凡治伤寒、瘟疫，宜清利者，非止一端。盖火实者，宜清火。气实者，宜行气。食滞
者，宜消食。痰盛者，宜化痰。皆所谓清利也。凡此数者，滞去则气行，而表邪自解。然此
宜用于邪实等证，而本非虚证之所宜。其有虚中挟实者，不妨少为兼用，此中权度，自有其
宜。若病在危急，则毫不容谬，设不当清而妄用之，亦与扑残灯者，无异也。
一、伤寒火盛者，治宜清解。若热入阳明，烦渴躁热，脉洪便实，而邪有不解者，宜柴
胡白虎煎，或单用白虎汤、太清饮，或玉泉散。若汗后仍热者，亦宜用之。若伤寒口渴，烦
热赤斑，脉洪大而无力者，宜人参白虎汤。若伤寒邪在太阳，发热头痛，脉洪大，表邪未解
，而内热又甚者，宜一柴胡饮，或三黄石膏汤，或六神通解散。若六经通热，火邪不解，或
狂斑烦躁，或头红面赤，口干舌黑，脉洪邪实者，宜抽薪饮，或黄连解毒汤，或加柴胡。若
伤寒热入血室，吐衄斑黄，及血热血燥，不能作汗而邪不解者，宜《局方》犀角地黄汤。热
甚者，宜《良方》犀角地黄汤。若热邪闭结血分，大便不通，而邪不能解者，宜《拔萃》犀
角地黄汤。若少阴水亏，阳明火盛，热渴失血，牙痛便结，脉空作喘，而邪不能解者，宜玉
女煎。若伤寒阳邪亢盛，血脉不通而四肢厥逆者，谓之热厥，宜四逆散。若暑月时行瘟疫，
表里俱热，宜清宜解者，羌活升麻汤。若伤寒热结膀胱，而小水不利，火邪不退，或挟热泄
泻者，宜大厘清饮，或柴芩煎，或益元散。若伤寒实热内蓄，小水不利，而口渴烦热发黄者
，宜茵陈饮，或大厘清饮。凡瘟疫热甚，而烦渴不宁者，宜悉尼浆时时与之，解渴退火最妙
，大胜于益元散。冷水禀天一之性，甘而不苦，故大能清热解烦，滋阴壮水。凡火盛水涸，
大渴便结，营卫热闭不能作汗者，最宜用之。虽虚证不可用，然亦有当用者。但察其喉口热
极，唇舌干焦，大便秘结不通，而大渴喜冷者，此阴虚水亏证也，不妨与人参、熟地、桂、
附、干姜之属，相间并用，借以滋阴，其功不小。惟大便不结，及微热微渴，劳倦阳虚等证
，最不宜用，若妄用之，则多致寒颤而败。
一、伤寒兼杂证者，治宜调和、清利。凡伤寒兼风，发热，咳嗽多痰者，宜柴陈煎。若
食滞气实，邪结胃脘，而表不解者，宜大和中饮加柴胡。若感四时寒湿之气，以致脾胃不和
，或呕或吐，或泄泻胀满者，宜平胃散。或寒盛多吐者，宜和胃饮。若外感风寒，内停饮食
，头痛寒热，或为吐泻胀满者，宜藿香正气散。若感四时寒湿，发热发黄，身痛脉紧，中寒
泄泻，小水不利者，宜柴芩饮。若中无寒而多火者，宜柴苓汤。若外伤暑热，霍乱泄泻，小
水不利，腹痛胀满，内阴外阳者，宜五苓散。若外伤寒湿，一身尽痛者，羌活胜湿汤。
凡是治疗伤寒、瘟疫，适宜采用清利法的，不止一种情况。如果是火邪亢盛的，适宜清火；气机郁滞的，适宜行气；饮食停滞的，适宜消食；痰湿壅盛的，适宜化痰。这些都属于所谓的清利法。凡此几种情况，只要积滞去除，气机自然通畅，表邪也就自行解散了。然而，这些方法适用于邪气实证的证候，并不适合本虚的证候。如果有虚实夹杂的情况，可以适当兼用，其中的权衡尺度，自有其适宜之处。如果病情危急，则容不得半点差错，如果不应当清利而妄加使用，这与扑灭将残的灯火没有区别。
第一条：伤寒火邪亢盛的，治疗适宜清解。如果热邪传入阳明经，出现心烦口渴、躁动发热，脉象洪大、大便干结，而表邪仍未解除的，适宜用柴胡白虎煎，或者单用白虎汤、太清饮，或者玉泉散。如果发汗后仍然发热的，也适宜使用上述方剂。如果伤寒导致口渴，心烦发热并出现红色斑疹，脉象洪大但无力的，适宜用人参白虎汤。如果伤寒邪气仍在太阳经，出现发热头痛，脉象洪大，表邪未解，而内热又很严重的，适宜用一柴胡饮，或者三黄石膏汤，或者六神通解散。如果六经都有通热，火邪不解，或者出现狂乱、斑疹、烦躁，或者头部发红、面色赤红，口干舌黑，脉象洪大且邪气实的，适宜用抽薪饮，或者黄连解毒汤，或者加入柴胡。如果伤寒热邪陷入血室，出现吐血、衄血、斑疹发黄，以及血热、血燥，不能出汗而邪气不解的，适宜用《太平惠民和剂局方》中的犀角地黄汤。热势极重的，适宜用《良方》中的犀角地黄汤。如果热邪闭结在血分，大便不通，而邪气不能解除的，适宜用《卫生宝鉴·拔萃方》中的犀角地黄汤。