阴阳大论云春气温和夏气暑热秋气清凉冬气冷冽此则四时正气之序也冬时严寒万类深藏君子固密则不伤于寒触冒之
者乃名伤寒耳其伤于四时之气皆能为病以伤寒为最者以其最成杀厉之气也中而即病者名曰伤寒不即病者寒毒藏于肌肤至
春变为温病至夏变为热病热病者热极重于温也是以辛苦之人春夏多温热病皆由冬时触寒所致非时行之气也。
寒毒藏于肌肤至春变为温病藏于骨髓至夏变为热病不言藏于骨髓者脱简也○内经云冬伤于寒春必温病又云逆冬气则
少阴不藏肾气独沉言冬时寒暖不均和暖之际人之腠理不固忽然严寒骤至郁闭其不正之气于内当是之时少阴之经脉流行于
外是不能退藏于密势不得不受其邪然肾藏之真阳沉伏于内自不受邪所受邪者少阴之经耳故真阳充满之人邪气不能为害即
使受邪气行则已惟是不藏精之人先逆冬月蛰藏之令故邪气行以袭入经脉骨髓乃至春夏温热之气内动而发为温热也李明之
曰冬伤于寒冬行春令也当冬而温火胜而水亏矣水既已亏则所胜妄行土有余也火土合德故为温病所以不病于冬。而病于春
者以其寒水居卯之分方得其权大寒之令。复行于春腠理开泄。少阴不藏房室之劳伤辛苦之人。阳气泄于处肾水亏于内。
木当发生阳已处泄孰为鼓舞肾水内竭孰为滋养此两者同病。生化之源既绝。木何成以生乎身之所存者热也时强木长。故
为温病。
凡时行者春时应暖而复大寒。夏时应大热而反大凉秋时应凉而反大热。冬时应寒而反大温此非其时而有其气是以一
岁之中。长幼之病多相似者。此则时行之气也。
伤寒是感天时肃杀之气以寒犯寒必先寒冰时行是感湿土郁蒸之气以湿犯湿必先湿。土阳明为营卫之原。始病则营卫
俱病经络无分。三焦相溷内外不通所以其病即发而暴非比伤寒以次传经而入也。盖地为污秽浊恶之总归平时无所不受。
适当天时不正之极则平时所受浊恶之气。亦必乘时迅发。或冬时过暖肃杀之令不行至春反大寒冷。或盛夏湿热污秽之气
交蒸忽然热极生风而入。汗孔闭拒毒邪不得发泄而为病病则老幼无分。此实时行之气也。
从霜降以后至春分以前。凡有触冒霜露体虚中寒即病者。谓之伤寒也。
言非体。虚即有风寒莫之能害。
其冬有非节之暖名曰冬温。冬温之毒。与伤寒大异亦有轻重为治不同。
冬温者。时当大寒而反大温东风时至则肌腠疏豁忽然大寒而衣袂单薄寒郁其邪。其病即发者为冬温以其所感非时温
气故言与伤寒大异若不即发藏于皮肤则入伤血脉至春发为温病藏于经络则入伤骨髓至夏发为热病矣。
从立冬节候其中无暴大寒又不冰雪而有人壮热为病者此属春时阳气发于冬时伏寒变为温病。
春时阳气发于冬时未至而至也伏寒变为温病言非时不正之温气又为外寒所伏至春而发为温病也。
从春分以后至秋分节前天有暴寒者。皆为时行寒疫也其病与温及热病相似但治有殊耳。
此言非时暴寒之证。虽与温热相似而源委迥殊。以伏气自内发外。必用苦寒内夺暴寒从外感冒。合用辛甘外解。故
治有不同耳。
凡伤于寒。则为病热。热虽盛不死。若两感于寒而病者必死。
尺寸俱浮者。太阳受病也当一二日发以其脉上连风府故头项痛腰脊强。
尺寸俱长者。阳明受病也。尝二三日发以其脉挟鼻络于目故身热目疼鼻干不得卧。
尺寸俱弦者。少阳受病也。当三四日发以其脉循胁络于耳故胸胁痛而耳聋。
此三经受病未入于腑者可汗而散。
尺寸俱沉细者太阴受病也当四五日发以其脉布胃中络于嗌故腹满而嗌干。
尺寸俱沉者少阴受病也当五六日发以其脉贯肾络于肺系舌本故口燥舌干而渴。
尺寸俱微缓者。厥阴受病也。当六七日发以其脉循阴器络于肝。故烦满而囊缩。
此三经受病。已入于腑者。可下而已。
伤寒经络传变原不可以日数而测。此六经受病不过设以为例。粗工不察病机每以三四日当汗。六七日当下。误人多
矣。设伏气发温之。三四日可汗之乎病传厥阴之六七日可下之乎若此可不辨哉。○凡云尺寸。则关在其中。可不言而喻。
若两感于寒者。一日太阳受之即与少阴俱病。则头痛口干烦满而渴。二日阳明受之即与太阴俱病。则腹满身热不欲
食谵语。三日少阳受之即与厥阴俱病则耳聋囊缩而厥。水浆不入不知人者六日死若三阴三阳五脏六腑皆受病。则营卫不
行脏腑不通而死矣。
其得病阴阳两证俱见其传经证阴阳两经俱传则邪气弥满充斥法当三日主死然必水浆不入不知人者。方为营卫不行。
