伤食亦头痛恶寒发热。但身不痛。右关脉短滑。或弦滑。与伤寒异。胸膈饱闷。恶食
嗳气。此食滞中脘也。宜辛温消导。紫苏、浓朴、枳实、楂肉、神曲、麦芽之类。兼风寒者。
身体拘痛也。加羌防散之。舌黄口渴者。兼内火也。加连翘、黄芩、莱菔子凉疏之。若
兼胀痛甚者。挟痧秽也。加广藿梗、川郁金逐之。按食与痰。乃伤寒兼有之症。临症者必须兼参可也。
凡停食胀痛。在大腹脐以上者。尚在小肠之间。宜消导。不可下。其痛满在脐及少
腹。方是燥屎在于大肠。下之可也。
蓄血伤寒者。非因伤寒热瘀蓄血。乃平时劳伤所蓄之血也。病不从太阳入。故无
恶寒头痛之症。但发热口渴。语言无伦。小便利。大便黑。或胸胁间有痛处。或因血
郁心脾。如见鬼状。药不宜凉。亦不可热。当用川郁金、参三七、生楂肉、红花、全归、桃
仁、延胡、香附、丹参、泽兰之类。和之行之。如舌润不渴者。加肉桂温之。舌燥便秘。加
酒制大黄行之。
凡痧秽。从口鼻吸入。即从膜原流布三焦。便见头痛恶寒发热。骨节酸疼。与伤寒
相似。但脉沉细。或手足指冷。腹满呕恶。与伤寒异。刺少商穴。其血紫滞者是也。须
用川郁金、石菖蒲、广藿香、槟榔、浓朴、青皮、紫苏等以逐秽邪。则膜原清肃。三焦通
利而愈矣。亦当兼察食痰暑湿为治。
邵评∶外经络。五内腑。膜原在内外交界之地。章虚谷薛氏湿热条辨。释膜原外
通肌肉。不独口鼻所入之邪归之。肌肉湿热之邪。亦必归之。其为三焦之门户
而近胃口。故膜原之邪。必由三焦而归脾胃也。
伤食也会引起头痛、恶寒（怕冷）、发热。但是身体不痛，右关脉（右手腕部桡动脉的关部）短而滑，或者弦而滑，这与伤寒不同。患者感到胸膈部饱闷，厌恶食物气味，嗳气。这是食积停滞在中脘（胃脘部）。适宜用辛温性质的药物进行消食导滞，如紫苏、厚朴、枳实、山楂肉、神曲、麦芽之类。如果兼有风寒，会出现身体拘挛疼痛，加入羌活、防风来疏散风寒。舌苔黄且口渴的，是兼有内火，加入连翘、黄芩、莱菔子来清热疏泄。如果兼有严重的胀痛，是挟带痧秽（感受秽浊之气），加入广藿梗、川郁金来驱除秽邪。按饮食与痰饮，是伤寒病中常兼有的症状，临证时必须综合参考判断。
凡是停食引起的胀痛，部位在大腹脐以上的，还在小肠之间，适宜消食导滞，不可使用泻下法。如果疼痛胀满在脐部及少腹部，这才是燥屎结聚在大肠，可以使用泻下法。
蓄血型伤寒，并不是因为伤寒热邪瘀滞导致的蓄血，而是平时劳损所积累的瘀血。这种病不从太阳经传入，所以没有恶寒、头痛的症状。只表现为发热、口渴，言语错乱无条理，小便通利，大便色黑，或者胸胁间有固定痛处。或者因为血郁在心脾，出现如见鬼魅般的幻觉。用药不宜过凉，也不宜过热，应当用川郁金、参三七、生山楂肉、红花、全当归、桃仁、延胡索、香附、丹参、泽兰之类，调和气血并运行血脉。如果舌面湿润且不渴，加入肉桂以温阳；如果舌燥且便秘，加入酒制大黄以通便行瘀。
凡是痧秽之邪，从口鼻吸入，随即从膜原（半表半里之隙）流布于三焦，便出现头痛、恶寒、发热、骨节酸痛，症状与伤寒相似。但脉象沉细，或者手足指端发冷，腹部胀满、呕吐恶心，这与伤寒不同。可针刺少商穴，若流出血液颜色紫暗滞涩，即可确诊。必须使用川郁金、石菖蒲、广藿香、槟榔、厚朴、青皮、紫苏等药物来驱逐秽邪，使膜原清肃，三焦通利，疾病即可痊愈。同时也应当兼察是否有食积、痰饮、暑湿等因素进行治疗。
邵评：外连经络，内通脏腑。膜原位于内外交界之地。章虚谷和薛氏在《湿热条辨》中解释，膜原外通肌肉，不仅仅是口鼻进入的邪气归于此，肌肉中的湿热邪气也必归于此。它是三焦的门户，且靠近胃口，所以膜原的邪气，必然通过三焦归于脾胃。
Food stagnation can also cause headache, aversion to cold (Ehan), and fever. However, the body does not ache, and the pulse at the Guan position of the right wrist (Guan position of the radial artery on the right hand) is short and slippery, or wiry and slippery, which differs from Taiyang disease (a syndrome caused by pathogenic factors attacking the Taiyang meridian). The patient feels fullness and oppression in the chest and diaphragm, aversion to food odors, and belching. This indicates food stagnation in the Zhongwan (epigastric region). It is appropriate to use acrid-warm herbs for digestion and guiding out stagnation, such as Perilla Herba (Zisu), Magnoliae Officinalis Cortex (Houpo), Immature Bitter Orange (Zhishi), Hawthorn Fruit (Shanzha), Medicated Leaven (Shenqu), and Malt (Maiya). If complicated by wind-cold, there will be bodily stiffness and pain; add Notopterygii Rhizoma et Radix (Qianghuo) and Saposhnikoviae Radix (Fangfeng) to disperse it. If the tongue coating is yellow and there is thirst, it indicates internal heat; add Forsythiae Fructus (Lianqiao), Scutellariae Radix (Huangqin), and Raphi Semen (Laifuzi) to clear heat and drain it. If accompanied by severe distending pain, it involves Sha hui (pathogenic miasma); add Pogostemonis Herba (Guanghuogen) and Curcumae Radix (Chuan yujin) to expel the miasma. According to dietary intake and phlegm, these are conditions often concurrent with Shanghan (Cold Damage); clinicians must consider them comprehensively during diagnosis.