如果少阴肾水亏虚，阳明胃火亢盛，出现热渴、失血、牙痛、大便干结，脉象空虚且气喘，而邪气不能解除的，适宜用玉女煎。如果伤寒阳邪亢盛，血脉不通导致四肢厥冷逆乱的，称为热厥，适宜用四逆散。如果暑月时令流行的瘟疫，表里俱热，适宜清解的，用羌活升麻汤。如果伤寒热邪结聚膀胱，导致小便不利，火邪不退，或者挟带热邪泄泻的，适宜用大厘清饮，或者柴芩煎，或者益元散。如果伤寒实热内蓄，小便不利，且口渴、烦热、发黄，适宜用茵陈饮，或者大厘清饮。凡是瘟疫热势严重，且心烦口渴不安的，适宜随时给予悉尼浆饮用，解渴退火效果最好，远胜于益元散。冷水禀受天一之性，味甘而不苦，所以能大清热邪、解除烦闷、滋阴壮水。凡是火盛水涸，大渴、大便干结，营卫热闭不能出汗的，最适宜使用。虽然虚证一般不可用，但也有当用的时候。只要观察患者喉口热极，嘴唇舌头干燥焦枯，大便秘结不通，且大渴喜冷饮的，这是阴虚水亏的证候，不妨与人参、熟地、桂枝、附子、干姜之类相间并用，借以滋阴，功效不小。只有大便不结，以及微热微渴，劳倦阳虚等证候，最不宜用，如果妄加使用，则多会导致寒战而病情败坏。
第二条：伤寒兼杂其他证候的，治疗适宜调和、清利。凡是伤寒兼夹风邪，出现发热、咳嗽、多痰的，适宜用柴陈煎。如果饮食停滞、气机实证，邪气结聚在胃脘，而表证未解的，适宜用大和中饮加柴胡。如果感受四时寒湿之气，导致脾胃不和，或者呕吐，或者泄泻胀满的，适宜用平胃散。如果寒邪盛而多呕吐的，适宜用和胃饮。如果外感风寒，内停饮食，出现头痛、寒热往来，或者吐泻胀满的，适宜用藿香正气散。如果感受四时寒湿，出现发热发黄，身体疼痛、脉紧，中寒泄泻，小便不利的，适宜用柴芩饮。如果体内无寒而多火邪的，适宜用柴苓汤。如果外伤暑热，出现霍乱泄泻，小便不利，腹痛胀满，内阴外阳（真寒假热或阴阳格拒）的，适宜用五苓散。如果外伤寒湿，全身都疼痛的，适宜用羌活胜湿汤。
In the treatment of Shanghan (Cold Damage) and epidemics, indications for employing the method of clearing and draining are manifold. If fire pathogen is excessive, it is appropriate to clear fire; if qi stagnation is present, it is appropriate to move qi; if food retention exists, it is appropriate to digest food; if phlegm abundance is prominent, it is appropriate to resolve phlegm. All these fall under the category of "clearing and draining." In all these cases, once the stagnation is removed, qi flows freely, and the exterior pathogen resolves spontaneously. However, these methods are suitable for excess syndromes and are not appropriate for deficiency syndromes. In cases of mixed deficiency and excess, a slight combination may be employed, with the appropriate balance determined by clinical judgment. If the condition is critical, no error can be tolerated; using clearing methods inappropriately is akin to extinguishing a dying lamp.
