秦子曰∶寒热病,即古静而得之为中暑病也。以暴寒而伤有热之人,则恶寒发热,乃非
时之伤寒。因在夏热之令,先伏暑热在内,故不得为伤寒矣。今更其名曰寒热病。夫寒热者
,以寒伤热而命其名也。伤寒与寒热病,时异而治殊,故余注明症治。则伤寒与寒热,两无
差误矣。总之同一暑热病,以无表邪者为中热病,以有表邪者为寒热病。同一有表邪病,以
热令里有暑热者,为寒热病,照后条治法;以冬月里无暑热,惟外感风寒,在表发热者,名伤寒,仍照伤寒治法。
【寒热病之症】头疼身痛,恶寒发热,去衣则凛凛,着衣则烦躁,口渴懊 ,足
冷耳聋,谵语喘呕,或手足无汗,或两足独冷,即静而得之为中暑症也。
【寒热病之因】痰饮之热积于中,时令之热感于内;或因纳凉太过,或因居处太静;
身无汗出,热气无从发泄,又被早晚阴寒,束其肌表,则恶寒身痛身热足冷之症作矣。
【寒热病之脉】脉见浮紧,太阳表邪。若见洪大,阳明有邪。或见弦数,少阳有邪。
脉伏烦躁者,升阳散火汤发之;待足暖有汗,脉出不伏,然后清其里热。肺素有热者,桔
梗汤;心热甚,导赤各半汤;心肺俱热,凉膈散。若足冷耳聋,寒热而呕,有 者,升麻干
葛汤加柴胡;无 者,小柴胡汤。若手足汗少,两足不温,邪热未曾发越,亦用升阳散火汤
。热令人手足应温,今反见足冷,乃是表邪未散,即上身热极,上身多汗,尚是表邪烦热,
羌活败毒散
羌活 独活 柴胡 前胡 枳壳 川芎 广皮 人参 甘草
羌活冲和汤
羌活 防风 苍术 川芎 细辛 白芷 生地 黄芩 甘草
升阳散火汤
升麻 干葛 羌活 独活 人参 白芍药 柴胡 防风 甘草
小柴胡汤 见前伤寒。
桔梗汤
导赤各半汤
凉膈散 以上三方见中热。
无恶寒身痛表症,但见内热烦渴多汗,唇焦消水,六脉沉数,即为无表邪之中热症。若
初起发热恶寒,头痛身痛,六脉浮数,则为有表邪之寒热症,当从三阳经主治。然一见恶寒
,即重太阳,以外感惟怕表邪不散耳。小柴胡汤,单主少阳一经之寒热者。若太阳少阳寒热
,仲景则有桂枝柴胡汤,家秘化立羌活柴胡汤。太阳阳明寒热,仲景则用桂枝葛根汤,家秘
化立羌活干葛汤。三阳寒热,今补立羌柴葛根汤。大凡寒热之病,必要先散表邪,即里热已
甚,必不得已,但可双解表里,不可纯用寒凉,以碍恶寒之表症。
秦子说:寒热病,就是古代所说的“静而得之”的中暑病。因为突然受寒邪侵袭了体内有热的人,所以出现恶寒发热的症状,这并非非时之伤寒。由于发生在夏季炎热之时,体内先伏藏了暑热,所以不能称为伤寒。现在给它改名为寒热病。之所以叫寒热病,是因为寒邪伤了体内的热邪而得名。伤寒与寒热病,虽然都是外感病,但发病季节不同,治疗方法也各异,所以我详细注明了各自的证治。这样,伤寒与寒热病两者就不会混淆出错了。总之,同属于暑热病一类,如果没有表邪的,称为中热病;如果有表邪的,称为寒热病。同样是有表邪的病,如果在热令(夏季)里兼有暑热的,称为寒热病,按照后面的条目的方法治疗;如果在冬季里没有暑热,只是外感风寒,在体表发热的,称为伤寒,仍然按照伤寒的方法治疗。
【寒热病的症状】头痛身痛,恶寒发热,脱去衣服则感到寒冷战栗,穿上衣服则感到烦躁,口渴懊恼,脚冷耳聋,胡言乱语、气喘呕吐,或者手足无汗,或者只有两脚特别冷,这就是所谓的“静而得之”的中暑症。
【寒热病的病因】痰饮的热积聚在体内,时令的热邪感受于内;或者因为乘凉太过,或者因为居住环境过于安静(导致气机郁滞);身体没有出汗,热气无法发泄,又被早晚的阴寒之气束缚肌表,于是出现了恶寒、身痛、身热、足冷的症状。
【寒热病的脉象】脉象见浮紧,是太阳经受表邪。如果见洪大脉,是阳明经有邪。或者见弦数脉,是少阳经有邪。脉象沉伏且烦躁的,用升阳散火汤发散;等到脚暖有汗,脉象不再沉伏,然后再清其里的热。肺素有热的,用桔梗汤;心热严重的,用导赤各半汤;心肺都有热的,用凉膈散。如果出现脚冷耳聋,寒热往来且呕吐,有胸胁苦满症状的,用升麻干葛汤加柴胡;没有胸胁苦满症状的,用小柴胡汤。如果手足汗少,两脚不温暖,邪热未能发散,也用升阳散火汤。热病通常让人手足应该温暖,现在反而见脚冷,这是表邪未散的表现,即使上身热极、上身多汗,仍然是表邪烦热,用羌活败毒散。
羌活冲和汤
羌活 防风 苍术 川芎 细辛 白芷 生地 黄芩 甘草
升阳散火汤
升麻 干葛 羌活 独活 人参 白芍药 柴胡 防风 甘草
如果没有恶寒身痛的表证,只见到内热、烦躁、口渴、多汗,嘴唇焦裂、想喝水,六脉沉数,就是没有表邪的中热症。如果初起时发热恶寒,头痛身痛,六脉浮数,就是有表邪的寒热症,应当从三阳经主治。但是一见到恶寒,就重视太阳经,因为外感病最怕表邪不散。小柴胡汤,专门主治少阳一经的寒热病。如果是太阳少阳合病的寒热,张仲景则有桂枝柴胡汤,家传秘方的化裁方立羌活柴胡汤。如果是太阳阳明合病的寒热,张仲景则用桂枝葛根汤,家传秘方的化裁方立羌活干葛汤。三阳合病的寒热,现在补充立下羌柴葛根汤。大凡寒热病,一定要先散表邪,即使里热已经很严重,实在不得已的情况下,也只能双解表里,不可纯用寒凉药,以免阻碍恶寒的表证。
