前哲徐洄溪曰。医者之学问。全在明伤寒之理。则万病皆通。故仲景之书有二。《伤寒论》治时病之法也。《金匮要略》治杂症之法也。而《金匮》之方。则又半从《伤寒论》中来。则伤寒乃病中之第一症。而学医者之第一功夫也。俞东扶曰。伤寒为大病。治法为最繁。必熟读仲景书。再遍读后贤诸书。临症方有把握。仲景书为叔和编次。或有差误。而聊摄注解。殊觉稳当。续注者。张卿子王三阳唐不岩沈亮宸张兼善张隐 林北海诸人。总不越其范围。程扶生《经注》尤为明白易晓。然亦不敢直指原文之错误。自方程喻三家。各以已意布置。而仲景原文。从此遂无定局。至柯氏来苏集始放胆删改。而以方名编次。又是一局。徐灵胎《伤寒类方》实宗其式。然予细绎柯氏删改处。万不及《医宗金 伤寒论》之精当。先刊仲景原文。另立正误存疑二篇。应改者注小字于旁。可删者摘诸条于后。是非判然。智愚皆晓。他如江西舒诏《伤寒集注》大半斥为伪撰。并取数方。痛加诋毁。别拟方以换之。以视汪琥将阴阳二候。分为二编。各补后贤之方。其意均欲使初学人不泥古方以害人。而汪犹拘谨。舒则放纵矣。惟吴绶蕴要节 《六书》王宇泰《伤寒准绳张路玉伤寒绪论》俱有裨于后人。即有功于仲景。
合二家之说观之。仲景《伤寒论》为千古用方之祖。且其阐明医理。尤为中国至精之本。惜其书难免错简。必参观后贤诸书。核对互勘。始有头绪。阅周 之读伤寒论法。颇有见地。爰节述其说曰。《伤寒》非奇症也。《伤寒论》非奇书也。仲景据其所见。笔之于书。非既有此书。而天下之人。根据书而病也。读者须每读一段。即设一病者于此。以揣
其病机治法。而后借证于书。不得专在文本上安排。总之读《伤寒论》只当涵泳白文。注家虽有数十。以予所见二十余种。皆不免穿鉴附会。言似新奇。莫能见之行事。鄙见只当分作四会。曰伤寒初起本证治法。曰伤寒初起兼证治法。曰伤寒日久化寒。并误治化寒证治。曰伤寒日久化热。并误治化热证治。其霍乱、风湿、食复、劳复。以杂症附之。再参之陶节 书。及各家论温热书。互相考证。庶于读书有条理。而临证亦可有径途矣。盖经脉部位。与夫形层表里浅深之事。固不可不讲。而究不可过执也。着力乃在气化上推求。不得专在部位上拘泥。此书在唐以前。已非一本。其章节离合。本无深意。论中叙证。有极简者。有极繁者。有方证不合者。有上下文义不贯者。经设身处境。实在难以遵行。安知非错简说简耶。读者只应各就本文思量。不必牵扯上下文。积久自能融会贯通。此真善读伤寒论之活法也。
前清《俞根初》先生。在干嘉之间。盛行四五十年。着《通俗伤寒论》十二卷。第一编第一章、勘伤寒要诀。第二章、六经方药。第二编病理诊断。第三章、表里寒热。第四章、气血虚实。第五章、伤寒诊法。第六章、伤寒脉舌。第三编证治各论。第七章、伤寒本症。第八章、伤寒兼证。第九章、伤寒夹证。第十章、伤寒坏症。第十一章、伤寒复证。第四编调理诸法。第十二章、瘥后调理法。其辨析诸症。颇为明晰。其条列治法。温寒互用。补泻兼施。亦无偏主一格之弊。方方切用。法法通灵。其定方宗旨。谓古方不能尽中后人之病。后人不得尽泥古人之法。全在一片灵机。对症发药。庶病伤寒者真有豸乎。善夫俞惺齐先生有言曰。读书与治病。时合时离。古法与今方。有因有革。善读书斯善治病。非读死书之谓也。用古法须用今方。非执板方之谓也。专读仲景书。不读后贤书。譬之井田对建。周礼周官。不可以治汉唐之天下也。仅读后贤书。不读仲景书。譬之五言七律。 体宫词。不可以代三百之雅颂也。俞氏此着。劝求古训。博采众法。加以临证多年。经验丰富。故能别开生面。独树一帜。多发前人所未发。一洗阴阳五行之繁文。真苦海之慈航。昏衢之巨烛也。学人诚能从此书切实研求。广为探索。则历代伤寒名家。皆堪尚友矣。兼臣研究之余。略
附臆说于后。阅者谅之。
公元一九一六年丙辰四月望
何廉臣印岩识于绍城卧龙山麓之宣化坊
前代贤哲徐洄溪曾说：“医者的学问，全在于通晓伤寒的理法。若能通晓伤寒之理，那么各种疾病都能融会贯通。”因此，张仲景的著作主要有两部：《伤寒论》是治疗时行疫病（外感热病）的方法；《金匮要略》是治疗内科杂病的方法。而《金匮要略》中的方剂，有一半是从《伤寒论》中化裁而来的。由此可见，伤寒是疾病中的首要病症，也是学习医者必须掌握的首要功夫。
俞东扶说：“伤寒属于大病，治疗方法最为繁杂。必须熟读张仲景的书籍，再广泛阅读后世贤良医家的著作，临证时才能心中有把握。”张仲景的原书由王叔和编次整理，其中或许存在差错错误，但刘完素（号聊摄）的注解，显得格外稳妥恰当。后来进行续注的人，如张卿子、王三阳、唐不岩、沈亮宸、张兼善、张隐庵、林北海等人，总括起来都不超出刘氏注解的范围。程扶生的《伤寒论经注》尤其明白易懂。然而，他们也不敢直接指出原文的错误。直到清代方有执、喻嘉言、张路玉三家，各自按照自己的意图重新编排布局，从此张仲景的原文便没有了固定的格局。到了柯琴（字韵伯，号来苏）编写《伤寒来苏集》时，才大胆地删改原文，并按照方剂名称进行分类编排，这又形成了一种新的格局。徐灵胎（名大椿，号灵胎）的《伤寒类方》实际上就是效法这种体例。然而，我仔细推敲柯氏删改的地方，认为远不如《医宗金鉴·伤寒论》精当确切。《医宗金鉴》先刊印张仲景的原文，另外设立“正误”和“存疑”两篇，应当修改的用小字注在旁边，可以删除的摘录条文放在后面，是非曲直判断得清清楚楚，无论智者愚者都能明白。其他如江西舒诏的《伤寒集注》，大半斥责为伪作，并选取几个方剂痛加诋毁，另外拟方替换。这与汪琥将阴阳两种证候分为两编，各自补充后世贤良医家方剂的意图相同，都是想让初学者不要拘泥于古方而害人。但是汪琥还比较拘谨，舒诏则过于放纵了。只有吴绶的《伤寒蕴要全书》、王宇泰的《伤寒准绳》、张路玉的《伤寒绪论》都对后人有所裨益，也就是对张仲景有功。
