主乎温散，有卒中天地之寒气，口伤生冷之物，外感无内伤用仲景法。若挟内伤，补中益气汤加发散之药，必先
用参 托住正气。中寒胃气大虚，法当温散理中汤，甚者加附子。中寒仓卒受感，其病即发而暴。盖中寒之人，乘其
腠理疏豁，一身受邪，难分经络，无热可散，温补自解。此胃气之大虚，若不急治，去死甚近。 戴云∶此谓身受肃杀
之气，口食冰水、瓜果冷物病者，必脉沉细，手足冷，息微身倦，虽热亦不渴，倦言语，或遇热病误用此法，轻者至重，
重者至死。凡脉数者，或饮水者，烦躁动摇者，皆是热病。寒热二证，若水火也，不可得而同治，误则杀人，学人慎之？
或曰∶既受邪即有余之病，何谓补？内经云∶邪之所凑，其气必虚，内伤者极多，外感间或有之，有感冒等轻症，不可
便认为伤寒妄治。伤寒为病，必须身犯
寒气，口食寒物者，是必从补中益气汤出入加减，加发散药。伤寒挟内伤者（已见《医要》），凡外感不问如何，
先必参 托其正气，然后用发散之药。有感冒等证，轻疾不可便认为伤寒妄治。西北二方，极寒肃杀之地，故外伤
甚多；东南二方，温和之地，外伤极少，所谓千百而一二者也。杂病有六经所见之病，故世俗混而难别。凡证与伤
寒相类极多，皆杂证也，其详出《内经·热论》自长沙以下诸家推明，甚至千载之下，能
得其粹者，东垣之言也。其曰内伤极多，外伤者间或有之，此发前人所未发，欲辨内外所伤之脉，东垣详矣。后人
徇俗不见真切雷同，指为外伤极谬。其或可者，盖亦因其不放肆，而多用和解，或和平之药散之耳。若粗率者即杀
人，切戒！
治疗原则以温散为主。如果是突然遭受天地寒气的侵袭，或者口部食用了生冷食物，且属于外感病而没有内伤情况，应使用张仲景的方法。如果兼有内伤，则用补中益气汤加入发散药物，但必须先用参（人参）来扶持正气。对于中寒导致胃气极度虚弱者，治法应当是温散并用理中汤，病情严重的加用附子。中寒症是仓促间受邪，发病迅速且猛烈。因为中寒之人，趁着腠理疏松，全身受到邪气侵袭，难以区分具体是哪条经络受病，体内没有热象可供发散，通过温补即可自愈。这是胃气的大虚，如果不紧急治疗，离死亡很近。戴元礼说：这指的是身体遭受肃杀寒气，口中食用冰水、瓜果等冷物而致病的人，其脉象必然沉细，手足冰冷，气息微弱，身体疲倦，即使发热也不口渴，倦怠少言。如果遇到热病误用此法，轻症会加重，重症会导致死亡。凡是脉数者，或饮水者，烦躁不安动摇者，都是热病。寒证和热证，就像水和火一样，不能混同治疗，误治则会杀人，学习者务必谨慎。有人问：既然受了邪气就是有余的病，为什么说要用补法？《内经》说：邪气聚集的地方，正气必定虚弱。内伤的病人极多，外感偶尔才有，有感冒等轻症，不能就认为是伤寒而胡乱治疗。伤寒这种病，必须是身体接触寒气，口中食用寒物所致，一定要从补中益气汤出入加减，加入发散药。伤寒兼有内伤的（已在《医要》中见过），凡是外感病不问具体情况如何，必须先用人参托住正气，然后再用发散药物。有感冒等证候的轻疾，不能就认为是伤寒而胡乱治疗。西北两个地方，是极其寒冷肃杀之地，所以外伤很多；东南两个地方，是温和之地，外伤极少，可以说是千百人中只有一两个。杂病有六经所见到的病证，所以世俗之人混淆难辨。凡是证候与伤寒相似的极多，都是杂证，详细情况出自《内经·热论》，自长沙（张仲景）以下的各家推演阐明，甚至千年之后，能得其精髓的，是李东垣的言论。他说内伤极多，外伤偶尔才有，这是阐发前人所未发现的问题，想要辨别内外所伤的脉象，李东垣论述得很详尽。后人顺从世俗，不见真切雷同，指为外伤是极大的谬误。其中可行的部分，大概也是因为他们不肆意妄为，而多用和解或平和的药物来消散罢了。如果粗率行事就会杀人，务必戒除！
The treatment principle is primarily based on warming and dispersing. If one suddenly suffers from the cold qi of heaven and earth, or ingests raw and cold substances orally, and it is an external contraction without internal injury, the methods of Zhang Zhongjing should be employed. If there is a concomitant internal injury, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with dispersing herbs should be used, but Ginseng Radix et Rhizoma (Renshen, 人参) must first be used to support the healthy qi. For middle-cold resulting in extreme deficiency of stomach qi, the method should be warming and dispersing using Lizhong Tang (Regulate the Middle Decoction), with Aconiti Lateralis Radix Praeparata (Fuzi, 附子) added for severe cases. Middle-cold is contracted hastily; the disease manifests immediately and violently. This is because persons with middle-cold have loose cou li (pores and interstitial spaces), allowing pathogens to invade the whole body, making it difficult to distinguish which meridian is affected. There is no heat to disperse; warming and tonifying will lead to resolution. This represents a great deficiency of stomach qi. If not treated urgently, death is near. Dai Yun stated: This refers to patients who suffer from the austere and killing