主乎温散 有卒中天地之寒气者，有口得寒物者。
从补中益气汤中加发散药，属内伤者十居八九。其法，邪之所凑，其气必虚，只用前汤
中，从所见之证，出入加减。必先用参耆托住正气。气虚甚者，少加附子以行参耆之剂，如
果气虚者，方可用此法。胃气大虚，必当温散，理中汤相宜，甚者加附子。仓卒感受大寒之
气，其病即发，非若伤寒之邪，循经以渐而深也。以上治法，宜用于南，不宜北。
戴云∶此伤寒，谓身受肃杀之气，口伤生冷物之类。因胃气大虚，肤腠疏豁，病者脉必
沉细，手足厥冷，息微身倦，虽身热亦不渴，倦言动者是也，宜急温之，迟则不救矣。与热
症若相似而实不同，凡脉数者，或饮水者，烦燥动摇者，皆热病。寒热二证，若水火然，不
可得而同治，误即杀人。
〔附录〕凡症与伤寒相类者极多，皆杂证也，其详出《内经·热论》，自长沙以下，诸家
推明甚至，千世之下，能得其粹者，东垣也。其曰∶内伤极多，外伤间而有之。此发前人之
所未发，后人 俗，不能真切，雷同指为外伤，极谬。其或可者，盖亦因其不敢放肆，而多
用和解及平和之药散之尔，若粗率者，则必杀人。初有感冒等轻症，不可便认作伤寒妄治，
西北二方，极寒肃杀之地，故外感甚多；东南二方，温和之地，外伤极少，杂病亦有六经所
见之证，故世俗混而难别。
正治温散，宜桂枝汤、四逆汤辈，甚者三建汤、霹雳散。从治用热药加凉剂引之，或热
药须俟冷冻饮料最妙。经曰∶从而逆之，此之谓也。反攻用煎乌头之类。
伤风属肺者多，宜辛温或辛凉之剂散之。
戴云∶新咳嗽鼻塞声重者是也。
附方∶
补中益气汤 见内伤类。
理中汤
人参 甘草 干姜 白术（等分）
上锉。每服五钱，水煎温服。
桂枝汤
桂枝 赤芍（各一两半） 甘草（一两） 生姜（一两半）大枣
上锉。每服五钱，水煎温服。
四逆汤
甘草（炙，二两） 干姜（一两半） 附子（半两）
上锉。每服五钱，水煎温服。
三建汤
大川乌 附子 天雄（并炮,等分）
上锉。每四钱，水二盏，姜十五片，煎服。
霹雳散
附子（一枚,及半两者，炮熟取出，用冷灰焙之）
细研，入真腊茶一大钱同和。分二服，每服水一盏，煎六分，临熟，入蜜半匙，放温服
姜附汤 治中寒身体强直，口噤不语，逆冷。
干姜（一两） 附子（生，去皮脐,一斤）
上锉。每服三钱，水煎服。挟气攻刺，加木
香半钱；挟气不仁，加防风一钱；挟湿者，加白术；筋脉牵急，加木瓜；肢节痛，加桂二钱
消风百解散
荆芥 白芷 陈皮 麻黄 苍术 甘草（等分）
上锉。用姜三片，葱白三根，水煎服。
神术散 治伤风头痛，鼻塞声重。方见痢类。
治疗原则以温通发散为主。有的是突然感受天地间的寒气，有的是因食用寒凉食物所致。这类情况多属于内伤体质，约占八九成，因此应从补中益气汤中加入发散药物进行治疗。其原理在于：邪气聚集之处，正气必然虚弱，所以只需在前述方剂的基础上，根据具体证候进行加减化裁。必须首先使用人参、黄芪来扶持正气。若气虚严重，可少量加入附子以推动参、芪的药力，但仅适用于确实存在气虚的患者。如果胃气极度虚弱，必须采用温散法，理中汤较为适宜；病情严重者，可加入附子。若是突然遭受大寒之气侵袭，病症随即发作，这与伤寒之邪沿经络逐渐深入的过程不同。上述治法适用于南方地区，而不宜用于北方。
戴元礼说：这里的“伤寒”，是指身体受到肃杀寒气侵袭，或口部损伤生冷食物等情况。由于患者胃气大虚，皮肤腠理疏松，脉象必定沉细，手足冰冷，气息微弱且身体疲倦，即使出现发热也不口渴，言语无力、行动倦怠，这就是典型的症状，应当紧急温补，拖延则无法救治。这种证候与热症看似相似实则不同，凡是脉象数急、饮水、烦躁不安、肢体动摇的，都属于热病。寒证与热证如同水火，不可混为一谈，误治会导致死亡。
【附录】凡症状与伤寒相似的疾病非常多，大多属于杂证，详细内容见《内经·热论》。自张仲景（长沙）以下，各家对此推演阐明得非常详尽，千世之下，能得其精髓的，唯有李东垣。他提出：“内伤极为常见，外伤偶尔发生。”这是前人未曾阐发的观点。后世庸俗之人不能真切理解，盲目雷同地将其指为外伤，极其谬误。那些可能有效的案例，大概是因为医者不敢肆意妄为，而多用和解及平和的药物来疏散罢了；如果是粗率草率的医生，则必致人死亡。起初若有感冒等轻症，不可便认定为伤寒而妄加治疗。西北两地是极寒肃杀之地，故外感病很多；东南两地气候温和，外伤极少，杂病中也有六经所见的证候，因此世俗之人容易混淆难以辨别。
正治法宜用温散，适合桂枝汤、四逆汤之类的方剂；病情严重者可用三建汤、霹雳散。从治法是用热药配合凉剂作为引导，或者热药需等待冷冻饮料送服最为巧妙。经文说：“顺从病势而逆治”，说的就是这种情况。反攻法可用煎煮乌头之类的药物。
附方：
补中益气汤 见内伤类。
理中汤
人参、甘草、干姜、白术（各等分）
以上药材切碎。每次服用五钱，加水煎煮后温服。
桂枝汤
桂枝、赤芍（各一两半）、甘草（一两）、生姜（一两半）、大枣
以上药材切碎。每次服用五钱，加水煎煮后温服。
四逆汤
甘草（炙，二两）、干姜（一两半）、附子（半两）
以上药材切碎。每次服用五钱，加水煎煮后温服。
三建汤
大川乌、附子、天雄（均炮制，各等分）
以上药材切碎。每次取四钱，加水两盏，生姜十五片，煎煮后服用。
霹雳散
附子（一枚，重约半两者，炮熟取出，用冷灰焙干）
细细研磨，加入真腊茶一大钱混合均匀。分为两次服用，每次用水一盏，煎至六分满，临熟时加入半匙蜂蜜，放温后服用。
姜附汤 治疗中寒引起的身体强直、口噤不语、四肢逆冷。
干姜（一两）、附子（生，去皮脐，一斤）
以上药材切碎。每次服用三钱，加水煎煮后服用。若兼挟气滞攻刺疼痛，加木香半钱；若兼挟气滞导致麻木不仁，加防风一钱；若兼挟湿邪，加白术；若筋脉牵引拘急，加木瓜；若肢节疼痛，加桂枝二钱。
