凡伤寒瘟疫，表证初感，速宜取汗，不可迟也。故仲景曰∶凡发汗服汤药，其方虽言日
三服，若病剧不解，当半日中尽三服。如服一剂，病证犹在，当复作本汤服之。至有不肯汗
出者，服三剂乃解。若汗不能出者，死病也。此所谓汗不宜迟也。然取汗之法，又当察其元
气、病气之虚实，若忽尔暴病，表证已具，而元气未亏者，但以辛平之剂，直散之可也。若
兼杂证，则当察其寒热温凉，酌宜而治，不得但知发散也。又若身虽大热，表证全具，而脉
见虚弱者，必不易汗，此即当详察补虚法，酌而治之。若不知标本，而概行强散，营竭则死。
一、伤寒之宜平散者，以其但有外证，内无寒热，而且元气无亏也，宜以正柴胡饮为
主治。此外如十神汤、参苏饮，皆可酌用。若病在阳明者，宜升麻葛根汤。若感四时瘟疫，
而身痛发热，及烟瘴之气者，宜败毒散，或荆防败毒散。若病在三阳，而头痛鼻塞，项强身
痛，咳嗽者，宜神术散。若伤风兼寒，而发热咳嗽者，宜柴陈煎，或金沸草散。甚者，小青
龙汤。
一、伤寒之宜温散者，以其寒邪外盛，而内无热证，及元气无亏而气清受寒者，皆可从
温直散之，宜二柴胡饮为最当。若寒甚表实者，惟麻桂饮为最妙，毋疑畏也。此外如五积散
、麻黄汤、桂枝汤、小青龙汤、葛根汤、圣散子之类，皆可酌用。
一、伤寒之宜凉散者，以其外热里亦热，必脉证俱阳，而烦渴喜冷，及元气强实者，乃
可兼凉兼散，宜一柴胡饮为先。或九味羌活汤，柴葛解肌汤。甚者，六神通解散，皆可酌用
。若内外俱热，而或为热泻者，宜柴芩煎。若表里俱热而兼斑疹者，宜柴葛煎。
一、伤寒之宜兼补兼散者，以营卫不足，血气不充也。用药如用兵，兵进而粮饷不继则
兵覆，攻病而元气不继则病覆。故治虚邪之宜散者，必当先本后末，此其最要者也。若寒邪
在营，肝脾血少，而邪热不退者，宜三柴胡饮，或归柴饮。若寒邪在卫，脾肺气虚，而表邪
不解者，宜四柴胡饮。若脾胃气血不足，而邪热不解者，宜五柴胡饮。若邪在半表半里，往
来寒热，而微见气虚者，宜小柴胡汤。若温暑大热大渴，津枯液涸，阴虚不能作汗者，宜归
葛饮。若寒邪深入，而阴中阳气不足，或背恶寒者，必难散解，非理阴煎不可。若中气大虚
大寒，身热恶寒，或大便溏泄，而表邪不能解者，非大温中饮不可。
凡是伤寒或瘟疫，在表证初起感受邪气时，应当迅速采用发汗法，不可延误。所以张仲景说：凡是用发汗汤药治疗，虽然方剂说明每日服用三次，但如果病情严重且未缓解，应当在半天内服完这三次的剂量。如果服用一剂后，病证仍然存在，应当继续服用原本的汤药。甚至有的患者不肯出汗，需要服用三剂才能解除病邪。如果服药后仍然不能出汗，那就是死症了。这就是所说的发汗不宜迟缓。然而，取汗的方法，又应当考察患者元气和病气的虚实情况。如果是突然发生的暴病，表证已经具备，而元气没有亏损的，只需使用辛平性质的药剂，直接发散即可。如果兼有其他杂证，则应当考察其寒热温凉的情况，酌情适宜地治疗，不能只知道发散。另外，如果身体虽然高热，表证完全具备，但脉象显示虚弱的，一定不容易出汗，这时就应当详细考察补虚的方法，酌情治疗。如果不知道标本缓急，一概强行发散，导致营血枯竭，就会死亡。
第一条：伤寒适宜用平和之剂散邪的，是因为只有外感症状，内部没有寒热偏盛，而且元气没有亏损，适宜用正柴胡饮为主治。此外如十神汤、参苏饮，都可以酌情使用。如果病在阳明经，适宜用升麻葛根汤。如果感染四时瘟疫，出现身体疼痛发热，以及烟瘴之气侵袭的，适宜用败毒散，或者荆防败毒散。如果病在三阳经，出现头痛鼻塞、项背强直身体疼痛、咳嗽的，适宜用神术散。如果伤风兼有寒邪，出现发热咳嗽的，适宜用柴陈煎，或者金沸草散。严重的，用小青龙汤。
第二条：伤寒适宜用温性之剂散邪的，是因为寒邪外部强盛，而内部没有热证，以及元气没有亏损且体质清冷受寒的，都可以从温性角度直接发散，适宜用二柴胡饮最为恰当。如果寒邪很盛且表实证的，只有麻桂饮最为妙效，不要犹豫畏惧。此外如五积散、麻黄汤、桂枝汤、小青龙汤、葛根汤、圣散子之类，都可以酌情使用。
第三条：伤寒适宜用凉性之剂散邪的，是因为外部热而内部也热，必定脉象和证候都属阳，并且烦躁口渴喜欢冷饮，以及元气强盛的，才可以兼用凉性和散邪之法，适宜用一柴胡饮为先。或者九味羌活汤，柴葛解肌汤。严重的，六神通解散，都可以酌情使用。如果内外都热，并且出现热性腹泻的，适宜用柴芩煎。如果表里都热并且兼有斑疹的，适宜用柴葛煎。
