甘草（四两炙） 生姜（三两切） 桂枝（三两去皮） 人参（二两） 生地黄（一斤） 阿胶（二两） 麦门冬
（半斤去心） 麻子仁（半升） 大枣（十二枚擘）
上九味。以清酒七升。水八升。先煮八味。取三升去滓。内胶。烊消尽。温服一升。日三服。一名复脉汤。
成注云补可以去弱。人参甘草大枣之甘。以补不足之气。桂枝生姜之辛。以益正气。圣济经曰。津液耗散为枯。
五脏痿弱。营卫涸流。湿剂所以润之。麻仁阿胶麦门冬地黄之甘。润经益血。复脉通心也。
琥按上注云。桂枝生姜之辛。以益正气。夫姜桂之辛。力能散邪。成氏反云。益气。误矣。又其引圣济经云。津液
耗散为枯。夫津液者。气血之所凝聚也。今者。伤寒至脉结代。心动悸。则血耗气散。故云。津液枯。炙甘草汤。本甘
温湿润之剂。用之以滋补枯竭。则气血充溢。而结代之脉自复。故一名复脉汤也。方中入清酒者。内台方云。以之为引。
为能通血助气。以复脉。故必欲用之。以煮药也。
脉按之来缓。而时一止。复来者。名曰结。又脉来动而中止。更来小数。中有还者。反动。名曰结。阴也。脉来动
而中止。不能自还。因而复动。名曰代阴也。得此脉者必难治。（此申明上文结代脉之状也。脉以指按之。来来者。滑伯
仁云。自骨肉之分。而出于皮肤之际。气之升者。是也。脉来缓时一止。即复来者。名曰结。成注云。此为邪气留结也。
脉来动而中止。更来时。脉小数。中。有一二至反动者。此即其既止而还来之脉。名曰结阴者是也。是为邪气留结更甚。
故不比前结脉之缓。其脉来时既动且数。乃真气卒不相续。而脉见止结也。又脉来动而中止。不能自还。不能自还者。
言既止之后不能即至。故云。若不能还。因而复动者。言既还之时。脉乃复动。是名曰代阴之脉。滑氏云。寻之良久乃
复强起。此善于形容代脉之状者也。成注以代脉为真气衰极。夫真气衰极。亦因邪气久留所致。叔和脉经云。脉结者生。
代者死。故云。难治。或问云。仲景既云。难治。何以复立炙甘草汤。余答云。代之与结。不甚悬绝。夫代者。结之甚。
结者。代之渐也。仲景言伤寒得此等脉为难治。非云。不治。因立炙甘草汤以救之。叔和言结脉生。代脉死者。以此等
止歇之脉。渐减。则邪气退。故生。渐增。则真气亡。故死。又仲景是专指伤寒之脉。叔和是兼指杂证之脉不可一例而
论）
（琥）按以上太阳病脉证并治法。仲景分上中下三篇。王叔和撰次伤寒论。以上编附伤寒例后。为第二卷。中篇为
第三卷。下编为第四卷。其第一卷。乃平脉辩脉法也。愚今以伤寒论。特取六经篇而辩注之。以故先述太阳篇例。学人
诚能取此书而读之。当知。仲景立法之备。制方之精有是证后用是药。无不效也。后医用其方药而不尽效者。必其见证
有未明也。且也。病家脉证。
未必条条与仲景立法之意相合。则用仲景方者。即可以方中药味分两。加减出入。神而明之。不惟冬月之正伤寒。
用其方而大效。即三时之类伤寒。用其方。亦无不效也。粗工临证草率。不知通变。死执仲景之方。用以治三时之类伤
寒不见效。即用以治冬月之正伤寒。亦未见效也。列传中。称仲景为医中之圣。其书为诸方之祖。古今治伤寒者。未有
能出其外者也。粗工用其方而少效。遂弃其书而不读。所以王宇泰辑伤寒准绳。窃笑世之医。有终身目不识仲景书者。
而犹自负云。我伤寒科也。善于治伤寒。是为欺世而盗虚名。杀人以养其身。噫抑何昧心之极至欤。
炙甘草（四两，经蜜炙） 生姜（三两，切片） 桂枝（三两，去皮） 人参（二两） 生地黄（一斤） 阿胶（二两） 麦门冬（半斤，去心） 麻子仁（半升） 大枣（十二枚，掰开）
以上九味药。用清酒七升、水八升，先煎煮前八味药，取汁三升，滤去药渣。加入阿胶，加热使其完全溶化。每次温服一升，每日服用三次。此方又名复脉汤。
成无己注解说：“补法可以治疗虚弱。人参、甘草、大枣的甘味，用来补充不足之气；桂枝、生姜的辛味，用来增益正气。”《圣济经》说：“津液耗散导致干枯，五脏痿弱，营卫之气枯竭流动停滞，湿性滋润的药物因此用来润燥。麻仁、阿胶、麦门冬、地黄的甘味，能滋润经脉、增益血液，恢复脉搏通畅心脏功能。”
琥按语：上述注释中说“桂枝、生姜的辛味，用来增益正气”。然而姜、桂的辛味，力量在于发散邪气，成氏反而说是益气，这是错误的。另外他引用《圣济经》说：“津液耗散导致干枯。”所谓津液，是气血凝聚而成的。如今伤寒病发展到出现脉结代、心动悸的症状，说明血耗气散，所以说津液干枯。炙甘草汤，本是甘温湿润的药剂，用它来滋补枯竭，则气血充盛，而结代之脉自然恢复，所以又名复脉汤。方中加入清酒的原因，《内台方义》说：把它作为引经药，因为它能通血脉、助阳气，以恢复脉搏，所以必须用它来煎煮药物。
