伤寒论平脉法篇∶师曰∶伏气之病，以意候之，今月之内，欲有伏气。假令旧有伏气，当须脉之。若脉微
弱者，当喉中痛似伤，非喉痹也。病患云∶实咽中痛。虽尔，今复欲下利。
诒按∶温邪化热内动，脉当数大，乃见微弱，是气弱不能托邪，邪郁不达之象。热不外达而循经上浮，则
为喉痛，以少阴之脉循喉咙也。伤寒少阴病，本有下利、咽痛之条，亦即此义。盖以热郁既久，则阴液腐败，
故不但咽痛，而复欲下利也。
又按∶此条可为温邪内伏少阴之证。
章虚谷曰∶观仲景标中风、伤寒、暑热等病脉，与难经同。惟难经言温病之脉，行在诸经，不知何经之动
也。是言温病初由伏邪随气血流行在诸经中，及其发也，不知从何经而动，其发无定处，故无一定之脉可指也
。今仲景又教人审脉，以辨邪发之经∶如脉微弱，即知其邪未离少阴，随经上下，必当有咽痛、下利等证，正
与难经互相发明也。下文邪出三阳，热势大盛，其脉浮大，上关上；则是脉随证变，证随脉见。在初起本无定
脉，故难经不标脉象也。由是观之，其与外感之邪，有定证定脉者，固迥不同矣。
少阴病（脉微细但欲寐也），二三日，咽痛者，可与
甘草汤；不瘥者，与桔梗汤。
章虚谷曰∶风寒外闭少阴而咽痛者，仲景用半夏散，辛温开泄之法矣。此少阴伏热内发，循经上灼而咽痛
，虽不合用辛温开泄，亦不可用凉药，以遏其外出之势；故专用甘草甘缓之品，导邪外达，且生用亦能泻火。
如不瘥，则火郁而不出也；加桔梗上通其气，则痛自止矣。伤寒自表入里，故先太阳而后至少阴；温病自里而
出表，故先少阴而后出太阳也。
沈宗淦曰∶伏气为病，皆自内而之外，不止春温一证也。盖四时之气，皆有伏久而发者，不可不知也。
少阴病，下利咽痛，胸满心烦者，猪肤汤主之。
张路玉曰∶病虽发于阴经，实为热证。下利咽痛，胸满心烦，其邪热之充斥，上下中间，已无处不到，而
又非寒下之法所宜，故立猪肤汤，以润少阴之燥，与用黑驴皮之意颇同。阳微者用附子温经，阴竭者用猪肤润
燥，同具散邪之意。比而观之，思过半矣。
少阴病，得之二三日以上，心中烦，不得卧，黄连阿胶汤主之。
周禹载曰∶伏邪未发，津液先已暗耗。今得之二三日以上，虽阴火不升，未见咽痛等证，而心烦不得卧，
已知阴液消耗；故以芩、连清热，以胶、芍滋阴，虚实两治也。
诒按∶以上少阴病三条，均与传经热邪不合，其为伏邪所致无疑也。
少阴病，下利六七日，咳而呕渴，心烦不得眠者，猪苓汤主之。
章虚谷曰∶下利六七日，热从下陷，不得外透，故逆于肺则
咳而呕，乘心则烦渴不得眠，以心肺皆通少阴之脉故也。主以猪苓汤，利水而滋阴；盖滋阴则热随利去，利水
则泻止。而烦渴亦解矣。
少阴病，得之二三日，口燥咽干者，急下之，宜大承气汤。
张路玉曰∶伏气之发于少阴，其势最急，与伤寒之传经热证不同。得病才二三日，即口燥咽干，延至五六
日始下，必枯槁难为矣。故宜急下，以救肾水之燔灼也。按少阴急下三证∶一属传经热邪亢极，一属热邪转属
胃府，一属温热发于少阴，皆刻不容缓之证，故当急救欲绝之肾水，与阳明急下三法，同源异派。
诒按∶此亦伏邪无疑。如系传经热邪，则从始病数起，决不止二三日；如从传至少阴数起，则不应二三日
始见口燥咽干也。
太阳病，发热而渴，不恶寒者，为温病。
王安道曰∶温病如此，则知热病亦如此。是则不渴而恶寒者，非温热病矣。温热病而有恶风恶寒之证者，
重有风寒新中也。
沈尧封曰∶此条虽不言脉，以后条参之，其尺部必浮也。
章虚谷曰∶温病之发无定处。少阴之表为太阳，热邪从里出表，即有发热头痛之太阳病也。不恶寒，则非
新感之邪可知。热从内发故渴，仲景恐人错认为太阳伤寒伤风之证，故特标明，谓此是伏热内发之温病也。其
少阴温病反不标者，因伏气条内，已申明咽痛下利，为少阴初发之温病矣。
王梦隐曰∶汪谢城云，吴氏温病条辨上焦篇，首引伤寒论云∶太阳病，但恶热，不恶寒而渴者，名曰温病
，桂枝汤主之。
今检伤寒论，却未见此数语。使此语真出仲景耶，亦当辨其简误。若系吴氏误记，尤不可不为之辨正。余谓非
误记也。因喻氏尝云，仲景治温证，凡表药皆用桂枝汤，以示微发于不发之意。尤在泾读书记云，此喻氏之臆
说，非仲景之旧章。鞠通自谓跳出伤寒圈子，而不知已入嘉言套中，又不甘为人下，遂肆改原文，HT 为圣训，
而不自觉其诬圣误世也。
若发汗已，身灼热者，名曰风温。风温为病，脉阴阳俱浮，自汗出，身重多眠睡，鼻息必鼾，语言难出。
若被下者，小便不利，直视失溲。若被火者，微发黄色，剧则如惊痫,时螈 。若火熏之，一逆尚引日，再逆
促命期。
章虚谷曰∶太阳外感之邪，若发汗已，当热退身凉矣。今热邪从少阴而发，当清其热，而误发其汗，反伤
津气而助邪势，故身更灼热，因而勾起其肝风。鼓荡其温邪，故曰风温。其为病也，虚阳外浮，热邪漫溢，故
脉阴阳俱浮；津液外泄，自汗不止；气乏神昏，则身重多眠睡；内风动而机窍窒，故鼻鼾而语言难出；其非外
感风邪可见矣。若被下者，谓未经误汗，非为汗后又下也。若误被火劫者，微则热伤营气，而血瘀发黄；剧则
热甚风生，而惊痫螈 也。盖邪伏少阴，热灼水枯，咽干口燥，法当急下；此热已发出太阳，则少阴空虚，若
下之伤阴，则小便不利，而直视失溲，则气亦脱矣。若未汗下而被火攻者，外火助内热，熏蒸而发黄；剧则火
邪扰心如惊痫，肝风炽甚而螈 ，皆坏象也。若只火熏之，一逆尚可引日苟延；若既汗又下而再逆之，更促其
命期矣。
服桂枝汤，大汗出后，大烦渴不解，脉洪大者，白
虎加人参汤主之。
诒按∶桂枝汤治风邪伤卫，表病而里和者，用之得当，则微汗而解。此则温邪自内而发，误用桂枝，适以
助邪而耗液，故大汗大渴，热势转甚。主以白虎，所以泄热解烦；因阴液被劫，故加人参以救之也。
