表。宜驱之于外。故当发汗也。亦不过笼统言之。示人知辨脉为要。与前段一势叙下。故下段稍易
前后焉。
趺阳脉浮而涩。少阴脉如经也。其病在脾。法当下利。何以知之。若脉浮大者。气实血虚也。
今趺阳脉浮而涩。故知脾气不足。胃虚也。以少阴脉弦而浮。才见此为调脉。故称如经也。若反滑
而数者。故知当屎脓也。
此段言辨脉之法。不但辨手三部。并当辨足HT 骨上之趺阳脉也。此辨脉于精微。多方求其至。不
惟表里脏腑。大势可明。即细微曲折。无不可明矣。趺阳。胃脉也。又以候少阴肾。胃者。就经
以候腑。肾者。就下以候下也。夫在经为胃脉。而四肢则属脾。胃又与脾为表里。故脉之行。实脾
胃之气互相为用也。今趺阳脉浮而涩。其浮不同于手脉之浮也。寸口浮。在经络之表。趺阳浮。则
在腑之里。然在腑虽为里。就脾脏言。则仍表也。然浮皆作表论。在趺阳亦然也。若浮而大。则为
气实血虚。是何病乎。亡血也。则大脉乃是外实中虚。浮按而得空之芤脉。故但为亡血。以是知浮
大之症。不同于脉浮而涩之症也。盖浮而又涩。似肾病。但诊肾脉之在手者。则弦而浮。弦虽似寒。
而按之不紧。且浮则非寒而弦也。乃少阴之气通于少阳。寒水上溉风木。水木相生。非为病脉。故
脉浮而涩。专为脾家病也。盖趺阳浮为胃气。兼涩则脾病。以涩为血不足。血不足。仍是气不足。
脾之阳气不足。则脉涩。实由胃之阳气虚。而不能温脾。表里俱虚。土不能障水。故下利也。因趺
阳属胃。又属肾。求之少阴。脉调如经。更求之胃阳浮。即得脾之阴涩。设下利之久。浮而涩。忽
反滑而数。知向脉之浮。阳虚外散者。因下利而随阴下趋。尽敛而陷入阴分。为挟热之利。且当便
脓血矣。是趺阳脉。虽兼肾而候胃。但候肾亦必少阴常负趺阳。方为调脉如经。故求之肾不得病脉。
而见调脉。即求之胃。亦先浮而涩。继滑而数。知病在脾。并不在胃。特以脾不离胃。应于趺阳。
故辨胃而知其病在脾耳。旧说。将滑而数谓少阴病。不知少阴已脉调如经。何得滑数。且少阴之数。
必兼沉细。或下利。未有不涩者。今云滑数。岂少阴病乎。况少阴虽开窍于二阴。却不司屎之软硬。
脓血之有无。明系自上文浮涩来。故加反字也。如此看本段文义方一线。
本段笔法。回互错综。极变化之妙。庸医不能骤解。真仲师之文也。即此已可知非后人伪作。
趺阳脉迟而缓者。胃气如经也。趺阳脉浮而数。浮则伤胃。数则动脾。此非本病。医下之所为也。
荣卫内陷。其数先微。脉反但浮。其人必大便硬。气噫而除。何以言之。本以数浮动脾。其数先
微。故知脾气不治。大便硬气噫而除。今脉反浮。其数改微。邪气独留。心中则饥。邪热不杀谷。
潮热发渴。数脉（跌阳脉）当迟缓。脉（此是手脉）因前后度数如法。病者则饥。数脉不时。
则生恶疮也。
此段再就趺阳明其为胃脉。以胃与脾表里。病必连及。故又当于脉辨之。迟而缓。迟字。只贴
缓作虚字看。非三至之迟。故为如经之调脉。浮而数则不如经矣。盖浮则正阳外散。而中气虚。故
曰胃伤。数则邪热入里。而中阴耗。故曰脾动。夫脾本动。今非本经之动。乃病邪触之使动也。医
所以下者。必以数为内热。故下之。不知浮为在表。虽兼数。无下理。数为在腑。必兼滑大。方为
实热。可下。数而微小。则为虚热。亦无下理也。今误下之。荣卫所受之表邪。悉内陷。脏腑虚热
浮游。不能持久。故脉之数者先罢而微。但见虚浮之象。则内陷之邪变热。必逼胃阳外出。胃中液
耗而便硬。且脉浮少气。浮而上逆。噫除更噫。皆由妄下伤阴。以致阳扰也。何以言之。先言数则
动脾。后因妄下而数脉先微。一切便硬气噫。皆脾气之不治也。夫前条因脾不足而知胃弱。此条因
脾不治而乱胃气。其表里相关如此。所以浮数改为但浮。而数已渐微先罢。数去浮存。必表邪独留
于内。遂致心中则饥。口不能食。食亦不消。且邪热耗液。液耗则阴虚。而热必潮。渴必发。于是
汗大泄。邪遂以散。邪散正复。是以趺阳脉复当迟缓也。且不独趺阳。即诸脉之在手者。亦必六诊
同等而如法。病患自饥而能食也。或有平日热邪内胜。误下后虽数。暂改微而病愈。然恐不时又起。
变生恶疮。故亦不可因病愈而忽之也。此段亦笔法回互。文义婉曲。一时不易猝解。
师曰。病患脉微而涩者。为医所病也。大发其汗。又数大下之。其人亡血。病当恶寒。后乃
发热。无休止时。夏月盛暑。欲着
复衣。冬月盛寒。欲裸其身。所以然者。阳微则恶寒。阴微则恶热。此医发其汗。阳气微。又大下之。
令阴气弱。五月之时。阳气在表。胃中虚冷。以阳气内微。不能胜冷。故欲着复衣。冬十一月之
时。阳气在里。胃中烦热。以阴气内弱。不能胜热。故欲裸其身。又阴脉迟涩。所以血亡也。
此段就脉之微涩。知为医所病。而致气血多虚之症也。
其人亡血句。宜着眼。包阴阳两虚在内。阳微阴微。不过示人知误汗误下之禁。其实汗即血也。
误汗多出。何尝不病阴。津液。气之化也。误下。何尝不病阳。此又可推展误汗下阴阳交病之理也。
兼以天时言之。亦俱推展阴阳来复。而知病之加损也。于是可以再申言之。脉之微者。寸日浮取之
也。脉之涩者。尺部沉取之也。微涩皆阴脉。而候之于尺寸浮沉。则分阴阳矣。故浮而涩。阴阳俱
病也。言亡血者。其阴脉涩之中又兼迟也。迟而涩。沉取于尺部而得之。可以专言血分。但既兼迟。
气不足运。脉不如经。过于缓而得迟。血亡由于气衰。误为汗下。可以一症而兼得之也。安可不
辨脉哉。
独言亡血者。血有形。气无形。血之亡可见。气之亡不可见。故言亡血下。即言当恶寒。后发
热。若但亡血。不过阴虚生内热。发热而已。何以复阳虚生外寒。而先恶寒后发热耶。但外感之邪。
亦有先寒后热。何以知其阴阳两虚。此又就症之寒热无休止时而可知矣。
脉浮而大。心下反硬。有热属脏者。攻之。不令发汗。属腑者。不令溲数。溲数则大便硬。汗
多则热愈。汗少则便难。脉迟尚未可攻。
此段就脉辨病。属脏属腑。分在里之表里。以求病邪。病邪得。尤必辨脉以施治也。不令溲数
数语。一贯说下。俱贴属腑一边。
脉浮而大。寸口得之。知病在表。然心下硬。邪已入里。且内有热。必烦必渴。此属心脏也。
肺脏也。此在胸则结胸。虽不入肺而碍于肺。在心则痞。虽不入心。而迫于心。故曰属脏。审于脉
浮大在表。原应令汗出以解病。至于变热内结。则必攻之。攻法不必尽言。尽言则非辨脉。是辨症
辨治矣。此因浮大既悉。又审于症。却无非辨脉耳。属腑
一段。亦根浮大脉来。脉大本宜汗。邪既变热入里。幸不成结胸痞诸近脏之症。惟转入阳明之腑。
则不可因内热而利小便。盖小便利。则津液从清道泄。无以润大肠。故便硬。是仍宜发汗。使邪从
阳明转太阳而出。盖热虽入胃腑。而胃尚未实。切宜禁下。况脉见浮大。故仍从表治。必令汗出彻。
而后邪热入里者。还从表解也。如汗出不彻。邪不透表。日久在胃。消耗正津。大便硬者。且渐
难。必至成实。有无所复传之危症。夫至便难。似宜下矣。然犹必辨脉。若带迟。胃虚冷。亦未可
下也。总之当初入胃腑。邪犹在表。一汗而热愈。为不易之良法也。此亦就辨脉而申论之症。示人
当知辨脉为先务也。
脉浮而洪。身汗如油。喘而不休。水浆不下。形体不仁。乍静乍乱。此为命绝也。又未知何脏
先受其灾。若汗出发润。喘不休者。此为肺绝也。阳反独留。形体如烟熏。直视摇头者。此心绝也。
唇吻反青。四肢 习者。此为肝绝也。环口黧黑。柔汗发黄者。此为脾绝也。溲便遗失。狂言。
目反直视者。此为肾绝也。又未知何脏阴阳前绝。若阳气前绝。阴气后竭者。其人死。身色必青。
阴气前绝。阳气后竭者。其人死。身色必赤。腋下温。心下热也。
此段因辨三部皆浮而无根。及洪大而散之脉。而知其大命之将绝。又就症辨何脏先绝。又辨阴
阳尽竭之前后。辨脉至此。精矣至矣。故非辨症也。所以命绝者。以脉三部皆浮而无根。洪大而散。
是阳将外脱上越。阴不能维持于中。以致离卸其交钮。再或阴寒内盛。自下逼上。孤阳外亡。独
阴无阳。亦成离判也。此皆辨脉而知其命将绝也。 习。谓振动搐搦。手足时引缩也。
