凡伤寒不由阳经传入。而直入阴经。肢厥脉微。下利清谷者。名曰中寒。仲景所谓急温之。宜四逆汤者是也。
【荣斋按】这节举证太简单，特转引石芾南学说以补充之。他在《医原》里指出∶“里寒一证，不外脾肾阳虚。
阳虚则化湿，故夹湿者多，治法不外四逆、真武、理中三法。四逆一类，不离姜附，再观其方中加减，皆欲其
通阳开闭，重在肾也。真武一类，不离苓附生姜，欲其温阳镇水，亦重在肾也。理中一类，不离干姜、白术，
欲其守中，重在脾也。”观此，则知同是一个里寒症，而治法却有分别──用四逆重在通阳开闭，用真武重在
温阳镇水，用理中着重在温脾守中。
凡身受寒邪。口食冷物。陡然腹痛吐泻。肢厥脉沉。此为两感寒证。轻者神术汤加干姜、肉桂。重者附子理中汤加
姜汁、半夏。
凡温暑证。始虽微恶风寒。一发热即不恶寒。反恶热。汗自出。口大渴。目痛鼻干。齿板燥。心烦不得眠
者。虽皆为阳明表热。但要辨身干热而无汗者。尚须辛凉解肌。使热从外达。葱豉桔梗汤为主。随证加减。身
大热而自汗者。只宜甘寒存津。使热不劫阴。新加白虎汤主之。
凡伤寒邪传入里。温热病热结于里。皆属阳明腑证。手足汗。发潮热。不大便。小便不利。腹胀满。绕
脐痛。心烦恶热。喘冒不得卧。腹中转矢气。甚则谵语发狂。昏不识人。大便胶闭。或自利纯青水。仲景所谓急
下之。而用三承气汤者是也。
【荣斋按】伤寒阳明急下症，它只是里热症的一部分，本节只有这些，不能包括全面。何氏在“重订广温热
论”中对于里热症分列七个类型，颇为明白晓畅，特转引如下∶
（一）热在营卫之候∶身热汗自出，不恶寒反恶热，身面局部红或肿，眼白黄，目珠胀，鼻孔干，唇燥，烦
躁。轻发疹 ，重发丹斑。舌苔白而底绛，或两边白苔而中红。或身热反减恶热反甚，咳嗽黄痰，上气喘急。
（二）热在胸膈、气分抑郁之候∶咽燥喉痛，胸胁满痛，甚或胸前红肿，按之热甚。小便色黄。舌苔浓白而
糙，或黄腻而燥，或见红点，或有裂纹，或黄白相兼，或灰白。
（三）热陷心包及心，血分灼热之候∶谵语发狂，或沉昏嗜睡，或烦躁不寐，四肢厥逆，指甲红紫，大便溏黑
极臭，小便赤涩或痛，舌绛无苔，或舌上略有粘苔。
（四）邪热攻脑之候∶晕厥不语，两手发痉状如惊痫，时螈 ，头独摇，甚或遗尿直视，筋惕肉 ，循衣摸床
撮空，舌苔起腐，间有黑点。
（五）热在胃肠之候∶便血，便脓血，谵语多言，腹满痛，唇裂齿燥，舌苔黄燥。
（六）热陷肝肾之候∶日轻夜重，朝凉暮热，面少华色，口干消渴，气上冲心，心中热疼，饥不欲食，食则吐
蛔；四肢厥逆，烦躁不寐，小便涩痛，甚或癃闭，腰 足冷，大便或秘结或泻水；舌绛无苔，或干粘带涩，或
紫中兼有黑点。
（七）热陷冲任之候∶朝凉暮热，冲任脉动，少腹里急，阴中拘挛，甚或舌卷囊缩，小便涩痛，男则遗精腰
痛，女则带下如注。舌色焦紫起刺如杨梅，或舌红无苔而胶粘，或舌红中有白糜点。
凡是伤寒病不经过阳经传入，而是直接侵入阴经，出现四肢厥冷、脉象微弱、下利且粪便中夹杂未消化食物的症状，这被称为“中寒”。张仲景所说的应当紧急温补，适宜使用四逆汤的情况就是此类。
【徐荣斋按语】这一节列举的证候过于简单，特意转引石芾南的学说以作补充。他在《医原》中指出：“里寒这一证候，不外乎是脾肾阳气虚弱。阳气虚弱则容易化生湿邪，所以夹带湿邪的情况较多，治疗方法不外乎四逆汤、真武汤、理中汤这三类方法。四逆汤一类，离不开干姜、附子，再观察其方中的加减变化，都是想要通达阳气、开通闭阻，重点在于肾脏。真武汤一类，离不开茯苓、附子、生姜，想要温补阳气、镇摄水饮，也重点在于肾脏。理中汤一类，离不开干姜、白术，想要固守中焦，重点在于脾脏。”通过这一点可以看出，同样是里寒症，但治疗方法却有区别——使用四逆汤重在通达阳气、开通闭阻，使用真武汤重在温补阳气、镇摄水饮，使用理中汤着重于温补脾脏、固守中焦。
凡是身体感受寒邪，又食用生冷食物，突然发生腹痛、呕吐、腹泻，四肢厥冷、脉象沉伏的，这属于内外俱感寒邪的证候。轻症用神术汤加入干姜、肉桂；重症用附子理中汤加入姜汁、半夏。
