发汗病〔不〕解，反恶寒者，虚故也，芍药甘草附子汤主之。
【按】
发汗病不解之「不」字，衍文也。发汗病不解，则当恶寒，何谓反恶寒，病解恶寒，
始可谓虚，当删之。
病发热头痛，脉反沉，若不差，身体疼痛，「下利清谷」，当温其里，宜四逆汤。
【按】
身体疼痛之下，当有「下利清榖」四字，若无此四字，则当温其里之文，竟无□落矣
，未有表病而温里之理也。阅后太阴篇中云：伤寒医下之，续得下利清谷不止，身痛
者，急当救里，四逆汤，其义益明，遵经补之。
伤寒，「若汗」、若吐、若下后，七、八日不解，热结在里，表里俱热，时「汗」〔
时〕恶风，大渴，舌上干燥而烦，欲饮水数升者，白虎加人参汤主之。
【按】
伤寒之下，当有「若汗」二字，盖汗较吐下伤津为多也。「时时恶风」，当是「时汗
恶风」，若非「汗」字，则时时恶风，是表不解，白虎汤在所禁也。论中谓发热无汗
，表不解者，不可与白虎汤。渴欲饮水，无表证者，白虎加人参汤主之。细玩经文自
知，当补之改之。
发汗已，脉浮数，「小便不利」烦渴者，五苓散主之。
【按】
脉浮数之下，当有「小便不利」四字，若无此四字，则为阳明内热口燥之烦渴，是白
虎汤证也。惟其小便不利而烦渴，斯为太阳水热瘀结之烦渴，始属五苓散证。若非小
便不利而用五苓散，则犯重竭津液之禁矣。况太阳上篇类此证者数条，惟水入即吐一
条，乃水不下行，故无小便不利之文，余皆有「小便不利」四字。今此四字，必是传
写之遗，当补之。
服桂枝汤，或下之，仍头项强痛，翕翕发热，无汗，心下满微痛，小便不利者，桂枝
汤去「芍药」〔桂〕加茯苓白术汤主之。
【按】
去桂当是去芍药。此方去桂，将何以治仍头项痛，发热无汗之表乎？细玩其服此汤，
曰余根据桂枝汤法煎服，其义自见。服桂枝汤已，温覆令一时许，通身□□微似有汗，
此服桂枝汤法也。若去桂则是白芍、甘草、茯苓、白术，并无辛甘走荣卫之品，而曰
：余根据桂枝汤法，无所谓也。且论中脉促胸满汗出恶寒者，用桂枝去芍药加附子汤主
之，去芍药者，为胸满也，今证虽稍异，而满则同，其为去芍药可知，当改之。
伤寒，医以丸药大下之，身热不去，微烦者，栀子「豉」〔干姜〕汤主之。
伤寒五、六日，大下之后，身热不去，心中结痛者，未欲解也，栀子「干姜」〔豉〕
汤主之。
【按】
栀子干姜汤，当是栀子豉汤；栀子豉汤，当是栀子干姜汤。断无烦热用干姜，结痛用
香豉之理，当移之。
太阳病，脉浮紧，无汗，发热，身疼痛，八、九日不解，表证仍在，此当发其汗，「
麻黄汤主之」。服药已，微除，其人发烦目瞑，剧者必衄，衄乃解，所以然者，阳气
重故也。〔麻黄汤主之〕
【按】
张兼善曰：「麻黄汤主之」五字，不应在阳气重之下，岂有衄乃解之后，而用麻黄汤
之理乎？服药已之上，并无所服何药之文，将此五字移于其上，文义始合，当移之。
伤寒不大便，六、七日，头痛有热者，与承气汤。其小便清者，知不在里，仍在表也
，当须发汗。「苦」〔若〕头痛者，必衄，宜桂枝汤。
【按】
若头痛之「若」字，当是「苦」字。「苦」头痛方为必衄证，若是「若」字，则凡头
痛皆能致衄矣。当改之。
心下痞，按之「不」濡，其脉关上浮者，大黄黄连泻心汤主之。
【按】
按之濡，当是「按之不濡」，若按之濡，乃虚痞也，补之不暇，岂有用大黄泻之之理
乎？当补之。
发汗后病证未解除，反而出现恶寒症状的，属于虚证，应当用芍药甘草附子汤主治。
【按语】
发汗后病证未解除中的“不”字，是衍文（多余的字）。如果发汗后病证未解除，那么应当出现恶寒症状，怎么能说是“反而”恶寒呢？只有当病证已解却仍见恶寒时，才可以称之为虚证，因此应当删去这个“不”字。
病人出现发热、头痛，脉象反而沉细，如果病情没有好转，身体疼痛，并且出现“下利清谷”（大便中有未消化的食物），应当温补里虚，适宜使用四逆汤。
【按语】
在“身体疼痛”之下，应当有“下利清谷”这四个字。如果没有这四个字，那么“应当温补里虚”的论述就失去了依据和落脚点，因为没有表证而直接温补里的道理是不通的。阅读后面的太阴篇中提到：“伤寒医生误用泻下法，随后出现下利清谷不止，身体疼痛的，应当紧急救里，使用四逆汤”，这样意义更加明确，遵循经文进行补充。
患伤寒病，如果经过发汗、催吐或泻下治疗后，七八天病邪仍未解除，热邪结聚在体内，表里都发热，有时出汗且伴有恶风，极度口渴，舌上干燥且心烦，想要喝几升水的，应当用白虎加人参汤主治。
【按语】
在“伤寒”之下，应当有“若汗”这两个字，因为发汗比催吐和泻下更伤津液。“时时恶风”（经常感到怕风），应当是“时汗恶风”（有时出汗且怕风）。如果不是“汗”字，而是经常怕风，说明表证未解，白虎汤就在禁忌之列了。论中说道：发热无汗，表证未解的，不可给予白虎汤。口渴想喝水，没有表证的，用白虎加人参汤主治。仔细研读经文自然明白，应当补充并修改。
发汗之后，脉象浮数，出现“小便不利”、心烦口渴的，应当用五苓散主治。
【按语】
在“脉浮数”之下，应当有“小便不利”这四个字。如果没有这四个字，那就是阳明经内热导致的口燥烦渴，这是白虎汤的适应证。正因为有小便不利且烦渴，这才是太阳经水热互结导致的烦渴，才属于五苓散的适应证。如果不是小便不利而使用五苓散，就犯了再次耗竭津液的禁忌。况且太阳上篇中类似的证候有好几条，只有“水入即吐”一条，是因为水气不能下行，所以没有提到小便不利，其余各条都有“小便不利”这四个字。现在这四个字，一定是传抄遗漏所致，应当补充。
