数如法，邪热内陷于脾，而心中善饥也。数脉不时者，为数当改微，而复不微，如此则是邪气不传于里，但郁
于荣卫之中，必出自肌皮，为恶疮也。
师曰∶病患脉微而涩者，此为医所病也。大发其汗，又数大下之，其人亡血，病当恶寒，后乃发热，无休
止时。夏月盛热，欲着覆衣，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（赵
本作“使”）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
着覆衣；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。又阴脉迟涩，故知血亡
也。（赵本作“亡血”）
微为亡阳，涩则无血，不当汗而强与汗之者，令阳气微，阴气上入阳中，则恶寒，故曰阳微则恶寒。不当
下而强与下之者，令阴气弱，阳气下陷入阴中，则发热，故曰阴弱则发热。气为阳，血为阴，阳脉以候气，阴
脉以候血，阴脉迟涩，为荣血不足，故知亡血。经曰∶尺脉迟者，不可发汗，以荣气不足，血少故也。
脉浮而大，心下反硬，有热属脏者，攻之，不令发汗。
浮大之脉，当责邪在表，若心下反硬者，则热已甚，而内结也。有热属脏者，为别无虚寒，而但见里热也。
脏属阴，为悉在里，故可下之。攻之谓下之也，不可谓脉浮大，更与发汗。
《病源》曰∶热毒瓦斯乘心，心下痞满，此为有实，宜速下之。
属腑者，不令溲数。溲数则大便硬，汗多则热愈，
汗少则便难，脉迟尚未可攻。
虽心下硬，若余无里证，但见表证者，为病在阳，谓之属腑，当先解表，然后攻痞。溲，小便也，勿为
饮结，而利小便，使其溲数，大便必硬也。经曰∶小便数者，大便必硬，谓走其津液也。汗多，则邪气除而
热愈，汗少，则邪热不尽，又走其津液，必便难也。硬家当下，设脉迟，则未可攻，以迟为不足，即
里气未实故也。
脉浮而洪，身汗如油，喘而不休，水浆不下，体形（赵本作“形体”）不仁，乍静乍乱，此为命绝也。
病有不可治者，为邪气胜于正气也。《内经》曰∶大则邪至。又曰∶大则病进。脉浮而洪者，邪气胜也；
身汗如油，喘而不休者；正气脱也；四时以胃气为本，水浆不下者，胃气尽也；一身以荣卫为充，形体不仁
者，荣卫绝也；不仁为痛痒俱不知也。《针经》曰∶荣卫不行，故为不仁。争则乱，安则静，乍
静乍乱者，正与邪争，正负邪胜也。正气已脱，胃气又尽，荣卫俱绝，邪气独胜，故曰命绝也。
又未知何脏先受其灾，若汗出发润，喘不休者，此为肺先绝也。
肺，为气之主，为津液之帅。汗出、发润者，津脱也；喘不休者，气脱也。
阳反独留，形体如烟熏，直视摇头，（赵本医统本皆有“者”字）此（赵本有“为”字）心绝也。
肺主气，心主血，气为阳，血为阴。阳反独留者，则为身体大热，是血先绝而气独在也。形体如烟熏者，
为身无精华，是血绝不荣于身也。心脉侠咽系目，直视者，心经绝也。头为诸
阳之会，摇头者，阴绝而阳无根也。
唇吻反青，四肢 习者，此为肝绝也。
唇吻者，脾之候。肝色青，肝绝，则真色见于所胜之部也。四肢者，脾所主。肝主筋，肝绝则筋脉引急，
发于所胜之分也。 习者，为振动，若搐搦，手足时时引缩也。
环口黧黑，柔汗发黄者，此为脾绝也。
脾主口唇，绝则精华去，故环口黧黑。柔为阴，柔汗，冷汗也。脾胃为津液之本，阳气之宗，柔汗发
黄者，脾绝，而阳脱，真色见也。
溲便遗失、狂言、目反直视者，此为肾绝也。
肾司开合，禁固便溺。溲便遗失者，肾绝不能约制也。肾藏志，狂言者，志不守也。《内经》曰∶狂言
者，是失志矣。失志者死。《针经》曰∶五脏之精气皆上注于目，骨之精为瞳子，
目反直视者，肾绝，则骨之精不荣于瞳子，而瞳子不转也。
又未知何脏阴阳前绝，若阳气前绝，阴气后竭者，其人死，身色必青；阴气前绝，阳气后竭者，其
人死，身色必赤，腋下温，心下热也。
阳主热而色赤，阴主寒而色青。其人死也，身色青，则阴未离乎体，故曰阴气后竭。身色赤，腋下温，
心下热，则阳未离乎体，故曰阳气后竭。《针经》云∶（医统本作“曰”）人有两死而无两生，此之谓也。
寸口脉浮大，而医反下之，此为大逆。浮则无血，大则为寒，寒气相搏，则为肠鸣，医乃不知，而反饮冷
水，令汗大出，水得寒气，冷必相搏，其人即KT 。
经云∶脉浮大，应发汗，若反下之，为大逆。浮大之脉，邪在表也，当发其汗，若反下之，是攻其正气，
邪气得以深入，故为大逆。浮则无血者，下后亡血也；大则为寒者，邪气独在也。
寒邪因里虚而入，寒气相搏，乃为肠鸣，医见脉大，以为有热，饮以冷水，欲令水寒胜热而作大汗，里先虚
寒，又得冷水，水寒相搏，使中焦之气涩滞，故令KT 也。
趺阳脉浮，浮则为虚，浮虚相搏，故令气KT ，言胃气虚竭也。脉滑，则为哕。此为医咎，责虚取实，
守空迫血。脉浮、鼻中燥者，必衄也。
趺阳脉浮为KT ，脉滑为哕，皆医之咎，责虚取实之过也。《内经》曰∶阴在内，阳之守也，阳在外，
阴之使也。发汗攻阳，亡津液，而阳气不足者，谓之守空。经曰∶表气微虚，里气不
守，故使邪中于阴也。阴（医统本作“阳”）不为阴守，邪气因得而入之，内搏阴血，阴失所守，血乃妄行，
