伤寒杂病。世分两途。伤寒以攻邪为务。杂病以调养为先。则知工伤寒者。胸中执一汗下和
解之法。别无顾虑正气之念矣。杂病家宁不有攻邪之证耶。只缘胶执己见。不能圆通。以致伤寒
一切虚证坏证。不敢用补。杂病一切表证实证。不敢用攻。举俗所见皆然。病家亦宁死无怨。良
由圣教久湮。邪说横行之故。是不得不以伤寒入门见证定名真诀。一句喝破。令杂病家粗知分经
辨腑。不致妄为举措。宁无小补于世哉。姑以阴阳传中冬温温热时行大纲。辨述如下。
阴阳传中 如交霜降节后。有病发热头痛。自汗。脉浮缓者。风伤卫证也。以风为阳邪。故
只伤于卫分。卫伤。所以腠理疏。汗自出。身不疼。气不喘。脉亦不紧。如见恶寒发热头疼。骨
节痛。无汗而喘。脉浮紧者。寒伤营证也。以寒为阴邪。故直伤于营分。营伤。所以腠理固闭。
无汗而喘。身疼骨节痛。而脉不柔和。如见发热恶寒。头痛身疼。汗不得出而烦躁。脉浮紧者。
风寒并伤营卫也。以风为阳邪。无窍不入。风性善动。法常有汗。寒为阴邪。万类固闭。寒气敛
束。郁遏腠理。所以不得外泄。热势反蒸于里而发烦躁也。上皆太阳经初病见证。有桂枝、麻黄、
青龙鼎峙三法。若交阳明
之经。则恶寒皆除。但壮热自汗而脉浮数。以阳明内达于胃。多气多血。邪入其经。蒸动水谷之
气。故皆有汗但以能食为阳邪属风。不能食为阴邪属寒辨之。若交少阳之经。则往来寒热。口苦
胁痛。以其经居表里之半。邪欲入则寒。正与争则热。所以只宜和解。而有汗下利小便三禁。至
其传变。虽有次第。本无定矩。有循经而传者。有越经而传者。有传遍六经者。有传至二三经而
止者。有犯本者。有入府者。有邪在太阳不传阳明之经即入阳明之府者。有阳明经府相传者。有
从少阳经传入阳明府者。所以仲景有太阳阳明。正阳阳明。少阳阳明之异。或云。少阳无逆传阳
明之理。殊不知胃为十二经之总司。经经交贯。且少阳之经在外。而阳明之府在内。何逆之有。
至若传入阴经。亦有转入胃府而成下证者。太阴脏腑相连。移寒移热最易。少阴亦有下利清水色
纯青。心下痛。口干燥者。厥阴亦有下利谵语者。此皆阴经入腑之证。少阴更有移热膀胱之府一
身手足尽热小便血者。厥阴亦有转出少阳呕而发热者。二经接壤故也。又有转出太阳表证者。如
下利后。清便自调。身疼痛。此阴尽复阳也。夫所谓犯本者。太阳经邪入膀胱之本。如烦渴引饮。
水入即吐。小便不利者。风伤卫之犯本也。如热结膀胱。其人如狂。或下血者。此寒伤营之犯本
也。所以仲景有五苓、桃核承气之分。邪热入胃。则当详三阳明之原。而与三承气缓急分治。盖
阳明居中。万物所归。无所复传。至此悉宜攻下。但须俟结定。则热邪尽归于胃。然后下之。若
结未定而下早。则有结胸痞硬挟热利等证。以邪热归并中土未尽。乘机内入而为变矣。故伤寒家
有汗不厌早。下不厌迟。发表不开。不可攻里之戒。邪在少阳。入犯胆府。则胸满惊烦。小便不
利。一身尽重不可转侧。或入血室。则昼日明了。夜则谵语如见鬼状。皆宜按证求治。但此经之
要。全重在于胃气。所以小柴胡中必用人参。仲景云。胃和则愈。胃不和则烦而悸之语。乃一
经之要旨也。至传三阴。太阴则腹满时痛。少阴则腹痛自利下重。小便不利。甚则口燥心下痛。
厥阴则寒热交错。寒多热少则病进。热多寒少则病退。大抵少阴传经热邪。必从太阴而入。厥阴
必从少阴而入。非若阴证有一入太阳不作郁热便入少阴之理。当知伤寒传经之证。皆是热邪。经
中邪盛而溢入奇经。故其传皆从阳维而传布三阳。阴维而传布三阴。与十二经脏腑相贯之次第无
预也。其邪必从太阳经始。以冬时寒水司令。故无先犯他经之理。但有他经本虚。或为合病。或
为越经或陷此经不复他传。非若感冒非时寒疫之三阳混杂也。大抵寒疫多发于春时。春则少阳司
令。风木之邪。必先少阳。而太阳阳明在外。病则三经俱受。以是治感冒之方。若香苏、芎苏、
参苏、正气、十神之类。皆三经杂用不分耳。试观夏暑必伤心包。秋燥必伤肺络。总不离于司运
之主令也。其有误治而成坏证者。证类多端。未能悉举。即如结胸痞满。良由误下表邪内陷。故
脉必有一部见浮。盖寒伤营。营属血。而硬痛者为结胸。风伤卫。卫属气。而不痛者为痞满。然
痞满之基。多由其人痰湿内蕴。非若结胸之必因下早而阳邪内陷。此大小陷胸、五种泻心分司结
胸痞满诸治也。至于懊 诸证。无结可攻。无痞可散。惟栀子豉汤可以开发虚人内陷之表邪。一
涌而迅扫无余。即劳复食复。但于方中加枳实一味。其温热时行。亦可取法乎此也。至于阴证。
即无热邪气蒸。万无传经之理。即有阴邪。阴主静。断不能传。原其受病。必先少阴。或形寒饮
冷伤脾。则入太阴有之。其厥阴之证。无不由少阴而病。所以少阴温经之药。峻用姜、附、四逆。
厥阴风木之脏。内伏真火。虽有阴寒。不过萸、桂之属。若当归四逆加吴茱萸换肉桂足矣。不必
姜、附也。然仲景厥阴例中。非无四逆等治也。当知厥阴之寒。皆是由少阴虚寒而来。故用姜、
附合少阴而温之。所谓肾肝同治也。即太阴未尝不用四逆也。亦是命门火衰。不能生土致病。故必兼
温少阴。所谓治病必求其本也。夫治伤寒之法。全在得其纲领。邪在三阳。则当辨其经腑。病入
三阴。则当分其传中。盖经属表。宜从外解。腑属里。必须攻下而除。传属热。虽有阳极似阴。
厥逆自利等证。但须审先前曾发热头痛。至四五日或数日而见厥利者。皆阳邪亢极。厥深热深之
证。急当清理其内。误与温药必死。但清之有方。须知阳极似阴之证。其人根气必虚。即与救热
存阴。须防热去寒起。间有发汗太过而成亡阳之候。亦有攻下太过而阴阳俱脱者。不妨稍用温补。
然脱止阳回。即当易辙。不可过剂以耗其津。况此证与真阴受病不同。中属寒。虽有阴极似阳。
发热躁闷等证。但须审初病不发热无头痛。便呕吐清水。蜷卧足冷。自利腹痛。脉来小弱。至四
五日或六七日。反见大热躁乱。欲坐卧泥水中。渴欲饮水而不能下喉。脉虚大不能鼓激者。此阴
盛格阳之假热。阳欲脱亡之兆。峻用参、附无疑。有卒暴中寒。厥冷不省者。此真阳大虚。寒邪
斩关直入之候。丹溪所谓一身受邪。难分经络是也。非频进白通、通脉不能挽回。更有少阴中风。
虽不发热。亦无自汗厥冷呕吐下利等证。但觉胸中痞满不安。不时心悬若饥。自言腹满。他人按
之不满。手足自温。六脉小弱而微浮者。此为阴经阳邪。人罕能识。惟宜黄 建中稍加人参、熟
附温散其邪。若挟饮食。则气口涩滞。亦有模糊不清者。当与枳实理中。手足微冷。加附子。若
误与发散。必死。破气宽中。亦死。消克攻下。亦死。若峻用四逆。伤犯真阴。多有咳逆血溢之
虞。此证初时不以为意。每每委之庸师。所以犯之百无一生也。