First: For Shanghan with excessive fire pathogen, the treatment should focus on clearing and resolving. If heat enters the Yangming channel, presenting with vexation, thirst, restlessness, fever, a flooding pulse, and solid stool, while the exterior pathogen remains unresolved, Chaihu Baihu Decoction (Bupleurum and White Tiger Decoction), or solely Baihu Tang (White Tiger Decoction), Taiqing Yin (Taiqing Drink), or Yuquan San (Jade Spring Powder) are indicated. If fever persists after sweating, these formulas are also appropriate. For Shanghan presenting with thirst, vexation, fever, red macules, and a flooding pulse that is forceless, Ren Shen Baihu Tang (Ginseng and White Tiger Decoction) is indicated. If the pathogen remains in the Taiyang channel, manifesting as fever, headache, a flooding pulse, with the exterior pathogen unresolved but internal heat severe, Yichaihu Yin (Single Bupleurum Drink), Sanhuang Shigao Tang (Three Yellow and Gypsum Decoction), or Liutong Shengjie San (Six-Channel Unblocking and Resolving Powder) are indicated. If heat permeates all six channels, with fire pathogen unresolved, accompanied by mania, macules, irritability, red head, flushed face, dry mouth, black tongue, and a flooding pulse indicating excess, Chouxin Yin (Drawing Out Firewood Drink), Huanglian Jiedu Tang (Coptis Detoxification Decoction), or adding Chaihu (Bupleuri Radix) is indicated. If heat pathogen enters the Blood Chamber due to Shanghan, presenting with hematemesis, epistaxis, yellow macules, blood heat, blood dryness, inability to sweat, and unresolved pathogen, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) from *Ju Fang* (Prescriptions of the Bureau) is indicated. For severe heat, Xijiao Dihuang Tang from *Liang Fang* (Excellent Prescriptions) is preferred. If heat pathogen is closed in the blood aspect, causing constipation and unresolved pathogen, Xijiao Dihuang Tang from *Bacui* (Extracts) is indicated. If Shaoyin kidney water is deficient while Yangming stomach fire is excessive, presenting with heat-thirst, hemorrhage, toothache, constipation, a hollow pulse with panting, and unresolved pathogen, Yuni Jian (Jade Woman Decoction) is indicated. If yang pathogen is hyperactive in Shanghan, blocking blood vessels and causing cold extremities (reversal cold), termed Re Jue (Heat Reversal), Sini San (Four Counterflow Powder) is indicated. For summerheat epidemic pathogens where both interior and exterior are hot, requiring clearing and resolving, Qianghuo Shengma Tang (Notopterygium and Ligusticum Decoction) is used. If Shanghan heat binds in the Bladder, causing difficult urination, unretreated fire pathogen, or diarrhea with heat, Dali Qingyin (Great Clearing Drink), Chaiqin Jian (Bupleurum and Scutellaria Decoction), or Yiyuan San (Origin-Supporting Powder) are indicated. If Shanghan excess heat accumulates internally, causing difficult urination, thirst, vexation, fever, and jaundice, Yinchen Yin (Artemisiae Scopariae Drink) or Dali Qingyin is indicated. For severe epidemic heat with persistent vexation and thirst, Xini Jiang (Sydney Slurry - *Note: likely a specific historical preparation or typo for a cooling slurry like Xi Gu Shui/Coconut Water in some editions, translated literally here*) given frequently is best for quenching thirst and reducing fire, far surpassing Yiyuan San. Cold water possesses the nature of Tianyi (Heaven One), is sweet and not bitter, thus greatly clearing heat, relieving vexation, nourishing yin, and strengthening water. It is most suitable for cases of excessive fire and depleted water, severe thirst, constipation, and heat closing Ying and Wei preventing sweating. Although generally contraindicated in deficiency syndromes, there are exceptions. If the throat and mouth are extremely hot, lips and tongue are dry and scorched, stool is hard and blocked, and there is intense thirst for cold drinks, this indicates yin deficiency and water depletion. In such cases, it may be combined alternately with Renshen (Ginseng), Shudi (Prepared Rehmannia), Guizhi (Cinnamon Twig), Fuzi (Aconite), Ganjiang (Dried Ginger), etc., to nourish yin, which yields significant benefit. However, it is strictly contraindicated in cases without constipation, mild heat/thirst, or fatigue-induced yang deficiency; misuse often leads to chills and deterioration.
Second: For Shanghan complicated by other syndromes, treatment should focus on harmonizing, clearing, and draining. For Shanghan complicated by wind, presenting with fever, cough, and profuse phlegm, Chaichen Jian (Bupleurum and Pinellia Decoction) is indicated. For food retention and qi excess, with pathogen binding in the epigastrium and unresolved exterior, Dahezhong Yin (Great Harmonizing Middle Drink) added with Chaihu is indicated. For contraction of four-season cold-dampness leading to spleen-stomach disharmony, vomiting, or diarrhea with fullness, Pingwei San (Stomach-Calming Powder) is indicated. For severe cold with frequent vomiting, Hewei Yin (Harmonizing Stomach Drink) is indicated. For external contraction of wind-cold with internal food retention, presenting with headache, alternating chills and fever, or vomiting/diarrhea with fullness, Huoxiang Zhengqi San (Patchouli Qi-Regulating Powder) is indicated. For contraction of four-season cold-dampness, presenting with fever, jaundice, body pain, tight pulse, cold-induced diarrhea, and difficult urination, Chaiqin Yin (Bupleurum and Scutellaria Drink) is indicated. For internal conditions without cold but with excessive fire, Chailing Tang (Bupleurum and Polyporus Decoction) is indicated. For external contraction of summerheat-heat, presenting with cholera-like diarrhea, difficult urination, abdominal pain and fullness, and internal yin with external yang (true cold/false heat or yin-yang separation), Wuling San (Five-Ingredient Powder with Poria) is indicated. For external contraction of cold-dampness causing whole-body pain, Qianghuo Shengshi Tang (Notopterygium Overcoming Dampness Decoction) is indicated.