（按伤寒论每篇首。冠以辨字。今要略无之者。盖后人所删也。外台疗疟方。引张仲景伤寒论。每条首。有辨
疟病。辨疟脉等字。亦足以证。）
论十三首（三。当作五。） 脉证三条（诸本。作二条。宜从。）
问曰。上工治未病。何也。
〔徐〕医中有大关目不可专指一病者。仲景于首卷。特揭数十端。以定治疗之法。此则论五行相克之理。必以
次传。而病亦当预备以防其传也。〔魏〕此条。乃仲景总揭诸病当预图于早。勿待病成方治以贻悔也。治之预。则
用力少。而成功多。所谓曲突徙薪之勋。宜加于焦头烂额之上也。先言肝者。以四时之气始乎春。五脏之气始于肝。
洪范言履端于始。序则不愆。故先引肝。以为之准云。〔朱〕甘味入脾。兼能缓肝。和调两脏。令弗相 也。
按赵氏于内经辛补。仲景酸补之理。详为之辨。盖系于尤氏所据。文繁不具录。
夫人禀五常。因风气而生长。（禀。周本。作秉。）
按礼记乐记曰。道五常之行。注。五常。五行也。礼运曰。故人者。其天地之德。阴阳之交。鬼神之会。五行
之秀气也。又曰。故人者。天地之心也。五行之端也。杨上善太素经注曰。风气一也。徐缓为气。急疾为风。人之
生也。感风气以生。其为病也。因风气为病。是以风为百病之长。集韵般字下曰。亦数别之名。无犯王法。盖谓无
犯王者之法律。以罹墨劓 宫等刑。白虎通曰。犯王法。使方伯诛之。先兄曰。竭乏。即内经以欲竭其精之义。又
金鉴。以为内所因中虚。外所因中实。不内外因。非中外虚实。徐氏。以为适中经络三句。应前内因一段。四肢才
觉重滞四句。应前外因一段。更能无犯王法二句。应前房室一段。并是。然更就服食节其冷热苦酸辛甘句考之。则
三者房室下。恐脱服食二字。否则彼句内。蕴有服食失节乎。如此看做。殆觉上下相应。于病理亦相叶。而更能无
犯王法以下五句。都应前房室一段。
又按喜多村直宽曰。服食。即衣服饮食之谓。灵师传篇云。饮食衣服。亦欲适寒温。可以征焉。斯说得之。（小
岛尚质曰。陈天竺三藏真谛释迦毗罗仙人金七十论云。三苦。一根据内。二根据外。三根据天。此亦论三因。与经旨略相
似。）
问曰。病患有气色见于面部。（胸上。周。作胸中。）
按魏曰。鼻为肺之开窍。而主一身之元气者也。五脏之气。莫不禀受于肺。而五脏之真色。亦必随气之出入而
发见于鼻头。此鼻头所以可验五脏之真色也。此解与尤意异。然宜备一说。痰饮篇曰。膈间支饮。其人喘满。心下
痞坚。面色黧黑。盖与本条相发。又色黄者。色白者。二证。沈魏朱属之鼻头。检千金方曰。论云。鼻头微白者亡
血。设令微赤非时者死。病患色白者。皆亡血也。又曰。凡人候鼻头色黄。法小便难也。盖是三家所本。
师曰。病患语声寂然。
按喑。当与 通。周礼典同职。微声 。郑玄注。 。声小不成也。
师曰。息摇肩者。心中坚。
按赵曰。此仲景因呼息以为察病之法。与后条吸对言。以举端耳。徐注本于此。又沈氏以为此言喘息有痰气肺
胀肺痿之别。其说似是。然不及魏之稳切。但魏唾沫解恐非。沈曰。肺热叶焦。气弱不振。津液化而为涎。上溢于
口。故吐涎沫。似是。盖古所谓沫者。即今之痰涎。不必是白沫。（宜参肺痿。及痰饮篇。）又金鉴痰嗽肺痿之辨。
欠妥。
又按徐氏注上气色条有曰。但望法贵在神气动静之间。此言甚妙。如欲候气息者。最所宜加思矣。
师曰。吸而微数。（沉。作息而微数。且曰。远。当作迟字。并误。）
按朱以上焦下焦二句。为虚者不治之注脚。谬矣。又魏注中筋脉二字。宜删。
师曰。寸口脉动者。
按此条。上文言脉不言色。下文言色不言脉。是互文见意。故结以非其时色脉句。
问曰。有未至而至。（为至而不至也上。俞本。类聚。并有此字。）
〔徐〕此论天气之至。有过不及。不言及医。然而随时制宜之意在其中。（辑义尤注中。至未得甲子下。脱而
天已温。或已得甲子。而天反未温。及已得甲子十九字。）
问曰。寸脉沉大而滑。（脉经。不设问答。卒厥下。有不知人三字。口字无。和上。有温字。）
按此条。脉经题云平卒尸厥脉证。（巢源。载之尸厥候中。）而杂疗方尸厥下原注。曰脉证见上卷者。徐 以为
此条。则殆是扁鹊所疗虢太子之病也。又素阳明脉解篇。厥逆连脏则死。连经则生。
问曰。脉脱入脏即死。
按先兄曰。此条。诸注失凿。盖是承上条。更申其理。脉。即血脉。系血气之省文。考字书。脱。或然之辞。
宜为助语看。始妥。脱本外脱之义。脱而称入。甚不相协。素方盛衰论。脉脱不具。诊无常行。吴 注云。脉或不
显也。可以相证矣。吴子励士篇。脱其不胜。取笑于诸侯。后汉书李通传。事既未然。脱可免祸。宋赵德麟侯鲭录
曰。脱者。可也尔也。谓不定之词。汉晋人多言脱如何。亦或也。胡三省通鉴注云。脱者。或也。又曰。脱者未可
必之辞也。此皆可例。
问曰。阳病十八。何谓也。（ 。类聚。作饪。）
〔周〕此总内经所着之病。而为之分阴阳悉表里。合上下内外以立言。庶几经络明。腑脏着。所因显。不致散
而难稽也。如三阳在外。病头痛等六证。则各有所行之经。各显本经之证。三而六之。非十八乎。而三阴之在里者