冬温 冬时天气大暖。而见发热咳嗽者。此为冬温。以伏藏之令而反阳气大泄。少阴不藏。
非时不正之气。得以入伤少阴之经。阳气发外。所以发热。热邪伤气。所以咳嗽。其经上循喉咙。
所以喉肿。下循腹里。所以感之深者。则自
利也。冬温本秋燥之余气。故咽干痰结。甚则见血。与伤风之一咳其痰即应不同。咳则颅胀者。
火气上逆也。咳甚则脏腑引痛者。火气内郁也。其脉或虚缓。或虚大无力。亦有小弱者。热邪伤
气故也。若肾气本虚。则尺中微弦。暮则微寒发热。素常气虚。则气口虚大。身热手足微冷。或
有先伤冬温。更加暴寒。寒郁热邪。则壮热头痛。自汗喘咳。脉来浮。举则微弦。中候则软滑。
重按则少力。虽有风寒。切不可妄用风药升举其邪。轻则热愈甚而咳愈剧。重则变风温灼热而死。
亦不可用辛散。多致咽喉不利。唾脓血。痰中见血。甚则血溢血泄。发斑狐惑。往往不救。又不
可用耗气药。多至咳剧痛引周身。面热足冷而致危候。惟宜加减葱白香豉汤调之。兼有风寒外袭。
则加羌活、紫苏。寒邪盛极而发烦躁者。但于前药中稍加麻黄五七分、石膏钱许。或葳蕤汤本方
主之。缘此证见于冬时。举世医流。莫不以伤寒目之。而与发散致夭枉者不可枚举。曷知西北二方。
患真中风伤寒者最多。患冬温者绝少。间有伤于火炕者。亦有伤于火而复伤于寒者。可与越婢汤、
桂枝二越婢一汤。以其地浓质实。可胜攻伐。非若东南之禀气孱弱也。至如大岭以南。阳气常泄
之地。但有瘴疠之毒。绝无伤寒之患。即使客游他处。感冒风寒。仅可藿香正气之类。若麻黄、
青龙。绝不可犯。误用而发动身中素蕴之瘴湿。则壮热不止。每致殒命。不可不慎。
温病 有冬时触犯邪气。伏于经中。至春分前后。乘阳气发动而为温病。素问所谓冬伤于寒。
春必病温是也。其证不恶寒。但恶热而大渴。其脉多数盛而浑浑不清。越人所谓温病之脉。行在
诸经。不知何经之动。绝不似伤寒浮紧之状。且右尺与气口。必倍于人迎。信非人迎紧盛之比。
此证大忌发汗。若误与表散。必躁热无汗。闷乱不宁而死。以其邪伏经中。日久皆从火化而发。
其热自内达外。必用辛凉以化在表之热。苦寒以泄在里之热。内气一通。自能
作汗。有服承气。大汗淋漓而愈者。有大渴饮水。通身汗出而热顿除者。有浑身壮热。服黄芩汤、
葱白香豉汤得汗而解者。有发热自利。服葛根黄芩黄连汤而愈者。有舌干便秘。服凉膈散而安者。
故古谚有温热病误下不为大害。误汗为害。
有非时寒疫。间杂其间。不可不审谛明白而为治疗。盖暴感风寒之说。初时畏寒不渴。至二
三日。热邪伤耗津液方渴。与温病热病之一病便昏昏不爽大热烦渴不同。其脉多浮盛而见于左手。
与温病之右脉数盛亦异。若兼右脉滑盛。或涩滞模糊者。必停饮食之故。故治寒疫。当先发散为
主。即有宿滞。兼与橘、半、枳、朴。不得滥用里药。倘邪未入里而误与攻下。不无引贼破家之
虞。故其治与伏气迥乎不类也。
热病 伏气之发于夏至后者。热病也。其邪乘夏火郁发。从少阴蒸遍三阳。与伤寒之逐经传
变不同。亦有兼中 而发者。其治与中 无异。 虽热毒暴中。皆缘热耗肾水。汗伤胃汁。火迫
心包。故用白虎之知母以净少阴之源。石膏以化胃府之热。甘草、粳米护心包而保肺胃之气。与
热病之邪伏少阴。热伤胃汁。火迫心包不殊。故可异病同治而热邪皆得涣散也。若热毒亢极不解。
腹满气盛者。凉膈、双解、承气、解毒。兼苦燥而攻之。或三黄、石膏、栀子豉汤汗之。用法不
峻。投剂不猛。必不应手。非如伤寒。待阳明胃实而后可攻下也。
时行 时行疫疠。非常有之病。或数年一发。或数十年一发。多发于饥馑兵荒之后。发则一
方之内。沿门阖境。老幼皆然。此大疫也。亦有一隅偶见数家。或一家止一二人或三五人。病证
皆同者。此常疫也。即如痘疹麻斑之类。或越一二年。或三五年一见。非若大疫之盛行。所以人
不加察耳。即如软脚瘟证。医者皆以香港脚目之。捻颈瘟证。医者
皆以喉痹目之。绞肠瘟证。医者皆以臭毒目之。杨梅瘟证。医者皆以丹肿目之。黑骨瘟证。医者
皆以中毒目之。瓜瓤瘟证。医者皆以蓄血伤寒目之。惟疙瘩瘟之阖门暴发暴死。大头瘟之骤胀热
蒸。秽气遍充。不敢妄加名目也。其常疫之气。皆是湿土之邪郁发。治宜表里分解。随邪气所在
而攻之。孙真人云。疫气伤寒。三日以前不解。葱白香豉汤加童便热服汗之。不汗。少顷更服。
以汗出热除为度。三服不解而脉浮。尚属表证。则用白虎。见里证则宜承气、解毒。表里不分。
则宜凉膈、双解。汗下后复见表证。再与白虎。复见里证。更与承气。表里势热。则宜三黄石膏、
三黄栀子豉汤汗之。有汗下三四次而热除者。有热除后忽复壮热。不妨再汗再下。若见脉证皆虚。
法无更攻之理。惟与清热解毒汤、人中黄丸、人中黄散之属调之。非如伤寒有下早变证之虑。亦
非温热不可频下之比。大率以热除邪尽为度。不当牵制其虚也。惟下元虚人。非生料六味补其真
阴。则不能化其余热。又不可拘于上说也。至于大疫。则一时详一时之证。一方用一方之法。难
可预为拟议也。以上所述。不过为杂病家开一辨证法门。其间肯綮。不遑繁述。
湖广礼部主事范求先讳克诚。寓金阊之石窝庵。患寒伤营证。恶寒三日不止。先曾用过发散
药二剂。第七日躁扰不宁。六脉不至。手足厥逆。其同寓目科方耀珍。邀石顽诊之。独左寸厥厥
动摇。知是欲作战汗之候。令勿服药。但与热姜汤助其作汗。若误服药。必热不止。后数日枉驾
谢别。询之。果如所言。不药而愈。
一童姓者。伏气发于盛暑。其子跪请求治。诊时大发躁扰。脉皆洪盛而躁。其妇云大渴索水
伤寒与杂病，世间分为两途。治疗伤寒以祛除邪气为要务；治疗杂病则以调养身体为先。由此可知，专攻伤寒的医生，胸中只执着于汗、下、和、解这几种治法，没有顾护正气的念头了。而专治杂病的医生难道就没有需要攻邪的证候吗？只是因为他们固执己见，不能灵活变通，导致对于伤寒的一切虚证、坏证，不敢使用补法；对于杂病的一切表证、实证，不敢使用攻法。世俗所见都是如此，病人也宁愿死去也不怨恨。这主要是因为圣人的教诲久已湮没，邪说横行造成的。因此不得不通过《伤寒论》入门时辨别症状、确定名称的真诀，一语道破，让杂病医生粗略懂得分经辨腑的知识，不至于妄自举措，这对世道难道没有小小的补益吗？姑且以阴阳传变、直中、冬温、温热、时行的大纲，辨析陈述如下。
【阴阳传变与直中】
