仲景云∶溲便遗失，狂言反目直视者，此肾绝也。风温被下必失溲。三阳合病，一焦
气绝，不归其部，不可汗下。
【温】阴阳俱虚，下焦脱，用附子。
【清】三阳合病，腹满身重，难以转侧，身不仁，谵语遗尿。发汗则谵语，下之则
额上生汗，手足厥冷，自汗而热，白虎加人参汤。
阳病下利便脓血，协热也。少阴下利便脓血，协寒也，脓为陈积，血为新积。热则清，
寒则固，此为治之大略也。
【清】下后脉数不解，下利不止，必协热而便脓血，犀角地黄汤。
【固】少阴下利不止，腹痛便脓血，桃花汤。
李子建伤寒十劝不可不知。医家病家知此十劝，则不致误，所益非轻，况伤寒之病，
与杂证不同，投药一差，生死立判。
一、伤寒头痛及身热，便是阳证，不可服热药。
伤寒病传三阳三阴共六经，内太阴病头不疼身不热，少阴病有反发热而无头疼，厥阴
病有头疼而无发热，故知头疼身热即是阳证。若妄投热药，决致死亡。
二、伤寒必须且攻毒瓦斯，不可补益。
邪气在经络中，即随证早攻之，只三日四日痊安。若妄补正气，使毒瓦斯流炽，多致
杀人。
三、伤寒不思饮食，不可服温睥胄药。
伤寒不思饮食，自是常事。不知邪气在胃，故亦不饥，虽不饮食亦不死。如理中丸、
人参黄 之类，不可
轻服。若阳病服之，热邪增重，多致不救。丁香、巴豆之药，尤不可服。
四、伤寒腹疼亦有热证，不可轻服温暖药。
仲景论腹满时痛之证，有曰痛甚者，加大黄。夫痛甚而加大黄，意可见也。于身
冷厥逆而腹痛者，方是阴证，须消息之。每见腹痛，便投热药，多致杀人。
五、伤寒自利，当看阴阳证，不可例服补药、热药、止泻药。
自利惟身不热手足温者属太阴，身冷四逆者属少阴厥阴，其余身热下利皆属阳，
随证根据仲景法治之。若阳证误投热药者，多不治。
六、伤寒胸胁痛及腹胀满，不可妄用艾灸。
常见村落间病伤寒无药，便用艾灼，多致毒瓦斯随火而盛，膨胀发喘而死。不知胸胁
痛自属少阳；腹胀虽属太阴，仲景以为当下之证，此外惟寒厥阴证可灸之。
七、伤寒手足厥冷，当看阴阳，不可例作阴证。
伤寒有阳厥阴厥，医者少能分辨。阳厥若投热药，杀人速于用刃。盖阳病不至于极热
者，不能发厥，仲景所谓热深厥亦深。又与热药，宁复生乎？但看初得病而身热，至三四
日后热气已深，大便秘，小便赤，或谵语昏愦，及别有热证而发厥，必是阳厥，急用承气汤
下之。若初得病身不热，大便不秘，自引衣盖身，或利，小便数，不见热证而厥逆，即是
阴厥，方可用四逆汤之类。二厥所以使人疑者，缘为其脉皆沉。然阳厥脉沉而滑，阴厥脉
沉而弱；又阳厥指爪时温，或时发热，阴厥则常冷，此为可别。
八、伤寒病已在里，即不可用发汗药。
伤寒证须看表里，如发热恶寒，则是在表，宜发汗；如不恶寒反恶热，即是里证。若一
例发汗，则所出之汗不是邪气，乃泄真气。邪气未除，真气先泄，死者必矣。又别有半表
半里之证，及无表里之证，皆不可下，
亦皆不可汗，但随证治之。
九、伤寒饮水为欲愈，不可令其恣饮过度。
凡病患大渴欲饮水，当与之，以消热气，故仲景以饮水为欲愈。人见此说，遂令
病患纵饮，因而为呕为喘，为咳逆为下利，为肿为悸，为水结胸，为小便不利者多
矣。且如病患欲饮一碗，只与半碗，常令不足为善。
十、伤寒病初安，不可过饱，及劳动，或食羊肉，行房，诸浓味饮酒。
病方愈，不必再服药，脾胃才复，不可过食。不能消化，病即再作，谓之食复。病方
愈，气血尚虚，劳动太早，病即再来，谓之劳复。若食羊肉及行房者，犯之必死。食诸浓
味并饮酒者，再作必重。
Zhang Zhongjing stated: Incontinence of urine and feces, delirious speech, and fixed staring gaze indicate exhaustion of Kidney Qi (Shen Jue, 肾绝). If Wind-Warmth disease is treated with purgatives, urinary incontinence will inevitably occur. In San Yang He Bing (Combined Disease of the Three Yang Channels), if Qi of the Lower Jiao (Lower Burner) is exhausted and fails to return to its proper position, neither diaphoresis nor purgation should be used.
