冬令严寒。万类闭藏。君子固密。则不伤于寒。触犯其邪。名曰伤寒。夫四时之气。皆
能为
肤。至春而发。名为温病。至夏而发。名为热病。独不言至秋为凉病者。何也。寒水之气。
与火为仇。遇仇不发。已为火胜。而长夏湿土。又制水邪。况逢金令。金得寒而愈坚。故秋
月无伤寒也。秋病之似伤寒者。皆夏月纳凉之邪。或时行不正之气。或秋令凉气之邪耳。仲
景方法。为冬月即病之正伤寒设也。后世混将冬月伤寒之方。通治春夏温热之病。遗祸至今
。未有能改。陶节庵以麻黄桂枝。难以轻投。竟以冲和代之。施于时疫之病。犹或可也。用
于伤寒之症。不亦悖乎。深嗟今之治伤寒者。在一二日。不问属虚属实。便汗之。在三四日
。不问在经在腑。便和之。在五六日。不问在表在里。便下之。投剂一瘥。幽泉沉冤矣。人
之表里虚实不同。邪之传变异气各别。奈何拘于日数不审形证耶。且寒邪伤人。原无定体。
或自太阳始。日传一经。六日传至厥阴而愈者。或不罢而留滞一经者。或间经而传者。或
但传二三经而止者。或始终只在一经者。或越经而传者。或阳经一齐合病者。或阳经后先并
病者。或初入太阳。不作郁热。便入少阴而成阴症者。或直中阴经而为真寒者。或伤生冷而
为内伤寒者。必审脉验症。辨名定经。确然无疑。然后投剂。日数虽多。但见表症脉浮者犹
宜汗之。日数虽少。但见里症脉沉者即当下之。若表里症俱见。或表里症俱无。此属半表半
里。禁汗禁下禁吐。但当和之。若日久不愈。脉虚神困者盒饭补之。果能辨阴阳。审表里。
察虚实。譬之善射。莫不中的矣。
In winter, the cold is severe, and all things are stored away. If a gentleman maintains his solidity and secrecy (preserves his vital qi), he will not be injured by cold. If one encounters its pathogenic factor, it is named Cold Damage (Shanghan). The qi of the four seasons can all affect the skin. When it emerges in spring, it is called Warm Disease (Wenbing); when it emerges in summer, it is called Heat Disease (Rebing). Why is there no mention of "Cool Disease" for autumn? This is because the qi of cold water is hostile to fire. It does not erupt when meeting its enemy (fire), as it has already been overcome by fire. Moreover, the damp earth of late summer controls the water pathogen. Furthermore, when the metal command arrives, metal becomes harder with cold. Therefore, there is no true Cold Damage in autumn. Diseases in autumn that resemble Cold Damage are all due to the pathogen of cooling down in summer, or irregular epidemic qi, or the cool qi pathogen of autumn. Zhang Zhongjing's methods were established for true Cold Damage occurring immediately in winter. Later generations confused the formulas for winter Cold Damage and used them generally to treat warm-heat diseases of spring and summer, leaving disasters until today, yet no one has been able to correct this. Tao Jie'an believed that Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction) should not be lightly administered, and instead replaced them with Chonghe Tang (Harmonizing Decoction). Applying this to epidemic diseases might be acceptable, but using it for Cold Damage symptoms is indeed contrary to principle. I deeply sigh at those who treat Cold Damage nowadays: within one or two days, without asking whether it is deficiency or excess, they administer sweating methods; within three or four days, without asking whether it is in the meridians or fu organs, they administer harmonizing methods; within five or six days, without asking whether it is in the exterior or interior, they administer purging methods. Once the dosage causes harm, the patient sinks into the underworld with grievances. People differ in their exterior-interior and deficiency-excess conditions, and the transmission and variation of pathogens are distinct. How can one rigidly adhere to the number of days without examining the physical signs and symptoms? Furthermore, cold pathogens injuring humans have no fixed form. Some start from Taiyang (Greater Yang), transmitting one meridian per day, reaching Jueyin (Terminal Yin) in six days and healing; some linger in one meridian; some transmit skipping meridians; some stop after transmitting two or three meridians; some remain in one meridian throughout; some skip meridians; some involve simultaneous combination of yang meridians; some involve sequential coexistence of yang meridians; some enter Shaoyin (Lesser Yin) directly from Taiyang without forming stagnant heat, becoming yin syndromes; some strike directly into yin meridians causing true cold; some become internal cold damage due to consuming raw or cold foods. One must examine pulses and verify symptoms, distinguish names, and determine meridians with certainty before administering medicine. Even if many days have passed, if exterior signs and floating pulse are present, sweating is still appropriate. Even if few days have passed, if interior signs and deep pulse are present, purging is immediate. If both exterior and interior signs are present, or neither is present, this belongs to Half-Exterior Half-Interior (Banbiao Banli). Sweating, purging, and vomiting are prohibited; only harmonizing is allowed. If the disease persists for a long time and the pulse is deficient with mental fatigue, tonification is required. If one can truly distinguish yin and yang, examine exterior and interior, and observe deficiency and excess, it is like a skilled archer hitting the target every time.