伤寒难疗，逆证须知。阳病怕逢阴脉，谵语阴证非宜。乍疏乍数脉之忌，口张目陷舌如煤。干
呕出气，骨节痛而呃逆弗已；发斑发黄，大便利而先赤后灰。霍乱躁烦，心下闷而喘胀；腹膨呃逆
，下泄利而难溲。四肢厥逆，眼定腹疼如石；内外关格，头汗阳脱溲迟。头连胸痛四肢冷，声哑唇
疮狐惑悲。七日已过复大热，喘逆上气脉散危。阴阳易，脉离经而外肾肿，手足挛拳加腹痛。阴阳
交，大汗后而热愈甚，躁急狂言食更稀。厥利无脉，灸而不至者肾殆；唇青舌卷，耳聋囊缩者肝离
。赤斑黑斑，救五而救一；寻衣撮空，两感者何疑。凡诸
汗证，仍当备言∶只在头面不遍身，鼻衄不止；口噤肉战多喘促，如油汗圆。当汗无汗，麻黄数剂
不能通，尤嫌脉躁；汗后呕吐，水药不入证反剧，言乱目眩。湿家大汗必成痉，风湿与疸皆谵言。
犯湿温，则身青面变，耳聋不语名重 ；发少阴，必九窍出血，下厥上竭奚能痊。动气脉迟弱皆忌
，风湿和中湿不堪。其诸下痢，尤宜细参∶热厥利而汗难止，冷厥利而躁不眠；少阳阳明合病，脉
弦者负；少阴吐泻无脉，拳厥躁烦。谵语直视而喘满，下痢频数而脉坚。脏结者脐痛引阴，白胎下
利；除中则厥逆而利，反能食焉。误下湿家之头汗，溲难便利喘加添。体如熏而摇头直视，心神已
绝；唇吻青而四肢多汗，肝气不全。肾绝者，直视狂言而遗尿反目；肺绝者，喘无休歇而汗润发颠
。虚汗发黄环口黑，非脾经之吉兆；孤阳偏胜脉暴出，知阴绝之在先。此伤寒之逆候，勿侥幸以图全
。
伤寒病难以治疗，必须了解其逆证（病情恶化、预后不良的证候）。阳热性质的疾病若出现阴寒性质的脉象，是危险的征兆；在阴寒证中出现谵语（神志不清，胡言乱语）是不适宜的。脉搏忽快忽慢是脉象的大忌，口张不开、眼睛凹陷、舌苔黑如煤炭，都是危重表现。干呕且气息微弱，骨节疼痛且呃逆不止；皮肤出现斑疹和黄疸，大便通畅但颜色先红后灰暗。霍乱伴有烦躁不安，心下痞闷且气喘腹胀；腹部膨隆伴呃逆，腹泻严重且小便困难。四肢厥冷（手脚冰凉），眼睛固定不动、腹痛坚硬如石；内外关格（阴阳之气不相顺接，上下阻隔不通），头部出汗而阳气外脱、小便延迟。头痛连及胸部、四肢发冷，声音嘶哑、唇生疮疡，神情悲苦似狐惑病。病程超过七日又出现高热，气喘逆气上冲、脉象散乱，预示危险。阴阳易（大病初愈因房事复发），脉象离经、外生殖器肿胀，手足拘挛抽搐并加重腹痛。阴阳交（温热病邪深入，正气衰败），大汗之后热势更盛，烦躁急切、狂言乱语、食欲减退。厥逆兼下利且无脉，艾灸后脉仍不恢复者，肾气将绝；嘴唇青紫、舌头卷缩、耳聋、睾丸上缩者，肝气已离决。出现赤色斑疹和黑色斑疹，十人中救活一人；患者摸索衣被、撮弄空物（神志昏迷前的动作），若是两感伤寒（表里两经同时受邪），预后无疑极差。凡是各种汗证，应当详细陈述：仅在头面部出汗而不遍及全身，或鼻衄（鼻出血）不止；牙关紧闭、肌肉颤抖且多伴气喘急促，或汗出如油、汗珠圆润不流（绝汗）。应当发汗却无汗，服用麻黄汤数剂仍不能通汗，尤其忌讳脉象躁动；发汗后出现呕吐，水药无法进入，症状反而加剧，言语错乱、头晕目眩。素患湿病的人若大发汗，必然导致痉病（筋脉拘急，角弓反张）；风湿病与黄疸病若误治，都会出现谵语。触犯湿温病，则身体发青、面色改变、耳聋不语，病情沉重；发展为少阴病，必见九窍出血，下焦厥冷而上焦津血枯竭，怎能治愈？凡有动气（脐旁跳动感）且脉象迟弱者均忌用攻下法，风湿病和中湿病也不堪攻伐。至于各种下痢，尤其需要仔细参详：热厥引起的下利且汗出不止，冷厥引起的下利且烦躁不眠；少阳阳明合病，脉弦者为逆证（负）；少阴病出现吐泻且无脉，手足厥冷、烦躁不安。谵语、直视（眼球固定）、气喘胸满，下痢频繁且脉象坚实有力。脏结病表现为脐部疼痛牵引至阴部，大便泄泻且舌苔白；除中（胃气将绝，回光返照）表现为厥逆下利，反而能进食。误用攻下法导致湿病患者头部出汗，小便困难、大便通畅且气喘加重。身体像被烟熏一样发黄、摇头直视，说明心神已绝；嘴唇周围发青且四肢多汗，说明肝气不全。肾气绝的表现是：直视、狂言、遗尿且眼球上翻；肺气绝的表现是：喘息不停歇且头发湿润倒竖。虚汗、发黄且口周发黑，不是脾经的吉兆；孤阳偏胜、脉象突然暴出，说明阴气先绝。以上是伤寒病的逆证候，不要抱有侥幸心理企图保全生命。
Shanghan (Cold Damage) is difficult to treat; one must understand its adverse syndromes (prognostically unfavorable conditions). Yang-type diseases are feared when accompanied by Yin-type pulses. Delirium (incoherent speech due to mental confusion) in a Yin syndrome is inappropriate. A pulse that alternates between slow and rapid is a major taboo; an open mouth, sunken eyes, and a tongue black as coal indicate critical severity. Dry retching with weak breath, bone joint pain, and unceasing hiccups; appearance of macules/rash and jaundice, with free stool but color changing from red to grayish-black. Huoluan (acute vomiting and diarrhea) with restlessness, epigastric fullness, wheezing, and distension; abdominal bloating with hiccups, severe diarrhea, and difficulty urinating. Cold extremities (cold hands and feet), fixed gaze, and abdominal pain hard as stone; internal and external blockage (obstruction of Qi and Blood between interior and exterior), head sweating indicating Yang collapse, and delayed urination. Headache extending to the chest, cold limbs, hoarse voice, ulcers on lips, and sorrowful demeanor resembling Huhuo disease. High fever returning after seven days, wheezing with rebellious Qi, and a scattered pulse indicate danger. Yi Chang (transmission of pathogen via intercourse during recovery) presents with pulse deviating from normal, swelling of external genitals, spasms of hands and feet, and aggravated abdominal pain. Yin Yang Jiao (exhaustion of healthy Qi by pathogenic