太阴之为病，腹满而吐，食不下，时腹自痛，若下之，必胸下结硬，（自利益甚）。
【按】吴人驹曰“自利益甚”四字，当在“必胸下结硬”之下，若在吐食不下之下，则是已吐食不下而自
利益甚矣。仲景复曰∶若下之无所谓也，从而移之。
伤寒，本自寒{下}〔格〕，医复吐下之，寒格更逆吐下，若食入口即吐，干姜黄连黄芩人参汤主之。
【按】经论中并无寒下之病，亦无寒下之文。玩本条下文，寒格更逆吐下，可知寒下之“下”字，当是
“格”字，文义始属。注家皆释胃寒下利，不但文义不属，且与芩、连之药不合，当改之。
少阴病，饮食入口即吐，心中{温温}〔 〕欲吐复不能吐。始得之，手足寒，脉弦迟者，此胸中实，不
可下也，当吐之。若膈上有寒饮，干呕者，不可吐也，当温之，宜四逆汤。
【按】“温温”当是“ ”。 者，乃吐饮之状也，当改之。
伤寒，厥而心下悸者，（以饮水多），宜先治水，当服茯苓甘草汤，却治其厥。不尔，水渍入胃，必作利也。
【按】“厥而心下悸者”之下，当有“以饮水多”四字，若无此四字，乃阴盛之厥悸，非停水之厥悸矣。
何以即知是水，而曰宜先治水耶？当补之。
伤寒脉微而厥，至七八日肤冷，其人躁，
无暂安时者，此为脏厥，非蛔厥也。蛔厥者，其人当吐蛔。今病者静，而复时烦者，{此}〔非〕为脏寒，蛔上
入其膈，故烦，须臾复止。得食而呕，又烦者，蛔闻食臭出，其人当自吐蛔。蛔厥者，乌梅丸主之，又主久利。
【按】“此为脏寒”之“此”字，当是“非”字，若是“此”字，即是脏厥，与辨蛔厥之义不属，当改之。
伤寒五六日，不{结胸}〔大便〕，腹濡，脉虚复厥者，不可下。此为亡血，下之死。
【按】“结胸”二字，当是“大便”二字。不结胸腹濡脉虚复厥，皆无可下之理，今曰不可下，何所谓也？
当改之。
伤寒始发热六日，厥反九日而利，凡厥利者，当不能食，今反能食者，恐为除中，食以索饼，{不}〔若〕
发热者，知胃气尚在，必愈。恐暴热来出而复去也，后三日脉之，其热续在者，期之旦日夜半愈。所以然者，
本发热六日，厥反九日，复发热三日，并前六日，亦为九日，与厥相应，故期之旦日夜半愈。后三日脉之而脉
数，其热不罢者，此为热气有余，必发痈脓也。
【按】“不发热者”之”‘不”字，当是“若”字，若是“不”字，即是除中，何以下接恐暴热来出而复
去之文耶？当改之。
伤寒脉迟，六七日，（厥而下利），而反与黄芩汤彻其热，脉迟为寒，今与黄芩汤复除其热，腹中应冷，
当不能食，今反能食，此名除中，必死。
【按】“伤寒脉迟六七日”之下，当有“厥而下利”四字，若无此四字，则非除中证也。况有此四字，始
与下文反与黄芩汤之义相属，当补之。
太阴病的主要表现为腹部胀满并伴有呕吐，饮食难以下咽，时常出现腹部自发疼痛。如果误用攻下法治疗，必然导致心窝下方结聚硬满。（若再出现自发性腹泻，病情会更加严重）。
【按语】吴人驹认为，“自利益甚”这四个字，应当放在“必胸下结硬”之后。如果放在“吐食不下”之后，那就意味着在已经发生呕吐、饮食难下的情况下，又出现了严重的自发性腹泻。张仲景原文接着说“若下之无所谓也”，（意指如果误下则后果不堪设想），因此应当将这句话移后。
伤寒病，原本就是寒邪格拒于中焦，医生又错误地使用催吐和攻下法，导致寒邪格拒更甚，加剧了呕吐和下利。如果食物刚入口就立即吐出，应使用干姜黄连黄芩人参汤主治。
【按语】经典论述中没有“寒下”这种病名，也没有“寒下”的文字。研读本条下文提到的“寒格更逆吐下”，可以知道“寒下”的“下”字，应当是“格”字，这样文义才通顺。注释家都解释为胃寒导致的下利，这不仅文义不通，而且与黄连、黄芩的药性不相符合，应当改正。
少阴病，饮食入口即吐，心中感觉烦闷不适，想吐却吐不出来。刚发病时，手足发凉，脉象弦而迟缓，这是胸中有实邪阻滞，不可使用攻下法，应当使用涌吐法。如果是膈上有寒饮停留，出现干呕症状的，不可使用涌吐法，应当使用温阳法，适宜使用四逆汤。
【按语】“温温”应当是“愠愠”（或作“蕴蕴”，指烦闷不舒之状）。“愠愠”是欲吐水饮的状态，应当改正。
伤寒病，出现四肢厥冷且心下悸动的，（是因为饮水过多所致），应当先治疗水饮，服用茯苓甘草汤，然后再治疗四肢厥冷。如果不这样做，水湿浸渍入胃，必然会导致腹泻。
【按语】在“厥而心下悸者”之下，应当有“以饮水多”这四个字。如果没有这四个字，那就是阴寒盛极导致的厥冷和心悸，而不是停水引起的厥冷和心悸。凭什么直接判断是水饮为患，而说适宜先治水呢？应当补上这四个字。
伤寒脉象微细且出现四肢厥冷，到了七八天，皮肤也变冷，其人烦躁不安，没有片刻安宁的时候，这是脏气衰竭导致的脏厥，不是蛔虫引起的蛔厥。蛔厥病患者，通常会吐出蛔虫。现在的病人安静下来，却又时不时感到心烦，这不是因为内脏寒冷，而是蛔虫上行进入膈部，所以心烦，过了一会儿又停止。进食后出现呕吐，并且再次心烦的，是因为蛔虫闻到食物的气味而出动，病人自然会吐出蛔虫。蛔厥证，使用乌梅丸主治，乌梅丸也可用于治疗久泻久痢。