亦然。五脏各有十八。合计为九十病。其为病。则于灵枢。论心脉为螈 。班班可考矣。若六腑则何如。腑居内而
合于经者也。故邪之在腑者。合外于经。其受患为浅。而欲散不难。不若五脏之深且甚焉。故曰微也。其为病。内
经有分属。仲景括为一百八病。盖因腑之六。以为数也。凡此共二百三十四病。统内外而言之也。人之一身。上下
表里尽之矣。而所谓清浊大小邪者。一为雾露。一为地浊。本天者亲上。本地者亲下。百病之长。伤人之阳。肃杀
之气。伤人之阴者。是也。从口入者为内伤。亦足使人发热腹痛。喘呕胀满。不去其陈而致新。不足以为功。〔魏〕
大约阳病皆躯壳以外之病。而阴病皆躯壳以里之病耳。
按此条分为两段。前段。是就经络脏腑。而举疾证数目。（程注错算。周氏为是。○后汉书郭玉传。方诊六微
之技。亦不审其义。）后段。说五邪而分三节。先就其性立名。（风善行而数变其性。见千金。）更反复示其所中。
余义结以极寒极热。可谓尽矣。但注家于大邪小邪。迂曲费说。甚失经旨。不知三节互相照应。大邪言风。小邪言
寒。其义了然。周氏所解殊卓。盖风则泛散。故称之大。寒则紧迫。故称之小。且风之伤人为最多。寒则稍逊。亦
其所以得名欤。风性轻扬。故先中表。而令脉浮。寒性 悍。故直中里。而令脉急。
又按素太阴阳明论曰。故伤于风者。上先受之。伤于湿者。下先受之。灵百病始生篇曰。风雨则伤上。清湿则
伤下。辨脉法曰。寸口脉阴阳俱紧者。法当清邪中于上焦。浊邪中于下焦。皆文异旨近。又陶氏本草序例曰。夫病
之所由来虽多端。而皆关于邪。邪者。不正之目。谓非人身之常理。风寒暑湿。饥饱劳逸。皆各是邪。非独鬼气疫
疠者矣。本条邪字。得此言而始明矣。
先兄曰。卢文 钟山札记。详辨 字。宜参。
夫病痼疾。加以卒病。
按说文。痼。久病也。（汲古阁刊宋本。作HT 。讹。）又金鉴所引赵注。二注本以为周氏。师曰。五脏病各
有得者愈。
按尤氏引藏气法时论。宣明五气篇。五味篇为征。宜参。又成氏注厥阴篇除中条曰。若胃气绝。得面则必发热。
若不发热者。胃气尚在也。恐是寒极变热。因暴热来而复去。使之能食。非除中也。金匮要略云。病患素不能食。
而反暴思之。必发热。是成氏既以思字作食义看。
夫诸病在脏。
按此条猪苓汤。不过姑假之以备隅反。徐沈朱附出其方。深误。
〔余述〕此篇。仲景揭示辨证处治之总例。而其最紧要。在首章与第二章。今深绎其意。则寓有三义。盖人之
有身。以脏腑为之主宰。故论理疾病。必始自脏腑。实为轩岐相传之学。故仲景举之于首。以为后人模范。其义一
也。病之大体。不过二端。曰内伤。曰外感。是已。首章所主在内伤。次章所主在外感。两相对列。使人知病之不
出二端。其义二也。治病之要。不过防微。渴穿斗铸。先圣所戒。是以首章举治未病。而次条亦曰。未流传脏。即
医治之。曰。勿令九窍闭塞。皆示见微得过之意。其义三也。此三义者。岂可不谓非医家入学之门径乎。其他诸条。
辨色。辨声。辨气息。辨色脉应否。辨脉之先后。诊察之法尽矣。病有起于急遽者。吉凶不可不察。内因之病。皆
有数目。外感之疾。各有法度。五脏之病。有所得。有所恶。亦辨证之纲领也。如夫天气消长。人身亦应之。则其
理不得不讲也。施治之法。先示防微。又示浅深之有别。又论病之表里新久。必有先后之序。而篇末一章。发攻导
诸剂之秘焉。夫然后辨证处治之例。无出于此篇范围之外。则此篇者。真医家之大经大法也。
（按：《伤寒论》每篇之首，都冠以“辨”字。现在《金匮玉函要略》没有这个字，大概是后人删去了。《外台秘要》治疗疟疾的方子，引用张仲景《伤寒论》，每条开头都有“辨疟病”、“辨疟脉”等字样，也足以证明这一点。）
论十三首（其中三首，应当是五首之误。） 脉证三条（各版本作两条，应当依从两条的说法。）
问曰：上工（高明的医生）治未病，是什么道理？
〔徐〕医学中有重大的关键，不能专门针对某一种病来论述。仲景在首卷，特意揭示数十个方面，来确定治疗的方法。这是论述五行相克的道理，疾病必然依次传变，所以病情也应当预先防备以防其传变。〔魏〕这一条，是仲景总括地指出各种疾病应当在早期就筹划好，不要等到病已成再治疗而留下悔恨。预先治疗，则用力少而成功多。这就是所谓的“曲突徙薪”（比喻事先采取措施防止危险发生）的功劳，应当加在“焦头烂额”（比喻事后补救）之上。先提到肝，是因为四季之气始于春季，五脏之气也始于肝。《尚书·洪范》说遵循正道开始，秩序就不会差错，所以先引用肝作为准则。〔朱〕甘味入脾，兼能舒缓肝气，调和两脏，使它们不相克伐。
按：赵氏对《内经》中“辛补”、仲景“酸补”的道理，详细进行了辨析，这源于尤氏所依据的内容，文字繁多不再全部录出。
人禀受五常（五行），依靠风气而生长。（“禀”，周本写作“秉”。）
