古之医者有云，外病自经络入，内病自五脏郁发。然当求所以证验，庶无差失。如伤寒
有阴阳表里，阳证多语，阴证无声；阳证则昼剧，阴证则夜争；阳证似阴，粪黑而脉滑；阴
证似阳，面赤而脉微矣。身重背疼烦闷，狂言奔走，咽痛，身斑斑若绵文，或下痢赤黄，多
因妄服燥药热味，阳毒是也。背强腹中绞痛，身如被杖，燥渴呕泄，冷汗郑声，多因脾胃虚
寒，重感于寒，阴毒明矣。阴阳二厥，若阳厥，则指爪时温，或畏热，或饮水，或扬手掷足，
躁烦不得眠，大便秘，小便赤，外证多昏愦；阴厥则指爪常冷，足多挛卧，恶寒，自引衣盖
覆，不饮水，或下利或清便如常，小便数，外证惺惺而静。表证，多恶寒不渴，发热而身体
痛。里证，多渴，只恶热而喘满，口燥咽干，手心、腋下 汗出，大便硬，涎赤谵语。复
有伤寒初证，发热恶寒，无汗，其色凄惨，复见风则多寒，手足微厥，发热下利，手足温暖
者生，手足厥逆，灸不温，证之极矣。中寒则口噤，四肢强直，失音不语，或卒然晕倒，吐
逆涎沫，手足挛搐，状如暗风。或复燥热伤风，有汗恶风，面色光而不惨，复见寒，手足微
温，发热多烦。其或中者，半身不遂，手足瘫痪，涎潮昏塞，口眼 斜，肌肤麻痹。归于六
腑者，物为偏缓，犹可苟延岁月。归于五脏者，眼闭口开，手散，声如鼾睡。遗尿，恶证迭
出，朝不及夕。伤暑，身热，恶寒，头痛，或烦而渴，眩晕，背寒面垢，或呕或泄。其中入
心，使人噎闷，昏不知人；入肝则眩晕顽痹；入脾则昏睡不觉；入肺则喘满痿 ；入肾则消
渴利小便。至于伤湿身重，关节重疼，发热恶寒，大便泄而小便涩，腰脚冷而腿膝浮，或自
利不渴。若气不平，中之亦使人半身不遂，口眼 斜，涎潮昏塞。又如七情，喜伤心者，不
可疾行，不可久立；怒伤肝者，上气不可忍，热来荡心，短气欲绝不得息；忧伤肺者，心系
急，上焦闭，营卫不通，夜卧不安；思伤脾者，气留不行，积聚中脘，不得饮食，腹胀满，
四肢怠惰；悲伤心胞者，善忘，不识人，置物在处，还取不得，筋挛，四肢浮肿；恐伤肾者，
上焦气闭不行，下焦回还不散，犹豫不决，呕逆恶心；惊伤胆者，神无所归，虑无所定，说
物不意而道。凡此七者，证虽不同，本乎一气。脏气不行，郁而不舒，结成痰涎，随气积聚
坚大如块，在心腹间，或塞咽喉，如粉絮梅核样，咯不出，咽不下，每发欲绝，逆害饮食。
若诸虚损证，则眩晕眼花，鼻多清涕，漩浊遗精，冷滑洞泄，水谷不化，洒淅自汗，呕吐清
痰，皆阳虚阴盛也。诸实热则五脏积热，口若咽干苦唇裂生疮，肠胃干涩，烦躁喜冷，涎唾
稠实，眵泪眼赤，或遍体痈疡。至于总说，则 疟证惟多，先寒后热名寒疟，先热后寒名温
疟，但热不寒名暑疟，寒热身重烦疼胀满名湿疟，寒多不热名牝疟。若一日一发则易愈，二
日一发犹可，三日一发则难痊。且斯疾俗在忌医之列，然得其所因，何忌其难。时疫证杂，
发热，腰痛强急，脚缩不伸， 中欲折，目中生花，或涩涩增寒复热，名曰温疫。身体颤掉
，不能自禁，或内热口干舌破，咽塞声嘶，名曰燥疫。头重颈直，皮肉强痹，或蕴而结核起
于咽喉颈项之侧，布热毒于皮肤分肉之中，名曰寒疫。乍寒乍热，损肺伤气，暴嗽呕逆，或
体热发斑，喘咳引气，名曰湿疫。四时之感，其证百端，皆常因其时而详辨则得之。喘急为
患，吐痰续续则生。自汗谵语，目直视则亡。失血诸证，有暴吐鼻衄，泄出或一二升至斗余
者。因感四气，流传经络，阴阳相胜，或怒气伤肝。风入肠胃，故血得寒则凝泣，得热则淖
溢，各随脏腑经络涌溢，凝停胸胃，因即满闷，或吐或衄或泄下。复有咳嗽中见红丝者，为
难愈。无故忽然泻下黑血，名心绝。痨瘵之证，得之者多讳而未肯求医，殊不知其根有虫啮
其心肺，可不深忧。中蛊毒之候，令人心腹绞痛，如物啮状，吐、下血如烂肉。若欲验其证