【按语】“此为脏寒”中的“此”字，应当是“非”字。如果是“此”字，那就是脏厥，这与辨别蛔厥的意义不符，应当改正。
伤寒五六天，大便不通，腹部柔软，脉象虚弱且伴有四肢厥冷，不可使用攻下法。这是因为亡血（血虚），攻下会导致死亡。
【按语】“结胸”二字，应当是“大便”二字。如果不结胸、腹部柔软、脉象虚弱且伴有四肢厥冷，都没有可以使用攻下法的理由，现在却说“不可下”，这有什么意义呢？应当改正。
伤寒开始发热六天，四肢厥冷反而持续九天并伴有腹泻。凡是厥冷和腹泻的病人，通常不能进食，现在反而能进食，这可能是除中（胃气将绝前的假象），给病人吃面条（索饼）来测试，如果吃完后不发热，说明胃气已绝；如果吃完后微微发热，说明胃气尚存，病必痊愈。担心的是突然发热随即消失，三天后再诊察脉象，如果发热持续存在，预测到第二天半夜会痊愈。之所以这样判断，是因为本来发热六天，厥冷反常地持续九天，后来又发热三天，加上之前的六天，总共也是九天，与厥冷的天数相应，所以预测到第二天半夜痊愈。三天后再诊察脉象，如果脉数，发热不退的，这是因为热气有余，必然会引发痈脓。
【按语】“不发热者”中的“不”字，应当是“若”字。如果是“不”字，那就是除中证，怎么下面接着写担心暴热来去无常的文字呢？应当改正。
伤寒脉迟，经过六七天，（出现四肢厥冷并伴有腹泻），医生反而给予黄芩汤来清除其热。脉迟属于寒证，现在给予黄芩汤再次清除其热，腹中应当变冷，应该不能进食，现在反而能进食，这叫做除中，必定死亡。
【按语】在“伤寒脉迟六七日”之下，应当有“厥而下利”这四个字。如果没有这四个字，就不是除中证了。况且有了这四个字，才能与下文“反与黄芩汤”的意义相衔接，应当补上。
Taiyin disease is characterized by abdominal fullness accompanied by vomiting, inability to take in food, and spontaneous abdominal pain occurring from time to time. If purgation is mistakenly applied, it will inevitably lead to hardness and binding below the chest. (If spontaneous diarrhea ensues, the condition will worsen).
[Commentary] Wu Renju stated that the four characters "spontaneous diarrhea worsens" should be placed after "hardness and binding below the chest." If placed after "vomiting and inability to eat," it would imply that severe spontaneous diarrhea occurs after vomiting and anorexia have already set in. Zhang Zhongjing subsequently states "if purged, there is no consequence" (implying dire consequences if purged), thus this phrase should be moved.
In cold damage, the pathogen is originally cold and obstructing at the middle jiao. If the physician erroneously employs emesis and purgation, the cold obstruction becomes more severe, exacerbating vomiting and diarrhea. If food is vomited immediately upon entering the mouth, Ganjiang Huanglian Huangqin Renshen Tang (Dried Ginger, Coptis, Scutellaria, and Ginseng Decoction) should be administered.
