总括 伤寒之候有多般，一概推详便觉难；面目俱红时喷涕，气粗身热是伤寒。
脉法，《难经》曰∶伤寒之脉，阴阳俱盛而紧涩，浮涩而紧为伤寒。
伤寒伤风何以判，寒脉紧涩风浮缓。伤寒恶寒风恶风，伤风自汗寒无汗。阳属膀胱并胃胆，阴居脾肾更连肝。浮长
弦细沉微缓，脉症先将表里看。
凡论脉息，若早晨小，至晚反大，病为未愈；若早晨大，至晚反小，病欲愈。所谓大则病进，小则病退也。
《内经》曰∶人之伤于寒也，则为病热，热虽甚不死，若日传二经病名两感，两感于寒者则不免于死矣。第大人与
小儿病原治法虽相去不远，然用药不可太热，盖小儿系纯阳之体。仲景云∶春气融和，夏气炎热，秋气清凉，冬气凛冽，
此四时正气之序也。冬时严寒，万类深藏，君子固密，不伤于寒，触冒之者乃名伤寒。其伤于四时之气皆能为病。冬受
寒毒之气，其实时而病者，头疼身疼肌热恶寒，此为正伤寒。（自批∶伤寒一日在太阳，腰脊头痛不可当；二日阳明胃
家热，目痛鼻干眠不得；三日少阳传胆经，胸胁疼痛耳聋鸣；四日太阴脾受病，腹满咽干传里应；五日少阴肾家病，口
燥舌干烦渴定；六日厥阴肝经尽，舌卷囊缩传里症。）其不实时病者，寒毒藏于肌肤之间，致春夏阳气发生，则寒毒于
阳气相搏于荣卫之间，其病与冬时即病无异。但至春而发名曰瘟病，至夏而发名曰热病。阳热未盛，寒为所制，故病为
温。阳热已盛，寒不能制，故病为热，此均谓之伤寒也。又春时应暖而反寒，夏应热而反冷，秋应凉而反热，冬应寒而
反温，此非时而有其气，病无长幼率相似者，此俗谓之天行是也。小儿感冒寒邪者，多因乳母解脱衣服，饮食起居不避
风寒，或夏秋之间天气盛热，乳母当风取凉，致风寒之气伤之，是以亦病伤寒也。然小儿是患此，口不能言其致病之由，
脉不能诊其必然之理，但只烦啼发热而已，视之其不可尽心乎？故初得之时，以虎口指纹之红色验之。长而童稚，则以
一指按其三关，按左手人迎之紧盛而断之，斯得之矣！
陶节庵曰∶凡症有头痛恶寒，皆是伤寒，无则皆非也，何则？伤寒恶寒，伤食恶食，理固然也。惟在冬时，恶寒殊
甚，盖冬时为正伤寒，寒风猛冽，触之者恶寒殊甚。其余时月，虽恶寒亦微也。盖冬时之气寒，腠理微密，非辛温不可，
故以桂枝等药治之。然风与寒常相因，寒则伤荣，恶寒头痛，脉浮紧而无汗，则用麻黄汤开发腠理，以散邪得汗即愈。
风则伤卫，头痛恶风，脉浮缓而自汗，则用桂枝汤先塞腠理以发邪，汗止即愈。
《经》曰∶甘辛发散为阳者是也，若夫荣卫俱伤，又非此二汤所能治也，须大青龙汤。然此汤太峻，亦有可代之者，
其非冬时，有恶寒头痛之症，宜羌活冲和汤，辛凉之剂兼表里以和之，兼可代大青龙汤也。过此则少阳阳明二经，在乎
半表半里（肌肉）之间，脉亦不沉不浮，外症至阳明则有咽痛、鼻干、不得眠之症，脉似洪而长以葛根升麻汤治之。在
少阳则心胁痛而耳聋，脉见弦数，以小柴胡汤加减而和解之。本方有加减法，此二经不从标本从乎中也，余常以小柴胡
汤加葛根、芍药治少阳阳明俱病，如拾草芥，过此不已则传阳明之本，为入里矣，便作实热治之。其外症悉罢，谓无头
痛恶寒，脉见沉实不浮，谵语恶热，六七日不大便，口燥咽干而渴，轻则大柴胡汤，重则大承气汤选用。
《伤寒蕴要》曰∶凡小儿伤寒则怕寒，拘急，发热，合为一，翕翕然在表，昼夜不止，直待汗出方解，其恶寒恶风，
必偎人藏身，引衣密隐，鼻塞多涕，是为表症，宜微汗之，解肌汤、萧氏小青龙汤、败毒散之类。恶热内实者必出头露
面扬手掷足、掀衣气粗烦渴燥粪，是为里症，宜疏利之，小柴胡汤、四顺饮之类。若头额冷、手足凉、口气冷、面色黯
淡、泻痢青白，是为阴症，宜与温之，五积散、理中汤之类。重者四逆汤主之。夹惊者因惊之时而又感风邪，或因伤寒
发热，以致热极生风，是热乘于心。心主血脉，心神易动，为热所乘，故发搐也，慎勿与治惊之剂，宜疏解之，王氏薄
荷散、人参羌活散之类，甚者抱龙丸主之。夹食者先伤于寒，后伤于食，或先伤于食，后伤于寒，以致发热气粗，口气
嗳气，肚热腹胀，上热下冷或大便酸 ，并宜解散，次与消导，甚则推荡之，先用败毒散，后用藿香正气散加神曲、麦
芽、棠 子、砂仁、香附之类。如不愈以大柴胡汤下之。
汤氏曰∶大凡小儿伤寒治法，周岁以前，热轻者服惺惺散，周岁以后须急解表，微汗为妙，在一昼夜得汗方保无虞。
今之医士多不表汗，致令五六日不除，入于经络，搏于血气，变传多症，或生惊风，渐致危笃，伤生害命，可不慎乎？
然表里不可不知，盖表里不分，汗下差误。古人云∶桂枝下咽，阳盛即毙；承气入胃，阴盛乃亡。伤寒有表症、有里症、
有半在表半在里症、有表里二症俱见、有无表里症。然表者宜汗，有里者宜下，在半表半里者宜和解，表里俱见，随
症渗泄，无表里者，大柴胡汤下之。
其表症者发热恶寒，身首俱痛，无汗、脉浮、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。头痛发热兼惊，只用葱白汤主之，甚则麻黄各半汤、解肌汤之类。
