凡勘伤寒。必先明表里寒热。有表寒。有里寒。有表里皆寒。有表热。有里热。有表里皆热。有表寒里热。
有表热里寒。有里真热而表假寒。有里真寒而表假热。发现于表者易明。隐伏于里者难辨。真寒真热者易明。
假寒假热者难辨。今试举其要以析言之。
凡头痛身热。恶寒怕风。项强腰痛。骨节烦疼者。皆表寒证。皆宜汗解。《内经》所谓体若燔炭。汗出而
散者是也。但要辨无汗者。寒甚于风。为正伤寒。必须使周身大汗淋漓而解。苏羌达表汤为主。随证加减。自汗
者风重于寒。为冷伤风。必兼鼻寒声重。咳嗽喷嚏。但须 微汗而解。苏羌达表汤去羌活、生姜。加荆
芥、前胡、桔梗为主。若发热恶寒如疟状。一日二三发。其人不呕。仍是太阳表证。苏羌达表汤主之。惟寒
已而热。热已而汗者。则为少阳之寒热往来。症多目眩耳聋。口苦善呕。膈满胁痛。必须上焦得通。津液得下。
胃气因和。津津汗出而解。谓之和解。轻者柴胡枳桔汤。重者柴胡陷胸汤选用。若发寒时身痛无汗。发热
时口渴恶热。太阳表证未罢。阳明里证已急。则为少阳寒热之重证。柴芩双解汤主之。如身热微恶
寒无汗而微喘。头额目痛。肌肉烦疼。此风寒由皮毛袭于阳明肌
肉也。仍宜发汗。苏羌达表汤去羌活、加葱豉主之。总之有一分恶寒。即有一分表证。虽有大汗微汗之不同。而同
归汗解。太阳发表。少阳和解。阳明解肌。其理一也。
凡是诊治伤寒病，必须先明确辨别表证、里证、寒证、热证。有表寒证，有里寒证，有表里皆寒证，有表热证，有里热证，有表里皆热证，有表寒里热证，有表热里寒证，有里真热而表假寒证，有里真寒而表假热证。表现于体表的容易明了，隐伏在体内的难以辨识；真正的寒热容易明了，假性的寒热难以辨识。现在试着列举其要点来分析说明。
凡是出现头痛、身体发热、怕冷畏风、颈项强直、腰部疼痛、骨节烦扰疼痛的，都属于表寒证，都适宜用发汗法解除。这就是《黄帝内经》所说的“身体像燃烧的炭火一样烫，出汗后病邪就消散了”的道理。但是必须辨别是否有汗：无汗的，说明寒邪重于风邪，属于正伤寒（由风寒之邪引起的典型伤寒），必须让周身大汗淋漓才能解除，以苏羌达表汤为主方，随证加减。自汗出的，说明风邪重于寒邪，属于冷伤风（感受风寒引起的感冒），必定兼有鼻塞声重、咳嗽、打喷嚏等症状，只需微微出汗即可解除，以苏羌达表汤去掉羌活、生姜，加入荆芥、前胡、桔梗为主方。如果发热恶寒像疟疾发作的样子，一天发作两三次，患者没有呕吐症状，这仍然是太阳表证，用苏羌达表汤主治。只有当寒战停止后发热，发热停止后出汗的，才是少阳病的寒热往来，症状多伴有目眩、耳聋、口苦、容易呕吐、胸膈满闷、胁肋疼痛，必须使上焦气机通畅，津液下行，胃气调和，从而津津汗出而病解，这叫做和解法。轻症选用柴胡枳桔汤，重症选用柴胡陷胸汤。如果在发冷时身体疼痛且无汗，发热时口渴且怕热，说明太阳表证尚未罢除，阳明里证已经紧急，这是少阳寒热往来的重症，用柴芩双解汤主治。如果是身体发热、轻微怕冷、无汗且微喘，额头和眼睛疼痛，肌肉烦扰疼痛，这是风寒从皮毛侵袭到阳明经肌肉所致，仍然适宜发汗，用苏羌达表汤去掉羌活，加入葱白、豆豉主治。总之，只要有一分怕冷的症状，就有一分表证存在，虽然有大汗和小汗的不同，但都归于通过发汗来解除。太阳病用发表法，少阳病用和解法，阳明病用解肌法，其中的道理是一致的。
In the diagnosis and treatment of Shanghan (Cold Damage), one must first clearly distinguish between exterior/interior and cold/heat patterns. There are exterior cold patterns, interior cold patterns, exterior-interior both cold patterns, exterior heat patterns, interior heat patterns, exterior-interior both heat patterns, exterior cold with interior heat patterns, exterior heat with interior cold patterns, interior true heat with exterior false cold patterns, and interior true cold with exterior false heat patterns. Manifestations on the exterior are easy to understand, while those hidden in the interior are difficult to differentiate. True cold and true heat are easy to identify, whereas false cold and false heat are difficult to discern. Now, let us briefly outline the key points for analysis.
