夫热病大汗将出而反寒战者，
古人以百病皆为杂病，惟伤寒名曰大病，俗言汗病是也。经言大汗者，非谓邪热自汗大出者也，乃
阳气怫热郁结后，得开通发散宣通，则蒸蒸而为汗出，是谓大汗。言大病怫热邪毒之气郁极，乃发以为汗出，
故曰大汗也。故经曰∶大气皆去，病得已矣。
表之正气与邪热并甚于里，大热亢极，而反兼水化制之，故反寒栗也（化谓造化之化也）。
经曰∶少阴所至为惊，或恶寒战栗，谵妄，谓少阴君火热气之所至，而为此等之病也。又经
曰∶诸禁 栗，如丧神守，皆属于火。注云∶热之内作然。禁∶俗作噤， 振摇而动也。言禁冷振栗反
寒战也。经曰∶亢则害，承乃制。谓五行之道，微者当其本化，实甚过亢，则反兼胜已之化，以制其
甚。老子云∶天之道，其张弓乎，高者抑之。斯其道也。经云∶水曰静顺。谓静而自己无为，但顺物之
气味也。及方圆不与物争，乃至柔顺者也。水本寒，寒极则水冰如地，而能载物。又经曰∶水发而雹、
雪。是水寒亢极，而反似克水之土化，是谓兼化也。故病寒极者反坚满也。夫土主湿， 云雨而安静，雨
湿极甚则飘骤散落，是反兼风水制其土湿也。故经言痉为湿极，而反似风强病也。木主生荣而王于春，
其气湿，其本风，风大则反凉而毁折，是兼金化制其本也。故风病过极，则中外燥涩，皮肤皴揭，反
气营运之燥涩而筋脉螈缓，是反兼金化也。金主于秋而属于阴，其气凉，凉极则天气清明，而万物反
燥，燥物莫若火，是金极反兼火化制之也。故为病血液衰少，燥金之化极甚，则反热也，燥物莫若火，
夏月火盛热极，甚则天气曛昧而万
物反润，以出水液，林木流津，及体热极而反出汗液，以火炼金，热极而反化为水，是火极而反兼水化制
之也。故病热极则反出五湿。妇人带下淋沥及厥逆身冷，或为恶寒战栗，而或反冷痛也。俗以带下，直
言冷病，及恶寒战栗，便为阴寒者，俗医未知此也。夫天道造化，病微必当其本化，寒见水化，热见火
化也。病甚者，反似胜己之化。如寒极反似湿土，热极反似寒水之化也。嗟夫！百病之极甚者，其状反
似于己之相反者。俗医不求其病之本气，而百端拟疑，莫知真源，不得已而但随兼化之虚象，妄为其治，
反助其病而害于生命多矣。以至举世皆云病至危极之时，则阴阳反变而无能辨别也。殊不知但以运气造化
之理推之，则设若千变万化，而归其要则一也。何得有难易之二邪。故经曰∶夫标本之为道，要而博、小
而大，可以言一而知百病之害。经又曰∶善言始者，必念于终；善言近者，必知其远。是则至数
而道不惑，所谓明矣。故老子曰∶不窥牖见天道，不出户见天下，其出弥远，其知弥少。盖知要与不知要也。
古圣曰∶反常合道。谓古圣天理大道协议，而常俗之心，则有相反者也。然古圣道不离于俗者，谓道
包于俗而入俗也。又云∶俗自离道者，常俗莫能合于道也。夫俗则有相，而
道本无形者，正如五行之变化，微则守常，而本化自见，乃有相之俗，是化
以自见也，甚则反似胜己之化，乃无相而反常合道，是谓变，以其取变于本化之相，而反见胜己之化
也。变化之道多端，此则微、甚外相之变化也。故仙经曰∶大道似不肖，浓德若不足，即藏其本相于内，
而反变化胜己之化，于外无相，乃反常合于道者也。却以道眼观之，则求其内也，若但以俗眼观
其外，则逐相而迁，何由得其要也。故圣经所论，天地变化，与道协议而俗无所慊，但随俗见编集方论，
有乖其理，只合俗心，致使后人皆由说，反自以为明，而圣经之妙理懵然罔究，病者无辜，竟罹横夭。
吁！可痛者。且如经言∶阳胜则热，阴胜则寒。俗直谓阳热之气胜则发热，阴寒之气胜则发寒
者，皆经之本旨也。此言表里之阴阳正气之虚实，言正气胜者为不病，而不胜者为病也。故经曰∶阴胜
则阳病，阳胜则阴病。阳胜则热，阴胜则寒。是谓表阳之正气为不病，里阴之正气衰而为受病也。里阴
之正气胜为不病，表阳之正气衰而为受病者也。此皆热在表里阴阳之部分者也。然病胜在里，为
阳胜阴虚，病当发热，故发热为病热在里。阳胜阴虚，下之则愈，汗之即死者是也。表热里和，则病当恶
寒，为阴胜阳虚，汗之则愈，下之即死者是也。故热在表，为阴胜阳虚，而言恶寒之寒，则为寒也。热在
里为阳胜阴虚，而言发热之热，则为热也。故伤寒表热则恶寒，当汗；里热则发热而当
下之。又经曰∶重寒则热，重热则寒者，非谓病寒而极重反变也。此重言当有两重恶寒，则不恶寒而恶
热，谓表热恶寒为一寒也；若里之阳和，正气又出之于表，则又当有一重恶寒，是谓重寒，则反不恶
寒，而为发热也。若表之正阳之气，与邪热并入于里，则为两重发热，则不发热而复禁栗寒战也。此反
言阳和卫气，并之于表阳分，则病气之胜为阳胜也。病气与卫气，并甚于里之阴分，则为阴胜也。此亦
表里之阴阳，正气之与邪热相并，而以言为虚实也。然邪热在于表，则恶寒而热，与里之卫气并之于表，
则反烦热也。邪热独在于里，则发热，而表之正气与邪热并之于里，则反寒战也。故经云∶阳虚则外寒，
阴虚则内热。此言不并者也。正气虚而受邪热，故言虚也。又曰∶阳胜则外热，阴胜则内寒，此言并者
也。夫表里阴阳之分，受其邪热之所在，其冲和正阳之卫气，又为邪热相并，而为病之所，正气转实
而不虚。故经言胜也。故经疟论云∶阳气并于阴，当是之时，阳虚而阴盛，外无气，故先寒栗也。阴气逆
极，则复出之阳，阳与阴复并于外，则阴虚而阳实，故先热而渴。又曰∶并于阳则阳胜，并于阴则阴胜，
阴胜则寒，阳胜则热。是言表里之阴阳，热气之虚实，非寒热阴阳之虚实也。故经云∶病在
阳则热而脉燥，在阴则寒而脉静。然气并于内，而外无气，故寒战，脉不能
燥，甚而沉细欲绝，静或不见也。夫疟者邪热与卫气并则作发，而不并则休止也。故经曰∶卫气相离，或
病得休，卫气集则复病也。故又云∶阴虚而阳盛，阳盛则热矣，衰则气复反入，入则寒矣。此只言表里
之阴阳气不并者为虚，而并者为实，其为病之气者，乃热之一也。俗未明之，直以经言阴胜则
寒，不明其经意以病热而反恶寒战栗，便为阴寒之病，误之久矣。其阴寒之为病者，脉迟细，不烦渴，小
便清白，吐利腥秽，屈伸不便，厥逆禁固，体寒而不热，不恶寒，无战栗者也。故经言∶人多病气也，
阳少阴多，故身寒如从水中出。又曰∶人有身寒，汤火不能热，浓衣不能温，不冻栗。此是阴
寒为病，而直云不冻栗寒冷也。夫阳动阴静，故经云∶战栗动摇为阳火热气以为病也。反寒冷者，亢
则害，承乃制，是火热极，而反似寒水者也。故病寒战者反渴，及杂病而寒战者多有燥粪也。及夫平
人冒寒而战栗者，寒主闭藏，而外冒于寒，则里热怫郁，而表之阳和卫气，以外寒逼入于里，则阳并
于阴而寒战也。夫恐极而战者，经言五志过极则劳伤本脏，恐为肾。故经曰∶恐伤肾。然肾伤而虚，则心
火自甚而热也。又经曰∶恐则气下。然阳主出行舒荣，故心火之志喜则身心放肆；而阴主收藏，故肾水
之志恐，则身心收敛也。夫恐则肾虚，心实而热，正气收藏，陷下于里，亦是阳并于阴而寒
战也。夫酒噤而战者，肠胃酒热未散，身表酒力已消，则阳热易为蓄热入里，故但冒于寒，则阳并
于阴而寒战也。夫欲汗而寒战者，伤寒日深，表证罢，蓄热于里则发热也，若表里之正气并入里，则火
热无极而反寒战也。阴分阳热之气，逆极而后出之阳，则烦热而大汗作也。
世所谓交阳者，非阴寒交热以为阳热也，乃怫热蓄之于里，而郁极乃发，则交传出之于表之阳分，
是为交阳，而后作汗也。或怫郁过极，而不能交出于表者，是郁极不发，否极不泰，即正气衰残，阴气先
绝，则阳气后竭而死矣。夫欲汗而脉忽沉细，而或不见者，阳表正气并入于里故也。交阳而燥乱昏冒者，
里热郁极，乃发而欲出，以怫郁而阳之气极不能出，故气乱则神背而躁扰也。凡欲作汗，无问病之微甚，
或已经新下者，或下证未全者，恒以凉膈散调之。甚者宜黄连解毒汤。或下后二、三日，或未经下，腹
满烦渴，脉沉实而有下证者，三一承气汤下之。势恶者，加黄连解毒汤下之。或已战不快者，或战后汗出不
快者，或微战数次，经大战而汗不出者，乃并之不甚，而病之不速也，通宜三一承气汤，或更加黄连解毒
汤下之，以散怫热而开郁结也。大法曰∶脉浮不可下。伤寒病已有里证，脉沉，下之，里证尚在，脉渐浮，至一、
二日汗不能出者，里证郁，发之不峻，病已，三一承气汤微下之。凡此诸可下者，或得利而汗便出者，或服药
而怫郁顿然开发，先汗出而后利者，或利性但随汗出，泄则气和而愈，更不利者，说不快交不过而死者，
止由里热极甚，而不能开发也。故常以寒凉，或下怫热，免致但以其作汗，而为邪热耗绝阴气而死也。
或不战而汗出者，津液不尽而阳不并阴也。或战而无汗，而自愈者，津液已衰，以经发汗、吐。利或自汗、
