戴 凡治伤寒须辨阴阳二候不可误也阳经有三太阳阳明少阳是也阴经亦有三太阴少阴厥阴是也经之阴阳以脏腑
言腑为阳膀胱胃胆是也脏为阴脾肾肝是也病之阴阳乃是外邪之阴阳阴气阳气是也病在太阳则热在皮肤之分翕翕然怫怫然
而热便有头痛恶寒体疼其脉必浮而紧病在阳明则热在肌肉之分或壮热或 而热或蒸蒸而热便有头额痛或潮热自汗其
脉必长而数病在少阳则必半表半里之热或往来寒热便有头角痛口苦呕而胸满胁痛其脉必弦而数病在太阴则手足渐冷脉
息渐沉或自利腹满呕吐不渴病在少阴虽然发热手足自冷脉必沉细病在厥阴则手足厥冷脉微而缓甚则唇青舌卷囊缩阳证
面红光彩唇红口干舌燥能饮水浆其人身轻易以转动常欲开眼见人目睛了了喜语言其声响亮口鼻之气呼吸出入能往而能
来小便或赤或黄大便或秘或硬手足自温暖爪甲俱红活阴证面青黑或有虚阳泛上虽亦赤色而不红活光彩其人身重难以转
侧或喜向壁卧或蜷卧欲寐或闭目不欲见人目睛不了了懒言语语无声气难布息鼻中呼不出吸不入往来口与鼻中气冷不欲
饮水面上恶寒有如刀刮唇口或青或紫舌色或青或紫或白苔铺满而滑不见红色手足自冷爪甲或青或紫血自不红活小便清
白或有淡黄大便不实或泻虽肌表有热以手按之则不甚热阴甚者则冷透手也阴阳二气皆能犯脏腑故阳气犯太阳则为伤风
恶风而有汗阴气犯太阳则为伤寒恶寒而无汗在太阳未得解转入阳明少阳二经则纯乎阳不如太阳之易治若阳气未能罢以
次传入阴经则为阴中之阳盖缘阳经之阳气来入阴经虽有自利欲寝唇青手足厥冷舌卷囊缩等证亦不可妄投热药宜泻其阳
之在阴经也若阳病下之太过阳气已脱遂变为阴所谓害热未已寒病复起或初得病便是阴证此是阴中之阴盖缘阴气攻阴经
阴自得传非自传诸阳经来只当以温药回其阳故阳入阴者变阳以救阴阴入阳者用阳以救阳二者不可不辨
活 太阳阳明少阳皆属阳证也太阳者膀胱也发热恶寒头疼腰痛而脉浮也阳明者胃也不恶寒反恶热 汗出大便
秘
潮热而脉长也少阳者胆也口苦咽干胁下满发热而呕或往来寒热而脉弦也麻黄汤大青龙汤桂枝汤治太阳伤风寒也大柴胡
汤调胃承气汤小承气汤大承气汤治阳明伤寒也小柴胡汤治少阴伤寒也其他药皆发汗吐下后证也若阳气独盛阴气暴绝即
为阳毒必发躁狂走妄言面赤咽痛身斑斑如锦纹或下利黄赤脉洪实或滑促当以酸苦之药投之令阴气复而大汗解矣古人云
酸苦涌泄为阴谓苦参大青葶苈苦酒之类皆复其阴气也微用苦甚则兼用酸苦折热复阴若热极发厥阳证似阴者学人当以脉
别之
太阴少阴厥阴皆属阴证也何谓太阴证太阴脾之经主胸膈 胀何谓少阴证少阴肾之经主脉细心烦但欲寐或自利而渴
何谓厥阴证厥阴肝之经主消渴气上冲心心中疼肌热不欲食食则吐蛔下之利不止也三阴中寒微则理中汤稍厥或中寒下利
即干姜甘草汤大段重者用四逆汤无脉者用通脉四逆汤若阴气独盛阳气暴绝则为阴毒其证四肢逆冷脐腹筑痛身如被杖脉
沉疾病或吐或利当急灸脐下服以辛热之药令阳气复而大汗解矣古人云辛甘发散为阳谓桂枝甘草干姜附子之类能复其阳
气也微用辛甘甚则用辛苦若阴极发躁阴证似阳学人亦当以脉别之
罗 阴证阳证辨静江府提刑李君长子年十九岁四月病伤寒九日医者作阴证治之与附子理中丸数服其证增剧别易
一
医又作阳证议论差互不敢服药李君邀予往视座间有数人予不欲直言其证但细为分解令自忖度之凡阳证者身大热而手足
不厥卧则怛然起则有力不恶寒反恶热不呕不泻渴而饮水烦躁不得眠能食而多语其脉浮大而数者阳证也凡阴证者身不热
而手足厥冷恶寒蜷卧恶闻人声或自引衣盖覆不烦渴不饮食小便自利大便反快其脉沉细而微迟者阴证也今诊其脉数得六
七至其母曰夜来叫呼不绝全不睡又喜饮水予闻其言知阳证悉具且三日不见大便宜急下之予遂以酒煨大黄六钱甘草炙二
钱芒硝五钱煎服至夕下数行燥粪二十余块是夜汗大出明日往视之身凉脉静矣予思素问热论云治之各通其脏腑故仲景述
伤寒论云六经各异传变不同活人亦云凡治伤寒先须明经络其义一也昧者不察经络不问病源按寸握尺妄意病证不知邪气
之所在动致颠覆真盲医哉昔韩子云医之病病在少思真理致之言也学人审之
吴 夫阴证似阳者乃水极似火也盖伤寒传变误服凉剂攻热太速其人素本肾气虚寒遂变阴证冷甚于内逼其浮阳之
火
发于外其人面赤烦躁身有微热渴欲饮水复不能饮大便秘结不通小便淡黄或呕逆或气促或难言或咽喉痛所以状似阳证或
见面赤烦渴大便秘结作阳证妄投寒凉之药下咽遂毙可不慎哉切其脉沉细迟微者急以通脉四逆汤倍加人参附子以接其真
阳之气设或差迟遂致阴盛阳衰参附亦不能救矣此与阴盛隔阳例同王太仆所谓身热脉数按之不鼓击者此名阴盛隔阳非热
也
娄 素问云脉从而病反言证似阳者脉亦从证似阳而其病反是寒也证似阴者脉亦从证似阴而其病反是热也故皆反
其
脉证施治如身热微热烦躁面赤其脉沉而微者阴证似阳也身热者里寒故也烦躁者阴盛故也面戴阳者下虚故也若医者不知
脉误谓实热反与凉药则气消成大病矣外台秘要云阴盛发躁名曰阴躁欲坐井中宜以热药治之故仲景少阳证面赤者四逆汤
加葱白治之 （垣 寒凉之药入腹周身之火得水则升走阴躁之极故欲坐井中是阳已先亡医犹不悟复认为热重以寒药投之
其死何疑焉）
垣 或因吐因呕因嗽而发躁蒸蒸身热如坐甑中欲得去衣居寒处或饮寒水则便如故振寒复至则气短促速胸中满闷
欲
绝甚则口开目瞪声闻于外而泪涕涎痰大作其发躁须臾而已如前六脉细弦而涩按之而虚此大寒证也以辛寒甘温之剂大泻
