夫伤寒者，前三日在表，法当汗，可用双解散，连进数服必愈。若不解者，病已传变。后
三日在里，法当下。殊不知下之太早，表热乘虚入里，遂成结胸、虚痞、懊 、斑疹、发黄之
证，轻者必危，危者必死。但当以平和之药，宣散其表，和解其里，病势或有汗而愈，或无汗
而愈。当用小柴胡、凉膈、天水。三药，合而服之。病若半在表、半在里，法当和解，小柴胡
、凉膈主之。若里热微者，则当微下，大柴胡合解毒汤。主之。热势未退，又以大柴胡合三一
承气汤。下之，两除表里之热。病至七八日，里证已甚，表热渐微，脉
虽浮数，则以三一承气合解毒。下之。其病胸膈满闷，或喘或呕，阳脉紧甚者，可用瓜蒂散。
涌之。汗吐下三法之后，别无异证者，凉膈散。调之。大热已去，微热者，以益元散。服之，
无令再病，此伤寒治法之大要也。
或伤风自汗，脉浮缓者，双解去麻黄。以汗之。其病半表半里，白虎汤。和解之。病在
里，脉沉细者，无问风寒暑湿，或表里证俱不已，或内外诸邪所伤，有汗无汗，心腹痛满，谵
语烦躁，蓄热内盛，但是脉沉者，并用承气合解毒下之。
或中暑自汗，解以白虎汤。（《直格》云∶夏至前为热，夏至后为暑，是以至后而用白虎
，宜乎？《局方》∶立秋后不用白虎。子和云∶若有白虎证，亦不用乎？却用，详审之耳。）白
虎解后，以五苓合天水。调之。多进数服无妨。或腹满
脉沉者，亦当承气合解毒。微下之。或发汗之后，热不解，脉尚浮者，白虎加苍术。再解之。
或里热内盛，阳厥极深，皆因失下而成此证，以致身冷脉微，昏懵将死。切不得以寒药下之，
误下即死。又，一辈庸医，妄言是阴厥，便欲易换，用真武、四逆温热之剂投之，下咽立死。
殊不知此证乃阴耗阳竭，阴气极弱谓之耗，阳厥极深谓之竭。蓄热怫郁，将欲死者。凡此之
证，寒剂热剂俱不可投，但进凉膈、解毒。以养阴退阳，宣散蓄热，脉气渐生，得大汗
而愈。（使汗气和而愈者。）未愈，却解毒合承气。下之，次以解毒、凉膈、天水。合而为一，调
合阴阳，洗涤脏腑，则其他别证，自不生矣。有大下之后，热不退，再三下之，热愈盛。若下
之不愈，脉微气虚力弱，不加以法，则无可生之理。若辍而不下，则邪热盛极，阴气极衰，脉
息断绝，必不可救，似此之证，是下之亦死，不下亦死。医者至此，活人杀人，一弹指间，其
不至手足失措者，几希矣。（《直格》云∶伤寒汗后，汗出不解，或反不汗，脉尚浮，白虎加
苍术汤再解之。又按，余论云∶伤寒下后，自汗，虚热不已，白虎加苍术、人参，一服如神，
汗止身凉，此通仙之法也。如此则汗下之后热不退，无问有汗无汗，通宜白虎加苍术解之，又
加人参亦妙。仍服凉膈、解毒调之。）经云三下而热不退者即死，后人有四五次下，以至十数
行而生者，此乃误中耳，活者未一二，死者千百，后学切不可以为法。但当根据前，用解毒合凉
膈调之，使阳热除退，阴气渐生，庶不失命。
若伤饮，不解散，或结胸之证，临时择用大小陷胸汤丸。累下之。脉浮者，不可下，是表
证未除，小柴胡合小陷胸汤。投之。脉虽浮而热太极者，大承气。徐徐疏利之。或有留
饮过度，湿热内生，小便自利，湿热未退，以解毒汤。治之。
阳证生斑，凉膈加当归。
怫郁热盛在表，燥而无汗，湿热在里，不能发于外，相搏遂成发黄，茵陈蒿汤调五苓散、
茵陈合承气下之。
心烦，不得眠，栀子豉汤。
误下太早，遂成结胸、虚痞，凉膈加枳壳、桔梗。
刚柔二 ，谵语发狂，逾垣赴井，皆阳热极盛者，承气合解毒。下之。
汗下后，烦渴饮水，则凉膈减桂、五苓、桂苓甘露饮、益元，选而用之。
小便不通，五苓泄之。大便闭结，承气下之。更有外证，加减防风通圣散方内随证用药。
妇人证治皆然，惟三四月并七八月不用硝，其余月分、用之无妨。
小儿减剂服之。
此中有古人治伤寒不传之妙，后之学人，其慎宝之。
伤寒病，前三日病邪在体表，治法应当发汗，可以使用双解散，连续服用数剂必定痊愈。如果病情没有解除，说明病邪已经传变。后三日病邪在体内，治法应当攻下。却不知道攻下太早，表热的病邪会乘虚进入体内，于是形成结胸、虚痞、懊憹、斑疹、发黄等证候，轻的必然危险，危险的必然死亡。只应当用平和的药物，宣散表邪，和解里气，病势或许通过出汗而愈，或许不出汗而愈。此时应当使用小柴胡汤、凉膈散、天水散这三种药物，合并服用。如果病邪一半在表、一半在里，治法应当和解，以小柴胡汤、凉膈散为主治方。如果里热轻微的，则应当轻微攻下，以大柴胡汤合解毒汤主治。如果热势没有消退，又用大柴胡汤合三一承气汤攻下，以同时清除表里两方面的热邪。病至七八日，里证已经很严重，表热逐渐微弱，脉象虽然浮数，也用三一承气汤合解毒汤攻下。如果病人胸膈满闷，或者气喘或者呕吐，阳脉紧束严重的，可以使用瓜蒂散涌吐。在汗、吐、下三法之后，如果没有其他异常证候，用凉膈散调理。大热已去，仅有微热的，服用益元散，不要让疾病复发，这是治疗伤寒的大要。
