辨者，别也。辨脉者，辨别诸脉之名也。法者，诸脉部位至数，形状相类相反，别之
各有其法也。脉名者，如浮、沉、迟、数、滑、涩诸脉之名是也。部位者，如浮、中
、沉、上、下之部位是也。至数者，如迟三至，数六至之至数是也。形状者，如滑流
、涩滞之形状是也。相类者，如弦与紧，滑与动之类是也。相反者，如浮与沉，虚与
实之反是也。皮肤取而得之，谓之浮；筋骨取而得之，谓之沉，此以脉之上下部位而
得名也，是则凡脉因部位而得名，皆统乎浮沉矣。如浮而无力谓之濡，沉而无力谓之
弱；浮而极有力谓之革，沉而极有力谓之牢；浮中沉俱有力，按之且大谓之实，浮中
沉俱无力，按之且大谓之虚；浮中沉极无力，按之且小，似有似无，谓之微，浮中沉
极无力，按之且大涣散不收，谓之散；浮沉有力，中取无力，谓之芤，按之至骨，推
寻始得，谓之伏，此皆以部位兼形状相反，而得名者也。一息三至，谓之迟；一息六
至，谓之数，此以脉之至数而得名者也，是则凡脉因至数而得名者，皆统乎迟数矣。
如一息四至谓之缓，一息七至谓之疾，数时一止谓之促，缓时一止谓之结，至数不乖
，动而中止，不能自还，须臾复动，谓之代，此皆以至数兼相类而得名者也。流利如
珠，谓之滑；进退艰难滞涩，谓之涩，此以脉之形状而得名也，是则凡脉因形状而得
名者，皆统乎滑涩矣。如脉形粗大，谓之大；脉形细小，谓之小；来去迢迢，谓之长
；来去缩缩，谓之短；来盛去衰，谓之洪；其形如豆，动摇不移，谓之动；状类弓弦
，按之端直且劲，谓之弦；较弦则粗，按之左右弹指，谓之紧，此皆以形状兼相类相
反而得名者也。此辨脉之大概也。诊者于此能详审而扩充之，则进乎法矣。今以浮、
沉、迟、数、滑、涩，六脉别之以为纲；以大、小、虚、实，诸脉辨之以为目，务使
阴阳标本，虚实寒热，心中有据，指下无差，庶心手相得，而辨证处方，自无错谬矣
。
@@@
问曰：脉有阴阳，何谓也？答曰：凡脉大、浮、数、动、滑，此名阳也；脉沉、涩、
弱、弦、微，此名阴也。凡阴病见阳脉者生，阳病见阴脉者死。
【注】
此以脉之阴阳，辨病之阴阳生死法也。浮、大、数、动、滑，五者，比之诸脉为有余
，阳道有余，故曰阳也。沉、涩、弱、弦、微，五者，比之诸脉为不及，阴道不及，
故曰阴也。阴病，谓阴寒病也。见阳脉，谓见阳热脉也，阳热脉，即浮、大、数、动
、滑类也。以阴病得阴脉证脉相应，死难必也。阴病若得阳脉，犹冬尽春生，万物虽
未即生，然日进生机，故曰生也。阳病，谓阳热病也。见阴脉、谓见阴寒脉也。阴寒
脉即沉、涩、弱、弦、微类也。以阳病得阳脉，证脉相应，生可卜也；阳病若得阴脉
，如暑去秋来，万物虽未即死，然日趋死候，故曰死也。盖天人无二理，春夏为阳，
秋冬为阴，阳主生，阴主杀故也。
【集注】
方有执曰：阴阳者，通藏府血气表里虚实，风寒寒热而总言之也。
程知曰：阴病见阳脉而主生者，邪气自里之表，欲汗而解也。阳病见阴脉而主死者，
邪气自表入里，正虚邪盛也。故正气实者，多见阳脉，正气虚者，多见阴脉。
@@@
脉来缓，时一止复来者，名曰结；脉来数，时一止复来者，名曰促，阳盛则促，阴盛
则结，此皆病脉。
【注】
缓，四至脉也，缓时一止复来者，名曰结脉。数，六至脉也，数时一止复来者，名曰
促脉。阳盛则促，阴盛则结，阴阳偏胜则病，故曰：此皆病脉也。
@@@
脉按之来缓，时一止复来者，名曰结，又脉来动而中止，更来小数，中有还者反动，
名曰结阴也；脉来动而中止，不能自还，因而复动者，名曰代阴也，得此脉者必难治
。
【按】
脉按之来缓，时一止至，名曰结阴也数语，文义不顺，且前论促结之脉已明，当是衍
文。
【注】
脉来至数不乖而中止，不能自还，因而复动，名曰代，乃一藏无气，求他藏以代续之
故也。凡病得此代脉者，必为难治，盖以促结之止，如急行而蹶，虽然中止，即能自
还，非代脉之止可比也。
@@@
阴阳相搏，名曰动，阳动则汗出，阴动则发热，形冷恶寒者，此三焦伤也。若数脉见
于关上，上下无头尾，如豆大，厥厥动摇者，名曰动也。
【按】
『素问』曰：阳加于阴谓之汗，阳加于阳，岂有汗出之理？阳动则「汗出」二字当是
「发热」二字；阴动则「发热」二字当是「汗出」二字。
【注】
动者躁动也，谓阴阳互相鼓击而不宁也。动，阳脉也，寸为阳，阳乘击于阳，故阳动
发热也。尺为阴，阴乘击于阴，故阴动汗出也。关界乎阴阳，则阴阳互相乘击，故发
热汗出同见也。此为动而有力，阳盛之候，若按之不鼓，是为阳衰之诊，则必形冷而
不发热，汗出而必恶寒，非搏击阳盛之动，乃扰乱阳虚之动也，由三焦之阳气伤，则
不能外温肉分，故有是证也。动脉之状，颇似数脉，惟上下无头尾，如豆大，厥厥动
摇，故名曰动也。厥厥者，谓似有根之摇动，动而不移，非若滑脉之流动，动而不居
也。
【集注】
方有执曰：阴阳相搏之阴阳，以二气言；阳动阴动之阴阳，以部位言。下言动脉之定
位与其形状，厥厥举发貌。
程知曰：阳升阴降，交通上下，往来于尺、寸之间，则冲和安静，惟阳欲升，而阴不
足以和之使降，则两相搏击，其脉必数，而厥厥摇动见于关上也。
@@@
脉浮而紧者，名曰弦也，弦者状如弓弦，按之不移也，脉紧者，如转索无常也。
【注】
脉浮而紧者，名曰弦也，此非谓浮紧即弦脉，乃谓浮而劲紧，弦之状也。弦紧相类，
惟恐人将弦作紧，将紧作弦，故并举相形以别之也。弦者状如弓弦，按之不移，即所
谓端直也；紧者如转索无常，即所谓不端直也。端直则不能如转索，转索则不能似端
直，其为劲急则同，所以相类也。
【集注】
方有执曰：此明弦紧之辨。按之不移，言如弦之张于弓，一定而不可动移也。转索无
常，言左右旋转而不可拘也。
程知曰：紧为寒邪方盛，直细中有转动急疾之意，故谓如转索也。张锡驹曰：弦紧之
分，在移与不移耳！
@@@
脉弦而大，弦则为减，大则为芤，减则为寒，芤则为虚。寒虚相搏，此名为革，妇人
则半产漏下，男子则亡血失精。
【注】
脉形粗大有力，谓之大；浮沉有力，中取无力，状如□管谓之芤；沉而且大，按之劲
急有力，谓之牢；浮而且大，举之劲急有力，谓之革，革脉者以鼓革而得名，外急中
空之象也。弦则为劲，减其中取之劲，外急象也；大则为实，小其中取之实，中空像
也，此以弦减、芤虚二脉，形容革脉也。女子得之半产漏下，男子得之亡血失精，寒
虚相搏故也。
【集注】
程知曰：言弦而虚大之脉也。弦则为减，谓阳气减少而寒也；大则为芤，谓似革中空
而虚也。虚寒相抟，则精血漏失，故有革象也。
@@@
问曰：脉有残贼，何谓也？师曰：脉有弦、紧、浮、滑、沉、涩。此六脉名曰残贼，
能为诸脉作病也。
【注】
此下，皆残贼为病之诊也。相乘之脉为正气虚，随我所虚而乘及之之谓也。残贼之脉
为邪气实，恃彼之强而虐及之之谓也。此六脉者名曰残贼，残则明伤，贼则暗袭，脉
中有此当属实邪，不论何部，但本脉中兼见此脉，辄防邪至也。
【集注】
方有执曰：诸脉，谓各部之脉也。作，起也。言六者若见于各部之脉中，则皆能于其
部生起病端。
张锡驹：残，伤残；贼，贼害也。言此六者之脉，足以暗伤人之经脉血气，如贼之害
人而不觉，故曰能为诸脉作病也。
@@@
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，名曰洁也；浊邪
