临症之际。已视其形容。观其坐卧矣。然有法焉。不拘于行住坐卧。难列于俯仰屈伸。屈指而计之。其纲有
四。曰KT KT 。曰振振。曰战。曰栗。KT KT 者何。项背强。KT KT 然。犹短羽之鸟。欲飞而不能飞也。振
振者何。身体动。振振然。若耸悚之容。欲定而不能定也。战则身为之摇矣。战之与振。振轻而战重也。栗则心为之战
矣。栗之与战。战外而栗内也。故其为病也。KT KT 者太阳实。甚则有卧不着席之形。振振者元气虚。甚则有身欲
擗地之状。战者其人本虚。邪在外而正与之争。正胜其邪。故势顺而易解。栗者其气愈微。邪入内而正与
之争。邪胜其正。故势逆而难瘳。且KT KT 者。太阳实。其证有有汗无汗之分。振振者。太阳虚。其证有汗前汗
后之辨。战在外。太阳之所属也。身温汗出。邪斯退矣。栗在内。少阴之所主也。身寒肢厥。邪则陷焉。故凡临
症之际。虽分观以审其常。必合论以通其变。盖不但不知其法者。不可为医。即知其法而泥于法。或知其
法而离于法。亦皆不可为医也。经曰。能合色脉。可以万全。斯诚活法也已。
望诊之法。既观身体视形容矣。然有时虽见于身体之外。实着于意态之间。又当存心省察。以诊其病焉。
析而言之。有因人之好恶者。有因时之寒暑者。有因体之寒热者。何谓因人之好恶。五十一难曰。病有欲
得温者。有欲得寒者。有欲见人者。有欲不见人者。而各不同。病在何脏腑也。然病欲得寒而欲见人者。病
在腑也。病欲得温而不欲见人者。病在脏也。何以言之。腑者阳也。阳病欲得寒。又欲见人。脏者阴也。阴病
欲得温。又欲闭户独处。恶闻人声。故别知脏腑之病也。是盖以寒热分阴阳。以阴阳分脏腑也。推之于喜
明属阳者。元气实。喜暗属阴者。元气虚。以及喜热饮寒饮。恶热饮寒饮。可广其好恶之意也。何谓因时之
寒暑。伤寒论曰。夏月盛热。欲着复衣。冬月盛寒。欲裸其身。所以然者。阳微则恶寒。阴弱则发热。此医发其
汗。令阳气微。又大下之。令阴气弱。五月之时。阳气在表。胃中虚冷。以阳气内微。不能胜冷。故欲着复衣。十
一月之时。阳气在里。胃中烦热。以阴气内弱。不能胜热。故欲裸其身。推之于夏月恶热者。知其阳气胜。冬
月恶寒者。知其阴气胜。以及春秋之恶寒恶热。喜寒喜热。可广其寒暑之意也。何谓因体之寒热。伤寒论
曰。病患身大热。反欲得近衣被者。热在皮肤。寒在骨髓也。身大寒。反不欲近衣被者。寒在皮肤。热在骨髓
也。推之于身热不欲近衣被者。则知骨髓不寒。身寒欲近衣被者。则知骨髓不热。以及外无寒热。欲近衣
被者。骨髓寒。外无寒热。不欲近衣被者。骨髓热。而凡衣多恶热。衣少畏寒之常。衣少恶热。衣多恶寒之变。
亦可广其寒热之意也。是皆见于意态之间。着于身体之外。可不存心省察。以诊其病欤。
医书汗牛充栋。何须祸枣灾梨。然余有不能已于言者。何则。炎黄之书。其旨深远。汉晋之书。其文缺
略。医家因陋就简。遂推趋时者为大名家。病家闻誉即延。亦信趋时者为真实学。自是术愈疏。方愈
乱。病不至死。而医死之。医不欲误。而书误之。安得岐黄复起。明其道以辨其非耶。是用忘其狂瞽。着
述遵经。非惟欲医家以是诊病。亦欲病家以是试医。且不欲医病之家以是遵我。亦欲医病之家以
是遵经。果尔。则虽祸枣灾梨。或未必无小补。
在临诊时，已经观察了患者的容貌形态，查看了其坐卧姿态。然而其中仍有法则，并不局限于行、住、坐、卧，也难以简单列举于俯、仰、屈、伸之中。屈指计算起来，其纲领主要有四种：一是拘挛（KT KT，指身体拘急不舒），二是振颤（振振，指身体震颤动摇），三是战栗（战，指剧烈颤抖），四是恐惧战栗（栗，指内心惊恐颤抖）。
什么是拘挛？即项背强直，拘挛然的样子，就像羽翼短小的鸟，想飞却飞不起来一样。什么是振颤？即身体动摇，振振然的样子，像是惊惧惶恐的神态，想要安定却无法安定。所谓“战”，是身体随之摇动。“战”与“振”相比，振较轻而战较重。所谓“栗”，是内心为之惊恐颤抖。“栗”与“战”相比，战表现于外而栗表现于内。
因此，它们所对应的病证是：拘挛属于太阳实（太阳经受邪且正气未虚的实证），严重时甚至有卧床时背部不着席的形态；振颤属于元气虚（人体根本之气虚弱），严重时甚至有身体想要扑向地面的状态；战是因为患者本体本虚，邪气在外而正气与之抗争，若正气战胜邪气，则病情顺遂而易解；栗是因为患者正气更加微弱，邪气入内而正气与之抗争，若邪气战胜正气，则病情逆乱而难愈。
况且，拘挛属于太阳实，其证候有有汗和无汗的区别；振颤属于太阳虚（太阳经气虚弱），其证候有发汗前和发汗后的辨别；战表现于外，归属于太阳经，若身体温暖并出汗，邪气即可退去；栗表现于内，由少阴（心肾）所主，若身体寒冷、四肢厥冷，邪气则已陷入体内。所以大凡临诊时，虽然要分开观察以审视其常态，但必须综合论述以通晓其变化。大概不仅是不懂这些法则的人不能做医生，即使是懂得这些法则却拘泥于法则，或者懂得法则却脱离法则的人，也都不能做医生。《内经》说：“能结合面色和脉象进行诊断，就可以万无一失。”这确实是灵活运用的方法啊。
望诊的方法，既然已经观察了身体形态和容貌，然而有时虽然表现在身体之外，实则体现在意态之间，又应当用心省察，以此来诊断疾病。
分析来说，有因个人喜好不同而表现的，有因季节寒暑不同而表现的，有因体质寒热不同而表现的。
