太阴之为病，腹满而吐，食不下，时腹自痛，若下之，必胸下结硬，（自利益甚）。
【按】吴人驹曰“自利益甚”四字，当在“必胸下结硬”之下，若在吐食不下之下，则是已吐食不下而自
利益甚矣。仲景复曰∶若下之无所谓也，从而移之。
伤寒，本自寒{下}〔格〕，医复吐下之，寒格更逆吐下，若食入口即吐，干姜黄连黄芩人参汤主之。
【按】经论中并无寒下之病，亦无寒下之文。玩本条下文，寒格更逆吐下，可知寒下之“下”字，当是
“格”字，文义始属。注家皆释胃寒下利，不但文义不属，且与芩、连之药不合，当改之。
少阴病，饮食入口即吐，心中{温温}〔 〕欲吐复不能吐。始得之，手足寒，脉弦迟者，此胸中实，不
可下也，当吐之。若膈上有寒饮，干呕者，不可吐也，当温之，宜四逆汤。
【按】“温温”当是“ ”。 者，乃吐饮之状也，当改之。
伤寒，厥而心下悸者，（以饮水多），宜先治水，当服茯苓甘草汤，却治其厥。不尔，水渍入胃，必作利也。
【按】“厥而心下悸者”之下，当有“以饮水多”四字，若无此四字，乃阴盛之厥悸，非停水之厥悸矣。
何以即知是水，而曰宜先治水耶？当补之。
伤寒脉微而厥，至七八日肤冷，其人躁，
无暂安时者，此为脏厥，非蛔厥也。蛔厥者，其人当吐蛔。今病者静，而复时烦者，{此}〔非〕为脏寒，蛔上
入其膈，故烦，须臾复止。得食而呕，又烦者，蛔闻食臭出，其人当自吐蛔。蛔厥者，乌梅丸主之，又主久利。
【按】“此为脏寒”之“此”字，当是“非”字，若是“此”字，即是脏厥，与辨蛔厥之义不属，当改之。
伤寒五六日，不{结胸}〔大便〕，腹濡，脉虚复厥者，不可下。此为亡血，下之死。
【按】“结胸”二字，当是“大便”二字。不结胸腹濡脉虚复厥，皆无可下之理，今曰不可下，何所谓也？
当改之。
伤寒始发热六日，厥反九日而利，凡厥利者，当不能食，今反能食者，恐为除中，食以索饼，{不}〔若〕
发热者，知胃气尚在，必愈。恐暴热来出而复去也，后三日脉之，其热续在者，期之旦日夜半愈。所以然者，
本发热六日，厥反九日，复发热三日，并前六日，亦为九日，与厥相应，故期之旦日夜半愈。后三日脉之而脉
数，其热不罢者，此为热气有余，必发痈脓也。
【按】“不发热者”之”‘不”字，当是“若”字，若是“不”字，即是除中，何以下接恐暴热来出而复
去之文耶？当改之。
伤寒脉迟，六七日，（厥而下利），而反与黄芩汤彻其热，脉迟为寒，今与黄芩汤复除其热，腹中应冷，
当不能食，今反能食，此名除中，必死。
【按】“伤寒脉迟六七日”之下，当有“厥而下利”四字，若无此四字，则非除中证也。况有此四字，始
与下文反与黄芩汤之义相属，当补之。
Taiyin disease is characterized by abdominal fullness accompanied by vomiting, inability to take in food, and spontaneous abdominal pain occurring from time to time. If purgation is mistakenly applied, it will inevitably lead to hardness and binding below the chest. (If spontaneous diarrhea ensues, the condition will worsen).
[Commentary] Wu Renju stated that the four characters "spontaneous diarrhea worsens" should be placed after "hardness and binding below the chest." If placed after "vomiting and inability to eat," it would imply that severe spontaneous diarrhea occurs after vomiting and anorexia have already set in. Zhang Zhongjing subsequently states "if purged, there is no consequence" (implying dire consequences if purged), thus this phrase should be moved.
In cold damage, the pathogen is originally cold and obstructing at the middle jiao. If the physician erroneously employs emesis and purgation, the cold obstruction becomes more severe, exacerbating vomiting and diarrhea. If food is vomited immediately upon entering the mouth, Ganjiang Huanglian Huangqin Renshen Tang (Dried Ginger, Coptis, Scutellaria, and Ginseng Decoction) should be administered.