寸口脉浮大。而医反下之。此为大逆。浮则无血。大则为寒。寒气相搏。则为肠鸣。医反不知。
而反饮冷水。令大汗出。水得寒气。冷必相搏也。其人即KT 。
此段只就寸口浮大一脉。推究之。以见左右三部九候应辨者。无穷也。
寸口脉浮。是邪在表。不治表而下之。自犯
大逆也。且凡言浮。则必过于浮。（凡脉皆当如此看）凡言大。则必过于大。故寸见浮。可知气胜
而亡血。阴不能维阳使静。故只见浮而且大。可知所谓气胜者。亦非正气。乃挟外感风寒之邪。参
杂而成大脉。是外感邪寒与正气相搏而成病者也。夫中表固为寒与正搏。即直中里。因肠胃素有虚
风。风亦气也。亦与时感之寒相搏。遂成肠鸣之症。即不下之。且将自利。可下之乎。然不可下。
俗医必为可汗。但因浮大。谓为实热在内。饮以冷水。令大汗出。不知冷水只可消实热。焉可治寒
气。今所饮冷水。得寒气又必相搏。搏于胸胃。阳滞阴凝。饮食入而必KT 矣。KT 即噎也。所以
KT者。以寒邪格于阳部。拒而不入也。饮冷水以发汗。诸家概置勿论。魏氏比义于白虎汤。而云
未能自信。然此无难知者。如今人患热病。食西瓜则汗出而解。亦此意也。
KT 病有成于饮冷者。有成于饮热酒者。无非寒热与虚气相搏而成也。
趺阳脉浮。浮则为虚。浮虚相搏。故令气KT 。言胃气虚竭也。脉滑。则为哕。此为医咎。责
虚取实。守空迫血。脉浮。鼻中燥者。必衄也。
此段承上申言气逆之KT 。再审于专主胃之趺阳脉也。下体之诊。浮即为虚。不同于寸口之必
兼大也。浮虚相搏之虚。乃胃虚也。虚必有寒。虚寒之胃气相搏。是以气必上逆而为KT 。不必定
成噎症。凡胃虚寒。胸膈必反有浮游之热。逆而上冲。重可噎饮食。轻亦可逆膈气。是胃已虚。不
治。则将竭也。如浮带滑。滑近数。邪热上冲。必为空哕。是胃虚气逆。更甚于呕矣。此由医误汗
下。或误饮冷水也。夫胃本虚而以为实。反责虚以取实。其为大逆。如前段所云也。于是胃气内空。
则阳不足而越于外。阴之内守者。亦不能自固于中。且阴既虚。又生邪热。热入阴中。迫血妄行。
于是血随邪热而上行。必从鼻而出。故趺阳脉浮而觉鼻中燥者。必衄也。然则趺阳得一浮脉。即知
胃气之虚竭。兼一滑脉。即知邪热之妄行。其可不辨之而误有所治哉。
此段言胃虚。大约虚寒则KT 食。虚热则吐血。于浮脉兼滑兼大而辨之。大即芤。滑即数也。
可体原文上段言芤言革言数而明之。
诸脉浮数。当发热而洒淅恶寒。若有痛处。饮食如常者。蓄积有脓也。脉浮而迟。面赤而战惕者。六七
日当汗出而解。反发热者。瘥迟。迟则无阳。不能作汗。其身必痒也。
此段就脉之浮数辨论。曰诸脉。则左右三部九候皆该。不独两寸也。然必以两寸为气之聚。脉
之归焉。
寸口脉阴阳俱紧者。法当清邪中于上焦。浊邪中于下焦。清邪中上。名曰洁。浊邪中下。名曰
浑也。阴中于邪。必内栗也。表气虚微。里气不守。故使邪中于阴也。阳中于邪。必发热。头痛。
项强。颈挛。腰痛。胫酸。所谓阳中雾露之气。故曰清邪中上。浊邪中下。阴气为栗。足膝逆冷。
便溺妄出。表气虚微。里气微急。三焦相混。内外不通。上焦怫郁。脏气相熏。口烂食断也。中焦
不治。胃气上冲。脾气不转。胃气为浊。荣卫不通。血凝不流。若卫气前通者。小便赤黄。与热相
搏。因热作使。游于经络。出入脏腑。热气所过。则为痈脓。若阴气前通者。阳气厥微。阴无所使。
客气内入。嚏而出之。声 咽塞。寒厥相逐。为热所壅。血凝自下。状如猪肝。阴阳俱厥。脾气孤
弱。五液注下。下焦不阖。清便下重。令便数难。脐筑湫痛。命将难全。
此段似乎辨症。但起手重提寸口脉阴阳俱紧一语。则浮中沉取之俱紧。乃三焦阴寒涸冱之象。
故必详究表里上下之症。以为阴阳俱紧之脉证验。则辨症正以辨脉也。
脉阴阳俱紧者。口中气出。唇口干燥。蜷卧足冷。鼻中涕出。舌上苔滑。勿妄治也。到七日以
来。其人微发热。手足温者。欲解。到八日以上。反大发热者。此为难治。设使恶寒者。必欲呕也。
腹内痛者。必欲利也。
此段承上脉阴阳俱紧。申言寒湿中人上下成病。其症候次序。病情转变。大命生死。一切情状
也。
此段单就初病言。下段又就变迁言。
表证。应当将病邪驱除于体表之外。因此应当采用发汗法。这不过是笼统地说法，旨在提示人们辨别脉象是诊疗的关键。这与前一段落顺着同一思路叙述，所以下一段落在论述上稍作变化。
趺阳脉（足背动脉，候脾胃）浮而涩，少阴脉（太溪穴处动脉，候肾）像正常的经脉一样。这说明病位在脾，按照规律应当出现下利（腹泻）。怎么知道呢？如果脉象浮大，那是气实血虚的表现。现在趺阳脉浮而涩，所以知道是脾气不足，胃气虚弱。因为少阴脉弦而浮，刚刚看到这种脉象就是调和的脉象，所以称为“如经”（像正常经脉一样）。如果反而出现滑而数的脉象，所以知道应当排出脓血。
这一段讲的是辨别脉象的方法，不仅要辨别手部的三部脉，还应当辨别足部踹骨上方的趺阳脉。这是在精微之处辨别脉象，多方探求其极致，不仅表里脏腑的大势可以明了，即使是细微曲折的变化，也没有不能明察的。趺阳脉是胃脉，又用来候察少阴肾。胃，是通过本经来候察腑；肾，是通过下部来候察下部。在经脉中它是胃脉，而四肢属于脾，胃与脾互为表里。所以脉气的运行，实际上是脾和胃的气互相为用。现在趺阳脉浮而涩，它的“浮”不同于手部脉象的“浮”。寸口脉浮，是在经络之表；趺阳脉浮，则是在腑之里。虽然在腑属于里，但就脾脏而言，仍然属于表。然而浮脉都按表证论治，在趺阳脉也是如此。如果浮而大，就是气实血虚，这是什么病呢？是失血。那么“大”脉乃是外实中虚，浮取时感觉中空，即芤脉。所以只是失血的症状，由此可知浮大的症状，不同于脉浮而涩的症状。大概浮而又涩，看似肾病，但诊察手部的肾脉，则是弦而浮。弦虽然似寒，但按之不紧，且浮则不是寒而是弦。这是因为少阴之气通于少阳，寒水上滋风木，水木相生，并非病脉。所以脉浮而涩，专门是脾家的病。大概趺阳脉浮是胃气，兼见涩象则是脾病，因为涩代表血不足，血不足，仍然是气不足。脾的阳气不足，则脉涩，实际上是由于胃的阳气虚，不能温煦脾土，表里俱虚，土不能制水，所以下利。因为趺阳属胃，又属肾，求之于少阴，脉调如常，再求之于胃阳浮，即得到脾的阴涩。如果下利日久，浮而涩的脉忽然反变为滑而数，知道先前脉之浮，是阳虚外散，因下利而随阴气下趋，全部收敛并陷入阴分，成为挟热之利，并且应当大便脓血了。这是说趺阳脉，虽然兼候肾而主要候胃，但候肾也必须是少阴脉经常负于趺阳脉，才算是调脉如经。所以求之于肾没有得病脉，而见到调脉，即求之于胃，也是先浮而涩，继之滑而数，知道病在脾，并不在胃，特别因为脾不离胃，应于趺阳脉，所以辨胃脉而知病在脾罢了。旧的说家，将滑而数认为是少阴病，不知道少阴脉已经调如常，怎么会滑数？而且少阴之数，必兼沉细，或者下利，没有不涩的。现在说是滑数，难道是少阴病吗？况且少阴虽然开窍于二阴，却不主管屎的软硬、脓血的有无。明显是从上文浮涩而来，所以加一个“反”字。这样看本段的文义才贯通。
本段的笔法，回互错综，极尽变化之妙，庸医不能立刻理解，真是仲景先生的文章。仅凭这一点就可以知道不是后人伪作。
趺阳脉迟而缓，说明胃气如常。趺阳脉浮而数，浮则伤胃，数则动脾。这不是本来的病，是医生误用下法造成的。营卫内陷，其数脉先变微弱，脉反而只现浮象，其人必定大便硬，嗳气且伴有呃逆（或指气逆不适）。为什么这样说？本来是因为数脉浮动扰动脾，其数脉先变微弱，所以知道脾气不治，导致大便硬、嗳气及气逆。现在脉反而浮，其数脉改作微弱，邪气独留，心中觉得饥饿，但邪热不能消化食物，出现潮热、口渴发渴。数脉（指趺阳脉）应当迟缓，脉（这里指手部脉）因为前后诊法合乎规范，病人则会感到饥饿。如果数脉不时出现，则会产生恶疮。