其表症恶热不恶寒，手足心并腋下 汗出，胃中干涸，燥粪细聚，潮热大便结，小便如常，腹满而喘，烦躁而渴，
脉实而滑，内热而谵语，此属足阳明胃经也，宜下之，可用大小承气并四顺饮、洗心散斟酌而用之。
其在半表半里者，心下满，口不欲食，大便坚，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 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。此属足少阳胆经也，宜和解之。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，须当发汗，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，尺寸脉俱沉者，此属足
太阴脾经也，自利不渴当温之，宜四逆汤、理中汤。
其无表里症者，伤寒四五日，以后及至过经，无表里症又无里症，未可下，但非汗症，亦非下症者，皆用小柴胡汤，
随症加减用之。至十余日外，用小柴胡汤不愈者，若大便坚看可下，则用大柴胡汤下之。仲景云∶六七日目中了了，睛
不和，无表里症，大便难，身微热，此谓实也，宜当下大承气汤；若不渴，不口燥、舌干，而脉沉者，急温之，宜四逆
汤，此属足少阴肾经也。
其表里寒热者，身大热而反欲得衣，热在皮肤，寒在骨髓也，宜先与温胆汤。寒已，次以小柴胡汤加桂以治其表。
又身大寒而反不欲近衣，寒在皮肤，热在骨髓也，宜先与白虎汤加人参，热除，次以桂枝麻黄各半汤。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，此属足厥阴肝经也。然以表里症内，似三阴三阳之症，而
疏于各症之下，非所以尽备六经之大法也，当以活人书《伤寒论》为主，其疟症亦与大方同，其暑症玉露散主之，亦与
大方同，第剂分大小耳。《口议》有脱甲散，大能散热扶表，真良方也。
〔附方〕
麻黄汤 见咳嗽症内。
桂枝汤 见惊风症内。
大青龙汤 桂枝 麻黄 石膏 杏仁 甘草 生姜 大枣
羌活冲和汤 苍术 白芷 细辛 生地 羌活 防风 茯苓 川芎 甘草
葛根升麻汤 升麻 葛根 芍药 甘草
小柴胡汤 见诸吐症内。
大柴胡汤 见疟疾症内。
大承气汤 见痢疾症内。
解肌汤 干葛 桂枝 芍药 麻黄 黄芩 甘草
小青龙汤 麻黄 赤芍 半夏 细辛 干姜 桂枝 五味 甘草
败毒散 见痢疾症内，或去茯苓用黄芩。
四顺汤 当归 大黄 赤芍 甘草
五积散 麻黄 苍术 陈皮 白芷 人参 茯苓 桂枝 桔梗 半夏 白芍 当归 浓朴 川芎 干姜 枳
壳甘草
理中汤 见惊风症内。
四逆汤 附子 干姜 甘草（炙）
薄荷散 金樱 葛根 薄荷 甘草 骨碎补
人参羌活散 人参 羌活 赤芍 赤茯苓 柴胡 前胡 独活 川芎 桔梗 甘草 苍术 枳壳
抱龙丸 胆星 天竹黄 雄黄 朱砂 麝香 甘草为丸
藿香正气散 见积滞症内
惺惺散 见诸吐症内。
葱白汤 葛根 芍药 知母 川芎
桂枝麻黄各半汤 见疟疾症内。
小承气汤 大黄 枳实 浓朴
洗心散 麻黄 大黄 白芍 当归 白术 荆芥 甘草
小柴胡汤 见诸吐症内。
五苓散 见惊风症内。
桂枝汤 风惊风症内。
桂枝芍药汤 桂枝 干葛 芍药 大枣 甘草
桂枝大黄汤 桂枝 芍药 大黄 甘草
温胆汤 竹茹 枳实 半夏 陈皮 甘草 生姜
白虎汤 石膏 知母 人参 甘草 粳米
小建中汤 胶饴 桂枝 芍药 甘草 生姜 大枣
玉露散 见霍乱症内。
脱甲散 柴胡 当归 胆草 茯苓 人参 知母 川芎 甘草
总括：伤寒的症状表现多种多样，如果一概而论地详细推究，就会觉得难以把握；若见面部和眼睛都发红，时常打喷嚏，呼吸粗重且身体发热，这就是伤寒。
脉法：《难经》说：伤寒的脉象，阴脉和阳脉都盛大且紧涩，浮取时涩而紧，这是伤寒的脉象。
如何判断是伤寒还是伤风？伤寒的脉象紧涩，伤风的脉象浮缓。伤寒怕冷（恶寒），伤风怕风（恶风）；伤风自汗出，伤寒无汗。阳经受邪涉及膀胱、胃和胆，阴经受邪涉及脾、肾并牵连肝。脉象有浮、长、弦、细、沉、微、缓等不同变化，诊断时要先将表证和里证区分清楚。
凡是论述脉息，如果早晨脉小，到了晚上反而变大，说明病未愈；如果早晨脉大，到了晚上反而变小，说明病将要痊愈。这就是所谓“脉大则病进，脉小则病退”的道理。
