潮热之阳，舌无黄黑芒刺之苔，虽有硬满之证，慎不可攻，理中、四逆辈温之，尚有可生之义。○脏结，有如
结胸者，亦有如痞状者，因其人素有痞积在胁下，与下后心下痞不同。脐为立命之原，脐傍者，天枢之位，阳
明脉之所合，少阳脉之所出。脾肝肾三脏之阴凝结于此，所以痛引少腹，入阴筋也。此阴常在，绝不见阳，
阳气先绝，阴气继绝，故死。少腹者，厥阴之部，两阴交尽之处。阴筋者，宗筋也。今人多有阴筋上冲少腹而
痛死者，名曰疝气，即是此类。然痛止便苏者，《金匮》所云入脏则死，入腑则愈也。治以茴香、吴萸等味而
痊者，亦可明脏结之治法矣。（《来苏集》）
除中
除中者，脏寒应不能食，今反能食者是也。其证有二，悉属厥阴，一由误服黄芩汤而致者，必死；一则
厥热相应，胃气在者必愈。恐暴热来出而复去者死，其热续在者生。（《伤寒类证》）
呃逆
呃逆，俗谓呃忒，发声于咽喉，轧轧然连续短促不长。古谓之哕，非也。哕与干呕无异，其声浊恶而长，
比之呃忒，大有径庭矣。有因胃中实热失下而作，有因胃中痰饮而作，有因服寒药过多胃中虚冷而作。其气皆
从胃起，冲至胸嗌之间而为呃。如胃热失下者，承气汤下之；胃虚有热者，橘皮竹茹汤清之；有痰饮者，橘皮
半夏生姜汤加茯苓、枳实和之；胃冷者，橘皮干姜汤温之。若过服凉药，胃寒呃忒者，丁附理中汤主之；若其
气自脐下直冲于胸嗌间而作呃者，病不在胃，因下虚误服寒药，冷极于下，迫其相火上冲，乃水极似火，阴证
似阳也，急温其下，阳回而呃乃
止。（《全生集》）
世有谓哕为呃逆、吃逆、噫气者，皆非也。盖哕之声，气自胃出于口，而有哕哕之声，壮而迫急也；
呃逆之声，气自脐下冲上退场门，而作格格之声，散而不续也。夫所谓呃逆者，即《论》中平脉篇所谓KT KT
者，气噎结有声也。吃逆、噫气者，即今之所谓嗳气也。因饱食太急，比时作嗳，而不食臭，故名曰吃逆也；
因过食伤食，过时作嗳，有食臭气，故名曰噫气也。哕、KT 、嗳、噫，俱有声无物，虽均属气之上逆，然不
无虚、实、寒、热、轻、重、新、久之别也。甚至以咳逆为呃逆者，殊不知咳逆即今之喘嗽也，兹乃与呃逆混
而为一，不可以不辨。（《医宗金鉴》）
坏病
病为医所坏，如器为工所损。审其原何脉证，作何治法，变何脉证，知汗、吐、下、温针坏之之故。何
处为逆，即于何处为救，仲师不能代为区画于千载之上矣。○坏病之成，不必一误再误三误，但应与不与，不
应与而与，以致病变，皆坏病也。即屡误而病未变，虽误又何坏乎？仍以本病之法治其误，而坏否亦同法也。
坏由于误，误必救之，救其逆而反于顺也。（魏荔彤）
合病并病
余究心伤寒，初见合病、并病之说，殊有不明，而今始悉之。夫所谓合病者，乃二阳三阳同病，病之相
合者也。并病者，如太阳先病不解，又并入阳明、少阳之类也。观仲景曰∶二阳并病，太阳初得病时，发其汗，
汗先出不彻，因转属阳明。若太阳证不罢者，不可下。按∶此云转属阳明，则自太阳而来可知也。云太阳病证
不罢，则二经皆病可知也。凡并病者，由浅而深，由此而彼，势使之必然也。此合病、并病之义，而不知者
皆以此为罕见之证，又岂知今时之病则皆合病、并病耳。何以见之？盖凡诊伤寒，初未见有单经挨次相传者，
亦未见有表证悉罢止有里证者。若欲根据经如式求证，则未见有如式之病而方治可相符者。是不知
合病、并病之义。（张景岳）
病有定体，故立六经而分司之；病有变迁，更求合、并而互参之。夫阴阳互根，气分神合。三阳之里，便
是三阴；三阴之表，即是三阳。如太阳病而脉沉，便合少阴；少阴病而发热，便合太阳。阳明脉迟，即合太阴；
太阴脉缓，即合阳明。少阳脉小，是合厥阴；厥阴脉浮，是合少阳。虽无并、合之名，而有并、合之实。或阳
得阴而解，阴得阳而解；或阳入阴而危，阴亡阳而逆。种种脉证不一，学人当于阴阳两证中察病势之合不合，
更于三阳三阴中审其证之并不并，阴病治阳，阳病治阴，扶阳抑阴，泻阳补阴等法，用之恰当矣。三阳皆有发
热证，三阴皆有下利证，如发热而下利，是阴阳合病也。阴阳合病，阳盛者属阳经，则下利为实热，如太阳阳
明合病、阳明少阳合病、太阳少阳合病，必自下利，用葛根黄芩等汤是也。阴盛者属阴经，则下利为虚寒，如
少阴病，吐利反发热者不死；少阴病，下利清谷，里寒外热，不恶寒而面色赤，用通脉四逆者是也。若阳与阳
合，不合于阴，即是三阳合病，则不下利而自汗出，为白虎证也；阴与阴合，不合于阳，即是三阴合病，则不
发热而吐利厥逆，为四逆病也。并病与合病稍异，合则一时并见，并则以次相乘，如太阳之头项强痛未罢，递
见脉弦、眩冒、心下痞硬，是与少阳并病；更见谵语，即三阳并病矣。太阳与阳明并病，太阳证未罢者，从太
阳而小发汗；太阳病已罢者，从阳明而下之。其机在恶寒发热而分也。若不于合并参之，安知病情之变迁若是，
而为之施治哉？（柯韵伯）
百合病
百合病用百合，如《论》云太阳病桂枝证，亦病因药而得名也。后人见百脉一宗四字及列证庞杂，似乎百
端凑合之病矣，不知一气为病，而一药为治，无取乎歧杂之见也。《本草》言∶百合甘平无毒，主邪气。盖气
病，则正气为邪气，治其气，而邪气复为正气矣。又云∶利大、小便，补中益气，此百合病中所以为
主药也。气之为病无二义，非实而不顺，即虚而不足。今一物而兼顺利与补益，则有余之邪气可泄，而不足之
正气可充。道一以贯之，君予多乎哉！（魏荔彤）
狐惑
狐惑，虫病也。虫因热生，热因虚生。然则狐惑者，阴虚血热之病也。狐性多疑，狐惑即疑惑也。心主血，
阴虚则血耗而热生，血热则心烦而病作，神明之官，失于贞静，滋乎憧扰，所谓执狐疑之心者，此病也。惟
其血分有热，而虫遂随上下皆生，虫为有情识之物，故能乱有情识之心脏而生狐疑。惟其为血化之物，故仍归
于心。方以类聚，物以群分也。（魏荔彤）
阳毒阴毒
按∶古方书谓阳毒者，阳气独盛，阴气暴衰，内外皆阳，故成阳毒；谓阴毒者，阴气独盛，阳气暴衰，内
外皆阴，故成阴毒。二者，或伤寒初得，便成是证；或服药后变而成之。阳毒治以寒凉，阴毒治以温热，药如
冰炭，何乃仲景以一方治之乎？其曰阴毒去雄黄、蜀椒，则反去其温热者矣。岂非一皆热毒伤于阴阳二经乎？（赵以德）
阴阳二毒，与阴阳二证迥异。考仲景书虽有阴毒之名，然其所叙之证，不过面目青、身痛如被杖、咽喉痛
而已，并不言阴寒极甚之证。况其所治之方，亦不过升麻、甘草、当归、鳖甲而已，并不用大温热之药。是知
仲景所谓阴毒者，非阴寒之病，乃是感天地之恶毒异气，入于阴经，故曰阴毒耳。后人遂以阴寒极甚之证，
混入仲景证中，治用附子散等温药，窃谓阴寒极甚之证，或内伤冷物，或暴中阴寒，或过服凉药所致，固可名
为阴毒，然终非仲景所以立名之本意也。（王安道）
动气
动气一证，即筑筑然动于脐傍，及左乳之下曰虚里者也。考之《难经》，则以脐之上、下、左、右分心、
肾、肝、肺四脏而
各列其证，在《伤寒论》所载亦详。成无己曰∶动气者，脏气不治，正气内虚也。虽诸说如此，然皆未尽其要。
盖动气之在脐傍者，皆本于下焦之阴分，凡病关格劳损者，多有此证。其动之微，则止于脐傍上下；其动之甚，
则连及虚里心胁，真若舂舂连续而浑身皆振动者。此以天一无根，故气不能蓄藏而鼓动于下，诚真阴不守，大
虚之候也。何以验之？但察于呼吸、饥饱之顷，可得其征。凡病此者，馁时更甚，饱时稍缓；呼出更甚，吸入
稍缓。此虚甚者动必甚，虚微者动亦微，岂非虚实之明验乎？即病者虽常觉其振动，然无疼痒，尚不知为何故，
医家弗能详察，亦不知为何病，此动气之不明者久矣。但动气之见于虚损者固多，而见于伤寒者亦不少，仲景
但言其禁，而不言其治，此惟直救真阴以培根本，使其气有所归，无不获效。（张景岳）
两感
两感者，阴阳双传也。虽为死候，然虚而感之深者必死，实而感之浅者犹或可治。盖用药先后，发表攻里，
本自不同。仲景云∶太阳与少阴俱病，头疼恶寒，为太阳邪盛于表；口干而渴，为少阴邪盛于里也。阳明与太
阴俱病，身热谵语，为阳明邪盛于表；不欲食腹满，为太阴邪盛于里也。少阳与厥阴俱病，则耳聋寒热、呕而
口苦，为少阳邪盛于表；烦满囊缩，为厥阴邪盛于里也。三阳头疼身热、耳聋胁痛、恶寒而呕，邪在表者，固
不可下，其三阴腹满干呕、口渴囊缩、谵语便实，邪在里者，可不下乎？《活人》引下利身疼痛，虚寒救里之
法，而欲施于烦渴、腹满、囊缩、谵语实热之证，岂不差乎？原仲景所谓发表者，葛根麻黄是也；攻里者，调
胃承气是也。《活人》却谓救里则是四逆，救表则是桂枝。以救为攻，岂不相背？盖表里不可并攻，阴阳难同
