不敢虚伪欺人，致蹈前人著书，铺张扬厉之覆辙。阅者宜注意此点，深信余言也。）伤寒（一）伤寒（伤寒与温病，根本不同，西医肠窒扶斯症，则包括伤寒、温病而言，殊嫌含混（论详前）。）．（原因）本病为体外严寒所侵而致，尤以身居暖室，骤遇外间大寒，遂致皮肤所感，冷热悬殊，周身毛孔，骤然紧缩闭塞，体内热气，不得透达于外，蓄积体内，遂成伤寒之症。然此症多见于严冬天气，若春夏秋间，则极少也。西医则谓由于肠窒扶斯杆菌之传染，自是确论，然考西医书所谓肠窒扶斯，实不仅指伤寒一症而言。（温病、瘟疫均包括在内）故余对本病主张，仍宜分别立名，不敢从同。盖伤寒与温病，确系两病，若以中医同一治法治之必左。西医既以肠窒扶斯名此二症，故其治法亦无分别。（盖伤寒一症，系外表先伤于寒，初病治法，必先解表寒。唯治不得法，乃传经入里成为内热，结果必至肠热。温病一症，系肺内先有实热，初病治法，必先解肺热。唯治不得法，亦必至肠热。二症结果，虽似相同，然在初病之时，中医之治法及药·品，绝不相同，且有奇效。唯西医对此二症，则治无分别，故治疗成绩，远逊于中医也。）除预防注射，对症疗法，待期疗法外，若患者既已病倒，实无他法可，以使该病从速痊愈。（血清疗法效力亦；不尽准确）结果必视肠之病变若何？而待其自然之转归，此实不得不谓为西医之缺点，然此种缺点，或由于中西医药隔阂太甚，此隔阂二字，并非西医不通中药，中医不通西药之谓。盖现今中西药物，已渐有混合之势；近阅中医刊物，多有论及西药者，西药之中，亦有从事化制中药者。表面上视之，似已减少隔阂，中西汇通，殊不知中西医药之隔阂，不但仍在，且恐又因此不彻底之贯通，而失去中医治法及药品之特长，不但无益，而反害之。举例说明于下：①西药中近已适用麻黄素，其功用则有定喘及利尿诸作用，然以此种麻黄素代中医之麻黄汤，以治伤寒之太阳证，未有不大左者。②中医刊物上，曾有列麻黄等发散药于解热剂中者，曰服之有发汗作用，名之曰发汗解热剂，与西药之安基比林等退热药，相提并论，曰：安基比林眼之，每每发汗，亦名之曰发汗解热剂，此种著述，看似中西贯通，毫无隔阂，然试将此二药，分别治疗同一之病症，则绝对不能一律有效。且既称麻黄等为发汗退热剂，若概以麻黄治热病，其杀人之速，必易如反掌。若以安其比林等退热剂，而冠以发汗二宇，尤觉可笑。盖安其比林之发汗，系其副作用，绝非麻黄之发汗解表专能透澈表里之比也。伤寒表证，或较重之感冒症，一试便知，何可只凭理想，强加拢合以误后人。
余深恐因此不彻底之汇通，失去中西医之特长，与夫本来之面目，故不惮反复言之，非好辩也。）或由于中医之故步自封，西医之囿之科学，（科学无止境，以现在之科学为神圣而卑视一切，亦故步白封之类也。）根本限于一偏，并无二者之真识，以故不能舍短取长，裨益实际，此研究医学者之大耻，愿吾辈医者个个努力也。
亡症候）此症可分三期说明之。第一期，头项强痛、身痛、骨节痛、腰痛、恶寒、（此二宇最重要）或恶风、无汗、（有汗者少）呕逆、或身热、（迟早必有身热，此或宇作如是解）鼻塞声重、或咳喘、脉紧、或浮紧，（此紧脉，最为伤寒之初步、必然现象，温症绝少此咏，应注意。）所谓表证是也。（此即古医书所谓太阳证也，然余不欲谈此等字。）第二期，此约在得病四、五日后，脉渐大身体潮热、（已渐入内，胃已热矣。）不恶寒、或微汗出、身重，头或眩或痛、呕不能食、或厥逆、口干咽燥而渴、心烦腹满、或心下硬痞、或发黄、便燥或下血、或鼻衄、舌苔黄，谵语亦多于此期见之，与潮热均是最主要之证候，应特别注意。胁痛、舌苔黄裂、小便赤短、耳聋、往来寒热、呕吐、痞满结胸、腹痛、或数日不大便、或泻利、神昏谵语、脉多弦数，此期热度极高，且不易下降。
第三期，热不退或四肢厥逆、（厥逆太甚，有通体皆凉者）脉细微、或停止、便溏、或自利清谷、或泻脓血、热或骤退（愈危）、息高（呼气长、吸气短）、声微、神衰、身倦（此时亦有恶寒、绝不可认为表症）、自汗、盗汗、（此汗与第二期大异）寻衣摸床。（此四字，系形容病者精神将散之朦胧状态，较谵语尤重，已成危候。）亡治法丁此症治法，中西医绝不能相合，实以中西药品不同，理论亦异，故不能强为拢合。当第一期（中医所谓太阳经证）初得之始，（注意初得二字）恶寒极甚，头痛身痛亦剧，此时唯一有效治法，即为发汗解表。若在严冬之候，{注意严冬二字，则麻黄、羌活、独活、防风、生姜、甘草、苏叶等，均为必需之品，可视病之轻重，人之强弱，（此最宜注意，以免过汗）酌量选用。如有咳喘，可以酌加杏仁。服药后，多饮热水，覆被取汗，为第一要着。（如有干呕不必顾及只用发散药可也。，此治法及早用之，对于伤寒初起，往往一药而愈，绝不致演成重症。（此时若用西药安基比林等，不但无效，且恐耽误病机，酿成重症，此余实在经验，特以告知学者。，伤寒与温病治法不同之处，即在此开手第一着，西药中绝无治伤寒初起之药品，故·对于此症，虽亦有发汗治法，并无特效，因而曰此症只有期待疗法而已。（深愿西医于此种中药方法虚心采择，共济灾疠。
）此症当初得之时较重者，无论如何热浴或蒸气，多不能出汗，惟服中药之发散药后，始能发汗，尤以麻黄一药为最效。若改用麻黄素则不出汗。一汗之后，渚症根本皆除，直接了当，并无若何神秘。伤寒表证发汗，有一种鄙俚之病理，人人易懂，就是病人皮子外面的毛孔，被寒气一侵，全闭煞啦，内里的热气，透不出来了，所以攻的浑身不好受，冶此伤寒表证的中药，全是温性，，而且多带辛辣气味的，所以有用生姜的，吃下去，能叫内里头热气格外的膨胀得很，一下子就把外皮的毛孔，完全的拿汗给冲开了，这病就立时好了，这有什么神奇呢？可是温病初得的发散，不是这样，所以中医治此二症，格外的灵。所最忌者，于以上诸药之中，妄加其他药品，例如死守古方，视力神圣，而又误于玄虚之说，自入迷途是也。以致药力不纯，不能发汗，反而贻误病机，良可浩叹！此段余有反对古书之意思，知我罪我，所不薛也。此症用发汗药，有应注意者，大凡太弱之人，及老年人，用药分量，均宜格外谨慎，嘱其覆被发汗，亦应谆嘱看护者，格外注意，以防发汗过量，心脏停止。所谓汗脱麻黄更不可用大量，成年人一至二钱为准。且须用蜜炙，以免危险。宁使一剂汗不透，再服一剂．万不可猛浪从事，致出危险。而桂枝一药，尤易令人鼻衄，用时亦宜小量，或以不用力是，此伤寒病第一期之治法也。此症初得之始，发散得法，——汗而解。病者或认为感冒风寒，殊不重视，故中医药功用之妙，亦半掩没于此感冒风寒四字之中矣。失此不治，或用药杂乱，致内外闭塞略久，而后体内蓄热太多，侵及肠胃各脏，于是种种热候，不易消散，（肠窒扶斯热型）遂有西医待期疗法无可奈何之名词。然余于此症，每相机处理，屡经试验，认定第一期之根本治法，中药实有不可思议之妙，厅不可拘拘于西医之说，自弃其固有之良法，更望有志世界医学者；采余此说保守中药之特长，而应用之，以佐治疗之成绩，则幸甚矣。余所主张肠窒扶斯病名，不能概括伤寒与温病两病而言，其实验之理由，即基于此。盖温病初起，亦有恶寒、恶风、头痛、骨节痛等表证。
