凡二十条方三
此皆旧本错杂乱出。今分类为篇。
（一）太阳病。发热而渴。不恶寒者。为温病。
发热。温亦阳。故热亦即发也。渴。热伤血也。不恶寒。无阴寒之雠也。温。春令之气也。
气之于时。或则未应至而至。或则应至未至而不齐。故冬夏虽有温。要必以春为正。是故必也证
候显见有如此者。始可以言是触犯于温而病也。此揭温病之名实。而不出其治者。论温以辨明伤
寒。故不之及也。说者以为有论无治而不自满。吁。乌足与论经之大旨哉。
若发汗已。身灼热者。名曰风温。风温为病。脉阴阳俱浮。自汗出。身重。多眠睡。鼻息必
鼾。语言难出。若被下者。小便不利。直视失溲。若被火者。微。发黄色。剧。则如惊痫。时螈
。若火熏之。一逆尚引日。再逆促命期。
鼾音旱。溲。音小。痫。音闲。螈。音炽。 。音踪。灼热谓热转加甚也。风温。谓触犯于
温而有风也。阴阳俱浮。太阳本浮而风温皆阳。故上下皆见浮也。自汗出。亦卫受伤也。身重多
眠睡。鼻息必鼾。语言难出者。风拥则气昏。热甚则气郁也。小便不利者。太阳主膀胱而风温皆
阳。下则反攻阴。徒亡其津液。而膀胱之气伤也。直视者。太阳之筋。支者为目上纲。故不转睛
而上窜也。失溲。言小便甚失其常度也。火。灸熨。之类也。微。言攻之微。则变亦微。发黄者。
火热则土燥。故其色外夺也。剧。言攻之剧。则变亦剧。如惊痫时螈 者。火甚热极而生风也。
熏。亦火劫也。一逆。言乍误也。尚引日。言犹可以俄延。再逆。言复误也。促命期。言夭枉人
之天年。其致警之意深矣。
（二）形作伤寒。其脉不弦紧而弱。弱者。必渴。被火者。必谵语。弱者发热。脉浮。解之。
当汗出。愈。
形作伤寒。犹曰似伤寒。指上条而申言之也。不弦紧。谓非伤寒也。弱即风性柔缓之谓。谵语
者。火甚则土燥也。弱者发热。盖引素问诸弱发热。以明上文之必渴也。解之。言脉既属浮则当
以法解之。诀人用治之大意也。
（三）脉浮热甚。反灸之。此为实。实以虚治。因火而动。必咽燥。唾血。
此又承上条而申致戒警之意。实。谓脉浮热甚。为邪气胜则实。咽燥者。肾为膀胱之合。其
脉之直者。入肺中。循喉咙舌本也。唾血者。火性炎上。血因之而妄逆也。以上皆言温。
（四）病如桂枝证。头不痛。项不强。寸脉微浮。胸中痞硬。气上冲咽喉。不得息者。此为
胸有寒也。当吐之。宜瓜蒂散。
瓜蒂散方
瓜蒂（一分熬黄） 赤小豆（一分）
上二味。各别捣筛为散。已。合治之。取一钱匕。以香豉一合。热汤七合。煮作稀糜。去滓。
取汁。和散。温。顿服之。
不吐者。少少加。得快吐。乃止。诸亡血虚家。不可与爪蒂散。
如桂枝证。言大约似中风也。头不痛。项不强。言太阳经中无外入之风邪。以明非中风也。
寸候身半以上。微浮。邪自内出也。胸中痞硬痰涎塞膈也。气上冲咽喉者。痰涌上逆。或谓喉中
声如曳锯是也。寒以痰言。痰。内证也。内者为虚。故曰寒也。是病也想当先仲景命名时。命名
者。盖不过按素问阳之气以天地之疾风名之。而亦呼为中风。岂意后世足以
夺本经之中风相乱而相误哉。经革其名。而以病如桂枝证揭之。诚万世辨明中风似是而非之至教也。
易吐实风寒之栀子豉而以瓜蒂散者。瓜蒂苦寒。能吐顽痰而快膈。小豆酸平。善涌风涎而逐水。
香豉能起信而潮汐。故佐二物而主治。稀糜。则又承载三物者之舟航。此所以为吐虚风虚寒之对
药也。然而又曰虚家不可与何也。是又一说也。此风此寒。虽人身之虚象。而痰涎顾非胸中之实
物邪。然则虚家者不言痰可乎。噫。本气自病之。东垣不作。难乎可与同论此也。休哉。
（五）病患有寒。复发汗。胃中冷。必吐蛔。
有寒。承上文而言。复。反也。言误也。误汗则徒亡津液。胃中空虚。故曰冷也。胃虚则蛔
失其所养而悖乱。故吐出可必。此乃申致上文不可发汗。以严戒慎之意。当作一条。旧本出在两
篇。数拘有定。今一之则目不合旧数。故但移就相次。存二以仍旧计。凡如此者。读者自会可也。
（六）病患手足厥冷。脉乍紧者。邪结在胸中。心中满而烦。饥不能食者。病在胸中。当须
吐之。宜瓜蒂散。
手足厥冷。似涉于厥阴伤寒也。乍。忽也。言非厥阴伤寒。乃虚寒之邪自内而作。
故曰。邪结在胸中。邪亦以痰言。所以胸中满而烦也。饥不能食者。痰涎涌上。逆而塞膈。气窒
而食不通也。病在胸中。乃承上起下之句。吐宜瓜蒂散。而与前条同者。虚风虚寒虽殊。而痰之
所以为邪则一也。然前条虚风生痰。即俚俗所谓中风。而此条虚寒痰症。即诸家方书。所谓四证
类伤寒。而痰居其一者是也。经皆揭之而不明者。想当时皆不过以中风伤寒为通称。经以虚风之
风。非风寒之风也。故不曰风痰。而曰胸寒。寒。以虚寒之寒。与风寒之寒不同也。故不曰寒痰。