综合这两方面的观点来看，张仲景的《伤寒论》是千古以来使用方剂的始祖，并且它阐明的医学原理，更是中国医学中最精深的根本。可惜这本书难免有竹简错乱的问题，必须参考后世的各类书籍，核对互勘，才能理清头绪。阅读周扬俊（字禹载）关于研读《伤寒论》的方法，颇有见地，于是简要叙述他的学说如下：《伤寒论》并非记载奇异病症的书，《伤寒论》本身也不是奇书。张仲景是根据他临床所见，记录成书的，并不是因为天下人有了这本书，才依据这本书去生病的。读者必须每读一段，就设想有一个病人在这里，以此来揣测其病机治法，然后再向书本求证，不能专门在文字文本上安排臆想。总之，研读《伤寒论》只应当沉浸涵泳于原文之中。虽然注家有数十家，据我所见的二十多种，都不免穿凿附会，言语看似新奇，却无法应用于实际诊疗。我的见解是将内容分为四个部分来领会：一是伤寒初起的本证治法；二是伤寒初起的兼证治法；三是伤寒日久转化为寒证，以及误治后转化为寒证的治法；四是伤寒日久转化为热证，以及误治后转化为热证的治法。至于霍乱、风湿、食复、劳复等病症，作为杂病附在后面。再参考陶华（字节庵）的著作，以及各家论述温热病的书籍，互相考证，这样读书才有条理，临证也才能有路径可循。大概经脉部位，以及形体层次表里浅深的事情，固然不可不讲求，但终究不可过分执着。着力之处应在气化上进行推求，不得专门在部位上拘泥。这本书在唐代以前，就已经不是同一个版本，其章节的离合，本来没有深意。书中叙述证候，有的极简略，有的极繁复，有的方证不相符合，有的上下文义不连贯。如果设身处地去遵循执行，实在难以操作。怎么知道不是因为竹简错乱或脱漏呢？读者只应各自就本文深入思考，不必牵扯上下文，时间久了自然能融会贯通。这才是真正善于研读《伤寒论》的活方法。
清朝的俞根初先生，在乾隆、嘉庆年间，盛行四五十年，著有《通俗伤寒论》十二卷。第一编第一章为“勘伤寒要诀”，第二章为“六经方药”；第二编为“病理诊断”，第三章为“表里寒热”，第四章为“气血虚实”，第五章为“伤寒诊法”，第六章为“伤寒脉舌”；第三编为“证治各论”，第七章为“伤寒本症”，第八章为“伤寒兼证”，第九章为“伤寒夹证”，第十章为“伤寒坏症”，第十一章为“伤寒复证”；第四编为“调理诸法”，第十二章为“瘥后调理法”。他对各种病症的辨析颇为明晰，所条列的治疗方法，温法和寒法互用，补法和泻法兼施，也没有偏执一格的弊病。每一个方剂都切合实用，每一种方法都通达灵动。他制定方剂的宗旨是：古方不能完全契合后人的病情，后人也不能完全拘泥于古人的治法。全凭灵活的机变，对症用药，这样患伤寒的人才能真正得到救治吗？俞惺齐先生说过得好：“读书与治病，有时结合，有时分离。古法与今方，既有继承也有革新。善于读书才能善于治病，这不是指死读书。运用古法必须结合今方，这不是指固执板方的用法。只读张仲景的书，不读后世贤良医家的书，就像井田制对应封建制度，《周礼》《周官》无法治理汉唐的天下一样。仅读后世贤良医家的书，不读张仲景的书，就像五言七律、宫体诗无法代替《诗经》三百篇的雅颂一样。”俞氏的这种举措，劝勉人们寻求古代训诂，广泛采纳众家之法，加上他多年临床经验，经验丰富，所以能别开生面，独树一帜，多发表前人未曾发表的见解，一扫阴阳五行繁琐文辞的弊端，真是苦海中的慈航，昏暗道路上的巨烛啊。学习者如果能从这本书切实研究追求，广泛探索，那么历代伤寒名家都可以与之交友了。我在研究之余，略微附上个人的见解在后面，请读者谅解。
公元一九一六年丙辰四月十五日
何廉臣 印岩 识于绍兴卧龙山麓之宣化坊
The former sage Xu Huixi said: "A physician's learning lies entirely in understanding the principles of *Shanghan* (Cold Damage). If one understands the principles of *Shanghan*, all diseases can be comprehended." Therefore, Zhang Zhongjing's works are twofold: *Shanghan Lun* (Treatise on Cold Damage) deals with the methods for treating epidemic diseases (exogenous febrile diseases), while *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) deals with the methods for treating miscellaneous internal diseases. The prescriptions in *Jingui Yaolue* are derived half from *Shanghan Lun*. Thus, *Shanghan* is the primary among diseases and the first skill a medical student must master.
