病患身热欲得衣。寒在骨髓热在肌。先与桂枝使寒已。小柴加桂次温之。病患身寒衣褫退。寒在皮肤热在髓。白虎
加参先除热。桂黄各半解其外。（仲景云。病患身大热。反欲得衣者。热在皮肤。寒在骨髓也。身大寒。反不欲近衣者。
寒在皮肤。热在骨髓也。仲景俱无治法。朱肱云。寒在骨髓。先与桂枝。次与小柴胡加桂汤。热在骨髓。先以白虎加人
参汤。以除其热。次以桂枝麻黄各半汤。以解其外也。）病有标本并始末。先后不同当审察。里寒表热脉沉迟。里热表寒
脉必滑。（朱肱云。里寒表热者。脉沉而迟。里热表寒。脉必滑也。）
脉浮而缓表中虚。有汗恶风腠理疏。浮紧而涩表却实。恶寒无汗体焚如。（伤寒最要辨表里虚实为先。有表实。有表
虚。有里实。有里虚。有表里俱实。有表里俱虚。先辨此六者。然后用药。无不瘥矣。盖脉浮而缓。又恶风有汗。此表
虚中风证也。脉浮紧而涩。尺有力。恶寒无汗。此表实。伤寒证也。）脉沉无力里虚证。四逆理中为对病。沉而有力紧且
实。柴胡承气宜相应。（里虚宜温之。故用四逆理中。里实。宜下之。故用柴胡承气。）又有表和而里病。下之则愈斯为
正。里和表病汗为宜。忽然误下应难拯。（外台云。表和里病。下之则愈。汗之则死。里和表病。汗之则愈。下之则死。）
虚则温之实泻之。病形脉证要相宜。更兼药饵如精对。立便安康待甚时。（孙尚云。精对无差。立当见效。不必三日以前
汗。五日以后下也。）
The patient's body feels hot, yet they desire to wear clothing. This indicates cold deep within the Marrow (bone marrow) and heat floating in the Muscle layer (muscle tissue). Initially administer Guizhi Tang (Cinnamon Twig Decoction) to resolve the exterior cold, followed by Xiaochaihu Jia Gui Tang (Minor Bupleurum Decoction with Cinnamon Twig) to warm the interior.
The patient's body feels cold, yet they desire to remove clothing. This indicates cold superficially in the Skin (skin surface) and heat deep within the Marrow. First use Baihu Jia Renshen Tang (White Tiger Decoction with Ginseng) to clear the internal heat, then use Guizhi Mahuang Banxia Tang (Guizhi and Ephedra Half-Volume Decoction) to resolve the exterior pathogen. (Zhang Zhongjing stated: If the patient's body is very hot but desires to wear clothes, the heat is in the Skin and the cold is in the Marrow. If the body is very cold but does not desire to be near clothes, the cold is in the Skin and the heat is in the Marrow. Zhang Zhongjing did not provide specific treatments for these cases. Zhu Gong stated: For cold in the Marrow, first give Guizhi Tang, then Xiaochaihu Jia Gui Tang; for heat in the Marrow, first use Baihu Jia Renshen Tang to clear the heat, then Guizhi Mahuang Banxia Tang to resolve the exterior.)
Diseases have distinctions of root and branch, as well as beginning and end; the sequence of treatment differs and must be carefully examined. In cases of Interior Cold and Exterior Heat, the pulse is Deep (Chen) and Slow (Chi); in cases of Interior Heat and Exterior Cold, the pulse is necessarily Slippery (Hua). (Zhu Gong stated: The pulse for Interior Cold and Exterior Heat is Deep and Slow; for Interior Heat and Exterior Cold, the pulse is necessarily Slippery.)
A Pulse that is Floating (Fu) and Moderate (Huan) indicates Deficiency at the Exterior. With sweating and aversion to wind, the Couli (pores) are loose. A Pulse that is Floating, Tight (Jin), and Choppy (Se) indicates Excess at the Exterior. With aversion to cold and no sweating, the body feels burning hot. (In treating Shaoyang disease, it is most crucial to first distinguish between Exterior/Interior and Excess/Deficiency. There are six patterns: Exterior Excess, Exterior Deficiency, Interior Excess, Interior Deficiency, Exterior-Interior both Excess, and Exterior-Interior both Deficiency. Once these six are distinguished, medication can be applied without fail. A Floating and Moderate pulse, accompanied by aversion to wind and sweating, constitutes an Exterior Deficiency Wind Strike pattern. A Floating, Tight, and Choppy pulse, with strength in the Chi position, accompanied by aversion to cold and no sweating, constitutes an Exterior Excess Cold Damage pattern.)
A Deep (Chen) pulse without force indicates an Interior Deficiency pattern; Sini Tang (Four Reversal Decoction) and Lizhong Tang (Regulate the Middle Decoction) are appropriate. A Deep pulse with force, being Tight and Solid, corresponds to the use of Chaihu Chengqi Tang (Bupleurum and Cathartic Decoction variations). (Interior Deficiency requires warming, hence Sini Tang and Lizhong Tang are used; Interior Excess requires purging, hence Chaihu Chengqi formulas are used.) There are also cases where the Exterior is harmonized but the Interior is diseased; applying a purgative method leads to recovery, which is the correct approach. If the Interior is harmonized but the Exterior is diseased, sweating is appropriate. If a purgative is mistakenly applied suddenly, the condition becomes difficult to rescue. (Waitai Mi Yao states: If the Exterior is resolved and the Interior is diseased, purging leads to recovery while sweating leads to death; if the Interior is harmonized and the Exterior is diseased, sweating leads to recovery while purging leads to death.)
For Deficiency, apply warming methods; for Excess, apply purging methods. The clinical manifestations, pulse, and syndrome must correspond appropriately. With precise herbal matching, health will be restored immediately; why wait? (Sun Shang stated: Precise matching yields immediate results; one need not adhere strictly to the rule that sweating is only for before the third day and purging only for after the fifth day.)