如果是伤风导致自汗，脉象浮缓的，双解散去掉麻黄来发汗。如果病邪在半表半里，用白虎汤和解。病在里，脉象沉细的，不论风寒暑湿，或者表里证都不缓解，或者被内外各种邪气所伤，有汗无汗，心腹疼痛胀满，说胡话烦躁不安，蓄积的热邪在体内旺盛，只要是脉象沉的，都用承气汤合解毒汤攻下。
或者是中暑导致自汗，用白虎汤解表。（《直格》说：夏至前为热，夏至后为暑，所以夏至后用白虎汤，合适吗？《局方》：立秋后不用白虎汤。张子和说：如果有白虎汤证，也不用吗？却用了，详细审察罢了。）白虎汤解表后，用五苓散合天水散调理。多进服几剂无妨。如果腹部胀满脉象沉的，也应当用承气汤合解毒汤轻微攻下。或者发汗之后，热不退，脉象还浮的，用白虎加苍术汤再次解表。或者里热内盛，阳气厥逆极深，都是因为失于攻下而成为这种证候，以致身体冷脉象微弱，昏迷懵懂快要死亡。切不可以用寒凉药攻下，误用攻下就会死亡。另外，有一类庸医，胡乱说是阴厥，便想要更换药物，用真武汤、四逆汤等温热药剂投喂，咽下去立刻死亡。却不知道这种证候乃是阴液耗竭阳气枯竭，阴气极度虚弱叫做耗，阳气厥逆极深叫做竭。蓄积的热邪郁结，将要死亡。凡是这种证候，寒剂和热剂都不可投用，只进服凉膈散、解毒汤来滋养阴气退制阳气，宣散蓄积的热邪，脉气逐渐恢复，出大汗而痊愈。（使汗出气和而痊愈的。）如果未愈，再用解毒汤合承气汤攻下，接着用解毒汤、凉膈散、天水散合在一起，调和阴阳，洗涤脏腑，那么其他的别证，自然就不会产生了。有大面积攻下之后，热不退，再三攻下，热更盛。如果攻下不愈，脉微气虚力弱，不加以正确的方法，就没有存活的道理。如果停止不再攻下，那么邪热盛极，阴气极衰，脉息断绝，必不可救，像这样的证候，是攻下也死，不攻下也死。医生到了这种地步，救人杀人，就在弹指之间，能不至于手足失措的，太少了。（《直格》说：伤寒发汗后，汗出不解，或者反而不出汗，脉还浮，用白虎加苍术汤再解表。又按，我的论述说：伤寒攻下后，自汗，虚热不已，用白虎加苍术、人参，一服如神，汗止身凉，这是通仙之法。这样看来，汗下之后热不退，不论有汗无汗，都适宜用白虎加苍术汤解表，再加人参也很好。仍服凉膈散、解毒汤调理。）经书说三次攻下而热不退的就死，后人有的四五次攻下，以至十多次排便而存活的，这是误打误撞罢了，活着的不到一二个，死去的千百个，后学者切不可以此为法。只应当根据前面的方法，用解毒汤合凉膈散调理，使阳热除退，阴气渐生，才不至于丧命。
如果是伤饮，不解散，或者结胸的证候，临时选择使用大小陷胸汤丸。多次攻下。脉浮的，不可攻下，这是表证未除，用小柴胡汤合小陷胸汤投服。脉虽然浮但热极严重的，用大承气汤慢慢疏利通便。或者有留饮过度，湿热内生，小便自利，湿热未退，用解毒汤治疗。
怫郁热盛在体表，干燥而无汗，湿热在体内，不能发散到体外，相互搏结于是形成发黄，用茵陈蒿汤调服五苓散、茵陈合承气汤攻下。
刚痉柔痉，说胡话发狂，爬墙跳井，都是阳热极盛的，用承气汤合解毒汤攻下。
汗下之后，烦渴饮水，则从凉膈散减桂枝、五苓散、桂苓甘露饮、益元散中选择使用。
小便不通，用五苓散泄利。大便闭结，用承气汤攻下。更有外证，在加减防风通圣散方内随证用药。
妇人证治都一样，只是三月四月和七月八月不用芒硝，其余月份，使用无妨。
小儿减少剂量服用。
Shaoyang (Taiyang) disease: in the first three days, the pathogen is at the exterior; the treatment method should be sweating (diaphoresis), and Shuangjie San (Double-Release Powder) can be used. Continuous administration for several doses will surely lead to recovery. If the condition does not resolve, the disease has transmitted. In the subsequent three days, the pathogen is at the interior; the treatment method should be purgation. However, one must not know that purging too early allows the exterior heat to enter