今夫热病者，皆伤寒之类也，或愈或死，其死皆以六七日之间，其余皆以十日以上者，何也？（伤寒者，
中阴寒杀厉之气也。寒盛于冬，中而疾病者，是为伤寒，其不即病者，至春则名为温病，
至夏则名为暑病。然有四时不正之气随感随发者，亦名伤寒。寒邪束于肌表则玄府闭，阳气不得散越，乃郁
而为热，故凡系外感发热者，皆伤寒之类。）然巨阳者，诸阳之属也。（巨，大也。太阳为六经之长，统摄阳
分，故诸阳皆其所属。）其脉连于风府，故为诸阳主气也。（风府，督脉穴。太阳经脉覆于巅背之表，故主
诸阳之气分。）人之伤于寒也，则为病热，热虽甚不死；（人伤于寒而传为热者，寒甚则生热也。寒散则
热退，故虽甚不致死。）其两感于寒而病者，必不免于死矣。（表里俱受，是谓两感。）伤寒一日，巨
阳受之，故头项痛，腰脊强；（巨阳，足太阳也，为三阳之表而脉连风府，故凡病伤寒者多从太阳始。太
阳之经，从头项下肩膊，挟背抵腰中，故其为病如此。仲景曰∶“太阳之为病，脉浮，头
项强痛而恶寒，”人身经络，三阳为表，三阴为里。三阳之序，则太阳为三阳，阳中之阳也；阳明为二阳，
居太阳之次；少阳为一阳，居阳明之次，此三阳为表也。三阴之序，则太阴为三阴，居少阳之次；
少阴为二阴，居太阴之次；厥阴为一阴，居少阴之次。此三阴为里也。其次序之数，则以内而外，故有
一二三之先后者如此。邪之中人，必自外而内。邪客于皮则腠理开，开则邪入客于络脉，络脉满则注于经脉，
经脉满则入舍于府藏，此所以邪必先于皮毛，经必始于太阳，而后三阴三阳，五脏六腑皆受病也。）二日
阳明受之，阳明主肉，其脉挟鼻，络于目，故身热目疼而鼻干，不得卧也；（伤寒多发热，而独此云“身热”
者，盖阳明主肌肉，身热尤甚也。邪热在胃则烦，故不得卧。余症皆本经之所及。仲景曰∶阳明之为病，胃
家实也”。）三日少阳受之，少阳主胆，其脉循胁，络于耳，故胃胁痛而耳聋。（邪在少阳者，三阳已尽，
将入太阴，故为半表半里之经。其经脉出耳前后，下循胸胁，故为胁痛、耳聋等证。仲景曰∶“伤寒脉弦细，
头痛发热者，属少阳。”“少阳之病。口苦、咽干、目眩也。”又曰∶“太阳病不解，转入少阳者，胁下鞭
满，干呕不能食，往来寒热。”盖邪在阴则寒。邪在阳则热，邪在表则无呕满等症，邪在里则胸满干呕不能食。
故成无己曰∶“少阳之邪，在半表半里之间。”）三阳经络皆受其病而未入于脏者，故可汗而已。（三阳为表
属腑，邪在表而未入于三阴之脏者，皆可汗而散之。）四日太阴受之，太阴脉布胃中，络于嗌，故腹满而嗌干；
（邪在三阳，失于汗解，则入三阴，自太阴始也。仲景曰∶“伤寒脉浮而缓，手足自温者，系在太阴。”
“太阴之为病，腹满而吐，食不下，自利益甚，时腹自痛”也。）五日少阴受之，少阴脉贯肾，络于脉，
系舌本，故口燥舌干而渴；（肾经属水，而邪热涸之，故口舌为之干渴，仲景曰∶“少阴之为病，脉微
细，但欲寐之。”）六日厥阴受之，厥阴脉循阴器而络于肝，故烦满而囊缩。（六经传遍，乃至厥阴。邪热甚
于阴分，故为烦满。仲景曰∶“厥阴之为病，气上撞心，心中疼热，饥而不欲食，食则吐蛔，下之利不
止。”按，伤寒一病，传变无穷，此不过言传经之常，而未及于变。自仲景而后，诸大家俱有名言可法，学人
所当尽读而精思之。然义多出于仲景，于仲景书又当闭户深求者也。）三阴三阳，五脏六腑皆受病，营卫
不行，五脏不通，则死矣。（伤寒邪在经络，本为表症，经尽气复，自当渐解。若六经传遍而邪不退，则深
入于腑，腑不退，则深至于脏，故五脏六腑皆受病矣。邪盛于外。则营卫不行，气竭于内，则五脏不通，故
六七日间致死也，善治此者，必不使其邪入内，亦必不使其脏气竭。知斯二者，近于神矣。止言足经，不言
手者，以伤寒为表邪，欲求外症，但当察于周身，而周身上下脉络，惟足六经则尽之矣，手经无能遍也。且
手经所至，足经无不至者，故但言足经，则其左右前后阴阳诸证，无不可按而得，而手经亦在其中，不必
言矣，刘草窗不读此经，谬创邵说，万世唾骂，
学人可不慎诸！）其不两感于寒者，七日巨阳病衰，头痛少愈；（邪气渐退则正气渐复，如下文也。）
八日阳明病衰，身热少愈；九日少阳病衰，耳聋微闻；十日太阴病哀，腹减如故，则思饮食；十一日少阴
病衰，渴止不满，舌干，已而嚏；十二日厥阴病衰，囊纵，少腹微下，大气皆去，病日已矣。（所谓其余皆十
日以上者如此。）治之之法，各通其脏脉，病日衰已矣。其未满三日者，可汗而已；其满三日者，可泄而已。
（各通其脏脉，谓当随经分治也，凡传经之邪未满三日者，其邪在表，故可以汗已；满三日者，
其邪传里，故可以下，然此言表里之大体耳。按，脉大浮数，病为在表，可发其汗；脉实沉数，病为在里，
可下之。日数虽多，但有表症而脉浮大者，犹宜发汗；日数虽少，但有里症，而脉沉实者，即当下之。此汗
下之法，但当以表里为据，有不可以执一也。）
其两感于寒者，一日则巨阳与少阴俱病，则头痛口干而烦满；（两感者，表里同病也。足太阳与少阴为
表里，故在太阳则为头痛，在少阴则为口干烦满。）二日则阳明与太阴俱病，则腹满身热，不
欲食，谵言；（阳明、太阴为表里，二经同病也。谵言，妄言也，阳明病则身热谵言，太阴病则腹满不欲食。）
三日则少阳与厥阴俱病，则耳聋囊缩而厥。水浆不入，不知人，六日死。（少阳、厥阴，表里同
病也。少阳病则为耳聋，厥阴病则为囊缩而厥。至是则三阴三阳俱受病，故水浆不入，昏不知人，于六日之
际当死也。）五脏已伤，六腑不通，营卫不行，如是之后三日乃死，何也？（如此之后三日乃死，谓两
感传遍之后，复三日而死也，盖即六日之义。）盖阳明者，十二经脉之长也，其血气盛，故不知人，三日其
气乃尽，故死矣。（阳明为十二经脉之长，多气多血之经，若感于邪，其邪必甚，故不知人。凡两
