王海藏云阴毒本因肾气虚寒因欲事或食生冷物而后傍风内既伏阴外又伤寒或先感外寒而
后伏
阴内外皆阴则阳气不守遂发阴毒身重眼睛疼身体倦怠而甚热四肢厥逆冷额上及手背冷汗不止
或多烦渴精神恍惚如有所失三二日间或可起行不甚觉重诊之则六脉沉细而疾尺部短小寸口或
无若服凉药则渴转甚躁转急有此证者急服还阳退阴之药则安惟补虚和气而已宜服正元散之类
阴证不宜发汗如气正脉大身热未瘥用药发汗无妨 或寸口小而尺脉微大亦同积阴感于下则微
阳消于上故其候沉重四肢逆冷腹痛转甚或喉不利或心下胀满结硬躁渴虚汗不止或时狂言爪
甲
面色青黑六脉沉细而一息七至以来有此证者速宜于气海关元二穴灸三二百壮以手足和暖为效
仍服金液丹来复丹之类随证治之
按此言阳气不守或积阴感于下微阳消于上遂为阴毒与活人书论阴毒为阴气独盛阳气暴绝
者殊
有发明矣但言不守与消之义而又不若赵氏释活人书云阴气极盛阳气极微为阴毒阳气极盛阴气
极微为阳毒庶不为竭绝之证义尤明白阴盛格阳脉附见热门
详见热门
谨按世传以寒痰香港脚食积劳烦四证为似伤寒然以形证较之亦岂止四证而已故集证论
详见热门
此事难知云足太阳为巨阳为老阳又为诸阳之首故多传变尔太阳传阳明谓之微邪是水传土
也又
谓之循经得度传太阳传少阳谓之越经传太阳传太阴谓之误下传太阳传少阴谓之表里传变之邪
太阳
为甚复传少阴水胜火火胜水此南北二方之变顷刻之间其害人也甚于太阳多矣若辨之不早必成
不救之疾况乱投汤药者乎太阳传厥阴谓之首尾传厥阴与督脉上行与太阳相接又名巡经得度传
灾变至重不为不多矣
按此可谓发仲景之心法矣赵氏亦曰伤寒六经传变或虚或实或冷或热无非邪气之所为也有
次第
传经之阳邪有直入本经之阴邪有下后内陷之邪皆不可不辨也然成无己引华陀云伤寒一日在皮
二日在肤三日在肌四日在胸五日在腹六日入胃即传里也与成所论七日不解为再经二七日不解
为过经皆大约也故一无治例惟六经传变为的故太阳传变居多者因其初感邪气乘虚而入则传也
有三五日止在本经或十数日不传者有之有传过一经而不再传者亦有之有误服药而致传变者多
矣大抵邪在阳经则易治传入阴分则危殆盖阳微阴盛正虚邪实矣况误下内陷汗虚别经者则坏异
倾危可立待也学人慎之
王海藏说:阴毒原本是因为肾气虚寒,因房事或食用生冷食物,随后感受风邪,体内既潜伏阴寒,体外又受伤寒侵袭;或者先感受外寒而后导致阴寒内伏。内外皆属阴寒,则阳气不能固守,于是发作阴毒。症状表现为身体沉重、眼睛疼痛、身体倦怠且发热严重、四肢厥冷逆乱、额头及手背冷汗不止、或多烦渴、精神恍惚如有所失。两三天间或许可以起身行走,并不觉得特别沉重。诊察其脉象,六脉沉细而疾速,尺部短小,寸口脉或无。如果服用凉药,则口渴更甚,烦躁更急。有此证者,应立即服用还阳退阴的药物则能安宁,只需补虚和气即可,适宜服用正元散之类的方剂。阴证不宜发汗,如正气尚存、脉象宏大、身热未退,用药发汗无妨。或者寸口脉小而尺脉微大,情况也相同。积聚的阴寒感于下部,则微弱的阳气消损于上部,所以其候表现为身体沉重、四肢逆冷、腹痛加剧,或者咽喉不利,或者心下胀满结硬、烦躁口渴、虚汗不止,或者时而胡言乱语、爪甲面色青黑。六脉沉细,一息七至以上。有此证者,应迅速在气海、关元两个穴位灸三二百壮,以手足温暖为见效标准,同时服用金液丹、来复丹之类的药物,随证治疗。
按语:此段论述阳气不守,或积阴感于下、微阳消于上,遂成为阴毒,这与《活人书》论述阴毒为阴气独盛、阳气暴绝者,颇有发明之处。但仅说不守与消的含义,不如赵氏解释《活人书》所说“阴气极盛、阳气极微为阴毒,阳气极盛、阴气极微为阳毒”,这样就不至于认为是竭绝之证,义理更加明白。阴盛格阳脉附见于热门章节。详见热门章节。
谨按:世间流传将寒痰、香港脚(脚气)、食积、劳烦四证视为类似伤寒,然而比较其形证,难道仅仅只有这四证而已吗?故汇集证候进行论述。此事难知云:足太阳经为巨阳,为老阳,又为诸阳之首,所以多发生传变。太阳传入阳明称为微邪,这是水传土的关系,也称为循经得度传;太阳传入少阳称为越经传;太阳传入太阴称为误下传;太阳传入少阴称为表里传变之邪,太阳为甚,再传入少阴,水胜火,火胜水,这是南北二方的变化,顷刻之间,其危害人比太阳病大多了。如果不能尽早辨别,必定成为不可救治的疾病,何况胡乱投予汤药的人呢?太阳传入厥阴称为首尾传,厥阴与督脉上行与太阳相接,又名巡经得度传,灾变极其严重,不为不多。
按语:这可以说是阐发了张仲景的心法。赵氏也说:伤寒六经传变,或虚或实,或冷或热,无非是邪气所为。有按次第传经的阳邪,有直入本经的阴邪,有下后内陷的邪气,都不可不辨别。然而成无己引用华佗的话说:伤寒一日在皮,二日在肤,三日在肌,四日在胸,五日在腹,六日入胃即传里。这与成无己所论七日不解为再经,二七日不解为过经,都是大约的说法。所以没有固定的治疗条例,只有六经传变才是确切的。因此太阳传变居多,是因为初感邪气乘虚而入所致。传变的情况有三五日止于本经,或有十数日不传的,也有传过一经而不再传的,更有误服药物而导致传变的,这种情况很多。大抵邪在阳经则易治,传入阴分则危殆,因为阳微阴盛,正虚邪实。何况误下内陷、汗出伤虚、别经传变者,则坏证倾危可以立等而至。学者务必谨慎。
