患内伤寒后,又兼之寒热间作,鼻中微出血,两手脉沉涩,皮肤按之殊无大热,
身上有斑三五点,此内伤寒斑也,调中汤主之。夹暑加香薷、扁豆。
调中汤
陈皮 半夏(制) 甘草 桔梗 苍术(泔浸,炒) 川芎(酒洗) 白芍(酒炒)
砂仁(炒研) 藿香 羌活 白芷 麻黄(或代苏叶) 桂枝 枳壳
生姜煎。
内伤寒发黄者,其人脾胃素虚,或食寒凉生冷之物,以致寒实结搏,停滞不散,中州变寒而发
黄色。或呕吐,或腹满自利,小便短少者,宜调中汤(见前。)加茵陈,或理中汤加茵陈、枳实、
草果,手足逆冷,脉沉者加附子。
按∶内伤寒为病,本系杂症,而采入瘟疫门中者,因瘟疫愈后不戒生冷,每患此症。或再微
发热恶寒,昧者不察,往往误认为瘟病之复,而以疫法治之,寒凉清解害人不浅,故特为拈出。再
者,瘟疫之复,不能吃烟,内伤寒始终能吃烟,以此为辨。锦志。
《此事难知》云∶汗无太早,非预早之早,乃早晚之早。谓当日午以前谓阳之分,当发其汗。
午后阴之分,不当发汗。下无太晚,非待久之晚,乃当日巳后,为阴之分也,下之谓当巳前,
为阳之分也。
凡人初感寒邪,一觉憎寒,头痛身痛,身热脊强,便宜用温散之剂,速发其汗,断无不愈之
理。虽年老及平素虚怯之人,不易作汗者,觉病即服汗剂,其邪亦无不即当时解散者。此余屡用而
屡效者也。迟则寒邪稽留,传变百出,而斑黄狂躁等症作矣。所以一觉感寒便宜速治,若必如
《难知》所说,或日午以后感寒,必迟至明朝午前服汗剂不亦晚乎!假如午后感寒,此时虽属阴
分,亦宜速服散剂,且服之多未有当时即汗者,必俟次早药力既行,又逢阳分出汗更易易耳。所
谓汗无太早者,明系预早之早,岂早晚之早乎?伤寒如此,瘟疫亦然。瘟病之所谓不宜发汗者,指
麻、桂、紫苏而言,至于元霜、紫雪等丹,岂非凉散之剂乎?瘟疫初起当即服药,亦不必拘以时
日也。至所谓太晚之说,分明解作迟下,非早晨夜晚,第此言为庸医不应下而妄下之者说法耳。
然其言□不能无弊也。若遇宜急下之症,而必执下无太晚之说。则阳明胃腑势必被邪火烧至燥裂
而不可救矣!下剂若必拘以时不亦谬哉。早晚二字,当易以迟速云。汗无太速,下无太迟,则不烦言而解矣。
患内伤寒后,又兼有寒热交替发作,鼻孔轻微出血,两手脉搏沉而涩滞,皮肤按压下去并没有明显的大热感,身上出现三五点斑疹,这是内伤寒引起的发斑,用调中汤主治。如果夹带暑邪,加入香薷、扁豆。
调中汤
陈皮 半夏(制) 甘草 桔梗 苍术(淘米水浸泡,炒) 川芎(酒洗) 白芍(酒炒)
砂仁(炒后研碎) 藿香 羌活 白芷 麻黄(或用紫苏叶代替) 桂枝 枳壳
生姜煎煮服用。
患内伤寒导致发黄的人,其脾胃平时虚弱,或者吃了寒凉生冷的食物,导致寒邪实结搏聚,停滞不散,中焦变为寒性而发出黄色。如果有呕吐,或者腹部胀满、自发性腹泻,小便短少的,适宜用调中汤(见前文),加入茵陈;或者用理中汤加入茵陈、枳实、草果;如果手足逆冷,脉搏沉的,加入附子。
按语:内伤寒这种病,本来属于杂症,但被收录在瘟疫门类中,是因为瘟疫痊愈后不忌口生冷食物,常常患上此症。或者再次出现轻微发热恶寒,不明事理的人不加考察,往往误认为是瘟病的复发,而用治疗疫病的方法去治,使用寒凉清解的药物害人很深,所以特意提出来辨析。再者,瘟疫复发的人,不能吃烟,内伤寒始终能吃烟,以此作为辨别依据。锦志。
《此事难知》说:发汗不要过早,不是指预先提前的早,而是指早晚的早。意思是说当天中午以前属于阳分时段,应当发汗。午后属于阴分时段,不应当发汗。攻下不要过晚,不是指等待很久的晚,而是指当天巳时以后,为阴分时段,攻下应当在巳时以前,为阳分时段。
大凡人刚感受寒邪,一感到怕冷,头痛身痛,身体发热脊背僵硬,就应当立即使用温散的药物,迅速发汗,断没有不愈的道理。即使是年老以及平时体虚怯弱的人,不容易出汗的,感觉生病就服用发汗剂,邪气也没有不能当即解散的。这是我多次使用且多次见效的方法。拖延则寒邪滞留,传变出各种病症,而发斑、发黄、狂躁等症状就会发作。所以一旦感觉受寒就应当速治,如果一定要像《难知》所说,如果是日午以后感受寒邪,必须推迟到第二天中午以前才服用发汗剂,不也太晚了吗!假如午后感寒,此时虽然属于阴分,也应当迅速服用发散剂,而且服药后大多没有当即就出汗的,必须等到第二天早上药力运行之后,又逢阳分时段,出汗更容易罢了。所谓“发汗不要过早”,明明是指预先提前的早,难道是早晚的早吗?伤寒如此,瘟疫也是如此。瘟病所谓的不宜发汗,指的是麻黄、桂枝、紫苏而言,至于元霜、紫雪等丹药,难道不是凉散的药物吗?瘟疫初起当即服药,也不必拘泥于时日。至于所谓“太晚”的说法,分明解释为迟下,不是早晨夜晚,只是这话是为那些不该用下法却妄用下法的庸医说的罢了。然而这句话□难免有弊端。如果遇到急需急下的病症,却一定执着于“攻下不要过晚”的说法。那么阳明胃腑势必被邪火烧至干燥破裂而无法救治了!攻下的药物如果一定要拘泥于时辰,不也太荒谬了吗。早晚二字,应当改为迟速来说。发汗不要太快,攻下不要太慢,就不必多言就能明白了。
After suffering from internal cold damage (Nei Shang Han), accompanied by alternating chills and fever, slight bleeding from the nose, deep and choppy pulses in both hands, and no significant heat upon pressing the skin, with three to five macules appearing on the body, this is macular eruption due to internal cold damage. It is primarily treated with Tiaozhong Decoction. If complicated by summerheat, add Xiangru (Moslae Herba) and Biandou (Dolichoris Semen).
