伯曰∶逆者正治,从者反治,从少从多,观其事也。帝曰∶有病热者,寒之而热;有病寒者
,热之而寒,二者皆在,新病复起,奈何治?曰∶诸寒之而热者取之阴,热之而寒者取之阳
。所谓求其属也。
《八正神明论》曰∶天温日明,则人血淖溢而卫气浮,故血易泻,气易行。天寒日阴,
则人血凝泣而卫气沉。是以天寒无刺,天温无凝,月生无泻,月满无补,月郭空无治,是谓
得时而调之。
《骨空论》曰∶灸寒热之法先灸项大椎,以年为壮数。次灸撅骨,以年为壮数。视背俞
陷者灸之。举臂肩上陷者灸之。两季胁之间灸之。外踝上绝骨之端灸之。足小指次指间灸之
。下陷脉灸之。外踝后灸之。缺盆骨上切之坚痛如筋者,灸之。膺中陷骨间灸之。掌
束骨下灸之。脐下关元三寸灸之。毛际动脉灸之。膝下三寸分间灸之。足阳明跗上动脉灸之
。颠上一灸之。犬所啮之处灸之三壮。凡当灸二十九处。伤食灸之。不已者,必视其经之过
于阳者,数刺其俞而药之。
病有寒热者,由阴阳之有偏胜也。凡阳胜则热,以阴之衰也。阴胜则寒,以阳之衰也。
故曰∶发热恶寒者,发于阳也;无热恶寒者,发于阴也。此寒热之病有不同,而阴阳之不可
不察也。又若外来之寒热,由风寒之外感。内生之寒热,由脏气之内伤,此寒热之因有不同
,而表里之不可不察也。虽曰阳证多热,阴证多寒,然极热者反有寒证,极寒者亦有热证,
此又真假之不可不察也。虽曰外入之邪多有余,内出之邪多不足,然阳盛生外热,阳虚生外
寒,阴盛生内寒,阴虚生内热,此又虚实之不可不察也。诸如此者,有证可据,有脉可诊,
有因可问。且经文尽发其深秘,已列前条,余有寒热篇,亦悉其证候,具在首卷。及伤寒门
,亦有寒热辨。但因此以详求其理,则可尽悉其要,而辨治自无难也。
一、寒热真假篇,义详一卷及火证门论虚火条中。
一、治法有逆从论,在一卷论治篇中。
岐伯说:逆着病势治疗的称为正治,顺着病势治疗的称为反治,顺从的用药少或多的原则,要观察具体病情而定。黄帝问:有的热病患者,用寒凉药治疗而热不退;有的寒病患者,用温热药治疗而寒不除,这两种情况都存在,且又有新病发生,该如何治疗?岐伯回答:凡是使用寒凉药治疗热证而热不退的,应当从阴分求治;使用温热药治疗寒证而寒不除的,应当从阳分求治。这就是所谓“求其属”(探求疾病的根本属性)。
《素问·八正神明论》说:天气温暖、阳光明媚时,人的血液运行滑利充盈,卫气浮越于表,所以此时血容易泻出,气容易运行。天气寒冷、阴暗时,人的血液凝滞涩少,卫气沉伏于里。因此,天气寒冷时不宜针刺,天气温暖时气血不易凝滞(可正常施治),月亮初生时不宜用泻法,月亮圆满时不宜用补法,月亮亏缺无光时不宜进行治疗,这叫做顺应天时来调治人体。
《素问·骨空论》说:治疗寒热病症的灸法,先灸项后的大椎穴,根据患者年龄决定壮数(每岁一壮)。其次灸尾骨端的撅骨穴,同样以年龄决定壮数。观察背部膀胱经俞穴处有凹陷的,进行艾灸。举起手臂时肩部出现的凹陷处,进行艾灸。两侧季胁之间,进行艾灸。外踝上绝骨端的悬钟穴,进行艾灸。足小趾与次趾之间,进行艾灸。下陷的脉管处,进行艾灸。外踝后方,进行艾灸。缺盆骨上方按压坚硬疼痛如筋结者,进行艾灸。胸膺中骨骼间的凹陷处,进行艾灸。手掌束骨下方的穴位,进行艾灸。脐下关元穴三寸处,进行艾灸。毛际处的动脉(冲门穴附近),进行艾灸。膝下三寸的分肉间,进行艾灸。足阳明胃经足背上的动脉处,进行艾灸。头顶正中百会穴,进行艾灸。被狗咬伤的地方,灸三壮。总共应当灸二十九个部位。饮食积滞伤食者,也可施灸。如果灸后病仍不愈,必须观察经脉经过阳分的部位,多次针刺其俞穴并配合药物治疗。
疾病出现寒热症状,是由于阴阳偏胜所致。凡是阳气偏胜则发热,是因为阴气衰少。阴气偏胜则发冷,是因为阳气衰少。所以说:发热且恶寒的,是病发于阳经;无发热但恶寒的,是病发于阴经。这些寒热病症的表现有所不同,因此阴阳之理不可不仔细辨别。另外,外来的寒热,是由风寒外感引起;内生的寒热,是由脏腑内伤引起,这些寒热的病因有所不同,因此表里之辨不可不仔细辨别。虽然常说阳证多热,阴证多寒,但是极热的时候反而可能出现寒象(真热假寒),极冷的时候也可能出现热象(真寒假热),这真假之辨又不可不仔细辨别。虽然常说外入的邪气多为实证有余,内出的邪气多为虚证不足,但是阳气盛则生外热,阳气虚则生外寒,阴气盛则生内寒,阴气虚则生内热,这虚实之辨又不可不仔细辨别。诸如此类情况,都有证候可以依据,有脉象可以诊察,有病因可以询问。况且经文已经揭示了其中的深奥秘密,已列在前面的条文中,我另有《寒热篇》,也详尽叙述了证候,都在本书首卷。以及《伤寒门》中,也有寒热辨析。只要由此详细推求其道理,就能完全掌握其要点,那么辨证施治自然就没有困难了。
Qibo stated: Treating contrary to the disease's manifestation is called "direct treatment" (Zheng Zhi), while treating in accordance with the false manifestation is called "reverse treatment" (Fan Zhi). The dosage or frequency, whether adhering to the lesser or greater extent, should be observed according to the specific circumstances. The Yellow Emperor asked: If a patient with heat syndrome undergoes cold treatment but the heat persists; or a patient with cold syndrome undergoes hot treatment but the cold persists, and both conditions exist simultaneously with new diseases arising, how should they be treated? Qibo replied: For those whose heat persists despite cold treatment, one should seek the root in Yin; for those whose cold persists despite hot treatment, one should seek the root in Yang. This is referred to as "seeking its affiliation" (Qiu Qi Shu), i.e., identifying the fundamental nature of the disease.