脏腑不通更越三日而阳明之经始绝也。
其不两感于寒更不传经不加异气者。至七日太阳病衰头痛少愈。八日阳明病衰身热少歇九日少阳病衰耳聋微闻十日
太阴病衰腹减如故则思饮食十一日少阴病衰渴止舌干。已而嚏。十二日厥阴病衰囊纵少腹微下大气皆去病患精神爽慧也。
更不传经。不加异气则邪气传尽正气将复愈。日可期然亦立法大意不可拘执也。至若更加异气乃病中之病莫可限于
时日矣。
若过十三日以上不间尺寸陷者大危。
言尺寸之脉沉陷为正气衰微莫能载邪外出。过经其病不间诚为危候也。
若更感异气变为他病者当根据坏证例治之。
若脉阴阳俱盛重感于寒变为温疟。
阳脉浮滑阴脉濡弱更遇于风变为风温。
阳脉洪数阴脉实大更感温热变为温毒温毒为病最重也。
阳脉濡弱。阴脉弦紧更遇温气变为温疫。
此以冬伤于寒。发为温病。脉之变证方治如说。
言脉证皆变为热。不得复用辛温发表。所谓方治如说也。
凡伤寒之病。多从风寒得之。始表中风寒入里则不消矣未有温覆当而不消散者。不在证治。
拟欲攻之。犹当先解表。乃可下之。
若表已解。而内不消非大满犹生寒热。则病不除。大满大实坚有燥屎。自可除下之。虽四五日不能为祸也。
言非大满大实而下之。则犹生寒热变证。必待大满大实坚有燥屎者方可下之。虽迟至四五日不能为害也。
若不宜下而便攻之。内虚热入协热遂利烦燥诸变不可胜数轻者困笃。重者必死矣。
夫阳盛阴虚。汗之则死下之则愈阳虚阴盛汗之则愈。下之则死。
阳乘阴位。则为阳盛阴虚。故可下而不可汗。阴乘阳位。则为阳虚阴盛。故可汗而不可下。即表病里和里病表和之
谓也。盖表实里虚。而邪入腑汗之则死下之则愈里实表虚。而邪郁于经下之则死汗之则愈。
夫如是则神丹安可以误发。甘遂何可以妄攻。虚盛之治相背千里。吉凶之机应若影响。岂容易哉况桂枝下咽。阳盛
则毙。承气入胃阴盛以亡死生之要在乎须臾。视身之尽。不暇计日。此阴阳虚实之交错。其候至微发汗吐下之相反其祸
至速而医术浅狭懵然不知病源为治乃误使病者殒殁。自谓其分至仁者。鉴此岂不痛欤。
桂枝下咽。阳盛则毙。承气入胃。阴盛以亡。以概言汗下关系非细。不过借此为例。非误用二汤。必致不救也。
凡两感病俱作。治有先后。发表攻里。本是不同。而热迷妄意者。乃云神丹甘遂。合而饮之。且解其表。又除其里
言巧似是。其理实违。夫智者之举错也。常审以慎。愚者之动作也必果而速安危之变。岂可诡哉。
两感皆是热邪。然治有先后。发表攻里。本是不同持说甚正亦甚明。何奉议误认为救里耶。
凡发汗温服汤药。其方虽言日三服。若病剧不解。当促其间。可半日中尽三服。若与病相阻。即便有所觉。如服一
剂病证犹在故当复作本汤服之。至有不肯汗出服三剂乃解。若汗不出者。死病也。
凡得时气病。至五六日而渴欲饮水。饮不能多。不当与也。何者。以胃中热尚少。不能消之便更与人作病也。
至七八日大渴欲饮水者犹当根据证与之。与之常令不足勿极意也。
若饮而腹满。小便不利。若喘若哕。不可与之。忽然大汗出。是为自愈也。
凡得病反能饮水。此为欲愈之病。其不晓病者。但闻病饮水自愈小渴者。乃强与饮之。因成其祸不可复救。
上四条皆是春夏温热之邪。故言时气病乃可与水。非冬月正伤寒可比例也。
凡得病厥脉动数。服汤药更迟。脉浮大减小。初躁后静此皆愈证也。
厥脉动数。犹言其脉动数不可连上句读。
《阴阳大论》说：春季气候温和，夏季气候暑热，秋季气候清凉，冬季气候寒冷凛冽，这是四季正常气候的次序。冬季严寒时，万物深藏，君子（指懂得养生的人）若能固密腠理，就不会受寒邪伤害；若是触犯冒犯寒气，这才叫做伤寒。那些被四时之气所伤而致病的情况，都能导致疾病，但以伤寒最为严重，因为它是最具杀伤厉气的病邪。感受寒邪后立即发病的，名叫伤寒；没有立即发病的，寒毒潜伏在肌肤之间，到了春天就变为温病，到了夏天就变为热病。所谓热病，是指热势极盛，比温病更重。因此，辛勤劳苦的人在春夏季节多患温热病，这都是因为冬天时触犯了寒气所致，并非属于时行疫病之气。
