伤寒一书，系东汉张仲景先生所着，为历代医家施术之蓝本，因仲景居北方之地，寒气凛冽，其
药多用辛甘温热重剂。若在南方，寒不甚严，且去古渐远，人之元气渐薄，故其法可师，而其药则有
时可改。非违仲景也，变而通之，以从时地，斯真善学仲景者也。治伤寒大法，如见太阳病，头疼发热
恶寒，身疼腰疼，脊强无汗，脉浮紧而不数，为不传经，烦躁脉急数者，是欲传经，宜先发汗以解表
邪，香苏散加羌、防、芎、豉等药治之，得汗为解，头疼发热自汗，脉浮缓为伤风，宜实表，投以羌
防香苏散。即上方去苏叶，加白芍，汗止为解。若外症头疼身疼不解，而见目疼鼻干，不得卧者，是邪
已传阳明，未离太阳，即系太阳阳明症。治有二法。不呕无汗，羌防香苏散加葛根，或羌活汤中加之。
喜凉恶热自汗，烦躁口渴饮冷，羌活汤加石膏知母麦冬，大剂与之，若身热目疼，鼻干不得卧，是已离太阳，未
接少阳，谓之正阳明经病。不呕无汗，宜葛根汤辛凉之剂以解肌。若喜凉恶热，自汗烦躁，口渴饮
冷，咽燥唇裂，舌苔芒刺，谵语潮热，甚则发呃发厥，发斑发狂，脉洪大者，是属正阳明腑病。治亦有
二法。大便不硬，或虽硬而腹无所苦，宜大剂竹叶石膏汤，解热生津止渴，而退胃热。若不大便五、
六日，绕脐疼或腹满疼，手不可按，转失气者，此有燥粪也，当承气汤下之，以开结除热，而存津液，
不可大下，恐伤其正。下后按其腹中不疼，即病已解，如仍满疼，是燥粪未尽，病重药轻故也，当
再下之，以腹中和，二便通为度。若脉弱或不能食，其人本虚，勿轻议下，必不得已，或用补泻兼用之
法，寓战于守可也。或黄龙汤，或承气养荣汤，随宜用之。若阳明症未解，兼见少阳症之口苦咽干，
目眩耳聋，是邪已入少阳，未离阳明，谓之少。阳阳明症，只以小柴胡加葛根，加减为治。若见往来寒
热，头角微疼，口苦咽干，目眩耳聋，胸胁苦满，默默不欲饮食，心烦喜呕，是邪传足少阳也，小柴胡
汤加减治之。所谓合病者，如太阳症之头疼恶寒身疼，阳明症之目疼鼻干不得卧，少阳病之口苦咽干，
目眩耳聋，胸胁苦满，各有专司，或太阳与阳明，或阳明与少阳，二经表症，各见一半，不偏多
少，俱半兼阳明。邪既相合，胃中水谷不安，必自下利，不下利者，亦必有上逆而呕，或喘而胸满
之里症。以太阳邪在胸，阳明邪在胃，两邪相合，必上攻其肺，所以喘而胸满。两经之邪会合胸腹而
不传，真为合病，若无胸腹表里相合之征，即是传经未罢，不为合病矣。治太阳阳明合病，协热下利
者，以羌、葛解两经之邪，芩、连清在里之热，而调服天水散。心下痞者，加栝蒌实。阳明少阳合病
，协热下利者，芍药黄芩汤，加柴葛治之。大抵二经合病者，必用二经之主药，三经合病，必用三经
之主药为治。治并病之法，亦如是。并病者，不论多少，或一经见三、五症，或一经见一症二症，即
是。必太阳病多，阳明少阳症少，羁留时日，故为并病。若阳明、少阳症多，太阳症少，不羁时日，
顷刻传过它经，不为并病也。坏病者，乃误施汗吐下温针，病仍不解，反增病剧，故为坏病。病在三阳，
未及于阴，即汗多亡阳厥逆，筋惕肉 ，以误汗之所致；腹中饥不能食，呕吐不止，以误吐之所致；
结胸痞满利下，以误下之所致；惊狂起卧不安，以误灸之所致。观其脉症，知犯何逆，随症治之。
伤寒六、七日，或十二至十四日，经气旺而当复之时犹未愈，谓之过经不解，正气多虚，尚有表症宜
汗者，微汗之，有里症宜下者，微下之。如其年壮力盛者，不在禁例，随病制宜。若传至三阴，邪热
入里，虽云阴分，病属于热，总宜清解邪热为治。渴者竹叶石膏汤，不渴心下痞者，
黄连、栝蒌、枳壳，麦冬之属以清之，分而言之，如见太阴病之腹满咽干，吐而食不下，自利而腹
痛，宜芍药黄芩汤加减治之。若见少阴病之口燥舌干而渴，身凉欲寐，脉沉细数，宜黄连阿胶汤加地、
冬、知、柏之属，以清解热邪，滋养肾水为治，如舌苔黑刺，不大便，而小便不利者，乃肾水津液皆
竭，急宜大剂煎汤，十中或救一、二。若见厥阴病之烦满，囊缩消渴，气上冲心，心中痛热，饥不欲
食，食则吐者，本经之邪，冲心入胃，无所不至，急宜龙胆清肝饮救之。须知三阴症中，俱有复转阳
明，而成胃实可下之症，如腹中大实满痛，手不可按者，是太阴转阳明也，可下。六、七日不大便，腹胀
满者，是少阴转阳明也，可下。协热下利谵语者，有燥粪也，是厥阴转阳明也，可下。若邪不转入阳
明，大便不坚硬者，慎勿轻下，或邪未结于下焦，少腹不坚痛，而误用芒硝，以伐真阴，洞泄不已，元
气将脱，宜用大剂理中汤，加白芍、大枣、乌梅，不止，佐以升提固涩之剂。病新愈后，元气已虚，邪
热未净，或起居作劳，复发热者，谓立劳复，宜甘寒益虚清热之药，随症施治。因多食而复发者，谓之食
复。缘脾胃气弱，不能消谷，轻则健脾消食，重则微下，或用攻补兼施之法可也。但日暮微烦者，当
减损谷食，休养脾胃，不药自愈。以上既明伤寒，既明六经
症治，以及合病并病坏病，过经不解，并劳复食复等症，而尤不能无言者，其治法之要，不可不悉也。
节庵云∶伤寒治法，得其要领，易如拾芥，若求之多岐，则支离破碎，如涉海问津矣。盖脉症与理而
已。脉以浮大数滑为阳，沉小迟涩为阴。叔和云∶指下难明者真言也，夸言通晓者，但能言而不能行
也。余尝法节庵之秘，专以浮沉迟数大小滑涩，察其有力无力，则病之表里虚实，阴阳寒热，无遁情
矣。证者，如获贼则证其为盗，故一经有一经之的证，如上文之所述者，皆是。如见何经之症，即发
何经之药。仲景曰∶日数虽多，但有表症而脉浮大者，仍宜解表，日数虽少，但有里症，而脉沉实者，