一治，用药之法，可不一定于胸中乎？（陶节庵）
先辈言两感者，感而复感也。老幼体弱，皆无此病，强壮者有之。盖体弱之人，一感已觉难任，慎重而调
治焉，故热虽甚不
死。强壮之人，恃其气血，不肯服药，病虽未作，邪实未除，数日之后，复感于寒，后至者入，前至者传，前
至者传，后至者随，是于一日之间，太阳与少阴俱病，二日三日如之，六经皆受邪，水浆不入，不知人，六
日死矣。余见病两感者数人，皆出强壮，皆系六日死，前辈称此病为打好汉，信然。东垣以表里齐受为两感，
后世以感而复感为两感。然实有此二种，究竟齐受者急，复感者缓，后学并宜知之。（《怡堂散记》）
两感者，本表里之同病，似若皆以外感为言也，而实有未必尽然者，正以外内俱伤，便是两感。今见有少
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
食不调之两感也；厥阴气逆于脏，少阳复病于腑者，即七情不慎，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。或谓两感证之不多见者，盖亦见之不广，而义自未达耳。其如何治法，
亦在乎知其由而救其本也。（钱祯）
夫两感病，既曰三日乃死，不在顷刻可知，极力救援，亦可冀其侥幸也。余每见头痛、恶寒、恶风、腰脊
痛引周身等太阳证才见，即具少阴证者；阳明证才见，而腹满、不食、谵妄等证即具者，胁满、耳聋等象未齐，
即兼囊缩、乳平者，皆在一两日间。不与攻击，亦不表汗，惟斟酌其藜藿膏粱老幼之殊，悉从内伤温补治法，
往往获效。其有余波不罢，轻调本经，无不中肯。先辈立言，有置之不治者，有从外感治者，有从内伤治者，
有先表后里者，有先里后表者，有表里齐行攻击者，有攻表攻里间施者，有攻后再行补益者，有见内外皆溃始
行温补者，总总穿凿，法无可遵。岁之甲申，始得钱祯所论∶原有各种内伤于前，继有外感于后，一着便成两
感。玩味其言，先得我心之所同然者。（曹恒占）
阴阳易
男女交媾而病传焉，奇病也。其授者，者始因伤寒，而实种
于欲火；其受者，因于欲火，而实发于阴虚。此阴阳易之病所由来也。 裆者，男女阴阳之卫。卫乎外者，自
能清乎内。感于无形者，治之以有形，取其隐内烧而服之。形气相感，小便即利，阴头微肿，浊阴走下窍，
而清阳出上窍，欲火平而诸证自息矣。然更宜六味地黄汤合生脉散治之。（柯韵伯）
瘥复
伤寒新愈，起居作劳，因而复病，谓之劳复；强食谷食，因而复病，谓之食复；男女交接，复而自病，谓
之房劳复；男女交接，相易为病，谓之阴阳易。盖因其人新瘥，余邪伏于脏腑，未经悉解，故犯之辄复也。学
者于临证时，审其脉证而详辨之，则施治自无误矣。（《医宗金鉴》）
伤寒既愈复热者，其故有四∶或以邪气方散，胃气未清，因而过食者，是为食复；或以表邪方解，原不
甚虚，有过慎者，辄加温补，是误补而复。若此二者，所谓食入于阴，长气于阳，致卫气复闭，阳邪复聚而然。
仍宜汗也。又或新病方瘳，失于调摄，或劳伤脾阴，因而复热者，是名劳复；或不慎房室，因而再感者，是名
女劳复。若此二者，所谓阴虚者阳必凑之而然。或从补，或从汗，因时制宜，权其缓急，而治分虚实也。（张景岳）
伤寒瘥后，终不惺惺，精神欠爽，言语错谬，诸治不效，或潮热颊赤，或寒热似疟，都是发汗不彻，余
邪在心包所致。（《得效方》）
感病善后法
凡病感者，须明善后之法。盖人之感后，元气已虚，邪热未净，补虚则热不可除，清热则虚不能任，即一
潮热而舌苔无黄黑芒刺，虽有腹部硬满的症状，切不可使用攻下法，应用理中汤、四逆汤等温里方剂治疗，尚存一线生机。○脏结证，症状有的像结胸证，有的像痞证，这是因为患者平素胁下有痞块积聚，这与误用下法后导致的心下痞不同。脐部是生命根本所在，脐旁是天枢穴的位置，是阳明脉会合之处，也是少阳脉发出之地。脾、肝、肾三脏的阴寒凝结于此，所以疼痛牵引至小腹，进入阴筋（生殖器）。这种阴寒之邪常存，绝不见阳气，阳气先绝，阴气随后也绝，所以预后不良，多致死。小腹是厥阴经所主的部位，是两阴交尽的地方。阴筋就是宗筋。现在很多人因阴筋上冲小腹而痛死，名叫疝气，就是这一类病。然而疼痛停止后能苏醒的，正如《金匮要略》所说“入脏则死，入腑则愈”。用茴香、吴茱萸等药物治疗而痊愈的，也可以从中明白脏结证的治疗方法。（出自《来苏集》）
除中
除中证，是指脏腑虚寒本应不能进食，现在反而能进食的情况。其证候有两种，都属于厥阴经病变：一种是由于误服黄芩汤导致的，必然死亡；另一种是厥冷与发热相应，胃气尚存，必然痊愈。如果担心突然发热来去匆匆的会死亡，而发热持续存在的则会生存。（出自《伤寒类证》）
呃逆
呃逆，俗称打嗝，声音发自咽喉，轧轧然连续短促不长。古代称之为哕，这是错误的。哕与干呕没有区别，其声音浑浊恶劣且长，与呃逆截然不同。呃逆有因胃中实热未及时攻下而引发的，有因胃中痰饮而引发的，有因服用寒药过多导致胃中虚冷而引发的。这些气都从胃发起，冲至胸膈咽喉之间而产生呃逆。如果是胃热未及时攻下的，用承气汤攻下；胃虚有热的，用橘皮竹茹汤清热；有痰饮的，用橘皮半夏生姜汤加茯苓、枳实调和；胃冷的，用橘皮干姜汤温中。如果过服凉药，导致胃寒呃逆的，用丁香附子理中汤主治；如果气自脐下直冲胸膈咽喉而产生呃逆，病不在胃，是因为下焦虚损误服寒药，寒气极盛于下，逼迫相火上冲，这是水极似火，阴证似阳的表现，急需温补下焦，阳气回复则呃逆自止。（出自《全生集》）
世人称哕为呃逆、吃逆、噫气的，都不正确。哕的声音，气从胃出于口，发出哕哕之声，壮盛而迫急；呃逆的声音，气自脐下冲上至肛门（此处原文可能有误，通常指冲上咽喉），发出格格之声，散乱而不连续。所谓呃逆，即《内经·平人气象论》中所说的“哕哕”（注：原文KT KT应为拟声词或排版错误，指呃逆声），气噎结有声。吃逆、噫气，就是现在的嗳气。因为饱食太急，当时就打嗝，没有食物臭味，所以叫吃逆；因为过食伤食，过后打嗝，有食物臭味，所以叫噫气。哕、呃、嗳、噫，都有声而无物吐出，虽然都属于气机上逆，但其中有虚、实、寒、热、轻、重、新、久的区别。甚至有人将咳逆当作呃逆，殊不知咳逆就是现在的喘嗽，这里将其混为一谈，不可不加以辨别。（出自《医宗金鉴》）
坏病
疾病被医生治坏，就像器物被工匠损坏一样。审察其原本的脉证，制定相应的治法，观察脉证发生了何种变化，了解是因汗、吐、下、温针哪种误治导致的。哪里出现了逆乱，就在哪里进行救治，张仲景不能在千年之上代为谋划了。○坏病的形成，不必是一误再误三误，只要是该用某法而未用，不该用某法却用了，导致病情变化，都是坏病。即使多次误治而病情未变，虽误又何尝算是坏病呢？仍然用治疗原发病的方法来处理误治，是否算作坏病也是一样的道理。坏病源于误治，误治必须补救，补救其逆乱使其回归顺境。（魏荔彤）
合病并病
我研究伤寒，起初对合病、并病的说法很不明白，现在才完全知晓。所谓合病，是指两阳经或三阳经同时发病，是病邪相互合并。并病，如太阳经先发病未解，又传入阳明、少阳经等。看张仲景说：“二阳并病，太阳初得病时，发其汗，汗先出不透彻，因而转属阳明。”按：这里说转属阳明，可知是从太阳传来的。说太阳病证未罢，可知两经都病了。凡是并病，都是由浅入深，由此传到彼，这是势所必然的。这就是合病、并病的含义，不知道的人都将此视为罕见之证，又怎知当今时代的疾病都是合病、并病呢？何以见得？大凡诊治伤寒，从未见过单经依次相传的，也未见过表证完全消失只有里证的。如果想根据经络如公式般求证，则未见有如公式般的病证而方治能相符的。这是不懂合病、并病的含义。（张景岳）