寒毒潜伏在肌肤之间，到春天变为温病；若潜伏在骨髓之中，到夏天变为热病。（原文未提潜伏于骨髓至夏变热病前的中间状态，只说了藏于肌肤和骨髓，中间缺失的部分是脱简。）《内经》说：“冬天伤了寒气，春天必定发生温病。”又说：“违背了冬季养藏之气，少阴肾气就不能闭藏，肾气就会独沉。”意思是说，冬季气候寒暖不均，在和暖的时候，人的腠理不坚固，忽然遇到严寒骤降，郁闭了体内的不正之气。在这个时候，少阴经脉的气血流行于外，不能退守闭藏，势必不得不受到邪气侵袭。然而，肾中所藏的元阳如果沉伏于内，本身是不受邪的，所受的邪气只是少阴的经脉罢了。所以，真阳充足的人，邪气不能为害，即使受了邪，随着气血运行也就消散了。只有那些不能封藏精气的人，先违背了冬季蛰伏闭藏的规律，所以邪气得以侵入经脉骨髓，等到春夏温热之气在内发动，就发为温热病。
李东垣（李明之）说：“冬伤于寒”，是因为冬季行的是春令（应寒反温）。应当寒冷的冬季却温暖，火气胜而水气亏。水气既然已亏，则土气妄行而有余。火与土合德，所以发生温病。之所以不在冬天发病而在春天发病，是因为寒水之气居于卯位（东方木位），正当其权，大寒的时令又复行于春季，腠理开泄。少阴不藏，加上房室劳伤，辛苦之人阳气外泄，肾水亏于内。木气应当生发，但阳气已经外泄，谁来鼓舞生机？肾水内竭，谁来滋养？这两者同病，生化之源既已断绝，木气怎能成以生发呢？身体中存留的只有热邪，时令强盛，木气生长，所以发生温病。
凡是时行疫病，春季应当温暖却反而大寒，夏季应当大热却反而大凉，秋季应当凉爽却反而大热，冬季应当寒冷却反而大温。这不是正常的时令却有这种气候，因此一年之中，无论老少患病大多相似，这就是时行之气。
伤寒是感受天时肃杀之气，以寒邪侵犯人体，必先经历寒冰阶段；时行疫病是感受湿土郁蒸之气，以湿邪侵犯人体，必先经历湿土阶段。阳明胃经是营卫生成的源头，初起时营卫都受病，经络不分，三焦混杂，内外不通，所以病情发作突然且猛烈，不像伤寒那样依次传经而入。大地是污秽浊恶之气的总归处，平时无所不受。正当天时不正之气达到极点时，平时所受的浊恶之气，也必然乘时而迅速发作。或者冬季过分温暖，肃杀之令不行，到春天反而大寒冷；或者盛夏湿热污秽之气交蒸，忽然热极生风而入，汗孔闭塞拒绝，毒邪不得发泄而致病，这时不论老幼都会患病，这就是时行之气。
从霜降以后到春分以前，凡是触犯冒犯霜露，体质虚弱、中寒即发病的，叫做伤寒。
（这句话的意思是：如果不是体质虚弱，即使有风寒也不会造成伤害。）
冬季出现非节令的暖意，叫做冬温。冬温的毒气，与伤寒大不相同，也有轻重之分，治疗方法也不同。
冬温，是指时令本该大寒却反而大温，东风时至，肌腠疏豁，忽然大寒而衣着单薄，寒邪郁闭体内，随即发病的，称为冬温。因为它所感受的不是时令应有的温气，所以说与伤寒大不相同。如果不立即发病，寒毒潜伏在皮肤，则入伤血脉，到春天发为温病；潜伏在经络，则入伤骨髓，到夏天发为热病。
从立冬节气开始，其中没有暴大的寒冷，也没有冰雪，但有人壮热生病的，这属于春季阳气在冬季潜伏的寒气激发出来，变为温病。
“春时阳气发于冬时未至而至也，伏寒变为温病”：意思是说非时令不正的温气，又被外寒所伏，到春天而发为温病。
从春分以后到秋分节气前，天空出现暴寒的，都属于时行寒疫。它的病症与温病及热病相似，但治疗方法不同。
这是说非时令暴寒的证候，虽然与温热病相似，但源流根本不同。伏气是从内部发于外部，必须用苦寒药从内部攻夺；暴寒是从外部感冒，应当用辛甘药从外部解表。所以治疗方法不同。
凡是受寒邪，就会发生热病，热势即使很盛也不会死。如果是两感于寒（表里两经同时受邪）而发病的，必定死亡。
寸口尺部脉象都浮的，是太阳经受病，应当在第一二天发病，因为它的经脉上连风府，所以头项痛、腰脊强直。
寸口尺部脉象都长的，是阳明经受病，应当在第二三天发病，因为它的经脉挟鼻、联络于目，所以身热、目痛、鼻干、不得安卧。
寸口尺部脉象都弦的，是少阳经受病，应当在第三四天发病，因为它的经脉循行胁肋、联络于耳，所以胸胁痛且耳聋。
这三经受病，尚未入腑的，可以用发汗法解散。
寸口尺部脉象都沉细的，是太阴经受病，应当在第四五天发病，因为它的经脉布散于胃中、联络于咽喉，所以腹部胀满且咽喉干燥。
