【脉】 阳浮而阴弱，谓之伤风。邪在六经俱强，加之风伤阳，故浮虚。阳浮，
阴弱，营气弱也。浮紧而无汗，谓之伤寒。寒伤营，营实则卫虚。寒伤阴，故坚牢。阳紧，
邪在上焦，主欲呕；阴紧，邪在下焦，必欲利。
脉浮，头项痛，腰脊强，病在太阳。脉长，身热目痛鼻干，病在阳明。脉弦，胸胁痛而
耳聋，病在少阳。脉俱沉，口燥舌干，邪在少阴。脉俱微缓，烦满囊缩，邪在厥阴。脉俱沉
细，嗌干腹满，邪在太阴。脉阴阳俱盛，重感于寒而紧涩，变为温疟。阴阳俱盛，伤寒之脉
，前病热未已，后寒复盛也。脉阳浮滑，阴濡弱，更遇于风乘，变为风温。阳浮而滑，阴濡
而弱，皆风脉也，前热未歇，风来乘热。脉阳洪数，阴实大，遇湿热两合，变为温毒。洪数
、实大，皆两热相合。脉阳濡阴弱而阴弦紧，更遇温气，变为温疫。
病发热，脉沉而细，表得太阳，名曰痉。病太阳身热疼，脉微弱、弦芤，名曰中 。病若发汗已，身灼然热，名曰
风温，风温为病，脉阴阳俱浮，自汗出，身重多眠，睡鼾，语难
则惊痫，时螈 。若火熏则死。病
水，狂闷，名是阳厥。脉当有神，不问数极、迟败，当中有力即有神焉。神者，血气之先。伤寒热甚，脉浮大者生，沉
小者死；已汗，沉小者生，浮大者死。温病二三日，体热腹满头痛，饮食如故，脉直而疾者，八日死。温病八九日，头
身不痛，目不赤，色不变而反利，脉来牒牒，
来细强，十二日死。温病汗不出，出不至足者死。厥汗出，肾脉
七八日，不汗躁狂，口舌暴燥焦黑，脉反细或代者死。八日以上反大热，死。邪胜故也。热病七八日
者死。热病得汗，
日，脉不躁，喘不数，后三日中有汗。不汗者，四日死。热病脉涩小疾，腹满 胀
大绝，喘而短气，大衄不止，腹中疼，死。热病脉浮洪
身热甚，死。热病脉小疾，咳喘眩悸，夺形肉，身热，死。热病腹胀便血
者，死。热病脉转小，身热甚，死。热病脉转小，身热甚，咳而便血，目陷，妄言，循衣缝，躁扰不卧，死。热病呕血，
咳而烦满，身黄
气胜也。身体如油，正气脱也。喘而不休，水浆不下，胃气尽也。体麻不仁，营
绝也。
热病喘咳唾血，手足腹肿面黄，振栗不言，名肺绝，死。丁日死，后仿此。热病头痛呕
，呕逆吐血，水浆不入口，狂妄，腹大满，名脾绝，死。热病烦满骨痛，嗌肿不可咽，欲咳
不能咳，歌笑而哭，名心绝，死。热病僵卧，足不安地，呕血，血妄行，遗屎溺，名肝绝，
死。热病喘悸吐逆，骨痛短气，目视不明，汗如珠，肾绝，死。
太阳病，脉反躁盛，是阴阳交，死；得汗，脉静者生。少阴病，恶寒而蜷，下利，手足
死。又吐利躁逆者，死。少阴病，四逆，恶寒而蜷。其脉不至，不烦而躁者死。少阴病，下
利止而头眩，时时自冒者死。又七八日息高者死。少阴病，脉微沉细，但欲卧，汗出不烦，
自欲吐，五六日自利烦躁，不得卧寐者死。若利止，恶寒而蜷，手足温者，可活。少阴病，
下利止，厥逆无脉不烦、服汤药，其脉暴出者死；微续者生。伤寒下利厥逆，躁不得卧者死
；下利至厥不止者死。伤寒厥逆，六七日不利，便发热而利者生。汗出利不止者死，有阴无
阳故也。伤寒五六日，不结胸，腹濡，脉虚，复厥者不可下，下之亡血，死。热病不知所痛
，不能自收，口干阳热甚，阴颇有寒者死。热病在肾，渴，口干，舌燥黄赤，日夜饮水不
知，腹大胀尚饮，目无精光者死。伤寒下利，日十余行，脉反实者死。病者胁下素有痞，而
下至于脐旁，痛引小腹入阴挟筋，为脏结者死。结胸证具，而烦躁者死。直视谵语，喘满者
【因】 房劳、辛苦之过，腠理开泄，少阴不藏，触冒冬时杀厉之气，严寒之毒。
病，曰伤寒，不即病，寒毒藏于肌肤之间，至春变为温，至夏变为热病。皆肾水涸，春无以
发生故也。皆热不得发泄，郁于内，遇感而发，虽曰伤寒，实为热病。春病温疫，夏为热病
及飧泄，秋发 疟，冬生咳嗽，皆因感四时不正之气，总名之曰伤寒。
【证治】 自外而入，内传经络。
太阳证，头疼，发热恶寒，腰脊强。脉浮而紧，无汗，谓之伤寒，可汗，宜麻黄汤。脉
缓自汗，谓之伤风，宜桂枝汤。忌利小便、重汗、下大便。
阳明证，身热目疼，鼻干不得卧，不恶风寒而自汗。尺寸脉俱长，宜白虎汤。浮沉按之
有力，宜大承气汤。胃，血也，不主汗、利。忌汗，利小便。
少阳证，往来寒热，胸胁痛而呕，耳聋，脉弦，宜和解之，小柴胡汤。胆无出入水火之
间，下犯太阳，汗、下、利皆不可。忌利小便，忌汗，忌利大便。
太阴证，腹满咽干，手足自温，自利不渴，时腹痛，脉沉细，其脏寒，宜四逆汤。脉浮
可汗，宜桂枝汤。又大实痛，可下，用详。忌三法，宜三法，用详。
少阴证，口噤，舌干而渴，脉沉实，宜大承气汤。脉沉细迟者，宜用温之，四逆汤。身
脉沉细而虚，宜泻心汤。身热，烦躁不宁，大小便自利，脉浮洪无力，按之全无，宜附子泻
心汤。其吐泻不渴，脉浮弱，理中汤主之。渴而脉沉，有力而疾，宜五苓散。少阴证，脉沉
发热，当汗，麻黄细辛附子汤。少阴证，下利色不青，当温；色青口燥，当下。脉弱忌下；
