凡证有头疼恶寒，皆是伤寒，无则皆否也，何则？盖伤寒则恶寒，伤食则恶食，理固然也，但
在冬时恶寒为甚。盖冬时为正伤寒，天气严凝，风寒猛烈，触冒之者，恶寒殊甚。其余时月，虽有
恶寒亦微，未若冬时之恶寒为甚也。虽四时皆有伤寒，治之不可一概论也。冬时气寒，腠理微密，
非辛甘温不可，故以桂枝等汤以治之。然风与寒常相因。寒则伤荣，恶寒头痛，脉浮紧而无汗，则
用麻黄汤开发腠理以散
邪，得汗即愈。风则伤卫，头痛恶风，脉浮缓而自汗，则用桂枝汤充塞腠理以散邪，汗止即愈。经
云辛甘发散为阳者是也。若夫荣卫俱伤，又非此二汤所以治也，须大青龙汤。然此汤大峻，又非庸
俗所可拟也。予亦有代之者。盖冬时为正伤寒，天气严凝，风寒猛烈，触冒之者，必宜用辛温散之。
其非冬时亦有恶寒头疼之证，皆宜辛凉之剂通表里，和之则愈矣。若以冬时所用桂枝辛温之药通治
之，则杀人多矣。曰∶辛凉者何？羌活冲和汤是也。兼能代大青龙汤，为至稳。呜呼，一方可代三
方，危险之药如坦夷，其神乎？但庸俗辈所未知也。过此则少阳阳明二经，在乎半表半里，肌肉之
间，脉亦不浮不沉。外证在阳明，则有目疼鼻干，不得眠之证，脉似洪而长，以葛根汤、解肌汤、
升麻汤之类治之。在少阳，则胸胁痛而耳聋，脉见弦数，以小柴胡汤加减而和之。（本方有加减法。）
此二经不从标本从乎中治。余尝以小柴胡汤加葛根、芍药治少阳阳明合病如拾芥，但不使世俗知此
奇妙耳。过此不已，则传阳明之本。为入里。大便作实，其外证悉罢，谓无头痛恶寒也。脉见沉实
不浮，谵语恶寒，六七日不大便，口燥咽干而渴，轻则大柴胡汤，重则三乙承气汤选用。或曰∶邪
既入里而作实，无非大黄苦寒之药除下之，何其用方之杂 也？余曰∶传来非
一，治之乃殊耳。病有三焦俱伤者，则痞、满、燥、实俱全矣，则宜大承气汤，浓朴苦寒以去痞，
枳实苦寒以泄满，芒硝咸寒以润燥软坚，大黄苦寒以泄实去热，病斯愈矣。邪在中焦，则有燥、实、
坚三证，故用调胃承气汤，以甘草和中，芒硝润燥，大黄泄实，不用枳实、浓朴以伤上焦虚无氤氲
轻清之元气，调胃之名，于此立矣。上焦受伤，则为痞、实，用小承气汤，枳实、浓朴除痞，大黄
以泄实，去芒硝则不伤下焦血分之真阴，谓不伐其根也。若夫大柴胡汤，则有表邪尚未除而里证又
急，不得不下，只得以此汤通表里而缓治之。犹有老弱及血气两虚之人，不宜用此。三阳之邪在里
为患，春、夏、秋有不头痛恶寒而反渴者，此则温病也。暑病亦然，比之温病，犹加热也，治宜加
减小柴胡汤。盖此汤春可治温，夏宜治暑，秋能润肺。又宜升麻葛根汤、解肌汤、败毒散。中暑而
渴者，小柴胡石膏汤、人参白虎汤，看渴微甚而用之，无不效。经曰∶发热不恶寒而渴者，温病也。
若夫阴证，则别有法，不在此例矣。
凡是出现头痛、恶寒的症状，都是伤寒病；如果没有这些症状，就都不是。为什么呢？因为伤寒会导致恶寒，伤食会导致厌恶食物，这是理所当然的道理。只是在冬季时，恶寒的症状尤为严重。这是因为冬季是真正的伤寒季节，天气严寒凝滞，风寒猛烈，触犯冒犯的人，恶寒会非常严重。在其他季节，虽然也有恶寒，但程度轻微，不如冬季那样严重。虽然四季都有伤寒，但治疗不能一概而论。冬季气候寒冷，腠理（皮肤毛孔）致密，非辛甘温性的药物不可，所以用桂枝汤等方剂来治疗。然而风与寒常常相互影响。寒邪损伤营气，表现为恶寒、头痛，脉象浮紧且无汗，则使用麻黄汤开发腠理以驱散邪气，出汗后即刻痊愈。风邪损伤卫气，表现为头痛、恶风，脉象浮缓且自汗，则使用桂枝汤充实腠理以驱散邪气，汗止后即刻痊愈。《内经》说“辛甘发散为阳”指的就是这种情况。如果营卫两伤，就不是这两张方剂所能治疗的，必须使用大青龙汤。然而此方药性峻猛，不是普通庸医所能比拟的。我也有替代它的方子。因为冬季是真正的伤寒，天气严寒，风寒猛烈，触犯的人，必定适宜用辛温药物发散。如果不是冬季，也有恶寒、头痛的症状，都适宜用辛凉的药物疏通表里，调和后即可痊愈。如果用冬季所用的桂枝汤等辛温药物通治所有情况，就会造成很多人死亡。问：什么是辛凉？就是羌活冲和汤。它兼能替代大青龙汤，最为稳妥。唉，一方可以替代三方，使危险的药物变得像平坦大道一样安全，这真是神妙啊！但这只是普通庸医所不知道罢了。过了这个阶段，就是少阳经和阳明经的问题，位于半表半里之间，肌肉之中，脉象也不浮不沉。外证在阳明经，则有眼睛疼痛、鼻干、无法入睡的症状，脉象似洪大而长，用葛根汤、解肌汤、升麻汤之类治疗。在少阳经，则有胸胁疼痛和耳聋，脉象弦数，用小柴胡汤加减来调和。（本方有具体的加减方法。）这两条经络不从标本论治，而从中间状态论治。我曾经用小柴胡汤加葛根、芍药治疗少阳阳明合病，就像从地上捡起草芥一样容易，只是不让世俗之人知道这种奇妙之处罢了。再往里传变，则传入阳明之本。这是入里。大便结实，外部症状全部消失，即没有头痛恶寒。脉象沉实而不浮，谵语、恶寒，六七天不大便，口燥咽干而渴，轻症用大柴胡汤，重症选用三乙承气汤。有人说：邪气既然入里导致实证，无非是用大黄这类苦寒药物攻下，为什么用药方剂如此杂乱？我说：传来的途径不同，治疗方法也就不同。如果病在三焦都受伤，那么痞、满、燥、实四证俱全，则适宜用大承气汤，用厚朴的苦寒来消除痞满，用枳实的苦寒来泄除胀满，用芒硝的咸寒来润燥软坚，用大黄的苦寒来泄实清热，病就能痊愈。邪气在中焦，则有燥、实、坚三个证候，所以用调胃承气汤，用甘草调和脾胃，用芒硝润燥，用大黄泄实，不用枳实、厚朴以免伤害上焦虚无氤氲轻清的元气，“调胃”这个名字，由此确立。上焦受伤，则形成痞、实，用小承气汤，用枳实、厚朴消除痞满，用大黄泄实，去掉芒硝就不会伤害下焦血分的真阴，称为不伐其根本。至于大柴胡汤，则是表邪尚未清除而里证又紧急，不得不攻下，只能用这个方剂疏通表里并缓和地治疗。还有年老体弱及气血两虚的人，不宜使用此方。三阳经的邪气在里为患，春、夏、秋三季有不头痛恶寒反而口渴的，这就是温病。暑病也是如此，比温病更加热盛，治疗适宜用加减小柴胡汤。因为这个方剂春季可治温病，夏季适宜治暑病，秋季能润肺。也适宜用升麻葛根汤、解肌汤、败毒散。中暑而口渴的，用小柴胡石膏汤、人参白虎汤，根据口渴程度的轻重来选择使用，没有不有效的。《内经》说：“发热不恶寒而口渴的，是温病。”至于阴证，则有另外的治疗方法，不在此例了。
For any syndrome presenting with headache and aversion to cold, it is all Cold Damage (Shanghan); if absent, it is not. Why? Because Cold Damage causes aversion to cold, while food retention causes aversion to food; this is the natural principle. However, in winter, aversion to cold is particularly severe. This is because winter is the time of true Cold Damage; the weather is strictly cold and congealed, wind and cold are fierce, and those who are exposed will experience severe aversion to cold. In other seasons, although there may be some aversion to cold, it is mild and not as severe as in