《伤寒》一书，后汉张机所着，发明《内经》奥旨，启万世之章程，为医门秘诀。其文佶屈，其义 ，
其方简峭而警辟。有志集注，适有养胎之举，托迹昭潭（涟源黄德
安，同里旧交，寄居潭市，主于其家，怂恿着论，力救时世），客舍清闲，窃举茅庐诵读时所心得者，提要成
篇，姑从简略（携稿诣省垣，衡邑成子凝秀，故人新吾子也，随 真以补前刻）。
经曰∶“伤寒一日，巨阳受之（一日，一次也，不以日数拘。巨阳，太阳也。太阳，经也；膀胱，腑也，
经脉从癫络脑，夹脊抵腰。受之，受其邪也）。”时值 发栗冽，有寒有风（寒为阴邪，伤营；风为阳邪，伤
卫），其中风也，经先受其风，桂枝症（不以病名病，而以药名病者，重乎其药也）。脉浮而缓，头痛项强而
恶寒（有风不皆无寒），过时即热，有汗，鼻鸣而恶风。倘消渴而小便不利，邪入膀胱腑之卫分矣，五苓散主
之。其中寒也，经先受其寒，麻黄症。脉浮而紧，体痛（统头痛、身疼、腰痛、骨节疼痛而言），呕逆而恶
寒，历时方热，无汗喘满而恶凤（有寒不皆无风）。倘如狂（淤热冲心）而小腹急结（淤热不行），邪入膀胱
腑之营分矣，桃仁承气汤主之。大青龙汤治风寒两中经而烦躁（寒郁于外，热蒸于内，阴阳攻击），小青龙汤
治风寒两中腑之干呕（小便不利，心下有水气，干呕，或兼咳，兼渴，兼噎，兼喘）。
中风经症 桂枝汤（桂枝、芍药、甘草、生姜、大枣。服已须臾，饮热稀粥以助药力，温覆一时许，取微
汗。发汗遂漏不止，恶风，小便难，四肢微急，难以屈伸，桂枝汤加附子。发汗后而喘，麻黄、杏仁、甘草、
石膏）。
中风府症 五苓散（猪苓、茯苓、泽泻、白术、肉桂）。
中寒经症 麻黄汤（麻黄、桂枝、杏仁、甘草，温服覆
取汗。发汗不解，反恶寒者，虚故也，芍药、炙草、附子，三味温服。发汗后身疼痛，脉沉迟者，桂枝、生姜、
人参、芍药、甘草、大枣。发汗过多，叉手冒心，心下悸欲得按者，桂枝、炙草，二味煮去滓顿服。未经汗下，
脉沉，当温其里，宜四逆汤，附子、干姜、炙草，未经汗下心悸而烦者，小建中汤∶桂枝、芍药、炙甘草、
生姜、饴糖）。
中寒府症 桃仁承气汤（桃仁、桂枝、大黄、芒硝、炙草。发汗，若下之，懊 不得眠，胸中窒碍者，
栀子十四枚，香豉四合，煮去滓温服，得吐则止。大下后，恶寒痞结，桂枝汤先解恶寒，大黄、黄连，二味煮去
滓，温服以攻痞。心下痞而复恶寒汗出者，附子泻心汤，大黄、黄连、黄芩、附子）。
风寒雨中经症 大青龙汤（麻黄、桂枝、炙草、杏仁、生姜、大枣、石膏）。
风寒雨中腑症 小青龙汤（麻黄、芍药、五味、甘草、干姜、半夏、桂枝、细辛。渴去半夏加栝蒌；噎去麻
黄加附子；小便不利，小腹满，去麻黄加茯苓；喘去麻黄，加杏仁；发汗，若下之，病仍不解，烦躁者，茯苓
四逆汤主之，茯苓、人参、炙草、干姜、附子）。
“二日阳明受之”（阳明，经也；胃，腑也。经脉起鼻额，循鼻外，系目系）。居戊土之乡，原禀坤静，
摄离火之篆（阳明纯热），反揽干刚脉浮而大，烦渴目痛，鼻干不得眠者，阳明经病也；脉浮而实，潮热谵语，腹满、大
便硬者，胃家腑病也。经病治以白虎汤，腑病治以三承气汤，其为正阳明则然。六经虽分阴阳，而宰之者阳明，
为六经之所朝宗，即为六经之所归宿。三阳有类聚之条，三阴有转属之症。太阳阳明，不更衣（不大便）而
无所苦（脾约丸）；少阳阳明。时烦躁而大便难（以法治之）。大实腹痛，阳明杂见太阳之篇（桂枝大黄汤）
；土燥水干，阳明混入少阴之类（急下之），脉滑而厥（里有热，白虎汤），厥阴中亦有阳明。随经而见，妙
蕴无方。
阳明经症 白虎汤（石膏、粳米、知母、炙草）。附录钱仲阳葛根汤（葛根、升麻、白芷、炙草、大枣、
生姜）。
阳明腑症 三承气汤（汗吐下后微烦，小便数，大便硬，小承气汤∶大黄、浓朴、枳实；腹胀满，调胃承
气汤∶大黄、炙草、芒硝，不大便，发热汗多，大承气汤∶大黄、浓朴、枳实、芒硝。太阳阳明，脉浮而涩，
麻仁脾约丸∶麻仁、芍药、枳实、大黄、浓朴、杏仁；少阳阳明，以法治之，相胃家虚实加减。下，桂枝大黄
汤，见后少阴，急下之，大承气汤。）
备录阳明症方（身黄如橘子色，小便不利，茵陈蒿汤∶大黄、茵陈、栀子。身黄发热，栀子、黄柏、炙
草）。
“三日少阳受之”（少阳，经也；胆，腑也。经脉循胁络
耳）。兼木火之德（属甲木，寄相火），司出入之门（入太阳，出太阴）。邪犯经，胸满胁痛而耳聋，邪犯腑，
口苦（胆热上蒸）、呕逆（胆热上冲）而目眩（胆热上熏）。脉之大者，变而为弦，症之热者，转而似疟，
居阴阳之界（半表半里），通阴通阳；无汗下之方，禁汗禁下。邪正相持，进退互拒，小柴胡汤为和解少阳之
统剂，而其变则有辨焉者。呕逆（胆热）而腹痛（胃寒），黄连汤分理阴阳；呕吐而硬（胃实）烦（郁热），
大柴胡汤双清表里。宜应手而解，方工勿借口于和为套。
小柴胡汤（柴胡、黄芩、人参、法夏、炙草、生姜、大枣。胸中满而不呕，去法夏、人参，加栝蒌仁；渴去
法夏，加人参、花粉；腹痛去黄芩，加芍药；心下悸，小便不利，去黄芩，加茯苓）。黄连汤（黄连、炙草、
干姜、人参、桂枝、半夏、大枣）。大柴胡汤（柴胡、半夏、枳实、大黄、黄芩、芍药、生姜、大枣）。备录
少阳症方（胸胁微绪，小便不利，柴胡、桂枝、干姜、花粉、黄芩、牡蛎、炙草。服柴胡汤已，反渴以阳明
治）。
“四日太阴受之”（太阳，经也，脾，脏也。经脉布胃中，络于嗌，邪入阴分，经脏齐病）。阴阳变态之妙，
