伤寒表证当汗而不可下，里证当下而不可汗，半在表半在里则当和解，不可发汗
吐下，在上则通之，在下则泄之。伤寒无汗，表病里和，则麻黄汤汗之，或天水散之类亦
佳。表不解，半入于里，半尚在表者，小柴胡汤和解之，或天水、凉膈散甚良。表里热势
俱甚者，大柴胡汤微下之。更甚者，大承气汤下之。表热多，里热少者，天水一、凉膈半
和解之。里热多，表热少，未可下之者，凉膈一、天水半调之。热更甚者，小承气汤下
之。表证解，但有里证者，大承气汤下之。凡此诸可下者，通宜三一承气汤下之。发汗不
解，下后，前后无异证者，通宜凉膈散调之，以退其热。两感仿此而已。伤风自汗，
表病里和者，桂枝汤解肌。半在表半在里，白虎汤和解之。病在里者，大承气汤下之。
一法，无问风寒暑湿，有汗无汗，内外诸邪所伤，但有可下诸证，或表里两证俱不见
而日深，但目睛不了了，睛
不和者，或腹满实痛者，或烦渴，或谵妄，或狂躁喘满者，或蓄热极而将死者，通宜大承
气汤下之，或三一承气汤尤良。伤寒，大发汗，汗出不解，反无汗，脉虚浮者，苍术白虎汤
再解之。或中暑，自汗大出，脉虚弱，头痛口干，倦怠烦躁，或时恶寒，或畏日气，无问表
里，通宜白虎。或里热势甚，腹满而脉沉，可下者，宜大承气汤，或三一承气汤。伤寒，
表热极甚，身疼头痛不可忍者，或眩或呕，里有微热，不可发汗吐下，拟以小柴胡、天水、
凉膈之类和解。恐不能退其热势之甚。或大下后，再三下后，热势尚甚不能退，本气损虚而
脉不能实，拟更下之，恐下脱而立死，不下亦热极而死，寒凉之药，不能退热势之甚者。
或热湿内余，下利不止，热不退者，或因大下后，热退利不止，热不退，脉弱气虚，不可更
下者，或诸湿热内余，小便赤涩，大便溏泄，频并少而急痛者，必欲作利也，须宜黄连解毒
汤。或里热极甚，而恐阴气不能退者，或已下后，热不退者，或蓄热内甚，阳厥极深，以至
阳气沉伏，而不能营运于身，阴欲绝而以致遍身青冷，痛甚不堪，项背拘急，目赤睛疼，
昏眩恍惚，咽干或痛，燥渴虚汗，呕吐下利，腹满实痛，烦痞闷乱，喘息急声，脉虽疾数，
以其蓄热极探，而脉道不利，以致脉沉细而欲绝，俗未明其造化之理，而反伤热，寒极阴毒
者，或始得之，阳热暴甚，而便有此证者，或两感势甚者，通宜解毒汤加大承气汤下之。
热不退者，再下之。然虽古人皆云三下热不退即死矣，亦有按法以下四五次，利一二十行，
热方退而救活者，免致不下退其热而必死也。下后热稍退而未愈者，黄连解毒汤调之。或
微热未除者，凉膈散调之。或失下热极，以至身冷脉微，而昏冒将死者，若急下之，则残阴暴
绝，阳气后竭而立死，不下亦死，当以凉膈散或者黄连解毒汤养阴退阳。蓄热渐以消散，则
心胸腹暖，脉渐以生。至阳脉复有力者，方可以三一承气汤微下之，或解毒汤加大承气汤
尤良。或下后微热不解者，凉膈散调之。愈后但宜退热之药，忌发热诸物，阳热易为再作也。
伤寒表证应当使用发汗法，而不可使用泻下法；里证应当使用泻下法，而不可使用发汗法。病邪一半在表、一半在里时，应当使用和解法，不可使用发汗或吐下法。病邪在上焦则通过涌吐等方法疏通，在下焦则通过泻下等方法排泄。
伤寒无汗，属于表病而里气平和的，用麻黄汤（Mahuang Tang, Ephedra Decoction）发汗解表，或者天水散（Tianshui San, Cool Water Powder）之类的方剂也很好。如果表证未解，病邪一半传入里，一半仍在表的，用小柴胡汤（Xiaochaihu Tang, Minor Bupleurum Decoction）进行和解，或者使用天水散、凉膈散（Liangge San, Cooling Chest Powder）效果很好。如果表里热势都很严重的，用大柴胡汤（Dachaihu Tang, Major Bupleurum Decoction）轻微泻下。更严重的，用大承气汤（Da Chengqi Tang, Major Order the Qi Decoction）泻下。如果表热多、里热少的，用一份天水散加半份凉膈散进行和解。如果里热多、表热少，且尚不可泻下的，用一份凉膈散加半份天水散调和。如果热势更重的，用小承气汤（Xiao Chengqi Tang, Minor Order the Qi Decoction）泻下。如果表证已解，只有里证的，用大承气汤泻下。凡上述各种可下之证，通常都适宜用三一承气汤（Sanyi Chengqi Tang, Three-One Order the Qi Decoction）泻下。
发汗后病不解，经过泻下治疗后，前后症状没有明显变化的，通常适宜用凉膈散调和，以退去热邪。两感伤寒（Lianggan Shanghan, Simultaneous Invasion of Exterior and Interior）参照此法即可。
伤风自汗，属于表病而里气平和的，用桂枝汤（Guizhi Tang, Cinnamon Twig Decoction）解肌发表。病邪一半在表、一半在里的，用白虎汤（Baihu Tang, White Tiger Decoction）和解。病邪在里的，用大承气汤泻下。
另一种治法是：不论风寒暑湿何种外邪，无论有汗无汗，只要是内外诸邪所伤，只要有可下之证，或者表里两证都不见但病情日益加重，出现眼睛视物不清、眼球转动不灵活，或者腹部胀满坚实疼痛，或者烦躁口渴，或者胡言乱语、狂躁气喘胸满，或者蓄热极盛濒临死亡的，都适宜用大承气汤泻下，或者用三一承气汤效果更好。
