乌梅（三百个味酸温） 细辛（六两辛热） 干姜（十两辛热） 黄连（一斤苦寒）
当归（四两辛温） 附子（六两炮辛热） 蜀椒（四两去子辛热） 桂枝（六两辛热）
人参（六两甘温） 黄柏（六两苦寒）
上十味。异捣筛。合治之。以苦酒渍乌梅一宿。去核。蒸之五升米下。饭熟。捣成
泥。和药令相得。内臼中。与蜜。杵二千下。丸如梧桐子大。先食饮服十丸。日三服。
稍加至二十丸。禁生冷滑物臭食等。
肺主气。肺欲收。急食酸以收之。乌梅之酸。以收肺气。脾欲缓。急食甘以缓之。人
参之甘。以缓脾气。寒淫于内。以辛润之。以苦坚之。当归桂椒细辛之辛。以润内寒。
寒淫所胜。平以辛热。姜附之辛热。以胜寒。蛔得甘则动。得苦则安。黄连黄柏
之苦。以安蛔。
伤寒热少厥微。指头寒。默默不欲食。烦躁数日。小便利。色白者。此热除也。欲
得食。其病为愈。若厥而呕。胸胁烦满者。其后必便血。
指头寒者。是厥微热少也。默默不欲食。烦躁者。邪热初传里也。数日之后。小便
色白。里热去。欲得食。为胃气已和。其病为愈。厥阴之脉。挟胃贯膈。布胁肋。厥而
呕。胸胁烦满者。传邪之热甚于里也。厥阴肝主血。后数日。热不去。又不得外泄。迫
血下行。故致便血。
王宇泰云。设未欲食。宜干姜甘草汤。呕而胸胁烦满者。少阳证也。少阳与厥阴为
表里。邪干其腑。故呕而胸胁烦满也。肝主血。故后必便血。
病者手足厥冷。言我不结胸。小腹满。按之痛者。此冷结在膀胱关元也。
手足厥。不结胸者。无热也。小腹满。按之痛。下焦冷结也。
吴氏云。小腹满。俱是热病。惟冷结膀胱一证为寒。有手足厥冷可辨。
又云。小腹。下焦所治。当膀胱上口。主分别清浊或用真武汤。
伤寒发热四日。厥反三日复热四日。厥少热多。其病当愈。四日至七日热不除者。
其后必便脓血。
先热后厥者。阳气邪传里也。发热为邪气在表。至四日后厥者。传之阴也。后三日
复传阳经。则复热。厥少则邪微。热多为阳胜。其病为愈。至七日传经尽。热除则愈。
热不除者。为热气有余。内搏厥阴之血。其后必大便脓血。
伤寒厥四日。热反三日。复厥五日。其病为进。寒多热少。阳气退。故为进也。
伤寒阴胜者先厥。至四日。邪传里。重阴必阳。却热三日。七日传经尽。当愈。若
不愈而复厥者。传作再经。至四日。则当复热。若不复热。至五日厥不除者。阴胜于阳。
其病进也。
伤寒六七日。脉微。手足厥冷。烦躁。灸厥阴。厥不还者死。
伤寒六七日。则正气当复。邪气当罢。脉浮身厥。为欲解。若反脉微而厥。则阴胜
阳也。烦躁者。阳虚而争也。灸厥阴以复其阳。厥不还。则阳气已绝。不能复正而死。
伤寒发热。下利厥逆。躁不得卧者。死。
伤寒发热。邪在表也。下利厥逆。阳气虚也。躁不得卧者。病胜脏也。故死。
伤寒发热。下利至甚厥不止者。死。
金匮要略曰。六腑气绝于外者。手足寒。五脏气绝于内者。利下不禁。伤寒发热。
为邪气独甚。下利至甚。厥不止。为腑脏气绝。故死。
伤寒六七日不利。便发热而利。其人汗出不止者死。有阴无阳故也。
伤寒至七日。为邪正争之时。正胜则生。邪胜则死。始不下利。而暴忽发热下利。
汗出不止者。邪气胜正。阳气脱也。故死。
伤寒五六日。不结胸。复濡脉虚。复厥者。不可下。此为亡血。下之死。
伤寒五六日。邪气当作里实之时。若不结胸而腹濡者。里无热也。脉虚者。亡血也。
复厥者。阳气少也。不可下。下之为重虚。故死。金匮玉函曰。虚者重泻。真气乃绝。
发热而厥。七日下利者。为难治。
发热而厥。邪传里也。至七日传经尽。则正气胜邪。当汗出而解。反下利。则邪气
胜。里气虚。则为难治。
伤寒脉促。手足厥逆者。可灸之。
脉促。则为阳虚不相续。厥逆。则为阳虚不相接。灸之以助阳气。
王三阳云。厥逆则为阳虚。阳虚二字。当作阴胜二字。必有差讹。
伤寒脉滑而厥者。里有热也。白虎汤主之。
滑为阳厥。气内陷。是里热也。与白虎汤以散里热也。
手足厥寒。脉细欲绝者。当归四逆汤主之。
手足厥寒者。阳气外虚。不温四末。脉细欲绝者。阴血内弱。脉行不利。与当归四
逆汤。助阳生阴也。
