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。服汤已，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。
麻黄汤主之句，读当在发其汗之下。（吴灵稚）
麻黄汤主之五字，不当在阳气重之下。岂有衄乃解之后，而用麻黄汤之理乎？（张兼善）
解后复烦，烦见于内，此余邪未尽，故用桂枝更汗。微除复烦，是烦见于外，此大邪已解，故不可更汗。
仲景每有倒句法，前辈随文衍义，谓当再用麻黄以散余邪，不知得衄乃解句，何处着落？○粗工不知倒序等法，
又溺于风寒二字，而曰是虽热甚，邪犹在经，以麻黄治衄，是发散经中邪气耳。请问邪气寒乎、热乎？若寒
邪，则血凝不流，焉得有衄？若热邪，则清降不遑，而敢升发耶？（柯韵伯）
伤寒，脉浮紧，不发汗，因致衄者，麻黄汤主之。
脉紧无汗者，当用麻黄汤发汗，则阳气得泄，阴血不伤；所谓夺汗者无血也。不发汗阳气内扰，阳络伤则
衄血；是夺血者无汗也。若用麻黄汤再汗，液脱则毙矣。言不发汗因致衄，岂有因致衄更发汗之理乎？观少阴
病无汗，而强发之，则血从口鼻而出，或从目出，能不慎哉！愚故急为校正，恐误人者多耳。（柯韵伯）
伤寒，不大便六七日，头痛有热者，与承气汤。其大便圊者，知不在里，仍在表也，当须发汗。若头痛者必衄。
宜桂枝汤。
宜桂枝汤句，读当在发汗之下。（吴灵稚）
本条当有汗出证，故合用桂枝、承气。有热当作身热。大便圊，从宋本订正，恰合不大便句；他本作
小便清者谬！宜桂枝句直接发汗来，不是用桂枝止衄，亦非用在已衄后也。勿以词害义可耳！○太阳衄血证，
宜桂枝汤句，语意在当须发汗下；麻黄汤主之句，在当发其汗下；二句皆于结句补出，是倒序法也。夫桂枝乃
行血之品，仲景用桂枝发汗，不是用桂枝止衄；是用在未衄时，非用在已衄后。且夺血者无汗，此理甚明。麻
黄乃上升之品，夫既云衄乃解，又云自衄者愈，若复用升提之药，衄流不止可必矣。且衄家不可发汗，此禁甚
明矣。（柯韵伯）
伤寒，心下有水气，咳而微喘，发热，不渴。服汤已，渴者，此寒去欲解也。小青龙汤主之。
小青龙汤主之句，读当在不渴之下。（吴灵稚）
小青龙主之，语意在服汤已上。岂有寒去欲解，反用燥热之剂，重亡津液，令渴不解乎？且云服汤已者
是何汤耶？（柯韵伯）
小青龙汤主之句，是缴上文。他书曾易《经》文，今仍古本。（周禹载）
伤寒五六日，中风，往来寒热，胸胁苦满，默默不欲饮食，心烦喜呕，或胸中烦而不呕，或渴，或腹中痛，
或胁下痞硬，或心下悸、小便不利，或不渴、身有微热，或咳者，小柴胡汤主之。
小柴胡汤主之句，读当在喜呕之下。（吴灵稚）
伤寒，十三日不解，过经谵语者，以有热也，当以汤下之。若小便利者，大盒饭硬，而反下利，脉调和者，
知医以丸药下之，非其治也。若自下利者，脉当微厥，今反和者，此为内实也，调胃承气汤主之。
调胃承气汤主之句，读当在当以汤下之之下。（吴灵稚）
少阴病，二三日不已，至四五日，腹痛，小便不利，四肢沉重疼痛，自下利者，此为有水气，其人或咳，
或小便利，或下利，
或呕者，真武汤主之。
末句真武汤主之，语意直接有水气来。后三项，是真武加减证，不是主证。（柯韵伯）
少阴病，下利清谷，里寒外热，手足厥冷，脉微欲绝，身反不恶寒，其人面赤色，或腹痛，或干呕，或咽痛，
或利止脉不出者，通脉四逆汤主之。
通脉四逆汤主之句，读当在其人面赤色之下。（吴灵稚）
少阴病，四逆，其人或咳、或悸、或小便不利、或腹中痛、或泄利下重者，四逆散主之。
四逆散主之句，读当在四逆之下。（吴灵稚）
少阴病，四逆，泄利下重，其人或咳、或悸、或小便不利、或腹中痛者，四逆散主之。
条中无主证，而皆是或然证，四逆下必有阙文。今以泄利下重四字，移至四逆下，则本方乃有纲目。
或咳、或利、或小便不利，同小青龙证；厥而心悸，同茯苓甘草证；或咳、或利、或腹中痛、或小便不利，
同真武证；种种是水气为患。不发汗利水者，泄利下重故也。泄利下重，又不用白头翁汤者，四逆故也。此少
阴气分之下剂，厥应下之者，即此方也。（柯韵伯）
太阳病，脉象浮紧，无汗，发热，身体疼痛，经过八九天病情仍未解除，表证依然存在，此时应当采用发汗的方法治疗。服用汤药后，如果症状轻微缓解，患者出现心烦、闭目嗜睡，严重的必然会出现鼻出血，鼻出血后病情才会解除。之所以这样，是因为阳气郁滞过重的缘故。此处应使用麻黄汤。（吴灵稚认为：“麻黄汤主之”这五个字，应当读在“此当发其汗”这句话的下面。）张兼善认为：“麻黄汤主之”这五个字，不应当放在“阳气重故也”之后。哪有鼻出血后病情解除，反而还要用麻黄汤的道理呢？（柯韵伯指出：如果是解表后再次出现烦热，且烦热表现于体内，这是余邪未尽，所以用桂枝汤调和营卫以微汗解表；如果是服药后轻微缓解又出现烦热，且烦热表现于体表，这是大邪已解，所以不可再发汗。张仲景经常使用倒装句法，前辈们顺着文意解释，认为应当再用麻黄发散余邪，却不知道“衄乃解”这一句该安置在哪里？粗疏的医生不懂倒序等修辞手法，又沉迷于风寒这两个字，说虽然热势很盛，但邪气仍在经络，用麻黄治疗鼻出血，只是发散经络中的邪气罢了。请问邪气是寒还是热？如果是寒邪，血液就会凝滞不流，怎么会有鼻出血？如果是热邪，清降尚且来不及，怎敢用升散发散的药物呢？）
