先里后表者。始则发热。渐盖理证。下之便愈。后复发热。反加头疼身重脉浮者。宜
白虎汤。服之不得汗者。津液枯竭也。加人参。覆杯即解。若大汗大下后。表里之证
悉去。继而一身尽痛。身如被杖。脉沉细者。此汗出太过。阳气不周。骨寒而痛。非表
证也。此不必治。二三日内阳回自愈。
表证偏胜者。膜原伏邪发时。传表之邪多。传里之邪少。何以知之。表证多而里证少。当治其表。里证兼之。
若里证多而表证少。但治其里。表证自愈。
邪之伤人也。始而伤气。既而伤血。伤肉伤筋。以至伤骨。有行邪。有伏邪。故治法有
难有易。取效有迟有速。如行邪者。即正伤寒也。始自太阳。或传阳明。或传少阳。病
势虽重。一汗可解。若归胃府。一下而愈。如瘟疫之邪。先伏后行。伏于膜原。如鸟栖
巢。如兽藏穴。营卫所不关药石所难及。至其发也。邪毒渐张。内侵于腑。外淫于经。
营卫受伤。诸证渐显。然后得而治之。方其侵淫之际。邪毒尚在膜原。此时但可疏
利。使伏邪易出。邪毒既离膜原。乃观其变。或出表或入里。然后可导邪而出。邪尽
方愈。初发之时。毒邪渐张。莫之能御。不惟不能即瘳。而病证日惟加重。病家见证
反增。即欲更医。医家不解。亦自惊诧。竟不知先时感受。邪盛则病重。邪微则病轻
也。人云。瘟疫莫治头。劳怯莫治尾。所以疫邪方张之际。势不可遏。但使邪毒速离
膜原。便是治法也。全在后段工夫。识得表里虚实。详夫缓急轻重。投剂不致差谬。
如是可以万全。即使感受之最重者。按法治之。必无陨命之理。若夫久病枯极。酒
色耗竭。耆耄之年。皆是天真几绝。又加疫证。自难支矣。
先治里证后治表证的情况。起初出现发热，逐渐转变为里热实证，使用下法治疗即可痊愈。之后再次发热，反而出现头痛、身体沉重、脉象浮的症状，适宜使用白虎汤。服用后若不能出汗，说明津液枯竭，应加入人参，服药片刻后即可痊愈。如果在大量发汗或大量攻下之后，表证和里证都消失了，接着全身疼痛，身体像被棍棒打过一样，脉象沉细，这是因出汗过多导致阳气不能周流全身，骨骼寒冷而疼痛，并非表证。这种情况不需要特别治疗，两三天内阳气恢复即可自愈。
表证偏胜的情况。膜原潜伏的邪气发作时，传变到表的邪气多，传变到里的邪气少。怎么知道呢？因为表证多而里证少。应当治疗表证，兼治里证。
如果里证多而表证少，只需治疗里证，表证自然会痊愈。
邪气伤害人体，起初伤及气分，随后伤及血分，伤及肌肉、筋脉，以至于伤及骨骼。有行邪（即时发病的邪气），有伏邪（潜伏后发病的邪气），所以治疗方法有难有易，见效有快有慢。如行邪，就是普通的伤寒病，起始于太阳经，或者传入阳明经，或者传入少阳经。病情虽然严重，一次发汗即可解除。如果邪气归入胃腑，一次攻下即可痊愈。如瘟疫的邪气，先潜伏后发作，潜伏在膜原，像鸟栖息在巢穴中，像野兽藏在洞穴里，营卫之气所不及，药物也难以到达。等到它发作时，邪毒逐渐嚣张，向内侵扰腑脏，向外淫溢经络，营卫受伤，各种症状逐渐显现，然后才能进行治疗。在它浸润蔓延之际，邪毒尚在膜原，此时只能采用疏利的方法，使伏邪容易排出。邪毒一旦离开膜原，再观察其变化，或出于表或入于里，然后引导邪气排出，邪气排尽疾病才痊愈。刚发病时，毒邪逐渐嚣张，没有人能抵御，不仅不能立即治愈，而且病症日益加重，病人看到的症状反而增多，即使想更换医生，医生如果不理解，也会感到惊讶诧异，竟然不知道先前感受的邪气，邪盛则病重，邪微则病轻。人们说，瘟疫不要从头部开始治疗，虚劳咳嗽不要从尾部开始治疗。所以在疫邪刚刚嚣张的时候，势头不可遏制，只要使邪毒迅速离开膜原，就是正确的治疗方法。关键在于后面的功夫，认清表里虚实，详细分析缓急轻重，用药不致差错，这样就可以万无一失。即使感受最重的，按照法治疗，也必定没有死亡的道理。至于久病枯极，酒色耗竭，年老体衰的人，都是先天真元几乎断绝，又加上疫病，自然难以支撑了。
Treating the Interior First, then the Exterior: Initially, there is fever. Gradually, it transforms into a Yangming interior excess syndrome (Yangming Fu Syndrome), which can be cured by purgation (Xia Fa). Later, fever recurs, accompanied by headache, heaviness of the body, and a floating pulse; Baihu Tang (White Tiger Decoction) is indicated. If sweating does not occur after administration, it indicates exhaustion of body fluids (Jin Ye); add Ginseng (Renshen), and recovery will follow quickly upon finishing the cup. However, if after massive diaphoresis or massive purgation, both exterior and interior syndromes have disappeared, followed by generalized body pain, feeling as if beaten with a club, and a deep, fine pulse, this is due to excessive sweating causing Yang Qi to fail to circulate throughout the body, resulting in cold bones and pain. This is not an exterior syndrome. No specific treatment is necessary; within two to three days, Yang Qi will return, and self-healing will occur.
Predominance of Exterior Syndromes: When latent pathogens in the Membrane Source (Mo Yuan) manifest, the pathogens transmitting to the exterior are numerous, while those transmitting to the interior are few. How do we know this? Because exterior symptoms are predominant and interior symptoms are few. One should treat the exterior, addressing the interior concurrently.
