清散外入之火，如薄荷、黄芩、防风、荆芥、连翘、升麻、葛根、黄连、黄柏、大
黄、犀角、羚羊角、柴胡、赤芍药之类，随候采用。
清理中郁之火，如山栀梗、制香附、青黛、青蒿、龙胆草，黄连、黄芩、射干、芦
根、石膏、竹茹、竹叶、兰叶、葛根、连翘之类，随候采用。
滋降下起之虚火，如龟甲、鳖鱼、地黄、丹皮、玄参、麦冬、五味子、地骨皮、
牛膝、黄柏、秋石、童便、人中白之类，随候采用。
温熄肝肾龙雷之火，如黑姜、附子、肉桂、熟地、山茱、丹皮、山药、茯苓、泽
泻、麦冬、牛膝、五味子之类，随候采用。
温养脾胃炉中之火，加人参、黄 、白术、当归、炮姜、附子、补骨脂、炙甘草、
五味子之类，随候采用。
伤寒一症幼科方论甚少，故为总论合参，庶由深而得浅易耳。
仲景曰∶冬时严寒，万类深藏，君子固密，不伤于寒，冒触之者，乃名伤寒。然小
儿之伤寒，与大人无异，所异治者，夹惊而已，但八岁以下无伤寒，不过感冒伤风，故
散利败毒，尤非幼稚所宜也。凡冬日受寒，至春阴与阳气相搏而发，先夏至日者，为病
温，后夏至日者为病暑。惟自霜降以后，春分以前，体中寒邪，杀厉之气，而即壮热头
疼者，方是正伤寒也。复有冬日大温而病，名曰冬温，至三四月或有暴寒卒冷，其时阳
气尚弱，为寒所折，病热则轻，五六月阳气已盛，为寒所折，病热则重，七八月阳气已
衰，为寒所折，病热亦微，此皆时行瘟疫，为类伤寒也，故君子春夏养阳，秋冬养阴，
顺天地之刚柔，冒触之者，其病伏焉。《经》曰∶春伤于风，邪气留连，乃为洞泄。（风气
通肝，肝以春旺，木胜脾土，故洞泄生也。）夏伤于暑，秋为 疟。（夏热已甚，秋阳
复收，阳热相攻，则为 疟， ，老也，亦曰瘦也。）秋伤于湿，上逆而 ，
（秋湿既胜，冬水复旺，水来乘肺，故咳逆病生。）发为痿厥。（湿气内攻则咳逆，
外散筋脉则痿弱。）冬伤于寒，春必温病，（冬寒且凝，春阳气发，寒不为释，
阳怫于中，寒怫相持，故为温病。）其有即发而为病者，谓之伤寒，言其病之原也。《内经》谓
之病热，言其病之候也，盖风则伤卫，寒则伤荣，荣得寒则痛，卫得风则热，风寒一
伤，使人毫毛笔直，皮窍闭而为热，名曰伤寒。始病三日，病传三阳，一二日太阳受
病，其络上连风府，故必身热头疼，腰脊卒强，脉则尺寸俱浮。二三日阳明受病，其脉
起于鼻，络于目，故必鼻干目疼，身热而卧不宁。《经》曰∶胃不和，则卧不安。脉则
尺寸俱长。三四日少阳受病，其脉循胁通耳，故胁痛而耳聋，脉则尺寸俱弦，如脉不
沉细而带数，且犹恶风恶寒，见人藏身，引衣密隐，是为表症，未入于腑，但可取汗而
已。若四五日，尺寸俱沉细者，是太阴受病也。其脉布胃中，络于嗌，故必腹满而嗌
干，脾经壅而成热。五六日少阴受病，尺寸俱沉，其脉贯于肾，络于肺，故必口燥舌干
而渴，至此而热气渐深矣。六七日厥阴受病，尺寸俱缓，其脉循阴器，络于肝，故必
烦满，舌卷囊缩而搐，此热气已尽聚于内，极深极重，阳热既极，阴气消亡，故必出头
露面，扬手掷足，掀衣气粗，口渴烦燥，如有便结等候，宜用大承气汤下之，以承领其
一线之阴，使阴气不尽，为阳所劫，因而得生者多矣。既有下多亡阴之大戒，复有急下
救阴之活法，故曰一二日可发表而散，三匹日宜和解而痊，五六日便实，方可议下，七
八日不解，又复再传，如遇传分不根据日数，或两感等症则又不可一例也。如不两感于
寒，不加异气，则七日太阳病衰，头痛少愈；八日阳明病衰，身热少歇；九日少阳病
衰，耳聋微闻；十日太阴病衰，腹减如故而思饮食；十一日少阴病衰，渴已津生已而能
嚏；十二日厥阴病衰，囊缩自愈，小腹亦
平，其邪皆去，则病患精神自爽也。若至六七日而头痛更甚，此又于太阳传起，以至厥
阴，名曰二候∶若至十三日而病复如是，是谓三候；一候则病，二候病甚，三候病必危
矣。正气内虚，邪气独胜，故热不已也。脉若尺寸俱沉陷者，是属阳亡，必死之候。然
伤寒有合病、有并病，或呕、或痢者，何也？合病者，三阳俱受其邪，脉候皆现，相
协议病，而不传者是也。并病者，如太阳病尚未解，即并与阳明俱病，二阳相并，而共
病是也。然阳气太盛，则里气不宁，因上逆而为呕，或下行而为痢矣。脉若阴阳俱盛而
紧涩者，是伤寒病热未痊之脉也。如再感于寒，则寒热相搏，变为温疟。若阳脉洪数，
阴脉实大，此内外皆热之脉也。如更感温热之气，则又变为温毒。温毒者，表里俱热为
病最重也。然伤寒再经，有阳结，有阴结，阳结者，不大便而能食，其脉浮数者是也。
阴结者，大便秘不能食，其脉沉迟者是也。阳结必于十七日而解，阴结必于十四日而解
者，何也？十七日是传至少阴肾经也。肾为水，阳为火，水制火，故结自解也。十四日
是传至阳明胃也。胃属土，阴为水，土制水，故结自解也。总阳遇阴解，阴遇阳解
耳。然伤寒治法，宜和解。便宜和解，可汗便宜汗之，可下便宜下之，阳盛阴虚，则邪
乘虚而入于里，下之则除其内邪而愈，汗之则竭其津液而死。阴实阳虚，则邪仅客于腠
理，而未能入，汗之则邪自散而愈，下之则邪尽入而凶。亦有身战大汗而解者，是邪与
正争，乃正气胜邪，大汗而解，有不汗不战而解者，因内无津液，故不汗耳，其身必微
痒。若欲解而身反大热者，是邪气远表也。至若热久而不已者，是内亡津液，阴虚不能
退阳。胃虚者，补土以藏阳，阴虚者，养阴而退火，则余热自己也。若在初起一二日
间，又非津液枯少，如连汗三剂而不汗出者，是邪气恣盛，阳不能胜，必成大疾而
死。若谵语狂烦者，是阳症也。其脉浮大者生，沉细者死。又若额上汗多而喘，小便不
