辨表分寒热 昼夜头疼浑不了（先提清表分），身热脉浮邪在表。病症看来似一般，表寒表热须分晓（点出眉
目）。或有汗，或无汗，汗少汗多且莫管。只就脉浮中，分出两条线（是最当着眼处）。表寒浮紧或兼弦，表热浮数兮，
或兼滑长与弦缓。寒者身疼惯怕寒（以下旁证之），频求衣被遮温暖；热者虽然也畏风，无风便欲开帷幔。寒不渴兮热或
渴，寒舌白苔热黄泽，寒者口和热口苦，寒减食兮热能食。表寒散以辛温味（收束），表热辛凉非一例。表寒切勿先消食，
惟恐引邪入里去；表热切忌是辛温，变成燥热为难治。
辨表分虚寒虚热 头痛脉浮（表也）或兼大兼弦，或兼数兼弦，按无力（虚也），表分虚同寒热别。表若虚寒
必恶寒，屡进辛温汗难出（若用辛凉，必致汗多而近于亡阳矣。）气扰翻教身体麻（此下言辛温之后变象），或大热兮或
微热，胸前微满且欲呕，口淡或渴或不渴。表如虚热口亦淡，必兼微渴思润泽。服过辛凉身反痛，舌形定现微苔色（此
下是服辛凉后变象）。不论大汗与无汗，但查热势加猖獗。两症皆须补益来，寒加姜桂（宜用桂枝汤加 、术，甚则加人
参、干炮姜之类；如血虚，无汗可加当归、红花和其阴血。）热芩柴（宜柴、芩、归、芍、 、术之类，甚则加人参。）
辨里寒 里寒脉沉紧，或兼缓与迟。恶寒骨节痛（五字是表证），表症似而非。胸腹满痛且欲呕，或吐或利俱
有诸。或热或不热，手足指冷厥。喉有冷涎苔白滑，或如猪腰或茶褐。此宜桂枝汤去芍加干姜，里寒温补是良方，甚则
加桂、附，可以复其阳。
辨里热 里热脉沉数（主脑），或缓滑以长。无论其神昏与清，无论其身热与凉，唇焦齿黑 语现，舌短苔黑
或起芒。裂破出血反不渴，或渴饮冷小溲长。或利清水或便鞭，声音洪厉力气强，狂发登高弃衣走，否且循衣而摸床。
面目或赤或不赤，其色垢浊如薰黄（即不赤亦面垢）。此宜芩、连、石膏类，甚则芒硝与大黄。
辨里虚寒 里若虚寒者，脉必沉而缓（主脑），微细按无神，救之惟愁晚。手足常四逆，面色青黑黯。渴而不
欲饮，但觉口中淡，惟喜极热汤，稍解胸中满。或呕或吐或下利，或不大便心下悸。心烦喜躁不思食，蜷卧恍惚每独语。
舌带淡黑色，或如猪腰或糙米，或白苔而润，或无苔而燥，短缩不能伸，望之萎且槁。理中四逆急温之，否则神昏汗脱
了。
辨里虚热 欲知里虚热，脉沉而数按无力（主脑）。身热退不净，口渴神恍惚，与汤则饮之，不与亦不讨。有
时思食来，食到便先饱。舌上略觉燥，得汤燥即好；或有微苔或无苔，或淡红色如桃腮。此为里分少津液，泻心、导赤
佐生脉。
辨假虚寒 脉沉细兮或缓长，出则迟兮入则疾（主脑），或伏筋骨按有力。口中不渴舌燥短，不但身凉且四逆。
神昏谵语口目动，状若惊风作痉厥。或利清水或不便，解下或如烂桃色。人事不知歌且哭，身轻偏自能起立（大证据）。
或吐蛔虫口苦辣，小便行时长且赤。此是虚寒假症现，应须解毒和凉膈。
辨假实热 脉弦而大或洪数，无奈按之全不见（主脑）。任他热势如燎原，真底实板已先现。苔白或黑短不燥，
或如猪腰或米糙。面目俱赤为戴阳，谵语发狂手足躁。或有汗兮或无汗，坐卧只求井中蹈。舌肿唇焦齿出血，渴饮汤水
常不绝。内是真寒外假热，理中八味合生脉，煎成冷冻饮料代茶汤，庶几虚火归源得，误用芩连增躁渴（变成死症），庸师到
此休饶舌。
辨渴 渴症须分寒与热，热者脉数而口苦（主脑），身热汗出喜冷冻饮料，或兼汤水百杯可（大证据）。此宜花粉与
川连，加味参同伴白虎。虚寒而渴者，脉必细兼迟，即教洪且大，终是数而虚（主脑）。渴喜极热汤，稍温便嫌冷；有时
思得水，仍复不能饮（大证据）。此宜生脉中，姜、附辛以润。又有汗下之后亡津液（着眼），生津之品始为得，不宜凉
药不宜温，何况诸多辛与热。
辨舌 胃气现于舌，上有淡白苔。俗医漫消食，必致光无胎。调理到思食，苔白渐生来。君不见病有浓苔满舌
者，忽然退去光而燥，乃为胃气绝之征，从此参详便分晓。又有大红舌色无苔者，君火之色浮于外，盛极将衰欲化灰（无
病之人亦常有之，宜用附子。）引火归源才得退（舌色纯红，必肾气素虚之人，无他症而忽现此舌者，用附子引火归源固
合。又若《敖氏伤寒金镜录》载纯红为将瘟舌，乃热畜于内而病将发也，不问何经，宜用透顶清神散搐鼻法，亦不可不
知。）又有舌黑如淡墨，更不须分燥与湿，总归肾水克心火，阴盛阳衰须早识；除非黑起芒刺燥而裂，阳邪热结何消说。
辨虚寒舌燥 舌燥有多般，或淡黄，或淡白，或起微刺或灰色。更有望之如燥们之泽，其色或紫而或黑，必兼
吐利而厥逆，神昏谵语词謇涩（舌燥而语言不清，因燥而下清可治。舌润而语言不清，所谓口虽欲言，舌不得前，死
症也。）脉形微细定如丝（虚寒定案），或虽洪大终无力。急用生脉以养津，附、姜、苓、草和 、术（俗医谓五味味浓，
多则用十余粒，少则七八粒，此不通之论，必须钱余方效。）
辨实热舌燥 实热舌燥先有地，或黄或黑起芒刺。即使苔轻偏破裂，必兼身热焦唇齿。渴喜饮冷面目赤，并无
吐利与厥逆。 语便闭诸症现，洪数滑长脉可验，白虎承气随变换。
辨寒头痛 寒头痛脉浮而紧（主脑），或弦或沉更兼迟。恶风与寒四肢冷（大证据），头喜热物包裹之（更有刘
河间论头痛属热者，亦恶寒喜热，缘热为寒闭，则其痛甚，热气流通，则痛止也，然止后必复作而益甚为验，脉亦必有
异。）理中参入桂、天麻，附子、细辛重者加，少佐羌、防法亦精。
辨热头痛 热头痛脉浮而数，或滑而长亦有诸。口苦舌干渴欲饮，痛连风府与风池（大证据）。恶热其常恶风
暂，此为风热症已显。羌、防、柴、葛、连翘、芩，甚则石膏用之验。
辨虚头痛 虚头痛脉弦而大，弦则为寒大则虚（主脑）。痛极不堪喜得按，日夜呼叫语声嘶（大证据）。其痛或
专在额上，遍头皆痛亦有之。急宜参、苓、 、术加附子，此症失治危即死。
辨风寒骨痛 风寒骨痛脉弦紧（主脑），或迟而缓亦有准。身热恶寒手足冷（大证据），舌上白苔口不渴，拘挛