伤寒病，脉象浮紧，没有及时发汗，导致出现鼻出血的，应当使用麻黄汤。（柯韵伯反驳道：脉象紧且无汗的人，应当用麻黄汤发汗，这样阳气得以宣泄，阴血就不会受伤；这就是所谓的“夺汗者无血”。如果不发汗，阳气内扰，阳络受损就会导致鼻出血；这就是所谓的“夺血者无汗”。如果用麻黄汤再次发汗，津液枯竭就会死亡。文中说因为不发汗而导致鼻出血，哪有因为导致鼻出血而更要发汗的道理呢？看少阴病无汗，如果强行发汗，血液会从口鼻而出，或者从眼睛流出，能不谨慎吗！所以我急忙为此校正，恐怕误人者太多了。）
伤寒病，六七天不大便，头痛且有发热的，给予承气汤。如果大便正常（或指小便清长），知道病不在里，仍在表，应当需要发汗。如果头痛的，必然会出现鼻出血，适宜用桂枝汤。（吴灵稚认为：“宜桂枝汤”这句，应当读在“当须发汗”的下面。本条应当有汗出的症状，所以合用了桂枝和承气。有热应当理解为身热。“大便圊”根据宋本校正，恰好对应“不大便”一句；其他版本作“小便清者”是错误的！“宜桂枝”句直接承接“发汗”，不是用桂枝来止鼻血，也不是用在已经鼻出血之后。不要因文字而误解原意！○太阳病鼻出血证，“宜桂枝汤”句，语意在于“当须发汗”之下；“麻黄汤主之”句，在“当发其汗”之下；这两句都是在结尾处补出，是倒序法。桂枝是行血的药物，张仲景用桂枝发汗，不是用桂枝止鼻血；是用在未鼻出血时，非用在已鼻出血后。而且“夺血者无汗”，这个原理是很明确的。麻黄是上升的药物，既然说鼻出血后病情解除，又说自发性鼻出血会痊愈，如果再复用升提的药物，鼻血流不止是一定的了。而且鼻出血多的人不可发汗，这个禁忌是非常明确的。）
伤寒病，心下有停饮，咳嗽且轻微气喘，发热，不口渴。服用汤药后，感到口渴的，这是寒气去除、病情将要解除的表现。此处应使用小青龙汤。（吴灵稚认为：“小青龙汤主之”这句，应当读在“不渴”的下面。柯韵伯认为：“小青龙主之”，语意意在“服汤已”之上。哪有寒气去除、病情将要解除，反而用燥热之剂，重伤津液，令口渴不解的呢？况且说“服用汤药后”，是什么汤呢？周禹载认为：“小青龙汤主之”这句，是总结上文。其他书籍曾更改《内经》原文，现在仍保留古本。）
伤寒五六天，中风，往来寒热，胸胁部苦闷胀满，神情沉默不想饮食，心烦喜呕，或者胸中烦闷但不呕吐，或者口渴，或者腹中疼痛，或者胁下痞硬，或者心下悸动、小便不利，或者不渴、身体有轻微发热，或者咳嗽的，应当使用小柴胡汤。（吴灵稚认为：“小柴胡汤主之”这句，应当读在“喜呕”的下面。）
伤寒病，十三天未解除，经过传经出现谵语的，是因为有热，应当用汤药攻下。如果小便通利的，大便应当干硬，反而出现腹泻，脉象调和的，知道是医生用了丸药攻下，这不是正确的治法。如果是自行腹泻，脉象应当微弱厥冷，现在反而平和，这是里有实热，应当使用调胃承气汤。（吴灵稚认为：“调胃承气汤主之”这句，应当读在“当以汤下之”的下面。）
少阴病，二三天未愈，到四五天，腹痛，小便不利，四肢沉重疼痛，自发性腹泻的，这是有水气，其人或者咳嗽，或者小便通利，或者腹泻，或者呕吐的，应当使用真武汤。（柯韵伯认为：末句“真武汤主之”，语意直接承接“有水气”而来。后三项，是真武汤的加减证，不是主证。）
少阴病，下利清谷（完谷不化），里寒外热，手足冰冷，脉微细几乎摸不到，身体反而不恶寒，其人面色发红，或者腹痛，或者干呕，或者咽痛，或者腹泻停止但脉搏不出来的，应当使用通脉四逆汤。（吴灵稚认为：“通脉四逆汤主之”这句，应当读在“其人面赤色”的下面。）
少阴病，四肢厥逆，其人或者咳嗽、或者心悸、或者小便不利、或者腹中疼痛、或者泄泻且肛门重坠感的，应当使用四逆散。（吴灵稚认为：“四逆散主之”这句，应当读在“四逆”的下面。另一版本为：少阴病，四肢厥逆，泄泻且肛门重坠感，其人或者咳嗽、或者心悸、或者小便不利、或者腹中疼痛的，四逆散主之。柯韵伯认为：条文里没有主证，而都是或然证，“四逆”下必定有脱文。现在将“泄利下重”四字移到“四逆”之下，则本方才有纲目。或者咳嗽、或者腹泻、或者小便不利，同小青龙汤证；四肢厥冷而心悸，同茯苓甘草汤证；或者咳嗽、或者腹泻、或者腹中疼痛、或者小便不利，同真武汤证；种种都是水气为患。不发汗利水的，是因为有泄利下重的缘故。泄利下重，又不用白头翁汤的，是因为有四肢厥逆的缘故。这是少阴气分的下剂，所谓“厥应下之”的，就是这个方子。）
Taiyang disease (Disease of the Taiyang/Bladder channel), with a floating and tight pulse, absence of sweating, fever, and body pain. After eight or nine days, if the condition remains unresolved and the exterior syndrome persists, this should be treated by inducing sweating. After taking the decoction, if symptoms slightly alleviate but the patient experiences irritability and drowsiness with eyes closed, severe cases will inevitably suffer from epistaxis (nosebleed); only after epistaxis does the condition resolve. The reason for this is the excessive accumulation of Yang Qi. Mahuang Tang (Ephedra