这一段再次就趺阳脉作为胃脉，因为胃与脾互为表里，病必然牵连，所以又应当在脉象上辨别。迟而缓，这里的“迟”字，只贴近“缓”看作虚象，不是三至一息的迟，所以是如常的调脉。浮而数就不如常了。大概浮则正气外散，而中气虚，所以说胃受伤。数则邪热入里，而中阴耗损，所以说脾被扰动。脾本来是动的，现在不是本经的动，而是病邪触动使之动。医生之所以用下法，一定是认为数是内热，所以下之。不知道浮是在表，虽然兼数，没有可下的道理。数是在腑，必须兼滑大，才是实热，才可下。数而微小，则是虚热，也没有可下的道理。现在误用下法，营卫所受表的邪气，全部内陷，脏腑虚热浮游，不能持久，所以脉之数者先罢去而变微。只见虚浮之象，则内陷之邪变热，必定逼迫胃阳外出，胃中津液耗损而大便硬。而且脉浮少气，浮而上逆，嗳气甚至呃逆不止，都是由妄用下法损伤阴液，以致阳气扰乱。为什么这样说？先说数则动脾，后因妄下而数脉先微，一切便硬、嗳气，都是脾气不治所致。前一条因脾不足而知胃弱，这一条因脾不治而乱胃气，它们的表里关系如此。所以浮数改为但浮，而数已渐微先罢。数去浮存，必定表邪独留于内，遂致心中则饥，口不能食，食亦不消。而且邪热耗液，液耗则阴虚，而热必潮，渴必发，于是汗大泄，邪遂以散。邪散正复，是以趺阳脉复当迟缓。且不独趺阳，即诸脉在手者，也必六诊同等而如法，病患自然从饥饿到能进食。或者有平日热邪内盛，误下后虽数，暂改微而病愈，然而恐怕不时又起，变生恶疮，所以也不可因病愈而忽视它。这一段也是笔法回互，文义婉曲，一时不易猝然理解。
老师说：病人脉微而涩，是被医生治坏的。大发其汗，又多次大下之，其人亡血，病应当恶寒，后来才发热，没有停止的时候。夏天盛暑，想穿厚衣；冬天盛寒，想裸露身体。为什么会这样？阳微则恶寒，阴微则恶热。这是医生发其汗，使阳气微，又大下之，令阴气弱。五月之时，阳气在表，胃中虚冷，因为阳气内微，不能胜冷，所以想穿厚衣。冬十一月之时，阳气在里，胃中烦热，因为阴气内弱，不能胜热，所以想裸露身体。又阴脉迟涩，所以血亡。
这一段就脉之微涩，知道是被医生治坏，而导致气血多虚的症状。
“其人亡血”一句，应当着眼，包含阴阳两虚在内。阳微阴微，不过是提示人们知道误汗误下的禁忌。其实汗即血也，误汗多出，何尝不病阴？津液，是气的化生。误下，何尝不病阳？这又可以推展误汗下导致阴阳交病的道理。兼以天时言之，也俱推展阴阳来复，而知病的加损。于是可以再申言，脉之微者，是寸口浮取之象。脉之涩者，是尺部沉取之象。微涩皆阴脉，而候之于尺寸浮沉，则分阴阳了。所以浮而涩，阴阳俱病。说亡血者，其阴脉涩之中又兼迟也。迟而涩，沉取于尺部而得之，可以专言血分。但既兼迟，气不足运，脉不如常，过于缓而得迟，血亡由于气衰，误为汗下，可以一症而兼得之也。安可不辨脉哉。
独言亡血者，血有形，气无形，血之亡可见，气之亡不可见。所以言亡血下，即言当恶寒，后发热。若但亡血，不过阴虚生内热，发热而已。何以复有阳虚生外寒，而先恶寒后发热耶？但外感之邪，亦有先寒后热，何以知其阴阳两虚？此又就症之寒热无休止时而可知矣。
脉浮而大，心下反硬，有热属脏者，攻之，不令发汗。属腑者，不令溲数。溲数则大便硬。汗多则热愈，汗少则便难。脉迟尚未可攻。
这一段就脉辨病，属脏属腑，分在里之表里，以求病邪。病邪得，尤必辨脉以施治也。不令溲数数语，一贯说下，俱贴属腑一边。
脉浮而大，寸口得之，知病在表。然心下硬，邪已入里，且内有热，必烦必渴。此属心脏也，肺脏也。此在胸则结胸，虽不入肺而碍于肺；在心则痞，虽不入心，而迫于心。故曰属脏。审于脉浮大在表，原应令汗出以解病，至于变热内结，则必攻之。攻法不必尽言，尽言则非辨脉，是辨症辨治矣。此因浮大既悉，又审于症，却无非辨脉耳。属腑一段，亦根浮大脉来。脉大本宜汗，邪既变热入里，幸不成结胸痞诸近脏之症，惟转入阳明之腑，则不可因内热而利小便。盖小便利，则津液从清道泄，无以润大肠，故便硬。是仍宜发汗，使邪从阳明转太阳而出。盖热虽入胃腑，而胃尚未实，切宜禁下。况脉见浮大，故仍从表治，必令汗出彻，而后邪热入里者，还从表解也。如汗出不彻，邪不透表，日久在胃，消耗正津，大便硬者，且渐难，必至成实，有无所复传之危症。夫至便难，似宜下矣。然犹必辨脉，若带迟，胃虚冷，亦未可下也。总之当初入胃腑，邪犹在表，一汗而热愈，为不易之良法也。此亦就辨脉而申论之症，示人当知辨脉为先务也。
脉浮而洪，身汗如油，喘而不休，水浆不下，形体不仁，乍静乍乱，此为命绝也。又未知何脏先受其灾。若汗出发润，喘不休者，此为肺绝也。阳反独留，形体如烟熏，直视摇头者，此心绝也。唇吻反青，四肢抽搐者，此为肝绝也。环口黧黑，柔汗发黄者，此为脾绝也。溲便遗失，狂言，目反直视者，此为肾绝也。又未知何脏阴阳前绝。若阳气前绝，阴气后竭者，其人死，身色必青。阴气前绝，阳气后竭者，其人死，身色必赤。腋下温，心下热也。
这一段因辨三部皆浮而无根，及洪大而散之脉，而知其大命之将绝。又就症辨何脏先绝，又辨阴阳尽竭之前后。辨脉至此，精矣至矣。故非辨症也。所以命绝者，以脉三部皆浮而无根，洪大而散，是阳将外脱上越，阴不能维持于中，以致离卸其交钮。再或阴寒内盛，自下逼上，孤阳外亡，独阴无阳，亦成离判也。此皆辨脉而知其命将绝也。习，谓振动搐搦，手足时引缩也。
寸口脉浮大，而医反下之，此为大逆。浮则无血，大则为寒。寒气相搏，则为肠鸣。医反不知，而反饮冷水，令大汗出。水得寒气，冷必相搏也。其人即噎。
这一段只就寸口浮大一脉，推究之，以见左右三部九候应辨者，无穷也。
寸口脉浮，是邪在表，不治表而下之，自犯大逆也。且凡言浮，则必过于浮。（凡脉皆当如此看）凡言大，则必过于大。故寸见浮，可知气胜而亡血，阴不能维阳使静。故只见浮而且大，可知所谓气胜者，亦非正气，乃挟外感风寒之邪，参杂而成大脉，是外感邪寒与正气相搏而成病者也。夫中表固为寒与正搏，即直中里，因肠胃素有虚风，风亦气也，亦与时感之寒相搏，遂成肠鸣之症。即不下之，且将自利，可下之乎？然不可下。俗医必为可汗，但因浮大，谓为实热在内，饮以冷水，令大汗出。不知冷水只可消实热，焉可治寒气。今所饮冷水，得寒气又必相搏，搏于胸胃，阳滞阴凝，饮食入而必噎矣。噎即噎也。所以噎者，以寒邪格于阳部，拒而不入也。饮冷水以发汗，诸家概置勿论。魏氏比义于白虎汤，而云未能自信。然此无难知者，如今人患热病，食西瓜则汗出而解，亦此意也。
噎病有成于饮冷者，有成于饮热酒者，无非寒热与虚气相搏而成也。
趺阳脉浮，浮则为虚，浮虚相搏，故令气噎。言胃气虚竭也。脉滑，则为哕。此为医咎。责虚取实，守空迫血。脉浮，鼻中燥者，必衄也。
这一段承上申言气逆之噎，再审于专主胃之趺阳脉也。下体之诊，浮即为虚，不同于寸口之必兼大也。浮虚相搏之虚，乃胃虚也。虚必有寒，虚寒之胃气相搏，是以气必上逆而为噎。不必定成噎症。凡胃虚寒，胸膈必反有浮游之热，逆而上冲，重可噎饮食，轻亦可逆膈气。是胃已虚，不治，则将竭也。如浮带滑，滑近数，邪热上冲，必为空哕。是胃虚气逆，更甚于呕矣。此由医误汗下，或误饮冷水也。夫胃本虚而以为实，反责虚以取实，其为大逆，如前段所云也。于是胃气内空，则阳不足而越于外，阴之内守者，亦不能自固于中。且阴既虚，又生邪热，热入阴中，迫血妄行，于是血随邪热而上行，必从鼻而出。故趺阳脉浮而觉鼻中燥者，必衄也。然则趺阳得一浮脉，即知胃气之虚竭，兼一滑脉，即知邪热之妄行。其可不辨之而误有所治哉。
这一段言胃虚，大约虚寒则噎食，虚热则吐血，于浮脉兼滑兼大而辨之。大即芤，滑即数也。可体原文上段言芤言革言数而明之。
诸脉浮数，当发热而洒淅恶寒。若有痛处，饮食如常者，蓄积有脓也。脉浮而迟，面赤而战惕者，六七日来当汗出而解，反发热者，瘥迟。迟则无阳，不能作汗，其身必痒也。
这一段就脉之浮数辨论。曰诸脉，则左右三部九候皆该，不独两寸也。然必以两寸为气之聚，脉之归焉。
