辨者，别也。辨脉者，辨别诸脉之名也，法者，诸脉部位、至数、形状、相类、相反，别之各有其法也。
脉名者也，如浮、沉、迟、数、滑、涩诸脉之名是也。部位者，如浮、中、沉，上、下之部位是也。至数者，
如迟三至，数六至之至数是也。形状者，如滑流，涩滞之形状是也。相类者，如弦与紧，滑与动之类是也。相
反者，如浮与沉，虚与实之反是也。皮肤取而得之，谓之浮；筋骨取而得之，谓之沉。此以脉之上下部位而得
名也，是则凡脉因部位而得名，皆统乎浮沉矣。如浮而无力谓之濡；沉而无力谓之弱；浮而极有力谓之革；沉
而极有力谓之牢。浮中沉俱有力，按之且大谓之实；浮中沉俱无力，按之且大谓之虚；浮中沉极无力，按之且
小，似有似无，谓之微；浮中沉极无力，按之且大涣散不收，谓之散；浮沉有力，中取无力，谓之芤；按之至
骨，推寻始得，谓之伏。此皆以部位兼形状相反，而得名者也。一息三至，谓之迟；一息六至，谓之数。此以
脉之至数而得名者也，是则凡脉因至数而得名者，皆统乎迟数矣。如一息四至谓之缓；一息七至谓之疾；数时
一止谓之促；缓时一止谓之结；至数不乖，动而中止，不能自还，须臾复动，谓之代。此皆以至数兼相类而得
名者也。流利如珠，谓之滑；进退艰难滞涩，谓之涩。此以脉之形状而得名也，是则凡脉因形状而得名者，皆
统乎滑涩矣。如脉形粗大，谓之大；脉形细小，谓之小；来去迢迢，谓之长；来去缩缩，谓之短；来盛去衰，
谓之洪；其形如豆，动摇不移，谓之动；状类弓弦，按之端直且劲，谓之弦；较弦则粗，按之左右弹指，谓之
紧。此皆以形状兼相类相反而得名者也。此辨脉之大概也。诊者于此能详审而扩充之，则进乎法矣。今以浮、
沉、迟、数、滑、涩，六脉别之以为纲；以大、小、虚、实，诸脉辨之以为目，务使阴阳标本，虚实寒热，
心中有据，指下无差，庶心手相得，而辨证处方，自无错谬矣。
问曰∶脉有阴阳，何谓也？答曰∶凡脉大、浮、数、动、滑，此名阳也；脉沉、涩、弱、弦、微，此名阴
也。凡阴病见阳脉者生，阳病见阴脉者死。
【注】此以脉之阴阳，辨病之阴阳生死法也。浮、大、数、动、滑五者，比之诸脉为有余，阳道有余，故
曰阳也。沉、涩、弱、弦、微五者，比之诸脉为不及，阴道不及，故曰阴也。阴病，谓阴寒病也。见阳脉，谓
见阳热脉也。阳热脉，即浮、大、数、动、滑类也。以阴病得阴脉，证脉相应，死难必也。阴病若得阳脉，犹
冬尽春生，万物虽未即生，然日进生机，故曰生也。阳病，谓阳热病也。见阴脉，谓见阴寒脉也。阴寒脉即沉、
涩、弱、弦、微类也。以阳病得阳脉，证脉相应，生可卜也；阳病若得阴脉，如暑去秋来，万物虽未即死，然
日趋死候，故曰死也。盖天人无二理，春夏为阳，秋冬为阴，阳主生，阴主杀故也。
【集注】方有执曰∶阴阳者，通脏腑、血气、表里、虚实、风寒、寒热而总言之也。
程知曰∶阴病见阳脉而主生者，邪气自里之表，欲汗而解也。阳病见阴脉而主死者，邪气自表入里，正虚
邪盛也。故正气实者，多见阳脉，正气虚者，多见阴脉。
脉来缓，时一止复来者，名曰结；脉来数，时一止复来煮，名曰促。阳盛则促，阴
盛则结，此皆病脉。
【注】缓，四至脉也。缓时一止复来者，名曰结脉。数，六至脉也。数时一止复来者，名曰促脉。阳盛则
促，阴盛则结，阴阳偏胜则病，故曰∶此皆病脉也。
脉按之来缓，时一止复来者，名曰结；又脉来动而中止，更来小数，中有还者反动，名曰结阴也。脉来动
而中止，不能自还，因而复动者，名曰代阴也，得此脉者必难治。
【按】脉按之来缓，时一止至，名曰结阴也数语，文义不顺，且前论促结之脉已明，当是衍文。
【注】脉来至数不乖而中止，不能自还，因而复动，名曰代。乃一脏无气，求他脏以代续之故也。凡病得
此代脉者，必为难治，盖以促结之止，如急行而蹶，虽然中止，即能自还，非代脉之止可比也。
阴阳相搏，名曰动。阳动则汗出，阴动则发热，形冷恶寒者，此三焦伤也。若数脉见于关上，上下无头尾，
如豆大，厥厥动摇者，名曰动也。
【按】《素问》曰∶阳加于阴谓之汗。阳加于阳，岂有汗出之理？阳动则“汗出”二字当是“发热”二字；
阴动则“发热”二字当是“汗出”二字。
【注】动者，躁动也，谓阴阳互相鼓击而不宁也。动，阳脉也。寸为阳，阳乘击于阳，故阳动发热也。尺
为阴，阴乘击于阴，故阴动汗出也。关界乎阴阳，则阴阳互相乘击，故发热汗出同见也。此为动而有力，阳盛
之候，若按之不鼓，是为阳衰之诊，则必形冷而不发热，汗出而必恶寒，非抟击阳盛之动，乃扰乱阳虚之动也。
由三焦之阳气伤，则不能外温肉分，故有是证也。动脉之状，颇似数脉，惟上下无头尾，如豆大，厥厥动摇，
故名曰动也，厥厥者，谓似有根之摇动，动而不移，非若滑脉之流动，动而不居也。
【集注】方有执曰∶阴阳相搏之阴阳，以二气言；阳动阴动之阴阳，以部位言。下言动脉之定位与其形
状。厥厥，举发貌。
程知曰∶阳升阴降，交通上下，往来于尺、寸之间，则冲和安静；惟阳欲升，而阴不足以和之使降，则
两相搏击，其脉必数，而厥厥摇动见于关上也。
脉浮而紧者，名曰弦也。弦者，状如弓弦，按之不移也。脉紧者，如转索无常也。
【注】脉浮而紧者，名曰弦也，此非谓浮紧即弦脉，乃谓浮而劲紧，弦之状也。弦紧相类，惟恐人将弦
作紧，将紧作弦，故并举相形以别之也。弦者，状如弓弦，按之不移，即所谓端直也；紧者，如转索无常，即
所谓不端直也。端直则不能如转索，转索则不能似端直，其为劲急则同，所以相类也。
【集注】方有执曰∶此明弦紧之辨。按之不移，言如弦之张于弓，一定而不可动移也。转索无常，言左
右旋转而不可拘也。
程知曰∶紧为寒邪方盛，直细中有转动急疾之意，故谓如转索也。
张锡驹曰∶弦紧之分，在移与不移耳。
脉弦而大，弦则为减，大则为芤；减则为寒，芤则为虚。寒虚相抟，此名为革。妇人则半产漏下，男子
则亡血失精。
【注】脉形粗大有力，谓之大；浮沉有力，中取无力，状如葱管谓之芤；沉而且大，按之劲急有力，谓
之牢；浮而且大，举之劲急有力，谓之革。革脉者，以鼓革而得名，外急中空之象也。弦则为劲，减其中取之
劲，外急象也；大则为实，小其中取之实，中空象也。此以弦减、芤虚二脉，形容革脉也。女子得之半产漏下，
男子得之亡血失精，寒虚相抟故也。
【集注】程知曰∶言弦而虚大之脉也。弦则为减，谓阳气减少而寒也；大则为芤，谓似革中空而虚也。
虚寒相抟，则精血漏失，故
有革象也。
问曰∶脉有残贼，何谓也？师曰∶脉有弦、紧、浮、滑、沉、涩。此六脉名曰残贼，能为诸脉作病也。
【注】此下，皆残贼为病之诊也。相乘之脉为正气虚，随我所虚而乘及之之谓也。残贼之脉为邪气实，恃
彼之强而虐及之之谓也。此六脉者名曰残贼，残则明伤，贼则暗袭，脉中有此当属实邪，不论何部，但本脉中
兼见此脉，辄防邪至也。
【集注】方有执曰∶诸脉，谓各部之脉也。作，起也。言六者若见于各部之脉中，则皆能于其部生起病端。
张锡驹曰∶残，伤残；贼，贼害也。言此六者之脉，足以暗伤人之经脉血气，如贼之害人而不觉，故曰
能为诸脉作病也。
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，
所谓阳中雾露之气，故曰清邪中上。浊邪中下，阴气为栗，足膝逆冷，便尿妄出，表气微虚，里气微急，三焦
