文蛤五两
右一味，为散，沸汤和一钱匕服，汤用五合。
【按】
文蛤即五倍子也。
音切
强群养切 恶污去声 中音众 啬音色 淅音锡 翕音吸 □音父 咀音苴 去上声
滓音第 歠与啜同 覆芳救切 □音蛰 差与差同 谐音鞋 噤渠饮切 剧音屐 传
音啭 为去声 识与志同 干音干 散上声 和去声 悸音季 灌音贯 更去声 痞
音否 □音硬 颈音景 羸音雷 养上声 糜音迷 咽音咽 数音朔 懊影考切 □
音农 燥音扫 晡布胡切 痉音泾 潠心艮切
太阳统摄之荣卫，乃风寒始入之两途，风则伤卫，寒则伤荣。卫气剽疾，统气而行脉
外，其用疏泄而属阳，邪之犯也易，故其犯之也，则有汗，为虚邪。荣气专精，统血
而行脉中，其体固密而属阴，邪之犯也难，故其犯之也，则无汗，为实邪。夫冬固寒
令也，然春月余寒，秋末早寒，皆能致病，但有无汗，实邪证候显然，即可谓之伤寒
，不必尽属隆冬也。然太阳经也，膀胱府也，由经视府，则经为表，而府为里矣。上
篇用桂枝汤解肌，所以治风伤卫之表也，而未及卫分之里，故又立五苓散一方，佐桂
枝以和卫分之里焉。此篇用麻黄汤发汗，所以治寒伤荣之表也，而未及荣分之里，故
又立桃核抵当方，佐麻黄以攻荣分之里焉。至于汗下失宜，过之则伤正而虚其阳，不
及则热炽而伤其阴。虚其阳、则从少阴阴化之证多，以太阳少阴为表里也。伤其阴，
则从阳明阳化之证多，以太阳、阳明递相传也，此篇中所以又有四逆、承气之治也。
凡风伤卫之虚邪已列上篇，兹以寒伤荣之实邪疏为中篇，使读者先会大意于胸中，斯
临证处分，自不致误矣。
太阳病，或已发热，或未发热，必恶寒，体痛，呕逆，脉阴阳俱紧者，名曰伤寒。
【注】
太阳病，即上篇首条脉浮，头项强痛，恶寒之谓也。荣，表阴也。寒，阴邪也。寒邪
伤人则荣受之，从其类也。已发热者，寒邪束于皮毛，元府闭密，阳气郁而为热也。
未发热者，寒邪初入，尚未郁而为热，顷之即发热也。恶寒者，为寒所伤，故恶之也
。必恶寒者，谓不论已热未热，而必恶寒也。寒入其经，故体痛也。胃中之气被寒外
束不能发越，故呕逆也。寒性劲急，故脉阴阳俱紧也。此承上篇首条言太阳病，又兼
此脉此证者，名曰伤寒。以为伤寒病之提纲。后凡称伤寒者，皆指此脉证而言也。
【集注】
方有执曰：或者，未定之辞；必者，定然之谓。曰或曰必者，言发热早晚不一，而恶
寒则定然即见也。
喻昌曰：仲景虑恶寒、体痛、呕逆、又未发热，恐误认为阴经之证，故早于篇首揭明
此语以辨之。
程应旄曰：伤寒阴阳俱紧之脉，大不同于中风阳浮而阴弱之缓脉矣。证与脉兼得其实
，然后乃得正其名曰，此太阳伤寒之病，而非中风所能混也。
魏荔彤曰：伤寒中风同一浮脉，而彼为浮缓，此为浮紧；阳邪舒散故缓，阴邪劲急故
紧。同为在表之浮，而一缓一紧，风寒回异矣。
太阳病，头痛发热，身疼腰痛，骨节疼痛，恶风无汗而喘者，麻黄汤主之
【注】
此承上条而详言其证、以出其治也。太阳经脉起于目内眦，上额交巅，入络脑还出，
别下项，循肩膊内，挟脊抵腰中，至足小指出其端。寒邪客于其经，则荣血凝涩，所
伤之处，无不痛也。荣病者恶寒，卫病者恶风，今荣病而言恶风者，盖以风动则寒生
，恶则皆恶，未有恶寒而不恶风，恶风而不恶寒者。所以仲景于中风、伤寒证中，每
互言之，以是知中风、伤寒，不在恶寒、恶风上辨，而在微甚中别之也。无汗者，伤
寒实邪，腠理闭密，虽发热而汗不出，不似中风虚邪，发热而汗自出也。阳气被寒邪
所遏，故逆而为喘。主之以麻黄汤者，解表发汗，逐邪安正也。
【集注】
成无己曰：寒则伤荣，头痛身疼腰痛，以致牵连骨节疼痛者，太阳经荣血不利也。
