太阳病，脉浮而动数，浮则为风，数则为热，动则为痛，数则为虚；头痛发热，微盗汗出，而反恶寒者，表
未解也。医反下之，动数变迟，膈内拒痛，胃中空虚，客气动膈，短气躁烦，心中懊 ，阳气内陷，心下因
硬，则为结胸，大陷胸汤主之。
按∶太阳病在表，未曾解表而攻里，可谓虚矣。况所得之脉皆浮而动数，今复误下，动数变迟矣；又曰
胃中空虚，又曰短气烦躁，虚之甚矣。借曰阳气内陷，心下因硬，而可迅攻之乎？岂陷胸之力反缓于承气，一
下再下，可不畏其重虚乎？且《经》明曰∶结胸脉浮大者，不可下，下者死。又曰∶结胸证悉具，烦躁者
死。今曰脉浮，又曰烦躁，大陷胸果可用乎？（朱丹溪）
太阳病，重发汗，而复下之，不大便五六日，舌上燥而渴，日晡所小有潮热，从心下至少腹，硬满而不可
近者，大陷胸汤主之。
按∶太阳病已重发汗，表则虚矣。若复下之，里又虚矣。不大便五六日，可见津液之耗矣。虽有硬痛，
而可以迅攻之乎？若曰潮热于申酉系阳明，属调胃承气证，既又曰少有潮热，犹可疑待之间，将无他法以缓
取之乎？（朱丹溪）
结胸证，仲景治用大陷胸汤。余见惟伤寒本病，不因误下，而实邪传里，心下硬满，痛连少腹，手不可
近，或燥渴谵语，便硬，脉实者所宜也。其余太、少表邪未解，下早而致者，表邪犹在，再用陷胸，是一误
再误，诚所未敢。不若以痞满门诸法酌而施之。（张景岳）
厥阴中风，脉微浮，为欲愈；不浮，为未愈。
有厥阴中风欲愈脉，则应有未愈证。夫以风木之脏，值风木主气时，复中于风，则变端必有更甚于他经
者，不得一焉，不能无阙文之憾。○仲景分别六经，各经俱有中风、伤寒脉证治法。叔和时，《太阳篇》存者
多而失者少，他经存者少而失者多；《阳明篇》尚有中风脉证二条，少阳经只证一条，而不及脉；三阴但
有中风欲愈脉，俱无中风脉证。以《伤寒论》为全书，不亦疏乎？（柯韵伯）
病在阳，应以汗解之；反以冷水 之，若灌之，其热被劫不得去，弥更益烦，肉上粟起，意欲饮水，反不渴
者，服文蛤散；
若不瘥者，与五苓散；身热皮粟不解，欲引衣自覆者，若以水 之、洗之，益令热被劫不能出，当汗而不汗则
烦；假令汗出已，腹中痛，与芍药三两如上法。○太阳病二日反躁云云。（见《会通》）○下之后，复发汗，
昼日烦躁不得眠，夜而安静，不呕不渴。无表证，脉沉微，身无大热者，干姜附子汤主之。○发汗，若下之，
病仍不解，烦躁者，茯苓四逆汤主之。○伤寒，腹满谵语，寸口脉浮而紧，此肝乘脾也，名曰纵，刺期门。
○伤寒发热，啬啬恶寒云云。○病患无表里证，发热七八日云云。（俱见《错简》）○脉浮而芤，浮为阳，
芤为阴，浮芤相搏，胃气生热，其阳则绝。○阳明病，反无汗而小便利，二三日呕而咳，手足厥者，必苦头
痛；若不咳不呕，手足不厥者，头不痛。○阳明病，但头眩，不恶寒，故能食而咳，其人咽必痛；若不咳者，
咽不痛。○少阴病，吐利，手足逆冷，烦躁欲死者，吴茱萸汤主之。○伤寒脉浮，自汗出，小便数，心烦，微
恶寒，脚挛急，反与桂枝汤，欲攻其表，此误也，得之便厥。咽中干，烦躁吐逆者，作甘草干姜汤与之，以复
其阳。若厥愈足温者，更作芍药甘草汤与之，其脚即伸。若胃气不和，谵语者，少与调胃承气汤。若重发汗，
复加烧针者，四逆汤主之。○问曰证象阳旦云云。（见《问难》）○伤寒六七日，大下后，寸脉沉而迟，手足
厥逆云云。（见《方考》）○伤寒
八九日，下之，胸满烦惊，小便不利，谵语，一身尽重，不可转侧者，柴胡加龙骨牡蛎汤主之。○微数之脉，
慎不可灸，因火为邪，则为烦逆，追虚逐实，血散脉中，火气虽微，内攻有力，焦骨伤筋，血难复也。○脉
浮宜以汗解，用火灸之，邪无从出，因火而盛，病从腰以下，必重而痹，名火逆也。○伤寒脉浮，医以火迫劫
之云云。（《见问难》）○湿家下之，额上汗出，微喘，小便利者，死；若下利不止者，亦死。○太阳中
者，身热疼重，而脉微弱，此亦夏月伤冷水，水行皮中所致也。○脉濡而弱，弱反在关，濡反在颠，微反在上，
涩反在下；微则阳气不足，涩则无血，阳气反微，中风汗出，而反躁烦；涩则无血，厥而且寒，阳微发汗，躁
不得眠。○脉濡而弱，弱反在关，濡反在颠；弦反在上，微反在下；弦为阳运，微为阴寒；上实下虚，意欲
得温；微弦为虚，不可发汗，发汗则寒栗不能自还。○厥而脉紧，不可发汗，发汗则声乱，咽嘶舌萎，声不
得前。○咳者则剧，数吐涎沫，咽中必干，小便不利，心中饥烦， 时而发，其形似疟，有寒无热，虚而寒
栗，咳而发汗，蜷而苦满，腹中复坚。○脉濡而弱，弱反在关，濡反在颠蜷；微反在上，涩反在下；微则阳
气不足，涩则无血，阳气反微，中风汗出，而反躁烦；涩则无血，厥而且寒；阳微不可下，下之则心下痞硬。
○脉濡而弱，弱反在关，濡反在颠；弦反在上，微反在下；弦为阳运，微为阴寒；上实下虚，意欲得温；微
弦为虚，虚者不可下也。○脉濡而弱，弱反在关，濡反在颠；浮反在上，数反在下；浮为阳虚，数为无血；
浮为虚，数为热；浮为虚，自汗出而恶寒；数为痛，振寒而栗。微弱在关，胸下为急，喘汗而不得呼吸，呼吸
之中，痛在于胁，振寒相搏，形如疟状，医反下之，故令脉数发热，狂走见鬼，心下为痞，小便淋漓，少腹甚
硬，小便则尿血也。○脉濡而紧，濡则卫气微，紧则营中寒。阳微卫中风，发热而恶寒。营紧胃气冷，微呕心