脉搏按之来势缓慢，且偶尔有一次停顿，之后又继续跳动的，叫做“结”脉。另外，脉搏跳动时中途停止，再次跳动时频率稍快，中间有回返跳动的，也叫做“结”，属阴脉。脉搏跳动时中途停止，不能自行恢复，随后才再次跳动的，叫做“代”脉，也属阴脉。得到这种脉象的人，必定难以治疗。（此处阐明上文结脉和代脉的形态。脉搏用手指按压，来去的，滑伯仁说：从骨肉之间发出，到达皮肤表面，是气上升的表现。脉搏来势缓慢且偶尔停止，停止后又继续跳动的，叫做结脉。成无己注解说：这是邪气留滞凝结所致。脉搏跳动时中途停止，再次来时，脉搏稍快，中间有一两次反向跳动的，这就是既停止后又回来的脉，叫做结阴脉。这是邪气留滞更严重，所以不像前面的结脉那样缓慢。其脉来时既快又数，是真气突然不相接续，而脉出现止结。另外，脉搏跳动时中途停止，不能自行恢复。所谓不能自行恢复，是说停止之后不能立即到来，所以说“若不能还”。随后再次跳动的，是说回来之时，脉才再次跳动，这叫做代阴脉。滑氏说：寻按良久才重新强劲起搏，这善于形容代脉的状态。成无己认为代脉是真气极度衰微。真气极度衰微，也是由于邪气久留所致。王叔和《脉经》说：脉结者生，代者死。所以说难治。有人问：仲景既然说难治，为什么又设立炙甘草汤？我回答说：代脉与结脉，差别并不悬殊。代脉是结脉的严重阶段，结脉是代脉的渐进过程。仲景说伤寒得了这些脉象为难治，并不是说不治。因此设立炙甘草汤来救治。王叔和说结脉生、代脉死，是因为这类止歇的脉，逐渐减少，则邪气退却，所以生；逐渐增加，则真气消亡，所以死。另外，仲景是专指伤寒的脉象，王叔和是兼指杂病的脉象，不可一概而论。）
琥按：以上太阳病脉证并治的方法，仲景分为上、中、下三篇。王叔和编纂《伤寒论》，将上编附在《伤寒例》之后，作为第二卷；中篇作为第三卷；下编作为第四卷。第一卷乃是《平脉辩脉法》。我现今针对《伤寒论》，特别选取六经篇章进行辨析注释，因此先叙述太阳篇的体例。学者如果能取读此书，应当知道，仲景立法完备，制方精妙，有某种证候就用某种药物，没有不有效的。后世医生使用其方药而不尽有效，一定是因为对证候的认识不够明确。况且，病人的脉证，未必条条都与仲景立法的本意相符合，那么使用仲景方剂的人，就可以根据方中的药物味数和剂量，进行加减变化，神妙地运用它，不仅冬季的正伤寒，用其方剂大效，就是春、夏、秋三季类伤寒，用其方剂，也没有不有效的。庸医临证草率，不知变通，死板地执着于仲景的方剂，用来治疗三季的类伤寒不见效，即用来治疗冬季的正伤寒，也未见效。传记中称仲景为医中之圣，他的书为诸方之祖，古今治疗伤寒的人，没有能超出其范围的。庸医使用其方剂而疗效少，于是抛弃他的书不读。所以王宇泰编纂《伤寒准绳》，嘲笑世间的医生，有终身目不识丁不识仲景书的，却还自负地说：“我是伤寒科医生，善于治疗伤寒。”这是欺世盗名，杀人以养其身，唉，真是昧良心到了极点啊。
Gancao (Licorice Root, four liang, honey-fried) Shengjiang (Fresh Ginger, three liang, sliced) Guizhi (Cinnamon Twig, three liang, bark removed) Renshen (Ginseng Radix et Rhizoma, two liang) Shengdihuang (Rehmanniae Radix, one jin) Ejiao (Donkey-hide Gelatin, two liang) Maimendong (Ophiopogonis Radix, half jin, core removed) Maziren (Cannabis Fructus, half sheng) Dazao (Jujubae Fructus, twelve pieces, split open)
The above nine ingredients. Use seven sheng of clear wine and eight sheng of water. First decoct the first eight ingredients to obtain three sheng of liquid, then filter out the dregs. Add Ejiao and heat until completely dissolved. Take one sheng warm each time, three times a day. This formula is also known as Fumai Tang (Pulse-Recovering Decoction).
