section represents the fundamental intent of Zhang Zhongjing’s treatise. A member of my clan died due to Shanghan because he was mistakenly treated with methods intended for Warm Disease. Cold water and cold pathogens clashed, further accelerating Stomach Qi; how could hiccups not occur? I once treated a patient named Gong, whose condition matched this exactly. In February, the patient suddenly vomited profusely, injuring the throat and hindering food intake. It was mistaken for Fire syndrome, and cooling formulas were administered. Subsequently, chills and fever developed, which were mistaken for Spring Warmth, leading to an increase in cooling medications, which resulted in hiccups. On the third day, I was invited to diagnose. The pulse was wiry, long, stiff, and intermixed, trembling under pressure, especially profound in the Chi position upon deep palpation. Hiccups were frequent, with Qi rushing straight up from below the navel to strike the heart. I stated: "This is latent Cold in the Lower Jiao, rising with seasonal Yang, suppressed by cooling medicines, causing hiccups. Within three days, there should be a turning point; otherwise, within another seven days, the condition will become critical." I prescribed Raw Aconite Root (Sheng Fuzi), Cinnamon Twig (Rougui), Asarum (Xixin), Evodia Fruit (Wuyu), Notopterygium Rhizome (Qianghuo), Angelica Pubescens Root (Duhuo), Pedalanthus Seed (Huluba), and Psoralea Fruit (PoguZhi), adding Alisma Rhizome (Zexie) and Achyranthes Root (Niuxi) to guide the action downward. I instructed stopping warm tonics and urgently taking this prescription. Three days later, upon follow-up, the patient's father welcomed me at the door, reporting that hiccups had greatly decreased, urination became smooth, bone and muscle pain reduced, and the patient could sit up independently. Upon entering to examine, the face appeared withered and yellow, lips and tongue dry and shriveled, the pulse was short and powerless, lacking spirit and showing severe wavering. I asked in surprise: "Has the prescription been changed?" He replied: "The child has a weak constitution, and your prescription is too potent. The first decoction from two days ago was divided into three doses; after each dose, hiccups stopped, and he slept soundly for two hours, sweating slightly at night. Yesterday, another doctor came, stating that one dose of your prescription was sufficient, and switched to a mild tonic. Looking at that prescription, it contained large doses of Ginseng (Renshen), Astragalus (Huangqi), Angelica Sinensis (Danggui), and Atractylodes Macrocephala (Baizhu), added with Ginger Juice and Bear Bile. You avoided the Middle Jiao and targeted the Lower Jiao; he tonified the Middle Jiao, inadvertently lifting Qi from the Lower Jiao. Moreover, Atractylodes is contraindicated for moving Qi. The patient shouted from the bedroom: 'Since taking that doctor's prescription, urination has ceased again, and I suffer from chest fullness and urgent difficulty breathing.' At this moment, if he were willing to take Black Tin Pill (Heixi Dan) or Yin-Breaking Pill (Poyin Dan) again, there might be hope. Reluctantly, I added Bamboo Shavings (Zhuru) and Anemarrhena Rhizome (Zhimu) to the original formula. He passed away as predicted, seeing ghosts." (Above analyzes hiccups caused by erroneous purgation and variable syndromes)
"Ping" (Level/Normal) in Ping Mai is pronounced like "Pian," meaning to differentiate.
"Guan" (Carpel/Gate) is akin to "Bu" (Section). The three positions Cun, Guan, and Chi are called the Three Guans. The Dong Mai (Surging Pulse) appears at the Guan position without head or tail; its shape is round like a bean, appearing separately above each Guan, but unable to extend longitudinally with distinct heads and tails.
"Wei" (Fine/Micro) is a pulse name, meaning not prominent. The character distinction depends on the presence or absence of "bu" (not) in the sentence.
"Ruo" (If/Like) indicates possibility. As in "sweating or purging," here referring to having previously sweated, vomited, purged, or lost blood.
"Zuo" (Sit) means "because." As in "only because sweat discharge was incomplete." Also seen in *Mo Shang Sang*: "Returning home, the new wife complains, only because she watched Luofu." And "without cause, suddenly occurring," such as "handling blades with hands, sitting [causing] wounds." Also in Bao Zhao’s *Wucheng Fu*: "Lonely tumbleweed shakes itself, startled sand flies by chance."
"Fan" (Reverse/Opposite) is a pulse name; coming weak and going strong is thus called Fan. Also, in *Jingui Yaolue*, coming close and going far is called Fan.
"Fan" also means "not" or "yet." As in "pulse floating and large, physician erroneously purges." It also means "again" or "instead." As in "Shaoyin disease, just acquired, yet has fever, pulse sinking," meaning since just acquiring the disease, there is instead fever and exterior signs. "Taiyang disease, stiff neck and back, yet has sweating and aversion to wind," meaning since stiff neck and back, there is instead sweating and aversion to wind.
"Fan" also serves as a particle meaning "however." As in "its rate was previously fine, pulse however only floats," meaning the pulse was previously fine then rapid, but ultimately remains only floating. "Also, pulse is soft and weak, weakness however is at Guan, softness however is at Dian." (Above corrects errors in character definitions)