周禹载曰。内经刺热云。太阳之脉色荣颧骨。营未交。曰今且得汗。待时而已。与厥
阴争见者。死期不过三日。其热病内连肾。少阳之脉色荣颊前。热病也。营未交。
曰今且得汗。待时而已。与少阴脉争见者死。太阳之脉色属赤。初起时其色止
荣颧骨一处。不交他处。纯是赤色。曰今且得汗者。谓邪势渐从外解。即余证未
靖。少待而自解。言无害也。至于厥阴争见者。死不外三日。是为交已。热病大热
烦渴汗出。反见厥阴肝经之脉色。争见赤紫晦滞。已为主死。况争见青黑之色
耶。何者。少阳青色。少阴黑色也。争见者。命期甚促矣。又评热病论云。帝问曰。有
病温者。汗出辄复热。而脉躁疾。不为汗衰。狂言不能食。病名为何。夫帝既曰病
温矣。复曰病名为何者。正欲知病之本于阴阳也。岐伯曰。名阴阳交。交者死。何
也。交则不解也。谓人所以汗出者。生于精气也。精气者谷气也。邪正交争而得
汗者。是邪退而精气胜也。精气胜则能食而不复热。复热者邪胜。则是汗出不
为汗衰也。不能食者。精无俾也。病而留。其寿可立而倾也。故热病曰。汗出脉尚
躁盛者死。脉既不与汗应。此不胜病矣。其死必矣。狂言者是失志。失志者死。今
见三死。不见一生。虽愈必死也。此段论温。独创谷气之旨。谷气为精。精气为汗。
故藏精者不病温。其病温者。咸不藏精之人也。而有生有死者。不藏精甚与不甚之分也。
二阳搏。病温者。死不治。虽未入阴。不过十日死。二阳者。手足阳明也。
温病发于三阴。脉微足冷者难治。
温病大热。脉反细小。手足逆冷者死。
温病初起大热。目昏谵语。脉小足冷。五六日而脉反躁急。呕吐昏沉。失血痉搐。舌
本焦黑。脉促结代沉小者皆死。
温病汗后反热。脉反盛者死。
温病误发汗。狂言不能食。脉躁盛者皆不治。(以上春温死证)
热病七八日。脉微小。溲血。口中干。一日半而死。脉代者。一日死。
热病七八日。脉不躁或躁不散数。后三日中有汗。三日不汗。四日死。
热病已得汗。脉尚躁。喘且复热。喘甚者死。
热病不知痛处。耳聋不能自收持。口干阳热甚。阴颇有寒者。热在髓。死不治。
热病汗不出。大颧发赤。哕者死。
热病泄甚。而腹愈满者死。
热病目不明。热不已者死。
热病汗不出。呕吐下血者死。
热病舌本烂。热不止者死。
热病咳而衄。汗出不至足者死。
热病热而痉者死。腰折螈 齿噤 也。(以上夏热死证)
周禹载说:《内经·刺热篇》记载:“太阳经脉的色泽反映在颧骨部位,如果营气尚未与邪气交争,此时若能出汗,只需等待时辰到来病就会痊愈。”但如果出现与厥阴经脉色同时显现的情况,死亡期限不超过三天。这是因为热病内连肾脏,若少阳经脉色泽反映在脸颊前方,这是热病。同样,若营气未交争且得汗,待时而解;若与少阴脉色争见,则主死。
太阳经脉色泽属赤色。初起时,其红色仅反映在颧骨一处,不波及他处,呈现纯赤色。所谓“今且得汗”,是指邪气之势逐渐从体表解除,即使其他症状尚未完全平息,稍加等待自然会缓解,这表示无害。至于出现厥阴脉色争见的情况,死亡不出三日,这是因为阴阳之气已经交争。热病表现为大热、烦渴、汗出,反而出现厥阴肝经的脉色,呈现出赤紫晦滞之象,这已经是主死的征象,更何况是出现青黑之色呢?为什么呢?因为少阳对应青色,少阴对应黑色。脉色争见,意味着生命期限非常短促。
又《评热病论》记载:黄帝问:“患有温病的人,出汗后随即再次发热,脉搏躁动疾速,不因出汗而减弱,胡言乱语,不能进食,这种病叫什么名字?”既然黄帝已经说是“病温”了,为什么又问“病名为何”?这正是为了探知疾病的根本在于阴阳的关系。岐伯回答说:“名叫阴阳交。‘交’意味着死亡。”为什么呢?因为“交”表示邪气不解。人之所以出汗,是因为精气的作用。精气来源于水谷之气。邪正相争而得出汗,说明邪气退却而精气占优势。精气占优势就能进食且不再发热。如果再次发热,说明邪气占优势,这就是出汗后热度并未减退的原因。不能进食,是因为精气得不到补充。病邪滞留体内,寿命很快就会终结。所以热病篇说:“出汗后脉搏仍然躁动旺盛的,主死。”脉搏既然不与出汗相应,说明正气不胜病邪,死亡是必然的。胡言乱语是神志丧失的表现,神志丧失则死。现在出现了三种死证(汗出脉躁、狂言、不能食),却没有看到一丝生机,即使暂时好转,最终也必死无疑。这段论述温病的文字,独创性地提出了“谷气”的理论。谷气即为精,精气化为汗。因此,能固藏精气的人不得温病;患温病的人,都是不能固藏精气的人。而有生有死的区别,在于不藏精的程度深浅不同。
二阳脉搏动剧烈,患温病的,属于死症无法治疗。即使病邪尚未传入阴经,不过十天也会死亡。“二阳”指的是手阳明大肠经和足阳明胃经。温病发于三阴经,脉象微弱、脚冷的,难以治疗。
温病初起高热,眼睛昏花、胡言乱语,脉小脚冷,五六日后脉象反而躁急,呕吐、昏沉、失血、痉挛抽搐,舌根焦黑,脉象促、结、代、沉、小的,都主死。
