论曰∶春气温和。夏气暑热。秋气清凉。冬气冰冽。此四时正气之序也。冬时严寒。万
类深
而以
至春
者。
反大
之病
帝兴
人
虑
故
立
时
然此病也。俗人谓之横病。多不解疗。皆云日满自瘥。以此致枉者天下大半。凡始觉不佳。
便须救疗。若至于病。即汤食兢进。折其毒势。自然而瘥。必不可令病气自长。恣意攻人。
拱手待毙。斯为误矣。夫得病一日在皮。当摩膏火灸。淋浴发汗则愈。若不解者。二日在肤
可法针。服解肌散发汗。汗出则愈。若不解至三日。复一发汗则愈。若不解者。则勿复发
也。至四日在胸。宜服赤小豆瓜蒂散吐之。则愈。至五日在腹。六日入胃。则可下之。若热
在胃外。如误下之。其热乘虚入胃。然病要须下者。又不得留于胃中也。若胃实者。热毒为
病。三死一生。若胃虚者。热毒入胃即胃烂矣。其微者赤斑出。此候五死一生。剧者黑斑出
此候十死一生。以病患各有强弱。人有难易效相倍也。若得伤寒病无热。但狂言躁烦不安。
精气言语。与人不相主。当勿以火迫之。但以五苓散三二钱服之。可与新汲水一升。或一升
半。可至二升。强饮之。指刺喉中吐之。随手便愈。若不便吐者。此病皆多不善。勿以余药
吐也。又此病。不急以猪苓散及吐解之者。其毙速。亦可先以发表之药尤佳。病者过日不已
则不是热。不可下之者。热毒承虚入胃。亦令胃烂斑出也。又春夏无大吐下。秋冬无大发汗
。若冬及始春天寒。宜服神丹丸。亦可摩膏火灸。若末春夏月初秋。凡此热月。不宜火灸。
又不宜浓覆。宜服六味青散。若无丸散及煎。但用柴胡数两煎服。伤寒时行。皆可服也。亦
可以发汗药发汗。不但一也。直至再三发汗不解者。当与阳实者宜转下之。其脉朝夕快者为
实癖也。朝平夕快非癖也。转阳可早与服。但当少与。勿令下多。其间诸虚烦热者。与伤寒
相似。然不恶寒。身不疼痛。故知非伤寒也。不可发汗。若头不痛。脉不紧数。故知非里实
。不可下也。如此外内皆不可攻。而医强攻之。必致危损。多死难痊也。虚烦者但当与竹叶
汤。若呕者与橘皮汤。不愈可重与服之。若得病连服汤药发汗。汗不出者皆死病也。凡难得
汗者可蒸之。如蒸中风法。蒸湿之气于外迎之。不得不汗出也。
凡病发热恶寒脉洪者。便宜发汗。后以粉粉之。勿令着风。若当发汗而其人适已失血。
及大
和里
甘
可
变
诊
内
食
小
以滋
鲜有
日而渴欲饮水者。未宜多与也。为腹中热气尚少。不能消之。便更与人作病深矣。若至七八
日大
满。
也。
者。
论述说:春天的气候温和,夏天的气候暑热,秋天的气候清凉,冬天的气候冰冽。这是四季正常气候的次序。冬季严寒,万物深藏,如果到了春天反而出现大的病变(指冬伤于寒,春必病温),这就是所谓的“时行”疾病。世俗之人称之为“横病”,大多不懂得治疗,都说日子满了自然就会痊愈,因此导致枉死者天下大半。凡是刚开始感觉身体不适,就必须立即救治。等到已经发病,就争着进用汤药饮食,以折损其毒势,这样自然会痊愈。绝不可以让病气自行增长,肆意攻伐人体,那样拱手等待死亡,就是错误的了。
大凡得病第一天,邪气在皮,应当使用膏摩和火灸,淋浴发汗即可痊愈。如果不愈,第二天邪气在肤,可以依法针刺,服用解肌散发汗的药,汗出则愈。如果不愈到第三天,再次发汗则愈。如果不愈,就不要再次发汗了。到第四天,邪气在胸,适宜服用赤小豆瓜蒂散进行催吐,则愈。到第五天,邪气在腹;第六天,邪气入胃,则可以采用下法。如果热邪在胃外,误用下法,热邪就会乘虚进入胃中。然而,如果病情确实需要下法,又不能让邪气留在胃中。如果胃气实,热毒致病,十死一生;如果胃气虚,热毒入胃就会导致胃烂。轻微的会出现赤斑,这种证候十死一生;严重的出现黑斑,这种证候十死一生。这是因为病人各有强弱,人的体质有难易,疗效相差数倍。
如果得了伤寒病,没有发热,只是胡言乱语、烦躁不安,精气神错乱,与人言语不相应对,千万不要用火法逼迫发汗。只需用五苓散三二钱服用,并给饮新汲水一升,或一升半,甚至可达二升,强行灌服,用手指刺激喉咙催吐,随手就能痊愈。如果不便呕吐,这种病大多预后不良,不要用其他药物催吐。另外,这种病如果不紧急用猪苓散及催吐法解除,死亡迅速。也可以先用发表的药物,尤其好。病人过了几天病不愈,就不是热证,不可用下法。热毒乘虚入胃,也会导致胃烂和斑出。
