凡治小儿伤寒，须辨表里，表里不分，汗下差误。古人云∶桂枝下咽、阳盛即毙，承气入胃、阴盛以亡。伤寒有表
症，有里症，有半在表半在里，有表里两症俱见。然在表者宜汗，在里者宜下，在半表半里者宜和解，表里俱见随症施
治，无表里症，用大柴胡汤下之。其表症者、发热恶寒，身体痛而脉浮无汗，头疼项强腰脊痛，此足太阳膀胱经受病也，
宜汗之，然伤寒发表，当随病轻重而汗之，头疼发热兼惊，亦只用葱白汤汗之，甚则桂枝麻黄各半汤、解肌汤、葛根汤、
柴胡散，皆可选而用之。其里症者、恶热不恶寒，手掌心并腋下 汗出，胃中干涸，燥粪结聚，潮热大便硬，小便如
常，腹满而喘，躁渴脉沉而滑，内热而谵语，此属足阳明胃经也，宜下之，小承气汤、大承气汤、四顺饮、洗心散，斟
酌轻重用之。其在半表半里者、心下满，口不欲食，大便硬，脉沉细，是里症当下，其人头汗出，微恶寒，手足冷，即
当汗，此两症俱见者，仲景所谓半在表、半在里也，小柴胡汤主之。太阳病不解，传入少阳，胁下硬满，干呕不能食，
往来寒热，尚未吐下，诊其脉弦紧者，小柴胡汤主之，此属少阳胆经也，宜和解。其表里两症俱见者、病患脉浮而大，
是表症当汗。其人发热烦渴，小便赤，是里症当下，此是表里症俱见，五苓散主之。又伤寒不大便六七日，头痛有热者，
是里症当下，其人小便清者，知不在里，仍在表当须发汗，此是两症俱见，即未可下，宜与桂枝汤。又太阳病，医反下
之，因而腹痛，是有表复有里，仲景用桂枝加芍药汤，痛甚者，桂枝加大黄汤，或腹满时痛，尺寸脉俱浮洪者，此足太
阴脾经也，自利不渴，当温之，四逆汤、理中汤。其无表里者、伤寒四五日以后，以至过经，无表里症，又于里症未可
下者、但非汗症亦非下症者，皆用小柴胡汤随症加减用之，以至十余日外用小柴胡汤不愈者，若大便硬，看可汗则用大
柴胡汤下之。仲景云∶六七日目中不了了、睛不和，无表里症，大便难，身微热，此为实也，急下，宜大承气汤。若不
渴，口不燥，舌干而脉沉者，急温之，宜四逆汤，此足少阴肾经也。其表热里寒者，身大热而反欲得衣、热在皮肤、寒
在骨髓也，宜先与阴旦汤，寒已，次以小柴胡汤加桂，以温其表。又身大寒而反不欲近衣，寒在皮肤，热在骨髓也，宜
先与白虎加人参汤，热除，次以桂枝麻黄各半汤以解其外。又厥阴症脉浮缓者，必囊不缩，外症必发热恶寒似疟为欲愈，
宜桂枝麻黄各半汤，若脉尺寸俱沉短者，必囊缩，毒瓦斯入脏，宜承气汤下之，厥阴病，其脉微浮为欲愈，不浮为未愈，
宜小建中汤，此足厥阴肝经也。然以表里症内、近似三阴三阳之症，而疏于各症之下，非可以尽备六经之大法也，当以
活人书、伤寒论为主。其疟症与大方治法同，后有本条。夏伤于暑、秋必 疟，其暑症玉露散主之，其详亦与大方同其
治法，但用分剂轻耳。口议有脱甲散，大能除热，扶表救里，真良方也。
麻黄汤 治伤寒头疼发热，身痛恶风，无汗而喘。又治太阳病、脉浮紧无汗，发热身疼痛，八九日不解，表症
仍在，此当发其汗，服药已微除，其人烦目瞑，剧者必衄，衄乃解，所以然者，阳气重故也。
甘草（半两） 麻黄（去节、一两） 桂枝（一两） 杏仁（去皮尖、三十个）
上 咀，每服三钱，水一盏，煎八分去滓，大小加减服，衣复取微汗，夏至后、须加知母一两，石膏一两，黄芩一
两。盖麻黄性热，夏月温之，必有发黄发斑出血之失，凡伤寒热病，药性须凉，不可太温，惟冬及春，或病患平素虚寒
者，乃用正方，不再加减。
葱白汤 见第五十一问。
解肌汤 见第五十二问。
葛根汤 见第十六问。
柴胡散 见第五十问。
桂枝麻黄各半汤 治太阳病得之八九日、如疟状，发热恶寒，热多寒少，其人不呕，清便欲自可。一日二三
度发，脉微缓者、欲愈也。脉微而恶寒者，此阴阳俱虚，不可更发汗、更吐下也。面色反有热色者，未欲解也，以其
不能得小
汗出，身必痒。
桂枝（八钱） 芍药（半两） 生姜（半两） 甘草（半两） 麻黄（去节、半两） 杏仁（去皮尖、十四个） 大
枣（二个）
上 咀，每服三钱，水一小盏，煎八分，去滓温服。
小承气汤 治太阳病吐下后、发汗而微烦，小便数，大便坚宜服。阳明病，若出汗多而微恶寒，为外未解，无
潮热不可与之，若腹满不大便，可少少与之。
大黄（一两、微炒） 浓朴（半两、制） 枳实（一两，炒）
上 咀煎，阳明病潮热，大便微硬，可与大承气汤，不硬者，不可与之。若不大便六七日，恐有燥屎，欲知之法，
少与小承气汤，汤入腹中转失气者，此有燥屎也，乃可攻之。若不转失气者，必先硬后溏，不可攻之，攻之必腹满不能
食也。欲饮水者，与水则哕，其后发热者，必大便复硬而少也，以小承气汤和之，不转失气者，慎不可攻也。
大承气汤 见第二十九问。
四顺饮 见第四十四问四顺清凉饮。
洗心散 见第三十七问。
小柴胡汤 见第二十九问。
五苓散 见第五十二问。
桂枝汤 治太阳中风，阳浮而阴弱，阳浮者、热自发，阴弱者、汗自出，啬啬恶寒，淅淅恶风，翕翕发热，鼻
鸣干呕者。
桂枝（去皮、一两半） 芍药（一两半） 甘草（炙，一两） 生姜（一两半） 枣子（六个）
上为饮子，每服三钱，水一盏，煎至八分，去滓，大小加减服，须臾啜热粥一盏以助药力，温复令一时许，通身热，
微微似有汗者。加减桂枝汤，自西北二方居人，四时行之，无不应验，江淮间惟冬及春可行。自春末及夏至以前，桂枝
症，加黄芩一分，谓之阳旦汤。夏至后有桂枝症，可加知母半两，石膏一两，或升麻一分。若病素虚寒者，正用古方，
不再加减也。戒曰∶桂枝最难用，虽用云表不解可发汗，宜桂枝汤。须是病患常自汗出，小便不数，手足温和，或手足
指梢作微冷，少顷却温，身虽微似烦，而又憎寒，始可行之。若病患身无汗，小便数，或手足冷，不恶寒，或饮酒家不
喜甘者，慎不可行桂枝也。仍有桂枝症，服汤已、无桂枝症者，尤不可再与。
