二条但言病机，不及脉法，治宜桃仁承气、犀角地黄辈。（柯韵伯）
愚按邪入血分，热甚于经，故欲漱水；未入于府，故不欲咽。使此时以葛根汤汗之，不亦可以夺汗而无血
乎？（周禹载）
脉浮发热，则在经而不在里；口鼻干燥，阳明经热炽矣。能食为风邪，风性上行，所以衄也。宜治以黄芩、
芍药辈。（程扶生）
服柴胡汤已，渴者，属阳明也。以法治之。
喻氏因仲师不出方，更为之说，言用五苓、白虎等汤，贻害不浅。不知仲师所谓属阳明者，乃言服小柴胡
汤，非治少阳、阳明不对也。乃服后，少阳、阳明之证虽可愈，而阳明之津液未必
遽复，所以用小柴胡本有加减之法，立此令人勿惑于一渴而漫议小柴胡有误，终是顾虑阳明之津液，未能尽善
所致耳。苟知此渴系胃中津亡之故，则用小柴胡汤时，已如法矣，何必又言以法治之乎？仲师所言以法者，岂有
他法！试观小柴胡汤下，原有加减之法，明言若渴者，去半夏加人参、栝蒌根，则是《经》文本有成宪，诸
注自不留心，而谬为自用。胃中津亡则渴，五苓用之，津益亡。胃中燥气作渴，迥非实热可比，白虎用之，
虚且寒矣。（魏荔彤）
按∶风寒之邪，传至少阳，起先不渴，里证未具也。及服柴胡汤而渴反加，则邪归阳明之府，断乎无疑。
不言治法，而曰以法治之者，正以外证未罢，当用本汤去半夏加栝蒌法；里多外少，当用大柴胡法；若全入里，
则用小承气法，庶近病情。（周禹载）
伤寒，哕而腹满，视其前后，知何部不利，利之则愈。
愚按腹满固里证具，而哕则外邪未尽也。乃仲景竟云∶视其前后何部不利，利之愈。岂圣人置表证不问
耶？如利前谓五苓散，利后有大柴胡，则桂枝柴胡解外者也。若竟以承气为解，大失仲景两解立言之旨。（周禹载）
伤寒，脉弦细，头痛发热者，属少阳。少阳不可发汗，发汗则谵语，此属胃。胃和则愈，胃不和，则烦而悸。
此处云属胃，胃虚故也。和胃不曾出方。然玩胃不和则烦而悸，当是小建中汤。以下有二、三日心中
悸而烦者，小建中汤主之之条也。（程郊倩）
少阳少血，虽有表证，不可发汗。发汗则津液越出，相火燥，必胃实而谵语，当与柴胡以和之。上焦得
通，津液得下，胃气因和。若加烦躁，则为承气证矣。（柯韵伯）
少阴病，欲吐不吐，心烦，但欲寐，五六日自利而渴者，属少阴也，虚故引水自救。若小便色白者，少阴病
形悉具；小便白者，以下焦虚有寒，不能制水，故令色白也。
欲吐不吐，心烦，肾气上逆之征也。自利而渴，加以口燥舌干，引水自救，似乎热证之形，然肾热则水道
黄赤；若小便色白，又非肾热，乃下焦虚寒，不能制水，仍当从事温法。不可误认为热，而轻投寒下也。（喻嘉言）
病患脉阴阳俱紧，反汗出者，亡阳也。此属少阴，法当咽痛而复吐利。
亡阳者，虚阳不归其原，皆由少阴不藏所致。故上焦从火化而咽痛呕吐，下焦从阴虚而下利不止也。
宜八味肾气丸主之。（柯韵伯）
当用温经散寒之法，不言可知。（喻嘉言）
少阴病，脉微，不可发汗，亡阳故也。阳已虚，尺脉弱涩者，复不可下之。
当急行温法，又可见矣。（喻嘉言）
厥而脉紧，不可发汗，发汗则声乱、咽嘶、舌萎、声不得前。
以上四条，皆少阴经虚寒坏证也。仲景俱不出方。详少阴病欲吐不吐一条，宜真武汤。病患脉阴阳俱紧一
条，宜附子汤加桔梗、赤石脂。少阴病脉微一条，宜白通加人尿、猪胆汁。此条厥而脉紧，则当用四逆汤温之。
反误发汗，致声乱、咽嘶、舌萎，不可救矣。（张路玉）
少阴病，八九日，一身手足尽热者，以热在膀胱，必便血也。
宜当归四逆，和营透表，兼疏利膀胱为合法也。（张路玉）
少阴病，便脓血者，可刺。
若不用刺法，当从事白头翁汤；设更兼咽干，心烦不得卧，又须黄连阿胶汤为合法耳。（张路玉）
少阴病，下利，若利自止，恶寒而蜷卧，手足温者，可治。
手足温者，乃真阳未离，急用白通、四逆之类，温经散寒，
则邪退而真阳复矣。故曰可治。（沈明宗）
少阴病，恶寒而蜷，时时自烦，欲去衣被者，可治。
设见躁逆闷乱，扰攘不安，手足厥冷，脉反躁急，或散大无伦者，皆死证也。（张路玉）
少阴病，咳而下利谵语者，被火气劫故也。小便必难，以强责少阴汗也。
少阴属肾，主水者也。少阴受邪，不能主水，上攻则咳，下攻则利。邪从寒化，真武汤证也；邪从热化，
猪苓汤证也。今被火气劫汗，则从热化，而转属于胃，故发谵语；津液内竭，故小便难。是皆由强发少阴之汗
故也。欲救其阴，白虎、猪苓二汤，择而用之可耳。（《医宗金鉴》）
少阴病，咽中痛，半夏散及汤主之。
此必有恶寒欲呕证，故加桂枝以散寒，半夏以除呕，若夹相火，则辛温非所宜矣。（柯韵伯）
伤寒先厥后发热，下利必自止。而反汗出，咽中痛者，其喉为痹。发热无汗，而利必自止；若不止。必便脓
血。便脓血者，其喉不痹。
喉痹者，桔梗汤；便脓血者，白头翁汤。（张路玉）
伤寒一二日至四五日而厥者，必发热。前热者，后必厥。厥深者，热亦深。厥微者，热亦微。厥应下之，而
反发汗者，必口伤烂赤。
前云诸四逆厥者，不可下矣。此云厥应下之者，其辨甚微。盖先四逆而后厥，与先发热而后厥者，其
来迥异。故彼云不可下，此云应下之者，以其热深厥深，当用苦寒之药，清解其在里之热，即名为下，从未
闻有峻下之法也。（《尚论篇》）
一友云∶厥应下之，下之为言，泄也。不指定承气言，故不出方。肝属阴而恶燥，凡酸咸润下之品，
亦阴之泄也。此说非不可从，然细思之，仲景于《厥阴篇》，无一条无方者，其所以不
出方者，皆有所伏，而欲人互得之也。岂于下之之条，欲人另自融会，当不其然，下利谵语条，小承气汤一
