凡病鲜有不发热者而内伤外感其大关键也人迎脉大于气口为外感气口脉大于人迎为内伤外感则寒热齐作而无间内
伤则寒热间作而不齐外感恶寒虽近烈火不能除内伤恶寒得就温暖而必解外感恶风乃不禁一切风寒内伤恶风惟恶夫些少
贼风外感证显在鼻故鼻气不利而壅盛有力内伤证显在口故口不知味而腹中不和外感则邪气有余故发言壮厉先轻而后重
内伤则元气不足故出言懒怯先重而后轻外感头痛常常而痛内伤头痛时止时作外感手背热手心不热内伤手心热手背不热
东垣辨法大要如此有内伤而无外感有外感而无内伤以此辨之判然矣若夫内伤外感兼病而相合者则其脉证并见而难辨尤
宜细心求之若显内证多者则是内伤重而外感轻宜以补养为先若是外证多者则是外感重而内伤轻宜以发散和解为急此又
东垣未言之意也
（冬温 温病 寒疫 热病 湿温 风温 霍乱 痉 伤食 虚烦 痰 香港脚 内痈 蓄血）
世传以痰饮香港脚虚烦四证为似伤寒王叔和又以痉湿 霍乱等证似伤寒者编入伤寒论中然以形证较之非止此数者而
已其内伤劳倦之似伤寒者已前见今以冬温等病与伤寒辨析差别胪列于下自霜降以后天令寒冱感之而病者伤寒也（脉浮
紧无汗为伤寒脉浮缓有汗为伤风）霜降以后当寒而不寒乃更温暖因而衣被单薄以致感寒而病者冬温也（时气发斑与伤寒
热未已再遇温热为温毒）春时天道和暖有人壮热口渴而不恶寒者温病也以辛温汗之则坏矣（若天令尚寒冰雪未解感寒而
病者亦曰伤寒）三月以后八月以前天道或有暴寒感之而病者时行寒疫也夏至以后时令炎热有人壮热烦渴而不恶寒者热病
也热病与中暑相似但热病脉盛中暑脉虚夏月有病头痛谵语自汗身不甚热两胫逆冷四肢沉重胸腹满者湿温也其人常伤于
湿因而中暑湿热相搏故发此病不可发汗头痛身热自汗与伤寒同而脉尺寸俱浮身重默默但欲眠鼻息鼾语言难出四肢不收
者风温也不可发汗病呕吐而利头痛身痛恶寒发热或吐利止而发热者霍乱也身热足寒头项强急恶寒时头热面赤目脉赤独
头面摇卒口噤背反张者痉也恶寒无汗为刚痉恶风有汗为柔痉仰面而卧开目为阳合面而卧闭目为阴脉浮紧数为阳脉沉细
涩为阴口中燥渴为阳口中和为阴阳痉易治阴痉难治头疼发热与伤寒同而身不痛右手气口脉紧盛右关短滑左手反平和者
伤食也必兼中脘痞闷噫气作酸或恶闻食臭或欲吐不吐或吐之不尽等证亦有停食而又感寒者则左右手人迎气口俱大烦热
与伤寒相似而脉不浮紧头不疼身不痛不恶寒或烦时头亦痛烦止而痛止者虚烦也憎寒发热恶风自汗胸满气上冲咽不得息
与伤寒相似而头不痛项不强亦有时而头痛但作止无常其脉紧而不大者痰也痰在上焦则寸口脉沉滑或沉伏痰在中焦则右
手关脉滑大有气郁则沉而滑夹食则短而滑凡脉弦滑者有痰饮偏弦者主饮沉而弦者有悬饮内痛凡左右关大或关上脉浮而
大或目下如灰烟熏者皆痰之候也发热憎寒头疼肢节痛呕恶与伤寒相似而病起自脚脚膝肿痛两痉或肿满或枯细大便坚者
香港脚也伤寒论云诸脉浮数当发热而洒淅恶寒若有痛处饮食如常者蓄积有脓也此言内痈也素问云肝满肾满肺满皆实即为
肿王注云满谓脉气满实肿谓痈肿大抵口中咳即胸中隐痛心胸甲错振寒脉数咽干不渴时出浊唾腥臭久久吐脓如米粥者肺
痈也小腹重而强按之则痛便数似淋时时汗出复恶寒身皮甲错腹皮急如肿状脉滑而数者肠痈也胃脘隐隐而痛手不可近胃
脉沉细人迎逆而盛者胃脘痈也内伤外感以人迎口气口别之故内伤之脉人迎平而胃脘痈之脉人迎反盛未有不误以为伤寒
者宜辨之早也京口钱氏室女患肠痈发热庸医作伤寒治之禁绝饮食旬余而毙垂毙之日下脓数升方知是痈欲救已无及矣呜
呼仲景之书岂可以弗读哉发热如伤寒而其人有所从高坠下 扑损伤或盛怒叫呼无何而病小便自利口不甚渴按心下或胁
下或脐腹间有痛处或至手不可近者蓄血也劳逸饥饱七情房室所伤皆能瘀血不止一途友人缪仲 每服滋补丸药多至数两
忽发热不已投凉解之药有加无损沉困之极殆将不支余用蓄血法治之方烹煎次仲 闻其气曰一何香也饮已而热退明日下
黑粪斗许而安然伤寒自有蓄血证当于本科求之此言杂证蓄血之类伤寒者耳
凡是疾病，很少有不发热的，而内伤与外感的关键区别在于：人迎脉（位于颈部两侧颈动脉搏动处）大于气口（位于手腕桡动脉搏动处）为外感；气口脉大于人迎脉为内伤。外感病则恶寒与发热同时发作且无间歇；内伤病则恶寒与发热交替发作且不相齐整。外感之恶寒，即使靠近烈火也不能消除；内伤之恶寒，靠近温暖之处即可缓解。外感之恶风，是禁受不住一切风寒；内伤之恶风，只是畏惧那一点点贼风（穿堂风）。外感病症显现在鼻部，所以鼻息不利且壅盛有力；内伤病症显现在口部，所以口不知味且腹中不和。外感因邪气有余，所以说话声音壮厉，先轻后重；内伤因元气不足，所以说话懒怯，先重后轻。外感头痛是持续疼痛；内伤头痛是时断时续。外感手背热而手心不热；内伤手心热而手背不热。李东垣的辨别方法大致如此。有内伤而无外感，或有外感而无内伤，据此辨别，泾渭分明。如果是内伤与外感兼病相合，则脉象与证候并见而难以辨别，尤其应当细心探求。如果内伤证候多者，则是内伤重而外感轻，宜以补养为先；如果外感证候多者，则是外感重而内伤轻，宜以发散和解为急务。这又是李东垣未曾明言的意思。