内烦。医为有大热，解肌而发汗。亡阳虚烦躁，心下苦痞坚。表里
俱虚竭，卒起而头眩。客热在皮肤，怅怏不得眠。不知胃气冷，紧寒在关元。技巧无所施。汲水灌其身。客热
因时罢，栗栗而振寒。重被而覆之，汗出而冒巅。体惕而又振，小便为微难。寒气因水发，清谷不容间。呕变
反肠出，颠倒不得安。手足为微逆，身冷而内烦。迟欲从后救，安可复追还？○脉浮而大，浮为气实，大为血
虚；血虚为无阴，孤阳独下阴部者，小盒饭亦而难，胞中当虚；今反小便利而大汗出，法应卫家当微；今反更
实，津液四射，营竭血尽，干烦而不得眠，血薄肉消，而成暴液；医复以毒药攻其胃，此为重虚。客阳去有期，
必下如污泥而死。○伤寒，脉阴阳俱紧，恶寒发热，则脉欲厥。厥者脉初来大，渐渐小，更来渐渐大，是其
候也。如此者恶寒，甚者翕翕汗出，喉中痛。若热多者，目赤脉多，睛不慧；医复发之，咽中则伤；若复下之，
则两目闭，寒多便清谷，热多便脓血；若熏之则身发黄；若熨之则咽燥。若小便利者可救之，若小便难者为危
殆。○伤寒发热，口中勃勃气出云云。（见《脱佚》）○微则为咳，咳则吐涎，下之则咳止而利因不休；利不休，
则胸中如虫啮，粥入则出，小便不利，两胁拘急，喘息为难，颈背相引，臂则不仁，极寒，反汗出，身冷若冰，眼
睛不慧，语言不休，而谷气多入，此为除中。口虽欲言，舌不得前。○脉数者，久数不止，止则邪结，正气
不能复，正气却结于脏，故邪气浮之与皮毛相得。脉数者不可下，下之必烦，利不止。○伤寒发热，头痛微
汗出，发汗则不识人；熏之则喘，不得小便，心腹满；下之则短气，小便难，头痛背强；加温针则衄。○下利
脉大者，虚也，以强下之故也。设脉浮革，因尔肠鸣者，属当归四逆汤。
仲景《伤寒论》，篇篇可法。但成于汉末，传写多讹，错简亦复不少，如论中下利、呕逆，用十枣汤峻剂
攻之；阳重衄血，以麻黄汤发之；发汗病解，反恶寒，病解之中多一不字；心下痞，按之濡，濡字之上，少
一不字之类。诸家遵经注解，不得不穿凿
附会，致令千古不可多得之书，不能传信于世，良可惜也。今加正误，一一列明，每条凡小字旁上者，原文
也；旁下者，改正之文也；居中者，原文所有。或移上，或移下，或他处移入，及原文所无而补之者也。字上
加口，删去者也。尤有整节舛谬者，三十五条，证不与脉符，药不与病合，虽有是方，世无其病，即有其病，
虽用是药，承讹袭谬，无济实用。然其中尚有可采之句，所以各篇不动《经》文，强加注释，复录原文附于
卷末，以志阙疑云。（《医宗金鉴》）
《可不可》诸篇，谓为医圣原文，有数可疑∶原文言简而意该，斯则辞多而仍意未尽，一也；故作趁
韵语句，且有似五言诗者，六经论中，无此体裁，二也，可不可之故，有引六经中原文者，有云已见《伤寒论》
某篇中者，不相画一，三也；多用反字，却无反意，如云脉濡而弱，弱反在关，濡反在巅之类，岂濡宜在关
而弱宜在巅耶？在巅二字，亦医圣言，脉所未见，四也；诸可下内，概用大承气，医圣言下之多有不出方者，
盖自大柴胡、调胃、大、小三承气、陷胸、泻心、抵当等法，皆言下也，今可下不可下，但言下大便，已
觉其义不备，况下大便，亦非一大承气可该，并不详晰，何须专论，五也；至于诸注，大约傅会成文，其说
可稍通顺，若加攻驳，则不胜龃龉，焉能起九原之人而问之乎？六也；方注摘冗长者六段，以为伦类不清，不
为立注，以愚观之，此伦类不清四字，可该四篇全义，七也；可吐、可汗、可下大法定时令，犹是作例故智，
更为胶柱鼓瑟，八也。（魏荔彤）
叔和之增入者，《辨脉》、《平脉》，与《可汗》、《可下》等篇而已。其六经等篇，必非叔和所能
赞辞也。但厥阴经中，下利呕哕诸条，却是叔和因其有厥逆而附，遂并无厥逆而同类者，亦附之耳。（《溯洄集》）
六淫首重伤寒，《素问》虽启其端，未穷其旨，后汉张仲景着《伤寒论》，阐其底蕴，详其治法，诚医
林之宝筏。第其书文词古奥，且流传日久，既多散亡，而王叔和之编，林亿之校，成无己之注，复多乖舛，致
使学人门径难窥，读之懵懂，赖有后起英贤，各具巨眼，一一为之订证。惜乎希珍散见，未能罗列一区，难于
泛览。不辞冒昧，谨将诸家注释细加寻绎，凡《论》中所有倒序、错简、传误、脱佚、衍文、字讹及注谬、方
乖，经前贤拈出，补移删改，辨正考订，与夫会通、问难、阙疑者，谨录若干条，分为十一篇，汇成一卷，读
者庶可触目了然耳。○或问相传《素问》非出轩岐，乃战国时人所撰，根据托其名，而《伤寒论》义理，比《素
问》反深，其讹错反多者，何也？予曰∶悉乎哉问也！曩闻老医方星岩云∶《伤寒论》非仲景自作之书，乃
伊芳尹之言，而祖述之也。故其书较《素问》尤为古奥，洵非汉文所有，且自序与本论词气亦复各别，其出两手
可知矣。按伊芳尹原着有《汤液》，仲景自序中已有勤求古训、博采众方之语，又考皇甫谧云∶仲景论广《伊芳尹
汤液》为数十卷，用之多验。由此观之，方氏之言，当有所本，姑附记之，以质明哲。后学程文囿识。
太阳病，脉象浮而动数，浮脉主风邪，数脉主热，动脉主痛，数脉也主虚；出现头痛、发热，且有轻微盗汗，反而恶寒的，说明表证尚未解除。医生反而使用攻下法，导致原本动的数脉变为迟脉，膈内拒按而痛，胃中空虚，客气扰动膈间，出现短气、烦躁，心中懊恼，阳气内陷，心下因此变硬，这就形成了结胸证，应当用大陷胸汤主治。
