（此门系初稿故仲景法与后人续法混列以其颇有条理不复改正读者详之）
恶寒者风寒客于荣卫非寒热之寒又非恶风也故不待见风而后怯寒虽身大热亦不欲去衣被也甚则向火增被不能遏其
寒所以然者由阴气上入阳中或阳微或风虚相搏之所致也恶寒一切属表虽里证悉具而微恶寒者亦表未解犹当先解其外俟
不恶寒乃可攻也经云发热恶寒发于阳可发汗
无热恶寒而蜷脉沉细发于阴可可温里恶寒虽悉属表亦有虚实之分若汗出而恶寒为表虚无汗而恶寒为表实表虚可解
肌表实可发汗
伤寒太阳病在表故恶寒少阳半在表半在里亦微恶寒阳明在里本不恶寒或恶寒者与太阳合病也
太阳 恶寒发热脉浮（方论见前太阳病发热门）
阳明 中风口苦咽干腹满微喘发热恶寒脉浮而紧亦麻黄汤证也 阳明病脉迟汗多微恶寒者表未解亦桂枝汤证
也（三时用代药如前例）
少阳 证头汗出微恶寒小柴胡加桂汤
三阴 惟少阴经有恶寒之证太阴厥阴皆不恶寒然少阴恶寒又有二证发于少阴者无热而恶寒宜温之属理中汤四逆
汤少阴无热恶寒似与前太阳经未即热一条相似所谓寒未即热者为太阳证具而未热耳此之无热恶寒盖无太阳头痛等证知为
少阴也
少阴 病下利恶寒而蜷四逆汤真武汤小建中汤 若恶寒而蜷时时自烦欲去衣被者活人用大柴胡汤下之赵氏以为
宜温散阴邪导引真阳汗而解可也若下之非惟不能表解反虚其里使恶寒之邪乘虚内陷纵使其脉沉滑而实亦未可遽用大柴胡
必须先解表使恶寒证罢而后可用也 少阴病恶寒身蜷而利手足逆冷者不治（无阳故也）少阴四逆恶寒而身蜷脉不至不烦
而躁者死
外有太阴自利不渴厥阴下利厥逆俱或恶寒太阴宜理中汤厥阴宜四逆汤前既言二阴不恶寒今又言或恶寒要知太阴厥
阴皆不恶寒者此阳传阴者也三阴皆能恶寒者阴入阴者也特在少阴为多耳恶寒脉微而复利利止亡血也四逆加人参汤主之
（成 恶寒脉微而利者阳虚阴盛也利止则津液内竭故云亡血金匮玉函曰水竭则无血与四逆汤温经助阳加人参生津液益
血）
四逆加人参汤方
人参 干姜 甘草（各一两） 附子（一枚去皮煨）上 咀每服五钱水煎温服日三次
发汗病不解反恶寒者虚故也芍药甘草附子汤主之（成 发汗病解则不恶寒发汗病不解表实者亦不恶寒今发汗病且不
解又反恶寒者荣卫俱虚也汗出则荣虚恶寒则卫虚与芍药甘草附子汤以补荣卫）
芍药甘草附子汤方
芍药 炙甘草（各三两） 附子（一枚炮去皮破八片）以上三味以水五升煮取一升五合去滓分温服疑非仲景意（成
芍药之酸收敛津液而益荣附子之辛热固阳气而补卫甘草之甘调和辛酸而安正气）下后复发汗心振寒脉微细者此内外俱虚
也当归四逆汤真武汤
太阳病下后脉促胸满者桂枝去芍药汤主之
桂枝去芍药汤方
桂枝（去粗皮） 生姜（切各一两半） 甘草（炙一两） 大枣（六枚）上 咀每服五钱水煎温服若微恶寒者去芍
药加附子汤主之（前方加附子半个去皮炮 活人云芍药味酸脉促胸满恐成结胸故云芍药单用辛甘之味发散毒瓦斯也）
伤寒汗下后心下痞而恶寒者表未解也先用桂枝汤解表用大黄黄连泻心汤攻痞若痞而汗出恶寒者表已解也附子泻心
汤主之（方论见痞）
背恶寒 背负阳抱阴背寒者阳弱也然有阴阳二证少阴一证以阴寒气盛不能消耗津液故口中和三阳合病以阳气陷
入
津液为之涸故舌干口燥以此别之思过半矣 口中和而背恶寒者属少阴宜附子汤（见欲寐嗜卧）舌干口燥内有热证口中不
仁背恶寒者为三阳合病宜白虎汤（见发热）经云腹满身重面垢谵语遗尿口中不仁为三阳合病白虎加人参汤主之（见渴）
若自汗者亦用白虎加人参汤 又阳明证背微恶寒无大热口中燥渴者亦用白虎加人参汤 中暑亦有背恶寒证但面垢自汗
脉虚而伏详见杂病中 凡脾胃素虚之人遇暑月间饮冷冰水或啖生冷寒气蓄聚阴上乘阳故寒从背起冷如掌大此当以温药
主之（大顺散之类）
（此门类因系初稿，故张仲景的治法与后人的续法混杂排列，因其颇有条理，不再重新改正，请读者仔细查阅。）