病有固定的体例，所以设立六经来分司管理；病有变迁，更要寻求合病、并病来互相参考。阴阳互根，气分神合。三阳经的里，便是三阴经；三阴经的表，即是三阳经。如太阳病而脉沉，便合少阴；少阴病而发热，便合太阳。阳明脉迟，即合太阴；太阴脉缓，即合阳明。少阳脉小，是合厥阴；厥阴脉浮，是合少阳。虽然没有并、合的名称，而有并、合的实质。或阳得阴而解，阴得阳而解；或阳入阴而危，阴亡阳而逆。种种脉证不一，学者应当在阴阳两证中察看病势是否相合，更在三阳三阴中审认证候是否相并，运用阴病治阳、阳病治阴、扶阳抑阴、泻阳补阴等方法，用得恰当即可。三阳经都有发热证，三阴经都有下利证，如发热而下利，是阴阳合病。阴阳合病，阳盛的属于阳经，则下利为实热，如太阳阳明合病、阳明少阳合病、太阳少阳合病，必自下利，用葛根黄芩黄连汤等方剂是也。阴盛的属于阴经，则下利为虚寒，如少阴病，吐利反发热者不死；少阴病，下利清谷，里寒外热，不恶寒而面色赤，用通脉四逆汤是也。若阳与阳合，不合于阴，即是三阳合病，则不下利而自汗出，为白虎汤证；阴与阴合，不合于阳，即是三阴合病，则不发热而吐利厥逆，为四逆汤证。并病与合病稍有不同，合病是一时并见，并病则是依次相乘，如太阳的头项强痛未罢，陆续出现脉弦、眩晕冒昧、心下痞硬，这是与少阳并病；更出现谵语，就是三阳并病了。太阳与阳明并病，太阳证未罢的，从太阳经轻微发汗；太阳病已罢的，从阳明经攻下。关键在于恶寒发热来区分。如果不将合并参，怎能知道病情的变迁如此，从而施以治疗呢？（柯韵伯）
百合病
百合病用百合治疗，如《伤寒论》所说太阳病桂枝证，也是因病名和药名而得名。后人见到“百脉一宗”四个字及列出的证候庞杂，似乎认为是百端凑合的病，不知这是一气为病，一药为治，不需要那些杂乱的观点。《本草》说：百合甘平无毒，主治邪气。气生病，则正气变为邪气，治疗其气，而邪气又恢复为正气的状态。又说：百合利大小便，补中益气，这就是百合病中将其作为主药的原因。气之为病没有两种情况，不是实证而不通畅，就是虚证而不足。现在一味药兼有利尿通便和补益的作用，则有余的邪气可泄，不足的正气可充。道一以贯之，君药需要很多吗！（魏荔彤）
狐惑
狐惑，是虫病。虫因热而生，热因虚而生。那么狐惑就是阴虚血热的病。狐性多疑，狐惑即疑惑的意思。心主血，阴虚则血耗而生热，血热则心烦而发病，神明之官，失去贞静，充满扰动，所谓怀着狐疑之心，就是这个病。正因为血分有热，虫就随上下皆生，虫是有情识之物，所以能扰乱有情识的心脏而产生狐疑。正因为它是血化之物，所以仍归于心。方以类聚，物以群分。（魏荔彤）
阳毒阴毒
按：古方书说阳毒，是阳气独盛，阴气暴衰，内外皆阳，所以成为阳毒；说阴毒，是阴气独盛，阳气暴衰，内外皆阴，所以成为阴毒。这两种病，有的是伤寒初得时就形成此证；有的是服药后变化而成。阳毒用寒凉药治疗，阴毒用温热药治疗，药物如冰炭相反，为何张仲景用一方治疗呢？文中说阴毒去掉雄黄、蜀椒，则是反而去掉了温热药了。难道不都是热毒伤于阴阳二经吗？（赵以德）
阴阳二毒，与阴阳二证完全不同。考证张仲景的书虽然有阴毒之名，然而他所叙述的证候，不过是面目青、身痛如被杖打、咽喉痛而已，并不说阴寒极甚的证候。况且他所治疗的方剂，也不过是升麻、甘草、当归、鳖甲而已，并不用大温热的药。由此可知张仲景所说的阴毒，不是阴寒的病，而是感受天地间的恶毒异气，侵入阴经，所以叫阴毒。后人遂将阴寒极甚的证候，混入张仲景的证候中，治疗用附子散等温药，窃以为阴寒极甚的证候，或许是内伤冷物，或许是暴中阴寒，或许是过服凉药所致，固然可以称为阴毒，但这终究不是张仲景立名的本意。（王安道）
动气
动气一证，就是筑筑然跳动在脐旁，以及左乳之下名为虚里的地方。考证《难经》，则以脐的上、下、左、右分别对应心、肾、肝、肺四脏而各列其证，在《伤寒论》中记载也很详细。成无己说：动气，是脏气不治，正气内虚。虽然各种说法如此，但都没有抓住要点。大概动气在脐旁的，都本于下焦的阴分，凡是病关格劳损的，多有此证。其跳动轻微的，只限于脐旁上下；其跳动严重的，则连及虚里心胁，真的像舂米一样连续震动而浑身都振动。这是因为天一无根，所以气不能蓄藏而鼓动于下，这确实是真阴不守，大虚的征候。如何验证呢？只要观察呼吸、饥饱的时候，就可以得到征兆。凡是患此病的，饥饿时更严重，饱食时稍缓解；呼气时更严重，吸气时稍缓解。这是虚严重的动必严重，虚轻微的动也轻微，难道不是虚实明显的验证吗？即使病人常觉得振动，但没有疼痒，还不知道是什么缘故，医生如果不能详细察辨，也不知道是什么病，这动气不明朗的情况已经很久了。但动气见于虚损的固然多，见于伤寒的也不少，张仲景只说了禁忌，而没有说治疗方法，这只有直接救真阴以培补根本，使气有所归，没有不获效的。（张景岳）
两感
两感，是阴阳双传。虽然属于死候，但虚而感邪深的必然死亡，实而感邪浅的或许还可以治疗。大概用药的先后，发表攻里，本来就有不同。张仲景说：太阳与少阴俱病，头疼恶寒，是太阳邪盛于表；口干而渴，是少阴邪盛于里。阳明与太阴俱病，身热谵语，是阳明邪盛于表；不欲食腹满，是太阴邪盛于里。少阳与厥阴俱病，则耳聋寒热、呕而口苦，是少阳邪盛于表；烦满囊缩，是厥阴邪盛于里。三阳头疼身热、耳聋胁痛、恶寒而呕，邪在表的，固然不可攻下，其三阴腹满干呕、口渴囊缩、谵语便实，邪在里的，可以不下吗？《活人书》引用下利身疼痛，虚寒救里的方法，想要施用于烦渴、腹满、囊缩、谵语实热的证候，岂不是差了吗？原来张仲景所说的发表，是葛根、麻黄；攻里，是调胃承气汤。《活人书》却说救里则是四逆汤，救表则是桂枝汤。以救为攻，岂不相违背？大概表里不可同时攻伐，阴阳难以同一治法，用药的法度，心中难道不可以确定吗？（陶节庵）
先辈说两感，是感而复感。老幼体弱的人，都没有这个病，强壮的人才有。大概体弱的人，一旦感邪就觉得难以承受，慎重地调理治疗，所以热虽重也不死。强壮的人，倚仗气血，不肯服药，病虽未发作，邪实未除，数日之后，再次感寒，后至的邪气入内，前至的邪气传变，前至的传变，后至的跟随，这样在一天之内，太阳与少阴俱病，二日三日也是如此，六经受邪，水浆不入，不知人事，六日而死。我见过患两感的几个人，都是出自强壮之人，都是六日而死，前辈称此病为打好汉，确实如此。东垣认为表里齐受为两感，后世认为感而复感为两感。然而实际上有两种，究竟齐受的急，复感的缓，后学应当都知道。（《怡堂散记》）
两感，本是表里同病，似乎都是以外感来说的，但实际上未必尽然，正是由于内外俱伤，才是两感。现在见到有少阴先溃于内，而太阳继之于外的，就是纵情肆欲的两感；太阴受伤于里，而阳明重感于表的，就是劳倦竭力，饮食不调的两感；厥阴气逆于脏，少阳复病于腑的，就是七情不慎，疲筋败血的两感。人们知道两感是伤寒，而不知道伤寒的两感，内外俱困，病就严重了。有人说两感证不多见，大概是见得少，而义理自然未通达罢了。其治疗方法，也在于知道病因而救治根本。（钱祯）
夫两感病，既然说三日乃死，不在顷刻可知，极力救援，也可以希望侥幸存活。我每见头痛、恶寒、恶风、腰脊痛引周身等太阳证刚出现，就具备少阴证；阳明证刚出现，而腹满、不食、谵妄等证就具备；胁满、耳聋等象未齐全，就兼有囊缩、乳平者，都在一两日间发生。不给予攻伐，也不发汗，只是斟酌其平民富贵、老人小孩的差别，全部从内伤温补治法，往往获效。如果有余波未平，轻调本经，无不中肯。先辈立言，有的置之不治，有的从外感治，有的从内伤治，有的先表后里，有的先里后表，有的表里齐行攻伐，有的攻表攻里间施，有的攻后再行补益，有的见内外皆溃始行温补，总之穿凿附会，法无可遵。岁在甲申，才得到钱祯的论述：原有各种内伤在前，继有外感在后，一着便成两感。玩味他的话，先得我心之所同然者。（曹恒占）
阴阳易
男女交媾而病传，是奇病。其传授者，开始因伤寒，实则种于欲火；其接受者，因于欲火，实则发于阴虚。这就是阴阳易病的由来。裆者，是男女阴阳的卫护。卫护于外的，自然能清肃于内。感于无形的，用有形之物治疗，取其隐内烧而服之。形气相感，小便即利，阴头微肿，浊阴走下窍，而清阳出上窍，欲火平而诸证自息矣。然而更宜用六味地黄汤合生脉散治疗。（柯韵伯）
瘥复
伤寒刚刚痊愈，起居劳作，因而复发，叫做劳复；强行进食谷物，因而复发，叫做食复；男女交接，复发而自己生病，叫做房劳复；男女交接，相互交换致病，叫做阴阳易。大概是因为其人新愈，余邪伏于脏腑，未曾完全解除，所以犯之辄复发。学者在临证时，审察其脉证而详细辨别，则施治自然无误。（《医宗金鉴》）
伤寒既愈复热者，其原因有四：或是邪气刚散，胃气未清，因而过食的，是为食复；或是表邪刚解，原本不甚虚，有过分谨慎的，辄加温补，是误补而复。像这两者，所谓“食入于阴，长气于阳”，导致卫气重新闭塞，阳邪重新聚集而然。仍然适宜发汗。又或者是新病刚愈，失于调摄，或劳伤脾阴，因而复热的，是名劳复；或是不慎房室，因而再感的，是名女劳复。像这两者，所谓“阴虚者阳必凑之”而然。或从补，或从汗，因时制宜，权其缓急，而治分虚实。（张景岳）
伤寒瘥后，始终不清醒，精神不爽，言语错谬，诸治不效，或潮热颊赤，或寒热似疟，都是发汗不彻，余邪在心包所致。（《得效方》）