乌梅（三百个，味酸，性温） 细辛（六两，味辛，性热） 干姜（十两，味辛，性热） 黄连（一斤，味苦，性寒）
当归（四两，味辛，性温） 附子（六两，炮制后使用，味辛，性热） 蜀椒（四两，去籽，味辛，性热） 桂枝（六两，味辛，性热）
人参（六两，味甘，性温） 黄柏（六两，味苦，性寒）
以上十味药。分别捣碎并过筛。混合处理。用醋浸泡乌梅一夜。去掉核。在五升米下蒸熟。饭熟后，将乌梅捣成泥状。与药物混合均匀。放入臼中。加入蜂蜜。杵捣两千下。制成梧桐子大小的丸剂。饭前服用十丸。每日三次。逐渐增加至二十丸。禁止食用生冷、滑腻食物及腐臭食物等。
肺主气。肺喜欢收敛。急需食用酸味食物来收敛它。乌梅的酸味，用来收敛肺气。脾喜欢缓和。急需食用甘味食物来缓和它。人参的甘味，用来缓和脾气。寒气盛行于体内，用辛味来润燥，用苦味来坚阴。当归、桂枝、蜀椒、细辛的辛味，用来温润体内的寒气。寒气盛行而胜复，用辛热之品来平抑它。干姜、附子的辛热，用来战胜寒气。蛔虫遇到甘味就会躁动，遇到苦味就会安静。黄连、黄柏的苦味，用来安定蛔虫。
伤寒病发热轻微而四肢厥冷也轻微，仅指尖发凉。神情沉默，不想进食，烦躁持续数日。小便通畅，颜色清白，这是热邪已除的表现。想要进食，说明疾病即将痊愈。如果出现四肢厥冷且呕吐，胸胁部烦闷胀满的，其后必然出现便血。
指尖发凉的，是厥冷轻微、热邪较少的表现。神情沉默，不想进食，烦躁的，是邪热刚开始传入里证。几天之后，小便颜色变白，说明里热已去；想要进食，说明胃气已经调和，疾病即将痊愈。厥阴经脉，夹着胃，贯穿膈肌，分布于胁肋。出现四肢厥冷且呕吐，胸胁部烦闷胀满的，是传变的邪热在里证部位很盛的表现。厥阴肝主血。过了几天，热邪不去，又无法向外宣泄，逼迫血液下行，所以导致便血。
王宇泰说：如果患者仍不想进食，适宜用干姜甘草汤。呕吐且胸胁部烦闷胀满的，属于少阳证。少阳与厥阴互为表里。邪气侵犯其腑，所以出现呕吐和胸胁部烦闷胀满。肝主血，所以后来必然出现便血。
患病者手足冰冷，说我不觉得胸部硬满疼痛（不结胸），小腹胀满，按压时疼痛的，这是寒气凝结在膀胱关元穴部位。
手足厥冷，且不结胸的，说明没有热邪。小腹胀满，按压时疼痛，是下焦寒气凝结。
吴氏说：小腹胀满，都是热病，只有寒气凝结膀胱这一证候属于寒证。可以通过手足厥冷来辨别。
又说：小腹，是下焦所管辖的部位，正当膀胱上口，主要功能是分别清浊。可以使用真武汤。
伤寒发热四天，四肢厥冷反而三天，随后又发热四天。厥冷时间短而发热时间长，疾病应当痊愈。从第四天到第七天，如果热邪不消除的，其后必然出现脓血便。
先发热后出现四肢厥冷的，是阳气受邪气影响传入里证。发热表示邪气在表。到了第四天后出现厥冷，是邪气传入阴经。之后三天又传回阳经，所以再次发热。厥冷时间短说明邪气微弱，发热时间长说明阳气胜复，疾病将会痊愈。到了第七天传经结束，热邪消除则痊愈。如果热邪不消除，是因为热气有余，内迫厥阴之血，其后必然出现大便脓血。
伤寒四肢厥冷四天，发热反而三天，随后又厥冷五天，疾病正在进展。寒多热少，阳气衰退，所以病情进展。
伤寒阴气偏胜者先出现四肢厥冷。到了第四天，邪气传入里证。重阴必转化为阳，却出现了三天的发热。到了第七天传经结束，应当痊愈。如果不痊愈又出现四肢厥冷的，是邪气传入再一经。到了第四天，应当再次发热。如果不再次发热，到了第五天四肢厥冷不消除的，是阴气胜于阳气，疾病正在进展。
伤寒病程六七天，脉象微细，手足冰冷，烦躁不安，灸治厥阴经穴位。如果四肢厥冷不能恢复的，预后不良（死）。
伤寒病程六七天，正气应当恢复，邪气应当罢退。如果脉浮身厥，是即将解除的迹象。如果反而脉微而四肢厥冷，则是阴气胜复阳气。烦躁，是阳气虚衰而抗争的表现。灸治厥阴经以恢复阳气。如果四肢厥冷不能恢复，说明阳气已经衰竭，不能恢复正气而死。
伤寒发热，伴有腹泻、四肢厥逆，躁动不安无法躺卧的，预后不良（死）。
伤寒发热，表示邪气在表。腹泻、四肢厥逆，表示阳气虚衰。躁动不安无法躺卧，表示病邪胜过脏腑功能。所以预后不良（死）。