又春夏季节不宜大吐大下,秋冬季节不宜大发汗。如果在冬季及初春天气寒冷时,适宜服用神丹丸,也可以膏摩火灸。如果是夏末春初或月初秋,凡是这些热月,不宜火灸,也不宜厚盖被子。适宜服用六味青散。如果没有丸散及煎剂,只用柴胡数两煎服,伤寒时行疾病,都可以服用。也可以用发汗药发汗,不止一种方法。直到经过多次发汗仍不解者,对于阳实证患者适宜转用下法。其脉象早晨平稳傍晚急促的是实癖证。早晨平静傍晚急促的不是癖证。转阳证可早服药,但应当少量给予,不要令泻下过多。其间各种虚烦热证,与伤寒相似,但不恶寒,身体不疼痛,所以知道不是伤寒,不可发汗。如果头不痛,脉不紧数,所以知道不是里实证,不可下法。如此内外都不可攻伐,而医生强行攻伐,必然导致危重损伤,多死难愈。虚烦者只应当给予竹叶汤。如果呕吐者给予橘皮汤,不愈可以重复服用。如果得病后连续服用汤药发汗,汗不出来的都是死证。凡难得汗的可以蒸之,如蒸中风的方法,将蒸湿之气从外部迎引,不得不汗出。
大凡病发热恶寒脉洪大的,适宜立即发汗,之后用粉扑身,不要令受风。如果应当发汗而其人恰好已经失血,以及……(原文此处有缺漏)调和里气……甘……可……变……诊……内……食……小……以滋……鲜有……日而渴欲饮水者,未宜多与也。因为腹中热气尚少,不能消解,便更让人病深入了。如果到七八日大……满……也……者。(原文结尾残缺)
It is said: The climate of spring is mild, the climate of summer is hot and sultry, the climate of autumn is cool and clear, and the climate of winter is icy cold. This is the order of the normal Qi of the four seasons. In winter, when it is bitterly cold, all things hide deeply. If major pathological changes occur in spring (referring to "Winter injury by Cold leads to Warm disease in Spring"), this is what is called a "Shi Xing" (Epidemic/Seasonal) disease. Laypeople call it "Heng Bing" (Sudden/Catastrophic Disease), and most do not know how to treat it, claiming that it will heal itself after a certain number of days. Consequently, more than half of those who die wrongly attribute it to this belief. Whenever one initially feels unwell, immediate treatment is required. Once the disease has fully manifested, one should eagerly administer decoctions and food to reduce the toxic pathogenic factor, which will naturally lead to recovery. One must never allow the pathogenic factor to grow unchecked and ravage the body; otherwise, waiting passively for death is a mistake.