遍体酸难忍，甚则上呕下利并。桂枝汤内用天麻，有湿去芍加附稳。
辨虚骨痛 脉弦而大数无力（主脑），或发热兮或不热。恶风兮拘急，口淡兮神思恍惚（大证据）。痛在骨节兮，
服发散药而痛愈剧，此神气伤也，合用桂枝与 、术。大凡人身诸骨节，其数三百有六十，是神气之所游行而出入，君
不见仲景新加汤，重用参、姜以复脉。
辨虚寒腹满 藏寒生满病（出《内经》），脉迟缓兮或沉紧，或虚大兮按无力（主脑）。腹满时减减又甚（证据
出《金匮》），不欲食兮食即呕，或泄泻恶寒兮，而渴喜热饮。姜、桂、香砂温散之，不应再加参、术、 。
辨实热腹满 脉沉而实兮（主脑），或滑与长兼。腹满不减兮（证据），减亦不足言（二句出《金匮》）。大便虽
解而不畅兮，或得解而少宽。腹满硬痛不可按兮，无吐晕等虚症之相参。此宜枳、朴以消之，甚则加大黄参其间。
辨虚寒不大便 大便不通群呼热，不知寒凝亦敛结。腹不满兮口不渴（疑案），白滑胎兮弦紧脉（定案）。此属
虚寒无浪攻，照常饮食且从容（切不可饿），迟之一二十日后，温补足时气自通。
辨实热不大便 脉数有力长滑甚（主脑），烦渴腹满按之硬（证据），或潮热兮食即胀，时有浊气从后进，此为
胃热宜下之，一有虚症须细审（大约实症一下即愈，一有虚症，便须细审，即必当下者，亦只用凉膈以微利之，解毒以
和之，陶氏黄龙汤以补而下之。）
辨小便不通 小便不通分虚实，虚则三焦失其职，屡经利水不相合；此宜《金匮》肾气丸，治其三焦决渎官，
象牙生煎服亦安。实者人素强，或好食热物，肺热不能通水道，以致膀胱成热结，宜用猪苓、泽泻、栀、滑石。用后仍
不效，须向膀胱寻外窍，《经》说毫毛是其应（《经》曰∶三焦膀胱者，腠理毫毛其应，是三焦主腠理，膀胱主毫毛，膀
胱有出窍而无入窍，济泌别汁而渗入于膀胱者也。毫毛是其外窍，譬如水注，塞其上窍，则永不能出矣。如人不虚，利
小水而仍不通者，宜发其汗，外窍通而内窍亦通，此所谓开鬼门也），改从发汗最为妙。又有动其胞中血，虚寒实热随症
别，虚寒便温补，热则清热而养血，因症施方不可执。
辨呕 其人受暴寒（审因），或食生冷物，吐酸并干呕（证据），平胃、正气合。脉滑胃有余（主脑），饮冷不
喜热，服温热药呕愈甚（证据），黄连、竹茹佐姜汁，兼虚参以参加入。脉或虚大数无力（主脑），呕吐清涎及冷沫（证
据），胃虚不能容谷食，闻食即呕食反出，人参理中最为良，丁香、附子加亦得。脉滑有力症不虚，胸满按之痛愈剧（证
据），合用朴、实与二陈，此谓中焦之呕从乎积（东垣语）。
辨吐蛔 热厥吐蛔蛔必多，神情清楚脉形和，随生随吐无烦躁，泻其湿热勿蹉跎。厥阴伤寒属风木，吐虫兼吐
水清绿，手足厥冷烦躁甚，乌梅丸义君须读。
辨汗 虚汗须分阴与阳，阳虚自汗补其卫（其人素虚，或劳伤，或大病后，腠理虚，阳不能卫外而为固，则自
汗，宜用参、 、五味、芩、术，甚则加桂、附，如干姜、半夏、陈皮开达之药，皆不可用。）盗汗归之阴气虚，参、
归、甘、地从其类。（人卧则血归于肝，阴虚而不能为守，则盗汗，宜参、芩、 、术、五味、归、芍、生、熟地之类）。
惟有阳明邪并来，热气薰蒸毛窍开，汗出溱溱常不止，但宜凉解得和谐（汗有心家血液之汗，太阳津液之汗，俱不可出，
惟阳明水谷之汗，虽出无害，故阳症伤寒，热气熏蒸，毛窍开发，溱溱而自出，亦犹滚汤贮于器中，热气上蒸而外湿也，
若汗不出，热气不得泄，必郁而发黄，即宜用清凉以解其热，而汗自止，不必用止汗之药）。更有伤寒病久无汗出，大剂
参、 、柴、桂合，顿然出汗退其热，景岳书中亦曾说。
辨谵妄 语是多言，皆因胃汁干。就中 语有实象， 字从严侃侃然。旋转风轮难自主，才呼李四便张三。
郑声气短神萧索，郑重频烦不厌复，一样逢人讲话多，不曾说南又道北。设使 与郑，大半属无稽，是则名为妄，虚实
皆有之。若夫似睡非睡间，隐隐跃跃如交谈，此为独语未全乱，各从脉症细详参。
辨面目赤 面目赤有三，须从脉症参。阳气郁于表，辛凉可散焉。里热薰于上，白虎及黄连。无根火外浮，此
是内真寒，八味生脉煎冷冻饮料，假对假兮古所传。
辨下利 下清谷者为虚寒，下清水者为实热，惟有脓血、稀溏、和汁沫，此三件中细详别。假如作呕不食兮，
腹痛喜按，心恍惚而烦兮，或动悸与头眩，燥而不欲饮兮，头眩耳鸣而口淡；后重逼迫兮，既解而仍不减；脉弦数而虚
大兮，皆虚寒之外现。苟脉症之反是兮，即实热之证验。
辨厥 手足冷时为四逆，厥者其冷过肘膝，仲景《伤寒》俱禁汗，无论阳厥与阴厥。阳厥是传经，病自三阳并
入阴，热极必兼胜化行，还有始热终寒因。药误也能转入阴寒路，执定传经亦是错。阴厥是直中，喻氏《中寒论》当诵。
寒邪斩关直入来，急救真阳休梦梦。还怕热邪深入血，顿然厥冷身无热。君不见吞痧样子忌热汤，不比中寒一例说。总
之脉症要详参，茎草拈来生杀间，阳厥谵渴阴吐涎，阳者身轻阴者蜷。复看其人唇、爪、甲，青紫为热青黑寒。又有痰
厥、食厥、和尸厥，病久阴阳二气虚亦厥，各等各样在《准绳》，步步须求脉症合。
辨腹痛 腹痛是虚喜揉按，虚者必寒病涉阴，脉迟缓兮或虚大，诸多虚象察其因，理中桂、附可施行。热者面
黄泽，加以长滑脉，宜用黄连苦清热，少佐姜、萸亦相得。更有欲呕不呕腹痛多，寒热其如错杂何，黄连汤内干姜、桂，
好共参、甘两下和。食痛应消食，难在虚寒兼食积，学士温脾法可宗（许学士有温脾汤，见《本事方》）。化为煎法尤熨
贴（有虚寒之人患腹痛，服温补药而相安。时止时作，痛仍不解，甚则利清水或白沫，此虚中有买，或先有宿食在肠不
曾去，或病中肠胃虚不能运化，所食之物停于肠中，即一二块宿粪，亦能作楚，宜用温补药煎好，去渣，入大黄一钱，
不甚虚者，可加一钱五分，滚四五沸服之，宿食自下，正气不伤，而病随愈。此屡试屡验之妙法也。）虫痛面黄吐涎沫，