寸口尺部脉象都沉的，是少阴经受病，应当在第五六天发病，因为它的经脉贯穿肾脏、联络于肺系舌根，所以口燥舌干且口渴。
寸口尺部脉象都微缓的，是厥阴经受病，应当在第六七天发病，因为它的经脉循行阴器、联络于肝脏，所以烦闷且阴囊收缩。
这三经受病，已经入腑的，可以用泻下法治疗。
伤寒经络传变的原委，本来不可以按日数来推测。这六经受病的日数，不过是设立一个例子。粗浅的医生不察病机，往往认为三四天应当发汗，六七天应当泻下，误人很多啊。假设伏气发为温病，三四天可以发汗吗？病传至厥阴的六七天可以泻下吗？像这样，能不辨别清楚吗？○凡是说“尺寸”，关脉就在其中，不言而喻。
如果是两感于寒的，第一天太阳经受病，即与少阴经同时受病，则头痛、口干、烦满且渴。第二天阳明经受病，即与太阴经同时受病，则腹满、身热、不想吃饭、谵语。第三天少阳经受病，即与厥阴经同时受病，则耳聋、阴囊收缩且四肢厥冷。如果不能进水浆、神志昏迷不知人的，六天死亡。如果三阴三阳、五脏六腑都受病，则营卫不行、脏腑不通而死。
如果得病后阴阳两证俱见，其传经证也是阴阳两经俱传，则邪气弥满充斥，法当三日主死。但必须是水浆不入、不知人，才算是营卫不行、脏腑不通，再超过三天，阳明经气才绝。
如果不两感于寒，且不传经、不加异气的，到第七天太阳病衰，头痛减轻；第八天阳明病衰，身热稍歇；第九天少阳病衰，耳聋稍能听到声音；第十天太阴病衰，腹部减如故，则想饮食；第十一天少阴病衰，渴止舌干，随后打喷嚏；第十二天厥阴病衰，阴囊松弛，小腹微软，大气皆去，病患精神爽慧。
如果不传经、不加异气，则邪气传尽，正气将恢复痊愈，日期是可以期待的。但这只是立法的大意，不可拘执。至于如果再加重异气，那就是病中之病，不可限于时日了。
如果过了十三日以上，病情没有间歇，且寸口尺部脉象沉陷的，是大危之候。
意思是寸口尺部脉象沉陷，表示正气衰微，不能载邪外出。经过传经期，病情没有间歇，确实是危候。
如果再次感受异气，变为其他疾病的，应当根据坏证的原则治疗。
阳脉浮滑，阴脉濡弱，再次遇风，变为风温。
阳脉濡弱，阴脉弦紧，再次遇温气，变为温疫。
这是因冬天伤于寒，发为温病，脉象变化的证候及方治如上所说。
意思是脉证都变为热证，不得再用辛温发表药。所谓方治如上所说。
凡是伤寒的病，多从风寒得来。起初是表中风寒，入里后就不再消散了。未有盖着被子保暖而不能消散的。这种情况不在常规的证治范围内。
如果表证已解，而内里不消，如果不是大满证，仍然会产生寒热，则病不除。如果是大满大实坚且有燥屎的，自然可以泻下。即使过了四五天，也不能造成祸害。
意思是如果不是大满大实，就泻下，则仍然产生寒热变证。必须等到有大满大实坚且有燥屎的情况下，才可以泻下。即使迟至四五天，也不能为害。
如果不应当泻下却便去攻下，导致内虚热入，协热遂利，烦躁等诸种变证不可胜数。轻者困笃，重者必死。
阳盛阴虚，发汗则死，泻下则愈。阳虚阴盛，发汗则愈，泻下则死。
阳乘阴位，则为阳盛阴虚，所以可下而不可汗。阴乘阳位，则为阳虚阴盛，所以可汗而不可下。这就是所谓的表病里和、里病表和。大概是表实里虚，而邪入腑，发汗则死，泻下则愈；里实表虚，而邪郁于经，泻下则死，发汗则愈。
像这样，那么神丹（发汗峻剂）怎么可以误发？甘遂（泻下峻剂）怎么可以妄攻？虚实的治法相差千里，吉凶的关键响应如影随形，难道容易吗？况且桂枝汤服下，若阳盛则会毙命；承气汤入胃，若阴盛则会死亡。死生的关键就在须臾之间，观察病人的情况，来不及计算日子。这是阴阳虚实交错，其征候极其细微，发汗、吐、下的方法相反，其祸害极快。而医术浅陋的人，懵然不知病源，进行治疗乃至于使病人殒命，自己还认为是本分，仁者看到这些，岂不痛心吗？
“桂枝下咽，阳盛则毙；承气入胃，阴盛以亡”，这是概言汗下关系非同小可，不过借此为例，并不是说误用了这两个汤剂，必然导致无法救治。
凡是两感病同时发作，治疗有先后顺序。发表攻里，本是不同的。而热迷妄意的人，却说神丹和甘遂合在一起饮用，既解其表，又除其里。这话看似巧妙合理，其实违背医理。智者举动审慎，愚者动作果断迅速，安危的变化，岂可诡诈呢？