《金匮要略》说：六腑之气在外衰竭的，表现为手足寒冷；五脏之气在内衰竭的，表现为泄泻不禁。伤寒发热，是邪气独盛；腹泻极其严重，四肢厥冷不止，是脏腑之气衰竭。所以预后不良（死）。
伤寒病程六七天，原本没有腹泻，突然发热并且腹泻，其人汗出不止的，预后不良（死）。这是因为有阴无阳的缘故。
伤寒到了第七天，是邪正相争的时候。正气胜则生，邪气胜则死。开始没有腹泻，突然暴发性发热下利，汗出不止的，是邪气胜过正气，阳气脱失。所以预后不良（死）。
伤寒病程五六天，不结胸，脉象濡软虚弱，又出现四肢厥冷的，不可使用攻下法。这是因为亡血所致。如果使用攻下法会导致死亡。
伤寒病程五六天，邪气本当形成里实证的时候。如果不结胸且腹部柔软，说明里没有热邪。脉象虚弱的，是亡血。又出现四肢厥冷的，是阳气不足。不可使用攻下法。攻下会造成双重虚损，所以致死。《金匮玉函》说：虚证重用泻法，真气就会断绝。
发热且四肢厥冷，是邪气传入里证。到了第七天传经结束，正气胜复邪气，应当出汗而解。反而出现腹泻，说明邪气胜复，里气虚弱，所以属于难治之证。
脉象急促，说明阳气虚衰而不连续。四肢厥逆，说明阳气虚衰而不能相接。灸治以辅助阳气。
王三阳说：四肢厥逆则是阳气虚衰。“阳气虚”这三个字，应当作“阴气胜复”三个字理解。必定有讹误。
手足厥冷的，是阳气在外虚衰，不能温煦四肢末端。脉象细微几乎摸不到的，是阴血在内虚弱，脉道运行不利。给予当归四逆汤，以助阳生阴。
Wumei (300 pieces, sour flavor, warm nature) Xixin (6 liang, pungent flavor, hot nature) Ganjiang (10 liang, pungent flavor, hot nature) Huanglian (1 jin, bitter flavor, cold nature)
Danggui (4 liang, pungent flavor, warm nature) Fuzi (6 liang, processed/pao, pungent flavor, hot nature) Shujiao (4 liang, seeds removed, pungent flavor, hot nature) Guizhi (6 liang, pungent flavor, hot nature)
Renshen (6 liang, sweet flavor, warm nature) Huangbai (6 liang, bitter flavor, cold nature)
The above ten herbs. Crush each separately and sieve. Mix and process together. Soak Wumei in vinegar overnight. Remove the pits. Steam over five sheng of rice until the rice is cooked. After the rice is done, crush the Wumei into a paste. Mix evenly with the other medicines. Place in a mortar. Add honey. Pound two thousand times. Form pills the size of paulownia seeds. Take ten pills before meals with water. Three times daily. Gradually increase to twenty pills. Prohibit consumption of raw/cold foods, slippery/greasy foods, and putrid/spoiled foods, etc.
