（正解见中卷少阴病中）
琥按上汤。本治少阴病。肾气虚寒。不能制水之证。其治太阳病。汗出。仍发热。心下悸云云者。此不过借以
兼主也。夫心下悸。非水气上逆之比。乃阳虚而心气不安。方中用苓术姜附以补里虚。助真阳。保惊悸。其用芍药
者。谓能挟术附以敛阳虚之汗。盖汗敛而热自衰也。人身之阳主气。为火。火之源。本于心。下通于肾。肾属水。
水中有火。阳虚。则火离其根。故外发热。而上见心悸头眩等证。汤名真武者。正以见上证。不治太阳膀胱之经。
当治少阴右肾命门。此实从其根。固其本也。斯其理。岂易言哉。
或问治不在表。何以方中犹用生姜。余答云。病自太阳经误汗而来。虽无郁热可发。其虚寒之邪。终由此经而
入。方中用生姜者。乃补中有发之意也。
病患有寒。复发汗。胃中冷。必吐蛔。（此条系中寒证。病患有寒。乃是里寒。里寒宜温。医反误发其汗。凡
汗药皆辛散。成注云损阳气。阳气损。则胃中冷。蛔不能安。故必由吐而上出也。○按此条论。仲景无治法。补亡
论常器之云。可服乌梅丸。郭白云云。宜理中汤。愚以乌梅丸。乃治吐蛔之药。若于未发汗以前。还宜服理中汤也。
○或问里寒表寒。截然两途。何至复发其汗。余答云。里寒不作郁热。表寒必发大热。夫人而知之也。但太阳一经。
有未发热之证。况里既寒矣。则外岂无寒状。发汗之误。或由此欤。○或又问胃中何以有蛔。余答云。胃为水谷之
海。海中无物不生。故虽有蛔而不为害。夫人胃气本温。温则蛔得其养而自安。若过寒则冷。过温则热。凡人伤冷
伤热。则胃中之气不得其平。故见吐蛔之证。）
伤寒医下之。续得下利清谷不止。身疼痛者。急当救里。后身疼痛。清便自调者。急当救表。救里。宜四逆汤。
救表。宜桂枝汤。（此条病。乃阴阳两证并举。非一证分表里而用二汤也。寒邪伤表。医误下之。续得下利清谷不
止。此阳从内脱。中下二焦无火。不能腐熟水谷。故色不变而完出。且不能止也。身疼痛者。为里有真寒。寒气凝
泣。则骨属不利。故身疼痛。并非表邪骨节疼痛之比。急当救里。宜四逆汤。以扶阳抑阴。则利止而身疼痛自除。
此为中寒。乃里虚证也。若下后。身疼痛。清便自调者。邪未入里。故二便清调。必其人胃气本实。不为误下所害。
但见身疼痛。为在表有邪。此非里寒身如被杖之比。急当救表。宜桂枝汤。以和营散邪。乃太阳中风正治之法也。
诸家皆误注后身疼痛。清便自调。为用四逆汤以后之见证。大谬之极。夫四逆汤系中寒阴证之药。桂枝汤。系伤寒
热病之方。况乎既先温里。随即发表。又施之于误下之后。其杀人何异于操刃邪。仲景立方本旨。盖谓身疼痛。不
可尽以为表邪。又有里寒误下。利不止而身疼痛者。故与桂枝汤证。相对而并举也。○桂枝汤方。见伤寒辩注。第
三卷太阳篇中。○或问桂枝汤。治太阳有汗之中风。中风之证必发热。医既误下。其便虽调。未必能清。余答云。
惟其身疼痛。为邪在表。以故清便自调。且仲景原论中不云乎。伤寒不大便。六七日。头痛有热者。与承气汤。小
便清者。知不在里。仍在表。当发其汗。宜桂枝汤。此言清便自调。彼言小便清。此言身疼痛。彼言头痛有热。证
虽不同。学人可以意会之而已。）
病发热头痛。脉反沉。若不瘥。身体疼痛。当救其里宜四逆汤。（此条系太阳病。内无郁热。邪入少阴。遂成
虚寒之证。且以见身疼痛之当救里。不止于上条矣。发热头痛者。病在太阳也。病在太阳。则脉宜浮紧。或浮缓。
或浮数。斯为热病。今者。脉反沉。沉为阴。与寒。病剧不愈。更加身体疼痛。此与上条利不止。而身疼痛者。同
为阴寒之证。亦当救里。宜四逆汤。以温里而散其寒邪也。○或问发热头痛。脉反沉。此阳证见阴脉。乃死候也。
成注反云。表病得里脉。则当瘥者。何欤。余答云。成注云。病当瘥诚误。子以见阴脉为死候。亦非。夫病加身体
疼痛。即是不瘥。非发热头痛。见沉脉。反为向愈之征也。盖此条病。本自太阳经而入。故先见发热头痛。其脉反
