凡感四时六淫之邪。而病身热者。今人悉以伤寒名之。是伤寒者。热病之总名也。
其因于寒者。自是正病。若夫因暑因湿。因燥因风。因六淫之兼气。或非时之戾气。发为风温、湿温、
温病、寒疫等症。皆类伤寒耳。病热虽同。所因各异。不可概以伤寒法治之。且伤寒正病绝少。类症尤多。
苟不辨明。未免有毫厘千里之差。准绳独以类症弁诸首。亦以辨症为先务也。用仿其意。首列类症。凡
同伤寒之例而治者十一症。不同者八症。共一十九症。庶临症者得其先务云。
冬温 春温 寒疫 热病 湿温 风温 霍乱 痉 湿痹 风湿 中 （以上十一症同伤寒施治）
伤食 痰 香港脚 内痈 虚烦 蓄血 黄耳 赤胸(以上八症不同伤寒施治）
自霜降以后。天气寒冷。感之而病者。伤寒也。
霜降以后。当寒不寒。乃更温暖。因而衣被单薄。以致感寒而病者。冬温也。
邵评∶冬温者。冬时受邪而即病者也。症多客寒包火。
春时天道和暖。有人壮热口渴。而不恶寒者。温病也。以辛温药汗之。则坏矣。若天令尚寒。
冰雪未解。感寒而病者。亦伤寒也。
邵评∶春温病有两种。冬受寒邪不即病。至春而伏气发热者。名曰春温。若春令太热。外受时邪而病者。
此感而即发之春温也。辨症之法。伏气春温。初起但热不寒而口渴。此自内而发出于外也。感而即发之
春温。初起微寒。后则但热不寒。此由肺卫而受也。
三月以后。八月以前。天道或有暴寒。感之而病者。时行寒疫也。此寒疫亦伤寒也。不得以正疫治之。
夏至以后。时令炎热。有人壮热烦渴。而不恶寒者。热病也。热病与中暑相似。但热病脉盛。中暑脉虚。
邵评∶热病中暑两病。同在夏天。故必以脉辨之。热病脉盛。大而有力。中暑脉虚。弦而芤细。
夏月有病。头痛谵语。自汗。身不甚热。两胫逆冷。四肢沉重。胸腹满而渴者。湿温也。
其人常伤于湿。因而中暑。湿热相搏。故发此病。不可发汗。
头痛身热自汗。与伤寒同。而脉尺寸俱浮。身重默默。但欲眠鼻鼾。语言难出。四肢不收者。风温也。不可发汗。
病呕吐而腹痛泄泻。恶寒发热。或吐或利。而发热者。霍乱也。
身热足寒。头项强急。恶寒时头热面赤。目脉赤。独头摇。卒口噤。背反张者。痉也。
太阳病。发热无汗。反恶寒者。为刚痉。发热汗出。不恶寒者。为柔痉。
邵评∶以有汗无汗。恶寒不恶寒。分别刚柔二痉。刚为寒。柔为风。
太阳病。关节痛而烦。脉沉而细。此名湿痹。其候小便不利。大便反快。但当利其小便。
病者一身尽痛。发热晡剧。脉浮而濡。额上微汗。不欲去衣被。或四肢浮肿。此风温也。不可大汗。若汗
大出。风去湿不去。但令微微似欲汗出者。风湿俱去也。
太阳中热。 是也。发热恶寒。身重而痛。汗出而渴。脉微弱。以上十一症。同伤寒施治。
头痛发热。与伤寒同。而身不痛。右关短滑。左脉和平者。伤食也。中脘必痞闷。亦有停食兼感寒者。
人迎气口脉俱大。
憎寒发热。恶风自汗。胸满气上冲咽。不得息。与伤寒相似。而头不痛。或时痛时止。
其脉紧而不大者。痰也。痰在上焦。则寸口脉沉滑。或沉伏。痰在中焦。则右关脉滑大。有气郁。则沉
而滑。夹食。则短而滑。凡脉弦滑者。有痰饮。偏弦者主饮。沉弦者。有悬饮内痛。
发热憎寒头痛。肢节痛。呕恶。与伤寒相似。而痛起自脚。脚膝肿痛。两胫肿满。或枯细。大便坚者。香港脚也。
脉浮数发热。洒淅恶寒。若有痛处。饮食如常者。内痈也。胸中隐隐痛。振寒脉数。咽
干不渴。口中咳。时出浊唾腥臭。久而吐脓者。肺痈也。小腹重皮急。按之痛。便数如
淋。久必便脓血。时时汗出。复恶寒。脉滑而数者。肠痈也。胃脘隐隐而痛。手不可近。
胃脉沉细。人迎逆而盛者。胃脘痈也。
烦热与伤寒相似。而脉不浮紧。头不疼。身不痛。不恶寒。或烦时头亦痛。烦止而痛止者。虚烦也。
发热如伤寒。而其人有所从高坠下。 扑损伤。或盛怒叫呼。或强力负荷。无何而病。小便自利。
口不甚渴。按胸胁脐腹间有痛处。或手不可近者。蓄血也。（以上出准绳）
发热恶寒。脊强背直。有似痉状。耳中策策作痛者。黄耳也。此属太阳。风入肾经。以荆防败毒散、
加蝉蜕、黄芩、赤芍、紫荆皮。寒邪重者。以小续命汤、加白附、天虫、天麻。外治法。用苦参磨水滴耳中。
发热恶寒头痛。似伤寒。而胸膈赤肿疼痛者。赤胸也。属少阳风热。以荆防败毒散、加芩、连、栝蒌、
元参、赤芍、升麻、紫荆皮、大便燥实加大黄。外治法。用三棱针刺其血。则肿消痛止矣。（黄耳赤胸出
伤寒奥旨）以上八症。不同伤寒施治。
按伤寒类症虽多。惟温热关于伤寒为尤重。以今之伤寒。大半属于温热也。且
治法与伤寒不侔。伤寒入足经。而温邪兼入手经。伤寒宜表。而温邪忌汗。伤寒药宜辛温。而温邪
药宜辛凉。苟不辨明。必有误治。故兹集特参以温热立论。而以温热之法为兼治焉。凡列于太阳症内。
是伤寒正病。而列于阳明少阳经中。其症都兼温热。盖少阳木火之原。阳明湿热之薮。其风温温热之
邪。自是同气之感。他如霍乱香港脚等症。治法各备本门。
邵评∶此数句。分别伤寒温热之来路不同。治法用药之各异。大宜着眼。
Whenever one contracts the pathogenic factors of the Six Excesses (Liu Yin) of the four seasons and develops fever, people nowadays generally call it Shanghan (Cold Damage). Therefore, Shanghan is the general term for heat diseases.