两感都是热邪，但治疗有先后，发表攻里，本是不同。持此说非常正确也非常明白，为什么奉议（王履）误认为是救里呢？
凡是发汗，温服汤药。处方虽说是每日三服，如果病重不解，应当缩短服药间隔，可在半日内服完三剂。如果药性与病邪相阻，即便有所感觉，如服了一剂病证仍在，就应当继续服用本汤。甚至有不肯出汗，服了三剂才解的。如果汗不出来的，是死病。
凡是得了时气病，到五六天而口渴想喝水，但喝不多，不应当给太多水。为什么呢？因为胃中热尚少，不能消化它，再给人水喝会制造新的病患。
到七八天大渴想喝水的，还应当根据证候给予饮水。给水时要常令不足，不要刻意让其喝饱。
如果饮水后腹部胀满，小便不利，或者气喘或者呃逆，不应当给水。忽然大汗出的，是自愈的表现。
凡是得病反而能饮水，这是将要痊愈的病。那些不懂病的人，只听听说病后饮水自愈，对于小渴的人，强行给他们喝水，因而造成祸害，不可复救。
以上四条都是针对春夏温热之邪，所以说时气病可以与水，不是冬天正伤寒可以类比比较的。
凡是得病，脉象动数，服药后脉更迟，脉由浮大减小，初躁后静，这些都是痊愈的征象。
“厥脉动数”，犹言其脉动数，不可连上句读。
The *Yin Yang Da Lun* (Great Treatise on Yin and Yang) states: The climate of spring is mild, summer is hot and humid, autumn is cool and clear, and winter is cold and piercing. This is the sequence of the normal qi of the four seasons. In winter, when it is severely cold, all things hide deeply. A gentleman who can secure and close his pores will not be injured by cold. Those who are exposed to and offend against the cold are said to have contracted Shanghan (Cold Damage). Injuries caused by the qi of the four seasons can all lead to disease, but among them, Shanghan is the most severe because it constitutes the most lethal and destructive qi. If one contracts cold and falls ill immediately, it is named Shanghan. If one does not fall ill immediately, the cold toxin hides in the skin and muscles; when spring arrives, it transforms into Wenbing (Warm Disease); when summer arrives, it transforms into Rebing (Heat Disease). Rebing refers to heat that is extreme and heavier than Wenbing. Therefore, hardworking people often suffer from warm-heat diseases in spring and summer, all caused by contracting cold in winter, not by the qi of seasonal epidemics.
