(诸过者切之，涩者阳气有余也，为身热、无汗；滑
前人多以此三句连续，殊觉脉证不相属，而下文诸过者，亦嫌突起而无着也。予以上二
句为
一段，以下五字连下文“诸过者”读，属下滑涩寒热为义。其义即《通评虚实论》所谓肠
下脓血白沫者，身热则死，寒则生；脉涩则死，滑则生之义也。上二句前人亦未剖析透彻。
夫气之动于脏也，如弓弩之发。若里脉有病，则气初发之处，即为之阴滞，而脉之应指必软
弱矣。今其脉迫促而数，搏滑而动，是其气已涌至于表，因表脉有阻而不得畅达，故有此郁
勃之象，而仅偶间一至软弱而代也。数音促，不音索，旧读去声者误。代之本义为弱，详《
平人气象论》，后人专释为止，是不读《内经》之过也。
《金匮》备急丸方下，有若口噤亦须折齿灌之之语。后世方书，有谓口噤不得入药者，
打去
一齿灌之，其义盖本诸此。其实《金匮》之意，非谓打去一齿也，只是撬之使开耳!齿根上
连于脑，内应 于心，敲之即痛彻心脑。口噤本是心气闭塞，若再使痛气入心，不速之毙乎?
此数语，虽无深义，而有新感与伏气之殊。前人辨论纷纭，读之迄不能令人心意朗豁者
，空
谈不切事情也。以己身所未见，天下所必无之事，而大言不怍，强作解人，是何意耶?详玩
语气，阴阳二字是指表里之部分，非指风寒温热之气化也。何者?其意是专辨伤寒有此两途
，非两辨伤寒、温病之异也。凡感于风寒而即病者，皆因发热，而始恶寒，未见有不热但恶
寒者。即初时爪尖略形厥冷，不过片刻之事，临诊之时必已发热，岂得谓之无热、未发热耶
?惟伏气之病，激于时令之气而发者，或早恶寒而夜发热，或夜恶寒而早发热，更有迟至一
日以外者，以寒邪内伏，至春初阳气当升，邪阻其道，二气相争，荣卫不通，遂见恶寒，待
里气奋达于表，始见发热。故发热、恶寒，一时并见者，即已发热之谓也。是新感风寒，病
起于表，故曰发于阳；无热恶寒，久乃发热者，即未发热之证也，是伏邪内动，病起于里，
故曰发于阴。
凡伏气之病，发于里者，有寒热两途。热即寒邪入郁而化热者也。其人若真阴充裕，寒
虽久
伏，不能化热；若真阴不足，虚阳亢燥，遂发为春温、风温之病矣。其初起皆不即发热，而
治法之寒热虚实迥异。仲景是专指伏气寒病也。近人如叶天士、薛生白、王孟英辈，止知有
伏气之温病，而不知有伏气之寒病，皆揣理而谈，未尝征之实事也。汪幼纯所说汗病之事，
即伏气之寒病也，详见第四卷证治类中。
两“愈”字，乃半面之词，若至期不愈，即不可为矣。如辨脉云∶表有病者，脉当浮大
，今
反沉迟，故知愈也；里有病者，脉当沉细，今反浮大，故知愈也。《千金方》引此文而申之
曰∶若不愈者必死，以其脉与病不相应也。即此义
也。愈，非痊愈也，只是邪气至此，当已尽头，不能再进，而可渐退也。“六”、“七”两
字
，前人见原文有阳数、阴数之语，莫不滑口读过，未尝深考其实。夫病之愈也，必藉于气，
六、七数也，何与人身之气耶?鄙见此当指人身之形层言也。刘河间曰∶天地自太虚至黄泉
，有六位；人身自头至足，有六位；而胸腹之间，自肺至肾，亦有六位。是人身形层之表里
，显有六分也。故发于阴者，自里而表，六日传至极表，而邪气散矣；发于阳者，自表而里
，
六日行至极里，为里分正气所持，不得久留，越一日而邪气始从三焦消散，故阳病转比阴病
多一日也。原文阳数七、阴数六者，即以里必行至六，而邪乃衰；表必行至七，而邪乃衰也
，不然，阴阳之数，四、五、八、九皆是也，且五、六尤有合于脏腑之数，何独取六、七耶
?
