虚烦头身不痛，无汗而脉鲜紧；
虚烦者，七情六欲以致肾水虚，而心火烦躁，或杂病后余热未净而烦，或劳役气衰火旺而烦，或阴虚相火
动而烦。有类伤寒初证，外亦发热，但头身不痛，脉不紧数为异。虽阴虚亦恶寒而不甚，脉亦能数而无力。
大概病后虚羸少气，烦躁欲呕者，竹叶石膏汤；轻者，小柴胡汤。痰逆恶心者，橘皮竹茹汤。阴证内寒外热，
肢节痛，口不燥而虚者，阴旦汤。服凉药后，脉愈大而无力，热愈甚而燥渴者，单人参汤、或人参黄 煎汤下
五苓散。劳役气虚者，补中益气汤。阴虚者，四物汤加知母、黄柏。脾胃弱者，三白汤。惊悸痰盛者，温胆汤。
心神不安者，朱砂安神丸。妇人新产挟血虚烦者，四物汤加人参、淡竹叶、麦门冬、甘草。表虚忌汗，里虚忌
下，但宜平和之剂调理。《千金》云∶虚烦不可太攻，热去则寒起，若用伤寒汗下重剂而治虚烦，重则津竭而
死，轻则内消盗汗，变为痨瘵。伤寒有未经汗吐下而烦者，胸满膈实烦热；有已经汗吐下而烦者，胸满烦躁
懊，见各条。
痰证头项不痛，寒热而寸多浮。
痰者，津液所化，风伤肺，湿伤脾，凝浊而生。外证头项皆和，惟寒热类伤寒耳。初起便胸膈满闷，气
上冲咽，寸浮为异。有热者，参苏饮、金沸草散、柴胡半夏汤；无热者，二陈汤、温胆汤；通用，导痰汤。
有痰结胸者，鹤顶丹、枳梗二陈汤；有痰上攻，非次头疼者，瓜蒂散吐之。
食积心腹满闷，
外证头疼发热恶寒，全类伤寒。惟身不
痛，心腹饱闷，嗳噎呕逆，右脉弦盛为异耳。《百证》云∶头疼而恶心，身不痛者，食积也；头疼而身亦痛者，
伤寒也。食在上脘，胸满恶心欲吐，实者，瓜蒂散吐之；食在中脘，痞胀欲呕，有热者，二陈汤加黄连、生姜、
乌梅，或陶氏平胃散。腹痛欲泻者，胃苓汤；寒者，治中汤；心腹满痛不大便者，大柴胡汤下之。又有夹食伤
寒，谓之太阴积证。表证，藿香正气散，或五积散去当归、麻黄，加人参、苏叶；有表复有里者，桂枝加大黄
汤；表证已罢，但里实满者，小承气汤。凡伤寒下后，六七日不大便，烦热腹满而痛，胃中有宿食故也。若中
寒夹食，即见吐利厥逆霍乱等证，急用理中汤加枳实，或四逆汤救之。凡夹食脾胃已伤，不可轻易汗下。
香港脚膝胫软柔。
脚曰气者，风寒暑湿四气蒸于足，循经入脏之深，而发则以渐，非若四气中人虽浅而骤也。外证全类伤寒，
且有六经传变，一如太阳头疼身热云云，直至厥阴烦满囊拳。又有合、并二病。但初起脚膝软弱顽痹，转筋赤
肿为异耳。如太阳证见外踝循京骨至小指外侧皆痛者，随四气偏胜发散，麻黄汤加防风、羌活、细辛、葛根、
白术、茯苓，防己，或败毒散合槟苏散。阳明证见髀膝外廉下入中指内痛者，随四气偏胜微利，大柴胡汤加羌
活、细辛、杏仁，或升麻葛根汤合槟苏散。少阳证见诸足指节痛者，宜和解，小柴胡汤去参加防风、葛根、细
辛，白术、茯苓、麦门冬、干姜、小草。三阳合病，拘挛便闭者，合前三方加减而服，名左经汤。或专入足太
阴经，证见股膝内廉、足大指端内侧痛或浮肿者，古桂附汤加防己、白术、茯苓。少阴经，证见足小指下连
足心，廉股内痛冲胸不食，面黑溺涩，小腹不仁者，难治，八味丸救之。厥阴经。证见足大指连内廉，脐腹
胀痛，脚挛干呕者，养真丹。如足三阴挛痹缓弱，上攻胸胁肩背，下注脚膝，足心热者，换腿丸。要之，风多
入肝，病筋走注，脉浮无汗，小续命汤加独活。风毒肿痛，排风汤、槟榔散；筋急掣痛，乳香定痛散。湿多入
脾，病肉重着，行起忽倒或肿，除湿汤；痰多者，用此汤吞清州白丸子。暑多入心，病气喘闷烦躁，所患必热，
败毒散加大黄。寒多入肾，病骨挛急掣痛，所患必冷，五积散、越婢汤加木瓜，通用千金续命汤、流气饮子、
乌药顺气散。烦躁者，单竹沥饮之；便闭者，三和散、脾约丸；毒瓦斯冲心作痛者，苏子降气汤下养正丹，或吴
萸煎汤，刺入姜汁救之，死在旦夕。寻常春夏，槟苏散加川楝子，热肿赤者，败毒散加木瓜、苍术；秋冬，
五积散加木瓜、槟榔、牛膝、吴萸。最忌补汤淋洗，草药摊 。其证有因于气，因于饮食及丹石者，不可不知。
瘀血昏忘如狂，胸胁小腹不快；
血乃人身河渠，贵流通而不贵凝滞。或当汗不汗，津液内渗；或不当汗而汗，津液内竭；或利小便过多，
以致血热化为恶瘀；又或其人素有跌扑闪挫、善思善郁、过食煎炒，以致血热瘀滞。蓄于上焦，则衄血善忘，
甚则昏迷，良久乃苏，或胸胁腹皆满痛，谵语昏愦，谓之血结胸证；蓄于中焦，则头汗作渴发黄；蓄于下焦，
则如狂便黑，小腹急结，按之则痛，其脉必芤涩。外证寒热，全类伤寒。太阳证则如狂，阳明证则善忘，少阳
证则寒热似疟。大概治上，犀角地黄汤；治中，桃仁承气汤；治下，抵当汤、丸。然必证重脉数，方可抵当攻
之；证轻脉微，通用犀角地黄汤，加青皮、芩、连、大黄，或小柴胡汤加桃仁、生地兼栀子、茵陈。一切血证，
皆此治法不易。伤寒有用承气大下不解，反便坚善食者，瘀血也。凡病日轻夜重，便是瘀血，所以打扑伤损，
证亦类伤寒。
疮毒饮食如旧，掀发肿痛可求。
凡患痈疽背发疔疮，一切无名肿毒，初起寒热，全类伤寒。但伤寒不食，疮毒饮食如常，且身有红肿
痛处可验。不可妄施汗下，宜外科法治之。俗呼流注伤寒，流者，行也；注者，
住也。血气流行，遇寒邪则凝涩，结如堆核，大者如拳，小者如李，初起寒热，全类伤寒。未溃者，宜败毒散