《内经》说：人受寒邪侵袭，就会发为热病，即使热势很严重也不会死亡；但如果一天内传变两条经脉，称为“两感于寒”，患两感伤寒的人就难免死亡了。大体上，成人和小儿的病因及治法虽然相差不远，但用药不可过于温热，因为小儿属于“纯阳之体”。张仲景说：春气融和，夏气炎热，秋气清凉，冬气凛冽，这是四时正气的次序。冬季严寒，万物深藏，君子注意固护密闭，就不受寒邪伤害，触犯冒犯的就叫作伤寒。受四时之气侵害都能致病。冬季感受寒毒之气，当时就发病的，出现头痛身痛、肌肉发热、怕冷等症状，这叫“正伤寒”。（自批注：伤寒第一天在太阳经，腰脊头痛剧烈难忍；第二天阳明胃家热盛，目痛鼻干睡不着；第三天少阳传至胆经，胸胁疼痛耳鸣耳聋；第四天太阴脾受病，腹满咽干，病已传入里部；第五天少阴肾家生病，口燥舌干烦渴确定；第六天厥阴肝经病尽，舌卷囊缩，病已传入里部。）当时不发病的，寒毒潜伏在肌肤之间，等到春夏阳气生发时，寒毒与阳气在荣卫之间相互搏结，其病症与冬天即时发病没有区别。只是到春天发作的叫作瘟病，到夏天发作的叫作热病。阳热尚未强盛，被寒邪所制约，所以病名为温。阳热已经强盛，寒邪不能制约，所以病名为热，这些都统称为伤寒。另外，春季应该温暖却反常寒冷，夏季应该炎热却反常寒冷，秋季应该凉爽却反常炎热，冬季应该寒冷却反常温暖，这种非时令而有相应气候，病人无论老少症状都相似的，这就是俗话说的“天行”（时行疫病）。小儿感冒寒邪，多是因为乳母脱去衣服，饮食起居不注意避风寒，或者夏秋之间天气酷热，乳母当风乘凉，导致风寒之气伤害婴儿，因此也患上伤寒。然而小儿患此病，口不能说出致病的原因，脉象也不能完全诊察出其必然的道理，只是表现为烦躁啼哭、发热而已，看着他们这样，医生怎能不尽心诊治呢？所以在初得病时，通过观察虎口指纹的红色来验证。稍长一些的童稚，可以用一根手指按压三关，按察左手人迎穴处脉象是否紧盛来判断，这样才能准确掌握病情！
陶节庵说：凡是症状有头痛恶寒的，都是伤寒，如果没有这些症状，就都不是伤寒。为什么呢？伤寒怕冷，伤食厌恶食物，道理本来就是这样的。只是在冬季，怕冷特别严重，因为冬季是正伤寒时节，寒风猛烈刺骨，触犯者怕冷特别严重。其他月份，虽然也有怕冷，但也较轻。因为冬季气候寒冷，腠理致密，不用辛温药物不行，所以用桂枝汤等药物治疗。然而风与寒常常互为因果，寒邪伤营血，出现恶寒头痛，脉浮紧而无汗，就用麻黄汤开发腠理，发散邪气，出汗即愈。风邪伤卫气，出现头痛恶风，脉浮缓而自汗，就用桂枝汤先固护腠理以发散邪气，汗止即愈。
《内经》说：甘辛发散的药物属于阳药，如果是营卫俱伤，就不是这两张方剂所能治疗的，必须用大青龙汤。然而此汤药性太峻猛，也有可以替代它的方子，如果不是冬季，有恶寒头痛的症状，宜用羌活冲和汤，这是辛凉的药剂，兼治表里以调和它，也可以替代大青龙汤。过了这个阶段，就是少阳和阳明二经，位于半表半里（肌肉）之间，脉象也不沉也不浮，外症到了阳明经则有咽痛、鼻干、睡不着觉等症状，脉象似洪大而长，用葛根升麻汤治疗。在少阳经则心胁痛且耳聋，脉见弦数，用小柴胡汤加减来和解它。本方有加减法，这两经不从标本而从乎中，我常用小柴胡汤加葛根、芍药治疗少阳阳明同病，如同拾取草芥般容易。过了这个界限如果不愈，则传入阳明之本，成为入里了，便作为实热证治疗。其外症全部消失，谓无头痛恶寒，脉见沉实不浮，谵语怕热，六七天不大便，口燥咽干而渴，轻症用大柴胡汤，重症用大承气汤选用。
《伤寒蕴要》说：凡是小儿伤寒则怕冷，肢体拘急，发热，合在一起，热势像覆盖物一样在体表，昼夜不止，直到出汗才解除，其恶寒恶风，必定依偎在人怀里藏身，拉过衣服严密遮盖，鼻塞流涕多，这是表证，宜用微汗法，解肌汤、萧氏小青龙汤、败毒散之类。怕热内实者必定出头露面、扬手掷足、掀开衣服、气粗烦渴、大便干燥，这是里证，宜用疏利法，小柴胡汤、四顺饮之类。如果头额冷、手足凉、口气冷、面色暗淡、泻痢青白色，这是阴证，宜给予温补，五积散、理中汤之类。重症用四逆汤主治。夹惊者，因为受惊之时又感受风邪，或因伤寒发热，以致热极生风，这是热邪乘袭于心。心主血脉，心神易动，被热邪乘袭，所以发生抽搐，千万不要给治惊的药物，宜用疏解法，王氏薄荷散、人参羌活散之类，严重的用抱龙丸主治。夹食者，先伤于寒，后伤于食，或先伤于食，后伤于寒，以致发热气粗，口气嗳气，肚热腹胀，上热下冷或大便酸臭，并宜解散，其次给予消导，严重时用推荡法，先用败毒散，后用藿香正气散加神曲、麦芽、棠梨子、砂仁、香附之类。如不愈，用大柴胡汤攻下。
汤氏说：大凡小儿伤寒治法，周岁以前，热轻者服用惺惺散，周岁以后须急解表，微汗为妙，在一昼夜内得汗才能保无危险。现在的医生大多不解表发汗，致使五六天病除不了，病邪进入经络，搏结于血气，变传多种症状，或生惊风，逐渐导致危重，伤害生命，能不谨慎吗？然而表里不可不知，因为表里不分，汗法和下法就会出错。古人说：桂枝汤喝下去，阳盛者即死；承气汤入胃，阴盛者乃亡。伤寒有表证、有里证、有半在表半在里证、有表里二证俱见、有无表里证。然而表证宜发汗，有里证宜攻下，在半表半里者宜和解，表里俱见，随症渗泄，无表里证者，用大柴胡汤攻下。