厥阴证，烦满而囊缩，大小便不通，发热引饮腹满，脉俱微沉实，按之有力，当下；无
力，当温。厥阴乃二阴交尽，曰厥阴，为生化之源，喜温而恶清。
大抵三阴非胃实不可下，此三阴无传经，止胃实可下也。
太阳，标本不同。标热，太阳发热；本寒，膀胱恶寒。故宜汗。阳明，从中气。标阳，
；本实，妄语。标阳，故宜解肌；本实，故宜下。少阳，标阳，发热；本火，恶寒。前有阳
明，后有太阴，故宜和解。太阴，标阴；本湿，腹胀满，或嗌干，身目黄。从标治则温；从
本治宜泄满下湿。少阴，标阴，爪甲清冷；本热，脉沉实，口干渴。标宜温，本宜下。厥阴
，中气宜温；烦满囊缩，故为热，宜苦辛下之。
麻黄、桂枝之辈，汗而发之。葛根、升麻之属，因其轻而扬之。三承气、陷胸之辈，引
之。泻心、十枣之类，中满泄之。在表宜汗，在里宜下，在半表半里宜和。表多里少，和而
少汗之。里多表少，和而微下之。在上者，吐之。中气与脉气微者，温之。脉亦同法，又当
求本。假令腹痛，用桂枝芍药汤。何不只用芍药？却于桂内加之。要知从太阳中来，故太阳
为本。又如结胸，麻黄亦然。
刘法∶分病及脉。以五脏言之，诸在皮者，汗之，麻黄汤内加表之。在内者，下之。麻
辛附子汤内加下之。此言藏者，五脏也。可通经入脏。物之藏者，腑也，方可下。麻黄汤，
治外证之外，麻黄细辛附子汤，治内证之外。肝脉外证，善洁，面青，善怒，脉弦，前方加
羌活、防风三钱。内证，满秘便难，淋溲，转筋，沉而弦，后方加同前。心脉外证，面赤，
口干，善笑，脉沉而洪，前方加黄芩、石膏各三钱。内证，烦心，心痛，掌中热而哕，脉沉
，后方加同前。肺脉外证，面白，善嚏，悲愁欲哭，脉浮而涩，前方加姜、桂各三钱。内证
，喘咳，洒淅寒热，脉沉，后方加生姜、桂枝。脾脉外证，面黄，善噫，善思味，脉浮而缓
，前方加白术、汉防己。内证，腹胀满，食不消，怠惰，脉沉。后方加同前。肾脉外证，面
黑，善恐，脉浮，前方加附子、生姜。内证，泄如注，下重胫寒，脉沉，后方加同前。
以前外证，皆表之表，汗而发之；内证者，里之表也，渍形以汗，如脉沉，复有里证。
为发热引饮，便利赤涩，泄下赤水，或秘，按之内痛，此为里证。宜速下之，根据方加大黄三
钱。如邪又未尽，复加大黄二钱。
刘、张又相继论∶人多劳役饥饱者，得之火化、火扰。治之宜以辛凉。比及年少性急
劳役
之。表里证有相似，药不可差。伤寒表证，发热恶寒而渴，独头痛，身热，目疼，鼻干，不
得卧，乃阳明经病也，白虎汤主之。杂证，里证亦同。但目赤者，脏病也。脉亦洪大，甚则
吐血，先有形也。乃手太阴肺不足，不能管领阳气，亦以枸杞、地黄等物治之。补泻当察虚
实。假如洪弦相杂，洪，客也，弦，主也。子能令母实。又脉弦无表证，是东方实，西方虚
也。又前来者，为实邪。根据此补泻，余仿此行之。
表汗，通圣散、双解散。半表半里，凉膈散、柴胡汤。里下，右手脉实，承气汤；左手
脉实，抵当汤。不分浮沉，但实可用。
血气俱实，主三承气汤；温，四逆汤、真武汤；解利，五苓散、解毒散、白虎汤、甘露
饮、栀子汤；发黄，茵陈汤。
伤寒得伤风脉，伤风得伤寒脉。假如太阳证，头疼，身热，自汗，恶风，脉当缓而反紧
，是伤风得伤寒脉也。余以例推之。桂枝麻黄各半汤、羌活汤尤妙。
吐 瓜蒂散∶瓜蒂 赤小豆
豆豉汤下一钱。
结胸，脉浮大者，不可下之，下之必死。
小陷胸汤 半夏 连（姜汁炒） 栝蒌实
大陷胸汤 炒大黄（五钱） 苦葶苈（炒，三钱） 芒硝（一钱） 杏仁（十二个）
丸如弹子大。每服一丸，入甘遂末三字，蜜半匙，水煎，至半温服。
【脉象】 脉象阳部浮而阴部弱，称为伤风。邪气在六经都表现为强盛，加之风邪损伤阳气，所以脉象浮而虚。阳浮、阴弱，说明营气虚弱。脉象浮紧且无汗，称为伤寒。寒邪损伤营分，营分实则卫分虚。寒邪损伤阴分，所以脉象坚牢。阳部脉紧，说明邪气在上焦，主症想呕吐；阴部脉紧，说明邪气在下焦，必然想要腹泻。
脉象浮，头项痛，腰脊僵硬，病在太阳经。脉象长，身体发热，眼睛痛，鼻子干，病在阳明经。脉象弦，胸胁痛且耳聋，病在少阳经。脉象俱沉，口燥舌干，邪气在少阴经。脉象俱微缓，烦闷且阴囊收缩，邪气在厥阴经。脉象俱沉细，咽喉干、腹部胀满，邪气在太阴经。脉象阴阳两部都盛大，再次感受寒邪而变得紧涩，转变为温疟。阴阳两部都盛大，是伤寒的脉象，前一种病的余热未消，后一种寒邪又盛发。脉象阳部浮滑，阴部濡弱，再遇到风邪侵袭，转变为风温。阳部浮而滑，阴部濡而弱，都是风邪的脉象，前一种热邪未歇，风邪乘热而来。脉象阳部洪数，阴部实大，遇到湿热两相合，转变为温毒。洪数、实大，都是两种热邪相合。脉象阳部濡、阴部弱且阴部弦紧，再遇到温气，转变为温疫。
