方
消风散 治诸风上攻，头目昏弦，背项强急，耳作蝉鸣，及皮
肤瘙痒，顽麻瘾疹，妇人血风头痛。
防风 荆芥 川芎 茯苓 人参 藿香 甘草（各一两） 羌活（一两
五钱） 蝉蜕 僵蚕 陈皮 浓朴（各五钱）
上为细末，每服三钱，清茶送下。
蝉蜕散 治饮酒后搔出紫血黄水，痛痒不一。
蝉蜕（去头、足） 薄荷（各等分）
上为末，每服二钱，酒调下。（一方用消风散一两，蝉蜕一两）
胡麻散 治脾肺风毒攻冲，遍身皮肤搔痒，或生疮疥瘾疹，浸淫糜烂，久而不瘥，面如虫行。
胡麻 苦参 何首乌 荆芥（各二两） 威灵仙 甘草（各一两）
上为细末，每服二钱，薄荷汤调下。
苦参丸 治心肺积热，脏腑蕴毒，攻于皮肤，发为疥癫，及成厉风，手足烂坏，眉毛脱落，并能调治。
苦参（四两） 荆芥穗（一两）
上为细末，炼蜜丸如桐子大。每服五六十丸，清茶送下。
脉
伤寒以浮、大、动、数、滑为阳，沉、涩、弱、弦、微为阴。其弦、紧，浮、滑、沉、涩六者，为残
贼脉，能为诸经作病。春弦，夏洪、秋毛、冬石、土缓，为四季之正脉；浮、沉、迟数
为客脉。左为人迎，右为气口。呼出心、肺为阳，吸入肝，肾为阴。一呼一吸为一息。寸口为阳，尺泽为阴，
中为关界。阳主气，阴主血。血为荣，气为卫。寒伤荣，风伤卫。所谓伤寒之病，从浅
入深，先以皮肤肌肉，次入肠胃筋骨。其阴阳，表里、寒热、虚实，俱在浮、中、沉三脉有力无力中分。有
力者为实、为阳、为热；无力者为虚、为阴，为寒。若浮、中、沉之不见，则委曲而求
之。若隐若见，则阴阳伏匿之脉也，三部皆然。杂病以弦为阳，伤寒以弦为阴，杂病以缓为弱，伤寒以缓为
和。伤寒以大为病进，以缓为邪退。缓为胃脉，有胃气曰生，无胃气曰死。伤寒病
中，脉贵有神。脉中有力，即为有神。神者，气血之先也。两手无脉曰双伏，一手无脉曰单伏。寸口阳脉中，
或见沉细者，但无力者，为阳中伏阴。尺部阴脉中，或见沉数者，为阴中伏阳。寸口数
大有力为重阳，尺部沉细无力为重阴。寸口细微如丝为脱阳，尺部
微而无力为脱阴。寸脉浮而有力，主寒邪、表实，宜汗；浮而无力，主风邪、表虚，宜实；尺脉沉而有力，主
阳邪在里为实，宜下；无力，主阴邪在里为虚，宜温，寸脉弱而无力，切忌汗下。初按
来疾去徐，名曰内虚外实；去疾来徐，名曰内实外虚。尺寸俱同名曰缓。缓者，和而生也。汗下后脉静者
生，躁乱身热者死。乃邪气胜也。如寒邪直中阴经，温之而脉来断续为歇止，正气脱而不复生
也。纯弦之脉名曰负，负者死。按之如解索者，名曰阴阳离，离者死。阴病见阳脉者生，阳病见阴脉者死。今
将浮、中、沉三脉下，注证治之法，使因脉以知证，缘证以明治；以此达彼，由粗入精，
亦可以为后学之窥鉴矣。
浮脉∶初排指于皮肤之上，轻手按之便得，曰浮。此为寒邪初入足太阳经，病在表之标，可发而去之。
虽然，其治法则有二焉，寒伤荣则无汗恶寒，风伤卫则自汗恶风。一通一塞；不可同也。
浮紧有力则无汗，恶寒，头项痛，腰脊强，发热，此为伤寒之表，宜发汗。冬时用麻黄汤，余三时
用羌活冲和汤。有渴加石膏、知母。
浮缓无力则有汗，恶风，头项痛，腰脊强，发热。此为伤风在表，宜和卫。冬时用桂枝汤，余三时
用加减冲和汤。腹痛，小建中汤。痛甚，桂枝加大黄汤。
中脉∶按至皮肤之下，肌肉之间，略重按之乃得。谓之半表半里。然亦有二焉，盖阳明、少阳二经，不
从标本从乎中也。长而有力，即微洪脉也，此为阳明在经，其证微有头痛，眼眶痛；鼻干不
得眠，发热无汗，用葛根解肌汤。若渴而有汗不解，或经汗过，渴不解者，白虎加人参汤。无渴不可服。此
药为大忌。
弦而数，此为少阳经脉，其证胸胁痛而耳聋，寒热，呕而口苦，用小柴胡汤。或两经合病，则脉弦而长，
此汤加葛根、芍药。缘胆无出入，有三禁，止宜和解表里耳。
沉脉∶重手按之，至肌肉之下，筋骨之间乃得，此为沉脉。然亦有二，阴阳寒热，俱在沉脉中分。若沉
而有力，为阳、为热；沉
而无力，为阴，为寒；沉数有力，则为阳明之本，表证罢而热入于里。恶寒头痛悉除，及觉怕热，欲揭衣被，
扬手掷足，谵语狂妄，躁渴，或潮热自汗，五、六日不大便，轻则大柴胡汤下之，重则六一顺气汤选用。
沉迟无力为寒。初病起，外证无头痛；无身热，便就怕寒，四肢厥冷，或腹痛吐泻。或口吐白沫，或流
冷涎，或战栗面如刀刮，引衣蜷卧，不渴，或手足指甲青，此为阴经自中其寒，非从阳经传
来，急温之，轻则理中汤，重则姜附汤、四逆汤之类。故经云∶发热恶寒发于阳，无热恶寒发于阴也。
证
夫伤寒者，冬时天气严寒，水冰地冻，而成杀厉之气。体虚之人，触犯之者，中而即病，名曰正伤寒。不即
病者，乃寒邪藏于肌肤之间，伏于荣卫之内，至春因温暖之气而发者，名曰温病。至夏因暑热之气而作者，
名曰热病。热重于温病也。虽曰伤寒，实为热病，热病乃汗病也。非时行之气，春应温而反寒，夏应热而
反凉，秋应凉而反热，冬应寒而反温。此非其时而有其气。故一岁之中，长幼病皆相似也。是时行不正之气，
非暴厉之气。暴病者，疫病也。疫病者，乃春分至秋分前，天有暴寒，皆为时行之寒疫也。又
有四时之正气者，春气温和，夏气暑热，秋气清凉，冬气凛冽。然正气亦能为病。春伤于风，夏必飧泄；夏
伤于暑，秋必疟痢；秋伤于湿，冬必咳嗽；冬伤于寒，春必温病。总曰伤寒。病自外入，或
入于阳，或入于阴，皆无定体。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，
邪气衰而不传自愈者；亦有不能再传者；或有间经而传者；或有传之二三经而止者，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；
有变证者；有脉变者；有取证不取脉者；有取脉不取证者；又有二阳，三阳同受而为合病者；或太阳、阳明先