Decoction) is the primary formula. (Wu Lingzhi suggests that the phrase "Mahuang Tang is the primary formula" should be read immediately after "this should be treated by inducing sweating." Zhang Jianshan argues that these five characters should not follow "because Yang Qi is excessive." How could one use Mahuang Tang after the condition has resolved via epistaxis? Ke Yunbo points out: If irritability appears internally after resolution, it indicates residual pathogenic factors remain, so Guizhi Tang (Cinnamon Twig Decoction) should be used to harmonize Ying and Wei for mild sweating. If irritability appears externally after slight relief, the major pathogen has already been resolved, so further sweating is contraindicated. Zhang Zhongjing often employs inverted syntax; predecessors interpreted this as using Ma Huang again to disperse residual pathogens, failing to see where the phrase "resolves after epistaxis" fits. Crude practitioners, unaware of such rhetorical devices and obsessed with the terms "wind-cold," argue that even with high heat, the pathogen remains in the channels, and using Ma Huang for epistaxis merely disperses channel pathogens. But is the pathogen cold or hot? If cold, blood coagulates and stagnates, how can epistaxis occur? If hot, clearing and descending are urgent enough; how dare one use ascending and dispersing herbs? (Ke Yunbo))
In Shanghan (Cold Damage) disease, with a floating and tight pulse, if sweating is not induced, leading to epistaxis, Mahuang Tang (Ephedra Decoction) is indicated. (Ke Yunbo refutes: For those with a tight pulse and no sweating, Mahuang Tang should be used to induce sweating, allowing Yang Qi to vent without injuring Yin Blood; this is known as "those deprived of sweat have no blood." If sweating is not induced, Yang Qi disturbs internally, damaging Yang collaterals and causing epistaxis; this is known as "those deprived of blood have no sweat." Using Mahuang Tang to induce further sweating would lead to fluid exhaustion and death. The text states epistaxis results from lack of sweating; how could epistaxis necessitate further sweating? Observe Shaoyin disease with no sweating: forcing sweating causes bleeding from the mouth, nose, or eyes. One must be cautious! I urgently correct this to prevent widespread error.) (Ke Yunbo)
