钱院使主河间两解之法，利于实热之病，余又续景岳内托之法，利于虚寒之病。正法之
外，得此两法，治伤寒无余蕴矣。
发表无汗病为逆，须审阴阳施补益。阳虚再造散如神，小建中汤生津液。东垣变用益气
汤，只缘饥饱与劳役。又有无汗属阴虚，理阴归柴二方择。若宜凉解归葛煎，阳明温暑及时
疫。阴阳两虚汗最难，大温中饮当考核。仲景驱外是恒经，各家内托亦上策。
李东垣云∶伤寒无内伤者，用仲景法；挟内伤者，十居八九，（劳役饥饱过度谓之内伤）只用补中益气汤加减。又云∶
尺脉迟者，不可发汗，当与小建中汤和之。和之而邪解，设不解，服至尺脉有力，乃与麻黄汤汗之。喻嘉言云∶宜小建
中汤生其津液，津液充，便自汗而愈。陶节庵云∶伤寒服发表药而不作汗，名无阳症。宜再造散助阳以作汗。张景岳云∶
阳根于阴，化于液，从补血而散。此云腾致雨之妙，则犹仲景所未及。观其自制数方，平散如归柴饮，温散如大温中饮
及理阴煎，凉散如归葛饮，皆取邪从营解之义也。仲景重在驱邪，此则重在补正。驱邪是逐之于外，补正是托之于内。
法虽不同，而散寒之意则一也。
再造散
阳虚再造散称奇，附子辛参草桂 。羌活芎防姜枣入，或加芍药水煎之。（人参一钱、
黄二钱、桂枝一钱、甘草五分、附子炮一钱、细辛七分、羌活八分、防风七分、川芎一钱，
煨姜二片、大枣二枚，加芍药一撮，夏加黄芩，石膏用之。）
小建中汤
阳气素虚乏津液，伤寒温补必须急。桂枝倍芍加胶饴，小小建中大有益。（白芍三钱、
桂枝、生姜各一钱五分、炙草一钱，水煎入饴糖三钱拌服。）
补中益气汤
补中益气术归 ，炙草人参与橘皮。姜枣柴升煎水服，六经加味始相宜。（炙 二钱、
人参、白术、当归、炙草各一钱、陈橘皮五分、柴胡、升麻各三分、姜枣水煎服。）
太阳加羌活、 本、桂枝，阳明加葛根、倍升麻，少阳加黄芩、半夏、川芎，倍柴胡。
太阴加枳实、浓朴；少阴加甘草、橘皮；厥阴加川芎；变症发渴，加干葛、元参，倍升麻。
理阴煎
熟地当归炙草姜，理阴煎剂最为良。方中加减须消息，肉桂加之用亦强。（熟地四钱、
当归一钱五分、炙草一钱、干姜一钱五分，水二盅，煎八分服。）
归柴饮
归柴二味及甘草，伤寒平散用之好。大便多溏归易术，还有加减方中讨。（当归一两、
柴胡五钱、炙草八分，水煎服。）
大温中汤
伤寒温散大温中，参术柴胡肉桂同。草地麻黄姜归用，水煎去沫服为功。（熟地五钱、
白术三钱、当归一钱、人参一钱、炙草八分、柴胡一钱、麻黄一钱、肉桂一钱、干姜一钱、
白术二钱水二盅，煎七分，去浮沫，温服或略盖微汗。）
归葛饮
当归干葛两般宜，凉散方中此最奇。煎后好将凉水浸，徐徐服下汗来时。（当归五钱、
干葛二钱，水二盅，煎一盅以冷水浸凉，徐徐服之。）
钱院使推崇刘河间“两解”之法，此法适用于实热性质的病证；我又补充了张景岳的“内托”之法，此法适用于虚寒性质的病证。在正统治法之外，加上这两种方法，治疗伤寒便没有遗漏之处了。
发表（通过发汗解除表邪）后仍无汗出的病症属于逆证，必须审察阴阳虚实来施用补益法。若是阳虚，再造散效果如神；若是津液不足，小建中汤可生津液。李东垣变通使用益气汤，是因为病因与饥饱失调及过度劳役有关。又有因阴虚导致无汗的情况，可从理阴煎或归柴饮中选择。若适宜用凉性解表法，则选用归葛煎，适用于阳明经病、温病及时行疫病。若是阴阳两虚导致难以出汗，应当仔细考核使用大温中饮。张仲景驱除外邪是常规法则，各家提出的内托法也是上策。