吐、利，亡液过多，则津液衰竭，无由作津，但气和而愈也。或不战，无汗而愈
者，阳不并阴则不战，津液已衰，故无汗而已也。
世俗未知，而直以恶寒战栗名阳热气虚，阴寒实胜，因而为治，误人多矣。
凡是热病大汗即将发出，却反而出现寒战的情况，
古人认为百病都属于杂病，只有伤寒被称为大病，也就是俗话所说的“汗病”。经典所言的大汗，并不是指邪热导致的自汗大量流出，而是指阳气在怫热郁结之后，得到开通发散、宣通，于是蒸蒸发热而出汗，这叫做“大汗”。所谓大病，是因为怫热邪毒之气郁结到了极点，才发作而出汗，所以称为“大汗”。因此经典说：“大气（指邪气）都已去除，病就好了。”
表部的正气与邪热一同深入于里，大热亢盛到了极点，反而兼有水气的变化来制约它，所以反而出现寒冷颤抖（“化”指造化自然的变化）。
经典说：“少阴经气所至，会出现惊悸，或者恶寒战栗、胡言乱语”，这是说少阴君火热气所致，从而产生这些病症。又经典说：“各种口噤、寒战，如同失去神志主宰，都归属于火。”注解说：“是热邪在内作祟。”“禁”字俗写作“噤”，指身体振摇而动。说的是口噤冷颤、反而寒战。经典说：“亢盛就会为害，有承制才能平衡。”这是说五行的道理，轻微时保持其本来的气化，如果实盛过度亢奋，就会反过来兼取克制它的那一行的气化，以制约其亢盛。老子说：“天的规律，就像张弓射箭一样，高的地方压低它。”这就是那个道理。经典说：“水的性质是静顺。”意思是安静而自己无为，只是顺应万物的气味。以及方圆不与万物争竞，是最柔顺的。水本性寒，寒极则水结冰像大地一样，却能承载万物。又经典说：“水气发动时会有雹、雪。”这是水寒亢盛到了极点，反而类似克水之土的气化，这叫“兼化”。所以病到寒极的时候反而坚硬胀满。土主湿，云雨而安静，雨湿极甚则飘骤散落，这是反过来兼取风水之气来制约土的湿气。所以经典说痉病是湿极，反而类似风强盛的病症。木主生发繁荣而在春天王相，其气湿，其本是风，风大则反而变凉并毁折，这是兼取了金的气化来制约其本气。所以风病过极，则内外燥涩，皮肤皴裂揭起，反而出现气营运行的燥涩和筋脉抽搐舒缓，这是反兼金的气化。金主秋天而属于阴，其气凉，凉极则天气清明，而万物反而干燥，没有比火更燥的了，这是金极反而兼取火的气化来制约它。所以生病血液衰少，燥金的气化极甚，反而发热，没有比火更燥的了。夏天月火盛热极，甚至天气昏暗而万物反而滋润，因为出水液，林木流津，以及人体热极而反而出汗液，以火炼金，热极而反化为水，这是火极而反兼取水的气化来制约它。所以病热极则反而出现五种湿象。妇人带下淋沥及厥逆身冷，或者恶寒战栗，或者反而冷痛。俗人把带下直接说是冷病，以及恶寒战栗，就认为是阴寒，世俗医生不知道这个道理。天道造化，病轻微必定符合其本化，寒见水化，热见火化。病严重的，反而类似胜己（克制自己）的气化。如寒极反而类似湿土，热极反而类似寒水的气化。唉！百病中极严重的，其症状反而类似于与自己相反的。世俗医生不探求病的本气，而多方猜疑，不知真源，不得已而只随着兼化的虚象，胡乱治疗，反而助长病情而危害生命很多了。以至于举世都说病到了危极之时，则阴阳反变而无法辨别。殊不知只要以运气造化的道理推究，那么设若千变万化，归结其要点则只有一个。怎么会有难易的区别呢？所以经典说：“标本的道理，简要而广博、微小而宏大，可以说知一而知百病的危害。”经典又说：“善于谈论开始的，必定想到结束；善于谈论近处的，必定知道远处的。”这就是至数而道不迷惑，所谓的明智。所以老子说：“不窥视窗户就能看见天道，不出门户就能知晓天下，他出去得越远，知道的越少。”这是因为知道要点与不知道要点的区别。古圣人说：“反常合道。”是说古圣人与天理大道协议，而常人的俗心，则有相反的地方。然而古圣人的道不离于俗，是说道包含于俗而入于俗。又说：俗人自己背离道，是因为常人不能合于道。夫俗则有形相，而道本来无形，正如五行的变化，轻微则守常，而本化自然显现，是有形的俗，是化以自我显现，严重则反而类似胜己的气化，是无相而反常合道，这叫变，因为它取变于本化的相，而反见胜己的气化。变化的道理多端，这只是微、甚外在相的变化。所以仙经说：“大道似乎不像样子，浓德好像不足，即藏其本相于内，而反变化胜己的气化，于外无相，乃反常合于道。”如果用道眼观察，则是探究其内在；如果只用俗眼观察其外在，则随相而迁转，怎么能得其要领呢？所以圣经所论述的天地变化，与道协议而俗无所不满，但随俗见编集方论，有违背其理，只迎合俗心，致使后人皆由说法，反而自以为明，而圣经的妙理懵然不究，病人无辜，竟遭横死。唉！可痛惜啊。且如经典说：“阳胜则热，阴胜则寒。”俗人直接认为阳热之气胜则发热，阴寒之气胜则发寒，都是经典的本旨。这里讲的是表里之阴阳正气的虚实，说正气胜者为不病，而不胜者为病。所以经典说：“阴胜则阳病，阳胜则阴病。阳胜则热，阴胜则寒。”这是说表阳的正气为不病，里阴的正气衰而为受病。里阴的正气胜为不病，表阳的正气衰而为受病。这都是热在表里阴阳的部分。然而病胜在里，为阳胜阴虚，病应当发热，所以发热为病热在里。阳胜阴虚，用下法则愈，用汗法即死者就是这种情况。表热里和，则病应当恶寒，为阴胜阳虚，用汗法则愈，用下法即死者就是这种情况。所以热在表，为阴胜阳虚，而言恶寒的寒，则为寒。热在里为阳胜阴虚，而言发热的热，则为热。所以伤寒表热则恶寒，当用汗法；里热则发热而当用下法。又经典说：“重寒则热，重热则寒”，不是说病寒而极重反而变热。这里的“重”言当有两重恶寒，则不恶寒而恶热，谓表热恶寒为一寒；如果里的阳和，正气又出于表，则又当有一重恶寒，这叫重寒，则反而不恶寒，而为发热。如果表的正阳之气，与邪热并入于里，则为两重发热，则不发热而反而口噤寒战。这是反言阳和卫气，并之于表阳分，则病气之胜为阳胜。病气与卫气，并甚于里之阴分，则为阴胜。这也是表里之阴阳，正气与邪热相并，而以言为虚实。然而邪热在于表，则恶寒而热，与里的卫气并之于表，则反而烦热。邪热独在于里，则发热，而表的正气与邪热并之于里，则反而寒战。所以经典说：“阳虚则外寒，阴虚则内热。”这是说不相并的情况。正气虚而受邪热，所以说虚。又说：“阳胜则外热，阴胜则内寒”，这是说相并的情况。夫表里阴阳之分，受其邪热所在，其冲和正阳之卫气，又为邪热相并，而为病之所，正气转实而不虚。所以经典说“胜”。所以经典《疟论》说：“阳气并于阴，当是之时，阳虚而阴盛，外无气，故先寒栗也。阴气逆极，则复出之阳，阳与阴复并于外，则阴虚而阳实，故先热而渴。”又说：“并于阳则阳胜，并于阴则阴胜，阴胜则寒，阳胜则热。”这是说表里之阴阳，热气之虚实，不是寒热阴阳之虚实。所以经典说：“病在阳则热而脉躁，在阴则寒而脉静。”然而气并于内，而外无气，故寒战，脉不能躁，甚而沉细欲绝，静或不见。夫疟者是邪热与卫气并则发作，而不并则休止。所以经典说：“卫气相离，或病得休，卫气集则复病。”所以又说：“阴虚而阳盛，阳盛则热矣，衰则气复反入，入则寒矣。”这只说表里之阴阳气不并为虚，而并为实，其为病之气者，乃是热之一。俗人未明白这一点，直接以经典说阴胜则寒，不明其经意以病热而反恶寒战栗，就认为是阴寒的病，误了很久了。那些阴寒作为病的，脉迟细，不烦渴，小便清白，吐利腥秽，屈伸不便，厥逆禁固，体寒而不热，不恶寒，无战栗。所以经典说：“人多病气也，阳少阴多，故身寒如从水中出。”又说：“人有身寒，汤火不能热，浓衣不能温，不冻栗。”这是阴寒为病，而直接说不冻栗寒冷。夫阳动阴静，所以经典说：“战栗动摇为阳火热气以为病。”反寒冷者，亢则害，承乃制，是火热极，而反似寒水。所以病寒战者反而口渴，以及杂病而寒战者多有燥粪。以及普通人冒寒而战栗，寒主闭藏，而外冒于寒，则里热怫郁，而表的阳和卫气，以外寒逼入于里，则阳并于阴而寒战。恐惧至极而战栗，经典说五志过极则劳伤本脏，恐为肾。所以经典说：“恐伤肾。”然而肾伤而虚，则心火自甚而热。又经典说：“恐则气下。”然而阳主出行舒荣，所以心火之志喜则身心放肆；而阴主收藏，所以肾水之志恐，则身心收敛。夫恐则肾虚，心实而热，正气收藏，陷下于里，亦是阳并于阴而寒战。饮酒后口噤而战栗，肠胃酒热未散，身表酒力已消，则阳热易为蓄热入里，所以但冒于寒，则阳并于阴而寒战。想要出汗而寒战，伤寒日深，表证罢，蓄热于里则发热，如果表里正气并入里，则火热无极而反寒战。阴分阳热之气，逆极而后出之阳，则烦热而大汗作。
