尝考轩岐《灵》、《素》,及仲景《伤寒》杂病,
《金柜玉函》诸书,有伤寒而无冬温。迨南医辈出,
始着其名。其症之由,皆因冬令温燠,阳失潜藏,
甚至冰霜不见,桃李舒葩,而乾坤之气,遂有辟而
无阖矣。人生(1)一小天地,天地既有辟而无阖,则
人身之气化亦有泄而无藏矣。是故冬应寒而反温者,
即为恒燠之咎征。人或正气有亏,则邪尤易感。以
致头痛无汗,发热恶寒,与伤寒仿佛,但口渴脉数,
鼻干气燥,则与伤寒有异。甚则为痧、为斑、为痘,
(1)生:疑为"身"字之误。
皆此类也,更有阴亏阳亢之体,阴气暴绝,阳邪独
发,初起便目赤齿枯,舌绛口渴,斑如锦纹,神昏
咽痛,脉弦数促,此名温毒,即《伤寒例》中阳毒
症也。较诸冬温更上一层,为感症中之最险者,故
名为毒。而惟幼稚为甚者,盖以体属纯阳,阳与阳
合,以类相招,其感尤速。凡遇此症,即宜辛凉清
解,甘寒养阴,佐以解毒,可免万一。若再温表,
犹抱薪救火,定遭热毙。故大江以南,地卑气湿,
潮湿雾露,皆能致病。况冬失其令,尚易感温,其
真伤寒者,廿无一二。间有证类太阳,而头痛身疼,
发热恶寒,只须辛凉清解,得汗即愈。究因地暖气
疏,易感易散,非若北方地寒气刚,可概以真伤寒
法治之也。
I have examined the *Ling Shu* (Spiritual Pivot) and *Su Wen* (Basic Questions) attributed to Yellow Emperor and Qibo, as well as Zhang Zhongjing’s *Shanghan Lun* (Treatise on Cold Damage Diseases), *Jingui Yufan Jing* (Golden Cabinet Jade Box Classic), and other texts. These works describe Shanghan (Cold Damage) but do not mention Dongwen (Winter Warmth). It was not until southern physicians emerged that this disease name was explicitly recorded. The etiology of its symptoms lies in the abnormal warmth of winter, where Yang Qi fails to conceal itself. In extreme cases, frost and snow are absent, and peach and plum trees bloom prematurely. Consequently, the Qi of Heaven and Earth becomes expansive without being restrictive. The human body is a microcosm of Heaven and Earth; since Heaven and Earth exhibit expansion without restriction, the physiological transformation (Qi Hua) within the human body also exhibits dispersion without storage. Therefore, when winter should be cold but turns warm instead, it is a sign of climatic anomaly. If an individual’s Zheng Qi (Upright Qi) is deficient, pathogenic factors can easily invade. This results in headache, absence of sweating, fever, and aversion to cold, resembling Shanghan. However, the presence of thirst, rapid pulse, dry nose, and dry breath distinguishes it from Shanghan. In severe cases, it may manifest as sand-rash (Sha Zhen), macules (Ban Zhen), or smallpox-like eruptions, all belonging to this category. Furthermore, individuals with Yin deficiency and Yang hyperactivity may experience sudden exhaustion of Yin Qi, allowing Yang pathogens to erupt independently. Early symptoms include red eyes, withered teeth, crimson tongue, thirst, macules resembling brocade patterns, coma, sore throat, and a string-taut, rapid, and hurried pulse. This is termed Wendu (Warm Toxin), corresponding to Yang Du (Yang Toxicity) mentioned in the *Shanghan Li*. It is more severe than Dongwen and represents the most dangerous form among exogenous diseases, hence the term "toxin." This condition is particularly severe in children because their constitution is purely Yang; Yang combines with Yang, attracting similar pathogens rapidly. For such cases, one should immediately employ acrid-cool clearing and resolving methods, combined with sweet-cold nourishing of Yin, assisted by detoxification, to prevent disaster. If warm diaphoretic agents are used again, it is like adding fuel to a fire, inevitably leading to death by heat. Thus, in regions south of the Yangtze River, where the terrain is low and the air humid, dampness, fog, and dew can all cause disease. Moreover, due to the loss of proper winter climate, susceptibility to warmth pathogens increases. True Shanghan accounts for less than 5-10% of cases. Occasionally, symptoms resemble Taiyang Bing (Disease of the Taiyang Channel), presenting with headache, body pain, fever, and aversion to cold. These require only acrid-cool clearing and resolving methods; recovery occurs upon sweating. This is because the local earth Qi is loose and dispersible, making infection and resolution easy, unlike the rigid and cold earth Qi of the north, which cannot be treated uniformly with methods for true Shanghan.