发热恶寒头项强。腰脊分明似反张。螈 口噤如痫状。此名 病是其常。（仲景云。病身热暑寒。头项强急。恶寒。
时头面赤。目脉赤。独头面摇。卒口噤。背反张者。 病也。）先感风寒后感湿。沉迟弦细脉相当。（仲景云。太阳病发
热。脉沉而细者。名曰 。千金云。太阳中风。重感于寒湿。则变 病也。仲景又云。太阳发汗太多。因成 。孙尚云。
病热而脉沉细者。难治也。）有汗不恶名柔 。无汗恶寒名曰刚。无汗葛根有汗桂。二 皆宜续命汤。（无汗葛根汤。有
汗桂枝汤。而分发汗解肌。 有刚 。有柔 。刚 无汗。柔 有汗。自宜续命汤。仲景云。太阳病发热。无汗。反恶
寒。名曰刚 。汗出不恶寒者。名曰柔 。）脚挛啮齿皆阳热。承气汤宜下最良。（以上皆热证。当用承气汤。）亦名阳痉
并阴痉。名异实同安可忘。（ 音炽。痉。巨郢反。名异实同也。）
（食积 虚烦 寒痰 香港脚）
食积虚烦并有痰。更兼香港脚似伤寒。四家病证虽云异。发热憎寒却一般。（此四证虽非伤寒。然发热憎寒。则同。当
以脉证辨之。）中脘寒痰胸痞满。脉浮自汗体难干。（此痰证也。有痰则胸中痞满。自汗。脉浮。）食积令人头必痛。身不
疼兮积证端。气口紧盛伤于食。心烦脉数呕吞酸。（此食积也。食积则身不疼。但呕恶吞酸。气口脉紧盛。而它脉数。朱
肱云。气口紧盛。伤于食。）虚烦之脉不紧实。但觉身心热与烦。身不疼兮头不痛。唯宜竹叶便须安。（孙尚云。虚烦与
伤寒相似。但得病二三日。脉不浮。不恶寒。身不疼痛。但热而不烦。不可发汗。发汗必危损。如脉不紧实。不甚痛。
但热而或不烦。非里实。亦不可下。下之必危损。唯可服竹叶汤主之。）又有香港脚之为病。大便坚硬足行难。两胫肿满或
枯细。莫与伤寒一例看。（此论香港脚也。香港脚大便坚。脚膝肿痛。两胫或有肿满。或有枯细者。方其发时。亦发热憎寒。
呕恶。似伤寒证候也。）
发热、恶寒、头项强直，腰脊明显呈现角弓反张之状，肢体抽搐、牙关紧闭如同癫痫发作。这称为痓病（以筋脉拘急、项背强直为特征的疾病），这是其常态。（张仲景说：痓病身体发热、怕冷，头项强直紧急，恶寒，有时头面发红，眼目脉络赤红，唯独头部摇动，突然牙关紧闭，背部反张，这就是痓病。）先感受风寒，后感受湿邪，脉象表现为沉、迟、弦、细。（张仲景说：太阳病发热，脉象沉而细的，名叫痓。《千金方》说：太阳中风，又重感寒湿，则变为痓病。张仲景又说：太阳病发汗过多，因而形成痓病。孙尚说：痓病发热而脉象沉细的，难以治疗。）有汗且不恶寒的叫柔痓，无汗且恶寒的叫刚痓。无汗用葛根汤，有汗用桂枝汤，两种痓病都适宜使用续命汤。（无汗用葛根汤，有汗用桂枝汤，分别进行发汗和解肌的治疗。痓病有刚痓和柔痓之分。刚痓无汗，柔痓有汗，自然适宜使用续命汤。张仲景说：太阳病发热，无汗，反而恶寒，名叫刚痓；出汗不恶寒的，名叫柔痓。）脚部痉挛、咬齿都是阳热所致，承气汤适宜攻下，效果最好。（以上都属于热证，应当使用承气汤。）这也分为阳痓和阴痓，名称不同实质相同，不可忘记。（痓音炽，痉读巨郢反，名称不同实质相同。）
（食积、虚烦、寒痰、香港脚）
食积导致的虚烦并伴有痰饮，再加上香港脚（一种以足胫肿重无力为主症的疾病）症状类似伤寒。这四类疾病的证候虽然声称不同，但发热憎寒的表现却是一样的。（这四种证候虽然不是伤寒，然而发热憎寒是相同的，应当通过脉象和证候来辨别。）中脘穴处因寒痰导致胸膈痞闷胀满，脉象浮，自汗出，身体难以保持干燥。（这是痰证。有痰则胸中痞闷胀满，自汗，脉浮。）食积令人必定头痛，身体不疼痛则是积证的特征。气口脉紧盛说明伤于饮食，心烦、脉数、呕吐吞酸。（这是食积。食积则身体不疼痛，只是呕吐恶心、吞酸，气口脉紧盛，而其他脉象数。朱肱说：气口脉紧盛，是伤于饮食。）虚烦的脉象不紧实，只感觉身心发热与烦躁。身体不疼痛，头部也不痛，唯宜服用竹叶汤即可安宁。（孙尚说：虚烦与伤寒相似，但得病二三天，脉象不浮，不恶寒，身体不疼痛，只是发热而不烦躁，不可发汗，发汗必然造成危重损伤。如果脉象不紧实，疼痛不严重，只是发热或者不烦躁，不是里实证，也不可攻下，攻下必然造成危重损伤。唯可服用竹叶汤主治。）又有香港脚这种病，大便坚硬，行走困难。两小腿肿胀满溢或者枯瘦细小，不要将香港脚与伤寒一例看待。（这里论述的是香港脚。香港脚患者大便干结，脚膝肿痛，两小腿或者有肿胀满溢，或者有枯瘦细小的情况。当其发作时，也出现发热憎寒、呕吐恶心，类似伤寒的证候。）
Fever, aversion to cold, and stiffness of the head and neck; the waist and spine clearly present opisthotonos (backward arching of the body). Convulsions (spasmodic twitching of limbs) and trismus (lockjaw) resemble epilepsy. This is named Ji disease (a disease characterized by spasticity and rigidity of the neck and back), which is its normal presentation. (Zhang Zhongjing stated: In Ji disease, there is fever, aversion to cold, stiffness and urgency of the head and neck, aversion to cold, sometimes redness of the head and face, redness of the eye vessels, only the head shakes, sudden trismus, and opisthotonos; this is Ji disease.) First, wind-cold is contracted, then dampness; the pulse corresponds to deep, slow, wiry, and fine. (Zhang Zhongjing stated: In Taiyang disease with fever, if the pulse is deep and fine, it is named Ji. *Qianjin Fang* stated: In Taiyang wind-stroke, if re-exposed to wind-cold and dampness, it transforms into Ji disease. Zhang Zhongjing also stated: If Taiyang disease undergoes excessive sweating, Ji disease results. Sun Shang stated: Ji disease with fever and a deep, fine pulse is difficult to treat.) With sweating and no aversion to cold, it is called Rou Ji (Soft Spasm); without sweating and with aversion to cold, it is called Gang Ji (Hard Spasm). Without sweating, Gegen Tang is used; with sweating, Guizhi Tang is used; both