Yang fever (fever with tidal patterns) where the tongue coating lacks yellow, black, or thorn-like projections, even if there are symptoms of abdominal hardness and fullness, one must be cautious not to use purgation. Instead, warm formulas such as Lizhong Tang (Cinnamon Twig and Atractylodes Decoction) and Sini Tang (Frigid Extremities Decoction) should be used; there is still a possibility of survival. ○ Zang Jie (Organ Knotting), presenting symptoms similar to Xiong Jie (Chest Knotting) or Pi Syndrome (Epigastric Fullness), occurs because the patient has had pre-existing Pi masses in the hypochondrium. This differs from epigastric fullness caused by inappropriate purgation. The umbilicus is the root of life; its sides are the location of Tianshu (ST25), where the Yangming meridians converge and Shaoyang meridians emerge. Yin cold coagulation of the Spleen, Liver, and Kidney here causes pain radiating to the lower abdomen and into the Zongjin (major tendons/genitals). This Yin pathogen persists without any sign of Yang; when Yang Qi perishes first, Yin Qi follows, leading to death. The lower abdomen is the domain of the Jueyin meridian, where two Yins meet. Zongjin refers to the major tendons. Many people today die from pain caused by Zongjin rushing upward to the lower abdomen, a condition named Shanqi (Hernia), which belongs to this category. However, those who recover when the pain stops align with the statement in *Jingui Yaolue*: "Entering the Zang leads to death, entering the Fu leads to recovery." Recovery using herbs like Fennel and Evodia indicates the treatment method for Zang Jie. (From *Laisu Ji*)
Chu Zhong (Elimination of the Middle)
Chu Zhong refers to a condition where internal organ cold should prevent eating, yet the patient can eat. There are two types, both belonging to the Jueyin meridian: one results from taking Huangqin Tang (Scutellaria Decoction) erroneously and inevitably leads to death; the other occurs when Jue (cold extremities) and Re (fever) correspond, indicating that Stomach Qi remains, leading to recovery. One must fear sudden heat that comes and goes quickly, which indicates death, whereas sustained heat indicates survival. (From *Shanghan Leizheng*)
E Ni (Hiccups)
E Ni, commonly known as hiccupping, produces sound from the throat, continuous, short, and abrupt. Ancient texts called it Yue, which is incorrect. Yue is indistinguishable from Gan Ou (dry heaving); its sound is turbid, foul, and long, vastly different from E Ni. E Ni can arise from excess heat in the Stomach not being purged, phlegm-fluid retention in the Stomach, or excessive intake of cold medicines causing Stomach deficiency-cold. All these Qi originate in the Stomach, rush to the chest and throat, and cause hiccups. For Stomach heat not purged, use Chengqi Tang (Gut-Regulating Decoction) to purge; for Stomach deficiency with heat, use Chupi Zhuru Tang (Tangerine Peel and Bamboo Shave Decoction) to clear; for phlegm-fluid, use Chupi Banxia Shengjiang Tang (Tangerine Peel, Pinellia, and Ginger Decoction) plus Poria and Immature Bitter Orange to harmonize; for Stomach cold, use Chupi Ganjiang Tang (Tangerine Peel and Dried Ginger Decoction) to warm. If excessive cooling medicines cause Stomach cold hiccups, Dingfu Lizhong Tang (Cardamom and Aconite Cinnamon Twig and Atractylodes Decoction) is indicated. If Qi rushes straight from below the umbilicus to the chest and throat causing hiccups, the disease is not in the Stomach but due to lower-jiao deficiency and erroneous cold medicine intake, causing extreme cold below forcing Ministerial Fire to rush up—this is water extreme resembling fire, a Yin syndrome resembling Yang. Urgently warm the lower jiao; once Yang returns, hiccups stop. (From *Quansheng Ji*)