相溷，内外不通。上焦怫郁，脏气相熏，口烂食龈也。中焦不治，胃气上冲，脾气不转，胃中为浊，营卫不通，
血凝不流。若卫气前通者，小便赤黄，与热相抟，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，客气入内，嚏而出之，声 咽塞，寒厥相追，为热所拥，血凝自下，状如
豚肝。阴阳俱厥，脾气孤弱，五液注下，下焦不阖，清便下重，令便数难，脐筑湫痛，命将难全。
【注】寸口阴阳俱紧者，谓六脉浮沉俱紧也。浮脉紧，则雾露之邪中于上焦；沉脉紧，则寒邪中于下焦。
上焦指太阳也，下焦指少阴也。雾露之邪，曰洁、曰清。清邪中上，发热头痛，项强颈挛，腰疼胫酸者，雾露
之邪中于太阳表也。寒邪曰浑、曰浊。浊邪中下，阴气为栗，足胫逆冷，便尿妄出者，寒邪中于少阴里也。经
曰∶虚邪不能独伤人，必因身形之虚而后客之也。盖因其人表气虚，里气不固，清浊之邪，中伤上下。三焦相
溷，表里不通，以致上焦清气不宣，邪气怫郁，与脏相熏，口烂食龈；中焦不治，胃气主下，而反上冲，脾气
主运，而反不转，中焦皆浊，营卫不通，血凝不流行也。若正能胜邪，卫气先通，其人必先小便赤黄，热伤之
经必血凝肉腐，而外发为痈脓也。若营气先通，其人必先嚏 咽塞，热拥于里之血凝者自下，状如豚肝也。若正
不胜邪，阴阳俱逆，营卫不通，脾气孤弱，不能散精，五液注下，下焦不阖，里急坠痛，圊便数窘，命将难全也。
【集注】沈亮宸曰∶伤寒之证，转热即佳，故少阴、厥阴，皆以发热而愈，而凡下脓血与痈脓皆非死证。
若阴阳俱厥，厥者必利，五液注下，下焦不阖，命将难全也。
方有执曰∶清指风，浊指寒，曰洁、曰浑，以天地之偏气言也。阴中于邪已下至浊邪中下一节，是释上文。
阴即下焦，阳即上焦也。阴气为栗已下至血凝不流，是言证。若卫气前通已下，言变痈脓之故。若阴气前通
已下，言变脓血利之故。卫气既阳气，营气即阴气，乃承上营卫不通而言，而清浊之所以为病，在其中矣！阴
阳俱厥已下，言证并于里而加重，故曰∶命将难全也。
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。到七日以来，其人微
发热，手足温者，此为欲解；或到八日以上，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。
【注】此承上条互详其证，戒人临此阴阳混淆之病，慎勿妄治也。此条之蜷卧足冷，即上条之浊邪中下
也。此条之鼻涕舌苔，即上
条之清邪中上也；此条之唇口干燥，即上条之口烂蚀龈也；此条之反大发热，即上条之痈脓下血也；此条之腹
中痛，即上条之下重湫痛也；此条之恶寒，即上条之必内栗也。脉阴阳俱紧，伤寒脉也；口中气出，唇口干燥，
胃经热也；蜷卧足冷，少阴寒也；鼻中涕出，表伤风也；舌上苔滑，里无热也。似此表里、阴阳、寒热、虚实
杂揉未定之病，慎勿妄治，则当审其孰轻、孰重、孰缓、孰急，先后施治可也。到七日以来，其人微发热手足
渐温者，此阴退阳复为欲解也；若到八日以上，反大发热煮，乃邪盛正衰，此为难治也，设使恶寒，知尚在表。
若呕，必欲入里也。腹内痛者，知邪已入里，内攻必欲下利也。
【集注】方有执曰∶微发热，邪退也。大发热，邪盛也。恶寒，尚在表也。腹内痛，已入里也。
脉阴阳俱紧，至于吐利，其脉独不解；紧去入安，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。
【按】紧去入安之“入”字，当是“人”字。人安，谓不吐利也。必是传写之讹。“此为晚发，水停故也”
二句，与上下文义不属，当是衍文。
【注】此发明脉阴阳俱紧，内外寒甚，至于吐、利解不解之义也。吐利后脉仍紧，为邪未尽不解也；紧去
脉缓，为邪尽人安欲解也。若紧去脉迟，至六七日不欲食者，则胃未和为未解也；若欲食者，则胃已和，虽脉
迟亦为欲解也。
【集注】成无己曰∶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
人安为欲解也。
寸口脉浮而大，浮为虚，大为实，在尺为关，在寸为格，关则不得小便，格则吐逆。
【注】平脉以脉内外候关格，此以脉尺寸候关格。于此推之，凡阴阳盛极皆病关格，而不必定在内外、
尺寸也。寸口脉浮而大，浮为正气虚，大为邪气实。在尺则阴邪实，关闭正气不能宣，名曰关，关则不得小便
也。在寸则阳邪实，格拒正气不能化，名曰格，格则吐逆也。
【集注】张锡驹曰∶浮大之脉在于尺，则为关阴，阴气不能施化，故不得小便。浮大之脉在于寸，则为格
阳，阳气不能宣通，故吐逆。
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。
辨别，就是区分的意思。辨脉，就是辨别各种脉象的名称；法，是指各种脉象的部位、至数（脉搏跳动的频率）、形状、相似之处和相反之处，区分它们各有其方法。
所谓“脉名”，如浮、沉、迟、数、滑、涩等脉的名称。所谓“部位”，如浮取、中取、沉取，以及上、下等部位。所谓“至数”，如一息三至为迟，一息六至为数这样的跳动频率。所谓“形状”，如滑利流畅、涩滞不畅的形状。所谓“相类”，如弦脉与紧脉、滑脉与动脉之类。所谓“相反”，如浮脉与沉脉、虚脉与实脉的相对立。轻按皮肤即可触及的，称为浮脉；重按筋骨才能触及的，称为沉脉。这是根据脉象在上下部位的深浅而得名，因此凡是因部位不同而得名的脉象，都统属于浮脉和沉脉两类。例如：浮取无力称为濡脉；沉取无力称为弱脉；浮取极有力称为革脉；沉取极有力称为牢脉。浮、中、沉三部都有力，且重按时脉形宽大称为实脉；浮、中、沉三部都无力，且重按时脉形宽大称为虚脉；浮、中、沉三部极无力，重按时脉形细小，似有似无，称为微脉；浮、中、沉三部极无力，重按时脉形宽大涣散不收摄，称为散脉；浮取和沉取有力，唯独中取无力，称为芤脉；重按至骨，推寻之后才能触及，称为伏脉。这些都是结合部位和形状、或相反特征而得名。一息跳动三次，称为迟脉；一息跳动六次，称为数脉。这是根据脉象的频率而得名，因此凡是因频率不同而得名的脉象，都统属于迟脉和数脉两类。例如：一息四至称为缓脉；一息七至称为疾脉；数脉中偶尔出现一次停顿，称为促脉；缓脉中偶尔出现一次停顿，称为结脉；至数没有错乱，但跳动中途停止，不能立即恢复，过一会儿再跳动，称为代脉。这些都是结合频率和相似特征而得名。流利如珠滚动，称为滑脉；进退艰难、滞涩不畅，称为涩脉。这是根据脉象的形状而得名，因此凡是因形状不同而得名的脉象，都统属于滑脉和涩脉两类。例如：脉形粗大，称为大脉；脉形细小，称为小脉；来去悠长，称为长脉；来去短缩，称为短脉；来时盛大、去时衰减，称为洪脉；脉形像豆子一样，动摇不移，称为动脉；状如弓弦，按之端正直挺且劲急，称为弦脉；比弦脉更粗，按之左右弹指，称为紧脉。这些都是结合形状及相似、相反特征而得名。这就是辨别脉象的大概内容。诊察者若能在此基础详审并扩充知识，就能进入精通法的境界了。现在以浮、沉、迟、数、滑、涩这六种脉象作为纲领；以大、小、虚、实等脉象作为辨析的条目，务必使阴阳标本、虚实寒热在心中有所依据，手指下没有差错，这样心手相应，辨证处方自然就不会出错。