（冬温、温病、寒疫、热病、湿温、风温、霍乱、痉病、伤食、虚烦、痰饮、香港脚、内痈、蓄血）
世间流传将痰饮、香港脚、虚烦四证视为类似伤寒。王叔和又将痉病、湿病、霍乱等证视为类似伤寒编入《伤寒论》中。然而，从形证比较来看，不止这些。其中内伤劳倦导致的类似伤寒的情况，前面已经见过。现在将冬温等疾病与伤寒进行辨析差别，罗列如下：自霜降以后，天气寒冷冻结，感受此寒气而发病的，称为伤寒（脉浮紧无汗为伤寒，脉浮缓有汗为伤风）。霜降以后，本该寒冷却不寒冷，反而温暖，因而衣着单薄导致感受寒气而发病的，称为冬温（时气发斑，以及伤寒热势未退又遇温热气候的，称为温毒）。春季天道和暖，有人壮热口渴且不恶寒的，称为温病（如果用辛温药物发汗则会坏病）。如果天气尚寒冰雪未解，感受寒气而发病的，也称为伤寒。三月以后八月以前，天道若有暴寒，感受此寒气而发病的，称为时行寒疫。夏至以后，时令炎热，有人壮热烦渴且不恶寒的，称为热病。热病与中暑相似，但热病脉象盛大，中暑脉象虚弱。夏季有病，头痛谵语自汗，身体不甚热，两小腿逆冷，四肢沉重，胸腹胀满的，称为湿温。其人常伤于湿气，因而中暑，湿热相搏结，故发此病，不可发汗。头痛身热自汗与伤寒相同，但寸尺脉俱浮，身体沉重，沉默只想睡觉，鼻息鼾声，语言难出，四肢不收的，称为风温，也不可发汗。呕吐而腹泻，头痛身痛，恶寒发热，或者吐利停止而发热的，称为霍乱。身体发热足部寒冷，头项强急，恶寒时而头部发热，面赤目红，唯独头部摇动，突然牙关紧闭，角弓反张的，称为痉病。恶寒无汗为刚痉，恶风有汗为柔痉。仰面而卧睁眼为阳痉，合面而卧闭眼为阴痉。脉浮紧数为阳痉，脉沉细涩为阴痉。口中燥渴为阳痉，口中和润为阴痉。阳痉易治，阴痉难治。头疼发热与伤寒相同但身体不痛，右手气口脉紧盛，右关脉短滑，左手反而平和的，称为伤食。必定兼有中脘痞闷、嗳气作酸，或者厌恶闻食物气味，或者想吐吐不出，或者吐不尽等证候。也有停食而又感受寒气的，则左右手人迎脉和气口脉都大，烦热与伤寒相似，但脉不浮紧，头不疼，身体不痛，不恶寒。或者心烦时头也痛，心烦止则头痛止的，称为虚烦。憎寒发热，恶风自汗，胸满气上冲咽喉不得呼吸，与伤寒相似但头不痛项不强，有时头痛但发作无常，其脉紧但不大的，称为痰证。痰在上焦则寸口脉沉滑或沉伏；痰在中焦则右手关脉滑大；有气郁则脉沉而滑；夹食则脉短而滑。凡脉弦滑者有痰饮，偏弦者主饮，沉而弦者有悬饮、内痛。凡左右关脉大，或关上脉浮大，或眼下如灰烟熏色的，都是痰的征候。发热憎寒，头疼肢节痛，呕恶，与伤寒相似，但病起自脚，脚膝肿痛，两腿或肿满或枯细，大便坚硬的，称为香港脚。《伤寒论》说：诸脉浮数，应当发热而洒淅恶寒，如果有痛处而饮食如常的，是蓄积有脓。这是指内痈。《素问》说：肝满、肾满、肺满皆实，即为肿。王冰注解说：满是指脉气满实，肿是指痈肿大。大体上口中咳嗽即胸中隐痛，心胸甲错，振寒，脉数，咽干不渴，时时吐出浊唾腥臭，久久吐出如米粥样的脓液的，是肺痈。小腹重坠，用力按压则痛，小便频数似淋证，时时出汗又恶寒，皮肤甲错，腹部皮肤紧急如肿状，脉滑而数的，是肠痈。胃脘隐隐而痛，手不可接近，胃脉沉细，人迎脉逆而盛的，是胃脘痈。内伤与外感以人迎脉和气口脉来区分，所以内伤的脉象是人迎平而气口盛，而胃脘痈的脉象是人迎反而盛，没有不误认为是伤寒的，应当尽早辨别。京口钱氏的女儿患肠痈发热，庸医当作伤寒治疗，禁止饮食十几天而死。临死那天排出脓液几升，才知道是痈，想要救治已来不及了。唉！仲景的书怎么能不读呢？发热像伤寒，但病人有从高坠落、扑打损伤，或者盛怒叫呼不久而发病，小便自利，口不甚渴，按心下或胁下或脐腹间有痛处，甚至手不可接近的，是蓄血证。劳逸、饥饱、七情、房室所伤都能导致瘀血，不止这一种途径。友人缪仲淳每次服用滋补丸药多至数两，忽然发热不已，投用凉解药物不仅无效反而加重，沉困至极几乎要死亡。我用治蓄血的方法治疗他，正在煎药时，缪仲淳闻到香气说：“多么香啊！”喝完后热退，第二天排出一斗多黑粪而安然无恙。伤寒自有蓄血证，应当在伤寒本科中寻求。这里说的是杂证中蓄血之类类似伤寒的情况。