什么叫因个人喜好不同？《难经·五十一难》说：“有的病人喜欢温暖，有的喜欢寒冷；有的希望见人，有的不希望见人。”而且各不相同，病在哪个脏腑呢？然而，病人喜欢寒冷且希望见人的，病在腑；病人喜欢温暖而不希望见人的，病在脏。为什么这样说？腑属阳，阳病喜欢寒冷，又喜欢见人；脏属阴，阴病喜欢温暖，又喜欢关上门独自居住，厌恶听到人声。所以可以分别知晓是脏病还是腑病。这大概是以寒热来区分阴阳，以阴阳来区分脏腑。推而广之，喜欢明亮属于阳，说明元气实；喜欢昏暗属于阴，说明元气虚。以及喜欢热饮或冷饮，厌恶热饮或冷饮，都可以推广这种好恶之意来判断病情。
什么叫因季节寒暑不同？《伤寒论》说：“夏天天气炎热，病人却想穿厚衣服；冬天天气严寒，病人却想裸露身体。”之所以这样，是因为阳气微弱则怕冷，阴气虚弱则发热。这是因为医生发了汗，导致阳气微弱；又大用泻下法，导致阴气虚弱。在五月的时候，阳气在体表，胃中虚冷，因为阳气内部微弱，不能抵御寒冷，所以想穿厚衣服。在十一月的时候，阳气在体内，胃中烦热，因为阴气内部虚弱，不能抵御热邪，所以想裸露身体。推而广之，夏天怕热的，知道是阳气胜；冬天怕冷的，知道是阴气胜。以及春秋两季怕冷或怕热，喜寒或喜热，都可以推广这种寒暑之意来判断病情。
什么叫因体质寒热不同？《伤寒论》说：“病人身体大热，反而想要靠近衣被的，是热在皮肤，寒在骨髓；身体大寒，反而不想要靠近衣被的，是寒在皮肤，热在骨髓。”推而广之，身体热而不想要靠近衣被的，就知道骨髓不寒；身体寒而想要靠近衣被的，就知道骨髓不热。以及外表没有明显的寒热感觉，但想要靠近衣被的，是骨髓寒；外表没有明显的寒热感觉，却不想要靠近衣被的，是骨髓热。而凡是衣服多却怕热、衣服少却怕冷的常理，以及衣服少却怕热、衣服多却怕冷的变局，也可以推广这种寒热之意来判断病情。这些都是表现在意态之间，体现于身体之外的，怎能不用心省察，以此来诊断疾病呢？
医书多得汗牛充栋，何必再增加书籍的数量（祸枣灾梨，指刻印书籍耗费木材，此处谦辞，意为不必再多著书立说）。然而我有所不能沉默不言的。为什么呢？炎黄时代的医书，旨意深远；汉晋时代的医书，文字多有缺略。医家因循守旧、简陋简化，于是推崇那些迎合时俗的人为著名大家。病患听到声誉就延请，也相信那些迎合时俗的人是真正的学问。从此医术越来越疏漏，方剂越来越混乱。病还没到死的地步，却被医生治死了；医生不想误人，却是书籍误导了医生。怎么能期待岐伯、黄帝复活，阐明正道以辨明谬误呢？因此我忘却了自己的狂妄浅陋，撰写此书遵循经典。不仅希望医家以此诊断疾病，也希望病患以此检验医生；不仅希望医患之家以此遵循我的观点，更希望医患之家以此遵循经典。果真如此，那么即使增加书籍数量，或许也不无小补。
During clinical practice, one has already observed the patient's appearance and posture, as well as their sitting and lying positions. However, there are principles involved that are not strictly confined to walking, standing, sitting, or lying down, nor can they be simply listed under bending, extending, leaning forward, or backward. Counting them up, the main categories are four: first, stiffness and spasm (Jujin, referring to bodily rigidity and discomfort); second, tremor (Zhenzhen, referring to bodily shaking and trembling); third, shivering (Zhan, referring to violent trembling); and fourth, fearful trembling (Li, referring to inner fear and trembling).
What is stiffness and spasm? It refers to rigidity of the neck and back, appearing stiff and spasmodic, like a bird with short wings that wishes to fly but cannot. What is tremor? It refers to bodily movement, appearing shaky, resembling an expression of alarm and dread, wishing to stabilize but unable to do so. "Shivering" (Zhan) involves the body shaking. Compared to tremor, shivering is more severe. "Fearful trembling" (Li) involves the heart being frightened. Compared to shivering, shivering manifests externally while fearful trembling manifests internally.