（凡是脉象出现异常变化的，都需要切诊。脉涩说明阳气有余，表现为身体发热、无汗；脉滑……）前人大多将这三句话连在一起读，总觉得脉象与证候不相符合，而且下文突然出现的“诸过者”，也显得突兀而没有着落。我认为上两句为一段，以下五个字（滑前人多以此三句连续，殊觉脉证不相属，而下文诸过者，亦嫌突起而无着也。予以上二 句为 一段，以下五字连下文“诸过者”读，属下滑涩寒热为义。）应连下文“诸过者”来读，其含义是指脉象的滑、涩以及寒热的变化。这个含义就是《素问·通评虚实论》中所说的：大便下脓血或白沫，如果身体发热则预后不良（死），如果身体不发热则预后良好（生）；脉象涩则预后不良，脉象滑则预后良好的道理。前人也没有把上两句剖析透彻。
气在脏腑中的运行，就像弓弩发射箭矢一样。如果里脉有病，那么气初发之处，就会受到阴邪的阻滞，因此脉象按之必然软弱无力。现在脉搏急促而数，搏动滑利且动，这说明气已经涌至体表，但因为表脉有阻碍而不能畅达，所以呈现出这种郁勃旺盛的景象，只是偶尔夹杂一次软弱无力的代脉。“数”音同“促”，不同“索”，旧时读去声是错误的。“代”字的本义是弱，详见《素问·平人气象论》，后人专门解释为“止”，这是没有研读《内经》的过错。
《金匮要略》备急丸方下，有“如果牙关紧闭，也必须撬开牙齿灌药”的说法。后世的方书，有的说牙关紧闭无法服药时，打掉一颗牙齿灌药，其意义大概源于此。其实《金匮要略》的意思，并不是说要打掉一颗牙齿，只是撬开嘴巴罢了！齿根向上连接于脑，内部对应于心，敲击牙齿会痛彻心脑。口噤（牙关紧闭）本是心气闭塞，如果再让痛气进入心脏，岂不是导致迅速死亡？
这几句话，虽然没有深奥的含义，但指出了新感病与伏气温病的区别。前人对此争论纷纷，读起来始终不能让人豁然开朗的原因，在于空谈而不切合实际。用自己从未见过、天下必定不存在的事情，却大言不惭，强行充当懂行的人，这是什么用意呢？仔细玩味语气，“阴阳”二字指的是表里的部位，并非指风寒温热的气化性质。为什么呢？其意图是专门辨析伤寒有此两种途径，而不是分别辨析伤寒与温病的差异。凡是感受风寒而立即发病的，都是因为发热，开始恶寒，没有见过只有恶寒而不发热的。即使起初指尖略微厥冷，也不过是一会儿的事，临诊时一定已经发热，怎么能说是无热、未发热呢？只有伏气病，被时令之气激发而发作的，或者早晨恶寒而夜间发热，或者夜间恶寒而早晨发热，更有延迟到一天以后的，因为寒邪内伏，到了春初阳气应当升发的时候，邪气阻断了它的道路，正气与邪气相争，营卫不通，于是见到恶寒，等到里气奋达于体表，才见到发热。所以发热、恶寒同时并见的，就是所谓“已发热”。这是新感风寒，病起于体表，所以说“发于阳”；没有发热而恶寒，很久以后才发热的，就是所谓“未发热”的证候，这是伏邪在内发动，病起于体内，所以说“发于阴”。
凡是伏气病，发于体内的，有寒热两个途径。热证即寒邪入里郁结而化热。如果这个人真阴充足，寒邪虽然久伏，也不能化热；如果真阴不足，虚阳亢盛燥热，就发为春温、风温的病。这些初起都不立即发热，而治法的寒热虚实截然不同。张仲景这里专指伏气的寒病。近代人如叶天士、薛生白、王孟英等人，只知道有伏气的温病，而不知道有伏气的寒病，都是揣测医理而谈论，未曾验证于实事。汪幼纯所说的汗病之事，就是伏气的寒病，详见第四卷证治类中。
两个“愈”字，只是片面的说法，如果到了期限还没有好转，那就不可救治了。如《辨脉法》所说：表有病的人，脉应当浮大，现在反而沉迟，所以知道快要好了；里有病的人，脉应当沉细，现在反而浮大，所以知道快要好了。《千金方》引用这段话并补充说：如果不好的话一定会死，因为脉象与病证不相呼应。就是这个道理。“愈”，不是痊愈，只是邪气到这里，应当已经到头，不能再前进，从而可以逐渐消退。“六”、“七”这两个数字，前人看到原文有阳数、阴数的说法，无不顺口读过，未曾深入考察其实质。我认为这应当是指人身形体层次的数目。刘河间说：天地从太虚到黄泉，有六个层次；人身从头到足，有六个层次；而胸腹之间，从肺到肾，也有六个层次。所以人身形体的表里，明显分为六层。因此，发于阴的病，从里向表传变，六天传到极表，邪气就消散了；发于阳的病，从表向里传变，六天行走到极里，被里分的正气所持守，不能久留，过了一天邪气才从三焦消散，所以阳病比阴病多一天。原文说阳数七、阴数六，就是因为邪气在里必须行至第六层才衰退，在表必须行至第七层才衰退。否则，阴阳的数字，四、五、八、九都可以，而且五、六尤其符合脏腑之数，为什么唯独取六、七呢？
(When there are any abnormal changes in the pulse, palpation is required. A choppy (Se) pulse indicates an excess of Yang Qi, manifesting as body heat and absence of sweating; a slippery (Hua)... ) Predecessors often read these three sentences together, which seems inconsistent between pulse signs and symptoms, and the subsequent "Zhu Guo Zhe" (those with various abnormalities) appears abrupt and lacks context. I consider the first two sentences as one paragraph, and