此一卷，首论恶寒。大抵太阳病，必发热而恶寒。恶寒家，慎不可过当覆衣被
及近火气，寒热相搏，脉道沉伏，愈令病患寒不可遏。但去被撤火，兼饮以和表之药，自然
不恶寒矣。妇人恶寒，尤不可近火，寒气入腹，血室结聚，针药所不能治矣。
（六十三）问恶寒
恶寒有二证∶发热而恶寒者，发于阳也；无热而恶寒者，发于阴也。发于阳者，
宜解表，脉必浮数，属桂枝汤（正方一）、桂枝二越婢一汤（正四）、麻黄汤（正方二十）、青龙汤（正方三十六）证也；
发于阴者宜温里，脉必沉细，属理中汤（正方七十四）、四
者可治，宜建中汤（正方三十七）；若少阴病恶寒而蜷，时时自烦，不欲浓衣，用大柴胡汤下之。（正方三十）若发热微
恶寒者，属柴胡桂枝汤也（正方三十一）。发汗后反恶寒者，虚故也，属芍
而恶寒者，此阴阳俱虚也，不可更吐下也。发汗面色赤有热者，为欲解，宜桂枝麻黄各半汤。（正方二）
伤寒大下后，复发其汗，心下痞，恶寒者，表未解也，不可攻其
痞，当先解表，表解乃可攻痞，解表宜桂枝汤（正方一），攻痞大黄黄连
泻心汤（正方五十九）。虽然，太阳、阳明、少阴，皆有恶寒，要之，太阳病
或已发热，或未发热，必恶寒也。阳明证俱宜下，唯恶寒中寒为病在经，与太阳合病属表
发其汗耳。若吐、若下后，七八日不解，热结在里，表里俱热，时时恶寒者，白虎证也（正方六十四）
。又问∶有汗出恶寒者，有汗出多而微恶寒者，有头汗出而微恶寒
者，何也？仲景云∶太阳病，其人发热汗出，复恶寒不呕，但心下痞者，此以医下之也；心
下痞而复恶寒汗出者，附子泻心汤主之（正方六十）。阳明病脉迟汗出多，
恶寒者，表未解也，可发汗，宜桂枝汤也。（正方一）头汗出而微恶寒者
，属少阳，宜小柴胡汤也。（正方二十九）又问∶背恶寒者何也？背恶寒
有两证∶三阳合病背恶寒者，口中不仁，口燥舌干也；少阴病背恶寒者，口中和也，以
之。口中不仁、口燥舌干而背恶寒者，白虎加人参汤主之；（正六十五）
口中和而背恶寒者，附子汤主之，（正方六八）仍灸之（仲景云∶少阴病得之一二日，口中
和，其背恶寒者，当灸之，附子汤主之）。
（六十四）问恶风
恶风者，卫中四时之虚风，所以恶风也，其人当汗出而脉缓也。数与桂枝汤（正方一）、桂
枝加葛根汤（正方十八），使遍体微润连日
当自解矣。又有太阳病发汗多，亡阳遂漏不止，卫虚而恶风者，当温其经也。其人恶风，
小便难，四肢微急，难以屈伸者，桂枝加附子也（正方六）。若伤寒四
五日，身热恶风，颈项强，胁下满，手足温而渴者，小柴胡汤也（正方二十九）。风湿相搏，
骨节疼烦，掣痛不得屈伸，汗出短气，小便不利，恶风不欲去衣，
或身微肿者，甘草附子汤主之。（正方二十二）
（六十五）问伤寒不得汗
《甲乙经》云∶热病脉常躁盛而不得汗者，此阳脉之极也，死；脉盛躁而得汗
者，生。大抵伤寒营卫俱病则无汗，麻黄汤（正方二十）、葛根汤（正方二十六）、
大青龙汤（正方三十五）、葱豉汤（杂方七十四）可选而用之。若伤寒连服汤剂而汗不出者，死。如中风
法。蒸之，温热之气于外迎之，无不得汗也。薪火烧地良久，扫除去火，可以水洒之
，取蚕沙、柏叶、桃叶、糠麸皆可用，相和，铺烧地上，可侧手浓，上铺席，令病患当上卧
，温覆之；夏月热，只布单覆之，汗移时立至，俟周身至脚心皆汗
，乃用温
粉扑止汗，
移上床。最得力者，蚕沙、桃、柏叶也；无蚕沙亦得，单桃叶亦得，蒴藿亦可；用麸糠，乃
助添令多尔；不用亦得。伤寒亦有气虚不能作汗者。仲景云∶脉浮而迟，迟为无
阳，不能作汗，其身必痒，宜桂枝麻黄各半汤主之（正方二），阳明病法多汗，反无汗，如虫行
皮中状者，此久虚故也，宜术附汤（正方七十）、黄 建中汤（正方三十七）。
（六十六）问自汗
伤寒无汗者七证，自汗者九证。太阳伤寒、刚 病、太阴病、少阴病、厥阴病、阴
易病、冬阳明病，皆无汗（凡少阴证无汗，类麻黄汤之证，然类麻黄证。脉阴阳
俱紧，少阴脉微细为异也。又汗出为阳微。故仲景云∶阴不得有汗，脉阴阳俱紧而反汗出为
亡阳，属少阴经也）。汗出者九证，卫不和自汗。病患脏无他病，时发
热自汗出而不愈者，卫不和也，先其时发汗则愈，属桂枝也。（正方一）太阳病发热汗出者，
此为营弱卫强，故汗出，欲救风邪者，宜桂枝汤。又云∶病常自汗出者，此为营气和，营气
和
者外不谐也，以卫气不共营气谐故尔，以营行脉中，卫行脉外，复发其汗，营卫和则愈。
伤风自汗。太阳病，发热汗出恶风，脉缓为中风，属桂枝汤（正方一）。又云∶太
阳病，项背强几几，反汗出恶风，桂枝加葛根汤（正方十八）主之。汗出而渴者，五
苓散；（正方六十六）不渴者，茯苓甘草汤。（正五十三）虽然，仲景云∶伤风自汗，用桂枝
然桂枝汤难用，须是仔细消息之。假令伤风自汗，若脉浮而弱，设当行桂枝汤，服后无桂枝
脉息证候而烦者，即不可再服也；若伤风自汗出而小便数者，切不可与桂枝也。仲景云∶太
阳病自汗，四肢拘急，难以屈伸，若小便难者，可桂枝汤内加附子服之；（正方六）若小便数
者，慎不可与桂枝附子汤，宜服芍药甘草汤；（正方五七）若误行桂枝附子攻表，便咽干烦燥
，厥逆呕吐，作甘草干姜汤（正五十五）与之，以复其阳；若厥愈足温，更作芍药甘草汤与之，
