问曰∶伤寒温病何以脉辩？答曰∶温病于冬时感寒所得也，至春变为温病耳。伤寒汗下不愈而
过经，其证尚在而不除者，亦温病也。经曰∶温病之脉行在诸经，不知何经之动，随其经之所在而
取之。
如太阳证，头疼恶寒，汗下后过经不愈，诊得尺寸俱浮者，太阳病温也。
如身热目疼，汗下后过经不愈，诊得尺寸俱长者，阳明病温也。
如胸胁痛，汗下后过经不愈，诊得尺寸俱弦者，少阳病温也。
如腹满嗌干，诊得尺寸俱沉细，过经不愈，太阴病温也。
如口燥舌干而渴，诊得尺寸俱沉，过经不愈者，少阴温病也。
如烦满囊缩，诊得尺寸俱微缓，过经不愈者，厥阴病温也。
是故随其经而取之，随其证而治之。如发斑，乃温毒也。
治温大抵不宜发汗，过时而发，不在表也。已经汗下，亦不在表也。经曰∶不
恶寒而反渴者，温病也。明其热自内达外，无表证明矣。
凡看伤寒，且要识各经中死证、死脉亲切，须一一理会过，免致临病疑惑。但见死证，便以脉
参之，如果有疑，切莫下药。虽至亲浼，亦不可治，倘有差失，咎将归于己矣。
阳病热证不退，反似阴脉，凶。汗后热退，阴脉，瘥。阴阳诸证，脉平，吉。伤寒咳逆上气，
脉散者，凶。脉浮而滑，身汗如油，喘息不休，水浆不入，身体不仁，乍静乍喘者，死。汗出发润，
喘不休者，肺先绝也。阳反独留，体如烟熏，直视摇头，心先绝也。唇吻反青，四肢 汗出，肝
先绝也。环口黧黑，虚汗发黄，脾先绝也。三部紧盛，大汗出不解者，死。阴阳尺寸俱虚，热不止
者，死。身热喘粗，见阳脉而燥者，死。汗后微热不解，未可言死，如转
索者，即日死也。谵语微热，脉浮大，手足温，欲汗出，脉暴出者，死也。阴衰欲绝而阳暴独胜，
则脉出，一日阴气先绝，阳气后竭，死。逆冷，脉沉细者，一日死。
死证虽多，至于危极处，无过死也。
凡看伤寒，初学后生，不可轻易治之，治其病之可晓者，缺其不可晓者。胸中证不明白，有一
毫疑惑，不可强治，故君子不强其所不能。若不量力，私于亲故，或见利而动，轻易玩弄，视人命
如草芥，非君子之用心也。谨而敬慎，毋怠毋忽。
初得伤寒一二日，头痛恶寒皆除，便觉胸中连脐腹注闷疼痛，脉沉有力，坐卧不安，上气喘促，
不候他证，便可用下药。若头项强痛，恶寒发热，每日如此，不可以日数多少，病尚在太阳经，正
宜发汗，要在随所见者，表里而治之，不必拘于日数也。若烦渴欲饮水，由内水消竭，欲得外水自
救耳。大渴欲饮一升，只与一半，常令不足，不可过饮。若过饮水，重则为水结之证，射于肺为喘，
为咳；留于
胃为嗌，为哕；溢于脾为肿；蓄于下焦为癃，皆饮水之过也。病若经十余日以上，有下证者，只宜
大柴胡汤，恐承气太峻。盖伤寒过经则正气多虚故也。
病七八日，未得汗，大便闭，发黄生斑，谵语而渴，越婢桃仁汤主之。
病八九日，已经汗下，脉尚洪数，两目如火，五心烦热，狂叫欲走，三黄石膏汤主之。
病五六日，但头汗出，身无汗，际颈而还，小便自利，渴饮水浆，此瘀血证也，宜犀角地黄汤、
桃仁承气汤。看上下虚实，用犀角地黄汤治上，桃仁承气汤治中，抵当汤、丸治下也。
病六七日，别无刑克证候，忽然冒昧不知人事，六脉俱静，或至无脉，此欲汗，勿攻之。如久
旱将雨，六合阴晦，雨后庶物皆苏，换阳之吉兆也。