Cheng Wuji’s commentary states: "Tonification methods can treat weakness. The sweet nature of Renshen, Gancao, and Dazao tonifies deficient Qi. The pungent nature of Guizhi and Shengjiang benefits righteous Qi." The *Shengji Jing* (Holy Relief Classic) says: "When body fluids are consumed and scattered, dryness ensues; the five zang organs become atrophic and weak, and Ying and Wei Qi flow stagnates. Moistening agents are therefore used to moisten. The sweet nature of Maziren, Ejiao, Maimendong, and Shengdihuang moistens the meridians and benefits blood, restoring pulse flow and heart function."
Hu’s note: The aforementioned commentary states that "the pungent nature of Guizhi and Shengjiang benefits righteous Qi." However, the pungency of ginger and cinnamon has the power to disperse pathogenic factors; Cheng’s assertion that it benefits Qi is erroneous. Furthermore, his citation from the *Shengji Jing* states: "When body fluids are consumed and scattered, dryness ensues." Body fluids are the coagulation of Qi and Blood. In the current stage of Shanghan (Cold Damage) disease, where Jiedai Mai (Knotted and Intermitting Pulse) and Xindongji (Palpitations) occur, it indicates that Blood is depleted and Qi is scattered; thus, it is said that body fluids are dry. Zhigancao Tang is originally a sweet, warm, and moistening agent. Used to tonify dryness and depletion, it causes Qi and Blood to become abundant, and the knotted and intermitting pulse naturally recovers; hence, it is also named Fumai Tang. The reason for adding clear wine to the formula, according to the *Neitai Fangyi*, is that it serves as a guiding drug because it can unblock blood vessels and assist Qi to restore the pulse; therefore, it must be used to decoct the herbs.
