注《伤寒》者无虑数十家，皆以为专论伤寒之书，故恒支离附会，不适于用。公指出为统论外感之书，觉
《伤寒论》之全体俱现，此与尧封之见相同者。
风伤卫证全似伤寒，但时时自汗而脉浮缓。误治亦有变证，若不治则历半月或一月仍系本证，不见传变，
投以轻剂桂枝汤，即汗敛而愈。后世所称伤风证，与伤寒大异。其见证则咳嗽头疼，鼻流清涕。徐洄溪论之极
详，此证并不自汗，与桂枝毫无干涉。风温证则其人初无所苦，不过昏沉欲睡耳。初起颇似伤寒之少阴欲寐证，
但脉不沉细而浮洪为异。误汗则大睡不醒而死；服辛热药与苦寒药俱若罔知，然亦必死，惟甘寒轻透之品始能
愈之。此三证名虽相似而证实悬殊，医书恒互相牵引，苦难别白，总由未经身历，故言之不能亲切耳。今公以
风寒属桂枝证，而以风热属伤风与风温证，眼光高前人多矣。
虚损之病，多由阴虚，其证无不潮热咳嗽、吐红食减、脉来细数者。治法固以滋阴清热为主，然滋而不滞，
清而不寒，且时时兼顾脾胃，方不犯手。但得脉象日和，饮食渐增，即是生机。至阴气已充，可以用参、 时，
而其病已愈矣。从古医书专重扶阳，每云不服参、 者不治，脉细数者不治。不知能服参、 之证，愈之甚易，
固不劳诸公之畅发高论也。至阴虚而脉细数，误投参、 则阴竭而死，故古人皆谓为不治，然调
治得法，亦有生者，未可尽诿为不治也。公拈出“阴液难充”四字，令人恍然悟其治法，识力非古人所及。然
如立斋、景岳辈，亦有补阴之论，特专任重浊腻滞之品，枢机愈窒，去生愈远，使人愈信扶阳之说为不诬，而
虚损之证遂万无愈理。故余恒折服孟英之用药灵通活变，为此道独开生面。今读此编，乃知其渊源之有自也。
《伤寒论》之除中，乃大病后元气伤残，故主死。若平人忽见此证，乃胃火炽盛耗其津液，大剂甘寒滋润
即愈。公论三消以“火燔其液，风耗其津”二语括之，固属不磨之论，然余谓病机由此者甚多，公此二语固不
徒为三消之指南也。
血因火溢，是其常也，气不摄血，是其变也。苟不知其常，侈谈其变，是为乱道。公此数语说尽千古着书
通病。如滞下本属湿热，而亦间有虚寒，疫病本属秽邪，而亦间有体虚不能托邪外出，吞酸本属木火犯胃，而
亦间有胃寒不化∶如此之类，指不胜屈。着书者不先明本证，反将间有之证反复议论，认宾作主，使读者尽入
迷途，安得公一一辟其弊耶！
沈明生所治之证，虽非虚劳，然脉至如丝，阴已困乏，奈何复以参、 、桂、附蹙之，迨用硝、黄而始愈
，则非治病乃治药矣。此证误而易复，虚损误则难挽。以公前后所论合参之，可以知所取法矣。
仲醇一代名医，而滞腻误投，尚令病留不去，若误投于虚损之证，何以救之？然非公具过人之识，明白指
示，则世人震于盛名，孰知腻滞重浊之非宜，而甘凉养胃之当用乎？古案中此类甚多，苟不善读之，未有不覆
辙相寻者也。
魏柳洲善于滋阴，而论喉闭一证与景岳同失，真可谓人左枉而我右枉矣。叶氏识力超卓，洵属独胜，得公
辨别，其证愈
明，后有患者，庶免夭枉。又魏君论喻氏治郭台尹单腹胀，以为系水亏木旺，乘其所不胜之脾而成胀，窥其意
亦欲以滋阴治之，余亦未敢以为信然也。
滋补丸药，最难消化，从古无人道及。得公指明，喜服丸药者可以戒矣。孟英于宜补之药，每令熬膏，以
对证之药收之成丸，使其易化，真善承家学人哉。
薛一瓢为昭代良医，而其治病处方，均未流传，识者憾之。公录存二方，具有理致，真足嘉惠后学。
本草以《本经疏证》为第一善本，其援引浩繁，穿穴精透，可谓空前绝后，第文笔沉晦，较卢氏《半偈》
为尤甚，读者苦之。公所疏数十种，精切不让邹氏，而显豁过之。学人由此以进窥邹氏之书，或可免望洋之叹。
人与物皆有胰，医书未有及之者。王勋臣亲验脏腑，亦未论及。西士名曰甜肉，言其味甜而不言其功用，
反以胃中化物之功归诸胆汁，此亦未可尽信者。又云西国曾验一人，见饮食入胃，胃出甜汁以化之。此即万物
归土之义，正胰之功用也。公于豕脑条内言胰主运化食物，正与西士所验相合。若果系胆汁入胃，则其汁应苦
矣。此亦西士疏漏之一端也。
赵恕轩《纲目拾遗》辨李氏之缺谬，最为精当。公摄其精华，附诸此编，所余者皆糟粕也，读者不必生不
见全书之憾。
格物之学，最为医家要务。凡物性之相制、相使、相宜、相忌，与其力量之刚柔长短，皆宜随时体验，然
后用之无误。公所疏解毒之品与物性之宜，真可以御仓卒而益神智，学人宜谨识之。
西士诸书与王勋臣《医林改错》，皆医家必不可少之书，而其言脏腑之功用与气机之流行，则不能无弊。