types of Ji are suitable for Xuming Tang. (Without sweating, Gegen Tang; with sweating, Guizhi Tang, respectively inducing sweating and releasing the muscle layer. Ji has Gang Ji and Rou Ji. Gang Ji has no sweating, Rou Ji has sweating, naturally suitable for Xuming Tang. Zhang Zhongjing stated: In Taiyang disease with fever, without sweating, and contrary aversion to cold, it is named Gang Ji; with sweating and no aversion to cold, it is named Rou Ji.) Leg cramps and teeth-grinding are all due to Yang heat; Chengqi Tang is suitable for purging and is most effective. (All the above are Heat syndromes, and Chengqi Tang should be used.) These are also named Yang Ji and Yin Ji; names differ but reality is the same, do not forget. (Ji sounds like 'chi', Jing reads 'ju ying' reverse, names differ but reality is the same.)
(Food Stagnation, Deficiency Disturbance, Cold Phlegm, Hongxiangjiao [Beriberi])
Food stagnation causing deficiency disturbance combined with phlegm, plus Hongxiangjiao symptoms resembling Shanghan (Cold Damage). Although the four diseases' presentations are said to be different, fever and aversion to cold are the same. (These four syndromes are not Shanghan, yet fever and aversion to cold are identical; they must be distinguished by pulse and syndrome.) Cold phlegm at Zhongwan causes chest fullness and oppression; the pulse is floating, spontaneous sweating occurs, and the body is difficult to keep dry. (This is a Phlegm syndrome. With phlegm, there is chest oppression, spontaneous sweating, and a floating pulse.) Food stagnation causes inevitable headache; lack of body pain indicates the presence of stagnation. A tight and full Qi Kou pulse indicates food injury; mental restlessness, rapid pulse, vomiting, and acid regurgitation. (This is Food Stagnation. With food stagnation, the body does not hurt, only vomiting/nausea and acid regurgitation occur; the Qi Kou pulse is tight and full, while other pulses are rapid. Zhu Gong stated: A tight and full Qi Kou pulse indicates food injury.) The pulse of Deficiency Disturbance is not tight or solid; one only feels heat and restlessness in the body and mind. No body pain, no headache; only Zhuye Tang is suitable for peace. (Sun Shang stated: Deficiency Disturbance resembles Shanghan, but after two or three days of illness, the pulse is not floating, there is no aversion to cold, no body pain, only heat without restlessness. Sweating must not be induced, as it will cause critical damage. If the pulse is not tight/solid, pain is not severe, only heat or lack of restlessness, it is not an Interior Excess syndrome, so purging must not be used, as it will cause critical damage. Only Zhuye Tang can be administered.) There is also Hongxiangjiao disease, where stool is hard and walking is difficult. Both calves are swollen and full or withered and thin. Do not view Hongxiangjiao as the same category as Shanghan. (This discusses Hongxiangjiao. Patients with Hongxiangjiao have hard stools, swollen and painful feet/knees, and either swollen/full or withered/thin calves. During onset, there is also fever and aversion to cold, vomiting and nausea, resembling Shanghan manifestations.)