厥阴中风。脉微浮为欲愈。不浮为未愈。
此厥阴经自受风邪之证。脉微为邪气少。浮为病在经。经病而邪少。故为欲愈。或始先脉不微
浮。继乃转而为浮者。为自阴之阳之候。亦为欲愈。所谓阴病得阳脉者生是也。然必兼有发热微汗
等候。仲景不言者。以脉该证也。若不浮则邪着阴中。漫无出路。其愈正未可期。故曰不浮为未愈
。
伤寒下利。日十余行。脉反实者。死。
伤寒下利。至日十余行。邪既未尽。而正已大惫矣。其脉当微或弱。而反实者。是邪气有余。
所谓病胜脏也。故死。
下利脉沉弦者。下重也。脉大者为未止。脉微弱数者。为欲自止。虽发热。不死。
沉为里为下。弦为阴。下利脉沉弦者。阴邪在里。而盛于下。故下重也。脉大者。邪气盛。经
曰、大则病进。故为未止。脉微弱。为邪气微。数为阳气复。阴寒下利。阳复而邪微。则为欲愈之
候。虽复发热。亦是阳气内充所致。不得比于下利发热者死之例也。
下利有微热而渴。脉弱者令自愈。下利脉数。有微热。汗出。令自愈。设复紧。为未解。
此二条亦为阴邪下注者设。微热而渴。与脉数有微热汗出。并阳气内充之象。而脉弱又阴气衰
退之
征。故令自愈。夫脉弱者。脉紧去而转弱也。设复紧。则阴邪仍盛。其病岂能遽已耶。
下利脉数而渴者。令自愈。设不瘥。必圊脓血。以有热故也。
此亦阴邪下利而阳气已复之证。脉数而渴。与下利有微热而渴同意。然脉不弱而数。则阳之复
者已过。阴寒虽解热气旋增。将更伤阴而圊脓血也。
发热而厥七日。下利者。为难治。
发热而厥者。身发热而手足厥。病属阳而里适虚也。至七日。正渐复而邪欲退。则当厥先已而
热后除。乃厥热如故。而反加下利。是正不复而里益虚矣。夫病非阴寒。则不可以辛甘温其里。而
内虚不足。复不可以苦寒坚其下。此其所以为难治也。
伤寒发热。下利厥逆。躁不得卧者。死。
伤寒发热。下利厥逆者。邪气从外之内。而盛于内也。至躁不得卧。则阳气有立亡之象。故死
。此传经之邪。阴气先竭。而阳气后绝者也。
伤寒发热。下利至甚。厥不止者。死。
发热。下利厥逆。证与上同。而下利至甚。则阴欲亡。厥逆不止。则阳亦伤。虽不躁犹死也。
此亦传经之邪。阴先竭而阳后绝者也。
伤寒六七日。不利。便发热而利。其人汗出不止者。死。有阴无阳故也。
寒伤于阴。至六七日发热者。阳复而阴解。虽下利犹当自止。所谓伤寒先厥后发热而利者。
必自止也。乃伤寒六七日。本不下利。而忽热与利俱见。此非阳复而热也。阴内盛而阳外亡也。若
其人汗出不止。则不特不能内守。亦并无为外护矣。是谓有阴无阳。其死必矣。
下利。手足厥冷。无脉者。灸之不温。若脉不还。反微喘者。死。
阴寒下利。而至厥冷无脉。阳气将竭而死矣。灸之所以通既绝之阳。乃厥不回。脉不还而反微
喘。残阳上奔。大气下脱。故死。
下利后。脉绝。手足厥冷。 时脉还。手足温者。生。脉不还者。死。
时、周时也。下利后脉绝。手足厥冷者。阴先竭而阳后绝也。是当俟其 时。经气一周。其
脉当还。其手足当温。若脉不还。其手足亦必不温而死矣。
伤寒六七日。脉微。手足厥冷。烦躁。灸厥阴。厥不还者死。
伤寒六七日。阳气当复。阴邪当解之时。乃脉不浮而微。手足不烦而厥冷。是阴气反进。而阳
气反退也。烦躁者。阳与阴争。而阳不能胜之也。灸厥阴。所以散阴邪而复阳气。阳复则厥自还。
设不还。则阳有绝而死耳。是故传经之邪至厥阴者。阴气不绝则不死。直中之邪入厥阴者。阳气不
复则不生也。
伤寒脉迟。六七日。而反与黄芩汤彻其热。脉迟为寒。今与黄芩汤。复除其热。腹中应冷。当
不能食。今反能食。此名除中。必死。
脉数为热。脉迟为寒。诊家之大要也。热者清之。寒者温之。医家之大法也。乃伤寒脉迟。至
六七日而不变。其为寒无疑矣。而反与黄芩汤。复除其热。是以寒益寒也。于是阳气消亡。阴寒独
胜。法当腹中冷而不能食。今反能食者。非胃气盛也。胃中之阳。发露无余。譬之贫儿夸富。罄诸
所有而暴之于外。虽炫耀目前。然其尽可立而待也。故直断之曰。此名除中。必死。
厥阴病欲解时。从寅至卯上。
厥阴属风木之脏。寅卯为木王之时。脏气胜而邪气解。亦如三阳及太少二阴之例也。
厥阴经受风邪侵袭。脉象微带浮象，是病情将要痊愈的征兆；若脉不浮，则说明病未愈。