有不见其朕兆。阳邪入阴，尺寸皆沉，腹满吐食自利。有腹满时痛之寒症（理中丸），即有腹满实痛之热症（桂枝汤
加大黄），有得食缓吐之寒症（理中丸通治），即有得食即吐之热症（干姜黄连汤），有自利不渴当温之寒症
（理中丸通治），即有自利腐秽当下之热症（大承气汤）。盖人之形有浓薄，气有盛衰，脏有本寒本热，每从
赋禀以为转移。如必以直中为寒，传经为热，其何解仲景寒热并论，列于四日。
理中丸（人参、白术、炙草、干姜、捣碎蜜和为丸，如龙眼大，以沸汤和一丸，研碎温服），干姜黄连
汤（干姜、黄连、人参）。
“五日少阴受之”（少阴，经也；肾，脏也。经脉系舌本）。生人之命蒂安危系于少阴。病则脉细欲寐，
自利发厥（手足冷曰厥），口干舌燥，渴欲饮水自救。无奈水火同宫辨别最宜分晓。挟水为动，则为阴邪；挟
火而动，则为阳邪。阴邪脉沉细而迟，阳邪脉沉细而数。阴邪但欲寐，身无热，阳邪虽欲寐，心多烦。阴邪下
利清谷，阳邪下利清水。阴邪面赤而里寒，小便白，阳邪手足厥而里热，小便赤。阴邪口干舌躁而带和，阳邪
口干舌燥而至裂。阴邪渴欲饮热水以自救，阳邪渴欲饮温水以自救。临症审视，只争芒芴。
寒症方 （身体痛，附子汤∶附子、茯苓、人参、白术、芍药。四逆汤通治∶炙草、干姜、附子。下利，
白通汤∶葱白、干姜、附子。手足冷，烦躁欲死，吴茱萸汤∶吴茱萸、人参、生姜、大枣。）
热症方 （心烦不卧，黄连汤∶黄芩、黄连、芍药、鸡子黄、阿胶。咽痛，甘桔汤∶甘草、桔梗。口烂咽干，
大承气汤。自利清水，色纯青，心痛，口干，大承气汤。）
“六日厥阴受之（厥阴，经也；肝，脏也。经脉绕阴器，抵小腹，贯心膈。）。传经而至厥阴，在时为丑，
在岁为冬，在卦为坤。脉细肢厥（厥，逆也。四肢以温为顺，以冷为逆），烦渴囊缩，症则犹是也，而治法
悬绝。漏尽更残，四望阴霾，而有纯寒无热之症；天寒地冻，满腹阳春，而有纯热无寒之症；阴凝于阳必战，
其血元黄，而有阴阳错杂之症。彼纯寒而厥，当归四逆汤，夫人而知之。热愈深，厥愈深，纯热之厥甚于纯寒，
非急下不足以救水，医将何以决之（脉数、咽干、小便赤）？而况阴阳错杂者之眩人耳目乎？当此阴尽阳
回，晦朔交卸之时，仲景立乌梅丸以安蛔，其实统阴阳而治。医而知治厥阴，医道其庶几乎！
纯寒症 （当归四逆汤∶当归 桂枝 芍药 细辛 通草 甘草 大枣。下利清谷，里寒外热，汗出而厥者，
通脉四逆汤。）
纯热症 （急下，大承气汤。）
阴阳错杂症∶乌梅丸∶乌梅三百枚，细辛六两，干姜十两，黄连十六两，当归四两，附子六两，蜀椒四两，
桂枝六两，人参六两，黄柏六两，上十味，共捣筛，合治之，以苦
酒渍乌梅，一宿去核，蒸之五升米下，饭熟捣成泥，和药令相得，纳臼中与蜜杵二千下，如梧桐子大，先食饭，
服十丸，日三服，稍加二十丸。禁生冷、滑物、臭食等。
备录 （脉滑而厥，里有热，白虎汤。）
夫三阴三阳，班班可考，而有治表里急，治里表急，阴同乎阳，为两感（太阳少阴同病，阳明太阴同病，
少阳厥阴同病）。余读经文莫治，仲景无方，不禁怃然三叹焉。窃意表重于里者，以里为主，稍解其表；里重
于表者，纯治其里，管窥之见，不敢告人。壮游四方，而以此法活人居多。偶捡李挺《伤寒论阅》，亦有是说。
余生也晚，安敢并驾古人？不谓理之所在，古今人所见有略同也。岐伯、仲景，有知其将许我友李 为徒
乎？若世所传大羌活汤则吐弃之矣。至于合病、并病、坏病、劳复、食复、饮酒复、阴易、阳易、阴阳易，六
经精透，举而措之裕如。一百一十三方，采方总撮要领，三百九十七法，注法悉本原文。练就长沙（仲景为长
沙太守，人称张长沙）之明珠，化作涅 （佛说法处。《金刚》经∶“入涅 而灭度之”）之舍利（牟尼珠名
舍利
子）。
《伤寒论》一书，由后汉张机所著，阐发了《黄帝内经》的深奥旨意，开启了后世医学的规范，是医家的秘诀。其文字古奥难懂，其义理精微，其方剂简练峻切而警醒透彻。有志于汇集注解此书的人，恰逢我养胎之事，便寄居在昭潭（涟源人黄德安，是同乡旧交，居住于潭市，住在他家，怂恿我撰写论述，极力救治时弊），客舍清闲，我便举起茅庐诵读时的心得，提炼要点写成篇章，暂且从简略入手（带着稿件前往省城，衡邑成凝秀，是老友新吾之子，随即校正以补前次刻印的不足）。
经典说：“伤寒第一天，太阳经受邪。”（“一日”指一次，不拘泥于天数。“巨阳”即太阳。太阳，指经脉；膀胱，指腑脏。经脉从巅顶联络脑部，夹脊柱抵腰部。受之，指受到邪气侵袭。）当时正值寒冷凛冽，有寒有风（寒为阴邪，损伤营气；风为阳邪，损伤卫气）。其中风证，经脉先受风邪，出现桂枝汤证（不以病名命名，而以药名命名，是重视该药的作用）。脉象浮而缓，头痛项强且恶寒（有风并非没有寒），过一段时间后发热，有汗，鼻鸣且恶风。如果出现消渴和小便不利，说明邪气进入膀胱腑的卫分，用五苓散主治。其中寒证，经脉先受寒邪，出现麻黄汤证。脉象浮而紧，身体疼痛（统括头痛、身疼、腰痛、骨节疼痛而言），呕吐逆气且恶寒，过了很长时间才发热，无汗、气喘胸闷且恶风（有寒并非没有风）。如果出现如狂状（瘀热冲心）和小腹急结（瘀热不行），说明邪气进入膀胱腑的营分，用桃仁承气汤主治。大青龙汤治疗风寒同时中伤经脉导致的烦躁（寒郁于外，热蒸于内，阴阳相互攻击）；小青龙汤治疗风寒同时中伤腑脏导致的干呕（小便不利，心下有停饮，干呕，或兼咳嗽、口渴、噎塞、气喘）。