方，在阳明原为和剂，以减去芒硝，只下邪热，非下胃实，则里有邪热者，何不可互用也。（程郊倩）
此指热伤气而言，是胃热而不是胃实，非三承气所宜。厥微者，当用四逆散，芍药、枳实以攻里，柴胡、
甘草以和表也。厥深者，当用白虎汤，参、甘、粳米以扶阳，石膏、知母以除热也。（柯韵伯）
伤寒热少厥微，指头寒，默默不欲食，烦躁，数日，小便利、色白者，此热除也。欲得食，其病为愈。若厥
而呕，胸胁烦满者，其后必便血。○下利寸脉反浮数，尺中自涩者，必圊脓血。
此少阳半表半里证，微者小柴胡和之，深者大柴胡下之。（柯韵伯）
热不除而便血，可用犀角地黄汤。（郭雍）
此条与上条厥呕胸胁烦满者，虽有轻重之殊，而治法不异，并宜白头翁汤；脓血止，宜芍药甘草汤。（张路玉）
此条乃下利变脓血之候也。热利而得数脉，非反也，得浮脉则为反矣。论无治法，宜以仲师黄芩汤治之。（汪琥）
病者手足厥冷，言我不结胸，小腹满，按之痛者，此冷结在膀胱关元也。
当用温用灸可知。（喻嘉言）
下利清谷，不可攻表，汗出必胀满。
合用浓朴生姜半夏甘草人参汤，以温胃消胀为务也。（张路玉）
呕家有痈脓者，不须治呕，脓尽自愈。
此谓热气有余，必发痈脓，未有不呕者。然此为内实之呕，而非外邪之呕也。乃可以辛散之药投之乎？
不言治法而曰脓尽自愈，则治法已善为人言之矣。总以热结多血之脏，无论在肺在
胃，不离乎辛凉以开结，苦泄以排脓，甘寒以养正，使脓尽而呕自止耳。（《伤寒论三注》）
呕家有脓，不须治呕，脓尽自愈者，此言胃脘痈也。盖阳明多气多血，故脓尽自能生肌长肉，而胃自完。
若咳吐脓血而为肺痈，则多死少生，治亦惧其不愈矣。故《金匮》言始萌可救，脓成则死。（《医参》）
病患身大热，反欲得近衣者，热在皮肤，寒在骨髓也。身大寒，反不欲近衣者，寒在皮肤，热在骨髓也。
东垣云∶当不从内外，从乎中治。谓以小柴胡和之。愚以为未传少阳，岂可先用此汤？身热畏寒属阳虚，
身寒畏热属阴虚。阳虚者治宜黄 建中，阴虚者治宜当归建中。（《伤寒论三注》）
Article 2 discusses only the pathogenesis, omitting pulse diagnosis. Treatment is suitable with formulas such as Taoren Chengqi Tang (Peach Kernel and Rhubarb Decoction) and Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). (Ke Yunbo)
My analysis: When evil qi enters the blood level, heat becomes severe in the meridians, causing the patient to desire rinsing the mouth with water; however, since it has not entered the fu organs, the patient does not wish to swallow. If Guigen Tang (Kudzu Root Decoction) were used to induce sweating at this time, would it not lead to exhaustion of fluids and depletion of blood? (Zhou Yuzai)
A floating pulse and fever indicate that the disease is in the meridians and not in the interior; dryness of the mouth and nose indicates blazing heat in the Yangming meridian. The ability to eat suggests wind evil, whose nature is ascending, thus leading to epistaxis. Treatment should employ herbs such as Huangqin (Scutellariae Radix) and Shaoyao (Paeoniae Radix). (Cheng Fusheng)
After taking Xiaochaihu Tang (Minor Bupleurum Decoction), if thirst occurs, it belongs to Yangming. Treat according to the method.
