此一卷论痰证、食积、虚烦、香港脚。与伤寒相似。实非伤寒也。所谓朱紫相陵。玉石不分。医
者处病灭裂。见其发热恶寒。往往作伤寒治之。发汗吐下。因兹夭横者多矣。今特立一门。别而论
之、庶几览者知其非伤寒也。
（五十一） 问憎寒发热。恶风自汗。寸口脉浮。胸膈痞满。气上冲咽喉不得息。而头不疼。项不强。
此为有痰也。中脘有痰。亦令人憎寒发热。胸膈痞满。有类伤寒。但头不疼。项不强为异。
宜服柴胡半夏汤、（杂六二）金沸草散、（杂六三）大半夏汤。（杂六四）若气上冲咽喉不得息者
。用瓜蒂散吐之。古法服瓜蒂散。（正百十一）凡服一钱匕。药下使卧。欲吐且忍之。良久不吐。取三
钱匕汤二合和服。以手指 之便吐矣。不吐复稍增之。以吐为度。若吐少病不除。明日如前法再服
之。可至再三。不可令人虚也。药力过时不吐者。啜热汤一升。以助药力。吐讫。便可食。无复余
毒。若服药过多者。饮水解之。
（五十二） 问头疼脉数。发热恶寒。而身不痛。左手脉平和。
此名食积也。伤食亦令人头痛。脉数发热。但验左手人迎脉平和。身不疼痛者是也。甲乙经云
。人迎紧盛伤于寒。气口紧盛伤于食。左手关前一分者。人迎之位也。右手关前一分者。气口之
位也。盖人迎主外。气口主中。以此别之。伤食之证。由脾胃伏热。因食不消。发热似伤寒。
却身不疼痛。此为异耳。若膈实呕吐者。食在上脘。宜吐之。若心腹满痛者。
宜下之治中汤（杂百十五）五积散、（杂廿一）黑神丸、（杂六七）可选而用也。
（五十三） 问不恶寒身不痛。头不疼。脉不紧。但烦热者。
此名虚烦也。诸虚烦热。与伤寒相似。然不恶寒。身不疼痛。故知非伤寒也。不可发汗。头
不痛。脉不紧数。故知非里实也。不可下。如此者。内外皆不可攻。攻之必遂损竭多死也。此虚
烦。但当与竹叶汤。（正九五）若呕者与橘皮汤（杂三十七）一剂不愈。再与之。孙真人云。此法
数用甚有效。伤寒虚烦。亦宜服之。王叔和云。有热不可大攻之。热去则寒起。正宜服竹叶汤。
（五十四） 问伤寒头疼身热。支节痛。大便秘。或呕逆而脚屈弱者。
此名香港脚也。伤寒只传足经。不传手经。地之寒暑风湿皆作蒸气。足常履之。遂成香港脚。所以
病证与伤寒相近。其脉浮而弦者。起于风。濡而弱者起于湿。洪而数者起于热。迟而涩者起
于寒。风者汗而愈。湿者温而愈。热者下而愈。寒者熨而愈。香港脚之病。始得不觉。因他病乃
知。毒瓦斯入心。则小腹顽痹不仁。令人呕吐。死在朝夕矣。然终是与伤寒不同者。孙真人云。卒
起脚屈弱不能转动。有此为异耳。要之有香港脚之人。先从脚起。或先缓弱疼痹。（寒气胜者为痛痹
。有寒故痛也）或行起忽倒。或两胫肿痛。（亦有不肿者）或脚膝枯细。或心中忪悸。或小腹
不仁。（病久入深。营卫之行涩。皮肤不茱。故为不仁。不仁者。皮顽不知有无也）或举体转
筋。或见食呕逆。恶闻食气。或胸满气急。或遍体酸痛。皆香港脚候也。黄帝所谓缓风湿痹是也。顽
弱名缓风。疼痛为湿痹。（痹者闭也。闭而不仁。故曰痹也）寒中三阳。所患必冷。越婢汤（杂
六五）小续命汤（杂五七）主之。（小续命煎汤成。旋入生姜自然汁最快）暑中三阴。所患必
热。（小续命汤去附子减）桂一半。（大烦躁者。紫雪最良）大便秘者。脾约丸。（杂六十六）
神功丸。（杂六八）五柔丸。
（杂六九）大三脘散。（杂七十）木瓜散。（杂七三）主之。（香港脚之疾。皆由气实。而始终无一
人以服药致虚而殂者）头痛身热。肢节痛而脚屈弱者。是其人素有香港脚。此时发动也。脚肿者
。槟榔散主之（杂七十一）香港脚方论、千金。外台、最详。此不复叙。大抵越婢汤、小续命汤、薏苡
仁酒法、（杂七二）脾约神功丸。皆要药也。仍针灸为佳。服补药与用汤淋洗者。皆医之大禁也。
这一卷论述痰证、食积、虚烦、香港脚（脚气病）。这些病症与伤寒相似，但实际上并非伤寒。这正如朱紫混杂、玉石难辨。医生诊治疾病时草率马虎，见到患者发热恶寒，往往当作伤寒来治疗，采用发汗、催吐、泻下等法，因此导致许多患者夭折横死。现在特别设立一门，单独加以论述，希望阅读者能知道它们不是伤寒。
（五十一） 问：憎寒发热，恶风自汗，寸口脉浮，胸膈痞满，气上冲咽喉导致呼吸不畅，但头不疼，项不强。这是有痰。中脘部位有痰，也会让人憎寒发热，胸膈痞满，症状类似伤寒。只是头不疼、项不强作为区别。适宜服用柴胡半夏汤、金沸草散、大半夏汤。如果气上冲咽喉导致呼吸不畅的，用瓜蒂散催吐。古法服用瓜蒂散，每次服一钱匕的药粉，药服下后让患者躺卧，想吐的时候暂且忍住。过了很久还不吐，取三钱匕的药粉加入二合汤剂混合服用，用手指探喉促使呕吐。如果不吐再稍微增加剂量，以吐出为限度。如果吐得少病未除，第二天按前法再服，可以重复两三次，不可让患者身体虚弱。药力过时仍不吐的，喝热汤一升，以助药力。吐完后，就可以进食，没有残留毒性。如果服药过多，饮水解毒。
（五十二） 问：头疼脉数，发热恶寒，但身不痛，左手脉平和。这叫食积。伤食也会导致头痛、脉数发热，只要验证左手人迎脉平和，身体不疼痛的就是食积。《甲乙经》说：人迎脉紧盛是伤于寒，气口脉紧盛是伤于食。左手关前一分处，是人迎脉的位置；右手关前一分处，是气口脉的位置。大概人迎主外感，气口主内伤。以此辨别。伤食的证候，是由于脾胃伏热，因食物不消化，发热似伤寒，但身体不疼痛，这就是不同之处。如果膈实呕吐的，说明食在上脘，宜用吐法。如果心腹满痛的，宜用下法，可选用治中汤、五积散、黑神丸等治疗。