People mistakenly call Yue, E Ni, Chi Ni, and Yi Qi the same. Yue's sound comes from the Stomach out the mouth, loud and urgent. E Ni's sound comes from below the umbilicus rushing up, producing a 'ge ge' sound, scattered and discontinuous. E Ni corresponds to the "Yue Yue" sound in the *Ping Mai Pian* chapter of the *Neijing*, indicating Qi obstruction with sound. Chi Ni and Yi Qi refer to modern belching. Chi Ni occurs after eating too fast, with no food odor; Yi Qi occurs after overeating/food stagnation, with a food odor. Yue, E Ni, Ai (belching), and Yi all produce sound without matter, all involving rebellious Qi, but differ in deficiency/excess, cold/heat, severity, and duration. Confusing Ke Ni (coughing against) with E Ni is wrong, as Ke Ni is modern asthma/cough. They must be distinguished. (From *Yizong Jinjian*)
Huai Bing (Ruined Disease)
A disease ruined by medical error is like a vessel damaged by a craftsman. Examine the original pulse and symptoms, determine the treatment method, observe how the pulse and symptoms changed, and understand the cause of ruin from sweating, vomiting, purging, or moxibustion. Where there is rebellion, there must be rescue. Zhang Zhongjing could not plan this for us across millennia. ○ Huai Bing does not require multiple errors; simply failing to treat when necessary or treating when unnecessary, leading to change, constitutes Huai Bing. Even if mis-treated repeatedly without symptom change, it is not Huai Bing. Treat the error with the method for the original disease; whether it is Huai Bing or not depends on the method. Ruin stems from error; error requires rescue to reverse rebellion back to order. (Wei Litong)
He Bing and Bing Bing (Combined and Merged Diseases)
I studied Shanghan thoroughly; initially unclear on He Bing and Bing Bing, now I understand. He Bing refers to two or three Yang meridians suffering simultaneously, merging diseases. Bing Bing refers to, for example, Taiyang disease persisting unresolved and then merging into Yangming or Shaoyang. As Zhang Jingyue notes regarding Zhang Zhongjing: "Two Yangs merged disease... sweat was induced but not thorough, thus transferring to Yangming." If Taiyang symptoms persist, do not purge. Transferring to Yangming implies origin from Taiyang. Persistent Taiyang symptoms imply both meridians are diseased. Bing Bing progresses from shallow to deep, inevitable. Those unaware think this rare, but modern diseases are mostly He Bing and Bing Bing. Diagnosis rarely shows single-meridian sequential transmission, nor purely interior symptoms after exterior resolves. Strict adherence to meridian formulas fails because such pure cases don't exist. Ignorance of He/Bing Bing concepts causes this. (Zhang Jingyue)