按语：太阳病在表，未曾解表而直接攻里，可以说是虚妄了。况且所得的脉象都是浮而动数，现在又误用下法，使动数之脉变为迟脉；又说胃中空虚，又说短气烦躁，这是极度虚弱啊。假如说是阳气内陷，心下因此变硬，就可以迅速攻下吗？难道陷胸汤的力量反而比承气汤还缓吗？一下再下，难道不怕造成严重的虚损吗？而且《内经》明确说：结胸证脉象浮大的，不可攻下，攻下则死。又说：结胸证症状全部具备，且烦躁的，也是死证。现在说脉浮，又说烦躁，大陷胸汤果真可以用吗？（朱丹溪）
太阳病，再次发汗，然后又攻下它，导致五六天不大便，舌上干燥且口渴，傍晚时分有轻微的潮热，从心下直到小腹部，硬满疼痛且不能触碰的，用大陷胸汤主治。
按语：太阳病已经重发汗，表气已虚。如果再攻下，里气又虚了。五六天不大便，可见津液耗伤。虽然有硬痛，就可以迅速攻下吗？如果说傍晚潮热属于阳明经，是调胃承气汤的适应证，但又说只是“小有”潮热，还在可疑待决之间，难道没有别的方法可以缓和地取效吗？（朱丹溪）
结胸证，张仲景治疗使用大陷胸汤。我见到的情况只有伤寒本病，不是因为误下，而是实邪传入里部，心下硬满，疼痛牵连少腹，手不能触碰，或者燥渴谵语，大便硬，脉象实的，才适宜使用。其余太阴、少阳表邪未解，因过早攻下而导致的，表邪仍在，再用陷胸汤，这是一误再误，实在不敢苟同。不如参照痞满门的诸种方法酌情施用。（张景岳）
有厥阴中风欲愈的脉象，就应该有未愈的证候。以风木之脏，正值风木主气之时，又中于风邪，那么变端必定有比其他经络更严重的，不可能完全没有，不能不遗憾于文献缺失。○张仲景分别六经，各经都有中风、伤寒的脉证治法。王叔和时期，《太阳篇》保存的多而失传的少，其他经络保存的少而失传的多；《阳明篇》还有中风脉证两条，少阳经只有一条证候，而不涉及脉象；三阴经只有中风欲愈的脉象，都没有中风脉证。把《伤寒论》当作全书，不是太疏漏了吗？（柯韵伯）
病在阳分，应该用发汗法解除；反而用冷水喷洒或浇灌它，热气被遏制无法散去，更加烦闷，皮肤起粟粒，想喝水，反而不觉得渴的，服用文蛤散；
如果不好转，给予五苓散；身体发热、皮肤粟粒不解，想要拉衣服覆盖自己，如果用冷水喷洒、洗涤，更加使得热气被遏制不能外出，应当出汗却不出汗则烦闷；假如出汗后，腹中痛，给予芍药三两，按照上述方法。○太阳病第二天反而躁动云云。（见《会通》）○攻下之后，再次发汗，白天烦躁不得睡眠，夜间安静，不呕吐不口渴，无表证，脉象沉微，身体没有大热的，用干姜附子汤主治。○发汗，或者攻下，病仍不解除，烦躁的，用茯苓四逆汤主治。○伤寒，腹部胀满谵语，寸口脉浮而紧，这是肝乘脾，名叫纵，针刺期门穴。○伤寒发热，啬啬恶寒云云。○病患无表里证，发热七八天云云。（均见《错简》）○脉浮而芤，浮为阳，芤为阴，浮芤相搏，胃气生热，其阳则绝。○阳明病，反而无汗而小便通利，二三天呕吐且咳嗽，手足厥冷的，一定痛苦于头痛；如果不咳不呕，手足不厥冷的，头不痛。○阳明病，只是头晕眩，不恶寒，所以能进食且咳嗽，其人咽喉一定痛；如果不咳嗽的，咽喉不痛。○少阴病，吐利，手足逆冷，烦躁欲死的，用吴茱萸汤主治。○伤寒脉浮，自汗出，小便频数，心烦，微恶寒，脚挛急，反而给予桂枝汤，想要攻其表，这是错误，得到这种结果便出现四肢厥冷。咽中干，烦躁吐逆的，制作甘草干姜汤给予他，以恢复其阳气。如果厥冷愈、足温的，再制作芍药甘草汤给予他，他的脚就能伸直。如果胃气不和，谵语的，少量给予调胃承气汤。如果重发汗，再加烧针的，用四逆汤主治。○问曰证象阳旦云云。（见《问难》）○伤寒六七天，大攻下后，寸脉沉而迟，手足厥逆云云。（见《方考》）○伤寒八九天，攻下后，胸满烦惊，小便不利，谵语，一身尽重，不能转侧的，用柴胡加龙骨牡蛎汤主治。○脉象微数的，千万不可灸，因为火成为邪气，就会烦躁逆乱，追虚逐实，血散脉中，火气虽然微弱，内攻有力，焦骨伤筋，血难恢复。○脉浮宜用发汗法解除，用火灸它，邪气无从出路，因火而盛，病从腰以下，一定沉重而麻痹，名叫火逆。○伤寒脉浮，医生用火迫劫云云。（见《问难》）○湿家攻下后，额头出汗，微喘，小便通利的，死；如果下利不止的，也死。○太阳中暍，身体发热疼重，而脉微弱，这也是夏月伤冷水，水行皮中所致。○脉濡而弱，弱反在关部，濡反在巅部（指寸部），微反在上，涩反在下；微则阳气不足，涩则无血，阳气反微，中风汗出，反而躁烦；涩则无血，厥而且寒，阳微发汗，躁不得眠。○脉濡而弱，弱反在关部，濡反在巅部；弦反在上，微反在下；弦为阳运，微为阴寒；上实下虚，意欲得温；微弦为虚，不可发汗，发汗则寒栗不能自还。○厥而脉紧，不可发汗，发汗则声音杂乱，咽喉嘶哑舌头萎缩，声音发不出来。○咳嗽的则剧烈，多次吐涎沫，咽喉一定干，小便不利，心中饥烦，时而发作，其形似疟，有寒无热，虚而寒栗，咳嗽而发汗，蜷缩而苦于胀满，腹中又坚硬。○脉濡而弱，弱反在关部，濡反在巅部蜷缩；微反在上，涩反在下；微则阳气不足，涩则无血，阳气反微，中风汗出，反而躁烦；涩则无血，厥而且寒；阳微不可下，下之则心下痞硬。○脉濡而弱，弱反在关部，濡反在巅部；弦反在上，微反在下；弦为阳运，微为阴寒；上实下虚，意欲得温；微弦为虚，虚者不可下。