而曰邪在胸中。但详其痰之状而革
其名。正其义。以出其治。其所以为晓寤天下后世也。亦已至矣。何天下后世卒深沉昏惑。而反
多口于经。甚者则直诋桂枝汤为偶中。于今之末世。诬之为不可用。群然没其所谓中风之病名。
而懵其病于不知。颠倒其伤寒之经旨于分崩离析。使故习之弊今尚然。噫。陋俗之难化。愚夫之
难晓。一至是邪。宜乎后之人。年不古若。而日陷于促也。冤哉。
（七）病患身大热。反欲得近衣者。热在皮肤。寒在骨髓也。身大寒反不欲衣者。寒在皮肤。
热在骨髓也。
此揭五合表里之为病而分晓之。所以勉人当求病于的之意。皮肤。五合之表也。骨髓。五合
之里也。热在皮肤。寒在骨髓者。表实里虚也。寒在皮肤。热在骨髓者。表虚里实也。然此以脏
腑不预而言耳。合脏腑而统言之。则皆表而无里之可称也。学人不可不究。
表热里寒者。脉虽沉而迟。手足微厥。下利清谷。此里寒也。所以阴证亦有发热者。此表热也。
表寒里热者。脉必滑。身厥。舌干也。所以少阴恶寒而 。此表寒也。时时自烦。不欲浓衣。此
里热也。
此承上文而详释之之意。所以阴证亦有发热者之上。疑有脱落。
（八）病。发热头痛。脉反沉。若不瘥。身体疼痛。当救其里。宜四逆汤。
此冯脉不冯证之大旨。方见太阳下。
（九）病在阳。应以汗解之。反以冷水 之。若灌之。其热被却不得去。弥更益烦。肉上
粟起。意欲饮水反不渴者。服文蛤散。若不瘥者。与五苓散。寒实结胸。无热证者。与三物小陷
胸汤。白散亦可服。
文蛤散方
文蛤（五两）
上一味为散。以沸汤和一钱匕服。汤用五合。
白散方
桔梗（三分） 贝母（三分） 巴豆（一分去皮熬黑研如泥）
上件二味为末。内巴豆。更于臼中杵之。以白饮和服。强人一钱。羸者减之。病在膈上必吐。
在膈下必利。不利。进热粥一杯。利过不止。进冷粥一杯。身热皮粟不解。欲引衣自覆者。若水以
之。洗之。益令热被不得出。当汗而不汗。则烦。假令汗出已。腹中痛。与芍药三两如上法。
。心艮切。在阳。谓表未罢热未除也。 。喷之也。灌。溉之也。被。蒙也。言邪蒙冒于
灌之水。郁闭而不散。热 烦恼益甚也。粟起。言肤上粒起如粟。水寒郁留于表而然也。意欲
得水而不渴者。邪热虽甚。反为水寒所制也。文蛤。即海蛤之有文理者。咸寒走肾而利水。以之
独专任者。盖取督肾而行水也。不瘥者。水虽内渍。犹有外被者。故用五苓散。内以消之。外以
散之。而两解也。寒以饮言。饮本塞也。又得水寒。两寒搏结而实于胸中。故谓无热证也。小陷
胸汤。固小结胸之主治。然白散者。桔梗贝母。能消饮而开膈。巴豆辛温。能散寒而逐水。所以
寒结或重。而小陷胸不能解者。则此又可服也。小陷胸汤方。见太阳中。
（十）病患。脏无他病。时发热。自汗出而不愈者。此卫气不和也。先其时发汗。则愈。宜
桂枝汤主之。
脏无他病。里气和也。时以暂言。谓或时则然。或时不然也。卫气不和。表不固也。先其时。
言于未发热之先也。方见太阳上。
（十一）病常自汗出者。此为荣气和。荣气和者。外不谐。以卫气不共荣气和谐故尔。以荣
行脉中。卫行脉外。复发其汗。荣卫和则愈。宜桂枝汤。
此与上条同。上以暂言。此以常者。谓无时不然也。上言脏。脏为阴而主里。此言荣。荣亦
阴而主里。卫亦外。皆变文之互词。盖上条以暂言。故其词略。此以常言。故其词详。两相互发。
义不殊也。然皆发汗。而此不言先其时者。以常故。无先后之可言也。
（十二）病患脉数。数为热。当消谷引食。而反吐者。此以发汗令阳气微。膈气虚。脉乃数
也。数为客热。不能消谷。以胃中虚冷故吐也。
数为客热以下。乃反复详明上文之义。客热以邪气言。虚冷以正气言。
（十三）微数之脉。慎不可灸。因火为邪。则为烦逆。追虚逐实。血散脉中。火气虽微。内攻
有力。焦骨伤筋。血难复也。
微数。虚热也。故戒慎不可灸。逐。亦追也。实。谓热也。血散脉中。言追逐之余。必至迫
血。血为荣而行脉中。故谓散于脉中也。火气虽微以下。甚言追逐之害大。盖骨赖血以濡。既失
其所濡必枯而焦。筋赖血以荣。既亡以为荣。必衰而伤。残伐其本源故也。以此示人。而近来人
之以火灸阴虚发热者犹比比焉。窃见其无有不焦骨伤筋而毙者。吁。是岂正命哉。可哀也已。
（十四）病患烦热。汗出则解。又如疟状。日晡所发热者。属阳明也。脉实者。宜下之。脉
浮虚者。宜发汗。下之。宜大承气汤。发汗。宜桂枝汤。
烦热。太阳也。故脉浮虚而宜汗散。如疟状。谓热之往来。犹疟之作辍有时而不爽也。晡。
日加申。阳明之王时也。故脉实而宜下解。
（十五）未持脉时。病患手叉自冒心。师因教试令咳。而不咳者。此必两耳聋无闻也。所以
