太阳中热者， 是也。其人汗出恶寒，身热而渴也。
王安道曰∶暑热者，夏之令也。大行于天地之间，人受伤而为病，名曰中暑，亦曰中热，一也。叶香岩曰∶热地如
炉，伤人最速。
赵以德曰∶汗出恶寒，身热而不渴者，中风也；渴者，中 也。
周禹载曰∶冬月有寒，则能伤人，名中寒；夏月有热，亦能伤人，名中热。此是外来之热，故曰中。非即伏寒发出，
夏必病热之热也。然而同用白虎者，总以所伤在气，则所主在金，所病在热。生金者土，金生者水，金病则我母我子俱
病，故与伏气之在少阴，发出之由阳明者无异。要皆并主一汤，全不因冬月之伏，与夏月之中为二义也。又全不以伏气
之渴，与今病之渴为稍异也。呜呼！圣人于此，有意立方，无心表异，以千古之前，自有此理，万世之下，自有此悟也。
雄按∶古人但以寒为肃杀之气，而于暑热甚略，是阙文也。
徐洄溪曰∶凡汗出多之病，无不恶寒者，以其恶寒汗出而误认为寒，妄用热剂，则立危矣。
何报之曰∶汗大泄不止亡阳，且令肾水竭绝，津液内枯，是谓亡阴。急当滋水之上源。三伏之义，为金受囚也。金
遇丙丁，失其清肃，而壬水绝于巳，癸水绝于午，西北之寒清绝矣。前人有谓夏月宜补者，乃补天元之真气，非补热火
也。令人夏食寒是也。
沈尧封曰∶此是热病证据，《素问》在天为热，在地为火。热者，火之气也。故热乃五气之一。而热病即伤寒有五之
一。《伤寒论》以《难经》“热”字，恐与下文“温”字相混，故特指出曰∶ 是也。感烈日之气而病，即《素问》寒、
暑、燥、湿、风之暑病。或曰∶ 是阳邪，暑是阴邪，土润溽暑，热兼湿言也。似与 有异，曰寒往则暑来，与寒对待，
非专言热而何？古人称“暑、 、热”一也。若湿热并至之病，《难经》名曰湿温，不名暑。迨至隋唐后皆指湿热为暑，
于是真暑之名失，而 之名更不知为何病矣？
雄按∶《北齐书·后主纪》∶六月游南苑，从官 死者六十人。《千金须知》
云∶热死曰 ，是唐时尚知暑 之为热也。
雄按∶《内经》云∶在天为热，在地为火，其性为暑。又云∶岁火太过，炎暑流行。盖暑为日气，其字从日，曰炎暑，
曰酷暑，皆指烈日之气而言也。夏至后有小暑、大暑；冬至后有小寒、大寒。是暑即热也，寒即冷也。暑为阳气，寒为
阴气。乃天地间显然易知之事，并无深微难测之理，而从来歧说偏多，岂不可笑！更有调停其说者，强分动得、静得为
阴阳。夫动静惟人，岂能使天上之暑气，随人而判别乎？况《内经》有阴居避暑之文，武王有樾荫 人之事，仲景以白
虎汤为热病主方，同条共贯，理益彰彰。何后贤之不察？而好为聚讼以紊道，深文以晦道耶！若谓暑必兼湿，则亢旱之
年，湿难必得，况兼湿者何独暑哉？盖湿无定位，分旺四季，风湿寒湿，无不可兼，惟夏季之土为独盛，故热湿多于寒
湿。然暑字从日，日为天气。湿字从土，土为地气。霄壤不同，虽可合而为病，究不可谓暑中原有湿也。
伤寒，脉浮滑，此表有热，里有寒，白虎汤主之。
王三阳曰∶经文“寒”字，当作“邪”字解，亦热也。方中行曰∶世本作“表有热，里有寒”，必系传写之误。夫白
虎本为治热病、暑病之药，其性大寒，安得里有寒者可服之理？详本文脉浮滑，不但无紧，且复多滑，乃阳气甚而郁蒸，
此里有热也。里热甚必格寒于外，多厥逆身凉而为亢害之证，此表有寒也。《厥阴篇》中脉滑而厥者，里有热也，白虎汤
主之。则知此“表里”二字为错误可知，当为上下更易。
魏念庭曰∶此里尚为经络之里，非脏腑之里也。
沈尧封曰∶里有寒之“寒”字，乃“ ”字之误。如果里有寒，何以反用石膏、知母乎？表有热，即身热也。上节
止言病名，不言脉证，此节详言脉证，出方主治，两节本是相承，叔和校订时，此节幸有“寒字”之误，不被摘出。若
见“ ”字，早已摘置别论中矣。程郊倩云∶ 病脉不浮，不思《伤寒论》之 ，即《难经》之热病也。《难经》云∶热
病之脉，阴阳俱浮。浮之而滑，沉之散涩，此是紧要处，岂可模糊读过。本条脉浮滑，与《难经》热病脉合，则白虎的
是热病主方，而“寒”字的是“ ”字之误。
雄按∶杨素园大令云∶此条“寒”字，诸家所辩，未能妥贴。徐君亚枝谓∶当作“痰”字解，于义较协。余谓徐君
此解，可称千古只眼。夫本论无痰字，如湿家胸中有寒之“寒”字，亦作痰字解。盖痰本作淡，会意二火搏水成痰也。
彼湿家火微湿盛，虽渴而不能饮，是为湿痰。此 病火盛烁液，脉既滑矣，主以白虎汤，则渴欲饮水可知，是为热痰。
凡痰因火动，脉至滑实，而口渴欲饮者，即可以白虎治之，况 家乎？汪按∶《灵》、《素》两经，亦但曰水。曰寒无一痰
字。
伤寒，脉滑而厥者，里有热也，白虎汤主之。
张路玉曰∶滑，阳脉也，故其厥为阳厥，里热郁炽，所以其外反恶寒，厥逆往往有唇面爪甲俱青者，故宜白虎以清
里而除热也。
伤寒，无大热，口燥渴，心烦，背微恶寒者，白虎加人参汤主之。
张兼善曰∶白虎专治大烦、大渴、大燥、大热之证，惟恐表证未罢而早用之。若背微恶寒及时时恶风二条，因其中
烦渴、燥热已甚，非白虎不能遏也。
沈尧封曰∶背为阳，背微恶寒者，阳虚证也。但阳有不同，真水、真火，是肾中之阴阳也；气血，是营卫之阴阳也。
此条口燥渴、心烦、则 热内炽，仍是白虎证。惟 热伤其卫气，致背微恶寒，故加人参补其卫也。至若少阴病口中和，
其背恶寒者，则卫阳与肾阳并伤，故人参与附子并用以两补之也。
雄按∶吴鹤皋云∶背微恶寒者，但觉微寒而不甚也。既有燥渴，则白虎加参，用可无疑。若背恶寒而不燥渴者，不
可用也。余谓以下条参之，必有汗，故可用也。
伤寒，脉浮，发热无汗，其表不解者，不可与白虎汤；渴欲饮水，无表证者，白虎加人参汤主之。
沈尧封曰∶此承上文言烦渴、背恶寒，固当用白虎加人参汤，但亦有中 而外复伤风寒，亦能令恶寒、发热、脉浮，
更当于有汗、无汗上辨表证解不解，以定此方之可用不可用耳！
