议曰正受伤寒所由感受邪冒冷脱着伤于腠理轻即伤风重即壮热头痛鼻塞流涕斯乃正伤寒
候又
有伤风伤着伤冷伤湿皆能作热困乏但不咳嗽又有夹惊因惊之时而又伤寒故云夹惊伤寒又有因
食之时而感受寒邪故曰夹食大抵伤寒或有他症似积之类切不可妄下若下之太早表里俱虚虽以
调理谓之坏症大人坏症由尚可药小儿坏症救疗无门哀哉凡伤寒有惊候亦不可下惊药饵是夹惊
症亦不可用惊药幼幼伤寒只可表解虽曰用表不可令儿汗出如王氏杜薄荷散和剂方人参羌活
散之类名热在里谵语郑声于症当下者只用散末药七宝洗心散四顺饮之类不可用以丸子或以取
积药下之其热不去反成无辜夹食者于理用下宜紫霜凡下之量其虚实而用须究门先伤寒后夹食
或先夹食后伤寒然伤寒夹食乃在于食时之间惟母觉知其先后多是不觉若知其理以后受者而先
调理既不明其先后即可表解以候里症有者方可与下尤为善也且下与表二理不可并行有乎得失
旦如家宝有云三日前在表三日后在里斯乃大概约而言之恐后人传之不当及为其害凡伤寒在表
即解在里即下不可以日限为拘其或有在表里之间亦宜和解又不愈小柴胡汤治之又不愈候传里
下为良（大者谵语小即烦啼）切不可意急取愈宜在用心明究表里若也审察妄恣用药不当吁哉
议曰：所谓“正伤寒”，是指感受寒邪，冒犯冷风，导致腠理（皮肤毛孔）受损。轻者表现为伤风，重者则出现壮热、头痛、鼻塞、流涕等症状，这就是典型的伤寒证候。
此外，还有伤风、受寒、感湿等，这些都能引起发热和困倦乏力，但通常不伴有咳嗽。
又有“夹惊伤寒”，是因为在受到惊吓的同时又感染了伤寒，所以称为夹惊伤寒；又有“夹食伤寒”，是因为在饮食积滞的时候又感受了寒邪，所以称为夹食。
大抵而言，患伤寒时如果出现类似积滞的其他症状，切不可盲目使用泻下法。如果过早使用泻下法，会导致表里俱虚，即使经过调理，也会变成“坏症”（因误治而变坏的病证）。大人的坏症尚可用药救治，而小儿的坏症则救疗无门，实在令人哀叹！
凡是伤寒伴有惊厥征象的，也不可使用泻下法。惊药（镇惊安神药）仅适用于夹惊证，对于幼童的伤寒，只可采用解表法。虽然使用解表法，但不可让患儿出汗过多。例如王隐君的杜薄荷散，以及《和剂局方》中的人参羌活散等方剂。
如果热邪在里，出现谵语（胡言乱语）、郑声（语言重复低微）等症状，属于应当用下法的证候，此时只宜使用散剂，如七宝洗心散、四顺饮等，不可使用丸药，更不可用消积导滞的药来强行泻下。否则热邪不去，反而可能形成“无辜疳”（一种严重的儿科疳积重症）。
对于夹食的情况，从理论上讲应当使用下法，适宜选用紫霜丸。但是，下法的用量必须根据患儿的虚实情况而定，并且需要探究发病的先后顺序。或者是先患伤寒后夹食，或者是先夹食后患伤寒。然而，伤寒与夹食往往发生在进食前后不久，母亲往往难以察觉其先后顺序。如果能明白这个道理，对于后发生的病症先进行调理；如果无法明确先后顺序，可以先通过解表法观察，待里证明确存在时，方可使用下法，这才是最好的方法。
况且，解表与泻下两种治法不可同时进行，否则会有得失之弊。正如《家宝》所说：“前三日病在表，三日后病在里。”这只是一般性的概括说法，恐怕后人传抄不当而产生危害。凡伤寒在表的就解表，在里的就泻下，不可以天数作为拘泥的标准。如果有病在表里之间的，也应当采用和解法，用小柴胡汤治疗；如果仍不愈，等待病邪传入里部，再用下法为良。（成人表现为谵语，小儿表现为烦躁啼哭。）
Commentary: The term "Zheng Shanghan" (True Cold Damage) refers to contracting cold pathogens, being exposed to cold winds, and damaging the Couli (skin pores). Mild cases manifest as Wind-Cold invasion, while severe cases present with high fever, headache, nasal congestion, and runny nose; these are the typical symptoms of Shanghan.
