涂蔚生曰∶天地六淫之气，病患以风寒最甚而独多。治之得当，疗如反掌，治之失当，其后演成虚实厥亡
等症。诚非臆及所能道者。张仲景之《伤寒论》，以风寒温为三大提纲，而以伤寒居首。盖亦以其为百病之导火
线，而生死即系于此几微枢机也。然其谓伤寒为脉浮，头项强痛而恶寒；伤风为脉缓，发热汗出而恶风；温病
为发热而渴不恶风；是其将三者之显明界限，又为划分真确者也。风温二者，余已有另条专释，兹将伤寒一症，
略为节疏。以最简单之赅括，作治者之指引，夫亦曰变化之妙，存乎其人耳。经云∶太阳之上，寒气治之。以
其本寒而标阳也。盖足太阳膀胱，与手太阳小肠，合化吾人饮入之水，透出内外油
膜，以为周身卫外之气。若空中寒气袭入皮毛，而卫气不能抵抗，则寒气滞于皮毛之内，而为病矣。其脉浮者，
以卫气行于脉管之外，虽为寒气外束，而尚欲鼓动外出也。其头项强痛者，以三阳之气，皆上于头。今太阳卫气
为寒所闭，已上者不能输出卫外，未上者不能上走头项，故发生疼痛也。其恶寒者，以太阳化生卫外之气，不能
外出以护表也。其后尚有发热，背强KT KT ，逆满咳嗽等症，亦无不以太阳之受寒气，为使然也。盖太阳既化气卫
外，
而寒邪束于其表，其势欲出不得，欲返不能，不得不逞其温热之力，以为抵御之奋斗也。其背强KT KT 者，以寒气
既入皮毛，而后入于经输，经输不能转运自如也。其逆满咳嗽者，以卫气不能外出，壅塞于肺脏膈膜也。兹举仲
景治伤寒之要者二方，摘录于下，以后见症用药，全凭因时因病，以为加减更换耳。
仲景麻黄汤
麻黄（一钱） 桂枝（一钱） 杏仁（一钱） 炙甘草（一钱）
涂蔚生曰∶上四味，先以水煮麻黄去上沫，后纳诸药合煮，去滓温服，覆取微汗，为仲景治伤寒之大法。如头
项强痛，恶寒无汗者是也。然桂枝汤可以无麻黄，麻黄汤却不可以无桂枝。因伤风是病在肌肉一层，桂枝既直走营血，
即可疗风邪之在营血也。伤寒是病在皮毛一层，较肌肉为外。麻黄力虽猛峻，可以直走卫气，然其由内达外，非
从肌肉不能经过。若无桂枝以为之助，则恐其力纵猛峻，亦不能直达肌肉之营血，以达于卫气之皮毛也。
仲景葛根汤
葛根（一钱） 麻黄（一钱） 桂枝（一钱） 白芍（一钱） 炙甘草（一钱） 生姜（一钱） 大枣（一枚）
涂蔚生曰∶此汤之煎法服法，俱如前。即前方合桂枝汤，去杏仁而加葛根也。其所以加葛根者，因寒邪既入
皮毛，而复入经输，项背强KT KT 也。于此足见仲景治病，总是叫人使用活法，不
是叫人使用碍法。添一症，则添一药，去一症则去一药。有伤风之发热，恶风汗出等症，则有直入肌肉营血之桂
枝汤。有伤风之发热恶风汗出而兼项背强KT KT 等症，则有直入肌肉，兼入太阳经脉之桂枝加葛根汤。有伤寒之发
热恶寒身痛等症，则有直走皮毛之麻黄汤。有伤寒之发热恶寒身痛，而兼项背强KT KT 等症，则有直入皮毛，兼入
太
阳经脉之麻黄加葛根汤。推其喘满而加杏朴，胀满而加苓术，无不随其症之所在，以为药之增减也。学人能以
举一反三，自有无数法门，又何至开卷了然，临症盲然，而胸中毫无所主者哉。再若病患体壮而感寒轻者，可用
小柴胡汤，加防风荆芥葛根等味以治之。热稍甚，可去半夏，酌加苓连；寒稍甚，可酌减黄芩，亦甚稳妥。
涂蔚生说：天地间的六淫邪气中，病患感受风寒最为严重且最多。治疗得当，疗效立竿见影；治疗失当，其后会演变成虚证、实证、厥逆、亡阳等病症。这确实不是凭空臆想所能道尽的。张仲景的《伤寒论》，以伤寒、中风、温病为三大提纲，而以伤寒居首位。大概也是因为它作为百病的导火线，生死即系于这几微的关键枢机之中。然而他说伤寒表现为脉浮、头项强痛而恶寒；中风表现为脉缓、发热汗出而恶风；温病表现为发热而口渴不恶风；这是将三者的明显界限划分得真确无误。风温和温病这两者，我已有另外的专门条目解释，这里将伤寒这一病症，略作梳理。用最简单扼要的方式，作为治疗者的指引，其中的变化之妙，全在于运用之人罢了。经文说：太阳之上，由寒气主治。因为它的本气是寒，标气是阳。足太阳膀胱经与手太阳小肠经，共同化生人体饮入之水，透出内外油膜，形成周身卫外之气。如果空中的寒气侵袭皮毛，而卫气不能抵抗，则寒气滞留于皮毛之内，从而致病。其脉象浮，是因为卫气行于脉管之外，虽然被寒气外束，但仍欲鼓动外出。其头项强痛，是因为三阳之气都上达头部。如今太阳卫气被寒气闭阻，已上行的不能输出以卫外，未上行的不能上行至头项，所以发生疼痛。其恶寒，是因为太阳化生的卫外之气，不能外出以护卫体表。其后还有发热、背强急不适（KT KT）、气逆胀满、咳嗽等症状，无不因为太阳受寒气所致。盖因太阳既化气以卫外，而寒邪束缚于其表，其势欲出不得，欲返不能，不得不发挥其温热之力，以进行抵御的奋斗。其背强急不适，是因为寒气既入皮毛，而后进入经络腧穴，经络腧穴不能转运自如。其气逆胀满、咳嗽，是因为卫气不能外出，壅塞于肺脏膈膜之间。这里列举仲景治疗伤寒的两个重要方剂，摘录如下，以后见到症状用药，全凭因时因病，进行加减更换罢了。
仲景麻黄汤
麻黄（一钱） 桂枝（一钱） 杏仁（一钱） 炙甘草（一钱）