病人发热，脉象沉而细，表证属于太阳，名叫痉病。患太阳病身体发热疼痛，脉象微弱、弦芤，名叫中暍（中暑）。如果已经发过汗，身体灼热，名叫风温。风温这种病，脉象阴阳两部都浮，自汗出，身体沉重多睡，睡觉打鼾，说话困难，就会惊痫，时而抽搐。如果用火熏疗法则会死亡。患水病，狂乱闷乱，名叫阳厥。脉象应当有神，不论脉率极快或极慢败坏，只要中间有力就是有神。神，是血气的前兆。伤寒热势很盛，脉象浮大的能活，沉小的会死；已经发过汗，脉象沉小的能活，浮大的会死。温病二三天，身体发热、腹部胀满、头痛，饮食如常，脉象直而疾速的，八天会死。温病八九日，头身不痛，眼睛不红，面色不变反而腹泻，脉来急促，来势细而强劲，十二天会死。温病不出汗，出汗不到足部的会死。厥逆出汗，肾脉出现于七八日，不出汗且躁狂，口舌突然干燥焦黑，脉象反而细或代脉的会死。八日以上反而大热的，会死。这是邪气胜的缘故。热病七八日会死。热病得汗，脉不躁动，喘促不频繁，后三天中有汗。不出汗的，四天会死。热病脉象涩小疾速，腹部胀大如绝，喘促且短气，大量鼻出血不止，腹中疼痛，会死。热病脉象浮洪，身体热势很盛，会死。热病脉象小疾，咳嗽气喘眩晕心悸，形体肌肉消瘦，身体发热，会死。热病腹胀便血的，会死。热病脉象转小，身体热势很盛，会死。热病脉象转小，身体热势很盛，咳嗽且便血，眼睛凹陷，胡言乱语，摸寻衣缝，躁扰不能卧床，会死。热病呕血，咳嗽且烦闷，身体发黄，是肺气胜的表现。身体像油一样，是正气脱失的表现。喘促不停，水浆不进，是胃气耗尽的表现。身体麻木不仁，是营气断绝的表现。
热病气喘咳嗽唾血，手足腹部肿胀面黄，颤抖栗动不言语，名叫肺绝，会死。丁日死，其余脏腑仿照此例。热病头痛呕吐，呕逆吐血，水浆不能入口，狂妄，腹部大满，名叫脾绝，会死。热病烦闷骨痛，咽喉肿痛不可吞咽，想咳不能咳，唱歌笑而哭，名叫心绝，会死。热病僵卧，脚不能着地，呕血，血液妄行，大小便失禁，名叫肝绝，会死。热病气喘心悸吐逆，骨痛短气，视力不明，汗如珠状，肾绝，会死。
太阳病，脉象反而躁盛，这是阴阳交争，会死；得汗后，脉象平静的能活。少阴病，恶寒且蜷缩，下利，手足冷会死。又有呕吐下利躁逆的，会死。少阴病，四肢逆冷，恶寒且蜷缩。脉象摸不到，不烦躁但躁动的会死。少阴病，下利停止但头晕，时常自觉昏冒的会死。又有七八日呼吸高远的会死。少阴病，脉象微沉细，只想睡觉，出汗不烦躁，自己想吐，五六天自利烦躁，不能卧床睡眠的会死。如果下利停止，恶寒且蜷缩，手足温暖的，可以存活。少阴病，下利停止，厥逆无脉，不烦躁，服用汤药后，脉象突然暴出的会死；脉象逐渐恢复微续的能活。伤寒下利厥逆，躁动不能卧床的会死；下利至厥逆不止的会死。伤寒厥逆，六七天不下利，突然发热而下利的能活。出汗下利不止的会死，这是因为有阴无阳的缘故。伤寒五六日，不结胸，腹部柔软，脉象虚，又厥逆的不可攻下，攻下会导致亡血，会死。热病不知道哪里痛，不能自我收摄，口干阳热很盛，阴分颇有寒气的会死。热病在肾，口渴，口干，舌燥黄赤，日夜饮水不知满足，腹部大胀尚且饮水，眼睛没有精光的会死。伤寒下利，一天十多次，脉象反而实大的会死。病人胁下素有痞块，而且下至于脐旁，疼痛牵引小腹入阴挟筋，为脏结的会死。结胸证具备，但烦躁的会死。直视谵语，喘满的……
【病因】 房事劳累、辛苦过度，腠理开泄，少阴不藏，触冒冬季时杀厉之气，严寒之毒。患病，叫作伤寒，如果不立即发病，寒毒藏在肌肤之间，到春天变为温病，到夏天变为热病。都是因为肾水枯竭，春天无法发生生发之气。都是因为热邪不得发泄，郁积在内，遇感而发，虽然叫作伤寒，实为热病。春天病温疫，夏天为热病及飧泄，秋天发疟疾，冬天生咳嗽，都是因为感受四时不正之气，总名之叫作伤寒。
【证治】 病邪从外而入，内传经络。
太阳证，头疼，发热恶寒，腰脊僵硬。脉象浮而紧，无汗，叫作伤寒，可发汗，宜用麻黄汤。脉象缓自汗，叫作伤风，宜用桂枝汤。忌利小便、重发汗、攻下大便。
阳明证，身体发热眼睛痛，鼻子干不能卧，不恶风寒而自汗。尺寸脉象俱长，宜用白虎汤。浮沉按之有力，宜用大承气汤。胃属血，不主汗、利。忌发汗，忌利小便。
少阳证，往来寒热，胸胁痛且呕，耳聋，脉弦，宜和解，用小柴胡汤。胆位于水火之间，下犯太阳，汗、下、利皆不可用。忌利小便，忌发汗，忌利大便。
太阴证，腹部胀满咽干，手足自温，自利不渴，时常腹痛，脉象沉细，其脏寒，宜用四逆汤。脉象浮可发汗，宜用桂枝汤。又大实痛，可攻下，用法详见下文。忌三法，宜三法，用法详见下文。
少阴证，口噤，舌干而渴，脉象沉实，宜用大承气汤。脉象沉细迟者，宜用温法，四逆汤。身体脉象沉细而虚，宜用泻心汤。身体发热，烦躁不宁，大小便自利，脉象浮洪无力，按之全无，宜用附子泻心汤。其吐泻不渴，脉象浮弱，理中汤主治。渴而脉沉，有力而疾，宜用五苓散。少阴证，脉沉发热，当发汗，用麻黄细辛附子汤。少阴证，下利色不青，当温；色青口燥，当下。脉弱忌下。
厥阴证，烦满而阴囊收缩，大小便不通，发热引饮腹满，脉象俱微沉实，按之有力，当下；无力，当温。厥阴乃二阴交尽，叫作厥阴，为生化之源，喜温而恶清。