寸口脉阴阳俱紧者，法当清邪中于上焦，浊邪中于下焦。清邪中上，名曰洁。浊邪中下，名曰浑也。阴中于邪，必内栗也。表气虚微，里气不守，故使邪中于阴也。阳中于邪，必发热、头痛、项强、颈挛、腰痛、胫酸，所谓阳中雾露之气，故曰清邪中上。浊邪中下，阴气为栗，足膝逆冷，便溺妄出。表气虚微，里气微急，三焦相混，内外不通。上焦怫郁，脏气相熏，口烂食断也。中焦不治，胃气上冲，脾气不转，胃气为浊，荣卫不通，血凝不流。若卫气前通者，小便赤黄，与热相搏，因热作使，游于经络，出入脏腑，热气所过，则为痈脓。若阴气前通者，阳气厥微，阴无所使，客气内入，嚏而出之，声嗌咽塞，寒厥相逐，为热所壅，血凝自下，状如猪肝。阴阳俱厥，脾气孤弱，五液注下，下焦不阖，清便下重，令便数难，脐筑湫痛，命将难全。
这一段似乎辨症，但起手重提寸口脉阴阳俱紧一语，则浮中沉取之俱紧，乃三焦阴寒涸冱之象。故必详究表里上下之症，以为阴阳俱紧之脉证验，则辨症正以辨脉也。
脉阴阳俱紧者，口中气出，唇口干燥，蜷卧足冷，鼻中涕出，舌上苔滑，勿妄治也。到七日以来，其人微发热，手足温者，欲解。到八日以上，反大发热者，此为难治。设使恶寒者，必欲呕也。腹内痛者，必欲利也。
这一段承上脉阴阳俱紧，申言寒湿中人上下成病，其症候次序，病情转变，大命生死，一切情状也。
这一段单就初病言，下段又就变迁言。
The exterior syndrome. The pathogenic factor should be expelled from the exterior. Therefore, sweating therapy (Diaphoresis) should be employed. This is merely a general statement, intended to show people that pulse differentiation (Bian Mai) is essential. It follows the same momentum as the previous paragraph, so the following paragraph changes slightly in its narrative structure.
The Fuyang pulse (pulse at the dorsum of the foot, reflecting the Stomach and Spleen) is floating (Fu, indicating an exterior or superficial condition) and choppy (Se, indicating deficiency of blood or fluids). The Shaoyin pulse (pulse at the Taixi point, reflecting the Kidney) resembles a normal pulse (Ru Jing). The disease is located in the Spleen. According to the law, diarrhea (Xia Li) should occur. How do we know this? If the pulse were floating and large, it would indicate excess Qi and deficient Blood. Now, since the Fuyang pulse is floating and choppy, we know there is insufficiency of Spleen Qi and deficiency of Stomach Qi. Because the Shaoyin pulse is wiry (Xuan) and floating, and seeing this constitutes a harmonious pulse, it is called "resembling a normal pulse." If it instead becomes slippery (Hua) and rapid (Shu), we know that pus and stool will be discharged.
This section discusses the method of pulse differentiation. It is not only about differentiating the three positions on the hand but also about differentiating the Fuyang pulse above the ankle bone. This is a precise differentiation of pulses, seeking the utmost truth through various methods. Not only can the general trend of the interior and exterior and the Zang-Fu organs be clarified, but even subtle and complex variations can be understood. The Fuyang pulse is the pulse of the Stomach, yet it is also used to observe the Shaoyin Kidney. For the Stomach, we observe the Fu organ via its own meridian; for the Kidney, we observe the lower part via the lower pulse. In the meridians, it is the Stomach pulse, while the four limbs belong to the Spleen. The Stomach and Spleen are exterior-interior partners. Thus, the movement of the pulse actually relies on the mutual interaction of Spleen and Stomach Qi. Now, the Fuyang pulse is floating and choppy. Its "floating" is different from the "floating" of the hand pulse. Floating at the Cun Kou (radial artery) indicates the exterior of the meridians; floating at the Fuyang indicates the interior of the Fu organs. Although being in the Fu is considered interior, relative to the Spleen organ, it is still exterior. However, floating pulses are generally treated as exterior syndromes, and the same applies to the Fuyang pulse. If it is floating and large, it