伤寒伤风何以判。寒脉紧涩风浮缓。伤寒恶寒风恶风。伤风自汗寒无汗。阳属膀胱并胃胆。
阴居脾肾更连肝。浮长弦沉细微缓。脉症先将表里看。阴病见阳脉者生。阳病见阴脉者死。
夫伤寒者。乃大病也。生死反掌之间。要随机应变而治之也。盖伤寒发热恶寒。腰痛脊
强。
则知病在太阳经也。身热目痛鼻干。不得眠。则知病在阳明经也。胸胁痛。耳聋口苦舌干。
往来寒热而呕。则知病在少阳经也。腹满咽干。手足自温。或自利不渴。或腹满时痛。则
知病在太阴经也。烦满囊缩。则知病在厥阴经也。引衣蜷卧。恶寒。或舌干口燥。则知病在
少阴经也。潮热自汗。谵语发渴。不恶寒。反恶热。揭去衣被。扬手掷足。或发黄斑狂乱。
五六日不大便。则知病在阳明腑也。设若脉症不明。误用麻黄。令人汗多亡阳。误用承气。
令人大便不禁。误用姜附。令人失血发狂。正为寒凉耗其胃气。辛热损其汗液。燥热助其邪
热。庸医杀人。莫此为甚。伤寒之邪。实无定体。或入阳经气分。则太阳为首。其脉必浮。
轻手便得。或入阴经血分。则少阴为先。其脉必沉。
重手乃得。浮而有力无力。是知表之虚实。沉而有力无力。是知里之寒热。中而有力无力。
是知表里缓急。脉有浮沉虚实。症乃传变不常。治疗之法。先分表里虚实。寒热标本。先病
为本。次病为标。先以治其急者。此为第一义也。问症以知其外。察脉以知其内。全在活法
二字。不可拘于日数。但见太阳症在。直攻太阳。但少阴症在。直攻少阴。但见真寒。直
攻
真寒。但见一二症具。便作主张。不必悉具。当何如处。此为活法。若同而异者明之。似是
而非者辨之。在表者汗之散之。在里者下之利之。在上者因而越之。下陷者升而举之。从乎
中者和解之。直中阴经者温补之。若解表。不可攻里。日数虽多。但有表症而脉浮者。尚宜
发散。此事不明。攻之为逆。经云。一逆尚引日。再逆促命期。若表症解而里症存者。不可
攻表。日数少。但有里热而脉沉实者。急当下之。此事不明。祸如反掌。经云。邪热未除。
复加燥热。如抱薪救火矣。如直中阴经。真寒症也。无热恶寒不渴。宜温补。切忌寒凉。此
事不明。杀人甚速。阴症似阳症者温之。阳症似阴症者下之。阳毒者分轻重下之。阴毒者分
缓急温之。阳狂者下之。阴厥者温之。湿热发黄者利之下之。血症发黄者清之下之。发斑
者清之下之。谵语者下之清之。痞满者消之泻之。结胸者解之下之。太阳症似少阴者温之。少
阴症似太阳者汗之。衄血者解之止之。发喘者汗之下之。咳嗽者利之解之。正伤寒者。大汗
之。大下之。感冒寒者。微汗之。微下之。劳力感寒者。温之散之。温热病者。微解之。大
下之。此经常之大法也。有病一经而用热药寒药之不同。如少阴症有用白虎汤、四逆散之
寒药者。少阴症有用四逆汤、真武汤之热药者。庸俗狐疑。讵能措手哉。呜呼。能察其伤寒
之
症名。而得其伤寒之方脉。如此亲切。乃为良医。是知寒药治少阴。乃传经里热也。热药治
少阴。乃直中真寒也。辨脉定经。识症用药。真知其为表也而汗之。真知其为里热而下之。
真知其为直中阴经而温之。如此而汗。如此而下。又如彼而温。麻黄承气。投之不瘥。姜附
理中。用之必当。病奚逃乎。然必须分轻重缓急。老少虚实。久病新发。妇人胎产。室女经
水。大凡有临产而伤寒者。与男子伤寒治法不同。若无胎产。治亦相同。妇人室女。经水适来
适断。寒热似疟者。即是热入血室。但当和解表里。久病者过经不解。坏症也。新发者始病
也。老者血气衰。少者血气壮。缓者病之轻也。急者病之重也。寒药热服。热药凉服。中和
之剂。温而服之。战汗分四症。要知邪正盛衰。类伤寒四症。照常例而治之也。学人宜究心
焉。
伤寒与伤风如何辨别？伤寒的脉象紧涩，伤风的脉象浮缓。伤寒表现为恶寒，伤风表现为恶风。伤风有自汗，伤寒无汗。阳经涉及膀胱、胃和胆。阴经位于脾、肾并连接肝。脉象有浮、长、弦、沉、细、微、缓之分。诊察时先将表里区分清楚。阴病出现阳脉者生，阳病出现阴脉者死。
所谓伤寒，是大病，生死只在顷刻之间，必须随机应变来治疗它。如果伤寒患者发热、恶寒、腰痛、脊背强直，就知道病在太阳经。如果身体发热、眼睛痛、鼻子干、不能睡眠，就知道病在阳明经。如果胸胁痛、耳聋、口苦、舌干、往来寒热且呕吐，就知道病在少阳经。如果腹部胀满、咽干、手足自然温暖，或者自利而不口渴，或者腹部胀满且时而疼痛，就知道病在太阴经。如果烦闷、阴囊收缩，就知道病在厥阴经。如果蜷缩而卧、恶寒，或者舌干口燥，就知道病在少阴经。如果潮热、自汗、说胡话、发渴、不恶寒反而怕热、掀开衣被、扬手掷足，或者发黄、出斑、狂乱，或者五六天不大便，就知道病在阳明腑。假如脉症不明，误用麻黄，会导致出汗过多而亡阳；误用承气汤，会导致大便失禁；误用姜、附子，会导致出血发狂。这是因为寒凉药耗损胃气，辛热药损伤汗液，燥热药助长邪热。庸医杀人，没有比这更严重的了。伤寒的病邪，确实没有固定的形态。如果进入阳经气分，则以太阳经为首，其脉必浮，轻按即可触及。如果进入阴经血分，则以少阴经为先，其脉必沉，重按才能触及。脉浮而有力或无力，可知表证的虚实；脉沉而有力或无力，可知里证的寒热；脉中取而有力或无力，可知表里证的缓急。脉象有浮沉虚实，症状则传变无常。治疗的方法，先分清表里虚实、寒热标本。先发生的病为本，后发生的病为标。先治疗紧急的情况，这是第一要义。询问症状以了解外部情况，诊察脉象以了解内部情况，全在于灵活变通二字，不可拘泥于发病的天数。只要见到太阳证存在，就直接治疗太阳经；只要见到少阴证存在，就直接治疗少阴经；只要见到真寒证，就直接治疗真寒；只要见到一两个症状具备，就可以做出判断，不必所有症状都具备。应当如何处理？这就是灵活变通。对于相似而不同的病症要明辨，对于似是而非的病症要鉴别。在表的用发汗法解散，在里的用泻下法通利，在上部的用涌吐法祛除，下陷的用升提法举托，从中焦调和的予以和解，直中阴经的用温补法治疗。如果要解表，不可攻里。即使天数很多，只要有表证且脉浮，仍然适宜发散。如果不明白这个道理，攻里就是逆治。经书说：一次误治尚且拖延病程，再次误治就会加速死亡。如果表证已解而里证仍在，不可再攻表。即使天数很少，只要有里热且脉沉实，就应当紧急泻下。如果不明白这个道理，祸患如反掌之间发生。经书说：邪热未除，再加燥热，就像抱着木柴去救火一样。如果是直中阴经，属于真寒证，无热、恶寒、不口渴，适宜温补，切忌寒凉。如果不明白这个道理，杀人非常快。阴证似阳证的用温法，阳证似阴证的用下法。阳毒证根据轻重程度用下法，阴毒证根据缓急程度用温法。阳狂证用下法，阴厥证用温法。湿热发黄的用利法、下法，血症发黄用的清法、下法，发斑的用清法、下法，说胡话的用下法、清法，痞满的用消法、泻法，结胸的用解法、下法，太阳证似少阴证的用温法，少阴证似太阳证的用汗法，鼻出血的用解法、止法，发喘的用汗法、下法，咳嗽的用利法、解法。正伤寒的用大汗法、大下法；感冒寒邪的用微汗法、微下法；劳力感寒的用温法、散法；温热病的用微解法、大下法。这是常规的大法。有一种情况是一经病却使用热药或寒药不同，比如少阴证有用白虎汤、四逆散的寒药的，也有用四逆汤、真武汤的热药的。庸俗之人狐疑不定，怎么能下手治疗呢？唉！能察知伤寒的症状名称，并掌握伤寒的方剂和脉理，如此亲切深入，才是良医。由此可知，寒药治少阴，是传经入里的热证；热药治少阴，是直中的真寒证。辨别脉象确定经络，识别症状用药，真正知道它是表证就发汗，真正知道它是里热就泻下，真正知道它是直中阴经就温补。像这样发汗，像这样泻下，又像那样温补，如果使用麻黄汤、承气汤无效，使用姜附子、理中丸必定恰当。疾病怎能逃脱呢？然而必须分轻重缓急，老少虚实，久病新发，妇女胎产，少女月经。大凡临产时患伤寒的，与男子伤寒治法不同。如果没有胎产问题，治法也相同。妇女少女，月经刚来或刚断，寒热像疟疾一样的，就是热入血室。只应当和解表里。久病过经不解的，是坏证；新发的，是始病。老年人气血衰弱，年轻人气血壮盛。缓者病情轻，急者病情重。寒药热服，热药凉服，中和之剂温服。战汗分为四种症状，要知道邪正盛衰。类伤寒四种症状，照常例治疗即可。学习者应该用心研究。
