《伤寒论》分六经见证，方有发表攻里之异，注述甚多，皆随文释义，或各鸣一得，彼此
辨驳。若究其源理，有顾彼失此之嗟，何也？岂知时事有更代，地土有南北，人体有强弱。近
世以来，四时感症，类伤寒多，正伤寒罕见也。夫类伤寒者，春温、夏热、湿温、秋燥、冬温是
也。虽然仲景谓伤寒有五，方分温散、辛散、攻下、和解诸法，后人识浅，殊难领悟，惟拘执传
经限日成法，遂致遗误者多。
惟近年凶荒饥馑, 兵火之余，酿成疫疠，互相传染，切勿拘执日数。余治疫症，大剂攻
下，每多获效。缘此病邪由目鼻吸入者多，往往两手脉微弱，若不知者，以为脉虚，不敢用
攻，孰不知下后邪去，脉即平复。此症初起，多见恶寒肢冷，舌苔黄腻，神识呆钝，或邪热下
迫，每多自利，所下几微，最易惑人。必视舌苔垢腻之有无，以定攻下之轻重，每见下去一
层，又起一层。轻者两三剂，重者八九剂，浊苔退尽，脉平而不躁急为准。仍须用下，庶免反
复，要知此邪乃天地间至恶之气，必须除恶务尽。以大承气为主方，随症加减，减至单用元
明粉为极轻。总以三候之内为率，若延至三候以外，必自利红水，肠胃已烂，必死无疑。余历
验心得，以验苔之滞腻，干而无津之苔，凭此用下；若舌无浊垢之苔，虽见大热不可用下。
余之心得经验，无误之秘法也，然则与无疫之温热有间，未可混淆以误人者。夫温热
者，天地之常候也。经云∶冬伤于寒，春必病温。惟冬令外虽严寒，而阳气潜藏于内，若天
时晴燥，雨雪稀少，则阳失潜藏，致生冬温之证，当用葱豉汤加大贝、芩、翘、银花、牛子、
甘、桔等味。盖春为一岁之首，严寒未退，仍防寒邪遏伏；直待春升，木气发透，风阳化温，是
为风温。其气近燥，多犯上焦，致有身热、咳嗽、胸闷、气促之症，法宜清宣轻剂，如薄荷、
牛子、桔梗、杏仁、大贝、蒌皮之类。久延失治，转入营分。误用辛温成法，多致衄血、咯血，甚
则成痨。若已入胃，舌黄干燥，亟宜攻下。初夏渐热火旺，宜仿此方，重加清药可耳。如长
夏湿土司令，宜燥湿清热，苍术启虎汤治之。直至秋深，燥令大行，身热、咳嗽、咽痛者，辨
天时之凉暖，以分寒化、热化，然用药有温润、甘寒之别，此秋燥之治法也。若热已入胃，便
结溲赤，舌苔黄焦垢腻，亦宜急下存津，切勿延久，正伤气弱，反成危候。
近年以来，四时感症温热独多，每憾治法仍沿辛温，以致不死于病而死于误药者，比比
皆然。偶见新出六书，乃余杭陶节庵所辑，意在变化成法，独出心裁，将仲景所集增损加
减，标新立异，不为无功，惜未将温热见症阐明原理。余细为研究，有择焉不精，语焉不详，
何足以尽格致生化之源，跳出伤寒之范围哉。于是焚膏继晷，精审四时代谢之序，参以六淫
偏盛之因，豁然自得。不揣草率无文，爰将各篇病理，随时笔记，以免遗忘，是否有所采择，
质之海内明哲，愿早赐之削政，则感如师资之深矣。
澜按∶温热者，四时之常气也；温疫者，天地之恶气也。盖常气以常法治之，恶气以峻法
治之，理势然也。先生治疫，重用攻下，除恶务尽耳，与吴又可法暗合。其时各居一境，所治
之症大略相同。袁氏辨舌苔垢腻浓薄，以定攻邪之轻重；又辨明温热与瘟疫有间，岂可混淆
以误人哉。况先生济世心切，每以慎审为本，其学邃深在又可之上。且吴氏虽有九传方法，
未将病理阐明，书虽流传，惜乎混疫于温，贻误亦多，不足为法也。或谓当时彼此各居一
邑，未能面商至理为憾。如袁、吴同处一堂，互相讨论，吴氏必不致混淆立论，温热原理毋待
叶氏发明之。
呜呼！天下事，有幸、有不幸。吴书早经刊传，袁氏此书渺无知者，缘先生志尚高傲，
不求闻达，又非医流，此书乃当时之日记耳。观其自记云∶“不揣草率无文，随笔记录，以免
遗忘”，即知其仅记病理、临症实验而已，其言辞不加修饰，已可慨见。澜因先生为吾邑先
达，兼与其玄孙同局襄修邑志，始获此书，字迹蠹蚀过半，用特重录，以免淹没。奈无别本
可以校对，只姑仍旧贯，未敢更易一字。稍有疑义者，附以按语，以醒眉目云尔。
时在咸丰戊午中秋节后二日，后学赵观澜谨录拜志于三十六湖楼客次。