太阳与少阳合病，自下利者，与黄芩汤；若呕者，黄芩加半夏生姜汤主之。
张路玉曰∶黄芩汤，温病之主方，即桂枝汤以黄芩易桂枝去生姜也。盖桂枝主在表风寒，黄芩主在里风热
；其生姜辛散，非温热所宜，故去之。
周禹载曰∶明言太少二阳，何不用二经药，则以非伤寒故也。何以知其非伤寒，以不恶寒而即热，不得谓
之伤寒也。何以云太少二阳，以或胁满，或头痛，或口苦引饮，皆二经证也。果系伤寒合病，应见表证；今不
但无表，且有下利里证。如云伤寒协热下利，必自传经来，不若此之即利也。盖温邪内郁已久，中气不足者，
岂能一时尽泄于外，其下走而作利，亦自然之势也。
王梦隐曰∶少阳胆木，挟火被猖；呕是上冲，利由下迫；何必中虚始利，饮聚而呕乎。半夏、生姜，专开
饮结；如其热炽，宜易连、茹。
三阳合病，脉浮大，上关上，但欲眠睡，目合则汗。
周禹载曰∶温病至三阳合病，其邪热溷实可知，故脉浮大也。意邪在少阴，尺脉已大，今由内达外，而浮
大见于关上，故曰上关上也。然脉虽见于阳位，而少阴之源未清，故欲眠仍见少阴证，而盗汗又少阳证也。太
阳脉浮，阳明脉大，而关上是
少阳部位，故三阳合病。
诒按∶春温所以异于热病者，以目合则汗，不似热病之大汗不止也。
杨素园曰∶此条与发汗已身灼热之风温，初是一串，初起为此病，误汗则为风温。
按∶此条治法，缪仲淳拟用百合一两，麦冬五钱，知母、花粉、白芍各二钱，鳖甲三钱，炙甘草一钱，竹
叶五十片。
金匮曰∶温疟者，其脉如平，身无寒但热，骨节疼烦，时呕，白虎加桂枝汤主之。
尤拙吾曰∶此与内经论疟文不同。内经论其因，此详其脉与证也。瘅疟、温疟俱无寒但热，俱呕，而其因
不同。瘅疟者，肺素有热，而外加感冒，为表寒里热之证；缘阴气内虚，不能与阳相争，故不作寒也。温疟者
，邪气内伏少阴，至春夏而发，为伏气外出之证；寒蓄久而变热，故亦不作寒也。脉如平者，病非外感，故脉
如平时也。骨节疼烦、时呕者，热从少阴而出，舍于肾之所合，而上并于阳明也。白虎甘寒除热，桂枝则因势
而利导之耳。
王梦隐曰∶喻氏谓仲景论疟，既云弦数者多热，而复申一义曰，弦数者风发；可见多热不已，必至耗液生
风，木来侮土，传其热于胃。此非可徒求之药，须以饮食消息，止其炽热，如梨汁、蔗浆之类，以止渴生津
，正内经风淫于内，治以甘寒之旨也。
伤寒论曰∶阳明病，脉浮而紧，咽燥口苦，腹满而喘，发热汗出，不恶寒反恶热，身重。若发汗，则躁，
心愦愦，反谵语。若加烧针，必怵惕烦躁，不得眠。若下
之，则胃中空虚，客气动膈，心下懊 。舌上苔者，栀子豉汤主之。若脉浮发热，渴欲饮水，小便不利者，猪
苓汤主之。
周禹载曰∶浮紧，伤寒脉也，何以为热病？以其发于夏，不恶寒反恶热也。又何以独言阳明？以夏时湿热
上蒸，邪从胃发，且腹满而喘，种种皆阳明证也。然咽燥口苦，非少阴证耶？不知阳明为从出之途，少阴其伏
藏之地，故证或兼见也。夫既阳明热病，曷又为脉反浮紧？正因浮甚有力，热邪盛而致也。若不知者，以辛热
汗之，耗其津液，必至躁妄昏昧；火劫温针，燥其阴血，必至惊扰无寐；下之而伤其阴，必至胃虚邪陷，心中
懊；此皆误治所致，将何以救之乎？观舌苔滑者，则外邪尚在，以栀子解热，香豉去邪，是为合法。若渴欲
饮水，口干舌燥，知热邪大伤津液，故以白虎汤解热；加人参者，以益元气也。若紧脉去而浮在，发热饮水，
小便不利，则其热已入膀胱，故以猪苓消热除渴也。伤寒之小便不利，结于气分；热病之小便不利，由于血分
。邪郁既深，耗液日久，故必以阿胶补血，滑石祛热∶无取于白术也。
沈尧封曰∶未经误治之时，本是白虎汤主治。
阳明病，汗出多而渴者，不可与猪苓汤，以汗多胃中燥。猪苓汤复利其小便故也。
周禹载曰∶渴而小便不利，本当用猪苓汤，然汗多在所禁也。此与伤寒入腑，不令溲数同意。盖邪出阳明
，已劫其津，汗出复多，更耗其液，津液几何，更可下夺耶？当以白虎加人参去其热，则小便之不利者，津回而自利矣。
三阳合病，腹满身重，难以转侧，口不仁而面垢，
谵语遗溺。发汗则谵语；下之则额上生汗，手足逆冷。若自汗出者，白虎汤主之。（王士雄按∶发汗则谵语，
下似脱一甚字。）
章虚谷曰∶此条邪热更重，弥漫三阳，而致腹满身重，难以转侧。口不仁者，不知味也。由胃中浊壅熏蒸
，故又面垢也。热甚神昏∶则谵语遗溺。若未经误治，而自汗出者，主以白虎汤（王士雄按∶仲淳云，宜加百
合）。此倒装文法，谓非误发其汗之汗，故名自汗出（王士雄按∶尤在泾云，若自汗出句，顶腹满身重四句来
）。若误发其汗，而致谵语（王士雄按∶白虎加人参汤或可救也）；或下之，额上生汗者，是绝汗也。手足逆
冷，阳气将亡，即所谓再逆促命期，非白虎所可治也。
《伤寒论·平脉法篇》记载：老师说：伏气致病，需要通过诊察来推测，本月之内，可能有伏气潜伏。假如原本就有伏气，应当通过切脉来诊断。如果脉象微弱无力，患者会感到喉咙痛，像是受伤一样，但这并不是喉痹（咽喉红肿溃烂）。病人说：确实是咽中剧痛。即使如此，现在又想要腹泻。
柳宝诒按语：温邪化热内动，脉象应当数大，现在却见到微弱，这是正气虚弱不能托举邪气，邪气郁结不得外达的征象。热邪不能向外透达而顺着经络上浮，就会引起喉痛，因为少阴经脉循行经过喉咙的缘故。《伤寒论》少阴病条文中，本来就有下利、咽痛的条文，也是这个意思。大概是因为热邪郁结时间既久，导致阴液腐败，所以不仅咽痛，而且想要腹泻。
