春戌、夏丑、秋辰、冬未，四时之喜神，取五行之养气为用，皆历三辰而数，如春以
戌为喜神，即正月在戌，二月在亥，三月在子，四时放此而推，若于脉中得之，犯他脉，喜
有喜庆之事，四时脉皆于胃中见，以五行皆资土以致用，而周身之脉，亦因胃脉，然后见于
气口，如春脉以弦为主，须六部脉皆循循，不急不绝，不紧不数，而胃脉微弦而缓，弦为春，
缓为本，六脉无犯，主一月内喜应，若正月于戌日见，二月于亥日见，三月于子日见，则旬
内应如胃脉带弦而毛，则主灾，夏脉洪为主，六脉皆隐隐而大，不散不浮，不滑不数，胃脉
微洪而缓，洪为夏，缓为本脉，六脉无犯，一月内喜应，旬内得脉，皆不出旬，秋脉主毛，
胃脉上轻，带毛而缓，又须有根蒂，此一脉难辨，如四时之脉，盖若毛而轻，如风如气，则
反为灾，不为喜脉，惟不浮不轻，缓缓而徐，浮手按之，乍如秋脉，重手取之，则去来如一
，压之不散举之不轻然后为喜脉，日辰之应，与春夏同法，冬脉最为易辨，但胃脉沉而不击
，即是。
病有悬性命于毫发之端，决死生于顷刻之下，死生之间，系医者之工拙，医者之工，则
病之痊愈速如转圜。医者之拙，则所投之药过于白刃，此伤寒之病，非独伤人之急，医者之
难事也，古人有言，一日二日，在于皮肤，四日五日，传之脏腑，故皮肤之间可汗。传脏腑
之间可下，世之学人，未尝不宗之以为定论，然不知人之有虚实，则病之有轻重，病之有轻
重，则传之有迟速，忽有经两日三日，而尚在皮肤，忽有初经两日三日，而传脏腑，善为医
者，当审察其脉，审其病之所在而已，尝以治伤寒之病有四失，一失之愚，盖伤寒之病，其
始在于皮肤，其次传之脏腑，当皮肤之间可汗，于脏腑之间可下，苟不辨阴阳，不分内外，
当汗而下，当下而汗，误投药饵，以倾人性命。此一失之愚也。二、失之不精，盖伤寒之病
，传之脏腑，则证候多端，千变万化，莫能尽究，其毒瓦斯之在肝者，不可疏脾，在心者，不
可疏肺，五脏之治，余皆同此，医者治之，决以为病之所传，在于何脏，方之所投，当以何
药，病之所减，当以何时，药之一投，遂可平复，苟不知病之源流，不识病之传受，误投药
饵，以希苟合，不幸而少有差误，人之倾危，可立而待，此二失不精也。三、失之怯，盖伤
寒热毒，传在五脏，攻损正气，其毒瓦斯之盛，如烟如雾，熏炙三焦，致令病危困，不思饮食
，医者反以为胃气之虚，不肯通疏，遂见倾损性命，但今患伤寒热毒之人，饮食不进，大府
不通，小便黄赤，病者危困，即先定其病之所传，在于何脏，急以疏转之药，取其毒瓦斯，其
病势轻减，则饮食增加，而平复如故矣，此三失之怯也。四、失之暴，盖治伤寒之法，既失
之愚，又失之怯，则不精不详者，不可容易言也，愚因言治伤寒之怯，切虑后之学人心术未
明，见识未到，但务以不怯为志，妄投转药以伤人性命，此余所以言四失之暴也。后之学人
，苟能明此四失，亦足以识治伤寒之大略，至于阳毒所次，阴毒所注，其传在五脏，则脏证
各殊，贯于六腑，则腑证各异，其伤人之急者，惟二感尤为极重。余今辄以病证脉候陈其一
二，庶几世人缘此之传也。
一日，巨阳受之，巨阳之脉，起于目内 ，上额交颠，上入络脑，下项，循膊内，夹背
，抵腰中，在手为小肠，在足为膀胱，故头项腰背强，其脉当疾数而浮以散，如新沐浴，如
风，而左尺脉微紧而数。
二日，阳明受之，阳明主肉，其脉夹鼻络于目，故身热目疼而鼻干，不得卧，其脉又经
于腹背，上头项，在手为大肠，在足为胃，诊其脉，当疾数而浮，渐渐按之，如通于里，以
阳明为宗筋，而胃脉受之，又渐入于里，六脉虽浮数，而胃脉一指微洪而数。
三日，少阳受之，问其脉，循胁，络于耳，故胸胁痛而耳聋，又起于目锐 ，上抵头角
，下耳后，其脉当疾数而利，得六七至以上，而肝脉又差数，此三阳受病，皆属于表，故其
脉疾数而浮，以其未入于脏腑，故言汗而已。
四日，太阴受之，太阴脉布胃中，络于嗌，入胃，上隔，夹咽，连舌本而散于舌下，其
脉当疾数而洪大，有骨力，胃脉差大。
五日，少阴受之，其脉直行者，从肾上肝鬲，入肺中，循喉咙，夹舌本，故口燥舌干而
渴，其脉最为洪大，六七至以上，心脉隐隐应指，来去如一。
六日，厥阴受之，厥阴之脉，自足上循阴器，抵少腹，又上贯鬲，故烦满而囊缩，其脉
疾数如长，三阴三阳，五脏六腑，荣卫不行，五脏不通，则死，大抵三日以前为三阳受病，
其脉在表，宜汗，三日以后三阴受病，其脉在里，宜泄，若初经三日，其脉疾数大，表里如
一，即不可汗，亦不可下，只以解利药通其中而已。
一二日，脉气疾数，以温辛发散药汗之而愈，药中亦须有通表解药，不可纯用热药，既
汗之后，脉当安和绵软，不疾不数，如老年衰削人脉，轻手按之，绵绵不绝，重手按之，隐
隐不乏，即自然安宁，若既汗之后，疾数不解，即难治，加之以结，则困重，或至于死，盖