这是厥阴经直接感受风邪的病证。脉微表示邪气已衰，脉浮表示病位在经络。既然病在经络且邪气微弱，所以说是将要痊愈。或者起初脉象不微不浮，后来转变为浮脉，这是病由阴转阳的征候，也是将要痊愈的表现。这就是所说的“阴病见到阳脉者生”。然而，这种情况必须同时伴有轻微发热和微微出汗等症状，张仲景没有明说，是因为通过脉象可以推知症状。如果脉不浮，那么邪气就会滞留于阴分，没有出路，其痊愈就难以预料了，所以说脉不浮就是病未愈。
伤寒出现下利（腹泻），一天十几次，脉象反而坚实有力，这是死证。
伤寒下利，达到一天十几次，邪气尚未排尽，而正气已经极度疲惫。此时脉象应当微弱或软弱，如果反而表现为实脉，这是邪气有余，也就是所谓的“病胜脏”（病邪胜过脏腑正气），所以会死亡。
下利脉象沉弦的，会有肛门坠胀感（后重）；脉象大的，说明病势未止；脉象微弱而数的，说明下利将要自行停止，即使有发热，也不会死亡。
沉脉主里、主下，弦脉属阴。下利见沉弦脉，是阴邪在里且盛于下部，所以会出现肛门坠胀感。脉大，表示邪气盛，《内经》说“大则病进”，所以病势未止。脉微弱，表示邪气微弱；数脉表示阳气恢复。对于阴寒性质的下利，阳气恢复而邪气微弱，就是将要痊愈的征候。即使出现发热，也是由于阳气内充所致，不能等同于下利伴发热属于死证的例子。
下利伴有轻微发热和口渴，脉象弱的，将会自愈；下利脉数，伴有轻微发热和出汗，将会自愈；如果脉象再次变为紧脉，说明病邪未解。
这两条论述也是针对阴邪下注的情况。轻微发热和口渴，以及脉数伴轻微发热出汗，都是阳气内充的表现，而脉弱又是阴气衰退的迹象，所以能够自愈。所谓脉弱，是指脉象由紧转为弱。如果脉象再次变紧，说明阴邪仍然旺盛，疾病怎么能立刻痊愈呢？
下利脉数且口渴的，将会自愈；如果病不好转，必然会排泄脓血，这是因为体内有热。
这也是阴邪下利而阳气已经恢复的病证。脉数且口渴，与前面提到的“下利有微热而渴”意思相同。但是脉不弱而数，说明阳气的恢复过度了。虽然阴寒已解，但热气随即增加，将进一步损伤阴液而导致排泄脓血。
发热且手足厥冷七天，又出现下利的，属于难治之证。
发热且手足厥冷，是身体发热而四肢冰冷，病属阳证而里虚。到了第七天，正气逐渐恢复，邪气想要退去，应当是先解除厥冷，然后热才消退。现在厥冷和发热依旧，反而加上腹泻，这是正气不能恢复而里虚更加严重的表现。如果不是阴寒病，就不能用辛甘温热的药物来温补里虚；而内部虚弱不足，又不能再用苦寒的药物来坚阴止利，这就是之所以难治的原因。
伤寒发热，下利且手足厥逆，躁动不安无法躺卧的，是死证。
伤寒发热，下利且手足厥逆，是邪气从外部传入内部，且在内部亢盛。发展到躁动不安无法躺卧，说明阳气有立即亡失的迹象，所以死亡。这是传经之邪，阴气先枯竭，阳气随后断绝。
伤寒发热，下利极其严重，手足厥冷不止的，是死证。
发热、下利、厥逆，证候与上一条相同，但下利极其严重，说明阴气将要亡失；手足厥冷不止，说明阳气也受损伤。即使没有躁动，也是死证。这也是传经之邪，阴气先竭，阳气后绝。
伤寒六七天，原本没有下利，突然发热并出现下利，其人汗出不止的，是死证，这是因为有阴无阳。
寒邪伤及阴分，到了六七天出现发热，是阳气恢复而阴邪解散，即使有下利也应当自行停止。这就是所说的“伤寒先厥后发热而利者，必自止”。然而，伤寒六七天，本来没有下利，却突然发热与下利同时出现，这不是阳气恢复的热，而是阴气内盛而阳气外亡。如果其人汗出不止，不仅不能固守于内，也没有护卫于外的能力了。这叫做“有阴无阳”，必然死亡。
下利，手足厥冷，摸不到脉搏，施灸后手脚仍不温暖，如果脉搏不恢复，反而出现轻微喘息的，是死证。
阴寒下利，发展到厥冷无脉，说明阳气即将竭尽而死。施灸是为了通达已经断绝的阳气，但如果厥冷不回，脉搏不恢复反而轻微喘息，这是残存的阳气上浮奔散，大气（宗气）下脱，所以死亡。
下利之后，脉搏消失，手足厥冷，过一段时间脉搏恢复，手足变暖的，可生；脉搏不恢复的，死。
“时”指一个周期（如十二时辰）。下利后脉搏消失，手足厥冷，是阴气先竭而阳气后绝。这时应当等待一个周期，经气运行一周，脉搏应当恢复，手足应当变暖。如果脉搏不恢复，手足也不变暖，就会死亡。