cold qi externally and ingest ice water, melons, fruits, and other cold substances internally. Their pulse must be deep and fine, hands and feet cold, breath weak, and body fatigued. Even if there is fever, there is no thirst, and they are lethargic with little desire to speak. If this method is mistakenly applied to heat diseases, mild cases become severe, and severe cases result in death. Any patient with a rapid pulse, those who drink water, or those who are restless and agitated all have heat diseases. Cold and heat syndromes are like water and fire; they cannot be treated identically. Misdiagnosis leads to death; students must be cautious. One might ask: Since contracting pathogens implies an excess condition, why use tonification? The Nei Jing states: Where pathogenic factors gather, healthy qi must be deficient. Internal injuries are very common, while external contractions occur occasionally. Mild conditions such as colds should not be mistaken for Shanghan (Cold Damage) and treated recklessly. Shanghan disease requires exposure to cold qi and ingestion of cold substances. Treatment must be based on modifications of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with the addition of dispersing herbs. For Shanghan with concomitant internal injury (as seen in *Yiyao*), regardless of the nature of the external contraction, Ginseng Radix et Rhizoma (Renshen, 人参) must first be used to anchor the healthy qi, followed by dispersing herbs. Mild conditions like colds should not be diagnosed as Shanghan and treated arbitrarily. The northwest regions are extremely cold and austere, hence external injuries are frequent; the southeast regions are mild, hence external injuries are rare, occurring only once or twice in a thousand cases. Miscellaneous diseases present symptoms seen in the six meridians, causing confusion among the lay public. Many conditions resemble Shanghan but are actually miscellaneous diseases; details are found in *Nei Jing: Re Lun* (Treatise on Heat). Since Zhang Zhongjing (Changsha), various schools have elaborated on these. Among those after a millennium, Li Dongyuan's words capture the essence most accurately. He stated that internal injuries are very common, while external contractions are occasional. This insight reveals what predecessors had not yet expounded. To differentiate pulses of internal versus external injury, Li Dongyuan provided detailed explanations. Later generations, following popular misconceptions and failing to see clearly, mistakenly attribute these to external injuries, which is a grave error. The viable aspects of their approach likely stem from their restraint, using mostly harmonizing or mild-pacifying herbs to dissipate pathogens. Carelessness can be fatal; this must be strictly avoided!