the interior due to deficiency, thereby forming syndromes such as Jie Xiong (Chest Binding), Xu Pi (Empty Fullness), Ao Nao (Restlessness), Ban Zhen (Macules and Papules), and Huang Jin (Jaundice). Mild cases will become critical, and critical cases will result in death. One should only use mild medications to disperse the exterior and harmonize the interior. The disease trend may resolve with sweating or without sweating. At this time, Xiao Chai Hu Tang (Minor Bupleurum Decoction), Liang Ge San (Cooling the Diaphragm Powder), and Tian Shui San (Heavenly Water Powder) should be used together. If the pathogen is half at the exterior and half at the interior, the treatment method should be harmonization, primarily using Xiao Chai Hu Tang and Liang Ge San. If the interior heat is slight, mild purgation should be employed, primarily using Da Chai Hu Tang (Major Bupleurum Decoction) combined with Jiedu Tang (Detoxification Decoction). If the heat intensity has not subsided, Da Chai Hu Tang combined with Sanyi Chengqi Tang (Three-One Bowel-Regulating Decoction) should be used for purgation to remove heat from both the exterior and interior simultaneously. By the seventh or eighth day, the interior syndrome is severe, and the exterior heat is gradually diminishing. Although the pulse is floating and rapid, Sanyi Chengqi Tang combined with Jiedu Tang should still be used for purgation. If the patient experiences chest and diaphragm fullness, or wheezing or vomiting, and the Yang pulse is extremely tight, Gouti San (Melon Seed Powder) can be used for emesis. After the application of sweating, emesis, and purgation methods, if there are no other abnormal symptoms, Liang Ge San should be used for regulation. Once the high fever has gone and only slight fever remains, Yiyuan San (Benefit Origin Powder) should be taken to prevent recurrence. This is the general principle of treating Shaoyang (Taiyang) disease.