结脉疾数而悬绝，累累如珠，而又不流利，与滑不同，但逐部位通流于指，如滴水起头是也
，然初得病，一日二日内，有增寒壮热，脉轻而浮，乃谓之伤寒，若才得病，并无增寒，头
疼欲碎，身热如火，头目赫赤，眼睛迸火，大府秘，小府赤，六脉洪大，有骨力，此名热病
，虽初得亦不汗，盖治伤寒之法，惟初一二日，与热病使药不同。
三四日以后，与热病同医，一日二日，脉气微小，不疾不数，不浮不散，唯沉软而细，
则汗之之药，宜极以温辛，如脾胃濡沉，则是感冷之一候，多变成阴证，阳毒伤寒，面赤头
痛，身热如火，心神烦躁，头目昏眩，项背强直，脉候当洪大而有骨力。
伤寒烦躁，饮水不休，若脉实而洪，不是疾数，是为涎毒，若洪大而不实，是为心脾受
毒。
伤寒后，寒热已退，腹中余一块，疼痛不可忍，忽走在腿面上疼，此为遗气在肝，脉气
洪而长，肝脉循循而过左足，宜清其血。
四五日，热毒上冲，心胸噎塞满闷，浑身壮热，头痛不止，大府不通，胸中痰实，脉气
当寸关脉实，而尺泽轻如绝，心脉炎炎而上。
热毒在肝，善怒，筋脉碎痛，神昏，不欲见人，两胁胀满，手足躁，不安卧，右手关脉
，当偏大紧急而长，热毒在心，头疼烦躁，面赤舌强，口语不快，忽心痛，善呕，狂言妄语
，忽思狂走入水，精神不守，左手脉，一指偏大，若舌强硬急，以妙手针刺其舌两傍，出恶
血，不可刺其舌心，热毒在脾，浑身肌肉碎疼，闻食即恶，思吐，通身发热，两唇干焦，边
脉动，或环唇青黑色，甚则腰痛腹满，两颊痛，右手关上脾脉，一指偏大，如众脉。
热毒在肺，上冲咽喉，心胸壅实隔塞不通，浑身大热，面色或赤，而又带白，喘咳不得
大息，右手寸口，一指偏大，而加之以浮。
热毒在肾，腰背疼痛，脊膂强急，头不痛，若渴数饮，甚则项痛而强， 寒以酸足下，
不欲言，其脉当左手尺泽微而轻浮，又轻紧。
伤寒，热毒攻于肝心两脏，毒瓦斯烦盛，上冲于肺，血随气逆，鼻中衄血，口中吐血，甚
则耳中眼中皆有血，诊其脉，当洪大而炎上，如流水之长，如乍开乍合，乍敛乍散，此为失
血之候。热毒内伤肝心两脏，肝心失守，不能主血，毒瓦斯烦盛，上蒸于肺，血随气行流入于
肌肤，发为赤斑，通身大热，头重疼痛，睡时如己身傍畔更有一身精神昏乱不守，其脉虽大
而郁结不解，重手取，隐隐而有骨力，如重夹绫绢裹之，为发斑之候，伤寒。热病发嗽，坐
卧喘急不安，其脉右手寸关脉当洪大，而加之浮数，伤寒，热毒炽盛，熏炙三焦，攻击皮肤
，通身发如橘色，其脉如发斑候而差沉，与黄胆同法。
热病结胸，心前闭塞，胸中有一块不通，坚硬不散，通身发热，头疼不安，面色黯赤，
喉中涎溢，大府秘热，昏闷不省人事，病则伏暑相似，其肺当洪大而有骨力，而肺脉实而不
浮，伏暑即结而沉。
伤寒热病，五六日，愈加困重，因吃疏药，下粪如紫黑色，病势不减，神思昏昏，小腹
膨胀，狂言妄语，不省人事，甚则腹中有块，坚硬不散，其脉结伏，此毒瓦斯攻血，腹内有淤
积恶物，十尝九死。
阴毒伤寒，浑身手足厥冷，面青，唇皮无色，四肢无力，心中寒栗，重则闭目，不知人
事，脉气当细微而沉，重手取之，又软而无骨力，若肾脉细微而搏沉者，为重。
春、夏、秋、冬四季的喜神方位，分别对应戌、丑、辰、未四个地支时辰。这是取五行中滋养之气的作用，都以经过三个地支时辰来推算。例如春季以戌为喜神，即正月在戌，二月在亥，三月在子，其他季节依此类推。如果在脉象中遇到这种脉象，且没有侵犯其他正常的脉象规律，预示会有喜庆之事。四季的脉象都应在胃气（脾胃运化功能在脉象上的反映）中显现，因为五行皆依赖土（脾胃）才能发挥作用，周身之脉也需通过胃脉，然后才能在气口（寸口脉）处诊察到。如春季脉象以弦脉（端直而长，如按琴弦）为主，必须六部脉（左右手寸关尺）都从容和缓，不急不躁，不紧不快，而胃脉微带弦意但总体缓和，弦代表春季，缓和代表根本。如果六脉没有违背这一规律，预示一月内将有喜事应验；若在正月于戌日见到，二月于亥日见到，三月于子日见到，则十日内应有喜事。如果胃脉带有弦意又兼见毛脉（浮而虚软，如抚榆钱），则主有灾祸。夏季脉象以洪脉（来盛去衰，如波涛汹涌）为主，六脉都隐隐约约而盛大，不散乱不浮越，不滑利不疾数，胃脉微洪而缓和，洪代表夏季，缓和为本脉。六脉无违逆，一月内喜事应验，十日内的脉象出现，喜事不出十日就会发生。秋季脉象以毛脉为主，胃脉上部轻虚，带有毛意而缓和，并且必须有根蒂（沉取有力）。这一种脉象难以辨别，如同四季之脉，如果脉象轻浮如风如气，反而为灾，不是喜脉；只有不浮不轻，缓缓徐来，轻取时乍看似秋脉，重按时来去如一，按压不散，提起不轻，这才是喜脉。日辰的应验方法，与春夏相同。冬季脉象最容易辨别，只要胃脉沉而不击指（不弹手），就是了。