涂蔚生说：以上四味药，先用水煮麻黄去掉上面的浮沫，然后放入其他药物合煮，去渣后温服，覆盖衣被取微汗，这是仲景治疗伤寒的大法。如头项强痛、恶寒无汗的就是这种情况。然而桂枝汤可以没有麻黄，但麻黄汤却不可以没有桂枝。因为中风是病在肌肉一层，桂枝既然直走营血，即可治疗风邪在营血的病症。伤寒是病在皮毛一层，比肌肉更外。麻黄力量虽猛峻，可以直走卫气，然而它由内达外，非经过肌肉不可。如果没有桂枝作为辅助，恐怕其力即使猛峻，也不能直达肌肉的营血，以到达卫气的皮毛。
仲景葛根汤
葛根（一钱） 麻黄（一钱） 桂枝（一钱） 白芍（一钱） 炙甘草（一钱） 生姜（一钱） 大枣（一枚）
涂蔚生说：此汤的煎法和服法，都如同前文。即前方合桂枝汤，去掉杏仁而加入葛根。之所以加葛根，是因为寒邪既入皮毛，又复入经络腧穴，导致项背强急不适。于此可见仲景治病，总是叫人使用活法，不是叫人使用死板的方法。添一个症状，就添一味药；去一个症状就去一味药。有中风之发热、恶风、汗出等症状，则有直入肌肉营血的桂枝汤。有中风之发热、恶风、汗出而兼项背强急不适等症状，则有直入肌肉、兼入太阳经脉的桂枝加葛根汤。有伤寒之发热、恶寒、身痛等症状，则有直走皮毛的麻黄汤。有伤寒之发热、恶寒、身痛，而兼项背强急不适等症状，则有直入皮毛、兼入太阳经脉的麻黄加葛根汤。推究其喘满而加杏仁、厚朴，胀满而加茯苓、白术，无不随着症状所在，来作为药物的增减。学者若能举一反三，自有无数法门，又何至于开卷了然，临症茫然，而胸中毫无主见呢？再者若病患体质壮实而感寒轻者，可用小柴胡汤，加防风、荆芥、葛根等味来治疗。热稍甚，可去半夏，酌情加黄芩、黄连；寒稍甚，可酌情减黄芩，也很稳妥。
Tu Weisheng stated: Among the six excess pathogens (Liu Yin, 六淫) of heaven and earth, patients are most severely and frequently affected by wind-cold. If treated appropriately, the cure is as easy as turning over one's hand; if treated inappropriately, it may later evolve into conditions such as deficiency-excess patterns (Xu Shi, 虚实), Jue syndrome (Jue Zheng, 厥证), and collapse of Yang (Wang Yang, 亡阳). This is indeed beyond what can be described by mere speculation. Zhang Zhongjing's *Treatise on Cold Damage* (*Shanghan Lun*, 《伤寒论》) takes cold damage (Shang Han, 伤寒), wind strike (Shang Feng, 伤风), and warm disease (Wen Bing, 温病) as the three major outlines, with cold damage taking precedence. This is likely because it serves as the fuse for hundreds of diseases, with life and death hanging upon this subtle pivot. However, he stated that cold damage presents with a floating pulse (Mai Fu, 脉浮), stiffness and pain in the head and neck (Tou Xiang Qiang Tong, 头项强痛), and aversion to cold (E Han, 恶寒); wind strike presents with a slow pulse (Mai Huan, 脉缓), fever (Fa Re, 发热), sweating (Chu Han, 汗出), and aversion to wind (E Feng, 恶风); and warm disease presents with fever and thirst without aversion to wind. This clearly delineates the distinct boundaries among the three with accuracy. Regarding wind-warmth and warmth, I have provided separate specific explanations in other sections. Here, I will briefly outline the condition of cold damage. Using the simplest and most comprehensive summary as a guide for practitioners, the