便者，有瘀血也，宜抵当汤。若脉数不解，而下利不止，必协热而便脓血也。
虽云无表里证，然发热脉浮数，表证尚在也。其所以可下者，以七八日为时既久，而发热脉数，则胃
中热炽，津液尽亡，势不得不用下法，如大柴胡汤之类是也。若下后脉数不解，可知果胃中热炽，其候当消谷
善饥，然谷食既多，则大便必多，乃至六七日竟不大便，其证非气结，而为血结明矣。所以亦宜于抵当汤也。
若数不解，而下利不止，注谓用抵当汤下之，数仍不解，大谬。此乃对假令已下脉数不解五句之文，见已下
脉数不解，反六七日不大便，则宜抵当以下其血；若已下脉数不解，而下利不止，则不宜抵当之峻攻，但当消
息以清其血分热邪；若血分之邪
不除，必协热而便脓血矣。（喻嘉言）
伤寒五六日，头汗出，微恶寒，手足冷，心下满，口不欲食，大便硬，脉细者，此为阳微结，必有表，复有
里也。脉沉，亦在里也。汗出，为阳微；假令纯阴结，不得复有外证，悉入在里，此为半在里半在外也。脉虽
沉紧，不得为少阴病。所以然者，阴不得有汗，今头汗出，故知非少阴也，可与小柴胡汤。设不了了者，得屎而解。
阳微结者，阳邪微结未尽散也。注作阳气衰微，故邪气结聚，大差！果尔，则头汗出为亡阳之证，非半
表半里之证矣。果尔，则阴结又是阴气衰微矣。玩本文假令纯阴结等语，谓阳邪若不微结，纯是阴邪内结，
则不得复有外证，其义甚明。得屎而解，即取大柴胡为和法之意也。（《尚论篇》）
大病瘥后，劳复者，枳实栀子豉汤主之。
劳复，乃起居作劳，后生余热之病。方注作女劳后，大谬！女劳复者，自犯伤寒后之大戒，多死少生，岂
有反用上涌下泄之理耶？（喻嘉言）
病患脉已解，而日暮微烦，以病新瘥，人强与谷，脾胃气尚弱，不能消谷，故令微烦，损谷则愈。
脉已解者，阴阳和适，其无表里之邪可知也，日暮微烦者，日中卫气行阳，其不烦可知也，乃因脾胃气弱，
不能消谷所致，损谷则脾胃渐趋于旺而自愈矣。注家牵扯日暮为阳明之旺时，故以损谷为当小下，不知此论瘥
后之证，非论六经转阳明之证也。日暮，即《内经》日西而阳气已衰之意，所以不能消谷也。损谷当是减损谷
食，以休养脾胃，不可引前条宿食例，轻用大黄，重伤脾胃也。（喻嘉言）
大便排出黑色瘀血，说明体内有瘀血阻滞，适宜使用抵当汤。如果脉象数动而症状未解，且腹泻不止，必然会出现热邪与瘀血相搏结而导致大便带脓血的情况。
虽然文中提到没有典型的表证或里证，但既然出现发热、脉浮数，说明表证依然存在。之所以可以使用下法，是因为病程已持续七八天，时间较长，加上发热、脉数，导致胃中热势炽盛，津液耗竭，形势所迫不得不采用下法，例如大柴胡汤之类的方剂。如果在服用下法药物后，脉数仍未缓解，可以推断确实是胃中热盛，其表现应当是食欲旺盛、容易饥饿；然而如果进食量多，大便次数理应增多，甚至到了六七天仍然不大便，这就明确不是气机郁结，而是瘀血凝结所致。因此也适宜使用抵当汤。如果脉数不缓解，反而出现腹泻不止，注家认为此时应使用抵当汤攻下，结果脉数仍不缓解，这是极大的谬误。此处是针对“假如已经用过下法，脉数仍不缓解”这五句话的辨析：如果已经用过下法，脉数不缓解，反而六七天不大便，则适宜用抵当汤来攻下瘀血；如果已经用过下法，脉数不缓解，却出现腹泻不止，则不宜再用抵当汤这种峻猛的攻下药，只应当斟酌病情，清泄血分中的热邪；如果血分的热邪不能清除，必然会导致热邪与瘀血相搏结而出现大便脓血。（喻嘉言）