Whenever food retention causes distending pain located above the umbilicus in the large abdomen, it remains within the small intestine; digestion and guidance are suitable, but purgation should not be used. If the pain and fullness are at the umbilicus and the lower abdomen, this indicates dry stool accumulated in the large intestine, and purgation may be applied.
Sha xue (Blood Stasis) Shanghan is not due to heat-stasis blood accumulation caused by Shanghan, but rather blood accumulated from previous physical overexertion. This condition does not enter via the Taiyang meridian, so there are no symptoms of aversion to cold or headache. It presents only with fever, thirst, incoherent speech, free urination, black stools, or fixed pain in the chest and hypochondrium. Or, due to blood stagnation affecting the Heart and Spleen, hallucinations such as seeing ghosts may occur. Medications should not be too cooling nor too heating; instead, use Curcumae Radix (Chuan yujin), Panax Notoginseng Radix et Rhizoma (Shen sanqi), raw Hawthorn Fruit (Sheng shanzha), Carthami Flos (Honghua), Angelicae Sinensis Radix (Quan gui), Persicae Semen (Taoren), Corydalis Rhizoma (Yanhusu), Cyperi Rhizoma (Xiangfu), Salviae Miltiorrhizae Radix et Rhizoma (Danshen), and Lonicerae Japonicae Caulis (Zelan) to harmonize and invigorate the blood. If the tongue is moist and there is no thirst, add Cinnamomi Ramulus (Rougui) to warm; if the tongue is dry and constipation exists, add Rheum Palmatum Radix et Rhizoma processed with wine (Jiu da huang) to promote bowel movement and resolve stasis.
Sha hui pathogens, inhaled through the mouth and nose, spread from the Mo yuan (Membrane Source) to the San jiao (Triple Burner), presenting with headache, aversion to cold, fever, and soreness of bone joints, resembling Shanghan. However, the pulse is deep and fine, or the fingertips are cold, accompanied by abdominal fullness and vomiting/nausea, which differs from Shanghan. Pricking the Shaoshang point (LU11) is indicated; if the blood drawn is dark and stagnant, the diagnosis is confirmed. One must use Curcumae Radix (Chuan yujin), Acori Tatarinowii Rhizoma (Shichangpu), Pogostemonis Herba (Guanghuoxiang), Arecae Semen (Binglang), Magnoliae Officinalis Cortex (Houpo), Citri Reticulatae Pericarpium (Qingpi), and Perillae Folium (Zisu) to expel the turbid pathogens, thereby clearing the Mo yuan and unblocking the San jiao to achieve recovery. Treatment should also concurrently address food stagnation, phlegm, summerheat, and dampness.
Commentary by Shao: The Mo yuan connects externally to the meridines and internally to the zang-fu organs. It is located at the boundary between the exterior and interior. Zhang Xuguxu and Mr. Xue explained in "Regulations on Damp-Heat" that the Mo yuan connects externally to the muscles. It is not only the site where pathogens entering via the mouth and nose reside, but also where damp-heat pathogens in the muscles gather. As it serves as the gateway to the San jiao and is close to the stomach opening, pathogens in the Mo yuan must return to the Spleen and Stomach via the San jiao.