李东垣说：伤寒病如果没有内伤因素，使用张仲景的方法；如果夹杂内伤因素，十有八九，（劳役和饮食饥饱过度称为内伤），只需用补中益气汤加减治疗。他又说：尺脉迟者，不可发汗，应当给予小建中汤调和。调和之后如果邪气解除，假设未解除，等到服药至尺脉有力时，再给予麻黄汤发汗。喻嘉言说：宜用小建中汤滋生津液，津液充足，自然出汗而痊愈。陶节庵说：伤寒服用发表药却不作汗出，称为无阳症。宜用再造散助阳以促使汗出。张景岳说：阳气根源于阴，由津液化生，从补血角度发散。这就像云气升腾致雨的奥妙，这是张仲景未曾涉及的。观察他自制的数个方剂，平和疏散的如归柴饮，温性疏散的如大温中饮及理阴煎，凉性疏散的如归葛饮，都是取邪气从营分解散的意义。张仲景重在驱除邪气，这里则重在补益正气。驱邪是将邪气驱逐于体外，补正是将正气托举于体内。治法虽然不同，但散寒的意图是一致的。
【再造散】
阳虚证用再造散称奇效，方含附子、细辛、人参、甘草、桂枝。（加入羌活、川芎、防风、生姜、大枣，或者加芍药用水煎服。）（人参一钱、黄芪二钱、桂枝一钱、甘草五分、炮附子一钱、细辛七分、羌活八分、防风七分、川芎一钱，煨姜两片、大枣二枚，加芍药一撮，夏季加黄芩，石膏酌情使用。）
【小建中汤】
阳气素来虚弱且缺乏津液，伤寒温补必须紧急进行。桂枝加倍芍药并加入饴糖，小小的小建中汤大有益处。（白芍三钱、桂枝、生姜各一钱五分、炙甘草一钱，水煎后加入饴糖三钱拌服。）
【补中益气汤】
补中益气汤含白术、当归，以及炙甘草、人参和陈橘皮。加入生姜、大枣、柴胡、升麻煎水服用，根据六经病变加减始为适宜。（炙黄芪二钱、人参、白术、当归、炙甘草各一钱、陈橘皮五分、柴胡、升麻各三分，生姜大枣水煎服。）
太阳经加羌活、藁本、桂枝；阳明经加葛根、倍用升麻；少阳经加黄芩、半夏、川芎，倍用柴胡。
太阴经加枳实、厚朴；少阴经加甘草、橘皮；厥阴经加川芎；变症出现口渴，加干葛、玄参，倍用升麻。
【理阴煎】
熟地黄、当归、炙甘草、生姜，理阴煎剂最为良善。方中加减须斟酌考量，加入肉桂功效也更强。（熟地黄四钱、当归一钱五分、炙甘草一钱、干姜一钱五分，水两盅，煎至八分服。）
【归柴饮】
当归、柴胡两味药及甘草，伤寒平和疏散用之甚好。大便多溏泄者可将当归换为白术，还有更多加减法在方中探讨。（当归一两、柴胡五钱、炙甘草八分，水煎服。）
【大温中饮】
伤寒温散用大温中饮，含人参、白术、柴胡、肉桂同用。草地（此处指甘草）、麻黄、生姜、当归配合使用，水煎去浮沫服用见效。（熟地黄五钱、白术三钱、当归一钱、人参一钱、炙甘草八分、柴胡一钱、麻黄一钱、肉桂一钱、干姜一钱、白术二钱[注：原文重复列出白术，此处依原文转录]，水两盅，煎至七分，去浮沫，温服或略盖被子微汗。）
【归葛饮】
当归、干葛两者相宜，凉性疏散方中此方最奇妙。煎好后最好用凉水浸泡，徐徐服下，汗来时即愈。（当归五钱、干葛二钱，水两盅，煎至一盅，以冷水浸凉，徐徐服之。）
Qian Yuanshi advocated Liu Hejian's "Liangjie" (Dual Resolution) method, which is suitable for excess-heat conditions; I further supplemented Zhang Jingyue's "Neituo" (Internal Support/Retaining) method, which is suitable for deficiency-cold conditions. Beyond the orthodox methods, with these two additional approaches, there would be no omissions in treating Shanghan (Cold Damage).