未知从何道而出。若脉浮、鼻燥者，知血必从鼻中出也。
诸脉浮数，当发热，而洒淅恶寒，若有痛处，饮食如常者，蓄积有脓也。
浮数之脉，主邪在经，当发热，而洒淅恶寒，病患一身尽痛，不欲饮食者，伤寒也。若虽发热，恶寒而
痛，偏着一处，饮食如常者，即非伤寒，是邪气郁结于经络之间，血气壅遏不通，欲蓄聚而成痈脓也。
脉浮而迟；面热赤而战惕者，六七日当汗出而解；反发热者，瘥迟。迟为无阳，不能作汗，其身必痒也。
脉浮，面热赤者，邪气外浮于表也；脉迟，战惕者，本气不足也。六七日为（医统本有“邪”字）传经
尽，当汗出而解之时。若当汗不汗，反发热者，为里虚津液不多，不能作汗，既不汗，邪无
从出，是以瘥迟。发热为邪气浮于皮肤，必作身痒也，经曰∶以其不能得小汗出，故其身必痒也。
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，所为阳中雾露之气，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，三焦相混，内外不通，上焦怫郁，脏气相熏，口烂食
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，客气内入，
嚏而出之，声 咽塞，寒厥相逐，（赵本作“追”）为热所拥，血凝自下，状如豚肝，阴阳俱厥，脾气弧弱，
五液注下，下焦不阖，（赵本注∶“一作盍”）清便下重，令便数、难，脐（赵本作“齐”）筑湫痛，命将难全。
浮为阳，沉为阴。阳脉紧，则雾露之气中于上焦；阴脉紧，则寒邪中于下焦。上焦者，太阳也。下焦者，
少阴也。发热、头痛、项强、颈挛、腰疼、胫酸者，雾露之气中于太阳之经也；浊邪中下，阴气为栗，足胫
逆冷，便溺妄出者，寒邪中于少阴也。因表气微虚，邪入而客之，又里气不守，邪乘里弱，遂中于阴，
阴虚遇邪，内为惧栗，致气微急矣。《内经》曰∶阳病者，上行极而下；阴病者，下行极而上。此上焦之邪，
甚则下干中焦，下焦之邪，甚则上干中焦，由是三焦混乱也。三焦主持诸气，三焦既相混乱，则内外之气，俱
不得通，膻中为阳气之海，气因不得通于内外，怫郁于上焦而为热，与脏相熏，口烂食 。《内经》曰∶隔热不
便，上为口糜。中焦为上下二焦之邪混乱，则不得平治，中焦在胃之中，中焦失治，胃气因上冲也。脾，坤
也，坤助胃气，消磨（医统本作“磨消”）水谷，脾气不转，则胃中水谷不得磨消，故胃中浊也。《金匮
要略》曰∶谷气不消，胃中苦浊。荣者，水谷之精气也；卫者，水谷之悍气也。气不能布散，致荣卫不通，血
凝不流。卫气者，阳气也；荣血者，阴气也。阳主为热，阴主为寒。卫气前通者，阳气先通而热气得行也。
《内经》曰∶膀胱者，津液藏焉，化则能出。以小便赤黄，知卫气前通也。热气与胃（医统本作“卫”）气相
搏而行，出入脏腑，游于经络，经络客热，则血凝肉腐，而为痈脓，此见其热气得行。若阴
气前通者，则不然，阳在外为阴之使，因阳气厥微，阴无所使，遂阴气前通也。《内经》曰∶阳气者，卫外
而为固也，阳气厥微，则不能卫外，寒气因而客之。鼻者，肺之候，肺主声，寒气内入者，客于肺经，则嚏而
出之，声 咽塞。寒者，外邪也；厥者，内邪也。外内之邪合并，相逐为热，则血凝不流。今为热
所拥，使血凝自下，如豚肝也。上焦阳气厥，下焦阴气厥，二气俱厥，不相顺接，则脾气独弱，不能行化
气血，滋养五脏，致五脏俱虚，而五液注下。《针经》曰∶五脏不和，使液溢而下流于阴。阖，合也。清，
圊也。下焦气脱而不合，故数便而下重。脐为生气之原，脐筑湫痛，则生气欲绝，故曰命将难全。
脉阴阳俱紧者，口中气出，唇口干燥，蜷卧足冷，鼻中涕出，舌上苔滑，勿妄治也。到七日已（赵本作
“以”）来，其人微发热，手足温者，此为欲解；或到八日已（赵本作“以”）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。
脉阴阳俱紧，为表里客寒。寒为阴，得阳则解。口中气出，唇口干燥者，阳气渐复，正气方温也。虽尔
然而阴未尽散，蜷卧足冷，鼻中涕出，舌上滑苔，知阴犹在也。方阴阳未分之
时，不可妄治，以偏阴阳之气。到七日以来，其人微发热，手足
温者，为阴气已绝，阳气得复，是为欲解。若过七日不解，到八日以上，反发大热者，为阴极变热，邪气胜正，
故云难治。阳脉紧者，寒邪发于上焦，上焦主外也；阴脉紧者，寒邪发于下焦，
下焦主内也。设使恶寒者，上焦寒气胜，是必欲呕也；复内痛者，下焦寒气胜，是必欲利也。
脉阴阳俱紧，至于吐利，其脉独不解，紧去入（熊校记∶紧去人安，汪本赵本人作入。按注云∶紧去则
人安，以文意求之成本自作人，不作入）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。
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。
若脉迟至六七日，不欲食者，为吐利后，脾胃大虚。《内经》曰∶饮入于胃，游溢精气，上输于脾，脾气散
