仲景第四卷十七证云。脉虽沉紧。不得为少阴病。所以然者。阴不得有汗。今头汗出。故知非少阴也。又云
脉阴阳俱紧。而又汗出。为亡阳。此属少阴。大抵阴虚者多汗。而此言阴不得有汗。何也。余尝深究虚汗之
证。亦自有阴阳之别。阳病自汗有九证。皆有治法。唯阴毒则额上手背有冷汗。甚者如水洗。然此是阳虚
阴盛。亡阳而将脱也。其死必矣。仲景此篇。方论半在表。半在里。故先曰汗出为阳微。此则虚汗。阳微故也。
非阴证无汗。不得有汗也。有汗则九死一生。由是言之。阳得有汗。阴不得有汗。以意逆志。是为得之。
仲景称伤寒。若吐下后七八日不解。热结在里。表里俱热者。白虎加人参汤主之。又云伤寒脉浮。发热无
汗。其表不解。不可与白虎汤。又云。脉浮滑。此以表有热里有寒。白虎汤主之。国朝林亿校正。
谓仲景于此表里自差矣。是大不然。大抵白虎能除伤寒中 。表里发热。故此前后二证。或云表
里俱热。或云表热里寒。皆可服之宜也。中一证。称表不解不可服者。盖以脉浮无汗发热。此
全是伤寒表证。宜麻黄葛根之类也。安可用白虎。亿但见所称表里不同。便谓差互。是亦不精不
思之过也。
仲景云。脉，大浮数动滑。此名阳也。脉，沉涩弱弦微。此名阴也。脉诀以动脉为阴。以弦脉为阳。
何也。此是开卷第一行疑处。而世人不知讲。予谓脉诀所言。分七表八里而单言之也。此之所论。
兼众脉而合言之也。大抵杂病各见一脉。唯伤寒必兼众脉而见。何以言之。仲景之意。若曰浮大
者阳也。兼之以动、数、滑之类。安得不为阳。沉细者阴也。兼之以涩弦数之类。安得不为阴。故仲
景论动脉。则曰阳动则汗出。阴动则发热。数脉见于关上。上下无头尾如豆大。厥厥动摇。名曰动也。
又结胸证云。脉浮而动。浮则为风。动则为痛。故兼数与浮而言动脉。则阳脉阳病也宜矣。仲景
论弦脉。则曰弦者状如弓弦。按之不移。弦则为减。又曰。支饮急弦。又少阴证云。手足寒。脉弦迟。
故此兼迟而言。弦则为阴脉阴病也宜矣。故仲景伤寒脉。不可与杂病脉同日而语。今阳证往往浮大。
而厥厥动摇。其沉细而弦者。必阴证也。何疑之有哉。不特此也。至如曰高、曰章、曰纲、曰 、
曰卑、曰损。有纵有横。有逆有顺。趺阳太溪之类极多。予尝撰仲景三十六种脉法图。故知治
伤寒。当以仲景脉法为本。
张仲景在《伤寒论》第四卷第十七证中说：“脉象虽然沉紧，但不能据此诊断为少阴病。之所以这样讲，是因为少阴病（属里虚寒证）通常不会有汗出。现在患者头面部出汗，所以知道这不是少阴病。”又说：“脉象寸关尺三部都紧，却又出现汗出，这是阳气亡失的表现，这属于少阴病。”大抵阴虚体质的人容易多汗，而这里却说“少阴病不得有汗”，为什么呢？我曾深入探究虚汗的病症，发现其中自有阴阳的区别。阳病引起的自汗有九种证型，都有相应的治疗方法。只有阴毒证会在额头和手背出现冷汗，严重的像水洗一样。然而这是阳气虚弱、阴气盛极，阳气即将亡脱的表现，这种情况死亡是必然的。张仲景这篇论述，方剂与理论分析一半涉及表证，一半涉及里证，所以说先提到“汗出”是因为阳气微弱，这属于虚汗，是由于阳气微弱的缘故。这并不是说阴证绝对没有汗，而是指典型的少阴病不应有汗。如果出现这种汗出，则是九死一生的危候。由此而言，阳证可以有汗，而少阴病（阴证）原则上不应有汗。通过推究其意旨来理解经文，这才是正确的解读方法。
张仲景论述伤寒病，如果在经过吐法或下法治疗后七八天病情仍未解除，热邪结聚在体内，表现为表里俱热的症状，应当用白虎加人参汤治疗。他又说：“伤寒病脉象浮，发热且无汗，说明表证未解，不可给予白虎汤。”他还说：“脉象浮滑，这是因为表有热、里有寒，应用白虎汤治疗。”本朝林亿在校正医书时，认为张仲景在这里关于表里的论述存在矛盾差错。这完全不对。大抵白虎汤能够清除伤寒病中表里两方面的发热，所以前面两种证候，有的说“表里俱热”，有的说“表热里寒”，都可以服用此药适宜。其中一种说法称“表不解不可服”，是因为脉浮、无汗、发热，这完全是伤寒表证的典型表现，应该使用麻黄、葛根之类的药物发汗解表。怎么可以用白虎汤呢？林亿只是看到文中提到的表里情况不同，就认为是文字错乱，这也是不精细、不深思的过错。
张仲景说：“脉象大、浮、数、动、滑，这些称为阳脉。”“脉象沉、涩、弱、弦、微，这些称为阴脉。”《脉诀》将动脉归为阴脉，将弦脉归为阳脉，这是为什么呢？这是本书开篇第一行存在的疑点，世人不知探讨。我认为《脉诀》所说的，是将七表八里脉象分开单独论述的；而这里所讨论的，是综合多种脉象一起论述的。大抵杂病往往只显现某一种脉象，唯独伤寒病必须兼见多种脉象。为什么这样说呢？张仲景的意思大概是：脉象浮大的属于阳，如果兼见动、数、滑等脉象，怎么能不是阳脉呢？脉象沉细的属于阴，如果兼见涩、弦、数等脉象，怎么能不是阴脉呢？所以张仲景论述动脉时说：“阳动则汗出，阴动则发热。”对于数脉出现在关部，上下没有头尾，像豆子大小，厥厥然跳动的，称为动脉。又在结胸证的论述中说：“脉浮而动，浮则为风邪，动则为疼痛。”所以兼见数和浮而言动脉，那么作为阳脉对应阳病是适宜的。张仲景论述弦脉时说：“弦脉的形状像弓弦，按之不移，弦脉表示正气减损。”又说：“支饮证脉象急弦。”还有少阴证说：“手足寒冷，脉象弦迟。”因此这里兼见迟脉而言，弦脉作为阴脉对应阴病也是适宜的。所以张仲景论述的伤寒脉象，不能与杂病的脉象同日而语。如今阳证往往脉象浮大，并且厥厥然跳动；脉象沉细而弦的，必定是阴证。这有什么可怀疑的呢？不仅如此，诸如高、章、纲、覆、卑、损等脉象，有纵有横，有逆有顺，趺阳脉、太溪脉等种类极多。我曾撰写过张仲景三十六种脉法图，所以知道治疗伤寒病，应当以张仲景的脉法为根本。
