异气者，为先病未已，又感别异之气也。两邪相合，变为他病，脉阴阳俱盛者，伤寒之脉也。《难经》曰∶伤
寒之脉，阴阳俱盛而紧涩。经曰∶脉盛身寒，得之伤寒，则为前病热未
已，再感于寒，寒热相搏，变为温疟。
阳脉浮滑，阴脉濡弱者，更遇于风，变为风温。
此前热未歇，又感于风者也。《难经》曰∶中风之脉，阳浮而滑，阴濡而弱，风来乘热，故变风温。
阳脉洪数，阴脉实大者，（赵本有“更”字）遇温热，变为温毒。温毒为病最重也。
此前热未已，又感温热者也。阳主表，阴主里，洪数实大皆热也，两热相合，变为温毒。以其表里俱热，
故为病最重。
阳脉濡弱，阴脉弦紧者，更遇温气，变为温疫。（赵本注∶“一本作疟”）以此冬伤于寒，发为温病，
脉之变证，方治如说。
此前热未已，又感温气者也。温热相合，变为温疫。
凡人有疾，不时即治，隐忍冀瘥，以成痼疾。
凡觉不佳，急须求治，苟延时日，则邪气入深，难可复制。《千金》曰∶凡有少苦，似不如平常，即须
早道；若隐忍不治，冀望自瘥，须臾之间，以成痼疾，此之谓也。
小儿女子，益以滋甚。
小儿气血未全，女子血室多病，凡所受邪，易于滋蔓。
时气不和，盒饭早言，寻其邪由，及在腠理，以时治之，罕有不愈者。
腠理者，津液腠泄之所，文理缝会之中也。《金匮要略》曰∶腠者，是三焦通会元真之处，为血气所注；
理者，是皮肤脏腑之文理也。邪客于皮肤，则邪气浮浅，易为散发，若以时治之，罕有不愈者矣。《金匮玉
函》曰∶主（医统本作“生”）候长存，形色未病，未入腠理，针药及时，服将调节，委以良医，病无不愈。
患人忍之，数日乃说，邪气入脏，则难可制，此为家有患，备虑之要。
邪在皮肤，则外属阳而易治；邪传入里，则内属阴而难治。《内经》曰∶善治者，治皮毛，其次治肌肤，
其次治筋脉，其次治六腑，其次治五脏。治五脏者，半死，半生也。昔桓侯怠于皮
肤之微疾，以至骨髓之病，家有患者，可不备虑。
凡作汤药，不可避晨夜，觉病须臾，即宜便治，不等早晚，则易愈矣。
《千金》曰∶凡始觉不佳，即须治疗，迄至于病，汤食竞进，折其毒势，自然而瘥。
若（赵本作“如”）或瘥迟，病即传变，虽欲除治，必难为力。
传有常也，变无常也。传为循经而传，此太阳传阳明是也；变为不常之变，如阳证变阴证是也。邪既传
变，病势深也。《本草》曰∶病势已成，可得半愈；病势已过，命将难全。
服药不如方法，纵意违师，不须治之。
《内经》曰∶拘于鬼神者，不可与言至德；恶于针石者，不可与言至巧。病不许治者，病必不治，
治之无功矣。
凡伤寒之病，多从风寒得之。
凡中风与伤寒为病，自古通谓之伤寒。《千金》曰∶夫伤寒病者，起自风寒，入于腠理，与精气分争，
荣卫偏隔，周身不通而病。
始表中风寒，入里则不消矣。
始自皮肤，入于经络，传于脏腑是也。
未有温覆而当，不消散者。
风寒初客于皮肤，便投汤药，温暖发散而当者，则无不消散之邪。
不在证治，拟欲攻之，犹当先解表，乃可下之。
先解表而后下之，则无复传之邪也。
若表已解，而内不消，非大满，犹生寒热，则病不除。
表证虽罢，里不至大坚满者，亦未可下之。是邪未收敛成实，下之则里虚而邪复不除，犹生寒热也。
若表已解，而内不消，大满大实，坚有燥屎，自可
除下之。虽四五日，不能为祸也。
外无表证，里有坚满，为下证悉具。《外台》云∶表和里病，下之则愈。下证既具，则不必拘于日数。
若不宜下，而便攻之，内虚热入，协热遂利，烦躁诸变，不可胜数，轻者困笃，重者必死矣。
下之不当，病轻者，证犹变易而难治，又矧重者乎。
夫阳盛阴虚，汗之则死，下之则愈；阳虚阴盛，汗之则愈，下之则死。
表为阳，里为阴。阴虚者，阳必凑之，阳盛之邪，乘其里虚而入于腑者，为阳盛阴虚也。经曰∶尺脉弱，
名曰阴不足。阳气下陷入阴中，则发热者是矣。下之，除其内热而愈，若反汗
之，则竭其津液而死。阴脉不足，阳往从之；阳脉不足，阴往乘之。阴邪乘其表虚，客于荣卫之中者，为阳虚
阴盛也。经曰∶假令寸口脉微，名曰阳不足。阴气上入阳中，则洒淅恶寒者是矣。汗之，散其表寒则愈，若
反下之，则脱其正气而死。经曰∶本发汗而复下之，此为逆也。本先下之，而反汗之为逆。
夫如是，则神丹安可以误发，甘遂何可以妄攻。虚盛之治，相背千里，吉凶之机，应若影响，岂容易哉！
神丹者，发汗之药也。甘遂者，下药也。若汗下当则吉，汗下不当则凶，其应如影随形，如附应声。
况桂枝下咽，阳盛则（赵本作“即”）毙；承气入胃，阴盛以亡。
桂枝汤者，发汗药也。承气汤者，下药也。《金匮玉函》曰∶不当汗而强与汗之者，令人夺其津液，枯
槁而死；不当下而强与下之者，令人开肠洞泄，便溺不禁而死。
死生之要，在乎须臾，视身之尽，不暇计日。
投汤不当，则灾祸立见，岂暇计其日数哉。
此阴阳虚实之交错，其候至微；发汗吐下之相反，其祸至速，而医术浅狭，懵然不知病源，为治乃误，使
病者殒殁，自谓其分，至今（医统本作“令”）冤魂塞于冥路，死尸盈于旷野，仁者鉴此，岂不痛欤！凡
两感病俱作，治有先后，发表攻里，本自不同，而执迷妄（赵本作“用”）意者，乃云神丹、甘遂，合而饮