精，上归于肺，通调水道，下输膀胱，水精四布，五经并行。脾胃气强，则能输散水饮之气；若脾胃气虚，
则水饮内停也。所谓晚发者，后来之疾也。若至六七日而欲食者，则脾胃已和，寒邪已散，故云欲解。
病六七日，手足三部脉皆至，大烦而口噤不能言。其人躁扰者，必欲解也。
烦，热也。传经之时，病患身大烦，口噤不能言，内作躁扰，则阴阳争胜。若手足三部脉皆至，为正
气胜，邪气微，阳气复，寒气散，必欲解也。
若脉和，其人大烦，目重，睑内际黄者，此为（赵本无“为”字）欲解也。
《脉经》曰∶病患两目 有黄色起者，其病方愈。病以脉为主，若目黄大烦，脉不和者，邪胜也，其
病为进；目黄大烦，而脉和者，为正气已和，故云欲解。
脉浮而数，浮为风，数为虚，风为热，虚为寒，风虚相搏，则洒淅恶寒也。
《内经》曰∶有者为实，无者为虚。气并则无血，血并则无气。风则伤卫，数则无血。浮数之脉，风邪
并于卫，卫胜则荣虚也。卫为阳，风搏于卫，所以为热。荣为阴，荣气虚，所以为寒。风并于卫者，发热、
恶寒之证具矣。
脉浮而滑，浮为阳，滑为实，阳实相搏，其脉数疾，卫气失度，浮滑之脉数疾，发热汗出者，此为不治。
浮为邪气并于卫，而卫气胜；滑为邪气并于荣，而荣气实。邪气胜实，拥于荣卫，则荣卫行速，故脉数疾。
一息六至曰数，平人脉一息四至，卫气行六寸，今一息六至，则卫气行九寸，计过平人之半，是脉数疾，知卫
气失其常度也。浮滑数疾之脉，发热汗出而当解，若不解者，精气脱也，必不可治。经曰∶脉阴阳俱盛，大
汗出不解者死。
伤寒咳逆上气，其脉散者死。谓其形损故也。
《千金方》云∶以喘嗽为咳逆，上气者肺病，散者心脉，是心火刑于肺金也。《内经》曰∶心之肺谓
脉象数而符合常法，是邪热内陷于脾脏，导致患者心中容易感到饥饿。若脉数但持续时间不长，本应转变为微脉，却反而不转为微脉，这说明邪气没有传入里部，只是郁结在荣卫之间，必然从肌肤表面发出，形成恶疮。
老师说：病人脉象微而涩，这是医生治疗失误造成的。医生大发其汗，又多次使用峻下法，导致病人亡失血液。此时病人应当先感到恶寒，随后发热，且发热无休止。夏季天气酷热，病人却想穿厚衣；冬季天气严寒，病人却想裸露身体。之所以这样，是因为阳气微弱则恶寒，阴血虚弱则发热。这是因为医生发汗，使阳气微弱；又大下之，使阴气虚弱。五月之时，阳气浮越于体表，胃中虚冷，因为体内阳气微弱，不能抵御寒冷，所以想穿厚衣；十一月之时，阳气潜藏于体内，胃中烦热，因为体内阴气虚弱，不能抵御热邪，所以想裸露身体。另外，阴脉迟涩，所以知道是亡血所致。
微脉主亡阳，涩脉主无血。不当用汗法而强行发汗，导致阳气微弱，阴气上入阳分，就会恶寒，所以说“阳微则恶寒”。不当用下法而强行攻下，导致阴气虚弱，阳气下陷入阴分，就会发热，所以说“阴弱则发热”。气属阳，血属阴，阳脉用来候气，阴脉用来候血。阴脉迟涩，说明荣血不足，所以知道是亡血。经书说：“尺脉迟者，不可发汗，因为荣气不足，血少。”
脉象浮而大，心下反而硬满，如果有热邪归属于脏（里实），应当用攻下法，不要发汗。
浮大的脉象，通常责求邪气在表，如果心下反而硬满，说明热邪已经很盛，并且内结。所谓“有热属脏”，是指没有其他虚寒症状，只见到里热。脏属阴，病位完全在里，所以可以用下法。“攻”指的就是下法，不能说脉象浮大，就再用发汗法。
《病源》说：热毒之气侵犯心脏，导致心下痞满，这是实证，应当迅速攻下。
如果热邪归属于腑，不要令小便频数。小便频数则大便干硬，汗出多则热势更甚，汗出少则排便困难。如果脉迟，还不可以攻下。
虽然心下硬满，但如果其余没有里证，只有表证，说明病在阳分，称为“属腑”，应当先解表，然后再攻痞满。“溲”指小便，不要因为水饮内结，就利小便使其尿频，这样大便一定会变硬。经书说：“小便频数的人，大便一定干硬，这是因为津液流失。”汗出多，则邪气除而热退；汗出少，则邪热不尽，又流失津液，必然导致排便困难。大便硬满应当攻下，如果脉迟，则不可攻下，因为迟脉表示正气不足，即里气未充实。
脉象浮而洪，身体出汗如油，气喘不停，水浆不能入口，形体麻木不仁，时而安静时而躁乱，这叫做“命绝”。
病有不可治的，是因为邪气胜过正气。《内经》说：“脉大则是邪气至。”又说：“脉大则病情进展。”脉浮而洪，是邪气胜的表现；身体出汗如油，气喘不停，是正气脱失的表现；四时以胃气为本，水浆不能入口，说明胃气已尽；全身依靠荣卫充盈，形体麻木不仁，说明荣卫已绝。“不仁”指痛痒都感觉不到。《针经》说：“荣卫不通，所以为不仁。”争斗则躁乱，安宁则静，时而静时而乱，是正气与邪气相争，正气败、邪气胜。正气已脱，胃气又尽，荣卫俱绝，邪气独胜，所以叫“命绝”。
又不知道是哪一脏先受灾害，如果出汗后头发湿润，气喘不停，这是肺先绝。
肺是气的主宰，也是津液的统帅。出汗、头发湿润，是津液脱失；气喘不停，是气脱失。
阳气反而单独留存，身体像烟熏一样黑，两眼直视，摇头，这是心绝。
肺主气，心主血，气属阳，血属阴。阳气反而单独留存的，就是身体大热，这是血先绝而气独存。身体像烟熏一样黑的，是因为身体没有精华滋润，这是血绝不荣养身体。心脉夹咽喉连系眼睛，两眼直视，是心经气绝。头是诸阳之会，摇头，是阴绝而阳无根。