腰痛者少惟其脉则与伤寒大异，温病脉多浮洪右寸脉尤显或大而濡，绝少伤寒初起之紧弦等脉，此为最应注意之点。再则为气候关系，伤寒多在天气极寒之冬季，而春夏秋三季独少，温病则四时皆有。且一有温病流行，较伤寒更多普遍较伤寒之传染为速尤易分辨。然温病初起，症状虽与伤寒略同，此时若以治伤寒表证之辛温发散药治之，例如用麻贡、桂枝、古书治温病，有主用桂枝者，大谬。羌活、细辛、独活等药，发汗过当必致危险。此时用西药中之安基比林等更无效。故余谓肠窒扶斯病名，实不宜概括伤寒与温病两病，笼统言之也。
第二期中医所谓阳明、少阳各证，治法，此是汗不得法，邪已渐渐入里，内脏已渐干燥，一切发汗之药，不能再用。此时治法之有效者，首推大黄、芒硝，其次则柴胡、前胡、黄芩、竹叶、石膏、青皮、厚朴、枳实，再次则瓜蒌、半夏、此药略燥，用时注意栀子、豆豉、茵陈蒿、赤小豆、发黄者用之杏仁、黄柏等药，可以相机择用。此时总以甘寒苦降疏通肠胃为要，凡见痞闷结胸症，宜以小陷胸汤加减为治，若见潮热、谵语、腹满或痛，此时或有头痛，不可误认，疑为仍有表证也。均宜用大黄、若症结不实，或病人太弱，宜用熟大黄。枳实、厚朴等药微卜之。此时不必用芒硝若脉症均实，舌黄唇裂、口渴、腹痛、谵语、潮热、小便赤短。急以生大黄加芒硝枳实、厚朴等亦可用．下之，此时必有皮肤之热。井宜以阿斯比林。安基比林等西药作退热用，但与中药须隔开六点钟用之，此时亦可用硫苦等。此第二期之治法也，此期治之得法，亦不致病势加重，演成肠出血及肠穿孑L之危险，惟此期间有借重西药之时，参看医验与第一期之治法，纯用中药者有别第一期西药必无效不可不知。柴胡为此期有寒热往来之专药，与头痛加以川芎、白芷皆有效。此期亦有黄疸症状，西药硫苦治黄疸有效可用之应参照茵陈汤等治法，再佐以对症各药可也。此期治法，于疏通肠胃等法之外，用承气汤等；胜于用硫苦及甘汞等。必须用西药退热。撤曹、安基比林、阿斯比林、硫规等，均可选用，亦可兼用清凉剂，例如稀盐酸等。惟心脏衰弱者，脉微细，或有自汗、盗汗者．于用退热剂时，宜特别谨慎，勿用太大之量较之纯用中药，特别有效，失此不治，则入于第三期，势愈危险矣。古方中非无灵验之方，但大多数为其他成方所混淆，故必经多年实验，方有真确认识，抉择而出，即本编所采之古方是也。
第三期治法此期中医所谓太阴、少阴、厥阴各症，西医所谓肠出血及肠穿孔等合并症。更觉棘手，若第一、二期治之得法，（汗下）绝不致演成三期，此种病变纯由于过信中医古书含混迷离之说，杂成胸际。一遇此病，无从下手，以放认症则迷惘犹疑。（因声说貌似精妙玄深，实则纷乱杂揉，导入迷阵，学者愈究心，精神愈紊乱矣。）用药则拘板牵强，（视古方为神圣，杀人即在于此）一误再误，病势演进不已，乃至不可救药，医者犹自称曰此某经症，，用某经方也，哀哉1症已至此，绝非病之当然现象，西医治伤寒，以药品不能如中医之适应此症，故多演成重症，遂认待期疗法，为确乎不拔之说，实则西医非不精，所苦者无此药也。设使此症初起，当纯粹表症之时，一汗而愈，肠何由热？何由出血？何由穿孔耶？迨演至第二期，中医承气汤等确实较西药为优，然又苦于退热药不如西药之适应此症，又再惑于种种古书之说，一误再误，亦可演成第三期之危险，余经过此症多矣，确知中西治法，合之（适当病机）则十之八九可以速愈，离之则各有所短也。此时不可不有心灵手敏之主张，挽救垂死之病者，运用医药，随机应变、处处得法，十或救其二、三。以余之经验，病至此种阶段，十之八九已成险症。肠出血期，所便多脓血，或黑油样之物，此时尚能希望治愈，至肠穿孔期，则绝少挽救之法矣。此时恒有四肢厥逆，若其体温仍高，则仍可下之，或大剂滋阴，此时要有十二分认识病症，不可滥用泻药。若完全表现虚脱症状，例如脉微身凉，自汗盗汗，喘息失眠，虚烦，下利清谷种种，皆现极虚之症者，此时只有大补阴阳之一法。此法尚较西药之强心止血等剂为愈然以上二法，一泻一补若非认症确实，用药稍有错误，杀人即在顷刻。此则视医者之学术经验与运用方法之何如为定，所谓可以意会，不可以言传也。
中医对于伤寒、温病二症，由于古书之根本混淆，早已纠缠不清，幸经后人逐渐试验，渐渐分晰，始知伤寒治法与温病治法，绝然不同。四十年前余纯粹偏信西医，曾根据肠窒扶斯病菌之理，主张伤寒、温病实系一症并无分别，中医治法，不过药品上之区别，与本病毫无关系，此种见解，今已知其大错矣。历考温症诸书，虽仍不免牵扯玄虚之习，然实已知治温病之正轨，惟伤寒一症，仍有人拘泥古书，经学家对于今文古语文之争辩检详，因而抉出真伪，以示来者，厥功甚伟。中国古医书之文笔句法，多非秦汉间文字，稍读古书者，极易辨别，一望而知为假托，乃后之医者不乏通儒，初来见有根本纠正者，惜哉，贻误害人者。古书治伤寒，非全部不灵验，但有一部分，实不可从者。故本编论病，开首先将伤寒一症，详细言之，此皆本诸实验立论非臆断也。
不敢虚伪欺骗他人，从而重蹈前人著书立说时夸大其词的覆辙。读者应当注意这一点，深信我的言论。（伤寒（一）伤寒（伤寒与温病在根本上是不同的，西医所说的肠窒扶斯症，实际上包含了伤寒和温病，这样划分显得过于含混（详细论述见前文）。）．（病因）本病是由于体外严寒侵袭所致，特别是当人身处温暖的室内，突然遭遇外界的极寒天气，导致皮肤感受到的冷热差异巨大，全身毛孔骤然收缩闭塞，体内的热气无法向外透发，蓄积在体内，从而形成伤寒病症。然而，这种病症多见于严冬季节，若在春夏秋三季，则极少发生。西医则认为这是由于肠窒扶斯杆菌的传染引起的，这确实是确切的论断，但考察西医书籍中所谓的“肠窒扶斯”，实际上不仅仅指伤寒这一种病症。（还包括温病、瘟疫等）因此，我主张对本病仍应分别命名，不敢随同从众。因为伤寒与温病确实是两种不同的疾病，如果用中医同一套治法来治疗，必然会出现偏差。西医既然用“肠窒扶斯”来统称这两种病症，所以其治疗方法也没有区分。（大概伤寒这一病症，是体表先受寒邪侵袭，初起时的治法，必须先解除表寒。只有治疗不得法，才会传经入里变成内热，结果必然导致肠热。温病这一病症，是肺内先有实热，初起时的治法，必须先清解肺热。同样，如果治疗不得法，也必然会导致肠热。这两种病症的结果，虽然看似相同，但在初起之时，中医的治法及药品，截然不同，且往往有奇效。而西医对这两种病症，治疗方法没有区别，所以治疗效果远逊于中医。）除了预防注射、对症疗法、等待自然病程外，若患者已经病倒，实在没有其他办法，只能让该病尽快痊愈。（血清疗法的效果也不尽准确）结果必然取决于肠道病变的情况，等待其自然转归，这确实不得不说是西医的缺点。然而，这种缺点，或许是由于中西医药隔阂太深造成的。这个“隔阂”二字，并非指西医不懂中药，或中医不懂西药的意思。因为现今中西药物，已逐渐有混合的趋势；最近阅读中医刊物，多有讨论西药的，西药界中，也有从事化制中药的。表面上看，似乎已经减少了隔阂，实现了中西汇通，殊不知中西医药的隔阂不但仍然存在，而且恐怕会因这种不彻底的贯通，而失去中医治法及药品的特长，不但无益，反而有害。举例说明如下：①西药中近来已适用麻黄素，其功效则有定喘及利尿等作用，然而用这种麻黄素代替中医的麻黄汤，来治疗伤寒的太阳证，没有不出大错的。②中医刊物上，曾有人将麻黄等发散药列入解热剂中，称服用后有发汗作用，命名为“发汗解热剂”，将其与西药的安基比林等退热药相提并论，称：安基比林服用后，每每也会发汗，也称之为“发汗解热剂”。这种著述，看似中西贯通，毫无隔阂，然而试将这两种药分别治疗同一病症，则绝对不能一律有效。况且既然称麻黄等为发汗退热剂，若一概用麻黄治疗热病，其致人死亡的速度，必易如反掌。若给安基比林等退热剂冠以“发汗”二字，更觉可笑。因为安基比林的发汗，是其副作用，绝非麻黄发汗解表那样能透彻表里的可比。伤寒表证，或者较重之感冒症，一试便知，怎能只凭理想，强行凑合以误导后人。