Zhang Zhongjing stated in the 17th syndrome of Volume 4: "Although the pulse is deep and tight, it cannot be diagnosed as Shaoyin disease (a syndrome characterized by interior deficiency-cold). The reason for this statement is that Shaoyin disease typically does not present with sweating. Since the patient currently has sweat on the head, we know this is not Shaoyin disease." He also stated: "If the pulse is tight at all three positions (cun, guan, chi), yet sweating occurs, this indicates the loss of Yang Qi (vital energy) and belongs to Shaoyin disease." Generally, individuals with Yin deficiency tend to sweat easily, so why does it say here that 'Shaoyin disease should not have sweating'? I have deeply investigated syndromes of deficiency sweating and found distinctions between Yin and Yang. There are nine types of spontaneous sweating caused by Yang diseases, each with specific treatments. Only in Yin Poison syndrome (a severe cold-toxin condition) will there be cold sweat on the forehead and back of the hands, which may be profuse like being washed in water. However, this represents extreme Yin flourishing due to Yang deficiency, where Yang Qi is about to collapse; death is inevitable. In this chapter, Zhang Zhongjing's discussion involves both exterior and interior aspects. Thus, when he first mentions 'sweating,' it is because of weak Yang Qi, constituting a type of deficiency sweating. This does not mean that Yin syndromes absolutely never have sweating, but rather that typical Shaoyin disease should not exhibit sweating. If such sweating occurs, it indicates a critical condition with only one chance in nine of survival. Therefore, Yang syndromes can have sweating, whereas Shaoyin disease (a Yin syndrome)原则上 should not. By inferring the author's intent to understand the text, one grasps the correct meaning.