沉者。为寒中少阴之本脉。非阳证见阴脉之比。至病剧身体疼痛之时。其邪尽归少阴。而发热头痛等候。已无有矣。
故当直救少阴无疑。○或又问阳证头痛。阴证不头痛。今者邪伤太阳。何以又中少阴。余答云。邪从背入。太阳居
表。少阴居里。邪伤太阳。不及少阴。邪中少阴。无有不自太阳经入者。邪竟入里。则不头痛。少有停留。即见头
痛等候矣。世医但知头痛为阳证。亦知真阴证。间有自头痛始者。不可不细察也。）
上六条证（见原论中第三卷太阳病治法中第六）
伤寒八九日。风湿相搏。身体疼烦不能自转侧不呕不渴。脉浮虚而涩者。桂枝附子汤主之。（此条伤寒乃中寒
证。寒气与风湿相搏击。至八九日。身体犹然疼烦。不能自转侧。盖寒凝则痛。风扰则烦。湿着则不能转侧。乃三
气相夹之病。若风气胜。则风从阳。在里必见热渴等候矣。兹则风为寒湿所持。寒湿从阴。在里不呕不渴。虽至八
九日之久。不作郁热。诊其脉。又浮虚而涩。成注引经云。风则浮虚。脉来涩者。当病寒湿。且脉浮主表。身又疼
烦。里不呕渴。知风湿但在经也。与桂枝附子汤。以温经散风湿。）
（正确的解释见中卷少阴病篇）
胡氏按语：上述汤剂，原本用于治疗少阴病。肾气虚寒，不能制约水液的证候。它治疗太阳病，汗出后仍发热、心下悸动等症，这不过是借用此方兼治罢了。所谓心下悸动，并非水气上逆的情况，而是阳虚导致心气不安。方中使用茯苓、白术、干姜、附子来补益里虚，助益真阳，安定惊悸。使用芍药的原因，是认为它能协助白术和附子收敛阳虚导致的汗出。汗液收敛而热势自然衰退。人体的阳气主司气化，属于火。火的根源本于心，向下通达于肾。肾属水，水中含有火。阳虚时，火就会离开其根本，所以外部表现为发热，而上部出现心悸、头晕目眩等症状。汤剂名为“真武汤”，正是针对上述症状而言，不治疗太阳膀胱经，而应当治疗少阴右肾命门。这实际上是追溯其根源，巩固其根本。其中的道理，岂是容易言说的呢？
有人问：治疗不在表分，为什么方中还要使用生姜？我回答说：疾病从太阳经误用发汗法而来，虽然体内没有郁结的热邪可以发散，但虚寒之邪终究是通过这条经络进入体内的。方中使用生姜，是在补益之中蕴含发散之意。
患者患有寒证，医生又再次发汗，导致胃中寒冷，必定会出现吐蛔虫的现象。（这一条论述的是中寒证。患者患有寒证，指的是里寒。里寒适宜温补，医生反而错误地使用了发汗法。凡是发汗的药物都具有辛散的特性，成无己注释说会损伤阳气。阳气受损，则胃中寒冷，蛔虫不能安宁，所以必然向上吐出。○按：这一条论述中，张仲景没有给出治疗方法，《补亡论》中常器之说可以服用乌梅丸。郭白云说适宜服用理中汤。我认为乌梅丸是治疗吐蛔虫的药物，如果在未发汗之前，还是适宜服用理中汤。○有人问：里寒和表寒截然分为两条路径，怎么会再次发汗呢？我回答说：里寒如果不产生郁热，表寒必然会引发大热。这是人人都知道的道理。但是太阳一经，有尚未发热的证候。况且既然里寒已经存在，那么外部难道没有寒象吗？发汗的错误，或许就由此产生吧。○又有人问：胃中为什么会有蛔虫？我回答说：胃是水谷汇聚的大海，大海中没有东西不生长。所以即使有蛔虫也不会造成危害。人的胃气本来是温暖的，温暖则蛔虫得到滋养而自然安宁。如果过冷则寒，过热则热。凡人受到寒冷或热邪的伤害，胃中的气机就不能保持平衡，所以出现吐蛔虫的证候。）
伤寒被医生误用攻下法后，接着出现下利清谷不止。身体疼痛的，应当紧急救治里证。之后身体疼痛，大小便正常的，应当紧急救治表证。救治里证，适宜用四逆汤。救治表证，适宜用桂枝汤。（这一条病症，是阴阳两证并列提出，不是将一个证候分为表里而分别使用两种汤剂。寒邪伤害体表，医生误用攻下法，接着出现下利清谷不止，这是阳气从内部脱失，中焦和下焦没有火气，不能腐熟水谷，所以排泄物颜色不变且完谷排出，并且不能停止。身体疼痛，是因为里有真寒，寒气凝滞，导致骨节不利，所以身体疼痛。这并不是表邪引起的骨节疼痛。