我深恐因此种不彻底的汇通，失去中西医各自的特长，以及本来面目，所以不厌其烦地反复言说，并非喜好争辩。）或许是由于中医故步自封，西医局限于科学。（科学无止境，以现在的科学为神圣而轻视一切，也是故步自封的一类。）根本限于偏颇，并没有二者真正的见识，因此不能舍短取长，裨益实际，这是研究医学者的耻辱，愿我们医者个个努力。
亡症状候）此症可分为三期来说明。第一期，头项强痛、身痛、骨节痛、腰痛、恶寒、（这两个字最重要）或恶风、无汗、（有汗者少）呕逆、或身热、（迟早必有身热，这个“或”字作如是解）鼻塞声重、或咳喘、脉紧、或浮紧，（这个紧脉，最为伤寒的初步、必然现象，温症绝少此脉象，应注意。）所谓表证是也。（这就是古医书所谓太阳证，然而我不想谈这些字眼。）第二期，大约在得病四、五日后，脉渐大身体潮热、（已渐渐入内，胃已热了。）不恶寒、或微汗出、身重，头或眩或痛、呕不能食、或厥逆、口干咽燥而渴、心烦腹满、或心下硬痞、或发黄、便燥或下血、或鼻衄、舌苔黄，谵语也多在此期见到，与潮热均是最主要的证候，应特别注意。胁痛、舌苔黄裂、小便赤短、耳聋、往来寒热、呕吐、痞满结胸、腹痛、或数日不大便、或泻利、神昏谵语、脉多弦数，此期热度极高，且不易下降。
第三期，热不退或四肢厥逆、（厥逆太甚，有通体皆凉者）脉细微、或停止、便溏、或自利清谷、或泻脓血、热或骤退（愈危）、息高（呼气长、吸气短）、声微、神衰、身倦（此时亦有恶寒、绝不可认为表症）、自汗、盗汗、（此汗与第二期大异）寻衣摸床。（这四个字，是形容病者精神将散的朦胧状态，较谵语尤重，已成危候。）亡治法对于此症治法，中西医绝不能相合，实在是因为中西药品不同，理论亦异，所以不能强行凑合。当第一期（中医所谓太阳经证）初得之始，（注意“初得”二字）恶寒极甚，头痛身痛亦剧，此时唯一有效的治法，即为发汗解表。若在严冬之候，{注意“严冬”二字，则麻黄、羌活、独活、防风、生姜、甘草、苏叶等，均为必需之品，可视病的轻重，人的强弱，（这点最宜注意，以免过汗）酌量选用。如有咳喘，可以酌加杏仁。服药后，多饮热水，盖被取汗，为第一要着。（如有干呕不必顾及，只用发散药即可。此治法及早用之，对于伤寒初起，往往一药而愈，绝不致演成重症。（此时若用西药安基比林等，不但无效，且恐耽误病机，酿成重症，这是我实在的经验，特以此告知学者。，伤寒与温病治法不同之处，即在于开手第一着，西药中绝无治伤寒初起的药品，所以对于此症，虽也有发汗治法，并无特效，因而曰此症只有期待疗法而已。（深愿西医对此种中药方法虚心采择，共济灾疠。
）此症当初得之时较重者，无论如何热浴或蒸气，多不能出汗，惟服中药之发散药后，始能发汗，尤以麻黄一药为最效。若改用麻黄素则不出汗。一汗之后，诸症根本皆除，直接了当，并无若何神秘。伤寒表证发汗，有一种鄙俚之病理，人人易懂，就是病人皮子外面的毛孔，被寒气一侵，全闭煞啦，内里的热气，透不出来了，所以搞得浑身不好受，冶此伤寒表证的中药，全是温性，而且多带辛辣气味的，所以有用生姜的，吃下去，能叫内里头热气格外的膨胀得很，一下子就把外皮的毛孔，完全的拿汗给冲开了，这病就立时好了，这有什么神奇呢？可是温病初得的发散，不是这样，所以中医治此二症，格外的灵。所最忌者，于以上诸药之中，妄加其他药品，例如死守古方，视力神圣，而又误于玄虚之说，自入迷途是也。以致药力不纯，不能发汗，反而贻误病机，良可浩叹！此段余有反对古书之意思，知我罪我，在所不辞也。此症用发汗药，有应注意者，大凡太弱之人，及老年人，用药分量，均宜格外谨慎，嘱其覆被发汗，亦应谆嘱看护者，格外注意，以防发汗过量，心脏停止。所谓汗脱麻黄更不可用大量，成年人一至二钱为准。且须用蜜炙，以免危险。宁使一剂汗不透，再服一剂，万不可猛浪从事，致出危险。而桂枝一药，尤易令人鼻衄，用时亦宜小量，或以不用为宜，此伤寒病第一期之治法也。此症初得之始，发散得法，——汗而解。病者或认为感冒风寒，殊不重视，故中医药功用之妙，亦半掩没于此感冒风寒四字之中矣。失此不治，或用药杂乱，致内外闭塞略久，而后体内蓄热太多，侵及肠胃各脏，于是种种热候，不易消散，（肠窒扶斯热型）遂有西医待期疗法无可奈何之名词。然余于此症，每相机处理，屡经试验，认定第一期之根本治法，中药实有不可思议之妙，厅不可拘拘于西医之说，自弃其固有之良法，更望有志世界医学者；采余此说保守中药之特长，而应用之，以佐治疗之成绩，则幸甚矣。余所主张肠窒扶斯病名，不能概括伤寒与温病两病而言，其实验之理由，即基于此。盖温病初起，亦有恶寒、恶风、头痛、骨节痛等表证。
腰痛者少惟其脉则与伤寒大异，温病脉多浮洪右寸脉尤显或大而濡，绝少伤寒初起之紧弦等脉，此为最应注意之点。再则为气候关系，伤寒多在天气极寒之冬季，而春夏秋三季独少，温病则四时皆有。且一有温病流行，较伤寒更多普遍较伤寒之传染为速尤易分辨。然温病初起，症状虽与伤寒略同，此时若以治伤寒表证之辛温发散药治之，例如用麻贡、桂枝、古书治温病，有主用桂枝者，大谬。羌活、细辛、独活等药，发汗过当必致危险。此时用西药中之安基比林等更无效。故余谓肠窒扶斯病名，实不宜概括伤寒与温病两病，笼统言之也。
第二期中医所谓阳明、少阳各证，治法，此是汗不得法，邪已渐渐入里，内脏已渐干燥，一切发汗之药，不能再用。此时治法之有效者，首推大黄、芒硝，其次则柴胡、前胡、黄芩、竹叶、石膏、青皮、厚朴、枳实，再次则瓜蒌、半夏、此药略燥，用时注意栀子、豆豉、茵陈蒿、赤小豆、发黄者用之杏仁、黄柏等药，可以相机择用。此时总以甘寒苦降疏通肠胃为要，凡见痞闷结胸症，宜以小陷胸汤加减为治，若见潮热、谵语、腹满或痛，此时或有头痛，不可误认，疑为仍有表证也。均宜用大黄、若症结不实，或病人太弱，宜用熟大黄。枳实、厚朴等药微卜之。此时不必用芒硝若脉症均实，舌黄唇裂、口渴、腹痛、谵语、潮热、小便赤短。急以生大黄加芒硝枳实、厚朴等亦可用．下之，此时必有皮肤之热。井宜以阿斯比林。安基比林等西药作退热用，但与中药须隔开六点钟用之，此时亦可用硫苦等。此第二期之治法也，此期治之得法，亦不致病势加重，演成肠出血及肠穿孑L之危险，惟此期间有借重西药之时，参看医验与第一期之治法，纯用中药者有别第一期西药必无效不可不知。柴胡为此期有寒热往来之专药，与头痛加以川芎、白芷皆有效。此期亦有黄疸症状，西药硫苦治黄疸有效可用之应参照茵陈汤等治法，再佐以对症各药可也。此期治法，于疏通肠胃等法之外，用承气汤等；胜于用硫苦及甘汞等。必须用西药退热。撤曹、安基比林、阿斯比林、硫规等，均可选用，亦可兼用清凉剂，例如稀盐酸等。惟心脏衰弱者，脉微细，或有自汗、盗汗者．于用退热剂时，宜特别谨慎，勿用太大之量较之纯用中药，特别有效，失此不治，则入于第三期，势愈危险矣。古方中非无灵验之方，但大多数为其他成方所混淆，故必经多年实验，方有真确认识，抉择而出，即本编所采之古方是也。
