伤寒热病，脉喜浮洪。沉微涩小，证反必凶。
汗后脉静，身凉则安。汗后脉躁，热甚必难。
阳病见阴，病必危殆。阴病见阳，虽困无害。
上不至关，阴气已绝。下不至关，阳气已竭。
代脉止歇，脏绝倾危。散脉无根，形损难医。
《素问》热论曰∶今夫热病者，皆伤寒之类也。又曰∶人之伤于寒也，则为病热。
热虽甚，不死。观此，则知伤寒虽是阴寒之邪，袭人生气中，正气与之抗拒，郁蒸
成热，亦理势之必然者。抗拒在表，故脉浮。郁蒸成热，故脉洪。热病得此阳脉，
知正气不陷缩而能鼓发，胜邪必矣，故喜焉。若沉微涩小，是皆阴类。证阳脉阴，
表病见里。证与脉反，邪盛正衰，凶之兆也。至若汗后，邪解正复。此时脉躁盛者，
亦应宁静。身体自然凉和。设脉仍躁而热加甚，是正气已衰，邪气更进，必难乎其
为生矣。即《素问》评热论所谓有病温者，汗出辄复热，而脉躁疾，不为汗衰，狂
言不能食，病名阴阳交者是也。（一派阳邪，阴不能复。若与阳交，并为一而不分，是阴已绝亡，
故死。）阳病见阴者，见阴脉也，即上文所云热病而得沉微涩小之类。言证与脉反，故亦危殆。
阴病见阳者，见阳脉也。亦似与证相反，惟伤寒则不然。伤寒自表入里，从阳之阴，
刻刻侵传，层层渐入。今阴病得阳脉，是转寒凛而变温和，起深沉而出浮浅。死阴
忽作生阳，病虽困笃，自当无害。故仲景云∶阴病见阳脉者生，阳病见阴脉者死。
尺为阴，尺脉上不至关，是阴已绝于下。寸为阳，寸脉下不至关，是阳已竭于上。
《脉经》曰∶阳生于寸，动于尺。阴生于尺，动于寸。言阴阳互相生动。今两不至关，
是阴阳离异矣。《素问》生气通天论曰∶阴阳离决，精气乃绝，非此之谓欤！代脉止
歇者，乃藏真不能接续，其倾危可立见也。散脉无根者，谓脉外散而不敛，内无根
蒂之候。若形见损伤，必难医治。仲景平脉篇云∶伤寒咳逆上气，其脉散者死，谓
其形损故也。其义谓咳逆属肺，散脉属心。肺金心火，火刑其金，故主死。形刑二义俱通，姑两存之。
伤寒热病，脉象以浮洪为吉。若见沉、微、涩、小之脉，病情反而凶险。
发汗之后，脉象平静，身体凉爽，则病情安稳。发汗之后，脉象躁动，发热严重，则预后艰难。
阳证出现阴脉，病情必定危险。阴证出现阳脉，虽然困顿但无大害。
脉气上行不到关部，说明阴气已经断绝。脉气下行不到关部，说明阳气已经枯竭。
代脉表现为间歇停跳，是脏腑真气断绝、病情危重的征象。散脉没有根基，形体已受损，难以医治。
《素问·热论》说：现在的热病，都属于伤寒的范畴。又说：人受寒邪侵袭，就会发生热病。
热势即使很盛，也不会死亡。由此可知，伤寒虽然是阴寒之邪，侵入人体正气之中，正气与之抗拒，郁结蒸腾而化热，这也是情理和趋势上的必然结果。正气在体表抗拒，所以脉象浮；郁结蒸腾化热，所以脉象洪。热病得到这种阳脉，说明正气没有下陷收缩，而是能够鼓动激发，战胜邪气是必然的，所以认为这是吉兆。如果见到沉、微、涩、小等脉，这些都是阴类脉象。阳证见到阴脉，表病见到里脉。症状与脉象相反，说明邪气盛而正气衰，是凶险的征兆。至于发汗之后，邪气解除，正气恢复。此时脉象应当宁静。身体自然凉爽平和。假如脉象仍然躁动而热势加重，这是正气已经衰退，邪气更加深入，必定很难生存了。这就是《素问·评热论》所说的有温病的人，出汗后随即又发热，而且脉象躁急，不因出汗而衰减，胡言乱语不能进食，病名叫做“阴阳交”的病。（这是一派阳邪，阴气不能回复。如果与阳邪相交，混为一团而不分，说明阴气已经断绝消亡，所以死亡。）阳证见到阴脉，是指见到阴脉，就是上文所说的热病而得到沉、微、涩、小之类的脉象。意思是症状与脉象相反，所以也危险。阴证见到阳脉，是指见到阳脉。似乎也同症状相反，唯独伤寒不是这样。伤寒从体表传入体内，从阳经传入阴经，时刻侵袭传变，层层逐渐深入。现在阴证得到阳脉，是转变寒冷凛冽而为温和，从深沉转为浮浅。死阴忽然变为生阳，病情虽然困顿严重，自然应当无害。所以张仲景说：阴证见到阳脉的能生，阳证见到阴脉的会死。
尺部属阴，尺脉上行不到关部，说明阴气已经在下部断绝。寸部属阳，寸脉下行不到关部，说明阳气已经在上部枯竭。
《脉经》说：阳气生于寸部，发动于尺部。阴气生于尺部，发动于寸部。说的是阴阳互相生动。现在上下都不到关部，说明阴阳分离异路了。《素问·生气通天论》说：阴阳分离决裂，精气就会断绝，说的不就是这个意思吗！代脉有间歇停跳，是脏腑真气不能接续，其倾覆危重可以立刻见到。散脉没有根基，是说脉象向外散漫而不收敛，内部没有根蒂的表现。如果形体已经损伤，必定难以医治。张仲景《平脉篇》说：伤寒咳嗽气逆上冲，脉象散的会死，说是因为形体受损的缘故。其含义是说咳逆属于肺，散脉属于心。肺金心火，火克金，所以主死。这里的“形”字有两种解释都通顺，姑且两种都保留。
In cold damage (Shanghan) and febrile diseases, a floating and surging pulse is auspicious. If the pulse is deep, minute, choppy, or small, the prognosis is inevitably ominous.