○脉濡而弱，弱反在关部，濡反在巅部；浮反在上，数反在下；浮为阳虚，数为无血；浮为虚，数为热；浮为虚，自汗出而恶寒；数为痛，振寒而栗。微弱在关部，胸下为急，喘汗而不得呼吸，呼吸之中，痛在于胁，振寒相搏，形如疟状，医生反而攻下，所以令脉数发热，狂走见鬼，心下为痞，小便淋漓，少腹甚硬，小便则尿血。○脉濡而紧，濡则卫气微，紧则营中寒。阳微卫中风，发热而恶寒。营紧胃气冷，微呕心内烦。医生认为有大热，解肌而发汗。亡阳虚烦躁，心下苦痞坚。表里俱虚竭，卒起而头眩。客热在皮肤，怅怏不得眠。不知胃气冷，紧寒在关元。技巧无所施。汲水灌其身。客热因时罢，栗栗而振寒。重被而覆之，汗出而冒巅。体惕而又振，小便为微难。寒气因水发，清谷不容间。呕变反肠出，颠倒不得安。手足为微逆，身冷而内烦。迟欲从后救，安可复追还？○脉浮而大，浮为气实，大为血虚；血虚为无阴，孤阳独下阴部者的，小便当难而排尿困难，胞中当虚；现在反而小便通利而大汗出，法应卫气当微；现在反而更实，津液四射，营竭血尽，干烦而不得眠，血薄肉消，而成暴液；医生再用毒药攻其胃，这是重虚。客阳去有期，必下如污泥而死。○伤寒，脉阴阳俱紧，恶寒发热，则脉欲厥。厥者脉初来大，渐渐小，更来渐渐大，是其候也。如此者恶寒，甚者翕翕汗出，喉中痛。若热多者，目赤脉多，睛不慧；医生再发汗，咽中则伤；如果再攻下，则两目闭，寒多便清谷，热多便脓血；如果熏之则身发黄；如果熨之则咽燥。如果小便通利的可救，如果小便难的为危殆。○伤寒发热，口中勃勃气出云云。（见《脱佚》）○微则为咳，咳则吐涎，下之则咳止而利因不休；利不休，则胸中如虫啮，粥入则出，小便不利，两胁拘急，喘息为难，颈背相引，臂则不仁，极寒，反汗出，身冷若冰，眼睛不慧，语言不休，而谷气多入，此为除中。口虽欲言，舌不得前。○脉数者，久数不止，止则邪结，正气不能复，正气却结于脏，故邪气浮之与皮毛相得。脉数者不可下，下之必烦，利不止。○伤寒发热，头痛微汗出，发汗则不识人；熏之则喘，不得小便，心腹满；下之则短气，小便难，头痛背强；加温针则衄。○下利脉大者，虚也，以强下之故也。设脉浮革，因尔肠鸣者，属当归四逆汤。
张仲景《伤寒论》，篇篇值得效法。但成书于汉末，传写多有讹误，错简也不少，如论中下利、呕逆，用十枣汤峻剂攻之；阳重衄血，用麻黄汤发之；发汗病解，反恶寒，病解之中多一个“不”字；心下痞，按之濡，濡字之上，少一个“不”字之类。各家遵循经典注解，不得不穿凿附会，致使千古不可多得之书，不能传信于世，实在可惜。现在加以正误，一一列明，每条凡小字旁上的，是原文；旁下的，是改正之文；居中的，是原文所有。或移上，或移下，或他处移入，及原文所无而补之者也。字上加圈，表示删去者也。尤其整节舛谬的，有三十五条，证不与脉符，药不与病合，虽有是方，世无其病，即有其病，虽用是药，承讹袭谬，无济实用。然而其中尚有可采之句，所以各篇不动《经》文，强加注释，复录原文附于卷末，以志阙疑云。（《医宗金鉴》）
《可不可》诸篇，谓为医圣原文，有数可疑：原文言简而意该，这里则辞多而仍意未尽，一也；故作趁韵语句，且有似五言诗者，六经论中，无此体裁，二也，可不可之故，有引六经中原文者，有云已见《伤寒论》某篇中者，不相画一，三也；多用反字，却无反意，如云脉濡而弱，弱反在关，濡反在巅之类，岂濡宜在关而弱宜在巅耶？在巅二字，亦医圣言，脉所未见，四也；诸可下内，概用大承气，医圣言下之多有不出方者，盖自大柴胡、调胃、大、小三承气、陷胸、泻心、抵当等法，皆言下也，今可下不可下，但言下大便，已觉其义不备，况下大便，亦非一大承气可该，并不详晰，何须专论，五也；至于诸注，大约傅会成文，其说可稍通顺，若加攻驳，则不胜龃龉，焉能起九原之人而问之乎？六也；方注摘冗长者六段，以为伦类不清，不为立注，以愚观之，此伦类不清四字，可该四篇全义，七也；可吐、可汗、可下大法定时令，犹是作例故智，更为胶柱鼓瑟，八也。（魏荔彤）
王叔和增入的，《辨脉》、《平脉》，与《可汗》、《可下》等篇而已。其六经等篇，必非王叔和所能赞辞也。但厥阴经中，下利呕哕诸条，却是王叔和因其有厥逆而附，遂并无厥逆而同类者，亦附之耳。（《溯洄集》）
六淫首重伤寒，《素问》虽启其端，未穷其旨，后汉张仲景着《伤寒论》，阐其底蕴，详其治法，诚医林之宝筏。只是这本书文词古奥，且流传日久，既多散亡，而王叔和之编，林亿之校，成无己之注，复多乖舛，致使学人门径难窥，读之懵懂，赖有后起英贤，各具巨眼，一一为之订证。可惜希珍散见，未能罗列一区，难于泛览。不辞冒昧，谨将诸家注释细加寻绎，凡《论》中所有倒序、错简、传误、脱佚、衍文、字讹及注谬、方乖，经前贤拈出，补移删改，辨正考订，与夫会通、问难、阙疑者，谨录若干条，分为十一篇，汇成一卷，读者庶可触目了然耳。○有人问相传《素问》非出轩岐，乃战国时人所撰，根据托其名，而《伤寒论》义理，比《素问》反深，其讹错反多者，何也？我说：问得详尽啊！从前听老医方星岩说：《伤寒论》不是张仲景自作之书，乃是伊尹之言，而祖述之也。所以这本书较《素问》尤为古奥，确实不是汉代文字所有，且自序与本论词气亦复各别，其出两手可知矣。按伊尹原著有《汤液》，张仲景自序中已有勤求古训、博采众方之语，又考皇甫谧说：张仲景论广《伊尹汤液》为数十卷，用之多验。由此观之，方氏之言，当有所本，姑附记之，以质明哲。后学程文囿识。
