病人面无血色，无寒热，脉「浮」〔沉〕弦者，衄；脉「沉」〔浮〕弱，手按之绝者
，下血；烦欬者，必吐血。
【按】
脉沉当是「脉浮」，脉浮当是「脉沉」，文义始属，当改之。
寸口脉弦而大，弦则为减，大则为芤，减则为寒，芤则为虚，寒虚相搏，如名曰革，
妇人则半产漏下，男子则亡血。
【按】
此条注详见『伤寒·辨脉篇』内，故不复释。
心气「有余」〔不足〕，吐血衄血，泻心汤主之。
【按】
心气「不足」二字，当是「有余」二字，若是不足，如何用此方治之，当改之。
夫病人饮水多，必暴喘满。凡食少饮多，水停心下，甚者则悸，微者短气。〔脉双弦
者寒也，皆大下里虚，脉偏弦者饮也。〕
【按】
微者短气句下，古本有「脉双弦者寒也……」诸句，文义不属，另分一条，在本门二
十七条之次。
假令「病」〔瘦〕人脐下有悸，吐涎沫而「巅」〔癫〕眩，此水也，五苓散主之。
【按】
瘦人之「瘦」字，当是「病」字，癫眩之「癫」字，当是「巅」字，巅者头也，文义
始属，当改之。
夫心下有留饮，其人背寒冷如掌大。留饮者，□下痛引缺盆，咳嗽则转甚。胸中有留
饮，其人短气而「喘」〔渴〕，四肢历节痛。〔脉沉者，有留饮。〕
【按】
此条古本于四肢历节痛之下，有「脉沉者，有留饮」一句，当另为一条，始合论脉之
义。短气而渴之「渴」字，当是「喘」字，四肢上，当有缺文。
病者脉伏，其人欲自利，利反快，「此为留饮欲去故也；」虽利，心下续坚满，〔此
为留饮欲去故也，〕甘遂半夏汤主之。
【按】
心下续坚满句下，「此为留饮欲去故也」八字，当在利反快之下，此传写之□，当移
之。
水在心，心下坚筑短气，恶水不欲饮。水在肺，吐涎沫，欲饮水。水在脾，少气身重
。水在肝，□下支满，嚏而痛。水在肾，「脐」〔心〕下悸。
【按】
心下悸之「心」字，当是「脐」字，当改之。
支饮「腹」〔胸〕满者，厚朴大黄汤主之。
【按】
支饮胸满之「胸」字，当是「腹」字，若是「胸」字，无用承气汤之理，当改之。
脉弦「迟」〔数〕有寒饮，冬夏难治。
【按】
脉弦数之『数』字，当是『迟』字，始与寒饮之理合，当改之。
欬逆倚息不得卧，小青龙汤主之。青龙汤「汗」〔下〕已，多唾，口燥，寸脉沉，尺
脉微，手足厥逆，气从少腹上冲胸咽，手足痹，其面翕热如醉状，因复下流阴股，小
便难，时复冒者，与茯苓桂枝五味甘草汤，治其气冲。
【按】
小青龙汤下已之「下」字，当是「汗」字，盖大、小青龙汤，皆汗剂也，当改之。
病人面色苍白无血色，没有恶寒发热的症状，脉象浮（或沉）且弦的，会发生鼻出血；脉象沉（或浮）且弱，手指按压后脉搏感觉中断的，会发生便血；心烦咳嗽的，一定会吐血。
【按语】
原文中“脉沉”应当是“脉浮”，“脉浮”应当是“脉沉”，这样文义才通顺，应当改正。
寸口脉象弦而大，弦脉表示阳气减退，大脉表示中空如芤，阳气减退则生内寒，中空则主虚损，寒与虚相互搏结，这种脉象名为革脉。妇女会出现半产（小产）及漏下（非经期阴道持续出血），男子会出现失血。
【按语】
此条目的注解详见《伤寒论·辨脉篇》内，因此不再解释。
心气有余（或不足），导致吐血、衄血，用泻心汤主治。
【按语】
“心气不足”这四个字，应当是“心气有余”。如果是心气不足，怎么能用这个方子治疗呢？应当改正。
凡是病人饮水过多，必然突然发生气喘胸满。凡是进食少而饮水多，水饮停滞在心下（胃脘部），严重的会出现心悸，轻微的会出现短气。〔脉象双弦的是寒证，都是因剧烈攻下导致里虚；脉象偏弦的是饮证。〕
【按语】
在“轻微的会出现短气”句下，古本中有“脉象双弦的是寒证……”等句子，文义不连贯，另列为一条，放在本门第二十七条之后。
假如病人（或瘦人）脐下有悸动感，吐涎沫并且头眩，这是水饮为患，用五苓散主治。
【按语】
“瘦人”的“瘦”字，应当是“病”字；“癫眩”的“癫”字，应当是“巅”字。“巅”指头部，这样文义才通顺，应当改正。
心下有停留的水饮，病人的背部寒冷感如手掌大小。停留的水饮，会导致胁下疼痛牵引至缺盆穴，咳嗽时疼痛加剧。胸中有停留的水饮，病人会短气而且喘（或渴），四肢关节疼痛。〔脉象沉的，是有停留的水饮。〕
【按语】
此条古本在“四肢关节疼痛”之下，有“脉象沉的，是有停留的水饮”一句，应当单独作为一条，才符合论述脉义的原则。“短气而且渴”的“渴”字，应当是“喘”字，“四肢”之上，应当有脱文。
病人的脉象伏匿，其人想要自利（腹泻），泻后反而觉得爽快，〔这是因为停留的水饮将要离去的原因；〕虽然腹泻，但心下继续坚硬胀满，〔这是因为停留的水饮将要离去的原因，〕用甘遂半夏汤主治。
【按语】
