太阴之为病，腹满而吐，食不下，时腹自痛，若下之，必胸下结□，「自利益甚」。
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吴人驹曰：「自利益甚」四字，当在必胸下结□之下，若在吐食不下之下，则是已吐
食不下而自利益甚矣。仲景复曰：若下之无所谓也，从而移之。
伤寒，本自寒「格」〔下〕，医复吐下之，寒格更逆吐下，若食入口即吐，干姜黄连
黄芩人参汤主之。
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经论中并无寒下之病，亦无寒下之文。玩本条下文，寒格更逆吐下，可知寒下之「下
」字，当是「格」字，文义始属。注家皆释胃寒下利，不但文义不属，且与芩、连之
药不合，当改之。
少阴病，饮食入口即吐，心中「嗢嗢」〔温温〕欲吐，复不能吐，始得之，手足寒，
脉弦迟者，此胸中实，不可下也，当吐之，若膈上有寒饮，干呕者，不可吐也，当温
之，宜四逆汤。
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「温温」当是「嗢嗢」，嗢嗢者，乃吐饮之状也，当改之。
伤寒，厥而心下悸者，「以饮水多」，宜先治水，当服茯苓甘草汤，却治其厥，不尔
，水渍入胃，必作利也。
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厥而心下悸者之下，当有「以饮水多」四字，若无此四字，乃阴盛之厥悸，非停水之
厥悸矣，何以即知是水，而曰宜先治水耶？当补之。
伤寒脉微而厥，至七、八日肤冷，其人躁，无暂安时者，此为藏厥，非蛔厥也。蛔厥
者，其人当吐蛔，今病者静，而复时烦者，「非」〔此〕为藏寒，蛔上入其膈，故烦
，须臾复止，得食而呕，又烦者，蛔闻食臭出，其人当自吐蛔，蛔厥者，乌梅丸主之
，又主久利。
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此为藏寒之「此」字，当是「非」字，若是「此」字，即是藏厥，与辨蛔厥之义不属
，当改之。
伤寒五、六日，不「大便」〔结胸〕，腹濡，脉虚复厥者，不可下，此为亡血，下之
死。
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「结胸」二字，当是「大便」二字。不结胸腹濡脉虚复厥，皆无可下之理。今曰：不
可下，何所谓也？当改之。
伤寒始发热六日，厥反九日而利，凡厥利者，当不能食，今反能食者，恐为除中，食
以索饼，「若」〔不〕发热者，知胃气尚在，必愈。恐暴热来出复去也，后三日脉之
，其热续在者，期之旦日夜半愈。所以然者，本发热六日，厥反九日，复发热三日，
并前六日，亦为九日，与厥相应，故期之旦日夜半愈，后三日脉之而脉数，其热不罢
者，此为热有余，必发痈脓也。
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不发热者之「不」字，当是「若」字，若是「不」字，即是除中，何以下接恐暴热来
出而复去之文耶？当改之。
伤寒脉迟，六、七日，「厥而下利」，而反与黄芩汤彻其热，脉迟为寒，今与黄芩汤
复除其热，腹中应冷，当不能食，今反能食，此名除中，必死。
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伤寒脉迟六、七日之下，当有「厥而下利」四字，若无此四字，则非除中证也。况有
此四字，始与下文反与黄芩汤之义相属，当补之。
太阴病的主要表现是腹部胀满并伴有呕吐，饮食难以下咽，时常出现腹部自发性疼痛。如果误用攻下法治疗，必然导致心下痞结硬满，并且腹泻症状会加重。
【按语】
吴人驹说：“腹泻加重”这四个字，应当放在“心下痞结硬满”之后。如果放在“呕吐、饮食难以下咽”之后，那就意味着在已经呕吐、无法进食的情况下就已经出现了严重的腹泻。张仲景又说“如果误用攻下法”，这似乎没有意义，因此建议将这两句位置互换。
伤寒病，原本就有寒邪格拒（胃气上逆）的情况，医生又错误地使用催吐和攻下法，导致寒邪格拒更加严重，引起更剧烈的呕吐和下利。如果食物刚入口就立即吐出，应使用干姜黄连黄芩人参汤主治。
【按语】
经典论述中并没有“寒下”这一病名，也没有关于“寒下”的条文。研读本条下文提到的“寒邪格拒导致更剧烈的呕吐和下利”，可以推断出“寒下”中的“下”字，应当是“格”字，这样文义才通顺。历代注家都解释为胃寒引起的下利，这不仅文义不通，而且与方中黄芩、黄连的药性不符，应当改正。