感于邪者，三日之后，胃气乃尽，故当死也。两感者，本表里之同病，似若皆以外邪为言，而实未必有
尽然者，正以内外俱伤，便是两感，今见少
阴先溃于内，而太阳继之于外者，即纵情肆欲之两感也；太阴受伤于里，而阳明重感于表者，即劳倦竭力，
饮食失调之两感也；厥阴气逆于脏，少阳复病于腑者，必七情不慎，疲筋败血之两感也。人知两感为伤寒，而不
知伤寒之两感内外俱困，病斯剧矣，但伤有轻重，医有贤不肖，则死生系
之，或谓两感之症不多见者，盖亦见之不广，而义有未达耳。）
凡病伤寒而成温者，先夏至日者为病温，后夏至日者为病暑。（寒邪中人而成温病、暑病者，其在
时则以夏至前后言，在病则以热之微甚言，故凡温病、暑病，皆伤寒也。）暑当与汗皆出，勿止。
（暑气侵入，当令有汗，则暑随汗出，故曰“勿止”。温病、暑病，后贤另有成书，所当详考。）
热病已愈，时有所遗者，热甚而强食之，故有所遗也。若此者，皆病已衰而热有所藏，因其谷气相薄，
两热相合，治之视其虚实，调其逆从，可使必已。（病虽衰而余热未除，尚有所藏，因而强食，则病气与食气
相并，两热合邪，以致留连不解，故名曰“遗”。食滞于中者病之实，脾弱不能运者病之虚，实则泻，虚
则补，虚实勿失，则逆从可调，病必已矣。）当何禁之？病热少愈，食肉则复，多食则遗，此其禁也。（复者
病复作，遗则延久也。凡病后脾胃气虚，未能消化饮食，故于肉食之类，皆当从缓。若犯食复，为害非浅，其
有挟虚内馁者，又不可过于禁制，所以贵得宜也。）
有病温者，汗出辄复热，而脉躁疾，不为汗衰，狂言，不能食，病名阴阳交，交者死也。（汗者，阴
之液。身热脉躁者，阳之邪。病温汗出之后，则当邪从汗解，热退脉静矣。今其不为汗衰者，
乃阳胜之极，阴气不能复也，故为狂言，为不食，正以阳邪交入阴分，则阴气不守，故曰“阴阳交，交者死”
也。）人所以汗出者，皆生于谷，谷生于精。（谷气内盛则生精，精气外达则为汗。）今邪气交争于骨肉
而得汗者，是邪却而精胜也，精胜则当能食而不复热，（惟精
胜邪，所以能汗。邪从汗散，则当能食，不复热矣。）复热者邪气也，汗者精气也。今汗出而辄复热者，是邪
胜也；不能食者，精无俾也。（俾，使也。精，阴气也。五脏所以藏精，脏气虚则不能使人饮食，
故曰“精气俾”也。）病而留者，其寿可立而倾也。（病气留而不退，则元气日败，必致损命矣。）汗出而
脉尚躁盛者死。（凡汗后脉当迟静，而反躁盛者，真阴竭而邪独胜也，故病必死。）今脉不与汗相应，此不胜
其病也，其死明矣。（精气不胜病气也。）狂言者是失志，失志者死。（此总五志为言也。志舍于精，精不
胜邪则五脏之志皆失，故致狂言者，多死。）今见三死不见一生，虽愈必死也。（汗后辄复热不能食
者，一死；汗后脉尚躁盛者，二死；汗后反狂言失志者，三死。有此三者，则必死之候。）
肝热病者，小便先黄，腹痛，多卧，身热。（肝脉环阴器，故小便黄；抵少腹。故腹痛。肝主筋，筋
热则 ，故多卧。邪在厥阴经则行于股阴腹胁，故身热。前言伤寒，此即所以治伤寒也，但前分伤寒之六
经，此详伤寒之五脏。正彼此相为发明耳。观后节之复言两感，概可知矣。
凡欲察伤寒之理者，毋忽此义。）热争则狂言及惊，胁满痛，手足躁，不得安卧。（热入于脏则邪正相胜，故
曰“争”，下同。气争于肝则肝气乱，故狂言而惊，肝病主惊骇也。肝脉布胁肋，故胁为满痛。热极则
生风，风淫四末，故手足躁扰。木邪乘土，必及于胃，胃不和则卧不安。）庚辛甚，甲乙大汗，气逆则庚
辛死。（庚辛属金，肝所畏也，故甚而死。甲乙属木，肝所王也，故汗而愈。）刺足厥阴、少阴。（少阳为厥
阴之表，皆可泻其热邪，药法皆然，下同此义。）其逆则头痛员员，脉引冲头也。（肝脉与督脉会于巅，故
气逆于上则头痛员员，脉引冲于头也。员员，靡定貌。）心热病者，先不乐，数日乃热。（心者，神明之所出，
邪不易犯，犯必先觉之，故热邪将入于脏，则先有不乐之兆。）热争则卒心痛，烦闷善呕，头痛面赤
无汗。（热与心气分争，故卒然心痛而烦
闷。心火上炎，故善呕。头者精明之府，手少阴之脉上出于面，故头痛面赤。汗为心液，心热则液亡，故无
汗。）壬癸甚，丙丁大汗，气逆则壬癸死。（壬癸属水，心所畏也，丙丁属火，心之王也。）刺手少阴、太
阳。（手太阳为少阴之表，故皆当刺之。）脾热病者，先头重颊痛，烦心，颜青，欲呕，身热。（脾胃相为表
里，脾病必及于胃也。阳明胃脉，循颊车，上耳前，至额颅，故头重颊痛。脾脉注心中，故烦心，脾病
则肝木乘之，故颜上色青。脾胃受邪则饮食不纳，故欲呕。太阴、阳明主肌肉，故邪盛则身热。）热争则腰
痛不可俯仰，腹满泄，两颔痛。（腰者肾之府，热争于脾，则土邪乘肾，必注于腰，故为腰痛不可俯仰。太
阴之脉，入腹属脾络胃，故腹满而泄。阳明脉循颐后下廉，出大迎，故两颌痛。）甲乙甚，戊己大汗，气逆
则甲乙死。（甲乙木，脾所畏也。戊己土，脾之王也。）刺足太阴、阳明。（表里俱当取之，以去其热。）肺
热病者，先淅然厥起毫毛，恶风寒，舌上黄，身热。（肺主皮毛，热则畏寒，故先淅然恶风寒，起毫毛也。
肺脉起于中焦，循胃口，肺热入胃，则胃热上升，故舌上黄而身热。）热争则喘咳，痛走胸膺背，
不得太息，头痛不堪，汗出而寒。（热争于肺，其变动则为喘为咳。肺者胸中之脏，背者胸中之腑，故痛走
胸膺及背，且不得太息也。喘逆在肺，气不下行，则三阳俱壅于上，故头痛不堪。热邪在肺则皮毛不敛，故
汗出而寒。）丙丁甚，庚辛大汗，气逆则丙丁死。（丙丁属火，克肺者也。庚辛属金，肺所王也。）刺手
太阴、阳明，出血如大豆，立已。（太阴、阳明二经，表里俱当刺之。出血者，取其络脉之盛者也。）肾
热病者，先腰痛 酸，苦渴数饮，身热。（足少阴之络贯腰脊，故先为腰痛，其脉循内踝之后，以上 内，