其脚即伸；若胃气不和谵语者，与调胃承气汤（正四十三），微溏则止其谵语，缘芍药甘草汤
主脉浮自汗，小便数者，寸口脉浮为风，大为温风则生微热，虚则两胫挛，小便数，仍汗
出，为津液少，不可误用桂枝，宜服芍药甘草补虚退风热通治。误服桂枝汤后。病证仍存
者，风温自汗。太阳病发热而渴，不恶寒者，为温病；若发汗已，身灼
名风温。风温为病，脉阴阳俱浮，自汗出，身重多眠睡，鼻息必鼾，语言难，属葳蕤汤，（杂四十五）
中湿自汗（《难经》云∶何以知伤湿得之？然当喜汗出，不可
止。何以言之？肾主湿，故知肾入心为汗出不可止也），中暑自汗（太
阳中热者， 是也，其人汗出恶寒，身热而渴，属白虎汤），（正六十四）阳明病自汗
不恶寒，反恶热， 然汗自出者，属阳明也。若阳明病汗出
多而渴者，不可与五苓散，以汗多胃
中燥，猪苓复利其小便故也。故仲景云∶阳明病发热汗多者，急下之，阳明病其人汗多，以
津液外出，胃中燥，大便必硬，谵语者，属调胃承气汤（正四十三）。虽然，阳明汗多急下，若
小便自利者，此为津液内竭，虽尔不可攻之，须自大便导之，宜用蜜煎导法。（正一百十二）
阳明病汗出而脉迟，微恶寒者，表未解也，宜桂枝汤。（正方一）阳明法多汗则脉浮，无汗而喘
者，发汗则愈，宜麻黄汤，（正方二十）亡阳自汗太阳病发汗多，遂
漏不止，其人恶风，当温其经，宜桂枝加附子汤。（正方六）伤寒尺寸脉俱紧而汗出者，亡阳
也，此属少阴，法当咽痛而复吐利，其人热不去，内拘急，四肢疼，厥逆而恶寒者，四逆汤
主之。汗多不止者，可用温粉扑之。若汗多不止，必恶风烦躁，不得卧者，先服
防风白术牡蛎汤（杂二），次服小建中汤，（正三十七）柔 自汗（太阳
病发热，脉沉细，摇头口噤，背反张，汗出而不恶寒者，名柔
，小续命汤主之也），（杂五十七）霍乱自
汗（吐利汗出，发热恶寒，四肢拘急，手足厥冷者，四逆汤
主之）。（正七十五）虽然，少阴不得有汗，而少阴亦有反自汗出之证（
阴证四肢逆冷，额上及手背冷汗 者，亡阳也）。阳明病法多
汗，而阳明亦有反无汗之证，不可不
（六十七）问头汗出
病患表实里虚，玄府不开，则阳气上出，汗见于头。凡头汗出者，五内干枯，胞中空虚，津液少也，慎不可下，下
之者谓之重虚。然头汗出者，有数证∶伤寒五六日，头汗出，微恶寒，手足冷，心下满，口不欲食，大便硬，脉细者，
此为阳微结，必有表复有里也。脉沉亦有里也，汗出为阳微，假令纯阴结，不得复有外证，悉入在里，此为半在里半在
外也。脉虽沉紧，不得为少阴病，所以然者，阴不得有汗，今头汗出，故知非少阴也（小柴胡汤主之）。（正二十九）伤
寒
五六日，已汗下，胸胁满微结，小便不利，渴而不呕，但头汗出，往来寒热，心烦者，此表未解也（柴胡桂枝干姜汤主
之）。
（正方三十二）病患但头汗出，身无汗，剂颈而还，小便不利，渴引水浆者，此为瘀热在里，身必发黄。五苓散（正六
十六）、茵陈汤（正方九十三）。阳明病下之，其外有热，手足温，不结胸，心中懊 ，饥不能食，但头汗出者（栀子豉
汤主之）。（正四十五）
心下紧满，无大热，头汗出者。茯苓汤主之。（杂八十四）仲景云∶伤
寒心下紧满，无大热，但头汗出者，此名为水结在胸胁，以头汗出，别水结证，小半夏加茯
苓汤（杂方八十二）。阳明病，下血谵语者，为热入血室，但头汗出者，刺期门，随
其实而泻之，汗出则愈。汗出谵语者，有燥屎也，过经乃可下也；下之早，语言
必乱，以表实里虚故也。
（六十八）问头疼
头疼者，阳证也。太阳证头疼，必发热恶寒，无汗者，麻黄汤（正方二十）；有汗者，桂枝汤
。若已发汗，或未发汗，头痛如破者，连须葱白汤；（杂七十五）
服汤不止者，葛根葱白汤主之。（杂七十六）脉
弦细头痛发热者，属少阳也，少阳不可发汗，小柴胡主之。（正二十九）阳
明证，头疼，不恶寒，反恶热，胃实故也，阳明气实，故攻头也，调胃承气汤（正四十三）主
之。仲景云∶伤寒不大便，六七日头疼有热者，与承气汤，其小便
清者，知不在里，续在表也，当须发汗；若头疼者必衄，属桂枝汤（正方一）。太阴、少阴经从足至胸，俱不至头，唯
厥阴经挟胃，属肝，络胆，循喉咙，上颃颡，连目
，出额，故太阴、少阴并无头疼之证，仲景只有厥阴一证吴茱萸汤，（正方一百）
治干呕、吐涎沫、头疼而已。大抵属三阳者，头疼为多也。孙真人云∶阳伤寒者
，体热头疼是也；阴伤寒者，不壮热，不头痛是也。若非次头疼，胸中满，及发
寒热，
脉紧而不大者，即是膈上有涎，宜用瓜蒂末一钱暖水调下，吐涎立愈，又问∶病患头疼鼻
塞而烦者，何证也？此属湿家，头中寒湿，故鼻塞而头疼也。内瓜蒂末鼻中。则愈，
法在发黄门中。
（六十九）问身体痛（身痒附）
太阳、少阴、厥阴皆有身体痛，当以外证与脉别之。太阳证表未解，脉浮紧，法
当
宜以汗解；假令尺脉迟者，不可发汗，何以知其然，营气不足，血少故也。尺脉迟者，先以
小建中汤以养之；（正三十七）脉浮者，麻黄汤主之。太阳中湿，一身尽痛，发热
身黄，小便不利，病患中湿，因而伤风，风湿相搏，一身痛重，是名风湿，当于风湿中求之
（麻黄加术汤主之）。（杂方一百二十二）若脉沉自利而身体痛者，阴证
