瘈者，筋脉急也。瘲者，筋脉缓也。急则引而缩，缓则纵而伸，或伸动而不止，名曰瘈瘲，俗谓之搐是也。
然瘈瘲者，风痰也，故癫痫则瘈瘲焉。伤寒瘈瘲者，皆由汗下之后，脾土受伤，肝木时旺，肺金不能制
之，是以木生火，火生热，热生风，风火交？，则手足动摇而搐搦也。伤寒至此，可谓危矣。治须平木降
火，佐以和血脉、祛风痰之剂，倘势稍减，症可治也。
郁者，为郁结而气不舒。冒者，为昏冒而神不清。世谓之昏迷者是也。经曰、诸虚乘寒，则为郁冒不仁。
又曰、冒家汗出自愈。由此观之，郁冒为虚寒可知矣。若少阴病下利而头眩，时时自冒者，又为死证，
谓其虚极而脱也。观其若是，幸毋忽焉。
自利者，不经攻下，而自然泄泻者是也。然有协热、协寒之别，须当明辩之。夫协热者，即表邪传里，里
虚协热，而自下列者是也。又有不应下而误攻之，内虚协热，亦为下利者是也。协寒者，即三阴经病。
协热利者，脐下必热，渴欲饮水，泄下黄赤，发热后重，脉数者是也。协寒利者，脐下必寒，自利不渴，泄
下清谷，脉微恶寒者是也。盖伤寒自利多种，须识阴阳二字。如三阳下利，则身热。太阴下利，则手足
温。少阴、厥阴下利，则身凉无热。此确论也。大抵伤寒下利，挟太阳脉证，便不得用温药。俗医但见下
利，便作阴症而用温热之药，其不发黄生斑也几希。至若下利而有头疼腰痛，肌热目疼，鼻干脉长
者，此太阳阳明合病，葛根汤主之。若下利而有头疼脉满，口苦咽干，或往来寒热，脉弦而呕者，此太
阳少阳合病也，柴苓汤主之。若下利而有身热□痛，往来寒热，或干呕，脉弦而长者，此阳明少阳合
病，承气汤主之。若脉不弦者顺，脉弦者逆也。若风邪入胃，木来侮土，故令暴下。其治法或温，或攻，或
清下焦，或利小便，切不可发汗耳。设或下利而发热，下利而厥逆，下利而肺实，下利而烦躁不得眠。
皆不可治也。
伤寒不利，十有六七，俗人不识，呼为溃底，遽用温燥止涩之剂以助邪，变为危症，深可哀悯。
瘈，是指筋脉拘急。瘲，是指筋脉弛缓。拘急则牵引收缩，弛缓则舒展伸长，或者伸展抖动不止，这种病症称为瘈瘲，俗称搐搦。
然而，瘈瘲的病因是风痰，所以癫痫发作时会出现瘈瘲。伤寒病出现瘈瘲，都是因为发汗或攻下之后，脾土受损，肝木之气时常亢盛，肺金不能制约它，因此木生火，火生热，热生风，风火相煽，导致手足动摇而抽搐。伤寒病发展到这一步，可以说是非常危险了。治疗必须平抑肝木、降泄心火，辅以调和血脉、祛除风痰的药物，如果病情稍见减轻，症状还有治愈的希望。
郁，是指气机郁结而不舒畅。冒，是指头目昏蒙而神志不清。世人称之为昏迷。《内经》说：各种虚证感受寒邪，就会发生郁冒且肢体麻木不仁。又说：患有郁冒的人，如果出汗后自然痊愈。由此看来，郁冒属于虚寒证是可以知道的。如果是少阴病出现下利并伴有头晕，经常感到头目昏蒙的，又是死证，这是因为正气极度虚弱而欲脱散。看到这种情况，千万不要忽视。
自利，是指没有经过攻下治疗，而自然发生的泄泻。然而有协热利和协寒利的区别，必须明确辨别。所谓协热利，就是表邪传入体内，里虚兼有热邪，从而自然发生下利。又有本不应攻下却误用攻下法，导致内虚兼有热邪，也出现下利的情况。所谓协寒利，就是三阴经的病证。协热利的表现是：脐下必觉发热，口渴想喝水，大便黄赤，发热且肛门重坠感，脉象数。协寒利的表现是：脐下必觉寒冷，自利且不口渴，大便排出未消化的食物残渣，脉象微弱且恶寒。大概伤寒病的自利有多种情况，必须认清“阴阳”二字。如三阳经的下利，身体发热；太阴经的下利，手足温暖；少阴、厥阴经的下利，身体发凉无热。这是确切的论述。大抵伤寒病的下利，如果夹杂太阳经的脉证，就不能使用温药。世俗医生只见下利，就当作阴症而使用温热药物，这样的人如果不发生发黄、生斑等变证，是很少见的。至于下利而伴有头痛腰痛、肌肉发热、眼睛疼痛、鼻子干燥、脉象长的，这是太阳阳明合病，用葛根汤主治。如果下利而伴有头痛、脉象满实、口苦咽干，或者忽冷忽热、脉弦且呕吐的，这是太阳少阳合病，用柴苓汤主治。如果下利而伴有身体发热、疼痛（原文缺字，推测为身痛），忽冷忽热，或者干呕、脉弦而长的，这是阳明少阳合病，用承气汤主治。如果脉不弦的是顺证，脉弦的是逆证。如果风邪侵入胃腑，肝木来克制脾土，导致突然暴泻。其治疗方法有的用温法，有的用攻法，有的清利下焦，有的通利小便，千万不可发汗。假如出现下利而发热，下利而四肢厥逆，下利而肺气壅实，下利而烦躁不得睡眠的情况，都是不可治疗的。
伤寒病中不下利的，占十分之六七，世俗之人不认识，称之为“溃底”，急忙使用温燥止涩的药物来助长邪气，转变为危重病症，实在令人哀悯同情。
Chi (spasm) refers to the tension and cramping of tendons and vessels. Zhan (flaccidity) refers to the relaxation and laxity of tendons and vessels. Tension causes pulling and shrinking, while relaxation allows stretching and extending; or it may involve continuous stretching and trembling. This condition is named Chi-Zhan (spasm and flaccidity), commonly known as convulsion.
