《金匮》劳篇，男子劳之为病，其脉浮大，手足烦热，春夏剧，秋冬差，阴寒精自出，
酸削
不能行。泉案∶酸削当为酸消，谓酸嘶消沮也。髓藏于头，而会绝骨。绝骨穴在胫外廉，故
脑髓少者，则头痛而胫不能行。其至春夏剧者，以春气病在头故也。《周礼·疾医》春时有
首疾。郑注∶ 酸削也；首疾，头疾也。彼削亦当作消，所以叠 也。《说文》 ，酸
，头痛也。《周礼》曰∶春时有 首疾。此与郑同义。郑注是分释“ 首疾”三字之义，非
分三字为二症名。《说文》“酸 头痛也”五字句，是浑括其状。贾疏头痛之外，别有酸削
之疾云云，盖误会郑意。《蜀都赋》味蠲疠 。注∶ ，头痛也。是误会许意。余目验春温
症及春月伤风而病头痛者，无不胫酸。《周礼》“ 首疾”三字，真善状病态者。许、郑由
头言之，仲景由胫言之，各以其次为异耳！
古书多言下利。下即泄字；利言其快，加 旁即为痢字。下利与吐利文同，吐利为快吐
，则
下利即为快泄已。两经或称其甚者为洞泄，又为肠 。王注谓肠门开辟，知本作辟，读为辟
，其病即下利也。所云肠 下白沫，即今之白积；肠 下脓血，即今之红白积；肠 下血
，即今之赤痢、肠红等。近世分下为泄泻，利为痢疾，于是今之痢，异于古之利矣。岂知今
之痢，即《难经》五泄中之大瘕泄。《难经》与余四泄同称泄，是古之下，赅今之痢。仲景
书亦止加“下重”二字以别之，不另立一名。隋唐时或称滞下，或称重下，皆不脱“下”字
，存古义也。徐氏《轨范》泛指肠 为肠红，而以《难经》五泄概入泄，仲景下利概入痢。
于此叹论古之难！
《金匮要略》虚劳篇记载，男子患虚劳病时，脉象浮大，手足烦热，春夏季节病情加重，秋冬季节病情减轻，阴寒导致精液自行滑出，肢体酸痛消瘦，无法行走。徐灵胎按语：酸削应当是“酸消”，意为酸楚、嘶哑、消沉沮丧。髓藏于头部，并与绝骨穴相连。绝骨穴位于小腿外侧，因此脑髓不足的人，会出现头痛且小腿无法行走的症状。病情在春夏加重的原因，是因为春季的病症表现在头部。《周礼·疾医》记载春季有首疾。郑玄注解说：“酸削”；首疾，即头部的疾病。这里的“削”也应当作“消”，这是为了叠韵通假。《说文解字》解释：“酸削”是头痛的意思。《周礼》说：“春季有酸削首疾。”这与郑玄的解释意义相同。郑玄的注解是分别解释“酸削首疾”这三个字的含义，并不是将这三个字分为两个症状名称。《说文解字》中“酸削头痛也”这五个字是概括描述这种状态。贾公彦疏认为除了头痛之外，另有酸削的疾病云云，这大概是误解了郑玄的本意。《蜀都赋》中提到“味蠲疠酸削”。注解说：“酸削”是头痛的意思。这也是误解了许慎（《说文解字》作者）的原意。我亲眼验证过春温症以及春季伤风而患头痛的人，无不伴有小腿酸痛。《周礼》中的“酸削首疾”三个字，确实是善于描绘病态的词句。许慎是从头部来说的，张仲景是从小腿来说的，只是各自依据不同的部位描述不同罢了！
古书中多提到下利。“下”即“泄”字；“利”表示畅快，加上“疒”旁即为“痢”字。下利与吐利的文字相同，吐利是指痛快呕吐，那么下利就是痛快排泄。两部经典有时称其严重的为洞泄，又称肠澼。王冰注解说肠门开辟，知道原本写作“辟”，读作“辟”，这个病就是下利。所说的肠澼下白沫，就是现在的白痢；肠澼下脓血，就是现在的红白痢；肠澼下血，就是现在的赤痢、肠红等。近代将“下”区分为泄泻，“利”区分为痢疾，于是现在的痢疾，不同于古代的“利”了。哪里知道现在的痢疾，就是《难经》五泄中的大瘕泄。《难经》与其他四种泄并称“泄”，说明古代的“下”，包含现在的“痢”。张仲景的书也只是加上“后重”二字来区别它，不另外设立一个名称。隋唐时期有时称为滞下，有时称为重下，都不脱离“下”字，保留了古义。徐氏《轨范》泛指肠澼为肠红，并将《难经》的五泄一概归入泄，将张仲景的下利一概归入痢。对此不禁感叹论述古代医学概念的困难！
In the "Xu Lao" (Deficiency and Emaciation) chapter of *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet), it is recorded that when men suffer from Xu Lao disease, the pulse is floating and large, there is vexation and heat in the hands and feet, the condition worsens in spring and summer, and improves in autumn and winter. Due to yin-cold, essence spontaneously slips out; the limbs feel sore and emaciated, making walking impossible. Commentary by Xu Lingtai: "Suanxiao" should be read as "Suanshao," meaning soreness, hoarseness, and dejection. Marrow resides in the head and connects with the Juegu acupoint. The Juegu point is located on the lateral side of the tibia; therefore, those with insufficient brain marrow experience headache and inability to walk in the lower legs. The reason the condition worsens in spring and summer is that spring diseases manifest in the head. *Zhou Li* (Rites of Zhou) · Ji Yi (Physicians) records that in spring there are "Shouji" (head ailments). Zheng Xuan's commentary states: "Suanxiao"; Shouji refers to head diseases. Here, "Xiao" should also be written as "Xiao," serving as a phonetic loan for reduplication. *Shuowen Jiezi* explains: "Suanxiao" means headache. *Zhou Li* says: "In spring there are Suanxiao Shouji." This shares the same meaning as Zheng's commentary. Zheng's annotation separately explains the meaning of the