大要口燥舌干，渴而谵语，大便实者，知其热。须详呕吐，泻利不渴，或恶
寒腹痛者，别其寒。
脉见沉实有力，宜当下。脉见沉迟无力，宜当温。
口燥咽干，渴而谵语，大便实，或绕脐硬痛，或下利纯清水，心下硬痛者，俱是邪热燥屎使然，
急用六乙顺气汤，分轻重下之。（即承气汤，有加减法。）无热恶寒，厥冷蜷卧，不渴，或腹痛呕
吐，泻利沉重，或阴毒手指甲唇青，呕逆绞痛，身如被杖，面如刀刮，战栗者，俱是寒邪中里使然，
急用回阳救急汤温之。（即四逆汤，有加减法。）
烦满囊卷者，是足厥阴肝经受证。假如先起消渴烦满者，本病。已后舌卷囊缩者，标病。亦有
寒热两端，不可概作热治。
烦满囊卷，消渴者，属热。口吐涎沫，不渴，厥冷者，属寒。似疟不呕，清便，必自愈。
脉沉实者，宜当下。脉沉迟者，宜当温。脉浮缓者，病自愈。
消渴烦满，舌卷囊缩，大便实，手足乍冷乍温者，急用六乙顺气汤下之。（即承气汤，有加减
法。）口吐涎沫，或四肢厥冷不温，过乎肘膝，不渴，小腹绞痛，呕逆者，急用茱萸四逆汤温之。
（即回阳救急汤，自有加减法。）
或人问曰∶治伤寒先明脉证，脉证不明，取方无法，脉证既明，工中之甲。夫
脉之一字，实先天后天之造化。何为先天？何为后天？何为脉也？答曰∶人之阴阳，即为先天。人
之气血，即为后天。脉者，非血非气，乃血气之先，即营行之道路。又问曰∶既知先后天之脉理，
须明持脉之要，曰举曰按曰寻三字。若此不明，则阴阳表里虚实，何以别之。持脉者轻手循之，曰
举。重手取之，曰按。不轻不重，委曲求之，曰寻。初持轻手候之，脉见皮肤之间便得，曰浮，是
太阳经脉也。有力者，主寒邪在表，无汗为寒伤荣血，表实者，宜汗之。无力者，主风邪在表，有
汗为风伤卫气，表虚者，宜实之。脉附于肌肉之下，筋骨之间而得，曰沉，是三阴经脉也。其三阴
俱是沉脉，妙在指下有力无力中分。有力者，主热邪在里，为里实，宜下之。无力者，主寒邪中里，
为里虚，宜温之。不轻不重，中而取之乃得，其脉应于血肉之间，阴阳相半。若见微洪，是阳明经
脉也，主邪在表多里少，宜解肌。若见弦数，是少阳经脉也，主邪在半表半里，宜和解。前之所云
阴阳表里、虚实寒热，俱在浮、中、沉三脉有力无力中分。有力者，为阳，为实，为热。无力者，
为阴，为虚，为寒。若浮、沉、中之不见，则委曲而求之，若隐若见，则阴阳伏匿之脉也，三部皆
然。或曰∶君之了然，非庸俗所能识也。其三脉中，有进退焉，有伏脉焉，有可解
不可解焉，有歇至焉，有燥乱焉，请备言其所由。答曰∶脉大者，为病进，大则邪气胜而正气无权。
脉缓者，为邪退，缓则胃气和而邪气无权。何谓伏脉？一手无脉，曰单伏。两手无脉，曰双伏。若
病初起头痛，发热恶寒而脉伏者，缘阴邪陷于阳中，不得发越，此欲汗而当攻之，使邪气退而正气
复，脉自至而病自除。如欲雨则天郁热，晴霁天乃反凉之可见也。若七八日以来，别无刑克证候，
或昏冒不知人事，或脉全无者，此欲汗而勿攻之。如六合阴晦，雨后庶物皆苏，换阳之吉兆也。何
谓可解不可解？脉浮缓，在表者，以汗解之。脉沉实，在里者，以下解之。脉沉迟，在里者，以温
解之。且夫浮汗，沉下而温，固其宜也。然浮宜下，沉宜汗，其故又何耶？答曰∶浮而下者，因大
便难也。设使大便不难，岂敢下乎！沉而汗者，因表有热也。设使身不发热，岂敢汗乎！何谓歇至？
