时行者,春应暖而寒,夏应热而凉,秋应凉而热,冬应寒而湿,是以一岁之中,长幼之病
俱相似也。疫者,暴厉之气是也,治法与伤寒不同,又不可拘以日数,疫气之行,无以脉论。
春应温,而清折之邪在肝,身热头疼,目眩呕吐,长幼率似,升麻葛根解肌类也。
夏应暑,而寒折之邪在心,身热头疼,腹满自利,理中汤、射干半夏桂甘汤也。
秋应凉,而热折之邪在肺,湿热相搏,多病黄胆,咳嗽喘急,金沸草散、白虎加苍术;发黄,茵陈五苓。
冬应寒,而温折之邪在肾,多病咽痛,或生赤疹,喘咳挛痛,葳蕤汤、升麻
葛根汤;咽痛甘桔汤、败毒散之类。
湿家 一身尽疼发热,身色如熏黄。又太阳病,关节疼痛而烦(湿内流也),脉沉而细,此名
湿痹。其候大便反快,小便不利,头汗,背强(寒湿相搏),反欲近火,寒湿在表,若下之早则
哕而胸满(伤动胃气),小便不利(下后内虚也),舌上如胎,以丹田有热,胸上有寒,渴欲得水
而不能饮,则口烦燥也,湿家下之额上汗出微喘,小便利者死,下利不止者亦死。又有身上疼,
面黄而喘,头痛鼻塞而烦(阳也,表也,)脉大(阳也),自能饮食,腹中无病(不在内也),病
在头中,内药鼻中则愈,湿宜利小便。
风湿 一身尽疼,日晡热剧(风也),脉浮身重,恶风汗出,此先客湿而后感风也,
治宜麻黄薏苡仁杏子甘草汤,又宜五苓散。
湿温 吐利,大烦大渴,冷汗转筋,但尺脉沉弱,手足微厥,先伤于湿,因而中暑,
治宜五苓。又胫冷胸满,头目痛,妄言,多汗,阳脉濡弱,阴脉小急,治宜茯苓白术汤、白虎加
苍术汤,忌汗,汗之 死。
一 发热恶寒身重,脉弦细芤迟,小便已洒然毛耸,手足冷,劳则热,口
开,前板齿燥,白虎加参;小便不利及赤,五苓散;不恶寒,竹叶石膏汤;昏愦不省,葱饼熨法。
中之候,自汗面垢烦热脉虚,若脉洪浮,伏暑也,宜辛温散之。若病如痫者,风暑也。
一 状与伤寒相似,但项背反张强硬,口噤,如发痫状,头摇,此太阳中风,重
感寒湿而然。无汗,脉弦长劲急,名曰刚 ,为表实感寒也,治宜葛根麻黄,便秘宜大承气;有
汗,脉迟濡弱弦细,名曰柔 ,为表虚感湿也,治宜桂枝栝蒌葛根汤,便秘宜大承气,二症通用
小续命。大发湿家汗,亡阳亦作 。
时行病,是指春季本该温暖却寒冷,夏季本该炎热却凉爽,秋季本该凉爽却炎热,冬季本该寒冷却潮湿。因此,在一年的四季中,无论老少,人们的病症都相似。
疫病,是由暴烈厉毒之气引起的。其治疗方法与伤寒不同,不能拘泥于发病的天数来判断病情,疫气的流行情况,无法仅凭脉象来论述。
春季本该温热,若被清冷之邪所伤,病邪在肝,症状表现为身体发热、头痛、目眩、呕吐,老少症状大致相同,可用升麻葛根汤等解肌类方剂治疗。
夏季本该暑热,若被寒邪所伤,病邪在心,症状表现为身体发热、头痛、腹部胀满、自发性腹泻,可用理中汤、射干半夏桂甘汤治疗。
秋季本该凉爽,若被热邪所伤,病邪在肺,湿热相互搏结,多患黄疸病,伴有咳嗽、气喘急促,可用金沸草散、白虎加苍术汤;若出现发黄症状,可用茵陈五苓散。
冬季本该寒冷,若被温邪所伤,病邪在肾,多患咽喉疼痛,或生出红色疹子,伴有气喘咳嗽、肢体挛缩疼痛,可用葳蕤汤、升麻葛根汤;若咽喉疼痛,可用甘桔汤、败毒散之类。
湿家(素患湿病之人),全身疼痛、发热,面色像熏黄一样晦暗。又有太阳病,关节疼痛且烦躁(因湿气内流所致),脉象沉而细,这称为湿痹。其证候特点是大便反而通畅,小便不利,头部出汗,背部僵硬(因寒湿相搏),反而想要靠近火源取暖。这是寒湿在表,如果过早使用泻下法,则会导致呃逆和胸满(损伤胃气),小便不利(泻下后体内虚弱),舌面上像有一层胎垢,这是因为丹田有热,胸上有寒,口渴想喝水却无法下咽,从而感到口中烦闷燥热。湿家若误用泻下法,导致额头出汗、轻微气喘、小便通利的,主死;若腹泻不止的,也主死。又有身上疼痛,面色黄且气喘,头痛鼻塞且烦躁(属阳证、表证),脉象大(属阳证),能正常饮食,腹部没有病痛(病不在内脏),病位在头部,将药物纳入鼻中即可痊愈,治疗湿病应当利小便。
风湿病,全身疼痛,傍晚时分发热加剧(风邪作祟),脉浮、身体沉重、怕风、出汗,这是先感受湿邪后感感风邪所致,治疗宜用麻黄薏苡仁杏子甘草汤,又宜用五苓散。
湿温病,呕吐腹泻,极度烦躁口渴,出冷汗、转筋,但尺脉沉弱,手足微微厥冷,这是先伤于湿,进而中暑所致,治疗宜用五苓散。又有小腿发冷、胸满、头目疼痛、胡言乱语、多汗,阳脉濡弱,阴脉小急,治疗宜用茯苓白术汤、白虎加苍术汤,忌用发汗法,发汗会导致死亡。
另一种情况:发热恶寒、身体沉重,脉象弦细芤迟,小便结束后感觉洒然发冷、毫毛竖起,手足冰冷,劳累后发热,张口呼吸,前板齿干燥,可用白虎加人参汤;若小便不利及颜色发红,用五苓散;若不恶寒,用竹叶石膏汤;若神志昏愦不省人事,用葱饼熨敷法。
中暑的征候,自汗、面色污垢、烦躁发热、脉虚,若脉象洪大浮起,是伏暑,宜用辛温之法发散。若病症像癫痫发作,则是风暑所致。
还有一种病症,状貌与伤寒相似,但项背反张强硬,口噤不开,像发癫痫的样子,头部摇动,这是太阳中风,再次感受寒湿所致。无汗,脉象弦长劲急,称为刚痉,属于表实感受寒邪,治疗宜用葛根麻黄汤,若便秘宜用大承气汤;若有汗,脉象迟濡弱弦细,称为柔痉,属于表虚感受湿邪,治疗宜用桂枝栝蒌葛根汤,若便秘宜用大承气汤,这两种病症通用小续命汤。大发湿家之汗,导致亡阳也会引发痉病。