章虚谷说：看张仲景标注的中风、伤寒、暑热等病的脉象，与《难经》相同。只有《难经》说温病的脉象，运行在诸经之中，不知道是哪一经发动。这是说温病起初由伏邪随着气血流行在诸经中，等到发作时，不知道从哪一经而动，其发作没有固定位置，所以没有固定的脉象可以指认。现在张仲景又教导人审察脉象，以辨别邪气发动的经络：比如脉象微弱，就知道邪气未离开少阴，随经络上下，必然会有咽痛、下利等症状，正与《难经》互相印证说明。下文讲到邪气出于三阳，热势盛大，脉象浮大，上至关部；这就是脉象随证候变化，证候随脉象显现。在初起时本无固定脉象，所以《难经》不标注脉象。由此看来，它与外感之邪有固定证候和固定脉象的情况，确实截然不同。
少阴病（脉微细，只想睡觉），发病二三天，出现咽痛的，可以给予甘草汤；如果不痊愈的，给予桔梗汤。
章虚谷说：风寒外闭少阴而导致咽痛的，张仲景使用半夏散，是辛温开泄的方法。这里是少阴伏热内发，顺着经络向上灼烧而导致咽痛，虽然不适合用辛温开泄，但也不可用凉药，以免遏制邪气外出的势头；所以专门使用甘草这种甘缓的药物，引导邪气外达，而且生用也能泻火。如果还不痊愈，则是火郁结而不能外出；加入桔梗宣通肺气，疼痛自然停止。伤寒是从表入里，所以先太阳而后至少阴；温病是从里出表，所以先少阴而后出太阳。
沈宗淦说：伏气致病，都是从内部向外部发展，不仅仅是春温这一种证候。大概四季之气，都有潜伏久而发作的情况，不可不知道。
张路玉说：病虽然发于阴经，实际上是热证。下利、咽痛、胸满、心烦，邪热充斥，上下中间无处不到，而又不是寒下法所适宜的，所以设立猪肤汤，来滋润少阴的燥热，这与使用黑驴皮的意思颇为相同。阳气微弱的用附子温经，阴液枯竭的用猪肤润燥，都具有疏散邪气的意思。比较起来观察，思虑便过半了。
少阴病，得病二三天以上，心中烦乱，不能卧睡的，黄连阿胶汤主治。
周禹载说：伏邪未发，津液先前已经暗中消耗。现在得病二三天以上，虽然阴火不升，未见咽痛等证，但心烦不得卧，已知阴液消耗；所以用黄芩、黄连清热，用阿胶、白芍滋阴，虚实两治。
柳宝诒按语：以上少阴病三条，都与传经热邪不合，它们是由伏邪所致无疑。
少阴病，下利六七天，咳嗽而呕吐、口渴、心烦不得眠的，猪苓汤主治。
章虚谷说：下利六七天，热邪从下陷落，不能向外透发，所以逆犯于肺则咳嗽而呕吐，乘袭于心则烦渴不得眠，因为心肺都通连少阴的经脉缘故。主治用猪苓汤，利水而滋阴；大概滋阴则热邪随利而去，利水则泻止。而烦渴也解除了。
张路玉说：伏气发于少阴，其势最急，与伤寒的传经热证不同。得病才二三天，就口燥咽干，拖延到五六日才下，必定枯槁难为了。所以宜急下，以救肾水的燔灼。按少阴急下三证：一属传经热邪亢极，一属热邪转属胃腑，一属温热发于少阴，都是刻不容缓的证候，所以应当急救欲绝的肾水，与阳明急下三法，同源异派。
柳宝诒按语：这也是伏邪无疑。如果是传经热邪，则从开始生病数起，决不止二三天；如果从传至少阴数起，则不应二三天始见口燥咽干。
王安道说：温病如此，则知热病也是如此。那么不渴而恶寒的，就不是温热病了。温热病而有恶风恶寒症状的，是重又有风寒新中。
沈尧封说：这一条虽然不言脉，以后条参合来看，其尺部脉必浮。
章虚谷说：温病的发作没有固定位置。少阴之表为太阳，热邪从里出表，就有发热头痛的太阳病。不恶寒，则可知不是新感之邪。热从内发故口渴，张仲景恐怕人错认为太阳伤寒伤风的证候，所以特别标明，谓这是伏热内发的温病。其少阴温病反而不标明的，因为在伏气条内，已申明咽痛下利，为少阴初发的温病了。
王梦隐说：汪谢城说，吴鞠通的《温病条辨》上焦篇，首引《伤寒论》云：“太阳病，但恶热，不恶寒而渴者，名曰温病，桂枝汤主之。”
现在检查《伤寒论》，却未见这几句话。假使这话真出自张仲景，也应当辨别其中的简略错误。如果是吴氏误记，尤其不可不为他辨正。我认为不是误记。因为喻嘉言曾说，张仲景治疗温证，凡是表药皆用桂枝汤，以示微发汗而不发汗的意思。尤在泾《读书记》说，这是喻氏的臆说，不是张仲景的旧章。吴鞠通自称跳出伤寒圈子，却不知道已落入嘉言套中，又不甘为人之下，于是肆意改动原文，将其作为圣训，而不自觉其诬蔑圣人误导世人。
如果发汗后，身体灼热的，名叫风温。风温为病，脉阴阳俱浮，自汗出，身重多眠睡，鼻息必鼾，语言难出。
如果被误用下法的，小便不利，直视失溲（大小便失禁）。如果被误用火疗的，轻微的发黄色，严重的像惊痫，时时抽搐。如果用火熏的，一次误治尚能拖延时日，再次误治则加速死亡。
章虚谷说：太阳外感之邪，如果发汗后，应当热退身凉。现在热邪从少阴而发，应当清其热，而误发其汗，反而伤津气而助长邪势，所以身体更灼热，因而勾起肝风。鼓荡其温邪，所以叫风温。它发病时，虚阳外浮，热邪漫溢，所以脉阴阳俱浮；津液外泄，自汗不止；气乏神昏，则身重多眠睡；内风动而机窍窒塞，所以鼻鼾而语言难出；这就可见不是外感风邪。如果被误用下法，是指未经误汗，不是为汗后又下。如果误用火劫，轻微的则热伤营气，而血瘀发黄；严重的则热甚风生，而惊痫抽搐。大概邪伏少阴，热灼水枯，咽干口燥，法当急下；此热已发出太阳，则少阴空虚，若下之伤阴，则小便不利，而直视失溲，则气亦脱矣。若未汗下而被火攻的，外火助内热，熏蒸而发黄；严重的则火邪扰心如惊痫，肝风炽甚而抽搐，都是坏象。若只火熏的，一次误治尚可引日苟延；若既汗又下而再误治的，更促其命期。
服桂枝汤，大汗出后，大烦渴不解，脉洪大的，白虎加人参汤主治。
柳宝诒按语：桂枝汤治疗风邪伤卫，表病而里和的，用得恰当，则微汗而解。这里则是温邪自内而发，误用桂枝，恰好助邪而耗液，所以大汗大渴，热势转甚。主治用白虎，所以泄热解烦；因阴液被劫，所以加人参以救之。
太阳与少阳合病，自下利的，与黄芩汤；如果呕吐的，黄芩加半夏生姜汤主治。
