伤寒寒热者。谓往来寒热也。经曰。邪正分争。往来寒热者。言邪气之入也。而正气不
与之
不发
阴
而
则
之不定。或出或入。由是而寒热且往且来也。是以往来寒热。属半表半里之证。邪居表多则
多
深
常
热
恶
热
下
活人书云。往来寒热者。阴阳相胜也。阳不足则先寒后热。阴不足则先热后寒。往来寒
热有
有里
仲景云。血弱气虚。腠理开邪气入。与正气相争。往来寒热休作有时者。小柴胡汤主之。
又
或
伤寒十余日。热结在里。往来寒热者。大柴胡汤主之。伤寒五六日。已发汗。复下之。胸腹
满
前
麻
汗
若
胃
歌曰。热多寒少属膀胱。不呕清便各半汤。尺脉若迟为血少。脉皆微弱号无阳。热多寒
少阳
如常
如脉
亦可
汗余寒热脉中论。若见憎寒法用温。沉实当攻浮在表。风温误汗热而烦。汗后寒热。邪
气未解彻也。脉浮洪者。邪在太阳。法当再汗。脉沉实者。邪在阳明。又须下之。若厥阴余
热。加以下利。厥逆恶寒者。四逆汤温之无疑矣。憎寒者属厥阴。大汗出热不去。拘急体痛。
下
若身恶寒则为虚。用芍药甘草附子汤。身发热则为实。用大承气汤。脉浮洪者属太阳。汗后
寒热。桂枝二麻黄一汤。风温不恶寒。若误发汗。必心烦热渴。独语。葳蕤汤。风温家。汗
后大热脉躁。名阴阳交。不治。热病已得汗。而脉躁盛者。亦不治。详见阴阳交条。有再汗
再下之剂。
伤寒病中的寒热症状，指的是寒热往来交替出现。《内经》说：邪气与正气相互争斗，导致寒热往来。这是描述邪气侵入人体，而正气未能及时抗邪外出，导致阴阳之气出入不定，有时出表、有时入里，因此出现寒热交替往来的现象。所以，寒热往来属于半表半里的证候。如果邪气在表较多，则恶寒明显；若邪气深入，则发热明显。
《活人书》说：寒热往来是阴阳相互偏胜的结果。阳气不足，则先出现恶寒，后出现发热；阴气不足，则先出现发热，后出现恶寒。
张仲景说：若血弱气虚，腠理开泄，邪气乘虚而入，与正气相争，出现寒热往来且发作有定时者，用小柴胡汤主治。
另外，若伤寒十余日，热邪结聚在里，出现寒热往来者，用大柴胡汤主治。
伤寒五六日，已经发过汗，又误用下法，导致胸腹满闷……（原文此处有缺漏或错简，依文意推测为少阳阳明合病之象）。
歌诀说：热多寒少属膀胱经病变，若不呕吐、二便正常，可用清半汤（注：此处“清半汤”疑为传抄错误或特定方名，通常指代和解或清利之剂，保留原名）治疗。若尺脉迟，说明血少；若脉皆微弱，称为无阳证。
热多寒少属阳证……（原文此处有缺漏）。
关于汗后余留的寒热脉象论述：若见憎恶寒冷，治法当用温法。脉沉实者，邪气在里，应当攻下；脉浮者，邪气在表，应当发汗。若是风温病误用发汗法，会导致身体烦热。
汗后出现的寒热，是因为邪气未完全解除。若脉象浮洪，说明邪气仍在太阳经，治法应当再次发汗。若脉象沉实，说明邪气在阳明经，应当使用下法。若是厥阴经余热，兼见下利、四肢厥冷、恶寒者，用四逆汤温阳散寒，毫无疑问。
憎恶寒冷属于厥阴经病变。若大汗出后热势不退，伴有筋脉拘急、身体疼痛，若身体恶寒则为虚证，用芍药甘草附子汤治疗；若身体发热则为实证，用大承气汤治疗。
脉象浮洪属于太阳经病变。汗后出现的寒热，可用桂枝二麻黄一汤治疗。
风温病不恶寒，若误用发汗法，必然导致心烦、口渴、独自胡言乱语，用葳蕤汤治疗。
风温病患者，汗后出现大热、脉象躁动，名为“阴阳交”，属于不治之症。热病已经出汗，但脉象依然躁盛者，也是不治之症。详见“阴阳交”条目。文中提到了有再次发汗和再次攻下的方剂。
The chills and fever in Shanghan (Cold Damage) disease refer to alternating chills and fever. The Classics state: "When pathogenic factors and healthy Qi contend, alternating chills and fever occur." This describes the invasion of pathogenic factors, while healthy Qi fails to expel them effectively, leading to unstable Yin and Yang energies that move in and out. Consequently, chills and fever alternate. Therefore, alternating chills and fever belong to the Shaoyang (Half-Exterior, Half-Interior) syndrome. If pathogenic factors are predominantly in the Exterior, chills will be prominent; if they penetrate deeply, fever will be prominent.
