伤寒十劝
（一）伤寒头疼又身热。便是阳证。不可服热药。
伤寒传三阴三阳。共六经。内太阴病头不疼身不热。少阴病有反发热无头疼。厥阴
病有头疼而无发热。故知头疼又身热。即是阳证。若投热药必不救。
（二）伤寒当直攻毒瓦斯。不可补益。
邪气在经络中。若随证早攻之。只三四日痊安。医者乃妄谓先须正气。却行补益。使毒瓦斯流炽。致杀人。
（三）伤寒不思饮食。不可服温脾药。
伤寒不思饮食。自是常事。终无饥死之理。如理中丸之类。亦不可轻服。若阳病服
之。致热气增重。或致不救。
（四）伤寒腹痛亦有热证。不可服温暖药。
难经云。痛为实。故仲景论腹满时痛之证。有曰痛甚者加大黄。夫痛甚而反加大黄
。意可见也。惟身冷厥逆而腹痛者。方是阴证。须消息之。每见医者。多缘腹痛便投热药而致杀人也。
（五）伤寒自利。当看阴阳证。不可例服补暖及止泻药。
自利惟身不热。手足温者。属太阴。身冷四逆者。属少阴厥阴外。其余身热下利。
皆是阳证。当随证根据仲景法治之。每见医者。多缘下利便投暖药及止泻药而杀人。
（六）伤寒胸胁痛及腹胀满。不可妄用艾灸。
常见村落间有此证。无药便用艾灸。多致毒瓦斯随火而炽。膨胀发喘而死。不知胸胁
痛。自属少阳。腹膨胀自属太阴也。此外惟阴证乃可灸耳。
（七）伤寒手足厥冷。
当看阴阳。不可一例作阴证治。有阴厥。有阳厥。医者少能
分辩。阳厥而投热药。杀人速于用刃。盖阳病不至于极热。不能发厥。仲景所谓热深者
厥深也。热深而更与热药。宁复有活之理。但看初得病而身热。至三日以后热气已深。
大便秘。小便赤。或谵语昏愦。及别有热证而反发厥者。必是阳证也。宜急用承气汤下
之。若初得病身不热。大便不秘。自引衣盖身。或下利或小便数。不见热证而厥逆者。
即是阴厥也。方可用四逆汤之类。二厥所以使人疑者。缘脉皆沉。然阳厥脉沉而滑。阴
厥脉沉而弱。又阳厥时复指爪却温。阴厥常冷。此为可别也。
（八）伤寒已在里。即不可轻用药发汗。
伤寒证须看表里。如发热恶寒则是在表。正宜发汗。如不恶寒反恶热。则是里证。
若医者一例发汗。则所出之汗。不是邪气。皆是真气。邪气未除。而真气先涸。死者多
矣。又半在表半在里之证。及无表里之证。不惟皆不可下。仍亦皆不可汗。但当随证而治之可也。
（九）伤寒饮水为欲愈。不可令病患恣饮过度。
病患大渴。当与之水以消热气。故仲景以饮水为欲愈。人见此说。遂令病患纵饮。
由是为呕。为哕。为咳逆。为下利。为肿。为悸。为水结。为小便不利者多矣。且如病
人欲饮一碗。只可半碗之水。少少与之为善也。
（十）伤寒初瘥。不可过饱及劳动、或食羊肉、及行房事与食诸骨汁、并饮酒。
病方愈。脾胃尚弱。食而过饱。不能消化。病即再来。谓之食复。病方愈。气血尚
虚。劳动太早。病亦再来。谓之劳复。又伤寒食羊肉。行房事。立死。食诸汁饮酒者。
再病之也。予每念父祖俱死于伤寒。乃取仲景所着。深绎熟玩。八年之后。始大通悟。
阴阳经络。病证药性。俱了然于胸中。缘比年江淮之民。冒寒避寇。得此疾者颇众。兹
根据仲景法随证而施之药。所活不啻数百人。仍知伤寒本无恶证。皆是妄投药剂所致。因
追悼父祖之命。皆为庸医所杀。而又叹人无间于贫富贵贱。于此不能自晓。则轻付一命
于庸工之手也。今辄摭其流弊多误有害于命者。略开其说。目曰伤寒十劝。其言不欲成
文。冀人易晓而以为深戒云。
伤寒十劝
（一）伤寒患者出现头痛且身体发热，这就是阳证。不可服用热性药物。
伤寒病邪传变涉及三阴经和三阳经，共六经。其中太阴病的特点是头部不痛、身体不发热的；少阴病有反而发热但无头痛的情况；厥阴病则有头痛但不发热的情况。因此，知道头痛且身体发热，就是阳证。如果投用热性药物，必然无法挽救。
（二）伤寒应当直接攻逐毒邪之气，不可进行补益治疗。
邪气在经络之中，如果能根据证候早期攻逐，只需三四日即可痊愈。然而医生却胡乱认为必须先扶助正气，于是进行补益治疗，导致毒邪之气流窜炽盛，致使病人死亡。
（三）伤寒患者不思饮食，不可服用温脾药物。
伤寒患者不思饮食，本是常事，最终没有饿死的道理。像理中丸之类的药物，也不可轻易服用。如果是阳证误服，会导致热气加重，或者导致无法挽救的后果。
（四）伤寒腹痛也有热证，不可服用温热药物。
《难经》说：“痛属于实证。”所以张仲景在论述腹满时痛的证候时说：“疼痛严重的加大黄用量。”既然疼痛严重反而加大黄，其中的用意显而易见。只有身体寒冷、四肢厥逆且腹痛的，才是阴证，需要仔细斟酌判断。常见许多医生，多因为腹痛就投用热性药物而导致病人死亡。
（五）伤寒自发性腹泻，应当辨别阴阳证候，不可一概服用补暖及止泻药物。
自发性腹泻中，只有身体不发热、手足温暖的，属于太阴病；身体寒冷、四肢逆冷的，属于少阴病或厥阴病。除此之外，身体发热并伴有下利的，都是阳证。应当根据证候，依据张仲景的方法治疗。常见许多医生，多因为下利就投用暖药及止泻药而导致病人死亡。