张路玉说：黄芩汤，是温病的主方，即桂枝汤以黄芩易桂枝去生姜而成。盖桂枝主在表风寒，黄芩主在里风热；其生姜辛散，非温热所宜，所以去掉。
周禹载说：明言太少二阳，为何不用二经药，因为不是伤寒的缘故。何以知道不是伤寒，因为不恶寒而即热，不得谓之伤寒。何以云太少二阳，因为或胁满，或头痛，或口苦引饮，都是二经证候。果系伤寒合病，应见表证；现在不但无表，且有下利里证。如果说伤寒协热下利，必自传经来，不如这般的即利。大概温邪内郁已久，中气不足的，岂能一时尽泄于外，其下走而作利，也是自然之势。
王梦隐说：少阳胆木，挟火被猖；呕是上冲，利由下迫；何必中虚始利，饮聚而呕乎。半夏、生姜，专开饮结；如其热炽，宜易连、茹（黄连、竹茹）。
周禹载说：温病至三阳合病，其邪热溷实可知，所以脉浮大。意邪在少阴，尺脉已大，现在由内达外，而浮大见于关上，所以说上关上。然而脉虽见于阳位，而少阴之源未清，所以欲眠仍见少阴证，而盗汗又是少阳证。太阳脉浮，阳明脉大，而关上是少阳部位，所以三阳合病。
柳宝诒按语：春温所以异于热病的，因为目合则汗，不像热病的大汗不止。
杨素园说：这一条与发汗已身灼热之风温，初是一串，初起为此病，误汗则为风温。
按语：这一条治法，缪仲淳拟用百合一两，麦冬五钱，知母、花粉、白芍各二钱，鳖甲三钱，炙甘草一钱，竹叶五十片。
《金匮要略》说：温疟者，其脉如平，身无寒但热，骨节疼烦，时呕，白虎加桂枝汤主治。
尤拙吾说：这与《内经》论疟文不同。《内经》论其因，此详其脉与证。瘅疟、温疟俱无寒但热，俱呕，而其因不同。瘅疟者，肺素有热，而外加感冒，为表寒里热之证；缘阴气内虚，不能与阳相争，所以不作寒。温疟者，邪气内伏少阴，至春夏而发，为伏气外出之证；寒蓄久而变热，所以也不作寒。脉如平的，病非外感，所以脉如平时。骨节疼烦、时呕的，热从少阴而出，舍于肾之所合，而上并于阳明。白虎甘寒除热，桂枝则因势而利导之耳。
王梦隐说：喻氏说张仲景论疟，既云弦数者多热，而复申一义曰，弦数者风发；可见多热不已，必至耗液生风，木来侮土，传其热于胃。此非可徒求之药，须以饮食消息，止其炽热，如梨汁、蔗浆之类，以止渴生津，正合《内经》风淫于内，治以甘寒的宗旨。
《伤寒论》说：阳明病，脉浮而紧，咽燥口苦，腹满而喘，发热汗出，不恶寒反恶热，身重。如果发汗，则躁，心愦愦（心中烦乱），反谵语。如果加烧针，必怵惕烦躁，不得眠。如果下之，则胃中空虚，客气动膈，心下懊憹。舌上苔的，栀子豉汤主治。如果脉浮发热，渴欲饮水，小便不利的，猪苓汤主治。
周禹载说：浮紧，是伤寒脉，何以为热病？因为它发于夏，不恶寒反恶热。又何以独言阳明？因为夏时湿热上蒸，邪从胃发，且腹满而喘，种种皆是阳明证。然而咽燥口苦，不是少阴证吗？不知阳明为从出之途，少阴其伏藏之地，所以证或兼见。夫既阳明热病，曷又为脉反浮紧？正因浮甚有力，热邪盛而致。若不知者，以辛热汗之，耗其津液，必至躁妄昏昧；火劫温针，燥其阴血，必至惊扰无寐；下之而伤其阴，必至胃虚邪陷，心中懊憹；这都是误治所致，将何以救之？观舌苔滑的，则外邪尚在，以栀子解热，香豉去邪，是为合法。若渴欲饮水，口干舌燥，知热邪大伤津液，所以以白虎汤解热；加人参的，以益元气。若紧脉去而浮在，发热饮水，小便不利，则其热已入膀胱，所以以猪苓消热除渴。伤寒的小便不利，结于气分；热病的小便不利，由于血分。邪郁既深，耗液日久，所以必以阿胶补血，滑石祛热：无取于白术。
阳明病，汗出多而渴的，不可与猪苓汤，因为汗多胃中燥。猪苓汤复利其小便的缘故。
周禹载说：渴而小便不利，本当用猪苓汤，然汗多在所禁也。这与伤寒入腑，不令溲数同意。盖邪出阳明，已劫其津，汗出复多，更耗其液，津液几何，更可下夺耶？当以白虎加人参去其热，则小便之不利者，津回而自利。
三阳合病，腹满身重，难以转侧，口不仁而面垢，谵语遗溺。发汗则谵语；下之则额上生汗，手足逆冷。如果自汗出的，白虎汤主治。（王士雄按：发汗则谵语，下似脱一“甚”字。）
章虚谷说：这一条邪热更重，弥漫三阳，而致腹满身重，难以转侧。口不仁的，不知味。由胃中浊壅熏蒸，所以又面垢。热甚神昏：则谵语遗溺。若未经误治，而自汗出的，主以白虎汤（王士雄按：仲淳说，宜加百合）。此为倒装文法，谓非误发其汗之汗，故名自汗出（王士雄按：尤在泾说，若自汗出句，顶腹满身重四句来）。若误发其汗，而致谵语（王士雄按：白虎加人参汤或可救）；或下之，额上生汗的，是绝汗。手足逆冷，阳气将亡，即所谓再逆促命期，非白虎所可治。
Chapter: Ping Mai Fa (Methods of Pulse Diagnosis) in the Treatise on Cold Damage records: The Master said, "Disease caused by latent qi can be anticipated through careful observation. Within this month, there may be latent pathogenic factors. If one originally harbors latent pathogenic factors, pulse diagnosis is necessary. If the pulse is faint and weak, the patient will experience throat pain as if injured, but this is not Hou Bi (sore throat with redness, swelling, and ulceration). The patient states, 'Indeed, there is severe pain in the throat.' Even so, diarrhea is now desired."
