身热恶寒脉又浮。偏宜发汗更何求。（仲景云。脉浮宜以汗解之。）要须手足俱周遍。不欲淋漓似水流。（金匮云。凡
发汗欲令手足皆周。 一时间益佳。但不欲流离。若病不解。当重发汗。汗多则亡阳。阳虚不得重发汗也。）轻则随时
与和解。重须正发病当瘳。（仲景有和解之者。有正发之者。和解若小柴胡桂枝是也。正发若麻黄之类是也。）初春阳弱
阴尚胜。不可亟夺成扰搜。夏时暑热脉洪大。玄府开时汗易谋。（初春阳弱。不可大发汗以扰乎阳。夏则玄府汗空开。故
易汗。）不可汗脉微而弱。更兼尺中脉迟缓。（金匮云。脉微不可发汗。无阳故也。又云。尺中脉迟。荣不足。血气少。
不可汗。）微弱无阳迟少血。安可麻黄求发散。更有衄血并下血。（仲景云。衄家不可发汗。发汗则额上陷。亡血家不可
发汗。则寒栗而振。）风温湿温如何发。坏病虚烦且慎之。腹间动气宜区别。（此五证皆不可汗。解在第三十一。）妇人经
水适来时。此是小柴胡证决。忽然误汗表里虚。郁冒不知人作孽。（妇人经水适来适断。属小柴胡证。误汗。郁冒不知人。）
不恶寒兮反恶热。胃中干燥并潮热。（阳明证。身热。汗自出。不恶寒。反恶热。当下之。又云。潮热者。实也。宜
下之。）手心腋下汗常润。小便如常大便结。腹满而喘或谵语。脉沉而滑里证决。（手心与两腋下润。小便如经。大便结
硬。皆里证也。内实则腹满而喘。沉而滑者病在内。是曰里证也。）阳盛阴虚速下之。安可日数拘屑屑。（仲景云。阳盛
阴虚。汗之则死。下之则愈。盖阳盛则外热。阴虚则内热。内外皆热。故当下。虽三二日便可下。不必四五日过经也。）
失下心胸皆疰闷。冒郁不安成热厥。（失下则热极生寒。故冒而厥。厥则半日后复热也。）庸医不晓疑是阴。误进热药精
魂绝。（庸医见厥。便以为阴。误服热药。则发斑发黄。不知人也。）三阴大约可温之。积证见时方发泄。太阴腹满或时
痛。少阴口燥心下渴。积证悉具更无疑。要在安详加审别。（三阴大约可温。唯有积证当下。仲景云。太阳病。医反下之。
因腹满时痛属太阴。桂枝加芍药汤主之。其大实痛。则大黄汤主之。又云。少阴口燥咽干。急下之。宜承气汤。如此者
当下之也。）病犹在表不可下。脉浮更兼虚细者。（仲景云。脉浮为在表。又云虚细。不可下之。）恶寒呕吐小便清。（恶
寒者。表未解。金匮云。欲吐者不可下。小便清者。知不在里而在表也。）不转矢气应难泻。（不转矢气者。屎强硬。其
后必溏也。）大便坚硬小便数。（脾约证。）阳明自汗津液寡。（蜜兑证。）如斯之类下为难。莫便参差成误也。
身体发热，怕冷，脉象浮。最适合的方法是发汗，还能有什么别的追求呢？（张仲景说：脉浮适宜用发汗法来解除病邪。）必须让手足的汗出得均匀遍布全身，不希望大汗淋漓像水流一样。（《金匮要略》说：凡是发汗，希望手足都周身出汗，持续一段时间更好，但不希望汗出淋漓。如果病没好，应当再次发汗，但汗出太多会亡失阳气，阳气虚弱就不能再次发汗了。）病情轻的随时给予和解的方法，病情重的必须在正气发病时彻底治愈。（张仲景有和解的方法，也有正发汗的方法。和解如小柴胡汤、桂枝汤等；正发汗如麻黄汤之类。）初春阳气微弱，阴气尚盛，不可以急于攻伐而扰乱阳气。夏季暑热，脉象洪大，玄府（汗孔）开启时容易发汗。（初春阳气弱，不可以大发汗来扰动阳气。夏季则玄府汗孔开放，所以容易发汗。）不可以发汗的情况是脉微而弱，再加上尺中脉迟缓。（《金匮要略》说：脉微不可发汗，因为无阳的缘故。又说：尺中脉迟，营血不足，气血少，不可发汗。）脉微弱、无阳、迟、少血，怎么可以用麻黄汤寻求发散呢？还有鼻衄（流鼻血）和便血的情况。（张仲景说：经常流鼻血的人不可发汗，发汗会导致额上凹陷；亡血家不可发汗，否则会出现寒战颤抖。）风温、湿温如何发汗？坏病、虚烦都要谨慎对待。腹部动气需要区别对待。（这五种情况都不可发汗，解释在第三十一证。）妇女月经刚来时，这是小柴胡证的决断。忽然误用发汗导致表里俱虚，郁冒昏迷不省人事是自作孽。（妇女月经刚来或刚断，属于小柴胡证。误用发汗，导致郁冒不知人。）
不怕冷反而怕热，胃中干燥并伴有潮热。（阳明证：身体发热，汗自出，不怕冷，反而怕热，应当用下法。又说：潮热的，是实证，宜用下法。）手心腋下经常湿润，小便正常，大便干结。腹部胀满且气喘，或者胡言乱语，脉象沉而滑，里证确定。（手心和两腋下润，小便如常，大便干硬，都是里证。内实则腹满而喘，脉沉而滑说明病在内，这叫里证。）阳盛阴虚要迅速用下法，怎么能拘泥于天数琐碎计较呢？（张仲景说：阳盛阴虚，发汗则死，下之则愈。因为阳盛则外热，阴虚则内热，内外皆热，所以当下。虽然二三天就可以下，不必等到四五日过经之后。）错过时机不下，心胸都会感到痞闷，郁闷不安形成热厥。（失下则热极生寒，所以昏冒而四肢厥冷，厥冷半天后又发热。）庸医不懂，怀疑是阴证，误进热药导致精气灵魂断绝。（庸医见到厥逆，就以为是阴证，误服热药，就会发斑发黄，神志不清。）三阴病大约可以用温法，积证出现时才用下法发泄。太阴病腹部胀满或有时疼痛，少阴病口燥咽干心下渴。积证全部具备更无疑义，关键在于安详地加以审慎辨别。（三阴病大约可用温法，唯有积证当下。张仲景说：太阳病，医生反用下法，因腹满时痛属太阴，主方为桂枝加芍药汤；若大实痛，则用大黄汤。又说：少阴病口燥咽干，急下之，宜用承气汤。像这样的情况当下。）病还在表不可用下法，脉象浮而且兼见虚细的。（张仲景说：脉浮为在表，又说脉虚细，不可用下法。）怕冷呕吐，小便清长。（怕冷，说明表未解，《金匮要略》说：想吐的不可下，小便清长，知道病不在里而在表。）不放屁应该难以泻下。（不放屁，说明屎硬，其后必溏。）大便坚硬小便频数。（脾约证。）阳明病自汗津液少。（蜜兑证。）像这类情况用下法很难，不要随意差错造成误治。
