（三十七）伤寒下利。日十余行。脉反实者。死。
实。言邪胜也。
（三十八）下利有微热而渴。脉弱者。令自愈。
微热。阳渐回也。渴内燥未复也。弱。邪退也。令自愈。言不须治也。
（三十九）下利。脉数而渴者。令自愈。设不瘥。必清脓血。以有热故也。
清。与圊通。脉数。与上文微热互相发明。清。犹言便脓血也。
（四十）下利。脉数有微热。汗出。令自愈。设复紧。为未解。
此与上二条互相发明。汗出。亦阳回气彻也。紧。寒未除也。
（四十一）下利。脉沉而迟。其人面少赤。身有微热。下利清谷者。必郁冒汗出而解。病患
必微厥。所以然者。其面戴阳。下虚故也。
诸阳聚于面。少赤。亦阳回也。故曰戴阳。郁冒。作汗也。微厥。邪正争也。下虚指利而言也。
（四十二）下利。手足厥冷。无脉者。灸之不温。若脉不还。反微喘者。死。
喘。言息短而声不续。阳气衰绝也。
（四十三）下利后。脉绝。手足厥冷。 时脉还。手足温者。生。脉不还者。死。
。音碎。 时。周时也。此与上条互相发明。
（四十四）下利。寸脉反浮数。尺中自涩者。必清脓血。
清。与圊同。寸反浮数者。热转上逆也。尺中自涩者。热壅而血瘀也。
（四十五）下利。脉沉弦者。下重也。脉大者。为未止。脉微弱数者。为欲自止。虽发热。
不死。
下重。谓滞下也。大则病进。微弱者邪气衰也。
（四十六）热利下重者。白头翁汤主之。
白头翁汤方
白头翁（三两） 黄连（三两去须） 黄柏（三两去皮） 秦皮（三两）
上四味。以水七升。煮取二升。去滓。温服一升。不愈。更服一升。
此申上条而出其治。白头翁。逐血以疗癖。秦皮。洗肝而散热。黄连。调胃而浓肠。黄柏者。
除热而止泄也。
（四十七）下利。欲饮水者。以有热故也。白头翁汤主之。
有热。谓亡津液而内燥。所以欲饮水也。方同上。
（四十八）干呕吐涎沫头痛者。吴茱萸汤主之。
厥阴之脉。挟胃。属肝。上贯膈。布胁肋。循喉咙之后。上入颃颡。连目系。上出额。与督
脉会于巅。其支者。复从肝。别贯膈。上注肺。故灵枢曰。是肝所生病者。腹满呕逆。然则厥阴
之邪。循经而上逆。故其证见如此。方见阳明篇。
（四十九）呕而发热者。小柴胡汤主之。
小柴胡或为有呕。故通其治。
（五十）呕而脉弱。小便复利。身有微热。见厥者难治。四逆汤主之。
脉弱。虽似邪衰。而小便复利。则是里属虚寒也。故曰见厥者难治。以身有微热也。故虽厥。
可以四逆汤得救其阳之复。
（五十一）呕家有痈脓者。不可治呕。脓尽自愈。
肝脉。其支者上注肺。肝主血。善呕。血热瘀。与肺痿者。皆为痈而呕脓。不可治者。谓脓
当呕。与邪逆而呕者不同也。
（五十二）伤寒本自寒下。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。
干姜黄连黄芩人参汤方
干姜（三两去皮） 黄连（三两去须） 黄芩（三两） 人参（三两）
上四味。以水六升。煮取二升。去滓。分温再服。
寒格。谓药寒致成格拒也。干姜人参。正治以遏其吐。黄连黄芩。反佐以通其格。
（五十三）伤寒大吐大下之。极虚。复极汗出者。以其人外气怫郁。复与之水。以发其汗。
因得哕。所以然者。胃中寒冷故也。
上条以药吐下言。此以水发汗言。亦互明之意。
（五十四）伤寒哕而腹满。视其前后。知何部不利。利之则愈。
哕。承上条而言。腹满。即寒生 胀也。前后。谓二便也。三条疑太阳中篇错简。
（三十七）伤寒病出现下利，一天排便十多次，脉象反而实大有力的，属于死证。
所谓“实”，是指邪气亢盛。
（三十八）下利伴有轻微发热且口渴，脉象弱的，将会自愈。
轻微发热，说明阳气逐渐恢复；口渴是因为体内津液未复、内燥尚存；脉弱，说明邪气已退。所谓“自愈”，是指不需要治疗即可痊愈。
（三十九）下利，脉象数且口渴的，将会自愈。如果病不愈，必然会出现便脓血的情况，这是因为有热邪的缘故。
“清”通“圊”，指如厕。脉数与上一条中的“微热”互相印证。“清”，这里指大便排出脓血。
（四十）下利，脉象数且有轻微发热、汗出的，将会自愈。如果脉象再次变得紧，说明病邪未解。
这一条与上面两条互相印证。汗出，也是阳气回复、气机通达的表现。脉紧，说明寒邪尚未去除。
（四十一）下利，脉象沉而迟，病人面部稍微发红，身体有轻微发热，下利排出未消化的食物（完谷不化）的，必然会出现郁冒（头晕目眩如蒙），随后汗出而病解。病人必然会有轻微的四肢厥冷。之所以这样，是因为病人面部泛红是“戴阳”证，由于下焦虚寒所致。