也，急当救里，宜四逆汤（正七十五）、附子汤（正六十八）、真武汤（一百五）之类以温
之（大抵大便利而身体
疼者，当救里；大便如常而身体痛者，急当救表，此不可不知也）。或身重背强，
腹中绞痛，咽喉不利，身如被杖者，当作阴毒治之。又问∶发汗后身疼痛，脉沉而迟，当
用何
药？仲景有桂枝加芍药生姜人参新加汤（正方十一），盖为此证也；小建
中汤（正三十七），兼治汗后身疼、脉沉而迟者；若霍乱吐泻止而身疼痛
不休者，少与桂枝汤（正方一）即愈。《金匮要略》云∶疮家虽身体痛，不可
发汗，汗出则 。又问∶身痒者，何也？脉
浮而迟，迟为无阳，不能作汗，其身必痒。太阳病
七八日，脉微而恶寒，以阴阳俱虚，不可更发汗、更下、更吐也。小柴胡汤主之
；若重反发汗，则气虚，必两耳聋无闻，素无热人，可芍药甘草附子汤；（正七十二）素有热
人，可黄 建中汤。（正三十七）
面赤有热者，未欲解也，以其不能得小汗出，身必当痒，宜桂枝麻黄各半汤。（正方二）
（七十）问筋惕肉 ，头眩身摇
太阳病发汗不解，发热心悸，头眩，身
欲擗地者，属真武汤（正一百五）。大凡发汗过多，即身 动振摇，虚羸之人
，微发汗，便有此证，俱宜服真武汤。羸甚者，去
芍
药，或少用之；有热证恶热药者，去附子，余根据本方加减法详之。伤寒若吐、若下后，心
下
逆满，气上冲胸，起则头眩，脉沉紧，发汗则动经，身为振摇者，茯苓桂枝白术甘草汤主之（正方五十二）
，伤寒应发汗，而动气在左，不可发汗，发汗则头眩汗出，
筋惕肉 ，此为逆，难治，且先服防风白术牡
这一卷首先论述恶寒。大抵太阳病，必定发热并且恶寒。患有恶寒症状的人，千万不要过度覆盖衣被以及靠近火源，否则寒热相互搏结，导致脉道沉伏，更加使得患者寒冷难以遏制。只要去掉衣被、撤去火源，同时服用调和表证的药物，自然就不会恶寒了。妇女出现恶寒，尤其不可靠近火源，否则寒气进入腹部，导致血室（子宫）气血结聚，这就不是针药所能治疗的了。
（六十三）问恶寒
恶寒有两种证候：发热而恶寒的，是发于阳经；不发热而恶寒的，是发于阴经。发于阳经的，适宜解表，脉象必然浮数，属于桂枝汤、桂枝二越婢一汤、麻黄汤、青龙汤的证候；发于阴经的适宜温里，脉象必然沉细，属于理中汤、建中汤的证候；如果是少阴病恶寒且身体蜷缩，时常自觉烦闷，但不想穿厚衣服，可用大柴胡汤攻下。如果发热轻微恶寒的，属于柴胡桂枝汤的证候。发汗后反而恶寒的，是因为虚损，属于阴阳俱虚，此时不可再用吐法或下法。发汗后面色发红且有热的，是病情将要解除的表现，适宜用桂枝麻黄各半汤。
伤寒经过猛烈攻下后，又再次发汗，心下部痞塞胀满，且恶寒的，说明表证未解，不可攻逐痞块，应当先解表，表证解除后才能攻逐痞块，解表适宜用桂枝汤，攻痞适宜用大黄黄连泻心汤。虽然如此，太阳、阳明、少阴三经都有恶寒症状，总之，太阳病无论是否已经发热，必定恶寒。阳明病证大多适宜攻下，唯独恶寒这种中寒的情况，是因为病邪在经脉，与太阳经合病属于表证，应当发汗。如果经过吐法或下法后，七八天病邪未解，热邪结聚在体内，表里都发热，时常恶寒的，是白虎汤的证候。
又问：有出汗而恶寒的，有出汗多而轻微恶寒的，有只有头部出汗而轻微恶寒的，这是什么原因？张仲景说：太阳病，患者发热出汗，又恶寒且不呕吐，只是心下部痞塞的，这是因为医生误用下法所致；心下部痞塞而又恶寒出汗的，用附子泻心汤主治。阳明病脉迟出汗多，恶寒的，说明表证未解，可以发汗，适宜用桂枝汤。只有头部出汗而轻微恶寒的，属于少阳病，适宜用小柴胡汤。
又问：背部恶寒是什么原因？背部恶寒有两种证候：三阳合病导致背部恶寒的，伴有口中感觉麻木不仁、口燥舌干；少阴病导致背部恶寒的，口中感觉平和正常。口中不仁、口燥舌干且背部恶寒的，用白虎加人参汤主治；口中平和正常且背部恶寒的，用附子汤主治，并配合艾灸。（张仲景说：少阴病得之一两天，口中平和正常，背部恶寒的，应当艾灸，并用附子汤主治。）
（六十四）问恶风
恶风，是指卫气受到四季虚风的侵袭，所以会恶风，患者应当出汗且脉象缓弱。多次给予桂枝汤、桂枝加葛根汤，使全身微微湿润连续几天，应当自然痊愈。又有太阳病发汗过多，导致阳气亡失从而汗漏不止，卫气虚弱而恶风的，应当温补经脉。患者恶风，小便困难，四肢轻微拘急，难以屈伸的，用桂枝加附子汤。如果伤寒四五天，身体发热恶风，颈项强直，胁下胀满，手足温暖且口渴的，用小柴胡汤。风湿相搏，骨节疼痛烦躁，牵掣疼痛不能屈伸，出汗短气，小便不利，恶风不想脱掉衣服，或者身体轻微浮肿的，用甘草附子汤主治。
（六十五）问伤寒不得汗
《甲乙经》说：热病脉象常躁动盛大而无汗的，这是阳脉的极点，主死；脉象盛大躁动而有汗的，主生。大抵伤寒营卫都生病则无汗，可选用麻黄汤、葛根汤、大青龙汤、葱豉汤来使用。如果伤寒连续服用汤剂而不出汗的，主死。如果用中风的方法治疗，进行熏蒸，让温热之气从外部迎导，没有不出汗的。用木炭烧地很久，扫去余火，可以洒水，取蚕沙、柏叶、桃叶、糠麸都可以使用，混合铺在烧热的地上，厚度可容纳一只手，上面铺席子，让患者躺在上面，温暖覆盖；夏季天气热，只铺单子覆盖，过一会儿汗立刻就会出来，等到全身直到脚心都出汗，然后用温粉扑止汗，再移到床上。最得力的是蚕沙、桃叶、柏叶；没有蚕沙也可以，单用桃叶也可以，蒴藿也可以；用麦麸糠，是为了帮助增加汗量罢了；不用也可以。伤寒也有气虚不能作汗的。张仲景说：脉浮而迟，迟代表无阳，不能作汗，身体必定瘙痒，适宜用桂枝麻黄各半汤主治。阳明病法度上多汗，反而无汗，像虫子在皮肤中爬行一样的感觉，这是因为久虚的缘故，适宜用术附汤、黄芪建中汤。