Taiyang disease, with a pulse that is floating, moving, and rapid. Floating indicates wind, rapid indicates heat, moving indicates pain, and rapid also indicates deficiency; headache and fever, with slight night sweats, yet conversely aversion to cold, indicate that the exterior syndrome has not yet resolved. The physician erroneously applies purgation, causing the moving and rapid pulse to change to a slow one, rejection pain within the diaphragm, emptiness in the stomach, disturbance of the pathogenic qi affecting the diaphragm, shortness of breath, irritability, mental restlessness (Ao Nao), internal sinking of Yang Qi, hardness below the heart, thus forming Jie Xiong (Chest Binding); Da Xian Xiong Tang (Great Decoction to Drain the Chest) is the primary treatment.
Commentary: Taiyang disease is at the exterior; attacking the interior without first resolving the exterior is indeed erroneous. Moreover, the obtained pulses are all floating, moving, and rapid; now, after erroneous purgation, the moving and rapid pulse becomes slow; it is also said that the stomach is empty and there is shortness of breath and irritability, indicating extreme deficiency. If one were to say that Yang Qi has sunk internally and hardness has occurred below the heart, can one swiftly apply purgation? Is the power of Xian Xiong Tang actually slower than Cheng Qi Tang? Purging once and then again, how can one not fear severe depletion? Furthermore, the Classics clearly state: In Jie Xiong syndrome, if the pulse is floating and large, do not purge; purging leads to death. It also states: If all symptoms of Jie Xiong are present and there is irritability, it is a death case. Now it says the pulse is floating and there is irritability; can Da Xian Xiong Tang truly be used? (Zhu Danxi)
Taiyang disease, after heavy sweating and subsequent purgation, resulting in no bowel movement for five or six days, dryness and thirst on the tongue, slight tidal fever in the late afternoon, hardness and fullness from the epigastrium down to the lower abdomen that cannot be touched, is treated with Da Xian Xiong Tang.