食酸即安甜即剧，虚实寒热要分晓，杀虫方中求配合。气痛因郁恼，必连胃脘与两胁，病久人必虚，滋补兼疏郁。痛不
可近者，按之濡软为畜血，不比硬满为热结，重则桃仁承气汤，轻者宣通微下夺。别有吞痧一症现，湿热薰蒸邪变幻，
急刺委中出血良，磨服玉枢丹亦善。最怕是三阴寒症认为痧，不饮温汤饮冷茶，乱进丹丸并放、刮，临危空自悔前差。
Differentiating Cold and Heat in the Exterior: Headache persists day and night (first clarify this is a matter of the exterior), body heat with a floating pulse indicates pathogenic factors at the surface. The symptoms may appear similar, but one must clearly distinguish between exterior cold and exterior heat (highlighting the key point). There may be sweating or no sweating; whether sweat is scanty or profuse should not be the primary concern. Focus instead on distinguishing two lines from the floating pulse: exterior cold presents with a floating-tight pulse, or possibly accompanied by a wiry pulse; exterior heat presents with a floating-rapid pulse, or possibly accompanied by slippery, long, wiry-slow pulses. Those with cold experience body pain and habitual aversion to cold (following are collateral evidence), frequently seeking clothing and blankets for warmth; those with heat, although also fearing wind, desire to open curtains when there is no wind. Cold cases do not feel thirsty, while heat cases may feel thirsty; cold tongues have white coating, heat tongues have yellow moist coating; cold cases have a neutral taste in the mouth, heat cases have a bitter taste; cold reduces appetite, while heat allows for normal eating. To disperse exterior cold, use acrid-warm flavors; treating exterior heat with acrid-cool methods is not uniform. Do not first use food-resolving drugs for exterior cold, lest you draw the pathogen inward; strictly avoid acrid-warm drugs for exterior heat, as they can transform into difficult-to-treat dry-heat.
Differentiating Deficiency-Cold and Deficiency-Heat in the Exterior: Headache with a floating pulse (exterior) possibly accompanied by large or wiry pulses, or rapid-wiry pulses; if pressing reveals weakness (deficiency), differentiate deficiency-cold and deficiency-heat in the exterior. If exterior deficiency-cold, there must be aversion to cold; repeatedly using acrid-warm drugs fails to induce sweat (if acrid-cool drugs are used, it will inevitably cause excessive sweating approaching Yang collapse). Qi disturbance causes body numbness; there may be high fever or slight fever, slight fullness in the chest, and desire to vomit; the mouth may be