伤寒病，若吐、下后，七八日不解，热结在里，表里俱热，时时恶风，大渴，舌上干燥而烦，欲饮水数升者，白虎
加人参汤主之。
张路玉曰∶详此条表证，比前较重，何以亦用白虎加参耶？本文“热结在里，表里俱热”二句，已自酌量。惟热结
在里，所以表热不除。邪火内伏，所以恶风大渴。舌燥而烦，欲饮水不止，安得不以生津解热为急耶！
雄按∶御纂《医宗金鉴·正误篇》∶“时时恶风”，作“时汗恶风”，当遵之。又沈亮宸云∶舌干且燥，谓视之无液也。
然则温热之审舌苔以察津液，仲师已逗其倪矣。
太阳中 者，身热疼重，而脉微弱，此以夏月伤冷水，水行皮中所致也。一物瓜蒂汤主之。
皇甫士安曰∶脉盛身寒，得之伤寒；脉虚身热，得之伤暑。盖寒伤形而不伤气，所以脉盛；热伤气而不伤形，所以
脉虚。
雄按∶所云身寒者，虽发热而仍恶寒，不似暑热病之喜凉恶热也。
朱奉议曰∶夏月发热，恶寒，头痛，身体肢节痛重，其脉洪盛者，热病也。夏月自汗，恶寒，身热而渴，其脉微弱
者，中暑也。
雄按∶此注之热病，乃夏至后所发之伏邪也。《内经》亦谓之暑病。中暑者，夏月外感之热病，亦曰中 。
病有内外之殊，脉有洪微之别，是微弱本 脉，惟身重为湿候，后条虽亦身重，而口开齿燥，暑热内炽已极，似宜急与
甘寒救液也。
方中行曰∶夏日则饮水，人之常事，而曰伤，何哉？良由暑迫，饮之过多，或得之冷水澡洗，暑反入内也。
张路玉曰∶此条言因热伤冷之病，乃中 之变证。喻氏谓无形之热，伤其肺金，则用白虎加人参汤以救之。有形之
湿，伤于肺金，则用瓜蒂汤救之。各有所主也。
太阳中 者，发热恶寒，身重而疼痛，其脉弦细芤迟；小便已洒洒然毛耸，手足逆冷，小有劳身即热，口开，前板
齿燥。若发汗，则恶寒甚。加温针，则发热甚。数下之，则淋甚。
成聊摄曰∶病有在表者，有在里者，有表里俱病者，此则表里俱病者也。发热恶寒，身重疼痛者，表中 也；脉弦
细芤迟者，中暑脉虚也；小便已洒洒然毛耸，手足逆冷者，太阳经气不足也。小有劳身即热者，谓劳动其阳，而 即发
也。口开，前板齿燥者，里有热也。
雄按∶即此一端，可见其为热炽津枯之候。虽身重恶寒，岂可再投清暑益气汤、五
苓散、藿香正气丸等，辛温燥烈以重劫其阴液乎？东垣、虚谷之言，贻误后人不浅。《内经》云∶因于暑汗，烦则喘喝。
口开谓喘喝也。以喘喝不止，故前板齿燥。若发汗，以去表邪，则阳气外虚，故恶寒甚。若以温针助阳，则火热内攻，
故发热甚。若下之以除里热，则内虚而膀胱燥，故淋甚。
雄按∶观此治法之三禁，则仲景虽未立方，而甘凉撤热存津之
当用，已可不言而喻矣。赵氏、方氏主用白虎加人参汤，殆从三阳合病比例而出，似亦近理。
沈尧封曰∶此言精气素亏而中 者。
伤寒，脉结代，心动悸者，炙甘草汤主之。一名复脉汤。脉按之来而缓，时一止复来者，名曰结。又脉来动而中止，
更来小数，中有还者反动，名曰结，阴也。脉来动而中止，不能自还，因而复动者，名曰代，阴也。得此脉者，必难治。
方中行曰∶脉结代而心动悸者，虚多实少，譬如寇欲退散，主弱不能遣发，而反自彷徨也。复脉乃核实义之名，然
则是汤也，必欲使虚者加进，而驯至于实，则实者自退散，而还复于元之义也。
喻嘉言曰∶脉者气血之先，仲景于津液内亡之脉，名之曰结阴、代阴，又名无阳。原有至理，何可不知？聊为四言
俚句，以明其义。胃藏津液，水谷之海，内充脏腑，外灌形骸。津多脉盛，津少脉衰，津结病至，津竭祸来。脉见微弱，
宜先建中。汗则津越，下则津空。津耗脉细，不可妄攻。小便渐减，大便自通。阳明内实，急下救焚。少缓须臾，津液
无存。阳明似实，稍用调承。驱热存津，此法若神。肾中真阳，阴精所裁。胃中真阳，津液所胎。阴枯津盛，冽泉可溉。
阴精衰薄，瓶罄 哀。何谓结阴？无阳脉阖。何谓代阴？无阳脉夺。经揭无阳，津液欲竭，较彼亡阳，天地悬阔。
沈尧封曰∶此论精气素亏而感微邪之治。前节有脉证而无方治，此未必即是前节主方。然观方中药，又宁必不可以
治前证。
脉浮而芤，浮为阳，芤为阴。浮芤相搏，胃气生热，其阳则绝。
方中行曰∶浮为气上行，故曰阳；芤为血内损，故曰阴。胃中生热者，阴不足以和阳，津液干而成枯燥也。
雄按∶
沈氏云∶浮为邪，芤为阴血虚。以余论之，凡见浮芤相搏之脉，多是暑热伤津。
沈尧封曰∶卫气为阳，人之所知也；津液为阳，人之所未知也。经云∶上焦出气，宣五谷味，熏肤充身泽毛，若雾
露之溉，是谓气。卫气，即津液也。故在外之津液少，则曰无阳，不能作汗。在内亡津液，则曰阳绝于里，要之言阳也，
即言卫气也，即言津液也。
王安道说：暑热是夏季的气候特征。它在天地之间广泛流行，人受其侵害而发病，称为中暑，也称为中热，两者含义相同。叶香岩说：地面热得像火炉一样，伤人速度最快。
赵以德说：如果汗出、恶寒、身热但不口渴，那是中风（外感风邪）；如果口渴，那就是中暑。
周禹载说：冬季有寒气，能伤害人体，称为中寒；夏季有热气，也能伤害人体，称为中热。这是外来的热气，所以称为“中”。它不是潜伏的寒邪发作出来的，也不是夏天必然患热的伏气之热。然而，治疗时同样使用白虎汤，总是因为所伤在气分，气分属金，病变在于热。土生金，金生水，金有病则其母（土）和其子（水）都受牵连，所以这与伏气温病发于少阴，或由阳明发出的情况没有区别。总之，都主治以一方，完全不因为冬季的伏气和夏季的中热而有两种不同的义理。也完全不因为伏气温病的口渴和当下患病的口渴有稍微的不同。唉！圣人在这里，有意创立方剂，无心标新立异，因为在千古之前，自有此理，万世之后，自有此领悟。
王士雄按语：古人只把寒当作肃杀之气，而对暑热论述很少，这是文献的缺失。
徐洄溪说：凡是出汗多的病，无不伴有恶寒，因为因恶寒、汗出而误认为是寒证，妄用热性药物，就会立即导致危险。
