丹溪谓《金匮》为论杂病之书,以示别于《伤寒论》似也。抑知《金匮》即论伤寒中杂
病,
非论一切杂病乎!夫痉、湿、 、奔豚气、宿食、呕吐、哕、下利之为寒类,仲景有明文;
百合、狐惑、阴阳毒之属寒科,《千金》有成例;疟、痈、咳、心痛、腹满、寒疝、积聚、
水气之挟寒,见于《灵》、《素》∶中风、历节、心痹、胸痹、痰饮,消渴、黄胆、惊悸、
吐衄、下血、瘀血、转筋、狐疝之或由风或由寒,详于《病源》,虚劳必助其阳,肢肿必吐
其痰,蛔动必温其胃可见也。其尤着者,中风宜若多端,反取风寒湿杂至之痹为正;下利宜
若不一,专以阳脉阳症为顺;肺萎、上气、淋似乎热矣,而萎有甘草干姜汤症,上气有半夏
越婢汤症,淋有弦急痛引症。妇人病则尤杂矣,则妊娠、呕吐、产后三症,皆从伤寒法治;
经水不论过期、不及期,并主温经汤,是皆以或纯寒或兼寒者言也。若临症者泥此概施,鲜
不贻害!作书之旨,自为“寒”字穷其类耳,勿执小异而疑大同。仲景自名其书曰《伤寒杂
病论》,自叙其由曰宗族死伤寒,故迄于隋唐总呼伤寒者以此。自林亿校成,始与伤寒分。
而丹溪之说行,近世又以其方论多倚温热,不得其解,则曰此北学也。吁!其蔽甚于丹溪矣
。
丹溪认为《金匮要略》是论述杂病的书籍,以此与《伤寒论》相区别,这似乎是有道理的。但他哪里知道,《金匮要略》所论述的正是伤寒病中的杂病,而非论述所有的杂病啊!
那些痉病(以项背强直、角弓反张为特征的疾病)、湿病(感受湿邪所致的疾病)、暍病(中暑)、奔豚气(自觉有气从少腹上冲胸咽)、宿食(停滞不化的食物)、呕吐、哕(呃逆)、下利(腹泻)属于寒证类别,张仲景在书中已有明确记载;百合病(一种以精神恍惚、饮食行为失调为特征的疾病)、狐惑病(类似现代白塞氏病,以口腔、生殖器溃疡及眼炎为特征)、阴阳毒(以发斑、咽喉痛为主要表现的急性热病)属于寒证范畴,《千金方》已有成例;疟疾(由疟邪引起的周期性寒战高热疾病)、痈肿(体表化脓性感染)、咳嗽、心痛、腹满(腹部胀满)、寒疝(因寒邪引起的腹痛)、积聚(腹内结块)、水气(水肿)夹杂寒邪的情况,见于《灵枢》、《素问》;中风(外感风邪或肝风内动所致病证)、历节病(关节疼痛遍历全身的风湿痹证)、心痹(心脏受邪导致的痹证)、胸痹(胸部闷痛为主的病证)、痰饮(体内水液代谢障碍形成的病理产物)、消渴(以多饮、多食、多尿、消瘦为特征的疾病)、黄疸(以身黄、目黄、小便黄为主症的疾病)、惊悸(心神不宁、心跳不安)、吐血衄血(各种出血症状)、下血(便血等下部出血)、瘀血(血液运行不畅或离经之血)、转筋(肌肉痉挛,俗称抽筋)、狐疝(时隐时现的疝气)有的由风邪引起,有的由寒邪引起,这些在《诸病源候论》中都有详细记载。虚劳病必须扶助其阳气,肢体肿胀必须吐出其痰饮,蛔虫扰动必须温补其胃气,这些都是显而易见的。
其中尤为显著的是,中风看似病因繁多,反而取风寒湿邪杂至所致的痹证作为正治之法;下利看似种类繁多,专门以阳脉、阳症为顺证;肺痿(肺部萎弱不用,以咳吐浊唾涎沫为主症)、上气(气逆喘促)、淋证(小便频数短涩滴沥刺痛)似乎属于热证了,但肺痿有使用甘草干姜汤的证候,上气有使用半夏越婢汤的证候,淋证有弦急痛引的证候。妇女的疾病则更加复杂了,然而妊娠、呕吐、产后这三种病症,都按照伤寒法治则处理;月经不论过期还是不及期,都主治以温经汤,这都是针对或纯寒或兼寒的情况而言的。如果临证医生拘泥于此而一概施用,很少有不造成危害的!著书的宗旨,自然是为了围绕“寒”字穷究其类罢了,不要执着于细微的差异而怀疑整体的大同。张仲景自己将他的书命名为《伤寒杂病论》,自己在序言中说宗族死于伤寒,所以直到隋唐时期总称为伤寒的原因就在这里。自从林亿校订完成后,才与伤寒分开。于是丹溪的说法得以流行,近代人又因为书中的方论多倚重温热药,无法理解,就说这是北方学术。唉!这种偏见比丹溪还要严重啊。
Danyu (Zhu Danxi) stated that the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) is a book discussing miscellaneous diseases, seemingly to distinguish it from the *Shanghan Lun* (Treatise on Cold Damage). However, he fails to realize that the *Jingui Yaolue* discusses miscellaneous diseases occurring within the context of cold damage, rather than all miscellaneous diseases.
