伤寒头重有二症。有太阳恶寒项强头疼而不能举，宜发散寒邪。有易病百节解散而眩运不能举，
宜补益真元。
咽痛者，热毒上冲所致也，宜甘桔、苦酒汤主之。然有阴阳二病。脉浮数，面赤斑斑如锦纹，而咽痛吐
脓血者，此阳毒也。脉沈迟，手足冷，或吐利，而咽痛者，此少阴也。
身痒者，或太阳不能作汗而致，或阳明久虚无汗而致，或厥阴似疟不能得小汗而致。
耳聋者，邪传少阳之经也。若未曾经汗，宜和解，曾重发汗，宜补。
胸满者，谓膈间气塞满闷，非心下满也。?满者，谓?助下气塞填满，非腹中满也。盖邪气自表传里，
必先自胸膈、?助，以次至腹入胃。是以胸满多带表症，治宜发散。?满为半表半里症，治宜和解。若
腹满，又为里症，而用通利之法也。大抵胸?满者，以邪气初入里，未停留为实，气郁积而不行，致生
满也，发散和解之斯可矣。若邪气留于胸中，聚而为实者，非涌吐不可也。
心下满者，谓正当心下、高起满硬者是也。若不经下后而满，则有吐下之殊。若下后而满，则有结胸
痞气之别。一云、实邪留结，则为硬为痛，名结胸也。虚邪留滞，则为痞满，满而不痛，名虚痞也。经云、病
发于阳，而反下之，热入于里, 因作结胸。病发于阴，而反下之，因作痞气。病发于阳者，谓身热恶寒也。
应宜发汗，若由下之，则表邪乘虚而入，结于心下，而为结胸也。病发于阴者，谓无热恶寒也，先宜解
表，若由下之，则邪气入于中焦，而为痞气。是以结胸痞气等症，皆因下早而成，当分大、小、寒、热、水五
者以治之。若不按而痛，或腹脐坚硬，手不可近者，大结胸也，大陷胸汤主之。心下满，按之方痛者，小
结胸也，小陷胸汤主之。懊□满闷，身无热者，寒结胸也，三物白散或枳实理中汤主之。懊□烦躁，舌
上燥渴者，热结胸也，大陷胸汤主之。心下怔忡，头微汗出，身无大热，揉之汩汩有者，水结胸也，小
半夏加茯苓汤主之。大抵结胸与痞，皆应下之，若表未解，不可攻之，仲景曰、当先解表，待表解乃可
攻之，解表宜桂枝汤，攻痞宜大黄黄连泻心汤。一说、治痞服泻心不愈，然后可用陷胸下之。节痷曰、
结胸因下由而成，若未经下，非结胸也，乃表邪传至胸中，未入乎腑，症虽满闷，尚在于表，只须小柴
胡汤加枳桔可也。世医但见心下满，便呼为结胸，
用泻利之药，反成真结胸，有之也。设或结胸症
烦躁者，不治。脏结者，其症如结胸状，饮食如故，时时下利，仲景无治法，故曰脏结者死。
一切结胸等症，先用枳桔以宽其气，外用姜渣揉熨，法甚良。
伤寒引起的头重有两种症状。一种是太阳经受邪，表现为恶寒、项部僵硬、头痛且头部沉重难以抬起，适宜用发散寒邪的方法治疗。另一种是正气虚弱导致全身关节松懈而眩晕，头部沉重难以抬起，适宜用补益真元的方法治疗。
咽喉疼痛，是由热毒上冲所致，适宜用甘桔汤或苦酒汤主治。然而也有阴证和阳证两种情况。如果脉象浮数，面色红赤且有如锦纹般的斑疹，同时咽喉疼痛并吐出脓血，这是阳毒证。如果脉象沉迟，手足冰冷，或者伴有呕吐腹泻，同时咽喉疼痛，这是少阴病。
咽喉发痒，可能是由于阳厥证误用发汗法所致，或者是寒气伏留于肾脏，导致阴火上炎所致。
身体发痒，可能是由于太阳经邪气郁闭不能作汗所致，或者是阳明经久虚无汗所致，或者是厥阴经邪气类似疟疾但不能得到轻微出汗所致。
耳聋，是邪气传入少阳经脉的表现。如果此前未曾使用过发汗法，适宜用和解的方法治疗；如果已经多次发汗，则适宜用补益的方法治疗。
胸满，指的是膈间气机阻塞感到满闷，并非心下（胃脘部）的胀满。胁满，指的是两胁肋下方气机阻塞感到填满，并非腹中的胀满。这是因为邪气从体表传入体内，必然先从胸膈、胁肋部位开始，依次传至腹部进入胃腑。因此，胸满多带有表证特征，治疗适宜用发散法。胁满是半表半里证，治疗适宜用和解法。如果是腹满，则属于里证，应当使用通利泻下的方法。大抵胸满和胁满，是因为邪气初入里，尚未停留形成实证，而是气机郁积运行不畅，从而产生胀满感，此时使用发散或和解的方法即可。如果邪气留滞于胸中，聚结而形成实证，则非涌吐法不可。
心下满，指的是正当心窝处高起、胀满且坚硬的情况。如果没有经过攻下治疗后出现胀满，则有呕吐和攻下治疗的差异。如果是在攻下治疗后出现胀满，则有结胸和痞气的区别。有一种说法认为：实邪留结，表现为硬痛，称为结胸。虚邪留滞，表现为痞满，胀满但不疼痛，称为虚痞。医经记载：疾病发于阳证，反而误用攻下法，热邪内陷入里，因而形成结胸。疾病发于阴证，反而误用攻下法，因而形成痞气。所谓“病发于阳”，是指身体发热、恶寒的症状。本应适宜发汗，如果误用攻下法，则表邪乘虚而入，结聚于心下，形成结胸。所谓“病发于阴”，是指无发热、仅恶寒的症状，本应先解表，如果误用攻下法，则邪气陷入中焦，形成痞气。因此，结胸、痞气等症状，都是因为过早攻下造成的，应当根据大、小、寒、热、水五种类型来分别治疗。如果不按压就疼痛，或者腹部脐周坚硬，手不能触碰的，是大结胸，宜用大陷胸汤主治。心下胀满，只有按压时才疼痛的，是小结胸，宜用小陷胸汤主治。心中烦闷懊恼、身体没有发热的，是寒结胸，宜用三物白散或枳实理中汤主治。心中烦闷懊恼、烦躁不安、舌上干燥口渴的，是热结胸，宜用大陷胸汤主治。心下悸动不安，头部微微出汗，身体没有大热，揉按时有水流声的，是水结胸，宜用小半夏加茯苓汤主治。