（脉阴阳俱盛。当汗出而解。若汗出不解。则邪气内盛。正气外脱。故死。内经曰。汗
出而
脉阴阳俱虚。热不止者死。
（脉阴阳俱虚者。真气弱也。热不止者。邪气胜也。内经曰。病温。虚甚者死。）
脉至乍疏乍数者死。
（谓天真营卫之气断绝也。）
脉至如转索者。其日死。
（为紧急而不软。是中无胃气。故不出其日而死。）
谵言妄语。身微热。脉浮大。手足温者生。逆冷。脉沉细者。不过一日死矣。
（谵言妄语。阳病也。身微热。脉浮大。手足温。为脉病相应。若身逆冷。脉沉细。为
阳病
此以前是伤寒热病证候也。
伤寒所致太阳。 湿 三种。宜应别论。以为与伤寒相似。故此见之。
（ 。当作痉。传写之误也。 者恶也。非强也。内经曰。肺移热于肾。传为柔 。柔
为筋
反张
太阳病。发热无汗。反恶寒者。名曰刚 。
（千金曰。太阳中风。重感寒湿。则变 。太阳病。发热无汗。为表实。则不当恶寒。
今反
太阳病。发热汗出。不恶寒者。名曰柔 。
（太阳病。发热汗出。为表虚。则当恶寒。其不恶寒者。为阳明病。今发热汗出。而不
恶寒
太阳病。发热。脉沉而细者。名曰 。
（太阳主表。太阳病。发热为表病。脉当浮大。今脉反沉细。既不愈。则太阳中风。重
感于
。栝蒌桂
太阳病。发汗太多。因致 。
（太阳病。发汗太多。则亡阳。内经曰。阳气者。精则养神。柔则养筋。阳微不能养筋。
则
病身热足寒。颈项强急。恶寒。时头热面赤。目脉赤。独头摇。猝口噤。背反张者。
病也
（太阳中风。为纯中风也。太阳伤寒。为纯伤寒也。皆不作 。惟是太阳中风。重感寒
湿。
风
搦。此者。内挟寒湿。故头摇也。口噤者。寒主急也。猝口噤者。不常噤也。有时而缓。若
风寒
额。
下至
太阳病。关节疼痛而烦。脉沉而细者。此名湿痹。湿痹之候。其人小便不利。大便反快。
但
（金匮要略曰。雾伤皮腠。湿流关节。疼痛而烦者。湿气内流也。湿。同水也。脉沉而
细者
则濡
湿之病
湿家之为病。一身尽疼。发热。身色如似熏黄。
（身黄如橘子色者。阳明瘀热也。此身色如似熏黄。即非阳明瘀热。身黄发热者。栀子
柏皮
脾
湿家。其人但头汗出。背强。欲得被覆向火。若下之早。则哕。胸满。小便不利。舌上
如苔
（湿家有风湿。有寒湿。此寒湿相搏者也。湿胜则多汗。伤寒则无汗。寒湿相搏。虽有
汗而
气不
而恶
阳气
也。
湿家。下之。额上汗出。微喘。小便利者死。若下利不止者。亦死。
（湿家发汗。则愈。金匮要略曰。湿家身烦疼。可与麻黄加术四两。发其汗。为宜。若
妄下
阳相
问曰。风湿相搏。一身尽疼痛。法当汗出而解。值天阴雨不止。医云。此可发汗。汗之
病不
发
（值天阴雨不止。明其湿胜也。内经曰。阳受风气。阴受湿气。又曰。伤于风者。上先
受之
邪出
俱去也。
湿家病。身上疼痛。发热。面黄而喘。头痛鼻塞而烦。其脉大。自能饮食。腹中和。无
病。
（病有浅深。证有中外。此则湿气浅者也。何以言之。湿家不云关节烦疼。而云身上疼
痛。
于脾。而
也。湿家
饮食。胸
病者一身尽疼。发热。日晡所剧者。此名风湿。此病伤于汗出当风。或久伤取冷所致也。
（一身尽疼者。湿也。发热日晡所剧者。风也。若汗出当风。而得之者。则先客湿。而
后感
略中
太阳中热者。 是也。其人汗出。恶寒。身热而渴也。
（汗出恶寒。身热而不渴者。中风也。汗出恶寒。身热而渴者。中 也。白虎加人参汤
主之
太阳中 者。身热疼重。而脉微弱。此亦夏月伤冷水。水行皮中所致也。
（经曰。脉虚身热。得之伤暑。身热脉微弱者。 也。身体疼重者。水也。夏时暑热。
以水
太阳中 者。发热恶寒。身重而疼痛。其脉弦细芤迟。小便已。洒洒然毛耸。手足逆冷。
小
甚
（病有在表。有在里者。有表里俱病者。此则表里俱病者也。发热恶寒。身重疼痛者。
表中
也。小
因于
外虚
膀胱
（脉象寸关尺三部均盛大有力，应当通过发汗使邪气随汗而解。如果出汗后病证仍未解除，说明邪气在体内亢盛，正气向外脱失，因此会导致死亡。《内经》说：出汗后脉象寸关尺三部均虚弱无力，且发热不止的，属于死证。）
（脉象寸关尺三部均虚弱无力，说明人体真气衰弱。发热不止，说明邪气胜过正气。《内经》说：患温病时，正气虚损严重的，属于死证。）
脉象跳动忽快忽慢、忽疏忽数的，属于死证。
（这是因为先天真元、营气与卫气断绝的缘故。）
脉象摸起来像转动绳索一样紧硬弹指的，患者当天就会死亡。
（因为脉象紧急而不柔和，这是胃气已绝的表现，所以不出当天就会死亡。）
胡言乱语、神志不清，身体微热，脉象浮大，手足温暖的，可以存活。如果手足逆冷，脉象沉细的，不超过一天就会死亡。
（胡言乱语、神志不清，属于阳病。身体微热，脉象浮大，手足温暖，说明脉象与病证相应。如果身体逆冷，脉象沉细，说明是阳病……）
以上是伤寒和热病的证候表现。
伤寒所导致的太阳病、痉病、湿病这三种情况，应当分别论述，因为它们与伤寒相似，所以在此一并列出。
（“痉”字，当作“痉”，是传抄书写时的错误。“痉”意为恶疾，并非指强直。《内经》说：肺将热邪转移给肾，传变为柔痉。柔痉表现为筋脉……反张……）
（《千金方》说：太阳中风证，又重感寒湿之邪，则会转变为痉病。太阳病，发热无汗，属于表实证，本不应怕冷。现在反而……）
（太阳病，发热有汗，属于表虚证，本应当怕冷。其不怕冷的，属于阳明病。现在发热有汗，却……）
（太阳主表，太阳病发热属于表病，脉象应当浮大。现在脉象反而沉细，既不能痊愈，则是太阳中风证，又重感于……栝蒌桂……）
（太阳病，发汗过多，会导致亡阳。《内经》说：阳气，精纯则养神，柔和则养筋。阳气微弱不能养筋，则……）
