趺阳脉浮而涩，少阴脉如经者，其病在脾，法当下利。何以知之？若脉浮大者，气实血虚也。今趺阳脉浮而
弦，故知脾气不足，胃气虚也。以少阴脉弦而浮才见。此为调脉，故称如经也。若反滑而数者，故知当屎脓也。
按∶若脉浮大者，气实血虚也二句，与上下文义不属，当删之。
少阴脉弦而浮，岂可谓如经乎？当改沉滑二字。（《医宗金鉴》）
问曰∶翕奄沉，名曰滑。何谓也？师曰∶沉为纯阴，翕为正阳，阴阳和合，故令脉滑。关尺自平，阳明脉微沉，
食饮自可，少阴脉微滑，滑者紧之浮名也，此为阴实。其人必股内汗出，阴下湿也。
按∶滑者，紧之浮名也。此为阴实二句，与上下文义不属，当是错简。（《医宗金鉴》）
太阳病，小便利者，以饮水多，必心下悸；小便少者，必苦里急也。
以饮水多，接太阳病句。小便利者，接下句。（吴灵稚）
发汗后，不可更行桂枝汤，无汗而喘，（旧本有无字）大热者，可与麻黄杏仁甘草石膏汤。
下后，不可更行桂枝汤；若无汗而喘，大热者，可与麻黄杏仁甘草石膏汤。
二条无字，旧本讹在大热上。前辈因循不改，随文衍义，为后学之迷途。仲景每于汗下后，表不解者，用
桂枝更汗，而不用麻黄。此则内外皆热，而不恶寒，必其用麻黄汤后，寒解而热反甚，与发汗解、半日许复烦、
下后而微喘者不同。发汗而不得汗，或下之而仍不汗，喘不止，其阳气重者，若与桂枝加浓朴杏仁汤，下咽即
毙矣。故于麻黄汤去桂枝之辛热，加石膏之辛寒，佐麻黄而发汗，助杏仁以定喘。一加一减，温解之方，转为
凉散之剂矣。（柯韵伯）
伤寒，吐下后，发汗，虚烦，脉甚微，八九日心下痞硬、胁下痛、气上冲咽喉。眩冒，经脉动惕者，久而成痿。
按∶八九日心下痞硬、胁下痛、气上冲咽喉三句，与上下文义不属。注家皆因有此三句，不得不支离蔓
衍，牵强解释。每见此病，总因汗出过多，大伤津液而成，当用补气、补血、益筋、壮骨之药，经年始愈。三
句必是错简，当删之。（《医宗金鉴》）
伤寒发热，啬啬恶寒，大渴欲饮水，其腹必满，自汗出，小便利，其病欲愈，此肝乘肺也，名曰横，刺期门。
此肝乘肺，读当在腹必满之下；自汗出小便利，当在刺期门之下。（吴灵稚）
太阳病，寸缓、关浮、尺弱，其人发热，汗出，复恶寒，不呕，但心下痞者，此以医下之也。如其不下者，病
人不恶寒而渴者，此转属阳明也。小便数者，大便必硬，不更衣十日无所苦也。渴欲饮水，少少与饮之。但以
法救之，渴者，宜五苓散。
但以法救之一节，读当在医下之也之下。（吴灵稚）
阳明病，脉浮而紧，咽燥口苦，腹满而喘，发热汗出，不恶寒，反恶热，身重。若发汗则躁，心愦愦，反谵语。
若加烧针，必怵惕烦躁不得眠。若下之，则胃中空虚，客气动膈，心中懊 。舌上苔者，栀子豉汤主之。
心中懊 一节，读当在身重之下。（吴灵稚）
阳明病，脉浮而紧，咽燥口苦，腹满而喘，发热汗出，不恶寒，反恶热，身重，此处当接栀子豉汤主之
句。若发汗三段，因不用此方，而妄治所致。仍当栀子豉汤主之。仲景但于结句一见，是省文法也。后人竟认
栀子豉汤为汗、下救逆之剂，否则未汗、下前，仲景何法以治之乎？（柯韵伯）
病患无表里证，发热七八日，虽脉浮数者，可下之。假令已下，脉数不解，合热则消谷善饥，至六七日不大便
者，有瘀血也，宜抵当汤。若脉数不解，而下利不止，必协热而便脓血也。
若脉数已下，读当在可下之之下。（吴灵稚）
伤寒，四五日，脉沉而喘满。沉为在里，而反发其汗，津液越出，大便则难。表虚里实，久则谵语。
表虚里实一句，读当在沉为在里之下。（吴灵稚）
汗出谵语者，以有燥屎在胃中，此为风也。须下之，过经乃可下之下；之若早，语言必乱，以表虚里实故也。
下之则愈，宜
大承气汤。
以表虚里实故也句，宜安在乃可下之句下。（程郊倩）
须下之接胃中句，下之则愈接须下之句。（吴灵稚）
下之则愈宜大承气汤九字，当在过经乃可下之之下，不当在于章末。观前章谵语燥屎，不云大承气汤下
之，而云须下之，须字意义，欲而尚未也。至此，语言必乱。下早，表邪乘虚入胃故耳，反用大承气下之乎？（方咫园）