按：《礼记·乐记》说：“道五常之行。”注解说：“五常，就是五行。”《礼运》说：“所以人，是天地之德，阴阳之交，鬼神之会，五行的秀气。”又说：“人是天地的心，五行的开端。”杨上善在《太素经》注中说：“风气和气是一样的。徐缓称为气，急疾称为风。人的出生，感受风气和气而生；人患病，因为风气和气而致病。所以风是百病的先导。”《集韵》般字下说：“也是数别的名称。不侵犯王法。”大概是指不侵犯君王的法律，从而遭受墨、劓、宫等刑罚。《白虎通》说：“侵犯王法，让方伯诛杀他。”先兄说：“竭乏”，即《内经》中“因欲望而耗竭精气”的意思。又《医宗金鉴》认为，内所因是中虚，外所因是中实，不内外因，不是中外虚实。徐氏认为，“适中经络”三句，对应前文内因一段；“四肢才觉重滞”四句，对应前文外因一段；“更能无犯王法”二句，对应前文房室一段，都是正确的。然而再结合“服食节其冷热苦酸辛甘”一句考证，那么在“房室”之下，恐怕脱漏了“服食”二字，否则那句话里，蕴含有服食失节吗？这样看来，上下相应，于病理也相契合。而“更能无犯王法”以下五句，都应合前文房室一段。
又按：喜多村直宽说：“服食”，就是衣服饮食的意思。《灵枢·师传》篇说：“饮食衣服，也要适应寒温”，可以据此验证。这种说法是正确的。（小岛尚质说：陈代天竺三藏真谛翻译的《释迦毗罗仙人金七十论》说：“三苦，一根据内部，二根据外部，三根据天象。”这也论述了三因，与经文旨意大致相似。）
问曰：病患的气色表现在面部。（“胸上”，周本、类聚本均作“胸中”。）
按：魏氏说：“鼻是肺的开窍，主宰一身元气。五脏之气，无不禀受于肺，而五脏的真色，也必然随着气的出入而在鼻头发现。这就是鼻头可以检验五脏真色的原因。”这个解释与尤氏的意思不同，但应该作为一种说法保留下来。《痰饮篇》说：“膈间支饮，其人喘满，心下痞坚，面色黧黑。”这与本条相互发明。另外，色黄者、色白者两种证候，沈、魏、朱三家归属于鼻头。检查《千金方》说：“论云：鼻头微白者亡血，如果微赤且非正常时候出现的会死。病患色白的，都是亡血。”又说：“凡人观察鼻头色黄，法度上是小便难。”大概是这三家所依据的。
师曰：病患说话声音寂静无声。
按：“喑”（哑），应当与“默”相通。《周礼·典同职》：“微声默。”郑玄注：“默，声音小不成。”
师曰：呼吸时摇动肩膀的，心中坚硬。
按：赵氏说：“这是仲景通过呼吸来察病的方法，与后一条‘吸’相对言，只是举出一个端绪罢了。”徐注本于此。又沈氏认为这是说喘息有痰气、肺胀、肺痿的区别，这种说法似乎有理，但不如魏氏稳妥确切。只是魏氏将“唾沫”解释为恐非如此。沈氏说：“肺热叶焦，气弱不振，津液化而为涎，上溢于口，所以吐涎沫。”这似乎是合理的。大概古所谓“沫”，就是现在的痰涎，不一定是白沫。（宜参考《肺痿》及《痰饮篇》。）又《医宗金鉴》对痰嗽和肺痿的辨析，欠妥当。
又按：徐氏注释上气色条时说：“但望诊贵在神气动静之间。”这句话非常精妙。如果要候气息，最应该深思。
师曰：吸气轻微而急促。
按：朱氏以上焦、下焦两句，作为虚者不治的注脚，是错误的。又魏注中的“筋脉”二字，应当删除。
师曰：寸口脉动的情况。
按：这一条，上文讲脉不讲色，下文讲色不讲脉，是互文见意，所以总结为“非其时色脉”的句子。
问曰：有未到时间却到了的。（“为至而不至也”上，俞本、类聚本都有此字。）
〔徐〕这是论述天气的至，有过分和不及，虽然没有直接涉及医学，但随时制宜的意思在其中。（辑义尤注中，“至未得甲子”下，脱漏了“而天已温，或已得甲子，而天反未温”及“已得甲子”十九字。）
问曰：寸脉沉大而滑。（《脉经》不设问答，在“卒厥”下有“不知人”三字，“口”字无，“和上”有“温”字。）
按：这一条，《脉经》题目叫“平卒尸厥脉证”。（巢元方记载在“尸厥候”中。）而《杂疗方》尸厥下的原注说：“脉证见上卷者。”徐氏认为这一条，大概是扁鹊所治疗的虢太子之病。又《素问·阳明脉解篇》说：“厥逆连脏则死，连经则生。”
问曰：脉脱入脏即死。
按：先兄说：这一条，诸家注释都失之穿凿。大概是承接上一条，进一步申述其理。“脉”，即血脉，是血气的省文。考字书，“脱”，是或许之辞，应当作为助语来看，才妥当。“脱”本有外脱之义，称“脱”而说“入”，很不协调。《素问·方盛衰论》说：“脉脱不具，诊无常行。”吴崑注云：“脉或不显也。”可以互相印证。《吴子励士篇》说：“脱其不胜，取笑于诸侯。”《后汉书·李通传》说：“事既未然，脱可免祸。”宋赵德麟《侯鲭录》说：“脱者，可也，尔也。”谓不定之词。汉晋人多说“脱如何”，也是“或也”的意思。胡三省《通鉴注》说：“脱者，或也。”又说：“脱者，未可必之辞也。”这些都可以作为例证。
问曰：阳病十八，是什么？（“饪”，类聚本作“饪”。）
