乱，精神散也。此皆命绝之候。由此推之，脉虽浮洪，必然无根，是为真脏孤阳飞越之诊也。
【集注】王肯堂曰∶火之将灭也必明，脉来浮洪涌盛，此将去人体之兆也，然又必兼下一二证，始可断其命绝。
阳反独留，形体如烟熏，直视摇头者，此心绝也。
【注】心绝阴尽，惟阳独留，故身体大热，形如烟熏，从火化也。心藏神，直视，神去也。头属阳，阳无
所根据，故摇头也。
【集注】成无己曰∶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。
【注】唇吻之色当赤而黄，反见青色者，木土相克也。四肢汗出 不已，此为肝绝也。
【集注】成无己曰∶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，发于所胜也。
方有执曰∶口唇边曰吻。四肢，手足也。 ，汗出貌。习，鸟数飞也，言手足颤摇如鸟之习飞，奋振而不已也。
环口黧黑，柔汗发黄者，此为脾绝也。
【注】脾之华在唇四白，环口黧黑，其华萎矣！冷汗、阴黄，皆脾绝也。
【集注】方有执曰∶口为脾之窍，黧黑者，熏黄黑暗，土败之色也。柔汗，俗谓冷汗是也。
张锡驹曰∶脾主四白，环口黧黑，土败而水侮也。柔汗者，柔软而腻，脾之真液，黄者脾之真色，真液泄
而真色见，故为脾绝也。
溲便遗失，狂言，目反直视者，此为肾绝也。
【注】肾司二便，溲便遗失，肾绝也。肾藏精与志，狂言直视，精志俱败也。
【集注】方有执曰∶溲便，遗尿也。肾司阖辟，阖辟废，故二便皆无禁约也。经曰∶肾藏志，狂言者，是
失志矣，失志者死。肾主骨，骨之精为瞳子，目反直视者，骨之精不上荣于瞳子，而不能转也。
问曰∶上工望而知之，中工问而知之，下工脉而知之，原闻其说。师曰∶病家人请云；病患苦发热，身体
疼。病患自卧，师到诊其脉，沉而迟者，知其瘥也。何以知之？若表有病者，脉当浮大，今脉反沉迟，故知愈也。
【注】此下皆详望问而知之之类也。望谓观其形之盛衰，色之深浅；问谓询其情之苦欲，病之根因；脉谓
诊其脉之阴阳，合乎形色也。设病家人来请，告以病者苦发热，身体疼，师到病患自卧，诊其脉沉而迟，知其
瘥也。何以知之？表有病脉当浮大，今反沉迟而无表脉，且无表证，故知愈也。
【集注】张锡驹曰∶有问发热身疼，脉反沉迟，是阳病而见阴脉，何以说得愈也？答曰∶是必望其有恬然
嗜卧之状，问其有热除身轻之意，而后合脉以断其愈也。
假令病患云∶腹内卒痛。病患自坐，师到脉之，浮而大者，知其瘥也。何以知之？若里有病者，脉当沉而
细，今脉浮大，故知愈也。
【注】病家人来请，告以病者腹内卒痛，医师到，病患自坐无苦容，诊其脉浮而大，知其差也。何以言之？
里有病，脉当沉细，今反浮大而无里脉，且无里证，故知愈也。
师曰∶病家人来请云∶病患发热烦极，明日师到，病患向壁卧，此热已去也。设令脉不和，处言已愈。
【按】不和当是“自和”，若不和如何言愈。
【注】此申上二条之义也。病家人来言病者发热烦极，师未即去，明日到，病患向壁静卧，此热已去，因
知其差。假令脉不和缓，未可言愈，必和缓而始可断其已愈也，推之腹痛亦然。此篇首所云∶设有不应，消息
诊看。消息者，谓今日之望，异于昨日之问闻也。
假令向壁卧，闻师到，不惊起而盼视，若三言三止，脉之咽唾者，此诈病也。假令脉自和，处言此病大重，
当须服吐、下药，针灸数十百处乃愈。
【注】此设治诈病之法也。盖仲景不欲人售其欺，亦不欲医为其欺而妄治也。医者玩此而揣摩之，则彼不
敢欺，而我不妄治矣。
【集注】程知曰∶彼以诈病，我以诈治，非良工不能具是巧也。
师持脉，病患欠者，无病也。脉之呻者，病也。言迟者，风也。摇头言者，里痛也。行迟者，表强也。
坐而伏者，短气也。坐而下一脚者，腰痛也。里实护腹，如怀卵物者，心痛也。