嘴唇和口角发青，四肢抽搐，这是肝绝。
嘴唇和口角是脾的外候。肝色青，肝绝，则真色出现在被克制的部位（脾主口唇）。四肢是脾所主。肝主筋，肝绝则筋脉拘急收缩，表现在被克制的部位（脾主四肢）。“习习”指振动，像抽搐一样，手足时时牵引收缩。
口周发黑，出冷汗且汗色发黄，这是脾绝。
脾主口唇，气绝则精华离去，所以口周发黑。“柔”属阴，柔汗即冷汗。脾胃是津液的根本，阳气的宗主，出冷汗且汗色发黄，是脾绝，阳气脱失，真色显现。
大小便失禁，胡言乱语，两眼向上翻且直视，这是肾绝。
肾主管开合，控制二便。大小便失禁，是肾气不能约束。肾藏志，胡言乱语，是志意不守。《内经》说：“胡言乱语，是失志了。”失志者死。《针经》说：“五脏的精气都上注于目，骨的精气表现为瞳子。”两眼向上翻且直视，是肾绝，骨的精气不能荣养瞳子，所以瞳子不能转动。
又不知道是阴阳哪一方先绝，如果阳气先绝，阴气后竭，人死，身体颜色必青；阴气先绝，阳气后竭，人死，身体颜色必赤，腋下温暖，心下发热。
阳主热而色赤，阴主寒而色青。人死后，身体色青，说明阴气未离开身体，所以叫阴气后竭。身体色赤，腋下温，心下热，说明阳气未离开身体，所以叫阳气后竭。《针经》说：“人有两死而无两生”，说的就是这个道理。
寸口脉浮大，医生反而用下法，这是大逆。浮脉表示无血，大脉表示有寒，寒气相互搏结，则肠鸣。医生不知道，反而让病人喝冷水，导致大汗出。水遇到寒气，冷气相互搏结，病人就会发出“嗳”的声音（或作“哕”）。
经书说：“脉浮大，应当发汗，如果反而用下法，是大逆。”浮大的脉象，邪气在表，应当发汗，如果反而用下法，是攻伐正气，邪气得以深入，所以是大逆。浮则无血，是下后亡血；大则为寒，是邪气独存。
寒邪因里虚而入，寒气相互搏结，成为肠鸣。医生见脉大，以为有热，给喝冷水，想让水冷胜热而作大汗。里先虚寒，又得冷水，水寒相互搏结，使中焦之气涩滞，所以令病人“嗳”（或作“哕”）。
趺阳脉浮，浮则为虚，浮虚相搏，所以令气“嗳”（或作“哕”），这是说胃气虚竭。脉滑，则为呃逆。这是医生的过错，责虚取实，守空迫血。脉浮、鼻中干燥的，必定流鼻血。
趺阳脉浮为“嗳”（或作“哕”），脉滑为呃逆，都是医生的过错，是责虚取实的过失。《内经》说：“阴在内，是阳的守持；阳在外，是阴的役使。”发汗攻伐阳气，亡失津液，而阳气不足，叫做“守空”。经书说：“表气微虚，里气不守，所以使邪气中于阴。”阴不为阴守，邪气因而进入，内搏阴血，阴失所守，血乃妄行，不知道从哪条道而出。如果脉浮、鼻燥，就知道血必从鼻中出。
各种脉象浮数，应当发热，却洒淅恶寒，如果有疼痛处，饮食如常，这是蓄积有脓。
浮数的脉象，主邪在经络，应当发热，如果洒淅恶寒，病人一身尽痛，不欲饮食，是伤寒。如果虽然发热、恶寒且痛，但痛处偏着一处，饮食如常，这就不是伤寒，是邪气郁结在经络之间，血气壅遏不通，欲蓄聚而成痈脓。
脉浮而迟，面红发热且战栗恐惧的，六七天应当汗出而解；如果反而发热，痊愈就迟缓。迟为无阳，不能作汗，身体必然发痒。
脉浮，面红发热，是邪气外浮于表；脉迟，战栗恐惧，是本气不足。六七天是传经尽，当汗出而解的时候。如果应当汗出不汗，反而发热，是因为里虚津液不多，不能作汗，既然不出汗，邪无从出，所以痊愈迟缓。发热是邪气浮于皮肤，必然身体发痒，经书说：“因为不能得小汗出，所以身体必痒。”
寸口脉阴阳俱紧，按法应当是清邪中于上焦，浊邪中于下焦。清邪中上，名叫“洁”；浊邪中下，名叫“浑”。阴分受邪，必内里战栗，表气微虚，里气不守，所以使邪气中于阴。阳分受邪，必发热、头痛、项强、颈挛、腰痛、胫酸，这是因为阳分受了雾露之气，所以叫清邪中上。浊邪中下，阴气战栗，足膝逆冷，大小便失控，表气微虚，里气微急，三焦相混，内外不通，上焦怫郁，脏气相熏，导致口烂食糜。中焦不治，胃气上冲，脾气不转，胃中为浊，荣卫不通，血凝不流。如果卫气先通，小便赤黄，与热相搏，因热而行，游于经络，出入脏腑，热气所过，则为痈脓。如果阴气先通，阳气厥微，阴无所使，客气内入，打喷嚏而出，声音嘶哑咽塞，寒厥相逐，被热所拥，血凝自下，状如豚肝。阴阳俱厥，脾气孤弱，五液注下，下焦不合，清便下重，令便数、难，脐下筑痛湫痛，生命将难保全。
