自序又云。撰用素问九卷。八十一难。阴阳大论。胎胪药录。并平脉辨证。作伤寒杂病论合十六卷。盖伤寒三阴
三阳。乃原于素问九卷。伤寒中风温病等之目。本于八十一难。其他如阴阳大论。虽未知何等书。然要之纂旧典
之文。而编着者。非悉仲景之创论立方也。元吴澄作活人书辨序曰。汉末张仲景着伤寒论。予尝叹东汉之文气。
无复能如西都。独医家此书。渊奥典雅。焕然三代之文。心一怪之。及观仲景于序。卑弱殊甚。然后知序乃仲景
自序。而伤寒论。即古汤液论。盖上世遗书。仲景特编纂云尔。吴氏此说。原于士安。其论未可定然。但至论文
章之更变。则虽非我医家所能及。似宜以资考镜也。林亿等校定序曰。张仲景汉书无传。见名医录。云。按皇甫
谧甲乙经序。晋书皇甫谧传。其被称于当时可见。晋去汉不远。其言如此。仲景虽于汉书无传。其为汉末人无疑
矣。后汉书刘表传曰。建安三年。长沙太守张羡率零陵桂阳三郡畔表。表遣兵攻围。破羡平之。英雄记曰。张羡
南阳人。盖仲景羡之族。岂表破羡之后。使仲景代之乎。林亿等校定序又曰。自仲景于今。八百余年。惟王叔和
能学之。成无己亦曰。仲景之书。逮今千年。而显用于世者。王叔和之力也。盖仲景书。当三国兵燹之余。残缺
失次。若非叔和撰集。不能延至于今。功莫大矣，而明洪武中芗溪黄氏作伤寒类证辨惑曰。仲景之书。六经至劳
复而已。其间是三百九十七法。一百一十三方。纤悉毕备。有条而不紊也。辨脉平脉伤寒例三篇。叔和采摭群书。
附以己意。虽
间有仲景说。实三百九十七法之外者也。 湿 一篇。出金匮要略。叔和反编入于六经之右。又有汗吐下可不可。
并汗吐下后证。叔和重集于篇末云。此说原乎王履溯洄集。但履以伤寒例。为仲景旧文也。从此而降。方有执喻
昌柯琴辈。从而宗其说。或驳或贬。以加诋 。如序例。则云搜采仲景旧论。外台乃载其文。揭以王叔和曰。则
此一篇。叔和所撰。非敢伪托而作也。至辨脉。平脉。汗吐下可不可等篇。叔和既于脉经中引其文。以为仲景语。
高湛养生论曰。王叔和性沉静。好着述。考核遗文。采摭群言。撰脉经十卷。叔和脉经序亦曰。今撰集岐伯以来。
逮于华佗经论要决。合为十卷。其王阮傅戴吴葛吕张所传异同。咸悉载录。伤寒例固多不合仲景之绳墨。而言属
荒谬者。然叔和亦一名士也。岂有以我所立论。嫁名于前贤。而为采摭于已着书中。如毒手狡狯之伎俩乎。阴阳
五行汉儒好谈之。五脏六腑，经络流注。史记扁仓传。间及于此。汉志亦重载其书目。仲景生于汉末。何独屏去。
今根据临川吴氏之言而考之。如六经至劳复。文辞典雅蕴奥者，系于所撰用古经之文。其他言涉迂拘。而文气早弱。
世人以为叔和所羼入者。岂知非却是仲景之笔乎。因意伤寒例。及原文中。或曰。疑非仲景方。或曰。无大黄恐
不为大柴胡汤。或本云等之语。皆叔和所录，其语气明显。此余尽是仲景旧文。而其义前后矛盾。文理暧昧难晓
者。古书往往有之。又何疑焉。方喻诸家。逐条更定。删改字句。以为复仲景之旧。殊不知益乖本来。惑乱后人。
莫此为甚。视诸叔和。其功罪之轻重。果奈何也。张遂辰仲景全书卷首。载医林列传曰。王叔和撰次张仲景方论。
为三十六卷。大行于世。此原出于太平御览。引高湛养生论。然隋志等。不载三十六卷目。汪琥曰。仲景为伤寒
杂病论十六卷。叔和编次。何至遽增二十卷书邪。则云三十六卷。误矣。要之伤寒论一部。全是性命之书。其所
关系大矣。故读此书者。涤尽胸中成见。宜于阴阳表里。虚实寒热之分。发汗吐下。攻备和温之别。而痛着工夫。
欲方临证处疗。身亲试验之际。而无疑殆也。其中或有条理 牾。字句钩棘。不易晓者。勿敢妄为穿凿。大
抵施之行事。深切着明者。经义了然。无太难解者。太阳病。头痛发热。汗出恶风者。桂枝汤主之之类。岂不至
平至易乎。学人就其至平至易处。而细勘研审。辨定真假疑似之区别。而得性命上之神理。是为之得矣。其所难
解释。诸家费曲说者。纵令钻究其旨。不免隔靴抓痒。如以其不的确明讲者。施之于方术。则害于性命。亦不可
测。然则其所难解释者。置诸阙如之例而可也。谚云。开卷了然。临证茫然。是医家之通患。学人宜致思于此。
亦何苦以诋诘古人为事乎哉。
又按南阳府志载清张三翼募建张医圣祠序。桑芸张仲景先生祠墓记。称南阳郡东南阜处。父老相传。为先生
墓。与故宅存在。洪武初。有指挥郭云仆其碑。墓遂没。越二百六十余年。为崇祯戊辰，有兰阳诸生冯应鳌者。
感寒疾殆危。恍惚中。有神人抚体。百节通快。问之曰。汉长沙太守南阳张仲景也。城东四里许有祠。祠后七十
七步有墓。今将凿井其上。封之惟子。后病愈。千里走南阳。访之不可得。因谒三皇庙。有仲景像。即纪石庙中
而去。后数年。园丁掘井得石碣。题曰汉长沙太守医圣张仲景墓云。其言荒唐不足信矣。三异序中。仲景名作玑。