【注】阴阳相引故欠，欠者先引气入而后呵之，故谓之呵欠。阴阳不相引则病，相引则和，故曰∶欠者
无病也。诊脉时，有呻吟
病苦之声，故曰∶呻者病也。言迟者，语言謇涩，故曰∶言迟者，风也。摇头言者，痛极艰于发声，摇头以意
示缓，故曰∶摇头言者，里痛也。行迟者，风病筋络不利，故曰；行迟者，表强也。坐而伏者，气不能接，故
曰∶坐而伏者，短气也。凡腰痛者，皆不能坐，即略坐非伸足根据倚不可，故曰∶坐而下一脚者，腰痛也。凡心
痛者，皆伛偻护其痛处，故曰∶里实护腹，如怀卵物者，心痛也。
【集注】方有执曰∶舌强则言迟，经络牵急则舌强。筋挛则经络拘急，肝属木，其合筋，其主风。头属
阳，里属阴，头摇者，阴不与阳和也。短气者，里不足也。此条八者，皆望而知之之事也。
张志聪曰∶师持脉者，犹言师但持脉而不问也。八条皆察人之神情，得人之病机，所谓望而知之者。
问曰∶人恐怖者，其脉何状？师曰∶脉形如循丝累累然，其面白脱色也。
【注】人病恐怖者，阳神不足也。阳不足则恐，神不足则怖，恐则血随气下，故面白脱色不润泽也；怖
则气随神乱，故脉形如循丝累累然而乱也。
【集注】方有执曰∶恐怖，惶惧也。循，理治也，丝，言细也。累累，联系貌。脱色，犹言失色也。盖
内气馁者，则外色夺，所以有卒然之变也。
程应旄曰∶此示人察色合脉之法，恐则气下神被夺矣，故脉细而且不定，面色白而且脱也。
问曰∶人不饮，其脉何类？师曰∶脉自涩，唇口干燥也。
【注】津液少则脉涩，唇口因以干燥，此因不饮而然，非由此而不饮也。
【集注】程应旄曰∶不饮如与人 气，至二三日汤水不沾唇之类。肺失游溢精气，故脉涩而唇口干燥也。
问曰∶人愧者，其脉何类？师曰∶脉浮，而面色乍白乍赤。
【注】愧者，羞也。羞则神色荡而不定，故脉浮，而面色乍白乍赤也。此皆察色合脉，以意消息而知之之类也。
【集注】程应旄曰∶以上数条，不论有病无病，凡人有所负于中，辄复形之色与脉也。于此推之，以意消
息，则诸病之情，无不可即外以征内矣。
问矣∶脉有灾怪，何谓也？师曰∶假令人病，脉得太阳，与形证相应，因为作汤，比还送汤如食顷，病患
乃大吐，若下利，腹中痛。师曰∶我前来不见此证，今乃变异，是名灾怪。又问曰∶何缘作此吐利？答曰∶或
有旧时服药，今乃发作，故名灾怪耳。
【注】脉有灾怪，谓因药而变灾怪也。假令人病太阳病，得太阳脉，脉证相应，因为作太阳病汤药与服之；
比还，如食顷，病患乃大吐下利，腹中痛，师问曰∶我先来不见此证，今乃灾变怪异，缘何作此吐利？病者
答曰∶或有旧时服药，今乃发作，故为此灾怪耳！望、问固医家之事，亦须病患毫无隐讳，方能尽医所长。仲
景为病家服药未告于医，医失问先服何药，故出此条以示戒耳！
【集注】成无己曰∶医以脉证与药相对，而反变异为其灾可怪，故名灾怪。
张志聪曰∶脉得太阳与形证相应者，如太阳病，脉浮头项强痛而恶寒，此脉与形证相应也。或有旧时服药，
今乃发作者，言送汤如食顷，所投之药未周于经，必旧时服药之故也。
脉象散乱，是精神涣散的表现。这些都是生命终结的征兆。由此推断，脉象虽然浮大洪盛，但必然无根，这是真脏之气孤阳飞越的诊断指征。
【集注】王肯堂说：火即将熄灭时必定会突然明亮，脉象来势浮大洪涌且盛大，这是即将离开人体的征兆，然而必须兼见下面的一两个证候，才可以断定生命终结。
阳气反而独自留存，形体面色如烟熏般晦暗，两眼直视、摇头不止的，这是心气绝灭。
【注】心气绝则阴液耗尽，只有阳气独自留存，所以身体极度发热，形体像烟熏一样，这是从火化所致。心藏神，两眼直视，说明神气已去。头属阳，阳气无所依托，所以出现摇头。
【集注】成无己说：心脉沿着咽喉连接眼睛，两眼直视，说明心经之气绝灭。头是诸阳经汇聚的地方，摇头说明阴气绝灭而阳气没有根基。
嘴唇和口角发青，四肢抽搐颤动的，这是肝气绝灭。