合凉膈散加金银花；已溃者，托里散，不可作正伤寒治之。俗呼赤膈伤寒，胸膈赤肿疼痛，寒热类伤寒，非正
伤寒也，宜荆防败毒散合小陷胸汤，里实者，防风通圣散。
痘疹尻足当时冷，
凡幼稚及年长之人，忽类伤寒证，如未患痘疹，尻足中指皆冷，宜从痘证初热条治之。
劳发痰火待日周。
素有痰火，略有劳动，便发寒热，全类伤寒。轻者，将息周日自愈；重者，颈腋膊胯之间遂结核肿硬，
或消，下次遇劳又发，治宜八物二陈汤，加降火和解之药。
外感疏泄勿甚，
旧谓伤为中，感冒为伤。今悉分之，正恐人以伤寒重剂而治感冒轻病，变生异证。盖感寒虽亦恶寒面惨，
其头疼发热，不如伤寒之甚，脉多沉迟；感风虽亦恶风鼻塞，其发热等证，亦不如伤风之甚，脉多浮数。大概
未发热者，感寒，香苏散；感风，苏葛汤、古苍荆散。已发热者，九味羌活汤之类热服，肌体微润即愈。寻常体
薄多疾之人，只于原服药中加生姜、陈皮，或寒用二陈汤，风用三白汤加减。详见杂病。
内伤补益兼投。
外感挟内伤者，素冒风寒未发，加之饮食劳倦触动，外证全类伤寒。但左手人迎及关脉，大于右手气口
一二倍，此外感重而内伤轻也，治以九味羌活汤去苍术、生地，用白术，随六经见证加减。如内伤脾胃，外感
寒邪者，藿香正气散、人参养胃汤。如内伤饮食，外感风寒者，平胃散加黄连、枳实；便闭加桃仁、大黄。如内
伤生冷，外感风寒者，五积散。内伤挟外感者，先因饮食劳役过度，身痛腰腿酸软，而其体已解 ，又感冒风
寒，外证全类伤寒。但右手气口及关脉，大于左手人迎一二倍，此内伤重而外感轻也，治以补中益气汤，或调
中益气汤，随六经见证加减。误作伤寒，大发其汗者死。内伤房室，又感风者，玉屏风散，或加桂枝、白芍；
内伤房室，又感寒者，川芎汤。风寒两感者，玉屏风散合川芎汤。体薄者，通用十全大补汤，少加防风、羌活、
细辛、白芷。肢冷者，加姜附。阴虚者，八物汤加陈皮、炒干姜，不可误用风寒燥药，愈亏肾水。内伤虚损，
四肢无力发热，亦类伤寒，但必兼盗汗、遗精、白浊为异，内伤卫虚恶风，荣虚恶寒，亦类伤寒，但居密室则
不恶也。内伤阴虚火动，恶寒非寒，恶热非热，但体清瘦，脉无力为异，内伤大渴体热，脉洪大，似阳明中热
白虎证，但脉无力耳。内伤长夏困倦，似外感湿热，或发热头疼似温暑病。以上俱宜补中益气汤，或四物汤、
四君子汤加减。详内外伤辨及杂病各条。解 出《内经》，解者，肌肉解散； 者，筋不束骨。其证似寒非寒，
似热非热，四肢骨节解散，怠惰烦疼，饮食不美。或因伤酒，或中湿，或感冒风寒，或房事过多，或妇人经
水不调，似痧病而实非痧也。治宜通其气血，疏其腠理，以内伤兼外感药调之；轻者，从俗刮痧，刺十指及委
中血。痧证类伤寒，见杂病蛊瘴。
上一段论类伤寒名义。
旧以痰饮、虚烦、香港脚、食积、疮毒、瘀血，劳发、痘疹八证，六类伤寒。添加感冒、劳伤，共成十证。
要之百病皆类伤寒，不可不知。
正、类伤寒如斯，传变伤寒何谓？尝闻∶传阳则潮（热自）汗（便）闭（溺）涩（腹）满，（口）渴（发）
狂谵（语），甚则（发）斑呕（血）喘急，能升墙屋；变阴则厥冷呕吐利，不渴静蜷，甚则咽痛郑声，欲坐井
地，请以初证言之。
所谓虚烦，是由于七情六欲导致肾水亏虚，心火亢盛而烦躁，或者是杂病之后余热未清而感到烦闷，或者是劳累过度导致气衰火旺而感到烦闷，或者是阴虚导致相火妄动而感到烦闷。这些情况类似于伤寒的初期症状，体表也有发热，但区别在于头部和身体不疼痛，脉象不紧数。即使是阴虚引起的，也会有恶寒但不严重，脉象虽然快但无力。大抵病后身体虚弱消瘦、气短、烦躁想呕吐的，用竹叶石膏汤；病情较轻的，用小柴胡汤。痰逆恶心者，用橘皮竹茹汤。阴证内寒外热，肢体关节疼痛，口不干而体质虚弱者，用阴旦汤。服用凉药后，脉象更加洪大但无力，热势更重且燥渴者，用人参单味煎汤，或者用人参黄（注：此处原文似有脱漏或异体字，通常指人参黄芪或类似补气药，依文意译为参类煎剂）煎汤送服五苓散。劳累导致气虚者，用补中益气汤。阴虚者，用四物汤加知母、黄柏。脾胃虚弱者，用三白汤。惊悸痰多者，用温胆汤。心神不安者，用朱砂安神丸。妇女新产后兼有血虚烦躁者，用四物汤加人参、淡竹叶、麦门冬、甘草。表虚忌用发汗法，里虚忌用攻下法，只宜用平和的药物调理。《千金方》说：虚烦不可过于攻伐，热邪去除则寒邪就会兴起，如果用治疗伤寒的汗法、下法重剂来治疗虚烦，重的会导致津液枯竭而死，轻的会导致体内阴液消损、盗汗，转变为劳瘵（慢性消耗性疾病）。伤寒中有未经过发汗、催吐、泻下而出现烦躁的，表现为胸满膈实、烦热；有已经经过发汗、催吐、泻下而出现烦躁的，表现为胸满烦躁、心中懊恼，详见各相关条目。
痰是由津液转化而成的，风邪伤肺，湿邪伤脾，浊气凝聚而生。外在症状是头项部和缓舒适，只有寒热感类似伤寒而已。初起时就胸膈满闷，气向上冲至咽喉，寸脉浮为其特征。有热者，用参苏饮、金沸草散、柴胡半夏汤；无热者，用二陈汤、温胆汤；通用方为导痰汤。有痰结于胸部的，用鹤顶丹、枳梗二陈汤；有痰上攻引起非正常发作性头痛的，用瓜蒂散催吐。