〔周〕这是总括《内经》所记载的病，而为之分阴阳，悉表里，合上下内外来立论。这样经络明了，腑脏显著，病因显露，不至于散乱而难以稽考。比如三阳在外，病头痛等六证，则各有所行之经，各显本经之证。三乘以六，不就是十八吗？而三阴在里的也是如此。五脏各有十八，合计为九十病。其发病，则在《灵枢》中，论心脉为抽搐等，班班可考。至于六腑怎么样呢？腑居内而合于经。所以邪气在腑者，合外于经，其受害较浅，想要消散不难，不像五脏那样深且严重。所以说“微也”。其发病，《内经》有分属，仲景概括为一百零八病，大概是因腑之六，作为数目。凡此共二百三十四病，统内外而言之。人之一身，上下表里尽在其中。而所谓清浊大小邪者，一是雾露，一是地浊。本乎天的亲上，本乎地的亲下，百病之长，伤人之阳；肃杀之气，伤人之阴，就是这些。从口入者为内伤，也足使人发热腹痛，喘呕胀满。不去除陈旧而招致新的，不足以建功。〔魏〕大约阳病都是躯壳以外的病，而阴病都是躯壳以内的病罢了。
按：这一条分为两段。前段，是就经络脏腑，而列举疾证数目。（程注算错，周氏是对的。○《后汉书·郭玉传》：“方诊六微之技”，也不审其义。）后段，说五邪而分三节。先就其性立名。（风善行而数变其性，见《千金》。）更反复示其所中。其余意义总结为极寒极热，可以说穷尽了。但注家对于大邪小邪，迂曲费说，很失经旨。不知道三节互相照应，大邪言风，小邪言寒，其义了然。周氏的解释特别卓越。大概风则泛散，故称为大；寒则紧迫，故称为小。而且风伤人为最多，寒则稍逊，这也是它们得名的原因吧。风性轻扬，所以先中表，而使脉浮；寒性慓悍，所以直中里，而使脉急。
又按：《素问·太阴阳明论》说：“故伤于风者，上先受之。伤于湿者，下先受之。”《灵枢·百病始生篇》说：“风雨则伤上，清湿则伤下。”《辨脉法》说：“寸口脉阴阳俱紧者，法当清邪中于上焦，浊邪中于下焦。”都是文异旨近。又陶氏《本草序例》说：“夫病之所由来虽多端，而皆关于邪。邪者，不正之目，谓非人身之常理。风寒暑湿，饥饱劳逸，皆各是邪，非独鬼气疫疠者矣。”本条的“邪”字，有了这番话才开始明确。
先兄说：卢文弨《钟山札记》详细辨析“饪”字，宜参看。
夫病痼疾（久病），加以卒病（新病）。
按：《说文》：“痼，久病也。”（汲古阁刊宋本，写作HT，讹误。）又《医宗金鉴》所引赵注，二注本以为周氏。
师曰：五脏病各有得者愈。
按：尤氏引用《藏气法时论》、《宣明五气篇》、《五味篇》为证据，宜参看。又成无己注《厥阴篇》除中条说：“若胃气绝，得面则必发热。若不发热者，胃气尚在也。恐是寒极变热，因暴热来而复去，使之能食，非除中也。”《金匮要略》说：“病患素不能食，而反暴思之，必发热。”是成氏既然把“思”字当作“食”义来看。
夫诸病在脏。
按：这一条猪苓汤，不过是姑且借用它来备隅反（举一反三）。徐、沈、朱三家附出其方，深深错误。
〔余述〕这一篇，仲景揭示辨证处治的总例，而其最紧要的，在首章与第二章。现在深入推绎其意，则寓有三义。大概人有身体，以脏腑为主宰，所以论理疾病，必起始于脏腑。实为轩辕、岐伯相传之学，所以仲景举之于首，以为后人模范。这是第一义。病的大体，不过两端：曰内伤，曰外感。已经确定。首章所主在内伤，次章所主在外感。两相对列，使人知道病不出这两端。这是第二义。治病的关键，不过防微杜渐。渴穿斗铸（比喻防患于未然），是先圣所告诫的。所以首章举治未病，而次条也说：“未流传脏，即医治之”，“勿令九窍闭塞”，都是示见微得过之意。这是第三义。这三义，难道不可以说是医家入学的门径吗？其他诸条，辨色，辨声，辨气息，辨色脉是否相应，辨脉之先后，诊察之法尽矣。病有起于急遽者，吉凶不可不察。内因之病，皆有数目；外感之疾，各有法度。五脏之病，有所得，有所恶，也是辨证的纲领。如天气消长，人身也应之，则其理不得不讲也。施治之法，先示防微，又示浅深之有别，又论病之表里新久，必有先后之序。而篇末一章，发攻导诸剂之秘焉。然后辨证处治之例，无出于此篇范围之外。则此篇者，真是医家之大经大法也。
(Commentary: At the beginning of each chapter in the *Shanghan Lun* (Treatise on Cold Damage Diseases), the character "Bian" (Differentiation/Discernment) is prefixed. The absence of this character in the current *Jin Gui Yu Han Yao Lue* (Essentials from the Golden Cabinet and Jade Box) is likely due to deletion by later editors. The *Waitai Miyao* (Secret Essentials of the Outer Palace), in its formulas for treating malaria, quotes Zhang Zhongjing's *Shanghan Lun*, where each item begins with phrases such as "Bian Malaria Disease" and "Bian Malaria Pulse," which serves as sufficient evidence.)