字考机古与玑通。书舜曲。璇玑玉衡。释文云。玑。本作机。晋书陆机字士衡。可以证矣。
自序中又说：（我）撰写本书时，参考了《素问》九卷、《八十一难》、《阴阳大论》、《胎胪药录》，并结合平脉与辨证的方法，编写成《伤寒杂病论》，共十六卷。大概伤寒中的三阴三阳病证，原本源于《素问》九卷；伤寒、中风、温病等病名，本于《八十一难》。其他如《阴阳大论》，虽然不知道具体是哪本书，但总之是编纂旧典文献而编著的，并不全是张仲景的独创理论和处方。元代吴澄作《活人书辨序》说：汉代末年张仲景撰写《伤寒论》，我曾感叹东汉的文风气势，再也没有能像西汉那样，唯独医家的这本书，深奥典雅，光彩照人如同夏商周三代的文章，心里对此感到奇怪。等到看到张仲景在序言中自谦之辞非常卑微软弱，这才知道序言乃是张仲景的自序，而《伤寒论》，就是古代的《汤液经法》，大概是上古遗留下来的书籍，张仲景只是特别对其进行编纂罢了。吴氏的这个说法，源自皇甫士安（皇甫谧），其论点未必可以断定正确。但是谈到文章风格的变迁，即使是非医家所能企及，似乎也适宜用来作为考证借鉴的材料。林亿等人校定序中说：张仲景在《汉书》中没有传记，见于《名医录》。称：按照皇甫谧《甲乙经》序和《晋书·皇甫谧传》，他当时受到的称赞可见一斑。晋朝距离汉朝不远，他的言论如此。张仲景虽然在《汉书》中没有传记，但他无疑是汉末的人。《后汉书·刘表传》记载：建安三年，长沙太守张羡率领零陵、桂阳三郡背叛刘表，刘表派遣军队攻打包围，击败并平定了张羡。《英雄记》记载：张羡是南阳人，大概是张仲景的同族。难道是刘表击败张羡之后，让张仲景接替了他的职位吗？林亿等人的校定序又说：自从张仲景到现在，八百多年，只有王叔和能学习他的医术。成无己也说：张仲景的书，到现在一千年，而在世上显扬使用的，是王叔和的力量。大概张仲景的书，当经历三国战乱兵火之后，残缺且次序混乱，如果不是王叔和整理编纂，不能流传至今，功劳没有比这更大的了。然而明代洪武年间，芗溪黄氏作《伤寒类证辨惑》说：张仲景的书，从六经病到劳复病而已，其中包含三百九十七法和一百一十三方，细致完备，有条理而不混乱。《辨脉》、《平脉》、《伤寒例》三篇，是王叔和采集群书，附加自己的见解，虽然间或有张仲景的说法，实际上是在三百九十七法之外的内容。《湿病》一篇，出自《金匮要略》，王叔和反而将其编排在六经篇目的右侧。又有汗法、吐法、下法的可用与不可用，以及汗吐下后的证候，王叔和重新集结在篇章末尾。这种说法原本源于王履的《溯洄集》，但王履认为《伤寒例》是张仲景的原文。从此以后，方有执、喻昌、柯琴等人，从而尊崇这种说法，有的驳斥有的贬低，加以诋毁。比如对于序例，则声称是搜集采择张仲景的旧论，《外台秘要》乃记载其文字，揭示说是王叔和所说，那么这一篇，就是王叔和所撰写的，不敢伪托而作。至于《辨脉》、《平脉》、汗吐下可不可等篇，王叔和既然在《脉经》中引用其文字，认为是张仲景的话。高湛《养生论》说：王叔和性格沉静，喜好著述，考核遗文，采集众言，撰写《脉经》十卷。王叔和《脉经》序也说：现在编纂收集自岐伯以来，直到华佗的经论要诀，合为十卷。其中王、阮、傅、戴、吴、葛、吕、张各家传承的异同，都全部记录收录。《伤寒例》固然有很多不符合张仲景的法度，言辞荒谬，但王叔和也是一位名士，难道会有把我所立的论点，嫁名给前贤，而在自己已著的书中采集收录，使用这种毒辣狡诈的手段吗？阴阳五行是汉代儒生喜欢谈论的，五脏六腑、经络流注，《史记·扁鹊仓公列传》中间提及于此，《汉书·艺文志》也大量重载其书目。张仲景生于汉末，为何独自摒弃不去？现在根据临川吴氏的话来考证，如从六经到劳复，文辞典雅深奥的，属于他所参考使用的古经文献。其他言辞涉及迂腐拘泥，而文气早已衰弱的，世人认为是王叔和掺入的，哪里知道这不正是张仲景的笔迹呢？因此推测《伤寒例》，以及原文中“有人说”、“怀疑不是张仲景的方子”、“或者原本说是‘等’”之类的语句，都是王叔和所记录的，其语气明显。这些都是张仲景的旧文，而其义前后矛盾，文理暧昧难以理解，古书往往有这样的情况，又有什么可疑的呢？方有执、喻昌诸家，逐条更定，删改字句，以为恢复张仲景的原貌，殊不知更加背离本来面目，迷惑扰乱后人，没有比这更严重的了。与王叔和相比，他们的功过轻重，究竟如何呢？张遂辰《仲景全书》卷首，载有《医林列传》说：王叔和编纂张仲景方论，为三十六卷，广泛流行于世。这原本出于《太平御览》引用高湛《养生论》，然而《隋书·经籍志》等，不记载三十六卷的目录。汪琥说：张仲景作《伤寒杂病论》十六卷，王叔和编次，怎么会突然增加二十卷书呢？