利而频，是阳气上逆，阴气下流，而阴阳离矣。如体形不仁，振振恶寒者，是荣卫绝而
阳亡也。如水浆不入者，是胃气绝也。如发热不已，身汗如油，喘不休者，是正气脱而
邪气胜也。此等之症，并决必死。
小儿之伤寒，二三日散得为妙，盖元气未足，不能耐病，如日久深入经络，则搏耗
气血，而成慢惊者有之，或邪气不散，余热不退者有之，或行动不调，变成劳复者有
之，或脾虚饮食不化，为食复者有之，或邪热未退，复感于寒，变疟疾者有之。凡暮热
朝凉为阴虚，若日晡潮热为胃实，盖平旦属少阳，日中属太阳，日晡属阳明，伤寒症
中，日脯潮热为胃实，无虚症耳。
伤寒专祖仲景。凡读仲景书，须将伤寒与中寒分为二门，逐一辨明，庶不使阴阳二
症混乱。夫伤寒治之得其纲领，分以邪正虚实，真假寒热，则治之不难也。若求之多
歧，则支离矣。先以阳症言之，夫既云伤寒，则寒邪自外入内而伤之也。其入则有浅
深次第，自表达里，先皮毛次筋肉，又次筋骨肠胃，此其渐入之势也。风寒之初入，必
先太阳，寒水之经，便有恶风、恶寒、头痛脊痛之症。寒郁皮毛是为表症，脉浮紧无汗
为伤寒，以麻黄汤发之，得汗为解。然邪之所凑，岂有定所，亦不必拘以传毕六经而方
愈也。故仲景立法，言在表发散，在中和解，在里攻下，随其邪之所在而驱散之，不
过使邪热退而正气复行耳。若浮缓有汗为伤风，用桂枝汤散邪，汗止为解。若无头疼恶
寒，脉又不浮，此为表症罢而在中，中者何？表里之间也，乃阳明少阳之分，脉不浮
不沉，在乎肌肉之间，谓皮肤之下也。然有二焉，若微洪而长，即阳明脉也。外证鼻干
不眠，用葛根汤以解肌。脉弦而数，少阳脉也。其症胁痛耳聋，寒热往来而口苦，以小
柴胡汤和之，盖阳明少阳不从标本，从乎中治也。若有一毫恶寒，尚在表也。虽入中还
当兼散邪，过此为邪入里为实热，脉沉实洪数有力，外症不恶风寒而反恶热，谵语大
渴，掀衣气粗，扬手掷足，四肢燥热，身轻易于转侧，六七日不大便；明其热入里而肠
胃燥实也。轻则大柴胡汤，重则二承气汤，大便通而热愈矣。以阴症言之，初起便怕
寒，手足厥冷，或战栗，身静气短少息，目不了了，水浆不入，二便不禁，喜向壁卧，
闭目不欲见人，唇口不红，蜷卧不渴，腹痛腹满，呕吐泄泻，或口出涎沫，面惨息冷，
引衣自隐，身重难于转侧，不发热而脉沉迟，或细数无力，此自阴经受寒，即真阴
症。不从阳经传入热症治例，更当看外症何如，轻则理中汤，重则姜附汤、四逆汤以温
之，不可少缓。《经》所谓∶发热恶寒者，发于阳也。无热恶寒者，发于阴也。此法人
皆知之，至于发热面赤，烦燥，揭去衣被，脉大无力者，人皆不识，认作阳症，误设寒
药，死者多矣。不知阴症不分热与不热，不论脉之浮沉大小，但指下无力，重按全无，
便是伏阴，急与五积散，一服通解表里之寒。若内有沉寒，必须姜附温之。若作热
治，而用凉药，则渴愈甚而躁愈急，岂得生乎？此取脉不取症也。
寒中于表宜汗，寒中于里宜温，盖人之一身，以阳气为主，《经》曰∶阳气者，若
天与日，失其所，则折寿而不彰。寒者，阴惨肃杀之气也。阴盛则阳衰，迨至阳竭阴绝
则死矣。仲景着书，先从伤寒以立论者，诚欲以寒病为纲，而明其例也。其在三阳者，
则用桂麻柴葛之辛温以散之，其在三阴者，非假姜附桂萸之辛热，参术炙草之甘温，则
无以祛其阴冷之邪，而复其若天与日之阳也。诸伤寒湿者，视此皆可以类推为治矣。
何后人不明病情之至理，竟将伤寒立一门，设一局，过求其端，反增其惑，尚异立说，
流散无穷。凡遇病者头疼发热，即谓伤寒，太阳受邪，实非其病，必加是法，默受夭
枉，不可胜数。（张）深悯其厄，谨竭鄙见，有《评伤寒论》一篇，列于一卷之内，痛言
其弊，幸高明鉴诸。
六腑属阳，若阳经受寒，邪先发于太阳。五脏属阴，若阴经受寒，邪必发于太
阴。阳经发病，必先除表清利邪热，六七日后愈；阴经发病，必须温托，扶正却邪。脏
病无泻法，二七后乃愈，故伤寒者，由皮毛而后入脏腑，初虽恶寒发热，而终为热症，
其人必素有火者。中寒者，直入脏腑，始终恶寒，而并无发热等症，其人必无火者。一
则发表攻里，一则温中散寒，两门判然明白，何至混杂于中，而使后人疑误耶？然相
传拘于七日者，盖以五脏之传，十二时奇而传一经，则七日始能传遍也。况天地之气，
七日来复，人之胃气，亦从七日复也。
太阳经表之表也，行身之背；阳明经，表之里也，行身之前；少阳经，半表半里
也，行乎两胁之旁。过此则少阴、太阴、厥阴，其入脏而为里。凡伤寒温病初发，邪在
于表，必头疼身热，病属三阳，即于此时急表散之，如冬月即病，宜用辛温、辛热以汗
之；春温夏热，宜用辛凉辛寒甘寒以汗之。汗后身凉脉静，无所伤犯，病不复作而愈。
如投药濡滞，或病重药轻，不散之于表，致邪热内结，病属三阴，须下乃愈。内虚之
人，不胜下药，多致危殆。种种难治，皆失于不早散也。
中寒之症，身强口噤，眩运无汗，或自汗者，腠理素虚而阳微也。伤寒发热，中寒
不发热，以此为异，盖阳动阴静，阴寒既郁而成热，遂从乎阳，传变不一，靡有定方。
不热者，阴邪一定而不移，则不变也。外寒所受皆同，惟里之有火无火，所以为中为伤
乃异耳。
《医贯》云∶阴毒病者，肾本虚寒，或伤冷物，或感寒邪，或汗后亡阳，以致手足
指甲皆青，腹中绞痛，四肢逆冷，虚汗恍惚，郑声呕吐，倦怠身痛，六脉沉微，或尺
衰寸盛，或沉细而急者，四逆汤、理中汤∶
无脉者，通脉四逆汤；阴毒，甘草汤；脐中葱熨气海、关元，着艾炙之，乃用温和补气