Thirteen Discourses (The number "three" should be "five".) Three Sections on Pulse and Symptoms (All versions read "two sections," but "three" should be adopted.)
Question: What is the principle behind a superior physician (Shanggong) treating disease before it arises?
[Xu] In medicine, there are major critical points that cannot be addressed solely by focusing on a single disease. In the first volume, Zhongjing specifically highlights dozens of aspects to establish treatment methods. This discusses the principle of the mutual overcoming of the Five Elements (Wu Xing), where diseases inevitably transmit sequentially; therefore, one must prepare in advance to prevent transmission. [Wei] This section comprehensively indicates that various diseases should be planned for early on, rather than waiting until the disease is established to treat it, which would lead to regret. Treating in advance requires less effort and yields greater success. This is akin to the merit of "bending the chimney and moving the firewood" (preventing disaster before it happens), which should be valued above "scorched heads and broken foreheads" (remedying after damage has occurred). Mentioning the Liver first is because the Qi of the four seasons begins in Spring, and the Qi of the Five Zang Organs also begins with the Liver. The *Book of Documents* (*Hong Fan*) states that following the correct path at the start ensures order without error; thus, the Liver is cited first as a standard. [Zhu] Sweet flavor enters the Spleen and can also soothe the Liver, harmonizing both organs so they do not overcome each other.
Note: Zhao Shi detailed the辨析 (differentiation) of the principles of "Pungent tonification" in the *Neijing* and "Sour tonification" by Zhongjing. This stems from content relied upon by You Shi; due to length, it is not fully recorded.
Humans inherit the Five Constants (Five Elements) and grow relying on Wind and Qi. ("Bin" is written as "Bing" in Zhou's edition.)
