黄帝曰∶今夫热病者，皆伤寒之类也，岐伯曰∶人之伤于寒也，则为热病。巨阳受之，头
项痛腰背强；阳明受之，身热目疼鼻干不得卧；少阳受之，胸痛而耳聋。三阳经络皆受其
病，而未入于脏者，故可汗而已。此言三阳经表症未入于里，故可发汗而已者。又曰∶太阴
受之，腹满而咽干；少阴受之，口燥舌干而渴；厥阴受之，烦满而囊缩；三阴三阳、五脏六
腑皆受病，营卫不行、脏腑不通则死矣。此言阳邪传入三阴经而不愈者。又曰∶未满三日，
可汗之；其满三日者，可泄之。言未满三日者，非拘日数，言表症在前也∶言满三日者，亦
不拘日数，言里症在后也。按此乃是伤寒传经之阳症，非言寒中三阴不发热之纯阴症也。仲
景于是补《内经》之缺，作《伤寒论》，阐发寒邪能伤阳经，而为传经热病；岂寒邪反不能伤阴
经。而为直中阴经之阴症乎？于是详列六经，其各条下注明证形脉治，分别某者为表，某者
为里，某者为传经之热病，某者为直中阴经之寒病，而同以伤寒论命名。故将冬月及令之正
伤寒立论，而主发表用，麻黄汤、桂枝汤，攻里用三乙承气汤，其表里兼见之症，用小柴
胡汤双解和解。惟有冬月正伤寒治法，而不及春夏秋三时之症。然其中默示，据寒悟热，据
冬悟夏，据长沙之地以悟南方。其发表攻里，各因其症，寒热温凉，各随其时，察老少，辨
强弱，分别方宜，比例推详，以冬月伤寒，未始不可广推春温夏热之症。不明此旨者，因见
《伤寒论》以阴症阳症同卷，遂以阴症阳症混而施治。即明识阴阳者，又以仲景冬月北方之
麻黄、桂枝汤，妄治春夏秋三时南方之，人以致热病误用温热，变症百出。或以表邪不散，
邪汗未出，烦躁不宁，误认里热烦躁，反用寒凉，遂至表邪不出。幸陶节庵、王宇泰发明仲
景阴症阳症各是一条。然于《伤寒论》原注中差误诸条，尚未改注明白。又于麻黄、桂枝汤
下，不详注此方乃是治河北长沙等处者，江浙地方即冬月亦宜详审。又不注明直中阴经之
寒症，惟北方冬月有之，江浙东南，患此绝少。今东南所患之病，皆是早晚感冒风露，郁而
发热，无汗恶寒，此乃是非时暴感之伤寒，从外而得，未有里热之寒热病也。故用败毒散、
羌活防风汤辛温散表，不宜骤用苦寒。另有积热在内，外被寒邪所束，新寒而凝故热，遂
发有表复有里之症。是以外见发热汗出，内兼喘呕作渴者，在春谓之风温，夏秋谓之暑热，
此乃是热令时静而得之，有表邪之中暑寒热病也。宜用双解散、羌活冲和汤等散表清热。
兼有食滞中焦，用保和平胃散消食和胃。又有积热在内，不冒寒邪外束，并无恶寒身痛、头
痛腰痛、足冷拘紧、不能转侧之表症、但见唇焦口渴、烦躁引饮、多汗恶热、谵语便闭、里
热之证，此乃是热令时动而得之，无表邪之中热瘅热病也。宜用白虎汤、凉膈散、三黄巨胜
汤、导赤各半汤∶有下症者，三乙承气汤。明此三条，则治表邪之热病，治里邪之热病，治
有表邪复有里邪之热病，井井不乱矣。
黄帝说：如今的热病，都属于伤寒的范畴。岐伯说：人受寒邪侵袭，就会发生热病。太阳经受邪，出现头痛、项强、腰背僵硬；阳明经受邪，出现身热、目痛、鼻干、不能安卧；少阳经受邪，出现胸痛、耳聋。三阳经的经络都受到病邪影响，但病邪尚未传入内脏，所以可以通过发汗的方法治愈。这是说三阳经的表证尚未入里，因此可以只用发汗法治疗。又说：太阴经受邪，出现腹部胀满、咽喉干燥；少阴经受邪，出现口燥、舌干而渴；厥阴经受邪，出现心烦腹满、阴囊收缩。如果三阴三阳、五脏六腑都受到病邪侵害，导致营卫之气运行停滞、脏腑气机不通，那么病人就会死亡。这是说阳邪传入三阴经且病情未愈的情况。又说：病程未满三天，可以用发汗法；病程已满三天，可以用泄下法。说“未满三天”，并非拘泥于具体的天数，而是指表证仍在前面；说“已满三天”，也并非拘泥于天数，而是指里证出现在后面。按照这种说法，这指的是伤寒传经过程中的阳证，并不是指寒邪直中三阴经而不发热的纯阴证。张仲景为了补充《内经》的不足，撰写了《伤寒论》，阐发了寒邪能伤害阳经并导致传经性热病的道理；难道寒邪反而不能伤害阴经，导致直中阴经的阴证吗？于是详细列出了六经辨证，在各条下面注明症状、脉象和治法，分别指出哪些属于表证，哪些属于里证，哪些属于传经的热病，哪些属于直中阴经的寒病，但统一以《伤寒论》命名。因此，主要论述冬季及当令的正统伤寒，发表（解表）使用麻黄汤、桂枝汤，攻里（泻下）使用三乙承气汤，对于表里同见的症状，使用小柴胡汤进行和解。只有冬季正统伤寒的治疗方法，而没有涉及春、夏、秋三个季节的症状。然而其中隐含的道理是，根据寒悟出热，根据冬天悟出夏天，根据长沙的气候悟出南方的气候。发表和攻里，各自依据症状而定；寒、热、温、凉，各自顺应时节而定；观察病人的老少，辨别体质的强弱，分别适宜使用的方药，通过类比推理详细说明，以冬季伤寒为基础，未尝不可以推广到春温、夏热的病症。不明白这一主旨的人，因为看到《伤寒论》将阴证和阳证合在一卷中，于是将阴证和阳证混淆施治。即使是明辨阴阳的人，又错误地用张仲景在冬季北方所用的麻黄汤、桂枝汤，去治疗春夏秋季南方的人，导致热病患者误用温热药物，变证百出。或者因为表邪未散，邪气未能通过汗液排出，出现烦躁不宁，误认为是里热烦躁，反而使用寒凉药物，导致表邪更加无法外出。幸好陶节庵、王宇泰阐明了张仲景的阴证和阳证各是一条独立的体系。然而对于《伤寒论》原注中存在的差错和遗漏的各条内容，尚未修改并注明清楚。又在麻黄汤、桂枝汤之下，没有详细注明这些方剂是治疗河北、长沙等地的，江浙地区即使在冬季也应当仔细审察。又不注明直中阴经的寒证，只有北方冬季才有，江浙东南地区患此病极少。如今东南地区所患的疾病，都是早晚感受风露，郁结而发热，无汗恶寒，这是非时暴感（不时令之邪）引起的伤寒，从外部获得，没有里热的寒热病。所以使用败毒散、羌活防风汤等辛温药物发散表邪，不宜突然使用苦寒药物。另有积热在内，外部被寒邪束缚，新感寒邪凝滞故而生热，于是出现既有表证又有里证的病症。因此外在表现为发热汗出，内在兼有气喘、呕吐、口渴，在春季称为风温，夏秋季节称为暑热，这是在炎热季节静处所得的，属于有表邪的中暑寒热病。宜使用双解散、羌活冲和汤等发散表邪、清除内热。兼有食积停滞在中焦，使用保和平胃散消食和胃。又有积热在内，没有外感寒邪束缚，并没有恶寒、身痛、头痛腰痛、脚冷拘紧、不能转侧等表证，只见到嘴唇焦裂、口渴、烦躁引饮、多汗恶热、胡言乱语、大便闭塞等里热证候，这是在炎热季节活动所得的，没有表邪的中热、瘅热病。宜使用白虎汤、凉膈散、三黄巨胜汤、导赤各半汤；有可下之症的，使用三乙承气汤。明白这三条原则，那么治疗表邪的热病、治疗里邪的热病、治疗既有表邪又有里邪的热病，就能条理清晰、不乱矣。
Huangdi said: "Currently, all febrile diseases belong to the category of Shanghan (Cold Damage)." Qibo replied: "When humans are injured by cold pathogens, they develop febrile diseases." When the Taiyang meridian (Greater Yang) is affected, there is pain in the head and neck, and stiffness in the waist and back. When the Yangming meridian (Yang Brightness) is affected, there is body heat, eye pain, dry nose, and inability to lie down. When the Shaoyang meridian (Lesser Yang) is affected, there is chest pain and deafness. If the meridians of the Three Yang are all affected by disease, but the pathogen has not yet entered the Zang organs, it can be cured by sweating (diaphoresis). This refers to the exterior syndromes