何报之说：大汗淋漓不止会导致亡阳，并且使肾水枯竭，津液内里干枯，这叫做亡阴。应当紧急滋补水之上源（肺）。三伏天（夏至后第三个庚日）的含义，是金处于囚困的状态。金遇到丙丁火，失去清肃之性，壬水绝于巳月，癸水绝于午月，西北的寒清气机断绝了。前人有人说夏季适宜进补，那是补天元真气，不是补热火。让人夏天吃寒凉食物就是这种道理。
沈尧封说：这是热病的证据，《素问》说在天为热，在地为火。热，是火的气化表现。所以热是五气之一。而热病就是伤寒五种类型之一。《伤寒论》借用《难经》中的“热”字，恐怕与下文的“温”字相混淆，所以特别指出说：“这就是中暑。”感受烈日之气而生病，就是《素问》中寒、暑、燥、湿、风里的暑病。有人说：暑是阳邪，暑是阴邪，土润溽暑，热兼带湿气而言。似乎与暑不同，回答说：寒往则暑来，与寒相对待，难道不是专指热吗？古人称“暑、暍、热”是一个概念。如果是湿热并至的病，《难经》称为湿温，不称为暑。等到隋唐以后，都把湿热当作暑，于是真正的暑之名失传，而暍之名更不知道是什么病了。
王士雄按语：《北齐书·后主纪》记载：六月在南苑游玩，随从官员中暑死亡的有六十人。《千金须知》说：热死称为暍，这说明唐代还知道暑暍就是热病。
王士雄按语：《内经》说：在天为热，在地为火，其性质为暑。又说：岁火太过，炎暑流行。大概暑是日气，这个字从日，叫炎暑、叫酷暑，都是指烈日之气而言。夏至后有小暑、大暑；冬至后有小寒、大寒。所以暑就是热，寒就是冷。暑是阳气，寒是阴气。这是天地间明显易知的事情，并没有深奥难测的道理，却历来歧说偏多，岂不可笑！更有调和折衷其说法的人，强行区分动得、静得为阴阳。动静只是人的行为，难道能使天上的暑气随人而判别吗？况且《内经》有阴居避暑的文章，武王有在树荫下休息的事，张仲景以白虎汤作为热病的主方，条理贯通，道理更加显著。为什么后来的贤者不考察清楚，却喜好聚讼纷纭以扰乱医道，深文周纳以晦涩医道呢？如果说暑必定兼夹湿气，那么亢旱之年，湿气难以必得，何况兼夹湿气的难道只有暑吗？大概湿气没有固定位置，分旺于四季，风湿、寒湿，没有什么不可以兼夹的，只是夏季的土气独盛，所以热湿多于寒湿。然而暑字从日，日是天气。湿字从土，土是地气。霄壤不同，虽然可以合而为病，终究不能说暑中原先就有湿。
王三阳说：经文中的“寒”字，应当作“邪”字解释，也是热的意思。方中行说：世传本作“表有热，里有寒”，一定是传写错误。白虎汤本来是治疗热病、暑病的药，其性大寒，哪里有里有寒的可以服用的道理？详查本文脉象浮滑，不但没有紧象，而且多见滑象，这是阳气很盛而郁蒸，这是里有热。里热甚盛必然格拒寒气于外，多见四肢厥逆、身体发凉而出现亢害的证候，这是表有寒。《厥阴篇》中说脉滑而四肢厥冷的，是里有热，用白虎汤主治。由此可知这里的“表里”二字是错误的，应当上下互换。
魏念庭说：这里的里还是经络的里，不是脏腑的里。
沈尧封说：里有寒的“寒”字，是“热”字的误写。如果真是里有寒，为什么反而用石膏、知母呢？表有热，就是身热。上一节只言病名，不言脉证，这一节详细言脉证，出示方剂主治，两节本是承接的，叔和校订时，这一节幸亏有“寒”字的错误，没有被摘出。如果见到“热”字，早就被摘置到别论中了。程郊倩说：暍病的脉不浮，没思考《伤寒论》中的暍病，就是《难经》的热病。《难经》说：热病的脉，阴阳俱浮。轻取而滑，重取散涩，这是紧要之处，怎么能模糊读过。本条脉浮滑，与《难经》热病脉相符，那么白虎汤确实是热病的主方，而“寒”字确实是“热”字的误写。
王士雄按语：杨素园大令说：这一条的“寒”字，各家辩论，未能妥帖。徐君亚枝说：应当作“痰”字解释，于义较协调。我认为徐君的这个解释，可称为千古只眼。本论中没有痰字，如湿家胸中有寒的“寒”字，也作痰字解释。大概痰本作淡，会意二火搏水成痰。那些湿家火微湿盛，虽然渴但不能饮水，这是湿痰。此暍病火盛烁液，脉既滑了，主治以白虎汤，那么渴欲饮水可知，这是热痰。凡是痰因火动，脉至滑实，而口渴欲饮的，就可以用白虎治疗，何况暍家呢？汪按：《灵枢》、《素问》两经，也只说水。说寒无一痰字。
张路玉说：滑，是阳脉，所以其厥为阳厥，里热郁炽，所以外表反而恶寒，厥逆往往有嘴唇、面部、指甲都发青的，所以宜用白虎汤清里除热。
伤寒，没有大热，口燥渴，心烦，背部微微恶寒的，用白虎加人参汤主治。
张兼善说：白虎汤专门治疗大烦、大渴、大燥、大热的证候，惟恐表证未罢而早用之。如果背部微微恶寒和时时恶风两条，因为其中烦渴、燥热已甚，不用白虎汤不能遏制。
沈尧封说：背为阳，背部微微恶寒的，是阳虚证。但阳有不同，真水、真火，是肾中的阴阳；气血，是营卫的阴阳。此条口燥渴、心烦，则是暑热内炽，仍是白虎证。惟独暑热伤了卫气，导致背部微微恶寒，所以加人参补卫气。至于少阴病口中和，背部恶寒的，则是卫阳与肾阳并伤，所以人参和附子并用以两补之。
王士雄按语：吴鹤皋说：背部微微恶寒的，只是觉得微寒而不严重。既然有燥渴，那么白虎加人参，使用可以无疑。如果背恶寒而不燥渴的，不可用。我认为参照以下一条，必有汗，所以可用。
伤寒，脉浮，发热无汗，表证不解的，不可给白虎汤；渴欲饮水，无表证的，用白虎加人参汤主治。
沈尧封说：这是承接上文讲烦渴、背恶寒，固然应当用白虎加人参汤，但也有中暑而外面又伤风寒的，也能令恶寒、发热、脉浮，更应当在有汗、无汗上辨别表证解不解，以确定此方可用不可用。
伤寒病，如果吐、下后，七八天不解，热结在里，表里俱热，时时恶风，大渴，舌上干燥而烦，想喝几升水的，用白虎加人参汤主治。
张路玉说：详查此条表证，比前条较重，为什么也用白虎加人参呢？本文“热结在里，表里俱热”两句，已经自行斟酌。惟独热结在里，所以表热不除。邪火内伏，所以恶风大渴。舌燥而烦，想喝水不止，怎么不以生津解热为急呢！