[Clearing Heat Method] When both Yin and Yang are deficient and there is slippage from the Lower Jiao, use Aconiti Lateralis Radix Praeparata (Fuzi, 附子).
[Clearing Heat Method] In Combined Disease of the Three Yang Channels, symptoms include abdominal fullness, heaviness of the body, difficulty turning over, numbness of the limbs, delirium, and urinary incontinence. If diaphoresis is mistakenly applied, it leads to delirium; if purgation is mistakenly applied, it leads to sweating on the forehead, cold hands and feet, spontaneous sweating with fever. Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) should be used.
Yang syndrome presenting with diarrhea accompanied by pus and blood belongs to Xie Re Li (Diarrhea accompanying heat). Sha Yin syndrome presenting with diarrhea accompanied by pus and blood belongs to Xie Han Li (Diarrhea accompanying cold). Pus represents old accumulation, while blood represents new accumulation. Heat syndromes should be cleared with cooling methods, and cold syndromes should be secured with astringent methods; this is the general principle of treatment.
[Clearing Heat Method] After purgation, if the pulse remains rapid and unrelieved, and diarrhea persists, it must be Xie Re Li leading to pus and blood in the stool. Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) should be used.
[Astringent Method] For Sha Yin syndrome with persistent diarrhea, abdominal pain, and pus and blood in the stool, Taohua Tang (Peach Blossom Decoction) should be used.
Li Zijian's "Ten Admonitions on Shanghan" must not be ignored. If physicians and patients understand these ten admonitions, errors can be avoided, and the benefits are significant. Moreover, Shanghan disease differs from miscellaneous diseases; a slight error in medication can determine life or death instantly.
1. Headache and fever in Shanghan indicate a Yang syndrome; hot-natured medicines must not be administered.
Shanghan transmission involves the Six Channels (Three Yang and Three Yin). Tai Yin syndrome presents without headache or fever; Shao Yin syndrome may present with counterfever but no headache; Jue Yin syndrome may present with headache but no fever. Therefore, headache and fever indicate a Yang syndrome. Mistakenly administering hot medicines will inevitably lead to death.
2. Shanghan requires temporary attack on pathogenic toxins; tonification must be avoided.
When pathogens reside in the meridians, they should be attacked early according to the syndrome, leading to recovery within three to four days. Mistakenly tonifying healthy Qi causes toxins to spread and intensify, often resulting in death.
3. Loss of appetite in Shanghan does not warrant warming and tonifying Spleen and Stomach medicines.
Loss of appetite is common in Shanghan because pathogens affect the Stomach, causing lack of hunger. Death does not result from lack of food. Medicines such as Lizhong Wan (Regulate the Middle Pill), Ren Shen (Ginseng Root), and Huang Qi (Astragalus Root) should not be taken lightly. If administered in Yang syndromes, heat pathogens will worsen, often leading to untreatable conditions. Clove (Ding Xiang) and Croton Fruit (Ba Dou) are especially contraindicated.
4. Abdominal pain in Shanghan can also be a heat syndrome; warm medicines must not be rashly administered.
Zhang Zhongjing discussed abdominal fullness and intermittent pain, stating that for severe pain, Da Huang (Rhubarb Root and Rhizome) should be added. The intent is clear: Da Huang is added only when pain is severe. Only when the body is cold and extremities are cold with abdominal pain is it a Yin syndrome, requiring careful consideration. It is common to see physicians administer hot medicines upon seeing abdominal pain, which often leads to death.