Yu Jiayan, because Zhang Zhongjing did not provide a specific formula, offered an alternative interpretation, suggesting the use of Wuling San (Five-Ingredient Poria Pill) or Baihu Tang (White Tiger Decoction), which causes significant harm. He fails to realize that when Zhang Zhongjing says "belongs to Yangming," he refers to the progression after taking Xiaochaihu Tang, not implying that the treatments for Shaoyang and Yangming are mismatched. After administration, although symptoms of both Shaoyang and Yangming may resolve, the fluids of Yangming may not immediately recover. Therefore, Xiaochaihu Tang originally possesses modification methods; this clause exists to prevent confusion over a single instance of "thirst" and unwarranted criticism of Xiaochaihu Tang. This ultimately stems from insufficient consideration of Yangming fluids. If one understands that this thirst results from the loss of stomach fluids, then the method was already applied correctly when using Xiaochaihu Tang. Why mention "treat according to the method"? What other method could Zhang Zhongjing mean? Observe the modifications under Xiaochaihu Tang: it explicitly states that if thirsty, remove Banxia (Pinelliae Rhizoma) and add Renshen (Ginseng Radix et Rhizoma) and Gualougen (Trichosanthis Radix). Thus, the Classics have established rules; commentators who neglect these and impose their own views are mistaken. Thirst due to loss of stomach fluids makes Wuling San further deplete fluids; thirst due to dryness in the stomach is incomparable to excess heat, making Baihu Tang inappropriate as it would induce deficiency and cold. (Wei Litong)
Analysis: Wind-cold evil transmitting to Shaoyang initially presents without thirst, as interior signs are not yet formed. If thirst worsens after taking Chaihu Tang, the evil has definitely returned to the Yangming fu organs. The phrase "treat according to the method" implies that since exterior signs persist, one should use the base formula modified by removing Banxia and adding Gualougen; if interior signs outweigh exterior ones, Dazhaihu Tang (Major Bupleurum Decoction) should be used; if fully interior, Xiao Chengqi Tang (Minor Order the Qi Decoction) is appropriate, thereby aligning closely with the pathology. (Zhou Yuzai)
In Shanghan (Cold Damage), if there is hiccups and abdominal fullness, examine the anterior and posterior orifices to determine which is obstructed; unblocking the obstruction leads to recovery.
