妇人中风六七日。身热续续发寒 。经水适来或适断。热随阴血居其室。昼则明了
暮
语。状如见鬼似疟疾。无犯胃气及三焦。小柴胡汤尤为的。更刺期门似泻肝。邪去自然保安
吉。切须急疗莫迟迟。变症来时恐莫及。
春气温和夏暑热。秋气清凉冬凛冽。四时正气自调匀。不犯寒邪无病孽。冬时严寒
欲周
密。君子深藏宜入室。中而即病曰伤寒。触冒寒邪成此疾。毒瓦斯入深不即病。至春与夏邪方
出。春为温病夏为暑。变态无端病非一。若乃时行自不同。盖是非时之气失。春时应暖反大
寒。夏时应热偏寒 。秋气清凉大热来。冬月严寒如春日。少长一般病相似。此是时行归瘟
疫。防风通圣扶正气。九味羌和汤检一。
食积寒痰并香港脚。更兼亦有患劳烦。要识四般相类症。不与伤寒一例看。
寒痰者。中脘停痰。自中胸满。但头不痛。项不强。与伤寒异耳。宜二陈汤主之。
食积
者谓胃中停食。发热头痛。但身不痛气口紧盛。与伤寒异耳。宜平胃散主之。香港脚者。足
受寒湿。头痛、身热、肢节痛、便秘、呕逆。但脚痛。或肿满。或枯细。与伤寒异耳。宜加减
小续命汤主之。劳烦者。气血俱虚。燥烦发热。但身不痛。头不痛。不恶寒。脉不浮紧。与
伤寒异耳。宜补中益气汤主之。李东垣内伤外感辨曰。伤于饮食劳复。七情六欲。为内伤。
伤于风寒暑湿为外感。内伤发热。时热时止。外感发热。热甚不休。内伤恶寒。得暖便
解。外感恶寒。虽浓衣烈火不除。内伤恶风。不畏甚风。反畏隙风。外感恶风。见风便恶。
内伤头痛。乍痛乍止。外感头痛。连痛不休。直待表邪传里方罢。内伤有湿。或不作渴。或
心火乘肺。亦作燥渴。外感须一二日外。表热传里。口方作渴。内伤则热伤气。四肢沉困无
力。倦怠嗜卧。外感则风伤筋。寒伤骨。一身筋骨疼痛。内伤则短气不足以息。外感则喘壅
气盛有余。内伤则手心热。外感则手背热。天气通于肺鼻者。肺之外候。外感伤寒。则鼻塞
。伤风则流涕。然能饮食。口知味。腹中和。二便如常。地气通于脾口者。脾之外候。内伤则
懒言恶食。口不知味。小便黄赤。大便或秘或泄。左人迎脉主里。内伤则气口大于人迎。内
伤证属不足。宜温。宜补。宜和。外感证属有余。宜汗。宜吐。宜下。若内伤之症。误作外
感。妄发其表。重虚元气。祸如反掌。故立补中益气汤主之。又有内伤外感兼病者。若内伤
重者。宜补养为先。外感重者。宜发散为急。惟上焦痰呕。中焦湿热。伤食膈满者。皆不服
补中益气汤。明医杂着云。世间发热症。类伤寒者数种。治各不同。张仲景论伤寒伤风。此
外感也。风寒之邪。感于外。自表入里。故宜发表以解散之。此麻黄桂枝之义也。以其感于
冬时之令。寒冷之月。实时发病。故谓之伤寒。而药用辛热以胜寒。若时非寒冷。则药当有
变矣。如春温之月。则当变以辛凉之药。夏暑之月。则当变以甘寒苦之药。又有一种冬温之
病。谓之非其时而有其气。盖冬寒时也。而反病温焉。此天时不正。阳气反泄。用药不可温
热。又有一种时行寒疫。却在温暖之时。当温暖而寒反为病。此亦天时不正。阴气反逆。用
药不可寒凉。又有一种温疫热病。多发于春夏之间。沿门合境相同者。此天地之疠气。当随
时令。参气运。而施治。宜用刘河间辛凉甘苦寒之药。以清热解毒。以上诸症。皆为感天地
之邪者。若夫饮食劳倦为内伤元气。此则真阳下陷。内生虚热。故东垣发补中益气之论。用
参等甘温之味。大补其气。而提其下陷。此用气药以补其不足也。又若劳心好色。内伤真
阴。阴血既伤。故阳气偏胜而变为火矣。是谓阴虚火旺。劳瘵之症。故丹溪发阳有余。阴不
足之论。用四物加黄柏知母补其阴。而火自降。此用血药以补血之不足也。补气补血。皆
内伤症也。一则因阳气之下陷以升提之。补其气。一则因阴火之上升。滋其阴。以降下之。
一升一降。迥然不同矣。又有夏月伤暑之病。虽属外感。却类伤寒。与伤寒大异。盖伤寒
则寒邪客表有余之症。故宜汗之。暑伤气。元气为热所伤。而耗散不足之症。故宜补之。东
垣所谓清暑益气是也。又有因时暑热而多食冷物以伤其内。或过取凉风以伤其外。此非暑伤
。乃因暑而自致之病。治宜辛热解表。或辛温理中之药。却与伤寒治法相类者也。凡此数
症。外形相似。实有不同。治法多端。不可或谬。故必审其果为伤寒及寒疫也。则用仲景法
。果为温病及瘟疫也。则用河间法。果为气虚也。则用东垣法。果为阴虚也。则用丹溪法。
如是。则庶无差误以害人矣。今人但见发热之症。一皆认作伤寒外感。率用汗药以发其表。
汗后不解。又用表药以凉其肌。设是虚症。岂不死哉。间有颇知发热属虚。而用补药。则
又不知气血之分。或气病而补血。或血病而补气。误人多矣。故外感之与内伤。寒病之与热
病。气虚之与血虚。如冰炭相反。治之若差。则轻病必重。重病不救矣。医贯曰。读伤寒而
不读东垣书。则内伤不明。而杀人多矣。读东垣书而不读丹溪书。则阴虚不明。而杀人多矣
。东垣脾胃论。深明饥饱劳役发热等症。俱是内伤。悉类伤寒。切戒汗下。以为内伤多而外
感少。只须温补。不必发散。如外感多而内伤少。温补中少加发散。以补中益气汤为主。如
内伤兼寒者。加麻黄。兼风者加桂枝。兼暑者加黄连。兼湿者加羌活。此特阳虚发热之一
门也。然阴虚发热者十有六七。亦类伤寒。今人一见发热。则曰伤寒。须用发散而致死。则
曰伤寒之法已穷。余尝于阴虚发热者。见其大热、面赤、口渴、燥烦、与六味地黄丸一剂。
即愈。如下部恶寒。足冷。上部渴甚。燥极。或饮而反吐。即如肉桂五味。甚则加附子冷冻饮料