桂枝加芍药汤 治太阳病反下之，因腹痛、是有表复有里，宜服。
桂枝（一两半） 生姜（一两半） 大枣（六个） 甘草（炙、一两） 芍药（三两半、利者、先煎三四沸）
上 咀，水煎加减服。痛甚者加大黄，大实者加一两半，羸瘦虚弱者减之。
桂枝加大黄汤 治太阳病反下之，因腹满痛，属太阴，桂枝加芍药主之。大实痛者、桂枝加大黄汤主之。
桂枝（去皮、一两） 芍药（一两半） 甘草（炙、半两） 大黄（半两、羸者减之）
上 咀，每服三钱，水一盏，姜一片，枣一枚，煎服。
四逆汤 治阴症伤寒，自利不渴，呕哕不止，吐利俱作，小便或涩或利，脉微欲绝，腹痛胀满，手足厥冷，或
咳或悸，内寒外热，下利清谷，四肢沉重，或汗出热不出内，拘急身疼痛而恶寒者。
干姜（一两半） 附子（一个、生用） 甘草（一两）
上 咀，每服三钱，水一盏，煎七分，温服。
理中汤 治脾胃不和，中寒上冲，心腹 痛，痰逆恶心呕吐，心下虚烦痞满，膈塞不通，饮食减少，短气羸困，
温中逐水，止汗去湿，泄泻注下，水谷不分，腹中雷鸣，伤寒时气，里寒外热，霍乱吐利，手足厥冷。
人参（去芦、三两） 白术（三两） 干姜（炮、三两） 甘草（炙、一两半）
上 咀，每服三钱，水一盏，煎六分，去滓，带热服，空心食前。或研细末，白汤调下。腹痛者，加人参一两半。
脐上筑者，肾气动也，去白术加桂四两。吐多者，去术加生姜三两。下多者还用术。悸者加茯苓二两。或四肢拘急，腹
满下利，转筋者，去术加附子一个生用。末之，蜜丸如鸡子黄大，名理中丸，又名调中丸，治厥阴脏寒，蛔上入鬲，吐
长虫，或胃中虚冷，因发汗，故吐虫，先服理中丸。或加枳实、茯苓、蜜丸，治伤寒结胸欲绝，心鬲高起，实满作痛，
手不得近，并用热汤化下。
大柴胡汤 见第二十九问。
阴旦汤 治伤寒肢节疼痛，内寒外热虚烦。
桂（二两） 芍药（一两半） 甘草（炙一两） 干姜（炮一两半） 黄芩（一两半）
上 咀，每服三钱，水一盏，枣一个，同煎去滓，温服，复令少汗。
白虎加人参汤 治伤寒若吐若下后，七八日不解，热结在里，内外俱热，时恶寒，大渴大汗，烦渴不解，脉洪
大者。
石膏（四两、研细） 知母（一两半） 甘草（炙、半两） 粳米（一合） 人参（半两、去芦）
上 咀，每服三钱，水一盏，煎六分，米熟为度服。
小建中汤 治伤寒阳脉涩，阴脉弦，法当腹中急痛，先与小建中汤。
桂枝（一两半） 芍药（三两） 甘草（二两炙） 胶饴（半升）
上 咀，每服三钱，水一盏，生姜三片，枣一枚，煎六分，去滓，下胶饴两匙许，再煎化温服，日三夜二服。尺脉
尚迟，再作一剂，加黄 末一钱。
玉露散 凉心经，解诸热，治口燥咽干，烦渴躁啼，小便闭。
寒水石（一两） 石膏（一两、水飞） 甘草（三钱）
上为末，每服半钱，麦门冬泡汤化下，汤、散随意。加辰砂、金箔，名桃红散，亦治急惊。入栀子仁、名金莲散。
加滑石半两，名玉真散。汤氏方，治小儿秋夏伏暑，多烦热，吐黄涎，头额温，五心热，小便赤少。或干哕无物，宜服
香薷散。又宜服玉露散，生姜汁和白汤调下。独用姜汁一服而止。
脱甲散 治婴孩小儿，伤寒体热，头目昏沉，不思饮食，夹惊夹食寒热，大小便闭涩，或赤或白，烦躁作渴，
冷汗妄流，夹积伤滞，膈满胀急，青黄体瘦，日夜大热。及疗伤风、伤寒、伤暑，惊痫客忤，筋骨肾脏疳气等热，并宜
服之。
柴胡（去芦、二钱） 当归（酒洗、三钱） 白茯苓（三钱） 龙胆草（去芦、二钱） 人参（去芦、二钱） 知
母（去毛、二钱） 甘草（炙、四钱） 川芎（二钱）
上为末，每服一钱，水一盏，连须葱白一寸，煎至半盏，温服不拘时。此方散热，扶表救里，表虚令汗不妄行，里
热令气不闭结，外即通关，内即开渠，通关流行经路，开渠不壅脏腑，热在表里之间。施无不可。
凡治疗小儿伤寒，必须辨别表证和里证，如果表里不分，发汗或攻下的治疗就会出错。古人说：“桂枝汤服下，若阳热亢盛就会导致死亡；承气汤入胃，若阴寒内盛就会导致亡失。”伤寒有表证，有里证，有半在表半在里，还有表里两证同时出现。然而在表的适宜用发汗法，在里的适宜用攻下法，在半表半里的适宜用和解法，表里两证同时出现的随症状施治，没有表里证的（指邪气已离表入里但未成实，或病势较轻者），使用大柴胡汤攻下。
其表证的表现是：发热、恶寒，身体疼痛且脉浮、无汗，头痛、项强、腰脊痛，这是足太阳膀胱经受病，适宜发汗。然而治疗伤寒发表，应当根据病情的轻重来发汗，如果头痛发热兼有惊风，也只用葱白汤发汗；病情严重的，则可选用桂枝麻黄各半汤、解肌汤、葛根汤、柴胡散等方剂。
其里证的表现是：恶热不恶寒，手掌心和腋下出汗，胃中干燥，燥屎结聚，潮热、大便硬，小便正常，腹部胀满而喘，烦躁口渴、脉沉而滑，内热而谵语，这属于足阳明胃经，适宜攻下。小承气汤、大承气汤、四顺饮、洗心散，斟酌病情轻重选用。
其在半表半里的表现是：心下痞满，口不欲食，大便硬，脉沉细，这是里证应当攻下；其人头汗出，微恶寒，手足冷，这就应当发汗。这两种症状同时出现的，就是张仲景所说的“半在表、半在里”，用小柴胡汤主治。
太阳病不解，传入少阳，胁下硬满，干呕不能食，往来寒热，尚未经过吐下法治疗，诊察其脉弦紧的，用小柴胡汤主治，这属于少阳胆经，适宜和解。
其表里两证同时出现的是：患者脉浮而大，这是表证应当发汗。其人发热烦渴，小便赤，这是里证应当攻下。这是表里证俱见，用五苓散主治。
又伤寒不大便六七日，头痛有热的，这是里证应当攻下；其人小便清的，知道病不在里，仍在表，应当发汗。这是两证俱见，即暂时不可攻下，适宜给予桂枝汤。
又太阳病，医生反而用了攻下法，因而腹痛，这是有表证又有里证，张仲景用桂枝加芍药汤；疼痛剧烈的，用桂枝加大黄汤。或者腹满时痛，寸关尺脉俱浮洪的，这是足太阴脾经病，自利不渴，应当温补，用四逆汤、理中汤。