世人所谓的“交阳”，不是阴寒交热以为阳热，而是怫热蓄之于里，而郁极乃发，则交传出之于表之阳分，这叫交阳，而后作汗。或者怫郁过极，而不能交出于表，是郁极不发，否极不泰，即正气衰残，阴气先绝，则阳气后竭而死。想要出汗而脉忽然沉细，或者不见，是阳表正气并入于里。交阳而燥乱昏冒，是里热郁极，乃发而欲出，以怫郁而阳之气极不能出，故气乱则神背而躁扰。凡是要作汗，无论病之微甚，或者已经新下者，或者下证未全者，恒以凉膈散调治。严重的宜用黄连解毒汤。或者下后二、三日，或者未经下，腹满烦渴，脉沉实而有下证者，三一承气汤下之。势恶者，加黄连解毒汤下之。或者已战不快者，或者战后汗出不快者，或者微战数次，经大战而汗不出者，乃并之不甚，而病之不速，通宜三一承气汤，或者更加黄连解毒汤下之，以散怫热而开郁结。大法说：脉浮不可下。伤寒病已有里证，脉沉，下之，里证尚在，脉渐浮，至一、二日汗不能出者，里证郁，发之不峻，病已，三一承气汤微下之。凡此诸可下者，或者得利而汗便出者，或者服药而怫郁顿然开发，先汗出而后利者，或者利性但随汗出，泄则气和而愈，更不利者，说不快交不过而死者，止由里热极甚，而不能开发。所以常用寒凉，或者下怫热，免致只以其作汗，而为邪热耗绝阴气而死。或者不战而汗出，是津液不尽而阳不并阴。或者战而无汗，而自愈，是津液已衰，以经发汗、吐、利或自汗、吐、利，亡液过多，则津液衰竭，无由作津，但气和而愈。或者不战，无汗而愈，是阳不并阴则不战，津液已衰，故无汗而已。
世俗不明白，而直接以恶寒战栗名阳热气虚，阴寒实胜，因而为治，误人多矣。
In cases where a heat disease is about to produce profuse sweating but instead presents with chills and rigors,
the ancients considered that among the hundred diseases, only Typhoid (Shanghan) was called a "major disease," which is what colloquially referred to as the "sweat disease." The classics refer to "profuse sweating" not as spontaneous sweating caused by pathogenic heat flowing out in large amounts, but rather as follows: after Yang Qi has been constrained, heated, and stagnant, once it obtains release, dispersion, and unblocking, it steams and produces sweat; this is termed "profuse sweating." It is called a major disease because the Qi of constrained heat and pathogenic toxins has stagnated to an extreme degree before manifesting as sweat, hence the term "profuse sweating." Therefore, the classics state: "When the great Qi (pathogenic factor) has departed, the illness is resolved."
When the righteous Qi at the exterior and pathogenic heat both intensify within the interior, and excessive heat reaches its peak, it may paradoxically undergo a transformation resembling Water to restrain it; thus, cold trembling occurs instead. ("Transformation" refers to the natural processes of creation and change.)
The classics state: "When Shaoyin [Kidney/Ministerial Fire] Qi arrives, it causes fright, or aversion to cold with rigors, delirium." This indicates that these conditions arise from the arrival of Shaoyin Ministerial Fire and Heat Qi. Furthermore, the classics say: "Various cases of locked jaws, tremors, and loss of spiritual control all belong to Fire." The commentary notes: "This is due to heat acting internally." "Locked jaw" (Jin) is commonly written as "Jin" (clamping), referring to bodily shaking and movement. This describes locked jaws, cold tremors, and paradoxical chills. The classics state: "Excess leads to harm; restraint brings balance." This explains the principle of the Five Elements: when subtle, it adheres to its original transformation; when excessive and hyperactive, it paradoxically adopts the transformation of the element that overcomes it to restrain the excess. Laozi said: "The Way of Heaven is like drawing a bow; it lowers what is high." This is that principle. The classics state: "Water is characterized by stillness and compliance." Meaning it is quiet and non-action-oriented, merely complying with the nature of things. Its form does not contend with other things, making it extremely compliant. Water is inherently cold; when cold reaches its extreme, water freezes like earth, yet can bear weight. The classics also say: "When Water Qi mobilizes, hail and snow occur." This means when Water-Cold is hyperactive to the extreme, it paradoxically resembles the transformation of Earth (which controls Water); this is called "paradoxical transformation." Thus, when illness reaches extreme cold, the body may feel rigid and full. Earth governs dampness, cloud and rain, and tranquility; when rain-dampness becomes excessive, it scatters violently, which is a paradoxical adoption of Wind-Water Qi to restrain Earth-Dampness. Hence, the classics state that spasm results from extreme dampness but paradoxically resembles a Wind-strong condition. Wood governs growth and prosperity in Spring; its Qi is moist, its root is Wind. When Wind is strong, it paradoxically turns cool and causes destruction, adopting Metal's transformation to restrain its root. Thus, when Wind pathology is extreme, there is dryness and astringency inside and out, skin cracking and peeling, and paradoxically, Qi and Blood circulation becomes dry and astringent with tendon spasms and flaccidity; this is a paradoxical adoption of Metal's transformation. Metal governs Autumn and belongs to Yin; its Qi is cool. When coolness reaches its extreme, the weather becomes clear, and things paradoxically become dry. Nothing is drier than Fire; thus, when Metal is extreme, it paradoxically adopts Fire's transformation to restrain it. In illness, if blood is deficient and Dry-Metal transformation is extreme, heat paradoxically appears. Nothing is drier than Fire. In summer, when Fire is abundant and heat is extreme, the weather may become murky, yet things paradoxically become moist as fluids are produced, trees exude sap, and the human body, when extremely hot, paradoxically sweats. Fire refining Metal, extreme heat transforms into Water; this is Fire reaching extremity and paradoxically adopting Water's transformation to restrain it. Thus, when illness heat is extreme, five types of dampness may appear. Women may suffer from leukorrhea dripping, cold limbs, aversion to cold with rigors, or paradoxical cold pain. Laypeople directly call leukorrhea a cold disease, and associate aversion to cold with rigors with Yin-Cold; lay physicians do not understand this. Heavenly Dao and creation follow principles: mild illness conforms to its original transformation (Cold shows Water transformation, Heat shows Fire transformation). Severe illness paradoxically resembles the transformation of the element that overcomes it. For example, extreme cold resembles Wet Earth, and extreme heat resembles Cold Water. Alas! In the most severe cases of the hundred diseases, symptoms paradoxically resemble their opposites. Lay physicians fail to seek the fundamental Qi of the illness, suspecting variously without knowing the true source. Forced to do so, they treat based on the illusory signs of paradoxical transformations, inadvertently aggravating the illness and harming life frequently. Consequently, the world claims that when illness reaches critical extremity, Yin and Yang reverse and cannot be distinguished. Little do they know that by deducing from the principles of Luck and Creation, no matter how myriad the changes, the essence remains one. How could there be distinctions of difficulty? Therefore, the classics state: "The Way of Root and Branch is concise yet extensive, small yet large; knowing one allows understanding the harm of a hundred diseases." The classics further state: "One who speaks well of beginnings must consider endings; one who speaks well of near things must know far things." This is having the supreme numbers and the Way without confusion, which is called enlightenment. Thus, Laozi