第三期治法此期中医所谓太阴、少阴、厥阴各症，西医所谓肠出血及肠穿孔等合并症。更觉棘手，若第一、二期治之得法，（汗下）绝不致演成三期，此种病变纯由于过信中医古书含混迷离之说，杂成胸际。一遇此病，无从下手，以放认症则迷惘犹疑。（因声说貌似精妙玄深，实则纷乱杂揉，导入迷阵，学者愈究心，精神愈紊乱矣。）用药则拘板牵强，（视古方为神圣，杀人即在于此）一误再误，病势演进不已，乃至不可救药，医者犹自称曰此某经症，，用某经方也，哀哉1症已至此，绝非病之当然现象，西医治伤寒，以药品不能如中医之适应此症，故多演成重症，遂认待期疗法，为确乎不拔之说，实则西医非不精，所苦者无此药也。设使此症初起，当纯粹表症之时，一汗而愈，肠何由热？何由出血？何由穿孔耶？迨演至第二期，中医承气汤等确实较西药为优，然又苦于退热药不如西药之适应此症，又再惑于种种古书之说，一误再误，亦可演成第三期之危险，余经过此症多矣，确知中西治法，合之（适当病机）则十之八九可以速愈，离之则各有所短也。此时不可不有心灵手敏之主张，挽救垂死之病者，运用医药，随机应变、处处得法，十或救其二、三。以余之经验，病至此种阶段，十之八九已成险症。肠出血期，所便多脓血，或黑油样之物，此时尚能希望治愈，至肠穿孔期，则绝少挽救之法矣。此时恒有四肢厥逆，若其体温仍高，则仍可下之，或大剂滋阴，此时要有十二分认识病症，不可滥用泻药。若完全表现虚脱症状，例如脉微身凉，自汗盗汗，喘息失眠，虚烦，下利清谷种种，皆现极虚之症者，此时只有大补阴阳之一法。此法尚较西药之强心止血等剂为愈然以上二法，一泻一补若非认症确实，用药稍有错误，杀人即在顷刻。此则视医者之学术经验与运用方法之何如为定，所谓可以意会，不可以言传也。
中医对于伤寒、温病二症，由于古书之根本混淆，早已纠缠不清，幸经后人逐渐试验，渐渐分晰，始知伤寒治法与温病治法，绝然不同。四十年前余纯粹偏信西医，曾根据肠窒扶斯病菌之理，主张伤寒、温病实系一症并无分别，中医治法，不过药品上之区别，与本病毫无关系，此种见解，今已知其大错矣。历考温症诸书，虽仍不免牵扯玄虚之习，然实已知治温病之正轨，惟伤寒一症，仍有人拘泥古书，经学家对于今文古语文之争辩检详，因而抉出真伪，以示来者，厥功甚伟。中国古医书之文笔句法，多非秦汉间文字，稍读古书者，极易辨别，一望而知为假托，乃后之医者不乏通儒，初来见有根本纠正者，惜哉，贻误害人者。古书治伤寒，非全部不灵验，但有一部分，实不可从者。故本编论病，开首先将伤寒一症，详细言之，此皆本诸实验立论非臆断也。
Dare not deceive people with falsehoods, thereby repeating the mistakes of predecessors who wrote books with excessive embellishment and exaggeration. Readers should pay attention to this point and firmly believe my words. (Shanghan) Shanghan (Shanghan and Wenbing are fundamentally different; the Western medical term "Enteric Fever" actually encompasses both Shanghan and Wenbing, which is rather ambiguous [detailed discussion in previous sections].) (Etiology) This disease is caused by invasion from severe cold outside the body, especially when a person stays in a warm room and suddenly encounters extreme cold outdoors. This causes a drastic temperature difference felt by the skin, leading to the sudden contraction and closure of pores all over the body. The internal heat cannot penetrate outward, accumulates inside, and thus forms the symptoms of Shanghan. However, this condition is mostly seen in severe winter weather; it rarely occurs during spring, summer, or autumn. Western medicine attributes it to infection by Salmonella typhi, which is indeed an accurate conclusion. However, examining Western medical texts, the term "Enteric Fever" does not refer only to Shanghan. (It also includes Wenbing and Plague.) Therefore, I advocate that this disease should still be named separately, and I dare not follow the common practice. Because Shanghan and Wenbing are indeed two different diseases; treating them with the same TCM method would inevitably lead to errors. Since Western medicine uses "Enteric Fever" to name these two conditions, their treatment methods are also undifferentiated. (Actually, Shanghan involves external cold injury first; the initial treatment must resolve the exterior cold. Only if treated improperly will it transmit through meridians into the interior, becoming