之，且解其表，又除其里，言巧似是，其理实违。夫智者之举错也，常审以慎；愚者之动作也，必果而速。
安危之变，岂可诡哉！世上之士，但务彼翕习之荣，而莫见此倾危之败，惟明者，
居然能护其本，近取诸身，夫何远之有焉。
两感病俱作，欲成不治之疾，医者大宜消息，审其先后，次第而治之；若妄意攻治，以求速效者，必
致倾危之败。
凡发汗温服（赵本作“暖”）汤药，其方虽言日三服，若病剧不解，当促其间，可半日中尽三服。若与
病相阻，即便有所觉。重病（赵本作“病重”）者，一日一夜，当 时观之，如服一剂，病证犹在，故当复
作本汤服之。至有不肯汗出，服三剂乃解；若汗不出者，死病也。
发汗药，须温暖服者，易为发散也。日三服者，药势续也。病势稍重，当促急服之，以折盛热，不可拘于
本方。设药病不相对，汤入即便知之，如阴多者，投以凉药，即寒逆随生；阳多
者，饮以温剂，则热毒即起，是便有所觉。 时者，周时也，一日一夜服汤药尽剂，更看其传，如病证犹在，
当复作本汤，以发其汗；若服三剂不解，汗不出者，邪气大甚，汤不能胜，必成大
疾。《千金》曰∶热病脉躁盛而不得汗者，此阳脉之极也，死。
凡得时气病，至五六日，而渴欲饮水，饮不能多，不当与也，何者？以腹中热尚少，不能消之，便更与人
作病也。至七八日，大渴，欲饮水者，犹当根据证（赵本有“而”字）与之。与之常令不足，勿极意也。言能（
医统本作“欲”）饮一斗，与五升。若饮而腹满，小便不利，若喘若哕，不可与之。（赵本有“也”字）忽
然大汗出，是为自愈也。
热在上焦，则为消渴，言热消津液，而上焦干燥，则生渴也。大热则能消水，热少不能消之，若强饮，
则停饮变为诸病。至七八日阳胜气温，向解之时，多生大渴也，亦须少少与之，以润胃气，不可极意饮也。
若饮而腹满，小便不利，若喘若哕者，为水饮内停而不散，不可更与之。忽然阳气通，水气散，先发
于外，作大汗而解。
凡得病，反能饮水，此为欲愈之病。其不晓病者，但闻病饮水自愈，小渴者，乃强与饮之，因成其祸，不
可复数。（赵本有“也”字）
小渴者，为腹中热少。若强与水，水饮不消，复为诸饮病也。
凡得病厥，脉动数，服汤药更迟；脉浮大减小；初躁后静，此皆愈证也。
动数之脉，邪在阳也，汤入而变迟者，阳邪愈也。浮大之脉，邪在表也，而复减小者，表邪散也。病初躁
乱者，邪所烦也，汤入而安静者，药胜病也。是皆为愈证。
凡治温病，可刺五十九穴。
五十九穴者，以泻诸经之温热。《针经》曰∶热病，取之诸阳五十九穴，刺，以泻其热，而出其汗；实
其阴，而补其不足。所谓五十九刺，两手内外侧各三，凡十二 ；五指间各一，凡八
；足亦如是；头入发际一寸，旁三分，各三，凡六 ；更入发三寸，边五，凡十 ；耳前后、口下，各一，
项中一穴，凡六 ；巅上一、囟会一、发际一、廉泉一、风池二、天柱二。又《内经》曰∶
热俞五十九，头上五行。行五者，以泻诸阳之热逆也。大杼、膺俞、缺盆、背俞，此八者，以泻胸中之热也；
气冲、（熊校记∶各本同。按素问作气街）三里、巨虚、上下廉，此八者，以泻胃中之热也；云门、 骨、委
中、髓空，此八者，以泻四肢之热也；五脏俞旁五，此十者，以泻五脏之热也。凡此五十九穴者，皆热之左右也。
又身之穴，三百六十有五，其三十九（赵本无“九”字）穴，灸之有害；七十九穴，刺之为灾。并中髓也。
穴有三百六十五，以应一岁。其灸刺之禁，皆肉薄骨解之处，血脉虚少之分，针灸并中髓也。
凡（赵本无“凡”字）脉四损，三日死。平人四息，病患脉一至，名曰四损。脉五损，一日死。平人
五息，病患脉一至，名曰五损。脉六损，一时死。平人六息，病患脉一至，名曰六损。
四脏气绝者，脉四损；五脏气绝者，脉五损；五脏六腑俱绝者，脉六损。
脉盛身寒，得之伤寒；脉虚身热，得之伤暑。
《内经》曰∶脉者，血之府也。脉实血实，脉虚血虚。寒则伤血，邪并于血，则血盛而气虚，故伤
寒者，脉盛而身寒。热则伤气，邪并于气，则气盛而血虚，故伤暑者，脉虚而身热。
脉阴阳俱盛，大汗出，不解者，死。
脉阴阳俱盛，当汗出而解；若汗出不解，则邪气内胜，正气外脱，故死。《内经》曰∶汗出，而脉
尚躁盛者，死。《千金》曰∶热病已得汗，脉尚躁盛，此阳脉之极也，死。
脉阴阳俱虚，热不止者，死。
脉阴阳俱虚者，真气弱也；热不止者，邪气胜也。《内经》曰∶病温虚甚者，死。
脉至乍疏乍数（赵本作“乍数乍疏”）者，死。
为天真荣卫之气断绝也。
脉至如转索者，（赵本无“者”字）其日死。
为紧急而不软，是中无胃气，故不出其日而死。
谵言妄语，身微热，脉浮大，手足温者，生。逆冷，脉沉细者，不过一日，死矣。
谵言妄语，阳病也。身微热，脉浮大，手足温，为脉病相应；若身逆冷，脉沉细，为阳病见阴脉，脉
病不相应，故不过一日而死。《难经》曰∶脉不应病，病不应脉，是为死病。
此以前是伤寒热病证候也。
异气，是指先患某种疾病尚未痊愈，又感染了另一种不同的邪气。两种邪气相结合，转化为其他病证。如果脉象寸关尺三部都盛大，这是伤寒的脉象。《难经》说：伤寒的脉象，阴阳两部都盛大且紧涩。医经说：脉象盛大而身体发冷，是得了伤寒，这是因为之前的病热尚未消退，再次感受寒邪，寒热相互搏结，转化为温疟。