《伤寒论》将病症分为六经进行辨证，方剂有解表发汗和攻里泻下的区别，相关的注解阐述非常多，都是随着原文解释义理，或者各自发表独到见解，彼此之间互相辩驳。如果追究其中的源流原理，往往会有顾此失彼的感叹，为什么呢？这是因为时代时事有更替变化，地理环境有南北差异，人体体质有强弱不同。近代以来，四季感受外邪引起的病症，大多类似伤寒，而真正的典型伤寒却很少见了。那些类似伤寒的病症，包括春温、夏热、湿温、秋燥、冬温等。虽然张仲景说伤寒包含五种类型，并区分了温散、辛散、攻下、和解等各种治法，但后人见识浅薄，很难领悟这些深意，只是拘泥于按传经次序和固定日数的成法，导致误治延误病情的情况很多。
尤其是近年来遭遇饥荒灾年，加上战乱兵火之后，酿成了疫病疠气，相互传染，千万不要拘泥于固定的日数。我治疗疫病，使用大剂量攻下法，往往能取得疗效。因为这种病的邪气多从眼睛和鼻子吸入体内，患者常常两手脉象微弱，如果不了解病情的人，认为这是脉虚，不敢使用攻下法，哪里知道攻下之后邪气去除，脉象就会恢复平稳。这种病症初起时，多见恶寒肢冷，舌苔黄腻，神志呆滞迟钝，或者因邪热向下逼迫，常常出现自发性腹泻，所下的粪便量极少，最容易迷惑医生。必须观察舌苔垢腻的程度，来决定攻下法的轻重，经常看到下去一层浊邪，又生出一层浊邪。轻症两到三剂药，重症八到九剂药，直到浊苔退尽，脉象平和且不躁急为止。仍然需要继续使用攻下法，以免病情反复，要知道这种邪气是天地间最恶劣的气，必须除恶务尽。以大承气汤作为主方，根据症状加减，减至单独使用元明粉（芒硝）为极轻的用法。总以三个候（约九天）之内为期限，如果拖延到三个候以外，必然会出现拉红色水样的大便，肠胃已经腐烂，必定死亡无疑。这是我经过大量验证的心得体会，依据舌苔的滞腻程度、干燥无津液的舌苔，凭此决定使用攻下法；如果舌头上没有浊垢的舌苔，即使见到高热也不可用攻下法。这是我的心得经验，无误的秘法，然而这与没有疫气的温热病是有区别的，不可混淆而误导他人。
所谓温热，是天地运行的正常气候规律。医经说：冬天感受寒邪，春天必定发生温病。只有在冬季外面虽然严寒，但阳气潜藏于体内，如果天时晴朗干燥，雨雪稀少，那么阳气就失去潜藏，导致产生冬温的病症，应当使用葱豉汤加大贝母、黄芩、连翘、金银花、牛蒡子、甘草、桔梗等药物。因为春季是一年的开始，严寒尚未完全消退，仍要防范寒邪郁伏；直等到春季阳气升发，肝木之气透发，风阳化为温气，这就是风温。风温之气接近燥性，多侵犯上焦，导致身体发热、咳嗽、胸闷、气促等症状，治法适宜用清宣轻剂的方药，如薄荷、牛蒡子、桔梗、杏仁、大贝母、瓜蒌皮之类。如果久延不愈失治，病邪转入营分。误用辛温的成法，多导致鼻出血、咯血，甚至形成劳损之证。如果病邪已经进入胃腑，舌苔黄且干燥，急需使用攻下法。初夏时节逐渐炎热火旺，宜仿照此方，加重清热药物的用量即可。如果是长夏季节湿土当令，宜燥湿清热，用苍术启虎汤治疗。直到深秋，燥令大行，出现身热、咳嗽、咽痛的症状，辨别天时的凉暖，来区分寒化、热化，然而用药有温润、甘寒的区别，这是秋燥的治疗方法。如果热邪已经入胃，大便干结小便赤黄，舌苔黄焦垢腻，也宜急下存阴，切勿拖延，正气受伤气弱，反而成为危重证候。
近年来，四季感受外邪的病症中温热独多，常常遗憾治疗方法仍沿用辛温之法，以至于病人不是死于疾病而是死于误治用药的情况，比比皆是。偶然看到新出的六书，是余杭陶节庵所辑录，意在变化成法，独出心裁，对张仲景所集的内容进行增损加减，标新立异，并非没有功劳，可惜未能将温热病的见症阐明其原理。我仔细研究，发现其中选择不够精当，论述不够详细，怎么能穷尽格物致知生化之源，跳出伤寒的范围呢？于是日夜苦读，精心审察四时代谢的秩序，参考六淫偏盛的成因，豁然开朗自得于心。不顾自己草率无文，于是将各篇病理，随时笔记记录，以免遗忘，是否有可取之处，请海内明智之士指正，希望能早日赐教修改，那感激之情如同对待老师一般深厚。
赵澜按语：温热，是四季的正常气候；温疫，是天地间的恶劣气候。大概正常气候用正常法治疗，恶劣气候用峻猛法治疗，这是道理和趋势使然。先生治疗疫病，重用攻下法，旨在除恶务尽，这与吴又可的方法暗中契合。当时他们各自居住在不同的地方，所治疗的病症大致相同。袁氏通过辨别舌苔垢腻的浓淡，来决定攻邪的轻重；又辨明温热与瘟疫是有区别的，怎么可以混淆而误导人呢？况且先生济世之心急切，每每以谨慎审慎为本，其学问深邃在吴又可之上。而且吴氏虽然有九传方法，但未将病理阐明，书籍虽然流传，可惜混淆了疫病与温热，贻误也很多，不足以作为效法的标准。有人说当时他们彼此各居一邑，未能当面商讨论真理，令人遗憾。如果袁、吴二人同处一堂，互相讨论，吴氏必定不会混淆立论，温热的原理无需等到叶天士来发明。
