伤寒无阴证，人伤于寒，则为病热，热病乃汗病也。造化汗液，皆阳气也。冬
时肾水用事，为伤寒者，其风伤于荣卫，使人毫毛毕直，皮肤闭而为热。初入太阳膀胱受证，头疼，
恶寒发热，腰脊强直，按至皮肤之上，下手便得，脉来浮紧有力，无汗，为伤寒表证。寒则伤荣血，
冬用麻黄汤，开发腠理，表汗除邪。脉来浮缓无力，有汗怕风，为伤风。风则伤卫气，冬用桂枝汤，
充塞腠理，止汗散邪。其余月时，虽无恶寒，为重也。治三时感寒，无汗，以羌活冲和去地黄，加
紫苏、藿香，以发散之；有汗，用加减羌活汤。如用桔梗汤止汗退邪，必加凉药于中，免斑出黄生
之患，此谓无伐天和也。若将冬时正伤寒之药，通治非时暴感寒热，定为害矣。
假如一日至十三日，若有一毫头痛恶寒者，每日如此，不论日数多少，尚有表证未解，还用微
汗，不可攻里。若攻下之，则为结胸等证。
一二日，恶寒皆除，便觉胸中满闷疼痛，大便闭，渴而不恶寒反怕热，热入里也，大柴胡、承
气下之，切不可拘于日数并始太阳终厥阴之论也。
二三日，邪传阳明胃，身热目痛，鼻干不眠，按至皮肤之下，肌肉之间，脉来
微洪而长者，属半表半里。渴而无汗，葛根汤；渴而有汗，人参白虎汤；微微恶寒者，桂枝汤。若
无头疼恶寒而反怕热，便闭燥渴，狂言谵语，揭去衣被，扬手掷足者，此为热邪传入阳明之本。脉
来沉数有力，正宜承气汤下之，泄去胃中实热燥屎而愈也。
三四日，邪传少阳胆，胸胁痛而耳聋，寒热，呕而口苦，按至半阴半阳及脉来弦数者，是半表
半里也。缘胆无出入之路，用小柴胡。其经有三禁，汗、下、吐也。盖阳明与少阳二经，不从标本
从乎中治也。中者，半表半里，两阳交中，名曰少阳也。
四五日，邪传太阴脾，腹满咽干，口燥而渴，按至筋骨之间，脉来沉而有力者，桂枝大黄汤。若
不渴，自利，身无热，脉来沉缓无力者，四逆汤温之也。
五六日，邪传少阴肾，舌干口燥，重指按至筋骨之间，脉来沉而有力者，正用大柴胡、承气下
之。若发渴，自利清水不多，腹胀者，亦当下之。俱是阳邪传入
阴经之阴证也。若有一时初起，不入太阳，竟入太阴，无头疼身热，便见四肢厥冷，怕寒，或腹痛
自利，小便清白，脉沉无力，或脉全无者，此是直中阴经之阴证也，非是三阳传来，急用附子理中
汤温之。脉沉有二，阴阳、寒热、虚实，用在有力无力中分。有力为热，无力为寒。又有少阴太阳
二证相并，脉沉无力，当无热，今反有热，如不头痛者，阴证反阳也，麻黄细辛汤。身发热，脉当
浮大，今反沉细，若有头痛者，阳证反阴也，四逆汤主之。
六七日，邪传厥阴肝，烦渴囊缩，舌卷耳聋，身不热，大便闭，按至筋骨之间，脉实弦而有力，
正用承气下之。此邪从三阳传入三阴，外有厥冷，内有邪热耳。如脉微而无力，腹痛自利，不渴，
四肢厥冷，怕寒者，真阴寒证也，附子理中汤温之。口中出沫流涎者，亦寒也，茱萸理中汤主之。
伤寒没有阴证，人受寒邪侵袭，就会发生热病，热病就是汗病。自然界中的汗液，都是阳气的作用。冬季肾水当令，患伤寒的人，风邪伤及营卫，使人毫毛竖起，皮肤闭塞而发热。初起时太阳膀胱经受邪，出现头痛、恶寒发热、腰脊强直，按压至皮肤表面，下手即可触及，脉象浮紧有力，无汗，这是伤寒的表证。寒邪伤及营血，冬季用麻黄汤，开发腠理，通过发汗祛除邪气。脉象浮缓无力，有汗且怕风，这是伤风。风邪伤及卫气，冬季用桂枝汤，充实腠理，止汗并驱散邪气。其余季节，虽然没有明显的恶寒，但病情较重。治疗其他三个季节感受寒邪，若无汗，用羌活冲和汤去掉地黄，加入紫苏、藿香，以发散邪气；若有汗，用加减羌活汤。如果使用桔梗汤来止汗退邪，必须在其中加入凉药，以免出现斑疹发黄的危害，这叫做不破坏人体的自然和谐。如果将冬季正伤寒的药物，通用于非时令突然感受的寒热病，一定会造成危害。
假如从第一日到第十三日，只要有一点点头痛恶寒的症状，每天都如此，不论过了多少天，说明还有表证未解，仍需用微汗法，不可攻下里实。如果攻下，就会导致结胸等证候。
一到两天，恶寒全部消除，便觉得胸中满闷疼痛，大便闭结，口渴且不恶寒反而怕热，这是热邪入里，用大柴胡汤或承气汤攻下，切不可拘泥于日数以及始于太阳终于厥阴的理论。
两到三天，邪气传入阳明胃经，身体发热、眼睛痛、鼻子干、失眠，按压至皮肤之下、肌肉之间，脉象微洪而长，属于半表半里。口渴而无汗，用葛根汤；口渴而有汗，用人参白虎汤；微微恶寒的，用桂枝汤。如果没有头痛恶寒反而怕热，大便闭结、燥渴、胡言乱语、掀去衣被、挥手踢脚，这是热邪传入阳明之本。脉象沉数有力，正适宜用承气汤攻下，泄去胃中的实热燥屎即可痊愈。
三到四天，邪气传入少阳胆经，胸胁疼痛且耳聋，寒热往来，呕吐且口苦，按压至半阴半阳部位及脉象弦数，这是半表半里。因为胆经没有出入的路径，用小柴胡汤。该经有三禁：汗法、下法、吐法。大概阳明与少阳二经，不从标本而从乎中治。中者，即半表半里，两阳交合之中，名为少阳。
四到五天，邪气传入太阴脾经，腹部胀满、咽干、口燥而渴，按压至筋骨之间，脉象沉而有力，用桂枝大黄汤。如果不渴，自利（腹泻），身体无热，脉象沉缓无力，用四逆汤温补。
五到六天，邪气传入少阴肾经，舌干口燥，重指按压至筋骨之间，脉象沉而有力，正用大柴胡汤或承气汤攻下。如果发生口渴，自利清水不多，腹胀，也应当攻下。这些都是阳邪传入阴经的阴证。如果有一时初起，不入太阳经，竟直接传入太阴经，没有头痛身热，立即出现四肢厥冷、怕寒，或腹痛自利，小便清白，脉沉无力，或脉象全无，这是直中阴经的阴证，不是从三阳传来，急用附子理中汤温补。脉沉有两种情况，阴阳、寒热、虚实，要在有力无力中区分。有力为热，无力为寒。又有少阴太阳二证相兼，脉沉无力，应当无热，现在反而有热，如不头痛的，是阴证反阳，用麻黄细辛汤。身体发热，脉应当浮大，现在反而沉细，如果有头痛的，是阳证反阴，用四逆汤主治。