如果阳脉（寸脉）浮滑，阴脉（尺脉）濡弱，这是又感受了风邪，转化为风温。这是之前的热病未愈，又感受风邪所致。《难经》说：中风的脉象，阳部浮而滑，阴部濡而弱，风邪趁着热势侵袭，所以转化为风温。
如果阳脉洪数，阴脉实大（赵本有“更”字），这是又感受了温热之邪，转化为温毒。温毒这种病是最严重的。这是之前的热病未愈，又感受温热之邪所致。阳主表，阴主里，洪、数、实、大都是热象，两热相合，就转化为温毒。因为表里俱热，所以病情最重。
如果阳脉濡弱，阴脉弦紧，这是又感受了温气，转化为温疫。（赵本注：另一版本作“疟”）。这是因为冬天受了寒邪，后来发为温病，脉象的变化和证候，治疗方法如前所述。这是之前的热病未愈，又感受温气所致。温热相合，就转化为温疫。
大凡人有疾病，如果不及时治疗，隐忍希望自愈，就会形成顽固难治的疾病。
凡是觉得身体不适，必须立即求医，如果拖延时日，邪气就会深入体内，难以再治愈。《千金方》说：凡是有一点不舒服，感觉不如平常，就必须尽早告知医生；如果隐忍不治疗，希望它自己好，片刻之间，就会变成顽固疾病，说的就是这个道理。
小儿和女子，病情会更加严重。
小儿气血尚未完全发育，女子血室容易生病，凡是受到的邪气，容易蔓延扩散。
时气不和，应当尽早诊治，寻找邪气的来源，当邪气还在腠理（皮肤纹理及肌肉间隙）时，按时进行治疗，很少有不痊愈的。
腠理，是津液排泄的地方，也是皮肤纹理交汇之处。《金匮要略》说：腠，是三焦通会元气真精的地方，是血气灌注之处；理，是皮肤和脏腑的纹理。邪气客居在皮肤，则邪气浮浅，容易发散，如果按时治疗，很少有不痊愈的。《金匮玉函》说：只要生命体征尚存，面色形态没有病变，邪气尚未进入腠理，及时使用针灸药物，服用并调理，委托给良医，病没有不愈的。
病人忍耐不就医，过了几天才说，邪气传入五脏，就很难控制了，这是家中有人患病，需要防备考虑的关键。
邪气在皮肤，则外属阳而容易治疗；邪气传入体内，则内属阴而难治。《内经》说：善于治疗的医生，在皮毛阶段就治疗，其次治疗肌肤，其次治疗筋脉，其次治疗六腑，其次治疗五脏。治疗五脏的病，一半能治好，一半治不好。从前齐桓侯轻视皮肤的微小疾病，以至于发展到骨髓的病，家里有人患病，怎能不加以防备考虑呢？
凡是配制汤药，不要避开早晨或夜晚，发觉有病片刻，就应该立即治疗，不等早晚，这样容易痊愈。
《千金方》说：凡是刚开始觉得身体不适，就必须治疗，直到病愈，汤药饮食连续进用，以挫败毒势，自然就会痊愈。
如果病愈得慢，病势就会传变，虽然想要去除治疗，也一定难以奏效。
传变是有规律的，变化是无常的。传是沿着经络传变，比如太阳病传阳明病就是；变是不寻常的变化，比如阳证变为阴证就是。邪气既然传变，病势就深重了。《本草》说：病势已经形成，只能治好一半；病势已经过去，性命将难保全。
服药如果不按方法，随心所欲违背医嘱，就不必再治疗了。
《内经》说：拘泥于鬼神的人，不可以跟他谈论高深的医德；厌恶针石的人，不可以跟他谈论高超的技巧。病人不允许治疗的，病一定治不好，治疗也不会有效果。
大凡伤寒的病，多从风寒得来。
大凡中风与伤寒致病，自古以来通称为伤寒。《千金方》说：所谓伤寒病，起自风寒，侵入腠理，与精气抗争，营卫运行偏隔，周身不通畅而发病。
开始是表受风寒，入里后就不能自行消散了。
没有保暖得当而不能消散的。
风寒初客于皮肤，就投用汤药，温暖发散得当的，就没有不能消散的邪气。
不在证候治疗范围内，打算攻下，还应当先解表，然后才可以攻下。
如果表证已解，但内部邪气未消，如果不是大满实证，仍然产生寒热，那么病就不能消除。
表证虽然解除，但里证不至于大坚满的，也不可以攻下。这是邪气尚未收敛成实，攻下则里虚而邪气仍不除，仍然会产生寒热。
如果表证已解，但内部邪气未消，出现大满大实，坚硬有燥屎，自然可以攻下。即使过了四五天，也不会造成祸害。
外部没有表证，内部有坚满，是攻下的证候全部具备。《外台秘要》说：表和解除了，里有病，攻下就能痊愈。攻下的证候既然具备，就不必拘泥于日数。
如果不适合攻下，却便去攻伐，导致内虚热入，协热下利，烦躁等各种变证，数不胜数，轻者困顿危重，重者必然死亡。
攻下不当，病轻的，证候还会变化而难治，何况病重的呢？
如果是阳盛阴虚，发汗则死，攻下则愈；如果是阳虚阴盛，发汗则愈，攻下则死。
表为阳，里为阴。阴虚者，阳邪必定凑集，阳盛的邪气，乘其里虚而入于腑的，叫做阳盛阴虚。医经说：尺脉弱，名叫阴不足。阳气下陷入阴中，就会发热，就是这种情况。攻下，除去内热而痊愈，如果反而发汗，就会耗竭津液而死。阴脉不足，阳往随从；阳脉不足，阴往乘袭。阴邪乘其表虚，客居于营卫之中的，叫做阳虚阴盛。医经说：假如寸口脉微，名叫阳不足。阴气上入阳中，就会洒淅恶寒，就是这种情况。发汗，散其表寒则痊愈，如果反而攻下，就会脱失正气而死。医经说：本来该发汗却反而攻下，这叫逆治。本来应先攻下却反而发汗，这也叫逆治。
像这样，那么神丹怎么可以误用发汗，甘遂怎么可以妄用攻下。虚实的治法，相差千里，吉凶的机兆，应验如同影随形、声应响，难道能轻易对待吗！