中下，名曰浑也。阴中于邪；必内栗也，表气微虚，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，表气微虚，里气微急，三焦相溷，内外不
通，上焦怫郁，藏气相熏，口烂食龂也。中焦不治，胃气上冲，脾气不转，胃中为浊
，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
，出入藏府，热气所过，则为痈脓。若阴气前通者，阳气厥微，阴无所使，客气入内
，嚏而出之，声嗢咽塞，寒厥相迫，为热所拥，血凝自下，状如豚肝，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。
【注】
寸口阴阳俱紧者，谓六脉浮沉俱紧也。浮脉紧，则雾露之邪中于上焦；沉脉紧，则寒
邪中于下焦，上焦指太阳也，下焦指少阴也。雾露之邪，曰洁、曰清，清邪中上，发
热头痛，项强颈挛，腰疼胫酸者，雾露之邪中于太阳表也。寒邪曰浑、曰浊、浊邪中
下，阴气为栗，足胫逆冷便溺妄出者，寒邪中于少阴里也。经曰：虚邪不能独伤人，
必因身形之虚而后客之也。盖因其人表气虚，里气不固，清浊之邪，中伤上下，三焦
相溷，表里不通，以致上焦清气不宜，邪气怫郁，与藏相熏，口烂蚀龂。中焦不治，
胃气主下，而反上冲，脾气主运，而反不转，中焦皆浊，荣卫不通，血凝不流行也。
若正能胜邪，卫气先通，其人必先小便赤黄，热伤之经必血凝肉腐，而外发为痈脓也
。若荣气先通，其人必先嚏嗢咽塞，热拥于里之血凝者自下，状如豚肝也。若正不胜
邪，阴阳俱逆，荣卫不通，脾气孤弱，不能散精，五液注下，下焦不阖，里急坠痛，
圊便数窘，命将难全也。
【集注】
沈亮宸曰：伤寒之证，转热即佳，故少阴、厥阴，皆以发热而愈，而凡下脓血与痈脓
皆非死证。若阴阳俱厥，厥者必利，故五液注下，下焦不阖，命将难全也。
方有执曰：清指风，浊指寒，曰洁、曰浑，以天地之偏气言也。阴中于邪已下至浊邪
中下一节，是释上文阴即下焦，阳即上焦也。阴气为栗已下至血凝不流，是言证。若
卫气前通已下，言变痈脓之故。若阴气前通已下，言变脓血利之故。卫气即阳气，荣
气即阴气，乃承上荣卫不通而言，而清浊之所以为病，在其中矣！阴阳俱厥已下，言
证并于里而加重，故曰：命将难全也。
@@@
脉阴阳俱紧者，口中气出，唇口干燥，蜷卧足冷，鼻中涕出，舌上胎滑，勿妄治也。
到七日以来，其人微发热，手足温者，此为欲解；或到八日已上，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。
【注】
此承上条互详其证，戒人临此阴阳混淆之病，慎勿妄治也。此条之蜷卧足冷，即上条
之浊邪中下也；此条之鼻涕舌胎，即上条之清邪中上也；此条之唇口干燥，即上条之
口烂蚀龂也；此条之反大发热，即上条之痈脓下血也；此条之腹中痛，即上条之下重
湫痛也；此条之恶寒，即上条之必内栗也。脉阴阳俱紧，伤寒脉也；口中气出，唇口
干燥胃经热也；蜷卧足冷，少阴寒也；鼻中涕出，表伤风也；舌上胎滑，里无热也。
似此表里、阴阳、寒热、虚实，杂揉未定之病，慎勿妄治，则当审其孰轻、孰重、孰
缓、孰急，先后施治可也。到七日以来，其人微发热手足渐温者，此阴退阳复为欲解
也；若到八日以上，反大发热者，乃邪盛正衰，此为难治也。设使恶寒知尚在表，若
呕必欲入里也。腹内痛者，知邪已入里，内攻必欲下利也。
【集注】
方有执曰：微发热邪退也，大发热邪盛也，恶寒尚在表也，腹内痛已入里也。
@@@
脉阴阳俱紧，至于吐利，其脉独不解，紧去入安，此为欲解。若脉迟至六、七日不欲
食，此为晚发，水停故也，为未解，食自可者为欲解。
【按】
紧去入安之「入」字，当是「人」字，人安谓不吐利也，必是传写之讹。「此为晚发
，水停故也」二句，与上下文义不属，当是衍文。
【注】
此发明脉阴阳俱紧，内外寒甚，至于吐、利解不解之义也。吐利后脉仍紧，为邪未尽
不解也；紧去脉缓，为邪尽人安欲解也。若紧去脉迟，至六、七日不欲食者，则胃未
和为未解也；若欲食者，则胃已和，虽脉迟亦为欲解也。
【集注】
成无己曰：脉阴阳俱紧，为寒气甚于上下，至于吐利之后，紧脉不罢者，为其脉独不
解，紧去则人安为欲解也。
@@@
寸口脉浮而大，浮为虚，大为实，在尺为关，在寸为格，关则不得小便，格则吐逆。
【注】
平脉以脉内外候关格，此以脉尺寸候关格。于此推之，凡阴阳盛极皆病关格，而不必
定在内外尺、寸也。寸口脉浮而大，浮为正气虚，大为邪气实，在尺则阴邪实，关闭
正气不能宣，名曰关，关则不得小便也。在寸则阳邪实，格拒正气不能化，名曰格，
格则吐逆也。
【集注】
辨别，就是分别的意思。辨脉，就是辨别各种脉象的名称。法，是指各种脉象的部位、至数和形状，有的相似，有的相反，辨别它们各有其方法。脉名，如浮、沉、迟、数、滑、涩等脉的名称。部位，如浮、中、沉、上、下等部位。至数，如一息三至为迟，一息六至为数这样的至数。形状，如滑利流畅、涩滞不畅这样的形状。相类，如弦脉与紧脉，滑脉与动脉之类。相反，如浮脉与沉脉，虚脉与实脉的相对立。在皮肤取而得之，称为浮；在筋骨取而得之，称为沉，这是根据脉的上下部位而得名，那么凡是因部位而得名的脉，都统属于浮和沉了。如浮而无力称为濡（Ruru, Soft pulse），沉而无力称为弱（Ruomai, Weak pulse）；浮而极有力称为革（Gemai, Drum-skin pulse），沉而极有力称为牢（Laomai, Firm pulse）；浮、中、沉三部都有力，按之且大称为实（Shimai, Excess pulse），浮、中、沉三部都无力，按之且大称为虚（Xumai, Deficiency pulse）；浮、中、沉极无力，按之且小，似有似无，称为微（Weimai, Fine pulse），浮、中、沉极无力，按之且大涣散不收，称为散（Sanmai, Scattered pulse）；浮沉有力，中取无力，称为芤（Koumai, Scallion-stalk pulse），按之至骨，推寻始得，称为伏（Fumai, Deep pulse），这些都是以部位兼形状相反而得名。一息三至，称为迟（Chimai, Slow pulse）；一息六至，称为数（Sumai, Rapid pulse），这是根据脉的至数而得名，那么凡是因至数而得名的脉，都统属于迟和数了。如一息四至称为缓（Huanmai, Moderate pulse），一息七至称为疾（Jimai, Hasty pulse），数时偶尔停止称为促（Cuomai, Interrupted rapid pulse），缓时偶尔停止称为结（Jiemai, Intermittent slow pulse），至数不乱，跳动中止，不能自行恢复，片刻后再次跳动，称为代（Daimai, Replacement pulse），这些都是以至数兼相类而得名。流利如珠，称为滑（Huamai, Slippery pulse）；进退艰难滞涩，称为涩（Semai, Choppy pulse），这是根据脉的形状而得名，那么凡是因形状而得名的脉，都统属于滑和涩了。如脉形粗大，称为大（Damai, Large pulse）；脉形细小，称为小（Xiaomai, Small pulse）；来去悠长，称为长（Changmai, Long pulse）；来去短缩，称为短（Duannai, Short pulse）；来势盛而去势衰，称为洪（Hongmai, Surging pulse）；脉形如豆，动摇不移，称为动（Dongmai, Agitated pulse）；状如弓弦，按之端直且劲，称为弦（Xianmai, Wiry pulse）；较弦脉更粗，按之左右弹指，称为紧（Jinmai, Taut pulse），这些都是以形状兼相类相反而得名。这是辨脉的大概。诊者若能在此详细审察并扩充知识，就进入法的境界了。现在以浮、沉、迟、数、滑、涩这六脉作为纲；以大、小、虚、实等脉作为目进行辨别，务必使阴阳标本、虚实寒热在心中有所依据，指下无误，这样心手相应，辨证处方，自然就不会有错谬了。