然者。以重发汗。虚。故如此。
此诀人推测病情之大法。
（十六）病患不大便五六日。绕脐痛。烦躁。发作有时者。此有燥屎。故使不大便也。
病患。谓凡有病之人。证犯有如此者。则皆当如此而治之之谓。非独以风寒之病为言而已也。
此诀人辨凡百胃实之大旨。
（十七）病患小便不利。大便乍难乍易。时有微热。喘冒不能卧者。有燥屎也。宜大承气汤。
小便不利。所以大便有乍难乍易也。时有微热。阳明潮作也。喘冒不能卧。胃不和也。故曰
有燥屎。方见阳明篇。下同。
（十八）大下后。六七日不大便。烦不解。腹满痛者。此有燥屎也。宜大承气汤。
烦不解。则热未退可知。腹满痛。则胃实可诊。故曰有燥屎。以上三条。皆诀人当下之大法。
（十九）本发汗而复下之。此为逆也。若先发汗。治不为逆。本先下之。而反汗之。为逆。若先下之。治不为逆。
复。与覆同。古字通用。复。亦反也。犹言误也。与下文反汗之反同意。盖两比而互相发明。
以诀人汗下之大法。
（二十）凡病。若发汗。若吐。若下。若亡津液。阴阳自和者。必自愈。
阴阳以脉言。而二便在其中。两者和。则血气无相胜负可知。故自愈可必。此诀人持诊之大要。
共计二十条，附方剂三个。
这些内容在旧版中错乱混杂地出现。现在将其分类整理为篇章。
（一）太阳病（太阳经受邪所致的病证）。发热且口渴，不恶寒（不怕冷）的，称为温病（一种外感热病）。
发热，温邪属于阳邪，所以热象随即显现。口渴，是因为热邪损伤了阴血。不恶寒，说明没有阴寒之邪与之对抗。温，是春季的气候特征。
气候与季节的关系，有时该到而未到，有时该到却未到而参差不齐。所以冬夏虽然也有温暖的时候，但必须以春季为正统。因此，必须见到症状表现确实如此的情况，才可以说是触犯了温邪而发病。这里揭示了温病的名称和实质，而没有给出治疗方法，是因为论述温病是为了辨析它与伤寒的区别，所以不予涉及。评论的人认为有理论论述而无治疗方法，这并非自满。唉，这些人哪里懂得经典的大旨呢？
如果发汗后，身体灼热加重的，名叫风温（温病复感风邪）。风温这种病，脉象寸关尺三部都浮，自汗出，身体沉重，嗜睡，呼吸必然带有鼾声，说话困难。如果误用泻下法，会导致小便不通利，两眼直视，大小便失禁。如果误用火疗（如艾灸、火熏等），轻则面色发黄，重则像惊痫发作，时而抽搐。如果被火邪熏灼，一次误治还能拖延时日，再次误治就会缩短寿命。
“鼾”音同“旱”。“溲”音同“小”。“痫”音同“闲”。“螈”音同“炽”。“ ”音同“踪”。灼热是指热势更加严重。风温，是指触犯温邪又兼感风邪。阴阳俱浮，太阳本脉浮，而风温皆属阳邪，所以上下脉象都见浮。自汗出，也是卫气受伤的表现。身体沉重、多眠睡、鼻息必鼾、语言难出，是因为风邪壅滞导致气机昏蒙，热邪极盛导致气机郁结。小便不利，是因为太阳经主司膀胱，而风温皆属阳邪，误下反而攻伐阴分，白白耗伤津液，导致膀胱之气受损。直视，是因为太阳经的筋脉，分支者上行成为目上纲（眼睑），所以眼球不能转动而上窜。失溲，是说小便完全失去了正常控制。火，指艾灸、熨法等疗法。微，指攻伐轻微，那么变证也轻微；发黄，是因为火热导致土燥，所以面色被夺而发黄。剧，指攻伐剧烈，那么变证也剧烈；像惊痫、时而抽搐，是因为火邪极盛、热极生风。熏，也是火劫疗法。一逆，指初次误治；尚引日，指还可以暂时拖延。再逆，指再次误治；促命期，指夭折人的自然寿命。其警示之意非常深远。
（二）症状表现像伤寒，但脉象不弦紧而弱。脉弱的，必定口渴。若误用火疗，必定出现谵语（胡言乱语）。脉弱且发热，脉浮，应当解表，出汗后即可痊愈。
“形作伤寒”，就是说像伤寒，指上一条并进一步说明。不弦紧，说明不是伤寒。弱即指风性柔缓的特点。谵语，是因为火邪极盛导致土燥。脉弱发热，是引用《素问》中“诸弱发热”的说法，以说明上文必定口渴的道理。“解之”，是说脉既属浮，就应当依法解除表邪，这是给人治病的大意。
（三）脉浮且热势很盛，反而用灸法治疗。这属于实证，却按虚证治疗，因火邪扰动，必定咽喉干燥，唾血。
这是承接上一条进一步发出警告。实，指脉浮热盛，是邪气胜则实。咽喉干燥，是因为肾与膀胱相合，其经脉直行者入肺中，循喉咙至舌根。唾血，是因为火性炎上，血液随之妄行逆乱。以上都是论述温病。
（四）病症类似桂枝汤证（中风表虚证），但头不痛，项不强，寸脉微浮，胸中痞塞坚硬，气上冲咽喉，呼吸困难，这是胸中有寒饮（痰饮）。应当用吐法，适宜用瓜蒂散。
瓜蒂散方：
瓜蒂（一分，炒黄） 赤小豆（一分）
以上两味药，分别捣碎筛成散剂。混合均匀。取一方寸匕的药量，用香豉一合，热汤七合，煮成稀粥状，去渣，取汁，调和散剂，温服，一次性服下。