夫今人治伤寒一二日间，不问属虚属实，便用桂枝汤之类以汗之。三五日后，不问在表在里，
便以承气汤之类以下之，多致内外俱虚，诸变蜂起。大抵病患虚实
表里不同，所以邪之传变有异，岂可以日数为准。盖有即传者，有传一二经而止者，有始终只在一
经者，不必拘始太阳终厥阴也。
伤寒无出于仲景书，但文本深奥，非浅学可仿佛。况其残缺颇多，晋人作全书诠次，其中不可
晓处，十有四五。苟未能统之有宗，会之有元，未易窥测，临病之际不能无惑。必须破的而后用，
又恐病危有所不逮，既不可不救，又不可失之苟且。今备此数事，以备缓急之用，非博雅通医之所
尚。（以上略引东垣先生引举。）
问：伤寒和温病如何通过脉象来辨别？
答：温病是在冬季感受寒邪所致，到了春季就转变为温病。如果伤寒经过发汗或攻下治疗后仍未痊愈，且病情传变超过一经（过经），症状依然存在而未消除的，也属于温病。经典记载说：温病的脉象运行于各条经络之中，不知道是哪条经络受邪，就根据该经络所在的位置进行诊察和治疗。
如果是太阳经证候，出现头痛、恶寒，在发汗或攻下后病情传变超过一经仍未痊愈，诊察发现寸口和尺部脉象都呈现浮象的，是太阳经温病。
如果是身体发热、眼睛疼痛，在发汗或攻下后病情传变超过一经仍未痊愈，诊察发现寸口和尺部脉象都呈现长象的，是阳明经温病。
如果是胸胁部疼痛，在发汗或攻下后病情传变超过一经仍未痊愈，诊察发现寸口和尺部脉象都呈现弦象的，是少阳经温病。
如果是腹部胀满、咽喉干燥，诊察发现寸口和尺部脉象都呈现沉细象，且病情传变超过一经仍未痊愈的，是太阴经温病。
如果是口腔干燥、舌干而口渴，诊察发现寸口和尺部脉象都呈现沉象，且病情传变超过一经仍未痊愈的，是少阴经温病。
如果是心烦、腹部胀满、阴囊收缩，诊察发现寸口和尺部脉象都呈现微缓象，且病情传变超过一经仍未痊愈的，是厥阴经温病。
因此，要随着经络的变化来诊察，随着证候的表现来治疗。如果出现发斑疹，这是温毒所致。
治疗温病大体上不宜使用发汗法，因为如果是过了时令才发作的，病邪就不在体表。如果已经经过发汗或攻下治疗，病邪也不在体表了。经典记载说：不恶寒反而口渴的，就是温病。这明确表明热邪是从内部达于外部的，没有表证的证据了。
凡是诊治伤寒，首先要清楚识别各经络中的死证和死脉，必须逐一领会掌握，以免在面对疾病时产生疑惑。只要见到死证，就用脉象来参验，如果有疑问，千万不要下药。即使是至亲恳求，也不可治疗，倘若出现差错，罪责将归于自己。
阳病热证不退，反而出现阴脉，主凶险。发汗后热退，出现阴脉，表示病愈。阴阳各种证候，脉象平和，主吉利。伤寒咳嗽气逆，脉象散乱的，主凶险。脉象浮而滑，身体出汗如油，喘息不停，水浆不能入口，身体麻木不仁，时而安静时而喘促的，主死亡。出汗后头发湿润，喘息不停，是肺气先绝。阳气反独留于内，身体像烟熏一样黑，直视摇头，是心气先绝。嘴唇周围发青，四肢冷汗出，是肝气先绝。口周颜色黧黑，虚汗发黄，是脾气先绝。三部脉紧盛，大汗出而病不解的，主死亡。阴阳寸关尺三部脉象都虚弱，发热不止的，主死亡。身体发热，呼吸粗重，出现阳脉且伴有燥象的，主死亡。发汗后轻微发热未解，还不能说是死证，但如果脉搏跳动像转索一样急促紊乱的，当天就会死亡。胡言乱语，轻微发热，脉象浮大，手足温暖，想要出汗，但脉象突然暴出的，主死亡。阴气衰败欲绝而阳气突然独自亢盛，则脉象显现，这是一天内阴气先绝，阳气后竭，主死亡。四肢逆冷，脉象沉细的，一天内死亡。