（六）伤寒出现胸胁痛及腹胀满，不可妄用艾灸。
常见乡村间有此证候的患者，没有药物时就使用艾灸，多导致毒邪之气随着火气而炽盛，引起膨胀气喘而死。他们不知道胸胁痛自然属于少阳病，腹部胀满自然属于太阴病。此外，只有阴证才可以施灸。
（七）伤寒患者手足厥冷。
应当辨别阴阳，不可一概作为阴证治疗。有阴厥，有阳厥。医生很少能分辨清楚。阳厥误投热性药物，杀人速度比用刀还快。大概阳病不至于极热，不能引发厥逆。张仲景所谓“热深者厥深也”。热邪深入反而给予热性药物，哪里还有救活的道理？只要看初得病时身体发热，到了三日以后热气已经深入，大便秘结，小便赤红，或者有谵语昏愦，以及别的热证表现却反而发生厥逆的，必定是阳证。应当紧急使用承气汤攻下。如果初得病时身体不发热，大便不秘结，自己拉衣服盖在身上，或者下利或者小便频数，不见热证表现而发生厥逆的，就是阴厥。这时才可以使用四逆汤之类的药物。这两种厥证之所以使人疑惑，是因为脉象都沉。然而阳厥脉沉而滑，阴厥脉沉而弱。另外阳厥时常反复出现指爪回暖，阴厥则始终寒冷。这是可以区分的。
（八）伤寒病邪已在里，即不可轻率用药发汗。
伤寒证候必须辨别表里。如发热恶寒，则是在表，正宜发汗。如不恶寒反而恶热，则是里证。如果医生一概发汗，那么排出的汗液，不是邪气，而是真气。邪气未除，而真气先枯竭，死亡的很多了。又有半在表半在里的证候，以及无表里之分的证候，不仅都不可攻下，也都不可发汗。只应当根据证候治疗即可。
（九）伤寒患者饮水是为了想要痊愈，不可让病患恣意过度饮水。
病患极度口渴，应当给予水以消除热气，所以张仲景认为饮水是想要痊愈的表现。人们看到这种说法，就让病患纵情饮水。由此导致呕吐、呃逆、咳嗽气逆、下利、浮肿、心悸、水饮结聚、小便不利等情况很多。况且比如病人想喝一碗水，只可给半碗水，少量多次给予才是好的做法。
（十）伤寒初愈，不可过饱及劳动、或食用羊肉、或行房事与吃各种骨头汤、并饮酒。
病刚痊愈，脾胃尚虚弱，吃得过饱，不能消化，疾病就会复发，这叫做食复。病刚痊愈，气血尚虚弱，过早劳动，疾病也会复发，这叫做劳复。另外伤寒期间食用羊肉、行房事，会立即致死。食用各种骨汤和饮酒的，会导致再次生病。我常念及父亲和祖父都死于伤寒，于是取来张仲景所著的书籍，深入推究熟读玩味。八年之后，才开始大通大悟。阴阳经络、病证药性，都了然于胸中。因为近年来江淮地区的百姓，冒着寒冷躲避寇乱，得此病的很多。现在根据张仲景的方法随证施用药物，救活的不止数百人。仍然知道伤寒本来没有恶劣的证候，都是胡乱投药所致。因而追悼父祖的性命，都被庸医害死。又感叹人们无论贫富贵贱，对此不能自我知晓，就将性命轻易托付给庸医之手。现在姑且摘取那些流传弊端、多有误治、有害于生命的情况，略开其说，题目叫作《伤寒十劝》。这些话不想写成工整的文章，希望人们容易明白并以此作为深深的警戒。
Ten Admonitions on Cold Damage
(1) When a patient with cold damage presents with headache and fever, this is a Yang syndrome. Hot-natured medicines must not be administered.
Cold damage pathogens transmit through the Three Yin and Three Yang meridians, totaling six channels. In Taiyin disease, the head does not hurt and the body is not hot; in Shaoyin disease, there may be contrary fever without headache; in Jueyin disease, there may be headache without fever. Therefore, knowing that headache accompanied by fever indicates a Yang syndrome. If hot medicines are prescribed, rescue will inevitably fail.
(2) Cold damage should be treated by directly attacking the pathogenic toxic qi; tonification must not be used.