神丹，是发汗的药。甘遂，是攻下的药。如果汗下得当则吉，汗下不当则凶，其应验如同影随形、声应响。
况且桂枝汤咽下，阳盛则（赵本作“即”）毙命；承气汤入胃，阴盛则亡。
桂枝汤，是发汗药。承气汤，是攻下药。《金匮玉函》说：不该发汗而强行发汗的，使人夺去津液，干枯而死；不该攻下而强行攻下的，使人肠穿洞泄，大小便失禁而死。
生死的关键，在于须臾之间，看生命的终结，无暇计算日数。
投药不当，灾祸立刻显现，哪里有空闲计算日数呢。
这是阴阳虚实交错，其征候极其微妙；发汗、吐、下方法的相反，其祸害极其迅速，而医术浅陋狭窄，糊涂不知病源，治疗乃致错误，使病人死亡，自以为命中注定，至今冤魂塞满冥路，死尸布满旷野，仁爱的人看到这些，难道不痛心吗！大凡两感病同时发作，治疗有先后顺序，发表攻里，本来不同，而执迷狂妄的人，却说神丹、甘遂，混合饮用，既解其表，又除其里，言辞巧妙似是而非，其理实则违背。聪明人的举动，常常审慎而谨慎；愚者的动作，必定果断而快速。安危的变化，岂可欺诈啊！世上的士人，只追求那种聚集学习的荣耀，而看不到这种倾覆失败的败局，只有明智的人，居然能保护其根本，就近取譬于自身，有什么远的呢？
两感病同时发作，想成为不治之疾，医者非常应该仔细斟酌，审察先后，次第治疗；如果妄意攻治，以求速效，必然导致倾覆失败的败局。
凡是发汗，温服汤药，虽然方子说一天服三次，如果病重不解，应当缩短服药间隔，可以在半天内服完三剂。如果药性与病邪相抵触，立刻就会有感觉。重病者，一天一夜，应当时时观察，如果服完一剂，病证仍在，所以应当再服原来的汤药。甚至有不肯出汗，服了三剂才解；如果不出汗的，是死病。
发汗药，必须温暖服用的，容易发散。一天服三次，是为了药势连续。病势稍重，应当催促急服，以挫败盛热，不可拘泥于原方。假设药与病不相适应，汤药入口立刻就知道，比如阴多的人，投以凉药，寒逆随即产生；阳多的人，饮以温剂，热毒即刻兴起，这就是有所感觉。时，指周时，一天一夜服完汤药一剂，再看其传变，如果病证仍在，应当再服原来的汤药，以发其汗；如果服了三剂不解，不出汗的，邪气大甚，汤药不能胜任，必然成大疾。《千金方》说：热病脉躁盛而不得汗的，这是阳脉的极点，死。
大凡得时气病，到了五、六天，口渴想喝水，但不能多喝，不应当给他喝，为什么呢？因为腹中热还少，不能消化，便再给人带来病患。到了七、八天，大渴，想喝水的，还应当根据证候给他喝。给他喝时要经常让他感到不足，不要让他喝得太饱。说能喝一斗，只给五升。如果喝了之后腹满，小便不利，或者喘或者哕，不应当给他喝。（赵本有“也”字）忽然大汗出，这是自愈。
热在上焦，则为消渴，说热消耗津液，而上焦干燥，则生渴。大热能消水，热少不能消，如果强饮，则停饮变为各种病。到了七、八天阳胜气温，向愈之时，多生大渴，也必须少量给予，以润胃气，不可刻意让其喝足。
如果喝了之后腹满，小便不利，或者喘或者哕的，是水饮内停而不散，不可以再给他喝。忽然阳气通，水气散，先发于外，作大汗而解。
大凡得病，反而能喝水，这是将要痊愈的病。那些不懂病的人，只听说病饮水自愈，小渴的时候，就强行给他喝，因而造成祸患，不可复数。（赵本有“也”字）
小渴，是因为腹中热少。如果强行给水，水饮不消，又变成各种饮病。
大凡得病厥，脉动数，服汤药后脉更迟；脉浮大减小；初躁后静，这些都是痊愈的征象。
动数的脉，邪在阳，汤药进入后变迟，说明阳邪愈。浮大的脉，邪在表，而又减小的，说明表邪散。病初躁乱，是邪气烦扰，汤药进入后安静，是药胜病。这些都是痊愈的征象。
大凡治疗温病，可以刺五十九穴。
五十九穴，是用来泻诸经的温热。《针经》说：热病，取诸阳五十九穴，刺，以泻其热，而出其汗；实其阴，而补其不足。所谓五十九刺，两手内外侧各三，共十二穴；五指间各一，共八穴；足部也是如此；头入发际一寸，旁开三分，各三，共六穴；再入发三寸，边五，共十穴；耳前后、口下，各一，项中一穴，共六穴；巅上一、囟会一、发际一、廉泉一、风池二、天柱二。又《内经》说：热俞五十九，头上五行。行五者，用来泻诸阳的热逆。大杼、膺俞、缺盆、背俞，这八个穴位，用来泻胸中之热；气冲、三里、巨虚上下廉，这八个穴位，用来泻胃中之热；云门、髀骨、委中、髓空，这八个穴位，用来泻四肢之热；五脏俞旁五，这十个穴位，用来泻五脏之热。凡这五十九穴，都是热的左右旁侧。
又身上的穴，三百六十五个，其中三十九穴，灸之有害；七十九穴，刺之为灾。并中髓也。
穴有三百六十五，以对应一岁。其灸刺的禁忌，都在肉薄骨解之处，血脉虚少之分，针灸并中髓也。
大凡脉四损，三日死。平人四息，病患脉一至，名叫四损。脉五损，一日死。平人五息，病患脉一至，名叫五损。脉六损，一时死。平人六息，病患脉一至，名叫六损。
四脏气绝者，脉四损；五脏气绝者，脉五损；五脏六腑俱绝者，脉六损。
《内经》说：脉，是血的府库。脉实血实，脉虚血虚。寒则伤血，邪并于血，则血盛而气虚，所以伤寒者，脉盛而身寒。热则伤气，邪并于气，则气盛而血虚，所以伤暑者，脉虚而身热。