伤寒六七天，脉微，手足厥冷，烦躁，施灸厥阴经穴位，如果厥冷不缓解的，死。
伤寒六七天，本是阳气应当恢复、阴邪应当解散的时候，现在脉不浮而微，手足不烦而厥冷，这是阴气反而进展，阳气反而衰退。烦躁，是阳气与阴气抗争，但阳气不能战胜阴气。施灸厥阴经，是为了疏散阴邪并恢复阳气。阳气恢复，厥冷自然会缓解。如果不缓解，说明阳气将断绝而死。所以，传经之邪传到厥阴的，阴气不绝就不会死；直中（直接侵犯）厥阴的，阳气不复原就不能生存。
伤寒脉迟，六七天了，反而给予黄芩汤来清热。脉迟主寒，现在给黄芩汤，进一步清除其热，腹中应当寒冷，应当不能进食，现在反而能进食，这名叫“除中”，必死。
脉数主热，脉迟主寒，这是诊脉的要诀。热证用清法，寒证用温法，这是医家的基本法则。然而，伤寒脉迟，到了六七天没有变化，肯定是寒证无疑。反而给予黄芩汤，进一步除热，这是以寒治寒，使寒气更甚。于是阳气消亡，阴寒独盛，按理说腹中寒冷且不能进食。现在反而能进食，并不是胃气旺盛，而是胃中的阳气完全暴露无遗，就像贫穷的人夸耀财富，把家里所有的东西都拿出来炫耀在外面，虽然眼前耀眼，但其家底空虚立等可见。所以直接断定：这名叫“除中”，必死。
厥阴病欲解的时间，是从寅时到卯时。
厥阴属于风木之脏，寅卯时是木气旺盛的时候，脏气胜而邪气解散，也像三阳经及太少二阴经一样。
Wind-stroke of Jueyin. A pulse that is slightly floating indicates impending recovery; if not floating, the disease has not yet resolved.
This refers to a syndrome where the Jueyin meridian directly contracts wind pathogenic factors. A slight pulse indicates that the pathogenic factor is diminishing, while a floating pulse indicates that the disease is located in the meridians. Since the disease is in the meridians and the pathogen is weak, it indicates impending recovery. Alternatively, if the pulse was initially neither slight nor floating but later transforms into a floating pulse, this is a sign of transformation from Yin to Yang, also indicating impending recovery. This is what is meant by "those with Yin diseases obtaining Yang pulses will survive." However, this must be accompanied by symptoms such as mild fever and slight sweating. Zhang Zhongjing did not explicitly state these because the pulse encompasses the symptoms. If the pulse is not floating, the pathogen remains lodged within the Yin aspect without an outlet, making recovery uncertain; thus, it is said that a non-floating pulse indicates the disease has not resolved.