大抵三阴经非胃实不可攻下，这三阴经无传经，只有胃实才可攻下。
太阳，标本不同。标热，太阳发热；本寒，膀胱恶寒。所以宜发汗。阳明，从中气。标阳，妄语。标阳，所以宜解肌；本实，所以宜攻下。少阳，标阳，发热；本火，恶寒。前有阳明，后有太阴，所以宜和解。太阴，标阴；本湿，腹胀满，或咽喉干，身目黄。从标治则温；从本治宜泄满下湿。少阴，标阴，爪甲清冷；本热，脉沉实，口干渴。标宜温，本宜下。厥阴，中气宜温；烦满囊缩，所以为热，宜苦辛攻下。
麻黄、桂枝之类，发汗发散。葛根、升麻之属，因其轻而扬之。三承气、陷胸之类，引之。泻心、十枣之类，中满泄之。在表宜发汗，在里宜攻下，在半表半里宜和解。表多里少，和解而少发汗。里多表少，和解而微攻下。在上者，吐之。中气与脉气微者，温之。脉也同此法，又应当求本。假令腹痛，用桂枝芍药汤。为何不只用芍药？却在桂枝中加入。要知道是从太阳经来的，所以太阳为本。又如结胸，麻黄亦然。
刘完素之法：区分病及脉。以五脏言之，诸在皮者，汗之，麻黄汤内加发表药。在内者，下之。麻黄细辛附子汤内加攻下药。此言藏者，指五脏。可通经入脏。物之藏者，指腑，方可攻下。麻黄汤，治外证之外，麻黄细辛附子汤，治内证之外。肝脉外证，爱清洁，面青，易怒，脉弦，前方加羌活、防风三钱。内证，满秘便难，淋溲，转筋，脉沉而弦，后方加同前。心脉外证，面赤，口干，易笑，脉沉而洪，前方加黄芩、石膏各三钱。内证，烦心，心痛，掌中热而哕，脉沉，后方加同前。肺脉外证，面白，易嚏，悲愁欲哭，脉浮而涩，前方加姜、桂各三钱。内证，喘咳，洒淅寒热，脉沉，后方加生姜、桂枝。脾脉外证，面黄，易噫，好思味，脉浮而缓，前方加白术、汉防己。内证，腹胀满，食不消，怠惰，脉沉。后方加同前。肾脉外证，面黑，易恐，脉浮，前方加附子、生姜。内证，泄如注，下重胫寒，脉沉，后方加同前。
以前外证，皆表之表，发汗发散；内证者，里之表也，渍形以汗，如脉沉，复有里证。为发热引饮，便利赤涩，泄下赤水，或便秘，按之内痛，此为里证。宜速攻下，根据方加大黄三钱。如邪未尽，复加大黄二钱。
刘完素、张元素又相继论述：人多劳役饥饱者，得之火化、火扰。治之宜以辛凉。比及年少性急劳役……表里证有相似，药不可差。伤寒表证，发热恶寒而渴，独头痛，身热，目疼，鼻干，不得卧，乃阳明经病也，白虎汤主之。杂证，里证亦同。但目赤者，脏病也。脉亦洪大，甚则吐血，先有形也。乃手太阴肺不足，不能管领阳气，亦以枸杞、地黄等物治之。补泻当察虚实。假如洪弦相杂，洪，客也，弦，主也。子能令母实。又脉弦无表证，是东方实，西方虚也。又前来者，为实邪。根据此补泻，余仿此行之。
表汗，通圣散、双解散。半表半里，凉膈散、柴胡汤。里下，右手脉实，承气汤；左手脉实，抵当汤。不分浮沉，但实可用。
血气俱实，主三承气汤；温，四逆汤、真武汤；解利，五苓散、解毒散、白虎汤、甘露饮、栀子汤；发黄，茵陈汤。
伤寒得伤风脉，伤风得伤寒脉。假如太阳证，头疼，身热，自汗，恶风，脉当缓而反紧，是伤风得伤寒脉也。余以例推之。桂枝麻黄各半汤、羌活汤尤妙。
大陷胸汤 炒大黄（五钱）、苦葶苈（炒，三钱）、芒硝（一钱）、杏仁（十二个）
丸如弹子大。每服一丸，入甘遂末三字，蜜半匙，水煎，至半温服。
[Pulse] A pulse that is floating at the Yang position and weak at the Yin position is called Wind Injury (Shang Feng). When pathogenic factors affect all six meridians, they manifest as strong; additionally, wind damages Yang Qi, resulting in a floating and deficient pulse. Floating Yang and weak Yin indicate deficiency of Ying Qi (Nutritive Qi). A pulse that is floating and tight with no sweating is called Cold Injury (Shang Han). Cold damages the Ying level, making Ying full and Wei level deficient. Cold damages Yin, resulting in a firm and solid pulse. Tightness at the Yang position indicates pathogenic factors in the Upper Jiao, primarily causing nausea; tightness at the Yin position indicates pathogenic factors in the Lower Jiao, inevitably causing diarrhea.