应当紧急救治里证，适宜用四逆汤，以扶持阳气抑制阴寒，这样腹泻停止而身体疼痛自然消除。这是中寒，属于里虚证。如果攻下之后，身体疼痛，大小便正常，说明邪气未入里，所以二便清调。必定是此人胃气本来充实，没有被误下所伤害。只是见到身体疼痛，是因为在表有邪气。这不是里寒身体像被棍棒打击那样的疼痛。应当紧急救治表证，适宜用桂枝汤，以调和营卫疏散邪气，这是治疗太阳中风正证的法则。各家都错误地注解“后身疼痛，清便自调”是使用四逆汤之后的见证，这是极大的谬误。四逆汤是中寒阴证的药物，桂枝汤是伤寒热病的方剂。况且既然先温里，随即发表，又施加在误下之后，这与拿着刀刃杀人有什么区别呢？张仲景创立方剂的原本宗旨，大概是说身体疼痛，不能完全认为是表邪，又有里寒误用攻下，腹泻不止而身体疼痛的情况，所以与桂枝汤证相对而并列提出。○桂枝汤方，见《伤寒辩注》第三卷太阳篇中。○有人问：桂枝汤治疗太阳有汗的中风。中风的证候必定发热。医生既然误用攻下，大便虽然调畅，未必能清澈。我回答说：正因为身体疼痛，说明邪气在表，所以大小便清调。而且张仲景原论中不是说吗？伤寒不大便六七天，头痛且有发热的，给予承气汤；小便清的，知道病不在里，仍在表，应当发汗，适宜用桂枝汤。这里说大小便清调，那里说小便清；这里说身体疼痛，那里说头痛发热。证候虽然不同，学者可以通过心意领会罢了。）
病人发热头痛，脉象反而沉，如果病情不愈，身体疼痛，应当救治其里证，适宜用四逆汤。（这一条属于太阳病，内部没有郁热，邪气侵入少阴，遂成为虚寒证。并且以此说明身体疼痛应当救里，不仅仅局限于上一条了。发热头痛，病在太阳。病在太阳，脉象应当浮紧，或浮缓，或浮数，这才是热病。现在脉象反而沉，沉为阴脉，与寒相应。病情严重不愈，再加上身体疼痛，这与上一条腹泻不止而身体疼痛的情况相同，同为阴寒之证，也应当救里，适宜用四逆汤，以温补里阳而散除寒邪。○有人问：发热头痛，脉象反而沉，这是阳证见到阴脉，是死证征候。成无己的注释反而说，表病得到里脉，则应当痊愈，为什么呢？我回答说：成无己说病应当痊愈确实错误。你认为见到阴脉就是死证，也不对。加上身体疼痛，就是不痊愈，并不是发热头痛见到沉脉反而是向愈的征兆。大概这一条病症，本是从太阳经传入，所以先见到发热头痛。其脉象反而沉，是因为寒邪中伤少阴的本脉，并不是阳证见到阴脉的情况。到病情严重身体疼痛的时候，邪气全部归入少阴，而发热头痛等表现已经没有了。所以应当直接救治少阴无疑。○又有人问：阳证头痛，阴证不头痛。现在邪气伤害太阳，为什么又中伤少阴？我回答说：邪气从背部进入，太阳居表，少阴居里。邪气伤害太阳，不及少阴；邪气中伤少阴，没有不从太阳经进入的。邪气竟然深入里，就不头痛；稍有停留，就出现头痛等表现了。世间的医生只知道头痛是阳证，也知道真正的阴证，间或有从头痛开始的，不可不仔细考察。）
以上六条证候（见原论中第三卷太阳病治法中第六条）
伤寒八九日，风湿相搏，身体疼痛烦扰，不能自行转侧，不呕吐，不口渴，脉象浮虚而涩的，用桂枝附子汤主治。（这一条伤寒属于中寒证。寒气与风湿相互搏击，到了八九天，身体仍然疼痛烦扰，不能自行转侧。大概寒气凝滞则痛，风邪扰动则烦，湿邪留着则不能转侧，这是三种邪气夹杂的病症。如果风邪偏胜，则风从阳化，在里必定出现热渴等表现。现在风被寒湿所束缚，寒湿从阴化，在里不呕不渴。即使到了八九天的时间，也不产生郁热。诊察其脉象，又浮虚而涩。成无己引用经文说，风邪则脉浮虚，脉来涩者，应当病在寒湿。而且脉浮主表，身体又疼痛烦扰，里不呕渴，知道风湿仅在经络。给予桂枝附子汤，以温通经络散除风湿。）
(The correct explanation can be found in the Middle Volume, section on Shaoyin Disease.)
