伤寒表实汗为难，火数如逢发等间，（王胥山曰∶火数，谓七日及十四日之期，病证多
于此候转机也。未至其期，强发其汗，汗或不出，或虽有汗而病仍不解，若至其期，用药中的，
应手取效矣。发等间，言发汗之不难也。炳章按∶余见近时，市医多有持此论者，余常笑之
不意，乃原本于此，夫风寒中人，急于星火当其，初起用药驱之使出，则邪去而正不伤，最
要法也。迟疑逗留坐视其传经，则变症蜂起，虽欲乘火数而发其汗，庸有冀平。）历代明医
无此诀，于今说破妙机关。外感有余之证，必身热头疼，恶寒无汗，乃表实之故。虽言表实
者，理宜发汗，然服发汗药而汗不出，不宜再发其汗，候逢火数，其汗必出，或作战而汗，
亦有不战而汗者。若战汗时，药宜用温补以一助之，要使正气胜其邪，邪汗出而愈。如火数
未至，将药强发，虽汗亦非自然之汗，不免反伤其气，其病反甚于前。历代明医，不立此法
有汗当止，无汗当候。或兼吐泻，亦当调理中宫，或虚实相兼，攻补互用。（钱本于验
字条下有此数句，盖亦慎斋之言，而草庐本不载，今改附录候字条下，稍低一字，以别于草
临证随机立见高，宜攻宜守辨分毫，心存专主人司命，仇夺乾坤造化标。经云∶精气夺
则虚。又云∶夺血者无汗（汗即血所化也。）夺之为言，重虚之谓也。精气夺，夺血者，宜守
之，毋再伤其精气血。又经云∶土郁夺之。夺之即攻之谓也，言土郁者，宜攻下之，令无壅
窒也。宜守宜攻，辨得分明，自无虚虚实实之祸矣。（王胥山曰∶病有危急，而虚实介于疑
似之间，治之苟失其宜，虚虚实实，死亡不旋踵矣。惟深于理法者辨之明而察之，审宜守宜
攻，确然不惑，独排群议而急救之，所谓夺者，乃夺之死也而置之生，夺之危地而置之安也
。其引经文，不过取以为攻守二途作一引子，于夺字符机不甚紧对，盖精气夺则虚血，血夺
者无气，二夺字当作失字解，土郁夺之，此夺字当是夺而去之之义，玩诗意，细绎经文，其
伤寒表实证，发汗较为困难。所谓“火数”，是指发病后的第七天和第十四天这两个时间节点，病情多在此时发生转机。（王胥山说：火数，指的是第七日和第十四日的期限，病证大多在此时候出现转机。如果未到这个期限，强行发汗，汗可能出不来，或者虽然出了汗但病仍未解除；如果到了这个期限，用药精准，就能立刻见效。“发等间”意思是发汗变得不困难了。炳章按语：我见到近代许多医生持有这种观点，我常常嘲笑他们，没想到这原本就是出自本书。风寒侵袭人体，应当像星火一样急切地在初起时用药驱除邪气外出，这是最重要的方法。如果迟疑拖延，坐视病情传入其他经络，那么变证就会蜂拥而起，即使想等到“火数”之时再发汗，又哪里还有希望痊愈呢。）历代名医没有这一诀窍，如今将其妙处揭示出来。外感有余的证候，必然表现为身体发热、头痛、怕冷、无汗，这是由于表实所致。虽然说是表实证，按理应该发汗，但如果服用了发汗药却不出汗，就不宜再次强行发汗，应等待“火数”到来，那时汗自然会出，有的会先战栗后出汗，也有不战栗直接出汗的情况。如果在战汗的时候，药物宜用温补之剂以助正气，要使正气战胜邪气，随着邪气随汗排出而痊愈。如果“火数”未到，强行用药发汗，即使出汗也不是自然的汗，难免反而损伤正气，病情反而比之前更重。历代明医不设立此法，主张有汗就停止发汗，无汗就等待时机。如果兼有呕吐腹泻，也应当调理中焦脾胃；如果是虚实夹杂，则攻邪与补虚交替使用。（钱本在“验”字条下有这几句话，大概是慎斋的话，但草庐本未收录，现在改为附录在“候”字条下，缩进一字，以区别于草庐本）
临证时要随机应变，立见高明，适宜攻伐还是固守，需辨别毫厘之差，心中专一者方能司掌人命，如同仇氏夺取乾坤造化之标尺。经典说：“精气被耗夺则导致虚证。”又说：“失血的人不能有汗（汗是由血化生的）。”“夺”的意思，是严重的虚弱。精气被耗夺，或血液被耗夺，应当采取保守治疗，不要再损伤精气血。又经典说：“土郁结者，当用‘夺’法。”这里的“夺”就是“攻”的意思，指土气郁结时，应当用攻下法，使其通畅无阻。适宜保守还是攻伐，分辨得清楚明白，自然就不会造成“虚其虚、实其实”的祸患了。（王胥山说：病情危急，虚实介于疑似之间，治疗如果失当，造成虚者更虚、实者更实，死亡就会接踵而至。只有深通理法的人才能辨明察审，确定适宜保守还是攻伐，坚定不惑，独自排除众议而急救病人。所谓的“夺”，是将人从死地夺回生机，从危险境地夺回安全。所引用的经文，不过是取作攻守两途的一个引子，对于“夺”字的深层含义并不紧密对应。大概“精气夺则虚”、“血夺者无气”中的两个“夺”字应当解释为“丧失”，“土郁夺之”中的“夺”字应当是“去除”的意思。品味诗意，细绎经文，其……）
In Taiyang excess syndrome (Excess Syndrome of the Taiyang Channel) caused by cold damage, inducing sweating is difficult. The term "Huoshu" (Fire Number) refers to the seventh and fourteenth days after onset, periods during which the disease condition often undergoes a turning point. (Wang Xushan stated: Huoshu refers to the timeframes of the seventh and fourteenth days; the disease pattern frequently shifts at these junctures. If one forces sweating before this timeframe arrives, sweat may not emerge, or if it does, the disease remains unresolved. However, if treatment is administered accurately upon reaching the timeframe, efficacy will be immediate. "Fa deng jian" implies that inducing sweating becomes effortless. Bingzhang's note: I have observed many contemporary physicians adhering to this theory, often mocking them, yet unaware that this concept originates from this very text. When wind-cold invades the human body, it is crucial to expel the pathogen immediately upon initial onset, akin to the urgency of sparks and lightning. This is the most essential method. Hesitation and delay allow the pathogen to transmit through the meridians, leading to a proliferation of complicated symptoms. Even if one waits for the Huoshu to induce sweating, there is little hope for recovery.) Past renowned physicians did not possess this specific principle; now its subtle mechanism is revealed. For exterior excess syndromes due to external contraction, symptoms necessarily include