程应旄曰：头痛发热，太阳病皆然，而身疼腰痛，骨节疼痛，是寒伤荣室，若风伤卫
，则无是也。恶风，太阳病皆然，而无汗而喘，是阳被壅遏，若风伤卫，则无是也。
得其所同，因以别其所异也。
沈明宗曰：太阳之邪从皮毛而入，郁逆肺气，以故作喘。且寒主收歛，伤荣则腠理闭
密，故用麻黄汤发之。
文蛤五两
以上一味药，研成散剂，用沸水调和一钱匕服用，用水五合。
【按语】
文蛤就是五倍子。
音切（注音）
强群养切 恶污去声 中音众 啬音色 淅音锡 翕音吸 □音父 咀音苴 去上声
滓音第 歠与啜同 覆芳救切 □音蛰 差与差同 谐音鞋 噤渠饮切 剧音屐 传
音啭 为去声 识与志同 干音干 散上声 和去声 悸音季 灌音贯 更去声 痞
音否 □音硬 颈音景 羸音雷 养上声 糜音迷 咽音咽 数音朔 懊影考切 □
音农 燥音扫 晡布胡切 痉音泾 潠心艮切
太阳经统摄营卫之气，这是风寒邪气初入人体的两条途径：风邪伤卫气，寒邪伤营血。卫气剽悍滑疾，统率气行于脉外，其功能主疏泄而属阳，邪气侵犯它比较容易，所以受邪后会有汗出，属于虚邪。营气精纯专一，统率血行于脉中，其体固密而属阴，邪气侵犯它比较困难，所以受邪后无汗出，属于实邪。冬季确实是寒冷的主令时节，然而春末的余寒、秋初的早寒，也都能够致病，只要有无汗出的实邪证候表现明显，就可以称之为伤寒，不必一定局限于隆冬时节。然而太阳是经络，膀胱是脏腑，从经络来看脏腑，则经络为表，脏腑为里。上篇使用桂枝汤（Cinnamon Twig Decoction）解肌，是用来治疗风邪伤及卫气的表证，但未涉及卫分里的病变，所以又设立五苓散（Poria Decoction）一方，辅助桂枝汤来调和卫分之里。本篇使用麻黄汤（Ephedra Decoction）发汗，是用来治疗寒邪伤及营血的表证，但未涉及营分里的病变，所以又设立桃核承气汤（Peach Kernel Decoction，注：原文“桃核抵当方”疑为笔误或泛指攻下瘀血之剂，此处依语境译为桃核承气类或保留原意桃核抵当方，鉴于WHO标准通常对应Taohe Chengqi Tang或Didang Tang，结合上下文“佐麻黄以攻荣分之里”，多指攻逐瘀血，故译为桃核承气方或抵当汤方，此处暂译Peach Kernel and Water Buffalo Horn Decoction或Peach Kernel Decoction，考虑到“抵当”通常指Di Dang Tang，但前文提到“桃核”，故推测为桃核承气汤之误写或泛指，此处忠实原文译为Peach Kernel and Di Dang Fang），辅助麻黄汤来攻逐营分之里。至于汗法和下法使用不当，过度则会损伤正气而使阳气虚弱，不足则会导致热势炽盛而损伤阴液。阳气虚弱，则多出现少阴病阴化证的证候，因为太阳与少阴互为表里。阴液受损，则多出现阳明病阳化证的证候，因为太阳与阳明依次相传，本篇中因此又有四逆汤（Four Reversal Decoction）和承气汤（Ganglia-Resolving Decoction）的治疗方法。凡是风邪伤卫气的虚邪已经列在上篇，这里将寒邪伤营血的实邪梳理为中篇，使读者先在胸中领会大意，这样在临证处方时，自然就不会出错。
太阳病，或者已经发热，或者尚未发热，必定恶寒，身体疼痛，呕吐逆气，脉象寸关尺三部都紧的，名叫伤寒。
【注释】
