太阳下焦有热秘。小腹必满便不利。小便不利反自利。此是抵当血症谛。阳明自汗小便
结。
忽若利时津液竭。屎难坚硬不可攻。蜜导用之斯要诀。又问小便何故数。肾与膀胱虚热作。
虚不故令小便频。热则迟涩相击搏。有汗不可服桂枝。趺阳浮涩是脾约。胃中不和谵语时。
调胃承气宜斟酌。
大便坚硬或不通。柴胡承气可收功。亦有不可攻击者。歌载篇章里症中。寒则溏泄热则
垢。可揣阴阳虚实候。藏火不及大寒行。民病 溏肠胃讹。
阴症身凉二便清。病初自汗不头疼。也无烦躁也无渴。脉息沉微自可明。
阳症身热头疼痛。体痛咽干难卧动。或有谵语及寻衣。脉急洪长宜审用。
伤寒表症是如何。无汗恶寒身热多。头项俱疼脉浮取。施方审症汗之和。
伤寒里症心腹痛。不恶寒而恶热蒸。其脉沉数兼自汗。二便秘少下之生。
阴厥身凉热不由。二便清滑不烦时。脉来沉浮如端的。三建汤兼四逆宜。
阳厥时时指爪温。心烦便闭口干论。脉来沉细中还疾。承气柴胡最可吞。
阴症似阳面色红。小便清滑大便通。浑身微热沉迟脉。真武汤兼用理中。
太阳病若下焦有热邪蕴结，必然导致小腹胀满、大便不通。如果小便反而通畅自利，这是抵当汤证（瘀血阻滞）的确切指征。阳明病出现自汗且小便短少涩滞，一旦小便变得通利，说明津液已经枯竭，粪便干硬难以攻下，此时应使用蜜导法（外用润肠通便），这是关键要点。又问为何小便频数？这是因为肾与膀胱存在虚热。虚证本不应导致小便频数，而是热邪使得尿液排泄迟滞涩痛，相互搏击所致。若有汗出，不可服用桂枝汤；趺阳脉呈现浮涩之象，则是脾约证（脾阴不足，胃强脾弱，约束津液）。胃气不和时常出现谵语，此时宜斟酌使用调胃承气汤。
大便干硬或不通畅，可用大柴胡承气汤收功。也有不可使用攻下法的，歌诀中记载于篇章的里症部分。寒邪则导致溏泄，热邪则导致垢浊，可据此揣测阴阳虚实的情况。脏腑之火不及，大寒之气盛行，民众易患溏泄及肠胃病变。
阴证表现为身体发凉，大小便清长。病初起时自汗出但不头痛。也没有烦躁和口渴的症状，脉象沉微，由此可以明确诊断。
阳证表现为身体发热、头痛、全身疼痛、咽干，难以安卧或转动。有时出现谵语以及无意识地抓摸衣物，脉象急洪长，应当仔细审察后使用相应方药。
伤寒表证是怎样的表现？无汗、恶寒、身体发热较多。头项部都疼痛，脉象浮取即得。施方时要审慎辨证，通过发汗使邪气和解。
伤寒里证表现为心腹疼痛。不恶寒而怕热蒸腾。脉象沉数且伴有自汗，大小便闭塞量少，采用攻下法可获生机。
阴厥表现为身体发凉，热象并非由内热引起，大小便清滑且不烦扰。脉象沉浮分明如确实可见，适宜使用三建汤兼服四逆汤。
阳厥表现为手指脚趾时时温暖，心烦、大便闭结、口干舌燥。脉象沉细但中间部位疾速，承气汤或柴胡类方剂最可服用。
阴证似阳表现为面色发红，小便清滑，大便通畅。浑身微热，脉象沉迟，真武汤兼用理中汤为宜。
阳证似阴表现为身体发凉、四肢冰冷，小便赤少，大便稀溏。心烦口燥，脉象沉数，白虎汤兼竹叶石膏汤效果奇特。
妇人患此病应当区别对待，身体沉重与轻爽是不同的情况。产前身体沉重需先安胎，产后血虚应先补血。唯有使用柴胡四物汤，才能调和气血，使患者安心喜悦。
If the Taiyang disease involves heat in the lower jiao (Lower Burner), there will inevitably be fullness in the lower abdomen and difficulty in defecation. If urination is instead free and unobstructed, this is a definitive sign of the Dandang Tang syndrome (blood stasis obstruction). In Yangming disease, spontaneous sweating occurs with scanty or obstructed urination. Once urination becomes frequent, it indicates exhaustion of body fluids; the stool becomes hard and dry, making purgative therapy inadvisable. In such cases, honey suppositories should be used; this is a crucial principle. One may ask why urination is frequent? This is caused by deficient-heat in the Kidney and Bladder. Deficiency alone does not typically cause frequent urination; rather, heat causes sluggishness and astringency in urine flow, creating a combative interaction. If sweating is present, Guizhi Tang (Cinnamon Twig Decoction) must not be administered. A floating and choppy pulse at the Yuyang position indicates Splee Constraint (Pi Yue, where weak Spleen Yin fails to distribute fluids due to strong Stomach heat). When the Stomach Qi is disharmonious, delirium may occur; in such instances, Tiaowei Chengqi Tang (Harmonizing the Stomach and Directing Downward Decoction) should be considered with caution.
