《伤寒论》于伤寒外称中风,各详其脉证于六经篇。《病源》谓之中风、伤寒,其论即
取论
中六经脉证。《千金》、《外台》相承皆如此。泉案《金匮》有中风篇, 仲景不以此病同
列于彼者,以此与伤寒相似,与痹、历节等不相似故也。巢氏以伤寒称之,最得其旨。盖冬
时疾风及非时寒风,其来无渐,非关触冒,故云中。又以其彼来而我始冒之,故云中,又可
云伤。又以此风起毫毛发腠理,入袭于卫而自汗,不能循经而传,故论文特起传经例于伤寒
条后,而中风条不之及。欲知传经与否之义,但取《伤寒论》营行脉中、卫行脉外,及风则
伤卫、寒则伤营数语绎之自明,勿为近世所惑也。
凡论四气,当分二例。自春分至秋分皆为暑,自秋分至立春皆为寒。二气极偏,皆从风
伤于
人。经以暑配夏、寒配冬者,据其极偏之气,配以极偏之时也。春之温和,秋之凉和,本无
所偏,介乎寒暑往来之间,而不可以寒暑言,故于春言风,以温非邪,风则为邪。又以此风
不偏胜,故但言伤于风,不别言寒者,非谓风止于春伤人也。于秋言湿者,秋承中土之后,
本气既无可言,即以中土之湿配之。秋谓秋分以前,若秋分后天气已寒,此时伤之,则从伤
寒法。经意以四气分发四时,言自难齐,当以意逆实,当如伤寒例从秋分后皆为伤寒也。秋
以土气为气者,正如草木黄落,以土色为色之比。近喻嘉言欲改“湿”字为燥,非是。不观
《灵·九宫八风》又以湿配东乎,喻又将何以改之?
《伤寒论》在论述伤寒之外,还专门论述了中风,并在六经篇中详细记载了各自的脉象和症状。《诸病源候论》(简称《病源》)关于中风和伤寒的论述,也是直接引用《伤寒论》中六经的脉证内容。孙思邈的《千金方》和王焘的《外台秘要》也都沿袭了这一做法。我(泉)考证认为,《金匮要略》中有中风篇,张仲景没有将这种病与伤寒并列在那里的原因,是因为中风与伤寒相似,而与痹证、历节病等不相似。巢元方将其称为“伤寒”,最得其中旨意。大概是因为冬季的疾风和不合时令的寒风,来得没有征兆,并非因为接触冒犯所致,所以称为“中”(意为突然遭受)。又因为是外界邪气袭来而人体才开始受邪,所以称为“中”,也可以称为“伤”。再者,因为这种风邪从毫毛和腠理侵入,袭击卫气导致自汗,不能按照常规经络传变,所以在《伤寒论》中特别在伤寒条文后设立传经的例子,而对中风条文则未提及传经的问题。想要了解是否发生传经的意义,只需依据《伤寒论》中“营气行于脉中,卫气行于脉外”,以及“风邪伤卫,寒邪伤营”这几句话来推演,自然就会明白,不要被近世人的观点所迷惑。
凡是论述四时之气,应当分为两种情况。从春分到秋分都称为暑,从秋分到立春都称为寒。这两种气候极端偏颇,都是从风邪伤人。经典中将暑配属夏季、寒配属冬季,是根据它们极端偏颇的气候特征,配属于极端偏颇的时节。春季的温和、秋季的凉和,本来没有什么偏颇,介于寒暑交替之间,不能用寒暑来概括,所以在春季谈论风,因为温不是邪气,风才是邪气。又因为这种风邪不偏胜,所以只说伤于风,不另外说伤于寒,这并不是说风只在春季伤人。在秋季谈论湿,是因为秋季承接在中央土气之后,本气既然无可言说,就用中央土的湿气来配属它。这里所说的秋是指秋分以前,如果秋分后天气已经寒冷,此时受邪,就按照伤寒的方法治疗。经典的用意是将四气分别配属四时,说法难以完全整齐划一,应当通过心意去逆推其实质,应该像《伤寒例》所说的那样,从秋分以后都算作伤寒。秋季以土气为其特征,正如草木枯黄凋落,以土的颜色为颜色一样。近代的喻嘉言想要将“湿”字改为“燥”,这是不对的。如果不看《灵枢·九宫八风》又将湿配属于东方,喻嘉言又打算如何修改呢?