of the Three Yang meridians that have not yet entered the interior; therefore, only diaphoresis is needed. It is also said: When the Taiyin meridian (Greater Yin) is affected, there is abdominal fullness and dry throat. When the Shaoyin meridian (Lesser Yin) is affected, there is dry mouth, dry tongue, and thirst. When the Jueyin meridian (Terminal Yin) is affected, there is vexation and abdominal fullness, and contraction of the scrotum. If the Three Yin and Three Yang, as well as the Five Zang and Six Fu organs, are all diseased, leading to the stagnation of Ying and Wei (Defensive and Nutritive Qi) and the blockage of the Zang and Fu organs, death will ensue. This refers to the situation where Yang pathogens transmit into the Three Yin meridians and the condition does not resolve. It is also said: If the duration is less than three days, sweating may be used; if the duration is more than three days, purgation may be used. Saying "less than three days" does not rigidly adhere to the number of days, but indicates that the exterior syndrome is still present; saying "more than three days" also does not rigidly adhere to the number of days, but indicates that the interior syndrome follows. According to this, these refer to the Yang syndromes of the transmission of Shanghan, not the pure Yin syndromes where cold directly invades the Three Yin meridians without fever. Zhang Zhongjing, in order to supplement the deficiencies of the *Neijing* (Inner Canon), wrote the *Shanghan Lun* (Treatise on Cold Damage), elucidating that cold pathogens can injure the Yang meridians and cause transmitted febrile diseases; how could it be that cold pathogens cannot injure the Yin meridians and cause direct invasion Yin syndromes? Thus, he detailed the Six Meridians, noting the symptoms, pulse, and treatment under each clause, distinguishing which are exterior, which are interior, which are transmitted febrile diseases, and which are cold diseases from direct invasion of the Yin meridians, yet naming them all under *Shanghan Lun*. Therefore, he established the theory for Zheng Shanghan (True Shanghan) of winter and the season, using Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction) for releasing the exterior, Sanyichengqi Tang (Three Yi Chengqi Decoction) for attacking the interior, and Xiaochaihu Tang (Minor Bupleurum Decoction) for harmonizing and resolving both exterior and interior when both are present. There were only the treatment methods for winter True Shanghan, without mentioning the syndromes of spring, summer, and autumn. However, the implicit meaning within is to understand heat from cold, summer from winter, and the climate of Nanfang (the South) from Changsha. Releasing the exterior and attacking the interior should be based on the syndrome; cold, heat, warmth, and coolness should follow the season; observing the young and old, distinguishing strong and weak constitutions, selecting appropriate formulas through analogy and detailed reasoning, one can extend the treatment of winter Shanghan to cover Spring Warmth and Summer Heat syndromes. Those who do not understand this principle, seeing that Yin and Yang syndromes are in the same volume of *Shanghan Lun*, treat Yin and Yang syndromes indiscriminately. Even those who clearly distinguish Yin and Yang mistakenly use the Mahuang Tang and Guizhi Tang of Zhang Zhongjing, intended for winter in the North, to treat people in the South