伤寒，太阳经头痛，自脑后上至巅顶，项强，腰脊痛。阳明头痛在额前，连目
珠，鼻孔干，不眠。少阳头痛在两角，及耳聋，胁痛。厥阴头痛在巅顶，收引头角，
脉沉弦，手足厥冷，此为在经。（当归四逆汤。）若在里，则干呕，吐涎沫。（吴茱萸汤。）太阴、
少阴脉不上头，无头痛证。然太阴中湿亦头痛，鼻塞，吐痰，腹满自利。（要知是湿浊
之气上乾清阳之分使然耳。）少阴中寒，亦有头痛，连脑齿，爪甲青，此真头痛，不治。（亦寒
邪上攻使然。）温热病，时疫病，凡一切内火上炎之证，皆头痛。内伤火升，新产血虚，
皆有头痛，但时痛时止，而无脑后痛者。盖火炎则痛在两角，血虚则痛连鱼尾，以
其自内达外，必由少阳。是以痛见两角者，则有少阳风热与虚火之别。若痛在额前
者，亦有阳明与食积之殊。其见脑后者，必太阳无疑也。头痛如破者，风火相煽
也。眩晕者，痰火上升也。头倾视深，（目陷。）精神夺矣。耳聋耳疼，胸胁痛，寒热口
苦者，少阳经证。耳聋，舌卷唇青，为直中厥阴。耳鸣及痛，火上冲也。耳
聋，叉手冒心者，汗多而阳虚也。耳聋者，耳内无声，窍常闭而不闻也。耳鸣者，
耳内有声，窍不闭，时闻时不闻也。（火动而上冲则鸣，而不闻外声，火静气下，则不鸣
而闻。）面热
者，足阳明病。邪在肺，则皮肤痛，喘咳动肩背。邪在肝，则胁痛，恶血在内抽掣，
舌卷卵缩为肝绝。邪在脾胃，则肉痛善饥。（热也。）邪在肾，则骨痛腰痛。（腰者肾之府也，
转摇不能，肾将惫矣。）伤寒太阳身痛，但拘急耳。若阴毒身痛，则体势沉重如被杖。中湿
身痛，不可转侧。（骨节掣痛，屈伸不利，身重或肿，汗出恶风，不欲去衣。）
中暑亦身痛。汗后身仍
疼，邪未尽也。然血虚者身亦疼。头痛身热自汗，与伤寒同。而默默但欲眠，鼻鼾，
语言难出，四肢不收者，风温也，不可发汗。霍乱亦头痛身痛，恶寒发热如伤寒，
而有吐利为异。身热恶寒。头项强急如伤寒，而头热，目脉赤，面赤，独头摇，口
禁齿 ，背反张者，痉也。无汗为刚痉，有汗为柔痉。头疼发热与伤寒同，而身不
痛者，伤食也。必中脘痞闷，噫气作酸，或恶闻食臭，或欲吐不吐。烦热似伤寒，
而脉不浮紧，头身不疼，不恶寒，或烦时头亦痛，烦止而痛止者，虚烦也。身热恶
风自汗似伤寒，但头不痛，项不强，或亦头痛而作止无常者，痰也。或胸满气上冲，
或目下如灰烟黑者，是其候也。发热恶寒头痛，肢节痛，呕恶，似伤寒，而病自脚，
脚膝痛，或肿满，或枯细者，香港脚也。身热恶寒，若有痛处者，痈疽也。发热如伤
寒，小便自利，口不渴，按其心下或胁下，或脐腹间有痛处，或至手不可近者，
蓄血也。凡劳逸、七情、房劳，皆能瘀血，不止一途。劳损病剧，忽身痛甚者，此
阴虚之极，不能滋养筋骨也，难治。胸腹间胀闷而痛，邪在中上二焦，不可补。若
气虚不运，但痞满者，不可攻。勿因其胃口不开，妄行消导。虚症须补，而胀满不
受补者难治。卒然仆倒，昏不知人，痰涎壅盛，口眼 斜，手足瘫软，或半身不遂
者，中风也。若见口开手撒，眼合遗尿，痰声如锯，不治。卒倒，而身体强直，口
噤不语，或四肢战掉，发热无汗者，中寒也。卒然闷倒，昏不知人，汗出面垢，手
足微冷，或吐或泻者，中暑也。中气大类中风，卒倒，痰塞，牙关紧急，然中风口
有痰涎，身温，中气口无痰沫，身冷也。中食亦似中风，难辨。须审其曾着怒气否，
曾饮食否。若在醉饱后着恼，或感风寒，食填胸中，胃气不行，便致厥倒，昏迷不
醒，其脉气口急盛，或沉伏，宜盐汤探吐之，吐不出者死。中痰者，卒然麻眩，舌
本强直，痰涎有声，四肢不举，重者不醒，为痰中。轻者自醒，为痰厥。心火暴甚，
热气怫郁，而卒倒无知。轻者发过自醒，重者阴气暴绝，阳气后竭而死。中恶者，
忽然手足逆冷，肌肤粟起，头面青黑，精神不守，或错言妄语，牙紧口噤，卒然晕
倒，昏不知人，此是卒厥客忤，飞尸鬼击。凡吊死问丧，入庙登冢，多有此证。
腹痛，气自下冲上者，火也。从上转下，趋少腹者，寒也。气从少腹上冲者，阴火
也。从两胁上冲者，肝火也。少腹痛引腰背睾丸者，疝病也。肉 筋惕者，血虚也。
身如虫行者，表虚也。不能仰卧，仰卧则咳者，水气也，（水气上乘于肺，则气喘促。）身重
难行。（胃主肉，其脉下行于足，水犯胃，故肉重而足不能行。）口苦，为胆热。口甘，
为脾热。口淡，
为胃中虚热（胃为一身之主，淡为五味之本。）口酸，为肝热。口咸，为肾热。口中常觉血腥，
为肺伤。口燥咽干赤烂，为内热。口辣，为肺热。所谓内伤则口中不和，饮食无
味也。
伤寒病中，太阳经受邪引起的头痛，疼痛从脑后向上延伸至头顶，伴有颈部僵硬、腰部和脊柱疼痛。阳明经头痛位于前额，牵连眼球，鼻孔干燥，无法入睡。少阳经头痛位于头部两侧，并伴有耳聋、胁肋疼痛。厥阴经头痛位于头顶，牵引头角疼痛，脉象沉弦，手脚冰凉，这是病在经络的表现。（可用当归四逆汤治疗。）如果病邪在里，则出现干呕、吐出涎沫。（可用吴茱萸汤治疗。）太阴经和少阴经的病证通常不表现为头痛，因此没有头痛的症状。然而，太阴经受湿邪侵袭也会引起头痛，伴有鼻塞、吐痰、腹部胀满、自发性腹泻。（要知道这是因为湿浊之气上犯清阳部位所致。）少阴经受寒邪侵袭，也会有头痛，牵连脑部牙齿，指甲发青，这称为“真头痛”，属于不治之症。（这也是寒邪上攻所致。）温热病、时行疫病，以及一切因内火上升引起的病证，都会导致头痛。内伤导致的火气上升、新产后血虚，也都会引起头痛，但特点是疼痛时作时止，且没有后脑勺的疼痛。因为火性炎上，所以疼痛多在头部两侧；血虚则疼痛牵连眼角（鱼尾），因为气血由内达外，必经少阳经。因此，疼痛出现在头部两侧的，有少阳风热与虚火的区别。如果疼痛在前额的，也有阳明经病与食积的不同。疼痛出现在后脑勺的，必定是太阳经无疑。头痛剧烈如要破裂的，是风火相互煽动所致。眩晕的，是痰火上升所致。头低垂、眼睛深陷，说明精神已经耗竭。耳聋耳痛，胸胁疼痛，恶寒发热、口苦的，是少阳经证候。耳聋，舌头卷缩、嘴唇发青，是寒邪直中厥阴经。耳鸣及耳痛，是火气上冲所致。耳聋，双手交叉护住心口，是出汗过多导致阳气虚弱所致。耳聋，是指耳内无声，耳窍常闭而听不见声音。耳鸣，是指耳内有声响，耳窍未闭，有时能听见有时听不见。（火气扰动而上冲则鸣响，此时听不见外界声音；火气平息、气机下行，则不鸣响而能听见外界声音。）面部发热，是足阳明经病变。邪气在肺，则皮肤疼痛，气喘咳嗽并牵动肩背。邪气在肝，则胁肋疼痛，体内有瘀血抽掣作痛，舌头卷缩、睾丸上缩为肝气绝的表现。邪气在脾胃，则肌肉疼痛、容易饥饿。（这是热证。）邪气在肾，则骨骼疼痛、腰部疼痛。（腰是肾的外府，转动摇晃困难，说明肾气将要衰竭了。）伤寒太阳经的身痛，只是拘急而已。