论外感初起 论内伤初起 论伤寒初起
天师曰∶先治者，宜先而先之也。人病发热，必须散其邪气，俟邪气速去，而后再扶其正气，则正
气不为邪所伤。方用柴胡一钱，荆芥一钱，半夏一钱，黄芩一钱，甘草一钱，水煎服，则邪散而身凉。
盖四时不正之气，来犯人身，必然由皮毛而入营卫。今用柴胡、荆芥先散其皮毛之邪，邪既先散，安得入
里；方中又有半夏以祛痰，使邪不得挟痰以作崇，又有黄芩，使不得挟火以作殃；况又有甘草，调和药味
以和中。邪气先散，而正气又不相伤，此先治之妙也。一症一方，亦可类推。
张公曰∶先治法最妙，无奈世人不肯先服药何，所以邪由皮毛而入营卫，由营卫而入脏腑也。倘先用
此方，又何至传经深入哉。先治法甚多，不能尽，再传二方，触类旁通。无非先治之法。一方用柴胡一钱，
当归一钱，白芍二钱，甘草、陈皮各一钱，天花粉二钱，栀子一钱，水煎服。（〔批〕内伤散邪汤，神
妙。）此方凡肝脉郁者，用一剂即快，不必专是外感也，治内伤初起者神效。又一方用柴胡一钱，白芍一
钱，茯苓一钱，甘草一钱，当归二钱，麻黄一钱，桂枝一钱，陈皮五分，水煎服。（〔批〕外感祛邪汤。）
此方专治伤寒初起者神效。乘其尚未传经，可从补正之中，兼用祛邪之品，而热散之也。盖初起之邪，尚
不敢与正气相敌，故一补正气、而邪气自消。及一传经，则正气遁入于脏腑、不敢与邪相争，愈补而愈
不敢出
也，故一传经，则万万不可用补药。今乘其初起之时，亟用补剂而加之祛邪之品，用桂枝以热散，用麻
黄以祛寒，寒热相攻，邪难内入，而又有正气之健助，所以一剂而尽愈也。先治之法，二方最妙，幸留
意而善用之。
华君曰∶予未闻师传也。
雷公曰∶天下最难治者，莫过于伤寒，然得其法，治之又甚易，张仲景论之详矣。今又增一法，以
治伤寒初起之病，攻补兼施，实有卓见，惜世人未知其论耳。其方可试，无不神效。然而人见白术、当归
之多用，疑于太补，不知伤寒初起，何畏于补。鄙意尚可加入人参一钱，乘其邪未深入，补正以逐邪，则
邪易走也，又何疑于术、归之用哉。（〔批〕天师曰∶此予方也。但三日内可加参，三日外者，不可轻用
也。）
（治外感初起，用小柴胡汤，人参、姜、枣加荆芥。按小柴胡原治伤寒少阳经主药，此经半表半里，
寒邪渐逼，而稍稍成热，故用之，亦非外感初起。须知内有湿热之人，而兼外感者，用之则宜。其脉
左右两寸关俱弦洪者为准。李子永识。）
天师说：所谓“先治”，就是应当在适宜的时候提前进行治疗。人如果生病出现发热，必须首先发散邪气，等到邪气迅速去除后，再扶持正气，这样正气就不会被邪气所伤害。方剂使用柴胡一钱，荆芥一钱，半夏一钱，黄芩一钱，甘草一钱，用水煎服，就能使邪气消散而身体凉爽。大概四季中不正的气候之气，侵犯人身，必然从皮毛进入营卫（运行于体表及脏腑之间的精微物质及其功能）。现在用柴胡、荆芥先发散皮毛的邪气，邪气既然先被发散，怎么能进入体内呢？方中又有半夏来祛除痰湿，使邪气不能挟带痰湿来作乱；又有黄芩，使邪气不能挟带火热来造成祸殃；况且还有甘草，调和药味以中和脾胃。邪气先被散去，而正气又不受损伤，这就是“先治”的奥妙所在。一种症状对应一个方剂，也可以由此类推。
张公说：“先治法”最为精妙，无奈世人不肯在初期服药，所以邪气由皮毛进入营卫，再由营卫传入脏腑。倘若一开始就使用这个方子，又怎么会发展到传经深入的地步呢。“先治法”有很多，无法全部列举，再传授两个方子，以便触类旁通。这无非都是“先治”的方法。一方使用柴胡一钱，当归一钱，白芍二钱，甘草、陈皮各一钱，天花粉二钱，栀子一钱，用水煎服。（批注：内伤散邪汤，神妙。）此方凡是肝脉郁结的人，服用一剂就会感到舒畅，并不专门针对外感病，治疗内伤初起非常有效。另一方使用柴胡一钱，白芍一钱，茯苓一钱，甘草一钱，当归二钱，麻黄一钱，桂枝一钱，陈皮五分，用水煎服。（批注：外感祛邪汤。）此方专门治疗伤寒初起非常有效。趁着邪气尚未传经，可以从补益正气之中，兼用祛除邪气的药物，从而发散热邪。大概初起的邪气，还不敢与正气抗衡，所以一旦补益正气，邪气自然消减。等到一经传变，正气就退入脏腑，不敢与邪气相争，越补越不敢出来，所以一经传变，就万万不可使用补药。现在趁着初起之时，急切地使用补剂并加上祛邪的药物，用桂枝来发散热邪，用麻黄来祛除寒邪，寒热相互攻伐，邪气难以内入，再加上正气的健旺辅助，所以一剂药就能完全痊愈。“先治”的方法，这两个方子最妙，希望留意并善于使用它们。
华君说：我没有听说过老师的传授。
