春温初起,头痛身疼,无汗恶寒,发热目赤,口
渴舌白,脉浮数,此温邪袭卫。宜用薄荷、大力、黄
芩、杏仁、甘草、桑叶、连翘、革根等味,凉辛解表
也。
温邪初起,无异伤寒,仲景谓:口渴则为温症,不渴则
为伤寒,是千古只眼也。盖伤寒必先太阳,而后阳明、少阳。
以太阳经脉最长 由睛明穴,上额交巅络脑循项,挟脊抵腰
入困,行身之背,至足眼而终。故见证必恶寒发热,头痛项
强·腰痛足酸,而阳明则在大阳之次,其经起于面,挟鼻上
额循目眶,行身之前,至足内踝而终。故见证必目痛鼻干,
不得卧。而少阳则又在阳明之次 其经起于目锐眦.上头
角,络耳中,循胸肋,行身之侧,至足外跟而终。故见症必
胸协痛而耳聋,寒热,呕而口苦。至传入三阴,始太阴,则
口燥咽干,腹满便泻,以其经脉循腹绕嗌入口故也。继少
阴,则咽痛舌干,身热下利,以其经脉入腹循喉咙·挟舌本
故也。终厥阴,则舌卷囊缩,四肢逆冷,以其经脉循少腹,
绕阴器。《伤寒例》中论之最详。若春温则木火炙乎中,微
寒袭乎外,病起之时,憎寒壮热,虽与三阳伤寒相类,而口
干舌燥则异。良由先感温邪,后再感寒,被引而发·故初起
必头痛身疼,恶寒发热,与太阳伤寒似乎相同。虽宜表散;
而目赤口渴,热自内蒸,必兼清凉。故用薄荷、大力、桑
叶、葛根解表,黄芩、甘草、杏仁、连翘清里。无汗,加葱
白、淡豉以助之;咳嗽,加枇杷叶以泄之。惟羌活为太阳表
药,葛根为阳明表药,柴胡为少阳表药。今头痛身疼,不用
羌活,而用葛根者,以阳明为大阳之次,邪既在表,先用葛
根、薄荷、大力、桑叶协力透表,以断太阳入阳明之路也。
不然,传入阳明,则或气或血,为疹为斑,变幻恐无已时
焉。
春温病初起时,出现头痛、身体疼痛、无汗、怕冷、发热、眼睛发红、口渴、舌苔白、脉象浮数,这是温邪侵袭卫分。适宜使用薄荷、牛蒡子、黄芩、杏仁、甘草、桑叶、连翘、葛根等药物,采用凉性辛味药来解表。
温邪初起时的表现,与伤寒没有不同。张仲景曾说:“口渴的就是温病,不渴的就是伤寒”,这是千古以来的独到见解。大概伤寒病必须先侵犯太阳经,然后才传至阳明经、少阳经。因为太阳经脉最长,从睛明穴开始,向上经过额头交会于头顶,联络脑部,沿着颈部,夹脊背抵腰部进入脊柱,行走在身体背部,直到足部结束。所以出现的症状一定是恶寒发热、头痛项强、腰痛脚酸;而阳明经在太阳经之后,其经脉起于面部,夹鼻上行至额头,沿着眼眶,行走在身体前面,直到足内踝结束。所以出现的症状一定是目痛鼻干、不能安卧。而少阳经又在阳明经之后,其经脉起于眼外角,向上到头角,联络耳中,沿着胸肋,行走在身体侧面,直到足外踝结束。所以出现的症状一定是胸胁痛且耳聋、寒热往来、呕吐且口苦。等到传入三阴经,首先是太阴经,则出现口燥咽干、腹部胀满、大便泄泻,因为其经脉循行腹部环绕咽喉入口的缘故。接着是少阴经,则出现咽痛舌干、身热下利,因为其经脉入腹循喉咙、夹舌根的缘故。最后是厥阴经,则出现舌卷缩、阴囊收缩、四肢逆冷,因为其经脉循行少腹,绕阴器的缘故。《伤寒例》中对这些论述得非常详细。至于春温病,则是木火之气炽盛于体内,微寒之邪侵袭于体外,发病之时,憎寒壮热,虽然与三阳伤寒相似,但口干舌燥则不同。这主要是因为先感受了温邪,后又感受了寒邪,被寒邪引动而发作,所以初起时必定头痛身疼、恶寒发热,与太阳伤寒似乎相同。虽然适宜用发散法,但因为眼睛发红、口渴,热气自内蒸腾,必须兼用清凉法。所以使用薄荷、牛蒡子、桑叶、葛根来解表,黄芩、甘草、杏仁、连翘来清里。如果没有汗,加葱白、淡豆豉来帮助发汗;如果有咳嗽,加枇杷叶来宣肺止咳。只有羌活是太阳经的解表药,葛根是阳明经的解表药,柴胡是少阳经的解表药。现在头痛身疼,不用羌活,而用葛根,是因为阳明经在太阳经之后,邪气既然在表,先用葛根、薄荷、牛蒡子、桑叶协力透达表邪,以切断太阳经邪气传入阳明经的路径。否则,邪气传入阳明经,就会或气分或血分,形成疹子或斑疹,变化恐怕没有穷尽的时候。
At the initial stage of Spring-Warmth disease, symptoms include headache, body ache, absence of sweating, aversion to cold, fever, redness of the eyes, thirst, a white tongue coating, and a floating and rapid pulse. This indicates that Warmth pathogen has invaded the Wei (Defensive) level. It is appropriate to use herbs such as Bohe (Menthae Haplocalycis Herba), Niubangzi (Arctii Fructus), Huangqin (Scutellariae Radix), Xingren (Armeniacae Semen Amarum), Gancao (Glycyrrhizae Radix et Rhizoma), Sangye (Mori Folium), Lianqiao (Forsythiae Fructus), and Gegen (Puerariae Lobatae Radix). The treatment principle is to release the exterior using cool and acrid herbs.