Therefore, the diseases associated with them are as follows: Stiffness and spasm belong to Taiyang Excess (a syndrome of excess pathogenic factors in the Taiyang channel), and in severe cases, may present with a form where the back does not touch the bed when lying down. Tremor belongs to Yuanqi Deficiency (deficiency of the primordial Qi), and in severe cases, may present with a sensation that the body wants to collapse to the ground. Shivering occurs because the person is originally deficient; the pathogen is external and the righteous Qi struggles against it. If the righteous Qi overcomes the pathogen, the condition is favorable and easy to resolve. Fearful trembling occurs because the Qi is even more depleted; the pathogen has entered internally and the righteous Qi struggles against it. If the pathogen overcomes the righteous Qi, the condition is adverse and difficult to cure.
Moreover, stiffness and spasm belong to Taiyang Excess, and the symptoms may present with or without sweating. Tremor belongs to Taiyang Deficiency (deficiency of Qi in the Taiyang channel), and the symptoms require differentiation between before and after sweating. Shivering manifests externally and is associated with the Taiyang channel; if the body is warm and sweating occurs, the pathogen will retreat. Fearful trembling manifests internally and is governed by Shaoyin (Heart and Kidney); if the body is cold and the limbs are cold, the pathogen has sunk inward. Thus, in clinical practice, although one must observe separately to understand the normal patterns, one must also discuss comprehensively to grasp the variations. Generally speaking, those who do not know these methods cannot be physicians; even those who know them but adhere rigidly to them, or those who know them but deviate from them, also cannot be physicians. The Classic says, "If one can combine the observation of complexion and pulse, one can achieve perfection." This is indeed the method of flexible application.