Hu's commentary: The aforementioned decoction was originally intended to treat Shaoyin disease characterized by deficiency-cold of Kidney Qi and the inability to control water metabolism. Its application to Taiyang disease presenting with sweating, persistent fever, and palpitations (Xin Xia Ji) is merely a secondary indication borrowed for concurrent treatment. Palpitations described here are not due to the counterflow of water qi, but rather result from Yang deficiency causing insecurity of Heart Qi. In the formula, Poria (Fuling), Atractylodes (Baizhu), Dried Ginger (Ganjiang), and Prepared Aconite Root (Fuzi) are used to tonify interior deficiency, assist True Yang, and stabilize palpitations. The inclusion of White Peony Root (Shaoyao) is based on its ability to collaborate with Atractylodes and Aconite to restrain sweating caused by Yang deficiency; once sweating is restrained, heat naturally subsides. Human Yang governs Qi transformation and belongs to Fire. The source of Fire originates in the Heart and extends downward to the Kidney. The Kidney belongs to Water, within which resides Fire. When Yang is deficient, Fire departs from its root, manifesting externally as fever and internally as palpitations, dizziness, and vertigo. The name "Zhenwu Tang" (True Warrior Decoction) corresponds precisely to these symptoms, indicating that treatment should target the Shaoyin Right Kidney and Mingmen (Gate of Life) rather than the Taiyang Bladder meridian. This approach addresses the root and consolidates the foundation. Such principles are not easily articulated.