Note: The *Book of Rites* (*Yueji*) says, "Guide the movement of the Five Constants." The commentary notes: "The Five Constants refer to the Five Elements." The *Liyun* chapter states: "Therefore, humans are the virtue of Heaven and Earth, the intersection of Yin and Yang, the meeting of spirits, and the essence of the Five Elements." It further says: "Humans are the heart of Heaven and Earth, the beginning of the Five Elements." Yang Shangshan, in his commentary on the *Taisu Jing*, states: "Wind Qi and Air Qi are the same. Slow-moving is called Qi, fast-moving is called Wind. Human birth occurs by sensing Wind and Air Qi; human illness occurs due to Wind and Air Qi. Thus, Wind is the leader of a hundred diseases." The *Jiyun* under the character "Ban" says: "It is also a name for numbers. Do not violate the King's Law." This generally refers to not violating the King's laws to incur punishments like tattooing, nose-cutting, or castration. The *Baihu Tong* states: "Violating the King's law leads to execution by the Fangbo." My elder brother said: "Exhaustion" refers to the meaning in the *Neijing* of "exhausting essence through desire." Additionally, the *Yizong Jinjian* holds that the internal cause involves deficiency in the center, the external cause involves excess in the center, and the non-internal/non-external cause is neither central interior nor exterior. Xu Shi believes that the three sentences "fitting into meridians and collaterals" correspond to the previous paragraph on internal causes; the four sentences "limbs just feeling heavy and stagnant" correspond to the previous paragraph on external causes; and the two sentences "moreover, do not violate the King's law" correspond to the previous paragraph on sexual activity, all of which are correct. However, examining the sentence "regulate food and drink regarding cold, heat, bitter, sour, pungent, and sweet," it seems that below "sexual activity," the characters "food and drink" might have been omitted. Otherwise, does that sentence imply irregularities in food and drink? Viewing it this way, the upper and lower parts correspond well, and it aligns with pathology. The five sentences following "moreover, do not violate the King's law" all correspond to the previous paragraph on sexual activity.
Furthermore, Kitamura Naohiro stated: "Food and drink" refers to clothing and diet. The *Ling Shu* chapter *Shi Chuan* says: "Diet and clothing should also adapt to cold and heat," which supports this view. This interpretation is correct. (Kojima Hisamasa noted: In the *Golden Seventy Treatise* translated by the Indian monk Didi from the Chen dynasty, it is stated: 'Three sufferings: one based internally, one based externally, one based on heaven.' This also discusses the three causes, somewhat similar to the scripture's intent.)
Question: The patient's complexion appears on the face. ("Chest above" is written as "Chest middle" in Zhou and Leiju editions.)
Note: Wei Shi said: "The nose is the opening of the Lung and governs the primal Qi of the whole body. The Qi of the Five Zang Organs is all received from the Lung, and the true color of the Five Zang Organs must emerge at the tip of the nose along with the entry and exit of Qi. This is why the tip of the nose can verify the true color of the Five Zang Organs." This explanation differs from You Shi's view but should be preserved as an alternative interpretation. The *Tan Yin Pian* (Discourse on Phlegm-Fluids) states: "Inter-diaphragmatic retained fluid, the person wheezes and feels full, the epigastrium is hard and obstructed, and the complexion is dark." This elucidates the current section. Furthermore, cases of yellow complexion and white complexion were attributed by Shen, Wei, and Zhu to the nose. Checking the *Qianjin Fang*: "The discourse says: A slightly white tip of the nose indicates loss of blood; if slightly red and not during the proper season, death ensues. Patients with a white complexion all suffer from loss of blood." It also says: "Observing a patient's nose tip being yellow indicates difficulty in urination according to method." These seem to be the basis for the three scholars.
Master said: The patient speaks with a silent voice.
Note: "Yin" (mute) should be interchangeable with "Mo" (silent). The *Rites of Zhou* (*Dian Tong Zhi*) states: "Faint voice Mo." Zheng Xuan's commentary: "Mo means the voice is small and indistinct."
Master said: Breathing accompanied by shoulder movement indicates hardness in the chest/heart.
Note: Zhao Shi said: "This is Zhongjing's method of observing disease through respiration, mentioned alongside the subsequent point on inhalation, merely to present an aspect." Xu's commentary is based on this. Shen Shi believed this distinguishes between panting with phlegm-Qi, lung distension, and lung flaccidity. While plausible, it is not as precise as Wei Shi's. However, Wei Shi's interpretation of "saliva/froth" may be incorrect. Shen Shi said: "Heat in the Lung scorches the leaves, Qi becomes weak and unaroused, body fluids transform into saliva, which overflows upward to the mouth, causing spitting of saliva/froth." This seems reasonable. Generally, what ancients called "mo" is modern phlegm-saliva, not necessarily white froth. (Refer to *Fei Fei* and *Tan Yin Pian*.) Also, the differentiation between phlegm-cough and lung flaccidity in the *Yizong Jinjian* is inadequate.
Furthermore, Xu Shi commented on the complexion section: "Inspection values the dynamics of Shen Qi (Spirit Qi)." This is a profound statement. One should ponder deeply when inspecting breath.
Master said: Inhalation is slight and rapid.
Note: Zhu Shi used the sentences about Upper Jiao and Lower Jiao as footnotes for untreatable deficiency, which is erroneous. Also, the term "tendons and vessels" in Wei Shi's commentary should be deleted.
