不解。以大势言。不独谓表也。表里俱热。言风寒俱有也。时时恶风。言表未除也。以舌干燥
烦而表里之热俱甚。故用白虎。以大渴欲饮水。故加人参。方见前。
（三十四）伤寒五六日。头汗出。微恶寒。手足冷。心下满。口不欲食。大便硬。脉细者。
此为阳微结。必有表复有里也。脉沉。亦在里也。汗出为阳微。假令纯阴结。不得复有外证。悉入
在里。此为半在里。半在外也。脉虽沉紧。不得为少阴病。所以然者。阴不得有汗。今头汗出。
故知非少阴也。可与小柴胡汤。设不了了者。得屎而解。
表以头汗出。微恶寒。手足冷言。里以心下满。口不欲食。大便硬言。阳微结。谓由阳气衰
微故结。不可全责病于阴也。脉沉亦在里。言不但细为在里。以见表里证俱有也。汗出为阳微。至
此为半在里半在外也。一节。是申释上文。脉虽沉紧。
至故知非少阴也。一节。言此但以头汗可辨为有阳。不然余皆似少阴。晓人当致精细。大意类第
二条。第二条以中伤之初。故脉如彼。而用大青龙以发汗。此以五六日证属半表半里。而脉如此。
故从小柴胡以和解之也。末言和之若犹不愈。则当消息胃实而用治。故曰得屎而解。
（三十五）伤寒胸中有热。胃中有邪气。腹中痛欲呕吐者。黄连汤主之。
黄连汤方
黄连（三两） 甘草（三两炙） 干姜（三两） 人参（二两） 桂枝（三两去皮） 半夏
（半升洗） 大枣（十二枚擘）
上七味。以水一斗。煮取六升。去滓。温服一升。日三服。夜二服。
胸。上焦也。热以风言。阳也。言阳热抟于上焦也。胃。中焦也。邪气以寒言。阴也。言阴
寒郁于中焦也。腹中痛。阴凝而窒滞也。欲呕吐。热壅而上逆也。夫热抟上焦。黄连清之。非桂
枝不解也。寒郁中焦。人参理之。非干姜不散也。甘草大枣。益胃而和中。半夏辛温。宽胸而止
呕吐也。
（三十六）伤寒有热。少腹满。应小便不利。今反利者。为有血也。当下之。不可余药。宜抵当丸。
抵当丸方
水蛭（二十个熬） 虻虫（二十五个熬去翅） 桃仁（二十个去皮尖） 大黄（三两）
上四味。杵。分为四丸。以水一升。煮一丸。取七合。服。 时当下血。若不下。更服。
应。平声。 。音醉。此与上编第二十一以下三条同。以风寒俱有。而比上编为难解。故用上编
之方而变汤为丸。然名虽丸也。犹煮汤焉。夫汤。荡也。丸缓也。变汤为丸而犹不离乎汤。其取
欲缓不缓。不荡而荡之意欤。且曰不可余药。言即使如上编之用汤犹未为对。必如是而后可。亦
奇制也。其犹兵家之八阵欤。八阵武侯兵也。变则反正为奇。以奇为正。谓医与将同道者。尚在
同一权变哉。 时。周时也。
（三十七）得病六七日脉迟浮弱。恶风寒。手足温。医二三下之。不能食而胁下满痛。面目及
身黄。颈项强。小便难者。与柴胡汤。后必下重。本渴而饮水呕者。柴胡汤不中与也。食谷者哕。
六七日经尽之时也。脉迟浮弱。风寒入里而表未除。所以犹恶风寒也。手足温。半入于里而未可
下也。不能食。误下而里伤也。胁下满痛。邪抟少阳也。面目及身黄。土受木贼而色外薄也。颈
项强。太阳阳明之证犹在也。小便难。亡津液也。后以大便言。下重者。柴胡寒。里阴已虚而气
滞也。本渴而饮水呕者。水逆也。柴胡不中与者。以呕由水逆。非少阳或为之证也。食谷者哕。
言过饱则亦当哕噫。申明上文。呕。非柴胡所宜之意。末后疑有脱落。
（三十八）伤寒十三日不解。过经谵语者。以有热也。当以汤下之。若小便利者。大盒饭
硬。而反下利脉调和者。知医以丸药下之。非其治也。若自下利者。脉当微厥。今反和者。此为