中风经症：桂枝汤（桂枝、芍药、甘草、生姜、大枣。服用后片刻，喝热稀粥以助药力，覆盖衣被约一顿饭时间，取微汗。若发汗导致汗漏不止，恶风，小便困难，四肢轻微拘急，难以屈伸，桂枝汤加附子。发汗后出现气喘，用麻黄、杏仁、甘草、石膏）。
中寒经症：麻黄汤（麻黄、桂枝、杏仁、甘草，温服覆盖取汗。若发汗后病不解，反而恶寒，这是虚证，用芍药、炙甘草、附子，三味药温服。发汗后身体疼痛，脉象沉迟的，用桂枝、生姜、人参、芍药、甘草、大枣。发汗过多，双手交叉护住心口，心中悸动想按压的，用桂枝、炙甘草两味药煮去渣一次性服用。未经过发汗和攻下，脉象沉的，应当温里，宜用四逆汤，附子、干姜、炙甘草。未经过发汗和攻下，心中悸动且烦躁的，用小建中汤：桂枝、芍药、炙甘草、生姜、饴糖）。
中寒府症：桃仁承气汤（桃仁、桂枝、大黄、芒硝、炙甘草。若发汗或攻下后，心中懊恼不得安眠，胸中窒塞的，用栀子十四枚，香豉四合，煮去渣温服，吐了则停止。大攻下后，恶寒痞结，先用桂枝汤解除恶寒，再用大黄、黄连两味药煮去渣温服以攻除痞结。心下痞满又恶寒汗出的，用附子泻心汤：大黄、黄连、黄芩、附子）。
风寒雨中经症：大青龙汤（麻黄、桂枝、炙甘草、杏仁、生姜、大枣、石膏）。
风寒雨中腑症：小青龙汤（麻黄、芍药、五味子、甘草、干姜、半夏、桂枝、细辛。口渴去半夏加瓜蒌根；噎塞去麻黄加附子；小便不利，小腹满，去麻黄加茯苓；气喘去麻黄加杏仁。若发汗或攻下后，病仍不愈，烦躁的，用茯苓四逆汤主治：茯苓、人参、炙甘草、干姜、附子）。
“第二天阳明经受邪”（阳明，指经脉；胃，指腑脏。经脉起于鼻旁额部，沿鼻外侧，联系目系）。居于戊土之乡，原本禀受坤静之性，摄取离火之篆（阳明纯热），反而揽获刚健之脉，脉浮而大，烦渴目痛，鼻干不得安眠的，是阳明经病；脉浮而实，潮热谵语，腹部胀满、大便硬的，是胃家腑病。经病用白虎汤治疗，腑病用三承气汤治疗，这是正治阳明病的常规。六经虽然分阴阳，但主宰者是阳明，它是六经朝宗之所，也是六经归宿之处。三阳有类聚的条目，三阴有转属的症状。太阳阳明，不大便但没有痛苦（脾约丸）；少阳阳明，时而烦躁且大便困难（依法治疗）。大实腹痛，阳明杂见于太阳篇（桂枝大黄汤）；土燥水干，阳明混入少阴之类（急下之），脉滑而手足厥冷（里有热，白虎汤），厥阴中也有阳明。随经脉而见症，妙处在于无固定方剂。
阳明经症：白虎汤（石膏、粳米、知母、炙甘草）。附录钱仲阳葛根汤（葛根、升麻、白芷、炙甘草、大枣、生姜）。
阳明腑症：三承气汤（汗吐下后微烦，小便数，大便硬，用小承气汤：大黄、厚朴、枳实；腹胀满，用调胃承气汤：大黄、炙甘草、芒硝；不大便，发热汗多，用大承气汤：大黄、厚朴、枳实、芒硝。太阳阳明，脉浮而涩，用麻仁脾约丸：麻仁、芍药、枳实、大黄、厚朴、杏仁；少阳阳明，依法治疗，根据胃家虚实加减。下法，用桂枝大黄汤，见后文少阴篇。急下之，用大承气汤）。
备录阳明症方（身黄如橘子色，小便不利，用茵陈蒿汤：大黄、茵陈、栀子。身黄发热，用栀子、黄柏、炙甘草）。
“第三天少阳经受邪”（少阳，指经脉；胆，指腑脏。经脉循行胁肋联络耳朵）。兼具木火之德（属甲木，寄居相火），司管出入之门（入太阳，出太阴）。邪气侵犯经脉，胸满胁痛且耳聋；邪气侵犯腑脏，口苦（胆热上蒸）、呕吐逆气（胆热上冲）且目眩（胆热上熏）。脉象大的，变而为弦；症状热的，转而似疟疾。居于阴阳交界（半表半里），通阴通阳；没有汗法和下法的方剂，禁止发汗和攻下。邪正相持，进退互拒，小柴胡汤是和解少阳的总方，但其变化则有辨别。呕吐逆气（胆热）且腹痛（胃寒），用黄连汤分理阴阳；呕吐且胃实（硬）心烦（郁热），用大柴胡汤双清表里。应当应手而解，医生不要借口“和法”为套话。
小柴胡汤（柴胡、黄芩、人参、法半夏、炙甘草、生姜、大枣。胸中满但不呕，去法半夏、人参，加瓜蒌仁；口渴去法半夏，加人参、花粉；腹痛去黄芩，加芍药；心下悸，小便不利，去黄芩，加茯苓）。黄连汤（黄连、炙甘草、干姜、人参、桂枝、半夏、大枣）。大柴胡汤（柴胡、半夏、枳实、大黄、黄芩、芍药、生姜、大枣）。备录少阳症方（胸胁微绪，小便不利，用柴胡、桂枝、干姜、花粉、黄芩、牡蛎、炙甘草。服用柴胡汤后，反而口渴，按阳明病治疗）。
“第四天太阴经受邪”（此处原文误写为太阳，应为太阴，经也；脾，脏也。经脉布散胃中，联络咽喉，邪气侵入阴分，经脏同病）。阴阳变化的微妙，有不见征兆的。阳邪入阴，尺寸脉皆沉，腹满吐食自利。有腹满时痛的寒症（理中丸），即有腹满实痛的热症（桂枝汤加大黄）；有得食缓吐的寒症（理中丸通治），即有得食即吐的热症（干姜黄连汤）；有自利不渴当温的寒症（理中丸通治），即有自利腐秽当下之热症（大承气汤）。大概人的形体有浓薄，气有盛衰，脏腑有本寒本热，往往随禀赋而转移。如果必定认为直中为寒，传经为热，那如何解释仲景寒热并论，列于第四日？
理中丸（人参、白术、炙甘草、干姜，捣碎蜜和为丸，如龙眼大，用沸汤化开一丸，研碎温服）。干姜黄连汤（干姜、黄连、人参）。
“第五天少阴经受邪”（少阴，指经脉；肾，指脏。经脉系舌本）。人的生命安危系于少阴。生病则脉细欲寐，自利发厥（手足冷叫厥），口干舌燥，渴欲饮水自救。无奈水火同宫，辨别最宜分晓。挟水而动，则为阴邪；挟火而动，则为阳邪。阴邪脉沉细而迟，阳邪脉沉细而数。阴邪但欲寐，身无热；阳邪虽欲寐，心多烦。阴邪下利清谷，阳邪下利清水。阴邪面赤而里寒，小便白；阳邪手足厥而里热，小便赤。阴邪口干舌躁而带和润，阳邪口干舌燥而至裂开。阴邪渴欲饮热水以自救，阳邪渴欲饮温水以自救。临症审视，只争毫厘。