indicates excess Qi and deficient Blood. What disease is this? It is loss of Blood. The "large" pulse here represents exterior excess and interior deficiency, feeling hollow upon light pressure, known as a Kun pulse. Thus, it signifies only blood loss. From this, we know that symptoms of floating and large differ from those of floating and choppy pulses. Generally, floating and choppy may seem like a Kidney disease, but examining the hand pulse for the Kidney reveals it to be wiry and floating. Although wiry seems like cold, it is not tight upon pressure, and floating combined with wiry does not indicate cold. This is because Shaoyin Qi connects with Shaoyang; cold water nourishes wind-wood, and water and wood generate each other, forming a non-pathological pulse. Therefore, a floating and choppy pulse specifically indicates a Spleen disorder. Generally, floating at Fuyang indicates Stomach Qi, and when combined with choppy, it indicates Spleen disease, as choppy signifies insufficient Blood. Insufficient Blood implies insufficient Qi. Insufficiency of Spleen Yang leads to a choppy pulse, which is actually due to deficiency of Stomach Yang failing to warm the Spleen. With both interior and exterior deficient, Earth fails to control Water, resulting in diarrhea. Since Fuyang belongs to the Stomach and also relates to the Kidney, if we examine the Shaoyin and find the pulse harmonious like normal, and then examine the Stomach Yang finding it floating, we obtain the Yin-choppy quality of the Spleen. If diarrhea persists for a long time, and the floating and choppy pulse suddenly reverses to slippery and rapid, we know that the previous floating was due to Yang deficiency dispersing outward. Due to diarrhea, it followed the Yin downward, fully converging and sinking into the Yin aspect, becoming a diarrhea with mixed heat, and likely involving pus and blood in the stool. This means that although the Fuyang pulse observes the Kidney, it primarily observes the Stomach. To observe the Kidney, the Shaoyin pulse must consistently lag behind the Fuyang pulse to be considered harmonious like normal. Thus, if no pathological pulse is found in the Kidney but a harmonious one is seen, and the Stomach pulse goes from floating and choppy to slippery and rapid, we know the disease is in the Spleen, not the Stomach. Specifically, because the Spleen is inseparable from the Stomach and manifests at the Fuyang, by differentiating the Stomach pulse, we know the disease is in the Spleen. Old commentators mistakenly attributed the slippery and rapid pulse to a Shaoyin disease, not realizing that the Shaoyin pulse is already harmonious like normal, so how could it be slippery and rapid? Moreover, a rapid Shaoyin pulse must be accompanied by deep and thin qualities, or diarrhea without being choppy. A slippery and rapid pulse now—could it be a Shaoyin disease? Furthermore, although Shaoyin opens into the two yin orifices, it does not govern the hardness of stool or the presence of pus and blood. Clearly, this derives from the previous floating and choppy description, hence the word "reverse" (Fan) is added. Only by viewing it this way is the meaning of this section coherent.