内实也。调胃承气汤主之。
热。风也。言俗谓伤寒过经不解者。以庸下不省并中有风。误于治之所致也。若自下利至末。
乃推明其所以为误。而出其救误之治。反和以不厥言。非宜谓平和。方见前。
不理解。从整体大势来看，不仅仅指表证。表里俱热，说明风寒邪气都存在。时时感到恶风，说明表证未除。因为舌体干燥，烦渴且表里之热都很严重，所以使用白虎汤（清热剂）。因为极度口渴想喝水，所以加入人参。方剂见前文。
（三十四）伤寒病经过五六天，出现头部出汗，轻微怕冷，手脚发凉，心下痞满，嘴里不想吃东西，大便干硬，脉象细的，这叫做阳微结（阳气郁结较轻）。一定既有表证又有里证。脉沉，也属于里证范畴。出汗是因为阳气微弱（郁结）。假如是纯阴结，就不会再有外证，症状全部入里。这属于一半在里，一半在表。脉虽然沉紧，但不能诊断为少阴病。之所以这样，是因为阴证不应该有汗，现在头部出汗，所以知道不是少阴病。可以给予小柴胡汤（和解少阳方）。如果服药后仍然感觉不舒服，通过排便就能痊愈。
这里用头部出汗、轻微怕冷、手脚发凉来描述表证；用心下痞满、嘴里不想吃东西、大便干硬来描述里证。阳微结，是指由于阳气衰微微弱导致的气机结滞，不能全怪罪于阴邪。脉沉也属于里证，意思是不仅脉细表示在里，而且表明表里证候同时存在。出汗代表阳气微弱，到这里说是半在里半在表。这一段是申述解释上文。从“脉虽沉紧”到“故知非少阴也”这一段，是说这里仅凭头部出汗就可以辨别出有阳证，否则其余症状都像少阴病，告诫人们应当诊断精细。大意类似于第二条。第二条是因为刚受邪初期，所以脉象那样，而用大青龙汤（发汗峻剂）来发汗。这一条是因为过了五六天，证候属于半表半里，而脉象如此，所以用小柴胡汤来和解。最后说如果和解之后仍然不愈，就应当审察是否有胃实（燥屎内结）而进行治疗，所以说通过排便就能痊愈。
（三十五）伤寒病胸中有热，胃中有邪气，腹部疼痛想要呕吐的，主治黄连汤（清上温下方）。
黄连汤方
黄连（三两） 甘草（三两，炙） 干姜（三两） 人参（二两） 桂枝（三两，去皮） 半夏（半升，洗） 大枣（十二枚，掰开）
以上七味药，用水一斗，煮取六升，去渣滓。每次温服一升，每天三次，晚上两次。
胸，属于上焦。热，由风邪引起，属阳。意思是阳热搏结于上焦。胃，属于中焦。邪气，由寒邪引起，属阴。意思是阴寒郁结于中焦。腹中痛，是阴寒凝滞导致气血阻滞。想要呕吐，是热邪壅盛而上逆。既然热邪搏结于上焦，用黄连来清解它，但不用桂枝就不能解散表邪。寒邪郁结于中焦，用人参来调理，但不用干姜就不能散寒。甘草和大枣，能补益脾胃并调和其中。半夏辛温，能宽胸膈并止呕吐。
（三十六）伤寒病身体发热，小腹胀满，应该小便不利，现在反而小便通利的，是有瘀血。应当攻下，不要服用其他药物，适宜用抵当丸（破血逐瘀剂）。
抵当丸方
水蛭（二十个，熬制） 虻虫（二十五个，熬制，去翅） 桃仁（二十个，去皮尖） 大黄（三两）
以上四味药，捣碎，分成四丸。用水一升，煮一丸，取七合药液服用。此时应当排出瘀血。如果没有排出，再服用。
