夫伤寒急下急温者，病势已迫将有变也，故称急者，非若他证尚可缓也。少阴属肾主
水，口燥咽干，乃热
邪内炎，肾水将竭，故当急下。如腹胀不大便，土胜水也，亦当急下。阳明属胃土，汗多
热盛，急下以存津液。腹满痛为土实，急当下之。热病目不明，热不已者死。今目睛不
和，证亦危矣，须急下。少阴急温二证，内寒已甚，急温无疑也。
【下】少阴病得之二三日，口燥咽干者，急下之，大承气场。少阴病自利纯清水，心
下必痛，口燥咽干者，急下之。（方同上）。少阴病六七日，腹胀不大便，急下之。（方
同上。）阳明发热汗多者，急下之。（方同上）。伤寒六七日，目中不了了，睛不和，无
表里证，大便难，身微热，急下之。（方同上。）发热不解，腹满痛，急下之。（方同上。）
【温】少阴脉沉，急温之，四逆汤。少阴膈上有寒饮，干呕，不可吐，急温之，
四逆汤。
外证是伤寒，诊其脉是伤风，脉浮而缓也，故曰伤寒见风，见风脉也。外证寒多热
少，不烦，手足微厥是也。
【解表】伤寒见风，风则伤卫，寒则伤荣。卫伤者桂枝汤，荣伤者麻黄汤，荣卫俱伤，
大青龙汤。（烦躁者用。）不烦躁者，桂枝麻黄各半汤。
外证是伤风，诊其脉则是伤寒，脉浮而紧者是也。其证恶风发热多烦，或手足微温。
【解表】伤风见寒，脉似桂枝而无汗，病似麻黄而反烦躁是也，大青龙汤。脉若缓而
有汗者，桂枝汤。脉紧不烦躁者，麻黄汤。
所谓伤寒需要紧急攻下或紧急温补的情况，是因为病势紧迫，即将发生变证，所以称为“急”，不像其他病证还可以从容缓治。少阴经属于肾，主司水液代谢，出现口燥咽干的症状，是热邪在内炽盛，肾水即将枯竭的表现，因此应当紧急攻下。如果伴有腹部胀满、大便不通，这是土气（脾胃）过盛克制水气（肾），也应当紧急攻下。阳明经属于胃土，如果出汗多且热势亢盛，必须紧急攻下以保存津液。腹部胀满疼痛是由于土气实盛，必须紧急通下。热病患者眼睛视物不清，如果热势不退就会死亡。现在患者眼球转动不灵活，病情也很危险，必须紧急攻下。少阴病需要紧急温补的两种情况，是因为体内寒邪已经很严重，毫无疑问需要紧急温补。
【攻下法】少阴病发病两三天，出现口燥咽干的，要紧急攻下，用大承气汤。少阴病自发腹泻，排出纯清色的水样便，心下部必定疼痛，口燥咽干的，要紧急攻下。（方剂同上）。少阴病到了六七天，腹部胀满且大便不通的，要紧急攻下。（方剂同上）。阳明病发热且汗出多的，要紧急攻下。（方剂同上）。伤寒病六七天，眼睛视物模糊不清，眼球转动不灵活，没有明显的表证或里证，大便困难，身体微有发热，要紧急攻下。（方剂同上）。发热不退，腹部胀满疼痛的，要紧急攻下。（方剂同上）。
【温补法】少阴病脉象沉细的，要紧急温补，用四逆汤。少阴病膈上有寒饮停滞，干呕，不能用吐法，要紧急温补，用四逆汤。
外在症状表现为伤寒，但诊察其脉象却是伤风，脉象浮而缓，所以称为“伤寒见风”，即看到了伤风的脉象。外在症状表现为怕冷多而发热少，心中不烦躁，手脚微微发凉，就是这种情况。
【解表法】伤寒兼见风邪，风邪伤害卫气，寒邪伤害营血。卫气受伤的用桂枝汤，营血受伤的用麻黄汤，营卫都受伤的，用大青龙汤。（如果有烦躁症状则用此方）。如果不烦躁，用桂枝麻黄各半汤。
外在症状表现为伤风，但诊察其脉象却是伤寒，脉象浮而紧的就是这种情况。其症状表现为怕风、发热且多烦躁，或者手脚微微温暖。
【解表法】伤风兼见寒邪，脉象类似桂枝汤证但没有汗出，病症类似麻黄汤证却反而烦躁，这是大青龙汤证。脉象缓且有汗出的，用桂枝汤。脉象紧且不烦躁的，用麻黄汤。
The term "urgent purgation" (Ji Xia) or "urgent warming" (Ji Wen) in Cold Damage (Shanghan, 伤寒) refers to situations where the disease progression is imminent and liable to transform; thus, it is termed "urgent," unlike other syndromes that may be treated with a more leisurely approach. The Shaoyin channel belongs to the Kidney and governs water metabolism. Symptoms such as dry mouth and throat indicate internal blazing of heat pathogens and the impending exhaustion of Kidney Water (Shen Shui, 肾水); therefore, urgent purgation is indicated. If accompanied by abdominal distension and constipation, this represents Earth (Spleen/Stomach) overacting on Water (Kidney), which also warrants urgent purgation. The Yangming channel belongs to the Stomach and Earth. Profuse sweating and intense heat necessitate urgent purgation to preserve Body Fluids (Jin Ye, 津液). Abdominal fullness and pain indicate excess in Earth, requiring urgent downward draining. In febrile diseases, unclear vision indicates death if the heat does not subside. Currently, if the eyeballs are stiff and unresponsive, the syndrome is critical, and urgent purgation is required. For the two Shaoyin syndromes requiring urgent warming, the internal cold is severe, leaving no doubt that urgent warming is necessary.