恶寒，是风寒邪气客居于营卫之间，并非指寒热往来中的“寒”，也不是恶风。因此，不需要见到风才感到怕冷，即使身体高热，也不愿脱去衣被。严重时，即使靠近火源、增加被子，也不能遏制其寒冷。之所以如此，是因为阴气上入阳分，或者是阳气微弱，或者是风邪与虚损相互搏结所致。恶寒一概属于表证，虽然里证全部具备，但只要仍有轻微恶寒，就说明表证未解，仍应当先解除表邪，等到不再恶寒时，才可以攻里。经文说：“发热恶寒，发于阳经，可用发汗法。”
无热而恶寒，身体蜷缩，脉象沉细，这是发于阴经，可以用温里法。恶寒虽然都归属于表证，但也有虚实之分。如果汗出且恶寒，属于表虚；无汗且恶寒，属于表实。表虚可用调和肌表的方法，表实可用发汗法。
伤寒太阳病在表，所以恶寒；少阳病半在表半在里，所以微恶寒；阳明病在里，本不应恶寒，如果出现恶寒，是与太阳病合病的情况。
阳明病：中风，口苦、咽干、腹满、微喘、发热、恶寒、脉浮紧，这也是麻黄汤证。阳明病，脉迟，汗多，微恶寒，说明表证未解，也是桂枝汤证。（三阴病用药如有替代药物，如前例所示）
三阴病：只有少阴经有恶寒的证候，太阴和厥阴都不恶寒。然而少阴的恶寒又有两种证型：发于少阴者，无热而恶寒，宜用温法，属于理中汤或四逆汤证。少阴无热恶寒，似乎与前文太阳经未即发热的一条相似，所谓“寒未即热”，是指具有太阳证的特征但尚未发热。这里的无热恶寒，大概是没有太阳病的头痛等症状，从而知道是少阴病。
少阴病：下利，恶寒而蜷缩，用四逆汤、真武汤或小建中汤。如果恶寒而蜷缩，时时自觉心烦，想要脱去衣被，朱肱《活人书》主张用大柴胡汤攻下。赵氏认为应当用温散阴邪、导引真阳的方法，通过发汗来解表。如果攻下，不仅不能解表，反而会使里气更虚，使恶寒之邪乘虚内陷。纵然脉象沉滑而实，也不可立即使用大柴胡汤，必须先解表，待恶寒证消失后，方可使用。少阴病，恶寒，身体蜷缩而下利，手足逆冷，属不治之症（因为无阳）。少阴四逆，恶寒而身体蜷缩，脉不至，不烦而躁，属死症。
外证方面，太阴自利不渴，厥阴下利厥逆，都可能出现恶寒。太阴宜用理中汤，厥阴宜用四逆汤。前文既说二阴（太阴、厥阴）不恶寒，现在又说可能恶寒，要知道太阴、厥阴皆不恶寒，是因为阳气传入阴经；三阴都能恶寒，是因为阴邪深入阴经，特别在少阴更为多见。恶寒，脉微而复利，利止后亡血，用四逆加人参汤主治。（成无己注：恶寒脉微而利，是阳虚阴盛。利止则津液内竭，所以说亡血。《金匮玉函》说：水竭则无血。与四逆汤温经助阳，加人参生津液益血。）
四逆加人参汤方：
人参、干姜、甘草（各一两）、附子（一枚，去皮，煨）。上药捣碎，每服五钱，水煎，温服，日三次。
发汗后病不解，反而恶寒，这是虚证，用芍药甘草附子汤主治。（成无己注：发汗后病解则不恶寒。发汗后病不解，若表实者也不恶寒。今发汗后病且不解，又反恶寒，是营卫俱虚。汗出则荣虚，恶寒则卫虚，给予芍药甘草附子汤以补益营卫。）
芍药甘草附子汤方：
芍药、炙甘草（各三两）、附子（一枚，炮，去皮，破为八片）。以上三味，用水五升，煮取一升五合，去滓，分次温服。疑非张仲景原意。（成无己注：芍药的酸味收敛津液而益荣，附子的辛热固护阳气而补卫，甘草的甘味调和辛酸而安正气。）
攻下后又发汗，心中震颤怕冷，脉微细，这是内外俱虚，用当归四逆汤或真武汤。
桂枝去芍药汤方：
桂枝（去粗皮）、生姜（切，各一两半）、甘草（炙，一两）、大枣（六枚）。上药捣碎，每服五钱，水煎，温服。若微恶寒者，用桂枝去芍药加附子汤主治。（前方加附子半个，去皮，炮制。朱肱《活人书》云：芍药味酸，脉促胸满，恐成结胸，所以说芍药单用辛甘之味发散毒瓦斯也。）