问：脉象有阴脉和阳脉之分，这是什么意思？答：凡是脉象大、浮、数、动、滑，这些名称属于阳脉；脉象沉、涩、弱、弦、微，这些名称属于阴脉。凡是阴病见到阳脉的预后良好，阳病见到阴脉的预后不良（主死）。
【注】这是通过脉象的阴阳属性，来辨别疾病的阴阳生死的方法。浮、大、数、动、滑这五种脉象，与其他脉象相比属于有余，阳道有余，所以称为阳脉。沉、涩、弱、弦、微这五种脉象，与其他脉象相比属于不足，阴道不足，所以称为阴脉。阴病，指的是阴寒性质的疾病。见到阳脉，指的是见到阳热性质的脉象。阳热脉，即浮、大、数、动、滑这一类。如果阴病得到阴脉，证候与脉象相应，死亡是必然的。如果阴病得到阳脉，就像冬尽春生，万物虽然还没有立刻生长，但每天都在增加生机，所以说预后良好。阳病，指的是阳热性质的疾病。见到阴脉，指的是见到阴寒性质的脉象。阴寒脉即沉、涩、弱、弦、微这一类。如果阳病得到阳脉，证候与脉象相应，生存是可以预料的；如果阳病得到阴脉，就像暑去秋来，万物虽然还没有立刻死亡，但一天天趋向死亡的状态，所以说预后不良。大概天地人道理相通，春夏为阳，秋冬为阴，阳主生发，阴主肃杀的缘故。
【集注】方有执说：阴阳，是通盘考虑脏腑、血气、表里、虚实、风寒、寒热而言的。
程知说：阴病见到阳脉而主生的，是因为邪气从里出表，想要通过出汗而解除。阳病见到阴脉而主死的，是因为邪气从表入里，正气虚弱邪气盛实。所以正气充实的人，多见阳脉；正气虚弱的人，多见阴脉。
脉来缓慢，偶尔停顿后又继续跳动的，名叫结脉；脉来快速，偶尔停顿后又继续跳动的，名叫促脉。阳气盛实则出现促脉，阴气盛实则出现结脉，这都是病脉。
【注】缓脉，是一息四至的脉象。缓脉中偶尔停顿又继续跳动的，名叫结脉。数脉，是一息六至的脉象。数脉中偶尔停顿又继续跳动的，名叫促脉。阳气盛实则出现促脉，阴气盛实则出现结脉，阴阳偏胜就会生病，所以说：这都是病脉。
脉按之来势缓慢，偶尔停顿后又继续跳动的，名叫结阴脉；又有一种脉象，跳动中途停止，再次跳动时先快几下，中间有恢复后再跳动，这叫结阴脉。还有一种脉象，跳动中途停止，不能自行恢复，过了一会儿才再次跳动，这叫代阴脉，得到这种脉象的人一定难以治疗。
【按】“脉按之来缓，时一止复来者，名曰结阴也”这几句话，文义不通顺，而且前面已经论述了促脉和结脉，这应该是衍文（多余的文字）。
【注】脉来的至数没有错乱但中途停止，不能自行恢复，过了一会儿才再次跳动，名叫代脉。这是因为某一脏气绝，寻求其他脏气来替代接续的缘故。凡是疾病出现这种代脉的，一定难以治疗，因为促脉和结脉的停顿，就像快走时跌倒，虽然暂停，但能立即恢复，不能与代脉的停顿相比。
阴阳相互搏击，名叫动脉。阳动则汗出，阴动则发热，身体寒冷怕冷的，这是三焦受伤。如果数脉出现在关部，上下没有头尾，像豆子大小，厥厥动摇不定，名叫动脉。
【按】《素问》说：阳加于阴谓之汗。阳加于阳，怎么会有汗出的道理？阳动则“汗出”二字应当是“发热”二字；阴动则“发热”二字应当是“汗出”二字。
【注】动，就是躁动，指阴阳互相鼓击而不安宁。动，属于阳脉。寸口属阳，阳乘袭搏击于阳位，所以阳动表现为发热。尺部属阴，阴乘袭搏击于阴位，所以阴动表现为汗出。关部介于阴阳之间，则阴阳互相乘袭搏击，所以发热和汗出同时出现。这是动脉有力，属于阳盛的表现；如果按之不鼓指，这是阳衰的诊断，那么一定身体寒冷而不发热，汗出而必定怕冷，这不是搏击阳盛的动脉，而是扰乱阳虚的动脉。由于三焦的阳气受伤，不能外温肌肉腠理，所以出现这些证候。动脉的形状，颇像数脉，只是上下没有头尾，像豆子大小，厥厥动摇，所以名叫动脉。“厥厥”，形容好像有根的摇动，动而不移，不像滑脉那样流动，动而不居。
【集注】方有执说：阴阳相搏中的阴阳，是从二气角度说的；阳动阴动中的阴阳，是从部位角度说的。下面讲动脉的定位与其形状。厥厥，是举发的样子。
程知说：阳升阴降，交通上下，往来于尺、寸之间，则是冲和安静；只有当阳欲上升，而阴不足以调和使其下降时，两者相互搏击，脉必数，且厥厥摇动出现在关部。
脉浮而紧的，名叫弦脉。弦脉，形状像弓弦，按之不移。脉紧的，像扭转的绳索无常定。
【注】脉浮而紧的，名叫弦脉，这里不是说浮紧就是弦脉，而是说浮而劲紧，是弦脉的形状。弦脉和紧脉相似，唯恐人们将弦当作紧，将紧当作弦，所以并列比较以区别它们。弦脉，形状像弓弦，按之不移，就是所谓的端正直挺；紧脉，像扭转的绳索无常定，就是所谓的不端直。端直就不能像扭转的绳索，扭转的绳索就不能像端直，它们的劲急程度相同，所以相似。
【集注】方有执说：这是阐明弦脉和紧脉的区别。按之不移，是说像弦张在弓上，固定不可移动。转索无常，是说左右旋转不可拘泥。
程知说：紧脉为寒邪正盛，细中有转动急疾之意，所以说像扭转的绳索。
张锡驹说：弦脉和紧脉的区别，在于是否移动。
脉弦而大，弦则意味着减弱，大则意味着中空（芤）；减弱则意味着寒，中空则意味着虚。寒与虚相互搏结，这名叫革脉。妇女得此脉则半产漏下，男子得此脉则亡血失精。
【注】脉形粗大有力，称为大脉；浮取和沉取有力，中取无力，状如葱管，称为芤脉；沉取且大，按之劲急有力，称为牢脉；浮取且大，举之劲急有力，称为革脉。革脉，以鼓皮得名，是外急中空的形象。弦脉代表劲急，减去其中取的劲急，就是外急的形象；大脉代表实，减去其中取的实，就是中空的形象。这是用弦减、芤虚两脉来形容革脉。女子得此脉出现半产漏下，男子得此脉出现亡血失精，都是寒虚相互搏结的缘故。
【集注】程知说：说的是弦而虚大的脉象。弦则为减，是说阳气减少而寒；大则为芤，是说像革脉中空而虚。虚寒相搏，则精血漏失，所以有革脉的形象。
问：脉象有残贼，是什么意思？老师说：脉象有弦、紧、浮、滑、沉、涩。这六种脉象名叫残贼，能导致其他脉象出现病变。
【注】以下，都是残贼致病的诊察。相乘的脉象是因为正气虚，随着我所虚的地方而乘袭，叫作相乘。残贼的脉象是因为邪气实，倚仗它的强盛而虐害其他部位，叫作残贼。这六种脉象名叫残贼，“残”指明伤，“贼”指暗袭，脉中出现这些应当属实邪，不论在哪一部，只要本脉中兼见这些脉，就要防备邪气到来。
【集注】方有执说：诸脉，指各部的脉象。作，起也。意思是这六种若出现在各部脉中，都能在该部生起病端。
张锡驹说：残，伤残；贼，贼害。意思是这六种脉象，足以暗中伤害人的经脉血气，像贼害人而不觉察，所以说能为诸脉作病。
寸口脉阴阳俱紧的，按照法则应当是清邪中伤上焦，浊邪中伤下焦。清邪中伤上部，名叫洁；浊邪中伤下部，名叫浑。阴分受到邪气侵袭，必定内心战栗，表气微弱虚弱，里气不固守，所以使邪气中伤阴分。阳分受到邪气侵袭，必定发热头痛，项强颈挛，腰痛胫酸，这就是所说的阳分中雾露之气，所以叫清邪中上。浊邪中伤下部，阴气战栗，足膝逆冷，小便失禁妄出，表气微弱虚弱，里气微急，三焦混杂，内外不通。上焦郁结，脏气相互熏蒸，口腔糜烂牙龈溃烂。中焦不治，胃气上冲，脾气不运化，胃中形成浊气，营卫不通，血液凝滞不流。如果卫气先通畅，小便赤黄，与热相搏，因热而成为致病因素，游走于经络，出入脏腑，热气所过之处，就形成痈脓。如果阴气先通畅，阳气厥微，阴无所使，客气入内，打喷嚏而出，声音嘶哑咽喉阻塞，寒厥相互追逐，被热所拥塞，血液凝滞自下，状如猪肝。阴阳都厥逆，脾气孤弱，五液注下，下焦不闭合，大便清稀下重，令排便次数多且困难，脐腹筑痛隐痛，性命难保。