Among these, those caused by cold are considered Zheng Bing (typical Shanghan). As for those caused by summerheat, dampness, dryness, or wind, or by combined influences of the Six Excesses, or by pestilential qi occurring out of season, which manifest as symptoms such as Fengwen (Wind-Heat), Shiwēn (Damp-Heat), Wenbing (Warm Disease), and Hanyi (Cold Epidemic), they all belong to Lei Shanghan (Shanghan-like diseases). Although the presentation of fever is similar, the etiologies differ; thus, they cannot be treated uniformly with methods for typical Shanghan. Moreover, typical Shanghan cases are rare, while Shanghan-like presentations are numerous. Failure to distinguish them clearly may lead to significant errors in treatment. *Yi Zong Jin Jian* (Golden Mirror of Medicine) places Shanghan-like diseases at the beginning of its volume, emphasizing that differentiation of syndromes is the primary task. I have followed this intent and listed Shanghan-like diseases first. There are eleven syndromes treated similarly to Shanghan and eight treated differently, totaling nineteen syndromes, so that practitioners may grasp the primary tasks when encountering clinical cases.
Winter Warmth, Spring Warmth, Cold Epidemic, Heat Disease, Damp-Heat, Wind-Heat, Huoluan (Cholera-like disease), Jing (Spasm), Shi Bi (Damp Bi), Feng Shi (Wind-Damp), Zhong Yue (Summerheat Strike) (The above eleven syndromes are treated similarly to Shanghan)
Food Retention, Phlegm, Xianggangjiao (Foot Qi/Charcot-Marie-Tooth like condition), Nei Yong (Internal Abscess), Xu Fan (Deficiency Restlessness), Chu Xue (Blood Stasis), Huang Er (Yellow Ear), Chi Xiong (Red Chest) (The above eight syndromes are treated differently from Shanghan)
After the Frost Descent solar term, when the weather is cold, contracting cold pathogens and becoming ill constitutes Shanghan.
After the Frost Descent solar term, if the weather should be cold but remains warm instead, leading to illness due to thin clothing and subsequent contraction of cold, this is Winter Warmth.
Shao's Commentary: Winter Warmth refers to a disease contracted in winter that manifests immediately. The symptoms often present as external cold binding the exterior with internal heat (Ke Han Bao Huo).
In spring, when the heavenly climate is mild and warm, if a person presents with high fever, thirst, and no aversion to cold, it is Wenbing (Warm Disease). Using acrid-warm herbs to induce sweating would result in a complicated disease (Huai Bing). If the seasonal climate remains cold and ice has not melted, contracting cold and becoming ill is also classified as Shanghan.