寒症方（身体痛，用附子汤：附子、茯苓、人参、白术、芍药。四逆汤通治：炙甘草、干姜、附子。下利，用白通汤：葱白、干姜、附子。手足冷，烦躁欲死，用吴茱萸汤：吴茱萸、人参、生姜、大枣）。
热症方（心烦不卧，用黄连汤：黄芩、黄连、芍药、鸡子黄、阿胶。咽痛，用甘桔汤：甘草、桔梗。口烂咽干，用大承气汤。自利清水，色纯青，心痛，口干，用大承气汤）。
“第六天厥阴经受邪”（厥阴，指经脉；肝，指脏。经脉绕阴器，抵小腹，贯心膈）。传经而至厥阴，在时辰为丑，在岁序为冬，在卦象为坤。脉细肢厥（厥，逆也。四肢以温为顺，以冷为逆），烦渴囊缩，症状还是那样，但治法截然不同。漏尽更残，四望阴霾，而有纯寒无热的症候；天寒地冻，满腹阳春，而有纯热无寒的症候；阴凝于阳必战，其血元黄，而有阴阳错杂的症候。那些纯寒而厥的，用当归四逆汤，这是人人都知道的。热越深，厥越深，纯热的厥比纯寒更严重，非急下不足以救水，医生将如何决断（脉数、咽干、小便赤）？更何况阴阳错杂者迷惑人耳目呢？正当此阴尽阳回，晦朔交替之时，仲景立乌梅丸以安蛔，其实统摄阴阳而治。医生如果懂得治疗厥阴，医道差不多就掌握了！
纯寒症（当归四逆汤：当归、桂枝、芍药、细辛、通草、甘草、大枣。下利清谷，里寒外热，汗出而厥的，用通脉四逆汤）。
阴阳错杂症：乌梅丸：乌梅三百枚，细辛六两，干姜十两，黄连十六两，当归四两，附子六两，蜀椒四两，桂枝六两，人参六两，黄柏六两。以上十味药，共捣筛，混合处理，用苦酒浸泡乌梅，一夜后去核，在五升米下蒸熟，饭熟捣成泥，和药令其相得，纳入臼中与蜜杵两千下，如梧桐子大，饭前服十丸，每日三次，稍加至二十丸。禁生冷、滑物、臭食等。
三阴三阳，条理清晰可考，但有治表里急、治里表急的情况，阴同乎阳，称为两感（太阳少阴同病，阳明太阴同病，少阳厥阴同病）。我读经文时无从治理，仲景无方，不禁怅然三叹。私下认为表重于里的，以治里为主，稍解其表；里重于表的，纯治其里。这是管窥之见，不敢告人。壮游四方，以此法救人很多。偶然捡到李挺《伤寒论阅》，也有这种说法。我生得晚，怎敢与古人并驾齐驱？没想到道理所在，古今人所见略有相同。岐伯、仲景，难道知道我将许李挺为徒吗？至于世所传的大羌活汤，则应吐弃之。至于合病、并病、坏病、劳复、食复、饮酒复、阴易、阳易、阴阳易，六经精透，举而措之裕如。一百一十三方，采方总撮要领，三百九十七法，注法悉本原文。练就长沙（仲景为长沙太守，人称张长沙）之明珠，化作涅槃（佛说法处。《金刚经》：“入涅槃而灭度之”）之舍利（牟尼珠名舍利子）。
The *Shanghan Lun* (Treatise on Cold Damage) was authored by Zhang Ji of the Later Han Dynasty. It elucidates the profound principles of the *Huangdi Neijing* (Yellow Emperor's Inner Canon), establishing standards for medicine for all generations, and serves as a secret manual for physicians. Its text is archaic and difficult, its meaning is subtle, and its prescriptions are concise,峻切 (sharp and cutting), and enlightening. Those who aspire to compile annotations for this book, coinciding with my pregnancy care, resided in Zhaotan (Huang De'an from Lianyuan, an old friend from the same hometown, living in Tan City, hosting me at his home, urging me to write treatises to save the times). In the quiet guesthouse, I gathered insights gained during my studies in thatched huts, extracted key points to form chapters, and kept it brief (taking the manuscript to the provincial capital, Cheng Ningxiu from Hengyi, a new friend of my old acquaintance Xinwu, subsequently corrected it to supplement previous editions).