如果不吐，稍微增加剂量，直到快吐出来为止。凡是失血或体质虚弱的人，不可服用瓜蒂散。
“如桂枝证”，意思是大约像中风。头不痛、项不强，说明太阳经中没有外来的风邪，以明确这不是中风。寸部候身半以上，微浮，说明邪气从内向外出。胸中痞硬，是痰涎堵塞膈膜。气上冲咽喉，是痰涌上逆，有人说喉中声音像拉锯一样。这里的“寒”指痰，痰是内伤病证。内者为虚，所以叫“寒”。这个病名大概是张仲景命名时，不过按照《素问》阳气以天地疾风命名的说法，也称为中风。岂料后世足以混淆本经的中风概念而导致错误。经文更改其名称，而以“病如桂枝证”来揭示，确实是万世辨别中风似是而非的最高教诲。将原本用于实风寒的栀子豉汤改为瓜蒂散，是因为瓜蒂苦寒，能吐出顽痰而宽畅胸膈；赤小豆酸平，善于涌吐风涎而逐水；香豉能起信而调和水火，所以辅助这两味药主治。稀粥则是承载这三种药物的媒介。这就是治疗虚风虚寒的对药。然而又说虚家不可服用，这是什么意思？这是另一种说法。这种风和寒，虽然是人体虚弱的表象，但痰涎难道是胸中的实物吗？既然是虚家，不提痰可以吗？唉，如果是本气自病，李东垣不作此论，很难与他们同论此事。罢了。
（五）患者体内有寒，又误发汗，胃中寒冷，必定呕吐蛔虫。
“有寒”，承接上文而言。“复”，通“覆”，意为反、误。误汗则徒然耗伤津液，胃中空虚，所以叫冷。胃虚则蛔虫失去滋养而悖乱，所以呕吐是必然的。这是为了重申上文不可发汗，以严格警戒谨慎的意思。应当作为一条，旧版出现在两篇中。数目拘泥于固定数量，现在合并为一则目数不合旧版数量，所以只是移动位置使其相邻，保留两条以维持旧版计数。凡此类情况，读者自行领会即可。
（六）患者手足厥冷，脉象突然紧，邪气结在胸中，心中胀满而烦闷，饥饿但不能进食，病位在胸中，应当用吐法，适宜用瓜蒂散。
手足厥冷，似乎涉及厥阴伤寒。乍，忽也。说明不是厥阴伤寒，而是虚寒之邪从内生发。所以说邪结在胸中。邪也指痰，所以胸中满而烦。饥饿不能食，是因为痰涎涌上，逆而堵塞膈膜，气机窒塞而食物不通。病在胸中，是承上启下的句子。吐宜用瓜蒂散，与前条相同的是，虚风虚寒虽不同，但痰之所以为邪是一样的。然而前条是虚风生痰，即俗话所谓中风；此条是虚寒痰症，即各家方书所谓四证类伤寒，而痰居其一。经文都揭示出来而不明说，想当时都不过以中风伤寒为通称。经文以虚风之风，非风寒之风，所以不说风痰，而说胸寒。寒，以虚寒之寒，与风寒之寒不同，所以不说寒痰，而说邪在胸中。只是详细观察痰的状态而更改其名称，正其义理，以提出治疗方法，以此来开导天下后世，也已经到了极致。为什么天下后世最终深沉昏惑，反而对经文多口非议，甚至直接诋毁桂枝汤为偶然中效，在当今末世，诬蔑其为不可用，群起抹杀所谓中风的病名，而对疾病懵懂无知，颠倒伤寒经旨于分崩离析，使故习的弊端至今依然存在。唉，陋俗难以教化，愚夫难以开导，竟到了这种地步。难怪后人不如古人，日益陷入困境。冤枉啊。
（七）患者身体大热，反而想要穿衣取暖的，是热在皮肤，寒在骨髓。身体大寒，反而不想穿衣的，是寒在皮肤，热在骨髓。
这是揭示五脏表里为病的区别，勉励人们应当探求确切的病因。皮肤，是五脏之表；骨髓，是五脏之里。热在皮肤，寒在骨髓，是表实里虚。寒在皮肤，热在骨髓，是表虚里实。然而这是不考虑脏腑而言的。结合脏腑统而言之，则都只有表而没有里可言。学者不可不研究。
表热里寒，脉象虽沉迟，手足微厥，下利清谷，这是里寒。所以阴证也有发热的，这是表热。
表寒里热，脉象必滑，身体厥冷，舌干。所以少阴病恶寒而蜷卧，这是表寒。时时自烦，不欲穿厚衣，这是里热。
这是承接上文详细解释的意思。所以在“所以阴证亦有发热者”之上，怀疑有脱落。
（八）患病，发热头痛，脉象反而沉，如果不愈，身体疼痛，应当救里，适宜用四逆汤。
这是凭脉不凭证的大旨。方剂见太阳篇下部。
（九）病在阳分（表证），应当用汗法解表，反而用冷水喷洒或浇洗，热势被遏制而不能去除，更加烦躁，皮肤起粟粒，想喝水反而不渴的，服用文蛤散。如果不愈，给予五苓散。寒实结胸，无热证的，给予三物小陷胸汤，白散也可以服用。
文蛤散方：
文蛤（五两）
以上一味药研成散剂，用沸水调和一方寸匕服用。用水五合。
白散方：
桔梗（三分） 贝母（三分） 巴豆（一分，去皮，炒黑，研如泥）