大抵结胸与痞气，都应当使用攻下法，但如果表证未解，不可攻下，张仲景说：“应当先解表，待表证解除后方可攻下。”解表适宜用桂枝汤，攻除痞气适宜用大黄黄连泻心汤。另一种说法认为：治疗痞气服用泻心汤无效后，然后才可用陷胸汤攻下。《金匮要略》提到：结胸是因误下而成，如果未经过攻下，就不是结胸，乃是表邪传至胸中，尚未入腑，症状虽然满闷，但尚在于表，只需小柴胡汤加枳壳、桔梗即可。世间的医生只见到心下胀满，便称之为结胸，使用泻利药物，反而导致变成真正的结胸，这种情况是存在的。假如结胸证出现烦躁不安的，属于不治之症。脏结证，其症状表现如同结胸，但饮食如常，时常腹泻，张仲景没有给出治疗方法，所以说脏结证预后不良，多致死。一切结胸等症，先用枳壳、桔梗来宽畅气机，外用姜渣揉搓熨烫，这种方法非常好。
There are two types of head heaviness caused by *Shanghan* (Cold Damage). One type is characterized by aversion to cold, stiffness in the neck, headache, and an inability to lift the head due to the weight; it should be treated with methods that disperse cold pathogens. The other type involves general joint laxity accompanied by dizziness and an inability to lift the head due to deficiency; it should be treated with methods that tonify the True Yuan (original Qi).
Sore throat is caused by heat toxins rushing upward; it should be primarily treated with Ganjie Tang (Licorice and Platycodon Decoction) or Kujiu Tang (Bitter Wine Decoction). However, there are two patterns: Yin and Yang. If the pulse is floating and rapid, the face is red with mottled spots resembling brocade patterns, and the patient has a sore throat while vomiting pus and blood, this is Yang Du (Yang Toxin). If the pulse is sunken and slow, the hands and feet are cold, or there is vomiting and diarrhea accompanied by a sore throat, this is Shaoyin disease (Disease of the Lesser Yang Meridian, specifically referring to the Kidney channel pattern in this context).
Itching in the throat may result from erroneous sweating in cases of Yang Jue (Yang Reversal), or it may be caused by cold latent in the Kidneys leading to the flaming up of Yin Fire.
Body itching may result from the Taiyang stage where sweat cannot be produced due to pathogen constraint, or from chronic deficiency in the Yangming stage resulting in no sweat, or from the Jueyin stage where symptoms resemble malaria but slight sweating cannot be achieved.
Deafness indicates that the pathogen has transmitted to the Shaoyang meridian. If sweating has not been used previously, harmonization is appropriate; if heavy sweating has already been employed, tonification is appropriate.