Diseases have fixed forms, hence Six Meridians divide them; diseases change, so He and Bing must be cross-referenced. Yin and Yang root each other; Qi and Spirit merge. The interior of Three Yang is Three Yin; the exterior of Three Yin is Three Yang. Taiyang disease with deep pulse combines with Shaoyin; Shaoyin disease with fever combines with Taiyang. Yangming slow pulse combines with Taiyin; Taiyin moderate pulse combines with Yangming. Shaoyang small pulse combines with Jueyin; Jueyin floating pulse combines with Shaoyang. Though names differ, reality merges. Yang resolving via Yin, or Yin resolving via Yang; Yang entering Yin brings danger, Yin losing Yang brings rebellion. Scholars must examine pulse/symptoms for combination in Yin/Yang and merger in Three Yang/Three Yin, applying methods like treating Yang for Yin disease, tonifying Yang suppressing Yin, etc., appropriately. Three Yang have fever; Three Yin have diarrhea. Fever with diarrhea is Yin-Yang He Bing. Yang excess belongs to Yang meridians (excess-heat diarrhea, e.g., Ge Gen Qin Lian Tang for Taiyang-Yangming or Yangming-Shaoyang He Bing). Yin excess belongs to Yin meridians (deficiency-cold diarrhea, e.g., Tong Mai Si Ni Tang for Shaoyin with clear stool, interior cold/exterior heat, flushed face). Yang-Yang He Bing (Three Yang combined) presents with spontaneous sweating, not diarrhea (Bai Hu Tang pattern). Yin-Yin He Bing (Three Yin combined) presents with no fever, vomiting/diarrhea/cold limbs (Si Ni Tang pattern). Bing Bing differs from He Bing; He Bing appears simultaneously, Bing Bing sequentially. Taiyang head/neck stiffness persisting while Shaoyang signs (wiry pulse, dizziness, epigastric fullness) appear is Taiyang-Shaoyang Bing Bing. Adding delirium makes it Three Yang Bing Bing. For Taiyang-Yangming Bing Bing, if Taiyang signs persist, slight sweating; if resolved, purging. Key is distinguishing chills/fever. Without combining analysis, one cannot know disease changes or treat effectively. (Ke Yunbo)
Baihe Bing (Lily Disease)
Baihe Bing uses Baihe (Lily Bulb). As stated in the *Lun*, Taiyang disease Guizhi pattern, named after cause and drug. Later scholars saw "hundred vessels one source" and complex symptoms, thinking it a hundred-cause disease, missing that it is one Qi disease treated by one drug. *Bencao* states Baihe is sweet, neutral, non-toxic, treating evil Qi. When Qi is diseased, righteous Qi becomes evil; treating Qi restores righteousness. It also promotes urination/bowel movements and tonifies middle/Qi, making it the main drug. Qi disease is either excess-blockage or deficiency-insufficiency. Baihe drains excess and tonifies deficiency. The Way is one; why need many drugs? (Wei Litong)
Huo Chu (Fox-Haunting)
Huo Chu is a parasite disease. Parasites arise from heat, heat from deficiency. Thus, Huo Chu is Yin deficiency with blood-heat. Foxes are suspicious; Huo Chu means doubt. Heart governs Blood; Yin deficiency consumes Blood generating heat, causing irritability. The Spirit Office loses tranquility, becoming agitated—the "suspicious heart" is this disease. Blood-heat allows parasites to move up/down. Parasites have consciousness, disturbing the conscious Heart, creating suspicion. Being blood-derived, they return to the Heart. Forms gather by type. (Wei Litong)
Yang Du and Yin Du (Yang Poison and Yin Poison)
Ancient texts say Yang Du is excessive Yang, sudden Yin decline,内外皆阳 (all Yang inside/outside). Yin Du is excessive Yin, sudden Yang decline,内外皆阴 (all Yin inside/outside). These may occur at Shanghan onset or post-medication. Yang Du treated with cold/cool; Yin Du with hot/warm. Why did Zhang Zhongjing use one formula? Removing Xionghuang and Shujiao from Yin Du removes warmth. Are they both heat toxins injuring Yin/Yang meridians? (Zhao Yi-de)