internal heat, eventually resulting in intestinal heat. Wenbing involves solid heat in the lungs first; the initial treatment must clear lung heat. Similarly, improper treatment will also lead to intestinal heat. Although the results of these two conditions seem similar, at the onset, TCM treatment methods and medicines are absolutely different and often yield miraculous effects. Western medicine, however, treats these two conditions without distinction, so its therapeutic results are far inferior to TCM.) Besides preventive injections, symptomatic therapy, and expectant therapy, if a patient has already fallen ill, there is truly no other method to make the disease recover quickly. (The efficacy of serum therapy is also not entirely accurate.) The final result depends on how the intestinal lesions develop, waiting for natural progression. This is indeed a shortcoming of Western medicine. However, this shortcoming may stem from the deep divide between Chinese and Western medicine. This "divide" does not mean Western doctors do not understand Chinese herbs or vice versa. Currently, there is a trend of mixing Chinese and Western medicines; recent TCM journals discuss Western drugs, and some Western practitioners engage in processing Chinese herbs. Superficially, it seems the divide has decreased and integration achieved, but in reality, the divide persists, and this incomplete integration might cause the loss of TCM's unique strengths in treatment and medication, doing more harm than good. Examples are as follows: ① Ephedrine (Ephedrae Herba active ingredient) is now used in Western medicine for its ability to calm asthma and promote diuresis. However, using Ephedrine instead of Mahuang Tang (Cinnamon Twig Decoction) to treat Taiyang syndrome (Taiyang Exterior Syndrome) of Shanghan invariably leads to serious errors. ② Some TCM journals have listed dispersing herbs like Mahuang (Ephedrae Herba) in antipyretics, calling them "diaphoretic antipyretics," comparing them with Western antipyretics like Aminopyrine (Aminopyrinum). They claim: "Aminopyrine often induces sweating after ingestion, so it is also called a diaphoretic antipyretic." Such writings appear to integrate Chinese and Western medicine seamlessly. However, if these two drugs are used separately to treat the same condition, they cannot produce consistent effects. Moreover, if Mahuang is indiscriminately used for febrile diseases under the label of diaphoretic antipyretics, death could occur swiftly. Conversely, labeling Aminopyrine as having "diaphoretic" properties is ridiculous. Aminopyrine's sweating is merely a side effect, unlike Mahuang's specific ability to release the exterior and penetrate both interior and exterior. Whether for Shanghan exterior syndrome or severe colds, clinical trial proves this immediately. How can one rely solely on theory to force a synthesis and mislead future generations?