唉！天下的事情，有幸与不幸。吴氏的书早已刊印流传，袁氏的这本书很少有人知晓，因为先生志向高尚高傲，不求闻名显达，又不是医家流派出身，这本书不过是当时的日记罢了。看他的自记说：“不顾自己草率无文，随笔记录，以免遗忘”，就知道他仅仅记录病理、临症实验而已，他的言辞不加修饰，已经可以感慨可见。我因为先生是我们县里的前辈，又与其玄孙一起参与编修县志，才获得这本书，字迹被虫蛀腐蚀过半，特意重新抄录，以免埋没。无奈没有其他版本可以校对，只暂且沿袭旧貌，不敢更改一个字。稍有疑问的地方，附上按语，以醒目醒脑罢了。
时在咸丰戊午年中秋节后第二天，后学赵观澜恭敬记录并题记于三十六湖楼客舍。
The *Shanghan Lun* (Treatise on Cold Damage) categorizes syndromes into the Six Channels for differentiation, with formulas differing in their functions of releasing the exterior (Jie Biao) and purging the interior (Gong Li). There are numerous annotations and commentaries, all interpreting the principles following the original text, or each expressing unique insights, refuting one another. If one investigates the source and principles, there is often a lament of attending to one aspect while neglecting another. Why? Because times and circumstances change, geography varies between north and south, and human constitutions differ in strength. In recent times, seasonal exogenous diseases mostly resemble cold damage, while true typical cold damage is rare. These diseases resembling cold damage include Spring Warmth (Chun Wen), Summer Heat (Xia Re), Damp-Warmth (Shi Wen), Autumn Dryness (Qiu Zao), and Winter Warmth (Dong Wen). Although Zhang Zhongjing stated that cold damage encompasses five types, and distinguished methods such as warm dispersal (Wen San), acrid dispersal (Xin San), purgation (Gong Xia), and harmonization (He Jie), later generations with shallow understanding failed to grasp these meanings deeply. They merely adhered to rigid rules regarding meridian transmission and fixed days, leading to many cases of misdiagnosis and delay.