疾病有时性命悬于毫发之间，决断生死于顷刻之下，死生之间，取决于医生的技艺高低。医生技艺高超，则病痊愈迅速如转动圆物；医生技艺拙劣，则所投之药比白刃还危险。伤寒病，不仅伤人急骤，也是医生治疗的难点。古人说：一日二日，邪气在皮肤，四日五日，传入脏腑。所以在皮肤之间可用汗法，传入脏腑之间可用下法。世间的学医者，无不尊奉此说作为定论，然而不知道人有虚实之分，则病有轻重之别；病有轻重，则传变有迟有速。忽然有人患病两三日，邪气尚在皮肤；忽然有人初患两三日，邪气已传入脏腑。善于行医的人，应当审察其脉象，审察病邪所在之处罢了。我曾经总结治疗伤寒病的四种失误：第一种是愚昧。伤寒病，起初在皮肤，其次传入脏腑，当在皮肤之间可用汗法，在脏腑之间可用下法。如果不分辨阴阳，不分内外，该用汗法却用了下法，该用下法却用了汗法，误投药物，导致人命倾覆。这是第一种愚昧的失误。第二种是精密度不够。伤寒病传入脏腑后，证候多端，千变万化，无法穷尽。毒瓦斯在肝脏的，不可疏理脾脏；在心臟的，不可疏理肺脏。五脏的治疗，其余皆同此理。医生治疗时，断定病邪传变到了哪一脏，方剂该投什么药，病情减轻需要多久，一旦投药，随即平复。如果不知道病的源流，不认识病的传变，误投药物以求侥幸吻合，不幸稍有差错，人的危亡立等可待。这是第二种不精密的失误。第三种是怯懦。伤寒热毒，传入五脏，攻损正气，毒瓦斯旺盛，如烟如雾，熏炙三焦，致使病情危困，不思饮食。医生反而认为是胃气虚弱，不肯通利疏泄，遂致性命倾损。如今患伤寒热毒之人，饮食不进，大便不通，小便黄赤，病人危困，应先确定病邪传变到了哪一脏，急忙使用疏转药物，祛除毒瓦斯。病势轻减，则饮食增加，恢复如初。这是第三种怯懦的失误。第四种是暴戾。治疗伤寒的方法，既然有愚昧和怯懦的失误，那么不精密不详审的情况，就不容易谈论了。我刚才谈到治疗伤寒的怯懦，深切担忧后来的学医者心术不明，见识不到，只致力于以不怯懦为目标，妄用转药伤害人性命。这就是我所说的第四种暴戾的失误。后来的学医者，如果能明白这四种失误，也足以认识治疗伤寒的大略。至于阳毒所停留的部位，阴毒所注重的地方，其传变在五脏，则脏证各不相同；贯穿六腑，则腑证各异。其中伤人之急迫者，唯有两种感受最为极重。我现在就列举一二病证脉候，希望世人能由此了解其传变规律。
第一天，巨阳经（太阳经）受邪。巨阳之脉，起于目内眦，上额交巅，上入络脑，下项，循膊内，夹背，抵腰中。在手为小肠经，在足为膀胱经。所以头项腰背强痛，其脉应当疾数而浮散，像刚沐浴完，像风吹一样，左尺脉微紧而数。
第二天，阳明经受邪。阳明主肉，其脉夹鼻络于目，所以身热、目疼、鼻干，不得卧。其脉又经过腹背，上头项。在手为大肠经，在足为胃经。诊其脉，应当疾数而浮，渐渐按之，感觉通于里。因为阳明为宗筋之主，胃脉受邪，又渐入于里，六脉虽浮数，但胃脉一指微洪而数。
第三天，少阳经受邪。询问其脉，循胁，络于耳，所以胸胁痛而耳聋。又起于目锐眦，上抵头角，下耳后。其脉应当疾数而利，达到六七至以上，肝脉又稍显数象。这三阳经受病，都属于表证，所以其脉疾数而浮，因为未入于脏腑，所以说只需发汗即可。
第四天，太阴经受邪。太阴脉布胃中，络于咽，入胃，上膈，夹咽，连舌本而散于舌下。其脉应当疾数而洪大，有骨力，胃脉稍大。
第五天，少阴经受邪。其脉直行者，从肾上肝膈，入肺中，循喉咙，夹舌本。所以口燥舌干而渴。其脉最为洪大，六七至以上，心脉隐隐应指，来去如一。
第六天，厥阴经受邪。厥阴之脉，自足上循阴器，抵少腹，又上贯膈。所以烦满而囊缩。其脉疾数如长。三阴三阳，五脏六腑，营卫不行，五脏不通，则死。大抵三日以前为三阳受病，其脉在表，宜用汗法；三日以后三阴受病，其脉在里，宜用泄法。如果初经三日，其脉疾数大，表里如一，就不可汗，也不可下，只用解利药通利其中而已。
一二日，脉气疾数，用温辛发散药发汗而愈。药中也须有通表解药，不可纯用热药。既汗之后，脉应当安和绵软，不疾不数，像老年人衰削后的脉，轻手按之，绵绵不绝，重手按之，隐隐不乏，即自然安宁。如果既汗之后，疾数不解，则难治。加上结脉，则困重，或至于死。盖结脉疾数而悬绝，累累如珠，而不流利，与滑脉不同，只是逐部位通流于指，像滴水起头那样。然而初得病，一日二日内，有增寒壮热，脉轻而浮，这才叫伤寒。如果才得病，并无增寒，头疼欲碎，身热如火，头目赫赤，眼睛迸火，大便秘结，小便赤涩，六脉洪大，有骨力，这叫热病。虽然初得也不发汗。盖治疗伤寒的方法，惟初一二日，与热病使药不同。
三四日以后，与热病同医。一日二日，脉气微小，不疾不数，不浮不散，唯沉软而细，则发汗之药，宜极用温辛。如脾胃濡沉，则是感冷之一候，多变成阴证。阳毒伤寒，面赤头痛，身热如火，心神烦躁，头目昏眩，项背强直，脉候应当洪大而有骨力。
