（原病集）
伤寒者，以病因而为病名者也。温病热病，以天时与病形而为名者也。由三者皆起于感
或者通以伤寒称之。夫通称伤寒者，原其因之所自耳。至于用药，不可以一例施也，何也？
人之伤寒，盖于霜降后，春分前，天令严冷之时，感而即发。寒邪闭其腠理，故非辛甘温之
剂，不足以散之，此仲景所以桂枝麻黄等汤之必用也。温病热病，在霜降后春分前，感不即
发，寒邪伏于肌肉，至春夏天令暄热之时，怫然自内达外，郁其腠理，无寒在表。此非辛凉
之剂，不足以解之。此桂枝麻黄等汤之所以不用也。而后人所处冲和汤，通解散、解肌汤，
调和表里者之所以可用也。夫即病之伤寒，有恶风恶寒之证者，风寒在表，而表气受伤故也
。后发之温病热病，有恶风恶寒之证者，重有风寒新中，而表气亦受伤故也。若无新中之风
寒，则无恶风恶寒之证。即间有之，亦因病患表气本虚，热达于表，又重伤表气，故不禁风
寒。非伤风恶风，伤寒恶寒，但卫虚则恶风，营虚则恶寒耳。故仲景曰∶太阳病，发热而
渴不恶寒者，为温病。不恶寒，则病非外来，渴则明其热自内炽，温病如此，则热病可类推
矣。凡不渴而恶寒者，非温病热病明矣。然温病热病，亦有先见表证而后入里者。由怫郁自
内达外，热郁腠理，不得外泄，遂还里而成可攻之证，非如伤寒从表而始也。或者不悟此理
，乃于春夏温热病，而求浮紧之脉，不亦疏乎？不知紧为寒脉，有寒邪则见之，无寒邪则不
见也。岂其本然哉？又或者不识脉形，但见弦便呼为紧，断为寒而妄治。盖脉之盛而有力者
，每每见弦，岂可错认为紧而断为寒。夫温热病之脉多在肌肉之分而不甚浮，且右手反甚于
左手，诚由怫郁在内故也。其或左手盛或浮者，必有重感于风寒，否则非温热病，暴感风寒
之病耳。凡温热病，苦无重感表证，虽见而里热为多，
故
不渴者少。治法当以清热为主，而解表兼之。亦有治里而表自解者，余每见世人治温热病，
或误攻其里，犹无大害。误发其表，变不可言。此足以明其热之自内达外矣。其间有误攻里
而致大害者，乃春夏暴寒所中之疫证。邪纯在表，未入于里故也。宁可与温热同论哉？夫惟
世以温热病混称伤寒，故每混寒热二字，以求浮紧之脉，以用温热之药，又方书多混称四时
伤寒，每以春夏之温热病，与秋冬之伤寒一类治之而无别。不知秋冬之伤寒，真伤寒也。春
夏之伤寒，疫病也。与温病自是两涂，岂可同治？况伤寒之有直伤阴经与太阳，虽伤不及郁
热，即传阴经为寒证而当温者，又与温热大不相同，其可妄治乎？或者知一不知二，谓仲景
发表之药今不可用，而攻里之药乃可用。呜呼！其可用不可用之理，果何在耶？彼时行不正之
气所作，及重感异气而变者，又当观其何时何气，参酌伤寒温热之法，损益而治之，尤不可
例以仲景即病伤寒之药通用也。
（原病集）
伤寒，是根据病因来命名的疾病。温病和热病，是根据季节气候和病症表现来命名的。由于这三种病都起因于感受外邪，所以人们通称为“伤寒”。之所以这样统称伤寒，是因为追溯其病因的源头。但是至于用药治疗，不能一概而论地施用同样的方法，为什么呢？人如果在霜降之后、春分之前这段时间感受寒邪，往往是在天气严寒寒冷的时候感邪随即发病。寒邪闭塞了腠理（皮肤毛孔及肌肉纹理），所以非用辛甘温性质的药物，不足以发散它，这就是张仲景必须使用桂枝汤、麻黄汤等方剂的原因。而温病和热病，虽然在霜降后春分前也感受了寒邪，但当时不立即发病，寒邪潜伏在肌肉之间，等到春夏季天气温暖炎热时，郁热从体内向外透发，郁闭了腠理，此时体表没有寒邪。这种情况非用辛凉性质的药物，不足以解除它，这就是不再使用桂枝汤、麻黄汤等方剂的原因。而后人所开的冲和汤，以及通解散、解肌汤等调和表里的方剂，则是可以使用的。那种即感即发的伤寒，如果有怕风或怕冷的症状，是因为风寒邪气在体表，导致卫表之气受伤的缘故。后来发作的温病和热病，如果有怕风或怕冷的症状，是因为再次新受了风寒邪气，导致卫表之气也受伤的缘故。如果没有新近感受的风寒，就不会出现怕风怕冷的症状。即使偶尔有这种症状，也是因为患者本身卫表之气虚弱，热气到达体表，又进一步重伤了卫表之气，所以禁不住风寒。这并不是所谓的伤风就恶风、伤寒就恶寒，仅仅是卫气虚就会恶风，营气虚就会恶寒罢了。所以张仲景说：太阳病（太阳经受邪所致的病证），发热且口渴、不怕冷的，是温病。不怕冷，说明病邪不是从外来的；口渴，明确表明热势是从内部炽盛的。温病是这样，那么热病就可以类推了。凡是口不渴且怕冷的，显然不是温病或热病。然而，温病和热病，也有先表现出表证，然后病邪入里的情况。这是因为郁热从内向外透发，热邪郁闭在腠理，不能向外宣泄，于是返回体内形成可以攻下的里实证，这与伤寒从体表开始不同。有的人不明白这个道理，竟然在春夏季的温热病中寻求浮紧脉象，这不是太疏忽了吗？不知道紧脉是寒邪的脉象，有寒邪才会出现，没有寒邪就不会出现。这难道是疾病的本来面目吗？又或者有人不认识脉象形态，只要见到弦脉就称之为紧脉，判断为寒邪而胡乱治疗。一般来说，脉搏盛大有力的时候，常常表现为弦脉，怎么能错误地认为是紧脉并判断为寒邪呢？温热病的脉象多在肌肉层次而不很浮浅，而且右手脉反而比左手脉强盛，这确实是因为郁热在体内的缘故。如果左手脉盛大或浮浅的，必定是再次严重感受了风寒，否则就不是温热病，而是暴感风寒的疾病。大凡温热病，苦于没有再次感受风寒的表证，即使有，也是里热居多，所以口不渴的情况很少。治疗方法应当以清热为主，兼以解表。