【注】嘴唇和口角的颜色应当是赤中带黄，如果反而见到青色，这是木（肝）克土（脾）的表现。四肢出汗不止，这是肝气绝灭。
【集注】成无己说：嘴唇和口角是脾的外候，肝的颜色是青色，肝气绝灭则真色显现于它所克的部位（脾主唇四白）。四肢由脾所主，肝主筋，肝气绝灭则筋脉拘急牵引，表现在它所克的部位。
方有执说：口唇边缘叫吻。四肢，指手和脚。习，是出汗的样子；习，像鸟多次飞翔，意思是手足颤抖摇动像鸟在练习飞翔，奋起振动不停止。
口周发黑，出冷汗、汗色发黄的，这是脾气绝灭。
【注】脾的精华中显露于口唇四周，口周发黑，说明其精华已经枯萎！冷汗、阴黄，都是脾气绝灭的表现。
【集注】方有执说：口是脾的窍道，黧黑是指熏黄变黑暗，这是土气败坏的颜色。柔汗，俗称冷汗。
张锡驹说：脾主管口唇四周，口周发黑，是土气败坏而被水气反侮。柔汗，质地柔软而黏腻，是脾的真液；黄色是脾的真色，真液外泄而真色显露，所以称为脾气绝灭。
大小便失禁，胡言乱语，眼球上翻直视的，这是肾气绝灭。
【注】肾主管二便，大小便失禁，说明肾气绝灭。肾藏精与志，胡言乱语、两眼直视，说明精与志都败坏了。
【集注】方有执说：溲便，指遗尿。肾主管开阖，开阖功能废弛，所以大小便都不能控制。经文说：肾藏志，胡言乱语，就是失去了志；失去志的人必死。肾主骨，骨的精华表现为瞳孔，眼球上翻直视，说明骨的精华不能上荣于瞳孔，而不能转动。
问：上等医生望而知之，中等医生问而知之，下等医生脉而知之，我想听听其中的道理。老师说：病人的家属来说：“病人痛苦于发热，身体疼痛。”病人自己躺着，医生到来诊察他的脉象，脉沉而迟的，知道病将要痊愈。为什么这样知道？如果表证有病，脉应当浮大，现在脉反而沉迟，所以知道痊愈了。
【注】以下内容都是详细阐述通过望诊和问诊来判断病情的一类。望，是指观察形体的盛衰、颜色的深浅；问，是指询问病情的苦乐、疾病的根源；脉，是指诊察脉象的阴阳，使之与形色相符合。假设病人的家属前来请求，告知病人痛苦于发热、身体疼痛，医生来到后看到病人自己躺着，诊察其脉象沉而迟，就知道病将痊愈。为什么这样知道？表证有病脉应当浮大，现在反而沉迟且没有表脉，而且没有表证，所以知道痊愈了。
【集注】张锡驹说：有问发热身疼，脉反而沉迟，这是阳病见到阴脉，为什么说痊愈呢？回答说：这一定是观察到病人有安静嗜睡的状态，询问到有热退身轻的意思，然后结合脉象来判断痊愈。
假如病人说：“腹内突然疼痛。”病人自己坐着，医生到来诊察脉象，脉浮大的，知道病将痊愈。为什么这样知道？如果里有病，脉应当沉细，现在脉浮大，所以知道痊愈了。
【注】病人的家属前来请求，告知病人腹内突然疼痛，医师来到后，看到病人自己坐着没有痛苦的表情，诊察其脉象浮大，就知道病将痊愈。为什么这样说？里有病，脉应当沉细，现在反而浮大且没有里脉，而且没有里证，所以知道痊愈了。
老师说：病人的家属前来请求说：“病人发热烦躁至极。”第二天医生到来，病人面向墙壁静卧，这说明热邪已经去除。假如脉象不和缓，也宣告已经痊愈。
【按】“不和”应当是“自和”，如果不和怎么能说痊愈呢。
【注】这是申述上面两条的意义。病人家属说病人发热烦躁至极，医生还没有离开，第二天到来，病人面向墙壁安静地躺着，这说明热邪已经去除，因此知道病愈。假如脉象不缓和，还不能说痊愈，必须脉象和缓才可以断定为已愈，推及腹痛也是如此。本篇开头所说的：假设有不符合的情况，要仔细斟酌诊察。斟酌，是说今天的望诊，不同于昨天的问诊听闻。
假如面向墙壁躺着，听到医生到来，不惊起而是用眼角看，如果说话三句停三次，诊脉时吞咽唾液的，这是装病。假如脉象自然平和，医生宣告此病很重，必须服用催吐、泻下的药物，针灸数十上百个穴位才能痊愈。