The Lung governs Qi. The Lung desires contraction/astringency. It urgently requires sour substances to contract it. The sourness of Wumei contracts Lung Qi. The Spleen desires relaxation/soothing. It urgently requires sweet substances to soothe it. The sweetness of Renshen soothes Spleen Qi. When Cold dominates internally, use Pungent to moisten and Bitter to firm/strengthen. The pungency of Danggui, Guizhi, Shujiao, and Xixin moistens internal Cold. When Cold dominates and prevails, use Pungent-Hot to level it. The pungent-hot nature of Ganjiang and Fuzi defeats Cold. Roundworms move when encountering Sweet; they settle when encountering Bitter. The bitterness of Huanglian and Huangbai settles the roundworms.
In Shanghan (Cold Damage), if fever is slight and Jue (cold extremities) is mild, only the fingertips are cold. The patient is silent, has no desire to eat, and experiences irritability for several days. If urination is smooth and the color is clear/white, this indicates the Heat has been eliminated. If the patient desires food, the disease will heal. However, if there are Jue accompanied by vomiting, and fullness/distress in the chest and hypochondrium, hematochezia (blood in stool) will likely follow later.
Fingertip cold indicates mild Jue and slight Heat. Silence, lack of appetite, and irritability indicate that pathogenic Heat has just transmitted to the interior. Several days later, if urine becomes white, it means interior Heat has gone; desiring food indicates Stomach Qi has harmonized, and the disease will heal. The Jueyin meridian clamps the Stomomach, pierces the diaphragm, and spreads along the hypochondrium. Jue with vomiting and chest/hypochondrial distress indicates that transmitted pathogenic Heat is severe in the interior. Jueyin Liver governs Blood. After several days, if Heat persists and cannot vent outward, it forces blood downward, causing hematochezia.
Wang Yutai stated: If the patient still does not desire food, Ganjiang Gancao Tang (Dry Ginger and Licorice Decoction) is suitable. Vomiting with chest/hypochondrial distress belongs to Shaoyang syndrome. Shaoyang and Jueyin are exterior-interior pairs. Pathogen invading its fu organ causes vomiting and chest/hypochondrial distress. Since Liver governs Blood, hematochezia will likely follow later.
If the patient has cold hands and feet, states that there is no Jie Xiong (chest binding/fullness), but has abdominal distension in the lower abdomen which is painful upon pressure, this is Cold binding at the Bladder Guan Yuan point.
Cold hands and feet without Jie Xiong indicate absence of Heat. Lower abdominal distension painful on pressure indicates Cold binding in the Lower Jiao.
Wu Shi said: Lower abdominal distension is generally due to Heat diseases; only Cold binding in the Bladder is a Cold pattern. It can be distinguished by cold hands and feet.
He also said: The lower abdomen is governed by the Lower Jiao, located at the upper opening of the Bladder, primarily responsible for separating the clear from the turbid. Zhenwu Tang may be used.
In Shanghan, fever lasts four days, then Jue lasts three days, followed by fever for another four days. Less Jue and more Heat indicates the disease should heal. If from day four to seven the Heat does not subside, hematochezia/pus-blood stool will likely follow later.
Fever first, then Jue, indicates Yang Qi transmitting to the interior due to pathogen. Fever means pathogen is in the exterior. By day four, Jue appears, meaning transmission to Yin meridians. After three days, transmission returns to Yang meridians, hence fever again. Less Jue means weak pathogen; more Heat means Yang predominance, so the disease heals. By day seven, transmission cycles complete; if Heat subsides, healing occurs. If Heat persists, it is due to excess Heat pressing into Jueyin Blood, leading to pus-blood stool later.