状，先令病患唾于水中，若沉即其实矣。消渴与漩浊为邻，慎莫作疽疮等证，鲜有安之日矣
。至于下痢，身凉能食，小便通易安；体热多汗，渴甚，小便不利，或手足厥冷，灸不温，
兼微喘不食者死。二便秘涩之证，暂秘，小漩还有点滴利者，易愈。若秘日久，膨上心胸切
痛，气促身冷，面色黑，前后俱无，名曰气实，转盼而殂。胀满得之未久，或胀或消，腹皮
稍软，不泄不喘，随治随瘥。若脐心突起，利后复胀急，久病羸之，喘息不得安，名曰脾肾
俱败，无有愈期。肿满善证，男从上肿下，女从下肿上，所患未久，利漩退肿定喘则愈矣。
若证不善，则手足盘骨肿，脐与掌心俱凸，咳嗽失声，青筋纹横肚上，及爪甲青卒肿，头
面苍黑，呕吐头重，岂复能救。霍乱一证，犹为卒暴之最，盖人之起居无常，摄调不善，挥
霍之至，便至变乱，闷绝不救，甚为可畏。临深履薄，纵蹈虎尾，不足以谕其危。其如厉风，
名大风恶疾，故其色败皲裂，疡溃眉面，白皮如蛇蜕，久则鼻梁塌坏，又名风癞，十无一生。
若症瘕之为病，症者坚也，坚则难破，瘕者假也，假物成形能动者是。至于蛟龙蛇鳖肉发虱
米之证，初非定名，偶因食物相感，而致斯患。梦寐不详，多生恐怖，为祟惑证矣。吁！内
外
古代医生曾说，外感病邪从经络传入体内，内伤病则由五脏气机郁滞而引发。然而应当寻求确切的证据来验证，以免出现差错失误。例如伤寒病有阴证和阳证、表证和里证的区别：阳证患者多言语不休，阴证患者则沉默无声；阳证在白天加重，阴证在夜间加剧；阳证看似阴证，表现为大便黑色但脉象滑利；阴证看似阳证，表现为面色发红但脉象微弱。身体沉重、背部疼痛、烦闷不安、胡言乱语、奔跑不止、咽喉疼痛、身上出现斑纹如同绵纹，或者下痢赤黄色粪便，这大多是因为误服燥热药物或食用辛辣热性食物所致，属于阳毒病。背部僵硬、腹部绞痛、身体感觉像被棍棒打过一样疼痛、口干烦躁、呕吐泄泻、出冷汗且语言重复（郑声），这大多是因为脾胃虚寒，再次感受寒邪所致，属于阴毒病无疑。
阴阳两种厥逆证，如果是阳厥，则手指脚趾有时温暖，或者怕热，或者想喝水，或者扬手掷足，躁动心烦无法入睡，大便秘结，小便颜色深红，外部症状多表现为神志昏沉迷糊；如果是阴厥，则手指脚趾经常冰冷，双脚多蜷缩卧倒，怕冷，自己拉过衣服覆盖身体，不想喝水，或者下利清谷或者大小便正常，小便频数，外部症状表现为神志清醒而安静。表证，多表现为怕冷而不口渴，发热且身体疼痛。里证，多表现为口渴，只怕热并且气喘胸闷，口干燥咽干，手心、腋下出汗，大便干硬，唾液发黄且胡言乱语。
又有伤寒初期的症状，发热怕冷，无汗，面色凄惨，再次遇到风邪则更加怕冷，手脚微微发凉，如果发热同时伴有下利，但手脚温暖的是可生之兆；如果手脚厥冷，艾灸后也不回暖，这是病情极重的表现。中寒证则表现为牙关紧闭，四肢强直，失音不能说话，或者突然晕倒，呕吐逆出涎沫，手脚痉挛抽搐，症状类似中风暗哑。或者是再次感受燥热伤风，有汗怕风，面色光亮而不凄惨，再次遇到寒冷，手脚微微温暖，发热且多烦躁。如果是中风的，则半身不遂，手脚瘫痪，痰涎上涌导致神志昏塞，口眼歪斜，肌肤麻木。病邪归于六腑的，病情相对缓慢，还可以苟延残喘多年。病邪归于五脏的，则眼睛闭合、嘴巴张开、双手散开、声音如打鼾睡熟，遗尿，恶证接连出现，早晨还活着晚上就去世了。
伤暑证，身体发热，怕冷，头痛，或者烦躁口渴，眩晕，背部发冷面部油腻污垢，或者呕吐或者泄泻。如果病邪入心，使人噎闷，昏迷不知人事；入肝则眩晕且肢体顽痹；入脾则昏睡不醒；入肺则气喘胸闷且肢体痿软；入肾则消渴且小便频多。至于伤湿证，身体沉重，关节重痛，发热怕冷，大便泄泻而小便涩滞，腰脚寒冷且腿膝浮肿，或者自利而不口渴。如果气机不平，中邪也会使人半身不遂，口眼歪斜，痰涎上涌神志昏塞。