王士雄按语：御纂《医宗金鉴·正误篇》：“时时恶风”，作“时汗恶风”，应当遵从。又沈亮宸说：舌干且燥，谓视之无液。然而温热病审察舌苔以察津液，仲师已开其端倪。
太阳中暍病，身热疼重，而脉微弱，这是因为夏天受了冷水，水行皮中所致。用一物瓜蒂汤主治。
皇甫士安说：脉盛身寒，得之于伤寒；脉虚身热，得之于伤暑。大概寒伤形而不伤气，所以脉盛；热伤气而不伤形，所以脉虚。
王士雄按语：所说的身寒，虽然是发热但仍恶寒，不像暑热病喜欢凉爽厌恶热。
朱奉议说：夏天发热，恶寒，头痛，身体肢节痛重，脉象洪盛的，是热病。夏天自汗，恶寒，身热而渴，脉象微弱的，是中暑。
王士雄按语：这个注释的热病，是夏至后所发的伏邪。《内经》也称其为暑病。中暑，是夏天外感的热病，也称为中暍。
病有内外之殊，脉有洪微之别，微弱本是暍脉，惟独身重是湿候，后条虽然也身重，但口开齿燥，暑热内炽已极，似乎应当紧急给予甘寒救液。
方中行说：夏日则饮水，是人之常事，为什么说伤呢？良由暑迫，饮之过多，或者得之冷水澡洗，暑反而入内。
张路玉说：此条言因热伤冷的病，是中暍的变证。喻氏认为无形之热，伤了肺金，就用白虎加人参汤来救它。有形之湿，伤了肺金，就用瓜蒂汤救它。各有所主。
太阳中暍病，发热恶寒，身重而疼痛，脉象弦细芤迟；小便后洒洒然毛耸，手足逆冷，稍微劳动身体就发热，口开，前板齿燥。如果发汗，则恶寒更甚。加温针，则发热更甚。多次攻下，则淋证更甚。
成聊摄说：病有在表的，有在里的，有表里俱病的，此则是表里俱病的。发热恶寒，身重疼痛的，是表中有暍；脉弦细芤迟的，是中暑脉虚；小便后洒洒然毛耸，手足逆冷的，是太阳经气不足。稍微劳动身体就发热的，是说劳动其阳，而暍即发。口开，前板齿燥的，是里有热。
王士雄按语：仅就此一端，可见其为热炽津枯的证候。虽然身重恶寒，难道可以再投清暑益气汤、五苓散、藿香正气丸等辛温燥烈之品以重劫其阴液吗？东垣、虚谷的说法，贻误后人不少。《内经》说：因于暑汗，烦则喘喝。口开谓喘喝。因为喘喝不止，所以前板齿燥。如果发汗以去表邪，则阳气外虚，所以恶寒甚。如果用温针助阳，则火热内攻，所以发热甚。如果攻下以除里热，则内虚而膀胱燥，所以淋甚。
王士雄按语：观此治法的三禁，则仲景虽未立方，而甘凉撤热存津的方法当用，已可不言之而喻。赵氏、方氏主张用白虎加人参汤，大概是从三阳合病比例而出，似乎也近理。
沈尧封说：这是说精气素亏而中暍的。
伤寒，脉结代，心动悸的，用炙甘草汤主治。一名复脉汤。脉按之来而缓，时一止复来的，名叫结。又脉来动而中止，更来小数，中有还者反动，名叫结，属阴。脉来动而中止，不能自还，因而复动的，名叫代，属阴。得此脉的，一定难治。
方中行说：脉结代而心动悸的，虚多实少，譬如寇欲退散，主弱不能遣发，而反自彷徨。复脉乃核实义的名，然而此汤，一定要使虚者加进，而驯至于实，则实者自退散，而还复于元的意思。
喻嘉言说：脉是气血的先导，仲景对于津液内亡的脉，命名为结阴、代阴，又名无阳。原有至理，怎么可以不知？聊为四言俚句，以明其义。胃藏津液，是水谷之海，内充脏腑，外灌形骸。津多脉盛，津少脉衰，津结病至，津竭祸来。脉见微弱，宜先建中。汗则津越，下则津空。津耗脉细，不可妄攻。小便渐减，大便自通。阳明内实，急下救焚。稍缓须臾，津液无存。阳明似实，稍用调承。驱热存津，此法若神。肾中真阳，阴精所裁。胃中真阳，津液所胎。阴枯津盛，冽泉可溉。阴精衰薄，瓶罄 哀。何谓结阴？无阳脉阖。何谓代阴？无阳脉夺。经揭无阳，津液欲竭，较彼亡阳，天地悬阔。
沈尧封说：这是论精气素亏而感微邪的治疗。前节有脉证而无方治，此未必即是前节主方。然而观方中药，又宁必不可以治前证。
方中行说：浮为气上行，故曰阳；芤为血内损，故曰阴。胃中生热者，阴不足以和阳，津液干而成枯燥。
王士雄按语：
沈氏说：浮为邪，芤为阴血虚。以我的论述，凡见浮芤相搏之脉，多是暑热伤津。
沈尧封说：卫气为阳，是人所知道的；津液为阳，是人所未知的。经云：上焦出气，宣五谷味，熏肤充身泽毛，若雾露之溉，是谓气。卫气，即津液。所以在外的津液少，则曰无阳，不能作汗。在内亡津液，则曰阳绝于里，总而言之言阳，即言卫气，即言津液。
Taiyang Zhongre (Heatstroke in the Taiyang stage), also known as Shu Bing (Summerheat disease). The patient presents with sweating, aversion to cold, fever, and thirst.
Wang Andao stated: Summerheat is the climatic characteristic of summer. It circulates widely between heaven and earth; when humans are affected by it and fall ill, it is called Zhongshu (Heatstroke) or Zhongre (Middle Heat), both terms having the same meaning. Ye Xianyan stated: The ground is hot like a furnace, injuring people at the fastest speed.
Zhao Yi-de stated: If there is sweating, aversion to cold, and fever without thirst, it is Fengzhong (Wind-strike/Exogenous Wind Syndrome); if there is thirst, it is Zhongshu (Heatstroke).