问：脉有阴阳之分，是什么意思？答：凡是脉大、浮、数、动、滑，这些名为阳脉；脉沉、涩、弱、弦、微，这些名为阴脉。凡是阴病见到阳脉者生，阳病见到阴脉者死。
【注】
这是通过脉的阴阳，来辨别病的阴阳生死的方法。浮、大、数、动、滑这五种脉，相比其他脉属于有余，阳道有余，所以称为阳。沉、涩、弱、弦、微这五种脉，相比其他脉属于不及，阴道不及，所以称为阴。阴病，指阴寒病。见阳脉，指见阳热脉，即浮、大、数、动、滑这类脉。如果阴病得到阴脉，证与脉相应，必死无疑。阴病若得阳脉，犹如冬尽春生，万物虽然未立即生长，但日渐生机，所以说生。阳病，指阳热病。见阴脉，指见阴寒脉，即沉、涩、弱、弦、微这类脉。如果阳病得到阳脉，证与脉相应，可断言为生；阳病若得阴脉，犹如暑去秋来，万物虽然未立即死亡，但日趋死候，所以说死。大概天理与人理无二致，春夏为阳，秋冬为阴，阳主生发，阴主肃杀的缘故。
【集注】
方有执说：阴阳，是通指脏腑、气血、表里、虚实、风寒、寒热而言的。
程知说：阴病见阳脉而主生，是因为邪气从里出表，欲通过汗解而愈。阳病见阴脉而主死，是因为邪气由表入里，正气虚而邪气盛。所以正气实者，多见阳脉；正气虚者，多见阴脉。
脉来缓，偶尔停止后又来，名叫结脉；脉来数，偶尔停止后又来，名叫促脉，阳盛则促，阴盛则结，这都是病脉。
【注】
缓，是一息四至的脉，缓时偶尔停止又来的，名叫结脉。数，是一息六至的脉，数时偶尔停止又来的，名叫促脉。阳盛则促，阴盛则结，阴阳偏胜则病，所以说：这都是病脉。
脉按之来缓，偶尔停止后又来，名叫结阴脉；又脉来跳动中止，后来脉稍快，中间有回还的反动，名叫结阴脉；脉来跳动中止，不能自行恢复，因而再次跳动的，名叫代阴脉，得到这种脉的人一定难治。
【按】
“脉按之来缓，时一止至，名曰结阴也”这几句，文义不顺，且前文论促结之脉已明，应当是衍文。
【注】
脉来至数不乱而中止，不能自行恢复，因而再次跳动，名叫代脉，这是因为一脏无气，求他脏之气以替代延续的缘故。凡是病得此代脉的，一定难治，因为促结之止，如同急行而跌倒，虽然中止，随即能自行恢复，不可与代脉之止相比。
阴阳相搏，名叫动脉，阳动则汗出，阴动则发热，形体寒冷恶寒的，这是三焦受伤。如果数脉见于关上，上下无头尾，如豆大，厥厥动摇的，名叫动脉。
【按】
《素问》说：阳加于阴谓之汗，阳加于阳，哪里有汗出的道理？阳动则“汗出”二字当是“发热”二字；阴动则“发热”二字当是“汗出”二字。
【注】
动，是躁动，指阴阳互相鼓击而不宁。动，属阳脉，寸口为阳，阳乘击于阳，故阳动发热。尺部为阴，阴乘击于阴，故阴动汗出。关部界乎阴阳之间，则阴阳互相乘击，故发热汗出同见。此为动而有力，是阳盛的征候，如果按之不鼓指，是为阳衰的诊断，则必然形体寒冷而不发热，汗出而必恶寒，这不是搏击阳盛之动，而是扰乱阳虚之动，由于三焦阳气受伤，不能外温肌肉腠理，所以有此证候。动脉的形状，颇似数脉，只是上下无头尾，如豆大，厥厥动摇，所以名叫动。厥厥，是说似有根之摇动，动而不移，不像滑脉之流动，动而不居。
【集注】
方有执说：阴阳相搏之阴阳，是以二气而言；阳动阴动之阴阳，是以部位而言。下文讲动脉的定位与其形状，厥厥是举发的样子。
程知说：阳升阴降，交通上下，往来于尺、寸之间，则冲和安静，只有阳欲升，而阴不足以和之使降，则两相搏击，其脉必数，而厥厥摇动见于关部。
脉浮而紧的，名叫弦脉，弦脉的样子像弓弦，按之不移。脉紧的，像转索无常。
【注】
脉浮而紧的，名叫弦脉，这里不是说浮紧就是弦脉，而是说浮而劲紧，是弦的状态。弦紧相类，唯恐人将弦作紧，将紧作弦，所以并举以相互比较来区别它们。弦脉的样子像弓弦，按之不移，即所谓的端直；紧脉像转索无常，即所谓的不端直。端直则不能像转索，转索则不能似端直，它们的劲急相同，所以相类。
【集注】
方有执说：这是阐明弦紧的区别。按之不移，是说像弦张于弓上，一定而不可移动。转索无常，是说左右旋转而不可拘束。
程知说：紧为寒邪正盛，直细中有转动急疾之意，所以说像转索。张锡驹说：弦紧的区分，在于移与不移！
脉弦而大，弦则为减，大则为芤，减则为寒，芤则为虚。寒虚相搏，这名叫革脉，妇人得此脉则半产漏下，男子得此脉则亡血失精。
【注】
脉形粗大有力，称为大脉；浮沉有力，中取无力，状如葱管称为芤脉；沉而且大，按之劲急有力，称为牢脉；浮而且大，举之劲急有力，称为革脉，革脉以鼓革而得名，是外急中空之象。弦则为劲，减去其中取的劲，是外急之象；大则为实，减小其中取的实，是中空之象，这是用弦减、芤虚两脉来形容革脉。女子得此脉则半产漏下，男子得此脉则亡血失精，是寒虚相搏的缘故。
【集注】
程知说：说的是弦而虚大的脉。弦则为减，谓阳气减少而为寒；大则为芤，谓似革中空而虚。虚寒相抟，则精血漏失，所以有革象。
问：脉有残贼，是什么意思？师曰：脉有弦、紧、浮、滑、沉、涩。这六脉名叫残贼，能为诸脉作病。
【注】
以下，都是残贼为病的诊断。相乘之脉为正气虚，随我所虚而乘及之叫相乘。残贼之脉为邪气实，恃彼之强而虐及之叫残贼。这六脉名叫残贼，残则明伤，贼则暗袭，脉中有此当属实证邪气，不论何部，只要本脉中兼见此脉，就要防备邪气至。
【集注】
方有执说：诸脉，指各部之脉。作，起也。说这六种脉若见于各部之脉中，则都能在其部生起病端。
张锡驹说：残，伤残；贼，贼害也。说这六种脉，足以暗伤人之经脉血气，如贼害人而不觉，所以能说能为诸脉作病。
寸口脉阴阳俱紧的，法当清邪中于上焦，浊邪中于下焦，清邪中上，名叫洁；浊邪中下，名叫浑。阴中于邪，必内栗，表气微虚，里气不守，故使邪中于阴。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，所以叫清邪中上。浊邪中下，阴气为栗，足膝逆冷，便溺妄出，表气微虚，里气微急，三焦相溷，内外不通，上焦怫郁，藏气相熏，口烂食龂。中焦不治，胃气上冲，脾气不转，胃中为浊，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，客气入内，嚏而出之，声嗢咽塞，寒厥相迫，为热所拥，血凝自下，状如豚肝，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。
【注】