When exterior-releasing treatments fail to produce sweating, the condition is considered adverse; one must examine Yin and Yang to apply tonification. For Yang deficiency, Zaizao San (Reconstruction Decoction) is miraculous; for fluid depletion, Xiaojianzhong Tang (Minor Construct the Middle Decoction) generates fluids. Li Dongyuan variably used Yiqi Tang (Qi-Supplementing Decoction), owing to causes related to irregular diet and overexertion. There are also cases of anhidrosis due to Yin deficiency, where one may choose between Liyin Jian (Yin-Nourishing Infusion) or Guichai Yin (Angelica and Bupleurum Decoction). If a cooling exterior-release is appropriate, Guige Jian (Angelica and Pueraria Infusion) should be used, applicable to Yangming disorders, warm diseases, and epidemic febrile diseases. When both Yin and Yang are deficient making sweating difficult, Dawenzhong Yin (Great Warming the Middle Decoction) should be carefully evaluated. Zhang Zhongjing's expulsion of external pathogens is the constant principle, while the internal support methods proposed by various schools are also superior strategies.
Li Dongyuan stated: In Shanghan without internal injury, use Zhang Zhongjing's methods; if complicated by internal injury, which accounts for eight or nine out of ten cases (internal injury refers to excessive exertion and dietary irregularities), only modify Buyuzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). He also said: If the Chi pulse (cun position at the wrist) is slow, do not induce sweating; instead, administer Xiaojianzhong Tang to harmonize. If harmonization resolves the pathogen, good; if not, continue until the Chi pulse becomes forceful, then administer Mahuang Tang (Ephedra Decoction) to induce sweating. Yu Jiayan said: It is appropriate to use Xiaojianzhong Tang to generate fluids; once fluids are sufficient, spontaneous sweating will occur and the patient will recover. Tao Jie'an said: When Shanghan patients take exterior-releasing medicines but do not sweat, it is called "Wu Yang Zheng" (Yang-Deficient Syndrome). Use Zaizao San to assist Yang to produce sweat. Zhang Jingyue said: Yang originates from Yin and transforms from fluids, dispersing through nourishing blood. This resembles the subtle mechanism of clouds rising to bring rain, an aspect Zhang Zhongjing had not fully addressed. Observing his self-formulated prescriptions, such as the mild dispersing Guichai Yin, the warming dispersing Dawenzhong Yin and Liyin Jian, and the cooling dispersing Guige Jian, all aim to resolve pathogens from the Ying (Nutritive) level. Zhang Zhongjing focused on expelling pathogens, whereas this approach focuses on tonifying righteous Qi. Expelling pathogens drives them outward; tonifying righteous Qi supports them inward. Although the methods differ, the intent to disperse cold remains the same.
**Zaizao San (Reconstruction Decoction)**
For Yang deficiency, Zaizao San is praised for its wonder. It contains Fuzi (Prepared Aconite Root), Xixin (Asarum), Renshen (Ginseng), Gancao (Licorice), and Guizhi (Cinnamon Twig). Add Qianghuo (Notopterygium Rhizome), Chuanxiong (Szechwan Lovage Rhizome), Fangfeng (Saposhnikovia Root), Shengjiang (Fresh Ginger), and Dazao (Jujube); alternatively add Shaoyao (Peony Root) and decoct with water. (Renshen 1 qian, Huangqi [Astragalus Root] 2 qian, Guizhi 1 qian, Gancao 5 fen, Paofuzi [Prepared Aconite Root] 1 qian, Xixin 7 fen, Qianghuo 8 fen, Fangfeng 7 fen, Chuanxiong 1 qian, Wei Jiang [Baked Ginger] 2 slices, Dazao 2 pieces, plus a pinch of Shaoyao; add Huangqin [Scutellaria Root] in summer, and Shigao [Gypsum] as needed.)