后受而为并病者；有日传二经而为两感者。盖病有标本，治有逆从。若夫常病用常法，理固易知。设有感冒非时暴
寒，而误作正伤寒者，有劳力感寒，而误作真伤寒者，有直中阴经真寒证，而误作传经之热证者，有温热病而
误作正伤寒治者，有暑证而误作寒证者，有如狂而误作发狂者，有血证发黄而误作湿热发黄者，有蚊迹而误作
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，有痞满而误作结胸者，有心下硬痛，下利纯清水，而俗名为漏底，而治之以燥热药者，
有哕而误作干呕者，有并病而误作合病者，有正阳明腑病而误作阳明经病者，有太阳无脉而便认作死证者，
有里恶寒而误作表恶寒者，有表热而误作里热者，有阴极发躁而误作阳证者，有少阴病发热而误作太阳证者，
有标本全不晓者。此几件终世不相认者，比比皆然。胸中若不明脉识证，论方得法，但一概妄治，则杀人不
用刀耳。且如麻黄、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证，则误之甚矣。
又将传经之阴证，作直中阴经之阴证，误人多矣。若夫寒邪自三阳传次三阴之阴证，外虽厥逆，内有热邪耳。若
不发热，四肢厥冷而恶寒者，此则直中阴经之寒证也。盖先起三阳气分，传次三阴血分，则热入深矣。热入
既深，表虽厥冷，而内真热邪也。经云∶亢则害，承乃制。热极反兼寒化也。若先热后厥逆者，传经之阴证
也。经云∶热深厥亦深，热微厥亦微是也。故宜四逆散、大承气汤，看微、甚而治之。如其初病便厥，但寒
无热，此则直中阴经之寒证也。轻则理中汤，重则四逆汤辈以温之。经云∶发热恶寒者，发于阳也；无热恶
寒者，发于阴也。尚何疑哉。有病一经，已用热药，而又用寒药。如少阴证用白虎汤、四逆散寒药者；少
阴证用四逆汤、真武汤热药者。是知寒药治少阴，乃传经热证也；是知热药治
少阴，乃直中阴经之寒证也。辨名定体，验证用药，则治伤寒之法判然明矣。
伤寒汗、下、温之法，最不可轻。据脉以验证，问证而对脉。太阳者，阳证之表也；阳明者，阳证之里
也，少阳者，二阳三阴之间；太阴、少阴、厥阴，又居于里，总而谓之阴证也。发于阳，则太阳为之首；发
于阴，则少阴为之先。太阳恶寒而少阴亦恶寒，太阳之脉多浮，少阴之脉沉细，与其他证状亦自异也。发
热恶寒，身体疼痛；或自汗，或无汗，是为表证，可汗。不恶寒，反恶热，手掌心、腋下 而汗。口燥咽干，
壮热腹满，小便如常，不白不少，而大便闭硬，是为里证，可下。厥冷蜷默，自利烦躁而无身热
头痛，是为阴证，可温。单浮与浮洪、浮数、浮紧者，此表病之脉。滑、实、弦、紧，中间数盛者，此里病
之脉。在表者，邪传于荣卫之间；在里者，邪入于胃腑入内。胃腑而下，少阳居焉。若传次三
阴，则为邪气之脏矣。荣与卫居，为表也，亦均可汗也。然自汗者为伤风。风伤卫气，卫行脉外，其脉浮缓
而病尚浅，则以桂枝汤助阳而汗之轻。无汗者为伤寒。寒伤荣血，荣行脉中，其脉浮紧而病
稍深，则以麻黄汤助阳而汗之重。荣卫固为表也，胃腑亦可以为表也。然以腑脏而分表里，则在腑者谓之表，在
脏者谓之里。胃取诸腑、可以表言。若合荣卫脏腑而分之，则表者，荣卫之所行。里者，胃
腑之所主，而脏则又深于里者矣。审脉问证，辨名定经。真知其为表邪则汗之，真知其为里邪则下之；真知
其为阴病则温之。表有邪，则为阳虚阴盛，而发表之药温；里有邪，则为阴虚阳盛，而攻里之药寒；阴经
受邪，则为脏病，而温之药热。是三者，贵平得中，不则宁可不及，不可太过。得中者上也，不及者次也。
夫苟太过，则斯为下矣。盖得中者。如此而汗，如彼而下，又如彼而温。桂枝承气投之不瘥；姜附理中，发而
必中。重者用药紧，轻者用药微。不背阴阳，深合法度。故曰得中者上也。宁可不及者，证与脉，大同而
小异。名与证，似异而实同。当五分取汗，而三分之剂散之；当五分转下，而三分之剂导之；当纯刚温里，而
略温之剂扶持之。未可汗下者，与之和解；未可遽温者，且安其中。若犹未也，则增减于其间，细细而加
消详，徐徐而就条理。虽无遽安，亦无传变，故曰宁可不及者次也。太过者，粗工不知深浅，轻
举妄动者为之。或问证而不知脉，或执脉而不对证，或名实之不辨，或日数之为拘。是有汗下太早之失。甚者
诿曰∶不问阴阳，当汗而反下，则为痞、为结胸、为懊 ；当下而反汗，则为谵语、为亡阳动经、为下厥
上竭。至于阳厥似阴之类，但以刚剂投之，是以火济火，以致舌卷囊缩，烦乱可畏。性命至贵，可轻试哉？故
曰∶夫苟太过，则斯为下矣。大抵治伤寒有法，与他病不同，条例审的，药进病除，七剂少瘥，生死立判矣。
古人处方立论，曰可汗，曰可下，曰可温，曰和解，曰少与，曰急下，曰随证渗泄。与夫先温其里，乃发其
表，先解其表，乃攻其里。惟知者若网在纲，有条不紊，此固中者之事也。若班固所谓有病不服药。当得中医。
许仁则以为守过七日，最为得计。此非宁可不及之意乎。王叔和善脉，而且以承气为戒。初虞世善方，而论
伤寒一节，且谓麻黄、桂枝，非深于其道则莫之敢为。又非所以为太过者之戒乎？论而至此，则知古人之立论
甚严。如伤寒汗、下、温之法，固自有定论矣。经云∶伤寒六、七日，目中不了了，无表证，脉虽浮，亦
有可下者；少阴病二、三日，无表、里证，亦有可汗者。阴证四逆，法当用温。而四逆有柴胡、枳壳，此岂
属诬哉？曰∶医在九流之中，非圆机之士，不足与语也。何者？脉虽浮，而可下者，无表
里证，谓六、七日大便难也。藉使大便不难，其可轻下之乎？少阴病亦有可汗者，谓阴证初病，便属少阴，而
反发热。少阴本无热，今反发热者，是表犹未解，故用温药，微取其汗也。藉使身不发
热，其可轻汗之乎？四逆汤用姜附，四逆散用柴枳，一热一寒，并主厥逆，固不侔矣。然传经之邪，与