the following five characters should be connected to the subsequent "Zhu Guo Zhe" for reading. The meaning refers to the variations in pulse slipperiness/choppiness and cold/heat. This meaning aligns with what is stated in *Tong Ping Xu Shi Lun* (Treatise on Communicating Excess and Deficiency): regarding purulent bloody or white mucous stools, if accompanied by body heat, prognosis is poor (death); if without body heat, prognosis is good (survival); a choppy pulse indicates poor prognosis, while a slippery pulse indicates good prognosis. Predecessors did not thoroughly analyze the first two sentences.
The movement of Qi within the Zang organs is like the release of a bow or crossbow. If there is disease in the interior pulses, the initial site of Qi emission will be obstructed by Yin pathogens, causing the pulse response to the finger to be necessarily soft and weak. Now, the pulse is rapid and hurried (Cu), beating slippery and dynamic, indicating that Qi has surged to the exterior. However, due to obstruction in the exterior pulses preventing smooth flow, this image of turbulent abundance arises, occasionally interspersed with a single weak and intermittent (Dai) pulse. "Shu" (rapid) is pronounced like "Cu" (hurried), not "Suo"; the old reading as a departing tone is incorrect. The original meaning of "Dai" (intermittent) is weakness, as detailed in *Ping Ren Qi Xiang Lun* (Treatise on the Pulse Images of Healthy People). Later scholars specifically interpreted it as "stopping," which is an error resulting from not studying the *Nei Jing*.
Under the formula for Bei Ji Wan (Emergency Rescue Pill) in *Jin Gui Yao Lue*, there is a statement: "If the jaw is locked, teeth must be pried open to administer the medicine." Later medical texts state that when the jaw is locked and medicine cannot be taken, one tooth should be removed to administer the medicine, likely deriving its meaning from this. Actually, the intent in *Jin Gui Yao Lue* was not to remove a tooth, but simply to pry the mouth open! The roots of the teeth connect upward to the brain and internally correspond to the Heart; striking the teeth causes pain penetrating the heart and brain. Jaw locking (Kou Jin) is originally caused by the closure of Heart Qi. If pain Qi is further allowed to enter the Heart, would it not lead to rapid death?