bland, or there may be thirst or no thirst. If exterior deficiency-heat, the mouth is also bland, definitely accompanied by slight thirst desiring moisture. After taking acrid-cool drugs, the body反而 feels painful, and the tongue shape definitely shows a slight coating color (following are changes after taking acrid-cool drugs). Regardless of heavy sweating or no sweating, check if the heat intensity becomes more rampant. Both conditions require tonification: add Ginger and Cinnamon Twig for cold (Gui Zhi Tang plus Cang Zhu and Bai Zhu is suitable; severe cases add Ren Shen and Gan Pao Jiang; if blood deficient with no sweat, add Dang Gui and Hong Hua to harmonize Yin-blood); add Huang Qin and Chai Hu for heat (Chai Hu, Huang Qin, Dang Gui, Bai Shao, Cang Zhu, Bai Zhu are suitable; severe cases add Ren Shen).
Differentiating Interior Cold: Interior cold presents with a deep-tight pulse, or possibly accompanied by slow or delayed pulses. Aversion to cold and bone-joint pain (these five characters indicate an exterior syndrome, but here it is seemingly so but not truly so). Chest and abdominal fullness and pain with desire to vomit; vomiting or diarrhea all occur. Fever may or may not be present; fingers and toes are cold or cold up to the elbows/knees (Jue). Cold saliva in the throat, white slippery tongue coating, or smooth like a pig kidney, or tea-brown colored. This suits Gui Zhi Tang removing Shao Yao and adding Gan Jiang; warming and tonifying interior cold is a good prescription; severe cases add Rou Gui and Fu Zi to restore Yang.
Differentiating Interior Heat: Interior heat presents with a deep-rapid pulse (main feature), or slow, slippery, and long. Regardless of whether consciousness is confused or clear, regardless of whether the body is hot or cool, lips are scorched, teeth are black, delirious speech appears, the tongue is short with black coating or prickles. Cracked bleeding tongue without thirst, or thirst desiring cold water with long urination. Diarrhea of clear water or hard dry stool; voice is loud, strength is strong; mania causing climbing high and discarding clothes, or grasping at bedding and bed rails. Face and eyes may be red or not red, but the color is turbid like smoky yellow (even if not red, the face is turbid). This suits Huang Qin, Huang Lian, Shi Gao categories; severe cases use Mang Xiao and Da Huang.