Liu Baozhi's commentary: When warm pathogens transform into heat and move internally, the pulse should be rapid and large. The appearance of a faint and weak pulse here indicates that righteous qi is too weak to expel the pathogen, resulting in a picture of pathogenic stagnation without external release. Heat failing to reach the exterior floats upward along the meridians, causing throat pain, because the Shaoyin meridian traverses the throat. In the Treatise on Cold Damage, the clauses regarding Shaoyin disease originally include symptoms of diarrhea and throat pain, which share this same principle. Generally, prolonged heat stagnation corrupts yin fluids; thus, not only does throat pain occur, but diarrhea also arises.
I further comment: This clause serves as evidence for warm pathogens lying latent within the Shaoyin meridian.
Zhang Xugu stated: Observing Zhang Zhongjing's labeling of pulses for wind-stroke, cold damage, summer-heat, etc., they align with the Classic of Difficult Issues (Nan Jing). Only the Nan Jing states that the pulse of warm diseases travels through various meridians, making it unclear which specific meridian is activated. This implies that initially, warm pathogens follow the circulation of qi and blood through the meridians; upon manifestation, it is unknown from which meridian they emerge, as their onset has no fixed location, hence no fixed pulse pattern can be identified. Now, Zhang Zhongjing teaches examining the pulse to distinguish the meridian of pathogenic activation: for instance, a faint and weak pulse indicates the pathogen has not left the Shaoyin, moving up and down with the meridian, inevitably presenting with throat pain and diarrhea, perfectly corroborating the Nan Jing. The following text discusses pathogens emerging into the Three Yang, where heat intensity peaks and the pulse becomes floating and large, extending to the Guan position; this demonstrates that the pulse changes with the syndrome, and the syndrome manifests through the pulse. Since there is no fixed pulse at the onset, the Nan Jing does not specify pulse images. Thus, compared to exogenous pathogens with fixed syndromes and pulses, these are indeed distinct.