少阴病，饮食入口即吐，心中感觉恶心欲吐，却又吐不出来。在发病初期，如果手足发凉，脉象弦而迟缓，这是胸中有实邪阻滞，不可使用攻下法，应当使用涌吐法。如果是膈上有寒饮停留，表现为干呕的，不可使用涌吐法，应当使用温阳法，适宜使用四逆汤。
【按语】
“温温”应当是“嗢嗢”（wà wà），嗢嗢是指想吐水饮的样子，应当改正。
伤寒病，出现四肢厥冷且心下悸动的，是因为饮水过多，应当先治疗水饮，服用茯苓甘草汤，然后再治疗四肢厥冷。如果不这样做，水湿浸渍入胃，必然会导致腹泻。
【按语】
在“四肢厥冷且心下悸动”之下，应当补入“因为饮水过多”这四个字。如果没有这四个字，那就是阴寒内盛导致的厥冷和心悸，而不是水饮停聚导致的厥冷和心悸了。既然不能确定是水饮所致，为什么说适宜先治疗水饮呢？应当补入。
伤寒病，脉象微细且四肢厥冷，到了七八天，皮肤也变冷，病人烦躁不安，没有片刻安宁的时候，这是脏厥（内脏阳气衰竭），不是蛔厥（蛔虫引起的厥逆）。蛔厥的病人，通常会吐出蛔虫。现在的病人安静，却时不时感到心烦，这是因为内脏有寒，蛔虫向上进入膈部，所以心烦，过了一会儿又停止。如果进食后发生呕吐，再次出现心烦，这是因为蛔虫闻到食物的气味而出动，病人通常会自行吐出蛔虫。蛔厥，使用乌梅丸主治，乌梅丸也可以主治长期的腹泻。
【按语】
“这是因为内脏有寒”中的“此”字，应当是“非”字。如果是“此”字，那就成了脏厥，与辨别蛔厥的意义不相符合，应当改正。
伤寒病，经过五六天，没有出现结胸证，腹部柔软，脉象虚弱且四肢厥冷的，不可使用攻下法，这是因为亡血（血虚），如果使用攻下法会导致死亡。
【按语】
“结胸”二字，应当是“大便”二字。如果不结胸、腹部柔软、脉象虚弱且四肢厥冷，都没有使用攻下法的理由。现在却说“不可攻下”，那是什么意思呢？应当改正。
伤寒病，起初发热六天，四肢厥冷反而持续九天并伴有腹泻。凡是厥冷和腹泻的病人，通常不能进食，现在反而能进食，这可能是除中（胃气将绝前的假象）。给病人吃索饼（面条类食物），如果不再发热，说明胃气尚存，病一定会痊愈。担心的是突然发热随后又消退，三天后再诊察脉象，如果发热持续存在，预计第二天半夜会痊愈。之所以这样判断，是因为原本发热六天，厥冷九天，后来又发热三天，加上之前的六天，总共也是九天，这与厥冷的天数相应，所以预计第二天半夜痊愈。如果三天后诊察脉象，脉数，发热不退的，这是热邪有余，必然会引发痈脓。
【按语】
“不再发热”中的“不”字，应当是“若”字。如果是“不”字，那就是除中证，怎么能接着写担心突然发热来去无常的文字呢？应当改正。
伤寒病，脉象迟，经过六七天，出现四肢厥冷并伴有腹泻，医生反而给予黄芩汤来清除热邪。脉迟代表寒证，现在给予黄芩汤进一步清除热邪，腹中应当寒冷，应该不能进食，现在反而能进食，这叫做除中，必死无疑。
【按语】
在“伤寒病，脉象迟，经过六七天”之下，应当补入“出现四肢厥冷并伴有腹泻”这四个字。如果没有这四个字，就不是除中证了。况且有了这四个字，才能与下文“反而给予黄芩汤”的意义相衔接，应当补入。
Taiyin disease is characterized by abdominal fullness and vomiting, inability to take food, and spontaneous abdominal pain occurring from time to time. If purgatives are mistakenly applied, it will inevitably lead to epigastric knotting (hardness and fullness below the chest), and diarrhea will become severe.
[Commentary]
Wu Renju stated: The four characters "diarrhea becomes severe" should be placed after "epigaastriac knotting". If placed after "vomiting and inability to eat", it would imply that severe diarrhea occurs even when vomiting has already taken place and eating is impossible. Zhang Zhongjing also said, "If purgatives are applied," which seems meaningless; therefore, the order should be swapped.