Qin Zi said: Hanre Bing (Cold-Heat Disease) is what was anciently referred to as Zhongshu Bing (Heatstroke) obtained from remaining still. It occurs when sudden cold pathogen invades a person who has internal heat, resulting in aversion to cold and fever; this is not Shanghan (Cold Damage) occurring out of season. Since it happens during the hot summer season, with summer-heat pathogen previously latent inside, it cannot be classified as Shanghan. Therefore, its name is now changed to Hanre Bing. It is named Hanre Bing because cold pathogen injures the internal heat pathogen. Although both are exogenous diseases, Shanghan and Hanre Bing differ in their onset seasons and treatments; thus, I have clearly distinguished their syndromes and treatments so that there will be no confusion between them. In summary, both belong to the category of summer-heat diseases. Those without exterior pathogen are called Re Bing (Heat Stroke); those with exterior pathogen are called Hanre Bing. Among diseases with exterior pathogen, if there is internal summer-heat during the hot season, it is Hanre Bing, treated according to the following methods; if there is no internal summer-heat in winter, but only external wind-cold causing fever at the exterior, it is called Shanghan, treated according to Shanghan methods.
[Symptoms of Hanre Bing] Headache and body pain, aversion to cold and fever, shivering when removing clothes, irritability when wearing clothes, thirst with vexation, cold feet, deafness, delirium, panting, and vomiting. There may be no sweat on hands and feet, or only the two feet are particularly cold. This corresponds to the Zhongshu syndrome obtained from remaining still.
[Etiology of Hanre Bing] Heat accumulation from phlegm-fluids in the interior, combined with seasonal heat pathogen affecting the interior; or due to excessive cooling, or living in overly quiet environments leading to stagnation of Qi mechanism; the body does not sweat, preventing heat from dissipating, while Yin-cold from morning and evening binds the muscle layer, resulting in symptoms of aversion to cold, body pain, body heat, and cold feet.