Any disease rarely occurs without fever. The key distinction between internal injury (Neishang) and external contraction (Waigan) lies in the pulse: if the Renying pulse (pulse at the carotid artery in the neck) is larger than the Qikou pulse (pulse at the radial artery in the wrist), it indicates external contraction; if the Qikou pulse is larger than the Renying pulse, it indicates internal injury. In external contraction, aversion to cold (Ehan) and fever (Fare) occur simultaneously without interval; in internal injury, they alternate and are not synchronized. Aversion to cold due to external contraction cannot be relieved even by approaching a fierce fire, whereas aversion to cold due to internal injury can be resolved by seeking warmth. Aversion to wind (Efeng) in external contraction implies intolerance to all kinds of wind and cold, while in internal injury, it refers only to sensitivity to slight drafts. External contraction manifests in the nose, causing nasal congestion with forceful breathing; internal injury manifests in the mouth, leading to loss of taste and abdominal disharmony. Due to excess pathogenic factors in external contraction, speech is loud and vigorous, starting light and becoming heavy; due to deficiency of healthy qi (Yuanqi) in internal injury, speech is lazy and timid, starting heavy and becoming light. Headache in external contraction is constant; in internal injury, it comes and goes. Hand dorsum heat with cool palms indicates external contraction; palm heat with cool hand dorsum indicates internal injury. These are the main points of differentiation by Li Dongyuan. Cases with internal injury but no external contraction, or vice versa, are clearly distinguished by these criteria. However, when internal injury and external contraction coexist, their pulses and symptoms appear together, making differentiation difficult, requiring careful investigation. If internal injury symptoms predominate, internal injury is severe and external contraction is mild; nourishment should be prioritized. If external contraction symptoms predominate, external contraction is severe and internal injury is mild; dispersing and harmonizing should be urgent. This is an implicit meaning not explicitly stated by Li Dongyuan.