In cold damage, diarrhea occurring more than ten times a day, with a pulse that is surprisingly solid/excess (Shi), indicates death.
In cold damage with diarrhea reaching over ten times a day, the pathogens are not yet exhausted, but the healthy Qi is already severely depleted. The pulse should be thready or weak; if it is surprisingly solid/excess, it indicates excess pathogenic factors, known as "the disease overcoming the Zang organs." Therefore, it leads to death.
In diarrhea, a deep and wiry pulse indicates heaviness in the lower rectum (tenesmus); a large pulse indicates the condition has not stopped; a faint and rapid pulse indicates that the diarrhea is about to stop spontaneously. Even if there is fever, it will not be fatal.
A deep pulse indicates interior and downward conditions; a wiry pulse belongs to Yin. In diarrhea, a deep and wiry pulse indicates Yin pathogens in the interior and flourishing in the lower part, hence the sensation of heaviness in the lower rectum. A large pulse indicates flourishing pathogens; as the Classic states, "Large indicates disease progression," so the condition has not stopped. A faint pulse indicates weak pathogens; a rapid pulse indicates the return of Yang Qi. For Yin-cold diarrhea, the return of Yang Qi and weakening of pathogens indicate impending recovery. Even if fever occurs, it is caused by the internal sufficiency of Yang Qi and cannot be compared to the rule that diarrhea with fever indicates death.
In diarrhea, with slight fever and thirst, and a weak pulse, spontaneous recovery is expected. In diarrhea, with a rapid pulse, slight fever, and sweating, spontaneous recovery is expected. If the pulse becomes tight again, the disease is not resolved.
These two clauses are designed for cases of Yin pathogens sinking downward. Slight fever with thirst, and rapid pulse with slight fever and sweating, are all signs of internal sufficiency of Yang Qi, while a weak pulse is a sign of declining Yin Qi; thus, spontaneous recovery occurs. By "weak pulse," it means the pulse changes from tight to weak. If it becomes tight again, it means Yin pathogens remain strong, so how can the disease suddenly resolve?
In diarrhea, if the pulse is rapid and there is thirst, spontaneous recovery is expected. If it does not improve, pus and blood will inevitably appear in the stool, due to the presence of heat.
This is also a case of Yin-pathogen diarrhea where Yang Qi has already recovered. A rapid pulse with thirst is consistent with "diarrhea with slight fever and thirst." However, since the pulse is not weak but rapid, the recovery of Yang has exceeded the normal limit. Although Yin-cold is resolved, heat rapidly increases, which will further injure Yin and cause pus and blood in the stool.
Fever and cold extremities for seven days, accompanied by diarrhea, is difficult to treat.
Fever with cold extremities means the body is hot while the hands and feet are cold; the disease belongs to Yang, but the interior is deficient. By the seventh day, healthy Qi gradually recovers and pathogens retreat, so cold extremities should resolve first, followed by the disappearance of fever. Now, if cold extremities and fever remain unchanged, and diarrhea is added, it indicates that healthy Qi fails to recover and interior deficiency worsens. If the disease is not Yin-cold, one cannot use pungent-sweet-warm herbs to warm the interior; yet, due to internal insufficiency, one cannot use bitter-cold herbs to firm the lower jiao. This is why it is difficult to treat.
In cold damage, with fever, diarrhea, cold extremities, restlessness, and inability to lie down, indicates death.
In cold damage, with fever, diarrhea, and cold extremities, pathogens move from exterior to interior and flourish inside. When progressing to restlessness and inability to lie down, it indicates an imminent collapse of Yang Qi; therefore, it is fatal. This is transmitted-meridian pathogen, where Yin Qi exhausts first, followed by the cessation of Yang Qi.
In cold damage, with fever, severe diarrhea, and unceasing cold extremities, indicates death.
Fever, severe diarrhea, and cold extremities present similarly to the previous clause. However, severe diarrhea indicates impending exhaustion of Yin; unceasing cold extremities indicate injury to Yang. Even without restlessness, it is still fatal. This is also a transmitted-meridian pathogen, where Yin exhausts first and Yang follows.