My analysis: Abdominal fullness indeed indicates established interior signs, but hiccups suggest residual exterior evil. Yet Zhang Zhongjing states: "Examine the anterior and posterior... unblocking leads to recovery." Does the Sage ignore exterior signs? If unblocking the anterior uses Wuling San, and unblocking the posterior involves Dazhaihu Tang, then Guizhi Tang (Cinnamon Twig Decoction) and Chaihu Tang are for resolving the exterior. Treating Chengqi Tang (Rhubarb Decoctions) as an exterior resolver would greatly miss Zhang Zhongjing's intent of simultaneous exterior-interior resolution. (Zhou Yuzai)
In Shanghan, if the pulse is wiry and fine, accompanied by headache and fever, it belongs to Shaoyang. Shaoyang disease contraindicates sweating; inducing sweat leads to delirium, which pertains to the Stomach. If Stomach qi harmonizes, recovery ensues; if disharmonious, irritability and palpitations occur.
The phrase "pertains to Stomach" here indicates Stomach deficiency. No formula is given for harmonizing the Stomach. However, considering "Stomach disharmony leads to irritability and palpitations," this likely refers to Xiaojianzhong Tang (Minor Construct the Middle Decoction). The following clause regarding "palpitations and irritability after two or three days" confirms Xiaojianzhong Tang as the primary treatment. (Cheng Jiaoqian)
Shaoyang has relatively little blood; even with exterior signs, sweating is contraindicated. Sweating causes fluid leakage, drying the ministerial fire, inevitably leading to Stomach excess and delirium. One should administer Chaihu Tang to harmonize. Once the Upper Jiao is unblocked and fluids descend, Stomach qi harmonizes. If irritability is added, it becomes a Chengqi Tang syndrome. (Ke Yunbo)
In Shaoyin disease, if the patient desires to vomit but cannot, feels irritable, and only wishes to sleep, and after five or six days experiences spontaneous diarrhea with thirst, it belongs to Shaoyin. This is due to deficiency, prompting the patient to draw water to self-rescue. If urine color is white, all Shaoyin disease manifestations are complete. White urine indicates lower Jiao deficiency-cold, unable to control water, thus resulting in pale color.
Desire to vomit without success and irritability are signs of Kidney qi rebelling upward. Spontaneous diarrhea with thirst, combined with dry mouth and tongue, drawing water for relief, appears like a heat syndrome. However, Kidney heat causes yellow-red urinary pathways; if urine is white, it is not Kidney heat, but lower Jiao deficiency-cold unable to control water. Warm methods should still be employed. Do not mistake it for heat and lightly administer cold purgatives. (Yu Jiayan)
If a patient's pulses at cun, guan, and chi positions are all tight, yet sweating occurs, this is Yang collapse. It belongs to Shaoyin, and legally should present with sore throat accompanied by vomiting and diarrhea.
Yang collapse means deficient Yang fails to return to its origin, caused by Shaoyin failing to store. Thus, the Upper Jiao transforms into fire causing sore throat and vomiting, while the Lower Jiao suffers yin deficiency leading to incessant diarrhea.
Bawei Shenqi Wan (Eight-Ingredient Kidney Qi Pill) is indicated. (Ke Yunbo)
Warm meridians and scatter cold methods should be used, which goes without saying. (Yu Jiayan)
In Shaoyin disease, if the pulse is faint, sweating is contraindicated due to the risk of Yang collapse. If Yang is already deficient and the chi pulse is weak and choppy, purging is also contraindicated.