winter. Although Cold Damage occurs in all four seasons, treatment cannot be generalized. In winter, the climate is cold, and the Cou Li (skin pores and interstices) are tight and dense; non-acrid, sweet, and warm herbs are indispensable, so Guizhi Tang (Cinnamon Twig Decoction) and similar formulas are used for treatment. However, Wind and Cold often influence each other. When Cold damages Ying (Nutritive Qi), symptoms include aversion to cold and headache, with a floating, tight pulse and no sweating; Mahuang Tang (Ephedra Decoction) is used to open the Cou Li and disperse the pathogen, and recovery follows once sweating occurs. When Wind damages Wei (Defensive Qi), symptoms include headache and aversion to wind, with a floating, moderate pulse and spontaneous sweating; Guizhi Tang (Cinnamon Twig Decoction) is used to fill the Cou Li and disperse the pathogen, and recovery follows once sweating stops. The Classic states that "Acrid and sweet substances that diffuse belong to Yang," which refers to this situation. If both Ying and Wei are damaged, these two formulas are insufficient; Da Qing Long Tang (Major Blue Green Dragon Decoction) must be used. However, this formula is extremely potent and unsuitable for ordinary physicians. I have alternatives. Since winter is true Cold Damage with severe weather and fierce wind-cold, exposure requires acrid-warm dispersing agents. For non-winter cases presenting with aversion to cold and headache, acrid-cool agents should be used to unblock the exterior and interior and harmonize the body, leading to recovery. Using winter-specific acrid-warm drugs like Guizhi Tang for all cases would cause many deaths. Question: What are acrid-cool agents? Huoqu Chonghe Tang (Notopterygium Harmonizing Decoction) is one. It can also substitute Da Qing Long Tang and is very stable. Alas, one formula replacing three makes dangerous drugs as safe as flat roads; this is divine! Yet this is unknown to ordinary practitioners. Beyond this stage involves the Shaoyang (Lesser Yang) and Yangming (Yang Brightness) meridians, located halfway between the exterior and interior, within the muscles, with pulses neither floating nor sunken. Exterior manifestations in Yangming include eye pain, nasal dryness, and insomnia, with a pulse resembling flooding and elongation; Gegen Tang (Kudzu Decoction), Ji Ji Tang (Release Muscle Decoction), or Shengma Tang (Cimicifuga Decoction) are used. In Shaoyang, symptoms include chest and hypochondriac pain and deafness, with a string-taut and rapid pulse; Xiaochaihu Tang (Minor Bupleurum Decoction) is modified to harmonize. (This formula has specific modification methods.) These two meridians are treated from the intermediate aspect rather than the root or branch. I have successfully treated combined Shaoyang-Yangming disease using Xiaochaihu Tang plus Gegen Tang (Kudzu Decoction) and Baishao Radix (White Peony Root), as easily as picking up grass from the ground, but I keep this wonder secret from commoners. Further transmission enters the root of Yangming, signifying entry into the interior. Stools become solid, external symptoms cease (no headache or aversion to cold). Pulses