Wang Haicang stated: Yin poison (Yin Du) originally arises from deficiency-cold of the Kidney Qi, following sexual activity or consumption of raw and cold foods, after which wind pathogen is contracted. Internally, yin-cold is latent; externally, cold damage (Shang Han) is suffered. Or, external cold is felt first, leading to internal yin-cold accumulation. When both interior and exterior are yin-cold, Yang Qi cannot maintain its guard, thus Yin poison erupts. Symptoms include heavy body, eye pain, physical fatigue with severe heat sensation, cold reversal in the four limbs, continuous cold sweat on the forehead and back of hands, frequent thirst and irritability, mental confusion as if losing something. Within two or three days, one might be able to walk without feeling particularly heavy. Pulse diagnosis reveals six pulses that are deep (Chen), fine (Xi), and rapid (Ji); the Chi position is short and small, while the Cun Kou position may be absent. If cooling medicines are taken, thirst becomes worse and irritability intensifies. For those with these symptoms, immediate administration of medicines to restore Yang and retreat Yin will bring peace; only tonifying deficiency and harmonizing Qi is needed. Formulas such as Zheng Yuan San (Correct Origin Powder) are suitable. Yin syndromes should not induce sweating. However, if Qi is upright, pulse is large, and fever has not subsided, inducing sweating with medicine is permissible. Similarly, if Cun Kou pulse is small and Chi pulse is slightly large, the situation is the same. Accumulated yin-cold affects the lower part, causing微弱 Yang Qi to diminish in the upper part. Thus, symptoms manifest as heavy body, cold reversal in four limbs, worsening abdominal pain, throat discomfort, fullness and hardness below the heart, irritability, thirst, continuous deficient sweating, occasional delirium, cyanotic nails, and dark blue-black complexion. The six pulses are deep and fine, with more than seven breaths per pulse beat. For those with these symptoms, moxibustion should be rapidly applied to the Qihai (CV6) and Guanyuan (CV4) acupoints, 300-200 moxa cones, until the hands and feet become warm. Simultaneously, medicines such as Jin Ye Dan (Golden Liquid Pill) and Lai Fu Dan (Returning Return Pill) should be taken according to the syndrome.
