温病者,冬时感冒寒邪,不实时而病,藏于肌肉之中,至春温暖而发者是也。其症发热而渴,不恶寒
者为温病也。或用升麻葛根汤,或用葛根解肌汤。大抵治温病之法,无正汗之理,此怫郁之热,自内
达外,无表症明矣,宜辛平之剂发散之。
热病者,冬伤于寒不即发,至春又不发,郁而至夏发者是也。其病身热头痛,烦渴,不恶寒,脉洪而盛。
盖因夏月时热两盛,治宜苦辛寒,清解为主。寒邪郁久化热,经曰、热病者伤寒之类也,故主苦辛寒
法以救之。
温病热病,其脉洪大有力,此阳症见阳脉也,可治。若脉来沈微细小,此阳症见阴脉也,必死。经曰、温病攘攘,
大热脉小足冷者死。
晚发者,清明后、夏至前、而发者是也。其症身热头疼,或恶风恶寒,或有汗无汗,或烦躁脉来洪数。亦
由冬时感寒所致,比之温热二症稍轻耳。不宜峻剂,宜清解邪热,通用槴子生麻汤加减治之。
痉病者,太阳经伤风、重感寒湿而致也。又曰、大发湿家汗,则成痉。其症头项强直,身热恶寒,摇头噤
口,背反张者是也。外症发热恶寒,与伤寒相似,但其脉沈迟弦细,两目圆张,而项背反张强硬,如发
痫之状。当视其有汗、无汗,以分刚痉、柔痉,若无汗恶寒,名刚痉,宜葛根汤。有汗不恶寒,名柔痉,桂枝
加葛根汤,如汗下太过,重亡津液,以致筋脉失养,不柔和而变痉者,又宜补养气血为主。更有产后
或金疮一切去血过多之症,皆能成痉,亦当补养为先。此则似痉而非痉者,岂可一例,而用风药?
之。
温病,是指在冬季感受了寒邪,当时没有立即发病,邪气潜伏在肌肉之中,到了春季天气温暖时才发作的疾病。其症状表现为发热且口渴,不恶寒的,就是温病。治疗时可以用升麻葛根汤,或者用葛根解肌汤。大抵上治疗温病的方法,没有使用发正汗的道理,这是因为怫郁的热邪从体内达于体表,没有表证是明确的,适宜用辛平性质的药剂来发散它。
热病,是指冬季受寒邪侵袭但没有立即发病,到了春季也没有发作,郁积到夏季才发作的疾病。其病症表现为身体发热、头痛、心烦口渴、不恶寒,脉象洪大而盛。这是因为夏季时令的热邪与体内的邪气两相旺盛,治疗适宜用苦辛寒性质的药物,以清热解表为主。寒邪郁久化热,经书说:“热病属于伤寒的一类”,所以主张用苦辛寒的方法来救治它。
温病和热病,如果脉象洪大有力,这是阳证见到阳脉,可以治疗。如果脉象沉微细小,这是阳证见到阴脉,必定死亡。经书说:“温病患者躁动不安,高热但脉小、足冷的,会死亡。”
晚发,是指在清明之后、夏至之前发作的疾病。其症状表现为身体发热、头痛,有的怕风怕冷,有的有汗无汗,有的烦躁、脉象洪数。这也是由冬季感受寒邪所致,比之温病和温热两种病症稍微轻一些罢了。不宜用峻猛的药剂,适宜清解邪热,通用栀子生麻汤加减来治疗。
痉病,是由太阳经受风邪,又重感寒湿而导致的。又说:“大发汗导致湿家(素患湿病的人)津液亏损,就会形成痉病。”其症状表现为头项强直、身体发热、恶寒、摇头、口噤(牙关紧闭)、背部反张(角弓反张)。外在症状发热恶寒,与伤寒相似,但其脉象沉迟弦细,两眼圆睁,且项背反张强硬,像发癫痫的样子。应当观察其有汗、无汗,以此区分刚痉和柔痉。如果没有汗且恶寒,名叫刚痉,适宜用葛根汤。如果有汗且不恶寒,名叫柔痉,适宜用桂枝加葛根汤。如果是汗法或下法太过,严重耗伤津液,导致筋脉失去滋养,不能柔和而变成痉病的,又适宜以补养气血为主。更有产后或金疮(金属利器造成的伤口)等一切失血过多的病症,都能导致痉病,也应当以补养为先。这些情况则是类似痉病而非真正痉病的,怎么可以一概而论,都使用祛风药呢?