阴经受邪初病便厥者不同。故四逆散用药寒，主先阳而后阴也；四逆汤用药热，主阳不足而阴有余
也。其敢例视阴逆，一切温之乎？不特此耳，伤寒有始得病，其脉沉数，外证腹痛，口燥咽干，即为阳盛入
内之证。医当以下剂攻之，不可概以一、二日太阳而发表也。前所谓阴证伤寒，初病以来，便见脉沉，厥冷
恶寒，更无头痛，即是少阴受病之证。医当以干姜、附子辈温之，又不可概以三阴传次，先太阴而后少阴也。张
方剂
消风散：治疗各种风邪上攻，导致头目眩晕昏花，背部和颈部僵硬拘急，耳朵发出蝉鸣声，以及皮肤瘙痒、顽固性麻木和风团瘾疹，妇女血虚受风引起的头痛。
防风、荆芥、川芎、茯苓、人参、藿香、甘草（各一两），羌活（一两五钱），蝉蜕、僵蚕、陈皮、厚朴（各五钱）。
以上药物研成细末，每次服用三钱，用清茶送服。
蝉蜕散：治疗饮酒后搔抓皮肤出现紫血和黄水，疼痛和瘙痒程度不一。
蝉蜕（去掉头和足）、薄荷（各等分）。
以上药物研成细末，每次服用二钱，用酒调服。（另一种方子用消风散一两，蝉蜕一两）。
胡麻散：治疗脾肺风毒攻冲，全身皮肤瘙痒，或者生疮疥、风团瘾疹，浸淫糜烂，久治不愈，面部感觉像虫子爬行。
胡麻、苦参、何首乌、荆芥（各二两），威灵仙、甘草（各一两）。
以上药物研成细末，每次服用二钱，用薄荷汤调服。
苦参丸：治疗心肺积热，脏腑蕴藏毒素，毒素攻于皮肤，发为疥癣癞疾，甚至形成厉风（严重皮肤病），手足溃烂坏死，眉毛脱落，都能调理治疗。
苦参（四两），荆芥穗（一两）。
以上药物研成细末，用炼蜜制成梧桐子大小的药丸。每次服用五六十丸，用清茶送服。
脉诊
伤寒病中，浮、大、动、数、滑脉属于阳脉；沉、涩、弱、弦、微脉属于阴脉。其中弦、紧、浮、滑、沉、涩这六种脉象，被称为“残贼脉”，能够导致各条经络发病。春季脉弦，夏季脉洪大，秋季脉浮毛（轻浮如毛），冬季脉沉石（沉实如石），长夏季节脉缓，这是四季的正常脉象；浮、沉、迟、数是客脉（外感或临时变化的脉象）。左手寸口为人迎脉，右手寸口为气口脉。呼气时气血出于心、肺，属阳；吸气时气血入于肝、肾，属阴。一呼一吸称为一息。寸部属阳，尺部属阴，中间为关界。阳主气，阴主血。血为营气，气为卫气。寒邪损伤营气，风邪损伤卫气。所谓伤寒的病，是从浅入深发展，先在皮肤肌肉，然后传入肠胃筋骨。其中的阴阳、表里、寒热、虚实，都可以通过浮、中、沉三部脉的有力无力来区分。有力者为实、为阳、为热；无力者为虚、为阴、为寒。如果在浮、中、沉三部都摸不到脉象，就要细致曲折地寻找。如果脉象若隐若现，那就是阴阳伏匿的脉象，三部都是如此。杂病中以弦脉为阳，伤寒中以弦脉为阴；杂病中以缓脉为弱，伤寒中以缓脉为平和。伤寒病中，脉象大为病势进展，脉象缓为邪气退却。缓脉是胃气的表现，有胃气则生，无胃气则死。在伤寒病中，脉象贵在“有神”。脉中有力量，就是有神。神，是气血的先导。两手都摸不到脉象叫双伏，一只手摸不到脉象叫单伏。在寸口阳脉中，如果出现沉细且无力的脉象，这叫阳中伏阴。在尺部阴脉中，如果出现沉数有力的脉象，这叫阴中伏阳。寸口脉数大有力叫重阳，尺部脉沉细无力叫重阴。寸口脉细微如丝叫脱阳，尺部脉微弱无力叫脱阴。寸脉浮而有力，主寒邪、表实证，宜用发汗法；浮而无力，主风邪、表虚证，宜用补益固表法；尺脉沉而有力，主阳邪在里为实证，宜用泻下法；无力，主阴邪在里为虚证，宜用温补法。寸脉弱而无力，切忌使用发汗和泻下法。初按时脉搏来快去慢，名叫内虚外实；去快来慢，名叫内实外虚。尺寸两部脉象相同名叫缓。缓脉，是和缓而生机旺盛的表现。发汗或泻下后脉象安静者生，脉象躁乱身体发热者死，这是邪气胜过的表现。如果寒邪直接侵入阴经，温补后脉象断续出现歇止，这是正气脱失而不能复生的表现。纯弦的脉象名叫负，负的脉象主死。按之如解绳索般散乱无序的脉象，名叫阴阳离决，离决的主死。阴病见到阳脉者生，阳病见到阴脉者死。现在将浮、中、沉三部脉下的注证治之法列出，使医者能因脉而知证，缘证以定治法；以此通达彼理，由粗浅进入精微，也可以作为后学者的借鉴了。
浮脉：初时将手指排在皮肤之上，轻手按压即可得，叫做浮脉。这是寒邪刚初入足太阳经，病在表的标部，可以发汗祛除。虽然如此，其治疗方法有两种：寒伤营气则无汗恶寒，风伤卫气则自汗恶风。一通一塞，不可混同。
浮紧有力则无汗，恶寒，头项痛，腰脊强直，发热，这是伤寒的表证，宜发汗。冬季用麻黄汤，其他三个季节用羌活冲和汤。如果有口渴，加石膏、知母。
浮缓无力则有汗，恶风，头项痛，腰脊强直，发热。这是伤风在表，宜调和卫气。冬季用桂枝汤，其他三个季节用加减冲和汤。如果有腹痛，用小建中汤。疼痛剧烈，用桂枝加大黄汤。
中脉：按压至皮肤之下，肌肉之间，略重按才能得，叫做半表半里。然而也有两种情况，因为阳明、少阳两条经脉，不从标本而从乎中。脉长而有力，即微洪脉，这是阳明经在经，症状轻微头痛，眼眶痛；鼻干不得眠，发热无汗，用葛根解肌汤。如果口渴且有汗不解，或者经过发汗后，口渴仍不解的，用白虎加人参汤。没有口渴不可服用。此药是大忌。
脉弦而数，这是少阳经脉，症状胸胁痛且耳聋，寒热往来，呕吐且口苦，用小柴胡汤。或者是两经合病，则脉弦而长，此汤加葛根、芍药。因为胆腑没有出入之径，有三禁，只宜和解表里罢了。
沉脉：重手按压，至肌肉之下，筋骨之间才能得，这是沉脉。然而也有两种，阴阳寒热，都在沉脉中区分。如果沉而有力，为阳、为热；沉而无力，为阴、为寒；沉数有力，则是阳明之本，表证已罢而热入于里。恶寒头痛全部消除，并且觉得怕热，想要掀开衣被，扬手掷足，说胡话狂妄，烦躁口渴，或者潮热自汗，五六天不大便，轻则用大柴胡汤泻下，重则选用六一顺气汤。