[Purgation] In Shaoyin disease, if dry mouth and throat appear within two to three days of onset, urgent purgation is indicated using Dachengqi Tang (Major Order the Qi Decoction). In Shaoyin disease, if spontaneous diarrhea consists of pure clear water, accompanied by pain in the epigastrium and dry mouth/throat, urgent purgation is indicated (Formula same as above). In Shaoyin disease, if after six or seven days there is abdominal distension and constipation, urgent purgation is indicated (Formula same as above). In Yangming disease, if there is fever and profuse sweating, urgent purgation is indicated (Formula same as above). In Cold Damage, after six or seven days, if the patient has unclear vision and stiff eyeballs, without obvious exterior or interior signs, but with difficult defecation and slight body heat, urgent purgation is indicated (Formula same as above). If fever persists with abdominal distension and pain, urgent purgation is indicated (Formula same as above).
[Warming] In Shaoyin disease, if the pulse is deep, urgent warming is indicated using Sini Tang (Frigid Extremities Decoction). In Shaoyin disease, if there is cold-fluid retention above the diaphragm causing dry retching, vomiting methods are contraindicated; urgent warming is indicated using Sini Tang.
When the external manifestations suggest Cold Damage, but the pulse diagnosis reveals Wind Injury, characterized by a floating and moderate pulse, it is termed "Cold Damage seeing Wind," indicating the presence of a Wind-injury pulse. The external symptoms include predominant chills with mild fever, absence of irritability, and slightly cold hands and feet.
[Exterior-Resolving Methods] When Cold Damage is complicated by Wind, Wind injures the Defensive Qi (Wei Qi, 卫气), while Cold injures the Nutritive Blood (Ying Xue, 营血). If only Defensive Qi is injured, Guizhi Tang (Cinnamon Twig Decoction) is used; if only Nutritive Blood is injured, Mahuang Tang (Ephedra Decoction) is used; if both are injured, Daqinglong Tang (Major Blue Green Dragon Decoction) is used (specifically when irritability is present). If there is no irritability, Guizhi Mahuang Banxia Tang (Half-and-Half Cinnamon Twig and Ephedra Decoction) is used.
When the external manifestations suggest Wind Injury, but the pulse diagnosis reveals Cold Damage, characterized by a floating and tight pulse. The symptoms include aversion to wind, fever, significant irritability, or slightly warm hands and feet.
[Exterior-Resolving Methods] When Wind Injury is complicated by Cold, the pulse resembles that of a Guizhi Tang pattern but without sweating, and the condition resembles a Mahuang Tang pattern but with paradoxical irritability; this is a Daqinglong Tang (Major Blue Green Dragon Decoction) pattern. If the pulse is moderate and there is sweating, use Guizhi Tang (Cinnamon Twig Decoction). If the pulse is tight and there is no irritability, use Mahuang Tang (Ephedra Decoction).