应，读平声。 ，音醉。这与上编第二十一以下三条相同，因为风寒邪气都存在，而且比上编更难理解，所以用上编的方剂但将汤剂改为丸剂。然而名义上是丸剂，实际上还是像煮汤一样煎服。汤剂，作用是荡涤；丸剂，作用缓和。将汤剂改为丸剂但仍然不离乎汤剂的煎煮方式，这是取其欲缓而不缓、不荡涤而具有荡涤作用的意思吧。并且说“不可余药”，意思是即使像上编那样使用汤剂还不够对症，必须像这样做才可以。这也是奇特的制剂方法。这就像兵家的八阵图吗？八阵图是诸葛亮的兵法。变正为奇，以奇为正，说的是医道与将道是相通的，都在于权变。时，指周时（一周的时间）。
（三十七）得病六七天，脉象迟而浮弱，怕冷怕风，手脚温暖，医生多次误用泻下法，导致不能进食，胁下胀满疼痛，面目及全身发黄，颈项强直，小便困难的，如果给予柴胡汤，后来必然会出现肛门重坠感。本来口渴却饮水即吐的，柴胡汤不适合使用。进食后打嗝的，也不适合。
六七天是经气运行完毕的时候。脉迟浮弱，说明风寒入里而表证未除，所以仍然怕冷怕风。手脚温暖，说明病邪半入于里，但还不可以用泻下法。不能进食，是因为误用泻下法损伤了里气。胁下胀满疼痛，是邪气搏结于少阳经。面目及全身发黄，是脾土受肝木克制而颜色外现于皮肤。颈项强直，太阳和阳明的证候仍然存在。小便困难，是因为津液亡失。后面关于大便的描述，下重（肛门重坠），是因为柴胡汤性寒，里阴已虚而气机阻滞。本来口渴却饮水即吐，这是水逆证。不适合用柴胡汤的原因，是因为呕吐是由水逆引起的，而不是少阳病导致的证候。进食后打嗝，是说吃得太饱也会打嗝噫气，以此申明上文，呕吐并不是柴胡汤所适宜的适应症。最后部分怀疑有文字脱落。
（三十八）伤寒病十三天没有痊愈，过了传经周期出现谵语（神志不清，胡言乱语）的，是因为有热。应当用汤剂攻下。如果小便通利的，大便应当干硬，反而出现腹泻，脉象调和的，知道是医生用了丸药攻下，这不是正确的治疗方法。如果是自然腹泻，脉象应当微厥（微弱或四肢厥冷），现在反而平和，这是因为内有实邪。主治调胃承气汤（缓下热结剂）。
热，指风邪。意思是世俗认为伤寒过了传经周期没有痊愈，是因为庸医不懂兼夹风邪，误治所致。从“若自下利”到最后，是推究说明其误治的原因，并提出纠正误治的方法。“反和”是以脉不厥逆来说明，并非指脉象平和。方剂见前文。
Not understood. Speaking from the general trend, it does not refer only to the exterior syndrome. Heat in both the interior and exterior indicates that both wind-cold pathogens are present. Occasional aversion to wind indicates that the exterior pathogen has not been eliminated. Due to dryness of the tongue, vexation, and severe heat in both the interior and exterior, Baihu Tang (White Tiger Decoction) is used. Because of extreme thirst with a desire to drink water, Ginseng Radix et Rhizoma (Renshen, 人参) is added. The formula is seen in the preceding text.