脉阴阳俱盛，应当汗出而解；如果汗出不解，则邪气内胜，正气外脱，所以死。《内经》说：汗出，而脉尚躁盛者，死。《千金方》说：热病已得汗，脉尚躁盛，这是阳脉的极点，死。
脉阴阳俱虚，热不止者，死。
脉阴阳俱虚者，真气弱也；热不止者，邪气胜也。《内经》说：病温虚甚者，死。
脉至乍疏乍数（赵本作“乍数乍疏”）者，死。
为天真荣卫之气断绝也。
脉至如转索者，（赵本无“者”字）其日死。
为紧急而不软，是中无胃气，所以不出其日而死。
谵言妄语，身微热，脉浮大，手足温者，生。逆冷，脉沉细者，不过一日，死矣。
谵言妄语，是阳病。身微热，脉浮大，手足温，为脉病相应；如果身逆冷，脉沉细，为阳病见阴脉，脉病不相应，所以不过一日而死。《难经》说：脉不应病，病不应脉，是为死病。
Heterogeneous pathogens refer to the situation where a person, having contracted an initial illness that has not yet resolved, is subsequently infected by a different pathogen. When these two pathogens combine, they transform into other diseases. If the pulse is vigorous in both yin and yang positions (cun and chi), this is the pulse of Shanghan (Cold Damage). The Nan Jing states: "The pulse of Shanghan is vigorous in both yin and yang, tight and choppy." The Classics state: "A vigorous pulse accompanied by cold body indicates Shanghan; this occurs when the heat from a previous illness has not subsided, and cold is contracted again. Cold and heat contend, transforming into Wen Nue (Warm Malaria)."
If the yang pulse (cun) is floating and slippery, and the yin pulse (chi) is soggy and weak, this indicates a subsequent contraction of wind, transforming into Feng Wen (Wind-Warmth). This results from the previous heat not subsiding followed by wind contraction. The Nan Jing states: "The pulse of Zhong Feng (Wind Strike) is floating and slippery at the yang position, and soggy and weak at the yin position. Wind exploits the heat, thus transforming into Feng Wen."
If the yang pulse is surging and rapid, and the yin pulse is solid and large (the Zhao edition adds the character 'geng' meaning 'further'), this indicates a subsequent contraction of warm-heat, transforming into Wen Du (Warm-Toxin). Wen Du is the most severe among these diseases. This results from the previous heat not subsiding followed by warm-heat contraction. Yang governs the exterior, yin governs the interior; surging, rapid, solid, and large are all heat signs. Two heats combining transform into Wen Du. Because both interior and exterior are hot, the disease is most severe.