Differentiating Interior Deficiency-Cold: If interior deficiency-cold, the pulse must be deep-slow (main feature), faint and fine, lacking spirit upon pressing; rescue is feared to be too late. Hands and feet are often Jue (cold extremities), face is dark blue-black. Thirsty but unwilling to drink, only feeling bland in the mouth, preferring extremely hot soup to slightly relieve chest fullness. Vomiting, diarrhea, or constipation with epigastric palpitations. Heart vexation, irritability, loss of appetite, curling up lying down, trance-like muttering alone. Tongue has pale black color, or like a pig kidney, or coarse rice, or white moist coating, or no coating but dry, tongue short and unable to extend, looking withered and shriveled. Li Zhong Tang and Si Ni Tang urgently need warming; otherwise, confusion and sweating collapse will occur.
Differentiating Interior Deficiency-Heat: To know interior deficiency-heat, the pulse is deep-rapid and powerless upon pressing (main feature). Body heat does not fully subside, thirst with mental trance; drinks when offered, does not seek when not offered. Sometimes desires food, but feels full immediately upon eating. Tongue feels slightly dry, which improves with soup; there may be slight coating or no coating, or pale red like peach cheeks. This is interior lack of Jin-Ye (body fluids); Xie Xin Tang and Dao Chi San assisted by Sheng Mai San are suitable.
Differentiating False Deficiency-Cold: Pulse is deep-fine or slow-long, exiting pulse is slow, entering pulse is rapid (main feature), or hidden in sinews and bones but powerful upon pressing. Mouth is not thirsty, tongue is dry and short; not only is the body cool, but extremities are Jue. Confusion, delirium, mouth and eye twitching, resembling convulsive wind. Diarrhea of clear water or constipation; stool may resemble rotten peach color. Unconscious yet singing and crying, body light yet able to stand up (major evidence). Vomiting roundworms, bitter and spicy mouth, urine passage is long and red. This is false deficiency-cold presenting; detoxification and cooling with Liang Ge San is indicated.
Differentiating False Excess-Heat: Pulse is wiry-large or flooding-rapid, but completely absent upon pressing (main feature). Regardless of how raging the heat is like a prairie fire, the true underlying reality is cold-solidity already present. Coating is white or black, short but not dry, or like a pig kidney or coarse rice. Face and eyes both red indicate Dai Yang (floating Yang); delirium, mania, restless extremities. Sweating or no sweating; sitting and lying wishing to tread in a well. Swollen tongue, scorched lips, bleeding teeth, constant drinking of soup/water. Internal true cold, external false heat; Li Zhong Tang and Ba Wei Wan combined with Sheng Mai San, decocted as a frozen beverage to replace tea, hopefully returning floating fire to its source. Misusing Huang Qin and Huang Lian increases restlessness and thirst (becoming a fatal condition); mediocre doctors should stop talking here.
Differentiating Thirst: Thirst must be differentiated into cold and heat. Heat cases have rapid pulse and bitter mouth (main feature), body heat, sweating, preference for cold drinks, or even drinking hundreds of cups of water (major evidence). This suits Hua Fen and Chuan Lian, added with Ren Shen accompanying Bai Hu Tang. For deficiency-cold thirst, the pulse must be fine and slow; even if flooding and large, it is ultimately rapid and empty (main feature). Thirst prefers extremely hot soup, rejecting anything slightly warm; sometimes wants water but cannot drink it (major evidence). This suits Sheng Mai San, adding Jiang and Fu Zi to moisten with acrid-warmth. Also, after sweating and purging depletes Jin-Ye (focus here), generating fluid products are appropriate; neither cool nor warm drugs are suitable, let alone numerous acrid-hot ones.
Differentiating Tongue: Stomach Qi manifests on the tongue with pale white coating. Vulgar physicians casually resolve food stagnation, inevitably leading to a peeled, coating-less tongue. When调理 reaches the point of desiring food, white coating gradually grows. Do you not see cases where thick coating covers the whole tongue, suddenly retreating to become peeled and dry? This is a sign of Stomach Qi exhaustion, allowing differentiation upon reflection. Also, bright red tongue without coating: Minister Fire color floats externally, peak abundance declining towards ash (common in healthy people, suitably use Fu Zi). Guiding fire back to its source allows retreat (pure red tongue must be in someone with inherent Kidney Qi deficiency, with no other symptoms suddenly appearing; using Fu Zi to guide fire back is correct. Also, *Ao Shi Shang Han Jin Jing Lu* records pure red as a pre-plague tongue, indicating heat accumulating internally before disease onset; regardless of meridian, Tou Ding Qing Shen San snuff method is applicable, which must be known). Also, tongue black like pale ink; no need to distinguish dry or wet, it always returns to Kidney Water overcoming Heart Fire, Yin excess and Yang deficiency must be recognized early; unless black with prickles, dry and cracked, that is Yang pathogen heat accumulation, needless to say.
