伤寒之病，从表入里，里必达外，见证之由，所属必相审，治庶无误也。且如头痛项强者，太
阳证也。头摇者，里病也。头汗者，里有瘀血，必发黄也。面戴阳者，下虚也。面惨不光，伤寒也。
面光不惨，伤风也。面上乍黑乍白，唇口生疮，狐惑也。面如锦纹者，阳毒也。口难言，血少也。
舌上有白苔、黄苔，内热也。或黑者，热极也。鼻燥，漱水不下，或目瞑，溺血也。目睛黄，小肠
热也。 懊者，胃虚也。喜恶如狂，蓄血也。肉 筋惕，汗下虚也。身如被杖，阴毒也。一身尽痛，
多眠，或微肿难转者，风湿也。身目俱黄，湿热疸病也。身如虫行，表虚也。背恶寒，阴胜寒也。不
眠，因汗下多而神虚也。坐而伏者，短气也。下利清谷，内寒也。咽中生疮，上实下虚也。舌上生
刺，热盛也。利者，热盛也。叉手冒心，因汗多而血虚也。腹满手足温者，邪入太阴也。舌卷囊缩，
邪入厥阴也。
夫伤寒死证，一一须明，生死不明，将何措手？非惟有干名节，亦且投药无用。且赤斑者，五
死五生。黑斑者，十死一生。阳证见阴脉者，死。发少阳汗连厥阴血者，厥竭而死。发左右动气汗
者，死。发风湿者，死。发阴阳毒，过六七日死。大发湿家汗，成 热而 者，死。发热，发少阳
汗，谵语者，死。发温家汗，为重 者，死。两感伤寒者，死。有汗不为汗衰，为阴阳交者，死。
结胸证悉具，烦躁者，死。狂言不食者，死。发厥肌冷而发躁无时得安者，曰脏厥而死。结胸，舌
上生苔，为脏结者，死。咳逆不止者，死。舌卷囊缩者，死。少阴吐利，烦躁四逆者，死。结胸证，
烦躁悉具者，死。少阳与阳明合病，下利，脉长大，名曰负，负者，死。目乱无神气，目无精者，
死。男子病新瘥，妇人与之交，曰阳易。妇人病新瘥，男子与之交，曰阴易。男子阴肿，小腹痛，
妇人里急连腰股，眼昏，四肢拘急，为女劳复者，死。厥利，本不能食，反能食，为除中者，死。
伤寒七八日，大发热，汗出不止如贯珠，此本气衰者，死。爪甲青，为阳衰者，死。循衣摸床，喘
而不休，
卫气绝者，死。柔汗为冷汗出，发黄者，乃脾绝也，死。唇吻反青，乃肝绝也，死。环口黎黑，脉
绝也，死。直视摇头，心绝也，死。面黑遗尿，肾绝也，死。声如鼻鼾，肺绝也，死。身体如僵，
正气脱也，死。喘而不休，邪气胜也，死。水浆不下，胃气绝也，死。形体不仁，荣卫不行也，死。
乍静乍乱者，死也。
伤寒这种疾病，病邪从体表侵入体内，体内的病邪也必然要向外透达。对于症状表现及其所属的证候，必须仔细审察，治疗才可能不出差错。
例如：头痛且项部强直的，是太阳病（太阳经受邪所致的病证）。头部摇动的，是里病（脏腑内部病变）。只有头部出汗的，是里有瘀血，必定会出现发黄的症状。面色泛红如戴阳状（两颧潮红），是下焦虚寒。面色惨淡无光泽的，是伤寒。面色光亮但不惨淡的，是伤风。面色忽黑忽白，嘴唇和口腔生疮的，是狐惑病（一种以口腔、咽喉及前后二阴腐蚀溃疡为特征的疾病）。面部皮肤出现如锦缎花纹般红斑的，是阳毒（感受温热毒邪所致的一种急性热病）。口难言语，是血少。舌面上有白苔或黄苔，是内热。如果是黑苔，则是热极。鼻干燥，想漱口喝水却咽不下去，或者眼睛闭合不愿睁开，小便出血的，是……（原文此处似有脱漏，通常指阳明热盛或蓄血等证，依文意译为相关症状描述）。眼球发黄，是小肠热。心中烦闷不安（懊憹），是胃气虚弱。喜欢恶作剧像发狂一样，是蓄血证（瘀血阻滞心包或下焦）。肌肉跳动、筋脉抽搐，是发汗或攻下后导致的虚证。身体疼痛得像被棍棒打过一样，是阴毒（感受阴寒毒邪所致）。全身都痛，嗜睡，或者轻微肿胀难以转身的，是风湿病。身体和眼睛都发黄，是湿热黄疸病。身体感觉像有虫子在爬，是表虚。背部怕冷，是阴寒胜。失眠，是因为发汗或攻下过多导致神气虚弱。坐着并向前俯伏的，是短气（呼吸短促）。腹泻排出未消化的食物，是内寒。咽喉部长疮，是上实下虚。舌头上长出刺状物，是热盛。腹泻，也是热盛。双手交叉护住心前区，是因为发汗过多导致血虚。腹部胀满且手足温暖的，是邪气传入太阴脾经。舌头卷缩、睾丸收缩，是邪气传入厥阴肝经。
至于伤寒的死证，必须一一明确。如果生死界限不明，将如何下手用药？这不仅关乎医生的名声和气节，而且即使用药也无效。
例如：出现赤色斑点的，五死五生（预后一半死亡一半存活）。出现黑色斑点的，十死一生（预后极差）。阳证见到阴脉的，死。误发少阳病汗法进而损伤厥阴血的，因厥逆竭绝而死。误发动气证的汗法的，死。误发风湿病的汗法的，死。误发阴阳毒的病证，超过六七天死的。误大发湿家（素患湿病者）的汗，形成大热并出现……（原文脱漏，通常指惊痫或抽搐）的，死。发热，误发少阳病汗法，出现谵语的，死。误发温病（温家）的汗，导致重证……（原文脱漏，通常指痉病或严重津伤）的，死。两感伤寒（同时感受风寒之邪，表里同病）的，死。有汗出但热度不因汗出而减退，称为阴阳交（正气衰败，邪气亢盛）的，死。结胸证（痰水互结于胸膈）的所有症状都具备，且烦躁不安的，死。胡言乱语且不进食的，死。四肢厥冷且肌肤冰冷，躁动不安无法得到安宁的，称为脏厥（内脏阳气衰竭）而死。结胸证，舌上生苔，诊断为脏结（脏气虚寒与邪气凝结）的，死。咳嗽气逆不止的，死。舌头卷缩、睾丸收缩的，死。少阴病出现呕吐腹泻，烦躁且四肢逆冷的，死。结胸证，烦躁症状全部具备的，死。少阳病与阳明病合病，出现腹泻，脉象长大，名为“负”（正气负于邪气），负者，死。眼神混乱没有神采，眼中无精光的，死。男子病刚痊愈，妇女与之发生性关系，称为阳易（男性病后房劳复感女性余毒）。妇女病刚痊愈，男子与之发生性关系，称为阴易（女性病后房劳复感男性余毒）。男子阴囊肿胀，小腹痛，妇女自觉腹中急迫连及腰股，眼花昏蒙，四肢拘挛紧急，称为女劳复（因房事劳累导致的复发），死。四肢厥冷腹泻，本来不能吃东西，反而能吃东西，称为除中（胃气垂绝，回光返照）的，死。伤寒七八天，突然高热，汗出不止像串珠一样滴落，这是本气衰败的，死。指甲青紫，是阳气衰败的，死。手循摸衣被床沿，喘息不停，卫气断绝的，死。柔汗（冷汗淋漓）并发黄，这是脾气绝灭，死。嘴唇周围反常发青，这是肝气绝灭，死。口唇四周颜色黎黑，这是脉气绝灭，死。两眼直视且摇头，这是心气绝灭，死。面色发黑且遗尿，这是肾气绝灭，死。声音像打鼾一样，这是肺气绝灭，死。身体僵硬，这是正气脱失，死。喘息不停，这是邪气战胜正气，死。水浆不进，这是胃气绝灭，死。形体麻木不仁，这是营卫之气运行停止，死。时而安静时而混乱的，死。
The disease of Shanghan (Cold Damage) enters from the exterior into the interior, and pathogens in the interior must necessarily emerge to the exterior. Regarding the manifestation of symptoms and their corresponding syndromes, one must carefully examine them so that treatment may be free from error.
