凡治伤寒，不必拘于日数，但见表证，即当治表，但见里证，即当治里，因证辨经，随经施治
，乃为良法。若表邪未解，即日数虽多，但有表证而脉见紧数者，仍当解散，不可攻里也。若表邪
已轻，即日数虽少，但有里证而脉见沉实者，即当攻里，不可发表也。然此二者，一曰发表，一曰
攻里，皆以邪实者为言也。其有脉气不足，形气不足者，则不可言发言攻，而当从乎补矣。但补有
轻重，或宜兼补，或宜全补，则在乎明而慧者之用之如法耳。
一、伤寒但见发热恶寒，脉紧数，无汗，头项痛，腰脊强，或肢体酸软者，便是表证，不拘日
数多寡，即当解散，但于阴阳虚实，不可不预辨也，而于后开汗散方中择宜用之。
一、伤寒但见往来寒热，胁痛，口苦而呕，或渐觉耳聋，脉见弦数者，即少阳经半表半里之证
，治宜和解，以新方诸柴胡饮，及小柴胡汤之类，酌宜用之。然少阳之治有三禁，曰不可汗、吐、
下也。
一、伤寒如头痛、发热、恶寒表证之类悉除，反见怕热，躁渴谵语，揭去衣被，扬手掷足，斑
黄发狂，或潮热自汗，大便不通，小便短赤，或胸腹胀满疼痛，或上气喘促，脉实有力者，即是传
里之热证，不拘日数多少，即当清里。如果实邪内结，不得宣通，此必大为涤荡，庶使里通而表亦
通也。然必其胸腹胀满，肠胃燥结，而大满大实坚者，乃可攻之。故法曰∶痞满燥实坚，五者具而
后可下。又曰∶下不嫌迟。盖恐内不实而误攻之，则必致不救矣。
一、凡治伤寒，如时寒火衰，内无热邪而表不解者，宜以辛温热剂散之；时热火盛而表不解者
，宜以辛甘凉剂散之；时气皆平而表不解者，宜以辛甘平剂散之，此解散之要法也。盖人在气交之
中，随气而化，天地之气寒，则宜辛热，天地之气热，则宜辛凉，经文既以冬为伤寒，春为温病，
夏为暑病，名既因时而易，则方亦不容不随时而更也。第以凉散之法，当知所辨，必其表里俱有热
证，方可兼用清凉，若身
表虽热，而内无热证者，此以表邪未解，因寒而为热也，不可妄用凉药、盖恐表寒未除，
而内寒复至，以寒遇寒，则凝结不解，必将愈甚，经曰∶发表不远热，正此之谓也。且舍
时从证，尤为治伤寒紧要之法，此又不可不知常变。
一、凡暑热盛行，瘟疫大起，焦渴斑黄，脏腑如火，此则或用寒肃，以清其里，或用
寒散，以救其表，但当察表里而酌缓急之宜也。
凡是治疗伤寒，不必拘泥于发病的天数，只要见到表证，就应当治疗表证；只要见到里证，就应当治疗里证。根据症状辨别病经，顺着病经实施治疗，这才是良好的治疗方法。如果表邪尚未解除，即使发病天数较多，但只要出现表证且脉象表现为紧或数，仍然应当解表散邪，不可攻逐里实。如果表邪已经减轻，即使发病天数较少，但只要出现里证且脉象表现为沉而实，就应当攻逐里实，不可再发汗解表。然而这两种情况，一个是发表（通过发汗祛除在表之邪），一个是攻里（通过泻下祛除在里之邪），都是针对邪气盛实的病症而言的。如果有脉气不足、形体元气不足的情况，则不可以使用发表或攻里的方法，而应当采用补益法。但是补益有轻重之分，或者适宜兼用补益，或者适宜全面补益，这就要看医生是否明智聪慧并能依法运用罢了。
第一，伤寒病只要见到发热恶寒、脉象紧数、无汗、头项疼痛、腰脊僵硬，或者肢体酸软等症状，就是表证。不论发病天数多少，都应当立即解表散邪。但在治疗前，不可不预先辨别阴阳虚实，然后从后文所列的发汗解表方剂中选择合适的服用。
第二，伤寒病只要见到寒热往来、胁肋疼痛、口苦且呕吐，或者逐渐感觉耳聋、脉象弦数，这就是少阳经半表半里的证候。治疗适宜和解少阳，可以使用新方诸柴胡饮，以及小柴胡汤之类的方剂，酌情选用。然而少阳病的治疗有三条禁忌，即不可使用发汗、催吐、泻下的方法。
第三，伤寒病如果头痛、发热、恶寒等表证全部消除，反而出现怕热、烦躁口渴、说胡话、掀开衣被、挥手踢脚、身上出现斑疹发黄或发狂，或者定时发热自汗、大便不通、小便短赤，或者胸腹胀满疼痛，或者上气喘促、脉象实而有力的，这就是传入里的热证。不论发病天数多少，都应当清泄里热。如果是实邪内结，导致气机不得宣通，这就必须大力涤荡清除，才能使里气通畅，表气也随之通畅。但是，必须是胸腹胀满、肠胃干燥结滞，并且达到大满、大实、坚硬的程度，才可以攻下。所以医法说：痞、满、燥、实、坚五种症状具备后，才可以攻下。又说：攻下不宜过早。这是担心体内没有实邪而误用攻下，那样必然会导致无法挽救的后果。