If wind injury causes spontaneous sweating and a floating-slow pulse, remove Mahuang (Ephedrae Herba) from Shuangjie San to induce sweating. If the disease is half-exterior half-interior, Baihu Tang (White Tiger Decoction) should be used for harmonization. If the disease is at the interior with a deep-thin pulse, regardless of wind-cold or summerheat-dampness, or if exterior-interior syndromes do not resolve, or if injured by various internal and external pathogens, whether with or without sweating, accompanied by heart and abdominal pain and fullness, delirium, and irritability, where accumulated heat is abundant internally, and whenever the pulse is deep, all such cases should be treated with Chengqi Tang (Bowel-Regulating Decoction) combined with Jiedu Tang for purgation.
Or, if summerheat injury causes spontaneous sweating, it should be resolved with Baihu Tang. (*Zhige* states: Heat before the Summer Solstice, Summerheat after the Summer Solstice; thus, using Baihu Tang after the solstice seems appropriate? *Ju Fang* states: Do not use Baihu Tang after the Start of Autumn. Zhang Hezi said: If there is a Baihu Tang syndrome, should it not be used? Yet it was used; examine it carefully.) After resolution with Baihu Tang, regulate with Wuling San (Five-Ingredient Poria Powder) combined with Tian Shui San. Taking several additional doses is harmless. If there is abdominal fullness and a deep pulse, mild purgation with Chengqi Tang combined with Jiedu Tang is also appropriate. Or, after sweating, if the fever does not subside and the pulse remains floating, Baihu Jia Cangzhu Tang (White Tiger Decoction plus Atractylodis Rhizoma) should be used again for resolution. Or, if interior heat is abundant and Yang reversal is extreme, all resulting from failure to purge, leading to cold body and faint pulse, coma and near-death state, one must absolutely not use cold medicines for purgation; erroneous purgation leads to death. Furthermore, some quack doctors wrongly claim it is Yin reversal and wish to switch treatments, administering warm-hot agents like Zhenwu Tang (True Warrior Decoction) or Sini Tang (Reversed Extremities Decoction); upon swallowing, death occurs immediately. They do not realize that this syndrome is characterized by Yin consumption and Yang exhaustion. Extreme weakness of Yin is called consumption; extreme depth of Yang reversal is called exhaustion. Accumulated heat is stifled and depressed, nearing death. For such syndromes, neither cold nor hot agents should be administered. Only administer Liang Ge San and Jiedu Tang to nourish Yin, retreat Yang, and disperse accumulated heat. As the pulse energy gradually returns, profuse sweating leads to recovery (resolving when sweat is harmonious). If not recovered, then Jiedu Tang combined with Chengqi Tang should be used for purgation. Subsequently, Jiedu Tang, Liang Ge San, and Tian Shui San should be combined to harmonize Yin and Yang, cleanse the Zang-Fu organs, so that other separate syndromes naturally do not arise. After severe purgation, if fever does not subside and purgation is repeated multiple times, the fever becomes more intense. If purgation fails to resolve it, and the pulse is faint, Qi is deficient, and strength is weak, without proper method, there is no hope of survival. If purgation is stopped, the evil heat becomes extremely abundant, Yin Qi becomes extremely deficient, pulse and respiration cease, making it incurable. Such syndromes mean purgation leads to death, and non-purgation leads to death. Physicians at this juncture save or kill lives within a finger snap; those who do not lose their composure are