在“心下继续坚硬胀满”句下，“这是因为停留的水饮将要离去的原因”这八个字，应当在“泻后反而觉得爽快”之下，这是传抄过程中的错乱，应当移动位置。
水饮在心，心下坚硬筑动、短气，厌恶水而不想喝。水饮在肺，吐涎沫，想要喝水。水饮在脾，少气、身体沉重。水饮在肝，胁下支撑胀满，打喷嚏时疼痛。水饮在肾，〔脐〕（或心）下悸动。
【按语】
“心下悸动”的“心”字，应当是“脐”字，应当改正。
支饮出现腹（或胸）满的，用厚朴大黄汤主治。
【按语】
“支饮胸满”的“胸”字，应当是“腹”字。如果是“胸”字，就没有使用承气汤类方剂的道理了，应当改正。
脉象弦迟（或数）而有寒饮，冬夏两季难治。
【按语】
“脉象弦数”的“数”字，应当是“迟”字，这才符合寒饮的道理，应当改正。
咳嗽气逆，倚靠呼吸不能平卧，用小青龙汤主治。服用小青龙汤发汗（或攻下）后，如果多唾、口燥，寸脉沉，尺脉微，手足厥冷，气从少腹上冲至胸咽，手足麻木，面部潮红发热像醉酒的样子，随后又向下流注于大腿内侧，小便困难，时常头晕目眩的，给予茯苓桂枝五味甘草汤，治疗其气上冲的症状。
【按语】
“小青龙汤下已”的“下”字，应当是“汗”字。因为大青龙汤、小青龙汤，都是发汗剂，应当改正。
The patient's face lacks blood luster (is pale), without aversion to cold or fever, if the pulse is Floating (or Deep) and Wiry, epistaxis occurs; if the pulse is Deep (or Floating) and Weak, and feels interrupted upon finger pressure, hematochezia occurs; if there is irritability and coughing, hematemesis will definitely occur.
[Commentary]
"Deep pulse" should be "Floating pulse", and "Floating pulse" should be "Deep pulse"; only then does the textual meaning make sense, so it should be corrected.
At the Cun Kou (Radial artery) position, the pulse is Wiry and Large. Wiry indicates reduction (deficiency), Large indicates Hollow (Kou). Reduction implies Cold, Hollow implies Deficiency. When Cold and Deficiency combine, this pulse is named Ge (Leather-like). In women, it manifests as spontaneous abortion and continuous uterine bleeding; in men, it manifests as blood loss.
[Commentary]
The annotation for this passage is detailed in the 'Shanghan Lun · Bian Mai Pian' (Differentiating Pulse Chapter of Treatise on Cold Damage), therefore no further explanation is provided.
If Heart Qi is Excess (or Deficient), causing hematemesis and epistaxis, Xie Xin Tang (Drain the Epigastrium Decoction) is the primary treatment.
[Commentary]
The phrase "Heart Qi Deficient" should be "Heart Qi Excess". If it were deficiency, how could this formula be used? It should be corrected.