Conditions such as Jing disease (spasm characterized by stiffness and opisthotonos), Shi disease (dampness-induced disorders), Ye disease (heatstroke), Ben tun qi (running piglet qi, sensation of gas rushing upward), Su shi (food stagnation), Ou tu (vomiting), Yue (hiccups), and Xia li (diarrhea) belong to the category of cold pathogens, as explicitly recorded by Zhang Zhongjing. Diseases such as Bai he disease (lily disease, characterized by mental restlessness and sensory disturbances), Hu huo disease (fox惑 disease, resembling Behçet's disease with oral/genital ulcers), and Yin Yang du (yin-yang toxicity, acute febrile disease with macules) fall under cold pathogen categories, with established examples in the *Qianjin Fang*. Malaria (periodic chills and fever), Yong zhong (abscesses), Ke sou (cough), Xin tong (heart pain), Fu man (abdominal fullness), Han shan (cold hernia), Ji ju (accumulations and masses), and Shui qi (water qi/edema) involving cold pathogens are seen in the *Ling Shu* and *Su Wen*; Zhong feng (wind stroke), Li jie disease (painful joints throughout the body), Xin bi (heart bi), Xiong bi (chest bi), Tan yin (phlegm-fluid retention), Xiao ke (wasting-thirst), Huang dan (jaundice), Jing ji (palpitations), Tu nu (hematemesis and epistaxis), Xia xue (lower bleeding), Yu xue (blood stasis), Zhuan jin (muscle cramps), and Hu shan (intermittent hernia) are caused either by wind or cold, detailed in the *Bing Yuan*. For deficiency consumption (Xu lao), yang must be assisted; for limb edema, phlegm must be expelled; for roundworm agitation, the stomach must be warmed. These are evident.
Most notably, although Zhong feng seems to have diverse causes, its treatment often targets Bi syndrome caused by the mixture of wind, cold, and dampness. Although Xia li seems varied, it specifically regards yang pulse and yang symptoms as favorable. Fei wei (lung atrophy/withering), Shang qi (rebellious qi), and Lin syndrome (stranguria) seem to involve heat, yet Fei wei has indications for Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction), Shang qi has indications for Ban Xia Yue Bi Tang (Pinellia and Ma Huang Decoction), and Lin syndrome presents with wiry, urgent pain pulling sensations. Women's diseases are even more complex; however, pregnancy, vomiting, and postpartum conditions are all treated according to the principles of cold damage therapy. Menstrual irregularities, whether delayed or early, are primarily treated with Wen Jing Tang (Warming the Menses Decoction). All these discussions address conditions that are purely cold or mixed with cold. If clinicians rigidly apply these without differentiation, they will rarely avoid causing harm! The author's intent was simply to categorize based on the character "Cold," so do not cling to minor differences while doubting the general unity. Zhang Zhongjing named his work *Shanghan Zabing Lun* (Treatise on Cold Damage and Miscellaneous Diseases) and wrote in his preface that his clan died of cold damage; hence, until the Sui and Tang dynasties, it was collectively referred to as cold damage. Only after Lin Yi's collation were they separated. Thus, Danyu's theory gained traction. In recent times, because the prescriptions rely heavily on warm and hot herbs, people fail to understand and claim this is Northern scholarship. Alas! This prejudice is even greater than Danyu's.