伤寒治法，得其纲领者，如拾芥。若求之多岐，则支离破碎，如涉海问津矣。
盖脉证与理而已。伤寒之脉，以浮、大、动、数、滑为阳，沉、涩、弱、弦、微为阴。然脉理精深，
今人何能到此田地耶。夫脉者，非血非气，乃营行之道路，实先天后天之大造，无所穷尽。叔和脉
云指下难明者，真言也。今人夸诞通晓者，但能言而不能行也。吾老专以浮、中、沉三脉候而治之，
察其阴阳表里，虚实寒热，如见其肺肝然，无所逃其情矣。既云伤寒，则寒邪自外入内而伤之，其
入则有浅深次第，自表达里，先入皮肤肌肉，次入筋骨肠胃，以此推之而不难也。原风寒初入，或
先太阳寒水之经，此经本寒标热，便有恶风恶寒，头疼发热。盖寒郁皮毛，是为表证。若在他经，
则无此证矣。脉若浮紧，无汗，为伤寒，用麻黄汤发之，得汗为解。脉若浮缓，有汗，为伤风，用
桂枝汤以散邪，汗止为解。若无头疼恶寒，脉又不浮，此为表证罢而在中。中者，即半表半里之间
也，乃阳明少阳之分，脉又不浮不沉，在乎肌骨之间，谓皮肤之下。然则有二焉∶若微洪而长，阳
明脉也，外证则目痛鼻干，不眠，用葛根以解肌；脉弦而数，少阳脉也，其证胸胁痛而耳聋，寒热，
呕而口苦，如见此证此脉，便以小柴胡和之。盖阳明少阳二经，不从标本从乎中也。
过此邪入里为热实，脉不浮而沉，沉则按之筋骨之间方是。若是脉来沉实有力，外证则不恶风寒而
反恶热，谵语大渴，或潮热自汗，或扬手掷足，揭去衣被，五六日不大便，明其热入里而肠胃燥实也，
轻则大柴胡汤，重则三承气汤选用，大便通而热愈矣。若脉来沉迟无力，此为直中阴经真寒证之阴
脉，其证无头痛，无身热，初起怕寒，手足厥冷，或战栗蜷卧，不渴，兼之腹痛，呕吐泄泻，或口
出涎沫，面如刀刮者，乃阴经自中之寒，不从阳经传入，故不在传经热证治例，更当看外证如何，
轻则理中汤，重则姜附四逆以温之。其中紧要关节，吾再表而出之。太阳者，阳证之表。阳明者，
阳证之里。少阳者，二阳三阴之间。太阴、少阴、厥阴又居于里，总而谓之阴证。然三阴俱是沉脉，
妙在指下有力无力中分。有力者，为阳，为实，为热；无力者，为阴，为虚，为寒，最为切当。其
三阳经证，前论已云，不再多录。夫三阴传经热证，脉虽开明，论尤未详，重加订证。如腹满咽干，
属太阴；舌干口燥，属少阴；烦满囊缩，属厥阴。此三者，俱是阳经传入阴经之热证。脉见沉实有
力，急当攻里，下之。如其下后利不止，身疼痛，脉反沉细无力，又当救里，温之。此权变之法也。
三阴传经热证，与其三阴直中寒证，脉虽沉，而有力无力所别，证
有异而治各不同，是其大法也欤。前云正阳明病，本经风盛气实，脉亦沉实有力者，因邪热传入胃
腑而有燥屎。此一节，指腑病属里而言也，实证治之奇功，指法之玄妙。秘之，不与俗人言之耳。
今将浮、中、沉三脉列为三图，图下就注证治之法，使因脉以知证，缘证以明治，以此达彼，犹粗
入精，亦可以为后人之宗也。
伤寒的治疗法则，若能掌握其纲领，便如同拾取草芥般容易。若追求繁杂的分支，则会支离破碎，如同渡海寻路一般艰难。
大抵不外乎脉象、证候与医理罢了。伤寒病的脉象，以浮、大、动、数、滑为阳脉，以沉、涩、弱、弦、微为阴脉。然而脉理精深，现代人怎能达到这种境界呢？脉，既不是血也不是气，而是营气运行的道路，实乃先天与后天造化之大成，深不可穷尽。王叔和在《脉经》中说“指下难明”，真是至理名言。如今那些夸口通晓脉理的人，只是能说而不能行而已。我年老之后，专门通过浮、中、沉三种脉位来诊察并治疗，辨别其阴阳、表里、虚实、寒热，就像看见肺肝一样清晰，病情无所遁形。
既然称为伤寒，就是寒邪从外侵入体内而致病，其入侵有浅深次第，由表入里，先侵犯皮肤肌肉，次进入筋骨肠胃，依此推演并不难理解。原本风寒初起，往往先侵犯太阳膀胱经（足太阳膀胱经），此经本气为寒，标气为热，因此会出现恶风、恶寒、头痛、发热等症状。这是因为寒邪郁闭皮毛，属于表证。如果在其他经络，则不会有这些症状。如果脉象浮紧，无汗，属于伤寒，用麻黄汤发汗解表，出汗后病愈。如果脉象浮缓，有汗，属于伤风，用桂枝汤疏散邪气，汗止后病愈。
如果没有头痛恶寒，脉象也不浮，这说明表证已罢，病邪在中间部位。“中”即半表半里之间，是阳明胃经和少阳胆经的分界处，脉象不浮不沉，位于肌骨之间，谓皮肤之下。此时有两种情况：如果脉象微洪且长，这是阳明脉，外在证候则是目痛、鼻干、失眠，用葛根解肌退热；如果脉象弦而数，这是少阳脉，其证候为胸胁疼痛、耳聋、寒热往来、呕吐、口苦，见到这种证候和脉象，就用小柴胡汤和解少阳。因为阳明和少阳二经，不从标本而从乎中气。
过了这个阶段，邪气入里化为热实证，脉象不浮而沉，沉脉需按至筋骨之间才能触及。如果脉来沉实有力，外在证候是不恶风寒反而恶热，谵语、大渴，或潮热自汗，或扬手掷足，掀去衣被，五六天不大便，明确这是热邪入里导致肠胃燥结实证，轻症用大柴胡汤，重症选用三承气汤，大便通畅后热邪自除。如果脉来沉迟无力，这是直中阴经的真寒证之阴脉，其证候无头痛，无身热，初起怕冷，手足厥冷，或战栗蜷卧，不口渴，兼有腹痛、呕吐、泄泻，或口出涎沫，面色如刀刮般苍白，这是阴经直接受中的寒邪，不从阳经传入，所以不属于传经热证的治法范围，更应当观察外在证候如何，轻症用理中汤，重症用姜附四逆汤温阳散寒。其中紧要的关键环节，我再加以阐明。
太阳经，是阳证的表证。阳明经，是阳证的里证。少阳经，处于二阳（太阳、阳明）与三阴之间。太阴、少阴、厥阴又居于里，总称为阴证。然而三阴经都是沉脉，妙处在于指下有力与无力的区分。有力的，属阳、属实、属热；无力的，属阴、属虚、属寒，最为恰当。关于三阳经的证候，前文已论述过，不再多录。至于三阴经传经的热证，脉象虽然明了，但论述尚不详细，现重新加以订正验证。如腹满咽干，属于太阴；舌干口燥，属于少阴；烦躁胀满、囊缩，属于厥阴。这三者，都是阳经传入阴经的热证。脉象见沉实有力，急当攻里，使用下法。如果使用后利不止，身体疼痛，脉象反见沉细无力，又应当救里，使用温法。这是权变的方法。
三阴经传经的热证，与其三阴经直中的寒证，脉象虽同为沉，但通过有力无力的区别，证候不同，治法也各不相同，这是大法啊。前文所说的正阳明病，本经风盛气实，脉象也是沉实有力的，是因为邪热传入胃腑而有燥屎。这一节，是指腑病属于里而言，实证治疗的奇功，指法的玄妙。秘而不宣，不与俗人谈论罢了。