其表证者发热恶寒，身首俱痛，无汗、脉浮、项强、腰脊痛，这是足太阳膀胱经受病，宜发汗。然而伤寒发表，应当随病情轻重而发汗。头痛发热兼惊，只用葱白汤主治，严重的用麻黄各半汤、解肌汤之类。
其表证恶热不恶寒，手足心并腋下出汗，胃中干涸，燥粪细聚，潮热大便结，小便如常，腹满而喘，烦躁而渴，脉实而滑，内热而谵语，这属于足阳明胃经，宜攻下，可用大小承气汤并四顺饮、洗心散斟酌而用。
其在半表半里者，心下满，口不欲食，大便坚，脉沉细，这是里证，当下。其人头汗出，微恶寒，手足冷，即当发汗。这两个症状同时出现的，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，胁下满，干呕不能食，往来寒热，尚未吐下，诊其脉弦紧的，用小柴胡汤主治。这属于足少阳胆经，宜和解。其表里两证俱见者，病患脉浮而大，是表证，当发汗，其人发热，烦渴，小便赤，是里证，当下，这是表里证俱见，用五苓散主治。又伤寒不大便，六七天头痛有热的，是里证，当下；其人小便清的，知道不在里，仍在表，须当发汗，这是两证俱见，即不可下，宜给桂枝汤。又太阳病，医生反而攻下，因而腹痛，是有表复有里，张仲景用桂枝加芍药汤，痛严重的用桂枝加大黄汤。或腹满时痛，尺寸脉俱沉的，这属于足太阴脾经，自利不渴当温之，宜四逆汤、理中汤。
其无表里证者，伤寒四五日，以后及至过经，无表里证又无里证，不可下，但非汗证，亦非下证者，都用小柴胡汤，随症加减用。至十余日外，用小柴胡汤不愈的，若大便坚硬看可下，则用大柴胡汤攻下。张仲景说：六七天目中明了，睛不和，无表里证，大便难，身微热，这叫实，宜当下，用大承气汤；若不渴，不口燥、舌干，而脉沉的，急温之，宜四逆汤，这属于足少阴肾经。
其表里寒热错杂者，身大热而反欲得衣，热在皮肤，寒在骨髓，宜先给温胆汤。寒已，次以小柴胡汤加桂枝以治其表。又身大寒而反不欲近衣，寒在皮肤，热在骨髓，宜先给白虎汤加人参，热除，次以桂枝麻黄各半汤。又厥阴证，脉浮缓的，必睾丸不缩，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，必睾丸缩，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。然而以表里证内，似三阴三阳之证，而在各证之下疏略，不是用来完备六经的大法，应当以《活人书》《伤寒论》为主，其疟疾证也与大方相同，其暑证玉露散主治，也与大方相同，只是剂量分大小罢了。《口议》中有脱甲散，大能散热扶表，真是良方。
〔附方〕
麻黄汤 见咳嗽症内。
桂枝汤 见惊风症内。
大青龙汤 桂枝 麻黄 石膏 杏仁 甘草 生姜 大枣
羌活冲和汤 苍术 白芷 细辛 生地 羌活 防风 茯苓 川芎 甘草
葛根升麻汤 升麻 葛根 芍药 甘草
小柴胡汤 见诸吐症内。
大柴胡汤 见疟疾症内。
大承气汤 见痢疾症内。
解肌汤 干葛 桂枝 芍药 麻黄 黄芩 甘草
小青龙汤 麻黄 赤芍 半夏 细辛 干姜 桂枝 五味子 甘草
败毒散 见痢疾症内，或去茯苓用黄芩。
四顺汤 当归 大黄 赤芍 甘草
五积散 麻黄 苍术 陈皮 白芷 人参 茯苓 桂枝 桔梗 半夏 白芍 当归 浓朴 川芎 干姜 枳壳 甘草
理中汤 见惊风症内。
四逆汤 附子 干姜 甘草（炙）
薄荷散 金樱子 葛根 薄荷 甘草 骨碎补
人参羌活散 人参 羌活 赤芍 赤茯苓 柴胡 前胡 独活 川芎 桔梗 甘草 苍术 枳壳
抱龙丸 胆南星 天竹黄 雄黄 朱砂 麝香 甘草为丸
藿香正气散 见积滞症内
惺惺散 见诸吐症内。
葱白汤 葛根 芍药 知母 川芎
桂枝麻黄各半汤 见疟疾症内。
小承气汤 大黄 枳实 浓朴
洗心散 麻黄 大黄 白芍 当归 白术 荆芥 甘草
小柴胡汤 见诸吐症内。
五苓散 见惊风症内。
桂枝汤 见惊风症内。
桂枝芍药汤 桂枝 干葛 芍药 大枣 甘草
桂枝大黄汤 桂枝 芍药 大黄 甘草
温胆汤 竹茹 枳实 半夏 陈皮 甘草 生姜
白虎汤 石膏 知母 人参 甘草 粳米
小建中汤 胶饴 桂枝 芍药 甘草 生姜 大枣
玉露散 见霍乱症内。
脱甲散 柴胡 当归 胆草 茯苓 人参 知母 川芎 甘草
Overview: The manifestations of Shanghan (Cold Damage) are diverse; attempting to analyze them all comprehensively can be difficult. If the face and eyes are both red, accompanied by frequent sneezing, coarse breathing, and body heat, this is Shanghan.