寸口阴阳俱紧，指六脉浮沉俱紧。浮脉紧，则雾露之邪中于上焦；沉脉紧，则寒邪中于下焦，上焦指太阳经，下焦指少阴经。雾露之邪，叫洁、叫清，清邪中上，发热头痛，项强颈挛，腰疼胫酸，是雾露之邪中于太阳表。寒邪叫浑、叫浊，浊邪中下，阴气为栗，足胫逆冷便溺妄出，是寒邪中于少阴里。经说：虚邪不能独伤人，必因身形之虚而后客之。大概因其人表气虚，里气不固，清浊之邪，中伤上下，三焦相溷，表里不通，以致上焦清气不宜，邪气怫郁，与脏相熏，口烂蚀龂。中焦不治，胃气主下，而反上冲，脾气主运，而反不转，中焦皆浊，荣卫不通，血凝不流行也。如果正气能胜邪，卫气先通，其人必先小便赤黄，热伤之经必血凝肉腐，而外发为痈脓。如果荣气先通，其人必先嚏嗢咽塞，热拥于里之血凝者自下，状如豚肝。如果正气不胜邪，阴阳俱逆，荣卫不通，脾气孤弱，不能散精，五液注下，下焦不阖，里急坠痛，圊便数窘，命将难全。
【集注】
沈亮宸说：伤寒之证，转热即佳，所以少阴、厥阴，都以发热而愈，而凡下脓血与痈脓都不是死证。如果阴阳俱厥，厥者必利，所以五液注下，下焦不阖，命将难全。
方有执说：清指风，浊指寒，叫洁、叫浑，是以天地之偏气而言。阴中于邪已下至浊邪中下一节，是解释上文阴即下焦，阳即上焦。阴气为栗已下至血凝不流，是言证。若卫气前通已下，言变痈脓之故。若阴气前通已下，言变脓血利之故。卫气即阳气，荣气即阴气，乃承上荣卫不通而言，而清浊之所以为病，在其中矣！阴阳俱厥已下，言证并于里而加重，所以说：命将难全。
脉阴阳俱紧，至于吐利，其脉独不解，紧去人安，此为欲解。若脉迟至六、七日不欲食，此为晚发，水停故也，为未解，食自可者为欲解。
【按】
紧去人安之“人”字，原文误作“入”，人安谓不吐利也，必是传写之讹。“此为晚发，水停故也”二句，与上下文义不属，当是衍文。
【注】
这是发明脉阴阳俱紧，内外寒甚，至于吐、利解不解的意义。吐利后脉仍紧，为邪未尽不解；紧去脉缓，为邪尽人安欲解。若紧去脉迟，至六、七日不欲食者，则胃未和为未解；若欲食者，则胃已和，虽脉迟亦为欲解。
【集注】
成无己说：脉阴阳俱紧，为寒气甚于上下，至于吐利之后，紧脉不罢者，为其脉独不解，紧去则人安为欲解。
寸口脉浮而大，浮为虚，大为实，在尺为关，在寸为格，关则不得小便，格则吐逆。
【注】
平脉以脉内外候关格，此以脉尺寸候关格。由此推之，凡阴阳盛极皆病关格，而不必定在内外尺、寸。寸口脉浮而大，浮为正气虚，大为邪气实，在尺则阴邪实，关闭正气不能宣，名叫关，关则不得小便。在寸则阳邪实，格拒正气不能化，名叫格，格则吐逆。
【集注】
Differentiation means distinction. Differentiating pulses refers to distinguishing the names of various pulse types. "Method" refers to the location, frequency (beats per respiration), and shape of various pulses; some are similar, while others are opposite, and each has its specific method for differentiation. Pulse names include those such as Floating (Fu, 浮), Deep (Chen, 沉), Slow (Chi, 迟), Rapid (Shu, 数), Slippery (Hua, 滑), and Choppy (Se, 涩). Location refers to positions such as Superficial (Fu, 浮), Middle (Zhong, 中), Deep (Chen, 沉), Upper (Shang, 上), and Lower (Xia, 下). Frequency refers to counts such as three beats per respiration for Slow (Chi, 迟) and six beats per respiration for Rapid (Shu, 数). Shape refers to characteristics such as smooth flow for Slippery (Hua, 滑) and stagnation for Choppy (Se, 塞). Similarity includes pairs like Wiry (Xian, 弦) and Taut (Jin, 紧), or Slippery (Hua, 滑) and Agitated (Dong, 动). Opposition includes pairs like Floating (Fu, 浮) and Deep (Chen, 沉), or Deficient (Xu, 虚) and Excess (Shi, 实). Pulses obtained by palpating the skin are called Floating (Fu, 浮); those obtained by palpating the sinews and bones are called Deep (Chen, 沉). These are named according to their vertical location; thus, all pulses named by location are categorized under Floating (Fu, 浮) and Deep (Chen, 沉). For instance, a Floating (Fu, 浮) pulse that is forceless is called Soft (Ruo, 濡); a Deep (Chen, 沉) pulse that is forceless is called Weak (Ruo, 弱); a Floating (Fu, 浮) pulse that is extremely forceful is called Drum-skin (Ge, 革); a Deep (Chen, 沉) pulse that is extremely forceful is called Firm (Lao, 牢); a pulse that is forceful at Superficial (Fu, 浮), Middle (Zhong, 中), and Deep (Chen, 沉) levels, and appears large upon pressure, is called Excess (Shi, 实); a pulse that is forceless at all three levels and appears large upon pressure is called Deficient (Xu, 虚); a