故为 酸，又其直者，循喉咙，挟舌本，邪火耗伤肾水，故苦渴数饮。肾与太阳为表里，太阳之脉从巅下
背，抵腰走足，故为身热。）热争则项痛而强， 寒且酸，足下热，不欲言。（热争在表，则太阳经也，
太阳之脉，别下项，故项痛而强，热
争在里，则少阴经也。少阴之脉，斜走足心，上 内，挟舌本，故为 寒且酸、足热不言等病。）其逆则项
如今所说的热病，都属于伤寒的范畴。有的痊愈，有的死亡，死亡的往往发生在发病后的六七天之间，其余痊愈的都在十日以上，这是为什么呢？（所谓伤寒，是指人体感受了阴寒暴烈之气。寒气在冬季最盛，人感受寒邪而立即发病的，称为伤寒；当时没有发病的，到了春天就称为温病，到了夏天就称为暑病。然而也有四时不正之气，随感随发的，也叫做伤寒。寒邪束缚肌表，导致玄府闭塞，阳气不能发散，于是郁结而化热，所以凡是外感引起的发热，都属于伤寒一类。）但是足太阳膀胱经，是统摄诸阳经的。（巨，就是大的意思。太阳经是六经之长，统摄阳分，所以所有的阳经都归属于它。）它的经脉连于风府穴，所以它是诸阳经的主气。（风府是督脉的穴位。太阳经脉覆盖在头顶和背部的体表，所以主管诸阳经的气分。）人受到寒邪侵袭，就会发为热病，热势虽然严重但不会致死；（人受寒邪后转化为热证，是因为寒邪极盛而生热。寒邪散去则热退，所以即使热势严重也不会致死。）如果是表里两经同时感受寒邪而发病的，就一定难免于死。（表里两经同时受邪，称为两感。）
伤寒第一天，足太阳经首先受邪，所以出现头痛、项强、腰脊僵硬的症状；（足太阳经是三阳经的表层，且经脉连接风府，所以凡是患伤寒的人多从太阳经开始。太阳经脉从头项下行至肩膊，夹脊柱抵腰部，所以患病会出现这些症状。张仲景说：“太阳病的特征是脉浮、头项强痛而恶寒。”人体的经络，三阳经属表，三阴经属里。三阳经的顺序中，太阳为三阳，是阳中之阳；阳明为二阳，居太阳之后；少阳为一阳，居阳明之后，这三阳经属表。三阴经的顺序中，太阴为三阴，居少阳之后；少阴为二阴，居太阴之后；厥阴为一阴，居少阴之后，这三阴经属里。其传变的次序，是由内向外推演的，所以有一、二、三的先后顺序。邪气侵犯人体，必定由外向内。邪气客于皮肤则腠理开泄，开泄则邪气进入络脉，络脉满溢则注入经脉，经脉满溢则传入脏腑，这就是为什么邪气必先侵犯皮毛，经脉病变必始于太阳，然后三阴三阳、五脏六腑都会受病的原因。）
第二天，足阳明经受邪，阳明经主肌肉，其经脉夹鼻旁，联络目系，所以出现身体发热、眼睛疼痛、鼻子干燥、无法安卧的症状；（伤寒多伴有发热，这里特别强调“身热”，是因为阳明经主肌肉，身热症状尤为严重。邪热在胃中会导致烦躁，所以无法安卧。其他症状都是本经所及。张仲景说：“阳明病的特征是胃家实”。）
第三天，足少阳经受邪，少阳经主胆，其经脉循行胁肋，联络耳部，所以出现胁肋疼痛和耳聋。（邪气在少阳经，说明三阳经的病邪已尽，即将传入太阴，所以少阳是经处于半表半里的位置。其经脉出于耳前后，向下循行胸胁，所以出现胁痛、耳聋等症状。张仲景说：“伤寒脉弦细，头痛发热的，属于少阳。”“少阳病的特征是口苦、咽干、目眩。”又说：“太阳病未愈，转入少阳的，表现为胁下硬满、干呕不能食、往来寒热。”邪气在阴分则恶寒，在阳分则发热，在表则无呕吐胀满等症状，在里则有胸满、干呕不能食。所以成无己说：“少阳的邪气，在半表半里之间。”）
如果三阳经的经络都受了病邪但未传入脏，那么可以通过发汗的方法治愈。（三阳经属表，关联腑，邪气在表而未传入三阴之脏的，都可以用发汗法来解散。）
第四天，足太阴经受邪，太阴经脉散布于胃中，联络咽喉，所以出现腹部胀满和咽喉干燥；（邪气在三阳经，若失于发汗解表，则会传入三阴经，从太阴经开始。张仲景说：“伤寒脉浮而缓，手足自温的，病系在太阴。”“太阴病的特征是腹满而吐，进食不下，自利日益加重，时常腹痛。”）
第五天，足少阴经受邪，少阴经脉贯穿肾脏，联络膀胱（原文“络于脉”此处据语境及后世注疏多指络膀胱或泛指络属，结合下文肾经属水，此处译为络属相关脏腑/经脉），系于舌根，所以出现口燥、舌干而渴；（肾经属水，邪热耗竭肾水，所以口舌为之干渴。张仲景说：“少阴病的特征是脉微细，只想睡觉。”）
第六天，足厥阴经受邪，厥阴经脉循行阴器并联络肝脏，所以出现心烦、胀满和睾丸收缩。（六经传变完毕，到达厥阴。邪热在阴分很盛，所以出现烦满。张仲景说：“厥阴病的特征是气上撞心，心中疼热，饥饿但不想吃东西，吃东西就吐蛔虫，如果用下法则腹泻不止。”按：伤寒一病，传变无穷，这里只是讲述传经的常规情况，而没有涉及变证。自从张仲景之后，各位名医都有名言可供效法，学习的人应当全部阅读并深入思考。然而义理大多出自张仲景，对于张仲景的著作更应当闭门深究。）
如果三阴三阳、五脏六腑都受了病邪，营卫运行停滞，五脏气机不通，就会死亡。（伤寒邪气在经络，本来属于表证，如果经气恢复，自然会逐渐缓解。如果六经传遍而邪气不退，就会深入于腑，腑病不退，就会深入于脏，所以五脏六腑都受病了。邪气盛于外，则营卫不行；元气竭于内，则五脏不通，所以在六七天之间致死。善于治疗此病的人，一定不让邪气入内，也一定不让脏气衰竭。懂得这两点，就近乎神明了。这里只讲足经，不讲手经，是因为伤寒是表邪，想要观察外在症状，应当考察周身，而周身上下脉络，只有足六经能够涵盖全面，手经无法遍及全身。而且手经所到的地方，足经没有不到的，所以只讲足经，那么左右前后阴阳的各种证候，没有不可以据此推知的，手经也就包含在其中了，不必再说了。刘草窗不读这部经典，荒谬地创立邵雍之说，被万世唾骂，学习的人能不谨慎吗！）
