伤寒恶风。何以明之。黄帝针经曰。卫气者。所以温分肉。充皮肤。肥腠理。司开阖者
也。风邪中于卫也。则必恶风。何者。以风则伤卫。寒则伤荣。为风邪所中。于分肉不
温而热矣。皮毛不充而缓矣。腠理失其肥。则疏而不密。开阖失其司则泄而不固。
是以恶风也。是恶风恶寒二者。均为表证。其恶风则比之恶寒而轻也。恶寒者，啬
啬然增寒也。虽不当风。而自然寒矣。恶风者。谓常居密室之中。帏帐之内。则舒缓
而无所畏也一或用扇。一或当风。淅淅然而恶者。此为恶风者也。恶寒则有属于
阳者。有属于阴者。及其恶风者。悉属于阳。非若恶寒之有阴阳也。三阴之证。并无
恶风者以此也恶风虽悉在表。而发散又自不同。若无汗而恶风者。则为伤寒。当
发其汗。若汗出而恶风者。则为中风。当解其肌。里证虽具。而恶风未罢者。尤当先
解其外也。又有发汗多亡阳。与其风湿皆有恶风之证。盖以发汗。多漏不止则亡
阳。外不固。是以恶风也。必以桂枝加附子汤温其经。而固其卫。风湿相搏。骨节疼
烦。湿胜自汗而皮腠不密。是以恶风也。必以甘草附子汤散其湿而实其卫。由是
观之。恶风属乎卫者可知矣。
伤寒寒热。何以明之。寒热者。谓往来寒热也。经曰。邪正分争。往来寒热者。言邪气
之入也。而正气不为之争。则但热而无寒也。乃有热而寒者。谓其正气与邪气分
争。于是寒热作矣。争则气郁不发于外。而寒热争焉。争甚则愤然而热故寒已而
热作焉。兹乃寒热之理也。或谓寒热者。阴阳争胜也。阳胜则热。阴胜则寒。此阴阳
之争也。何则。盖以寒为阴。而热为阳里为阴而表为阳。邪之客于表者为寒。邪与
阳相争。则为寒矣。邪之入于里者为热。邪与阴相争。则为热矣；其邪在半表半里；
外与阳争而为寒。内与阴争而为热矣。表里之不拘。内外之不定。或出或入。由是
而寒热且往且来也。是以往来寒热属半表半里之证。邪居表多则多寒。邪居里
多则多热。邪气半在表半在里。则寒热亦半矣。审其寒热多少。见其邪气浅深矣。
小柴胡汤。专主往来寒热。而又立成诸加减法。亦为邪气在半表半里。未有定处。
往来不常。又寒热如疟。与夫发热恶寒。皆似而非也。然寒热加疟者。作止有时者
也。及往来寒热。则作止无时。或往或来。日有至于三五发者。甚者十数发。其与疟
状有以异也。至于发热恶寒者。为发热时寒并不见。恶寒时热不见也。不若此热
已而寒。寒已而热者。虽然。应往来寒热。属半表半里。当和解之。又有病至十余日。
而结热在里。复往来寒热者。亦可与大柴胡汤下之。不可不知也。
伤寒恶风。何以明之。黄帝针经曰。卫气者。所以温分肉。充皮肤。肥腠理。司开阖者也。风邪中于卫也。则必恶风。何者。以风则伤卫。寒则伤荣。为风邪所中。于分肉不温而热矣。皮毛不充而缓矣。腠理失其肥。则疏而不密。开阖失其司则泄而不固。是以恶风也。是恶风恶寒二者。均为表证。其恶风则比之恶寒而轻也。恶寒者，啬啬然增寒也。虽不当风。而自然寒矣。恶风者。谓常居密室之中。帏帐之内。则舒缓而无所畏也一或用扇。一或当风。淅淅然而恶者。此为恶风者也。恶寒则有属于阳者。有属于阴者。及其恶风者。悉属于阳。非若恶寒之有阴阳也。三阴之证。并无恶风者以此也恶风虽悉在表。而发散又自不同。若无汗而恶风者。则为伤寒。当发其汗。若汗出而恶风者。则为中风。当解其肌。里证虽具。而恶风未罢者。尤当先解其外也。又有发汗多亡阳。与其风湿皆有恶风之证。盖以发汗。多漏不止则亡阳。外不固。是以恶风也。必以桂枝加附子汤温其经。而固其卫。风湿相搏。骨节疼烦。湿胜自汗而皮腠不密。是以恶风也。必以甘草附子汤散其湿而实其卫。由是观之。恶风属乎卫者可知矣。
【白话翻译】
伤寒病中的“恶风”症状，该如何阐明呢？《黄帝针经》说：卫气（运行于脉外，具有温养肌肤、调节汗孔开合等功能的气），是用来温煦肌肉、充盈皮肤、滋润腠理（皮肤纹理及皮下组织间隙）、主管汗孔开阖的。如果风邪侵袭了卫气，就一定会出现恶风的症状。为什么呢？因为风邪容易损伤卫气，寒邪容易损伤营气（运行于脉中，具有营养全身作用的气）。被风邪侵袭后，肌肉得不到温煦而感到寒冷，同时伴有发热；皮毛失去充盈而变得松弛；腠理失去滋润，就会疏松而不致密；汗孔的开阖功能失职，就会导致津液泄漏而不能固摄。因此会出现恶风的症状。恶风和恶寒这两种表现，都属于表证（病位在体表，多见于外感病初期）。其中，恶风比恶寒的程度要轻。所谓恶寒，是指身体瑟瑟发抖地感到寒冷加重。即使没有吹到风，也会自然地感到寒冷。所谓恶风，是指平时居住在密闭的房间内、帷帐之中，就会感到舒缓而没有畏惧；一旦使用扇子扇风，或者对着风口，就会感到像风吹雨淋般的寒意而厌恶它，这就是恶风。恶寒有属于阳证的，也有属于阴证的；但恶风则全部属于阳证，不像恶寒那样既有阳证也有阴证。三阴病（太阴病、少阴病、厥阴病）的证候中，并没有恶风的表现，原因就在这里。恶风虽然都发生在表证阶段，但治疗方法却各不相同。如果没有汗且恶风，就是伤寒（此处指狭义伤寒，即风寒束表无汗证），应当用发汗法治疗；如果有汗且恶风，就是中风（此处指太阳中风证，即风邪袭表营卫不和证），应当用解肌法治疗。即使具备里证（病位在脏腑），但如果恶风的症状还没有消除，尤其应当先解除体表的邪气。另外，还有因发汗过多导致亡阳（阳气极度耗损），以及风湿痹证，都有恶风的症状。这是因为发汗过多，汗液淋漓不止导致阳气亡失，体表防御不坚固，所以出现恶风。必须用桂枝加附子汤（由桂枝汤加附子组成，功效为调和营卫、复阳固表）来温通经脉，并巩固卫气。风湿相互搏结，导致骨节疼痛烦扰，湿气偏盛导致自汗，使得皮肤腠理不致密，所以出现恶风。必须用甘草附子汤（由甘草、附子、白术、桂枝组成，功效为温经散寒、祛风除湿）来驱散湿气并充实卫气。由此看来，可以知道恶风是属于卫气病变的。
伤寒病中的“寒热”，该如何阐明呢？这里的寒热，指的是往来寒热（忽冷忽热交替出现）。医经说：邪气与正气相互争斗，就会出现往来寒热。这句话的意思是，当邪气侵入时，如果正气不与邪气抗争，就只会发热而不会恶寒。之所以既发热又恶寒，是因为正气与邪气相互争斗，于是寒热症状就产生了。争斗时，气机郁结不能发散于外，从而产生寒热交争的现象。争斗剧烈时，气机愤郁而化热，所以恶寒过后就会发热。这就是寒热往来的机理。有人说是寒热代表阴阳的争胜。阳胜则热，阴胜则寒，这是阴阳之间的争斗。为什么呢？大概因为寒属于阴，热属于阳；里属于阴，表属于阳。邪气客居在体表，与阳相争，就表现为恶寒；邪气深入体内，与阴相争，就表现为发热；邪气在半表半里之间，向外与阳争则恶寒，向内与阴争则发热。由于表里的界限不拘泥固定，内外的位置不确定，邪气或出或入，因此寒热症状也就此起彼伏、往来不定。所以，往来寒热属于半表半里证（病位介于表里之间，少阳病典型证候）。邪气在表较多，则恶寒较重；邪气在里较多，则发热较重；邪气一半在表一半在里，则寒热程度各半。仔细审察寒热的多少，就能了解邪气的浅深。小柴胡汤（由柴胡、黄芩、人参、半夏、甘草、生姜、大枣组成，功效为和解少阳）专门主治往来寒热，并且确立了多种加减法，这也是因为邪气在半表半里，没有固定的位置，往来无常。另外，寒热如疟疾般发作，以及发热恶寒同时存在，看起来相似但实际上不同。疟疾的寒热发作是有时间规律的；而往来寒热，发作没有时间规律，有时往有时来，一天可能发作三五次，严重的甚至十几次，这与疟疾的症状是有区别的。至于发热恶寒（指太阳病表证，恶寒与发热同时存在），是指在发热的时候并不见恶寒，在恶寒的时候并不见发热，不像这种寒去热来、热去寒来的情况。虽然如此，凡是出现往来寒热的，属于半表半里证，应当采用和解法治疗。另外，有的病发展到十多天，热邪结聚在体内，却又出现往来寒热的，也可以给予大柴胡汤（由柴胡、黄芩、半夏、枳实、芍药、大黄、生姜、大枣组成，功效为和解少阳、内泻热结）进行攻下治疗。这一点是不可不知道的。
