The question was asked: “There is ‘arriving before its time,’ ‘not arriving at its time,’ ‘arriving but not departing,’ and ‘arriving in excess’ — what do these mean?”
The Master replied: “After the Winter Solstice, at midnight on the day of Jiazi, the Shaoyang arises. At the time of Shaoyin, Yang begins to be born, and the heavens become warm and mild. If warmth arrives before the Jiazi day, this is called ‘arriving before its time.’ If the Jiazi day comes but the heavens remain unwarmed, this is ‘not arriving at its time.’ If the Jiazi day comes but the great cold persists without relenting, this is ‘arriving but not departing.’ If the Jiazi day comes and it is as warm as the height of summer in the fifth or sixth month, this is ‘arriving in excess.'”
The Master said: “When a patient’s floating pulse is felt in the anterior position, the disease is in the exterior; when the floating pulse is felt in the posterior position, the disease is in the interior — there will be lower back pain, a stiff back, and inability to walk, with inevitable shortness of breath and exhaustion.”
The question was asked: “The Classic says, ‘Jue Yang travels alone’ — what does this mean?”
The Master replied: “This means there is Yang without Yin, and so it is called Jue Yang.”
The Master said: “When the Cun pulse is deep, large, and slippery — deep indicates excess, slippery indicates Qi — when excess and Qi struggle together, if blood and Qi enter the Zang organs the patient will die; if they enter the Fu organs the patient will recover. This is called sudden Jue — what does this mean?”
The Master replied: “If the lips and mouth turn blue and the body becomes cold, this means Qi has entered the Zang organs — death follows. If the body feels normal and there is sweating from the eyes, this means Qi has entered the Fu organs — recovery follows.”
The question was asked: “When the pulse collapses — entering the Zang means death, entering the Fu means recovery — what does this mean?”
The Master replied: “This is not limited to one disease — a hundred diseases all follow this pattern. Take spreading sores (浸淫疮), for example: if they begin at the mouth and spread toward the limbs, they are treatable; if they begin at the limbs and spread toward the mouth, they are untreatable. Diseases on the exterior are treatable; diseases that penetrate to the interior are fatal.”
Study Notes
The question of arriving on time versus not arriving on time belongs to the framework of Five Movements and Six Qi (五运六气). It expounds Zhang Zhongjing’s views on life and disease, embodying the important concept of heaven-human unity. This passage is beyond reproach.
However, the appearance of Shaoyin and Shaoyang here has prompted many scholars to write extensively about it. I personally believe this has little to do with the Six Channels of the Shanghan Lun.
The next paragraph is similar — “anterior” and “posterior.” Many people use this to fit it into a Yin-Yang framework. Even though the Neijing may contain similar statements, the true meaning remains hotly debated. Most historical commentators believed this to be a description of the Cun-Kou pulse, but I find this unreliable — otherwise, how would one explain the “shortness of breath and exhaustion”? I suspect this may be a corrupted text, pieced together from fragments.
The later sections adopt a question-and-answer format to present the core content of “disease, pulse, pattern, and treatment.” Worth reading through, but pulse diagnosis throughout the entire Shanghan Zabing Lun occupies a crucial position, and ancient pulse methods likely differ greatly from modern ones. Textbook pulse methods primarily aim to explain disease etiology and pathogenesis, whereas Zhongjing’s pulse methods are more about indicating the body’s overall state. While we can extrapolate to pathogenesis, I personally feel the value is limited.
The art of harmonizing the pulse and differentiating patterns — how much of it have we truly inherited?
中文原文 / Chinese Original
问曰：有未至而至，有至而不至，有至而不去，有至而太过，何谓也？师曰：冬至之后，甲子夜半少阳起，少阴之时，阳始生，天得温和。以未得甲子，天因温和，此为末至而至也；以得甲子，而天未温和，为至而不至也；以得甲子，而大大寒不解，此为至而不去也；以得甲子，而天温如盛夏五六月时，此为至而太过也。
师曰：病人脉浮者在前，其病在表；浮者在后，其病在里，腰痛背强不能行，必短气而极也。
问曰：经云：”厥阳独行”，何谓也？师曰：此为有阳无阴，故称厥阳。
师曰：寸脉沉大而滑，沉则为实，滑则为气，实气相搏，血气入藏即死，入府即愈，此为卒厥，何谓也？师曰：唇口青，身冷，为入藏，即死；如身和，汗目出，为入府，即愈。
问曰：脉脱，入藏即死，入府即愈，何谓也？师曰：非为一病，百病皆然。譬如浸淫疮，从口起流向四肢者可治，从四肢流来入口者不可治；病在外者可治，入里者即死。
至和不至的问题属于五运六气范畴，阐释了仲景的生命和疾病观，蕴藏了天人合一的重要思想，此段没得说。但是这里面出现了少阴少阳，很多人由此做了不少文章，我认为这个跟伤寒六经关系不大。
下一段也是，在前在后，很多人拿这个去套阴阳，纵然内经上可能有类似的说法，但是内涵究竟是什么至今众说纷纭。历代诸家多认为是对寸口脉的描述，我认为不可靠，否则短气而极又当如何解释？恐为错简，拼起来的。
后面是一问一答，用这种形式讲述”病脉证并治”的核心内容，看看就行了，脉诊在整本伤寒杂病论中都占有重要地位，但是古脉法很有可能跟现在差距很大，教科书上的脉法更多是去阐释病因病机，仲景脉法更多的是表明机体状态，当然我们也可以引申到病机，个人感觉意思不大。
平脉辨证，现在还继承了多少？
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