曹生初病伤寒。六七日。腹满而吐。食不下。身温。手足热。自利。腹中痛。呕。恶心。医
者谓之阳多。尚疑其手足热。恐热蓄于胃中而吐呕。或见吐利而为霍乱。请予诊。其脉细而沉。
质之。曰太阴证也。太阴之为病。腹满而吐。食不下。自利益甚。时腹自痛。予止以理中丸。用
仲景云如鸡子黄大。昼夜投五六枚。继以五积散。数日愈。
论曰。予见世医论伤寒。但称阴证阳证。盖仲景有三阴三阳。就一证中又有偏胜多寡。须是
分明辩质。在何经络。方与证候相应。用药有准。且如太阴少阴。就阴证中。自有补泻。岂可止
谓之阴证也哉。
毗陵一时官得病。身疼痛。发热。体重。其脉虚弱。人多作风湿。或作热病。则又疑其脉虚
弱不敢汗也。已数日矣。予诊视之。曰中 证也。仲景云太阳中 者。身热体疼。而脉微弱。此
以夏月伤冷水。水行皮中所致也。予以瓜蒂散。治之。一呷而愈。
论曰。仲景论 有三证。一则汗出。恶寒。身热而渴。此太阳经中 也。一则发热恶寒。身
疼痛。其脉弦细芤迟。一则夏月伤冷水。水行皮中。身热。疼痛重而脉微弱。不可下。不可行温
针。上二证皆宜用白虎加人参汤。后一证宜用瓜蒂散方治。不见于本论。而见于金匮要略。其脉
证云。治太阳中 。身热。疼痛。而脉微弱者。夏月伤冷水。水行皮中所致。宜瓜蒂散。盖谓此也。
曹生起初患上伤寒。到了第六七天，出现腹部胀满并呕吐，饮食难进，身体温热，手足发热，自行腹泻，腹中疼痛，干呕，恶心。医生认为这是阳气偏盛，仍然怀疑他手足发热是因为热邪积聚在胃中导致呕吐。或者有人见到他吐泻交作，便认为是霍乱。请我诊治，他的脉象细而沉。我询问病情后判断说：这是太阴证。太阴病的症状是腹部胀满、呕吐、饮食不下，腹泻日益加重，时常腹痛。我只给他服用理中丸，用量按照张仲景所说的如鸡蛋黄大小，白天黑夜共投服五六枚。随后又服用五积散，几天后痊愈。
评论说：我看见当今的医生论述伤寒，只是笼统地称为阴证或阳证。其实张仲景有太阳、阳明、少阳、太阴、少阴、厥阴三阴三阳之分，就在一个证候中又有偏胜和轻重的区别。必须分明地辨别体质，确定病在何条经络，才能与证候相应，用药才有把握。况且像太阴、少阴，就阴证而言，自有补法和泻法之分，怎么可以只称之为阴证呢？
毗陵有一位官员患病，身体疼痛，发热，身体沉重，脉象虚弱。众人多认为是风湿，或者认为是热病，但又因为脉象虚弱而不敢使用发汗法。已经过了好几天了。我去诊视，说：这是太阳中暍（中暑）证。张仲景说：太阳中暍者，身体发热，肢体疼痛，而脉象微弱。这是因为夏天受了冷水刺激，水气运行于皮肤之间所致。我给他服用瓜蒂散治疗，喝了一口就好了。
评论说：张仲景论述中暍有三种证候。第一种是汗出、恶寒、身热而口渴，这是太阳经中的中暍。第二种是发热恶寒，身体疼痛，脉象弦细芤迟。第三种是夏天受了冷水刺激，水气行于皮中，身热，疼痛沉重而脉象微弱，不可用下法，不可用温针。前两种证候都适宜用白虎加人参汤，后一种证候适宜用瓜蒂散方治疗。这一内容不见于《伤寒论》本篇，而见于《金匮要略》。其脉证记载说：治疗太阳中暍，身热，疼痛，而脉微弱的，是夏天受了冷水，水气行于皮肤之间所致，适宜用瓜蒂散。大概指的就是这种情况。
Cao Sheng initially contracted Shanghan (Cold Damage). By the sixth or seventh day, he presented with abdominal fullness and vomiting, inability to eat, warm body temperature, heat in the hands and feet, spontaneous diarrhea, abdominal pain, retching, and nausea. The attending physician attributed this to an excess of Yang, still doubting whether the heat in his extremities was due to heat accumulation in the stomach causing vomiting. Others, observing both vomiting and diarrhea, suspected Huoluan (Cholera-like disease). I was invited to diagnose him; his pulse was fine and deep. Upon inquiry, I determined it was Taiyin Syndrome (Disease of the Taiyin Meridian). The manifestations of Taiyin disease include abdominal fullness, vomiting, inability to eat, worsening diarrhea, and occasional spontaneous abdominal pain. I prescribed only Lizhong Wan (Regulate the Middle Pill), administered according to Zhang Zhongjing’s instruction: a size equivalent to a chicken egg yolk, given five to six pills throughout the day and night. Subsequently, Wujie San (Five Accumulations Powder) was administered, and he recovered after several days.
Commentary: I observe that contemporary physicians discussing Shanghan merely categorize them broadly as Yin syndromes or Yang syndromes. However, Zhang Zhongjing delineates three Yin and three Yang stages. Within a single syndrome, there are variations in dominance and severity. One must clearly differentiate the constitution and identify the specific meridian involved to match the treatment to the symptoms accurately. For instance, within Yin syndromes such as Taiyin and Shaoyin, there are distinct tonifying and purging methods; how can one simply label them as Yin syndromes?
An official in Biling fell ill with body pain, fever, heaviness of the body, and a weak pulse. Many diagnosed it as Fengshi (Wind-Dampness) or Rebing (Heat Disease), but hesitated to use sweating methods due to the weak pulse. After several days, I examined him and diagnosed it as Taiyang Zhongshu (Summerheat Stroke of the Taiyang Meridian). Zhang Zhongjing stated: In Taiyang Zhongshu, the body is hot and painful, yet the pulse is faint and weak. This results from exposure to cold water in summer, causing water qi to circulate within the skin. I treated him with Goudi San (Melon Peduncle Powder); after a single sip, he recovered.
Commentary: Zhang Zhongjing describes three types of Zhongshu (Summerheat). The first involves sweating, aversion to cold, fever, and thirst, representing Zhongshu affecting the Taiyang Meridian. The second involves fever, aversion to cold, body pain, with a pulse that is string-taut, fine, hollow, and slow. The third involves summer exposure to cold water, with water qi circulating in the skin, presenting with fever, heavy pain, and a weak pulse; this type should not be treated with purgation or warm needle therapy. The first two types are suitable for Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng), while the third type is suitable for Goudi San. This latter indication is not found in the main text of Shanghan Lun but appears in Jin Gui Yao Lue (Essential Prescriptions from the Golden Cabinet). Its pulse and symptom description states: To treat Taiyang Zhongshu characterized by fever, pain, and a weak pulse caused by summer exposure to cold water circulating in the skin, Goudi San is indicated. This refers to the case described above.