（六十六）问自汗
伤寒无汗的有七种证候，自汗的有九种证候。太阳伤寒、刚痉病、太阴病、少阴病、厥阴病、阴易病、冬季发生的阳明病，都无汗（凡是少阴证无汗，类似麻黄汤的证候，然而脉象阴阳俱紧，少阴脉微细是区别所在。另外出汗为阳微。所以张仲景说：阴证不得有汗，脉阴阳俱紧反而出汗的为亡阳，属于少阴经）。出汗的有九种证候，第一种是卫不和自汗。患者脏腑没有其他疾病，时常发热自汗出而不愈的，是卫气不和，应当在发作前发汗则痊愈，属于桂枝汤证。又说：太阳病发热出汗的，这是营弱卫强，所以出汗，想要救治风邪的，适宜用桂枝汤。又说：病时常自汗出的，这是营气调和，营气和者外在不和谐，因为卫气不与营气协调的缘故，因为营气行于脉中，卫气行于脉外，再次发汗，营卫调和则痊愈。
第二种是伤风自汗。太阳病，发热出汗恶风，脉缓为中风，属于桂枝汤证。又说：太阳病，项背强几几，反而出汗恶风，用桂枝加葛根汤主治。出汗而口渴的，用五苓散；不口渴的，用茯苓甘草汤。虽然如此，张仲景说：伤风自汗，用桂枝汤，然而桂枝汤难用，必须仔细斟酌。假如伤风自汗，如果脉浮而弱，假设应当用桂枝汤，服后如果没有桂枝汤的脉息证候而心烦的，就不可再服；如果伤风自汗出而小便频数的，切不可给桂枝汤。张仲景说：太阳病自汗，四肢拘急，难以屈伸，如果小便困难的，可在桂枝汤内加附子服用；如果小便频数的，千万不可给桂枝附子汤，适宜服芍药甘草汤；如果误用桂枝附子汤攻表，导致咽干烦躁，四肢厥逆呕吐，制作甘草干姜汤与之，以恢复其阳气；如果厥逆好转足部变暖，再制作芍药甘草汤与之，其脚就能伸展；如果胃气不和出现谵语的，给调胃承气汤，轻微腹泻则停止谵语，因为芍药甘草汤主治脉浮自汗，小便频数的情况，寸口脉浮为风，大为温风则生微热，虚则两小腿挛急，小便频数，仍然出汗，为津液少，不可误用桂枝，适宜服芍药甘草补虚退风热通治。误服桂枝汤后，病证仍存在的，第三种是风温自汗。太阳病发热而渴，不恶寒的，为温病；如果发汗后，身体灼热，名为风温。风温为病，脉阴阳俱浮，自汗出，身体沉重多眠睡，鼻息一定鼾声，语言困难，属于葳蕤汤证。
第四种是中湿自汗（《难经》说：怎么知道是伤湿得的？应当喜欢出汗，不可止住。为什么这样说？肾主湿，所以知道肾入心为汗出不可止也）。第五种是中暑自汗（太阳中热者，就是中暑，其人汗出恶寒，身热而渴，属白虎汤证）。第六种是阳明病自汗（不恶寒，反恶热，濈然汗自出的，属阳明病。如果阳明病出汗多而口渴的，不可与五苓散，因为汗多胃中燥，猪苓汤又会利其小便的缘故。所以张仲景说：阳明病发热汗多的，急下之，阳明病其人汗多，因为津液外出，胃中燥，大便必硬，谵语的，属调胃承气汤。虽然如此，阳明汗多急下，如果小便自利的，这是津液内竭，虽然这样也不可攻下，须自行大便导之，适宜用蜜煎导法）。第七种是阳明病汗出而脉迟，微恶寒的，表未解也，宜桂枝汤。第八种是亡阳自汗（太阳病发汗多，遂漏不止，其人恶风，当温其经，宜桂枝加附子汤。伤寒尺寸脉俱紧而汗出的，亡阳也，此属少阴，法当咽痛而复吐利，其人热不去，内拘急，四肢疼，厥逆而恶寒的，四逆汤主治。汗多不止的，可用温粉扑之。若汗多不止，必恶风烦躁，不得卧的，先服防风白术牡蛎汤，次服小建中汤）。第九种是柔痉自汗（太阳病发热，脉沉细，摇头口噤，背反张，汗出而不恶寒的，名柔痉，小续命汤主治）。第十种是霍乱自汗（吐利汗出，发热恶寒，四肢拘急，手足厥冷的，四逆汤主治）。虽然如此，少阴不得有汗，而少阴亦有反自汗出之证（阴证四肢逆冷，额上及手背冷汗出的，亡阳也）。阳明病法多汗，而阳明亦有反无汗之证，不可不察。
（六十七）问头汗出
患者表实里虚，玄府（汗孔）不开，则阳气上出，汗见于头。凡头汗出的，五脏内干枯，胞宫中空虚，津液少也，千万不可攻下，攻下的叫做重虚。然而头汗出的，有好几种证候：伤寒五六天，头汗出，微恶寒，手足冷，心下满，口不欲食，大便硬，脉细的，此为阳微结，必有表证又有里证。脉沉也有里证，汗出为阳微，假如纯阴结，不得再有外证，全部入在里，此为半在里半在外。脉虽沉紧，不得诊断为少阴病，之所以这样，是因为阴证不得有汗，现在头汗出，所以知道不是少阴病（用小柴胡汤主治）。伤寒五六天，已经发汗或攻下，胸胁满微结，小便不利，渴而不呕，但头汗出，往来寒热，心烦的，此为表未解（用柴胡桂枝干姜汤主治）。患者但头汗出，身无汗，仅到颈部而还，小便不利，渴引水浆的，此为瘀热在里，身体必发黄。用五苓散、茵陈汤。阳明病攻下后，其外有热，手足温，不结胸，心中懊恼，饥不能食，但头汗出的（用栀子豉汤主治）。心下紧满，无大热，头汗出的。用茯苓汤主治。张仲景说：伤寒心下紧满，无大热，但头汗出的，这名为水结在胸胁，以头汗出，辨别水结证，用小半夏加茯苓汤。阳明病，下血谵语的，为热入血室，但头汗出的，刺期门穴，随其实而泻之，汗出则愈。汗出谵语的，有燥屎也，过经才可攻下；攻下早了，语言必乱，因为表实里虚的缘故。