伤寒汗下后，心下痞塞且恶寒，说明表证未解。先用桂枝汤解表，再用大黄黄连泻心汤攻痞。如果痞塞且汗出、恶寒，说明表已解，用附子泻心汤主治。（方论见“痞”门）
背恶寒：背部属阳，腹部属阴，背寒是阳气虚弱。但有阴阳两种证型：少阴一证，因阴寒气盛，不能消耗津液，所以口中平和；三阳合病，因阳气陷入，津液枯竭，所以舌干口燥。以此区别，思过半矣。口中平和而背恶寒，属少阴，宜用附子汤（见“欲寐嗜卧”条）。舌干口燥，内有热证，口中感觉麻木不适，背恶寒，为三阳合病，宜用白虎汤（见“发热”条）。经文说：“腹满身重，面垢，谵语，遗尿，口中不仁，为三阳合病，用白虎加人参汤主治（见“渴”条）。如果有自汗，也用白虎加人参汤。另外，阳明证，背微恶寒，无大热，口中燥渴，也用白虎加人参汤。中暑也有背恶寒证，但见面色垢浊、自汗、脉虚而伏，详见杂病篇。凡是脾胃素虚之人，遇到暑月饮用冷水冰水或吃生冷食物，寒气蓄积，阴上乘阳，所以寒气从背部升起，冷如手掌大小，这应当用温药主治（如大顺散之类）。
(This section, being a first draft, mixes Zhang Zhongjing's methods with later additions. Due to its logical structure, no corrections are made; please review carefully.)
Chills (Ehan) refer to wind-cold pathogens lodging in the Ying (Nutrient) and Wei (Defensive) levels. It is not the "cold" aspect of alternating chills and fever, nor is it aversion to wind. Therefore, one feels afraid of cold even without exposure to wind; even if the body has high fever, there is no desire to remove clothing or bedding. In severe cases, even sitting near fire or adding quilts cannot suppress the cold. This occurs because Yin qi ascends into the Yang region, or due to deficient Yang, or the interplay between wind pathogen and deficiency. Chills generally belong to Exterior syndromes. Even if Interior symptoms are fully present, if there is slight chills, the Exterior syndrome remains unresolved, and one should first resolve the Exterior. Only when chills cease can one proceed to treat the Interior. The Classic states: "Fever with chills indicates onset in Yang meridians; sweating may be used."