Pulse Diagnosis: The *Nan Jing* (Classic of Difficult Issues) states: In Shanghan, both Yin and Yang pulses are vigorous and tight/rough (Jin Se). A pulse that is floating, rough, and tight indicates Shanghan.
How to distinguish between Shanghan (Cold Damage) and Shangfeng (Wind Damage)? The pulse in Shanghan is tight and rough, whereas in Shangfeng it is floating and slow. Patients with Shanghan experience aversion to cold (E Han), while those with Shangfeng experience aversion to wind (E Feng). Shangfeng presents with spontaneous sweating, while Shanghan presents without sweating. Yang meridians involve the Bladder, Stomach, and Gallbladder; Yin meridians involve the Spleen, Kidney, and Liver. Pulses may present as floating, long, string-taut, fine, deep, minute, or moderate. In diagnosis, one must first distinguish between Exterior (Biao) and Interior (Li) patterns.
Regarding pulse observation: If the pulse is small in the morning but becomes larger by evening, the disease is not yet resolved; if the pulse is large in the morning but becomes smaller by evening, the disease is about to resolve. This is what is meant by "a large pulse indicates disease progression, a small pulse indicates disease retreat."
The *Nei Jing* (Inner Canon) states: When humans are injured by Cold, they develop febrile diseases. Even if the fever is severe, death does not ensue. However, if two meridians are affected on the same day, it is called "Liang Gan Yu Han" (Double Injury from Cold), and such patients inevitably die. Generally, although the etiology and treatment principles for adults and children are not far apart, medicinal herbs should not be too hot/warm, because children are considered to have a "Pure Yang Constitution" (Chun Yang Zhi Ti). Zhang Zhongjing said: Spring air is harmonious, Summer air is hot, Autumn air is cool, and Winter air is biting cold; these are the sequences of the righteous Qi of the four seasons. In winter, when it is freezing cold and all things hide deeply, gentlemen maintain their solidity and closure, thus avoiding Cold injury. Those who violate this are said to have Shanghan. Injury by the Qi of the four seasons can cause disease. If one contracts Cold Toxic Qi in winter and falls ill immediately, presenting with headache, body ache, muscle heat, and aversion to cold, this is called "Zheng Shanghan" (True Shanghan). (Self-commentary: On the first day of Shanghan, the pathogen is in the Taiyang meridian, causing unbearable lower back, spine, and head pain; on the second day, Yangming Stomach heat arises, causing eye pain, dry nose, and insomnia; on the third day, Shaoyang transmits to the Gallbladder meridian, causing chest/hypochondriac pain and tinnitus/deafness; on the fourth day, Taiyin Spleen is affected, causing abdominal fullness and dry throat, indicating transmission to the interior; on the fifth day, Shaoyin Kidney is diseased, causing dry mouth/tongue and definite thirst/restlessness; on the sixth day, Jueyin Liver meridian completes its cycle, causing curled tongue and retracted testicles, indicating transmission to the interior.) If the illness does not manifest immediately, the Cold Toxic Qi hides between the skin and muscles. When Yang Qi generates in spring and summer, the Cold Toxic Qi contends with Yang Qi between Ying (Nutritive) and Wei (Defensive) levels. The pathology is no different from immediate winter onset. However, manifestation in spring is called Wenbing (Warm Disease), and manifestation in summer is called Rebing (Heat Disease). If Yang Heat is not yet strong and is controlled by Cold, the disease is named Wen (Warmth). If Yang Heat is already strong and cannot be controlled by Cold, the disease is named Re (Heat). All these are collectively referred to as Shanghan. Furthermore, if spring should be warm but is cold, summer should be hot but is cold, autumn should be cool but is hot, and winter should be cold but is warm, this is an abnormal climate. Regardless of age, symptoms are similar; this is commonly known as Tianxing (Epidemic/Seasonal Pathogen). Children contracting Cold Evil often do so because nursing mothers expose themselves, fail to avoid wind/cold in diet and daily life, or seek cooling in the wind during hot summer/autumn days, allowing Wind-Cold to injure the infant. Thus, they also suffer from Shanghan. Since children cannot verbalize the cause of their illness, and pulse diagnosis alone may not reveal the inevitable logic, they typically present only with irritability, crying, and fever. Can physicians not devote their utmost care? Therefore, upon initial onset, one verifies using the redness of the fingerprint at the Tiger's Mouth (Hu Kou). For older toddlers, one presses the Three Passes (San Guan) with one finger and judges based on whether the pulse at the Left Renying acupoint is tight and vigorous. This ensures accurate diagnosis!
Tao Jian'an said: Any symptom involving headache and aversion to cold is Shanghan; if absent, it is not. Why? Shanghan involves aversion to cold, and food stagnation involves aversion to food; this is natural. However, in winter, aversion to cold is particularly severe because winter is the season of True Shanghan, with biting cold winds; those touched by it feel severe aversion to cold. In other months, aversion to cold is mild. Because winter Qi is cold and pores are tight, pungent-warm herbs are necessary, hence Guizhi Tang (Cinnamon Twig Decoction) etc. are used. Wind and Cold often accompany each other. Cold injures Ying (Nutritive) Blood, causing aversion to cold, headache, floating-tight pulse, and no sweating; use Mahuang Tang (Ephedra Decoction) to open pores and disperse evil; recovery follows sweating. Wind injures Wei (Defensive) Qi, causing headache, aversion to wind, floating-slow pulse, and spontaneous sweating; use Guizhi Tang (Cinnamon Twig Decoction) to secure pores and disperse evil; recovery follows cessation of sweating.