**Xiaojianzhong Tang (Minor Construct the Middle Decoction)**
When Yang qi is inherently deficient and fluids are lacking, urgent warm tonification is required for Shanghan. Double the dosage of Guizhi relative to Shaoyao and add Yitang (Maltose). The minor Xiaojianzhong Tang yields great benefit. (Baishao [White Peony Root] 3 qian, Guizhi 1.5 qian, Shengjiang 1.5 qian, Zhigancao [Honey-fried Licorice] 1 qian; decoct with water and mix in Yitang 3 qian before taking.)
**Buyuzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction)**
To tonify the middle and augment Qi, use Baizhu (Atractylodes Macrocephala Rhizome), Danggui (Chinese Angelica Root), Zhigancao, Renshen, and Chenpi (Tangerine Peel). Decoct with Shengjiang, Dazao, Chaihu (Bupleurum Root), and Shengma (Cimicifuga Rhizome) in water; modifications based on the Six Channels are most appropriate. (Zhi Huangqi [Honey-fried Astragalus Root] 2 qian, Renshen 1 qian, Baizhu 1 qian, Danggui 1 qian, Zhigancao 1 qian, Chenpi 5 fen, Chaihu 3 fen, Shengma 3 fen; decoct with Shengjiang and Dazao in water.)
Add Qianghuo, Gaoben (Ligusticum Sinense Rhizome), and Guizhi for Taiyang channel involvement; add Gegen (Pueraria Root) and double Shengma for Yangming channel involvement; add Huangqin, Banxia (Pinellia Tuber), and Chuanxiong, doubling Chaihu for Shaoyang channel involvement.
Add Zhishi (Immature Bitter Orange) and Houpo (Magnolia Bark) for Taiyin channel involvement; add Gancao and Chenpi for Shaoyin channel involvement; add Chuanxiong for Jueyin channel involvement. For altered symptoms presenting with thirst, add Gegen and Xuanshen (Scrophularia Root), doubling Shengma.
**Liyin Jian (Yin-Nourishing Infusion)**
Shudihuang (Prepared Rehmannia Root), Danggui, Zhigancao, and Shengjiang constitute Liyin Jian, which is excellent. Modifications within the formula require careful consideration; adding Rougui (Cinnamon Bark) enhances its efficacy. (Shudihuang 4 qian, Danggui 1.5 qian, Zhigancao 1 qian, Ganjiang [Dried Ginger] 1.5 qian; decoct with two zhong of water to yield eight fen, then take.)
**Guichai Yin (Angelica and Bupleurum Decoction)**
Danggui and Chaihu combined with Gancao are good for mild dispersal in Shanghan. If stool is frequently loose, replace Danggui with Baizhu; further modifications can be explored within the formula. (Danggui 1 liang, Chaihu 5 qian, Zhigancao 8 fen; decoct with water and take.)
**Dawenzhong Yin (Great Warming the Middle Decoction)**
For warming dispersal in Shanghan, use Dawenzhong Yin, containing Renshen, Baizhu, Chaihu, and Rougui together. Combine with Gancao, Mahuang (Ephedra Herb), Shengjiang, and Danggui; decoct with water, remove foam, and take for effect. (Shudihuang 5 qian, Baizhu 3 qian, Danggui 1 qian, Renshen 1 qian, Zhigancao 8 fen, Chaihu 1 qian, Mahuang 1 qian, Rougui 1 qian, Ganjiang 1 qian, Baizhu 2 qian [Note: Baizhu listed twice in original]; decoct with two zhong of water to yield seven fen, remove floating foam, take warm, or cover slightly to induce slight sweating.)
**Guige Jian (Angelica and Pueraria Infusion)**
Danggui and Gegen are well-suited together; this is the most remarkable among cooling dispersal formulas. After decocting, immerse in cold water, and take slowly; sweating will occur upon administration. (Danggui 5 qian, Gegen 2 qian; decoct with two zhong of water to yield one zhong, cool with cold water, and take slowly.)