The methods of inspection have already covered the observation of the body and appearance. However, sometimes what appears on the outside of the body actually resides in the demeanor and mental state. One must pay close attention and examine carefully to diagnose the disease.
Analyzing this, there are manifestations due to individual preferences, those due to seasonal cold and heat, and those due to constitutional cold and heat.
What is meant by individual preferences? The *Nan Jing* (Classic of Difficult Issues), Chapter 51, states: "Some patients desire warmth, some desire cold; some wish to see people, some wish not to see people." These vary, indicating which Zang-Fu organ is diseased. If a patient desires cold and wishes to see people, the disease is in the Fu organs. If a patient desires warmth and wishes not to see people, the disease is in the Zang organs. Why is this? Fu organs belong to Yang; Yang diseases desire cold and wish to see people. Zang organs belong to Yin; Yin diseases desire warmth and wish to stay indoors alone, disliking human voices. Thus, one can distinguish between Zang and Fu diseases. This essentially uses cold and heat to differentiate Yin and Yang, and Yin and Yang to differentiate Zang and Fu. Extending this logic, a preference for brightness belongs to Yang, indicating solid Yuanqi; a preference for darkness belongs to Yin, indicating deficient Yuanqi. Similarly, preferences for hot or cold drinks, and aversions to them, can broaden the understanding of these preferences to assess the condition.
What is meant by seasonal cold and heat? The *Shanghan Lun* (Treatise on Cold Damage) states: "In summer, when heat is intense, the patient desires to wear thick clothes; in winter, when cold is intense, the patient desires to expose their body." The reason is that weak Yang leads to aversion to cold, and weak Yin leads to fever. This often results from improper treatment: excessive sweating depletes Yang Qi, and harsh purging depletes Yin Qi. In the fifth month, Yang Qi is on the exterior, and the Stomach is cold and empty internally. Because internal Yang is weak and cannot overcome the cold, the patient desires thick clothes. In the eleventh month, Yang Qi is inside, and the Stomach is烦热 (hot and restless). Because internal Yin is weak and cannot overcome the heat, the patient desires to expose their body. Extending this, aversion to heat in summer indicates strong Yang; aversion to cold in winter indicates strong Yin. Preferences for cold or heat in spring and autumn can similarly expand the understanding of seasonal influences.
What is meant by constitutional cold and heat? The *Shanghan Lun* states: "If a patient has high fever but desires to be near clothing and bedding, the heat is superficial, and the cold is deep in the marrow. If a patient has low body temperature but does not desire to be near clothing and bedding, the cold is superficial, and the heat is deep in the marrow." Extending this, if the body is hot and the patient does not desire clothing/bedding, the marrow is not cold. If the body is cold and the patient desires clothing/bedding, the marrow is not hot. Furthermore, if there is no obvious external cold or heat sensation, but the patient desires clothing/bedding, the marrow is cold. If there is no obvious external cold or heat sensation, but the patient does not desire clothing/bedding, the marrow is hot. Common patterns include wearing many clothes yet fearing heat, or wearing few clothes yet fearing cold. Variations include wearing few clothes yet fearing heat, or wearing many clothes yet fearing cold. These can all broaden the understanding of constitutional thermal states. All these manifest in demeanor and appear on the body surface; how can one fail to pay close attention and examine them to diagnose the disease?
Medical books are numerous enough to make oxen sweat and fill barns with pears and dates (a metaphor for excessive publishing). Why add more? Yet I cannot remain silent. Why? Medical texts from the times of Yan and Huang have profound meanings; those from the Han and Jin dynasties are often incomplete. Physicians, relying on simplicity and convention, promote those who follow trends as famous masters. Patients, hearing of their reputation, hire them, believing them to possess true learning. Consequently, medical skills become more negligent, and prescriptions more chaotic. Diseases do not lead to death, but doctors do. Doctors do not intend to err, but books mislead them. How can we expect Qi Bo and Huang Di to rise again to clarify the correct way and refute errors? Therefore, disregarding my own arrogance and ignorance, I wrote this book following the Classics. Not only do I hope physicians will use it to diagnose diseases, but also that patients will use it to test physicians. I do not merely want medical families to follow my views, but to follow the Classics. If this happens, then even adding to the volume of books may offer some small benefit.