如果是阴毒身痛，则身体沉重得像被打过一样。中湿导致的身痛，身体无法转动侧身。（骨节牵拉疼痛，屈伸不利，身体沉重或浮肿，出汗怕风，不想脱衣。）中暑也会导致身痛。发汗后身体仍然疼痛，说明邪气未尽。然而血虚的人身体也会疼痛。头痛、身热、自汗，与伤寒相似。但如果神情沉默只想睡觉，打鼾，说话困难，四肢无力收持的，是风温病，不可发汗。霍乱也会头痛身痛，恶寒发热像伤寒，但以呕吐腹泻为不同之处。身热恶寒，头项强急像伤寒，但头部发热，眼结膜充血，面色发红，只有头部摇动，牙关紧闭，背部反张的，是痉病。无汗的为刚痉，有汗的为柔痉。头疼发热与伤寒相同，但身体不痛的，是伤食。必然伴有胃脘部痞闷，嗳气泛酸，或者厌恶食物气味，或者想吐吐不出来。烦热像伤寒，但脉象不浮紧，头身不疼，不恶寒，或者烦躁时头也痛，烦躁停止则疼痛停止的，是虚烦。身热恶风自汗像伤寒，但头不痛，项不强，或者也头痛但发作时间无常的，是痰证。或者胸部胀满气上冲，或者眼下像灰烟黑气的，是其征候。发热恶寒头痛，肢节疼痛，恶心呕吐，像伤寒，但病起于脚部，脚膝疼痛，或肿胀满盈，或枯瘦细小的，是香港脚（脚气病）。身热恶寒，如果有固定痛处的，是痈疽。发热像伤寒，小便通利，口不渴，按压心下或胁下，或脐腹间有痛处，甚至手不能靠近的，是蓄血证。凡是劳累过度、七情内伤、房劳过度，都能导致瘀血，不止一种途径。劳损病重，忽然身体剧痛的，这是阴虚到了极点，不能滋养筋骨，难以治疗。胸腹部胀闷而痛，邪气在中上二焦，不可用补法。如果是气虚不运，仅仅痞满的，不可用攻法。不要因为胃口不开，就胡乱使用消导药。虚证需要补益，但胀满不受补的难治。突然仆倒，昏迷不省人事，痰涎壅盛，口眼歪斜，手足瘫软，或半身不遂的，是中风。如果出现口开手撒，眼睛闭合、遗尿，痰声如锯，是不治之症。突然倒下，身体强直，牙关紧闭不语，或四肢颤抖，发热无汗的，是中寒。突然胸闷倒下，昏迷不省人事，出汗、面部污垢，手脚微冷，或呕吐或腹泻的，是中暑。中气（气厥）大类同中风，突然倒下，痰塞，牙关紧急，但是中风人口中有痰涎，身体温暖；中气人口中无痰沫，身体寒冷。中食（食厥）也像中风，难以辨别。必须审察患者是否曾发怒，是否曾进食。如果在醉饱之后恼怒，或感受风寒，食物填塞胸中，胃气不行，便导致昏厥，昏迷不醒，其脉象气口急盛，或沉伏，宜用盐汤催吐，吐不出来的会死。中痰者，突然麻木眩晕，舌根强直，痰涎有声，四肢不能举动，重的不省人事，称为痰中。轻的自己醒来，称为痰厥。心火暴甚，热气郁结，而突然倒下无知觉。轻的发过后自己醒来，重的阴气暴绝，阳气随后竭尽而死。中恶者，忽然手脚逆冷，肌肤起粟粒，头面青黑，精神不能守舍，或胡言乱语，牙关紧闭口噤，突然晕倒，昏迷不省人事，这是卒厥客忤，飞尸鬼击。凡是吊丧问疾，进入庙宇登上坟墓，多有此证。腹痛，气从下往上冲的，是火证。从上往下转，趋向小腹的，是寒证。气从少腹上冲的，是阴火。从两胁上冲的，是肝火。少腹痛牵连腰背睾丸的，是疝病。肌肉跳动、筋脉抽搐的，是血虚。身体像有虫子爬行的，是表虚。不能仰卧，仰卧则咳嗽的，是水气。（水气上乘于肺，则气喘急促。）身体沉重难以行走。（胃主肌肉，其经脉下行于足，水邪侵犯胃，所以肉重而足不能行。）口苦，是胆热。口甜，是脾热。口淡，是胃中虚热（胃是一身之主，淡是五味之本）。口酸，是肝热。口咸，是肾热。口中常觉得血腥味，是肺受伤。口燥咽干、嘴唇赤烂，是内热。口辣，是肺热。所谓内伤则口中不和，饮食无味。
In the context of Shanghan (Cold Damage) disease, headache caused by pathogenic factors in the Taiyang meridian (Taiyang Meridian Disease) radiates from the back of the head up to the vertex, accompanied by stiffness of the neck and pain in the waist and spine. Headache associated with the Yangming meridian (Yangming Meridian Disease) is located in the forehead, extending to the eyeballs, with dry nasal passages and insomnia. Headache related to the Shaoyang meridian (Shaoyang Meridian Disease) occurs at the temples, along with deafness and hypochondriac pain. Headache involving the Jueyin meridian (Jueyin Meridian Disease) is at the vertex, drawing pain to the temples, with a deep and wiry pulse, and cold extremities; this indicates the pathogen is in the meridians. (Danggui Sini Tang [Cinnamon Twig and Angelica Decoction] may be used.) If the pathogen is in the interior, symptoms include dry retching and vomiting of saliva. (Wuzhuyu Tang [Evodia Decoction] may be used.) Diseases of the Taiyin and Shaoyin meridians typically do not present with headaches. However, Taiyin affected by dampness can cause headache, nasal congestion, phlegm expectoration, abdominal fullness, and spontaneous diarrhea. (This is due to turbid dampness ascending to disturb the clear yang.) Shaoyin