A question arises: If the treatment does not focus on the exterior, why is Fresh Ginger (Shengjiang) included in the formula? I answer: The illness originated from an erroneous sweating method applied to the Taiyang meridian. Although there is no stagnant heat to disperse, the deficiency-cold pathogen ultimately entered through this channel. The use of Fresh Ginger in the formula embodies the intent of dispersal within tonification.
If a patient suffering from cold syndrome undergoes repeated sweating, it causes coldness in the Stomach, inevitably leading to vomiting of roundworms. (This clause discusses Zhonghan [Cold Damage] syndrome. "Patient suffering from cold" refers to Interior Cold. Interior Cold requires warming treatment, yet the physician erroneously employed sweating methods. All diaphoretic agents possess acrid-dispersing properties. Cheng Wuji noted that this damages Yang Qi. Once Yang Qi is damaged, the Stomach becomes cold, causing roundworms to become restless and vomit upward. ○ Note: Zhang Zhongjing did not provide a treatment method for this clause. Chang Qizhi in *Bu Wang Lun* suggested Wumei Wan (Mume Pill). Guo Baiyun recommended Lizhong Tang (Regulate the Middle Decoction). I believe Wumei Wan treats vomiting roundworms, but prior to sweating, Lizhong Tang would have been more appropriate. ○ Another question: Interior cold and Exterior cold are distinct pathways; how could one sweat again? I answer: Interior cold does not generate stagnant heat, whereas Exterior cold often induces high fever—a common knowledge. However, Taiyang disease has stages before fever appears. Moreover, if Interior cold exists, Exterior cold signs may also be present. The error in sweating might stem from this confusion. ○ Yet another question: Why are there roundworms in the Stomach? I answer: The Stomach is the sea of water and grain; nothing does not grow in such a vast environment. Thus, roundworms exist without causing harm normally. Human Stomach Qi is inherently warm; warmth nourishes roundworms, keeping them at peace. Excessive cold causes chilliness, excessive heat causes heat. When humans suffer from cold or heat pathogens, Stomach Qi loses balance, resulting in vomiting of roundworms.)
In Shanghan (Cold Damage), if a physician erroneously applies purgation, followed by unceasing diarrhea with undigested food, and body pain persists, urgent rescue of the Interior is required. Later, if body pain remains but bowel movements and urination normalize, urgent rescue of the Exterior is required. To rescue the Interior, Sini Tang (Frigid Extremities Decoction) is indicated. To rescue the Exterior, Guizhi Tang (Cinnamon Twig Decoction) is indicated. (This case presents both Yin and Yang syndromes simultaneously, not splitting one syndrome into exterior/interior for two different formulas. Cold pathogen attacks the exterior; erroneous purgation leads to Yang collapse from within. With no fire in the Middle and Lower Jiao to digest food, undigested matter passes unchanged and uncontrollably. Body pain indicates true Interior cold; cold stagnation causes joint immobility and pain, distinct from exterior pathogen-induced joint pain. Urgent Interior rescue with Sini Tang supports Yang and suppresses Yin, stopping diarrhea and resolving pain. This is Zhonghan, a deficiency-cold syndrome. If after purgation, body pain persists but excretions are clear and regulated, the pathogen has not entered the Interior. This implies the patient’s Stomach Qi was originally robust and unaffected by erroneous purgation. Body pain indicates exterior pathogen presence, distinct from the severe pain of Interior cold. Urgent Exterior rescue with Guizhi Tang harmonizes Ying and Wei and disperses pathogens, the standard treatment for Taiyang Wind Strike. Many commentators incorrectly interpret "later body pain, clear excretions" as post-Sini Tang manifestations, which is a grave error. Sini Tang treats Interior Cold Yin syndromes; Guizhi Tang treats Shanghan Heat syndromes. Applying exterior release immediately after warming the Interior, especially post-purgation, is akin to wielding a blade against oneself. Zhang Zhongjing’s original intent was to contrast body pain not solely attributed to exterior pathogens with cases of Interior cold mistaken for purgation leading to diarrhea and pain, juxtaposing it with Guizhi Tang indications. ○ Guizhi Tang formula is detailed in *Shanghan Bianzhu*, Vol 3, Taiyang Chapter. ○ Question: Guizhi Tang treats Taiyang Wind Strike with sweating. Wind Strike involves fever. After erroneous purgation, even if stool is regulated, urine may not be clear. Answer: Body pain confirms exterior pathogen location, hence clear excretions. As Zhang Zhongjing stated: In Shanghan with constipation for 6-7 days, headache, and fever, administer Chengqi Tang; if urine is clear, the pathogen is still in the Exterior, requiring sweating with Guizhi Tang. Here, "clear excretions" parallels "clear urine"; "body pain" parallels "headache and fever." Though symptoms differ, scholars should grasp the underlying principle.)