（六十八）问头疼
头疼者，是阳证。太阳证头疼，必发热恶寒，无汗的，用麻黄汤；有汗的，用桂枝汤。如果已经发汗，或未发汗，头痛如破的，用连须葱白汤；服汤不止的，用葛根葱白汤主治。脉弦细头痛发热的，属少阳也，少阳不可发汗，用小柴胡汤主治。阳明证，头疼，不恶寒，反恶热，胃实故也，阳明气实，故攻头也，用调胃承气汤主治。张仲景说：伤寒不大便，六七天头疼有热的，与承气汤，其小便清的，知不在里，续在表也，应当发汗；如果头疼的必衄血，属桂枝汤。太阴、少阴经从足至胸，都不至头，唯有厥阴经挟胃，属肝，络胆，循喉咙，上颃颡，连目系，出额，所以太阴、少阴并无头疼之证，张仲景只有厥阴一证吴茱萸汤，治干呕、吐涎沫、头疼而已。大抵属三阳的，头疼为多也。孙真人说：阳伤寒者，体热头疼是也；阴伤寒者，不壮热，不头痛是也。如果不是经常头疼，胸中满，及发寒热，脉紧而不大的，即是膈上有涎，适宜用瓜蒂末一钱暖水调下，吐涎立愈。又问：患者头疼鼻塞而烦的，什么证候？这属湿家，头中寒湿，所以鼻塞而头疼也。内瓜蒂末鼻中。则愈，法在发黄门中。
（六十九）问身体痛（身痒附）
太阳、少阴、厥阴皆有身体痛，应当以外证与脉别之。太阳证表未解，脉浮紧，法当宜以汗解；假如尺脉迟的，不可发汗，何以知其然，营气不足，血少故也。尺脉迟的，先以小建中汤以养之；脉浮的，麻黄汤主治。太阳中湿，一身尽痛，发热身黄，小便不利，病患中湿，因而伤风，风湿相搏，一身痛重，是名风湿，当于风湿中求之（用麻黄加术汤主治）。如果脉沉自利而身体痛的，阴证也，急当救里，宜四逆汤、附子汤、真武汤之类以温之（大抵大便通利而身体疼的，当救里；大便如常而身体痛的，急当救表，此不可不知也）。或者身重背强，腹中绞痛，咽喉不利，身如被杖的，当作阴毒治之。又问：发汗后身疼痛，脉沉而迟的，当用什么药？张仲景有桂枝加芍药生姜人参新加汤，盖为此证也；小建中汤，兼治汗后身疼、脉沉而迟者；如果霍乱吐泻止而身疼痛不休的，少与桂枝汤即愈。《金匮要略》说：疮家虽身体痛，不可发汗，汗出则痉。又问：身痒的，为什么呢？脉浮而迟，迟为无阳，不能作汗，其身必痒。太阳病七八日，脉微而恶寒，以阴阳俱虚，不可更发汗、更下、更吐也。用小柴胡汤主治；如果重反发汗，则气虚，必两耳聋无闻，素无热人，可芍药甘草附子汤；素有热人，可黄芪建中汤。面赤有热的，未欲解也，以其不能得小汗出，身必当痒，宜桂枝麻黄各半汤。
（七十）问筋惕肉瞤，头眩身摇
太阳病发汗不解，发热心悸，头眩，身欲擗地者，属真武汤。大凡发汗过多，即身动振摇，虚羸之人，微发汗，便有此证，俱宜服真武汤。羸甚者，去芍药，或少用之；有热证恶热药的，去附子，余根据本方加减法详之。伤寒若吐、若下后，心下逆满，气上冲胸，起则头眩，脉沉紧，发汗则动经，身为振摇的，茯苓桂枝白术甘草汤主治。伤寒应发汗，而动气在左，不可发汗，发汗则头眩汗出，筋惕肉瞤，此为逆，难治，且先服防风白术牡
This volume begins by discussing aversion to cold. Generally, Taiyang disease (disease of the Taiyang channel) must present with fever and aversion to cold. Patients with aversion to cold should absolutely not be excessively covered with clothes or bedding, nor brought near fire sources; otherwise, cold and heat will contend with each other, causing the pulse channels to sink and hide, making the patient's coldness even more unbearable. Simply remove the covers and fire sources, and simultaneously administer herbs that harmonize the exterior, and the aversion to cold will naturally cease. In women, aversion to cold should especially not be treated by bringing them near fire; otherwise, cold qi may enter the abdomen, causing stagnation in the Blood Chamber (uterus), which cannot be cured by acupuncture or herbs.