即如切脉一端，无论其为气管为血管，若如所论，则与脏腑了不相关，理应强则俱强，弱则俱弱，何以六部之脉参差不
齐，悉与病机相应？可见目稽与悬揣，虚实固自有辨。公之言曰∶“信其可信，阙其可疑”，是皮里春秋读法，
余谓真可为读一切书之法。至亚枝、次瑶诸君子，畅发公未言之意，议论奇伟，余读之又不觉首之至地矣。
四诊之法，以切居末，见脉之不可独恃也。举世医家专言切脉，不惟大言欺人，实卤莽从事耳。而公反复
推勘，皆亲切体验之言，非医书泛泛铺张者可比。业此者潜心玩索，临证庶有把握，真此道中度人经也。
以上诸条谨就管见所及，随笔附记，以志景仰。其实公之所论，触目皆精金粹玉，学人潜心玩索，自能增
长识力，殊非后生末学之所能铺陈盛美也。
中山后学杨照藜谨识
注释《伤寒论》的学者多达数十家，都把它当作专门论述伤寒的书，因此往往牵强附会、支离破碎，不适用于临床实际。叶天士（注：此处“公”指孟英，即王孟英，但原文语境似在评价前人观点或特定医家，结合后文“孟英之用药”，此处“公”应指王孟英本人或其推崇的观点，但根据“尧封之见相同”，尧封是杨照藜的字，故此处“公”指王孟英）指出这是统论外感病的书，使得《伤寒论》的全貌得以显现，这与杨尧封的看法是一致的。
风邪伤卫分的证候与伤寒非常相似，只是时常自汗且脉象浮缓。误治也会产生变证，如果不治疗，经过半个月或一个月仍然保持原证，不会发生传变，投以轻剂的桂枝汤，汗止而痊愈。后世所说的伤风证，与伤寒大不相同。其表现为咳嗽、头痛、流清鼻涕。徐灵胎对此论述得非常详细，此证并不自汗，与桂枝汤毫无关系。风温证则患者起初没有痛苦，只是昏沉想睡而已。初起颇像伤寒少阴病的欲寐证，但脉象不沉细而是浮洪，这是不同之处。误用发汗法会导致深度睡眠不醒而死；服用辛热药或苦寒药也都无反应，但也必死无疑，只有甘寒轻透的药物才能治愈。这三种证候名称虽相似但病情实质相差悬殊，医书常常互相引用混淆，难以辨别清楚，总归是因为医生未曾亲身经历，所以讲起来不能切中要害。如今王孟英将风寒归属于桂枝汤证，而将风热归属于伤风与风温证，眼光比前人多得多。
虚损的病，多由阴虚引起，其症状无不表现为潮热、咳嗽、吐血、食欲减退、脉象细数。治疗方法固然以滋阴清热为主，但要滋而不腻滞，清而不寒凉，并且时时兼顾脾胃，才不会犯错误。只要脉象变得柔和，饮食逐渐增加，就是生机。等到阴气已经充足，可以用人参、黄芪时，病也就痊愈了。从古以来的医书特别重视扶阳，常说不服用人参、黄芪的就无法救治，脉象细数的就无法救治。却不知道能服用人参、黄芪的证候，治愈很容易，确实不需要各位先生大发高论。至于阴虚而脉象细数，如果误投人参、黄芪，就会导致阴液枯竭而死，所以古人都说这是不治之症，然而如果调治得当，也有存活的可能，不能完全推诿为不治之症。王孟英提出“阴液难充”四个字，让人恍然大悟其治疗方法，见识和力量不是古人所能比的。然而像薛立斋、张景岳等人，也有补阴的论述，只是专门重用厚重、油腻、滞涩的药物，导致气机更加闭塞，离生命越来越远，使人更加相信扶阳的说法是正确的，从而认为虚损之证完全没有治愈的道理。所以我常常佩服王孟英用药灵活多变，为此道开辟了新的局面。今天读这篇文字，才知道他的学术渊源是有来历的。
《伤寒论》中的除中证，是大病之后元气受损，所以主死。如果是普通人突然见此证，则是胃火炽盛耗伤津液，用大剂量的甘寒滋润药物即可痊愈。王孟英论述三消症用“火燔其液，风耗其津”两句话概括它，确实是不朽的言论，然而我认为由此引起的病机非常多，他这两句话不仅仅是三消症的指南。
血液因火热而溢出，是正常的情况；气不能统摄血液，是异常情况。如果不知道正常情况，却大肆谈论异常情况，那就是乱说。王孟英这几句话说尽了千古以来著书的通病。比如痢疾本属于湿热，但也间或有虚寒的情况；疫病本属于秽浊邪气，但也间或有体质虚弱不能托举邪气外出的情况；吞酸本属于肝木之火侵犯胃腑，但也间或有胃寒不能消化的情况：如此之类，数不胜数。著书的人不明确主要证候，反而对偶尔出现的证候反复议论，认客为主，使读者全部陷入迷途，幸好有王孟英一一揭露这些弊端！
沈明生治疗的病例，虽然不是虚劳，但脉象细如丝线，阴气已经困乏，为什么还要用人参、黄芪、桂枝、附子来逼迫它，等到用了芒硝、大黄才痊愈，这已经不是治病而是治药了。这个病例误治后容易恢复，虚损之证误治则难以挽回。结合王孟英前后的论述来参考，可以知道取法的原则了。