Taiyang disease with aversion to wind. How is this explained? The *Huangdi Zhenjing* (Yellow Emperor's Classic of Acupuncture) states: Wei Qi (Defensive Qi), which warms the muscles, fills the skin, plumps the interstices (pores and tissue spaces), and controls the opening and closing of the pores, is responsible for these functions. When Wind Evil invades the Wei Qi, aversion to wind inevitably occurs. Why? Because Wind damages Wei Qi, while Cold damages Ying Qi (Nutritive Qi). When invaded by Wind Evil, the muscles fail to receive warmth and become cold, accompanied by heat; the hair and skin lose their fullness and become lax; the interstices lose their plumpness, becoming loose and not dense; the control over the opening and closing of the pores fails, leading to leakage and inability to secure fluids. Thus, aversion to wind arises. Both aversion to wind and aversion to cold are exterior syndromes. However, aversion to wind is milder than aversion to cold. Aversion to cold refers to shivering and an increasing sensation of cold. Even without exposure to wind, one naturally feels cold. Aversion to wind means that while staying in a sealed room or within curtains, one feels relaxed and unafraid; but once using a fan or facing the wind, one feels a chilling sensation like rain and wind and dislikes it; this is aversion to wind. Aversion to cold can belong to Yang syndromes or Yin syndromes; however, aversion to wind belongs entirely to Yang syndromes, unlike aversion to cold which has both Yin and Yang aspects. This is why Taiyin, Shaoyin, and Jueyin syndromes (the Three Yin diseases) do not present with aversion to wind. Although aversion to wind always occurs in exterior syndromes, the dispersing methods differ. If there is no sweating and aversion to wind, it is Taiyang Cold Damage (Exterior Excess Cold Syndrome without sweating), and diaphoresis (sweating therapy) should be used. If there is sweating and aversion to wind, it is Taiyang Wind Strike (Exterior Deficiency Syndrome with disharmony of Ying and Wei), and muscle-releasing therapy should be used. Even if interior syndromes are present, if aversion to wind has not ceased, the exterior must be resolved first. Additionally, excessive sweating leading to Yang collapse (extreme depletion of Yang Qi) and Bi syndrome caused by Wind-Dampness both present with aversion to wind. This is because excessive sweating causes continuous dripping, leading to Yang collapse and insecure exterior defense, resulting in aversion to wind. Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite Root) must be used to warm the meridians and secure the Wei Qi. In cases where Wind and Dampness struggle against each other, causing painful and vexed joints, with dampness predominance leading to spontaneous sweating and loose interstices, aversion to wind occurs. Gancao Fuzi Tang (Licorice Root and Aconite Root Decoction) must be used to dissipate dampness and strengthen the Wei Qi. From this, it can be known that aversion to wind belongs to disorders of the Wei Qi.
