伤寒杂病论义疏-第5部分
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鹿茸附子人参干姜汤方·········402
麻黄升麻汤方·························403
伤寒杂病论义疏卷十一下
···················405
辨厥阴病脉证并治
·························405
干姜黄芩黄连人参汤方·········405
柏叶阿胶干姜丹皮汤方·········407
通脉四逆汤方·························410
白头翁汤方·····························410
伤寒杂病论义疏
—15—
桂枝汤方
································
411
小承气汤方
····························412
栀子豉汤方
····························412
吴茱萸汤方
····························413
小柴胡汤方
····························414
桂枝当归阿胶茯苓黄芩半夏汤
················································415
伤寒杂病论义疏卷十二
····················417
辨霍乱脉证并治
····························417
理中汤方
································419
白术茯苓半夏枳实汤方
········419
小柴胡加白术茯苓方
············420
四逆汤方
································421
白术石膏半夏干姜汤方
········421
四逆汤加吴茱萸黄连方
········421
白术茯苓半夏泽泻栝蒌根汤方
················································422
人参干姜半夏生姜汤方
········423
茯苓白术泽泻干姜厚朴汤方
423
理中汤方
································424
黄连黄芩干姜半夏汤方
········424
桂枝茯苓细辛白术防己汤方
424
五苓散方
································425
理中丸方
································425
四逆加人参汤方
····················427
桂枝汤方
································427
四逆汤方
································427
四逆加猪胆汤方
····················428
辨痉阴阳易差脉证并治
················429
栝蒌桂枝汤方
························435
葛根汤方
································436
桂枝加附子当归细辛人参干姜
汤方
········································437
大承气汤方
····························437
枳实栀子豆豉汤方
················438
牡蛎泽泻散方
························439
竹叶石膏汤方
························440
伤寒杂病论义疏卷十三上
················441
辨不可发汗病脉证并治
················441
伤寒杂病论义疏卷十三下
·················449
辨可发汗病脉证并治
·····················449
伤寒杂病论义疏卷十四上·················456
辨发汗后病脉证并治
·····················456
伤寒杂病论义疏卷十四中·················461
辨不可吐·················································461
伤寒杂病论义疏卷十四下·················463
辨可吐·············································463
伤寒杂病论义疏卷十五上
·················465
辨不可下病脉证并治
·····················465
伤寒杂病论义疏卷十五下
·················479
辨可下病脉证并治
·························479
伤寒杂病论义疏卷十六
·····················487
辨发汗吐下后病脉证并治