沉迟无力为寒。初起病时，外证无头痛；无身热，就怕冷，四肢厥冷，或者腹痛吐泻。或者口吐白沫，或者流冷涎，或者战栗面色如刀刮，拉过衣服蜷缩而卧，不渴，或者手足指甲青紫，这是阴经直接感受寒邪，不是从阳经传来，急需温补，轻则用理中汤，重则用姜附汤、四逆汤之类。所以经文说：发热恶寒发于阳，无热恶寒发于阴。
证候
所谓伤寒，是冬天天气严寒，水冰地冻，形成的杀厉之气。体质虚弱的人，触犯这种寒气，中了即病，名叫正伤寒。没有立即发病的，是寒邪藏在肌肤之间，伏于营卫之内，到了春天因为温暖之气而发作的，名叫温病。到了夏天因为暑热之气而发作的，名叫热病。热病比温病更重。虽然叫伤寒，实际上是热病，热病也就是汗病（指通过发汗治疗的疾病，此处语境似指热病性质）。非时行之气，春天应该温暖反而寒冷，夏天应该炎热反而凉爽，秋天应该凉爽反而炎热，冬天应该寒冷反而温暖。这不是在那个时候却有那样的气候。所以一年之中，老少生病都相似。这是时行不正之气，不是暴厉之气。暴病者是疫病。疫病，是从春分到秋分前，天有暴寒，都是时行的寒疫。又有四时的正气，春气温和，夏气暑热，秋气清凉，冬气凛冽。然而正气也能致病。春天伤于风，夏天必定飧泄（完谷不化的腹泻）；夏天伤于暑，秋天必定疟痢；秋天伤于湿，冬天必定咳嗽；冬天伤于寒，春天必定温病。总称为伤寒。病从外入，或入于阳经，或入于阴经，都没有固定的形体。不仅仅是开始于太阳，结束于厥阴的论述。或者有从太阳开始，每天传变一条经，六天传至厥阴，邪气衰败而不继续传变自愈的；也有不能再传变的；或者有跳过一条经而传变的；或者有传变到二三经就停止的；或者有始终只在一条经的；或者有越过一条经而传变的；或者有初入太阳，不产生郁热，就直接进入少阴而成真阴证的；或者有直接中于阴经而成寒证的；有变证的；有脉象变化的；有取证不取脉的；有取脉不取证的；又有二阳、三阳同时受邪而为合病的；或者太阳、阳明先后受邪而为并病的；有一天传变两条经而为两感的。大概病有标本，治疗有逆从。如果是常病用常法，道理固然容易知晓。假设有感冒非时暴寒，而误作正伤寒治疗的，有劳力感寒，而误作真伤寒治疗的，有直接中于阴经的真寒证，而误作传经的热证治疗的，有温热病而误作正伤寒治疗的，有暑证而误作寒证治疗的，有如狂而误作发狂治疗的，有血证发黄而误作湿热发黄治疗的，有蚊迹而误作发斑治疗的，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，有痞满而误作结胸治疗的，有心下硬痛，下利纯清水，而俗名为漏底，而用燥热药治疗的，有哕而误作干呕治疗的，有并病而误作合病治疗的，有正阳明腑病而误作阳明经病治疗的，有太阳无脉而便认作死证的，有里恶寒而误作表恶寒治疗的，有表热而误作里热治疗的，有阴极发躁而误作阳证治疗的，有少阴病发热而误作太阳证治疗的，有对标本全不了解的。这几类终身不相认识的情况，比比皆是。胸中如果不明白脉识证，论方得法，只是一概妄治，那就是不用刀杀人。况且如麻黄、桂枝两个汤，张仲景设立治疗冬天正伤寒的方子，现在的人通治非时暴寒温暑之证，那就错得很厉害了。又将传经的阴证，当作直中阴经的阴证，误导人很多。如果寒邪从三阳传次三阴的阴证，外面虽然四肢厥逆，里面却有热邪。如果不发热，四肢厥冷而恶寒的，这才是直中阴经的寒证。大概先起于三阳气分，传次三阴血分，则热入深了。热入既深，表面虽然厥冷，而内部真是热邪。经文说：亢则害，承乃制。热极反兼寒化。如果先热后厥逆的，是传经的阴证。经文说：热深厥亦深，热微厥亦微是也。所以宜用四逆散、大承气汤，看轻重而治疗。如其初病就厥冷，只有寒没有热，这才是直中阴经的寒证。轻则用理中汤，重则用四逆汤辈以温补。经文说：发热恶寒者，发于阳也；无热恶寒者，发于阴也。还有什么可疑的呢？有病在一经，已经用了热药，而又用寒药。如少阴证用白虎汤、四逆散寒药的；少阴证用四逆汤、真武汤热药的。由此可知寒药治少阴，乃是传经热证；由此可知热药治少阴，乃是直中阴经的寒证。辨别名称确定体性，验证症状用药，那么治疗伤寒的方法就判然明了了。
伤寒汗、下、温的方法，最不可轻视。依据脉象验证症状，询问症状对应脉象。太阳，是阳证的表；阳明，是阳证的里；少阳，是二阳三阴之间；太阴、少阴、厥阴，又居于里，总称为阴证。发于阳，则以太阳为首；发于阴，则以少阴为先。太阳恶寒而少阴也恶寒，太阳的脉多浮，少阴的脉沉细，与其他证状自然不同。发热恶寒，身体疼痛；或者自汗，或者无汗，这是表证，可发汗。不恶寒，反恶热，手掌心、腋下出汗。口燥咽干，壮热腹满，小便正常，不多不少，而大便闭硬，这是里证，可泻下。厥冷蜷缩沉默，自利烦躁而无身热头痛，这是阴证，可温补。单浮与浮洪、浮数、浮紧的，这是表病的脉。滑、实、弦、紧，中间数盛的，这是里病的脉。在表的，邪气传于荣卫之间；在里的，邪气入于胃腑入内。胃腑以下，少阳居焉。如果传次三阴，则为邪气之脏了。荣与卫居，为表，也都可发汗。然而自汗的是伤风。风伤卫气，卫行脉外，其脉浮缓而病尚浅，则以桂枝汤助阳而轻发其汗。无汗的是伤寒。寒伤荣血，荣行脉中，其脉浮紧而病稍深，则以麻黄汤助阳而重发其汗。荣卫固然是表，胃腑也可以说是表。然而以腑脏分表里，则在腑的叫表，在脏的叫里。胃取诸腑，可以说表。如果合荣卫脏腑而分，则表，是荣卫所行。里，是胃腑所主，而脏又是更深于里的。审脉问证，辨名定经。真正知道它是表邪则汗之，真正知道它是里邪则下之；真正知道它是阴病则温之。表有邪，则为阳虚阴盛，而发表的药温；里有邪，则为阴虚阳盛，而攻里的药寒；阴经受邪，则为脏病，而温的药热。这三者，贵在平得适中，否则宁可不及，不可太过。得中的是上策，不及的是次策。如果太过，这就是下策了。大概得中的，如此而汗，如彼而下，又如彼而温。桂枝承气投之不瘥；姜附理中，发而必中。