【注】这是假设治疗装病的方法。大概张仲景不想让人欺骗他，也不想医生被欺骗而胡乱治疗。医生玩味这条内容并揣摩其中的道理，那么病人就不敢欺骗，而我也不会胡乱治疗了。
【集注】程知说：对方以装病应对，我以假装治疗回应，不是优秀的医生不能具备这种技巧。
医生诊脉时，病人打哈欠的，是没有病。诊脉时呻吟的，是有病。说话迟缓的，是有风病。说话时摇头的，是里有痛症。行走迟缓的，是表证强急。坐着伏身的，是短气。坐着时一只脚垂下的，是腰痛。腹部充实护住腹部，像怀着蛋物一样的，是心痛。
【注】阴阳相互牵引故打哈欠，打哈欠是先吸入气然后呵出，所以叫呵欠。阴阳不相引则有病，相互牵引则调和，所以说：打哈欠的是没有病。诊脉时，有呻吟的痛苦声音，所以说：呻吟的是有病。说话迟缓，语言謇涩，所以说：说话迟缓的是风病。说话时摇头，是因为疼痛极甚难以发声，摇头示意缓解，所以说：说话时摇头的是里有痛症。行走迟缓，是风病导致筋络不利，所以说：行走迟缓的是表证强急。坐着伏身，是气不能接续，所以说：坐着伏身的是短气。凡是腰痛的人，都不能坐稳，即使稍微坐也不是伸直脚依靠不可，所以说：坐着时一只脚垂下的是腰痛。凡是心痛的人，都弯腰护住疼痛处，所以说：腹部充实护住腹部，像怀着蛋物一样的是心痛。
【集注】方有执说：舌强则说话迟缓，经络牵急则舌强。筋挛则经络拘急，肝属木，合筋，主风。头属阳，里属阴，头摇，是阴不与阳和谐。短气，是里气不足。这八条，都是通过望诊来判断病情的事项。
张志聪说：医生诊脉，犹言医生只诊脉而不问诊。这八条都是观察人的神情，获取人的病机，所谓望而知之。
问：人感到恐惧时，脉象是什么样子？医生说：脉象像顺着丝线一颗颗相连的样子，面色苍白失去血色。
【注】人生病感到恐惧，是阳神不足。阳不足则恐，神不足则怖，恐则血随气下行，所以面色苍白失去润泽；怖则气随神乱，所以脉象像顺着丝线一颗颗相连而紊乱。
【集注】方有执说：恐怖，是惶惧。循，梳理治理，丝，形容细。累累，联系的样子。脱色，犹言失色。大概内气气馁，则外在神色被剥夺，所以有突然的变化。
程应旄说：这是展示人察色合脉的方法，恐则气下神被剥夺，所以脉细而且不定，面色白而且脱失。
问：人不喝水，脉象是什么样？医生说：脉象自然涩滞，嘴唇和口腔干燥。
【注】津液少则脉涩，嘴唇和口腔因此干燥，这是因不喝水造成的，不是因为由此而不喝水。
【集注】程应旄说：不喝水就像与人斗气，到了两三天连汤水都不沾唇之类。肺失去游溢精气，所以脉涩而嘴唇和口腔干燥。
问：人感到羞愧时，脉象是什么样？医生说：脉浮，而且面色忽白忽红。
【注】愧，就是羞。羞则神色动荡不定，所以脉浮，而且面色忽白忽红。这都是察色合脉，凭心意斟酌判断的一类。
【集注】程应旄说：以上几条，不论有病无病，凡人心中有亏欠，就会表现于颜色和脉象上。由此推断，凭心意斟酌，那么各种病情的情况，没有不可以从外部征验内部的。
问：脉有灾怪，是什么意思？医生说：假如有人生病，脉象得到太阳脉，与形体证候相应，于是为他配制汤药，等到送汤药回来大约一顿饭的时间，病人却剧烈呕吐，或者腹泻，腹中疼痛。医生说：我先前没见到这个证候，现在竟然变异，这叫灾怪。又问：为什么会发生这种呕吐腹泻？回答说：或者是以前服过药，现在才发作，所以名叫灾怪。
【注】脉有灾怪，谓因为服药而变生灾怪。假如有人患太阳病，得到太阳脉，脉证相应，于是为太阳病配制汤药给他服用；等到送药回来，大约一顿饭的时间，病人却剧烈吐泻，腹中疼痛，医生问：我先前没见到这个证候，现在竟然灾变怪异，为何发生这种吐泻？病人回答说：或许有旧时服过药，现在才发作，所以为此灾怪！望、问固然是医生的事，但也需要病人毫无隐讳，才能充分发挥医生的特长。张仲景因为病家服药未告诉医生，医生失于询问先服了什么药，所以提出这一条以示警戒！