A floating pulse with headache in the head and neck, and stiffness in the waist and spine, indicates disease in the Taiyang (Greater Yang) meridian. A long pulse with body heat, eye pain, and nasal dryness indicates disease in the Yangming (Yang Brightness) meridian. A wiry pulse with chest and hypochondriac pain and deafness indicates disease in the Shaoyang (Lesser Yang) meridian. Pulses that are both deep indicate dry mouth and tongue, with pathogenic factors in the Shaoyin (Lesser Yin) meridian. Pulses that are both slightly slow indicate irritability, fullness, and retraction of the scrotum, with pathogenic factors in the Jueyin (Terminal Yin) meridian. Pulses that are both deep and fine indicate dry throat and abdominal fullness, with pathogenic factors in the Taiyin (Greater Yin) meridian. Pulses that are both abundant at Yin and Yang positions, becoming tight and choppy after secondary exposure to cold, transform into Warm Malaria (Wen Nüe). Abundant pulses at both Yin and Yang positions characterize Cold Injury; if the heat from the previous illness has not subsided and cold becomes prevalent again, it is this condition. A pulse that is floating and slippery at the Yang position and soft and weak at the Yin position, upon further encounter with wind, transforms into Wind-Warmth (Feng Wen). Floating and slippery at Yang, soft and weak at Yin, are both wind pulses; if previous heat has not ceased and wind comes to exploit the heat. A pulse that is surging and rapid at the Yang position and solid and large at the Yin position, upon encounter with damp-heat combining, transforms into Warm-Toxicity (Wen Du). Surging-rapid and solid-large both indicate the combination of two types of heat. A pulse that is soft at Yang, weak at Yin, and wiry-tight at Yin, upon further encounter with warm qi, transforms into Warm Epidemic (Wen Yi).