又如七情致病：喜伤心者，不可快步行走，不可久站；怒伤肝者，气机上逆难以忍受，热气冲荡心胸，短气几乎要断绝无法呼吸；忧伤肺者，心系拘急，上焦闭塞，营卫之气不通畅，夜晚睡眠不安；思伤脾者，气机停留不行，积聚在中脘，不能饮食，腹胀满，四肢懈怠懒惰；悲伤心包者，容易遗忘，不认识人，东西放在某处却找不着，筋脉挛急，四肢浮肿；恐伤肾者，上焦气机闭塞不行，下焦气机回环不散，犹豫不决，呕吐恶心；惊伤胆者，神志无所归依，思虑没有定准，说话不经思考脱口而出。凡是这七种情况，症状虽然不同，根本都在于一气。脏气运行不畅，郁结而不能舒展，凝结成痰涎，随着气机积聚变坚硬大如块状，在心腹之间，或者堵塞咽喉，像粉絮梅核样，咳不出来，咽不下去，每次发作想要断气，阻碍饮食。
如果是各种虚损证，则眩晕眼花，鼻流清涕，小便浑浊遗精，冷滑洞泄，水谷不消化，洒淅自汗，呕吐清稀痰液，这都是阳虚阴盛的表现。各种实热证则是五脏积热，口苦唇裂生疮，肠胃干涩，烦躁喜欢冷饮，唾液稠厚，眼屎泪水多且眼红，或者全身痈疡。至于总括来说，疟疾证候很多，先冷后热名为寒疟，先热后冷名为温疟，只有热没有冷名为暑疟，冷热身重烦疼胀满名为湿疟，冷多热少名为牝疟。如果一天发作一次则容易痊愈，两天发作一次还可以，三天发作一次则难治愈。而且这种病俗世中列为忌讳就医之列，但如果找到病因，何必忌讳其难治。时疫证候复杂，发热，腰痛强直，脚收缩不能伸直，膝盖欲折，眼中生花，或者忽冷忽热反复发热，名为温疫。身体颤抖抖动，不能自我控制，或者内热口干舌破，咽喉堵塞声音嘶哑，名为燥疫。头重颈项僵硬，皮肉强直麻痹，或者蕴结结核起于咽喉颈项侧面，将热毒散布于皮肤肌肉之中，名为寒疫。忽冷忽热，损伤肺气和元气，突发咳嗽呕吐逆出，或者身体发热发斑，气喘咳嗽引动气息，名为湿疫。四季的感受，证候百端，都是常常因为顺应时节详细辨别才能确诊。
喘急为患，吐痰连续不断则生机尚存。自汗胡言乱语，眼睛直视则死亡。失血诸证，有突然吐血或鼻出血，流出量有一二升到一斗多的。因为感受四时之气，流传于经络，阴阳相互胜负，或者怒气伤肝。风邪进入肠胃，所以血液遇寒则凝滞，遇热则泛滥溢出，各自随着脏腑经络涌溢，凝停于胸胃，因此感到满闷，或者吐血或者衄血或者泄下。又有咳嗽中带红丝的，为难愈之症。无故忽然泻下黑血，名为心绝。痨瘵之证，得此病的人大多隐瞒而不肯求医，殊不知其根源是有虫蛀蚀心肺，怎能不深深忧虑。中蛊毒的症状，令人心腹绞痛，像有东西啃咬的样子，呕吐、排泄出的血像烂肉。如果要验证其症状，先让病人吐口水在水中，如果下沉就是真的了。消渴与小便浑浊相邻近，千万不要当作疽疮等证治疗，很少有安宁的日子了。至于下痢，身体凉爽能进食，小便通畅容易治疗；身体发热多汗，极度口渴，小便不利，或者手脚厥冷，艾灸不回暖，兼轻微气喘不能进食的则死。二便秘涩之证，暂时便秘，小便还有点滴排出的，容易痊愈。如果便秘日久，膨胀上至心胸剧烈疼痛，气促身冷，面色黑，前后二便俱无，名为气实，转眼就会死亡。胀满得病不久，或者胀或者消，腹皮稍软，不泄不喘，随治疗随即好转。如果肚脐突起，泻后复又胀急，久病消瘦，喘息不得安，名为脾肾俱败，没有痊愈的日期。肿满善证，男性从上肿向下发展，女性从下肿向上发展，患病不久，利尿消肿平喘则痊愈。如果证候不善，则手足盘骨肿胀，肚脐与掌心都凸起，咳嗽失声，青筋纹路横贯腹部，以及指甲青紫突然肿胀，头面苍黑，呕吐头重，岂能再救。霍乱一证，尤为猝暴之最，大概人的起居无常，调养不善，挥霍至极，便至变乱，闷绝不救，非常可怕。面临深渊脚踏薄冰，即使踩到虎尾，也不足以比喻其危险。至于厉风，名为大风恶疾，所以面色败坏皲裂，溃疡溃烂眉毛面部，白皮如蛇蜕皮，久了鼻梁塌陷毁坏，又名风癞，十无一生。如果是症瘕这类病，症是指坚硬，坚硬则难破除，瘕是指假象，借物成形且能移动的是瘕。至于蛟龙蛇鳖肉发虱米之证，起初并非定名，偶然因食物相感，而导致此患。梦寐不详，多生恐怖，成为祟惑证了。唉！内外……
Ancient physicians stated that external pathogens enter the body via the meridians, while internal diseases arise from the stagnation and eruption of the five Zang organs. However, one must seek definitive evidence to verify diagnoses, thereby avoiding errors. For instance, in Shanghan (Cold Damage) disease, there are Yin and Yang, Exterior and Interior patterns. Yang patterns often present with excessive talking, whereas Yin patterns are silent; Yang patterns worsen during the day, while Yin patterns intensify at night; a Yang pattern may mimic a Yin pattern, presenting with black stool but a slippery pulse; conversely, a Yin pattern may mimic a Yang pattern, presenting with a red face but a faint pulse.
Symptoms such as heavy body, back pain, restlessness, delirious speech, running about, sore throat, mottled skin resembling cotton textures, or dysentery with red and yellow stools, are often caused by the reckless consumption of drying-hot medicines or spicy-hot foods, constituting Yang Du (Yang Toxin). Stiffness of the back, colicky abdominal pain, a sensation as if beaten by a club, dry thirst, vomiting and diarrhea, cold sweating, and repetitive speech (Zheng Sheng) are clearly due to deficiency-cold of the Spleen and Stomach compounded by secondary exposure to cold, constituting Yin Du (Yin Toxin).