pulse that is extremely forceless at all three levels, appears small, and seems present yet absent, is called Fine (Wei, 微); a pulse that is extremely forceless at all three levels, appears large, and is scattered and uncollected, is called Scattered (San, 散); a pulse that is forceful at Superficial (Fu, 浮) and Deep (Chen, 沉) levels but forceless at the Middle (Zhong, 中) level is called Scallion-stalk (Kou, 芤); a pulse that can only be felt by pressing to the bone and requires pushing to locate is called Deep/Hidden (Fu, 伏). These are named based on location combined with opposing shapes. Three beats per respiration are called Slow (Chi, 迟); six beats per respiration are called Rapid (Shu, 数). These are named by frequency; thus, all pulses named by frequency are categorized under Slow (Chi, 迟) and Rapid (Shu, 数). For example, four beats per respiration are called Moderate (Huan, 缓); seven beats per respiration are called Hasty (Ji, 疾); a Rapid (Shu, 数) pulse that occasionally stops is called Interrupted (Cuo, 促); a Moderate (Huan, 缓) pulse that occasionally stops is called Intermittent (Jie, 结); a pulse with regular frequency that stops during movement, cannot recover spontaneously, and resumes after a moment is called Replacement (Dai, 代). These are named by frequency combined with similarity. Smoothness like pearls is called Slippery (Hua, 滑); difficulty in advance and retreat with stagnation is called Choppy (Se, 涩). These are named by shape; thus, all pulses named by shape are categorized under Slippery (Hua, 滑) and Choppy (Se, 涩). A pulse with a coarse and large form is called Large (Da, 大); a pulse with a fine and small form is called Small (Xiao, 小); a pulse that extends long in both arrival and departure is called Long (Chang, 长); a pulse that is short in both arrival and departure is called Short (Duan, 短); a pulse that arrives vigorously and depares weakly is called Surging (Hong, 洪); a pulse shaped like a bean, trembling without moving, is called Agitated (Dong, 动); a pulse resembling a bowstring, straight and tense upon pressure, is called Wiry (Xian, 弦); a pulse coarser than Wiry (Xian, 弦), which rebounds against the fingers from side to side upon pressure, is called Taut (Jin, 紧). These are named by shape combined with similarity and opposition. This is the general principle of differentiating pulses. If practitioners can examine these in detail and expand their knowledge, they will master the methods. Now, we take Floating (Fu, 浮), Deep (Chen, 沉), Slow (Chi, 迟), Rapid (Shu, 数), Slippery (Hua, 滑), and Choppy (Se, 涩) as the main categories (Gang); and differentiate using Large (Da, 大), Small (Xiao, 小), Deficient (Xu, 虚), and Excess (Shi, 实) as sub-categories (Mu). This ensures that Yin-Yang, root and branch, deficiency-excess, and cold-heat are clearly understood in the mind, leading to accurate finger diagnosis, harmonious mind-hand coordination, and error-free syndrome differentiation and prescription.