Yin-Yang Er Du differs from Yin-Yang Er Zheng. Zhang Zhongjing’s Yin Du describes blue face, body pain like beaten, sore throat—not extreme cold. His formula uses Shengma, Gancao, Danggui, Biejia—no strong warming drugs. Thus, Zhang’s Yin Du is not cold disease but infection by toxic qi entering Yin meridians. Later doctors confused it with extreme cold, using Fuzi San. While extreme cold (from cold food, sudden cold, or over-cooling) can be called Yin Du, it is not Zhang’s original intent. (Wang Andao)
Dong Qi (Moving Qi)
Dong Qi is pulsating movement below the umbilicus or at Xuli (CV15, left of sternum). *Nan Jing* maps upper/lower/left/right of umbilicus to Heart/Kidney/Liver/Lung. *Shanghan Lun* details this. Cheng Wuji says Dong Qi is organ dysfunction and internal deficiency. But this misses the point. Dong Qi below umbilicus originates from Lower Jiao Yin. Patients with Guan Ge or exhaustion often have this. Mild movement stays near umbilicus; severe extends to Xuli/chest, vibrating whole body. This is Tianyi (Primordial Qi) lacking root, Qi unable to store, moving downward—True Yin unguarded, severe deficiency. Verify via respiration/hunger: worse when hungry/breathing out, better when full/breathing in. Severe deficiency = severe movement. Patients feel vibration without pain/itch, often undiagnosed. Dong Qi appears in deficiency and Shanghan. Zhang Zhongjing listed contraindications but not treatments. Directly saving True Yin to root the Qi is effective. (Zhang Jingyue)
Liang Gan (Double Transmission)
Liang Gan is simultaneous Yin-Yang transmission. Usually fatal, but deep transmission in deficiency dies, shallow in excess may be treatable. Treatment timing differs for exterior release vs. interior attack. Zhang Zhongjing: Taiyang-Shaoyin dual disease—headache/chills (Taiyang exterior excess); dry mouth/thirst (Shaoyin interior excess). Yangming-Taiyin dual—fever/delirium (Yangming exterior excess); anorexia/abdominal fullness (Taiyin interior excess). Shaoyang-Jueyin dual—deafness/chills/vomiting/bitter taste (Shaoyang exterior excess); irritability/shrinkage (Jueyin interior excess). Three Yang exterior signs (headache, fever, deafness, costal pain, chills, vomiting) cannot be purged. Three Yin interior signs (fullness, dry heaving, thirst, shrinkage, delirium, constipation) should not be spared from purging? *Huren* cites purging for diarrhea/body ache (deficiency-cold interior rescue) applied to excess-heat signs (thirst, fullness, delirium)—is this not wrong? Zhang’s exterior release uses Gegen/Mahuang; interior attack uses Tiao Wei Chengqi. *Huren* says interior rescue is Sini, exterior is Guizhi. Using rescue as attack contradicts. Exterior/Interior cannot be attacked simultaneously; Yin/Yang cannot share one treatment. (Tao Jian'an)
Predecessors said Liang Gan is re-infection. Weak/elderly/youth don’t get it; strong adults do. Weak patients rest/treat, surviving high fever. Strong patients rely on Qi/Blood, refuse meds, pathogens remain. Days later, re-infected. New pathogens enter, old transmit. Within days, Taiyang-Shaoyin dual, then others. Six meridians affected, inability to swallow/consciousness lost, death in six days. I saw several strong patients die in six days. Called "beating the hero," truly so. Dong Yuan defined Liang Gan as simultaneous exterior-interior reception; later generations as re-infection. Both exist; simultaneous is acute, re-infection is chronic. Students must know. (*Yitang Sanji*)