These few words, though lacking profound meaning, distinguish between newly contracted diseases and latent qi diseases. Predecessors debated this endlessly, yet readers never felt enlightened because their discussions were empty talk detached from reality. Using things they had never seen and which undoubtedly do not exist in the world, yet speaking boldly without shame and forcing themselves to act as experts, what is the purpose? Carefully examining the tone, the terms "Yin" and "Yang" refer to the locations of Exterior and Interior, not to the transformations of Wind-Cold or Wind-Heat pathogens. Why? The intent is specifically to differentiate that Shang Han (Cold Damage) has these two pathways, not to differentiate between Shang Han and Wen Bing (Warm Diseases). For those who contract Wind-Cold and fall ill immediately, it is always due to fever, starting with aversion to cold. There are no cases of only aversion to cold without fever. Even if the tips of the nails are slightly cold initially, it is only for a moment; upon clinical examination, fever must already be present. How can this be called "no heat" or "not yet febrile"? Only in latent qi diseases, triggered by seasonal qi, might one see aversion to cold in the morning and fever at night, or aversion to cold at night and fever in the morning, or even delayed beyond a day. Because Cold pathogens lie latent inside, when Yang Qi should rise in early Spring, the pathogen blocks its path. The two qi struggle, Ying and Wei fail to circulate smoothly, leading to aversion to cold. Only when interior Qi vigorously reaches the exterior does fever appear. Therefore, when fever and aversion to cold appear simultaneously, it is referred to as "already febrile." This is a newly contracted Wind-Cold disease originating in the Exterior, hence called "Fa Yu Yang" (Emanating from Yang). When there is no fever but aversion to cold, followed by fever after a long time, this is the syndrome referred to as "not yet febrile." This is latent pathogen moving internally, originating in the Interior, hence called "Fa Yu Yin" (Emanating from Yin).
For latent qi diseases originating in the Interior, there are two pathways: Cold and Heat. Heat syndromes occur when Cold pathogens enter the Interior, become stagnant, and transform into Heat. If a person's True Yin is abundant, even if Cold lies latent for a long time, it cannot transform into Heat. If True Yin is insufficient, Deficient Yang becomes hyperactive and dry, leading to diseases such as Chun Wen (Spring Warmth) or Feng Wen (Wind Warmth). These all do not present with immediate fever upon onset, and their treatment methods differ significantly in terms of Cold/Heat and Excess/Deficiency. Zhang Zhongjing here specifically refers to latent Cold diseases. Recent scholars such as Ye Tianshi, Xue Shengbai, and Wang Mengying only knew of latent Warm diseases and were unaware of latent Cold diseases. They speculated on principles without verifying them against actual cases. The case of sweating mentioned by Wang Youchun is indeed a latent Cold disease, detailed in Volume 4 under Treatment Categories.
The two instances of the character "Yu" (recovery/improvement) are one-sided statements. If recovery does not occur by the expected time, the condition becomes untreatable. As stated in *Bian Mai* (Differentiating Pulses): "For diseases in the Exterior, the pulse should be Floating and Large; now it is instead Deep and Slow, so we know recovery is imminent. For diseases in the Interior, the pulse should be Deep and Fine; now it is instead Floating and Large, so we know recovery is imminent." *Qian Jin Fang* cites this and adds: "If it does not improve, death is certain, because the pulse does not correspond to the disease." This is the same principle. "Yu" does not mean complete cure, but rather that the pathogen has reached its limit, cannot advance further, and can gradually recede. Regarding the numbers "Six" and "Seven," predecessors saw the text mention Yang number and Yin number and read them offhand without deep investigation. I believe this refers to the layers of the human body. Liu Hejian said: From the Great Void to the Yellow Springs, Heaven and Earth have six levels; from head to foot, the human body has six levels; and between the chest and abdomen, from Lung to Kidney, there are also six levels. Thus, the Exterior-Interior of the human body form clearly divides into six parts. Therefore, a disease emanating from Yin travels from Interior to Exterior, reaching the extreme Exterior on the sixth day, where the pathogen dissipates. A disease emanating from Yang travels from Exterior to Interior, reaching the extreme Interior on the sixth day. Held by the Righteous Qi in the Interior, it cannot stay long; after passing one day, the pathogen dissipates through the San Jiao. Thus, Yang diseases last one day longer than Yin diseases. The original text stating Yang number seven and Yin number six means that pathogens in the Interior must reach the sixth layer to decline, and pathogens in the Exterior must reach the seventh layer to decline. Otherwise, among Yin-Yang numbers, four, five, eight, and nine are all possible, and five and six particularly align with the number of Zang-Fu organs. Why specifically choose six and seven?