外在症状头疼、发热、恶寒，完全像伤寒。只是身体不疼痛，心腹部饱闷，打嗝噎气、呕吐逆气，右脉弦而盛大为其特征。《百证歌》说：头疼而恶心，身体不疼痛的，是食积；头疼而且身体也疼痛的，是伤寒。食物停滞在上脘，胸满恶心想要呕吐，实证者，用瓜蒂散催吐；食物停滞在中脘，痞胀想要呕吐，有热者，用二陈汤加黄连、生姜、乌梅，或者陶氏平胃散。腹痛想要腹泻的，用胃苓汤；属寒者，用治中汤；心腹满痛且不大便的，用大柴胡汤攻下。又有夹带食积的伤寒，称为太阴积证。有表证的，用藿香正气散，或者五积散去当归、麻黄，加人参、苏叶；既有表证又有里证的，用桂枝加大黄汤；表证已解，只有里实满胀的，用小承气汤。凡是伤寒泻下后，六七天不大便，烦热腹满而痛，是因为胃中有宿食。如果是中寒夹带食积，立即出现呕吐、腹泻、四肢厥冷、霍乱等症状，急用理中汤加枳实，或者四逆汤救治。凡是夹带食积导致脾胃已受伤的，不可轻易使用发汗或攻下法。
所谓“脚气”，是风寒暑湿四种邪气蒸腾于足部，沿着经络深入脏腑，发病时逐渐发展，不像其他邪气伤人那样浅表而突然。外在症状完全像伤寒，且有六经传变，就像太阳经头疼身热等等，直至厥阴经烦躁胀满、睾丸收缩。又有合病、并病的情况。只是初起时脚膝软弱麻木痹阻，转筋、红肿为其特征。如见到太阳经证，外踝沿京骨穴至小指外侧都疼痛的，根据四种邪气偏胜进行发散，用麻黄汤加防风、羌活、细辛、葛根、白术、茯苓、防己，或者败毒散合槟苏散。阳明经证见大腿膝盖外侧向下至中指内侧疼痛的，根据四种邪气偏胜轻微通利，用大柴胡汤加羌活、细辛、杏仁，或者升麻葛根汤合槟苏散。少阳经证见各个脚趾节疼痛的，宜和解，用小柴胡汤去半夏加防风、葛根、细辛、白术、茯苓、麦门冬、干姜、小草。三阳合病，拘挛便秘的，合用前三方加减服用，名为左经汤。或者专门侵入足太阴经，证见大腿膝盖内侧、足大指端内侧疼痛或浮肿的，用古桂附汤加防己、白术、茯苓。少阴经证见足小指下连足心，大腿内侧疼痛冲至胸部、不想进食、面色黑、小便涩滞、小腹感觉迟钝的，难治，用八味丸救治。厥阴经证见足大指连内侧，脐腹胀痛，脚挛缩干呕的，用养真丹。如果足三阴经挛缩痹阻、缓弱，上攻胸胁肩背，下注脚膝，足心热的，用换腿丸。总之，风邪多入肝，病在筋走窜疼痛，脉浮无汗，用小续命汤加独活。风毒肿痛，用排风汤、槟榔散；筋急牵引疼痛，用乳香定痛散。湿邪多入脾，病在肌肉沉重，行走突然跌倒或肿胀，用除湿汤；痰多者，用此汤吞服清州白丸子。暑邪多入心，病气喘闷躁烦躁，所患必定是热证，用败毒散加大黄。寒邪多入肾，病在骨骼挛急牵引疼痛，所患必定是冷证，用五积散、越婢汤加木瓜，通用千金续命汤、流气饮子、乌药顺气散。烦躁的，单用竹沥饮用；便秘的，用三和散、脾约丸；毒瓦斯冲心作痛的，用苏子降气汤送服养正丹，或者吴茱萸煎汤，刺入姜汁救治，死亡就在早晚之间。寻常春夏季节，用槟苏散加川楝子，热肿红色的，用败毒散加木瓜、苍术；秋冬季节，用五积散加木瓜、槟榔、牛膝、吴茱萸。最忌讳用补汤淋洗，以及草药摊敷。其病因有因于气，因于饮食及丹石的，不可不知道。
血液是人身的河渠，贵在流通而不贵凝滞。或者该发汗而没有发汗，津液内渗；或者不该发汗而发了汗，津液内竭；或者利尿过多，以致血热化为恶瘀；又或者其人素有跌打闪挫、思虑忧郁、过食煎炒食物，以致血热瘀滞。蓄积在上焦，则鼻出血、健忘，甚至昏迷，很久才苏醒，或者胸胁腹部都满痛，胡言乱语神志不清，称为血结胸证；蓄积在中焦，则头汗出、口渴、发黄；蓄积在下焦，则如狂、大便黑色，小腹急结，按压则痛，其脉必芤涩。外在症状寒热，完全像伤寒。太阳经证则如狂，阳明经证则善忘，少阳经证则寒热像疟疾。大抵治疗上部，用犀角地黄汤；治疗中部，用桃仁承气汤；治疗下部，用抵当汤、丸。但是必须证候重、脉数，才可以抵当汤攻之；证候轻、脉微，通用犀角地黄汤，加青皮、黄芩、黄连、大黄，或者小柴胡汤加桃仁、生地兼栀子、茵陈。一切血证，都是这个治法不变。伤寒有用承气汤大下不解，反而大便坚硬、能吃东西的，是瘀血。凡是病白天轻晚上重，就是瘀血，所以跌打损伤，证候也像伤寒。
凡是患痈疽、背发疔疮，一切无名肿毒，初起时有寒热，完全像伤寒。只是伤寒不吃东西，疮毒患者饮食如常，而且身上有红肿痛处可以验证。不可妄用发汗或攻下法，宜用外科方法治疗。俗呼流注伤寒，“流”是指运行，“注”是指停留。血气流行，遇到寒邪则凝涩，结聚如堆核，大的如拳头，小的如李子，初起时有寒热，完全像伤寒。未溃破的，宜用败毒散合凉膈散加金银花；已溃破的，用托里散，不可当作正伤寒治疗。俗呼赤膈伤寒，胸膈赤肿疼痛，寒热像伤寒，不是正伤寒，宜用荆防败毒散合小陷胸汤，里实者，用防风通圣散。
痘疹患者尻部和足部当时寒冷，
凡是婴幼儿及年长之人，忽然出现类似伤寒的症状，如尚未患痘疹，尻部和足中指都冷的，宜从痘证初热条治疗。
劳发痰火需等待一周时间自愈。
素来有痰火，稍微劳动，就发作寒热，完全像伤寒。轻的，调养一周自愈；重的，颈腋胳膊胯部之间遂结核肿硬，或者消退，下次遇劳又发作，治疗宜用八物二陈汤，加降火和解的药物。
旧时说伤为重，感冒为轻。现在完全区分开来，正是恐怕人们用治疗伤寒的重剂来治疗感冒的轻病，变生其他证候。感受寒邪虽然也恶寒面色惨白，但其头疼发热，不如伤寒严重，脉多沉迟；感受风邪虽然也恶风鼻塞，其发热等证，也不如伤风严重，脉多浮数。大抵未发热的，感寒用香苏散；感风用苏葛汤、古苍荆散。已发热的，九味羌活汤之类热服，肌体微微湿润即愈。平常体质薄弱多病的人，只在原服药中加生姜、陈皮，或者寒证用二陈汤，风证用三白汤加减。详见杂病。