第四，凡是治疗伤寒，如果遇到时令寒冷而人体阳气衰弱，内部没有热邪但表证不解的，适宜用辛温热的药剂来发散；遇到时令火热旺盛而表证不解的，适宜用辛甘凉的药剂来发散；遇到时令气候平和而表证不解的，适宜用辛甘平的药剂来发散，这是解表散邪的重要法则。大概因为人生活在天地气交之中，随着气化而变化，天地之气寒冷，就适宜用辛热药；天地之气炎热，就适宜用辛凉药。经文既然以冬天为伤寒，春天为温病，夏天为暑病，名称既因季节不同而改变，那么方剂也不容许不随季节变化而更改。只是对于使用清凉发散的方法，应当知道加以辨别，必须是表里都有热证，才可以兼用清凉药。如果身体表面虽然发热，但内部没有热证，这是因为表邪未解，因受寒而化热所致，不可妄用凉药。这是担心表寒未除，而内部寒气又至，以寒遇寒，就会凝结不解，病情必将更加严重。经文说：“发表不远热”，正是这个意思。而且“舍时从证”（忽略时令而依据证候用药），更是治疗伤寒紧要的方法，这一点又不可不知常理与变通。
第五，凡是暑热盛行，瘟疫大规模发生，出现极度口渴、斑疹发黄，脏腑如火烧一般，这时或者使用寒凉肃杀的药物以清泄里热，或者使用寒凉发散的药物以救治表证，但应当考察表里情况并斟酌缓急适宜的治法。
In the treatment of *Shanghan* (Cold Damage), one should not be bound by the number of days since onset. Whenever exterior syndrome is observed, treat the exterior; whenever interior syndrome is observed, treat the interior. Differentiating the meridians based on symptoms and applying treatments according to the affected meridians constitutes a sound method. If exterior pathogenic factors have not yet resolved, even if many days have passed, provided that exterior signs are present and the pulse is tight or rapid, one must still resolve the exterior and must not attack the interior. Conversely, if exterior pathogenic factors have lightened, even if few days have passed, provided that interior signs are present and the pulse is deep and excess, one must attack the interior and must not induce sweating to release the exterior. However, these two approaches—releasing the exterior (*Fabiao*, dispersing pathogens from the surface) and attacking the interior (*Gongli*, purging internal accumulation)—both refer to conditions characterized by excess pathogenic factors. In cases where there is insufficiency of pulse qi and physical vitality, neither releasing the exterior nor attacking the interior should be employed; instead, tonification should be adopted. Tonification varies in degree: sometimes it is appropriate to combine tonification with other methods, and sometimes full tonification is required. This depends on the physician's wisdom and adherence to proper protocols.
