戴 凡治伤寒须辨阴阳二候不可误也阳经有三太阳阳明少阳是也阴经亦有三太阴少阴厥阴是也经之阴阳以脏腑言
腑为阳膀胱胃胆是也脏为阴脾肾肝是也病之阴阳乃是外邪之阴阳阴气阳气是也病在太阳则热在皮肤之分翕翕然怫怫然
而热便有头痛恶寒体疼其脉必浮而紧病在阳明则热在肌肉之分或壮热或 而热或蒸蒸而热便有头额痛或潮热自汗其
脉必长而数病在少阳则必半表半里之热或往来寒热便有头角痛口苦呕而胸满胁痛其脉必弦而数病在太阴则手足渐冷脉
息渐沉或自利腹满呕吐不渴病在少阴虽然发热手足自冷脉必沉细病在厥阴则手足厥冷脉微而缓甚则唇青舌卷囊缩阳证
面红光彩唇红口干舌燥能饮水浆其人身轻易以转动常欲开眼见人目睛了了喜语言其声响亮口鼻之气呼吸出入能往而能
来小便或赤或黄大便或秘或硬手足自温暖爪甲俱红活阴证面青黑或有虚阳泛上虽亦赤色而不红活光彩其人身重难以转
侧或喜向壁卧或蜷卧欲寐或闭目不欲见人目睛不了了懒言语语无声气难布息鼻中呼不出吸不入往来口与鼻中气冷不欲
饮水面上恶寒有如刀刮唇口或青或紫舌色或青或紫或白苔铺满而滑不见红色手足自冷爪甲或青或紫血自不红活小便清
白或有淡黄大便不实或泻虽肌表有热以手按之则不甚热阴甚者则冷透手也阴阳二气皆能犯脏腑故阳气犯太阳则为伤风
恶风而有汗阴气犯太阳则为伤寒恶寒而无汗在太阳未得解转入阳明少阳二经则纯乎阳不如太阳之易治若阳气未能罢以
次传入阴经则为阴中之阳盖缘阳经之阳气来入阴经虽有自利欲寝唇青手足厥冷舌卷囊缩等证亦不可妄投热药宜泻其阳
之在阴经也若阳病下之太过阳气已脱遂变为阴所谓害热未已寒病复起或初得病便是阴证此是阴中之阴盖缘阴气攻阴经
阴自得传非自传诸阳经来只当以温药回其阳故阳入阴者变阳以救阴阴入阳者用阳以救阳二者不可不辨
活 太阳阳明少阳皆属阳证也太阳者膀胱也发热恶寒头疼腰痛而脉浮也阳明者胃也不恶寒反恶热 汗出大便秘
潮热而脉长也少阳者胆也口苦咽干胁下满发热而呕或往来寒热而脉弦也麻黄汤大青龙汤桂枝汤治太阳伤风寒也大柴胡
汤调胃承气汤小承气汤大承气汤治阳明伤寒也小柴胡汤治少阴伤寒也其他药皆发汗吐下后证也若阳气独盛阴气暴绝即
为阳毒必发躁狂走妄言面赤咽痛身斑斑如锦纹或下利黄赤脉洪实或滑促当以酸苦之药投之令阴气复而大汗解矣古人云
酸苦涌泄为阴谓苦参大青葶苈苦酒之类皆复其阴气也微用苦甚则兼用酸苦折热复阴若热极发厥阳证似阴者学人当以脉
别之
太阴少阴厥阴皆属阴证也何谓太阴证太阴脾之经主胸膈 胀何谓少阴证少阴肾之经主脉细心烦但欲寐或自利而渴
何谓厥阴证厥阴肝之经主消渴气上冲心心中疼肌热不欲食食则吐蛔下之利不止也三阴中寒微则理中汤稍厥或中寒下利
即干姜甘草汤大段重者用四逆汤无脉者用通脉四逆汤若阴气独盛阳气暴绝则为阴毒其证四肢逆冷脐腹筑痛身如被杖脉
沉疾病或吐或利当急灸脐下服以辛热之药令阳气复而大汗解矣古人云辛甘发散为阳谓桂枝甘草干姜附子之类能复其阳
气也微用辛甘甚则用辛苦若阴极发躁阴证似阳学人亦当以脉别之
罗 阴证阳证辨静江府提刑李君长子年十九岁四月病伤寒九日医者作阴证治之与附子理中丸数服其证增剧别易一
医又作阳证议论差互不敢服药李君邀予往视座间有数人予不欲直言其证但细为分解令自忖度之凡阳证者身大热而手足
不厥卧则怛然起则有力不恶寒反恶热不呕不泻渴而饮水烦躁不得眠能食而多语其脉浮大而数者阳证也凡阴证者身不热
而手足厥冷恶寒蜷卧恶闻人声或自引衣盖覆不烦渴不饮食小便自利大便反快其脉沉细而微迟者阴证也今诊其脉数得六
七至其母曰夜来叫呼不绝全不睡又喜饮水予闻其言知阳证悉具且三日不见大便宜急下之予遂以酒煨大黄六钱甘草炙二
钱芒硝五钱煎服至夕下数行燥粪二十余块是夜汗大出明日往视之身凉脉静矣予思素问热论云治之各通其脏腑故仲景述
伤寒论云六经各异传变不同活人亦云凡治伤寒先须明经络其义一也昧者不察经络不问病源按寸握尺妄意病证不知邪气
之所在动致颠覆真盲医哉昔韩子云医之病病在少思真理致之言也学人审之
吴 夫阴证似阳者乃水极似火也盖伤寒传变误服凉剂攻热太速其人素本肾气虚寒遂变阴证冷甚于内逼其浮阳之火
发于外其人面赤烦躁身有微热渴欲饮水复不能饮大便秘结不通小便淡黄或呕逆或气促或难言或咽喉痛所以状似阳证或
见面赤烦渴大便秘结作阳证妄投寒凉之药下咽遂毙可不慎哉切其脉沉细迟微者急以通脉四逆汤倍加人参附子以接其真
阳之气设或差迟遂致阴盛阳衰参附亦不能救矣此与阴盛隔阳例同王太仆所谓身热脉数按之不鼓击者此名阴盛隔阳非热
也
娄 素问云脉从而病反言证似阳者脉亦从证似阳而其病反是寒也证似阴者脉亦从证似阴而其病反是热也故皆反其
脉证施治如身热微热烦躁面赤其脉沉而微者阴证似阳也身热者里寒故也烦躁者阴盛故也面戴阳者下虚故也若医者不知
脉误谓实热反与凉药则气消成大病矣外台秘要云阴盛发躁名曰阴躁欲坐井中宜以热药治之故仲景少阳证面赤者四逆汤
加葱白治之 （垣 寒凉之药入腹周身之火得水则升走阴躁之极故欲坐井中是阳已先亡医犹不悟复认为热重以寒药投之
其死何疑焉）
垣 或因吐因呕因嗽而发躁蒸蒸身热如坐甑中欲得去衣居寒处或饮寒水则便如故振寒复至则气短促速胸中满闷欲
绝甚则口开目瞪声闻于外而泪涕涎痰大作其发躁须臾而已如前六脉细弦而涩按之而虚此大寒证也以辛寒甘温之剂大泻