太阳病，就是上篇首条所说的脉浮、头项强痛、恶寒的情况。营血，属于表中之阴。寒邪，属于阴邪。寒邪伤人则营血受之，这是同类相感。已经发热的，是因为寒邪束缚皮毛，玄府（汗孔）闭密，阳气郁结而化为热。尚未发热的，是因为寒邪刚侵入，尚未郁结化为热，不久就会发热。恶寒的，是因为被寒邪所伤，所以厌恶寒冷。必定恶寒的，是说无论是否已经发热，都必定恶寒。寒邪侵入经脉，所以身体疼痛。胃中的气被寒邪在外束缚，不能发散，所以呕吐逆气。寒性劲急，所以脉象寸关尺三部都紧。这是承接上篇首条关于太阳病的论述，又兼有这些脉象和证候的，名叫伤寒。作为伤寒病的提纲。后世凡是称伤寒的，都是指这些脉证而言。
【集注】
方有执说：或者，是不确定的说法；必，是必然的意思。说“或”说“必”，是说发热的时间早晚不一，而恶寒则是必然立即出现的。
喻昌说：张仲景担心患者恶寒、身体疼痛、呕吐逆气，且尚未发热，恐怕被误认为是阴经的病证，所以在篇首提前揭示这句话来加以辨别。
程应旄说：伤寒脉象阴阳俱紧，与大不同于中风脉象阳浮而阴弱的缓脉不同。证候与脉象兼得其实质，然后才能正名叫做此太阳伤寒的病，而不是中风所能混淆的。
魏荔彤说：伤寒和中风脉象都是浮脉，但中风是浮缓，伤寒是浮紧；阳邪舒散所以脉缓，阴邪劲急所以脉紧。同样是在表的浮脉，但一缓一紧，风邪和寒邪就不同了。
太阳病，头痛发热，身体疼痛，腰痛，骨节疼痛，怕风无汗而喘息的，用麻黄汤主治。
【注释】
这是承接上一条详细阐述证候，从而提出治疗方法。太阳经脉起于目内眦，向上至额部交会于巅顶，入络于脑，复出，向下别行经过项部，沿肩膊内侧，夹脊柱到达腰部，至足小趾端。寒邪客居在经脉中，则营血凝涩，受伤的地方，没有不疼痛的。营分生病者恶寒，卫分生病者恶风，现在营分生病却说恶风，大概是因为风动则寒生，厌恶寒冷和厌恶风是一起的，没有只恶寒而不恶风，或只恶风而不恶寒的。所以张仲景在中风和伤寒的证候描述中，常常互相通用，由此可知区分中风和伤寒，不在于恶寒还是恶风，而在于程度的轻重。无汗的，是因为伤寒实邪，腠理闭密，虽然发热但汗不出，不像中风虚邪，发热而汗自出。阳气被寒邪遏制，所以逆乱而为喘。用麻黄汤主治，是为了解散表邪、发汗，驱逐邪气安护正气。
【集注】
成无己说：寒邪伤营血，导致头痛、身体疼痛、腰痛，甚至牵连骨节疼痛，这是太阳经营血运行不利。
程应旄说：头痛发热，太阳病都是如此，但身体疼痛、腰痛、骨节疼痛，是寒邪伤及营血，如果是风邪伤卫气，就没有这些症状。恶风，太阳病都是如此，但无汗而喘息，是阳气被壅遏，如果是风邪伤卫气，就没有这些症状。找到它们的共同点，从而区别它们的不同之处。
沈明宗说：太阳的邪气从皮毛而入，郁逆肺气，所以造成喘息。而且寒主收敛，伤及营血则腠理闭密，所以用麻黄汤发散。
Wen Ge San (Clam Shell Powder) consists of five liang of Wen Ge (Clam Shell).
The above single herb is ground into a powder. Mix one qian bi (a measure equivalent to approximately 1-2 grams) with boiling water for oral administration, using five he (approximately 100 ml) of water.
[Commentary]
Wen Ge (Clam Shell) is the same as Wu Bei Zi (Galla Chinensis).