(63) Inquiry into Aversion to Cold
There are two types of aversion to cold: one accompanied by fever originates from Yang channels; one without fever originates from Yin channels. Those originating from Yang channels are suitable for releasing the exterior, with a pulse that is necessarily floating and rapid, belonging to the patterns of Guizhi Tang (Cinnamon Twig Decoction), Guizhi Er Yuebi Yi Tang (Two Parts Cinnamon Twig and One Part Green Dragon Decoction), Mahuang Tang (Ephedra Decoction), and Qinglong Tang (Green Dragon Decoction). Those originating from Yin channels are suitable for warming the interior, with a pulse that is necessarily deep and fine, belonging to the patterns of Lizhong Tang (Regulate the Middle Decoction) and Jianzhong Tang (Establish the Middle Decoction); if it is Shaoyin disease with aversion to cold and curling up, frequent self-irritation, but no desire for thick clothing, Dachi Hu Tang (Major Rhubarb Decoction) can be used to purge. If there is slight fever and slight aversion to cold, it belongs to Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction). If aversion to cold appears after sweating, it is due to deficiency, indicating both Yin and Yang are deficient, and emesis or purgation should not be used again. If the face becomes red and hot after sweating, it indicates the condition is about to resolve, and Guizhi Mahuang Ge Ban Tang (Half Cinnamon Twig and Half Ephedra Decoction) is suitable.
After severe purgation in Shanghan (Cold Damage) followed by sweating, if there is epigastric fullness and obstruction (Pi) and aversion to cold, the exterior pattern has not resolved. One must not attack the Pi; instead, resolve the exterior first. Once the exterior is resolved, then attack the Pi. To resolve the exterior, use Guizhi Tang; to attack the Pi, use Dahuang Huanglian Xiexin Tang (Rhubarb, Coptis, and Scutellaria Heart-Purging Decoction). Although Taiyang, Yangming, and Shaoyin all have aversion to cold, essentially, Taiyang disease always has aversion to cold, whether fever has appeared or not. Yangming patterns generally require purgation, except when aversion to cold occurs due to cold pathogen in the channels, combined with Taiyang as an exterior pattern, which requires sweating. If after emesis or purgation, the disease persists for seven to eight days, heat is bound internally, both interior and exterior are hot, and there is occasional aversion to cold, this is a Baihu Tang (White Tiger Decoction) pattern.
Another question: There are cases of sweating with aversion to cold, sweating profusely with slight aversion to cold, and only head sweating with slight aversion to cold. What is the cause? Zhang Zhongjing said: In Taiyang disease, if the patient has fever, sweating, aversion to cold, no vomiting, but only epigastric fullness, this is due to the physician's erroneous purgation; if there is epigastric fullness accompanied by aversion to cold and sweating, Fuzi Xiexin Tang (Aconite Heart-Purging Decoction) governs. In Yangming disease, if the pulse is slow, sweating is profuse, and there is aversion to cold, the exterior has not resolved, and sweating is permissible, using Guizhi Tang. If only the head sweats with slight aversion to cold, it belongs to Shaoyang, and Xiaochaihu Tang (Minor Bupleurum Decoction) is suitable.
Another question: What causes aversion to cold in the back? There are two patterns of back aversion to cold: In San Yang combined disease, back aversion to cold is accompanied by numbness in the mouth, dry mouth, and dry tongue; in Shaoyin disease, back aversion to cold is accompanied by a normal sensation in the mouth. For numbness in the mouth, dry mouth/tongue, and back aversion to cold, Baibu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) governs; for a normal mouth sensation and back aversion to cold, Fuzi Tang (Aconite Decoction) governs, along with moxibustion. (Zhang Zhongjing said: In Shaoyin disease, within one or two days, if the mouth feels normal and there is back aversion to cold, moxibustion should be applied, and Fuzi Tang governed.)
(64) Inquiry into Wind Aversion
Wind aversion (E Feng) occurs when the Defensive Qi (Wei Qi) is invaded by deficient winds of the four seasons. The patient should sweat and have a slow pulse. Repeatedly administering Guizhi Tang or Guizhi Jia Gegen Tang (Cinnamon Twig plus Kudzu Root Decoction) until the body is slightly moist for several days should lead to spontaneous resolution. Another case involves Taiyang disease where excessive sweating leads to Yang depletion and continuous leakage of sweat; due to deficient Defensive Qi and wind aversion, the meridians should be warmed. If the patient has wind aversion, difficulty urinating, slight stiffness in the four limbs making flexion and extension difficult, Guizhi Jia Fuzi Tang (Cinnamon Twig plus Aconite Decoction) is indicated. If Shanghan presents on the fourth or fifth day with body heat, wind aversion, neck stiffness, hypochondriac fullness, warm hands/feet, and thirst, Xiaochaihu Tang is indicated. When Wind-Dampness contends, causing painful joints, pulling pain preventing movement, sweating, shortness of breath, dysuria, wind aversion with reluctance to remove clothes, or slight edema, Gancao Fuzi Tang (Licorice and Aconite Decoction) governs.
(65) Inquiry into Shanghan Without Sweat
The *Jiayi Jing* states: In heat diseases, if the pulse is often restless and vigorous without sweat, this is the extreme of Yang pulses and indicates death; if the pulse is vigorous and restless but sweat appears, it indicates life. Generally, in Shanghan, if both Ying (Nutrient) and Wei (Defensive) levels are diseased, there is no sweat. Mahuang Tang, Gegen Tang (Kudzu Root Decoction), Da Qinglong Tang (Major Green Dragon Decoction), and Congchi Tang (Scallion and Fermented Soybean Decoction) can be selected. If Shanghan persists despite taking decoctions without sweating, it indicates death. Using the method for Wind Strike, fumigation can be employed: heat the ground with charcoal, sweep away the fire, sprinkle water, and spread a mixture of silkworm sand (Can Sha), cypress leaves (Bai Ye), peach leaves (Tao Ye), and bran. Lay a mat over this, place the patient on top, cover warmly; in summer, use a single sheet. Sweat will appear shortly. Once sweat reaches the soles of the feet, stop it with warm powder and move the patient to bed. Silkworm sand, peach leaves, and cypress leaves are most effective; either alone or in combination works. Bran helps increase sweat but is optional. Shanghan can also result from Qi deficiency failing to produce sweat. Zhang Zhongjing said: Floating and slow pulse indicates lack of Yang and inability to sweat, causing body itching; Guizhi Mahuang Ge Ban Tang governs. Yangming disease typically has much sweat; if there is no sweat and a sensation like insects crawling under the skin, it is due to chronic deficiency, and Shu Fu Tang (Atractylodes and Aconite Decoction) or Huangqi Jianzhong Tang (Astragalus Establish the Middle Decoction) is suitable.