雷公说：天下最难治疗的病，没有比得上伤寒的，然而掌握了方法，治疗起来又非常容易，张仲景论述得很详细了。现在又增加一种方法，用来治疗伤寒初起的疾病，攻邪与补正同时施用，确实有卓越的见解，可惜世人不知道这种理论罢了。这个方子可以尝试，没有不神效的。然而人们看到白术、当归大量使用，怀疑过于滋补，不知道伤寒初起，何必畏惧补益。我的意见还可以加入人参一钱，趁着邪气尚未深入，补益正气以驱逐邪气，那么邪气就容易排出，又何必对白术、当归的使用感到怀疑呢。（批注：天师说：这是我的方子。但三天内可以加人参，三天以外的人，不可以轻易使用。）
（按语：治疗外感初起，用小柴胡汤，加入人参、生姜、大枣和荆芥。按：小柴胡汤原本是治疗伤寒少阳经的主药，少阳经位于半表半里，寒邪逐渐逼近，稍微形成热象，所以使用它，但这并非适用于所有外感初起的情况。须知体内有湿热之人，兼有外感者，使用此方才适宜。其脉象左右两寸关部都呈现弦洪之象作为标准。李子永识。）
On the Initial Stage of External Contraction, On the Initial Stage of Internal Injury, and On the Initial Stage of Cold Damage
The Heavenly Master said: "Pre-treatment" (Xian Zhi) refers to treating at the appropriate early stage. When a person suffers from fever due to illness, one must first disperse the pathogenic factors. Only after the pathogenic factors have been quickly eliminated should one support the healthy qi (Zheng Qi), so that the healthy qi is not damaged by the pathogens. The prescription consists of Chai Hu (Bupleuri Radix) 1 qian, Jing Jie (Schizonepetae Herba) 1 qian, Ban Xia (Pinelliae Rhizoma Preparatum) 1 qian, Huang Qin (Scutellariae Radix) 1 qian, and Gan Cao (Glycyrrhizae Radix et Rhizoma) 1 qian. Decocted in water and taken orally, it disperses the pathogens and cools the body. Generally, the abnormal qi of the four seasons invading the human body enters the Ying and Wei (Nutritive and Defensive levels/substances) through the skin and hair. By using Chai Hu and Jing Jie to first disperse the pathogens in the skin and hair, once the pathogens are dispersed externally, how can they enter the interior? Furthermore, Ban Xia in the formula dispels phlegm, preventing the pathogens from causing harm by carrying phlegm; Huang Qin prevents the pathogens from causing disaster by carrying fire; and Gan Cao harmonizes the medicinal properties to benefit the middle jiao (Middle Burner). Since the pathogens are dispersed first without injuring the healthy qi, this embodies the subtlety of pre-treatment. One symptom corresponds to one formula, and other cases can be inferred analogously.
