夫伤寒二字。盖冬时严寒而成杀厉之气。触冒之而实时病者。乃名伤寒。不即发者。寒毒藏于肌肤。至春
变为温。至夏变为暑病。暑病者。热极重于温也。既变为温。则不得复言其为寒。不恶寒而渴者是也。此仲景
经文也。其麻黄桂枝。为即病之伤寒设。与温热何与。受病之源虽同。所发之时则异。仲景治之。当别有方。
缘皆遗失而无征。是以各家议论纷纷。至今未明也。刘守真谓欲用麻黄桂枝。必加凉药于其中。以免发黄之
病。张子和六神通解散。以石膏寒药中。加麻黄苍术。皆非也。盖麻黄桂枝辛热。乃冬月表散寒邪所宜之药。
不宜用于春夏之时。陶氏欲以九味羌活汤。谓一方可代三方。亦非也。羌活汤易老所制之方。乃治感四时不正
之气。如春宜温而反寒。夏宜热而反温。秋宜凉而反热。冬宜寒而反温。又有春夏秋三时为暴寒所折。虽有恶
寒发之证。不若冬时肃杀之气为甚。故不必麻黄桂枝以散寒。惟宜辛凉之药。通内外而解之。况此方须按六经
加减之法。不可全用也。不若逍遥散为尤妙。真可一方代三方也。然则欲治温病者。将如何。余有一法。请申
而明之。经曰。不恶寒而渴者是也。不恶寒则知其表无寒邪矣。曰渴则知肾水干枯矣。盖缘其人素有火者。冬
时触冒寒气。虽伤而亦不甚。惟其有火在内。寒亦不能深入。所以不即发。而寒气伏藏于肌肤。自冬
至三四月。历时既久。火为寒郁。中藏亦久。将肾水熬煎枯竭。盖甲木阳木也。借癸水而生。肾水既枯。至
此时强木旺。无以为发生滋润之本。故发热而渴。非有所感冒也。海藏谓新邪唤出旧邪。非也。若复有所感。
表又当恶寒矣。余以六味地黄滋其水。以柴胡辛凉之药舒其木郁。随手而应。此方活人者多矣。
予又因此而推展之。凡冬时伤寒者。亦是郁火证。若其人无火。
则为直中矣。惟其有火。故由皮毛而肌肉。肌肉而腑脏。今人皆曰寒邪传里。寒变为热。既曰寒邪。何故入内
而反为热。又何为而能变热耶。不知即是本身中之火。为寒所郁而不得泄。一步反归一步。日久则纯热而无寒
矣。所以用三黄解毒。解其火也。升麻葛根即火郁发之也。三承气即土郁则夺之。小柴胡汤木郁达之也。其理
甚简而易。只多了传经六经诸语。支离多歧。凡杂证有发热者。皆有头疼项强目痛鼻干胁痛口苦等证。何
必拘为伤寒。局伤寒方以治之也。余于冬月正伤寒。独麻黄桂枝二方。作寒郁治。其余俱不恶寒者。作郁火
治。此不佞之创论也。闻之者孰不骇然吐舌。及阅虞天民医学正传伤寒篇云。有至人传曰。传经伤寒。是
郁病。余见之。不觉窃喜。以为先得我心之同然。及考之内经。帝曰。人伤于寒。而传为热何也。岐伯
曰。寒气外凝内郁之理。腠理坚致。玄府闭密。则气不宣通。湿气内结。中外相搏。寒盛热生。故人伤于寒。
转而为热。汗之则愈。则外凝内郁之理可知。观此而余以伤寒为郁火者。不为无据矣。故特着郁论一篇。
论阳毒阴毒
金匮要略云。阳毒之为病。面赤斑斑如锦纹。咽喉痛。唾脓血。五日可治。七日不可治。
阴毒之为病。面目青。身痛如被杖。咽喉痛。死生如阳毒。升麻鳖甲汤并主之。
千金云。阳毒汤治伤寒一二日。变成阳毒。或服药吐下后。变成阳毒。身重腰脊背痛。烦闷不安。狂
言或走。或见鬼神。或吐血下利。其脉浮。
伤寒二字，指的是冬季严寒所形成的具有杀伤力的邪气。人们触冒这种邪气而随即发病的，才称为伤寒。如果当时没有立即发作，寒毒就会潜伏在肌肤之间，到了春天就转变为温病，到了夏天就转变为暑病。暑病的热势比温病更重。既然已经转变为温病，就不能再说是寒邪了，其表现是不怕冷且口渴，这是张仲景经文中的原意。麻黄汤和桂枝汤是为即时发作的伤寒所设立的方剂，与温热病有什么关系呢？虽然受病的源头相同，但发病的时间却不同。张仲景治疗伤寒时，应当另有专门的方剂，只是因为这些方剂已经遗失而无法考证，所以各家议论纷纷，直到今天也没有弄清楚。
刘守真认为，如果要使用麻黄、桂枝，必须在其中加入凉药，以避免出现发黄的症状；张子和的六神通解散，是在石膏等寒药中加入麻黄、苍术，这些都是不对的。因为麻黄、桂枝性味辛热，是冬季发散寒邪适宜的药材，不适合在春夏季节使用。陶华（陶氏）想用九味羌活汤，声称一方可以代替三方，这也是不对的。九味羌活汤是王好古（易老）制定的方子，它是用来治疗感受四时不正之气的，比如春天本该温暖却反而寒冷，夏天本该炎热却反而凉爽，秋天本该凉爽却反而炎热，冬天本该寒冷却反而温暖。又有春夏秋三季被暴寒所伤的情况，虽然有恶寒发热的症状，但不像冬季肃杀之气那样严重，所以不必用麻黄、桂枝来散寒，只适宜用辛凉的药材，通达内外而解除病邪。况且这个方子必须按照六经加减的方法使用，不能全盘照用。不如逍遥散更为精妙，真正可以做到一方代替三方。