If the yang pulse is soggy and weak, and the yin pulse is string-like and tight, this indicates a subsequent contraction of warm qi, transforming into Wen Yi (Warm Epidemic). (Zhao edition note: another version reads 'Nue'). This is because winter cold injury later manifests as Wen Bing (Warm Disease); the pulse variations and symptoms, and their treatments, are as described previously. This results from the previous heat not subsiding followed by warm qi contraction. Warm and heat combining transform into Wen Yi.
Generally, when people have illnesses, if they do not treat them promptly and instead endure them hoping for spontaneous recovery, they will develop stubborn, chronic diseases.
Whenever one feels unwell, medical attention must be sought immediately. If time is delayed, pathogens will penetrate deeply, making them difficult to cure. The Qian Jin Fang states: "Whenever there is slight discomfort, feeling unlike normal, one must inform a doctor early; if one endures without treatment, hoping for self-recovery, within moments it becomes a chronic disease." This is what is meant.
In children and women, the condition becomes even more severe.
Children's qi and blood are not fully developed; women's blood chamber (Xue Shi) is prone to disease. Any pathogen received by them easily spreads and proliferates.
When seasonal qi is discordant, early diagnosis and treatment are required. One should trace the source of the pathogen; while it remains in the Cou Li (skin texture and interstitial spaces), timely treatment rarely fails to cure.
Cou Li refers to the sites where body fluids excrete and where skin textures intersect. The Gui Zhi Yao Lue states: "Cou is where the San Jiao connects and distributes primordial true qi, the place where blood and qi pour; Li refers to the textures of skin and zang-fu organs." When pathogens lodge in the skin, they are superficial and easy to disperse; if treated timely, they rarely fail to heal. The Jin Gui Yu Han states: "As long as vital signs persist, and appearance/form shows no disease, and pathogens have not entered the Cou Li, timely use of acupuncture and herbs, along with proper regulation entrusted to a good physician, ensures healing."
If patients endure suffering and delay reporting until days later, pathogens enter the Zang organs, becoming hard to control. This is the key precaution for families with sick members.
Pathogens in the skin belong to Yang externally and are easy to treat; pathogens penetrating inward belong to Yin internally and are difficult to treat. The Nei Jing states: "A skilled healer treats at the hair/skin level first, then muscle/skin, then sinews/vessels, then Six Fu organs, then Five Zang organs. Treating Zang organ diseases, half recover, half die." Formerly, Duke Huan of Qi neglected minor skin ailments, leading to bone marrow disease. Families with sick members must certainly take precautions.
When preparing decoctions, one should not avoid morning or night. Upon detecting illness, treatment should begin immediately, regardless of time, facilitating easier recovery.
The Qian Jin Fang states: "Upon feeling unwell, treatment must begin immediately. Continue decoctions and food until recovery, breaking the toxic force, leading to natural healing."
If recovery is slow, the disease will transmit and transform. Although one wishes to eliminate it, efforts will likely be futile.
Transmission follows regular patterns; transformation is irregular. Transmission refers to movement along meridians, e.g., Taiyang transmitting to Yangming; transformation refers to irregular changes, e.g., Yang syndrome transforming into Yin syndrome. Once pathogens transmit and transform, the disease depth increases. The Ben Cao states: "When disease momentum forms, half may be cured; when disease momentum passes, life is hard to save."
If medication is not taken according to method, or if one willfully disobeys the physician, treatment should cease.
The Nei Jing states: "One bound by ghosts/spirits cannot be spoken to regarding high virtue; one who abhors needles and stones cannot be spoken to regarding skillful techniques. If a patient refuses treatment, the disease will not be cured, and treatment will yield no merit."
Generally, Shanghan diseases mostly arise from Wind-Cold.
Historically, diseases caused by Wind Strike and Shanghan were collectively termed Shanghan. The Qian Jin Fang states: "Shanghan originates from Wind-Cold, entering the Cou Li, contending with essence and qi, causing imbalance in Ying and Wei, blocking the whole body, resulting in disease."
Initially, Wind-Cold affects the exterior; once entering the interior, it cannot dissipate on its own.
This refers to progression from skin to meridians, then to zang-fu organs.
There is no case where proper warming and covering fails to dissipate [pathogens].
When Wind-Cold initially lodges in the skin, administering decoctions with appropriate warming and dispersing properties ensures no pathogen remains undissipated.
If the syndrome does not warrant purgation but one intends to attack internally, one must first resolve the exterior before purging.
Resolving the exterior first, then purging, prevents further transmission of pathogens.
If the exterior is resolved but internal pathogens remain, and it is not a full/excess condition, yet chills and fever persist, the disease is not eliminated.
Even if exterior signs have ceased, if the interior is not severely full and hard, purging is not indicated. This is because pathogens have not consolidated into excess; purging would cause interior deficiency, leaving pathogens unresolved, still generating chills and fever.
If the exterior is resolved but internal pathogens remain, presenting with severe fullness and excess, hardness, and dry feces, purging is naturally indicated. Even after four or five days, this will not cause harm.
External absence of exterior signs, combined with internal hardness and fullness, indicates all conditions for purging are met. The Wai Tai Mi Yao states: "Exterior harmonized, interior diseased, purging leads to cure." Once purging indications are present, one need not adhere strictly to the number of days.
If purging is inappropriate but performed anyway, interior deficiency allows heat to enter, leading to diarrhea with heat, irritability, and numerous other transformations. Mild cases become critical; severe cases result in death.
Improper purging: for mild diseases, symptoms change and become hard to treat; how much more so for severe ones?