·············487
跋·····························································501
伤寒杂病论义疏
—1—
伤寒杂病论义疏卷一上
平脉法第一
平脉法者，启后贤以诊要也。平，释如《书》“平章百姓”之平，义犹辨也（脉法旧
皆以平脉冠之，序云平脉辨证者是也。后人以辨之义释平，遂讹有平脉、辨脉之分）。病有证，脉有
象。辨证而后能议病，别象而后能平脉。证之表见者，藏府消息之外着也。脉之效象者，
气血变化之形容也。故首明气血先见，以示效象之源。次示平脉大法，以明诊要有分部、
察息、辨象、审势之方。次则明藏气之异用，而脉各呈其象焉；分六气之异性，而脉各
呈其象焉。次则示察色之妙，明问闻之法。更合脉证而析其呿吟之微，洞其参伍之变，
而终之以奇经八脉。学者苟能精求其象，更进而通其效象之源，熟肄其法，更深而得其
奇恒之巧，察合之于色脉，比类之于证候，则病之在内在外，属藏属府，伤荣伤卫，病
气病血，中于何气，舍于何经，莫不各有其不变不易之诊，至明至晰之辨。惟精惟一之
理，既微妙以玄通，复彰显而质实，此真发天地之秘奥，出赤水之玄珠者矣。盖先师以
脉学统四诊，以出入升降象势统脉法，举一例凡，无法不摄。孔子曰：举一隅不以三隅
反，在精而熟之，思乃通也。若乃受师不卒，意惑心迷，思用难精，隅反莫悟，广之万
卷，其义莫穷。师之序曰：自非才高识妙，岂能探其理致哉。下根邪悟，末之何也。
问曰：脉何以知气血藏府之诊也？师日：脉乃气血先见，气血有盛衰，
藏府有偏胜。气血俱盛，脉阴阳俱盛，气血俱衰，脉阴阳俱衰。气独盛者则
脉强，血独盛者则脉滑，气偏衰者则脉微，血偏衰者则脉涩。气血和者则脉
缓，气血平者则脉平，气血乱者则脉乱，气血脱者则脉绝。阳迫气血则脉数，
阴阻气血则脉迟。若感于邪，气血扰动，脉随变化，变化无穷，气血使之。
病变百端，本原别之。欲知病源，当平脉变。欲知病变，先揣其本。本之不
齐，在人体躬。相体以诊，病无遁情（通行本佚）。
问曰：脉何以知气血藏府之诊也？此问脉者血之府，心之合也。寸口者，则手太阴
之动脉也。气血异病，何以辨之？藏府异候，何经辨之？六气异邪，何以辨之？又一脉
何以为数十病？一病何以见数十脉？脉何以因病而效其象？象何以辨别而知其源？此理
难明，故首问之。师曰以下答辞，明脉之源也。盖人处于气交之中，以天地之气生，以
四时之法成，如鱼之育于江海，如金之冶于烘炉。圣人仰观俯察，有以知形假物成，命
惟天赋，天地合气，命之曰人。于是推物性变化之理，以定藏府血气之诊。求之物性，
伤寒杂病论义疏
—2—
纷赜而不可尽也，统之以金木水火土，而物之性尽矣。更进而求其承制之化，则金遇火
而液化，水得冷而冰凝，木绝水而枯，火加水而灭，土性中和，兼乎四气（经曰：木得金
而伐，土得木而达，水得土而绝，火得水而灭，金得火而两缺，万物尽然，不可胜竭。疏义本此）于
是知物性不同，随缘变异，性由体具，象以变形。圣人既究极乎天地物性之变，而论理
于人形，原其本则万物同体也。清者为气而无形，浊者为血而有质。在人身虽内有府藏
经络，外而毛肤官窍，无不资气以煦之，血以濡之。气竭则华痿，血弱则荣枯。更见夫
天地温和，则经水（义即江河）安静；天寒地冻，则经水凝泣；天暑地热，则经水沸溢；
卒风暴起，则经水波涌而陇起。血脉者，亦人身之江河也。荣行脉中，卫行脉外，气血
和谐，脉道以行。故合之于人，凡藏气之内变，六淫之外伤，邪之及体，气血受病，气
血扰动，病虽未见，脉象先形，故曰：脉乃气血先见也。气血有盛衰，藏府有偏胜者，
此释人之秉赋不同。气血在人，各有偏盛偏衰之异，藏府之秉，各有偏强偏弱之殊。脉
之动也，气血使之。故气血俱盛，脉阴阳俱盛。气血俱衰，脉阴阳俱衰。阴阳指寸尺，
兼浮按沉按，脉随气血为变化也。气独盛者则脉强，血独盛者则脉滑，气偏衰者则脉微，
血偏衰者则脉涩。此释脉诊气血之辨，诊法之最为微妙者也。察脉之法，曰分部，曰察
息，曰辨象，曰审势。何谓分部？浮中沉为表里之部，以察气血之出入；寸关尺为上下
之部，以察气血之升降。故分部乃可以定病之所舍。何谓察息？脉之动也，随息迟疾（平
人亦有呼吸促而脉徐者寿，呼吸徐而脉躁者，不病则夭，不尽随息也）。经曰：脉一呼再至，一吸
再至，闰以太息，五至曰平，此言其常也。然人之呼吸，迟疾之度各异。故但察迟疾，
不足以为虚实寒热之准。分部察息，庸工易晓，脉之微妙，在象与势。何谓势？势者，
脉动之变也。气动无形，故以势彰。何谓象？象者，脉形之异也。血流有质，故以象显。
气血之辨，势象攸分。气独盛则脉强，强者势也。血独盛则脉滑，滑者象也。气偏衰则
脉微，微亦势也。血偏衰则脉涩，涩亦象也。诊法之妙，先别气血。在经络为荣卫，言
其循周之用也。在藏府为气血，表其变化之体也。病在气分，则脉之势变。病入血分，
则脉之象改。故脉之势变而象不变者，气病而血不病也。脉之象变而势不变者，血病而
气不病也。象势俱变，则气血俱病。故气血和者则脉缓，气血平者则脉平，气血乱者则
脉乱，气血脱者则脉绝。脉随病变，如影随形。