如寒邪直中阴经，温之而断续者，为歇至。何谓燥乱？因汗下后脉当静，今反盛者，曰燥乱，大凶
之兆也。然则，君子言有所据乎？吁，难言也，此出经常大法之格语也。客欣然起而谢曰∶予虽白
首无穷，生平仰慕，不意邂逅，幸获开予茅塞。正谓鼷鼠而发千钧之弩，甚所不当，可谓切而磋，
琢而磨者也。较今庸俗，实醯鸡坎蛙，不知瓮外之有天，井外之有海耳。
感君发明于后，岂非再来人乎！遂笔录以示之。
总的来说，如果患者出现口燥舌干、口渴且胡言乱语、大便干结的情况，可以判断为热证。必须详细辨别呕吐、腹泻且不渴，或者恶寒腹痛的情况，以区分其为寒证。
脉象沉实有力的，适宜采用攻下法。脉象沉迟无力的，适宜采用温补法。
口燥咽干，口渴且胡言乱语，大便干结，或者脐周硬痛，或者腹泻排出纯清水，心下部硬痛，这些都是邪热与燥屎内结所致，应立即使用六乙顺气汤，根据病情轻重进行攻下。（即承气汤，有加减变化之法。）若无热而恶寒，四肢厥冷蜷卧，不渴，或者腹痛呕吐，腹泻沉重，或者阴毒证见手指甲及嘴唇青紫，呕吐逆气绞痛，身体像被棍棒打过一样疼痛，面部像刀刮一样难受，战栗发抖的，这都是寒邪直中脏腑所致，应立即使用回阳救急汤进行温治。（即四逆汤，有加减变化之法。）
烦躁胀满、阴囊收缩的，是足厥阴肝经受邪的表现。假如起初出现消渴、烦躁胀满的，是本病；后来出现舌卷缩、阴囊收缩的，是标病。也有寒证和热证两种情况，不能一概当作热证来治疗。
烦躁胀满、阴囊收缩、消渴的，属于热证。口吐涎沫、不渴、四肢厥冷的，属于寒证。症状类似疟疾但不呕吐，大小便正常，必定会自愈。
脉象沉实的，适宜采用攻下法。脉象沉迟的，适宜采用温补法。脉象浮缓的，疾病将自行痊愈。
消渴、烦躁胀满、舌卷缩、阴囊收缩、大便干结、手足时而冷时而温的，应立即使用六乙顺气汤攻下。（即承气汤，有加减变化之法。）口吐涎沫，或者四肢厥冷不温，超过肘部和膝盖，不渴，小腹绞痛，呕吐逆气的，应立即使用茱萸四逆汤温治。（即回阳救急汤，自有加减变化之法。）
有人问道：治疗伤寒首先要明确脉象和证候，脉证不明，开方就没有依据；脉证既明，就是医生中的佼佼者。那“脉”这个字，实在包含了先天和后天的造化。什么是先天？什么是后天？什么又是脉呢？回答说：人的阴阳，就是先天。人的气血，就是后天。脉，不是血也不是气，而是血气运行的先导，也就是营气运行的道路。又问：既然知道了先后的脉理，必须明白诊脉的要领，即“举、按、寻”三个字。如果不明白这些，如何辨别阴阳、表里、虚实呢？诊脉时轻手循摸，叫作“举”。重手按压，叫作“按”。不轻不重，仔细探寻，叫作“寻”。初诊时轻手候之，脉象在皮肤之间就能触及，叫作“浮”，这是太阳经脉的特征。脉有力，主寒邪在表，无汗是寒邪损伤营血，表实证，适宜发汗。脉无力，主风邪在表，有汗是风邪损伤卫气，表虚证，适宜固表（实表）。脉附着在肌肉之下、筋骨之间才能触及，叫作“沉”，这是三阴经脉的特征。三阴经都是沉脉，妙处在于通过指下的有力或无力来区分。脉有力，主热邪在里，为里实证，适宜攻下。脉无力，主寒邪中里，为里虚证，适宜温补。不轻不重，中等力度取脉，脉象应于血肉之间，阴阳各半。若见到微洪的脉象，是阳明经脉的特征，主邪气在表多里少，适宜解肌。