In cold damage, on the sixth or seventh day, when there was previously no diarrhea, sudden onset of fever and diarrhea, with incessant sweating in the patient, indicates death, due to having Yin but no Yang.
Cold injuring the Yin aspect, fever appearing on the sixth or seventh day usually indicates Yang recovery and Yin resolution; even with diarrhea, it should stop spontaneously. This is what is meant by "in cold damage, if there is initial cold extremities followed by fever and diarrhea, the diarrhea must stop." However, in cold damage on the sixth or seventh day, if there was originally no diarrhea but sudden fever and diarrhea appear together, this is not Yang-recovery heat, but rather Yin flourishing internally and Yang perishing externally. If the patient has incessant sweating, not only can Qi not guard internally, but there is also no protection externally. This is called "having Yin but no Yang," and death is certain.
In diarrhea, with cold extremities and absent pulse, if moxibustion does not warm the limbs, and if the pulse does not return but instead slight panting occurs, indicates death.
Yin-cold diarrhea progressing to cold extremities and absent pulse indicates that Yang Qi is about to exhaust, leading to death. Moxibustion is used to restore severed Yang Qi. If cold extremities do not reverse, the pulse does not return, and slight panting occurs, it indicates residual Yang rushing upward and vital Qi collapsing downward; therefore, it is fatal.
After diarrhea, if the pulse is absent and extremities are cold, but the pulse returns at intervals and extremities become warm, survival is possible; if the pulse does not return, death ensues.
"Interval" refers to a full cycle (e.g., twelve double-hours). After diarrhea, absent pulse and cold extremities indicate Yin exhaustion preceding Yang cessation. One should wait for a cycle for the meridian Qi to circulate once; then the pulse should return and extremities should warm. If the pulse does not return and extremities remain cold, death will occur.
In cold damage, on the sixth or seventh day, with a faint pulse, cold extremities, and irritability, moxibustion applied to the Jueyin meridian; if cold extremities do not resolve, indicates death.
On the sixth or seventh day of cold damage, it is the time when Yang Qi should recover and Yin pathogens should resolve. Yet, the pulse is faint rather than floating, and extremities are cold rather than merely irritable; this indicates Yin advancing while Yang retreats. Irritability signifies Yang struggling against Yin but failing to overcome it. Moxibustion on the Jueyin meridian aims to disperse Yin pathogens and restore Yang Qi. If Yang recovers, cold extremities will naturally resolve. If they do not resolve, it indicates Yang cessation and death. Thus, for transmitted-meridian pathogens reaching Jueyin, death does not occur if Yin Qi is not exhausted; for direct invasion pathogens entering Jueyin, life is impossible if Yang Qi does not recover.
In cold damage, with a slow pulse persisting for six or seven days, if one erroneously administers Huangqin Decoction to clear heat: Slow pulse indicates cold. Administering Huangqin Decoction further removes heat. The abdomen should feel cold, and appetite should be lost. If the patient can eat contrary to expectation, this is named "Chu Zhong" (Elimination of the Middle), indicating certain death.
Rapid pulse indicates heat; slow pulse indicates cold; this is a fundamental principle of pulse diagnosis. Heat is cleared; cold is warmed; this is the primary method of treatment. However, in cold damage, if the slow pulse persists for six or seven days without change, it is undoubtedly cold. Erroneously administering Huangqin Decoction (Scutellaria Root Decoction) to clear heat exacerbates the cold. Consequently, Yang Qi perishes, and Yin-cold dominates. Physiologically, the abdomen should be cold and appetite absent. If the patient can eat, it is not due to robust Stomach Qi, but rather the exposure of Stomach Yang without reserve. It is like a poor person boasting of wealth, displaying everything they own; although dazzling momentarily, their emptiness is immediately apparent. Therefore, it is directly diagnosed as "Chu Zhong" (Elimination of the Middle), indicating certain death.
The time when Jueyin disease tends to resolve is from Yin hour to Mao hour.
Jueyin belongs to the Wind-Wood viscera. Yin and Mao hours are the times when Wood Qi is dominant. When the visceral Qi prevails, pathogens resolve. This follows the same pattern as the Three Yang meridians and the Taiyang-Shaoyin and Shaoyang-Taiyin pairs.