Master Zhang said: The method of pre-treatment is most excellent, but unfortunately, people in the world are unwilling to take medicine at this early stage. Consequently, pathogens enter the Ying and Wei from the skin and hair, and then from the Ying and Wei into the zang-fu organs. If this formula were used initially, how could the disease progress through the meridians and penetrate deeply? There are many methods of pre-treatment, which cannot be fully listed here. I will transmit two more formulas to facilitate associative learning. These are essentially all methods of pre-treatment. One formula uses Chai Hu 1 qian, Dang Gui (Angelicae Sinensis Radix) 1 qian, Bai Shao (Paeoniae Radix Alba) 2 qian, Gan Cao and Chen Pi (Citri Reticulatae Pericarpium) each 1 qian, Tian Hua Fen (Trichosanthis Radix) 2 qian, and Zhi Zi (Gardeniae Fructus) 1 qian. Decocted in water and taken orally. [Comment: Nei Shang San Xie Tang (Internal Injury Dispersing Pathogen Decoction) is miraculous.] This formula brings immediate relief for those with liver qi stagnation, regardless of whether it is an external contraction or not; it is highly effective for the initial stage of internal injury. Another formula uses Chai Hu 1 qian, Bai Shao 1 qian, Fu Ling (Poria) 1 qian, Gan Cao 1 qian, Dang Gui 2 qian, Ma Huang (Ephedrae Herba) 1 qian, Gui Zhi (Cinnamomi Ramulus) 1 qian, and Chen Pi 5 fen. Decocted in water and taken orally. [Comment: Wai Gan Qu Xie Tang (External Contracting Expelling Pathogen Decoction).] This formula is specifically highly effective for the initial stage of cold damage. While the pathogens have not yet transmitted through the meridians, one can simultaneously use agents that expel pathogens within the context of tonifying the healthy qi to dissipate heat. Generally, pathogens at the initial stage do not dare to contend with the healthy qi; thus, once the healthy qi is tonified, the pathogens naturally diminish. However, once transmission occurs, the healthy qi retreats into the zang-fu organs and dares not contend with the pathogens; further tonification makes them even less likely to emerge. Therefore, once transmission has occurred, tonics must absolutely not be used. Now, taking advantage of the initial stage, we urgently use tonics combined with pathogen-expelling agents. Gui Zhi dissipates heat, and Ma Huang expels cold. The attack of cold and heat makes it difficult for pathogens to enter internally, and with the robust assistance of the healthy qi, one dose results in complete recovery. Among the methods of pre-treatment, these two formulas are the best; please pay attention and apply them skillfully.
Master Hua said: I have not heard of this teaching from my master.
Master Lei said: The most difficult diseases to treat in the world are none other than cold damage. However, once the method is mastered, treatment becomes very easy, as detailed in Zhang Zhongjing's discussions. Now, an additional method is added to treat the initial stage of cold damage, combining attacking pathogens and tonifying the healthy qi. This demonstrates profound insight, though unfortunately, the world does not yet know this theory. This formula can be tried and proves miraculous. However, seeing the heavy use of Bai Zhu (Atractylodis Macrocephalae Rhizoma) and Dang Gui, people suspect it is too tonifying, not realizing why one should fear tonification in the initial stage of cold damage. In my opinion, Ren Shen (Ginseng Radix) 1 qian could be added. Taking advantage of the fact that the pathogens have not penetrated deeply, tonifying the healthy qi to drive out the pathogens allows the pathogens to exit easily. Thus, there is no reason to doubt the use of Bai Zhu and Dang Gui. [Comment: The Heavenly Master said: This is my formula. However, Ren Shen can be added within three days; for cases beyond three days, it should not be used lightly.]
[Note: For the initial stage of external contraction, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is used, with added Ren Shen, Sheng Jiang (Zingiberis Rhizoma Recens), Da Zao (Jujubae Fructus), and Jing Jie. Note: Xiao Chai Hu Tang is originally the main prescription for Shaoyang meridian cold damage. The Shaoyang meridian is located between the exterior and interior. As cold pathogens gradually approach, slight heat forms, hence its use. However, this is not suitable for all initial stages of external contraction. It is indicated only for individuals with internal damp-heat who also have an external contraction. The pulse should present as wiry and surging at both left and right cun and guan positions. Recorded by Li Zi Yong.]