[Pulse of Hanre Bing] A floating-tight pulse indicates Taiyang (Greater Yang) exterior pathogen. A surging-large pulse indicates Yangming (Yang Brightness) pathogen. A string-like-rapid pulse indicates Shaoyang (Lesser Yang) pathogen. If the pulse is deep-hidden with vexation, use Shengyang Sanhuo Tang (Raise Yang Scatter Fire Decoction) to disperse; wait until feet become warm and sweating occurs, and the pulse rises from being hidden, then clear the interior heat. For pre-existing lung heat, use Jiegeng Tang (Platycodon Decoction); for severe heart heat, use Daochi Geban Tang (Guide Red Half-Decoction); for both heart and lung heat, use Liangge San (Cool Diaphragm Powder). If accompanied by cold feet, deafness, alternating chills and fever, vomiting, and chest/hypochondriac fullness, use Shengma Gan'ge Tang (Cimicifuga and Pueraria Decoction) added with Chaihu (Bupleurum); without chest/hypochondriac fullness, use Xiao Chaihu Tang (Minor Bupleurum Decoction). If there is little sweat on hands and feet, and feet are not warm, indicating pathogenic heat has not yet dispersed, also use Shengyang Sanhuo Tang. Heat diseases usually cause warm hands and feet; current cold feet indicate unresolved exterior pathogen. Even with extreme upper body heat and profuse upper body sweating, it remains exterior pathogen vexation-heat, treated with Qianghuo Baidu San (Notopterygium Decoction to Overcome Toxins).
Ingredients: Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Chaihu (Bupleuri Radix), Qianhu (Peucedani Radix), Zhike (Aurantii Fructus Immaturus), Chuanxiong (Ligusticum Chuanxiong Rhizoma), Guangpi (Citri Reticulatae Pericarpium), Renshen (Ginseng Radix et Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma).
Qianghuo Chonghe Tang (Notopterygium Harmonizing Decoction)
Ingredients: Qianghuo, Fangfeng (Saposhnikoviae Radix), Cangzhu (Atractylodis Rhizoma), Chuanxiong, Xixin (Asari Radix et Rhizoma), Baizhi (Angelicae Dahuricae Radix), Shengdi (Rehmanniae Radix), Huangqin (Scutellariae Radix), Gancao.
Shengyang Sanhuo Tang (Raise Yang Scatter Fire Decoction)
Ingredients: Shengma (Cimicifugae Rhizoma), Gan'ge (Puerariae Lobatae Radix), Qianghuo, Duhuo, Renshen, Baishao (Paeoniae Radix Alba), Chaihu, Fangfeng, Gancao.
Xiao Chaihu Tang (Minor Bupleurum Decoction) See previous Shanghan section.
Jiegeng Tang (Platycodon Decoction)
Daochi Geban Tang (Guide Red Half-Decoction)
Liangge San (Cool Diaphragm Powder) See above three formulas under Re Bing section.
If there is no exterior syndrome of aversion to cold and body pain, but only internal heat, vexation, thirst, profuse sweating, cracked lips, desire to drink water, and deep-rapid pulses throughout all positions, it is Re Bing (Heat Stroke) without exterior pathogen. If initially presenting with fever, aversion to cold, headache, body pain, and floating-rapid pulses, it is Hanre Bing with exterior pathogen, to be treated via the Three Yang meridians. Upon seeing aversion to cold, prioritize the Taiyang meridian, as exogenous diseases fear most the failure to resolve the exterior pathogen. Xiao Chaihu Tang specifically treats Shaoymeridian alternating chills and fever. For combined Taiyang-Shaoyang alternating chills and fever, Zhang Zhongjing used Guizhi Chaihu Tang (Cinnamon Twig and Bupleurum Decoction), and our family secret formula established Qianghuo Chaihu Tang (Notopterygium and Bupleurum Decoction). For combined Taiyang-Yangming alternating chills and fever, Zhang Zhongjing used Guizhi Gegen Tang (Cinnamon Twig and Kudzu Decoction), and our family secret formula established Qianghuo Gan'ge Tang (Notopterygium and Pueraria Decoction). For Three-Yang combined alternating chills and fever, we now supplement with Qiangchai Gegen Tang (Notopterygium-Bupleurum-Kudzu Decoction). Generally, for Hanre Bing, one must first scatter the exterior pathogen. Even if interior heat is severe, if absolutely necessary, one can only simultaneously resolve both exterior and interior, never using purely cold-natured herbs, which would hinder the resolution of the aversion-to-cold exterior syndrome.