Question: What does it mean that pulses have Yin and Yang? Answer: Pulses that are Large (Da, 大), Floating (Fu, 浮), Rapid (Shu, 数), Agitated (Dong, 动), and Slippery (Hua, 滑) are named Yang pulses. Pulses that are Deep (Chen, 沉), Choppy (Se, 涩), Weak (Ruo, 弱), Wiry (Xian, 弦), and Fine (Wei, 微) are named Yin pulses. In Yin diseases, the appearance of Yang pulses indicates survival; in Yang diseases, the appearance of Yin pulses indicates death.
[Annotation]
This section uses the Yin-Yang nature of pulses to determine the Yin-Yang prognosis of life and death in diseases. Floating (Fu, 浮), Large (Da, 大), Rapid (Shu, 数), Agitated (Dong, 动), and Slippery (Hua, 滑) are considered surplus compared to other pulses; since the Yang path involves surplus, they are called Yang. Deep (Chen, 沉), Choppy (Se, 涩), Weak (Ruo, 弱), Wiry (Xian, 弦), and Fine (Wei, 微) are considered deficient compared to other pulses; since the Yin path involves deficiency, they are called Yin. Yin disease refers to Yin-cold disease. Seeing Yang pulses means seeing Yang-heat pulses, i.e., Floating (Fu, 浮), Large (Da, 大), Rapid (Shu, 数), Agitated (Dong, 动), Slippery (Hua, 滑). If Yin disease presents with Yin pulses, the symptoms and pulse correspond, indicating inevitable death. If Yin disease presents with Yang pulses, it is like winter ending and spring arriving; although things do not immediately grow, vitality increases daily, hence survival. Yang disease refers to Yang-heat disease. Seeing Yin pulses means seeing Yin-cold pulses, i.e., Deep (Chen, 沉), Choppy (Se, 涩), Weak (Ruo, 弱), Wiry (Xian, 弦), Fine (Wei, 微). If Yang disease presents with Yang pulses, symptoms and pulse correspond, indicating survival. If Yang disease presents with Yin pulses, it is like summer leaving and autumn arriving; although things do not immediately die, they approach death daily, hence death. The principle of Heaven and humanity is one; Spring and Summer are Yang, Autumn and Winter are Yin; Yang governs generation, Yin governs destruction.
[Collected Annotations]
Fang Youzhi said: Yin and Yang here refer generally to Zang-Fu organs, Qi and Blood, Exterior and Interior, Deficiency and Excess, Wind-Cold, and Cold-Heat.
Cheng Zhi said: Yin disease presenting with Yang pulses leads to survival because the pathogenic factor moves from Interior to Exterior, seeking resolution through sweating. Yang disease presenting with Yin pulses leads to death because the pathogenic factor moves from Exterior to Interior, with righteous Qi deficient and pathogenic factor exuberant. Thus, when righteous Qi is substantial, Yang pulses are common; when righteous Qi is deficient, Yin pulses are common.
A pulse that is Moderate (Huan, 缓) and occasionally stops before returning is called Intermittent (Jie, 结); a pulse that is Rapid (Shu, 数) and occasionally stops before returning is called Interrupted (Cuo, 促). Exuberance of Yang causes Interrupted (Cuo, 促); exuberance of Yin causes Intermittent (Jie, 结). These are all pathological pulses.
[Annotation]
Moderate (Huan, 缓) refers to a pulse of four beats per respiration; an Intermittent (Jie, 结) pulse is one that is Moderate (Huan, 缓) and occasionally stops before returning. Rapid (Shu, 数) refers to a pulse of six beats per respiration; an Interrupted (Cuo, 促) pulse is one that is Rapid (Shu, 数) and occasionally stops before returning. Exuberance of Yang causes Interrupted (Cuo, 促); exuberance of Yin causes Intermittent (Jie, 结). Imbalance of Yin and Yang leads to disease, hence these are all pathological pulses.
A pulse that feels Moderate (Huan, 缓) upon pressure and occasionally stops before returning is called Yin Intermittent (Jie Yin, 结阴); furthermore, a pulse that stops during movement, returns slightly faster, and has a rebounding motion is also called Yin Intermittent (Jie Yin, 结阴); a pulse that stops during movement, cannot recover spontaneously, and then resumes is called Yin Replacement (Dai Yin, 代阴). Patients with these pulses will certainly be difficult to treat.
[Commentary]
The phrase "pulse feels Moderate (Huan, 缓) upon pressure, occasionally stops, named Yin Intermittent (Jie Yin, 结阴)" is grammatically awkward, and since the pulses of Cuo and Jie were already clarified earlier, this is likely a textual error or interpolation.
[Annotation]
A pulse with regular frequency that stops, cannot recover spontaneously, and then resumes is called Replacement (Dai, 代). This occurs because one Zang organ lacks Qi and seeks another Zang organ to substitute and continue the function. Any disease presenting with a Replacement (Dai, 代) pulse is difficult to treat. The stops in Cuo (Cuo, 促) and Jie (Jie, 结) pulses are like stumbling while walking fast; although they stop, they recover immediately, unlike the Replacement (Dai, 代) pulse.
When Yin and Yang contend, it is called Agitated (Dong, 动). Yang agitation causes sweating; Yin agitation causes fever. If the body is cold and the patient fears cold, this indicates injury to the Sanjiao (Triple Burner). If a Rapid (Shu, 数) pulse appears at the Guan (Middle) position, without head or tail above or below, about the size of a bean, trembling firmly, it is called Agitated (Dong, 动).
[Commentary]
The *Su Wen* states: "Yang added to Yin is called sweat." How can there be sweating if Yang is added to Yang? Therefore, "sweating" in "Yang agitation causes sweating" should be "fever"; and "fever" in "Yin agitation causes fever" should be "sweating".
[Annotation]
"Dong" (Agitated) means restless, referring to Yin and Yang mutually stimulating each other without peace. Dong is a Yang pulse. The Cun (Inch) position is Yang; when Yang attacks Yang, Yang agitation causes fever. The Chi (Cubit) position is Yin; when Yin attacks Yin, Yin agitation causes sweating. The Guan (Middle) position lies between Yin and Yang, so Yin and Yang mutually attack, causing both fever and sweating. This describes a Dong pulse that is forceful, indicating Yang exuberance. If it does not bulge upon pressure, it indicates Yang deficiency, manifesting as cold body without fever, and sweating with aversion to cold. This is not the Dong of Yang exuberance due to contention, but the Dong of Yang deficiency due to disturbance. Injury to the Yang Qi of the Sanjiao (Triple Burner) prevents external warming of the muscle layer, resulting in these symptoms. The shape of the Agitated (Dong, 动) pulse resembles the Rapid (Shu, 数) pulse, but lacks head and tail, is bean-sized, and trembles firmly, hence the name. "Jue jue" describes a trembling motion that seems rooted and immobile, unlike the flowing, non-abiding motion of the Slippery (Hua, 滑) pulse.