之药，通其内外，以复阳气。若俱不救，死症也，五日内可治，六七日不可治。然阴症
而见阴候，人易知之，至于反常，则不易晓，如发热面赤烦躁，揭去衣被，饮冷脉
大，误认为阳症，投寒药死者多矣。必须凭脉下药，不问浮沉大小，但指下无力，按至
筋骨全无力者，必有伏阴在内，所以逼阳在外，断不可与凉药，所谓阳欲暴脱者，外显
假热也。故读伤寒书而不读东垣书，则内伤不明，而杀人多矣。读丹溪书而不读薛氏
书，则真阴真阳不明，而杀人亦多矣。东垣曰∶邪之所凑，其气必虚。世间内伤者多，
外感者间而有之，此一间字，当作五百年间出之间，甚言其无外感也。东垣《脾胃论》
与夫《内伤外感辨》，深明饥饱劳逸发热等症，俱是内伤，悉类伤寒，切戒汗下，以为
内伤多，外感少，只须温补，不必发散，正气得力，始能推出寒邪。外感多而内伤少，
温补中少加发散。以补中益气汤一方为主。加减出入，如内伤兼伤寒者，以本方加麻
清除散逸于体表的外感火邪，如薄荷、黄芩、防风、荆芥、连翘、升麻、葛根、黄连、黄柏、大黄、犀角、羚羊角、柴胡、赤芍药等药物，根据具体证候选用。
清理中焦郁结的火邪，如山栀梗、制香附、青黛、青蒿、龙胆草、黄连、黄芩、射干、芦根、石膏、竹茹、竹叶、兰叶、葛根、连翘等药物，根据具体证候选用。
滋降下焦升腾的虚火，如龟甲、鳖甲、地黄、丹皮、玄参、麦冬、五味子、地骨皮、牛膝、黄柏、秋石、童便、人中白等药物，根据具体证候选用。
温熄肝肾之龙雷之火（指肾阳虚衰、虚阳上浮之火），如黑姜、附子、肉桂、熟地黄、山茱萸、丹皮、山药、茯苓、泽泻、麦冬、牛膝、五味子等药物，根据具体证候选用。
温养脾胃中的命门之火（指脾胃阳气），加入人参、黄芪、白术、当归、炮姜、附子、补骨脂、炙甘草、五味子等药物，根据具体证候选用。
关于伤寒一症，儿科的方论较少，因此撰写此总论合参，希望能由深奥转为浅显易懂。
张仲景说：冬季严寒，万物深藏，君子注意保暖固密，不伤于寒；若冒犯触犯寒气，才称为伤寒。然而小儿的伤寒，与大人没有不同，所不同的只是治疗时是否兼夹惊风而已。但八岁以下儿童没有真正的伤寒，不过是感冒伤风，所以使用发散、利窍、败毒的方法，尤其不适合年幼稚嫩的孩童。凡是冬日受寒，到春季阴气与阳气相搏而发病，在夏至日之前发的，称为病温；在夏至日之后发的，称为病暑。只有从霜降以后，到春分以前，体内感受寒邪及杀厉之气，立即出现壮热头疼的，才是正伤寒。又有冬日气候大暖而发病的，称为冬温。到了三四月间若有暴寒突然降临，此时阳气尚弱，被寒气折损，发病热度较轻；五六月阳气已盛，被寒气折损，发病热度较重；七八月阳气已衰，被寒气折损，发病热度也轻微。这些都属于时行瘟疫，属于类伤寒范畴。所以君子春夏保养阳气，秋冬保养阴气，顺应天地的刚柔变化，若冒犯触犯寒气，病邪就会潜伏。《内经》说：春伤于风，邪气留连，就会发生洞泄。（风气通于肝，肝在春季旺盛，木气胜脾土，所以产生洞泄。）夏伤于暑，秋季就会发生疟疾。（夏季热气极盛，秋季阳气收敛，阳热相互攻伐，就形成疟疾，“疟”字意为老，也指消瘦。）秋伤于湿，湿气上逆就会咳嗽，（秋季湿气既胜，冬季水气又旺，水来乘肺，所以咳逆病生。）进而发展为痿厥。（湿气内攻则咳逆，外散筋脉则痿弱。）冬伤于寒，春天必定发为温病，（冬季寒气凝结，春季阳气发动，寒气不能解散，阳气郁闭于中，寒邪与郁阳相持，所以形成温病。）那些随即发病的，称为伤寒，是言其病的本源。《内经》称之为病热，是言其病的征候。大概风邪伤卫气，寒邪伤营血，营血得寒则痛，卫气得风则热，风寒一旦伤人，使人毫毛竖立，皮肤毛孔闭塞而发热，称为伤寒。初病三日，病邪传入三阳经。一二日太阳经受病，其络脉上连风府，所以必然身热头疼，腰脊突然僵硬，脉象尺寸俱浮。二三日阳明经受病，其脉起于鼻，联络于目，所以必然鼻干眼痛，身热且卧睡不宁。《经》说：胃不和，则卧不安。脉象尺寸俱长。三四日少阳经受病，其脉循行胁肋通达耳部，所以胁痛耳聋，脉象尺寸俱弦。如果脉不沉细而带数，且仍然恶风恶寒，见人就想躲藏，拉衣严密隐蔽，这是表证，未入于腑，只可取汗解表而已。若四五日，尺寸脉俱沉细，这是太阴经受病。其脉布散胃中，联络咽喉，所以必然腹满咽干，脾经壅滞而成热。五六日少阴经受病，尺寸脉俱沉，其脉贯肾络肺，所以必然口燥舌干而渴，至此热气渐深。六七日厥阴经受病，尺寸脉俱缓，其脉循行阴器，联络肝脏，所以必然烦闷胀满，舌卷囊缩并抽搐，这是热气已完全聚积于内，极深极重，阳热至极，阴气消亡，所以必然露出头面，扬手掷足，掀衣气粗，口渴烦躁，好像有大便干结等待排出，宜用大承气汤攻下，以承接引领那一线残存的阴气，使阴气不被阳气劫夺，因而得以生存者很多。既然有“下法过多会亡阴”的大戒，又有“急下以救阴”的活法，所以说一二日可发表散邪，三日后宜和解痊愈，五六日大便结实，方可议用下法，七八日不解，又再次传变，如果遇到传经不按日数，或两感伤寒等症，则不可一概而论。如果不两感于寒，不加杂气，那么七日太阳病衰，头痛稍减；八日阳明病衰，身热稍歇；九日少阳病衰，耳聋微能听见；十日太阴病衰，腹部减除如常而思饮食；十一日少阴病衰，口渴已止津液生出并能打喷嚏；十二日厥阴病衰，囊缩自愈，小腹亦平，邪气皆去，病患精神自然清爽。若至六七日头痛更甚，这又是从太阳传起，直至厥阴，称为二候；若至十三日病仍如此，称为三候；一候则病，二候病重，三候病必危矣。正气内虚，邪气独盛，所以热势不退。