治伤寒业擅专门，诚为重寄。论死生易如反掌，利莫苟图。杂证缓可取方，伤寒专在活法。原
伤寒有《活人书》、《明理论》、《指掌图》、《伤寒论》。其中有论缺方者，有方失论者，有脉
无证者，有证无法者，非仲景之全书。缘其历年已久，遗失颇多。王叔和以断简残篇而补方造论，
成无己顺文注释而集成全书，所以遗祸至今而未已也。较今庸俗治伤寒一二日，不问属虚属实，而便
用麻黄、桂枝之类汗之；三四日，不问在经在腑，而便用柴胡之类和之；五六日，不问在表在里，
而便用承气之类下之，以致内外俱虚，变证蜂起。大抵病患表里虚实不同，邪之传变有异，岂可以
日数为准。盖风寒国中人无常，或入于阴，或入于阳，事无定体，非但始太
阳终厥阴论也。或有自太阳始，日传一经，六日传至厥阴，邪气衰不传而愈者，或有不罢再传者，
或有即传者，或有间经而传者，或有传至二三经而止者，或有始终只在一经者，或有越经而传者，
或有初入太阳不作郁热，便入少阴而成真阴证者，或有直中阴经而成寒证者，或有证变者，或有脉
变者，或有取证不取脉者，或有取脉不取证者，缘经无明文，后人有妄治之失。况前人立法之差，
使后人蒙害者多矣。夫麻黄、桂枝二汤，仲景立治冬时正伤寒之方，今人通治非时暴寒温暑之误。
又将传经阴证与直中阴经之阴证混同立论，岂为善乎。暴寒温暑必有别方，直中传阴必有活法，今
皆忘失而无征也。古人之书，引领后进，书不尽意，意不尽言，说其大概，虽博古而通今，皆在得
其传受，须活泼泼地。且活法者，如珠走盘，但见太阳证者，宜直攻太阳，但见少阴，直攻少阴，
此活法也。仲景又云∶日数虽多，但有表证而脉浮者，尤宜汗之。日数虽少，但有里证而脉沉者，
尤宜下之。此先贤之确论也。切不可执定一二日发表，三四日和解，五六日方下。此庸医执死法也。
务俾审脉验证，辩名定经，一一亲切无疑，方可下手。真知其为表邪而汗之，真知其为
里邪而下之，真知其为直中而温之。如此而汗，如彼而下，又如彼而温，桂枝、承气授之不差，姜
附、理中发而必当。投剂少差，死证立见，可不深思而熟虑哉！仲景取方立论甚严，曰可温，曰可
汗，曰少与，曰急下。与夫先温其里，乃攻其表；先解其表，乃攻其里。得其纲领者，不难也。如
附应声，如影随形，见病者则目识心通，见医人则接谈无虑。不得其传者，实难也。见病者举手无
措，见医人则汗颜缄默。此犹绣麒麟耳，正谓名节虚隆而实德则病矣。嗟夫，常病用常法，谁人不
知。设有感冒非时暴寒而误认作正伤寒者，有劳力感寒而误认作真伤寒者，有杂证类伤风而误认作
伤寒治者，有直中阴经真寒证而误认作传经之热证者，有温热病而误认作正伤寒治者，有暑证而误
认作伤寒治者，有如狂而认作发狂者，有血证发黄而误认湿热发黄者，有蚊迹而认作发斑者，有动
阴血而认作鼻衄者，有谵语而认作狂言者，有独语而认作郑声者，有女劳复而认作阴阳易者，有短
气而认作发喘者，有痞满而认作结胸者，有心下硬痛，下利纯清水而俗呼为漏底者，有哕而误认干
呕者，有并病而认作合病者，有正阳明腑病而认作阳明经病者，有太阳证无脉而便认死证
者，有里恶寒而认作表恶寒者，有表热而误作里热者，有阴发躁而认作阳证者，有少阴病发热而认
作太阳证者，有标本全不晓者，此几件终世不相认者，比比然乎。胸中若不证脉讲明，论方得法，
但同庸俗，一概妄治，此杀人不用刃耳。非惟救人功大，亦且阴骘匪轻。吾老矣，伤寒专科，实得
仲景先师厥旨，虽无万全之功，十中可生八九。曾着有书，不能尽心刻骨，因今老迈，后恐继业者
不得其传，有玷名行，遂将一生所蓄肺腑语句，并家秘不传之妙，及一提金、杀车槌法，逐一语录
于后。论注证而证注脉，脉注法而法注方。再三叮咛吾后子孙，不必集闲方而睹别论，别繁乱而莫
知其源。必须熟记，久则自然精贯。不与庸医伍，不使时医笑可也。尔宜珍藏受授，谨之慎之，毋
怠毋忽，故戒。
从事伤寒治疗并以此专精，确实责任重大。判断生死易如反掌，切勿贪图私利。杂病可以缓慢地选取方剂治疗，但伤寒必须依靠灵活变通的方法。
原本关于伤寒的著作有《活人书》、《明理论》、《指掌图》、《伤寒论》。其中有的只有论述而缺少方剂，有的只有方剂而缺少论述，有的只有脉象而没有症状描述，有的只有症状而没有治疗方法，这些都不是张仲景的完整著作。因为这些书流传年代久远，遗失了很多内容。王叔和拿着断简残篇来补充方剂和撰写论述，成无己顺着文意进行注释从而集成全书，所以遗留的祸患至今仍未停止。
比较现在庸俗的医生治疗伤寒，一二天不问属于虚证还是实证，就使用麻黄汤、桂枝汤之类的发汗；三四天不问病邪在经还是在腑，就使用小柴胡汤之类的和解；五六天不问病邪在表还是在里，就使用承气汤之类的攻下，导致内外都虚弱，变证蜂拥而起。大抵病患的表里虚实各不相同，邪气的传变也有差异，怎么能以天数作为标准呢？
大概风寒侵入人体没有固定的规律，有时进入阴经，有时进入阳经，事情没有固定的形态，不仅仅是从太阳病开始到厥阴病结束的理论。有的从太阳病开始，每天传变一经，六天传到厥阴，邪气衰退不再传变而痊愈；有的病邪未罢再次传变；有的立即传变；有的跳过一经传变；有的传变到二经或三经就停止；有的始终只在一经；有的越经传变；有的初入太阳病阶段不产生郁热，就直接进入少阴病成为真阴寒证；有的直中阴经成为寒证；有的症状发生变化；有的脉象发生变化；有的只看症状不看脉象；有的只看脉象不看症状。因为经典中没有明文规定，后人就有妄加治疗的失误。况且前人立法存在偏差，使后人受害的人很多了。
麻黄汤、桂枝汤这两首方剂，是张仲景创立的治疗冬季正伤寒的方子，现在的人却通用治疗非时暴寒、温病、暑病的错误方法。又将传经而来的阴证与直中阴经的阴证混同立论，这难道好吗？暴寒、温病、暑病必然有别方的治疗，直中与传经的阴证必然有灵活的方法，现在都遗忘失传而没有验证了。古人的书籍，指引后进学者，书本不能完全表达意思，意思不能完全通过言语表达，只是说个大概，虽然博古通今，关键在于得到真正的传承，必须活泼灵动。