For instance: Headache with stiffness of the neck is a Taiyang syndrome (disease pattern involving the Taiyang channel). Shaking of the head indicates an interior disease. Sweating only on the head suggests blood stasis in the interior, which will inevitably lead to jaundice. A flushed face resembling "floating yang" (false heat signs) indicates deficiency in the lower jiao. A dull and lusterless complexion indicates Shanghan (Cold Damage). A bright but not dull complexion indicates Shangfeng (Wind Cold/Exterior Deficiency pattern). Sudden changes between black and white on the face, along with sores on the lips and mouth, indicate Huhuo disease (a condition characterized by erosive ulcers in the oral cavity, pharynx, and genitalia). A facial rash resembling brocade patterns indicates Yangdu (acute febrile disease caused by warm-heat toxic pathogens). Difficulty in speaking indicates blood deficiency. White or yellow coating on the tongue indicates internal heat. If the coating is black, it indicates extreme heat. Dryness of the nose, desire to rinse the mouth with water but inability to swallow, or closed eyes unwilling to open, along with hematuria, are symptoms... [Text implies specific heat or stasis patterns]. Yellowing of the eyeballs indicates heat in the Small Intestine. Restlessness and discomfort (Ao Nao) indicate stomach qi deficiency. Behaving like madness due to fear or dislike indicates blood accumulation (stasis blocking the heart or lower jiao). Muscle twitching and tendon spasms indicate deficiency resulting from excessive sweating or purging. Body pain as if beaten by a stick indicates Yindu (disease caused by yin-cold toxic pathogens). Generalized body pain, drowsiness, or slight swelling making turning difficult indicates Wind-Dampness disease. Jaundice of both the body and eyes indicates Damp-Heat Jaundice. Sensation of insects crawling on the skin indicates exterior deficiency. Aversion to cold in the back indicates excess of yin-cold. Insomnia results from excessive sweating or purging leading to spirit deficiency. Sitting while leaning forward indicates shortness of breath. Diarrhea with undigested food indicates interior cold. Sores in the throat indicate upper excess and lower deficiency. Thorn-like projections on the tongue indicate excessive heat. Diarrhea also indicates excessive heat. Crossing hands over the heart region results from blood deficiency due to excessive sweating. Abdominal fullness with warm hands and feet indicates pathogen entering the Taiyin spleen channel. Tongue retraction and testicular contraction indicate pathogen entering the Jueyin liver channel.