阳明病，谵语，有潮热，反不能食者，胃中必有燥屎五六枚也。宜大承气汤下之，若能食者，但硬耳。
按∶宜大承气汤下之句，应在必有燥屎五六枚之下始合。若但便硬，即用大承气汤下之，殊失仲景慎重
误下之旨，当移之。（《医宗金鉴》）
宜大承气汤下之，旧在但硬尔下，今正之。（《伤寒缵论》）
阳明病，下之，心中懊 而烦，胃中有燥屎者，可攻之。腹微满，初头硬，后必溏，不可攻之。若有燥屎者，
宜大承气汤。
末二句乃申上节，以决治意。（方中行）
阳明病，下之，心中懊 而烦，胃中有燥屎者，可攻之，宜大承气汤。腹微满，初头硬，后必溏，不可攻之。
下后心中懊 而烦，栀子豉证。若腹大满不通，是胃中燥屎上攻也；若微满，犹是栀子浓朴汤证。（柯韵伯）
三阳合病，腹满身重，难以转侧，口不仁而面垢，谵语遗尿。若发汗则谵语，下之则额上生汗、手足逆冷。
若自汗出者，白虎汤主之。
若自汗出一节，读当在遗尿之下。（吴灵稚）
太阴之为病，腹满而吐，食不下，自利益甚，时腹自痛。若下之，必胸下结硬。
食不下，当接有自利句；自利益甚，当在末句。（吴灵稚）
按∶吴人驹曰∶自利益甚四字，当在必胸下结硬句之下，其说
甚是。若在吐食不下句之下，则是已吐食不下，而自利益甚矣。仲景复曰若下之，无所谓也。（《医宗金鉴》）
少阴病，欲吐不吐，心烦，但欲寐，五六日自利而渴者，属少阴也，虚故饮水自救。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。
属少阴句，当在欲寐之下。（吴灵稚）
伤寒，发热四日，厥反三日，复热四日；厥少热多，其病当愈。四日至七日热不除者，其后必便脓血。
复热四日句，语意在其病当愈下。（柯韵伯）
The Fuyang pulse (radial artery at the dorsum of the foot, reflecting Spleen and Stomach Qi) is floating and choppy; the Shaoyin pulse (radial pulse at the cun position, reflecting Kidney Qi) resembles that of a normal meridian. The disease resides in the Spleen; according to the principles, diarrhea should occur. How do we know this? If the pulse were floating and large, it would indicate excess Qi and deficient Blood. Now, since the Fuyang pulse is floating and wiry, we know that Spleen Qi is insufficient and Stomach Qi is weak. Because the Shaoyin pulse is wiry and floating, appearing only slightly, this constitutes a harmonious pulse, hence it is called "like a normal meridian." If instead the pulse were slippery and rapid, we would know that pus and blood would appear in the stool.
Note: The two sentences "If the pulse were floating and large, it would indicate excess Qi and deficient Blood" do not align with the context and should be deleted.
