仲景『伤寒论』,篇篇可法,但成于汉末,传写多讹,错简亦复不少。如论中下利、
呕逆,用十枣汤峻剂攻之。阳重衄血,以麻黄汤发之。发汗病解反恶寒,病解之中,
多一「不」字。心下痞,按之濡,濡字之上少一「不」字之类。诸家遵经注解,不得
不穿凿附会,致令千古不可多得之书,不能传信于世,良可惜也。今加正误一一列明
,每条凡小字傍右者,原文也;傍左者,改正之文也;居中者,原文所有或移上,或
移下,或他处移入及原文所无而补之者也。字上加〔 〕,删去者也,尤有整节舛谬
者三十五条,证不与脉符,药不与病合,虽有是方,世无其病,即有其病,难用是药
,承讹袭谬,无济实用。然其中尚有可采之句,所以各篇不动经文,强加注释,复录
原文,附于卷末,以志阙疑云。
┌───────────────────────────────────┐
│补注:本文各条置于引号内者为改正正确者,置于中括弧内者为应删错误原文。│
└───────────────────────────────────┘
桂枝汤方
桂枝三两〔去皮〕 芍药三两 甘草(炙)二两 生姜(切)三两 大枣(擘)十二
枚
【按】
桂枝汤方,原文有「去皮」二字。夫桂枝气味辛甘,全在于皮,若去皮是枯木矣,如
何有解肌发汗之功耶?当删之,后仿此。
若脉和,其人大烦,目重「睑」〔脸〕,内际黄者,此欲解也。
【按】
「脸」字当是「睑」字,睑眼弦也。作「脸」字非,当改之。
太阳中风「不」〔下〕利呕逆,表解者,乃可攻之。其人□□汗出,发「热」〔作〕
有时,头痛,心下痞□满,引□下痛,干呕短气,汗出不恶寒者,此表解里未和也,
十枣汤主之。
【按】
下利之「下」字,当是「不」字,若是「下」字,岂有上呕下利而用十枣汤峻剂攻之
之理乎?惟其大便不利,痞□满痛,始属里病;小便不利,呕逆短气,始属饮病,乃
可峻攻。发作之「作」字,当是「热」字,始与太阳阳邪热饮之义相合。若无热汗出
,乃少阴阴邪寒饮,真武汤证也。且「作」字与上下句文义皆不相属,当改之。
太阳病,下之,其脉「浮」[促]不结胸者,此为欲解也。脉「促」[浮]者,必结胸,
脉「细数」[紧]者,必咽痛,脉弦者,必两□拘急,脉「紧」[细数]者,头痛未止,
脉沉紧者,必欲呕,脉沉滑者,协热利,脉「数」[浮]滑者,必下血。
【按】
脉促当是「脉浮」,始与不结胸为欲解之文义相属。脉浮当是「脉促」,始与论中结
胸,胸满同义。脉紧当是「脉细数」,脉细数当是「脉紧」,始同论中二经本脉。脉
浮滑当是「脉数滑」,浮滑是论中白虎汤证之脉,数滑是论中下脓血之脉。均当改之
。
太阳病,二、三日,不能卧,但欲起,心下必结,脉微弱者,此本有寒分也,反下之
,若利止,必作结胸,未止者,四日复下「利」[之],此作协热利也。
【按】
四日复下之之「之」字,当是「利」字,上文利未止 ,岂有复下之理乎?当改之。
太阳病下之后,脉促胸满者,桂枝去芍药汤主之。若「汗出」微恶寒;去芍药方中,
加附子汤主之。
【按】
微恶寒之上,当有「汗出」二字,若无「汗出」二字,乃表未解也,无加附子之理,
当补之。
太阳病,脉浮而动数,浮则为风,数则为热,动则为痛,〔数则为虚〕头痛发热,微
盗汗出,而反恶寒者,表未解也。医反下之,动数变迟,膈内拒痛,胃中空虚,客气
动膈,短气烦躁,心中懊□阳气内陷,心下因□,则为结胸,大陷胸汤主之。若不结
胸,但头汗出,余无汗,剂颈而还,小便不利,身必发黄也。
【按】
「数则为虚」句,衍文也,当删之。
寒实结胸,无热证者,与三物〔小陷胸汤〕白散。〔亦可服〕
【按】
与三物小陷胸汤,当是「三物白散」。「小陷胸汤」四字,当是错简。桔梗、贝母、
巴豆三物,其色皆白,有三物白散之义,温而能攻,与寒实之理相合。小陷胸汤仍栝
蒌、黄连,皆性寒之品,岂可以治寒实结胸之证耶?「亦可服」三字,亦衍文也,俱
当删之。
张仲景的《伤寒论》,每一篇都值得效法,但该书成书于汉代末年,在传抄过程中出现了许多错误,竹简错乱的情况也不少。例如,书中关于下利、呕逆的症状,却使用十枣汤这种峻猛之剂来攻逐;对于阳气过盛导致的衄血(鼻出血),却用麻黄汤来发汗解表;在描述发汗后病愈反而恶寒的情况中,多了一个“不”字;在心下痞满、按之柔软的描述中,“濡”字前面少了一个“不”字。诸家遵循经典进行注解,不得不牵强附会,致使这部千古难遇的珍贵书籍,无法准确流传于世,实在令人惋惜。现在我将正误之处一一列出,每条凡小字标注在右侧的,是原文;标注在左侧的,是改正后的文字;居中的,是原文原本存在或从上面移下来、下面移上来、从他处移入以及原文没有而补充的内容。字上加〔 〕符号的,表示删去的内容。尤其有三十五条整节内容谬误严重,证候与脉象不符,药物与病情不合,虽然有这个方子,世上却没有这种病;即使有这种病,也难以使用这个药。沿袭讹误和谬误,对临床实用毫无帮助。然而其中仍有可取之处,所以各篇不动经文,强行加以注释,又收录原文,附在卷末,以记录存疑之处。
┌───────────────────────────────────┐
│补注:本文各条置于引号内者为改正正确者,置于中括弧内者为应删错误原文。│
└───────────────────────────────────┘
桂枝汤方
桂枝三两〔去皮〕 芍药三两 甘草(炙)二两 生姜(切)三两 大枣(擘)十二枚
【按】
桂枝汤方的原文中有“去皮”二字。桂枝的气味辛甘,全在于皮,如果去掉皮就是枯木了,怎么还有解肌发汗的功效呢?应当删去,后面的类似情况仿照此例处理。
如果脉象平和,病人非常烦躁,眼睛重「睑」〔脸〕,眼内眦发黄,这是将要痊愈的表现。
【按】
“脸”字应当是“睑”字,睑指眼睑。写作“脸”字不对,应当改正。
太阳中风「不」〔下〕利呕逆,表解者,乃可攻之。其人□□汗出,发「热」〔作〕有时,头痛,心下痞□满,引□下痛,干呕短气,汗出不恶寒者,此表解里未和也,十枣汤主之。
【按】
下利之“下”字,应当是“不”字,如果是“下”字,哪有上吐下泻却用十枣汤这种峻猛之剂攻下的道理呢?只有大便不通,痞满疼痛,才属于里病;小便不利,呕逆短气,才属于饮邪为病,才可以峻猛攻逐。发作之“作”字,应当是“热”字,这才符合太阳阳邪热饮的意义。如果没有热而汗出,那是少阴阴邪寒饮,是真武汤的证候。而且“作”字与上下句的文义都不相属,应当改正。
