愚因删之。）
若过十三日以上不间。尺寸陷者。大危（病少瘥。为间。此承上文而言。伤寒过十三日。诸经之病热。犹然不瘥。
其脉尺寸沉陷者。成注云。正气内衰。邪气独胜。故云大危。此一节乃仲景以证合脉脉证相参之大法也。愚按叔和参论
仲景伤寒处辄以脉验证。如最前节云。尺寸俱浮。尺寸俱长。俱弦等脉。而云此是太阳阳明少阳等病。又如下节云。脉
阴阳俱盛。重感于寒。变为温疟。又云阳脉浮滑。阴脉濡弱更遇于风变为风温等四病。反以脉为主。而病由脉定以至后
世之医。每每自矜神诊。专以不问病源为奇。其乖错可胜道哉。纵使叔和精于诊法。不宜作此等论。以误后之学人。）
若更感异气变为他病者。当根据后坏证病而治之若脉阴阳俱盛。重感于寒者。变为温疟。阳脉浮滑阴脉濡弱者。更遇
于风。变为风温。阳脉洪数。阴脉实大者。更遇温热。变为温毒。温毒为病最重也。阳脉濡弱。阴脉弦紧者。更遇温气。
变为温疫。以此冬伤于寒。发为温病。脉之变证。方治如说。（按仲景言坏病止二条。有太阳病不解之坏病。有本太阳病
不解。转入少阳之坏病皆以发汗吐下温针病仍不解。为医所坏。故云坏病。然仲景于两条之下。皆云观其脉证。知犯何
逆。随证治之。岂有更感异气。变为温疟风温温毒温疫等病。亦与坏病同一治法者邪。况仲景论中。但言治坏病之法。
无治坏病之方。叔和偏以此四种温病。皆因冬伤于寒所发。且云脉之变证。方治当如其所言。根据坏病之法而治之。庶起
叔和于今日。而求仲景治坏病之方。彼将何所指也。又按上四种温病。喻氏尚论篇已辩其妄。且此系叔和杜撰之文。愚
因起而删之。免致后学于脉上寻此四病。又欲于仲景坏病条。求治温之方。徒增疑惑耳。）
凡人有疾不时即治隐忍异差。以成痼疾。小儿女子。益以滋甚。时气不和。盒饭早言。寻其邪由。及在腠理。以时
治之罕有不愈者。患人忍之。数日乃说邪气入脏则难可制。此为家有患备虑之要。
凡作汤药不可避晨夜。觉病须臾。即宜便治。不等早晚则易愈矣。若或差迟病即传变。虽欲除治。必难为力。服药
不如方法。纵意违师。不须治之。（上二节喻氏云此巴人下里之音。因从删例。）
凡伤寒之病多从风寒得之。始表中风寒。入里则不消矣。未有温覆而当。不消散者。不在证治。（温覆而当。则在表
之风寒已散。不至传入于里。不须再议汤药。故云不在证治。）拟欲攻之。犹当先解表。乃可下之。若表已解。而内不消
非大满。犹生寒热则病不除。（上言非大满。犹生寒热。是表虽解而未尽解也。若但下之。则病不除。愚意云。此是大柴
胡汤证。成注云非大满。是邪未收敛成实。下之。则里虚而邪复不除。犹生寒热。斯言误矣。）若表已解。而内不消。大
满大实坚。有燥屎。自可除下之。虽四五日。不能为祸也。（上言四五日不能为祸。因医人于四五日之伤寒。每不敢轻用
下药。要之下证悉具。即用下药。实无所害非云证属可下。复可迟至四五日也。愚意云。此是大承气汤证无疑。）若不宜
下。而便攻之。内虚热入。协热遂利。烦躁诸变。不可胜数。轻者困笃重者必死矣。（以上系仲景语以下叔和之论居多。）
夫阳盛阴虚（外台秘要中作表和里病）汗之则死。下之则愈。（外台作下之而愈汗之则死。）阳虚阴盛。（又作里和表
病。）汗之则（又作而）愈下之则死。（按此节。外台中系王叔和之论。考其原论云表里。何等径捷快畅。表病宜汗里病
宜下。汗下合法者愈相反者死。自改作阴阳虚盛。致令后人。千言万语。注释不明。识者云。此是成无己以表为阳。以
里为阴。改其正文。以见己之善注。然亦无从征也。据坊本云。阳盛阴虚。此是热邪郁于里。乃里实之证。非真阴虚也。
若果阴虚。岂可轻言下乎。阳虚阴盛。此是寒邪束于表。乃表实之证。非真阳虚也。若果阳虚。岂可轻言汗乎。又阳盛。
当作热甚看。里热甚。故宜下。阴盛。当作寒甚看。表寒甚。故宜汗）
夫如是。则神丹安可以误发甘遂何可以妄攻。（神丹甘遂想叔和时汗下之药。世医之所通用。故遂举而作汗下之论耳。
按千金方有神丹丸见发汗第六第一方。）虚实（外台作表里。）之治。相背千里。吉凶之机。应若影响。岂容易哉。
况桂枝下咽。阳盛（外台作表和。）则毙。承气入胃。阴盛（又作里平。）以亡。（此承上文复申言阳盛之病。里热已
极。如误投桂枝汤。乃辛热发表之药。反济其里热之火。其人焉得不毙。然叔和何不曰麻黄下咽。而必曰桂枝也。愚以
仲景论桂枝证。皆系发热汗出。其阳明胃家实之证。亦身热汗自出。则是上言阳盛者。乃承气汤证也。当用承气。误投