[Commentary] The classics contain no mention of a disease named "cold purgation" nor the text thereof. Examining the subsequent text "cold obstruction reverses vomiting and diarrhea," it can be deduced that the character "xia" (purgation) in "han xia" should be "ge" (obstruction), making the textual meaning coherent. Commentators interpret this as stomach-cold-induced diarrhea, which not only contradicts the text but also conflicts with the properties of Coptidis Rhizoma (Huanglian) and Scutellariae Radix (Huangqin); it should be corrected.
Shaoyin disease presents with vomiting immediately after food enters the mouth, a sensation of discomfort and oppression in the heart region, where one desires to vomit but cannot. At the onset, the hands and feet are cold, and the pulse is wiry and slow. This indicates excess pathogenic factors in the chest; purgation is contraindicated, and emesis should be induced. If there is cold fluid retention above the diaphragm causing dry heaving, emesis is contraindicated; instead, warming therapy should be used, preferably Sini Tang (Frigid Extremities Decoction).
[Commentary] "Wenwen" should be "Yunyun" (a state of discomfort and desire to vomit). It describes the manifestation of desiring to vomit fluid; it should be corrected.
In cold damage, if there is cold extremities accompanied by palpitations in the epigastrium (due to excessive water intake), water retention should be treated first by administering Fuling Gancao Tang (Poria, Licorice, and Ginger Decoction), followed by treating the cold extremities. Otherwise, water dampness infiltrating the stomach will inevitably cause diarrhea.
[Commentary] The four characters "due to excessive water intake" should be added after "cold extremities accompanied by palpitations in the epigastrium." Without these words, it would refer to cold extremities and palpitations caused by yin excess rather than water retention. How can one immediately determine it is water and advise treating water first? These four characters should be supplemented.
In cold damage, if the pulse is faint and there are cold extremities, progressing to day seven or eight with cold skin and restlessness without any moment of peace, this is Zang Jue (Visceral Cold Damage), not Hui Jue (Roundworm Cold Damage). Patients with Hui Jue typically vomit roundworms. The current patient is quiet but occasionally irritable; this is not due to visceral cold, but rather roundworms moving up into the diaphragm, causing irritability which ceases after a while. Vomiting and irritability after eating occur because the roundworms emerge upon smelling food, leading to spontaneous vomiting of roundworms. Hui Jue is treated with Wumei Wan (Mume Pill), which is also indicated for chronic diarrhea.
[Commentary] The character "ci" (this) in "ci wei zang han" (this is visceral cold) should be "fei" (not). If it were "ci," it would indicate Zang Jue, which contradicts the differentiation of Hui Jue; it should be corrected.
In cold damage lasting five or six days, if there is constipation, soft abdomen, weak pulse, and cold extremities, purgation is contraindicated. This is due to blood loss (blood deficiency); purgation will lead to death.
[Commentary] The two characters "Jie Xiong" (Chest Binding) should be "Da Bian" (Stool/Bowel movement). If there is no Chest Binding, soft abdomen, weak pulse, and cold extremities, there is no rationale for purgation. Saying "purgation is contraindicated" under these conditions lacks logical connection; it should be corrected.
In cold damage, fever lasts for six days initially, but cold extremities persist for nine days accompanied by diarrhea. Generally, patients with cold extremities and diarrhea cannot eat. If they can eat now, it may be Chu Zhong (Elimination of the Middle, a sign of impending gastric qi exhaustion). Feeding them Suobing (noodles/wheat cakes): if there is no subsequent fever, gastric qi is exhausted; if there is mild fever afterward, gastric qi remains, and recovery is certain. One must fear sudden heat appearing and disappearing quickly. Three days later, upon pulse diagnosis, if the fever persists, recovery is expected at midnight on the following day. This is because the initial six days of fever plus the subsequent three days of fever total nine days, matching the nine days of cold extremities, hence the prediction of recovery at midnight. If three days later the pulse is rapid and fever does not cease, this indicates excess heat, which will likely manifest as carbuncles and pus.
[Commentary] The character "bu" (not) in "bu fa re zhe" (if there is no fever) should be "ruo" (if). If it were "bu," it would indicate Chu Zhong, which contradicts the following text discussing the fear of sudden heat; it should be corrected.
In cold damage with a slow pulse, after six or seven days (accompanied by cold extremities and diarrhea), if the physician erroneously administers Huangqin Tang (Scutellaria Decoction) to clear heat: a slow pulse indicates cold. Administering Huangqin Tang further clears heat, causing internal cold and an inability to eat. If the patient can eat now, this is called Chu Zhong, and death is inevitable.
[Commentary] The four characters "cold extremities and diarrhea" should be added after "cold damage slow pulse six or seven days." Without these, it is not Chu Zhong. Furthermore, these characters are necessary to connect with the subsequent text regarding the erroneous use of Huangqin Tang; they should be supplemented.