（五十三） 问：不恶寒身不痛，头不疼，脉不紧，只是烦热的。这叫虚烦。各种虚烦热，与伤寒相似，然而不恶寒，身体不疼痛，所以知道不是伤寒。不可发汗。头不痛，脉不紧数，所以知道不是里实证。不可泻下。像这样的，内外都不可攻伐，攻伐必然导致损耗枯竭，多会死亡。这种虚烦，只应当给予竹叶汤。如果呕吐的给予橘皮汤。一剂无效，再给一剂。孙真人说，此法多次使用非常有效。伤寒虚烦，也适宜服用。王叔和说，有热不可大攻之，热去则寒起，正适宜服用竹叶汤。
（五十四） 问：伤寒头疼身热，支节痛，大便秘，或呕逆而脚屈弱。这叫香港脚（脚气病）。伤寒只传足经，不传手经。地上的寒暑风湿都化作蒸气，脚经常踩踏接触，遂成香港脚。所以病证与伤寒相近。其脉浮而弦的，起于风；濡而弱的起于湿；洪而数的起于热；迟而涩的起于寒。风邪导致的用汗法痊愈，湿邪导致的用温法痊愈，热邪导致的用下法痊愈，寒邪导致的用熨法痊愈。香港脚病，刚开始不觉察，因为其他病才知晓。毒瓦斯入心，则小腹顽痹不知痛痒，令人呕吐，早晚就会死亡。然而终究与伤寒不同的是，孙真人说，突然发作脚屈弱不能转动，以此为异。总之有香港脚的人，先从脚起，或者先缓弱疼痹。（寒气胜者为痛痹，因为有寒所以痛）或者行走突然跌倒，或者两胫肿痛。（也有不肿的）或者脚膝枯细，或者心中忪悸，或者小腹不仁。（病久入深，营卫之行涩滞，皮肤不荣，故为不仁。不仁者，皮顽不知有无也）或者全身转筋，或者见食呕逆，厌恶闻食气，或者胸满气急，或者遍体酸痛，都是香港脚的征候。黄帝所说的缓风湿痹就是这类。顽弱叫缓风，疼痛叫湿痹。（痹者闭也，闭而不仁，所以叫痹）寒中三阳，所患必定冷，越婢汤、小续命汤主治。（小续命汤煎好汤后，随即加入生姜自然汁最快）暑中三阴，所患必定热。（小续命汤去掉附子减半桂枝）大便秘的，脾约丸、神功丸、五柔丸、大三脘散、木瓜散主治。（香港脚之疾，皆由气实，而始终无一人因服药致虚而死）头痛身热，肢节痛而脚屈弱的，是其人素有香港脚，此时发动。脚肿的，槟榔散主治。香港脚方论，《千金方》、《外台秘要》最详细，这里不再叙述。大致越婢汤、小续命汤、薏苡仁酒法、脾约神功丸，都是要药。仍然针灸为佳，服用补药与用汤淋洗的，都是医家的大禁。
This volume discusses Phlegm Syndrome (Tan Zheng), Food Stagnation (Shi Ji), Deficiency Irritability (Xu Fan), and Hongjiao (Foot Qi Disease). These conditions resemble Taiyang Cold Damage (Taiyang Shanghan) but are actually not Taiyang Cold Damage. This is akin to mixing purple with red or jade with stone. Physicians often treat diseases carelessly; upon seeing fever and aversion to cold, they frequently treat it as Taiyang Cold Damage, employing sweating, vomiting, or purging methods, resulting in many premature deaths. Now, a specific section is established to discuss these separately, hoping that readers will understand they are not Taiyang Cold Damage.
(51) Question: Aversion to cold with fever, aversion to wind with spontaneous sweating, floating pulse at the Cun Kou position, fullness and obstruction in the chest and diaphragm, qi rushing up to the throat causing dyspnea, yet no headache and no stiffness of the neck. This indicates the presence of Phlegm. Phlegm in the Zhongwan area can also cause aversion to cold with fever and chest/diaphragmatic fullness, resembling Taiyang Cold Damage. The distinguishing feature is the absence of headache and neck stiffness. It is appropriate to administer Chaihu Banxia Tang (Bupleurum and Pinellia Decoction), Jinfeicao San (Boilweed Powder), or Banxia Houpo Tang (Pinellia and Magnolia