。以此活人多矣。此丹溪发明阴虚发热之外。尚遗未尽之旨也。
When a woman suffers from Wind-stroke (Zhongfeng, 中风) for six or seven days, her body feels hot and then alternates with chills. Her menstrual flow happens to start or has just ended. The Heat pathogen enters the Blood Chamber (Xueshi, 血室) along with the Yin blood. During the day, her consciousness is clear; at dusk, she speaks incoherently, resembling seeing ghosts or suffering from Malaria (Nüejí, 疟疾). Do not injure the Stomach Qi and the Triple Burner (Sanjiao, 三焦). Xiao Chai Hu Tang (Minor Bupleurum Decoction) is particularly appropriate. Additionally, puncturing Qimen (LR14) helps to drain Liver fire. Once the pathogen is expelled, peace and auspiciousness are naturally restored. One must treat urgently without delay, lest when complications arise, it may be too late.
Spring air is mild, Summer heat is scorching, Autumn air is cool, Winter air is biting. The righteous Qi of the four seasons naturally harmonizes; if one does not violate Cold pathogens, no disease disaster occurs. In winter, when severe cold prevails, gentlemen should hide deeply indoors, keeping precautions meticulous. Illness that arises immediately upon exposure to Cold is called Cold Damage (Shanghan, 伤寒). Illness caused by touching Cold pathogens. If toxic vapors penetrate deeply and do not manifest immediately, the pathogen emerges in Spring or Summer. Manifesting in Spring is Warm Disease (Wenbing, 温病); manifesting in Summer is Summerheat Disease (Shushu, 暑病). The transformations are endless, and diseases are not singular. If it is a Time-Running illness (Shixing, 时行), it is different because it stems from abnormal Qi out of season. When Spring should be warm but is severely cold; when Summer should be hot but is biased towards cold; when Autumn is cool but great heat arrives; when Winter is severely cold yet resembles Spring. Regardless of age, symptoms are similar. This is Time-Running illness归类ed to Plague-Epidemic (Wenyi, 瘟疫). Fang Feng Tong Sheng San (Saposhnikovia and Gardenia Powder to Support Righteous Qi) can support the righteous Qi; Jiu Wei Qiang Huo Tang (Nine-Ingredient Notopterygium Decoction) is also an option.
