温病中 温毒病,证同温热热尤炎。伤湿汗出当风立,风湿发热重疼牵。
【注】中 ,即中暑也。温热之病复中于暑,名曰温毒证;治同乎温热,但热尤盛也。
伤湿之病复感于风,名曰风湿;其证发热身重,疼痛牵掣也,治法已详于身痛矣。中
详在暑门。
痉证反张摇头噤,项强拘急转侧难,身热足寒面目赤,须审刚柔治法全。
【注】风湿寒之邪合而为痉,其证则背反张,摇头口噤,项强拘急,转侧艰难,身热
足寒,面目赤色也。须审刚柔治之可痊也。风湿盛者则有汗,为柔痉。风寒盛者则无汗,为
刚痉。均以小续命汤主之。刚痉去附子,柔痉去麻黄。表实者去参、附,加羌活、独活。
里实者去参、附,加芒硝、大黄。甚者则以葛根汤、桂枝加葛根汤发之。此治痉之大略
也,详在痉门。
神清色泽亮音声,身轻肤润脉和洪,忽然口噤难言躁,脉即停伏战汗宁,饮多消散
知酿汗,能食脉浮表还平,子得午解阳来济,午得子解是阴从。
【注】易愈之病,取于神则神清,取于色则色泽,取于声则音长,取于体则身轻,取
于皮则肤润,取于脉则和洪,皆一派不死之证,故曰生证也。若有如是之生证,忽然口
噤不语,烦躁而甚,六脉停伏,宜谨察之,非变凶也,乃邪正交争,生战汗之候,为将愈
之兆也。凡伤寒渴者,多阳证易愈,若忽然饮多寻常,消散无停,知酿汗而作解也。伤
寒多不能食,若忽然能食且脉浮,知胃和邪还于表而作解也。若不即解者,阴阳未得其
时也,子时得之午时必解,阳济阴生而解也,午时得之子时必解,阴从阳化而解也。
温病中,温毒病,症状与温热病相同,但热势更加炽盛。若患湿病后出汗时站立于风中,则形成风湿病,表现为发热且身体沉重疼痛、牵掣不适。
【注】“中”,即中暑。温热之病又感受暑邪,称为温毒证;治疗方法与温热病相同,只是热势更盛罢了。
患湿病后又感受风邪,称为风湿;其症状为发热、身体沉重、疼痛牵掣,治疗方法已在“身痛”章节中详细说明。详细内容见“暑门”。
痉证表现为角弓反张、摇头、牙关紧闭,颈项强直拘急,转动侧身困难,身体发热而足部发凉,面目发红,必须仔细辨别刚痉与柔痉,治疗方法才能完备。
【注】风、湿、寒三种邪气结合导致痉证,其症状为背部向后反折(角弓反张)、摇头、口噤不开、颈项强直拘急、转侧困难、身体发热、足部发凉、面目赤红。必须辨别是刚痉还是柔痉进行治疗方可痊愈。风湿偏盛者有汗,称为柔痉;风寒偏盛者无汗,称为刚痉。均用小续命汤为主方治疗。刚痉去掉附子,柔痉去掉麻黄。表实证去掉人参、附子,加羌活、独活。里实证去掉人参、附子,加芒硝、大黄。病情严重者用葛根汤或桂枝加葛根汤发汗解表。这是治疗痉证的大致原则,详细内容见“痉门”。
神志清醒、面色光泽明亮、声音洪亮悠长,身体轻便、皮肤润泽、脉象和缓有力,这是正常的表现。如果突然出现牙关紧闭、难以言语、烦躁不安,脉搏隐伏不起,随后出现战栗出汗而病情安宁,这是易愈的征兆。饮水增多后消散,预示即将酿汗而解;能够进食且脉象浮起,预示胃气调和、邪气还表而将解。若在子时发病,午时必解,这是因为阳气来助益;若在午时发病,子时必解,这是因为阴气顺从阳气而化。
【注】容易痊愈的疾病,观察神志则神志清醒,观察面色则色泽光亮,观察声音则音长,观察体态则身体轻便,观察皮肤则润泽,观察脉象则和缓有力,这些都是一派不死之象,所以称为生证(预后良好的证候)。如果有上述的生证,却突然牙关紧闭不语、烦躁严重、六脉隐伏,应当谨慎观察,这不是转变为凶险之证,而是正气与邪气交争,即将发生战汗的征候,是疾病将要痊愈的兆头。凡是伤寒口渴的病人,多属阳证,容易痊愈;如果突然饮水很多且正常消化,没有停积,预示即将酿汗而病解。伤寒病人大多不能进食,如果突然能进食且脉象浮起,预示胃气调和、邪气返回体表而即将病解。如果不能立即解除,是因为阴阳之气尚未得到协调时机,在子时得病则在午时必解,这是阳气济助阴气而解;在午时得病则在子时必解,这是阴气顺从阳气而化而解。
Among warm diseases, the Wen Du (Warm Toxin) disease presents with symptoms similar to those of Warm Heat diseases, but with a more intense heat. If one stands in the wind while sweating after contracting dampness, Wind-Dampness develops, characterized by fever accompanied by heavy body and pulling pain.