If the cold toxin hides in the skin and muscles, it transforms into Wenbing in spring; if it hides in the bone marrow, it transforms into Rebing in summer. (The text omits the intermediate stage between hiding in the skin/muscles and the bone marrow, which is a missing slip.) The *Neijing* (Inner Canon) says: "Injury by cold in winter leads to Wenbing in spring." It also says: "Violating the qi of winter storage causes Shaoyin (Lesser Yin) to fail to store, and the Kidney qi sinks alone." This means that during winter, when the climate is unevenly warm and cold, during warm periods, a person's pores are not firm. If sudden severe cold arrives, it depresses and closes the abnormal qi inside. At this time, the meridians of Shaoyin circulate outward and cannot retreat to store tightly, inevitably receiving the pathogen. However, the true yang stored in the Kidneys, if sunk within, itself does not receive the pathogen; only the meridians of Shaoyin receive it. Thus, those with abundant true yang are not harmed by pathogens; even if infected, the qi moves and dissipates. Only those who fail to store essence first violate the command of winter hibernation and storage, allowing pathogens to invade the meridians and bone marrow. When the warm-heat qi of spring and summer stirs internally, warm-heat diseases erupt.
Li Dongyuan (Li Mingzhi) said: "Winter injury by cold" occurs because winter follows the order of spring (it should be cold but is warm). In winter, fire prevails and water is deficient. Since water is deficient, earth overacts. Fire and earth combine their virtues, thus causing Wenbing. The reason it does not manifest in winter but in spring is that cold water resides in the Mao sector (East/Wood), holding power, and the great cold command reappears in spring. The pores open and leak. Shaoyin fails to store, compounded by sexual exhaustion. Hardworking people leak yang externally, and Kidney water is deficient internally. Wood should generate, but yang has already leaked externally; who will inspire vitality? Kidney water is exhausted internally; who will nourish? These two conditions coexist. The source of generation and transformation is cut off; how can wood grow? What remains in the body is heat. The season strengthens, and wood grows, thus causing Wenbing.
Whenever there is a seasonal epidemic, spring should be warm but is instead severely cold; summer should be very hot but is instead very cool; autumn should be cool but is instead very hot; winter should be cold but is instead very warm. This is having the qi of a different season at the wrong time. Therefore, throughout the year, the illnesses of young and old are mostly similar. This is the qi of seasonal epidemics.
Shanghan is contracting the austere and killing qi of heaven, where cold offends cold, necessarily passing through the icy phase. Seasonal epidemics contract the damp-earth stagnant qi, where dampness offends dampness, necessarily passing through the damp-earth phase. Yangming Stomach meridian is the origin of Ying (Nutritive) and Wei (Defensive) qi. Initially, both Ying and Wei are diseased, meridians are indistinguishable, Sanjiao (Triple Burner) is mixed, and internal and external communication is blocked. Thus, the disease erupts suddenly and violently, unlike Shanghan which transmits sequentially through meridians. The earth is the total return of filth and turbid evil, accepting everything normally. When the abnormal qi of heaven reaches its extreme, the filth and turbid evil received normally must also erupt swiftly with the times. Or, if winter is excessively warm, the killing command does not act, and spring becomes severely cold. Or, in midsummer, damp-heat and filth qi steam together, suddenly generating wind from extreme heat, entering while sweat pores close and reject, preventing toxic pathogens from excreting, causing disease regardless of age. This is the qi of seasonal epidemics.
From Frost Descent until Spring Equinox, anyone who touches frost and dew, has weak constitution, suffers middle-cold, and falls ill immediately, is called Shanghan.
(This implies: If not weak, even with wind-cold, harm cannot occur.)
Non-seasonal warmth in winter is called Dongwen (Winter Warmth). The toxin of Dongwen is greatly different from Shanghan, varying in severity and requiring different treatments.
Dongwen occurs when it should be severely cold but is instead very warm. East wind blows, pores open, suddenly severe cold comes, clothing is thin, cold depresses the pathogen, and illness erupts immediately. Because the contracted qi is not the seasonal warm qi, it is said to be greatly different from Shanghan. If it does not erupt immediately, hiding in the skin, it enters and injures blood vessels, erupting as Wenbing in spring; hiding in meridians, it enters and injures bone marrow, erupting as Rebing in summer.
From Start of Winter, if there is no violent severe cold, no ice or snow, yet someone suffers high fever, this belongs to spring yang qi emerging from winter latent cold, transforming into Wenbing.
"Spring yang qi emerges in winter before its time; latent cold transforms into Wenbing": This means non-seasonal abnormal warm qi, suppressed by external cold, erupts as Wenbing in spring.
From Spring Equinox until before Autumn Equinox, if violent cold occurs in the sky, it is all Shixing Hanyi (Seasonal Cold Epidemic). Its symptoms resemble Wenbing and Rebing, but treatment differs.