Yu Dongfu stated: "*Shanghan* is a major disease, and its treatment methods are the most complex. One must thoroughly read Zhang Zhongjing's books, and then extensively read the works of later virtuous physicians, to have confidence in clinical practice." Zhang Zhongjing's original text was compiled by Wang Shuhe, which may contain errors. However, Liu Wansu's (styled Liaoshe) annotations are considered particularly sound. Later annotators, such as Zhang Qingzi, Wang Sanyang, Tang Buyan, Shen Liangchen, Zhang Jianshan, Zhang Yin'an, and Lin Beihai, generally did not exceed the scope of Liu's annotations. Cheng Fusheng's *Jingzhu* (Commentary on the Classic) is especially clear and easy to understand. However, they dared not directly point out errors in the original text. It was only with Fang Youzhi, Yu Jiayan, and Zhang Luyu that each rearranged the content according to their own ideas, causing the original text of Zhang Zhongjing to lose its fixed structure. When Ke Qin (courtesy name Yunbo, pseudonym Laisu) compiled *Shanghan Lansuji* (Collected Commentaries on Shanghan), he boldly deleted and altered the original text, organizing it by prescription names, creating a new format. Xu Lingtai's *Shanghan Leifang* (Classified Formulas for Shanghan) essentially followed this model. However, upon careful examination of Ke Qin's alterations, I found them far less precise than those in *Yizong Jinjian·Shanghan Lun* (Golden Mirror of Medicine: Treatise on Cold Damage). *Yizong Jinjian* first published Zhang Zhongjing's original text, separately establishing chapters on "Correcting Errors" and "Preserving Doubts," noting corrections in small print beside the text and extracting deletable items at the end, making right and wrong clear to both the wise and the foolish. Others, such as Shu Zhao's *Shanghan Jizhu* from Jiangxi, largely dismissed the text as apocryphal, criticized specific prescriptions harshly, and substituted his own formulas. This intent was similar to Wang Hu's division of yin and yang syndromes into two sections with added later prescriptions, aiming to prevent beginners from blindly following ancient formulas to harm patients. Yet Wang was cautious, whereas Shu was too liberal. Only Wu Shou's *Shanghan Yunyao Quanshu* (Complete Book of Essential Secrets for Shanghan), Wang Yutai's *Shanghan Zhunsheng* (Standard Rules for Shanghan), and Zhang Luyu's *Shanghan Xulun* (Continuation of Discourses on Shanghan) were beneficial to later generations, thus meriting credit to Zhang Zhongjing.
