庞曰∶辛苦之人,春夏多温热者,皆由冬时触冒寒毒所致。自春及夏至前为温病者,《素问》、
仲景所谓伤寒也。有冬时伤非节之暖,名曰冬温之毒,与伤寒大异,实时发病温者,乃天行之病耳。
其冬月温暖之时,人感乖候之气,未即发病,至春或被积寒所折,毒瓦斯不得泄,至天气暄热,温毒
乃发,则肌肉斑烂也。又四时自受乖气,而成腑脏阴阳温毒者,则春有青筋牵,夏有赤脉KT ,秋有
白气 ,冬有黑骨温,四季有黄肉随,治亦别有法。《难经》载五种伤寒,言温病之脉,行在诸经,
不知何经之动,随经所在而取之。中风木,伤寒金,热病火,湿温水,温病土,治之者各取其所属。
据《难经》温病,本是四种伤寒,感异气而变成温病也。土无正形,因火而名,故以温次热也。土
寄在四维,故附金木水火而变病,所以王叔和云∶
阳脉浮滑,阴脉濡弱,更遇于风热,变成风温;阳脉洪数,阴脉实大,更遇其热,变成温毒,温毒
为病最重也;阳脉濡弱,阴脉弦紧,更遇湿气,变为湿温;脉阴阳俱盛,重感于寒,变成温疟,斯
乃同病异名,同脉异经者也。故风温取足厥阴木、手少阴火,温毒专取手少阴火,温疟取手太阴金,
湿温取足少阴水、手少阴火,故云随经所在而取之也。天行之病,大则流毒天下,次则一方,次则
一乡,次则偏着一家,悉由气运郁发,有胜有伏,迁正退位,或有先后。天地九室相形,故令升之
不前,降之不下,则天地不交,万化不安,必偏有宫分,受斯害气,庄子所谓运动之泄者也。且人
命有遭逢,时有否泰,故能偏着一家。天地有斯害气,还以天地所生之物,以防备之,命曰贤人知
方矣。
庞安石说:辛勤劳作的人,在春夏季节多患温热病,这都是因为冬季感受了寒邪毒气所致。从春季到夏至之前发生的温病,就是《素问》和张仲景所说的伤寒。如果在冬季遭受了非时令的暖热之气,这种病名叫“冬温之毒”,它与伤寒大不相同;如果是当时立即发病的温热病,那就是天行(流行性)疾病。
在冬月温暖的时候,人如果感染了违背节令的气候,当时没有立即发病,到了春天又被积存的寒气所遏制,体内的毒气无法宣泄,等到天气变得暄热时,温毒就会发作,导致肌肉出现斑烂的症状。另外,如果在四季中直接感染了乖戾之气,从而形成脏腑阴阳温毒的话,那么春天会有青筋牵掣的病证,夏天有赤脉拘急的病证,秋天有白气郁滞的病证,冬天有黑骨温的病证,四季交替之时还有黄肉随动的病证,治疗这些病症也有各自不同的方法。
《难经》记载了五种伤寒,谈到温病的脉象,运行于各条经脉之中,不知道是哪条经脉发生病变,就根据经脉所在的位置来选取治疗方法。中风对应木,伤寒对应金,热病对应火,湿温对应水,温病对应土,治疗者应当分别取用它们所属的五行对应的经脉。依据《难经》,温病原本属于四种伤寒,是因为感受了异样的气而变成了温病。土没有固定的形态,因火而得名,所以将温排在热的后面。土寄居在四维(四隅),所以依附于金、木、水、火而发生变化产生疾病,正如王叔和所说:阳脉浮滑,阴脉濡弱,如果再遇到风热,就变成了风温;阳脉洪数,阴脉实大,如果再遇到热邪,就变成了温毒,温毒作为疾病是最严重的;阳脉濡弱,阴脉弦紧,如果再遇到湿气,就变成了湿温;脉象阴阳俱盛,再次感受寒邪,就变成了温疟,这些都是同一种病因却有不同的名称,相同的脉象却源于不同经脉的情况。所以风温选取足厥阴肝经和手少阴心经,温毒专门选取手少阴心经,温疟选取手太阴肺经,湿温选取足少阴肾经和手少阴心经,所以说要根据经脉所在的位置来选取治疗方法。
天行疾病,严重的会流毒天下,次一级的影响一个地区,再次的只影响一个乡里,最轻微的只偏着一户人家,这都是由于气运郁结而发,有胜气有伏气,迁正退位(气候主气的更替),或者有时间上的先后。天地九室相互影响,使得升发之气不能前行,降敛之气不能下行,于是天地之气不交合,万物化生不安定,必然有特定的宫分(方位/区域)受到这种害气的影响,这就是庄子所说的运动中的泄气。况且人的命运有遭遇的不同,时势有否塞与通泰的变化,所以能够只偏着一户人家。天地既然产生了这种害气,就用天地所生的事物来防备它,这就叫做贤人懂得应对的方法了。
Pang stated: Hardworking people often suffer from warm-heat diseases in spring and summer, all caused by contracting cold pathogenic toxins during winter. Warm diseases occurring from spring until before the Summer Solstice are what *Suwen* (Plain Questions) and Zhang Zhongjing referred to as Shanghan (Cold Damage). If one is affected by unseasonal warmth during winter, this condition is named "Winter-Warmth Poison" (Dongwen Zhi Du), which is vastly different from Shanghan; if a warm disease manifests immediately at that time, it is a Tianxing (epidemic) disease.