所以说三十六卷是错误的。总之，《伤寒论》一部，全是关乎性命的书，其所关系重大。所以读这本书的人，应涤尽胸中的成见，适宜于阴阳、表里、虚实、寒热的区分，发汗、吐下、攻补、和温的区别，而痛下功夫，想要在面临临床治疗，亲身试验之际，而没有疑惑迟疑。其中或许有条理违背、字句艰涩，不易理解的，不敢妄加穿凿附会。大致施行于行事，深切显著明白的，经义了然，没有太难理解的，如太阳病（太阳经受邪所致的病证），头痛发热，汗出恶风者，用桂枝汤（Cinnamon Twig Decoction）主治之类，岂不极其平常简易吗？学者就在其极其平常简易之处，而仔细勘验研究审察，辨别确定真假疑似的区别，而得到性命上的神妙道理，这就是有所得了。那些难以解释的，诸家费尽心思曲解的，纵然钻研探究其旨意，不免隔靴搔痒，如果以其不确切明确讲解的，施之于方术，则危害性命，也不可估量。然而那些难以解释的，置于阙疑保留的态度就可以了。谚语说：开卷了然，临证茫然，这是医家的通病，学者应该深思于此，又何必以诘责古人为事呢？
另外按：《南阳府志》记载清张三翼募建张医圣祠序，桑芸《张仲景先生祠墓记》，称南阳郡东南高地，父老相传，是先生的墓，与故宅存在。明洪武初年，有指挥郭云推倒其碑，墓于是埋没。过了二百六十多年，到了崇祯戊辰年，有兰阳的生员冯应鳌，患寒疾几乎危重，恍惚中，有神人抚摸身体，百节通畅舒适，问他，说：我是汉长沙太守南阳张仲景。城东四里左右有祠堂，祠后七十七步有墓，现在将在其上凿井，封土只为了你。后来病愈，千里奔走南阳，访求不可得，于是拜谒三皇庙，有张仲景像，就刻石记录在庙中而去。几年后，园丁掘井得到石碑，题写曰：汉长沙太守医圣张仲景墓。这些话荒唐不足信。三异序中，仲景名写作玑，字考机，古与玑相通，《尚书·舜典》：“璇玑玉衡”，释文说：玑，本作机。《晋书》陆机字士衡，可以证明这一点。
The preface also states: "In compiling this work, I utilized the *Suwen* (Basic Questions) nine volumes, the *Nanjing* (Classic of Difficult Issues), the *Yinyang Dalun* (Great Treatise on Yin and Yang), the *Tailu Yaolu* (Record of Fetal Development and Pharmacology), combined with pulse differentiation and syndrome identification, to compose the *Shanghan Zabing Lun* (Treatise on Cold Damage and Miscellaneous Diseases), totaling sixteen volumes." Generally, the three Yin and three Yang syndromes of cold damage originate from the *Suwen* nine volumes; the categories such as cold damage, wind strike, and warm disease are based on the *Nanjing*. As for the *Yinyang Dalun*, although it is unknown which specific book it refers to, it is essentially a compilation of ancient canonical texts. Therefore, it is not entirely Zhang Zhongjing's original theories and prescriptions.