凡是温病或暑病，起初虽然轻微恶风怕冷，但一旦发热就不再恶寒，反而怕热，自然出汗，口中大渴，眼睛疼痛、鼻子干燥，牙齿板结干燥，心烦意乱无法入睡的，这些虽然都属于阳明经表热证，但要辨别身体干燥发热且无汗者，仍然需要用辛凉的方法解肌散热，使热邪从体表发散出去，以葱豉桔梗汤为主方，随证加减。身体大热且自然出汗者，只宜用甘寒的药物保存津液，防止热邪劫伤阴液，以新加白虎汤为主方。
凡是伤寒邪气传入体内，或者温热病的热邪结聚在体内，都属于阳明腑实证。出现手足出汗、定时潮热、大便不通、小便不利、腹部胀满、围绕肚脐疼痛、心烦怕热、气喘头晕无法平卧、腹部有肠鸣排气声，甚至胡言乱语、发狂、昏迷不认识人、大便胶结闭塞，或者自行下利纯青色稀水的，张仲景所说的应当紧急攻下，而使用三承气汤的情况就是此类。
【徐荣斋按语】伤寒阳明急下症，它只是里热症的一部分，本节仅列出这些内容，不能包括全面。何氏在《重订广温热论》中对于里热症分列了七个类型，颇为明白晓畅，特意转引如下：
（一）热在营卫阶段的证候：身体发热，自然出汗，不恶寒反而恶热，身体面部局部发红或肿胀，眼白发黄，眼球胀痛，鼻孔干燥，嘴唇干燥，烦躁不安。轻者出疹，重者发丹斑。舌苔白色而底色绛红，或者两边白苔中间红。或者身热反而减轻但恶热反而加重，咳嗽黄痰，上气喘急。
（二）热在胸膈、气分郁滞的证候：咽喉干燥疼痛，胸胁胀满疼痛，甚至胸前红肿，按压时感觉热甚。小便颜色黄。舌苔浓白而粗糙，或者黄腻而干燥，或者出现红点，或者有裂纹，或者黄白相间，或者灰白。
（三）热陷心包及心脏，血分灼热的证候：胡言乱语、发狂，或者昏沉嗜睡，或者烦躁失眠，四肢厥冷，指甲红紫，大便溏黑极臭，小便赤涩或疼痛，舌质绛红无苔，或者舌上略有粘苔。
（四）邪热攻脑的证候：晕厥不语，两手痉挛状如惊痫，时而抽搐，头部独自摇动，甚至遗尿、直视，筋肉跳动，循衣摸床、撮空理线，舌苔起腐，间或有黑点。
（五）热在胃肠的证候：便血，便脓血，胡言乱语多话，腹部胀满疼痛，嘴唇破裂牙齿干燥，舌苔黄燥。
（六）热陷肝肾的证候：白天轻晚上重，早晨凉傍晚热，面色少华，口干消渴，气向上冲心，心中热痛，饥饿但不想进食，进食则吐蛔虫；四肢厥冷，烦躁失眠，小便涩痛，甚至癃闭，腰部和小腿足部寒冷，大便或者秘结或者泻水；舌质绛红无苔，或者干粘带涩，或者紫色中兼有黑点。
（七）热陷冲任的证候：早晨凉傍晚热，冲任脉跳动，少腹拘急，阴部拘挛，甚至舌头卷缩、睾丸收缩，小便涩痛，男性则遗精腰痛，女性则带下如注。舌色焦紫起刺如杨梅，或者舌红无苔而胶粘，或者舌红中有白糜点。
In cases where Shanghan (Cold Damage) does not transmit from the Yang meridians but directly invades the Yin meridians, presenting with limb coldness (Zhi Jue), faint pulse (Mai Wei), and diarrhea with undigested food (Xia Li Qing Gu), it is termed Zhong Han (Middle Cold). This corresponds to Zhang Zhongjing's principle of urgent warming, for which Sini Tang (Four Reversal Decoction) is indicated.