脉若尺寸俱沉陷，这是阳气亡脱，必死的征候。然而伤寒有合病、并病，或有呕吐、或痢疾的，为什么呢？合病，是三阳经同时受邪，脉候都显现，商议诊断病情，而不传变的是合病。并病，如太阳病尚未解除，即合并阳明经一起生病，二阳相并，共同患病就是并病。然而阳气太盛，则里气不宁，因而上逆而为呕吐，或下行而为痢疾。脉若阴阳俱盛而紧涩，是伤寒病热未愈的脉象。如果再感于寒，则寒热相搏，变为温疟。若阳脉洪数，阴脉实大，这是内外皆热的脉象。如果更感温热之气，则又变为温毒。温毒，是表里俱热，为病最重。然而伤寒再经，有阳结，有阴结。阳结，是大便不通但能进食，脉象浮数是阳结。阴结，是大便秘结不能进食，脉象沉迟是阴结。阳结必在十七日而解，阴结必在十四日而解，为什么呢？十七日是病邪传至少阴肾经。肾属水，阳属火，水制火，所以结自解。十四日是病邪传至阳明胃。胃属土，阴属水，土制水，所以结自解。总之是阳遇阴解，阴遇阳解罢了。然而伤寒治法，宜和解。便宜和解则和解，可汗则汗，可下则下。阳盛阴虚，则邪乘虚而入于里，下之则除其内邪而愈，汗之则竭其津液而死。阴实阳虚，则邪仅客于腠理，而未能深入，汗之则邪自散而愈，下之则邪尽入而凶险。也有身体战栗大汗而解的，是邪气与正气相争，乃正气胜邪，大汗而解；有不汗不战而解的，因内无津液，故不出汗，其身必微痒。若想解表而身体反而大热的，是邪气远表。至于热久而不已的，是内亡津液，阴虚不能退阳。胃虚者，补土以藏阳；阴虚者，养阴而退火，则余热自除。若在初起一二日间，又不是津液枯少，如连服三剂发汗药而不汗出，是邪气恣盛，阳气不能胜邪，必成大疾而死。若谵语狂烦，是阳症。其脉浮大者生，沉细者死。又如额上汗多而喘，小便不利而频，是阳气上逆，阴气下流，而阴阳离决。如体形麻木不仁，振振恶寒，是营卫绝而阳亡。如水浆不入，是胃气绝。如发热不已，身汗如油，喘不休，是正气脱而邪气胜。此类病症，均判断为必死。
小儿的伤寒，二三日散邪为妙，因为元气未足，不能耐病，如日久深入经络，则搏耗气血，而成慢惊风的有之；或邪气不散，余热不退的有之；或行动不调，变成劳复的有之；或脾虚饮食不化，为食复的有之；或邪热未退，复感于寒，变疟疾的有之。凡暮热朝凉为阴虚，若日晡潮热为胃实。盖平旦属少阳，日中属太阳，日晡属阳明，伤寒症中，日晡潮热为胃实，无虚症。
伤寒专门宗法张仲景。凡读仲景书，须将伤寒与中寒分为两门，逐一辨明，才能使阴阳二症不混乱。夫伤寒治之得其纲领，分以邪正虚实、真假寒热，则治之不难。若求之多歧，则支离破碎。先以阳症言之，既然叫伤寒，则是寒邪自外入内而伤之。其入则有深浅次第，自表达里，先皮毛次筋肉，又次筋骨肠胃，这是逐渐深入的趋势。风寒之初入，必先太阳，寒水之经，便有恶风、恶寒、头痛脊痛之症。寒郁皮毛是为表症，脉浮紧无汗为伤寒，用麻黄汤发汗，得汗为解。然而邪气所凑，岂有定所，也不必拘泥于传遍六经才愈。所以仲景立法，言在表发散，在中和解，在里攻下，随其邪之所在而驱散之，不过是使邪热退而正气复行罢了。若浮缓有汗为伤风，用桂枝汤散邪，汗止为解。若无头疼恶寒，脉又不浮，此为表症罢而在中，中者何？表里之间也，乃阳明少阳之分，脉不浮不沉，在乎肌肉之间，谓皮肤之下。然有二种情况，若微洪而长，即阳明脉也。外证鼻干不眠，用葛根汤以解肌。脉弦而数，少阳脉也。其症胁痛耳聋，寒热往来而口苦，用小柴胡汤和之，盖阳明少阳不从标本，从乎中治也。若有一毫恶寒，尚在表也。虽入中还当兼散邪，过此为邪入里为实热，脉沉实洪数有力，外症不恶风寒而反恶热，谵语大渴，掀衣气粗，扬手掷足，四肢燥热，身轻易于转侧，六七日不大便；明了其热入里而肠胃燥实。轻则大柴胡汤，重则二承气汤，大便通而热愈矣。以阴症言之，初起便怕寒，手足厥冷，或战栗，身静气短少息，目不了了，水浆不入，二便不禁，喜向壁卧，闭目不欲见人，唇口不红，蜷卧不渴，腹痛腹满，呕吐泄泻，或口出涎沫，面惨息冷，引衣自隐，身重难于转侧，不发热而脉沉迟，或细数无力，此自阴经受寒，即真阴症。不从阳经传入热症治例，更当看外症何如，轻则理中汤，重则姜附汤、四逆汤以温之，不可稍缓。《经》所谓：发热恶寒者，发于阳也。无热恶寒者，发于阴也。此法人皆知之，至于发热面赤，烦躁，揭去衣被，脉大无力者，人皆不识，认作阳症，误设寒药，死者多矣。不知阴症不分热与不热，不论脉之浮沉大小，但指下无力，重按全无，便是伏阴，急与五积散，一服通解表里之寒。若内有沉寒，必须姜附温之。若作热治，而用凉药，则渴愈甚而躁愈急，岂得生乎？此取脉不取症也。
寒中于表宜汗，寒中于里宜温，盖人之一身，以阳气为主，《经》曰：阳气者，若天与日，失其所，则折寿而不彰。寒者，阴惨肃杀之气也。阴盛则阳衰，迨至阳竭阴绝则死矣。仲景着书，先从伤寒以立论者，诚欲以寒病为纲，而明其例也。其在三阳者，则用桂麻柴葛之辛温以散之，其在三阴者，非假姜附桂萸之辛热，参术炙草之甘温，则无以祛其阴冷之邪，而复其若天与日之阳也。诸伤寒湿者，视此皆可以类推为治矣。何后人不明病情之至理，竟将伤寒立一门，设一局，过求其端，反增其惑，尚异立说，流散无穷。凡遇病者头疼发热，即谓伤寒，太阳受邪，实非其病，必加是法，默受夭枉，不可胜数。（冯）深悯其厄，谨竭鄙见，有《评伤寒论》一篇，列于一卷之内，痛言其弊，幸高明鉴诸。