即当攻里。若同而异者明之，似是而非者辨之，用药当如盘珠，慎勿刻舟求剑。景岳云∶余尝治此症，
多非本门正方，辄随手而应，无他，药对症而已矣。所谓理者，知其常，通其变也。得真理则治无一
失。昔贤治伤寒立六法，曰∶汗、吐、下、温、清、补。夫表有邪，不汗之何从而出。仲景曰，凡发
汗，温服汤药，其方虽言日三服，若病剧不解，可半日中尽三服。又曰∶凡作汤药，不可避晨夜，
初病即治，不等早晚，则易愈。此所以汗不嫌早。但汗法有三∶一曰温散。经云∶发表不远热。又曰∶
寒无犯寒，故身虽大热，必用辛温。二曰凉解。炎热炽盛，表里枯涸，阴气不营，亦不能汗，宜用辛凉
。三曰平解。病在阴阳之间，既
不可温，又不可凉，但宜用平解表而已。二曰吐。吐者治在上也。吐中有发散之意，可祛胸中之实
邪，若无实邪在上，不可用之。故所用既少，而法亦无多。三曰下。下者攻其里也。实邪内结，不下从
何而去，但当察症之轻重缓急而变通用之，若非大满燥实坚者，不可轻下，此所以下不嫌迟也。四曰
温。温者温其中也。脏有寒气，不温之何自而除。然伤寒乃传经热症，岂有中反变寒之理，或因过用
寒凉，间有可温之者，所当详审。节庵云∶误用姜、附，令人失血发狂，辛热耗其津液，燥热助其邪热，
庸医杀人莫此为甚。五曰清。清者清其热也。有热无结，本非下症，若不清之，热何由散，下后余邪，亦
宜清也。六曰补。补者救其虚也，盖人受外感之邪，惟元气旺者，始能领药势以驱邪外出，所以虚弱之
人，必用人参三、五、七分，入表药中，少助元气，以为驱邪之主，使邪气得药，一涌而去，非真取其补
养虚弱也。即和解攻里药中，有人参之大力者居间，正气得伸，则邪气自不争而退舍，不过借之以得其平，
亦非偏补一边之意也。而不知者，方谓伤寒无补法，邪得补而弥炽，断不敢用，以致体虚病感之人，百无
一活！独不观古方解表，有参苏饮，败毒散，和解有小柴胡汤，白虎汤，攻里有黄龙汤，皆借人参之力，
领出在内之邪，仲景、节庵，未尝不用，盖
不当用参而用之杀人者，皆是与 、术、归、姜、桂、附等药同行温补之所致，不与羌、苏、柴、葛、
芩、羔、硝、黄同用汗下和解之法所致。汗下和解药中，兼用人参，并不伤人，嘉言辨之甚明，且誓之
曰∶今后有以汗下和解药中，不宜用人参之言误人者，死入犁耕地狱。景岳亦云∶伤寒虽其万变，虚实
二字，可以提纲，正胜则愈，邪胜则死。正气实者，虽感大邪，其病亦轻，抗力强也。正气虚者，虽感
微邪，其病亦重，抗力弱也。气实而病者，攻之即愈，虽不服药，经尽即安，何足虑也，所可虑者，惟挟虚
耳。但今之人，患挟虚伤寒者，十尝六、七，而庸浅之辈，不能察其虚而为之补救，且恣意攻之，不死何
待。又曰∶如表邪不解，屡散之而汗不出者，阴气不能达也。盖汗即水也，水既不足，汗自何来？人知汗
属阳分，升阳可以解表，而不知汗生于阴，补阴最能发汗，今有饮水而汗出者，即其验也。又如内热不
解，屡清之而火不退者，阴不足也。人知惟寒凉可以祛热，而不知壮水方能熄火也。故人伤于寒而为热，
则阳胜阴伤，是当补阴，所以伤寒偏死下虚人者，以邪传少阴，热涸残阴也。沈氏云∶人有房劳伤其
阴，复遇风寒乘虚感入肾间，即病身热似火燎，口渴烦躁，经谓是人阴气虚，阳气盛，少水不能制盛
火，而阳独治，逢风而如炙如火者是也。
必以大剂先滋其阴，俾阴气不绝，然后疏表，始为合法。知此六者，用药即握伤寒之要，不必求之多
岐矣。至若观病法则之精，无过节庵，姑举其所言，而补其所未备。凡治伤寒，先问始于何日，以知
久近；起于何因，以知病本，时下所见何症，根据经断为何病。次问饮食之喜恶多寡，二便之滑涩有
无，以察其肠胃之乖和。口之渴与不渴，饮水之多与不多，以察其津液之存亡。然后观神色，以定其
吉凶。目赤为热甚，目黄为疸症，但发黄有湿热瘀血之不同。次看唇齿润燥，以及舌上有无苔状，辨里
热之轻重，听其声之清浊长短若何，识其在中之虚实。后以手按其心胸至少腹有无痛处，如按之而痛，
当审其气结胸胃与瘀血之异。更当究其服过何药，效与不效，并平素有无宿疾病症，一一详明，参之以
脉，则有是病，即用是药，病千变，药亦千变，无不桴鼓附应矣。但杂症之类伤寒者甚多，嘉言虽云类
伤寒名目一出，则头上安头，愈求愈失，其言果善。然后学失此辨症之一法，似为缺文，故仍为拈出以
明之。夫类伤寒，节庵分为五症。一曰痰饮。中脘伤痰，亦能憎寒发热自汗，胸膈满闷喘逆，但头不痛，
项不强，与伤寒异耳。二曰食积。胃中伤食，亦身体发热，间有头痛，但身不痛，必左脉平和，右脉有
力，有嗳腐吞酸，痞胀满痛等症，与伤寒异耳。三曰虚
烦。谓诸虚烦热，如劳倦伤脾，亦发热自汗，但不头痛，亦不恶寒，必左脉和平，右脉无力，少气懒
言，四肢倦怠。又如纵欲伤肾，亦微寒发热，或头胀微痛，但其发时，必在午后子前，有五心烦热，腿
胫酸软，肾虚诸症，与伤寒异耳。四曰瘀血。因斗殴跌仆，负重闪挫，血瘀在外，或即发，或久远而
发，亦寒热自汗，但心胸或胁下，或少腹，按之满痛为辨耳。五曰香港脚。足受湿气，亦头痛发热，恶寒
呕逆，但起于脚胫肿痛为异耳。伤寒虽重症，能明六经症治，合病并病诸病，以及六法治要，观病准绳，
更详审类伤寒诸症，如是投剂，而犹误杀人者，吾未之前闻。虽云大略，孔子曰∶举一隅当以三隅反。
易曰∶变而通之，神而明之，存乎其人。所谓由浅而入深，由博而反约者，其在斯乎。学人慎勿忽诸。