affected by cold can also cause headache radiating to the brain and teeth, with cyanotic nail beds; this is called "True Headache" (Zhen Tou Tong), which is incurable. (This is also caused by cold pathogens attacking upwards.) Warm diseases, epidemic diseases, and all conditions where internal fire flares upward result in headache. Internal injury causing fire to rise, or blood deficiency after childbirth, also cause headaches, but these are intermittent and lack posterior head pain. Since fire flares upward, pain is often at the temples; blood deficiency causes pain to extend to the lateral canthi (fish tails), as qi and blood travel from the interior to the exterior via the Shaoyang meridian. Thus, temple pain distinguishes between Shaoyang wind-heat and deficient fire. Forehead pain distinguishes between Yangming disease and food stagnation. Posterior head pain is undoubtedly Taiyang. Severe headache feeling like bursting indicates wind and fire stirring each other. Vertigo indicates rising phlegm-fire. A drooping head and sunken eyes indicate depletion of spirit. Deafness and ear pain, with chest/hypochondriac pain, aversion to cold, fever, and bitter taste, are signs of Shaoyang meridian syndrome. Deafness with tongue retraction and cyanotic lips indicates direct invasion of the Jueyin meridian by cold. Tinnitus and ear pain indicate fire rushing upward. Deafness with hands crossing over the heart indicates yang deficiency due to excessive sweating. Deafness refers to silence in the ears and closed orifices unable to hear. Tinnitus refers to sounds within the ears without closed orifices, heard intermittently. (When fire moves and rushes upward, there is ringing and inability to hear external sounds; when fire settles and qi descends, there is no ringing and hearing returns.) Facial heat indicates Foot-Yangming disease. Pathogens in the Lung cause skin pain, wheezing, coughing, and shoulder/back movement pain. Pathogens in the Liver cause hypochondriac pain, internal blood stasis pulling sensations, tongue retraction, and testicular retraction indicating Liver exhaustion. Pathogens in the Spleen/Stomach cause muscle pain and hunger (heat). Pathogens in the Kidney cause bone pain and lower back pain. (The waist is the mansion of the Kidney; inability to turn or sway indicates impending Kidney failure.) In Taiyang Shanghan, body pain is merely stiffness. Yin toxicity body pain feels heavy as if beaten. Dampness-induced body pain prevents turning or side-lying. (Joint pulling pain, limited flexion/extension, heaviness or edema, sweating with aversion to wind, reluctance to remove clothes.) Heatstroke also causes body pain. Persistent body pain after sweating indicates