伤寒无汗,何以明之。盖腠理者,津液凑泄之所、为腠,文理缝会之中、为理。如津液为风暑湿气所干,
外凑皮腠,则为自汗。若寒邪中经,腠理致密,津液内渗,则为无汗。然无汗之由,又有数种,如寒邪在
表,及邪气行于里,或水饮内蓄,与夫已阳久虚,皆令无汗者也。如或当汗不汗,服汤剂病症仍在,至
三剂不汗者,死。
头痛者,寒邪入足太阳经,邪气上攻于头所致也。盖三阳之脉,皆上于头,而头疼独太阳为专主也。
若太阴少阴之脉,至颈而还,不上循头,则无头疼之症。稚厥阴之脉,循喉咙,入颃颡,连目眦,上出额,
虽有头疼,却无身汗。故发热恶寒头痛者,太阳也。至于头痛不大便,潮热谵语者,承气汤主之。头痛
口苦脉弦者,小柴胡汤主之。头痛吐?沫者,吴茱萸汤主之。设或两感于寒而头痛,与夫痛连入脑,
手足青至节,又为直头痛而不可治也。
身体痛者,盖因风寒入于肌肤,孔窍闭塞,血脉渐滞不和所致,乃太阳经病也。然有发汗温经之不
同。如太阳身痛,恶寒发热,头疼无汗者,麻黄汤。风湿身痛,一身困重,莫能转侧者,桂枝汤加附子。阴
症身痛如被杖,脉沈自利者,四逆汤。至若脉寸迟而身痛,与汗后脉沈迟而身痛者,皆血不足也,并
用黄?建中汤。劳倦之人身体疼痛者,必脉虚因倦,用补中益气汤。茗疮家身体痛,切不可发汗,汗
之则成痉。
伤寒病出现无汗症状,该如何辨析呢?腠理,是津液渗出排泄的部位;“腠”指皮肤纹理之间的缝隙,“理”指肌理的纹路。如果津液被风、暑、湿等邪气所干扰,向外渗出于皮肤腠理之间,就会表现为自汗。若是寒邪侵入经脉,导致腠理致密,津液向内渗透而不能外达,就会表现为无汗。然而,导致无汗的原因又有几种情况:如寒邪在体表,或者邪气传入体内,或者是水饮内停蓄积,以及阳气久虚,都会导致无汗。如果应当发汗却未发汗,服用汤药后病症仍在,到了服三剂药仍不出汗的,预后不良,属死证。
头痛,是因为寒邪侵入足太阳经,邪气向上攻冲头部所致。大概三阳经的脉气,都上行至头部,而头痛这一症状唯独由太阳经主要主管。如果是太阴经和少阴经的脉气,运行到颈部就返回,不向上循行经过头部,就不会出现头痛的症状。厥阴经的脉气,循行喉咙,进入颃颡(鼻咽部),连接目内眦,上行出额部,虽然也会有头痛,但不会伴有身体出汗。所以,发热、恶寒、头痛并见的,属于太阳病。至于头痛伴有大便不通、潮热、胡言乱语的,用承气汤主治。头痛伴有口苦、脉弦的,用小柴胡汤主治。头痛伴有呕吐清稀涎沫的,用吴茱萸汤主治。假如是两感于寒(表里同病)而头痛,或者疼痛连及脑部,手足青紫甚至到达关节,这属于直中头痛,是不可治愈的死证。
身体疼痛,大概是因为风寒侵入肌肤,孔窍闭塞,血脉逐渐阻滞不和所致,这是太阳经的病证。然而治疗方法有发汗和温经的不同。如太阳病身痛,伴有恶寒、发热、头痛、无汗的,用麻黄汤。风湿病身痛,全身困重,不能转侧的,用桂枝汤加附子。阴证身痛如同被棍棒打过一样,脉沉、自下利的,用四逆汤。至于脉象寸部迟滞而身痛,以及发汗后脉象沉迟而身痛的,都是血不足所致,都用黄芪建中汤。劳累过度之人身体疼痛的,必定脉虚且因疲倦所致,用补中益气汤。患有疮疡的人身体疼痛,切不可发汗,若发汗则会演变为痉病。
In the context of Cold Damage (Shanghan) presenting with anhidrosis (lack of sweating), how should this be understood? The Couli (interstitial spaces of the skin and muscles) are the sites where body fluids (Jinye) exude and escape. "Cou" refers to the gaps between skin textures, while "Li" refers to the grain of the muscle tissue. If body fluids are disturbed by Wind, Summerheat, or Dampness pathogens and exude outward into the skin and Couli, it manifests as spontaneous sweating. However, if Cold pathogens invade the meridians, causing the Couli to become dense and tight, and body fluids infiltrate inward rather than reaching the exterior, it manifests as anhidrosis. Nevertheless, there are several causes for anhidrosis: such as Cold pathogens remaining at the Exterior, pathogenic factors moving into the Interior, internal accumulation of Fluid retention (Shuiyin), or prolonged deficiency of Yang Qi, all of which can lead to anhidrosis. If sweating should have been induced but was not, and symptoms persist after administering decoctions, leading to a state where no sweat occurs even after three doses, the prognosis is fatal.