I deeply fear that such incomplete integration will lose the respective strengths and true nature of both Chinese and Western medicine. Thus, I repeat myself tirelessly, not out of a desire to argue. ) Or perhaps due to TCM's conservatism and Western medicine's limitation by science. (Science is boundless; regarding current science as sacred while despising everything else is also a form of conservatism.) Being fundamentally biased, lacking true understanding of both, they cannot discard shortcomings and adopt strengths to benefit practice. This is a shame for medical researchers. I hope every doctor strives hard.
(Symptoms) This condition can be explained in three stages. Stage 1: Stiffness and pain in the head and neck, body pain, joint pain, lower back pain, aversion to cold, (these two characters are most important) or aversion to wind, anhidrosis, (sweating is rare), vomiting, or fever, (fever will inevitably occur sooner or later, interpret 'or' accordingly), nasal congestion with heavy voice, or cough and wheezing, tight pulse, or floating-tight pulse. (This tight pulse is the most characteristic initial phenomenon of Shanghan, rarely seen in Wenbing, note this.) This is what is called the exterior syndrome. (This is what ancient medical texts call Taiyang syndrome, but I do not wish to discuss such terms.) Stage 2: Approximately four to five days after onset, the pulse gradually becomes larger, tidal fever, (indicating pathogen entering the interior, stomach heat has developed,) aversion to cold disappears, or slight sweating, heaviness of the body, dizziness or headache, vomiting and inability to eat, or cold extremities, dry mouth and throat with thirst, irritability, abdominal fullness, or hardness and stuffiness below the heart, or jaundice, dry stool or bloody stool, or epistaxis, yellow tongue coating, delirium is also common in this stage. Tidal fever and delirium are the most major symptoms and require special attention. Hypochondriac pain, cracked yellow tongue coating, scanty dark urine, deafness, alternating chills and fever, vomiting, chest stuffiness and pain, abdominal pain, constipation for several days or diarrhea, coma and delirium, wiry-rapid pulse. The fever in this stage is extremely high and difficult to reduce.
Stage 3: Fever persists or cold extremities, (if cold extremities are severe, the whole body may be cold) thready-faint pulse, or intermittent pulse, loose stool or spontaneous passage of undigested food, or purulent bloody stool, fever may suddenly drop (more critical), rapid breathing (long exhalation, short inhalation), weak voice, mental fatigue, physical exhaustion (aversion to cold may occur here, absolutely do not mistake it for exterior syndrome), spontaneous sweating, night sweats, (this sweat is very different from Stage 2), groping at clothes and bed. (These four characters describe the hazy state of dissipating spirit, more severe than delirium, indicating a critical condition.)