Differentiating Dry Tongue from Deficiency-Cold: Dry tongue has many types: pale yellow, pale white, slight prickles, or gray. Some look dry but feel moist to touch, color purple or black, definitely accompanied by vomiting, diarrhea, and Jue, confusion, delirium, and slurred speech (dry tongue with unclear speech due to dryness and lower clear stool is treatable. Moist tongue with unclear speech, meaning "mouth wants to speak but tongue cannot advance," is a death case). Pulse form is faint and fine like silk (definitive for deficiency-cold), or though flooding and large, ultimately powerless. Urgently use Sheng Mai San to nourish fluids; Fu Zi, Gan Jiang, Fu Ling, Gan Cao harmonized with Cang Zhu and Bai Zhu (vulgar physicians say Wu Wei Zi is strong-flavored, using ten-plus grains or seven-eight grains is incorrect; must use over one qian to be effective).
Differentiating Dry Tongue from Excess-Heat: Excess-heat dry tongue first has a base, yellow or black with prickles. Even if coating is light and cracked, definitely accompanied by body heat, scorched lips/teeth. Thirst desiring cold drinks, red face/eyes, no vomiting/diarrhea or Jue. Delirium and constipation present; flooding-rapid-slippy-long pulse verifies; Bai Hu Tang or Cheng Qi Tang change accordingly.
Differentiating Cold Headache: Cold headache has floating-tight pulse (main feature), or wiry/deep additionally slow. Aversion to wind/cold, cold limbs (major evidence), head prefers wrapping with hot objects (Liu He Jian also discussed heat headaches involving aversion to cold and preference for heat, because heat closed by cold causes severe pain; when heat flows freely, pain stops, but stops then recurs worse as verification, pulse also differs). Li Zhong Tang enters Gui Zhi and Tian Ma; Fu Zi and Xi Xin added for severe cases; minor addition of Qiang Huo and Fang Feng is also exquisite.
Differentiating Heat Headache: Heat headache has floating-rapid pulse, or slippery-long also occurs. Bitter mouth, dry tongue, thirst desiring drink, pain connecting Feng Fu and Feng Chi (major evidence). Aversion to heat is usual, aversion to wind is temporary; this is obvious Wind-Heat syndrome. Qiang Huo, Fang Feng, Chai Hu, Ge Gen, Lian Qiao, Huang Qin; severe cases use Shi Gao effectively.
Differentiating Deficiency Headache: Deficiency headache has wiry-large pulse, wiry indicates cold, large indicates deficiency (main feature). Pain unbearable, likes pressure, calling day and night with hoarse voice (major evidence). Pain may focus on forehead, or whole head hurts. Urgently use Ren Shen, Fu Ling, Cang Zhu, Bai Zhu plus Fu Zi; failure to treat this condition is critical and deadly.
Differentiating Wind-Cold Bone Pain: Wind-cold bone pain has wiry-tight pulse (main feature), or slow-slow also accurate. Body heat, aversion to cold, cold hands/feet (major evidence), white tongue coating, no thirst, spasms and body soreness unbearable, severe cases upper vomiting lower diarrhea together. Gui Zhi Tang uses Tian Ma; remove Shao Yao and add Fu Zi for dampness, stable.
Differentiating Deficiency Bone Pain: Pulse wiry-large-numerous powerless (main feature), or fever or no fever. Aversion to wind and spasm, bland mouth and mental trance (major evidence). Pain in bone joints; taking dispersing drugs makes pain worse, this is Spirit-Qi injury; combine Gui Zhi with Cang Zhu and Bai Zhu. Generally, human bone joints number 360, places where Spirit-Qi travels in and out; do you not see Zhang Zhongjing's Xin Jia Tang, heavily using Ren Shen and Jiang to restore pulse?
Differentiating Deficiency-Cold Abdominal Fullness: Visceral cold generates fullness disease (from *Nei Jing*), pulse slow-delayed or deep-tight, or void-large powerless upon pressing (main feature). Abdominal fullness decreases then increases again (evidence from *Jin Gui*), no desire to eat, vomiting upon eating, or diarrhea, aversion to cold, thirst preferring hot drinks. Jiang, Gui, Xiang Sha warm and disperse; if ineffective, add Ren Shen, Bai Zhu, Cang Zhu.
Differentiating Excess-Heat Abdominal Fullness: Pulse deep-excess (main feature), or slippery-long combined. Abdominal fullness does not decrease (evidence), decrease is negligible (two sentences from *Jin Gui*). Bowel movement resolved but not smooth, or slightly relieved after resolution. Abdominal fullness hard/painful unpressable, no vomiting/dizziness etc. deficiency signs mixed. This suits Zhi Shi and Hou Po to resolve; severe cases add Da Huang.