那么，想要治疗温病的人，应该怎么办呢？我有一种方法，请让我阐述清楚。经文说：“不怕冷且口渴的就是。”不怕冷，就知道体表没有寒邪；说口渴，就知道肾水干枯了。大概是因为这个人素来体内有火，冬季触冒寒气，虽然受了寒也不严重。正因为体内有火，寒气也不能深入，所以没有立即发作，而寒气潜伏在肌肤之间。从冬季到三四月份，历时已久，火被寒气郁遏，在中焦脏腑停留时间也久，将肾水煎熬得枯竭。甲木属阳木，依靠癸水（肾水）生长，肾水既已枯竭，到了这个时候，强旺的肝木失去了发生滋润的根本，所以出现发热和口渴，这并不是因为外感了什么邪气。李东垣的学生海藏（张元素）所说的“新邪唤出旧邪”是不对的。如果又受到了新的外感，体表应当会出现恶寒的症状。我用六味地黄丸滋补肾水，用柴胡这味辛凉的药材疏解肝木的郁结，随手就能见效。这个方子救活的人很多了。
我又由此推演开来。凡是冬季患伤寒的，也都是郁火证。如果那个人体内没有火，那就是直中阴经了。正因为体内有火，所以病邪由皮毛进入肌肉，由肌肉进入腑脏。现在的人都说是寒邪传入体内，寒转变为热。既然说是寒邪，为什么进入体内反而变成热？又凭什么能变成热呢？不知道这就是本身之火，被寒气郁遏而不能宣泄，一步步退归体内，日子久了就纯粹是热而没有寒了。所以用三黄解毒汤来解其火；升麻葛根汤是用来“火郁发之”的；三承气汤是用来“土郁则夺之”的；小柴胡汤是用来“木郁达之”的。其中的道理非常简单容易，只是多了关于传经和六经的各种说法，支离破碎，歧路众多。凡是杂症中有发热的，都有头痛、项强、目痛、鼻干、胁痛、口苦等症状，何必拘泥于认为是伤寒，局限在伤寒方剂中来治疗呢？我在冬季遇到真正的伤寒，唯独对麻黄、桂枝两方，当作寒郁来治；其余都不怕冷的，都当作郁火来治。这是我个人的创见。听到的人谁不惊讶地吐舌头？等到我阅读虞天民《医学正传》的伤寒篇时，看到其中有至人传授的说法：传经伤寒，是郁病。我看了之后，不禁暗自高兴，认为这是与我内心认同的观点一致。等到考察《内经》，黄帝问：人受寒邪侵袭，为什么会转变成热呢？岐伯回答：寒气外凝，内郁的道理在于，腠理致密，玄府闭锁，导致气机不能宣通，湿气在内结聚，内外相互搏结，寒盛则热生，所以人受寒邪侵袭，转而变成热。发汗就好了，这样外凝内郁的道理就可以知道了。看这一点，我把伤寒看作郁火，并不是没有依据的。所以我特意写了一篇《郁论》。
论阳毒和阴毒
《金匮要略》说：阳毒这种病，面色红赤，斑纹像锦缎一样，咽喉疼痛，吐出脓血。五天内可以治疗，七天后无法治疗。
阴毒这种病，面目发青，身体疼痛像被棍棒打过一样，咽喉疼痛，生死情况与阳毒相同。升麻鳖甲汤都主治这两种病。
《千金方》说：阳毒汤治疗伤寒一两天，变成阳毒；或者服药后经过吐下法，变成阳毒。症状包括身体沉重、腰脊背痛、烦闷不安、胡言乱语或奔跑，或者看见鬼神，或者吐血、腹泻。脉象浮。
The term "Shanghan" (Cold Damage) refers to the lethal pathogenic qi formed by severe cold in winter. When individuals are exposed to this pathogen and fall ill immediately, it is named Shanghan. If it does not manifest immediately, the cold toxin hides in the skin and muscles; by spring, it transforms into Wenbing (Warm Disease), and by summer, it transforms into Shubing (Summerheat Disease). Shubing involves heat that is more severe than that of Wenbing. Once transformed into Wenbing, it can no longer be described as cold; its manifestations include aversion to cold being absent and thirst, which is consistent with Zhang Zhongjing's classic text. Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction) were established for immediate-onset Shanghan and have no relevance to warm-heat diseases. Although the source of infection is the same, the time of onset differs. Zhang Zhongjing treated Shanghan with specific formulas, but these have been lost and cannot be verified, leading to divergent opinions among various schools of thought that remain unresolved to this day.
Liu Wansu (Liu Shouzhen) argued that if Mahuang or Guizhi must be used, cooling herbs should be added to prevent jaundice. Zhang Congzheng’s Liushentong Jie San (Six-Spirit Resolving Powder) adds Mahuang and Cangzhu (Atractylodes Rhizome) to cold herbs like Shigao (Gypsum). Both approaches are incorrect. Mahuang and Guizhi are acrid and hot, suitable for dispersing cold pathogens in winter, but inappropriate for use in spring and summer. Tao Hua (Tao Shi) proposed using Jiuwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction), claiming one formula could replace three. This is also incorrect. Jiuwei Qianghuo Tang was formulated by Wang Haogu (Yi Lao) to treat irregular qi of the four seasons, such as cold when warmth is expected in spring, coolness when heat is expected in summer, heat when coolness is expected in autumn, and warmth when cold is expected in winter. Additionally, sudden cold injuries during spring, summer, and autumn may present with aversion to cold and fever, but they are not as severe as the killing qi of winter. Therefore, Mahuang and Guizhi are unnecessary for dispersing cold; acrid-cooling herbs are preferred to unblock the interior and exterior and resolve the pathogen. Moreover, this formula requires modification according to the Six Channels (Liu Jing) and cannot be used indiscriminately. Xiaoyao San (Free and Easy Wanderer Powder) is superior and truly capable of replacing multiple formulas.