桂枝。此以阳明汗多实热之条。错认作太阳汗出发热之候。所以承气桂枝。彼此多。两相误服也。若麻黄汤。乃太阳经
无汗之的药。与阳明 然汗出之证。两不相侔。不待智者。自能分辩。曷由而致误也。又阴盛之病。表寒外束。发热如
火。医人反认以为里实热甚。误投承气。焉得不亡。成注引金匮云。不当下而强与下之者。令人开肠洞泄。便溺不禁而
死。是以阴盛为里寒之阴证。误矣。）
死生之要。在乎须臾。视身之尽。不暇计日。此阴阳（外台作表里。）虚实之交错。其候至微发汗吐下之相反。其祸
至速。而医术浅狭。懵然不知病源。为治乃误使病者殒殁。自谓其分。至今冤魂塞于冥路。死尸盈于旷野。仁者鉴此。
岂不痛欤。
凡两感病俱作。治有先后。发表攻里。本自不同。而执迷妄意者。乃云神丹甘遂。合而饮之。且解其表。又除其里。
言巧似是。其理实违。夫智者之举错也。常审以慎。愚者之动作也。必果而速。安危之变。岂可诡哉世上之士。但务彼
翕习之荣。而莫见此倾危之败。惟明者。居然能护其本。近取诸身。夫何远之有焉。（上二节。辞义冗杂。大半可删。）
凡发汗温暖汤药其方。虽言日三服。若病剧不解。当促其间。可半日中尽三服。若与病相阻。即便有所觉病重者。
一日一夜。当 时观之。如服一剂。病证犹在。故当复作本汤服之。至有不肯汗出。服三剂乃解。若汗不出者。死病也。
（此一节辞义。仲景已明注在桂枝汤下。不宜于例中言之。）
凡得时气病。至五六日。而渴欲饮水。饮不能多。不当与也。何者。以腹中热尚少。不能消之。便更与人作病也。
至七八日。大渴欲饮水者。犹当根据证与之。与之常令不足。勿极意也。言能饮一斗。与五升。若饮而腹满。小便不利。
若喘若哕。不可与之。忽然大汗出。是为自愈也。凡得病。反能饮水。此为欲愈之病。其不晓病者。但闻病饮水。自愈。
小渴者乃强与饮之。因成其祸不可复数。（按上言时气病。即四时伤寒。皆是热病。热病属火。仲景用水法者。以水寒能
胜火热。故也。）
凡得病。厥脉动数。服汤药更迟。脉浮大减小。初躁后静。此皆愈证也。（更平声厥。其也。凡得病之人。其脉动数
者。或浮大者。服汤药后。其人脉更迟。或减小。又人于初病时。则躁乱。服汤药后得安静。凡此者。皆是向愈之证）
凡治温病。可刺五十九穴。人身之穴。三百六十有五。其三十穴。灸之有害七十九穴。刺之为灾。并中髓也。（按上
云温病。即内经云热病。皆系伤寒之类刺热病之法。详素问刺热论。又灵枢热病论中。愚以二篇经义。悉心参阅。合成
刺热病法。在后第十四卷中。凡治伤寒家。不可不知此法。盖以热邪之气。注入经络。一时汤药不能取效。非针则无以
泄其热。况仲景亦有刺风池风府期门等法。学医者所当究心。上言刺法。略举其端。令人无可下手处。此必是仲景刺热
遗论。叔和偶撰入此。）
脉四损。三日死。平人四息。病患脉一至。名曰四损。脉五损。一日死。平人五息。病患脉一至。名曰五损。脉六
损。一时死。平人六息。病患脉一至。名曰六损（愚按伤寒。系热病。热病缘何有损脉。此明系叔和增入。删之可也。）
脉盛身寒。得之伤寒。脉虚身热得之伤暑。（考素问刺志论云。气盛身寒。得之伤寒。气虚身热。得之伤暑。推内经
之意。以人形气盛者。身宜常温。而今反寒者。盖得之伤寒也。此伤寒。必是初起之寒。乃太阳病。未发热之时也。否
则身寒二字。不可为准。抑人形气虚者。身宜常清。而今反热者。盖得之伤暑也。此伤暑。必是受夏月清凉之气。其人
反无汗而身发热也。否则身热二字。亦不可为准。愚按此二句辞义。与上下文不相贯。叔和竟自我作古。以气字改脉字。
成注亦随文作解云。伤寒者。脉盛而身寒。伤暑者。脉虚而身热。自改脉字后。则撰者注者。遂相习于非。而违经作解。
使后之学人。察脉辩证。每见脉盛者。身未必寒而多热。脉虚者。身未必热而反凉。至有以身寒之中寒。为伤寒。身热
之伤寒。为伤暑。世医执此二语。其错误将无穷矣。况伤寒暑病。仲景于伤寒例前。言之已明。何得更入死脉类中。徒
起疑端耳。）
脉阴阳俱盛。大汗出不解者死。（汗出后宜解。不解者。脉仍盛也。）
脉阴阳俱虚。热不止者。死。（是为正气已虚。不胜邪热故也。）
脉至乍疏乍数者。死（成注云。此天真营卫之气。断绝也。）
脉至如转索者。其日死（成注云。此为紧急而不软。是中无胃气。故不出其日而死。）