伤寒大发汗后，汗出而病不解，反而无汗，脉象虚浮的，用苍术白虎汤（Cangzhu Baihu Tang, Atractylodes White Tiger Decoction）再次解表清热。如果是中暑，自汗大汗出，脉象虚弱，头痛口干，倦怠烦躁，有时怕冷，有时畏惧日光，不论表里，都适宜用白虎汤。如果里热势甚，腹部胀满且脉沉，可以泻下的，适宜用大承气汤，或者三一承气汤。
伤寒，表热极盛，身体疼痛、头痛难以忍受，或者眩晕、呕吐，里有微热，不可发汗、吐、下，拟用小柴胡汤、天水散、凉膈散之类进行和解。恐怕不能退去其严重的热势。或者在大泻下之后，反复多次泻下，热势仍然严重不能消退，本元受损虚弱而脉象不能充实，打算再次泻下，恐怕会导致阳气脱失立即死亡，不泻下也会因热极而死，此时寒凉药物已不能退去严重的热势。
或者热湿内蕴，下利不止，热不退者，或者因为大泻下后，热退但下利不止，热不退，脉弱气虚，不可再泻下者，或者各种湿热内蕴，小便赤涩，大便溏泄，频繁并伴有急迫疼痛，必定要发生痢疾的，必须适宜用黄连解毒汤（Huanglian Jiedu Tang, Coptis Decoction for Detoxification）。
或者里热极盛，恐怕阴气不能退却者，或者已经泻下后，热不退者，或者蓄热内甚，阳厥极深，以至于阳气沉伏，不能在周身营运，阴气欲绝而导致遍身青紫冰冷，疼痛难忍，项背拘急，眼睛红赤疼痛，昏眩恍惚，咽干或痛，燥渴虚汗，呕吐下利，腹部胀满实痛，烦闷痞塞扰乱，喘息急促声音嘶哑，脉象虽然疾数，但因为蓄热极盛，脉道不利，导致脉象沉细而欲绝。世俗之人不明其造化之理，反而误认为这是寒极阴毒之证，或者初得病时阳热暴盛而出现此证者，或者两感伤寒势甚者，都适宜用解毒汤加大承气汤泻下。热不退的，再次泻下。虽然古人都说三次泻下热不退就会死，但也有按照方法泻下四五次，排便一二十行，热才退而救活的情况，以免因不泻下退热而必然死亡。
泻下后热稍退但未痊愈的，用黄连解毒汤调和。或者微热未除的，用凉膈散调和。或者因失于泻下导致热极，以至身体冰冷、脉微，昏迷将死的，如果紧急泻下，则残存的阴气会暴绝，阳气随后竭尽而立即死亡，不泻下也会死，此时应当用凉膈散或者黄连解毒汤滋养阴气、退却阳热。蓄热逐渐消散，则心胸腹部温暖，脉象逐渐恢复。等到阳脉重新有力时，才可以用小剂量三一承气汤轻微泻下，或者用解毒汤加大承气汤效果更好。或者泻下后微热不解的，用凉膈散调和。痊愈后只宜用退热的药物，忌食发热性质的食物，因为阳热容易再次发作。
For Taiyang disease (Taiyang syndrome) exterior patterns, sweating methods should be used, and purgation methods must not be used; for interior patterns, purgation methods should be used, and sweating methods must not be used. When the pathogen is half in the exterior and half in the interior, harmonizing methods should be used, and sweating or emetic/purgative methods must not be used. If the pathogen is in the upper jiao (Upper Burner), it should be cleared through vomiting or similar methods; if in the lower jiao (Lower Burner), it should be drained through purgation.
In cold damage with no sweating, where there is an exterior pattern but the interior qi is peaceful, Mahuang Tang (Ephedra Decoction) should be used to induce sweating, or Tianshui San (Cool Water Powder) and similar formulas are also excellent. If the exterior pattern remains unresolved, with the pathogen half entering the interior and half remaining in the exterior, Xiaochaihu Tang (Minor Bupleurum Decoction) should be used to harmonize, or Tianshui San and Liangge San (Cooling Chest Powder) are very effective. If both exterior and interior heat conditions