rare. (*Zhige* states: After sweating in Shaoyang (Taiyang) disease, if sweating does not resolve the condition, or conversely, no sweating occurs, and the pulse remains floating, use Baihu Jia Cangzhu Tang again for resolution. Also, my discussion states: After purgation in Shaoyang (Taiyang) disease, if spontaneous sweating persists and deficiency-heat does not cease, use Baihu Jia Cangzhu Ren Shen Tang (White Tiger Decoction plus Atractylodis Rhizoma and Ginseng Radix); one dose works miraculously, stopping sweating and cooling the body; this is the immortal method. Thus, after sweating or purgation, if fever does not subside, regardless of sweating or not, it is generally suitable to use Baihu Jia Cangzhu Tang for resolution, adding Ginseng is also excellent. Continue taking Liang Ge San and Jiedu Tang for regulation.) The Classics state that if fever does not subside after three purgations, death ensues. Later practitioners have survived after four or five purgations, even up to ten or more bowel movements; this is merely accidental error. The survivors are one or two out of hundreds or thousands. Later learners must absolutely not take this as a standard. One should only follow the previous method, using Jiedu Tang combined with Liang Ge San for regulation, allowing Yang-heat to recede and Yin Qi to gradually regenerate, thereby avoiding loss of life.
If fluid retention injury does not resolve with Shuangjie San, or if there is a Jie Xiong syndrome, choose between Da/Xiao Xianxiong Tang/Wan (Major/Minor Chest-Binding Decoction/Pill) temporarily. Purge repeatedly. If the pulse is floating, do not purge; this indicates the exterior syndrome is not yet removed. Use Xiao Chai Hu Tang combined with Xiao Xianxiong Tang. If the pulse is floating but heat is extreme, slowly unblock and lubricate with Da Chengqi Tang (Major Bowel-Regulating Decoction). Or, if retained fluid is excessive, generating internal damp-heat, with free urination, and damp-heat has not subsided, treat with Jiedu Tang.
Yang syndrome with macules: Liang Ge San plus Danggui (Angelicae Sinensis Radix).
Stifling depression with heat abundant at the exterior, dry without sweating; damp-heat at the interior unable to vent outward; struggling together leads to jaundice. Regulate with Yinchen Hao Tang (Artemisiae Scopariae Decoction) mixed with Wuling San; or purge with Yinchen combined with Chengqi Tang.
Heart vexation, inability to sleep: Zhizi Chi Tang (Gardeniae and Soya Bean Decoction).
Erroneous early purgation leading to Jie Xiong and Xu Pi: Liang Ge San plus Zhike (Aurantii Fructus) and Jiegeng (Platycodonis Radix).
Gang and Rou Jing (Spasm syndromes), delirium and mania, climbing walls or jumping into wells: all indicate extreme Yang heat. Purge with Chengqi Tang combined with Jiedu Tang.
After sweating and purgation, with vexation, thirst, and desire to drink water: select from Liang Ge San minus Guizhi (Cinnamomi Ramulus), Wuling San, Guiling Ganlu Yin (Cassia and Poria Sweet Dew Drink), or Yiyuan San.
Urinary obstruction: drain with Wuling San. Fecal impaction: purge with Chengqi Tang. If there are additional exterior symptoms, adjust medications according to the syndrome within the Fangfeng Tongsheng San (Saposhnikovia Universal Relief Powder) formula.
For women, the treatment principles are the same, except that Mangxiao (Natrii Sulfas) is not used in the third, fourth, seventh, and eighth months; usage is harmless in other months.
For children, reduce the dosage.
This contains the untransmitted subtleties of ancient physicians in treating Shaoyang (Taiyang) disease. Future students should guard and cherish it carefully.