那些没有发生两感的，第七天足太阳经病势衰退，头痛减轻；（邪气逐渐消退，正气逐渐恢复，如下文所述。）第八天足阳明经病势衰退，身热减轻；第九天足少阳经病势衰退，耳聋稍微能听到声音；第十天足太阴经病势衰退，腹部胀满消退如常，开始想吃饭；第十一天足少阴经病势衰退，口渴停止，腹部不再胀满，舌头干燥缓解，随后打喷嚏；第十二天足厥阴经病势衰退，睾丸松弛，小腹轻微下坠，大气邪气都已去除，病一天天好了。（所谓其余痊愈的都在十日以上，就是这样。）
治疗的原则，是分别疏通各经所属脏腑的脉气，病势就会一天天衰退直至痊愈。病程未满三天的，可以通过发汗治愈；病程已满三天的，可以通过泻下治愈。（“分别疏通各经所属脏腑的脉气”，意思是应当根据经络分别治疗。凡是传经的邪气未满三天的，邪气在表，所以可以用发汗法；已满三天的，邪气传入里，所以可以用下法。但这只是讲述表里的大体原则。按：脉象大浮数，病在表，可以发汗；脉象实沉数，病在里，可以泻下。天数虽然多，只要有表证且脉浮大的，仍然适宜发汗；天数虽然少，只要有里证且脉沉实的，就应当泻下。这种汗法和下法的应用，应当以表里为依据，不可拘泥固执。）
那些发生两感的，第一天足太阳与足少阴同时发病，出现头痛、口干和烦满；（两感是指表里两经同病。足太阳与足少阴互为表里，所以在太阳经表现为头痛，在少阴经表现为口干烦满。）第二天足阳明与足太阴同时发病，出现腹部胀满、身体发热、不想吃东西、胡言乱语；（阳明、太阴互为表里，两经同病。谵言，即胡言乱语，阳明病则身热谵言，太阴病则腹满不欲食。）第三天足少阳与足厥阴同时发病，出现耳聋、睾丸收缩和四肢厥冷。此时水浆不进，神志昏迷不知人，在第六天会死亡。（少阳、厥阴互为表里，同病。少阳病则耳聋，厥阴病则囊缩而厥。到这时三阴三阳都受病，所以水浆不进，昏不知人，在第六天左右应当死亡。）
五脏已经受伤，六腑不通，营卫不行，像这样之后三天才死亡，为什么呢？（像这样之后三天才死亡，是指两感传遍之后，又过了三天才死，这也就是第六天死的含义。）因为阳明经是十二经脉之长，气血旺盛，所以神志昏迷，经过三天胃气耗尽，所以死亡。（阳明是十二经脉之长，是多气多血的经脉，如果感受邪气，邪气必然很盛，所以神志昏迷。凡是两感于邪气的，三天之后，胃气耗尽，所以应当死亡。两感，本来是表里同病，表面上似乎都说是外邪所致，但实际上未必完全如此，正因为内外俱伤，才叫两感。现在见到少阴先溃败于内，而太阳继而在外受邪的，就是纵情肆欲导致的两感；太阴受伤于里，而阳明再次感受于表的，就是劳倦竭力、饮食失调导致的两感；厥阴气逆于脏，少阳又在腑发病的，一定是七情不慎、疲筋败血导致的两感。人们只知道两感是伤寒，却不知道伤寒的两感是内外俱困，病势就非常危重了。但伤害有轻重，医生有贤良与不肖之分，生死就取决于此。有人说两感的病症不多见，这也是因为见得少，且对义理理解不透彻罢了。）
凡是患伤寒而转化为温病的，在夏至日之前发病的叫温病，在夏至日之后发病的叫暑病。（寒邪侵入人体而成为温病、暑病的，从时间上说是在夏至日前后，从病情上说则是热的程度不同，所以凡是温病、暑病，都属于伤寒。）暑病应当随着汗液排出，不要强行止汗。（暑气侵入，应当让患者出汗，这样暑气随汗而出，所以说“勿止”。温病、暑病，后世医家有专门的著作，应当详细考证。）
热病刚刚痊愈，有时还有余热遗留，这是因为热势尚盛时就勉强进食，所以导致余热遗留。像这种情况，都是病势已衰但热邪有所潜藏，因为食物之气与残存的热邪相互搏结，两热相合，治疗时要视其虚实，调理其逆顺，就可以使疾病必愈。（病势虽衰但余热未除，尚有潜藏，因而勉强进食，则病气与食气相并，两热合邪，以致留连不解，所以名叫“遗”。食滞于中是实证，脾弱不能运化是虚证，实证则泻，虚证则补，虚实不失，则逆顺可调，病必愈。）应当禁忌什么？病热稍减时，吃肉就会复发，多吃就会遗留余热，这就是禁忌。（复，指病复发；遗，指病程延长。凡是大病后脾胃气虚，未能消化饮食，所以对于肉食之类，都应当暂缓食用。如果犯了食复，危害非浅，其中有夹杂虚弱内馁的，又不可过于禁制，所以贵在得当。）
有一种温病，出汗后立即再次发热，脉象躁急，不因出汗而减退，出现狂言，不能进食，这种病名叫阴阳交，交则死。（汗，是阴液的体现。身热脉躁，是阳邪的表现。患温病出汗后，应当邪气随汗而解，热退脉静。现在不因出汗而减退，乃是阳胜之极，阴气不能恢复，所以出现狂言、不食，正是阳邪交入阴分，阴气不能固守，所以说“阴阳交，交则死”。）人之所以能出汗，都是因为谷气，谷气生于精气。（谷气内盛则生精，精气外达则为汗。）现在邪气与精气在骨肉间交争而得汗的，是邪气退却而精气胜利，精气胜利则应当能进食而不反复发热，（只有精气胜邪，所以能出汗。邪气随汗散出，则应当能进食，不再发热。）再次发热的是邪气，出汗的是精气。现在出汗后立即再次发热的，是邪气胜；不能进食的，是精气得不到补充。（俾，使也。精，阴气也。五脏所以藏精，脏气虚则不能使人进食，所以说“精气俾”。）病邪留恋不去，寿命很快就会终结。（病气留恋不退，则元气日渐败坏，必致丧命。）出汗后脉象仍然躁盛的，死。（凡出汗后脉应当迟静，反而躁盛的，是真阴枯竭而邪气独胜，所以病必死。）现在脉象不与汗出相应，这是不胜病邪，死亡是明显的。（精气不胜病气。）狂言是失志，失志者死。（这是总括五志而言。志藏于精，精不胜邪则五脏之志皆失，所以导致狂言的，多死。）现在看到三种死征而不见一种生机，即使暂时看似好转，最终必死。（出汗后随即发热不能进食，是一死；出汗后脉仍躁盛，是二死；出汗后反狂言失志，是三死。有此三者，则是必死的征候。）