(34) After five or six days of Shanghan (Cold Damage), symptoms include sweating on the head, slight aversion to cold, cold hands and feet, fullness and oppression in the epigastrium, lack of desire to eat, hard stools, and a fine pulse. This is called Yang Wei Jie (mild yang constraint). There must be both an exterior and an interior component. A deep pulse also belongs to the interior category. Sweating occurs due to mild yang deficiency (constraint). If it were pure Yin Jie (Yin constraint), there would be no exterior signs remaining; all symptoms would have entered the interior. This condition is half in the interior and half in the exterior. Although the pulse may be deep and tight, it cannot be diagnosed as Shaoyin disease (Disease of the Lesser Yang). The reason is that Yin syndromes should not present with sweating; since there is sweating on the head, we know it is not Shaoyin disease. Xiao Chai Hu Tang (Minor Bupleurum Decoction) may be administered. If the patient still feels unwell after taking the medicine, relief will come with defecation.
The sweating on the head, slight aversion to cold, and cold hands and feet describe the exterior aspect. The epigastric fullness, lack of desire to eat, and hard stools describe the interior aspect. Yang Wei Jie refers to qi stagnation caused by the decline and mildness of yang qi; one cannot blame the pathology entirely on yin. A deep pulse also indicates the interior, meaning that not only a fine pulse signifies the interior, but also that exterior and interior signs coexist. Sweating indicates mild yang; here it is described as half in the interior and half in the exterior. This section elaborates on the previous text. From "Although the pulse is deep and tight" to "thus we know it is not Shaoyin," this part explains that the presence of yang can be distinguished solely by sweating on the head; otherwise, the remaining symptoms resemble Shaoyin disease. This warns practitioners to be meticulous. The main idea is similar to Article 2. In Article 2, because the injury occurred at the beginning, the pulse was such, and Da Qing Long Tang (Major Green Dragon Decoction) was used to induce sweating. In this case, because five or six days have passed and the syndrome belongs to half-exterior/half-interior, and the pulse is as described, Xiao Chai Hu Tang is used for harmonization. Finally, if harmonization does not cure the condition, one should consider gastric excess (dry fecal impaction) and treat accordingly; hence, it says relief comes with defecation.
(35) In Shanghan, with heat in the chest and pathogenic factors in the stomach, accompanied by abdominal pain and a desire to vomit, Huang Lian Tang (Coptis Decoction) is the primary treatment.
Huang Lian Tang Formula
Coptidis Rhizoma (Huanglian, 黄连) - 3 liang
Glycyrrhizae Radix et Rhizoma Praeparata cum Melle (Zhigancao, 甘草) - 3 liang, honey-fried
Zingiberis Rhizoma (Ganjiang, 干姜) - 3 liang
Panacis Ginseng Radix (Renshen, 人参) - 2 liang
Cinnamomi Ramulus (Guizhi, 桂枝) - 3 liang, bark removed
Pinelliae Rhizoma Preparatum (Banxia, 半夏) - half sheng, washed
Jujubae Fructus (Dazao, 大枣) - 12 pieces, split open
Take these seven ingredients, add ten dou of water, decoct to obtain six sheng. Remove the dregs. Take one sheng warm, three times a day, and twice at night.
The chest belongs to the Upper Jiao (Upper Burner). Heat, attributed to wind, is yang. This means yang-heat is congested in the Upper Jiao. The stomach belongs to the Middle Jiao. Pathogenic factors, attributed to cold, are yin. This means yin-cold is depressed in the Middle Jiao. Abdominal pain results from yin-cold condensation causing obstruction. The desire to vomit results from heat congestion reversing upward. Since heat congests the Upper Jiao, Coptis clears it; however, without Cinnamon Twig, the exterior cannot be resolved. Since cold depresses the Middle Jiao, Ginseng regulates it; however, without Dried Ginger, the cold cannot be dispersed. Licorice and Jujube tonify the stomach and harmonize the middle. Pinellia is acrid and warm, widening the chest and stopping vomiting.
(36) In Shanghan with fever and fullness in the lower abdomen, urination should be difficult. Now that urination is actually free, this indicates blood stasis. It should be purged; do not use other medicines. Di Dang Wan (Di Dang Pill) is appropriate.