[Collected Annotations]
Fang Youzhi said: The Yin and Yang in "Yin and Yang contend" refers to the two Qi; the Yin and Yang in "Yang agitation" and "Yin agitation" refer to locations. The following text describes the fixed location and shape of the Agitated (Dong, 动) pulse, with "jue jue" describing the manner of emergence.
Cheng Zhi said: Yang rises and Yin descends, communicating above and below, moving between Chi (Cubit) and Cun (Inch) positions, resulting in harmony and tranquility. If Yang desires to rise but Yin is insufficient to harmonize and descend them, they contend. The pulse becomes Rapid (Shu, 数), and firm trembling appears at the Guan (Middle) position.
A pulse that is Floating (Fu, 浮) and Taut (Jin, 紧) is called Wiry (Xian, 弦). The Wiry (Xian, 弦) pulse resembles a bowstring and remains immovable upon pressure. The Taut (Jin, 紧) pulse resembles a twisting rope that changes constantly.
[Annotation]
A pulse that is Floating (Fu, 浮) and Taut (Jin, 紧) is called Wiry (Xian, 弦). This does not mean that Floating-Taut is exactly the Wiry pulse, but rather that Floating and tense/tight constitutes the state of Wiry. Wiry and Taut are similar; to prevent confusion between them, they are presented together for comparison. Wiry resembles a bowstring, immovable upon pressure, i.e., straight. Taut resembles a twisting rope, i.e., not straight. Straightness precludes twisting; twisting precludes straightness. However, both are tense and urgent, hence they are similar.
[Collected Annotations]
Fang Youzhi said: This clarifies the distinction between Wiry and Taut. "Immovable upon pressure" means like a string stretched on a bow, fixed and unmovable. "Twisting rope changing constantly" means rotating left and right without constraint.
Cheng Zhi said: Taut indicates exuberant cold pathogens; it has a sense of rotation and urgency within its straightness and thinness, hence likened to a twisting rope.
Zhang Xiju said: The distinction between Wiry and Taut lies in whether it moves or not!
A pulse that is Wiry (Xian, 弦) and Large (Da, 大): Wiry indicates reduction; Large indicates Empty (Kou, 芤). Reduction indicates Cold; Empty indicates Deficiency. Cold and Deficiency contend, this is called Drum-skin (Ge, 革). In women, it indicates spontaneous abortion and continuous bleeding; in men, it indicates loss of blood and essence.
[Annotation]
A pulse form that is coarse and large with force is called Large (Da, 大). A pulse that is forceful at Floating (Fu, 浮) and Deep (Chen, 沉) levels but forceless at the Middle (Zhong, 中) level, resembling a scallion stalk, is called Empty (Kou, 芤). A pulse that is Deep (Chen, 沉) and large, forceful and tense upon pressure, is called Firm (Lao, 牢). A pulse that is Floating (Fu, 浮) and large, forceful and tense upon light pressure, is called Drum-skin (Ge, 革). Drum-skin is named after a drum cover, representing an exterior tense and interior hollow image. Wiry implies tension; reducing the tension at the middle level creates the exterior tense image. Large implies solidity; reducing the solidity at the middle level creates the interior hollow image. This uses the Wiry-reduction and Empty-deficiency pulses to describe the Drum-skin pulse. Women presenting with this pulse suffer spontaneous abortion and leakage; men suffer blood loss and essence depletion, due to the contention of Cold and Deficiency.
[Collected Annotations]
Cheng Zhi said: This describes a Wiry and vacuously Large pulse. Wiry indicates reduction, meaning Yang Qi is reduced leading to Cold. Large indicates Empty, meaning it resembles the hollow center of a Drum-skin pulse and is Deficient. Contention of Deficiency and Cold causes leakage of essence and blood, hence the Drum-skin image.
Question: What are the "Mutilating and Robbing" (Can Zei) pulses? Master said: There are Wiry (Xian, 弦), Taut (Jin, 紧), Floating (Fu, 浮), Slippery (Hua, 滑), Deep (Chen, 沉), and Choppy (Se, 涩) pulses. These six pulses are called Mutilating and Robbing (Can Zei), as they can cause pathology in other pulses.
[Annotation]
The following sections discuss diagnoses where Mutilating and Robbing pulses cause disease. Pulses of mutual overcoming indicate deficient righteous Qi, where the pathogen attacks the deficient area. Mutilating and Robbing pulses indicate excess pathogenic Qi, where the strong pathogen tyrannizes. These six pulses are called Mutilating and Robbing; "Mutilating" implies open injury, "Robbing" implies secret invasion. Their presence in the pulse indicates excess pathogenic factors. Regardless of the position, if any of these pulses appear alongside the primary pulse, one must guard against the arrival of pathogens.
[Collected Annotations]
Fang Youzhi said: "Other pulses" refers to pulses at various positions. "Zuo" means arise. It means that if these six appear within the pulses of various positions, they can all initiate pathology in those positions.
Zhang Xiju said: "Can" means mutilation; "Zei" means robbery/harm. It means these six pulses can secretly harm the meridians, Qi, and Blood, like a robber harming someone unnoticed, hence they can cause pathology in other pulses.
When Cun Kou pulses are both Yin and Yang Tight (Jin, 紧), the method dictates that Clear Pathogens invade the Upper Jiao, and Turbid Pathogens invade the Lower Jiao. Clear pathogens invading above are called Clean (Jie, 洁); Turbid pathogens invading below are called Muddy (Hun, 浑). When Yin is invaded by pathogens, internal shivering occurs; because Exterior Qi is slightly deficient and Interior Qi does not hold, pathogens invade Yin. When Yang is invaded by pathogens, fever, headache, neck stiffness, cervical spasm, lower back pain, and leg soreness occur. This is known as Yang being invaded by mist and dew, hence Clear Pathogens invade above. Turbid pathogens invading below cause Yin Qi to shiver, cold feet and knees, and inappropriate urination/defecation. Exterior Qi is slightly deficient, Interior Qi is slightly urgent, Sanjiao is confused, Interior and Exterior are blocked. Upper Jiao is stagnant, Zang Qi薰 (smokes/fumes), causing mouth ulcers and gum erosion. Middle Jiao fails to regulate, Stomach Qi rushes upward, Spleen Qi fails to transform, the Stomach becomes turbid, Ying and Wei do not communicate, and Blood congeals and fails to flow. If Wei Qi communicates first, urine becomes red and yellow; contending with Heat, acting as a vehicle for Heat, it wanders through meridians, entering and exiting Zang-Fu organs. Where Heat passes, abscesses and pus form. If Yin Qi communicates first, Yang Qi is severely deficient, Yin has no use, external pathogens enter internally, sneezing expels them, voice is hoarse, throat is blocked, Cold and Reversal press each other,擁 (surrounded) by Heat, Blood congeals and flows out from below, resembling pig liver. Both Yin and Yang are reversed, Spleen Qi is isolated and weak, Five Fluids pour downward, Lower Jiao fails to close, clear stool feels heavy, frequent and difficult defecation occurs, umbilical colic and shallow pain arise, life is hard to preserve.