three characters "Suanxiao Shouji," rather than dividing them into two separate symptom names. The five-character phrase in *Shuowen Jiezi*, "Suanxiao [is] headache," comprehensively describes the state. Jia Gongyan's subcommentary claims that besides headache, there is another ailment called Suanxiao, which is likely a misunderstanding of Zheng's intent. In *Shudu Fu*, it mentions "Wei Juan Li Suanxiao." The annotation states: "Suanxiao" means headache. This is also a misunderstanding of Xu Shen's original meaning. Through my own clinical observation of patients with Spring Warmth syndromes or catching wind in spring who suffered from headaches, none lacked accompanying soreness in the lower legs. The three characters "Suanxiao Shouji" in *Zhou Li* are indeed excellent descriptors of the pathological state. Xu Shen spoke from the perspective of the head, while Zhang Zhongjing spoke from the perspective of the lower legs; they differed only in the anatomical focus!
Ancient texts frequently mention "Xiali" (lower purging/diarrhea). "Xia" is the character for "Xie" (purging); "Li" implies smoothness or ease, and adding the "bing" (disease) radical creates the character "Li" (dysentery). The term Xiali shares its etymology with Tuli (vomiting and purging). If Tuli refers to forceful vomiting, then Xiali refers to forceful purging. Two classics sometimes refer to severe cases as "Dongxie" (cavity diarrhea) or "Changpi" (intestinal disorder). Wang Bing's commentary states that Changpi implies the opening of the anal gate, indicating the original character was "Pi," pronounced as such, referring to this disease as Xiali. What is described as Changpi discharging white mucus corresponds to modern white dysentery; Changpi discharging pus and blood corresponds to modern red-and-white dysentery; Changpi discharging blood corresponds to modern red dysentery or intestinal bleeding. In recent times, "Xia" has been differentiated as diarrhea, and "Li" as dysentery, so modern dysentery differs from ancient "Li." How could one know that modern dysentery is precisely the "Da Jia Xie" (Great Mass Diarrhea) among the Five Diarrheas in *Nanjing* (Classic of Difficult Issues)? *Nanjing* groups it with four other types under the general term "Xie," indicating that ancient "Xia" encompassed modern "Li." Zhang Zhongjing's works merely add the term "Houzhong" (tenesmus/feeling of incomplete evacuation) to distinguish it, without establishing a new name. During the Sui and Tang dynasties, it was sometimes called "Zhixia" (stagnant downward flow) or "Chongxia" (heavy downward flow), never departing from the character "Xia," thus preserving ancient meanings. Xu's *Guifan* generally equates Changpi with intestinal bleeding, categorizes all Five Diarrheas from *Nanjing* under simple diarrhea, and categorizes all of Zhang Zhongjing's Xiali under dysentery. At this, one cannot help but sigh at the difficulty of discussing ancient medical concepts!