伤寒脉浮此表有热里有寒白虎汤主之
少阴病下利清谷里寒外热手足厥逆脉微欲绝身反不恶寒其人面赤色或腹痛或干呕或咽痛或利止脉不出者通脉四逆
汤（方见下利）既吐且利小便复利大汗出下利清谷内寒外热脉微欲绝者四逆汤主之（成 吐利无津液则小盒饭少小便复
利而大汗出津液不禁阳气大虚也脉微为止阳若无外热但内寒下利清谷为纯阴此以外热为阳未绝犹可与通脉四逆汤救
之）下利清谷里寒外热汗出而厥者通脉四逆汤（成 下利清谷为里寒身热不解为外热汗出阳气通行于外则未当厥其汗出
而厥者阳气太虚也与通脉四逆汤以固阳气）脉浮而迟表热里寒下利清谷者通脉四主之（成 浮为表热迟为里寒下利清谷
者里寒甚也与四逆汤温里散寒）
表热里寒者脉虽沉而迟手足微厥下利清谷此里寒也所以阴证亦有发热者此表热也（四逆汤通脉四逆汤）表寒里热者
脉必滑身厥舌干也所以少阴恶寒而蜷此表寒也时时自烦不欲近衣此里热也（大柴胡汤）
太阳病发热恶寒热多寒少脉微弱者此无阳也不可发汗宜桂枝二越婢一汤（刘氏云脉迟者小建中加黄 或温中）
太阳病八九日如疟状发热恶寒热多寒少其人不呕清便欲自可一日二三度发脉微缓者为欲愈脉微恶寒者此阴阳俱虚
不可更发汗更下更吐也面色反有热色者未欲解也以其不得小汗出身必痒宜桂枝麻黄各半汤主之
赵 愚详仲景论中热多
寒少止有二证如上文一证仲景之意盖以得病七八日如疟状发热恶寒热多寒少十六字为自初至今之证以下文乃是以后拟
病防变之辞当分作三截看若其人不呕清便欲自可一日二三度发脉微缓为欲愈此一节乃里和无病而脉微缓微者邪气微缓
者阴阳同等脉证皆向安之兆可不待汗而欲自愈也若脉微而恶寒者此阴阳俱虚不可发汗更下更吐也此一节宜温之若面色
反有热者未欲解也以其不能得小汗出其身必痒宜各半汤此一节必待汗而后愈也活人书不详文意却将其人不呕清便欲自
可九字本是欲愈之证反以他证各半汤汗之又将不可汗吐下及各半汤证语句并脱略而不言反将其中欲愈之证而用彼药汗
其所不当汗何也其第二证仲景云太阳病发热恶寒热多寒少脉微弱者亡阳也不可发汗宜桂枝二越婢一汤活人书于脉微弱
上添都大二字岂以仲景论脉为未足而加之乎其第三证尺脉迟者仲景论中无热多寒少语句但云脉浮紧法当身疼痛宜以汗
解之假令尺中迟者不可发汗以荣气不足血少故也活人书但举尺中迟血少之语自添寒少热多四字加于其上因而编入此问
中何邪如一证尺迟者止当收入不可汗门中
刘 仲景一书只有热多寒少之条无寒多热少之证又云不烦躁手足厥逆为伤寒
脉反浮缓为伤风大青龙汤或云各半汤
少阴病，下利且排出未消化的食物（完谷不化），这是里有寒而外有热，手足冰冷厥逆，脉搏微弱几乎摸不到，身体反而不怕冷，病人面色发红；或者伴有腹痛，或者干呕，或者咽喉痛，或者腹泻停止但脉搏仍摸不到的情况，用通脉四逆汤主治。（成无己注：呕吐和腹泻导致津液枯竭，小便应当减少，现在反而小便通利且大汗出，说明津液无法固摄，阳气极度虚弱。脉微是阳气将绝之象，若无外热仅有内寒，下利清谷属于纯阴证；此处因为有外热，说明阳气尚未完全断绝，还可以用通脉四逆汤来救治。）
下利且排出未消化的食物，里有寒而外有热，出汗且手足厥冷，用通脉四逆汤主治。（成无己注：下利清谷是里有寒，身体发热不退是外有热。出汗说明阳气通行于体表，按理说不应当出现厥冷；现在既出汗又厥冷，说明阳气太虚，需用通脉四逆汤来固护阳气。）
脉象浮而迟，表有热、里有寒，且下利排出未消化食物的，用通脉四逆汤主治。（成无己注：浮脉主表热，迟脉主里寒。下利清谷说明里寒严重，需用四逆汤温补里阳、驱散寒气。）
表热里寒的情况，脉象虽然沉而迟，手足轻微厥冷，下利排出未消化食物，这是里有寒。所以阴证也有发热的，这是表热。（可用四逆汤、通脉四逆汤治疗。）
表寒里热的情况，脉象必定滑数，身体厥冷，舌干。所以少阴病恶寒且身体蜷缩，这是表寒；时常自觉烦热，不喜欢穿厚衣服，这是里热。（可用大柴胡汤治疗。）
太阳病，发热恶寒，热多寒少，脉象微弱，这是“无阳”（阳气虚衰），不可发汗，宜用桂枝二越婢一汤。（刘氏说：若脉迟，可用小建中汤加黄芪，或者温中法。）
太阳病经过八九天，症状像疟疾一样，发热恶寒，热多寒少，病人没有呕吐，大小便基本正常，一天发作两三次，脉象微缓的，是病情将要痊愈的迹象。若脉微且恶寒，这是阴阳俱虚，不可再用发汗、攻下或催吐的方法。若面色反现红赤色，说明病未解除，因为不能通过微微出汗使邪气外出，身体一定会发痒，宜用桂枝麻黄各半汤主治。
赵以愚详细考证张仲景的论述中，“热多寒少”只有两个证候。如上文所述的一个证候，张仲景的本意大概是把“得病七八日，像疟疾状，发热恶寒，热多寒少”这十六个字作为从发病至今的整体证候描述，而下文则是针对后续可能出现的病情变化进行的预防性论述，应当分为三段来看待。如果病人不呕吐，大小便基本正常，一天发作两三次，脉象微缓，这是欲愈之兆，这一节说明里气平和无病，脉微表示邪气微弱，脉缓表示阴阳平衡，脉证都趋向安宁，可不待发汗而自愈。若脉微而恶寒，这是阴阳俱虚，不可发汗、攻下或催吐，这一节宜用温补法。若面色反现红赤，说明病未解除，因为不能得小汗出，身体必痒，宜用桂枝麻黄各半汤，这一节必须待发汗后才能痊愈。《活人书》不明文章原意，却将“其人不呕，清便欲自可”这九个字本是欲愈的证候，反而用其他证候的方剂桂枝麻黄各半汤去发汗；又将不可汗、吐、下及桂枝麻黄各半汤的禁忌语句省略不说，反而对其中欲愈的证候使用发汗药物，这是为什么呢？第二个证候，张仲景说：“太阳病，发热恶寒，热多寒少，脉微弱者，亡阳也，不可发汗，宜桂枝二越婢一汤。”《活人书》在“脉微弱”上添加了“都大”二字，难道认为仲景论脉不足而加以补充吗？第三个证候，尺脉迟者，张仲景原文中没有“热多寒少”的字句，只说“脉浮紧，法当身疼痛，宜以汗解之。假令尺中迟者，不可发汗，以荣气不足，血少故也。”《活人书》只列举了尺中迟、血少的语句，自行添加了“寒少热多”四个字加在上面，因而编入这个问题中，这是为什么呢？对于尺脉迟这一证，只应当收入不可发汗的门类中。