said: "Without looking out the window, one sees the Heavenly Way; without stepping outside, one knows the World. The farther one goes out, the less one knows." This is the difference between knowing the essential and not knowing the essential. The ancient sages said: "Paradoxical yet conforming to the Dao." This means the ancient sages' Heavenly Principle and Great Dao align, while ordinary worldly minds are opposite. However, the ancient sages' Dao does not separate from the mundane; it encompasses the mundane and enters it. It is also said that the mundane separates itself from the Dao because ordinary people cannot align with the Dao. The mundane has forms, while the Dao is originally formless. Just like the changes of the Five Elements: when subtle, it keeps constancy, and the original transformation reveals itself; this is the formed mundane, where transformation reveals itself. When severe, it paradoxically resembles the transformation of the overcoming element; this is formless, paradoxical yet conforming to the Dao, called Change. It takes change from the form of the original transformation and paradoxically reveals the overcoming transformation. The ways of change are manifold; this is merely the external change of subtle versus severe. Thus, the Immortal Classics say: "The Great Dao seems unlike anything; Great Virtue seems insufficient." It hides its original form internally and paradoxically changes into the overcoming transformation externally, appearing formless, thus being paradoxical yet conforming to the Dao. If viewed through the Eye of Dao, one seeks the interior; if viewed through worldly eyes externally, one follows forms and shifts, never grasping the essence. Therefore, the Sacred Texts discuss heavenly and earthly changes, aligning with the Dao and leaving no dissatisfaction for the mundane. But compiling formulas and theories based on worldly views deviates from the principle, catering only to worldly hearts. This causes later generations to follow explanations, mistakenly thinking themselves enlightened, while remaining ignorant of the profound truths of the Sacred Texts. Patients suffer innocently, meeting untimely deaths. Sigh! What a pity. As the classics state: "Yang excess leads to heat, Yin excess leads to cold." Laypeople directly interpret this as Yang-Heat Qi excess causing fever, and Yin-Cold Qi excess causing cold; this is the original intent of the classics. Here, it discusses the deficiency and excess of Righteous Qi of Yin-Yang in the interior and exterior. It states that when Righteous Qi is in excess, there is no illness; when not in excess, there is illness. Thus, the classics say: "Yin excess leads to Yang pathology; Yang excess leads to Yin pathology. Yang excess leads to heat; Yin excess leads to cold." This means the Righteous Qi of Exterior Yang is not ill, while the Righteous Qi of Interior Yin is deficient and susceptible to illness. Conversely, if Interior Yin Righteous Qi is in excess, it is not ill; if Exterior Yang Righteous Qi is deficient, it becomes ill. These describe heat located in the parts of Exterior-Interior and Yin-Yang. However, if the pathological excess is in the interior, it is Yang excess and Yin deficiency; the illness should present with fever. Thus, fever indicates heat in the interior. In Yang excess and Yin deficiency, purgation leads to recovery, while diaphoresis leads to death. If Exterior Heat is present but the