【集注】成无己说：医生以脉证与药物相对，反而变异成为灾怪，所以名叫灾怪。
张志聪说：脉得太阳与形证相应，如太阳病，脉浮、头项强痛而恶寒，这就是脉与形证相应。或者有旧时服药，现在才发作的，是说送药回来大约一顿饭的时间，所投的药物尚未在经脉中周流完毕，必然是旧时服药的缘故。
Disordered pulse indicates the scattering of spirit. These are all signs of the extinction of life. From this, we can deduce that although the pulse may appear floating and surging (Hong), it must be rootless; this is the diagnostic sign of the isolated Yang of the Zang organs flying away (Zhen Zang Gu Yang Fei Yue).
[Collected Notes] Wang Kentang said: When fire is about to extinguish, it must shine brightly. A pulse that comes floating, surging, and vigorous is a sign that the body is about to depart. However, one or two of the following symptoms must also be present before concluding that life has ended.
Yang remains alone while Yin is exhausted; the body appears dark like smoke, with fixed staring eyes and shaking head—this indicates the exhaustion of Heart Qi.
[Note] When Heart Qi exhausts, Yin fluids are depleted, leaving only Yang alone. Thus, the body becomes extremely hot, and the form appears dark like smoke, transforming from Fire. The Heart stores Spirit; fixed staring eyes indicate the departure of Spirit. The Head belongs to Yang; when Yang has no foundation, the head shakes.
[Collected Notes] Cheng Wuji said: The Heart meridian runs along the throat and connects to the eyes. Fixed staring eyes indicate the exhaustion of the Heart meridian. The Head is the meeting point of all Yang meridians; shaking head indicates the exhaustion of Yin and the lack of a root for Yang.