The writing style of this section is intricate and interwoven, exhibiting great variation. Unskilled physicians cannot grasp it immediately; it is truly the text of Master Zhongjing. From this alone, we can know it is not a later forgery.
If the Fuyang pulse is slow (Chi) and moderate (Huan), the Stomach Qi is normal. If the Fuyang pulse is floating and rapid, floating injures the Stomach, and rapid disturbs the Spleen. This is not the original disease but the result of the physician's incorrect use of purgation (Xia). Ying and Wei have sunk inward. The rapid quality first becomes faint. The pulse reverses to only floating. The person will certainly have hard stools, belching, and hiccups/eructation. Why say this? Originally, the rapid pulse floated and disturbed the Spleen. Because the rapid quality first became faint, we know the Spleen Qi is dysfunctional, leading to hard stools, belching, and qi rebellion. Now the pulse reverses to floating, and the rapid quality changes to faint. The pathogenic factor remains alone. The person feels hungry in the heart/chest, but the pathogenic heat cannot digest food. There is tidal fever, thirst, and desire to drink. The rapid pulse (at Fuyang) should be slow and moderate. The pulse (at the hand) follows standard measurements. The patient feels hungry. If the rapid pulse appears intermittently, malignant sores (E Chuang) will develop.
This section again focuses on the Fuyang pulse as the Stomach pulse. Since the Stomach and Spleen are exterior-interior partners, diseases inevitably involve both, so differentiation must be done via the pulse. Slow and moderate: here, "slow" should be read as "deficient" akin to "moderate," not the traditional definition of three beats per respiration. Thus, it is a normal, harmonious pulse. Floating and rapid is not normal. Floating indicates righteous Yang dispersing outward and middle Qi becoming deficient, hence "Stomach injury." Rapid indicates pathogenic heat entering the interior and middle Yin being consumed, hence "Spleen disturbance." The Spleen naturally moves, but this is not its natural movement; it is moved by pathogenic factors. Physicians use purgatives because they see rapidity as internal heat. They do not realize that floating indicates the exterior; even with rapidity, there is no indication for purgation. Rapidity in the Fu organs must be accompanied by slippery and large qualities to constitute excess heat suitable for purgation. Rapidity with minute/small qualities indicates deficient heat, also unsuitable for purgation. Now, erroneous purgation causes the exterior pathogens received by Ying and Wei to sink entirely inward. Deficient heat in the Zang-Fu floats aimlessly and cannot last long, so the rapid quality of the pulse disappears first, becoming faint. Only a deficient floating image remains. The sinking pathogen transforms into heat, forcing Stomach Yang outward. Stomach fluids are consumed, causing hard stools. Also, floating pulse indicates shortness of Qi; floating and rebelling upward causes belching and hiccups. All these result from reckless purgation damaging Yin, leading to Yang disturbance. Why say this? First, it said rapidity disturbs the Spleen. Later, due to reckless purgation, the rapid pulse first became faint. All instances of hard stools and belching are due to Spleen Qi dysfunction. In the previous clause, Spleen insufficiency revealed Stomach weakness; in this clause, Spleen dysfunction disrupts Stomach Qi. Their interior-exterior relationship is thus. So, floating and rapid change to only floating, and the rapid quality gradually fades and disappears. With rapidity gone and floating remaining, surely the exterior pathogen remains alone inside, causing hunger in the chest, inability to eat, and indigestion. Pathogenic heat consumes fluids; fluid consumption leads to Yin deficiency, heat becomes tidal, and thirst develops. Then sweat pours out, and the pathogen disperses. As the pathogen disperses and righteousness recovers, the Fuyang pulse returns to being slow and moderate. Not only the Fuyang, but all hand pulses must also be six examinations equal and standard. The patient will go from hunger to being able to eat. If one usually has internal excess heat, after erroneous purgation, although rapid, it temporarily changes to faint and the disease heals. However, fear that it may arise again intermittently, transforming into malignant sores. Thus, one must not ignore it just because the disease seems healed. This section also features intricate writing and subtle meaning, difficult to understand hastily.
The Master said: If the patient's pulse is faint (Wei) and choppy (Se), it is due to medical error. Profuse sweating was induced, followed by repeated severe purgation. The person has lost Blood. The illness should present with aversion to cold, followed by fever, without cessation. In midsummer heat, they wish to wear extra clothes; in midwinter cold, they wish to naked themselves. Why is this? Faint Yang causes aversion to cold; faint Yin causes aversion to heat. The physician induced sweating, making Yang faint, and then purged severely, making Yin weak. In the fifth month, Yang is at the exterior, and the Stomach is cold and deficient internally. Because internal Yang is faint, it cannot overcome cold, so they wish to wear extra clothes. In the eleventh month, Yang is at the interior, and the Stomach is vexed and hot internally. Because internal Yin is weak, it cannot overcome heat, so they wish to naked themselves. Additionally, the Yin pulse is slow and choppy, indicating blood loss.
This section uses the faint and choppy pulse to identify medical error leading to significant Qi and Blood deficiency.