Warm disease (Wen Bing) refers to a condition contracted by catching cold pathogens during winter, which does not manifest immediately but remains latent in the muscles, erupting when the weather warms up in spring. Its symptoms include fever and thirst without aversion to cold; this is defined as warm disease. Treatment may employ Shengma Gengen Tang (Ligusticum and Pueraria Decoction) or Gegen Jiexu Tang (Pueraria Muscle-Relieving Decoction). Generally, the principle of treating warm disease does not involve inducing normal sweating (Zheng Han), because the stifled heat (Fuyu Zhi Re) radiates from the interior to the exterior, clearly indicating the absence of exterior syndrome (Biao Zheng). It is appropriate to use acrid-neutral agents to disperse it.
Heat disease (Re Bing) refers to a condition where cold injury occurs in winter without immediate onset, fails to erupt in spring, and manifests in summer due to accumulation and stagnation. The pathology involves body heat, headache, irritability, thirst, absence of aversion to cold, and a surging and full pulse (Mai Hong Er Sheng). This is because the seasonal heat of summer is doubly abundant. Treatment should prioritize bitter-acrid-cold herbs to clear and resolve the pathogen. Since long-standing cold stagnation transforms into heat, the classics state: "Heat disease belongs to the category of cold damage." Therefore, the method of using bitter-acrid-cold formulas is advocated for rescue.
In both warm disease and heat disease, if the pulse is surging, large, and forceful, this represents a Yang syndrome presenting with a Yang pulse, which is treatable. If the pulse comes in a deep, faint, fine, and small manner, this represents a Yang syndrome presenting with a Yin pulse, which indicates certain death. The classics state: "In warm disease, if the patient is restless, has high fever, a small pulse, and cold feet, death will occur."
Late eruption (Wan Fa) refers to diseases that manifest after the Qingming Festival and before the Summer Solstice. Symptoms include body heat and headache, possibly accompanied by aversion to wind or cold, presence or absence of sweat, irritability, and a surging and rapid pulse. This is also caused by contracting cold in winter, but it is slightly milder than warm disease and warm-heat syndromes. Potent purgative or dispersing agents should not be used; instead, clearing and resolving pathogenic heat is appropriate. Zhizi Shengma Tang (Gardenia and Ephedra Decoction) modified is generally used for treatment.
Jing disease (Spasm Disease) is caused by wind injury to the Taiyang Meridian compounded by severe contraction of cold and dampness. It is also stated: "Excessive sweating in patients with dampness leads to Jing disease." Symptoms include stiffness and rigidity of the head and neck, body heat, aversion to cold, shaking of the head, trismus (lockjaw), and opisthotonos (backward arching of the back). The external symptoms of fever and aversion to cold resemble cold damage, but the pulse is deep, slow, wiry, and fine, with eyes wide open and rigid backward arching of the neck and back, resembling epilepsy. One must observe the presence or absence of sweat to distinguish between Gang Jing (Rigid Spasm) and Rou Jing (Flexible Spasm). If there is no sweat and aversion to cold, it is named Gang Jing, treated with Gegen Tang (Pueraria Decoction). If there is sweat and no aversion to cold, it is named Rou Jing, treated with Guizhi Jia Gegen Tang (Cinnamon Twig Plus Pueraria Decoction). If excessive sweating or purgation severely depletes body fluids, causing the sinews and vessels to lose nourishment and become non-pliable, resulting in spasm, the primary treatment should be tonifying Qi and Blood. Furthermore, conditions such as postpartum states or traumatic wounds involving excessive blood loss can all lead to spasm; these too require tonification as the priority. These cases are similar to Jing disease but are not true Jing disease; how can they all be treated uniformly with wind-dispelling herbs?