First, in *Shanghan*, if fever and aversion to cold, a tight and rapid pulse, absence of sweating, pain in the head and nape, stiffness of the waist and spine, or soreness and weakness of the limbs are observed, this indicates an exterior syndrome. Regardless of the number of days elapsed, immediate resolution of the exterior is required. However, differentiation of Yin and Yang deficiency or excess must be conducted beforehand, and appropriate formulas from the subsequent list of diaphoretic prescriptions should be selected for use.
Second, in *Shanghan*, if alternating chills and fever, hypochondriac pain, bitter taste in the mouth with vomiting, gradual hearing loss, or a wiry and rapid pulse are observed, this indicates a Shaoyang meridian syndrome located half-exterior and half-interior. The treatment should aim at harmonizing, using formulas such as Xin Fang Zhu Chaihu Yin (New Formula Various Bupleurum Decoctions) or Xiao Chaihu Tang (Minor Bupleurum Decoction), selected as appropriate. However, there are three prohibitions in treating Shaoyang disorders: sweating, emesis, and purgation are all contraindicated.
Third, if in *Shanghan* the exterior signs such as headache, fever, and aversion to cold have completely disappeared, and instead there is heat intolerance, restlessness, thirst, delirium, tossing off clothes and bedding, waving hands and kicking feet, appearance of macules and jaundice, or mania, along with tidal fever, spontaneous sweating, constipation, scanty dark urine, chest and abdominal distension, fullness, pain, shortness of breath, and a forceful excess pulse, this indicates a heat syndrome transmitted to the interior. Regardless of the number of days, clearing the interior heat is required. If excess pathogens are internally accumulated and obstructing free flow, vigorous purging is necessary to unblock the interior, which will consequently unblock the exterior. However, purgation is only permissible when there is significant chest and abdominal distension, dry fecal impaction in the intestines and stomach, and severe fullness, excess, and hardness. Thus, the method states: only after the five conditions of obstruction (*Pi*), fullness (*Man*), dryness (*Zao*), excess (*Shi*), and hardness (*Jian*) are present can purgation be applied. It is also said: "Purgation should not be performed too early." This caution exists because mistakenly purging a non-excess condition will inevitably lead to untreatable collapse.
Fourth, in treating *Shanghan*, if the seasonal climate is cold and internal Yang is weak, with no internal heat but unresolved exterior syndrome, acrid-warm-hot agents should be used to disperse; if the seasonal climate is hot and fire is prevalent with unresolved exterior syndrome, acrid-sweet-cool agents should be used to disperse; if the seasonal climate is balanced with unresolved exterior syndrome, acrid-sweet-neutral agents should be used to disperse. These are essential methods for resolving the exterior. Humans exist within the interaction of Qi between Heaven and Earth and transform accordingly. When the Qi of Heaven and Earth is cold, acrid-warm agents are suitable; when hot, acrid-cool agents are suitable. Since the Classics designate winter diseases as *Shanghan*, spring diseases as Warm Diseases (*Wenbing*), and summer diseases as Heat Diseases (*Shubing*), and names change with the seasons, formulas must also adapt to the times. However, when using cool dispersal methods, careful differentiation is required. Cool agents may be combined only if both exterior and interior exhibit heat signs. If the body surface is hot but there are no internal heat signs, this heat arises from exterior pathogens constrained by cold. In such cases, cool medicines must not be used recklessly. There is a risk that if exterior cold is not removed and internal cold subsequently arrives, cold meeting cold will cause coagulation without resolution, worsening the condition. The Classic states: "Releasing the exterior does not avoid heat," which refers precisely to this principle. Furthermore, "setting aside the season to follow the syndrome" (*She Shi Cong Zheng*) is a critical method in treating *Shanghan*, and understanding the balance between routine and flexibility is indispensable.
Fifth, when summer-heat is rampant and plagues arise extensively, presenting with extreme thirst, macules, jaundice, and organs feeling like burning furnaces, one may either use cold-astringent agents to clear the interior or cold-dispersal agents to rescue the exterior. The key is to examine the exterior and interior status and determine the appropriate urgency of treatment.