The classics state: "On the first day of Shanghan, the Taiyang meridian receives the pathogen." ("One day" refers to one stage, not restricted by calendar days. "Juyang" is Taiyang. Taiyang refers to the meridian; Bladder refers to the fu organ. The meridian connects from the vertex to the brain, flanks the spine, and reaches the waist. "Receiving" means receiving the pathogenic factor.) At that time, it was cold and biting, with both cold and wind (Cold is a yin pathogen, damaging Ying Qi; Wind is a yang pathogen, damaging Wei Qi). In cases of Wind Strike, the meridian first receives wind, presenting Guizhi Tang syndrome (Named after the herb rather than the disease, emphasizing the importance of the herb). The pulse is floating and slow, accompanied by headache, stiffness of the neck, and aversion to cold (Wind does not necessarily exclude cold). After some time, fever occurs, with sweating, nasal congestion, and aversion to wind. If thirst and difficulty urinating occur, the pathogen has entered the Wei division of the Bladder fu organ, treated primarily with Wuling San (Five-Ingredient Powder with Poria). In cases of Cold Strike, the meridian first receives cold, presenting Mahuang Tang syndrome. The pulse is floating and tight, with body pain (encompassing headache, body ache, lower back pain, and joint pain), vomiting, and aversion to cold. Fever appears only after a long duration, with no sweating, wheezing, chest fullness, and aversion to wind (Cold does not necessarily exclude wind). If delirious behavior resembling madness (stagnant heat rushing to the Heart) and acute binding in the lower abdomen (stagnant heat failing to move) occur, the pathogen has entered the Ying division of the Bladder fu organ, treated primarily with Tao Ren Chengqi Tang (Peach Kernel Decoction to Order the Qi). Da Qinglong Tang (Major Green Dragon Decoction) treats wind-cold simultaneously striking the meridians causing irritability (cold stagnating externally, heat steaming internally, attacking each other); Xiao Qinglong Tang (Minor Green Dragon Decoction) treats wind-cold simultaneously striking the fu organs causing dry retching (difficulty urinating, fluid retention in the epigastrium, dry retching, possibly with cough, thirst, choking, or wheezing).