The phrase "the person has lost Blood" should be emphasized, encompassing both Yin and Yang deficiency. Faint Yang and faint Yin merely warn against erroneous sweating and purgation. Actually, sweat is blood; excessive erroneous sweating certainly damages Yin. Jin-Ye (Body Fluids) are transformations of Qi. Erroneous purgation certainly damages Yang. This extends the principle that erroneous sweating and purgation cause simultaneous Yin and Yang pathology. Considering seasonal changes also extends the understanding of Yin-Yang recovery and disease progression. We can reiterate: The faint pulse refers to the Cun position upon light pressure. The choppy pulse refers to the Chi position upon deep pressure. Both faint and choppy are Yin pulses, but observing them at Cun-Chi and light-deep pressures distinguishes Yin and Yang. Thus, floating and choppy indicates both Yin and Yang are diseased. Speaking of blood loss, the Yin pulse is choppy and additionally slow. Slow and choppy, obtained at the Chi position upon deep pressure, specifically refers to the Blood aspect. But since it is also slow, Qi is insufficient to move it, and the pulse deviates from normal, being slower than moderate. Blood loss stems from Qi decline. Erroneous sweating and purgation can produce this symptom complex. How can one fail to differentiate the pulse?
Speaking only of blood loss is because Blood is tangible, while Qi is intangible. Loss of Blood is visible; loss of Qi is invisible. Therefore, after mentioning blood loss, it states there will be aversion to cold, followed by fever. If only blood were lost, there would merely be internal heat from Yin deficiency causing fever. Why is there external cold from Yang deficiency, causing aversion to cold first, then fever? Exterior pathogens can also cause cold first, then heat. How do we know it is dual Yin-Yang deficiency? This is known from the ceaseless nature of the cold and heat symptoms.
If the pulse is floating and large, and the epigastrium is rigid contrary to expectation, with heat belonging to the Zang organs, attack it (with purgation); do not induce sweating. If it belongs to the Fu organs, do not allow frequent urination. Frequent urination makes the stool hard. Excessive sweating increases heat; scant sweating makes defecation difficult. If the pulse is slow, attack is not yet appropriate.
This section differentiates disease via the pulse, distinguishing Zang from Fu, and separating interior from interior, to seek the pathogen. Once the pathogen is identified, treatment must be guided by pulse differentiation. The phrase "do not allow frequent urination" runs continuously, attaching to the Fu organ side.
Pulse floating and large, obtained at the Cun Kou, indicates disease in the exterior. However, rigidity in the epigastrium shows the pathogen has entered the interior. Internal heat causes vexation and thirst. This belongs to the Heart and Lung Zang organs. In the chest, it forms Jie Xiong (Chest Binding); although it doesn't enter the Lung, it obstructs it. In the Heart, it forms Pi (Glomus); although it doesn't enter the Heart, it presses upon it. Hence, "belongs to Zang." Observing the floating-large pulse in the exterior originally indicated inducing sweating to resolve the disease. Once heat transforms and binds internally, attack (purgation) is necessary. The methods of attack need not be fully detailed; detailing them would shift focus from pulse differentiation to symptom-based diagnosis and treatment. Given the floating-large pulse is known, and symptoms are examined, this is still pulse differentiation. The "belongs to Fu" section also stems from the floating-large pulse. A large pulse generally suits sweating. Since the pathogen has transformed into heat and entered the interior, fortunately, it hasn't formed Chest Binding or Glomus near the Zang organs. Instead, it has transferred to the Yangming Fu. One must not promote diuresis due to internal heat. If urine flows freely, body fluids drain through the clear pathway, leaving no moisture for the Large Intestine, causing hard stool. Thus, sweating is still appropriate to guide the pathogen from Yangming to Taiyang to exit. Although heat enters the Stomach Fu, the Stomach is not yet full/excess. Purgation is strictly forbidden. Moreover, the floating-large pulse suggests treating from the exterior. Sweating must be thorough so that heat entering the interior resolves from the exterior. If sweating is incomplete, the pathogen does not penetrate the exterior. Remaining in the Stomach for a long time, it consumes righteous fluids, causing hard stool, which becomes increasingly difficult, eventually becoming full-excess, posing a critical danger of having nowhere else to transmit. When stool becomes difficult, purgation seems appropriate. Yet, pulse differentiation is still required. If accompanied by slowness, indicating Stomach deficiency-cold, purgation is still inappropriate. In summary, when the pathogen initially enters the Stomach Fu, it is still at the exterior. One sweating episode resolves the heat; this is an unchangeable excellent method. This section elaborates on symptoms based on pulse differentiation, showing people that pulse differentiation is the priority.
If the pulse is floating and surging (Hong), sweat is like oil, panting does not cease, fluids cannot be taken in, the body is insensible, alternating between quietness and chaos, this is Life Exhaustion (Ming Jue). It is unknown which Zang organ suffered disaster first. If sweat makes the hair damp and panting does not cease, this is Lung Exhaustion. Yang remains alone, the body looks like smoke staining, eyes stare straight, head shakes, this is Heart Exhaustion. Lips and corners of the mouth turn green, limbs twitch/spasm, this is Liver Exhaustion. Around the mouth is dark/black, soft sweat is yellow, this is Spleen Exhaustion. Incontinence of urine and stool, delirious speech, eyes staring straight backward, this is Kidney Exhaustion. It is unknown whether Yin or Yang exhausted first. If Yang exhausts first and Yin exhausts later, the person dies, and the body color will be green. If Yin exhausts first and Yang exhausts later, the person dies, and the body color will be red. Axillae are warm, and the epigastrium is hot.
This section identifies impending death by differentiating that all three positions are floating without root, and the pulse is surging and scattered. It further differentiates which Zang exhausts first via symptoms, and the sequence of Yin-Yang exhaustion. Pulse differentiation reaches its pinnacle here. It is not merely symptom differentiation. Death occurs because the pulse at all three positions is floating without root, surging and scattered, indicating Yang is about to escape outward and upward, unable to be maintained by Yin internally, leading to separation of the interactive link. Alternatively, internal excess Yin-cold forces upward from below, solitary Yang escapes externally, and solitary Yin lacks Yang, also resulting in separation. These are all identified through pulse differentiation as impending death. "Xi" refers to vibration, spasms, and intermittent contraction of hands and feet.
If the Cun Kou pulse is floating and large, but the physician erroneously uses purgation, this is a Major Reversal (Da Ni). Floating indicates lack of Blood; large indicates Cold. Cold Qi clashes, causing borborygmus (intestinal rumbling). The physician, unaware, gives cold water to induce profuse sweating. Water meets Cold Qi, and cold clashes. The person immediately experiences dysphagia/choking (Ye).
This section investigates solely the floating-large Cun Kou pulse to show that the infinite aspects of the Left-Right Three Positions and Nine Holdings should be differentiated.