during spring, summer, and autumn, causing febrile diseases to be wrongly treated with warm-hot substances, resulting in myriad complications. Or, because the exterior pathogen is not dispersed and evil sweat has not emerged, causing restlessness and irritability, they mistakenly recognize this as interior heat restlessness and instead use cold-cool substances, leading to the exterior pathogen remaining trapped. Fortunately, Tao Jian'an and Wang Yutai elucidated that Zhang Zhongjing's Yin and Yang syndromes are separate lines of treatment. However, the errors and omissions in the original notes of *Shanghan Lun* have not yet been corrected and clarified. Furthermore, under Mahuang Tang and Guizhi Tang, it is not detailed that these formulas are for treating places like Hebei and Changsha; even in winter, the Jiangzhe region requires careful examination. Nor is it noted that direct invasion Yin cold syndromes occur mainly in northern winters, while they are extremely rare in the Jiangzhe southeast. The diseases currently prevalent in the southeast are caused by exposure to wind and dew at dawn and dusk, leading to depression and fever, anhidrosis, and aversion to cold. This is Shanghan caused by sudden exposure to non-seasonal pathogens, acquired from the outside, without interior heat. Therefore, Baidu San (Resolving Toxins Powder) and Qianghuo Fangfeng Tang (Notopterygium and Saposhnikovia Decoction) should be used to disperse the exterior with acrid-warm substances, and bitter-cold substances should not be used abruptly. There are cases of accumulated heat inside, bound by external cold pathogens, where new cold condenses existing heat, resulting in syndromes with both exterior and interior manifestations. Externally, there is fever and sweating; internally, there is wheezing, vomiting, and thirst. In spring, this is called Fengwen (Wind-Warmth); in summer and autumn, it is called Shure (Summer-Heat). This is obtained during hot seasons while resting, representing a Zhongshu (Summerheat) febrile disease with exterior pathogen. Shuangjie San (Double Resolution Powder) and Qianghuo Chonghe Tang (Notopterygium Harmonizing Decoction) should be used to disperse the exterior and clear heat. If accompanied by food stagnation in the middle Jiao, Baoping Weisan (Stomach-Pacifying Stomach-Clearing Powder) should be used to digest food and harmonize the stomach. There are also cases of accumulated heat inside, without external cold binding, lacking exterior symptoms such as aversion to cold, body pain, headache, waist and back pain, cold feet, stiffness, and inability to turn over, but presenting with cracked lips, thirst, vexation, desire to drink, profuse sweating, aversion to heat, delirium, and constipation—these are interior heat syndromes. This is obtained during hot seasons through activity, representing a Zhongre (Mid-Heat) or Danre (Blazing-Heat) disease without exterior pathogen. Baihu Tang (White Tiger Decoction), Liangge San (Cooling Diaphragm Powder), Sanhuang Jusheng Tang (Three Yellows Great Victory Decoction), and Daochi Banjie Tang (Half-Half Guide Red Urine Decoction) should be used; if there are indications for purgation, Sanyichengqi Tang should be used. Understanding these three categories allows for the orderly treatment of febrile diseases with exterior pathogens, febrile diseases with interior pathogens, and febrile diseases with both exterior and interior pathogens.