In Shanghan (Cold Damage) disease, if there is constipation for six or seven days accompanied by headache and fever, give Chengqi Tang (Gut-Purging Decoction). If the bowels move normally (or urine is clear), knowing the pathology is not in the interior but still in the exterior, sweating should be induced. If there is a headache, epistaxis is likely; Guizhi Tang (Cinnamon Twig Decoction) is appropriate. (Wu Lingzhi suggests reading "Guizhi Tang is appropriate" after "sweating should be induced." This clause implies sweating symptoms, combining Guizhi and Chengqi. "Fever" should be understood as body heat. "Bowels move normally" is corrected per Song editions to match "constipation"; other versions saying "urine is clear" are erroneous. "Guizhi Tang is appropriate" directly follows "induce sweating," not to stop epistaxis nor after it occurs. Do not let wording obscure meaning. ○ For Taiyang epistaxis, "Guizhi Tang is appropriate" relates to "induce sweating"; "Mahuang Tang is primary" relates to "induce sweating." Both are appended at the end via inverted syntax. Guizhi moves blood; Zhang Zhongjing uses it for sweating, not stopping epistaxis, applied before bleeding, not after. "Deprived of blood means no sweat" is clear. Ma Huang ascends; since epistaxis resolves the condition and spontaneous epistaxis leads to recovery, using ascending herbs would surely cause uncontrolled bleeding. Moreover, those prone to epistaxis cannot sweat; this prohibition is clear.) (Ke Yunbo)
In Shanghan (Cold Damage) disease, with water-fluid retention under the heart, coughing with slight wheezing, fever, and no thirst. After taking the decoction, if thirst develops, this indicates cold has departed and resolution is imminent. Xiao Qinglong Tang (Minor Blue Dragon Decoction) is the primary formula. (Wu Lingzhi suggests reading "Xiao Qinglong Tang is the primary formula" after "no thirst." Ke Yunbo argues the intent lies above "after taking the decoction." How could one use drying-hot agents to severely deplete fluids when cold has departed and resolution is near? Also, what decoction was taken? Zhou Yuzai states: "Xiao Qinglong Tang is the primary formula" summarizes the preceding text. Other books altered the Classic's text; we retain the ancient version.)