如交霜降节之后，有病发热头痛，自汗，脉浮缓的，是风伤卫分的证候。因为风是阳邪，所以只伤害卫分。卫分受伤，所以腠理疏松，汗自出，身体不疼，气不喘，脉也不紧。如果见到恶寒发热头疼，骨节痛，无汗而喘，脉浮紧的，是寒伤营分的证候。因为寒是阴邪，所以直接伤害营分。营分受伤，所以腠理固闭，无汗而喘，身体疼骨节痛，而脉不柔和。如果见到发热恶寒，头痛身疼，汗不得出而烦躁，脉浮紧的，是风寒同时伤害营卫。因为风是阳邪，无孔不入，风性善动，法度上常有汗；寒是阴邪，万物固闭，寒气敛束，郁遏腠理，所以热气不得外泄，热势反而蒸腾于里而发烦躁。以上都是太阳经初病的见证，有桂枝汤、麻黄汤、大青龙汤鼎足而立的三种治法。
如果传入阳明经，则恶寒都除去，只有壮热自汗而脉浮数。因为阳明内达于胃，多气多血，邪气进入其经，蒸动水谷之气，所以都有汗。但能以进食情况来辨别：能食的是阳邪属风，不能食的是阴邪属寒。如果传入少阳经，则往来寒热，口苦胁痛。因为其经居于表里之间，邪气欲入则寒，正气与之争则热，所以只宜和解，而有汗、下、利小便三禁。至于其传变，虽有次第，本无定规。有循经而传的，有越经而传的，有传遍六经的，有传至二三经而停止的，有犯本的，有入府的。有邪在太阳不传阳明之经就进入阳明之府的，有阳明经府相传的，有从少阳经传入阳明府的。所以仲景有太阳阳明、正阳阳明、少阳阳明之分。有人说，少阳没有逆传阳明的道理。殊不知胃是十二经的总司，经经交贯，且少阳之经在外，而阳明之府在内，有什么逆的呢？
至于传入阴经，也有转入胃府而成下证的。太阴脏腑相连，移寒移热最容易。少阴也有下利清水色纯青，心下痛，口干燥的。厥阴也有下利谵语的。这都是阴经入腑的证候。少阴更有移热膀胱之府，一身手足尽热，小便血的。厥阴也有转出少阳呕而发热的，这是因为二经接壤的缘故。又有转出太阳表证的，如下利后，清便自调，身疼痛，这是阴尽复阳。
所谓“犯本”，是指太阳经邪气进入膀胱之本，如烦渴引饮，水入即吐，小便不利的，是风伤卫的犯本。如热结膀胱，其人如狂，或下血的，是寒伤营的犯本。所以仲景有五苓散、桃核承气汤之分。邪热入胃，则应当详究三阳明的本源，而与三承气汤根据缓急分别治疗。盖阳明居中，是万物所归，无所复传，至此都适宜攻下。但必须等到结聚确定，则热邪尽归于胃，然后下之。如果结未定而下早，则有结胸、痞硬、挟热利等证，是因为邪热归并中土未尽，乘机内入而为变证了。所以伤寒家有“汗不厌早，下不厌迟，发表不开，不可攻里”的戒律。
邪在少阳，入犯胆府，则胸满惊烦，小便不利，一身尽重不可转侧。或入血室，则昼日明了，夜则谵语如见鬼状，都应当按证求治。但这经的要旨，全重在胃气。所以小柴胡汤中必用人参。仲景说：“胃和则愈，胃不和则烦而悸。”这是一经的要旨。
至于传入三阴，太阴则腹满时痛；少阴则腹痛自利下重，小便不利，甚则口燥心下痛；厥阴则寒热交错，寒多热少则病进，热多寒少则病退。大抵少阴传经热邪，必从太阴而入；厥阴必从少阴而入。不像阴证有一入太阳不作郁热便入少阴的道理。应当知道伤寒传经的证候，都是热邪，经中邪盛而溢入奇经，所以其传变皆从阳维而传布三阳，从阴维而传布三阴，与十二经脏腑相贯的次第无关预。其邪必从太阳经开始，因为冬时寒水司令，所以没有先犯他经的道理。但有他经本虚，或为合病，或为越经，或陷此经不复他传，不像感冒非时寒疫那样三阳混杂。大抵寒疫多发于春时，春则少阳司令，风木之邪，必先少阳，而太阳阳明在外，病则三经俱受。以是治疗感冒的方子，如香苏、芎苏、参苏、正气、十神之类，都是三经杂用不分耳。试看夏暑必伤心包，秋燥必伤肺络，总不离于司运之主令。
如果有误治而成坏证的，证候类多端，未能全部列举。就像结胸痞满，良由误下表邪内陷，所以脉必有一部见浮。盖寒伤营，营属血，而硬痛者为结胸；风伤卫，卫属气，而不痛者为痞满。然而痞满的基础，多由其人痰湿内蕴，不像结胸之必因下早而阳邪内陷。这是大小陷胸汤、五种泻心汤分司结胸痞满诸治的原因。至于懊憹诸证，无结可攻，无痞可散，惟栀子豉汤可以开发虚人内陷之表邪，一涌而迅扫无余。即劳复食复，但于方中加枳实一味。其温热时行，亦可取法于此。
至于阴证，即无热邪气蒸，万无传经的道理。即有阴邪，阴主静，断不能传。原其受病，必先少阴。或形寒饮冷伤脾，则入太阴有之。其厥阴之证，无不由少阴而病。所以少阴温经之药，峻用姜、附、四逆汤。厥阴风木之脏，内伏真火，虽有阴寒，不过萸、桂之属。若当归四逆汤加吴茱萸换肉桂足矣，不必姜、附。然仲景厥阴例中，并非没有四逆等治法。当知厥阴之寒，皆是由少阴虚寒而来，故用姜、附合少阴而温之。所谓肾肝同治。即太阴未尝不用四逆汤，也是命门火衰，不能生土致病，故必兼温少阴。所谓治病必求其本。
夫治伤寒之法，全在得其纲领。邪在三阳，则当辨其经腑；病入三阴，则当分其传中。盖经属表，宜从外解；腑属里，必须攻下而除。传属热，虽有阳极似阴，厥逆自利等证，但须审先前曾发热头痛，至四五日或数日而见厥利者，皆阳邪亢极，厥深热深之证，急当清理其内。误与温药必死。但清之有方，须知阳极似阴之证，其人根气必虚，即与救热存阴，须防热去寒起。间有发汗太过而成亡阳之候，亦有攻下太过而阴阳俱脱者，不妨稍用温补。然脱止阳回，即当易辙，不可过剂以耗其津。况此证与真阴受病不同。中属寒，虽有阴极似阳，发热躁闷等证，但须审初病不发热无头痛，便呕吐清水，蜷卧足冷，自利腹痛，脉来小弱，至四五日或六七日，反见大热躁乱，欲坐卧泥水中，渴欲饮水而不能下喉，脉虚大不能鼓激者，此阴盛格阳之假热，阳欲脱亡之兆。峻用参、附无疑。
有卒暴中寒，厥冷不省人事者，此真阳大虚，寒邪斩关直入之候。丹溪所谓一身受邪，难分经络是也。非频进白通汤、通脉四逆汤不能挽回。更有少阴中风，虽不发热，亦无自汗厥冷呕吐下利等证，但觉胸中痞满不安，不时心悬若饥，自言腹满，他人按之不满，手足自温，六脉小弱而微浮者，此为阴经阳邪，人罕能识。惟宜黄芪建中汤稍加人参、熟附温散其邪。若挟饮食，则气口涩滞，亦有模糊不清者，当与枳实理中汤。手足微冷，加附子。若误与发散，必死。破气宽中，亦死。消克攻下，亦死。若峻用四逆汤，伤犯真阴，多有咳逆血溢之虞。此证初时不以为意，每每委之庸师，所以犯之百无一生也。
【冬温】