《伤寒论》一书，由东汉张仲景先生所著，是历代医家施治的蓝本。因为张仲景居住在北方，寒气凛冽，所以他的用药多采用辛甘温热性质的重剂。如果在南方，寒冷并不严重，且距离古代时间渐远，人的元气逐渐薄弱，因此他的治疗方法可以效法，但他的药物有时需要修改。这并非违背张仲景的原意，而是变通以顺应时宜和地域，这才是真正善于学习张仲景的人。
治疗伤寒的大法：如果见到太阳病（太阳经受邪所致的病证），表现为头痛、发热、恶寒（怕冷）、身体疼痛、腰痛、脊柱僵硬、无汗，脉象浮紧且不数（快），这是病邪未传入他经；如果出现烦躁、脉象急数，这是病邪欲传入他经，应当先发汗以解除表邪，用香苏散（Cangpu and Cyperus Decoction）加羌活、防风、川芎、豆豉等药物治疗，出汗后病解。如果头痛、发热、自汗（不自主出汗），脉象浮缓，这是伤风（外感风邪），应当固护体表，投用羌活、防风、香苏散。即上方去掉紫苏叶，加入白芍，汗止即为病解。如果外症头痛身痛不解，却出现眼睛疼痛、鼻子干燥、无法安卧，这是邪气已传入阳明（阳明经/腑），但未离开太阳经，称为太阳阳明合病（Taiyang-Yangming Combined Disease）。治疗有两种方法。如果不呕吐、无汗，用羌活、防风、香苏散加葛根，或者在羌活汤中加入葛根。如果喜欢凉爽、厌恶炎热、自汗、烦躁、口渴想喝冷水，用羌活汤加石膏、知母、麦冬，大剂量给予。如果身体发热、眼睛疼痛、鼻子干燥、无法安卧，这是已离开太阳经，但未连接少阳经（Shao Yang Channel），称为正阳明经病（True Yangming Meridian Disease）。如果不呕吐、无汗，宜用葛根汤这种辛凉剂以解除肌表之邪。如果喜欢凉爽、厌恶炎热、自汗、烦躁、口渴想喝冷水、咽喉干燥、嘴唇开裂、舌苔有芒刺、说胡话、潮热（定时发热），甚至出现呃逆、四肢厥冷、发斑、发狂，脉象洪大，这属于正阳明腑病（True Yangming Fu-organ Disease）。治疗也有两种方法。如果大便不硬，或者虽然硬但腹部没有痛苦，宜用大剂量竹叶石膏汤（Zhuye Shigao Tang），以清热生津止渴，退去胃热。如果五六天不大便，脐周疼痛或腹部胀满疼痛，手不能按压，转放屁，这是有燥屎（Dry Stool），应当用承气汤（Chengqi Decoction）攻下，以开结除热，保存津液，不可猛烈攻下，恐怕损伤正气。攻下后按压腹部不疼，就是病已解；如果仍然胀满疼痛，是燥屎未尽，病重药轻的缘故，应当再次攻下，直到腹部平和，大小便通畅为止。如果脉弱或不能进食，此人本来虚弱，不要轻易议论攻下，如果不得已，可以用补泻兼用的方法，寓战于守（在防守中作战）即可。或者用黄龙汤（Huanglong Decoction），或者用承气养荣汤（Chengqi Yangrong Decoction），根据情况选用。如果阳明病未解，兼见少阳病的口苦、咽干、目眩、耳聋，这是邪气已进入少阳，未离开阳明，称为少阳阳明合病（Shaoyang-Yangming Combined Disease），只用小柴胡汤（Xiaochaihu Decoction）加葛根，加减治疗。如果见到往来寒热（Alternating Chills and Fever）、头角微痛、口苦咽干、目眩耳聋、胸胁苦满（Chest and Hypochondriac Fullness）、默默不欲饮食（Silently no desire to eat）、心烦喜呕（Irritability and frequent vomiting），这是邪气传入手足少阳经（此处指足少阳胆经），用小柴胡汤加减治疗。
所谓合病（Combined Disease），如太阳病的头痛恶寒身痛，阳明病的目疼鼻干不得卧，少阳病的口苦咽干、目眩耳聋、胸胁苦满，各有专门的主治经络，或者是太阳与阳明，或者是阳明与少阳，两经的表证各见一半，不偏多偏少，都算是半兼阳明。邪气既然相合，胃中的水谷不安定，必然自行下利（Diarrhea）；不下利的，也必然有上逆而呕，或者喘促而胸满的里证。因为太阳邪气在胸，阳明邪气在胃，两邪相合，必然上攻肺脏，所以喘促而胸满。两经邪气会合于胸腹而不传变，真正称为合病；如果没有胸腹表里相合的症状，就是传经未罢，不称为合病。治疗太阳阳明合病，伴有热性下利的，用羌活、葛根解除两经之邪，黄芩、黄连清在里的热，调和服用天水散（Tianshui Powder）。心下痞（Epigastric Oppression）的，加瓜蒌实。阳明少阳合病，伴有热性下利的，用芍药黄芩汤（Shaoyao Huangqin Decoction），加柴胡、葛根治疗。大抵两经合病，必须用两经的主药；三经合病，必须用三经的主药治疗。治疗并病（Concurrent Disease）的方法，也是如此。并病是指，不论多少，或者一经出现三、五个症状，或者一经出现一两个症状，就算。必定是太阳病多，阳明少阳病少，羁留时日，所以称为并病。如果阳明、少阳病多，太阳病少，不羁留时日，顷刻间传过其他经，就不称为并病。
坏病（Ruined Disease），是由于误用汗、吐、下、温针等治法，病仍不解，反而增加病情加重，所以称为坏病。病在三阳经，未及于阴经，如果汗出过多导致亡阳（Loss of Yang Qi）、四肢厥逆、筋惕肉瞤（Muscle Twitching），这是误用汗法所致；腹中饥饿但不能进食，呕吐不止，这是误用吐法所致；结胸（Phlegm-Rheum Binding in Chest）、痞满、下利，这是误用下法所致；惊狂、起卧不安，这是误用灸法所致。观察其脉症，知道犯了什么错误，随症治疗。