The initial presentation of Warmth pathogen is no different from Cold Damage (Shanghan). Zhang Zhongjing stated: "If there is thirst, it is a Warmth syndrome; if there is no thirst, it is Cold Damage." This is a unique insight through the ages. Generally, Cold Damage must first affect the Taiyang (Greater Yang) channel, and then transmit to the Yangming (Yang Brightness) and Shaoyang (Lesser Yang) channels. The Taiyang channel is the longest; it originates at Jingming (BL1), ascends to the forehead, meets at the vertex, connects with the brain, descends along the neck, flanks the spine, reaches the waist, enters the spinal column, runs along the back of the body, and terminates at the foot. Therefore, the manifestations must include aversion to cold and fever, headache and stiffness of the neck, lower back pain, and soreness of the legs. The Yangming channel follows the Taiyang; its meridian originates on the face, flanks the nose, ascends to the forehead, follows the orbital rim, runs along the anterior aspect of the body, and terminates at the medial malleolus. Therefore, the manifestations must include eye pain, nasal dryness, and inability to lie down. The Shaoyang channel follows the Yangming; its meridian originates at the outer canthus, ascends to the temporal region, connects with the ear, follows the chest and hypochondrium, runs along the lateral aspect of the body, and terminates at the lateral malleolus. Therefore, the manifestations must include pain in the chest and hypochondrium, deafness, alternating chills and fever, vomiting, and bitter taste in the mouth. When transmitting to the Three Yin channels, it first affects the Taiyin (Greater Yin) channel, resulting in dry mouth and throat, abdominal fullness, and diarrhea, because its meridian circulates around the abdomen and surrounds the throat entering the mouth. Next is the Shaoyin (Lesser Yin) channel, resulting in sore throat, dry tongue, fever, and lower body diarrhea, because its meridian enters the abdomen, follows the throat, and flanks the root of the tongue. Finally, it reaches the Jueyin (Terminal Yin) channel, resulting in curled tongue, retracted scrotum, and cold limbs, because its meridian circulates around the lower abdomen and surrounds the genitalia. These are discussed in great detail in the *Shanghan Li* (Treatise on Cold Damage Examples). As for Spring-Warmth disease, Wood and Fire qi are blazing internally, while slight Cold pathogen invades externally. At the onset of the disease, there is aversion to cold with high fever. Although this resembles the San-Yang (Three Yang) Cold Damage, the dry mouth and tongue distinguish it. This is primarily because the Warmth pathogen was contracted first, followed by the Cold pathogen, which triggered the outbreak. Thus, initially, there are inevitably headache, body ache, aversion to cold, and fever, which seem identical to Taiyang Cold Damage. Although dispersing the exterior is indicated, due to red eyes and thirst, with heat steaming from within, cooling methods must be combined. Therefore, Bohe, Niubangzi, Sangye, and Gegen are used to release the exterior, while Huangqin, Gancao, Xingren, and Lianqiao are used to clear the interior. If there is no sweat, add Congbai (Allii Tuberosi Bulbus) and Danshi (Fermented Soybean) to assist; if there is cough, add Pipaye (Eriobotryae Folium) to drain the lung. Qianghuo (Notopterygii Rhizoma et Radix) is the exterior-releasing herb for the Taiyang channel, Gegen for the Yangming channel, and Chaihu (Bupleuri Radix) for the Shaoyang channel. Now, although there is headache and body ache, Qianghuo is not used, but Gegen is used. This is because the Yangming channel follows the Taiyang channel. Since the pathogen is on the exterior, Gegen, Bohe, Niubangzi, and Sangye are used together to penetrate and release the exterior, thereby cutting off the pathway for the Taiyang pathogen to transmit to the Yangming channel. Otherwise, if the pathogen transmits to the Yangming channel, it may affect either the Qi or Blood levels, manifesting as macules or petechiae, and the transformations would likely be endless.