During the warm days of winter, if a person contracts climate qi that violates the seasonal norms without immediate onset, and later in spring is suppressed by accumulated cold, causing the internal toxins to fail to dissipate, then when the weather becomes hot, the warm toxin erupts, leading to ulceration and maculation of the muscle tissue. Furthermore, if one directly contracts aberrant qi in the four seasons, resulting in zang-fu yin-yang warm toxins, then in spring there is the syndrome of green sinew traction (Qing Jin Qian), in summer the syndrome of red vessel spasm (Chi Mai Ji), in autumn the syndrome of white qi stagnation (Bai Qi Yu), in winter the Black Bone Warmth (Hei Gu Wen), and during the transition of seasons, the Yellow Flesh Following (Huang Rou Sui). These conditions have their own distinct treatment methods.
*Nan Jing* (Classic of Difficult Issues) records five types of Shanghan, stating that the pulse of warm disease travels through the various meridians. One must not know which meridian is moving, but rather select treatment points based on the location of the meridian involved. Wind-strike corresponds to Wood, Cold Damage corresponds to Metal, Heat Disease corresponds to Fire, Damp-Warmth corresponds to Water, and Warm Disease corresponds to Earth. The practitioner should select the corresponding meridians for each. According to *Nan Jing*, warm disease originally belongs to four types of Shanghan, transforming into warm disease due to the contraction of abnormal qi. Earth has no fixed form and is named because of Fire, hence Warmth is placed after Heat. Earth resides in the four corners (Si Wei), thus attaching itself to Metal, Wood, Water, and Fire to generate diseases. Therefore, Wang Shuhe said: When the Yang pulse is floating and slippery, and the Yin pulse is soggy and weak, further encountering wind-heat transforms it into Fengwen (Wind-Warmth); when the Yang pulse is surging and rapid, and the Yin pulse is solid and large, further encountering heat transforms it into Wendu (Warm-Toxin), which is the most severe among warm diseases; when the Yang pulse is soggy and weak, and the Yin pulse is string-like and tight, further encountering dampness transforms it into Shiwen (Damp-Warmth); when both Yin and Yang pulses are full and vigorous, and one re-contracts cold, it transforms into Wen Nue (Warm Malaria). These are cases where the same disease has different names, and the same pulse arises from different meridians. Therefore, for Fengwen, one selects the Foot-Jueyin Liver Meridian and Hand-Shaoyin Heart Meridian; for Wendu, one exclusively selects the Hand-Shaoyin Heart Meridian; for Wen Nue, one selects the Hand-Taiyin Lung Meridian; for Shiwen, one selects the Foot-Shaoyin Kidney Meridian and Hand-Shaoyin Heart Meridian. Thus it is said to select points according to the location of the meridian.
Tianxing diseases, if severe, spread toxicity throughout the world; if moderate, they affect one region; if minor, they affect one township; if slight, they affect only one household. All are caused by the depression and eruption of Qi movement, with excess and latent factors, shifts in dominant Qi positions, and variations in timing. The interaction of the nine chambers of heaven and earth causes ascending Qi to be blocked from moving forward and descending Qi to be blocked from moving down, resulting in the non-interaction of Heaven and Earth Qi, leading to instability in the transformation of all things. Consequently, specific sectors (Gongfen) inevitably suffer from this harmful Qi, which Zhuangzi referred to as the leakage of movement. Moreover, human fate involves varying encounters, and times fluctuate between obstruction and smoothness, allowing the disease to affect only one household. Since heaven and earth produce such harmful Qi, they also provide substances born of heaven and earth to prevent it; this is called the wise person knowing the method (Xianren Zhifang).