仲醇是一代名医，但因为误投了滞腻的药物，导致病邪滞留不去，如果误投于虚损之证，怎么救得了呢？然而如果不是王孟英具有过人的见识，明确指示，那么世人震惊于他的盛名，谁知道厚重滞腻的药物是不适宜的，而甘凉养胃的药物才是应当使用的呢？古代医案中这类情况很多，如果不善于阅读它们，没有不重蹈覆辙的。
魏柳洲善于滋阴，但在论述喉闭这一证候上与张景岳犯了同样的错误，真可以说是左边歪斜右边也歪斜。叶天士见识卓越，确实独胜一筹，得到王孟英的辨别，这个证候更加明确，以后的患者，或许可以避免早夭枉死。另外魏君论述喻嘉言治疗郭台尹的单腹胀，认为是水亏木旺，乘其所不胜的脾土而成胀，窥探他的意思也是想用滋阴的方法治疗，我也不敢完全相信。
滋补丸药，最难消化，从古以来没有人提到过。得到王孟英指明，喜欢服用丸药的人可以警戒了。王孟英对于适宜滋补的药物，每令熬成膏，将对证的药物收制成丸，使其容易消化，真是善于继承家学的人啊。
薛一瓢是当代良医，但他治病处方，都没有流传下来，有识之士感到遗憾。王孟英收录保存了两个方子，具有理趣，真正足以嘉惠后学。
本草书中以《本经疏证》为第一善本，其援引浩繁，穿凿精透，可谓空前绝后，只是文笔深沉晦涩，比卢氏的《半偈录》更为严重，读者以此为苦。王孟英所疏解的几十种药物，精切不亚于邹氏，而显豁超过它。学习的人由此进而窥探邹氏的书，或许可以避免望洋兴叹。
人与动物都有胰脏，医书中没有提及的。王勋臣亲自验证脏腑，也没有论及。西方人称之为甜肉，说它味道甜而不说它的功用，反而把胃中消化食物的功能归于胆汁，这也不可全信。又说西方国家曾检验一个人，看见食物进入胃，胃分泌甜汁来消化它。这就是万物归土的含义，正是胰脏的功用。王孟英在豕脑条内说胰主运化食物，正与西方人所验证相符合。如果确实是胆汁进入胃，那么它的汁液应该是苦的。这也是西方人疏漏的一个方面。
赵恕轩的《纲目拾遗》辨驳李时珍的缺漏谬误，最为精当。王孟英摄取其精华，附在这篇编文中，剩下的都是糟粕，读者不必产生没见到全书的遗憾。
格物致知的学问，是最为医家的重要事务。凡是药性之间的相制、相使、相宜、相忌，以及力量的刚柔长短，都应当随时体验，然后使用无误。王孟英所疏解的解毒物品与药性的适宜之处，真的可以应对仓促之急并增益智慧，学习的人应该谨慎记住。
西方人的书籍与王勋臣的《医林改错》，都是医家必不可少的书，但它们关于脏腑功用的说法和气机流行的论述，则不能没有弊端。就像切脉一端，无论它是气管还是血管，如果像他们所说的那样，则与脏腑完全不相关，理应强的都强，弱的都弱，为什么六部的脉象参差不齐，都与病机相应？可见亲眼观察与凭空揣测，虚实自然有区别。王孟英说：“信其可信，阙其可疑”，这是皮里春秋的读法，我认为这真可以作为读一切书的方法。至于亚枝、次瑶诸位君子，阐发王孟英未说之意，议论奇伟，我读后又不觉低头致敬了。
四诊之法，以切脉居末位，说明脉象不可单独依赖。举世医家专言切脉，不仅是夸大欺人，实际上是鲁莽从事。而王孟英反复推敲勘验，都是亲切体验的话，不是医书中泛泛铺张的可比。从事这个行业的人潜心玩味探索，临证才有把握，真是此道中度人的经典。
以上各条谨就我所见的管见，随笔附记，以表达敬仰之情。其实王孟英所论述的，触目皆是精金粹玉，学习的人潜心玩味探索，自然能增长见识和力量，绝非后生末学所能铺陈赞美。
中山后学杨照藜谨识
Those who annotated the *Shanghan Lun* (Treatise on Cold Damage) numbered in the dozens, all regarding it as a book exclusively discussing cold damage. Consequently, they often resorted to forced interpretations and disjointed explanations, making it unsuitable for clinical application. Mr. Ye pointed out that it is a comprehensive treatise on external contraction diseases, thereby revealing the entirety of the *Shanghan Lun*. This aligns with the view of Yang Yaoli (courtesy name Yaofeng).