也有通过治疗里证而使表证自然解除的情况。我常常见到世人治疗温热病，有时错误地攻下里实，尚且没有造成大的危害；但如果错误地发汗解表，变证就不可胜言了。这足以证明热邪是从内部向外部透发的。其中也有因为错误攻下里实而导致严重危害的，那是春夏季暴寒所中的疫病。邪气纯粹在体表，尚未进入体内，所以如此。这怎么能与温热病混为一谈呢？正因为世人将温热病混淆称为伤寒，所以常常混淆寒热两个概念，为了求得浮紧脉象，而使用温热性质的药物。另外，医书中多将四季伤寒混称，经常把春夏季的温热病与秋冬季的伤寒作为一类疾病来治疗而没有区别。不知道秋冬季的伤寒，才是真正的伤寒。春夏季的所谓伤寒，其实是疫病。这与温病本是两条不同的路径，怎么可以一起治疗呢？况且伤寒中有直接伤害阴经和太阳经的情况，虽然伤害不及郁热，但传变到阴经成为寒证而需要用温法治疗的，又与温热病大不相同，怎么可以胡乱治疗呢？有的人知道一点却不知道两点，认为张仲景发表的药物现在不可用，而攻里的药物才可用。唉！那些可用与不可用的道理，究竟在哪里呢？如果是时行不正之气所作，以及再次感受异气而变化的病情，又应当观察是何时、何种气机，参照伤寒和温热的方法，增减损益来进行治疗，尤其不可以简单地用张仲景治疗即病伤寒的药物通用。
(Original Disease Collection)
Shanghan (Cold Damage), is a disease named according to its etiology. Wenbing (Warm Diseases) and Rebing (Heat Diseases) are named according to the seasonal climate and clinical manifestations. Since all three originate from external pathogenic invasion, they are collectively referred to as "Shanghan." The reason for this collective term lies in tracing the source of the cause. However, regarding medication, one cannot apply a uniform treatment method. Why? When humans contract cold pathogens after the Frost's Descent solar term but before the Spring Equinox, it typically occurs during the period of severe cold weather, with symptoms appearing immediately upon infection. Cold pathogens close the Couli (pores and interstitial spaces of the skin and muscles); therefore, only pungent, sweet, and warm agents are sufficient to disperse them. This is why Zhang Zhongjing must utilize formulas such as Guizhi Tang (Cinnamon Twig Decoction) and Mahuang Tang (Ephedra Decoction). In contrast, Wenbing and Rebing may involve cold pathogen exposure between Frost's Descent and Spring Equinox, but do not manifest immediately. The cold pathogen lies dormant within the muscles until the warm and hot weather of spring and summer causes internal heat to surge outward, obstructing the Couli. At this stage, there is no cold pathogen on the exterior. Such conditions require pungent and cool agents to resolve them; hence, Guizhi Tang and Mahuang Tang are not used. Formulas such as Chonghe Tang (Harmonizing Decoction), Tongjie San (Unblocking Exterior Powder), and Jiexi Tang (Releasing Muscle Decoction), which harmonize the interior and exterior, are applicable here.