After sweating, if the pulse becomes calm and the body cools down, the patient will be safe. After sweating, if the pulse is restless and the fever is severe, recovery will be difficult.
When Yang syndromes present with Yin pulses, the disease is critical. When Yin syndromes present with Yang pulses, although the condition is distressing, it is not harmful.
If the pulse does not reach up to the Guan position, the Yin Qi has been exhausted. If the pulse does not reach down to the Guan position, the Yang Qi has been depleted.
The Dai pulse (Intermittent Pulse), characterized by pauses, indicates the exhaustion of Zang organ true Qi and imminent danger. The San pulse (Scattered Pulse), lacking a root, indicates physical deterioration and is difficult to treat.
The *Suwen* (Plain Questions) states in its chapter on Febrile Diseases: "Currently, all febrile diseases belong to the category of cold damage." It also states: "When humans are injured by cold pathogens, they develop febrile diseases."
Even if the heat is severe, death does not ensue. From this, we understand that although cold damage is a Yin-cold pathogen, once it invades the body's healthy Qi, the healthy Qi resists it, leading to stagnation and steaming which generates heat; this is an inevitable logical progression. Resistance at the exterior causes the pulse to be floating. Stagnation and steaming generating heat cause the pulse to be surging. For a febrile disease to present with these Yang pulses indicates that the healthy Qi has not sunk or contracted but can surge and activate, ensuring victory over the pathogen; hence, this is considered auspicious. Conversely, deep, minute, choppy, and small pulses are all Yin-type pulses. A Yang syndrome presenting with Yin pulses, or an exterior disease presenting with interior pulses, signifies a contradiction between symptoms and pulse, indicating excess pathogenic factors and deficient healthy Qi, which is an omen of disaster. Regarding post-sweating conditions, when the pathogen is resolved and healthy Qi recovers, the pulse should be calm, and the body naturally cool and harmonious. If the pulse remains restless and the heat intensifies, it indicates that healthy Qi has declined while the pathogen has advanced further, making survival unlikely. This corresponds to what the *Suwen* chapter on Evaluating Febrile Diseases describes as having a warm disease where sweating is followed immediately by recurrent fever, with a restless and rapid pulse that does not diminish with sweating, accompanied by delirium and inability to eat; this disease is named "Yin-Yang Intersection" (Yin Yang Jiao). (This represents a mass of Yang pathogenic factors where Yin cannot recover. If it intersects with Yang, merging indistinguishably, it means Yin has been exhausted and perished, thus leading to death.) "Yang syndrome seeing Yin" refers to observing Yin pulses, specifically the deep, minute, choppy, and small types mentioned above. It implies a contradiction between syndrome and pulse, hence it is critical. "Yin syndrome seeing Yang" refers to observing Yang pulses. Although this seems contrary to the syndrome, it is different in cold damage. Cold damage enters from the exterior into the interior, moving from Yang meridians to Yin meridians, invading and transmitting constantly, layer by layer. Now, if a Yin syndrome presents with a Yang pulse, it signifies a transformation from cold and shivering to warmth, emerging from depth to superficiality. Dead Yin suddenly transforms into living Yang; although the disease is severe and critical, it should naturally be harmless. Thus, Zhang Zhongjing stated: "Yin syndromes presenting with Yang pulses indicate life; Yang syndromes presenting with Yin pulses indicate death."
The Chi position belongs to Yin. If the Chi pulse does not reach up to the Guan position, Yin has been exhausted below. The Cun position belongs to Yang. If the Cun pulse does not reach down to the Guan position, Yang has been depleted above.
The *Mai Jing* (Pulse Classic) states: "Yang Qi is born at the Cun position and moves at the Chi position. Yin Qi is born at the Chi position and moves at the Cun position." This speaks of Yin and Yang mutually generating each other. Now, if neither reaches the Guan position, it means Yin and Yang have separated and diverged. The *Suwen* chapter on Living Qi Connecting with Heaven states: "When Yin and Yang separate and break apart, Essence and Qi are exhausted." Is this not referring to this situation? The Dai pulse with pauses indicates that the Zang organ true Qi cannot connect continuously, and its perilous state is immediately apparent. The San pulse without a root refers to the pulse scattering outward without gathering, showing no internal root or foundation. If the physical form shows damage, it is certainly difficult to treat. Zhang Zhongjing's chapter on Calming Pulses states: "In cold damage, coughing and rebellious Qi rising, if the pulse is scattered, death occurs, because the physical form is damaged." The meaning here is that coughing and rebellious Qi belong to the Lung, while the scattered pulse belongs to the Heart. Lung Metal and Heart Fire, where Fire controls Metal, thus indicates death. The character "Xing" (Form/Shape) allows for two interpretations, both valid; therefore, both are preserved tentatively.