Interior is harmonious, the illness should present with aversion to cold; this is Yin excess and Yang deficiency. Diaphoresis leads to recovery, while purgation leads to death. Therefore, heat in the exterior is Yin excess and Yang deficiency; the mentioned "cold" of aversion to cold is indeed cold. Heat in the interior is Yang excess and Yin deficiency; the mentioned "heat" of fever is indeed heat. Thus, in Typhoid, exterior heat causes aversion to cold and requires diaphoresis; interior heat causes fever and requires purgation. The classics also state: "Repeated cold leads to heat, repeated heat leads to cold." This does not mean that extreme cold pathologically transforms into heat. "Repeated" here implies two stages of aversion to cold. First, exterior heat with aversion to cold constitutes one cold; if Interior Yang-Harmony and Righteous Qi emerge to the exterior, another stage of aversion to cold occurs. This is "repeated cold," which paradoxically results in no aversion to cold but rather fever. If Exterior Righteous Yang Qi merges with pathogenic heat into the interior, it constitutes two stages of fever; paradoxically, there is no fever but rather locked jaws and cold rigors. This paradoxically describes Yang-Harmony and Wei Qi merging into the Exterior Yang portion, where the pathological Qi's excess is Yang excess. If Pathological Qi and Wei Qi merge excessively into the Interior Yin portion, it is Yin excess. This again discusses the merging of Righteous Qi and pathogenic heat in Exterior-Interior Yin-Yang, expressed as deficiency and excess. When pathogenic heat is in the exterior, there is aversion to cold and heat; when it merges with Interior Wei Qi in the exterior, there is paradoxical irritability and heat. When pathogenic heat is solely in the interior, there is fever; when Exterior Righteous Qi merges with pathogenic heat in the interior, there is paradoxical cold rigors. Thus, the classics state: "Yang deficiency leads to exterior cold; Yin deficiency leads to interior heat." This refers to cases without merging. Righteous Qi is deficient and receives pathogenic heat, hence termed deficiency. It also states: "Yang excess leads to exterior heat; Yin excess leads to interior cold." This refers to cases with merging. Regarding the division of Exterior-Interior Yin-Yang, depending on where pathogenic heat resides, the Harmonious Righteous Yang Wei Qi merges with pathogenic heat, becoming the site of illness. Righteous Qi turns substantial and not deficient. Hence, the classics speak of "excess." The classic *Neijing·Malaria Treatise* states: "When Yang Qi merges into Yin, at that time, Yang is deficient and Yin is abundant, with no Qi on the exterior, hence first comes cold trembling. When Yin Qi reverses to the extreme, it emerges back into Yang. Yang and Yin merge again on the exterior, leading to Yin deficiency and Yang abundance, hence first comes heat and thirst." It also says: "Merging into Yang leads to Yang excess; merging into Yin leads to Yin excess. Yin excess leads to cold; Yang excess leads to heat." This discusses the deficiency and excess of Heat Qi in Exterior-Interior Yin-Yang, not the deficiency and excess of Cold-Heat Yin-Yang. Thus, the classics state: "Illness in Yang presents with heat and rapid pulse; illness in Yin presents with cold and quiet pulse." When Qi merges inward and there is no Qi outward, cold rigors occur; the pulse cannot become rapid, becoming