所谓活法，就像珍珠在盘中滚动，只要见到太阳病证，就直攻太阳病；只要见到少阴病证，就直攻少阴病，这就是活法。张仲景又说：天数虽然多，但只要还有表证且脉浮的，尤其适宜用发汗法；天数虽然少，但只要还有里证且脉沉的，尤其适宜用攻下法。这是先贤的确切言论。切不可固执地认为一二天发表，三四天和解，五六天才攻下。这是庸医拘泥于死板的方法。务必审察脉象验证症状，辨别名称确定经络，一一亲切无疑，才可以下手。真正知道是表邪就用汗法，真正知道是里邪就用下法，真正知道是直中就用温法。像这样发汗，像那样攻下，又像那样温补，桂枝汤、承气汤给予就不会出错，姜附汤、理中汤发出效力必定恰当。用药稍微差一点，死证立刻显现，能不深思熟虑吗！
张仲景取方立论非常严谨，说可以温，说可以汗，说少量给予，说急下。以及先温其里，再攻其表；先解其表，再攻其里。得到纲领的人，并不难。如同附应声，如同影随形，见到病人则目识心通，见到医生则交谈无忧。没有得到真正传承的人，实在很难。见到病人举手无措，见到医生则羞愧沉默。这就像绣麒麟一样，正谓名节虚隆而实德则病矣（比喻徒有虚名而无实际德行）。唉，常病用常法，谁人不知道。假设有感冒非时暴寒而误认作正伤寒的，有劳力感寒而误认作真伤寒的，有杂证类似伤风而误认作伤寒治疗的，有直中阴经真寒证而误认作传经热证的，有温热病而误认作正伤寒治疗的，有暑证而误认作伤寒治疗的，有如狂而认作发狂的，有血证发黄而误认作湿热发黄的，有蚊迹而认作发斑的，有动阴血而认作鼻衄的，有谵语而认作狂言的，有独语而认作郑声的，有女劳复而认作阴阳易的，有短气而认作发喘的，有痞满而认作结胸的，有心下硬痛，下利纯清水而俗呼为漏底的，有哕而误认干呕的，有并病而认作合病的，有正阳明腑病而认作阳明经病的，有太阳证无脉而便认死证的，有里恶寒而认作表恶寒的，有表热而误作里热的，有阴发躁而认作阳证的，有少阴病发热而认作太阳证的，有标本全不晓的，这几件终世不相认的情况，比比皆是。
胸中如果不将证候脉象讲明，论方得法，只是同庸俗之人一样一概妄治，这是不用刀杀人啊。不仅是救人的功劳大，而且阴德也不轻。我老了，伤寒专科，确实得到了张仲景先师的精髓，虽然没有万全之功，十次可救活八九次。曾经著书，不能尽心刻骨，因为如今年老体迈，担心后继业者得不到传承，有玷污名声品行，于是将一生所蓄肺腑语句，并家秘不传的妙法，及一提金、杀车槌法，逐一语录在后面。论注证而证注脉，脉注法而法注方。再三叮咛我的后子孙，不必收集闲方而睹别论，避免繁乱而莫知其源。必须熟记，久了自然精贯通达。不与庸医为伍，不使时医嘲笑就可以了。你们应当珍藏受授，谨之慎之，毋怠毋忽，故戒。
Engaging in the treatment of Shanghan (Cold Damage) with specialized expertise is indeed a heavy responsibility. Judging life and death is as easy as turning one's hand; do not seek profit recklessly. For miscellaneous diseases, one may slowly select prescriptions, but for Shanghan, one must rely on flexible and adaptive methods.
Originally, there were texts on Shanghan such as *Huoren Shu* (Book of Living People), *Mingli Lun* (Theory Clarification), *Zhizhang Tu* (Palm-Guiding Diagram), and *Shanghan Lun* (Treatise on Cold Damage). Among these, some have discussions but lack formulas, some have formulas but lack discussions, some have pulse descriptions but lack symptom records, and some have symptoms but lack treatment methods; none of these constitute Zhang Zhongjing's complete work. Due to the long passage of years, much has been lost. Wang Shuhe supplemented formulas and wrote discussions based on fragmented bamboo slips, and Cheng Wuji annotated the text according to its flow to compile a complete book; thus, the resulting errors and harms persist to this day.
Compare this with how mediocre physicians today treat Shanghan: within one or two days, without distinguishing between deficiency (Xu) and excess (Shi) patterns, they immediately use sweating methods like Mahuang Tang (Ephedra Decoction) or Guizhi Tang (Cinnamon Twig Decoction); within three or four days, without determining whether the pathogen is in the meridians (Jing) or fu