Liang Gan is simultaneous exterior-interior disease, seemingly external, but actually internal/external injury together. Shaoyin collapsing internally followed by Taiyang externally is sexual indulgence Liang Gan. Taiyin injured internally, Yangming re-infected externally is labor/dietary Liang Gan. Jueyin Qi rebellion internally, Shaoyang disease externally is emotional/muscle fatigue Liang Gan. People know Liang Gan as Shanghan, but don’t realize internal/external distress worsens it. Some say it’s rare due to lack of exposure/understanding. Treatment depends on knowing cause and saving root. (Qian Zhen)
Liang Gan supposedly kills in three days, not instantly. Rescue may save. I see Taiyang signs (headache, chills, back pain) appearing with Shaoyin signs simultaneously; Yangming signs with abdominal fullness/delirium; Shaoyang signs with Jueyin signs within 1-2 days. Do not attack or sweat. Adjust based on diet/status/age, treating as internal injury with warming/tonifying. Often effective. Minor residuals treated lightly. Predecessors’ methods vary (ignore, exterior treat, interior treat, exterior-first, interior-first, simultaneous attack, alternating, post-attack tonify, late tonify)—all arbitrary. In Jia Shen year, I read Qian Zhen: prior internal injury + subsequent external infection = Liang Gan. This resonates. (Cao Hengzhan)
Yin Yang Yi (Yin-Yang Exchange)
Transmission via intercourse is a strange disease. The transmitter started with Shanghan but planted desire-fire; the receiver caught desire-fire but manifested as Yin deficiency. This is the origin of Yin Yang Yi. Undergarments guard Yin-Yang. Guarding outside clears inside. Treating无形 (formless) with有形 (formed): burn undergarment and take orally. Form-Qi interaction promotes urination, slight penile swelling, turbid Yin exits lower orifice, clear Yang exits upper orifice, desire-fire calms, symptoms cease. Also use Liuwei Dihuang Tang combined with Shengmai San. (Ke Yunbo)
Chai Fu (Relapse after Recovery)
Shanghan newly recovered, activity causes relapse = Lao Fu (Labor Relapse). Forceful eating causes relapse = Shi Fu (Food Relapse). Intercourse causes relapse = Fang Lao Fu (Sexual Labor Relapse). Intercourse exchanges disease = Yin Yang Yi. Residual pathogens hide in organs, unresolved, triggering relapse upon violation. Examine pulse/symptoms carefully to treat correctly. (*Yizong Jinjian*)
Relapse fever after Shanghan has four causes: 1. Pathogen dispersing, Stomach Qi unclear, overeating = Shi Fu. 2. Exterior resolved, not very deficient, excessive warming/tonifying = Mis-tonification Relapse. Both cause "food enters Yin, grows Yang," closing Wei Qi, gathering Yang pathogen. Sweat required. 3. Newly recovered, poor care, Spleen Yin injury = Lao Fu. 4. Sexual indiscretion = Nu Lao Fu. Both cause "Yin deficiency attracts Yang." Treat via tonification or sweating, adjusting for urgency/deficiency-excess. (Zhang Jingyue)
Post-Shanghan recovery, mental cloudiness, speech errors, failed treatments, tidal fever/red cheeks, malaria-like chills/fever—all due to incomplete sweating leaving residual pathogens in Xinbao (Pericardium). (*Dexiao Fang*)
Post-Illness Care Method
For illness recovery, post-care is vital. Post-infection, Yuan Qi is deficient, pathogenic heat remains. Tonifying deficiency retains heat; clearing heat damages deficiency. Just one...