六腑属阳，若阳经受寒，邪先发于太阳。五脏属阴，若阴经受寒，邪必发于太阴。阳经发病，必先除表清利邪热，六七日后愈；阴经发病，必须温托，扶正却邪。脏病无泻法，二七后乃愈，故伤寒者，由皮毛而后入脏腑，初虽恶寒发热，而终为热症，其人必素有火者。中寒者，直入脏腑，始终恶寒，而并无发热等症，其人必无火者。一则发表攻里，一则温中散寒，两门判然明白，何至混杂于中，而使后人疑误耶？然相传拘于七日者，盖以五脏之传，十二时奇而传一经，则七日始能传遍也。况天地之气，七日来复，人之胃气，亦从七日复也。
太阳经表之表也，行身之背；阳明经，表之里也，行身之前；少阳经，半表半里也，行乎两胁之旁。过此则少阴、太阴、厥阴，其入脏而为里。凡伤寒温病初发，邪在于表，必头疼身热，病属三阳，即于此时急表散之，如冬月即病，宜用辛温、辛热以汗之；春温夏热，宜用辛凉辛寒甘寒以汗之。汗后身凉脉静，无所伤犯，病不复作而愈。如投药濡滞，或病重药轻，不散之于表，致邪热内结，病属三阴，须下乃愈。内虚之人，不胜下药，多致危殆。种种难治，皆失于不早散也。
中寒之症，身强口噤，眩运无汗，或自汗者，腠理素虚而阳微也。伤寒发热，中寒不发热，以此为异，盖阳动阴静，阴寒既郁而成热，遂从乎阳，传变不一，靡有定方。不热者，阴邪一定而不移，则不变也。外寒所受皆同，惟里之有火无火，所以为中为伤乃异耳。
《医贯》说：阴毒病者，肾本虚寒，或伤冷物，或感寒邪，或汗后亡阳，以致手足指甲皆青，腹中绞痛，四肢逆冷，虚汗恍惚，郑声呕吐，倦怠身痛，六脉沉微，或尺衰寸盛，或沉细而急者，用四逆汤、理中汤；无脉者，用通脉四逆汤；阴毒，用甘草汤；脐中葱熨气海、关元，着艾炙之，乃用温和补气之药，通其内外，以复阳气。若俱不救，死症也，五日内可治，六七日不可治。然阴症而见阴候，人易知之，至于反常，则不易晓，如发热面赤烦躁，揭去衣被，饮冷脉大，误认为阳症，投寒药死者多矣。必须凭脉下药，不问浮沉大小，但指下无力，按至筋骨全无力者，必有伏阴在内，所以逼阳在外，断不可与凉药，所谓阳欲暴脱者，外显假热也。故读伤寒书而不读东垣书，则内伤不明，而杀人多矣。读丹溪书而不读薛氏书，则真阴真阳不明，而杀人亦多矣。东垣曰：邪之所凑，其气必虚。世间内伤者多，外感者间而有之，此一间字，当作五百年间出之间，甚言其无外感也。东垣《脾胃论》与夫《内伤外感辨》，深明饥饱劳逸发热等症，俱是内伤，悉类伤寒，切戒汗下，以为内伤多，外感少，只须温补，不必发散，正气得力，始能推出寒邪。外感多而内伤少，温补中少加发散。以补中益气汤一方为主。加减出入，如内伤兼伤寒者，以本方加麻
To clear and disperse external fire entering from the exterior, such as Bohe (Menthae Haplocalycis Herba), Huangqin (Scutellariae Radix), Fangfeng (Saposhnikoviae Radix), Jingjie (Schizonepetae Spica), Lianqiao (Forsythiae Fructus), Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Lobatae Radix), Huanglian (Coptidis Rhizoma), Huangbai (Phellodendri Cortex), Dahuang (Rhei Radix et Rhizoma), Xijiao (Rhinoceoris Cornu), Lingyangjiao (Saiga Tataricae Cornu), Chaihu (Bupleuri Radix), Chi Shaoyao (Paeoniae Radix Rubra) etc., select according to the syndrome.
To clear and resolve middle jiao stagnant fire, such as Shanzhi Geng (Gardeniae Caulis), Zhi Xiangfu (Cyperi Rhizoma Preparatum), Qingdai (Indigo Naturalis), Qinghao (Artemisiae Annuae Herba), Longdancao (Gentianae Radix), Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Shegan (Belamcandae Rhizoma), Lugeng (Phragmitis Rhizoma), Shigao (Gypsum Fibrosum), Zhuru (Bambusae Caulis in Taedia), Zhuye (Bambusae Folium), Lanye (Magnoliae Flos - *Note: Context implies Magnolia or similar aromatic herb, literal translation used*), Gegen (Puerariae Lobatae Radix), Lianqiao (Forsythiae Fructus) etc., select according to the syndrome.