死证虽然很多，但在极其危险的情况下，无非就是死亡而已。
凡是诊治伤寒，初学的后生，不要轻易治疗，只治疗那些可以明确诊断的病，对于无法明确的病症暂时搁置。心中对证候不明白，有一丝毫疑惑，不可强行治疗，所以君子不强求做自己做不到的事。如果不顾自身能力，出于对亲友私情，或者见利忘义，轻易玩弄医术，视人命如草芥，这不是君子的心意。应当谨慎恭敬，不要懈怠疏忽。
刚得伤寒一两天，头痛恶寒都消失了，立刻觉得胸部连着脐腹闷痛，脉象沉而有力，坐卧不安，上气喘促，不需要等待其他证候，就可以使用攻下的药物。如果头项强痛，恶寒发热，每天如此，不管天数多少，病还在太阳经，正适宜发汗，关键在于根据所见到的情况，分辨表里进行治疗，不必拘泥于天数。如果烦躁口渴想喝水，是因为体内津液消竭，想要借助外部的水来自救。非常想喝一升水，只给一半的量，常令其感到不足，不可过量饮水。如果过量饮水，严重的话会导致水结之证，水气射入肺脏导致喘咳；停留在胃脘导致咽部不适、呃逆；溢于脾脏导致浮肿；蓄积在下焦导致小便不通，这都是过量饮水造成的过错。如果患病十几天以上，有可以使用下法的证候，只宜用大柴胡汤，恐怕承气汤药力太峻猛。因为伤寒传变超过一经后正气大多虚弱。
患病七八天，未能出汗，大便闭塞，皮肤发黄并出现斑疹，胡言乱语且口渴，用越婢桃仁汤主治。
患病八九天，已经经过发汗或攻下治疗，脉象仍然洪数，双眼像火一样红，五心烦热，狂叫想要奔跑，用三黄石膏汤主治。
患病五六天，只有头部出汗，身体无汗，汗止于颈部，小便自利，口渴想喝水浆，这是瘀血证，宜用犀角地黄汤、桃仁承气汤。根据上下虚实情况，用犀角地黄汤治上部，桃仁承气汤治中部，抵当汤、丸治下部。
患病六七天，没有其他克贼的证候，忽然神志昏迷不知人事，六脉都静伏，或者摸不到脉，这是将要出汗，不要攻下。就像久旱即将下雨，天地昏暗，雨后万物复苏，这是换回阳气的吉兆。
现在的人治疗伤寒一两天间，不问属于虚证还是实证，就用桂枝汤之类来发汗。三五天后，不问病邪在表还是在里，就用承气汤之类来攻下，多导致内外俱虚，各种变证蜂拥而起。大体上病患的虚实表里不同，所以邪气的传变也有差异，怎么能以天数作为标准呢？大概有的立即传变，有的传变一到两经就停止，有的始终只在一经，不必拘泥于始于太阳终于厥阴的说法。
伤寒学没有超出张仲景的书，但文本深奥，不是浅学之人可以轻易理解的。况且其中残缺很多，晋代人整理全书时，其中难以理解的地方，占十分之四五。如果不能统摄其宗旨，领会其本源，不容易窥测其奥秘，面对疾病时难免产生疑惑。必须确立目标然后用药，又担心病情危重来不及救治，既然不能不救，又不能失之苟且。现在准备这几件事，以备紧急之用，这并不是博学通医之士所推崇的。（以上略引李东垣先生引用的内容。）
Q: How can Taiyang cold damage (Shanghan) and warm disease (Wenbing) be distinguished by pulse?