[Annotation]
"Cun Kou Yin and Yang both Tight" means all six pulses are Tight at both Floating and Deep levels. Floating-Tight indicates Mist-Dew pathogens invading the Upper Jiao; Deep-Tight indicates Cold pathogens invading the Lower Jiao. Upper Jiao refers to the Taiyang channel; Lower Jiao refers to the Shaoyin channel. Mist-Dew pathogens, called Clean/Clear, invade above, causing fever, headache, neck stiffness, cervical spasm, lower back pain, and leg soreness, indicating Mist-Dew pathogens invading the Taiyang Exterior. Cold pathogens, called Muddy/Turbid, invade below, causing Yin Qi shivering, cold calves, and inappropriate urination/defecation, indicating Cold pathogens invading the Shaoyin Interior. The Classics state: Deficient pathogens cannot injure alone; they must encounter bodily deficiency to lodge. Generally, because Exterior Qi is deficient and Interior Qi is insecure, Clear and Turbid pathogens injure Above and Below, confusing Sanjiao, blocking Interior and Exterior. This leads to improper circulation of Clear Qi in the Upper Jiao, pathogenic stagnation, fuming with Zang Qi, causing mouth ulcers and gum erosion. Middle Jiao fails to regulate; Stomach Qi should descend but rushes up; Spleen Qi should transport but fails to turn; Middle Jiao becomes turbid, Ying and Wei do not communicate, and Blood congeals and fails to circulate. If Righteous Qi overcomes Pathogenic Qi, and Wei Qi communicates first, urine becomes red and yellow; Heat-injured meridians cause blood coagulation and flesh rot, emerging externally as abscesses and pus. If Ying Qi communicates first, sneezing, hoarseness, and throat blockage occur; Heat-surrounded congealed blood flows out from below, resembling pig liver. If Righteous Qi fails to overcome Pathogenic Qi, Yin and Yang are both reversed, Ying and Wei do not communicate, Spleen Qi is isolated and weak, failing to scatter essence, Five Fluids pour downward, Lower Jiao fails to close, abdominal urgency and dragging pain occur, frequent and窘迫 (urgent/difficult) defecation arises, life is hard to preserve.
[Collected Annotations]
Shen Liangchen said: In Typhoid disorders, turning to Heat is auspicious; thus, Shaoyin and Jueyin recover with fever. Downward discharge of pus/blood and external abscesses are not fatal. If Yin and Yang are both reversed, reversal leads to diarrhea; thus, Five Fluids pour downward, Lower Jiao fails to close, and life is hard to preserve.
Fang Youzhi said: Clear refers to Wind, Turbid refers to Cold; Clean and Muddy refer to biased Qi of Heaven and Earth. From "Yin invaded by pathogens" to "Turbid pathogens invade below" explains that Yin is Lower Jiao and Yang is Upper Jiao. From "Yin Qi shivers" to "Blood congeals and fails to flow" describes symptoms. From "If Wei Qi communicates first" explains the cause of abscess formation. From "If Yin Qi communicates first" explains the cause of pus-blood diarrhea. Wei Qi is Yang Qi; Ying Qi is Yin Qi, continuing from "Ying and Wei do not communicate," revealing why Clear and Turbid cause disease. From "Yin and Yang are both reversed" describes symptoms worsening in the Interior, hence "life is hard to preserve."
When Yin and Yang pulses are both Tight, leading to vomiting and diarrhea, if the pulse alone does not resolve, and the Tightness disappears and the person is at ease, this indicates impending resolution. If the pulse becomes Slow until the sixth or seventh day, and the person does not desire food, this is late onset, due to Water retention, indicating unresolved condition. If food desire returns, it indicates impending resolution.
[Commentary]
"Tightness disappears, person is at ease" - the character "Ru" (Enter) should be "Ren" (Person). "Person at ease" means no vomiting or diarrhea; this is likely a transcription error. The sentences "This is late onset, due to Water retention" do not fit the context and are likely interpolations.
[Annotation]
This elaborates on the meaning of Yin and Yang pulses both Tight, indicating severe Cold in Interior and Exterior, leading to vomiting and diarrhea, and whether they resolve. If the pulse remains Tight after vomiting and diarrhea, it indicates incomplete expulsion of pathogens and unresolved condition. If Tightness disappears and the pulse becomes Moderate, it indicates complete expulsion of pathogens, person is at ease, and resolution is impending. If Tightness disappears and the pulse becomes Slow, and until the sixth or seventh day the person does not desire food, the Stomach is not harmonized, indicating unresolved condition. If the person desires food, the Stomach is harmonized, and even with a Slow pulse, resolution is impending.
[Collected Annotations]
Cheng Wuji said: Yin and Yang pulses both Tight indicate severe Cold above and below. After vomiting and diarrhea, if the Tight pulse persists, the pulse alone does not resolve. If Tightness disappears, the person is at ease, indicating impending resolution.
At Cun Kou, if the pulse is Floating and Large: Floating indicates Deficiency, Large indicates Excess. At the Chi (Cubit) position, it is Guan (Obstruction); at the Cun (Inch) position, it is Ge (Rejection). Guan means inability to urinate; Ge means vomiting and regurgitation.
[Annotation]
Standard pulse diagnosis uses Interior/Exterior to assess Guan and Ge; this text uses Cun/Chi positions to assess Guan and Ge. From this, we infer that extreme Excess of Yin and Yang all lead to Guan Ge disease, not necessarily limited to Interior/Exterior or Cun/Chi. At Cun Kou, Floating and Large: Floating indicates deficient Righteous Qi, Large indicates exuberant Pathogenic Qi. At Chi, Yin Pathogen is Excess, obstructing Righteous Qi from circulating, named Guan (Obstruction), leading to inability to urinate. At Cun, Yang Pathogen is Excess, rejecting Righteous Qi from transforming, named Ge (Rejection), leading to vomiting and regurgitation.
[Collected Annotations]