deep, fine, nearly imperceptible, quiet, or invisible. Malaria arises when pathogenic heat merges with Wei Qi; it stops when they do not merge. Thus, the classics state: "When Wei Qi separates, the illness rests; when Wei Qi gathers, the illness returns." It also says: "Yin deficiency and Yang abundance lead to heat; when declining, Qi returns inward, leading to cold." This only discusses that non-merging of Exterior-Interior Yin-Yang Qi is deficiency, while merging is excess. The Qi causing the illness is essentially Heat. Laypeople do not understand this, directly interpreting "Yin excess leads to cold" from the classics, failing to grasp the meaning that heat illness paradoxically presenting with aversion to cold and rigors is not a Yin-Cold illness. This error has persisted for a long time. True Yin-Cold illnesses present with slow, fine pulses, no irritability or thirst, clear urine, foul vomiting/diarrhea, inability to flex/extend, cold limbs with locked joints, body cold without heat, no aversion to cold, and no rigors. Thus, the classics state: "People often have Qi pathology; Yang is scarce, Yin is abundant, hence the body feels cold as if emerging from water." It also says: "A person feels cold; hot water and fire cannot warm them, thick clothing cannot warm them, and they do not shiver." This is Yin-Cold illness, described simply as feeling cold without shivering. Yang moves, Yin is still; thus, the classics state: "Rigors and movement are caused by Yang-Heat Fire Qi." Paradoxical coldness occurs because "Excess leads to harm; restraint brings balance." Extreme Heat-Fire paradoxically resembles Cold Water. Thus, patients with cold rigors paradoxically feel thirsty, and those with miscellaneous diseases and cold rigors often have dry feces. When healthy individuals are exposed to cold and shiver, Cold governs storage and closure. External exposure to Cold causes internal Heat constraint. Exterior Yang-Harmony and Wei Qi, forced inward by external Cold, cause Yang to merge into Yin, resulting in cold rigors. Extreme fear causes rigors; the classics state that the Five Emotions at excess damage the corresponding Zang organs, and Fear corresponds to Kidney. Thus, the classics state: "Fear injures the Kidney." When Kidney is injured and deficient, Heart Fire naturally becomes excessive and hot. The classics also state: "Fear causes Qi to descend." Yang governs movement and expansion; thus, the emotion of Joy (Heart Fire) makes body and mind expansive. Yin governs storage; thus, the emotion of Fear (Kidney Water) makes body and mind contracted. Fear causes Kidney deficiency and Heart excess-heat. Righteous Qi stores and sinks into the interior; this is also Yang merging into Yin, causing cold rigors. After drinking alcohol, locked jaws and rigors occur because intestinal-stomach alcohol-heat has not dissipated, while surface alcohol power has faded. Yang-Heat easily accumulates and enters the interior. Thus, even slight cold exposure causes Yang to merge into Yin, resulting in cold rigors. When desiring to sweat but experiencing cold rigors, Typhoid progresses deeply, exterior signs cease, and heat accumulates in the interior, causing fever. If Exterior-Interior Righteous Qi merges into the interior, Fire-Heat becomes boundless, paradoxically causing cold rigors. Yang-Heat Qi in the Yin portion, reversing to the extreme, emerges as Yang, causing irritability and profuse sweating.