南方北方则愈冯内翰侄因病伤寒目赤而烦渴脉息七至按之不鼓经曰脉至而从按之不鼓诸阳皆然此阴盛格阳于外非热也
与姜附之剂汗出愈
许 伤寒六七日无热脉沉紧而细烦躁不饮水此阴盛格阳也当用附子霹雳散饮水者不可与服
吴 夫阳证似阴乃火极似水也盖伤寒热甚失于汗下阳气亢极郁伏于内反见胜已之化于外故身寒逆冷神气昏昏状
若
阴证也大抵唇焦舌燥能饮水大便秘硬小便赤涩设有稀粪水利出者此内有燥屎结聚乃旁流之物非冷利也再审有失气极臭
者是也其脉虽沉切之必滑有力或时躁热不欲衣被或扬手掷足或谵语有力此阳证也轻者人参白虎汤或小柴胡合解毒汤主
之内实者须下之以调胃承气汤或有潮热者以大柴胡加芒硝若大实大满秘而不通者以大承气汤下之必须审察轻重酌量用
之盖此与阳盛拒阴亦同王太仆所谓病患身寒厥冷其脉滑数按之鼓击于指下者此名阳盛拒阴非寒也
活 手足逆冷大便秘小便赤或大便黑色脉沉而滑者阳证似阴也轻者白虎汤重者承气汤伤寒失下血气不通令四肢
逆
冷此是伏热深故厥亦深速以大承气汤加腻粉下之汗出立愈盖热厥与阴厥自不同热厥者微厥却发热阴厥即不发热四肢逆
冷恶寒脉沉细大小便滑泄上二节言证似阳而脉病属阴证似阴而脉病属阳故反其证而治之盖证似阳而脉病属阴者世尚能
辨若脉证俱是阴而病独属阳者举世莫辨而致夭折者滔滔皆是许学士云熙宁中 守宋迪因其犹子病伤寒见其烦渴而汗多
以凉药治之遂成阴毒数日卒迪痛悼之遂着阴毒形证诀三篇盖伤世之意深矣
论曰阴盛则外寒阳虚则外寒属表故表证条云外寒者汗之则愈也阳盛则内热阴虚则内热内热属里故里证条云内热者
下之则愈也
赵 活人第三十三问引素问云阳虚则外寒阴虚则内热阳盛则内热阴盛则外寒故治伤寒者阳虚阴盛汗之则愈下之
则
死阴虚阳盛下之则愈汗之则死阴阳虚盛非谓分尺寸也难经云阴阳虚盛者说脉也素问云阴阳虚盛者说表里也仲景论伤寒
汗下故引素问表里之说与外台所论合矣外台云表病里和汗之则愈表和里病下之则愈愚详素问论阴阳虚盛四证者杂病也
难经六难之文论脉也外台所述之文论伤寒表里也但仲景所论阴阳虚盛之意理实奥焉经曰邪气盛则实精气脱则虚因正气
先虚以致邪气客之而为盛实于是有阴虚阳盛阳虚阴盛二证之别今活人书却将素问所论杂病阴阳虚盛四证合而引证仲景
伤寒四证之法又改阳盛内热作外热阴感内寒作外寒所论初未尝确合愚因拓仲景所主阴阳虚盛之理而详说之盖盛者指邪
气而言虚者指正气而言阴阳虚盛邪正消长之机也且正气在人阳主表而阴主里邪气中人表为阴而里为阳若夫表之真阳先
虚故阴邪乘阳而盛实表受邪者阳虚也脉浮紧者阴邪盛于外也是谓阳虚阴盛所以用桂枝辛甘之温剂汗之则阴邪消温之则
真阳长使邪去正安故愈又若里之真阴先虚故阳邪入阴而盛实里受邪者阴虚也脉沉实者阳邪盛于内也是谓阴虚阳盛所以
用承气酸苦之寒剂下之则阳邪消寒之则真阴长邪去正安故愈如其不然阳盛而用桂枝下咽即毙阴盛而用承气入胃即亡是
皆盛盛虚虚而致邪失正也以是知仲景所主阳虚阴盛阴虚阳盛二证之意深盖指一为表证一为里证邪正消长而言非兼言表
和里病里和表病而谓之阴阳虚盛也况和者无病处也以和字训虚字恐碍于理
王 难经曰伤寒阳虚阴盛汗出而愈下之即死阳盛阴虚汗出而死下之则愈嗟乎其伤寒汗下之枢机乎夫邪之伤于人
也
有浅深焉浅则居表深则入里居表而闭腠理发怫热见恶寒恶风头痛等证于斯时也惟辛温解散而可愈入里则为燥屎作潮热
形狂言谵语大渴等证于斯时也惟咸寒攻下而可平夫寒邪外客非阴盛而阳虚乎热邪内炽非阳盛而阴虚乎汗下一差生死反
掌吁是言也谓之伤寒汗下枢机其不然欤惜乎释者旁求厥义滋隐外台秘要曰此阴阳指身之表里言病者为虚不病者为盛表
病里和是阳虚阴盛也表和里病是阳盛阴虚也窃意阴阳之在人均则宁偏则病无过不及之谓均过与不及之谓偏盛则过矣虚
则不及矣其可以盛为和乎故内经云邪气盛则实精气夺则虚且谓阳虚当汗阴虚当下乃遗邪气而反指正气为言得无晦乎伤
寒微旨曰此阴阳指脉之尺寸言尺脉实大寸脉短小名阴盛阳虚可汗寸脉实大尺脉短小名阳盛阴虚可下苟汗证已具而脉未
应必待尺脉力过于寸而后行下证已具而脉未应必待寸脉力过于尺而后用窃意越人设难以病不以脉其所答也何反以脉不
以病乎且脉固以候病也倘汗下之证已急不可少缓待脉应而未应欲不待则惑于心欲待之则虑其变二者之间将从病欤将从
脉欤吾不得无疑于此也或诘予曰仲景伤寒论引此而继以桂枝下咽阳盛则毙承气入胃阴盛以亡之语夫桂枝表药承气里药
反则为害是固然矣然麻黄汤亦表药也其不言之何欤且子以阴盛为寒邪寒邪固宜用麻黄也今反举桂枝又何欤予曰何不味
仲景之言乎其曰凡伤寒之病多从风寒得之又曰脉浮而紧浮则为风紧则为寒又桂枝汤条而曰啬啬恶寒淅淅恶风麻黄汤涤
而曰恶风夫风寒分言则风阳而寒阴风苟行于天地严凝凛冽之时其得谓之阳乎是则风寒常相因耳故桂枝麻黄皆温剂也以
温剂为治足以见风寒之俱为阴邪矣但伤卫则桂枝伤荣则麻黄荣卫虽殊其为表则一耳仲景此言但以戒汗下之误为主不为
荣卫设也举桂枝则麻黄在其中矣所谓阳盛即毙者是言表证已罢而里证既全可攻而不可汗所谓阴盛以亡者是言里证未形
而表证独具可汗而不可攻由此观之则越人仲景之本旨庶乎畅然于其中矣