Regarding the fatal syndromes of Shanghan, each must be clearly understood. If life and death are not distinguished, how can medication be administered? This not only affects one's reputation and integrity but also renders medication useless.
For example: Red macules indicate a prognosis of five deaths and five survivals. Black macules indicate a prognosis of ten deaths and one survival. Yang syndromes presenting with Yin pulses result in death. Inducing sweat in Shaoyang disease thereby damaging Jueyin blood leads to death from exhaustion of jue (cold limbs/collapse). Inducing sweat in cases of moving qi results in death. Inducing sweat in Wind-Dampness cases results in death. Mismanagement of Yin-Yang Du diseases leading to death after six or seven days. Excessive sweating in patients with chronic dampness, leading to severe heat and... [text missing, likely convulsions], results in death. Fever, inducing sweat in Shaoyang disease, accompanied by delirium, results in death. Inducing sweat in Warm Disease (Wenjia) cases, leading to severe... [text missing, likely spasm], results in death. Lianggan Shanghan (simultaneous involvement of exterior and interior channels) results in death. Perspiration that does not reduce fever is called Yin-Yang Jiao (collapse of healthy qi with rampant pathogenic factors), resulting in death. When all symptoms of Jie Xiong (chest binding/phlegm-water accumulation) are present along with irritability, it results in death. Incoherent speech and refusal to eat result in death. Cold limbs with icy skin, restlessness without any relief, is called Zang Jue (failure of zang organ yang) and results in death. Jie Xiong with tongue coating diagnosed as Zang Jie (cold deficiency of organs with pathogenic knotting) results in death. Unceasing cough and air hunger result in death. Tongue retraction and testicular contraction result in death. Shaoyin disease with vomiting, diarrhea, irritability, and cold limbs results in death. Jie Xiong with complete irritability results in death. Combined disease of Shaoyang and Yangming with diarrhea and large, long pulse is named "Fu" (defeat/negative outcome), indicating death. Chaotic eyes lacking spirit and luster result in death. If a man recovers from illness and has sexual intercourse with a woman, it is called Yang Yi (male recovery relapse via female residual toxin). If a woman recovers and has intercourse with a man, it is called Yin Yi (female recovery relapse via male residual toxin). Male swelling of the genitals with lower abdominal pain, or female sensation of urgency in the abdomen extending to waist and thighs, blurred vision, and limb spasms, constitute Nu Lao Fu (relapse due to sexual exertion), resulting in death. Cold limbs and diarrhea where the patient, who previously could not eat, suddenly desires food, is called Chu Zhong (stomach qi perishing/rebound appetite), resulting in death. After seven or eight days of Shanghan, sudden high fever with continuous sweating dropping like beads indicates collapse of original qi, resulting in death. Cyanosis of the fingernails indicates collapse of yang qi, resulting in death. Grasping at clothes and bedrails with unceasing panting indicates severance of Wei Qi (defensive qi), resulting in death. Soft sweat (cold clammy sweat) with jaundice indicates failure of spleen qi, resulting in death. Lips turning unusually green indicates failure of liver qi, resulting in death. Darkening around the mouth indicates severance of pulse qi, resulting in death. Fixed gaze with head shaking indicates failure of heart qi, resulting in death. Black complexion with urinary incontinence indicates failure of kidney qi, resulting in death. Snoring-like sounds indicate failure of lung qi, resulting in death. Stiff body indicates loss of upright qi, resulting in death. Unceasing panting indicates pathogenic factors overcoming healthy qi, resulting in death. Inability to take fluids indicates failure of stomach qi, resulting in death. Numbness of the body indicates cessation of Ying and Wei (nutritive and defensive) circulation, resulting in death. Alternating calmness and confusion results in death.