服用桂枝汤后，或者经过泻下治疗，仍然头项强痛，发热如羽毛覆盖般（翕翕发热），无汗，胃脘部胀满微痛，小便不利的，应当用桂枝汤去掉“芍药”（改为去掉桂枝）加上茯苓、白术的主治方剂——桂枝去桂加茯苓白术汤来主治。
【按语】
去掉桂枝应当是去掉芍药。这个方子如果去掉桂枝，拿什么来治疗仍然存在的头项强痛、发热无汗的表证呢？仔细推敲文中说服用此汤，“其余按照桂枝汤的方法煎服”，其中的含义自然显现。服用桂枝汤后，加盖衣被约一顿饭工夫，全身微微似有汗出，这才是服用桂枝汤的方法。如果去掉桂枝，剩下的就是白芍、甘草、茯苓、白术，并没有辛甘发散以调和营卫的药物，却说“其余按照桂枝汤的方法”，这就毫无意义了。况且论中记载脉促胸满汗出恶寒的，用桂枝去芍药加附子汤主治，去掉芍药是因为胸满；现在的证候虽然稍有不同，但都有胀满，由此可知应当去掉芍药，应当改正。
患伤寒，医生用丸药猛烈泻下，身热不退，心中轻微烦躁的，应当用栀子豉汤（原文作干姜汤，应为误写）主治。
患伤寒五六天，经过猛烈泻下后，身热不退，心中结滞疼痛的，病势尚未解除，应当用栀子干姜汤（原文作豉汤，应为误写）主治。
【按语】
栀子干姜汤，应当是栀子豉汤；栀子豉汤，应当是栀子干姜汤。绝没有烦躁热邪用干姜，结滞疼痛用香豉的道理，应当互换位置。
太阳病，脉象浮紧，无汗，发热，身体疼痛，经过八九天病邪仍未解除，表证仍在，这应当发汗，[此处原误置于文末]“麻黄汤主治”。服药后，症状稍减，其人感到心烦，眼睛闭合不想睁开，严重的必然流鼻血，鼻血流出后病才能解除。之所以这样，是因为阳气郁闭过重的缘故。[麻黄汤主治]
【按语】
张兼善说：“麻黄汤主治”五个字，不应该放在“阳气重”之下，哪有流鼻血病解之后，再用麻黄汤的道理呢？在“服药已”之上，并没有说明服用的是什么药的文字，将这五个字移到“服药已”之上，文义才通顺，应当移动。
患伤寒不大便，六七天，头痛且有发热的，给予承气汤。如果小便清澈的，知道病邪不在里，仍在表，应当需要发汗。“苦”（原文作若）于头痛的，必然流鼻血，适宜用桂枝汤。
【按语】
“若头痛”的“若”字，应当是“苦”字。“苦”头痛才是必然流鼻血的证候，如果是“若”字，那么凡是头痛都能导致流鼻血了。应当改正。
If the disease persists after sweating, and chills appear instead, it is due to deficiency; Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction) should be administered.
[Commentary]
The character "bu" (not) in "disease does not resolve after sweating" is a superfluous character. If the disease does not resolve after sweating, chills are expected; how can they be described as appearing "instead"? Only when chills persist after the disease has resolved can it be termed deficiency. Therefore, this character should be deleted.
When a patient presents with fever, headache, and a pulse that is surprisingly deep, if the condition does not improve, and body pain occurs accompanied by "diarrhea with undigested food," the interior should be warmed, and Sini Tang (Four Reversal Decoction) is appropriate.
[Commentary]
The four characters "diarrhea with undigested food" should follow "body pain." Without these four characters, the instruction to "warm the interior" lacks a basis, as there is no rationale for warming the interior when only exterior symptoms exist. Reading further into the Taiyin Chapter states: "In cold damage, if the physician incorrectly uses purgatives, leading to continuous diarrhea with undigested food and body pain, one must urgently rescue the interior using Sini Tang." This clarifies the meaning, so we follow the classic text to supplement it.