Zhou Yuzai stated: In winter, cold qi can injure the human body, called Zhonghan (Cold Strike); in summer, heat qi can also injure the human body, called Zhongre (Middle Heat). This is exogenous heat, hence termed "Zhong" (Strike/Penetration). It is not the heat released from latent cold pathogens, nor is it the heat that inevitably occurs in summer due to latent Qi. However, Baihu Tang (White Tiger Decoction) is used for both, primarily because the injury is in the Qi level, which corresponds to Metal, and the pathology lies in Heat. Earth generates Metal, and Metal generates Water; if Metal is diseased, its mother (Earth) and child (Water) are both affected. Thus, this is no different from latent Qi diseases originating in Shaoyin or those emerging from Yangming. Ultimately, one formula governs them all; there are not two distinct principles based on whether it is latent cold in winter or summer heat strike. Nor is there any slight difference between the thirst of latent Qi disease and the current illness's thirst. Alas! The Sages established formulas here with intent but without desire for novelty. The principle existed before antiquity and will be understood forever.
Wang Shixiong's Note: Ancients only regarded Cold as the Qi of desolation and killing, while discussing Summerheat very briefly; this is a textual omission.
Xu Huixi stated: Any disease with profuse sweating invariably involves aversion to cold. If mistaken for a Cold syndrome due to aversion to cold and sweating, and hot medicines are wrongly administered, danger ensues immediately.
He Baozhi stated: Profuse, unceasing sweating leads to Wangyang (Collapse of Yang) and causes Kidney Water to dry up, with internal fluids withering away; this is called Wangyin (Collapse of Yin). One must urgently nourish the upper source of water (Lung). The meaning of the Sanfu days (Dog Days) is that Metal is imprisoned. When Metal encounters Bing-Ding Fire, it loses its clearing and descending nature; Ren Water perishes in Si month, Gui Water perishes in Wu month, and the cold, clear Qi of the northwest is cut off. Predecessors said that tonification in summer is for replenishing Yuanzhen Zhenqi (Primal True Qi), not for tonifying fire-heat. Allowing people to eat cold foods in summer exemplifies this.