subtlety of its application lies entirely with the individual practitioner. The Classic states: "Above Taiyang, Cold Qi governs." Because its root is Cold and its branch is Yang. The Foot-Taiyang Bladder Meridian (Zu Taiyang Pangguang Jing, 足太阳膀胱经) and Hand-Taiyang Small Intestine Meridian (Shou Taiyang Xiaochang Jing, 手太阳小肠经) jointly transform the water drunk by humans, penetrating the internal and external oil membranes to form the Wei Qi (Defensive Qi, 卫气) that protects the exterior of the body. If cold air from the atmosphere invades the skin and hair, and Wei Qi cannot resist, then cold qi stagnates within the skin and hair, causing disease. The floating pulse occurs because Wei Qi circulates outside the blood vessels; although constrained externally by cold, it still strives to surge outward. Stiffness and pain in the head and neck occur because the Qi of the Three Yang meridians all ascend to the head. Now, since the Taiyang Wei Qi is blocked by cold, the Qi that has already ascended cannot output to protect the exterior, and the Qi that has not yet ascended cannot reach the head and neck, thus causing pain. Aversion to cold occurs because the Wei Qi generated by Taiyang cannot go out to protect the surface. Later symptoms also include fever, stiffness and tension in the back (Bei Qiang Jin Jin, 背强急急), rebellious fullness, and coughing, all of which are caused by Taiyang being affected by cold qi. Since Taiyang generates Qi to protect the exterior, and cold pathogen binds the exterior, the pathogen's momentum desires to exit but cannot, desires to retreat but cannot, so it must exert its warm-hot power to fight against defense. Stiffness and tension in the back occur because after cold qi enters the skin and hair, it subsequently enters the meridians and shu points, which cannot transport freely. Rebellious fullness and coughing occur because Wei Qi cannot go out, becoming congested in the lungs and diaphragm. Here, I list two important formulas from Zhongjing for treating cold damage, excerpted below. For future symptom-based medication, adjustments and changes should be made entirely according to the time and disease.