谵言妄语身微热。脉浮大。手足温者。生。逆冷。（身不热。手足不温也。）脉沉细者。（不浮大也。）不过一日。死
矣。（是为脉证相反。故死。）
此以前。是伤寒热病证候也。（此指前七节之脉而言。以其中有不言是何病之脉。故复从而申明之也。或云。此总结
伤寒例通篇之意。成氏无注。诚为缺义。）
（琥）按上仲景伤寒例。其中杂入叔和之论颇多。金时成无己随文混注。不为分别。至明万历间歙人方中行。着伤
寒条辩。以其例非仲景书而削之。近今时有西昌喻嘉言云。此例乃叔和所作。遂从而驳正其失。复有程子郊倩。更起而
骂之。其毁讪前人。失之太过。愚家有宋板伤寒论。其例首。有四时八节气候决病法。此实出仲景手述。非叔和所能
道及。今读方喻程三家之书。知尊仲景矣。独略仲景决病法而不载。何昧昧也。愚以伤寒例。原系仲景之书。其中有与
内经相悖处。大都是叔和所撰。然叔和之言。亦有可采处。学人须悉心体认。则前人之得失迥然。自出。予非故为是毁
誉之端也。所可笑者。今医活人之技。万分不及古人。而指摘古人更甚。噫抑何不自量之甚欤。
（我因此将其删去。）
如果病程超过十三天以上，且病情没有间歇缓解。寸口和尺口的脉搏出现沉陷现象的，属于大危之证（病情稍有好转称为“间”。这是承接上文来说的。伤寒病过了十三天，各经的病热仍然没有痊愈。如果寸脉和尺脉都沉陷，成无己注释说：这是因为体内正气衰弱，邪气独自强盛。所以说这是大危之证。这一节是张仲景通过症状结合脉象、脉证相互参验的大法。我认为王叔和在论述张仲景治疗伤寒的方法时，总是以脉象来验证病症。如最前面一节说：寸脉和尺脉都浮，寸脉和尺脉都长，都弦等脉象，而说这是太阳病、阳明病、少阳病等。又如下一节说：脉象阴阳两部都盛大，再次感受寒邪，变为温疟。又说：阳脉浮滑，阴脉濡弱，再遇到风邪，变为风温等四种病。反而以脉象为主，由脉象来确定病症。以至于后世的医生，常常自夸诊断神奇，专门以不问疾病原因为奇能。这种错误难道能说尽吗？即使王叔和精通诊法，也不应该作出这样的论述，以免误导后来的学习者。）
如果再感受异气而变成其他疾病的，应当根据后面坏病的证候来治疗。如果脉象阴阳两部都盛大，再次感受寒邪的，变为温疟。阳脉浮滑，阴脉濡弱的，再遇到风邪，变为风温。阳脉洪数，阴脉实大的，再遇到温热邪气，变为温毒。温毒作为疾病是最严重的。阳脉濡弱，阴脉弦紧的，再遇到温气，变为温疫。像这样，冬天感受寒邪，发为温病，脉象变化的证候，方剂治疗方法如同上述所说。（按张仲景所说的坏病只有两条：有太阳病不解导致的坏病，有原本太阳病不解，转入少阳的坏病，都是因为发汗、吐下、温针治疗后病仍不愈，被医生治坏的，所以叫坏病。然而张仲景在两条之下，都说观察脉象和证候，知道犯了什么逆乱，随证治疗。哪里会有再次感受异气，变为温疟、风温、温毒、温疫等疾病，也与坏病采用同一治法的呢？况且张仲景的论著中，只说了治疗坏病的方法，没有治疗坏病的方子。王叔和偏偏认为这四种温病，都是因为冬天伤于寒邪所引发，并且说脉象变化的证候，方剂治疗应当像他所说的那样，根据坏病的方法来治疗。假如让王叔和活在今天，让他去寻找张仲景治疗坏病的方子，他将指向哪里呢？又按上面四种温病，喻昌在《尚论篇》中已经辨明其荒谬。而且这段文字是王叔和杜撰的，我因此起来将其删去，以免导致后学者在脉象上寻找这四种病，又想从张仲景坏病的条文中寻找治疗温病的方子，徒增疑惑罢了。）
大凡人有疾病，不及时治疗，隐忍拖延，导致差异变大，从而形成顽固性疾病。小儿和女子，病情会更加严重。时令之气不和，应当尽早告知（患者）。寻找邪气的来源，趁邪气还在腠理之间时，按时治疗，很少有不痊愈的。患者忍耐痛苦，几天后才诉说，此时邪气已经进入脏腑，就难以控制了。这是家中有人患病需要防备的关键要点。
凡是制作汤药，不可避开早晨或夜晚。发觉生病片刻，就应当立即治疗，不等早晚，就容易痊愈了。如果延误时机，病情就会传变，虽然想要去除治疗，也一定难以奏效。服药如果不按照方法，随意违背医嘱，就不必再治疗了。（上面两节，喻昌说是粗俗之音，因此跟随删除条例。）