第四条：伤寒适宜兼用补益和散邪方法的，是因为营卫不足，气血不充盈的缘故。用药如同用兵，军队前进而粮饷不继则军队覆灭，攻治病邪而元气不继则病邪难除（或指正气崩溃）。所以治疗虚损兼有邪气需要散邪的，必须首先顾本而后治标，这是最关键的地方。如果寒邪在营分，肝脾血少，而邪热不退的，适宜用三柴胡饮，或者归柴饮。如果寒邪在卫分，脾肺气虚，而表邪不解的，适宜用四柴胡饮。如果脾胃气血不足，而邪热不解的，适宜用五柴胡饮。如果邪气在半表半里之间，出现往来寒热，并且轻微出现气虚的，适宜用小柴胡汤。如果温暑大热大渴，津液干枯，阴虚不能作汗的，适宜用归葛饮。如果寒邪深入，而阴中阳气不足，或者背部恶寒的，一定难以散发解除，非理阴煎不可。如果中气大虚大寒，身体发热恶寒，或者大便溏泄，而表邪不能解除的，非大温中饮不可。
In cases of Shanghan (Cold Damage) or plague, when the exterior syndrome is initially contracted, sweating therapy should be employed promptly; delay is inadvisable. Thus, Zhang Zhongjing stated: "When administering herbal decoctions for sweating, although the prescription instructions specify three doses per day, if the condition is severe and unresolved, all three doses should be consumed within half a day." If, after one dose, the symptoms persist, the original decoction should be administered again. In some instances where sweating does not occur, three doses may be required to resolve the pathogen. If sweating remains impossible despite treatment, it indicates a fatal prognosis. This illustrates the principle that sweating therapy should not be delayed. However, the method of inducing sweating must assess the deficiency or excess of both the patient's Yuan Qi (Original Qi) and the pathogenic factor. In sudden acute illnesses where the exterior syndrome is fully manifested but Yuan Qi is intact, mild acrid-pungent agents can be used directly to disperse the pathogen. If complicated by other syndromes, one must evaluate the cold, heat, warmth, or coolness patterns and treat accordingly, rather than relying solely on dispersing methods. Furthermore, even if the body presents with high fever and complete exterior symptoms, if the pulse is weak, sweating will likely not occur easily; in such cases, detailed assessment and treatment focusing on tonifying deficiency are necessary. Ignoring the root and branch relationship and indiscriminately forcing dispersion can lead to exhaustion of Ying Blood (Nutritive Blood), resulting in death.