[Note] "Zhong" refers to heatstroke. When a Warm Heat disease is superimposed with summer-heat pathogen, it is named Wen Du syndrome; the treatment is the same as for Warm Heat diseases, but the heat is even more severe.
When a Dampness disease is further affected by wind, it is called Wind-Dampness; its symptoms include fever, heaviness of the body, and pulling pain. The treatment methods have been detailed in the section on Body Pain. For details, see the Summer-Heat section.
Jing Syndrome (Spasm) manifests as opisthotonos (backward arching of the back), shaking of the head, trismus (lockjaw), stiffness and spasm of the neck making turning difficult, fever in the body with cold feet, and redness of the face and eyes. One must carefully distinguish between Gang Jing (Stiff Spasm) and Rou Jing (Soft Spasm) to apply complete treatment methods.
[Note] Jing Syndrome results from the combination of Wind, Dampness, and Cold pathogens. Symptoms include opisthotonos, head shaking, trismus, neck stiffness and spasm, difficulty in turning, body heat with cold feet, and redness of the face and eyes. Treatment depends on distinguishing between Stiff and Soft spasms for recovery. When Wind-Dampness is predominant, there is sweating, termed Rou Jing (Soft Spasm); when Wind-Cold is predominant, there is no sweating, termed Gang Jing (Stiff Spasm). Both are primarily treated with Xiao Xu Ming Tang (Minor Continuation of Life Decoction). For Stiff Spasm, remove Fuzi (Prepared Aconite Root); for Soft Spasm, remove Mahuang (Ephedra Stem). For exterior excess patterns, remove Renshen (Ginseng Root) and Fuzi, add Qianghuo (Notopterygii Rhizoma et Radix) and Duhuo (Angelicae Pubescentis Radix). For interior excess patterns, remove Renshen and Fuzi, add Mangxiao (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma). In severe cases, use Gegen Tang (Kudzu Decoction) or Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Kudzu Root) to induce sweating. This is the general principle for treating Jing Syndrome; for details, see the Jing Syndrome section.
Clear spirit, bright complexion, and long voice; light body, moist skin, and harmonious and surging pulse indicate normalcy. If suddenly trismus occurs, speech becomes difficult, restlessness ensues, and pulses become hidden and deep, followed by chills and sweating leading to calmness, this indicates an easy recovery. Increased drinking that dissipates normally suggests impending sweating and resolution; ability to eat with a floating pulse suggests stomach harmony and the return of pathogenic factors to the exterior, indicating resolution. If onset occurs at Zi hour (11 PM–1 AM), resolution will likely occur at Wu hour (11 AM–1 PM), as Yang assists Yin. If onset occurs at Wu hour, resolution will likely occur at Zi hour, as Yin follows Yang.
[Note] Diseases prone to recovery exhibit clear spirit, bright complexion, long voice, light body, moist skin, and harmonious, surging pulses. These are all signs of life (Sheng Zheng), hence termed "Life Signs." Even if such favorable signs are present, sudden trismus, muteness, severe restlessness, and hidden pulses should be carefully observed; this is not a transformation into a ominous sign, but rather a struggle between healthy Qi and pathogenic factors, heralding Chanshan Han (Battle Sweat), a sign of imminent recovery. In typhoid fever, thirst often indicates a Yang pattern which recovers easily; sudden excessive drinking with normal digestion implies impending sweating and resolution. Typhoid patients usually cannot eat; sudden appetite with a floating pulse indicates stomach harmony and pathogen returning to the exterior, implying resolution. If resolution does not occur immediately, it is because Yin and Yang have not yet reached harmony. Onset at Zi hour leads to resolution at Wu hour (Yang assisting Yin); onset at Wu hour leads to resolution at Zi hour (Yin following Yang).