伤寒烦躁，饮水不休，若脉实而洪，不是疾数，是为涎毒。若洪大而不实，是为心脾受毒。
伤寒后，寒热已退，腹中余一块，疼痛不可忍，忽走在腿面上疼，此为遗气在肝，脉气洪而长，肝脉循循而过左足，宜清其血。
四五日，热毒上冲，心胸噎塞满闷，浑身壮热，头痛不止，大便不通，胸中痰实。脉气当寸关脉实，而尺泽轻如绝，心脉炎炎而上。
热毒在肝，善怒，筋脉碎痛，神昏，不欲见人，两胁胀满，手足躁，不安卧。右手关脉，当偏大紧急而长。热毒在心，头疼烦躁，面赤舌强，口语不快，忽心痛，善呕，狂言妄语，忽思狂走入水，精神不守。左手脉，一指偏大。若舌强硬急，以妙手针刺其舌两旁，出恶血，不可刺其舌心。热毒在脾，浑身肌肉碎疼，闻食即恶，思吐，通身发热，两唇干焦，边脉动，或环唇青黑色，甚则腰痛腹满，两颊痛。右手关上脾脉，一指偏大，如众脉。
热毒在肺，上冲咽喉，心胸壅实隔塞不通，浑身大热，面色或赤，而又带白，喘咳不得大息。右手寸口，一指偏大，而加之以浮。
热毒在肾，腰背疼痛，脊膂强急，头不痛。若渴数饮，甚则项痛而强，足下寒冷，不欲言。其脉当左手尺泽微而轻浮，又轻紧。
伤寒，热毒攻于肝心两脏，毒瓦斯烦盛，上冲于肺，血随气逆，鼻中衄血，口中吐血，甚则耳中眼中皆有血。诊其脉，当洪大而炎上，如流水之长，如乍开乍合，乍敛乍散，此为失血之候。热毒内伤肝心两脏，肝心失守，不能主血，毒瓦斯烦盛，上蒸于肺，血随气行流入于肌肤，发为赤斑。通身大热，头重疼痛，睡时如己身傍畔更有一身精神昏乱不守。其脉虽大而郁结不解，重手取，隐隐而有骨力，如重夹绫绢裹之，为发斑之候。伤寒热病发嗽，坐卧喘急不安，其脉右手寸关脉当洪大，而加之浮数。伤寒，热毒炽盛，熏炙三焦，攻击皮肤，通身发如橘色，其脉如发斑候而差沉，与黄疸同法。
热病结胸，心前闭塞，胸中有一块不通，坚硬不散，通身发热，头疼不安，面色黯赤，喉中涎溢，大便秘热，昏闷不省人事。病则伏暑相似，其肺当洪大而有骨力，而肺脉实而不浮。伏暑即结而沉。
伤寒热病，五六日，愈加困重，因吃疏药，下粪如紫黑色，病势不减，神思昏昏，小腹膨胀，狂言妄语，不省人事，甚则腹中有块，坚硬不散。其脉结伏，此毒瓦斯攻血，腹内有淤积恶物，十尝九死。
阴毒伤寒，浑身手足厥冷，面青，唇皮无色，四肢无力，心中寒栗，重则闭目，不知人事。脉气当细微而沉，重手取之，又软而无骨力。若肾脉细微而搏沉者，为重。
The auspicious deities (Xishen, spirits bringing joyous events) of spring, summer, autumn, and winter correspond to the Earthly Branches Xu, Chou, Chen, and Wei respectively. This utilizes the nourishing Qi (vital energy) of the Five Elements (Wood, Fire, Earth, Metal, Water), calculated by passing through three Earthly Branches. For example, in spring, Xu is the auspicious deity; thus, the first month is at Xu, the second at Hai, and the third at Zi. The other seasons follow this pattern. If such a pulse is found in the pulse diagnosis, without violating other normal pulse patterns, it indicates that joyful events will occur. The pulses of all four seasons must manifest with Stomach Qi (the reflection of spleen-stomach digestive function in the pulse), because the Five Elements all rely on Earth (spleen-stomach) to exert their functions. The pulses of the whole body also emerge at the Qikou (Cunkou, radial artery at the wrist) only after passing through the