Cun Kou pulse floating indicates pathogen in the exterior. Treating the exterior by purging commits a Major Reversal. Generally, "floating" implies excessively floating (all pulses should be viewed this way). "Large" implies excessively large. Thus, floating at Cun indicates Qi excess and Blood loss, where Yin cannot maintain Yang to keep it calm. Seeing only floating and large indicates that the "Qi excess" is not righteous Qi but a mixture of external Wind-Cold pathogens, creating a large pulse. This is a disease formed by the clash of external pathogenic cold and righteous Qi. Even if the interior is directly affected by cold due to pre-existing deficiency-wind in the intestines/stomach, Wind (which is Qi) clashes with seasonal cold, forming borborygmus. Even without purgation, spontaneous diarrhea would occur; can it be purged? No. Vulgar physicians might think sweating is appropriate, but because of floating and large, they mistake it for internal excess heat, giving cold water to induce sweating. They don't realize cold water only clears excess heat, not cold Qi. The ingested cold water meets cold Qi and clashes in the chest/stomach. Yang stagnates, Yin coagulates. Upon eating/drinking, dysphagia occurs. "Ye" means choking/blockage. Dysphagia occurs because cold pathogen blocks the Yang portion, rejecting entry. Using cold water to induce sweating is ignored by most commentators. Mr. Wei compared it to Bai Hu Tang but expressed doubt. However, this is easy to understand: nowadays, patients with heat diseases eat watermelon, sweat, and resolve; this is the same principle. Dysphagia can result from drinking cold liquids or hot wine, essentially a clash of cold/heat with deficient Qi.
If the Fuyang pulse is floating, floating indicates deficiency. Floating and deficiency clash, causing Qi dysphagia/rebellion. This indicates Stomach Qi exhaustion. If the pulse is slippery, it indicates hiccups (Yue). This is the physician's fault. Blaming deficiency for excess, guarding emptiness while pressing blood. If the pulse is floating and the nose is dry, epistaxis (Nv) will definitely occur.
This section continues discussing Qi rebellion causing dysphagia, re-examining the Fuyang pulse, which specifically governs the Stomach. Lower body diagnosis: floating indicates deficiency, unlike the Cun Kou which must be accompanied by largeness. The "deficiency" in the clash of floating and deficiency is Stomach deficiency. Deficiency necessarily involves cold. The clash of deficient-cold Stomach Qi causes Qi to rebel upward as dysphagia. It doesn't necessarily become complete dysphagia. Generally, Stomach deficiency-cold causes floating heat in the chest/diaphragm, rebelling upward. Severely, it blocks food/drink; mildly, it rebels as Diaphragm Qi. If untreated, Stomach Qi will exhaust. If floating is accompanied by slippery, and slippery approaches rapid, pathogenic heat rebels upward, causing empty hiccups. Stomach deficiency with Qi rebellion is worse than vomiting. This results from erroneous sweating/purging or cold water ingestion. The Stomach is fundamentally deficient but treated as excess; blaming deficiency to seek excess is a Major Reversal as stated before. Thus, internal Stomach Qi is empty; Yang is insufficient and escapes outward; Yin, which should guard internally, cannot consolidate in the middle. Since Yin is deficient, pathogenic heat arises. Heat enters Yin, forcing Blood to move recklessly. Blood follows pathogenic heat upward, exiting from the nose. Thus, if the Fuyang pulse is floating and the nose feels dry, epistaxis will occur. Therefore, one floating pulse at Fuyang indicates Stomach Qi exhaustion; one slippery pulse indicates reckless pathogenic heat movement. How can one fail to differentiate and treat erroneously?
This section discusses Stomach deficiency: generally, deficiency-cold causes dysphagia with food, deficiency-heat causes hematemesis. Differentiate via floating pulse accompanied by slippery or large. Large is Kun; slippery is Shu (rapid). Refer to the upper text mentioning Kun, Ge, and Shu for clarification.
For all pulses that are floating and rapid, fever and shivering aversion to cold should occur. If there is a painful area, but diet is normal, it indicates accumulated pus. If the pulse is floating and slow, with a red face and trembling/fear, after six or seven days, sweating should occur for resolution. If instead there is fever, resolution is delayed. Slowness indicates lack of Yang, inability to produce sweat, and the body will itch.
This section discusses floating and rapid pulses. "All pulses" includes all three positions on left and right, not just the two Cun positions. However, the two Cun are the gathering of Qi and the return of the pulse.
If the Cun Kou pulse Yin and Yang are both tight (Jin), according to the law, Clear Pathogen attacks the Upper Jiao, and Turbid Pathogen attacks the Lower Jiao. Clear Pathogen attacking Up is called "Jie" (Clean/Pure). Turbid Pathogen attacking Down is called "Hun" (Turbid/Muddy). Yin being attacked by pathogen causes internal trembling. Exterior Qi is deficient and slight, Interior Qi does not guard, allowing pathogen to attack Yin. Yang being attacked by pathogen causes fever, headache, neck stiffness, neck spasm, lower back pain, and shin soreness. This is referred to as Yang being attacked by fog/mist-dampness, hence "Clear Pathogen attacks Up." Turbid Pathogen attacks Down. Yin Qi trembles, feet and knees are reverse-cold, urination and defecation are erratic. Exterior Qi is deficient and slight, Interior Qi is slightly urgent. The Three Jiaos mix, interior and exterior do not communicate. Upper Jiao is stifled and depressed, Zang Qi薰 (fumes/permeates), causing mouth ulcers and food refusal. Middle Jiao is dysfunctional, Stomach Qi rushes upward, Spleen Qi does not transform. Stomach Qi becomes turbid, Ying and Wei do not communicate, Blood coagulates and does not flow. If Wei Qi passes through first, urine is red-yellow. Clashing with heat, acting as a vehicle for heat, wandering through meridians, entering and exiting Zang-Fu, wherever heat passes, carbuncles and pus form. If Yin Qi passes through first, Yang Qi is厥 (cold/extreme) and slight, Yin has no function. Guest Qi enters internally, sneezing expels it, voice is hoarse, throat blocked. Cold厥 chases each other, blocked by heat, Blood coagulates and exits downward, resembling pig liver. Both Yin and Yang are厥, Spleen Qi is lonely and weak, Five Fluids pour downward. Lower Jiao does not close, clear stool has heaviness, causing frequent difficult defecation, umbilical colic and shallow pain. Life is hard to preserve.
This section seems to differentiate symptoms, but starts by reiterating "Cun Kou Yin and Yang both tight." Tightness upon light, medium, and deep pressure is the image of Three Jiao Yin-cold freezing. Thus, one must detail interior/exterior and upper/lower symptoms as verification for the Yin-Yang tight pulse. Differentiating symptoms is precisely differentiating the pulse.
If the Yin and Yang pulses are both tight, there is breath coming from the mouth, dry lips and mouth, curling up to sleep, cold feet, runny nose, and slippery coating on the tongue. Do not treat rashly. By the seventh day, if the person has slight fever and warm hands/feet, resolution is desired. By the eighth day or more, if there is sudden high fever, this is difficult to treat. If there is aversion to cold, there will certainly be vomiting. If there is abdominal pain, there will certainly be diarrhea.
This section follows the Yin-Yang tight pulse, explaining how Cold-Dampness affects the upper and lower parts of the body upon invasion, including the sequence of symptoms, disease transformation, life-and-death situations, and all circumstances.
This section speaks only of the initial illness; the next section speaks of changes.