How can a Shaoyin pulse that is wiry and floating be considered "normal"? It should be amended to "deep and slippery." (*Yi Zong Jin Jian*)
Question: A pulse that gathers and disperses suddenly, appearing and disappearing intermittently, is named Slippery Pulse. What does this mean? The Master said: Deep pulse belongs to pure Yin; Xi pulse (light touch yields sensation like a feather touching skin) belongs to correct Yang. When Yin and Yang harmonize, the pulse becomes slippery. The Guan and Chi pulses are naturally balanced; the Yangming pulse (right Guan pulse) is slightly deep, indicating normal appetite and digestion; the Shaoyin pulse (left Chi pulse) is slightly slippery. Slippery pulse is the floating manifestation of a Wiry pulse; this indicates Yin Excess. Such a person will surely have sweating on the inner thighs and dampness in the external genitalia.
Note: The two sentences "Slippery pulse is the floating manifestation of a Wiry pulse. This indicates Yin Excess" do not align with the context and are likely due to bamboo slip dislocation. (*Yi Zong Jin Jian*)
In Taiyang disease (early stage of exterior cold-heat disorder), if urination is free, it is because excessive water intake has occurred, inevitably leading to palpitations in the epigastrium; if urination is scanty, there will surely be distressing urgency in the lower abdomen.
"Excessive water intake" connects to the sentence "Taiyang disease." "Free urination" connects to the following sentence. (Wu Lingzhi)
After inducing sweating, Guizhi Tang (Cinnamon Twig Decoction) must not be used again. If there is no sweat accompanied by wheezing, (there is textual debate regarding the presence of the character "no" in old editions) and high fever, Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) may be administered.
After purgation, Guizhi Tang must not be used again; if there is no sweat accompanied by wheezing and high fever, Mahuang Xingren Gancao Shigao Tang may be administered.
The missing character "no" in these two passages was erroneously placed before "high fever" in old editions. Predecessors followed suit without correction, extending the meaning along with the text, leading later learners astray. Zhang Zhongjing usually employs Guizhi Tang for further sweating when the exterior syndrome remains unresolved after sweating or purgation, rather than using Mahuang Tang. In this case, however, there is heat both inside and outside, without aversion to cold. This必定 follows the use of Mahuang Tang, where the cold pathogen has resolved but heat intensifies. This differs from cases where sweating fails to produce sweat, or restlessness returns after half a day, or slight wheezing occurs after purgation. If sweating fails to produce sweat, or purgation still results in no sweat, with persistent wheezing and heavy stagnation of Yang Qi, administering Guizhi Jia Houpo Xingren Tang (Guizhi Tang plus Magnolia Bark and Apricot Kernel) would be fatal upon ingestion. Therefore, in Mahuang Tang, the acrid-hot Guizhi is removed, and the acrid-cool Shigao (Gypsum) is added to assist Mahuang in inducing sweating and help Xingren calm wheezing. One addition and one subtraction transform a warm-releasing formula into a cool-releasing agent. (Ke Yunbo)
In Shanghan (Cold Damage), after emesis and purgation, followed by sweating, deficiency vexation occurs, and the pulse is extremely faint. After eight or nine days, epigastric fullness and hardness, hypochondriac pain, Qi rushing up to the throat, dizziness, vertigo, and twitching of the meridians occur; over time, this develops into Wei syndrome (flaccidity syndrome).
Note: The three sentences "After eight or nine days, epigastric fullness and hardness, hypochondriac pain, Qi rushing up to the throat" do not align with the context. Commentators, forced by the presence of these sentences, offer fragmented and forced explanations. Whenever I encounter this condition, it is always caused by excessive sweating severely damaging body fluids. It should be treated with herbs that tonify Qi, nourish Blood, benefit tendons, and strengthen bones, taking a year to recover. These three sentences are certainly misplaced slips and should be deleted. (*Yi Zong Jin Jian*)
In Shanghan, with fever,啬啬 aversion to cold (shivering/chilling), intense thirst wanting to drink, abdominal fullness, spontaneous sweating, and free urination, the disease is about to resolve. This is Liver Wood overacting on Lung Metal, named "Heng" (Horizontal), and Qimen (LR14) should be punctured.