Stomach pulse. For instance, the spring pulse is primarily Xian (String-like, straight and long like pressing a zither string). All six positions (three on each hand: Cun, Guan, Chi) must be moderate and unhurried, neither tight nor rapid. The Stomach pulse should be slightly Xian but overall gentle (Huan). Xian represents spring, while Huan represents the root. If the six pulses do not violate this rule, it predicts joyful events within a month. If seen on the day of Xu in the first month, Hai in the second month, and Zi in the third month, the event will occur within ten days. However, if the Stomach pulse carries both Xian and Mao (Feather-like, floating and soft) qualities, it indicates disaster. The summer pulse is primarily Hong (Surging, abundant at the start and declining at the end like a wave). All six pulses should be faint yet large, not scattered or floating, not slippery or rapid. The Stomach pulse should be slightly Hong but gentle. Hong represents summer, and Huan is the fundamental pulse. If the six pulses are unviolated, joyful events will occur within a month; if the pulse appears within ten days, the event will happen within ten days. The autumn pulse is primarily Mao. The Stomach pulse is light on top, carrying Mao quality but gentle, and must have a root (strength when pressed deeply). This type of pulse is difficult to distinguish. Similar to the seasonal pulses, if it feels light like wind or Qi, it is contrary to disaster, not an auspicious pulse. Only if it is neither floating nor light, coming slowly and gently, appearing like an autumn pulse upon light pressure, but returning uniformly upon heavy pressure,不散 (not scattering) when pressed and not light when lifted, is it an auspicious pulse. The timing of these events follows the same method as spring and summer. The winter pulse is easiest to identify; if the Stomach pulse is Chen (Deep) and does not strike the fingers, it is correct.