In Yang-excess and Yin-deficiency, sweating causes death, purging leads to recovery. In Yang-deficiency and Yin-excess, sweating leads to recovery, purging causes death.
Exterior is Yang, interior is Yin. In Yin deficiency, Yang pathogens inevitably gather. Yang-excess pathogens entering the Fu organs due to interior deficiency constitute Yang-excess/Yin-deficiency. The Classics state: "Weak chi pulse is named Yin insufficiency." When Yang qi sinks into Yin, fever occurs—this is the case. Purging removes internal heat, leading to recovery; conversely, sweating depletes fluids, causing death. In Yin pulse insufficiency, Yang follows; in Yang pulse insufficiency, Yin attacks. Yin pathogens attacking exterior deficiency, lodging in Ying and Wei, constitute Yang-deficiency/Yin-excess. The Classics state: "If cunkou pulse is faint, it is named Yang insufficiency." When Yin qi enters Yang, shivering and aversion to cold occur—this is the case. Sweating disperses exterior cold, leading to recovery; conversely, purging depletes righteous qi, causing death. The Classics state: "Originally requiring sweating but performing purging is contrary therapy. Originally requiring purging but performing sweating is also contrary therapy."
Thus, how can Shen Dan be mistakenly used for sweating, or Gan Sui recklessly used for purging? Treatments for deficiency and excess differ by a thousand miles; the mechanism of auspiciousness and peril responds like shadow to form or echo to sound. Is it something to be taken lightly!
Shen Dan is a sweating herb. Gan Sui is a purgative herb. If sweating/purging is appropriate, there is auspiciousness; if inappropriate, there is peril. The response is like shadow following form or echo responding to sound.
Moreover, if Gui Zhi Tang is swallowed in Yang-excess, death ensues (Zhao edition reads 'ji' meaning 'immediately'); if Cheng Qi Tang enters the stomach in Yin-excess, death follows.
Gui Zhi Tang is a sweating formula. Cheng Qi Tang is a purgative formula. The Jin Gui Yu Han states: "Forcing sweating when not indicated deprives the body of fluids, leading to withering and death; forcing purging when not indicated causes intestinal洞泄 (洞泄 means severe diarrhea/loose stools), incontinence of urine and stool, leading to death."
The crux of life and death lies in an instant; watching life end, there is no time to count days.
Improper administration of decoctions brings immediate disaster; how could there be time to count days?
This involves the interweaving of Yin-Yang and deficiency-excess, where signs are subtle; the opposition of sweating, vomiting, and purging methods brings rapid disaster. Physicians with shallow knowledge, ignorant of disease origins, make errors in treatment, causing patient death, attributing it to fate. To this day, vengeful souls fill the underworld, corpses fill the wilderness. Would benevolent people not grieve seeing this! Generally, in Liang Gan Bing (Double-Contraction Disease) where exterior and interior are simultaneously affected, treatment has a sequence. Resolving exterior and attacking interior are fundamentally different. Obsessed and deluded individuals claim Shen Dan and Gan Sui can be mixed and drunk to simultaneously resolve exterior and interior. Their words are clever and seemingly plausible, but their logic violates principles. The wise act with caution and deliberation; the foolish act decisively and hastily. How can the changes of safety and danger be deceptive! Scholars of the world pursue the glory of gathering and learning but ignore the peril of collapse. Only the enlightened can protect the root, taking examples from themselves. What distance is there?
In Liang Gan Bing occurring simultaneously, intending to become incurable, physicians must carefully deliberate, examine the sequence, and treat step-by-step. Reckless aggressive treatment seeking quick effects inevitably leads to collapse.
Generally, for sweating, decoctions should be taken warm. Although formulas state three doses daily, if the disease is severe and unresolved, the interval should be shortened, completing three doses within half a day. If the medicine conflicts with the disease, sensations will arise immediately. For severe diseases, observe throughout day and night. If, after one dose, symptoms persist, administer the original decoction again. Some may not sweat after three doses; only then do they resolve. If no sweat occurs after three doses, it is a fatal disease.
Sweating medicines must be taken warm to facilitate dispersion. Three doses daily maintain continuous medicinal power. If disease severity is slightly higher, urgent administration is needed to break intense heat; one must not be bound by the original formula. If medicine and disease are mismatched, one knows upon ingestion: e.g., in those with excessive Yin, cooling medicines generate cold reversal; in those with excessive Yang, warming agents trigger heat toxicity. This is 'having sensations'. 'Shi' refers to a full cycle (24 hours). Taking one dose over 24 hours, then observing transmission: if symptoms persist, repeat the original decoction to induce sweat. If three doses fail to resolve and no sweat occurs, pathogens are excessive, decoctions are insufficient, leading to major disease. The Qian Jin Fang states: "Heat disease with restless, vigorous pulse and no sweat is the extreme of Yang pulses; fatal."
Generally, in Seasonal Qi diseases, by the fifth or sixth day, if thirsty and wanting water but unable to drink much, do not give it. Why? Because internal heat is still low, unable to digest it, giving it creates further pathology. By the seventh or eighth day, if extremely thirsty and wanting water, give it according to symptoms (Zhao edition adds 'er' meaning 'and'). Give sparingly, never to excess. If they can drink one dou, give five sheng. If drinking causes abdominal fullness, urinary difficulty, wheezing, or hiccups, do not give it. (Zhao edition adds 'ye' meaning particle). Sudden profuse sweating indicates spontaneous recovery.
Heat in the Upper Jiao causes Xiao Ke (Consumption-Thirst), meaning heat consumes fluids, Upper Jiao dries, causing thirst. Intense heat can consume water; low heat cannot. Forced drinking leads to fluid retention and various diseases. By the seventh or eighth day, Yang prevails, temperature rises, approaching resolution, great thirst often occurs. Still, give sparingly to moisten Stomach qi; do not force drinking.