The syndrome of wind damaging the Wei (Defensive) level resembles cold damage closely, but is characterized by spontaneous sweating and a floating, moderate pulse. Mismanagement can lead to transformed syndromes; if left untreated, the original syndrome persists for half a month or a month without transmission. Administering a mild formula such as Guizhi Tang (Cinnamon Twig Decoction) stops the sweating and cures the patient. The so-called "wind injury" syndrome described in later generations differs significantly from cold damage. Its manifestations include cough, headache, and clear nasal discharge. Xu Lingtai discussed this syndrome in great detail; notably, this syndrome does not involve spontaneous sweating and has no relation to Guizhi Tang. The Wind-Warmth syndrome presents initially with no significant discomfort, merely a sense of lethargy and drowsiness. Early on, it somewhat resembles the Shaoyin (Lesser Yin) desire-to-sleep syndrome of cold damage, but differs in that the pulse is floating and forceful rather than deep and fine. Incorrect use of diaphoresis leads to deep coma and death; administration of acrid-warm or bitter-cold herbs yields no response, yet death is inevitable. Only sweet-cold, light-penetrating herbs can cure it. Although these three syndromes share similar names, their pathological realities are vastly different. Medical texts often cite each other confusingly, making distinction difficult. This stems from physicians' lack of personal experience, resulting in imprecise descriptions. Today, Mr. Wang Mengying categorizes Wind-Cold under Guizhi Tang syndrome, while classifying Wind-Heat under Wind Injury and Wind-Warmth syndromes, demonstrating superior insight compared to predecessors.