The phrase "Liver Wood overacting on Lung Metal" should be read after "abdominal fullness"; "spontaneous sweating and free urination" should be read after "puncture Qimen." (Wu Lingzhi)
In Taiyang disease, the Cun pulse is slow, the Guan pulse is floating, and the Chi pulse is weak. The patient has fever, sweating, and renewed aversion to cold, no vomiting, but only epigastric stuffiness. This is due to the physician's erroneous use of purgation. If purgation had not been used, and the patient is not averse to cold but is thirsty, this has transferred to the Yangming disease. If urination is frequent, the stool will surely be hard; even if no bowel movement occurs for ten days, there is no discomfort. If there is a desire to drink water, give small amounts frequently. As long as treatment follows the appropriate method, for thirst, Wuling San (Five-Ingredient Powder with Poria) is suitable.
The section "But save it according to the method" should be read after "the physician used purgation." (Wu Lingzhi)
In Yangming disease, the pulse is floating and tight, with dry throat, bitter taste, abdominal fullness and wheezing, fever and sweating, no aversion to cold, but aversion to heat, and heavy body. If sweating is induced, restlessness, mental confusion, and delirium will occur. If moxibustion with burning needles is applied, fright, irritability, and insomnia will result. If purgation is used, the Stomach becomes empty, pathogenic Qi disturbs the Diaphragm, causing mental depression and vexation. If there is coating on the tongue, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) governs.
The section "Mental depression and vexation" should be read after "heavy body." (Wu Lingzhi)
In Yangming disease, with floating and tight pulse, dry throat, bitter taste, abdominal fullness and wheezing, fever and sweating, no aversion to cold, aversion to heat, and heavy body, the sentence "Zhizi Chi Tang governs" should follow here. The three paragraphs regarding sweating imply that because this formula was not used, wrongful treatment ensued. Zhizi Chi Tang should still be the primary treatment. Zhang Zhongjing mentions it only at the conclusion, employing a省略 (elliptical) writing style. Later generations mistakenly regarded Zhizi Chi Tang as a rescue formula for post-sweating or post-purgation complications. Otherwise, before sweating or purgation, what method did Zhang Zhongjing use? (Ke Yunbo)
A patient presents with neither exterior nor interior syndromes, with fever for seven or eight days. Although the pulse is floating and rapid, purgation may be used. If purgation has already been applied and the rapid pulse persists, combined heat causes efficient digestion and hunger. By the sixth or seventh day, if there is no bowel movement, blood stasis exists, and Didang Tang (Di Dang Decoction) is suitable. If the rapid pulse persists and diarrhea continues incessantly, heat combines with pathogens leading to pus and blood in the stool.
"If the pulse is rapid after purgation" should be read after "purge may be used." (Wu Lingzhi)
In Shanghan, on the fourth or fifth day, the pulse is deep with wheezing and fullness. Deep pulse indicates interior pathology. Inducing sweating in error causes body fluids to escape, making defecation difficult. Exterior deficiency and interior excess, persisting over time, lead to delirium.
"The sentence 'Exterior deficiency and interior excess'" should be read after "Deep pulse indicates interior pathology." (Wu Lingzhi)
Sweating accompanied by delirium indicates dry fecal matter in the Stomach, caused by Wind. Purging is required, but only after passing the meridian cycle (exiting the current disease stage) can purging be performed; if done too early, speech will become chaotic due to exterior deficiency and interior excess. Purging will then cure the condition; Dachengqi Tang (Major Order the Qi Decoction) is suitable.