Regarding the two types of Jue (Reversal/Cold Extremities) syndromes: in Yang Jue, the fingernails and toenails are sometimes warm, or the patient fears heat, desires water, throws hands and feet about, is irritable and restless unable to sleep, has constipation, dark urine, and exterior signs of confusion and stupor. In Yin Jue, the nails and toes are constantly cold, legs are often curled up, the patient fears cold, pulls clothes to cover themselves, does not desire water, may have clear diarrhea or normal bowel movements, frequent urination, and exterior signs of being alert yet quiet.
Exterior patterns typically present with aversion to cold without thirst, fever, and body pain. Interior patterns typically present with thirst, aversion only to heat, panting and fullness, dry mouth and throat, sweating in the palms and axillae, hard stool, yellow saliva, and delirious speech.
In the initial stage of Shanghan, symptoms include fever, aversion to cold, anhidrosis, and a miserable complexion. If exposed to wind again, aversion to cold increases, and extremities are slightly cold. If fever is accompanied by diarrhea but extremities remain warm, prognosis for survival is good; if extremities are cold and do not warm even after moxibustion, the condition is extreme. Zhong Han (Mid-Cold) presents with locked jaw, rigid limbs, aphonia, sudden fainting, vomiting of frothy saliva, and convulsions of hands and feet, resembling stroke (An Feng). Alternatively, re-exposure to dry-heat wind injury presents with sweating, aversion to wind, a lustrous rather than miserable complexion, slight warmth in extremities upon cold exposure, fever, and irritability. If it is Wind Stroke (Zhong Feng), there is hemiplegia, limb paralysis, flooding of phlegm causing stupor, deviation of mouth and eyes, and numbness of skin and muscles. If the pathogen resides in the Six Fu organs, the course is relatively slow, allowing life to be prolonged for years. If it resides in the Five Zang organs, symptoms include closed eyes, open mouth, scattered hands, snoring-like sounds, enuresis, and successive malignant signs leading to death within a day.
Shang Shu (Summerheat Injury) presents with fever, aversion to cold, headache, irritability, thirst, dizziness, cold back, and greasy face, possibly with vomiting or diarrhea. If the pathogen enters the Heart, it causes chest oppression and unconsciousness; if it enters the Liver, it causes dizziness and stiff paralysis; if it enters the Spleen, it causes deep sleep and unawareness; if it enters the Lungs, it causes panting, fullness, and flaccidity; if it enters the Kidneys, it causes Xiao Ke (Wasting-Thirst) and frequent urination. Regarding Shi (Dampness) injury, symptoms include heavy body, heavy joint pain, fever, aversion to cold, loose stools, scanty urine, cold waist and legs, swollen knees, or spontaneous diarrhea without thirst. If Qi is unbalanced, pathogenic invasion can also cause hemiplegia, facial deviation, phlegm flooding with stupor.
Regarding the Seven Emotions: Joy injuring the Heart contraindicates fast walking or standing for long periods. Anger injuring the Liver causes rebellious Qi that is unbearable, heat rushing to the heart, shortness of breath nearly to cessation. Sorrow injuring the Lungs causes tightness of the Heart vessel, closure of the Upper Jiao, obstruction of Ying and Wei Qi, and restless sleep. Overthinking injuring the Spleen causes Qi stagnation, accumulation in the Middle Jiao, inability to eat, abdominal distension, and limb lethargy. Grief injuring the Pericardium causes forgetfulness, failure to recognize people, inability to find misplaced objects, tendon cramping, and limb edema. Fear injuring the Kidneys causes closure of Upper Jiao Qi and stagnation of Lower Jiao Qi, indecision, vomiting, and nausea. Shock injuring the Gallbladder causes loss of spirit anchoring, unsettled thoughts, and impulsive speech. Although these seven manifestations differ, they all stem from Qi. When Zang Qi fails to circulate, stagnation leads to the formation of phlegm-saliva, which accumulates into hard masses in the chest and abdomen or blocks the throat like a plum pit, difficult to expectorate or swallow, causing near-fainting episodes and hindering diet.
Various deficiency-consumption patterns present with dizziness, blurred vision, clear nasal discharge, turbid urine with spermatorrhea, cold watery diarrhea, undigested food, spontaneous sweating, and vomiting of clear phlegm, all indicating Yang deficiency and Yin excess. Various excess-heat patterns involve accumulation of heat in the five Zang organs, bitter taste, cracked lips with sores, dry intestines and stomach, irritability preferring cold, thick saliva, excessive eye discharge, red eyes, or generalized carbuncles.