以上两味药研末，加入巴豆，再在臼中杵匀，用白米汤调和服用。体强者服一方寸匕，体弱者减量。病在膈上必定呕吐，在膈下必定腹泻。如果不腹泻，喝一杯热粥；如果腹泻不止，喝一杯冷粥。身体热、皮肤粟粒不解，想拉被子覆盖的，如果用冷水浇洗，只会让热邪被遏制不能外出，应当出汗而不出汗，则烦躁。假如出汗后，腹中痛，给予芍药三两，如上法。心艮切（此处疑为衍文或特定术语，暂译心情急切/心痛）。在阳，谓表未罢、热未除。喷，指喷洒。灌，指浇灌。被，指蒙盖。说邪气蒙盖于灌注的水中，郁闭而不散，热邪烦恼更加严重。粟起，指皮肤上颗粒突起如粟米，是水寒郁留于体表所致。想喝水但不渴，是因为邪热虽盛，反被水寒所制约。文蛤，即海蛤中有纹理者，咸寒走肾而利水，用它单独专任，是取其督促肾气而行水。如果不愈，是因为水虽内渍，犹有外被，所以用五苓散，内以消之，外以散之，两解。寒指饮邪，饮本涩滞，又得水寒，两寒搏结而实于胸中，所以谓无热证。小陷胸汤，固然是小结胸的主治，但白散中，桔梗贝母能消饮开膈，巴豆辛温能散寒逐水，所以寒结或重，而小陷胸不能解时，则此又可服。小陷胸汤方，见太阳篇中。
（十）患者，脏腑无其他病变，时常发热，自汗出而不愈的，这是卫气不和。在其发热之前发汗，则愈，适宜用桂枝汤主治。
脏腑无其他病变，说明里气和顺。时，指暂时，谓有时这样，有时不这样。卫气不和，说明表不固。先其时，指在未发热之前。方剂见太阳篇上部。
（十一）患者经常自汗出，这是营气和。营气和，说明外不谐，因为卫气不与营气和谐所致。因为营行脉中，卫行脉外，再次发其汗，营卫和谐则愈，适宜用桂枝汤。
这与上一条相同。上一条以“时”言，此条以“常”者，谓无时无刻不这样。上一条言脏，脏为阴而主里；此条言营，营亦阴而主里；卫亦在外，都是变文互词。大概上一条以“时”言，所以词句简略；此条以“常”言，所以词句详尽。两者互相发明，义理没有不同。然而都发汗，而此条不言“先其时”，是因为常态，无所谓先后可言。
（十二）患者脉数，数为热，应当消化谷物吸引食物，反而呕吐的，这是因为发汗令阳气微弱，膈气虚，脉才数。数为客热，不能消化谷物，因为胃中虚冷所以呕吐。
“数为客热”以下，乃反复详细说明上文的意义。客热指邪气，虚冷指正气。
（十三）脉微数的，千万不可灸。因火成为邪气，则会出现烦逆，追虚逐实，血液散乱于脉中。火气虽然微弱，内攻有力，会焦骨伤筋，血液难以恢复。
微数，是虚热。所以戒慎不可灸。逐，也是追的意思。实，指热。血液散乱于脉中，是说追逐之余，必定迫血妄行。血为营而行于脉中，所以谓散于脉中。火气虽微以下，甚言追逐的危害大。大概骨赖血以濡养，既然失去其所濡养，必定枯而焦；筋赖血以荣养，既然亡以为荣，必定衰而伤。残伐其本源。以此示人，而近来有人用火灸治疗阴虚发热者比比皆是。我看他们没有不焦骨伤筋而死的。唉，这难道是正常的死亡吗？可悲啊。
（十四）患者烦热，汗出则缓解，又如疟疾状，日晡时（下午3-5点）发热的，属于阳明病。脉实的，适宜用下法。脉浮虚的，适宜用汗法。下法，适宜用大承气汤。汗法，适宜用桂枝汤。
烦热，属太阳。所以脉浮虚而宜汗散。如疟状，谓热之往来，如同疟疾发作有时而不爽。晡，日加申，是阳明王旺之时。所以脉实而宜下解。
（十五）还没诊脉时，患者双手交叉护住心口。医生于是教他试着咳嗽，他不咳嗽的，这必定双耳耳聋听不见。之所以这样，是因为重发汗，虚，所以如此。
这是医生推测病情的大法。
（十六）患者不大便五六天，绕脐痛，烦躁，发作有时的，这是有燥屎，所以导致不大便。
“患者”，谓凡有病之人。证候犯有如此情况的，都应当如此治疗，并非独指风寒之病而言。这是医生辨别各种胃实的大旨。
（十七）患者小便不利，大便乍难乍易，时有微热，喘冒不能卧的，有燥屎，适宜用大承气汤。
小便不利，所以大便有乍难乍易。时有微热，是阳明潮作。喘冒不能卧，是胃不和。所以说有燥屎。方剂见阳明篇，下同。
（十八）大下之后，六七天不大便，烦不解，腹满痛的，这是有燥屎，适宜用大承气汤。
烦不解，则热未退可知。腹满痛，则胃实可诊。所以说有燥屎。以上三条，都是医生当下法的大法。
（十九）本来应当发汗却反而用下法，这是逆治。如果先发汗，治疗不为逆。本来应当先下法却反而用汗法，为逆。如果先下法，治疗不为逆。
“复”，与“覆”同，古字通用。复，也是反的意思。犹言误也。与下文“反汗之”的反同意。大概两比而互相发明，以教导医生汗下的大法。
（二十）凡病，如果发汗，如果吐，如果下，如果亡津液，阴阳自和的，必定自愈。
阴阳以脉言，而二便在其中。两者和，则血气无相胜负可知。所以自愈可必。这是医生持诊的大要。
Totaling twenty clauses with three formulas.