The lips and corners of the mouth turn cyan, and the four limbs twitch and tremble—this indicates the exhaustion of Liver Qi.
[Note] The color of the lips and mouth should be red with yellow undertones. If cyan appears instead, it indicates Wood (Liver) overcoming Earth (Spleen). Continuous sweating from the four limbs indicates the exhaustion of Liver Qi.
[Collected Notes] Cheng Wuji said: The lips and mouth are the external manifestations of the Spleen. The color of the Liver is cyan; when Liver Qi exhausts, its true color appears in the area it overcomes (the Spleen governs the lips and mouth). The four limbs are governed by the Spleen, while the Liver governs the sinews. When Liver Qi exhausts, the sinews and vessels become tense and contracted, manifesting in the area it overcomes.
Fang Youzhi said: The edges of the lips are called "Wen". The four limbs refer to the hands and feet. "Xi" describes the appearance of sweating; "Xi" also means birds flying frequently, implying that the hands and feet tremble as if birds are practicing flight, flapping continuously without stopping.
The area around the mouth turns dark black, with soft cold sweat and yellowish sweat—this indicates the exhaustion of Spleen Qi.
[Note] The Spleen's brilliance manifests in the skin around the lips. Dark blackening around the mouth indicates the withering of its brilliance. Cold sweat and Yin jaundice are both signs of Spleen Qi exhaustion.
[Collected Notes] Fang Youzhi said: The mouth is the orifice of the Spleen. "Li hei" refers to a smoky yellow turning dark, which is the color of failing Earth. "Rou han" is commonly known as cold sweat.
Zhang Xiju said: The Spleen governs the four whites (skin around the lips). Dark blackening around the mouth indicates failing Earth being insulted by Water. "Rou han" is soft and sticky, representing the true fluid of the Spleen; yellow is the true color of the Spleen. When true fluid leaks out and true color appears, it is called Spleen Qi exhaustion.
Incontinence of urine and feces, delirious speech, and eyes rolling upward with fixed staring—this indicates the exhaustion of Kidney Qi.
[Note] The Kidney controls the two lower orifices. Incontinence indicates Kidney Qi exhaustion. The Kidney stores Essence and Will; delirious speech and fixed staring indicate the failure of both Essence and Will.
[Collected Notes] Fang Youzhi said: "Sou bian" refers to urinary incontinence. The Kidney controls opening and closing; when these functions fail, both urine and feces cannot be controlled. The Classic states: The Kidney stores Will. Delirious speech indicates loss of Will; those who lose their Will will die. The Kidney governs bones, and the essence of bones manifests in the pupils. Eyes rolling upward with fixed staring indicate that the bone essence fails to nourish the pupils, resulting in an inability to move them.
Question: An excellent physician knows through observation, a mediocre physician through inquiry, and a poor physician through pulse diagnosis. I wish to hear the explanation. Master said: The patient's family says, "The patient suffers from fever and body pain." The patient lies down on their own. When the physician arrives and palpates the pulse, finding it deep and slow, they know the illness will recover. Why do they know this? If there were a exterior pathology, the pulse should be floating and large. Now that the pulse is deep and slow, recovery is indicated.
[Note] The following details methods of knowing through observation and inquiry. Observation involves examining the prosperity or decline of the form and the depth or shallowness of the color. Inquiry involves asking about the patient's suffering and desires, and the root cause of the disease. Pulse diagnosis involves examining the Yin and Yang of the pulse, ensuring it aligns with the form and color. Suppose the patient's family comes requesting help, stating the patient suffers from fever and body pain. Upon arrival, seeing the patient lying down, and palpating a deep and slow pulse, recovery is predicted. Why? Exterior diseases typically present with a floating and large pulse. The current deep and slow pulse, lacking exterior pulse characteristics and symptoms, indicates recovery.
[Collected Notes] Zhang Xiju said: There is a question regarding fever and body pain with a deep and slow pulse, which is a Yang disease presenting with a Yin pulse. Why is recovery stated? The answer is: One must observe signs of peacefulness and drowsiness, and inquire about the cessation of heat and lightness of the body, before combining these with the pulse to conclude recovery.