The *Huoren Shu* (Book for Saving Lives) states: Alternating chills and fever result from the mutual overcoming of Yin and Yang. Insufficiency of Yang leads to chills first, followed by fever; insufficiency of Yin leads to fever first, followed by chills.
Zhang Zhongjing stated: When blood is deficient and Qi is weak, the interstices (*Couli*) open, allowing pathogenic factors to enter and contend with healthy Qi, resulting in alternating chills and fever that occur at regular intervals. This should be treated with Xiaochaihu Tang (Minor Bupleurum Decoction).
Furthermore, if after ten-plus days of Shanghan, heat accumulates internally causing alternating chills and fever, Dachaihu Tang (Major Bupleurum Decoction) should be used.
If after five or six days of Shanghan, sweating has already been applied, followed by purgation, leading to chest and abdominal fullness... [Note: Original text contains gaps/omissions here].
A medical rhyme states: "Heat more than chills belongs to the Bladder channel; if there is no vomiting and bowel movements are normal, Qingban Tang may be used. If the Chi pulse is slow, it indicates blood deficiency; if all pulses are weak and faint, it is called 'No-Yang' syndrome."
Heat more than chills belongs to Yang syndromes... [Note: Original text contains gaps/omissions here].
Regarding the discussion on residual chills and fever and their pulses after sweating: If aversion to cold is observed, warming methods should be employed. A deep and forceful pulse indicates pathogenic factors in the Interior, requiring purgation; a floating pulse indicates pathogenic factors in the Exterior, requiring diaphoresis. If Fengwen (Wind-Warmth) is mistakenly treated with diaphoresis, it will cause irritability and heat.
Chills and fever appearing after sweating indicate that pathogenic factors have not been completely resolved. A floating and洪 (Hong/Large) pulse suggests the pathogen remains in the Taiyang (Greater Yang) channel, warranting repeated diaphoresis. A deep and forceful pulse suggests the pathogen is in the Yangming (Yang Brightness) channel, requiring purgation. If residual heat in the Jueyin (Terminal Yin) channel is accompanied by diarrhea, cold extremities, and aversion to cold, Sini Tang (Frigid Extremities Decoction) should be used to warm and dispel cold without doubt.
Aversion to cold belongs to Jueyin channel pathology. If heavy sweating occurs but fever persists, accompanied by tendon constraint and body pain: if the body feels cold, it is a deficiency pattern, treated with Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction); if the body feels hot, it is an excess pattern, treated with Dachengqi Tang (Major Order the Qi Decoction).
A floating and Hong pulse belongs to the Taiyang channel. For chills and fever after sweating, Guizhi Er Mahuang Yi Tang (Cinnamon Twig Twice, Ephedra Once Decoction) can be used.
Fengwen (Wind-Warmth) does not present with aversion to cold. If mistakenly treated with diaphoresis, it will inevitably cause mental restlessness, thirst, and solitary muttering, treated with Weirui Tang (Polygonatum Decoction).
In patients with Fengwen, if heavy sweating leads to high fever and a restless pulse, this is named "Yin-Jiao" (Intersection of Yin and Yang), which is incurable. If after a febrile disease sweating occurs but the pulse remains restless and rapid, it is also incurable. See the entry on "Yin-Jiao" for details. The text mentions formulas for repeated diaphoresis and purgation.