These contents appeared in a disordered and mixed manner in the old editions. They are now classified and organized into chapters.
(1) Taiyang disease (a syndrome caused by pathogenic factors invading the Taiyang meridian). If there is fever, thirst, and aversion to cold is absent, it is called Warm Disease (an external febrile disease).
Fever: Warm pathogens belong to Yang, so heat manifestations appear immediately. Thirst: Heat pathogens damage Yin blood. Absence of aversion to cold: Indicates no Yin-cold pathogen is opposing it. "Warm" refers to the climatic characteristics of Spring.
The relationship between climate and seasons: Sometimes the expected climate arrives early, sometimes late or irregularly. Although Winter and Summer may have warm periods, Spring is considered the orthodox season. Therefore, only when symptoms manifest exactly as described can one say that the disease was contracted by encountering Warm pathogens. Here, the name and essence of Warm Disease are revealed, but no treatment is provided because discussing Warm Disease aims to differentiate it from Cold Damage (Shanghan), hence it is not elaborated. Critics argue that having theory without treatment shows self-satisfaction. Alas, how can they understand the main purport of the classics?
If after sweating therapy, the body becomes scorching hot, it is named Wind-Warm Disease (Warm Disease complicated by Wind pathogen). In Wind-Warm Disease, the pulse is floating at all three positions (Cun, Guan, Chi), there is spontaneous sweating, heaviness of the body, excessive sleepiness, snoring during breathing, and difficulty speaking. If purgation is mistakenly used, it leads to dysuria, staring gaze, and incontinence of urine and feces. If fire therapy (such as moxibustion or fire fumigation) is mistakenly applied, mild cases result in yellowish complexion, while severe cases resemble convulsive epilepsy with occasional spasms. If subjected to fire fumigation, one error may prolong the illness slightly, but a second error will shorten life expectancy.
"Snoring" sounds like "Han". "Sour" (urine/feces) sounds like "Xiao". "Epilepsy" sounds like "Xian". "Spasm" sounds like "Chi". " " sounds like "Zong". Scorching heat means the heat intensifies. Wind-Warm Disease implies encountering Warm pathogens plus Wind. Floating pulse at Yin and Yang positions: The Taiyang baseline pulse is floating, and since Wind-Warm is purely Yang, both upper and lower pulses appear floating. Spontaneous sweating indicates injury to Wei Qi (Defensive Qi). Heaviness, somnolence, snoring, and speech difficulties arise because Wind stagnation causes mental clouding and extreme Heat causes Qi depression. Dysuria occurs because Taiyang governs the Bladder, and Wind-Warm is Yang; mistaken purgation attacks Yin, wasting fluids and injuring Bladder Qi. Staring gaze results from Taiyang meridians connecting to the eyes; inability to rotate eyes leads to upward deviation. Incontinence means loss of normal urinary control. "Fire" refers to moxibustion and warming therapies. Mild errors cause mild complications (yellowing due to Heat drying Earth/Spleen); severe errors cause severe complications (convulsions due to extreme Heat generating Wind). Fumigation is also a Fire coercion. One error delays death; two errors hasten it. The warning intent is profound.
(2) Symptoms resemble Cold Damage, but the pulse is weak rather than string-tight. A weak pulse indicates thirst. If fire therapy is used, delirium will occur. With weakness, fever, and a floating pulse, resolution via sweating leads to recovery.
"Resembling Cold Damage" refers to the previous clause and expands upon it. Not string-tight means it is not Cold Damage. Weakness reflects the soft and slow nature of Wind. Delirium results from extreme Heat drying Earth. Weakness with fever cites *Suwen* ("All weak pulses indicate fever") to explain the inevitability of thirst mentioned earlier. "Resolution" means using appropriate methods to resolve the exterior when the pulse is floating; this is the general principle of treatment.
(3) Pulse is floating and heat is severe; moxibustion is wrongly applied. This is an Excess condition treated as Deficiency. Due to Fire, there will be dry throat and hemoptysis.
This continues the warning from the previous clause. Excess refers to floating pulse and severe heat, indicating pathogen dominance. Dry throat: Kidney pairs with Bladder; its meridian enters the Lung, follows the throat to the tongue root. Hemoptysis: Fire flares upward, causing blood to rebel and flow recklessly. The above discusses Warm Disease.
(4) The condition resembles Guizhi Tang syndrome (Wind Strike with deficiency sweating), but there is no headache or stiff neck. The Cun pulse is slightly floating, the chest feels stuffy and hard, Qi rushes up to the throat causing dyspnea. This is Cold-Fluid (Phlegm-Fluid) in the Chest. Emesis should be induced using Gouti San.
Gouti San Formula:
Gou Ti (Melon Rind/Gardenia Seed - *Note: Traditionally Citrullus colocynthis seed*, 1 fen, roasted yellow)
Chi Xiao Dou (Red Adzuki Bean, 1 fen)
Grind each separately into powder. Mix thoroughly. Take one qian bi (measure). Add Xiang Chi (Prepared Soybean) 1 he, and hot water 7 he. Boil into a thin porridge, strain, take the juice, mix with the powder, and drink warm in one dose.