大凡伤寒的病，多从风寒得来。开始是表中风寒，进入里层就不能消散了。没有保暖得当，而不能消散的情况。不在证候治疗的范围内。（保暖得当，那么在表的风寒已经散去，不至于传入内部，不需要再议汤药。所以说不在证治范围内。）打算攻逐邪气，还应当先解表，才可以泻下。如果表证已解，而内部邪气未消，如果不是大满实证，仍然产生寒热，那么病不能消除。（上面说如果不是大满实证，仍然产生寒热，是表证虽然解了但未尽解。如果只用泻下法，则病不能消除。我的意思是，这是大柴胡汤证。成无己注释说：不是大满实证，是邪气没有收敛成实，用泻下法，则里虚而邪气复留，仍然产生寒热。这种说法是错误的。）如果表证已解，而内部邪气未消，大满大实坚硬，有燥屎，自然可以施用泻下法。即使是四五天，也不会造成祸害。（上面说四五天不会造成祸害，是因为医生对于四五天的伤寒，往往不敢轻易使用下药。重要的是，如果下证全部具备，就立即使用下药，实际上并无害处。并不是说证候属于可下，还可以推迟到四五天。我的意思是，这无疑是承气汤证。）如果不适合泻下，却便去攻伐它，会导致内虚热入，协热下利，烦躁等各种变化，数不胜数。轻者困顿加重，重者必然死亡。（以上是张仲景的话，以下多为王叔和的论述。）
所谓阳盛阴虚（《外台秘要》中作表和里病），发汗则死，泻下则愈。（《外台》作泻下则愈，发汗则死。）阳虚阴盛。（又作里和表病。）发汗则（又作而）愈，泻下则死。（按这一节，《外台》中系王叔和的论述，考察其原文说表里，何等直接快捷流畅。表病宜发汗，里病宜泻下，发汗泻下合法则愈，相反则死。自己改为阴阳虚盛，致使后人千言万语，注释不明。有见识的人说，这是成无己把表当作阳，把里当作阴，修改正文，以显示自己善于注释。然而也无从考证。据坊间版本说，阳盛阴虚，这是热邪郁结在里，乃里实证，并非真正的阴虚。如果真的阴虚，岂可轻易言下？阳虚阴盛，这是寒邪束缚在表，乃表实证，并非真正的阳虚。如果真的阳虚，岂可轻易言汗？另外，阳盛，应当看作热甚。里热甚，故宜泻下。阴盛，应当看作寒甚。表寒甚，故宜发汗。）
像这样，那么神丹怎么可以误发汗，甘遂怎么可以妄攻下。（神丹、甘遂想是王叔和时代，医生通用的发汗和泻下药物，所以举出来作为发汗和泻下的论述罢了。按《千金方》中有神丹丸，见发汗第六第一方。）虚实（《外台》作表里）的治疗，相差千里。吉凶的机微，响应如同影随形。岂是容易的事呢？何况桂枝汤咽下，如果是阳盛（《外台》作表和）则毙命；承气汤入胃，如果是阴盛（又作里平）则死亡。（这是承接上文，再次申述阳盛的病，里热已到极点。如果误投桂枝汤，那是辛热发表的药物，反而资助里热之火，那人怎能不死。然而王叔和为什么不说是麻黄汤咽下，而一定要说桂枝汤呢？我认为张仲景论述桂枝证，都是发热汗出。其阳明胃家实的证候，也是身热汗自出。那么上面说的阳盛者，乃是承气汤证。应当用承气汤，误投桂枝汤。这是把阳明汗多实热的条文，错认作太阳汗出发热的证候。所以承气汤和桂枝汤，彼此多，两相误服。如果麻黄汤，是太阳经无汗的药物，与阳明汗出的证候，两者不相符合，不用智者，也能分辨，怎么会导致误治呢？另外阴盛的病，表寒外束，发热如火，医生反而认为是里实热甚，误投承气汤，怎能不死。成无己引用《金匮要略》说：不当下而强行给予泻下的，使人肠穿洞泄，大小便失禁而死。因此把阴盛当作里寒的阴证，是错误的。）
死生的关键，在于顷刻之间。看生命终结，来不及计算日子。这是阴阳（《外台》作表里）虚实交错，其征候至为微小。发汗、吐下方法的相反，其祸患至为迅速。而医术浅陋狭窄，糊涂不知病源，进行治疗于是错误，使病人殒命，自认为是本分。至今冤魂塞满冥路，死尸布满旷野。仁爱的人鉴察此情，难道不痛心吗？
凡是两感病同时发作，治疗有先后顺序。发表攻里，本来自然不同。而执迷妄想的人，却说神丹和甘遂，合在一起饮用。既解其表，又除其里。言辞巧妙似是而非，其道理实际违背常理。聪明人的举措，常常审慎而谨慎。愚昧者的动作，必定果断而快速。安危的变化，岂可欺诈呢？世上的人士，只追求那种合群习得的荣耀，而不看见这种倾覆危险的败局。只有明智的人，居然能保护其根本。近取诸身，有什么远的呢？（上面两节，辞义冗杂，大部分可以删去。）
凡是发汗温暖的汤药方子，虽然说一天服用三次，如果病情剧烈不缓解，应当缩短服药间隔，可以在半天中服完三剂。如果与病情相抵触，立刻就有感觉。病重的，一天一夜，应当时时观察。如果服了一剂，病证仍在，所以应当继续服用本汤。甚至有不肯出汗的，服了三剂才缓解。如果不出汗的，是死病。（这一节辞义，张仲景已经在桂枝汤下明确注明，不应当在条例中说。）