Body heat, aversion to cold, and the pulse is floating. Sweating (Fahan) is most suitable; what else could be sought? (Zhang Zhongjing stated: A floating pulse indicates that sweating should be used to resolve the pathogen.) The sweat must spread evenly over the hands and feet; profuse sweating like flowing water is undesirable. (The *Jin Gui Yao Lue* states: When inducing sweating, it is desired that the hands and feet all perspire uniformly, which is better if sustained for a period, but profuse dripping is not desired. If the disease does not resolve, sweating may be repeated, but excessive sweating leads to the loss of Yang Qi. With deficient Yang, sweating should not be repeated.) For mild cases, harmonizing methods (Hejie) may be applied at any time; for severe cases, direct resolution (Zhengfa) must be employed when the righteous Qi confronts the pathogen to achieve cure. (Zhang Zhongjing mentioned both harmonizing and direct resolving methods. Harmonizing includes formulas such as Xiao Chai Hu Tang (Minor Bupleurum Decoction) and Guizhi Tang (Cinnamon Twig Decoction); direct resolving includes formulas such as Mahuang Tang (Ephedra Decoction).) In early spring, Yang Qi is weak and Yin still prevails; one must not hastily attack and disturb the Yang. In summer, with summer-heat and fire, the pulse is large; when the Xuanku (pores/sweat orifices) are open, sweating is easily achieved. (In early spring, Yang is weak; one must not induce heavy sweating to disturb Yang. In summer, the Xuanku are open, so sweating is easy.) Sweating is contraindicated when the pulse is faint and weak, especially combined with a slow pulse in the Chi position. (The *Jin Gui Yao Lue* states: A faint pulse contraindicates sweating due to the absence of Yang. It also states: A slow pulse in the Chi position indicates deficiency of Ying Blood and insufficiency of Qi and Blood, contraindicating sweating.) With faint and weak pulses, absent Yang, slowness, and blood deficiency, how can one seek dispersion using Mahuang Tang (Ephedra Decoction)? Furthermore, there are cases of epistaxis (Nuxue) and lower bleeding. (Zhang Zhongjing stated: Those prone to epistaxis should not be sweated, as sweating causes depression of the forehead; those who have lost blood should not be sweated, as this leads to chills and trembling.) How should Fengwen (Wind-Warmth) and Shiwenn (Damp-Warmth) be treated with sweating? Binghuang (Ruined Disease) and Xu Fan (Deficiency Irritability) require caution. Dongqi (Abdominal Pulsation) requires differentiation. (These five conditions all contraindicate sweating; explanations are found in the 31st Proof.) When a woman’s menses has just begun, this is a decisive indication for Xiao Chai Hu Tang (Minor Bupleurum Decoction). Sudden mistaken sweating leads to deficiency in both exterior and interior, resulting in Yu Mao (Depression and Dizziness) and unconsciousness, which is self-inflicted harm. (When menses has just begun or ended, it belongs to Xiao Chai Hu Tang syndrome. Mistaken sweating leads to depression, dizziness, and unconsciousness.)