伤寒病经过五六天，出现头部出汗，轻微怕冷，手脚发凉，心下部胀满，不想吃东西，大便干硬，脉象细弱的，这叫做阳微结（阳气轻微郁结），必定既有表证，又有里证。脉沉，说明病位在里。头汗出，是阳气轻微郁结的表现；假如是纯粹的阴寒内结，就不会再有体表的证候，所有症状都表现在内部，这属于病位一半在里、一半在外的情况。即使脉象沉紧，也不能诊断为少阴病。之所以这样判断，是因为阴证通常不会有汗出，现在患者头部出汗，所以知道这不是少阴病，可以给予小柴胡汤治疗。如果服药后症状仍不彻底缓解，通过排便即可痊愈。
所谓阳微结，是指阳热邪气轻微郁结尚未完全消散。注家将其解释为阳气衰微导致邪气结聚，这是巨大的错误！如果真的那样，那么头汗出就是亡阳（阳气脱失）的证候，而不是半表半里的证候了。如果真的那样，那么阴结又变成了阴气衰微了。仔细玩味原文中“假如纯阴结”等语句，意思是说如果阳邪不是轻微郁结，而是纯粹的阴邪内结，就不会再有体表的证候，其含义非常明确。“得屎而解”，即取用大柴胡汤作为和解之法的意思。（《尚论篇》）
大病初愈后，因劳累而复发的，以枳实栀子豉汤为主治方剂。
劳复，是指在起居劳作之后产生的余热病症。注家将其解释为房事后复发，这是极大的谬误！女劳复（房事不慎导致的复发）是患伤寒后的大忌，大多死亡极少存活，怎么会有反过来使用具有涌吐和泻下作用的方剂的道理呢？（喻嘉言）
患者的脉象已经平和正常，但在傍晚时分出现轻微的烦闷，这是因为大病刚刚痊愈，人们强行给病人进食，脾胃之气尚且虚弱，不能消化食物，所以导致轻微烦闷，减少饮食摄入就会痊愈。
所谓脉象已解，是指阴阳调和，可知没有表里之邪。傍晚时分轻微烦闷，是因为白天卫气行于阳分，本不应烦闷，这是由于脾胃气弱，不能消化食物所致，减少饮食摄入，脾胃之气逐渐恢复旺盛，疾病就会自愈。注家牵强附会地将傍晚解释为阳明经旺盛的时辰，因此认为减少饮食应当配合轻微的攻下，却不知道这是论述病愈后的证候，而非论述六经病传变为阳明病的证候。傍晚，即《内经》所说的太阳西下时阳气开始衰退的意思，所以不能消化食物。减少饮食应当是减少谷物食物的摄入，以休养脾胃，不可引用前条关于宿食的例子，轻易使用大黄，从而严重损伤脾胃。（喻嘉言）
Passage of black, tarry stools indicates the presence of blood stasis; *Didang Tang* (Rescue the Extremities Decoction) is indicated. If the pulse remains rapid and symptoms do not resolve, accompanied by incessant diarrhea, it is certain that heat will combine with blood to produce pus and blood in the stool.