This describes non-seasonal violent cold. Although similar to warm-heat, the source and destination are vastly different. Latent qi erupts from inside out, requiring bitter-cold herbs to drain internally. Violent cold is contracted from outside, requiring acrid-sweet herbs to resolve externally. Hence, treatment differs.
Any injury by cold results in heat disease. Even if heat is intense, death does not ensue. If one contracts cold on two levels (Lianggan) and falls ill, death is certain.
If Cun and Chi pulses are both floating, Taiyang (Greater Yang) is diseased. Eruption occurs on days 1-2. Because its meridian connects to Fengfu, headache, stiff neck, and back stiffness occur.
If Cun and Chi pulses are both long, Yangming (Bright Yang) is diseased. Eruption occurs on days 2-3. Because its meridian flanks the nose and connects to the eyes, fever, eye pain, dry nose, and inability to sleep occur.
If Cun and Chi pulses are both wiry, Shaoyang (Lesser Yang) is diseased. Eruption occurs on days 3-4. Because its meridian follows the hypochondrium and connects to the ears, hypochondriac pain and deafness occur.
For these three meridians, if diseased but not yet entered the Fu organs, sweating can disperse it.
If Cun and Chi pulses are both deep and fine, Taiyin (Greater Yin) is diseased. Eruption occurs on days 4-5. Because its meridian spreads in the stomach and connects to the throat, abdominal fullness and dry throat occur.
If Cun and Chi pulses are both deep, Shaoyin (Lesser Yin) is diseased. Eruption occurs on days 5-6. Because its meridian penetrates the Kidney, connects to the Lung system and tongue root, dry mouth, dry tongue, and thirst occur.
If Cun and Chi pulses are both faint and slow, Jueyin (Terminal Yin) is diseased. Eruption occurs on days 6-7. Because its meridian follows the genitalia and connects to the Liver, irritability, fullness, and testicular contraction occur.
For these three meridians, if diseased and already entered the Fu organs, purgation can resolve it.
The transmission of Shanghan along meridians cannot originally be measured by days. These six meridians' diseases are merely examples. Crude physicians, failing to observe the mechanism, often assume sweating is needed on days 3-4 and purgation on days 6-7, harming many. If latent qi erupts as Wenbing, can one sweat on day 3-4? If disease transmits to Jueyin on day 6-7, can one purge? Such distinctions must be recognized. ○ Whenever "Cun Chi" is mentioned, Guan is included, understood without saying.
If Lianggan (two-level contraction) occurs, on day 1 Taiyang is diseased, simultaneously with Shaoyin, causing headache, dry mouth, irritability, fullness, and thirst. On day 2 Yangming is diseased, simultaneously with Taiyin, causing abdominal fullness, fever, aversion to food, and delirious speech. On day 3 Shaoyang is diseased, simultaneously with Jueyin, causing deafness, testicular contraction, and cold limbs. If unable to drink fluids and unconscious, death occurs on day 6. If all Three Yin and Three Yang, Five Zang and Six Fu are diseased, Ying and Wei cease to circulate, Zang and Fu blockage leads to death.
If both Yin and Yang syndromes appear upon getting sick, and transmission involves both Yin and Yang meridians, pathogenic qi fills and overwhelms. According to method, death occurs on day 3. But only if fluids are not taken and consciousness is lost, indicating Ying/Wei cessation and Zang/Fu blockage, does death follow after another three days when Yangming meridian qi finally perishes.
If not Lianggan, no transmission, no added abnormal qi, on day 7 Taiyang disease wanes, headache lessens. Day 8 Yangming disease wanes, fever rests slightly. Day 9 Shaoyang disease wanes, hearing slightly returns. Day 10 Taiyin disease wanes, abdomen reduces, appetite returns. Day 11 Shaoyin disease wanes, thirst stops, tongue dries, then sneezing occurs. Day 12 Jueyin disease wanes, scrotum relaxes, lower abdomen softens, great qi departs, patient spirit refreshes.
No transmission, no added abnormal qi, pathogenic qi exhausts, righteous qi recovers, recovery date is expectable. Yet this is general principle, do not rigidly adhere. If additional abnormal qi adds to the disease, it is disease within disease, not limited by days.
If beyond thirteen days, no interval, and Cun/Chi pulses sink, it is critical danger.
Sinking pulses indicate righteous qi deficiency, unable to carry pathogen out. Passing the meridian period without relief is indeed critical.
If further affected by abnormal qi, transforming into other diseases, treat according to Huazheng (Ruined Syndrome) principles.
If pulse Yin/Yang both excess, re-contracting cold transforms into Wen Nue (Warm Malaria).
Yang pulse floating/slippery, Yin pulse soft/weak, encountering wind transforms into Fengwen (Wind Warmth).