伤寒六七天，或十二至十四天，经气旺盛且应当恢复的时候仍未愈，称为过经不解（Passing the Meridian Without Resolution），正气大多虚弱，还有表证宜用汗法的，轻微发汗；有里证宜用下法的，轻微攻下。如果其人年轻力壮，不在禁忌之列，随病情制宜。如果传至三阴经，邪热入里，虽然说是阴分，病属于热，总宜清解邪热为治。口渴的用竹叶石膏汤，不渴且心下痞的，用黄连、瓜蒌、枳壳、麦冬之类以清之。分别论述，如见到太阴病（Taiyin Disease）的腹满咽干、吐而食不下、自利而腹痛，宜用芍药黄芩汤加减治疗。如果见到少阴病（Shaoyin Disease）的口燥舌干而渴、身凉欲寐（Body cool, desire to sleep）、脉沉细数，宜用黄连阿胶汤（Huanglian Ejiao Decoction）加地黄、麦冬、知母、黄柏之类，以清解热邪，滋养肾水为治。如果舌苔黑有刺，不大便，而小便不利，这是肾水津液皆竭，急宜用大剂量煎汤，十人中或许能救一二。如果见到厥阴病（Jueyin Disease）的烦满、囊缩（Testicular Retraction）、消渴（Wasting-Thirst）、气上冲心、心中痛热、饥不欲食、食则吐者，是本经邪气，冲心入胃，无所不至，急宜用龙胆清肝饮（Longdan Qinggan Yin）救治。须知三阴病中，都有复转阳明，而成胃实可下的症状，如腹中大实满痛，手不可按的，是太阴转阳明，可下。六七天不大便，腹胀满的，是少阴转阳明，可下。协热下利说胡话的，有燥屎，是厥阴转阳明，可下。如果邪不转入阳明，大便不坚硬，千万不要轻易攻下。或者邪未结于下焦，少腹不坚痛，而误用芒硝，以伐真阴，洞泄不已（Unceasing Diarrhea），元气将脱，宜用大剂量理中汤（Lizhong Decoction），加白芍、大枣、乌梅，不止，佐以升提固涩之剂。
病新愈后，元气已虚，邪热未净，或因起居劳作，又发热的，称为劳复（Relapse due to Labor），宜用甘寒益虚清热之药，随症施治。因多食而复发的，称为食复（Relapse due to Diet）。缘于脾胃气弱，不能消化谷物，轻则健脾消食，重则轻微攻下，或用攻补兼施的方法即可。只是傍晚轻微烦闷的，应当减少谷物食物，休养脾胃，不吃药也能自愈。以上既讲明了伤寒，既讲明了六经症治，以及合病、并病、坏病、过经不解，还有劳复、食复等症状，而尤其不能不言的是，其治法的关键，不可不详尽了解。节庵说：伤寒治法，得其要领，容易得像捡草芥一样；如果追求多方面枝节，就会支离破碎，像在海里问渡口一样难。大概不过是脉、症、理而已。脉象以浮、大、数、滑为阳，沉、小、迟、涩为阴。叔和说：指下难明是真言，夸言通晓的人，只能言而不能行。我曾效法节庵的秘密，专以浮、沉、迟、数、大、小、滑、涩，察其有力无力，那么病的表里虚实、阴阳寒热，就没有隐藏的了。证，如同抓获盗贼要证明他是贼，所以一经有一经的确切证候，如上文所述者，都是。如见到何经的症状，就发何经的药。张仲景说：日数虽多，但有表证而脉浮大的，仍宜解表；日数虽少，但有里证，而脉沉实的，即当攻里。如果同中有异的要阐明，似是而非的要辨别，用药应当像盘中之珠圆转自如，切勿刻舟求剑。景岳说：我常治此症，多非本门正方，辄随手而应，无他，药对症而已矣。所谓理，是知其常，通其变。得真理则治无一失。昔贤治伤寒立六法，曰：汗、吐、下、温、清、补。表有邪，不汗之从何而出？张仲景说，凡发汗，温服汤药，其方虽言日三服，若病剧不解，可半日中尽三服。又说：凡作汤药，不可避晨夜，初病即治，不等早晚，则易愈。这就是汗法不嫌早的原因。但汗法有三种：一是温散。经云：发表不远热。又说：寒无犯寒，故身虽大热，必用辛温。二是凉解。炎热炽盛，表里枯涸，阴气不营，亦不能汗，宜用辛凉。三是平解。病在阴阳之间，既不可温，又不可凉，但宜用平解表而已。二是吐。吐者治在上也。吐中有发散之意，可祛胸中之实邪，若无实邪在上，不可用之。故所用既少，而法亦无多。三是下。下者攻其里也。实邪内结，不下从何而去，但当察症之轻重缓急而变通用之，若非大满燥实坚者，不可轻下，此所以下不嫌迟也。四是温。温者温其中也。脏有寒气，不温之何自而除。然伤寒乃传经热症，岂有中反变寒之理，或因过用寒凉，间有可温之者，所当详审。节庵说：误用姜、附，令人失血发狂，辛热耗其津液，燥热助其邪热，庸医杀人莫此为甚。五是清。清者清其热也。有热无结，本非下症，若不清之，热何由散，下后余邪，亦宜清也。六是补。补者救其虚也，盖人受外感之邪，惟元气旺者，始能领药势以驱邪外出，所以虚弱之人，必用人参三、五、七分，入表药中，少助元气，以为驱邪之主，使邪气得药，一涌而去，非真取其补养虚弱也。即和解攻里药中，有人参之大力者居间，正气得伸，则邪气自不争而退舍，不过借之以得其平，亦非偏补一边之意也。而不知者，方谓伤寒无补法，邪得补而弥炽，断不敢用，以致体虚病感之人，百无一活！独不观古方解表，有参苏饮（Rensu Yin），败毒散（Baidu San），和解有小柴胡汤，白虎汤（Baihu Tang），攻里有黄龙汤，皆借人参之力，领出在内之邪，仲景、节庵，未尝不用，盖不当用参而用之杀人者，皆是与人参、白术、当归、干姜、肉桂、附子等药同行温补之所致，不与羌活、紫苏、柴胡、葛根、黄芩、石膏、芒硝、大黄同用汗下和解之法所致。