肝热病的人，小便先黄，腹痛，嗜睡，身体发热。（肝脉环绕阴器，所以小便黄；抵少腹，所以腹痛。肝主筋，筋热则弛缓无力，所以嗜睡。邪气在厥阴经则行于股阴腹胁，所以身热。前面讲伤寒，这里就是讲治疗伤寒的方法，只是前面分述伤寒的六经，这里详述伤寒的五脏。正彼此互相发明。看后面再次提到两感，大概就可以知道了。凡是想要探究伤寒机理的人，不要忽视这个义理。）
热邪与正气相争，则出现狂言和惊骇，胁肋满痛，手足躁扰，不得安卧。（热邪入于脏，则邪正相胜，所以说“争”，下同。气争于肝则肝气紊乱，所以狂言而惊，肝病主惊骇。肝脉布于胁肋，所以胁肋满痛。热极则生风，风淫于四肢末梢，所以手足躁扰。木邪乘土，必波及胃，胃不和则卧不安。）
庚辛日病重，甲乙日大汗出则愈，若气逆则庚辛日死。（庚辛属金，是肝所畏的，所以病重甚至死。甲乙属木，是肝所旺的，所以大汗出而愈。）针刺足厥阴、足少阴经。（少阳为厥阴之表，都可以泻其热邪，用药法则也是如此，下面同理。）
如果气逆，则头部晕痛，脉气上冲头部。（肝脉与督脉会于巅顶，所以气逆于上则头部晕痛，脉气上冲于头。员员，形容头晕不定貌。）
心热病的人，先心情不乐，几天后才发热。（心是神明发出的地方，邪气不易侵犯，一旦侵犯必先有感觉，所以热邪将要入脏，先有不乐的征兆。）
热邪与正气相争，则突然心痛，烦闷，喜欢呕吐，头痛面赤无汗。（热与心气分争，所以突然心痛而烦闷。心火上炎，所以喜欢呕吐。头是精明之府，手少阴经脉上行出于面部，所以头痛面赤。汗为心液，心热则津液亡失，所以无汗。）
壬癸日病重，丙丁日大汗出则愈，若气逆则壬癸日死。（壬癸属水，是心所畏的，丙丁属火，是心所旺的。）
针刺手少阴、手太阳经。（手太阳为少阴之表，所以都应当针刺。）
脾热病的人，先头重颊痛，心烦，面色发青，想呕吐，身体发热。（脾胃互为表里，脾病必波及胃。阳明胃脉，循行颊车，上耳前，至额颅，所以头重颊痛。脾脉注入心中，所以心烦，脾病则肝木乘之，所以面色发青。脾胃受邪则饮食不纳，所以想呕吐。太阴、阳明主肌肉，所以邪盛则身热。）
热邪与正气相争，则腰痛不可俯仰，腹部胀满泄泻，两侧下颌疼痛。（腰是肾之府，热争于脾，则土邪乘肾，必注于腰，所以腰痛不可俯仰。太阴经脉，入腹属脾络胃，所以腹满而泄。阳明脉循行颐后下廉，出大迎，所以两侧下颌痛。）
甲乙日病重，戊己日大汗出则愈，若气逆则甲乙日死。（甲乙木，是脾所畏的。戊己土，是脾所旺的。）
肺热病的人，先淅然怕冷，毫毛竖起，恶风寒，舌苔黄，身体发热。（肺主皮毛，热则畏寒，所以先淅然恶风寒，毫毛竖起。肺脉起于中焦，循胃口，肺热入胃，则胃热上升，所以舌苔黄而身热。）
热邪与正气相争，则喘咳，疼痛游走于胸膺背部，不能深呼吸，头痛剧烈，出汗而怕冷。（热争于肺，其变动则为喘为咳。肺是胸中之脏，背是胸中之腑，所以疼痛游走于胸膺及背，且不能深呼吸。喘逆在肺，气不下行，则三阳经气俱壅于上，所以头痛剧烈。热邪在肺则皮毛不收敛，所以出汗而怕冷。）
丙丁日病重，庚辛日大汗出则愈，若气逆则丙丁日死。（丙丁属火，是克肺的。庚辛属金，是肺所旺的。）
针刺手太阴、手阳明经，放出如大豆大小的血，立刻就好。（太阴、阳明二经，表里都应当刺。出血，是取其络脉气血旺盛之处。）
肾热病的人，先腰痛，膝酸，苦于口渴多次饮水，身体发热。（足少阴之络贯腰脊，所以先为腰痛，其脉循内踝之后，以上膝内，所以膝酸，又其直行者，循喉咙，挟舌本，邪火耗伤肾水，所以苦于口渴多次饮水。肾与太阳互为表里，太阳经脉从巅下背，抵腰走足，所以身热。）
热邪与正气相争，则项痛而强，膝寒且酸，足下热，不想说话。（热争在表，则是太阳经，太阳经脉，别下项，所以项痛而强，热争在里，则是少阴经。少阴经脉，斜走足心，上膝内，挟舌本，所以为膝寒且酸、足热不言等病。）如果气逆，则项……
The so-called heat diseases (Re Bing, febrile diseases) all belong to the category of Cold Damage (Shang Han, damage by cold pathogen). Some recover, while some die; those who die usually do so within six or seven days after onset, whereas those who recover typically take more than ten days. Why is this? (Cold Damage refers to contracting Yin-cold and virulent qi. Cold is most prevalent in winter; immediate illness upon contraction is termed Cold Damage. If not immediately ill, it becomes Warm Disease (Wen Bing) in spring or Summerheat Disease (Shu Bing) in summer. However, irregular qi of the four seasons that causes immediate illness is also called Cold Damage. When cold pathogen binds the muscle surface, closing the Xu Fu (pores/sweat glands), Yang Qi cannot disperse, leading to stagnation and transformation into heat. Thus, all