The Classics state: Pungent-sweet dispersing agents are Yang. If Ying and Wei are both injured, these two decoctions are insufficient; Da Qing Long Tang (Major Blue Green Dragon Decoction) is required. However, this decoction is too harsh. Alternatives exist: if outside winter, with aversion to cold and headache, Qiang Huo Chong He Tang (Notopterygium Harmony Decoction) is suitable. This is a pungent-cool agent that harmonizes both exterior and interior, serving as a substitute for Da Qing Long Tang. Beyond this stage, the Shaoyang and Yangming meridians are located in the half-exterior, half-interior region (muscles). The pulse is neither deep nor floating. Exterior symptoms at Yangming include sore throat, dry nose, and insomnia; the pulse appears surging and long. Treat with Gegen Shengma Tang (Kudzu and Cimicifuga Decoction). At Shaoyang, there is heart/hypochondriac pain and deafness; the pulse is string-taut and rapid. Treat with Xiaochaihu Tang (Minor Bupleurum Decoction) with modifications to harmonize. This formula has modification methods. These two meridians follow the middle rather than root or branch. I often treat simultaneous Shaoyang-Yangming disease with Xiaochaihu Tang plus Gegen and Shaoyao, finding it as easy as picking up grass. If unresolved beyond this point, it transmits to the root of Yangming, entering the interior, and is treated as Excess Heat. When exterior symptoms cease (no headache/aversion to cold), and the pulse is deep-solid-floating-less, with delirium, aversion to heat, constipation for 6-7 days, dry mouth/throat, and thirst: mild cases use Daxiehu Tang (Major Bupleurum Decoction); severe cases use Dachengqi Tang (Major Order the Qi Decoction).
*Shanghan Yunyao* states: Children with Shanghan fear cold, have stiff limbs, and fever. The heat feels like it is covered on the surface, persisting day and night until sweat breaks the condition. Aversion to cold/wind causes them to huddle close, hide under clothes, with nasal congestion and runny nose; this is an Exterior pattern, treat with mild sweating: Ji Ji Tang (Muscle-Releasing Decoction), Xiao Qing Long Tang (Minor Blue Green Dragon Decoction), or Baidu San (Defeat Poison Powder). Aversion to heat with internal excess causes protruding head/face, flailing limbs, lifting clothes, coarse breath, irritability, thirst, and dry stool; this is an Interior pattern, treat with purgation/drainage: Xiaochaihu Tang (Minor Bupleurum Decoction) or Sishun Yin (Four Smooths Drink). If forehead/hands/feet are cold, breath is cold, complexion is dull, and diarrhea/stool is green-white, this is a Yin pattern, treat with warming: Wuji San (Five Accumulations Powder) or Lizhong Tang (Regulate the Middle Decoction). Severe cases use Sini Tang (Restore the Counterflow Decoction). Complicated by fright: caused by fright combined with Wind Evil, or high fever from Shanghan generating extreme heat/Wind, affecting the Heart. The Heart governs blood vessels; Heart Spirit is easily disturbed by heat, causing convulsions. Do not use anticonvulsants; use dispersing/resolving agents: Wangshi Bohe San (Wang's Mint Powder) or Renshen Qianghuo San (Ginseng and Notopterygium Powder). Severe cases use Baolong Wan (Embrace Dragon Pill). Complicated by food stagnation: injury by Cold then Food, or Food then Cold, causing fever, coarse breath, belching, abdominal heat/fullness, upper heat/lower cold, or sour-smelling stool. Treat with dispersion first, then digestion/promotion. Severe cases use pushing/purgation: start with Baidu San, then Huoxiang Zhengqi San (Agarwood Rectify Qi Decoction) plus Shenqu, Maiya, Tangliizi, Sharen, Xiangfu. If unresolved, use Daxiehu Tang to purge.
Mr. Tang stated: General treatment for pediatric Shanghan: Under one year old, mild heat uses Xingxing San (Awakening Powder). Over one year old, urgent exterior release is needed; mild sweating is ideal. Sweating within 24 hours ensures safety. Modern physicians often neglect sweating, allowing pathogens to linger for 5-6 days, enter meridians, contend with blood/Qi, transform into multiple symptoms, or generate Fright Wind, leading to critical danger and death. Is caution not essential? One must know Exterior vs. Interior. Confusing them leads to errors in sweating or purging. Ancients said: "Guizhi Tang enters the throat, Yang Excess dies; Chengqi enters the stomach, Yin Excess perishes." Shanghan has Exterior patterns, Interior patterns, Half-Exterior/Half-Interior patterns, simultaneous Exterior-Interior patterns, and patterns with neither. Exterior requires sweating; Interior requires purging; Half-Exterior/Half-Interior requires harmonizing; Simultaneous requires following symptoms to drain/seep; Neither requires Daxiehu Tang to purge.
Exterior patterns: Fever, aversion to cold, head/body pain, no sweating, floating pulse, neck stiffness, lower back/spine pain. This is Foot-Taiyang Bladder Meridian disease; treat with sweating. Release exterior according to severity. Headache/fever with fright: use Congbai Tang (Scallion White Decoction). Severe: Mahuang Ge Ban Tang (Mahuang and Guizhi Half-Decoction) or Ji Ji Tang.