In the *Shanghan Lun* (Treatise on Cold Damage), besides discussing cold damage, Zhongfeng (Wind Strike) is also addressed, with their respective pulse manifestations and symptoms detailed in the chapters on the Six Meridians. The *Bingyuan* (Source of Diseases) discusses Zhongfeng and cold damage, basing its arguments directly on the pulse and symptom patterns of the six meridians from the *Shanghan Lun*. This approach was inherited by the *Qianjin Yaofang* (Essential Prescriptions Worth a Thousand Gold) and the *Waitai Miyao* (Secret Essentials of the External Sage). In my examination, although the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) has a chapter on Zhongfeng, Zhang Zhongjing did not list this disease alongside cold damage there because it is similar to cold damage but dissimilar to Bi Syndrome (Obstruction Syndrome) and Lijie Disease (Periarthritis/Joint Deformity). Chao Yuanfang’s designation of it as "cold damage" captures the essence most accurately. Generally, fierce winds in winter and unseasonable cold winds arrive without gradual warning, not necessarily due to direct contact or exposure, hence termed "Zhong" (to be struck/inflicted). Furthermore, since the pathogen comes externally and the body begins to suffer upon exposure, it is called "Zhong," which can also be interpreted as "Shang" (injury/damage). Moreover, such wind pathogens enter through the hair follicles and interstices (Couli), attacking the Wei Qi (Defensive Qi) causing spontaneous sweating, and do not transmit along the meridians in the usual manner. Therefore, in the text, the example of meridian transmission is specifically established after the cold damage clauses, while no mention is made of transmission in the Zhongfeng clauses. To understand the meaning regarding whether transmission occurs, one need only deduce from the statements in the *Shanghan Lun*: "Ying Qi (Nutritive Qi) circulates within the vessels, Wei Qi circulates outside the vessels," and "Wind injures Wei Qi, Cold injures Ying Qi." This will become clear; do not be confused by modern interpretations.
When discussing the Four Qi (Four Climatic Factors), two examples should be distinguished. From the Spring Equinox to the Autumn Equinox is all considered Shu (Summer Heat); from the Autumn Equinox to the Start of Winter is all considered Han (Cold). These two climatic factors are extremely biased/extreme and both harm humans via Wind. The classics pair Shu with Summer and Han with Winter based on their extreme climatic characteristics and associate them with the most extreme seasons. The mildness of Spring and the cool harmony of Autumn have no inherent bias; they lie between the transition of Cold and Heat and cannot be described merely as Cold or Heat. Thus, in Spring, we speak of Wind, because Warmth is not a pathogenic factor, whereas Wind is. Since this Wind is not excessively dominant, we simply say "injured by Wind" and do not separately specify "Cold," not implying that Wind only harms people in Spring. Regarding Autumn, we speak of Shi (Dampness) because Autumn follows the Central Earth element. Since the intrinsic Qi of Autumn itself is hard to define, the Dampness of Central Earth is paired with it. Here, "Autumn" refers to the period before the Autumn Equinox. If injury occurs after the weather has turned cold post-Autumn Equinox, it should be treated according to the methods for Cold Damage. The intent of the classics is to distribute the Four Qi among the Four Seasons, making the descriptions difficult to align perfectly; one must infer the reality through understanding, just as the *Shanghan Li* (Example of Cold Damage) states that everything from the Autumn Equinox onwards constitutes Cold Damage. Autumn is associated with Earth Qi, just as trees turn yellow and fall, adopting the color of Earth. Yu Jiayan of recent times wished to change the character "Shi" (Dampness) to "Zao" (Dryness), which is incorrect. Has he not observed that in the *Lingshu: Jiugong Bafeng* (Spiritual Pivot: Nine Palaces and Eight Winds), Dampness is also paired with the East? How then could Yu Jiayan justify such a change?