Yang pulse surging/rapid, Yin pulse solid/large, encountering warm-heat transforms into Wendu (Warm Toxicity). Wendu disease is heaviest.
Yang pulse soft/weak, Yin pulse wiry/tight, encountering warm qi transforms into Wenyi (Warm Epidemic).
These result from winter cold injury erupting as Wenbing. Pulse changes, syndromes, and prescriptions are as stated.
Syndromes and pulses all transform into heat; acrid-warm releasing methods must not be reused. Prescriptions are as stated.
All Shanghan diseases mostly arise from wind-cold. Initially wind-cold in the exterior, entering interior does not dissipate. None dissipate merely by covering with warmth. This is not within standard syndrome treatment.
To attack internally, one must first release the exterior, then purge.
If exterior is resolved but interior stagnation remains, if not major fullness, cold/heat may still arise, disease persists. If major fullness, major excess, hardness, and dry feces exist, purgation can naturally remove them. Even if four-five days pass, no disaster ensues.
Purging without major fullness/excess generates cold/heat transformations. Wait for major fullness/excess/hardness/dry feces before purging. Delaying to four-five days causes no harm.
If purging is inappropriate but performed, interior deficiency allows heat entry,協热 (collateral heat) diarrhea, irritability, etc., countless transformations. Light cases become critical, heavy cases die.
Yang excess/Yin deficiency: Sweating kills, purging heals. Yang deficiency/Yin excess: Sweating heals, purging kills.
Yang occupying Yin position is Yang excess/Yin deficiency, so purgation allowed, sweating forbidden. Yin occupying Yang position is Yang deficiency/Yin excess, so sweating allowed, purgation forbidden. This is "Exterior disease, Interior harmonious; Interior disease, Exterior harmonious." Generally, Exterior excess/Interior deficiency with pathogen entering Fu: sweating kills, purging heals. Interior excess/Exterior deficiency with pathogen depressed in meridians: purging kills, sweating heals.
Thus, how can Shendan (potent diaphoretic) be mistakenly issued? How can Gansui (potent purgative) be recklessly attacked? Treatment of deficiency/excess differs by a thousand miles. Mechanism of fortune/misfortune responds like shadow/form. Is it easy? Once Guizhi Tang enters the throat, Yang excess leads to death. Once Chengqi Tang enters the stomach, Yin excess leads to demise. Life/death hinges on an instant. Observing the whole body leaves no time to count days. This is the interlacing of Yin/Yang deficiency/excess. Signs are subtle. Opposite actions of sweating/vomiting/purging bring rapid disaster. Physicians shallow in skill, ignorant of disease source, cause patient death, claiming it is their due. Benevolent ones seeing this, would not they grieve?
"Guizhi Tang enters throat, Yang excess dies; Chengqi Tang enters stomach, Yin excess perishes" generally states the significance of sweating/purging, using these as examples. It does not mean misusing these two decoctions inevitably leads to untreatable death.
For Lianggan diseases occurring together, treatment has priority. Releasing exterior and attacking interior are fundamentally different. Those confused by heat and madness claim Shendan and Gansui can be drunk together, resolving exterior and removing interior. This sounds clever but violates principle. Wise acts cautiously; foolish acts decisively and quickly. Changes in safety/danger, how can they be deceptive?
Lianggan are all heat pathogens, but treatment has priority. Releasing exterior and attacking interior are distinct. This view is correct and clear. Why did Fengyi (Wang Lv) mistake it for rescuing the interior?
When sweating, take herbal medicine warm. Although prescription says three doses daily, if disease is severe and unresolved, shorten intervals, finishing three doses in half a day. If medicine clashes with disease, even if some sensation arises, if after one dose syndrome persists, continue taking the same decoction. Some do not sweat until three doses are taken. If no sweat occurs, it is a death case.
For seasonal qi diseases, by day 5-6, if thirsty for water but drinking little, do not give much. Why? Stomach heat is still slight, cannot digest it. Giving more water creates new disease.
By day 7-8, if greatly thirsty for water, still give according to syndrome. Give moderately, do not force excessive intake.
If drinking causes abdominal fullness, urinary difficulty, wheezing, or hiccuping, do not give. Sudden profuse sweating indicates self-healing.
Any disease where one can drink water indicates impending healing. Those ignorant hear "drinking water heals," and for slight thirst, force-feed water, causing disaster irreparable.
The above four items concern warm-heat pathogens of spring/summer, hence seasonal qi diseases allow water. Not comparable to winter Zheng Shanghan.
Any disease with Jue pulse (extreme reversal) moving/rapid, after taking medicine pulse becomes slower, pulse floats/large then decreases, initial restlessness then calmness, are all healing signs.
"Jue pulse moving/rapid" means the pulse is moving/rapid; do not link to previous sentence.