Wu Cheng of the Yuan Dynasty wrote the preface to his *Huoren Shu Bian* (Differentiation of the Living Person Book), stating: "Zhang Zhongjing of the late Han Dynasty authored the *Shanghan Lun* (Treatise on Cold Damage). I often sighed that the literary style of the Eastern Han did not compare to that of the Western Han. Only in medical literature does this book stand out, profound and elegant, shining like the literature of the Xia, Shang, and Zhou dynasties. I found this strange. However, upon seeing Zhang Zhongjing's humble self-deprecation in the preface, I realized that the preface was indeed written by Zhang Zhongjing himself, and the *Shanghan Lun* is actually the ancient *Tangye Lun* (Treatise on Decoctions). It is likely a surviving text from antiquity, which Zhang Zhongjing merely compiled and edited." Wu's theory originates from Huangfu Mi (courtesy name Shian), but its validity cannot be definitively established. Nevertheless, regarding the evolution of literary styles, even if non-medical scholars cannot match it, it serves as a valuable reference for textual research.
Lin Yi and others stated in their collated preface: "Zhang Zhongjing has no biography in the *Book of Han* (Hanshu), but appears in the *Records of Famous Doctors*. According to the preface of Huangfu Mi's *Jiayi Jing* (Systematic Classic of Acupuncture and Moxibustion) and the *Biography of Huangfu Mi* in the *Book of Jin* (Jinshu), his reputation at the time was evident. Since the Jin Dynasty was not far removed from the Han Dynasty, his account is credible. Although Zhang Zhongjing lacks a biography in the *Hanshu*, he was undoubtedly a figure of the late Han Dynasty." The *Book of Later Han* (Houhanshu) records in the Biography of Liu Biao: "In the third year of Jian'an, Zhang Xian, the Administrator of Changsha, led the three commanderies of Lingling and Guiyang to rebel against Liu Biao. Liu Biao sent troops to besiege and defeat Zhang Xian." The *Heroic Records* (Yingxiong Ji) notes: "Zhang Xian was from Nanyang." He was likely a clansman of Zhang Zhongjing. Was it possible that after Liu Biao defeated Zhang Xian, Zhang Zhongjing succeeded him?