If a patient has fever with a deep and fine pulse, and the exterior syndrome belongs to Taiyang, it is named Spasm Disease (Jing Bing). If suffering from Taiyang disease with body heat and pain, and a pulse that is weak, wiry, or hollow, it is named Heat Stroke (Zhong Shu). If sweating has already been induced and the body feels burning hot, it is named Wind-Warmth. In Wind-Warmth disease, the pulse is floating at both Yin and Yang positions, there is spontaneous sweating, heavy body, excessive sleepiness, snoring during sleep, and difficulty speaking, leading to convulsive epilepsy and occasional twitching. If treated with fire moxibustion/fumigation, death will ensue. Suffering from Water Disease (Edema) with mania and oppression is named Yang Reversal (Yang Jue). The pulse should possess Shen (Spirit/Vitality); regardless of whether it is extremely rapid or extremely slow/degenerate, if it has strength in the middle, it possesses Shen. Shen is the precursor of Blood and Qi. In Cold Injury with severe heat, a floating and large pulse indicates survival, while a deep and small pulse indicates death; after sweating, a deep and small pulse indicates survival, while a floating and large pulse indicates death. In Warm Disease on the second or third day, with body heat, abdominal fullness, headache, but normal diet, a straight and rapid pulse indicates death on the eighth day. On the eighth or ninth day of Warm Disease, if the head and body do not hurt, eyes are not red, complexion does not change but diarrhea occurs, and the pulse comes rapidly, thin yet strong, death will occur on the twelfth day. If Warm Disease presents with no sweating, or sweating that does not reach the feet, death ensues. In Reversal (Jue), sweating occurs; if Kidney pulse appears on the seventh or eighth day without sweating, accompanied by mania and restlessness, sudden dryness and blackening of the mouth and tongue, and a pulse that is suddenly fine or intermittent, death ensues. If after eight days there is a return to intense heat, death ensues due to pathogenic excess. Death occurs in Heat Disease on the seventh or eighth day. If Heat Disease presents with sweating, non-restless pulse, non-frequent panting, and sweating within the next three days, survival is possible; if no sweating occurs, death ensives on the fourth day. If Heat Disease presents with a choppy, small, and rapid pulse, abdominal distension and enlargement as if severed, panting and shortness of breath, continuous severe epistaxis, abdominal pain, death ensues. If Heat Disease presents with a floating and surging pulse and intense body heat, death ensues. If Heat Disease presents with a small and rapid pulse, cough, panting, dizziness, palpitations, emaciation, and body heat, death ensues. If Heat Disease presents with abdominal distension and bloody stool, death ensues. If Heat Disease presents with a turning small pulse and intense body heat, death ensues. If Heat Disease presents with a turning small pulse, intense body heat, cough, bloody stool, sunken eyes, delirium, grasping at bedclothes, restlessness preventing lying down, death ensues. If Heat Disease presents with hematemesis, cough, irritability, fullness, and yellowing of the body, it indicates Lung Qi excess. If the body feels oily, it indicates collapse of Righteous Qi. If panting is unceasing and fluids cannot be taken, it indicates exhaustion of Stomach Qi. If the body is numb and insensible, it indicates severance of Ying Qi.
If Heat Disease presents with panting, cough, spitting blood, swelling of hands, feet, and abdomen, yellow face, trembling and silence, it is named Lung Exhaustion (Fei Jue), leading to death on Ding days, and similarly for other organs. If Heat Disease presents with headache, vomiting, retching, hematemesis, inability to take fluids, mania, and abdominal fullness, it is named Spleen Exhaustion (Pi Jue), leading to death. If Heat Disease presents with irritability, bone pain, swollen throat unable to swallow, desire to cough but inability, singing/laughing then crying, it is named Heart Exhaustion (Xin Jue), leading to death. If Heat Disease presents with stiff lying, feet unable to touch the ground, hematemesis, random bleeding, and incontinence, it is named Liver Exhaustion (Gan Jue), leading to death. If Heat Disease presents with panting, palpitations, vomiting/reversal, bone pain, shortness of breath, unclear vision, and sweat like pearls, it is named Kidney Exhaustion (Shen Jue), leading to death.
In Taiyang Disease, if the pulse is reversely restless and abundant, it is Yin-Yang Intersection (Yin Yang Jiao), leading to death; if sweating occurs and the pulse becomes calm, survival is indicated. In Shaoyin Disease, aversion to cold with curling up, diarrhea, and cold extremities lead to death. Vomiting, diarrhea, restlessness, and reversal also lead to death. In Shaoyin Disease with cold extremities, aversion to cold, and curling up, if the pulse is absent and there is restlessness without irritability, death ensues. In Shaoyin Disease, if diarrhea stops but dizziness occurs with frequent fainting spells, death ensues. Also, if respiration becomes high after seven or eight days, death ensues. In Shaoyin Disease, with a micro-deep-fine pulse, desire to sleep, sweating without irritability, and desire to vomit, if spontaneous diarrhea and irritability occur on the fifth or sixth day preventing sleep, death ensues. However, if diarrhea stops, there is aversion to cold and curling up, but extremities are warm, survival is possible. In Shaoyin Disease, if diarrhea stops, there is reversal with no pulse and no irritability; after taking decoction, if the pulse suddenly emerges, death ensues; if it gradually recovers, survival is indicated. In Cold Injury with diarrhea and reversal, restlessness preventing sleep leads to death; if diarrhea continues until reversal persists, death ensues. In Cold Injury with reversal, if there is no diarrhea for six or seven days and sudden fever with diarrhea occurs, survival is indicated. Sweating with unceasing diarrhea leads to death due to having Yin without Yang. In Cold Injury on the fifth or sixth day, if there is no Chest Binding, abdomen is soft, pulse is deficient, and reversal occurs, purgation is contraindicated; purging will cause loss of blood and death. In Heat Disease where the patient cannot locate pain, cannot self-regulate, has dry mouth with intense Yang heat, and significant Yin cold, death ensues. If Heat Disease affects the Kidney, with thirst, dry mouth, dry yellow-red tongue, drinking day and night without satisfaction, abdominal distension despite drinking, and lack of luster in the eyes, death ensues. In Cold Injury with diarrhea occurring more than ten times a day, if the pulse is reversely solid, death ensues. If a patient has a chronic mass under the hypochondrium extending to beside the umbilicus, with pain radiating to the lower abdomen and genitals involving tendons, known as Zang Binding (Zang Jie), death ensues. If Chest Binding symptoms are complete but irritability occurs, death ensues. Fixed gaze and delirium with panting and fullness...