What the world calls "Jiao Yang" (Crossing Yang) is not Yin-Cold crossing into Heat to become Yang-Heat, but rather constrained heat accumulating in the interior, stagnating to the extreme, then crossing out to the Exterior Yang portion. This is "Jiao Yang," followed by sweating. If constraint stagnates excessively and cannot cross to the exterior, stagnation does not release, misfortune does not turn to fortune. Righteous Qi becomes depleted, Yin Qi perishes first, then Yang Qi perishes last, leading to death. When desiring to sweat, if the pulse suddenly becomes deep and fine or invisible, it is because Exterior Righteous Yang Qi has merged into the interior. Crossing Yang with agitation and coma occurs because interior heat stagnates to the extreme, attempting to emerge. Due to constraint, Yang Qi cannot exit at the extreme; Qi becomes chaotic, Spirit departs, and restlessness ensues. Whenever sweating is about to occur, regardless of illness severity, whether recently purged or purgation signs are incomplete, always regulate with Li Ge San (Cool the Chest Powder). For severe cases, use Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity). If two to three days post-purgation, or unpurged, with abdominal fullness, irritability, thirst, deep-solid pulse, and purgation signs, use San Yi Cheng Qi Tang (Three-One Bowel-Relieving Decoction) to purge. For malignant trends, add Huang Lian Jie Du Tang to purge. If rigor was ineffective, post-rigor sweating is ineffective, or slight rigors occurred multiple times but major rigors failed to produce sweat, it is because merging was not intense and illness progression was slow. Generally, use San Yi Cheng Qi Tang, or add Huang Lian Jie Du Tang to purge, to dissipate constrained heat and resolve stagnation. The general rule states: "Floating pulse prohibits purgation." In Typhoid, if interior signs exist and pulse is deep, purging resolves interior signs; if interior signs persist and pulse gradually floats, but after one or two days sweat cannot emerge, interior signs are constrained, release is not vigorous, and illness is resolving, use San Yi Cheng Qi Tang to mildly purge. Among these purgable cases, some recover with sweating and bowel movement after gaining stool; some experience sudden release of constraint after medication, sweating first then having bowel movements; some have bowel movements following sweat, where discharge harmonizes Qi and restores health without further purgation. Those who die without effective sweating or crossing are due to extreme interior heat unable to release. Thus, one commonly uses cold-natured herbs or purges constrained heat to avoid mistaking sweating for the cure, which would allow pathogenic heat to consume Yin Qi and cause death. If sweating occurs without rigors, it is because fluids are not exhausted and Yang does not merge into Yin. If rigors occur without sweating but self-heal, it is because fluids are already depleted. Due to prior diaphoresis, emesis, purgation, or spontaneous sweating/vomiting/diarrhea, fluid loss was excessive, leading to fluid exhaustion. No fluids remain to produce sweat; health returns through Qi harmony alone. If no rigors, no sweat, but self-heals, it is because Yang does not merge into Yin (no rigors) and fluids are depleted (no sweat).
Laypeople do not understand, directly naming aversion to cold and rigors as Yang-Heat Qi deficiency and Yin-Cold excess, treating accordingly, causing much harm.