重的用药紧，轻的用藥微。不背阴阳，深合法度。所以说得中的是上策。宁可不及的，证与脉，大同而小异。名与证，似异而实同。当五分取汗，而三分之剂散之；当五分转下，而三分之剂导之；当纯刚温里，而略温之剂扶持之。不可汗下的，给它和解；不可遽温的，暂且安其中。如果还是不行，则在中间增减，细细而加消详，徐徐而就条理。虽然没有立刻安宁，也没有传变，所以说宁可不及的是次策。太过的，是粗工不知深浅，轻举妄动者为之。有人问证而不知脉，或执脉而不对证，或名实之不辨，或日数之为拘。这是有汗下太早的过失。严重的推诿说：不问阴阳，当汗而反下，则为痞、为结胸、为懊憹；当下而反汗，则为谵语、为亡阳动经、为下厥上竭。至于阳厥似阴之类，但以刚剂投之，是以火济火，以致舌卷囊缩，烦乱可畏。性命至贵，可轻试哉？所以说如果太过，这就是下策了。大体上治疗伤寒有法，与其他病不同，条例审确，药进病除，七剂少差，生死立判矣。古人处方立论，曰可汗，曰可下，曰可温，曰和解，曰少与，曰急下，曰随证渗泄。与夫先温其里，乃发其表，先解其表，乃攻其里。只有智者如网在纲，有条不紊，这确实是中策之事。如班固所说有病不服药，当得中医。许仁则认为守过七日，最为得计。这不是宁可不及的意思吗？王叔和善于脉，而且以承气为戒。初虞世善于方，而论伤寒一节，且谓麻黄、桂枝，非深于其道则莫之敢为。又不是给太过者之戒吗？论而至此，则知古人之立论甚严。如伤寒汗、下、温之法，固自有定论矣。经文说：伤寒六、七日，目中不了了，无表证，脉虽浮，亦有可下的；少阴病二、三日，无表、里证，亦有可汗的。阴证四逆，法当用温。而四逆有柴胡、枳壳，这难道是诬蔑吗？曰：医在九流之中，非圆机之士，不足与语也。何者？脉虽浮，而可下的，无表里证，谓六、七日大便难也。假如大便不难，其可轻下之乎？少阴病亦有可汗的，谓阴证初病，便属少阴，而反发热。少阴本无热，今反发热者，是表犹未解，故用温药，微取其汗也。假如身不发热，其可轻汗之乎？四逆汤用姜附，四逆散用柴枳，一热一寒，并主厥逆，固不侔矣。然而传经的邪，与阴经受邪初病便厥的不同。所以四逆散用药寒，主先阳而后阴也；四逆汤用药热，主阳不足而阴有余也。其敢例视阴逆，一切温之乎？不只这样，伤寒有始得病，其脉沉数，外证腹痛，口燥咽干，即为阳盛入内之证。医当以下剂攻之，不可概以一、二日太阳而发表也。前所谓阴证伤寒，初病以来，便见脉沉，厥冷恶寒，更无头痛，即是少阴受病之证。医当以干姜、附子辈温之，又不可概以三阴传次，先太阴而后少阴也。张
Formulas
Xiaofeng San (Wind-Dispersing Powder): Treats various wind pathogens attacking upward, causing dizziness and blurred vision, stiffness and tension in the back and neck, tinnitus sounding like cicadas, as well as skin itching, stubborn numbness, and urticaria. It also treats headaches caused by blood deficiency and wind exposure in women.
Fangfeng (Saposhnikoviae Radix), Jingjie (Schizonepetae Spica), Chuanxiong (Ligustici Chuanxiong Rhizoma), Fuling (Poria), Renshen (Ginseng Radix et Rhizoma), Huoxiang (Agastaches Herba), Gancao (Glycyrrhizae Radix et Rhizoma) (each 1 liang), Qianghuo (Notopterygii Rhizoma et Radix) (1 liang 5 qian), Chantui (Cicadae Periostracum), Jiangcan (Bombyx Batryticatus), Chenpi (Citri Reticulatae Pericarpium), Houpo (Magnoliae Officinalis Cortex) (each 5 qian).
Grind the above herbs into a fine powder. Take 3 qian each time, swallowed with clear tea.
Chantui San (Cicadae Periostracum Powder): Treats purple blood and yellow fluid oozing from scratching after drinking alcohol, with varying degrees of pain and itching.
Chantui (Cicadae Periostracum, remove head and feet), Bohe (Menthae Haplocalycis Herba) (equal parts).
Grind the above into powder. Take 2 qian each time, mixed with wine. (Another prescription uses Xiaofeng San 1 liang and Chantui 1 liang).