Wind Strike Meridian Syndrome: Guizhi Tang (Cinnamon Twig Decoction) [Guizhi, Shaoyao, Gancao, Shengjiang, Dazao]. After ingestion, drink hot thin porridge shortly to assist the medicinal power, cover with warm blankets for about the time it takes to cook a meal, aiming for slight sweating. If sweating leads to leakage that cannot stop, with aversion to wind, difficulty urinating, slight rigidity of the four limbs making flexion and extension difficult, add Fuzi to Guizhi Tang. If wheezing occurs after sweating, use Mahuang, Xingren, Gancao, Shigao.
Wind Strike Fu Organ Syndrome: Wuling San (Five-Ingredient Powder with Poria) [Zhuling, Fuling, Zexie, Baizhu, Rougui].
Cold Strike Meridian Syndrome: Mahuang Tang (Ephedra Decoction) [Mahuang, Guizhi, Xingren, Gancao], taken warm, covered to induce sweating. If the condition persists after sweating and aversion to cold worsens, indicating deficiency, use Shaoyao, Zhigancao, Fuzi (three ingredients, taken warm). If body pain persists after sweating with a deep and slow pulse, use Guizhi, Shengjiang, Renshen, Shaoyao, Gancao, Dazao. If excessive sweating causes crossing hands over the heart, palpitations relieved by pressure, boil Guizhi and Zhigancao together, strain, and take once. If no sweating or purging has occurred and the pulse is deep, warm the interior using Sini Tang (Frigid Extremities Decoction): Fuzi, Ganjiang, Zhigancao. If palpitations and irritability occur without prior sweating or purging, use Xiaojianzhong Tang (Minor Construct the Middle Decoction): Guizhi, Shaoyao, Zhigancao, Shengjiang, Yitang.
Cold Strike Fu Organ Syndrome: Tao Ren Chengqi Tang (Peach Kernel Decoction to Order the Qi) [Taoren, Guizhi, Dahuang, Mangxiao, Zhigancao]. If after sweating or purging, there is inner vexation preventing sleep and chest oppression, use 14 Zhizi and 4 he of Xiangchi, boil, strain, and take warm; stop if vomiting occurs. After severe purging, if aversion to cold and epigastric obstruction persist, first resolve the aversion to cold with Guizhi Tang, then attack the obstruction with Dahuang and Huanglian (two ingredients, boiled, strained, taken warm). If epigastric obstruction is accompanied by aversion to cold and sweating, use Fuzi Xiexin Tang (Aconite Decoction to Drain the Epigastrium): Dahuang, Huanglian, Huangqin, Fuzi.
Wind-Cold Rain Meridian Syndrome: Da Qinglong Tang (Major Green Dragon Decoction) [Mahuang, Guizhi, Zhigancao, Xingren, Shengjiang, Dazao, Shigao].
Wind-Cold Rain Fu Organ Syndrome: Xiao Qinglong Tang (Minor Green Dragon Decoction) [Mahuang, Shaoyao, Wuweizi, Gancao, Ganjiang, Banxia, Guizhi, Xixin]. For thirst, remove Banxia and add Gualougen; for choking, remove Mahuang and add Fuzi; for difficulty urinating and lower abdominal fullness, remove Mahuang and add Fuling; for wheezing, remove Mahuang and add Xingren. If the condition persists after sweating or purging with irritability, treat with Fuling Sini Tang (Poria Frigid Extremities Decoction): Fuling, Renshen, Zhigancao, Ganjiang, Fuzi.
"On the second day, the Yangming meridian receives the pathogen" (Yangming refers to the meridian; Stomach refers to the fu organ. The meridian originates at the nose and forehead, follows the lateral side of the nose, and connects to the eye system). Dwelling in the realm of Wu Earth, originally endowed with Kun stillness, absorbing Li fire (Yangming pure heat), yet embracing the rigid pulse, floating and large, with irritability, thirst, eye pain, dry nose, and insomnia, this is Yangming meridian disease. If the pulse is floating and solid, with tidal fever, delirium, abdominal fullness, and hard stool, this is Stomach fu disease. Meridian disease is treated with Baihu Tang (White Tiger Decoction), and fu disease with the Three Chengqi Decoctions. This is the standard treatment for Zheng Yangming. Although the Six Meridians are divided into Yin and Yang, Yangming governs them. It is the place where the Six Meridians gather and return. There are categories for the accumulation of the Three Yangs and transformations for the Three Yins. Taiyang-Yangming involves infrequent bowel movements without distress (Pi Yue Wan); Shaoyang-Yangming involves intermittent irritability and difficulty passing stool (treat according to method). Severe abdominal pain due to excess appears in the Yangming section mixed with Taiyang (Guizhi Dahuang Tang); when earth is dry and water is depleted, Yangming mixes with Shaoyin (urgent purging), with a slippery pulse and cold extremities (heat inside, Baihu Tang); Jueyin also contains Yangming. Symptoms appear along the meridians, with profound implications beyond fixed formulas.
Yangming Meridian Syndrome: Baihu Tang (White Tiger Decoction) [Shigao, Jingmi, Zhimu, Zhigancao]. Appendix: Qian Zhongyang's Gegen Tang (Kudzu Decoction) [Gegen, Shengma, Baizhi, Zhigancao, Dazao, Shengjiang].
Yangming Fu Organ Syndrome: The Three Chengqi Decoctions. After sweating, vomiting, or purging, if there is slight irritability, frequent urination, and hard stool, use Xiaochengqi Tang (Minor Order the Qi Decoction): Dahuang, Houpo, Zhishi. If abdominal fullness exists, use Tiaoweichengqi Tang (Regulate the Stomach Order the Qi Decoction): Dahuang, Zhigancao, Mangxiao. If there is constipation, fever, and profuse sweating, use Dachengqi Tang (Major Order the Qi Decoction): Dahuang, Houpo, Zhishi, Mangxiao. Taiyang-Yangming with floating and choppy pulse uses Maren Pi Yue Wan (Hemp Seed Constriction Restriction Pill): Maren, Shaoyao, Zhishi, Dahuang, Houpo, Xingren. Shaoyang-Yangming is treated according to method, adjusting based on the deficiency or excess of the Stomach house. For purging, use Guizhi Dahuang Tang (see Shaoyin below). For urgent purging, use Dachengqi Tang.