Regarding Zhang Zhongjing's discussion on Cold Damage (Shanghan): if after vomiting or purging therapies, the condition remains unresolved after seven to eight days, with heat accumulating internally and presenting with fever and heat in both the exterior and interior, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) should be administered. He further stated: "In Cold Damage, if the pulse is floating, accompanied by fever and absence of sweating, indicating the exterior syndrome is unresolved, Baihu Tang (White Tiger Decoction) must not be given." He also said: "A floating and slippery pulse indicates heat in the exterior and cold in the interior; Baihu Tang should be used." During the Song Dynasty, Lin Yi, while correcting medical texts, argued that Zhang Zhongjing's statements regarding the exterior and interior in this context were contradictory. This is entirely incorrect. Broadly speaking, Baihu Tang can clear heat from both the exterior and interior in Cold Damage. Therefore, in the preceding two syndromes, whether described as 'heat in both exterior and interior' or 'heat in the exterior and cold in the interior,' the use of this decoction is appropriate. The statement 'if the exterior is unresolved, do not administer' applies because floating pulse, absence of sweating, and fever constitute a pure exterior syndrome of Cold Damage, which requires herbs like Mahuang (Ephedrae Herba) or Gegen (Puerariae Lobatae Radix) to induce sweating and resolve the exterior. How could Baihu Tang be used? Lin Yi merely observed the differing descriptions of the exterior and interior and concluded there was a textual error, which reflects a lack of precision and deep thought.
Zhang Zhongjing stated: "Large, floating, rapid, moving, and slippery pulses are named Yang pulses." "Deep, choppy, weak, wiry, and thready pulses are named Yin pulses." The Mai Jue (Pulse Classic) classifies the Moving pulse as Yin and the Wiry pulse as Yang. Why is this? This is a point of doubt in the very first line of the opening chapter, which people generally fail to discuss. I believe the Mai Jue discusses these separately within the framework of Seven Exterior and Eight Interior pulses, whereas the current discussion synthesizes multiple pulse qualities together. Generally, miscellaneous diseases often manifest a single pulse quality, whereas Cold Damage necessarily presents with combined pulse qualities. Why? Zhang Zhongjing's intent seems to be: A large and floating pulse is Yang; if combined with moving, rapid, or slippery qualities, how can it not be Yang? A deep and fine pulse is Yin; if combined with choppy, wiry, or rapid qualities, how can it not be Yin? Thus, when discussing the Moving pulse, Zhang Zhongjing said: "Yang movement causes sweating; Yin movement causes fever." Regarding the Rapid pulse appearing at the Guan position, lacking head or tail, bean-sized, and beating vigorously, it is named the Moving pulse. In the discussion of Chest Binding syndrome, it states: "The pulse is floating and moving; floating indicates Wind pathogen, moving indicates pain." Therefore, when the Moving pulse is discussed in conjunction with rapid and floating qualities, it is appropriate for it to be a Yang pulse corresponding to a Yang disease. When discussing the Wiry pulse, Zhang Zhongjing said: "The Wiry pulse feels like a bowstring, unyielding to pressure; Wiry indicates reduction of healthy Qi." He also stated: "In Fluid Retention (Zhi Yin), the pulse is urgently wiry." Additionally, in Shaoyin syndrome, it says: "Cold extremities and a wiry, slow pulse." Thus, when combined with the slow quality, the Wiry pulse appropriately corresponds to a Yin pulse and Yin disease. Therefore, the pulse patterns in Zhang Zhongjing's treatment of Cold Damage cannot be equated with those in miscellaneous diseases. Currently, Yang syndromes often present with large, floating pulses that beat vigorously; deep, fine, and wiry pulses indicate Yin syndromes. What is there to doubt? Furthermore, there are numerous pulse descriptions such as High, Chapter, Outline, Cover, Low, and Loss, involving vertical/horizontal, reverse/forward dynamics, as well as Du Yang and Tai Xi pulses. I once compiled a diagram of Zhang Zhongjing's Thirty-Six Pulse Methods. Thus, I know that treating Cold Damage must take Zhang Zhongjing's pulse methodology as the foundation.