In immediate-onset Shanghan, symptoms of aversion to wind or cold occur because wind-cold pathogens reside on the exterior, injuring the Wei Qi (Defensive Qi) of the surface. In delayed-onset Wenbing and Rebing, if symptoms of aversion to wind or cold appear, it is due to a new contraction of wind-cold, further injuring the Wei Qi. Without new wind-cold invasion, these symptoms would not exist. Even if they occasionally occur, it is because the patient's superficial Qi was originally deficient; as heat reaches the exterior, it further damages the Wei Qi, making the patient susceptible to wind and cold. This is not simply that wind injury causes aversion to wind and cold injury causes aversion to cold; rather, deficiency of Wei Qi leads to aversion to wind, and deficiency of Ying Qi (Nutritive Qi) leads to aversion to cold. Thus, Zhang Zhongjing stated: In Taiyang Bing (Disease of the Taiyang Channel), fever accompanied by thirst and absence of aversion to cold indicates Wenbing. Absence of aversion to cold implies the pathogen is not exogenous; thirst indicates intense internal heat. Wenbing presents thus, and Rebing can be inferred similarly. Any case presenting without thirst and with aversion to cold is clearly not Wenbing or Rebing.
However, Wenbing and Rebing may initially present with exterior syndromes before progressing inward. Due to internal stagnation and heat surging outward, heat becomes trapped in the Couli and cannot vent externally, causing it to revert inward and form excess syndromes amenable to purgation. This differs from Shanghan, which begins at the exterior. Those who fail to comprehend this logic might seek a floating-tight pulse (Fu Jin Mai) in spring-summer heat diseases, which is highly negligent. One must know that a tight pulse indicates cold pathogens; it appears only when cold pathogens are present. Is this the natural state of heat diseases? Others, unfamiliar with pulse morphology, mistake a wiry pulse (Xian Mai) for a tight pulse, diagnose cold, and treat erroneously. A vigorous and forceful pulse often manifests as wiry; it should not be mistaken for tight or diagnosed as cold. The pulse in heat diseases usually resides deeper in the muscle layer rather than being very superficial, and the right hand pulse is often stronger than the left, indeed due to internal stagnation. If the left hand pulse is strong or superficial, it indicates a severe re-infection with wind-cold; otherwise, it is not a heat disease but an acute wind-cold contraction. Generally, heat diseases lack signs of re-infection on the exterior; even if present, interior heat predominates, so cases without thirst are rare. Treatment should primarily focus on clearing heat, supplemented by releasing the exterior. Sometimes, treating the interior resolves the exterior spontaneously. I have often observed that when people treat heat diseases, erroneous purgation of the interior may not cause major harm, whereas erroneous diaphoresis (sweating) to release the exterior can lead to unpredictable complications. This sufficiently proves that heat originates internally and moves outward. Cases where erroneous purgation caused severe harm were actually epidemic conditions caused by sudden cold in spring and summer, where pathogens remained purely on the exterior without entering the interior. How can these be discussed together with heat diseases?
Because the world conflates heat diseases with Shanghan, people often confuse cold and heat concepts, seeking floating-tight pulses and using warm-hot medications. Furthermore, medical texts often conflate "Four Seasons Shanghan," treating spring-summer heat diseases identically to autumn-winter Shanghan without distinction. It is unknown that autumn-winter Shanghan represents true Shanghan, while spring-summer Shanghan represents epidemics. These are distinct paths from Wenbing and should not be treated alike. Moreover, Shanghan involves direct injury to the Yin channels and Taiyang channel. Although less likely to transform into stagnant heat, transmission to Yin channels results in cold syndromes requiring warming methods, which is vastly different from heat diseases; how can they be treated recklessly? Some understand part but not all, claiming Zhang Zhongjing’s exterior-releasing drugs are unusable today, while interior-purgative drugs are usable. Alas! Where exactly lie the principles of usability and non-usability? For conditions caused by miasma of seasonal irregular qi, or those transformed by re-infection with heterogeneous qi, one must observe the timing and nature of the qi, reference methods from both Shanghan and Wenbing, and adjust treatments accordingly. It is especially inadvisable to universally apply Zhang Zhongjing’s formulas for immediate-onset Shanghan.