温病误用发汗法,出现胡言乱语、不能进食、脉象躁动的,都属不治之症。(以上是春温的死证)
热病七八日,脉象微小,尿血,口中干燥,一天半后死亡。脉象出现代脉的,一天后死亡。
热病七八日,脉象不躁动,或者躁动但不散乱急促,之后三天中有汗出的,若三天无汗,第四天死亡。
热病已经出汗,脉象仍然躁动,气喘且再次发热,气喘严重的死亡。
热病不知道疼痛的部位,耳聋不能自主控制肢体,口干且阳热甚重,阴分颇有寒意的,热邪在骨髓,主死无法治疗。
热病不出汗,两颧发红,呃逆的,主死。
热病腹泻严重,腹部反而胀满的,主死。
热病眼睛不明亮,热势不退的,主死。
热病舌根溃烂,热势不止的,主死。
Zhou Yucai stated: The *Neijing* (Inner Canon) chapter "Acupuncture for Heat" records: "When the color of the Taiyang meridian manifests on the cheekbones, if Ying Qi has not yet interacted with pathogenic factors, and sweating occurs at this time, one need only wait for the appropriate time for recovery." However, if the pulse colors of Jueyin appear simultaneously, death will occur within three days. This is because heat disease internally connects to the Kidney. If the Shaoyang meridian's color manifests on the front of the cheeks, it indicates heat disease. Similarly, if Ying Qi has not interacted and sweating occurs, recovery comes with waiting; but if the pulse colors of Shaoyin appear in contention, it indicates death.
The color of the Taiyang meridian belongs to Red. At the onset, the redness is confined solely to the cheekbones, not spreading elsewhere, presenting as pure red. The phrase "if sweating occurs now" implies that the pathogenic factor is gradually resolving from the exterior. Even if other symptoms are not yet settled, they will resolve naturally after a short while, indicating no harm. Conversely, when Jueyin pulse colors appear in contention, death occurs within three days, signifying that Yin and Yang have interacted. Heat disease presents with high fever, irritability, thirst, and sweating. If the pulse colors of the Jueyin Liver Meridian appear instead, showing dull, stagnant purple-red hues, this is already a sign of impending death. How much more so if green-black colors appear? Why? Because Shaoyang corresponds to Green, and Shaoyin corresponds to Black. Contending pulse colors indicate a very short life expectancy.