external-contracted heat conditions fall under Cold Damage.) However, the Greater Yang (Ju Yang, referring to the Foot-Taiyang Bladder meridian) belongs to all Yang meridians. (Ju means great. The Taiyang meridian is the chief of the Six Meridians, commanding the Yang aspect, so all Yang meridians belong to it.) Its vessels connect to the Fengfu acupoint (GV16), thus governing the Qi of all Yang meridians. (Fengfu is an acupoint of the Du vessel. The Taiyang meridian covers the vertex and back surface, thus governing the Qi aspect of all Yang meridians.) When humans are injured by cold, they develop heat disease; even if the heat is severe, it is not fatal. (When humans contract cold and transform into heat, it is because extreme cold generates heat. When cold dissipates, heat recedes, so severity does not lead to death.) However, those who suffer from "Liang Gan" (simultaneous contraction of exterior and interior meridians by cold) will inevitably die. (Exterior and interior meridians both receiving pathogens is called Liang Gan.)
On the first day of Cold Damage, the Greater Yang receives the pathogen, resulting in headache, stiff neck, and stiffness/pain in the lower back and spine. (Foot-Taiyang is the exterior of the Three Yang meridians and connects to Fengfu; thus, Cold Damage often begins here. The Taiyang meridian descends from the head and neck over the shoulders, along the back to the waist, causing these symptoms. Zhang Zhongjing stated: "The characteristic of Taiyang disease is floating pulse, headache, stiff neck, and aversion to cold." In the human body, Three Yang meridians are exterior, Three Yin meridians are interior. Among Yang, Taiyang is the first (Yang within Yang), Yangming is second, Shaoyang is third. These constitute the exterior. Among Yin, Taiyin is first, Shaoyin is second, Jueyin is third. These constitute the interior. The order proceeds from interior to exterior numerically, but pathogens enter from exterior to interior. Pathogens at the skin open the Cou Li (interstices); once open, they enter Luo vessels; when Luo vessels are full, they move to Jing meridians; when Jing meridians are full, they settle in Zang-Fu organs. Thus, pathogens first affect hair and skin, Jing meridians start with Taiyang, and then all Six Meridians and Five Zang-Six Fu organs are affected.)