(Winter-warmth [Dongwen], Warm-pathogen disease [Wenbing], Cold-epidemic [Hanyi], Heat-disease [Rebing], Damp-warmth [Shiwen], Wind-warmth [Fengwen], Cholera-like disorder [Huoluan], Spasm [Jing], Food stagnation [Shangshi], Deficiency vexation [Xufan], Phlegm [Tan], Beriberi [Xianggangjiao], Internal abscess [Neiyong], Blood stasis [Xuxue])
It is commonly believed that Phlegm-fluid retention [Tanyin], Beriberi [Xianggangjiao], Deficiency vexation [Xufan], and four other conditions resemble Shaoyang disease (Shanghan). Wang Shuhe also included Spasm [Jing], Dampness [Shi], and Cholera-like disorder [Huoluan] as resembling Shaoyang disease in the *Treatise on Cold Pathogenic Diseases* (*Shanghan Lun*). However, comparing their manifestations reveals more than just these. The cases of internal injury from overwork resembling Shaoyang disease have been discussed previously. Here, we differentiate Winter-warmth [Dongwen] and similar diseases from Shaoyang disease as follows: After Frost's Descent [Shuangjiang], if one contracts cold weather and becomes ill, it is Shaoyang disease (Floating-tight pulse without sweat indicates Shaoyang disease; Floating-slow pulse with sweat indicates Wind-injury [Shangfeng]). If after Frost's Descent, the weather should be cold but is warm, and one falls ill due to thin clothing exposing them to cold, it is called Winter-warmth [Dongwen] (Skin eruption due to seasonal qi, or heat lingering from Shaoyang disease encountering further warmth, is called Warm-toxin [Wendu]). In spring, when the weather is mild, if someone has high fever, thirst, and no aversion to cold, it is Warm-pathogen disease [Wenbing] (Using acrid-warm diaphoretics would ruin the case). If the weather remains cold with ice and snow, and one contracts cold, it is also called Shaoyang disease. Between the third and eighth months, if sudden cold strikes and causes illness, it is called Seasonal Cold-Epidemic [Shixing Hanyi]. After Summer Solstice [Xiazhi], during hot weather, if someone has high fever, irritability, thirst, and no aversion to cold, it is Heat-disease [Rebing]. Heat-disease resembles Summerheat [Zhongshu], but Heat-disease has a full pulse, while Summerheat has a deficient pulse. In summer, if there is headache, delirium, spontaneous sweating, slight body heat, cold legs below the knees, heavy limbs, and chest/abdominal fullness, it is Damp-warmth [Shiwen]. This occurs when dampness injury combines with Summerheat, creating damp-heat conflict; diaphoresis is contraindicated. If headache, body heat, and spontaneous sweating resemble Shaoyang disease, but both Cun and Chi pulses are floating, body is heavy, the person is silent and sleepy, breathes snoringly, speaks with difficulty, and limbs are flaccid, it is Wind-warmth [Fengwen]; diaphoresis is contraindicated. Vomiting and diarrhea with headache, body pain, aversion to cold, and fever, or cessation of vomiting/diarrhea followed by fever, is Cholera-like disorder [Huoluan]. Body heat with cold feet, stiff neck, aversion to cold, intermittent head heat, red face and eyes, head tremor, sudden jaw lock, and opisthotonos is Spasm [Jing]. Aversion to cold without sweat is Yang-Spasm [Gangjing]; aversion to wind with sweat is Yin-Spasm [Roujing]. Lying on back with open eyes is Yang-Spasm; lying on stomach with closed eyes is Yin-Spasm. Floating-tight-rapid pulse is Yang-Spasm; sinking-thin-choppy pulse is Yin-Spasm. Dry mouth/thirst is Yang-Spasm; normal mouth sensation is Yin-Spasm. Yang-Spasm is easy to treat; Yin-Spasm is difficult. Headache and fever like Shaoyang disease but without body pain, with a tight/full Qi-kou pulse on the right hand, short/slippery Right Guan pulse, and normal Left hand pulse, indicates