Shao's Commentary: There are two types of Spring Warmth. One type involves cold pathogens contracted in winter that do not manifest immediately but cause fever in spring due to latent qi; this is named Spring Warmth. The other type occurs when the spring climate is excessively hot, and the person contracts seasonal pathogens causing immediate onset; this is Spring Warmth manifesting immediately after contraction. Differentiation method: For Spring Warmth due to latent qi, initial presentation features only fever without aversion to cold and thirst, indicating emergence from within to the exterior. For Spring Warmth manifesting immediately after contraction, initial presentation features slight aversion to cold, followed by only fever without aversion to cold, indicating invasion via the Lung and Defensive levels.
Between the third and eighth lunar months, if sudden cold occurs in the climate, contracting cold pathogens and becoming ill is called Shixing Hanyi (Seasonal Cold Epidemic). This Cold Epidemic also falls under the category of Shanghan and should not be treated as a typical epidemic disease.
After the Summer Solstice, during the hot season, if a person presents with high fever, restlessness, thirst, and no aversion to cold, it is Re Bing (Heat Disease). Heat Disease resembles Zhong Shu (Heat Stroke), but the pulse in Heat Disease is vigorous, whereas in Heat Stroke it is deficient.
Shao's Commentary: Both Heat Disease and Heat Stroke occur in summer, so they must be differentiated by pulse. Heat Disease presents with a vigorous, large, and forceful pulse; Heat Stroke presents with a string-taut, cun-kou fine, and deficient pulse.
In summer, if a patient presents with headache, delirium, spontaneous sweating, body not significantly hot, reverse coldness in both calves, heaviness in the limbs, fullness in the chest and abdomen, and thirst, it is Shi Wen (Damp-Heat).
This individual has frequently been injured by dampness and subsequently struck by summerheat; the dampness and heat contend with each other, causing this disease. Sweating methods should not be used.
Headache, body heat, and spontaneous sweating resemble Shanghan, but the pulse at the cun, guan, and chi positions on both hands is floating. The body feels heavy, the person is silent, desires sleep, snores, has difficulty speaking, and cannot control the limbs. This is Feng Wen (Wind-Heat). Sweating methods should not be used.
Illness presenting with vomiting, abdominal pain, diarrhea, aversion to cold and fever, alternating between vomiting and purging, accompanied by fever, is Huoluan (Cholera-like disease).
Body heat, cold feet, stiffness and tension in the head and neck, aversion to cold with simultaneous heat in the head and red face, redness of the eye vessels, isolated head tremor, sudden lockjaw, and opisthotonos constitute Jing (Spasm).
In Taiyang disease, fever without sweating and paradoxical aversion to cold indicates Gang Jing (Stiff Spasm). Fever with sweating and no aversion to cold indicates Rou Jing (Flexible Spasm).
Shao's Commentary: Gang Jing and Rou Jing are distinguished by the presence or absence of sweating and aversion to cold. Gang Jing is associated with cold, while Rou Jing is associated with wind.
In Taiyang disease, joint pain accompanied by irritability and a deep, fine pulse is named Shi Bi (Damp Bi). Its signs include difficult urination and loose stools; treatment should focus on promoting diuresis.
A patient suffering from generalized body pain, fever worsening in the late afternoon, a floating and soggy pulse, slight sweating on the forehead, reluctance to remove clothes, or edema in the four limbs, suffers from Feng Shi (Wind-Damp). Profuse sweating should be avoided. If sweating is excessive, the wind pathogen leaves but the dampness remains. Only by inducing a slight, continuous perspiration can both wind and dampness be expelled.
Taiyang Zhong Re (Heat Strike in Taiyang) refers to Zhong Yue (Summerheat Strike). Symptoms include fever, aversion to cold, heaviness and pain in the body, sweating, thirst, and a weak pulse. The above eleven syndromes are treated similarly to Shanghan.
Headache and fever resemble Shanghan, but the body does not hurt. The right guan pulse is short and slippery, while the left pulse is peaceful. This indicates Food Retention. There will likely be stuffiness and oppression in the Zhongwan area. In some cases, food retention is combined with cold contraction, resulting in both Renying and Qikou pulses being large.
Avulsion from cold, fever, aversion to wind, spontaneous sweating, chest fullness, qi rushing up to the throat causing dyspnea, resembling Shanghan but without headache, or with intermittent headache. A tight pulse that is not large indicates Phlegm. If phlegm is in the Upper Jiao, the cunkou pulse is deep and slippery, or deep and hidden. If phlegm is in the Middle Jiao, the right guan pulse is slippery and large. With qi stagnation, the pulse is deep and slippery. With food retention, the pulse is short and slippery. Generally, a string-taut and slippery pulse indicates phlegm-fluids. A predominantly string-taut pulse indicates fluid retention. A deep and string-taut pulse indicates Xuan Yin (hanging fluid) and internal pain.