On the second day, the Yangming receives the pathogen. Yangming governs flesh/muscle; its vessels run alongside the nose and connect to the eyes. Symptoms include fever, eye pain, dry nose, and inability to sleep. (Cold Damage often involves fever, but here "body heat" is emphasized because Yangming governs muscle, making body heat particularly severe. Heat in the stomach causes irritability, leading to insomnia. Other symptoms relate to this meridian. Zhang Zhongjing said: "The characteristic of Yangming disease is a fullness/excess in the Stomach.")
On the third day, the Shaoyang receives the pathogen. Shaoyang governs the Gallbladder; its vessels follow the flanks and connect to the ears. Symptoms include flank pain and deafness. (Pathogen in Shaoyang indicates the end of the Three Yang stages, approaching Taiyin, placing it in the Half-Exterior/Half-Interior position. Vessels emerge around the ears and descend through the chest/flanks, causing these symptoms. Zhang Zhongjing said: "In Cold Damage, a string-taut and fine pulse with headache and fever belongs to Shaoyang." "Characteristics of Shaoyang disease: bitter taste, dry throat, blurred vision." Also: "If Taiyang disease is unresolved and transfers to Shaoyang, there is fullness/hardness below the costal margin, dry retching, inability to eat, and alternating chills and fever." Pathogen in Yin causes chills; in Yang, heat; in Exterior, no vomiting/fullness; in Interior, chest fullness, dry retching, inability to eat. Cheng Wuji stated: "Shaoyang pathogen is between Half-Exterior and Half-Interior.")
If the disease affects the meridians of the Three Yang but has not entered the Zang organs, it can be cured by sweating (diaphoresis). (Three Yang belong to the Exterior and Fu organs; if pathogen is in the Exterior and has not entered the Three Yin Zang, diaphoresis can disperse it.)
On the fourth day, the Taiyin receives the pathogen. Taiyin vessels distribute in the stomach and connect to the throat. Symptoms include abdominal fullness and dry throat. (If pathogen in Three Yang is not resolved by sweating, it enters Three Yin, starting with Taiyin. Zhang Zhongjing said: "Cold Damage with floating and slow pulse, warm hands and feet, relates to Taiyin." "Characteristics of Taiyin disease: abdominal fullness, vomiting, inability to eat, worsening diarrhea, spontaneous abdominal pain.")
On the fifth day, the Shaoyin receives the pathogen. Shaoyin vessels pass through the Kidney, connect to the bladder (or general vessels), and tie to the root of the tongue. Symptoms include dry mouth, dry tongue, and thirst. (Kidney meridian belongs to Water; pathogenic heat dries it, causing dry mouth/thirst. Zhang Zhongjing said: "Characteristics of Shaoyin disease: faint and fine pulse, desire to sleep.")
On the sixth day, the Jueyin receives the pathogen. Jueyin vessels follow the genitalia and connect to the Liver. Symptoms include irritability, fullness, and retraction of the testicles. (Transmission completes at Jueyin. Extreme heat in the Yin aspect causes irritability/fullness. Zhang Zhongjing said: "Characteristics of Jueyin disease: Qi rushing up to the heart, pain/heat in the heart, hunger without desire to eat, vomiting worms if eating, and unceasing diarrhea if purged." Note: Cold Damage transmission is infinite; this describes the normal sequence, not variations. Post-Zhang Zhongjing masters have valuable insights for study. Principles largely derive from Zhang Zhongjing, requiring deep study of his works.)
If all Three Yin and Three Yang, Five Zang and Six Fu organs are affected, Ying and Wei circulation stops, and Five Zang obstruction occurs, death results. (Initially, Cold Damage is an Exterior syndrome; if Qi recovers, it resolves. If transmission completes without resolution, it penetrates deeply into Fu, then Zang. External excess blocks Ying/Wei; internal exhaustion blocks Zang Qi, leading to death in 6-7 days. Skilled treatment prevents internal invasion and Zang Qi depletion. This text mentions only Foot meridians because Cold Damage is an Exterior pathogen affecting the whole body; Foot meridians cover the entire surface comprehensively, whereas Hand meridians do not. Foot meridians encompass all patterns, including Hand meridians implicitly. Liu Caochuang’s criticism was erroneous and condemned.)
For those without Liang Gan: On the 7th day, Taiyang declines, headache lessens. (Pathogen retreats, Zheng Qi recovers.) On the 8th day, Yangming declines, body heat lessens. On the 9th day, Shaoyang declines, hearing slightly returns. On the 10th day, Taiyin declines, abdominal fullness subsides, appetite returns. On the 11th day, Shaoyin declines, thirst stops, abdomen softens, tongue moistens, followed by sneezing. On the 12th day, Jueyin declines, testicles relax, lower abdomen softens, major Qi clears, and the disease heals daily. (This explains recovery after ten days.)
Treatment involves unblocking the pulses of the respective Zang organs. For cases under three days, use diaphoresis; for cases over three days, use purgation. ("Unblocking pulses" means treating according to the meridian. Under three days: pathogen in Exterior, use sweating. Over three days: pathogen in Interior, use purging. Generally, large/floating/rapid pulse indicates Exterior (sweat); solid/deep/rapid pulse indicates Interior (purge). Even with many days, if Exterior signs and floating pulse exist, sweat. Even with few days, if Interior signs and solid pulse exist, purge. Treatment depends on Exterior/Interior status, not rigidly on days.)