However, Chi-Zhan is caused by Wind-Phlegm; thus, epilepsy involves Chi-Zhan. In Shanghan (Cold Damage) disease, Chi-Zhan occurs due to injury to Spleen Earth after sweating or purging therapies. Consequently, Liver Wood becomes hyperactive, and Lung Metal fails to control it. Therefore, Wood generates Fire, Fire generates Heat, and Heat generates Wind. When Wind and Fire interact violently, the hands and feet tremble and convulse. Shanghan disease reaching this stage can be considered critical. Treatment requires calming Liver Wood and descending Fire, assisted by agents that harmonize blood vessels and dispel Wind-Phlegm. If the condition shows slight improvement, the symptoms are treatable.
Yu (depression/stagnation) refers to Qi stagnation without smooth flow. Mao (dizziness/obscuration) refers to mental cloudiness and lack of clarity of spirit. The world calls this coma. The Classics state: "Various deficiency conditions combined with Cold lead to Yu-Mao and numbness." It also states: "Patients with Mao recover spontaneously when they sweat." From this, it is evident that Yu-Mao belongs to Deficiency-Cold. If Shaoyin disease presents with diarrhea accompanied by dizziness and frequent sensations of head obscuration, it is a death syndrome, indicating extreme deficiency and collapse. Given such presentations, one must not neglect them.
Zili (spontaneous diarrhea) refers to natural diarrhea occurring without prior purgative treatment. However, there are distinctions between Xiere Li (Diarrhea accompanying Heat) and Xiehan Li (Diarrhea accompanying Cold), which must be clearly differentiated. Xiere Li refers to exterior pathogens transmitting inward, where interior deficiency combines with Heat, leading to spontaneous diarrhea. Another scenario involves improper purgation in cases where it was not indicated, causing interior deficiency combined with Heat, also resulting in diarrhea. Xiehan Li refers to diseases of the Three Yin meridians. Symptoms of Xiere Li include heat below the umbilicus, thirst with desire to drink, yellow-red stool, fever with tenesmus, and a rapid pulse. Symptoms of Xiehan Li include cold below the umbilicus, spontaneous diarrhea without thirst, passage of undigested food, a faint pulse, and aversion to cold. Generally, Shanghan spontaneous diarrhea has various types; one must recognize the concept of Yin and Yang. For example, diarrhea from the Three Yang meridians presents with body heat; diarrhea from Taiyin presents with warm hands and feet; diarrhea from Shaoyin and Jueyin presents with a cool body and no heat. This is an accurate theory. Broadly speaking, if Shanghan diarrhea is accompanied by Taiyang pulse and symptom patterns, warming medicines must not be used. Empirical physicians often see only diarrhea and treat it as a Yin syndrome using warming drugs; those who do not develop jaundice or macules are rare. Regarding diarrhea accompanied by headache, lower back pain, muscle heat, eye pain, dry nose, and a long pulse, this is a concurrent disease of Taiyang and Yangming, treated with Gegen Tang (Kudzu Decoction). If diarrhea is accompanied by headache, full pulse, bitter taste, dry throat, alternating chills and fever, a wiry pulse, and vomiting, this is a concurrent disease of Taiyang and Shaoyang, treated with Chai Ling Tang (Bupleurum and Poria Decoction). If diarrhea is accompanied by body heat, pain, alternating chills and fever, dry retching, a wiry and long pulse, this is a concurrent disease of Yangming and Shaoyang, treated with Chengqi Tang (Gut-Draining Decoction). A non-wiry pulse indicates a favorable prognosis (Shun), while a wiry pulse indicates an unfavorable prognosis (Ni). If Wind-Evil enters the Stomach, Liver Wood insults Spleen Earth, causing sudden violent diarrhea. Treatments may involve warming, purging, clearing the Lower Jiao, or promoting urination, but sweating therapy must absolutely be avoided. If diarrhea is accompanied by fever, cold limbs, Lung excess, or restlessness and insomnia, these are untreatable conditions.
In Shanghan disease, six or seven out of ten cases do not present with diarrhea. Laypeople fail to recognize this, calling it "bottom rot" (kuidi), and hastily use warming, drying, astringent agents to stop diarrhea, thereby assisting the pathogen and transforming it into a critical condition. This is deeply pitiable.