戴氏曰：大凡治疗伤寒，必须辨别阴证和阳证两种证候，不可误判。阳经有三条，即太阳、阳明、少阳；阴经也有三条，即太阴、少阴、厥阴。这里的经络阴阳是从脏腑角度而言的：腑属阳，包括膀胱、胃、胆；脏属阴，包括脾、肾、肝。疾病的阴阳则是从外邪的阴阳属性而言，即阴气和阳气。
病在太阳经，则热邪在皮肤层面，表现为翕翕发热（如羽毛覆盖般的温热感）或怫怫发热（郁结不通的发热），同时伴有头痛、恶寒、身体疼痛，其脉象必然浮而紧。病在阳明经，则热邪在肌肉层面，表现为壮热（高热）、或者蒸蒸发热（热气由内向外透发），同时伴有头额痛，或者潮热（定时发热）、自汗，其脉象必然长而数。病在少阳经，则必然是半表半里的热证，表现为往来寒热（忽冷忽热），同时伴有头角痛、口苦、呕吐、胸满、胁痛，其脉象必然弦而数。病在太阴经，则手足逐渐变冷，脉搏气息逐渐沉伏，或者出现自利（腹泻）、腹满、呕吐但不口渴。病在少阴经，虽然可能有发热，但手足自然冰冷，脉象必然沉细。病在厥阴经，则手足厥冷，脉微而缓，严重时会出现嘴唇青紫、舌头卷缩、睾丸收缩。
阳证的表现是：面色红亮有光彩，嘴唇红润，口干舌燥，能喝饮水浆。病人身体轻便，容易转动，常想睁眼见人，眼睛明亮有神，喜欢说话，声音响亮。口鼻呼吸出入通畅，小便颜色或赤或黄，大便或秘结或坚硬，手足自然温暖，指甲红润鲜活。
阴证的表现是：面色青黑，或者有虚阳上浮，虽然也显红色，但不红润鲜活无光彩。病人身体沉重，难以转侧，或者喜欢面向墙壁躺卧，或者蜷缩而卧，昏昏欲睡，或者闭眼不想见人，眼睛昏花无神，懒于言语，说话声音低微无力。气息短促，鼻子呼不出气，吸不进气，口鼻中呼出的气寒冷，不想喝水。面上怕冷，像刀刮一样难受，嘴唇或口唇青色或紫色，舌色或青或紫或白，舌苔铺满且滑腻，不见红色。手足自然冰冷，指甲或青或紫，血色不红活。小便清长白色，或者淡黄色，大便不成形，或者腹泻。即使肌表有热，用手按压时热度也不明显；阴寒严重的，寒气会透入手掌。
阴阳二气都能侵犯脏腑。所以阳气侵犯太阳经，则为伤风，表现为恶风且有汗；阴气侵犯太阳经，则为伤寒，表现为恶寒而无汗。如果在太阳经未得解，转入阳明、少阳二经，则纯为阳证，不如太阳经那样容易治疗。如果阳气未能罢休，依次传入阴经，则成为“阴中之阳”。这是因为阳经的阳气进入阴经，虽然出现自利、想睡觉、嘴唇青、手足厥冷、舌头卷缩、睾丸收缩等症状，也不可妄投热药，应当泻除停留在阴经的阳热。如果阳病误用下法太过，导致阳气脱失，随即变为阴证，这就是所谓的“害热未已，寒病复起”，或者初得病就是阴证，这是“阴中之阴”。这是因为阴气攻犯阴经，阴经自身传变，并非从诸阳经传来，只应当用温药来回复阳气。所以，阳入阴者，变阳以救阴；阴入阳者，用阳以救阳。这两者不可不仔细辨别。
活人书曰：太阳、阳明、少阳都属于阳证。太阳经属于膀胱，症状是发热、恶寒、头疼、腰痛，脉象浮。阳明经属于胃，症状是不恶寒反而恶热，出汗，大便秘结，潮热，脉象长。少阳经属于胆，症状是口苦、咽干、胁下胀满，发热而呕，或者往来寒热，脉象弦。麻黄汤、大青龙汤、桂枝汤用于治疗太阳经的伤风和伤寒。大柴胡汤、调胃承气汤、小承气汤、大承气汤用于治疗阳明经的伤寒。小柴胡汤用于治疗少阴经的伤寒（注：此处原文有误，通常小柴胡治少阳，但依原文翻译）。其他药物都是用于发汗、催吐、泻下之后的证候。
如果阳气独盛，阴气暴绝，就称为阳毒，必定出现烦躁狂乱、奔走妄言、面赤、咽喉痛、身上斑纹如锦缎般，或者下利黄赤色，脉象洪实或滑促。此时应当用酸苦性质的药物投服，使阴气恢复，通过大汗而解。古人说：“酸苦涌泄为阴”，指的是苦参、大青、葶苈子、醋之类，都能回复阴气。轻微使用苦味，严重则兼用酸味，以折损热势，回复阴气。如果热极导致发厥，阳证似阴证，学习者应当通过脉象来辨别。
太阴、少阴、厥阴都属于阴证。什么是太阴证？太阴是脾的经脉，主要症状是胸膈胀满。什么是少阴证？少阴是肾的经脉，主要症状是脉细、心烦、只想睡觉，或者自利而口渴。什么是厥阴证？厥阴是肝的经脉，主要症状是消渴（极度口渴）、气上冲心、心中疼痛、肌肉发热、不想吃东西，吃了就吐蛔虫，如果用下法会导致腹泻不止。在三阴经中，寒邪轻微则用理中汤；稍微厥冷或者中寒下利的，就用干姜甘草汤；病情特别严重的，用四逆汤；没有脉象的，用通脉四逆汤。如果阴气独盛，阳气暴绝，就称为阴毒，症状是四肢逆冷，脐腹部剧烈疼痛，身体像被棍棒打过一样，脉象沉伏。疾病或者呕吐或者下利，应当紧急灸脐下，服用辛热药物，使阳气回复，通过大汗而解。古人说：“辛甘发散为阳”，指的是桂枝、甘草、干姜、附子之类，能回复阳气。轻微使用辛甘，严重则用辛苦。如果阴极导致发躁，阴证似阳证，学习者也应当通过脉象来辨别。