若见到弦数的脉象，是少阳经脉的特征，主邪在半表半里，适宜和解。前面所说的阴阳、表里、虚实、寒热，都包含在浮、中、沉三脉的有力或无力之中。有力者，为阳、为实、为热。无力者，为阴、为虚、为寒。如果在浮、沉、中三部都摸不到明显的脉象，就要仔细探寻，若脉象似有似无，那就是阴阳伏匿的脉象，三部皆如此。有人说：您的见解透彻明了，不是庸俗之人所能认识的。在这三部脉中，还有进退之分，有伏脉，有可解与不可解之分，有歇止脉，有躁乱脉，请详细说明其缘由。回答说：脉大，表示病势进展，大则邪气盛而正气无权。脉缓，表示邪气退去，缓则胃气和而邪气无权。什么叫伏脉？一只手摸不到脉，叫单伏。两只手都摸不到脉，叫双伏。如果病初起头痛、发热恶寒而脉伏的，是因为阴邪陷入阳分，不得发散，这是想要出汗却应当攻下的情况，使邪气退而正气复，脉自然恢复而病自除。就像要下雨时天空闷热，雨后天晴反而凉爽，可见一斑。如果是七八天以来，没有其他克贼的证候，或者昏迷不知人事，或者脉完全消失的，这是想要出汗而不宜攻下的情况。就像天地阴暗，雨后万物复苏，是阳气转换的好兆头。什么叫可解与不可解？脉浮缓，病在表的，用发汗法解除。脉沉实，病在里的，用攻下法解除。脉沉迟，病在里的，用温法解除。而且浮脉宜汗，沉脉宜下而宜温，本是适宜的。然而浮脉宜下，沉脉宜汗，这是什么缘故呢？回答说：浮脉而下法的，是因为大便困难。假使大便不难，岂敢用下法！沉脉而汗法的，是因为体表有热。假使身体不发热，岂敢用汗法！什么叫歇至？如寒邪直中阴经，温治疗后脉象断续出现的，叫歇至。什么叫躁乱？因为发汗或攻下后脉象应当平静，现在反而盛大躁动的，叫躁乱，是大凶的征兆。那么，君子说话有依据吗？唉，难以言尽啊，这是出自经典大法的原则性话语。客人高兴地起身谢道：我虽然白发苍苍，终身仰慕，没想到偶然相遇，有幸开启我的茅塞。正所谓用小老鼠去发射千钧重的弩箭，非常不当，可以说是切磋琢磨（精益求精）了。比起现在的庸俗之辈，实在是像瓮中之鸡、坎井之蛙，不知道瓮外有天，井外有海罢了。感谢您后来的阐发明理，难道不是再来人吗！于是笔录下来以示后人。
In general, if a patient presents with dry mouth and tongue, thirst accompanied by delirious speech, and constipation, it can be determined as a Heat syndrome. One must carefully distinguish cases of vomiting, diarrhea without thirst, or aversion to cold with abdominal pain to differentiate them as Cold syndromes.
If the pulse is deep, solid, and forceful, purgation (downward draining) is appropriate. If the pulse is deep, slow, and weak, warming is appropriate.