[Commentary by Xu Rongzhai] The evidence presented in this section is too simple; therefore, I specially quote the theory of Shi Feinan to supplement it. In his work *Yi Yuan* (Origin of Medicine), he pointed out: "The syndrome of Interior Cold essentially involves deficiency of Spleen and Kidney Yang. When Yang is deficient, it transforms into Dampness, so cases complicated by Dampness are common. The treatment methods do not go beyond three approaches: Sini Tang, Zhenwu Tang, and Lizhong Tang. Sini Tang-type formulas rely on Ganjiang (Dried Ginger) and Fuzi (Prepared Aconite Root); observing their modifications, they aim to unblock Yang and open obstruction, focusing on the Kidney. Zhenwu Tang-type formulas rely on Fuling (Poria), Fuzi, and Shengjiang (Fresh Ginger); they aim to warm Yang and suppress Water, also focusing on the Kidney. Lizhong Tang-type formulas rely on Ganjiang and Baizhu (Atractylodes Macrocephala Rhizome); they aim to secure the Middle Jiao, focusing on the Spleen." From this, we can see that although the syndrome is Interior Cold, the treatments differ: Sini Tang focuses on unblocking Yang and opening obstruction; Zhenwu Tang focuses on warming Yang and suppressing Water; Lizhong Tang focuses on warming the Spleen and securing the Middle.
When the body is exposed to Cold pathogenic factors and cold food is ingested, resulting in sudden abdominal pain, vomiting, diarrhea, limb coldness, and a deep pulse, this is a syndrome of simultaneous exterior and interior Cold invasion. For mild cases, Shenzhu Tang (Divine Efficacy Formula) with added Ganjiang and Rougui (Cinnamon Bark) is used. For severe cases, Fuzi Lizhong Tang (Aconite Lizhong Decoction) with added Jiangzhi (Ginger Juice) and Banxia (Pinellia Tuber) is used.