The *Ba Zheng Shen Ming Lun* (Treatise on Eight Upright Divine Spirits) states: When the weather is warm and sunny, human blood flows freely and abundantly, and Wei Qi (Defensive Qi) floats superficially; thus, blood is easily dispersed, and Qi moves readily. When the weather is cold and cloudy, human blood becomes stagnant and sluggish, and Wei Qi sinks deep. Therefore, acupuncture should be avoided when the weather is cold; when the weather is warm, coagulation does not occur (treatment can proceed normally); during the waxing moon, draining methods should be avoided; during the full moon, tonifying methods should be avoided; during the waning moon, treatment should be suspended. This is called regulating the body in accordance with the seasons and timing.
The *Gu Kong Lun* (Treatise on Bone Gaps) states: In the moxibustion method for treating cold-heat syndromes, first moxa the Da Zhui (Dazhui, GV14) point at the nape of the neck, applying the number of moxa cones equal to the patient's age. Next, moxa the Jugu (Jiegu, GV8) point at the tip of the coccyx, again using the number of cones equal to the age. Observe any depressions in the Back-Shu points on the back and apply moxa there. Raise the arm and moxa the depression at the top of the shoulder. Moxa between the two costal margins. Moxa the end of the Juegu (Xuanzhong, GB39) point above the lateral malleolus. Moxa between the little toe and the second toe. Moxa any depressed vessels. Moxa behind the lateral malleolus. If pressing above the clavicle (Quepen area) reveals hardness and pain resembling a tendon, apply moxa. Moxa the depression between the bones in the chest (Yingzhong area). Moxa below the bundled bones of the palm. Moxa three cun below the umbilicus at the Guanyuan (CV4) point. Moxa the arterial pulse at the pubic hairline. Moxa the space between muscles three cun below the knee. Moxa the arterial pulse on the dorsum of the foot belonging to the Foot-Yangming Stomach Meridian. Moxa once at the vertex (Baihui, GV20). For areas bitten by dogs, apply three moxa cones. In total, twenty-nine locations should be moxa-ed. For food stagnation, moxa may also be applied. If the condition does not improve after moxa, one must examine the meridians passing through the Yang aspects, frequently puncture their Shu points, and administer herbal medicine.
Diseases presenting with cold and heat symptoms arise from an imbalance or excess of Yin and Yang. Generally, Yang excess leads to heat due to Yin deficiency. Yin excess leads to cold due to Yang deficiency. Thus it is said: Fever accompanied by aversion to cold indicates onset from Yang; absence of fever but presence of aversion to cold indicates onset from Yin. These cold-heat diseases present differently, so the distinction of Yin and Yang must not be neglected. Furthermore, external cold-heat results from exogenous Wind-Cold invasion; internal cold-heat results from internal injury to Zang-Fu organs. Since the causes differ, the distinction of Exterior and Interior must not be neglected. Although it is said that Yang syndromes often involve heat and Yin syndromes often involve cold, extreme heat may paradoxically present with cold signs (True Heat, False Cold), and extreme cold may paradoxically present with heat signs (True Cold, False Heat); thus, the distinction of True and False must not be neglected. Although it is said that exogenous pathogens are often Excess patterns, and endogenous pathogens are often Deficiency patterns, Yang excess generates exterior heat, Yang deficiency generates exterior cold, Yin excess generates interior cold, and Yin deficiency generates interior heat; thus, the distinction of Excess and Deficiency must not be neglected. In such cases, there are symptoms to rely upon, pulses to diagnose, and etiologies to inquire about. Moreover, the classic texts have already revealed these profound secrets, listed in previous sections. I have also written a "Chapter on Cold and Heat," which details the syndromes, found in the first volume. Additionally, the "Shanghan Section" contains distinctions of cold and heat. By carefully seeking the principles through this, one can fully grasp the essentials, making differentiation and treatment naturally straightforward.
1. Regarding the chapter on True and False Cold and Heat, the theoretical details are found in Volume 1 and under the section discussing Deficient Fire in the Fire Syndromes category.
2. Regarding the theory of Direct and Reverse Treatment methods, see the Treatise on Treatment in Volume 1.