After five or six days of Shanghan (Cold Damage) or wind-strike, with alternating chills and fever, fullness and distress in the chest and hypochondrium, silence and loss of appetite, irritability and frequent vomiting, or alternatively chest irritability without vomiting, thirst, abdominal pain, hardness below the ribs, palpitations with urination difficulty, no thirst with slight body heat, or coughing, Xiaochaihu Tang (Minor Bupleurum Decoction) is the primary formula. (Wu Lingzhi suggests reading "Xiaochaihu Tang is the primary formula" after "frequent vomiting.")
If Shanghan (Cold Damage) persists for thirteen days without resolution, and delirium occurs after passing through the meridians, it is due to heat, and purgative decoctions should be used. If urination is free, stool should be hard; if diarrhea occurs instead with a harmonious pulse, it is known that the physician used pill-based purgatives, which is incorrect treatment. If there is spontaneous diarrhea, the pulse should be faint and cold; if it is now harmonious, this indicates internal excess, and Tiaowei Chengqi Tang (Stomach-Regulating Gut-Purging Decoction) is the primary formula. (Wu Lingzhi suggests reading "Tiaowei Chengqi Tang is the primary formula" after "purgative decoctions should be used.")
In Shaoyin disease, if it persists for two or three days and progresses to four or five days with abdominal pain, difficult urination, heavy and painful limbs, and spontaneous diarrhea, this indicates water-fluid retention. If the patient also has cough, free urination, diarrhea, or vomiting, Zhenwu Tang (True Warrior Decoction) is the primary formula. (Ke Yunbo notes: The final sentence "Zhenwu Tang is the primary formula" directly connects to "water-fluid retention." The latter items are modifications of Zhenwu Tang, not the main syndrome.)
In Shaoyin disease, with diarrhea of undigested food, interior cold with exterior heat, cold extremities, a faint pulse nearly imperceptible, yet the body feels no aversion to cold, and the face is red, or alternatively abdominal pain, dry retching, sore throat, or cessation of diarrhea with absent pulse, Tongmai Sini Tang (Pulse-Restoring Counterflow Cold Decoction) is the primary formula. (Wu Lingzhi suggests reading "Tongmai Sini Tang is the primary formula" after "the face is red.")
In Shaoyin disease, with cold extremities, and optionally cough, palpitations, difficult urination, abdominal pain, or diarrhea with a sensation of heaviness in the anus, Sini San (Counterflow Cold Powder) is the primary formula. (Wu Lingzhi suggests reading "Sini San is the primary formula" after "cold extremities." Another version places "diarrhea with heaviness" after "cold extremities." Ke Yunbo argues: The clause lacks a main syndrome, containing only optional symptoms; there must be missing text after "cold extremities." Moving "diarrhea with heaviness" here establishes the framework. Cough/diarrhea/difficult urination parallels Xiao Qinglong Tang; cold extremities with palpitations parallels Fuling Gancao Tang; cough/diarrhea/abdominal pain/difficult urination parallels Zhenwu Tang. All involve water-fluid pathology. Sweating and diuresis are avoided due to diarrhea with heaviness. Bai Tou Weng Tang is not used because of cold extremities. This is a purgative for Shaoyin Qi-level disorders; "extremity cold requires purgation" refers to this formula.) (Ke Yunbo)