Dry mouth and throat, thirst with delirious speech, constipation, or hardness and pain around the navel, or diarrhea passing only clear water, hardness and pain in the epigastrium, are all caused by pathogenic heat and dry fecal matter accumulation. One should immediately use Liuyi Shunqi Tang (Six-Yi Harmonizing Qi Decoction) to purge according to the severity of the condition. (This is Chengqi Tang [Cassia Twig Decoction], with methods for modification.) In cases of no heat but aversion to cold, cold extremities with curling up, no thirst, or abdominal pain with vomiting, heavy diarrhea, or Yin Toxicity presenting with cyanosis of fingernails and lips, retching with colicky pain, body pain as if beaten by a club, facial discomfort as if scraped by a knife, and shivering, these are all caused by Cold pathogen directly invading the interior. One should immediately use Huiyang Jiuji Tang (Return Yang Rescue Crisis Decoction) to warm. (This is Sini Tang [Frigid Extremities Decoction], with methods for modification.)
Irritability, fullness, and retraction of the scrotum indicate involvement of the Foot-Jueyin Liver Meridian. If initially there is Xiao Ke (Wasting-Thirst/Irritable Thirst) with irritability and fullness, this is the root disease; subsequently appearing tongue retraction and scrotal contraction indicates the branch disease. There are both Cold and Heat presentations, so one cannot generally treat it as Heat alone.
Irritability, fullness, scrotal contraction, and Xiao Ke belong to Heat. Saliva spitting without thirst and cold extremities belong to Cold. Symptoms resembling malaria but without vomiting, and with normal urination and defecation, will likely resolve spontaneously.
A deep, solid pulse indicates suitability for purgation. A deep, slow pulse indicates suitability for warming. A floating, moderate pulse indicates the disease will resolve spontaneously.
Xiao Ke, irritability, fullness, tongue retraction, scrotal contraction, constipation, and hands and feet alternating between cold and warmth require immediate purgation with Liuyi Shunqi Tang. (This is Chengqi Tang, with methods for modification.) Saliva spitting, or cold extremities not warming beyond elbows and knees, no thirst, severe lower abdominal colic, and retching require immediate warming with Zhuyu Sini Tang. (This is Huiyang Jiuji Tang, with its own methods for modification.)
Someone asked: "To treat Shanghan (Cold Damage), one must first clarify the pulse and signs. Without clear pulse and signs, prescribing has no basis; once clarified, the physician becomes an expert. The character 'Mai' (Pulse) truly embodies the creation of Xiantian (Pre-heaven/Innate) and Hou Tian (Post-heaven/Acquired). What is Xiantian? What is Hou Tian? And what is Mai?" The answer was: "Human Yin and Yang constitute Xiantian. Human Qi and Blood constitute Hou Tian. Mai is neither blood nor Qi, but the precursor to Qi and Blood, being the pathway where Ying (Nutritive) Qi travels." Another question arose: "Having understood the pulse principles of Xiantian and Hou Tian, one must know the essentials of holding the pulse: Ju (Lifting), An (Pressing), and Xun (Searching). Without understanding these, how can one distinguish Yin/Yang, Exterior/Interior, Deficiency/Excess?" When holding the pulse, light palpation is called Ju. Heavy pressure is called An. Neither light nor heavy, seeking carefully, is called Xun. Initially, with light touch, if the pulse is felt at the skin level, it is called Floating (Fu), characteristic of the Taiyang (Greater Yang) meridian. Forceful indicates Cold pathogen in the Exterior; absence of sweating indicates Cold damaging Ying Blood, representing an Exterior Excess syndrome, suitable for diaphoresis (sweating method). Weak indicates Wind pathogen in the Exterior; presence of sweating indicates Wind damaging Wei (Defensive) Qi, representing an Exterior Deficiency syndrome, suitable for consolidating the exterior. If the pulse is felt beneath the muscle, between sinew and bone, it is called Deep (Chen), characteristic of the Three Yin meridians. All Three Yin pulses are Deep; the subtlety lies in distinguishing