A: Warm disease originates from contracting cold pathogens in winter, which transforms into warm disease in spring. If cold damage fails to resolve after sweating or purging therapies, and the condition has passed beyond one meridian (Guojing), yet symptoms persist without elimination, it is also considered warm disease. The classics state: "The pulse of warm disease travels through various meridians; if one does not know which meridian is affected, treat according to the location of that meridian."
If there are Taiyang syndrome manifestations, such as headache and aversion to cold, and after sweating or purging, the condition passes beyond one meridian without resolution, and the cun (inch) and chi (foot) pulses at both wrists are floating (Fu), it is Taiyang warm disease.
If there is body heat and eye pain, and after sweating or purging, the condition passes beyond one meridian without resolution, and the cun and chi pulses are long (Chang), it is Yangming warm disease.
If there is hypochondriac pain, and after sweating or purging, the condition passes beyond one meridian without resolution, and the cun and chi pulses are wiry (Xian), it is Shaoyang warm disease.
If there is abdominal fullness and dry throat, and the cun and chi pulses are deep and fine (Chen Xi), and the condition passes beyond one meridian without resolution, it is Taiyin warm disease.
If there is dry mouth and tongue with thirst, and the cun and chi pulses are deep (Chen), and the condition passes beyond one meridian without resolution, it is Shaoyin warm disease.
If there is irritability, abdominal fullness, and contraction of the scrotum, and the cun and chi pulses are faint and slow (Wei Huan), and the condition passes beyond one meridian without resolution, it is Jueyin warm disease.
Therefore, diagnose according to the meridian and treat according to the syndrome. If macules appear, this is due to warm toxin (Wendu).
Generally, treating warm disease should not involve inducing sweating, because if it occurs after the season has passed, the pathogen is not in the exterior. If sweating or purging has already been performed, the pathogen is no longer in the exterior. The classics state: "Those who do not have aversion to cold but instead have thirst have warm disease." This clearly indicates that heat arises from within and reaches outward, proving the absence of exterior syndrome evidence.
When diagnosing cold damage, one must first thoroughly understand the death syndromes and death pulses of each meridian to avoid confusion when facing illness. Upon seeing a death syndrome, verify with the pulse. If there is any doubt, do not administer medication. Even if requested by close relatives, do not treat; if an error occurs, the blame will fall upon oneself.
In yang diseases with persistent heat, if the pulse unexpectedly becomes yin-type, it is ominous. After sweating, if heat subsides and the pulse becomes yin-type, recovery is indicated. For various yin-yang syndromes, if the pulse is peaceful, it is auspicious. In cold damage with cough and rebellious qi, if the pulse is scattered (San), it is ominous. If the pulse is floating and slippery, sweat is like oil, panting is unceasing, fluids cannot be taken, the body is numb, and there is alternating calmness and panting, death is imminent. If sweat wets the hair and panting is unceasing, lung qi is failing first. If yang remains alone internally, the body appears smoked, eyes stare fixedly, and the head shakes, heart qi is failing first. If lips turn blue and limbs sweat coldly, liver qi is failing first. If the area around the mouth turns dark yellowish-black and sweat is yellowish, spleen qi is failing first. If the three positions (cun, guan, chi) are tight and full, and profuse sweating does not resolve the condition, death is imminent. If yin and yang pulses at all positions are deficient, and fever persists, death is imminent. If the body is hot, breathing is coarse, the pulse is yang-type, and there is dryness, death is imminent. After sweating, if slight fever persists, it is not yet death; however, if the pulse feels like a turning rope (Zhuan Suo), death will occur on that day. If there is delirium, slight fever, floating and large pulse, warm hands and feet, desire for sweat, but the pulse suddenly emerges violently, death is imminent. If yin qi is declining towards extinction while yang qi suddenly overpowers, the pulse appears; this indicates yin qi fails first, followed by yang qi exhaustion, leading to death within a day. With cold extremities and deep, fine pulse, death occurs within a day.
Although there are many death syndromes, in extreme critical conditions, the outcome is simply death.