Phonetic Notation
Qiang Qun Yang Qie E Wu Qu Sheng Zhong Yin Zhong Se Yin Se Xi Yin Xi [Character] Yin Fu Ju Yin Ju Qu Shang Sheng Zi Yin Di Chuo Yu Chuo Tong Fu Fang Jiu Qie [Character] Yin Zhe Cha Yu Cha Tong Xie Yin Xie Jin Qu Yin Qie Ju Yin Ji Zhuan Yin Zhuan Wei Qu Sheng Shi Yu Zhi Tong Gan Yin Gan San Shang Sheng He Qu Sheng Ji Yin Ji Guan Yin Guan Geng Qu Sheng Pi Yin Fou [Character] Yin Ying Jing Yin Jing Lei Yin Lei Yang Shang Sheng Mi Yin Mi Yan Yin Yan Shuo Yin Shuo Ao Ying Kao Qie [Character] Yin Nong Zao Yin Sao Bu Bu Hu Qie Jing Yin Jing Xun Xin Gen Qie
The Taiyang (Greater Yang) channel governs Ying (Nutritive Qi) and Wei (Defensive Qi), which are the two pathways through which Wind (Wind Pathogen) and Cold (Cold Pathogen) initially enter the body. Wind injures Wei Qi (Defensive Qi), while Cold injures Ying Blood (Nutritive Blood). Wei Qi (Defensive Qi) is swift and vigorous, governing Qi that circulates outside the vessels; its function is dispersing and draining, belonging to Yang. It is easily invaded by pathogens, so invasion results in sweating, constituting a Deficient (Xu) pathogenic factor. Ying Blood (Nutritive Blood) is pure and concentrated, governing Blood that circulates inside the vessels; its structure is solid and dense, belonging to Yin. It is difficult to invade by pathogens, so invasion results in no sweating, constituting an Excess (Shi) pathogenic factor. Winter is indeed the season of Cold, but residual Cold in spring and early Cold in late autumn can also cause disease. As long as the symptom of no sweating and the Excess (Shi) pathogenic pattern are obvious, it can be called Shang Han (Cold Damage); it need not be limited strictly to mid-winter. However, Taiyang (Greater Yang) refers to the channels, and Bladder refers to the fu organs. Viewing from the channels to the fu organs, the channels are exterior and the fu organs are interior. In the previous chapter, Guizhi Tang (Cinnamon Twig Decoction) was used to resolve the muscle layer, treating the exterior syndrome of Wind injuring Wei Qi (Defensive Qi), but it did not address the interior of the Wei division. Therefore, Wuling San (Poria Powder) was established to assist Guizhi Tang (Cinnamon Twig Decoction) in harmonizing the interior of the Wei division. In this chapter, Mahuang Tang (Ephedra Decoction) is used to induce sweating, treating the exterior syndrome of Cold injuring Ying Blood (Nutritive Blood), but it does not address the interior of the Ying division. Therefore, Taohe Didang Fang (Peach Kernel and Di Dang Formula) is established to assist Mahuang Tang (Ephedra Decoction) in attacking the interior of the Ying division. Regarding improper use of sweating and purging methods: excessive use damages healthy Qi and causes Yang deficiency, while insufficient use leads to blazing heat that damages Yin fluids. Yang deficiency tends to manifest as Shaoyin (Lesser Yin) Yin-transformation syndromes because Taiyang (Greater Yang) and Shaoyin (Lesser Yin) are exterior-interior pairs. Yin fluid damage tends to manifest as Yangming (Yang Brightness) Yang-transformation syndromes because Taiyang (Greater Yang) and Yangming (Yang Brightness) transmit sequentially. Hence, this chapter also includes treatments with Sini Tang (Four Reversal Decoction) and Chengqi Tang (Ganglia-Resolving Decoction). Since the deficient pathogenic factors of Wind injuring Wei Qi (Defensive Qi) have been listed in the previous chapter, the excess pathogenic factors of Cold injuring Ying Blood (Nutritive Blood) are organized here in the middle chapter, allowing readers to grasp the general idea beforehand, so that clinical prescription will naturally avoid errors.
In Taiyang Disease (Taiyang Syndrome), whether fever has already appeared or not, there is invariably aversion to cold, body pain, vomiting and regurgitation, and a tight pulse at all three positions (Cun, Guan, Chi). This is named Shang Han (Cold Damage).
[Annotation]
Taiyang Disease (Taiyang Syndrome) refers to floating pulse, stiffness and pain in the head and nape, and aversion to cold mentioned in the first article of the previous chapter. Ying Blood (Nutritive Blood) is Yin within the Exterior. Cold is a Yin pathogenic factor. When Cold injures the human body, Ying Blood (Nutritive Blood) is affected due to resonance of similar natures. "Already fever" means Cold binds the skin and hair, closing the Xu Fu (Sweat Pores), causing Yang Qi to stagnate and generate heat. "Not yet fever" means Cold has just entered and has not yet stagnated to generate heat; fever will appear shortly. "Aversion to cold" occurs because the body is injured by Cold, hence aversion to it. "Invariably aversion to cold" means regardless of whether fever has appeared, aversion to cold is always present. Cold entering the channels causes body pain. Stomach Qi is bound externally by Cold and cannot disperse, causing vomiting and regurgitation. Cold nature is forceful and urgent, causing a tight pulse at all three positions. This follows the first article of the previous chapter regarding Taiyang Disease (Taiyang Syndrome), adding these specific pulses and symptoms, naming it Shang Han (Cold Damage). It serves as the outline for Shang Han (Cold Damage) diseases. Subsequent mentions of Shang Han (Cold Damage) refer to these specific pulses and symptoms.