南方北方则愈冯内翰侄因病伤寒目赤而烦渴脉息七至按之不鼓经曰脉至而从按之不鼓诸阳皆然此阴盛格阳于外非热也
与姜附之剂汗出愈
许 伤寒六七日无热脉沉紧而细烦躁不饮水此阴盛格阳也当用附子霹雳散饮水者不可与服
吴 夫阳证似阴乃火极似水也盖伤寒热甚失于汗下阳气亢极郁伏于内反见胜已之化于外故身寒逆冷神气昏昏状若
阴证也大抵唇焦舌燥能饮水大便秘硬小便赤涩设有稀粪水利出者此内有燥屎结聚乃旁流之物非冷利也再审有失气极臭
者是也其脉虽沉切之必滑有力或时躁热不欲衣被或扬手掷足或谵语有力此阳证也轻者人参白虎汤或小柴胡合解毒汤主
之内实者须下之以调胃承气汤或有潮热者以大柴胡加芒硝若大实大满秘而不通者以大承气汤下之必须审察轻重酌量用
之盖此与阳盛拒阴亦同王太仆所谓病患身寒厥冷其脉滑数按之鼓击于指下者此名阳盛拒阴非寒也
活 手足逆冷大便秘小便赤或大便黑色脉沉而滑者阳证似阴也轻者白虎汤重者承气汤伤寒失下血气不通令四肢逆
冷此是伏热深故厥亦深速以大承气汤加腻粉下之汗出立愈盖热厥与阴厥自不同热厥者微厥却发热阴厥即不发热四肢逆
冷恶寒脉沉细大小便滑泄上二节言证似阳而脉病属阴证似阴而脉病属阳故反其证而治之盖证似阳而脉病属阴者世尚能
辨若脉证俱是阴而病独属阳者举世莫辨而致夭折者滔滔皆是许学士云熙宁中 守宋迪因其犹子病伤寒见其烦渴而汗多
以凉药治之遂成阴毒数日卒迪痛悼之遂着阴毒形证诀三篇盖伤世之意深矣
论曰阴盛则外寒阳虚则外寒属表故表证条云外寒者汗之则愈也阳盛则内热阴虚则内热内热属里故里证条云内热者
下之则愈也
赵 活人第三十三问引素问云阳虚则外寒阴虚则内热阳盛则内热阴盛则外寒故治伤寒者阳虚阴盛汗之则愈下之则
死阴虚阳盛下之则愈汗之则死阴阳虚盛非谓分尺寸也难经云阴阳虚盛者说脉也素问云阴阳虚盛者说表里也仲景论伤寒
汗下故引素问表里之说与外台所论合矣外台云表病里和汗之则愈表和里病下之则愈愚详素问论阴阳虚盛四证者杂病也
难经六难之文论脉也外台所述之文论伤寒表里也但仲景所论阴阳虚盛之意理实奥焉经曰邪气盛则实精气脱则虚因正气
先虚以致邪气客之而为盛实于是有阴虚阳盛阳虚阴盛二证之别今活人书却将素问所论杂病阴阳虚盛四证合而引证仲景
伤寒四证之法又改阳盛内热作外热阴感内寒作外寒所论初未尝确合愚因拓仲景所主阴阳虚盛之理而详说之盖盛者指邪
气而言虚者指正气而言阴阳虚盛邪正消长之机也且正气在人阳主表而阴主里邪气中人表为阴而里为阳若夫表之真阳先
虚故阴邪乘阳而盛实表受邪者阳虚也脉浮紧者阴邪盛于外也是谓阳虚阴盛所以用桂枝辛甘之温剂汗之则阴邪消温之则
真阳长使邪去正安故愈又若里之真阴先虚故阳邪入阴而盛实里受邪者阴虚也脉沉实者阳邪盛于内也是谓阴虚阳盛所以
用承气酸苦之寒剂下之则阳邪消寒之则真阴长邪去正安故愈如其不然阳盛而用桂枝下咽即毙阴盛而用承气入胃即亡是
皆盛盛虚虚而致邪失正也以是知仲景所主阳虚阴盛阴虚阳盛二证之意深盖指一为表证一为里证邪正消长而言非兼言表
和里病里和表病而谓之阴阳虚盛也况和者无病处也以和字训虚字恐碍于理
王 难经曰伤寒阳虚阴盛汗出而愈下之即死阳盛阴虚汗出而死下之则愈嗟乎其伤寒汗下之枢机乎夫邪之伤于人也
有浅深焉浅则居表深则入里居表而闭腠理发怫热见恶寒恶风头痛等证于斯时也惟辛温解散而可愈入里则为燥屎作潮热
形狂言谵语大渴等证于斯时也惟咸寒攻下而可平夫寒邪外客非阴盛而阳虚乎热邪内炽非阳盛而阴虚乎汗下一差生死反
掌吁是言也谓之伤寒汗下枢机其不然欤惜乎释者旁求厥义滋隐外台秘要曰此阴阳指身之表里言病者为虚不病者为盛表
病里和是阳虚阴盛也表和里病是阳盛阴虚也窃意阴阳之在人均则宁偏则病无过不及之谓均过与不及之谓偏盛则过矣虚
则不及矣其可以盛为和乎故内经云邪气盛则实精气夺则虚且谓阳虚当汗阴虚当下乃遗邪气而反指正气为言得无晦乎伤
寒微旨曰此阴阳指脉之尺寸言尺脉实大寸脉短小名阴盛阳虚可汗寸脉实大尺脉短小名阳盛阴虚可下苟汗证已具而脉未
应必待尺脉力过于寸而后行下证已具而脉未应必待寸脉力过于尺而后用窃意越人设难以病不以脉其所答也何反以脉不
以病乎且脉固以候病也倘汗下之证已急不可少缓待脉应而未应欲不待则惑于心欲待之则虑其变二者之间将从病欤将从
脉欤吾不得无疑于此也或诘予曰仲景伤寒论引此而继以桂枝下咽阳盛则毙承气入胃阴盛以亡之语夫桂枝表药承气里药
反则为害是固然矣然麻黄汤亦表药也其不言之何欤且子以阴盛为寒邪寒邪固宜用麻黄也今反举桂枝又何欤予曰何不味
仲景之言乎其曰凡伤寒之病多从风寒得之又曰脉浮而紧浮则为风紧则为寒又桂枝汤条而曰啬啬恶寒淅淅恶风麻黄汤涤
而曰恶风夫风寒分言则风阳而寒阴风苟行于天地严凝凛冽之时其得谓之阳乎是则风寒常相因耳故桂枝麻黄皆温剂也以
温剂为治足以见风寒之俱为阴邪矣但伤卫则桂枝伤荣则麻黄荣卫虽殊其为表则一耳仲景此言但以戒汗下之误为主不为
荣卫设也举桂枝则麻黄在其中矣所谓阳盛即毙者是言表证已罢而里证既全可攻而不可汗所谓阴盛以亡者是言里证未形
而表证独具可汗而不可攻由此观之则越人仲景之本旨庶乎畅然于其中矣
戴：凡是治疗伤寒，必须辨别阴证和阳证两种证候，不可误诊。阳经有三条：太阳、阳明、少阳。阴经也有三条：太阴、少阴、厥阴。这里的经络阴阳是从脏腑角度而言的：腑属于阳，包括膀胱、胃、胆；脏属于阴，包括脾、肾、肝。疾病的阴阳则是外邪性质的阴阳，即阴气和阳气。