凡是得到时气病，到了五六天，口渴想喝水，但不能多喝，不应当给予。为什么呢？因为腹中热还少，不能消化它，便更给人带来病患。到了七八天，大渴想喝水的，还应当根据证候给予水喝。给予水时，常令其不足，不要刻意满足。说能喝一斗，给五升。如果喝了之后腹满，小便不利，如果喘或者哕，不可以给予。忽然大汗出，这是自愈。凡是得病，反而能喝水，这是将要痊愈的病。那些不懂病的人，只听说病饮水自愈，小渴的人就强行给他们喝，因而造成祸患，不可胜数。（按上面说的时气病，即四时伤寒，都是热病。热病属火，张仲景用水法，是因为水寒能胜火热，所以如此。）
凡是得病，厥脉动数，服用汤药后脉更迟，脉浮大减小，初躁后静，这些都是痊愈的证候。（更，读平声。厥，其也。凡是得病的人，其脉动数的，或浮大的，服用汤药后，其人脉更迟，或减小。又在初病时，则躁乱，服用汤药后得安静。凡此者，都是向愈的证候。）
凡是治疗温病，可以刺五十九穴。人身穴位三百六十有五。其中三十穴，灸之有害；七十九穴，刺之为灾，并中髓也。（按上面说的温病，即《内经》说的热病，都是伤寒之类。刺热病之法，详查《素问·刺热论》。又《灵枢·热病论》中，我仔细参阅二篇经义，合成刺热病法，在后第十四卷中。凡是治疗伤寒的人，不可不知此法。大概因为热邪之气，注入经络，一时汤药不能见效，非针刺无以泄其热。况且张仲景也有刺风池、风府、期门等法，学医者所当研究。上面说的刺法，略举其端，让人无可下手处。这一定是张仲景刺热病的遗论，王叔和偶然撰入其中。）
脉四损，三日死。平人四息，病患脉一至，名曰四损。脉五损，一日死。平人五息，病患脉一至，名曰五损。脉六损，一时死。平人六息，病患脉一至，名曰六损（我认为伤寒，系热病。热病为何有损脉？这明显是王叔和增入的，删去即可。）
脉盛身寒，得之伤寒。脉虚身热，得之伤暑。（考《素问·刺志论》说：气盛身寒，得之伤寒。气虚身热，得之伤暑。推究《内经》之意，以人体形气盛者，身宜常温，而今反寒者，大概是得了伤寒。此伤寒，必是初起之寒，乃太阳病，未发热之时。否则身寒二字，不可为准。抑人体形气虚者，身宜常清，而今反热者，大概是得了伤暑。此伤暑，必是受夏月清凉之气，其人反无汗而身发热也。否则身热二字，亦不可为准。我认为这两句辞义，与上下文不相连贯，王叔和竟自我作古，以气字改脉字。成无己也随文作解说：伤寒者，脉盛而身寒；伤暑者，脉虚而身热。自从改了脉字后，撰写者和注释者，便相习于非，而违背经文作解，使后之学人，察脉辨证，每见脉盛者，身未必寒而多热；脉虚者，身未必热而反凉。甚至以身寒之中寒，为伤寒；身热之伤寒，为伤暑。世医执着这两句话，其错误将无穷无尽。况且伤寒暑病，张仲景在《伤寒例》前，已经说得明白，何必再放入死脉类中，徒起疑端耳。）
脉阴阳俱盛，大汗出不解者死。（汗出后宜解，不解者，脉仍盛也。）
脉至乍疏乍数者，死（成无己注释说：这是天真营卫之气，断绝也。）
脉至如转索者，其日死（成无己注释说：此为紧急而不软，是中无胃气，故不出其日而死。）
谵言妄语，身微热，脉浮大，手足温者，生。逆冷。（身不热，手足不温也。）脉沉细者。（不浮大也。）不过一日，死矣。（这是脉证相反，故死。）
此以前，是伤寒热病证候也。（此指前七节的脉而言，其中有不言是何病的脉，所以又从而申明之。有人说，这是总结《伤寒例》通篇之意。成氏无注，诚为缺义。）
（琥）按上面张仲景《伤寒例》，其中杂入王叔和的论述颇多。金代成无己随文混注，不为分别。至明代万历年间，歙县人方中行，着《伤寒条辨》，以其例非张仲景书而削之。近来时有西昌喻嘉言说，此例乃王叔和所作，遂从而驳正其失。又有程郊倩，更起而骂之。其毁讪前人，失之太过。我家有宋版《伤寒论》，其例首，有四时八节气候决病法，此实出张仲景手述，非王叔和所能道及。今读方、喻、程三家之书，知尊张仲景矣。独略张仲景决病法而不载，何昧昧也。我认为《伤寒例》，原系张仲景的书，其中有与《内经》相悖处，大都是王叔和所撰。然而王叔和之言，亦有可采处。学人须悉心体认，则前人之得失迥然自出。我并非故意为此毁誉之端也。所可笑者，今医活人之技，万分不及古人，而指摘古人更甚。噫，抑何不自量之甚欤。
(I therefore deleted it.)
