其证有二。一寒水侮土证。吐泻腹痛。手足厥逆。冷汗自出。肉 筋惕。语言无力。纳少脘满。两足尤冷。小
便清白。舌肉胖嫩。苔黑而滑。黑色止见于舌中。脉沉微欲绝。此皆里真寒之证据。惟肌表浮热。重按则不热。烦
躁而渴欲饮水。饮亦不多。口燥咽痛。索水至前。复不能饮。此为无根之阴火。乃阴盛于内。逼阳于外。外假
热而内真阴寒。格阳证也。法宜热壮脾阳。附子理中汤救之。一肾气凌心证。气短息促。头晕心悸。足冷溺清。
大便或溏或泻。气少不能言。强言则上气不接下气。苔虽黑色直底舌尖。而舌肉浮胖而嫩。此皆里真虚寒之证据。
惟口鼻时或失血。口燥齿浮。面红娇嫩带白。或烦躁欲裸形。或欲坐卧泥水中。脉则浮数。按之欲散。或浮大
满指。按之则豁豁然空。虽亦为无根之阴火。乃阴竭于下。阳越于上。上假热而下真虚寒。戴阳证也。治宜滋
阴纳阳。加味《金匮》肾气汤救之。总而言之。伤寒变证百出。总不外表里寒热四字。表里寒热。亦不一致。
总不外此章精义。此十者。皆辨明表里寒热之要诀也。
【秀按】此辨表里寒热之总诀。初学务熟读而切记之。
【廉勘】表里寒热。尚不难辨。即假寒假热。能熟用温度计。以测病状发热之高低。试验精透者。亦不难
辨。惟用药最难。冷用犀羚牛黄。热用附桂硫黄。补用人参熟地。泻用大黄芒硝。幸中病机。胆小者尚诋其
猛。不幸而死。则庸医杀人。异口同声。故名医用药。辄多避重就轻。
其证候有两种。一是寒水侮土证。表现为呕吐、腹泻、腹痛，手足厥冷，冷汗自出，肌肉跳动（肉瞤筋惕），语言无力，食欲减退且胃脘部胀满，双足尤其寒冷，小便清亮色白，舌体胖嫩，苔黑而滑润，黑色仅见于舌中部，脉象沉微欲绝。这些都是里真寒的证据。唯独肌表有浮热，重按则不热，烦躁且口渴想喝水，但饮水不多，口燥咽痛，索要水到面前，却又不能喝。这是无根之阴火，乃阴盛于内，逼迫阳气外越所致，属外假热而内真阴寒的格阳证。治法宜温壮脾阳，用附子理中汤救治。二是肾气凌心证。表现为气短息促，头晕心悸，足冷尿清，大便或溏或泻，气少不能言语，勉强说话则上气不接下气，舌苔虽黑直达舌尖，但舌体浮胖而嫩。这些都是里真虚寒的证据。唯独口鼻有时出血，口燥齿浮，面色红娇嫩带白，或烦躁想要脱衣裸身，或想坐卧在泥水中，脉象浮数，重按则散乱无力，或浮大满指，重按则豁然空虚。这也属于无根之阴火，乃阴竭于下，阳气越于上，属上假热而下真虚寒的戴阳证。治法宜滋阴纳阳，用加味《金匮》肾气汤救治。总而言之，伤寒变证百出，总离不开表里寒热四个字。表里寒热，也不一致，总不外乎本章的精义。这十点，都是辨明表里寒热的要诀。
【秀按】这是辨别表里寒热的总诀。初学者务必熟读并牢记。
【廉勘】表里寒热，尚不难辨别。即使是假寒假热，若能熟练运用温度计，以测量病状发热的高低，试验精透者，也不难辨别。唯独用药最难。冷症用犀角、羚羊角、牛黄；热症用附子、肉桂、硫黄；补益用人参、熟地黄；泻下用大黄、芒硝。若幸而击中病机，胆小的医生还会诋斥其药性猛烈；若不幸导致死亡，则庸医杀人，异口同声地指责。因此名医用药，往往多避重就轻。
There are two types of syndromes. The first is the Cold-Water Insulting Earth syndrome (Han Shui Wu Tu Zheng). It presents with vomiting, diarrhea, abdominal pain, coldness of the hands and feet, spontaneous sweating of cold sweat, muscle twitching (Rou Tun Jin Ti), weak voice, poor appetite with epigastric fullness, especially cold soles, clear and white urine, a fat and tender tongue body, black and slippery coating (with black color appearing only in the center of the tongue), and a deep, faint pulse nearly imperceptible. These are all evidences of true interior cold. However, there is floating heat on the skin surface, which disappears upon heavy pressure; restlessness, thirst wanting to drink water but drinking little; dry mouth and sore throat; demanding water but being unable to drink when it arrives. This is rootless Yin fire, caused by excess Yin inside forcing Yang to the exterior, constituting the Ge Yang syndrome (Ge Yang Zheng) characterized by false exterior heat and true interior Yin-cold. The treatment method should be to warm and strengthen Spleen-Yang, using Fuzi Lizhong Tang (Aconite Decoction for Regulating the Middle) to rescue it. The second is the Kidney-Qi Overwhelming Heart syndrome (Shen Qi Ling Xin Zheng). It presents with shortness of breath and rapid respiration, dizziness, palpitations, cold