消风百解散
荆芥、白芷、陈皮、麻黄、苍术、甘草（各等分）
以上药材切碎。用生姜三片，葱白三根，加水煎煮后服用。
神术散 治疗伤风引起的头痛、鼻塞、声音沉重。方剂见痢疾类。
The treatment principle focuses on warming and dispersing. Some cases involve sudden exposure to the cold qi of heaven and earth, while others result from ingesting cold substances. These conditions mostly belong to internal injury constitutions, accounting for eight or nine out of ten cases; therefore, dispersing herbs should be added to Bu Zhong Yi Qi Tang (Tonifying the Middle and Augmenting the Qi Decoction). The rationale is that where pathogenic factors gather, the healthy qi must be deficient. Thus, one should only modify the aforementioned decoction according to the observed symptoms by adding or subtracting ingredients. It is essential to first use Ren Shen (Ginseng Radix) and Huang Qi (Astragali Radix) to support the righteous qi. In cases of severe qi deficiency, a small amount of Fu Zi (Aconiti Lateralis Radix Praeparata) may be added to facilitate the action of Ren Shen and Huang Qi, but this method is applicable only when qi deficiency is confirmed. If the Stomach qi is severely deficient, warming and dispersing methods are mandatory, and Li Zhong Tang (Regulate the Middle Decoction) is appropriate; in severe cases, Fu Zi (Aconiti Lateralis Radix Praeparata) can be added. If one suddenly suffers from intense cold qi, the disease manifests immediately, which differs from Shang Han (Cold Damage) where pathogens gradually penetrate deeper along the meridians. The above treatments are suitable for the South but not for the North.
Dai Yuanli stated: Here, "Shang Han" refers to the body being affected by killing cold qi or the mouth being injured by raw and cold foods. Due to severe deficiency of Stomach qi and open skin pores, the patient's pulse will necessarily be deep and fine, with cold hands and feet, weak respiration, and physical fatigue. Even if there is fever, there is no thirst; the patient speaks little and lacks energy in movement. This is the condition, which requires urgent warming; delay renders it incurable. This syndrome resembles heat syndromes but is fundamentally different. Any case with a rapid pulse, desire to drink water, restlessness, agitation, or trembling belongs to heat diseases. Cold and heat syndromes are like water and fire and cannot be treated identically; misdiagnosis leads to death.