刘氏指出：张仲景的书中只有“热多寒少”的条文，没有“寒多热少”的证候。又说：如果不烦躁、手足厥冷，脉象反见浮缓，这是伤风，可用大青龙汤，或者说用桂枝麻黄各半汤。
In cold damage (Shanghan), if the pulse is floating, this indicates heat at the exterior and cold at the interior; it should be treated with Baihu Tang (White Tiger Decoction).
In Shaoyin disease (Disease of the Lesser Yin), if there is diarrhea with undigested food in the stool, this indicates cold at the interior and heat at the exterior. The hands and feet are cold and inverted (Jue), the pulse is faint and nearly imperceptible, yet the body does not feel aversion to cold, and the person's face appears red. Alternatively, there may be abdominal pain, dry retching, sore throat, or cessation of diarrhea while the pulse remains unobtainable. In such cases, Tongmai Sini Tang (Pulse-Restoring Four Reversal Decoction) should be used. (Cheng Wuji notes: Vomiting and diarrhea deplete fluids, so urination should decrease. However, here urination is frequent accompanied by profuse sweating, indicating that fluids are uncontrolled and Yang Qi is severely deficient. A faint pulse signifies impending Yang collapse. If there were no exterior heat and only interior cold with undigested diarrhea, it would be a pure Yin syndrome. Since there is exterior heat, it indicates that Yang has not completely perished, and Tongmai Sini Tang can still be used to rescue it.)
If there is diarrhea with undigested food, cold at the interior and heat at the exterior, sweating, and cold extremities, Tongmai Sini Tang (Pulse-Restoring Four Reversal Decoction) should be used. (Cheng Wuji notes: Diarrhea with undigested food indicates interior cold; persistent body heat indicates exterior heat. Sweating implies Yang Qi circulating to the exterior, which normally should not lead to cold extremities. The combination of sweating and cold extremities indicates severe Yang deficiency, requiring Tongmai Sini Tang to consolidate Yang Qi.)
If the pulse is floating and slow, indicating heat at the exterior and cold at the interior, accompanied by diarrhea with undigested food, Tongmai Sini Tang (Pulse-Restoring Four Reversal Decoction) should be used. (Cheng Wuji notes: A floating pulse indicates exterior heat; a slow pulse indicates interior cold. Diarrhea with undigested food signifies severe interior cold, requiring Sini Tang (Four Reversal Decoction) to warm the interior and dispel cold.)