诸阳经汇聚于面部，面部微红，也是阳气回复的表现，所以称为“戴阳”。郁冒，是即将作汗的前兆。微厥，是正气与邪气相争的表现。“下虚”指的是下利导致的下部虚损。
（四十二）下利，手足冰冷，摸不到脉搏的，施灸后手脚仍不温暖，如果脉搏不恢复，反而出现轻微喘息的，属于死证。
“喘”，指呼吸短促且声音断续，这是阳气衰败绝灭的表现。
（四十三）下利之后，脉搏消失，手足冰冷，如果偶尔脉搏恢复，手足变温暖的，预后良好（生）；如果脉搏不恢复的，属于死证。
“碎”音同“猝”，意为突然、短暂。“时”，指周期性地、偶尔。这一条与上一条互相印证。
（四十四）下利，寸脉反而浮数，尺脉自涩的，必然会出现便脓血。
“清”通“圊”。寸脉反见浮数，说明热邪转而上逆；尺脉自涩，说明热邪壅滞导致血行瘀阻。
（四十五）下利，脉象沉弦的，会有肛门坠胀感（里急后重）；脉象大的，说明病势未止；脉象微弱而数的，说明病势将要自行停止，即使伴有发热，也不会死亡。
“下重”，即指痢疾样的滞下感。脉大表示病进，脉微弱表示邪气衰退。
（四十六）热性下利且伴有肛门坠胀感的，用白头翁汤主治。
白头翁汤方
白头翁（三两） 黄连（三两，去须） 黄柏（三两，去皮） 秦皮（三两）
以上四味药，用水七升，煮取二升，去渣，温服一升。若未愈，再服一升。
此条补充上一条的治疗方法并给出方剂。白头翁，能逐瘀血以治疗积聚；秦皮，能洗肝散热；黄连，能调胃厚肠；黄柏，能除热止泻。
（四十七）下利，想要喝水的，是因为有热邪的缘故。用白头翁汤主治。
“有热”，指津液耗伤而内部干燥，所以想要喝水。方剂同上。
（四十八）干呕、吐出涎沫且头痛的，用吴茱萸汤主治。
厥阴肝经的经脉，夹胃，属肝，向上穿过膈肌，分布于胁肋，沿喉咙后面，向上进入鼻咽部（颃颡），连系目系，向上出于额部，与督脉会合于头顶。其支脉，又从肝分出，穿过膈肌，向上注入肺中。所以《灵枢》说：肝脏所生的疾病，包括腹满、呕吐逆气。既然这样，厥阴之邪循经上逆，所以出现上述症状。方剂见阳明病篇。
（四十九）呕吐且发热的，用小柴胡汤主治。
小柴胡汤证有时表现为有呕吐，因此通用此法治疗。
（五十）呕吐且脉象弱，小便通畅，身体有轻微发热，出现四肢厥冷的，难治。用四逆汤主治。
脉弱，虽然看似邪气衰退，但小便通畅（利），说明里属虚寒。所以说出现四肢厥冷的难治。因为身体有轻微发热，所以虽然四肢厥冷，可以用四逆汤来挽救回复阳气。
（五十一）患有痈脓而呕吐的病人，不可治疗呕吐，待脓排尽后自然痊愈。
肝脉的支脉向上注入肺。肝主血，容易呕吐，若是血热瘀滞，与肺痿患者一样，都会因痈肿而呕吐脓血。所谓“不可治”，是指这种呕吐是脓液当吐而出，与邪气上逆引起的呕吐不同。
（五十二）伤寒本来就有寒性下利，医生又误用吐法或下法，导致寒邪格拒，进一步引起呕吐和下利，如果食物刚入口就立即吐出，用干姜黄连黄芩人参汤主治。
干姜黄连黄芩人参汤方
干姜（三两，去皮） 黄连（三两，去须） 黄芩（三两） 人参（三两）
以上四味药，用水六升，煮取二升，去渣，分两次温服。
“寒格”，指药性寒凉导致形成格拒（排斥）。干姜、人参，正治以遏制呕吐；黄连、黄芩，反佐以疏通格拒。
（五十三）伤寒经过剧烈的吐下治疗后，极度虚弱，又出现极度出汗的情况，因为病人体表气机郁闭，医生又给他喝水来发汗，因而导致呃逆（哕）。之所以这样，是因为胃中寒冷所致。
上一条是用药物吐下来说明，这一条是用饮水发汗来说明，也是互相阐明的意思。
（五十四）伤寒呃逆且腹部胀满，观察前后二阴，知道哪一部分不通利，通利它就能痊愈。
“哕”，承接上一条而言。“腹满”，即寒气产生的胀满。“前后”，指大小便。这三条疑似太阳病篇的错简。
(37) In a Shanghan (Cold Damage) condition presenting with diarrhea, if the patient defecates more than ten times a day and the pulse is unexpectedly excess-strong (Shi), it indicates a fatal prognosis.