汗下和解药中，兼用人参，并不伤人，嘉言辨之甚明，且誓之曰：今后有以汗下和解药中，不宜用人参之言误人者，死入犁耕地狱。景岳亦云：伤寒虽其万变，虚实二字，可以提纲，正胜则愈，邪胜则死。正气实者，虽感大邪，其病亦轻，抗力强也。正气虚者，虽感微邪，其病亦重，抗力弱也。气实而病者，攻之即愈，虽不服药，经尽即安，何足虑也，所可虑者，惟挟虚耳。但今之人，患挟虚伤寒者，十尝六、七，而庸浅之辈，不能察其虚而为之补救，且恣意攻之，不死何待。又曰：如表邪不解，屡散之而汗不出者，阴气不能达也。盖汗即水也，水既不足，汗自何来？人知汗属阳分，升阳可以解表，而不知汗生于阴，补阴最能发汗，今有饮水而汗出者，即其验也。又如内热不解，屡清之而火不退者，阴不足也。人知惟寒凉可以祛热，而不知壮水方能熄火也。故人伤于寒而为热，则阳胜阴伤，是当补阴，所以伤寒偏死下虚人者，以邪传少阴，热涸残阴也。沈氏云：人有房劳伤其阴，复遇风寒乘虚感入肾间，即病身热似火燎，口渴烦躁，经谓是人阴气虚，阳气盛，少水不能制盛火，而阳独治，逢风而如炙如火者是也。必以大剂先滋其阴，俾阴气不绝，然后疏表，始为合法。知此六者，用药即握伤寒之要，不必求之多岐矣。
至于观察病法则之精，无过节庵，姑举其所言，而补其所未备。凡治伤寒，先问始于何日，以知久近；起于何因，以知病本，时下所见何症，根据经断为何病。次问饮食之喜恶多寡，二便之滑涩有无，以察其肠胃之乖和。口之渴与不渴，饮水之多与不多，以察其津液之存亡。然后观神色，以定其吉凶。目赤为热甚，目黄为疸症（Jaundice），但发黄有湿热瘀血之不同。次看唇齿润燥，以及舌上有无苔状，辨里热之轻重，听其声之清浊长短若何，识其在中之虚实。后以手按其心胸至少腹有无痛处，如按之而痛，当审其气结胸胃与瘀血之异。更当究其服过何药，效与不效，并平素有无宿疾病症，一一详明，参之以脉，则有是病，即用是药，病千变，药亦千变，无不桴鼓相应矣。但杂症之类伤寒者甚多，嘉言虽云类伤寒名目一出，则头上安头，愈求愈失，其言果善。然后学失此辨症之一法，似为缺文，故仍为拈出以明之。夫类伤寒，节庵分为五症。一曰痰饮（Phlegm-Fluid Retention）。中脘伤痰，亦能憎寒发热自汗，胸膈满闷喘逆，但头不痛，项不强，与伤寒异耳。二曰食积（Food Stagnation）。胃中伤食，亦身体发热，间有头痛，但身不痛，必左脉平和，右脉有力，有嗳腐吞酸，痞胀满痛等症，与伤寒异耳。三曰虚烦（Deficiency Irritation）。谓诸虚烦热，如劳倦伤脾，亦发热自汗，但不头痛，亦不恶寒，必左脉和平，右脉无力，少气懒言，四肢倦怠。又如纵欲伤肾，亦微寒发热，或头胀微痛，但其发时，必在午后子前，有五心烦热（Five-Center Heat），腿胫酸软，肾虚诸症，与伤寒异耳。四曰瘀血（Blood Stasis）。因斗殴跌仆，负重闪挫，血瘀在外，或即发，或久远而发，亦寒热自汗，但心胸或胁下，或少腹，按之满痛为辨耳。五曰香港脚（Gout / Foot Weakness）。足受湿气，亦头痛发热，恶寒呕逆，但起于脚胫肿痛为异耳。伤寒虽重症，能明六经症治，合病并病诸病，以及六法治要，观病准绳，更详审类伤寒诸症，如是投剂，而犹误杀人者，吾未之前闻。虽云大略，孔子曰：举一隅当以三隅反。易曰：变而通之，神而明之，存乎其人。所谓由浅而入深，由博而反约者，其在斯乎。学人慎勿忽诸。
The *Treatise on Cold Pathogenic Diseases* (Shanghan Lun) was authored by Mr. Zhang Zhongjing of the Eastern Han Dynasty and serves as the blueprint for medical practice throughout history. Because Zhang Zhongjing resided in the north where the cold is biting, his prescriptions predominantly utilized heavy doses of acrid, sweet, warm, and hot herbs. In the south, however, the cold is not severe, and as time has passed since antiquity, human primordial qi (Yuan Qi, 元气) has gradually weakened. Therefore, while his therapeutic principles can be emulated, his herbal formulas may sometimes require modification. This does not violate Zhang Zhongjing’s original intent; rather, it represents adaptation to suit the times and geography, which is true mastery of learning from Zhang Zhongjing.
