伤寒九日以上病不除者，或初一经受病，即不能相传；或已传三阳讫，而不能传于阴，
致停滞累日，病证不罢者；或三阳三阴传病已竟，又重感于寒，名为两感伤寒，则腑脏俱病
，故日数多而病候改变。
伤寒病过经而不愈，脉反沉迟，手足厥逆者，此为下部脉不至，阴阳隔绝，邪客于足少
阴之络。毒瓦斯上熏，故咽喉不利，或痛而生疮。
伤寒病证在表，或未发汗，或经发汗未解，或吐下后而热不除，此毒瓦斯盛故也。毒既未
散，而表已虚，热毒乘虚出于皮肤，所以发斑疮隐轸如锦文，重者，喉口身体皆成疮也。
夫伤寒，冬时发其汗，必吐利，口中烂生疮，以其表里俱热，热不已，毒瓦斯熏上焦故也
伤寒势毒瓦斯盛，多发 疮，其疮色白或赤，发于皮肤，头作瘭浆，戴白脓者，其毒则轻
；有紫黑色作根，隐隐在肌肉里，其毒则重。甚者，五内七窍皆有疮。其疮形如豌豆，
故以名焉。
伤寒病发豌豆疮者，皆是热毒所为。所病折则疮愈，而毒瓦斯尚未全散，故疮痂虽
落，其瘢犹 ，或凹凸肉起，所以宜用消毒灭瘢之药以敷之。
伤寒四五日，脉沉而喘满者，沉为在里，而反发其汗，津液越出，大便为难，表虚里实
，久久则 语。发汗后，重发其汗，亡阳 语，其脉反和者，不死。阳明病，下血
而语者，此为热入血室，但头汗出，当刺期门穴，随其实者而泻之， 然汗出者
则愈。病若谵言妄语，身当有热，脉当得洪大，而反手足四厥，脉反沉细而微者，死病
也。谵言妄语，身热，脉洪大生；沉细微，手足四逆者死。
伤寒病经过九日以上，病情仍未消除的，有的起初只有一经受邪，随即不能传变到其他经；有的已经传遍三阳经，但不能传入阴经，导致病邪停滞多日，病症不愈；有的三阳三阴传变已尽，又再次感受寒邪，称为两感伤寒，此时脏腑都受病，所以病程长且病候发生改变。
伤寒病已过经而仍未痊愈，脉象反而沉迟，手足厥冷的，这是下部脉搏摸不到，阴阳之气隔绝，邪气客居在足少阴肾经的络脉中。毒热之气上熏，所以咽喉不利，或者疼痛并生疮。
伤寒病证在表，或者尚未发汗，或者虽然发汗但病未解除，或者吐下之后热势仍不消退，这都是因为毒热炽盛所致。毒热既未消散，而体表已虚，热毒乘虚外发于皮肤，所以出现斑疹疮疡，隐现如锦缎花纹一样；重症者，咽喉、口腔及全身都会形成疮疡。
大凡伤寒，若在冬季误用发汗法，必然导致呕吐腹泻，口中糜烂生疮，这是因为表里俱热，热势不止，毒热之气熏蒸上焦的缘故。
伤寒病势毒热炽盛，容易多发疮疡，其疮色白或红，发于皮肤，头部起水疱，顶端有白色脓液的，其毒较轻；若根部呈紫黑色，隐隐位于肌肉深处，其毒则重。严重的，五脏和七窍都会有疮疡。这种疮的形状像豌豆，因此以此命名。
伤寒病发作豌豆疮的，都是热毒所致。如果患病期间节制饮食（折指节制），疮疡就会愈合，但毒热尚未完全散尽，所以虽然疮痂脱落，疤痕仍然明显，或者皮肤凹凸不平、肉质突起，因此适宜使用消毒灭瘢的药物来敷治。
伤寒病至四五日，脉象沉而气喘胸满的，沉脉主病在里，却反而使用发汗法，导致津液外越，大便困难，表现为表虚里实，时间久了就会出现胡言乱语。发汗后，再次发汗，导致亡阳而出现胡言乱语，如果脉象反而调和的，不会死亡。阳明病，出现便血并胡言乱语的，这是热邪陷入血室，仅头部出汗，应当针刺期门穴，根据其实证情况予以泻法，如果周身濈然汗出的，就会痊愈。如果病人胡言乱语、妄动，身体应当发热，脉象应当洪大，却反而手足四肢厥冷，脉象反而沉细而微的，是死证。胡言乱语、妄动，身体发热，脉象洪大的可生；若脉象沉细微弱，手足四肢逆冷的则死。
If a cold damage disease persists beyond nine days without resolution, it may be that initially only one meridian was affected and failed to transmit further; or it may have transmitted through the three Yang meridians but failed to enter the Yin meridians, causing stagnation for several days with persistent symptoms; or after transmission through both the three Yang and three Yin meridians is complete, a secondary contraction of cold occurs, termed "Liang Gan Shang Han" (Double Contraction Cold Damage), where both fu and zang organs are diseased, resulting in prolonged duration and altered clinical manifestations.
When a cold damage disease has passed its meridian stage yet remains unresolved, accompanied by a pulse that is instead deep and slow, and cold extremities, this indicates the absence of pulse at the lower body, separation of yin and yang qi, and pathogenic factors lodging in the collaterals of the Foot Shaoyin Kidney Meridian. Toxic heat steaming upward causes throat discomfort, pain, or ulceration.
When cold damage pathology remains in the exterior, whether due to lack of sweating therapy, incomplete resolution after sweating, or persistent fever following emesis or purgation, this is due to excessive toxic heat. Since the toxin has not dispersed while the exterior is deficient, heat-toxin exploits this deficiency to emerge on the skin, causing macules and pustules resembling brocade patterns. In severe cases, ulcers form in the throat, mouth, and entire body.
Generally, if sweating therapy is incorrectly applied during winter for cold damage, vomiting and diarrhea will inevitably occur, along with oral erosion and ulceration, because both interior and exterior are hot. Unchecked heat causes toxic vapors to scorch the Upper Jiao.
In cold damage with intense toxic heat, numerous sores often develop. Sores that are white or red, appearing on the skin with vesicles topped by white pus indicate mild toxicity. Those with purple-black bases hidden within the muscles indicate heavy toxicity. In extreme cases, sores appear in the five viscera and seven orifices. These sores resemble peas, hence the name.
Pea sores arising from cold damage are caused by heat-toxin. If dietary restrictions are observed, the sores heal, but residual toxins may remain even after scabs fall off, leading to visible scars or uneven skin texture. Therefore, medications for detoxification and scar removal should be applied.
On the fourth or fifth day of cold damage, if the pulse is deep and accompanied by wheezing and chest fullness, the deep pulse indicates interior pathology. Incorrectly applying sweating therapy causes fluid loss and constipation, resulting in exterior deficiency and interior excess. Prolonged conditions lead to delirious speech. Repeated sweating after initial sweating leads to Yang exhaustion and delirium; if the pulse becomes harmonious, death is avoided. In Yangming disease, bleeding accompanied by delirium indicates heat entering the Blood Chamber. With sweating only on the head, puncturing the Qimen (LR14) acupoint to drain excess is indicated. Generalized sweating signifies recovery. If a patient exhibits delirious speech and agitation, they should have fever and a surging-large pulse; however, if extremities are cold and the pulse is deep, fine, and weak, it is a fatal condition. Delirium with fever and surging-large pulse suggests survival; delirium with deep-fine-weak pulse and cold extremities indicates death.