冬时天气大暖，而见发热咳嗽的，此为冬温。以伏藏之令而反阳气大泄，少阴不藏，非时不正之气，得以入伤少阴之经。阳气发外，所以发热。热邪伤气，所以咳嗽。其经上循喉咙，所以喉肿。下循腹里，所以感之深者，则自利也。冬温本秋燥之余气，故咽干痰结，甚则见血，与伤风之一咳其痰即应不同。咳则颅胀者，火气上逆也。咳甚则脏腑引痛者，火气内郁也。其脉或虚缓，或虚大无力，亦有小弱者，热邪伤气故也。若肾气本虚，则尺中微弦，暮则微寒发热。素常气虚，则气口虚大，身热手足微冷。或有先伤冬温，更加暴寒，寒郁热邪，则壮热头痛，自汗喘咳，脉来浮，举则微弦，中候则软滑，重按则少力。虽有风寒，切不可妄用风药升举其邪。轻则热愈甚而咳愈剧，重则变风温灼热而死。亦不可用辛散，多致咽喉不利，唾脓血，痰中见血，甚则血溢血泄，发斑狐惑，往往不救。又不可用耗气药，多至咳剧痛引周身，面热足冷而致危候。惟宜加减葱白香豉汤调之。兼有风寒外袭，则加羌活、紫苏。寒邪盛极而发烦躁者，但于前药中稍加麻黄五七分、石膏钱许。或葳蕤汤本方主之。缘此证见于冬时，举世医流，莫不以伤寒目之，而与发散致夭枉者不可枚举。曷知西北二方，患真中风伤寒者最多，患冬温者绝少。间有伤于火炕者，亦有伤于火而复伤于寒者，可与越婢汤、桂枝二越婢一汤。以其地浓质实，可胜攻伐，非若东南之禀气孱弱也。至如大岭以南，阳气常泄之地，但有瘴疠之毒，绝无伤寒之患。即使客游他处，感冒风寒，仅可藿香正气之类。若麻黄、青龙，绝不可犯。误用而发动身中素蕴之瘴湿，则壮热不止，每致殒命，不可不慎。
【温病】
有冬时触犯邪气，伏于经中，至春分前后，乘阳气发动而为温病。素问所谓冬伤于寒，春必病温是也。其证不恶寒，但恶热而大渴。其脉多数盛而浑浑不清。越人所谓温病之脉，行在诸经，不知何经之动，绝不似伤寒浮紧之状。且右尺与气口，必倍于人迎，信非人迎紧盛之比。此证大忌发汗，若误与表散，必躁热无汗，闷乱不宁而死。以其邪伏经中，日久皆从火化而发，其热自内达外，必用辛凉以化在表之热，苦寒以泄在里之热。内气一通，自能作汗。有服承气汤，大汗淋漓而愈者；有大渴饮水，通身汗出而热顿除者；有浑身壮热，服黄芩汤、葱白香豉汤得汗而解者；有发热自利，服葛根黄芩黄连汤而愈者；有舌干便秘，服凉膈散而安者。故古谚有温热病误下不为大害，误汗为害。
有非时寒疫，间杂其间，不可不审谛明白而为治疗。盖暴感风寒之说，初时畏寒不渴，至二三日，热邪伤耗津液方渴，与温病热病之一病便昏昏不爽大热烦渴不同。其脉多浮盛而见于左手，与温病之右脉数盛亦异。若兼右脉滑盛，或涩滞模糊者，必停饮食之故。故治寒疫，当先发散为主，即有宿滞，兼与橘、半、枳、朴，不得滥用里药。倘邪未入里而误与攻下，不无引贼破家之虞。故其治与伏气迥乎不类也。
【热病】
伏气之发于夏至后的，热病也。其邪乘夏火郁发，从少阴蒸遍三阳，与伤寒之逐经传变不同。亦有兼中暑而发者，其治与中暑无异。中暑虽热毒暴中，皆缘热耗肾水，汗伤胃汁，火迫心包，故用白虎汤之知母以净少阴之源，石膏以化胃府之热，甘草、粳米护心包而保肺胃之气，与热病之邪伏少阴，热伤胃汁，火迫心包不殊。故可异病同治而热邪皆得涣散也。若热毒亢极不解，腹满气盛者，凉膈散、双解散、承气汤、解毒汤，兼苦燥而攻之。或三黄、石膏、栀子豉汤汗之。用法不峻，投剂不猛，必不应手。非如伤寒，待阳明胃实而后可攻下也。
【时行】
时行疫疠，非常有之病。或数年一发，或数十年一发，多发于饥馑兵荒之后。发则一方之内，沿门阖境，老幼皆然，此大疫也。亦有一隅偶见数家，或一家止一二人或三五人，病证皆同者，此常疫也。即如痘疹麻斑之类，或越一二年，或三五年一见，非若大疫之盛行，所以人不加察耳。即如软脚瘟证，医者皆以香港脚目之；捻颈瘟证，医者皆以喉痹目之；绞肠瘟证，医者皆以臭毒目之；杨梅瘟证，医者皆以丹肿目之；黑骨瘟证，医者皆以中毒目之；瓜瓤瘟证，医者皆以蓄血伤寒目之。惟疙瘩瘟之阖门暴发暴死，大头瘟之骤胀热蒸，秽气遍充，不敢妄加名目也。其常疫之气，皆是湿土之邪郁发，治宜表里分解，随邪气所在而攻之。孙真人云：疫气伤寒，三日以前不解，葱白香豉汤加童便热服汗之。不汗，少顷更服，以汗出热除为度。三服不解而脉浮，尚属表证，则用白虎汤。见里证则宜承气汤、解毒汤。表里不分，则宜凉膈散、双解散。汗下后复见表证，再与白虎汤。复见里证，更与承气汤。表里势热，则宜三黄石膏汤、三黄栀子豉汤汗之。有汗下三四次而热除者，有热除后忽复壮热，不妨再汗再下。若见脉证皆虚，法无更攻之理，惟与清热解毒汤、人中黄丸、人中黄散之属调之。非如伤寒有下早变证之虑，亦非温热不可频下之比。大率以热除邪尽为度，不当牵制其虚也。惟下元虚人，非生料六味地黄丸补其真阴，则不能化其余热，又不可拘于上说也。至于大疫，则一时详一时之证，一方用一方之法，难可预为拟议也。以上所述，不过为杂病家开一辨证法门，其间肯綮，不遑繁述。
湖广礼部主事范求先讳克诚，寓金阊之石窝庵，患寒伤营证，恶寒三日不止。先曾用过发散药二剂，第七日躁扰不宁，六脉不至，手足厥逆。其同寓目科方耀珍，邀石顽诊之。独左寸厥厥动摇，知是欲作战汗之候，令勿服药，但与热姜汤助其作汗。若误服药，必热不止。后数日枉驾谢别，询之，果如所言，不药而愈。
Cold damage (Shanghan) and miscellaneous diseases (Zabing) are divided into two categories in the world. The treatment of cold damage focuses on expelling pathogenic factors, whereas the treatment of miscellaneous diseases prioritizes nourishing and regulating the body. From this, we know that physicians specializing in cold damage hold fast to the methods of sweating (Han), purging (Xia), harmonizing (He), and resolving (Jie), without any thought of protecting the healthy qi (Zhengqi). Do physicians of miscellaneous diseases not have syndromes requiring the expulsion of pathogens? It is merely because they adhere rigidly to their own views and cannot be flexible, leading