Shen Yaofeng stated: This is evidence of Re Bing (Heat Disease). *Suwen* states: In Heaven it is Heat, on Earth it is Fire. Heat is the Qi of Fire. Thus, Heat is one of the Five Qi. Re Bing is one of the five types of Shanghan (Cold Damage). *Shanghan Lun* borrows the character "Re" (Heat) from *Nanjing*, fearing confusion with the subsequent character "Wen" (Warmth), so it specifically points out: "This is Zhongshu." Illness caused by feeling the Qi of the scorching sun corresponds to the Shu Bing (Summerheat Disease) among Cold, Summerheat, Dryness, Dampness, and Wind in *Suwen*. Some say: Shu is Yang Evil, while Shu (another term) is Yin Evil; "Tu Run Ru Shu" (Damp heat in moist soil) implies Heat combined with Dampness. It seems different from Shu. I reply: As Cold goes, Summerheat comes; it stands in opposition to Cold. Is it not specifically referring to Heat? Ancients considered "Shu, He, Re" as one concept. Diseases where Dampness and Heat arrive together are named Shi Wen (Damp-Warmth) in *Nanjing*, not Shu. From Sui and Tang dynasties onward, Damp-Heat was identified as Shu, causing the true name of Shu to be lost, and the name "He" became unknown.
Wang Shixiong's Note: *Book of Northern Qi · Annals of the Last Ruler* records: In the sixth month, touring the South Park, sixty officials died of Zhongsi (Heat Death). *Qianjin Xu* states: Death by heat is called He. This shows that in the Tang dynasty, it was still known that Shu He referred to Heat.
Wang Shixiong's Note: *Neijing* states: In Heaven it is Heat, on Earth it is Fire, its nature is Shu. It also states: When Yearly Fire is excessive,炎暑 (Scorching Summerheat) prevails. Generally, Shu is the Qi of the Sun; the character contains "Sun". Terms like Yan Shu and Ku Shu all refer to the Qi of the scorching sun. After Summer Solstice come Xiao Shu (Minor Heat) and Da Shu (Major Heat); after Winter Solstice come Xiao Han (Minor Cold) and Da Han (Major Cold). Thus, Shu is Heat, Han is Cold. Shu is Yang Qi, Han is Yin Qi. This is obvious and easy to know in the world, involving no profound mystery, yet divergent theories abound, which is laughable. Others try to reconcile these views, forcibly distinguishing "obtained by movement" vs. "obtained by stillness" as Yin and Yang. Movement and stillness depend on humans; how can heavenly Summerheat Qi be judged by human activity? Moreover, *Neijing* mentions seeking shade to avoid heat, King Wu rested under tree shade, and Zhang Zhongjing used Baihu Tang as the main formula for Heat Disease. These are consistent and logical. Why do later scholars fail to investigate, preferring controversy to confuse the Way, and obscure interpretation to darken the Way? If one claims Shu must combine with Dampness, then in years of severe drought, Dampness cannot be guaranteed. Besides, why would only Shu combine with Dampness? Dampness has no fixed location and prospers in all four seasons; Wind-Damp, Cold-Damp can all combine. Only in Summer does Earth Qi dominate, making Heat-Damp more common than Cold-Damp. However, Shu contains "Sun" (Heavenly Qi), while Shi contains "Earth" (Earthly Qi). They are distinct like sky and ground. Although they can combine to cause disease, one cannot claim Shu originally contains Dampness.
Shanghan, with a floating and slippery pulse, indicates Heat on the Exterior and Cold on the Interior; treat with Baihu Tang (White Tiger Decoction).
Wang Sanyang stated: The character "Han" (Cold) in the text should be interpreted as "Xie" (Evil), implying Heat. Fang Zhongxing stated: The transmitted text reads "Heat on the Exterior, Cold on the Interior," which must be a transcription error. Baihu Tang is inherently for treating Heat and Summerheat diseases; its nature is greatly cold. How could it be taken for Interior Cold? Examining the floating and slippery pulse, lacking tightness but showing slipperiness, indicates abundant Yang Qi stagnating and steaming—this is Interior Heat. Severe Interior Heat repels Cold to the Exterior, often causing limb厥逆 (Jue Ni/Cold Extremities) and cool body, presenting as hyperactive pathological signs—this is Exterior Cold. In the Jueyin Chapter, a slippery pulse with cold extremities indicates Interior Heat, treated with Baihu Tang. Therefore, the characters "Exterior" and "Interior" here are erroneous and should be swapped.
Wei Nianting stated: The "Interior" here refers to the Interior of the meridians, not the Interior of the Zang-Fu organs.
Shen Yaofeng stated: The "Cold" in "Interior Cold" is a typo for "Re" (Heat). If there were truly Interior Cold, why use Shigao (Gypsum) and Zhimu (Anemarrhena)? "Heat on the Exterior" means fever. The previous section only named the disease without pulse/symptoms; this section details pulse/symptoms and provides the formula. The two sections are continuous. During Shuhe's editing, this section survived only because of the "Cold" error. If it read "Heat," it would have been moved to another discussion. Cheng Jiaoqian stated: He disease pulses are not floating. Did he not consider that He disease in *Shanghan Lun* is the Re Bing (Heat Disease) of *Nanjing*? *Nanjing* states: Heat disease pulses are floating in both Yin and Yang positions. Floating and slippery upon light pressure, scattered and choppy upon deep pressure. This is crucial; one cannot read it vaguely. This section's floating and slippery pulse matches *Nanjing*'s Heat disease pulse. Thus, Baihu Tang is indeed the main formula for Heat disease, and "Cold" is a typo for "Heat."