Suppose the patient says, "There was sudden abdominal pain." The patient sits on their own. When the physician arrives and palpates the pulse, finding it floating and large, recovery is indicated. Why? If there were an interior pathology, the pulse should be deep and fine. Now that the pulse is floating and large, recovery is indicated.
[Note] The patient's family requests help, stating sudden abdominal pain. Upon arrival, seeing the patient sitting comfortably without signs of distress, and palpating a floating and large pulse, recovery is predicted. Why? Interior diseases typically present with a deep and fine pulse. The current floating and large pulse, lacking interior pulse characteristics and symptoms, indicates recovery.
Master said: The patient's family requests help, stating the patient suffers from extreme fever and irritability. The next day, when the physician arrives, the patient lies facing the wall quietly, indicating the heat has gone. Even if the pulse is not harmonious, recovery may be declared.
[Commentary] "Not harmonious" should likely be "naturally harmonious"; how can recovery be declared if the pulse is not harmonious?
[Note] This elaborates on the previous two points. The family reports extreme fever and irritability. Before the physician leaves, upon returning the next day, seeing the patient lying quietly facing the wall indicates the heat has subsided, thus predicting recovery. If the pulse is not harmonious, recovery cannot yet be declared; it must be harmonious and slow to confirm recovery. This logic applies similarly to abdominal pain. As stated at the beginning of this chapter: "If circumstances do not match, carefully consider and examine." "Carefully consider" means today's observation differs from yesterday's inquiry.
Suppose the patient lies facing the wall. Upon hearing the physician arrive, they do not startle up but glance sideways. If they speak three words then pause three times, and swallow saliva during pulse diagnosis, this is feigned illness. Even if the pulse is naturally harmonious, the physician should declare the illness severe, requiring emetic and purgative medicines, and dozens or hundreds of acupuncture points to achieve recovery.
[Note] This sets forth a method for treating feigned illness. Zhang Zhongjing did not wish for people to deceive him, nor did he wish for physicians to be deceived into treating falsely. Physicians who study and ponder this will find that patients dare not deceive, and physicians will not treat recklessly.
[Collected Notes] Cheng Zhi said: Responding to feigned illness with feigned treatment requires skill that only an excellent physician possesses.
When the physician holds the pulse, if the patient yawns, there is no disease. If the patient groans during pulse diagnosis, there is disease. If speech is slow, it indicates Wind. If the head shakes while speaking, it indicates interior pain. If walking is slow, it indicates exterior stiffness. If sitting and leaning forward, it indicates shortness of breath. If sitting with one leg hanging down, it indicates waist pain. If the abdomen feels full and the patient protects it as if holding an egg, it indicates heart pain.
[Note] Yawning occurs due to the mutual attraction of Yin and Yang; air is drawn in first, then exhaled with a sigh, hence "yawning". Lack of mutual attraction between Yin and Yang indicates disease; mutual attraction indicates harmony. Thus, yawning signifies health. Groaning during pulse diagnosis indicates the sound of suffering from illness. Slow speech indicates language impediment, hence "slow speech indicates Wind". Shaking the head while speaking indicates pain so severe that vocalization is difficult; the head shake signals an attempt to alleviate pain, hence "shaking head while speaking indicates interior pain". Slow walking indicates Wind disease causing poor circulation in sinews and collaterals, hence "slow walking indicates exterior stiffness". Sitting and leaning forward indicates inability to connect Qi, hence "sitting and leaning forward indicates shortness of breath". Those with waist pain cannot sit steadily; even slight sitting requires extending the legs for support, hence "sitting with one leg hanging down indicates waist pain". Those with heart pain hunch over to protect the painful area, hence "full abdomen protecting the belly as if holding an egg indicates heart pain".
[Collected Notes] Fang Youzhi said: Tongue stiffness causes slow speech; tendon contraction causes stiff collaterals. The Liver belongs to Wood, governs sinews, and rules Wind. The Head belongs to Yang, the interior to Yin; head shaking indicates Yin does not harmonize with Yang. Shortness of breath indicates interior deficiency. These eight items are matters of knowing through observation.