其无表里证的是：伤寒四五日以后，以至过经（病传尽），无表里证，又对于里证尚不可攻下的，既不是发汗证也不是攻下证的，都用小柴胡汤随症加减使用。以至十余日外用小柴胡汤不愈的，若大便硬，看是否可以发汗则用大柴胡汤攻下。
张仲景说：“六七日目中不了了、睛不和，无表里证，大便难，身微热，此为实证，急下，宜大承气汤。”若不渴，口不燥，舌干而脉沉的，急温之，宜四逆汤，这属于足少阴肾经。
其表热里寒的，身体大热却反想穿衣，热在皮肤，寒在骨髓，适宜先给阴旦汤，寒去后，次用小柴胡汤加桂枝，以温其表。
又身体大寒却反不想靠近衣服，寒在皮肤，热在骨髓，适宜先给白虎加人参汤，热除后，次以桂枝麻黄各半汤以解其外。
又厥阴病脉浮缓的，必然睾丸不收缩，外证必发热恶寒似疟疾，为欲愈，宜桂枝麻黄各半汤；若脉尺寸俱沉短的，必然睾丸收缩，毒瓦斯入脏，宜承气汤攻下。厥阴病，其脉微浮为欲愈，不浮为未愈，宜小建中汤，这属于足厥阴肝经。
然而以表里证在内，近似三阴三阳的证候，而在各证之下疏漏了，不可以尽备六经的大法，应当以《活人书》、《伤寒论》为主。
其疟疾与大人治法相同，后面有本条。夏伤于暑，秋必患疟，其暑证玉露散主治，其详细也与大人治法相同，只是用药分量轻罢了。口议有脱甲散，大能除热，扶表救里，真是良方。
麻黄汤：治疗伤寒头疼发热，身痛恶风，无汗而喘。又治疗太阳病，脉浮紧无汗，发热身疼痛，八九日不解，表证仍在，此当发其汗。服药后症状轻微缓解，其人烦闷目瞑，严重者必鼻衄，衄血乃解，之所以这样，是因为阳气重故也。
甘草（半两） 麻黄（去节、一两） 桂枝（一两） 杏仁（去皮尖、三十个）
以上切碎，每服三钱，水一盏，煎至八分，去渣，大小儿酌情加减服用，服药后盖衣取微汗。夏至后，须加知母一两，石膏一两，黄芩一两。因为麻黄性热，夏季温之，必有发黄发斑出血的失误。凡伤寒热病，药性须凉，不可太温，只有冬季及春季，或病患平素虚寒者，才用正方，不再加减。
葱白汤：见第五十一问。
解肌汤：见第五十二问。
葛根汤：见第十六问。
柴胡散：见第五十问。
桂枝麻黄各半汤：治疗太阳病得之八九日，如疟状，发热恶寒，热多寒少，其人不呕，清便欲自可。一日发作二三次，脉微缓的，为欲愈。脉微而恶寒的，这是阴阳俱虚，不可更发汗、更吐下。面色反有热色的，未欲解，因为其不能得小汗出，身必痒。
桂枝（八钱） 芍药（半两） 生姜（半两） 甘草（半两） 麻黄（去节、半两） 杏仁（去皮尖、十四个） 大枣（二个）
以上切碎，每服三钱，水一小盏，煎至八分，去渣温服。
小承气汤：治疗太阳病吐下后，发汗而微烦，小便数，大便坚宜服。阳明病，若出汗多而微恶寒，为外未解，无潮热不可与之。若腹满不大便，可少少与之。
以上切碎煎煮。阳明病潮热，大便微硬，可与大承气汤；不硬的，不可与之。若不大便六七日，恐有燥屎，欲知之法，少与小承气汤，汤入腹中转失气的，此有燥屎也，乃可攻之。若不转失气的，必先硬后溏，不可攻之，攻之必腹满不能食也。欲饮水者，与水则哕，其后发热者，必大便复硬而少也，以小承气汤和之。不转失气的，慎不可攻也。
大承气汤：见第二十九问。
洗心散：见第三十七问。
小柴胡汤：见第二十九问。
五苓散：见第五十二问。
桂枝汤：治疗太阳中风，阳浮而阴弱。阳浮者，热自发；阴弱者，汗自出。啬啬恶寒，淅淅恶风，翕翕发热，鼻鸣干呕者。
桂枝（去皮、一两半） 芍药（一两半） 甘草（炙，一两） 生姜（一两半） 枣子（六个）
以上为饮子，每服三钱，水一盏，煎至八分，去渣，大小儿酌情加减服用。须臾啜热粥一盏以助药力，温复令一时许，通身热，微微似有汗者。加减桂枝汤，自西北二方居人，四时行之，无不应验；江淮间惟冬及春可行。自春末及夏至以前，桂枝症，加黄芩一分，谓之阳旦汤。夏至后有桂枝症，可加知母半两，石膏一两，或升麻一分。若病素虚寒者，正用古方，不再加减也。戒曰：桂枝最难用，虽用云表不解可发汗，宜桂枝汤。须是病患常自汗出，小便不数，手足温和，或手足指梢作微冷，少顷却温，身虽微似烦，而又憎寒，始可行之。若病患身无汗，小便数，或手足冷，不恶寒，或饮酒家不喜甘者，慎不可行桂枝也。仍有桂枝症，服汤已、无桂枝症者，尤不可再与。
桂枝加芍药汤：治疗太阳病反下之，因腹痛，是有表复有里，宜服。
桂枝（一两半） 生姜（一两半） 大枣（六个） 甘草（炙、一两） 芍药（三两半、利者、先煎三四沸）
以上切碎，水煎加减服。痛甚者加大黄，大实者加一两半，羸瘦虚弱者减之。
桂枝加大黄汤：治疗太阳病反下之，因腹满痛，属太阴，桂枝加芍药主之。大实痛者，桂枝加大黄汤主之。
桂枝（去皮、一两） 芍药（一两半） 甘草（炙、半两） 大黄（半两、羸者减之）
以上切碎，每服三钱，水一盏，姜一片，枣一枚，煎服。
四逆汤：治疗阴症伤寒，自利不渴，呕哕不止，吐利俱作，小便或涩或利，脉微欲绝，腹痛胀满，手足厥冷，或咳或悸，内寒外热，下利清谷，四肢沉重，或汗出热不出内，拘急身疼痛而恶寒者。
以上切碎，每服三钱，水一盏，煎七分，温服。
理中汤：治疗脾胃不和，中寒上冲，心腹痛，痰逆恶心呕吐，心下虚烦痞满，膈塞不通，饮食减少，短气羸困，温中逐水，止汗去湿，泄泻注下，水谷不分，腹中雷鸣，伤寒时气，里寒外热，霍乱吐利，手足厥冷。
人参（去芦、三两） 白术（三两） 干姜（炮、三两） 甘草（炙、一两半）
以上切碎，每服三钱，水一盏，煎六分，去渣，带热服，空心食前。或研细末，白汤调下。腹痛者，加人参一两半。脐上筑者，肾气动也，去白术加桂四两。吐多者，去术加生姜三两。下多者还用术。悸者加茯苓二两。或四肢拘急，腹满下利，转筋者，去术加附子一个生用。末之，蜜丸如鸡子黄大，名理中丸，又名调中丸，治厥阴脏寒，蛔上入鬲，吐长虫，或胃中虚冷，因发汗，故吐虫，先服理中丸。或加枳实、茯苓、蜜丸，治伤寒结胸欲绝，心鬲高起，实满作痛，手不得近，并用热汤化下。