【注】寸口脉阴阳俱紧，是指六脉浮沉都紧。浮脉紧，则是雾露之邪中伤上焦；沉脉紧，则是寒邪中伤下焦。上焦指太阳经，下焦指少阴经。雾露之邪，叫洁、叫清。清邪中伤上部，出现发热头痛，项强颈挛，腰疼胫酸，是雾露之邪中伤太阳表。寒邪叫浑、叫浊。浊邪中伤下部，阴气战栗，足胫逆冷，小便妄出，是寒邪中伤少阴里。经文说：虚邪不能单独伤人，必须因为身形虚弱而后客居。大概因为其人表气虚，里气不固，清浊之邪，中伤上下。三焦混杂，表里不通，以致上焦清气不宣，邪气郁结，与脏气相熏，口腔糜烂牙龈溃烂；中焦不治，胃气主下却反上冲，脾气主运却反不转，中焦皆浊，营卫不通，血液凝滞不流行。如果正气能胜邪，卫气先通，此人必先小便赤黄，热伤的经络必血凝肉腐，而外发为痈脓。如果营气先通，此人必先打喷嚏咽喉阻塞，热拥于里的血凝者自下，状如猪肝。如果正气不胜邪，阴阳都逆乱，营卫不通，脾气孤弱，不能散精，五液注下，下焦不闭合，里急坠痛，排便频窘，性命难保。
【集注】沈亮宸说：伤寒的证候，转热就好，所以少阴、厥阴，都以发热而愈，而凡下脓血与痈脓都不是死证。如果阴阳都厥逆，厥逆必定下利，五液注下，下焦不闭合，性命难保。
方有执说：清指风，浊指寒，叫洁、叫浑，是以天地的偏气来说的。阴中于邪已下至浊邪中下一节，是解释上文。阴即下焦，阳即上焦。阴气为栗已下至血凝不流，是讲证候。若卫气前通已下，讲变痈脓的原因。若阴气前通已下，讲变脓血利的原因。卫气既阳气，营气即阴气，是承接上文营卫不通而言，而清浊之所以为病，就在其中了！阴阳俱厥已下，讲证候并于里而加重，所以说：性命难保。
脉阴阳俱紧，口中呼气，唇口干燥，蜷卧足冷，鼻中流涕，舌上苔滑，不要胡乱治疗。到了七天以后，其人微发热，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。假使恶寒的，必定想呕吐；腹内痛的，必定想腹泻。
【注】这是承接上一条详细互参其证候，告诫人们面对这种阴阳混淆的病，千万不要胡乱治疗。这条的蜷卧足冷，就是上一条的浊邪中下；这条的鼻涕舌苔，就是上一条的清邪中上；这条的唇口干燥，就是上一条的口烂蚀龈；这条的反大发热，就是上一条的痈脓下血；这条的腹中痛，就是上一条的下重湫痛；这条的恶寒，就是上一条的必内栗。脉阴阳俱紧，是伤寒脉；口中气出，唇口干燥，是胃经热；蜷卧足冷，是少阴寒；鼻中涕出，是表伤风；舌上苔滑，是里没有热。像这样表里、阴阳、寒热、虚实杂揉未定的病，千万不要胡乱治疗，应当审察哪个轻、哪个重、哪个缓、哪个急，先后施治即可。到了七天以后，其人微发热手足渐温的，这是阴退阳复，将要解除；如果到了八日以上，反而大发热，乃是邪盛正衰，这是难治。假使恶寒，知道还在表。如果呕吐，必定要入里。腹内痛，知道邪已入里，内攻必定想下利。
【集注】方有执说：微发热，是邪退。大发热，是邪盛。恶寒，还在表。腹内痛，已入里。
脉阴阳俱紧，至于吐利，脉象独自不解；紧脉消失，人安适，这是将要解除。如果脉迟，到了六七日不想吃东西，这是晚发，因为有水停，为未解；如果想吃东西，为欲解。
【按】紧去入安之“入”字，应当是“人”字。人安，指不吐利。一定是传写错误。“此为晚发，水停故也”这两句，与上下文义不连贯，应该是衍文。
【注】这是阐明脉阴阳俱紧，内外寒甚，至于吐、利解不解的意义。吐利后脉仍紧，为邪未尽，不解；紧脉消失，脉缓，为邪尽人安，欲解。如果紧脉消失，脉迟，到了六七日不想吃东西，则胃未和，为未解；如果想吃东西，则胃已和，虽脉迟也为欲解。
【集注】成无己说：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，紧去则人安为欲解也。
寸口脉浮而大，浮为虚，大为实，在尺部为关，在寸部为格，关则不得小便，格则吐逆。
【注】平脉以脉内外候关格，这里以脉尺寸候关格。由此推断，凡是阴阳盛极都会病关格，而不一定在内外、尺寸。寸口脉浮而大，浮为正气虚，大为邪气实。在尺部则阴邪实，关闭正气不能宣通，名叫关，关则不得小便。在寸部则阳邪实，格拒正气不能气化，名叫格，格则吐逆。
Differentiation means distinction. Differentiating pulse (Bian Mai) refers to distinguishing the names of various pulses; "method" (Fa) refers to the methods for distinguishing the location, frequency (Zhi Shu), shape, similarities, and opposites of various pulses.
The term "pulse name" refers to names such as Floating (Fu), Deep (Chen), Slow (Chi), Rapid (Shu), Slippery (Hua), and Choppy (Se). "Location" refers to locations such as Light Pressure (Fu), Medium Pressure (Zhong), Heavy Pressure (Chen), Upper, and Lower. "Frequency" refers to the rate of beats, such as three beats per breath being Slow, and six beats per breath being Rapid. "Shape" refers to shapes such as smooth and flowing, or choppy and stagnant. "Similarity" refers to similarities such as between Wiry (Xian) and Tight (Jin), or Slippery and Moving (Dong). "Opposition" refers to opposites such as between Floating and Deep, or Deficient (Xu) and Excess (Shi). Pulses that can be felt with light pressure on the skin are called Floating; those that require heavy pressure down to the bones and sinews to be felt are called Deep. These are named according to their depth in the upper and lower