In cold damage, if, after sweating, vomiting, or purging, the pathogen remains unresolved after seven or eight days, heat becomes fixed within, causing both exterior and interior heat. There may be occasional sweating with aversion to wind, extreme thirst, dryness on the tongue with irritability, and a desire to drink several liters of water. Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) should be administered.
[Commentary]
The two characters "ruo han" (if sweating) should follow "cold damage," as sweating injures fluids more than vomiting or purging. "Shishi ewufeng" (frequent aversion to wind) should likely be "shi han ewufeng" (occasional sweating with aversion to wind). If it were merely frequent aversion to wind without sweating, it would indicate an unresolved exterior, making Baihu Tang contraindicated. The treatise states: "For fever without sweating and unresolved exterior, Baihu Tang must not be given. For thirst with desire to drink water but no exterior syndrome, Baihu Jia Renshen Tang is indicated." Careful study of the text reveals this; corrections and supplements are necessary.
After sweating, if the pulse is floating and rapid, and there is "difficulty in urination" accompanied by irritability and thirst, Wuling San (Five-Ingredient Powder with Poria) should be administered.
[Commentary]
The four characters "difficulty in urination" should follow "floating and rapid pulse." Without them, the irritability and thirst would stem from Yangming internal heat, indicating Baihu Tang as the indication. However, because there is difficulty in urination along with irritability and thirst, this indicates water-heat entanglement in the Taiyang channel, which is the specific indication for Wuling San. Using Wuling San without difficulty in urination would violate the prohibition against further depleting fluids. Furthermore, in the Taiyang Upper Chapter, similar cases are listed; only the case of "vomiting immediately after drinking" lacks mention of difficulty in urination because the water fails to descend. All other cases include these four characters. Their absence here is likely a transcription error and should be supplemented.