are deep, solid, and not floating; delirium, aversion to cold, constipation for six to seven days, dry mouth/throat, and thirst occur. Mild cases use Daxiehu Tang (Major Bupleurum Decoction); severe cases select San Yi Chengqi Tang (Three Yi Chengqi Decoction). Some ask: Since pathogens enter the interior causing excess, isn't it just about using bitter-cold purgatives like Dahuang Rhizome (Rhubarb)? Why such variety in formulas? I reply: Transmission paths differ, so treatments differ. If pathogens injure all three Jiao (Burners), Pi (fullness/oppression), Man (distension), Zao (dryness), and Shi (excess) are all present; Dachengqi Tang (Major Order the Qi Decoction) is appropriate. Houpo Bark (Magnolia Bark) clears Pi with its bitter-cold nature; Zhishi Immature Bitter Orange Fruit (Aurantii Fructus Immaturus) drains Man with its bitter-cold nature; Mangxiar Crystal (Mirabilite) moistens Zao and softens hardness with its salty-cold nature; Dahuang Rhizome (Rhubarb) drains Shi and clears heat with its bitter-cold nature, curing the disease. Pathogens in the Middle Jiao present with Zao (dryness), Shi (excess), and Jian (firmness); Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction) is used. Gancao Licorice Root (Glycyrrhizae Radix) harmonizes the middle; Mangxiar Crystal (Mirabilite) moistens dryness; Dahuang Rhizome (Rhubarb) drains excess. Zhishi (Immature Bitter Orange Fruit) and Houpo (Magnolia Bark) are omitted to avoid injuring the ethereal, light, and clear Yuan Qi (Primal Qi) of the Upper Jiao. The name "Regulate the Stomach" originates here. Injury to the Upper Jiao results in Pi (oppression) and Shi (excess); Xiao Chengqi Tang (Minor Order the Qi Decoction) is used. Zhishi (Immature Bitter Orange Fruit) and Houpo (Magnolia Bark) remove Pi; Dahuang Rhizome (Rhubarb) drains Shi. Omitting Mangxiar Crystal (Mirabilite) avoids injuring the True Yin of the Blood aspect in the Lower Jiao, termed "not chopping the roots." As for Daxiehu Tang (Major Bupleurum Decoction), it is indicated when exterior pathogens remain unresolved yet interior symptoms are urgent, requiring downward action; this formula unblocks exterior and interior while treating gently. It is unsuitable for the elderly, weak, or those with dual deficiency of Qi and Blood. When Three Yang pathogens reside in the interior causing illness, spring, summer, and autumn cases may lack headache/aversion to cold but feature thirst; this is Warm Disease (Wenbing). Summerheat disease is similar but hotter; Jiajian Xiaochaihu Tang (Modified Minor Bupleurum Decoction) is suitable. This formula treats Warm Disease in spring, Summerheat in summer, and moistens the lungs in autumn. Shengma Gegen Tang (Cimicifuga Kudzu Decoction), Ji Ji Tang (Release Muscle Decoction), and Baidu San (Detoxify Poison Powder) are also appropriate. For Summerheat with thirst, Xiaohu Shigao Tang (Bupleurum Gypsum Decoction) or Renshen Baihu Tang (Ginseng White Tiger Decoction) are used based on thirst severity, always effective. The Classic states: "Fever without aversion to cold but with thirst is Warm Disease." Yin syndromes follow different rules and are not covered here.