locations. Thus, all pulses named by location are categorized under Floating and Deep. For example: Floating but forceless is called Soft (Ru); Deep but forceless is called Fine (Ruo); Floating and extremely forceful is called Drum-skin (Ge); Deep and extremely forceful is called Firm (Lao). If all three levels (Floating, Medium, Deep) are forceful, and pressing reveals a large pulse, it is called Excess (Shi); if all three levels are forceless, and pressing reveals a large pulse, it is called Deficient (Xu); if all three levels are extremely forceless, pressing reveals a small pulse that seems present yet absent, it is called Minute (Wei); if all three levels are extremely forceless, pressing reveals a large, scattered pulse that does not gather, it is called Scattered (San); if Floating and Deep are forceful, but Medium is forceless, it is called Cauliflower (Kou); if one must press to the bone and search to find it, it is called Hidden (Fu). These are named by combining location and shape, or opposition. Three beats per breath is called Slow; six beats per breath is called Rapid. These are named by frequency, so all pulses named by frequency fall under Slow and Rapid. For instance: four beats per breath is called Moderate (Huan); seven beats per breath is called Hasty (Ji); a Rapid pulse with occasional pauses is called Surging (Cu); a Moderate pulse with occasional pauses is called Knotted (Jie); a pulse with regular frequency but intermittent pauses that do not self-recover, resuming after a moment, is called Interchangeable (Dai). These are named by combining frequency and similarity. Smooth like rolling pearls is called Slippery; difficult and choppy progression is called Choppy. These are named by shape, so all pulses named by shape fall under Slippery and Choppy. For example: a coarse and large pulse shape is called Large (Da); a fine and small pulse shape is called Small (Xiao); a pulse that comes and goes long is called Long (Chang); a pulse that comes and goes short is called Short (Duan); a pulse that arrives vigorously and departs weakly is called Flood (Hong); a pulse shaped like a bean, shaking without moving, is called Moving (Dong); a pulse resembling a bowstring, straight and forceful upon pressure, is called Wiry (Xian); thicker than Wiry, rebounding against fingers from both sides upon pressure, is called Tight (Jin). These are named by combining shape and similarity/opposition. This is the general overview of differentiating pulses. A practitioner who can carefully examine and expand upon this will advance to mastery. Now, we take Floating, Deep, Slow, Rapid, Slippery, and Choppy as the main categories; and use Large, Small, Deficient, and Excess to differentiate sub-categories, ensuring that Yin-Yang, root-branch, Deficiency-Excess, and Cold-Heat are clear in mind and accurate under the fingers, so that heart and hand correspond, and diagnosis and prescription will naturally be error-free.