Taiyang disease with chills and fever. How is this explained? Here, "chills and fever" refers to alternating chills and fever (alternating sensations of cold and heat). The classics state: When pathogenic factors and healthy Qi struggle, alternating chills and fever occur. This means that when pathogenic factors invade, if healthy Qi does not struggle against them, only fever will occur without chills. The reason for having both fever and chills is that healthy Qi struggles with pathogenic factors, thus generating alternating chills and fever. During the struggle, Qi stagnates and cannot diffuse outward, leading to the contention of cold and heat. When the struggle is intense, Qi becomes agitated and transforms into heat, so after chills cease, fever arises. This is the mechanism of alternating chills and fever. Some say that chills and fever represent the struggle between Yin and Yang. Yang excess leads to heat, Yin excess leads to cold; this is the struggle of Yin and Yang. Why? Generally, cold belongs to Yin, and heat belongs to Yang; the interior belongs to Yin, and the exterior belongs to Yang. When pathogenic factors reside in the exterior and struggle with Yang, chills manifest; when they enter the interior and struggle with Yin, heat manifests; when they are in the half-exterior half-interior region, struggling outwardly with Yang causes chills, and struggling inwardly with Yin causes heat. Because the boundaries of exterior and interior are not fixed, and the positions of inside and outside are uncertain, with pathogenic factors moving in and out, the symptoms of chills and fever come and go alternately. Therefore, alternating chills and fever belong to half-exterior half-interior syndromes (typical of Shaoyang disease). If pathogenic factors are mostly in the exterior, chills predominate; if mostly in the interior, heat predominates; if half in the exterior and half in the interior, chills and heat are equal. Carefully examining the degree of chills and heat reveals the depth of the pathogenic factors. Xiao Chaihu Tang (Minor Bupleurum Decoction) specifically treats alternating chills and fever and establishes various modification formulas, also because the pathogenic factor is in the half-exterior half-interior, without a fixed location, coming and going irregularly. Furthermore, chills and fever resembling malaria, as well as simultaneous fever and aversion to cold, appear similar but are different. Malaria attacks have a regular timing; whereas alternating chills and fever have no fixed timing, occurring intermittently, sometimes three to five times a day, or even more than ten times in severe cases, which differs from malaria symptoms. As for simultaneous fever and aversion to cold (indicative of Taiyang Exterior Syndrome), it means that during fever, aversion to cold is not seen, and during aversion to cold, fever is not seen, unlike the pattern where chills cease then fever arises, or fever ceases then chills arise. Nevertheless, alternating chills and fever belong to half-exterior half-interior syndromes and should be treated with harmonizing methods. Additionally, in diseases progressing for more than ten days, with heat binding in the interior yet presenting with alternating chills and fever, Da Chaihu Tang (Major Bupleurum Decoction) can be used for purging. This point must not be overlooked.