Generally speaking, Malaria patterns are numerous: Chuan Nue (Cold Malaria) starts with chills then fever; Wen Nue (Warm Malaria) starts with fever then chills; Shu Nue (Summerheat Malaria) has fever without chills; Shi Nue (Damp Malaria) has chills, fever, heaviness, pain, and distension; Pin Nue (Female Malaria) has more chills than fever. Daily attacks are easy to cure; every-other-day attacks are manageable; every-three-day attacks are difficult to cure. Although this disease is traditionally avoided by doctors, knowing the cause removes the difficulty. Yi Ji (Epidemic Disease) presents with complex symptoms: fever, stiff lower back pain, contracted legs unable to extend, feeling as if knees will break, visual disturbances, alternating chills and fever, named Wen Yi. Trembling uncontrollably, internal heat, dry mouth, tongue ulcers, throat blockage, and hoarseness constitute Zao Yi (Dry Epidemic). Heavy head, stiff neck, rigid skin and muscles, or nodules arising on the sides of the throat and neck with heat-toxin spreading in skin and muscle layers constitute Han Yi (Cold Epidemic). Alternating chills and fever, damaging Lung Qi, sudden cough and vomiting, or fever with macules, panting, and coughing constitutes Shi Yi (Damp Epidemic). Seasonal infections manifest in hundreds of ways; accurate diagnosis requires careful differentiation according to the season.
Panting with continuous sputum indicates survival; spontaneous sweating, delirium, and fixed gaze indicate death. Hemorrhagic patterns include sudden hematemesis or epistaxis, ranging from one or two sheng to over a dou. Caused by four Qi pathogens circulating through meridians, winning/losing between Yin and Yang, or anger injuring the Liver, wind entering the intestines/stomach causes blood to coagulate in cold and overflow in heat, surging through organs and meridians, stopping in the chest/stomach, causing fullness, hematemesis, epistaxis, or bloody diarrhea. Cough with red threads is difficult to cure. Sudden passage of black blood indicates Heart exhaustion. Lao Zhai (Consumptive Disease) is often hidden by patients who refuse treatment, unaware that worms gnaw the lungs and heart, warranting deep concern. Gu Du (Gu Poison) presents with colicky abdominal pain as if bitten, vomiting and defecating blood resembling rotten meat. Verification involves spitting into water; sinking indicates authenticity. Xiao Ke adjacent to turbid urine should not be mistaken for abscesses, or peace is unlikely.
For dysentery: cool body, ability to eat, and free urination indicate ease of cure. Fever, profuse sweating, severe thirst, obstructed urination, cold extremities unresponsive to moxa, mild panting, and anorexia indicate death. Constipation with occasional urinary drops is easy to cure. Prolonged constipation with upper abdominal pain, shortness of breath, cold body, black face, and total obstruction of bowels/bladder is Qi Excess, leading to rapid death. Distension recent in onset, fluctuating, with soft abdomen, no diarrhea/panting, responds well to treatment. Protruding umbilicus, post-evacuation urgency, chronic emaciation, and restless panting indicate Spleen and Kidney failure, with no hope of recovery. Favorable edema descends from top to bottom in men and bottom to top in women; early intervention with diuretics reduces swelling and calms panting, leading to cure. Unfavorable edema presents with swollen limbs, protruding umbilicus and palms, voice loss, transverse blue veins on abdomen, cyanotic swollen nails, dark face, vomiting, and heavy head, rendering it incurable. Huo Luan (Cholera/Vomiting-Diarrhea) is the most acute, caused by irregular lifestyle and poor regulation; sudden chaos leads to suffocation and death, very fearful. Approaching danger is likened to treading on tiger tails. Li Feng (Malignant Wind/Leprosy), also called Da Feng or Feng Lai, presents with ruined cracked skin, ulcerated brows/face, snake-skin peeling, collapsed nose bridge, and is fatal in ten out of ten cases.
Zheng Zha (Masses): Zheng is hard and difficult to break; Zha is false/shifting, taking shape from external factors. Conditions like dragon/snake/turtle meat reactions or lice/rice grains are not fixed names but result from food interactions. Bad dreams and fear constitute Gui Huo (Spirit Affliction). Alas! Internal and external...