Diseases sometimes hang life and death on the tip of a hair, deciding survival in an instant. Between life and death lies the skill or clumsiness of the physician. A skilled physician brings recovery as quickly as turning a wheel; a clumsy physician makes the administered medicine more dangerous than a white blade. Shanghan (Cold Damage disease) not only attacks people rapidly but is also a difficult condition for physicians to treat. The ancients said: On the first and second days, the pathogen is in the skin; on the fourth and fifth days, it transmits to the Zang-Fu organs. Therefore, when in the skin, sweating (Han method) can be used; when transmitted to the Zang-Fu, purgation (Xia method) can be used. Scholars of the world revere this as a fixed theory, yet they fail to realize that people have deficiency and excess conditions, so diseases have severity levels; depending on severity, transmission speed varies. Sometimes after two or three days, the pathogen remains in the skin; sometimes after just two or three days, it has already transmitted to the Zang-Fu. Good physicians should examine the pulse and determine the location of the disease. I have summarized four errors in treating Shanghan: First, foolishness. Shanghan begins in the skin and then transmits to the Zang-Fu. When in the skin, use sweating; when in the Zang-Fu, use purgation. If one fails to distinguish Yin and Yang, interior and exterior, using purgation when sweating is indicated, or sweating when purgation is indicated, misadministering drugs leads to death. This is the first error of foolishness. Second, lack of precision. When Shanghan transmits to the Zang-Fu, symptoms are manifold and change endlessly, impossible to fully investigate. Toxin in the Liver cannot be treated by soothing the Spleen; toxin in the Heart cannot be treated by soothing the Lungs. Treatment of the five Zang organs follows this principle. Physicians decide which Zang organ is affected, prescribe formulas and herbs accordingly, and expect immediate recovery. If one does not know the source and flow of the disease, nor its transmission, and misadministers drugs hoping for accidental correctness, even slight errors lead to imminent death. This is the second error of imprecision. Third, timidity. Shanghan heat-toxin transmits to the five Zang organs, attacking healthy Qi. The toxin is abundant like smoke and fog, scorching the Sanjiao (Triple Burner), causing critical illness, loss of appetite. Physicians mistakenly attribute this to deficient Stomach Qi and refuse to use draining and unblocking methods, leading to death. For patients with Shanghan heat-toxin who cannot eat, have constipation, and yellow-red urine, one must first determine which Zang organ is affected, urgently use draining/unblocking drugs to remove the toxin. As the disease subsides, appetite returns, and health is restored. This is the third error of timidity. Fourth, violence/rashness. Regarding treatment methods for Shanghan, given the errors of foolishness and timidity, cases of imprecision and lack of detail are hard to discuss. I spoke of timidity to warn future scholars whose minds are unclear and insight insufficient, who strive only to avoid timidity and rashly use transforming drugs, harming lives. This is my fourth error of rashness. Future scholars who understand these four errors can grasp the general principles of treating Shanghan. Regarding where Yang Du (Yang Toxin) resides and where Yin Du (Yin Toxin) focuses, transmission to the five Zang organs results in different Zang syndromes; penetration into the six Fu organs results in different Fu syndromes. Among those that attack rapidly, only two types of infection are particularly severe. I now list a few syndrome and pulse manifestations, hoping others may understand the transmission from this.