If drinking causes abdominal fullness, urinary difficulty, wheezing, or hiccups, it indicates internal fluid retention not dispersing; do not give more. Suddenly, Yang qi opens, water qi disperses, emerging externally as profuse sweat, resolving the disease.
Generally, if a patient can drink water, it indicates impending recovery. Those ignorant of disease hear that drinking water aids recovery; for slight thirst, they force drinking, causing disaster, which is incalculable. (Zhao edition adds 'ye').
Slight thirst indicates low internal heat. Forcing water leads to indigestion, creating various fluid diseases.
Generally, in Jue disease with rapid, moving pulse, if the pulse becomes slower after taking medicine; if the floating-large pulse decreases; if restlessness turns to calmness, these are all signs of recovery.
Rapid-moving pulse indicates pathogen in Yang; slowing after medicine indicates Yang pathogen resolving. Floating-large pulse indicates pathogen in Exterior; decreasing indicates Exterior pathogen dispersing. Initial restlessness is due to pathogen disturbance; calmness after medicine indicates medicine overcoming disease. These are all recovery signs.
Generally, treating Wen Bing, one can needle fifty-nine acupoints.
The fifty-nine points are used to drain heat-warmth from all meridians. The Zhen Jing states: "For heat diseases, select fifty-nine points from Yang meridians, needle to drain heat and induce sweat; tonify Yin and supplement deficiency." The so-called fifty-nine pricks: three on each inner and outer side of hands, twelve total; one between each finger, eight total; feet similarly; one cun inside hairline, three on each side, six total; three cun inside hairline, five on each side, ten total; one each in front/behind ears, below mouth, one in neck, six total; one at vertex, one at Xinhui, one at hairline, one at Lianquan, two Fengchi, two Tianzhu. Also, the Nei Jing states: "Fifty-nine Heat Shu points, five rows on head. Five per row drains rebellious heat from all Yang." Dazhu, Ying Shu, Quepen, Bei Shu (eight points) drain chest heat; Qichong (Suwen reads Qiejie), Zusanli, Shangjuxu, Xiajuxu (eight points) drain Stomach heat; Yunmen, Bitong (likely referring to specific thigh points), Weizhong, Suikong (eight points) drain limb heat; five beside each Zang Shu (ten points) drain Zang heat. All fifty-nine points are lateral to heat.
Furthermore, there are 365 acupoints on the body. Thirty-nine are harmful to moxa; seventy-nine are disastrous to needle. Both involve piercing the Marrow.
There are 365 points corresponding to the year. Contraindications for moxibustion and needling are at places where flesh is thin and bones separate, or where blood vessels are deficient and few, involving piercing the Marrow.
Generally, Si Sun (Four Damages) pulse indicates death in three days. A healthy person breathes four times per pulse beat; if the patient's pulse beats once per four breaths, it is named Si Sun. Wu Sun (Five Damages) pulse indicates death in one day. Healthy person breathes five times per pulse beat; if patient's pulse beats once per five breaths, it is named Wu Sun. Liu Sun (Six Damages) pulse indicates death in one moment (shi). Healthy person breathes six times per pulse beat; if patient's pulse beats once per six breaths, it is named Liu Sun.
Absence of Qi in Four Zang organs corresponds to Si Sun; absence in Five Zang organs corresponds to Wu Sun; absence in Five Zang and Six Fu organs corresponds to Liu Sun.
Vigorous pulse with cold body indicates Shanghan; weak pulse with hot body indicates Shangshu (Summerheat Injury).
The Nei Jing states: "Pulse is the residence of Blood. Vigorous pulse means vigorous Blood; weak pulse means weak Blood. Cold injures Blood; pathogen merges with Blood, making Blood excess and Qi deficiency, hence Shanghan presents with vigorous pulse and cold body. Heat injures Qi; pathogen merges with Qi, making Qi excess and Blood deficiency, hence Shangshu presents with weak pulse and hot body."
Vigorous pulse in both Yin and Yang positions, profuse sweating, unresolved, indicates death.
Vigorous pulse in Yin and Yang positions should resolve with sweating; if sweating does not resolve it, pathogens overcome internally, righteous Qi escapes externally, hence death. The Nei Jing states: "Sweating with still restless/vigorous pulse indicates death." The Qian Jin Fang states: "Heat disease with sweat but still restless/vigorous pulse is the extreme of Yang pulses; fatal."
Weak pulse in both Yin and Yang positions, persistent heat, indicates death.
Weak pulse in Yin and Yang indicates weak True Qi; persistent heat indicates victorious Pathogen. The Nei Jing states: "Warm disease with severe deficiency is fatal."
Pulse alternating between intermittent and rapid indicates death.
Indicates severance of Primordial Ying and Wei Qi.
Pulse like a turning cord indicates death on that day.
Tight and non-soft, indicating lack of Stomach Qi, hence death within the day.
Delirium and妄语 (wild speech), slight body heat, floating-large pulse, warm hands and feet indicate survival. Cold limbs, deep-thin pulse indicate death within one day.
Delirium and wild speech are Yang diseases. Slight heat, floating-large pulse, warm limbs indicate pulse-disease correspondence. Cold limbs, deep-thin pulse indicate Yang disease showing Yin pulse, pulse-disease non-correspondence, hence death within one day. The Nan Jing states: "Pulse not matching disease, disease not matching pulse, is a fatal disease."
These above are the syndromes and signs of Shanghan and Heat Diseases.