Furthermore, the *Ping Re Bing Lun* (Discourse on Evaluating Heat Diseases) records: The Yellow Emperor asked, "In patients suffering from warm disease, sweating is followed immediately by recurrent fever. The pulse is rapid and restless, not subsiding with sweat. There is delirium and inability to eat. What is the name of this disease?" Since the Emperor had already identified it as "warm disease," why ask for its name again? This was precisely to understand the root of the disease in terms of Yin and Yang. Qibo replied, "It is named 'Yin-Yang Interaction' (Yin Yang Jiao). 'Interaction' signifies death." Why? Because 'interaction' means the pathogen does not resolve. Sweating originates from Essence-Qi. Essence-Qi derives from Grain Qi. When fighting between pathogenic and healthy factors results in sweating, it means the pathogen retreats and healthy Qi prevails. If healthy Qi prevails, the patient can eat and fever will not recur. Recurrent fever indicates pathogenic victory, meaning sweat fails to reduce the fever. Inability to eat means Essence lacks support. With disease stagnation, life ends swiftly. Thus, the Heat Disease chapter states: "If the pulse remains rapid and vigorous after sweating, death ensues." Since the pulse does not correspond with sweating, healthy Qi cannot overcome the disease, making death inevitable. Delirium indicates loss of Shen (Spirit); loss of Spirit leads to death. Now, three signs of death are present (rapid pulse after sweat, delirium, inability to eat), with no sign of life remaining. Even if there is temporary improvement, death is certain. This discussion on warm disease uniquely proposes the concept of "Grain Qi." Grain Qi becomes Essence, and Essence transforms into sweat. Therefore, those who store Essence well do not contract warm disease; those who do are individuals failing to store Essence. The difference between life and death lies in the degree of this failure.
If the Er Yang (Two Yang) pulses are forceful and beating strongly, warm disease is incurable and fatal. Even if the pathogen has not entered the Yin meridians, death occurs within ten days. "Er Yang" refers to the Hand-Yangming Large Intestine Meridian and Foot-Yangming Stomach Meridian. Warm disease originating in the Three Yin meridians, with faint pulses and cold feet, is difficult to treat.
In warm disease with high fever, if the pulse is unexpectedly fine and small, and hands and feet are cold, it indicates death.
At the onset of warm disease with high fever, if there is visual impairment and delirium, small pulse, and cold feet, and after five to six days the pulse becomes unexpectedly rapid and restless, accompanied by vomiting, stupor, hemorrhage, and spasms, with a blackened tongue root, and pulses that are hurried, knotted, intermittent, deep, or small, all indicate death.
If warm disease recurs with fever after sweating, and the pulse becomes unexpectedly vigorous, it indicates death.
If warm disease is mistakenly treated with diaphoresis, resulting in delirium, inability to eat, and a rapid/vigorous pulse, it is untreatable. (These are fatal syndromes of Spring Warmth.)
In heat disease lasting seven to eight days, if the pulse is minute, there is hematuria, and dry mouth, death occurs within half a day. If the pulse is intermittent (Dai Mai), death occurs within one day.
In heat disease lasting seven to eight days, if the pulse is not rapid, or if it is rapid but not scattered/rapid, and sweating occurs within the following three days, but ceases after three days, death occurs on the fourth day.
If heat disease has produced sweat, but the pulse remains rapid, accompanied by wheezing and recurrent fever, severe wheezing indicates death.
In heat disease where the pain location is unknown, deafness prevents self-control, the mouth is dry, Yang heat is excessive, yet Yin shows signs of cold, the heat resides in the Marrow, indicating death and untreatability.
In heat disease without sweating, if the malar region turns red and hiccups occur, it indicates death.
In heat disease with severe diarrhea, if abdominal distension worsens, it indicates death.
In heat disease, if vision is unclear and fever persists, it indicates death.
In heat disease without sweating, if vomiting and lower bleeding occur, it indicates death.
In heat disease, if the tongue root ulcerates and fever persists, it indicates death.
In heat disease with coughing and epistaxis, if sweating does not reach the feet, it indicates death.
In heat disease, if fever is accompanied by spasm, it indicates death, manifesting as opisthotonos, convulsions, and trismus. (These are fatal syndromes of Summer Heat.)