温病者,冬月伏寒化热,至春而发,所谓春时阳气发,于冬时伏寒者是也。风温者,温
病而
兼新风,发汗已则风气去,而温气发,故身灼热也。温疫者,温气盛而成疠也。湿温者,温
气而兼湿邪,湿能生温,温亦生湿也。温毒者,温气发而不能遽散,怫郁成毒,犹伤寒之有
阳毒、阴毒也。温疟者,温病系在少阳,时作时止,乍进乍退者也。春温之症,轻重不同。
旧有冬伏之寒邪,新感春时之风气,其寒从风而并于外者轻,其风从寒而并于内者重矣。并
于内者治其内,毋遗其外;并于外者治其外,毋外其内。若旧伏之寒已变为热,而更感春时
之风,风热相激,多成风疟。其引之而随出者轻,其发之而转陷者危矣。又有七情、饮饱、
劳倦之人,复受六气风寒暑湿之邪,若内就外而甚于外者,先治其外而后调其内;若外就内
而甚于内者,先治其内而后调其外。王好古云∶治内兼外者,不可寒下,若寒下,则经邪陷
于内矣;治外兼内者,不可热发,若热发,则益中热于外矣。又曰∶外重而内轻者,先治其
外,后治其内;若积寒伤冷,脉已从阴,虽有标病,不须治标,独治内也,内既得温,标病
不
发而自愈。何以然?发表之药不远热也。故曰∶阴症治本不治表,表本俱得;治标不治本,
标本俱失。
温邪之发,阴必先伤,设有当行解散者,必兼滋阴之品于其中。昔人于葱豉汤中加童便
,于栀豉汤内加地黄、麦冬,亦此意也。
温毒发班,与伤寒发斑不同。温毒之邪,从内之外;伤寒之邪,从外入内。是以温毒发
斑者
,邪气离里而之表,其症轻;伤寒发斑者,邪气盛于内而见于外,其症重。盛于内者,必使
下泄,而后者可去,华元化所谓须要下之,不可留于胃中是也;之于外者,可从表而出之,
郭白云所谓其毒久郁而发,病不在里,故不可下,必随表症治之,当用药解肌热者是也。
温病,是指冬季潜伏的寒邪化为热邪,到了春季发作,这就是所谓的“春时阳气发动,源于冬季潜伏的寒邪”。风温,是温病兼感新的风邪,发汗后风气虽去,但温气随之发动,所以身体灼热。温疫,是温气旺盛而形成的疠气。湿温,是温气兼夹湿邪,湿能生温,温也能生湿。温毒,是温气发动而不能迅速消散,郁结而成毒,就像伤寒中有阳毒、阴毒一样。温疟,是温病邪气在少阳经,症状时作时止,忽进忽退。
春温病症,有轻重之分。如果体内原有冬季潜伏的寒邪,又新感春季的风气,若寒邪随风邪并聚于体表则病情轻;若风邪随寒邪并聚于体内则病情重。对于并聚于体内的,治疗要针对内部,不要遗漏外部;对于并聚于体表的,治疗要针对外部,不要忽略内部。如果原本潜伏的寒邪已经变为热邪,又更感春季的风邪,风热相互激荡,多形成风疟。如果是引导邪气使其随之外出的,病情较轻;如果是激发邪气反而导致其内陷的,病情危重。又有因七情、饮食过饱、劳累疲倦的人,又受到六气中风寒暑湿等邪气的侵袭,如果病邪向内发展且内部病变重于外部的,先治疗外部再调理内部;如果病邪向外发展且外部病变重于内部的,先治疗内部再调理外部。王好古说:治疗内部兼及外部的,不可使用寒凉攻下之法,如果使用寒凉攻下,表邪就会陷入体内;治疗外部兼及内部的,不可使用温热发汗之法,如果使用温热发汗,就会使体内的热邪更加炽盛于外部。又说:外部病重而内部病轻的,先治外部,后治内部;如果是积寒伤冷,脉象已呈现阴证特征,虽然有标病(表面症状),不需要治疗标病,只需单独治疗内部,内部得到温煦后,标病不发而自愈。为什么这样呢?因为发表的药物性质不远于热。所以说:阴证只治本而不治表,表和本都能得到救治;只治标不治本,标和本都会失去。
温邪发作,阴液必定先受损伤,如果有应当进行解散治疗的,必须在方剂中兼加滋阴的药物。古人常在葱豉汤中加入童便,在栀豉汤中加入地黄、麦冬,也是这个意思。
温毒引起的发斑,与伤寒引起的发斑不同。温毒的病邪,是从内部发到外部;伤寒的病邪,是从外部侵入内部。因此,温毒发斑,是邪气离开里部趋向体表,病情较轻;伤寒发斑,是邪气在体内强盛而表现于外部,病情较重。邪气强盛于内部的,必须通过泻下排出,后面的情况可以去除,正如华元化所说的“必须用下法,不可让邪气留在胃中”;邪气趋向于外部的,可以从表解出,正如郭白云所说的“毒邪久郁而发,病不在里,所以不可用下法,必须随着表证来治疗,应当用药解除肌表之热”。
Warm disease refers to the condition where cold pathogenic factors latent in winter transform into heat, manifesting in spring. This is what is meant by "the yang qi of spring arises from the latent cold of winter." Wind-warmth is a warm disease complicated by new wind pathogenic factors. After inducing sweating, the wind pathogen is expelled, but the warmth pathogen emerges, resulting in burning heat of the body. Warm plague (Wenyi) occurs when warmth qi becomes excessive and forms pestilential qi. Damp-warmth involves warmth qi combined with dampness pathogen; dampness can generate warmth, and warmth can also generate dampness. Warm toxin refers to warmth qi that fails to dissipate rapidly, becoming stagnant and transforming into toxin, similar to Yang Toxin and Yin Toxin in Cold Damage diseases. Warm malaria is a warm disease where the pathogen resides in the Shaoyang channel, characterized by intermittent symptoms that come and go.
Spring-warmth syndromes vary in severity. If there is pre-existing latent cold from winter and a new contraction of spring wind, if the cold follows the wind and aggregates externally, the condition is mild; if the wind follows the cold and aggregates internally, the condition is severe. For aggregation internally, treat the interior without neglecting the exterior; for aggregation externally, treat the exterior without neglecting the interior. If the previously latent cold has already transformed