forceful from weak under the fingers. Forceful indicates Heat pathogen in the Interior, representing Interior Excess, suitable for purgation. Weak indicates Cold pathogen invading the Interior, representing Interior Deficiency, suitable for warming. With neither light nor heavy pressure, taking the middle position, the pulse corresponds to the flesh and blood layer, with equal Yin and Yang. If a slightly洪 (Hong/Surging) pulse is seen, it is the Yangming (Yang Brightness) meridian, indicating pathogen mostly in the Exterior with little in the Interior, suitable for resolving the muscle layer. If a string-like and rapid (Xuan Shu) pulse is seen, it is the Shaoyang (Lesser Yang) meridian, indicating pathogen in the Half-Exterior Half-Interior, suitable for harmonizing. The previously mentioned Yin/Yang, Exterior/Interior, Deficiency/Excess, Cold/Heat are all distinguished within the forcefulness or weakness of the Floating, Middle, and Deep pulses. Forceful indicates Yang, Excess, Heat. Weak indicates Yin, Deficiency, Cold. If the pulse is not visible in Floating, Deep, or Middle positions, one must search carefully; if it appears faintly or intermittently, it is a Hidden Pulse of Yin/Yang concealment, applicable to all three positions. Someone said: "Your clarity is profound, unrecognizable to vulgar minds. Among these three pulses, there are progression and retreat, hidden pulses, resolvable and non-resolvable types, intermittent pulses, and chaotic pulses. Please explain their origins." The answer was: "A large pulse indicates disease progression; largeness means pathogen is strong while healthy Qi is powerless. A slow/moderate pulse indicates pathogen retreat; moderation means Stomach Qi is harmonious and pathogen is powerless. What is a Hidden (Fu) pulse? No pulse on one hand is Single Hidden. No pulse on both hands is Double Hidden. If at the onset of illness there is headache, fever, and aversion to cold with a hidden pulse, it is because Yin pathogen has sunk into Yang, unable to vent; this desires sweating but requires purgation to allow pathogen retreat and healthy Qi recovery, after which the pulse returns and disease clears. Like weather becoming hot before rain, then cool after rain. However, if after seven or eight days there are no clashing symptoms, or the patient is comatose/unconscious, or the pulse is completely absent, this desires sweating but forbids purgation. Like dark skies after rain bringing life to all things, a auspicious sign of Yang transformation. What is resolvable vs. non-resolvable? Floating-moderate pulse in the Exterior resolves via sweating. Deep-solid pulse in the Interior resolves via purgation. Deep-slow pulse in the Interior resolves via warming. Although Floating suits sweating, Deep suits purgation/warming, why would Floating suit purgation and Deep suit sweating? The answer: Purging a Floating pulse is due to difficult defecation. If defecation were not difficult, how could one dare to purge! Sweating a Deep pulse is due to exterior heat. If the body were not feverish, how could one dare to sweat! What is intermittent pulse? If Cold pathogen directly strikes Yin meridians, and after warming the pulse remains intermittent, it is called intermittent. What is chaotic/restless? After sweating or purging, the pulse should calm; if it instead becomes vigorous and chaotic, it is called Chaotic, a sign of great misfortune. Then, does the gentleman speak with evidence? Alas, it is hard to explain fully; this comes from the standard principles of classic laws. The guest rose happily and thanked him: 'Though I am white-haired and endless in years, I have admired this throughout my life. Unexpectedly meeting you, I am fortunate to have my mind opened. It is like using a small mouse to fire a thousand-jin crossbow—very inappropriate—truly like cutting and polishing gems. Compared to modern vulgar people, I am indeed a chicken in a jar or a frog in a well, unaware that there is sky outside the jar and sea outside the well. Thank you for your enlightenment later on; are you not a reincarnated master!' Thus, it was recorded and transcribed to show posterity."