After taking Guizhi Tang, or following purgation, if head and nape stiffness, mild fever (like a feather covering), anhidrosis, epigastric fullness with slight pain, and difficulty in urination persist, Guizhi Qu Gui Jia Fuling Baizhu Tang (Cinnamon Twig Decoction minus Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction) should be administered. [Note: The original text suggests removing Guizhi, but commentary argues for removing Shaoyao].
[Commentary]
Removing Guizhi should actually mean removing Shaoyao. If Guizhi is removed, what agent treats the persistent head/nape stiffness, fever, and anhidrosis of the exterior? Carefully considering the instruction to "prepare the rest according to Guizhi Tang methods" reveals the intent. Taking Guizhi Tang involves covering with blankets for about an hour until slight perspiration appears—this is the method for Guizhi Tang. If Guizhi were removed, the remaining ingredients (Shaoyao, Gancao, Fuling, Baizhu) lack acrid-sweet properties to move Ying and Wei, rendering the instruction to follow Guizhi Tang methods meaningless. Additionally, in cases of rapid pulse, chest fullness, sweating, and aversion to wind, Guizhi Qu Shaoyao Jia Fuzi Tang is used; Shaoyao is removed due to chest fullness. Although the current case differs slightly, fullness is present, indicating Shaoyao should be removed. Correction is needed.
In cold damage, if a physician uses pill-based strong purgatives, and body heat persists with slight irritability, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) should be administered. [Note: Text implies swap between Zhizi Chi Tang and Zhizi Ganjiang Tang].
In cold damage lasting five or six days, after strong purgation, if body heat persists and there is a knotted pain in the heart region, the disease is not yet resolving; Zhizi Ganjiang Tang (Gardenia and Dried Ginger Decoction) should be administered. [Note: Text implies swap between Zhizi Chi Tang and Zhizi Ganjiang Tang].
[Commentary]
Zhizi Ganjiang Tang should be Zhizi Chi Tang; Zhizi Chi Tang should be Zhizi Ganjiang Tang. It is illogical to use Ganjiang (Dried Ginger) for irritant heat or Chi Shi (Fermented Soybean) for knotted pain. The names should be swapped.
In Taiyang disease, with a floating-tight pulse, anhidrosis, fever, and body pain, if unresolved after eight or nine days and exterior signs remain, sweating should be induced, and Mahuang Tang (Ephedra Decoction) should be administered. After taking the medicine, symptoms may slightly subside; the patient may become irritable and close their eyes. In severe cases, epistaxis (nosebleed) will occur, and the disease resolves upon bleeding. This occurs because Yang Qi is excessively constrained. [Mahuang Tang should be administered - Note: Commentary suggests moving this phrase].
[Commentary]
Zhang Jianshan stated: The five characters "Mahuang Tang should be administered" should not appear after "Yang Qi is excessive." How could Mahuang Tang be used after the disease resolves via epistaxis? Above the phrase "after taking medicine," there is no mention of what drug was taken. Moving these five characters above "after taking medicine" makes the text coherent. Correction is needed.
In cold damage with constipation for six or seven days, if there is headache and fever, Chengqi Tang (Laxative Decoction) may be given. If urine is clear, knowing the pathogen is not in the interior but remains in the exterior, sweating should be induced. If the patient suffers from headache ("ku" headache), epistaxis is likely, and Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
[Commentary]
The character "ruo" (if) in "ruo tou tong" should be "ku" (suffer from). "Ku" headache is a sign of impending epistaxis; if "ruo" is used, it implies all headaches cause epistaxis, which is incorrect. Correction is needed.
Epigastric stuffiness, where palpation reveals hardness ("bu ru"), and the pulse is floating at the Guan position, indicates Da Huang Huanglian Xiexin Tang (Rhubarb, Coptis, and Scutellaria Heart-Draining Decoction) should be administered.
[Commentary]
Palpation revealing softness ("ru") should be "palpation revealing hardness" ("bu ru"). If it were soft, it would be a deficiency-type stuffiness, requiring tonification rather than purgation with Da Huang. Supplementation is needed.