Deficiency consumptive diseases mostly arise from Yin deficiency. Symptoms invariably include tidal fever, cough, hemoptysis, anorexia, and a fine, rapid pulse. Treatment primarily focuses on nourishing Yin and clearing heat, but must be non-stagnating and non-chilling, while constantly attending to the Spleen and Stomach. If the pulse becomes harmonious and appetite gradually increases, there is hope for recovery. Once Yin qi is replenished, Ren Shen (Ginseng Radix) and Huang Qi (Astragali Radix) may be used, at which point the disease resolves. Ancient medical texts heavily emphasized supporting Yang, often stating that patients unable to tolerate Ren Shen and Huang Qi are incurable, as are those with fine, rapid pulses. However, cases tolerating these tonics are easily cured, rendering elaborate theories unnecessary. Conversely, in Yin deficiency with fine, rapid pulses, misusing Ren Shen and Huang Qi leads to exhaustion of Yin fluids and death. Thus, ancients deemed them incurable. Yet, with proper regulation, survival is possible; one cannot dismiss them entirely as hopeless. Mr. Wang’s emphasis on the phrase "Yin fluids are difficult to replenish" illuminates treatment strategies, showing insight surpassing the ancients. Figures like Xue Lizhai and Zhang Jingyue also advocated nourishing Yin but relied heavily on heavy, greasy, and stagnating substances, further obstructing vital mechanisms and distancing patients from life. This reinforced the belief in supporting Yang, leading many to believe consumptive diseases were incurable. I have long admired Mr. Mengying’s flexible and ingenious prescribing, which opened new paths in this field. Reading this compilation reveals the depth of his academic lineage.
The "Chu Zhong" (Elimination of the Middle) syndrome in the *Shanghan Lun* occurs after severe illness damages Yuan Qi (Original Qi), indicating a fatal prognosis. If a healthy person suddenly exhibits this, it indicates blazing Stomach fire consuming fluids, curable with large doses of sweet-cold moistening herbs. Mr. Wang summarized the pathogenesis of San Xiao (Three Thirsts) using the phrase "fire roasts fluids, wind consumes Jin-Ye," which is indeed an immortal principle. However, I believe this mechanism applies to many diseases; his words serve not only as a guide for San Xiao.
Blood overflowing due to fire is the norm; Qi failing to control blood is the variation. Ignoring the norm while discussing variations constitutes nonsense. Mr. Wang’s remarks expose a common flaw in ancient medical literature. For instance, Li Ji (Dysentery) is primarily damp-heat, though occasionally cold-deficiency exists. Epidemic diseases are primarily caused by turbid pathogens, though sometimes weak constitution fails to expel them. Sour regurgitation is mainly Liver-Fire invading the Stomach, though occasionally Stomach cold prevents digestion. Such examples are countless. Authors fail to clarify primary syndromes, instead obsessing over rare variations, mistaking the secondary for the primary, leading readers astray. Fortunately, Mr. Wang exposes these flaws.
Case treated by Shen Mingsheng: Though not a consumptive disease, the pulse was thread-like, indicating exhausted Yin. Why administer Ren Shen, Huang Qi, Gui Zhi (Cinnamon Twig), and Fu Zi (Aconite Root) to aggravate it? Recovery only occurred after using Xia Shi (Mirabilite) and Da Huang (Rhubarb Root). This was treating the medication, not the disease. While this error was reversible, errors in consumptive diseases are hard to rectify. Comparing Mr. Wang’s previous and subsequent discussions provides guidance for practice.