incomplete elimination of pathogens. Blood deficiency also causes body pain. Headache, fever, and spontaneous sweating resemble Shanghan. However, silent desire to sleep, snoring, difficulty speaking, and flaccid limbs indicate Fengwen (Wind-Warmth), which must not be treated with sweating methods. Huoluan (Colic-Restlessness) also presents with headache and body pain, aversion to cold and fever resembling Shanghan, but differs by vomiting and diarrhea. Fever and aversion to cold with neck stiffness resemble Shanghan, but if accompanied by hot head, red eye vessels, red face, isolated head shaking, trismus, and opisthotonos, it is Jing (Spasm). Absence of sweat indicates Gang-Jing (Stiff Spasm); presence of sweat indicates Rou-Jing (Flaccid Spasm). Headache and fever similar to Shanghan but without body pain indicate Food Injury. Accompanied by epigastric stuffiness, belching with sour taste, aversion to food odors, or urge to vomit without success. Restless heat resembling Shanghan but with non-floating/tight pulse, no head/body pain, no aversion to cold, or headache coinciding with restlessness and subsiding with it, indicates Deficient Restlessness (Xu Fan). Fever, aversion to wind, and sweating resembling Shanghan but without head/neck pain, or irregular headache, indicates Phlegm. Accompanied by chest fullness with qi rushing upward or gray-black discoloration under eyes. Fever, aversion to cold, headache, joint pain, nausea, resembling Shanghan but originating in the feet with knee pain, swelling, or wasting, indicates Hong Kong Foot (Jiao Qi / Podagra). Fever and aversion to cold with fixed pain points indicate Carbuncles and Ulcers. Fever resembling Shanghan, with free urination, no thirst, and tenderness upon pressing the epigastrium, hypochondrium, or umbilical region (even intolerable to touch), indicates Blood Stasis (Xu Xue). Labor, emotional stress, and sexual excess can all cause blood stasis. In severe consumptive disease, sudden severe body pain indicates extreme yin deficiency failing to nourish sinews and bones, which is difficult to treat. Epigastric/abdominal distension and pain indicate pathogens in the Middle/Upper Jiao, contraindicating tonification. Qi deficiency causing mere fullness contraindicates purgation. Do not blindly use digestive agents for poor appetite. Deficiency requires tonification, but distension unresponsive to tonification is difficult. Sudden collapse, unconsciousness, profuse phlegm, facial deviation, limb flaccidity, or hemiplegia indicates Zhongfeng (Stroke). Mouth open, hands relaxed, eyes closed, incontinence, and sawing sputum indicate an incurable condition. Sudden collapse with rigid body, trismus, mutism, trembling