To nourish and descend deficiency fire rising from the lower jiao, such as Guijia (Testudinis Carapax et Plastrum), Biejia (Trionycis Carapax), Dihuang (Rehmanniae Radix), Danpi (Moutan Cortex), Xuanshen (Scrophulariae Radix), Maidong (Ophiopogonis Radix), Wuweizi (Schisandrae Fructus), Digupi (Lycii Cortex), Niuxi (Achyranthis Bidentatae Radix), Huangbai (Phellodendri Cortex), Qiushi (Urina Pueri Cocta - *Prepared urine of young boy*), Tongbian (Urina Pueri - *Urine of young boy*), Renzhongbai (Natrii Ureatis Depuratus) etc., select according to the syndrome.
To warm and extinguish the Dragon and Thunder fire of the Liver and Kidney (referring to floating Yang due to Kidney Yang deficiency), such as Heijiang (Zingiberis Rhizoma Carbonisatus), Fuzi (Aconiti Lateralis Radix Praeparata), Rougui (Cinnamomi Cortex), Shudi (Rehmanniae Radix Preparata), Shanzhuyu (Corni Fructus), Danpi (Moutan Cortex), Shanyao (Dioscoreae Rhizoma), Fuling (Poria), Zexie (Alismatis Rhizoma), Maidong (Ophiopogonis Radix), Niuxi (Achyranthis Bidentatae Radix), Wuweizi (Schisandrae Fructus) etc., select according to the syndrome.
To warm and nourish the furnace fire of the Spleen and Stomach (referring to Spleen/Stomach Yang), add Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), Paojiang (Zingiberis Rhizoma Preparatum), Fuzi (Aconiti Lateralis Radix Praeparata), Buguzhi (Psoraleae Fructus), Zhigancao (Glycyrrhizae Radix et Rhizoma Preparatum), Wuweizi (Schisandrae Fructus) etc., select according to the syndrome.
Regarding Shanghan (Cold Damage), there are few formulas and theories in pediatrics, so this general discussion is combined for reference, hoping to make the profound accessible and easy to understand.
Zhang Zhongjing said: In winter, when the cold is severe, all things hide deep. The gentleman keeps himself secure and does not injure himself with cold; those who are exposed and touched by it are named having Shanghan. However, children's Shanghan is no different from adults', except that treatment must consider accompanying fright. But children under eight years old do not have true Shanghan; they only suffer from common colds or wind injury. Therefore, methods of dispersing, draining, and detoxifying are particularly unsuitable for young children. Any cold contracted in winter that erupts in spring when Yin and Yang qi contend is called Bingwen (Warm Disease) if before Summer Solstice, and Bingshu (Summer Heat Disease) if after Summer Solstice. Only when cold pathogenic factors and killing qi are contracted between Frost Descent and Spring Equinox, immediately causing high fever and headache, is it True Shanghan. There is also Winter Warmth, contracted during an unusually warm winter. If sudden cold occurs in March-April when Yang qi is still weak, the resulting heat is mild. If in May-June when Yang qi is abundant, the resulting heat is heavy. If in July-August when Yang qi is declining, the resulting heat is slight. These are all seasonal epidemics belonging to Lei Shanghan (Shanghan-like diseases). Thus, gentlemen nourish Yang in spring and summer, and nourish Yin in autumn and winter, following the rigidity and softness of heaven and earth. Those who are exposed will have latent disease. The Classic says: Wind injuring in spring leads to lingering pathogenic qi, resulting in diarrhea. (Wind qi connects to the Liver, which prospers in spring; Wood overcomes Earth, hence diarrhea arises.) Summer heat injuring in summer leads to malaria in autumn. (Summer heat is extreme, autumn Yang contracts; Yang heat attacks each other, forming malaria. 'Nue' means old, also refers to emaciation.) Dampness injuring in autumn leads to upward reversal and cough. (Autumn dampness prevails, winter Water qi rises; Water overcomes Lung, hence cough and reversal arise.) This develops into flaccidity and cold limbs. (Internal dampness causes cough/reversal; external dispersion causes flaccidity.) Cold injuring in winter leads to Warm Disease in spring. (Winter cold condenses; spring Yang qi emerges. Cold is not released; Yang is blocked inside. Cold and blocked Yang contend, hence Warm Disease arises.) Those who develop illness immediately are called Shanghan, referring to the origin of the disease. The Neijing calls it Bingre (Disease Heat), referring to the symptoms. Generally, Wind injures Wei (Defensive) qi, Cold injures Ying (Nutritive) blood. Ying blood with Cold causes pain; Wei qi with Wind causes heat. Once Wind and Cold injure, hair stands erect, skin pores close, causing heat, named Shanghan. In the first three days, the disease transmits to the Three Yang meridians. On day one or two, Taiyang meridian is affected; its collaterals connect to Fengfu, so there is necessarily body heat, headache, sudden stiffness of waist and spine, and pulse floating at both cun and chi positions. On day two or three, Yangming meridian is affected; its pulse starts at the nose and connects to the eyes, so there is necessarily dry nose, eye pain, body heat, and restless sleep. The Classic says: When the Stomach is disharmonious, sleep is uneasy. Pulse is long at both cun and chi. On day three or four, Shaoyang meridian is affected; its pulse runs through the hypochondrium and reaches the ears, so there is hypochondriac pain and deafness, pulse string-like at both cun and chi. If the pulse is not deep/thin but rapid, and there is still aversion to wind/cold, hiding from people, pulling clothes tightly, this is a Exterior Syndrome, not yet entered the Fu organs, only sweating can resolve it. If on day four or five, pulse is deep and thin at both cun and chi, this is Taiyin meridian affected. Its pulse spreads in the