The general principles for treating cold pathogenic diseases are as follows: If Taiyang disease (disease of the Taiyang channel) is observed, characterized by headache, fever, aversion to cold, body pain, lower back pain, stiffness of the spine, absence of sweating, a floating and tight pulse that is not rapid, this indicates the pathogen has not transmitted to other channels. If irritability and a rapid, urgent pulse appear, this suggests impending transmission. One should first induce sweating to release the exterior pathogen, using Xiangsu San (Cyperi and Perillae Decoction) augmented with Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Xiong (Ligustici Chuanxiong Rhizoma), and Chidou (Sojae Semen Praeparatum). Resolution occurs when sweating ensues. If headache, fever, spontaneous sweating, and a floating, moderate pulse are present, this is Wind Injury (Shangfeng, 伤风). The exterior should be consolidated using Qianghuo, Fangfeng, and Xiangsu San. Specifically, remove Zisuye (Perillae Folium) from the above formula and add Baishao (Paeoniae Radix Alba); resolution is achieved when sweating stops. If exterior symptoms such as headache and body pain persist without relief, but eye pain, nasal dryness, and inability to lie down appear, the pathogen has entered Yangming but has not yet left Taiyang; this is termed Taiyang-Yangming Combined Disease. There are two treatment approaches. If there is no vomiting and no sweating, add Gegen (Puerariae Lobatae Radix) to Qianghuo, Fangfeng, and Xiangsu San, or add it to Qianghuo Tang. If the patient prefers coolness, dislikes heat, sweats spontaneously, feels irritable, thirsty, and desires cold drinks, use Qianghuo Tang augmented with Shigao (Gypsum Fibrosum), Zhimu (Anemarrhenae Rhizoma), and Maidong (Ophiopogonis Radix), administered in large doses. If body heat, eye pain, nasal dryness, and inability to lie down are present, the pathogen has left Taiyang but has not yet reached Shaoyang; this is called True Yangming Meridian Disease. If there is no vomiting and no sweating, use Gegen Tang, a pungent-cool preparation, to resolve the muscle layer. If the patient prefers coolness, dislikes heat, sweats spontaneously, feels irritable, thirsty, desires cold drinks, has a dry throat, cracked lips, prickly tongue coating, delirium, tidal fever, and potentially hiccups, limb coldness, macules, or mania, with a surging pulse, this belongs to True Yangming Fu-organ Disease. Treatment also has two approaches. If the stool is not hard, or even if hard but without abdominal distress, use a large dose of Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) to clear heat, generate fluids, quench thirst, and dissipate stomach heat. If there has been no bowel movement for five or six days, with periumbilical pain or abdominal fullness and pain that cannot be touched, accompanied by passing flatus, this indicates dry feces. Chengqi Tang (Downward-Pouring Decoction) should be used to unblock accumulation, clear heat, and preserve fluids. Do not purge violently, lest you damage righteous qi. After purgation, if pressing the abdomen causes no pain, the disease is resolved. If fullness and pain persist, the dry feces remain; the disease is severe and the medication too light, so purge again until the abdomen is peaceful and bowel/bladder movements are normal. If the pulse is weak or the patient cannot eat, indicating inherent deficiency, do not lightly consider purgation. If absolutely necessary, use a method combining tonification and purgation, engaging in battle within defense. Huanglong Tang (Yellow Dragon Decoction) or Chengqi Yangrong Tang (Chengqi Nourishing Harmony Decoction) may be used as appropriate. If Yangming disease persists alongside Shaoyang symptoms such as bitter taste, dry throat, vertigo, and deafness, the pathogen has entered Shaoyang but not left Yangming; this is Shaoyang-Yangming Combined Disease. Treat only with Xiaochaihu Tang (Minor Bupleurum Decoction) plus Gegen, modified as needed. If alternating chills and fever, slight pain at the temples, bitter taste, dry throat, vertigo, deafness, chest and hypochondriac fullness, silence with loss of appetite, irritability, and frequent vomiting are seen, the pathogen has transmitted to the Foot-Shaoyang Gallbladder Channel. Treat with modified Xiaochaihu Tang.
"Combined Disease" (Hebing, 合病) refers to situations where symptoms of multiple channels appear simultaneously. For example, Taiyang symptoms of headache, aversion to cold, and body pain; Yangming symptoms of eye pain, nasal dryness, and inability to lie down; Shaoyang symptoms of bitter taste, dry throat, vertigo, deafness, and chest/hypochondriac fullness. Each has its specific channel. Whether Taiyang-Yangming or Yangming-Shaoyang, if both exterior syndromes appear equally without predominance, it is considered half-combined with Yangming. Once pathogens combine, the water and grain in the stomach become unsettled, leading inevitably to diarrhea. If diarrhea does not occur, there will likely be upward rebellion with vomiting, or wheezing and chest fullness—interior signs. Since Taiyang pathogen resides in the chest and Yangming pathogen in the stomach, their combination attacks the Lung, causing wheezing and chest fullness. When pathogens from two channels converge in the chest and abdomen without transmitting further, it is truly Combined Disease. If there are no signs of interior-exterior convergence in the chest and abdomen, transmission is incomplete, and it is not Combined Disease. For Taiyang-Yangming Combined Disease with heat-associated diarrhea, use Qianghuo and Gegen to resolve the two channels' pathogens, Huangqin (Scutellariae Radix) and Lianqiao (forbidden here, likely meant Huanglian Scutellariae Radix based on context "Qin, Lian") to clear interior heat, and administer Tianshui San (Sky Water Powder) harmoniously. For epigastric oppression, add Gualou Shi (Trichosanthis Fructus). For Yangming-Shaoyang Combined Disease with heat-associated diarrhea, use Shaoyao Huangqin Decoction augmented with Chaihu (Bupleuri Radix) and Gegen. Generally, combined disease of two channels requires the principal herbs of those two channels; combined disease of three channels requires the principal herbs of all three. The method for treating Concurrent Disease (Bingbing, 并病) is similar. Concurrent disease occurs regardless of quantity: if one channel presents three to five symptoms, or one to two symptoms, it counts. It must be that Taiyang symptoms predominate while Yangming and Shaoyang symptoms are few, lingering over time, thus constituting Concurrent Disease. If Yangming and Shaoyang symptoms predominate and Taiyang symptoms are few, without lingering, transmitting instantly to other channels, it is not Concurrent Disease.