Symptoms such as headache, feverish body, aversion to cold and wind, stiffness of the neck and lower back, and vexatious pain in the joints all belong to the Exterior Cold pattern. All these should be resolved through diaphoresis (sweating). This corresponds to what is stated in the *Neijing* (Inner Canon): "The body feels like burning charcoal; once sweat is produced, the pathogen dissipates." However, one must distinguish between anhidrosis (no sweat) and diaphoresis (spontaneous sweating). In cases of anhidrosis, cold is more severe than wind, constituting Zheng Shanghan (True Cold Damage). It is necessary to induce profuse whole-body sweating to resolve it. The primary formula is Suqiang Dabiao Decoction, modified according to symptoms. In cases of spontaneous sweating, wind is heavier than cold, constitling Leng Shangfeng (Cold Wind Injury). This is invariably accompanied by nasal congestion, heavy voice, coughing, and sneezing. Only mild sweating is required for resolution. The primary formula is Suqiang Dabiao Decoction minus Qianghuo (Notopterygii Rhizoma et Radix) and Shengjiang (Zingiberis Rhizoma Recens), plus Jingjie (Schizonepetae Herba), Qianhu (Peucedani Radix), and Jiegeng (Platycodonis Radix). If fever and aversion to cold occur like malaria, two or three times a day, and the patient does not vomit, it remains a Taiyang Exterior pattern, treated with Suqiang Dabiao Decoction. However, if chills cease followed by fever, and fever ceases followed by sweating, this indicates the alternating chills and fever of Shaoyang disease. Symptoms often include vertigo, deafness, bitter taste in the mouth, propensity to vomit, fullness in the chest and diaphragm, and hypochondriac pain. One must ensure the free flow of Qi in the Upper Jiao, the descent of body fluids, and the harmonization of Stomach Qi, leading to gentle sweating and recovery. This is called Harmonization. For mild cases, Chaihu Zhijie Decoction is selected; for severe cases, Chaihu Xiantong Decoction is used. If during chills there is body pain and anhidrosis, and during fever there is thirst and aversion to heat, indicating that the Taiyang exterior pattern has not yet resolved but the Yangming interior pattern has become urgent, this is a severe form of Shaoyang alternating chills and fever, treated with Chaiqin Shuangjie Decoction. If there is fever, slight aversion to cold, anhidrosis, slight wheezing, pain in the forehead and eyes, and vexatious muscle pain, this indicates that Wind-Cold has invaded the muscles of the Yangming channel from the skin and hair pores. Diaphoresis is still appropriate, using Suqiang Dabiao Decoction minus Qianghuo, plus Congbai (Allii Fistulosi Bulbus) and Chidouchi (Fermented Soybean). In summary, wherever there is one part of aversion to cold, there is one part of exterior pattern. Although there are differences between profuse and mild sweating, they all aim at resolution through sweating. Taiyang diseases are treated with Exterior-Releasing methods, Shaoyang diseases with Harmonization methods, and Yangming diseases with Muscle-Resolving methods; the underlying principle is the same.