If interior symptoms are predominant and exterior symptoms are few, treating the interior alone will allow the exterior symptoms to resolve spontaneously.
When pathogens injure the human body, they initially affect Qi, subsequently affecting Blood, flesh, sinews, and finally bones. There are moving pathogens (Xing Xie) and latent pathogens (Fu Xie); thus, treatment methods vary in difficulty, and efficacy varies in speed. Moving pathogens refer to standard Shanghan (Cold Damage) diseases, starting from the Taiyang channel, potentially transmitting to the Yangming channel or Shaoyang channel. Although the disease severity may be high, one episode of diaphoresis (Han Fa) can resolve it. If the pathogen enters the Stomach Fu, one episode of purgation can cure it. In contrast, plague pathogens lie latent before moving, residing in the Membrane Source like birds nesting or beasts hiding in holes, beyond the reach of Ying-Wei circulation and difficult for herbal medicine to penetrate. Upon manifestation, pathogenic toxins gradually expand, invading internally into the Fu organs and externally flooding the channels, injuring Ying-Wei, and causing various symptoms to appear gradually, allowing for treatment thereafter. During the stage of infiltration, when pathogenic toxins remain in the Membrane Source, only dispersing and draining methods can be used to facilitate the exit of latent pathogens. Once the pathogenic toxins leave the Membrane Source, observe their changes; whether they emerge to the exterior or enter the interior, guide the pathogens out accordingly. Only when all pathogens are expelled is the disease cured. At the initial onset, toxic pathogens expand rapidly, resisting control. Not only can immediate cure not be achieved, but symptoms worsen daily, and patients perceive increasing distress. Even if seeking a new physician, if the physician lacks understanding, they too may be startled, failing to realize that prior infection determines the outcome: strong pathogens cause severe disease, weak pathogens cause mild disease. It is said, "Do not treat plague from the head; do not treat consumptive cough from the tail." Thus, when plague pathogens are just rising, their momentum is unstoppable; the key treatment is to make the pathogenic toxins leave the Membrane Source as quickly as possible. The crucial work lies in the subsequent stages: discerning exterior/interior, deficiency/excess, and analyzing urgency and severity. Prescribing accurately without error ensures complete safety. Even in cases of most severe infection, following proper treatment guarantees survival. However, for those with prolonged illness leading to extreme emaciation, depletion from alcohol and sexual indulgence, or advanced age, where innate vitality is nearly exhausted, adding a plague condition makes support extremely difficult.