Shaoyin disease (characterized by a faint and fine pulse and a desire to sleep), appearing two to three days after onset, with throat pain, may be treated with Gancao Tang (Licorice Decoction); if unrelieved, Jiegeng Tang (Platycodon Decoction) is given.
Zhang Xugu commented: For throat pain caused by wind-cold externally closing the Shaoyin, Zhang Zhongjing used Banxia San (Pinellia Powder), employing acrid-warm methods to open and drain. Here, however, latent heat within the Shaoyin flares up internally, burning along the meridian to cause throat pain. Although acrid-warm opening methods are unsuitable, cooling medicines should also be avoided to prevent suppressing the pathogen's outward movement. Therefore, only Gancao (Licorice Root), a sweet and緩 (moderating) herb, is used to guide the pathogen outward; raw usage also clears fire. If unrelieved, it indicates fire stagnation preventing exit; adding Jiegeng (Platycodon Root) opens lung qi, stopping pain naturally. Cold damage proceeds from exterior to interior, starting with Taiyang then reaching Shaoyin; warm diseases proceed from interior to exterior, starting with Shaoyin then emerging to Taiyang.
Shen Zonggan stated: Diseases caused by latent qi develop from inside out, not limited to Spring-Warmth (Chun Wen). Essentially, qi of all four seasons can lie latent and erupt later; this must be understood.
Shaoyin disease presenting with diarrhea, throat pain, chest fullness, and vexation is primarily treated with Zhufu Tang (Donkey-Hide Skin Decoction).
Zhang Luyu commented: Although the disease originates in a Yin meridian, it is essentially a heat syndrome. Diarrhea, throat pain, chest fullness, and vexation indicate pathogenic heat filling everywhere above, below, and in between. Since cold-purgative methods are inappropriate, Zhufu Tang was established to moisten Shaoyin dryness, similar in intent to using black donkey hide. For deficient yang, Fuzi (Aconite Root) warms the meridians; for exhausted yin, Zhufu (Donkey-Hide Skin) moistens dryness; both possess the intent of dispersing pathogens. Comparing them yields significant insight.
Shaoyin disease, persisting for more than two or three days, with mental vexation and inability to lie down, is primarily treated by Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction).
Zhou Yuzai commented: Before latent pathogens manifest, body fluids have already been secretly consumed. After two or three days, although yin-fire does not rise and symptoms like throat pain are absent, mental vexation and insomnia indicate yin fluid depletion. Thus, Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome) clear heat, while Ejiao (Donkey-Hide Gelatin) and Baishao (White Peony Root) nourish yin, treating both deficiency and excess.
Liu Baozhi's commentary: The above three Shaoyin disease clauses do not conform to transmitted heat pathogens; they are undoubtedly caused by latent pathogens.
Shaoyin disease presenting with diarrhea for six or seven days, accompanied by cough, vomiting, thirst, mental vexation, and insomnia, is primarily treated by Zhuling Tang (Polyporus Decoction).
Zhang Xugu commented: Diarrhea lasting six or seven days indicates heat sinking downward without external penetration. Rebelliously affecting the lungs causes cough and vomiting; invading the heart causes vexation, thirst, and insomnia, because both the Heart and Lung connect to the Shaoyin meridian. Zhuling Tang is used to promote urination and nourish yin; nourishing yin allows heat to depart with urination, and promoting urination stops diarrhea, resolving vexation and thirst.
Shaoyin disease, appearing two or three days after onset, with dry mouth and throat, requires urgent purgation, preferably using Dachengqi Tang (Major Order the Qi Decoction).
Zhang Luyu commented: Latent qi erupting in Shaoyin has the most urgent progression, differing from transmitted heat in cold damage. Dry mouth and throat appearing merely two or three days after onset, if delayed until five or six days for purgation, would lead to extreme withering. Hence, urgent purgation is needed to save the roasting Kidney water. Regarding the three urgent purgation clauses for Shaoyin: one belongs to extreme transmitted heat, one to heat transferring to the Stomach Fu, and one to warm-heat originating in Shaoyin; all are critical emergencies requiring immediate rescue of nearly exhausted Kidney water, sharing the same origin but different branches with the three urgent purgation methods of Yangming.
Liu Baozhi's commentary: This is undoubtedly latent qi. If it were transmitted heat, counting from the initial illness, it would not present so early; if counting from transmission to Shaoyin, dry mouth and throat would not appear so suddenly.
Taiyang disease presenting with fever, thirst, and aversion to cold being absent is defined as Warm Disease (Wen Bing).
Wang Andao stated: If warm disease presents thus, heat disease is the same. Therefore, absence of thirst with aversion to cold indicates it is not a warm-heat disease. If warm-heat disease presents with aversion to wind or cold, it is due to new invasion of wind-cold superimposed on existing conditions.
Shen Yaofeng commented: Although this clause mentions no pulse, comparing it with subsequent clauses, the Chi (Cun-Kuan-Guan-Chi) position must be floating.
Zhang Xugu commented: Warm disease onset has no fixed location. The exterior of Shaoyin is Taiyang; when heat pathogens emerge from interior to exterior, Taiyang disease symptoms like fever and headache appear. Absence of aversion to cold confirms it is not a new contraction. Thirst arises from internal heat generation. Zhang Zhongjing feared misdiagnosis as Taiyang cold-damage or wind-strike, hence specifically labeling it as warm disease caused by internal latent heat. The omission of labeling Shaoyin warm disease is because the latent qi clauses already clarified throat pain and diarrhea as initial Shaoyin warm disease manifestations.
Wang Mengyin cited Wang Xiecheng: Wu Juztong's *Treatise on Warm Diseases* (Wenbing Tiaobian), Upper Jiao Chapter, quotes the *Treatise on Cold Damage*: "Taiyang disease, characterized by aversion only to heat, no aversion to cold, and thirst, is named Warm Disease, treated with Guizhi Tang (Cinnamon Twig Decoction)."