病见身体发热，足部寒冷，颈项强直拘急，怕冷，有时头部发热、面部发红，眼脉络赤红，只有头部摇动，突然牙关紧闭，背部反张的，是痉病。
（太阳中风，是纯粹的中风证。太阳伤寒，是纯粹的伤寒证，都不会发生痉病。只有太阳中风证，又重感寒……）
风邪……抽搐。这种情况，是因为内挟寒湿，所以头部摇动。牙关紧闭，是因为寒性主收引拘急。突然牙关紧闭，是指不经常紧闭，有时会有缓解。如果风寒……额……下至……）
太阳病，关节疼痛且心烦，脉象沉而细的，这叫做湿痹。湿痹的证候，病人小便不利，大便反而通畅快速。
（《金匮要略》说：雾邪伤害皮腠，湿气流注关节。疼痛且心烦的，是湿气内流。湿，同水。脉象沉而细的……则濡……湿之病……）
患有湿病的病人，全身都疼痛，发热，身体颜色像被烟熏过的黄色。
（身体黄得像橘子色，是阳明瘀热。此处的身体颜色像被烟熏过的黄，就不是阳明瘀热。身体发黄发热的，用栀子柏皮汤……脾……）
患有湿病的病人，只有头部出汗，背部强直，想要盖被子靠近火源取暖。如果过早使用泻下法，就会出现呃逆，胸满，小便不利，舌上像有一层苔垢。
（湿家有风湿，有寒湿，此处是寒湿相搏结。湿胜则多汗，伤寒则无汗。寒湿相搏，虽然有汗但……气不……而恶……阳气……）
患有湿病的病人，误用泻下法，出现额头出汗，微喘，小便通利的，属于死证。如果出现腹泻不止的，也属于死证。
（湿家应当发汗，才能痊愈。《金匮要略》说：湿家身体烦疼，可以用麻黄加术汤四两，发其汗，比较适宜。如果妄用泻下……阳相……）
问曰：风湿相搏结，全身都疼痛，按照治法应当发汗而解。正值天下阴雨连绵不止，医生说：这可以发汗。发汗后……病不……发……
（正值天下阴雨连绵不止，说明湿气胜。《内经》说：阳受风气，阴受湿气。又说：伤于风邪的，上部先受之……邪出……俱去也。）
湿家患病，身上疼痛，发热，面色黄且气喘，头痛鼻塞且心烦，脉象大，能正常饮食，腹部平和，没有病痛。
（病有浅深，证有内外。这属于湿气较浅的情况。为什么说呢？湿家不说关节烦疼，而说身上疼痛……于脾，而……也。湿家……饮食，胸……）
病人全身都疼痛，发热，每天下午申时左右加剧的，这叫做风湿。这种病是由于出汗时当风，或者久处冷处贪凉所致。
（全身都疼痛，是湿邪。发热在下午申时左右加剧，是风邪。如果是出汗时当风而得的，则是先客留湿邪，后感……略中……）
（汗出怕冷，身体发热但不口渴的，是中风。汗出怕冷，身体发热且口渴的，是中暍。用白虎加人参汤主治……）
太阳中暍者，身体发热且沉重疼痛，脉象微弱。这也是夏天受了冷水，水气行于皮肤中所导致的。
（经书说：脉虚身热，得之于伤暑。身体发热脉象微弱的，是暍。身体疼痛沉重的，是水。夏季暑热……以水……）
太阳中暍者，发热怕冷，身体沉重且疼痛，脉象弦细芤迟。小便结束后，感觉洒洒然毛发耸立，手足逆冷，小……甚……
（病有在表的，有在里的，有表里同病的。这属于表里同病。发热怕冷，身体沉重疼痛的，是表中……也。小……因于……外虚……膀胱……）
(When the pulse is vigorous at both yin and yang positions [pulse positions on the wrist], sweating should be induced to resolve the condition. If sweating fails to resolve it, pathogenic qi becomes excessive internally while healthy qi collapses externally, leading to death. The *Neijing* states: "If the pulse is deficient at both yin and yang positions after sweating, and fever persists, it is a fatal case."
(A pulse deficient at both yin and yang positions indicates weakness of true qi. Persistent fever indicates that pathogenic qi prevails over healthy qi. The *Neijing* states: "In warm diseases, severe deficiency leads to death.")
A pulse that alternates between slow and rapid rhythms indicates death.
(This signifies the severance of innate essence, Ying [nutritive] qi, and Wei [defensive] qi.)
A pulse feeling like a turning rope [tight and wiry] indicates death on that day.
(Because it is tight and lacks softness, this shows the absence of Stomach Qi, hence death occurs within the day.)