Synthesizing these views, Zhang Zhongjing's *Shanghan Lun* is the ancestor of formula usage for millennia, and its elucidation of medical principles is the most profound foundation of Chinese medicine. Regrettably, the book inevitably suffers from bamboo slip disarray; one must consult later works and cross-reference them to find order. Zhou Yangjun's (courtesy name Yucai) method of reading *Shanghan Lun* offers great insight. I briefly summarize his view: *Shanghan* does not record strange diseases, nor is *Shanghan Lun* a strange book. Zhang Zhongjing recorded what he observed clinically; it is not that people fell ill because the book existed. Readers should imagine a patient whenever reading a passage, deduce the pathogenesis and treatment, and then verify with the text, rather than focusing solely on textual arrangement. In short, one should immerse oneself in the plain text. Although there are dozens of commentators, the more than twenty I have seen all fall into forced interpretations and far-fetched associations; their words seem novel but cannot be applied in practice. My view is to divide the study into four aspects: 1. Treatment of primary syndromes at the onset of *Shanghan*; 2. Treatment of concurrent syndromes at the onset; 3. Transformation into cold syndromes after prolonged duration or due to mis-treatment, and their treatments; 4. Transformation into heat syndromes after prolonged duration or due to mis-treatment, and their treatments. Conditions like cholera, wind-dampness, food relapse, and labor relapse are attached as miscellaneous diseases. By referencing Tao Hua's works and various texts on warm-heat diseases, and cross-verifying them, one can read systematically and find a path for clinical practice. While meridians, locations, and the depth/superficiality of tissue layers must be studied, one must not be overly rigid. Effort should focus on exploring Qi transformation, not being confined to anatomical locations. Before the Tang Dynasty, this book already existed in multiple versions; its chapter divisions had no deep meaning. Some syndrome descriptions are extremely brief, others extremely detailed; some prescriptions do not match syndromes; some contexts are disjointed. Strict adherence is difficult. Could this not be due to misplaced or lost slips? Readers should contemplate the text itself without forcing connections to other parts; over time, integration will occur naturally. This is the true dynamic method for reading *Shanghan Lun*.
Mr. Yu Genchu of the late Qing Dynasty flourished during the Qianlong and Jiaqing reigns for forty to fifty years. He authored *Tongsu Shanghan Lun* (Popular Treatise on Cold Damage) in twelve volumes. Volume 1, Chapter 1: Key Essentials for Examining Shanghan; Chapter 2: Six Meridians' Formulas and Herbs. Volume 2: Pathology and Diagnosis; Chapter 3: Exterior/Interior, Cold/Heat; Chapter 4: Qi/Blood, Deficiency/Excess; Chapter 5: Diagnostic Methods for Shanghan; Chapter 6: Pulse and Tongue for Shanghan. Volume 3: Specific Syndrome Treatments; Chapter 7: Primary Syndromes of Shanghan; Chapter 8: Concurrent Syndromes; Chapter 9: Clashing Syndromes; Chapter 10: Ruined Syndromes; Chapter 11: Relapsing Syndromes. Volume 4: Various Conditioning Methods; Chapter 12: Post-recovery Conditioning. His analysis of syndromes is clear; his listed treatments combine warming and cooling, tonification and purgation, avoiding bias toward any single approach. Every formula is practical; every method is flexible. His principle for prescribing is that ancient formulas cannot fully address modern patients' conditions, and modern practitioners should not rigidly adhere to ancient methods. It relies entirely on adaptability and prescribing according to the specific syndrome, so that those suffering from *Shanghan* may truly benefit. Mr. Yu Xingqi rightly said: "Reading and treating illness sometimes align, sometimes diverge. Ancient methods and modern formulas involve both inheritance and reform. Good reading leads to good treating; this does not mean reading dead texts. Using ancient methods requires using modern formulas; this does not mean sticking to rigid prescriptions. Reading only Zhang Zhongjing and ignoring later scholars is like trying to govern the Han and Tang dynasties with Well-field systems or *Rites of Zhou*. Reading only later scholars and ignoring Zhang Zhongjing is like expecting five-character or seven-character regulated verse to replace the Odes and Hymns of the *Classic of Poetry*." Yu's approach encourages seeking ancient teachings, collecting diverse methods, and applying years of clinical experience, thereby opening new paths and establishing a unique school, expressing insights previously unarticulated, and clearing away the verbosity of Yin-Yang and Five Elements theories. It is indeed a compassionate boat in the sea of suffering and a great candle in dark streets. If learners earnestly study and explore this book, they can associate with past masters of *Shanghan*. After my own research, I append my humble opinions below. Readers please forgive me.
April 15, Bingchen Year (1916 AD)
He Lianchen (Yinyan) noted at Xuanhua Fang, foot of Wolong Mountain, Shaoxing