Stomach and connects to the throat, so there is abdominal fullness and dry throat, Spleen meridian congestion generating heat. On day five or six, Shaoyin meridian is affected, pulse deep at both cun and chi. Its pulse penetrates the Kidney and connects to the Lung, so there is dry mouth/tongue and thirst; here heat gradually deepens. On day six or seven, Jueyin meridian is affected, pulse slow at both cun and chi. Its pulse circles the genitalia and connects to the Liver, so there is irritability and fullness, curled tongue, retracted scrotum, and convulsions. Here heat has gathered entirely internally, extremely deep and severe. Extreme Yang heat causes Yin qi to perish, so the patient exposes head/face, throws hands/feet, lifts clothes, breathes roughly, is thirsty and irritable, appearing to have constipation awaiting passage. Da Chengqi Tang should be used to purge, to inherit/lead the remaining thread of Yin qi, preventing Yin from being robbed by Yang, allowing survival. Although there is a major warning against excessive purging leading to Yin loss, there is also the active method of urgent purging to save Yin. Thus, days 1-2 allow exterior release; day 3 allows harmonization and recovery; day 5-6 with solid stool allows consideration of purging; day 7-8 without resolution indicates further transmission. If transmission does not follow days, or in Lianggan (Dual Invasion) cases, rules cannot be applied uniformly. If not Lianggan and no mixed pathogens, on day 7 Taiyang disease declines, headache lessens; day 8 Yangming declines, body heat rests; day 9 Shaoyang declines, hearing slightly returns; day 10 Taiyin declines, abdomen reduces to normal, appetite returns; day 11 Shaoyin declines, thirst stops, fluids generate, sneezing occurs; day 12 Jueyin declines, scrotal retraction heals, lower abdomen flattens, pathogens leave, spirit refreshes. If headache worsens by day 6-7, it transmits from Taiyang to Jueyin, called Second Stage (Er Hou); if still present on day 13, called Third Stage (San Hou). First stage: illness; second stage: worsening; third stage: critical. Internal righteous qi is deficient, pathogenic qi dominates, so heat persists. Pulse deep/sunken at both cun/chi indicates Yang collapse, a death sign. However, Shanghan has Hebing (Combined Disease) and Bingbing (Concurrent Disease), with vomiting or dysentery. Why? Hebing: Three Yang meridians simultaneously affected, pulses manifest, diagnosed together, non-transmitting. Bingbing: e.g., Taiyang unresolved, merging with Yangming, Two Yangs concurrent. Excessive Yang qi disturbs interior, causing upward vomiting or downward dysentery. Pulse surging/full/tight/choppy indicates unresolved heat. Re-exposure to cold causes cold-heat contention, transforming into Wen Nue (Warm Malaria). Yang pulse surging/rapid, Yin pulse solid/large indicates internal/external heat. Further exposure to warm qi transforms into Wendu (Warm Toxin). Wendu is severe, with internal/external heat. Subsequent stages have Yang Jie (Yang Knot) and Yin Jie (Yin Knot). Yang Jie: constipation but able to eat, pulse floating/rapid. Yin Jie: constipation unable to eat, pulse deep/slow. Yang Jie resolves on day 17; Yin Jie on day 14. Why? Day 17 transmits to Shaoyin Kidney. Kidney is Water, Yang is Fire; Water controls Fire, knot resolves. Day 14 transmits to Yangming Stomach. Stomach is Earth, Yin is Water; Earth controls Water, knot resolves. Ultimately, Yang meets Yin to resolve, Yin meets Yang to resolve. Treatment should prioritize harmonization. Harmonize if suitable, sweat if suitable, purge if suitable. Yang excess/Yin deficiency: pathogen enters interior via deficiency. Purging removes internal pathogen; sweating exhausts fluids and causes death. Yin excess/Yang deficiency: pathogen stays in couli (skin/muscle interstices), cannot enter. Sweating disperses pathogen; purging drives pathogen inward, causing disaster. Some resolve with shivering and profuse sweating (Righteous Qi defeats Pathogen). Some resolve without sweating/shivering due to lack of fluids, causing slight itching. If resolving but body becomes very hot, pathogen is distant from surface. Prolonged heat indicates fluid loss, Yin deficiency failing to control Yang. Stomach deficiency: tonify Earth to store Yang. Yin deficiency: nourish Yin to retreat fire, residual heat clears. If early stage (1-2 days) without fluid depletion, and three doses of diaphoretics fail to induce sweat, pathogen is overwhelming, Yang cannot overcome it, leading to fatal illness. Delirium and mania indicate Yang syndrome. Floating/large pulse: survival; deep/thin pulse: death. Sweat on forehead with panting, difficult/frequent urination indicates Yang reversing upward, Yin flowing downward, Yin-Yang separation. Numbness with trembling aversion to cold indicates Ying-Wei collapse and Yang loss. Inability to swallow liquids indicates Stomach Qi collapse. Persistent fever, oily sweat, continuous panting indicates Righteous Qi exhaustion and Pathogen dominance. All these are death signs.
For pediatric Shanghan, dispersing within 2-3 days is ideal, as Yuan Qi is insufficient to withstand disease. Prolonged entry into meridians consumes Qi/Blood, causing Slow Convulsion. Unresolved pathogen leaves residual heat. Disordered movement causes Labor Recurrence. Spleen deficiency with undigested food causes Food Recurrence. Unresolved heat re-exposed to cold causes Malaria. Evening fever/morning coolness indicates Yin deficiency. Afternoon tidal fever indicates Stomach Excess. Dawn belongs to Shaoyang, noon to Taiyang, afternoon to Yangming. In Shanghan, afternoon tidal fever is Stomach Excess, never Deficiency.