Differentiating Deficiency-Cold Constipation: Constipation everyone calls heat, unaware cold coagulation also gathers. Abdomen not full, mouth not thirsty (doubtful case), white slippery coating, wiry-tight pulse (definitive case). This belongs to deficiency-cold, do not attack rashly; maintain normal diet calmly (do not starve); wait 10-20 days, when warmed and sufficient, Qi naturally flows.
Differentiating Excess-Heat Constipation: Pulse rapid-powerful long-slippery extreme (main feature), vexation/thirst, abdominal fullness, hard upon pressing (evidence), or tidal fever, or bloating after eating, occasional foul gas from rear; this is Stomach heat suitable for purging, carefully examine any deficiency signs (generally excess resolves with one purge; if deficiency exists, examine carefully; even if purging is necessary, only use Liang Ge San for mild relief, Du Jie to harmonize, Tao Shi Huang Long Tang to tonify and purge).
Differentiating Urinary Inhibition: Differentiate deficiency/excess in urinary inhibition; deficiency means San Jiao loses function, repeated diuretics fail; this suits *Jin Gui* Shen Qi Wan to treat San Jiao Decree Officer; raw Ivory decoction also soothes. Excess cases are usually strong persons, or love hot foods, Lung heat cannot pass water channels, causing Bladder heat knot; use Zhu Ling, Ze Xie, Zhi Zi, Hua Shi. If still ineffective after use, seek external orifice of Bladder; *Classic* says hair follicles correspond (*Classic* says: San Jiao and Bladder correspond to Cou Li and hair follicles; San Jiao governs Cou Li, Bladder governs hair follicles; Bladder has exit but no entry, filtering juices seeping into Bladder. Hair follicles are external orifices; like water injection, blocking upper orifice prevents exit forever. If person is not deficient, diuresis fails, induce sweating; external orifice opens, internal orifice opens, this is called opening Ghost Gate), changing to inducing sweating is best. Also, disturbing Blood in Bao Zhong, deficiency-cold/excess-heat distinguished by symptoms; deficiency-cold warms and tonifies, heat clears heat and nourishes blood; prescribe according to symptoms, do not be rigid.
Differentiating Vomiting: Person receives sudden cold (examine cause), or eats raw/cold food, sour regurgitation and dry heaving (evidence), Ping Wei San and Zheng Qi San combined. Slippery pulse indicates Stomach excess (main feature), drinks cold dislikes heat, taking warm/hot drugs worsens vomiting (evidence), Huang Lian, Zhu Ru assisted by Jiang Zhi; if deficient, add Ren Shen. Pulse void-large-rapid-powerless (main feature), vomiting clear saliva and cold foam (evidence), Stomach deficiency cannot hold grain food, smelling food causes vomiting/returning, Ren Shen Li Zhong is best, Ding Xiang and Fu Zi added also get result. Slippery-powerful pulse, symptom not deficient, chest fullness pain worsens on pressing (evidence), combine Hou Po, Shi with Er Chen Tang; this is Middle Jiao vomiting from accumulation (Dong Yuan quote).
Differentiating Vomiting Roundworms: Heat Jue vomiting roundworms implies many worms, spirit clear, pulse harmonious, worms generated/vomited continuously without vexation, drain Damp-Heat without delay. Jue Yin Shang Han belongs to Wind-Wood, vomiting worms plus clear/green water, cold extremities, severe vexation; read Wu Mei Wan principles.
Differentiating Sweat: Deficiency sweat must distinguish Yin/Yang; Yang deficiency spontaneous sweat tonifies Wei (person inherently weak, or labor injury, or post-major illness, Cou Li deficient, Yang cannot guard exterior and solidify, thus spontaneous sweat; suit Ren Shen, Huang Qi, Wu Wei Zi, Huang Qin, Bai Zhu; severe add Gui Zhi, Fu Zi; drugs like Gan Jiang, Ban Xia, Chen Pi that open/reach are all unusable). Night sweat belongs to Yin Qi deficiency; Ren Shen, Dang Gui, Gan Cao, Di Cong follow their category (when sleeping blood returns to Liver, Yin deficiency cannot hold, thus night sweat; suit Ren Shen, Huang Qin, Huang Qi, Bai Zhu, Wu Wei Zi, Dang Gui, Bai Shao, Sheng Di, Shu Di categories). Only when Yang Ming pathogen combines, heat steams pores open, sweat pours constantly; only cooling resolution brings harmony (sweat includes Heart blood sweat, Tai Yang fluid sweat, both must not come out; only Yang Ming grain-water sweat, though coming out, is harmless; thus Yang syndrome Shang Han, heat steaming, pores opening, pouring self-sweat, like boiling water in vessel, heat steaming externally; if sweat doesn't come out, heat cannot vent, must郁 turn to jaundice; immediately use cooling to resolve heat, sweat stops itself, no need for anti-sweat drugs). Also, Shang Han long-term no sweat, large dose Ren Shen, Huang Qi, Chai Hu, Gui Zhi combined, suddenly sweating reduces heat; Jing Yue book also mentions this.