Food stagnation, Cold Phlegm, and Hong Kong Foot (Jiaoxie, 香港脚 - a condition of lower limb cold-dampness), along with illnesses due to labor and vexation, must be recognized as four types of similar syndromes and not viewed identically to Shanghan. Cold Phlegm syndrome involves phlegm retention in Zhongwan (CV12), causing chest fullness, but without headache or neck stiffness, differing from Shanghan. Er Chen Tang (Two-Cured Decoction) is indicated. Food stagnation refers to food retention in the Stomach, causing fever and headache, but without body pain, with a tight and abundant Qi-kou pulse, differing from Shanghan. Ping Wei San (Peace the Stomach Powder) is indicated. Hong Kong Foot syndrome results from Cold-Damp invading the feet, causing headache, body heat, joint pain, constipation, vomiting, but specifically foot pain, which may be swollen or emaciated, differing from Shanghan. Modified Xu Ming Tang (Extended Life-Giving Decoction) is indicated. Labor-Vexation syndrome involves deficiency of both Qi and Blood, causing dry vexation and fever, but without body pain, headache, aversion to Cold, or a floating-tight pulse, differing from Shanghan. Bu Zhong Yi Qi Tang (Decoction to Supplement the Middle and Augment the Qi) is indicated. Li Dongyuan stated in his differentiation of Internal Injury and External Contraction: Injuries from diet, overwork, Seven Emotions, and Six Desires constitute Internal Injury; injuries from Wind, Cold, Summerheat, and Dampness constitute External Contraction. Internal injury fever comes and goes; external contraction fever is intense and unceasing. Internal injury aversion to Cold resolves with warmth; external contraction aversion to Cold persists despite thick clothing and fire. Internal injury aversion to Wind fears drafty gaps rather than strong wind; external contraction aversion to Wind is triggered by any wind. Internal injury headache is intermittent; external contraction headache is continuous until the exterior pathogen transmits inward. Internal injury dampness may cause no thirst or dry thirst due to Heart Fire attacking Lung; external contraction causes thirst only after one or two days when exterior Heat transmits inward. Internal injury damages Qi, causing heavy, weak limbs, fatigue, and desire to lie down; external contraction damages sinews and bones, causing whole-body pain. Internal injury causes shortness of breath; external contraction causes wheezing and excess Qi. Internal injury causes palm heat; external contraction causes back-of-hand heat. Heaven's Qi connects to the Lung, and the Nose is the external manifestation of the Lung; external Shanghan causes nasal congestion, Wind-injury causes runny nose, yet digestion remains normal, taste is perceived, abdomen is harmonious, and excretion is regular. Earth's Qi connects to the Spleen, and the Mouth is the external manifestation of the Spleen; internal injury causes reluctance to speak, anorexia, loss of taste, yellow urine, and either constipation or diarrhea. The Left Renying pulse governs the interior; in internal injury, the Qi-kou pulse is larger than Renying. Internal injury syndromes belong to Deficiency, requiring warming, tonifying, and harmonizing. External contraction syndromes belong to Excess, requiring sweating, vomiting, and purging. Mistaking internal injury for external contraction and wrongly inducing sweat severely depletes Yuan Qi, bringing disaster swiftly. Therefore, Bu Zhong Yi Qi Tang is established as the primary treatment. For combined internal injury and external contraction, prioritize tonification if internal injury is severe, or dispersion if external contraction is severe. However, cases of upper Jiao phlegm-vomiting, middle Jiao Damp-Heat, or food stagnation with diaphragmatic fullness should not use Bu Zhong Yi Qi Tang. *Ming Yi Za Zhu* states: Among fever syndromes in the world, several resemble Shanghan but require different treatments. Zhang Zhongjing’s discussion of Shanghan and Wind-injury refers to external contraction. Wind-Cold pathogens enter from outside, moving from exterior to interior, thus requiring exterior-releasing methods to disperse them. This is the principle behind Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction). Because they occur in the cold months of Winter and manifest immediately, they are called Shanghan, treated with Acrid-Warm herbs to overcome Cold. If the season is not cold, the medication must change. In warm Spring months, use Acrid-Cool herbs; in hot Summer months, use Sweet-Cold and Bitter herbs. There is also Winter-Warm disease, where the climate is inappropriate. Winter should be cold, but