Delirious speech and incoherent talking, with slight body heat, a floating and large pulse, and warm hands and feet indicate survival. Conversely, cold extremities and a deep, thin pulse indicate death within one day.
(Delirious speech and incoherent talking are Yang pathologies. Slight body heat, a floating and large pulse, and warm extremities indicate correspondence between pulse and pathology. If the body is cold and the pulse deep and thin, it indicates...")
The above describes the syndromes of Cold Damage (Shanghan) and febrile diseases.
Cold Damage can lead to three conditions: Taiyang disease, Jing [spasm] disease, and Shi [dampness] disease. These should be discussed separately as they resemble Cold Damage, hence they are presented here.
(The character "Jing" should be read as "Jing" [spasm/stiff neck]; this is a transcription error. "Jing" implies a severe illness, not merely stiffness. The *Neijing* states: "Lung heat transfers to the Kidney, transforming into Rou Jing [soft spasm]. Rou Jing presents with tendon retraction... opisthotonos...")
Taiyang disease presenting with fever, anhidrosis [absence of sweating], and aversion to cold is named Gang Jing [rigid spasm].
(The *Qianjin Fang* states: "Taiyang Wind Strike, when compounded by cold-dampness, transforms into Jing disease. Taiyang disease with fever and no sweating indicates excess in the exterior, so aversion to cold should not occur. Now, however...")
Taiyang disease presenting with fever, diaphoresis [sweating], and absence of aversion to cold is named Rou Jing [soft spasm].
(Taiyang disease with fever and sweating indicates deficiency in the exterior, so aversion to cold should occur. Absence of aversion to cold indicates Yangming disease. Now, with fever and sweating but...")
Taiyang disease presenting with fever and a deep, thin pulse is named...
(Taiyang governs the exterior; fever in Taiyang disease indicates an exterior pattern, so the pulse should be floating and large. A deep and thin pulse instead indicates failure to recover, suggesting Taiyang Wind Strike compounded by... Gualou Guizhi Tang...)
Taiyang disease treated with excessive sweating may result in Jing disease.
(Excessive sweating in Taiyang disease causes loss of Yang. The *Neijing* states: "Yang qi, when refined, nourishes the spirit; when soft, nourishes the tendons. Weak Yang cannot nourish the tendons, leading to...")