Headache is caused by Cold pathogens invading the Foot-Taiyang Meridian and attacking upward toward the head. Generally, the meridians of the Three Yang channels all ascend to the head, but headache is predominantly associated with the Taiyang channel. The meridians of the Taiyin and Shaoyin channels return at the neck and do not ascend to the head; therefore, they do not present with headache symptoms. The Jueyin channel meridian circulates through the throat, enters the pharynx (Hangsang), connects to the inner canthus of the eye, and ascends to the forehead. Although headache may occur in Jueyin disorders, it does not typically present with sweating of the body. Thus, the combination of fever, aversion to cold, and headache indicates a Taiyang disorder. Regarding headache accompanied by constipation, tidal fever, and delirium, Chengqi Tang (Gut-Draining Decoction) is indicated. For headache accompanied by a bitter taste in the mouth and a wiry pulse, Xiaochaihu Tang (Minor Bupleurum Decoction) is indicated. For headache accompanied by vomiting of clear saliva or froth, Wuzhuyu Tang (Evodia Decoction) is indicated. If one suffers from simultaneous invasion of Exterior and Interior by Cold (Lianggan) resulting in headache, or if the pain extends into the brain with hands and feet turning cyanotic up to the joints, this is termed direct headache (Zhitou Tong) and is incurable.
Body pain is generally caused by Wind-Cold invading the skin and muscles, closing the pores, and causing gradual stagnation and disharmony in the blood vessels; this is a disease of the Taiyang channel. However, treatment methods differ between inducing sweating and warming the meridians. For Taiyang body pain accompanied by aversion to cold, fever, headache, and anhidrosis, Mahuang Tang (Ephedra Decoction) is used. For body pain due to Wind-Dampness, characterized by a sensation of heaviness throughout the body and inability to turn over, Guizhi Tang (Cinnamon Twig Decoction) combined with Fuzi (Prepared Aconite Root) is used. For Yin-pattern body pain described as feeling like being beaten with a club, accompanied by a deep pulse and spontaneous diarrhea, Sini Tang (Frigid Extremities Decoction) is used. In cases where the pulse is slow at the Cun position with body pain, or where body pain persists with a deep and slow pulse after sweating therapy, these indicate insufficiency of Blood; Huangqi Jianzhong Tang (Astragalus Decoction for Building the Middle) is applied to both scenarios. For individuals suffering from fatigue and exhaustion who experience body pain, characterized by a deficient pulse and fatigue, Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) is used. For patients with sores or ulcers experiencing body pain, sweating therapy must strictly be avoided; inducing sweat in such cases will transform the condition into Spasm (Jing).