外感挟带内伤的，素来冒受风寒未发作，加上饮食劳倦触动，外在症状完全像伤寒。只是左手人迎及关脉，比右手气口大一两倍，这是外感重而内伤轻，治疗用九味羌活汤去苍术、生地，用白术，随六经见证加减。如内伤脾胃，外感寒邪者，用藿香正气散、人参养胃汤。如内伤饮食，外感风寒者，用平胃散加黄连、枳实；便秘加桃仁、大黄。如内伤生冷，外感风寒者，用五积散。内伤挟带外感的，先因饮食劳役过度，身痛腰腿酸软，而其体已解，又感冒风寒，外在症状完全像伤寒。只是右手气口及关脉，比左手人迎大一两倍，这是内伤重而外感轻，治疗用补中益气汤，或者调中益气汤，随六经见证加减。误作伤寒，大发其汗的会死。内伤房事，又感风者，用玉屏风散，或者加桂枝、白芍；内伤房事，又感寒者，用川芎汤。风寒两感者，用玉屏风散合川芎汤。体质薄者，通用十全大补汤，少加防风、羌活、细辛、白芷。肢冷者，加姜附。阴虚者，用八物汤加陈皮、炒干姜，不可误用风寒燥药，愈亏损肾水。内伤虚损，四肢无力发热，也像伤寒，但必兼盗汗、遗精、白浊为特征，内伤卫虚恶风，荣虚恶寒，也像伤寒，但在密室居住就不恶风了。内伤阴虚火动，恶寒非真寒，恶热非真热，只是身体清瘦，脉无力为特征，内伤大渴体热，脉洪大，似阳明中热白虎证，只是脉无力罢了。内伤长夏困倦，似外感湿热，或者发热头疼似温暑病。以上都宜用补中益气汤，或者四物汤、四君子汤加减。详内外伤辨及杂病各条。解㑊（jié yì），解者，肌肉解散；㑊者，筋不束骨。其证似寒非寒，似热非热，四肢骨节解散，怠惰烦疼，饮食无味。或因伤酒，或中湿，或感冒风寒，或房事过多，或妇人经水不调，似痧病而实非痧也。治疗宜通其气血，疏其腠理，以内伤兼外感药调之；轻者，从俗刮痧，刺十指及委中穴放血。痧证类伤寒，见杂病蛊瘴。
上一段论述类伤寒的名义。
旧时将痰饮、虚烦、香港脚、食积、疮毒、瘀血，劳发、痘疹八种证候，归为六类伤寒。添加感冒、劳伤，共成十种证候。总之百病皆类似伤寒，不可不知道。
正伤寒、类伤寒如此，传变伤寒是什么？曾听说：传阳经则潮热、自汗、便秘、尿涩、腹满、口渴、发狂谵语，甚至发斑、呕血、喘急，能登上墙屋；变阴经则四肢厥冷、呕吐、腹泻，不渴、安静蜷卧，甚至咽痛、郑声，想坐在井地里，请让我从初证说起。
**Deficiency Irritability (Xu Fan)** presents with no pain in the head and body, absence of sweating, and a pulse that is not tight.
"Deficiency irritability" refers to irritability caused by emotional disturbances and desires leading to deficiency of Kidney Water, resulting in hyperactive Heart Fire; or irritability due to residual heat remaining after miscellaneous diseases; or irritability arising from labor overexertion causing Qi deficiency and hyperactive Fire; or irritability due to Yin deficiency triggering the movement of Ministerial Fire. These conditions resemble the initial stage of *Shanghan* (Cold Damage), with external fever present, but distinguished by the absence of head and body pain and a non-tight, non-rapid pulse. Even when caused by Yin deficiency, there may be aversion to cold, though not severe, and the pulse can be rapid but forceless. Generally, for post-illness weakness, emaciation, shortness of breath, irritability, and desire to vomit, use **Zhuye Shigao Tang** (Bamboo Leaf and Gypsum Decoction); for milder cases, use **Xiaochaihu Tang** (Minor Bupleurum Decoction). For phlegm-rebellion