In cases of heat at the exterior and cold at the interior, although the pulse may be deep and slow, with slight cold extremities and diarrhea with undigested food, this is due to cold at the interior. Therefore, Yin syndromes can also present with fever, which represents heat at the exterior. (Treat with Sini Tang (Four Reversal Decoction) or Tongmai Sini Tang (Pulse-Restoring Four Reversal Decoction).)
In cases of cold at the exterior and heat at the interior, the pulse must be slippery, accompanied by cold extremities and a dry tongue. Thus, in Shaoyin disease, aversion to cold and curling up indicate cold at the exterior; frequent spontaneous vexation and a desire not to wear heavy clothing indicate heat at the interior. (Treat with Da Chaihu Tang (Major Bupleurum Decoction).)
In Taiyang disease (Disease of the Greater Yang), if there is fever and aversion to cold, with more heat than cold, and the pulse is faint, this indicates "absence of Yang" (deficiency of Yang Qi). Sweating methods should not be used; instead, Guizhi Er Yuebi Yi Tang (Cinnamon Twig Twice, Poria and Gypsum Decoction in One Part) should be preferred. (Liu states: If the pulse is slow, Xiaojianzhong Tang (Minor Construct the Middle Decoction) with Huangqi (Astragalus) or warming methods may be used.)
In Taiyang disease, after eight or nine days, if the condition resembles malaria with fever and aversion to cold, where heat predominates over cold, the patient does not vomit, bowel movements and urination are relatively normal, and episodes occur two or three times a day, a slightly rapid pulse indicates that recovery is imminent. If the pulse is faint and there is aversion to cold, this indicates deficiency of both Yin and Yang; sweating, purging, or emetic methods should not be used again. If the face appears reddish, the disease has not resolved because slight sweating has not occurred to release the pathogen, leading to itching of the skin. In this case, Guizhi Mahuang Ge Ban Tang (Half Cinnamon Twig and Half Ephedra Decoction) should be used.
Zhao Yiyu carefully examined Zhang Zhongjing's discussions, noting that "more heat than cold" appears in only two conditions. As mentioned above, Zhang Zhongjing's intent was likely to treat the sixteen characters "getting sick for seven or eight days, resembling malaria, fever and aversion to cold, more heat than cold" as the overall condition from onset to the present, while the following text describes preventive measures for subsequent changes. This should be divided into three sections. If the patient does not vomit, bowel movements and urination are normal, episodes occur two or three times a day, and the pulse is slightly rapid, this is a sign of impending recovery. This section indicates that the interior is harmonious and free of disease; a faint pulse suggests weak pathogens, and a rapid pulse suggests balanced Yin and Yang, with all signs pointing towards peace. Recovery may occur without sweating. If the pulse is faint and there is aversion to cold, this indicates deficiency of both Yin and Yang; sweating, purging, or emetics are contraindicated, and warming treatment is appropriate. If the face appears reddish, the disease has not resolved because slight sweating cannot be achieved, causing itching; Guizhi Mahuang Ge Ban Tang (Half Cinnamon Twig and Half Ephedra Decoction) is required, and recovery depends on inducing sweating. *The Book of Vitality* (*Huo Ren Shu*) misunderstands the text structure. It incorrectly applies Guizhi Mahuang Ge Ban Tang (Half Cinnamon Twig and Half Ephedra Decoction) to sweat the patient, misinterpreting the nine characters "the patient does not vomit, bowel movements and urination are normal" which originally indicated recovery. It omits the contraindications for sweating, purging, and emesis, and wrongly uses diaphoretic drugs for symptoms that do not require them. Regarding the second condition, Zhang Zhongjing stated: "Taiyang disease, fever and aversion to cold, more heat than cold, faint pulse, loss of Yang, sweating is contraindicated, use Guizhi Er Yuebi Yi Tang." *The Book of Vitality* added the words "very much" to "faint pulse," questioning whether Zhang's pulse description was insufficient. Regarding the third condition, regarding a slow Chi pulse, Zhang Zhongjing's original text did not mention "more heat than cold," but rather: "Floating and tight pulse, methodologically associated with body pain, should be treated with sweating. Suppose the Chi position pulse is slow, sweating is contraindicated because Ying Qi is insufficient and blood is scant." *The Book of Vitality* merely cited the slow Chi pulse and scant blood, arbitrarily adding "less cold, more heat" and incorporating it into this question, which is erroneous. The case of a slow Chi pulse should have been classified under contraindications for sweating.
Liu pointed out that Zhang Zhongjing's work contains only the clause for "more heat than cold" and lacks evidence for "more cold than heat." Furthermore, it states: If there is no vexation and cold extremities, but the pulse is floating and relaxed, this is Wind Injury (Shang Feng), which can be treated with Da Qinglong Tang (Major Green Dragon Decoction) or, alternatively, Guizhi Mahuang Ge Ban Tang (Half Cinnamon Twig and Half Ephedra Decoction).