Differentiating Delirium: Delirious speech is excessive talking, all due to dry Stomach juice. Among them, delirious speech has excess aspect, delirium words are serious and confident. Rotating wind wheel hard to control oneself, just called Li Si then Zhang San. Zheng Sheng (repetitive low voice) short breath, spirit desolate, earnest frequent repetition not tired of repeating, same meeting people talking much, never saying South then North. Assuming Delirium and Zheng Sheng, mostly belong to groundless talk, thus named Wang (delusion), both deficiency and excess exist. If between sleep and wakefulness, faint jumping like chatting, this is Du Yu (soliloquy) not fully chaotic, each from pulse/symptoms carefully consult.
Differentiating Red Face/Eyes: Red face/eyes has three types, must consult pulse/symptoms. Yang Qi郁 at exterior, acrid-cool can disperse. Interior heat steams upward, Bai Hu and Huang Lian. Rootless fire floats outward, this is internal true cold; Ba Wei and Sheng Mai decocted as frozen beverage, false matching false as ancient passed down.
Differentiating Diarrhea: Downward clearing grain is deficiency-cold, downward clearing water is excess-heat; only pus/blood, loose stool, and frothy juice, these three items carefully distinguish. Suppose vomiting/no eating, abdominal pain likes pressure, heart trance/vexation, or palpitations/dizziness, dry/unwilling to drink, dizziness/tinnitus/bland mouth; tenesmus forcing, resolved but not reduced; wiry-rapid/void-large pulse, all deficiency-cold external manifestation. If pulse/symptoms opposite, then excess-heat proof.
Differentiating Jue: Hand/foot cold time is Si Ni, Jue means cold passes elbow/knee, Zhong Jing *Shang Han* all prohibit sweating, regardless of Yang Jue or Yin Jue. Yang Jue is transmission, disease from Three Yang enters Yin, extreme heat must accompany winning transformation, also initial heat final cold cause. Drug error can also turn to Yin-cold path, insisting on transmission is also wrong. Yin Jue is direct invasion, Yu Shi *Zhong Han Lun* must recite. Cold pathogen cuts gate straight in, urgently rescue True Yang don't dream. Also fear heat pathogen deeply enters Blood, suddenly Jue cold body no heat. Do you not see swallowing Sha appearance forbids hot soup, not same as middle cold one example say.总之 pulse/symptoms must detail consult, straw picked life-death between, Yang Jue delirium/thirst Yin vomits saliva, Yang person light Yin curls. Again look person lip/claw/nail, cyan-purple heat cyan-black cold. Also Phlegm Jue, Food Jue, Corpse Jue, disease long Yin/Yang two Qi deficiency also Jue, each each kind in *Zhun Sheng*, step step must seek pulse/symptom match.
Differentiating Abdominal Pain: Abdominal pain is deficiency likes rubbing/pressing, deficiency must be cold disease involves Yin, pulse slow-delayed or void-large, many deficiency images examine cause, Li Zhong Gui/Fu can execute. Heat person yellow luster face, add long-slippery pulse, suit Huang Lian bitter clear heat, minor assist Jiang/Yu also gets along. More desire vomit not vomit abdominal pain many, cold/heat how like mixed, Huang Lian Tang inside Gan Jiang/Gui, good together Ren/Gan two below harmonize. Food pain should resolve food, hard in deficiency-cold combine food stagnation, Scholar Wen Pi method can follow (Xu Scholar has Wen Pi Tang, see *Ben Shi Fang*). Transform into decoction method especially fits (deficiency-cold person suffers abdominal pain, takes warm-tonic drugs and is peaceful. Stops and starts, pain still not resolves, severe even clears clear water or white foam, this deficiency has real, or previously had old food in intestine not gone, or disease mid stomach/intestine weak cannot transport/digest, eaten thing stops in intestine, even one-two pieces old stool, also can make pain, suit warm-tonic drug decoct good, remove dregs, enter Da Huang one qian, not very deficient, can add one qian five fen, boil four-five boils take, old food self-down, righteous Qi not injured, and disease follows cures. This repeatedly tried repeatedly verified wonderful method.) Worm pain yellow face vomits saliva foam, eats acid then safe sweet then severe, deficiency/excess cold/heat must distinguish, kill worm formula among seek combination. Qi pain due to depression/anger, must connect epigastrium and two hypochondria, disease long person must be deficient, tonify/nourish combine disperse depression. Pain cannot approach, press soft is stored blood, not compare hard/full is heat knot, heavy then Tao Ren Cheng Qi Tang, light then Xuan Tong micro-purge. Another swallowing Sha one symptom appears, damp-heat steaming pathogen transforms, urgently prick Wei Zhong bleed good, grind take Yu Shu Dan also good. Most fear Three Yin cold symptom regard as Sha, not drink warm soup drink cold tea, disorderly advance pills and cupping/scraping,臨危 empty self regret previous mistake.