Commentary: Taiyang disease has already undergone heavy sweating, so the exterior is deficient. If purged subsequently, the interior is also deficient. No bowel movement for five or six days shows consumption of body fluids. Although there is hardness and pain, can one swiftly purge? If one argues that tidal fever in Shen and You hours belongs to Yangming and is an indication for Tiao Wei Cheng Qi Tang, yet it says "slight" tidal fever, leaving room for doubt; are there not other methods to achieve relief gradually? (Zhu Danxi)
For Jie Xiong syndrome, Zhang Zhongjing uses Da Xian Xiong Tang. I have observed that this is suitable only for original Shanghan (Cold Damage) disease, not caused by erroneous purgation, but where excess pathogen transmits to the interior, causing hardness and fullness below the heart, pain radiating to the lower abdomen that cannot be touched, or dry thirst, delirium, hard stool, and a solid pulse. For cases where Tai and Shao Yang exterior pathogens remain unresolved due to premature purgation, the exterior pathogen is still present; using Xian Xiong Tang again would be one error after another, which I dare not endorse. It is better to refer to the methods in the Pi Man (Fullness and Obstruction) section and apply them judiciously. (Zhang Jingyue)
Jueyin wind strike, with a pulse slightly floating, indicates impending recovery; if not floating, it indicates non-recovery.
If there is a pulse for impending recovery in Jueyin wind strike, there should be signs of non-recovery. Given that Jueyin is the wood organ, and during the time when wind-wood governs the qi, being struck by wind again implies that complications must be more severe than in other meridians; it is impossible that there are none, leaving regret over missing texts. ○ Zhang Zhongjing distinguishes the Six Meridians, each having pulse, syndrome, and treatment methods for wind strike and cold damage. During Wang Shuhe's time, the Taiyang chapter had many preserved and few lost; other meridians had few preserved and many lost; the Yangming chapter still has two items of wind strike pulse and syndrome, Shaoyang meridian has only one syndrome item without mentioning pulse; the Three Yin meridians only have the pulse for wind strike impending recovery, lacking wind strike pulse and syndrome entirely. To consider the Shanghan Lun as a complete work is too negligent. (Ke Yunbo)
Disease in the Yang aspect should be resolved by sweating; instead, cold water is sprayed or poured on the patient. The heat is constrained and cannot escape, becoming increasingly烦 (fán - vexed/restless), skin rises like millet grains, desire to drink water but no actual thirst; administer Wen Ge San (Clam Shell Powder).
If not improved, administer Wu Ling San (Five-Ingredient Powder with Poria). If body heat and skin millet grains persist, and the patient desires to pull clothes to cover themselves, spraying or washing with water further constrains the heat preventing its exit; sweating should occur but does not, leading to vexation; if sweating occurs and abdominal pain follows, administer three liang of Shaoyao (Paeoniae Radix) according to the above method. ○ Taiyang disease on the second day, conversely restless, etc. (See Huitong) ○ After purgation, re-sweating, daytime irritability preventing sleep, nighttime quietness, no vomiting, no thirst, no exterior syndrome, pulse deep and faint, no significant body heat; Gan Jiang Fu Zi Tang (Ginger and Aconite Decoction) is the primary treatment. ○ Sweating, or purgation, disease remains unresolved, with irritability; Fu Ling Si Ni Tang (Poria and Four Reversal Decoction) is the primary treatment. ○ Cold damage, abdominal fullness and delirium, Cun Kou (radial) pulse floating and tight, this is Liver overacting on Spleen, named Zong (Vertical Overaction), puncture Qimen (LR14). ○ Cold damage fever, se se (shivering) aversion to cold, etc. ○ Patient with no exterior or interior syndrome, fever for seven to eight days, etc. (All see Cuojian) ○ Pulse floating and hollow (Kou); floating is Yang, hollow is Yin; floating and hollow interacting, Stomach Qi generates heat, its Yang is severed. ○ Yangming disease, conversely no sweat and clear urination, vomiting and coughing after two to three days, cold hands and feet, must suffer headache; if no coughing or vomiting, and hands and feet are not cold, the head does not hurt. ○ Yangming disease, only dizziness, no aversion to cold, thus able to eat and cough, the person's throat must hurt; if no coughing, the throat does not hurt. ○ Shaoyin disease, vomiting and diarrhea, cold hands and feet, irritability desiring death; Wu Zhu Yu Tang (Evodia Decoction) is the primary treatment. ○ Cold damage, pulse floating, spontaneous sweating, frequent urination, heart vexation, slight aversion to cold, leg cramping; conversely given Guizhi Tang (Cinnamon Twig Decoction) to attack the exterior, this is an error, resulting in cold limbs. Dry throat, irritability, vomiting and reflux; prepare Gan Cao Gan Jiang Tang (Licorice and Ginger Decoction) to restore Yang. If cold resolves and feet warm, prepare Shao Yao Gan Cao Tang (Peony and Licorice Decoction), legs will extend. If Stomach Qi is disharmonious and delirium occurs, give small amounts of Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct to the Interior Decoction). If heavily sweated and moxa needles added, Si Ni Tang (Four Reversal Decoction) is the primary treatment. ○ Question: Syndrome resembles Yangdan, etc. (See Wendan) ○ Cold damage six to seven days, after major purgation, Cun pulse deep and slow, cold hands and feet, etc. (See Fangkao) ○ Cold damage eight to nine days, after purgation, chest fullness, vexation and fright, difficult urination, delirium, heaviness throughout the body unable to turn; Chai Hu Jia Long Gu Mu Li Tang (Bupleurum plus Dragon Bone and Oyster Shell Decoction) is the primary treatment. ○ Pulse slightly rapid, strictly avoid moxibustion; because fire becomes pathogenic, causing vexation and rebellion, chasing deficiency and pursuing excess, blood scatters in vessels; although fire qi is weak, internal attack is powerful, scorching bones and injuring sinews, blood is hard to recover. ○ Pulse floating should be resolved by sweating; applying moxibustion leaves pathogen no