浮为阳，沉为阴。阳脉紧，则是雾露之气中于上焦；阴脉紧，则是寒邪中于下焦。上焦者是太阳，下焦者是少阴。发热、头痛、项强、颈挛、腰疼、胫酸，是雾露之气中于太阳之经；浊邪中下，阴气战栗，足胫逆冷，便溺妄出，是寒邪中于少阴。因表气微虚，邪入而客之，又里气不守，邪乘里弱，遂中于阴，阴虚遇邪，内为惧栗，致气微急。《内经》说：“阳病者，上行极而下；阴病者，下行极而上。”此上焦之邪，甚则下干中焦，下焦之邪，甚则上干中焦，由是三焦混乱。三焦主持诸气，三焦既相混乱，则内外之气，俱不得通，膻中为阳气之海，气因不得通于内外，怫郁于上焦而为热，与脏相熏，口烂食糜。《内经》说：“隔热不便，上为口糜。”中焦为上下二焦之邪混乱，则不得平治，中焦在胃之中，中焦失治，胃气因上冲也。脾，坤也，坤助胃气，消磨水谷，脾气不转，则胃中水谷不得磨消，故胃中浊。《金匮要略》说：“谷气不消，胃中苦浊。”荣者，水谷之精气也；卫者，水谷之悍气也。气不能布散，致荣卫不通，血凝不流。卫气者，阳气也；荣血者，阴气也。阳主为热，阴主为寒。卫气前通者，阳气先通而热气得行也。《内经》说：“膀胱者，津液藏焉，化则能出。”以小便赤黄，知卫气前通也。热气与卫气相搏而行，出入脏腑，游于经络，经络客热，则血凝肉腐，而为痈脓，此见其热气得行。若阴气前通者，则不然，阳在外为阴之使，因阳气厥微，阴无所使，遂阴气前通也。《内经》说：“阳气者，卫外而为固也，阳气厥微，则不能卫外，寒气因而客之。”鼻者，肺之候，肺主声，寒气内入者，客于肺经，则嚏而出之，声音嘶哑咽塞。寒者，外邪也；厥者，内邪也。外内之邪合并，相逐为热，则血凝不流。今为热所拥，使血凝自下，如豚肝也。上焦阳气厥，下焦阴气厥，二气俱厥，不相顺接，则脾气独弱，不能行化气血，滋养五脏，致五脏俱虚，而五液注下。《针经》说：“五脏不和，使液溢而下流于阴。”阖，合也。清，圊也。下焦气脱而不合，故数便而下重。脐为生气之原，脐筑湫痛，则生气欲绝，故曰命将难全。
脉阴阳俱紧，口中气出，唇口干燥，蜷卧足冷，鼻中涕出，舌上苔滑，不要胡乱治疗。到了七日以来，病人微微发热，手足温暖的，这是将要解除；或者到了八日以上，反而大发热的，这是难治。
脉阴阳俱紧，是表里客寒。寒为阴，得阳则解。口中气出，唇口干燥，是阳气渐复，正气方温。虽然如此，然而阴未尽散，蜷卧足冷，鼻中涕出，舌上滑苔，知道阴犹在。方阴阳未分之时候，不可妄治，以免偏颇阴阳之气。到了七日以来，病人微微发热，手足温的，是阴气已绝，阳气得复，是为欲解。若过七日不解，到八日以上，反而发大热的，是阴极变热，邪气胜正，所以说难治。阳脉紧者，寒邪发于上焦，上焦主外；阴脉紧者，寒邪发于下焦，下焦主内。假使恶寒的，上焦寒气胜，是必欲呕；复内痛的，下焦寒气胜，是必欲利。
脉阴阳俱紧，至于吐利，其脉独不解，紧去则人安，此为欲解。如果脉迟至六七日，不欲食，这是晚发，水停故也，为未解；饮食自可者，为欲解。
脉阴阳俱紧，是寒气甚于上下，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。如果脉迟至六七日，不欲食者，是吐利后，脾胃大虚。《内经》说：“饮入于胃，游溢精气，上输于脾，脾气散精，上归于肺，通调水道，下输膀胱，水精四布，五经并行。”脾胃气强，则能输散水饮之气；若脾胃气虚，则水饮内停也。所谓晚发者，后来之疾也。若至六七日而欲食者，则脾胃已和，寒邪已散，故云欲解。
病六七日，手足三部脉皆至，大烦而口噤不能言。其人躁扰的，必定欲解。
烦，热也。传经之时，病人身大烦，口噤不能言，内作躁扰，则阴阳争胜。如果手足三部脉皆至，为正气胜，邪气微，阳气复，寒气散，必欲解。
《脉经》说：“病人两目眦有黄色起的，其病方愈。”病以脉为主，如果目黄大烦，脉不和者，邪胜也，其病为进；目黄大烦，而脉和者，为正气已和，故云欲解。
脉浮而数，浮为风，数为虚，风为热，虚为寒，风虚相搏，则洒淅恶寒。
《内经》说：“有者为实，无者为虚。”气并则无血，血并则无气。风则伤卫，数则无血。浮数之脉，风邪并于卫，卫胜则荣虚。卫为阳，风搏于卫，所以为热。荣为阴，荣气虚，所以为寒。风并于卫者，发热、恶寒之证具矣。
脉浮而滑，浮为阳，滑为实，阳实相搏，其脉数疾，卫气失度，浮滑之脉数疾，发热汗出者，此为不治。
浮为邪气并于卫，而卫气胜；滑为邪气并于荣，而荣气实。邪气胜实，拥于荣卫，则荣卫行速，故脉数疾。一息六至曰数，平人脉一息四至，卫气行六寸，今一息六至，则卫气行九寸，计过平人之半，是脉数疾，知卫气失其常度。浮滑数疾之脉，发热汗出而当解，若不解者，精气脱也，必不可治。经说：“脉阴阳俱盛，大汗出不解者死。”
If the pulse is rapid and conforms to the standard method, it indicates that pathogenic heat has sunk into the Spleen, causing frequent hunger in the heart region. If the rapid pulse does not persist and should change to a fine (Wei) pulse but fails to do so, this means the pathogen has not transmitted to the interior but is merely stagnant within the Ying (Nutrient) and Wei (Defensive) levels. It will inevitably manifest on the skin and muscles as malignant sores.