Lin Yi's collated preface further states: "Since Zhang Zhongjing, eight hundred years have passed. Only Wang Shuhe could learn from him." Cheng Wuji also said: "Zhang Zhongjing's works have reached us over a millennium. Their prominence in the world is due to Wang Shuhe's efforts." Zhang Zhongjing's texts were fragmented and disordered after the wars of the Three Kingdoms. Without Wang Shuhe's compilation, they would not have survived to the present day; his merit is immense.
However, during the Hongwu era of the Ming Dynasty, Huang Xi of Xiangxi wrote *Shanghan Leizheng Bianhuo* (Discernment and Confusion Regarding Cold Damage Syndrome Differentiation), arguing: "Zhang Zhongjing's book covers only from the Six Channels to fatigue recovery. It contains 397 methods and 113 formulas, meticulously complete and orderly. The chapters 'Bian Mai' (Differentiating Pulse), 'Ping Mai' (Leveling Pulse), and 'Shanghan Li' (Cold Damage Examples) were collected by Wang Shuhe from various sources, appended with his own opinions. Although they occasionally contain Zhang Zhongjing's words, they fall outside the scope of the 397 methods. The chapter on 'Dampness' comes from the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet), yet Wang Shuhe erroneously placed it after the Six Channels sections. He also recompiled discussions on the indications and contraindications of sweating, vomiting, and purging, along with post-treatment syndromes, at the end of the volume." This view originated from Wang Lv's *Suhui Ji*, who believed the *Shanghan Li* was Zhang Zhongjing's original text. Subsequently, Fang Youzhi, Yu Chang, Ke Qin, and others followed this view, either refuting or denigrating it. For instance, regarding the Preface and Examples, they claimed these were gathered from Zhang Zhongjing's old theories. The *Waitai Miyao* cites them attributing them to Wang Shuhe, implying Wang Shuhe authored this section rather than forging it. As for the chapters on Pulse Differentiation, Leveling Pulse, and Purging Indications, Wang Shuhe cited them in his *Mai Jing* (Pulse Classic) as Zhang Zhongjing's words. Gao Zhan's *Yangsheng Lun* states: "Wang Shuhe had a quiet nature, loved writing, examined lost texts, collected diverse views, and compiled the *Mai Jing* in ten volumes." Wang Shuhe's preface to the *Mai Jing* also says: "I have now compiled essential theories from Qibo down to Hua Tuo into ten volumes, recording all variations transmitted by Wang, Ruan, Fu, Dai, Wu, Ge, Lu, and Zhang." While the *Shanghan Li* contains many inconsistencies with Zhang Zhongjing's standards and absurd statements, Wang Shuhe was a renowned scholar. Would he truly attribute his own theories to ancient sages and record them in his own published works using such deceitful tactics?
Yin-Yang and Five Elements were favored topics among Han Confucians. The internal organs, meridians, and flow of Qi and Blood are mentioned in the *Records of the Grand Historian* (Shiji) biographies of Bian Que and Cang Gong, and heavily listed in the *Bibliographic Treatise* (Yiwenzhi) of the *Book of Han*. Why would Zhang Zhongjing, living in the late Han, exclude them? Based on the arguments of Wu of Linchuan, we can examine this: The sections from the Six Channels to fatigue recovery, with their elegant and profound language, belong to the ancient classics he utilized. Other parts, which seem pedantic and stylistically weak, are often attributed by modern readers to Wang Shuhe's interpolations. Could it be that these are actually Zhang Zhongjing's own writings? Thus, phrases like "some say," "suspected not to be Zhang Zhongjing's formula," or "originally stated 'etc.'" in the *Shanghan Li* and other texts appear to be recordings by Wang Shuhe. These are clearly Zhang Zhongjing's original texts. The contradictions in meaning and obscure logic are common in ancient books; why doubt them? Fang Youzhi, Yu Chang, and others attempted to restore the original text by deleting and modifying sentences line by line. Unknowingly, they deviated further from the original truth and confused later generations more severely than Wang Shuhe did. Compared to Wang Shuhe, who is more culpable?