Recorded Yangming Formulas: For yellow skin like orange peel with difficulty urinating, use Yinchen Hao Tang (Artemisia Capillaris Decoction): Dahuang, Yinchen, Zhizi. For yellow skin with fever, use Zhizi, Huangbai, Zhigancao.
"On the third day, the Shaoyang meridian receives the pathogen" (Shaoyang refers to the meridian; Gallbladder refers to the fu organ. The meridian follows the hypochondrium and connects to the ear). It combines the virtues of Wood and Fire (belongs to Jia Wood, houses Ministerial Fire), governing the gate of entry and exit (entering Taiyang, exiting Taiyin). Pathogen invading the meridian causes chest fullness, hypochondriac pain, and deafness; invading the fu organ causes bitter taste (Gallbladder heat steaming upward), vomiting (Gallbladder heat rushing upward), and dizziness (Gallbladder heat薰ing upward). Large pulses transform into wiry ones; hot symptoms turn into malaria-like patterns. Situated at the boundary of Yin and Yang (half-exterior, half-interior), connecting Yin and Yang; there are no formulas for sweating or purging, and these methods are prohibited. When pathogen and healthy qi stand off against each other, retreating and advancing mutually rejecting, Xiaochaihu Tang (Minor Bupleurum Decoction) is the general formula for harmonizing Shaoyang, but its variations require discrimination. Vomiting and abdominal pain (Gallbladder heat, Stomach cold) are separated by Yin and Yang using Huanglian Tang (Coptis Decoction); vomiting with hardness (Stomach excess) and irritability (depressed heat) are cleared from both exterior and interior using Dachaihu Tang (Major Bupleurum Decoction). Treatment should be effective; physicians should not use "harmonization" as an excuse.
Xiaochaihu Tang (Minor Bupleurum Decoction) [Chaihu, Huangqin, Renshen, Banxia, Zhigancao, Shengjiang, Dazao]. If chest fullness without vomiting, remove Banxia and Renshen, add Gualouren. If thirsty, remove Banxia, add Renshen and Huafen. If abdominal pain, remove Huangqin, add Shaoyao. If palpitations and difficulty urinating, remove Huangqin, add Fuling. Huanglian Tang (Coptis Decoction) [Huanglian, Zhigancao, Ganjiang, Renshen, Guizhi, Banxia, Dazao]. Dachaihu Tang (Major Bupleurum Decoction) [Chaihu, Banxia, Zhishi, Dahuang, Huangqin, Shaoyao, Shengjiang, Dazao]. Recorded Shaoyang Formulas: For slight hypochondriac tension and difficulty urinating, use Chaihu, Guizhi, Ganjiang, Huafen, Huangqin, Muli, Zhigancao. If after taking Chaihu Tang, thirst develops, treat as Yangming disease.
"On the fourth day, the Taiyin meridian receives the pathogen" (Note: Text says Taiyang, context implies Taiyin. Meridian; Spleen, zang organ. Meridian spreads in the stomach, connects to the throat. Pathogen enters Yin division, affecting both meridian and zang). The subtlety of Yin-Yang transformation may show no signs. When Yang pathogen enters Yin, both Cun and Chi pulses are deep, with abdominal fullness, vomiting, and spontaneous diarrhea. There are cold syndromes of abdominal fullness and intermittent pain (Lizhong Wan), and hot syndromes of abdominal fullness and solid pain (Guizhi Tang plus Dahuang). There are cold syndromes of slow vomiting after eating (Lizhong Wan generally treats), and hot syndromes of immediate vomiting after eating (Ganjiang Huanglian Tang). There are cold syndromes of spontaneous diarrhea without thirst requiring warming (Lizhong Wan generally treats), and hot syndromes of spontaneous diarrhea with foul matter requiring purging (Dachengqi Tang). Generally, human bodies vary in thickness, Qi in strength, and organs in inherent cold or heat, shifting according to constitution. One cannot simply assert that direct transmission is cold and meridian transmission is heat; how else to explain Zhang Zhongjing discussing cold and heat together on the fourth day?
Lizhong Wan (Regulate the Middle Pill) [Renshen, Baizhu, Zhigancao, Ganjiang], crushed and mixed with honey into pills the size of longan seeds, dissolved in boiling water, ground, and taken warm. Ganjiang Huanglian Tang (Dried Ginger and Coptis Decoction) [Ganjiang, Huanglian, Renshen].
"On the fifth day, the Shaoyin meridian receives the pathogen" (Shaoyang refers to the meridian; Kidney refers to the zang organ. The meridian connects to the root of the tongue). The life and safety of humans depend on Shaoyin. Disease presents with fine pulse, desire to sleep, spontaneous diarrhea, and cold extremities (cold hands/feet called Jue), dry mouth and tongue, thirst desiring water to save oneself. However, Water and Fire share the same palace, so distinction must be clear. Accompanied by water movement, it is a Yin pathogen; accompanied by fire movement, it is a Yang pathogen. Yin pathogen: pulse deep, fine, and slow; Yang pathogen: pulse deep, fine, and rapid. Yin pathogen: only desires sleep, no body heat; Yang pathogen: though desires sleep, heart is often irritable. Yin pathogen: diarrhea with undigested food; Yang pathogen: diarrhea with clear water. Yin pathogen: red face with interior cold, white urine; Yang pathogen: cold extremities with interior heat, red urine. Yin pathogen: dry mouth and tongue but moist; Yang pathogen: dry mouth and tongue until cracked. Yin pathogen: thirst desiring hot water to save oneself; Yang pathogen: thirst desiring warm water to save oneself. Clinical examination distinguishes them by hair's breadth.