Wang Shixiong's Note: Yang Suyuan noted: Various debates on the "Cold" character in this section are unsatisfactory. Mr. Xu Yazhi suggested interpreting it as "Tan" (Phlegm), which fits better. I believe Mr. Xu's explanation deserves praise as a unique insight. The Treatise lacks the character "Tan." For example, the "Han" (Cold) in "Cold in the Chest of a Dampness Patient" is also interpreted as "Tan." Originally, Tan was written as Dan, meaning two Fires combusting Water to form Phlegm. In dampness patients, Fire is weak and Dampness strong; although thirsty, they cannot drink—this is Wet Phlegm. In He disease, Fire is strong and scorches fluids; with a slippery pulse, treated with Baihu Tang, thirst for water is evident—this is Hot Phlegm. Whenever Phlegm moves due to Fire, resulting in a slippery-solid pulse and thirst for water, Baihu Tang can be used, especially for He patients. Wang An note: *Linghu* and *Suwen* only mention Water. There is no character "Tan" associated with Cold.
Shanghan, with a slippery pulse and cold extremities, indicates Interior Heat; treat with Baihu Tang (White Tiger Decoction).
Zhang Luyu stated: Slippery is a Yang pulse, so the Jue (cold extremities) is Yang Jue. Interior Heat is stagnant and blazing, causing exterior aversion to cold. Jue often presents with blue lips, face, and nails. Thus, Baihu Tang should be used to clear the Interior and remove Heat.
Shanghan, without significant fever, with dry mouth/thirst, mental restlessness, and slight aversion to cold on the back, is treated with Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction).
Zhang Jianshan stated: Baihu Tang specializes in treating severe irritability, thirst, dryness, and heat. One fears using it too early if the Exterior syndrome has not resolved. Regarding the slight aversion to cold on the back and frequent aversion to wind, since the interior irritability, thirst, and dry-heat are severe, only Baihu Tang can suppress them.
Shen Yaofeng stated: The back is Yang. Slight aversion to cold on the back indicates Yang deficiency. However, Yang differs: True Water and True Fire are the Yin/Yang of the Kidney; Qi and Blood are the Yin/Yang of Ying and Wei. This section shows dry mouth/thirst and irritability, indicating Summerheat blazing internally—still a Baihu pattern. However, Summerheat damaged the Wei Qi, causing slight aversion to cold on the back; thus, Renshen (Ginseng) is added to tonify Wei. In contrast, Shaoyin disease with a neutral mouth and aversion to cold on the back involves damage to both Wei Yang and Kidney Yang, requiring Renshen and Fuzi (Aconite) together to tonify both.
Wang Shixiong's Note: Wu Hegao stated: Slight aversion to cold on the back means feeling slightly cold but not severely. With dryness and thirst, Baihu Jia Renshen Tang is undoubtedly appropriate. If there is aversion to cold on the back without dryness/thirst, it is contraindicated. I add: Referencing the next section, there must be sweating, making its use possible.
Shanghan, with a floating pulse, fever, and no sweating, where the Exterior is not resolved, Baihu Tang is contraindicated. If there is thirst for water and no Exterior syndrome, treat with Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction).
Shen Yaofeng stated: This continues the discussion on irritability/thirst and aversion to cold on the back, confirming Baihu Jia Renshen Tang is indicated. However, some may suffer from Summerheat compounded by external Wind-Cold, causing aversion to cold, fever, and floating pulse. One must distinguish between sweating and non-sweating to determine if the Exterior is resolved, thereby deciding if this formula is applicable.
In Shanghan disease, after vomiting or purgation, if unresolved after seven to eight days, with Heat knotting in the Interior, simultaneous Exterior and Interior Heat, occasional aversion to wind, severe thirst, dry tongue with irritability, and desire to drink several liters of water, treat with Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction).
Zhang Luyu stated: The Exterior syndrome here is heavier than before; why use Baihu Jia Renshen? The phrases "Heat knotting in the Interior" and "Simultaneous Exterior and Interior Heat" provide the rationale. Because Heat knots in the Interior, Exterior Heat persists. Hidden pathogenic fire causes aversion to wind and severe thirst. Dry tongue, irritability, and incessant desire to drink necessitate urgent generation of fluids and removal of heat.
Wang Shixiong's Note: Imperial *Yizong Jinjian · Correction of Errors*: "Occasional aversion to wind" should be "Sweating with occasional aversion to wind"; follow this. Shen Liangchen stated: Dry and parched tongue means no fluid visible upon inspection. Thus, examining tongue coating to assess fluids in Warm-Heat diseases began with Zhang Zhongjing.
Taiyang Zhonghe (Summerheat Strike), presenting with fever, heaviness/pain, and a weak/micropulse, is caused by Summer Cold Water injury, where water circulates in the skin. Treat with Yiwu Gaudi Tang (Single Melon Pedicle Decoction).
Huangfu Mi stated: Pulse vigorous with cold body results from Shanghan; pulse deficient with hot body results from Shangshu. Cold injures Form but not Qi, hence vigorous pulse; Heat injures Qi but not Form, hence deficient pulse.
Wang Shixiong's Note: The mentioned "cold body" means fever accompanied by aversion to cold, unlike Summerheat diseases which prefer coolness and dislike heat.
Zhu Fengyi stated: Summer fever, aversion to cold, headache, body/joint heaviness/pain with a surging pulse is Re Bing (Heat Disease). Summer spontaneous sweating, aversion to cold, fever with thirst and a weak pulse is Zhongshu (Heatstroke).
Wang Shixiong's Note: This "Heat Disease" refers to latent pathogens emerging after Summer Solstice, also called Shu Bing in *Neijing*. Zhongshu is an exogenous Heat Disease in summer, also called Zhonghe.
Diseases differ in interior/exterior origins; pulses differ in surging/weakness. A weak pulse is typical for He disease; only heaviness indicates Dampness. The following section also mentions heaviness, but with open mouth and dry front teeth, indicating extreme internal Summerheat blazing; urgent sweet-cold fluid rescue is needed.
Fang Zhongxing stated: Drinking in summer is natural; why "injury"? Likely due to Summerheat pressure, drinking excessively, or bathing in cold water, causing Summerheat to enter internally.