"The sentence 'due to exterior deficiency and interior excess'" should be placed under "then purging may be performed." (Cheng Jiaoqian)
"Sufficient to purge" connects to "in the Stomach"; "Purging then cures" connects to "Sufficient to purge." (Wu Lingzhi)
The nine characters "Purging then cures, suitable for Dachengqi Tang" should be placed after "after passing the meridian cycle, then purging may be performed," not at the end of the chapter. Observing the previous chapter on delirium and dry feces, it says "sufficient to purge" rather than "use Dachengqi Tang to purge." The word "sufficient" implies intent but not yet action. Here, speech is chaotic. Premature purging allows exterior pathogens to enter the Stomach via deficiency; should Dachengqi Tang be used for purging? (Fang Zhiyuan)
In Yangming disease, delirium with tidal fever, yet inability to eat, indicates five or six pieces of dry fecal matter in the Stomach. Dachengqi Tang should be used to purge. If able to eat, the stool is merely hard.
Note: The sentence "Dachengqi Tang should be used to purge" should follow "five or six pieces of dry fecal matter in the Stomut" to be logical. Using Dachengqi Tang merely for hard stool violates Zhang Zhongjing's principle of caution against erroneous purging; it should be moved. (*Yi Zong Jin Jian*)
"Dachengqi Tang should be used to purge" was previously under "merely hard," now corrected. (*Shanghan Zuanyu*)
In Yangming disease, after purgation, mental depression and vexation occur. If there is dry fecal matter in the Stomach, it may be attacked. If the abdomen is slightly full, with hard stool at the beginning and loose stool later, it must not be attacked. If there is dry fecal matter, Dachengqi Tang is suitable.
The last two sentences elaborate on the previous section to determine the treatment intent. (Fang Zhongxing)
In Yangming disease, after purgation, mental depression and vexation occur. If there is dry fecal matter in the Stomach, it may be attacked, and Dachengqi Tang is suitable. If the abdomen is slightly full, with hard stool at the beginning and loose stool later, it must not be attacked.
Post-purgation mental depression and vexation is a Zhizi Chi Tang syndrome. If abdominal fullness is severe and obstructed, it is dry fecal matter attacking from the Stomach; if slightly full, it remains a Zhizi Houpo Tang syndrome. (Ke Yunbo)
In San Yang He Bing (Combined Disorder of the Three Yang Meridians), there is abdominal fullness, body heaviness, difficulty turning over, insensitivity of the mouth, facial grease, delirium, and urinary incontinence. If sweating is induced, delirium occurs; if purged, sweating appears on the forehead with cold extremities.
If there is spontaneous sweating, Baihu Tang (White Tiger Decoction) governs.
The section "If there is spontaneous sweating" should be read after "urinary incontinence." (Wu Lingzhi)
Taiyin disease manifests as abdominal fullness and vomiting, inability to eat, worsening spontaneous diarrhea, and occasional spontaneous abdominal pain. If purged, chest and hypochondriac knotting and hardness will definitely occur.
"Inability to eat" should connect to the sentence with "spontaneous diarrhea"; "worsening spontaneous diarrhea" should be at the end. (Wu Lingzhi)
Note: Wu Renju stated: The four characters "worsening spontaneous diarrhea" should be placed after the sentence "chest and hypochondriac knotting and hardness will definitely occur," which is very correct. If placed after "vomiting and inability to eat," it implies that after vomiting and inability to eat, diarrhea worsens. Then Zhang Zhongjing says "if purged," which loses its meaning. (*Yi Zong Jin Jian*)
Shaoyin disease presents with desire to vomit but inability to do so, heart vexation, and desire to sleep. After five or six days, spontaneous diarrhea with thirst belongs to Shaoyin; due to deficiency, drinking water is an attempt at self-rescue. If urine color is white, the manifestations of Shaoyin disease are complete. White urine is due to lower Jiao deficiency-cold, unable to control water, thus causing white color.
"The sentence 'belongs to Shaoyin'" should be under "desire to sleep." (Wu Lingzhi)
In Shanghan, fever for four days, reversal (cold limbs) for three days, then fever for four days again; less reversal and more fever indicates the disease should resolve. If fever persists from the fourth to the seventh day without abating, pus and blood will subsequently appear in the stool.
The sentence "fever for four days again" has its semantic meaning under "the disease should resolve." (Ke Yunbo)