Huma San (Sesami Indici Fructus Powder): Treats wind-toxin attacking the Spleen and Lungs, causing whole-body skin itching, or sores, scabies, and urticaria that exude and erode, persisting for a long time without healing, with a sensation on the face like insects crawling.
Huma (Sesami Indici Fructus), Kushen (Sophorae Flavescentis Radix), Heshouwu (Polygoni Multiflori Radix), Jingjie (Schizonepetae Spica) (each 2 liang), Weilingxian (Salviae Miltiorrhizae Radix et Rhizoma - *Note: Standard TCM uses Salvia for Weilingxian in some contexts but traditionally Notopterygium or others; here likely refers to standard herb*), Gancao (Glycyrrhizae Radix et Rhizoma) (each 1 liang).
Grind the above into a fine powder. Take 2 qian each time, mixed with Mint Decoction.
Kushen Wan (Sophorae Flavescentis Radix Pill): Treats accumulated heat in the Heart and Lungs, toxin accumulation in the Zang-Fu organs, attacking the skin, manifesting as scabies and leprosy-like conditions, even forming severe dermatological diseases (Li Feng), with rotting and necrosis of hands and feet, and loss of eyebrows. It can regulate and treat these conditions.
Kushen (Sophorae Flavescentis Radix) (4 liang), Jingjiesui (Schizonepetae Spica) (1 liang).
Grind the above into powder, mix with refined honey to make pills the size of tung tree seeds. Take 50-60 pills each time, swallowed with clear tea.
Pulse Diagnosis
In Shanghan (Cold Damage) disease, Fu (Floating), Da (Large), Dong (Surging), Shuo (Rapid), and Hua (Slippery) pulses are Yang pulses; Chen (Deep), Se (Choppy), Ruo (Weak), Xian (Wiry), and Wei (Fine) pulses are Yin pulses. Among these, Xian (Wiry), Jin (Tight), Fu (Floating), Hua (Slippery), Chen (Deep), and Se (Choppy) are called "Residual and Hostile Pulses" (Can Ze Mai), which can cause disease in various meridians. In Spring, the pulse is Wiry; in Summer, it is洪 (Hong/Large); in Autumn, it is Mao (Feather-like/Floaty); in Winter, it is Shi (Stone-like/Deep); and in the late summer season (Earth), it is Huan (Moderate). These are the normal pulses of the four seasons. Fu (Floating), Chen (Deep), Chi (Slow), and Shuo (Rapid) are Guest Pulses (Ke Mai). The left Cun Kou is Ren Ying Pulse, and the right Cun Kou is Qi Kou Pulse. Exhalation relates to Heart and Lung (Yang); inhalation relates to Liver and Kidney (Yin). One exhalation and one inhalation constitute one Xi (breath). Cun (Inch) position is Yang, Chi (Cubit) position is Yin, and Guan (Gate) is the boundary between them. Yang governs Qi, and Yin governs Blood. Blood is Ying (Nutritive) Qi, and Qi is Wei (Defensive) Qi. Cold pathogen damages Ying, and Wind pathogen damages Wei. The disease of Shanghan progresses from shallow to deep, starting in the skin and muscles, then entering the stomach, intestines, sinews, and bones. The Yin/Yang, Exterior/Interior, Cold/Heat, and Deficiency/Excess are distinguished by the strength or weakness of the pulse at the Floating, Middle, and Deep levels. Strength indicates Excess, Yang, and Heat; weakness indicates Deficiency, Yin, and Cold. If the pulse is not felt at Floating, Middle, or Deep levels, seek it carefully. If the pulse is faint or intermittent, it is a Hidden Yin-Yang pulse, appearing similarly in all three positions. In miscellaneous diseases, Wiry is Yang; in Shanghan, Wiry is Yin. In miscellaneous diseases, Moderate is Weak; in Shanghan, Moderate is Harmonious. In Shanghan, Large indicates disease progression, while Moderate indicates pathogen retreat. Moderate is the Stomach pulse; having Stomach Qi means life, lacking it means death. In Shanghan disease, the pulse values "Shen" (Spirit). Strength in the pulse constitutes Shen. Shen is the precursor of Qi and Blood. Absence of pulse in both hands is called Double Fu (Hidden); absence in one hand is Single Fu. In the Yang pulse of the Cun position, if a Deep and Fine pulse appears and is weak, it is called Yin Hidden within Yang. In the Yin pulse of the Chi position, if a Deep and Rapid pulse appears, it is called Yang Hidden within Yin. A Rapid and Large pulse with strength at Cun is Double Yang; a Deep and Fine pulse without strength at Chi is Double Yin. A Fine pulse like a thread at Cun is Yang Collapse; a Weak and powerless pulse at Chi is Yin Collapse. A Floating and strong pulse at Cun indicates Cold Pathogen and Exterior Excess, suitable for Sweating; a Floating and weak pulse indicates Wind Pathogen and Exterior Deficiency, suitable for Tonifying/Solidifying; a Deep and strong pulse at Chi indicates Yang Pathogen in Interior Excess, suitable for Purging; a weak pulse indicates Yin Pathogen in Interior Deficiency, suitable for Warming. A Weak and powerless pulse at Cun strictly forbids Sweating and Purging. At initial palpation, if the pulse comes fast and goes slow, it is called Internal Deficiency and External Excess; if it goes fast and comes slow, it is called Internal Excess and External Deficiency. If Cun and Chi pulses are identical, it is called Moderate. Moderate implies harmony and vitality. After sweating or purging, if the pulse becomes quiet, there is life; if it is restless and the body is hot, there is death, indicating pathogen superiority. If Cold Pathogen directly invades the Yin meridians, and warming results in an intermittent pulse with pauses, it indicates collapse of Zheng Qi (Upright Qi) without recovery. A purely Wiry pulse is called Fu (Negative), indicating death. A pulse felt like untying a rope is called Separation of Yin and Yang, indicating death. Yin disease showing Yang pulse indicates life; Yang disease showing Yin pulse indicates death. Below are the methods for diagnosing and treating based on the Floating, Middle, and Deep pulses, allowing practitioners to know the syndrome from the pulse and determine treatment from the syndrome, progressing from coarse to refined, serving as a guide for students.
Fu (Floating) Pulse: Placing fingers lightly on the skin, obtaining the pulse with light pressure is called Floating. This indicates Cold Pathogen has just entered the Foot Taiyang Meridian, affecting the superficial aspect of the Exterior, treatable by Sweating. However, there are two treatment approaches: Cold damaging Ying causes no sweat and aversion to cold; Wind damaging Wei causes spontaneous sweating and aversion to wind. They differ significantly.