(Treatment Methods) The treatment methods for this condition cannot be combined between Chinese and Western medicine. It is truly because the medicines differ and theories are distinct, so forced integration is impossible. At the beginning of Stage 1 (TCM's Taiyang Meridian Syndrome), (note "beginning") aversion to cold is extreme, headache and body pain are severe. The only effective treatment at this time is diaphoresis to release the exterior. If in severe winter, {note "severe winter"}, Mahuang (Ephedrae Herba), Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Fangfeng (Saposhnikoviae Radix), Shengjiang (Zingiberis Rhizoma Recens), Gancao (Glycyrrhizae Radix et Rhizoma), Ziye (Perillae Folium) are all necessary items. Select appropriately based on severity of illness and strength of the person, (this is crucial to avoid excessive sweating). If cough and wheezing exist, add Xingren (Armeniacae Semen Amarum) appropriately. After taking medicine, drink plenty of hot water, cover with blankets to induce sweating, which is the primary key. (If there is dry heaving, ignore it; just use dispersing herbs.) Using this treatment early for early Shanghan often cures with one dose, preventing progression to severe illness. (Using Western antipyretics like Aminopyrine at this stage is not only ineffective but may delay proper treatment and cause severe illness, which is my practical experience, shared with students.) The difference in treatment between Shanghan and Wenbing lies in this first step. There are absolutely no Western medicines for early Shanghan. Although Western medicine has diaphoretic methods, they lack specific efficacy, hence the term "expectant therapy." (I sincerely hope Western medicine will humbly learn from these TCM methods to combat epidemics together.)
For severe cases at onset, regardless of hot baths or steam, sweating is usually impossible. Only after taking TCM dispersing herbs can sweating occur, with Mahuang being the most effective. If Ephedrine is used instead, no sweating occurs. After one episode of sweating, all symptoms are fundamentally resolved, straightforwardly, without mystery. The pathology of inducing sweating for Shanghan exterior syndrome is simple and understandable: cold invades and closes the pores completely, trapping internal heat, causing discomfort. TCM herbs for this are warm-natured and pungent-spicy (e.g., Ginger). Ingesting them expands internal heat, forcefully opening pores via sweat, curing the disease instantly. What is magical about this? However, dispersing for early Wenbing is different, which is why TCM is particularly effective for these two conditions. The greatest taboo is arbitrarily adding other drugs to the above prescriptions, such as rigidly adhering to ancient formulas, viewing them as sacred, and falling into mysticism. This leads to impure medicinal power, failure to induce sweating, and missed treatment opportunities, which is lamentable! In this section, I oppose blind faith in ancient books. Judge me as you will. When using diaphoretic herbs, note that for very weak individuals and the elderly, dosages must be extra cautious. Instruct caregivers to monitor closely during blanket-induced sweating to prevent excessive sweating and cardiac arrest. For "sweat collapse," Mahuang must not be used in large doses; adults should take 1-2 qian (approx. 3-6g). It must be honey-fried to avoid danger. Better to have insufficient sweating from one dose and take another, rather than acting rashly and causing danger. Guizhi (Cinnamomi Ramulus) easily causes epistaxis; use small doses or avoid it. This is the treatment for Stage 1 of Shanghan. If dispersing is done correctly at onset, the disease resolves with one sweat. Patients may dismiss it as a common cold, neglecting it. Thus, the wonder of TCM is half-hidden behind the term "common cold." Missing this treatment or using杂乱 medicines causes prolonged blockage, excessive internal heat accumulation invading intestines and stomach, making various heat symptoms hard to dissipate (Enteric Fever heat type), leading to the Western concept of "expectant therapy" as helpless. However, I handle this case flexibly, tested repeatedly, confirming that the fundamental treatment in Stage 1 has incredible TCM efficacy. Do not stick to Western views and abandon inherent good methods. I hope those interested in world medicine adopt this view to preserve TCM strengths and aid treatment success. My argument that "Enteric Fever" cannot encompass both Shanghan and Wenbing is based on this. Early Wenbing also presents exterior symptoms like aversion to cold, aversion to wind, headache, and joint pain.
Lower back pain is less common. The pulse differs greatly from Shanghan; Wenbing pulses are often floating-rapid, especially prominent in the right Cun position, or large and soggy. Tight-string-like pulses typical of early Shanghan are rare. This is the most crucial point to note. Secondly, climate relations: Shanghan occurs mostly in extremely cold winters, rarely in spring, summer, autumn. Wenbing occurs in all seasons. When Wenbing epidemics occur, they are more widespread and spread faster than Shanghan, making them easier to distinguish. Although early Wenbing symptoms resemble Shanghan slightly, using acrid-warm dispersing herbs for Shanghan exterior syndrome (e.g., Mahuang, Guizhi - ancient texts advocating Guizhi for Wenbing is a huge error; Qianghuo, Xixin, Duhuo, etc.) with excessive sweating will definitely cause danger. Using Western antipyretics like Aminopyrine is even more ineffective. Thus, I say "Enteric Fever" should not broadly encompass both Shanghan and Wenbing.