Bark Decoction). If qi rushes to the throat causing dyspnea, use Gengti San (Melon Seed Powder) to induce vomiting. According to ancient methods, take one qianbi dose of Gengti San powder. After ingestion, have the patient lie down. If the urge to vomit arises, restrain it temporarily. If vomiting does not occur after a long time, mix three qianbi doses of the powder with two he of decoction and drink it. Use a finger to stimulate the throat to induce vomiting. If it does not work, slightly increase the dosage until vomiting occurs. If little is vomited and the disease persists, repeat the method the next day, up to two or three times, without causing excessive debility. If the drug's potency passes without vomiting, drink one sheng of hot water to assist the drug's action. After vomiting, eating is permitted as there is no residual toxicity. If too much medicine is taken, drink water to detoxify.
(52) Question: Headache with rapid pulse, fever and aversion to cold, but no body pain, and a normal pulse on the left hand. This is named Food Stagnation (Shi Ji). Damaging food can also cause headache, rapid pulse, and fever. However, if the Renying pulse on the left hand is normal and the body is not painful, it is confirmed as Food Stagnation. The *Jia Yi Jing* states: "A tight and full Renying pulse indicates damage by cold; a tight and full Qikou pulse indicates damage by food." The position one-fen anterior to the Guan position on the left hand is where the Renying pulse is located; the corresponding position on the right hand is where the Qikou pulse is located. Generally, Renying governs external factors, while Qikou governs internal factors. Thus, differentiation is made. Food stagnation syndrome arises from latent heat in the Spleen and Stomach due to undigested food, causing fever similar to Taiyang Cold Damage, but distinguished by the absence of body pain. If there is fullness in the diaphragm with vomiting, indicating food in the upper Jiao, vomiting therapy is indicated. If there is abdominal fullness and pain, purgative therapy is indicated. Zhi Zhong Tang (Regulate the Middle Decoction), Wuji San (Five Accumulations Powder), or Heishen Wan (Black Divine Pill) may be selected for treatment.