罗氏曰：辨别阴证阳证。静江府提刑李君的长子十九岁，四月患伤寒九天。医生按阴证治疗，给予附子理中丸服用数次，病情加重。另一位医生又按阳证议论，意见不一，不敢服药。李君邀请我去诊治。座间有几个人，我不想直言病情，只是细细分解让病人自己揣摩。凡是阳证：身体大热而手足不厥冷，躺着惊恐不安起来有力，不恶寒反而恶热，不呕吐不腹泻，口渴想喝水，烦躁不能入睡，能吃而且多话，脉象浮大而数，这是阳证。凡是阴证：身体不热而手足厥冷，恶寒蜷卧，厌恶听到人声，或者自己拉被子盖住，不烦躁不口渴，不吃东西，小便自利，大便反快，脉象沉细而微迟，这是阴证。现在诊察他的脉象，一息六七至（脉搏很快）。他母亲说：昨晚叫喊不停，完全没睡觉，又喜欢喝水。我听了这些话，知道阳证全部具备，而且三天没有大便，应当急用下法。于是我用了酒煨大黄六钱，炙甘草二钱，芒硝五钱，煎服。到了傍晚，下了几次燥粪二十多块。那天晚上大汗出，第二天去看他，身体凉快，脉象平静了。我思考《素问·热论》说：“治之各通其脏腑”，所以仲景阐述《伤寒论》说：“六经各异，传变不同”，《活人书》也说：“大凡治疗伤寒，必须先明经络”，道理是一样的。糊涂的人不考察经络，不问病源，按寸握尺，随意猜测病证，不知道邪气所在，动不动就导致病情恶化，真是盲目的医生啊！以前韩愈说：医生的毛病在于缺乏深思熟虑，追求真理的话啊，学习者要审慎对待。
吴氏曰：所谓阴证似阳，是水极似火。大概伤寒传变，误服凉剂清热太快，其人本来肾气虚寒，于是变成阴证，冷甚于内，逼迫浮阳之火发于外。其人面赤、烦躁、身有微热、渴欲饮水但又不能多喝、大便秘结不通、小便淡黄，或者呕吐逆气、或者气促、或者难言、或者咽喉痛，所以状似阳证。或者见面赤烦渴、大便秘结，当作阳证妄投寒凉药物，下咽就死了，能不谨慎吗？切其脉沉细迟微的，紧急用通脉四逆汤倍加人参、附子来接引真阳之气。如果差迟，就会致使阴盛阳衰，人参附子也不能救了。这与阴盛隔阳的例子相同。王冰所谓“身热脉数，按之不鼓击者”，这名叫阴盛隔阳，不是热证。
娄氏曰：《素问》说：“脉从而病反”，意思是证候似阳，脉象也顺从证候似阳，但病反而是寒。证候似阴，脉象也顺从证候似阴，但病反而是热。所以都要反过来根据脉证施治。比如身热、微热、烦躁、面赤，但脉象沉而微的，是阴证似阳。身热是因为里有寒，烦躁是因为阴盛，面戴阳（面部泛红）是因为下虚。如果医者不知脉象，误认为是实热，反而给凉药，那么正气消损，成大病了。《外台秘要》说：“阴盛发躁，名叫阴躁”，想要坐在井中，应当用热药治疗。所以仲景治少阳证面赤的，用四逆汤加葱白。（垣氏注：寒凉药物入腹，周身之火得水则升，走到阴躁的极点，所以想坐井中，这是阳气已经先亡，医者还不醒悟，还认为是热，重用寒药投之，其死有何怀疑？）
垣氏曰：有的因为吐、因为呕、因为咳嗽而发躁，蒸蒸身热如坐蒸笼中，想要脱衣住在寒冷处，或者喝冷水则便如故（正常），振寒再次到来则气短促速，胸中满闷快要断绝，严重时张口瞪眼，声音传于外面，眼泪鼻涕涎痰大作。这种发躁须臾而已。前面提到六脉细弦而涩，按之而虚，这是大寒证。用辛寒甘温的药剂，大泻南方（火）北方（水），则痊愈。冯内翰的侄子因病患伤寒，目赤而烦渴，脉息七至，按之不鼓击。经书说：“脉至而从，按之不鼓”，诸阳皆然，这是阴盛格阳于外，不是热证。给予姜附之剂，汗出而愈。
许氏曰：伤寒六七天，无热，脉沉紧而细，烦躁不饮水，这是阴盛格阳。应当用附子霹雳散。饮水的不可与服。
吴氏曰：所谓阳证似阴，是火极似水。大概伤寒热甚，失于汗下，阳气亢极，郁伏于内，反而见到胜己之化（寒象）于外。所以身寒逆冷，神气昏昏，状若阴证。大抵唇焦舌燥，能饮水，大便秘硬，小便赤涩。设有稀粪水利出者，这是内有燥屎结聚，乃旁流之物，不是冷利。再审察有放屁极臭的是。其脉虽沉，切之必滑有力，或者时而躁热不欲衣被，或者扬手掷足，或者谵语有力，这是阳证。轻者用人参白虎汤，或者小柴胡合解毒汤主治。内实者必须用下法，以调胃承气汤。或者有潮热的，以大柴胡加芒硝。如果大实大满秘而不通的，以大承气汤下之。必须审察轻重，酌量用之。盖此与阳盛拒阴也是相同的。王冰所谓“病患身寒厥冷，其脉滑数，按之鼓击于指下者”，这名叫阳盛拒阴，不是寒证。
活人书曰：手足逆冷，大便秘，小便赤，或者大便黑色，脉沉而滑的，是阳证似阴。轻者用白虎汤，重者用承气汤。伤寒失于下法，血气不通，令四肢逆冷，这是伏热深，所以厥亦深。速以大承气汤加腻粉下之，汗出立愈。盖热厥与阴厥自然不同。热厥者，微厥却发热；阴厥即不发热，四肢逆冷，恶寒，脉沉细，大小便滑泄。上两节说的是证似阳而脉病属阴，证似阴而脉病属阳，所以反其证而治之。盖证似阳而脉病属阴者，世人尚能辨别；若脉证俱是阴而病独属阳者，举世莫辨，而致夭折者滔滔皆是。许学士说：熙宁年间，太守宋迪因其侄子患伤寒，见其烦渴而汗多，以凉药治之，遂成阴毒，数日卒。宋迪痛悼之，遂著《阴毒形证诀》三篇。盖伤世之意深矣。
论曰：阴盛则外寒，阳虚则外寒。属表，故表证条云：外寒者，汗之则愈也。阳盛则内热，阴虚则内热。内热属里，故里证条云：内热者，下之则愈也。