(66) Inquiry into Spontaneous Sweating
There are seven patterns of no sweat in Shanghan and nine patterns of spontaneous sweating. Taiyang Shanghan, Gang Jing (Stiff Spasm), Taiyin, Shaoyin, Jueyin, Yin Yi (Yin Transformation), and Winter Yangming diseases all have no sweat. (Note: Shaoyin patterns without sweat resemble Mahuang Tang patterns, but the pulse differs: Shaoyin is micro and fine. Also, sweating indicates weak Yang. Thus, Zhang Zhongjing said: Yin patterns do not have sweat; if the pulse is tight on both sides yet sweating occurs, it is Yang depletion belonging to Shaoyin.)
The nine sweating patterns are:
1. Wei Disharmony Spontaneous Sweating: If the viscera are healthy but the patient has intermittent fever and spontaneous sweating that does not resolve, it is Wei disharmony. Sweating before the onset resolves it; Guizhi Tang governs. In Taiyang disease with fever and sweating, this is weak Ying and strong Wei. To rescue from wind pathogen, use Guizhi Tang. If the patient constantly sweats, it means Ying Qi is harmonious but discordant externally because Wei Qi does not harmonize with Ying Qi. Since Ying moves in the vessels and Wei moves outside, re-sweating harmonizes them.
2. Wind Strike Spontaneous Sweating: Taiyang disease with fever, sweating, wind aversion, and slow pulse is Wind Strike, governed by Guizhi Tang. If there is neck/back stiffness with sweating and wind aversion, Guizhi Jia Gegen Tang governs. If sweating with thirst, Wuling San (Five-Ingredient Powder with Poria) governs; if no thirst, Linggan Jiangzhi Tang (Poria, Licorice, Ginger, and Jujube Decoction) governs. Note: Guizhi Tang is difficult to use carefully. If the pulse is floating and weak, take Guizhi Tang; if restlessness occurs without the typical pulse/symptoms, do not repeat. If sweating with frequent urination, do not give Guizhi Tang. If Taiyang spontaneous sweating with limb stiffness and difficulty moving, and dysuria, add Fuzi to Guizhi Tang. If frequent urination, do not give Guizhi Fuzi Tang; use Shaoyao Gancao Tang (Peony and Licorice Decoction). If mistakenly using Guizhi Fuzi Tang causes dry throat, restlessness, cold limbs, and vomiting, give Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) to restore Yang. Once limbs warm, give Shaoyao Gancao Tang to extend legs. If stomach disharmony causes delirium, give Tiaowei Chengqi Tang (Harmonize the Stomach and Direct Downward Decoction) until slight stooling stops delirium. Shaoyao Gancao Tang treats floating pulse, spontaneous sweating, frequent urination, wind, warmth generating slight heat, deficiency causing calf cramps, and fluid shortage; do not misuse Guizhi.
3. Fengwen (Wind-Warmth) Spontaneous Sweating: Taiyang disease with fever, thirst, and no aversion to cold is Warm Disease. If sweating makes the body burning hot, it is named Fengwen. Fengwen has floating pulses on both sides, spontaneous sweating, heavy body, somnolence, snoring, and difficulty speaking; Zhirui Tang (Polygonatum Decoction) governs.
4. Shi (Dampness) Spontaneous Sweating: As per *Nan Jing*, dampness causes persistent sweating. Kidney governs dampness; kidney entering heart causes unstoppable sweating.
5. Zhongshu (Summerheat) Spontaneous Sweating: Taiyang Zhongre (Heat in Taiyang) causes sweating, wind aversion, body heat, and thirst; Baihu Tang governs.
6. Yangming Spontaneous Sweating: No aversion to cold, aversion to heat, and continuous sweating belong to Yangming. If sweating is profuse with thirst, do not give Wuling San because stomach dryness exists and Zhu Ling Tang would further drain fluids. Profuse sweating with delirium indicates dry feces; Tiaowei Chengqi Tang governs. However, if urination is free, fluids are exhausted internally; do not purge, use honey suppository (Mi Jian Dao). If Yangming sweating with slow pulse and slight aversion to cold, exterior is unresolved; Guizhi Tang governs. Yangming typically has sweating and floating pulse; if no sweat and wheezing, release exterior with Mahuang Tang.
7. Wang Yang (Yang Depletion) Spontaneous Sweating: Excessive sweating in Taiyang causes leakage and wind aversion; warm meridians with Guizhi Jia Fuzi Tang. Tight pulses on Cun/Chi with sweating in Shanghan indicate Yang depletion belonging to Shaoyin, likely with sore throat, vomiting, diarrhea, internal cramping, limb pain, cold limbs, and aversion to cold; Sini Tang (Frigid Extremities Decoction) governs. Use warm powder to stop profuse sweating. If profuse sweating continues with wind aversion, restlessness, and inability to lie down, first take Fangfeng Baizhu Muli Tang (Saposhnikovia, Atractylodes, and Oyster Shell Decoction), then Xiao Jianzhong Tang (Minor Establish the Middle Decoction).
8. Rou Jing (Soft Spasm) Spontaneous Sweating: Taiyang disease with fever, deep/fine pulse, head shaking, jaw clenching, opisthotonos, sweating without aversion to cold is Rou Jing; Xiao Xuming Tang (Minor Continuation of Life Decoction) governs.
9. Huoluan (Colic-Restlessness) Spontaneous Sweating: Vomiting, diarrhea, sweating, fever, wind aversion, limb stiffness, and cold limbs; Sini Tang governs.
Note: Shaoyin usually has no sweat, but reverse spontaneous sweating can occur (cold limbs, cold sweat on forehead/back indicates Yang depletion). Yangming usually has sweat, but reverse no sweat can occur.
(67) Inquiry into Head Sweating
When the exterior is excess and interior is deficient, pores do not open, Yang Qi ascends, and sweat appears on the head. Head sweating indicates dryness of the five viscera, emptiness of the Bladder/Uterus, and scanty fluids. Do not purge; purging causes double deficiency.