Exterior patterns with heat aversion (no cold aversion): Sweating in palms/soles/armpits, dry stomach, aggregated dry stool, tidal fever, constipation, normal urination, abdominal fullness with wheezing, irritability/thirst, solid-slippery pulse, internal heat with delirium. This belongs to Foot-Yangming Stomach Meridian; treat with purging. Use Da/Xiao Chengqi Tang, Sishun Yin, or Xixin San judiciously.
Half-Exterior/Half-Interior: Fullness below the heart, desire not to eat, hard stool, deep-fine pulse. This is an Interior pattern, should be purged. Head sweating, slight aversion to cold, cold hands/feet: should be sweated. Simultaneous presentation is "Half-Exterior/Half-Interior" per Zhang Zhongjing; use Xiaochaihu Tang (Minor Bupleurum Decoction). Taiyang unresolved transmitting to Shaoyang: hypochondriac fullness, dry retching, inability to eat, alternating chills/fever, no vomiting/purging yet, string-tight pulse: use Xiaochaihu Tang. This is Foot-Shaoyang Gallbladder Meridian; harmonize. Simultaneous Exterior-Interior: Floating-large pulse indicates Exterior (sweat); fever, thirst, red urine indicates Interior (purge). Use Wuling San (Five-Ling Powder). Constipation for 6-7 days with headache/heat: Interior (purge). Clear urine: not Interior, still Exterior (sweat). Simultaneous: do not purge, use Guizhi Tang (Cinnamon Twig Decoction). Taiyang disease incorrectly purged causing abdominal pain: Exterior and Interior present. Zhang Zhongjing uses Guizhi Jia Shaoyao Tang (Guizhi Plus Peony Decoction); severe pain: Guizhi Jia Dahuang Tang (Guizhi Plus Rhubarb Decoction). Abdominal fullness/intermittent pain, deep pulse at Cun/Cchi: Foot-Taiyin Spleen Meridian. Spontaneous diarrhea without thirst: warm it. Use Sini Tang (Restore the Counterflow Decoction) or Lizhong Tang (Regulate the Middle Decoction).
No Exterior-Interior patterns: Shanghan day 4-5 or beyond passing the meridian stages, no Exterior/Interior symptoms, not suitable for purging, not a sweating pattern, nor a purging pattern: use Xiaochaihu Tang (Minor Bupleurum Decoction) with modifications. After 10+ days, if Xiaochaihu Tang fails and stool is hard (suitable for purging), use Daxiehu Tang. Zhang Zhongjing said: Day 6-7, clear eyes but uncoordinated gaze, no Exterior-Interior symptoms, difficulty defecating, slight body heat: this is Excess, should be purged with Dachengqi Tang (Major Order the Qi Decoction). If no thirst, no dry mouth/tongue, but deep pulse: urgently warm with Sini Tang (Restore the Counterflow Decoction). This is Foot-Shaoyin Kidney Meridian.
Mixed Exterior-Interior Cold-Heat: Body very hot but desires clothing (Heat in skin, Cold in marrow): first use Wendan Tang (Warm Gallbladder Decoction). Once Cold resolves, use Xiaochaihu Tang plus Guizhi to treat Exterior. Body very cold but refuses clothing (Cold in skin, Heat in marrow): first use Baihu Tang (White Tiger Decoction) plus Renshen. Once Heat resolves, use Guizhi Mahuang Ge Ban Tang. Jueyin pattern, floating-slow pulse: testicles not retracted, exterior symptoms fever/aversion-to-cold resembling malaria indicate recovery: use Guizhi Mahuang Ge Ban Tang. Deep-short pulse at Cun/Cchi: testicles retracted, toxic qi enters viscera: use Chengqi Tang to purge. Jueyin disease, faintly floating pulse indicates recovery; non-floating indicates non-recovery: use Xiaojianzhong Tang (Minor Construct the Middle Decoction). This is Foot-Jueyin Liver Meridian. Regarding Exterior-Interior patterns resembling Six Meridians, the text is sparse and does not fully cover the great methods of the Six Meridians. One should primarily rely on *Huo Ren Shu* (Book That Revives People) and *Shanghan Lun* (Treatise on Cold Damage). Malaria patterns are similar to general formulas; Summerheat patterns use Yulu San (Jade Dew Powder), also similar to general formulas, differing only in dosage size. *Kou Yi* mentions Tuojia San (Shell-Removing Powder), which greatly dissipates heat and supports the exterior; truly a good formula.
[Attached Formulas]
Mahuang Tang (Ephedra Decoction) - See Cough section.
Guizhi Tang (Cinnamon Twig Decoction) - See Fright Wind section.
Da Qing Long Tang (Major Blue Green Dragon Decoction): Guizhi (Cinnamon Twig), Mahuang (Ephedra), Shigao (Gypsum), Xingren (Apricot Seed), Gancao (Licorice), Shengjiang (Fresh Ginger), Dazao (Jujube).
Qiang Huo Chong He Tang (Notopterygium Harmony Decoction): Cangzhu (Atractylodes Rhizome), Baizhi (Angelica Dahurica), Xixin (Asarum), Shengdi (Rehmannia Root), Qianghuo (Notopterygium Rhizome), Fangfeng (Saposhnikovia Root), Fuling (Poria), Chuanxiong (Ligusticum Rhizome), Gancao (Licorice).
Gegen Shengma Tang (Kudzu and Cimicifuga Decoction): Shengma (Cimicifuga Rhizome), Gegen (Kudzu Root), Shaoyao (Peony Root), Gancao (Licorice).
Xiaochaihu Tang (Minor Bupleurum Decoction) - See Vomiting/Diarrhea section.
Daxiehu Tang (Major Bupleurum Decoction) - See Malaria section.
Dachengqi Tang (Major Order the Qi Decoction) - See Dysentery section.