[Commentary] The classics contain no mention of a disease named "cold purgation" nor the text thereof. Examining the subsequent text "cold obstruction reverses vomiting and diarrhea," it can be deduced that the character "xia" (purgation) in "han xia" should be "ge" (obstruction), making the textual meaning coherent. Commentators interpret this as stomach-cold-induced diarrhea, which not only contradicts the text but also conflicts with the properties of Coptidis Rhizoma (Huanglian) and Scutellariae Radix (Huangqin); it should be corrected.
Shaoyin disease presents with vomiting immediately after food enters the mouth, a sensation of discomfort and oppression in the heart region, where one desires to vomit but cannot. At the onset, the hands and feet are cold, and the pulse is wiry and slow. This indicates excess pathogenic factors in the chest; purgation is contraindicated, and emesis should be induced. If there is cold fluid retention above the diaphragm causing dry heaving, emesis is contraindicated; instead, warming therapy should be used, preferably Sini Tang (Frigid Extremities Decoction).
[Commentary] "Wenwen" should be "Yunyun" (a state of discomfort and desire to vomit). It describes the manifestation of desiring to vomit fluid; it should be corrected.
In cold damage, if there is cold extremities accompanied by palpitations in the epigastrium (due to excessive water intake), water retention should be treated first by administering Fuling Gancao Tang (Poria, Licorice, and Ginger Decoction), followed by treating the cold extremities. Otherwise, water dampness infiltrating the stomach will inevitably cause diarrhea.
[Commentary] The four characters "due to excessive water intake" should be added after "cold extremities accompanied by palpitations in the epigastrium." Without these words, it would refer to cold extremities and palpitations caused by yin excess rather than water retention. How can one immediately determine it is water and advise treating water first? These four characters should be supplemented.
In cold damage, if the pulse is faint and there are cold extremities, progressing to day seven or eight with cold skin and restlessness without any moment of peace, this is Zang Jue (Visceral Cold Damage), not Hui Jue (Roundworm Cold Damage). Patients with Hui Jue typically vomit roundworms. The current patient is quiet but occasionally irritable; this is not due to visceral cold, but rather roundworms moving up into the diaphragm, causing irritability which ceases after a while. Vomiting and irritability after eating occur because the roundworms emerge upon smelling food, leading to spontaneous vomiting of roundworms. Hui Jue is treated with Wumei Wan (Mume Pill), which is also indicated for chronic diarrhea.
[Commentary] The character "ci" (this) in "ci wei zang han" (this is visceral cold) should be "fei" (not). If it were "ci," it would indicate Zang Jue, which contradicts the differentiation of Hui Jue; it should be corrected.
In cold damage lasting five or six days, if there is constipation, soft abdomen, weak pulse, and cold extremities, purgation is contraindicated. This is due to blood loss (blood deficiency); purgation will lead to death.
[Commentary] The two characters "Jie Xiong" (Chest Binding) should be "Da Bian" (Stool/Bowel movement). If there is no Chest Binding, soft abdomen, weak pulse, and cold extremities, there is no rationale for purgation. Saying "purgation is contraindicated" under these conditions lacks logical connection; it should be corrected.
In cold damage, fever lasts for six days initially, but cold extremities persist for nine days accompanied by diarrhea. Generally, patients with cold extremities and diarrhea cannot eat. If they can eat now, it may be Chu Zhong (Elimination of the Middle, a sign of impending gastric qi exhaustion). Feeding them Suobing (noodles/wheat cakes): if there is no subsequent fever, gastric qi is exhausted; if there is mild fever afterward, gastric qi remains, and recovery is certain. One must fear sudden heat appearing and disappearing quickly. Three days later, upon pulse diagnosis, if the fever persists, recovery is expected at midnight on the following day. This is because the initial six days of fever plus the subsequent three days of fever total nine days, matching the nine days of cold extremities, hence the prediction of recovery at midnight. If three days later the pulse is rapid and fever does not cease, this indicates excess heat, which will likely manifest as carbuncles and pus.
[Commentary] The character "bu" (not) in "bu fa re zhe" (if there is no fever) should be "ruo" (if). If it were "bu," it would indicate Chu Zhong, which contradicts the following text discussing the fear of sudden heat; it should be corrected.
In cold damage with a slow pulse, after six or seven days (accompanied by cold extremities and diarrhea), if the physician erroneously administers Huangqin Tang (Scutellaria Decoction) to clear heat: a slow pulse indicates cold. Administering Huangqin Tang further clears heat, causing internal cold and an inability to eat. If the patient can eat now, this is called Chu Zhong, and death is inevitable.
[Commentary] The four characters "cold extremities and diarrhea" should be added after "cold damage slow pulse six or seven days." Without these, it is not Chu Zhong. Furthermore, these characters are necessary to connect with the subsequent text regarding the erroneous use of Huangqin Tang; they should be supplemented.