现在将浮、中、沉三脉列为三张图，图下注解证治之法，使医者因脉而知证，缘证以明治，以此通达彼理，犹如由粗入精，也可以作为后人的宗法准则。
The treatment principles of Shanghan (Cold Damage), if one grasps the general outline, are as easy as picking up a mustard seed. If one seeks complexity in many divergent paths, the result will be fragmented and broken, like trying to find a ferry crossing while wading through the sea.
It essentially comes down to pulse diagnosis, symptoms, and medical theory. In Shanghan disease, pulses that are Floating (Fu), Large (Da), Moving (Dong), Rapid (Shu), or Slippery (Hua) are considered Yang pulses; those that are Deep (Chen), Choppy (Se), Weak (Ruo), Wiry (Xian), or Minute (Wei) are considered Yin pulses. However, the principles of pulse diagnosis are profound; how can modern people reach such a level? The pulse is neither blood nor Qi; it is the pathway through which Ying (Nutritive) Qi circulates, representing the great creation of both Pre-heaven and Post-heaven origins, boundless and inexhaustible. Wang Shuhe stated in his *Mai Jing* (Pulse Classic) that "the pulse is difficult to discern under the fingers," which is truly insightful words. Those today who boast of mastering pulse diagnosis can only speak of it but not practice it correctly. In my old age, I specialize in diagnosing and treating via the Floating, Middle, and Deep pulse positions, inspecting Yin and Yang, Exterior and Interior, Deficiency and Excess, Cold and Heat, seeing them as clearly as if viewing the lungs and liver, leaving no room for the true nature of the disease to escape.
Since it is called Shanghan, it means Cold Evil enters from the exterior to injure the interior. Its entry has degrees of depth and sequence, moving from the Exterior to the Interior: first invading the skin and muscles, then entering the sinews, bones, stomach, and intestines. Inferring from this is not difficult. Originally, when Wind-Cold first invades, it often affects the Taiyang Bladder Channel (Foot-Taiyang Bladder Meridian) first. This channel has Cold as its root and Heat as its manifestation, thus presenting with aversion to wind, aversion to cold, headache, and fever. This is because Cold stagnates in the hair follicles and skin, constituting an Exterior Syndrome. If it were in other channels, these symptoms would not appear. If the pulse is Floating and Tight, with no sweating, it is Shanghan (Cold Damage); use Mahuang Tang (Ephedra Decoction) to induce sweating for resolution. If the pulse is Floating and Slow, with sweating, it is Shangfeng (Wind Strike); use Guizhi Tang (Cinnamon Twig Decoction) to disperse the pathogen, resolving when sweating stops.