them to dare not use tonification for all deficiency and complicated syndromes of cold damage, and dare not use purgation for all exterior and excess syndromes of miscellaneous diseases. This is the common view, and patients would rather die than resent it. This is undoubtedly due to the long obscurity of the sage's teachings and the rampant spread of heretical theories. Therefore, it is necessary to break through this with the true principles of identifying symptoms and naming conditions at the entry level of *Shanghan Lun* (Treatise on Cold Damage), so that physicians of miscellaneous diseases may roughly understand the differentiation of meridians and fu organs, avoiding reckless actions. Would this not offer some benefit to the world? I shall tentatively discuss the general outlines of yin-yang transmission, direct invasion, winter-warmth (Dongwen), warm-heat (Wenre), and epidemic season (Shixing) as follows.
[Yin-Yang Transmission and Direct Invasion]
For example, after the Frost Descent solar term, if a patient has fever, headache, spontaneous sweating, and a floating-slow pulse, this is a syndrome of wind damaging the defensive layer (Wei Fen). Since wind is a yang pathogen, it only damages the defensive layer. When the defensive layer is damaged, the interstices become loose, causing spontaneous sweating; the body does not ache, breathing is not panting, and the pulse is not tight. If one observes aversion to cold and fever, headache, bone and joint pain, absence of sweating with panting, and a floating-tight pulse, this is a syndrome of cold damaging the nutritive layer (Ying Fen). Since cold is a yin pathogen, it directly damages the nutritive layer. When the nutritive layer is damaged, the interstices close tightly, causing absence of sweating with panting, body ache, bone and joint pain, and a pulse that is not soft. If one observes fever and aversion to cold, headache and body ache, inability to sweat accompanied by irritability, and a floating-tight pulse, this is a syndrome where wind and cold simultaneously damage both the nutritive and defensive layers. Wind is a yang pathogen that penetrates everywhere; its nature is active, and typically induces sweating. Cold is a yin pathogen that causes closure; its qi constricts and suppresses the interstices, preventing heat from escaping outward, so the heat steams inward causing irritability. The above are initial manifestations of the Taiyang Meridian (Taiyang Jing). There are three distinct methods represented by Guizhi Tang (Cinnamon Twig Decoction), Mahuang Tang (Ephedra Decoction), and Da Qinglong Tang (Major Green Dragon Decoction).