outlet, flourishing due to fire, disease from waist down becomes heavy and numb, named Fire Rebellion. ○ Cold damage pulse floating, physician uses fire coercion, etc. (See Wendan) ○ Dampness patient purged, sweat on forehead, slight panting, clear urination, death; if diarrhea unceasing, also death. ○ Sunstroke in Taiyang, body heat and heavy pain, pulse faint and weak, this is also caused by summer injury to cold water, water circulating in the skin. ○ Pulse soft and weak, weakness reversed in Guan position, softness reversed in Dian position (Cun), faintness reversed above, choppy reversed below; faintness means insufficient Yang Qi, choppy means lack of blood, Yang Qi conversely faint, wind strike sweating, conversely vexation; choppy means lack of blood, reversal and cold, faint Yang sweating, vexation preventing sleep. ○ Pulse soft and weak, weakness reversed in Guan, softness reversed in Dian; wiry reversed above, faint reversed below; wiry is Yang movement, faint is Yin cold; upper excess lower deficiency, desire for warmth; faint and wiry is deficiency, do not sweat, sweating causes chills unable to recover. ○ Reversal with tight pulse, do not sweat, sweating causes voice disorder, hoarse throat, atrophied tongue, voice cannot emerge. ○ Coughing becomes severe, frequent spitting of saliva, throat must be dry, difficult urination, hunger and vexation in heart, attacks intermittently resembling malaria, cold without heat, deficiency with chills, coughing and sweating, curling up suffering fullness, abdomen again hard. ○ Pulse soft and weak, weakness reversed in Guan, softness reversed in Dian curling; faintness reversed above, choppy reversed below; faintness means insufficient Yang Qi, choppy means lack of blood, Yang Qi conversely faint, wind strike sweating, conversely vexation; choppy means lack of blood, reversal and cold; faint Yang cannot purge, purging causes epigastric pi-hardness. ○ Pulse soft and weak, weakness reversed in Guan, softness reversed in Dian; wiry reversed above, faint reversed below; wiry is Yang movement, faint is Yin cold; upper excess lower deficiency, desire for warmth; faint and wiry is deficiency, deficiency cannot purge. ○ Pulse soft and weak, weakness reversed in Guan, softness reversed in Dian; floating reversed above, rapid reversed below; floating is Yang deficiency, rapid is lack of blood; floating is deficiency, rapid is heat; floating is deficiency, spontaneous sweating and aversion to cold; rapid is pain, chills and shivering. Faint and weak in Guan, urgency below chest, panting and sweating unable to breathe, breathing pain in hypochondrium, chills interacting, shape like malaria, physician erroneously purges, thus making pulse rapid and feverish, running mad seeing ghosts, epigastric pi, dripping urination, severe lower abdominal hardness, hematuria. ○ Pulse soft and tight, soft means Wei Qi is weak, tight means Ying Cold in interior. Yang weak, Wei struck by wind, fever and aversion to cold. Ying tight, Stomach Qi cold, slight vomiting, internal heart vexation. Physician thinks there is great heat, releases muscle and sweats. Loss of Yang, deficiency vexation, epigastric bitter pi-hardness. Exterior and interior both exhausted, sudden rising causes dizziness. Guest heat in skin, discontented unable to sleep. Ignoring cold Stomach Qi, tight cold in Guanyuan. Skill useless. Drawing water to pour on body. Guest heat ceases with time, shivering and chills. Heavy blankets covering, sweating and head covered. Body trembling and shaking, urination slightly difficult. Cold qi triggered by water, clear undigested food allows no interval. Vomiting changes to evisceration, turning upside down unable to rest. Hands and feet slightly reversed, body cold and internal vexation. Late attempt to save from behind, how can it be追回 (retrieved)? ○ Pulse floating and large, floating is Qi excess, large is Blood deficiency; Blood deficiency is no Yin, solitary Yang descends alone to Yin parts, urine should be difficult and difficult to pass, uterus should be empty; now conversely clear urination and heavy sweating, law dictates Wei Qi should be weak; now conversely more solid, body fluids scatter four ways, Ying exhausted Blood finished, dry vexation unable to sleep, blood thin flesh wasting, becoming sudden fluid loss; physician again uses toxic drugs to attack Stomach, this is double deficiency. Guest Yang departure has a date, must defecate like mud and die. ○ Cold damage, Yin and Yang pulses both tight, aversion to cold and fever, then pulse wants to reverse. Reverse means pulse initially large, gradually small, then gradually large, this is its sign. Such cases have aversion to cold, severely fluttering sweat, throat pain. If heat is dominant, red eyes and many pulses, eyes dull; physician re-sweats, throat injured; if re-purged, both eyes close, cold dominant clear stool, heat dominant pus and blood in stool; if fumigated, body turns yellow; if ironed, throat dry. If urination clear, can be saved; if urination difficult, critical. ○ Cold damage fever, bubbling air from mouth, etc. (See Tuoyi) ○ Faintness causes cough, coughing spits saliva, purging stops cough but diarrhea continues unceasing; diarrhea unceasing, chest feels like insect biting, porridge enters and exits, difficult urination, bilateral hypochondriac tension, difficult breathing, neck and back pulling, arms numb, extreme cold, conversely sweating, body cold as ice, eyes dull, speech unceasing, grain qi enters much, this is Chu Zhong (Elimination of Central Qi). Mouth wants to speak, tongue cannot advance. ○ Rapid pulse, long-lasting rapid without stopping, stopping means pathogen binds, Zheng Qi cannot recover, Zheng Qi binds in Zang, thus pathogen floats and connects with skin and hair. Rapid pulse cannot be purged, purging causes vexation, diarrhea unceasing. ○ Cold damage fever, headache, slight sweat, sweating causes inability to recognize people; fumigation causes panting, inability to urinate, heart and abdominal fullness; purging causes shortness of breath, difficult urination, headache and stiff back; adding warm needle causes nosebleed. ○ Diarrhea with large pulse is deficiency, due to strong purgation. Suppose pulse floating and革 (Ge - drumskin), thus intestinal borborygmus, belongs to Dang Gui Si Ni Tang.