Shixing disease (Seasonal epidemic disease) refers to situations where spring should be warm but is cold, summer should be hot but is cool, autumn should be cool but is hot, and winter should be cold but is damp. Therefore, throughout the year, regardless of age, people's illnesses tend to be similar.
Yi disease (Plague/Epidemic) is caused by violent and toxic pathogenic qi. Its treatment methods differ from those for Shanghan (Cold Damage), and one cannot rigidly adhere to the number of days since onset to judge the condition. The progression of epidemic qi cannot be discussed solely based on pulse diagnosis.
In spring, when warmth is expected, if injured by clear-cold pathogens, the pathogen resides in the Liver. Symptoms include fever, headache, dizziness, and vomiting, with similar manifestations across all ages. Shengma Gegen Tang (Bupleurum and Pueraria Decoction) or similar muscle-relieving formulas may be used.
In summer, when heat is expected, if injured by cold pathogens, the pathogen resides in the Heart. Symptoms include fever, headache, abdominal fullness, and spontaneous diarrhea. Lizhong Tang (Regulate the Middle Decoction) and Shegan Banxia Guigan Tang (Belamcanda, Pinellia, Cinnamon Twig, and Licorice Decoction) are indicated.
In autumn, when coolness is expected, if injured by heat pathogens, the pathogen resides in the Lung. Damp-heat struggles together, often causing Jaundice (Huangdan), accompanied by cough and rapid breathing. Jinfeicao San (Boiling Water Grass Powder) and Baihu Jia Cangzhu Tang (White Tiger plus Atractylodes Macrocephala Decoction) are indicated; for yellowing of the skin, Yinchen Wuling San (Artemisia Capillaris Five-Ingredient Powder) is used.
In winter, when cold is expected, if injured by warm pathogens, the pathogen resides in the Kidney. Illnesses often involve sore throat or the emergence of red rashes, accompanied by wheezing, coughing, and limb cramping pain. Weirui Tang (Polygonatum Decoction) and Shengma Gegen Tang (Bupleurum and Pueraria Decoction) are indicated; for sore throat, Ganjie Tang (Licorice and Platycodon Decoction) and Baidu San (Resist Toxicity Powder) are used.