Absence of fever with chills, curling up, and deep, fine pulse indicate onset in Yin meridians; warming the Interior is appropriate. Although chills all belong to the Exterior, there are Deficiency and Excess distinctions. Sweating with chills indicates Exterior Deficiency; absence of sweating with chills indicates Exterior Excess. Exterior Deficiency can be treated by harmonizing the muscle layer; Exterior Excess can be treated by inducing sweating.
In Cold Damage (Shanghan), Taiyang disease is at the Exterior, hence chills; Shaoyang disease is half-Exterior, half-Interior, hence slight chills; Yangming disease is at the Interior and typically does not involve chills. If chills occur in Yangming, it is a combined disease with Taiyang.
Taiyang: Chills, fever, floating pulse. (Formula discussion see previous section on "Taiyang Disease with Fever")
Yangming: Wind-stroke, bitter taste in mouth, dry throat, abdominal fullness, slight wheezing, fever, chills, floating-tight pulse—this is also a Mahuang Tang (Ephedra Decoction) pattern. Yangming disease, slow pulse, profuse sweating, slight chills—Exterior unresolved, this is also a Guizhi Tang (Cinnamon Twig Decoction) pattern. (For three-Yin diseases, substitute herbs as per previous examples.)
Shaoyang: Head sweating, slight chills—use Xiaochaihu Tang plus Guizhi (Minor Chaihu Decoction plus Cinnamon Twig).
Three-Yin Diseases: Only the Shaoyin meridian presents with chills; Taiyin and Jueyin do not. However, Shaoyin chills have two patterns: Onset in Shaoyin involves no fever but chills, suitable for warming methods, belonging to Lizhong Tang (Regulate the Middle Decoction) or Sini Tang (Frigid Extremities Decoction). Shaoyin no-fever chills resemble the earlier Taiyang case where heat does not immediately appear; "cold not yet hot" means Taiyang signs are present but fever has not developed. Here, no-fever chills lack Taiyang headache signs, identifying it as Shaoyin.
Shaoyin Disease: Diarrhea, chills, curling up—use Sini Tang, Zhenwu Tang (True Warrior Decoction), or Xiaojianzhong Tang (Minor Construct the Middle Decoction). If chills, curling up, frequent inner restlessness, and desire to remove clothing/bedding occur, Zhu Gong's *Huoren Shu* suggests using Dachaihu Tang (Major Chaihu Decoction) to purge. Zhao believes warming dispersing Yin pathogen and guiding True Yang to resolve via sweating is better. Purging would further weaken the Interior, allowing chills pathogen to sink inward. Even with deep-slippery-solid pulse, Dachaihu Tang should not be used immediately; first resolve the Exterior until chills cease. Shaoyin disease with chills, curling up, diarrhea, and cold extremities is untreatable (due to loss of Yang). Shaoyin Sini with chills, curling up, absent pulse, no irritability but agitation is fatal.
External signs: Taiyin spontaneous diarrhea without thirst, Jueyin diarrhea with cold extremities, both may have chills. Taiyin suits Lizhong Tang; Jueyin suits Sini Tang. Previously stated that Two-Yin do not have chills, now stating they may. Note: Taiyin/Jueyin do not have chills when Yang transmits to Yin; Three-Yin can have chills when Yin enters Yin, most notably in Shaoyin. Chills, faint pulse, followed by diarrhea, cessation of diarrhea implies blood depletion—treat with Sini Jia Renshen Tang (Sini Decoction plus Ginseng). (Cheng Wuji notes: Chills, faint pulse, diarrhea indicate Yang deficiency and Yin excess. Cessation of diarrhea depletes fluids, termed "blood depletion." *Jinkui Yufan* states: Water exhaustion leads to blood depletion. Use Sini Tang to warm meridians and assist Yang, add Renshen to generate fluids and benefit blood.)
Sini Jia Renshen Tang Formula:
Renshen (Ginseng Radix et Rhizoma), Ganjiang (Dried Ginger Rhizome), Gancao (Licorice Root) (each 1 liang); Fuzi (Prepared Aconite Lateralis Radix) (1 piece, peeled, roasted). Crushed. Take 5 qian per dose, decoct in water, take warm, three times daily.