Tiaozhong Decoction
Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma Preparatum), Gancao (Glycyrrhizae Radix et Rhizoma), Jiegeng (Platycodonis Radix), Cangzhu (Atractylodis Rhizoma, soaked in rice water, stir-fried), Chuanxiong (Ligustici Chuanxiong Rhizoma, washed with wine), Baishao (Paeoniae Radix Alba, stir-fried with wine), Sharen (Amomi Fructus, stir-fried and crushed), Huoxiang (Agastaches Herba), Qianghuo (Notopterygii Rhizoma et Radix), Baizhi (Angelicae Dahuricae Radix), Mahuang (Ephedrae Herba, or substitute with Ziye, Perillae Folium), Guizhi (Cinnamomi Ramulus), Zhike (Aurantii Fructus Immaturus).
Decoct with Shengjiang (Zingiberis Rhizoma Recens).
Those who develop jaundice due to internal cold damage typically have a constitutionally weak spleen and stomach, or have consumed cold and raw foods, leading to the binding and stagnation of cold pathogenic factors. This causes the middle jiao to become cold, resulting in yellow discoloration. If there is vomiting, abdominal fullness, spontaneous diarrhea, or scanty urination, Tiaozhong Decoction (see above) with Yinchen (Artemisiae Scopariae Herba) is appropriate. Alternatively, Lizhong Decoction with Yinchen, Zhishi (Aurantii Fructus), and Caoguo (Tsao-ko Fructus) may be used. If there is cold reversal in the four limbs and deep pulses, Fuzi (Aconiti Lateralis Radix Praeparata) should be added.
Note: Internal cold damage is originally a miscellaneous disease, but it is included in the plague section because after recovering from plague, patients often neglect dietary restrictions regarding cold and raw foods, frequently contracting this condition. They may experience mild fever and aversion to cold again. Ignorant practitioners, failing to examine carefully, often mistake it for a recurrence of the plague and treat it with plague protocols. The use of cold and cooling clearing agents harms people significantly; therefore, it is specifically highlighted for differentiation. Furthermore, those with recurrent plague cannot tolerate smoking, whereas those with internal cold damage can smoke throughout the illness; this serves as a distinguishing feature. Jin Zhi.
"Cishi Nan Zhi" states: "Do not sweat too early." This does not mean prematurely early, but rather early in the sense of morning versus evening. It means that before noon on a given day belongs to the yang phase, and sweating should be induced. After noon belongs to the yin phase, and sweating should not be induced. "Do not purge too late" does not mean waiting until very late, but refers to the time after Si hour (9–11 AM) on a given day, which is the yin phase. Purging should be done before Si hour, which is the yang phase.
When a person initially contracts cold pathogenic factors, feeling aversion to cold, headache, body pain, fever, and stiffness of the spine, one should immediately use warm dispersing agents to induce rapid sweating. There is no reason why it would not heal. Even in the elderly or those constitutionally weak and prone to difficulty sweating, if they take sweating agents as soon as they feel ill, the pathogenic factors will invariably be resolved at that moment. This is a method I have used repeatedly with success. Delay allows cold pathogens to linger and transform into various complications, such as macular eruption, jaundice, mania, and restlessness. Therefore, once cold contraction is felt, prompt treatment is advisable. If one strictly follows the saying in "Nan Zhi," and feels cold after noon, waiting until the next morning before noon to take sweating agents would indeed be too late! Suppose one contracts cold after noon; although this time belongs to the yin phase, one should still quickly take dispersing agents. Moreover, most people do not sweat immediately after taking them; one must wait until the next morning when the medicinal power has circulated and the yang phase arrives, making sweating easier. Thus, "do not sweat too early" clearly refers to premature early, not early in the sense of morning/evening. This applies to cold damage, and similarly to plague. When plague says sweating is inappropriate, it refers to Mahuang (Ephedrae Herba), Guizhi (Cinnamomi Ramulus), and Zisu (Perillae Folium). What about Yanshuang and Zixue pills? Are they not cooling dispersing agents? For plague onset, medication should be taken immediately, without being bound by specific times. As for the concept of "too late," it clearly refers to delayed purging, not morning or evening. However, this statement was made to excuse quacks who wrongly used purging when it was not indicated. Nevertheless, this saying □ inevitably has drawbacks. If encountering conditions requiring urgent purging, yet adhering strictly to "do not purge too late," the Yangming stomach fu organ will inevitably be scorched by pathogenic fire until dry and cracked, becoming incurable! If purging agents must be bound by timing, is this not absurd? The words "morning and evening" should be replaced with "delay and speed." "Do not sweat too fast, do not purge too slow," and the matter will be understood without further explanation.