However, checking the *Treatise on Cold Damage*, these words are absent. If truly from Zhang Zhongjing, textual errors should be辨析 (analyzed). If Wu Juztong misremembered, correction is essential. I believe it is not a misremembering. Yu Jia Yan once stated that Zhang Zhongjing used Guizhi Tang for all exterior treatments of warm syndromes to indicate slight sweating without excessive diaphoresis. You Zai Jing's *Reading Records* argues this is Yu's speculation, not Zhang's original doctrine. Wu Juztong claimed to transcend cold damage frameworks yet fell into Yu's trap, unwilling to be inferior, thus arbitrarily altering texts, presenting them as sage teachings, unwittingly insulting sages and misleading the world.
If after inducing sweating, the body becomes scorching hot, it is named Wind-Warmth (Feng Wen). Wind-Warmth presents with floating pulses at both Yin and Yang positions, spontaneous sweating, heaviness of the body with excessive drowsiness, snoring breath, and difficulty speaking.
If mistakenly treated with purgatives, urination becomes difficult, eyes stare fixedly, and incontinence occurs. If mistakenly treated with fire therapy, mild cases show yellowing; severe cases resemble convulsions or epilepsy with periodic spasms. Fire fumigation: one error may prolong life slightly; a second error accelerates death.
Zhang Xugu commented: For Taiyang exogenous pathogens, sweating should resolve fever and cool the body. Here, heat originates from Shaoyin; clearing heat is correct, but mistaken sweating damages fluids and qi, aiding pathogen strength, causing scorching heat and stirring Liver Wind, agitating warm pathogens—hence named Wind-Warmth. Pathogenesis involves floating deficient yang and overflowing heat, causing floating pulses at Yin and Yang positions; fluid loss causes continuous sweating; qi deficiency and spirit confusion cause body heaviness and drowsiness; internal wind movement obstructs orifices, causing snoring and speech difficulty, proving it is not exogenous wind. Mistaken purgation refers to cases not previously sweated, not purging after sweating. Mistaken fire劫 (coercion): mild cases damage Ying-Qi with heat, causing blood stasis and yellowing; severe cases generate wind from intense heat, causing convulsions. Generally, pathogens latent in Shaoyin burn water and dry fluids, requiring urgent purgation; once heat emerges to Taiyang, Shaoyin is empty. Purgation injuring yin leads to difficult urination, staring, and incontinence, indicating qi collapse. Fire attack before sweating/purging adds external fire to internal heat, causing yellowing; severe cases involve heart disturbance resembling epilepsy and intense Liver wind spasms—all bad omens. Fire fumigation alone might prolong life slightly after one error; sweating, purging, and another error accelerate death.
After taking Guizhi Tang, if heavy sweating ensues followed by unresolved severe vexation and thirst with a洪大 (surging-large) pulse, Baihu Jia Renshen Tang (White Tiger plus Ginseng Decoction) is indicated.
Liu Baozhi's commentary: Guizhi Tang treats wind damaging Wei (Defensive) level, suitable for exterior pathology with interior harmony, inducing slight sweat for resolution. Here, warm pathogens originate internally; mistaken use of Guizhi aids pathogens and consumes fluids, causing heavy sweating, severe thirst, and intensified heat. Baihu (White Tiger) clears heat and relieves vexation; Ren Shen (Ginseng Root) rescues depleted yin fluids.
Taiyang and Shaoyang combined disease presenting with spontaneous diarrhea is treated with Huangqin Tang (Scutellaria Decoction); if vomiting occurs, Huangqin Jia Banxia Shengjiang Tang (Scutellaria plus Pinellia and Fresh Ginger Decoction) is used.
Zhang Luyu commented: Huangqin Tang is the main formula for warm diseases, derived from Guizhi Tang by replacing Guizhi with Huangqin and removing Shengjiang. Guizhi addresses exterior wind-cold; Huangqin addresses interior wind-heat; Shengjiang's acrid dispersion is unsuitable for warm-heat, hence removed.
Zhou Yuzai commented: Explicitly mentioning Taiyang and Shaoyang, why not use herbs for both meridians? Because it is not cold damage. How do we know? Lack of aversion to cold and immediate heat rule out cold damage. Why mention Taiyang and Shaoyang? Symptoms like hypochondriac fullness, headache, or bitter taste with thirst belong to these meridians. True combined cold damage should show exterior signs; here, lacking exterior signs but having diarrhea indicates interior pathology. Unlike cold damage with heat-associated diarrhea arising from transmission, this diarrhea occurs immediately. Prolonged internal stagnation of warm pathogens in those with insufficient Middle Qi cannot fully vent externally; downward flow causing diarrhea is a natural progression.
Wang Mengyin commented: Shaoyang Gallbladder Wood, carrying fire, runs rampant; vomiting is upward rebellion, diarrhea is downward pressure. Why assume Middle Deficiency causes diarrhea or fluid accumulation causes vomiting? Banxia and Shengjiang open fluid knots; if heat is intense, replace with Lian (Huanglian) and Ru (Zhuru/Bamboo Shavings).
Combined disease of the Three Yang, with floating and large pulse extending to the Guan position, drowsiness, and sweating upon closing eyes.
Zhou Yuzai commented: At combined disease of Three Yang, pathogenic heat is turbid and solid, hence floating and large pulse. Originally, Shaoyin disease shows large Chi pulse; now emerging from interior to exterior, floating and large pulse appears at Guan, hence "extending to Guan." Although pulse appears in Yang positions, Shaoyin root remains uncleared; drowsiness reflects Shaoyin syndrome, while night sweats reflect Shaoyang syndrome. Taiyang pulse is floating, Yangming pulse is large, and Guan is Shaoyang position, hence combined disease of Three Yang.
Liu Baozhi's commentary: Spring-Warmth differs from heat disease because sweating occurs only upon closing eyes, unlike the continuous profuse sweating of heat disease.