and nausea, use **Jupi Zhuru Tang** (Tangerine Peel and Bamboo Shavings Decoction). For Yin-pattern internal cold with external heat, limb and joint pain, dry mouth absent but constitution weak, use **Yindan Tang**. After taking cooling medicines, if the pulse becomes more large yet forceless, and heat intensifies with dryness and thirst, use **Danren Shen Tang** (Single Ginseng Decoction) or decoct **Renshen Huang** (Ginseng and Astragalus) to administer **Wuling San** (Five-Ingredient Poria Powder). For labor-induced Qi deficiency, use **Buzhong Yiqi Tang** (Tonify the Middle and Augment the Qi Decoction). For Yin deficiency, use **Siwu Tang** (Four Substances Decoction) plus **Zhimu** (Anemarrhena Rhizome) and **Huangbai** (Phellodendron Bark). For Spleen and Stomach weakness, use **Sanbai Tang**. For palpitations and abundant phlegm, use **Wendan Tang** (Warm the Gallbladder Decoction). For unsettled mind and spirit, use **Zhusha Anshen Wan** (Cinnabar Calming the Spirit Pill). For women newly postpartum with blood deficiency and irritability, use **Siwu Tang** plus **Renshen** (Ginseng), **Danzhuye** (Light Bamboo Leaf), **Maimendong** (Ophiopogon Tuber), and **Gancao** (Licorice Root). Exterior deficiency contraindicates sweating methods; interior deficiency contraindicates purgation methods; only mild and balanced formulas should be used for regulation. The *Qianjin Fang* states: Deficiency irritability must not be treated with excessive attack; once heat is removed, cold will arise. If heavy sweating or purging agents used for *Shanghan* are applied to deficiency irritability, severe cases lead to exhaustion of fluids and death, while mild cases lead to internal consumption, night sweats, and transformation into *Laozai* (Consumptive Disease). In *Shanghan*, those who have not undergone sweating, vomiting, or purging may experience irritability with chest fullness, diaphragmatic solidity, and烦热 (irritating heat); those who have already undergone these treatments may experience irritability with chest fullness, vexation, and inner restlessness (*Ao Nao*), as detailed in respective sections.