大柴胡汤：见第二十九问。
桂（二两） 芍药（一两半） 甘草（炙一两） 干姜（炮一两半） 黄芩（一两半）
以上切碎，每服三钱，水一盏，枣一个，同煎去渣，温服，复令少汗。
白虎加人参汤：治疗伤寒若吐若下后，七八日不解，热结在里，内外俱热，时恶寒，大渴大汗，烦渴不解，脉洪大者。
石膏（四两、研细） 知母（一两半） 甘草（炙、半两） 粳米（一合） 人参（半两、去芦）
以上切碎，每服三钱，水一盏，煎六分，米熟为度服。
小建中汤：治疗伤寒阳脉涩，阴脉弦，法当腹中急痛，先与小建中汤。
以上切碎，每服三钱，水一盏，生姜三片，枣一枚，煎六分，去渣，下胶饴两匙许，再煎化温服，日三夜二服。尺脉尚迟，再作一剂，加黄末一钱。
以上为末，每服半钱，麦门冬泡汤化下，汤、散随意。加辰砂、金箔，名桃红散，亦治急惊。入栀子仁、名金莲散。加滑石半两，名玉真散。汤氏方，治小儿秋夏伏暑，多烦热，吐黄涎，头额温，五心热，小便赤少。或干哕无物，宜服香薷散。又宜服玉露散，生姜汁和白汤调下。独用姜汁一服而止。
脱甲散：治疗婴孩小儿，伤寒体热，头目昏沉，不思饮食，夹惊夹食寒热，大小便闭涩，或赤或白，烦躁作渴，冷汗妄流，夹积伤滞，膈满胀急，青黄体瘦，日夜大热。及疗伤风、伤寒、伤暑，惊痫客忤，筋骨肾脏疳气等热，并宜服之。
柴胡（去芦、二钱） 当归（酒洗、三钱） 白茯苓（三钱） 龙胆草（去芦、二钱） 人参（去芦、二钱） 知母（去毛、二钱） 甘草（炙、四钱） 川芎（二钱）
以上为末，每服一钱，水一盏，连须葱白一寸，煎至半盏，温服不拘时。此方散热，扶表救里，表虚令汗不妄行，里热令气不闭结，外即通关，内即开渠，通关流行经路，开渠不壅脏腑，热在表里之间。施无不可。
In the treatment of pediatric Shanghan (Cold Damage), it is essential to differentiate between exterior and interior syndromes. Failure to distinguish between them leads to errors in sweating or purging therapies. The ancients said: "If Guizhi Tang (Cinnamon Twig Decoction) is taken when Yang heat is flourishing, death ensues; if Chengqi Tang enters the stomach when Yin cold is excessive, demise occurs." Shanghan presents with exterior syndromes, interior syndromes, half-exterior half-interior syndromes, and simultaneous exterior-interior syndromes. However, those in the exterior are suitable for diaphoresis (sweating therapy); those in the interior are suitable for purgation; those half-exterior half-interior are suitable for harmonization; simultaneous exterior-interior syndromes are treated according to symptoms; for cases without distinct exterior-interior signs (where pathogen has left the exterior but not formed excess internally, or disease is mild), Da Chaihu Tang (Major Bupleurum Decoction) is used for purgation.
Exterior syndromes manifest as fever, aversion to cold, body pain with floating pulse, anhidrosis, headache, stiffness of the neck and back, and lumbar/spinal pain. This indicates disease of the Foot-Taiyang Bladder Channel, suitable for diaphoresis. However, for exterior-releasing treatments in Shanghan, one must adjust based on severity. For headache and fever accompanied by fright, Congbai Tang (Scallion White Decoction) alone may be used for diaphoresis. In severe cases, Guizhi Mahuang Ge Ban Tang (Guizhi and Mahuang Half-Decoction), Ji Ji Tang (Muscle-Relieving Decoction), Gegen Tang (Kudzu Decoction), or Chaihu San (Bupleurum Powder) may be selected.