are severe, Dachaihu Tang (Major Bupleurum Decoction) should be used for mild purgation. For more severe cases, Da Chengqi Tang (Major Order the Qi Decoction) should be used for purgation. If there is more exterior heat and less interior heat, a ratio of one part Tianshui San to half part Liangge San should be used for harmonization. If there is more interior heat and less exterior heat, and purgation is not yet indicated, a ratio of one part Liangge San to half part Tianshui San should be used for regulation. If the heat is even more severe, Xiao Chengqi Tang (Minor Order the Qi Decoction) should be used for purgation. If the exterior pattern has resolved and only interior patterns remain, Da Chengqi Tang should be used for purgation. For all these various patterns suitable for purgation, Sanyi Chengqi Tang (Three-One Order the Qi Decoction) is generally appropriate.
If the disease persists after sweating, or after purgation, with no significant change in symptoms before or after, Liangge San should generally be used to regulate and clear the heat. This principle applies similarly to Lianggan Shanghan (Simultaneous Invasion of Exterior and Interior).
For wind-strike with spontaneous sweating, where there is an exterior pattern but the interior qi is peaceful, Guizhi Tang (Cinnamon Twig Decoction) should be used to release the muscle layer. If the pathogen is half in the exterior and half in the interior, Baihu Tang (White Tiger Decoction) should be used for harmonization. If the pathogen is in the interior, Da Chengqi Tang should be used for purgation.
Another method states: Regardless of whether the external pathogen is wind-cold, summer-heat, or dampness, and regardless of the presence or absence of sweating, if injured by internal or external pathogens, whenever there are patterns suitable for purgation, or when neither exterior nor interior patterns are evident but the condition worsens daily, accompanied by unclear vision or abnormal eye movement, abdominal fullness and solid pain, irritability and thirst, delirium, mania, panting, and chest fullness, or extreme accumulation of heat leading to near-death, Da Chengqi Tang should be used for purgation, or Sanyi Chengqi Tang is even better.