赵氏曰：《活人书》第三十三问引用《素问》说：“阳虚则外寒，阴虚则内热，阳盛则内热，阴盛则外寒。”所以治伤寒者，阳虚阴盛，汗之则愈，下之则死；阴虚阳盛，下之则愈，汗之则死。阴阳虚盛，不是说分尺寸脉。《难经》说阴阳虚盛是指脉，《素问》说阴阳虚盛是指表里。仲景论伤寒汗下，所以引《素问》表里之说，与《外台秘要》所论合了。《外台秘要》说：表病里和，汗之则愈；表和里病，下之则愈。我详细考察《素问》论阴阳虚盛四证，是杂病。《难经》第六难的条文论脉。《外台》所述之文论伤寒表里。但仲景所论阴阳虚盛之意，理实奥焉。经曰：“邪气盛则实，精气脱则虚。”因正气先虚，以致邪气客之而为盛实，于是有阴虚阳盛、阳虚阴盛二证之别。今《活人书》却将《素问》所论杂病阴阳虚盛四证合而引证仲景伤寒四证之法，又改阳盛内热作外热，阴感内寒作外寒，所论初未尝确合。我因此拓开仲景所主阴阳虚盛之理而详说之。盖盛者指邪气而言，虚者指正气而言，阴阳虚盛是邪正消长之机。且正气在人，阳主表而阴主里；邪气中人，表为阴而里为阳。若夫表之真阳先虚，故阴邪乘阳而盛实，表受邪者阳虚也，脉浮紧者是阴邪盛于外，是谓阳虚阴盛，所以用桂枝辛甘之温剂，汗之则阴邪消，温之则真阳长，使邪去正安，故愈。又若里之真阴先虚，故阳邪入阴而盛实，里受邪者阴虚也，脉沉实者是阳邪盛于内，是谓阴虚阳盛，所以用承气酸苦之寒剂，下之则阳邪消，寒之则真阴长，邪去正安，故愈。如其不然，阳盛而用桂枝，下咽即毙；阴盛而用承气，入胃即亡。是皆盛盛虚虚而致邪失正也。以是知仲景所主阳虚阴盛、阴虚阳盛二证之意深，盖指一为表证，一为里证，邪正消长而言，非兼言表和里病、里和表病而谓之阴阳虚盛也。况和者无病处也。以和字训虚字，恐碍于理。
王氏曰：《难经》说：“伤寒阳虚阴盛，汗出而愈，下之即死；阳盛阴虚，汗出而死，下之则愈。”唉，这大概是伤寒汗下的枢机吧！夫邪之伤人，有浅深焉。浅则居表，深则入里。居表而闭腠理，发怫热，见恶寒、恶风、头痛等证，于斯时也，惟辛温解散而可愈。入里则为燥屎，作潮热、形狂、言谵语、大渴等证，于斯时也，惟咸寒攻下而可平。夫寒邪外客，非阴盛而阳虚乎？热邪内炽，非阳盛而阴虚乎？汗下一差，生死反掌。吁，是言也，谓之伤寒汗下枢机，其不然欤？可惜那些解释的人旁求厥义，滋隐。《外台秘要》说：此阴阳指身之表里言。病者为虚，不病者为盛。表病里和，是阳虚阴盛也；表和里病，是阳盛阴虚也。我私下认为，阴阳在人，均则宁，偏则病，无过不及之谓均，过与不及之谓偏。盛则过矣，虚则不及矣。其可以盛为和乎？故《内经》云：“邪气盛则实，精气夺则虚。”且谓阳虚当汗，阴虚当下，乃遗邪气而反指正气为言，得无晦乎？《伤寒微旨》说：此阴阳指脉之尺寸言。尺脉实大，寸脉短小，名阴盛阳虚，可汗；寸脉实大，尺脉短小，名阳盛阴虚，可下。苟汗证已具而脉未应，必待尺脉力过于寸而后行；下证已具而脉未应，必待寸脉力过于尺而后用。我私下认为，越人设难，以病不以脉，其所答也，何反以脉不以病乎？且脉固以候病也。倘汗下之证已急，不可少缓，待脉应而未应，欲不待则惑于心，欲待之则虑其变。二者之间，将从病欤？将从脉欤？吾不得无疑于此也。或者诘我问：仲景《伤寒论》引此而继以“桂枝下咽，阳盛则毙；承气入胃，阴盛以亡”之语。夫桂枝表药，承气里药，反则为害，是固然矣。然麻黄汤亦表药也，其不言之何欤？且子以阴盛为寒邪，寒邪固宜用麻黄也，今反举桂枝又何欤？予曰：何不味仲景之言乎其？其曰：“凡伤寒之病，多从风寒得之。”又曰：“脉浮而紧，浮则为风，紧则为寒。”又桂枝汤条而曰：“啬啬恶寒，淅淅恶风。”麻黄汤条而曰：“恶风。”夫风寒分言，则风阳而寒阴。风苟行于天地严凝凛冽之时，其得谓之阳乎？是则风寒常相因耳。故桂枝、麻黄皆温剂也。以温剂为治，足以见风寒之俱为阴邪矣。但伤卫则桂枝，伤荣则麻黄。荣卫虽殊，其为表则一耳。仲景此言，但以戒汗下之误为主，不为荣卫设也。举桂枝则麻黄在其中矣。所谓“阳盛即毙”者，是言表证已罢而里证既全，可攻而不可汗。所谓“阴盛以亡”者，是言里证未形而表证独具，可汗而不可攻。由此观之，则越人、仲景之本旨，庶乎畅然于其中矣。
Dai Shi stated: In general, when treating Shanghan (Cold Damage), one must distinguish between Yin and Yang syndromes to avoid misdiagnosis. There are three Yang meridians: Taiyang (Greater Yang), Yangming (Yang Brightness), and Shaoyang (Lesser Yang). There are also three Yin meridians: Taiyin (Greater Yin), Shaoyin (Lesser Yin), and Jueyin (Terminal Yin). The Yin-Yang of the meridians is discussed in terms of Zang-Fu organs: Fu organs are Yang, including the Bladder, Stomach, and Gallbladder; Zang organs are Yin, including the Spleen, Kidney, and Liver. The Yin-Yang of diseases refers to the Yin-Yang nature of external pathogens, namely Yin Qi and Yang Qi.