"Excess-strong" refers to the predominance of pathogenic factors.
(38) In diarrhea accompanied by slight fever and thirst, if the pulse is weak, the disease will resolve spontaneously.
Slight fever indicates the gradual return of Yang Qi; thirst indicates that internal dryness has not yet recovered due to fluid deficiency; a weak pulse indicates the retreat of pathogens. "Spontaneous resolution" means no treatment is required for recovery.
(39) In diarrhea, if the pulse is rapid and there is thirst, the disease will resolve spontaneously. If it does not improve, pus and blood will inevitably appear in the stool, due to the presence of Heat.
"Qing" is interchangeable with "Qing" (to visit the latrine). The rapid pulse corroborates the "slight fever" mentioned in the previous clause. Here, "Qing" refers to the passage of pus and blood in the stool.
(40) In diarrhea, if the pulse is rapid, there is slight fever, and sweating occurs, the disease will resolve spontaneously. If the pulse becomes tight again, the pathogen has not been resolved.
This clause corroborates the preceding two. Sweating also indicates the return of Yang Qi and the thorough circulation of Qi. A tight pulse indicates that Cold has not yet been eliminated.
(41) In diarrhea, if the pulse is deep and slow, the patient's face shows slight redness, the body has slight fever, and the stool contains undigested food (Wan Gu Bu Hua), the patient will inevitably experience Yu Mao (dizziness and confusion as if covered), followed by sweating and resolution. The patient will likely have slight cold limbs (Jue). This is because the facial redness is Dai Yang (Floating Yang), caused by deficiency and Cold in the lower Jiao.
All Yang meridians converge on the face; slight redness here also indicates the return of Yang, hence termed "Dai Yang". Yu Mao is a precursor to sweating. Slight Jue represents the struggle between Healthy Qi and Pathogens. "Lower deficiency" refers to the deficiency resulting from diarrhea.
(42) In diarrhea, if the hands and feet are cold and the pulse is absent, and after moxibustion the limbs remain cold and the pulse does not return, but instead slight panting occurs, it indicates a fatal prognosis.
"Panting" refers to shortness of breath with discontinuous sounds, indicating the exhaustion and extinction of Yang Qi.
(43) After diarrhea, if the pulse vanishes and the hands and feet are cold, but the pulse occasionally returns and the hands and feet become warm, the prognosis is good (Life); if the pulse does not return, it indicates death.
"Sui" sounds like "Cu", meaning sudden or intermittent. "Shi" means periodically or occasionally. This clause corroborates the previous one.
(44) In diarrhea, if the Cun (inch) pulse is unexpectedly floating and rapid, while the Chi (cubit) pulse is naturally choppy (Se), pus and blood will inevitably appear in the stool.
"Qing" is interchangeable with "Qing". An unexpectedly floating and rapid Cun pulse indicates that Heat is turning upward and reversing; a naturally choppy Chi pulse indicates that Heat stagnation leads to Blood stasis.
(45) In diarrhea, if the pulse is deep and wiry (Xian), there is a sensation of heaviness and urgency in the lower rectum (Li Ji Hou Zhong); if the pulse is large, the disease has not stopped; if the pulse is weak, minute, and rapid, the disease is about to stop spontaneously. Even if there is fever, it will not be fatal.
"Heaviness in the lower part" refers to the feeling of tenesmus seen in dysentery. A large pulse indicates disease progression; a weak and minute pulse indicates the decline of pathogenic factors.
(46) For heat-type diarrhea accompanied by tenesmus, Bai Tou Weng Tang (Pulsatilla Decoction) is the primary treatment.