Especially in recent years, amidst famine and the aftermath of war, epidemics (Yi Li) have arisen, spreading through contagion. One must not rigidly adhere to fixed days. In my treatment of epidemic diseases, using large doses of purgative methods has often yielded effective results. This is because the pathogenic factors of this disease are mostly inhaled through the eyes and nose. Patients often present with weak and faint pulses in both hands. Those unaware of the condition might interpret this as pulse deficiency (Mai Xu) and dare not use purgatives. However, they do not know that after purgation removes the pathogen, the pulse returns to normal. At the onset of this syndrome, symptoms often include aversion to cold and cold limbs, yellow and greasy tongue coating, dull consciousness, or spontaneous diarrhea due to pathogenic heat forcing downward. The amount of stool is minimal, which easily confuses physicians. One must observe the presence and degree of turbid and greasy tongue coating to determine the severity of purgation. It is common to see one layer of turbidity removed only for another to appear. For mild cases, two to three doses suffice; for severe cases, eight to nine doses. Treatment continues until the turbid coating disappears completely and the pulse becomes calm and non-irritable. Purgation may still be necessary to prevent recurrence. One must understand that this pathogen is the most malignant qi in heaven and earth, and evil must be eradicated thoroughly. The primary formula is Da Cheng Qi Tang (Major Order of the Spleen Decoction), modified according to symptoms. The lightest modification involves using solely Yuan Ming Fen (Natrii Sulfas / Mirabilite). The general rule is to complete treatment within three "hou" (periods of approximately nine days). If delayed beyond three hou, red watery stools will inevitably occur, indicating rotting intestines and stomach, leading to certain death. This is my verified experience: use purgation based on the stagnation and greasiness of the tongue coating, specifically dry coatings without fluids. If there is no turbid coating on the tongue, even if high fever is present, purgation must not be used. This is my empirical secret method. However, it differs from non-epidemic warmth diseases and should not be confused to mislead others.
Warmth (Wen Re) refers to the normal climatic patterns of heaven and earth. The Classics state: "If one is injured by cold in winter, one will suffer from warmth in spring." Normally, although winter is externally freezing, yang qi hides internally. If the weather is sunny and dry with little rain or snow, yang qi loses its hidden state, causing Winter Warmth (Dong Wen). The treatment should use Cong Chi Tang (Scallion and Fermented Soybean Decoction) plus Da Bei Mu (Fritillariae Bulbus), Huang Qin (Scutellariae Radix), Lian Qiao (Forsythiae Fructus), Yin Hua (Lonicerae Japonicae Flos), Niu Bang Zi (Arctii Fructus), Gan Cao (Glycyrrhizae Radix), and Jie Geng (Platycodonis Radix). Since spring is the beginning of the year and severe cold has not fully receded, one must still guard against latent cold pathogens. Only when spring qi rises and liver wood qi penetrates does wind-yang transform into warmth, known as Wind-Warmth (Feng Wen). Its nature is close to dryness and often affects the Upper Jiao (Upper Burner), causing fever, cough, chest tightness, and shortness of breath. The appropriate method is to use light clearing and dispersing agents, such as Bo He (Menthae Haplocalycis Herba), Niu Bang Zi, Jie Geng, Xing Ren (Armeniacae Semen Amarum), Da Bei Mu, and Gua Lou Pi (Trichosanthis Pericarpium). If prolonged and untreated, the pathogen enters the Ying (Nutrient) level. Misusing acrid-warm formulas often leads to epistaxis (Nu Xue) and hemoptysis (Ke Xue), potentially developing into consumption (Lao). If the pathogen enters the Stomach, presenting with yellow and dry tongue coating, urgent purgation is required. In early summer, as heat increases, one should follow this formula but increase the dosage of clearing herbs. During late summer when damp-earth governs, one should dry dampness and clear heat, treating with Cang Zhu Qi Hu Tang. By deep autumn, when dryness prevails, symptoms like fever, cough, and sore throat require distinguishing between cold-transformation and heat-transformation based on weather coolness or warmth. Medications differ between moistening-warm and sweet-cold categories; this is the treatment for Autumn Dryness. If heat enters the Stomach, causing constipation and dark urine, with yellow, scorched, and greasy tongue coating, urgent purgation to preserve yin fluids is necessary. Do not delay, as damaged qi and weakness can lead to critical conditions.