organs, they immediately use harmonizing methods like Xiaochaihu Tang (Minor Bupleurum Decoction); within five or six days, without assessing whether the pathogen is in the exterior (Biao) or interior (Li), they immediately use purgative methods like Chengqi Tang (Gut-Clearing Decoction). This leads to both interior and exterior depletion, causing a swarm of complicated changes (Bian Zheng). Generally, patients differ in their exterior-interior and deficiency-excess states, and the transmission of pathogens varies; how can one rely solely on the number of days?
Generally, wind-cold invasion has no fixed pattern; it may enter Yin meridians or Yang meridians. The situation lacks a fixed form, contradicting the simplistic theory that it always starts in Taiyang and ends in Jueyin. Some cases start in Taiyang, transmitting one meridian per day, reaching Jueyin by the sixth day, where the pathogen weakens and stops transmitting, leading to recovery. Others may transmit repeatedly after stopping, transmit immediately, skip meridians, stop after transmitting to two or three meridians, remain confined to one meridian throughout, or transmit across meridians irregularly. Some enter Shaoyin directly from Taiyang without generating stagnant heat, becoming true Yin-cold syndromes. Some strike the Yin meridians directly causing cold syndromes. Symptoms may change, pulses may change, some rely only on symptoms ignoring pulses, others only on pulses ignoring symptoms. Because the classics lack explicit rules, later practitioners have made reckless treatment errors. Moreover, deviations in earlier established laws have harmed many later generations.
Mahuang Tang and Guizhi Tang were established by Zhang Zhongjing specifically for treating "Zheng Shanghan" (True Cold Damage) occurring in winter. Today, people mistakenly use them universally for non-seasonal sudden cold, warm diseases, and summerheat. Furthermore, conflating transmitted Yin syndromes with direct-strike Yin syndromes in theoretical discussions is unwise. Non-seasonal cold, warm diseases, and summerheat require distinct formulas; direct strikes and transmissions into Yin require flexible methods, yet these are now forgotten and unverified. Ancient books guide successors, but books cannot fully express meaning, nor words fully express intent; they provide general outlines. While being knowledgeable about the past and present is good, true mastery lies in receiving the authentic transmission and applying it dynamically.