病在太阳经，则热在皮肤层面，表现为翕翕发热（如羽毛覆盖般的温热感）或怫怫然发热（郁结不畅的热感），并伴有头痛、恶寒、身体疼痛，其脉象必定浮而紧。
病在阳明经，则热在肌肉层面，表现为壮热（高热）、或者蒸蒸发热（热气由内向外透发），并伴有头额痛、潮热（定时发热）或自汗（自然出汗），其脉象必定长而数。
病在少阳经，则一定是半表半里的热证，表现为往来寒热（忽冷忽热），并伴有头角痛、口苦、呕吐、胸满、胁痛，其脉象必定弦而数。
病在太阴经，则手足逐渐变冷，脉息逐渐沉伏，或者出现自利（自发腹泻）、腹满、呕吐、口不渴。
病在少阴经，虽然可能发热，但手足自然冰冷，脉象必定沉细。
病在厥阴经，则手足厥冷，脉微而缓，严重时会出现嘴唇发青、舌头卷缩、睾丸收缩。
阳证的表现：面色红亮有光彩，嘴唇红润，口干舌燥，能喝进水浆。身体轻便容易转动，常想睁眼见人，眼睛明亮有神，喜欢说话，声音响亮。口鼻呼吸之气出入通畅，小便颜色或赤或黄，大便或秘结或坚硬，手足自然温暖，指甲红润鲜活。
阴证的表现：面色青黑，或者有虚阳上浮，虽然也显红色但不红润鲜活无光彩。身体沉重难以转侧，或者喜欢面向墙壁躺卧，或者蜷缩而卧想睡觉，或者闭眼不想见人，眼睛昏花无神，懒于言语，说话声音低微。气息难以布散，鼻子呼不出吸不进，从口鼻中呼出的气寒冷，不想喝水。面上怕冷，像刀刮一样。嘴唇或青或紫，舌色或青或紫或白，舌苔铺满且滑润，不见红色。手足自然冰冷，指甲或青或紫，血色不红润鲜活。小便清长白色，或有淡黄色，大便不成形或腹泻。即使肌表有热，用手按压则感觉不太热；阴寒极盛时，寒气会透入手底。
阴阳二气都能侵犯脏腑。所以阳气侵犯太阳经，则为伤风，表现为恶风且有汗；阴气侵犯太阳经，则为伤寒，表现为恶寒而无汗。如果在太阳经未得解，转入阳明、少阳二经，则纯为阳证，不如太阳经那样容易治疗。如果阳气未能罢休，依次传入阴经，则为“阴中之阳”。这是因为阳经的阳气进入阴经，虽然出现自利、想睡、唇青、手足厥冷、舌卷、囊缩等症状，也不可妄投热药，应当泻除在阴经中的阳邪。如果阳病攻下太过，导致阳气已脱，遂变为阴证，所谓“害热未已，寒病复起”，或者初得病就是阴证，这是“阴中之阴”。这是因为阴气攻击阴经，阴经自身传变，并非从诸阳经传来，只应当用温药来回复阳气。所以阳气入阴者，变阳以救阴；阴气入阳者，用阳以救阳。这两者不可不辨别。
活人书补充：太阳、阳明、少阳都属于阳证。
太阳经是膀胱经，症状为发热、恶寒、头疼、腰痛，脉浮。
阳明经是胃经，不恶寒反恶热，汗出，大便秘结，潮热，脉长。
少阳经是胆经，口苦、咽干、胁下满闷，发热而呕，或往来寒热，脉弦。
麻黄汤、大青龙汤、桂枝汤用于治疗太阳经的伤风和伤寒。
大柴胡汤、调胃承气汤、小承气汤、大承气汤用于治疗阳明经的伤寒。
小柴胡汤用于治疗少阳经的伤寒。（注：原文此处写“治少阴伤寒”，结合上下文及方剂主治，通常小柴胡汤主少阳，此处依原文转录，但需注意中医理论中小柴胡汤主要对应少阳病）。其他药物都是用于发汗、催吐、攻下后的证候。
如果阳气独盛，阴气暴绝，即为阳毒。必然出现烦躁狂走、胡言乱语、面赤、咽痛、身上斑纹如锦缎般，或者下利黄赤色，脉洪实或滑促。应当用酸苦的药投之，使阴气恢复而大汗解。古人说：“酸苦涌泄为阴”，指苦参、大青、葶苈、苦酒之类，都能恢复其阴气。轻微用苦，甚则兼用酸苦来折热复阴。如果热极发厥，阳证似阴者，学者应当通过脉象来辨别。
太阴、少阴、厥阴都属于阴证。
什么是太阴证？太阴是脾经，主管胸膈胀满。
什么是少阴证？少阴是肾经，主管脉细、心烦、只想睡觉，或者自利而口渴。
什么是厥阴证？厥阴是肝经，主管消渴、气上冲心、心中疼、肌热、不欲食、食则吐蛔、攻下后利不止。
三阴经中寒，轻微的用理中汤；稍微厥冷或中寒下利的，用干姜甘草汤；特别严重的用四逆汤；无脉的用通脉四逆汤。
如果阴气独盛，阳气暴绝，则为阴毒。症状为四肢逆冷，脐腹筑痛（剧烈疼痛），身如被杖打，脉沉疾，或者呕吐或者下利。应当紧急灸脐下，服用辛热的药，使阳气恢复而大汗解。古人说：“辛甘发散为阳”，指桂枝、甘草、干姜、附子之类，能回复其阳气。轻微用辛甘，甚则用辛苦。如果阴极发躁，阴证似阳者，学者也应当通过脉象来辨别。
罗：阴证与阳证的辨别。静江府提刑李君的长子十九岁，四月患伤寒九天。医生按阴证治疗，给服了附子理中丸几服，病情加重。另换一位医生，又按阳证议论，意见差互，不敢服药。李君邀请我去诊治。座间有几个人，我不欲直言其证，便细细分解，让他们自己揣度。
凡阳证者：身体大热而手足不厥冷，卧则惊恐不安而起，起来有力，不恶寒反恶热，不呕不泻，渴而饮水，烦躁不得眠，能食而多语，脉浮大而数，这是阳证。
凡阴证者：身体不热而手足厥冷，恶寒蜷卧，恶闻人声，或者自己拉衣盖覆，不烦渴，不饮食，小便自利，大便反快，脉沉细而微迟，这是阴证。
现在诊察他的脉，一息六七至（脉搏较快）。他母亲说：昨晚叫呼不绝，完全没睡觉，又喜欢饮水。我听到这些，知道阳证具备，而且三天未见大便，应当急下。于是我用了酒煨大黄六钱，炙甘草二钱，芒硝五钱，煎服。到了傍晚，下了几次燥粪二十多块。那天晚上大汗出。第二天去看他，身体凉，脉静了。