In recent years, warmth diseases among seasonal exogenous illnesses are predominant. It is regrettable that treatment methods still follow acrid-warm approaches, resulting in patients dying from medical errors rather than the disease itself, which is common. I偶然ly encountered the newly published "Six Books," compiled by Tao Jie'an of Yuhang. His intent was to modify established methods with original creativity, adding and subtracting from Zhang Zhongjing's collected works. While this innovation is not without merit, he unfortunately failed to clarify the principles behind warmth symptoms. Upon careful study, I found his selections imprecise and explanations vague. How could this exhaust the sources of biological generation and transcend the scope of cold damage? Thus, working day and night, I carefully examined the order of seasonal transformation and referenced the causes of excessive Six Excesses (Liu Yin). Suddenly, I gained clarity. Not presuming my writing is rough or unpolished, I recorded the pathology of various chapters to avoid forgetting them. I submit this for the judgment of wise scholars within and outside the realm, hoping for early correction, so that my gratitude may be as deep as that towards a teacher.
Zhao Lan notes: Warmth is the normal qi of the four seasons; Warm Epidemic is the malignant qi of heaven and earth. Normal qi is treated with normal methods; malignant qi is treated with峻猛 (severe/strong) methods. This follows natural logic and trend. Mr. Yuan's treatment of epidemics heavily utilized purgation to eradicate evil thoroughly, which secretly aligns with Wu Youke's methods. Although they lived in different regions, the syndromes they treated were largely similar. Mr. Yuan determined the severity of expelling pathogens by observing the thickness of turbid tongue coating; he also clarified that warmth and plague are distinct and should not be confused to mislead people. Moreover, Mr. Yuan's heart for saving the world was urgent, prioritizing caution and prudence. His scholarship was profound, surpassing Wu Youke. Although Wu had the Nine Transformations method, he did not elucidate pathology clearly. Although his book circulated, confusing plague with warmth caused much error, making it insufficient as a standard. Some say it is regrettable that they lived in separate counties and could not discuss truths face-to-face. If Yuan and Wu had discussed together, Wu would not have confused his theories, and the principles of warmth would not have waited for Ye Tianshi to elucidate.
Alas! Worldly affairs have fortune and misfortune. Wu's book was printed and circulated early, while Yuan's book remained unknown. This is because Mr. Yuan had lofty ambitions and sought no fame, nor was he from a professional medical lineage. This book was merely a diary from that time. As he wrote in his own record: "Not daring to presume my rough and unpolished writing, I recorded casually to avoid forgetting." This shows he only recorded pathology and clinical experiments. His language was unadorned, revealing his character. Because Mr. Yuan was a senior figure in our county, and I assisted his great-grandson in compiling the county gazetteer, I obtained this book. Over half of the characters were eaten by insects. I specially re-copied it to prevent it from being submerged. Lacking other versions for collation, I kept the original text unchanged, daring not alter a single word. Where doubts exist, I added notes to clarify.
Recorded respectfully by junior scholar Zhao Guanlan at the guest room of Thirty-Six Lakes Pavilion, two days after the Mid-Autumn Festival in the Wuwu year of Xianfeng.