When the pulse is pressed and feels slow, yet occasionally stops and then resumes, it is called "Jie" (Knotted) pulse. Additionally, when the pulse beats but stops midway, and upon resuming, the rate is slightly faster, with some rebound beats in between, it is also called "Jie," which belongs to Yin pulses. When the pulse beats but stops midway, cannot resume on its own, and only moves again subsequently, it is called "Dai" (Intermitting) pulse, which also belongs to Yin pulses. Those who present with this type of pulse will certainly be difficult to treat. (This clarifies the morphology of the Jie and Dai pulses mentioned above. Regarding the pulse felt by finger pressure, coming and going, Hua Borin stated: emerging from between bone and flesh, reaching the skin surface, represents the rising of Qi. A pulse that comes slowly, occasionally stops, and then resumes is called Jie pulse. Cheng Wuji commented: this is due to pathogenic factors lingering and knotting. A pulse that beats, stops midway, and upon resuming is slightly faster, with one or two rebound beats in between, is the pulse that has stopped and then returned, called Jie Yin pulse. This indicates more severe lingering of pathogenic factors, hence not as slow as the previous Jie pulse. When the pulse comes fast and rapid, it is because True Qi suddenly fails to connect continuously, causing the pulse to show stopping and knotting. Additionally, when the pulse beats but stops midway and cannot resume on its own. "Cannot resume on its own" means that after stopping, it does not immediately arrive, hence "if it cannot return." The subsequent movement means that upon returning, the pulse moves again; this is called Dai Yin pulse. Master Hua stated: searching for a long time before it rises strongly again well describes the state of the Dai pulse. Cheng Wuji considered Dai pulse as extreme deficiency of True Qi. Extreme deficiency of True Qi is also caused by prolonged lingering of pathogenic factors. Wang Shuhe's *Mai Jing* (Classic of Pulses) states: those with Jie pulse survive, those with Dai pulse die. Hence, it is said to be difficult to treat. One may ask: Since Zhang Zhongjing said it is difficult to treat, why did he establish Zhigancao Tang? I reply: Dai and Jie pulses are not vastly different. Dai is the severe stage of Jie; Jie is the gradual onset of Dai. Zhang Zhongjing stated that obtaining these pulses in Shanghan is difficult to treat, not untreatable. Therefore, Zhigancao Tang was established to save them. Wang Shuhe stated that Jie pulse implies survival and Dai pulse implies death because, regarding these stopping and resting pulses, if they gradually decrease, pathogenic factors recede, hence survival; if they gradually increase, True Qi perishes, hence death. Furthermore, Zhang Zhongjing specifically referred to pulses in Shanghan, whereas Wang Shuhe included pulses in miscellaneous diseases; they cannot be treated uniformly.)
Hu’s note: Regarding the treatment methods for Taiyang disease pulse and syndrome combinations, Zhang Zhongjing divided them into upper, middle, and lower sections. Wang Shuhe compiled the *Shanghan Lun*, attaching the upper section after the *Shanghan Li* (Examples of Cold Damage) as Volume II; the middle section as Volume III; and the lower section as Volume IV. Volume I is the *Ping Mai Bian Mai Fa* (Methods for Assessing and Distinguishing Pulses). I now specifically select the Six Meridian chapters of the *Shanghan Lun* for analysis and annotation; therefore, I first describe the principles of the Taiyang chapter. If scholars can read this book, they should understand that Zhang Zhongjing’s establishment of laws is comprehensive, and his formulation of prescriptions is exquisite: having a specific syndrome and using specific medicines yields efficacy without exception. When later physicians use his formulas and drugs without full efficacy, it is necessarily because their understanding of the syndromes is unclear. Moreover, patients' pulses and syndromes do not always align perfectly with Zhang Zhongjing’s legislative intent. Therefore, those using Zhang Zhongjing’s formulas can adjust the number of ingredients and dosages, applying divine flexibility. Not only will the formulas be highly effective for Zheng Shanghan (True Cold Damage) in winter, but they will also be effective for Lei Shanghan (Similar Cold Damage) in the other three seasons. Crude physicians act rashly in clinical practice, failing to adapt, rigidly adhering to Zhang Zhongjing’s formulas. Using them to treat Lei Shanghan in the three seasons yields no effect; even using them for Zheng Shanghan in winter often fails. Biographies refer to Zhang Zhongjing as the Sage among Physicians and his book as the Ancestor of All Formulas. Throughout history, no one treating Shanghan has been able to go beyond his scope. Crude physicians, finding little efficacy in his formulas, discard his books unread. Thus, Wang Yutai, in compiling *Shanghan Zhunsheng*, mocked physicians who have never read Zhang Zhongjing’s works in their entire lives yet arrogantly claim, "I am a Shanghan specialist, skilled in treating Cold Damage." This is deceiving the world to steal false fame, killing people to sustain oneself. Alas, how extremely unscrupulous is this!