In Wenbing (Warm Diseases) or Shubing (Summerheat Diseases), although there may initially be slight aversion to wind and cold, once fever occurs, aversion to cold ceases, and instead, there is aversion to heat, spontaneous sweating, intense thirst, eye pain, nasal dryness, dry and stiff teeth, irritability, and insomnia. Although these all belong to Yangming Exterior Heat, one must distinguish between those with dry body heat and no sweat, who still require acrid-cool diaphoresis to release the muscle layer and allow heat to dissipate outward, using Congchi Jiegeng Tang (Scallion and Fermented Soybean Platycodon Decoction) as the main formula with modifications based on symptoms; and those with high fever and spontaneous sweating, who should only use sweet-cold herbs to preserve fluids and prevent heat from consuming Yin, using Xinjia Baihu Tang (Newly Added White Tiger Decoction) as the main formula.
When Shanghan pathogens transmit inward, or when Warm-Heat pathogens accumulate in the interior, both belong to Yangming Fu-organ syndromes. Symptoms include sweating on the hands and feet, tidal fever, constipation, dysuria, abdominal fullness and distension, periumbilical pain, irritability and aversion to heat, wheezing, dizziness, inability to lie down, flatus, delirium, mania, coma with loss of recognition, sticky fecal impaction, or spontaneous purging of pure green water. Zhang Zhongjing stated that urgent purgation is required, using the Three Chengqi Decoctions (San Chengqi Tangs).
[Commentary by Xu Rongzhai] Yangming urgent purgation syndromes in Shanghan are only a part of Interior Heat syndromes; the content in this section cannot cover them comprehensively. He Shi, in *Chongding Guang Wenre Lun* (Revised Extensive Treatise on Warm-Heat Diseases), divided Interior Heat syndromes into seven types, which is quite clear and lucid. It is quoted below:
(1) Heat in Ying and Wei stages: Fever with spontaneous sweating, no aversion to cold but aversion to heat, local redness or swelling of the body and face, yellow sclera, swollen eyeballs, dry nostrils, dry lips, restlessness. Mild cases present with macules; severe cases present with erysipelas-like rashes. Tongue coating is white with a crimson base, or white on sides and red in center. Or fever decreases while aversion to heat increases, accompanied by cough with yellow sputum and upper airway wheezing.
(2) Heat in Chest/Diaphragm and Qi level depression: Dry and painful throat, chest and hypochondriac fullness and pain, even redness and swelling of the chest front, feeling hot upon pressure. Yellow urine. Tongue coating is thick white and rough, or yellow greasy and dry, or has red spots, cracks, yellow-white mixture, or gray-white.
(3) Heat sinking into Pericardium and Heart, burning in Blood level: Delirium and mania, or lethargy and excessive sleepiness, or irritability and insomnia, limb coldness, crimson-purple fingernails, loose black foul-smelling stool, red and scanty or painful urination, crimson tongue without coating, or slightly sticky coating on tongue.
(4) Pathogenic Heat attacking the Brain: Syncope and mutism, hand spasms resembling convulsions, intermittent twitching, independent head shaking, even enuresis and fixed gaze, muscle tremors, picking at clothes and empty air grasping, tongue coating putrid with occasional black spots.
(5) Heat in Stomach and Intestines: Hematochezia, pus and blood in stool, verbose delirium, abdominal fullness and pain, cracked lips and dry teeth, yellow and dry tongue coating.
(6) Heat sinking into Liver and Kidneys: Milder in day, heavier at night; cool in morning, hot in evening; lackluster complexion, dry mouth and polydipsia, Qi rushing to heart, hot pain in heart, hunger but no desire to eat, vomiting roundworms after eating; limb coldness, irritability and insomnia, scanty painful urination, even urinary retention, cold waist and lower limbs, constipation or watery diarrhea; crimson tongue without coating, or dry/sticky/astringent, or purple with black spots.
(7) Heat sinking into Chong and Ren vessels: Cool in morning, hot in evening; pulsation of Chong and Ren vessels, tightness in lower abdomen, contraction in genitalia, even tongue curling and testicular retraction, scanty painful urination, male seminal emission and backache, female profuse leukorrhea. Tongue color scorched purple with prickles like bayberry, or red without coating and sticky, or red with white fungal spots.