我思考《素问·热论》说：治疗要疏通各脏腑。所以仲景阐述《伤寒论》说：六经各异，传变不同。《活人书》也说：凡是治伤寒，先须明经络。道理是一样的。愚昧的人不考察经络，不问病源，按寸握尺，随意猜测病证，不知道邪气所在，动辄导致颠覆，真是盲医啊！以前韩愈说：医生的毛病在于缺乏深思熟虑，探究真理的话。学者们审察吧。
吴：所谓阴证似阳，乃是水极似火。大概伤寒传变，误服凉剂，攻热太快，其人本来肾气虚寒，遂变成阴证，冷甚于内，逼迫其浮阳之火发于外。其人面赤、烦躁、身有微热、渴欲饮水但又不能饮、大便秘结不通、小便淡黄、或者呕吐逆气、或者气促、或者难言、或者咽喉痛。所以状似阳证。或者见面赤、烦渴、大便秘结，若作阳证妄投寒凉之药，下咽遂死，可不谨慎吗？切其脉沉细迟微的，急用通脉四逆汤，倍加人参、附子，以接引真阳之气。如果差错迟缓，遂致阴盛阳衰，人参附子也不能救了。这与阴盛隔阳的例子相同。王太仆所说：身热脉数，按之不鼓击的，此名阴盛隔阳，非热也。
娄：《素问》说：脉从而病反。言证似阳者，脉也随证似阳，而其病反而是寒。证似阴者，脉也随证似阴，而其病反而是热。所以都要反其脉证施治。如身热、微热、烦躁、面赤，其脉沉而微的，是阴证似阳。身热是因为里寒，故也；烦躁是因为阴盛，故也；面戴阳是因为下虚，故也。如果医者不知脉，误谓实热，反而给予凉药，则气消成大病矣。《外台秘要》说：阴盛发躁，名曰阴躁，欲坐井中，宜以热药治之。所以仲景少阳证面赤者，用四逆汤加葱白治之。（垣：寒凉之药入腹，周身之火得水则升，走到阴躁之极，所以欲坐井中，这是阳已先亡，医者犹不悟，复认为热，重以寒药投之，其死何疑焉？）
垣：或者因为吐、因为呕、因为嗽而发躁，蒸蒸身热如坐甑中，想要脱衣居寒处，或者饮寒水则便如故（正常），振寒复至，则气短促速，胸中满闷欲绝，甚至口开目瞪，声音闻于外，而泪涕涎痰大作。其发躁须臾而已。如前所述，六脉细弦而涩，按之而虚，这是大寒证。用辛寒甘温的药剂，大泻南方（火）、北方（水）则愈。冯内翰的侄子因病伤寒，目赤而烦渴，脉息七至，按之不鼓。经曰：脉至而从，按之不鼓，诸阳皆然。此阴盛格阳于外，非热也。给予姜附之剂，汗出愈。
许：伤寒六七日，无热，脉沉紧而细，烦躁，不饮水，这是阴盛格阳。当用附子霹雳散。饮水者不可与服。
吴：所谓阳证似阴，乃是火极似水。大概伤寒热甚，失于汗下，阳气亢极，郁伏于内，反见胜己之化于外，故身寒逆冷，神气昏昏，状若阴证。大抵唇焦舌燥，能饮水，大便秘硬，小便赤涩。设有稀粪水利出者，此内有燥屎结聚，乃旁流之物，非冷利也。再审有失气极臭的是。其脉虽沉，切之必滑有力，或者时躁热不欲衣被，或者扬手掷足，或者谵语有力，这是阳证。轻者用人参白虎汤或小柴胡合解毒汤主治。内实者须下之，用调胃承气汤。或者有潮热者，以大柴胡加芒硝。若大实大满秘而不通者，以大承气汤下之。必须审察轻重，酌量用之。盖此与阳盛拒阴亦同。王太仆所说：病患身寒厥冷，其脉滑数，按之鼓击于指下者，此名阳盛拒阴，非寒也。
活人书补充：手足逆冷，大便秘，小便赤，或者大便黑色，脉沉而滑的，是阳证似阴。轻者白虎汤，重者承气汤。伤寒失下，血气不通，令四肢逆冷，这是伏热深，故厥亦深。速以大承气汤加腻粉下之，汗出立愈。盖热厥与阴厥自不同。热厥者微厥却发热，阴厥即不发热，四肢逆冷，恶寒，脉沉细，大小便滑泄。上两节言证似阳而脉病属阴，证似阴而脉病属阳，故反其证而治之。盖证似阳而脉病属阴者，世尚能辨；若脉证俱是阴而病独属阳者，举世莫辨，而致夭折者滔滔皆是。许学士云：熙宁中，太守宋迪因其犹子（侄子）病伤寒，见其烦渴而汗多，以凉药治之，遂成阴毒，数日卒。迪痛悼之，遂着《阴毒形证诀》三篇。盖伤世之意深矣。
论曰：阴盛则外寒，阳虚则外寒。属表，故表证条云：外寒者汗之则愈也。阳盛则内热，阴虚则内热。内热属里，故里证条云：内热者下之则愈也。
赵：《活人书》第三十三问引《素问》云：阳虚则外寒，阴虚则内热，阳盛则内热，阴盛则外寒。故治伤寒者，阳虚阴盛，汗之则愈，下之则死；阴虚阳盛，下之则愈，汗之则死。阴阳虚盛，非谓分尺寸也。《难经》云：阴阳虚盛者，说脉也。《素问》云：阴阳虚盛者，说表里也。仲景论伤寒汗下，故引《素问》表里之说，与《外台》所论合矣。《外台》云：表病里和，汗之则愈；表和里病，下之则愈。愚详《素问》论阴阳虚盛四证者，杂病也。《难经》六难之文，论脉也。《外台》所述之文，论伤寒表里也。但仲景所论阴阳虚盛之意，理实奥焉。经曰：邪气盛则实，精气脱则虚。因正气先虚，以致邪气客之而为盛实，于是有阴虚阳盛、阳虚阴盛二证之别。今《活人书》却将《素问》所论杂病阴阳虚盛四证合而引证仲景伤寒四证之法，又改阳盛内热作外热，阴感内寒作外寒，所论初未尝确合。愚因拓仲景所主阴阳虚盛之理而详说之。盖盛者指邪气而言，虚者指正气而言，阴阳虚盛，邪正消长之机也。且正气在人，阳主表而阴主里；邪气中人，表为阴而里为阳。若夫表之真阳先虚，故阴邪乘阳而盛实，表受邪者，阳虚也。脉浮紧者，阴邪盛于外也。是谓阳虚阴盛，所以用桂枝辛甘之温剂，汗之则阴邪消，温之则真阳长，使邪去正安，故愈。又若里之真阴先虚，故阳邪入阴而盛实，里受邪者，阴虚也。脉沉实者，阳邪盛于内也。是谓阴虚阳盛，所以用承气酸苦之寒剂，下之则阳邪消，寒之则真阴长，邪去正安，故愈。如其不然，阳盛而用桂枝，下咽即毙；阴盛而用承气，入胃即亡。是皆盛盛虚虚，而致邪失正也。以是知仲景所主阳虚阴盛、阴虚阳盛二证之意深，盖指一为表证，一为里证，邪正消长而言，非兼言表和里病、里和表病而谓之阴阳虚盛也。况和者无病处也。以和字训虚字，恐碍于理。
