冬月伤于寒,即病者为伤寒,不即病而伏藏于中,至春随阳气发见者,为温。其症头痛项强,与伤寒无异,
惟初起不恶寒,便发热,脉数为异耳。伤寒由表入里,不得不先发其表;温病由里达表,不得不先清其里。所
以温病有误汗而无误下之语。仲景着《伤寒》一书,自秋分后至春分前止,若春分后,则为温矣。《内经》虽
有先夏至日者为温病之文,仲景虽有太阳病先发热者为温之论,晋唐以来,无人剖晰伤寒、温病,概以《伤寒》
书治之,得失参半。治此症者,茫无主张,延至于金刘河间出,始着《温论》。有明喻嘉言复畅其说,温病乃
有圭臬,而仲景之书亦得以昭着于世。当此韶光明媚之天,三阳出于地上(十月纯阴用事,在卦为坤;至十一
月黄钟应律,为复,卦则一阳生;十二月太吕应律,为临,卦则二阳生;正月太簇应律,为泰,卦则三阳生),
日丽风和,花香鸟语,一片春温之气,盎盎蓬蓬(盎盎,和蔼之状;蓬蓬,司空图《二十四诗品》∶“蓬蓬
远春”),故病亦名之曰温。轻则白虎汤(人参、石膏、粳米、知母、炙草)、黄芩芍药汤(黄芩、芍药、炙
草)、葛根升麻汤(升麻、葛根、芍药、炙草),重则三承气汤(大承气汤∶
大黄、芒硝、浓朴、枳实、小承气汤∶大黄、浓朴、枳实;调胃承气汤∶大黄、芒硝、炙草),无不应验。间
亦有先恶寒而后发热者,仍以伤寒治之。又曰∶“冬不藏精,春必病温。”盖冬主闭藏,漏泄春光(杜诗∶“
漏泄春光有柳条”)。邪之所凑,其气必虚。古人婚姻六礼,定在桃夭之时,良有以也。余则谓热蕴之极,必
致煎熬肾水,遇体之充足者,但以前汤治之;倘体之虚怯者,不问精之藏与不藏,前汤中重加生、熟二地,以
培其本(生地、熟地、黄芩、芍药、贝母、生草)。则二说不相歧而相为用矣,何必如喻嘉言之分疏其说也乎
?!
冬季感受寒邪,随即发病的称为伤寒;若未立即发病,而是潜伏在体内,到了春季随着阳气升发而显现出来的,称为温病。其症状表现为头痛、项部僵硬,与伤寒没有区别,只是初起时不恶寒,而是直接发热,脉象数(快),这是两者的不同之处。伤寒的病邪由体表传入体内,因此不得不先发散表邪;温病的病邪由体内达于体表,因此不得不先清泄里热。所以有“温病误用发汗法无害,但误用攻下法则有害”的说法。张仲景撰写《伤寒论》一书,时间范围是从秋分后到春分前止;如果是春分之后,则属于温病了。《黄帝内经》中虽然有“夏至日之前发生的称为温病”的记载,张仲景也有“太阳病中先发热的属于温病”的论述,但从晋代、唐代以来,没有人详细辨析伤寒与温病的区别,一概用治疗伤寒的方法来治疗,结果得失各半。治疗这类病症的人,茫然无主见,拖延到了金代刘河间出现,才开始撰写《温热论》。明代喻嘉言又进一步阐发这一学说,温病的治疗才有了准则,而张仲景的著作也因此得以彰显于世。在这春光明媚的日子里,三阳之气从地下生出(十月纯阴当令,在八卦中为坤卦;到了十一月黄钟律应,为复卦,卦象是一阳生;十二月大吕律应,为临卦,卦象是二阳生;正月太簇律应,为泰卦,卦象是三阳生),阳光明媚,和风拂面,花香鸟语,一片春天的温热之气,蓬勃旺盛(盎盎,形容和蔼的样子;蓬蓬,出自司空图《二十四诗品》:“蓬蓬远春”),所以这种病也称之为温病。病情轻的,可用白虎汤(人参、石膏、粳米、知母、炙甘草)、黄芩芍药汤(黄芩、芍药、炙甘草)、葛根升麻汤(升麻、葛根、芍药、炙甘草);病情重的,可用三承气汤(大承气汤:大黄、芒硝、厚朴、枳实;小承气汤:大黄、厚朴、枳实;调胃承气汤:大黄、芒硝、炙甘草),无不灵验。偶尔也有先恶寒而后发热的,仍然按照伤寒的方法治疗。又说:“冬天不能固藏精气,春天必定患温病。”大概是因为冬季主闭藏,若漏泄了春光(杜甫诗句:“漏泄春光有柳条”)。邪气聚集的地方,正气必然虚弱。古人在桃花盛开之时(桃夭之时)确定婚姻的六礼,是有道理的。我认为,热邪蕴结至极,必然会导致煎熬肾水。对于体质充足的人,只需用上述方剂治疗;如果体质虚弱怯懦的人,不论其精气是否封藏得当,在上述方剂中加重加入生地黄、熟地黄,以培补根本(生地、熟地、黄芩、芍药、贝母、生甘草)。这样,两种说法就不相矛盾而是相互补充了,何必像喻嘉言那样去强行区分它们的说法呢?!