Yang Suyuan commented: This clause connects with Wind-Warmth (scorching heat after sweating); initially this disease, mistaken sweating leads to Wind-Warmth.
Commentary: Treatment proposed by Miu Zhongchun uses Baihe (Lily Bulb) 1 liang, Maidong (Ophiopogon Tuber) 5 qian, Zimu (Anemarrhena Rhizome), Huafen (Trichosanthes Root) Baishao (White Peony Root) each 2 qian, Biejia (Turtle Shell) 3 qian, Zhigancao (Prepared Licorice Root) 1 qian, Zhuye (Bamboo Leaf) 50 pieces.
*Jingui Yaolue* states: Warm Malaria presents with normal-like pulse, no chills but only fever, painful joints, occasional vomiting, treated with Baihu Jia Guizhi Tang (White Tiger plus Cinnamon Twig Decoction).
You Zhuowu commented: This differs from *Neijing* discussions on malaria. *Neijing* explains etiology; this details pulse and symptoms. Dan Malaria and Warm Malaria both lack chills, featuring only fever and vomiting, but etiologies differ. Dan Malaria stems from pre-existing Lung heat compounded by external cold, creating exterior cold-interior heat syndrome; internal Yin deficiency prevents struggle with Yang, hence no chills. Warm Malaria involves pathogens latent in Shaoyin, erupting in Spring/Summer as latent qi moving outward; accumulated cold transforms into heat, hence no chills. Pulse like normal indicates non-exogenous origin. Painful joints and vomiting indicate heat emerging from Shaoyin, settling in Kidney's paired organ, and merging upward with Yangming. Baihu's sweet-cold clears heat; Guizhi guides pathogen according to momentum.
Wang Mengyin commented: Yu Shi stated Zhang Zhongjing's discussion on malaria notes string-rapid pulses indicate much heat, further explaining string-rapid implies wind generation; persistent heat consumes fluids generating wind, Wood insults Earth, transmitting heat to Stomach. This cannot be treated solely with medicine; dietary management is needed to curb intense heat, such as pear juice or sugarcane syrup, to quench thirst and generate fluids, aligning with *Neijing*'s principle: treat internal wind with sweet-cold.
*Treatise on Cold Damage* states: Yangming disease, with floating-tight pulse, dry throat, bitter taste, abdominal fullness, panting, fever, sweating, no aversion to cold but aversion to heat, and body heaviness. If sweated, restlessness, mental confusion, and delirium occur. If fire needles added, fright, irritability, and insomnia result. If purged, stomach empties, rebellious qi moves diaphragm, causing chest discomfort. With tongue coating, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is indicated. If pulse is floating with fever, thirst for water, and difficult urination, Zhuling Tang is indicated.
Zhou Yuzai commented: Floating-tight is cold damage pulse; why heat disease? Onset in Summer, no aversion to cold but aversion to heat. Why focus on Yangming? Summer damp-heat steams upward, pathogens originate from Stomach; abdominal fullness and panting are Yangming symptoms. Yet dry throat/bitter taste suggests Shaoyin? Yangming is the exit path, Shaoyin the storage site, hence combined symptoms. Why floating-tight in Yangming heat? Strong floating force indicates intense heat. Ignorance leads to acrid-warm sweating, consuming fluids, causing madness; fire-coercion dries Yin-blood, causing panic insomnia; purging injures Yin, causing stomach deficiency and pathogen sinking, chest discomfort; all result from mistreatment. How to rescue? Sliding tongue coating indicates lingering exterior pathogen; Zhizi clears heat, Chidao removes pathogen—correct method. Thirst for water, dry mouth/tongue indicates major fluid injury; Baihu Tang clears heat, Ren Shen boosts Yuan Qi. If tight pulse vanishes leaving floating, with fever/thirst/difficult urination, heat enters Bladder; Zhuling clears heat and thirst. Cold damage difficult urination stems from Qi level; heat disease difficult urination stems from Blood level. Deep stagnation and long-term fluid consumption require Ejiao (nourishing blood) and Huashi (clearing heat); Baizhu is unnecessary.
Shen Yaofeng commented: Before mistreatment, Baihu Tang was the primary indication.
Yangming disease with profuse sweating and thirst contraindicates Zhuling Tang, as profuse sweating causes Stomach dryness; Zhuling Tang further promotes urination.
Zhou Yuzai commented: Thirst with difficult urination warrants Zhuling Tang, but profuse sweating is a contraindication. This aligns with cold damage entering Fu organs prohibiting frequent urination. Pathogens exiting Yangming have already劫 (robbed) fluids; profuse sweating further depletes them. How much fluid remains for further loss? Use Baihu Jia Renshen to clear heat; as fluids return, urination normalizes.
Combined disease of Three Yang, with abdominal fullness, body heaviness, difficulty turning, insensitivity of mouth, facial grease, delirium, and urinary incontinence. Sweating causes delirium; purging causes sweating on forehead and cold extremities. If spontaneous sweating occurs, Baihu Tang (White Tiger Decoction) is indicated. (Wang Shizhong notes: "Sweating causes delirium" likely misses a "severe" character before purging.)
Zhang Xugu commented: This clause indicates heavier heat pervading Three Yang, causing abdominal fullness, body heaviness, and immobility. Insensitivity of mouth means loss of taste; turbid stagnation in Stomach steaming causes facial grease. Intense heat causing spirit confusion leads to delirium and incontinence. Without mistreatment, spontaneous sweating indicates Baihu Tang (Wang Shizhong notes: Zhongchun suggested adding Baihe). This is inverted syntax, meaning "spontaneous sweating" distinguishes it from mistaken sweating. If mistakenly sweated, delirium results (Wang Shizhong notes: Baihu Jia Renshen Tang might rescue); if purged, forehead sweating indicates绝汗 (terminal sweat). Cold extremities indicate impending Yang collapse, termed "second error accelerates death," untreatable by Baihu.