六到七天，邪气传入厥阴肝经，烦躁口渴、囊缩、舌卷、耳聋，身体不热，大便闭结，按压至筋骨之间，脉实弦而有力，正用承气汤攻下。这是邪气从三阳传入三阴，外有厥冷，内有邪热。如果脉微而无力，腹痛自利，不渴，四肢厥冷，怕寒，是真阴寒证，用附子理中汤温补。口中出沫流涎的，也是寒证，用茱萸理中汤主治。
There are no Yin syndromes in Shanghan (Cold Damage). When humans are injured by cold pathogens, they develop febrile diseases; febrile diseases are sweating diseases. The sweat fluids of creation are all generated by Yang Qi. In winter, when Kidney Water is dominant, those suffering from Shanghan have wind pathogens injuring Ying and Wei (Nutritive and Defensive levels), causing hair follicles to stand erect, skin pores to close, and resulting in fever. Initially, the Taiyang Bladder channel is affected, presenting with headache, aversion to cold, fever, stiffness of the waist and spine. Palpation at the superficial skin level reveals a floating, tight, and forceful pulse without sweating, which characterizes the exterior syndrome of Shanghan. Cold injures Ying Blood; in winter, Mahuang Tang (Ephedra Decoction) is used to open the Cou Li (skin and muscle interstices) and expel pathogens through sweating. A floating, slow, and weak pulse with sweating and aversion to wind indicates Wind Injury. Wind injures Wei Qi; in winter, Guizhi Tang (Cinnamon Twig Decoction) is used to fill the Cou Li, stop sweating, and scatter pathogens. During other seasons, although there may be no obvious aversion to cold, the condition is heavier. For cold injuries in these three seasons without sweating, Qianghuo Chonghe Tang (Notopterygium Harmonizing Decoction) with Dihuang (Rehmannia) removed, plus Zisu (Perilla Leaf) and Huoxiang (Patchouli), is used to disperse; if sweating is present, Jiajian Qianghuo Tang (Modified Notopterygium Decoction) is used. If Jiegeng Tang (Platycodon Decoction) is used to stop sweating and retreat pathogens, cooling herbs must be added to avoid complications like rashes and jaundice; this is called not violating Tian He (Heavenly Harmony/Natural Balance). Using winter-specific Shanghan formulas indiscriminately for non-seasonal acute cold-heat conditions will definitely cause harm.