How to distinguish between Shanghan (Cold Damage) and Shangfeng (Wind Strike)? The pulse in Shanghan is tight and choppy, while the pulse in Shangfeng is floating and moderate. Shanghan presents with aversion to cold, whereas Shangfeng presents with aversion to wind. Shangfeng involves spontaneous sweating, while Shanghan involves no sweating. The Yang meridians involve the Bladder, Stomach, and Gallbladder. The Yin meridians are located in the Spleen and Kidney and connect to the Liver. Pulses can be floating, long, string-taut, deep, fine, minute, or slow. In diagnosis, one must first distinguish between exterior and interior. If a Yin disease presents with a Yang pulse, there is hope for survival; if a Yang disease presents with a Yin pulse, death ensues.
Shanghan is a severe illness, where life and death hang in the balance, requiring treatment that adapts to changing circumstances. If a patient with Shanghan exhibits fever, aversion to cold, lower back pain, and stiffness of the spine, it indicates the disease is in the Taiyang Meridian (Greater Yang). If the body is hot, eyes hurt, nose is dry, and sleep is impossible, it indicates the disease is in the Yangming Meridian (Yang Brightness). If there is pain in the chest and hypochondrium, deafness, bitter taste in the mouth, dry tongue, alternating chills and fever, and vomiting, it indicates the disease is in the Shaoyang Meridian (Lesser Yang). If there is abdominal fullness, dry throat, naturally warm hands and feet, spontaneous diarrhea without thirst, or abdominal fullness with intermittent pain, it indicates the disease is in the Taiyin Meridian (Greater Yin). If there is irritability and fullness, and retraction of the genitals, it indicates the disease is in the Jueyin Meridian (Terminal Yin). If the patient curls up while lying down, has aversion to cold, or has a dry tongue and mouth, it indicates the disease is in the Shaoyin Meridian (Lesser Yin). If there is tidal fever, spontaneous sweating, delirium, thirst, aversion to heat rather than cold, throwing off clothes and bedding, flailing arms and legs, yellowing of the skin, macules, mania, or constipation for five to six days, it indicates the disease is in the Yangming Fu-organ (Stomach/Intestines). If the pulse and symptoms are unclear, mistakenly using Ephedra Decoction (Mahuang Tang) can cause excessive sweating and loss of Yang energy; mistakenly using Chengqi Decoction can lead to incontinence of stool; mistakenly using Ginger and Aconite can cause bleeding and madness. This is because cold-natured medicines consume Stomach Qi, acrid-hot medicines damage sweat fluids, and dry-hot medicines assist pathogenic heat. No act by quacks is more deadly than this. The pathogen of Shanghan indeed has no fixed