In cold damage, after excessive sweating, if sweating occurs but the disease does not resolve, and instead there is no sweating with a deficient and floating pulse, Cangzhu Baihu Tang (Atractylodes White Tiger Decoction) should be used again to resolve the exterior and clear heat. In cases of summer-heat stroke with profuse spontaneous sweating, weak pulse, headache, dry mouth, fatigue, irritability, occasional aversion to cold, or fear of sunlight, regardless of exterior or interior involvement, Baihu Tang is generally appropriate. If interior heat is severe, with abdominal fullness and a deep pulse, indicating suitability for purgation, Da Chengqi Tang or Sanyi Chengqi Tang is appropriate.
In cold damage, if exterior heat is extremely severe, causing unbearable body pain and headache, or dizziness and vomiting, with slight interior heat, sweating, vomiting, and purgation are contraindicated. Xiaochaihu Tang, Tianshui San, and Liangge San may be considered for harmonization. However, this may not suffice to reduce severe heat. After major or repeated purgations, if heat remains severe and unresponsive, and the vital qi is damaged and weak with a pulse that cannot fill out, attempting further purgation risks immediate death from collapse, while failing to purge leads to death from extreme heat. At this stage, cold-natured herbs can no longer reduce the severe heat.
If there is internal retention of heat and dampness with continuous diarrhea and persistent heat, or if after major purgation, heat subsides but diarrhea continues without heat reduction, accompanied by a weak pulse and deficient qi, making further purgation impossible, or if various damp-heat pathogens cause red and scanty urination, loose stools, frequent urgent painful defecation indicative of impending dysentery, Huanglian Jiedu Tang (Coptis Decoction for Detoxification) is required.
If interior heat is extremely severe and yin qi fails to subside, or if heat persists after purgation, or if accumulated heat is severe causing deep yang reversal (Yang Jue), leading to sunken yang qi unable to circulate in the body, approaching yin exhaustion with cyanosis and coldness of the whole body, unbearable pain, stiffness of the neck and back, red and painful eyes, dizziness and confusion, dry or painful throat, dryness, thirst, deficiency sweating, vomiting and diarrhea, abdominal fullness and solid pain, irritability and stifling sensation, rapid breathing with hoarse voice, and a rapid pulse that becomes deep, thin, and nearly imperceptible due to blocked meridians from extreme heat accumulation—often misdiagnosed by laypeople as extreme cold-yin toxicity, or occurring initially with sudden violent yang heat, or in severe Lianggan cases—Jiedu Tang combined with Da Chengqi Tang should be used for purgation. If heat persists, purgation should be repeated. Although ancients stated that failure to reduce heat after three purgations leads to death, there are cases where four or five purgations, resulting in ten to twenty bowel movements, successfully reduced heat and saved lives, avoiding inevitable death from non-purgation.
After purgation, if heat slightly subsides but recovery is incomplete, Huanglian Jiedu Tang should be used for regulation. If slight heat remains, Liangge San should be used. If heat was neglected until extreme, leading to cold body and faint pulse with coma and near-death, emergency purgation would cause sudden destruction of residual yin and subsequent exhaustion of yang, leading to immediate death; likewise, non-purgation leads to death. In such cases, Liangge San or Huanglian Jiedu Tang should be used to nourish yin and subdue yang. As accumulated heat dissipates, the chest, heart, and abdomen will warm, and the pulse will gradually recover. Only when the yang pulse regains strength should Sanyi Chengqi Tang be used for mild purgation, or Jiedu Tang combined with Da Chengqi Tang for better results. If slight heat persists after purgation, Liangge San should be used for regulation. After recovery, only heat-clearing medicines should be used, avoiding foods that generate heat, as yang heat is prone to recurrence.