Interior syndromes manifest as aversion to heat without aversion to cold, sweating in the palms and axillae, dryness in the stomach, accumulation of dry feces, tidal fever, hard stool, normal urination, abdominal fullness with wheezing, restlessness, thirst, deep and slippery pulse, internal heat with delirium. This belongs to the Foot-Yangming Stomach Channel, suitable for purgation. Xiao Chengqi Tang (Minor Order the Qi Decoction), Da Chengqi Tang (Major Order the Qi Decoction), Sishun Yin (Four-Compliance Drink), and Xixin San (Heart-Washing Powder) should be chosen according to severity.
Half-exterior half-interior syndromes manifest as fullness below the heart, lack of desire to eat, hard stool, and deep-thin pulse. This is an interior syndrome requiring purgation. If the patient has sweating only on the head, slight aversion to cold, and cold hands/feet, diaphoresis is required. When both sets of symptoms appear simultaneously, this is what Zhang Zhongjing termed "half-exterior, half-interior," treated primarily with Xiao Chaihu Tang (Minor Bupleurum Decoction).
If Taiyang disease remains unresolved and transmits to Shaoyang, presenting with hardness/fullness in the hypochondrium, dry retching, inability to eat, alternating chills and fever, and before emesis or purgation has been applied, a string-tight pulse indicates Xiao Chaihu Tang as primary treatment. This belongs to the Shaoyang Gallbladder Channel, suitable for harmonization.
Simultaneous exterior-interior syndromes present with floating and large pulses, indicating an exterior syndrome requiring diaphoresis. Fever, irritability, thirst, and red urine indicate an interior syndrome requiring purgation. For simultaneous exterior-interior signs, Wuling San (Five-Ling Powder) is used.
Furthermore, if Shanghan involves constipation for six to seven days with headache and fever, this suggests an interior syndrome requiring purgation. However, if urine is clear, the disease is known not to be in the interior but still in the exterior, requiring diaphoresis. This is a case of simultaneous signs where purgation is temporarily contraindicated; Guizhi Tang is appropriate.