form. If it enters the Qi level of the Yang meridians, it starts with Taiyang, and the pulse will be floating, easily felt with light pressure. If it enters the Blood level of the Yin meridians, it starts with Shaoyin, and the pulse will be deep, only felt with heavy pressure. A floating pulse, whether forceful or not, reveals the deficiency or excess of the exterior. A deep pulse, whether forceful or not, reveals the cold or heat of the interior. A medium-pressure pulse, whether forceful or not, reveals the urgency of the exterior and interior conditions. Pulses vary in floating, deep, deficiency, and excess, while symptoms change unpredictably. The method of treatment is to first distinguish between exterior/interior, deficiency/excess, cold/heat, and root/branch. The initial disease is the root, subsequent diseases are the branch. Treat the urgent condition first; this is the primary principle. Ask about symptoms to know the exterior, examine the pulse to know the interior. It all lies in flexibility; do not be bound by the number of days since onset. If Taiyang symptoms are present, treat Taiyang directly. If Shaoyin symptoms are present, treat Shaoyin directly. If true cold is present, treat true cold directly. If even one or two symptoms are present, make a judgment; it is not necessary for all symptoms to be present. How should one proceed? This is flexibility. Clarify what is similar but different, and differentiate what appears correct but is incorrect. For conditions in the exterior, use sweating to disperse them. For conditions in the interior, use purging to drain them. For conditions above, induce vomiting to expel them. For sinking conditions, lift and raise them. For conditions harmonizing from the middle, resolve them through harmonization. For conditions directly striking the Yin meridians, use warming and tonification. When resolving the exterior, do not attack the interior. Even if many days have passed, if there are exterior symptoms and a floating pulse, dispersion is still appropriate. Failing to understand this, attacking the interior is contraindicated. The Classics state: One error may prolong the disease, two errors hasten death. If the exterior is resolved but interior symptoms remain, do not attack the exterior. Even if few days have passed, if there is interior heat and a deep, solid pulse, urgent purging is required. Failing to understand this, disaster occurs instantly. The Classics state: If pathogenic heat is not removed, adding dry-heat is like carrying firewood to save a fire. If directly striking the Yin meridians, it is a true cold syndrome: no fever, aversion to cold, no thirst, suitable for warming and tonification, strictly avoiding cold-natured medicines. Failing to understand this, death comes quickly. Yin syndromes resembling Yang syndromes should be treated with warming; Yang syndromes resembling Yin syndromes should be treated with purging. Yang toxicity should be purged according to severity; Yin toxicity should be warmed according to