太阳病,下之,其脉「浮」[促]不结胸者,此为欲解也。脉「促」[浮]者,必结胸,脉「细数」[紧]者,必咽痛,脉弦者,必两□拘急,脉「紧」[细数]者,头痛未止,脉沉紧者,必欲呕,脉沉滑者,协热利,脉「数」[浮]滑者,必下血。
【按】
脉促应当是“脉浮”,这才与不结胸为欲解的文义相属。脉浮应当是“脉促”,这才与论中结胸、胸满同义。脉紧应当是“脉细数”,脉细数应当是“脉紧”,这才同论中二经的本脉。脉浮滑应当是“脉数滑”,浮滑是论中白虎汤证的脉象,数滑是论中下脓血的脉象。都应当改正。
太阳病,二、三日,不能卧,但欲起,心下必结,脉微弱者,此本有寒分也,反下之,若利止,必作结胸,未止者,四日复下「利」[之],此作协热利也。
【按】
四日复下之的“之”字,应当是“利”字,上文说利未止,哪有再次攻下的道理呢?应当改正。
太阳病下之后,脉促胸满者,桂枝去芍药汤主之。若「汗出」微恶寒;去芍药方中,加附子汤主之。
【按】
微恶寒之上,应当有“汗出”二字,如果没有“汗出”二字,那就是表证未解,没有加附子的道理,应当补充。
太阳病,脉浮而动数,浮则为风,数则为热,动则为痛,〔数则为虚〕头痛发热,微盗汗出,而反恶寒者,表未解也。医反下之,动数变迟,膈内拒痛,胃中空虚,客气动膈,短气烦躁,心中懊□阳气内陷,心下因□,则为结胸,大陷胸汤主之。若不结胸,但头汗出,余无汗,剂颈而还,小便不利,身必发黄也。
【按】
“数则为虚”一句,是衍文,应当删去。
寒实结胸,无热证者,与三物〔小陷胸汤〕白散。〔亦可服〕
【按】
与三物小陷胸汤,应当是“三物白散”。“小陷胸汤”四字,是错简。桔梗、贝母、巴豆三物,颜色皆白,有三物白散的含义,温性且能攻逐,与寒实的病机相合。小陷胸汤仍是栝楼、黄连,都是性寒的药物,怎么能用来治疗寒实结胸的证候呢?“亦可服”三字,也是衍文,都应当删去。
Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Pathogenic Diseases) is worthy of emulation in every chapter. However, as it was composed at the end of the Han Dynasty, numerous errors occurred during transmission and copying, including significant dislocation of bamboo slips. For instance, regarding symptoms of diarrhea and vomiting, the text employs Shizao Tang (Ten Date Decoction), a harsh purgative; for epistaxis (nosebleed) caused by excessive Yang heat, it employs Mahuang Tang (Ephedra Decoction) to induce sweating; in the description of aversion to cold appearing after disease resolution following sweating, an extra character "bu" (not) is present; in the description of fullness in the epigastrium that feels soft upon pressure, the character "ru" (soft) lacks a preceding "bu" (not). Scholars adhering to the classics for annotation were forced to resort to far-fetched interpretations, preventing this rare, invaluable work from being accurately transmitted to the world, which is truly regrettable. Herein, I list the corrections one by one: for each item, small characters aligned to the right represent the original text; those aligned to the left represent the corrected text; those centered represent text originally present or moved from above/below/other sections, or added where absent. Characters enclosed in 〔 〕 indicate deletions. Particularly, thirty-five entire sections contain severe errors where symptoms do not match pulses, and herbs do not match diseases. Although these formulas exist, the corresponding diseases are rare or non-existent in practice; even if such diseases existed, these herbs would be inappropriate. Continuing to propagate these errors offers no practical clinical benefit. Nevertheless, there are still valuable passages within. Therefore, while leaving the canonical text unchanged and adding strong annotations, I have also re-recorded the original texts and appended them to the end of the volume to record doubts and uncertainties.