If the pathogen enters the Yangming Meridian (Yangming Jing), aversion to cold disappears entirely, leaving only high fever, spontaneous sweating, and a floating-rapid pulse. Because Yangming connects internally to the Stomach (Wei), which is rich in qi and blood, when the pathogen enters its meridian, it steams the qi of food and fluids, resulting in sweating. However, one can distinguish based on appetite: ability to eat indicates a yang pathogen belonging to wind; inability to eat indicates a yin pathogen belonging to cold. If the pathogen enters the Shaoyang Meridian (Shaoyang Jing), there is alternating chills and fever, bitter taste in the mouth, and hypochondriac pain. Because this meridian resides halfway between exterior and interior, when the pathogen desires to enter, chills occur; when the healthy qi contends with it, fever occurs. Thus, only harmonization is suitable, and sweating, purging, and promoting urination are prohibited. Regarding its transmission, although there is a sequence, there is no fixed rule. Some transmit along the meridians, some skip meridians, some transmit through all six meridians, some stop after two or three meridians, some involve "offending the root" (Fan Ben), and some enter the fu organs. Some pathogen staying in Taiyang does not transmit to the Yangming meridian but enters the Yangming fu organ. Some transmit between Yangming meridian and fu organs. Some transmit from Shaoyang meridian to Yangming fu organ. Hence, Zhang Zhongjing distinguishes between Taiyang-Yangming, Zhengyang-Yangming, and Shaoyang-Yangming. Some say Shaoyang does not reverse-transmit to Yangming. Little do they know that the Stomach is the commander of the twelve meridians, interconnected. Moreover, the Shaoyang meridian is external, while the Yangming fu organ is internal; what is there to call "reverse"?
Regarding transmission to yin meridians, some also transfer to the Stomach fu organ forming purgative syndromes. The Spleen (Pi) and Intestines are closely connected, making the transfer of cold and heat easiest. Shaoyin may present with diarrhea of clear water pure green, pain under the heart, and dry mouth. Jueyin may present with diarrhea and delirious speech. These are all syndromes of yin meridians entering fu organs. Shaoyin may also transfer heat to the Bladder (Pangguang) fu organ, causing heat throughout the body and limbs, and blood in urine. Jueyin may also turn out to Shaoyang with vomiting and fever, due to the adjacency of these two meridians. There are also cases turning out to Taiyang exterior syndromes, such as after diarrhea, with normal stool and body ache; this is the return of yang from the end of yin.
What is called "offending the root" refers to the Taiyang meridian pathogen entering the root of the Bladder. For instance, vexation, thirst desiring drink, vomiting immediately after drinking, and difficult urination constitute offending the root by wind damaging the defensive layer. Heat binding in the Bladder, with the patient acting like a madman or passing blood, constitutes offending the root by cold damaging the nutritive layer. Hence, Zhang Zhongjing differentiates Wuling San (Five-Ling Powder) and Taohé Chengqi Tang (Peach Kernel Decocted Qi-Replenishing Decoction). When evil heat enters the Stomach, one must investigate the origins of the three Yangming stages and treat with Sanshengqi Tang (Three Purge Decoctions) according to urgency. Yangming resides in the center, is the destination of all things, and transmits nowhere further; thus, purgation is appropriate here. However, one must wait until the accumulation is firm, so that all evil heat returns to the Stomach, before purging. If purged too early before accumulation is firm, syndromes such as chest binding (Jiexiong), fullness-hardness (Piying), and purging with heat follow, because the evil heat has not fully converged in the middle earth and takes the opportunity to enter internally causing complications. Hence, cold damage physicians warn: "Sweating should not be delayed too early; purging should not be done too late; if the exterior is not resolved, do not attack the interior."
When the pathogen is in Shaoyang and invades the Gallbladder (Dan) fu organ, there is chest fullness, fright, and vexation, difficult urination, heaviness of the whole body making turning difficult. Or if it enters the Blood Chamber (Xuèshì), the patient is lucid during the day but delirious at night as if seeing ghosts. All should be treated according to the syndrome. The key to this meridian lies entirely in the Stomach qi. Therefore, Renshen (Ginseng Radix) is essential in Xiaochaihu Tang (Minor Bupleurum Decoction). Zhang Zhongjing said, "If the stomach is harmonized, the disease cures; if not harmonized, there is vexation and palpitations." This is the main principle of this meridian.
Regarding transmission to the Three Yin, Taidou presents with abdominal fullness and intermittent pain; Shaoyin presents with abdominal pain, spontaneous diarrhea with tenesmus, difficult urination, and severely, dry mouth and pain under the heart; Jueyin presents with alternating cold and heat. More cold than heat indicates progression; more heat than cold indicates regression. Generally, heat pathogens transmitting through Shaoyin must enter via Taidou; Jueyin must enter via Shaoyin. This differs from yin syndromes where entering Taiyang does not transform into stagnant heat before entering Shaoyin. One must know that cold damage transmission syndromes are all heat pathogens. When the meridian pathogen is excessive and overflows into the extraordinary meridians, transmission occurs via the Yang Linking Vessel (Yangwei) to distribute among the Three Yang, and via the Yin Linking Vessel (Yinwei) to distribute among the Three Yin, unrelated to the sequence of the twelve meridians and zang-fu organs. The pathogen must start from the Taiyang meridian because in winter, Cold-Water governs, so there is no reason to attack other meridians first. However, if other meridians have original deficiency, or it is a combined disease, or skips meridians, or sinks into this meridian without further transmission, it differs from non-seasonal cold epidemics where the Three Yang are mixed. Generally, cold epidemics occur mostly in spring. In spring, Shaoyang governs, and wind-wood pathogen attacks Shaoyang first, while Taiyang and Yangming are external, so all three meridians are affected. Thus, formulas for treating colds, such as Xiangsu, Xiongsu, Shensu, Zhengqi, and Shishen, mix the three meridians indiscriminately. Observe that summer heat必然 damages the Pericardium (Xinbao), and autumn dryness必然 damages the Lung collaterals; this always relates to the governing ruler of the season.
If misdiagnosis leads to complicated syndromes, the manifestations are numerous and cannot be fully listed. For example, chest binding and fullness arise from mistakenly using exterior-resolving herbs allowing exterior pathogen to sink inward. Thus, the pulse must show floating in one area. Cold damaging Ying belongs to blood, and hard/painful cases are chest binding; wind damaging Wei belongs to qi, and non-painful cases are fullness. However, the basis of fullness often lies in internal phlegm-dampness accumulation, unlike chest binding which necessarily results from early purging allowing yang pathogen to sink inward. This explains why Xiaoxianxiong Tang (Minor Chest-Binding Decoction), Daxianxiong Tang (Major Chest-Binding Decoction), and five types of Xiexin Tang (Drain Epigastrium Decoctions) manage these treatments. As for Ao'ao (restlessness) syndromes, there is no binding to purge and no fullness to scatter; only Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) can open up the interior pathogen sinking in deficient persons, sweeping it away rapidly. Even for relapse due to labor or diet, adding Zhishi (Immature Bitter Orange Fruit) alone suffices. Warm-heat epidemics can also adopt this method.