Question: What is meant by Yin and Yang pulses? Answer: Pulses that are Large, Floating, Rapid, Moving, and Slippery are named Yang; pulses that are Deep, Choppy, Fine, Wiry, and Minute are named Yin. In Yin diseases, seeing a Yang pulse indicates survival; in Yang diseases, seeing a Yin pulse indicates death.
[Note] This method uses the Yin-Yang nature of the pulse to distinguish the Yin-Yang life-and-death prognosis of the disease. Floating, Large, Rapid, Moving, and Slippery are considered "excess" compared to other pulses; since the Yang path is excess, they are called Yang. Deep, Choppy, Fine, Wiry, and Minute are considered "deficient" compared to other pulses; since the Yin path is deficient, they are called Yin. Yin disease refers to Yin-Cold disease. Seeing a Yang pulse means seeing a Yang-Heat pulse (such as Floating, Large, Rapid, Moving, Slippery). If a Yin disease presents with a Yin pulse, the symptoms and pulse correspond, indicating inevitable death. However, if a Yin disease presents with a Yang pulse, it is like winter ending and spring arriving; although things have not yet grown immediately, vitality increases daily, hence "survival." Yang disease refers to Yang-Heat disease. Seeing a Yin pulse means seeing a Yin-Cold pulse (such as Deep, Choppy, Fine, Wiry, Minute). If a Yang disease presents with a Yang pulse, symptoms and pulse correspond, indicating survival is probable; however, if a Yang disease presents with a Yin pulse, it is like summer leaving and autumn coming; although things do not die immediately, they daily approach death, hence "death." This is because the principles of Heaven and Man are identical: Spring and Summer are Yang, Autumn and Winter are Yin; Yang governs generation, Yin governs destruction.
[Ji Zhu - Collected Notes] Fang Youzhi said: Yin and Yang here refer comprehensively to Zang-Fu organs, Qi and Blood, Exterior-Interior, Deficiency-Excess, Wind-Cold, and Cold-Heat.
Cheng Zhi said: Yin disease presenting with Yang pulse and indicating survival means the pathogenic factor is moving from Interior to Exterior, seeking resolution through sweating. Yang disease presenting with Yin pulse and indicating death means the pathogenic factor has moved from Exterior to Interior, with righteous Qi deficient and pathogenic factor exuberant. Therefore, those with substantial righteous Qi often show Yang pulses; those with deficient righteous Qi often show Yin pulses.
A pulse that comes slowly and occasionally pauses before resuming is named Knotted (Jie); a pulse that comes rapidly and occasionally pauses before resuming is named Surging (Cu). Exuberant Yang leads to Surging pulse; exuberant Yin leads to Knotted pulse. Both are pathological pulses.
[Note] Moderate (Huan) refers to four beats per breath. A Moderate pulse with occasional pauses is named Knotted. Rapid (Shu) refers to six beats per breath. A Rapid pulse with occasional pauses is named Surging. Exuberant Yang leads to Surging; exuberant Yin leads to Knotted. Imbalance of Yin and Yang causes disease, hence "both are pathological pulses."
A pulse that feels slow upon pressure and occasionally pauses before resuming is named Yin-Knotted (Jie Yin); another type of pulse stops mid-beat, resumes with a few faster beats, then returns to normal rhythm, also named Yin-Knotted. A pulse that stops mid-beat, cannot self-recover, and resumes only after a while is named Yin-Interchangeable (Dai Yin); patients with this pulse are difficult to treat.
[Commentary] The phrase "Pulse feels slow upon pressure, occasionally pauses before resuming, named Yin-Knotted" is grammatically awkward, and since Surging and Knotted were already clearly discussed, this is likely an interpolation.
[Note] A pulse with regular frequency but mid-beat stoppage that cannot self-recover, resuming later, is named Interchangeable (Dai). This occurs when one Zang organ lacks Qi and seeks replacement from another. Diseases presenting with Dai pulse are difficult to treat, unlike the pauses in Cu and Jie pulses which are like stumbling while walking fast but recovering immediately; Dai pause is different.
When Yin and Yang struggle against each other, it is named Moving (Dong). Yang Moving manifests as sweating; Yin Moving manifests as fever. Body coldness and aversion to cold indicate injury to the San Jiao (Triple Burner). If a Rapid pulse appears at the Guan (Cun-Guan-Chi middle position) section, lacking head and tail, bean-sized, and trembling distinctly, it is named Moving.
[Commentary] *Su Wen* states: "Yang added to Yin is called sweat." How can Yang added to Yang cause sweat? Thus, "sweating" in "Yang Moving" should be "fever"; "fever" in "Yin Moving" should be "sweating."
[Note] "Moving" implies agitation, where Yin and Yang beat against each other restlessly. Moving is a Yang pulse. Cun (Inch) is Yang; Yang attacking Yang causes Yang Moving and fever. Chi (Cubit) is Yin; Yin attacking Yin causes Yin Moving and sweating. Guan lies between Yin and Yang, so Yin and Yang attack each other, causing simultaneous fever and sweating. This is a strong Moving pulse, indicating Yang Excess. If it does not throb under pressure, it indicates Yang Deficiency, manifesting as body coldness without fever, and sweating with aversion to cold. This is not the vigorous beating of Yang Excess, but the disturbance of Yang Deficiency. Injury to San Jiao Yang Qi prevents external warming of muscles/skin, causing these symptoms. The Moving pulse resembles Rapid pulse but lacks head/tail, is bean-sized, and trembles distinctly ("Jue Jue"), meaning it shakes with a root-like stability, unlike the flowing, non-stationary Slippery pulse.