Fever, avulsion from cold, headache, joint pain, vomiting, and nausea resemble Shanghan, but the pain originates in the feet, with swelling and pain in the ankles and knees, fullness or emaciation of the calves, and hard stools. This is Xianggangjiao (Foot Qi).
A floating and rapid pulse, fever, shivering chills, presence of painful areas, and normal appetite indicate Nei Yong (Internal Abscess). Hidden pain in the chest, chills, rapid pulse, dry throat without thirst, coughing up turbid, foul-smelling sputum, and eventual expectoration of pus over time indicate Fei Yong (Lung Abscess). Heaviness in the lower abdomen, tense skin, tenderness upon pressure, frequent urination resembling strangury, eventual passage of pus and blood in stool, occasional sweating, aversion to cold, and a slippery and rapid pulse indicate Chang Yong (Intestinal Abscess). Hidden pain in the epigastrium, extreme tenderness where touch is unbearable, a deep and fine stomach pulse, and a reversed and vigorous Renying pulse indicate Wei Wan Yong (Epigastric Abscess).
Restless heat resembling Shanghan, but with a pulse that is not floating and tight, no headache, no body pain, and no aversion to cold. Or, headache occurs only when restlessness is present and ceases when restlessness subsides, indicates Xu Fan (Deficiency Restlessness).
Fever resembling Shanghan, but the patient has suffered a fall from height, blunt trauma, intense anger with shouting, or strenuous labor, followed shortly by illness. Urination is free, thirst is minimal, and there is tenderness in the chest, hypochondrium, umbilicus, or abdomen, or extreme tenderness to touch. This is Chu Xue (Blood Stasis). (Above sourced from *Yi Zong Jin Jian*)
Fever, aversion to cold, spinal rigidity, resembling spasm, with stinging pain in the ears, is Huang Er (Yellow Ear). This belongs to the Taiyang channel, with wind entering the Kidney meridian. Use Jing Fang Bai Du San (Schizonepeta and Saposhnikovia Decoction) plus Chan Tui (Cicada Slough), Huang Qin (Scutellaria Root), Chi Shao (Red Peony Root), and Zi Jing Pi (Bark of Cinnamomum Camphora). For severe cold pathogens, use Xiao Xu Ming Tang (Minor Continuation of Life Decoction) plus Bai Fu Zi (Typhonii Rhizoma), Tian Nan Xing (Arisaema Cum Bile), and Tian Ma (Gastrodiae Rhizoma). External treatment: grind Ku Shen (Sophora Root) with water and drip into the ear.
Fever, aversion to cold, headache, resembling Shanghan, but with redness, swelling, and pain in the chest and diaphragm, is Chi Xiong (Red Chest). This belongs to Shaoyang Wind-Heat. Use Jing Fang Bai Du San plus Huang Qin, Lian Qiao, Gua Lou (Trichosanthes Fruit), Yuan Shen (Scrophulariae Radix), Chi Shao, Sheng Ma (Cimicifugae Rhizome), Zi Jing Pi, and Da Huang (Rhei Radix et Rhizoma) if there is dry stool and excess. External treatment: prick with a three-edged needle to release blood, which will reduce swelling and stop pain. (Huang Er and Chi Xiong sourced from *Shanghan Ao Zhi*) The above eight syndromes are treated differently from Shanghan.
Note: Although there are many Shanghan-like syndromes, Wenre (Warm-Thermal) diseases are particularly important in relation to Shanghan. Most contemporary Shanghan cases belong to the Warm-Thermal category. Furthermore, their treatment differs from Shanghan. Shanghan enters the Foot meridians, while Warm pathogens involve the Hand meridians. Shanghan requires surface-releasing methods, whereas Warm pathogens contraindicate sweating. Shanghan medications should be acrid-warm, while Warm pathogen medications should be acrid-cool. Failure to distinguish these will inevitably lead to misdiagnosis and mistreatment. Therefore, this collection specifically incorporates Warm-Thermal theory and applies Warm-Thermal methods as adjunctive treatments. Syndromes listed under Taiyang represent typical Shanghan, while those listed under Yangming and Shaoyang channels typically involve Warm-Thermal elements. This is because Shaoyang is the source of Wood and Fire, and Yangming is the reservoir of Dampness and Heat; thus, Wind-Warm and Warm-Thermal pathogens naturally resonate with these energies. Other syndromes such as Huoluan and Xianggangjiao have their respective treatments detailed in their own sections.
Shao's Commentary: These sentences differentiate the origins of Shanghan and Warm-Thermal diseases and highlight the differences in treatment methods and medication. This deserves careful attention.