Furthermore, conditions such as Wind-Cold injury, Cold exposure, and Dampness invasion can all cause fever and fatigue, but typically without coughing.
There is also "Shanghan Jia Jing" (Cold Damage complicated by Fright), which occurs when a child contracts Shanghan while simultaneously experiencing fright; hence it is termed complicated by fright. There is also "Shanghan Jia Shi" (Cold Damage complicated by Food Stagnation), which occurs when cold pathogens are contracted during a state of food stagnation; hence it is termed complicated by food.
Generally speaking, if Shanghan presents with other symptoms resembling food stagnation, one must not rashly employ purgative methods. If purgatives are used too early, both the exterior and interior will become deficient. Even after subsequent regulation, this may result in "Huai Zheng" (Ruined Syndrome caused by misdiagnosis or mistreatment). While an adult's Ruined Syndrome can still be treated with medicine, a child's Ruined Syndrome is beyond remedy, which is truly lamentable!
In any case where Shanghan is accompanied by signs of fright, purgatives must not be used. Medicines for calming fright (Zhen Jing Yao) are only suitable for syndromes complicated by fright. For pediatric Shanghan, only exterior-releasing methods should be employed. Although exterior-releasing methods are used, excessive sweating in the child must be avoided. Examples include Wang Yinxiong's Dumixiao San (Duduzhong Mint Powder) and Renshen Qianghuo San (Ginseng and Notopterygium Decoction) from the *Heji Jufang* (Formulas of the Bureau of Taiyi).
If heat is located in the interior, manifesting as Zhanyu (delirious speech) and Zhengsheng (repetitive, low-volume speech), this indicates a syndrome requiring purgation. In such cases, only powder formulations should be used, such as Qibao Xixin San (Seven-Treasure Heart-Washing Powder) or Sishun Yin (Four-Compliance Decoction). Pill formulations should not be used, nor should medicines intended for resolving stagnation be used to force purgation. Otherwise, the heat will not dissipate, potentially leading to "Wugu Ganshi" (Gu Worm Malnutrition, a severe form of pediatric malnutrition).
For cases complicated by food stagnation, theory dictates that purgation is appropriate, and Zishuang Wan (Purple Frost Pill) is suitable. However, the dosage of purgatives must be determined based on the child's deficiency or excess condition, and the sequence of onset must be investigated. It may be that Shanghan occurred first followed by food stagnation, or vice versa. However, Shanghan and food stagnation often occur close together around meal times, making it difficult for mothers to discern the sequence. If one understands this principle, one should regulate the later-onset condition first. If the sequence remains unclear, one may first employ exterior release to observe, and only apply purgation once the interior syndrome is clearly established; this is the optimal approach.
Moreover, exterior-releasing and purgative treatments should not be applied simultaneously, as this leads to gain-and-loss complications. As stated in *Jiabao*: "The first three days, the pathogen is in the exterior; after three days, it is in the interior." This is merely a general approximation, and fear exists that improper transmission of this rule could cause harm. Generally, Shanghan in the exterior is treated by releasing the exterior, and Shanghan in the interior is treated by purging; one should not rigidly adhere to the number of days. If the pathogen is between the exterior and interior, harmonization should be employed, using Xiaochaihu Tang (Minor Bupleurum Decoction). If there is no improvement, wait for the pathogen to transmit to the interior and then use purgation as the best course of action. (Adults present with delirium, while children present with irritability and crying.)
One must not be impatient to achieve a cure. One must carefully examine and thoroughly investigate the differentiation between exterior and interior. If examination is unclear and medications are used recklessly and inappropriately, alas, how dangerous!