In Shaoyin disease, if food is vomited immediately upon entering the mouth, and the patient feels nauseous and desires to vomit but cannot, accompanied by cold hands and feet and a string-taut and slow pulse at the onset, this indicates excess in the chest region. Purging is contraindicated; instead, emesis should be induced. However, if there is cold fluid retention above the diaphragm manifesting as dry heaving, emesis is contraindicated, and warming treatment should be used, preferably with Sini Tang (Four Reversal Decoction).
[Commentary]
"Wenwen" should be "Wawa" (wà wà), which describes the sensation of wanting to vomit fluids. This should be corrected.
In Shanghan (Cold Damage) disease, if the patient presents with cold limbs and palpitations in the epigastrium due to excessive water intake, water retention should be treated first by administering Lingzhi Gancao Tang (Poria and Licorice Decoction), followed by treating the cold limbs. Otherwise, water will seep into the stomach, inevitably causing diarrhea.
[Commentary]
The phrase "due to excessive water intake" should be inserted after "cold limbs and palpitations in the epigastrium". Without these four characters, the condition would be cold-limb coldness and palpitations caused by Yin excess, rather than those caused by water retention. How could one then determine it is water-related and advise treating water first? These characters should be added.
In Shanghan disease, if the pulse is faint and the limbs are cold, and after seven or eight days the skin becomes cold and the patient is restless without any moment of peace, this is Zang Jue (Visceral Cold-Reversal), not Hui Jue (Roundworm Cold-Reversal). Patients with Hui Jue typically vomit roundworms. The current patient is quiet but occasionally irritable because of internal cold, causing roundworms to move up into the diaphragm, leading to irritability, which stops after a while. If vomiting and irritability occur after eating, it is because the roundworms are disturbed by the smell of food, and the patient will likely vomit roundworms spontaneously. Hui Jue is treated with Wumei Wan (Mume Pill), which is also effective for chronic diarrhea.
[Commentary]
The character "Ci" (this) in "This is internal cold" should be "Fei" (not). If it were "Ci", it would describe Zang Jue, which contradicts the distinction between Zang Jue and Hui Jue. This should be corrected.
In Shanghan disease, after five or six days, if there is no Jie Xiong (Chest Binding), the abdomen is soft, the pulse is deficient, and the limbs are cold, purging is contraindicated. This is due to blood loss (deficiency of blood); applying purgatives will lead to death.
[Commentary]
The characters "Jie Xiong" (Chest Binding) should be "Da Bian" (Stool/Bowel movement). If there is no Chest Binding, the abdomen is soft, the pulse is deficient, and the limbs are cold, there is no rationale for purging. The statement "purging is contraindicated" would be nonsensical otherwise. This should be corrected.
In Shanghan disease, if fever lasts for six days initially, but cold limbs last for nine days accompanied by diarrhea, patients with cold limbs and diarrhea usually cannot eat. If the patient can now eat, it may indicate Chu Zhong (Elimination of the Middle, a false sign of recovering stomach qi before its total exhaustion). Feeding the patient Suobing (noodles/wheat cakes), if there is no subsequent fever, it indicates that stomach qi remains, and recovery is certain. One must fear a sudden flare-up of heat that comes and goes. After three days, if the pulse is examined and the heat persists, recovery is expected around midnight on the following day. This is because the initial fever lasted six days, cold limbs lasted nine days, and the subsequent fever lasted three days. Adding the three days to the initial six days equals nine days, matching the duration of the cold limbs, hence the prediction of recovery at midnight. If, after three days, the pulse is rapid and the heat does not cease, this indicates excess heat, which will inevitably lead to carbuncles and pus.
[Commentary]
The character "Bu" (not) in "no fever" should be "Ruo" (if). If it were "Bu", it would confirm Chu Zhong, making the subsequent text about fearing sudden heat irrelevant. This should be corrected.
In Shanghan disease, if the pulse is slow, and after six or seven days, cold limbs and diarrhea occur, but the physician mistakenly administers Huangqin Tang (Scutellaria Decoction) to clear heat: a slow pulse indicates cold. Administering Huangqin Tang further clears heat, causing coldness in the abdomen and an inability to eat. If the patient can now eat, this is called Chu Zhong, and death is inevitable.
[Commentary]
The four characters "cold limbs and diarrhea" should be inserted after "Shanghan disease, pulse slow, six or seven days". Without these characters, it is not Chu Zhong. Moreover, only with these characters does the meaning connect logically with the subsequent criticism of administering Huangqin Tang. These characters should be added.