Zhong Chun was a renowned physician, yet his misuse of cloying and stagnating herbs allowed pathogens to linger. Had he applied this to consumptive diseases, how could he have saved the patient? Thanks to Mr. Wang’s exceptional insight and clear guidance, people realize that heavy, greasy, and turbid substances are inappropriate, while sweet-cool Stomach-nourishing herbs are indicated. Many such cases exist in ancient records; without careful study, practitioners inevitably repeat past mistakes.
Wei Liuzhou excelled in nourishing Yin but erred similarly to Zhang Jingyue in discussing Hou Bi (Throat Closure), both being misguided. Ye Tianshi’s insights were outstanding. With Mr. Wang’s clarification, the syndrome becomes clearer, sparing future patients premature death. Regarding Yu Jiayan’s treatment of Guo Taiyin’s abdominal distension, Wei attributed it to Water deficiency and Wood excess attacking the Spleen, suggesting Yin nourishment. I remain skeptical.
Nourishing pills are hardest to digest; this was rarely mentioned in antiquity. Mr. Wang’s clarification warns against blind pill consumption. Mr. Mengying preferred decocting tonics into pastes and incorporating对症 herbs into pills to ensure easy digestion, truly inheriting his family’s learning.
Xue Yipiao was a virtuous physician of our era, but his prescriptions did not survive. Scholars regret this. Mr. Wang preserved two formulas, rich in rationale, benefiting future students.
Ben Cao (Materia Medica) scholarship regards *Benjing Shuzheng* as the best edition, with extensive citations and penetrating analysis, unprecedented in scope. However, its writing is obscure, even more so than Lu’s *Banji*, causing reader distress. Mr. Wang’s annotations on dozens of herbs are precise, rivaling Zou’s work but clearer. Students can use this to approach Zou’s text without feeling overwhelmed.
Humans and animals possess the pancreas, yet medical texts ignore it. Wang Xunchen verified internal organs but omitted it. Westerners call it "sweet flesh," noting its taste but ignoring function, attributing digestion to bile instead. This is questionable. Western experiments showed stomach secreting sweet juice to digest food, aligning with the concept of "all things returning to earth," confirming pancreatic function. Mr. Wang stated in the Porcine Brain entry that the pancreas governs food transformation, matching Western findings. If bile entered the stomach, it would be bitter, exposing a Western oversight.
Zhao Shuxuan’s *Gangmu Shiyi* accurately critiques Li Shizhen’s omissions. Mr. Wang extracted its essence for this compilation; the rest is dross. Readers need not regret missing the full book.
Investigating things is crucial for physicians. Understanding herb interactions (mutual restriction, enhancement, compatibility, incompatibility) and properties (strength, duration) requires practical experience before application. Mr. Wang’s notes on detoxification and herbal suitability prepare one for emergencies and enhance wisdom; students should memorize them carefully.
Western texts and Wang Xunchen’s *Yilin Gaicuo* are essential, but their theories on organ function and Qi dynamics have flaws. Regarding pulse diagnosis: whether arteries or veins, if unrelated to organs as claimed, all pulses should be uniformly strong or weak. Yet, the six positions vary according to pathology. Observation vs. speculation yields distinct results. Mr. Wang said, "Believe what is credible, omit what is doubtful." This method applies to reading all books. Scholars Yazhi and Ci Yao expanded on Mr. Wang’s ideas with profound discussions, earning my respect.
Among the Four Diagnostic Methods, palpation is last, indicating pulse alone is insufficient. Most physicians focus solely on pulse, engaging in exaggeration and negligence. Mr. Wang’s rigorous, experiential analysis contrasts sharply with superficial medical texts. Practitioners who study deeply will gain confidence in clinical practice; this is a classic guide for mastery.
I record these observations humbly to express admiration. Mr. Wang’s comments are all precious gems; students who study them will gain insight, far beyond what a junior scholar can praise.
Yang Zhaoli, Junior Scholar of Zhongshan, respectfully records this.