The Master said: "When a patient's pulse is fine and choppy, this is iatrogenic injury caused by the physician. Profuse sweating followed by repeated purgation leads to blood loss. The patient should initially experience aversion to cold, followed by fever without cessation. In the height of summer heat, the patient desires to wear heavy clothing; in the depth of winter cold, the patient desires to be naked. This occurs because deficiency of Yang causes aversion to cold, while deficiency of Yin causes fever. The physician's profuse sweating depleted Yang Qi, and aggressive purgation weakened Yin Qi. In the fifth month, when Yang Qi floats on the exterior, the Stomach becomes empty and cold; due to internal Yang deficiency, the body cannot withstand the cold, hence the desire for heavy clothing. In the eleventh month, when Yang Qi sinks into the interior, the Stomach becomes vexed and hot; due to internal Yin deficiency, the body cannot withstand the heat, hence the desire to be naked. Furthermore, the Yin pulse being slow and choppy confirms blood loss."
A fine pulse indicates loss of Yang, while a choppy pulse indicates absence of blood. Forcing sweat when sweating is contraindicated depletes Yang Qi, allowing Yin Qi to ascend into the Yang realm, causing aversion to cold; thus, "Yang deficiency causes aversion to cold." Forcing purgation when it is contraindicated weakens Yin Qi, causing Yang Qi to sink into the Yin realm, causing fever; thus, "Yin deficiency causes fever." Qi belongs to Yang, Blood belongs to Yin. The Yang pulse assesses Qi, and the Yin pulse assesses Blood. A slow and choppy Yin pulse indicates insufficient Ying Blood, confirming blood loss. The Classics state: "If the Chi position pulse is slow, sweating is contraindicated because Ying Qi is insufficient and Blood is scant."
If the pulse is floating and large, and the epigastrium is paradoxically hard, with heat belonging to the Zang organs (Interior Excess), one should use attacking methods (purgation) and not induce sweating.
A floating and large pulse usually indicates pathogen at the Exterior. However, if the epigastrium is hard, the heat is severe and internally knotted. "Heat belonging to the Zang" implies no deficiency-cold symptoms, only Interior Heat. Since Zang organs belong to Yin and the pathology is entirely Interior, purgation is indicated. "Attacking" refers to purgation; one must not induce sweating just because the pulse is floating and large.
The *Bing Yuan* states: "When heat-toxin qi attacks the Heart, causing epigastric fullness and stuffiness, this is an Excess pattern. Rapid purgation is appropriate."
If the heat belongs to the Fu organs, one must not cause frequent urination. Frequent urination leads to dry stool; excessive sweating exacerbates heat; scant sweating leads to difficult defecation. If the pulse is slow, purgation is still contraindicated.
Although the epigastrium is hard, if there are no other Interior signs and only Exterior signs remain, the disease is in the Yang level, termed "belonging to the Fu organs." One must first resolve the Exterior, then attack the fullness. "Sou" refers to urination. Do not promote diuresis due to fluid retention, as frequent urination will harden the stool. The Classics state: "Those with frequent urination inevitably have dry stools, due to the loss of Jin-Ye (Body Fluids)." Profuse sweating removes pathogen and reduces heat; scant sweating leaves pathogenic heat and loses fluids, leading to difficult defecation. Hard stool requires purgation, but if the pulse is slow, it is unready because slow indicates insufficiency and unfulfilled Interior Qi.
If the pulse is floating and surging, sweat oozes like oil, panting continues without rest, food and drink cannot enter, the body is insensible (numb), alternating between calmness and chaos, this is called "Life Exhaustion" (Ming Jue).
Some diseases are incurable because pathogen exceeds healthy Qi. The *Nei Jing* states: "A large pulse indicates pathogen arrival," and "A large pulse indicates disease progression." Floating and surging pulses indicate pathogen excess; sweat like oil and continuous panting indicate Healthy Qi exhaustion; the four seasons rely on Stomach Qi as the root; inability to take food/drink indicates Stomach Qi is exhausted; the whole body relies on Ying and Wei for fullness; bodily insensibility indicates Ying and Wei are severed. "Insensibility" means lack of pain or itch sensation. The *Zhen Jing* states: "When Ying and Wei do not circulate, there is insensibility." Struggle causes chaos, peace causes calmness; alternating calmness and chaos indicate Zheng (Healthy Qi) fighting Xie (Pathogen), with Zheng losing and Xie winning. With Healthy Qi exhausted, Stomach Qi gone, Ying and Wei severed, and Pathogen alone triumphant, it is called "Life Exhaustion."
It is unknown which Zang organ suffers first. If sweat wets the hair and panting continues, this is Lung exhaustion first.
The Lung is the master of Qi and the commander of Jin-Ye. Sweating and wet hair indicate Jin-Ye depletion; continuous panting indicates Qi depletion.
If Yang remains alone, the body appears smoked, eyes stare fixedly, and the head shakes, this is Heart exhaustion.
The Lung governs Qi, the Heart governs Blood. Qi is Yang, Blood is Yin. If Yang remains alone, the body becomes very hot, indicating Blood exhausted first while Qi remains. A body appearing smoked indicates lack of essence/nourishment, meaning Blood exhaustion fails to nourish the body. The Heart meridian runs along the throat and connects to the eyes; fixed staring indicates Heart Meridian exhaustion. The head is the meeting place of all Yang meridians; shaking head indicates Yin exhaustion and Yang having no root.
If lips and corners of the mouth turn blue, and limbs twitch/spasm, this is Liver exhaustion.
Lips and mouth corners are the external manifestation of the Spleen. Liver color is green; Liver exhaustion reveals its true color in the conquered area (Spleen governs lips/mouth). Limbs are governed by the Spleen. Liver governs sinews; Liver exhaustion causes sinew/tendon contraction, manifesting in the conquered area (Spleen governs limbs). "Xi Xi" refers to vibration, like spasms, where hands and feet constantly contract.