A Floating and Tight pulse with strength indicates no sweat, aversion to cold, headache and stiff neck, stiff waist and spine, and fever. This is Exterior Syndrome of Shanghan, suitable for Sweating. In Winter, use Mahuang Tang (Ephedra Decoction); in other seasons, use Qianghuo Chonghe Tang. Add Shigao (Gypsum) and Zhimu (Anemarrhenae Rhizoma) if thirsty.
A Floating and Moderate pulse without strength indicates sweating, aversion to wind, headache and stiff neck, stiff waist and spine, and fever. This is Exterior Syndrome of Wind Strike, suitable for Harmonizing Wei. In Winter, use Guizhi Tang (Cinnamon Twig Decoction); in other seasons, use Jiajian Chonghe Tang. For abdominal pain, use Xiao Jianzhong Tang. For severe pain, use Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction plus Rheum).
Zhong (Middle) Pulse: Pressing below the skin into the muscles, requiring slightly heavier pressure to obtain, is called Half-Exterior Half-Interior. There are two types here, as the Yangming and Shaoyang meridians follow the Middle rather than the Root or Branch. A Long and strong pulse, slightly Hong (Large), indicates Yangming Meridian involvement. Symptoms include mild headache, eye socket pain, dry nose, insomnia, fever, and no sweat. Use Gegen Ji Ji Tang (Kudzu Muscle-Releasing Decoction). If thirsty with sweating that does not resolve, or if thirst persists after sweating, use Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction). Do not use if not thirsty; this medicine is a major contraindication.
A Wiry and Rapid pulse indicates Shaoyang Meridian involvement. Symptoms include hypochondriac pain and deafness, alternating chills and fever, vomiting, and bitter taste. Use Xiaochaihu Tang (Minor Bupleurum Decoction). If both meridians are involved simultaneously, the pulse is Wiry and Long; add Gegen and Shaoyao to this formula. Since the Gallbladder has no direct exit/entry, there are three prohibitions, and only Harmonizing Exterior and Interior is appropriate.
Chen (Deep) Pulse: Pressing heavily until below the muscles into the sinews and bones to obtain the pulse is called Deep. There are two types here, distinguishing Yin/Yang and Cold/Heat.
If Deep and strong, it is Yang and Heat; if Deep and weak, it is Yin and Cold.
A Deep, Rapid, and strong pulse indicates the root of Yangming, where Exterior symptoms have resolved and Heat has entered the Interior. Aversion to cold and headache disappear, accompanied by fear of heat, desire to throw off covers, waving hands and kicking feet, delirium, mania, restlessness, thirst, tidal fever, spontaneous sweating, or constipation for 5-6 days. Mild cases use Dachaihu Tang (Major Bupleurum Decoction) to purge; severe cases select Liuyi Shunqi Tang.
A Deep, Slow, and weak pulse indicates Cold. Early onset with no external headache or fever, but fear of cold, cold limbs, abdominal pain, vomiting, and diarrhea. Or white foam from mouth, cold saliva, shivering, face feeling scraped, curling up under clothes, no thirst, or blue fingernails/toes. This is Cold directly invading the Yin meridians, not transmitted from Yang meridians. Urgently warm with Lizhong Tang (Regulate the Middle Decoction) for mild cases, or Jiangfu Tang (Ginger and Aconite Decoction) and Sini Tang (Four Reversal Decoction) for severe cases. As the classic states: Fever with aversion to cold originates in Yang; no fever with aversion to cold originates in Yin.
Syndromes
Shanghan refers to the killing and harsh qi formed during winter when weather is severely cold and water freezes. Those with weak constitutions who contract this qi fall ill immediately, called Zheng Shanghan (True Cold Damage). Those who do not fall ill immediately harbor the Cold Pathogen between skin and muscles, hidden within Ying and Wei, manifesting in spring due to warmth, called Wenbing (Warm Disease). Manifesting in summer due to summer heat is called Reb ing (Heat Disease), which is more severe than Warm Disease. Although called Shanghan, it is essentially Heat Disease, which involves sweating. Non-seasonal qi occurs when Spring should be warm but is cold, Summer should be hot but is cool, Autumn should be cool but is hot, and Winter should be cold but is warm. This is having the qi out of season. Thus, people of all ages suffer similarly throughout the year. This is irregular seasonal qi, not violent epidemic qi. Violent illness is Epidemic Disease. Epidemic disease occurs from Spring Equinox to before Autumn Equinox, where sudden cold creates seasonal Cold Epidemics. There is also the regular qi of the four seasons: Spring is mild, Summer is hot, Autumn is cool, Winter is biting. However, regular qi can also cause disease. Wind injury in Spring leads to undigested stool diarrhea in Summer; Summer heat injury leads to malaria and dysentery in Autumn; Dampness injury in Autumn leads to cough in Winter; Cold injury in Winter leads to Warm Disease in Spring. All are collectively called Shanghan. Diseases enter from outside, either into Yang or Yin meridians, without fixed form. It is not merely starting at Taiyang and ending at Jueyin. Some start at Taiyang, transmitting one meridian per day, reaching Jueyin on the sixth day, where pathogen declines and self-heals; some cannot transmit further; some skip meridians; some stop after 2-3 meridians; some stay in one meridian; some skip meridians; some enter Shaoyin directly from Taiyang without郁热 (stagnant heat), becoming True Yin Syndrome; some directly strike Yin meridians becoming Cold Syndrome; there are transformed syndromes, pulse changes, taking symptoms over pulse, taking pulse over symptoms, combined diseases of two or three Yang meridians, concurrent diseases of Taiyang and Yangming, and double infections transmitting two meridians daily. Diseases have root and branch; treatments have contrary and conforming approaches. Regular diseases use regular methods, which are easy to understand. However, mistaking non-seasonal sudden cold for True Shanghan, labor-induced cold for True Shanghan, direct Yin Cold for Transmitted Heat, Warm Disease for True Shanghan, Summerheat for Cold, mania-like state for Mania, blood-stain jaundice for Damp-Heat Jaundice, mosquito bites for Macules, Yin blood disturbance for Epistaxis, delirium for Mania, solitary speech for Zhengsheng (feeble speech), post-coital relapse in women for Yin-Yang Exchange, shortness of breath for Asthma, fullness for Chest Bind, epigastric hardness with pure watery diarrhea (Lou Di) treated with drying-hot medicines, hiccups for Dry Vomiting, concurrent disease for Combined disease, Yangming Fu disease for Yangming Jing disease, Taiyang pulseless condition for Death Syndrome, interior aversion to cold for exterior aversion to cold, exterior heat for interior heat, extreme Yin agitation for Yang syndrome, Shaoyang fever for Taiyang syndrome, and ignorance of root/branch—all these lifelong misidentifications are common. Without understanding pulse and syndrome differentiation and correct formula application, blind treatment kills without a knife. For instance, Mahuang Tang and Guizhi Tang were established by Zhang Zhongjing for Winter True Shanghan, yet modern practitioners use them indiscriminately for non-seasonal cold, heat, and summerheat, causing great error. Mistaking Transmitted Yin Syndrome for Direct Strike Yin Syndrome misleads many. If Cold transmits from Three Yang to Three Yin Yin Syndromes, exterior cold limbs may exist alongside interior Heat. If there is no fever, only cold limbs and aversion to cold, it is Direct Strike Yin Cold. Heat entering deeply from Qi level to Blood level causes true interior Heat despite cold extremities. As stated: Extreme heat mimics cold transformation. Preceding heat followed by reversal is Transmitted Yin Syndrome ("Deep heat causes deep reversal"). Treat with Sini San or Dachengqi Tang based on severity. Initial cold limbs without heat indicate Direct Strike Yin Cold; treat with Lizhong Tang or Sini Tang. Differentiating names and natures, verifying symptoms and using medicine clarifies Shanghan treatment.