If there is no headache or aversion to cold, and the pulse is not Floating, this indicates the Exterior Syndrome has ceased and the pathogen is in the middle. "Middle" refers to the Half-Exterior Half-Interior region, which is the domain of the Yangming Stomach Channel and Shaoyang Gallbladder Channel. The pulse is neither Floating nor Deep, located between muscle and bone, beneath the skin. There are two possibilities here: If the pulse is slightly Surging (Hong) and Long, it is a Yangming pulse; external symptoms include eye pain, dry nose, and insomnia; use Gegen (Kudzu Root) to resolve the muscle layer. If the pulse is Wiry and Rapid, it is a Shaoyang pulse; symptoms include chest and hypochondriac pain, deafness, alternating chills and fever, vomiting, and bitter taste in the mouth. Upon observing these symptoms and pulse, use Xiaochaihu Tang (Minor Bupleurum Decoction) to harmonize. This is because the Yangming and Shaoyang channels do not follow their root or manifestation exclusively but rather follow the Zhong Qi (Middle Qi).
Beyond this stage, the pathogen enters the Interior transforming into Heat and Excess. The pulse is not Floating but Deep; a Deep pulse requires pressing until the sinew and bone level to detect. If the pulse comes Deep, Solid, and Forceful, external symptoms include aversion to neither wind nor cold but rather aversion to heat, delirious speech, extreme thirst, tidal fever with spontaneous sweating, waving hands and throwing legs about, removing clothes and blankets, and constipation for five to six days. This clearly indicates Heat entering the Interior causing Dryness and Excess in the stomach and intestines. For mild cases, use Daxiehu Tang (Major Bupleurum Decoction); for severe cases, select among the Three Chengqi Decoctions (San Chengqi Tang). Once stool passes, the heat subsides. If the pulse is Deep, Slow, and Forceless, this is a Yin pulse indicating a True Cold Syndrome directly attacking the Yin Channels. Symptoms include no headache, no body heat, initial aversion to cold, cold limbs, shivering and curling up, no thirst, accompanied by abdominal pain, vomiting, diarrhea, salivation, or a face pale as if scraped by a knife. This is Cold directly invading the Yin Channels, not transmitted from Yang channels, so it does not fall under the treatment category of transmitted Heat Syndromes. One must further observe external symptoms: for mild cases, use Lizhong Tang (Regulate the Middle Decoction); for severe cases, use Jiangfu Sini Tang (Ginger and Aconite Decoction to Reverse Collapse) to warm and dispel cold. Regarding these critical junctures, I shall elaborate further.
Taiyang is the Exterior of Yang Syndromes. Yangming is the Interior of Yang Syndromes. Shaoyang lies between the Two Yangs and the Three Yins. Taeyin, Shaoyin, and Jueyin reside in the Interior, collectively termed Yin Syndromes. However, all Three Yin channels present with Deep pulses; the subtlety lies in distinguishing forcefulness versus forcelessness under the fingers. Forceful indicates Yang, Excess, and Heat; forceless indicates Yin, Deficiency, and Cold, which is most appropriate. The syndromes of the Three Yang channels have been discussed previously and are not repeated here. Regarding Heat Syndromes transmitted to the Three Yin channels, although the pulse principles are clear, the discussion was incomplete; I now re-examine and verify them. Abdominal fullness and dry throat belong to Taiyin; dry tongue and mouth belong to Shaoyin; irritability, fullness, and contraction of the genitals belong to Jueyin. These three are all Heat Syndromes transmitted from Yang channels to Yin channels. If the pulse is Deep, Solid, and Forceful, one should urgently attack the Interior using purgation. If after purgation diarrhea persists and body pain remains, and the pulse reverses to become Deep, Fine, and Forceless, one should rescue the Interior using warming methods. This is a method of flexibility.
Heat Syndromes transmitted to the Three Yin channels and True Cold Syndromes directly attacking the Three Yin channels both present with Deep pulses, but they are distinguished by forcefulness versus forcelessness; the symptoms differ, and treatments vary accordingly. This is the major principle. Previously mentioned, Zheng Yangming disease involves excessive Wind and strong Qi in its own channel, with a Deep, Solid, and Forceful pulse, due to pathogenic Heat entering the Stomach Fu organ causing dry fecal matter. This section refers to Fu-organ diseases belonging to the Interior; it demonstrates the miraculous efficacy of treating Excess Syndromes and the profundity of pulse diagnosis. It is kept secret and not discussed with ordinary people.
Now, the Floating, Middle, and Deep pulses are listed in three diagrams, with notes on syndrome differentiation and treatment methods below each diagram, enabling practitioners to know syndromes through pulses and understand treatment through syndromes, bridging the gap from coarse to refined, serving as a standard for future generations.