Regarding yin syndromes, since there is no steaming heat pathogen, there is absolutely no mechanism for transmission. Even if there is a yin pathogen, yin is static and cannot transmit. Originally, the disease must begin in Shaoyin. Or if cold exposure and cold drinks damage the Spleen, it enters Taidou. Jueyin syndromes invariably arise from Shaoyin. Therefore, warming meridian herbs for Shaoyin heavily use Jiang (Ginger Rhizome), Fu (Aconite Lateral Root), and Sini Tang (Recovery Decoction). Jueyin, the wind-wood zang organ, harbors true fire internally; even with yin-cold, herbs like Yuzhu (Cornus Fruit) and Rougui (Cinnamon Bark) suffice. Danggui Sini Tang (Angelica Decoction for Cold Extremities) with Wuzhuyu (Evodia Fruit) replacing Rougui is sufficient; Jiang and Fu are unnecessary. However, in Zhang Zhongjing's Jueyin examples, Sini Tang treatments exist. One must know that Jueyin cold originates from Shaoyin deficiency-cold, hence Jiang and Fu are used to warm Shaoyin together. This is treating Kidney (Shen) and Liver (Gan) together. Even Taidou sometimes uses Sini Tang, due to Mingmen Fire decline failing to generate Earth, necessitating concurrent warming of Shaoyin. This is seeking the root in treatment.
The method of treating cold damage relies entirely on grasping the outline. Pathogens in the Three Yang require distinguishing meridian vs. fu organ; diseases entering the Three Yin require distinguishing transmission vs. direct invasion. Meridians belong to the exterior, suitable for external resolution; fu organs belong to the interior, requiring purgation. Transmission involves heat. Although there are syndromes of extreme yang resembling yin, such as cold extremities and spontaneous diarrhea, one must examine if there was prior fever and headache. If cold extremities and diarrhea appear after four to five days or several days, this is extreme yang pathogen, deep cold corresponding to deep heat. One must urgently clear the interior. Mistakenly giving warming herbs will cause death. But clearing requires method. One must know that in extreme yang resembling yin syndromes, the patient's root qi is necessarily deficient. Even when saving heat and preserving yin, one must guard against heat departing and cold arising. Occasionally, excessive sweating leads to yang collapse, or excessive purging leads to simultaneous yin and yang collapse; in such cases, slight warming tonification is permissible. However, once yang returns, change tactics; do not overdose to consume fluids. Furthermore, this differs from true yin disease. Interior cold may present with extreme yin resembling yang, fever, restlessness, etc. One must examine if initially there was no fever/headache, but vomiting clear water, curling up, cold feet, spontaneous diarrhea/abdominal pain, and small-weak pulse. If after four to seven days, sudden high fever, restlessness, desire to sit/lie in mud/water, thirst unable to swallow, and large-empty pulse unable to surge occur, this is false heat from yin excess repelling yang, a sign of yang collapse. Heavy use of Renshen (Ginseng) and Fuzi (Prepared Aconite Root) is unquestionable.
In acute cold strike with cold extremities and unconsciousness, this is severe deficiency of true yang with cold pathogen breaking through gates. Danxi said, "When the whole body receives pathogen, meridians are hard to distinguish." Only frequent administration of Bitong Tang (White Connective Decoction) and Tongmai Sini Tang (Pulse-Connecting Recovery Decoction) can restore life. There is also Shaoyin wind-strike, without fever, spontaneous sweating, cold extremities, vomiting, or diarrhea, but with chest fullness/discomfort, occasional hunger-like sensation in the heart, self-reported abdominal fullness but none on palpation, warm hands/feet, and small-weak-micro-floating pulses. This is yang pathogen in yin meridians, rarely recognized. Only Huangqi Jianzhong Tang (Astragalus Replenish Middle Decoction) with added Renshen and Shufu (Prepared Aconite) to warm and disperse is suitable. If complicated by food stagnation, the Qi Kou pulse is choppy or vague; give Zhishi Lizhong Tang (Immature Bitter Orange Regulate Middle Decoction). If hands/feet are slightly cold, add Fuzi. Mistakenly using dispersants causes death. Breaking qi and widening middle causes death. Digesting and purging causes death. Heavily using Sini Tang damages true yin, risking coughing and bleeding. Initially disregarded and entrusted to mediocre physicians, almost all who fall victim die.
[Winter-Warmth]
In winter, if weather is unusually warm and fever/cough appear, this is Winter-Warmth (Dongwen). Due to the storage command being violated, yang qi leaks excessively, Shaoyin fails to store, and abnormal seasonal qi injures the Shaoyin meridian. Yang qi emerging externally causes fever. Heat pathogen damaging qi causes cough. The meridian ascends to the throat, causing sore throat; descends to the abdomen, causing diarrhea in deep infection. Winter-warmth is residual qi of autumn dryness, hence dry throat, phlegm knotting, even hemoptysis, differing from wind-cold cough where sputum appears immediately. Cough causing head distension indicates fire qi ascending; severe cough causing organ pain indicates internal fire stagnation. Pulses may be empty-slow, empty-large-weak, or small-weak, due to heat damaging qi. If Kidney qi is originally deficient, the Chi pulse is micro-stringy, with evening chills/fever. If generally qi deficient, the Qi Kou pulse is empty-large, with body heat and slightly cold hands/feet. If previously injured by winter-warmth plus sudden cold, cold traps heat, causing high fever, headache, spontaneous sweating, panting/cough, floating pulse, micro-stringy superficially, soft-slippery mid-level, weak deep. Even with wind-cold, never rashly use wind-dispersing herbs to lift the pathogen. Mildly, heat worsens and cough intensifies; severely, it transforms into wind-warmth burning heat causing death. Never use acrid-dispersants, often causing throat obstruction, spitting pus/blood, blood in sputum, even hemorrhage, macules, or Huo-Huo syndrome, often untreatable. Never use qi-consuming herbs, often causing severe cough, body pain, hot face/cold feet, leading to critical condition. Only Jiajian Congbai Xiangchi Tang (Modified Scallion and Fermented Soybean Decoction) is suitable. If complicated by external wind-cold, add Qianghuo (Notopterygium Rhizome) and Zisu (Perilla Leaf). If cold is extreme causing irritability, add slight Mahuang (Ephedra) 5-7 fen and Shigao (Gypsum) 1 qian, or primarily Weirui Tang (Anemarrhena Decoction). Since this syndrome appears in winter, all physicians mistake it for cold damage, and many die from mistaken dispersants. Did you know that in Northwest regions, true wind-stroke and cold damage are most common, while winter-warmth is rare. Sometimes injury from heated kang beds occurs, or injury from heat followed by cold, treatable with Yebibo Tang (Sheep Beard Decoction) or Guizhi Er Yuebiyi Tang (Cinnamon Twig Two-Parts Sheep Beard One-Part Decoction). Because people there are robust and can withstand attacking herbs, unlike the frail constitution of Southeast. South of the Great Ridge, where yang qi constantly leaks, there is only miasma poison, no cold damage risk. Even traveling elsewhere and catching cold/wind, only Huoxiang Zhengqi Tang (Patchouli Correct Qi Decoction) is suitable. Mahuang and Qinglong (Da Qinglong Tang) must never be used. Mistaken use activates latent damp-miasma, causing persistent high fever and often death. Caution is essential.