1. For Shanghan requiring mild dispersal, this applies when there are only exterior signs without internal cold-heat imbalance and with intact Yuan Qi. Zheng Chaihu Yin (Regular Bupleurum Decoction) is indicated as the primary formula. Additionally, Shishen Tang (Ten Spirits Decoction) and Shen Su Yin (Ginseng Perilla Decoction) may be used酌情ly. If the disease involves the Yangming channel, Shengma Gegen Tang (Cimicifuga and Pueraria Decoction) is appropriate. For infections from seasonal plagues presenting with body pain, fever, or exposure to miasmic vapors, Baidu San (Poison-Resolving Powder) or Jingfang Baidu San (Schizonepeta and Saposhnikovia Poison-Resolving Powder) are suitable. If the disease affects the Three Yang channels, presenting with headache, nasal congestion, stiffness of the neck and back, body pain, and cough, Shenzhu San (Divine Efficacy Powder) is indicated. For wind-cold invasion with fever and cough, Chaichen Jian (Bupleurum and Tangerine Peel Decoction) or Jinfeicao San (Boil-down Grass Powder) are appropriate. In severe cases, Xiao Qinglong Tang (Minor Green Dragon Decoction) is used.
2. For Shanghan requiring warm dispersal, this applies when external cold pathogens are strong, there are no internal heat signs, Yuan Qi is intact, and the constitution is clear/cold susceptible to cold. Er Chaihu Yin (Secondary Bupleurum Decoction) is most appropriate. In cases of severe cold with exterior excess, Magui Yin (Cinnamon Twig and Ephedra Decoction) is optimal, without hesitation. Additionally, Wuji San (Five Accumulations Powder), Mahuang Tang (Ephedra Decoction), Guizhi Tang (Cinnamon Twig Decoction), Xiao Qinglong Tang (Minor Green Dragon Decoction), Gegen Tang (Pueraria Decoction), and Shengsanzi (Holy Seed Powder) may be used酌情ly.
3. For Shanghan requiring cool dispersal, this applies when there is heat externally and internally, with yang-type pulses and symptoms, restlessness, thirst preferring cold drinks, and robust Yuan Qi. In such cases, cooling and dispersing methods can be combined, starting with Yi Chaihu Yin (Primary Bupleurum Decoction). Alternatively, Jiuwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction) or Chaige Jiexu Tang (Bupleurum and Pueraria Muscle-Releasing Decoction) may be used. In severe cases, Liutong Shengjie San (Six-Penetration Unblocking Powder) is suitable. If there is heat inside and out accompanied by hot diarrhea, Chaixin Jian (Bupleurum and Scutellaria Decoction) is indicated. If exterior and interior heat coexist with macules and rashes, Chaige Jian (Bupleurum and Pueraria Decoction) is appropriate.
4. For Shanghan requiring simultaneous tonification and dispersal, this is due to insufficiency of Ying and Wei (Defensive) Qi and lack of blood and qi. Using medicine is like using troops; if troops advance without supply, they perish; if attacking pathogens without supporting Yuan Qi, the patient suffers collapse. Therefore, treating deficiency with pathogenic factors requiring dispersal requires prioritizing the root before addressing the branch, which is crucial. If cold pathogens reside in the Ying level with liver-spleen blood deficiency and persistent pathogenic heat, San Chaihu Yin (Tertiary Bupleurum Decoction) or Guichai Yin (Angelica and Bupleurum Decoction) are indicated. If cold pathogens reside in the Wei level with spleen-lung qi deficiency and unresolved exterior pathogens, Si Chaihu Yin (Quaternary Bupleurum Decoction) is appropriate. If spleen-stomach qi and blood are insufficient with unresolved pathogenic heat, Wu Chaihu Yin (Quinary Bupleurum Decoction) is indicated. If pathogens are at the half-exterior half-interior level, presenting with alternating chills and fever and slight qi deficiency, Xiao Chaihu Tang (Minor Bupleurum Decoction) is suitable. For warm summer-heat with high fever, extreme thirst, dried-up fluids, and yin deficiency preventing sweating, Guige Yin (Angelica and Pueraria Decoction) is indicated. If cold pathogens penetrate deeply with insufficient yang qi within yin, or aversion to cold on the back, dispersion is difficult; Liyin Jian (Nourishing Yin Decoction) is essential. If middle jiao qi is severely deficient and cold, presenting with fever, aversion to cold, loose stools, and unresolved exterior pathogens, Dawenzhong Yin (Great Warming Middle Decoction) is indispensable.