When the disease is in the Taiyang meridian, the heat is at the skin level, manifesting as "Xi Xi" fever (a warm sensation like feathers covering) or "Fu Fu" fever (fever due to stagnation), accompanied by headache, aversion to cold, and body ache. The pulse will necessarily be floating and tight. When the disease is in the Yangming meridian, the heat is at the muscle level, manifesting as high fever ("Zhuang Re"), steaming fever ("Zheng Zheng Re"), or tidal fever ("Chao Re") with spontaneous sweating, accompanied by forehead pain. The pulse will necessarily be long and rapid. When the disease is in the Shaoyang meridian, it is a half-exterior, half-interior heat syndrome, manifesting as alternating chills and fever ("Wang Lai Han Re"), accompanied by pain at the temples, bitter taste in the mouth, vomiting, chest fullness, and hypochondriac pain. The pulse will necessarily be wiry and rapid. When the disease is in the Taiyin meridian, the hands and feet gradually become cold, the pulse becomes sinking, or there is spontaneous diarrhea, abdominal fullness, and vomiting without thirst. When the disease is in the Shaoyin meridian, although there may be fever, the hands and feet are naturally cold, and the pulse is necessarily deep and fine. When the disease is in the Jueyin meridian, the hands and feet are cold, the pulse is faint and slow, and in severe cases, cyanosis of the lips, curling of the tongue, and retraction of the testicles occur.
Yang syndrome manifestations include: a red and lustrous face, red lips, dry mouth and tongue, ability to drink fluids. The patient's body is light and easy to move, often wanting to open eyes and see people, with bright eyes, preferring to speak with a loud voice. Breathing through the nose and mouth is smooth. Urine may be red or yellow, stool may be constipated or hard, hands and feet are naturally warm, and nails are ruddy and vibrant.
Yin syndrome manifestations include: a blue-black face, or false Yang floating upward (red but not vibrant/lustrous). The patient's body is heavy and difficult to turn, preferring to lie facing the wall or curled up, drowsy, closing eyes and avoiding people, with dull eyes, reluctance to speak, and low voice. Breath is short, unable to inhale/exhale effectively, breath from mouth and nose is cold, no desire to drink. Face is sensitive to cold as if scraped by a knife, lips or mouth may be blue or purple, tongue color may be blue, purple, or white with a slippery coating covering the surface, lacking redness. Hands and feet are naturally cold, nails may be blue or purple, blood is not vibrant. Urine is clear and white or pale yellow, stool is loose or diarrheal. Even if the skin feels hot, pressing reveals little heat; in severe Yin cold, the cold penetrates the hand.
Both Yin and Yang Qi can invade Zang-Fu organs. Thus, if Yang Qi invades the Taiyang meridian, it is Wind Strike (Shang Feng), characterized by aversion to wind and sweating. If Yin Qi invades the Taiyang meridian, it is Cold Damage (Shang Han), characterized by aversion to cold and no sweating. If unresolved in Taiyang and transferring to Yangming and Shaoyang, it becomes purely Yang syndrome, which is harder to treat than Taiyang. If Yang Qi continues to transmit into Yin meridians, it becomes "Yang within Yin." Although symptoms like diarrhea, drowsiness, cyanotic lips, cold limbs, curled tongue, and retracted testicles appear, one must not recklessly administer warming herbs; instead, one should purge the Yang heat residing in the Yin meridians. If Yang disease is treated with purgatives excessively, causing Yang Qi depletion, it transforms into Yin syndrome, described as "the harm of heat has not ceased, yet cold disease arises," or initial Yin syndrome, known as "Yin within Yin." This occurs because Yin Qi attacks Yin meridians directly, not from Yang meridians. One should only use warming herbs to restore Yang. Therefore, when Yang enters Yin, transform Yang to save Yin; when Yin enters Yang, use Yang to save Yang. These two must be distinguished.
Huorenshu (The Living Manual) states: Taiyang, Yangming, and Shaoyang all belong to Yang syndromes. Taiyang belongs to the Bladder, with symptoms of fever, aversion to cold, headache, lower back pain, and floating pulse. Yangming belongs to the Stomach, with symptoms of no aversion to cold but aversion to heat, sweating, constipation, tidal fever, and long pulse. Shaoyang belongs to the Gallbladder, with symptoms of bitter taste, dry throat, hypochondriac fullness, fever with vomiting, or alternating chills and fever, and wiry pulse. Mahuang Tang (Ephedra Decoction), Da Qing Long Tang (Great Blue Dragon Decoction), and Guizhi Tang (Cinnamon Twig Decoction) treat Taiyang Wind Strike and Cold Damage. Da Chai Hu Tang (Major Bupleurum Decoction), Tiao Wei Cheng Qi Tang (Regulate the Stomach and Restore the Qi Decoction), Xiao Cheng Qi Tang (Minor Restoring the Qi Decoction), and Da Cheng Qi Tang (Major Restoring the Qi Decoction) treat Yangming Cold Damage. Xiao Chai Hu Tang (Minor Bupleurum Decoction) treats Shaoyin Cold Damage (Note: Textual error in original, typically for Shaoyang). Other formulas treat post-sweating, post-emetic, or post-purgative conditions.
If Yang Qi is exclusively abundant and Yin Qi abruptly ceases, it is called Yang Du (Yang Toxin), manifesting as restlessness, madness, running about, delirious speech, red face, sore throat, rash like brocade, or bloody diarrhea with crimson stool, and surging or slippery-rapid pulse. Acid-bitter herbs should be administered to restore Yin Qi, leading to resolution via profuse sweating. Ancients said: "Acid and bitter induce vomiting and purging, belonging to Yin," referring to herbs like Kushen (Sophora Root), Daqing (Arctium Leaf), Tinglizi (Lepidium Seed), and vinegar, which restore Yin. Mildly use bitter, heavily use acid to reduce heat and restore Yin. If extreme heat causes jue (cold extremities), and Yang syndrome resembles Yin, learners must distinguish by pulse.
Taiyin, Shaoyin, and Jueyin all belong to Yin syndromes. What is Taiyin syndrome? Taiyin is the Spleen meridian, mainly presenting with chest and diaphragm distension. What is Shaoyin syndrome? Shaoyin is the Kidney meridian, mainly presenting with fine pulse, vexation, desire to sleep, or spontaneous diarrhea with thirst. What is Jueyin syndrome? Jueyin is the Liver meridian, mainly presenting with excessive thirst, Qi rushing to the heart, heart pain, muscle heat, anorexia, vomiting worms after eating, and worsening diarrhea if purged. For mild cold in the Three Yin meridians, Lizhong Tang (Regulate the Middle Decoction) is used. For slight cold extremities or cold-induced diarrhea, Ganjiang Gancao Tang (Dried Ginger and Licorice Decoction) is used. For severe cases, Sini Tang (Frigid Extremities Decoction) is used. For absent pulse, Tongmai Sini Tang (Pulse-Restoring Frigid Extremities Decoction) is used. If Yin Qi is exclusively abundant and Yang Qi abruptly ceases, it is called Yin Du (Yin Toxin), manifesting as cold extremities, severe umbilical/abdominal pain, body feeling beaten, and sinking pulse. With vomiting or diarrhea, urgently moxa below the navel and administer acrid-hot herbs to restore Yang, resolving via profuse sweating. Ancients said: "Acrid and sweet disperse and ascend, belonging to Yang," referring to Guizhi (Cinnamon Twig), Gancao (Licorice), Ganjiang (Dried Ginger), and Fuzi (Aconite Root), which restore Yang. Mildly use acrid-sweet, heavily use acrid-bitter. If extreme Yin causes restlessness, and Yin syndrome resembles Yang, learners must distinguish by pulse.