Food stagnation [Shangshi]. Accompanied by epigastric stuffiness, belching with sour taste, aversion to food odor, desire to vomit without success, or incomplete vomiting. If food stagnation combines with cold, both Renying and Qi-kou pulses are large, with vexation and heat resembling Shaoyang disease, but pulse is not floating-tight, no headache/body pain, no aversion to cold. Vexation with headache that ceases when vexation ceases is Deficiency vexation [Xufan]. Aversion to cold, fever, aversion to wind, spontaneous sweating, chest fullness, qi rushing to throat causing dyspnea, resembling Shaoyang disease but without headache/stiff neck, with irregular headache and tight-but-not-large pulse, indicates Phlegm [Tan]. Phlegm in Upper Jiao shows sinking-slippery or sinking-hidden Cun pulse; Phlegm in Middle Jiao shows slippery-large Right Guan pulse; Qi stagnation shows sinking-slippery pulse; combined with food shows short-slippery pulse. Wiry-slippery pulse indicates Phlegm-fluid retention [Tanyin]; wiry-predominant indicates Fluid retention [Yin]; sinking-wiry indicates Suspended fluid [Xuanyin] or internal pain. Large pulses at Left/Right Guan or floating-large at Guan, or dark circles under eyes like smoke, are signs of Phlegm. Fever, aversion to cold, headache, joint pain, nausea/vomiting, resembling Shaoyang disease, but starting from feet with swollen/painful ankles/knees, either swollen or emaciated legs, and hard stool, is Beriberi [Xianggangjiao]. The *Treatise on Cold Pathogenic Diseases* states: Floating-rapid pulses usually indicate fever and chills; if there is pain but diet is normal, it indicates pus accumulation (Internal abscess [Neiyong]). *Suwen* states: Fullness in Liver, Kidney, or Lung indicating excess leads to swelling. Wang Bing notes: "Full" means full pulse qi; "Swelling" means abscess. Generally, cough with hidden chest pain, rough skin on chest, chills, rapid pulse, dry throat without thirst, frequent expectoration of foul-smelling turbid saliva, and long-term expectoration of rice-pus-like material indicates Lung Abscess [Feiyong]. Heavy lower abdomen, painful on pressure, frequent urination resembling strangury, sweating with aversion to cold, rough skin, tense abdominal wall, slippery-rapid pulse indicates Intestinal Abscess [Changyong]. Hidden epigastric pain intolerable to touch, sinking-thin Stomach pulse, and reverse-full Renying pulse indicates Epigastric Abscess [Weiyuan Yong]. Internal injury vs. external contraction is distinguished by Renying and Qi-kou pulses. Internal injury has flat Renying and full Qi-kou; Epigastric Abscess has reverse-full Renying. Mistaking this for Shaoyang disease is common; early differentiation is crucial. A maiden from Qian family in Jingkou had intestinal abscess fever, treated as Shaoyang disease by quacks, starved for ten days, and died. Only upon death did she expel liters of pus. Alas, how can one neglect reading Zhang Zhongjing's works? Fever resembling Shaoyang disease, but following trauma from falling/hitting, or intense anger/shouting, with free urination, slight thirst, and tender pain in epigastrium/hypochondrium/umbilicus intolerable to touch, indicates Blood stasis [Xuxue]. Overwork, hunger/fullness, emotional injury, or sexual excess can cause blood stasis. My friend Miao Zhongchun took excessive tonic pills, developed persistent fever, worsened by cooling herbs, nearly died. I treated him for Blood stasis. While brewing, he smelled the aroma, drank it, fever subsided, and he passed a bucket of black stool the next day, recovering fully. Shaoyang disease has its own Blood stasis syndrome; this text discusses miscellaneous diseases mimicking Shaoyang disease through blood stasis.