In winter, if one is injured by cold and falls ill immediately, it is termed Shanghan (Cold Damage); if it does not manifest immediately but remains latent within, emerging in spring along with the rising of Yang Qi, it is termed Wenbing (Warm Disease). The symptoms include headache and stiffness of the neck, which are no different from Shanghan. The difference lies in that at the onset, there is no aversion to cold, but rather immediate fever, and the pulse is rapid (Shu). Shanghan proceeds from the exterior to the interior, so it is imperative to first release the exterior; Wenbing proceeds from the interior to the exterior, so it is imperative to first clear the interior. Hence, the saying goes: "Mistaken sweating in Wenbing causes no harm, but mistaken purgation is dangerous." Zhang Zhongjing wrote the *Treatise on Cold Damage* (*Shanghan Lun*), covering the period from after the Autumnal Equinox to before the Vernal Equinox. If it occurs after the Vernal Equinox, it is classified as Warm Disease. Although the *Neijing* (Inner Canon) states that diseases occurring before the Summer Solstice are Warm Diseases, and Zhang Zhongjing discussed that Taiyang disease presenting with initial fever belongs to Warm Disease, since the Jin and Tang dynasties, no one had clearly differentiated between Shanghan and Wenbing. They generally treated all cases using methods for Shanghan, resulting in mixed outcomes. Physicians treating these conditions were often at a loss. It was not until Liu Hejian appeared in the Jin Dynasty that he began writing the *Treatise on Warmth* (*Wenlun*). In the Ming Dynasty, Yu Jiayan further elaborated on this theory, establishing standards for the treatment of Warm Disease, thereby allowing Zhang Zhongjing's works to be widely recognized. During this bright and beautiful springtime, when the Three Yang energies emerge from the earth (In the tenth month, pure Yin dominates, corresponding to the Kun hexagram; in the eleventh month, the Huangzhong pitch-pipe resonates, corresponding to the Fu hexagram where one Yang arises; in the twelfth month, the Dailv pitch-pipe resonates, corresponding to the Lin hexagram where two Yangs arise; in the first month, the Taicu pitch-pipe resonates, corresponding to the Tai hexagram where three Yangs arise), the sun shines brightly, the breeze is gentle, flowers scent the air, and birds sing, creating an atmosphere of abundant spring warmth (Ang'ang describes a gentle and amiable demeanor; Pengpeng is quoted from Sikong Tu's *Twenty-F-four Poetic Styles*: "Pengpeng distant spring"). Therefore, such diseases are also named Wen (Warmth). For mild cases, Baihu Tang (White Tiger Decoction: Renshen [Ginseng], Shigao [Gypsum Fibrosum], Jingmi [Oryzae Semen], Zhimu [Anemarrhenae Rhizoma], Zhi Cao [Prepared Licorice]), Huangqin Shaoyao Tang (Scutellaria and Peony Decoction: Huangqin [Scutellariae Radix], Shaoyao [Paeoniae Radix], Zhi Cao [Prepared Licorice]), or Gegen Shengma Tang (Kudzu and Cimicifuga Decoction: Shengma [Cimicifugae Rhizoma], Gegen [Puerariae Lobatae Radix], Shaoyao [Paeoniae Radix], Zhi Cao [Prepared Licorice]) may be used. For severe cases, San Chengqi Tang (Three Bowel-Regulating Decoctions) should be employed: Dachengqi Tang (Major Bowel-Regulating Decoction: Dahuang [Rhei Radix et Rhizoma], Mangxiao [Natrii Sulfas], Houpo [Magnoliae Officinalis Cortex], Zhishi [Aurantii Fructus]); Xiaochengqi Tang (Minor Bowel-Regulating Decoction: Dahuang [Rhei Radix et Rhizoma], Houpo [Magnoliae Officinalis Cortex], Zhishi [Aurantii Fructus]); Tiaowei Chengqi Tang (Stomach-Regulating Bowel-Regulating Decoction: Dahuang [Rhei Radix et Rhizoma], Mangxiao [Natrii Sulfas], Zhi Cao [Prepared Licorice]). These are invariably effective. Occasionally, there are cases with initial aversion to cold followed by fever, which are still treated according to Shanghan protocols. It is also said: "If one fails to store essence during winter, one will inevitably contract Warm Disease in spring." This is because winter governs storage and conservation; leaking spring energy (as Du Fu wrote: "Leaking spring energy are the willow branches") implies that where pathogenic factors gather, Qi must be deficient. Ancient people scheduled the six rites of marriage during the time of blooming peach blossoms (Taoyao zhi shi), which was well-founded. I argue that extreme accumulation of heat inevitably boils down Kidney Water. For those with sufficient constitution, the aforementioned decoctions suffice; however, for those with weak constitutions, regardless of whether their essence is stored properly, one should heavily add Shengdi Huang (Rehmanniae Radix Preparata) and Shudi Huang (Rehmanniae Radix Preparata) to the previous formulas to nourish the root (Shengdi, Shudi, Huangqin, Shaoyao, Beimu [Fritillariae Bulbus], Shengcao [Raw Licorice]). Thus, the two theories do not contradict each other but complement one another. Why must one differentiate them as Yu Jiayan did?!