Luo Shi stated: Distinguishing Yin and Yang syndromes. The eldest son of Li Jun, Procurator of Jingjiang Prefecture, aged 19, contracted Shanghan in April. After nine days, a physician treated him as Yin syndrome with Fuzi Lizhong Wan (Aconite Regulate the Middle Pills) several times, worsening the condition. Another physician argued it was Yang syndrome, causing confusion and hesitation to take medicine. Li Jun invited me to examine. I did not state the diagnosis directly but explained the distinctions for self-reflection. Yang syndrome: High body heat, cold-free extremities, restless lying but strong rising, no aversion to cold but aversion to heat, no vomiting/diarrhea, thirsty for water, vexed insomnia, able to eat and talk much, floating-large-rapid pulse. Yin syndrome: No body heat, cold extremities, aversion to cold, curled posture, aversion to sound, pulling covers, no vexation/thirst, anorexia, free urination, loose stool, deep-fine-micro-slow pulse. His pulse was 6-7 beats per breath. His mother reported night-long screaming, insomnia, and thirst. Knowing all Yang symptoms were present and no bowel movement for three days, I urgently purged. I prescribed Jiuhuang (Wine-processed Rhubarb) 6 qian, Zhigancao (Honey-fried Licorice) 2 qian, Mangxiao (Mirabilite) 5 qian. By evening, several movements of dry feces (over 20 pieces) passed. That night, profuse sweating occurred. Next day, body cool, pulse calm. Reflecting on Suwen's "Treat by unblocking Zang-Fu," Zhang Zhongjing's "Six Meridians differ in transmission," and Huorenshu's "Must understand meridians first," the principle is one. Ignorant physicians who ignore meridians and source, guessing blindly, cause disaster. As Han Yu said, physicians err by lacking deep thought. Learners must be prudent.
Wu Shi stated: Yin syndrome resembling Yang is like water extreme resembling fire. Due to rapid cooling herb misuse in Shanghan transmission, in patients with inherent Kidney Qi deficiency and cold, Yin syndrome develops. Internal cold forces floating Yang fire outward. Symptoms: red face, vexation, slight fever, thirst but inability to drink much, constipation, pale yellow urine, vomiting, shortness of breath, dysphonia, or sore throat, mimicking Yang syndrome. Misdiagnosing as Yang and administering cold herbs leads to death. Be cautious! Deep-fine-slow-micro pulse indicates urgent need for Tongmai Sini Tang with extra Renshen (Ginseng Root) and Fuzi (Aconite Root) to connect True Yang. Delay leads to Yin excess/Yang decline, where Ginseng and Aconite cannot save. This is Yin Excess Blocking Yang. Wang Bing stated: "Body heat, rapid pulse, non-beating upon pressure" is Yin Excess Blocking Yang, not heat.
Lou Shi stated: Suwen says: "Pulse follows but disease reverses." Syndrome resembles Yang, pulse resembles Yang, but disease is Cold. Syndrome resembles Yin, pulse resembles Yin, but disease is Heat. Thus, treat opposite to apparent syndrome/pulse. E.g., fever, slight heat, vexation, red face, but deep-micro pulse indicates Yin syndrome resembling Yang. Fever due to interior cold, vexation due to Yin excess, facial flushing (Dai Yang) due to lower deficiency. Misdiagnosing as excess heat and giving cold herbs destroys Qi. Waitai Miyao states: "Yin excess causes restlessness, named Yin Zaosao," desiring to sit in a well, treat with hot herbs. Thus, Zhang Zhongjing treats Shaoyang red face with Sini Tang plus Congbai (Scallion White). (Yuan Zhi Zhu note: Cold herbs enter stomach, fire rises with water, reaching extreme Yin Zaosao, desiring well. Yang is already lost. Physician unaware, treats as heat with cold herbs, death is certain.)
Yuan Zhi stated: Restlessness after vomiting/coughing, steaming fever like sitting in a steamer, wanting to remove clothes/cold places/hot water, then returning chills, shortness of breath, chest oppression, severe open-mouth/stare/extreme phlegm/saliva. Restlessness is brief. Six pulses are fine-wiry-choppy, empty upon pressure, indicating severe cold. Use acrid-cold and sweet-warm herbs to strongly drain South (Fire) and North (Water) to cure. Feng Neihan's nephew had Shanghan with red eyes, vexation, thirst, 7-beat pulse, non-beating upon pressure. Classic: "Pulse follows, non-beating upon pressure" applies to all Yang, indicating Yin Excess Blocking Yang externally, not heat. Given Jiangfu (Ginger and Aconite) decoction, resolved with sweating.
Xu Shi stated: Shanghan 6-7 days, no fever, deep-tight-fine pulse, vexation, no thirst, indicates Yin Excess Blocking Yang. Use Fuzi Pili San (Aconite Thunderbolt Powder). Do not use if drinking water.
Wu Shi stated: Yang syndrome resembling Yin is like fire extreme resembling water. Severe Shanghan heat, missed sweating/purging, Yang Qi hyperactive and depressed internally, manifests as cold externally (victor's transformation). Symptoms: cold extremities, dull spirit, resembling Yin. But dry lips/tongue, ability to drink, constipation, dark scanty urine indicate internal dryness. Loose stool is "side-flow" from dry feces accumulation, not cold diarrhea. Foul gas confirms this. Pulse deep but slippery-strong upon pressure, or periodic heat/restlessness, kicking, forceful delirium, indicates Yang syndrome. Mild cases: Renshen Baihu Tang (Ginseng White Tiger Decoction) or Xiao Chai Hu Tang combined with Jiedu Tang. Internal excess requires purging: Tiao Wei Cheng Qi Tang. Tidal fever: Da Chai Hu Tang plus Mangxiao. Severe excess/blockage: Da Cheng Qi Tang. Judge severity carefully. Similar to Yang Excess Rejecting Yin. Wang Bing stated: "Body cold/cold extremities, slippery-rapid pulse, beating upon pressure" is Yang Excess Rejecting Yin, not cold.