5. Spontaneous diarrhea in Shanghan requires differentiation of Yin and Yang syndromes; tonics, hot medicines, and antidiarrheals must not be used indiscriminately.
Spontaneous diarrhea with no fever and warm extremities belongs to Tai Yin; diarrhea with cold body and cold extremities belongs to Shao Yin or Jue Yin. All other cases of diarrhea with fever belong to Yang syndromes and should be treated according to Zhang Zhongjing’s methods. Mistakenly using hot medicines for Yang syndromes usually results in untreatable conditions.
6. Chest and hypochondriac pain and abdominal fullness in Shanghan do not warrant moxibustion.
It is common in villages where medicine is unavailable to use moxibustion for Shanghan, often causing toxins to intensify with the fire, leading to distension, asthma, and death. Chest and hypochondriac pain naturally belongs to Shao Yang syndrome; abdominal fullness, though belonging to Tai Yin, is considered by Zhang Zhongjing as a syndrome requiring purgation. Moxibustion is suitable only for cold-type Jue Yin syndromes.
7. Cold extremities in Shanghan require differentiation of Yin and Yang; they must not be assumed to be Yin syndromes.
Shanghan includes Yang Jue (Yang Reversal) and Yin Jue (Yin Reversal), which physicians rarely distinguish correctly. Administering hot medicines for Yang Jue kills faster than a blade. Yang syndromes do not reach reversal unless heat is extreme, as Zhang Zhongjing stated: "The deeper the heat, the deeper the reversal." Adding hot medicines would be fatal. If the patient had fever at onset, which deepens after three to four days, accompanied by constipation, red urine, delirium, confusion, or other heat signs preceding reversal, it is definitely Yang Jue. Chengqi Tang (Purge the Gangrene Decoction) should be urgently administered to purge. If the patient had no fever at onset, no constipation, prefers covering themselves, has loose stools, frequent urination, and no heat signs before reversal, it is Yin Jue. Sini Tang (Counterflow Decoction) may then be used. The reason these two reversals cause confusion is that both have sinking pulses. However, Yang Jue has a sinking and slippery pulse, while Yin Jue has a sinking and weak pulse. Additionally, fingers and nails in Yang Jue are sometimes warm or occasionally febrile, whereas in Yin Jue they are constantly cold. This distinguishes them.
8. Once Shanghan pathogens have entered the interior, diaphoretics must not be used.
Shanghan syndromes require assessment of exterior vs. interior. Fever with aversion to cold indicates an exterior syndrome, suitable for diaphoresis. No aversion to cold but aversion to heat indicates an interior syndrome. Indiscriminate diaphoresis expels not pathogens but Healthy Qi (Zhen Qi). With pathogens remaining and Healthy Qi depleted, death is inevitable. There are also half-exterior half-interior syndromes and syndromes lacking both exterior and interior signs; these should not be purged nor diaphoresed, but treated according to the specific syndrome.
9. Drinking water in Shanghan indicates impending recovery, but excessive drinking must be prevented.
When a patient is extremely thirsty and desires water, it should be provided to dissipate heat, hence Zhang Zhongjing regarded drinking water as a sign of recovery. Misinterpreting this, some allow patients to drink excessively, leading to vomiting, asthma, coughing, diarrhea, edema, palpitations, Water Accumulation in the Chest, and difficult urination. If a patient desires one bowl of water, providing half a bowl, keeping them slightly unsatisfied, is better.
10. Upon initial recovery from Shanghan, overeating, exertion, eating mutton, sexual intercourse, rich foods, and alcohol must be avoided.
Upon recovery, further medication is unnecessary. As the Spleen and Stomach recover, overeating must be avoided. Indigestion leads to relapse, known as Shi Fu (Relapse due to Diet). Upon recovery, Qi and Blood are still deficient; premature exertion causes the disease to return, known as Lao Fu (Relapse due to Labor). Consuming mutton or engaging in sexual intercourse upon recovery is fatal. Consuming rich flavors and alcohol leads to severe recurrence.