When a patient drinks excessive water, sudden asthma and chest fullness will inevitably occur. Generally, when food intake is low but water intake is high, water retention occurs in the lower epigastrium (Xin Xia). Severe cases manifest as palpitations; mild cases manifest as shortness of breath. [A Double-Wiry pulse indicates Cold, resulting from severe purgation leading to interior deficiency; a Single-Wiry pulse indicates Fluid Retention.]
[Commentary]
Below the sentence "mild cases manifest as shortness of breath," ancient editions contain sentences such as "Double-Wiry pulse indicates Cold...", which do not fit the context logically. This was listed as a separate item following Item 27 in this section.
Assuming a sick person (or thin person) has palpitations below the umbilicus, spits saliva and foam, and experiences vertigo, this is due to Water-Fluid Retention, treated primarily with Wu Ling San (Five-Ingredient Powder with Poria).
[Commentary]
The character "Thin" (Shou) in "Thin person" should be "Sick" (Bing); the character "Dian" (Epilepsy/Madness) in "Dian Xuan" should be "Dian" (Vertex/Head). "Dian" refers to the head, making the text coherent; it should be corrected.
When retained fluid exists in the heart region, the patient feels cold on the back over an area the size of a palm. Regarding retained fluid: pain in the hypochondriac region radiating to the Qumen acupoint, worsening with coughing. When retained fluid exists in the chest, the patient suffers from shortness of breath and wheezing (or thirst), and pain in all joints of the four limbs. [A Deep pulse indicates the presence of retained fluid.]
[Commentary]
In ancient editions, the sentence "A Deep pulse indicates the presence of retained fluid" appears below "pain in all joints of the four limbs." It should be a separate item to align with the principle of discussing pulses. The character "Thirst" in "shortness of breath and thirst" should be "Wheezing"; there is likely missing text before "four limbs."
If the patient's pulse is Hidden (Fu), and they desire diarrhea, feeling relieved after defecation, [this is because the retained fluid is attempting to exit]; although diarrhea persists, the epigastrium remains hard and full. [This is because the retained fluid is attempting to exit], Gan Sui Ban Xia Tang (Kansui and Pinellia Decoction) is the primary treatment.
[Commentary]
The eight characters "this is because the retained fluid is attempting to exit" under "the epigastrium remains hard and full" should be placed under "feeling relieved after defecation." This is a transcription error that needs relocation.
Water-fluid in the Heart: hardness and pounding sensation in the epigastrium, shortness of breath, aversion to water and unwillingness to drink. Water-fluid in the Lungs: spitting saliva and foam, desire to drink water. Water-fluid in the Spleen: lack of energy, heavy body. Water-fluid in the Liver: distension and fullness in the hypochondriac region, pain upon sneezing. Water-fluid in the Kidneys: palpitations in the [Umbilical] (or Epigastric) region.
[Commentary]
The character "Heart" in "Epigastric palpitations" should be "Umbilical"; it should be corrected.
For Zhi Yin (Supporting Fluid) presenting with abdominal (or chest) fullness, Hou Po Da Huang Tang (Magnolia Bark and Rhubarb Decoction) is the primary treatment.
[Commentary]
The character "Chest" in "Zhi Yin chest fullness" should be "Abdominal". If it were "chest", there would be no rationale for using Chengqi Tang-type formulas; it should be corrected.
A Wiry-Chi (Slow) (or Rapid) pulse with Cold-Fluid indicates difficulty in treatment during winter and summer.
[Commentary]
The character "Rapid" in "Wiry-Rapid pulse" should be "Chi" (Slow), to align with the pathology of Cold-Fluid; it should be corrected.
Coughing and wheezing with inability to lie flat are treated with Xiao Qing Long Tang (Minor Green Dragon Decoction). After Xiao Qing Long Tang induces sweating (or purging), if there is excessive salivation, dry mouth, Deep pulse at the Cun position, Micropulse at the Chi position, cold extremities, Qi rushing from the lower abdomen up to the chest and throat, numbness in hands and feet, facial flushing resembling drunkenness, followed by downward flow into the inner thighs, difficult urination, and occasional dizziness, Fu Ling Gui Zhi Wu Wei Gan Cao Tang (Poria, Cinnamon Twig, Schisandra, and Licorice Decoction) is administered to treat the Qi rushing symptom.
[Commentary]
The character "Purging" (Xia) in "After Xiao Qing Long Tang purging" should be "Sweating" (Han). Since both Da Qing Long Tang and Xiao Qing Long Tang are diaphoretic agents, it should be corrected.