When pathogenic qi resides in the meridians, if it is attacked early according to the syndrome, recovery occurs in only three or four days. However, physicians wrongly claim that one must first support the healthy qi, thereby employing tonification. This causes the toxic qi to spread and intensify, leading to death.
(3) Patients with cold damage who have no appetite must not be given spleen-warming medicines.
Loss of appetite in cold damage is common, and patients will never die of hunger. Medicines such as Lizhong Wan (Regulate the Middle Pill) must not be lightly administered. If taken for a Yang syndrome, it will aggravate the heat, potentially leading to untreatable conditions.
(4) Abdominal pain in cold damage can also present as a heat syndrome; warm medicines must not be administered.
The Nan Jing states: "Pain belongs to excess." Thus, Zhang Zhongjing, in discussing abdominal fullness and pain, stated: "For severe pain, increase the dosage of Dahuang (Rhubarb Root)." The fact that Dahuang is increased for severe pain reveals the intent. Only when the body is cold and limbs are inverted with abdominal pain is it a Yin syndrome, requiring careful deliberation. It is often seen that physicians prescribe hot medicines for abdominal pain, causing death.
(5) Spontaneous diarrhea in cold damage requires distinguishing between Yin and Yang syndromes; one must not indiscriminately administer warming or antidiarrheal medicines.
In spontaneous diarrhea, cases where the body is not hot and hands and feet are warm belong to Taiyin. Cases where the body is cold and limbs are inverted belong to Shaoyin or Jueyin. Aside from these, cases with fever and diarrhea are all Yang syndromes. Treatment should follow Zhang Zhongjing's methods according to the syndrome. It is frequently observed that physicians cause death by administering warming or antidiarrheal medicines for diarrhea.
(6) Chest and hypochondriac pain and abdominal distension in cold damage must not be treated with moxibustion recklessly.