On the first day, Juyang (Taiyang/Greater Yang) channel is affected. The Juyang pulse originates from the inner canthus, goes up to the forehead and vertex, enters the brain, descends the neck, runs along the arm interior, flanks the back, and reaches the waist. In the hand, it corresponds to the Small Intestine; in the foot, to the Bladder. Thus, there is stiffness and pain in the head, neck, waist, and back. The pulse should be rapid, numerous, and floating/scattered, like after a fresh bath or like wind blowing, with the left Chi position slightly tight and rapid.
On the second day, Yangming channel is affected. Yangming governs the flesh. Its pulse flanks the nose and connects to the eyes. Thus, there is body heat, eye pain, dry nose, and inability to sleep. The pulse also passes through the abdomen and back, up to the head and neck. In the hand, it corresponds to the Large Intestine; in the foot, to the Stomach. Diagnosis reveals a rapid, numerous, and floating pulse. Upon gradual pressing, it feels connected to the interior. Since Yangming is the master of tendons and sinews, and the Stomach pulse is affected, it gradually moves inward. Although the six pulses are floating and rapid, the Stomach pulse at one finger position is slightly Hong and rapid.
On the third day, Shaoyang (Lesser Yang) channel is affected. Inquiry about the pulse shows it running along the hypochondrium and connecting to the ears. Thus, there is chest and hypochondriac pain and deafness. It originates from the outer canthus, goes up to the corner of the head, and descends behind the ear. The pulse should be rapid, numerous, and smooth, reaching six or seven beats per breath cycle or more, with the Liver pulse showing slightly more rapidity. These three Yang channels being diseased belong to the exterior, so their pulses are rapid, numerous, and floating. Since they have not entered the Zang-Fu, only sweating is required.
On the fourth day, Taiyin (Greater Yin) channel is affected. The Taiyin pulse spreads in the stomach, connects to the throat, enters the stomach, goes up through the diaphragm, flanks the pharynx, connects to the root of the tongue, and disperses under the tongue. The pulse should be rapid, numerous, Hong, and large, with bone-force (depth/strength), and the Stomach pulse is slightly larger.
On the fifth day, Shaoyin (Lesser Yin) channel is affected. The direct branch of its pulse rises from the Kidney through the Liver and Diaphragm, enters the Lung, runs along the throat, and flanks the root of the tongue. Thus, there is dry mouth, dry tongue, and thirst. The pulse is most Hong and large, reaching six or seven beats per breath cycle or more. The Heart pulse is faintly palpable, coming and going uniformly.
On the sixth day, Jueyin (Terminal Yin) channel is affected. The Jueyin pulse ascends from the foot along the genitalia, reaches the lower abdomen, and pierces through the diaphragm. Thus, there is irritability, fullness, and contraction of the scrotum. The pulse is rapid, numerous, and long. If Ying and Wei (Nutritive and Defensive Qi) stop circulating among the three Yin and three Yang, five Zang and six Fu, and the five Zang become blocked, death ensues. Generally, before the third day, the three Yang channels are affected, the pulse is in the exterior, and sweating is appropriate. After the third day, the three Yin channels are affected, the pulse is in the interior, and purgation/drainage is appropriate. If after three days, the pulse is rapid, numerous, and large, with interior and exterior appearing identical, neither sweating nor purgation should be used; only resolving and unblocking medicines should be used to clear the middle.
On the first and second days, if the pulse Qi is rapid and numerous, treat with warm, acrid, dispersing medicines to induce sweating for recovery. The formula must also contain exterior-resolving agents; do not use purely hot medicines. After sweating, the pulse should be calm, soft, neither rapid nor numerous, resembling the pulse of a frail elderly person: faintly continuous upon light pressure, and faintly present without deficiency upon heavy pressure, indicating natural peace. If the rapid/numerous quality persists after sweating, it is difficult to treat. If accompanied by a Jie (Knotted) pulse, the condition becomes critical or fatal. The Jie pulse is rapid, numerous, and suspended/extreme, bead-like, but not smooth, differing from the Hua (Slippery) pulse; it flows through the fingers sequentially like drops of water starting. However, early Shanghan (day 1-2) presents with increasing chills and high fever, with a light and floating pulse. If there are no chills, but severe headache, burning body heat, red face and eyes, bursting eye vessels, constipation, and dark urine, with six pulses being Hong, large, and having bone-force, it is called Rebing (Heat Disease). Even in early stages, sweating is not induced. The treatment for Shanghan differs from Rebing only in the first one or two days.