Commentary: This discussion on Yang Qi failing to maintain its guard, or accumulated yin-cold affecting the lower part causing微弱 Yang Qi to diminish in the upper part, leading to Yin poison, offers significant insight compared to the *Huo Ren Shu*’s description of Yin poison as excessive Yin Qi and sudden collapse of Yang Qi. However, merely discussing "failing to maintain" and "diminishing" is less clear than Zhao’s explanation of the *Huo Ren Shu*: "Extreme excess of Yin Qi and extreme deficiency of Yang Qi constitute Yin poison; extreme excess of Yang Qi and extreme deficiency of Yin Qi constitute Yang poison." This interpretation avoids the notion of absolute exhaustion, making the principle clearer. Pulse patterns of Yin excess repelling Yang are attached to the Hot Syndromes chapter. See Hot Syndromes chapter for details.
Respectfully noted: In popular tradition, Cold Phlegm, Hong Kong Foot (Gout/Feet Qi), Food Stagnation, and Labor Fatigue are considered similar to Cold Damage. However, comparing their manifestations, are there really only these four syndromes? Therefore, various syndromes are collected and discussed.
The book *Ci Nan Zhi* states: The Foot-Taiyang channel is the Great Yang, the Old Yang, and the head of all Yang channels, so it undergoes transmission frequently. Transmission from Taiyang to Yangming is called Minor Evil, representing Water transmitting to Earth, also known as following the channel within limits. Transmission from Taiyang to Shaoyang is called crossing the channel. Transmission from Taiyang to Taiyin is called transmission due to mistaken purgation. Transmission from Taiyang to Shaoyin is called Interior-Exterior transmission; when Taiyang becomes severe and transmits to Shaoyin, Water overcomes Fire and Fire overcomes Water, representing changes between the North and South regions. Within moments, the harm to humans is far greater than in Taiyang disease alone. If not distinguished early, it will certainly become an incurable disease, let alone cases of indiscriminate prescription. Transmission from Taiyang to Jueyin is called Head-to-Tail transmission. Jueyin ascends along the Du Mai and connects with Taiyang, also named following the channel within limits. The disasters and changes are extremely serious and numerous.
Commentary: This can be said to reveal the secret method of Zhang Zhongjing. Zhao also stated: Transmission through the Six Channels in Cold Damage involves deficiency or excess, cold or heat, all caused by pathogenic factors. There are Yang pathogens transmitted in sequence, Yin pathogens entering the primary channel directly, and pathogens sinking inward after purgation; all must be distinguished. However, Cheng Wuji cited Hua Tuo saying: Cold Damage on day 1 is in the skin, day 2 in the flesh, day 3 in the muscles, day 4 in the chest, day 5 in the abdomen, day 6 enters the stomach and transmits to the interior. This aligns roughly with Cheng’s discussion that unresolved cases after seven days constitute a second cycle, and unresolved cases after fourteen days constitute passing the cycle. These are generalizations. Therefore, there are no fixed treatment examples; only Six Channel transmission is precise. Thus, Taiyang transmission is most common because initial pathogenic invasion takes advantage of deficiency to transmit. Transmission scenarios include staying in the primary channel for three to five days, or not transmitting for ten-plus days; some transmit past one channel and do not continue; many result from mistaken medication. Generally, pathogens in Yang channels are easy to treat, but once entering Yin divisions, they become critical, as Yang is weak, Yin is strong, Righteous Qi is deficient, and Pathogenic Qi is substantial. Moreover, cases of mistaken purgation causing sinking, sweating causing deficiency, or transmission to other channels lead to damaged syndromes where collapse and peril await immediately. Scholars must be cautious.