Zhang Luyu stated: This section describes illness from Heat injuring Cold, a variant of Zhonghe. Yu clan stated: Formless Heat injuring Lung Metal uses Baihu Jia Renshen Tang. Formless Dampness injuring Lung Metal uses Gaudi Tang. Each has its specific indication.
Taiyang Zhonghe, presenting with fever, aversion to cold, heaviness/pain, and a string-taut, fine, hollow, or slow pulse; chills/shivering after urination, cold extremities, fever upon slight exertion, open mouth, and dry front teeth. If sweating is induced, aversion to cold worsens. If warm needles are applied, fever worsens. If purged multiple times, stranguria worsens.
Cheng Liaoshe stated: Diseases exist in the Exterior, Interior, or both. This case involves both. Fever, aversion to cold, heaviness/pain indicate He in the Exterior. String-taut, fine, hollow, slow pulses indicate deficient pulse of Zhongshu. Chills after urination and cold extremities indicate insufficient Taiyang Meridian Qi. Fever upon slight exertion means moving Yang triggers He. Open mouth and dry front teeth indicate Interior Heat.
Wang Shixiong's Note: This alone shows Heat blazing and fluids withered. Despite heaviness and aversion to cold, one must not administer Xinwen Zaolie (Acrid-Warm Dry-Arousing) formulas like Qingshu Yiqi Tang, Wuling San, or Huoxiang Zhengqi Wan to further劫 (rob) Yin fluids. Dongyuan and Xugu's words misled later generations significantly. *Neijing* states: Due to Summerheat sweating, irritability leads to panting/drinking. Open mouth refers to panting. Continuous panting causes dry front teeth. Sweating to remove Exterior pathogens makes Exterior Yang deficient, worsening aversion to cold. Warm needles assist Yang, causing Internal Fire attack, worsening fever. Purging to remove Interior Heat causes Internal deficiency and Bladder dryness, worsening stranguria.
Wang Shixiong's Note: Observing these three prohibitions in treatment, although Zhang Zhongjing did not prescribe a formula here, the method of Sweet-Cool removing Heat and preserving Fluids is implicitly indicated. Zhao and Fang advocating Baihu Jia Renshen Tang likely derived from analogy with Three-Yang Combined Disease, which seems reasonable.
Shen Yaofeng stated: This describes Zhonghe in patients with inherent Essence/Qi deficiency.
Shanghan, with knotted/intermittent pulse and palpitations, is treated with Zhigancao Tang (Honey-Panax Notoginseng Decoction), also known as Fumai Tang (Restore Pulse Decoction). A pulse that comes slowly and stops occasionally then resumes is called Jie (Knotted). A pulse that moves and stops, then returns quickly with a slight acceleration, is also Jie, belonging to Yin. A pulse that moves and stops, cannot return spontaneously, and then resumes, is called Dai (Intermittent), belonging to Yin. Obtaining this pulse indicates difficult treatment.
Fang Zhongxing stated: Knotted/intermittent pulse with palpitations indicates much Deficiency and little Excess. Like bandits wanting to retreat, but the weak lord cannot dispatch them, leading to hesitation. "Restore Pulse" names the substance's function: making the deficient advance until solid, so the excess retreats and returns to origin.
Yu Jiayan stated: Pulses are precursors of Qi and Blood. Zhang Zhongjing named pulses of internal fluid loss as Jie Yin and Dai Yin, also called Wu Yang (No Yang). There is profound truth here. Let me explain in four-character verses: Stomach stores fluids, sea of grain/water, filling Zang-Fu internally, irrigating form externally. Abundant fluids mean vigorous pulse; scarce fluids mean weak pulse. Fluid stagnation brings disease; fluid exhaustion brings disaster. Weak pulse requires first establishing Middle Jiao. Sweating scatters fluids; purging empties fluids. Fluid consumption thins pulse; do not attack rashly. Urine gradually decreases, stool naturally clears. Yangming Internal Solidity requires urgent purging to save from burning. Delay slightly, and fluids vanish. Yangming appears solid, use mild Chengji formulas. Drive heat, preserve fluids; this method is miraculous. Kidney True Yang is governed by Yin Essence. Stomach True Yang is nurtured by fluids. Yin dried, fluids abundant, cold springs can irrigate. Yin essence thin, bottle empty, sorrowful cry. What is Jie Yin? No Yang, pulse closes. What is Dai Yin? No Yang, pulse seizes. Scripture reveals No Yang, fluids about to exhaust; compared to Wang Yang, the gap is vast.
Shen Yaofeng stated: This discusses treatment for inherent Essence/Qi deficiency contracting slight pathogens. The previous section had pulse/symptoms but no formula; this may not be the main formula for that section. However, observing the herbs, it certainly could treat the previous condition.
Pulse floating and hollow. Floating is Yang; hollow is Yin. Floating and hollow interacting, Stomach Qi generates Heat, its Yang becomes severed.
Fang Zhongxing stated: Floating is Qi ascending, hence Yang; hollow is Blood internal damage, hence Yin. Heat generated in Stomach means Yin is insufficient to harmonize Yang, fluids dry into aridity.
Wang Shixiong's Note:
Shen stated: Floating is Pathogen; hollow is Yin-Blood deficiency. In my view, whenever Floating-Hollow interaction is seen, it is mostly Summerheat damaging fluids.
Shen Yaofeng stated: Wei Qi is Yang, known to people; Jin Ye (Fluids) is Yang, unknown to people. Scripture says: Upper Jiao emits Qi, disseminates grain/flavor, warms skin, fills body, moistens hair, like mist/dew irrigation; this is Qi. Wei Qi is Jin Ye. Thus, less External Jin Ye is called Wu Yang (No Yang), unable to produce sweat. Internal loss of Jin Ye is called Yang Jue Yu Li (Yang Severed in Interior). In short, speaking of Yang means speaking of Wei Qi, which means speaking of Jin Ye.