Disease manifesting as body heat, cold feet, stiff and rigid neck and nape, aversion to cold, occasional head heat and facial redness, red eye vessels, isolated head tremor, sudden lockjaw, and opisthotonos [back arching backward] is Jing disease.
(Taiyang Wind Strike is pure Wind Strike; Taiyang Cold Damage is pure Cold Damage; neither typically causes Jing disease. Only Taiyang Wind Strike, when compounded by cold... Wind... convulsions. This occurs due to internal retention of cold-dampness, causing head tremor. Lockjaw occurs because cold causes tension. Sudden lockjaw means it is not constant but intermittent. If wind-cold... forehead... down to...")
Taiyang disease presenting with joint pain and vexation, with a deep and thin pulse, is named Shi Bi [dampness obstruction]. In Shi Bi, the patient experiences difficulty urinating and loose stools.
(The *Jinkui Yaolue* states: "Mist damages skin and interstices; dampness flows into joints. Pain with vexation indicates internal flow of dampness. Dampness is akin to water. A deep and thin pulse... then Ru [soft]... Dampness disease...")
Patients with chronic dampness suffer from generalized body pain, fever, and a sallow complexion resembling smoke-stained yellow.
(A bright orange-yellow complexion indicates Yangming blood stasis and heat. A smoke-stained yellow color is not Yangming stasis-heat. For jaundice with fever, Zhizi Baipi Tang... Spleen...)
Patients with chronic dampness who sweat only on the head, have a stiff back, and desire covering and warmth near fire. If purged prematurely, they develop hiccups, chest fullness, difficulty urinating, and a tongue coating resembling moss.
(Chronic dampness includes Wind-Damp and Cold-Damp; this case involves Cold-Damp binding. Excess dampness causes profuse sweating, whereas Cold Damage causes anhidrosis. In Cold-Damp binding, although there is sweating, Qi does not... and aversion... Yang Qi...)
If patients with chronic dampness are purged, resulting in sweating on the forehead, slight wheezing, and free urination, it is fatal. If diarrhea persists uncontrollably, it is also fatal.
(Chronic dampness should be treated with sweating to cure. The *Jinkui Yaolue* states: "For chronic dampness with bodily vexation and pain, Mahuang Jia Zhu Tang four liang to induce sweating is appropriate. If wrongly purged... Yang Xiang...")
Question: When Wind and Dampness bind, causing generalized pain, the method dictates resolving via sweating. However, if continuous rainy weather persists, the physician says sweating is indicated. After sweating, the disease does not... resolve...
(Continuous rain indicates excess dampness. The *Neijing* states: "Yang receives Wind, Yin receives Dampness." It also states: "Those injured by Wind, the upper part receives it first... Pathogen exits... Both depart.")
A patient with chronic dampness suffers from body pain, fever, yellow face, wheezing, headache, nasal congestion, and vexation. The pulse is large, yet they can eat, the abdomen is harmonious, and there is no internal disease.
(Disease has depth; symptoms have interior/exterior location. This is shallow dampness. Why? Chronic dampness does not mention joint vexation/pain but rather body pain... affecting the Spleen... Also, chronic dampness... diet, chest...)
A patient suffering from generalized body pain, fever, which worsens around 3-5 PM (Shi hour), is named Feng Shi [Wind-Damp]. This disease results from sweating while exposed to wind, or prolonged exposure to cold/drafts.
(Generalized pain indicates Dampness. Fever worsening in the afternoon indicates Wind. If contracted through sweating and wind exposure, Dampness enters first, then Wind... Jinkui...")
Taiyang Zhong Re [Heat Stroke in Taiyang] is Ye [miasma/heat] disease. The patient sweats, feels aversion to cold, has body heat, and thirst.
(Aversion to cold with sweating and body heat but no thirst is Wind Strike. Aversion to cold with sweating, body heat, and thirst is Zhong Ye [Heat Stroke]. Treat with Baihu Jia Renshen Tang...)
Taiyang Zhong Ye [Heat Stroke in Taiyang] presents with body heat, heaviness, and pain, with a weak pulse. This is also caused by drinking cold water in summer, causing water qi to circulate in the skin.
(The classics state: "Deficient pulse with body heat results from Summerheat. Body heat with weak pulse is Ye [Summerheat]. Body pain and heaviness is Water. In summer heat... using water...")
Taiyang Zhong Ye [Heat Stroke in Taiyang] presents with fever, aversion to cold, body heaviness and pain, and a string-taut, thin, hollow, or slow pulse. After urination, the patient feels chilly with hair standing on end, and cold extremities. Small... severe...
(Disease can be in the exterior, in the interior, or involving both. This involves both exterior and interior. Fever, aversion to cold, body heaviness and pain indicate exterior... Yes. Small... Due to... Exterior deficiency... Bladder...)