Zhang Zhongjing's Shanghan Lun, every chapter is worthy of emulation. But completed in the late Han, transmission has many errors, misplaced bamboo slips are also numerous, such as in the treatise, diarrhea and vomiting treated with Shi Zao Tang (Ten Date Pill) harsh purgative; severe Yang nosebleed treated with Mahuang Tang (Ephedra Decoction) to sweat; sweating resolves disease, conversely aversion to cold, one extra "not" in "disease resolves"; epigastric pi, pressing soft, one missing "not" above "soft". Various schools following classics to annotate, forced to interpret arbitrarily, causing this rare book of millennia to not be trusted in the world, truly pitiable. Now correcting errors, listed one by one, small characters above side are original text; below side are corrected text; centered are original existing. Or moved up, or moved down, or moved from elsewhere, and supplemented where original lacks. Circle above character means deleted. Especially whole sections erroneous, thirty-five items, syndrome does not match pulse, medicine does not match disease, although formula exists, world has no such disease, even if disease exists, although medicine used, inheriting errors and falsehoods, no practical help. Yet among them there are still sentences worth采 (collecting), so each chapter does not move Classic text, forcibly adds annotation, re-copies original text attached to end of volume, to record doubts. (Yizong Jinjian)
The "Ke Bu Ke" (Can and Cannot) chapters, claimed as Sage of Medicine's original text, have several suspicious points: Original text is concise and meaning complete, here words are many but meaning incomplete, one; deliberately rhyming sentences, resembling five-character poetry, Six Meridians treatises have no such style, two; reasons for can/cannot cite original texts from Six Meridians, some say already seen in certain chapters of Shanghan Lun, inconsistent, three; often use "fan" (conversely/reverse) character, but no reverse meaning, such as saying pulse soft and weak, weakness conversely in Guan, softness conversely in Dian, could softness suit Guan and weakness suit Dian? Dian two characters, also Sage's words, pulse never seen, four; various can-purge inside, generally use Da Cheng Qi, Sage's words on purging mostly do not give formulas, presumably from Da Chai Hu, Tiao Wei, Da, Xiao San Cheng Qi, Xian Xiong, Xie Xin, Di Dang etc. methods, all say purging, now can/cannot purge, only say purge stool, already feel meaning incomplete, moreover purging stool is not covered by just Da Cheng Qi, not detailed, why need special treatise, five; regarding various annotations, roughly fabricated into text, explanation slightly coherent, if attacked, cannot withstand contradiction, how can one raise the dead to ask? six; Formula notes extract six long paragraphs, thinking categories unclear, not establishing notes, in my view, these four characters "categories unclear" can cover the whole meaning of four chapters, seven; Can vomit, can sweat, can purge major rules set seasonal times, still old wisdom of making examples, even more rigid, eight. (Wei Litong)
Wang Shuhe's additions are Bian Mai (Differentiating Pulses), Ping Mai (Leveling Pulses), and Ke Han (Can Sweat), Ke Xia (Can Purge) etc. chapters. His Six Meridians etc. chapters must not be praised by Wang Shuhe. But in Jueyin meridian, diarrhea, vomiting, hiccups various items, are indeed Wang Shuhe attaching them because of Jue Ni (Reversal Cold), and thus those without Jue Ni but similar kind, also attached. (Su Hui Ji)
Six Evils first emphasize Cold Damage, Suwen although started its beginning, did not exhaust its meaning, Later Han Zhang Zhongjing wrote Shanghan Lun, elucidated its depths, detailed its treatment methods, truly a treasure raft in medical forest. Only its book language is ancient and profound, and transmitted for long time, already many scattered and lost, and Wang Shuhe's compilation, Lin Yi's proofreading, Cheng Wuji's annotation, again many deviations, causing learners' path hard to glimpse, reading confused, relying on later heroes, each possessing great vision, one by one verifying. Pity that precious things scattered, unable to list in one area, difficult to browse casually. Not daring presumption, carefully trace various schools' annotations,凡是 (all) in Lun having inverted order, misplaced slips, transmission errors, omissions, interpolations, character errors, annotation falsehoods, formula deviations, pointed out by former sages, supplemented, moved, deleted, changed, verified and examined, and Huitong, Wendan, Queyi, carefully recorded several items, divided into eleven chapters, compiled into one volume, readers may hopefully see clearly at a glance. ○ Someone asks: Traditionally Suwen not from Xuanyuan and Qibo, but written by Warring States people, falsely attributing name, and Shanghan Lun theory deeper than Suwen, yet errors more, why? I say: Ask thoroughly! Formerly heard old doctor Fang Xingyan say: Shanghan Lun not Zhang Zhongjing's own book, but Yi Yin's words, and elaborated upon. So this book more ancient and profound than Suwen, truly not Han literature, and preface and main text tone different, originating from two hands known. According to Yi Yin original writing You Tangye, Zhang Zhongjing preface already has diligent seeking ancient teachings, extensively collecting formulas words, also examine Huangfu Mi say: Zhang Zhongjing expanded Yi Yin Tangye into dozens of volumes, used much effective. From this view, Fang's words, must have basis, tentatively record, to question wise men. Student Cheng Wenyu knows.