urgency. Yang mania should be purged; Yin collapse should be warmed. Yellowing due to damp-heat should be drained and purged; yellowing due to blood disorders should be cleared and purged. Macules should be cleared and purged. Delirium should be purged and cleared. Fullness and stagnation should be reduced and purged. Chest binding should be resolved and purged. Taiyang symptoms resembling Shaoyin should be warmed; Shaoyin symptoms resembling Taiyang should be sweated. Epistaxis should be resolved and stopped. Wheezing should be sweated or purged. Cough should be drained or resolved. True Shanghan requires major sweating and major purging. Cold injury requires minor sweating and minor purging. Injury from labor with cold invasion requires warming and dispersing. Warm-heat diseases require minor resolution and major purging. These are the general principles. There are cases where the same meridian disease is treated with either hot or cold medicines. For example, Shaoyin syndrome may be treated with cold medicines like Baihu Tang (White Tiger Decoction) or Sini San (Four Reversal Powder), or with hot medicines like Sini Tang (Four Reversal Decoction) or Zhenwu Tang (True Warrior Decoction). Quacks hesitate and doubt, unable to administer treatment. Alas! Only by accurately identifying Shanghan symptoms and mastering its formulas and pulses can one be a good physician. Thus, cold medicines treating Shaoyin indicate transmitted interior heat; hot medicines treating Shaoyin indicate direct strike true cold. Differentiate the pulse to determine the meridian, identify symptoms to prescribe medicine. Truly knowing it is an exterior condition, sweat it. Truly knowing it is interior heat, purge it. Truly knowing it is a direct strike to Yin meridians, warm it. By sweating thus, purging thus, and warming thus, if Mahuang Tang or Chengqi Tang fail, Jiangfu Lizhong Wan (Ginger, Aconite, and Licorice Pill) will surely succeed. How can the disease escape? However, one must distinguish severity, urgency, age, constitution, chronic vs. acute onset, pregnancy/postpartum status, and menstruation in young women. Generally, Shanghan during childbirth differs from treatment in men. Without pregnancy/postpartum issues, treatment is similar. For women and young girls, if menstruation has just started or ended, and chills and fever resemble malaria, it is Heat Entering the Blood Chamber. Harmonize the exterior and interior. Chronic disease persisting beyond the meridian stage is a corrupted syndrome; new onset is initial disease. Elderly people have declining Qi and Blood; young people have robust Qi and Blood. Slow progression indicates mild disease; rapid progression indicates severe disease. Cold medicines taken hot, hot medicines taken cool, neutral medicines taken warm. Chills and sweating are divided into four types; understand the prosperity and decline of pathogenic and righteous factors. Four types of Shanghan-like diseases are treated according to standard examples. Students should study these carefully.