王：《难经》曰：伤寒阳虚阴盛，汗出而愈，下之即死；阳盛阴虚，汗出而死，下之则愈。嗟乎！其伤寒汗下之枢机乎！夫邪之伤于人，有浅深焉。浅则居表，深则入里。居表而闭腠理，发怫热，见恶寒、恶风、头痛等证，于斯时也，惟辛温解散而可愈。入里则为燥屎，作潮热，形狂言谵语，大渴等证，于斯时也，惟咸寒攻下而可平。夫寒邪外客，非阴盛而阳虚乎？热邪内炽，非阳盛而阴虚乎？汗下一差，生死反掌。吁！是言也，谓之伤寒汗下枢机，其不然欤？惜乎释者旁求厥义，滋隐。《外台秘要》曰：此阴阳指身之表里言。病者为虚，不病者为盛。表病里和，是阳虚阴盛也；表和里病，是阳盛阴虚也。窃意阴阳之在人，均则宁，偏则病，无过不及之谓均，过与不及之谓偏。盛则过矣，虚则不及矣。其可以盛为和乎？故《内经》云：邪气盛则实，精气夺则虚。且谓阳虚当汗，阴虚当下，乃遗邪气而反指正气为言，得无晦乎？《伤寒微旨》曰：此阴阳指脉之尺寸言。尺脉实大，寸脉短小，名阴盛阳虚，可汗；寸脉实大，尺脉短小，名阳盛阴虚，可下。苟汗证已具而脉未应，必待尺脉力过于寸而后行；下证已具而脉未应，必待寸脉力过于尺而后用。窃意越人设难，以病不以脉，其所答也，何反以脉不以病乎？且脉固以候病也。倘汗下之证已急，不可少缓，待脉应而未应，欲不待则惑于心，欲待之则虑其变。二者之间，将从病欤？将从脉欤？吾不得无疑于此也。或诘予曰：仲景《伤寒论》引此而继以“桂枝下咽，阳盛则毙；承气入胃，阴盛以亡”之语。夫桂枝表药，承气里药，反则为害，是固然矣。然麻黄汤亦表药也，其不言之何欤？且子以阴盛为寒邪，寒邪固宜用麻黄也，今反举桂枝又何欤？予曰：何不味仲景之言乎其？其曰：凡伤寒之病，多从风寒得之。又曰：脉浮而紧，浮则为风，紧则为寒。又桂枝汤条而曰：啬啬恶寒，淅淅恶风。麻黄汤涤而曰：恶风。夫风寒分言，则风阳而寒阴。风苟行于天地严凝凛冽之时，其得谓之阳乎？是则风寒常相因耳。故桂枝、麻黄皆温剂也。以温剂为治，足以见风寒之俱为阴邪矣。但伤卫则桂枝，伤荣则麻黄。荣卫虽殊，其为表则一耳。仲景此言，但以戒汗下之误为主，不为荣卫设也。举桂枝则麻黄在其中矣。所谓阳盛即毙者，是言表证已罢而里证既全，可攻而不可汗。所谓阴盛以亡者，是言里证未形而表证独具，可汗而不可攻。由此观之，则越人、仲景之本旨，庶乎畅然于其中矣。
Dai: In treating cold damage (Shanghan), one must distinguish between Yin and Yang syndromes to avoid misdiagnosis. There are three Yang meridians: Taiyang, Yangming, and Shaoyang. There are also three Yin meridians: Taiyin, Shaoyin, and Jueyin. The Yin-Yang of the meridians refers to Zang-Fu organs: Fu organs are Yang, including the Bladder, Stomach, and Gallbladder; Zang organs are Yin, including the Spleen, Kidney, and Liver. The Yin-Yang of diseases refers to the nature of external pathogens, i.e., Yin Qi and Yang Qi.
When disease is in the Taiyang meridian, heat is at the skin level, manifesting as "Xi Xi" fever (a warm sensation like feathers covering) or "Fu Fu" fever (stagnant heat), accompanied by headache, aversion to cold, and body ache. The pulse will be floating and tight.
When disease is in the Yangming meridian, heat is at the muscle level, manifesting as high fever ("Zhuang Re"), steaming heat ("Zheng Zheng Re"), accompanied by forehead pain, tidal fever ("Chao Re"), or spontaneous sweating ("Zi Han"). The pulse will be long and rapid.