┌───────────────────────────────────┐
│Supplementary Note: Items in quotation marks are corrected correct versions; items in square brackets are erroneous original texts to be deleted.│
└───────────────────────────────────┘
Guizhi Tang (Cinnamon Twig Decoction) Formula
Guizhi (Cinnamon Twig) 3 liang [remove skin] Shaoyao (Red Peony Root) 3 liang Gancao (Licorice Root) (roasted with honey) 2 liang Shengjiang (Fresh Ginger) (sliced) 3 liang Dazao (Jujube) (split open) 12 pieces
[Commentary]
The original text of Guizhi Tang includes the instruction "remove skin." The aromatic properties of Cinnamon Twig are entirely contained in its bark; removing the skin would leave dead wood, rendering it incapable of resolving the muscle layer and inducing sweat. This instruction should be deleted; subsequent similar cases follow this example.
If the pulse is harmonious, the patient is extremely restless, eyes are heavy [with swollen eyelids], and the inner canthus is yellowish, this indicates impending resolution.
[Commentary]
The character "lian" (face) should be "jian" (eyelid). Writing it as "lian" is incorrect and should be amended.
Taiyang Wind Strike [does not] cause diarrhea and vomiting. Only when the exterior is resolved can internal attack be employed. If the patient has □□ sweating, intermittent fever [heat], headache, epigastric fullness □ distension, pain radiating to □ below, dry retching, shortness of breath, sweating without aversion to cold, this indicates the exterior is resolved but the interior is unharmonized. Shizao Tang (Ten Date Decoction) is indicated.
[Commentary]
The character "xia" (lower/diarrhea) in "diarrhea" should be "bu" (not). If it were "diarrhea," how could one use the harsh purgative Shizao Tang for simultaneous upper vomiting and lower diarrhea? Only constipation with epigastric fullness and pain constitutes a Interior disease; only difficulty urinating, vomiting, retching, and shortness of breath constitute a Fluid Retention disease, warranting harsh purgation. The character "zuo" (act/make) in "intermittent action" should be "re" (heat), aligning with the meaning of Taiyang Yang pathogen and Heat-Fluid. Without heat but with sweating, it would be Shaoyin Yin pathogen and Cold-Fluid, indicating Zhenwu Tang (Aconite Decoction). Furthermore, "zuo" does not fit the context of surrounding sentences and should be corrected.