[Ji Zhu] Fang Youzhi said: The Yin/Yang in "Yin-Yang struggle" refers to the two Qi; the Yin/Yang in "Yang Moving/Yin Moving" refers to locations. Below describes the location and shape of Moving pulse. "Jue Jue" describes the appearance of eruption.
Cheng Zhi said: Yang rises, Yin descends, communicating above and below between Chi and Cun, resulting in harmony and quietude. Only when Yang desires to rise but Yin is insufficient to harmonize and descend do they clash, resulting in a Rapid pulse and distinct trembling at the Guan position.
A pulse that is Floating and Tight is named Wiry (Xian). Wiry resembles a bowstring and remains fixed under pressure. A Tight pulse resembles a twisting rope without constancy.
[Note] "Floating and Tight is named Wiry" does not mean Floating-Tight equals Wiry, but rather that Floating and Forceful/Tight describes the shape of Wiry. Wiry and Tight are similar; to prevent confusion, they are compared. Wiry is straight like a bowstring, fixed under pressure (straight); Tight twists like a rope (not straight). Straight cannot twist; twisting cannot be straight; both are tense, hence similar.
[Ji Zhu] Fang Youzhi said: This clarifies the distinction between Wiry and Tight. "Fixed under pressure" means like a string on a bow, fixed and immovable. "Twisting rope" means rotating left and right without constraint.
Cheng Zhi said: Tight indicates exuberant Cold pathogen, with a sense of rotation and urgency within thinness, hence "like a twisting rope."
Zhang Xiju said: The difference between Wiry and Tight lies in movement vs. immobility.
A pulse that is Wiry and Large: Wiry indicates reduction; Large indicates Hollow (Kou). Reduction indicates Cold; Hollow indicates Deficiency. Cold and Deficiency struggling together is named Drum-skin (Ge). In women, it indicates miscarriage and persistent bleeding; in men, blood loss and essence depletion.
[Note] Coarse and forceful is Large; Floating/Deep forceful, Medium forceless, like a scallion tube is Hollow (Kou); Deep and Large, forceful under pressure is Firm (Lao); Floating and Large, forceful upon lifting is Drum-skin (Ge). Ge is named after a drum skin, showing exterior tension and interior emptiness. Wiry represents tension; reducing the medium-pressure tension shows exterior tension. Large represents Excess; reducing the medium-pressure Excess shows interior emptiness. This uses Wiry-Reduction and Hollow-Deficiency to describe Ge pulse. Women with this pulse suffer miscarriage/bleeding; men suffer blood/essence loss due to Cold-Deficiency struggle.
[Ji Zhu] Cheng Zhi said: Describes a Wiry and Vacuously Large pulse. "Wiry indicates reduction" means Yang Qi reduces leading to Cold; "Large indicates Hollow" means resembling Ge pulse, hollow and deficient. Deficiency-Cold struggle causes essence/blood leakage, hence Ge image.
Question: What are "Residual and Robber" (Can Zei) pulses? Master said: Pulses include Wiry, Tight, Floating, Slippery, Deep, and Choppy. These six are named Residual and Robber, as they can cause pathology in other pulses.
[Note] Below discusses pathology caused by Residual/Robber pulses. "Mutual Overacting" (Xiang Cheng) pulses arise from Righteous Qi deficiency, where pathogen attacks the deficient area. "Residual/Robber" pulses arise from Pathogenic Excess, where strong pathogen harasses other areas. These six are Residual/Robber; "Residual" is open injury, "Robber" is secret invasion. Presence indicates Excess pathogen. Regardless of location, if seen accompanying the primary pulse, one must guard against incoming pathogen.
[Ji Zhu] Fang Youzhi said: "Other pulses" refers to pulses in various positions. "Zuo" means arise. If these six appear in any position, they can initiate pathology there.
Zhang Xiju said: Can means damage; Zei means robbery/harm. These six pulses secretly harm meridians and Qi/Blood like thieves, hence "can cause pathology in other pulses."
At Cun Kou, if Yin and Yang pulses are both Tight, clinically, Clear Pathogen attacks the Upper Jiao, and Turbid Pathogen attacks the Lower Jiao. Clear Pathogen attacking Upper is called "Jie" (Pure); Turbid Pathogen attacking Lower is called "Hun" (Muddy). Yin attacked by pathogen causes internal shivering; Exterior Qi is slightly deficient, Interior Qi does not hold, allowing pathogen to attack Yin. Yang attacked by pathogen causes fever, headache, neck stiffness/spasm, lower back pain, and leg soreness; this is Yang attacked by mist/dew Qi, hence Clear Pathogen attacks Upper. Turbid Pathogen attacks Lower, causing Yin Qi shivering, cold feet/knees, and involuntary urination; Exterior Qi slightly deficient, Interior Qi slightly urgent, San Jiao mixed, Interior/Exterior blocked. Upper Jiao stagnates, Zang Qi熏蒸 (fumes), causing oral ulcers and gum erosion. Middle Jiao fails to regulate, Stomach Qi rushes upward, Spleen Qi fails to transform, Middle Jiao becomes Turbid, Ying/Wei do not circulate, Blood coagulates and stagnates. If Wei Qi flows first, urine is red/yellow; combined with Heat, Heat acts as a driver, wandering meridians/organs, causing abscess/pus where Heat passes. If Yin Qi flows first, Yang Qi is厥 (Jue/collapsed), Yin has no command, external pathogen enters, sneezes out, voice hoarse/throat blocked, Cold/Jue chase each other,擁 (surrounded) by Heat, Blood coagulates and exits downward, resembling pig liver. If both Yin and Yang are 厥, Spleen Qi is isolated/weak, Five Fluids pour downward, Lower Jiao fails to close, clear stool heaviness, frequent difficult defecation, umbilical cramping pain, life is hard to preserve.