"Ruined Disease" (Huabing, 坏病) results from erroneous application of sweating, vomiting, purgation, or moxibustion/warming needles, where the disease persists and worsens. If the disease is in the Three Yang channels and has not reached the Yin, excessive sweating leads to loss of Yang Qi, limb coldness, muscle twitching, and tremors due to erroneous sweating. Hunger in the abdomen but inability to eat, and incessant vomiting, result from erroneous vomiting. Phlegm-rheum binding in the chest, epigastric oppression, and diarrhea result from erroneous purgation. Fright, mania, and restlessness result from erroneous moxibustion. Observe the pulse and symptoms, identify the error, and treat accordingly.
If six to seven days, or twelve to fourteen days have passed—the time when meridian qi is vigorous and recovery should occur—but the disease remains unresolved, it is called "Passing the Meridian Without Resolution." Righteous qi is usually deficient. If exterior signs persist requiring sweating, induce mild sweating; if interior signs require purgation, induce mild purgation. If the patient is young and strong, these are not contraindications; adapt to the condition. If transmission reaches the Three Yin channels, heat enters the interior. Although classified as Yin, the pathology is heat; generally, clearing and resolving heat is the treatment. For thirst, use Zhuye Shigao Tang. For non-thirst with epigastric oppression, use Huanglian (Coptidis Rhizoma), Gualou (Trichosanthis Fructus), Zhike (Aurantii Fructus), and Maidong to clear heat. Specifically, for Taiyin Disease presenting with abdominal fullness, dry throat, vomiting with inability to eat, spontaneous diarrhea with abdominal pain, use modified Shaoyao Huangqin Decoction. For Shaoyin Disease presenting with dry mouth/tongue and thirst, cool body with desire to sleep, and deep, fine, rapid pulse, use Huanglian Ejiao Decoction (Coptis and Donkey-Hide Gelatin Decoction) augmented with Dihuang (Rehmanniae Radix), Maidong, Zhimu, and Huangbai (Phellodendri Cortex) to clear heat and nourish Kidney Water. If the tongue coating is black with prickles, no bowel movement, and difficult urination, Kidney Water and Body Fluids are exhausted; urgently prepare a large-dose decoction; one or two out of ten might be saved. For Jueyin Disease presenting with irritability and fullness, testicular retraction, wasting-thirst, Qi rushing to the heart, burning pain in the heart, hunger without desire to eat, and vomiting after eating, the channel pathogen attacks the heart and stomach relentlessly. Urgently use Longdan Qinggan Yin (Gentian Liver-Clearing Drink). Note that among Three Yin diseases, there are cases reverting to Yangming, forming Stomach Excess patterns suitable for purgation. Abdominal severe fullness/pain untouchable indicates Taiyin reverting to Yangming; purgation is indicated. No bowel movement for six-seven days with abdominal distension indicates Shaoyin reverting to Yangming; purgation is indicated. Heat-associated diarrhea with delirium indicates dry feces, Jueyin reverting to Yangming; purgation is indicated. If the pathogen does not revert to Yangming and stool is not hard, do not purge lightly. If pathogen has not settled in the Lower Jiao and the lower abdomen is not hard/painful, but Mangxiao (Natrii Sulfas) is mistakenly used, destroying True Yin, leading to unceasing diarrhea and impending collapse of Yuan Qi, use a large dose of Lizhong Tang (Regulate the Middle Decoction) plus Baishao, Dazao (Ziziphi Jujubae Fructus), and Wumei (Mume Fructus). If ineffective, assist with lifting and astringent agents.
After recovery, if Yuan Qi is deficient and residual heat remains, or if labor/restoration triggers fever, it is called Relapse due to Labor (Laofu, 劳复). Use sweet-cold herbs to tonify deficiency and clear heat. Relapse due to excessive eating is called Relapse due to Diet (Shifu, 食复). Due to weak Spleen/Stomach Qi unable to digest grains, mild cases require strengthening Spleen and promoting digestion; severe cases require mild purgation or combined attack-tonification methods. Mild evening irritability requires dietary reduction and Spleen/Stomach rest; self-resolution occurs without medicine. Having clarified Cold Pathogenic Diseases, Six Channels treatments, Combined/Concurrent/Ruined Diseases, Passing the Meridian Without Resolution, and Relapses, we must emphasize the key therapeutic methods. Jie'an stated: Grasping the essence of Cold Pathogenic treatment is easy as picking up grass; seeking complexity leads to fragmentation like asking for a ferry crossing in the sea. It is merely Pulse, Symptom, and Principle. Pulses: Floating, Large, Rapid, Slippery are Yang; Deep, Small, Slow, Choppy are Yin. He Shuhe said: "Difficulty under the fingers is true words; claiming mastery is mere talk." I follow Jie'an’s secret: focusing on Floating/Deep, Slow/Rapid, Large/Small, Slippery/Choppy, assessing Forceful/Weak, reveals Exterior/Interior, Deficiency/Excess, Yin/Yang, Cold/Heat without concealment. Symptoms are like catching a thief; each channel has specific signs as described. Treat according to the channel. Zhang Zhongjing said: Many days with exterior signs and floating/large pulse require exterior resolution; few days with interior signs and deep/solid pulse require interior attack. Clarify similarities/differences; do not act rigidly. Jingyue said: My treatments often deviate from standard formulas but succeed because the herb matches the symptom. Principle means knowing the constant and adapting to change. Ancient sages established six methods: Sweating, Vomiting, Purgation, Warming, Clearing, Tonifying. Exterior pathogens require sweating. Zhang Zhongjing advised taking decoctions warm; if severe, finish three doses in half a day. Treat immediately, day or night. Sweating should not be delayed. Three sweating methods: 1. Warm Dispersion: "Releasing exterior does not avoid heat." Even