[Collected Notes]
Fang Youzhi said: "Or" indicates uncertainty; "Invariably" indicates certainty. Saying "or" and "invariably" means the timing of fever varies, but aversion to cold appears inevitably immediately.
Yu Chang said: Zhang Zhongjing feared that patients with aversion to cold, body pain, vomiting, and no fever might be mistaken for Shaoyin (Lesser Yin) channel diseases. Thus, he clarified this statement at the beginning of the chapter to differentiate it.
Cheng Yingmao said: The tight pulse of both Yin and Yang positions in Shang Han (Cold Damage) is significantly different from the slow pulse of floating Yang and weak Yin seen in Feng Shang Wei (Wind Injuring Defensive Qi). Only when both symptoms and pulse match the reality can it be correctly named Taiyang Shang Han (Cold Damage of Greater Yang), distinct from Feng Shang Wei (Wind Injuring Defensive Qi).
Wei Litong said: Both Shang Han (Cold Damage) and Feng Shang Wei (Wind Injuring Defensive Qi) present with floating pulses, but the latter is floating and slow, while the former is floating and tight. Yang pathogens are expansive, hence slow; Yin pathogens are forceful and urgent, hence tight. Although both are floating indicating exterior location, the difference between slow and tight distinguishes Wind from Cold.
In Taiyang Disease (Taiyang Syndrome), characterized by headache, fever, body ache, lower back pain, joint pain, aversion to wind, absence of sweating, and wheezing, Mahuang Tang (Ephedra Decoction) is the primary treatment.
[Annotation]
This elaborates on the symptoms following the previous article to propose the treatment. The Taiyang channel originates from the inner canthus of the eye, ascends to the forehead, intersects at the vertex, enters to connect with the brain, emerges again, descends separately along the neck, runs along the medial shoulder blade, flanks the spine to reach the waist, and ends at the little toe. When Cold pathogen lodges in the channel, Ying Blood (Nutritive Blood) becomes stagnant and sluggish, causing pain everywhere it affects. Diseases of Ying Blood (Nutritive Blood) involve aversion to cold; diseases of Wei Qi (Defensive Qi) involve aversion to wind. Here, Ying Blood (Nutritive Blood) disease mentions aversion to wind because wind movement generates cold; aversion to cold and wind go together. There is no case of aversion to cold without aversion to wind, or aversion to wind without aversion to cold. Therefore, Zhang Zhongjing often uses these terms interchangeably in describing Feng Shang Wei (Wind Injuring Defensive Qi) and Shang Han (Cold Damage). This shows that distinguishing between them lies not in aversion to cold versus wind, but in their severity. Absence of sweating occurs because the Excess (Shi) pathogenic factor of Cold seals the Cou Li (Interstitial Spaces/Pores); although fever exists, sweat does not come out, unlike the Deficient (Xu) pathogenic factor of Wind where fever accompanies spontaneous sweating. Yang Qi is constrained by Cold, reversing upward to cause wheezing. Mahuang Tang (Ephedra Decoction) is used to release the exterior and induce sweating, expelling pathogens and protecting healthy Qi.
[Collected Notes]
Cheng Wuji said: Cold injuring Ying Blood (Nutritive Blood) causes headache, body pain, lower back pain, extending to joint pain, due to impaired circulation of Ying Blood (Nutritive Blood) in the Taiyang channel.
Cheng Yingmao said: Headache and fever are common in Taiyang Disease (Taiyang Syndrome), but body ache, lower back pain, and joint pain indicate Cold injuring Ying Blood (Nutritive Blood); if Wind injured Wei Qi (Defensive Qi), these would not occur. Aversion to wind is common in Taiyang Disease (Taiyang Syndrome), but absence of sweating and wheezing indicate obstruction of Yang Qi; if Wind injured Wei Qi (Defensive Qi), these would not occur. By identifying similarities, differences are distinguished.
Shen Mingzong said: Taiyang pathogens enter via the skin and hair, stagnating and reversing Lung Qi, thus causing wheezing. Moreover, Cold governs contraction; injuring Ying Blood (Nutritive Blood) seals the Cou Li (Interstitial Spaces/Pores), so Mahuang Tang (Ephedra Decoction) is used to disperse them.