Cold Syndrome Formula: For body pain, use Fuzi Tang (Aconite Decoction): Fuzi, Fuling, Renshen, Baizhu, Shaoyao. Sini Tang generally treats: Zhigancao, Ganjiang, Fuzi. For diarrhea, use Baitong Tang (Scallion Decoction): Congbai, Ganjiang, Fuzi. For cold extremities, irritability, and feeling like dying, use Wuzhuyu Tang (Evodia Decoction): Wuzhuyu, Renshen, Shengjiang, Dazao.
Hot Syndrome Formula: For irritability and inability to lie down, use Huanglian Tang (note: text lists Huangqin, Huanglian, Shaoyao, Jizihuang, Ejiao here, distinct from previous Huanglian Tang): Huangqin, Huanglian, Shaoyao, Jizihuang, Ejiao. For sore throat, use Ganjie Tang (Licorice and Platycodon Decoction): Gancao, Jiegeng. For mouth ulcers and dry throat, use Dachengqi Tang. For spontaneous diarrhea with clear green stool, heart pain, and dry mouth, use Dachengqi Tang.
"On the sixth day, the Jueyin meridian receives the pathogen" (Jueyin refers to the meridian; Liver refers to the zang organ. The meridian surrounds the genitalia, reaches the lower abdomen, and penetrates the diaphragm and heart). Transmission reaching Jueyin corresponds to the Chou hour, Winter season, and Kun hexagram. Pulse is fine, extremities are cold (Jue means reversal. Limbs are smooth when warm, reversed when cold), irritability, thirst, and testicular retraction. The symptoms remain similar, but the treatment is drastically different. Just as night ends and dawn approaches, looking around in gloom, there are pure cold without heat syndromes; just as heaven is cold and earth frozen, there is spring warmth within, pure heat without cold syndromes; when Yin condenses on Yang, there is battle, blood is yellow and black, and there are Yin-Yang mixed syndromes. Those with pure cold and Jue use Danggui Sini Tang (Angelica Decoction for Reversal), which everyone knows. The deeper the heat, the deeper the Jue; pure heat Jue is worse than pure cold Jue. Without urgent purging, water cannot be saved; how shall the physician decide (rapid pulse, dry throat, red urine)? Moreover, Yin-Yang mixed syndromes confuse people. At this time of Yin ending and Yang returning, transition of dark and light, Zhongjing established Wumei Wan (Mume Pill) to calm roundworms, but it actually treats Yin and Yang collectively. If a physician understands treating Jueyin, their medical Dao is nearly complete!
Pure Cold Syndrome: Danggui Sini Tang (Angelica Decoction for Reversal) [Danggui, Guizhi, Shaoyao, Xixin, Tongcao, Gancao, Dazao]. For diarrhea with undigested food, interior cold with exterior heat, sweating, and Jue, use Tongmai Sini Tang (Pulse-Unblocking Frigid Extremities Decoction).
Pure Heat Syndrome: Urgent purging with Dachengqi Tang (Major Order the Qi Decoction).
Yin-Yang Mixed Syndrome: Wumei Wan (Mume Pill): 300 Wumei, 6 liang Xixin, 10 liang Ganjiang, 16 liang Huanglian, 4 liang Danggui, 6 liang Fuzi, 4 liang Shuzhao, 6 liang Guizhi, 6 liang Renshen, 6 liang Huangbai. These ten ingredients are crushed and sifted together. Soak Wumei in vinegar overnight, remove pits, steam under five sheng of rice. When rice is cooked, mash into paste, mix with herbs, pound in mortar with honey two thousand times, form pills the size of paulownia seeds. Take ten pills before meals, three times daily, gradually increasing to twenty pills. Avoid raw/cold, slippery, and foul foods.
Recorded: Slippery pulse with Jue indicates heat inside, treat with Baihu Tang (White Tiger Decoction).
The Three Yin and Three Yang are clearly documented, but there are cases of treating exterior-interior urgency and interior-exterior urgency, where Yin resembles Yang, called Lianggan (Simultaneous disease of Taiyang-Shaoyin, Yangming-Taiyin, Shaoyang-Jueyin). Reading the classics, I find no treatment, and Zhongjing provides no formula, causing me to sigh deeply. My humble opinion: when exterior is heavier than interior, prioritize treating interior and slightly release exterior; when interior is heavier than exterior, purely treat interior. This is a limited view,不敢告人 (dare not tell others). Traveling widely, I have saved many people with this method.偶然捡 (accidentally found) Li Ting's *Shanghan Lun Yue*, which also has this view. Born late, how dare I compete with ancients? Yet, where the principle lies, ancient and modern views are somewhat similar. Qibo and Zhongjing, would they know I will accept Li Ting as a disciple? As for the Great Qianghuo Tang passed down in the world, it should be discarded. Regarding Hebing, Bingbing, Huaibing, Laofu, Shipfu, Jiuniufu, Yinyi, Yangyi, and Yinyiyi, having thoroughly penetrated the Six Meridians, handling them with ease. One hundred and thirteen formulas, summarizing key points; three hundred and ninety-seven methods, notes based entirely on original text. Polishing the pearls of Changsha (Zhongjing was Governor of Changsha, known as Zhang Changsha), transforming them into relics of Nirvana (place of Buddha's teaching. *Diamond Sutra*: "Enter Nirvana and liberate them").