Huorenshu stated: Cold extremities, constipation, dark urine, or black stool, deep-slippery pulse, indicates Yang syndrome resembling Yin. Mild: Baihu Tang. Severe: Cheng Qi Tang. Missed purging in Shanghan causes Qi/Blood blockage, cold extremities due to deep latent heat ("Jue deep, heat deep"). Urgently purge with Da Cheng Qi Tang plus Nifen (Calomel). Sweating resolves immediately. Heat Jue differs from Yin Jue. Heat Jue: slight cold extremities with fever. Yin Jue: no fever, cold extremities, aversion to cold, deep-fine pulse, loose stool. Previous sections: Syndrome resembles Yang but pulse/disease is Yin; Syndrome resembles Yin but pulse/disease is Yang. Treat oppositely. People can distinguish syndrome-resembling-Yang/pulse-Yin. But pulse-syndrome-both-Yin/disease-Yang is universally unrecognized, causing many deaths. Xu Xueshi noted: Song Di's nephew had Shanghan with vexation/thirst/sweating, treated with cold herbs, became Yin Toxin, died. Song Di wrote "Yin Toxin Syndrome Resolution" out of grief.
Discussion: Yin excess causes exterior cold, Yang deficiency causes exterior cold. Exterior syndrome: sweat to cure. Yang excess causes interior heat, Yin deficiency causes interior heat. Interior syndrome: purge to cure.
Zhao Shi stated: Huorenshu Q33 cites Suwen: "Yang deficiency exterior cold, Yin deficiency interior heat, Yang excess interior heat, Yin excess exterior cold." Thus, Yang deficiency/Yin excess: sweat to cure, purge kills. Yin deficiency/Yang excess: purge to cure, sweat kills. Yin-Yang deficiency/excess refers to pulse in Nanjing, but exterior/interior in Suwen. Zhang Zhongjing cites Suwen's exterior/interior for Shanghan, matching Waitai Miyao: "Exterior disease interior harmony: sweat to cure; Interior disease exterior harmony: purge to cure." I analyze: Suwen's four Yin-Yang deficiency/excess syndromes refer to miscellaneous diseases. Nanjing Ch. 6 refers to pulse. Waitai refers to Shanghan exterior/interior. Zhang Zhongjing's meaning is profound. Classic: "Pathogen excess is excess, Essence depletion is deficiency." Primary Qi deficiency allows Pathogen invasion, creating Yin deficiency/Yang excess and Yang deficiency/Yin excess. Huorenshu conflates Suwen's miscellaneous disease theory with Zhang's Shanghan theory, changing "Yang excess interior heat" to "exterior heat" and "Yin sensation interior cold" to "exterior cold," which does not align. I expand on Zhang's theory: "Excess" refers to Pathogen, "Deficiency" refers to Primary Qi. It is the mechanism of Pathogen/Primary Qi fluctuation. Primary Qi: Yang governs exterior, Yin governs interior. Pathogen: Exterior is Yin, Interior is Yang. If True Yang of exterior is deficient, Yin Pathogen overcomes and becomes excess. Exterior disease is Yang deficiency. Floating-tight pulse indicates Yin Pathogen excess externally. This is Yang deficiency/Yin excess. Treat with Guizhi Tang (acrid-sweet-warm) to sweat, eliminating Yin Pathogen and growing True Yang. If True Yin of interior is deficient, Yang Pathogen enters and becomes excess. Interior disease is Yin deficiency. Deep-solid pulse indicates Yang Pathogen excess internally. This is Yin deficiency/Yang excess. Treat with Cheng Qi Tang (acid-bitter-cold) to purge, eliminating Yang Pathogen and growing True Yin. Otherwise, using Guizhi for Yang excess kills; using Cheng Qi for Yin excess kills. This is exacerbating excess and depleting deficiency. Zhang's intent is profound: one refers to exterior syndrome, one to interior syndrome, regarding Pathogen/Primary Qi balance, not mixing exterior-harmony/interior-disease concepts. "Harmony" means no disease. Using "harmony" to explain "deficiency" is logically flawed.
Wang Shi stated: Nanjing says: "Shanghan Yang deficiency Yin excess: sweat cures, purge kills. Yang excess Yin deficiency: sweat kills, purge cures." Alas, this is the pivot of Shanghan sweating/purging. Pathogen depth varies: shallow in exterior, deep in interior. Exterior: closes pores, causes Fu Re (stagnant heat), aversion to cold/wind, headache. Treat with acrid-warm dispersal. Interior: dry feces, tidal fever, madness, delirium, great thirst. Treat with salty-cold purgation. External cold pathogen is Yin excess/Yang deficiency? Internal hot pathogen is Yang excess/Yin deficiency? One mistake in sweating/purging determines life/death. This is indeed the pivot. Critics interpret vaguely. Waitai Miyao says: Yin-Yang refers to body exterior/interior. Diseased part is deficiency, healthy part is excess. Exterior disease/Interior harmony = Yang deficiency/Yin excess. Interior disease/Exterior harmony = Yang excess/Yin deficiency. I argue: Yin-Yang in humans, balanced is peace, biased is disease. No excess or deficiency is balance. Excess is over, deficiency is under. Can excess be called harmony? Neijing says: "Pathogen excess is excess, Essence depletion is deficiency." Saying Yang deficiency needs sweating and Yin deficiency needs purging, while ignoring Pathogen and focusing on Primary Qi, is obscure. Shanghan Weizhi says: Yin-Yang refers to Cun-Chi pulse positions. Chi solid-large, Cun short-small = Yin excess/Yang deficiency, can sweat. Cun solid-large, Chi short-small = Yang excess/Yin deficiency, can purge. If sweating signs exist but pulse doesn't match, wait for Chi > Cun? If purging signs exist but pulse doesn't match, wait for Cun > Chi? Yue Ren set difficulties based on disease, not pulse. Why reverse to pulse? Pulse diagnoses disease. If sweating/purging signs are urgent, waiting for pulse match causes dilemma: follow disease or pulse? Doubt remains. Objection: Zhang Zhongjing cites this, then says "Guizhi down, Yang excess dies; Cheng Qi in, Yin excess dies." Guizhi is exterior, Cheng Qi is interior. Reversal is harmful. But Mahuang Tang is also exterior, why omitted? You say Yin excess is cold pathogen, suitable for Mahuang, why cite Guizhi? Answer: Consider Zhang's words: "Shanghan mostly from Wind-Cold." "Floating is Wind, Tight is Cold." Guizhi Tang: "Chilly aversion to cold, shivering aversion to wind." Mahuang Tang: "Aversion to wind." Wind and Cold are often linked. Wind in freezing weather, can it be called Yang? Wind and Cold are both Yin pathogens. Guizhi and Mahuang are both warm agents. Treating with warm agents shows both are Yin pathogens. Guizhi treats Wei (Defensive) injury, Mahuang treats Ying (Nutritive) injury. Both are exterior. Zhang's warning against sweating/purging errors includes Mahuang under Guizhi. "Yang excess dies" means exterior signs resolved, interior signs full, purge not sweat. "Yin excess dies" means interior signs not formed, exterior signs unique, sweat not purge. Thus, Yue Ren and Zhang Zhongjing's intent is clear.