Generally, on the first day of illness, the pathogen is in the skin. One should apply medicated ointment massage and fire moxibustion, followed by bathing to induce sweating, which will lead to recovery. If there is no improvement, on the second day, the pathogen is in the flesh/skin layer. Acupuncture may be applied according to method, and herbs that release the muscle layer and induce sweating should be taken. Recovery occurs with sweating. If there is no improvement by the third day, another sweating therapy may be applied. If still unresolved, do not sweat again. By the fourth day, the pathogen is in the chest. It is appropriate to administer Chi Xiao Dou Gua Di San (Red Bean and Melon Peduncle Powder) to induce vomiting, leading to recovery. By the fifth day, the pathogen is in the abdomen; by the sixth day, it enters the Stomach. At this stage, purgation may be used. However, if the heat is outside the Stomach and purgation is mistakenly used, the heat will enter the Stomach through the deficiency. Nevertheless, if the condition truly requires purgation, the pathogen must not remain in the Stomach. If the Stomach is full/excess and the disease is caused by heat toxicity, the prognosis is ten deaths to one life. If the Stomach is deficient, heat toxicity entering the Stomach will cause the Stomach to rot. Mild cases present with red macules (Chi Ban), a prognosis of ten deaths to one life. Severe cases present with black macules, a prognosis of ten deaths to one life. This is because patients vary in strength, and individual constitutions affect efficacy significantly.
If one contracts Shang Han (Cold Damage) without fever, but with delirium, restlessness, and anxiety, where spirit and speech are disordered and communication with others is impaired, one must not use fire methods to force sweating. Instead, administer Wu Ling San (Five-Ingredient Powder with Poria) 3–2 qian, and drink fresh drawn water 1 sheng, or 1.5 sheng, up to 2 sheng. Force the patient to drink, then stimulate the throat to induce vomiting. Recovery follows immediately. If vomiting does not occur, the prognosis is generally poor; do not use other emetics. Furthermore, if this disease is not urgently resolved with Zhu Ling San (Polyporus Powder) and emesis, death comes quickly. Using exterior-releasing herbs first is also excellent. If the patient's illness persists beyond several days, it is no longer a heat syndrome, and purgation is contraindicated. Heat toxicity entering the Stomach via deficiency can also cause Stomach rot and macules.
In spring and summer, drastic vomiting and purgation are contraindicated. In autumn and winter, drastic sweating is contraindicated. In winter and early spring when it is cold, Shen Dan Wan (Divine Pill) is appropriate, along with ointment massage and fire moxibustion. In late spring or early autumn, during these hot months, fire moxibustion is inappropriate, nor is thick covering. Liu Wei Qing San (Six-Ingredient Green Powder) is appropriate. If pills, powders, or decoctions are unavailable, boiling Chai Hu (Bupleuri Radix) in large amounts for oral administration is suitable for Shang Han and Shi Xing diseases. Exterior-releasing herbs may also be used; there is more than one method. If sweating therapies fail even after repeated attempts, for patients with Yang Excess patterns, transition to purgation. A pulse that is calm in the morning and rapid in the evening indicates Shi Pi (Excess Mass); a pulse that is calm in the morning and rapid in the evening does not indicate Pi. For Yang transformation patterns, medication can be given early but in small doses to avoid excessive purgation. Various deficiency-related vexation and heat patterns resemble Shang Han but lack aversion to cold and body pain, indicating they are not Shang Han; thus, sweating is contraindicated. If there is no headache and the pulse is not tight and rapid, interior excess is ruled out, so purgation is contraindicated. When neither exterior nor interior attacks are indicated, yet the physician forces an attack, critical damage ensues, often resulting in death. For deficiency vexation, Zhu Ye Tang (Bamboo Leaf Decoction) is appropriate. For vomiting, Ju Pi Tang (Tangerine Peel Decoction) is appropriate; repeat if necessary. If, after continuous administration of decoctions for sweating, no sweat appears, it is a fatal sign. For difficult-to-induce sweating, steaming may be used, similar to the method for Feng Zhong (Wind Strike). Steaming moisture from the outside to attract sweat ensures its emergence.
Generally, for illnesses with fever, aversion to cold, and a洪 (Surging) pulse, immediate sweating is appropriate, followed by applying powder to the body to prevent wind exposure. If sweating is indicated but the patient has recently lost blood, and... [text missing] ...harmonize the interior... Gan (Licorice)... Ke (Can)... Bian (Change)... Zhen (Diagnosis)... Nei (Interior)... Shi (Food)... Xiao (Small)... Yi Zi (Nourish)... Xian You (Rarely)... Ri Er Ke Yu Yin Shui Zhe (Those who desire to drink water on the day)... Wei Yi Duo Yu Ye (Not yet appropriate to give much). Because the heat Qi in the abdomen is still scant and cannot dissipate it, giving more will deepen the illness. If by the seventh or eighth day... Man (Fullness)... Ye (Particle)... Zhe (Particle)... [text ends abruptly].