When disease is in the Shaoyang meridian, it is a half-exterior, half-interior heat syndrome, manifesting as alternating chills and fever ("Wang Lai Han Re"), accompanied by pain at the temples, bitter taste in the mouth, vomiting, chest fullness, and hypochondriac pain. The pulse will wiry and rapid.
When disease is in the Taiyin meridian, the hands and feet gradually become cold, the pulse becomes gradual and sunken, or there is spontaneous diarrhea, abdominal fullness, vomiting, and no thirst.
When disease is in the Shaoyin meridian, although fever may occur, the hands and feet are naturally cold, and the pulse is sunken and fine.
When disease is in the Jueyin meridian, the hands and feet are cold ("Jue Leng"), the pulse is faint and slow, and in severe cases, lips turn blue, the tongue curls, and the testicles retract.
Yang syndrome manifestations: The face is red and radiant, lips are red, the mouth and tongue are dry, and the patient can drink fluids. The body is light and easy to move, often wanting to open eyes and see people, with clear and bright eyes. The patient likes to speak, voice is loud. Breath from nose and mouth is smooth. Urine may be red or yellow, stool may be constipated or hard, hands and feet are naturally warm, and nails are red and vibrant.
Yin syndrome manifestations: The face is cyanotic or black, or there is floating false Yang causing a red complexion that is not vibrant or radiant. The body is heavy and difficult to turn, preferring to lie facing the wall, curled up, drowsy, or keeping eyes closed avoiding people. Eyes are dim, speech is lazy and low. Breath is difficult to distribute, unable to inhale/exhale smoothly, breath from mouth/nose is cold, no desire to drink. Face fears cold as if scraped by a knife. Lips may be cyanotic or purple, tongue color may be cyanotic, purple, or white, coated with slippery moss, lacking redness. Hands and feet are naturally cold, nails may be cyanotic or purple, blood is not vibrant. Urine is clear and white, or pale yellow, stool is loose or diarrheal. Even if the skin surface feels hot, pressing reveals little heat; in extreme Yin cold, the cold penetrates through to the hand.
Both Yin and Yang Qi can invade Zang-Fu organs. Thus, when Yang Qi invades the Taiyang meridian, it is Wind Strike (Shang Feng), characterized by aversion to wind and sweating. When Yin Qi invades the Taiyang meridian, it is Cold Damage (Shang Han), characterized by aversion to cold and no sweating. If unresolved in Taiyang and transferring to Yangming and Shaoyang, it becomes purely Yang syndrome, which is not as easy to treat as Taiyang. If Yang Qi continues to transmit into Yin meridians, it becomes "Yang within Yin." Although symptoms like spontaneous diarrhea, drowsiness, blue lips, cold limbs, curled tongue, and retracted testicles appear, one must not rashly administer hot medicines; instead, one should purge the Yang pathogen residing in the Yin meridians. If purgation was excessive for a Yang disease, leading to Yang Qi depletion, it transforms into a Yin syndrome, described as "heat harm not yet resolved, cold disease arises again," or initial presentation is Yin syndrome, known as "Yin within Yin." This occurs because Yin Qi attacks Yin meridians, transmitting internally rather than from Yang meridians. One should only use warm medicines to restore Yang Qi. Therefore, when Yang enters Yin, transform Yang to save Yin; when Yin enters Yang, use Yang to save Yang. These two must be distinguished.
Huoren Shu adds: Taiyang, Yangming, and Shaoyang all belong to Yang syndromes.
Taiyang is the Bladder meridian, with symptoms of fever, aversion to cold, headache, lower back pain, and floating pulse.
Yangming is the Stomach meridian, with no aversion to cold but aversion to heat, sweating, constipation, tidal fever, and long pulse.
Shaoyang is the Gallbladder meridian, with bitter taste, dry throat, hypochondriac fullness, fever with vomiting, or alternating chills and fever, and wiry pulse.
Mahuang Tang (Ephedra Decoction), Da Qing Long Tang (Great Blue Dragon Decoction), and Guizhi Tang (Cinnamon Twig Decoction) treat Taiyang Wind Strike and Cold Damage.
Da Chai Hu Tang (Major Bupleurum Decoction), Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward Decoction), Xiao Cheng Qi Tang (Minor Direct Downward Decoction), and Da Cheng Qi Tang (Major Direct Downward Decoction) treat Yangming Cold Damage.
Xiao Chai Hu Tang (Minor Bupleurum Decoction) treats Shaoyang Cold Damage. (Note: Text says "Shaoyin", but context implies Shaoyang). Other formulas treat post-sweating, post-emetic, or post-purgative conditions.
If Yang Qi is exclusively abundant and Yin Qi abruptly perishes, it is Yang Du (Yang Toxin). Symptoms include restlessness, manic walking, delirious speech, red face, sore throat, skin spots like brocade, or bloody diarrhea, with洪 (Flooding) or slippery-rapid pulse. Administer sour and bitter medicines to restore Yin Qi and resolve via profuse sweating. Ancients said: "Sour and bitter induce vomiting and purging, belonging to Yin," referring to herbs like Kushen (Sophora Root), Daqing (Indigo Naturalis), Tingli (Descurainia Seed), and Kujiu (Vinegar), which restore Yin Qi. Use bitter mildly, or combine sour and bitter severely to reduce heat and restore Yin. If heat extremity causes Jue (cold limbs), where Yang syndrome mimics Yin, scholars must differentiate by pulse.
Taiyin, Shaoyin, and Jueyin all belong to Yin syndromes.
What is Taiyin syndrome? Taiyin is the Spleen meridian, governing chest/diaphragm distension.
What is Shaoyin syndrome? Shaoyin is the Kidney meridian, governing fine pulse, vexation, desire to sleep, or spontaneous diarrhea with thirst.
What is Jueyin syndrome? Jueyin is the Liver meridian, governing thirst, Qi rushing to the heart, heart pain, muscle heat, anorexia, vomiting worms after eating, and persistent diarrhea after purgation.
For mild cold in the Three Yin meridians, use Lizhong Tang (Regulate the Middle Decoction); for slight cold limbs or cold-damage diarrhea, use Ganjiang Gancao Tang (Dried Ginger and Licorice Decoction); for severe cases, use Sini Tang (Frigid Extremities Decoction); for absent pulse, use Tongmai Sini Tang (Pulse-Resuscitating Frigid Extremities Decoction).
If Yin Qi is exclusively abundant and Yang Qi abruptly perishes, it is Yin Du (Yin Toxin). Symptoms include cold limbs, severe umbilical/abdominal pain, body feeling like being beaten, sinking疾 (rapid) pulse, vomiting, or diarrhea. Urgently moxa below the navel and administer acrid-hot medicines to restore Yang Qi and resolve via profuse sweating. Ancients said: "Acrid and sweet disperse and ascend, belonging to Yang," referring to Guizhi (Cinnamon Twig), Gancao (Licorice), Ganjiang (Dried Ginger), and Fuzi (Aconite Root), which restore Yang Qi. Use acrid-sweet mildly, or combine acrid-bitter severely. If Yin extremity causes restlessness, where Yin syndrome mimics Yang, scholars must differentiate by pulse.