**Phlegm Patterns** present with no pain in the head and neck, presence of chills and fever, and a floating pulse at the Cun position.
Phlegm is transformed from body fluids; Wind injures the Lung, Dampness injures the Spleen, and turbid qi condenses to form it. External signs show a relaxed head and neck, with only chills and fever resembling *Shanghan*. Initial onset features chest and diaphragm fullness, Qi rushing up to the throat, and a floating Cun pulse as distinguishing features. With heat, use **Shensu Yin**, **Jinfecao San**, or **Chaihu Banxia Tang**; without heat, use **Erchen Tang** or **Wendan Tang**; the universal formula is **Daotan Tang** (Guide Out Phlegm Decoction). For phlegm knotting in the chest, use **Heding Dan** or **Zhigeng Erchen Tang**; for phlegm attacking upward causing recurrent headaches, use **Gua Di San** to induce vomiting.
**Food Stagnation** presents with fullness and oppression in the heart and abdomen.
External symptoms include headache, fever, and aversion to cold, completely resembling *Shanghan*. The distinction lies in the absence of body pain, abdominal fullness, belching, hiccuping, vomiting, and a strong, wiry Right pulse. The *Baizheng Ge* states: Headache with nausea but no body pain indicates food stagnation; headache with body pain indicates *Shanghan*. Food stagnant in the Upper Jiao, causing chest fullness, nausea, and desire to vomit, in excess patterns, is treated with **Gua Di San** to induce vomiting. Food stagnant in the Middle Jiao, causing distension and desire to vomit, with heat, is treated with **Erchen Tang** plus **Huanglian** (Coptis Rhizome), **Shengjiang** (Fresh Ginger), and **Wumei** (Mume Fruit), or Tao’s **Pingwei San**. Abdominal pain with desire for diarrhea is treated with **Weiling Tang**; if cold, with **Zhizhong Tang**. Heart and abdominal fullness/pain with constipation is treated with **Dachaihu Tang** to purge. There is also *Shanghan* complicated by food stagnation, called Taiyin Accumulation Pattern. With exterior signs, use **Huoxiang Zhengqi San** or **Wuji San** removing Danggui and Mahuang, adding Renshen and Ziyè; with both exterior and interior signs, use **Guizhi Jiada Huang Tang** (Cinnamon Twig Decoction Plus Rhubarb); when exterior signs have resolved and only interior excess fullness remains, use **Xiaochengqi Tang**. After purging in *Shanghan*, if there is no bowel movement for six to seven days, accompanied by irritating heat, abdominal fullness, and pain, it is due to retained food in the Stomach. If Cold complicates food stagnation, immediately presenting with vomiting, diarrhea, cold limbs, and Huoluan, urgently use **Lizhong Tang** plus Zhishi, or **Sini Tang** to rescue. When Spleen and Stomach are injured by complicated food stagnation, do not lightly use sweating or purging methods.
**Hongxiangjiao** (Foot Qi / Beriberi) presents with softness and weakness in the knees and shins.
"Foot Qi" refers to the four pathogenic factors (Wind, Cold, Summerheat, Dampness) steaming the feet, entering deeply along meridians into the Zang organs, developing gradually, unlike other pathogens that strike superficially and suddenly. External signs fully resemble *Shanghan*, with Six Meridian transmission, just like Taiyang headache and fever, progressing until Jueyin irritability, fullness, and testicular retraction. There are also combined and concurrent diseases. The distinction is initial softness, numbness, and bi-syndrome in the feet and knees, tendon spasms, and red swelling. If Taiyang signs appear with pain along the Jinggu point from the lateral malleolus to the lateral side of the little toe, disperse according to the predominant pathogen using **Mahuang Tang** plus **Fangfeng**, **Qianghuo**, **Xixin**, **Gegen**, **Baizhu**, **Fuling**, and **Fangji**, or **Baidu San** combined with **Bin Su San**. If Yangming signs appear with pain from the lateral thigh/knee down to the medial side of the middle toe, mildly purge according to the predominant pathogen using **Dachaihu Tang** plus **Qianghuo**, **Xixin**, and **Xingren**, or **Shengma Gegen Tang** combined with **Bin Su San**. If Shaoyang signs appear with pain in all toe joints, harmonize using **Xiaochaihu Tang** removing Banxia, adding **Fangfeng**, **Gegen**, **Xixin**, **Baizhu**, **Fuling**, **Maimendong**, **Ganjiang**, and **Xiaocao**. For Three-Yang combined disease with spasms and constipation, combine the previous three formulas with modifications, named **Zuojing Tang**. If specifically invading the Foot Taiyin Meridian, presenting with pain or edema on the medial thigh/knee and medial tip of the big toe, use ancient **Guifu Tang** plus **Fangji**, **Baizhu**, and **Fuling**. For Shaoyin Meridian, presenting with pain from the little toe connecting to the sole, medial thigh pain radiating to the chest, anorexia, black complexion, dysuria, and insensitivity in the lower abdomen, it is difficult to treat; rescue with **Bawei Wan** (Eight-Ingredient Pill). For Jueyin Meridian, presenting with pain from the big toe connecting to the medial side, umbilical/abdominal distension/pain, foot spasms, and dry retching, use **Yangzhen Dan**. If the three Foot Yin meridians