It is commonly seen in villages that patients with these symptoms use moxibustion due to lack of medicine. This often causes toxic qi to intensify with the fire, leading to distension, panting, and death. They do not know that chest and hypochondriac pain naturally belongs to Shaoyang, and abdominal distension naturally belongs to Taiyin. Aside from this, moxibustion is only suitable for Yin syndromes.
(7) Cold extremities in cold damage.
One must distinguish between Yin and Yang; one must not treat all cases as Yin syndromes. There are Yin Jue (cold reversal) and Yang Jue. Physicians rarely distinguish them correctly. Administering hot medicines for Yang Jue kills faster than using a blade. Generally, Yang diseases do not reach extreme heat, so they cannot induce Jue. As Zhang Zhongjing said, "The deeper the heat, the deeper the Jue." If heat is deep and hot medicines are given, there is no hope of survival. Observe if the patient had fever at onset; after three days, if heat has penetrated deeply, constipation is present, urine is red, or there is delirium and confusion, along with other heat signs but contrary cold extremities, it is definitely a Yang syndrome. One should urgently use Chengqi Tang (Gut-Purging Decoction) to purge. If at onset the body was not hot, stool is not constipated, the patient pulls clothes to cover themselves, or has diarrhea or frequent urination, without heat signs but with cold extremities, it is Yin Jue. Only then can Sini Tang (Frigid Extremities Decoction) be used. These two types of Jue are confusing because both pulses are deep. However, Yang Jue pulse is deep and slippery, while Yin Jue pulse is deep and weak. Additionally, in Yang Jue, fingers and toes occasionally become warm, whereas in Yin Jue, they remain constantly cold. This distinguishes them.
(8) Once cold damage pathogens have entered the interior, one must not lightly use diaphoretic medicines to induce sweating.
Cold damage syndromes require distinguishing exterior and interior. Fever with aversion to cold indicates an exterior syndrome, suitable for diaphoresis. Aversion to heat without aversion to cold indicates an interior syndrome. If physicians indiscriminately induce sweating, the sweat expelled is not pathogenic qi but healthy qi. The pathogenic qi remains unremoved, while healthy qi is depleted first, leading to many deaths. For half-exterior half-interior syndromes, and syndromes lacking clear exterior/interior distinction, purgation is contraindicated, as is diaphoresis. Treatment should simply follow the syndrome.
(9) Thirst and drinking water in cold damage indicate a desire for recovery; patients must not be allowed to drink excessively.
Patients with extreme thirst should be given water to dissipate heat, which is why Zhang Zhongjing considers drinking water a sign of impending recovery. People seeing this allow patients to drink freely. This leads to vomiting, hiccups, coughing and wheezing, diarrhea, edema, palpitations, fluid retention, and difficulty urinating. If a patient desires one bowl of water, only half a bowl should be given; small amounts given frequently is best.
(10) After initial recovery from cold damage, one must not overeat, exert oneself, eat mutton, engage in sexual intercourse, consume bone broths, or drink alcohol.
When the illness just resolves, the spleen and stomach are still weak. Overeating leads to indigestion and relapse, called food relapse. Qi and blood are still deficient; early exertion leads to relapse, called labor relapse. Eating mutton or engaging in intercourse during cold damage can cause immediate death. Consuming bone broths and alcohol causes recurrent illness. I often recall my father and grandfather dying of cold damage. I took Zhang Zhongjing's writings, studied them deeply for eight years, until I achieved great enlightenment. The meridians of Yin and Yang, disease syndromes, and drug properties became clear in my mind. Recently, people in the Jianghuai region, braving cold to flee bandits, contracted this disease frequently. Following Zhang Zhongjing's methods, I have saved hundreds of lives. I realize that cold damage originally has no malignant syndromes; they are caused by reckless medication. Mourning my ancestors killed by quacks, and lamenting that people of all statuses fail to understand this, entrusting their lives to incompetent practitioners, I now excerpt these harmful errors. Titled "Ten Admonitions on Cold Damage," these words are not intended as formal prose, but to be easily understood as a grave warning.