For Liang Gan: Day 1, Taiyang and Shaoyin both sick: headache, dry mouth, irritability. (Exterior-Interior simultaneous disease. Taiyang-Shaoyin pair: Taiyang causes headache, Shaoyin causes dry mouth/irritability.) Day 2, Yangming and Taiyin both sick: abdominal fullness, fever, anorexia, delirious speech. (Yangming-Taiyin pair: Delirium from Yangming heat; fullness/anorexia from Taiyin.) Day 3, Shaoyang and Jueyin both sick: deafness, testicular retraction, cold limbs. Inability to drink, unconsciousness. Death occurs on the 6th day. (Shaoyang-Jueyin pair. All Six Meridians affected, leading to coma and death around day 6.)
Why death three days after the initial presentation in Liang Gan? (Death occurs three days after transmission completes, totaling six days.) Yangming is the chief of Twelve Meridians, abundant in Qi and Blood. Severe pathogen leads to unconsciousness. After three days, Stomach Qi exhausts, causing death. (Note: Liang Gan implies internal and external injury. Specific etiologies vary: Shaoyin failure with Taiyang attack suggests licentiousness; Taiyin injury with Yangming attack suggests fatigue/dietary error; Jueyin reversal with Shaoyang disease suggests emotional stress/blood deficiency. Severity and physician skill determine outcome. Rarity of observation may explain misconceptions.)
Heat diseases transforming into Warm diseases occur before Summer Solstice; those transforming into Summerheat diseases occur after. (Timing relative to Summer Solstice distinguishes Wen vs. Shu, though both stem from Cold Damage. Summerheat should exit via sweat; do not stop sweating.)
Residual heat after recovery often results from eating too soon while heat is still strong. (Pathogen lingers due to food-Qi clashing with residual heat. Treat based on Deficiency/Excess: drain excess, tonify deficiency. Adjust inversion/compliance.) Dietary prohibitions: Avoid meat (causes recurrence/Fu) and overeating (causes residual Yi) when heat subsides. (Post-illness Spleen/Stomach Qi is weak; digestives must be gentle. Balance restriction with nutritional needs.)
Yin-Yang Jiao (Intertwining): Sweating fails to reduce heat; pulse remains rapid/restless; delirium and anorexia occur. (Sweat is Yin fluid; heat/pulse is Yang pathogen. Failure to resolve indicates extreme Yang victory and Yin exhaustion. Yang pathogen invades Yin, causing loss of control. Death ensues.) Sweat originates from Grain Qi, which comes from Essence. (Grain Qi generates Essence; Essence transforms into Sweat.) If sweating occurs during struggle, it indicates Essence victory and Pathogen defeat. Victory allows eating and cessation of fever. Recurrence of fever indicates Pathogen victory. Anorexia indicates Essence cannot be assisted. (Essence nourishes the body; weak Zang Qi prevents eating. Lingering disease shortens life. Rapid pulse post-sweat indicates Yin exhaustion and Pathogen victory—death. Delirium indicates loss of Zhi (Will/Shen)—death. Three death signs (recurrent fever, rapid pulse, delirium) guarantee death even if temporary improvement occurs.)
Liver Heat Disease: Yellow urine, abdominal pain, lethargy, fever. (Liver channel circles genitals and ascends to abdomen. Liver governs sinews; heat causes flaccidity/lethargy. Jueyin channel affects thigh/abdomen/flank.) Heat struggle causes delirium,惊 (fright), flank pain, restless limbs, insomnia. (Liver Qi disorder causes fright. Wind generated by extreme heat disturbs extremities. Wood overacting on Earth affects Stomach, causing insomnia.) Worsens on Geng/Xin (Metal) days; improves with sweat on Jia/Yi (Wood) days. Death if Qi reverses on Geng/Xin. Puncture Foot-Jueyin and Foot-Shaoyin. Reversal causes vertigo/headache.
Heart Heat Disease: Initial dysphoria, followed by fever. (Heart houses Shen; pathogen detection is early.) Heat struggle causes sudden heart pain, irritability, vomiting, headache, red face, anhydrosis. (Heart Fire flares upward; Heart fluid depleted causes no sweat.) Worsens on Ren/Gui (Water) days; improves with sweat on Bing/Ding (Fire) days. Death if Qi reverses on Ren/Gui. Puncture Hand-Shaoyin and Hand-Taiyang.
Spleen Heat Disease: Heavy head, cheek pain, irritability, blueish complexion, nausea, fever. (Stomach channel affects head/cheeks. Spleen channel enters heart. Wood overacting on Earth causes blue complexion. Spleen/Stomach dysfunction causes nausea.) Heat struggle causes lower back pain (Earth attacking Water/Kidney), abdominal fullness, diarrhea, jaw pain. Worsens on Jia/Yi (Wood) days; improves with sweat on Wu/Ji (Earth) days. Death if Qi reverses on Jia/Yi. Puncture Foot-Taiyin and Foot-Yangming.
Lung Heat Disease: Chills, goosebumps, aversion to wind/cold, yellow tongue coating, fever. (Lung governs skin/hair. Lung-Stomach heat rises to tongue.) Heat struggle causes asthma, cough, chest/back pain, dyspnea, severe headache, sweating with chills. (Lung Qi rebellion blocks Upper Jiao; Lung heat causes porous skin/chills.) Worsens on Bing/Ding (Fire) days; improves with sweat on Geng/Xin (Metal) days. Death if Qi reverses on Bing/Ding. Puncture Hand-Taiyin and Hand-Yangming; bleed until bean-sized drops appear for immediate relief.
Kidney Heat Disease: Lower back pain, knee soreness, bitter thirst, frequent drinking, fever. (Shaoyin channel passes through back/knees/throat. Heat consumes Kidney Water.) Heat struggle causes stiff neck, cold/sore knees, hot soles, muteness. (Taiyang exterior involvement causes neck stiffness; Shaoyin interior involvement causes limb symptoms.) Reversal causes...