Shanghan follows Zhang Zhongjing exclusively. Reading his works requires separating Shanghan and Zhonghan (Direct Cold Injury) into two categories to avoid confusion. Mastering the principles, distinguishing pathogen/righteousness, excess/deficiency, true/false cold/heat makes treatment easy. Seeking too many variations leads to fragmentation. Speaking of Yang syndromes: Cold pathogen enters from exterior to interior. Depth varies: skin -> muscle -> bone/joint -> gut. Wind-Cold first affects Taiyang (Cold-Water meridian), causing aversion to wind/cold, headache, spine pain. Cold stagnating in skin is Exterior Syndrome. Floating/tight pulse without sweat is Shanghan, treated with Mahuang Tang to induce sweat. Pathogens have no fixed location; one need not wait for Six Meridians transmission to complete. Zhongjing's laws: Exterior-dispersing, Middle-harmonizing, Interior-purging, depending on pathogen location, to retreat heat and restore righteousness. Floating/relaxed pulse with sweat is Wind Injury, treated with Guizhi Tang. No headache/aversion to cold, pulse not floating, indicates Exterior resolved, pathogen in Middle (between exterior/interior, Yangming/Shaoyang division). Pulse neither floating nor sunken, in muscles/skin depth. Two types: Mildly surging/long is Yangming pulse. External signs: dry nose, insomnia, treat with Gegen Tang to resolve muscle layer. String-like/rapid is Shaoyang pulse. Signs: hypochondriac pain, deafness, alternating chills/fever, bitter taste, treat with Xiaochaihu Tang to harmonize. Yangming/Shaoyang do not follow standard root/branch, but middle treatment. Any aversion to cold remains in Exterior. Even in Middle, combine dispersing. Beyond this, pathogen enters Interior as Excess Heat. Deep/solid/surging/rapid forceful pulse, no aversion to cold/wind but aversion to heat, delirium, extreme thirst, lifting clothes, rough breathing, throwing limbs, hot extremities, ease of movement, constipation >6-7 days. Heat entered interior, intestines/stomach dry/excess. Mild: Dachaihu Tang. Severe: Er Chengqi Tang. Bowel movement clears heat. Speaking of Yin syndromes: Immediate fear of cold, cold limbs, shivering, quiet/breathless, blurred vision, inability to swallow, incontinence, preference for lying facing wall, closing eyes, red lips absent, curled posture, no thirst, abdominal pain/fullness, vomiting/diarrhea, salivation, pale face, cold breath, hiding, heavy body, no fever, deep/slow or thin/weak pulse. Direct Cold Injury to Yin meridians, True Yin Syndrome. Not transmitted from Yang/Heat. Assess external signs. Mild: Lizhong Tang. Severe: Jiangfu Tang, Sini Tang to warm. Do not delay. Classic: Fever with aversion to cold originates in Yang. No fever with aversion to cold originates in Yin. People know this, but fever/red face/irritability/lifting blankets/large weak pulse is often mistaken for Yang syndrome, treated with cold herbs, causing death. One must not distinguish Yin syndrome by heat presence or pulse size/floating, but by weakness under finger, especially deep pressure indicating hidden Yin. Urgently use Wuji San to resolve exterior/interior cold. Deep cold requires Ginger/Aconite warming. Treating as heat with cooling herbs increases thirst/agitation, leading to death. This prioritizes pulse over symptoms.
Cold in Exterior requires sweating; Cold in Interior requires warming. Yang Qi is master of the body. Classic: Yang Qi is like Heaven and Sun; losing it shortens life. Cold is Yin desolate/killing qi. Yin excess causes Yang decline; Yang exhaustion/Yin termination leads to death. Zhongjing started with Shanghan to establish cold disease as the guideline. For Three Yang, use Xinwen (Acrid-Warm) herbs like Guizhi, Mahuang, Chaihu, Gegen to disperse. For Three Yin, require Xinre (Acrid-Hot) herbs like Jiang, Fuzi, Rougui, Yuzhu, and Ganwen (Sweet-Warm) herbs like Renshen, Baizhu, Zhigancao to dispel Yin-cold and restore Yang. Dampness cases follow this logic. Later generations misunderstood, creating rigid categories, increasing confusion. Headache/fever is often wrongly diagnosed as Shanghan/Taiyang, causing unnecessary deaths. Feng Chu-zhan deeply pities this, offering "Commentary on Shanghan Lun" to expose flaws.
Six Fu organs are Yang; Cold affecting Yang meridians starts in Taiyang. Five Zang organs are Yin; Cold affecting Yin meridians starts in Taiyin. Yang meridian disease: clear exterior/heat first, resolves in 6-7 days. Yin meridian disease: requires warming/supporting righteousness, resolves in 14 days. Shanghan enters from skin to Zang-Fu, initially cold/fever, ultimately heat, patient usually has prior internal heat. Zhonghan enters directly to Zang-Fu, persistent cold, no fever, patient lacks internal heat. One releases exterior/purges interior; one warms middle/scatters cold. They are distinct. Seven-day transmission theory: Five Zangs transmit via Twelve Hours, completing cycle in seven days. Heaven/Earth Qi recurs every seven days; Stomach Qi also recurs.
Taiyang is outermost exterior, runs back. Yangming is inner exterior, runs front. Shaoyang is half-exterior/half-interior, runs sides. Beyond this, Shaoyin, Taiyin, Jueyin enter Zang (Interior). Early Shanghan/Wenbing, pathogen in exterior, headache/fever, Three Yang. Disperse immediately. Winter: Acrid-Warm/Hot to sweat. Spring/Summer: Acrid-Cool/Cold/Sweet-Cold to sweat. Post-sweat cool/pulse calm = cure. Delayed/heavy disease/light medicine causes interior binding, Three Yin disease, requires purging. Interior deficiency cannot tolerate purging, leads to danger. All difficult cases stem from late dispersal.
Zhonghan signs: stiff body, locked jaw, dizziness, no sweat or spontaneous sweat, due to deficient couli and weak Yang. Shanghan has fever; Zhonghan has none. Yang moves, Yin stills. Yin cold stagnating generates heat, transmitting variably. Non-heat indicates stable Yin pathogen. External cold exposure is same; difference lies in internal Fire presence.
Yiguan states: Induo (Yin Toxin) disease: Kidney originally deficient/cold, cold food/pathogen, or post-sweat Yang loss. Blue fingernails, abdominal cramping, cold limbs, sweating/confusion, muttering/vomiting, fatigue/body pain, deep/weak pulse, or weak chi/strong cun, or deep/thin/urgent. Treat with Sini Tang, Lizhong Tang. No pulse: Tongmai Sini Tang. Induo: Gancao Tang. Moxibustion on Qihai/Guanyuan with green onion. Use mild Qi-tonifying herbs to restore Yang. If unresponsive, death. Treatable within 5 days, not after 6-7. Yin signs are known, but atypical signs (fever/red face/irritability/lifting blankets/drinking cold/large pulse) are mistaken for Yang, causing death. Must rely on pulse. Weak/deep pressure indicates hidden Yin forcing Yang outward (false heat). Do not use cooling herbs. Failure to read Dongyuan leads to misunderstanding internal injury. Failure to read Danxi/Xue leads to misunderstanding True Yin/Yang. Dongyuan: Where pathogen gathers, Qi is deficient. Internal injuries are common, external rare. Dongyuan's Piwei Lun clarifies hunger/fullness/fatigue fever as internal injury, resembling Shanghan, forbidding sweating/purging. Tonify warmth, do not disperse. Righteous Qi pushes out cold. For external predominant, add slight dispersal to tonification. Main formula: Buzhong Yiqi Tang. Modifications: Internal injury with Shanghan, add Ma...