Ji Ji Tang (Muscle-Releasing Decoction): Gange (Kudzu Root), Guizhi (Cinnamon Twig), Shaoyao (Peony Root), Mahuang (Ephedra), Huangqin (Scutellaria Root), Gancao (Licorice).
Xiao Qing Long Tang (Minor Blue Green Dragon Decoction): Mahuang (Ephedra), Chishao (Red Peony Root), Banxia (Pinellia Tuber), Xixin (Asarum), Ganjiang (Dried Ginger), Guizhi (Cinnamon Twig), Wuwei Zi (Schisandra Berry), Gancao (Licorice).
Baidu San (Defeat Poison Powder) - See Dysentery section, or remove Fuling and use Huangqin.
Sishun Tang (Four Smooths Decoction): Danggui (Angelica Sinensis), Dahuang (Rhubarb Root), Chishao (Red Peony Root), Gancao (Licorice).
Wuji San (Five Accumulations Powder): Mahuang (Ephedra), Cangzhu (Atractylodes Rhizome), Chenpi (Tangerine Peel), Baizhi (Angelica Dahurica), Renshen (Ginseng Root), Fuling (Poria), Guizhi (Cinnamon Twig), Jiegeng (Platycodon Root), Banxia (Pinellia Tuber), Baishao (White Peony Root), Danggui (Angelica Sinensis), Houpo (Magnolia Bark), Chuanxiong (Ligusticum Rhizome), Ganjiang (Dried Ginger), Zhike (Bitter Orange Fruit), Gancao (Licorice).
Lizhong Tang (Regulate the Middle Decoction) - See Fright Wind section.
Sini Tang (Restore the Counterflow Decoction): Fuzi (Aconite Lateral Root), Ganjiang (Dried Ginger), Gancao (Licorice, honey-fried).
Bohe San (Mint Powder): Jinyingzi (Cherokee Rose Hip), Gegen (Kudzu Root), Bohe (Mint Herb), Gancao (Licorice), Gusuibu (Drynaria Rhizome).
Renshen Qianghuo San (Ginseng and Notopterygium Powder): Renshen (Ginseng Root), Qianghuo (Notopterygium Rhizome), Chishao (Red Peony Root), Chi Fuling (Red Poria), Chaihu (Bupleurum Root), Qianhu (Peucedanum Root), Duhuo (Angelica Pubescens Root), Chuanxiong (Ligusticum Rhizome), Jiegeng (Platycodon Root), Gancao (Licorice), Cangzhu (Atractylodes Rhizome), Zhike (Bitter Orange Fruit).
Baolong Wan (Embrace Dragon Pill): Danxing (Arisaema with Bile), Tianzhuhuang (Calamus Tuber), Xionghuang (Realgar), Zhusha (Cinnabar), Shexiang (Musk), Gancao (Licorice) made into pills.
Huoxiang Zhengqi San (Agarwood Rectify Qi Decoction) - See Food Stagnation section.
Xingxing San (Awakening Powder) - See Vomiting/Diarrhea section.
Congbai Tang (Scallion White Decoction): Gegen (Kudzu Root), Shaoyao (Peony Root), Zhimu (Anemarrhena Rhizome), Chuanxiong (Ligusticum Rhizome).
Guizhi Mahuang Ge Ban Tang (Mahuang and Guizhi Half-Decoction) - See Malaria section.
Xiao Chengqi Tang (Minor Order the Qi Decoction): Dahuang (Rhubarb Root), Zhishi (Bitter Orange Fruit), Houpo (Magnolia Bark).
Xixin San (Heart-Washing Powder): Mahuang (Ephedra), Dahuang (Rhubarb Root), Baishao (White Peony Root), Danggui (Angelica Sinensis), Baizhu (Atractylodes Macrocephala Rhizome), Jingjie (Schizonepeta Spike), Gancao (Licorice).
Xiaochaihu Tang (Minor Bupleurum Decoction) - See Vomiting/Diarrhea section.
Wuling San (Five-Ling Powder) - See Fright Wind section.
Guizhi Tang (Cinnamon Twig Decoction) - See Fright Wind section.
Guizhi Shaoyao Tang (Guizhi and Peony Decoction): Guizhi (Cinnamon Twig), Gange (Kudzu Root), Shaoyao (Peony Root), Dazao (Jujube), Gancao (Licorice).
Guizhi Dahuang Tang (Guizhi and Rhubarb Decoction): Guizhi (Cinnamon Twig), Shaoyao (Peony Root), Dahuang (Rhubarb Root), Gancao (Licorice).
Wendan Tang (Warm Gallbladder Decoction): Zhuru (Bamboo Shavings), Zhishi (Bitter Orange Fruit), Banxia (Pinellia Tuber), Chenpi (Tangerine Peel), Gancao (Licorice), Shengjiang (Fresh Ginger).
Baihu Tang (White Tiger Decoction): Shigao (Gypsum), Zhimu (Anemarrhena Rhizome), Renshen (Ginseng Root), Gancao (Licorice), Jingsmi (Rice Grain).
Xiaojianzhong Tang (Minor Construct the Middle Decoction): Jiaoyi (Maltose), Guizhi (Cinnamon Twig), Shaoyao (Peony Root), Gancao (Licorice), Shengjiang (Fresh Ginger), Dazao (Jujube).
Yulu San (Jade Dew Powder) - See Cholera-Restless section.
Tuojia San (Shell-Removing Powder): Chaihu (Bupleurum Root), Danggui (Angelica Sinensis), Danshen (Barberry Root/Forsythia? Note: Dansheng usually refers to Gentiana or Barberry, here likely Gentiana Scabra/Danshen contextually in ancient texts varies, but standard is Gentiana), Fuling (Poria), Renshen (Ginseng Root), Zhimu (Anemarrhena Rhizome), Chuanxiong (Ligusticum Rhizome), Gancao (Licorice).