In Shanghan, Jue lasts four days, Heat lasts three days, then Jue lasts five days. The disease progresses. More Cold and less Heat indicates declining Yang Qi, hence progression.
In Shanghan, Yin predominance presents initially as Jue. By day four, pathogen transmits to interior. Extreme Yin transforms to Yang, resulting in three days of Heat. By day seven, transmission completes, and healing should occur. If not healed and Jue recurs, it is transmission to the next cycle. By day four, Heat should return. If Heat does not return, and by day five Jue persists, Yin predominates over Yang, indicating disease progression.
In Shanghan, six or seven days in, pulse is faint, hands and feet are cold, and there is irritability. Moxibustion on Jueyin is indicated. If Jue does not resolve, death ensues.
By six or seven days in Shanghan, Zheng Qi (Upright Qi) should recover, and pathogen should cease. Floating pulse with body Jue suggests resolution. Conversely, faint pulse with Jue indicates Yin predominating over Yang. Irritability indicates deficient Yang struggling. Moxibustion on Jueyin restores Yang. If Jue does not resolve, Yang Qi is exhausted, unable to restore Zheng Qi, leading to death.
Shanghan with fever, diarrhea, Jue Ni (severe cold extremities), and restlessness preventing lying down indicates death.
Fever in Shanghan indicates pathogen in exterior. Diarrhea and Jue Ni indicate deficient Yang Qi. Restlessness preventing lying down indicates pathogen overcoming Zang-Fu function. Hence, death.
Shanghan with fever, severe diarrhea, and unceasing Jue indicates death.
Jin Gui Yao Lue states: When Qi of the Six Fu organs fails externally, hands and feet are cold; when Qi of the Five Zang organs fails internally, diarrhea is incontinent. In Shanghan, fever indicates pathogen alone is excessive; severe diarrhea and unceasing Jue indicate exhaustion of Zang-Fu Qi. Hence, death.
In Shanghan, six or seven days in, initially no diarrhea, but sudden fever and diarrhea with unceasing sweating indicates death. This is due to having Yin but no Yang.
By the seventh day in Shanghan, it is the time of struggle between pathogen and Zheng Qi. Zheng Qi victory brings life; pathogen victory brings death. Initially no diarrhea, but sudden violent fever, diarrhea, and unceasing sweating indicates pathogen overcoming Zheng Qi and Yang Qi collapse. Hence, death.
In Shanghan, five or six days in, no Jie Xiong, pulse is soft/deficient, and Jue recurs. Purging is contraindicated. This is due to loss of Blood. Purging leads to death.
At five or six days in Shanghan, when pathogen should form interior excess, if there is no Jie Xiong and the abdomen is soft, there is no interior Heat. A deficient pulse indicates loss of Blood. Recurrent Jue indicates insufficient Yang Qi. Purging is contraindicated. Purging causes double deficiency, leading to death. Jin Gui Yu Han states: Heavy purgation in deficiency exhausts True Qi.
Fever with Jue, progressing to diarrhea by the seventh day, is difficult to treat.
Fever with Jue indicates pathogen transmitting to interior. By day seven, transmission completes; Zheng Qi should overcome pathogen, resolving via sweating. Recurrent diarrhea indicates pathogen prevailing and interior Qi deficiency, making it difficult to treat.
In Shanghan, rapid pulse with Jue Ni can be treated with moxibustion.
A rapid pulse indicates deficient Yang Qi lacking continuity. Jue Ni indicates deficient Yang Qi lacking connection. Moxibustion assists Yang Qi.
Wang Sanyang stated: Jue Ni implies Yang deficiency. The phrase "Yang deficiency" should read "Yin predominance." There must be an error.
In Shanghan, slippery pulse with Jue indicates interior Heat. Baihu Tang is the primary treatment.
Slippery pulse indicates Yang Jue, Qi sinking inward, signifying interior Heat. Baihu Tang is given to disperse interior Heat.
Cold hands and feet with a fine pulse nearly imperceptible are treated with Danggui Sini Tang.
Cold hands and feet indicate deficient Yang Qi externally, failing to warm the four extremities. A fine, nearly imperceptible pulse indicates deficient Yin-Blood internally, with poor vessel flow. Danggui Sini Tang is given to assist Yang and generate Yin.