If Taiyang disease is mistakenly treated with purgation by the physician, resulting in abdominal pain, there is both an exterior and an interior component. Zhang Zhongjing uses Guizhi Jia Shaoyao Tang (Guizhi Decoction Augmented with Peony) for this. For severe pain, Guizhi Jia Dahuang Tang (Guizhi Decoction Augmented with Rhubarb) is used. Alternatively, for intermittent abdominal fullness/pain with floating and surging pulses at all three positions, this is Foot-Taiyin Spleen Channel disease; spontaneous diarrhea without thirst requires warming therapy, using Sini Tang (Frigid Extremities Decoction) or Lizhong Tang (Regulate the Middle Decoction).
For cases with no exterior-interior signs after four to five days of Shanghan, or after the disease has passed its course, where interior purgation is not yet indicated, and it is neither a sweating nor purging indication, Xiao Chaihu Tang is used with modifications. If after ten-plus days Xiao Chaihu Tang fails to resolve the condition, and stool is hard, if diaphoresis is possible, Da Chaihu Tang is used for purgation.
Zhang Zhongjing stated: "On the sixth or seventh day, if the eyes are unclear and pupils are unresponsive, with no exterior-interior signs, difficulty defecating, and slight body heat, this is an excess syndrome requiring urgent purgation with Da Chengqi Tang." If there is no thirst, dry mouth, dry tongue, and deep pulse, urgent warming with Sini Tang is required; this belongs to the Foot-Shaoyin Kidney Channel.
For exterior heat and interior cold, where the body is very hot but the patient desires clothing (heat in skin, cold in marrow), Yindan Tang should be given first. After the cold resolves, Xiaochaihu Tang plus Guizhi is used to warm the exterior. Conversely, for extreme cold without desire for clothing (cold in skin, heat in marrow), Baihu Jia Renshen Tang (White Tiger Decoction Plus Ginseng) is given first. After heat clears, Guizhi Mahuang Ge Ban Tang is used to release the exterior.
For Jueyin disease with floating-slow pulse, testicles will not retract; external signs of fever/chills resembling malaria indicate recovery, treated with Guizhi Mahuang Ge Ban Tang. If pulses at both cun and chi are deep and short, testicular retraction occurs due to toxin entering the zang organs, treated with Chengqi Tang for purgation. In Jueyin disease, a slightly floating pulse indicates recovery; non-floating indicates non-recovery, treated with Xiao Jianzhong Tang (Minor Construct the Middle Decoction), belonging to the Foot-Jueyin Liver Channel.
However, regarding interior/exterior signs approximating the Six Channels (Taiyang, Shaoyang, Yangming, Taiyin, Shaoyin, Jueyin), omissions exist in individual symptom descriptions, so one cannot rely solely on this text for the great principles of the Six Channels. One should primarily consult *Huoren Shu* (Book for Saving Lives) and *Shanghan Lun* (Treatise on Cold Damage).
Malaria treatment in children is the same as in adults, detailed later. Summer heat injury in summer leads to malaria in autumn; Yulu San (Jade Dew Powder) treats summer heat patterns, following adult methods but with lighter dosages. Tuojia San (Shell-Removing Powder) is highly effective for clearing heat, supporting the exterior, and saving the interior—a true excellent formula.
Mahuang Tang (Ephedra Decoction): Treats Shanghan with headache, fever, body pain, aversion to wind, anhidrosis, and wheezing. Also treats Taiyang disease with floating-tight pulse, anhidrosis, fever, body pain persisting for eight-nine days without resolution, where exterior signs remain. Diaphoresis is indicated. After medication, symptoms may slightly improve; the patient may feel irritated and close their eyes. Severe cases may experience epistaxis, which resolves the condition because Yang qi is heavy.
Gancao (Licorice Root, 0.5 liang), Mahuang (Ephedra Stem, de-node, 1 liang), Guizhi (Cinnamon Twig, 1 liang), Xingren (Apricot Seed, peel/remove tip, 30 pieces).
Chop ingredients. Take 3 qian per dose, boil in 1 sheng water to 0.8 sheng, remove dregs. Adjust dosage for age/size. Cover to induce slight sweating. After Summer Solstice, add Zhimu (Anemarrhena Rhizome, 1 liang), Shigao (Gypsum, 1 liang), Huangqin (Scutellaria Root, 1 liang). Because Mahuang is hot-natured, warming in summer risks jaundice, macules, or bleeding. For Shanghan febrile diseases, herbs should be cool, not too warm. Use the standard formula without modification only in winter/spring or for patients with chronic deficiency-cold.
Congbai Tang: See Question 51.
Ji Ji Tang: See Question 52.
Gegen Tang: See Question 16.
Chaihu San: See Question 50.
Guizhi Mahuang Ge Ban Tang: Treats Taiyang disease lasting eight-nine days, resembling malaria with fever/chills, more heat than cold, no vomiting, normal bowel/bladder function. Attacks occur 2-3 times daily. A slightly slow pulse indicates impending recovery. A faint pulse with aversion to cold indicates dual deficiency of Yin and Yang; do not use diaphoresis, emesis, or purgation. A ruddy complexion indicates unresolved condition due to inability to produce slight sweat, causing body itching.
Guizhi (Cinnamon Twig, 8 qian), Shaoyao (Peony Root, 0.5 liang), Shengjiang (Fresh Ginger, 0.5 liang), Gancao (Licorice Root, 0.5 liang), Mahuang (Ephedra Stem, de-node, 0.5 liang), Xingren (Apricot Seed, peel/remove tip, 14 pieces), Dazao (Jujube, 2 pieces).
Chop. Boil 3 qian in 0.1 sheng water to 0.8, remove dregs, take warm.