Master said: When the Cun Kou pulse moves...
Note: In this section, the preceding text discusses pulse without mentioning color, and the following text discusses color without mentioning pulse; this is a rhetorical device of mutual implication (huwen), concluding with the phrase "color and pulse not corresponding to the season."
Question: There is "arrival before time" and "failure to arrive at time." (Above "is failure to arrive at time," Yu edition and Leiju edition both have these words.)
[Xu] This discusses the arrival of weather having excess or deficiency. Although it does not explicitly mention medicine, the idea of adapting measures to circumstances is included. (You Shi's commentary in *Jiyi* omits nineteen characters: "and the sky has already warmed, or having obtained Jiazi, the sky instead remains unwarmed, and having obtained Jiazi.")
Question: The Cun pulse is deep, large, and slippery. (*Mai Jing* does not set up Q&A; under "Cu Jue" (Sudden Syncope), it adds "loss of consciousness"; the character "Kou" is absent; "He Shang" includes the character "Wen".)
Note: This section is titled "Ping Cu Shi Jue Mai Zheng" (Normal vs. Sudden Corpse-like Syncope Pulse and Symptoms) in *Mai Jing*. (Chao Yuanfang records it under "Shi Jue Hou".) The original note under "Shi Jue" in *Za Liao Fang* says: "Pulse and symptoms see Volume 1." Xu Shi believes this section likely describes the disease treated by Bian Que for the Crown Prince of Guo. Also, the *Su Wen* chapter *Yang Ming Mai Jie Pian* states: "Jue Ni connecting to Zang results in death; connecting to Jing results in survival."
Question: If the pulse disappears and enters the Zang, death ensues.
Note: My elder brother said: Previous commentaries on this section are overly speculative. It likely continues the previous section to elaborate further. "Mai" (Pulse) refers to blood vessels, a shorthand for blood and Qi. Examining dictionaries, "Tuo" (disappear/vanish) is a modal particle indicating possibility ("perhaps" or "maybe") and should be viewed as such to be appropriate. "Tuo" originally implies external collapse; saying "Tuo" while describing "entering" is inconsistent. The *Su Wen* chapter *Fang Sheng Shuai Lun* states: "Pulse disappearance is incomplete, diagnosis lacks constant practice." Wu Kun commented: "The pulse may not be visible." This corroborates the point. The *Wu Zi Li Shi Pian* states: "If one fails, one is laughed at by feudal lords." The *History of Later Han* (*Li Tong Zhuan*) states: "If the matter has not yet occurred, perhaps disaster can be avoided." Song Dynasty's Zhao Delin in *Hou Qing Lu* states: "Tuo means 'can' or 'you'; it denotes an indefinite term." People of Han and Jin often said "Tuo ruhe" (Perhaps how?), meaning "or perhaps." Hu Sansan in his commentary on *Tong Jian* states: "Tuo means 'or'." He also said: "Tuo is a term for uncertainty." All these serve as examples.
Question: What are the Eighteen Yang Diseases? ("Ren" is written as "Ren" in Leiju edition.)
[Zhou] This summarizes the diseases recorded in the *Neijing*, dividing them into Yin and Yang, fully addressing interior/exterior, combining upper/lower and interior/exterior to establish theory. Thus, meridians become clear, fu-organs distinct, and causes evident, preventing them from being scattered and difficult to trace. For example, San Yang (Three Yang) are external; diseases like headache involve six syndromes, each having its own meridian and manifesting its own meridian's symptoms. Three multiplied by six equals eighteen. The same applies to San Yin (Three Yin) located internally. Each of the Five Zang Organs has eighteen, totaling ninety diseases. Their manifestations are documented in the *Ling Shu*, discussing Heart pulse leading to convulsions, etc. As for the Six Fu Organs? Fu organs reside internally and connect to meridians. Therefore, pathogens in Fu organs connect externally to meridians; their injury is shallow, and dispersal is easy, unlike the depth and severity of Zang organ diseases. Hence, it is said to be "minor." The *Neijing* categorizes their diseases, while Zhongjing consolidates them into 108 diseases, likely based on the number six of the Fu organs. In total, there are 234 diseases, encompassing interior and exterior. The human body covers upper, lower, interior, and exterior. Regarding the so-called Clear/Turbid and Large/Small Pathogens: one is mist/dew, the other is earthy turbidity. Those originating from Heaven tend upward; those from Earth tend downward. The leader of a hundred diseases harms human Yang; the肃杀 (chilling/killing) energy harms human Yin. Entering via the mouth constitutes internal injury, causing fever, abdominal pain, wheezing, vomiting, and distension. Removing the old without bringing in the new achieves nothing. [Wei] Generally, Yang diseases are those outside the shell of the body, while Yin diseases are those inside the shell.