If vomiting does not occur, increase the dose slightly until near-vomiting is achieved. Do not give to those with blood loss or deficiency constitutions.
"Resembling Guizhi syndrome" implies similarity to Wind Strike. No headache/stiff neck confirms no external Wind in Taiyang, ruling out Wind Strike. Cun position reflects the upper body; slight floating indicates pathogen moving outward from within. Chest stuffiness/hardness is Phlegm-Fluid blocking the diaphragm. Qi rushing to throat is Phlegm surging upward. "Cold" here refers to Phlegm, an internal pathology. Internal implies Deficiency, hence called "Cold". Zhang Zhongjing likely named it based on *Suwen*'s concept of Wind, confusing later generations. Changing the name to "Resembling Guizhi Syndrome" clarifies the distinction. Gouti San replaces Zhi Zi Chi Tang because Gou Ti (bitter/cold) expels stubborn Phlegm; Chi Xiao Dou (sour/neutral) induces vomiting of Wind-Phlegm and drains water; Xiang Chi harmonizes. Porridge acts as a carrier. However, it is contraindicated for Deficiency patients because although the Wind/Cold is virtual, the Phlegm is real excess in the chest. Li Dongyuan's theories differ.
(5) The patient has internal Cold, and sweating is erroneously induced. The Stomach becomes cold, leading to vomiting of roundworms.
"Has Cold" continues the context. "Fu" means reverse/error. Erroneous sweating wastes fluids, leaving the Stomach empty and cold. Stomach deficiency causes roundworms to lose nourishment and act rebelliously, leading to inevitable vomiting. This reiterates the prohibition of sweating to warn against caution. It should be one clause; old editions split it. To maintain numbering, it is moved adjacent, keeping two clauses. Readers should understand this.
(6) Patient has cold hands and feet, pulse suddenly tight. Pathogen is knotted in the Chest. There is fullness and irritability in the heart/chest, hunger but inability to eat. The disease is in the Chest; emesis is indicated using Gouti San.
Cold extremities suggest Jueyin Cold Damage. "Zha" (suddenly) indicates it is not Jueyin Cold Damage, but internal Deficient-Cold. Thus, pathogen knots in the Chest. "Pathogen" refers to Phlegm, causing fullness and irritability. Hunger but inability to eat is due to Phlegm surging upward, blocking the diaphragm, and obstructing Qi/food passage. "Disease in Chest" bridges previous and next points. Gouti San is used because, despite differences between Virtual Wind and Virtual Cold, the nature of Phlegm as pathogen is the same. Previous clause: Virtual Wind generates Phlegm (common "Wind Strike"). This clause: Virtual Cold generates Phlegm (one of four syndromes resembling Cold Damage). The text uses "Chest Cold" instead of "Wind-Phlegm" and "Pathogen in Chest" instead of "Cold-Phlegm" to distinguish these specific etiologies from standard Wind/Cold. This clarification aims to enlighten future generations, yet confusion persists. Alas, how difficult it is to educate the ignorant!
(7) Patient has high body heat but desires clothing/warmth: Heat is in the Skin (Exterior), Cold is in the Marrow (Interior). Patient has low body temperature but refuses clothing: Cold is in the Skin (Exterior), Heat is in the Marrow (Interior).
This distinguishes Exterior/Interior diseases of the Five Zang. Skin is Exterior; Marrow is Interior. Heat in Skin/Cold in Marrow = Exterior Excess, Interior Deficiency. Cold in Skin/Heat in Marrow = Exterior Deficiency, Interior Excess. This discussion excludes specific Zang-Fu interactions. Combined with Zang-Fu, it implies pure Exterior or Interior presentations. Scholars must investigate.
Exterior Heat/Interior Cold: Pulse deep/slow, slight cold extremities, diarrhea with undigested food. This is Interior Cold. Hence, Yin syndromes can have fever (Exterior Heat).
Exterior Cold/Interior Heat: Pulse slippery, body cold, dry tongue. Hence, Shaoyin aversion to cold/curling up is Exterior Cold. Frequent irritation, desire to remove thick clothes is Interior Heat.
This explains the previous point. There may be missing text before "Hence, Yin syndromes can have fever."
(8) Disease presents with fever, headache, but pulse is surprisingly deep. If it does not improve and body pain persists, rescue the Interior using Sini Tang.
This emphasizes relying on pulse over symptoms. Formula seen in Lower Taiyang chapter.
(9) Disease in Yang (Exterior) should be resolved by sweating. Instead, cold water is sprayed/poured. Heat is suppressed and cannot leave, causing increased irritability, gooseflesh on skin, desire to drink but no thirst. Use Wenli San. If ineffective, use Wuling San. For Cold-Excess Jie-Xiong (Chest Binding) with no Heat signs, use Sanwu Xiaoxin Tang or Baisan.
Wenli San Formula:
Wen Li (Clam Shell/Sea Clam, 5 liang)
Grind into powder. Mix one qian bi with boiling water (5 he) and take.