Stage 2, corresponding to TCM's Yangming and Shaoyang syndromes. Treatment: Improper sweating allowed pathogens to enter the interior; internal organs are drying up. All diaphoretic herbs are contraindicated. Effective treatments here prioritize Dahuang (Rhei Radix et Rhizoma), Mangxiao (Natrii Sulfas). Next are Chaihu (Bupleuri Radix), Qianhu (Peucedani Radix), Huangqin (Scutellariae Radix), Zhuye (Bambusae Folium), Shigao (Gypsi Fibrosus), Qingpi (Citri Reticulatae Pericarpium Viride), Houpo (Magnoliae Officinalis Cortex), Zhishi (Aurantii Fructus Immaturus). Then Gualou (Trichosanthis Fructus), Banxia (Pinelliae Rhizoma - slightly drying, use with caution), Zhizi (Gardeniae Fructus), Douchi (Sojae Semen Preparatum), Yinchenshao (Artemisiae Scopariae Herba), Chixiaodou (Vigna Semen Rubrum - use for jaundice), Xingren (Armeniacae Semen Amarum), Huangbai (Phellodendri Cortex), etc., select according to circumstances. The key is sweet-cold and bitter-descending to unblock intestines and stomach. For chest stuffiness and pain, modify Xiaoxianxiong Tang (Minor Triplex Decoction). If tidal fever, delirium, abdominal fullness or pain occur, even with headache, do not mistakenly suspect residual exterior syndrome. Use Dahuang. If the condition is not solid or the patient is too weak, use Shu Dahuang (Prepared Rhubarb). Zhi Shi and Houpo should be used mildly. Mangxiao is not needed here. If pulse and symptoms are excess, yellow tongue, cracked lips, thirst, abdominal pain, delirium, tidal fever, scanty dark urine urgently use raw Dahuang plus Mangxiao, Zhishi, Houpo, etc., to purge. Skin heat will likely be present. Also use Western antipyretics like Aspirin (Aspirinum), Aminopyrine, etc., but separate from TCM by six hours. Salts (Sal Kallum) can also be used. This is the treatment for Stage 2. Proper treatment prevents worsening into intestinal bleeding or perforation risks. During this period, reliance on Western medicine may be needed. Refer to clinical experiences; it differs from Stage 1 where pure TCM is used. Note that Western medicine is definitely ineffective in Stage 1. Chaihu is the specific herb for alternating chills and fever in this stage; add Chuanxiong (Ligustici Chuanxiong Rhizoma) and Baizhi (Angelicae Dahuricae Radix) for headaches, both effective. Jaundice symptoms may also appear; Western Salts are effective for jaundice and can be used, referencing Yinchen Hao Tang (Artemisiae Scopariae Decoction) and adding symptomatic drugs. Beyond unblocking intestines, Chengqi Tang (Chengqi Decoction) is superior to Salts and Calomel. Western antipyretics are necessary. Acetaminophen (Paracetamolum), Aminopyrine, Aspirin, Salts, etc., can be selected. Cooling agents like dilute Hydrochloric Acid (Acidum Hydrochloricum Dilutum) can also be used. For patients with heart weakness, thready-faint pulse, or spontaneous/night sweats, use antipyretics with special caution and avoid large doses. Compared to pure TCM, this is particularly effective. Missing this treatment leads to Stage 3, increasing danger. Ancient formulas are not devoid of efficacy, but most are confused by other prescriptions. Years of experimentation are needed for true recognition and selection, which is what this compilation adopts.
Stage 3 Treatment: This stage corresponds to TCM's Taiyin, Shaoyin, Jueyin syndromes, and Western medicine's complications like intestinal bleeding and perforation. It is more troublesome. If Stage 1 and 2 were treated correctly (sweating and purging), progression to Stage 3 would be avoided. Such changes result purely from over-trusting confusing ancient TCM theories, cluttering the mind. Upon encountering this disease, one doesn't know where to start; recognizing symptoms leads to confusion and hesitation. (Because theories sound profound but are actually chaotic, leading scholars into a maze; the more they study, the more confused they become.) Medication becomes rigid and forced. (Viewing ancient formulas as sacred leads to killing patients.) Mistake after mistake, the disease progresses irreversibly, yet doctors still claim "This is a certain meridian syndrome, using a certain meridian formula." Alas! The condition reaching this stage is not the inevitable course of the disease. Western medicine treats Shanghan with drugs unsuitable for this condition, often leading to severe illness, thus accepting "expectant therapy" as absolute truth. Actually, Western medicine is not imprecise; the problem is lacking the right drugs. If this disease were treated at the pure exterior stage with one sweat, how would the intestines become hot, bleed, or perforate? By Stage 2, TCM Chengqi Tang is indeed superior to Western drugs, but Western antipyretics fit this condition better. Confused by ancient texts, mistakes lead to Stage 3 dangers. Having treated many such cases, I confirm that combining Chinese and Western treatments (when appropriate) cures 80-90% quickly; separating them leaves each with shortcomings. At this time, decisive action is needed to save dying patients. Applying medicine flexibly and appropriately saves 2-3 out of 10. In my experience, 80-90% of cases at this stage are critical. Intestinal bleeding stage involves passing pus/blood or black oily matter; cure is still possible. Intestinal perforation stage offers little hope for rescue. Cold extremities are constant. If body temperature remains high, purging or large-dose yin-nourishing can be used. Requires absolute certainty in diagnosis; do not abuse laxatives. If showing complete collapse symptoms (thready pulse, cold body, spontaneous/night sweats, panting, insomnia, empty irritability, passage of undigested food), indicating extreme deficiency, the only method is massive tonification of Yin and Yang. This method is superior to Western cardiotonics and hemostatics. However, the above two methods (purging vs. tonifying) require precise diagnosis; any error kills instantly. This depends on the doctor's academic experience and application skills, something that can be understood intuitively but not fully conveyed in words.
TCM regarding Shanghan and Wenbing has been entangled due to fundamental confusion in ancient books. Fortunately, later generations gradually experimented and clarified, realizing Shanghan and Wenbing treatments are absolutely different. Forty years ago, I purely believed in Western medicine. Based on the theory of Enteric Fever bacteria, I argued Shanghan and Wenbing were the same disease with no difference, and TCM treatment was merely a difference in drugs unrelated to the disease itself. I now know this view was largely wrong. Reviewing Wenbing books, although they retain some mystical habits, they essentially know the correct path for treating Wenbing. However, for Shanghan, some still cling to ancient books. Like philologists debating modern vs. ancient scripts to discern truth for future generations, their merit is great. Chinese ancient medical texts' writing style and syntax are mostly not from Qin/Han periods. Those who read ancient books can easily identify forgeries. Yet, later physicians, including Confucian scholars, failed to correct this fundamentally. Pity, those who misled and harmed people. Ancient books on treating Shanghan are not entirely ineffective, but parts are unacceptable. Therefore, this compilation discusses Shanghan in detail first. These arguments are based on experiments, not speculation.