If, from day one to thirteen, there is even a slight headache and aversion to cold persisting daily, regardless of the number of days, the exterior syndrome remains unresolved, and mild sweating should still be induced; interior purgation must not be used. If purged, it leads to syndromes such as Jie Xiong (Chest Binding).
On days one or two, if aversion to cold disappears completely, followed by chest fullness, pain, constipation, thirst, absence of aversion to cold but presence of aversion to heat, this indicates Heat entering the interior. Da Chaihu Tang (Major Bupleurum Decoction) or Chengqi Tang (Purgative Decoctions) should be used for purgation; one must not rigidly adhere to theories regarding the number of days or the progression from Taiyang to Jueyin.
On days two or three, the pathogen transmits to the Yangming Stomach channel, presenting with body heat, eye pain, nasal dryness, and insomnia. Palpation between the skin and muscle reveals a slightly surging and long pulse, belonging to the half-exterior, half-interior stage. With thirst but no sweating, Gegen Tang (Kudzu Decoction) is indicated; with thirst and sweating, Renshen Baihu Tang (Ginseng White Tiger Decoction) is indicated; with slight aversion to cold, Guizhi Tang (Cinnamon Twig Decoction) is indicated. If there is no headache or aversion to cold but rather aversion to heat, constipation, dry thirst, delirious speech, removing clothes/bedding, and waving hands/kicking feet, this is Heat pathogen transmitting to the root of Yangming. A deep, rapid, and forceful pulse indicates that Chengqi Tang (Purgative Decoction) is appropriate to purge excess heat and dry feces from the Stomach for recovery.
On days three or four, the pathogen transmits to the Shaoyang Gallbladder channel, presenting with hypochondriac pain, deafness, alternating chills and fever, vomiting, and bitter taste. Palpation at the semi-Yin semi-Yang area and a wiry, rapid pulse indicate the half-exterior, half-interior stage. Since the Gallbladder channel has no direct exit/entry pathway, Xiao Chaihu Tang (Minor Bupleurum Decoction) is used. This channel has three prohibitions: sweating, purgation, and vomiting. Generally, the Yangming and Shaoyang channels do not follow the root/subtle principle but are treated via the "Middle." The Middle refers to the half-exterior, half-interior, where two Yangs intersect, named Shaoyang.
On days four or five, the pathogen transmits to the Taiyin Spleen channel, presenting with abdominal fullness, dry throat, dry mouth, and thirst. Palpation between sinews and bones reveals a deep and forceful pulse; Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction) is used. If there is no thirst, spontaneous diarrhea, no body heat, and a deep, slow, weak pulse, Sini Tang (Frigid Extremities Decoction) is used for warming.
On days five or six, the pathogen transmits to the Shaoyin Kidney channel, presenting with dry tongue and mouth. Heavy palpation between sinews and bones reveals a deep and forceful pulse; Da Chaihu Tang (Major Bupleurum Decoction) or Chengqi Tang (Purgative Decoction) should be used for purgation. If thirst occurs, spontaneous passage of clear water in small amounts, and abdominal distension, purgation is also indicated. These are all Yin syndromes caused by Yang pathogens transmitting into Yin channels. However, if upon initial onset, the pathogen does not enter Taiyang but directly enters Taiyin, without headache or body heat, immediately presenting with cold limbs, aversion to cold, or abdominal pain with spontaneous diarrhea, clear urine, deep weak pulse, or absent pulse, this is a Zhizhong Yin Jing (Direct Invasion of Yin Channel) Yin syndrome, not transmitted from the Three Yang channels. Fuzi Lizhong Tang (Aconite and Poria Decoction) should be urgently used for warming. Deep pulses can be categorized into Yin/Yang, Cold/Heat, Deficiency/Excess, distinguished by forcefulness. Forceful indicates Heat; weak indicates Cold. There are also combined Shaoyin and Taiyang syndromes with deep, weak pulses. One should expect no heat, but if heat is present, and there is no headache, it is a Yin syndrome turning Yang, treated with Mahuang Xixin Tang (Ephedra and Asarum Decoction). If the body is hot and the pulse should be floating and large but is instead deep and thin, and if headache is present, it is a Yang syndrome turning Yin, treated primarily with Sini Tang (Frigid Extremities Decoction).
On days six or seven, the pathogen transmits to the Jueyin Liver channel, presenting with irritability, thirst, scrotal retraction, curled tongue, deafness, no body heat, and constipation. Palpation between sinews and bones reveals a solid, wiry, and forceful pulse; Chengqi Tang (Purgative Decoction) is used for purgation. This is pathogen transmission from Three Yang to Three Yin, with external cold limbs and internal heat. If the pulse is faint and weak, with abdominal pain, spontaneous diarrhea, no thirst, cold limbs, and aversion to cold, it is a True Yin Cold syndrome, treated with Fuzi Lizhong Tang (Aconite and Poria Decoction) for warming. Saliva drooling and foam from the mouth also indicate Cold, treated with Zhuyu Lizhong Tang (Cornus and Poria Decoction).