If a patient presents with fever, headache, and a pulse that is unexpectedly deep (Chen), and if the condition does not improve, accompanied by body pain, the Interior must be rescued urgently using Sini Tang. (This case involves Taiyang disease where no interior stagnant heat exists, but the pathogen enters Shaoyin, forming a deficiency-cold syndrome. It further illustrates that body pain necessitates Interior rescue, extending beyond the previous clause. Fever and headache indicate Taiyang involvement. Typically, Taiyang heat diseases present with floating-tight, floating-slow, or floating-rapid pulses. An unexpected deep pulse indicates Yin/Cold. Severe, unresolving condition with added body pain aligns with the previous case of unceasing diarrhea and body pain, both being Yin-Cold syndromes requiring Interior rescue with Sini Tang to warm the Interior and dispel cold. ○ Question: Fever, headache, and deep pulse represent Yang syndrome showing Yin pulse, a death omen. Cheng Wuji claimed surface disease with interior pulse implies recovery. Why? Answer: Cheng’s claim of recovery is incorrect. Viewing Yin pulse as strictly fatal is also wrong. Added body pain indicates non-recovery; deep pulse with fever/headache is not necessarily a sign of healing. This illness likely entered via Taiyang, initially showing fever/headache. The deep pulse reflects Cold damaging Shaoyin’s fundamental pulse, not simply Yang showing Yin. When body pain becomes severe, the pathogen fully resides in Shaoyin, and fever/headache cease. Thus, direct Shaoyin rescue is undeniable. ○ Question: Yang syndromes cause headache; Yin syndromes do not. How can Taiyang injury involve Shaoyin? Answer: Pathogens enter via the back. Taiyang is superficial; Shaoyin is deep. Taiyang injury does not directly affect Shaoyin; Shaoyin injury invariably enters via Taiyang. If the pathogen penetrates deeply, there is no headache; if it lingers slightly, headache occurs. Physicians often mistake headache for exclusively Yang syndrome, but true Yin syndromes can begin with headache. Careful observation is essential.)
The above six clauses (found in the original text, Vol 3, Taiyang Treatment Methods, Clause 6).
After eight or nine days of Shanghan, if Wind-Dampness interlock, causing severe body pain preventing self-turning, without vomiting or thirst, and with a floating-deficient and choppy pulse, Guizhi Fuzi Tang (Cinnamon Twig and Prepared Aconite Root Decoction) is the primary treatment. (This Shanghan case represents Zhonghan. Cold Qi locks with Wind-Dampness. By day eight or nine, severe body pain prevents turning over. Cold stagnation causes pain; Wind agitation causes restlessness; Dampness adherence prevents movement. This is a triad of pathogens. If Wind dominates, it follows Yang, generating internal heat/thirst. Here, Wind is constrained by Cold-Damp, which follows Yin, so no internal vomiting or thirst occurs. Despite prolonged duration, no stagnant heat forms. The pulse is floating-deficient and choppy. Cheng Wuji cites classics: Wind yields floating-deficient pulse; choppy pulse indicates Cold-Damp disease. Floating pulse indicates Exterior; body pain/restlessness with no internal vomiting/thirst confirms Wind-Damp remains in the meridians. Guizhi Fuzi Tang warms the meridians and disperses Wind-Damp.)