[Note] Cun Kou Yin/Yang both Tight means all six pulses (Floating/Deep) are Tight. Floating-Tight indicates Mist/Dew pathogen attacks Upper Jiao; Deep-Tight indicates Cold pathogen attacks Lower Jiao. Upper Jiao refers to Tai Yang; Lower Jiao refers to Shao Yin. Mist/Dew pathogen is Jie/Qing. Clear Pathogen attacking Upper causes fever/headache/neck stiffness/back pain/leg soreness, indicating Mist/Dew attacking Tai Yang Exterior. Cold pathogen is Hun/Turbid. Turbid Pathogen attacking Lower causes Yin shivering/cold legs/urinary incontinence, indicating Cold attacking Shao Yin Interior. Classic says: Empty pathogen cannot injure alone; it requires bodily deficiency. Due to deficient Exterior Qi and unsecured Interior Qi, Clear/Turbid pathogens attack Upper/Lower. San Jiao mixes, Interior/Exterior blocks, Upper Jiao Clear Qi fails to diffuse, pathogen stagnates, fumes with Zang Qi, causing oral/gum lesions; Middle Jiao fails, Stomach Qi rebels upward, Spleen Qi fails to transport, Middle Jiao becomes Turbid, Ying/Wei block, Blood coagulates. If Righteous Qi wins, Wei Qi flows first, urine red/yellow, Heat-damaged meridians cause blood coagulation/flesh rot, erupting externally as abscess. If Ying Qi flows first, sneezing/throat block, Heat-surrounded coagulated blood exits downward, like pig liver. If Righteous Qi loses, Yin/Yang reverse, Ying/Wei block, Spleen Qi weak, fails to distribute essence, Five Fluids pour, Lower Jiao fails to close, interior urgency/heaviness, frequent difficult stool, life endangered.
[Ji Zhu] Shen Liangchen said: In Shang Han, turning to Heat is good; thus Shao Yin/Jue Yin recover with fever. Pus/blood discharge is not fatal. But if Yin/Yang both 厥, 厥 implies diarrhea, Five Fluids pour, Lower Jiao fails to close, life endangered.
Fang Youzhi said: Qing refers to Wind, Zhuo refers to Cold; Jie/Hun refer to heaven/earth biased Qi. The section from "Yin attacked..." explains previous text. Yin is Lower Jiao, Yang is Upper Jiao. "Yin Qi shivering..." describes symptoms. "If Wei Qi flows first..." explains abscess formation. "If Yin Qi flows first..." explains pus/blood diarrhea. Wei Qi is Yang Qi, Ying Qi is Yin Qi, following "Ying/Wei block," explaining how Clear/Turbid cause disease. "Yin/Yang both 厥..." describes symptoms worsening in Interior, hence "life endangered."
If Yin/Yang pulses are both Tight, with mouth breathing, dry lips/mouth, curled posture, cold feet, nasal discharge, and slippery tongue coating, do not treat rashly. After seven days, if mild fever and warm hands/feet appear, this indicates resolution; if after eight days, high fever appears, this is difficult to treat. If aversion to cold exists, vomiting is likely; if abdominal pain exists, diarrhea is likely.
[Note] This elaborates on the previous clause's symptoms, warning against rash treatment for this Yin-Yang confused disease. Curled posture/cold feet = Turbid Pathogen attacking Lower; Nasal discharge/tongue coating = Clear Pathogen attacking Upper; Dry lips/mouth = Oral/Gum lesions; High fever = Abscess/Blood discharge; Abdominal pain = Heaviness/Cramping pain; Aversion to cold = Internal shivering. Yin/Yang Tight is Shang Han pulse; Mouth breathing/Dry lips is Stomach Heat; Curled/Cold feet is Shao Yin Cold; Nasal discharge is Exterior Wind; Slippery coating is Interior No Heat. For such mixed/undetermined Exterior/Interior, Yin/Yang, Cold/Heat, Deficiency/Excess conditions, do not treat rashly. Assess severity/urgency and treat sequentially. After seven days, mild fever/warm limbs indicates Yin retreating, Yang returning (resolution). After eight days, high fever indicates Pathogen Excess, Righteous Qi Deficiency (difficult). Aversion to cold indicates pathogen still in Exterior. Vomiting indicates entering Interior. Abdominal pain indicates pathogen entered Interior, likely leading to diarrhea.
[Ji Zhu] Fang Youzhi said: Mild fever = pathogen retreating. High fever = pathogen exuberant. Aversion to cold = still in Exterior. Abdominal pain = entered Interior.
If Yin/Yang pulses are both Tight, leading to vomiting/diarrhea, and the pulse remains unresolved; if Tightness disappears and the person is comfortable, this indicates resolution. If the pulse is Slow, and after six-seven days there is no desire to eat, this is late onset due to Water retention, indicating unresolved; if appetite returns, it indicates resolution.
[Commentary] "Ren An" (Person Comfortable) in "Jin Qu Ren An" should be "Ren" (Person), not "Ru" (Enter). "Ren An" means no vomiting/diarrhea. Likely a transcription error. "Late onset due to Water retention" is disconnected from context, likely an interpolation.
[Note] This clarifies the meaning of Tight pulse in Yin/Yang both Tight with severe Interior/Exterior Cold regarding vomiting/diarrhea resolution. Post-vomit/diarrhea, if pulse remains Tight, pathogen remains (unresolved); if Tightness vanishes and pulse becomes Slow/Moderate, pathogen exhausted, person comfortable (resolving). If Tightness vanishes but pulse is Slow, and no appetite after 6-7 days, Stomach not harmonized (unresolved); if appetite returns, Stomach harmonized (resolving).
[Ji Zhu] Cheng Wuji said: Yin/Yang both Tight indicates severe Cold above/below. After vomiting/diarrhea, if Tight pulse persists, it is unresolved. If Tightness vanishes and person is comfortable, it is resolving.
At Cun Kou, if pulse is Floating and Large: Floating indicates Deficiency, Large indicates Excess. At Chi position, it is Guan (Closure); at Cun position, it is Ge (Refusal). Guan leads to inability to urinate; Ge leads to vomiting/reversal.
[Note] Normal pulse assessment uses Interior/Exterior for Guan/Ge; here, Size/Position (Cun/Chi) is used. Thus, extreme Yin/Yang Excess causes Guan/Ge, not limited to Interior/Exterior or Cun/Chi. Cun Kou Floating/Large: Floating is Righteous Qi Deficiency, Large is Pathogenic Excess. At Chi, Yin Pathogen Excess closes Righteous Qi, preventing diffusion, named Guan, leading to urinary retention. At Cun, Yang Pathogen Excess refuses Righteous Qi, preventing transformation, named Ge, leading to vomiting/reversal.
[Ji Zhu] Zhang Xiju said: Floating/Large at Chi is Guan Yin; Yin Qi fails to transform, causing urinary retention. Floating/Large at Cun is Ge Yang; Yang Qi fails to diffuse, causing vomiting/reversal.
If pulse is Floating and Slippery: Floating is Yang, Slippery is Excess. Yang and Excess struggle, pulse becomes Rapid/Frequent, Wei Qi loses regulation. Floating-Slippery pulse, Rapid/Frequent, with fever and sweating, is untreatable.