Di Dang Wan Formula
Leech (Shuizhi, 水蛭) - 20 specimens, processed
Male Blowfly (Menchong, 虻虫) - 25 specimens, processed, wings removed
Peach Kernel (Taoren, 桃仁) - 20 specimens, skin and tips removed
Rhei Radix et Rhizoma (Dahuang, 大黄) - 3 liang
Grind these four ingredients into powder and divide into four pills. Boil one pill in one sheng of water until reduced to seven ge. Take the liquid. Blood should pass at this time. If it does not pass, take another dose.
"Should" is pronounced with the level tone. This corresponds to the last three articles of the second section above. Because both wind and cold pathogens are present, it is more difficult to understand than the earlier sections. Therefore, the formula from the upper section is used, but changed from decoction to pill. However, although named a pill, it is still boiled like a decoction. Decoctions act vigorously; pills act mildly. Changing from decoction to pill while still boiling it implies an intention to be mild yet vigorous, not vigorously purging yet possessing purging power. Furthermore, "do not use other medicines" means that even using the decoction form as in the upper section might not be perfectly targeted; one must proceed this way. This is also a unique preparation method. Is it like the Eight Formations of military strategy? The Eight Formations belong to Zhuge Liang's military tactics. Transforming orthodoxy into surprise, and using surprise as orthodoxy, suggests that medicine and warfare share the same principle of adaptability. "Shi" refers to a cycle of time.
(37) Six or seven days after contracting the disease, with a slow, floating, and weak pulse, aversion to wind and cold, and warm hands and feet, if the physician repeatedly uses purgatives, leading to inability to eat, fullness and pain in the hypochondrium, yellowing of the face, eyes, and body, stiff neck, and difficulty urinating: administering Chai Hu Tang (Bupleurum Decoction) will likely result in a sensation of heaviness in the rectum later. If the patient was originally thirsty but vomits upon drinking water, Chai Hu Tang is contraindicated. If belching occurs after eating food, [Chai Hu Tang is also unsuitable].
Six or seven days mark the completion of the meridian cycle. A slow, floating, and weak pulse indicates wind-cold entering the interior while the exterior remains unresolved, hence the continued aversion to wind and cold. Warm hands and feet indicate the pathogen has partially entered the interior, but purgatives are not yet indicated. Inability to eat results from internal injury due to erroneous purgation. Fullness and pain in the hypochondrium indicate pathogenic factors congesting the Shaoyang (Lesser Yang) channel. Yellowing of the face, eyes, and body indicates spleen earth being attacked by liver wood, causing color to manifest externally. Stiff neck indicates Taiyang (Greater Yang) and Yangming (Yang Brightness) syndromes persist. Difficulty urinating indicates loss of body fluids. Regarding the bowels mentioned later, rectal heaviness occurs because Chai Hu Tang is cold-natured; the interior yin is already deficient, leading to qi stagnation. Original thirst with vomiting upon drinking water constitutes Water Reversal (Shui Ni). Chai Hu Tang is contraindicated because the vomiting is due to water reversal, not a Shaoyang syndrome. Belching after eating indicates that overeating would also cause belching, clarifying the previous text that vomiting is not suitable for Chai Hu Tang. The final part suspects textual omission.
(38) After thirteen days of Shanghan without resolution, if delirium occurs after passing through the meridian stages, it is due to heat. One should use a decoction to purge. If urine is clear and copious, the stool should be hard; yet diarrhea occurs, and the pulse is harmonious. We know the physician used a pill-based purgative, which was incorrect treatment. If there were natural diarrhea, the pulse should be faint or extremities cold; now that the pulse is harmonious, this indicates internal excess. Tiao Wei Cheng Qi Tang (Regulate the Stomach and Order the Qi Decoction) is the primary treatment.
Heat refers to wind. This means laypeople believe that Shanghan failing to resolve after passing through the meridian stages is caused by incompetent physicians failing to recognize concurrent wind and making treatment errors. From "If there is natural diarrhea" to the end, the text deduces the cause of the error and proposes a remedy for the mistake. "Fan he" (pulse becomes harmonious) is explained by the absence of cold extremities, not implying a normal pulse. The formula is seen in the preceding text.