with high fever, use acrid-warm. 2. Cool Resolution: For intense heat drying interior/exterior, preventing sweating, use acrid-cool. 3. Balanced Resolution: For conditions between Yin/Yang, neither warm nor cool, use balanced exterior resolution. Vomiting treats upper jiao; it disperses excess phlegm-rheum in the chest. Not for deficiency. Rarely used. Purgation attacks the interior. Excess internal knotting requires purgation. Assess severity; do not purge lightly unless full, dry, solid, hard. Purgation should not be rushed. Warming warms the middle. Internal cold requires warming. However, Cold Pathogenic diseases are transmitting heat patterns; mid-body turning cold is rare, possibly from overuse of cold herbs. Jie'an warned: Misusing Jiang (Zingiberis Rhizoma) and Fuzi (Aconiti Lateralis Radix Praeparata) causes bleeding, mania, fluid consumption, and aids pathogenic heat; this is the most lethal medical error. Clearing clears heat. Heat without knotting is not a purgation indication; clearing is necessary. Residual heat post-purgation also needs clearing. Tonifying saves deficiency. Only robust Yuan Qi can lead herbs to expel pathogens. Weak patients need Renshen (Ginseng Radix et Rhizoma) 3-5 qian in exterior formulas to boost Yuan Qi as the leader driving out pathogens, not primarily for tonification. In harmonizing or attacking formulas, Renshen supports righteous qi, allowing pathogens to retreat. Ignorant people claim "Cold Pathogenic diseases have no tonification method," fearing supplements fuel pathogens, leading to death in deficient patients. Ancient exterior formulas like Rensu Yin (Ginseng and Perilla Drink) and Baidu San (Toxin-Resolving Powder), harmonizing Xiaochaihu Tang, Baihu Tang (White Tiger Decoction), and attacking Huanglong Tang all use Renshen to lead pathogens out. Zhang Zhongjing and Jie'an used them. Deaths from improper Renshen use resulted from combining it with warm-tonics like Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), Ganjiang (Zingiberis Rhizoma), Rougui (Cinnamomi Cortex), Fuzi, rather than using it with dispersing/clearing herbs like Qianghuo, Zisuye, Chaihu, Gegen, Huangqin, Shigao, Mangxiao, Dahuang (Rhei Radix et Rhizoma). Jia Yan clarified this strongly, swearing against those who forbid Renshen in these contexts. Jingyue added: Virtuality and Excess summarize all variations. Righteous victory brings cure; pathogen victory brings death. Strong righteous qi handles major pathogens lightly; weak righteous qi suffers heavily from minor pathogens. Excess conditions resolve with attack; deficiency is the concern. Today, 60-70% of cases involve deficiency. Quacks fail to detect deficiency and attack recklessly, causing death. If exterior pathogens persist despite repeated dispersal without sweating, Yin Qi cannot reach the surface. Sweat is water; insufficient water yields no sweat. People know sweating relates to Yang, but forget sweat is born from Yin; nourishing Yin promotes sweating (e.g., drinking water induces sweat). If internal heat persists despite cooling, Yin is insufficient. Cold herbs clear heat, but "Strengthening Water extinguishes Fire" is deeper truth. Cold transforming into heat implies Yang excess and Yin injury; thus, nourish Yin. This explains why Cold Pathogenic diseases disproportionately kill those with lower deficiency (Shaoyin transmission depletes residual Yin). Shen Shi noted: Sexual exhaustion damages Yin; wind-cold exploits this void entering the Kidney. Symptoms include fiery body heat, thirst, irritability. Classic text: Yin Qi deficient, Yang Qi abundant; little water cannot control raging fire. Must first nourish Yin with large doses, then release the exterior. Mastering these six aspects grasps the essence of Cold Pathogenic treatment.
Regarding diagnostic precision, Jie’an excelled. To treat Cold Pathogenic diseases: First, ask onset date (duration) and cause (root). Identify current symptoms and diagnose via channels. Second, ask about diet preferences/quantity and bowel/bladder habits to assess Spleen/Stomach harmony. Third, ask about thirst and water intake to assess Body Fluid status. Fourth, observe complexion and spirit for prognosis. Red eyes indicate severe heat; yellow eyes indicate Jaundice (differentiated by damp-heat vs. blood stasis). Fifth, check lips/teeth moisture and tongue coating to gauge interior heat severity. Sixth, listen to voice clarity/length to assess interior deficiency/excess. Seventh, palpate chest to lower abdomen for pain; distinguish Qi stagnation/phlegm-rheum from blood stasis. Eighth, investigate previous medications and chronic conditions. Correlate with pulse. Disease changes infinitely; herbs must match. Regarding "Similar-to-Cold" diseases, Jie’an categorized five: 1. Phlegm-Fluid Retention: Mimics cold with chills/fever/sweating/chest oppression/wheezing, but lacks headache/stiff neck. 2. Food Stagnation: Mimics fever/headache, but body pain absent, left pulse normal, right pulse forceful, with belching sour rot and bloating. 3. Deficiency Irritation: Fatigue/Spleen injury causes fever/sweating without headache/aversion to cold; Left pulse normal, Right pulse weak, shortness of breath, limb fatigue. Kidney injury from lust causes mild chills/fever, afternoon/evening onset, Five-Center Heat, leg weakness. 4. Blood Stasis: From trauma/falls, causes chills/fever/sweating, distinguished by tenderness in chest/hypochondrium/lower abdomen. 5. Gout/Foot Weakness: Dampness in feet causes headache/fever/aversion to cold/vomiting, distinguished by swelling/pain in calves/feet. Understanding Six Channels, Combined/Concurrent diseases, Six Methods, Diagnostic Criteria, and Similar-to-Cold diseases ensures accurate treatment. As Confucius said: "Teach one corner, let the student return with three." The I Ching says: "Transformation and illumination depend on the person." Learn from shallow to deep, broad to concise. Do not neglect this.