If the disease persists for more than thirteen days without remission, and the Cun (inch) and Chi (cubit) pulses appear sunken, this is a critical condition (Remission is referred to as "jian". This follows the previous text. After thirteen days of Shanghan, the heat in all meridians has not yet subsided. If both Cun and Chi pulses are sunken, Cheng Wuji annotated: "This indicates internal decline of righteous Qi and dominance of pathogenic factors." Hence, it is called a critical condition. This section illustrates Zhang Zhongjing's major principle of correlating symptoms with pulses.) I observe that Wang Shuhe, when discussing Zhang Zhongjing's treatments for Shanghan, often relied on pulse diagnosis to verify conditions. For instance, in the earliest section, it states that floating, long, or wiry pulses at both Cun and Chi correspond to Taiyang, Yangming, or Shaoyang diseases. In another section, it mentions that when both Yin and Yang pulses are excessive following a secondary cold contraction, it transforms into Wen Nue (Warm Malaria). It also states that floating-slippery Yang pulses combined with weak-soft Yin pulses, upon encountering wind, transform into Feng Wen (Wind-Warmth), among four such diseases. Here, the pulse takes precedence over the disease for diagnosis. This led later physicians to boast of their diagnostic prowess, priding themselves on treating without asking about the disease's origin. Such errors are countless. Even if Wang Shuhe was skilled in pulse diagnosis, he should not have made such assertions, lest they mislead future students.
If further exposure to different pathogens causes transformation into other diseases, treatment should follow the protocols for Huai Bing (Complicated Diseases) described later. If both Yin and Yang pulses are excessive and there is a secondary cold contraction, it transforms into Wen Nue (Warm Malaria). If Yang pulses are floating-slippery and Yin pulses are weak-soft, encountering wind leads to Feng Wen (Wind-Warmth). If Yang pulses are surging-numerous and Yin pulses are solid-large, encountering warm-heat leads to Wen Du (Warm Toxin). Wen Du is the most severe among these. If Yang pulses are weak-soft and Yin pulses are string-tight, encountering warm qi leads to Wen Yi (Warm Epidemic). Thus, winter injury by cold manifests as Wen Bing (Warm Diseases); the pulse changes and corresponding treatments are as described above. (Note: Zhang Zhongjing mentions only two types of Huai Bing: one resulting from unresolved Taiyang disease, and another where unresolved Taiyang disease transfers to Shaoyang. Both occur because sweating, vomiting, purging, or needle warming failed to resolve the illness, causing iatrogenic complications. In both cases, Zhang advises: "Observe the pulse and symptoms, identify the deviation, and treat according to the syndrome." How could secondary pathogen exposure leading to Wen Nue, Feng Wen, Wen Du, or Wen Yi be treated identically to Huai Bing? Moreover, Zhang Zhongjing's texts describe methods for treating Huai Bing but provide no specific formulas. Wang Shuhe uniquely claimed these four warm diseases stem from winter cold injury and suggested treating them via Huai Bing protocols. If Wang Shuhe were alive today, asked to find Zhang's formulas for Huai Bing, where would he look? Additionally, Yu Chang refuted the absurdity of these four warm diseases in his *Shanglun Pian*. Since this text appears fabricated by Wang Shuhe, I have deleted it to prevent students from seeking these non-existent conditions in pulse diagnoses or looking for warm-disease formulas in Zhang's Huai Bing sections, which only causes confusion.)
Generally, when illness strikes, prompt treatment is essential; delaying allows the condition to worsen into chronic disease. Children and women are particularly susceptible to aggravation. When seasonal qi is discordant, early intervention is advised. Identify the pathogen's entry point while it remains in the Cou Li (interstices). Timely treatment rarely fails. If patients endure suffering for days before seeking help, the pathogen may have entered the Zang-Fu organs, making control difficult. This vigilance is crucial for households managing illness.
When preparing decoctions, do not avoid day or night. Treat immediately upon detection; waiting is unnecessary for recovery. Delay allows transmission; even then, cure becomes difficult. Improper medication or ignoring medical advice renders treatment futile. (Yu Chang considered these two sections vulgar and followed the deletion guideline.)