Luo: Differentiation of Yin and Yang syndromes. The eldest son of Li, Controller of Jingjiang Prefecture, aged 19, contracted cold damage in April. After nine days, a physician treated him as Yin syndrome, administering Fuzi Lizhong Wan (Aconite Regulate the Middle Pills) several times, worsening his condition. Another physician argued for Yang syndrome. Conflicted, he did not take medicine. I was invited to examine him. To avoid speaking directly in front of others, I explained the details for them to deduce.
Yang syndrome: High body heat without cold limbs, restless lying down but strong rising, no aversion to cold but aversion to heat, no vomiting/diarrhea, thirst with drinking, restlessness insomnia, ability to eat and talk much, floating-large-rapid pulse.
Yin syndrome: No body heat, cold limbs, aversion to cold, curled lying, aversion to human voices, pulling clothes to cover, no vexation/thirst, no eating/drinking, free urination, loose stools, sinking-fine-micro-slow pulse.
His pulse was 6-7 beats per respiration. His mother said he cried out all night, slept none, and desired water. Knowing Yang syndrome signs were complete and he had no bowel movement for three days, I ordered urgent purgation. I used wine-wrapped Dahuang (Rhubarb Root) 6 qian, roasted Gancao (Licorice Root) 2 qian, and Mangxiao (Mirabilite) 5 qian, decocted and administered. By evening, he passed several motions of dry feces, over twenty pieces. That night, profuse sweating occurred. Next day, body cool, pulse calm.
Reflecting on Suwen's "Treat each organ/meridian," Zhang Zhongjing stated Six Meridians have different transmissions. Huoren Shu states: First clarify meridians. Ignorant physicians ignore meridians and pathology, guessing blindly, causing disaster. As Han Yu said, doctors fail due to lack of deep thought. Scholars should reflect.
Wu: Yin syndrome mimicking Yang is like Water Extreme mimicking Fire. Due to transmission errors and rapid cooling/purging, a patient with inherent Kidney Qi deficiency/cold develops Yin syndrome. Internal cold forces floating Yang fire outward. Symptoms: red face, restlessness, slight fever, thirst but inability to drink, constipation, pale yellow urine, vomiting, shortness of breath, dysarthria, sore throat. This mimics Yang syndrome. If mistaken for Yang and treated with cold/bitter drugs, death ensues quickly. For sinking-fine-slow-micro pulses, urgently use Tongmai Sini Tang with extra Renshen (Ginseng Root) and Fuzi (Aconite Root) to reconnect True Yang. Delay leads to Yin excess/Yang decline, unrescuable even by Ginseng/Aconite. This is Yin Excess Blocking Yang. Wang Taipu noted: Body heat, rapid pulse, but non-beating upon pressure indicates Yin Excess Blocking Yang, not Heat.
Lou: Suwen states: Pulse follows but disease reverses. Signs mimic Yang, pulse mimics Yang, but disease is Cold. Signs mimic Yin, pulse mimics Yin, but disease is Heat. Thus, treat contrary to signs/pulse. E.g., fever, slight heat, restlessness, red face, but sinking-micro pulse indicates Yin syndrome mimicking Yang. Fever is due to interior cold; restlessness due to Yin excess; facial redness (floating Yang) due to lower deficiency. Misinterpreting as excess heat and giving cold drugs dissipates Qi and causes major illness. Waitai Miyao states: Yin excess causing restlessness is called Yin Restlessness, desiring to sit in a well, treat with hot drugs. Thus, Zhang Zhongjing uses Sini Tang plus Congbai (Scallion White) for Shaoyang syndrome with red face. (Yuan: Cold drugs cause internal fire to rise due to water interaction, reaching Yin restlessness extremity, desiring well water. This is prior Yang loss. Physicians mistaking this for heat and giving more cold drugs ensure death.)
Yuan: Restlessness after vomiting/coughing, steaming body heat like sitting in a steamer, wanting to remove clothes/stay cold, drinking cold water doesn't help, returning chills, short rapid breath, chest oppression nearing death, wide-open eyes, loud voice, excessive tears/saliva/phlegm. Restlessness lasts briefly. Pulses are fine-wiry-choppy, empty upon pressure. This is Major Cold. Treat with acrid-cold and sweet-warm agents to strongly drain South (Fire) and North (Water). Feng Neihan's nephew had cold damage, red eyes, vexation/thirst, pulse 7 beats, non-beating upon pressure. Classics say: Pulse follows but non-beating upon pressure applies to all Yang. This is Yin Excess Blocking Yang externally, not Heat. Given Ginger/Aconite agents, cured via sweating.
Xu: Cold damage 6-7 days, no fever, sinking-tight-fine pulse, restlessness, no desire to drink. This is Yin Excess Blocking Yang. Use Fuzi Pili San (Aconite Thunderbolt Powder). Do not give to those desiring water.
Wu: Yang syndrome mimicking Yin is like Fire Extreme mimicking Water. Severe heat in cold damage, missed sweating/purgation, Yang Qi hyperactive and depressed internally, manifests as overcoming transformation externally. Symptoms: cold limbs, dull spirit, resembling Yin syndrome. However, dry lips/tongue, desire to drink, constipation/hard stool, red/scanty urine. Loose watery stool indicates dry feces accumulation internally (paradoxical diarrhea), not cold diarrhea. Foul flatus confirms this. Pulse is sinking but slippery-strong upon pressure, or intermittent heat aversion to covers, throwing limbs, forceful delirium. This is Yang syndrome. Mild cases: Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) or Xiao Chai Hu Tang combined with Jie Du Tang (Detoxification Decoction). Interior excess requires purgation: Tiao Wei Cheng Qi Tang. With tidal fever: Da Chai Hu Tang plus Mangxiao. Severe excess/blockage: Da Cheng Qi Tang. Judge severity carefully. This is similar to Yang Excess Rejecting Yin. Wang Taipu noted: Cold limbs, slippery-rapid pulse beating strongly under finger indicates Yang Excess Rejecting Yin, not Cold.