[Etiology] Overexertion from sexual activity or hard labor causes pores to open, Shaoyin fails to store, and one is exposed to the killing energy of winter and the toxicity of severe cold. This illness is called Cold Injury. If it does not manifest immediately, the cold toxin hides between the skin and muscles; in spring it transforms into Warm Disease, and in summer into Heat Disease. All result from the depletion of Kidney Water, preventing the generative energy of spring. All result from heat failing to vent, stagnating internally, and erupting upon exposure. Although called Cold Injury, it is essentially Heat Disease. Spring Warm Epidemics, Summer Heat Diseases and Sudden Diarrhea, Autumn Malaria, and Winter Coughs are all caused by contracting the abnormal Qi of the four seasons, collectively named Cold Injury.
[Syndrome and Treatment] Pathogens enter from the exterior and transmit internally to the meridians.
Taiyang Syndrome: Headache, fever, aversion to cold, stiffness in waist and spine. Pulse floating and tight, no sweating, named Cold Injury; induce sweating with Mahuang Tang. Pulse slow with spontaneous sweating, named Wind Injury; use Guizhi Tang. Contraindicate promoting urination, heavy sweating, and purging bowels.
Yangming Syndrome: Body heat, eye pain, nasal dryness, inability to lie down, no aversion to wind/cold but spontaneous sweating. Long pulses at Cun and Chi positions; use Baihu Tang. Strong pulse upon floating, sinking, and pressing; use Dachengqi Tang. The Stomach governs Blood and does not govern sweating or urination. Contraindicate sweating and promoting urination.
Shaoyang Syndrome: Alternating chills and fever, chest/hypochondriac pain, vomiting, deafness, wiry pulse; harmonize with Xiaochaihu Tang. The Gallbladder is between water and fire; attacking Taiyang below makes sweating, purging, and promoting urination inadvisable. Contraindicate promoting urination, sweating, and purging bowels.
Taiyin Syndrome: Abdominal fullness, dry throat, warm extremities, spontaneous non-thirsty diarrhea, occasional abdominal pain, deep-fine pulse, cold Zang; use Sini Tang. If pulse is floating, induce sweating with Guizhi Tang. For severe fullness/pain, purge (see details). Contraindicate three methods, apply three methods (see details).
Shaoyin Syndrome: Jaw lock, dry tongue with thirst, deep-solid pulse; use Dachengqi Tang. Deep-fine-slow pulse; warm with Sini Tang. Deep-fine-deficient body pulse; use Xiexin Tang. Body heat, irritability, normal urination/defecation, floating-surging-powerless pulse vanishing on pressure; use Fuzi Xiexin Tang. Vomiting/diarrhea without thirst, floating-weak pulse; Lizhong Tang governs. Thirst with deep pulse, strong and rapid; use Wuling San. Shaoyin Syndrome with deep pulse and fever, when sweating is needed; use Mahuang Xixin Fuzi Tang. Shaoyin Syndrome with non-green colored diarrhea, warm; green color with dry mouth, purge. Weak pulse contraindicates purging.
Jueyin Syndrome: Irritability/fullness with scrotal retraction, constipation/urinary retention, fever with thirst and abdominal fullness, micro-deep-solid pulse strong on pressure, purge; if weak, warm. Jueyin is the end of two Yins, named Jueyin, source of generation, prefers warmth and dislikes cooling.
Generally, the Three Yin meridians are not purged unless there is Stomach Excess; these Three Yins have no meridian transmission, only Stomach Excess warrants purging.
Taiyang: Biao (Branch) differs from Ben (Root). Biao Heat causes Taiyang fever; Ben Cold causes Bladder aversion to cold. Hence sweating is suitable. Yangming: Follows Middle Qi. Biao Yang causes delirium; Biao Yang requires muscle-releasing; Ben Solid requires purging. Shaoyang: Biao Yang causes fever; Ben Fire causes aversion to cold. Preceded by Yangming, followed by Taiyin, hence harmonizing is suitable. Taiyin: Biao Yin; Ben Dampness causes abdominal fullness, or dry throat, jaundice. Treating Biao uses warming; treating Ben drains fullness and dampness. Shaoyin: Biao Yin causes cold nails; Ben Heat causes deep-solid pulse, dry mouth/thirst. Biao requires warming, Ben requires purging. Jueyin: Middle Qi requires warming; irritability/scrotal retraction indicates heat, requiring bitter-acrid purging.