For beginners studying cold damage, do not treat lightly. Treat only what is clear; leave unclear cases aside. If the chest syndrome is not clear and there is the slightest doubt, do not force treatment. Thus, a gentleman does not force what he cannot do. Ignoring one's capacity, acting out of favoritism for relatives/friends, or being motivated by profit and playing recklessly with medicine, treating human life as grass, is not the mindset of a gentleman. Be cautious and respectful; do not be negligent or careless.
In the first one or two days of cold damage, if headache and aversion to cold disappear, and immediately one feels oppression and pain connecting the chest to the umbilicus and abdomen, with a deep and forceful pulse, restlessness, and rapid upper qi panting, without waiting for other syndromes, purgative herbs may be used. If there is stiffness and pain in the head and neck, aversion to cold and fever daily, regardless of the number of days, if the disease remains in the Taiyang meridian, sweating therapy is appropriate. Treatment depends on the observed exterior or interior patterns, not rigidly on the number of days. If there is irritability and thirst desiring water, it is due to internal fluid depletion, seeking external water for self-rescue. If extremely thirsty and wanting to drink one sheng, give only half, keeping them slightly unsatisfied; do not allow excessive drinking. Excessive drinking can lead to water accumulation syndromes: water attacking the lungs causes panting and cough; stagnating in the stomach causes throat discomfort and hiccups; overflowing to the spleen causes edema; accumulating in the lower jiao causes strangury. All these are faults of excessive drinking. If the disease has lasted more than ten days and there are indications for purging, Da Chai Hu Tang (Greater Bupleurum Decoction) is suitable, as Cheng Qi Tang (Order the Qi Decoction) may be too harsh, since righteous qi is often deficient after passing beyond one meridian.
On the seventh or eighth day, if there is no sweat, constipation, jaundice with macules, delirium, and thirst, Yue Bi Tao Ren Tang (Ma Huang Decoction with Peach Kernel) is the primary formula.
On the eighth or ninth day, after sweating or purging, if the pulse remains flooding and rapid, eyes are red like fire, five-center heat is present, and there is狂叫 (wild shouting) and desire to run, San Huang Shi Gao Tang (Three Yellows and Gypsum Decoction) is the primary formula.
On the fifth or sixth day, if only the head sweats, the body has no sweat, sweat stops at the neck, urination is normal, and there is thirst desiring fluids, this is a blood stasis syndrome. Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) and Tao Ren Cheng Qi Tang (Peach Kernel Order the Qi Decoction) are indicated. Assess upper and lower deficiency/excess: use Xi Jiao Di Huang Tang for the upper, Tao Ren Cheng Qi Tang for the middle, and Di Dang Tang/Wan (Di Dang Decoction/Pill) for the lower.
On the sixth or seventh day, without other clashing syndromes, if sudden unconsciousness occurs, and all six pulses are quiet or absent, this indicates impending sweating; do not purge. It is like rain coming after a long drought; after the rain, all things revive, which is an auspicious sign of restoring yang.
Currently, people treat cold damage within one or two days without distinguishing deficiency or excess, using Gui Zhi Tang (Cinnamon Twig Decoction) to induce sweating. Within three to five days, without distinguishing exterior or interior, they use Cheng Qi Tang to purge. This often leads to dual deficiency of interior and exterior, with various complications arising. Generally, patients differ in deficiency/excess and exterior/interior, so pathogen transmission varies. One cannot rely solely on the number of days. Some transmit immediately, some stop after one or two meridians, some remain in one meridian throughout. One should not rigidly adhere to the notion that it starts in Taiyang and ends in Jueyin.
Cold damage studies do not exceed Zhang Zhongjing's works, but the text is profound and not easily understood by shallow learners. Moreover, much is missing; Jin dynasty editors compiled the complete work, yet 40-50% remains obscure. Without grasping the core principles, it is difficult to penetrate its mysteries, leading to confusion in clinical practice. One must aim precisely before treating, fearing that critical conditions may not be saved. Since one cannot refuse to treat, nor act negligently, these few points are prepared for emergencies, though not necessarily favored by erudite physicians. (Above briefly cites Mr. Li Dongyuan.)