Zhang Suichen's *Complete Works of Zhang Zhongjing* includes a "Biographies of Medical Forest" stating: "Wang Shuhe compiled Zhang Zhongjing's formulas and theories into thirty-six volumes, widely circulated." This derives from the *Taiping Yulan* citing Gao Zhan's *Yangsheng Lun*. However, the *Sui Shu·Jingji Zhi* does not list thirty-six volumes. Wang Hu argues: "Zhang Zhongjing wrote the *Shanghan Zabing Lun* in sixteen volumes. How could Wang Shuhe's compilation suddenly add twenty volumes? Thus, the claim of thirty-six volumes is erroneous."
In summary, the *Shanghan Lun* is a book concerning life and death, of great significance. Readers should clear their preconceptions, carefully distinguish Yin/Yang, exterior/interior, deficiency/excess, and cold/heat, and understand the differences between sweating, vomiting, purging, attacking, tonifying, harmonizing, and warming. They must apply themselves diligently so that when facing clinical practice and personal experimentation, there is no hesitation. If there are logical contradictions or difficult phrasing, one should not force interpretations. Generally, practical applications that are clear and explicit, such as "For Taiyang disease (disease of the Taiyang channel) presenting with headache, fever, sweating, and aversion to wind, Guizhi Tang (Cinnamon Twig Decoction) is the primary treatment," are simple and easy to grasp. Scholars should study these accessible aspects carefully, distinguishing true from false and similar from different, thereby grasping the profound principles of life. This constitutes true mastery. Conversely, difficult explanations where scholars expend effort on convoluted theories may amount to scratching an itch from outside the boot. Applying uncertain interpretations to medical practice can endanger lives unpredictably. Therefore, unresolved difficulties should be left as open questions. As the proverb goes: "Clear when reading,茫然 (at a loss) when treating." This is a common flaw among physicians. Scholars should reflect on this rather than obsessing over criticizing ancients.
Furthermore, according to the *Nanyang Prefecture Gazetteer*, in the preface by Zhang Sanyi for the construction of the Temple of Medical Sage Zhang, and Sang Yun's *Record of the Shrine and Tomb of Mr. Zhang Zhongjing*, it is recorded that elders in the southeastern highlands of Nanyang Commandery相传 (pass down the tradition) that this is Mr. Zhang's tomb, existing alongside his former residence. In the early Hongwu period of the Ming Dynasty, Commander Guo Yun toppled the stele, causing the tomb to be buried. Over 260 years later, in the Wuchen year of Chongzhen, Feng Ying'ao, a student from Lanyang, suffered from a critical cold-disease. In a trance, a divine being touched his body, bringing relief to all joints. When asked, the spirit replied: "I am Zhang Zhongjing, Administrator of Changsha and native of Nanyang. There is a shrine about four li east of the city, and a tomb seventy-seven steps behind it. I will seal it above you [the well site]." After recovering, Feng traveled a thousand li to Nanyang to search but failed. He then visited the Temple of the Three Sovereigns, saw an image of Zhang Zhongjing, inscribed a stone tablet in the temple, and departed. Years later, a gardener digging a well unearthed a stone stele inscribed: "Tomb of Zhang Zhongjing, Administrator of Changsha of the Han Dynasty, Medical Sage." Such accounts are absurd and unreliable. Note that in the "Three Anomalies" preface, Zhang Zhongjing's given name is written as Ji (玑), courtesy name Kaoji. In ancient times, Ji and Ji were interchangeable. The *Book of Documents* (Shangshu) mentions "Xuanji Yuheng," and commentaries state: "Ji was originally written as Ji." The *Book of Jin* records Lu Ji's courtesy name as Shiheng, which confirms this usage.