Xiao Chengqi Tang: Treats post-emesis/purgation/diaphoresis in Taiyang disease with slight irritability, frequent urination, and hard stool. For Yangming disease, if profuse sweating with slight aversion to cold indicates unresolved exterior, do not give if there is no tidal fever. If abdominal fullness and constipation exist, give small amounts cautiously.
Dahuang (Rhubarb Root and Rhizome, lightly stir-fried, 1 liang), Houpo (Magnolia Bark, processed, 0.5 liang), Zhishi (Immature Bitter Orange, stir-fried, 1 liang).
Chop and boil. For Yangming tidal fever with slightly hard stool, Da Chengqi Tang may be used; if not hard, do not use. If constipated for 6-7 days suspecting dry feces, give a small amount of Xiao Chengqi Tang. If passing gas after ingestion, dry feces are present, and purgation can proceed. If no gas passes, stool is likely hard initially then loose; do not purge, as it causes abdominal fullness and anorexia. Thirst with water induces hiccups. Subsequent fever indicates recurrent hard/scanty stool; harmonize with Xiao Chengqi Tang. Do not purge if no gas passes.
Da Chengqi Tang: See Question 29.
Sishun Yin: See Question 44 (Sishun Qingliang Yin).
Xixin San: See Question 37.
Xiao Chaihu Tang: See Question 29.
Wuling San: See Question 52.
Guizhi Tang: Treats Taiyang Wind Strike with floating-yang and weak-yin pulses. Floating yang indicates spontaneous heat; weak yin indicates spontaneous sweating. Symptoms include chilly aversion to cold, drafty aversion to wind, mild fever, nasal congestion, and dry retching.
Guizhi (Cinnamon Twig, peeled, 1.5 liang), Shaoyao (Peony Root, 1.5 liang), Gancao (Licorice Root, roasted, 1 liang), Shengjiang (Fresh Ginger, 1.5 liang), Zaozi (Jujube, 6 pieces).
Prepare as infusion. Take 3 qian, boil in 1 sheng water to 0.8, remove dregs. Adjust for age. Drink hot porridge immediately to assist efficacy. Cover for about one hour until whole-body warmth and slight sweating occur. Modified Guizhi Tang is effective year-round in Northwest China; in Jianghuai regions, only in winter/spring. From late spring to pre-Summer Solstice, add Huangqin (Scutellaria Root, 0.1 fen) for Guizhi patterns, called Yangdan Tang. Post-Summer Solstice, add Zhimu (Anemarrhena Rhizome, 0.5 liang), Shigao (Gypsum, 1 liang), or Shengma (Cimicifuga Rhizome, 0.1 fen). For chronic deficiency-cold, use ancient formula without modification. Warning: Guizhi Tang is difficult to apply correctly. Although it releases the exterior, it requires spontaneous sweating, normal urination frequency, warm extremities (or slightly cold fingertips that warm quickly), and slight irritability combined with aversion to cold. Contraindicated in anhidrosis, frequent urination, cold extremities, lack of aversion to cold, or those who dislike sweet tastes (e.g., alcohol drinkers). Do not repeat if symptoms resolve after first dose.
Guizhi Jia Shaoyao Tang: Treats Taiyang disease mistakenly purged, resulting in abdominal pain (exterior and interior signs).
Guizhi (Cinnamon Twig, 1.5 liang), Shengjiang (Fresh Ginger, 1.5 liang), Dazao (Jujube, 6 pieces), Gancao (Licorice Root, roasted, 1 liang), Shaoyao (Peony Root, 3.5 liang; boil briefly first if diarrhea exists).
Chop, boil, adjust dosage. Add Dahuang for severe pain; add 1.5 liang for severe excess; reduce for frail/weak patients.
Guizhi Jia Dahuang Tang: Treats Taiyang disease mistakenly purged, resulting in abdominal fullness/pain belonging to Taiyin. Guizhi Jia Shaoyao Tang is primary. For severe excess pain, Guizhi Jia Dahuang Tang is used.
Guizhi (Cinnamon Twig, peeled, 1 liang), Shaoyao (Peony Root, 1.5 liang), Gancao (Licorice Root, roasted, 0.5 liang), Dahuang (Rhubarb Root and Rhizome, 0.5 liang; reduce for frail patients).
Chop. Take 3 qian, boil in 1 sheng water with 1 slice ginger and 1 jujube.
Sini Tang: Treats Yin-pattern Shanghan with spontaneous diarrhea without thirst, continuous retching/vomiting, simultaneous vomiting/diarrhea, obstructed or free urination, faint/almost imperceptible pulse, abdominal pain/distension, cold extremities, cough or palpitations, internal cold with external heat, clear grain diarrhea, heavy limbs, sweating with internal heat retention, spasmodic body pain with aversion to cold.
Ganjiang (Dried Ginger, 1.5 liang), Fuzi (Aconite Root, raw, 1 piece), Gancao (Licorice Root, 1 liang).
Chop. Take 3 qian, boil in 1 sheng water to 0.7, take warm.
Lizhong Tang: Treats Spleen/Stomach disharmony, middle-jiao cold rushing upward, heart/abdominal pain, phlegm/reversal qi with nausea/vomiting, empty irritability/fullness below heart, diaphragmatic obstruction, reduced appetite, shortness of breath/frailty. Warms middle, expels water, stops sweating/removes dampness, treats diarrhea/water-greasy stools, borborygmus, Shanghan seasonal pathogens, internal cold with external heat, cholera-like vomiting/diarrhea, cold extremities.