Shanghan typically originates from Wind-Cold. Initially affecting the exterior, if it penetrates inward, it cannot dissipate naturally. Proper warmth prevents this progression. If the exterior pathogen is resolved, no further herbal treatment is needed ("not within the scope of syndrome differentiation"). To attack internal pathogens, one must first release the exterior before purging. If the exterior is resolved but internal stagnation persists without fullness, and chills/fever remain, the disease is not cured. (The absence of fullness suggests incomplete exterior resolution. Purging alone will fail. I believe this indicates Da Chai Hu Tang syndrome. Cheng Wuji argued that without fullness, pathogens haven't consolidated; purging harms interior righteousness, leaving pathogens and causing chills/fever. This view is erroneous.) If the exterior is resolved but internal stagnation persists with severe fullness, solidity, hardness, and dry feces, purging is appropriate. Even after four or five days, this poses no harm. (Physicians often hesitate to purge after four/five days. However, if purgative indications are complete, immediate purging is safe. It does not mean delaying purgation until day four or five. I believe this is undoubtedly Cheng Qi Tang syndrome.) If purging is inappropriate but forced, interior deficiency allows heat invasion, leading to協熱下利 (diarrhea with fever), irritability, and numerous complications. Mild cases worsen; severe cases result in death. (The preceding text is Zhang Zhongjing's; the following is largely Wang Shuhe's.)
Regarding "Yang Excess and Yin Deficiency" (In *Wai Tai Mi Yao*, written as "Exterior Harmonious and Interior Disease"), sweating causes death, while purging cures. (In *Wai Tai*, it reads: purging cures, sweating causes death.) Regarding "Yang Deficiency and Yin Excess" (Also written as "Interior Harmonious and Exterior Disease"), sweating cures, while purging causes death. (In *Wai Tai*, this section is attributed to Wang Shuhe. The original text regarding Exterior/Interior is direct and clear: Exterior disease requires sweating, Interior disease requires purging; correct application heals, reversal kills. By changing this to "Yin/Yang Excess/Deficiency," Wang caused endless confusing commentary. Scholars suggest Cheng Wuji altered the text to align with his theory of Exterior=Yang and Interior=Yin. According to local editions, "Yang Excess Yin Deficiency" refers to heat constrained in the interior (Interior Excess), not true Yin deficiency. True Yin deficiency precludes harsh purging. "Yang Deficiency Yin Excess" refers to cold binding the exterior (Exterior Excess), not true Yang deficiency. True Yang deficiency precludes harsh sweating. Furthermore, "Yang Excess" implies intense heat (interior), warranting purging. "Yin Excess" implies intense cold (exterior), warranting sweating.)
Thus, how can Shen Dan be wrongly used to induce sweating, or Gan Sui be recklessly used to purge? (Shen Dan and Gan Sui were likely common diaphoretic and purgative drugs in Wang Shuhe's time, cited here as examples.) The treatment of Deficiency vs. Excess differs by a thousand li. The mechanism of fortune and misfortune responds like an echo. Is this easy? If Gui Zhi Tang is taken when Yang is Excess (or Exterior Harmonious), death ensues. If Cheng Qi Tang enters the stomach when Yin is Excess (or Interior Harmonious), death occurs. (This reiterates that extreme interior heat, if mistakenly treated with Gui Zhi Tang—a pungent-warm exterior-releasing formula—fuels the fire, leading to death. Why did Wang specify Gui Zhi instead of Ma Huang? Zhang Zhongjing associates Gui Zhi with fever and sweating. Yangming Stomach Excess also presents with fever and spontaneous sweating. Thus, "Yang Excess" refers to Cheng Qi Tang syndrome. Using Gui Zhi by mistake confuses Yangming excess-heat with Taiyang sweat-fever, leading to mutual misuse. Ma Huang is for Taiyang without sweat, distinct from Yangming sweating, easily distinguished. Regarding Yin Excess: exterior cold binding causes high fever. If mistaken for interior excess-heat and treated with Cheng Qi Tang, death results. Cheng Wuji cites *Jin Gui Yao Lue*: improper purging causes intestinal perforation and incontinence. Thus, equating Yin Excess with interior-cold Yin syndrome is incorrect.)
Life and death hinge on moments. Time runs out before one can count days. The interplay of Yin/Yang (or Exterior/Interior) and Deficiency/Excess presents subtle signs. Reversing sweating, vomiting, or purging brings rapid disaster. Shallow medical knowledge and ignorance of origins lead to fatal errors. Patients die, believing it their fate. Ghosts fill the netherworld; corpses litter the fields. Would not benevolent people grieve this?
When Liang Gan Bing (Double-Contraction Disease) occurs, treatment must follow a sequence. Releasing the exterior and attacking the interior are fundamentally different. Ignorant practitioners claim mixing Shen Dan and Gan Sui resolves both exterior and interior simultaneously. This sounds clever but is theoretically wrong. Wise actions are cautious; foolish actions are rash. Safety and danger vary greatly. People seek superficial glory, ignoring impending ruin. Only the wise protect the root. Taking oneself as reference, what need for distance? (These two sections are verbose and largely deletable.)