In Taiyang Disease, after purgation, if the pulse is [floating] rather than [rapid] and there is no Jie Xiong (Chest Binding), this indicates impending resolution. If the pulse is [rapid] [floating], Jie Xiong (Chest Binding) will definitely occur. If the pulse is [fine and rapid] [tight], throat pain will definitely occur. If the pulse is wiry, bilateral □ stiffness will definitely occur. If the pulse is [tight] [fine and rapid], headache will persist. If the pulse is deep and tight, vomiting will definitely occur. If the pulse is deep and slippery, Xie Re Li (Collateral Heat Diarrhea) will occur. If the pulse is [rapid] [floating] and slippery, hematochezia (blood in stool) will definitely occur.
[Commentary]
"Pulse rapid" should be "Pulse floating" to align with the text stating no Jie Xiong implies impending resolution. "Pulse floating" should be "Pulse rapid" to align with the discussion of Jie Xiong and chest fullness. "Pulse tight" should be "Pulse fine and rapid," and "Pulse fine and rapid" should be "Pulse tight," aligning with the primary pulses of the two meridians discussed. "Pulse floating and slippery" should be "Pulse rapid and slippery"; floating and slippery is the pulse for Baihu Tang (White Tiger Decoction) syndrome, while rapid and slippery is the pulse for passing pus and blood. All should be corrected.
In Taiyang Disease, on the second or third day, inability to lie down, desire only to rise, and必然 epigastric binding, with a faint and weak pulse, indicates pre-existing Cold-Fluid. If purgation is wrongly applied, and if diarrhea stops, Jie Xiong (Chest Binding) will definitely develop; if it does not stop, on the fourth day, repeated purgation [diarrhea] will result in Xie Re Li (Collateral Heat Diarrhea).
[Commentary]
The character "zhi" (it) in "repeatedly purge it" on the fourth day should be "li" (diarrhea). Since the text states diarrhea had not stopped previously, why would one purge again? It should be corrected.
After purgation in Taiyang Disease, if the pulse is rapid and there is chest fullness, Guizhi Qu Shaoyao Tang (Cinnamon Twig Decoction without Red Peony Root) is indicated. If [sweating] occurs with slight aversion to cold, Fuzi Tang (Aconite Decoction) added to the Guizhi Qu Shaoyao formula is indicated.
[Commentary]
The phrase "sweating" should precede "slight aversion to cold." Without "sweating," the Exterior is unresolved, and there is no rationale for adding Aconite. It should be supplemented.
In Taiyang Disease, the pulse is floating, moving, and rapid. Floating indicates Wind, rapid indicates Heat, and moving indicates Pain. [Rapid indicates Deficiency] headache and fever, slight night sweats, yet contrary aversion to cold indicate the Exterior is unresolved. If the physician wrongly applies purgation, the moving and rapid pulse changes to slow. Rejection pain in the diaphragm, emptiness in the Stomach, invading Qi disturbing the diaphragm, shortness of breath, irritability, and inner restlessness occur due to Yang Qi sinking inward. Epigastric binding ensues, resulting in Jie Xiong (Chest Binding), treated with Daxiexiong Tang (Major Downward Draining Chest Decoction). If Jie Xiong does not occur, but only head sweating exists, with no sweat elsewhere extending only to the neck, and difficulty urinating, jaundice will definitely develop.
[Commentary]
The sentence "Rapid indicates Deficiency" is a superfluous text and should be deleted.
For Cold-Excess Jie Xiong (Chest Binding) without Heat signs, Sanwu Baisan (Three-Ingredient White Powder) is given. [Xiao Xiexiong Tang (Minor Downward Draining Chest Decoction)] [may also be taken].
[Commentary]
"Sanwu Xiao Xiexiong Tang" should be "Sanwu Baisan." The four characters "Xiao Xiexiong Tang" are misplaced text. Jiegeng (Platycodon Root), Beimu (Fritillaria Bulb), and Badou (Croton Seed) are all white in color, fitting the meaning of Sanwu Baisan. It is warm and purgative, aligning with the pathology of Cold-Excess. Xiao Xiexiong Tang contains Gualou (Trichosanthes Fruit) and Huanglian (Coptis Rhizome), both cold-natured substances; how can they treat Cold-Excess Jie Xiong? The three characters "yi ke fu" (may also be taken) are also superfluous and should be deleted.