limbs, fever, and absence of sweat indicates Zhonghan (Cold Strike). Sudden chest oppression, unconsciousness, sweaty dirty face, cold extremities, vomiting or diarrhea indicates Zhongshu (Heat Stroke). Zhongqi (Qi Obstruction) resembles stroke with sudden collapse, phlegm obstruction, and trismus, but unlike stroke (which has phlegm and warm body), Zhongqi has no phlegm and a cold body. Zhongshi (Food Obstruction) also resembles stroke and is hard to distinguish. Determine if anger or eating preceded the event. Anger after overeating/drinking or exposure to cold/wind causes food to block the chest, stopping Stomach qi, leading to syncope. Pulse at the Qi Kou (Radial Artery) is rapid/full or deep/hidden. Use salt water to induce emesis; death ensues if vomiting fails. Zhongtan (Phlegm Strike) presents with sudden numbness/dizziness, stiff tongue base, audible phlegm, and immobility. Severe cases are unconscious (Tan Zhong); mild cases recover spontaneously (Tan Jue). Sudden collapse due to violent Heart Fire and trapped heat: mild cases recover; severe cases die from sudden Yin collapse followed by Yang exhaustion. Zhong'e (Evil Strike) presents with sudden cold extremities, gooseflesh, cyanotic/black face, mental instability, delirium, trismus, and sudden fainting/unconsciousness. This is Cu Jue (Sudden Syncope) or Ke Wu (Guest Malevolence), Fei Shi Gui Ji (Flying Corpse Ghost Strike). Common after mourning, visiting temples, or graves. Abdominal pain with qi rushing upward indicates Fire. Qi moving downward to the lower abdomen indicates Cold. Qi rushing from the lower abdomen indicates Yin Fire. Qi rushing from the hypochondrium indicates Liver Fire. Lower abdominal pain radiating to the back/testicles indicates Hernia (Shan Bing). Muscle twitching indicates Blood Deficiency. Sensation of insects crawling on the skin indicates Exterior Deficiency. Inability to lie supine, worsening cough when supine, indicates Water Qi (Water Retention). (Water qi attacking the Lung causes shortness of breath.) Heaviness and difficulty walking. (The Stomach governs muscles; its meridian descends to the feet. Water invading the Stomach causes heavy flesh and immobile feet.) Bitter taste indicates Gallbladder Heat. Sweet taste indicates Spleen Heat. Bland taste indicates Stomach Deficient Heat. (The Stomach is the master of the body; blandness is the root of the five flavors.) Sour taste indicates Liver Heat. Salty taste indicates Kidney Heat. Metallic/bloody taste in the mouth indicates Lung injury. Dry mouth/throat and red/cracked lips indicate Internal Heat. Spicy/pungent taste indicates Lung Heat. Internal injury leads to disharmony in the mouth and loss of taste for food.