If the ring around the mouth is dark/black, and cold sweat turns yellow, this is Spleen exhaustion.
Spleen governs lips and mouth; exhaustion causes essence to depart, resulting in blackening around the mouth. "Rou" is Yin; Rou sweat is cold sweat. Spleen and Stomach are the root of Jin-Ye and the patriarch of Yang Qi. Cold sweat turning yellow indicates Spleen exhaustion, Yang depletion, and revelation of true color.
If urine and feces are incontinent, speech is delirious, and eyes roll back with fixed staring, this is Kidney exhaustion.
Kidney controls opening and closing, restraining urine and feces. Incontinence indicates Kidney Qi cannot restrain. Kidney stores Zhi (Will); delirious speech indicates loss of Will. The *Nei Jing* states: "Delirious speech is loss of Will. Loss of Will leads to death." The *Zhen Jing* states: "Essence-Qi of all five Zang organs ascends to the eyes; the essence of Bone manifests in the pupil." Fixed staring indicates Kidney exhaustion, where Bone essence fails to nourish the pupil, causing immobility.
It is unknown whether Yin or Yang exhausts first. If Yang exhausts first and Yin follows, death occurs with bluish body color; if Yin exhausts first and Yang follows, death occurs with reddish body color, warm armpits, and heat in the epigastrium.
Yang governs heat and red color; Yin governs cold and blue color. After death, a blue body indicates Yin has not left the body, hence "Yin exhausts last." A red body, warm armpits, and epigastric heat indicate Yang has not left the body, hence "Yang exhausts last." The *Zhen Jing* says: "Humans have two deaths but no dual life," referring to this phenomenon.
If Cun Kou pulse is floating and large, yet the physician uses purgation, this is a Major Deviation (Da Ni). Floating indicates bloodlessness; large indicates cold. When cold qi clashes, borborygmus occurs. Unaware, the physician gives cold water to induce profuse sweating. Water meets cold qi, clashing causes "Ai" (belching/hiccups).
The Classics state: "Floating and large pulses require sweating; purgation is a Major Deviation." Floating-large pulse indicates Exterior pathogen requiring sweating. Purgation attacks Healthy Qi, allowing deep pathogen penetration. Floating indicates blood loss post-purgation; large indicates cold pathogen remaining.
Cold pathogen enters due to Interior deficiency. Clashing cold qi causes borborygmus. Seeing a large pulse, the physician assumes heat and gives cold water to suppress heat via sweating. Pre-existing Interior deficiency-cold combined with cold water causes clashing, stagnating Middle Jiao Qi, leading to "Ai".
Fu Yang pulse floating indicates deficiency; floating-deficiency clash causes "Ai", indicating Stomach Qi exhaustion. Slippery pulse indicates hiccups (Yue). This is physician error: treating deficiency as excess, guarding emptiness, forcing blood. Floating pulse with dry nose indicates epistaxis.
Floating Fu Yang pulse causes "Ai"; slippery pulse causes hiccups. Both are errors of treating deficiency as excess. The *Nei Jing* states: "Yin inside is the guardian of Yang; Yang outside is the servant of Yin." Sweating attacks Yang, depletes Jin-Ye, leaving Yang insufficient—this is "guarding emptiness." The Classics state: "Exterior Qi slightly deficient, Interior Qi unguarded, allows pathogen to enter Yin." Yin fails to guard, pathogen enters, clashes with Yin Blood, Blood wanders. Floating pulse and dry nose indicate blood from nose.
Various floating-rapid pulses usually indicate fever with chills. If there is a painful spot but diet is normal, pus is accumulating.
Floating-rapid pulse indicates pathogen in meridians, usually fever. If accompanied by generalized pain and anorexia, it is Shang Han. If fever, aversion to cold, and pain are localized with normal diet, it is not Shang Han. Pathogen stagnates in meridians, blocking Qi and Blood, accumulating into abscess/pus.
Floating-slow pulse with facial flushing and trembling indicates resolution via sweating in 6-7 days. If fever persists, recovery is delayed. Slow indicates lack of Yang, inability to sweat, causing itching.
Floating pulse and flushed face indicate pathogen floating on Exterior. Slow pulse and trembling indicate intrinsic deficiency. Day 6-7 is when transmission ends and sweating resolves disease. Failure to sweat with persistent fever indicates Interior deficiency and scant Jin-Ye, unable to produce sweat. Pathogen has no exit, delaying recovery. Fever indicates pathogen on skin, causing itching. The Classics state: "Inability to produce slight sweat causes itching."
If Cun Kou pulse Yin and Yang are both tight, typically Qing (Clear) pathogen attacks Upper Jiao, Hun (Turbid) pathogen attacks Lower Jiao. Qing pathogen attacking Upper is called "Jie"; Hun pathogen attacking Lower is called "Hun." Yin receiving pathogen causes internal trembling due to slight Exterior deficiency and unguarded Interior. Yang receiving pathogen causes fever, headache, neck stiffness, lumbar pain, and leg soreness from fog/dew (Qing pathogen). Hun pathogen attacking Lower causes Yin trembling, cold feet/knees, and incontinence. Slight Exterior deficiency and Interior urgency mix the Three Jiaos, blocking interior/exterior. Upper Jiao stagnation causes heat steaming Zang organs, leading to oral ulcers. Middle Jiao dysfunction causes Stomach Qi rebellion and Spleen Qi failure, creating turbidity in Stomach, blocking Ying/Wei, causing blood stasis.
If Wei Qi flows first, urine is red/yellow, clashing with heat, traveling through meridians/organs, causing abscesses. If Yin Qi flows first, Yang Qi is厥 (Jue/Cold), Yin has no guide, external pathogen enters, causing sneezing, hoarseness, and throat blockage. Cold and Jue chase each other, suppressed by heat, causing bloody discharge like pig liver. Both Yang and Yin are Jue, Spleen Qi is weak, Five Fluids flow down, Lower Jiao fails to close, causing tenesmus and difficult urination, umbilical pain, threatening life.