(53) Question: No aversion to cold, no body pain, no headache, no tight pulse, only irritability and heat. This is named Deficiency Irritability (Xu Fan). Various forms of deficiency irritability and heat resemble Taiyang Cold Damage. However, since there is no aversion to cold and no body pain, it is known not to be Taiyang Cold Damage. Sweating therapy is contraindicated. Since there is no headache and the pulse is not tight or rapid, it is known not to be an interior excess syndrome. Purging therapy is contraindicated. In such cases, neither exterior nor interior attacks should be used; attacking them will inevitably lead to depletion and death. For this type of deficiency irritability, only Zhuye Tang (Bamboo Leaf Decoction) should be given. If vomiting is present, Ju Pi Tang (Tangerine Peel Decoction) is given. If one dose is ineffective, administer another. Sun Simiao stated that this method has been highly effective when used repeatedly. Deficiency irritability in Taiyang Cold Damage is also suitable for this treatment. Wang Shuhe stated: "When heat is present, do not attack it heavily; once the heat is removed, cold will arise." Therefore, Zhuye Tang is precisely indicated.
(54) Question: Taiyang Cold Damage with headache, body heat, joint pain, constipation, or vomiting/retching accompanied by weak and flexed feet. This is named Hongjiao (Foot Qi Disease). Taiyang Cold Damage transmits only through the Foot meridians, not the Hand meridians. The cold, heat, wind, and dampness of the earth transform into vapors, and since the feet constantly tread upon them, Hongjiao develops. Consequently, its symptoms are similar to Taiyang Cold Damage. A floating and wiry pulse originates from Wind; a soggy and weak pulse originates from Dampness; a surging and rapid pulse originates from Heat; a slow and choppy pulse originates from Cold. Conditions caused by Wind are cured by sweating; those by Dampness by warming; those by Heat by purging; those by Cold by moxibustion/warming applications. Hongjiao disease is initially imperceptible and is recognized only when other illnesses appear. If toxic vapors enter the Heart, the lower abdomen becomes numb and insensible, leading to vomiting, and death may occur within a day or night. However, it ultimately differs from Taiyang Cold Damage. Sun Simiao noted that sudden onset of foot weakness and inability to move is a distinguishing feature. In summary, Hongjiao begins in the feet, presenting initially as flaccidity, weakness, pain, or numbness. (Painful numbness caused by excess Cold is called Tong Bi, painful because of Cold). Or sudden collapse while walking, or swelling and pain in both calves (sometimes without swelling). Or withered and thin feet and knees, or palpitations, or insensibility in the lower abdomen. (Long-standing disease penetrates deeply, causing sluggish circulation of Ying and Wei fluids, leading to malnourished skin and insensibility. Insensibility means the skin is dull and lacks sensation). Or generalized muscle spasms, or nausea/vomiting upon seeing food or smelling food odors, or chest fullness and急促 breathing, or generalized body ache. All are signs of Hongjiao. This corresponds to Huangdi's description of Huan Feng Shi Bi (Flaccid Wind-Damp Obstruction). Flaccidity is called Huan Feng; pain is called Shi Bi. (Bi means obstruction; obstruction leads to insensibility, hence Bi). When Cold invades the Three Yang meridians, the condition is necessarily cold; Yuebi Tang (Ephedra and Gypsum Decoction) and Xiao Xuming Tang (Minor Continuation of Life Decoction) are indicated. (For Xiao Xuming Tang, adding fresh ginger juice immediately after decoction is fastest). When Summer-Heat invades the Three Yin meridians, the condition is necessarily heat. (Reduce Guizhi by half in Xiao Xuming Tang and remove Fuzi). For severe restlessness, Zixue (Purple Snow) is best. For constipation, Piyue Wan (Spleen Restriction Pill), Shengong Wan (Divine Merit Pill), Wuru Wan (Five Softness Pill), Dasanwan San (Great Three Abdomen Powder), or Mugua San (Papaya Powder) are indicated. (Hongjiao diseases stem from Qi excess, and historically no one died from becoming deficient due to medication). Headache, body heat, joint pain, and weak feet indicate that the person had pre-existing Hongjiao which is now activated. For swollen feet, Binglang San (Areca Nut Powder) is indicated. Discussions on Hongjiao formulas in *Qianjin Fang* and *Waitai Miyao* are most detailed and are not repeated here. Generally, Yuebi Tang, Xiao Xuming Tang, Yiyiren Jiu Fa (Coix Seed Wine Method), Piyue Wan, and Shengong Wan are essential medicines. Acupuncture and moxibustion are preferred. Taking tonifying medicines or using herbal washes are major taboos in medical practice.