Although it is stated that there are no typical exterior or interior syndromes, the presence of fever and a floating, rapid pulse indicates that the exterior syndrome still exists. The reason why purgation can be used is that after seven or eight days, the duration has been long, and combined with fever and a rapid pulse, the heat in the stomach is blazing and body fluids are exhausted. Under these circumstances, purgation becomes necessary, such as using *Da Chaihu Tang* (Major Bupleurum Decoction). If the rapid pulse does not resolve after purgation, it can be inferred that the stomach heat is indeed severe; the manifestation should be excessive hunger due to efficient digestion. However, if food intake is high, bowel movements should increase, yet if there is no bowel movement for six or seven days, it is clearly not qi stagnation but blood stasis. Therefore, *Didang Tang* is also appropriate here. If the pulse remains rapid but is accompanied by incessant diarrhea, the commentator's assertion that *Didang Tang* should be used to purge, resulting in an unresolved rapid pulse, is a gross error. This passage addresses the five sentences regarding "if purgation has already been administered and the rapid pulse does not resolve": if purgation has been given, the rapid pulse does not resolve, and there is no bowel movement for six or seven days, then *Didang Tang* should be used to purge the blood stasis; however, if purgation has been given, the rapid pulse does not resolve, and there is incessant diarrhea, then the harsh purgative action of *Didang Tang* is contraindicated. Instead, one should carefully assess the condition and clear the heat pathogen in the blood level; if the heat pathogen in the blood level is not eliminated, it will inevitably lead to pus and blood in the stool due to heat combining with blood. (Yu Jiayan)
After five or six days of *Shanghan* (Cold Damage), if there is sweating only on the head, slight aversion to cold, cold hands and feet, fullness in the epigastrium, lack of desire to eat, hard stools, and a fine pulse, this is called "Yang Wei Jie" (Minor Yang Binding/Constriction). There must be both an exterior and an interior component. A deep pulse also indicates an interior location. Sweating indicates minor yang binding; if it were pure yin binding, there would be no exterior symptoms remaining, and all signs would be internal. This represents a condition half in the interior and half in the exterior. Even if the pulse is deep and tight, it cannot be diagnosed as a *Shaoyin* disease. The reason is that yin conditions typically do not present with sweating; since there is sweating on the head, it is known not to be *Shaoyin*. *Xiao Chaihu Tang* (Minor Bupleurum Decoction) may be administered. If the patient remains uncomfortable, resolution will occur upon passing stool.
"Yang Wei Jie" refers to mild binding of yang pathogens that have not yet fully dispersed. The commentator's interpretation that this is due to the decline of yang qi leading to pathogen binding is a major deviation! If that were the case, head sweating would be a sign of yang collapse, not a half-exterior/half-interior syndrome. Furthermore, yin binding would imply a decline of yin qi. Examining the text's phrase "if pure yin binding," the meaning is clear: if the yang pathogen were not mildly bound but purely yin pathogen binding internally, there would be no exterior symptoms. "Resolution upon passing stool" implies the intent of using *Da Chaihu Tang* as a harmonizing method. (*Shanglun Pian*)
For recurrence of illness due to overexertion after a major illness has healed, *Zhishi Zhizi Chi Tang* (Immature Bitter Orange, Gardenia, and Fermented Soybean Decoction) is the primary treatment.
"Lao Fu" (recurrence due to labor) refers to residual heat arising after physical exertion in daily activities. The commentator's interpretation that this refers to recurrence after sexual intercourse is a gross error! Recurrence after sexual intercourse ("Nv Lao Fu") is a major taboo after contracting *Shanghan*, often leading to death rather than survival. How could one use a formula with emetic and purgative properties in such a case? (Yu Jiayan)
If the patient's pulse has returned to normal, but they experience slight irritability in the evening, it is because the illness has just healed, and people force-feed them. The spleen and stomach qi are still weak and unable to digest food, causing slight irritability. Reducing food intake will lead to recovery.
"Pulse resolved" means yin and yang are harmonious, indicating no exterior or interior pathogens. Slight irritability in the evening occurs because wei qi (defensive qi) travels through the yang channels during the day, so irritability should not normally occur; it is caused by weak spleen and stomach qi failing to digest food. Reducing food intake allows spleen and stomach qi to gradually recover, leading to self-healing. Commentators erroneously associate the evening with the flourishing time of the *Yangming* channel, suggesting that reducing food should involve mild purgation. They fail to realize this discusses post-healing conditions, not the transmission of the Six Channels into *Yangming*. "Evening" refers to the concept in the *Neijing* that when the sun sets, yang qi begins to decline, hence the inability to digest food. "Reducing food" means decreasing grain consumption to nourish and rest the spleen and stomach. One should not cite previous cases of retained food to lightly administer *Dahuang* (Rhubarb Root), which would severely damage the spleen and stomach. (Yu Jiayan)