Mahuang and Guizhi release via sweating. Gegen and Shengma lift due to lightness. Three Chengqi and Xianxiong guide downwards. Xiexin and Shizao drain central fullness. Exterior requires sweating, Interior requires purging, Half-Exterior/Half-Interior requires harmonizing. More Exterior/Less Interior: Harmonize with slight sweating. More Interior/Less Exterior: Harmonize with slight purging. Upper Jiao: Induce vomiting. Deficient Middle/Qi pulse: Warm. Pulse follows same method, seek the Root. E.g., abdominal pain uses Guizhi Shaoyao Tang. Why not just Shaoyao? Because Guizhi is added. Know it originates from Taiyang, so Taiyang is Root. Similarly for Chest Binding, Mahuang applies.
Liu's Method: Differentiate disease and pulse. Speaking of Five Zang, diseases in skin/surface: sweat, add exterior herbs to Mahuang Tang. Diseases inside: purge, add interior herbs to Mahuang Xixin Fuzi Tang. "Zang" refers to Five Zang, penetrating meridians to Zang. "Fu" refers to Bowels, suitable for purging. Mahuang Tang treats exterior syndromes; Mahuang Xixin Fuzi Tang treats interior syndromes. Liver Meridian Exterior Syndrome: cleanliness preference, blue face, anger, wiry pulse; add Qianghuo, Fangfeng 3 qian to front formula. Interior Syndrome: fullness/constipation, difficult urination, spasms, deep-wiry pulse; add same to back formula. Heart Meridian Exterior Syndrome: red face, dry mouth, laughter, deep-surging pulse; add Huangqin, Shigao 3 qian each to front formula. Interior Syndrome: vexed heart, heart pain, hot palms, hiccups, deep pulse; add same to back formula. Lung Meridian Exterior Syndrome: white face, sneezing, sadness/crying, floating-choppy pulse; add Jiang, Gui 3 qian each to front formula. Interior Syndrome: panting/cough, chills/fever, deep pulse; add Shengjiang, Guizhi to back formula. Spleen Meridian Exterior Syndrome: yellow face, belching, overthinking, floating-slow pulse; add Baizhu, Hanfangji to front formula. Interior Syndrome: abdominal fullness, indigestion, lethargy, deep pulse; add same to back formula. Kidney Meridian Exterior Syndrome: black face, fear, floating pulse; add Fuzi, Shengjiang to front formula. Interior Syndrome: pouring diarrhea, heaviness/cold calves, deep pulse; add same to back formula.
Previous exterior syndromes are surface-of-surface, released by sweating; interior syndromes are surface-of-interior, steaming form to sweat. If pulse is deep with interior signs: fever with thirst, red/astringent urine, bloody watery diarrhea or constipation, internal pain on pressure, this is Interior Syndrome. Purge quickly, add Dahuang 3 qian to base formula. If pathogen remains, add Dahuang 2 qian more.
Liu and Zhang discussed successively: People with labor/fasting-fullness issues suffer Fire transformation/disturbance. Treat with Acrid-Cool. Young people with急躁/labor... Exterior/Interior signs are similar, drugs must not differ. Cold Injury Exterior Syndrome: fever, aversion to cold, thirst, isolated headache, body heat, eye pain, nasal dryness, insomnia, is Yangming Meridian disease, governed by Baihu Tang. Miscellaneous diseases, Interior signs are same. But red eyes indicate Zang disease. Pulse is also surging-large, even hematemesis, prior physical signs exist. It is Hand-Taiyin Lung deficiency, unable to manage Yang Qi, treat with Gouqi, Dihuang etc. Tonify/Purge must observe deficiency/excess. E.g., surging-wiry mixed: Surging is guest, Wiry is host. Son makes Mother solid. Also, wiry pulse without exterior signs indicates East Excess, West Deficiency. Approaching pulse indicates Excess Pathogen. Apply tonification/purgation accordingly, others follow.
Exterior sweating: Tongsheng San, Shuangjie San. Half-Exterior/Half-Interior: Liangge San, Chaihu Tang. Interior purging: Right hand solid pulse, Chengqi Tang; Left hand solid pulse, Didang Tang. Regardless of floating/sinking, if solid, usable.
Blood-Qi both solid: Governed by Three Chengqi Tang; Warm: Sini Tang, Zhenwu Tang; Resolve/Detox: Wuling San, Jiedu San, Baihu Tang, Ganlu Yin, Zhizi Tang; Jaundice: Yincheng Tang.
Cold Injury acquiring Wind Injury pulse, Wind Injury acquiring Cold Injury pulse. E.g., Taiyang syndrome: headache, body heat, spontaneous sweating, aversion to wind, pulse should be slow but is tight; this is Wind Injury acquiring Cold Injury pulse. Deduce others by example. Guizhi Mahuang Ban Tang, Qianghuo Tang are excellent.
Vomiting: Guiti San: Guiti, Chixiaodou, Douchi Decoction takes 1 qian.
Chest Binding: If pulse is floating-large, do not purge; purging leads to death.
Xiao Xianxiong Tang: Banxia, Lian (stir-fried with ginger juice), Gualou Shi.
Da Xianxiong Tang: Stir-fried Dahuang (5 qian), Ku Tingli (stir-fried, 3 qian), Mangxiao (1 qian), Xingren (12 pieces). Pill size of bullet. Take one pill per dose, add Gansui powder 3 zhu, half spoon honey, decoct in water, take warm when half remaining.