Floating is Yang, Deep is Yin. Tight Yang pulse indicates fog/dew attacking Upper Jiao (Tai Yang). Tight Yin pulse indicates cold attacking Lower Jiao (Shao Yin). Symptoms described match these patterns. Due to slight Exterior/Interior deficiency, pathogen enters Yin, causing fear/trembling. *Nei Jing* states: "Yang diseases go up then down; Yin diseases go down then up." Upper/Lower Jiao pathogens interfere with Middle Jiao, causing confusion. San Jiao governs Qi; confusion blocks Qi flow. Dan Zhong is sea of Yang Qi; stagnation causes heat steaming Zang, leading to oral ulcers. Middle Jiao dysfunction leads to Stomach Qi rebellion. Spleen (Kun) aids digestion; failure causes turbidity. *Jin Gui Yao Lue* states: "Undigested grain causes turbidity in Stomach." Ying is refined grain essence; Wei is fierce grain Qi. Blockage causes blood stasis.
If Wei Qi flows first, heat travels, causing abscesses. If Yin Qi flows first, Yang is weak, failing to guard Exterior, cold enters. Nose is Lung indicator; cold in Lung meridian causes sneezing/hoarseness. External/Internal pathogens combine, heating and clotting blood, causing bloody discharge. Upper/Lower Jiao Jue leads to Spleen weakness, Five Zang deficiency, and fluid leakage. *Zhen Jing* states: "Five Zang disharmony causes fluids to overflow downward." Lower Jiao Qi depletion causes frequent, heavy urination. Umbilicus is source of Life Qi; pain indicates Life Qi nearing exhaustion.
If Yin/Yang pulses are both tight, with breath emission, dry lips/mouth, curled posture, cold feet, nasal discharge, and slippery tongue coating, do not treat rashly. By day 7, if mild fever and warm hands/feet appear, resolution is imminent. By day 8+, if high fever returns, it is difficult to treat.
Chills indicate impending vomiting; abdominal pain indicates impending diarrhea.
Tight Yin/Yang pulses indicate Exterior/Interior cold. Cold is Yin, resolved by Yang. Dry lips/mouth indicate recovering Yang Qi. Curled posture, cold feet, nasal discharge, and slippery coating indicate lingering Yin. Before Yin/Yang separation, avoid rash treatment. Day 7 mild fever/warm extremities indicate Yin exhausted, Yang recovered (resolution). Day 8+ high fever indicates Yin transforming to heat, pathogen exceeding Zheng (difficult). Tight Yang pulse indicates Upper Jiao cold; Tight Yin pulse indicates Lower Jiao cold. Chills indicate Upper Jiao cold (vomiting); abdominal pain indicates Lower Jiao cold (diarrhea).
With tight Yin/Yang pulses, if vomiting/diarrhea occur and pulse loosens, health returns (resolution). If pulse becomes slow by day 6-7 with anorexia, it is late onset due to fluid retention (unresolved). Normal appetite indicates resolution.
Tight pulses indicate severe cold. Post-vomit/diarrhea, loose pulse indicates resolution. Slow pulse with anorexia by day 6-7 indicates Spleen/Stomach deficiency post-fluid loss. *Nei Jing* describes Spleen/Stomach transport of fluids. Weak Spleen/Stomach causes fluid retention. "Late onset" refers to subsequent illness. Appetite by day 6-7 indicates harmonized Spleen/Stomach and dispersed cold (resolution).
On day 6-7, if pulses at Hand and Foot positions are all present, with great vexation, locked jaw, and inability to speak, restlessness indicates impending resolution.
Vexation indicates heat. During transmission, great vexation and restlessness indicate Yin/Yang struggle. Present pulses at all three positions indicate Zheng victory, Xie defeat, Yang recovery, and cold dispersion (resolution).
If pulse is harmonious, with great vexation, heavy eyelids, and yellow inner canthi, this is resolution.
*Mai Jing* states: "Yellow rising in eye corners indicates healing." Disease is determined by pulse. Yellow eyes + vexation + discordant pulse = pathogen excess (progression). Yellow eyes + vexation + harmonious pulse = Zheng harmony (resolution).
Floating-rapid pulse: Floating is Wind, Rapid is Deficiency. Wind is Heat, Deficiency is Cold. Wind-Deficiency clash causes chills.
*Nei Jing* states: "Presence is Excess, Absence is Deficiency." Qi merging lacks Blood; Blood merging lacks Qi. Wind injures Wei; Rapid indicates Blood deficiency. Floating-rapid pulse shows Wind merging with Wei, making Wei strong and Ying weak. Wei is Yang; Wind clashing Wei causes Heat. Ying is Yin; Ying deficiency causes Cold. Wind merging with Wei presents both fever and aversion to cold.
Floating-slippery pulse: Floating is Yang, Slippery is Excess. Yang-Excess clash causes rapid pulse, losing Wei regulation. Floating-slippery-rapid pulse with fever and sweating is incurable.
Floating indicates Wind merging with Wei (Wei strong); Slippery indicates Pathogen merging with Ying (Ying excess). Pathogen excess blocks Ying/Wei, speeding circulation, causing rapid pulse. Six beats per breath is rapid (normal is four). Wei Qi normally moves 6 cun/breath; now 9 cun. This deviation indicates Wei Qi loss of regulation. Fever/sweating should resolve; if not, Essence/Qi exhaustion makes it incurable. Classics state: "Pulse Yin/Yang both full, unresolved after profuse sweating, dies."
Shang Han with cough/rebellious Qi and scattered pulse indicates death due to physical deterioration.
*Qian Jin Fang* states: Cough/rebellious Qi is Lung disease; Scattered pulse is Heart pulse. Heart Fire punishing Lung Metal. *Nei Jing* states: Heart to Lung implies...