After the third and fourth days, treat similarly to Rebing. On days one and two, if the pulse is minute, small, neither rapid nor numerous, neither floating nor scattered, but only deep, soft, and thin, the sweating medicine should be extremely warm and acrid. If the Spleen/Stomach pulse is moist and deep, it indicates cold invasion, often transforming into a Yin syndrome. Yang Du Shanghan presents with red face, headache, burning body heat, mental restlessness, dizziness, and stiff neck/back. The pulse should be Hong, large, and have bone-force.
Shanghan with irritability and constant drinking: if the pulse is solid and Hong but not rapid, it is caused by Phlegm-Toxin. If Hong and large but not solid, it indicates Heart and Spleen receiving toxin.
After Shanghan, if chills and fever have subsided but a lump remains in the abdomen, unbearable in pain, suddenly moving to the leg surface, this is residual Qi in the Liver. The pulse Qi is Hong and long; the Liver pulse flows smoothly over the left foot. Clear the blood.
On the fourth and fifth days, heat-toxin rushes upward, causing chest oppression and fullness, high fever, persistent headache, constipation, and phlegm-solidity in the chest. The pulse should be solid at Cun and Guan, while Chi is light as if absent; the Heart pulse burns upward.
Heat-toxin in the Liver causes anger, fragmented tendon/muscle pain, confusion, aversion to people, distension in both hypochondria, restless hands/feet, and inability to sleep. The right Guan pulse should be biased large, urgent, and long. Heat-toxin in the Heart causes headache, irritability, red face, stiff tongue, slow speech, sudden heart pain, vomiting, delirium, desire to run into water, and loss of spirit. The left pulse at one finger position is biased large. If the tongue is stiff and urgent, expertly needle both sides of the tongue to release bad blood; do not needle the center. Heat-toxin in the Spleen causes fragmented muscle pain, aversion to food smell, urge to vomit, whole-body fever, dry/cracked lips, pulsing at the lip margins, or cyanotic/black ring around lips. Severe cases have lower back pain, abdominal fullness, and cheek pain. The right Guan Spleen pulse at one finger position is biased large, like other pulses.
Heat-toxin in the Lungs rushes to the throat, causing chest/lung congestion and blockage, high fever, red or red-and-white face, wheezing/coughing unable to take deep breaths. The right Cun position pulse is biased large and floating.
Heat-toxin in the Kidneys causes lower back and spine pain, spinal stiffness, no headache. If thirsty and drinking frequently, severe cases have stiff neck. Feet feel cold, unwilling to speak. The pulse should be slightly light-floating and lightly tight at the left Chi position.
Shanghan, heat-toxin attacking Liver and Heart, toxin abundance rushing to Lungs, blood reversing with Qi, causing epistaxis, hematemesis, or even bleeding from ears and eyes. The pulse should be Hong, large, and flaming upward, like flowing water, opening/closing, gathering/scattering intermittently. This is a sign of blood loss. Heat-toxin internally injuring Liver and Heart, losing control of blood, toxin steaming to Lungs, blood flowing with Qi into skin, causing red macules (Ban). Whole-body high fever, heavy/headache, sleeping as if another spirit surrounds the body in confusion. The pulse is large but knotted/unresolved; heavy pressure reveals faint bone-force, like cloth wrapped tightly. This is a sign of macule eruption. Shanghan/Rebing with cough, sitting/lying wheezing/restlessness: right Cun/Guan pulse should be Hong, large, and floating-rapid. Shanghan, intense heat-toxin scorching Sanjiao, attacking skin, causing orange-yellow discoloration of the whole body. Pulse is similar to macule eruption but deeper, treated like Jaundice.
Rebing Jie Xiong (Knotting Chest) presents with anterior chest blockage, a hard lump in the chest that does not dissipate, whole-body fever, headache, dark-red face, salivation, constipation with heat, coma/unconsciousness. Resembles Fushu (Hidden Summerheat). Lung pulse should be Hong, large, with bone-force, but solid and not floating. Fushu pulse is knotted and deep.
Shanghan/Rebing on days five or six, worsening due to laxative use, passing purple-black stool, disease intensity unchanged, mental haze, lower abdominal distension, delirium, unconsciousness, possibly abdominal lumps hard and undissipated. Pulse is Jie (knotted) and Fu (deep). This is toxin attacking blood, accumulation of evil matter in abdomen. Nine out of ten die.
Yin Du Shanghan presents with cold limbs/hands/feet, blue face, colorless lips, limb weakness, internal chilling, severe cases close eyes and lose consciousness. Pulse should be minute, fine, and deep; heavy pressure reveals softness without bone-force. If Kidney pulse is minute, fine, and sinking/pulsing deeply, it is severe.