Note: This section is divided into two parts. The first part lists the number of diseases based on meridians and Zang/Fu organs. (Cheng's calculation was wrong; Zhou's is correct. ○ *History of Later Han* (*Guo Yu Zhuan*): "Skills of pulse diagnosis and subtle observations," also unclear in meaning.) The second part discusses the Five Pathogens in three segments. First, naming based on nature. (Wind moves swiftly and changes frequently; its nature is seen in *Qianjin*). Then repeatedly showing where it strikes. The remaining meaning concludes with extreme cold and extreme heat, which is comprehensive. However, commentators on Large and Small Pathogens offer convoluted explanations, missing the scripture's intent. They fail to see that the three segments correspond to each other: Large Pathogen refers to Wind, Small Pathogen refers to Cold, making the meaning clear. Zhou Shi's explanation is excellent. Wind scatters broadly, hence called Large; Cold is urgent/tight, hence called Small. Moreover, Wind harms people most frequently, while Cold is slightly less, which may explain their names. Wind is light and ascending, so it strikes the exterior first, causing floating pulse; Cold is fierce and bold, so it strikes the interior directly, causing tight pulse.
Furthermore, the *Su Wen* chapter *Tai Yang Yang Ming Lun* states: "Those injured by Wind are affected from above first. Those injured by Dampness are affected from below first." The *Ling Shu* chapter *Bai Bing Shi Sheng Pian* states: "Wind and Rain injure the upper, Clear Dampness injures the lower." The *Bian Mai Fa* states: "When Cun Kou pulse Yin and Yang are both tight, the method dictates Clear Pathogen strikes the Upper Jiao, Turbid Pathogen strikes the Lower Jiao." All have different wording but similar intent. Tao Hongjing's *Ben Cao Xu Li* states: "Although the origins of disease are manifold, they all relate to Pathogens. 'Pathogen' refers to abnormality, meaning it is not the normal state of the human body. Wind, Cold, Summer-heat, Dampness, hunger, fullness, labor, and rest are all pathogens, not just ghostly qi and epidemics." With this statement, the meaning of "Pathogen" in this section becomes clear.
My elder brother said: Lu Wenchao's *Zhong Shan Zha Ji* details the differentiation of the character "Ren"; reference is advised.
When a chronic disease (Gu Ji) is compounded by an acute disease (Cu Bing).
Note: *Shuo Wen*: "Gu means long-standing disease." (Jigu Ge printed Song edition writes HT, an error.) The *Yizong Jinjian* cites Zhao's commentary, which originally came from Zhou Shi.
Master said: Diseases of the Five Zang Organs heal when they obtain [what they favor].
Note: You Shi cites the *Zang Qi Fa Shi Lun*, *Xuan Ming Wu Qi Pian*, and *Wu Wei Pian* as evidence; reference is advised. Cheng Wuji's commentary on the "Chu Zhong" (Removing Middle) section of the *Jue Yin Pian* states: "If Stomach Qi is exhausted, obtaining [favorable condition] will definitely cause fever. If no fever occurs, Stomach Qi remains. It is feared that extreme cold transforms into heat; due to sudden heat coming and then going, enabling eating, this is not Chu Zhong." The *Jin Gui Yao Lue* states: "Patients who usually cannot eat but suddenly crave food will definitely develop fever." Cheng Wuji interpreted "crave" (Si) as "eat."
Regarding all diseases located in the Zang.
Note: The Zhu Ling Tang in this section is merely borrowed for illustrative purposes (to allow举一反三 - inferring other cases from one). Xu, Shen, and Zhu adding the formula is a deep error.
[Additional Commentary] This chapter reveals the general principles of syndrome differentiation and treatment by Zhongjing, with the greatest importance lying in the first and second chapters. Deeply analyzing its intent reveals three meanings. Firstly, the human body is governed by the Zang and Fu organs; thus, discussing disease logic must begin with the Zang and Fu. This is the teaching passed down from Xuanyuan and Qibo, which Zhongjing places at the beginning as a model for posterity. This is the first meaning. Secondly, the broad categories of disease are only two: Internal Injury and External Contraction. The first chapter focuses on Internal Injury, the second on External Contraction. Placing them side by side shows that disease does not exceed these two ends. This is the second meaning. Thirdly, the key to treatment lies in preventing minor issues from becoming major. "Drilling wood to make fire" (metaphor for prevention) is warned against by sages. Thus, the first chapter mentions treating disease before it arises, and the next section says: "Before it transmits to the Zang, treat it immediately," and "Do not let the nine orifices become blocked," all indicating the meaning of seeing the small to detect the excessive. This is the third meaning. Are these three meanings not the gateway for physicians entering the field? Other sections differentiate color, sound, breath, correspondence of color and pulse, and sequence of pulse; diagnostic methods are complete. Diseases arising suddenly require observation of auspicious/inauspicious signs. Internal cause diseases have specific numbers; external contraction diseases have specific rules. Zang organ diseases have conditions of favorability and aversion, which are also guidelines for differentiation. As weather waxing and waning corresponds to the human body, its principles must be discussed. Treatment methods first show prevention, then distinguish depth/shallowness, then discuss exterior/interior and new/old disease, establishing a necessary sequence. The final chapter reveals the secrets of purgative and guiding agents. Thus, the examples of syndrome differentiation and treatment fall within the scope of this chapter. This chapter is truly the great canon and fundamental law of physicians.