Chest fullness refers to a sensation of qi obstruction and stuffiness between the diaphragm, distinct from fullness below the heart (epigastric region). Hypochondriac fullness refers to a sensation of qi obstruction and filling beneath the ribs, distinct from abdominal fullness. Generally, when pathogens transmit from the exterior to the interior, they first affect the chest-diaphragm and hypochondrium before reaching the abdomen and stomach. Therefore, chest fullness often presents with exterior symptoms and should be treated with dispersing methods. Hypochondriac fullness is a half-exterior, half-interior syndrome and should be treated with harmonizing methods. Abdominal fullness, however, is an interior syndrome and requires purgative or draining methods. In general, chest and hypochondriac fullness occur because the pathogen has just entered the interior without forming a solid accumulation; rather, qi stagnation and failure to circulate cause the fullness, so dispersing or harmonizing methods suffice. If the pathogen lingers in the chest and condenses into a solid excess, emesis is required.
Fullness below the heart refers to a raised, full, and hard sensation directly at the epigastrium. If this occurs without prior purgation, treatment differs based on whether vomiting or purging is indicated. If it occurs after purgation, it distinguishes between Jie Xiong (Chest Binding) and Pi Qi (Pi Syndrome). One view states that if excess pathogens remain and bind, causing hardness and pain, it is called Jie Xiong. If deficient pathogens linger, causing pi-fullness without pain, it is called Xu Pi (Deficient Pi). The Classics state: "When a disease originates in Yang and is erroneously purged, heat enters the interior, resulting in Jie Xiong." "When a disease originates in Yin and is erroneously purged, Pi Qi results." "Disease originating in Yang" refers to fever and aversion to cold. It should have been treated with sweating; if purged instead, exterior pathogens enter via the deficiency and bind at the epigastrium, forming Jie Xiong. "Disease originating in Yin" refers to absence of fever with aversion to cold. It should have been treated by releasing the exterior; if purged instead, pathogens sink into the Middle Jiao, forming Pi Qi. Thus, Jie Xiong and Pi Qi arise from premature purgation and must be treated according to five categories: Major, Minor, Cold, Heat, and Water. If there is spontaneous pain upon palpation, or hardness around the umbilicus such that the area is intolerable to touch, it is Major Jie Xiong, treated with Da Xian Xiong Tang (Major Draining the Chest Decoction). If fullness below the heart causes pain only upon pressure, it is Minor Jie Xiong, treated with Xiao Xian Xiong Tang (Minor Draining the Chest Decoction). If there is mental restlessness and stifling sensation without fever, it is Cold Jie Xiong, treated with Sanwu Baisan (Three-Ingredient White Powder) or Zhishi Lizhong Tang (Immature Bitter Orange and Spleen-Tonifying Decoction). If there is restlessness, irritability, dry tongue, and thirst, it is Heat Jie Xiong, treated with Da Xian Xiong Tang. If there is palpitations below the heart, slight sweating on the head, no significant body heat, and a gurgling sound upon rubbing, it is Water Jie Xiong, treated with Xiao Banxia Jia Fuling Tang (Minor Pinellia Decoction plus Poria). Generally, both Jie Xiong and Pi require purgation; however, if the exterior is unresolved, attack is contraindicated. Zhang Zhongjing stated: "One must first resolve the exterior; only after the exterior is resolved can one attack." For resolving the exterior, Guizhi Tang (Cinnamon Twig Decoction) is suitable; for attacking Pi, Dahuang Huanglian Xiexin Tang (Rhubarb, Coptis, and Scutellaria Heart-Draining Decoction) is suitable. Another opinion holds that if Xiexin decoctions fail to treat Pi, then Xianxiong decoctions may be used for purgation. *Jinkui Yaolue* notes: "Jie Xiong arises from purgation; if not preceded by purgation, it is not Jie Xiong. It is merely exterior pathogens transmitting to the chest without entering the Fu organs. Although there is fullness and stuffiness, it remains at the exterior level, and Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Zhike (Aurantii Fructus Immaturus) and Jiegeng (Platycodon Root) suffices." Physicians of later generations often see epigastric fullness and immediately diagnose Jie Xiong, using purgative drugs, which can inadvertently create true Jie Xiong. If Jie Xiong presents with irritability, it is incurable. Zang Jie (Zang Binding) presents similarly to Jie Xiong, but digestion remains normal, and there is frequent diarrhea. Zhang Zhongjing provided no treatment method for this, stating that Zang Jie leads to death. For all Jie Xiong syndromes, initially use Zhike and Jiegeng to broaden the qi, and externally apply ginger residue for rubbing and warming; this method is very effective.