Bai Tou Weng Tang Formula
Bai Tou Weng (Pulsatillae Radix) (3 liang) Huang Lian (Coptidis Rhizoma) (3 liang, remove musts) Huang Bo (Phellodendri Cortex) (3 liang, remove bark) Qin Pi (Fraxini Cortex) (3 liang)
The above four ingredients are boiled in seven sheng of water until two sheng remain. Strain the dregs. Take one sheng warm. If not cured, take another sheng.
This clause elaborates on the treatment for the previous condition. Bai Tou Weng expels blood stasis to treat accumulations; Qin Pi clears the Liver and dissipates Heat; Huang Lian regulates the Stomach and thickens the intestines; Huang Bo eliminates Heat and stops diarrhea.
(47) In diarrhea, if the patient desires to drink water, it is due to Heat. Bai Tou Weng Tang (Pulsatilla Decoction) is the primary treatment.
"Having Heat" refers to the depletion of Jin Ye (Body Fluids) causing internal dryness, hence the desire to drink. The formula is the same as above.
(48) For dry heaving, vomiting of saliva/froth, and headache, Wu Zhu Yu Tang (Evodia Decoction) is the primary treatment.
The Jueyin Liver meridian clamps the Stomach, belongs to the Liver, passes through the diaphragm, distributes along the costal region, follows the posterior aspect of the throat, enters the nasopharynx (Hang Sang), connects to the eye system, emerges above the forehead, and meets the Du Meridian at the vertex. Its branch diverges from the Liver, pierces the diaphragm, and ascends to inject into the Lung. Thus, the Ling Shu states: Diseases generated by the Liver include abdominal fullness and vomiting/reversal of Qi. Therefore, when Jueyin pathogens reverse upward along the meridian, these symptoms manifest. The formula is found in the Yangming chapter.
(49) For vomiting accompanied by fever, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment.
Since Xiao Chai Hu Tang syndrome sometimes presents with vomiting, this formula is generally applicable for its treatment.
(50) For vomiting with a weak pulse, free urination, slight fever in the body, and the appearance of cold limbs (Jue), the condition is difficult to treat. Si Ni Tang (Frigid Extremities Decoction) is the primary treatment.
Although a weak pulse may seem to indicate declining pathogens, free urination indicates interior deficiency-Cold. Hence, the appearance of Jue makes it difficult to treat. However, due to the slight fever, Si Ni Tang can be used to rescue and restore Yang Qi despite the Jue.
(51) For patients vomiting due to abscesses and pus, do not treat the vomiting directly; once the pus is exhausted, it will heal spontaneously.
The branch of the Liver meridian ascends to inject into the Lung. The Liver governs Blood. Frequent vomiting may result from Blood Heat and stasis. Similar to patients with Fei Wei (Lung Atrophy), they may vomit pus due to abscesses. "Do not treat" means this vomiting is the expulsion of pus, which differs from vomiting caused by the reversal of pathogens.
(52) In Shanghan, if the patient originally had Cold-type diarrhea, and the physician erroneously applied emesis or purgation, leading to Cold rejection (Ge Ju) and further exacerbating vomiting and diarrhea, such that food is vomited immediately upon ingestion, Gan Jiang Huang Lian Huang Qin Ren Shen Tang (Ginger, Coptis, Scutellaria, and Ginseng Decoction) is the primary treatment.
Gan Jiang Huang Lian Huang Qin Ren Shen Tang Formula
Gan Jiang (Zingiberis Rhizoma) (3 liang, remove skin) Huang Lian (Coptidis Rhizoma) (3 liang, remove musts) Huang Qin (Scutellariae Radix) (3 liang) Ren Shen (Ginseng Radix) (3 liang)
The above four ingredients are boiled in six sheng of water until two sheng remain. Strain the dregs. Divide into two doses and take warm.
"Cold Ge" refers to rejection caused by the cold nature of the medicine/pathogen. Gan Jiang and Ren Shen act orthodoxy to suppress vomiting; Huang Lian and Huang Qin act as counter-agents (Fan Zuo) to overcome the rejection.
(53) In Shanghan, after severe emesis and purgation, the patient is extremely deficient. If extreme sweating then occurs, and because the exterior Qi was already constrained (Fu Yu), the physician gave water to induce sweating, resulting in hiccup (Yue). This is due to Cold in the Stomach.
The previous clause discussed drug-induced emesis/purgation; this clause discusses water-induced sweating. They mutually illuminate each other.
(54) In Shanghan, if there is hiccup (Yue) and abdominal fullness, observe the anterior and posterior orifices to determine which part is obstructed; unblocking it will lead to cure.
"Yue" continues from the previous clause. "Abdominal fullness" refers to distension caused by Cold. "Anterior and posterior" refer to urination and defecation. These three clauses are suspected to be misplaced text (Cuo Jian) from the Taiyang chapter.