Baisan Formula:
Jie Geng (Platycodon Root, 3 fen)
Bei Mu (Fritillaria Bulb, 3 fen)
Ba Dou (Croton Seed, 1 fen, peeled, roasted black, ground to paste)
Grind first two into powder, add Ba Dou, pound in mortar. Mix with white rice decoction. Strong adults take 1 qian bi; weak reduce dose. Pathogen above diaphragm causes vomiting; below causes diarrhea. If no diarrhea, drink hot porridge; if diarrhea persists, drink cold porridge. If heat/gooseflesh persist and patient wants covering, avoid cold water washing which traps heat. If sweating fails, causing irritability, and then sweating occurs followed by abdominal pain, use Shaoyao (Peony Root) 3 liang as above. "In Yang" means Exterior unresolved, Heat unremoved. "Penetrating/Spraying" refers to water application. "Bei" means covering. Pathogen trapped by cold water causes depression and worsening heat. "Gooseflesh" is cold-water stagnation in Exterior. Desire to drink but no thirst: Heat constrained by Cold Water. Wen Li (sea clam) is salty/cold, enters Kidney, promotes urination. Used alone to direct Kidney Qi to move water. If ineffective, residual exterior requires Wuling San to resolve internally and externally. "Cold" refers to Fluid retention. Cold-Fluid + External Cold = Solid Cold in Chest (no Heat signs). Xiaoxin Tang treats minor binding; Baisan (Jie Geng/Bei Mu open diaphragm/dissolve fluid; Ba Dou warms/scatters cold/drains water) treats heavier Cold-Binding. Formula seen in Middle Taiyang chapter.
(10) Patient has no internal organ pathology, but experiences intermittent fever and spontaneous sweating without recovery. This is Disharmony of Wei Qi. Sweat before the onset of fever leads to recovery. Use Guizhi Tang.
No internal pathology means Interior Qi is harmonious. "Intermittent" means occasional. Wei Qi disharmony means insecure Exterior. "Before onset" means prior to fever. Formula seen in Upper Taiyang chapter.
(11) Patient has constant spontaneous sweating. This is Harmony of Ying Qi. Ying Qi is harmonious, but Exterior is discordant because Wei Qi does not harmonize with Ying Qi. Ying moves in vessels; Wei moves outside vessels. Re-induce sweating; harmony of Ying and Wei leads to recovery. Use Guizhi Tang.
Similar to previous clause. "Constant" vs "Intermittent". Previous mentioned Zang (Yin/Interior); this mentions Ying (Yin/Interior) and Wei (Yang/Exterior). Both clarify the same principle. Previous was brief; this is detailed. Both induce sweating; this omits "before onset" because it is constant, not time-specific.
(12) Patient has rapid pulse. Rapid indicates Heat, which should aid digestion/appetite. Instead, vomiting occurs. This is due to sweating depleting Yang Qi, causing Qi deficiency in the Diaphragm, resulting in rapid pulse. Rapid pulse indicates Guest Heat, which cannot digest food. Vomiting occurs due to Cold Deficiency in the Stomach.
"Rapid is Guest Heat" explains the previous meaning. Guest Heat refers to pathogen; Cold Deficiency refers to healthy Qi.
(13) Pulse is slightly rapid; moxibustion must be avoided. Fire becomes pathogenic, causing irritability and rebellion. Pursuing Deficiency and chasing Excess scatters blood in vessels. Though Fire Qi is subtle, its internal attack is powerful, scorching bones and injuring sinews; blood is hard to restore.
Slightly rapid indicates Deficient Heat. Avoid moxibustion. "Chase" means pursue. Excess refers to Heat. Blood scattering in vessels: Pursuit forces blood to rebel. Blood (Ying) moves in vessels. Subtle Fire causes severe damage: Bones need blood for nourishment; without it, they scorch. Sinews need blood for prosperity; without it, they injure. This harms the source. Recent practitioners wrongly use fire for Deficient Heat, often leading to death. Tragic.
(14) Patient has irritability and heat; relief after sweating. Resembles malaria. Fever at dusk (You hour) belongs to Yangming. If pulse is Excess, use Purging. If pulse is Floating/Empty, use Sweating. For Purging, use Dachengqi Tang. For Sweating, use Guizhi Tang.
Irritability/Heat relates to Taiyang. Floating/Empty pulse indicates need for dispersing sweat. "Malaria-like" means alternating heat/cold. "You" (3-5 PM) is Yangming peak time. Excess pulse indicates need for purging.
(15) Before taking pulse, patient crosses hands over heart. Doctor asks them to cough; they cannot. This indicates bilateral deafness. Reason: Heavy sweating caused Deficiency.
This is a diagnostic method for inferring condition.
(16) Patient has not had bowel movement for 5-6 days, periumbilical pain, irritability, occurring intermittently. This indicates Dry Stool (Zao Shi), causing constipation.
"Patient" applies to any sick person with these symptoms, not just Wind/Cold. This is the principle for identifying various Stomach Excess conditions.
(17) Patient has dysuria, stool alternately difficult/easy, occasional slight heat, wheezing/dizziness preventing lying down. This indicates Dry Stool. Use Dachengqi Tang.
Dysuria causes alternating stool difficulty. Occasional slight heat is Yangming tidal fever. Wheezing/dizziness is Stomach disharmony. Hence, Dry Stool. Formula seen in Yangming chapter.
(18) After severe purgation, 6-7 days pass without bowel movement, irritability persists, abdominal fullness/pain. This indicates Dry Stool. Use Dachengqi Tang.
Persistent irritability means Heat remains. Abdominal fullness/pain confirms Stomach Excess. Hence, Dry Stool. These three clauses outline indications for purging.
(19) Originally should have sweated but purged instead: This is Reverse treatment. If sweated first, treatment is not Reverse. Originally should have purged but sweated instead: This is Reverse. If purged first, treatment is not Reverse.
"Fu" equals "Fu" (reverse). Means error. Contrasted with "Fan" (reverse) below. Illustrates principles of Sweating/Purging.
(20) Any disease: Whether through sweating, vomiting, purging, or fluid depletion, if Yin and Yang self-harmonize, it will surely recover.
Yin/Yang refers to pulse, including urination/defecation. Harmony implies blood/Qi balance without mutual defeat. Recovery is certain. This is the key to diagnosis.