For hard stools or constipation, Dachaihu Chengqi Tang (Minor Bupleurum and Major Purging Decoction) can achieve success. However, there are cases where purgatives are contraindicated, as recorded in the chapters on interior syndromes. Cold pathogens lead to loose stools, while heat pathogens lead to turbid excrement; one can infer the patterns of Yin-Yang deficiency and excess from these signs. If the internal fire is insufficient and severe cold prevails, the people may suffer from loose stools and gastrointestinal disorders.
Yin syndromes present with a cool body and clear urine and stools. At the onset, there may be spontaneous sweating without headache. There is no irritability or thirst. The pulse is deep and faint, which clarifies the diagnosis.
Yang syndromes present with fever, headache, generalized body pain, dry throat, and restlessness (difficulty lying still or turning over). Delirium or unconscious grasping at bedclothes may occur. The pulse is urgent, flooding, and long; appropriate treatment should be applied after careful examination.
What characterizes exterior syndromes of Shanghan (Cold Damage)? They manifest as absence of sweating, aversion to cold, and significant body heat. Pain in the head and neck is common, and the pulse is superficial upon light palpation. Formulas should be selected based on careful pattern differentiation, employing diaphoresis (sweating method) to harmonize the exterior.
Interior syndromes of Shanghan manifest as heart and abdominal pain. There is aversion to heat rather than aversion to cold. The pulse is deep and rapid, accompanied by spontaneous sweating. When both urine and stool are obstructed and scanty, purgative therapy leads to recovery.
Yin Jue (Cold Extremities) presents with a cool body, where heat is not internally generated; urine and stools are clear and slippery, without irritability. The pulse is distinct in both deep and superficial positions. Sanjian Tang (Three Establishments Decoction) combined with Sini Tang (Frigid Extremities Decoction) is suitable.
Yang Jue presents with warmth in the fingers and toes at times, irritability, constipation, and dry mouth. The pulse is deep and thin but rapid in the middle position. Chengqi Tang or Chaihu formulas are most appropriate for administration.
Yin syndromes mimicking Yang present with a red face, clear and slippery urine, and normal bowel movements. There is slight whole-body heat, and the pulse is deep and slow. Zhenwu Tang (True Warrior Decoction) combined with Lizhong Tang (Regulate the Middle Decoction) is indicated.
Yang syndromes mimicking Yin present with a cool body and cold limbs, scanty dark urine, and loose stools. There is irritability and dry mouth, and the pulse is deep and rapid. Baihu Tang (White Tiger Decoction) combined with Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) yields remarkable results.
When women contract this disease, differentiation is essential, as heaviness and lightness of the body represent different conditions. During pregnancy, if the body feels heavy, fetal calming should be prioritized. After childbirth, due to blood deficiency, tonifying blood should be the first step. Only by using Chaihu Siwu Tang (Bupleurum and Four Substances Decoction) can the Qi and Blood be harmonized, leading to peace and comfort.