show spasms, bi-syndrome, weakness, attacking upward to chest/hypochondrium/shoulder/back, downward to feet/knees, with hot soles, use **Huantui Wan**. Generally, Wind enters the Liver, causing sinew migration and pain, floating pulse, no sweat; treat with **Xiaxuming Tang** plus **Duhuo**. Wind-toxin swelling/pain: **Paifeng Tang**, **Bangling San**; Sinew tension pulling pain: **Ruxiang Ding Tong San**. Dampness enters the Spleen, causing heavy flesh, sudden falls upon walking, or edema; treat with **Chushi Tang**; if abundant phlegm, swallow **Qingzhou Baiwanzi** with this decoction. Summerheat enters the Heart, causing asthma, stifling, irritability, necessarily heat; treat with **Baidu San** plus **Dahuang**. Cold enters the Kidney, causing bone spasms and pulling pain, necessarily cold; treat with **Wuji San**, **Yeshi Tang** plus **Mugua**, universally **Qianjin Xuming Tang**, **Liuyin Yinzi**, **Wuyao Shunqi San**. For irritability, drink **Zhuli** (Bamboo Sap) alone; for constipation, use **Sanhe San** or **Xiyue Wan**; for toxic vapors rushing to the Heart causing pain, use **Suzi Jiangqi Tang** to deliver **Yangzheng Dan**, or decoct **Wuyu** to prick and inject Ginger Juice to rescue; death is imminent. In ordinary Spring/Summer, use **Bin Su San** plus **Chuanlianzi**; for hot/red swelling, use **Baidu San** plus **Mugua** and **Cangzhu**; in Autumn/Winter, use **Wuji San** plus **Mugua**, **Binglang**, **Niuxi**, and **Wuyu**. Most taboo is washing with tonifying decoctions and applying herbal pastes. Etiologies include Qi, diet, and mineral pills; this must be known.
**Blood Stasis** leads to confusion, forgetfulness, and manic behavior, with discomfort in the chest, hypochondrium, and lower abdomen.
Blood is the river system of the body, valued for flow rather than stagnation. Failure to sweat when indicated causes fluids to seep inward; sweating when inappropriate exhausts fluids inward; excessive diuresis causes Blood Heat transforming into malignant stasis; or pre-existing trauma, depression, or overconsumption of fried foods cause Blood Heat and stasis. Accumulated in the Upper Jiao: epistaxis, forgetfulness, coma (recovering slowly), or chest/hypochondrium/abdominal fullness/pain, delirium, and obtundation, called **Xue Jie Xiong** (Blood Knot Chest Syndrome). Accumulated in the Middle Jiao: head sweating, thirst, jaundice. Accumulated in the Lower Jiao: manic behavior, black stool, lower abdominal urgency/clumping, tenderness on pressure, with Kou and Se pulses. External signs of chills/fever fully resemble *Shanghan*. Taiyang signs manifest as manic behavior; Yangming signs as forgetfulness; Shaoyang signs as chills/fever resembling malaria. Generally, treat the Upper with **Xijiao Dihuang Tang** (Rhino Horn and Rehmannia Decoction); the Middle with **Taoren Chengqi Tang** (Peach Kernel and Rheum Decoction); the Lower with **Didang Tang** or Pills. However, only use Didang for heavy signs and rapid pulse; for light signs and faint pulse, universally use **Xijiao Dihuang Tang** plus **Qingpi**, **Huangqin**, **Huanglian**, **Dahuang**, or **Xiaochaihu Tang** plus **Taoren**, **Shengdi**, **Zhizi**, and **Yinchen**. This method applies to all blood disorders. In *Shanghan*, if purging with Chengqi fails and hardness/eating ability persists, it is blood stasis. Any disease worsening at night indicates blood stasis; thus, trauma resembles *Shanghan*.
**Sores and Toxins**: Diet remains normal; redness/swelling/pain is evident.
For carbuncles, ulcers, furuncles on the back, and any unnamed swellings/toxins, initial chills/fever fully resemble *Shanghan*. Distinction: *Shanghan* patients lose appetite, whereas toxin patients eat normally, and there are visible red/swollen/painful areas on the body. Do not blindly use sweating or purging; treat with surgical methods. "Liuzhu Shanghan" (Flowing Injection Cold Damage): "Liu" means flow; "Zhu" means stay. Qi/Blood flow, encountering Cold, becomes stagnant, forming nodules like piles of kernels (large as fist, small as plum), with initial chills/fever resembling *Shanghan*. Unulcerated: **Baidu San** combined with **Liangge San** plus **Jinyinhua** (Honeysuckle Flower). Ulcerated: **Tuoli San**. Do not treat as standard *Shanghan*. "Chige Shanghan" (Red Diaphragm Cold Damage): Red/swollen/painful chest/diaphragm, chills/fever resembling *Shanghan*, but not standard *Shanghan*; treat with **Jingfang Baidu San** combined with **Xiao Xiantong Tang**; if interior excess, use **Fangtong Tongsheng San**.
**Smallpox/Rash**: Buttocks and feet are cold initially.
For infants and adults suddenly presenting *Shanghan*-like symptoms, if smallpox/rash has not yet appeared and buttocks/middle toes are cold, treat according to the initial heat section of Smallpox protocols.
**Labor-induced Phlegm-Fire**: Awaits one week for resolution.
Those with chronic Phlegm-Fire, upon slight exertion, develop chills/fever resembling *Shanghan*. Mild cases resolve spontaneously after a week of rest; severe cases develop hard/lumpy swellings in neck/armpits/groin, which may subside but recur with exertion. Treatment: **Bawu Erchen Tang** plus fire-descending and harmonizing herbs.