Zhang Zhicong said: "Physician holding the pulse" implies the physician only palpates without asking questions. These eight items involve observing spirit and obtaining disease mechanisms, which is what is meant by "knowing through observation".
Question: What is the pulse condition of a person experiencing terror? Master said: The pulse feels like tracing beads on a thread, and the face is pale and loses color.
[Note] Fear in illness indicates insufficiency of Yang Spirit. Insufficiency of Yang leads to fear; insufficiency of Spirit leads to terror. Fear causes blood to follow Qi downward, resulting in a pale, lusterless face. Terror causes Qi to follow chaotic Spirit, resulting in a pulse that feels like tracing beads on a thread and is disordered.
[Collected Notes] Fang Youzhi said: "Kong bu" means panic and fear. "Xun" means to smooth or manage; "Si" means thin. "Lei lei" means connected. "Tuo se" means losing color. Generally, internal Qi deficiency leads to external loss of complexion, causing sudden changes.
Cheng Yingmao said: This demonstrates the method of observing color and combining it with pulse. Fear causes Qi to sink and Spirit to be deprived, resulting in a thin and unstable pulse, and a white, pallid face.
Question: What is the pulse condition of a person who does not drink water? Master said: The pulse is naturally choppy, and the lips and mouth are dry.
[Note] Scanty fluids lead to a choppy pulse, causing dry lips and mouth. This results from not drinking, not the other way around.
[Collected Notes] Cheng Yingmao said: Not drinking may resemble holding a grudge against others, where even after two or three days, no soup or water touches the lips. The Lung loses its ability to circulate essential Qi and fluids, resulting in a choppy pulse and dry lips and mouth.
Question: What is the pulse condition of a person feeling ashamed? Master said: The pulse is floating, and the face alternates between white and red.
[Note] "Kui" means shame. Shame causes spirit and color to fluctuate, resulting in a floating pulse and alternating white and red facial color. These are examples of observing color and combining it with pulse, using judgment to determine the condition.
[Collected Notes] Cheng Yingmao said: The above cases apply regardless of whether there is disease; any internal emotional burden manifests in color and pulse. From this, one can infer that by careful consideration, the nature of various diseases can be verified internally through external signs.
Question: What is meant by "disaster and strangeness" in pulses? Master said: Suppose a person is ill, presenting with a Taiyang pulse corresponding to their symptoms, and a decoction is prepared accordingly. Upon returning with the medicine, after about the time it takes to eat a meal, the patient suddenly vomits severely or experiences diarrhea with abdominal pain. The physician says: "I did not see these symptoms earlier; now they have changed strangely. This is called 'disaster and strangeness'." Asked again: "What causes this vomiting and diarrhea?" Answered: "Perhaps the patient took medication previously, which is now taking effect. Hence it is called 'disaster and strangeness'."
[Note] "Disaster and strangeness in pulse" refers to adverse reactions caused by medication. Suppose a person has a Taiyang disease, presents with a Taiyang pulse, and the pulse matches the symptoms, so a Taiyang decoction is administered. Upon returning with the medicine, after about a meal's time, the patient suffers severe vomiting and diarrhea with abdominal pain. The physician asks: "I did not see these symptoms before; why this strange change causing vomiting and diarrhea?" The patient answers: "Perhaps I took medication previously, which is now acting up, causing this disaster and strangeness!" Observation and inquiry are duties of the physician, but the patient must also be completely honest to allow the physician to perform their best. Zhang Zhongjing included this clause because patients often failed to inform doctors of prior medication use, serving as a warning!
[Collected Notes] Cheng Wuji said: When the physician matches the pulse and symptoms with the appropriate medicine, but a strange variation occurs, it is named "disaster and strangeness".
Zhang Zhicong said: When the pulse corresponds to Taiyang and the physical symptoms match, such as Taiyang disease with a floating pulse, stiff neck, headache, and aversion to cold, the pulse and symptoms correspond. If old medication taken previously now acts up, it means that within the time it takes to eat a meal, the newly administered medicine has not yet circulated fully through the meridians; this is necessarily due to the effects of the old medication.