Absence of aversion to cold but presence of aversion to heat, dryness in the Stomach accompanied by tidal fever. (Yangming Syndrome: Body heat, spontaneous sweating, no aversion to cold, but aversion to heat; purgation (Xia) is indicated. It also states: Tidal fever indicates excess; purgation is appropriate.) Moisture in the palms and axillae, normal urination, and constipation. Abdominal fullness with panting or delirium; a deep and slippery pulse confirms a Li Zheng (Interior Syndrome). (Moisture in palms and axillae, normal urine, and hard stool are all Interior Syndromes. Internal excess manifests as abdominal fullness and panting; a deep and slippery pulse indicates the disease is internal, termed Interior Syndrome.) When Yang is excessive and Yin is deficient, rapid purgation is required; one should not be constrained by trivial calculations of days. (Zhang Zhongjing stated: In Yang excess and Yin deficiency, sweating leads to death, while purgation leads to recovery. Yang excess causes external heat, Yin deficiency causes internal heat; with heat in both interior and exterior, purgation is necessary. Although purgation may be performed after two or three days, one need not wait until four or five days past the meridian cycle.) Failure to purge promptly leads to oppression in the chest and heart, restlessness, and the formation of Re Jue (Heat Jue/Extremity Cold). (Failure to purge allows extreme heat to generate cold, causing dizziness and Jue; after half a day, heat returns.) Ignorant physicians, suspecting a Yin syndrome, mistakenly administer hot medicines, leading to the severance of essence and soul. (Ignorant physicians see Jue and assume it is Yin; mistakenly taking hot medicines causes macules and jaundice, and loss of consciousness.) Generally, San Yin (Three Yin) syndromes can be treated with warming methods; only when Ji Zheng (Accumulation Syndrome) appears should purgation be used to vent. Taiyin presents with abdominal fullness or intermittent pain; Shaoyin presents with dry mouth and thirst below the heart. When all signs of accumulation are present, doubt is unnecessary; the key lies in calm and careful differentiation. (San Yin syndromes are generally treated with warming; only accumulation requires purgation. Zhang Zhongjing stated: In Taiyang disease, if the physician mistakenly uses purgation, resulting in abdominal fullness and intermittent pain, it belongs to Taiyin, treated with Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction plus Paeonia Root). For severe excess pain, Dahuang Tang (Rhubarb Decoction) is used. He also stated: In Shaoyin disease with dry mouth and throat, urgent purgation is needed, using Chengqi Tang (Chengqi Decoction). Such cases require purgation.) If the pathogen remains in the Exterior, purgation is contraindicated, especially if the pulse is floating and additionally deficient and fine. (Zhang Zhongjing stated: A floating pulse indicates the Exterior; a deficient and fine pulse contraindicates purgation.) Aversion to cold, vomiting, and clear urination. (Aversion to cold indicates the Exterior is unresolved. The *Jin Gui Yao Lue* states: Vomiting contraindicates purgation; clear urine indicates the disease is not in the Interior but in the Exterior.) Absence of flatus suggests difficulty in purging. (Absence of flatus indicates hard feces; later stools will likely be loose.) Hard stool with frequent urination. (Pi Yue Syndrome/Constrained Spleen Syndrome.) Yangming spontaneous sweating leads to scanty body fluids. (Mi Dui Syndrome/Honey Suppository Syndrome.) In such cases, purgation is difficult; do not act rashly to cause errors.