For diaphoretic warm decoctions, though prescribed three times daily, if the disease persists severely, shorten intervals to finish three doses within half a day. If symptoms resist, monitor closely. For severe cases, observe day and night. If one dose fails to resolve symptoms, continue the same decoction. Some require three doses to sweat. Failure to sweat indicates death. (Zhang Zhongjing already clarified this under Gui Zhi Tang; it shouldn't be repeated in the General Principles.)
For Seasonal Qi diseases, by day 5-6, if thirsty but unable to drink much, do not force fluids. Internal heat is insufficient to process large amounts; forcing it causes pathology. By day 7-8, if intensely thirsty, provide water according to symptoms. Do not overfill; limit intake (e.g., if they want one dou, give five sheng). If drinking causes abdominal fullness, urinary difficulty, wheezing, or hiccups, stop. Spontaneous heavy sweating indicates self-healing. Ability to drink water generally signals recovery. Uninformed people, hearing "water cures," force-feed the mildly thirsty, causing irreversible harm. (Seasonal Qi diseases are four-season Shanghan, all heat diseases. Water counteracts fire/heat.)
If the Jue pulse is active-numerous, and post-medication it becomes slower, or floating-large reduces to smaller, and restlessness turns to calm, these are signs of recovery. (Pulse slowing/reducing and calming indicate improvement.)
For treating Warm Diseases, fifty-nine acupuncture points may be used. Of the 365 points, thirty are harmful if moxa-ed, and seventy-nine are disastrous if punctured (risking marrow penetration). (Warm Disease equals Heat Disease in *Nei Jing*, a subset of Shanghan. See *Su Wen: Ci Re Lun* and *Ling Shu: Re Bing Lun*. I synthesized these into a Heat Disease Acupuncture method in Volume 14. Physicians must know this, as herbs may act too slowly against heat entering meridians; needles drain heat effectively. Zhang Zhongjing also used Feng Chi, Feng Fu, and Qi Men. The original text lists endpoints vaguely, likely lost fragments inserted by Wang Shuhe.)
Four-Damage Pulse: Death in three days. A healthy person breathes four times per pulse beat; patient has one beat per four breaths. Five-Damage Pulse: Death in one day. Patient has one beat per five breaths. Six-Damage Pulse: Death in an instant. Patient has one beat per six breaths. (Shanghan is a heat disease; why damage pulses? This is likely Wang Shuhe's addition and should be deleted.)
Excessive pulse with cold body indicates Shanghan. Weak pulse with hot body indicates Shang Shu (Summerheat Injury). (*Su Wen: Ci Zhi Lun* states: Qi excess/cold body = Shanghan; Qi deficiency/hot body = Shang Shu. Healthy Qi-excess bodies feel warm; coldness indicates initial Shanghan (Taiyang, pre-fever). Healthy Qi-deficiency bodies feel cool; heat indicates Summerheat from cooling air, causing anhidrosis and fever. These sentences contradict the context. Wang Shuhe changed "Qi" to "Pulse." Cheng Wuji followed suit. This error leads clinicians to misdiagnose: assuming pulse-excess always means cold (it often means heat), or pulse-weakness always means heat (it often means cold). Confusing Cold Damage with Summerheat Injury causes infinite errors. Zhang Zhongjing already clarified these distinctions earlier; inserting them here creates confusion.)
Excessive Yin-Yang pulses with unremitting profuse sweating: Death. (Sweating should resolve the condition; persistence indicates lingering excess pulse.)
Weak Yin-Yang pulses with unremitting fever: Death. (Righteous Qi is depleted, unable to overcome pathogenic heat.)
Intermittent slow-fast pulses: Death. (Cheng Wuji: Termination of primordial Ying-Wei Qi.)
Pulse like a turning cord: Death on that day. (Cheng Wuji: Tight and unyielding, indicating lack of Stomach Qi.)
Delirium, slight fever, floating-large pulse, warm hands/feet: Survival. Cold extremities (no fever, cold hands/feet), deep-thin pulse (not floating-large): Death within one day. (Pulse-symptom mismatch leads to death.)
The above describes Shanghan and Heat Disease syndromes. (Refers to the preceding seven sections on pulses, clarifying those without specific disease names. Some say this summarizes the entire *Shanghan Li*; Cheng Wuji lacked annotation, a deficiency.)
(Hu) Note: Zhang Zhongjing's *Shanghan Li* contains much of Wang Shuhe's commentary. Cheng Wuji mixed annotations without distinction. Fang Zhongxing in the Ming Dynasty (*Shanghan Tiaobian*) removed the *Li* as non-Zhang Zhongjing. Yu Jia Yan later refuted Wang Shuhe's authorship. Cheng Jiao Qian criticized them excessively. My Song edition of *Shanghan Lun* includes the "Four Seasons and Eight Festivals Climate Diagnosis Method" at the start, genuinely by Zhang Zhongjing, beyond Wang Shuhe's capability. Fang, Yu, and Cheng respected Zhang but omitted this diagnostic method, which is ignorant. I believe the *Shanghan Li* is originally Zhang's, but contradictions with *Nei Jing* are mostly Wang's additions. Wang's words still have value. Students must discern past merits and faults. I do not intend bias. It is laughable that modern doctors' healing skills are far inferior to ancients, yet they criticize ancients more severely. Alas, how immodest!