Urgent application of warm methods is evident. (Yu Jiayan)
With cold limbs and a tight pulse, sweating is contraindicated. Inducing sweat leads to disordered voice, hoarseness, flaccid tongue, and inability to speak.
The above four clauses all describe disastrous syndromes of Shaoyin deficiency-cold. Zhang Zhongjing provided no formulas. Detailed analysis suggests: For "desire to vomit but cannot," Zhenwu Tang (True Warrior Decoction) is suitable. For "tight pulses at all positions," Fuzi Tang (Aconite Decoction) plus Jiegeng (Platycodonis Radix) and Chishizhi (Halloysit Rubrum) is suitable. For "faint pulse," Baitong Tang (White Pass Decoction) plus human urine and pig bile is suitable. For this clause "cold limbs and tight pulse," Sini Tang (Counterflow Cold Decoction) should be used to warm. Misusing sweating leads to disordered voice, hoarseness, and flaccid tongue, rendering it incurable. (Zhang Luyu)
In Shaoyin disease, after eight or nine days, if the whole body and hands and feet become hot, it is because heat resides in the Bladder, inevitably leading to hematochezia.
Danggui Sini Tang (Angelica Sinensis and Counterflow Cold Decoction) is suitable to harmonize Ying and dissipate exterior, while simultaneously draining the Bladder. (Zhang Luyu)
In Shaoyin disease with pus and blood in stool, acupuncture may be used.
If acupuncture is not used, Baitouweng Tang (Patriniae Decoction) should be employed; if accompanied by dry throat, irritability, and inability to sleep, Huanglian Ejiao Tang (Coptis and Ass-Hide Gelatin Decoction) is the appropriate choice. (Zhang Luyu)
In Shaoyin disease with diarrhea, if diarrhea stops spontaneously, and the patient feels aversion to cold and curls up, but hands and feet are warm, it is treatable.
Warm hands and feet indicate that True Yang has not dispersed. Urgently use Baitong Tang or Sini Tang to warm meridians and scatter cold. As evil retreats and True Yang recovers, it is said to be treatable. (Shen Mingzong)
In Shaoyin disease, with aversion to cold, curling up, frequent self-irritation, and desire to remove clothing/blankets, it is treatable.
If restlessness, rebellion, confusion, and agitation occur, with cold limbs and a pulse that is either frantic or scattered and boundless, these are death syndromes. (Zhang Luyu)
In Shaoyin disease, coughing with diarrhea and delirium results from coercion by fire-induced sweating. Urination will certainly be difficult, caused by forcibly inducing sweat in Shaoyin.
Shaoyin belongs to the Kidney and governs water. Affected by evil, it cannot govern water; attacking upward causes cough, attacking downward causes diarrhea. If evil transforms via cold, it is a Zhenwu Tang syndrome; if via heat, it is a Zhuling Tang (Polyporus Decoction) syndrome. Now coerced by fire to sweat, it transforms via heat and shifts to the Stomach, causing delirium; internal exhaustion of fluids causes difficult urination. All result from forcibly sweating Shaoyin. To rescue Yin, choose between Baihu Tang and Zhuling Tang. (Zongjin Jian)
In Shaoyin disease with sore throat, Banxia San and Tang (Pinellia Powder and Decoction) is the main treatment.
This must involve aversion to cold and desire to vomit; thus, Guizhi (Cinnamomi Ramulus) is added to scatter cold, and Banxia (Pinelliae Rhizoma) to stop vomiting. If mixed with ministerial fire, acrid-warm herbs are unsuitable. (Ke Yunbo)
In Shanghan, if cold limbs precede fever, diarrhea will cease spontaneously. If sweating occurs instead, and there is sore throat, the throat becomes bi (obstructed). If fever occurs without sweating, diarrhea will cease; if it does not cease, pus and blood in stool will occur. Those with pus and blood in stool will not have throat bi.