Huoren Shu adds: Cold limbs, constipation, red urine, or black stool, sinking-slippery pulse indicates Yang syndrome mimicking Yin. Mild: Bai Hu Tang. Severe: Cheng Qi Tang. Missed purgation in cold damage causes Qi/Blood blockage, cold limbs. Deep latent heat causes deep Jue. Urgently use Da Cheng Qi Tang plus Nifen (Calomel) to purge, curing via sweat. Heat Jue differs from Yin Jue. Heat Jue has slight cold limbs then fever; Yin Jue has no fever, cold limbs, aversion to cold, sinking-fine pulse, loose stool/urine. Previous sections discussed signs mimicking Yang but pulse/pathology Yin, and vice versa, thus treating contrary to signs. World distinguishes sign-mimic-Yang/pulse-Yin easily, but misses pulse-signs-Yin/pathology-Yang, causing many deaths. Xu Xueshi recounted Song Di's nephew with cold damage, vexation/thirst/sweating, treated with cold drugs, becoming Yin Toxin, dying in days. Song Di wrote "Yin Toxin Syndrome Resolution" to warn the world.
Commentary: Yin excess causes exterior cold, Yang deficiency causes exterior cold. Exterior syndrome: Sweat to cure. Yang excess causes interior heat, Yin deficiency causes interior heat. Interior syndrome: Purge to cure.
Zhao: Huoren Shu Q33 cites Suwen: Yang deficiency/exterior cold, Yin deficiency/interior heat, Yang excess/interior heat, Yin excess/exterior cold. Thus, Yang deficiency/Yin excess: Sweat cures, purge kills. Yin deficiency/Yang excess: Purge cures, sweat kills. Yin-Yang deficiency/excess does not refer to Cun/Cun positions. Nanjing says Yin-Yang deficiency/excess refers to pulse. Suwen says it refers to Exterior/Interior. Zhang Zhongjing cited Suwen's Exterior/Interior for cold damage sweating/purging, aligning with Waitai. Waitai: Exterior disease/Interior harmony: Sweat cures. Exterior harmony/Interior disease: Purge cures. I detail: Suwen's four Yin-Yang deficiency/excess syndromes refer to miscellaneous diseases. Nanjing Ch. 6 refers to pulse. Waitai refers to cold damage Exterior/Interior. Zhang Zhongjing's meaning is profound. Classics: Pathogen excess is Excess, Essence depletion is Deficiency. Primary Qi deficiency allows Pathogen invasion, creating Yin Deficiency/Yang Excess and Yang Deficiency/Yin Excess. Huoren Shung incorrectly merges Suwen's miscellaneous disease theory with Zhang's cold damage methods, changing Yang excess/interior heat to exterior heat, etc. My expansion: "Excess" refers to Pathogen, "Deficiency" refers to Primary Qi. It is the mechanism of Pathogen/Primary Qi fluctuation. Primary Qi: Yang governs Exterior, Yin governs Interior. Pathogen: Exterior is Yin, Interior is Yang. If True Yang of Exterior is deficient, Yin Pathogen invades and becomes excess. Exterior disease is Yang Deficiency. Floating-tight pulse indicates Yin Pathogen excess externally. This is Yang Deficiency/Yin Excess. Treat with Guizhi Tang (acrid-sweet-warm) to sweat, eliminating Yin Pathogen and warming True Yang. If True Yin of Interior is deficient, Yang Pathogen invades and becomes excess. Interior disease is Yin Deficiency. Sinking-solid pulse indicates Yang Pathogen excess internally. This is Yin Deficiency/Yang Excess. Treat with Cheng Qi Tang (sour-bitter-cold) to purge, eliminating Yang Pathogen and cooling True Yin. Otherwise, using Guizhi for Yang excess kills; using Cheng Qi for Yin excess kills. This is exacerbating excess and depleting deficiency. Zhang's intent is profound: Yang Deficiency/Yin Excess refers to Exterior syndrome; Yin Deficiency/Yang Excess refers to Interior syndrome. "Harmony" means no disease. Using "Harmony" to explain "Deficiency" is logically flawed.
Wang: Nanjing states: Cold damage Yang deficiency/Yin excess: Sweat cures, purge kills. Yang excess/Yin deficiency: Sweat kills, purge cures. Ah! This is the pivot of cold damage sweating/purging. Pathogen depth varies. Superficial: Exterior, closing pores, stagnant heat, aversion to cold/wind, headache. Treat with acrid-warm dispersal. Deep: Interior, dry feces, tidal fever, mania, delirium, thirst. Treat with salty-cold purgation. External Cold Pathogen is Yin Excess/Yang Deficiency. Internal Hot Pathogen is Yang Excess/Yin Deficiency. One error in sweat/purge determines life/death. Critics obscure this. Waitai Miyao states: Yin-Yang here refers to Body Exterior/Interior. Diseased is Deficient, Healthy is Excess. Exterior disease/Interior harmony is Yang Deficiency/Yin Excess. Exterior harmony/Interior disease is Yang Excess/Yin Deficiency. I argue: Balance is peace, deviation is disease. Excess is over, Deficiency is under. Can Excess be Harmony? Neijing says: Pathogen excess is Real, Essence loss is Empty. Saying Yang Deficiency needs sweat and Yin Deficiency needs purge ignores Pathogen and focuses on Primary Qi, which is confusing. Shanghan Weizhi states: Yin-Yang refers to Cun/Cun pulse positions. Large Chi (尺) / Short Cun (寸) is Yin Excess/Yang Deficiency, sweatable. Large Cun / Short Chi is Yang Excess/Yin Deficiency, purgable. If symptoms ready but pulse not matching, wait for pulse? This contradicts Yue Ren's question-answer logic focusing on disease, not pulse. Pulse diagnoses disease. If symptoms are urgent, waiting for pulse is confusing. Or ask: Zhang Zhongjing quotes this then says "Guizhi enters Yang excess dies; Cheng Qi enters Yin excess dies." Guizhi is Exterior, Cheng Qi is Interior. Mahuang Tang is also Exterior, why not mentioned? You say Yin Excess is Cold Pathogen, suitable for Mahuang, why cite Guizhi? Answer: Zhang says cold damage comes from Wind-Cold. Floating is Wind, Tight is Cold. Guizhi line mentions aversion to cold/wind. Mahuang line mentions aversion to wind. Wind and Cold are often linked. Is Wind Yang in freezing weather? No. Wind and Cold are both Yin Pathogens. Guizhi and Mahuang are both warm agents. Treating with warm agents shows both are Yin. Injury to Wei (Defensive) uses Guizhi; injury to Ying (Nutritive) uses Mahuang. Both are Exterior. Zhang's warning against sweat/purge error includes Mahuang when citing Guizhi. "Yang excess dies" means Exterior resolved, Interior full, purge only, no sweat. "Yin excess dies" means Interior not formed, Exterior present, sweat only, no purge. Thus, Yue Ren and Zhang Zhongjing's intent is clear.