heat) presents with intense heat after profuse sweating, extreme restlessness, delirium, and loss of appetite. Jue Li (cold limbs and diarrhea) without a pulse, where moxibustion fails to restore the pulse, indicates impending Kidney failure; blue lips, curled tongue, deafness, and retraction of the testicles indicate Liver disintegration. Red macules and black macules: only one in ten can be saved; picking at empty air and clothes (signs of terminal coma): if it is Liang Gan (simultaneous involvement of exterior and interior meridians), doubt about prognosis is unnecessary. Regarding various sweating syndromes, they should be stated in detail: sweating confined to the head and face without covering the whole body, or continuous nosebleed (epistaxis); locked jaw, muscle tremors, and frequent wheezing, or oily sweat forming round beads that do not flow (terminal sweat). When sweating should occur but does not, and several doses of Mahuang Tang (Ephedra Decoction) fail to induce sweat, especially if the pulse is restless; after sweating, vomiting occurs, fluids and medicine cannot be retained, symptoms worsen, with confused speech and dizziness. Profuse sweating in patients with dampness inevitably leads to Jing Bing (spasm disorder). Rheumatism and jaundice treated incorrectly will both cause delirium. Contracting Shi Wen (damp-warmth) results in bluish body, altered facial complexion, deafness, and muteness, indicating severe illness. Developing into Shaoyin syndrome involves bleeding from nine orifices; lower Jiao coldness with upper Jiao exhaustion of fluids and blood is incurable. Any pulsation around the umbilicus (Dong Qi) with a slow and weak pulse contraindicates purgation; rheumatism and dampness in the middle Jiao cannot withstand harsh treatment. Regarding various dysenteries, careful analysis is required: heat-Jue with diarrhea and uncontrollable sweating; cold-Jue with diarrhea, restlessness, and insomnia; combined Shaoyang and Yangming disease with a wiry pulse indicates a negative outcome; Shaoyin disease with vomiting, diarrhea, absent pulse, cold limbs, and restlessness. Delirium, fixed gaze, wheezing, and chest fullness; frequent dysentery with a firm pulse. Zang Jie (organ knotting) presents with umbilical pain radiating to the genitals, white-coated tongue, and diarrhea. Chu Zhong (return of appetite before death, sign of stomach Qi exhaustion) presents with cold limbs, diarrhea, and sudden ability to eat. Incorrect purgation in dampness patients causes head sweating, difficult urination, free stool, and aggravated wheezing. Body yellow like smoked meat, shaking head, and fixed gaze indicate destruction of Heart Spirit; blue lips and excessive sweating on limbs indicate incomplete Liver Qi. Kidney exhaustion manifests as fixed gaze, delirium, enuresis, and upward-rolling eyes; Lung exhaustion manifests as ceaseless wheezing and moist, inverted hair. Deficient sweating, jaundice, and blackness around the mouth are auspicious signs for the Spleen channel? No, they are not auspicious signs. Lone Yang prevailing with a suddenly bursting pulse indicates Yin exhaustion occurring first. These are the adverse signs of Shanghan; do not rely on luck to seek survival.