The so-called "flexible method" is like a pearl rolling on a plate: if you see Taiyang syndrome, attack Taiyang directly; if you see Shaoyin syndrome, attack Shaoyin directly. This is flexibility. Zhang Zhongjing also stated: Even if many days have passed, if exterior signs exist and the pulse is floating, sweating is particularly appropriate. Even if few days have passed, if interior signs exist and the pulse is deep, purging is particularly appropriate. This is the definitive view of former sages. One must not rigidly adhere to releasing the exterior on days 1-2, harmonizing on days 3-4, and purging on days 5-6. This is the dead-handed approach of mediocre doctors. One must carefully examine pulses and verify symptoms, distinguish names, and determine meridians with absolute clarity before acting. Truly knowing it is an exterior pathogen, use sweating; truly knowing it is an interior pathogen, use purging; truly knowing it is a direct strike, use warming. Thus sweating, thus purging, thus warming: Guizhi Tang and Chengqi Tang will be applied without error; Jiangfu Tang (Ginger and Aconite Decoction) and Lizhong Tang (Regulate the Middle Decoction) will yield certain efficacy. A slight deviation in dosage leads immediately to fatal syndromes; can one fail to think deeply and consider thoroughly?
Zhang Zhongjing was very strict in selecting formulas and establishing principles, using terms like "can be warmed," "can be sweated," "give sparingly," and "urgently purge." He also discussed warming the interior first then attacking the exterior, or releasing the exterior first then attacking the interior. Those who grasp the outline find it easy. It becomes like an echo following a sound, or a shadow following a form; seeing a patient brings immediate understanding, and consulting colleagues brings ease. Those lacking true transmission find it difficult. Seeing a patient, they are at a loss; facing colleagues, they blush and remain silent. This is like embroidering a qilin—having nominal prestige but lacking substantive virtue. Alas, using standard methods for common diseases is known by everyone. However, consider those who mistake non-seasonal sudden cold for True Shanghan; those who mistake labor-induced cold for True Shanghan; those who treat miscellaneous diseases resembling Wind-Cold as Shanghan; those who mistake direct-strike Yin-cold syndromes for transmitted Heat syndromes; those who treat Warm Diseases as True Shanghan; those who treat Summerheat as Shanghan; those who mistake agitation resembling madness for actual mania; those who mistake blood-related jaundice for Damp-Heat jaundice; those who mistake mosquito bites for macules; those who mistake Yin-blood disturbance for epistaxis; those who mistake delirium for manic speech; those who mistake solitary muttering for confused speech (Zheng Sheng); those who mistake post-coital relapse (Nu Lao Fu) for Yin-Yang exchange; those who mistake shortness of breath for panting; those who mistake fullness/stuffiness for chest binding (Jie Xiong); those who mistake lower abdominal hardness with pure watery diarrhea (colloquially called "leaky bottom") for other conditions; those who mistake hiccups for dry heaving; those who mistake concurrent diseases (Bing Bing) for combined diseases (He Bing); those who mistake Yangming Fu organ disease for Yangming Meridian disease; those who see no pulse in Taiyang syndrome and declare it fatal; those who mistake interior aversion to cold for exterior aversion; those who mistake exterior heat for interior heat; those who mistake Yin-restlessness for Yang syndromes; those who mistake fever in Shaoyin disease for Taiyang syndrome; those who understand neither root nor branch. These cases of lifelong misidentification are commonplace. If one does not clarify symptoms and pulses in mind, and fails to master formula selection, merely joining mediocre practitioners in reckless treatment is killing without a blade. Not only is saving lives a great merit, but the hidden virtue is significant. I am old. My specialization in Shanghan truly captures the essence of Master Zhang Zhongjing. Though not infallible, I save eight or nine out of ten. Having written books previously, I could not pour my heart and soul into them. Now, fearing that successors will lose the transmission and tarnish our reputation due to my advanced age, I record here the insights of my life, family secrets, and techniques such as "Ti Jin" (Lifting Gold) and "Sha Che Chui" (Killing Cart Hammer). I discuss symptoms via theories, theories via pulses, pulses via methods, and methods via formulas. I earnestly instruct my descendants: do not collect random formulas or read scattered theories that lead to confusion without knowing the source. Memorize diligently; over time, precision will come naturally. Do not associate with mediocre doctors; avoid ridicule by contemporary practitioners. Treasure and transmit this carefully, with caution and diligence, never neglecting it. This is my warning.