Sweating, Purging, and Warming methods in Shanghan must not be used lightly. Verify syndrome by pulse, match pulse to symptoms. Taiyang is Exterior of Yang; Yangming is Interior of Yang; Shaoyang is between Two Yang and Three Yin; Taiyin, Shaoyin, Jueyin are Interior, collectively Yin Syndromes. Originating in Yang starts with Taiyang; originating in Yin starts with Shaoyin. Both have aversion to cold, but Taiyang pulse is Floating, Shaoyin is Deep and Fine, and symptoms differ. Fever, aversion to cold, body pain, with or without sweat, is Exterior Syndrome, treatable by Sweating. No aversion to cold, aversion to heat, sweating in palms/armpits, dry mouth/throat, high fever, abdominal fullness, normal urine, constipation/hard stool is Interior Syndrome, treatable by Purging. Cold limbs, curling, silent, spontaneous diarrhea, restlessness, no fever/headache is Yin Syndrome, treatable by Warming. Floating, Floating-Hong, Floating-Rapid, Floating-Tight are Exterior pulses. Slippery, Full, Wiry, Tight, Rapid are Interior pulses. Exterior pathogens affect Ying-Wei; Interior pathogens enter Stomach/Fu organs. Below Stomach is Shaoyang. Transmission to Three Yin affects Zang organs. Ying-Wei are Exterior, treatable by Sweating. Spontaneous sweat is Wind Strike (Wind damages Wei, Wei moves outside vessels, pulse Floating-Moderate, shallow disease, use Guizhi Tang to gently assist Yang and sweat). No sweat is Cold Damage (Cold damages Ying, Ying moves inside vessels, pulse Floating-Tight, deeper disease, use Mahuang Tang to heavily assist Yang and sweat). While Ying-Wei are Exterior, Fu organs can also be considered Exterior. Dividing by Zang-Fu, Fu is Exterior, Zang is Interior. Stomach represents Fu and can be called Exterior. Combining Ying-Wei and Zang-Fu, Exterior is Ying-Wei domain; Interior is Stomach domain; Zang is deeper Interior. Examine pulse and symptoms, differentiate name and meridian. Know Exterior pathogen -> Sweat; know Interior pathogen -> Purge; know Yin disease -> Warm. Exterior pathogen implies Yang Deficiency/Yin Excess, so Exterior-releasing medicines are Warm. Interior pathogen implies Yin Deficiency/Yang Excess, so Interior-purging medicines are Cold. Yin meridian pathogen implies Zang disease, so Warming medicines are Hot. Balance is key; better insufficient than excessive. Balanced is best; insufficient is second; excessive is worst. Balanced treatment follows specific protocols. Heavy cases use strong meds, light cases use mild meds, adhering to Yin-Yang principles. Better insufficient: When symptoms/pulses are similar but slightly different, or names/syndromes seem different but are same, use partial doses (e.g., 3/5 dose for sweating/purging, slight warming for pure warming). If not ready for sweating/purging, harmonize; if not ready for warming, stabilize middle. Adjust gradually. Though not instantly cured, transmission is prevented. Better insufficient is second. Excessive treatment is done by crude physicians who ignore depth, act rashly, confuse pulse/symptoms, or fixate on days. This leads to premature sweating/purging errors. Severe cases result in Pi (Glomus), Jie Xiong (Chest Bind), Ao Nan (Distress), delirium, Yang collapse, lower reversal/upper exhaustion. Treating Yang Reversal resembling Yin with hot medicines adds fire to fire, causing tongue retraction and testicular contraction. Life is precious; do not risk it lightly. Excessive treatment is worst. Shanghan treatment differs from other diseases; precise rules lead to cure within seven doses. Ancients prescribed: Sweating, Purging, Warming, Harmonizing, Small Doses, Emergency Purging, Symptom-based Drainage. Or Warm Interior first then Release Exterior, or Release Exterior first then Attack Interior. Only the wise manage this systematically. Ban Gu said "Not taking medicine when sick achieves the Medium Doctor." Xu Renze said waiting past seven days is best. This aligns with "Better Insufficient." Wang Shuhe excelled in pulses but warned against Chengqi. Chu Yushi excelled in formulas but warned that Mahuang/Guizhi require deep understanding. Ancient theories are strict. Classics state: Shanghan 6-7 days, unclear vision, no Exterior syndrome, even if Floating pulse, may be purged. Shaoyin 2-3 days, no Exterior/Interior signs, may be sweated. Yin Syndrome Sini requires Warming. But Sini includes Chaihu/Zhiqiao (Cold/Harmonizing) vs Sini Tang (Hot/Warming). Physicians must be versatile. Floating pulse purgable means no Exterior/Interior signs, just difficult bowel movement after 6-7 days. If bowels are not difficult, do not purge lightly. Shaoyin sweatable means Yin syndrome initially involving Shaoyin with fever (unusual for Shaoyin), indicating unresolved Exterior, so warm medicine gently induces sweat. If no fever, do not sweat lightly. Sini Tang uses Ginger/Aconite (Hot); Sini San uses Bupleurum/Zhiqiao (Cold). Both treat reversal, but for different causes: Transmitted Heat vs Primary Yin Cold. Do not treat all Yin reversal with warming. Also, early Shanghan with Deep-Rapid pulse, abdominal pain, dry mouth/throat indicates Yang Excess entering Interior. Purge, do not release Exterior based on day count. Previous Yin Shanghan with Deep pulse, cold limbs, aversion to cold, no headache indicates Shaoyin disease. Warm with Ginger/Aconite, do not assume sequential transmission from Taiyin to Shaoyin. Zhang