feet, clear urination, loose stools or diarrhea, scarcity of Qi making speech difficult, and gasping for breath if forced to speak. Although the coating is black reaching the tip of the tongue, the tongue body is floating, fat, and tender. These are all evidences of true interior deficiency-cold. However, there is occasional bleeding from the mouth and nose, dry mouth, floating teeth, a red and delicate complexion with whiteness, restlessness wanting to strip naked, or desire to sit/lie in mud or water. The pulse is floating and rapid, scattering upon heavy pressure, or floating and large filling the finger pads but hollow upon heavy pressure. This also belongs to rootless Yin fire, caused by exhaustion of Yin below and hyperfloating of Yang above, constituting the Dai Yang syndrome (Dai Yang Zheng) characterized by false upper heat and true lower deficiency-cold. The treatment method should be to nourish Yin and anchor Yang, using Jia Wei Jin Gui Shen Qi Tang (Modified Golden Chamber Kidney Qi Decoction) to rescue it. In summary, although complications of Shanghan (Cold Damage) manifest in hundreds of ways, they always revolve around the four characters: Exterior-Interior, Cold-Heat. The relationship between Exterior-Interior and Cold-Heat may not be consistent, but it ultimately adheres to the essence of this chapter. These ten points are the key techniques for distinguishing Exterior-Interior and Cold-Heat.
[Commentary by Xiu] This is the general principle for distinguishing Exterior-Interior and Cold-Heat. Beginners must read it repeatedly and memorize it firmly.
[Review by Lian] Distinguishing Exterior-Interior and Cold-Heat is not difficult. Even for false cold and false heat, if one can skillfully use a thermometer to measure the degree of fever and conduct precise tests, it is not hard to distinguish. The most difficult aspect is medication. For cold conditions, Rhinoceros Horn (Xijiao), Antelope Horn (Lingyang), and Calculus Bovis (Niuhuang) are used; for heat conditions, Radix Aconiti Preparata (Fuzi), Cinnamomi Cortex (Guirou), and Sulfur (Huanghuang) are used; for tonification, Ginseng Radix (Renshen) and Rehmanniae Radix Praeparata (Shudihuang) are used; for purgation, Rhei Radix et Rhizoma (Dahuang) and Natrii Sulfas (Mangxiao) are used. If fortunate enough to hit the pathogenesis accurately, even cautious doctors might criticize the potency as too strong; if unfortunate and death occurs, quacks are accused of murder, with accusations coming from all sides. Therefore, famous doctors often tend to avoid serious treatments and choose lighter ones.