**Exogenous Invasion**: Do not vent excessively.
Traditionally, "Shang" (Injury) was severe, "Ganmao" (Catch Cold) was mild. Now they are distinguished to prevent using heavy *Shanghan* formulas for mild Ganmao, causing complications. Cold invasion causes aversion to cold/pale face, but headache/fever are less severe than *Shanghan*, pulse often deep/slow. Wind invasion causes aversion to wind/nasal congestion, but fever is less severe than Wind injury, pulse often floating/rapid. Generally, for unfevered Cold: **Xiangsu San**; for Wind: **Suge Tang**, **Gu Cangjing San**. For fevered: **Jiuwei Qianghuo Tang** etc., taken hot until skin is slightly moist, then cured. For frail/chronically ill, add **Shengjiang** and **Chenpi** to original meds; Cold pattern: **Erchen Tang**; Wind pattern: **Sanbai Tang** with modifications. See Miscellaneous Diseases.
**Endogenous Injury**: Tonify and supplement concurrently.
Exogenous invasion complicated by endogenous injury: Chronic Wind/Cold exposure not yet manifested, triggered by diet/labor. External signs resemble *Shanghan*. Left Renying and Guan pulses are 1-2 times larger than Right Qikou, indicating heavy exogenous/light endogenous. Treat with **Jiuwei Qianghuo Tang** removing **Cangzhu**, **Shengdi**, using **Baizhu**, modified by Six Meridians. Spleen/Stomach endogenous injury + Cold exogenous: **Huoxiang Zhengqi San**, **Renshen Yangwei Tang**. Diet endogenous injury + Wind/Cold exogenous: **Pingwei San** plus **Huanglian**, **Zhishi**; constipation adds **Taoren**, **Dahuang**. Raw/cold endogenous injury + Wind/Cold exogenous: **Wuji San**. Endogenous injury complicated by exogenous: Prior diet/labor excess causing body pain/weakness, followed by Wind/Cold. Right Qikou/Guan pulses 1-2 times larger than Left Renying, indicating heavy endogenous/light exogenous. Treat with **Buzhong Yiqi Tang** or **Tiaozhong Yiqi Tang**, modified by Six Meridians. Mistaking for *Shanghan* and sweating heavily causes death. Sexual endogenous injury + Wind: **Yupingfeng San** or plus **Guizhi**, **Baishao**. Sexual endogenous injury + Cold: **Chuanxiong Tang**. Wind/Cold dual infection: **Yupingfeng San** combined with **Chuanxiong Tang**. Frail constitutions: Universally **Shiquan Dabu Tang**, lightly adding **Fangfeng**, **Qianghuo**, **Xixin**, **Baizhi**. Cold limbs: Add **Jiang**, **Fu**. Yin deficiency: **Bawu Tang** plus **Chenpi**, stir-fried **Ganjiang**; do not misuse drying Wind-Cold drugs, which further deplete Kidney Water. Endogenous deficiency with limb weakness/fever resembles *Shanghan*, but distinguished by night sweats, spermatorrhea, white turbidity. Endogenous Wei deficiency (aversion to wind) and Ying deficiency (aversion to cold) resemble *Shanghan*, but aversion disappears in closed rooms. Endogenous Yin deficiency with Fire movement: Aversion to cold is not true cold, aversion to heat is not true heat; distinguished by emaciation and forceless pulse. Endogenous extreme thirst/body heat with large pulse resembles Yangming White Tiger pattern, but pulse is forceless. Endogenous summer fatigue resembles exogenous Damp-Heat; fever/headache resembles Warmth/Summerheat. All above: **Buzhong Yiqi Tang**, **Siwu Tang**, or **Sijunzi Tang** with modifications. See Differentiation of Exogenous/Endogenous and Miscellaneous Diseases.
**Jie Yi** (Muscle/Joint Laxity): "Jie" means muscle dispersion; "Yi" means sinews failing to bind bones. Signs: pseudo-cold/pseudo-heat, lax limbs/joints, lethargy, painful irritation, poor appetite. Etiologies: Alcohol injury, Dampness, Wind/Cold, sexual excess, irregular menstruation. Resembles Sha disease but is not Sha. Treatment: Unblock Qi/Blood, open pores, regulate with endogenous/exogenous formulas. Mild cases: Scraping (Gua Sha), pricking ten fingers and Weizhong for bleeding. Sha disease resembling *Shanghan* see Miscellaneous Diseases/Gu Zhang.
The above discusses names of *Shanghan*-like conditions.
Traditionally, Phlegm-Fluid, Deficiency Irritability, Foot Qi, Food Stagnation, Sores/Toxins, Blood Stasis, Labor-induced, and Smallpox/Rash (8 conditions) were classified into 6 categories of *Shanghan*. Adding Ganmao and Labor Injury makes 10 categories. Ultimately, all hundred diseases resemble *Shanghan*; this must be known.
Standard *Shanghan* and *Shanghan*-like conditions are as described. What is transmitted *Shanghan*? It is heard that: Transmission to Yang meridians brings tidal fever, spontaneous sweating, constipation, dysuria, abdominal fullness, thirst, mania, delirium, even eruption of macules, hematemesis, asthma, climbing walls/roofs. Transformation to Yin meridians brings cold limbs, vomiting, diarrhea, no thirst, quiet curling, even sore throat, improper speech, desire to sit in wells/ground. Let me speak from the initial signs.