So, how should Wenbing be treated? I propose a method. The classic states: "Absence of aversion to cold and presence of thirst." Absence of aversion to cold indicates no exterior cold pathogen; thirst indicates dryness and depletion of Kidney Water (Jin Ye, body fluids). Generally, this occurs because the individual has inherent internal fire. Winter cold exposure causes only slight injury. Because internal fire exists, the cold cannot penetrate deeply, so it does not manifest immediately. Instead, cold qi lies dormant in the skin and muscles. From winter to the third or fourth lunar month, the duration is long. Fire is constrained by cold, lingering in the middle jiao, boiling and depleting Kidney Water. Jia Wood (Liver/Gallbladder Yang Wood) relies on Gui Water (Kidney Yin/Water) for nourishment. With Kidney Water depleted, the vigorous Liver Wood at this time lacks the root for growth and moistening, resulting in fever and thirst. This is not due to external contraction. Hai Zang (Zhang Yuansu) claimed that "new pathogens awaken old pathogens," which is incorrect. If a new pathogen were contracted, there would be aversion to cold. I use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) to nourish water and Chaihu (Bupleurum Root), an acrid-cooling herb, to soothe Liver Wood stagnation, yielding immediate results. This formula has saved many lives.
Extending this reasoning, all cases of Shanghan in winter are essentially Stagnant Fire (Yu Huo) patterns. If the person lacks internal fire, it is a direct transmission (Zhizhong) to the Yin channels. Because internal fire exists, the pathogen moves from hair follicles to muscles, then to the Fu and Zang organs. Modern practitioners claim cold pathogens transmit inward and transform into heat. If it is a cold pathogen, why does it become heat upon entering the interior? It is actually the body's own fire, constrained by cold and unable to vent, retreating step by step inward. Over time, it becomes purely heat without cold. Thus, Sanhuang Jiedu San (Three-Yellow Detoxifying Powder) clears the fire; Shengma Gegen Tang (Cimicifuga and Kudzu Root Decoction) employs the principle of "releasing stagnant fire"; the Three Chengqi Decoctions apply "purging earth stagnation"; and Xiao Chaihu Tang (Minor Bupleurum Decoction) applies "soothing wood stagnation." The logic is simple. The confusion arises from excessive theories regarding meridian transmission and the Six Channels, which are fragmented and misleading. Any miscellaneous disease presenting with fever may involve headache, neck stiffness, eye pain, nasal dryness, hypochondriac pain, and bitter taste. Why restrict treatment to Shanghan formulas? In winter, for true Shanghan, I treat only Mahuang and Guizhi patterns as cold stagnation; all others without aversion to cold are treated as stagnant fire. This is my original theory. Listeners are often shocked. However, reading Yu Tianmin’s *Yixue Zhengzhuan* (Correct Transmission of Medical Learning), chapter on Shanghan, I found a teaching stating that transmitted Shanghan is a stagnation disease. I was pleased, seeing agreement with my views. Consulting the *Neijing* (Classic of Internal Medicine), the Yellow Emperor asks: "Why does cold injury transform into heat?" Qibo answers: "External cold condensation and internal stagnation occur when pores are tight and sweat ducts closed, preventing qi circulation. Dampness accumulates internally, battling with external cold, generating heat from cold excess. Hence, cold injury transforms into heat, cured by sweating." This confirms the mechanism of external condensation and internal stagnation. My view of Shanghan as stagnant fire is well-founded. Thus, I wrote the "Treatise on Stagnation."
Regarding Yang Du (Yang Toxin) and Yin Du (Yin Toxin):
The *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) states: Yang Du presents with a red face, mottled rash like brocade, sore throat, and expectoration of pus and blood. It is treatable within five days but incurable after seven days.
Yin Du presents with blue-green complexion, body pain as if beaten by a club, and sore throat. Mortality parallels Yang Du. Shengma Biejia Tang (Cimicifuga and Turtle Shell Decoction) treats both.
The *Qianjin Fang* (Prescriptions Worth a Thousand Gold) states: Yang Du Tang treats Shanghan transforming into Yang Du after one or two days, or following emetic/purgative treatments. Symptoms include heavy body, back and spine pain, restlessness, delirium, running about, hallucinations, hematemesis, or diarrhea. The pulse is floating.