Patterns of head sweating:
1. After 5-6 days of Shanghan, head sweating, slight aversion to cold, cold hands/feet, epigastric fullness, anorexia, hard stool, and fine pulse indicate Yang Micro-Binding (Yang Wei Jie), having both exterior and interior aspects. Deep pulse indicates interior. Sweating indicates weak Yang. Pure Yin Binding would have no exterior signs. This is half-exterior, half-interior. Even with deep/tight pulse, it is not Shaoyin because Yin patterns do not sweat. Xiaochaihu Tang governs.
2. After 5-6 days, post-sweat/purge, chest/hypochondriac fullness with slight binding, dysuria, thirst without vomiting, only head sweating, alternating chills/fever, and irritability indicate unresolved exterior. Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction) governs.
3. Only head sweating, no body sweat up to the neck, dysuria, and thirst for drinks indicate stasis-heat in the interior leading to jaundice. Wuling San and Yinyin Tang (Artemisia Decoction) govern.
4. Post-Yangming purge, external heat, warm hands/feet, no Chest Bind, mental restlessness, hunger but inability to eat, only head sweating: Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) governs.
5. Epigastric tightness/fullness, no high heat, head sweating: Fuling Tang (Poria Decoction) governs. Zhang Zhongjing said: Epigastric tightness, no high heat, only head sweating indicates Water Binding in Chest/Hypochondrium. Xiaobanxia Jia Fuling Tang (Minor Pinellia plus Poria Decoction) governs.
6. Yangming disease with bleeding and delirium indicates Heat Entering the Blood Chamber. Only head sweating: puncture Qimen (LR14) to drain excess. Sweat indicates resolution. Delirium with sweating indicates dry feces; wait for the meridian cycle to pass before purging. Early purging causes speech disorder due to exterior excess and interior deficiency.
(68) Inquiry into Headache
Headache is a Yang pattern. Taiyang headache with fever, aversion to cold, and no sweat uses Mahuang Tang; with sweat uses Guizhi Tang. If headache is severe ("like breaking") regardless of prior sweating, Lianxu Congbai Tang (Scallion White Decoction) is used; if ineffective, Gegen Congbai Tang (Kudzu and Scallion White Decoction) governs. String-tight and fine pulse with headache/fever belongs to Shaoyang; do not sweat, use Xiaochaihu Tang. Yangming headache, no aversion to cold, aversion to heat, due to stomach excess: Tiaowei Chengqi Tang governs. Zhang Zhongjing said: Shanghan with constipation for 6-7 days, headache with heat: give Chengqi Tang. If urine is clear, the pathogen is still in the exterior; sweat it. If headache leads to nosebleed, Guizhi Tang governs. Taiyin and Shaoyin meridians do not reach the head; only Jueyin (Liver/Gallbladder) reaches the head. Thus, Taiyin/Shaoyin rarely have headaches. Zhang Zhongjing has one Jueyin pattern: Wuzhuyu Tang (Evodia Decoction) for dry heaving, spitting saliva, and headache. Generally, three Yang meridians cause most headaches. Sun Simiao said: Yang Shanghan has body heat and headache; Yin Shanghan has no high heat or headache. Sudden headache with chest fullness, chills/fever, and tight/small pulse indicates phlegm-fluid above the diaphragm; use Gengti Powder (Thladiantha Powder) with warm water to induce vomiting of phlegm. Headache with nasal congestion and irritability belongs to Dampness patterns (cold-damp in head); insert Gengti powder into the nose.
(69) Inquiry into Body Pain (Itching Attached)
Taiyin, Shaoyin, and Jueyin all have body pain; distinguish by exterior signs and pulse. Taiyang exterior unresolved with floating/tight pulse requires sweating. If Chi pulse is slow, do not sweat due to insufficient Ying Qi/blood; nourish first with Xiao Jianzhong Tang. If floating pulse, Mahuang Tang governs. Taiyang Dampness with whole-body pain, fever, jaundice, dysuria: Wind-Damp contention, whole-body heaviness/pain; Ma Huang Jia Zhu Tang (Ephedra plus Atractylodes Decoction) governs. If deep pulse with spontaneous diarrhea and body pain, it is a Yin pattern; urgently save the interior with Sini Tang, Fuzi Tang, or Zhenwu Tang (True Warrior Decoction). (Note: Diarrhea with body pain requires saving interior; normal stool with body pain requires saving exterior.) Heavy body, stiff back, abdominal colic, throat obstruction, feeling like being beaten: treat as Yin Du (Yin Toxin). After sweating, if body pain persists with deep/slow pulse, use Guizhi Jia Shaoyao Shengren Xinjia Tang (New Added Cinnamon Twig plus Peony, Ginger, and Ginseng Decoction) or Xiao Jianzhong Tang. If Huoluan vomiting/diarrhea stops but body pain remains, small dose of Guizhi Tang resolves it. *Jingui Yaolue* says: Chan Jia (Skin Disease Patient) with body pain cannot sweat; sweating causes spasms. Itching: Floating/slow pulse indicates lack of Yang and inability to sweat, causing itching. Taiyang 7-8 days, micro pulse, aversion to cold indicates dual Yin/Yang deficiency; do not sweat/purge/vomit. Xiaochaihu Tang governs. If re-sweated causing Qi deficiency and deafness, Suo Wu Re Ren (those without prior heat) use Shaoyao Gancao Fuzi Tang; Suo You Re Ren (those with prior heat) use Huangqi Jianzhong Tang. Red face with heat indicates unresolved condition due to lack of slight sweat; body itches, use Guizhi Mahuang Ge Ban Tang.
(70) Inquiry into Muscle Twitching, Dizziness, and Trembling
Taiyang disease unresolved after sweating, with fever, palpitations, dizziness, and trembling wanting to fall to the ground belongs to Zhenwu Tang. Excessive sweating causes tremors; deficient/thin patients get this from slight sweating. Zhenwu Tang governs all. For severe wasting, remove Shaoyao or use less; for heat patterns fearing heat-inducing herbs, remove Fuzi. Adjust according to the formula. After Shanghan emesis/purge, if epigastric fullness, Qi rushing to chest, dizziness upon standing, deep/tight pulse, and sweating causes meridian disturbance with trembling, Fuling Guizhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) governs. If Shanghan requires sweating but Dong Qi (Moving Qi) is on the left, do not sweat; sweating causes dizziness, sweating, muscle twitching, which is adverse and difficult to treat. First take Fangfeng Baizhu Muli Tang.