After sweating, if disease persists and chills worsen, it is deficiency—treat with Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction). (Cheng Wuji notes: After sweating, if resolved, no chills. If unresolved and Exterior is Excess, no chills. Now, unresolved after sweating with worsening chills indicates Ying and Wei both deficient. Sweating depletes Ying; chills deplete Wei. Give Shaoyao Gancao Fuzi Tang to tonify Ying and Wei.)
Shaoyao Gancao Fuzi Tang Formula:
Shaoyao (White Peony Root), Zhi Gancao (Honey-fried Licorice Root) (each 3 liang); Fuzi (1 piece, processed, peeled, broken into 8 pieces). These three ingredients, boil in 5 sheng water to obtain 1.5 sheng, strain, divide and take warm. Suspected non-Zhang Zhongjing original intent. (Cheng Wuji notes: Shaoyao's sourness astringes fluids and benefits Ying; Fuzi's pungent-hot nature secures Yang and benefits Wei; Gancao's sweetness harmonizes sour/pungent and stabilizes Zheng Qi.)
After purging and re-sweating, trembling chills, faint-fine pulse indicate interior-exterior deficiency—use Danggui Sini Tang (Angelica Sinensis Decoction for Frigid Extremities) or Zhenwu Tang.
Taiyang disease after purging, rapid pulse, chest fullness—treat with Guizhi Qu Shaoyao Tang (Cinnamon Twig Decoction minus White Peony).
Guizhi Qu Shaoyao Tang Formula:
Guizhi (Cinnamon Twig), Shengjiang (Fresh Ginger Rhizome) (each 1.5 liang), Zhi Gancao (1 liang), Dazao (Jujube) (6 pieces). Crushed. Take 5 qian per dose, decoct in water, take warm. If slight chills occur, use Guizhi Qu Shaoyao Jia Fuzi Tang (Cinnamon Twig Decoction minus White Peony plus Aconite). (Add half a peeled, processed Fuzi to the previous formula. Zhu Gong's *Huoren Shu* says: Shaoyao is sour; rapid pulse and chest fullness fear forming Jie Xiong (Chest Binding); thus, use only pungent-sweet flavors to disperse toxins.)
After sweating and purging in Cold Damage, epigastric fullness with chills indicates unresolved Exterior. First use Guizhi Tang to resolve Exterior, then Dahuang Huanglian Xiexin Tang (Rhubarb, Coptis, and Scutellaria Heart-Purging Decoction) to attack fullness. If fullness with sweating and chills, Exterior is resolved—use Fuzi Xiexin Tang (Aconite Heart-Purging Decoction). (Formula discussion see "Fullness" section.)
Back Chills: Back belongs to Yang, Front to Yin. Back cold indicates weak Yang. There are two patterns: Shaoyin pattern, due to excessive Yin-cold failing to consume fluids, results in normal mouth sensation. Three-Yang Combined Disease, due to Yang sinking and fluid depletion, results in dry tongue and mouth. This distinguishes them sufficiently. Normal mouth sensation with back chills belongs to Shaoyin—suitable for Fuzi Tang (see "Somnolence/Lethargy"). Dry tongue/mouth, internal heat, numb/unpleasant mouth sensation with back chills indicates Three-Yang Combined Disease—suitable for Baihu Tang (White Tiger Decoction) (see "Fever"). Classic states: Abdominal fullness, heavy body, greasy face, delirium, urinary incontinence, numb mouth—Three-Yang Combined Disease, treat with Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) (see "Thirst"). If spontaneous sweating occurs, also use Baihu Jia Renshen Tang. Additionally, Yangming pattern with slight back chills, no high fever, dry mouth/thirst—also use Baihu Jia Renshen Tang. Summerheat may also cause back chills, but with greasy face, sweating, void-deep pulse; see Miscellaneous Diseases. For those with inherent Spleen/Stomach deficiency, drinking cold water or eating raw/cold foods during summer causes cold accumulation, Yin rising over Yang, leading to cold starting from the back, size of a palm. Treat with warming medicines (such as Dashun San).