into heat, and is further aggravated by spring wind, the interaction between wind and heat often results in wind-malaria. If the pathogen is guided outwards, it is mild; if stimulation causes the pathogen to sink deeper inward, it is critical. Additionally, individuals suffering from emotional disturbances, overeating, or fatigue who are re-exposed to the six climatic pathogens (wind, cold, summer-heat, dampness, dryness, fire): if the pathogen moves inward and the interior pathology is more severe than the exterior, treat the exterior first, then regulate the interior; if the pathogen moves outward and the exterior pathology is more severe than the interior, treat the interior first, then regulate the exterior. Wang Haogu stated: When treating the interior while considering the exterior, one must not use cold purgatives; otherwise, the exterior pathogen will sink into the interior. When treating the exterior while considering the interior, one must not use hot diaphoretics; otherwise, internal heat will be exacerbated on the exterior. He further stated: When the exterior is heavy and the interior is light, treat the exterior first, then the interior. In cases of accumulated cold injuring the cold, where the pulse indicates a Yin syndrome, even if there are superficial symptoms (biao), they need not be treated; only the interior needs treatment. Once the interior is warmed, the superficial symptoms will cease and heal spontaneously. Why? Because releasing-the-exterior herbs are rarely devoid of hot properties. Thus it is said: For Yin syndromes, treat the root (ben) without treating the branch (biao); both branch and root are preserved. Treating the branch without the root results in the loss of both.
When warmth pathogens emerge, yin fluids are inevitably injured first. If dispersing and resolving methods are indicated, yin-nourishing substances must be included. Ancient practitioners added child's urine to Cong Chi Tang (Scallion and Fermented Soybean Decoction) and added Rehmanniae Radix (Dihuang) and Ophiopogonis Radix (Maidong) to Zhi Chi Tang (Gardenia and Fermented Soybean Decoction), embodying this principle.
The macules caused by Warm Toxin differ from those in Cold Damage. The pathogen of Warm Toxin originates from the interior and manifests externally; the pathogen of Cold Damage enters from the exterior into the interior. Therefore, in Warm Toxin macules, the pathogen leaves the interior and moves toward the exterior, indicating a milder condition. In Cold Damage macules, the pathogen is excessive internally and manifests externally, indicating a severe condition. When the pathogen is excessive internally, it must be purged downward; this corresponds to Hua Yuanyuan's statement that "purging is necessary to prevent the pathogen from remaining in the stomach." When the pathogen moves toward the exterior, it can be released through the surface, corresponding to Guo Baiyun's statement that "the toxin has been stagnant for a long time before erupting; the disease is not in the interior, so purging is contraindicated. One must treat according to the exterior syndrome, using herbs to release muscle-layer heat."