Individuals prone to dampness (Shijia) suffer from whole-body pain and fever, with a complexion resembling smoky yellow. Additionally, in Taiyang disease (Taiyang Disease), joint pain with irritability (due to internal flow of dampness) and a deep, thin pulse constitute Shi Bi (Dampness Bi). The presentation features loose stools, difficult urination, sweating only on the head, and stiffness in the back (due to cold-damp binding), with a desire to stay near fire. This indicates cold-dampness in the exterior. Premature use of purgatives leads to hiccups and chest fullness (damaging Stomach qi) and difficult urination (internal deficiency after purging). The tongue appears coated like fur because there is heat in the Lower Jiao (Dantian) and cold in the Upper Jiao (Chest), causing thirst for water that cannot be swallowed, resulting in oral irritation. If a Shijia patient undergoes purgation leading to sweating on the forehead, slight wheezing, and free urination, death ensues; similarly, if diarrhea persists uncontrollably, death ensues. Another presentation involves body pain, yellowish complexion, wheezing, headache, nasal congestion, and irritability (Yang/Exterior pattern), with a large pulse (Yang), normal appetite, and no abdominal pathology (pathology not in the interior). The disease is located in the head; administering medication into the nose cures it. Treatment for dampness should promote diuresis.
Fengshi (Wind-Dampness) presents with whole-body pain, worsening fever at dusk (Wind factor), floating pulse, heavy body, aversion to wind, and sweating. This results from first contracting dampness and then wind. Treatment favors Mahuang Yiyiren Xingzi Gancao Tang (Ephedra, Coix Seed, Apricot Kernel, and Licorice Decoction) or Wuling San (Five-Ingredient Powder with Poria).
Shiwenshi (Damp-Warmth) presents with vomiting and diarrhea, extreme irritability and thirst, cold sweat, and tetany. The Chi pulse is deep and weak, with slightly cold extremities. This arises from initial dampness injury followed by summerheat. Treatment favors Wuling San (Five-Ingredient Powder with Poria). Another presentation includes cold calves, chest fullness, headache and eye pain, delirium, and profuse sweating. The Yang pulses are soggy and weak, and the Yin pulses are small and urgent. Treatment favors Fuling Baizhu Tang (Poria and Atractylodes Macrocephala Decoction) and Baihu Jia Cangzhu Tang (White Tiger plus Atractylodes Macrocephala Decoction). Sweating is contraindicated; inducing sweating leads to death.
Another case: Fever, aversion to cold, and heaviness of the body, with a string-taut, thin, hollow, and slow pulse. After urination, the patient feels chilly with goosebumps, cold extremities, fever upon exertion, open mouth, and dry anterior teeth. Baihu Jiaren Shen Tang (White Tiger plus Ginseng Decoction) is indicated. For difficult urination and dark urine, Wuling San (Five-Ingredient Powder with Poria) is used. If there is no aversion to cold, Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) is used. For coma and unconsciousness, Congbing Yun Fa (Scallion Cake Moxibustion Method) is applied.
Zhongshu (Summerheat Stroke) presents with spontaneous sweating, greasy facial complexion, irritability and heat, and a deficient pulse. If the pulse is surging and floating, it is latent summerheat, treated with acrid-warm dispersing methods. If the illness resembles epilepsy, it is Wind-summerheat.
Another condition resembles Shanghan (Cold Damage) but features opisthotonos and rigidity of the neck and back, trismus (lockjaw), movements resembling epilepsy, and head shaking. This is Taiyang Fengzhong (Wind Strike of Taiyang) compounded by severe cold-dampness. Without sweating and with a string-taut, long, and tense pulse, it is called Gang Jing (Stiff Spasm), indicating Exterior Excess due to cold contraction. Ge Gen Ma Huang Tang (Pueraria and Ephedra Decoction) is indicated; for constipation, Dachengqi Tang (Major Order the Qi Decoction) is used. With sweating and a slow, soggy, weak, string-taut, and thin pulse, it is called Rou Jing (Soft Spasm), indicating Exterior Deficiency due to dampness contraction. Guizhi Gualou Gen Tang (Cinnamon Twig, Trichosanthes Root, and Pueraria Decoction) is indicated; for constipation, Dachengqi Tang (Major Order the Qi Decoction) is used. Both conditions may generally use Xiao Xuming Tang (Minor Continuation of Life Decoction). Profusely sweating a Shijia patient depletes Yang and can also induce Jing (Spasm).