fever, headache, aversion to cold, and anhidrosis (absence of sweating), resulting from exterior excess. Although exterior excess theoretically requires diaphoresis (inducing sweating), if sweating does not occur after administering diaphoretic herbs, one should not force further sweating. Instead, one must wait for the Huoshu, at which point sweat will naturally emerge. Some patients may experience chills followed by sweating (Zhan Han), while others may sweat without chills. During Zhan Han, warm and tonifying formulas should be used to assist the healthy Qi (Vital Energy), ensuring that the righteous Qi overcomes the pathogenic factor, allowing the disease to resolve as the pathogen exits with the sweat. If the Huoshu has not arrived and one forcibly induces sweating, any resulting sweat is unnatural and will inevitably damage the Qi, causing the disease to worsen compared to before. Past enlightened physicians did not establish this method; instead, they advocated stopping sweating if present and waiting if absent. If accompanied by vomiting and diarrhea, the Middle Jiao (Central Burner/Spleen and Stomach) should be regulated. If deficiency and excess coexist, purging and tonifying methods should be used alternately. (These sentences appear under the "Verification" entry in Qian's edition, likely words of Shenzhai, but were omitted in Caolu's edition. They are now appended to the "Waiting" entry, indented slightly to distinguish them from Caolu's version.)
Clinical practice requires flexibility and high discernment; one must distinguish meticulously between the appropriateness of attacking (purging) and defending (tonifying). A focused mind allows one to act as a healer, mastering the transformations of nature. The Classics state: "When Essence and Qi are depleted, deficiency results." It also states: "Those who have lost blood cannot sweat (sweat is transformed from blood)." The term "Duo" (Depletion/Seizure) signifies severe deficiency. When Essence and Qi are depleted, or when Blood is depleted, conservative treatment (tonification/protection) is indicated to avoid further injury to Essence, Qi, and Blood. Furthermore, the Classics state: "For Earth stagnation, apply Duo." Here, "Duo" means "attack" or "purge," indicating that when Earth Qi is stagnant, purgative methods should be employed to remove obstruction. Clearly distinguishing between conservative and aggressive treatments prevents the disaster of "making deficiency more deficient and excess more excessive." (Wang Xushan noted: In critical conditions where deficiency and excess are ambiguous, improper treatment can lead to rapid death by exacerbating both deficiency and excess. Only those deeply versed in theory and method can clearly discriminate, firmly deciding whether to defend or attack, resisting dissent to provide emergency rescue. Thus, "Duo" means snatching life from death and safety from danger. The cited scriptures serve merely as introductions to the two paths of attack and defense, not strictly aligning with the deeper meaning of the character "Duo." Likely, the two instances of "Duo" in "Depletion of Essence and Qi leads to deficiency" and "Depletion of Blood leads to lack of Qi" should be interpreted as "loss," whereas the "Duo" in "Earth stagnation, apply Duo" means "to remove." Examining the poetic intent and interpreting the scriptures carefully...)