[Appendix] There are many diseases whose symptoms resemble Shang Han (Cold Damage), most of which are miscellaneous disorders. Details are found in *Nei Jing: Re Lun* (Treatise on Heat Diseases of the Inner Canon). Since Zhang Zhongjing (of Changsha), various schools have elaborated extensively on this. Among them, Li Dongyuan is the one who grasped the essence after a thousand years. He proposed: "Internal injuries are very common, while external injuries occur occasionally." This revealed insights previously unexpressed by predecessors. Later vulgar practitioners failed to understand clearly and indiscriminately labeled these as external injuries, which is extremely erroneous. Cases that appeared effective were likely due to physicians refraining from reckless prescribing and instead using harmonizing and mild drugs to disperse the pathogen. However, careless practitioners would certainly cause death. Initially, mild symptoms such as common colds should not be mistaken for Shang Han (Cold Damage) and treated recklessly. The Northwest regions are places of extreme cold and killing qi, hence many external infections; the Southeast regions are mild, with very few external injuries. Miscellaneous diseases may also present with signs seen in the Six Meridians, causing confusion among laypeople.
For direct treatment, warming and dispersing are suitable, using formulas such as Gui Zhi Tang (Cinnamon Twig Decoction) or Si Ni Tang (Four Reversal Decoction); for severe cases, San Jian Tang (Three Establishments Decoction) or Pi Li San (Thunderbolt Powder) may be used. For counter-treatment, hot medicines are combined with cold agents as guides, or hot medicines are taken with frozen drinks, which is optimal. The Classic states: "Following the trend while opposing it," referring to this method. For aggressive counter-attack, decoctions containing Wu Tou (Aconiti Radix) are used.
Wind Injury often involves the Lung system and should be dispersed with acrid-warm or acrid-cool preparations.
Dai Yuanli stated: New-onset cough, nasal congestion, and heavy voice characterize this condition.
Attached Formulas:
Bu Zhong Yi Qi Tang (Tonifying the Middle and Augmenting the Qi Decoction) See Internal Injury category.
Li Zhong Tang (Regulate the Middle Decoction)
Ren Shen (Ginseng Radix), Gan Cao (Licorice Root), Gan Jiang (Dried Ginger), Bai Zhu (Atractylodis Macrocephalae Rhizoma) (equal parts)
Crush the herbs. Take five qian per dose, decoct in water, and take warm.
Gui Zhi Tang (Cinnamon Twig Decoction)
Gui Zhi (Cinnamomi Ramulus), Chi Shao (Paeoniae Radix Rubra) (each 1.5 liang), Gan Cao (Licorice Root) (1 liang), Sheng Jiang (Fresh Ginger), Da Zao (Jujubae Fructus) (1.5 liang each)
Crush the herbs. Take five qian per dose, decoct in water, and take warm.
Si Ni Tang (Four Reversal Decoction)
Gan Cao (Licorice Root, honey-fried) (2 liang), Gan Jiang (Dried Ginger) (1.5 liang), Fu Zi (Aconiti Lateralis Radix Praeparata) (0.5 liang)
Crush the herbs. Take five qian per dose, decoct in water, and take warm.
San Jian Tang (Three Establishments Decoction)
Da Chuan Wu (Sichuan Aconite Root), Fu Zi (Aconiti Lateralis Radix Praeparata), Tian Xiong (Aconiti Radix) (all processed, equal parts)
Crush the herbs. Take four qian per dose, add two zhan of water and fifteen slices of ginger, decoct, and take.
Pi Li San (Thunderbolt Powder)
Fu Zi (Aconiti Lateralis Radix Praeparata) (one piece, weighing approx. half liang, processed thoroughly, removed, and dried in cold ash)
Grind finely, mix with one da qian of Zhen La Cha (True Cambodian Tea). Divide into two doses. For each dose, add one zhan of water, decoct until six parts remain. Just before completion, add half a spoonful of honey, let cool to warm temperature, and take.
Jiang Fu Tang (Ginger and Aconite Decoction) Treats Zhong Han (Cold Strike) causing body rigidity, inability to speak due to locked jaw, and cold extremities.
Gan Jiang (Dried Ginger) (1 liang), Fu Zi (Aconiti Radix, raw, peeled and navel removed) (1 jin)
Crush the herbs. Take three qian per dose, decoct in water, and take. If accompanied by qi stagnation causing stabbing pain, add Mu Xiang (Aucklandiae Radix) 0.5 qian; if accompanied by qi stagnation causing numbness/loss of sensation, add Fang Feng (Saposhnikoviae Radix) 1 qian; if accompanied by dampness, add Bai Zhu (Atractylodis Macrocephalae Rhizoma); if tendons and vessels are tense/spasmodic, add Mu Gua (Chaenomelis Fructus); if limb joints hurt, add Gui Zhi (Cinnamomi Ramulus) 2 qian.
Xiao Feng Bai Jie San (Dispel Wind Hundred-Release Powder)
Jing Jie (Schizonepetae Spica), Bai Zhi (Angelicae Dahuricae Radix), Chen Pi (Citri Reticulatae Pericarpium), Ma Huang (Ephedrae Herba), Cang Zhu (Atractylodis Rhizoma), Gan Cao (Licorice Root) (equal parts)
Crush the herbs. Use three slices of ginger and three stalks of Cong Bai (Scallion White), decoct in water, and take.
Shen Zhu San (Divine Skill Powder) Treats Wind Injury causing headache, nasal congestion, and heavy voice. Formula see Dysentery category.