[Warm Disease]
If touched by pathogen in winter, lying dormant in meridians, and activating with yang qi around Spring Equinox, it becomes Warm Disease (Wenbing). As Suwen says, "Winter injury by cold leads to spring warmth disease." Symptoms include no aversion to cold, only aversion to heat and great thirst. Pulses are numerous/excessive and turbid. Yuèrén said warm disease pulses move in various meridians, unknown which is active, definitely not like cold damage's floating-tight. Right Chi and Qi Kou pulses must double Renying pulse, certainly not comparable to Renying tightness. This syndrome strictly forbids sweating. Mistaken exterior dispersion causes restless heat, anhidrosis, agitation, and death. Because pathogen lies dormant in meridians, transforming into fire over time, heat emerges from interior to exterior. Must use acrid-cool to resolve exterior heat, bitter-cold to drain interior heat. Once interior qi flows, sweating occurs naturally. Some cure with massive sweating after Chengqi Tang; some with massive sweating after drinking water; some with Huangqin Tang (Scutellaria Decoction) or Congbai Xiangchi Tang; some with Gegen Huangqin Huanglian Tang (Kudzu Scutellaria Coptis Decoction) for fever/diarrhea; some with Liangge San (Cool Diaphragm Powder) for dry tongue/constipation. Hence the proverb: mistaking purging for warm-heat disease is not major harm; mistaking sweating is harmful.
Non-seasonal cold epidemics interspersed must be carefully diagnosed. Acute wind-cold initially causes aversion to cold without thirst; by day 2-3, heat damages fluids causing thirst, differing from warm-heat disease's immediate confusion/high fever/thirst. Pulses are mostly floating-excessive on left hand, differing from warm disease's right-side rapid-excessive. If right pulse is slippery-excessive or choppy/vague, it indicates food stagnation. Thus, treating cold epidemic prioritizes dispersing; if old stagnation exists, add Ju (Tangerine Peel), Ban (Pinellia), Zhishi (Immature Bitter Orange), Pò (Magnolia Bark); do not abuse interior drugs. If pathogen hasn't entered interior and purging is mistaken, it risks inviting thieves to destroy the home. Thus, treatment differs vastly from latent qi.
[Heat Disease]
Latent qi manifesting after Summer Solstice is Heat Disease (Rèbìng). Pathogen exploits summer fire stagnation, steaming from Shaoyin through Three Yang, differing from cold damage's step-by-step transmission. Some complicate with heatstroke (Zhongshu); treatment is same as heatstroke. Heatstroke, though violent heat toxin, stems from heat consuming Kidney water, sweat damaging Stomach juice, fire pressing Pericardium. Hence Baihu Tang's Zhimu cleans Shaoyin source, Shigao transforms Stomach heat, Gancao and Jingmi protect Pericardium and preserve Lung/Stomach qi, similar to heat disease pathogen lying in Shaoyin, heat damaging Stomach juice, fire pressing Pericardium. Thus, different diseases share treatment, allowing heat pathogen to dissipate. If heat toxin is extreme unresolved with abdominal fullness/qi excess, use Liangge San, Shuangjie San, Chengqi Tang, Jiedu Tang, combined with bitter-dry purgatives. Or Sanhuang (Three Yellows), Shigao, Zhizi Chi Tang to sweat. Methods must not be mild, doses not gentle, or they fail. Unlike cold damage waiting for Yangming Stomach excess before purging.
[Epidemic Season]
Seasonal epidemics are unusual diseases, occurring every few or decades, mostly after famine/war. Outbreaks affect entire villages, young and old alike—this is Major Epidemic. Sometimes isolated cases in few families—this is Common Epidemic. Like smallpox/measles appearing every 1-3 years, not prevalent enough to notice. Like Soft-Leg Plague mistaken for Hong Kong Foot; Neck-Twisting Plague mistaken for Sore Throat; Intestine-Twisting Plague mistaken for Stink-Toxin; Yangmei Plague mistaken for Carbuncle-Swelling; Black-Bone Plague mistaken for Poisoning; Melon-Rind Plague mistaken for Blood-Stasis Cold Damage. Only Geda Plague (household outbreak/death) and Datou Plague (sudden swelling/heat/foul air) dare not be named lightly. Common epidemic qi is damp-earth pathogen stagnation; treatment requires exterior-interior resolution, attacking based on pathogen location. Sun Simiao said: Epidemic cold not resolved in 3 days, take Congbai Xiangchi Tang with child's urine hot to sweat. If no sweat, repeat. Stop when sweat comes and heat leaves. If 3 doses fail and pulse floats, still exterior, use Baihu Tang. If interior signs appear, use Chengqi Tang/Jiedu Tang. If exterior-interior indistinct, use Liangge San/Shuangjie San. After sweating/purging if exterior returns, give Baihu Tang again. If interior returns, give Chengqi Tang again. If exterior-interior heat intense, use Sanhuang Shigao Tang or Sanhuang Zhizi Chi Tang to sweat. Some cured after 3-4 sweats/purgations; some relapse with high fever, allow re-sweating/re-purging. If pulse/syndrome are deficient, no more attacking; use Qingre Jiedu Tang, Renzhonghuang Wan/San (Human Waste Ash Pill/Powder). Unlike cold damage fear of early purging complications, or warm-heat prohibition of frequent purging. Generally, aim for heat removal/pathogen exhaustion, do not constrain deficiency. Only if lower origin deficient, need Shengliao Liuwei Dihuang Wan (Raw Six-Ingredient Rehmannia Pill) to tonify true yin to transform residual heat; do not rigidly follow above. For Major Epidemic, analyze symptoms per time/place; methods vary; cannot pre-plan. Above describes opening diagnostic doors for miscellaneous disease physicians; key points not elaborated.
Fan Kecheng, Prefect of Ministry of Rites in Huguang, stayed at Shiwo Nunnery in Jin Chang. Suffered cold damaging nutritive layer, aversion to cold for 3 days. Previously took 2 doses of dispersants. On 7th day, restless, pulses absent, cold extremities. Fang Yaozhen, ophthalmologist colleague, invited Shiwan to diagnose. Only Left Cun pulse trembled violently. Knew this was impending battle-sweat (Zhan Han). Ordered no medicine, only hot ginger soup to assist sweating. Mistaken medicine would cause persistent heat. Days later, Fan visited to thank and leave. Inquiry confirmed prediction: cured without medicine.
A boy surnamed [Name], latent qi manifested in peak summer. Son knelt begging treatment. At diagnosis, severe restlessness, pulses洪盛 (surging-excessive) and restless. Wife said: great thirst demanding water...