Throat bi is treated with Jiegeng Tang (Platycodon Decoction); pus and blood in stool with Baitouweng Tang. (Zhang Luyu)
In Shanghan, if cold limbs appear between day one/four and day five, fever will necessarily follow. Previous fever leads to subsequent cold limbs. Deep cold limbs indicate deep heat; slight cold limbs indicate slight heat. Cold limbs should be treated with purging; if sweating is induced instead, oral lesions and redness will occur.
Previously, it was stated that various Ni/Jue cases should not be purged. Here, it states Jue should be purged; the distinction is subtle. Preceding Ni followed by Jue differs significantly from preceding fever followed by Jue. Hence, the former says "do not purge," while this says "should purge," because deep heat and deep Jue require bitter-cold herbs to clear interior heat, termed "purging," never harsh purgation. (Shanglun Pian)
A friend said: "Jue should be purged" means draining. It does not specify Chengqi Tang, hence no formula is given. Liver belongs to Yin and dislikes dryness; sour-sweet moistening-draining herbs are also Yin-draining. This view is acceptable, but consider that in the Jueyin chapter, every clause has a formula. The reason for omitting formulas is to allow mutual understanding. It is unlikely that for the "purge" clause, one should interpret it differently. In the "diarrhea and delirium" clause, Xiao Chengqi Tang is a harmonizing agent in Yangming; removing Mangxiao (Natrii Sulfas) targets only evil heat, not Stomach excess. Thus, interior evil heat can utilize it mutatis mutandis. (Cheng Jiaoqian)
This refers to heat damaging Qi, indicating Stomach heat rather than Stomach excess, making the three Chengqi Tangs unsuitable. For slight Jue, Sini San (Counterflow Cold Powder) should be used: Shaoyao and Zhishi (Aurantii Fructus Immaturus) to attack the interior, Chaihu (Bupleuri Radix) and Gancao (Glycyrrhizae Radix) to harmonize the exterior. For deep Jue, Baihu Tang should be used: Renshen, Gancao, and Jingmi (Oryza Sativa) to support Yang, Shigao (Gypsum Fibrosum) and Zhimu (Anemarrhenae Rhizoma) to remove heat. (Ke Yunbo)
In Shanghan, with slight heat and mild Jue, cold fingertips, silence, lack of appetite, and irritability, if after several days urination is free and white, this indicates heat removal. Desire to eat signifies recovery. If Jue is accompanied by vomiting and chest/hypochondriac fullness/irritation, hematochezia will follow later. ○ In diarrhea, if the cun pulse is surprisingly floating and rapid, while chi is naturally choppy, pus and blood in stool will inevitably occur.
This is a Shaoyang half-exterior half-interior syndrome. Mild cases are harmonized with Xiaochaihu Tang; deep cases are purged with Dazhaihu Tang. (Ke Yunbo)
If heat persists and hematochezia occurs, Xijiao Dihuang Tang can be used. (Guo Yong)
This clause and the previous "Jue, vomiting, chest/hypochondriac fullness" differ in severity but share the same treatment: both suit Baitouweng Tang. After pus and blood stop, Shaoyao Gancao Tang is suitable. (Zhang Luyu)
This clause describes the transformation of diarrhea into pus and blood. Heat diarrhea with a rapid pulse is not abnormal; a floating pulse would be abnormal. No treatment method is discussed; Huangqin Tang (Scutellaria Decoction) by Zhang Zhongjing is suitable. (Wang Hu)
If a patient has high body heat but desires to stay covered, heat is in the skin, cold in the marrow. If the body is very cold but desires to uncover, cold is in the skin, heat in the marrow.
Dongyuan said: Treat from the middle, not exterior or interior, meaning use Xiaochaihu Tang to harmonize. I argue that before transmission to Shaoyang, this decoction should not be used first. Body heat with aversion to cold indicates Yang deficiency; body cold with aversion to heat indicates Yin deficiency. Yang deficiency suits Huangqi Jianzhong Tang (Astragalus and Middle-Constructing Decoction); Yin deficiency suits Danggui Jianzhong Tang (Angelica and Middle-Constructing Decoction). (Shanghan Lun San Zhu)