Renshen (Ginseng Root, de-radicle, 3 liang), Baizhu (Atractylodes Macrocephala Rhizome, 3 liang), Ganjiang (Dried Ginger, roasted, 3 liang), Gancao (Licorice Root, roasted, 1.5 liang).
Chop. Take 3 qian, boil in 1 sheng water to 0.6, remove dregs, take warm on empty stomach before meals. Or grind to powder, mix with warm water. Add Renshen 1.5 liang for abdominal pain. For pulsation above navel (Kidney qi movement), remove Baizhu, add Rougui (Cinnamon Bark, 4 liang). For excessive vomiting, remove Baizhu, add Shengjiang (Fresh Ginger, 3 liang). For excessive diarrhea, retain Baizhu. For palpitations, add Fuling (Poria, 2 liang). For limb spasms, abdominal fullness/diarrhea, or muscle cramps, remove Baizhu, add raw Fuzi (Aconite Root, 1 piece). Grind, make honey pills size of chicken egg, named Lizhong Wan (Regulate the Middle Pill) or Tiaozhong Wan. Treats Jueyin organ cold, ascendant roundworms, vomiting long worms, or stomach deficiency-cold from diaphoresis causing worm vomiting; take Lizhong Wan first. Can add Zhishi (Immature Bitter Orange) and Fuling, honey pills, for severe Shanghan Jie Xiong (Chest Binding) with high chest fullness/pain sensitive to touch; dissolve in hot water.
Da Chaihu Tang: See Question 29.
Yindan Tang: Treats Shanghan with joint pain, internal cold with external heat and empty irritability.
Gui (Cinnamon Twig, 2 liang), Shaoyao (Peony Root, 1.5 liang), Gancao (Licorice Root, roasted, 1 liang), Ganjiang (Dried Ginger, roasted, 1.5 liang), Huangqin (Scutellaria Root, 1.5 liang).
Chop. Take 3 qian, boil in 1 sheng water with 1 jujube, remove dregs, take warm to induce slight sweating.
Baihu Jia Renshen Tang: Treats Shanghan post-emesis/purgation, unresolved after 7-8 days, heat binding in interior, internal/external heat, occasional chills, extreme thirst/sweating, persistent irritability/thirst, flooding-large pulse.
Shigao (Gypsum, crushed, 4 liang), Zhimu (Anemarrhena Rhizome, 1.5 liang), Gancao (Licorice Root, roasted, 0.5 liang), Jingmi (Glutinous Rice, 1 he), Renshen (Ginseng Root, de-radicle, 0.5 liang).
Chop. Take 3 qian, boil in 1 sheng water to 0.6, cook until rice is soft, then take.
Xiao Jianzhong Tang: Treats Shanghan with rough-yang and string-string yin pulses, indicating acute abdominal pain. Give Xiao Jianzhong Tang first.
Guizhi (Cinnamon Twig, 1.5 liang), Shaoyao (Peony Root, 3 liang), Gancao (Licorice Root, roasted, 2 liang), Yitang (Maltose, 0.5 sheng).
Chop. Take 3 qian, boil in 1 sheng water with 3 slices ginger and 1 jujube to 0.6, remove dregs, add 2 spoons Yitang, melt and take warm. Take 3 times day, 2 times night. If chi pulse is still slow, prepare another dose adding Huang Qin (Scutellaria Root) powder 1 qian.
Yulu San: Cools Heart channel, clears various heats, treats dry mouth/throat, irritability/thirst/restless crying, urinary obstruction.
Hanshuishi (Calcitum, 1 liang), Shigao (Gypsum, water-ground, 1 liang), Gancao (Licorice Root, 3 qian).
Grind to powder. Take 0.5 qian, dissolve in Mai Dong (Ophiopogon Tuber) decoction. Dosage of liquid/powder flexible. Add Chen Sha (Cinnabar) and Jin Bo (Gold Leaf), named Taohong San, also treats acute fright convulsion. Add Zhizi (Gardenia Fruit), named Jinlian San. Add Huashi (Talcum, 0.5 liang), named Yuzhen San. Tang Shi's formula treats pediatric latent summer heat in autumn/summer with irritability/heat, yellow saliva vomiting, warm forehead, five-palm heat, scanty red urine. For dry retching without material, Xiangru San (Elsholtzia Powder) is suitable. Also suitable is Yulu San mixed with Shengjiang Zhi (Fresh Ginger Juice) and warm water. Fresh ginger juice alone stops symptoms in one dose.
Tuojia San: Treats infant Shanghan with body heat, heavy/dizzy head, poor appetite, concurrent fright/food stagnation with chills/fever, urinary/fecal obstruction (red or white), irritability/thirst, profuse cold sweat, food stagnation, chest fullness/tightness, green/yellow thin body, severe day/night heat. Also treats Wind-Cold, Shanghan, Summer-Heat, fright epilepsy, alien spirits, bone/joint/kidney malnutrition heat. Suitable for all.
Chaihu (Bupleurum Root, de-radicle, 2 qian), Danggui (Angelica Sinensis Root, wine-washed, 3 qian), Baifuling (Poria, 3 qian), Longdan Cao (Gentiana Root, de-radicle, 2 qian), Renshen (Ginseng Root, de-radicle, 2 qian), Zhimu (Anemarrhena Rhizome, de-hair, 2 qian), Gancao (Licorice Root, roasted, 4 qian), Chuanxiong (Ligusticum Rhizome, 2 qian).
Grind to powder. Take 1 qian, boil in 1 sheng water with 1 cun scallion white (with roots) to 0.5 sheng, take warm anytime. This formula dissipates heat, supports exterior, saves interior. Deficient exterior prevents erratic sweating; interior heat prevents qi closure. Opens pathways externally, drains channels internally. Effective for heat between exterior and interior. No contraindications.