Warm disease occurs due to improper Heavenly timing and leaking Yang Qi; treatment must not use Warm-Hot herbs. There is also Time-Running Cold Epidemic occurring during warm times, where Cold becomes pathological instead of warmth, due to improper Heavenly timing and rebellious Yin Qi; treatment must not use Cold-Chill herbs. There is also Warm Epidemic Heat Disease, common in Spring and Summer, affecting entire communities similarly, caused by Pestilential Qi of Heaven and Earth; treatment should follow seasonal timing and Qi运气 (Yunqi, 运气), using Liu Hejian’s Acrid-Cool, Sweet-Bitter, Cold herbs to clear Heat and detoxify. All these syndromes result from Heaven and Earth pathogens. Dietary and labor injuries damage Yuan Qi, causing True Yang to sink and generating deficient Heat; hence Dongyuan proposed Bu Zhong Yi Qi theory, using Sweet-Warm herbs like Renshen (Ginseng Radix et Rhizoma) to tonify Qi and lift sinking Qi, using Qi herbs to supplement deficiency. Mental exertion and sexual excess damage True Yin; damaged Yin Blood leads to excessive Yang transforming into Fire, known as Yin Deficiency with Fire Hyperactivity, often leading to Consumption (Laozai, 劳瘵). Danxi proposed the theory of "Yang Excess, Yin Insufficiency," using Si Wu Tang (Four Substances Decoction) plus Huangbai (Phellodendron Cortex) and Zhimu (Anemarrhena Rhizome) to nourish Yin and subdue Fire, using Blood herbs to supplement Blood deficiency. Tonifying Qi and Blood are both internal injury syndromes. One lifts sinking Yang Qi to tonify Qi; the other nourishes Yin to descend rising Yin-Fire. Lifting and descending are distinctly different. Summer Summerheat injury, though external, resembles Shanghan but differs greatly. Shanghan is Cold pathogen in the exterior, an Excess syndrome, requiring sweating. Summerheat damages Qi, causing Yuan Qi depletion and insufficiency due to Heat, requiring tonification, as Dongyuan described in Qing Shu Yi Qi Tang (Clear Summerheat and Augment Qi Decoction). Eating cold foods due to Summerheat or exposing oneself to cool winds causes self-inflicted illness, not Summerheat injury itself; treatment uses Acrid-Warm exterior-releasing or Middle-warming herbs, resembling Shanghan treatment. These syndromes look similar but differ essentially, requiring diverse treatments without error. Verify if it is truly Shanghan or Cold Epidemic to use Zhongjing’s method; if Warm Disease or Plague, use Hejian’s method; if Qi Deficiency, use Dongyuan’s method; if Yin Deficiency, use Danxi’s method. Thus, errors harming patients are avoided. Modern practitioners mistake all fevers for Shanghan external contraction, blindly using sweating agents. If unresolved, they use cooling exterior agents. If it is a deficiency syndrome, this is fatal. Some know fever is deficiency and use tonics but fail to distinguish Qi and Blood, tonifying Blood for Qi disease or vice versa, causing much harm. External vs. Internal, Cold vs. Heat, Qi Deficiency vs. Blood Deficiency are like Ice and Charcoal; treatment errors turn light illness heavy and incurable. *Yi Guan* states: Reading Shanghan without Dongyuan leaves Internal Injury unclear, killing many. Reading Dongyuan without Danxi leaves Yin Deficiency unclear, killing many. Dongyuan’s *Pi Wei Lun* clarifies that fever from hunger, fullness, and labor are all internal injuries resembling Shanghan; strictly forbid sweating and purging. Internal injury is more common than external contraction; only warming and tonifying are needed, no dispersion. If external contraction is more common, add slight dispersion to warming/tonifying, primarily using Bu Zhong Yi Qi Tang. For internal injury with Cold, add Mahuang (Ephedrae Herba); with Wind, add Guizhi (Cinnamomi Ramulus); with Summerheat, add Huanglian (Coptidis Rhizoma); with Dampness, add Qianghuo (Notopterygii Rhizoma et Radix). This covers Yang Deficiency fever. However, Yin Deficiency fever accounts for 60-70% and also resembles Shanghan. Modern practitioners see fever, diagnose Shanghan, use dispersion, and cause death, claiming Shanghan methods are exhausted. I have treated Yin Deficiency fever presenting with high fever, red face, thirst, and dry vexation with one dose of Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia), resulting in cure. For lower body aversion to Cold and cold feet, with upper body extreme thirst and vexation, or vomiting after drinking, use Rougui (Cinnamomi Cortex) and Wuweizi (Schisandrae Fructus), adding Fuzi (Aconiti Lateralis Radix Praeparata) in severe cases as a cold drink. This has saved many lives. This reveals aspects of Yin Deficiency fever beyond Danxi’s exposition.