Zhongjing's Mahuang Decoction (Mahuang Tang, 麻黄汤)
Ephedrae Herba (Mahuang, 麻黄) (1 qian)
Cinnamomi Ramulus (Guizhi, 桂枝) (1 qian)
Armeniacae Semen Amarum (Xingren, 杏仁) (1 qian)
Prepared Glycyrrhizae Radix et Rhizoma (Zhi Gancao, 炙甘草) (1 qian)
Tu Weisheng said: For the above four ingredients, first boil Ephedrae Herba in water and remove the foam on top, then add the other herbs and boil together. Strain and take warm. Cover with blankets to induce slight sweating. This is the general method for Zhongjing's treatment of cold damage. Such cases present with stiffness and pain in the head and neck, aversion to cold, and absence of sweating. However, Guizhi Decoction (Guizhi Tang, 桂枝汤) can exist without Ephedrae Herba, but Mahuang Decoction cannot exist without Cinnamomi Ramulus. This is because wind strike affects the muscle layer; since Cinnamomi Ramulus directly enters the Ying Blood (Ying Xue, 营血), it can treat wind pathogen in the Ying Blood. Cold damage affects the skin and hair layer, which is more exterior than the muscles. Although Ephedrae Herba has strong and fierce power and can directly enter the Wei Qi, to move from interior to exterior, it must pass through the muscles. Without Cinnamomi Ramulus to assist, even if its power is fierce, it may not directly reach the Ying Blood in the muscles to arrive at the Wei Qi in the skin and hair.
Zhongjing's Gegen Decoction (Gegen Tang, 葛根汤)
Puerariae Lobatae Radix (Gegen, 葛根) (1 qian)
Ephedrae Herba (Mahuang, 麻黄) (1 qian)
Cinnamomi Ramulus (Guizhi, 桂枝) (1 qian)
Paeoniae Radix Alba (Baishao, 白芍) (1 qian)
Prepared Glycyrrhizae Radix et Rhizoma (Zhi Gancao, 炙甘草) (1 qian)
Zingiberis Rhizoma Recens (Shengjiang, 生姜) (1 qian)
Jujubae Fructus (Dazao, 大枣) (1 piece)
Tu Weisheng said: The decoction and administration methods of this formula are the same as mentioned before. It is essentially the previous formula combined with Guizhi Decoction, removing Armeniacae Semen Amarum and adding Puerariae Lobatae Radix. The reason for adding Puerariae Lobatae Radix is that after cold pathogen enters the skin and hair, it re-enters the meridians and shu points, causing stiffness and tension in the neck and back. From this, we can see that Zhongjing's treatment of disease always teaches people to use flexible methods, not rigid ones. Add a symptom, add an herb; remove a symptom, remove an herb. For wind strike presenting with fever, aversion to wind, and sweating, there is Guizhi Decoction, which directly enters the muscle Ying Blood. For wind strike presenting with fever, aversion to wind, sweating, and additionally stiffness and tension in the neck and back, there is Guizhi Jia Gegen Decoction (Guizhi Jia Gegen Tang, 桂枝加葛根汤), which directly enters the muscles and additionally enters the Taiyang meridian. For cold damage presenting with fever, aversion to cold, and body pain, there is Mahuang Decoction, which directly moves to the skin and hair. For cold damage presenting with fever, aversion to cold, body pain, and additionally stiffness and tension in the neck and back, there is Mahuang Jia Gegen Decoction (Mahuang Jia Gegen Tang, 麻黄加葛根汤), which directly enters the skin and hair and additionally enters the Taiyang meridian. Inferring further, for wheezing and fullness, add Armeniacae Semen Amarum and Magnoliae Officinalis Cortex (Houpo, 厚朴); for distending fullness, add Poria (Fuling, 茯苓) and Atractylodis Macrocephalae Rhizoma (Baizhu, 白术). All adjustments follow the location of the symptoms. If learners can infer other cases from one example, they will naturally possess countless methods, and how could they be clear when reading but confused when treating, with no firm grasp in their minds? Furthermore, if a patient is physically robust but lightly affected by cold, Xiao Chaihu Decoction (Xiao Chaihu Tang, 小柴胡汤) can be used, added with Saposhnikoviae Radix (Fangfeng, 防风), Schizonepetae Spica (Jingjie, 荆芥), and Puerariae Lobatae Radix (Gegen, 葛根) for treatment. If heat is slightly severe, remove Pinelliae Rhizoma (Banxia, 半夏) and酌情 add Scutellariae Radix (Huangqin, 黄芩) and Coptidis Rhizoma (Huanglian, 黄连); if cold is slightly severe,酌情 reduce Scutellariae Radix. This is very safe and sound.